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Marine animals such as the southern elephant seal (Mirounga leonina) rely on a productive marine environment and are vulnerable to oceanic changes that can affect their reproduction and survival rates. Davis Base, Antarctica, acts as a moulting site for southern elephant seals that forage in Prydz Bay, but the mitochondrial haplotype diversity and natal source populations of these seals have not been characterized. In this study, we combined genetic and animal tracking data on these moulting seals to identify levels of mitochondrial haplotype diversity, natal source population, and movement behaviours during foraging and haul-out periods. Using partial sequences of the mitochondrial control region, we identified two major breeding mitochondrial lineages of seals at Davis Base. We found that the majority of the seals originated from breeding stocks within the South Atlantic Ocean and South Indian Ocean. One seal was grouped with the Macquarie Island breeding stock (South Pacific Ocean). The Macquarie Island population, unlike the other two stocks, is decreasing in size. Tracking data revealed long-distance foraging activity of the Macquarie Island seal around Crozet Islands. We speculate that changes to the Antarctic marine environment can result in a shift in foraging and movement strategies, which subsequently affects seal population growth rates. [ABSTRACT FROM AUTHOR]

Background: In patients with lumbar spinal stenosis, female gender has been associated with higher pain and functional disability. Sarcopenia and multifidus atrophy have also been associated with symptomatic severity.Purpose: The purpose of this study was to determine if gender differences in sarcopenia and multifidus atrophy are associated with gender disparities in disease symptomatology.Study Design: Prospectively collected medical records and imaging studies were retrospectively reviewed.Patient Sample: We retrospectively reviewed medical records and imaging studies for 63 patients with clinically and radiologically defined lumbar spinal stenosis at L3/4 or L4/5 who underwent minimally invasive decompression.Outcome Measures: Pain and functional disability were measured using the Oswestry Disability Index (ODI) and visual analogue scores for back pain (VASB) and leg pain (VASL).Methods: Multifidus total cross sectional area (tCSA), multifidus functional cross sectional area (fnCSA), multifidus fatty infiltration (FI), psoas tCSA, and psoas relative cross sectional area (rCSA) were evaluated by univariable and multivariable regression to identify gender linked and gender independent predictors of higher ODI, VASB, and VASL.Results: Female gender was significantly associated with lower multifidus fnCSA (p < .001), higher multifidus FI (p < .001), lower psoas tCSA (p < .001), lower psoas rCSA (p = .002), and higher preoperative ODI (p = .008). Lower psoas rCSA (p = .044) and psoas tCSA in the lowest sex specific quartile (p = .034) were significantly associated with higher preoperative VASB and psoas rCSA less than the sex specific median (p = .050) was significantly associated with higher preoperative VASL after controlling for age and gender. Multifidus FI was significantly associated with preoperative ODI after adjusting for age (p = .048) but not after controlling additionally for gender (p = .651).Conclusions: Female patients with lumbar spinal stenosis may develop more severe and functionally significant multifidus atrophy, resulting in a more severe clinical course with higher functional disability. Sarcopenia was significantly associated with higher preoperative back pain and leg pain in both male and female patients with lumbar spinal stenosis. [ABSTRACT FROM AUTHOR]

The hydroxycinnamates (HCAs) ferulate and p-coumarate are among the most abundant constituents of lignin and their degradation by bacteria is an essential step in the remineralization of vascular plant material. Here, we investigate the catabolism of these two HCAs by the marine bacterium, Sagittula stellata E-37, a member of the roseobacter lineage with lignolytic potential. Bacterial degradation of HCAs is often initiated by the activity of a hydroxycinnamoyl-CoA synthase. Genome analysis of S. stellata revealed the presence of two feruloyl-CoA (fcs) synthase homologs, an unusual occurrence amongst characterized HCA degraders. In order to elucidate the role of these homologs in HCA catabolism, fcs1 and fcs2 were disrupted using insertional mutagenesis, yielding both single and double fcs mutants. Growth on p-coumarate was abolished in the fcs double mutant, whereas maximum cell yield on ferulate was only 2% of wildtype. Interestingly, the single mutants demonstrated opposing phenotypes: the fcs1 mutant showed impaired growth (extended lag and ~60% of wildtype rate) on p-coumarate and the fcs2 mutant showed impaired growth (extended lag and ~20% of wildtype rate) on ferulate, pointing to distinct, but overlapping roles of the encoded fcs homologs with fcs1 primarily dedicated to p coumarate utilization and fcs2 playing a dominant role in ferulate utilization. Finally, a TRAP family transporter was found to be required for growth on both HCAs. These findings provide evidence for functional redundancy in the degradation of HCAs in S. stellata E-37 and offer important insight into the genetic complexity of aromatic compound degradation in bacteria. [ABSTRACT FROM AUTHOR]

Objective In recent years, delivery of cost-effective “essential neurosurgery” in resource-limited communities has been recognized as an indispensable part of health care and a global health priority. The aim of this study was to review outcomes from operative management of spine trauma at a resource-limited government hospital in Phnom Penh, Cambodia, and to provide an epidemiologic report to guide prevention programs. Methods A retrospective review of a prospective neurosurgical database was performed to identify risk factors for spine trauma and severe spinal cord injury (American Spinal Injury Association A or American Spinal Injury Association B) and to evaluate the cost-effectiveness of surgery for patients treated at Preah Kossamak Hospital for subaxial and thoracolumbar spine trauma from 2013 to 2016. Results Surgical treatment was provided to 277 patients with cervical or thoracolumbar spine trauma, including 36 facet dislocations and 135 thoracolumbar burst fractures at a cost of $100–$280 per surgery. Six patients (2.2%) required treatment for postoperative wound infection. Reoperation was performed in 8 patients (2.9%) for wrong-level surgery. Failure of short-segment pedicle screw fixation was discovered in 4 patients (7.0%). Neurologic improvement was reported by 64 patients (65.3%) with incomplete spinal cord injury and available long-term follow-up. Conclusions Affordable neurosurgical care can be provided in a safe and sustainable manner to patients with traumatic spine and spinal cord injuries in resource-limited communities. This supports the call for essential neurosurgery to be made available around the world to individuals from all socioeconomic strata. [ABSTRACT FROM AUTHOR]

Antarctic subice environments are diverse, underexplored microbial habitats. Here, we describe the ecophysiology and annotated genome of a Marinobacter strain isolated from a cold, saline, iron-rich subglacial outflow of the Taylor Glacier, Antarctica. This strain (BF04_ CF4) grows fastest at neutral pH (range 6-10), is psychrophilic (range: 0°C-20°C), moderately halophilic (range: 0.8%-15% NaCl) and hosts genes encoding potential low temperature and high salt adaptations. The predicted proteome suggests it utilizes fewer charged amino acids than a mesophilic Marinobacter strain. BF04_ CF4 has increased concentrations of membrane unsaturated fatty acids including palmitoleic (33%) and oleic (27.5%) acids that may help maintain cell membrane fluidity at low temperatures. The genome encodes proteins for compatible solute biosynthesis and transport, which are known to be important for growth in saline environments. Physiological verification of predicted metabolic functions demonstrate BF04 CF4 is capable of denitrification and may facilitate iron oxidation. Our data indicate that strain BF04_ CF4 represents a new Marinobacter species, Marinobacter gelidimuriae sp. nov., that appears well suited for the subglacial environment it was isolated from. Marinobacter species have been isolated from other cold, saline environments in the McMurdo Dry Valleys and permanently cold environments globally suggesting that this lineage is cosmopolitan and ecologically relevant in icy brines. [ABSTRACT FROM AUTHOR]

Background The molecular mechanisms underlying cerebral vasospasm and delayed cerebral ischemia (DCI) after aneurysmal subarachnoid hemorrhage (aSAH) are incompletely understood. We hypothesized that circulating antiangiogenic factors, such as soluble Fms-like tyrosine kinase 1 (sFlt-1) and soluble transforming growth factor β coreceptor, soluble endoglin (sEng), are important markers of their pathophysiology. Methods We performed a prospective study in patients with aSAH and measured cerebrospinal fluid and serum levels of sFlt-1 and sEng on postbleed day 1 and 6 and correlated levels with incidence and severity of cerebral vasospasm and DCI. Results Twenty-seven patients with aSAH were enrolled in the study. Severe angiographic vasospasm was present in 14.8% of patients and DCI occurred in 33.3%. Serum sFlt1 levels were increased on postbleed day 6 in patients who developed vasospasm. However, on postbleed day 1, there were no differences in patients who developed vasospasm. Increased serum sFlt-1 levels on postbleed day 1 were found to predict the development of severe angiographic vasospasm with an area under the curve of 0.818 with an optimal cutoff value of 95 pg/mL. Alterations in sFlt1 were not associated with DCI. Serum and cerebrospinal fluid sEng levels did not correlate with vasospasm or DCI. Conclusions Serum levels of sFlt-1 are increased in patients with aSAH who are at risk for severe vasospasm. Further studies with larger sample sizes are needed to evaluate whether sFlt-1 levels may predict onset of severe vasospasm and DCI. [ABSTRACT FROM AUTHOR]

Introduction Established guidelines for radiologic surveillance after microsurgical treatment of intracranial aneurysms are lacking in the literature because of small sample sizes, poor definitions, and heterogeneous use of imaging modalities. We aimed to propose clinically meaningful definitions for postoperative aneurysm residual, recurrence, and de novo aneurysm formation and to analyze our long-term follow-up catheter angiography results in patients with microsurgically treated intracranial aneurysms. Methods A retrospective review of all aneurysms treated microsurgically in a consecutive, single-surgeon series from 1997 to present identified patients with long-term follow-up catheter angiography (>1 year after surgery). Clinical and radiologic data were collected for analysis. Results We identified 240 patients harboring 380 aneurysms (mean follow-up time, 6.0 ± 3.3 years per patient; range, 1.0–16.8 years). Postoperative residuals were present in 16 out of 346 clipped aneurysms (4.6%), of which only 3 were left unintentionally. Two out of 16 residual aneurysms (12.5%) demonstrated regrowth, with a regrowth risk of 2.1% per year from 93.6 patient-years of angiographic follow-up. Of 326 aneurysms with no postoperative residual, 5 (1.5%) demonstrated aneurysm recurrence, with a recurrence risk of 0.26% per year from 1931.9 patient-years of angiographic follow-up. Eight de novo aneurysms were identified in 240 patients (3.3%), with a risk of 0.6% per year from 1441.9 patient-years of angiographic follow-up. Conclusions Microsurgically treated aneurysms have a very low risk of postoperative residuals and aneurysm recurrence. Growth of residuals and de novo aneurysm formation justify following up with catheter angiography 3 to 5 years after microsurgical clipping. [ABSTRACT FROM AUTHOR]

Objective Neurologic condition at presentation is the most important predictor of morbidity and mortality from aneurysmal subarachnoid hemorrhage (aSAH). To guide management, it is important to identify patients who are at risk of presenting in poor neurologic condition after aSAH. Methods We retrospectively reviewed medical records and imaging studies for 387 consecutive cases of aSAH that were managed at a major academic neurovascular center in the United States from January 2008 to December 2013. Clinically accessible patient and aneurysm characteristics were evaluated by univariable analysis and multivariable logistic regression to identify predictors of poor neurologic status at presentation. Results For all aneurysms, multivariable logistic regression identified age (odds ratio [OR], 1.02; 95% confidence interval [CI], 1.00–1.04; P = 0.0129), aneurysm size (≥7 and <10 mm: OR, 1.78; 95% CI, 1.02–3.11; P = 0.0429; ≥10 mm: OR, 3.22; 95% CI, 1.82–5.70; P < 0.0001), and vertebrobasilar junction location (OR, 10.1; 95% CI, 1.93–52.5; P = 0.0060) as independent predictors of poor neurologic condition at presentation. For internal carotid artery (ICA) aneurysms, female gender (OR, 9.21; 95% CI, 1.54–55.1; P = 0.0151), hypertension (OR, 8.67; 95% CI, 1.80–41.7; P = 0.007), and size ≥7 mm (OR, 3.67; 95% CI, 0.852–15.8; P = 0.0807) were predictive of poor neurologic condition at presentation, with a C statistic of 0.842. No association was found between poor neurologic grade at presentation and smoking status or warfarin therapy. Conclusions Independent predictors of poor neurologic grade were identified for all, ICA, anterior cerebral artery/anterior communicating artery, middle cerebral artery, and posterior circulation aneurysms. A risk prediction chart was constructed using clinically accessible patient and aneurysm characteristics for poor presenting neurologic condition after ICA aneurysm rupture. These factors should be considered when counseling patients with unruptured intracranial aneurysms. [ABSTRACT FROM AUTHOR]

Variations of the anterior cerebral artery-anterior communicating artery complex are commonly identified in aneurysm surgery. An infraoptic course of the anterior cerebral artery is exceedingly rare. Robison first described this anomaly from an anatomic dissection in 1959. A unilateral anomalous infraoptic anterior cerebral artery is more common than anomalies of bilateral infraoptic anterior cerebral arteries. We present the case of an unruptured aneurysm at the anterior communicating artery in a patient with bilateral infraoptic anterior cerebral arteries, identified by computed tomography angiography and verified during surgery. Implications for aneurysm formation and surgical treatment are discussed. [ABSTRACT FROM AUTHOR]

Introduction More than 50% of people do not resume driving post-stroke. Potential disincentives include limited knowledge about assessment, access to services, cost and fear of failure. Factors contributing to a successful return to driving have been the focus of limited research. Aim To determine the proportion of people with stroke who successfully pass their first on-road occupational therapy driving assessment, and factors associated with a successful assessment outcome. Methods A retrospective cohort study design was used. The primary data collection method was a review of 441 consecutive occupational therapy driving assessment reports from one Australian metropolitan centre. Participants had a diagnosis of stroke, a driving licence pre-stroke and completed a driving assessment between 1999 and 2010. Results Of the 441 records analysed, the mean age of drivers was 65.4 years ( SD: 15.4). The majority (53.7%) passed their first assessment (pass/conditional pass); only 8.8% failed. A weak relationship was found between initial driving assessment outcome and time post-stroke (rs = 0.19), but a fair relationship with younger age (rs = 0.31) and higher scores on three off-road assessments (rs = −0.26 to −0.28). The strongest predictors of initial driving assessment outcome were off-road assessment scores, age, gender and time post-stroke (R2 = 19.7%, P < 0.01). Conclusions Data on stroke severity are required to confirm these preliminary predictors of driving assessment outcome. Stroke severity should be routinely documented by driving assessment services for use in future research. [ABSTRACT FROM AUTHOR]

Introduction: Subsequent osteoporotic vertebral fractures (SOVF) are a serious complication of osteoporosis that can lead to spinal deformity, chronic pain and disability. Several risk factors have been previously identified for developing SOVF. However, there are conflicting reports regarding the association between sarcopenia and multiple vertebral compression fractures. As such, the goal of this study was to investigate whether sarcopenia is an independent risk factor of SOVF. Methods: This was a retrospective case–control study of elderly patients who underwent percutaneous vertebral augmentation (PVA) due to a new osteoporotic vertebral compression fracture (OVCF). Collected data included: age, sex, BMI, steroid treatment, fracture level and type, presence of kyphosis at the level of the fracture and bone mineral density (BMD). Identification of SVOFs was based on clinical notes and imaging corroborating the presence of a new fracture. Sarcopenia was measured using the normalized psoas muscle total cross-sectional area (nCSA) at the L4 level. Results: Eighty-nine patients that underwent PVA were followed for a minimum of 24 months. Average age was 80.2 ± 7.1 years; 58 were female (65.2%) and 31 male (34.8%). Psoas muscle nCSA was significantly associated with age (p = 0.031) but not with gender (p = 0.129), corticosteroid treatment (p = 0.349), local kyphosis (p = 0.715), or BMD (p = 0.724). Sarcopenia was significantly associated with SOVF (p = 0.039) after controlling for age and gender. Conclusions: Psoas muscle nCSA can be used as a standalone diagnostic tool of sarcopenia in patients undergoing PVA. In patients undergoing PVA for OVCF, sarcopenia is an independent risk factor for SOVF. [ABSTRACT FROM AUTHOR]

Risk prediction requires comprehensive integration of clinical information and concurrent radiological findings. We present an upgraded chest radiograph (CXR) explainable artificial intelligence (xAI) model, which was trained on 241,723 well-annotated CXRs obtained prior to the onset of the COVID-19 pandemic. Mean area under the receiver operating characteristic curve (AUROC) for detection of 20 radiographic features was 0.955 (95% CI 0.938–0.955) on PA view and 0.909 (95% CI 0.890–0.925) on AP view. Coexistent and correlated radiographic findings are displayed in an interpretation table, and calibrated classifier confidence is displayed on an AI scoreboard. Retrieval of similar feature patches and comparable CXRs from a Model-Derived Atlas provides justification for model predictions. To demonstrate the feasibility of a fine-tuning approach for efficient and scalable development of xAI risk prediction models, we applied our CXR xAI model, in combination with clinical information, to predict oxygen requirement in COVID-19 patients. Prediction accuracy for high flow oxygen (HFO) and mechanical ventilation (MV) was 0.953 and 0.934 at 24 h and 0.932 and 0.836 at 72 h from the time of emergency department (ED) admission, respectively. Our CXR xAI model is auditable and captures key pathophysiological manifestations of cardiorespiratory diseases and cardiothoracic comorbidities. This model can be efficiently and broadly applied via a fine-tuning approach to provide fully automated risk and outcome predictions in various clinical scenarios in real-world practice. [ABSTRACT FROM AUTHOR]

Background: With the challenges that aging populations pose to health care, interventions that facilitate alleviation of age-related morbidities are imperative. A prominent risk factor for developing age-related morbidities is immunosenescence, characterized by increased chronic low-grade inflammation, resulting in T-cell exhaustion and senescence. Contact with nature and associated physical activities have been shown to boost immunity in older adults and may be promoted in the form of horticultural therapy (HT). We aimed to examine the effects of HT on immunosenescence.Method: We conducted a randomized controlled trial with 59 older adults assigned to either the HT intervention or waitlist control group. Older adults in the HT intervention group underwent HT intervention program over 6 months. Venous blood was drawn at baseline and at the third and sixth month from the commencement of this study. For participants who attended all 3 blood collection time points (HT: n = 22; waitlist: n = 24), flow cytometry analysis was performed on whole blood samples to evaluate the kinetics of lymphocyte subsets over the intervention period, revealing the composition of CD4+ and CD8+ subsets expressing exhaustion markers-CD57, CTLA4, and KLRG1. Enzyme-linked immunosorbent assays were employed to measure changes in plasma IL-6 levels.Results: HT is associated with increased numbers of naive CD8+ T cells and fewer CTLA4-expressing terminally differentiated effector CD4+ and CD8+ memory T cells re-expressing CD45RA (TEMRA). Furthermore, IL-6 levels were reduced during HT, and the frequencies of naive and TEMRA CD8+ T cells were found to be associated with IL-6 levels.Conclusion: HT is associated with a reduction in the levels of biomarkers that measure the extent of T-cell exhaustion and inflammaging in older adults. The positive effects of HT on T-cell exhaustion were associated with the reduction of IL-6 levels. [ABSTRACT FROM AUTHOR]

Vertebral compression fractures (VCFs) are a common cause of back pain and disability and are usually osteoporotic in nature. Therapy aims to adequately control pain and allow early mobilisation and return of function while preventing additional fractures. A proportion of patients do not achieve adequate pain relief using conservative measures alone. Unwanted adverse effects from medications may also ensue. Vertebroplasty represents an alternative treatment option for VCFs. Patients with acute VCFs (≤6 weeks old) may gain the most benefit from vertebroplasty as healed fractures are not as amenable to cement injection. High-quality studies have reported conflicting results regarding the use of vertebroplasty in the treatment of acute VCFs. Despite high-quality evidence, varying study designs and heterogenous patient cohorts make interpretation of this data difficult. Only one sham-controlled randomised controlled trial (RCT) has evaluated vertebroplasty exclusively in patients with acute VCFs, reporting favourable results. Pooled data from RCTs also suggest vertebroplasty to be safe. This article provides a concise and critical review of the current literature regarding vertebroplasty for the treatment of acute VCFs. [ABSTRACT FROM AUTHOR]

Background Stent-assisted coil embolization and flow diversion with the Pipeline embolization device (PED) are both effective endovascular treatment options for ophthalmic segment aneurysms (OSAs) of the internal carotid artery. Here we present a large comparative cohort study. Methods A multicenter, retrospective cohort comparison study of consecutively treated OSAs was conducted at 2 academic institutions in the United States comparing stent-coiling (between 2007 and 2015) and PED (between 2011 and 2016). Results A total of 62 of OSAs were treated with stent-coiling and 106 were treated with the PED. The stent-coiling–treated aneurysms were larger, although the maximum diameter was not significantly different between the 2 groups ( P = 0.05). The median duration of follow-up was 22.5 months for the stent-coiling group and 8.7 months for the PED group ( P = 0.0002). Complete occlusion at last follow-up was achieved in 75.9% of aneurysms in the stent-coiling group and in 81.1% of aneurysms in the PED group ( P = 0.516). The retreatment rate was higher with stent-coiling, but the difference did not reach statistical significance ( P = 0.062). A good functional outcome was achieved in 96.6% of patients in the stent-coiling group and in 94.7% of those in the PED group ( P = 0.707). The rate of neurologic complications was 4.8% in the stent-coiling group and 9.4% in the PED group ( P = 0.376). Conclusion Stent-coiling and the PED were equally effective for treating OSAs. There were no significant differences in terms of procedural complications, angiographic, functional, and visual outcomes. PED may be more favorable for multiple adjacent OSAs. [ABSTRACT FROM AUTHOR]

The original article can be found online at https://doi.org/10.1038/s41598-022-24721-5. Correction to: I Scientific Reports i https://doi.org/10.1038/s41598-022-24721-5, published online 07 December 2022 The original version of this Article contained an error in the spelling of the author Kyoung Doo Song which was incorrectly given as Kyungdoo Song. [Extracted from the article]

Background In an era of continued advancements in endovascular treatment of cerebral aneurysms, novel developments concerning microsurgical clipping are sparse. The Lazic aneurysm clip system represents such an advancement. The applier has a malleable shaft and is designed to minimally obstruct the view of the surgical field. The purpose of this study was to illustrate the transition to this new aneurysm clip system in an established cerebrovascular practice. Methods We retrospectively reviewed all aneurysms treated with microsurgical clipping using the Lazic aneurysm clip system in 1 cerebrovascular practice in the United States from January 2009 to June 2016. Results Between 2009 and 2016, a total of 973 aneurysms underwent surgical clipping. The Lazic clip system was used in 191 (19.6%) aneurysms (maximum diameter, 5.6 ± 3.8 mm) in 181 patients. The middle cerebral artery was the most frequent location (25.7%) followed by posterior communicating artery (20.9%). There was a continuous increase in the percentage of aneurysms treated with the Lazic clip system from 6% in 2009 to 98% in 2016. The proportion of posterior circulation aneurysms treated with Lazic clips decreased, whereas the middle cerebral artery location increased. There were a total of 11 complications (5.8%), but no instances of clip malfunction. Conclusions In the largest series to date, the Lazic clip system proved to be safe and efficacious and presents an interesting alternative to established aneurysm clip systems. This study illustrates the transition of an established cerebrovascular practice to the Lazic clip system. [ABSTRACT FROM AUTHOR]

Background: Moyamoya disease is a vascular disorder characterized by progressive stenosis of the internal carotid artery. The presentation, progression, treatment options, and post-operative clinical outcomes for elderly (60 and older) Moyamoya patients have never been reported. Methods: A retrospective analysis of all patients who were diagnosed with Moyamoya disease by the senior authors between 1991 and 2016 was performed. Patients who were 60 years or older at the time of surgery or last follow-up were further evaluated. Results: Seventy patients were diagnosed with probable or definite Moyamoya disease during the study period (1991-2016). Eight patients (11.4 %; six females: two males; median age 63; range, 60-71 years) were found to be 60 years or older at the time of surgery or last follow-up and were included in the study. All patients had a modified Rankin scale (mRS) of either one or two (median 1) pre-operatively. Six patients (75 %) underwent surgical treatment on a total on seven hemispheres. Post-surgery, one patient had an improved mRS score, three had no changes, and two had worsening in their mRS scores. Both patients who did not undergo surgical interventions suffered from intra-parenchymal hemorrhages post-diagnosis. Conclusions: Moyamoya disease is most commonly seen in young and middle-aged patients. Presentation in the elderly (defined as 60 years and older in this study) is rare, and has never been reported in the literature. In this study, both direct and indirect revascularization procedures demonstrated potential benefit in some of these patients, with stabilization of progressive symptoms. [ABSTRACT FROM AUTHOR]

Background Unruptured intracranial aneurysms (UIAs) are being detected and treated with endovascular techniques at an increasing rate, with little evidence on the optimal imaging follow-up protocol. We performed a survey of academic neurovascular centers in the United States to assess imaging follow-up strategies and costs after endovascular treatment of UIAs. Methods An online survey on 5-year follow-up strategies of UIAs treated with endovascular techniques was distributed to neurovascular directors of 101 academic neurovascular centers using the American Association of Neurological Surgeons/Congress of Neurological Surgeons Joint Cerebrovascular Section database. An online healthcare marketplace, NewChoiceHealth, was used to calculate costs. Results Of 33 (32.7%) institutions that responded to the survey, 26 (25.7%) provided data suitable for analysis. Nine (34.6%), 10 (38.5%), 4 (15.4%), and 3 (11.5%) centers were located in the northeastern, southern, midwestern, and western regions of the United States. Total costs of 5-year follow-up imaging after primary coil embolization and stent-assisted coiling procedures were $3391–$32,882. Costs for aneurysms treated with flow diversion were $2788–$46,670. Eighteen (69.2%) institutions performed cerebral angiography at 6-month follow-up after coil embolization and stent-assisted coiling, and 19 (73.1%) institutions performed cerebral angiography 6 months after flow diversion. Of institutions, 20% affirmed that they maintained an identical imaging follow-up regimen after treatment of ruptured aneurysms. Conclusions There is significant heterogeneity in imaging follow-up strategies and their associated costs. Stratification of patients by risk of recanalization and corresponding adjustment of follow-up imaging may be 1 strategy to limit unnecessary imaging and control costs. [ABSTRACT FROM AUTHOR]

Background and Objective Adhesions and scarring of the subcutaneous tissue to the dura mater or dural substitute often complicate cranioplasty. We present our experience with epidural bovine pericardium as a barrier membrane to minimize adhesions and facilitate separation of tissue layers. Methods A cohort of patients who underwent decompressive craniectomy and subsequent cranioplasty at a major academic institution in the United States from August 2007 to October 2013 and had epidural bovine pericardium placed as a barrier membrane was retrospectively reviewed. Medical records and imaging studies were reviewed for a number of variables including presence of adhesions, infection, contusions, and operative complications. Results Twenty-nine patients (male-to-female = 1:1.1; mean age 45 ± 14.7 years) who underwent decompressive craniectomy with placement of epidural bovine pericardium with subsequent cranioplasty were identified. The median interval between craniectomy and cranioplasty was 64 days, and autologous bone was used for cranioplasty in 86.2% of cases. The average size of cranial defect was 71.2 ± 28.5 cm 2 . At the time of cranioplasty, no or minimal adhesions were found between the subcutaneous tissue and the epidural bovine pericardium. There were 2 (6.9%) infections, 2 (6.9%) patients had contusion after the cranioplasty, and no patient had a complication after cranioplasty that required reoperation. Conclusions Epidural bovine pericardium at the time of decompressive craniectomy facilitates dissection at the time of cranioplasty and is not associated with any additional risks. [ABSTRACT FROM AUTHOR]