6-month Scores Research Articles

Impact of augmented reality fiber tractography on the extent of resection and functional outcome of primary motor area tumors.

This study aimed to evaluate the impact of augmented reality intraoperative fiber tractography (AR-iFT) on extent of resection (EOR), motor functional outcome, and survival of patients with primary motor area (M1) intra-axial malignant tumors. Data obtained from patients who underwent AR-iFT for M1 primary tumors were retrospectively analyzed and compared with those from a control group who underwent unaugmented reality intraoperative fiber tractography (unAR-iFT). A full asleep procedure with electrical stimulation mapping and fluorescein guidance was performed in both groups. The Neurological Assessment in Neuro-Oncology (NANO), Medical Research Council (MRC), and House-Brackmann grading systems were used for neurological, motor, and facial nerve assessment, respectively. Three-month postoperative NANO and MRC scores were used as outcome measures of the safety of the technique, whereas EOR and survival curves were related to its cytoreductive efficacy. In this study, p < 0.05 indicated statistical significance. This study included 34 and 31 patients in the AR-iFT and unAR-iFT groups, respectively. The intraoperative seizure rate, 3-month postoperative NANO score, and 1-week and 1-month MRC scores were significantly (p < 0.05) different and in favor of the AR-iFT group. However, no difference was observed in the rate of complications. Glioma had incidence rates of 58.9% and 51.7% in the study and control groups, respectively, with no statistical difference. Metastasis had a slightly higher incidence rate in the control group, without statistical significance, and the gross-total resection and near-total resection rates and progression-free survival (PFS) rate were higher in the study group. Overall survival was not affected by the technique. AR-iFT proved to be feasible, effective, and safe during surgery for M1 tumors and positively affected the EOR, intraoperative seizure rate, motor outcome, and PFS. Integration with electrical stimulation mapping is critical to achieve constant anatomo-functional intraoperative feedback. The accuracy of AR-iFT is intrinsically limited by diffusion tensor-based techniques, parallax error, and fiber tract crowding. Further studies are warranted to definitively validate the benefits of augmented reality navigation in this surgical scenario.

Efficacy of neuroendoscopic and small-bone-window craniotomy microsurgery for hypertensive cerebral hemorrhage: a meta-analysis of Chinese RCT studies.

To compare the clinical efficacy of neuroendoscopy and small-bone-window craniotomy microsurgery in the treatment of supratentorial hypertensive intracerebral hemorrhage. A search was conducted for Chinese randomized controlled trials on neuroendoscopy and small-bone-window craniotomy microsurgery treatment of hypertensive intracerebral hemorrhage published before February 1, 2024, in PubMed, Embase, Web of Science, Cochrane Library, China National Knowledge Infrastructure, Wanfang Data, and China Science and Technology Journal Database. Meta-analysis was performed using Review Manager 5.4 software. We included 9 randomized controlled trials, with 391 cases in the neuroendoscopy group and 403 cases in the craniotomy group. The meta-analysis results showed that compared to the small-bone-window craniotomy group, the neuroendoscopy group had a higher rate of hematoma clearance (95% CI [6.65, 18.52], p < 0.00001), less intraoperative bleeding (95% CI [-294.83, -284.75], p < 0.00001), shorter operation time (95% CI [-138.65, -63.04], p < 0.00001), fewer days in the ICU (95% CI [-8.56, -4.04], p < 0.00001), lower rate of postoperative complications (95% CI [0.15, 0.50], p < 0.0001), lower NIHSS score at 3 months postoperatively (95% CI [-6.82, -5.36], p < 0.00001), and higher ADL score (95% CI [16.5, 20.07], p < 0.00001). All comparison results were statistically significant. Compared with small-bone-window craniotomy microsurgery, neuroendoscopic surgery for episodic hypertensive cerebral hemorrhage resulted in a higher rate of hematoma clearance, less intraoperative bleeding, shorter operative time, fewer days in the ICU, a lower rate of postoperative complications and a lower 3-month postoperative NIHSS score, and a higher ADL score.

Association of intra-articular injection and knee arthroscopy prior to primary knee replacement with the timing and outcomes of surgery: Retrospective cohort study using data from the Clinical Practice Research Datalink GOLD database.

Patients with symptomatic knee osteoarthritis may undergo non-surgical interventions such as intra-articular steroid injections and knee arthroscopy. This study aimed to investigate their association with the timing and outcomes of subsequent primary knee replacement. Observational retrospective analysis of linked Clinical Practice Research Datalink, Hospital Episode Statistics, Patient Reported Outcome Measures (CPRD GOLD-HES-PROMS) data of 38,494 patients undergoing primary knee replacements in England. Prior use of intra-articular steroid injections and knee arthroscopy were identified. Hazard ratios (HRs) with 95% CIs were estimated for primary outcomes of revision and reoperation using Cox regression. Secondary outcomes included time from first diagnosis of ipsilateral knee osteoarthritis to knee replacement, 6-month post-operative Oxford Knee Scores (OKS), mortality (90-days and 3-months), and post-operative surgical site infection (SSI) (3-months) using linear and logistic regression. Prior steroid injections were associated with an increased risk of revision (HR = 1.25 95%CI (1.06 to 1.49)), re-operation (HR = 1.18 95%CI (1.05 to 1.32)), and SSI (HR = 3.10 95%CI (1.14 to 8.46). Timing from diagnosis of knee osteoarthritis to knee replacement was 6 months longer in patients receiving steroid injections. Knee arthroscopy was associated with an increased risk of revision (HR = 3.14 95%CI (2.64 to 3.73)), re-operation (HR = 3.25 95%CI (2.89 to 3.66)), lower post-operative OKS -1.63 95%CI (-2.31 to -0.95). Both interventions were associated with a lower risk of mortality. Steroid injection and knee arthroscopy prior to primary knee replacement are each associated with worse outcomes. The observed association of lower mortality risk is suggestive of confounding by indication. The observed associations in this study could be used to inform shared decision making with patients on the treatment pathway for knee osteoarthritis.

Importance of qSOFA Score in Terms of Prognosis and Mortality in Critical Care Patients.

Recent studies have analyzed the qSOFA (quick sequential organ failure assessment) score as a prognostic indicator in many diseases, particularly sepsis. However, the effect of qSOFA score on prognosis and mortality in critical care patients has not been sufficiently analyzed. There is not enough data, especially regarding its use as critical care mortality and prognosis scoring. In this study, we aimed to analyze the effect of qSOFA score on mortality and prognosis in critical care unit (CCU) patients. This study was conducted retrospectively using the chart review method. The APACHE II (Acute Physiology and Chronic Health Evaluation II) and SOFA (Sequential Organ Failure Assessment) scores of patients admitted to our CCU were compared with the qSOFA score. In addition, the need for intubation and mechanical ventilation, short- and long term mortality rates, the relationship between blood gas lactate values and qSOFA score were analyzed. A total of 1816 patients were included in the study. During critical care follow-up, 374 (20.6%) of our patients died, and at the end of 6 months, 796 (43.8%) of our patients died. A statistically significant association was found between in-hospital mortality and qSOFA, SOFA scores and lactate levels (P = 0.001, P = 0.001, P = 0.01 respectively). A statistically significant association was found between 6-month mortality and SOFA score only. (P = 0.001) The SOFA score appeared to be the most successful predictor of mortality. The cut-off for mortality using the ROC curve was ≥ 7 [sensitivity 78.1%; specificity 85.9%; AUC 0.91; 95% confidence interval (CI), 0.89 to 0.92; P = 0.001]. qSOFA scoring also performed well. The cut-off value for mortality using the ROC curve was ≥ 2 (sensitivity 42.5%; specificity 93.9%; AUC 0.83;95% CI, 0.80-0.85; P = 0.001). We believe that the qSOFA score can be used as a marker for in-hospital mortality and prognosis in critical care patients. Especially in cases where the qSOFA score is ≥ 2, it provides valuable information regarding mortality and prognosis.

Contralateral eye comparison of the efficacy and safety of two artificial tear formulations for corneal subbasal nerve fiber regeneration after photorefractive keratectomy

Background: Currently, artificial tears (ATs) are the first-line agents for managing dry eye disease (DED). This study compared the efficacy and safety of two different AT formulations, Systane® Hydration (SH) and Systane® Ultra (SU), on symptoms of DED and regeneration of the subbasal corneal nerve fiber length (CNFL) in photorefractive keratectomy (PRK)-treated eyes.&#x0D; Methods: This prospective contralateral comparative study recruited myopic eyes scheduled for PRK, and either SH or SU were administered for up to 3 months postoperatively. All participants underwent a standard comprehensive preoperative ophthalmological examination, in vivo confocal microscopy to evaluate the subbasal CNFL, and completed Ocular Surface Disease Index (OSDI) questionnaire for assessing dry eye symptoms. Image analysis software was used to calculate the subbasal CNFL (micrometer/mm2). Assessments were repeated at the 1- and 3-month follow-up visits. Pre- and postoperative subbasal CNFL and OSDI scores were compared to determine inter- and intra-group differences.&#x0D; Results: Fifty eyes of 25 participants were included in this study. The mean (standard deviation) age of the participants was 22.7 (3.8) years. The OSDI scores for both groups increased significantly at 1 month (both P&lt;0.05), followed by a decrease at 3 months to values comparable to the preoperative scores (both P&gt;0.05). Although OSDI scores were comparable at baseline and at the 1-month postoperative visit (both P&gt;0.05), the SU-treated eyes had a significantly better OSDI score at the 3-month visit (P&lt;0.05), despite being clinically insignificant. Preoperative subbasal CNFL differed significantly between the groups (P=0.001), yet the mean values at both postoperative visits were comparable (both P&gt;0.05). In both groups, subbasal CNFL was significantly reduced at 1 month, followed by a significant increase at the 3-month postoperative visit compared to baseline (all P&lt;0.05). No treatment-related complications were observed at the end of the study period.&#x0D; Conclusions: No significant difference was found between the preoperative and 3-month postoperative OSDI scores in the SH- or SU-treated eyes. Subbasal CNFL regeneration indicated a positive effect of both ATs, with a longer mean CNFL noted in the SH-treated eyes at the final visit. This suggests that SH may be a better option for improving corneal reinnervation after PRK. These observations must be verified in further trials with longer follow-up periods and larger sample sizes.

Long-term behavioral and neurochemical paradoxical alterations elicited following intranasal application of a chlorpyrifos formulation in mice

The intranasal (IN) administration route represents a pathway for xenobiotics to reach the brain. The present study aimed to address the long-term consequences of IN administration of a chlorpyrifos (CPF) commercial formulation (fCPF) in mice. For this purpose, adult male CF-1 mice were intranasally administered with fCPF (10 mg/kg/day) three days a week, for 2 and 4 weeks, respectively. Behavioral and biochemical analyses were conducted 3–7, and 7.5 months after the last IN fCPF administration, respectively. Following a 6-month fCPF-free washout period, fur appearance and body injuries scores improved in the fCPF-treated groups. Notably, spatial learning and memory enhancement was observed 4 and 7 months after the last IN fCPF administration. Changes in oxidative stress markers and the activities of enzymes involved in cholinergic and glutamatergic pathways were observed in different brain areas from fCPF-treated mice, still after 7.5 months from fCPF application. Altogether, these neurochemical disturbances could be responsible for the described behavioral observations.

Predicting traumatic brain injury outcomes using a posterior dominant rhythm.

Predicting severe traumatic brain injury (sTBI) outcomes is challenging, and existing models have limited applicability to individual patients. This study aimed to identify metrics that could predict recovery following sTBI. The researchers strived to demonstrate that a posterior dominant rhythm on electroencephalography is strongly associated with positive outcomes and to develop a novel machine learning-based model that accurately forecasts the return of consciousness. In this retrospective study, the authors assessed all intubated adults admitted with sTBI (Glasgow Coma Scale [GCS] score ≤ 8) from 2010 to 2021, who underwent EEG recording < 30 days from sTBI (n = 195). Seventy-three clinical, radiographic, and EEG variables were collected. Based on the presence of a PDR within 30 days of injury, two cohorts were created-those with a PDR (PDR[+] cohort, n = 51) and those without (PDR[-] cohort, n = 144)-to assess differences in presentation and four outcomes: in-hospital survival, recovery of command following, Glasgow Outcome Scale-Extended (GOS-E) score at discharge, and GOS-E score at 6 months post discharge. AutoScore, a machine learning-based clinical score generator that selects and assigns weights to important predictive variables, was used to create a prognostic model that predicts in-hospital survival and recovery of command following. Lastly, the MRC-CRASH and IMPACT traumatic brain injury predictive models were used to compare expected patient outcomes with true outcomes. At presentation, the PDR(-) cohort had a lower mean GCS motor subscore (1.97 vs 2.45, p = 0.048). Despite no difference in predicted outcomes (via MRC-CRASH and IMPACT), the PDR(+) cohort had superior rates of in-hospital survival (84.3% vs 63.9%, p = 0.007), recovery of command following (76.5% vs 53.5%, p = 0.004), and mean discharge GOS-E score (3.00 vs 2.39, p = 0.006). There was no difference in the 6-month GOS-E score. AutoScore was then used to identify the 7 following variables that were highly predictive of in-hospital survival and recovery of command: age, body mass index, systolic blood pressure, pupil reactivity, blood glucose, and hemoglobin (all at presentation), and a PDR on EEG. This model had excellent discrimination for predicting in-hospital survival (area under the curve [AUC] 0.815) and recovery of command following (AUC 0.700). A PDR on EEG in sTBI patients predicts favorable outcomes. The authors' prognostic model has strong accuracy in predicting these outcomes, and performed better than previously reported models. The authors' model can be valuable in clinical decision-making as well as counseling families following these types of injuries.

Novel online comprehensive pelvic floor therapy program following prostatectomy.

Although pelvic floor muscle training (PFMT) is widely shown to improve post-prostatectomy incontinence (PPI), numerous barriers impede access to formal PFMT and include the limited availability of specialized therapists and financial or scheduling barriers. To address these barriers, we developed a novel online program delivering comprehensive long-term PFMT, pelvic floor education (PFE), and dietary/behavioral modification education. This study is a prospective interim analysis of online PFMT/PFE (oPFMT/PFE), with focus on feasibility, satisfaction, and continence outcomes. Patients anticipating robotic-assisted laparoscopic prostatectomy (RALP) were recruited (6/2021-9/2022) for oPFMT/PFE. oPFMT/PFE comprises a 12-month program of 3 phases, including multiple exercises with varied contraction types and duration, and comprehensive dietary and behavioral technique education. Incontinence and quality of life (QOL) outcomes are assessed at 3 weeks, 3, 6, and 12 months following RALP using validated International Consultation on Incontinence Questionnaire Male Lower Urinary Tract Symptoms (ICIQ-MLUTS) and Incontinence Impact Questionnaire (IIQ-7) questionnaires and additional items assessing satisfaction, improvement, and daily pad use. Primary study outcomes included ICIQ-MLUTS stress urinary incontinence (SUI) domain score (SDS) and SUI cure [ICIQ SUI domain score (SDS) =0]. Interim 6-month analysis was performed using mixed effects linear regression and mixed effects Poisson regression. Analysis included 21 men (64±6 years). At 6-month follow-up, men undergoing oPFMT/PFE showed significant improvement in SDS compared to the 3-week time point [mean ± standard error (SE) =1.05±0.24 vs. 0.45±0.17, P=0.011], but still experienced higher scores than at baseline (P=0.017). Six-month patient-reported improvement averaged 7.42±0.74 (10-point Likert scale). All (100%) of 19 respondents (2 missing data) found the program easy to use, educational, and would recommend it to others, with 89% expressing satisfaction with the program. During patient interview at 6-month follow-up, no men reported inability to access the program online or any adverse events. Finally, IIQ-7 score improved significantly from the 3-week timepoint (4.47±1.10) at both time points (3-month 1.14±0.44, P<0.001 and 6-month 1.10±0.37, P<0.001), and neither 3- nor 6-month scores differed from baseline (P=0.808 and P=0.444, respectively). Our novel oPFMT/PFE yields significant improvements to validated urinary incontinence (UI) and QOL measures, providing a valuable and accessible treatment option for PPI.

Intracranial Pressure-Derived Cerebrovascular Reactivity Indices and Their Critical Thresholds: A Canadian High Resolution-Traumatic Brain Injury Validation Study.

Current neurointensive care guidelines recommend intracranial pressure (ICP) and cerebral perfusion pressure (CPP) centered management for moderate-severe traumatic brain injury (TBI) because of their demonstrated associations with patient outcome. Cerebrovascular reactivity metrics, such as the pressure reactivity index (PRx), pulse amplitude index (PAx), and RAC index, have also demonstrated significant prognostic capabilities with regard to outcome. However, critical thresholds for cerebrovascular reactivity indices have only been identified in two studies conducted at the same center. In this study, we aim to determine the critical thresholds of these metrics by leveraging a unique multi-center database. The study included a total of 354 patients from the CAnadian High-Resolution TBI (CAHR-TBI) Research Collaborative. Based on 6-month Glasgow Outcome Scores, patients were dichotomized into alive versus dead and favorable versus unfavorable. Chi-square values were then computed for incrementally increasing values of each physiological parameter of interest against outcome. The values that generated the greatest chi-squares for each parameter were considered to be the thresholds with the greatest outcome discriminatory capacity. To confirm that the identified thresholds provide prognostic utility, univariate and multivariable logistical regression analyses were performed adjusting for the International Mission for Prognosis and Analysis of Clinical Trials (IMPACT) variables. Through the chi-square analysis, a lower limit CPP threshold of 60 mm Hg and ICP thresholds of 18 mm Hg and 22 mm Hg were identified for both survival and favorable outcome predictions. For the cerebrovascular reactivity metrics, different thresholds were identified for the two outcome dichotomizations. For survival prediction, thresholds of 0.35, 0.25, and 0 were identified for PRx, PAx, and RAC, respectively. For favorable outcome prediction, thresholds of 0.325, 0.20, and 0.05 were found. Univariate logistical regression analysis demonstrated that the time spent above/below thresholds were associated with outcome. Further, multivariable logistical regression analysis found that percent time above/below the identified thresholds added additional variance to the IMPACT core model for predicting both survival and favorable outcome. In this study, we were able to validate the results of the previous two works as well as to reaffirm the ICP and CPP guidelines from the Brain Trauma Foundation (BTF) and the Seattle International Severe Traumatic Brain Injury Consensus Conference (SIBICC).

Association of Early Dexmedetomidine Utilization With Clinical and Functional Outcomes Following Moderate-Severe Traumatic Brain Injury: A Transforming Clinical Research and Knowledge in Traumatic Brain Injury Study.

To examine early sedation patterns, as well as the association of dexmedetomidine exposure, with clinical and functional outcomes among mechanically ventilated patients with moderate-severe traumatic brain injury (msTBI). Retrospective cohort study with prospectively collected data. Eighteen Level-1 Trauma Centers, United States. Adult (age > 17) patients with msTBI (as defined by Glasgow Coma Scale < 13) who required mechanical ventilation from the Transforming Clinical Research and Knowledge in TBI (TRACK-TBI) study. None. Using propensity-weighted models, we examined the association of early dexmedetomidine exposure (within the first 5 d of ICU admission) with the primary outcome of 6-month Glasgow Outcomes Scale Extended (GOS-E) and the following secondary outcomes: length of hospital stay, hospital mortality, 6-month Disability Rating Scale (DRS), and 6-month mortality. The study population included 352 subjects who required mechanical ventilation within 24 hours of admission. The initial sedative medication was propofol for 240 patients (68%), midazolam for 59 patients (17%), ketamine for 6 patients (2%), dexmedetomidine for 3 patients (1%), and 43 patients (12%) never received continuous sedation. Early dexmedetomidine was administered in 77 of the patients (22%), usually as a second-line agent. Compared with unexposed patients, early dexmedetomidine exposure was not associated with better 6-month GOS-E (weighted odds ratio [OR] = 1.48; 95% CI, 0.98-2.25). Early dexmedetomidine exposure was associated with lower DRS (weighted OR = -3.04; 95% CI, -5.88 to -0.21). In patients requiring ICP monitoring within the first 24 hours of admission, early dexmedetomidine exposure was associated with higher 6-month GOS-E score (OR 2.17; 95% CI, 1.24-3.80), lower DRS score (adjusted mean difference, -5.81; 95% CI, -9.38 to 2.25), and reduced length of hospital stay (hazard ratio = 1.50; 95% CI, 1.02-2.20). Variation exists in early sedation choice among mechanically ventilated patients with msTBI. Early dexmedetomidine exposure was not associated with improved 6-month functional outcomes in the entire population, although may have clinical benefit in patients with indications for ICP monitoring.

RADT-01. BASELINE HIPPOCAMPAL VOLUME AS A PREDICTOR OF NEUROCOGNITIVE CHANGES AFTER WBRT OR HA-WBRT: SECONDARY ANALYSIS OF NRG ONCOLOGY CC001

Abstract PURPOSE Hippocampal volume (HV) is a predictor of neurocognitive function (NCF) in neurodegenerative disease. The role of patient-specific anatomic variables has not been well investigated in patients with brain metastases. This work aimed to evaluate HV at baseline and 6 months as a predictor of NCF and differential benefit from HA-WBRT for patients enrolled on CC001. MATERIALS HV was calculated at baseline and 6 months. HV at baseline and 6 months were correlated with baseline and 2, 4, and 6-month NCF scores (HVLT-R Total and Delayed Recall, Delayed Recognition, TMT Parts A and B, and COWA) using Pearson correlation. Correlation was defined as weak if ρ ≤0.35. A cox proportional hazards model was used to determine the impact of baseline HV on time to NCF failure. RESULTS Of 518 patients randomized on CC001, 277 had baseline imaging, and 135 had 6-month imaging. However, only 87 patients were analyzable at both baseline and 6-month periods. At baseline, HV was not significantly associated with NCF score for any measure (p-value range: 0.06-0.72). Additionally, there was no association between baseline HV and time to NCF failure (p = 0.16). Additionally, the impact of treatment arm allocation on HV was examined but found to be non-significant (p = 0.06). Lastly, baseline HV and NCF scores were noted to have weak correlation at 2, 4, 6, and 12 month timepoints (ρ: range, -0.17-0.15; P-value range, 0.04-0.98). At 6 months, the correlation between HV, baseline NCF change, and 6 month standardized NCF change were also noted to be weak (ρ: range, 0.05-0.16; P-value range, 0.06-0.76). CONCLUSIONS Radiotherapy is known to have deleterious effects on neurocognition. In neurodegenerative disease, HV and rate of HV change are known predictors for NCF. However, baseline HV is not an independent predictor of neurocognitive changes after WBRT or HA-WBRT for patients with brain metastases.

BIOM-03. LACK OF CORRELATION OF MR-DETERMINED WHITE MATTER INJURY(WMI)WITH NEUROCOGNITIVE FUNCTION (NCF)6 MONTHS FOLLOWING WBRT+/-HIPPOCAMPAL AVOIDANCE(HA)+MEMANTINE:SECONDARY ANALYSIS OF NRG ONCOLOGY NRGCC001

Abstract PURPOSE Previous analysis of NRG-CC001 suggested pre-treatment WMI volume was a significant imaging-biomarker predictor of post-treatment neurocognitive decline at 4-and 12-months following HA-WBRT+Memantine. This suggested patients with greater pre-treatment WMI were more susceptible to neurocognitive decline, specifically when undergoing HA-WBRT, but not standard-WBRT. The current analysis examined the relationship between changes in MR-determined WMI and NCF 6-months following WBRT+memantine+/-HA. METHODS NCF-testing was performed at baseline, 2, 4, 6, and 12 months post-WBRT, and included Hopkins Verbal Learning Test–Revised (HVLT-R), Trail Making Test (TMT) Parts A and B, and Controlled Oral Word Association (COWA). Pre-treatment WMI was measured by FLAIR-volume corrected for whole brain volume and corrected for the FLAIR volume associated with metastases (met vol) (FLAIR-volume/(whole brain volume–met-vol). Pearson correlation coefficients were used to assess the correlation between pre-treatment WMI and change from baseline to 6-months for each standardized NCF score. RESULTS Of the 518 randomized patients, 443 (217 patients WBRT+Memantine and 226 HA-WBRT+Memantine) had WMI data available at baseline, and of those, 162 patients (89 patients WBRT+Memantine and 73 HA-WBRT+Memantine) had both baseline and 6-month imaging available. For these patients, there was only a trend toward significance for change in corrected FLAIR-volume from baseline to 6-months (p = 0.174) but no significant change in met-vol (p = 0.438) or whole brain volume (p = 0.977). The change in standardized TMT Part A and B and the change in composite 6-month change scores were moderately correlated with change in corrected FLAIR volume adjusted for met-vol but only in the WBRT+Memantine arm (rho=-0.35, -0.34, -0.39 and p-value = 0.003, 0.006, 0.001). CONCLUSIONS Despite an increase in post-WBRT MR-WMI at 6-months, analysis did not show strong correlation between NCF and MR-WMI as determined by FLAIR-volume change between baseline and 6-months. Similar analyses are underway for the NRG-CC003 imaging data.

Device specific quality of life in subcutaneous versus transvenous implantable cardioverter defibrillator implantations: results from the ATLAS multi-centre randomized controlled trial

Abstract Background Newer innovative subcutaneous implantable cardioverter defibrillators (S-ICDs) offer an alternative to transverse ICDs (TV-ICDs), placing leads outside of the heart thereby potentially reducing lead-related complications. The ATLAS trial, a multi-centre randomized controlled trial, showed a significant reduction in perioperative complications in TV-ICD versus S-ICD patients. The following results report device-related quality-of-life (QoL) measured in the trial. QoL measures are recognized as key patient-reported outcome measures (PROMs). Purpose To compare TV-ICD and S-ICD post implantation device-related QoL in the ATLAS trial. Methods Sample included all randomized ATLAS trial patients. The Florida Patient Acceptance Survey (FPAS) was completed at 1- and 6-months post implantation. The FPAS includes a total score and 4 subscale scores; 1) return to function, 2) device-related distress, 3) positive appraisal, and 4) body image concerns. Scores are scaled from 0-100, with total scores below 63 suggesting poor device acceptance. The primary analysis was based on complete cases and used analysis of covariance (ANCOVA) with 6-month scores as the dependent variable, group as the independent variable, and 1-month FPAS scores as the covariate. Change in FPAS total score over time within each group was explored using paired t-tests. Results There were 252 TV-ICD and 251 S-ICD patients enrolled in the main ATLAS trial, and of these, in the present analysis, 404 patients (197 TV-ICD; 207 S-ICD) had complete FPAS data. Sample mean age (SD) was 49.31 (11.54) years, males (74.3%) and Caucasian (83.7%). There were no substantive differences in patient characteristics between groups. The primary analyses found no differences between TV-ICD and S-ICD groups for FPAS total score (Mean Difference=-0.75; 95% CI, -3.15, 1.66; p=0.510) or FPAS subscale scores. Mean FPAS total scores increased from 74.43 (15.35) to 78.25 (15.88) and 73.73 (16.09) to 77.05 (16.13) between 1-month and 6-months in the TV-ICD and S-ICD groups respectively. The increase from 1-month to 6-months was statistically significant in both groups (p&amp;lt; 0.001). These findings suggest that regardless of ICD type, there is device acceptance in both groups from implantation and over time. Conclusion Analysis of the FPAS measure, a device-specific QoL measure, found both TV-ICD and S-ICD patients reported good acceptance of their devices, with no significant differences between groups for up to 6 months post implantation. These findings provide an important piece to the TV-ICD versus S-ICD line of inquiry in ICD patient populations particularly for this newer S-ICD innovation and can be included in decision making between health professionals and patients.

OPERATIVE VERSUS NONOPERATIVE MANAGEMENT OF DISTAL RADIUS FRACTURES IN ADULTS: A SYSTEMATIC REVIEW AND META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS WITH AN ELDERLY SUBGROUP ANALYSIS

This systematic review and meta-analysis aimed to compare the outcome of operative and non-operative management in adults with distal radius fractures, with an additional elderly subgroup analysis. The main outcome was 12-month PRWE score. Secondary outcomes included DASH score, grip strength, complications and radiographic parameters.Randomised controlled trials of patients aged ≥18yrs with a dorsally displaced distal radius fractures were included. Studies compared operative intervention with non-operative management. Operative management included open reduction and internal fixation, Kirschner-wiring or external fixation. Non-operative management was cast/splint immobilisation with/without closed reduction. Version 2 of the Cochrane risk-of-bias tool was used.After screening 1258 studies, 16 trials with 1947 patients (mean age 66yrs, 76% female) were included in the meta-analysis. Eight studies reported PRWE score and there was no clinically significant difference at 12 weeks (MD 0.16, 95% confidence interval [CI] −0.75 to 1.07, p=0.73) or 12 months (mean difference [MD] 3.30, 95% CI −5.66 to −0.94, p=0.006). Four studies reported on scores in the elderly and there was no clinically significant difference at 12 weeks (MD 0.59, 95% CI −0.35 to 1.53, p=0.22) or 12 months (MD 2.60, 95% CI −5.51 to 0.30, p=0.08). There was a no clinically significant difference in DASH score at 12 weeks (MD 10.18, 95% CI −14.98 to −5.38, p&lt;0.0001) or 12 months (MD 3.49, 95% CI −5.69 to −1.29, p=0.002). Two studies featured only elderly patients, with no clinically important difference at 12 weeks (MD 7.07, 95% CI −11.77 to −2.37, p=0.003) or 12 months (MD 3.32, 95% CI −7.03 to 0.38, p=0.08).There was no clinically significant difference in patient-reported outcome according to PRWE or DASH at either timepoint in the adult group as a whole or in the elderly subgroup.

Comparison of cutout risk factors between single- and doublescrew proximal nails in intertrochanteric femur fractures - a multicentric study

&amp;lt;p&amp;gt;&amp;lt;strong&amp;gt;Aim&amp;lt;/strong&amp;gt; &amp;lt;br /&amp;gt;Significant risk factors for femoral nail cutout are well-documented, primarily in the context of single-screw proximal nails.&amp;lt;br /&amp;gt;However, it remains uncertain whether those same risk factors are applicable when considering different implant devices. The aim of this retrospective cohort study was to compare cutout risk factors between single- versus double-screw proximal femoral nails. &amp;lt;br /&amp;gt;&amp;lt;strong&amp;gt;Methods&amp;lt;/strong&amp;gt; &amp;lt;br /&amp;gt;Patients over the age of 75 with intertrochanteric femur fractures (AO Classification 31-A1 or 31-A2) were included in the multicentre study. A study group was treated with a double-screw nail, while a control group received single-screw device. Demographic data, surgical time (min), fracture pattern, distal locking, reduction quality, comorbidities, tip-apex distance (TAD) and 12-month functional scores was collected.&amp;lt;br /&amp;gt;&amp;lt;strong&amp;gt;Results&amp;lt;/strong&amp;gt; &amp;lt;br /&amp;gt;Two hundred patients were enrolled, 100 for each group.&amp;lt;br /&amp;gt;Nine patients experienced a cutout complication, five in the study&amp;lt;br /&amp;gt;and four in the control group. The main differences were in distal locking configurations (p&amp;amp;lt;0.05) and in TAD values (p&amp;amp;lt;0.05). The TAD value was higher in the study than in the control group (30.40&amp;amp;plusmn;0.89 versus 26.79&amp;amp;plusmn;1.79). No differences at 12-month follow up were reported according to functional scores.&amp;lt;br /&amp;gt;&amp;lt;strong&amp;gt;Conclusion&amp;lt;/strong&amp;gt; &amp;lt;br /&amp;gt;This study provides insights into the choice of nail systems for intertrochanteric femur fractures, highlighting the importance of distal locking configurations and TAD values. The double screw nail exhibits quite a tolerance by having a higher&amp;lt;br /&amp;gt;average TAD value. These findings may guide clinical decisionmaking in the treatment of this challenging fracture type.&amp;lt;/p&amp;gt;

Single femoral artery access is safe and feasible during transcatheter aortic valve replacement: a propensity score matched analysis.

Transcatheter aortic valve replacement (TAVR) potentially may be significantly simplified by using the single artery access (SA) technique, which does not require a secondary artery access. Nevertheless, the safety and efficacy of this technique remains unclear. Our goal was to determine if single artery access TAVR (without upgrading the sheath size) is a feasible, minimally invasive procedure. Patients with symptomatic severe aortic stenosis who underwent TAVR via the femoral artery were consecutively enrolled in this study. Eligible individuals were divided into 2 groups: the SA group and the dual artery access (DA) group. The primary end point was device success (defined by the valve academic research consortium 3, VARC 3). A 6-month follow-up and propensity score matching analyses were performed. After propensity score matching analysis, a total of 130 patients were included: 65 in the SA group and 65 in the DA group. The SA procedure achieved similar device success (95.4% vs. 87.7%; P = 0.115) compared with the DA procedure. The SA procedure shortened the operating time (102 min vs. 125 min; P = 0.001) but did not increase the x-ray time or dose. Both a 20 Fr and a 22 Fr sheath (without upgrading the sheath size) could be used for the SA procedure. There was no major vascular complication occurred in both groups. The incidence of minor main vascular and access complications in the SA group was comparable to those of the DA procedure (0.0% vs. 3.1%; P = 0.156). The SA access procedure is a promising minimally invasive TAVR technique with a low incidence of vascular complications and a high incidence of device success. It is safe and possibly applicable in all TAVR procedures.

Video-Based Assessment of Microsurgical Trainees: An Evaluation of Gender Bias.

Gender bias in graduate medical evaluations remains a challenging issue. This study evaluates implicit gender bias in video-based evaluations of microsurgical technique, which has not previously been described in the literature. Two videos were recorded of microsurgical anastomosis; the first was performed by a hand/microsurgery fellow and the second by an expert microsurgeon. A total of 150 surgeons with microsurgical experience were recruited to evaluate the videos; they were told these videos depicted a surgical trainee 1 month into fellowship followed by the same trainee 10 months later. The only variable was the name ("Rachel" or "David") that each participant was randomly assigned to evaluate. Participants were asked to score each video for quality, technique, efficiency, as well as overall progression and development after the second video compared with the initial video. To focus on bias, these outcome measures were selected to be purposefully subjective and all ratings were based on a subjective 1to 10 scale (10 = excellent). The analysis included 150 participants (75% male). There were no statistically significant differences in scores between the "female" and "male" trainee. The trainees received the same median initial (1-month video) and final (11th-month video) scores for all criteria except initial technique, in which the female trainee received a 7 and the male trainee received an 8. Notably, 11-month scores were consistently the same or lower than 1-month scores for both study groups (p < 0.001). There were also no differences within either study group based on participant sex. Microsurgery practitioners overall rated both groups lower than those who do not currently practice microsurgery. Our study did not identify a gender bias in this evaluation method. Further investigation into how we assess and grade trainees as well as the presence and impact of implicit biases on varying surgical assessment methods is warranted.

2 Early Presentation of Autistic Features in Infants with Agenesis of the Corpus Callosum

Objective:Agenesis of the Corpus Callosum (ACC), a congenital disorder in which the corpus callosum partially or completely fails to develop properly, occurs in ∼1 in 4,000 live births. ACC has been identified as a major risk factor for receiving an Autism Spectrum Disorder (ASD) diagnosis (∼10% diagnosis rate, as compared to 2.3% in the general population), but little is currently known about behavioral and social development during infancy and early childhood in this disorder. In this study we aim to 1) characterize the manifestation of autistic features in 24-month-old children (a common age for early diagnosis of ASD) with ACC and a convenience sample of age matched comparison children from the community, and 2) determine if parent reports of autistic features during the first year of life are associated with reciprocal social behavior and autistic traits at 24-months of age in children with ACC.Participants and Methods:Parents of infants who had received a diagnosis of ACC completed the Parent Rating of Communication, Emotion, and Social Skills (PROCESS) for their child at 6, 12, and 24-months of age, and the video-referenced rating of reciprocal social behavior (vrRSB) at 24-months of age. Comparison data were obtained from a convenience community sample in Minnesota. Aim 1). The distributions of PROCESS total scores at 24-months were compared between the ACC group (n=43) and control group (n=1058) via a 2-tailed t-test. Likewise, distributions of reciprocal social behavior (RSB) scores at 24 months were compared between ACC (n=72) and controls (n=1438) via a 2-tailed t-test. Aim 2). A partial Pearson Correlation was conducted between ACC participants’ 6-month PROCESS scores and 24-month RSB (n=18) scores, as well as between their 12-month PROCESS and 24-month vrRSB (n=37) scores, controlling for child sex.Results:Aim 1). At 24 months of age, children with ACC are reported to have significantly higher PROCESS scores (t = 3.73, df = 42.67, p &lt; .001), and RSB (t = 4.89, df = 88.38, p &lt; .001) scores than comparison toddlers, indicating an elevated presentation of behaviors associated with autistic features. Aim 2). No correlation was found between participants’ 6-month PROCESS and 24-month RSB scores (r(16) = .39, p = .12). A relatively strong correlation (r(35) = .60, p &lt; .001) was found between participants’ 12-month PROCESS and 24-month RSB scores.Conclusions:As early as two years of age, children with ACC display a heightened presentation of autistic features compared to typically developing controls. Additionally, reports of social behaviors related to ASD at 24-months are correlated with reports of autistic features at 12-months of age. This evidence indicates that children with ACC who are at a higher likelihood for being diagnosed with ASD may be identified as early as 12-months old. Formulating and leveraging an early identification methodology is imperative for this population with an already elevated risk for ASD, as providing early interventions leads to improved outcomes later in life.

Improved Cochlear Implant Performance Estimation Using Tonotopic-Based Electrocochleography

Cochlear implantation produces remarkable results in postlingual deafness, although auditory outcomes vary. Electrocochleography (ECochG) has emerged as a valuable tool for assessing the cochlear-neural substrate and evaluating patient prognosis. To assess whether ECochG-total response (ECochG-TR) recorded at the best-frequency electrode (BF-ECochG-TR) correlates more strongly with speech perception performance than ECochG-TR measured at the round window (RW-ECochG-TR). This single-center cross-sectional study recruited 142 patients from July 1, 2021, to April 30, 2022, with 1-year follow-up. Exclusions included perilymph suctioning, crimped sound delivery tubes, non-native English speakers, inner ear malformations, nonpatent external auditory canals, or cochlear implantation revision surgery. Cochlear implantation. Speech perception testing, including the consonant-nucleus-consonant (CNC) words test, AzBio sentences in quiet, and AzBio sentences in noise plus 10-dB signal to noise ratio (with low scores indicating poor performance and high scores indicating excellent performance on all tests), at 6 months postoperatively; and RW-ECochG-TR and BF-ECochG-TR (measured for 250, 500, 1000, and 2000 Hz). A total of 109 of the 142 eligible postlingual adults (mean [SD] age, 68.7 [15.8] years; 67 [61.5%] male) were included in the study. Both BF-ECochG-TR and RW-ECochG-TR were correlated with 6-month CNC scores (BF-ECochG-TR: r = 0.74; 95% CI, 0.62-0.82; RW-ECochG-TR: r = 0.67; 95% CI, 0.54-0.76). A multivariate model incorporating age, duration of hearing loss, and angular insertion depth did not outperform BF-ECochG-TR or RW-ECochG-TR alone. The BF-ECochG-TR correlation with CNC scores was significantly stronger than the RW-ECochG-TR correlation (r difference = -0.18; 95% CI, -0.31 to -0.01; z = -2.02). More moderate correlations existed between 6-month AzBio scores in noise, Montreal Cognitive Assessment (MoCA) scores (r = 0.46; 95% CI, 0.29-0.60), and BF-ECochG-TR (r = 0.42; 95% CI, 0.22-0.58). MoCA and the interaction between BF-ECochG-TR and MoCA accounted for a substantial proportion of variability in AzBio scores in noise at 6 months (R2 = 0.50; 95% CI, 0.36-0.61). In this case series, BF-ECochG-TR was identified as having a stronger correlation with cochlear implantation performance than RW-ECochG-TR, although both measures highlight the critical role of the cochlear-neural substrate on outcomes. Demographic, audiologic, and surgical factors demonstrated weak correlations with cochlear implantation performance, and performance in noise was found to require a robust cochlear-neural substrate (BF-ECochG-TR) as well as sufficient cognitive capacity (MoCA). Future cochlear implantation studies should consider these variables when assessing performance and related interventions.

Association of Changes in Hip and Knee Kinematics During a Single-Leg Squat With Changes in Patient-Reported Outcomes at 6 Months and 1 Year After Hip Arthroscopy

Background: Previous studies have demonstrated alterations in squat kinematics in patients with femoroacetabular impingement syndrome (FAIS). Little is known about the effects of arthroscopic hip surgery on biomechanics during a single-leg squat (SLS) in these patients. Purpose/Hypothesis: The purpose of this study was to determine if (1) lower extremity dynamic range of motion (ROM) during an SLS task improves after hip arthroscopy for FAIS and (2) correlations exist between changes in patient-reported outcomes (PROs) and changes in lower extremity dynamic ROM during an SLS after hip arthroscopy for FAIS. It was hypothesized that dynamic hip ROM would improve after hip arthroscopy and that hip dynamic ROM would be associated with changes in PRO scores at both 6 months and 1 year. Study Design: Descriptive laboratory study. Methods: Patients with FAIS performed 3 SLSs that were analyzed using a 20-camera motion capture system. Dynamic ROMs were calculated in 3 planes for the hip, knee, ankle, and pelvic segments. Squat depth was calculated as the change in vertical center of mass during the squat cycle. PROs including the Hip Outcome Score–Activities of Daily Living (HOS-ADL), Hip Outcome Score–Sports (HOS–Sports), International Hip Outcome Tool–12, and visual analog scale for pain scores were collected preoperatively and at the time of postoperative testing. Paired-samples t tests were used to compare kinematic variables pre- and postoperatively. Correlations were used to compare changes in PROs with changes in kinematics. All statistical analysis was performed using SPSS Version 26. Results: Fifteen patients were tested preoperatively and at a mean of 9 months postoperatively. All PRO measures improved postoperatively at 6 months and 1 year. Squat depth and sagittal plane hip and knee dynamic ROMs were significantly improved postoperatively. Positive correlations existed between changes in (1) hip ROM with the 6-month HOS-ADL score (r = 0.665) and (2) knee ROM with the 6 month (r = 0.590) and 1-year (r = 0.565) HOS–Sports scores. Conclusion: Dynamic sagittal plane hip and knee ROMs improve after hip arthroscopy for FAIS. These improvements demonstrate strong correlations with improvements in some but not all postoperative PROs. Clinical Relevance: The current study sought to better understand the role of dynamic movement in the diagnosis and treatment of FAIS. These findings indicate that dynamic ROM and squat depth can, similarly to PROs, serve as biomarkers for patient function both before and after hip arthroscopic surgery.