Faculty Bibliography

BACKGROUND:Resection of glioblastoma (GBM) in eloquent regions depends on functional mapping to limit perioperative neurological morbidity. When neurological deficits preclude reliable mapping, neurosurgeons should explore potential mitigation strategies. The authors present the case of a patient with a large left cystic temporoinsular GBM and aphasia, for whom the authors used intraoperative language mapping and a staged approach to enable safe tumor resection. OBSERVATIONS/METHODS:A 49-year-old female presented with progressive mixed aphasia for 1 month and new-onset right facial droop. Magnetic resonance imaging (MRI) revealed a large, heterogeneously enhancing, left temporoinsular tumor with a significant cystic component. Her aphasia was profound, and resection without reliable language mapping was deemed unsafe. An initial stereotactic tumoral cyst aspiration was performed, which reduced local mass effect and improved her language function. Cyst decompression thereby enabled both task-based functional MRI and intraoperative awake speech mapping, resulting in a safe resection of her GBM. LESSONS/CONCLUSIONS:Safe resection of eloquently localized GBM is compromised when neurological deficits prohibit intraoperative functional mapping. This case demonstrates a mitigation strategy specific to cystic lesions in which an initial-stage stereotactic cyst aspiration is aimed at generating sufficient interval neurological improvement, such that intraoperative functional mapping can be performed during a second-stage resection. https://thejns.org/doi/10.3171/CASE24362.

TikTok is a social media platform that can educate users about dermatology, but this longitudinal analysis of skin of color-related TikTok hashtags from 2021 to 2022 suggests that nondermatologist influencers continue to dominate content creation, highlighting the need for more participation from board-certified dermatologists to actively counter misinformation and address potential disparities in skin-of-color health care.

BACKGROUND AND AIMS:Longitudinal studies have revealed that substance use treatment use is often recurrent among patients; the longitudinal patterns and characteristics of those treatment trajectories have received less attention, particularly in the global south. This study aimed to disentangle heterogeneity in treatment use among adult patients in Chile by identifying distinct treatment trajectory groups and factors associated with them. DESIGN:National-level registry-based retrospective cohort. SETTING AND PARTICIPANTS:Adults admitted to publicly funded substance use disorder treatment programs in Chile from November 2009 to November 2010 and followed for 9 years (n = 6266). MEASUREMENTS:Monthly treatment use; type of treatment; ownership of the treatment center; discharge status; primary substance used; sociodemographic. FINDINGS:A seven-class treatment trajectory solution was chosen using latent class growth analysis. We identified three trajectory groups that did not recur and had different treatment lengths: Early discontinuation (32%), Less than a year in treatment (19.7%) and Year-long episode, without recurrence (12.3%). We also identified a mixed trajectory group that had a long first treatment or two treatment episodes with a brief time between treatments: Long first treatment, or immediate recurrence (6.3%), and three recurrent treatment trajectory groups: Recurrent and decreasing (14.2%), Early discontinuation with recurrence (9.9%) and Recurrent after long between treatments period (5.7%). Inpatient or outpatient high intensity (vs. outpatient low intensity) at first entry increased the odds of being in the longer one-episode groups compared with the Early discontinuation group. Women had increased odds of belonging to all the recurrent groups. Using cocaine paste (vs. alcohol) as a primary substance decreased the odds of belonging to long one-episode groups. CONCLUSIONS:In Chile, people in publicly funded treatment for substance use disorder show seven distinct care trajectories: three groups with different treatment lengths and no recurring episodes, a mixed group with a long first treatment or two treatment episodes with a short between-treatment-episodes period and three recurrent treatment groups.

SIGNIFICANCE/UNASSIGNED:Rapid acquisition of large imaging volumes with microscopic resolution is an essential unmet need in biological research, especially for monitoring rapid dynamical processes such as fast activity in distributed neural systems. AIM/UNASSIGNED:We present a multifocal strategy for fast, volumetric, diffraction-limited resolution imaging over relatively large and scalable fields of view (FOV) using single-camera exposures. APPROACH/UNASSIGNED:Our multifocal microscopy approach leverages diffraction to image multiple focal depths simultaneously. It is based on a custom-designed diffractive optical element suited to low magnification and large FOV applications and customized prisms for chromatic correction, allowing for wide bandwidth fluorescence imaging. We integrate this system within a conventional microscope and demonstrate that our design can be used flexibly with a variety of magnification/numerical aperture (NA) objectives. RESULTS/UNASSIGNED: CONCLUSIONS/UNASSIGNED:Our study demonstrates the advantage of diffraction-based multifocal imaging techniques for 3D imaging of mm-scale objects from a single-camera exposure, with important applications in functional neural imaging and other areas benefiting from volumetric imaging.

INTRODUCTION/UNASSIGNED:Physiology-guided cardiopulmonary resuscitation (CPR) offers the potential to optimize resuscitation and enable early prognosis. METHODS/UNASSIGNED:Physiology-Guided CPR was one of six focus topic for the Wolf Creek XVII Conference held on June 14-17, 2023 in Ann Arbor, Michigan, USA. International thought leaders and scientists in the field of cardiac arrest resuscitation from academia and industry were invited. Participants submitted via online survey knowledge gaps, barriers to translation and research priorities for each focus topic. Expert panels used the survey results and their own perspectives and insights to create and present a preliminary unranked list for each category, which was then debated, revised and ranked by all attendees to identify the top 5 for each category. RESULTS/UNASSIGNED:Top knowledge gaps include identifying optimal strategies for the evaluation of physiology-guided CPR and the optimal values for existing patients using patient outcomes. The main barriers to translation are the limited usability outside of critical care environments and the training and equipment required for monitoring. The top research priorities are the development of clinically feasible and reliable methods to continuously and non-invasively monitor physiology during CPR and prospective human studies proving targeting parameters during CPR improves outcomes. CONCLUSION/UNASSIGNED:Physiology-guided CPR has the potential to provide individualized resuscitation and move away from a one-size-fits-all approach. Current understanding is limited, and clinical trials are lacking. Future developments need to consider the clinical application and applicability of measurement to all healthcare settings. Therefore, clinical trials using physiology-guided CPR for individualisation of resuscitation efforts are needed.

As people living with HIV experience increased life expectancy, there is a growing concern about the burden of comorbid non-communicable diseases, particularly hypertension. This brief describes the current policy landscape on the management of HIV and hypertension in Akwa Ibom State, Nigeria, stakeholder engagement meetings, and the resulting five policy recommendations rooted in an ongoing research study designed to integrate hypertension management into HIV care across primary health centers in the State. In order to identify the current gaps in integrated care, discussion sessions with three stakeholder groups (i.e., healthcare providers, patient advocacy groups, and policy makers) were held separately in November 2022. The discussions were purposed to brainstorm policy-level solutions for integrating hypertension into HIV treatment. After all the sessions were concluded, there were five recommendations provided by the stakeholders for integrating HIV and hypertension care in the Akwa Ibom State. Stakeholders unanimously agreed with the need to integrate hypertension care for HIV impacted communities in the State. Specifically, stakeholders recommended to: (1) engage retired community health nurses as mentors; (2) actively link communities to integrated care in clinics; (3) integrate hypertension management with HIV education; (4) expand health insurance accessibility; and (5) formally integrate hypertension management into primary healthcare centers in Akwa Ibom State.

This study investigates the use of chitin extracted from dead sea urchin shells (testa) to enhance the mechanical and physical properties of vinyl-based composites made using pineapple fiber. The chitin biopolymer is extracted via the thermo-chemical method and mixed with resin before making a composite. The composites were fabricated using the hand layup method and tested in accordance with the American Society for Testing and Materials (ASTM) standards. The resulting composites underwent a series of rigorous examinations to evaluate their mechanical performance, fatigue resistance, wear behavior, and hydrophobicity. Results demonstrated the synergistic effect of combining pineapple fiber and chitin in vinyl ester composites across various compositions. The mechanical properties were improved to higher up to C4 (chitin up to 15 vol. % and pineapple fiber of 40 vol. %) composite after that decreased. However, the wear resistance improved with higher chitin content, as evidenced by a reduced coefficient of friction and specific wear rate. Moreover, an extended fatigue life cycle of 17,732 is observed at 75% of ultimate tensile stress in the C4 composite. The contact angle measurements indicated a retained hydrophilicity with an angle of 86⁰ for the C5 composite. These findings provide crucial insights for advanced material engineering applications, highlighting the significant enhancement in mechanical properties with the incorporation of chitin derived from sea urchin shells. The comprehensive characterization reveals the multifaceted improvements brought about by chitin, paving the way for the development of eco-friendly and high-performance composite materials.

Deep learning methods have significantly advanced profiling side-channel attacks. Finding the optimal set of hyperparameters for these models remains challenging. Effective hyperparameter optimization is crucial for training accurate neural networks. In this work, we introduce a novel hill climbing optimization algorithm that is specifically designed for deep learning in profiled side-channel analysis. This algorithm iteratively explores hyperparameter space using gradient-based techniques to make precise, localized adjustments. By incorporating performance feedback at each iteration, our approach efficiently converges on optimal hyperparameters, surpassing traditional Random Search methods. Extensive experiments"”covering protected implementations, leakage models, and various neural network architectures"”demonstrate that our hill climbing method consistently achieves superior performance in over 80% of test cases, predicting the secret key with fewer attack traces and outperforming both Random Search and state-of-the-art techniques.

STUDY DESIGN/METHODS:Guideline. OBJECTIVES/OBJECTIVE:To develop an international guideline (AOGO) about the use of osteobiologics in anterior cervical discectomy and fusion (ACDF) for treating degenerative spine conditions. METHODS:The guideline development process was guided by AO Spine Knowledge Forum Degenerative (KF Degen) and followed the Guideline International Network McMaster Guideline Development Checklist. The process involved 73 participants with expertise in degenerative spine diseases and surgery from 22 countries. Fifteen systematic reviews were conducted addressing respective key topics and evidence was collected. The methodologist compiled the evidence into GRADE Evidence-to-Decision frameworks. Guideline panel members judged the outcomes and other criteria and made the final recommendations through consensus. RESULTS:Five conditional recommendations were created. A conditional recommendation is about the use of allograft, autograft or a cage with an osteobiologic in primary ACDF surgery. Other conditional recommendations are about the use of osteobiologic for single- or multi-level ACDF, and for hybrid construct surgery. It is suggested that surgeons use other osteobiologics rather than human bone morphogenetic protein-2 (BMP-2) in common clinical situations. Surgeons are recommended to choose 1 graft over another or 1 osteobiologic over another primarily based on clinical situation, and the costs and availability of the materials. CONCLUSION/CONCLUSIONS:This AOGO guideline is the first to provide recommendations for the use of osteobiologics in ACDF. Despite the comprehensive searches for evidence, there were few studies completed with small sample sizes and primarily as case series with inherent risks of bias. Therefore, high-quality clinical evidence is demanded to improve the guideline.

Cervical spine injuries (CSIs) in pediatric patients with traumatic brain injury (TBI) pose unique diagnostic and management challenges. Current studies on the intricate overlap between pediatric TBI and CSI are limited. This paper explores the existing literature as well as the epidemiology, mechanisms of injury, diagnostic criteria, treatment strategies, and outcomes associated with CSI in pediatric TBI patients.