Pub Date : 2024-11-06DOI: 10.1227/neu.0000000000003217
Michael J Link
{"title":"Commentary: Vestibular Schwannoma Koos Grade 1 International Study of Active Surveillance Versus Stereotactic Radiosurgery: The VISAS-K1 Study.","authors":"Michael J Link","doi":"10.1227/neu.0000000000003217","DOIUrl":"https://doi.org/10.1227/neu.0000000000003217","url":null,"abstract":"","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142582883","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-06DOI: 10.1227/neu.0000000000003215
Othman Bin-Alamer, Hussam Abou-Al-Shaar, Selcuk Peker, Yavuz Samanci, Isabelle Pelcher, Sabrina Begley, Anuj Goenka, Michael Schulder, Jean-Nicolas Tourigny, David Mathieu, Andréanne Hamel, Robert G Briggs, Cheng Yu, Gabriel Zada, Steven L Giannotta, Herwin Speckter, Sarai Palque, Manjul Tripathi, Saurabh Kumar, Rupinder Kaur, Narendra Kumar, Brandon Rogowski, Matthew J Shepard, Bryan A Johnson, Daniel M Trifiletti, Ronald E Warnick, Samantha Dayawansa, Elad Mashiach, Fernando De Nigris Vasconcellos, Kenneth Bernstein, Zane Schnurman, Juan Alzate, Douglas Kondziolka, Jason P Sheehan
Background and objective: This investigation evaluates the safety and efficacy of stereotactic radiosurgery (SRS) vs observation for Koos grade I vestibular schwannomas (VS).
Methods: In a multicenter study, we retrospectively analyzed data of patients with Koos grade I VS who underwent SRS (SRS group) or were observed (observation group). Propensity score matching was used to equilibrate demographics, tumor size, and audiometric data across groups. The outcome analyzed included tumor control, preservation of serviceable hearing, and neurological function.
Results: The study matched 142 patients, providing a median follow-up period of 36 months. SRS significantly enhanced tumor control compared with observation, with a 100% control rate at both 5- and 8-year marks in the SRS group vs 48.6% and 29.5% in the observation group at the same time intervals, respectively (P < .001). Preservation of serviceable hearing outcomes between groups showed no significant difference at 5 and 8 years, ensuring a comparable quality of auditory function (SRS 70.1% vs observation 53.4% at 5 years; P = .33). Furthermore, SRS was associated with a reduced likelihood of tinnitus (odds ratio [OR] = 0.46, P = .04), vestibular dysfunction (OR = 0.17, P = .002), and overall cranial nerve dysfunction (OR = 0.49, P = .03) at last follow-up.
Conclusion: SRS management of patients with Koos grade I VS was associated with superior tumor control and reduced odds for cranial nerve dysfunction, while not compromising hearing preservation compared with observation. These findings support the safety and efficacy of SRS as a primary care approach for this patient population.
{"title":"Vestibular Schwannoma Koos Grade I International Study of Active Surveillance Versus Stereotactic Radiosurgery: The VISAS-K1 Study.","authors":"Othman Bin-Alamer, Hussam Abou-Al-Shaar, Selcuk Peker, Yavuz Samanci, Isabelle Pelcher, Sabrina Begley, Anuj Goenka, Michael Schulder, Jean-Nicolas Tourigny, David Mathieu, Andréanne Hamel, Robert G Briggs, Cheng Yu, Gabriel Zada, Steven L Giannotta, Herwin Speckter, Sarai Palque, Manjul Tripathi, Saurabh Kumar, Rupinder Kaur, Narendra Kumar, Brandon Rogowski, Matthew J Shepard, Bryan A Johnson, Daniel M Trifiletti, Ronald E Warnick, Samantha Dayawansa, Elad Mashiach, Fernando De Nigris Vasconcellos, Kenneth Bernstein, Zane Schnurman, Juan Alzate, Douglas Kondziolka, Jason P Sheehan","doi":"10.1227/neu.0000000000003215","DOIUrl":"10.1227/neu.0000000000003215","url":null,"abstract":"<p><strong>Background and objective: </strong>This investigation evaluates the safety and efficacy of stereotactic radiosurgery (SRS) vs observation for Koos grade I vestibular schwannomas (VS).</p><p><strong>Methods: </strong>In a multicenter study, we retrospectively analyzed data of patients with Koos grade I VS who underwent SRS (SRS group) or were observed (observation group). Propensity score matching was used to equilibrate demographics, tumor size, and audiometric data across groups. The outcome analyzed included tumor control, preservation of serviceable hearing, and neurological function.</p><p><strong>Results: </strong>The study matched 142 patients, providing a median follow-up period of 36 months. SRS significantly enhanced tumor control compared with observation, with a 100% control rate at both 5- and 8-year marks in the SRS group vs 48.6% and 29.5% in the observation group at the same time intervals, respectively (P < .001). Preservation of serviceable hearing outcomes between groups showed no significant difference at 5 and 8 years, ensuring a comparable quality of auditory function (SRS 70.1% vs observation 53.4% at 5 years; P = .33). Furthermore, SRS was associated with a reduced likelihood of tinnitus (odds ratio [OR] = 0.46, P = .04), vestibular dysfunction (OR = 0.17, P = .002), and overall cranial nerve dysfunction (OR = 0.49, P = .03) at last follow-up.</p><p><strong>Conclusion: </strong>SRS management of patients with Koos grade I VS was associated with superior tumor control and reduced odds for cranial nerve dysfunction, while not compromising hearing preservation compared with observation. These findings support the safety and efficacy of SRS as a primary care approach for this patient population.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142582899","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-06DOI: 10.1227/neu.0000000000003216
Othman Bin-Alamer, Hussam Abou-Al-Shaar, Selcuk Peker, Yavuz Samanci, Isabelle Pelcher, Sabrina Begley, Anuj Goenka, Michael Schulder, Jean-Nicolas Tourigny, David Mathieu, Andréanne Hamel, Robert G Briggs, Cheng Yu, Gabriel Zada, Steven L Giannotta, Herwin Speckter, Sarai Palque, Manjul Tripathi, Saurabh Kumar, Rupinder Kaur, Narendra Kumar, Brandon Rogowski, Matthew J Shepard, Bryan A Johnson, Daniel M Trifiletti, Ronald E Warnick, Samantha Dayawansa, Elad Mashiach, Fernando De Nigris Vasconcellos, Kenneth Bernstein, Zane Schnurman, Juan Alzate, Douglas Kondziolka, Jason P Sheehan
Background and objectives: This study assessed the efficacy and safety of stereotactic radiosurgery (SRS) in comparison with watchful waiting for managing Koos grade II vestibular schwannomas (VS).
Methods: A retrospective, multicentric analysis was conducted, focusing on patients with Koos grade II VS who either received SRS (SRS group) or were observed (observation group). To ensure comparability between groups, propensity score matching was used, including factors such as demographic characteristics, tumor dimensions, and hearing assessments. The primary end points examined were tumor control, maintenance of serviceable hearing, and neurological outcomes.
Results: A total of 92 patients were equally matched across both cohorts, with a median follow-up of 37 months for the SRS group and 27.5 months for those observed. The SRS cohort exhibited superior tumor control over observation across 3, 5, and 8 years, achieving a 100% control rate vs 47.9%, 40.1%, and 34.3% for the observation group at these time intervals, respectively (P < .001). Serviceable hearing preservation rates were comparable between the 2 groups throughout 3, 5, and 7 years (72.9% for SRS vs 65.4% for observation at 3 years; P = .86). Moreover, SRS management correlated with a lower incidence of vestibular symptoms (odds ratio = 0.11, P = .002), with no significant disparity in the deterioration of cranial nerve (CN) V or CN VII functions. Notably, the likelihood of experiencing any CN impairment was significantly diminished in the SRS cohort (odds ratio = 0.47, P = .04).
Conclusion: For patients with Koos grade II VS, SRS offers superior tumor control rate and a lower risk of CN dysfunction without sacrificing hearing preservation.
背景和目的:本研究评估了立体定向放射外科手术(SRS)与观察等待治疗 Koos II 级前庭神经分裂瘤(VS)的疗效和安全性:进行了一项多中心回顾性分析,主要针对接受 SRS(SRS 组)或观察(观察组)的 Koos II 级 VS 患者。为确保组间的可比性,采用了倾向评分匹配法,包括人口统计学特征、肿瘤尺寸和听力评估等因素。研究的主要终点是肿瘤控制、听力维持和神经系统结果:两个队列中共有 92 名患者匹配度相同,SRS 组的中位随访时间为 37 个月,观察组的中位随访时间为 27.5 个月。在3年、5年和8年的随访中,SRS组的肿瘤控制率优于观察组,达到100%,而观察组在这些时间间隔内的肿瘤控制率分别为47.9%、40.1%和34.3%(P < .001)。在 3 年、5 年和 7 年期间,两组的听力保存率相当(3 年时,SRS 为 72.9% ,观察组为 65.4%;P = .86)。此外,SRS 治疗与较低的前庭症状发生率相关(几率比 = 0.11,P = .002),在颅神经 (CN) V 或 CN VII 功能恶化方面没有明显差异。值得注意的是,SRS 组群中出现任何 CN 功能障碍的可能性显著降低(几率比 = 0.47,P = .04):结论:对于 Koos II 级 VS 患者,SRS 可提供更高的肿瘤控制率和更低的 CN 功能障碍风险,同时不会牺牲听力的保护。
{"title":"Vestibular Schwannoma Koos Grade II International Study of Active Surveillance Versus Stereotactic Radiosurgery: The VISAS-K2 Study.","authors":"Othman Bin-Alamer, Hussam Abou-Al-Shaar, Selcuk Peker, Yavuz Samanci, Isabelle Pelcher, Sabrina Begley, Anuj Goenka, Michael Schulder, Jean-Nicolas Tourigny, David Mathieu, Andréanne Hamel, Robert G Briggs, Cheng Yu, Gabriel Zada, Steven L Giannotta, Herwin Speckter, Sarai Palque, Manjul Tripathi, Saurabh Kumar, Rupinder Kaur, Narendra Kumar, Brandon Rogowski, Matthew J Shepard, Bryan A Johnson, Daniel M Trifiletti, Ronald E Warnick, Samantha Dayawansa, Elad Mashiach, Fernando De Nigris Vasconcellos, Kenneth Bernstein, Zane Schnurman, Juan Alzate, Douglas Kondziolka, Jason P Sheehan","doi":"10.1227/neu.0000000000003216","DOIUrl":"10.1227/neu.0000000000003216","url":null,"abstract":"<p><strong>Background and objectives: </strong>This study assessed the efficacy and safety of stereotactic radiosurgery (SRS) in comparison with watchful waiting for managing Koos grade II vestibular schwannomas (VS).</p><p><strong>Methods: </strong>A retrospective, multicentric analysis was conducted, focusing on patients with Koos grade II VS who either received SRS (SRS group) or were observed (observation group). To ensure comparability between groups, propensity score matching was used, including factors such as demographic characteristics, tumor dimensions, and hearing assessments. The primary end points examined were tumor control, maintenance of serviceable hearing, and neurological outcomes.</p><p><strong>Results: </strong>A total of 92 patients were equally matched across both cohorts, with a median follow-up of 37 months for the SRS group and 27.5 months for those observed. The SRS cohort exhibited superior tumor control over observation across 3, 5, and 8 years, achieving a 100% control rate vs 47.9%, 40.1%, and 34.3% for the observation group at these time intervals, respectively (P < .001). Serviceable hearing preservation rates were comparable between the 2 groups throughout 3, 5, and 7 years (72.9% for SRS vs 65.4% for observation at 3 years; P = .86). Moreover, SRS management correlated with a lower incidence of vestibular symptoms (odds ratio = 0.11, P = .002), with no significant disparity in the deterioration of cranial nerve (CN) V or CN VII functions. Notably, the likelihood of experiencing any CN impairment was significantly diminished in the SRS cohort (odds ratio = 0.47, P = .04).</p><p><strong>Conclusion: </strong>For patients with Koos grade II VS, SRS offers superior tumor control rate and a lower risk of CN dysfunction without sacrificing hearing preservation.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142582980","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-04DOI: 10.1227/neu.0000000000003257
Erum Ajmal, Hamza Khilji, Ernest J Barthélemy, Tariq Khan
Background and objectives: Since its independence from India in 1947, Pakistan has struggled with economic crises such as global debt, corruption, constant regime change, and a decades-long war against terrorism. The resulting socioeconomic barriers have stymied efforts to develop a comprehensive and equitably accessible healthcare system, especially regarding safe, timely, and affordable surgical care. This article evaluates neurosurgery's development, current state, and prospects in Pakistan, a lower-middle-income country.
Methods: We performed a literature search using PubMed and analyzed relevant articles to better understand the state and landscape of neurosurgery in Pakistan. Moreover, we conducted ecological research by querying the databases of the World Bank and the Institute of Health Metrics and Evaluation to evaluate the neurological and neurosurgical disease burden in the Pakistani population.
Results: The neurosurgical workforce in Pakistan has demonstrated rapid growth over the past two decades, with approximately 450 neurosurgeons and a neurosurgeon-per-100 000 population density of 0.114. Nonetheless, access to essential neurosurgical procedures for the treatment of diseases such as stroke has been difficult to ensure, which likely contributes to Pakistan's stroke burden, ie, stroke was still the third most common cause of death in 2019, causing 21.7% of all deaths.
Conclusion: While Pakistan's political and economic instability has adversely affected the development of neurosurgery, the field has still made great strides and demonstrates a promising future in providing equitable neurosurgical care to all Pakistan's people.
{"title":"Neurosurgery in Pakistan: Past, Present, and Future.","authors":"Erum Ajmal, Hamza Khilji, Ernest J Barthélemy, Tariq Khan","doi":"10.1227/neu.0000000000003257","DOIUrl":"https://doi.org/10.1227/neu.0000000000003257","url":null,"abstract":"<p><strong>Background and objectives: </strong>Since its independence from India in 1947, Pakistan has struggled with economic crises such as global debt, corruption, constant regime change, and a decades-long war against terrorism. The resulting socioeconomic barriers have stymied efforts to develop a comprehensive and equitably accessible healthcare system, especially regarding safe, timely, and affordable surgical care. This article evaluates neurosurgery's development, current state, and prospects in Pakistan, a lower-middle-income country.</p><p><strong>Methods: </strong>We performed a literature search using PubMed and analyzed relevant articles to better understand the state and landscape of neurosurgery in Pakistan. Moreover, we conducted ecological research by querying the databases of the World Bank and the Institute of Health Metrics and Evaluation to evaluate the neurological and neurosurgical disease burden in the Pakistani population.</p><p><strong>Results: </strong>The neurosurgical workforce in Pakistan has demonstrated rapid growth over the past two decades, with approximately 450 neurosurgeons and a neurosurgeon-per-100 000 population density of 0.114. Nonetheless, access to essential neurosurgical procedures for the treatment of diseases such as stroke has been difficult to ensure, which likely contributes to Pakistan's stroke burden, ie, stroke was still the third most common cause of death in 2019, causing 21.7% of all deaths.</p><p><strong>Conclusion: </strong>While Pakistan's political and economic instability has adversely affected the development of neurosurgery, the field has still made great strides and demonstrates a promising future in providing equitable neurosurgical care to all Pakistan's people.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142568521","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-04DOI: 10.1227/neu.0000000000003244
Paul R Krafft, Ian Tafel, Anjali Khanna, Patrick Han, Rohit Khanna
Background and objectives: Dynamic craniotomy as opposed to a fixed plate craniotomy provides cranial decompression with a controlled outward bone flap movement to accommodate postoperative cerebral swelling and/or hemorrhage. The objective of this study was to evaluate if fixation of the bone flap following a trauma craniotomy with dynamic plates provides any advantage over fixed plates.
Methods: A review of our clinical series of 25 consecutive adult patients undergoing dynamic craniotomy with the Khanna NuCrani reversibly expandable bone flap fixation plates for the treatment of traumatic brain injury associated with mass lesions including subdural, epidural, and cerebral hematomas was conducted.
Results: Postoperative cerebral swelling was encountered in 21 of 25 patients (84%), which was compensated for with outward bone flap movement in all these patients and associated decreased midline shift. Severe brain swelling with outward bone flap movement of 8 mm or more was noted in 40% of the patients. All patients had a normal intracranial pressure after surgery. None of the patients required any reoperations for hematoma evacuation, rescue decompressive craniectomies, cranioplasty, or complications related to wound healing. The bone flap retracted after the resolution of the brain swelling, and none of the patients reported cosmetic symptoms related to bone flap or wound healing. Overall, 84% (21 of 25) of the patients achieved a good outcome.
Conclusion: Craniotomy bone flap fixation with dynamic plates is an alternative to craniotomy with fixed plates. The main advantage of dynamic craniotomy over a craniotomy with fixed plates is that it allows for immediate intracranial volume expansion with reversible outward bone flap migration in patients who may develop postoperative worsening brain swelling and/or hemorrhage, with decreased need for repeat surgeries and associated complications.
{"title":"Dynamic Craniotomy With Khanna NuCrani Plates as an Alternative to Craniotomy With Fixed Plates in Traumatic Brain Injury.","authors":"Paul R Krafft, Ian Tafel, Anjali Khanna, Patrick Han, Rohit Khanna","doi":"10.1227/neu.0000000000003244","DOIUrl":"https://doi.org/10.1227/neu.0000000000003244","url":null,"abstract":"<p><strong>Background and objectives: </strong>Dynamic craniotomy as opposed to a fixed plate craniotomy provides cranial decompression with a controlled outward bone flap movement to accommodate postoperative cerebral swelling and/or hemorrhage. The objective of this study was to evaluate if fixation of the bone flap following a trauma craniotomy with dynamic plates provides any advantage over fixed plates.</p><p><strong>Methods: </strong>A review of our clinical series of 25 consecutive adult patients undergoing dynamic craniotomy with the Khanna NuCrani reversibly expandable bone flap fixation plates for the treatment of traumatic brain injury associated with mass lesions including subdural, epidural, and cerebral hematomas was conducted.</p><p><strong>Results: </strong>Postoperative cerebral swelling was encountered in 21 of 25 patients (84%), which was compensated for with outward bone flap movement in all these patients and associated decreased midline shift. Severe brain swelling with outward bone flap movement of 8 mm or more was noted in 40% of the patients. All patients had a normal intracranial pressure after surgery. None of the patients required any reoperations for hematoma evacuation, rescue decompressive craniectomies, cranioplasty, or complications related to wound healing. The bone flap retracted after the resolution of the brain swelling, and none of the patients reported cosmetic symptoms related to bone flap or wound healing. Overall, 84% (21 of 25) of the patients achieved a good outcome.</p><p><strong>Conclusion: </strong>Craniotomy bone flap fixation with dynamic plates is an alternative to craniotomy with fixed plates. The main advantage of dynamic craniotomy over a craniotomy with fixed plates is that it allows for immediate intracranial volume expansion with reversible outward bone flap migration in patients who may develop postoperative worsening brain swelling and/or hemorrhage, with decreased need for repeat surgeries and associated complications.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142568507","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background and objectives: Photodynamic therapy (PDT) with talaporfin sodium is an intraoperative local therapy administered after the surgical removal of malignant gliomas. However, its clinical efficacy in a large patient population has not been determined. To analyze the clinical outcomes and prognosis in isocitrate dehydrogenase (IDH)-wildtype glioblastoma patients treated with PDT.
Methods: This retrospective study included patients with newly diagnosed IDH-wildtype glioblastoma treated at Kobe University Hospital between January 2013 and December 2022. PDT involves irradiation of the resection cavity with a 664-nm semiconductor laser after an intravenous infusion of talaporfin sodium. The main outcome measures were the recurrence patterns and survival times, which were compared between the PDT and non-PDT groups. Univariate and multivariate analyses were used to determine the prognostic factors. In addition, adverse events and prognostic factors in the PDT group were analyzed.
Results: A total of 44 and 56 patients were included in the PDT and non-PDT groups, respectively. The local recurrence rate was significantly lower in the PDT group than in the non-PDT group (51.3% vs 83.9%), whereas the distant recurrence and dissemination rates were significantly higher in the PDT group than in the non-PDT group (48.7% vs 16.1%). Two grade 3 adverse events were observed in the PDT group. The median progression-free survival and overall survival times were significantly longer in the PDT group than in the non-PDT group (progression-free survival: 10.8 vs 9.3 months, respectively, and overall survival: 24.6 vs 17.6 months, respectively). Multivariate analysis of the PDT groups revealed that younger age was an independent prognostic factor.
Conclusion: PDT with talaporfin sodium provided effective local control with minimal adverse effects. The survival time of the patients treated with PDT was significantly longer than that of the patients who did not receive PDT. Therefore, a randomized controlled clinical trial on PDT is warranted.
背景和目的:使用他拉泊芬钠的光动力疗法(PDT)是在手术切除恶性胶质瘤后进行的术中局部治疗。然而,其在大量患者中的临床疗效尚未确定。目的:分析接受过PDT治疗的异柠檬酸脱氢酶(IDH)-野生型胶质母细胞瘤患者的临床疗效和预后:这项回顾性研究纳入了2013年1月至2022年12月期间在神户大学医院接受治疗的新诊断IDH-野生型胶质母细胞瘤患者。PDT包括在静脉输注他拉泊芬钠后用664纳米半导体激光照射切除腔。主要结果指标是复发模式和生存时间,并在PDT组和非PDT组之间进行比较。单变量和多变量分析用于确定预后因素。此外,还分析了PDT组的不良事件和预后因素:结果:PDT 组和非 PDT 组分别有 44 名和 56 名患者。PDT组的局部复发率明显低于非PDT组(51.3% vs 83.9%),而PDT组的远处复发率和扩散率明显高于非PDT组(48.7% vs 16.1%)。PDT组出现了两例3级不良反应。PDT组的中位无进展生存期和总生存期明显长于非PDT组(无进展生存期:10.8个月对9.3个月,总生存期:24.6个月对17.6个月)。对PDT组进行的多变量分析表明,年龄较小是一个独立的预后因素:结论:使用他拉泊芬钠进行光动力疗法可有效控制局部病灶,且不良反应极小。结论:使用他拉泊芬钠进行光动力疗法可有效控制局部病灶,且不良反应极少,接受光动力疗法治疗的患者的生存时间明显长于未接受光动力疗法治疗的患者。因此,有必要对光导疗法进行随机对照临床试验。
{"title":"Clinical Benefits of Photodynamic Therapy Using Talaporfin Sodium in Patients With Isocitrate Dehydrogenase-Wildtype Diagnosed Glioblastoma: A Retrospective Study of 100 Cases.","authors":"Yosuke Fujimoto, Yuichi Fujita, Kazuhiro Tanaka, Hiroaki Nagashima, Shunsuke Yamanishi, Yusuke Ikeuchi, Hirofumi Iwahashi, Shoji Sanada, Yoshihiro Muragaki, Takashi Sasayama","doi":"10.1227/neu.0000000000003247","DOIUrl":"https://doi.org/10.1227/neu.0000000000003247","url":null,"abstract":"<p><strong>Background and objectives: </strong>Photodynamic therapy (PDT) with talaporfin sodium is an intraoperative local therapy administered after the surgical removal of malignant gliomas. However, its clinical efficacy in a large patient population has not been determined. To analyze the clinical outcomes and prognosis in isocitrate dehydrogenase (IDH)-wildtype glioblastoma patients treated with PDT.</p><p><strong>Methods: </strong>This retrospective study included patients with newly diagnosed IDH-wildtype glioblastoma treated at Kobe University Hospital between January 2013 and December 2022. PDT involves irradiation of the resection cavity with a 664-nm semiconductor laser after an intravenous infusion of talaporfin sodium. The main outcome measures were the recurrence patterns and survival times, which were compared between the PDT and non-PDT groups. Univariate and multivariate analyses were used to determine the prognostic factors. In addition, adverse events and prognostic factors in the PDT group were analyzed.</p><p><strong>Results: </strong>A total of 44 and 56 patients were included in the PDT and non-PDT groups, respectively. The local recurrence rate was significantly lower in the PDT group than in the non-PDT group (51.3% vs 83.9%), whereas the distant recurrence and dissemination rates were significantly higher in the PDT group than in the non-PDT group (48.7% vs 16.1%). Two grade 3 adverse events were observed in the PDT group. The median progression-free survival and overall survival times were significantly longer in the PDT group than in the non-PDT group (progression-free survival: 10.8 vs 9.3 months, respectively, and overall survival: 24.6 vs 17.6 months, respectively). Multivariate analysis of the PDT groups revealed that younger age was an independent prognostic factor.</p><p><strong>Conclusion: </strong>PDT with talaporfin sodium provided effective local control with minimal adverse effects. The survival time of the patients treated with PDT was significantly longer than that of the patients who did not receive PDT. Therefore, a randomized controlled clinical trial on PDT is warranted.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142568493","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-04DOI: 10.1227/neu.0000000000003256
Andrew N Chang, Deborah Boyett, Dean Chou, Andrew K Chan
Background and objectives: The authors report current 3-year and 5-year institutional bibliometric profiles and investigate the correlations between objective metrics of neurosurgical residency programs and social media presence, including residency program size, faculty count, Doximity rankings, and measures of research output.
Methods: A list of neurosurgery residency programs was obtained through the Doximity Residency Navigator. Publication history of faculty members was compiled using Scopus and analyzed to create institutional bibliometric profiles from 2018-2022 to 2020-2022. Mann-Whitney U tests were used to compare departmental metrics for institutions with and without social media accounts. Spearman rank correlations were used to examine the relationship between social media following and metrics, and between Twitter following and methods of Twitter use.
Results: 74% (n = 86) of neurosurgery programs have a Twitter account, 47% (n = 55) have a Facebook account, 63% (n = 73) have Instagram accounts, and 16% (n = 19) have LinkedIn accounts. The most notable differences were found when comparing departments with and without Twitter accounts, where a difference was found in all metrics except the average H-index. Residency program size, faculty count, average H-index, 3-year and 5-year publication and citation counts per faculty, and institutional H-indices were significantly correlated with Twitter following. Higher Doximity rankings were correlated with Twitter following and Facebook likes. There is a greater increase in 5-year citations per publication from 2009-2013 to 2018-2022 for institutions that created departmental Twitter accounts after 2013. Articles that were tweeted about had higher 3-year citations per publication than the institution's overall 3-year citations per publication.
Conclusion: Our findings provide updated insight into the relationship between social media presence and objective academic metrics of neurosurgery departments. We identify and quantify correlations between social media platforms and program characteristics, with a focus on research output. These metrics can be used to guide programs in their development of social media.
{"title":"Updated 5-Year Institutional Bibliometric Profiles for United States Neurosurgery Residency Programs and the Relationship Between Social Media Presence and Objective Departmental Metrics.","authors":"Andrew N Chang, Deborah Boyett, Dean Chou, Andrew K Chan","doi":"10.1227/neu.0000000000003256","DOIUrl":"https://doi.org/10.1227/neu.0000000000003256","url":null,"abstract":"<p><strong>Background and objectives: </strong>The authors report current 3-year and 5-year institutional bibliometric profiles and investigate the correlations between objective metrics of neurosurgical residency programs and social media presence, including residency program size, faculty count, Doximity rankings, and measures of research output.</p><p><strong>Methods: </strong>A list of neurosurgery residency programs was obtained through the Doximity Residency Navigator. Publication history of faculty members was compiled using Scopus and analyzed to create institutional bibliometric profiles from 2018-2022 to 2020-2022. Mann-Whitney U tests were used to compare departmental metrics for institutions with and without social media accounts. Spearman rank correlations were used to examine the relationship between social media following and metrics, and between Twitter following and methods of Twitter use.</p><p><strong>Results: </strong>74% (n = 86) of neurosurgery programs have a Twitter account, 47% (n = 55) have a Facebook account, 63% (n = 73) have Instagram accounts, and 16% (n = 19) have LinkedIn accounts. The most notable differences were found when comparing departments with and without Twitter accounts, where a difference was found in all metrics except the average H-index. Residency program size, faculty count, average H-index, 3-year and 5-year publication and citation counts per faculty, and institutional H-indices were significantly correlated with Twitter following. Higher Doximity rankings were correlated with Twitter following and Facebook likes. There is a greater increase in 5-year citations per publication from 2009-2013 to 2018-2022 for institutions that created departmental Twitter accounts after 2013. Articles that were tweeted about had higher 3-year citations per publication than the institution's overall 3-year citations per publication.</p><p><strong>Conclusion: </strong>Our findings provide updated insight into the relationship between social media presence and objective academic metrics of neurosurgery departments. We identify and quantify correlations between social media platforms and program characteristics, with a focus on research output. These metrics can be used to guide programs in their development of social media.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142568525","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01DOI: 10.1227/neu.0000000000003250
Annabelle Shaffer, Helen Kemprecos, Zelda Moran, Aaron T Anderson, Adam Tarr, John Flannell, Graham Huesmann, Tracey M Wszalek, Jerrad Zimmerman, Paul M Arnold
Background and objectives: Over a million sport-related concussions (SRC) affect children annually in the United States, posing a significant public health concern. Limited data exist on the premorbid risk factors and injury characteristics of SRCs in high school athletes. This study aims to understand acute SRC injury characteristics and describe premorbid risk factors in high school athletes.
Methods: Athletes (aged 14-19 years) from 19 central Illinois high schools participating in school-sponsored sports from 2009 to 2023 were included. Sports Concussion Assessment Tool evaluations were performed as part of preseason and postinjury evaluations. Injury characteristics, such as mechanism, setting, and symptoms, were described using all SRCs in the study period. Odds ratios (OR) were computed to determine risk factors using athletes with a baseline Sports Concussion Assessment Tool before SRC and nonconcussed athletes.
Results: In total, 4360 athletes were included (3953 without SRC; 407 with ≥1 SRC of whom 168 had a previous baseline). Overall, 24.2% of SRCs occurred in female athletes, and most SRCs occurred in competitions while playing American football (52.3%), soccer (20.4%), and basketball (7.6%). Blow/hit to the head was the most common mechanism. Headache was the most severe symptom (2.55 ± 1.51 [SD]), and symptoms of emotionality and nervousness/anxiety were significantly more severe in female athletes (P < .05). Students with previous concussions (OR 2.64 95% CI [1.81, 3.78]), previous hospitalization for head injury (OR 3.19 95% CI [1.9, 5.14]), headache/migraine disorders (OR 2.23 95% CI [1.29, 3.66]), and learning disabilities (OR 2.69 95% CI [1.47, 4.61]) had greater odds of SRC (P < .05). Lower odds of SRC were seen in athletes identifying as Black or African American (vs White) (OR 0.54 95% CI [0.32, 0.86]) and those attending larger (vs smaller) schools (OR 0.64 95% CI [0.46, 0.88]).
Conclusion: Understanding SRC risk factors and characteristics in high school athletes is critical for developing prevention and management programs, guiding neurosurgeons in mitigating SRC risk, and informing return-to-play decisions.
{"title":"Injury Characteristics and Risk Factors of Sport-Related Concussion Among High School Athletes in School-Sponsored Sports.","authors":"Annabelle Shaffer, Helen Kemprecos, Zelda Moran, Aaron T Anderson, Adam Tarr, John Flannell, Graham Huesmann, Tracey M Wszalek, Jerrad Zimmerman, Paul M Arnold","doi":"10.1227/neu.0000000000003250","DOIUrl":"https://doi.org/10.1227/neu.0000000000003250","url":null,"abstract":"<p><strong>Background and objectives: </strong>Over a million sport-related concussions (SRC) affect children annually in the United States, posing a significant public health concern. Limited data exist on the premorbid risk factors and injury characteristics of SRCs in high school athletes. This study aims to understand acute SRC injury characteristics and describe premorbid risk factors in high school athletes.</p><p><strong>Methods: </strong>Athletes (aged 14-19 years) from 19 central Illinois high schools participating in school-sponsored sports from 2009 to 2023 were included. Sports Concussion Assessment Tool evaluations were performed as part of preseason and postinjury evaluations. Injury characteristics, such as mechanism, setting, and symptoms, were described using all SRCs in the study period. Odds ratios (OR) were computed to determine risk factors using athletes with a baseline Sports Concussion Assessment Tool before SRC and nonconcussed athletes.</p><p><strong>Results: </strong>In total, 4360 athletes were included (3953 without SRC; 407 with ≥1 SRC of whom 168 had a previous baseline). Overall, 24.2% of SRCs occurred in female athletes, and most SRCs occurred in competitions while playing American football (52.3%), soccer (20.4%), and basketball (7.6%). Blow/hit to the head was the most common mechanism. Headache was the most severe symptom (2.55 ± 1.51 [SD]), and symptoms of emotionality and nervousness/anxiety were significantly more severe in female athletes (P < .05). Students with previous concussions (OR 2.64 95% CI [1.81, 3.78]), previous hospitalization for head injury (OR 3.19 95% CI [1.9, 5.14]), headache/migraine disorders (OR 2.23 95% CI [1.29, 3.66]), and learning disabilities (OR 2.69 95% CI [1.47, 4.61]) had greater odds of SRC (P < .05). Lower odds of SRC were seen in athletes identifying as Black or African American (vs White) (OR 0.54 95% CI [0.32, 0.86]) and those attending larger (vs smaller) schools (OR 0.64 95% CI [0.46, 0.88]).</p><p><strong>Conclusion: </strong>Understanding SRC risk factors and characteristics in high school athletes is critical for developing prevention and management programs, guiding neurosurgeons in mitigating SRC risk, and informing return-to-play decisions.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142558371","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01DOI: 10.1227/neu.0000000000003242
Helen Michaela de Oliveira, Lucas Mendes Barbosa, Fernanda Valeriano Zamora, Bruna Oliveira de Paula, Guilherme Oliveira de Paula, Julie G Pilitsis, Pablo Ramon Fruett da Costa
Background and objectives: Neuromodulation is an advanced therapeutic intervention for managing various neurological, psychiatric, and functional disorders. However, a significant challenge is the risk of infections at the device implantation site. Previous studies have shown that antibacterial envelopes used in cardiovascular surgeries significantly reduce infection risk. It is postulated that similar benefits could occur in neurosurgeries involving implant insertion, but the literature lacks studies analyzing this efficacy. This study aimed to evaluate the effectiveness of antibacterial envelopes in reducing infection rates associated with neuromodulation implants.
Methods: We systematically searched PubMed, Embase, and the Cochrane Central Register of Controlled Trials databases up to August 2024 for clinical trials comparing the use of antibacterial impregnated envelopes in patients undergoing neuromodulation-related implant insertion. This study followed Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Statistical analyses were performed using R version 4.3.2. Risk of bias was assessed using the Risk Of Bias In Nonrandomized Studies-of Interventions tool, and the quality of evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation assessment. The study was registered in Prospective Register of Systematic Reviews.
Results: Four studies, comprising 1242 patients, were included, of whom 704 (56.7%) received antibacterial envelopes. The pooled analysis showed that the odds of infection were 77% lower in patients using the antibacterial envelope compared with the control group (odds ratios = 0.23; 95% CI = 0.10-0.51; P < .001; I2 = 2%).
Conclusion: The use of an antibacterial envelope significantly reduces the odds of infection in patients undergoing neuromodulation-related implant insertion by 77%. These findings underscore the potential of antibacterial envelopes to improve postoperative outcomes.
背景和目的:神经调控是一种先进的治疗干预手段,可用于治疗各种神经、精神和功能性疾病。然而,一个重大挑战是装置植入部位的感染风险。先前的研究表明,心血管手术中使用的抗菌包膜可显著降低感染风险。据推测,神经外科手术中的植入物植入也会产生类似的益处,但文献中缺乏对这种功效的分析研究。本研究旨在评估抗菌包膜在降低神经调控植入物相关感染率方面的效果:我们系统地检索了 PubMed、Embase 和 Cochrane Central Register of Controlled Trials 数据库(截止到 2024 年 8 月)中关于比较在接受神经调控相关植入物的患者中使用抗菌浸渍包膜的临床试验。本研究遵循《系统综述和元分析首选报告项目》指南。统计分析使用 R 4.3.2 版本进行。使用 "非随机干预研究中的偏倚风险 "工具对偏倚风险进行了评估,并使用 "建议评估、开发和评价分级 "对证据质量进行了评估。该研究已在前瞻性系统综述注册中心注册:结果:共纳入了四项研究,包括 1242 名患者,其中 704 人(56.7%)接受了抗菌包膜治疗。汇总分析显示,与对照组相比,使用抗菌包膜的患者感染几率降低了 77%(几率比 = 0.23;95% CI = 0.10-0.51;P < .001;I2 = 2%):结论:使用抗菌包膜可将接受神经调控相关植入物插入手术的患者的感染几率大幅降低 77%。这些发现强调了抗菌包膜改善术后效果的潜力。
{"title":"Use of Antibacterial Envelopes in Neuromodulation Surgeries With Implantable Device Insertion: A Systematic Review and Meta-Analysis.","authors":"Helen Michaela de Oliveira, Lucas Mendes Barbosa, Fernanda Valeriano Zamora, Bruna Oliveira de Paula, Guilherme Oliveira de Paula, Julie G Pilitsis, Pablo Ramon Fruett da Costa","doi":"10.1227/neu.0000000000003242","DOIUrl":"https://doi.org/10.1227/neu.0000000000003242","url":null,"abstract":"<p><strong>Background and objectives: </strong>Neuromodulation is an advanced therapeutic intervention for managing various neurological, psychiatric, and functional disorders. However, a significant challenge is the risk of infections at the device implantation site. Previous studies have shown that antibacterial envelopes used in cardiovascular surgeries significantly reduce infection risk. It is postulated that similar benefits could occur in neurosurgeries involving implant insertion, but the literature lacks studies analyzing this efficacy. This study aimed to evaluate the effectiveness of antibacterial envelopes in reducing infection rates associated with neuromodulation implants.</p><p><strong>Methods: </strong>We systematically searched PubMed, Embase, and the Cochrane Central Register of Controlled Trials databases up to August 2024 for clinical trials comparing the use of antibacterial impregnated envelopes in patients undergoing neuromodulation-related implant insertion. This study followed Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Statistical analyses were performed using R version 4.3.2. Risk of bias was assessed using the Risk Of Bias In Nonrandomized Studies-of Interventions tool, and the quality of evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation assessment. The study was registered in Prospective Register of Systematic Reviews.</p><p><strong>Results: </strong>Four studies, comprising 1242 patients, were included, of whom 704 (56.7%) received antibacterial envelopes. The pooled analysis showed that the odds of infection were 77% lower in patients using the antibacterial envelope compared with the control group (odds ratios = 0.23; 95% CI = 0.10-0.51; P < .001; I2 = 2%).</p><p><strong>Conclusion: </strong>The use of an antibacterial envelope significantly reduces the odds of infection in patients undergoing neuromodulation-related implant insertion by 77%. These findings underscore the potential of antibacterial envelopes to improve postoperative outcomes.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142558374","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01DOI: 10.1227/neu.0000000000003222
Milos Duba, Dagmar Al Tukmachi, Tetiana Samoilenko, Marek Vecera, Michaela Ruckova, Tereza Vankova, Lenka Radova, Milos Kerkovsky, Marek Dostal, Tereza Koprivova, Ivana Roskova, Andrej Mrlian, Ondrej Hrdy, Jaroslav Duba, Leos Kren, Martin Smrcka, Ondrej Slaby, Pavel Fadrus, Jiri Sana
Background and objectives: Meningioma, the most common primary intracranial tumor, presents challenges in surgical treatment because of varying tissue stiffness. This study explores the molecular background of meningioma stiffness, a critical factor in surgical planning and prognosis, focusing on the utility of microRNAs (miRNAs) as diagnostic biomarkers of tissue stiffness.
Methods: Patients with meningiomas treated surgically at the University Hospital Brno were included in this study. Total RNA, isolated from tumor tissue samples, underwent quality control and small RNA sequencing to analyze miRNA expression. Differentially expressed miRNAs were identified, and their association with tumor stiffness was assessed.
Results: This study identified specific miRNAs differentially expressed in meningiomas with different stiffness levels. Key miRNAs, such as miR-31-5p and miR-34b-5p, showed significant upregulation in stiffer meningiomas. These findings were validated using reverse transcription-quantitative polymerase chain reaction, revealing a potential link between miRNA expression and tumor consistency. The expression of miR-31-5p was most notably associated with the stiffness of the tumor tissue (sensitivity = 71% and specificity = 83%).
Conclusion: This research highlights the potential of miRNAs as biomarkers for determining meningioma tissue stiffness. Identifying specific miRNAs associated with tumor consistency could improve preoperative planning and patient prognosis. These findings pave the way for further exploration of miRNAs in the clinical assessment of meningiomas.
{"title":"MicroRNA Analysis in Meningiomas with Different Degrees of Tissue Stiffness: A Potential Tool for Effective Preoperative Planning.","authors":"Milos Duba, Dagmar Al Tukmachi, Tetiana Samoilenko, Marek Vecera, Michaela Ruckova, Tereza Vankova, Lenka Radova, Milos Kerkovsky, Marek Dostal, Tereza Koprivova, Ivana Roskova, Andrej Mrlian, Ondrej Hrdy, Jaroslav Duba, Leos Kren, Martin Smrcka, Ondrej Slaby, Pavel Fadrus, Jiri Sana","doi":"10.1227/neu.0000000000003222","DOIUrl":"https://doi.org/10.1227/neu.0000000000003222","url":null,"abstract":"<p><strong>Background and objectives: </strong>Meningioma, the most common primary intracranial tumor, presents challenges in surgical treatment because of varying tissue stiffness. This study explores the molecular background of meningioma stiffness, a critical factor in surgical planning and prognosis, focusing on the utility of microRNAs (miRNAs) as diagnostic biomarkers of tissue stiffness.</p><p><strong>Methods: </strong>Patients with meningiomas treated surgically at the University Hospital Brno were included in this study. Total RNA, isolated from tumor tissue samples, underwent quality control and small RNA sequencing to analyze miRNA expression. Differentially expressed miRNAs were identified, and their association with tumor stiffness was assessed.</p><p><strong>Results: </strong>This study identified specific miRNAs differentially expressed in meningiomas with different stiffness levels. Key miRNAs, such as miR-31-5p and miR-34b-5p, showed significant upregulation in stiffer meningiomas. These findings were validated using reverse transcription-quantitative polymerase chain reaction, revealing a potential link between miRNA expression and tumor consistency. The expression of miR-31-5p was most notably associated with the stiffness of the tumor tissue (sensitivity = 71% and specificity = 83%).</p><p><strong>Conclusion: </strong>This research highlights the potential of miRNAs as biomarkers for determining meningioma tissue stiffness. Identifying specific miRNAs associated with tumor consistency could improve preoperative planning and patient prognosis. These findings pave the way for further exploration of miRNAs in the clinical assessment of meningiomas.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142558373","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}