Publications by authors named "Joshua D Bernstock"
Article Synopsis
- Adoptive cell therapy (ACT) with retrovirally transduced T cells and TriVax vaccination shows promise in boosting antitumor immune responses by expanding specific T cell populations.
- Stat5, a transcription factor, is crucial for T cell proliferation and differentiation, and the study investigates engineered CD8 T cells with active STAT5 in combination with TriVax.
- Results demonstrate that CA-STAT5 enhances T cell expansion, functional capabilities, and reduces exhaustion, leading to a stronger antitumor effect in melanoma models by inhibiting the PD-1/PD-L1 pathway.
Significance: Accurate identification between pathologic (e.g., tumors) and healthy brain tissue is a critical need in neurosurgery.
View Article and Find Full Text PDFThe development of novel therapeutics in the field of spinal neurosurgery faces a litany of translational challenges. Achieving precise drug targeting within the confined spaces associated with the spinal cord, canal and vertebra requires the development of next generation delivery systems and devices. These must be capable of overcoming inherent barriers related to drug diffusion, whilst concurrently ensuring optimal drug distribution and retention.
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- CPA meningiomas are challenging to treat due to their location near vital nerves and blood vessels, leading to potential postoperative complications and unpredictable recovery outcomes.
- A study of 95 patients at Mass General Brigham found that common symptoms included hearing loss, ataxia, and headaches, with gross total resection achieved in 62.1% of cases, which was more likely with smaller tumors and when the internal auditory canal was drilled.
- Post-surgery, most patients experienced stable or improved hearing, but 25.3% showed tumor progression or recurrence, with lower odds of progression linked to complete resection grades and older age.
Background: Despite the proven effectiveness of endovascular therapy (EVT) in acute ischemic strokes (AIS) involving anterior circulation large vessel occlusions, isolated posterior cerebral artery (PCA) occlusions (iPCAo) remain underexplored in clinical trials. This study investigates the comparative effectiveness and safety of EVT against medical management (MM) in patients with iPCAo.
Methods: This multinational, multicenter propensity score-weighted study analyzed data from the Multicenter Analysis of primary Distal medium vessel occlusions: effect of Mechanical Thrombectomy (MAD-MT) registry, involving 37 centers across North America, Asia, and Europe.
Background And Purpose: Progression-free survival (PFS) remains to be validated as an outcome measure for diffuse WHO grade 2 gliomas, and knowledge about the relationships between PFS, post-progression survival (PPS), and overall survival (OS) in this subset of tumors is limited. We sought to assess correlations between PFS and OS, and identify factors associated with PFS, PPS, and OS in patients treated for diffuse supratentorial WHO grade 2 gliomas.
Material And Methods: We included 319 patients from three independent observational cohorts.
Article Synopsis
- The study focused on how visual acuity (VA) recovery affects quality of life in patients who underwent surgery for medial sphenoid wing meningioma (SWM).
- Out of 153 patients, 35% had preoperative vision issues, with a key finding that those with impairments lasting 4 months or less had better postoperative VA improvements.
- Results suggested that shorter preoperative visual impairment corresponds with better postoperative health and daily activity outcomes, which can assist in preoperative patient counseling and decision-making.
Article Synopsis
- Medium vessel occlusion (MeVO) strokes, especially in the M2 segment of the middle cerebral artery, are a significant challenge in stroke management, necessitating effective prediction of patient outcomes after mechanical thrombectomy (MT).
- This study analyzed data from the MAD-MT registry to evaluate the relationship between follow-up infarct volume (FIV) and 90-day functional outcomes, using the modified Rankin Scale (mRS) as a measurement.
- Results showed that FIV is a strong predictor of outcomes, with specific volume thresholds indicating favorable prognosis; notably, an FIV of ≤15 ml had the best predictive capability, outperforming traditional recanalization scores.
Article Synopsis
- The study investigates the effectiveness and safety of two treatment methods for acute ischemic stroke (AIS) caused by distal medium vessel occlusion (DMVO): intravenous thrombolysis (IVT) with mechanical thrombectomy (MT) versus IVT alone.
- Data was collected from 37 centers worldwide, involving over 1,000 patients, with the primary focus on functional independence at 90 days and secondary outcomes including mortality and intracerebral hemorrhage.
- Findings suggest that both treatment options yield similar functional and mortality outcomes for DMVO patients, but the MT-IVT approach carries a higher risk of hemorrhagic complications, indicating that it may not provide significant advantages over IVT alone for every patient.
Article Synopsis
- The text discusses the need for a method to constantly monitor the integrity of spinal hardware, as current methods fail to detect issues until symptoms appear, which could lead to serious complications.* -
- It introduces a new technology called BioMDA (bio-adhesive metal detector array), designed to provide real-time, non-invasive tracking of spinal implants without using radiation.* -
- The BioMDA features advanced electromagnetic coupling for precise positioning of implants, achieving accuracy levels under 0.5 mm, potentially revolutionizing postoperative monitoring of spinal instrumentation.*
Interim results from two phase 1 trials demonstrate progress in the use of chimeric antigen receptor (CAR) T cell therapy for recurrent glioblastoma (GBM).
View Article and Find Full Text PDFBackground: Acute ischemic stroke (AIS) from primary medium vessel occlusions (MeVO) is a prevalent condition associated with substantial morbidity and mortality. Despite the common use of mechanical thrombectomy (MT) in AIS, predictors of poor outcomes in MeVO remain poorly characterized.
Methods: In this prospectively collected, retrospectively reviewed, multicenter, multinational study, data from the MAD-MT (Multicenter Analysis of primary Distal medium vessel occlusions: effect of Mechanical Thrombectomy) registry were analyzed.
Article Synopsis
- A study was conducted to compare the safety and effectiveness of endovascular treatment (EVT) versus best medical management (BMM) for patients with acute ischaemic stroke caused by distal medium vessel occlusion (DMVO).
- The analysis involved 2,125 patients, showing no significant difference in achieving functional independence at 90 days between EVT and BMM, despite EVT being associated with higher rates of hemorrhagic complications.
- The results suggest that EVT does not provide better functional outcomes than BMM in DMVO cases while increasing the risk of bleeding, indicating the need for cautious use of EVT and further research to improve treatment approaches.
Under what circumstances, is it ethical to perform tumor surgery on a brain-dead individual? The neurosurgeons at Brigham and Women's Hospital were recently faced with such a question when asked to operate on a 28-year-old man who was pronounced brain-dead secondary to a severe brain-stem injury. His advanced directives clearly documented a desire for organ donation. During his transplant work-up, cranial imaging suggested a possible cerebellar mass of unknown etiology that was concerning for metastatic disease.
View Article and Find Full Text PDFBackground: Brain computed tomography (CT) is an accessible and commonly utilized technique for assessing brain structure. In cases of idiopathic normal pressure hydrocephalus (iNPH), the presence of ventriculomegaly is often neuroradiologically evaluated by visual rating and manually measuring each image. Previously, we have developed and tested a deep-learning-model that utilizes transfer learning from magnetic resonance imaging (MRI) for CT-based intracranial tissue segmentation.
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- Acute ischemic stroke (AIS) from distal medium vessel occlusions (DMVOs) is common, and while IV thrombolysis is standard, mechanical thrombectomy (MT) is becoming more prevalent for treatment.
- A study reviewed data from 1708 DMVO patients treated with MT, finding that 8.7% experienced symptomatic intracerebral hemorrhage (sICH) and identified several risk factors, including older age, distal occlusion location, prior antiplatelet use, lower ASPECT scores, higher pre-op blood glucose, more passes during MT, and successful recanalization status.
- Understanding these risk factors can help healthcare providers better assess and manage the risk of sICH in patients undergoing MT for DM
Article Synopsis
- Recent research indicates that removing dead tissue (necrotic tissue) during surgery for ischemic cerebellar stroke may improve recovery more than just removing pressure (decompressive surgery) alone, but optimal procedures and outcomes related to the amount of tissue removed haven't been well-studied.* -
- This study analyzed data from 91 patients who had surgery for ischemic cerebellar stroke, measuring the volume of infarcted tissue before and after operations, and evaluating functionality at 3 months post-surgery using a standardized ranking scale.* -
- Results showed that patients who had necrosectomy (removal of necrotic tissue) were significantly more likely to achieve favorable recovery outcomes, with a specific threshold of
Article Synopsis
- Glioblastoma is a highly aggressive brain tumor with a median survival of only 6-9 months after progression, due to factors like molecular pathways and tumor microenvironment.
- Current treatments like surgery, radiation, and chemotherapy can manage the primary tumor but not effectively prevent relapse, and the role of surgery for recurrent cases is debated.
- New innovative therapies for recurrent glioblastoma are being developed, including checkpoint inhibitors and CAR T-cell therapy, aimed at improving treatment outcomes.
The emerging field of cancer neuroscience reshapes our understanding of the intricate relationship between the nervous system and cancer biology; this new paradigm is likely to fundamentally change and advance neuro-oncological care. The profound interplay between cancers and the nervous system is reciprocal: Cancer growth can be induced and regulated by the nervous system; conversely, tumors can themselves alter the nervous system. Such crosstalk between cancer cells and the nervous system is evident in both the peripheral and central nervous systems.
View Article and Find Full Text PDFIntrinsic, expansile pontine tumors typically occur in the pediatric population. These tumors characteristically present as diffuse intrinsic pontine glioma (DIPG), which is now considered as diffuse midline glioma (DMG), H3K27-mutated of the pons. DIPG has limited treatment options and a poor prognosis, and the value of tissue diagnosis from an invasive biopsy remains controversial.
View Article and Find Full Text PDFBackground: Stroke remains a major health concern globally, with oral anticoagulants widely prescribed for stroke prevention. The efficacy and safety of mechanical thrombectomy (MT) in anticoagulated patients with distal medium vessel occlusions (DMVO) are not well understood.
Methods: This retrospective analysis involved 1282 acute ischemic stroke (AIS) patients who underwent MT in 37 centers across North America, Asia, and Europe from September 2017 to July 2023.
Oncolytic virotherapy or immunovirotherapy is a strategy that utilizes viruses to selectively infect and kill tumor cells while also stimulating an immune response against the tumor. Early clinical trials in both pediatric and adult patients using oncolytic herpes simplex viruses (oHSV) have demonstrated safety and promising efficacy; however, combinatorial strategies designed to enhance oncolysis while also promoting durable T-cell responses for sustaining disease remission are likely required. We hypothesized that combining the direct tumor cell killing and innate immune stimulation by oHSV with a vaccine that promotes T cell-mediated immunity may lead to more durable tumor regression.
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- This study examined how taking antiplatelet medications before and after procedures affects the risk of thromboembolic complications (TECs) in patients treated with the Woven EndoBridge (WEB) device for specific brain aneurysms.
- It analyzed data from multiple centers, involving a total of 1412 patients, to determine if antiplatelet drugs reduce the likelihood of TECs, finding that those who took them before the procedure had a significantly lower risk.
- The study concluded that while preprocedural antiplatelet use significantly lowers the chances of TECs, the effect does not carry over when the medication is taken post-procedure.