Demographic Data Research Articles

Clinical Comparison of Endoscopic Posterior Lumbar Interbody Fusion and Open Posterior Lumbar Interbody Fusion for Treating Lumbar Spondylolisthesis.

A retrospective case-control study. To compare the clinical efficacy of endoscopic (Endo) and open posterior lumbar interbody fusion (PLIF) in treating lumbar spondylolisthesis. Endo-PLIF has emerged as a new technique for treating lumbar spondylolisthesis. We propose Endo-PLIF as an alternative method. Sixty-four patients with single-segment lumbar spondylolisthesis underwent Endo-PLIF (n = 39) or open PLIF (n = 25) treatment. Demographic data, perioperative parameters, and radiographic parameters were recorded. Clinical results were evaluated by Visual Analog Scale (VAS) and Oswestry Disability Index (ODI) scores. The fusion rate was evaluated by computed tomography at 12 months postoperatively. In addition, a case-control process was included to ensure unbiased comparisons. The average operation time was longer in the Endo-PLIF group. Endo-PLIF showed advantages in reducing blood loss, shortening hospital stay, and early ambulation, but with a longer x-ray exposure time. Both VAS and ODI scores significantly improved in both groups, but the VAS for back pain was lower in the Endo-PLIF group. The radiographic results were similar in both groups. Three patients in the Endo-PLIF group had minor complications. Two patients in the open PLIF group experienced cerebrospinal fluid leakage. Both VAS and ODI scores significantly improved in both groups compared with preoperative scores, but the Endo-PLIF group showed more significant improvement at early follow-up (P < 0.05). There was no significant difference in interbody fusion rate between the two groups. Both Endo-PLIF and open PLIF are effective for treating single-segment lumbar spondylolisthesis. Endo-PLIF shows advantages in reducing blood loss, shortening hospital stays, and promoting early ambulation, with comparable fusion rates and patient satisfaction to open PLIF. Despite minor complications in the Endo-PLIF group and cerebrospinal fluid leakage in the open PLIF group, both procedures lead to significant improvements in pain and disability scores, with Endo-PLIF demonstrating more significant early improvements.

Predictors of In-hospital and Short-term Outcomes of Thoracic Endovascular Aortic Repair for Aortic Aneurysm and Aortic Syndrome: A Single-Center Experience

BACKGROUND: Endovascular technique has replaced open repair as primary treatment for different aortic disease indications and was associated with low perioperative mortality and acceptable short-, mid-, and long-term survival. Locally, thoracic endovascular aortic repair (TEVAR) was not widely practiced until year 2017. This study aims to determine the predictors of in-hospital and short-term outcomes of patients who underwent TEVAR for aortic aneurysm and aortic syndrome in a single center and how it compares with local and international data. METHODS: This study is a retrospective analysis of 52 adult patients who underwent TEVAR for the treatment of aortic aneurysm and aortic syndrome. Demographic and clinical data, diagnostic imaging, and procedural details were obtained via inpatient charts at the medical records section and hospital system database archiving. Outcomes at 30 days and 1 year postprocedure were obtained through telephone follow-up after attaining verbal consent. Gathered data were analyzed as to association of different variables with or without the presence of complications. Outcomes reported included in-hospital mortality rate, presence of major adverse events (MAEs), 30-day and 1-year survival rates, and rate of freedom from reintervention. RESULTS: The overall in-hospital mortality was 7.69% (n = 4/52), and complication rate was 32% (n = 20/52), with a survival rate of 92.31% and 87.76% at 30 days and 1 year, respectively. The rates of overall freedom from reintervention were 83.33% and 100% at 30 days and 1 year, respectively. The independent predictors for in-hospital mortality and development of MAEs were increasing weight (odds ratio [OR], 1.0588; 95% confidence interval [CI], 1.003–1.208), preexisting chronic kidney disease (OR, 10.33; 95% CI, 1.1069–96.462), and TEVAR with debranching done as a single procedure (OR, 3.6667; 95% CI, 1.1154–12.054), whereas an estimated glomerular filtration rate of 49.05 ± 19.25 (OR, 0.9402; 95% CI, 0.9019–0.9801) and TEVAR with debranching done as a staged procedure (OR, 0.1624; 95% CI, 0.0321–0.8225) statistically decrease the risk for development of in-hospital mortality and MAEs (P = 0.001 and P = 0.028, respectively). CONCLUSIONS: In this single-center study, indications for TEVAR were fusiform and saccular aneurysm, high-risk intramural hematoma and penetrating aortic ulcer, complicated acute type B dissection, chronic complicated type B dissection with high-risk feature, and aortic rupture. The outcome of this study shows comparable results with other international studies with an acceptable in-hospital mortality rate, complication rate, short-term survival rate, and rate freedom from reintervention at 30 days and 1 year. Increasing weight, preexisting chronic kidney disease, and TEVAR with debranching done as a single setting are independent predictors for developing in-hospital mortality and MAEs, whereas a normal estimated glomerular filtration rate and TEVAR with debranching done as a staged procedure decrease the risk; hence, careful planning and scheduling of procedure among elective and amenable cases could further reduce complication rates of future TEVAR procedures.

Learning curve and long-term outcomes of minimally invasive correction and fusion for adolescent idiopathic scoliosis.

Retrospective analysis. This study sought to report the long-term outcomes of patients that underwent minimally invasive surgery (MIS) correction for Adolescent Idiopathic Scoliosis (AIS) in terms of radiographic, clinical, and patient-reported outcomes. Furthermore, we examined the learning curve of MIS technique over the course of 13years. Both MIS and open techniques are used to surgically address AIS. MIS techniques are purported to preserve the midline spinal musculature and to decrease estimated blood loss (EBL) and hospital length of stay (LOS). Data were collected at a single tertiary care center of all consecutive AIS patients undergoing deformity surgery from January 2008 to October 2021. Demographic, clinical, and radiographic data were collected at various intervals. Descriptive and inferential analyses were conducted. 70 AIS patients were included in the study. Mean patient age was 16.2years of which 95.7% were female, with a mean BMI of 21.7. The majority of the patients were Lenke type 1A (60%) followed by Lenke 1B (18.6%) with mean preop Cobb angle as 52.2°. The mean follow-up was approximately 6years with 35.7% of our cohort meeting the long-term follow-up landmark (> 5years, 2-11). The mean number of spinal levels treated was 9.3 with mean ASA score of 1.7. Overall, mean EBL was 151cc with mean OR of 308min. The mean LOS was 3.94days with postop Day 1 as the initiation of ambulation. Overall, the percent correction at the last visit was significantly greater than preop (Cobb: 77.6%, p < 0.05). Mean loss of correction on follow-ups was less than 5º. The overall revision rate was 2.9%. At 2years postop, 98.6% (69/70) of the patients achieved fusion with 100% (24/24) at 5years, and 96% (24/25) beyond the 5-year mark. Surgeon's technical proficiency in performing MIS for the treatment of AIS corrections was achieved after 23 cases. Based on our cohort's 2-11year follow-up data, we conclude that MIS provides an effective treatment option for AIS reconstruction. Our study indicates that MIS can achieve adequate deformity correction and positive long-term clinical outcomes as indicated by Cobb angle, VAS, ODI, and SRS-22r scores during follow-ups. If the individual goals of AIS surgery can be achieved, consideration should be given to less-invasive techniques. IV.

Risk assessment for rupture of brain arteriovenous malformations using high-resolution black-blood magnetic resonance imaging: a single-center case series.

Chronic inflammation's role in the pathogenesis, development, and rupture of vascular malformations is undebated. Advanced magnetic resonance imaging techniques with vessel wall studies, specifically Black Blood (bbMRI), may offer insights into vascular wall instability and predict rupture. This case series aims to assess bbMRI as a predictive diagnostic tool for brain arteriovenous malformations (bAVMs) rupture, suggesting early treatment. A prospective study included demographic, clinical, and neuroimaging data from a consecutive series of patients with ruptured or unruptured bAVMs, regardless of age or gender, between October 2018 and March 2024. All patients underwent MRI brain resonance with Black Blood study. Those with impaired renal function were excluded. Statistical analyses tested sample homogeneity. Univariate and multivariate logistical regressions assessed bbMRI as a rupture predictor for bAVMs, with a p-value set at < 0.05. Ninety patients were retrieved: 64 with unruptured and 26 with ruptured bAVMs. The mean age was 31.9 years, and 55 were female. Admission symptoms were headache, neurological deficits, and seizure in 49, 21, and 19 cases, respectively. bbMRI showed wall enhancement in 56 cases, with 19 in the ruptured and 37 unruptured groups. Univariate and multivariate analyses revealed a significant correlation between bbMRI wall enhancement and bAVM rupture (p:0.033; p:0.047). bbMRI may be a useful and feasible diagnostic implement to determine vessel inflammation and the bAVMs prone to rupture. Additional studies are needed to confirm the positive bbMRI as a predictive factor for bAVMs rupture.

SURG-06. IMPACT OF LASER INTERSTITIAL THERMAL THERAPY VERSUS RESECTION FOR METASTASES ASSOCIATED WITH THE MOTOR CORTEX

Abstract BACKGROUND For brain metastases (BM), resection remains a mainstay for the upfront management of large, symptomatic lesions, while laser interstitial thermal therapy (LITT) has become a key treatment for radiographically progressive BM following stereotactic radiosurgery (SRS). Compared to LITT, resection-associated morbidity may delay systemic therapies. We evaluated functional outcomes for resection versus LITT to primary motor cortex (PMC)-associated metastases. METHODS Patients receiving resection or LITT for BM radiographically associated with the PMC from 2015-2023 were retrospectively reviewed. Demographic and survival data were collected, with patient Karnofsky Performance Status (KPS) or modified Rankin Scale (mRS) scores assessed out to 1-year by independent raters. RESULTS Forty-one patients underwent resection and 30 underwent LITT to a PMC-associated lesion. Median age was 67 (range 38 – 80) vs 65 (44 – 80) for resection vs LITT; median pre-operative KPS (70 vs 80, P = 0.1) or mRS (2 vs 2, P = 0.66) did not differ between groups. Lung was the most common primary (56.1% resections vs 56.7% LITTs). Resected lesions were of larger median diameter than LITT, 2.8 vs 1.9 cm, P = 0.0001. For resections, length of stay was longer, median 2 vs 1 day, P = 0.0002, and ICU use more frequent (75.6% versus 20.0%, P &amp;lt; 0.0001). At 1-month post-op, 66.7% of resection patients and 51.7% of LITT patients had stable or improved symptoms from pre-op, P = 0.21, with parity at 3-months (65.7% vs 62.9%) and therafter. Further, there was no significant decrement in KPS or mRS score out to a year for either intervention. CONCLUSIONS While there is a short-term increased risk of post-operative neurologic worsening due to LITT-associated edema, our data shows that, relative to resection, this is a transient and clinically limited phenomenon. With careful patient selection, LITT to lesions involving the PMC is feasible.

Outcomes of Mucous Cystectomy and Osteophytectomy Using a Random Nonadvancement Flap Technique.

The purpose of this study was to determine the clinical outcomes of mucous cystectomy and osteophytectomy using a random nonadvancement flap technique. This was a therapeutic outcomes study of patients who underwent mucous cystectomy under local anesthesia by 1 of 2 hand fellowship-trained surgeons between 2012 and 2022. The key features of the surgical technique include designing a random nonadvancement flap with the cyst at its base; transecting the cyst pedicle as the flap is elevated; resecting the cyst wall from the undersurface of the reflected flap; decompressing the distal joint by removing marginal osteophytes; and insetting the flap without advancement. Patient demographic and disease-specific data were extracted from medical records and compiled in an electronic database. At minimum 1-year follow-up, patients were queried by telephone regarding wound complications, cyst recurrence, and satisfaction with outcome. The study cohort included 64 cysts in 61 patients, mean age 63 ± 10 years. The index or middle finger was affected in 63% of cases. At early postoperative follow-up, digital pain improved or resolved in 97% of cases. There were no complications of wound dehiscence or infection. At median 5-year follow-up in 34 cases, all patients except 1 were satisfied with the surgical outcome. There were 2 cyst recurrences in the study cohort (3%) and only 1 secondary procedure. Our study demonstrated that mucous cystectomy and distal joint osteophytectomy using a random nonadvancement flap is an effective surgical technique with low procedure complication and cyst recurrence rates and high patient satisfaction.

NIMG-71. T2 RELAXIVITY AND DIFFUSION TENSOR METRICS IN THE PREDICTION OF PROGRESSION-FREE SURVIVAL IN NON-RECURRENT HIGH GRADE GLIOMA

Abstract High grade glioma (HGG) is the most common primary brain tumour; we aimed to evaluate T2 relaxivity and diffusion tensor imaging (DTI) metrics in the prediction of progression-free survival. Seventy-two non-recurrent HGG subjects (IDH: MUT=10, Unknown=20) followed at our institution after surgery and combined chemo-radiotherapy were included. All data used were prior to progression as per RANO criteria; only the first 2 years of follow up was included in the analyses. T2 relaxation rates (1/T2) were calculated voxel-wise assuming mono-exponential decay. Diffusion data were corrected from two opposite phase encode acquisitions and DTI metrics evaluated included FA, MD, p, q, and L1. Whole- and half-brain (ipsilateral/contralateral) masks were generated by brain extraction and registration; data extracted from these masks were analyzed using python 3.8 with the exception of numerous histogram features extracted using fsl tools. Radiomics features were also extracted using the pyradiomics package. The lofo-importance package was used for feature selection. A multi-level approach was used to reduce the initial 32,000 MRI features to a final number of 443; from these, the 50 highest-ranked features were used further. Within-subject feature engineering was then performed including 1–4 step forward and backward lag, lag difference, as well as area, maximum, mean and cumulative sum. Non-MRI features included available demographic, histological and treatment-related data. A LightGBM classification model was used for the prediction of progression within 90 days; the data were grouped by subject, such that each subject was present only in training or testing datasets. Hyperparameters were tuned using randomized search cross validation, and the final model using 5-fold cross validation reached a mean ROC-AUC of 0.89. Our results show the potential of quantitative MRI features derived from qualitatively unremarkable images within the progress-free interval to identify subjects at risk of imminent progression.

Hand Assisted Transperitoneal versus Retroperitoneal Laparoscopic Nephrectomy (A Comparative Study): Our Experience in Prince Hussein Urology Center

Aim: Hand assisted laparoscopic nephrectomy could be an excellent alternative option to the open approach for benign renal conditions. Besides that, renal malignant processes can be managed by the previous mentioned hand-assisted laparoscopic technique of nephrectomy. In this research the outcomes and the complications of transperitoneal and retroperitoneal approaches of hand assisted laparoscopic nephrectomy were estimated for the differences. Methods: Retrospectively (223) hand assisted laparoscopic nephrectomies (transperitoneal grid iron incision (group1, N= 112) vs. retroperitoneal Pfannenstiel incision (group2, N=111) which were done between September 2022 and June 2024 in Prince Hussein Urology Center were enrolled in this study. Demographic and categorical data of both groups were compared herein. Follow-up period is between 3 and 18 months. Results: Patients’ ages were between (35 and 62 years). There were no differences in patient demographic, and most of categorical data between the both groups. The mean duration of the transperitoneal procedure was significantly shorter than that of the retroperitoneal approach (197.3 and 238.5 minutes, respectively, P &lt; 0.05). While the lower incidence of incisional hernia, blood loss, solid organs impact, and bowel injury were in group2 (P &lt; 0.05). Conclusion: Hand-assisted laparoscopic retroperitoneal nephrectomy is superior to transperitoneal approach in regards to incisional hernia incidence, operative blood loss, and organs injury. Due to the steeper learning in the retroperitoneal approach, the operative period can be equal to or shorter than that of the transperitoneal technique after the surgeons used to and getting more experience in this approach.

Sacralization of lumbar vertebrae-prevalence and association with low back ache and radiculopathy

Background: Low back pain (LBP) is a prevalent condition, often associated with various anatomical anomalies, including lumbar sacralization, that is, the fusion of the fifth lumbar vertebra (L5) with the sacrum. This study aims to evaluate the prevalence of sacralization among LBP patients and its relationship with radiculopathy. Methods: A retrospective study was conducted at the department of orthopaedics, Justice KS Hegde charitable hospital, from January 1, 2023, to July 31, 2024. Patients aged 18-75 years presenting with LBP who underwent lumbosacral radiographs were included. Demographic and clinical data were collected, and sacralization types were classified using the Castellvi system. Statistical analyses were performed using the chi-square test. Results: Among 771 radiographs analysed, the prevalence of sacralization was 10.1%. Most subjects were over 41 years old (81.6%), with a majority being female (54.5%). Type I A was the most common form of sacralization (30.77%). A significant association between sacralization and radiculopathy was observed, with 70 of the 78 subjects with sacralization experiencing radiculopathy (p&lt;0.0005). Conclusions: This study indicates a noteworthy association between sacralization and radiculopathy in patients with LBP. Given the low prevalence of sacralization, the findings emphasize the importance of recognizing anatomical variations in clinical evaluations of patients with low back ache, particularly in older populations. Further research is warranted to explore the implications of these anatomical anomalies on treatment strategies and patient outcomes.

Clinical, biochemical and molecular characteristics of classic homocystinuria in Saudi Arabia and the impact of newborn screening on prevention of the complications: A tertiary center experience

AbstractBackgroundClassic homocystinuria (HCU) is a rare inborn metabolic disease that is generally asymptomatic at birth. If untreated, it can cause a wide range of complications including intellectual disability, lens dislocation, and thromboembolism. This study aimed to describe the natural history and the molecular findings of patients with HCU, and to assess the importance of early diagnosis.MethodsThis study retrospectively collected data on patients attending the metabolic unit at Prince Sultan Military Medical City, Riyadh, Saudi Arabia from 2011 to 2024. Demographic, clinical, and molecular data was extracted from the electronic medical records.ResultsAmong the 33 patients with HCU enrolled, 5/33 (15%) were diagnosed by newborn screening and the rest were diagnosed on clinical grounds. The complication profile was vast, with neuropsychiatric, musculoskeletal, ophthalmic, and thromboembolic morbidities complicating the disease course in 28/33 (85%) of the patients. None of the newborn screened patients had complications while all of the non‐newborn screened patients had at least one complication, p &lt; 0.0001. The majority of parents in this cohort were highly consanguineous, with 90% had first or second cousin marriage. Seven previously reported variants were detected in this cohort and one novel variant was found in three patients (c.828+2‐828+ 3 delins ACACTTGCATCC, p.?). The known pathogenic variant (c.969G&gt;A, p. (Trp323*)) was seen in most of the patients, with all of them coming from one tribe.ConclusionsThis cohort gives further evidence that the newborn screening for HCU is likely to prevent the complications associated with the disease at least in the first few years of life. Therefore, newborn screening for HCU should be encouraged. Our molecular studies revealed the presence of a founder variant, detected in patients from a single tribe. This suggests that specific mutation testing may be cost‐effective for individuals from certain ethnicities.

Prevalence of anxiety and depression and the influence of correlates in acute coronary syndrome patients: a cross-sectional analysis

Abstract Background Acute coronary syndrome (ACS) patients are vulnerable to anxiety and depression. This study aimed to assess the mental health burden among Egyptian ACS patients by assessing the prevalence and associates of these conditions. This study enrolled 212 patients who underwent coronary angiogram. Anxiety and depression were assessed using the Hospital Anxiety and Depression Scale (HADS). Demographic, psychosocial, and clinical data were collected. Univariate and multivariate logistic regression analyses identified factors associated with anxiety and depression. Results The mean age of the participants was 54.1 years, and 80.7% were males. More than half (58.1%) exhibited anxiety, depression, or both, with depression being more prevalent than anxiety (48.1% vs 38.2%). Past major depressive disorder was strongly correlated with both anxiety and depression. Higher anxiety scores increased the odds of depression (OR = 1.234, p &lt; 0.001), and vice versa (OR = 1.55, p &lt; 0.001). Hypertension and the use of antihypertensive medications were associated with increased depression. Significant associates of anxiety included increased heart rate, past use of furosemide and enoxaparin, and current polypharmacy. Conclusions A substantial proportion of ACS patients experience comorbid anxiety and depression. Polypharmacy, past depression, and hypertension are key risk factors. Targeted interventions addressing these factors are essential for improving mental health in this vulnerable population.

Neutrophil-albumin ratio serves as a superior prognostic biomarker for traumatic brain injury.

Traumatic brain injury (TBI) represents a common and severe medical condition necessitating prompt risk stratification to enhance patient outcomes. Although substantial research has been conducted on the prognostic utility of various biomarkers for TBI, no single biomarker has been definitively recognized as the most precise predictor of disease outcomes. In comparison to other markers, the neutrophil-albumin ratio (NAR) has emerged as a cost-effective and reproducible inflammatory biomarker, demonstrating potential in evaluating the severity of inflammation and prognosticating outcomes in infections and cerebrovascular diseases. This study evaluated the prognostic significance of the NAR in comparison to two other readily accessible and cost-effective composite indices: the Neutrophil-Lymphocyte Ratio (NLR) and the Platelet-Lymphocyte Ratio (PLR) in individuals with TBI. We conducted a retrospective cohort analysis involving 297 hospitalized TBI patients, gathering comprehensive demographic, anthropometric, medical, clinical, laboratory, and imaging data to assess the expression changes of these biomarkers. Our findings suggest that both the NAR and the NLR possess predictive value regarding prognosis following TBI. However, receiver operating characteristic (ROC) curve analysis revealed that NAR outperformed NLR as a prognostic predictor. In conclusion, our examination of blood biochemistry composite indicators indicates that, while both NAR and NLR serve as significant prognostic markers, NAR is a more effective predictor of outcomes in patients with TBI.

BIOM-68. OUTCOMES IN PATIENTS WITH HIGH-GRADE MENINGIOMA (HGM): A MULTI-INSTITUTIONAL STUDY

Abstract BACKGROUND High-grade meningiomas (HGMs) are associated with increased risk of recurrence after primary treatment. This study aimed to evaluate factors affecting survival. METHODS We performed a multi-institutional retrospective chart review study of patients with HGM (defined as grade 2 or 3 meningioma) whose tumor had undergone next-generation sequencing. Statistical testing was performed in Stata/MP version 16.1 (StataCorp, College Station, TX) on the patients’ demographic, anatomic, clinical, and survival data (using Kaplan-Meier survivor function and long-rank test). Data are presented as mean±SD, median [interquartile range], or percent. Age/time reported in years. RESULTS There were 46 patients (45.7% female) with an age of 57.9±14.0 at initial HGM diagnosis. The most frequent HGM sites were middle cranial fossa (37.0%), frontal (28.3%), parietal (15.2%), posterior fossa (13.0%), parasagittal (10.9%), and petrous (10.9%). The most common presenting symptoms were headache (37.0%), seizure (23.9%), weakness (21.7%), vision changes (19.6%), memory issues (10.9%), and diplopia (10.9%). The most frequent gene mutations were in NF2 (58.7%), CDKN2A (13.0%), and TERT (8.7%). Median follow-up was 2.85 [1.4-7], during which time 65.2% of patients experienced recurrence. mPFS was 2.7 [0.83-6]. Kaplan-Meier analysis showed a mPFS of 5 [1.2-9] and 2.3 [0.8-3] in females and males, respectively (p=0.26). Age and Ki67 proliferative index at diagnosis did not significantly predict PFS. mOS was not reached (NR) [7-NR]. NF2 mutation status and presence of extracranial invasion did not significantly separate the PFS Kaplan-Meier curves on log-rank testing. However, the presence of NF2 mutation [mOS NR (5.2-NR) vs. NR (7-NR), p&amp;lt;0.0001], extracranial invasion [mOS 10 (2.4-NR) vs. NR (NR-NR), p&amp;lt;0.0001], and HGM recurrence [mOS NR (2.7-NR) vs. NR (7-NR), p&amp;lt;0.0001], were associated with shorter mOS. CONCLUSIONS These HGM patients experienced a high recurrence rate during the follow-up period. The presence of NF2 mutation, extracranial invasion, and recurrent HGM were associated with shorter OS.

Boston Marathon athlete performance outcomes and intra-event medical encounter risk associated with low energy availability indicators

ObjectiveTo determine the association between survey-based self-reported problematic low energy availability indicators (LEA-I) and race performance and intra-event medical encounters during the Boston Marathon.Methods1030 runners who were registered for the...

RADT-16. ADJUVANT CHEMO-RADIATION THERAPY AS A RISK FACTOR FOR POSTOPERATIVE HYDROCEPHALUS FOLLOWING RESECTION OF HIGH-GRADE GLIOMA: A PROPENSITY-MATCHED CASE SERIES

Abstract The discovery of the neural glymphatic network in the past decade has significant implications for clinical investigations on hydrocephalus. With emerging understanding of how meningeal lymphatics and perivascular pathways impact cerebrospinal fluid dynamics, it is conceivable that inflammatory and fibrotic changes induced by radiation and chemotherapy may contribute to the pathogenesis of postoperative hydrocephalus, a well-documented sequela of resective neurosurgery. This study investigates differences in adjuvant chemo-radiation therapy patterns between patients who develop hydrocephalus following high-grade glioma resection and those who do not experience this postoperative complication. A retrospective chart review identified 328 adult patients who underwent tumor resection at our institution between 2010-2020, of which 257 had high-grade gliomas. Demographic and clinical data were collected, including resection history and adjuvant chemotherapy and radiation history. Propensity Score Matching generated comparative cohorts (n=27) using covariates sex, age at first surgery, surgery type, tumor location, extent of first resection, tumor-associated seizures, ventricular opening, number of additional resective surgeries, and pre-surgical Karnofsky Performance Scale score. Independent t-tests assessed differences in adjunctive chemo-radiation trends between patients who developed hydrocephalus within 3 years postoperatively and those who did not. 27 of 257 patients (10.5%) who underwent resection for high-grade glioma developed hydrocephalus within 3 years of their first surgery. Patients who developed hydrocephalus were more likely to have initiated the Stupp protocol(P=0.004), completed the Stupp protocol(P=0.02), and undertaken multiple cycles of the Stupp protocol(P=0.0004). Additionally, these patients had a smaller time window between surgery and adjuvant chemo-radiotherapy initiation than patients who did not develop hydrocephalus (P=0.02). Importantly, engagement in other clinical trial regimens with chemotherapy or radiation therapy did not differ significantly between groups(P=0.08, P=0.49, respectively). Shortened time to initiation of chemo-radiation therapy postoperatively and increased number of chemo-radiation cycles may increase a patient’s susceptibility to develop postoperative hydrocephalus following resection of high-grade glioma.

Indoor and ambient influences on PM2.5 exposure and well-being for a rail impacted community and implications for personal protections

Abstract Background&amp;#xD;Higher air pollution concentrations can be observed near rail networks, local and highway automobile corridors, and shipyards. Communities adjacent to such sources are disproportionately exposed to air pollution from these stationary and mobile sources. One such community is West San Bernardino in California, where households are feet away from the Burlington Northern Santa Fe intermodal facility and are impacted by activities that are estimated to continuously emit air pollutants due to 24/7 operation.&amp;#xD;Objective&amp;#xD;This study aimed to (1) quantify the impact of personal mobility and housing characteristics on daily PM2.5 exposures and well-being for West San Bernardino community members, and (2) develop individualized resilience plans for community collaborators to support future PM2.5 exposure reduction. &amp;#xD;Methods&amp;#xD;Personal PM2.5 exposures were measured for community collaborators for seven consecutive days during three deployment periods: October 2021, January 2022, and March 2022. Indoor and ambient PM2.5 levels were also continuously measured for five households over six months using PurpleAir Classic monitors. Demographic and well-being data were collected upon recruitment and after each week of engagement, respectively. &amp;#xD;Results&amp;#xD;Personal exposures in home microenvironments were highest near the railyard and lower farthest away from the railyard. Home exposures were 40% higher on average compared to non-home microenvironments. Household PM2.5 had a higher-than-expected average infiltration factor of 0.55, and indoor 98th percentiles across the households far exceeded a healthy level at an average of 165 μg/m3. Resilience plans featured summaries of personal data and recommendations for mitigating exposures. &amp;#xD;Significance&amp;#xD;Results suggest that surrounding land use and residential building characteristics compound to worsen air pollution exposures beyond what is expected for exposures in non-industrialized areas. Findings prompt a call for stronger regulation, not only for emissions, but also for indoor air quality and zoning standards that specifically protect disproportionately impacted communities.

A New Research Model for Artificial Intelligence-Based Well-Being Chatbot Engagement: Survey Study.

Artificial intelligence (AI)-based chatbots have emerged as potential tools to assist individuals in reducing anxiety and supporting well-being. This study aimed to identify the factors that impact individuals' intention to engage and their engagement behavior with AI-based well-being chatbots by using a novel research model to enhance service levels, thereby improving user experience and mental health intervention effectiveness. We conducted a web-based questionnaire survey of adult users of well-being chatbots in China via social media. Our survey collected demographic data, as well as a range of measures to assess relevant theoretical factors. Finally, 256 valid responses were obtained. The newly applied model was validated through the partial least squares structural equation modeling approach. The model explained 62.8% (R2) of the variance in intention to engage and 74% (R2) of the variance in engagement behavior. Affect (β=.201; P=.002), social factors (β=.184; P=.007), and compatibility (β=.149; P=.03) were statistically significant for the intention to engage. Habit (β=.154; P=.01), trust (β=.253; P<.001), and intention to engage (β=.464; P<.001) were statistically significant for engagement behavior. The new extended model provides a theoretical basis for studying users' AI-based chatbot engagement behavior. This study highlights practical points for developers of AI-based well-being chatbots. It also highlights the importance of AI-based well-being chatbots to create an emotional connection with the users.

Multimodal neuroimaging-based prediction of Parkinson's disease with mild cognitive impairment using machine learning technique.

This study aimed to identify potential markers that can predict Parkinson's disease with mild cognitive impairment (PDMCI). We retrospectively collected general demographic data, clinically relevant scales, plasma samples, and neuroimaging data (T1-weighted magnetic resonance imaging (MRI) data as well as resting-state functional MRI [Rs-fMRI] data) from 173 individuals. Subsequently, based on the aforementioned multimodal indices, a support vector machine was employed to investigate the machine learning (ML) classification of PD patients with normal cognition (PDNC) and PDMCI. The performance of 29 classifiers was assessed based on various combinations of indicators. Results demonstrated that the optimal classifier in the validation set was composed by clinical + Rs-fMRI+ neurofilament light chain, exhibiting a mean Accuracy of 0.762, a mean area under curve of 0.840, a mean sensitivity of 0.745, along with a mean specificity of 0.783. The ML algorithm based on multimodal data demonstrated enhanced discriminative ability between PDNC and PDMCI patients.

Prevalence of Autoantibodies in patients with Hereditary Alpha Tryptasemia.

Hereditary alpha-tryptasemia (HT) is associated with postural orthostatic tachycardic syndrome (POTS), hypermobile Ehlers Danlos Syndrome (hEDS), and mast cell activation syndrome (MCAS). While POTS, hEDS and MCAS have all demonstrated increased prevalence of autoimmunity, this has not been investigated in HT populations. Our objective was to describe the prevalence of autoantibodies in individuals with HT. We retrospectively studied a cohort of patients with positive genotyping for HT at a tertiary care allergy clinic. Demographic data including previous autoimmune history and autoantibody serologies were extracted on chart review. A literature search was conducted to determine the prevalence of specific autoimmune and autoantibody prevalences in the general population. We compared the proportions of autoantibody positivity and established autoimmune diseases in our cohort of HT individuals against those in general populations. We identified 101 patients with HT. Median age was 43 years (range 15-75) and most were female (87/101; 86.1%). Prevalence of self-reported drug hypersensitivity was 52/101 (52.5%) patients. The proportion of individuals with HT with positive tTG antibody (3/61, 4.9%) was significantly higher than that reported in the general population (133/16667, 0.8%) (p<0.001). The prevalence of SLE (1/101, 1%) and celiac disease (5/101, 5%) in our cohort were found to be significantly higher than the prevalence in the general population [194/96996, 0.2% (p=0.035) and 26/2845, 0.9% (p<0.001), respectively]. Patients with HT have increased prevalence of celiac disease, SLE and positive anti-tTG serology as well as self-reported drug hypersensitivity, relative to general populations.

Influence of Knowledge and Cultural Beliefs on Attitudes Toward HPV Vaccination Among Israeli Nurses and Nursing Students: Implications for Vaccine Advocacy

Background: Human papillomavirus (HPV) poses a significant health burden, yet the vaccine which successfully prevents HPV and its associated cancers remains underutilized. Nurses play a crucial role in patient education and advocacy for HPV vaccination. This study explores how knowledge, along with cultural, religious, and social beliefs, shapes the attitudes of Israeli nurses and nursing students toward the HPV vaccine and their advocacy efforts. Methods: A cross-sectional study was conducted from August 2023 to January 2024 using an anonymous online questionnaire distributed via Facebook groups targeting Israeli nurses and nursing students. The questionnaire assessed demographic data, HPV-related knowledge, and attitudes toward HPV vaccination. Results: The study included 458 participants (229 nurses and 229 nursing students). Significant knowledge gaps were found, with 52% of participants incorrectly believing that the vaccine can cure existing infections and 47% mistakenly believing that it is administered in a single dose. Logistic regression revealed that nurses working in community settings were more likely to have positive attitudes toward HPV vaccination (OR = 2.98, 95% CI: 1.84–4.85). Higher levels of HPV-related knowledge (OR = 3.35, 95% CI: 2.10–5.35) and secular or traditional religious affiliations (OR = 2.45, 95% CI: 1.52–3.97) were strongly associated with positive attitudes toward and advocacy for the vaccine. Conclusions: Targeted educational programs addressing knowledge gaps, especially those tailored to Israel’s cultural and religious diversity, are crucial for empowering nurses and nursing students as advocates for HPV vaccination. Enhancing their understanding of HPV can increase vaccine uptake, reduce the incidence of HPV-related diseases, and strengthen public health initiatives in Israel.