World Neurosurg
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There are numerous innovative and promising approaches aimed at slowing, reversing, or healing degenerative disc disease. However, multiple treatment-specific impediments slow progress toward realizing the benefits of these therapies. First, the exact pathophysiology underlying degenerative disc disease remains complicated and challenging to study. ⋯ Biological treatments are subject to the complex biomechanical environment in which native discs degenerate. The regulatory approval environment for these therapeutics will likely involve a high degree of scrutiny. Finally, patient selection and assessment of outcomes are a particular challenge in this clinical setting.
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High-speed motor vehicle accidents (MVAs) are an important cause of brachial plexus injury (BPI). Some case reports have demonstrated shoulder seat belt use resulting in traction injuries to the brachial plexus. We used a national trauma registry to determine the association between seat belt use and brachial plexus injury in MVAs. ⋯ Despite anecdotal evidence suggesting increased likelihood of BPI with shoulder seat belt use, case-control analysis from a national trauma registry demonstrated that both seat belt use and airbag deployment are associated with lower odds of sustaining BPIs in MVAs, with the greatest protective effect observed with combined use. Future studies adjusting for rider location (passenger vs. driver) and other potential confounders such as make, type and speed of vehicle may help further characterize this association.
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Comparative Study
Diffusion-weighted magnetic resonance imaging improves the accuracy of differentiation of benign from malignant peripheral nerve sheath tumors.
In patients with neurofibromatosis type 1 (NF1), it is important to accurately determine when plexiform neurofibroma (pNF) transforms to a malignant peripheral nerve sheath tumor (MPNST). The purpose of this study is to investigate the usefulness of diffusion-weighted imaging (DWI) in differentiating pNF and MPNST in NF1 patients. ⋯ ADC values determined by DWI are useful in differentiating MPNST from pNF and adding ADC evaluation to standard MRI evaluation improved the diagnostic accuracy.
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Observational Study
A Nomogram for Predicting Venous Thromboembolism in Critically Ill Patients with Primary Intracerebral Hemorrhage.
To develop and validate a nomogram for predicting the risk of venous thromboembolism in critically ill patients with primary intracerebral hemorrhage. ⋯ This nomogram comprising D-dimer, National Institutes of Health Stroke Scale score and Glasgow Coma Scale score on admission can accurately predict the risk of venous thromboembolism in critically ill patients with intracerebral hemorrhage.
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Idiopathic normal pressure hydrocephalus (iNPH) is a chronic neurologic syndrome that affects the elderly population in a context of concomitant medical conditions. The aim of this study was to understand the significance of comorbidities using 4 validated and specific clinical scores: Cumulative Illness Rating Scale (CIRS), American Society of Anesthesiologists (ASA) score, Comorbidity Index (CMI), and Charlson Comorbidity Index (CCI). ⋯ Patients with multiple comorbidities have a worse preoperative condition compared to patients with less concomitant diseases, and the proposed comorbidity scores, CIRS in particular, are useful clinical tools for the anesthesiologist. Comorbidities, though, do not impact overall postoperative outcome.