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The outcomes of carotid revascularization among octogenarians are not well studied. We present analyses of 30-day stroke and mortality of patients aged ≥80 years using real-world data from a national surgical quality registry.The National Surgical Quality Improvement Program targeted data set for carotid endarterectomy (CEA) and carotid angioplasty and stenting (CAS) was queried for patients aged ≥80 years undergoing CEA and CAS between 2012 and 2019.A total of 122 and 3013 patients aged ≥80 years with symptomatic carotid stenosis undergoing CAS and CEA, respectively, were identified. Patients with CAS were more likely to be older than 90 years (P = 0.006) and have diabetes (P = 0.036), were more likely to have high-risk anatomy (P0.001), but had lower American Society of Anesthesiologists score (P0.001). An ipsilateral stroke had been experienced by 43.6% of patients with CAS and 44.7% of patients with CEA. The rate of 30-day composite outcome was 6.4% in the CAS group and 4.5% in the CEA group (P = 0.326). The f 30-day mortality was significantly higher for CAS (5.6% vs. 1.7%, P = 0.001); however, the difference between the cohorts was not significant (CAS, 2.4% vs. CEA, 3.4%, P = 0.555). On multivariable analysis, CEA was associated with significantly lower odds of mortality (odds ratio [OR], 0.32; P = 0.0145). Symptom presentation other than ipsilateral stroke was associated with significantly decreased odds of 30-day outcome (amaurosis fugax/transient monocular blindness, OR, 0.39, P = 0.004; transient ischemic attack, OR, 0.57, P = 0.003), whereas higher age had significantly increased odds (OR, 1.95; P = 0.0172).Real-world analyses from a surgical quality registry show that CEA may be associated with lower odds of mortality compared with CAS among octogenarians.

Vertebrovertebral arteriovenous fistulas (VVAVFs) are rare entities that lack consensus guidelines for their management. Our case describes the successful treatment of a traumatic VVAVF via a contralateral deconstructive endovascular approach. A 64-year-old female presented following a traumatic fall. Computed tomography angiogram highlighted a 2 cm pseudoaneurysm of the right vertebral artery (VA) with epidural contrast enhancement and a hematoma with flow voids within the epidural space. Digital subtraction angiography showed a VVAVF at C2-3 with retrograde filling of the distal right VA. Having undergone several unsuccessful passes of the proximal dissection flap in the right VA, the patient underwent a contralateral deconstructive approach with correction of the VVAVF without complication. The remaining feeding branches had occluded after 1 week. The patient made a complete recovery without neurological sequelae at 3-month follow-up.

Background Given the potential for social media to allow widespread public engagement, its role in healthcare, including in cancer care as a support network, is garnering interest. To date, the use of social media in neuro-oncology has not been systematically explored. In the current manuscript, we sought to review Twitter use on glioblastoma among patients, caregivers, providers, researchers, and other stakeholders. Methods The Twitter application programming interface (API) database was surveyed from inception to May 2022 to identify tweets about glioblastoma. Number of tweet likes, retweets, quotes, and total engagement were noted for each tweet. Geographic location, number of followers, and number of Tweets were noted for users. We also categorized Tweets based on their underlying themes. A natural language processing (NLP) algorithm was used to assign a polarity score, subjectivity score, and analysis label to each Tweet for sentiment analysis. Results A total of 1690 unique tweets from 1000 accounts were included in our analyses. The frequency of tweets increased from 2013 and peaked in 2018. The most common category among users was MD/researchers (21.6%, n = 216), followed by Media/News (20%, n = 200) and Business (10.7%); patients or caregivers accounted for only 4.7% (n = 47) while medical centers, journals, and foundations accounted for 5.4%, 3.7%, and 2.1%. The most common subjects that Tweets covered included research (54%), followed by personal experience (18.2%) and raising awareness (14%). In terms of sentiment, 43.6% of Tweets were classified as positive, 41.6% as neutral, and 14.9% as negative; a subset analysis of “personal experience” tweets revealed a higher proportion of negative Tweets (31.5%) and less neutral tweets (25%). Only media (β = 8.4; 95% CI [4.4, 12.4]) and follower count (minimally) predicted higher levels of Tweet engagement. Conclusion This comprehensive analysis of tweets on glioblastoma found that the academic community are the most common user group on Twitter. Sentiment analysis revealed that most negative tweets are related to personal experience. These analyses provide the basis for further work into supporting and developing the care of patients with glioblastoma.

The Woven EndoBridge (WEB) device (Terumno Corp. [parent company of Microvention]) was approved by the U.S. Food and Drug Administration as the first intrasaccular device for intracranial aneurysm treatment in December 2018. Its use has become more common since then, but both trial results and postmarket experiences have raised questions about the efficacy in achieving complete aneurysm obliteration. Retreatment after WEB embolization has not been extensively discussed. OBJECTIVE: To discuss the incidence and retreatment of aneurysms after initial WEB embolization. METHODS: Retrospective review across 13 institutions identified all occurrences of WEB retreatment within neurovascular databases. Details regarding demographics, aneurysm characteristics, treatment considerations, clinical outcomes, and aneurysm occlusion were obtained and analyzed. RESULTS: Thirty aneurysms were retreated in 30 patients in a cohort of 342 WEB-treated aneurysms. The retreatment rate was 8.8%. Endovascular methods were used for 23 cases, and 7 were treated surgically. Two aneurysms presented with rehemorrhage after initial WEB embolization. Endovascular treatments included stent-assisted coiling (12), flow diversion (7), coiling (2), PulseRider (Johnson & Johnson)–assisted coiling (1), and additional WEB placement (1). Surgical treatments included primary clipping (6) and Hunterian ligation (1). There were no major complications within the study group. CONCLUSION: WEB retreatments were successfully performed by a variety of techniques, including stent-assisted coiling, clipping, and flow diversion as the most common. These procedures were performed safely with subsequent obliteration of most aneurysms. The potential need for retreatment of aneurysms should be considered during primary WEB treatments.

Background and ObjectivesThe care of patients with large vessel occlusion (LVO) stroke has been revolutionized by endovascular thrombectomy (EVT). While EVT has a large effect size, most patients treated with EVT remain disabled or die within 90 days. A better understanding of outcomes may influence EVT selection criteria, novel therapies, and prognostication. We sought to identify associations between outcomes and brain regions involved in ischemic lesions.MethodsFor this cohort study, consecutive patients with LVO who were treated with EVT and underwent post-EVT MRI were identified from a tertiary referral center (2011–2019). Acute ischemic lesions were manually segmented from diffusion-weighted imaging and spatially normalized. Individual lesions were parcellated (atlas-defined 94 cortical regions, 14 subcortical nuclei, 20 white matter tracts) and reduced to 10 essential lesion patterns with the use of unsupervised dimensionality reduction techniques. Ninety-day modified Rankin Scale (mRS) score (>2) was modeled via bayesian regression, taking the 10 lesion patterns as inputs and controlling for lesion size, age, sex, acute NIH Stroke Scale (NIHSS) score, alteplase, prior stroke, intracerebral hemorrhage, and good reperfusion (Thrombolysis in Cerebral Infarction 2b–3). In comparative analyses, 90-day mRS score was modeled considering covariates only, and compartment-wise relevances for acute stroke severity and 90-day mRS score were evaluated.ResultsThere were 151 patients with LVO identified (age 68 ± 15 years, 52% female). The median NIHSS score was 16 (interquartile range 13–20); 56% had mRS score >2. Lesion locations predictive of 90-day mRS score involved bilateral but left hemispherically more pronounced precentral and postcentral gyri, insular and opercular cortex, and left putamen and caudate (area under the curve 0.91, highest probability density interval [HPDI] covering 90% certainty 0.90–0.92). The lesion location model outperformed the simpler model relying on covariates only (bayesian model comparison of 97% weight to the model with vs 3% weight to the model without lesion location). While lesions affecting subcortical nuclei had the highest relevance for stroke severity (posterior distribution mean 0.75, 90% HPDI 0.256–1.31), lesions affecting white matter tracts had the highest relevance for 90-day mRS score (0.656, 90% HPDI 0.0864–1.12).DiscussionThese data describe the significance for outcomes of specific brain regions involved in ischemic lesions on MRI after EVT. Future work in additional datasets is needed to confirm these granular findings.

Purpose Flow diverting stents have revolutionized the treatment of intracranial aneurysms through endoluminal reconstruction of the parent vessel. Despite this, certain aneurysms require retreatment. The purpose of this study was to identify clinical and radiologic determinants of aneurysm retreatment following flow diversion. Methods A multicenter flow diversion database was evaluated to identify patients presenting with an unruptured, previously untreated aneurysm with a minimum of 12 months’ clinical and angiographic follow-up. Univariate and multivariate logistic regression modeling was performed to identify determinants of retreatment. Results We identified 189 aneurysms treated in 189 patients with a single flow-diverting stent. Mean age was 54 years, and 89% were female. Complete occlusion was achieved in 70.3% and 83.6% of patients at six and 12 months, respectively. Aneurysm retreatment with additional flow-diverting stents occurred in 5.8% of cases. Univariate analysis revealed that dome diameter [Formula: see text]10 mm ( p = 0.012), pre-clinoid internal carotid artery location ( p = 0.012), distal > proximal parent vessel diameter ( p = 0.042), and later dual antiplatelet therapy (DAPT) discontinuation ( p Conclusions Prolonged DAPT is the most important determinant of aneurysm retreatment following single-device flow diversion. Abbreviating DAPT duration to only six months should be a consideration in this population, especially for patients with a large aneurysm dome diameter.

Background Open surgery has traditionally been preferred for the management of bifurcation middle cerebral artery (MCA) aneurysms. Flow diverting stents present a novel endovascular strategy for aneurysm treatment. Objective To add to the limited literature describing the outcomes and complications in the use of flow diverters for the treatment of these complex aneurysms. Methods This is a multicenter retrospective review of MCA bifurcation aneurysms undergoing flow diversion. We assessed post-treatment radiological outcomes and both thromboembolic and hemorrhagic complications. Results We reviewed the outcomes of 54 aneurysms treated with flow diversion. Four (7.4%) of the aneurysms had a history of rupture (3 remote and 1 acute). Fourteen (25.9%) of the aneurysms already underwent either open surgery or coiling prior to flow diversion. A total of 36 out of the 45 aneurysms (80%) with available follow-up data had adequate aneurysm occlusion with a median follow-up time of 12 mo. There were no hemorrhagic complications but 16.7% (9/54) had thromboembolic complications. Conclusion Flow diverting stents may be a viable option for the endovascular treatment of complex bifurcation MCA aneurysms. However, compared to published series on the open surgical treatment of this subset of aneurysms, flow diversion has inferior outcomes and are associated with a higher rate of complications.

Cardiovascular disease is prevalent worldwide. The goal of this research is to evaluate the knowledge of Riyadh, Saudi Arabia, population about heart attack symptoms and risk factors.A one-year cross-sectional study was carried out. The study was conducted on 385 individuals in Riyadh, Saudi Arabia. We used the Acute Coronary Syndrome Response Index, with additional questions added, such as risk factors of heart attack and physical activity time. An anonymous self-administered online questionnaire was used to collect the data.We collected data from 440 participants, but only 385 were included in the analysis. Males represented 41.4% of the participants. In terms of participant knowledge of heart attack symptoms, we found that chest pain or pressure was the most common (80.5%), followed by shortness of breath (77%) and weakness and fatigue (72.0%). In addition, 90.2% and 90.7% of the participants knew that smoking and obesity were risk factors for heart attacks. Furthermore, 46% of participants said they "would not be at all certain" of identifying the symptoms and indicators of a heart attack in another person and 45.7% "in themselves." We found that males were more likely than females to have low knowledge (RR: 1.84, 95% CI: 1.24:2.72,Our findings suggest that there is a lack of awareness of the heart attack warning signs and symptoms. We propose that future local campaigns focus on increasing awareness and recognition of heart attack symptoms.

There is little data on patient and caregiver perceptions of spine surgery in children and youth. This study aims to characterize the personal experiences of patients, caregivers, and family members surrounding pediatric spine surgery through a qualitative and quantitative social media analysis. The Twitter application programming interface was searched for keywords related to pediatric spine surgery from inception to March 2022. Relevant tweets and accounts were extracted and subsequently classified using thematic labels. Tweet metadata was collected to measure user engagement via multivariable regression. Sentiment analysis using Natural Language Processing was performed on all tweets with a focus on tweets discussing the personal experiences of patients and caregivers. 2424 tweets from 1847 individual accounts were retrieved for analysis. Patients and caregivers represented 1459 (79.0%) of all accounts. Posts discussed the personal experiences of patients and caregivers in 83.5% of tweets. Pediatric spine surgery research was discussed in a few posts (n=90, 3.7%). Within the personal experience category, 975 (48.17%) tweets were positive, 516 (25.49%) were negative, and 533 (26.34%) were neutral. Presence of a tag (beta: -6.1, 95% CI -9.7 to -2.5) and baseline follower count (beta

BACKGROUND AND PURPOSE Ischemic diffusion-weighted imaging-fluid-attenuated inversion recovery (DWI-FLAIR) mismatch may be useful in guiding acute stroke treatment decisions given its relationship to onset time and parenchymal viability; however, it relies on subjective grading. Radiomics is an emerging image quantification methodology that may objectively represent continuous image characteristics. We propose a novel radiomics approach to characterize DWI-FLAIR mismatch. METHODS Ischemic lesions were visually graded for FLAIR positivity (absent, subtle, obvious) among consecutive large vessel occlusion stroke patients who underwent hyperacute MRI. Radiomic features were extracted from within the lesions on DWI and FLAIR. The DWI-FLAIR mismatch radiomics signature was built with features systematically selected by a cross-validated ElasticNet linear regression model of mismatch. RESULTS We identified 103 patients with mean age 68 ± 16 years; 63% were female. FLAIR hyperintensity was absent in 25%, subtle in 55%, and obvious in 20%. Inter-rater agreement for visual grading was moderate (Κ = .58). The radiomics signature of DWI-FLAIR mismatch included native FLAIR histogram kurtosis and local binary pattern-filtered FLAIR gray-level cluster shade; both correlated with visual grading (ρ = -.42, p

BackgroundRandomized trials have not demonstrated benefit from intravenous thrombolysis among patients undergoing endovascular thrombectomy (EVT). However, these trials included primarily patients presenting directly to an EVT capable hub center. We sought to study outcomes for EVT candidates who presented to spoke hospitals and were subsequently transferred for EVT consideration, comparing those administered alteplase at spokes (i.e., ‘drip-and-ship’ model) versus those not.MethodsConsecutive EVT candidates presenting to 25 spokes from 2018 to 2020 with pre-transfer CT angiography defined emergent large vessel occlusion and Alberta Stroke Program CT score ≥6 were identified from a prospectively maintained Telestroke database. Outcomes of interest included adequate reperfusion (Thrombolysis in Cerebral Infarction (TICI) 2b–3), intracerebral hemorrhage (ICH), discharge functional independence (modified Rankin Scale (mRS) ≤2), and 90 day functional independence.ResultsAmong 258 patients, median age was 70 years (IQR 60–81), median National Institutes of Health Stroke Scale (NIHSS) score was 13 (6-19), and 50% were women. Ninety-eight (38%) were treated with alteplase at spokes and 113 (44%) underwent EVT at the hub. Spoke alteplase use independently increased the odds of discharge mRS ≤2 (adjusted OR 2.43, 95% CI 1.08 to 5.46, p=0.03) and 90 day mRS ≤2 (adjusted OR 3.45, 95% CI 1.65 to 7.22, p=0.001), even when controlling for last known well, NIHSS, and EVT; it was not associated with an increased risk of ICH (OR 1.04, 95% CI 0.39 to 2.78, p=0.94), and there was a trend toward association with greater TICI 2b–3 (OR 3.59, 95% CI 0.94 to 13.70, p=0.06).ConclusionsIntravenous alteplase at spoke hospitals may improve discharge and 90 day mRS and should not be withheld from EVT eligible patients who first present at alteplase capable spoke hospitals that do not perform EVT. Additional studies are warranted to confirm and further explore these benefits.

BACKGROUND Degenerative cervical myelopathy (DCM) is a progressive neurologic condition caused by age-related degeneration of the cervical spine. Social media has become a crucial part of many patients’ lives; however, little is known about social media use pertaining to DCM. OBJECTIVE This manuscript describes the landscape of social media use and DCM in patients, caretakers, clinicians, and researchers. METHODS A comprehensive search of the entire Twitter application programing interface database from inception to March 2022 was performed to identify all tweets about cervical myelopathy. Data on Twitter users included geographic location, number of followers, and number of tweets. The number of tweet likes, retweets, quotes, and total engagement were collected. Tweets were also categorized based on their underlying themes. Mentions pertaining to past or upcoming surgical procedures were recorded. A natural language processing algorithm was used to assign a polarity score, subjectivity score, and analysis label to each tweet for sentiment analysis. RESULTS Overall, 1859 unique tweets from 1769 accounts met the inclusion criteria. The highest frequency of tweets was seen in 2018 and 2019, and tweets decreased significantly in 2020 and 2021. Most (888/1769, 50.2%) of the tweets’ authors were from the United States, United Kingdom, or Canada. Account categorization showed that 668 of 1769 (37.8%) users discussing DCM on Twitter were medical doctors or researchers, 415 of 1769 (23.5%) were patients or caregivers, and 201 of 1769 (11.4%) were news media outlets. The 1859 tweets most often discussed research (n=761, 40.9%), followed by spreading awareness or informing the public on DCM (n=559, 30.1%). Tweets describing personal patient perspectives on living with DCM were seen in 296 (15.9%) posts, with 65 (24%) of these discussing upcoming or past surgical experiences. Few tweets were related to advertising (n=31, 1.7%) or fundraising (n=7, 0.4%). A total of 930 (50%) tweets included a link, 260 (14%) included media (ie, photos or videos), and 595 (32%) included a hashtag. Overall, 847 of the 1859 tweets (45.6%) were classified as neutral, 717 (38.6%) as positive, and 295 (15.9%) as negative. CONCLUSIONS When categorized thematically, most tweets were related to research, followed by spreading awareness or informing the public on DCM. Almost 25% (65/296) of tweets describing patients’ personal experiences with DCM discussed past or upcoming surgical interventions. Few posts pertained to advertising or fundraising. These data can help identify areas for improvement of public awareness online, particularly regarding education, support, and fundraising.

Background Degenerative cervical myelopathy (DCM) is a progressive neurologic condition caused by age-related degeneration of the cervical spine. Social media has become a crucial part of many patients’ lives; however, little is known about social media use pertaining to DCM. Objective This manuscript describes the landscape of social media use and DCM in patients, caretakers, clinicians, and researchers. Methods A comprehensive search of the entire Twitter application programing interface database from inception to March 2022 was performed to identify all tweets about cervical myelopathy. Data on Twitter users included geographic location, number of followers, and number of tweets. The number of tweet likes, retweets, quotes, and total engagement were collected. Tweets were also categorized based on their underlying themes. Mentions pertaining to past or upcoming surgical procedures were recorded. A natural language processing algorithm was used to assign a polarity score, subjectivity score, and analysis label to each tweet for sentiment analysis. Results Overall, 1859 unique tweets from 1769 accounts met the inclusion criteria. The highest frequency of tweets was seen in 2018 and 2019, and tweets decreased significantly in 2020 and 2021. Most (888/1769, 50.2%) of the tweets’ authors were from the United States, United Kingdom, or Canada. Account categorization showed that 668 of 1769 (37.8%) users discussing DCM on Twitter were medical doctors or researchers, 415 of 1769 (23.5%) were patients or caregivers, and 201 of 1769 (11.4%) were news media outlets. The 1859 tweets most often discussed research (n=761, 40.9%), followed by spreading awareness or informing the public on DCM (n=559, 30.1%). Tweets describing personal patient perspectives on living with DCM were seen in 296 (15.9%) posts, with 65 (24%) of these discussing upcoming or past surgical experiences. Few tweets were related to advertising (n=31, 1.7%) or fundraising (n=7, 0.4%). A total of 930 (50%) tweets included a link, 260 (14%) included media (ie, photos or videos), and 595 (32%) included a hashtag. Overall, 847 of the 1859 tweets (45.6%) were classified as neutral, 717 (38.6%) as positive, and 295 (15.9%) as negative. Conclusions When categorized thematically, most tweets were related to research, followed by spreading awareness or informing the public on DCM. Almost 25% (65/296) of tweets describing patients’ personal experiences with DCM discussed past or upcoming surgical interventions. Few posts pertained to advertising or fundraising. These data can help identify areas for improvement of public awareness online, particularly regarding education, support, and fundraising.

Sex-specific differences in ischemic stroke outcomes are prevalent. We sought to investigate sex differences in the determinants of reperfusion and functional outcomes after endovascular thrombectomy (EVT) for emergent large vessel occlusion ischemic stroke (ELVO). Patients presenting to a single referral center with an anterior circulation ELVO that underwent EVT from 2011 to 2019 were included in this retrospective analysis. Sex differences in history, presentation, adequate reperfusion (TICI 2b-3), and 90-day good outcome [delta modified Rankin Scale (mRS) ≤ 2 from pre-stroke] were examined. Multivariable logistic regression analyses were performed to assess sex-specific associations with outcomes. Three hundred and eighty-one consecutive ELVO patients were identified. Women (N = 193) were older (75 vs 64 years, p

The Woven EndoBridge (WEB) can be used to treat wide-necked aneurysms without antiplatelet medications, suggesting it may have advantages in the setting of aneurysmal subarachnoid hemorrhage (aSAH). The goal was assessment of safety and efficacy of WEB in aSAH given the delayed nature of aneurysmal thrombosis. An international retrospective analysis of patients with aSAH treated with WEB was conducted at 7 tertiary centers from 2016 to 2020. Outcomes included rates of rebleeding, retreatment, complications, and complete occlusion. Furthermore, a systematic review and meta-analysis was conducted from 2011 to 2020 assessing the same outcomes. All pooled event rates were calculated using a random effect model. Consecutive patients with aSAH harbored 25 aneurysms that were treated with 29 WEB devices. The mean age was 53 years, and 65% were female. Zero experienced rebleeding, 2 were retreated, 2 experienced complications, 16 were completely occluded at 3 months, and 21 were completed occluded at 9–12 months. Meta-analysis of 309 WEB treatments for aSAH from 7 case series revealed 2.5% (95% CI 1–5%) had rebleeding, 9% (95% CI 4–17%) were retreated, 17% (95% CI 10–30%) had complications, and 61% (95% CI 51–71%) were completely occluded at 3–6 months. WEB embolization in the setting of aSAH provides similar protection against rebleeding with comparable retreatment rates to traditional approaches. However, there is a higher rate of incomplete radiographic occlusion and operative complications compared to WEB embolization of unruptured aneurysms. Long-term prospective studies are needed to fully delineate the role of WEB embolization in aSAH.

Background Transradial access for neurointerventional procedures was adopted and modified from cardiovascular intervention and is increasingly established as a safe and effective alternative to transfemoral catheterization. As social media influences public opinion on medical treatment, this study analyzes Twitter conversations to elucidate social media’s depiction of transradial access as a neurointerventional tool. Materials and methods Twitter hashtags #RadialFirst and #RadialForNeuro were evaluated using a mixed-method analysis of quantitative social media metrics and qualitative thematic analysis. Results Between January 2015 and April 2020, 104,146 tweets from 141 countries employed the hashtag #RadialFirst (2015 (1); 2016 (0); 2017 (22,804); 2018 (33,074); 2019 (38,352); 2020 (9,915 January-April)). These generated 226,909,374 impressions and were retweeted 80,120 times by 13,707 users. Media was present in 62.5% of tweets (e.g. wrist image, angiographic runs) but only 14.5% had a reference article. Physicians authored 70.8% of tweets; interventional cardiologists accounted for 83% of top 100 influencers. #RadialForNeuro is more nascent (6 posts in 2019; 323 posts January–April 2020), with 392,662 impressions, and 254 retweets by 177 users; physicians authored 35.6%. Compared to #RadialFirst, #RadialforNeuro tweets were more likely to include media (76%), less likely to include citations (9.7%), and more likely to discuss complications and troubleshooting techniques. Conclusion Twitter activity regarding transradial access permits information dissemination and discussion on approach benefits and challenges. However, many posts arise from non-physician sources and lack links to peer-reviewed publication. The public should be mindful that tweets may reflect opinions, rather than experience or scientific evidence.

Background Online education has provided an important tool to continue medical education during the COVID-19 pandemic. Our study aimed to evaluate trainee and attending perceptions of online webinars as an educational tool in neurosurgery. Methods We conducted a cross-sectional survey study. A web-based 19-question survey was distributed to the people who attended the webinar series that was carried out by the Saudi Association of Neurological Surgery from March 29, 2020 to May 31, 2020. Candidates were identified through their registration e-mails. The survey was distributed June 5–8, 2020. Results A total of 156 responses were received (survey response rate: 60%). The overall satisfaction rate among residents and attendings (board-certified neurosurgeons) was similar (>80%). However, only 56.4% of attendings reported they were comfortable with online webinars compared with 81.2% of residents (P value Conclusions Online educational webinars provide an educational value that can be considered as an adjunct to traditional (in-person) education methods. Among trainees, the satisfaction of neurosurgery webinars was encouraging to consider as an education method. More objective research and progress are required to adopt and refine existing online didactic and neurosurgical teaching tools while creating more engaging future distant learning models.

الملخص: أهداف البحث: تحقيق ابتسامة طبيعية أثناء استعادة الأسنان الأمامية يمثل تحديا. ويعد اختيار البعد المناسب للأسنان أمرا مهما للحصول على ابتسامة جميلة. الهدف من هذه الدراسة هو قياس وتحليل أبعاد الأسنان الأمامية العلوية، ونسب عرضها النسبي في المجتمع السعودي. طرق البحث: ضم البحث ١٨٠ (ذكور = ١١٢؛ إناث = ٦٨) شخصا لديهم جميع الأسنان الأمامية للفك العلوي (المدى العمري = ٢٠-٣٠) سنة. تم عمل طبعات الفك العلوي باستخدام مادة (فينيل-بولي سيلوكسان) وصبها. وتم استخدام الفرجار الرقمي لحساب طول وعرض الأسنان الأمامية العلوية من قوالب الأسنان بالمليمترات (ملم) وتم تصوير القوالب رقميا لحساب نسب العرض النسبية. النتائج: متوسط عرض القاطعة المركزية كان ٨.٧٤ ملم (ذكر = ٨.٨٩ ملم، أنثى = ٨.٦٠ ملم)، والقواطع الجانبية ٦.٦٤ملم (ذكر = ٦.٧٩ ملم؛ أنثى = ٦.٤٩ ملم) وكان الناب ٧.٨٢ملم (ذكر = ٨.٠١ ملم؛ أنثى = ٧.٦٣ ملم). ومتوسط الطول المسجل لهذه الأسنان كان ٩.٨٤ ملم (ذكر = ١٠.٠٤ملم، أنثى = ٩.٦٤ملم)، ٨.٠٩ ملم (ذكر = ٨.٣٠ ملم، أنثى = ٧.٨٩ملم) و٩.٠٨ ملم (ذكر = ٩.٤٨ ملم، أنثى = ٨.٦٩ ملم)، على التوالي. وكانت القيم المتوسطة لنسبة العرض النسبي التي تم قياسها على صور قوالب الأسنان ٦٣.٦٩ للقواطع الجانبية / القاطعة المركزية و٣٥.٧٨ للقاطع الناب / الجانبي. ولم توجد فروق ذات دلالة إحصائية بين القيم المتوسطة لنسبة العرض النسبي للجانب الأيمن والأيسر وبين الذكور والإناث. الاستنتاجات: لوحظ عدم وجود تماثل بين الأسنان الأمامية اليسرى واليمنى. وكانت نسبة العرض إلى الطول للقواطع المركزية والجانبية مماثلة لكلا الجنسين مع اختلاف طفيف في الأنياب. وتتخذ الأسنان الأمامية للسكان السعوديين شكلا أقرب للمربع مع تشابه في الأبعاد مع السكان الأتراك. Abstract: Objectives: Achieving a natural smile while restoring anterior teeth is challenging. Selecting appropriate dimensions of teeth is important for aesthetics. This study aims to measure and analyse the dimensions of the maxillary anterior teeth and their relative width proportions in a Saudi subpopulation. Methods: One hundred and eighty patients (112 men and 68 women) with intact maxillary anterior teeth (age range = 20–30 years) participated in this research. Maxillary impressions (Vinyl Polysiloxane) were created and poured. A digital caliper was used to record the length and width of maxillary anterior teeth in millimetres (mm) from the dental casts, and the casts were digitally photographed to calculate relative width ratios. Results: The mean width for central incisor was 8.74 mm (men = 8.89 mm, women = 8.60 mm), lateral incisor 6.64 mm (men = 6.79 mm, women = 6.49 mm) and canine 7.82 mm (men = 8.01 mm women = 7.63 mm). The recorded mean lengths for these teeth were 9.84 mm (men = 10.04 mm, women = 9.64 mm), 8.09 mm (men = 8.30 mm, women = 7.89 mm) and 9.08 mm (men = 9.48 mm, women = 8.69 mm). The mean values of apparent width/width ratio measured on the cast photographs were 63.69 mm for the lateral incisor/central incisor and 78.35 mm for canine/lateral incisor. No statistically significant difference was found between the mean values of the apparent width/width ratio of the right and left sides and between men and women. Conclusions: This study showed a minor asymmetry between left and right side anterior teeth among the participants. The width to length ratio of the central and lateral incisors was similar for both genders, with minor differences in the canines. A squarish form of anterior teeth for the Saudi population with dimensional similarities to the Turkish population was found.

This case study aims to determine the effect of five-dimensional regularization and interpolation on seismic subsurface imaging, particularly focusing on impacts to noise attenuation, velocity analysis, and migration. Advanced seismic processing requires high fold coverage and regular cross-spread data to attain good noise attenuation and common offset vectors for appropriate migration. Complex geological scenarios pose substantial challenges for subsurface imagers and interpreters. Stratton Field, USA, contains a major fault, Agua Dulce, along with many smaller faults and thus requires dense acquisition for high-resolution subsurface imaging to reduce migration smiles. Data were processed twice, the first migration without 5D regularization and interpolation and the second with 5D regularization and interpolation. The migration without 5D regularization and interpolation was found to suffer from acquisition footprints, migration smiles and a lack of amplitude versus offset (AVO) behavior, whereas the subsurface image was enhanced with 5D regularization and interpolation and improved in terms of AVO behavior.

In the current study, the geotechnical properties of the near-surface geological units are collected, tested, correlated, evaluated, and then mapped. In addition, the groundwater level is estimated through comprehensive geotechnical investigations conducted in and around the entire Holy city of Makkah Al-Mukarramah. Based on the measured standard penetration test (SPT), the soil materials vary from soft to very dense materials where SPT ranges from 4 to >50 and increases with depth. On the other hand, the calculated rock quality designation (RQD), the rock quality spans from very poor to good where RQD changes from 0 to 80%. Accordingly, the ground conditions of Makkah can de differentiated into eight subsoil and rock units with various geotechnical properties. Moreover, it is indicated that the physical and chemical nature of these sub-soil and rock units have a considerable effect on the foundations of the constructions that may be risky in the future. The continuous evaluation of the geotechnical and chemical properties for the future projects on these soils and even rock units is highly recommended. These results will greatly support civil engineers and urban designers in the Makkah Al-Mukarramah municipality. Keywords: Geotechnical assessment, Chemical and physical properties, Ground conditions, Boreholes, Makkah, Saudi Arabia

Objective: The aim of the study was to assess the failure loads and compressive stresses among bilayered press on Y-TZP (POZ) and press on metal (POM) crowns with different core-veneer thickness. Methods: Thirty metal and Y-TZP copings were fabricated using CAD-CAM technology with specified thickness. All copings were veneered with ceramic materials using hot pressing technique, with 2mm and 2.5mm thickness. The different coping veneer thickness of crowns resulted in six study groups, including, POM: Coping/ veneer thickness of 0.7/2mm (Gp1), 0.7/2.5mm (Gp 2) and 1mm/2mm (Gp 3)- POZ: 0.7/2mm (Gp A), 0.7/2.5mm (Gp B) and 1mm/2mm (Gp C). Crowns were cemented to a standard implant analog and failure loads (FL) and compressive stress (CS) was ascertained by controlled load application in a universal testing machine. Data was analysed using ANOVA and multiple comparisons test. Results: The maximum FL were observed in the POM specimens with a C/V ratio of 1/2 (Group 3-1880.67± 256.78 N), however the lowest FL were exhibited by POZ crowns with 1/2 C/V ratio (Group C-611.89± 72.79 N). Mean FL and CS were significantly higher in POM compared to POZ crowns in respective groups. Increasing the coping-veneer thickness increased FL and CS among POM crowns. Increasing veneer and decreasing coping thickness improved FL and CS among POZ crowns. Conclusions: Press on metal specimen showed higher resistance to fracture than Press on Y-TZP specimens. Improved failure loads were observed in thin coping and thick veneers among Press on Y-TZP crowns. doi: https://doi.org/10.12669/pjms.36.7.2472 How to cite this:Vohra F, Shuwaish MB, Al-Deeb M, Alhamdan R, Alotaibi N, Abduljabbar T. Comparison of failure loads and compressive stress in Press on metal and Press on Y-TZP copings. Pak J Med Sci. 2020;36(7):1645-1650. doi: https://doi.org/10.12669/pjms.36.7.2472 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Given the efficacy of endovascular thrombectomy (EVT), optimizing systems of delivery is crucial. Magnetic resonance imaging (MRI) is the gold standard for evaluating tissue viability but may require more time to obtain and interpret. We sought to identify determinants of arrival-to-puncture time for patients who underwent MRI-based EVT selection in a real-world setting.Patients were identified from a prospectively maintained database from 2011-2019 that included demographics, presentations, treatments, and outcomes. Process times were obtained from the medical charts. MRI times were obtained from time stamps on the first sequence. Linear and logistic regressions were used to infer explanatory variables of arrival-to-puncture times and effects of arrival-to-puncture time on functional outcomes.In this study 192 patients (median age 70 years, 57% women, 12% non-white) underwent MRI-based EVT selection. 66% also underwent computed tomography (CT) at the hub before EVT. General anesthesia was used for 33%. Among the entire cohort, the median arrival-to-puncture was 102 min; however, among those without CT it was 77 min. Longer arrival-to-puncture times independently reduced the odds of 90-day good outcome (∆mRS ≤ 2 from pre-stroke, aOR = 0.990, 95%CI = 0.981-0.999, p = 0.040) when controlling for age, NIHSS, and good reperfusion (TICI 2b-3). Independent determinants of longer arrival-to-puncture were CT plus MRI (β = 0.205, p = 0.003), non-white race/ethnicity (β = 0.162, p = 0.012), coronary disease (β = 0.205, p = 0.001), and general anesthesia (β = 0.364, p 0.0001).Minimizing arrival-to-puncture time is important for outcomes. Real-world challenges exist in an MRI-based EVT selection protocol; avoiding double imaging is key to saving time. Racial/ethnic disparities require further study. Understanding variables associated with delay will inform protocol changes.

Shear-wave velocity profiles are the main site-specific data for site classification, which are commonly used for the purposes of seismic microzonation and hazard assessment. The controlled-source spectral analysis of surface wave (CSSASW) dispersion measurements have been successfully performed to characterize seismic sites up to 30-m depths. This study utilizes the CSSASW application in Jizan City to obtain shear-wave velocity profiling at 14 sites distributed throughout the city using an electromagnetic vibrator. The recorded Rayleigh wave phase velocity dispersion curves are transformed to calculate the apparent velocity distribution in depth. Shear-wave velocities, calculated using theoretical relationships, can then be utilized to obtain design parameters for the soil strata. Shear-wave velocity varies from 216.97 to 829.59 m/s through Jizan City indicating the remarkable change of the near-surface sediments. The hard soil profiles of soft rock that were revealed by Vs values in this terrain (sites No. 7, 8, and 13) can be attributed to the existence of a dense layer of salt rock. Construction in such areas is prohibited due to the high susceptibility of large settlements in foundations as a consequence of salt dissolution. In the Sabkha terrains, all soil profiles were related to Vs, defined as stiff soils that were then modified to a softer class owing to their high liquefaction potential. These results should be considered before establishing important and strategic projects in the city.

OBJECTIVE This study aims to glean patient and caregiver perspectives surrounding deep brain stimulation (DBS) in children and youth through an analysis of patterns of social media usage. METHODS The authors performed a comprehensive search of the Twitter Application Programming Interface (API) database for all tweets about DBS use in children and youth, with no date restriction. Data pertaining to each tweet were extracted for analysis. Results were analyzed using qualitative and quantitative methodologies. These included thematic analysis of tweets, accounts, and descriptive statistics. Sentiment analysis of extracted tweets was also performed. A multivariable regression model was used to identify predictors of higher engagement metrics (likes, retweets, and quotes). RESULTS A comprehensive search of the Twitter database yielded 877 tweets from 816 unique accounts meeting study inclusion criteria. Most tweets were from patients or caregivers, researchers, or news media outlets. The most common themes among analyzed tweets were research discussing novel findings (45.2%) or personal experiences of patients or caregivers (27.4%). Sentiment analysis showed that 54.5% of tweets were positive, 35.1% were neutral, and 10.4% were negative. The presence of pictures or videos increased the tweet engagement count by an average of 10.5 (95% CI 7.3–13.6). Tweets about personal patient experiences (β = 6, 95% CI 0.95–12) and tweets tagging other accounts (β = 3.2, 95% CI 0.63–5.8) were also significantly associated with higher engagement metrics. CONCLUSIONS The current study is the first to assess patient and caregiver perspectives surrounding pediatric DBS through a comprehensive analysis of social media usage. Given the nascent field, social media presents an opportunity to share experiences and promote patient and healthcare professional education surrounding pediatric DBS.

The study area has a complex geological structure and is studied for mapping the density interfaces using geophysical techniques. However, it has not been studied for mapping geological structures, such as contacts and faults that appear as lineaments in gravity data. In this study, the lineaments in the area have been delineated using Bouguer gravity anomaly data, though some modern processing methods, such as horizontal gradient amplitude (HGA), tilt angle of horizontal gradient amplitude (THGA), and enhancement of horizontal gradient amplitude (EHGA). Most of the identified lineaments are trending in the NW–SE direction and some WE-trending lineaments in the southeastern region. This study provides new information for a better understanding of the structural framework and tectonic setting of the Thua Thien Hue area.

BackgroundThe Woven EndoBridge (WEB) device is a novel intrasaccular flow disruptor tailored for bifurcation aneurysms. We aim to describe the degree of aneurysm occlusion at the latest follow-up, and the rate of complications of aneurysms treated with the WEB device stratified according to rupture status.MethodsOur data were taken from the WorldWideWeb Consortium, an international multicenter cohort including patients treated with the WEB device. Aneurysms were classified into two groups: ruptured and unruptured. We compared clinical and radiologic outcomes of both groups. Propensity score matching (PSM) was done to match according to age, gender, bifurcation, location, prior treatment, neck, height, dome width, daughter sac, incorporated branch, pretreatment antiplatelets, and last imaging follow-up.ResultsThe study included 676 patients with 691 intracranial aneurysms (529 unruptured and 162 ruptured) treated with the WEB device. The PSM analysis had 55 pairs. In both the unmatched (85.8% vs 84.3%, p=0.692) and matched (94.4% vs 83.3%, p=0.066) cohorts there was no significant difference in the adequate occlusion rate at the last follow-up. Likewise, there were no significant differences in both ischemic and hemorrhagic complications between the two groups. There was no documented aneurysm rebleeding after WEB device implantation.ConclusionThere was no significant difference in both the radiologic outcomes and complications between unruptured and ruptured aneurysms. Our findings support the feasibility of treatment of ruptured aneurysms with the WEB device.

Ninety-one geotechnical boreholes were drilled throughout Jizan City and the subsoil profiles were modeled. The SPT-N values were corrected to the N60 parameter. Then, the calculated shear wave velocity for 30 m depth (Vs30) varies between 196.086 and 589.931 m/s. Moreover, the site soil was classified into two of soil classes detected. Thereafter, the site response with SMSIM software is assigned at all borehole locations using Vs30, predominant frequency, and corresponding amplitude amplification factor. The estimated amplification factor varied between 1.6 and 18.2, reflecting the significant difference in the thicknesses of soil. The values of high amplification extend in a north–south strip to the west indicating very soft/loose sediments with a considerable thickness. Higher fundamental frequency values extend due north along the coast until the Ash-Shati and Ar-Rawabi districts verifying the compacted sediments. The peak ground acceleration (PGA) has been estimated for 91 borehole sites at bedrock level in the Jizan area using Mw 6.25 earthquake magnitude. This PGA was used to generate an ArcGIS contour map. The values of the PGA for the bedrock vary between 4.8 and 10.7 cm/s2. Moreover, PGA is computed at the ground surface level, where it varies between 7.7 and 32.0 cm/s2. Finally, the ground motion response spectra were also estimated with 5% critical damping for the locations of all of the boreholes. The pseudo-spectral acceleration (PSA) and its corresponding frequency/period were calculated for the 91 borehole locations. The values of the maximum PSA ranged between 17 and 103 cm/s2, covering the western zone of the Jizan study area. Furthermore, the PSAs were computed for 1.5, 3, 5, 8, and 10 Hz at 91 locations, and then contoured using the ArcGIS package. This frequency range from 1.5 to 10 Hz represents the range in the natural frequencies for tall to low-rise buildings.

Background Aneurysms of the anterior choroidal artery (AChA) have been associated with high treatment-associated morbidity due to ischemic complications. Objective To report a large clinical experience of microsurgically treated AChA aneurysms and describe a systematic approach to reduce ischemic complications. Methods One hundred forty-six patients with AChA aneurysms were retrospectively reviewed from a prospectively maintained database. Clinical characteristics, surgical techniques, clinical outcomes, arterial infarction, and use of intraoperative adjuncts (ie, ultrasonography, indocyanine green videoangiography, and neuromonitoring) were analyzed. Results In total, one hundred forty-three aneurysms (97.9%) were clipped. Temporary clipping was utilized in 47 cases (32.2%) with mean occlusion time of 5.6 min. Arterial infarction occurred in 12 patients (8.2%). In clipped aneurysms, 90.5% were completely obliterated, 8.8% had minimal residual ( 5% of original). Mortality (2.7%) was limited to patients with high-grade subarachnoid hemorrhage. Indocyanine green videoangiography and neuromonitoring altered operative technique in ∼20% of cases. Multivariate logistic regression identified intraoperative rupture as the sole predictor for arterial infarction. Conclusion Open microsurgical clipping remains a safe, effective treatment for AChA aneurysms. Microsurgical technique is paramount in preserving AChA patency and reducing ischemic complications. Despite increasing reliance on qualitative measures of AChA blood flow (videoangiography and ultrasonography) and neurophysiological monitoring, these technologies aid us infrequently. However, these adjuncts provide important safety checks for AChA patency. Temporary clipping must be used judiciously to lower the risk of intraoperative rupture while limiting possible ischemia in the AChA territory.

Computer-assisted navigation (CAN) improves the accuracy of spinal instrumentation in vertebral fractures and degenerative spine disease; however, it is not widely adopted because of lack of training, high capital costs, workflow hindrances, and accuracy concerns. We characterize shifts in the use of spinal CAN over time and across disciplines in a single-payer health system, and assess the impact of intra-operative CAN on trainee proficiency across Canada.A prospectively maintained Ontario database of patients undergoing spinal instrumentation from 2005 to 2014 was reviewed retrospectively. Data were collected on treated pathology, spine region, surgical approach, institution type, and surgeon specialty. Trainee proficiency with CAN was assessed using an electronic questionnaire distributed across 15 Canadian orthopedic surgical and neurosurgical programs.In our provincial cohort, 16.8% of instrumented fusions were CAN-guided. Navigation was used more frequently in academic institutions (15.9% vs. 12.3%, plt;0.001) and by neurosurgeons than orthopedic surgeons (21.0% vs. 12.4%, plt;0.001). Of residents and fellows 34.1% were fully comfortable using spinal CAN, greater for neurosurgical than orthopedic surgical trainees (48.1% vs. 11.8%, p=0.008). The use of CAN increased self-reported proficiency in thoracic instrumentation for all trainees by 11.0% (p=0.036), and in atlantoaxial instrumentation for orthopedic trainees by 18.0% (p=0.014).Spinal CAN is used most frequently by neurosurgeons and in academic centers. Most spine surgical trainees are not fully comfortable with the use of CAN, but report an increase in technical comfort with CAN guidance particularly for thoracic instrumentation. Increased education in spinal CAN for trainees, particularly at the fellowship stage and, specifically, for orthopedic surgery, may improve adoption.La chirurgie assistée par ordinateur (CAO) permet d’améliorer la précision de l’exploration instrumentale employée dans le cas de fractures vertébrales et de maladies dégénératives de la colonne vertébrale. Cela dit, elle n’a pas encore été adoptée à grande échelle en raison d’un manque de formation, de coûts d’immobilisation considérables, d’obstacles liés à l’organisation du travail et de doutes quant à son exactitude. C’est dans cette perspective que nous voulons décrire, parmi divers champs de pratique, les transformations se rapportant au fil du temps à l’utilisation de la CAO de la colonne vertébral dans le cadre d’un régime de santé universel à payeur unique. Qui plus est, nous voulons aussi évaluer l’impact de la CAO en ce qui a trait aux compétences des stagiaires partout au Canada.Pour ce faire, nous avons passé en revue de façon rétrospective une base de données tenue à jour prospectivement au sujet de patients ontariens ayant été soumis de 2005 à 2014 à une exploration instrumentale de la colonne vertébrale. Les données obtenues portaient sur le type de pathologie traitée, sur la région de la colonne vertébrale visée, sur l’approche chirurgicale privilégiée, sur le type d’établissement et sur la spécialité du chirurgien ayant intervenu. Les compétences des stagiaires en matière de CAO ont également été évaluées à l’aide d’un questionnaire en ligne diffusé au sein de 15 programmes canadiens de chirurgie orthopédique et de neurochirurgie.En tout, 16,8 % des fusions instrumentées réalisées au sein de notre cohorte ontarienne l’ont été à l’aide de la technique de la CAO. Cette dernière a été utilisée plus fréquemment dans des établissements d’enseignement universitaire (15,9 % par opposition à 12,3 % pour les autres; p0,001) mais aussi plus souvent par des neurochirurgiens (21,0 % par opposition à 12,4 % par des chirurgiens orthopédiques; p0,001). En outre, 34,1 % des résidents et des médecins suivant une formation complémentaire étaient parfaitement à l’aise dans l’utilisation de la CAO de la colonne vertébrale (48,1 % de ceux se spécialisant en neurochirurgie par opposition à 11,8 % de ceux se spécialisant en chirurgie orthopédique; p = 0,008). L’utilisation de la CAO a par ailleurs entraîné une augmentation, auto-déclarée, de 11,0 % de l’aptitude à faire usage de l’exploration instrumentale thoracique chez tous les stagiaires (p = 0,036); dans le cas de l’exploration instrumentale atlanto-axiale, cette augmentation a été de 18,0 % (p = 0,014) chez les stagiaires en chirurgie orthopédique.La CAO de la colonne vertébrale est employée le plus souvent par les neurochirurgiens dans des établissements d’enseignement universitaire. La plupart des stagiaires en chirurgie de la colonne vertébrale ne sont pas entièrement à l’aise en ce qui concerne l’utilisation de la CAO. Toutefois, ils ont signalé une augmentation de leur aisance à utiliser la CAO et à bénéficier de son assistance, en particulier dans des cas d’exploration instrumentale thoracique. En somme, une plus ample formation en matière de CAO de la colonne vertébrale offerte aux stagiaires, particulièrement à ceux suivant une formation complémentaire et dans le champ de la chirurgie orthopédique, pourrait favoriser son adoption.

Objective Intracranial arterial dissection (IAD) is a rare cerebrovascular disease that is likely underdiagnosed because of the inherent difficulty of visualizing the subtle radiographic signs of the pathologic small intracranial arteries. No widespread consensus exists on the treatment of IAD, and thus it is often managed empirically because of the absence of major randomized controlled trials. In this study, we conducted a systematic review to evaluate the management and treatment options for IAD. Methods We performed a systematic review in accordance with the PRISMA guidelines using the following databases: MEDLINE (PubMed) and Cochrane Library. Included studies were limited to human patients with dissections in intracranial vessels only. Results A total of 82 studies were included in this systematic review. The most common complications of IAD were cerebral infarction and subarachnoid hemorrhage, and thus, patients with IAD can be subdivided into those presenting with either ischemia or hemorrhage, respectively. Those with ischemia were predominantly managed with antiplatelet therapy, whereas patients presenting with hemorrhage often were amenable to treatment with endovascular techniques. Conclusions Given these findings, clinicians should prescribe antiplatelet therapy for patients with IAD presenting with ischemia and consider endovascular treatment for those presenting with hemorrhage. However, further investigation is required given the heterogeneity of methods and reporting outcomes in the investigated studies.

Study design Bibliometric analysis. Objective To identify, and summarize the key findings of, the top 100 most highly cited works published in spinal disorder topic-specific journals. Summary of background data There is an abundance of published articles pertaining to spine surgery and spinal disorders. The number of citations a work receives provides a useful measure of its scientific impact. An understanding of the most cited works in spine surgery can identify literature that surgeons and researchers should be familiar with, point to the most active areas of research, inform the design of educational curricula, and help guide future research efforts. Methods Journals relating to spinal disorders were identified using the Journal Citation Reports database. We then searched the Web of Science database for articles appearing in each of these journals. The top 100 most cited works were selected for analysis. Results The top 100 most cited articles appeared in seven of eight journals dedicated to spinal disorders, with 84 in Spine and seven in the European Spine Journal. The citation count for individual articles ranged from 343 to 1949. Most works (73) were published between 1990 and 2004. The greatest number of articles (22) focused on low back pain, followed by biomechanics (13), degenerative disc disease (12), and lumbar spinal stenosis/lumbar fusion (9). With regard to study design, laboratory investigations were the most common (12), followed by guideline documents (11), reviews (10), and retrospective cohort studies (10). Conclusion The most cited works in spinal disorder journals are guidelines for low back pain, descriptions of quality of life (QOL) metrics, or laboratory investigations into spinal biomechanics. A gap exists for work relating to neck pain or cervical spinal pathology (e.g., cervical myelopathy), representing opportunity for future work. Time of publication, topic of study, study design, and journal are possible determinants of likelihood of citation. Level of evidence N/A.

OBJECTIVEDespite increasing adoption of endoscopic techniques for repair of nonsagittal single-suture craniosynostosis, the efficacy and safety of the procedure relative to established open approaches are unknown. In this systematic review the authors aimed to directly compare open surgical and endoscope-assisted techniques for the treatment of metopic, unilateral coronal, and lambdoid craniosynostosis, with an emphasis on quantitative reported outcomes.METHODSA literature search was performed in compliance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Relevant articles were identified from 3 electronic databases (MEDLINE, EMBASE, and CENTRAL [Cochrane Central Register of Controlled Trials]) from their inception to August 2017. The quality of methodology and bias risk were assessed using the Effective Public Health Practice Project (EPHPP) Quality Assessment Tool for Quantitative Studies.RESULTSOf 316 screened records, 7 studies were included in a qualitative synthesis of the evidence, of which none were eligible for meta-analysis. These reported on 111 unique patients with metopic, 65 with unilateral coronal, and 12 with lambdoid craniosynostosis. For all suture types, 100 (53%) children underwent endoscope-assisted craniosynostosis surgery and 32 (47%) patients underwent open repair. These studies all suggest that blood loss, transfusion rate, operating time, and length of hospital stay were superior for endoscopically treated children. Although potentially comparable or better cosmetic outcomes are reported, the paucity of evidence and considerable variability in outcomes preclude meaningful conclusions.CONCLUSIONSLimited data comparing open and endoscopic treatments for metopic, unilateral coronal, and lambdoid synostosis suggest a benefit for endoscopic techniques with respect to blood loss, transfusion, length of stay, and operating time. This report highlights shortcomings in evidence and gaps in knowledge regarding endoscopic repair of nonsagittal single-suture craniosynostosis, emphasizing the need for further matched-control studies.

Because the impact of earthquake effects can extend over great distances from their origin, stress field inversion was performed for 440 earthquake focal mechanisms from the northwest Himalayas and surrounding regions compiled from the data bulletins of international seismological institutions. Earthquakes between November 1976 and April 2019 in the depth range of 10–258 km with moment magnitudes between 4.6 and 7.9 were selected. High-quality solutions were inverted to locate the best fitting stress tensor. Most of the earthquake fault plane solutions indicated thrust faulting, confirming northward underthrusting of the Indian plate along the Main Boundary Thrust and the Main Central Thrust systems and eastward underthrusting along the Burmese Arc. The focal mechanisms indicated right-lateral motion along the Karakoram Fault and left-lateral motion along the Kirthar–Sulaiman Range, which agrees with the expected sense of the lateral mass movement of the continental collision model. The present-day stress regimes obtained from the earthquake focal mechanism inversions indicated a predominantly compressional stress regime represented by NNE–SSW trending normal fault mechanisms in northwest India and Nepal and NNW–SSE trending normal fault mechanisms in Pakistan and Hindukush. These are consistent with the direction of the ongoing India–Eurasia plate collision and the extensional stress of WNW–ESE trending thrust faulting in the Xizang and Kashmir regions. These tectonic regimes connected with the major tectonic affecting the Arabian Peninsula. Accordingly, it is highly recommended to assess the earthquake hazards of the major cities in the eastern countries of Arabian Peninsula as Kuwait, Saudi Arabia, United Arab Emirates and Oman.

Introduction: Endovascular thrombectomy (EVT) has revolutionized large vessel occlusion (LVO) stroke care. However, over half remain functionally disabled or die despite treatment. Understanding outcomes may influence EVT selection, novel therapies, and prognostication. We sought to identify associations between outcomes and brain regions involved in ischemic lesions. Methods: For consecutive LVO patients with post-EVT MRI, acute ischemic lesions were manually segmented from DWI and spatially normalized. Individual lesion volumes were automatically parcellated (atlas-defined 94 cortical regions, 14 subcortical nuclei, 20 white matter tracts) and then reduced to ten anatomically plausible lesion patterns using unsupervised dimensionality reduction techniques. Ninety-day modified Rankin Scale (mRS) was modeled via Bayesian regression, taking the ten lesion patterns as inputs and controlling for lesion size, age, sex, acute NIH Stroke Scale, alteplase, and TICI 2b-3 reperfusion. Results: We identified 153 LVO patients with mean age 68±15 years and 51% female. Median NIHSS was 16 (IQR 13-20), 56% received alteplase, and 84% achieved TICI2b-3. The lesion patterns predictive of 90-day mRS involved bilateral subcortical nuclei, pre- and postcentral gyri, insular and opercular cortex, as well as left-sided inferior frontal and angular gyri ( Figure 1A ). Lesions affecting white matter tracts had the highest relevance predicting 90-day mRS ( Figure 1B ). Conclusions: These data describe the significance for outcomes of specific brain regions involved in ischemic lesions on MRI after EVT. Future work in additional datasets is needed to confirm these granular findings.

BACKGROUND: We used a cross-sectional study design (questionnaire) to investigate the use of image-guided navigation (IGN) in Saudi Arabia and explore possible differences in implementing IGN for daily practice. METHODS: An internet-based survey was sent to all spine surgeons who are practicing in Saudi Arabia (orthopedics or neurosurgery). The survey is composed of 12 items that collected demographic and academic data. RESULTS: Ninety-nine answered the questionnaire from 197; 80% were from Riyadh, the capital, and 50% were consultants (attending physicians). Orthopedic surgeons were almost 60% of responders compared to 40% neurosurgeons. The use of navigation in Saudi hospitals was high (76.8%). There was a significant difference between specialties in the preference of using navigation (23.2% for orthopedics versus 81.4% for neurosurgery, P < .001) and routine use in surgical spine cases (88.4% for neurosurgery versus 50.0% orthopedics, P < .001). The majority of responders from neurosurgery learned to use navigation during residency compared to orthopedics responders (51.2% versus 28.6%, P = .001). More than 30% of orthopedics responders expressed they never learned navigation compared to only 4% of neurosurgery responders. The comfort level of > 75% with performing surgery using navigation was significantly different between specialties (25% for orthopedics versus 46.5% for neurosurgery, P < .001). CONCLUSION: Saudi spine surgeons are among the highest users of IGN systems. The strong healthcare infrastructure and the availability of these devices across the country are among the most important factors for its prevalence. Enhancing surgical exposure and education of postgraduate trainees to use these tools, especially within orthopedics, could increase use and comfort level rates.

The Woven EndoBridge (WEB) can be used to treat wide-necked aneurysms without antiplatelet medications, suggesting it may have advantages in the setting of aneurysmal subarachnoid hemorrhage (aSAH). The goal was assessment of safety and efficacy of WEB in aSAH given the delayed nature of aneurysmal thrombosis.An international retrospective analysis of patients with aSAH treated with WEB was conducted at 7 tertiary centers from 2016 to 2020. Outcomes included rates of rebleeding, retreatment, complications, and complete occlusion. Furthermore, a systematic review and meta-analysis was conducted from 2011 to 2020 assessing the same outcomes. All pooled event rates were calculated using a random effect model.Consecutive patients with aSAH harbored 25 aneurysms that were treated with 29 WEB devices. The mean age was 53 years, and 65% were female. Zero experienced rebleeding, 2 were retreated, 2 experienced complications, 16 were completely occluded at 3 months, and 21 were completed occluded at 9-12 months. Meta-analysis of 309 WEB treatments for aSAH from 7 case series revealed 2.5% (95% CI 1-5%) had rebleeding, 9% (95% CI 4-17%) were retreated, 17% (95% CI 10-30%) had complications, and 61% (95% CI 51-71%) were completely occluded at 3-6 months.WEB embolization in the setting of aSAH provides similar protection against rebleeding with comparable retreatment rates to traditional approaches. However, there is a higher rate of incomplete radiographic occlusion and operative complications compared to WEB embolization of unruptured aneurysms. Long-term prospective studies are needed to fully delineate the role of WEB embolization in aSAH.

With the increase in heart disease and frequent heart attacks, the death rate has increased in a terrifying and appalling manner worldwide due to the lack of first aid practices such as cardiopulmonary resuscitation (CPR). Cardiopulmonary resuscitation is a dual process in which the paramedic resuscitates the lung and heart. As for resuscitation of the lung, it is through the delivery of air and oxygen to it through artificial respiration, as for reviving the heart, it is accomplished through manual pressure on the area of the injured heart “in the area between the thoracic bone and the spine” so that blood is pumped to human vital organs of the injured person’s body, especially the brain. This paper involves designing a manikin that interacts with humans to facilitate the application of CPR in a correct and scientific form by measuring the strength and depth of pressure and calculating the number of compression per minute (CPM). The system control architecture is based on IoT concept where data that is read from integrated sensors and sent to IoT hubs such as Amazon Web Services. The purpose of this work is to provide trainees with a training tool on resuscitation approaches.

Ultra-low frequency (ULF) signals in the geomagnetic records are important indicators for many phenomena; therefore identification of such signals is an important issue. Automatic identification of these ULF signals is not an easy target because of their small magnitudes. Through this study in hand, two algorithms are proposed to automatically detect these micro-pulsations. The first algorithm uses the multi-level components (details) of the discrete wavelet transform (DWT) instead of the original geomagnetic record. The vector of the maximum values of the cross-correlation between the record and an arbitrary chosen ULF pattern in the same frequency range is a good indicator for the existence of these micro-pulsations. The second algorithm is based on convolutional neural network (CNN) framework guided with the multi-resolution-analysis (MRA) of the DWT. Preprocessing the geomagnetic records using the MRA of DWT to produce the fifth and the sixth details to be the input to the deep CNN topology, highly improved the accuracy to approach 91.11%. In addition, deep learning based algorithm showed better results than the DWT based algorithm in light of all the performance metrics.

To meet the increasing in population, urbanization and public transportation needs of Dammam big city a new transportation infrastructure network is planned and being developed. In the same time, environmental threats of land subsidence on network has been raised and needs to be addressed. Site characterization for designing this transportation lines is crucial to ensure reliable and economic substructure design, because weak site soil conditions may cause land subsidence problems. Downhole seismic (DS) testing is commonly used to determine compression wave (P) and shear wave (S) velocity profiles in geotechnical engineering, which are required in evaluating responses to shaking of geotechnical sites and structures. A DS survey was conducted through boreholes at the center of the Dammam metropolitan city, Saudi Arabia. A sledgehammer horizontally striking a wooden plate generated shear (S) waves polarized in the crossline and inline directions, whereas a vertical hammer hitting a metal plate generated the P wave. Data were obtained using Freedom Data PC, a downhole tool with a triaxle geophone package, and a seismograph. In the downhole technique, the geophones were equestrian on an internal rotating block, and a built-in fluxgate compass as well as servo motor system maintained the orientation of the geophones inside the borehole. The instrumentation and processes complied with the standard test methods for downhole seismic testing (Standard and D7400-08, 2008). This represents, a versatile platform for evaluating structures/infrastructures and geophysical seismic engineering surveys. The estimated seismic velocities were used in estimating the various elastic moduli and density variations within the mapped boreholes. The integrated approach of proper geotechnical characterization and 1D velocity profile proved to be a helpful tool for assessment of subsidence of Dammam city in the future which, in turn, will reduce the environmental threats facing the city.