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Efficacy of Bone Health Clinic on Post Fracture Patients in Lehigh Valley Health Network
No full textAssociation of EEG Response to Hypertonic Saline and Neurologic Outcomes in Pediatric Acute Brain Injury.
No full textBackground EEG is a critical tool for neuromonitoring and neuroprognostication in children with acute brain injury. Quantitative EEG (qEEG), particularly the alpha-delta ratio (ADR), can detect worsening cerebral ischemia in adults, but it is unknown whether it can identify more subtle and transient changes in cerebral blood flow, such as those induced by hypertonic saline (HTS), in children. We aimed to determine whether we could identify a cohort of patients with an ADR response to HTS and to evaluate the association between an ADR response and neurologic outcomes in critically ill children with acute brain injury. Methods We conducted a retrospective cohort study of patients admitted to a pediatric intensive care unit with acute brain injury who received HTS during EEG monitoring from 2018-2023. The ADR was calculated before and after HTS administration. An ADR response was defined as \u3e 20% increase from baseline within 30 minutes of receiving HTS in either hemisphere. The primary outcome was survival with favorable neurologic outcome, defined as a Functional Status Scale (FSS) change \u3c 3 from pre-hospital baseline to discharge. Secondary outcome was survival to hospital discharge. Results Among 87 patients (median age 10 years [IQR 3.6-14.5], 46% female), 28% (24/87) had an ADR response to HTS. ADR responders were older (12.9 vs. 8.0 years, p = 0.004) and more likely to have continuous, normal-voltage EEG backgrounds (67% vs. 40%, p = 0.006). Patients with an ADR response had 4 times increased odds of favorable outcome and survival (OR 4.0, 95% CI 1.3-12.7; OR 3.9, 95% CI 1.0-10.7, respectively). Conclusions An ADR increase \u3e 20% following HTS was associated with increased odds of survival with favorable neurologic outcome and survival to hospital discharge in critically ill pediatric patients with acute brain injury. qEEG response to HTS may serve as a real-time, noninvasive biomarker of cerebral perfusion responsiveness
Multiple subpial transections with concomitant responsive neurostimulation of the insula: illustrative case.
No full textBACKGROUND: Focal epilepsy arising from the eloquent cortex can be treated with palliative surgical interventions such as multiple subpial transection (MST) or responsive neurostimulation (RNS). These techniques can be performed to reduce the burden of disabling seizures while avoiding disability associated with resection of the eloquent brain.
OBSERVATIONS: A 17-year-old girl with a history of complex, refractory multifocal epilepsy and previous right anterior temporal lobectomy and left temporal neocortical RNS presented with refractory status epilepticus. Scalp electroencephalography showed seizures that began prior to RNS detection, suggesting a focus outside of the left anterior temporal lobe. MRI showed new edema throughout the left insula. MST and concurrent insular RNS lead placement were performed. The patient was discharged 2 weeks later, and at the 6-month follow-up, she had a 100-fold reduction in clinical seizures and RNS detections.
LESSONS: This technical report is the first description of 1) concurrent MST and RNS, and 2) placement of a paddle electrode for the RNS over the surface of the insula using a transsylvian approach. Surgery in this case provided both immediate and sustained reduction in disabling seizures over several months. https://thejns.org/doi/10.3171/CASE24445
Safety review of antithrombotic therapy options after left atrial appendage occlusion.
No full textINTRODUCTION: Left atrial appendage occlusion (LAAO) is a viable alternative to anticoagulation for treatment in patients with Non-valvular Atrial fibrillation (NVAF) who cannot tolerate anticoagulation. Post-procedure patients are generally prescribed Oral anticoagulation (OAC) for 45 days while the device is undergoing endothelialization, following which patients are continued on antiplatelet agents. Recommendations for antithrombotic agents following LAAO arrived by consensus which are not tolerated by all patients.
AREAS COVERED: This review covers safety profile of antithrombotic therapy options after LAAO. We discuss the side effect profile including Device related thrombosis (DRT), bleeding, and thromboembolic events. The new randomized controlled trials and meta-analysis compared combinations of DOAC with Single Antiplatelet Therapy (SAPT), Dual Antiplatelet Therapy (DAPT), VKA or only SAPT and studied the incidence of major bleeding, DRT, and thromboembolic events. The review is a comprehensive summary of different antithrombotic agents\u27 combinations along with the duration recommendations and emphasizes the importance of a discussion amongst involved team members and patients.
EXPERT OPINION: Patients with NVAF undergoing LAAO, initial postprocedural antithrombotic monotherapy with DOAC is associated with low rates of thromboembolism, DRT and major bleeding followed by DAPT. DAPT is associated with lower incidence of thromboembolic events in comparison to SAPT
2054 Comparison of Quality, Empathy and Readability of Physician Responses Versus Chatbot Responses to Common Vascular Neurosurgery-Related Questions on a Social Media Platform
No full text63895 The Efficacy of Etanercept in the Management of Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis
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One- and Two-Year Outcomes of Genicular Artery Embolization for Symptomatic Knee Osteoarthritis: A Single-Center, Retrospective Study Using 200-µm Polyethylene Glycol Microspheres.
No full textPURPOSE: To evaluate one- and two-year outcomes of genicular artery embolization (GAE) using 200-µm permanent microspheres in patients with symptomatic knee osteoarthritis (KOA) and identify predictors of clinical response. Long-term GAE outcome data are sparse but necessary to understand durability of the intervention.
MATERIAL AND METHODS: A single-center, IRB-approved retrospective study including 34 consecutive patients received GAE for symptomatic KOA from September 2021 to January 2024. GAE was performed using 200-µm polyethylene glycol microspheres. Clinical outcomes were assessed with the Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scoring system at pre-GAE visit and up to 2 years post-GAE. A 20% reduction in the WOMAC pain score at 1 and 2 years was considered clinically significant as well as by the OARSI-Osteoarthritis Research Society International Standing Committee for Clinical Trials Response Criteria Initiative and the Outcome Measures in Rheumatology criteria (OMERACT). Kaplan-Meier analysis was performed to investigate clinical response over time. Univariate and multivariate analysis was performed for gender, race, age, BMI, vessels treated, embolic volume, Kellgren-Lawrence (KL) grading using Fisher and t-tests.
RESULTS: Thirty-four patients and 42 knees were treated with KOA severity: KL3 ≥ 90%. One-year proportion of clinical response by MCID: 23.8% (95% CI 13.9-40.9) and by OMERACT: 21.4% (95% CI 12.0-38.2). Two-year proportion of clinical response by MCID: 19.8% (95% CI 10.4-38.0) and by OMERACT: 16.1% (95% CI 7.2-36.1). Adverse event rate was 30.1%. BMI was predictive of categorical response (univariate: P = 0.012 and multivariate: P = 0.033).
CONCLUSION: GAE using 200-µm PEG microspheres shows modest long-term outcomes for KOA with acceptable safety profile
Prognostication of Three-Month Genicular Artery Embolization Outcomes Using Pre-Procedural MRIs.
No full textPURPOSE: To assess the utility of pre-procedural knee MRI prior to genicular artery embolization (GAE) for the prognostication of early outcomes for symptomatic knee osteoarthritis (KOA).
MATERIALS AND METHODS: A single-center study including 39 patients received GAE from 9/2021-4/2025 with pre-procedural MRIs. MRIs were evaluated for structural abnormalities including menisci, ligaments, cartilage, marrow signal, and loose bodies. For 24 patients, synovitis was assessed using a semiquantitative method. Clinical outcomes were measured with the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scoring system at pre-GAE and three-month postintervention. Categorical response was assessed as a 50% reduction in the WOMAC Pain. Student t-tests were used to evaluate WOMAC pain reduction, and subset analysis was performed between MRI structural abnormalities and categorical response.
RESULTS: Fifty-two knees received GAE with pre-procedural MRIs (33 with contrast). There was a 34.6% clinical response rate (N = 8/52). Lateral meniscus and cartilage abnormality were predictive of poor categorical response at three months (P = 0.039-0.040). ≥ 4 structural abnormalities were associated with poor treatment response (P = 0.004). Pre-GAE synovitis was not predictive of categorical response at three months (P = 0.809). Kellgren-Lawrence ≥ 3 was predictive of poor response (P \u3c 0.001). Lower adverse event rate was observed with temporary embolic compared to permanent embolic (P = 0.032).
CONCLUSION: Pre-GAE knee MRI may offer short-term prognostic utility. Pre-procedural abnormalities in the lateral menisci and cartilage can predict poor response to GAE at three months. A greater degree of structural abnormality (≥ 4 structural abnormalities) was associated with poor response. Temporary embolic agent may be safer than permanent embolic agent