UW Neurological Surgery Recent PubMed Publications

Frailty in Elderly Patients Undergoing Cardiac Surgery Increases Hospital Stay and 12-Month Readmission Rate.

Heart Lung Circ. 2019 Dec 05;:

Authors: Lal S, Gray A, Kim E, Bunton RW, Davis P, Galvin IF, Williams MJA

Abstract
BACKGROUND: Cardiac surgery risk scoring systems predict operative mortality but not outcomes related to preoperative frailty. The aim of this study was to assess frailty in a cohort of older cardiac surgery patients as a predictor of postoperative outcomes.
METHODS: Prospective data was collected on patients 65 years of age and older undergoing cardiac surgery between September 2015 and October 2016 at Dunedin Hospital. Frailty was assessed with the Edmonton frail scale and five-metre gait speed. The primary endpoint was length of hospital stay. Secondary outcomes included postoperative complications, major adverse events, death and 12-month readmission rate.
RESULTS: Among the 96 patients, median age was 74 (interquartile range 10.5) and 65 (68%) were males. Of the sample 64 (67%) were scored as not frail, 22 (23%) as vulnerable, and 10 (10%) as frail. The median (interquartile range) postoperative days' stay were: not frail 6 (2), vulnerable 9.5 (8), and frail 15 (13). Survival analysis adjusting for EuroSCORE II, age, sex and surgery type showed that greater Edmonton frail scale scores were independently predictive of longer post-surgery hospital stay with a hazard ratio for discharge of 0.83 (95% confidence interval 0.76-0.91, p<0.001) per point. The Edmonton frail scale score was associated with the 12-month post discharge number of readmissions (adjusted incidence rate ratio 1.24 (95% confidence interval 1.13-1.37, p<0.001) per point.
CONCLUSIONS: The Edmonton frail scale score predicts length of hospital stay post cardiac surgery and 12-month readmission rate in patients older than 65 years of age.

PMID: 31959552 [PubMed - as supplied by publisher]

IMPACT and CRASH prognostic models for traumatic brain injury: external validation in a South-American cohort.

Inj Prev. 2020 Jan 20;:

Authors: Wongchareon K, Thompson HJ, Mitchell PH, Barber J, Temkin N

Abstract
OBJECTIVE: To develop a robust prognostic model, the more diverse the settings in which the system is tested and found to be accurate, the more likely it will be generalisable to untested settings. This study aimed to externally validate the International Mission for Prognosis and Clinical Trials in Traumatic Brain Injury (IMPACT) and Corticosteroid Randomization after Significant Head Injury (CRASH) models for low-income and middle-income countries using a dataset of patients with severe traumatic brain injury (TBI) from the Benchmark Evidence from South American Trials: Treatment of Intracranial Pressure study and a simultaneously conducted observational study.
METHOD: A total of 550 patients with severe TBI were enrolled in the study, and 466 of those were included in the analysis. Patient admission characteristics were extracted to predict unfavourable outcome (Glasgow Outcome Scale: GOS<3) and mortality (GOS 1) at 14 days or 6 months.
RESULTS: There were 48% of the participants who had unfavourable outcome at 6 months and these included 38% who had died. The area under the receiver operating characteristic curve (AUC) values were 0.683-0.775 and 0.640-0.731 for the IMPACT and CRASH models respectively. The IMPACT CT model had the highest AUC for predicting unfavourable outcomes, and the IMPACT Lab model had the best discrimination for predicting 6-month mortality. The discrimination for both the IMPACT and CRASH models improved with increasing complexity of the models. Calibration revealed that there were disagreement between observed and predicted outcomes in the IMPACT and CRASH models.
CONCLUSION: The overall performance of all IMPACT and CRASH models was adequate when used to predict outcomes in the dataset. However, some disagreement in calibration suggests the necessity for updating prognostic models to maintain currency and generalisability.

PMID: 31959626 [PubMed - as supplied by publisher]

Development of a System for Postmarketing Population Pharmacokinetic and Pharmacodynamic Studies Using Real-World Data From Electronic Health Records.

Clin Pharmacol Ther. 2020 04;107(4):934-943

Authors: Choi L, Beck C, McNeer E, Weeks HL, Williams ML, James NT, Niu X, Abou-Khalil BW, Birdwell KA, Roden DM, Stein CM, Bejan CA, Denny JC, Van Driest SL

Abstract
Postmarketing population pharmacokinetic (PK) and pharmacodynamic (PD) studies can be useful to capture patient characteristics affecting PK or PD in real-world settings. These studies require longitudinally measured dose, outcomes, and covariates in large numbers of patients; however, prospective data collection is cost-prohibitive. Electronic health records (EHRs) can be an excellent source for such data, but there are challenges, including accurate ascertainment of drug dose. We developed a standardized system to prepare datasets from EHRs for population PK/PD studies. Our system handles a variety of tasks involving data extraction from clinical text using a natural language processing algorithm, data processing, and data building. Applying this system, we performed a fentanyl population PK analysis, resulting in comparable parameter estimates to a prior study. This new system makes the EHR data extraction and preparation process more efficient and accurate and provides a powerful tool to facilitate postmarketing population PK/PD studies using information available in EHRs.

PMID: 31957870 [PubMed - indexed for MEDLINE]

A Risk Score Including Carotid Plaque Inflammation and Stenosis Severity Improves Identification of Recurrent Stroke.

Stroke. 2020 03;51(3):838-845

Authors: Kelly PJ, Camps-Renom P, Giannotti N, Martí-Fàbregas J, McNulty JP, Baron JC, Barry M, Coutts SB, Cronin S, Delgado-Mederos R, Dolan E, Fernández-León A, Foley S, Harbison J, Horgan G, Kavanagh E, Marnane M, McCabe J, McDonnell C, Sharma VK, Williams DJ, O'Connell M, Murphy S

Abstract
Background and Purpose- In randomized trials of symptomatic carotid endarterectomy, only modest benefit occurred in patients with moderate stenosis and important subgroups experienced no benefit. Carotid plaque 18F-fluorodeoxyglucose uptake on positron emission tomography, reflecting inflammation, independently predicts recurrent stroke. We investigated if a risk score combining stenosis and plaque 18F-fluorodeoxyglucose would improve the identification of early recurrent stroke. Methods- We derived the score in a prospective cohort study of recent (<30 days) non-severe (modified Rankin Scale score ≤3) stroke/transient ischemic attack. We derived the SCAIL (symptomatic carotid atheroma inflammation lumen-stenosis) score (range, 0-5) including 18F-fluorodeoxyglucose standardized uptake values (SUVmax <2 g/mL, 0 points; SUVmax 2-2.99 g/mL, 1 point; SUVmax 3-3.99 g/mL, 2 points; SUVmax ≥4 g/mL, 3 points) and stenosis (<50%, 0 points; 50%-69%, 1 point; ≥70%, 2 points). We validated the score in an independent pooled cohort of 2 studies. In the pooled cohorts, we investigated the SCAIL score to discriminate recurrent stroke after the index stroke/transient ischemic attack, after positron emission tomography-imaging, and in mild or moderate stenosis. Results- In the derivation cohort (109 patients), recurrent stroke risk increased with increasing SCAIL score (P=0.002, C statistic 0.71 [95% CI, 0.56-0.86]). The adjusted (age, sex, smoking, hypertension, diabetes mellitus, antiplatelets, and statins) hazard ratio per 1-point SCAIL increase was 2.4 (95% CI, 1.2-4.5, P=0.01). Findings were confirmed in the validation cohort (87 patients, adjusted hazard ratio, 2.9 [95% CI, 1.9-5], P<0.001; C statistic 0.77 [95% CI, 0.67-0.87]). The SCAIL score independently predicted recurrent stroke after positron emission tomography-imaging (adjusted hazard ratio, 4.52 [95% CI, 1.58-12.93], P=0.005). Compared with stenosis severity (C statistic, 0.63 [95% CI, 0.46-0.80]), prediction of post-positron emission tomography stroke recurrence was improved with the SCAIL score (C statistic, 0.82 [95% CI, 0.66-0.97], P=0.04). Findings were confirmed in mild or moderate stenosis (adjusted hazard ratio, 2.74 [95% CI, 1.39-5.39], P=0.004). Conclusions- The SCAIL score improved the identification of early recurrent stroke. Randomized trials are needed to test if a combined stenosis-inflammation strategy improves selection for carotid revascularization where benefit is currently uncertain.

PMID: 31948355 [PubMed - indexed for MEDLINE]

medExtractR: A targeted, customizable approach to medication extraction from electronic health records.

J Am Med Inform Assoc. 2020 03 01;27(3):407-418

Authors: Weeks HL, Beck C, McNeer E, Williams ML, Bejan CA, Denny JC, Choi L

Abstract
OBJECTIVE: We developed medExtractR, a natural language processing system to extract medication information from clinical notes. Using a targeted approach, medExtractR focuses on individual drugs to facilitate creation of medication-specific research datasets from electronic health records.
MATERIALS AND METHODS: Written using the R programming language, medExtractR combines lexicon dictionaries and regular expressions to identify relevant medication entities (eg, drug name, strength, frequency). MedExtractR was developed on notes from Vanderbilt University Medical Center, using medications prescribed with varying complexity. We evaluated medExtractR and compared it with 3 existing systems: MedEx, MedXN, and CLAMP (Clinical Language Annotation, Modeling, and Processing). We also demonstrated how medExtractR can be easily tuned for better performance on an outside dataset using the MIMIC-III (Medical Information Mart for Intensive Care III) database.
RESULTS: On 50 test notes per development drug and 110 test notes for an additional drug, medExtractR achieved high overall performance (F-measures >0.95), exceeding performance of the 3 existing systems across all drugs. MedExtractR achieved the highest F-measure for each individual entity, except drug name and dose amount for allopurinol. With tuning and customization, medExtractR achieved F-measures >0.90 in the MIMIC-III dataset.
DISCUSSION: The medExtractR system successfully extracted entities for medications of interest. High performance in entity-level extraction provides a strong foundation for developing robust research datasets for pharmacological research. When working with new datasets, medExtractR should be tuned on a small sample of notes before being broadly applied.
CONCLUSIONS: The medExtractR system achieved high performance extracting specific medications from clinical text, leading to higher-quality research datasets for drug-related studies than some existing general-purpose medication extraction tools.

PMID: 31943012 [PubMed - indexed for MEDLINE]

Use of Amitriptyline in the Treatment of Headache After Traumatic Brain Injury: Lessons Learned From a Clinical Trial.

Headache. 2020 Jan 13;:

Authors: Hurwitz M, Lucas S, Bell KR, Temkin N, Dikmen S, Hoffman J

Abstract
OBJECTIVES: The primary outcome of this study was to assess the efficacy and safety of preventive treatment with amitriptyline on headache frequency and severity after mild traumatic brain injury (mTBI).
BACKGROUND: Despite the fact that headache is the most common and persistent physical symptom after TBI, there has been little research on the longitudinal course or pharmacologic treatment of this disorder. Of those who have headache after injury, about 60% continue to complain of headache at 3 months post injury, with higher levels of disability than those without headache. There have been no prospective, randomized, controlled trials of a pharmacologic agent for headache after TBI. Additionally, a brain-injured population may be more susceptible to side effects of medication.
DESIGN: This is a single-center phase II trial of amitriptyline to prevent persistent headache after an mTBI. Medication dose was gradually increased from 10 to 50 mg daily.
RESULTS: Fifty participants were enrolled and 33 who completed the 90-day assessment were included in the final analysis. In order to detect a possible cognitive impact of the study drug, 24 participants were randomly assigned to start amitriptyline immediately after study enrollment and 26 were assigned to start 30 days after enrollment. Forty-nine percent (18/37) of those assigned to take medication took none throughout the study period, with less compliance in younger participants with mean ages of 32.7 in those who did not take any medication, 33.4 who were less than 80% compliant, and 42.3 who were compliant (P = .013). Compliance in keeping a daily headache diary was low, with 29/50 participants (58%) meeting daily entry completion, and only 10 participants maintaining 100% diary completion. No differences were found between those who started medication immediately vs at day 30 in headache frequency or severity.
CONCLUSIONS: While headache is the most common symptom following mTBI, current evidence does not support a specific treatment. No differences were noted in headache frequency compared to our prior study. However, the current sample had significantly lower headache severity (15% vs 36% with pain rating of 6 or above, P = .015) compared to our prior study. Our current study was not able to determine whether there is any benefit for the use of amitriptyline as a headache preventive because of difficulty with study recruitment and compliance. The challenges with recruitment and retention in the mTBI population were instructive, and future research in this area will need to identify strategies to improve recruitment, diary compliance, and medication adherence in this population.

PMID: 31943197 [PubMed - as supplied by publisher]

Editorial: Misclassification of Type 2 Myocardial Infarction: Implications for Value-Based Programs and Quality Metrics.

Cardiovasc Revasc Med. 2020 02;21(2):180-181

Authors: Wasfy JH, Murphy SP

PMID: 31932169 [PubMed - indexed for MEDLINE]

Senescent mesenchymal stem cells remodel extracellular matrix driving breast cancer cells to more invasive phenotype.

J Cell Sci. 2020 Jan 13;:

Authors: Ghosh D, Mejia-Pena C, Quach N, Xuan B, Lee AH, Dawson MR

Abstract
Mesenchymal stem cells accumulated in tissue specific sites are essential for the regenerative process; however, biological aging and environmental stress can induce senescence - an irreversible state of growth arrest - that not only affects the behavior of cells but also disrupts their ability to restore tissue integrity. While abnormal tissue properties including increased extracellular matrix stiffness are linked with the risk of developing breast cancer, the role and contribution of senescent MSCs to the disease progression to malignancy are not well understood. Here, we investigated senescence associated biophysical changes in MSCs and how they influence cancer cell behavior in a 3D matrix interface model. Although senescent MSCs were far less motile than pre-senescent MSCs, they induced an invasive breast cancer phenotype, characterized by increased spheroid growth and cell invasion in collagen gels. Further analysis of collagen gels using second harmonic generation showed increased collagen density when senescent MSCs were present, suggesting that senescent MSCs actively remodel the surrounding matrix. This study provides direct evidence of the pro-malignant effects of senescent MSCs in tumors.

PMID: 31932504 [PubMed - as supplied by publisher]

Minimal tissue excision in the treatment of pilonidal sinus disease: results from a single surgical unit.

ANZ J Surg. 2020 Jan 12;:

Authors: Rogers P, Platell C, Levitt M

Abstract
BACKGROUND: Pilonidal sinus disease is a common surgical disorder for which a clearly superior corrective operation remains elusive. Recurrence after surgery requiring re-operation is a frequent outcome. This retrospective study examines healing rates, recurrence rates and time to healing of a minimalist approach - employing deroofing of tracks, curettage and minimal skin excision - at one centre over the last decade.
METHODS: The results of all minimal excision pilonidal sinus operations performed from 2005 to 2018 by two surgeons at one centre have been analysed retrospectively. Ethics approval for this study was granted by the St John of God Health Care Human Research Ethics Committee on 11 June 2018.
RESULTS: A total of 84 patients were included in this study with 19 females and 65 males. The median age at operation was 22 years. Of the 84 total patients, 78 achieved primary healing (93%) with an average healing time of 55 days. Of those that healed, seven recurred with an average time to recurrence of 812 days.
CONCLUSION: In our study, minimal excision management of pilonidal sinus disease achieved primary healing in 93% with an average healing time of 55 days and a recurrence rate of 8%. These outcomes are similar, but not significantly inferior, to those reported for other surgical modalities of management. Given this, we suggest less invasive management may be a preferable first surgical option given smaller surgical intervention for similar outcomes.

PMID: 31930671 [PubMed - as supplied by publisher]

Hypercalcemia in T-Cell/Histiocyte-Rich Large B-Cell Lymphoma: An Unusual Presentation of a Rare Disease and Literature Review.

World J Oncol. 2019 Dec;10(6):231-236

Authors: Conte GA, Harmon JS, Le ML, Sun X, Schuler JW, Levitt MJ, Chinnici AA, Hossain MA

Abstract
T-cell/histiocyte-rich large B-cell lymphoma (THRLBCL) is an extremely rare morphologic subtype of diffuse large B-cell lymphoma (DLBCL), accounting for only 1-3% of total cases. It is considered an aggressive lymphoma with a poor prognosis. Hypercalcemia has been described as an uncommon presenting symptom of patients with DLBCL in several case reports. Here, we report an unusual case of severe hypercalcemia in a patient who was ultimately diagnosed with T-cell/histiocyte-rich B-cell lymphoma. A 69-year-old male patient presented to our hospital with nausea, vomiting, weakness and unintentional weight loss. His initial blood tests showed a serum calcium level of 16.1 mg/dL and serum creatinine level of 3.25 mg/dL. He had high intact parathyroid hormone (PTH, 6.8 pg/mL), mildly elevated 25-hydroxyvitamin D and serum PTH-related peptide (PTHrP). To exclude malignancy, computed tomography (CT) scans of the chest, abdomen and pelvis were performed which were unremarkable. A bone marrow biopsy was performed to detect any hidden hematologic malignancy which showed large mononuclear cells with prominent nucleoli and occasional Reed-Sternberg cells, consistent with the diagnosis of THRLBCL. Subsequent positron emission tomography demonstrated diffuse fluorodeoxyglucose (FDG) uptake. This case reports a unique presentation of a rare subtype of non-Hodgkin's lymphoma. We highlight the importance of pursuing a thorough workup for causes of hypercalcemia as well as understanding the underlying mechanisms of severe hypercalcemia in malignancy.

PMID: 31921379 [PubMed]

Longitudinal neuroimaging following combat concussion: sub-acute, 1 year and 5 years post-injury.

Brain Commun. 2019;1(1):fcz031

Authors: Mac Donald CL, Barber J, Andre J, Panks C, Zalewski K, Temkin N

Abstract
Questions remain regarding the long-term impact of combat concussive blast exposure. While efforts have begun to highlight the clinical impact, less is known about neuroimaging trajectories that may inform underlying pathophysiological changes post-injury. Through collaborative efforts in combat, following medical evacuation, and at universities in the USA, this study followed service members both with and without blast concussion from the sub-acute to 1-year and 5-year outcomes with quantitative neuroimaging. The following two primary and two exploratory groups were examined: combat-deployed controls without blast exposure history 'non-blast control' and concussive blast patients (primary) and combat concussion arising not from blast 'non-blast concussion' and combat-deployed controls with blast exposure history 'blast control' (exploratory). A total of 575 subjects were prospectively enrolled and imaged; 347 subjects completed further neuroimaging examination at 1 year and 342 subjects completed further neuroimaging examination at 5 years post-injury. At each time point, MRI scans were completed that included high-resolution structural as well as diffusion tensor imaging acquisitions processed for quantitative volumetric and diffusion tensor imaging changes. Longitudinal evaluation of the number of abnormal diffusion tensor imaging and volumetric regions in patients with blast concussion revealed distinct trends by imaging modality. While the presence of abnormal volumetric regions remained quite stable comparing our two primary groups of non-blast control to blast concussion, the diffusion tensor imaging abnormalities were observed to have varying trajectories. Most striking was the fractional anisotropy 'U-shaped' curve observed for a proportion of those that, if we had only followed them to 1 year, would look like trajectories of recovery. However, by continuing the follow-up to 5 years in these very same patients, a secondary increase in the number of reduced fractional anisotropy regions was identified. Comparing non-blast controls to blast concussion at each time point revealed significant differences in the number of regions with reduced fractional anisotropy at both the sub-acute and 5-year time points, which held after adjustment for age, education, gender, scanner and subsequent head injury exposure followed by correction for multiple comparisons. The secondary increase identified in patients with blast concussion may be the earliest indications of microstructural changes underlying the 'accelerated brain aging' theory recently reported from chronic, cross-sectional studies of veterans following brain injury. These varying trajectories also inform potential prognostic neuroimaging biomarkers of progression and recovery.

PMID: 31915753 [PubMed]

Dental caries, diabetes mellitus, metabolic control and diabetes duration: A systematic review and meta-analysis.

J Esthet Restor Dent. 2020 Apr;32(3):291-309

Authors: Coelho AS, Amaro IF, Caramelo F, Paula A, Marto CM, Ferreira MM, Botelho MF, Carrilho EV

Abstract
OBJECTIVE: To analyze articles aimed at evaluating the association between diabetes, metabolic control, diabetes duration, and dental caries.
OVERVIEW: A systematic search in PubMed, Cochrane Library, Embase, and Web of Science was conducted to retrieve papers in English, Portuguese, and Spanish, up to April 2019. The research strategy was constructed considering the "PECO" strategy. Only quantitative observational studies were analyzed. The risk of bias was assessed using the Newcastle-Ottawa Quality Assessment Scale. The meta-analyses were performed based on random-effects models using the statistical platform R. A total of 69 articles was included in the systematic review and 40 in the meta-analysis. Type 1 diabetics have a significantly higher DMFT compared to controls. No significant differences were found between type 2 diabetics and controls and between well-controlled and poorly controlled diabetics. Concerning diabetes duration, all authors failed to find differences between groups.
CONCLUSION: Although there is still a need for longitudinal studies, the meta-analysis proved that type 1 diabetics have a high dental caries risk.
CLINICAL SIGNIFICANCE: It is necessary to be aware of all risk factors for dental caries that may be associated with these patients, making it possible to include them into an individualized prevention program.

PMID: 31912978 [PubMed - indexed for MEDLINE]

Surgical Versus Endovascular Management of Ruptured and Unruptured Intracranial Aneurysms: Emergent Issues and Future Directions.

World Neurosurg. 2020 Apr;136:17-27

Authors: Abecassis IJ, Zeeshan Q, Ghodke BV, Levitt MR, Ellenbogen RG, Sekhar LN

Abstract
Ideal management of unruptured intracranial aneurysms (UIAs) and ruptured intracranial aneurysms (RIAs) is a controversial issue. Over the last few decades, a significant paradigm shift has occurred away from open microsurgical clipping toward endovascular coil embolization. Multiple studies have been performed with mixed results. Some studies suggest that endovascular treatment produces better clinical and functional outcomes, but is associated with increased need for retreatment. Other studies report increased durability in aneurysms treated with microsurgical clipping, but that clipping may be associated with worse functional outcomes in some cases. Further complicating the dialogue are variable costs associated with different treatment modalities, including country-dependent cost differences. Here we provide a review of some of the major studies comparing open surgery versus endovascular treatment for both RIAs and UIAs to distill their key findings and corresponding implications for clinical practice. We relate these research results to our institution's experience with RIAs and UIAs and describe our approach to treatment of these conditions. Finally, we discuss implications of the paradigm shift for both open and endovascular surgery, including educational initiatives directed toward preserving important microsurgical tenets in the setting of diminishing surgical volume.

PMID: 31899398 [PubMed - indexed for MEDLINE]

Progress in diffuse intrinsic pontine glioma: advocating for stereotactic biopsy in the standard of care.

Neurosurg Focus. 2020 Jan 01;48(1):E4

Authors: Williams JR, Young CC, Vitanza NA, McGrath M, Feroze AH, Browd SR, Hauptman JS

Abstract
Diffuse intrinsic pontine glioma (DIPG) is a universally fatal pediatric brainstem tumor affecting approximately 300 children in the US annually. Median survival is less than 1 year, and radiation therapy has been the mainstay of treatment for decades. Recent advances in the biological understanding of the disease have identified the H3K27M mutation in nearly 80% of DIPGs, leading to the 2016 WHO classification of diffuse midline glioma H3K27M-mutant, a grade IV brainstem tumor. Developments in epigenetic targeting of transcriptional tendencies have yielded potential molecular targets for clinical trials. Chimeric antigen receptor T cell therapy has also shown preclinical promise. Recent clinical studies, including prospective trials, have demonstrated the safety and feasibility of pediatric brainstem biopsy in the setting of DIPG and other brainstem tumors. Given developments in the ability to analyze DIPG tumor tissue to deepen biological understanding of this disease and develop new therapies for treatment, together with the increased safety of stereotactic brainstem biopsy, the authors present a case for offering biopsy to all children with suspected DIPG. They also present their standard operative techniques for image-guided, frameless stereotactic biopsy.

PMID: 31896081 [PubMed - in process]

Intraoperative assessment of skull base tumors using stimulated Raman scattering microscopy.

Sci Rep. 2019 12 31;9(1):20392

Authors: Shin KS, Francis AT, Hill AH, Laohajaratsang M, Cimino PJ, Latimer CS, Gonzalez-Cuyar LF, Sekhar LN, Juric-Sekhar G, Fu D

Abstract
Intraoperative consultations, used to guide tumor resection, can present histopathological findings that are challenging to interpret due to artefacts from tissue cryosectioning and conventional staining. Stimulated Raman histology (SRH), a label-free imaging technique for unprocessed biospecimens, has demonstrated promise in a limited subset of tumors. Here, we target unexplored skull base tumors using a fast simultaneous two-channel stimulated Raman scattering (SRS) imaging technique and a new pseudo-hematoxylin and eosin (H&E) recoloring methodology. To quantitatively evaluate the efficacy of our approach, we use modularized assessment of diagnostic accuracy beyond cancer/non-cancer determination and neuropathologist confidence for SRH images contrasted to H&E-stained frozen and formalin-fixed paraffin-embedded (FFPE) tissue sections. Our results reveal that SRH is effective for establishing a diagnosis using fresh tissue in most cases with 87% accuracy relative to H&E-stained FFPE sections. Further analysis of discrepant case interpretation suggests that pseudo-H&E recoloring underutilizes the rich chemical information offered by SRS imaging, and an improved diagnosis can be achieved if full SRS information is used. In summary, our findings show that pseudo-H&E recolored SRS images in combination with lipid and protein chemical information can maximize the use of SRS during intraoperative pathologic consultation with implications for tissue preservation and augmented diagnostic utility.

PMID: 31892723 [PubMed - indexed for MEDLINE]

Knot my problem: Overcoming transradial catheter complications.

Clin Case Rep. 2019 Dec;7(12):2596-2597

Authors: Walker M, Levitt MR, Ghodke BV

Abstract
Not all complications from transradial access can be prevented, even with diligent patient selection and preprocedure planning. This brief visual report offers technical suggestions to reverse knots and kinks encountered during catheter manipulation for endovascular transradial cerebral procedures.

PMID: 31893113 [PubMed]

Acute traumatic presentation of Chiari I malformation with central cord syndrome and presyrinx in an infant.

Surg Neurol Int. 2019;10:253

Authors: Young CC, Ellenbogen RG, Hauptman JS

Abstract
Background: Chiari I malformation (CM-I) typically presents in late childhood and early adulthood. Often these lesions are asymptomatic and discovered incidentally. Patients typically present with tussive headaches and focal neurological findings, especially when associated with syringomyelia. Here, an 11-month-old child with a severely symptomatic CM-I required surgery (e.g., suboccipital craniectomy and C1/2 laminectomy) within the 1st year of life.
Case Description: An 11-month-old infant presented with acute bilateral upper extremity weakness following a ground-level fall. The magnetic resonance imaging of the cervical spine showed crowding at the craniocervical junction with 7 mm of cerebellar tonsillar herniation/descent, and swelling/edema of the cervical spinal cord with a presyrinx. The patient underwent an urgent suboccipital craniectomy and C1/2 laminectomy under intraoperative neuromonitoring; the motor evoked potentials in the upper and lower extremities partially recovered intraoperatively. One day postoperatively, bilateral upper extremity strength improved; 4 weeks later, he recovered full neurological function. The follow-up MR also showed complete resolution of the previously noted presyrinx.
Conclusion: Acute neurological deficits may occur in infants with CM-I who, following trauma, sustain the equivalent of a central cord syndrome. Neurosurgical evaluation with MR should prompt timely/appropriate surgical decompression (e.g., suboccipital craniectomy and C1/2 laminectomy).

PMID: 31893154 [PubMed]

Current basis and future directions of zebrafish nutrigenomics.

Genes Nutr. 2019;14:34

Authors: Williams MB, Watts SA

Abstract
This review investigates the current state of nutrigenomics in the zebrafish animal models. The zebrafish animal model has been used extensively in the study of disease onset and progression and associated molecular changes. In this review, we provide a synopsis of nutrigenomics using the zebrafish animal model. Obesity and dyslipidemia studies describe the genomics of dietary-induced obesity in relation to high-fat/high-calorie diets. Inflammation and cardiovascular studies describe dietary effects on the expression of acute inflammatory markers and resulting chronic inflammatory issues including atherosclerosis. We also evaluated the genomic response to bioactive dietary compounds associated with metabolic disorders. Carbohydrate metabolism and β-cell function studies describe the impacts of high-carbohydrate dietary challenges on nutritional programming. We also report tumorigenesis in relation to dietary carcinogen exposure studies that can result in permanent genomic changes. Vitamin and mineral deficiency studies demonstrate transgenerational genomic impacts of micronutrients in the diet and temporal expression changes. Circadian rhythm studies describe the relation between metabolism and natural temporal cycles of gene expression that impacts health. Bone formation studies describe the role of dietary composition that influences bone reabsorption regulation. Finally, this review provides future directions in the use of the zebrafish model for nutrigenomic and nutrigenetic research.

PMID: 31890052 [PubMed]

Publisher Correction: Direct stimulation of somatosensory cortex results in slower reaction times compared to peripheral touch in humans.

Sci Rep. 2019 Dec 27;9(1):20317

Authors: Caldwell DJ, Cronin JA, Wu J, Weaver KE, Ko AL, Rao RPN, Ojemann JG

Abstract
An amendment to this paper has been published and can be accessed via a link at the top of the paper.

PMID: 31882720 [PubMed - in process]

Complex regional pain syndrome after transradial cerebral intervention.

BMJ Case Rep. 2019 Dec 23;12(12):

Authors: Walker M, Levitt MR

Abstract
Access site complications from transradial approaches for endovascular interventions are uncommon and many are preventable. Complications described in the literature include hematoma, radial artery occlusion, vasospasm, and even compartment syndrome. Mild post-procedure discomfort reported by patients is typically self-limited and managed symptomatically with oral analgesics. Pain that has no obvious structural correlate and is unresponsive to intravenous narcotics is very unusual. We describe the diagnosis and management of a case of complex regional pain syndrome of the upper extremity after transradial stent-assisted coil embolization of a cerebral aneurysm.

PMID: 31874841 [PubMed - indexed for MEDLINE]