Tag: nevin manimala

J Neurosurg Spine. 2025 Jan 17:1-10. doi: 10.3171/2024.10.SPINE24808. Online ahead of print.

ABSTRACT

OBJECTIVE: The potential of robot-assisted (RA) single-position (SP) lateral lumbar interbody fusion (LLIF) warrants further investigation. This study aimed to assess the efficacy of RA-SP-LLIF in improving both clinical and radiographic outcomes in patients undergoing lumbar spinal fusion surgery.

METHODS: A total of 59 patients underwent either RA-SP-LLIF (n = 31 cases) or traditional LLIF (n = 28 cases). Surgical parameters including operative duration, estimated blood loss, and fluoroscopy duration were recorded. Clinical outcomes were assessed using the visual analog scale (VAS) for back and leg pain, Oswestry Disability Index (ODI), and the 36-item Short-Form Health Survey (SF-36). Radiographic parameters were also evaluated.

RESULTS: There were no significant differences between the two groups in terms of postoperative and last follow-up times, but both groups demonstrated significant improvements in VAS scores. Similarly, ODI and SF-36 scores showed comparable improvements. Radiographic parameters did not significantly differ between the groups preoperatively, postoperatively, and at last follow-up (p > 0.05). Neither group showed significant improvements in pelvic tilt and sacral slope parameters compared to baseline postoperatively and at last follow-up (p > 0.05). However, the RA-SP-LLIF group exhibited significantly greater improvements in lumbar lordosis (LL; p < 0.01), segmental lordosis (SL; p < 0.01), and pelvic incidence-LL mismatch (PI-LL; p < 0.01) immediately postoperatively compared to baseline, although these differences were not significant at subsequent evaluations. Similarly, the traditional LLIF group improved the LL, SL, and PI-LL parameters postoperatively. Importantly, there was no statistically significant difference in the Bridwell grade and complications between the two groups (p = 0.83 and p = 0.88, respectively). However, the RA-SP-LLIF group had significantly shorter operative and fluoroscopy durations compared to the traditional LLIF group (p = 0.04 and p < 0.01, respectively).

CONCLUSIONS: Both RA-SP-LLIF and traditional LLIF surgeries achieved satisfactory lordotic correction. However, RA-SP-LLIF surgery demonstrated shorter operative and fluoroscopy times compared to traditional LLIF surgery. Therefore, RA-SP-LLIF is a promising technique for enhancing surgical efficiency, safety, and precision in lumbar spinal fusion procedures.

PMID:39823634 | DOI:10.3171/2024.10.SPINE24808

J Neurosurg. 2025 Jan 17:1-9. doi: 10.3171/2024.8.JNS241276. Online ahead of print.

ABSTRACT

OBJECTIVE: Many patients with ruptured intracranial aneurysms (RIAs) underrepresented or excluded from previous randomized controlled trials (RCTs) comparing surgery with endovascular treatment (EVT) are still considered for surgical clipping, but the best management of these patients remains unknown.

METHODS: The International Subarachnoid Aneurysm Trial-2 was a randomized trial comparing surgical versus EVT of RIAs considered for surgical clipping, despite the results of previous RCTs, and also eligible for EVT. The primary endpoint was death or dependency according to the modified Rankin Scale score (mRS score > 2) at 1 year. Secondary endpoints included 1-year angiographic results and length of hospital stay. The primary hypothesis was that endovascular management would decrease the number of poor outcomes (mRS score > 2) from 30% to 23%, necessitating 1896 patients. The trial was interrupted after 10 years because of slow recruitment. Primary analysis was by intent-to-treat. There was no blinding.

RESULTS: From November 2012 to December 2022, 270 patients were recruited at 6 North American and European centers. After exclusions, 263 patients were randomly allocated to receive surgery (n = 133) or EVT (n = 130). There were 12 crossovers (9 from surgery to EVT). The primary outcome was reached in 40 of 133 surgical patients (30%, 95% CI 23%-38%) compared with 35 of 130 EVT patients (27%, 95% CI 20%-35%) (p = 0.572). Residual aneurysms at 1 year were less frequent with surgery (10/118 [8%, 95% CI 5%-15%]) than EVT (22/109 [20%, 95% CI 14%-29%]) (p = 0.015). Additional procedures (ventricular drainage and decompressive craniotomy, p < 0.05) and hospitalization > 20 days were more frequent in the surgery group (69/133 [52%, 95% CI 43%-60%]) than in the EVT group (38/130 [29%, 95% CI 22%-38%]) (p < 0.001).

CONCLUSIONS: This prematurely interrupted trial showed more frequent additional procedures and longer hospitalizations but better 1-year angiographic results with surgery. The primary clinical outcome, death or dependency at 1 year, was similar for EVT and surgery.

PMID:39823597 | DOI:10.3171/2024.8.JNS241276

JMIR Res Protoc. 2025 Jan 17;14:e54609. doi: 10.2196/54609.

ABSTRACT

BACKGROUND: Metastatic spine tumor surgery (MSTS) is often complex and extensive leading to significant blood loss. Allogeneic blood transfusion (ABT) is the mainstay of blood replenishment but with immune-mediated postoperative complications. Alternative blood management techniques (salvaged blood transfusion [SBT]) allow us to overcome such complications. Despite widespread use of intraoperative cell salvage (IOCS) in oncological and nononcological surgical procedures, surgeons remain reluctant to use IOCS in MSTS.

OBJECTIVE: This study aims to analyze safety of IOCS-leukocyte depletion filter (LDF)-processed blood transfusion for patients undergoing MSTS by assessing clinical outcomes-disease progression: tumor progression and overall survival. This study evaluates whether reinfusion of IOCS-LDF-processed blood reduces ABT rates in patients undergoing MSTS by sorting patients undergoing MSTS who require ABT into patients who consent to receive or not receive SBT.

METHODS: We aim to recruit a minimum of 90 patients-30 patients for SBT, 30 patients for ABT, and 30 patients with no blood transfusion. SBT and ABT form the 2 experimental arms, whereas no blood transfusion forms the control cohort. Available patient data will be reviewed to determine tumor burden secondary to metastasis and postoperative survival and disease progression, improvement in pain, and neurological and ambulatory status. Data collected will be studied postoperatively at 3, 6, 12, 24, 36, and 48 months or until demise, whichever occurs first. Outcomes of the experimental groups will be compared with those of the control group. Outcomes will be analyzed using 1-way ANOVA and Fisher exact test. The Kaplan-Meier curve and a log-rank test will be used to study overall survival. A multivariate and competing risk analysis will be used to study the association between blood transfusion type and tumor progression. All statistical analyses will be done using Stata Special Edition 14.0 (StataCorp LP).

RESULTS: This is the largest clinical study on use of IOCS in MSTS from various primary malignancies to date. It will provide significant clinical evidence regarding the safety and applicability of IOCS in MSTS. It will help reduce use of ABT, improving overall blood management of patients undergoing MSTS. A limitation of this study is that not all patients undergoing MSTS will survive for the follow-up period (4 years), theoretically leading to underreporting of disease progression. Study commenced in 2016 and patient recruitment continued till 2019. As of September 2019, we have collected operative data on 140 patients. However, the 2-year outcomes of about 40.0% (56/140) of patients are in the process of collection. The study is aimed to be published in the years 2023-2024.

CONCLUSIONS: Results will be disseminated via peer-reviewed publications, paving the way for future studies.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/54609.

PMID:39823595 | DOI:10.2196/54609

J Neurosurg. 2025 Jan 17:1-7. doi: 10.3171/2024.8.JNS232369. Online ahead of print.

ABSTRACT

OBJECTIVE: Studies have demonstrated the effectiveness of hydrogel-coated coils (HGCs) to achieve the composite endpoint of decreased recanalization rates and greater safety. Herein, the authors aimed to assess the true ability of second-generation HGCs to prevent recanalization.

METHODS: This randomized controlled study, the HYBRID (Hydrocoil Versus Bare Platinum Coil in Recanalization Imaging Data) trial, comparing HGCs with bare platinum coils (BPCs), was conducted in 43 Japanese institutions. The aneurysm diameter range was 7-20 mm. HGCs were used in 4 patients in the BPC arm, and at least one HGC was used in each patient in the HGC arm, excluding 3 patients. Additionally, an HGC length ≥ 50% of the length of all the coils used was strongly recommended. The primary endpoint was recanalization 1 year after embolization, according to core laboratory evaluation. Angiographic change was also classified as further thrombosis, unchanged, or recanalization. Changes in cases with both initial and 1-year posttreatment angiographic images were compared. In the post hoc analysis, major recanalization was defined as any change, from complete occlusion or a neck remnant at the end of the procedure to body filling (BF) on the 1-year posttreatment angiogram or any increase in the size of BF in patients with BF at the end of the procedure, and its rate was compared between the two treatment arms.

RESULTS: Recruitment ended when 432 patients were randomized; 217 and 215 patients were allocated to the HGC and BPC arms, respectively. The recanalization rates in the HGC and BPC arms were 3.3% and 7.1%, respectively (risk difference -3.8%, 95% CI -8.6 to 0.5), with no statistically significant difference (p = 0.083). Regarding aneurysm occlusion within 1 year, there was significantly more thrombosis and less recanalization in the HGC group (p = 0.043). The major recanalization rates were 2.3% and 6.6% in the HGC and BPC arms, respectively, with a significant difference between the two (p = 0.036).

CONCLUSIONS: The study results did not confirm the effectiveness of second-generation HGCs using recanalization imaging data. However, these coils may induce more thrombosis and less recanalization for medium-sized cerebral aneurysms. Clinical trial registration no.: UMIN000006748 (www.umin.ac.jp/ctr/).

PMID:39823584 | DOI:10.3171/2024.8.JNS232369

J Neurosurg. 2025 Jan 17:1-7. doi: 10.3171/2024.8.JNS24196. Online ahead of print.

ABSTRACT

OBJECTIVE: The purpose of this study was to present a newly designed 3D-printed personalized model (3D PPM) of a radiofrequency needle guide with a maxillary fixation for gasserian ganglion (GG) puncture.

METHODS: Implementation of 3D CT-guided radiofrequency therapy of the GG with and without use of 3D PPM was analyzed. The following parameters were assessed: radiation time, dose area product, air kerma reference point, pain severity during the puncture needle insertion, prosopalgia regression degree (according to visual analog scale) and the severity of facial numbness (according to the Barrow Neurological Institute scale) in the early postoperative period, and postpuncture complications.

RESULTS: Pain severity reduction was equivalent in both groups, and postoperative facial numbness was not observed. A statistically significant difference in radiation exposure parameters was revealed: radiation time was 181.67 ± 2.99 and 310.50 ± 18.46 seconds (p < 0.001); dose area product was 950.97 ± 115.41 and 1545.48 ± 135.04 µGy*m2 (p < 0.005); and the air kerma reference point was 114.53 ± 16.81 and 190.88 ± 17.48 mGy (p < 0.005) in groups 1 and 2, respectively. The severity of pain during a puncture needle insertion was assessed as mild in 62.5% and 25%, moderate in 37.5% and 41.6%, and severe in 0% and 33.3% of patients in groups 1 and 2, respectively. No serious perioperative complications were observed.

CONCLUSIONS: The use of 3D PPM allows for controlled needle insertion, reducing the radiation dose to the patient and medical staff, reducing pain during a puncture needle insertion into the area of the foramen ovale, and minimizing the risk of postoperative complications.

PMID:39823582 | DOI:10.3171/2024.8.JNS24196

Crit Care Explor. 2025 Jan 15;7(1):e1206. doi: 10.1097/CCE.0000000000001206. eCollection 2025 Jan 1.

ABSTRACT

OBJECTIVES: To investigate the prevalence of pulmonary embolism (PE) in children admitted to critical care diagnosed with COVID-19 infection.

DESIGN: Retrospective database study.

SETTING: Data reported to the Virtual Pediatric Systems, 2018-2021.

PATIENTS: Patients 28 days to younger than 18 years old, admitted to a PICU with either PE or COVID-19 diagnoses.

INTERVENTIONS: None.

MEASUREMENTS AND MAIN RESULTS: Among the PE-positive subgroups, from January 2020 to December 2021, 78 patients (14%) had an acute COVID-19 infection. The prevalence of PE pre-pandemic period (2018-2019) was 0.19% and for pandemic period (2020-2021) was 0.26% (p < 0.001). During the pandemic period, the prevalence of PE for COVID-negative patients was 0.21% and for COVID-positive patients was 1.01% (p < 0.001). The result shows that the chance to develop PE for COVID-positive patients is 4.8 times that for COVID-negative patients during the pandemic. In the subgroup of the PE-positive patients, 55.1% were Black or African American in the COVID-positive group and 19% in the COVID-negative group (p < 0.001). A multivariable logistic regression showed that race was an independent risk factor for COVID in PE-positive patients.

CONCLUSIONS: Our study demonstrates a significant increase in the prevalence of PE among pediatric patients admitted to PICUs during the COVID-19 pandemic compared with pre-pandemic. Our study indicates that COVID-positive patients are 4.8 times more likely to develop PE than COVID-negative patients. Additionally, the study highlights substantial racial disparities in the prevalence of PE, with Black or African American patients being disproportionately affected.

PMID:39823551 | DOI:10.1097/CCE.0000000000001206

Int J Oral Maxillofac Implants. 2025 Jan 17;0(0):1-20. doi: 10.11607/jomi.11254. Online ahead of print.

ABSTRACT

PURPOSE: Implant stability (IS) is crucial to the success of any implant-based therapy. The present work aimed to determine the relationship between primary and secondary stability and a range of variables.

MATERIAL AND METHODS: This retrospective cohort study included a total of 169 patients, who received 445 dental implants. A case history for each participant was created. Data collection included each patient’s age, implant design, length and diameter, bone type, and surgical factors. Implant Stability Quotient (ISQ) values were measured at baseline (T0: primary stability) and T1 (secondary stability). To calculate the ISQ values at T0, T1 and their differences in the variables age, design, length and diameter, a multivariate ANOVA test was performed to determine which variables acted as confounding factors and to adjust the ISQ values to these variables.

RESULTS: The main variables age, design, length and diameter were adjusted to their confounding factors. Regarding primary (T0) and secondary (T1) stability, statistically significant differences (p<0.05) were only found in implant diameter, with the larger the diameter, the greater the stability. In all the other main variables, no statistically significant differences were found for primary and secondary stability.

CONCLUSIONS: It may be concluded, within the limitations of the study, that the implant diameter variable is the one that significantly affects the primary and secondary stability of the implant.

PMID:39823542 | DOI:10.11607/jomi.11254

PLoS One. 2025 Jan 17;20(1):e0316617. doi: 10.1371/journal.pone.0316617. eCollection 2025.

ABSTRACT

Topological indices are crucial tools for predicting the physicochemical and biological features of different drugs. They are numerical values obtained from the structure of chemical molecules. These indices, particularly the degree-based TIs are a useful tools for evaluating the connection between a compound’s structure and its attributes. This study addresses the research problemof how to optimize drug design for HIV treatment using degree-based topological indices. The need for safer and more effective medicines for HIV is further emphasized by the advent of drug resistance and severe negative effects from current therapies. Employing degree-based graph invariants, the study investigates 13 HIV drugs by applying a quantitative structure-property relationship (QSPR) technique to associate their molecular structures with their physical properties. HIV drugs are ranked using the Analytic Hierarchy Process (AHP) according to specific parameters. The findings of the study demonstrate how well these approaches can determine the most effective possible drug combinations and designs, offering insightful information in developing improved HIV treatments.

PMID:39823527 | DOI:10.1371/journal.pone.0316617

PLoS Comput Biol. 2025 Jan 17;21(1):e1012746. doi: 10.1371/journal.pcbi.1012746. Online ahead of print.

ABSTRACT

Sensory neurons continually adapt their response characteristics according to recent stimulus history. However, it is unclear how such a reactive process can benefit the organism. Here, we test the hypothesis that adaptation actually acts proactively in the sense that it optimally adjusts sensory encoding for future stimuli. We first quantified human subjects’ ability to discriminate visual orientation under different adaptation conditions. Using an information theoretic analysis, we found that adaptation leads to a reallocation of coding resources such that encoding accuracy peaks at the mean orientation of the adaptor while total coding capacity remains constant. We then asked whether this characteristic change in encoding accuracy is predicted by the temporal statistics of natural visual input. Analyzing the retinal input of freely behaving human subjects showed that the distribution of local visual orientations in the retinal input stream indeed peaks at the mean orientation of the preceding input history (i.e., the adaptor). We further tested our hypothesis by analyzing the internal sensory representations of a recurrent neural network trained to predict the next frame of natural scene videos (PredNet). Simulating our human adaptation experiment with PredNet, we found that the network exhibited the same change in encoding accuracy as observed in human subjects. Taken together, our results suggest that adaptation-induced changes in encoding accuracy prepare the visual system for future stimuli.

PMID:39823517 | DOI:10.1371/journal.pcbi.1012746

PLoS One. 2025 Jan 17;20(1):e0317617. doi: 10.1371/journal.pone.0317617. eCollection 2025.

ABSTRACT

Latent transition analysis (LTA) is a useful statistical modelling approach for describe transitions between latent classes over time. LTA may be characterized in terms of prevalence at each time point and through transition probabilities over time. Investigating predictors of these transitions is often of key interest. Currently, LTA can mostly be carried out using commercial and specialized software and only to some limited extent by means of open source statistical software. This tutorial demonstrates a flexible and modular approach for LTA, providing a powerful alternative using R through a combination latent class analysis and multiple logistic regression models. This approach has several advantages from a modelling perspective, as demonstrated through revisiting a previously conducted LTA, published in PLoS ONE recently. In short, results were very similar to the original analysis using commercial software although some additional novel results were also obtained. The proposed alternative approach offers more options in terms of choice of effect measures, model assumptions such as hierarchical structures and covariate adjustment, and differential handling of missing data. R code snippets are provided in the tutorial. A detailed accompanying script is also provided for full reproducibility.

PMID:39823505 | DOI:10.1371/journal.pone.0317617