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Interrelationship between Body Mass Index, Venous Sinus Pressures, Craniospinal Elastance, and Intracranial Pressure In Idiopathic Intracranial Hypertension
No full textPurpose: To investigate the interrelationship between body mass index (BMI), venous sinus pressure (VSP), and craniospinal elastance in determining lumbar puncture opening pressure (LP OP) in idiopathic intracranial hypertension (IIH).
Methods: A single-center retrospective chart review was conducted to identify patients who received venous manometry (8/2021-11/2025) followed by LP within 7 days before stenting. VSPs were measured at standardized locations, including the torcula (TP) and sigmoid/jugular (SIJ) sinuses. Elastance was calculated as (OP – closing pressure)/volume of CSF removed. Statistical analysis (JASP 0.19.3) was performed using generalized linear model (Gaussian identity; scaled center) to assess relationships between LP OP, BMI, TP, elastance, and BMI×elastance interaction while controlling for age and sex, with random intercept, and hierarchical removal of interaction terms.
Results: Of 135 screened patients, 28 refractory IIH patients (92.9% female; BMI 38.2±9.5) met criteria. Racial distribution included 50.0% Caucasian, 39.3% African American, and 10.7% other groups. Mean LP OP was 32.7±14.1cmH₂O; mean TP 30.0±15.8mmHg; mean SIJ 15.6±6.5mmHg; and mean elastance 0.784±0.377cmH₂O/mL. TP, elastance, and the BMI×elastance interaction were significant predictors of LP OP. Notably, BMI’s effect on LP OP became significantly stronger as elastance increased.
Conclusions: These findings suggest that craniospinal elastance modulates how BMI contributes to intracranial pressure elevation in IIH, providing a potential explanation for heterogeneity in pressure responses among patients with similar BMI. Patients with elevated elastance may be particularly vulnerable to BMI-related pressure increases. Larger prospective studies are needed to validate these interactions and clarify their relevance to IIH pathophysiology and clinical management.https://jdc.jefferson.edu/aoa_research_symposium_posters/1027/thumbnail.jp
Does Adding an Interbody Cage in L4–L5 Posterolateral Fusion for Degenerative Spondylolisthesis and Stenosis Improve Clinical Outcome?
No full textINTRODUCTION: As the population ages, L4-L5 degenerative spondylolisthesis is increasingly common. Posterolateral fusion was long standard; interbody cages are widely used for perceived higher fusion rates.
RESEARCH QUESTION: Does adding an interbody cage to posterolateral fusion improve outcomes or reduce complications in elderly patients with grade I spondylolisthesis and severe stenosis?
MATERIALS AND METHODS: We retrospectively studied 319 adults aged 60-85 who underwent single-level L4-L5 fusion (2011-2018) after failed conservative care. Patients received posterior lumbar fusion (PLIF, n = 155) or posterolateral lumbar fusion (PLF, n = 164). Primary outcomes were Oswestry Disability Index (ODI) change and complications over a median five-year follow-up; secondary outcomes were operative time, hospital stay, and transfusions. Multivariable analyses adjusted for age, sex, BMI, year of surgery, and sagittal alignment.
RESULTS: Functional improvement was similar (median ODI reduction ≈22 points; p = 0.97), and implant-related revision and revision-free survival did not differ. Cage use increased overall complications (24.5 % vs 7.9 %), prolonged surgery (125 vs 95 min) and hospital stay (4 vs 3 days), and raised transfusions (9.7 % vs 1.8 %), dural tears (11.6 % vs 2.4 %), and radicular deficits (6.5 % vs 1.2 %). The association between cage use and complications persisted after adjustment.
CONCLUSION: In this elderly, low-grade L4-L5 degenerative spondylolisthesis cohort, adding a posterior interbody cage to instrumented posterolateral fusion did not improve 5-year disability but was associated with higher peri-operative morbidity and greater resource use
Outpatient Seizure & Epilepsy for the PCP
No full textOutline
- Evaluation of possible seizure (with a case)
- Seizure vs epilepsy
- Antiseizure medications (the TL;DR)
- Epilepsy patient co-management Breakthrough seizures Presentative care Contraception, family planning and pregnancy Surgery
- Neurology referra
Defining RNA oligonucleotides that reverse deleterious phase transitions of RNA-binding proteins with prion-like domains.
No full textRNA-binding proteins (RBPs) with prion-like domains (PrLDs), such as FUS and TDP-43, condense into functional liquids, which can transform into pathological fibrils that underpin fatal neurodegenerative disorders, including amyotrophic lateral sclerosis (ALS)/frontotemporal dementia (FTD). Here, we define short RNAs that prevent FUS fibrillization by promoting liquid phases and distinct short RNAs that prevent and reverse FUS condensation and fibrillization. These activities require interactions with multiple RNA-binding domains of FUS and are encoded by RNA sequence, length, and structure. We define a short RNA that dissolves cytoplasmic FUS aggregates, restores nuclear FUS, and mitigates FUS toxicity in optogenetic models and ALS patient-derived motor neurons. Another short RNA dissolves cytoplasmic TDP-43 aggregates, restores nuclear TDP-43, and mitigates TDP-43 toxicity. Since short RNAs can be effectively delivered to the human brain, these oligonucleotides could have utility for ALS/FTD and related disorders
Repair Techniques for Acute Rupture of the Patellar Tendon: A Systematic Review
No full textBACKGROUND: Multiple techniques exist to repair acute tears of the patellar tendon. Surgical repair is required to reestablish full function of the extensor mechanism of the knee, and optimal results typically occur when the tear is repaired acutely.
PURPOSE: To systematically review the literature to evaluate treatment outcomes and complication rates after acute surgical repair of patellar tendon ruptures using suture anchor repair, transosseous repair, and end-to-end repair.
STUDY DESIGN: Scoping review; Level of evidence, 4.
METHODS: A systematic review was performed to analyze outcomes after patellar tendon repair in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines. Potential studies were identified through searches of the Cochrane Central Register of Controlled Trials, PubMed, and Embase. Screening was completed independently by 2 authors, who sought to identify studies published from January 1980 to December 2024 that described the management of acute patellar tendon ruptures. Articles were excluded if they described chronic tears or included cases of patellar tendon ruptures in patients who previously underwent total knee arthroplasty. Clinical outcome data were recorded, including treatment outcomes and complications.
RESULTS: Twenty studies analyzing 1161 patients met the inclusion criteria. The most reported repair techniques were suture anchor repair, transosseous repair, and end-to-end repair. Six studies analyzed transosseous repair and found positive postoperative functional outcomes, including mean postoperative Lysholm scores ranging from 84 to 98.08 (any, n = 3). Two studies reported using suture anchors, and each stated a postoperative flexion range of motion \u3e130°, with no complications. Five studies analyzed end-to-end acute patellar tendon rupture repair and reported mean flexion \u3e130° (n = 3), with the most reported complication being wound infections. Eight studies compared multiple techniques for acute patellar tendon rupture repair, and 6 studies showed statistically significant improvements in functional outcome scores when comparing pre- and postoperative scoring within cohorts. Additionally, 5 studies in this group reported complications, with the most common being rerupture, reoperation, skin infections, and deep vein thrombosis.
CONCLUSION: Surgical repair of acute patellar tendon rupture with suture anchor repair, transosseous repair, and end-to-end repair all achieved high healing rates. The majority of surgical options demonstrated good functional outcomes with a low risk of complications, the most common of which related to wound complications and infection
Clinical Test Cases for Commissioning, QA, and Benchmarking of Model-Based Dose Calculation Algorithms In 1⁹2Ir HDR Gynecologic Tandem and Ring Brachytherapy
No full textPURPOSE: To develop clinically relevant test cases for commissioning Model-Based Dose Calculation Algorithms (MBDCAs) for 192Ir High Dose Rate (HDR) gynecologic brachytherapy following the workflow proposed by the TG-186 report and the WGDCAB report 372.
ACQUISITION AND VALIDATION METHODS: Two cervical cancer intracavitary HDR brachytherapy models were developed based on a real patient, using either uniformly structured regions or realistic segmentation. The patient\u27s computed tomography (CT) images were processed, converted to a series of digital imaging and communications in medicine (DICOM) CT images, and imported into two treatment planning systems (TPSs), the Oncentra Brachy and BrachyVision. The original segmentation of the clinical case was augmented to enable a thorough dosimetric analysis. The actual clinical treatment plan was generally maintained, with the source replaced by a generic 192Ir HDR source. Dose to medium in medium calculations were performed using the MBDCA option of each TPS, and three different Monte Carlo (MC) simulation codes. MC results demonstrated agreement within statistical uncertainty, while comparisons between the commercial TPS MBDCAs and a general-purpose MC code highlighted both the advantages and limitations of the studied MBDCAs, suggesting potential approaches to overcome the challenges.
DATA FORMAT AND USAGE NOTES: The datasets for the developed cases are available online at https://doi.org/10.5281/zenodo.15720996. The DICOM files include the treatment plan for each case, TPS, and the corresponding reference MC dose data. The package also contains a TPS- and case-specific user guide for commissioning the MBDCAs, as well as files necessary to replicate the MC simulations.
POTENTIAL APPLICATIONS: The provided datasets and proposed methodology can serve as a commissioning framework for TPSs that employ MBDCAs, as well as a benchmark for brachytherapy researchers using MC methods and MBDCA developers. They also facilitate intercomparisons of MBDCA performance and provide a quality assurance resource for evaluating future TPS software updates
Jackson-Pratt Drain-Related Challenges and a Potential Explanation for Associated Surgical Site Pain Variability Following Breast Mastectomy and Reconstruction
No full textBackground: The Jackson-Pratt (JP) drain is a closed suction drain used in surgeries throughout the body. This prevents seroma formation through continual negative pressure drainage while resisting collapse and obstruction. JP drains are mainstays in breast reconstruction and mastectomy.
Methods: Through a literature review using keywords such as “Surgical Site Infection” (SSI), “Quality of Life” (QOL), and “Surgical Site Pain” (SSP), we summarized JP drain-related complications in breast reconstruction and mastectomy. Although the drain effectively reduces seroma formation, there has been a lack of innovation in addressing these issues. There is no standardized approach to JP drain post-operative care or pain minimization addressing the variables contributing to pain, such as nerve structures, to inform placement.
Results: In a cross-sectional survey, patients reported increased pain at the body wall, incision site, and drain entry site, all significantly associated with drain durations of over 2 weeks. 84.7% of patients reported JP drains increased difficulty completing daily tasks, and 66% reported a negative impact on mood.
Conclusion: A standard practice to address these issues does not exist. There is a need for innovation within the JP drain space to improve QOL, reduce SSI rates, and reduce SSP. Chronic pain following mastectomy is a well-described phenomenon, likely from proximity to many peripheral nerves travelling along the anterior and lateral chest wall. Among the cutaneous distributions of these nerves, there may be certain locations where exit sites are particularly painful, a possible pain modifier that can be explored in future studies to decrease SSP.https://jdc.jefferson.edu/aoa_research_symposium_posters/1020/thumbnail.jp
Survival Impact of Intraoperative CO2 Dysregulation in patients undergoing Pancreaticoduodenectomy for Pancreatic Ductal Adenocarcinoma
No full textPurpose: Pancreatic ductal adenocarcinomas (PDAC) are aggressive malignancies with poor prognoses. Emerging evidence suggests tissue hypercapnia (elevated CO2) promotes aggressive, treatment resistant tumor biology. End-tidal CO2 (ETCO2) offers a composite measure of ventilation, systemic perfusion, and tissue CO2 production. During curative-intent pancreaticoduodenectomy, we hypothesized that intraoperative ETCO2 could serve as a marker of tissue CO2 dyscapnia; both low levels indicating decreased circulatory reserves and high levels indicating tissue hypercapnia may result in worse outcomes.
Methods: We conducted a retrospective review (2017-2023) of 343 patients undergoing pancreaticoduodenectomy for PDAC. Intraoperative ETCO2 data were obtained from anesthesia records, excluding the first and last 45 minutes of surgery. Patients with overall or disease-free survival (OS & DFS) under 90 days or intraoperative metastasis discovery were excluded. Mean ETCO2 was calculated per patient. ETCO2 groups were stratified by quartiles: low (Q1), normal (Q2-3), and high (Q4). Primary endpoints were DFS and OS.
Results: 243 total patients (49% male, average age: 68.5 (61.3–74.9 years)) were analyzed. Normocapnic patients had significantly better OS and DFS compared with both low and high ETCO2 groups (P\u3c 0.05, each, Figure 1A). Hypocapnia had poorer DFS than normocapnia (12.9 vs. 22.4 months, P=0.03, Figure 1B). Cox regression showed both hypocapnia and hypercapnia independently predicted recurrence (HR=1.58 and 1.50; P=0.02 and 0.05, respectively) and mortality (HR=1.65 and 1.66; P=0.03 and 0.04, respectively).
Conclusions: Mean intraoperative ETCO2 is strongly associated with oncologic outcomes post- pancreaticoduodenectomy for PDAC. Both low and high ETCO2 were linked to worse survival, indicating ETCO2’s potential as a clinically relevant prognostic marker.https://jdc.jefferson.edu/aoa_research_symposium_posters/1029/thumbnail.jp
Evaluating the Impact of BARD1 Isoform Targeting on PDAC Growth and Response to Olaparib
No full textPoster embargoed until March 30, 2026.https://jdc.jefferson.edu/aoa_research_symposium_posters/1030/thumbnail.jp
Women With Moderate Anaemia Prior to Conception Benefited Most From Nutrition Interventions: A Secondary Analysis of the Women First Preconception Maternal Nutrition Trial
No full textINTRODUCTION: The Women First (WF) Preconception Maternal Nutrition trial found greater benefits of small-quantity lipid-based nutrient supplements (SQ-LNS) for intrauterine growth among anaemic versus non-anaemic women at preconception. We investigated whether the benefits of SQ-LNS in improving markers of intrauterine growth occurred evenly across the mild to moderate spectrum of pre-pregnancy anaemia.
METHODS: We analysed WF data (n=2443 maternal-newborn dyads) from Pakistan, India, Guatemala and the Democratic Republic of Congo. Women received SQ-LNS either ≥3 months preconception through pregnancy (Arm 1); starting in the late first trimester (Arm 2); or not at all (Arm 3: control), with all supplementations discontinued at delivery. The outcomes were infant weight, length and head circumference measured within 48 hours of birth, expressed as Z-scores. For each site, adjusted mean differences in the Z-scores were computed across six pre-pregnancy haemoglobin (Hb) categories (80-89, 90-99, 100-109, 110-119, 120-129, and ≥130 g/L) and pooled using meta-analysis.
RESULTS: The effect of SQ-LNS on birth weight, length and head circumference varied by pre-pregnancy Hb categories. No significant differences in pooled mean Z-scores were observed for any Hb category \u3e110 g/L, and no differences were found for Arm 1 vs Arm 2 across any Hb categories. For women with Hb 90-99 g/L pooled mean differences (95% CI) in the Z-scores for length (0.60 (0.03 to 1.23)), weight (0.50 (0.11 to 0.89)) and head circumference (0.26 (0.02 to 0.51)) were greatest for Arm 1 versus Arm 3. For women with Hb 100-109 g/L in Arm 1 versus Arm 3, pooled mean difference (95% CI) in birth weight Z-scores was significantly greater (0.33 (0.24 to 0.42)). Arm 2 vs Arm 3 women with Hb 90-99 g/L had greater birth weight Z-scores (0.14 (0.05 to 0.22)).
CONCLUSION: The findings highlight the importance of identifying women preconception for whom nutrition interventions may have the greatest impact on fetal growth