Assessing Neurosurgery Training: Accreditation Council for Graduate Medical Education Case Minimums Versus Surgical Autonomy.

Background And Objectives: The Accreditation Council for Graduate Medical Education (ACGME) requires neurosurgery residents to reach a set number of cases in specified procedure types (case minimums) before graduation and mandates completion of Milestones. We used the Surgical Autonomy Program, a validated method of autonomy-based resident evaluation, to determine the number of cases it took for residents to become competent and compared these with the ACGME case minimums.

Methods: We collected data from neurosurgery residents at Duke University on 7 procedures (tumor craniotomy, trauma craniotomy, ventriculoperitoneal shunt, anterior cervical discectomy and fusion (ACDF), posterior cervical fusion (PCF), discectomy/laminectomy, and posterior thoracolumbar spinal fusion [PSF]).

Gender Differences in Operative Autonomy Using the Surgical Autonomy Program: A Multicenter Study.

The proportion of women surgeons is increasing, but studies show that women in surgical residency are granted less autonomy than men. We utilized the Surgical Autonomy Program (SAP), an educational framework, to evaluate gender differences in self-reported autonomy, attending-reported autonomy, and operative feedback among US neurosurgical residents. The SAP tracks resident progression and guides teaching in neurosurgery.

Clinical and radiographic outcomes after index anterior cervical discectomy and fusion with interbody spacer with integrated anchor fixation: a single-surgeon case study.

Background: The use of plate-cage systems in anterior cervical discectomy and fusion (ACDF) has been shown to produce fusion and good clinical outcomes though it has been associated with complications such as dysphagia at higher rates than stand-alone implant devices. This study aimed to assess the incidence of dysphagia and radiographic outcomes in adult patients who have undergone ACDF with interbody spacer with integrated anchor fixation (ISa).

Methods: Patients who underwent index ACDF with a commercially available ISa by a fellowship-trained spine surgeon between January 2018 and December 2021 were retrospectively included.

3T sodium-MRI as predictor of neurocognition in nondemented older adults: a cross sectional study.

Dementia is a burgeoning global problem. Novel magnetic resonance imaging (MRI) metrics beyond volumetry may bring new insight and aid clinical trial evaluation of interventions early in the Alzheimer's disease course to complement existing imaging and clinical metrics. To determine whether: (i) normalized regional sodium-MRI values (Na-SI) are better predictors of neurocognitive status than volumetry (ii) cerebral amyloid PET status improves modelling.

Do Molecular Fingerprints Identify Diverse Active Drugs in Large-Scale Virtual Screening? (No).

Computational approaches for small-molecule drug discovery now regularly scale to the consideration of libraries containing billions of candidate small molecules. One promising approach to increased the speed of evaluating billion-molecule libraries is to develop succinct representations of each molecule that enable the rapid identification of molecules with similar properties. Molecular fingerprints are thought to provide a mechanism for producing such representations.

The Area Law of Molecular Entropy: Moving beyond Harmonic Approximation.

This article shows that the gas-phase entropy of molecules is proportional to the area of the molecules, with corrections for the different curvatures of the molecular surface. The ability to estimate gas-phase entropy by the area law also allows us to calculate molecular entropy faster and more accurately than currently popular methods of estimating molecular entropy with harmonic oscillator approximation. The speed and accuracy of our method will open up new possibilities for the explicit inclusion of entropy in various computational biology methods.

Iron changes within infarct tissue in ischemic stroke patients after successful reperfusion quantified using QSM.

Purpose: For nearly half of patients who undergo Endovascular Thrombectomy following ischemic stroke, successful recanalisation does not guarantee a good outcome. Understanding the underlying tissue changes in the infarct tissue with the help of biomarkers specific to ischemic stroke could offer valuable insights for better treatment and patient management decisions. Using quantitative susceptibility mapping (QSM) MRI to measure cerebral iron concentration, this study aims to track the progression of iron within the infarct lesion after successful reperfusion.

Accurate space-group prediction from composition.

Predicting crystal symmetry simply from chemical composition has remained challenging. Several machine-learning approaches can be employed, but the predictive value of popular crystallographic databases is relatively modest due to the paucity of data and uneven distribution across the 230 space groups. In this work, virtually all crystallographic information available to science has been compiled and used to train and test multiple machine-learning models.

Botensilimab, an Fc-Enhanced Anti-CTLA-4 Antibody, Is Effective against Tumors Poorly Responsive to Conventional Immunotherapy.

This study reveals that Fc-enhanced anti-CTLA-4 harnesses novel mechanisms to overcome the limitations of conventional anti-CTLA-4, effectively treating poorly immunogenic and treatment-refractory cancers. Our findings support the development of a new class of immuno-oncology agents, capable of extending clinical benefit to patients with cancers resistant to current immunotherapies.

A phase 2, open-label study of anti-inflammatory NE3107 in patients with dementias.

Background: Alzheimer's disease (AD) is a progressive, multifactorial, neurodegenerative disorder affecting >6 million Americans. Chronic, low-grade neuroinflammation, and insulin resistance may drive AD pathogenesis. We explored the neurophysiological and neuropsychological effects of NE3107, an oral, anti-inflammatory, insulin-sensitizing molecule, in AD.

Autologous Platelet-rich Fibrin as a Three-dimensional Structural Scaffold in the Healing of Contracted Orbital Sockets.

Purpose: Evaluation of platelet-rich fibrin as an adjuvant in surface healing of contracted orbital sockets.

Methods: Prospective, interventional, and comparative study of 25 patients with moderate to severe contracted sockets conducted over 2 years (February 2020-February 2022). Group 1 underwent a dermis-fat graft with fornix forming sutures supplemented by a platelet-rich fibrin membrane, while group 2 received a dermis-fat graft with fornix forming sutures only.

Demographics of focused ultrasound thalamotomy for essential tremor and trends in deep brain stimulation surgery after its introduction in the USA.

Background: Essential tremor (ET) is a movement disorder that affects 4%-5% of adults >65 years. For patients with medically refractory ET, neurosurgical interventions such as deep brain stimulation (DBS) and unilateral MR-guided focused ultrasound thalamotomy (MRgFUS) are available. In this retrospective cohort study, we examined the demographics of patients with ET who have received MRgFUS and evaluated trends in DBS usage in the USA after the introduction of MRgFUS in 2016.

Nationwide Analysis of Risk Factors Related to Opioid Weaning Following Lumbar Decompression Surgery - A Retrospective Database Study.

Background: Opioids are often prescribed for patients who eventually undergo lumbar decompression. Given the potential for opioid-related morbidity and mortality, postoperative weaning is often a goal of surgery. The purpose of this study was to examine the relationship between preoperative opioid use and postoperative complete opioid weaning among lumbar decompression patients.

Disparities in the treatment of movement disorders using deep brain stimulation.

Objective: Deep brain stimulation (DBS) is a well-established treatment for Parkinson's disease (PD) and essential tremor (ET). Although the prevalence of PD and ET can vary by sex and race, little is known about the accessibility of neurosurgical treatments for these conditions. In this nationwide study, the authors aimed to characterize trends in the use of DBS for the treatment of PD and ET and to identify disparities in the neurosurgical treatment of these diseases based on ethnic, racial, sex, insurance, income, hospital, and geographic factors.

Blood within the bone: orbital intraosseous venous malformation.

Purpose: Description of clinical features, radiological characteristics, and management strategies in primary orbital intraosseous venous malformation (OIVM) with pertinent literature review.

Methods: A retrospective analysis including clinical, radiologic, operative, and histopathological data of six cases of histopathologically proven OIVM was done. A comprehensive literature review was conducted using online databases and augmented with manual search to identify reported cases of OIVM.

Post-chemotherapy changes in retinal pigment epithelium in retinoblastoma eyes.

Objective: Histopathological analysis of the retinal pigment epithelial (RPE) changes in retinoblastoma (RB) cases who received pre-surgical chemotherapy.

Design: Laboratory-based observational study.

Methods: Five-year analysis was performed to identify Retinoblastoma cases who underwent enucleation after receiving systemic chemotherapy.

Disparities in Access to Deep Brain Stimulation and Responsive Neurostimulation Approaches to Drug-Resistant Epilepsy.

Background: Epilepsy affects 1% to 2% of the global population, and those who are resistant to medical treatment may be candidates for neuromodulation. In select populations, brain stimulation approaches including deep brain stimulation (DBS) and responsive neurostimulation (RNS) are used. Although studies have shown that patients from Black, Hispanic, lower income, and rural communities have less access to epilepsy care and have lower rates of epilepsy surgery, disparities in the use of brain stimulation for epilepsy treatment are currently not known.

Improving patient outcomes with a mobile digital health platform for patients undergoing transcatheter aortic valve replacement.

Purpose: ManageMySurgery (MMS) is a digital health application (app) for patients undergoing surgery, including Transcatheter Aortic Valve Replacement (TAVR). Patients using MMS review procedure-specific education, view FAQs, and report patient-reported outcomes. This study assessed the impact of app use on postoperative outcomes.

Digital Health for Patients Undergoing Spine Surgery: A Systematic Review.

Objective: Digital health tools, including smartphone applications (apps), websites, and online search engines, are increasingly being utilized for health data collection and patient education. Studies have shown that these tools can help disseminate information widely and even help guide patients through acute surgical episodes. We aimed to search the literature to summarize available studies on using digital health tools for patients undergoing spine surgery.

Use of transcranial low-intensity focused ultrasound for targeted delivery of stem cell-derived exosomes to the brain.

The blood-brain barrier (BBB) presents a significant challenge for targeted drug delivery. A proposed method to improve drug delivery across the BBB is focused ultrasound (fUS), which delivers ultrasound waves to a targeted location in the brain and is hypothesized to open the BBB. Furthermore, stem cell-derived exosomes have been suggested as a possible anti-inflammatory molecule that may have neural benefits, if able to pass the BBB.

A community effort in SARS-CoV-2 drug discovery.

The COVID-19 pandemic continues to pose a substantial threat to human lives and is likely to do so for years to come. Despite the availability of vaccines, searching for efficient small-molecule drugs that are widely available, including in low- and middle-income countries, is an ongoing challenge. In this work, we report the results of an open science community effort, the "Billion molecules against COVID-19 challenge", to identify small-molecule inhibitors against SARS-CoV-2 or relevant human receptors.

Ratios of head circumference to ventricular size vary over time and predict eventual need for CSF diversion in intraventricular hemorrhage of prematurity.

Purpose: Intraventricular hemorrhage (IVH) of prematurity can lead to hydrocephalus, sometimes necessitating permanent cerebrospinal fluid (CSF) diversion. We sought to characterize the relationship between head circumference (HC) and ventricular size in IVH over time to evaluate the clinical utility of serial HC measurements as a metric in determining the need for CSF diversion.

Methods: We included preterm infants with IVH born between January 2000 and May 2020.