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Rodríguez Mallma MJ, Vilca-Aguilar M, Zuloaga-Rotta L, Borja-Rosales R, Salas-Ojeda M, Mauricio D. Machine Learning Approach for Analyzing 3-Year Outcomes of Patients with Brain Arteriovenous Malformation (AVM) after Stereotactic Radiosurgery (SRS). Diagnostics (Basel) 2023; 14:22. [PMID: 38201331 PMCID: PMC10871108 DOI: 10.3390/diagnostics14010022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 12/14/2023] [Accepted: 12/17/2023] [Indexed: 01/12/2024] Open
Abstract
A cerebral arteriovenous malformation (AVM) is a tangle of abnormal blood vessels that irregularly connects arteries and veins. Stereotactic radiosurgery (SRS) has been shown to be an effective treatment for AVM patients, but the factors associated with AVM obliteration remains a matter of debate. In this study, we aimed to develop a model that can predict whether patients with AVM will be cured 36 months after intervention by means of SRS and identify the most important predictors that explain the probability of being cured. A machine learning (ML) approach was applied using decision tree (DT) and logistic regression (LR) techniques on historical data (sociodemographic, clinical, treatment, angioarchitecture, and radiosurgery procedure) of 202 patients with AVM who underwent SRS at the Instituto de Radiocirugía del Perú (IRP) between 2005 and 2018. The LR model obtained the best results for predicting AVM cure with an accuracy of 0.92, sensitivity of 0.93, specificity of 0.89, and an area under the curve (AUC) of 0.98, which shows that ML models are suitable for predicting the prognosis of medical conditions such as AVM and can be a support tool for medical decision-making. In addition, several factors were identified that could explain whether patients with AVM would be cured at 36 months with the highest likelihood: the location of the AVM, the occupation of the patient, and the presence of hemorrhage.
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Affiliation(s)
| | - Marcos Vilca-Aguilar
- Instituto de Radiocirugía del Perú, Clínica San Pablo, Lima 15023, Peru
- Servicio de Neurocirugía, Hospital María Auxiliadora, Lima 15828, Peru
| | - Luis Zuloaga-Rotta
- Facultad de Ingeniería Industrial y de Sistemas, Universidad Nacional de Ingeniería, Lima 15333, Peru
| | - Rubén Borja-Rosales
- Facultad de Ingeniería Industrial y de Sistemas, Universidad Nacional de Ingeniería, Lima 15333, Peru
| | | | - David Mauricio
- Universidad Nacional Mayor de San Marcos, Lima 15081, Peru
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202
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Uri O, Alfandari L, Folman Y, Keren A, Smith W, Paz I, Behrbalk E. Acute disc herniation following surgical decompression of lumbar spinal stenosis: a retrospective comparison of mini-open and minimally invasive techniques. J Orthop Surg Res 2023; 18:974. [PMID: 38111077 PMCID: PMC10726635 DOI: 10.1186/s13018-023-04457-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Accepted: 12/09/2023] [Indexed: 12/20/2023] Open
Abstract
BACKGROUND Disc herniation following decompression of lumbar spinal stenosis is a less familiar surgical complication. Previous studies suggested that open lumbar decompression techniques, associated with relative segmental instability especially in the presence of degenerated disc in older patients, are more likely to result in disc herniation compared to minimally invasive techniques. The current study compares the incidence of acute disc herniation following mini-open and minimally invasive decompression of lumbar spinal stenosis. METHODS This was a retrospective study reviewing 563 patients who underwent spinal decompression for symptomatic lumbar stenosis by mini-open bilateral partial laminectomy technique or minimally invasive laminotomy utilizing a tubular system. Demographic and clinical data were collected and compared between the groups. RESULTS Postoperative disc herniation rate was significantly lower in the minimally invasive group with 2 of 237 cases (0.8%) versus 19 of 326 cases (5.8%) in the mini-open group (p = 0.002). This finding was more noticeable following multi-level procedures with no case of postdecompression disc herniation in the minimally invasive group compared to 8 of 39 cases (20.5%) in the mini-open group (p = 0.003). CONCLUSION The incidence of postoperative disc herniation following spinal decompression for symptomatic lumbar stenosis was 5.8% following mini-open bilateral partial laminectomy compared to only 0.8% after minimally invasive laminotomy (p = 0.002). These findings highlight the more extensive nature of mini-open surgery associated with relative segmental instability that poses a greater risk for postoperative disc herniation.
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Affiliation(s)
- Ofir Uri
- Spine Surgery Unit, Orthopedic Department, Hillel Yaffe Medical Center, Ha-Shalom, 38100, Hadera, Israel
| | - Liad Alfandari
- Spine Surgery Unit, Orthopedic Department, Hillel Yaffe Medical Center, Ha-Shalom, 38100, Hadera, Israel.
| | - Yoram Folman
- Spine Surgery Unit, Orthopedic Department, Hillel Yaffe Medical Center, Ha-Shalom, 38100, Hadera, Israel
| | - Amit Keren
- Spine Surgery Unit, Orthopedic Department, Hillel Yaffe Medical Center, Ha-Shalom, 38100, Hadera, Israel
| | - William Smith
- Department of Neurosurgery, University Medical Center, Las Vegas, NV, USA
| | - Inbar Paz
- Spine Surgery Unit, Orthopedic Department, Hillel Yaffe Medical Center, Ha-Shalom, 38100, Hadera, Israel
| | - Eyal Behrbalk
- Spine Surgery Unit, Orthopedic Department, Hillel Yaffe Medical Center, Ha-Shalom, 38100, Hadera, Israel
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203
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Ito Y, Hosoo H, Sato M, Marushima A, Hayakawa M, Matsumaru Y, Ishikawa E. Evaluation of Venous Structures that Are Involved in Transsylvian Approach Using 3D Rotational Venography. Neurol Med Chir (Tokyo) 2023; 63:555-562. [PMID: 37743508 PMCID: PMC10788483 DOI: 10.2176/jns-nmc.2022-0361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 07/24/2023] [Indexed: 09/26/2023] Open
Abstract
In the transsylvian (TS) approach, as characterized by clipping surgery, the presurgical visualization of the superficial middle cerebral vein (SMCV) can help change the surgical approach to ensure safe microsurgery. Nevertheless, identifying preoperatively the venous structures that are involved in this approach is difficult. In this study, we investigated the venous structures that are involved in the TS approach using three-dimensional (3D) rotational venography (3D-RV) and evaluated the effectiveness of this method for presurgical simulation. Patients who underwent 3D-RV between August 2018 and June 2020 were involved in this retrospective study. The 3D-RV and partial maximum intensity projection images with a thickness of 5 mm were computationally reconstructed. The venous structures were subdivided into the following three portions according to the anatomic location: superficial, intermediate, and basal portions. In the superficial portion, predominant frontosylvian veins were observed on 31 (41%) sides, predominant temporosylvian veins on seven (9%) sides, and equivalent fronto- and temporosylvian veins on 28 (37%) sides. The veins in the intermediate (deep middle cerebral and uncal veins) and basal portions (frontobasal bridging veins) emptied into the SMCV on 57 (75%) and 34 (45%) sides, respectively. The 3D-RV images were highly representative of the venous structures observed during microsurgery. In this study, 3D-RV was utilized to capture the details of the venous structures from the superficial to the deep portions. Presurgical simulation of the venous structures that are involved in the TS approach using 3D-RV may increase the safety of microsurgical approaches.
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Affiliation(s)
- Yoshiro Ito
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba
| | - Hisayuki Hosoo
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba
| | - Masayuki Sato
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba
| | - Aiki Marushima
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba
| | - Mikito Hayakawa
- Division of Stroke Prevention, Faculty of Medicine, University of Tsukuba
| | - Yuji Matsumaru
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba
- Division of Stroke Prevention, Faculty of Medicine, University of Tsukuba
| | - Eiichi Ishikawa
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba
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204
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Young JS, Morshed RA, Hervey-Jumper SL, Berger MS. The surgical management of diffuse gliomas: Current state of neurosurgical management and future directions. Neuro Oncol 2023; 25:2117-2133. [PMID: 37499054 PMCID: PMC10708937 DOI: 10.1093/neuonc/noad133] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Indexed: 07/29/2023] Open
Abstract
After recent updates to the World Health Organization pathological criteria for diagnosing and grading diffuse gliomas, all major North American and European neuro-oncology societies recommend a maximal safe resection as the initial management of a diffuse glioma. For neurosurgeons to achieve this goal, the surgical plan for both low- and high-grade gliomas should be to perform a supramaximal resection when feasible based on preoperative imaging and the patient's performance status, utilizing every intraoperative adjunct to minimize postoperative neurological deficits. While the surgical approach and technique can vary, every effort must be taken to identify and preserve functional cortical and subcortical regions. In this summary statement on the current state of the field, we describe the tools and technologies that facilitate the safe removal of diffuse gliomas and highlight intraoperative and postoperative management strategies to minimize complications for these patients. Moreover, we discuss how surgical resections can go beyond cytoreduction by facilitating biological discoveries and improving the local delivery of adjuvant chemo- and radiotherapies.
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Affiliation(s)
- Jacob S Young
- Department of Neurological Surgery, University of California, San Francisco, USA
| | - Ramin A Morshed
- Department of Neurological Surgery, University of California, San Francisco, USA
| | | | - Mitchel S Berger
- Department of Neurological Surgery, University of California, San Francisco, USA
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205
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Niazi F, Elkaim LM, Zadeh Khomami NM, Levett JJ, Weil AG, Hodaie M, Alotaibi NM. Microvascular Decompression and Trigeminal Neuralgia: Patient Sentiment Analysis Using Natural Language Processing. World Neurosurg 2023; 180:e528-e536. [PMID: 37778624 DOI: 10.1016/j.wneu.2023.09.107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 09/25/2023] [Indexed: 10/03/2023]
Abstract
OBJECTIVE Microvascular decompression (MVD) as a treatment for trigeminal neuralgia (TGN) has high success rate but is associated with risks of complication. This study analyzes Twitter to provide insights into discussions surrounding MVD for patients with TGN. METHODS A Twitter search performed in April 2022 yielded 491 tweets from 426 accounts. Tweets and accounts were classified thematically, and descriptive statistics were used for various social media metrics. Using a natural language processing machine learning algorithm, sentiment analysis (SA) was performed to evaluate patient perspectives before and after surgery, and a multivariate regression model was used to identify predictors of higher engagement metrics (likes, retweets, quote tweets, replies). RESULTS Most accounts were patients, caregivers, and other members of the public (70%). The most encountered themes were research (47%) and personal experiences (33.4%). SA of tweets about patient experiences showed that 40.2% of tweets were positive, 31.1% were neutral and 28.7% were negative. Negative tweets decreased significantly in postoperative tweets and mostly discussed complications or failure of surgery (63%). On multivariate analysis, only inclusion of media (photo or video) in a Tweet was associated with higher engagement metrics. CONCLUSIONS This study provides a comprehensive review of Twitter use discussing MVD in TGN and is the first to assess patient satisfaction after treatment using SA. The data presented on patient perspectives on social media could help physicians establish direct lines of communication with patients, fostering a more patient-focused care.
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Affiliation(s)
- Farbod Niazi
- Department of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Lior M Elkaim
- Department of Neurology and Neurosurgery, McGill University, Montreal, Quebec, Canada.
| | | | - Jordan J Levett
- Department of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Alexander G Weil
- Division of Neurosurgery, Sainte Justine Hospital, Montreal, Quebec, Canada
| | - Mojgan Hodaie
- Department of Surgery, Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada
| | - Naif M Alotaibi
- Department of Neurosurgery, National Neuroscience Institute, King Fahad Medical City, Riyadh, Saudi Arabia
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206
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Mishra A, Begley SL, Chen A, Rob M, Pelcher I, Ward M, Schulder M. Exploring the Intersection of Artificial Intelligence and Neurosurgery: Let us be Cautious With ChatGPT. Neurosurgery 2023; 93:1366-1373. [PMID: 37417886 DOI: 10.1227/neu.0000000000002598] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 05/14/2023] [Indexed: 07/08/2023] Open
Abstract
BACKGROUND AND OBJECTIVES ChatGPT is a novel natural language processing artificial intelligence (AI) module where users enter any question or command and receive a single text response within seconds. As AI becomes more accessible, patients may begin to use it as a resource for medical information and advice. This is the first study to assess the neurosurgical information that is provided by ChatGPT. METHODS ChatGPT was accessed in January 2023, and prompts were created requesting treatment information for 40 common neurosurgical conditions. Quantitative characteristics were collected, and four independent reviewers evaluated the responses using the DISCERN tool. Prompts were compared against the American Association of Neurological Surgeons (AANS) "For Patients" webpages. RESULTS ChatGPT returned text organized in paragraph and bullet-point lists. ChatGPT responses were shorter (mean 270.1 ± 41.9 words; AANS webpage 1634.5 ± 891.3 words) but more difficult to read (mean Flesch-Kincaid score 32.4 ± 6.7; AANS webpage 37.1 ± 7.0). ChatGPT output was found to be of "fair" quality (mean DISCERN score 44.2 ± 4.1) and significantly inferior to the "good" overall quality of the AANS patient website (57.7 ± 4.4). ChatGPT was poor in providing references/resources and describing treatment risks. ChatGPT provided 177 references, of which 68.9% were inaccurate and 33.9% were completely falsified. CONCLUSION ChatGPT is an adaptive resource for neurosurgical information but has shortcomings that limit the quality of its responses, including poor readability, lack of references, and failure to fully describe treatment options. Hence, patients and providers should remain wary of the provided content. As ChatGPT or other AI search algorithms continue to improve, they may become a reliable alternative for medical information.
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Affiliation(s)
- Akash Mishra
- Department of Neurological Surgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Lake Success , New York , USA
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207
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Jafari A, Khalatbary AR, Taghiloo S, Mirzaie MS, Nazar E, Poorhassan M, Akbari E, Asadzadeh M, Raoofi A, Nasiry D. Exosomes derived from human placental mesenchymal stem cells in combination with hyperbaric oxygen synergically alleviates spinal cord ischemia-reperfusion injury. Regen Ther 2023; 24:407-416. [PMID: 37727798 PMCID: PMC10506088 DOI: 10.1016/j.reth.2023.09.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 07/25/2023] [Accepted: 09/04/2023] [Indexed: 09/21/2023] Open
Abstract
Spinal cord ischemia-reperfusion injury (IR) is a terrible non-traumatic injury that occurs after abdominal aortic occlusion and causes serious damage to neurological function. Several treatment strategies have been suggested for IR, but they were not unable to effectively improve these conditions. Herein we investigated whether exosomes derived from human placental mesenchymal stem cells (hpMSCs-Exos) in combination with hyperbaric oxygen (HBO) could alleviate injury and promote recovery in IR rats. Eighty male Sprague-Dawley rats were randomly allocated into five equal groups. In addition to the control group that only underwent laparotomy, IR animals were planned into four groups as follows: IR group; IR-Exos group; IR-HBO group; and IR-Exos + HBO group. Neurological function evaluated before, 6 h, 12 h, 24 h, and 48 h after injury. After the last neurological evaluation, tissue samples were obtained for stereological, biochemical, and molecular assessments. Our results indicated that the neurological function scores (MDI), the numerical density of neurons, the levels of antioxidative factors (GSH, SOD, and CAT), and anti-inflammatory cytokine (IL-10) were considerably greater in treatment groups than in the IR group, and these changes were more obvious in the IR-Exos + HBO ones. This is while the numerical density of glial cells, the levels of an oxidative factor (MDA) and inflammatory cytokines (IL-1β, TNF-α, and IL-18), as well as the expression of an apoptotic protein (caspase-3) were meaningfully decreased in treatment groups, especially IR-Exos + HBO group, compared to the IR group. Generally, it was found that co-administration of hpMSCs-Exos and HBO has synergistic neuroprotective effects in the rats undergoing IR.
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Affiliation(s)
- Aref Jafari
- Department of Pharmacology, School of Pharmacy, Mazandaran University of Medical Sciences, Sari, Iran
| | - Ali Reza Khalatbary
- Cellular and Molecular Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Saeid Taghiloo
- Department of Immunology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Mohamad Sedigh Mirzaie
- Department of Physiotherapy, Faculty of Rehabilitation Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Eisa Nazar
- Psychiatry and Behavioral Sciences Research Center, Addiction Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Mahnaz Poorhassan
- Department of Artificial Intelligence, Smart University of Medical Sciences, Tehran, Iran
| | - Esmaeil Akbari
- Department of Physiology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Mahdiyeh Asadzadeh
- Department of Anatomical Sciences, School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Amir Raoofi
- Cellular and Molecular Research Center, Sabzevar University of Medical Sciences, Sabzevar, Iran
| | - Davood Nasiry
- Department of Paramedicine, Amol School of Paramedical Sciences, Mazandaran University of Medical Sciences, Sari, Iran
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208
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Vishwanathan K, Jain VK, Patralekh MK, Viswanathan VK. An updated meta-analysis comparing complications, functional, clinically relevant and radiological outcomes of accelerometer based portable navigation and conventional technique of total knee arthroplasty. J Orthop 2023; 46:24-50. [PMID: 37942220 PMCID: PMC10630554 DOI: 10.1016/j.jor.2023.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Revised: 10/12/2023] [Accepted: 10/15/2023] [Indexed: 11/10/2023] Open
Abstract
Introduction Since previous studies, including small-scale meta-analyses comparing accelerometer-based portable navigation (APN-TKA) and conventional techniqueof total knee arthroplasty (CONV-TKA), have reported divergent results, there is a need for an updated meta-analysis to compare complications, functional outcomes, clinically relevant outcomes and radiographic alignment of components. Methods This meta-analysis was conducted as per PRISMA guidelines. Randomised controlled trials, and non-randomised comparative cohort studies in English language on primary TKA were included. The complications compared were Deep Vein Thrombosis (DVT), Pulmonary Embolism (PE), infection, manipulation under anaesthesia (MUA) for postoperative knee stiffness, re-operation and mortality. The functional outcomes compared were the Knee Society Knee Score, Knee Society Score function, Oxford Knee Score, Knee Injury and Osteoarthritis Outcome Score and Western Ontario and McMaster Universities Arthritis Index. The evaluated clinically relevant outcomes were surgical time, blood loss, drop in haematocrit, tourniquet time, postoperative knee flexion and complications). The number of radiological outliers; as well as the absolute values of the alignment of the overall prosthesis, femoral and tibial components in both coronal and sagittal planes, was assessed. Results Twenty-five studies were included. Both the groups were comparable in terms of preoperative demographic features. There was no difference in complications and functional outcomes. Operation time was longer in APN-TKA (p < 0.00001) but there was no difference in rest of the clinically relevant outcomes. Restoration of the lower limb mechanical axis (p = 0.003) and coronal femoral alignment angle (p = 0.0002) was better with APN. APN also significantly reduced the risk of the odds of outliers of lower limb mechanical axis (p < 0.0001), coronal femoral alignment (p = 0.03), coronal tibial alignment (p < 0.0001) and sagittal tibial alignment (p = 0.0001). Conclusion The improvement in the accuracy of implantation by the use of APN-TKA, as determined by the overall alignments of prosthesis, or femoral and tibial components, does not necessarily translate into lesser complications and better functional and clinical outcomes. Level of evidence Therapeutic study, Level II.
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Affiliation(s)
- Karthik Vishwanathan
- Parul Institute of Medical Sciences and Research, Parul University, Vadodara, India
| | - Vijay Kumar Jain
- Atal Bihari Vajpayee Institute of Medical Sciences, Dr. Ram Manohar Lohia Hospital, New Delhi, India
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209
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Hashimoto H, Takemoto O, Chiba Y. Growth patterns and ratios of posterior cranial fossa structures in the Japanese pediatric population: a study utilizing CT scans. Neuroradiology 2023; 65:1835-1844. [PMID: 37798333 DOI: 10.1007/s00234-023-03229-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 09/26/2023] [Indexed: 10/07/2023]
Abstract
PURPOSE The changes in the proportion of posterior cranial fossa structures during pediatric development remain unclear. This retrospective study aimed to investigate the growth patterns and ratios of these structures using CT scans. METHODS Head CT scans of pediatric patients with minor head trauma from Osaka Women's and Children's Hospital between March 2006 and May 2023 were analyzed. The study segmented the intracranial volume (ICV), posterior cranial fossa volume (PCFV), cerebellum volume (CBMV), and brainstem volume (BSV). Correlation coefficients were calculated among the parameters. Patients aged 0 to 10 years were divided into 15 age-related clusters, and mean and standard deviation values were measured. Growth curves were created by plotting mean values sequentially. Ratios such as PCFV/ICV and (CBMV + BSV)/PCFV were examined. Statistical analyses, including unpaired t tests and logarithmic curve fitting, were performed. RESULTS A total of 234 CT scans (97 from females, 115 from infants under 1 year of age) were analyzed. Positive correlations were observed among the parameters, with the strongest between PCFV and CBMV. The growth curves for ICV, PCFV, CBMV, and BSV exhibited a two-phase process, with rapid growth until approximately 4 years of age, followed by stabilization. The ratios PCFV/ICV and (CBMV + BSV)/PCFV showed increasing trends from birth onwards, stabilizing by 4 and 1 years of age, respectively. CONCLUSION This study provides insights into the growth patterns and ratios of posterior cranial fossa structures in the pediatric population. The findings demonstrate a two-phase growth process and increasing trends in the examined ratios.
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Affiliation(s)
- Hiroaki Hashimoto
- Department of Neurosurgery, Osaka Women's and Children's Hospital, Osaka, Izumi, 594-1101, Japan.
- Department of Neurological Diagnosis and Restoration, Graduate School of Medicine, Osaka University, Osaka, Suita, 565-0871, Japan.
| | - Osamu Takemoto
- Department of Neurosurgery, Osaka Women's and Children's Hospital, Osaka, Izumi, 594-1101, Japan
| | - Yasuyoshi Chiba
- Department of Neurosurgery, Osaka Women's and Children's Hospital, Osaka, Izumi, 594-1101, Japan
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210
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Abhinav K, Jadhav D, Agrawal AK, Agrawal R, Agrawal A. Postoperative Evaluation of Pain and Disability in Patients Undergoing Spinal Discectomy. Cureus 2023; 15:e49963. [PMID: 38179379 PMCID: PMC10765259 DOI: 10.7759/cureus.49963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 12/04/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND A spinal discectomy surgery (SDS) is a common surgical procedure performed to treat lumbosacral radiculopathy. AIM To evaluate postoperative patterns of pain and disability in patients undergoing spinal discectomy. METHODS AND MATERIALS This investigation was a retrospective longitudinal review of prospective information gathered from 543 enrolled patients for lumbar radiculoplasty. The study participants were divided into two categories: Category 1 (SDS) comprising patients of lumbar radiculoplasty managed with SDS (n=270) and Category 2 (non-SDS) comprising patients of lumbar radiculoplasty managed with therapy other than SDS (n=273). It included study participants taking medication for pain control including opioids and non-opioids and physiotherapy for strengthening lower back muscles. At baseline, three months, 12 months, and 24 months after surgery, patient-reported information was gathered. Leg pain magnitude, back pain magnitude, and pain-related impairment were the key outcome metrics of interest. RESULTS The mean postoperative visual analog scale (VAS) score for leg pain at three-month follow-up was 4.3±1.2 in study participants in SDS and 8.1±1.3 in the non-SDS category. The VAS score was lower in the SDS category showing greater reduction in postoperative pain with statistically meaningful results (p<0.001). The mean postoperative VAS score at 12-month follow-up was 2.8±1.1 in study participants in SDS and 7.9±1.5 in the non-SDS category. The VAS score was lower in the SDS category showing greater reduction in postoperative pain with statistically meaningful results (p<0.001). The mean postoperative VAS score at 24-month follow-up was 1.7±1.2 in study participants in SDS and 7.1±1.1 in the non-SDS category. The VAS score was lower in the SDS category showing greater reduction in postoperative pain with statistically meaningful results (p<0.001). CONCLUSION It was observed that after discectomy, patients suffering from lumbar radiculopathy have significant pain and disability recovery. According to these results, only a small percentage of individuals exhibit negative results at the level of impairment.
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Affiliation(s)
- Kumar Abhinav
- Department of Neurosurgery, Lilavati Hospital and Research Centre, Mumbai, IND
| | - Dikpal Jadhav
- Department of Neurosurgery, King Edward Memorial (KEM) Hospital, Mumbai, IND
| | - Arun Kumar Agrawal
- Department of Neurosurgery, Patna Medical College and Hospital, Patna, IND
| | - Rama Agrawal
- Department of Physiology, Patna Medical College and Hospital, Patna, IND
| | - Ankita Agrawal
- Department of Conservative Dentistry and Endodontics, Buddha Institute of Dental Sciences and Hospital, Patna, IND
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211
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Siroya HL, Bhagavatula ID, Bhat DI, Sadashiva N. Intracranial high-grade glioma with malignant progression of spinal intramedullary metastasis: an atypical presentation with review of literature. Br J Neurosurg 2023; 37:1495-1501. [PMID: 34396889 DOI: 10.1080/02688697.2021.1961682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 07/23/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE High-grade gliomas (grade 3 and grade 4) are known to be highly locally invasive and distant metastasis though known, rarely manifest clinically due to poor survival. Recently, due to increasing survival in view of early diagnosis at relatively young age, more cases of extra neural symptomatic metastasis are being diagnosed and treated. Among these, symptomatic spinal metastasis is even more rare. Dissemination of GBM to the spinal compartment, albeit uncommon, has an even poorer outcome, with most patients dying within 2-3 months after diagnosis of metastatic disease. MATERIALS AND METHODS Here, we present a rare case report of a 25-year-old female with transformed/histologically progressed tumour in cranial region along with ultra-rapid progression of the spinal disease following metastasis. Proper consent of the patient relatives was taken prior to production of material as patient had expired by the time of writing of this paper. We also present an extensive review of spinal metastasis secondary to intracranial high-grade gliomas starting from 1950. We conducted a thorough and exhaustive systematic search and review of the indexed databases available in PUBMED, COCHRANE and GOOGLE SCHOLAR with key words 'spinal metastasis of glioma', 'spinal metastasis', 'glioma progression', 'secondary glioma', multicentric glioma', 'secondary spinal metastasis' and formulated a comprehensive table of the studies that met the set standards. The studies that included (a) Number of cases, (b) Age and sex of patients, (c) operated primary or non-operated primary with spinal metastasis, (d) time period from the index cranial surgery, (e) outcome after diagnosis of spine metastasis and (f) histopathology of both cranial and spinal tumour either following surgery or autopsy have been elucidated herewith. We searched the databases with no particular time period. Out of 42 case reports and series, 28 studies were selected for our publication as they met the standards set, starting from 1950 to 2020. RESULTS In this case, the primary histopathological diagnosis post cranial tumour removal was Grade-3 anaplastic astrocytoma, whereas Spinal autopsy report done 16 months after the primary diagnosis showed Grade-4 GBM suggestive of secondary transformation (Secondary GBM), it showed same genome of IDH mutation and ATRX loss, neoplastic fibrillary and gemistocytic astrocytes with de-differentiation, foamy histiocytes as seen in primary lesion suggestive of progression and metachronicity rather than multicentricity or synchronicity. What is more peculiar and rare in our case is that the spinal disease was very malignant and it progressed in course of just two days to involve the whole spine.
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Affiliation(s)
- Hardik Lalit Siroya
- National Institute of Mental Health and Neuro Sciences, NIMHANS, Bengaluru, Karnataka, India
| | - Indira Devi Bhagavatula
- National Institute of Mental Health and Neuro Sciences, NIMHANS, Bengaluru, Karnataka, India
- NIHR Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, UK
| | - Dhanjaya Ishwar Bhat
- National Institute of Mental Health and Neuro Sciences, NIMHANS, Bengaluru, Karnataka, India
- NIHR Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, UK
| | - Nishanth Sadashiva
- National Institute of Mental Health and Neuro Sciences, NIMHANS, Bengaluru, Karnataka, India
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212
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Li L, Luo X, Shu X, Li Z, Liu F, Liu X, Tong Y, Lv Q, Liu X, Zhang W, Peng D. Quality and educational content of Douyin and TikTok short videos on early screening of rectal cancer. JGH Open 2023; 7:936-941. [PMID: 38162855 PMCID: PMC10757490 DOI: 10.1002/jgh3.13005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 10/26/2023] [Accepted: 10/30/2023] [Indexed: 01/03/2024]
Abstract
Background and Aim The aim of this study was to assess the quality and content of videos on Douyin and TikTok for their educational role on early screening of rectal cancer (RC). Methods We conducted a search for videos related to RC on the Douyin and TikTok applications on 20 April 2023. The search was conducted in Chinese on Douyin and in English and Japanese on TikTok. A sample of the first 100 videos recommended by the software was selected for each language group. The content of the videos was evaluated using a content scorecard, while the quality of the videos was assessed using DISCERN. Subsequently, we conducted two partial correlations: one between the DISCERN score and the number of likes, and another between the video content score and the number of likes. Results This study encompassed a total of 89 Chinese, 54 English, and 51 Japanese videos. After selection, 78 Chinese, 38 English, and 25 Japanese videos were identified to contain content related to early screening for RC, prompting further quality assessment. Notably, videos in the Chinese language showed the highest DISCERN score (P < 0.05). In terms of partial correlation analysis, it was observed that both the content score and DISCERN score did not show a significant correlation with the number of likes (P > 0.05). Conclusion In terms of quality score and content score, the Chinese videos on Douyin show superiority over the English and Japanese videos on TikTok. However, there is potential for improving the overall appeal of the Chinese videos.
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Affiliation(s)
- Lian‐Shuo Li
- Department of Gastrointestinal SurgeryThe First Affiliated Hospital of Chongqing Medical UniversityChongqingChina
| | - Xiao‐Juan Luo
- Department of Endoscopy CenterThe First Affiliated Hospital of Chongqing Medical UniversityChongqingChina
| | - Xin‐Peng Shu
- Department of Gastrointestinal SurgeryThe First Affiliated Hospital of Chongqing Medical UniversityChongqingChina
| | - Zi‐Wei Li
- Department of Gastrointestinal SurgeryThe First Affiliated Hospital of Chongqing Medical UniversityChongqingChina
| | - Fei Liu
- Department of Gastrointestinal SurgeryThe First Affiliated Hospital of Chongqing Medical UniversityChongqingChina
| | - Xu‐Rui Liu
- Department of Gastrointestinal SurgeryThe First Affiliated Hospital of Chongqing Medical UniversityChongqingChina
| | - Yue Tong
- Department of Gastrointestinal SurgeryThe First Affiliated Hospital of Chongqing Medical UniversityChongqingChina
| | - Quan Lv
- Department of Gastrointestinal SurgeryThe First Affiliated Hospital of Chongqing Medical UniversityChongqingChina
| | - Xiao‐Yu Liu
- Department of Gastrointestinal SurgeryThe First Affiliated Hospital of Chongqing Medical UniversityChongqingChina
| | - Wei Zhang
- Department of Gastrointestinal SurgeryThe First Affiliated Hospital of Chongqing Medical UniversityChongqingChina
| | - Dong Peng
- Department of Gastrointestinal SurgeryThe First Affiliated Hospital of Chongqing Medical UniversityChongqingChina
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213
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Huldani H, Kozlitina IA, Alshahrani M, Daabo HMA, Almalki SG, Oudaha KH, Alawadi AH, Alsalamy A, Joshi SK, Mustafa YF. Exosomes derived from adipose stem cells in combination with hyaluronic acid promote diabetic wound healing. Tissue Cell 2023; 85:102252. [PMID: 37922674 DOI: 10.1016/j.tice.2023.102252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 10/17/2023] [Accepted: 10/18/2023] [Indexed: 11/07/2023]
Abstract
Diabetic wound is one of the main challenges in dermatology. Although stem cell-based treatment has therapeutic benefits in wound repair, the clinical application is still limited. Herein we investigated whether adipose stem cells -derived exosomes (Exo) loaded on hyaluronic acid (HA) could promote healing in diabetic rats. Sixty diabetic rats were randomly planned into the control group, Exo group, HA group, and HA+Exo group. On days 7, 14, and 21, five rats from each group were sampled for stereological, molecular, and tensiometrical assessments. Our results indicated that the wound closure rate, the total volumes of new epidermis and dermis, the numerical densities of fibroblasts, the length density blood vessels, collagen density as well as tensiometrical parameters of the healed wounds were significantly higher in the treated groups than in the control group, and these changes were more obvious in the HA+Exo ones. Furthermore, the expression of TGF-β and VEGF genes were meaningfully upregulated in all treated groups compared to the control group and were greater in the HA+Exo group. This is while expression of TNF-α and IL-1β, as well as numerical densities of neutrophils decreased more considerably in the HA+Exo group in comparison to the other groups. Generally, it was found that using both HA injection and exosomes has more effect on diabetic wound healing.
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Affiliation(s)
- Huldani Huldani
- Department of Physiology, Faculty of Medicine, Lambung Mangkurat University, Banjarmasin, South Kalimantan, Indonesia.
| | - Iuliia A Kozlitina
- Department of Pediatric, Preventive Dentistry and Orthodontics, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Mesfer Alshahrani
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, King Khalid University, Abha, Saudi Arabia
| | | | - Sami G Almalki
- Department of Medical Laboratory Sciences, College of Applied Medical Sciences, Majmaah University, Majmaah 11952, Saudi Arabia
| | - Khulood H Oudaha
- Pharmaceutical Chemistry Department, College of Pharmacy, Al-Ayen University, Thi-Qar, Iraq
| | - Ahmed Hussien Alawadi
- College of technical engineering, Islamic University, Najaf, Iraq; College of technical engineering, Islamic University of Al Diwaniyah, Iraq; College of technical engineering, Islamic University of Babylon, Iraq
| | - Ali Alsalamy
- College of technical engineering, Imam Ja'afar Al-Sadiq University, Al-Muthanna 66002, Iraq
| | - S K Joshi
- Department of Mechanical Engineering, Uttaranchal Institute of Technology, Uttaranchal University, Dehradun 248007, India
| | - Yasser Fakri Mustafa
- Department of Pharmaceutical Chemistry, College of Pharmacy, University of Mosul, Mosul 41001, Iraq
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214
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Lukić S, Petrović J. The quality of information provided by the most popular dementia videos on TikTok. Front Public Health 2023; 11:1266415. [PMID: 38089039 PMCID: PMC10713706 DOI: 10.3389/fpubh.2023.1266415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 11/06/2023] [Indexed: 12/18/2023] Open
Abstract
Summary of background Dementia is among the leading causes of death and disability worldwide, having a major impact not only on the affected person but also on all of society. The Internet is a popular and growing source of health-related information for patients, family members, carriers, and physicians. TikTok, one of the most popular social media platforms, is an important source for knowledge access and adoption. However, the quality of health information on TikTok has not been sufficiently studied. Objective To evaluate the quality of the information provided in the most popular videos on dementia shared on TikTok. Study design A cross-sectional study. Methods The top 100 most popular videos on TikTok obtained by searching the hashtag "dementia" were included in the study and grouped based on their source and content. The popularity of the videos was estimated based on the numbers of likes, comments, and shares. The quality of health-related information was evaluated using the DISCERN score and the Global Quality Score (GQS). Results Videos had a median duration of 33.29 s; the median number of likes was 635,100, with a total of 93,698,200 likes, 903,859 comments, and 5,310,912 shares. The source (uploader) of 65% of the videos was family members, while only 4% were uploaded by doctors. The content was lifestyle-related in 62% of the videos, while 12% of the videos were for fun. Videos had a median DISCERN score of 22.5 (IQR 20-27) and a median GQS of 2 (IQR 1-3). The videos uploaded by doctors had the highest quality scores and the lowest popularity. Conclusion The most popular dementia videos on TikTok are mostly shared by family members and are of poor quality. Given the major public health issues associated with dementia, experts must provide appropriate and active assistance to patients in interpreting the information identified.
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Affiliation(s)
- Stevo Lukić
- Neurology Department, Faculty of Medicine, University of Niš, Niš, Serbia
- Clinic of Neurology, University Clinical Centre Niš, Niš, Serbia
| | - Jovana Petrović
- Clinic of Psychiatry, University Clinical Centre Niš, Niš, Serbia
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Dos Santos Rubio EJ, Calderon C, Boeykens A, Park KB. Can we build better? Challenges with geospatial and financial accessibility in the Caribbean. Illustrative case. JOURNAL OF NEUROSURGERY. CASE LESSONS 2023; 6:CASE23472. [PMID: 38011699 PMCID: PMC10684057 DOI: 10.3171/case23472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 09/14/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND Within the Caribbean, Curaçao provides a neurosurgical hub to other Dutch Caribbean islands. At times, the inefficiency of neurosurgical referrals leads to unsatisfactory patient outcomes in true emergency cases. OBSERVATIONS This article reports an illustrative case of a patient in need of emergency neurosurgical care, who was referred to a tertiary health institution in Curaçao. This case highlights the challenges of timely neurosurgical referrals within the Dutch Caribbean. LESSONS Highlighting this case may provide a foundation for further discussions that may improve neurosurgical care and access. Limiting long-distance surgical referrals in the acute care setting will aid in saving lives.
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Affiliation(s)
- Ellianne J Dos Santos Rubio
- 1Neurosurgery/Mind and Brain, Curaçao Medical Center, Willemstad, Curaçao
- 5Department of Neurosurgery, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Chrystal Calderon
- 2Department of Neurosurgery, University of the West Indies, St. Augustine, Trinidad and Tobago
| | - Annegien Boeykens
- 3Department of Neurosurgery, Park Medical Center, Rotterdam, The Netherlands
- 5Department of Neurosurgery, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Kee B Park
- 4Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts; and
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216
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Misra S, Khan EI, Lam TT, Mazumder R, Gururangan K, Hickman LB, Goswami V, Funaro MC, Eldem E, Sansing LH, Sico JJ, Quinn TJ, Liebeskind DS, Montaner J, Kwan P, Mishra NK. Common Pathways of Epileptogenesis in Patients With Epilepsy Post-Brain Injury: Findings From a Systematic Review and Meta-analysis. Neurology 2023; 101:e2243-e2256. [PMID: 37550071 PMCID: PMC10727219 DOI: 10.1212/wnl.0000000000207749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 09/13/2023] [Indexed: 08/09/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Epilepsy may result from various brain injuries, including stroke (ischemic and hemorrhagic), traumatic brain injury, and infections. Identifying shared common biological pathways and biomarkers of the epileptogenic process initiated by the different injuries may lead to novel targets for preventing the development of epilepsy. We systematically reviewed biofluid biomarkers to test their association with the risk of post-brain injury epilepsy. METHODS We searched articles until January 25, 2022, in MEDLINE, Embase, PsycInfo, Web of Science, and Cochrane. The primary outcome was the difference in mean biomarker levels in patients with and without post-brain injury epilepsy. We used the modified quality score on prognostic studies for risk of bias assessment. We calculated each biomarker's pooled standardized mean difference (SMD) and 95% CI. Molecular interaction network and enrichment analyses were conducted in Cytoscape (PROSPERO CRD42021297110). RESULTS We included 22 studies with 1,499 cases with post-brain injury epilepsy and 7,929 controls without post-brain injury epilepsy. Forty-five biomarkers in the blood or CSF were investigated with samples collected at disparate time points. Of 22 studies, 21 had a moderate-to-high risk of bias. Most of the biomarkers (28/45) were investigated in single studies; only 9 provided validation data, and studies used variable definitions for early-onset and late-onset seizures. A meta-analysis was possible for 19 biomarkers. Blood glucose levels in 4 studies were significantly higher in patients with poststroke epilepsy (PSE) than those without PSE (SMD 0.44; CI 0.19-0.69). From individual studies, 15 biomarkers in the blood and 7 in the CSF were significantly associated with post-brain injury epilepsy. Enrichment analysis identified that the significant biomarkers (interleukin [IL]-6, IL-1β]) were predominantly inflammation related. DISCUSSION We cannot yet recommend using the reported biomarkers for designing antiepileptogenesis trials or use in the clinical setting because of methodological heterogeneity, bias in the included studies, and insufficient validation studies. Although our analyses indicate the plausible role of inflammation in epileptogenesis, this is likely not the only mechanism. For example, an individual's genetic susceptibilities might contribute to his/her risk of epileptogenesis after brain injury. Rigorously designed biomarker studies with methods acceptable to the regulatory bodies should be conducted.
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Affiliation(s)
- Shubham Misra
- From the Department of Neurology (S.M., E.E., L.H.S., J.J.S., N.K.M.), Yale University School of Medicine, New Haven, CT; Medical School (E.I.K.), B.J. Medical College and Civil Hospital, Ahmedabad, India; Keck MS & Proteomics Resource (T.T.L.), Yale University School of Medicine, New Haven, CT; Department of Neurology (R.M., K.G., L.B.H., D.S.L.), University of California, Los Angeles; Department of Neurology (K.G.), Icahn School of Medicine at Mount Sinai, New York, NY; Department of Neurology (V.G.), Tower Health, Philadelphia, PA; Harvey Cushing/John Hay Whitney Medical Library (M.C.F.), Yale University, New Haven, CT; Department of Immunobiology (L.H.S.), Yale University School of Medicine, New Haven, CT; Institute of Cardiovascular and Medical Sciences (T.J.Q.), University of Glasgow, Scotland, UK; Institute de Biomedicine of Seville (J.M.), IBiS/Hospital Universitario Virgen del Rocío/CSIC/University of Seville; Department of Neurology (J.M.), Hospital Universitario Virgen Macarena, Seville; Neurovascular Research Laboratory Vall d'Hebron Institute of Research (VHIR) (J.M.), Barcelona, Spain; and Department of Neuroscience (P.K.), Central Clinical School, Monash University, Melbourne, Australia
| | - Erum I Khan
- From the Department of Neurology (S.M., E.E., L.H.S., J.J.S., N.K.M.), Yale University School of Medicine, New Haven, CT; Medical School (E.I.K.), B.J. Medical College and Civil Hospital, Ahmedabad, India; Keck MS & Proteomics Resource (T.T.L.), Yale University School of Medicine, New Haven, CT; Department of Neurology (R.M., K.G., L.B.H., D.S.L.), University of California, Los Angeles; Department of Neurology (K.G.), Icahn School of Medicine at Mount Sinai, New York, NY; Department of Neurology (V.G.), Tower Health, Philadelphia, PA; Harvey Cushing/John Hay Whitney Medical Library (M.C.F.), Yale University, New Haven, CT; Department of Immunobiology (L.H.S.), Yale University School of Medicine, New Haven, CT; Institute of Cardiovascular and Medical Sciences (T.J.Q.), University of Glasgow, Scotland, UK; Institute de Biomedicine of Seville (J.M.), IBiS/Hospital Universitario Virgen del Rocío/CSIC/University of Seville; Department of Neurology (J.M.), Hospital Universitario Virgen Macarena, Seville; Neurovascular Research Laboratory Vall d'Hebron Institute of Research (VHIR) (J.M.), Barcelona, Spain; and Department of Neuroscience (P.K.), Central Clinical School, Monash University, Melbourne, Australia
| | - TuKiet T Lam
- From the Department of Neurology (S.M., E.E., L.H.S., J.J.S., N.K.M.), Yale University School of Medicine, New Haven, CT; Medical School (E.I.K.), B.J. Medical College and Civil Hospital, Ahmedabad, India; Keck MS & Proteomics Resource (T.T.L.), Yale University School of Medicine, New Haven, CT; Department of Neurology (R.M., K.G., L.B.H., D.S.L.), University of California, Los Angeles; Department of Neurology (K.G.), Icahn School of Medicine at Mount Sinai, New York, NY; Department of Neurology (V.G.), Tower Health, Philadelphia, PA; Harvey Cushing/John Hay Whitney Medical Library (M.C.F.), Yale University, New Haven, CT; Department of Immunobiology (L.H.S.), Yale University School of Medicine, New Haven, CT; Institute of Cardiovascular and Medical Sciences (T.J.Q.), University of Glasgow, Scotland, UK; Institute de Biomedicine of Seville (J.M.), IBiS/Hospital Universitario Virgen del Rocío/CSIC/University of Seville; Department of Neurology (J.M.), Hospital Universitario Virgen Macarena, Seville; Neurovascular Research Laboratory Vall d'Hebron Institute of Research (VHIR) (J.M.), Barcelona, Spain; and Department of Neuroscience (P.K.), Central Clinical School, Monash University, Melbourne, Australia
| | - Rajarshi Mazumder
- From the Department of Neurology (S.M., E.E., L.H.S., J.J.S., N.K.M.), Yale University School of Medicine, New Haven, CT; Medical School (E.I.K.), B.J. Medical College and Civil Hospital, Ahmedabad, India; Keck MS & Proteomics Resource (T.T.L.), Yale University School of Medicine, New Haven, CT; Department of Neurology (R.M., K.G., L.B.H., D.S.L.), University of California, Los Angeles; Department of Neurology (K.G.), Icahn School of Medicine at Mount Sinai, New York, NY; Department of Neurology (V.G.), Tower Health, Philadelphia, PA; Harvey Cushing/John Hay Whitney Medical Library (M.C.F.), Yale University, New Haven, CT; Department of Immunobiology (L.H.S.), Yale University School of Medicine, New Haven, CT; Institute of Cardiovascular and Medical Sciences (T.J.Q.), University of Glasgow, Scotland, UK; Institute de Biomedicine of Seville (J.M.), IBiS/Hospital Universitario Virgen del Rocío/CSIC/University of Seville; Department of Neurology (J.M.), Hospital Universitario Virgen Macarena, Seville; Neurovascular Research Laboratory Vall d'Hebron Institute of Research (VHIR) (J.M.), Barcelona, Spain; and Department of Neuroscience (P.K.), Central Clinical School, Monash University, Melbourne, Australia
| | - Kapil Gururangan
- From the Department of Neurology (S.M., E.E., L.H.S., J.J.S., N.K.M.), Yale University School of Medicine, New Haven, CT; Medical School (E.I.K.), B.J. Medical College and Civil Hospital, Ahmedabad, India; Keck MS & Proteomics Resource (T.T.L.), Yale University School of Medicine, New Haven, CT; Department of Neurology (R.M., K.G., L.B.H., D.S.L.), University of California, Los Angeles; Department of Neurology (K.G.), Icahn School of Medicine at Mount Sinai, New York, NY; Department of Neurology (V.G.), Tower Health, Philadelphia, PA; Harvey Cushing/John Hay Whitney Medical Library (M.C.F.), Yale University, New Haven, CT; Department of Immunobiology (L.H.S.), Yale University School of Medicine, New Haven, CT; Institute of Cardiovascular and Medical Sciences (T.J.Q.), University of Glasgow, Scotland, UK; Institute de Biomedicine of Seville (J.M.), IBiS/Hospital Universitario Virgen del Rocío/CSIC/University of Seville; Department of Neurology (J.M.), Hospital Universitario Virgen Macarena, Seville; Neurovascular Research Laboratory Vall d'Hebron Institute of Research (VHIR) (J.M.), Barcelona, Spain; and Department of Neuroscience (P.K.), Central Clinical School, Monash University, Melbourne, Australia
| | - L Brian Hickman
- From the Department of Neurology (S.M., E.E., L.H.S., J.J.S., N.K.M.), Yale University School of Medicine, New Haven, CT; Medical School (E.I.K.), B.J. Medical College and Civil Hospital, Ahmedabad, India; Keck MS & Proteomics Resource (T.T.L.), Yale University School of Medicine, New Haven, CT; Department of Neurology (R.M., K.G., L.B.H., D.S.L.), University of California, Los Angeles; Department of Neurology (K.G.), Icahn School of Medicine at Mount Sinai, New York, NY; Department of Neurology (V.G.), Tower Health, Philadelphia, PA; Harvey Cushing/John Hay Whitney Medical Library (M.C.F.), Yale University, New Haven, CT; Department of Immunobiology (L.H.S.), Yale University School of Medicine, New Haven, CT; Institute of Cardiovascular and Medical Sciences (T.J.Q.), University of Glasgow, Scotland, UK; Institute de Biomedicine of Seville (J.M.), IBiS/Hospital Universitario Virgen del Rocío/CSIC/University of Seville; Department of Neurology (J.M.), Hospital Universitario Virgen Macarena, Seville; Neurovascular Research Laboratory Vall d'Hebron Institute of Research (VHIR) (J.M.), Barcelona, Spain; and Department of Neuroscience (P.K.), Central Clinical School, Monash University, Melbourne, Australia
| | - Vaibhav Goswami
- From the Department of Neurology (S.M., E.E., L.H.S., J.J.S., N.K.M.), Yale University School of Medicine, New Haven, CT; Medical School (E.I.K.), B.J. Medical College and Civil Hospital, Ahmedabad, India; Keck MS & Proteomics Resource (T.T.L.), Yale University School of Medicine, New Haven, CT; Department of Neurology (R.M., K.G., L.B.H., D.S.L.), University of California, Los Angeles; Department of Neurology (K.G.), Icahn School of Medicine at Mount Sinai, New York, NY; Department of Neurology (V.G.), Tower Health, Philadelphia, PA; Harvey Cushing/John Hay Whitney Medical Library (M.C.F.), Yale University, New Haven, CT; Department of Immunobiology (L.H.S.), Yale University School of Medicine, New Haven, CT; Institute of Cardiovascular and Medical Sciences (T.J.Q.), University of Glasgow, Scotland, UK; Institute de Biomedicine of Seville (J.M.), IBiS/Hospital Universitario Virgen del Rocío/CSIC/University of Seville; Department of Neurology (J.M.), Hospital Universitario Virgen Macarena, Seville; Neurovascular Research Laboratory Vall d'Hebron Institute of Research (VHIR) (J.M.), Barcelona, Spain; and Department of Neuroscience (P.K.), Central Clinical School, Monash University, Melbourne, Australia
| | - Melissa C Funaro
- From the Department of Neurology (S.M., E.E., L.H.S., J.J.S., N.K.M.), Yale University School of Medicine, New Haven, CT; Medical School (E.I.K.), B.J. Medical College and Civil Hospital, Ahmedabad, India; Keck MS & Proteomics Resource (T.T.L.), Yale University School of Medicine, New Haven, CT; Department of Neurology (R.M., K.G., L.B.H., D.S.L.), University of California, Los Angeles; Department of Neurology (K.G.), Icahn School of Medicine at Mount Sinai, New York, NY; Department of Neurology (V.G.), Tower Health, Philadelphia, PA; Harvey Cushing/John Hay Whitney Medical Library (M.C.F.), Yale University, New Haven, CT; Department of Immunobiology (L.H.S.), Yale University School of Medicine, New Haven, CT; Institute of Cardiovascular and Medical Sciences (T.J.Q.), University of Glasgow, Scotland, UK; Institute de Biomedicine of Seville (J.M.), IBiS/Hospital Universitario Virgen del Rocío/CSIC/University of Seville; Department of Neurology (J.M.), Hospital Universitario Virgen Macarena, Seville; Neurovascular Research Laboratory Vall d'Hebron Institute of Research (VHIR) (J.M.), Barcelona, Spain; and Department of Neuroscience (P.K.), Central Clinical School, Monash University, Melbourne, Australia
| | - Ece Eldem
- From the Department of Neurology (S.M., E.E., L.H.S., J.J.S., N.K.M.), Yale University School of Medicine, New Haven, CT; Medical School (E.I.K.), B.J. Medical College and Civil Hospital, Ahmedabad, India; Keck MS & Proteomics Resource (T.T.L.), Yale University School of Medicine, New Haven, CT; Department of Neurology (R.M., K.G., L.B.H., D.S.L.), University of California, Los Angeles; Department of Neurology (K.G.), Icahn School of Medicine at Mount Sinai, New York, NY; Department of Neurology (V.G.), Tower Health, Philadelphia, PA; Harvey Cushing/John Hay Whitney Medical Library (M.C.F.), Yale University, New Haven, CT; Department of Immunobiology (L.H.S.), Yale University School of Medicine, New Haven, CT; Institute of Cardiovascular and Medical Sciences (T.J.Q.), University of Glasgow, Scotland, UK; Institute de Biomedicine of Seville (J.M.), IBiS/Hospital Universitario Virgen del Rocío/CSIC/University of Seville; Department of Neurology (J.M.), Hospital Universitario Virgen Macarena, Seville; Neurovascular Research Laboratory Vall d'Hebron Institute of Research (VHIR) (J.M.), Barcelona, Spain; and Department of Neuroscience (P.K.), Central Clinical School, Monash University, Melbourne, Australia
| | - Lauren H Sansing
- From the Department of Neurology (S.M., E.E., L.H.S., J.J.S., N.K.M.), Yale University School of Medicine, New Haven, CT; Medical School (E.I.K.), B.J. Medical College and Civil Hospital, Ahmedabad, India; Keck MS & Proteomics Resource (T.T.L.), Yale University School of Medicine, New Haven, CT; Department of Neurology (R.M., K.G., L.B.H., D.S.L.), University of California, Los Angeles; Department of Neurology (K.G.), Icahn School of Medicine at Mount Sinai, New York, NY; Department of Neurology (V.G.), Tower Health, Philadelphia, PA; Harvey Cushing/John Hay Whitney Medical Library (M.C.F.), Yale University, New Haven, CT; Department of Immunobiology (L.H.S.), Yale University School of Medicine, New Haven, CT; Institute of Cardiovascular and Medical Sciences (T.J.Q.), University of Glasgow, Scotland, UK; Institute de Biomedicine of Seville (J.M.), IBiS/Hospital Universitario Virgen del Rocío/CSIC/University of Seville; Department of Neurology (J.M.), Hospital Universitario Virgen Macarena, Seville; Neurovascular Research Laboratory Vall d'Hebron Institute of Research (VHIR) (J.M.), Barcelona, Spain; and Department of Neuroscience (P.K.), Central Clinical School, Monash University, Melbourne, Australia
| | - Jason J Sico
- From the Department of Neurology (S.M., E.E., L.H.S., J.J.S., N.K.M.), Yale University School of Medicine, New Haven, CT; Medical School (E.I.K.), B.J. Medical College and Civil Hospital, Ahmedabad, India; Keck MS & Proteomics Resource (T.T.L.), Yale University School of Medicine, New Haven, CT; Department of Neurology (R.M., K.G., L.B.H., D.S.L.), University of California, Los Angeles; Department of Neurology (K.G.), Icahn School of Medicine at Mount Sinai, New York, NY; Department of Neurology (V.G.), Tower Health, Philadelphia, PA; Harvey Cushing/John Hay Whitney Medical Library (M.C.F.), Yale University, New Haven, CT; Department of Immunobiology (L.H.S.), Yale University School of Medicine, New Haven, CT; Institute of Cardiovascular and Medical Sciences (T.J.Q.), University of Glasgow, Scotland, UK; Institute de Biomedicine of Seville (J.M.), IBiS/Hospital Universitario Virgen del Rocío/CSIC/University of Seville; Department of Neurology (J.M.), Hospital Universitario Virgen Macarena, Seville; Neurovascular Research Laboratory Vall d'Hebron Institute of Research (VHIR) (J.M.), Barcelona, Spain; and Department of Neuroscience (P.K.), Central Clinical School, Monash University, Melbourne, Australia
| | - Terence J Quinn
- From the Department of Neurology (S.M., E.E., L.H.S., J.J.S., N.K.M.), Yale University School of Medicine, New Haven, CT; Medical School (E.I.K.), B.J. Medical College and Civil Hospital, Ahmedabad, India; Keck MS & Proteomics Resource (T.T.L.), Yale University School of Medicine, New Haven, CT; Department of Neurology (R.M., K.G., L.B.H., D.S.L.), University of California, Los Angeles; Department of Neurology (K.G.), Icahn School of Medicine at Mount Sinai, New York, NY; Department of Neurology (V.G.), Tower Health, Philadelphia, PA; Harvey Cushing/John Hay Whitney Medical Library (M.C.F.), Yale University, New Haven, CT; Department of Immunobiology (L.H.S.), Yale University School of Medicine, New Haven, CT; Institute of Cardiovascular and Medical Sciences (T.J.Q.), University of Glasgow, Scotland, UK; Institute de Biomedicine of Seville (J.M.), IBiS/Hospital Universitario Virgen del Rocío/CSIC/University of Seville; Department of Neurology (J.M.), Hospital Universitario Virgen Macarena, Seville; Neurovascular Research Laboratory Vall d'Hebron Institute of Research (VHIR) (J.M.), Barcelona, Spain; and Department of Neuroscience (P.K.), Central Clinical School, Monash University, Melbourne, Australia
| | - David S Liebeskind
- From the Department of Neurology (S.M., E.E., L.H.S., J.J.S., N.K.M.), Yale University School of Medicine, New Haven, CT; Medical School (E.I.K.), B.J. Medical College and Civil Hospital, Ahmedabad, India; Keck MS & Proteomics Resource (T.T.L.), Yale University School of Medicine, New Haven, CT; Department of Neurology (R.M., K.G., L.B.H., D.S.L.), University of California, Los Angeles; Department of Neurology (K.G.), Icahn School of Medicine at Mount Sinai, New York, NY; Department of Neurology (V.G.), Tower Health, Philadelphia, PA; Harvey Cushing/John Hay Whitney Medical Library (M.C.F.), Yale University, New Haven, CT; Department of Immunobiology (L.H.S.), Yale University School of Medicine, New Haven, CT; Institute of Cardiovascular and Medical Sciences (T.J.Q.), University of Glasgow, Scotland, UK; Institute de Biomedicine of Seville (J.M.), IBiS/Hospital Universitario Virgen del Rocío/CSIC/University of Seville; Department of Neurology (J.M.), Hospital Universitario Virgen Macarena, Seville; Neurovascular Research Laboratory Vall d'Hebron Institute of Research (VHIR) (J.M.), Barcelona, Spain; and Department of Neuroscience (P.K.), Central Clinical School, Monash University, Melbourne, Australia
| | - Joan Montaner
- From the Department of Neurology (S.M., E.E., L.H.S., J.J.S., N.K.M.), Yale University School of Medicine, New Haven, CT; Medical School (E.I.K.), B.J. Medical College and Civil Hospital, Ahmedabad, India; Keck MS & Proteomics Resource (T.T.L.), Yale University School of Medicine, New Haven, CT; Department of Neurology (R.M., K.G., L.B.H., D.S.L.), University of California, Los Angeles; Department of Neurology (K.G.), Icahn School of Medicine at Mount Sinai, New York, NY; Department of Neurology (V.G.), Tower Health, Philadelphia, PA; Harvey Cushing/John Hay Whitney Medical Library (M.C.F.), Yale University, New Haven, CT; Department of Immunobiology (L.H.S.), Yale University School of Medicine, New Haven, CT; Institute of Cardiovascular and Medical Sciences (T.J.Q.), University of Glasgow, Scotland, UK; Institute de Biomedicine of Seville (J.M.), IBiS/Hospital Universitario Virgen del Rocío/CSIC/University of Seville; Department of Neurology (J.M.), Hospital Universitario Virgen Macarena, Seville; Neurovascular Research Laboratory Vall d'Hebron Institute of Research (VHIR) (J.M.), Barcelona, Spain; and Department of Neuroscience (P.K.), Central Clinical School, Monash University, Melbourne, Australia
| | - Patrick Kwan
- From the Department of Neurology (S.M., E.E., L.H.S., J.J.S., N.K.M.), Yale University School of Medicine, New Haven, CT; Medical School (E.I.K.), B.J. Medical College and Civil Hospital, Ahmedabad, India; Keck MS & Proteomics Resource (T.T.L.), Yale University School of Medicine, New Haven, CT; Department of Neurology (R.M., K.G., L.B.H., D.S.L.), University of California, Los Angeles; Department of Neurology (K.G.), Icahn School of Medicine at Mount Sinai, New York, NY; Department of Neurology (V.G.), Tower Health, Philadelphia, PA; Harvey Cushing/John Hay Whitney Medical Library (M.C.F.), Yale University, New Haven, CT; Department of Immunobiology (L.H.S.), Yale University School of Medicine, New Haven, CT; Institute of Cardiovascular and Medical Sciences (T.J.Q.), University of Glasgow, Scotland, UK; Institute de Biomedicine of Seville (J.M.), IBiS/Hospital Universitario Virgen del Rocío/CSIC/University of Seville; Department of Neurology (J.M.), Hospital Universitario Virgen Macarena, Seville; Neurovascular Research Laboratory Vall d'Hebron Institute of Research (VHIR) (J.M.), Barcelona, Spain; and Department of Neuroscience (P.K.), Central Clinical School, Monash University, Melbourne, Australia
| | - Nishant K Mishra
- From the Department of Neurology (S.M., E.E., L.H.S., J.J.S., N.K.M.), Yale University School of Medicine, New Haven, CT; Medical School (E.I.K.), B.J. Medical College and Civil Hospital, Ahmedabad, India; Keck MS & Proteomics Resource (T.T.L.), Yale University School of Medicine, New Haven, CT; Department of Neurology (R.M., K.G., L.B.H., D.S.L.), University of California, Los Angeles; Department of Neurology (K.G.), Icahn School of Medicine at Mount Sinai, New York, NY; Department of Neurology (V.G.), Tower Health, Philadelphia, PA; Harvey Cushing/John Hay Whitney Medical Library (M.C.F.), Yale University, New Haven, CT; Department of Immunobiology (L.H.S.), Yale University School of Medicine, New Haven, CT; Institute of Cardiovascular and Medical Sciences (T.J.Q.), University of Glasgow, Scotland, UK; Institute de Biomedicine of Seville (J.M.), IBiS/Hospital Universitario Virgen del Rocío/CSIC/University of Seville; Department of Neurology (J.M.), Hospital Universitario Virgen Macarena, Seville; Neurovascular Research Laboratory Vall d'Hebron Institute of Research (VHIR) (J.M.), Barcelona, Spain; and Department of Neuroscience (P.K.), Central Clinical School, Monash University, Melbourne, Australia.
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Min J, Zhao Y, Wang X, Zhao J. Associations of neutrophil to lymphocyte ratio and red cell distribution width on different days with the prognosis of aneurysmal subarachnoid hemorrhage patients. Medicine (Baltimore) 2023; 102:e36021. [PMID: 38013268 PMCID: PMC10681387 DOI: 10.1097/md.0000000000036021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 10/18/2023] [Indexed: 11/29/2023] Open
Abstract
The associations of neutrophil to lymphocyte ratio (NLR) and red cell distribution width (RDW) with the prognosis of aneurysmal subarachnoid hemorrhage (aSAH) patients were confirmed in a few studies. But NLR and RDW levels in most of these studies were on admission. Here we carried 1 retrospective study including 150 patients with aSAH who underwent surgeries in the First Affiliated Hospital of Yangtze University from January 2020 to February 2023 to explore the associations on the preoperative day, the first (1st), third (3rd), and seventh (7th) postoperative days. The level of RDW on the 3rd postoperative day and level of NLR on the 7th postoperative day in patients with poor prognosis were significantly higher than patients with good prognosis. The results of multivariate logistic analysis also confirmed the associations of RDW on the 3rd postoperative day (OR = 16.785, 95% CI: 4.077-69.107, P < .001) and NLR on the 7th postoperative day (OR = 8.399, 95% CI: 2.167-32.544, P = .002) with prognosis of aSAH patients. The results of receiver operating characteristic curve showed that cutoff values of RDW and NLR for predicting the prognosis in aSAH patients were 13.05% and 6.97, respectively. Higher RDW on the 3rd postoperative day and NLR on the 7th postoperative day were possibly associated with poor prognosis of aSAH patients. We should pay attention to the RDW and NLR levels during different hospitalization periods, especially in the short postoperative period. Moreover, the cutoff values for predicting prognosis need to be validated in larger-sample studies.
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Affiliation(s)
- Jie Min
- Neurointensive Care Unit, The First Affiliated Hospital of Yangtze University, Jingzhou, China
| | - Yongfeng Zhao
- Department of Hematology, The First Affiliated Hospital of Yangtze University, Jingzhou, China
| | - Xian Wang
- Department of Pharmacy, The First Affiliated Hospital of Yangtze University, Jingzhou, China
| | - Jian Zhao
- Neurointensive Care Unit, The First Affiliated Hospital of Yangtze University, Jingzhou, China
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218
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Bligh ER, Aldabbagh Y, Sheppard J, Krivankova B, Park JJ, Cheung J, Erdi-Krausz G, Thomas J, Altaher H, Courtney E, Farrow T. Virtual student-led neuroscience conferencing: a UK multicentre prospective study investigating delegate outcomes and delivery mode. BMC MEDICAL EDUCATION 2023; 23:883. [PMID: 37978372 PMCID: PMC10657021 DOI: 10.1186/s12909-023-04779-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 10/16/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND Clinical neuroscience training programmes are becoming increasingly competitive to enter. UK university neuroscience societies act as a local environment for students to develop their career interests and provide portfolio building opportunities through hosting events such as annual conferences. Recently there has been a transition to more of these events being held online yet the impact of this, if any, remains unclear. This prospective study aimed to identify the impact of student-led neuroscience conferences on delegates and examine attitudes towards an online delivery approach. METHODS Multi-centre prospective survey study using pre-conference, post-conference, and 6-month post-conference online questionnaires distributed at 6 virtual student-led neuroscience conferences in 2021. The questionnaires had five-domains: demographics, career aspirations, academic skillsets, an educational manipulation check (EMC) and mode of delivery preference. RESULTS Nine hundred twenty-four surveys were completed across 559 conference attendances. 79.9% of delegates were medical students. Interest in a neuroscience career (p < 0.001), preparedness to undertake research (p < 0.001) and presentation (p < 0.001), as well as EMC scores (p < 0.001) increased immediately post conference. Most participants at 6 months post-attendance had completed an academic project (71.9%) or presentation (50.9%), although 88.8% were lost to follow up. Online format was preferred (65%) with reasons including elimination of travel and access to home facilities whilst lack of face-to-face interaction and engagement were recognised limitations. CONCLUSION UK student-led online neuroscience conferences play a role in developing knowledge and may facilitate career interest, academic skillset and longer term portfolio building. A hybrid virtual and in-person experience would offer an ideal solution to future conferencing, providing options promoting engagement and interactivity whilst advocating sustainability, accessibility and widening participation.
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Affiliation(s)
- Emily R Bligh
- Department of Neurosurgery, University Hospital Southampton, Southampton, UK.
- Faculty of Medicine, Dentistry & Health, University of Sheffield Medical School, Sheffield, S10 2RX, UK.
- Insititute of Neurosciences, Glasgow, G51 4TF, UK.
| | - Yousif Aldabbagh
- UCL Medical School, University College London, London, WC1E 6DE, UK
| | - Jack Sheppard
- UCL Medical School, University College London, London, WC1E 6DE, UK
| | - Barbora Krivankova
- Department of Surgery, NHS Lothian, Edinburgh, UK
- School of Medicine, Dentistry & Nursing, University of Glasgow, Glasgow, G51 4TF, UK
| | - Jay J Park
- Edinburgh Medical School, University of Edinburgh, Edinburgh, EH16 4SB, UK
| | - Joe Cheung
- Queen Mary University of London, Barts and The London School of Medicine London, London, UK
| | - Gergo Erdi-Krausz
- Faculty of Medicine, University of Southampton, Southampton, SO17 1BJF, UK
| | - Joshua Thomas
- Faculty of Medicine, Dentistry & Health, University of Sheffield Medical School, Sheffield, S10 2RX, UK
| | - Hibatallah Altaher
- Faculty of Medicine, Dentistry & Health, University of Sheffield Medical School, Sheffield, S10 2RX, UK
| | - Ellie Courtney
- Faculty of Medicine, Dentistry & Health, University of Sheffield Medical School, Sheffield, S10 2RX, UK
| | - Tom Farrow
- Faculty of Medicine, Dentistry & Health, University of Sheffield Medical School, Sheffield, S10 2RX, UK
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219
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Fert S, River P, Bondonny L, Cauzinille L. Metastatic extradural melanoma of the lumbar spine in a cat. Vet Med Sci 2023; 9:2393-2398. [PMID: 37656442 PMCID: PMC10650352 DOI: 10.1002/vms3.1248] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 07/20/2023] [Accepted: 08/18/2023] [Indexed: 09/02/2023] Open
Abstract
A 7-year-old neutered male Domestic shorthair cat, with a 1.5-year history of left eye enucleation secondary to a diffuse iris malignant melanoma, was evaluated for progressive onset of pelvic limb paresis and ataxia with severe thoracolumbar hyperaesthesia and dysorexia. Neurological examination localised a lesion to the T3-L3 spinal cord segments. Magnetic resonance imaging of the thoracolumbar spine showed a well-defined extradural T1-weighted hyperintense non-contrast-enhancing mass, initially suggesting a potential haemorrhagic component. Exploratory surgery revealed a brownish extradural lumbar mass. Histologic examination concluded to a melanoma, most probably metastatic given the animal's previous medical history. This report highlights the importance of collecting a complete medical history, which can help in obtaining a preliminary differential diagnosis in cats with clinical signs of myelopathy. Although the location of this metastasis is particularly unusual both in human and veterinary medicine, making optimal treatment challenging for neurosurgeon, our increased understanding of immune and tumour cell biology during the past decade is likely to improve the future treatments of feline melanoma and its metastases.
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Affiliation(s)
- Sabrina Fert
- Department of NeurologyVeterinary Hospital Center FrégisGentillyFrance
| | - Pablo River
- Department of SurgeryVeterinary Hospital Center OnlyvetSaint PriestFrance
| | - Laura Bondonny
- Department of SurgeryVeterinary Hospital Center OnlyvetSaint PriestFrance
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220
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Kurland DB, Cheung ATM, Kim NC, Ashayeri K, Hidalgo T, Frempong-Boadu A, Oermann EK, Kondziolka D. A Century of Evolution in Spine Surgery Publications: A Bibliometric Analysis of the Field From 1900 to 2023. Neurosurgery 2023; 93:1121-1143. [PMID: 37610208 DOI: 10.1227/neu.0000000000002648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Accepted: 06/21/2023] [Indexed: 08/24/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Spine surgery has advanced in concert with our deeper understanding of its elements. Narrowly focused bibliometric analyses have been conducted previously, but never on the entire corpus of the field. Using big data and bibliometrics, we appraised the entire corpus of spine surgery publications to study the evolution of the specialty as a scholarly field since 1900. METHODS We queried Web of Science for all contents from 13 major publications dedicated to spine surgery. We next queried by topic [topic = (spine OR spinal OR vertebrae OR vertebral OR intervertebral OR disc OR disk)]; these results were filtered to include articles published by 49 other publications that were manually determined to contain pertinent articles. Articles, along with their metadata, were exported. Statistical and bibliometric analyses were performed using the Bibliometrix R package and various Python packages. RESULTS Eighty-five thousand five hundred articles from 62 journals and 134 707 unique authors were identified. The annual growth rate of publications was 2.78%, with a surge after 1980, concurrent with the growth of specialized journals. International coauthorship, absent before 1970, increased exponentially with the formation of influential spine study groups. Reference publication year spectroscopy allowed us to identify 200 articles that comprise the historical roots of modern spine surgery and each of its subdisciplines. We mapped the emergence of new topics and saw a recent lexical evolution toward outcomes- and patient-centric terms. Female and minority coauthorship has increased since 1990, but remains low, and disparities across major publications persist. CONCLUSION The field of spine surgery was borne from pioneering individuals who published their findings in a variety of journals. The renaissance of spine surgery has been powered by international collaboration and is increasingly outcomes focused. While spine surgery is gradually becoming more diverse, there is a clear need for further promotion and outreach to under-represented populations.
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Affiliation(s)
- David B Kurland
- Department of Neurological Surgery, New York University, New York , New York , USA
| | - Alexander T M Cheung
- Department of Neurological Surgery, New York University, New York , New York , USA
| | - Nora C Kim
- Department of Neurological Surgery, New York University, New York , New York , USA
| | - Kimberly Ashayeri
- Department of Neurological Surgery, New York University, New York , New York , USA
| | - Teresa Hidalgo
- Department of Neurological Surgery, New York University, New York , New York , USA
| | | | - Eric Karl Oermann
- Department of Neurological Surgery, New York University, New York , New York , USA
- Center for Data Science, New York University, New York , New York , USA
| | - Douglas Kondziolka
- Department of Neurological Surgery, New York University, New York , New York , USA
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221
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Ferreira Furtado LM, Da Costa Val Filho JA, Da Silva Pereira V, Coimbra YS, Caldas VHR, Magalhães AR, De Carvalho BAS, Moreira SG, Teixeira AL, De Miranda AS. Effect of the COVID-19 Pandemic on the Epidemiology of Pediatric Traumatic Brain Injury in Brazil. Cureus 2023; 15:e48896. [PMID: 38024051 PMCID: PMC10653551 DOI: 10.7759/cureus.48896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2023] [Indexed: 12/01/2023] Open
Abstract
Aim In response to the coronavirus 2019 disease (COVID-19) pandemic, governments worldwide implemented measures to prevent infection, resulting in restricted school activities, restricted children's freedom of movement, and increased risk of violence and injuries at home, including traumatic brain injury (TBI), among children. In Brazil, the consequences of the COVID-19 pandemic on the causes, severity, and mortality of pediatric TBI have not yet been investigated. Thus, our study aimed to determine whether the COVID-19 pandemic has affected the epidemiology of pediatric TBI among Brazilian children. Materials and methods We investigated the patients with TBI aged <18 years who visited a tertiary trauma center in Brazil in 2019 and 2020. TBI-related variables, such as classification, mechanism, clinical manifestations, need for intervention, morbidity, and mortality, were recorded. Furthermore, we used a nationwide databank to collect information on mortality from external causes of trauma and violence in the pediatric population in 2019 and 2020. The Mann-Whitney test was used to compare quantitative variables related to the mechanisms and severity of TBI in both periods in order to determine the impact of the COVID-19 pandemic. Results Of the patients with traumatic brain injury, 1371 visited the trauma center in 2019 and 1052 in 2020. No difference was noted in the incidence rate of abusive head trauma between these periods (p=0.142) or in mortality from violence in Brazil. Recreational causes of pediatric TBI increased during the first year of the COVID-19 pandemic in Brazil and falls from bicycles significantly increased during the pandemic (p<0.001). Conclusion A global reduction in pediatric admissions to emergency rooms as well as no impact on mortality and severity of pediatric TBI were observed during the COVID-19 pandemic in Brazil. Additionally, a public education program regarding child safety during recreational activities, particularly how to avoid falls from bicycles was recommended.
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Affiliation(s)
| | | | - Victor Da Silva Pereira
- Department of Neurological Surgery, Pontifícia Universidade Católica de Minas Gerais, Contagem, BRA
| | - Yasmin S Coimbra
- Department of Neurological Surgery, Faculdade de Ciências Médicas de Minas Gerais, Belo Horizonte, BRA
| | - Vitor Hugo R Caldas
- Department of Neurological Surgery, Faculdade de Ciências Médicas de Minas Gerais, Belo Horizonte, BRA
| | - Anne R Magalhães
- Department of Neurological Surgery, Pontifícia Universidade Católica de Minas Gerais, Contagem, BRA
| | - Bruna Athayde S De Carvalho
- Department of Neurological Surgery, João XXIII Hospital / Fundação Hospitalar do Estado de Minas Gerais (FHEMIG), Belo Horizonte, BRA
| | - Saulo G Moreira
- Department of Neurological Surgery, Faculdade de Ciências Médicas de Minas Gerais, Belo Horizonte, BRA
| | - Antônio L Teixeira
- Neuropsychiatry, The University of Texas Health Science Center at Houston, Houston, USA
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Wang X, Li Y, Lu Z, Jian Y, Han N, Zhao L, Dang M, Wu Y, Li T, Feng Y, Yang Y, Huang W, Zhang L, Wang H, Zhang R, Chang M, Zhang G. Endovascular recanalization in patients with severely disabling non-acute ischemic stroke. J Neurointerv Surg 2023; 15:e282-e288. [PMID: 36597954 DOI: 10.1136/jnis-2022-019346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 11/13/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND It is unclear whether patients with severely disabling ischemic stroke (SDIS-that is, modified Rankin scale (mRS) scores of 3-5) benefit from non-acute endovascular recanalization (ER). OBJECTIVE To determine the effect of non-acute ER or medical treatment in severely disabled patients with non-acute ischemic stroke (mRS scores of 3-5). METHODS Between January 2018 and August 2021, non-acute patients with SDIS and large vessel occlusion were collected from two regional stroke centers. Patients who met the inclusion and exclusion criteria were assigned to two groups based on whether they underwent ER (ER group) or not (medical group). The primary functional outcome was the mRS score at 90 days. The primary safety outcomes were the recurrence of stroke and mortality. RESULTS Of the 325 patients with hypoperfusion cerebral infarction caused by large vessel occlusion, 63 met the inclusion criteria (32 patients in the ER group, 31 patients in the medical group). A favorable outcome (mRS score ≤2) occurred more often in the ER group than in the medical group (59.4% vs 22.6%, respectively; OR=0.12, 95% CI 0.02 to 0.58; P<0.01). There were no significant differences in new-onset ischemic stroke (6.3% vs 3.2%, respectively; P=1.000), symptomatic intracerebral hemorrhage (12.5% vs 0%, respectively; P=0.113), or mortality within 90 days (6.3% vs 6.5%, respectively; P=1.000) between the two groups. Preoperative mRS scores (OR=7.34, 95% CI 1.56 to 34.5; P=0.02) and ER (OR=0.12, 95% CI 0.02 to 0.58; P<0.01) were significantly associated with outcome. CONCLUSION Our data suggest that patients with SDIS (mRS score 3-5) with smaller infarct cores and better collateral circulation can benefit from non-acute ER, with no additional perioperative complications or mortality.
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Affiliation(s)
- Xiaoya Wang
- Department of Neurology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Ye Li
- Department of Neurology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Ziwei Lu
- Department of Neurology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Yating Jian
- Department of Neurology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Nannan Han
- Department of Neurology, Xi'an No.3 Hospital, The Affiliated Hospital of Northwest University, Xi'an, Shannxi, China
| | - Lili Zhao
- Department of Neurology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Meijuan Dang
- Department of Neurology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Yulun Wu
- Department of Neurology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Tao Li
- Department of Neurology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Yuxuan Feng
- Department of Neurology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Yang Yang
- Department of Neurology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Wei Huang
- Department of Medical Imaging, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shannxi, China
| | - Lei Zhang
- Department of Neurology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Huqing Wang
- Department of Neurology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Ru Zhang
- Department of Neurology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Mingze Chang
- Department of Neurology, Xi'an No.3 Hospital, The Affiliated Hospital of Northwest University, Xi'an, Shannxi, China
| | - Guilian Zhang
- Department of Neurology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
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Nakajima H, Honjoh K, Watanabe S, Takahashi A, Kubota A, Matsumine A. Management of Cervical Spinal Cord Injury without Major Bone Injury in Adults. J Clin Med 2023; 12:6795. [PMID: 37959260 PMCID: PMC10650636 DOI: 10.3390/jcm12216795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 10/24/2023] [Accepted: 10/25/2023] [Indexed: 11/15/2023] Open
Abstract
The incidence of cervical spinal cord injury (CSCI) without major bone injury is increasing, possibly because older people typically have pre-existing cervical spinal canal stenosis. The demographics, neurological injury, treatment, and prognosis of this type of CSCI differ from those of CSCI with bone or central cord injury. Spine surgeons worldwide are debating on the optimal management of CSCI without major bone injury. Therefore, this narrative review aimed to address unresolved clinical questions related to CSCI without major bone injury and discuss treatment strategies based on current findings. The greatest divide among spine surgeons worldwide hinges on whether surgery is necessary for patients with CSCI without major bone injury. Certain studies have recommended early surgery within 24 h after injury; however, evidence regarding its superiority over conservative treatment remains limited. Delayed MRI may be beneficial; nevertheless, reliable factors and imaging findings that predict functional prognosis during the acute phase and ascertain the necessity of surgery should be identified to determine whether surgery/early surgery is better than conservative therapy/delayed surgery. Quality-of-life assessments, including neuropathic pain, spasticity, manual dexterity, and motor function, should be performed to examine the superiority of surgery/early surgery to conservative therapy/delayed surgery.
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Affiliation(s)
- Hideaki Nakajima
- Department of Orthopaedics and Rehabilitation Medicine, University of Fukui Faculty of Medical Sciences, 23-3 Matsuoka Shimoaizuki, Eiheiji-cho, Yoshida-gun, Fukui 910-1193, Japan; (K.H.); (S.W.); (A.T.); (A.K.); (A.M.)
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Song SY, Seo MS, Kim CW, Kim YH, Yoo BC, Choi HJ, Seo SH, Kang SW, Song MG, Nam DC, Kim DH. AI-Driven Segmentation and Automated Analysis of the Whole Sagittal Spine from X-ray Images for Spinopelvic Parameter Evaluation. Bioengineering (Basel) 2023; 10:1229. [PMID: 37892959 PMCID: PMC10604000 DOI: 10.3390/bioengineering10101229] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 10/15/2023] [Accepted: 10/18/2023] [Indexed: 10/29/2023] Open
Abstract
Spinal-pelvic parameters are utilized in orthopedics for assessing patients' curvature and body alignment in diagnosing, treating, and planning surgeries for spinal and pelvic disorders. Segmenting and autodetecting the whole spine from lateral radiographs is challenging. Recent efforts have employed deep learning techniques to automate the segmentation and analysis of whole-spine lateral radiographs. This study aims to develop an artificial intelligence (AI)-based deep learning approach for the automated segmentation, alignment, and measurement of spinal-pelvic parameters through whole-spine lateral radiographs. We conducted the study on 932 annotated images from various spinal pathologies. Using a deep learning (DL) model, anatomical landmarks of the cervical, thoracic, lumbar vertebrae, sacrum, and femoral head were automatically distinguished. The algorithm was designed to measure 13 radiographic alignment and spinal-pelvic parameters from the whole-spine lateral radiographs. Training data comprised 748 digital radiographic (DR) X-ray images, while 90 X-ray images were used for validation. Another set of 90 X-ray images served as the test set. Inter-rater reliability between orthopedic spine specialists, orthopedic residents, and the DL model was evaluated using the intraclass correlation coefficient (ICC). The segmentation accuracy for anatomical landmarks was within an acceptable range (median error: 1.7-4.1 mm). The inter-rater reliability between the proposed DL model and individual experts was fair to good for measurements of spinal curvature characteristics (all ICC values > 0.62). The developed DL model in this study demonstrated good levels of inter-rater reliability for predicting anatomical landmark positions and measuring radiographic alignment and spinal-pelvic parameters. Automated segmentation and analysis of whole-spine lateral radiographs using deep learning offers a promising tool to enhance accuracy and efficiency in orthopedic diagnostics and treatments.
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Affiliation(s)
- Sang-Youn Song
- Department of Orthopaedic Surgery, Institute of Medical Science, Gyeongsang National University Hospital and Gyeongsang National University School of Medicine, Jinju 52727, Republic of Korea; (S.-Y.S.); (M.-S.S.); (C.-W.K.)
| | - Min-Seok Seo
- Department of Orthopaedic Surgery, Institute of Medical Science, Gyeongsang National University Hospital and Gyeongsang National University School of Medicine, Jinju 52727, Republic of Korea; (S.-Y.S.); (M.-S.S.); (C.-W.K.)
| | - Chang-Won Kim
- Department of Orthopaedic Surgery, Institute of Medical Science, Gyeongsang National University Hospital and Gyeongsang National University School of Medicine, Jinju 52727, Republic of Korea; (S.-Y.S.); (M.-S.S.); (C.-W.K.)
| | - Yun-Heung Kim
- Deepnoid. Inc., Seoul 08376, Republic of Korea; (Y.-H.K.); (B.-C.Y.); (H.-J.C.)
| | - Byeong-Cheol Yoo
- Deepnoid. Inc., Seoul 08376, Republic of Korea; (Y.-H.K.); (B.-C.Y.); (H.-J.C.)
| | - Hyun-Ju Choi
- Deepnoid. Inc., Seoul 08376, Republic of Korea; (Y.-H.K.); (B.-C.Y.); (H.-J.C.)
| | - Sung-Hyo Seo
- Department of Biomedical Research Institute, Gyeongsang National University Hospital, Jinju 52727, Republic of Korea;
| | - Sung-Wook Kang
- Precision Mechanical Process and Control R&D Group, Korea Institute of Industrial Technology, Seoul 06211, Republic of Korea;
| | - Myung-Geun Song
- Department of Orthopaedic Surgery, College of Medicine, Inha University Hospital, Incheon 22212, Republic of Korea;
| | - Dae-Cheol Nam
- Department of Orthopaedic Surgery, Institute of Medical Science, Gyeongsang National University Hospital and Gyeongsang National University School of Medicine, Jinju 52727, Republic of Korea; (S.-Y.S.); (M.-S.S.); (C.-W.K.)
| | - Dong-Hee Kim
- Department of Orthopaedic Surgery, Institute of Medical Science, Gyeongsang National University Hospital and Gyeongsang National University School of Medicine, Jinju 52727, Republic of Korea; (S.-Y.S.); (M.-S.S.); (C.-W.K.)
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225
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Zhou Z, Zhang P. Formononetin ameliorates the LPS-induced inflammatory response and apoptosis of neuronal cells via NF-κB/NLRP3 signaling pathway. Funct Integr Genomics 2023; 23:321. [PMID: 37847432 DOI: 10.1007/s10142-023-01247-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 09/22/2023] [Accepted: 10/03/2023] [Indexed: 10/18/2023]
Abstract
The objective of this study was to investigate the impact of formononetin on cellular apoptosis and inflammatory responses following spinal cord injury (SCI), as well as the underlying mechanisms involved. In this study, PC12 cells were treated with lipopolysaccharide (LPS) and different concentrations of Formononetin (FT) (50 μM, 100 μM, 200 μM). To confirm the effect of nuclear factor-κB (NF-κB)/NLR family pyrin domain containing 3 (NLRP3) signaling pathways, the cells in the phorbol-12-myristate-13-acetate (PMA) group were treated with 0.1 μmol/L PMA (NF-κB/NLRP3 signaling pathway activators). The lactate dehydrogenase (LDH) concentration and cell viability, proliferating cell nuclear antigen (PCNA) fluorescence intensity, and cell apoptosis were determined using an LDH kit, Cell Counting Kit-8 (CCK-8), immunofluorescence, and flow cytometry assays, respectively. Tumor necrosis factor-α (TNF-α), interleukin-1β (IL-1β), and interleukin-16 (IL-6) expression levels were detected by quantitative ELISA assay. The expression of proteins related to the NF-κB/NLRP3 signaling pathway was detected by western blotting. Our results showed that LPS increased LDH levels in PC12 cells, suggesting that inflammation caused PC12 cell damage. However, the PC12 cell damage was decreased by methylprednisolone. Formononetin promotes cell survival and proliferation, and prevents apoptosis in a concentration-dependent manner. Formononetin reduced the TNF-α, IL-1β, and IL-6 levels in the LPS-treated model. Moreover, formononetin decreased the levels of p-p65 NF-κB and NLRP3 in PC12 cells. We conclude that formononetin ameliorated the inflammatory response and apoptosis in LPS-induced inflammatory injury in neuronal cells via the NF-κB/NLRP3 signaling pathway.
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Affiliation(s)
- Zhijing Zhou
- Department of Orthopedic, Lianyungang Hospital of Traditional Chinese Medicine, Chaoyang Middle Road No. 160, Haizhou District, Lianyungang, 222004, Jiangsu, China
| | - Peng Zhang
- Department of Orthopedic, Lianyungang Hospital of Traditional Chinese Medicine, Chaoyang Middle Road No. 160, Haizhou District, Lianyungang, 222004, Jiangsu, China.
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226
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Roy JM, Bangash AH, Skandalakis GP, Bowers CA. Frailty indices in patients undergoing surgical resection of brain metastases: a systematic review. Neurosurg Rev 2023; 46:267. [PMID: 37815634 DOI: 10.1007/s10143-023-02174-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 09/16/2023] [Accepted: 10/02/2023] [Indexed: 10/11/2023]
Abstract
Brain metastases are a relatively common occurrence in patients with primary malignancies, with an incidence ranging from 9 to 17%. Their prevalence has increased due to treatment advancements that have led to improved survival in cancer patients. Frailty has demonstrated the ability to outperform greater patient age in surgical decision-making by predicting postoperative adverse events that include mortality, extended length of hospital stay, non-routine discharge disposition, and postoperative complications. Although predictive models based on frailty have been increasingly utilized in literature, their generalizability remains questionable due to inadequacies in model development and validation. Our systematic review describes development and validation cohorts of frailty indices used in patients undergoing surgical resection of brain metastases and serves as a guide to their incorporation in the outpatient clinical setting. A systematic review of literature was performed using PubMed and Google Scholar. Articles that reported outcomes using frailty indices in patients undergoing surgical resection of brain metastases were included. The Newcastle Ottawa Scale (NOS) was used to assess for risk of bias across individual studies. Studies with NOS > 5 were considered high quality. We identified 238 articles through our search strategy. After a title and abstract screen, followed by a full text review, 9 articles met criteria for inclusion. The 5- and 11-factor modified frailty indices were most frequently utilized (n = 4). Five studies utilized single-hospital databases, and four utilized nationwide databases. Six studies were considered high-quality based on the NOS. Although frailty indices have demonstrated the ability to predict outcomes in patients undergoing surgical resection of brain metastases, further validation of these indices is necessary prior to their incorporation in clinical practice.
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Affiliation(s)
- Joanna M Roy
- Topiwala National Medical College, Mumbai, India
- Bowers Neurosurgical Frailty and Outcomes Data Science Lab, Albuquerque, NM, 87122, USA
| | | | - Georgios P Skandalakis
- Department of Neurosurgery, University of New Mexico Hospital (UNMH), Albuquerque, NM, 87131, USA
| | - Christian A Bowers
- Bowers Neurosurgical Frailty and Outcomes Data Science Lab, Albuquerque, NM, 87122, USA.
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227
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Efe IE, Çinkaya E, Kuhrt LD, Bruesseler MMT, Mührer-Osmanagic A. Neurosurgical Education Using Cadaver-Free Brain Models and Augmented Reality: First Experiences from a Hands-On Simulation Course for Medical Students. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1791. [PMID: 37893509 PMCID: PMC10608257 DOI: 10.3390/medicina59101791] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Revised: 09/16/2023] [Accepted: 10/07/2023] [Indexed: 10/29/2023]
Abstract
Background and Objectives: Neurosurgery has been underrepresented in the medical school curriculum. Advances in augmented reality and 3D printing have opened the way for early practical training through simulations. We assessed the usability of the UpSurgeOn simulation-based training model and report first experiences from a hands-on neurosurgery course for medical students. Materials and Methods: We organized a two-day microneurosurgery simulation course tailored to medical students. On day one, three neurosurgeons demonstrated anatomical explorations with the help of life-like physical simulators (BrainBox, UpSurgeOn). The surgical field was projected onto large high-definition screens by a robotic-assisted exoscope (RoboticScope, BHS Technologies). On day two, the students were equipped with microsurgical instruments to explore the surgical anatomy of the pterional, temporal and endoscopic retrosigmoid approaches. With the help of the RoboticScope, they simulated five clipping procedures using the Aneurysm BrainBox. All medical students filled out a digital Likert-scale-based questionnaire to evaluate their experiences. Results: Sixteen medical students participated in the course. No medical students had previous experience with UpSurgeOn. All participants agreed that the app helped develop anatomical orientation. They unanimously agreed that this model should be part of residency training. Fourteen out of sixteen students felt that the course solidified their decision to pursue neurosurgery. The same fourteen students rated their learning experience as totally positive, and the remaining two rated it as rather positive. Conclusions: The UpSurgeOn educational app and cadaver-free models were perceived as usable and effective tools for the hands-on neuroanatomy and neurosurgery teaching of medical students. Comparative studies may help measure the long-term benefits of UpSurgeOn-assisted teaching over conventional resources.
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Affiliation(s)
- Ibrahim E. Efe
- Department of Neurosurgery, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 10117 Berlin, Germany
| | - Emre Çinkaya
- University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany
- Facultad de Medicina, Universidad de Sevilla, 41004 Sevilla, Spain
| | - Leonard D. Kuhrt
- Department of Traumatology and Reconstructive Surgery, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 10117 Berlin, Germany
| | - Melanie M. T. Bruesseler
- Faculty of Medicine, Ludwig-Maximilians-University, 80539 Munich, Germany
- The GKT School of Medical Education, King’s College London, London WC2R 2LS, UK
| | - Armin Mührer-Osmanagic
- Department of Orthopaedics and Neurosurgery, Schulthess Klinik, 8008 Zurich, Switzerland
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228
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Hall E, Ullberg T, Andsberg G, Wasselius J. Incidence of intracranial hemorrhagic complications after anterior circulation endovascular thrombectomy in relation to occlusion site: a nationwide observational register study. J Neurointerv Surg 2023:jnis-2023-020768. [PMID: 37798105 DOI: 10.1136/jnis-2023-020768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 08/30/2023] [Indexed: 10/07/2023]
Abstract
BACKGROUND Intracranial hemorrhage (ICH) is a potentially severe complication of endovascular thrombectomy (EVT). However, the relationship between the incidence and severity of ICH and vascular occlusion location is not well described. OBJECTIVE To present a comprehensive analysis of subtypes of ICHs and their relationship to the occlusion site following EVT in the anterior circulation. METHODS All patients with anterior circulation vessel occlusion stroke (internal carotid (ICA) and middle cerebral artery's first (M1) and later segments (M2 and beyond)) registered in the two Swedish national quality registers for stroke care and endovascular therapy during 2015-2020 were included. Hemorrhagic complications identified on imaging within 36 hours post-EVT were classified according to Heidelberg Bleeding Classification and further divided into symptomatic (sICH) or non-symptomatic (non-sICH). RESULTS Of the 3077 patients, ICH frequency was 24.2%, which included 4.5% sICH. Subarachnoid hemorrhage (SAH) was the most frequent subtype of hemorrhage (10.9%). The hemorrhagic subtypes differed significantly by occlusion site, but the frequency of any bleed did not. EVT performed in and beyond the M2 more often resulted in SAH, frequently classified as non-sICH. EVT performed in the ICA was associated with more severe hemorrhages, such as intraventricular and large parenchymal hematomas, that were more often classified as sICH. CONCLUSION In this nationwide unselected EVT cohort we found that ICH severity significantly differed between different vessel occlusion sites.
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Affiliation(s)
- Emma Hall
- Department of Clinical Science, Lund University Faculty of Medicine, Lund, Sweden
- Department of Medical Imaging and Physiology, Skåne University Hospital Lund, Lund, Sweden
| | - Teresa Ullberg
- Department of Clinical Science, Lund University Faculty of Medicine, Lund, Sweden
- Department of Neurology, Skåne University Hospital Lund, Lund, Sweden
| | - Gunnar Andsberg
- Department of Clinical Science, Lund University Faculty of Medicine, Lund, Sweden
- Department of Neurology, Skåne University Hospital Lund, Lund, Sweden
| | - Johan Wasselius
- Department of Clinical Science, Lund University Faculty of Medicine, Lund, Sweden
- Department of Medical Imaging and Physiology, Skåne University Hospital Lund, Lund, Sweden
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229
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Kumar C, Kaye J, Phillips K, Forbes JA. Case report of bilateral middle ear effusion requiring myringotomy and tube placement following inferior U-shaped nasopharyngeal flap elevation for endonasal odontoidectomy: investigation of causality. Acta Neurochir (Wien) 2023; 165:2979-2983. [PMID: 37468660 DOI: 10.1007/s00701-023-05708-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Accepted: 06/24/2023] [Indexed: 07/21/2023]
Abstract
We describe a patient with symptomatic os odontoideum and a previous history of C1-2 wiring who underwent successful treatment with a staged endonasal odontoidectomy and C1-2 revision of instrumentation. Access to the odontoid process was gained through the endonasal corridor using an inverted U-shaped nasopharyngeal flap (IUNF). Post-operatively, the patient experienced resolution of her presenting neurologic symptoms but developed conductive hearing loss secondary to bilateral middle ear effusion, requiring bilateral myringotomy and tube placement 3 months post-operatively. We hypothesize this dysfunction may have resulted from surgical edema, packing buttressing the IUNF, or some combination thereof. In this manuscript, we review the evolution of the nasopharyngeal exposure for odontoidectomy and whether an IUNF may predispose to this complication.
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Affiliation(s)
- Chitra Kumar
- University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Joel Kaye
- Department of Neurological Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Katie Phillips
- Department of Otolaryngology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Jonathan A Forbes
- Department of Neurological Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
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230
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M Sethuraman R, Murugan R, Jassim M. Letter to the editor regarding "Ultrasonography guided erector spinae block in spinal surgery forpain management with enhanced recovery". World Neurosurg X 2023; 20:100224. [PMID: 37435397 PMCID: PMC10331574 DOI: 10.1016/j.wnsx.2023.100224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 06/12/2023] [Indexed: 07/13/2023] Open
Affiliation(s)
- Raghuraman M Sethuraman
- Corresponding author. Sree Balaji Medical College & Hospital (BIHER), #7, Works Road, New colony, Chromepet, Chennai, 600044, India.
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231
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Roy JM, Bowers CA, Rumalla K, Covell MM, Kazim SF, Schmidt MH. Frailty Indexes in Metastatic Spine Tumor Surgery: A Narrative Review. World Neurosurg 2023; 178:117-122. [PMID: 37499751 DOI: 10.1016/j.wneu.2023.07.095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Accepted: 07/19/2023] [Indexed: 07/29/2023]
Abstract
Quantification of preoperative frailty is an important prognostic tool in neurosurgical decision making. Metastatic spine tumor patients undergoing surgery are frail and have unfavorable outcomes that include an increased length of stay, unfavorable discharge disposition, and increased readmission rates. These undesirable outcomes result in higher treatment costs. A heterogeneous mixture of various frailty indexes is available with marked variance in their validation, leading to disparate clinical utility. The lack of a universally accepted definition for frailty, let alone in the method of creation or elements required in the formation of a frailty index, has resulted in a body of frailty literature lacking precision for predicting neurosurgical outcomes. In this review, we examine the role of reported frailty indexes in predicting postoperative outcomes after resection of metastatic spine tumors and aim to assist as a frailty guide for helping clinical decision making.
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Affiliation(s)
- Joanna M Roy
- Topiwala National Medical College, Mumbai, India; Bowers Neurosurgical Frailty and Outcomes Data Science Lab, Albuquerque, New Mexico, USA.
| | - Christian A Bowers
- Bowers Neurosurgical Frailty and Outcomes Data Science Lab, Albuquerque, New Mexico, USA; Department of Neurosurgery, University of New Mexico Hospital, Albuquerque, New Mexico, USA
| | - Kavelin Rumalla
- Bowers Neurosurgical Frailty and Outcomes Data Science Lab, Albuquerque, New Mexico, USA; Department of Neurosurgery, University of New Mexico Hospital, Albuquerque, New Mexico, USA
| | - Michael M Covell
- Bowers Neurosurgical Frailty and Outcomes Data Science Lab, Albuquerque, New Mexico, USA; School of Medicine, Georgetown University, Seattle, Washington DC, USA
| | - Syed Faraz Kazim
- Bowers Neurosurgical Frailty and Outcomes Data Science Lab, Albuquerque, New Mexico, USA; Department of Neurosurgery, University of New Mexico Hospital, Albuquerque, New Mexico, USA
| | - Meic H Schmidt
- Bowers Neurosurgical Frailty and Outcomes Data Science Lab, Albuquerque, New Mexico, USA; Department of Neurosurgery, University of New Mexico Hospital, Albuquerque, New Mexico, USA
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232
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Zhang W, Huang G, Zhang J, Bai Z, Yang K. "Cutoff Clipping" Technique as a Tentative Clipping Alternative for Large Aneurysms: A Preliminary Study. J Craniofac Surg 2023; 34:e651-e654. [PMID: 37394697 PMCID: PMC10521781 DOI: 10.1097/scs.0000000000009510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 05/30/2023] [Indexed: 07/04/2023] Open
Abstract
BACKGROUND Intraoperative rupture of an aneurysm is potentially devastating. The thin-walled regions (TIWRs) of an aneurysm are associated with rupture risk. This study aimed to describe the feasibility and concerns of the "cutoff clipping" technique for TIWRs disposition of certain complex aneurysms. METHODS Three cases were reported to illustrate the "cutoff clipping" technique which was applied to clip a large aneurysm. This study emphasized the exposure and clipping of the aneurysm fundus. The fundus was dissected according to the TIWRs size threshold the author proposed and was clipped transversely by a temporary clip to achieve size reduction and blood flow disconnection. The authors called this the "cutoff clipping" technique. After the cutoff clip was placed, the neck of the aneurysm was further dissected and clipped. RESULTS After successfully placing the cutoff clip, the surgeon achieved to reduce the size of the fundus, decrease the TIWRs proportion, and disconnect the blood flow from the neck to the distal thin-walled dome. Sequentially, three aneurysms were clip-ligated without complications. CONCLUSION The "cutoff clipping" technique applied under suitable conditions is a potential choice to dissect and clip a complex aneurysm with an adhesive neck and thin-walled dome.
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Affiliation(s)
- Weihua Zhang
- Center for Rehabilitation Medicine, Department of Neurosurgery, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, China
| | - Gaoming Huang
- Department of Neurosurgery, The First People’s Hospital of Aksu Region, Aksu, Xinjiang, China
| | - Jian Zhang
- Department of Neurosurgery, The First People’s Hospital of Aksu Region, Aksu, Xinjiang, China
| | - Zennan Bai
- Department of Neurosurgery, The First People’s Hospital of Aksu Region, Aksu, Xinjiang, China
| | - Kaichuang Yang
- Center for Rehabilitation Medicine, Department of Neurosurgery, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, China
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Awan M, Pinheiro T, Soumpasis C, Mirallave-Pescador A, Gullan R, Vergani F, Bhangoo R, Ashkan K, Lavrador JP. Letter: The Impact of Extent of Ablation on Survival of Patients With Newly Diagnosed Glioblastoma Treated With Laser Interstitial Thermal Therapy: A Large Single-Institutional Cohort. Neurosurgery 2023; 93:e110-e111. [PMID: 37477435 DOI: 10.1227/neu.0000000000002621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 06/06/2023] [Indexed: 07/22/2023] Open
Affiliation(s)
- Mariam Awan
- Department of Neurosurgery, King's College Hospital Foundation Trust, London , UK
| | - Teresa Pinheiro
- Department of Neurosurgery, King's College Hospital Foundation Trust, London , UK
- Department of Neurosurgery, Centro Hospitalar Lisboa Central, Lisboa , Portugal
| | - Christos Soumpasis
- Department of Neurosurgery, King's College Hospital Foundation Trust, London , UK
| | - Ana Mirallave-Pescador
- Department of Neurosurgery, King's College Hospital Foundation Trust, London , UK
- Department of Neurophysiology, King's College Hospital Foundation Trust, London , UK
| | - Richard Gullan
- Department of Neurosurgery, King's College Hospital Foundation Trust, London , UK
| | - Francesco Vergani
- Department of Neurosurgery, King's College Hospital Foundation Trust, London , UK
| | - Ranjeev Bhangoo
- Department of Neurosurgery, King's College Hospital Foundation Trust, London , UK
| | - Keyoumars Ashkan
- Department of Neurosurgery, King's College Hospital Foundation Trust, London , UK
| | - Jose Pedro Lavrador
- Department of Neurosurgery, King's College Hospital Foundation Trust, London , UK
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234
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Han RK, Chae JK, Garton ALA, Cruz A, Navarro-Ramirez R, Hussain I, Härtl R, Greenfield JP. Intraoperative occipital to C2 angle and external acoustic meatus-to-axis angular measurements for optimizing alignment during posterior fossa decompression and occipitocervical fusion for complex Chiari malformation. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2023; 14:365-372. [PMID: 38268687 PMCID: PMC10805164 DOI: 10.4103/jcvjs.jcvjs_59_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 08/21/2023] [Indexed: 01/26/2024] Open
Abstract
Background Excess flexion or extension during occipitocervical fusion (OCF) can lead to postoperative complications, such as dysphagia, respiratory problems, line of sight issues, and neck pain, but posterior fossa decompression (PFD) and OCF require different positions that require intraoperative manipulation. Objective The objective of this study was to describe quantitative fluoroscopic morphometrics in Chiari malformation (CM) patients with symptoms of craniocervical instability (CCI) and demonstrate the intraoperative application of these measurements to achieve neutral craniocervical alignment while leveraging a single axis of motion with the Mayfield head clamp locking mechanism. Methods A retrospective cohort study of patients with CM 1 and 1.5 and features of CCI who underwent PFD and OCF at a single-center institution from March 2015 to October 2020 was performed. Patient demographics, preoperative presentation, radiographic morphometrics, operative details, complications, and clinical outcomes were analyzed. Results A total of 39 patients met the inclusion criteria, of which 37 patients (94.9%) did not require additional revision surgery after PFD and OCF. In this nonrevision cohort, preoperative to postoperative occipital to C2 angle (O-C2a) (13.5° ± 10.4° vs. 17.5° ± 10.1°, P = 0.047) and narrowest oropharyngeal airway space (nPAS) (10.9 ± 3.4 mm vs. 13.1 ± 4.8 mm, P = 0.007) increased significantly. These measurements were decreased in the two patients who required revision surgery due to postoperative dysphagia (mean difference - 16.6°° in O C2a and 12.8°° in occipital and external acoustic meatus to axis angle). Based on these results, these fluoroscopic morphometrics are intraoperatively assessed, utilizing a locking Mayfield head clamp repositioning maneuver to optimize craniocervical alignment prior to rod placement from the occipital plate to cervical screws. Conclusion Establishing a preoperative baseline of reliable fluoroscopic morphometrics can guide surgeons intraoperatively in appropriate patient realignment during combined PFD and OCF, and may prevent postoperative complications.
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Affiliation(s)
- Rachael K. Han
- Department of Neurological Surgery, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, NY, USA
| | - John K. Chae
- Department of Neurological Surgery, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, NY, USA
| | - Andrew L. A. Garton
- Department of Neurological Surgery, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, NY, USA
| | - Amanda Cruz
- Department of Neurological Surgery, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, NY, USA
| | - Rodrigo Navarro-Ramirez
- Department of Neurological Surgery, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, NY, USA
- Department of Neurological Surgery, Weill Cornell Medicine, New York Presbyterian-Och Spine, New York, NY, USA
| | - Ibrahim Hussain
- Department of Neurological Surgery, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, NY, USA
- Department of Neurological Surgery, Weill Cornell Medicine, New York Presbyterian-Och Spine, New York, NY, USA
| | - Roger Härtl
- Department of Neurological Surgery, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, NY, USA
- Department of Neurological Surgery, Weill Cornell Medicine, New York Presbyterian-Och Spine, New York, NY, USA
| | - Jeffrey P. Greenfield
- Department of Neurological Surgery, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, NY, USA
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Robinow ZM, Peterson C, Riestenberg R, Waldau B, Yu N, Shahlaie K. Cosmetic Outcomes of Supraorbital Keyhole Craniotomy Via Eyebrow Incision: A Systematic Review and Meta-Analysis. J Neurol Surg B Skull Base 2023; 84:470-498. [PMID: 37671300 PMCID: PMC10477017 DOI: 10.1055/s-0042-1755575] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 07/08/2022] [Indexed: 10/14/2022] Open
Abstract
Background Supraorbital eyebrow craniotomy is a minimally invasive alternative to a frontotemporal craniotomy and is often used for tumor and vascular pathologies. The purpose of this study was to investigate how patient cosmetic outcomes are affected by technique variations of this approach. Methods PubMed, Embase, and Scopus databases were systematically searched, and results were reported according to PRISMA guidelines. For the meta-analysis portion, the DerSimonian-Laird random effects model was used, and the primary end points were patient satisfaction and percentage of permanent cosmetic complications. Results A total of 2,629 manuscripts were identified. Of those, 124 studies (8,241 surgical cases) met the inclusion criteria. Overall, 93.04 ± 11.93% of patients reported favorable cosmetic outcome following supraorbital craniotomy, and mean number of cases with permanent cosmetic complications was 6.62 ± 12.53%. We found that vascular cases are associated with more favorable cosmetic outcomes than tumor cases ( p = 0.0001). Addition of orbital osteotomy or use of a drain is associated with adverse cosmetic outcomes ( p = 0.001 and p = 0.0001, respectively). The location of incision, size of craniotomy, utilization of an endoscope, method of cranial reconstruction, skin closure, use of antibiotics, and addition of pressure dressing did not significantly impact cosmetic outcomes ( p > 0.05 for all). Conclusions Supraorbital craniotomy is a minimally invasive technique associated with generally high favorable cosmetic outcomes. While certain techniques used in supraorbital keyhole approach do not pose significant cosmetic risks, utilization of an orbital osteotomy and the addition of a drain correlate with unfavorable cosmetic outcomes.
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Affiliation(s)
- Zoe M. Robinow
- California Northstate University College of Medicine, Elk Grove, California, United States
| | - Catherine Peterson
- Department of Neurological Surgery, University of California Davis, Sacramento, California, United States
| | - Robert Riestenberg
- Department of Neurological Surgery, University of California Davis, Sacramento, California, United States
| | - Ben Waldau
- Department of Neurological Surgery, University of California Davis, Sacramento, California, United States
| | - Nina Yu
- Department of Neurological Surgery, University of California Davis, Sacramento, California, United States
| | - Kiarash Shahlaie
- Department of Neurological Surgery, University of California Davis, Sacramento, California, United States
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Aleid A, Aljohani AA, Alanazi KM, Hamzi R, Alqassab ZA, Alrrzqi AA, Altarqi AA, Al Mutair A, Alessa AA, Alhussain AA, Almalki SF. Barriers to Accessing Neurosurgical Services: A Cross-Sectional Study of Public and Patient Perspectives in Saudi Arabia. Cureus 2023; 15:e46948. [PMID: 38021594 PMCID: PMC10640699 DOI: 10.7759/cureus.46948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/12/2023] [Indexed: 12/01/2023] Open
Abstract
INTRODUCTION Neurosurgical care is paramount for addressing various neurological conditions. However, several factors may hinder individuals from accessing these services. This study aimed to identify the factors that deter Saudi citizens from receiving neurosurgical care, emphasizing perceived barriers and sociodemographic influences. METHODS Utilizing a cross-sectional research design, this study surveyed 1,795 participants from five distinct regions in Saudi Arabia, capturing a wide demographic range including age, gender, education, occupation, and residence. Stratified random sampling was adopted to ensure representation across different socioeconomic backgrounds. Data was collected using structured online questionnaires in both Arabic and English, which assessed demographic characteristics, patient experiences, perceived barriers, and satisfaction related to neurosurgical services. RESULTS The majority of the participants (79.6%) reported never accessing neurosurgical services, and 28.8% indicated difficulties in accessing them. Most participants expressed neutral feelings (38.1%) or satisfaction (23.4%) with neurosurgical service accessibility, though a significant minority expressed dissatisfaction (9.0%) or strong dissatisfaction (4.3%). Concerning factors for selecting neurological services, the expertise and reputation of healthcare professionals were paramount, while cost and proximity were lesser concerns. Significant perceived barriers included financial constraints and prolonged appointment waiting times. Results also revealed a relationship between sociodemographic characteristics and perceived barriers: females, certain age groups (25 to 34 and above 65), those with higher education levels, retired individuals, and residents of the Northern Province and urban areas reported higher perceived barriers. Regression analysis identified gender, education level, employment status, and residency as significant predictors of perceived barriers. CONCLUSION This study underscores the prominent barriers faced by Saudi citizens in accessing neurosurgical care, with financial constraints and waiting times being paramount. Additionally, sociodemographic factors play a crucial role in the perception of these barriers. As healthcare disparities persist, targeted interventions, policy reforms, and educational campaigns are essential to bridge the gap and ensure equitable neurosurgical care access across all demographic segments in Saudi Arabia.
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Affiliation(s)
| | | | | | - Renad Hamzi
- Medicine and Surgery, Jazan University, Abu Arish, SAU
| | | | - Arwa A Alrrzqi
- Medicine and Surgery, King Abdulaziz University, Jeddah, SAU
| | - Asmaa A Altarqi
- Medicine and Surgery, Ibn Sina National College, Jeddah, SAU
| | - Abbas Al Mutair
- Research Center, Almoosa Specialist Hospital, Al Mubarraz, SAU
| | - Awn A Alessa
- Neurosurgery, King Fahad Hospital Al Hofuf, Al Hofuf, SAU
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237
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Kawashima T, Sato F. Prominent caudal shift of the lumbar plexus roots in spines with 18 thoracolumbar vertebrae. Surg Radiol Anat 2023; 45:1245-1256. [PMID: 37522999 DOI: 10.1007/s00276-023-03210-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Accepted: 07/12/2023] [Indexed: 08/01/2023]
Abstract
PURPOSE It remains unclear whether concomitant changes in the thoracolumbar (TL) vertebrae and lumbar plexus roots seen in experimental embryology are present in humans with different vertebral formulas, particularly in humans with 18 TL vertebrae. We thus investigated the human lumbar plexus root changes occurring in spines with an additional TL vertebra (18TL). METHODS The lumbosacral plexus was macroscopically dissected in TL anomaly cases found in 161 computed tomography examinations. TL anomalies were distinguished as simple abnormalities in total TL count and abnormal TL trade-offs, i.e., exchanges between the last thoracic and first lumbar vertebrae, and were analyzed separately. RESULTS One additional TL vertebra (7C_18TL_5S) was observed in 4/159 cases (2.5%), excluding cases with cervical and sacral abnormalities. Different from the unclear shifts of nerve roots in cases with 16TL and 17TL trade-offs, the 18TL trade-off tended to involve a caudal shift at the cranial limit, without event change at the caudal limit. In addition, only one nerve segment shift was reconfirmed with a change in two vertebral segments from 16 to 18 TL vertebrae. CONCLUSIONS We revealed that concomitant changes in the lumbar plexus roots and vertebrae in humans with 18TL vertebrae may become more pronounced than those in humans with 16 or 17TL vertebrae, by approaching the typical mammalian TL formula (19TL). This study showed that the TL formula can be used to estimate changes in the lumbar plexus roots, which may assist in the planning of nerve-sparing spinal and pelvic surgery.
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Affiliation(s)
- Tomokazu Kawashima
- Department of Anatomy, School of Medicine, Toho University, 5-21-16 Omori-Nishi, Ota-ku, Tokyo, 143-8540, Japan.
| | - Fumi Sato
- Department of Anatomy, School of Medicine, Toho University, 5-21-16 Omori-Nishi, Ota-ku, Tokyo, 143-8540, Japan
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Mejía JA, Garcia Rairan L, Figueredo L, Niño C. Letter to the Editor Regarding Biomarkers in aneurysmal subarachnoid hemorrhage: A short review. World Neurosurg X 2023; 20:100223. [PMID: 37849454 PMCID: PMC10577088 DOI: 10.1016/j.wnsx.2023.100223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 06/12/2023] [Indexed: 10/19/2023] Open
Affiliation(s)
| | | | - Luisa Figueredo
- Department of Neurosurgery, Mayo Clinic, Jacksonville, FL, USA
| | - Claudia Niño
- Department of Neuroanesthesia, Fundación Santa Fe, Bogotá, Colombia
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Williams SC, Ahmed R, Davids JD, Funnell JP, Hanrahan JG, Layard Horsfall H, Muirhead W, Nicolosi F, Thorne L, Marcus HJ, Grover P. Benchtop simulation of the retrosigmoid approach: Validation of a surgical simulator and development of a task-specific outcome measure score. World Neurosurg X 2023; 20:100230. [PMID: 37456690 PMCID: PMC10344945 DOI: 10.1016/j.wnsx.2023.100230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 05/11/2023] [Accepted: 06/12/2023] [Indexed: 07/18/2023] Open
Abstract
Background Neurosurgical training is changing globally. Reduced working hours and training opportunities, increased patient safety expectations, and the impact of COVID-19 have reduced operative exposure. Benchtop simulators enable trainees to develop surgical skills in a controlled environment. We aim to validate a high-fidelity simulator model (RetrosigmoidBox, UpSurgeOn) for the retrosigmoid approach to the cerebellopontine angle (CPA). Methods Novice and expert Neurosurgeons and Ear, Nose, and Throat surgeons performed a surgical task using the model - identification of the trigeminal nerve. Experts completed a post-task questionnaire examining face and content validity. Construct validity was assessed through scoring of operative videos employing Objective Structured Assessment of Technical Skills (OSATS) and a novel Task-Specific Outcome Measure score. Results Fifteen novice and five expert participants were recruited. Forty percent of experts agreed or strongly agreed that the brain tissue looked real. Experts unanimously agreed that the RetrosigmoidBox was appropriate for teaching. Statistically significant differences were noted in task performance between novices and experts, demonstrating construct validity. Median total OSATS score was 14/25 (IQR 10-19) for novices and 22/25 (IQR 20-22) for experts (p < 0.05). Median Task-Specific Outcome Measure score was 10/20 (IQR 7-17) for novices compared to 19/20 (IQR 18.5-19.5) for experts (p < 0.05). Conclusion The RetrosigmoidBox benchtop simulator has a high degree of content and construct validity and moderate face validity. The changing landscape of neurosurgical training mean that simulators are likely to become increasingly important in the delivery of high-quality education. We demonstrate the validity of a Task-Specific Outcome Measure score for performance assessment of a simulated approach to the CPA.
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Affiliation(s)
- Simon C. Williams
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), London, UK
| | - Razna Ahmed
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), London, UK
- Queen Square Institute of Neurology, University College London, London, UK
| | - Joseph Darlington Davids
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
- Institute of Global Health Innovation and Hamlyn Centre for Robotics Surgery, Imperial College London, London, UK
| | - Jonathan P. Funnell
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), London, UK
| | - John Gerrard Hanrahan
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), London, UK
| | - Hugo Layard Horsfall
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), London, UK
| | - William Muirhead
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), London, UK
| | - Federico Nicolosi
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Lewis Thorne
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| | - Hani J. Marcus
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), London, UK
| | - Patrick Grover
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
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Matsumoto T, Okuda S, Nagamoto Y, Takahashi Y, Furuya M, Iwasaki M. Spinopelvic sagittal realignment and incidence of adjacent segment disease after single-segment posterior lumbar inter-body fusion using 12° lordotic cages-a 2-year prospective cohort study. JOURNAL OF SPINE SURGERY (HONG KONG) 2023; 9:269-277. [PMID: 37841797 PMCID: PMC10570649 DOI: 10.21037/jss-23-78] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 08/29/2023] [Indexed: 10/17/2023]
Abstract
Background The importance of spinopelvic sagittal alignment for adjacent segment disease (ASD) after lumbar fusion surgery has been reported. However, no longitudinal cohort studies have determined the extent to which segmental alignment and spinopelvic global alignment can be achieved using 12° lordotic cages in posterior lumbar inter-body fusion (PLIF) and the extent to which the development of ASD can be prevented. The purpose of this study was to analyze changes in segmental and spinopelvic sagittal alignment after single-segment PLIF with 12° lordotic cages, to clarify the relationship between changes in segmental and spinopelvic sagittal alignment, and to report the incidence of ASD at 2 years postoperatively. Methods Subjects in this 2-year prospective longitudinal cohort study were 28 patients who had undergone L4/5 PLIF using 12° lordotic cages. Incidence of operative ASD (O-ASD) was evaluated as clinical outcomes. Radiological measurements were examined preoperatively and at 3 months, 1 year and 2 years postoperatively. The following radiographic spinopelvic parameters were measured: segmental lordosis (SL) at L4/5; sagittal vertical axis (SVA); T1 pelvic angle (TPA); thoracic kyphosis (TK); lumbar lordosis (LL); sacral slope (SS); pelvic tilt (PT); and pelvic incidence (PI). With respect to radiological outcomes, changes in SL (ΔSL) and spinopelvic parameters and the incidence of radiological ASD (R-ASD) were evaluated. Correlations of ΔSL and changes in other spinopelvic parameters (ΔSVA, ΔTPA, ΔTK, ΔLL, ΔSS, ΔPT, and ΔPI-LL) between preoperatively and 3 months postoperatively were examined. Results The follow-up rate was 100% (n=28) at 1 year postoperatively and 96.4% (n=27) at 2 years postoperatively. No cases of O-ASD were seen during 2 years of follow-up. Significant realignment was observed and maintained at 2 years postoperatively in almost all spinopelvic sagittal parameters (SL, SVA, TPA, LL, PT, PI-LL). Regarding the correlation between ΔSL and other parameters, significant correlations were detected with ΔSVA (r=-0.37, P<0.05) and ΔLL (r=0.538, P<0.01). Three cases (11.1%) showed R-ASD at 2 years postoperatively. Conclusions PLIF with 12° lordotic cages for L4 degenerative spondylolisthesis improved SL and global sagittal realignment, and achieved satisfactory clinical outcomes with a low incidence of ASD during 2 years of follow-up.
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241
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Santos AN, Rauschenbach L, Gull HH, Olbrich A, Dinger TF, Darkwah Oppong M, Rieß C, Chen B, Lenkeit A, Schmidt B, Li Y, Jabbarli R, Wrede KH, Siegel A, Sure U, Dammann P. Natural course of cerebral and spinal cavernous malformations: a complete ten-year follow-up study. Sci Rep 2023; 13:15490. [PMID: 37726391 PMCID: PMC10509233 DOI: 10.1038/s41598-023-42594-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 09/12/2023] [Indexed: 09/21/2023] Open
Abstract
Knowledge of the bleeding risk and the long-term outcome of conservatively treated patients with cavernous malformations (CM) is poor. In this work, we studied the occurrence of CM-associated hemorrhage over a 10-year period and investigated risk factors for bleeding. Our institutional database was screened for patients with cerebral (CCM) or intramedullary spinal cord (ISCM) CM admitted between 2003 and 2021. Patients who underwent surgery and patients without completed follow-up were excluded. Analyses were performed to identify risk factors and to determine the cumulative risk for hemorrhage. A total of 91 CM patients were included. Adjusted multivariate logistic regression analysis identified bleeding at diagnosis (p = 0.039) and CM localization to the spine (p = 0.010) as predictors for (re)hemorrhage. Both risk factors remained independent predictors through Cox regression analysis (p = 0.049; p = 0.016). The cumulative 10-year risk of bleeding was 30% for the whole cohort, 39% for patients with bleeding at diagnosis and 67% for ISCM. During an untreated 10-year follow-up, the probability of hemorrhage increased over time, especially in cases with bleeding at presentation and spinal cord localization. The intensity of such increase may decline throughout time but remains considerably high. These findings may indicate a rather aggressive course in patients with ISCM and may endorse early surgical treatment.
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Affiliation(s)
- Alejandro N Santos
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, Hufelandstrasse 55, 45147, Essen, Germany.
- Center for Translational Neuroscience and Behavioral Science (C-TNBS), University of Duisburg-Essen, Essen, Germany.
| | - Laurèl Rauschenbach
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, Hufelandstrasse 55, 45147, Essen, Germany
- Center for Translational Neuroscience and Behavioral Science (C-TNBS), University of Duisburg-Essen, Essen, Germany
| | - Hanah H Gull
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, Hufelandstrasse 55, 45147, Essen, Germany
- Center for Translational Neuroscience and Behavioral Science (C-TNBS), University of Duisburg-Essen, Essen, Germany
| | - Angelina Olbrich
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, Hufelandstrasse 55, 45147, Essen, Germany
- Center for Translational Neuroscience and Behavioral Science (C-TNBS), University of Duisburg-Essen, Essen, Germany
| | - Thiemo F Dinger
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, Hufelandstrasse 55, 45147, Essen, Germany
- Center for Translational Neuroscience and Behavioral Science (C-TNBS), University of Duisburg-Essen, Essen, Germany
| | - Marvin Darkwah Oppong
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, Hufelandstrasse 55, 45147, Essen, Germany
- Center for Translational Neuroscience and Behavioral Science (C-TNBS), University of Duisburg-Essen, Essen, Germany
| | - Christoph Rieß
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, Hufelandstrasse 55, 45147, Essen, Germany
- Center for Translational Neuroscience and Behavioral Science (C-TNBS), University of Duisburg-Essen, Essen, Germany
| | - Bixia Chen
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, Hufelandstrasse 55, 45147, Essen, Germany
- Center for Translational Neuroscience and Behavioral Science (C-TNBS), University of Duisburg-Essen, Essen, Germany
| | - Annika Lenkeit
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, Hufelandstrasse 55, 45147, Essen, Germany
- Center for Translational Neuroscience and Behavioral Science (C-TNBS), University of Duisburg-Essen, Essen, Germany
| | - Börge Schmidt
- Institute for Medical Informatics, Biometry and Epidemiology, University Hospital of Essen, Essen, Germany
| | - Yan Li
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Ramazan Jabbarli
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, Hufelandstrasse 55, 45147, Essen, Germany
- Center for Translational Neuroscience and Behavioral Science (C-TNBS), University of Duisburg-Essen, Essen, Germany
| | - Karsten H Wrede
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, Hufelandstrasse 55, 45147, Essen, Germany
- Center for Translational Neuroscience and Behavioral Science (C-TNBS), University of Duisburg-Essen, Essen, Germany
| | - Adrian Siegel
- Department of Neurology, University of Zurich, Zurich, Switzerland
| | - Ulrich Sure
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, Hufelandstrasse 55, 45147, Essen, Germany
- Center for Translational Neuroscience and Behavioral Science (C-TNBS), University of Duisburg-Essen, Essen, Germany
| | - Philipp Dammann
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, Hufelandstrasse 55, 45147, Essen, Germany
- Center for Translational Neuroscience and Behavioral Science (C-TNBS), University of Duisburg-Essen, Essen, Germany
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Asante SK, Lee JJ, Jenson AV, Bhenderu LS, Patterson JD, Rivera AL, Britz GW. Primary thoracic intramedullary spinal cord tumor with likely metastases of glial origin to the lumbosacral vertebrae: Illustrative case. Surg Neurol Int 2023; 14:333. [PMID: 37810327 PMCID: PMC10559382 DOI: 10.25259/sni_231_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 08/13/2023] [Indexed: 10/10/2023] Open
Abstract
Background Metastasis of systemic neoplasms to the spine is common; however, the metastasis of primary spinal cord tumors to other regions in the body is an infrequent occurrence. A few case reports have described the metastasis of primary spinal cord tumors, and in most cases, patients were younger than 30 years of age. Case Description We present an illustrative case of a 47-year-old female with metastatic lesions to the lumbosacral vertebrae years after the initial diagnosis of an intradural, intramedullary spinal cord tumor (IMSCT). Although the surgical biopsy of the IMSCT was nondiagnostic, the patient was not found to have a separate primary neoplastic source, and the specimens of the metastatic lesions from the lumbar vertebral body were of glial origin. Conclusion Metastasis from primary IMSCTs is extremely rare. Distant vertebral body and intracranial metastasis are even rarer yet possible. The clinical course is highly aggressive and responds poorly to current standard treatment.
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Affiliation(s)
- Samuel K. Asante
- Department of Neurosurgery, Houston Methodist Hospital, Houston, Texas, United States
| | - Jonathan J. Lee
- Department of Neurosurgery, Houston Methodist Hospital, Houston, Texas, United States
| | - Amanda V. Jenson
- Department of Neurosurgery, Houston Methodist Hospital, Houston, Texas, United States
| | - Lokeshwar S. Bhenderu
- Department of Neurosurgery, Houston Methodist Hospital, Houston, Texas, United States
| | - John D. Patterson
- Department of Neurosurgery, Houston Methodist Hospital, Houston, Texas, United States
| | - Andreana L. Rivera
- Department of Pathology, Houston Methodist Hospital, Houston, Texas, United States
| | - Gavin W. Britz
- Department of Neurosurgery, Houston Methodist Hospital, Houston, Texas, United States
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Cui M, Liu Y, Zhou C, Chen H, Gao X, Liu J, Guo Q, Guan B, Ma X. Resection of high-grade glioma involving language areas assisted by multimodal techniques under general anesthesia: a retrospective study. Chin Neurosurg J 2023; 9:25. [PMID: 37691110 PMCID: PMC10494413 DOI: 10.1186/s41016-023-00340-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 08/21/2023] [Indexed: 09/12/2023] Open
Abstract
BACKGROUND Multimodal techniques-assisted resection of glioma under general anesthesia (GA) has been shown to achieve similar clinical outcomes as awake craniotomy (AC) in some studies. In this study, we aim to validate the use of multimodal techniques can achieve the maximal safe resection of high-grade glioma involving language areas (HGILAs) under GA. METHODS HGILAs cases were reviewed and collected between January 2009 and December 2020 in our center. Patients were separated into multimodal group (using neuronavigation, intraoperative MRI combined with direct electrical stimulation [DES] and neuromonitoring [IONM]) and conventional group (neuronavigation alone) and clinical outcomes were compared between groups. Studies of HGILAs were reviewed systematically and the meta-analysis results of previous (GA or AC) studies were compared with our results. RESULTS Finally, there were 263 patients in multimodal group and 137 patients in conventional group. Compared to the conventional group, the multimodal group achieved the higher median EOR (100% versus 94.32%, P < 0.001) and rate of gross total resection (GTR) (73.8% versus 36.5%, P < 0.001) and the lower incidence of permanent language deficit (PLD) (9.5% versus 19.7%, P = 0.004). The multimodal group achieved the longer median PFS (16.8 versus 10.3 months, P < 0.001) and OS (23.7 versus 15.7 months, P < 0.001) than the conventional group. The multimodal group achieved a higher rate of GTR than the cohorts in previous multimodal studies under GA and AC (73.8% versus 55.7% [95%CI 32.0-79.3%] versus 53.4% [35.5-71.2%]). The multimodal group had a lower incidence of PLD than the cohorts in previous multimodal studies under GA (9.5% versus 14.0% [5.8-22.1%]) and our incidence of PLD was a little higher than that of previous multimodal studies under AC (9.5% versus 7.5% [3.7-11.2%]). Our multimodal group also achieved a relative longer survival than previous studies. CONCLUSIONS Surgery assisted by multimodal techniques can achieve maximal safe resection for HGILAs under GA. Further prospective studies are needed to compare GA with AC for HGILAs.
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Affiliation(s)
- Meng Cui
- Department of Emergency, the Sixth Medical Center, Chinese People's Liberation Army General Hospital, Beijing, China.
- Department of Neurosurgery, the First Medical Center, Chinese People's Liberation Army General Hospital, Beijing, China.
| | - Yukun Liu
- Department of Neurosurgery, Chinese Air Force Medical Center, Beijing, China
| | - Chunhui Zhou
- Department of Neurosurgery, the Sixth Medical Center, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Hewen Chen
- Department of Neurosurgery, the First Medical Center, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Xin Gao
- Department of Neurosurgery, the First Medical Center, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Jiayu Liu
- Department of Neurosurgery, the First Medical Center, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Qingbao Guo
- Department of Neurosurgery, the First Medical Center, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Bing Guan
- Department of Health Economics, the First Medical Center, Chinese People's Liberation Army General Hospital, Beijing, China.
| | - Xiaodong Ma
- Department of Neurosurgery, the First Medical Center, Chinese People's Liberation Army General Hospital, Beijing, China.
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Yamamoto SH, Alverson CY. Post-high school outcomes of students with autism spectrum disorder and students with intellectual disability: Utilizing predictive analytics and state data for decision making. JOURNAL OF INTELLECTUAL DISABILITIES : JOID 2023; 27:633-647. [PMID: 35533266 DOI: 10.1177/17446295221100039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
This study analyzed the post-high school outcomes of exited high-school students with intellectual disability and autism spectrum disorder from a southwestern U.S. state. A predictive analytics approach was used to analyze these students' post-high school outcomes data, which every state is required to collect each year under U.S. special-education law. Data modeling was conducted with machine learning and logistic regression, which produced two main findings. One, the strongest significant predictors were (a) students spending at least 80% of their instructional days in general education settings and (b) graduating from high school. Two, machine learning models were consistently more accurate in predicting post-high school education or employment than were multilevel logistic regression models. This study concluded with the limitations of the data and predictive-analytic models, and the implications for researchers and state and local education professionals to utilize predictive analytics and state-level post-high school outcomes data for decision making.
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Affiliation(s)
- Scott H Yamamoto
- Courtesy Faculty, University of Oregon College of Education, Eugene, OR, USA
| | - Charlotte Y Alverson
- Research Associate Professor, Secondary Special Education and Transition Program, University of Oregon College of Education, Eugene, OR, USA
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245
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Covell MM, Warrier A, Rumalla KC, Dehney CM, Bowers CA. RAI-measured frailty predicts non-home discharge following metastatic brain tumor resection: national inpatient sample analysis of 20,185 patients. J Neurooncol 2023; 164:663-670. [PMID: 37787907 DOI: 10.1007/s11060-023-04461-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Accepted: 09/22/2023] [Indexed: 10/04/2023]
Abstract
PURPOSE Preoperative risk stratification for patients undergoing metastatic brain tumor resection (MBTR) is based on established tumor-, patient-, and disease-specific risk factors for outcome prognostication. Frailty, or decreased baseline physiologic reserve, is a demonstrated independent risk factor for adverse outcomes following MBTR. The present study sought to assess the impact of frailty, measured by the Risk Analysis Index (RAI), on MBTR outcomes. METHODS All MBTR were queried from the National Inpatient Sample (NIS) from 2019 to 2020 using diagnosis and procedural codes. The relationship between preoperative RAI frailty score and our primary outcome - non-home discharge (NHD) - and secondary outcomes - complication rates, extended length of stay (eLOS), and mortality - were analyzed via univariate and multivariable analyses. Discriminatory accuracy was tested by computation of concordance statistics in area under the receiver operating characteristic (AUROC) curve analysis. RESULTS There were 20,185 MBTR patients from the NIS database from 2019 to 2020. Each patient's frailty status was stratified by RAI score: 0-20 (robust): 34%, 21-30 (normal): 35.1%, 31-40 (very frail): 13.9%, 41+ (severely frail): 16.8%. Compared to robust patients, severely frail patients demonstrated increased complication rates (12.2% vs. 6.8%, p < 0.001), eLOS (37.6% vs. 13.2%, p < 0.001), NHD (52.0% vs. 20.6%, p < 0.001), and mortality (9.9% vs. 4.1%, p < 0.001). AUROC curve analysis demonstrated good discriminatory accuracy of RAI-measured frailty in predicting NHD after MBTR (C-statistic = 0.67). CONCLUSION Increasing RAI-measured frailty status is significantly associated with increased complication rates, eLOS, NHD, and mortality following MBTR. Preoperative frailty assessment using the RAI may aid in preoperative surgical planning and risk stratification for patient selection.
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Affiliation(s)
- Michael M Covell
- School of Medicine, Georgetown University, Washington, District of Columbia, USA
| | | | - Kranti C Rumalla
- Feinberg School of Medicine, Northwestern University, Evanston, Illinois, USA
| | | | - Christian A Bowers
- Bowers Neurosurgical Frailty and Outcomes Data Science Lab, Sandy, Utah, 84070, USA.
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246
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Alshahrani SH, Almajidi YQ, Hasan EK, Musad Saleh EA, Alsaab HO, Pant R, Hassan ZF, Al-Hasnawi SS, Romero-Parra RM, Mustafa YF. Hyperbaric Oxygen in Combination with Epigallocatechin-3-Gallate Synergistically Enhance Recovery from Spinal Cord Injury in Rats. Neuroscience 2023; 527:52-63. [PMID: 37499782 DOI: 10.1016/j.neuroscience.2023.07.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 07/08/2023] [Accepted: 07/11/2023] [Indexed: 07/29/2023]
Abstract
Spinal cord injury (SCI) following trauma is a devastating neurological event that can lead to loss of sensory and motor functions. However, the most effective measures to prevent the spread of damage are treatment measures in the early stages. Currently, we investigated the combined effects of hyperbaric oxygen (HBO) along with epigallocatechin-3-gallate (EGCG) in the recovery of SCI in rats. Ninety male mature Sprague-Dawley rats were randomly planned into five equal groups (n = 18). In addition to sham group that only underwent laminectomy, SCI rats were allocated into 4 groups as follows: control group; HBO group; EGCG group; and HBO + EGCG group. Tissue samples at the lesion site were obtained for stereological, immunohistochemical, biochemical, and molecular evaluation. In addition, behavioral tests were performed to assess of neurological functions. The finding indicated that the stereological parameters, antioxidant factors (CAT, GSH, and SOD), IL-10 gene expression levels and neurological functions were considerably increased in the treatment groups in comparison with control group, and these changes were more obvious in the HBO + EGCG group (P < 0.05). On the other hand, we observed that the density of apoptotic cells and gliosis, the biochemical levels of MDA and the expression levels of inflammatory genes (TNF-α and IL-1β) in the treatment groups, especially the HBO + EGCG group, were considerably reduced in comparison with control group (P < 0.05). We conclude that co-administration of HBO and EGCG has a synergistic neuroprotective effects in animals undergoing SCI.
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Affiliation(s)
| | - Yasir Qasim Almajidi
- Baghdad College of Medical Sciences-department of Pharmacy (Pharmaceutics), Baghdad, Iraq.
| | | | - Ebraheem Abdu Musad Saleh
- Department of Chemistry, Prince Sattam Bin Abdulaziz University, College of Arts and Science, Wadi Al-Dawasir 11991, Saudi Arabia
| | - Hashem O Alsaab
- Department of Pharmaceutics and Pharmaceutical Technology, Taif University, Taif 21944, Saudi Arabia
| | - Ruby Pant
- Mechanical in Department, Uttaranchal Institute of Technology, Uttaranchal University, Dehradun 248007, India
| | | | | | | | - Yasser Fakri Mustafa
- Department of Pharmaceutical Chemistry, College of Pharmacy, University of Mosul, Mosul 41001, Iraq
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247
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Nie JW, Hartman TJ, MacGregor KR, Oyetayo OO, Zheng E, Federico VP, Massel DH, Sayari AJ, Singh K. Preoperative predictors of prolonged hospitalization in patients undergoing lateral lumbar interbody fusion. Acta Neurochir (Wien) 2023; 165:2615-2624. [PMID: 37318634 DOI: 10.1007/s00701-023-05648-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 05/23/2023] [Indexed: 06/16/2023]
Abstract
PURPOSE We aim to examine the preoperative factors associated with increased postoperative length of stay in patients undergoing LLIF in the hospital setting. METHODS Patient demographics, perioperative characteristics, and patient-reported outcome measures (PROMs) were collected from a single-surgeon database. Patients undergoing LLIF in the hospital setting were separated into postoperative LOS <48 h (H) and LOS ≥ 48H. Univariate analysis for preoperative characteristics was utilized to determine covariates for multivariable logistic regression. Multivariable logistic regression was then utilized to determine significant predictors of extended postoperative length of stay. Secondary univariate analysis of inpatient complications, operative, and postoperative characteristics were calculated to determine postoperative factors associated with prolonged hospitalization. RESULTS Two-hundred and forty patients were identified with 115 patients' LOS ≥ 48H. Univariate analysis identified age/Charlson Comorbidity Index (CCI) score/gender/insurance type/number of contiguous fused levels/preoperative PROMs of Visual Analog Scale (VAS) back/VAS leg/Patient-Reported Outcomes Measurement Information System (PROMIS-PF)/Oswestry Disability Index (ODI)/degenerative spondylolisthesis diagnoses/foraminal stenosis/central stenosis for multivariable logistic regression. Multivariable logistic regression calculated significant positive predictors of LOS ≥ 48H to be age/3-level fusion/preoperative ODI scores. Negative predictors of LOS ≥ 48H were the diagnosis of foraminal stenosis/preoperative PROMIS-PF/male gender. The secondary analysis determined that patients with longer operative time/estimated blood loss/transfusion/postoperative day 0 and 1 pain and narcotic consumption/complications of altered mental status/postoperative anemia/fever/ileus/urinary retention were associated with prolonged hospitalization. CONCLUSION Older patients undergoing LLIF with greater preoperative disability and 3-level fusion were more likely to require prolonged hospitalization. Male patients with higher preoperative physical function and who were diagnosed with foraminal stenosis were less likely to require prolonged hospitalization.
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Affiliation(s)
- James W Nie
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL, 60612, USA
| | - Timothy J Hartman
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL, 60612, USA
| | - Keith R MacGregor
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL, 60612, USA
| | - Omolabake O Oyetayo
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL, 60612, USA
| | - Eileen Zheng
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL, 60612, USA
| | - Vincent P Federico
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL, 60612, USA
| | - Dustin H Massel
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL, 60612, USA
| | - Arash J Sayari
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL, 60612, USA
| | - Kern Singh
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL, 60612, USA.
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248
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Hakimjavadi R, Lu J, Yam Y, Dwivedi G, Small GR, Chow BJW. Pre-screening for non-diagnostic coronary computed tomography angiography. EUROPEAN HEART JOURNAL. IMAGING METHODS AND PRACTICE 2023; 1:qyad026. [PMID: 39045062 PMCID: PMC11195707 DOI: 10.1093/ehjimp/qyad026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 09/07/2023] [Indexed: 07/25/2024]
Abstract
Aims Indiscriminate coronary computed tomography angiography (CCTA) referrals for suspected coronary artery disease could result in a higher rate of equivocal and non-diagnostic studies, leading to inappropriate downstream resource utilization or delayed time to diagnosis. We sought to develop a simple clinical tool for predicting the likelihood of a non-diagnostic CCTA to help identify patients who might be better served with a different test. Methods and results We developed a clinical scoring system from a cohort of 21 492 consecutive patients who underwent CCTA between February 2006 and May 2021. Coronary computed tomography angiography study results were categorized as normal, abnormal, or non-diagnostic. Multivariable logistic regression analysis was conducted to produce a model that predicted the likelihood of a non-diagnostic test. Machine learning (ML) models were utilized to validate the predictor selection and prediction performance. Both logistic regression and ML models achieved fair discriminate ability with an area under the curve of 0.630 [95% confidence interval (CI) 0.618-0.641] and 0.634 (95% CI 0.612-0.656), respectively. The presence of a cardiac implant and weight >100 kg were among the most influential predictors of a non-diagnostic study. Conclusion We developed a model that could be implemented at the 'point-of-scheduling' to identify patients who would be best served by another non-invasive diagnostic test.
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Affiliation(s)
- Ramtin Hakimjavadi
- Department of Medicine, Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, ON K1Y 4W7, Canada
| | - Juan Lu
- Department of Medicine, The University of Western Australia, 35 Stirling Highway, CRAWLEY Western Australia 6009, Australia
- Department of Computer Science and Software Engineering, The University of Western Australia, 35 Stirling Highway, CRAWLEY Western Australia 6009, Australia
- Advanced Clinical and Translational Cardiovascular Imaging, Harry Perkins Institute of Medical Research, 6 Verdun Street, Nedlands Western Australia 6009, Australia
| | - Yeung Yam
- Department of Medicine, Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, ON K1Y 4W7, Canada
| | - Girish Dwivedi
- Department of Medicine, The University of Western Australia, 35 Stirling Highway, CRAWLEY Western Australia 6009, Australia
- Advanced Clinical and Translational Cardiovascular Imaging, Harry Perkins Institute of Medical Research, 6 Verdun Street, Nedlands Western Australia 6009, Australia
- Department of Medicine, Fiona Stanley Hospital, 11 Robin Warren Drive, Murdoch Western Australia 6150, Australia
| | - Gary R Small
- Department of Medicine, Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, ON K1Y 4W7, Canada
| | - Benjamin J W Chow
- Department of Medicine, Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, ON K1Y 4W7, Canada
- Department of Radiology, University of Ottawa, 451 Smyth Rd, Ottawa ON K1H 8M5, Canada
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249
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Zhang Y, Ju J, Wu J. Zero-profile anchored spacer versus conventional plate-cage construct in bilevel anterior cervical discectomy and fusion: a systematic review and meta-analysis. J Orthop Surg Res 2023; 18:644. [PMID: 37653510 PMCID: PMC10469803 DOI: 10.1186/s13018-023-04134-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 08/24/2023] [Indexed: 09/02/2023] Open
Abstract
BACKGROUND Zero-profile anchored spacers (ZAS) and plate-cage constructs (PCC) are currently employed when performing anterior cervical discectomy and fusion (ACDF). Nevertheless, the efficacy and safety of both devices in bilevel ACDF remain controversial. The goal of our meta-analysis is to assess the overall long-term efficacy and security among ZAS and PCC in bilevel ACDF. METHODS A search of four electronic databases was conducted to identify researches that compared ZAS with PCC for bilevel ACDF. Stata MP 17.0 software was used for this meta-analysis. RESULTS Nine researches with a total of 580 patients were involved. In comparison to PCC, ZAS significantly reduced intraoperative bleeding and postoperative dysphagia rates. No significant differences were found concerning operation time, JOA score, NDI score, cervical Cobb angle, fusion rates, the incidence of adjacent segmental degeneration (ASD) and implant sinking rates at last follow-up. CONCLUSION Compared to PCC, ZAS achieved similar efficacy and security in bilevel ACDF with respect to operative time, JOA score, NDI score, cervical Cobb angle, fusion rates, implant sinking rates and ASD rates at final follow-up. It is worth noting that ZAS offered considerable benefits over conventional PCC for the reduction of intraoperative bleeding and postoperative dysphagia. Therefore, for patients requiring bilevel ACDF, ZAS seems superior to PCC. Given the limitations of our study, larger prospective randomised controlled trials are needed to establish reliable proof to consolidate our conclusions.
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Affiliation(s)
- Yu Zhang
- Department of Orthopaedics, Jingjiang People's Hospital, The Seventh Affiliated Hospital of Yangzhou University, Jingjiang 214500, Taizhou, Jiangsu Province, China
| | - Jidong Ju
- Department of Orthopaedics, Jingjiang People's Hospital, The Seventh Affiliated Hospital of Yangzhou University, Jingjiang 214500, Taizhou, Jiangsu Province, China
| | - Jinchun Wu
- Department of Orthopaedics, Jingjiang People's Hospital, The Seventh Affiliated Hospital of Yangzhou University, Jingjiang 214500, Taizhou, Jiangsu Province, China.
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Liu J, Ning Y, Mei S, Qiu W, Tang B, Tang J. Laparoscopic resection of schwannoma in the lateral pelvic space based on the fascia plane: how we do it (with video). Langenbecks Arch Surg 2023; 408:346. [PMID: 37648838 DOI: 10.1007/s00423-023-03086-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Accepted: 08/22/2023] [Indexed: 09/01/2023]
Abstract
BACKGROUND Research on laparoscopic schwannoma resection (LSR) in the lateral pelvic space (LPS) remains limited. This study aimed to compare the short-term and oncological outcomes of LSR and conventional open schwannoma resection (OSR). METHODS Clinical data of 38 patients with lateral pelvic schwannomas were retrospectively collected. LSR in the LPS was based on fascial-oriented techniques. Operation-related results, neurological function, and oncological outcomes were compared. RESULTS A total of 38 patients were enrolled, including 18 and 20 patients who underwent LSR and OSR, respectively. The baseline characteristics showed no significant differences between the groups. The median blood loss and incision length in the LSR group were significantly lower (40.0 vs. 300 mL, 4.5 vs. 15 cm, P < 0.001). The LSR group showed less time to the first flatus (2.0 vs. 3.0 days, P = 0.029), time to pull drainage (5.0 vs. 6.0 days, P = 0.042), time to pull catheter (3.0 vs. 4.0 days, P = 0.027), and postoperative hospital stay (6.0 vs. 8.0 days, P = 0.048). The LSR group also showed fewer postoperative complications than the OSR group, although the difference was not significant (40.0% vs. 16.7%, P = 0.113). At a median follow-up of 36 months, no local recurrence was observed. CONCLUSIONS Fascial-oriented laparoscopic resection of schwannomas in the LPS is feasible without compromising oncological safety. LSR shows clear advantages, most notably small incisions, less blood loss, and quick recovery, as well as potential benefits of neurological function.
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Affiliation(s)
- Junguang Liu
- Department of General Surgery, Peking University First Hospital, Beijing, 100034, China
| | - Yingze Ning
- Department of General Surgery, Peking University First Hospital, Beijing, 100034, China
| | - Shiwen Mei
- Department of Colorectal Surgery, National Cancer Center / National Clinical Research Center for Cancer / Cancer Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100021, China
| | - Wenlong Qiu
- Department of Colorectal Surgery, National Cancer Center / National Clinical Research Center for Cancer / Cancer Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100021, China
| | - Bin Tang
- Department of Colorectal Surgery, National Cancer Center / National Clinical Research Center for Cancer / Cancer Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100021, China.
| | - Jianqiang Tang
- Department of Colorectal Surgery, National Cancer Center / National Clinical Research Center for Cancer / Cancer Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100021, China.
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