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Article ; Online: Honoring the career and contributions of neurosurgery founding member Walter Edward Dandy (1886-1946).

Brown, Nolan J / Streetman, Daniel / Shahrestani, Shane / Patel, Neal A / Pierzchajlo, Noah / Gendreau, Julian

2023 Volume 67, Issue 1, Page(s) 133–134

MeSH term(s)	Humans ; History, 20th Century ; Neurosurgery ; Neurosurgical Procedures
Language	English
Publishing date	2023-02-09
Publishing country	Italy
Document type	Historical Article ; Letter ; Comment
ZDB-ID	193139-8
ISSN	1827-1855 ; 0390-5616 ; 0026-4881
ISSN (online)	1827-1855
ISSN	0390-5616 ; 0026-4881
DOI	10.23736/S0390-5616.22.05804-0
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Article ; Online: Continuous Wound Irrigation and Intraoperative Methadone Decreases Opioid Use and Shortens Length of Stay After CRS/HIPEC.

Boesl, Markus A / Brown, Noah / Bleicher, Josh / Call, Tyler / Lambert, Donald H / Lambert, Laura A

Annals of surgical oncology

2024

Abstract: Background: Epidural analgesia is resource and labor intense and may limit postoperative management options and delay discharge. This study compared postoperative outcomes after cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS/ ... ...

Abstract	Background: Epidural analgesia is resource and labor intense and may limit postoperative management options and delay discharge. This study compared postoperative outcomes after cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) with epidural analgesia versus continuous wound infusion system (CWIS) with/without intraoperative methadone. Methods: A single-institution, retrospective chart review was performed including all patients undergoing open CRS/HIPEC from 2018 to 2021. Patient demographics, surgical characteristics, length of stay, and in-hospital analgesic use were reviewed. In-hospital opioid exposure in morphine milligram equivalents (MME) was calculated. Multivariate analysis (MVA) for mean total and daily opioid exposure was conducted. Results: A total of 157 patients were included. Fifty-three (34%) had epidural analgesia, 96 (61%) had CWIS, and 79 (50%) received methadone. Length of stay was significantly shorter with CWIS + methadone versus epidural (7 vs. 8 days, p < 0.01). MVA showed significantly lower mean total and daily opioid exposure with CWIS+methadone versus epidural (total: 252.8 ± 17.7 MME vs. 486.8 ± 86.6 MME; odds ratio [OR] 0.72, 95% confidence interval [CI] 0.52-0.98, p = 0.04; Daily: 32.8 ± 2.0 MME vs. 51.9 ± 5.7 MME, OR 0.72, 95% CI 0.52-0.99, p ≤ 0.05). The CWIS-only group (n = 17) had a significantly lower median oral opioid exposure versus epidural (135 MME vs. 7.5 MME, p < 0.001) and longer length of stay versus CWIS + methadone (9 vs. 7 days, p = 0.04), There were no CWIS or methadone-associated complications and one epidural abscess. Conclusions: CWIS + methadone safely offers better pain control with less in-hospital opioid use, shorter length of stay, and decreased resource utilization compared with epidural analgesia in patients undergoing CRS-HIPEC.
Language	English
Publishing date	2024-02-01
Publishing country	United States
Document type	Journal Article
ZDB-ID	1200469-8
ISSN	1534-4681 ; 1068-9265
ISSN (online)	1534-4681
ISSN	1068-9265
DOI	10.1245/s10434-024-14900-1
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Article ; Online: Renal mass imaging modalities: does body mass index (BMI) matter?

Son, Young / Quiring, Mark E / Dalton, Raeann M / Thomas, Brian / Davidson, Noah / DeVincentz, Dayna / Payne, Collin / Parikh, Sahil H / Fink, Benjamin A / Mueller, Thomas / Brown, Gordon

International urology and nephrology

2024

Abstract: Purpose: Accurate measurement of renal mass size is crucial in the management of renal cancer. With the burdensome cost of imaging yet its need for management, a better understanding of the variability among patients when determining mass size remains ... ...

Abstract	Purpose: Accurate measurement of renal mass size is crucial in the management of renal cancer. With the burdensome cost of imaging yet its need for management, a better understanding of the variability among patients when determining mass size remains of urgent importance. Current guidelines on optimal imaging are limited, especially with respect to body mass index (BMI). The aim of this study is to discern which modalities accurately measure renal mass size and whether BMI influences such accuracy. Methods: A multi-institutional chart review was performed for adult patients undergoing partial or radical nephrectomy between 2018 and 2021, with 236 patients ultimately included. Patients were categorized by BMI (BMI 1: 18.5-24.9, BMI 2: 25-29.9, BMI 3: 30-34.9, and BMI 4: ≥ 35). The greatest mass lengths were compared between the pathology report and the following: computerized tomography (CT), renal ultrasound, and magnetic resonance imaging (MRI). Results: The difference between greatest length on CT with contrast and MRI were significantly different when compared to pathologic measurement. BMI groups 3 and 4 were found to have a significant difference in size estimates compared to BMI 2 for CT with contrast. No difference was found between size estimates by BMI group for any other imaging modality. Conclusion: CT with contrast becomes less accurate at estimating mass size for patients with BMI > 30. While contrast-enhanced CT remains a vital imaging modality for tissue enhancement in the context of unknown renal masses, caution must be used for mass size estimation in the obese population.
Language	English
Publishing date	2024-03-18
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	204048-7
ISSN	1573-2584 ; 0301-1623 ; 0042-1162
ISSN (online)	1573-2584
ISSN	0301-1623 ; 0042-1162
DOI	10.1007/s11255-024-03962-5
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Article ; Online: Cell-Free DNA Extraction of Vitreous and Aqueous Humor Specimens for Diagnosis and Monitoring of Vitreoretinal Lymphoma.

Brown, Noah A / Rao, Rajesh C / Betz, Bryan L

Journal of visualized experiments : JoVE

2024 , Issue 203

Abstract: Vitreoretinal lymphoma (VRL) represents an aggressive lymphoma, often categorized as primary central nervous system diffuse large B-cell lymphoma. To diagnose VRL, specimens such as vitreous humor and, more recently, aqueous humor are collected. ... ...

Abstract	Vitreoretinal lymphoma (VRL) represents an aggressive lymphoma, often categorized as primary central nervous system diffuse large B-cell lymphoma. To diagnose VRL, specimens such as vitreous humor and, more recently, aqueous humor are collected. Diagnostic testing for VRL on these specimens includes cytology, flow cytometry, and molecular testing. However, both cytopathology and flow cytometry, along with molecular testing using cellular DNA, necessitate intact whole cells. The challenge lies in the fact that vitreous and aqueous humor typically have low cellularity, and many cells get destroyed during collection, storage, and processing. Moreover, these specimens pose additional difficulties for molecular testing due to the high viscosity of vitreous humor and the low volume of both vitreous and aqueous humor. This study proposes a method for extracting cell-free DNA from vitreous and aqueous specimens. This approach complements the extraction of cellular DNA or allows the cellular component of these specimens to be utilized for other diagnostic methods, including cytology and flow cytometry.
MeSH term(s)	Humans ; Vitreous Body ; Retinal Neoplasms/diagnosis ; Retinal Neoplasms/genetics ; Retinal Neoplasms/pathology ; Cell-Free Nucleic Acids ; Aqueous Humor ; Biomarkers, Tumor/genetics ; Eye Neoplasms/pathology ; Lymphoma/diagnosis ; Lymphoma/genetics ; Lymphoma/pathology ; DNA
Chemical Substances	Cell-Free Nucleic Acids ; Biomarkers, Tumor ; DNA (9007-49-2)
Language	English
Publishing date	2024-01-12
Publishing country	United States
Document type	Journal Article ; Video-Audio Media
ZDB-ID	2259946-0
ISSN	1940-087X ; 1940-087X
ISSN (online)	1940-087X
ISSN	1940-087X
DOI	10.3791/65708
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Article ; Online: Reducing Care Overuse in Older Patients Using Professional Norms and Accountability : A Cluster Randomized Controlled Trial.

Persell, Stephen D / Petito, Lucia C / Lee, Ji Young / Meeker, Daniella / Doctor, Jason N / Goldstein, Noah J / Fox, Craig R / Rowe, Theresa A / Linder, Jeffrey A / Chmiel, Ryan / Peprah, Yaw Amofa / Brown, Tiffany

Annals of internal medicine

2024 Volume 177, Issue 3, Page(s) 324–334

Abstract: Background: Effective strategies are needed to curtail overuse that may lead to harm.: Objective: To evaluate the effects of clinician decision support redirecting attention to harms and engaging social and reputational concerns on overuse in older ... ...

Abstract	Background: Effective strategies are needed to curtail overuse that may lead to harm. Objective: To evaluate the effects of clinician decision support redirecting attention to harms and engaging social and reputational concerns on overuse in older primary care patients. Design: 18-month, single-blind, pragmatic, cluster randomized trial, constrained randomization. (ClinicalTrials.gov: NCT04289753). Setting: 60 primary care internal medicine, family medicine and geriatrics practices within a health system from 1 September 2020 to 28 February 2022. Participants: 371 primary care clinicians and their older adult patients from participating practices. Intervention: Behavioral science-informed, point-of-care, clinical decision support tools plus brief case-based education addressing the 3 primary clinical outcomes (187 clinicians from 30 clinics) were compared with brief case-based education alone (187 clinicians from 30 clinics). Decision support was designed to increase salience of potential harms, convey social norms, and promote accountability. Measurements: Prostate-specific antigen (PSA) testing in men aged 76 years and older without previous prostate cancer, urine testing for nonspecific reasons in women aged 65 years and older, and overtreatment of diabetes with hypoglycemic agents in patients aged 75 years and older and hemoglobin A Results: At randomization, mean clinic annual PSA testing, unspecified urine testing, and diabetes overtreatment rates were 24.9, 23.9, and 16.8 per 100 patients, respectively. After 18 months of intervention, the intervention group had lower adjusted difference-in-differences in annual rates of PSA testing (-8.7 [95% CI, -10.2 to -7.1]), unspecified urine testing (-5.5 [CI, -7.0 to -3.6]), and diabetes overtreatment (-1.4 [CI, -2.9 to -0.03]) compared with education only. Safety measures did not show increased emergency care related to urinary tract infections or hyperglycemia. An HbA Limitation: A single health system limits generalizability; electronic health data limit ability to differentiate between overtesting and underdocumentation. Conclusion: Decision support designed to increase clinicians' attention to possible harms, social norms, and reputational concerns reduced unspecified testing compared with offering traditional case-based education alone. Small decreases in diabetes overtreatment may also result in higher rates of uncontrolled diabetes. Primary funding source: National Institute on Aging.
MeSH term(s)	Male ; Humans ; Aged ; Prostate-Specific Antigen ; Single-Blind Method ; Diabetes Mellitus ; Hypoglycemic Agents ; Prostatic Neoplasms
Chemical Substances	Prostate-Specific Antigen (EC 3.4.21.77) ; Hypoglycemic Agents
Language	English
Publishing date	2024-02-06
Publishing country	United States
Document type	Randomized Controlled Trial ; Journal Article
ZDB-ID	336-0
ISSN	1539-3704 ; 0003-4819
ISSN (online)	1539-3704
ISSN	0003-4819
DOI	10.7326/M23-2183
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Article: Mapping single-cell developmental potential in health and disease with interpretable deep learning.

Kang, Minji / Armenteros, Jose Juan Almagro / Gulati, Gunsagar S / Gleyzer, Rachel / Avagyan, Susanna / Brown, Erin L / Zhang, Wubing / Usmani, Abul / Earland, Noah / Wu, Zhenqin / Zou, James / Fields, Ryan C / Chen, David Y / Chaudhuri, Aadel A / Newman, Aaron M

bioRxiv : the preprint server for biology

2024

Abstract: Single-cell RNA sequencing (scRNA-seq) has transformed our understanding of cell fate in developmental systems. However, identifying the molecular hallmarks of potency - the capacity of a cell to differentiate into other cell types - has remained ... ...

Abstract	Single-cell RNA sequencing (scRNA-seq) has transformed our understanding of cell fate in developmental systems. However, identifying the molecular hallmarks of potency - the capacity of a cell to differentiate into other cell types - has remained challenging. Here, we introduce CytoTRACE 2, an interpretable deep learning framework for characterizing potency and differentiation states on an absolute scale from scRNA-seq data. Across 31 human and mouse scRNA-seq datasets encompassing 28 tissue types, CytoTRACE 2 outperformed existing methods for recovering experimentally determined potency levels and differentiation states covering the entire range of cellular ontogeny. Moreover, it reconstructed the temporal hierarchy of mouse embryogenesis across 62 timepoints; identified pan-tissue expression programs that discriminate major potency levels; and facilitated discovery of cellular phenotypes in cancer linked to survival and immunotherapy resistance. Our results illuminate a fundamental feature of cell biology and provide a broadly applicable platform for delineating single-cell differentiation landscapes in health and disease.
Language	English
Publishing date	2024-03-21
Publishing country	United States
Document type	Preprint
DOI	10.1101/2024.03.19.585637
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Article ; Online: Donor-containing cortical and intraventricular glioneuronal nodules in Huntington's disease brain decades after fetal cell transplantation.

Pinarbasi, Emile S / Liu, Elaine A / Yu, Zhigang / Kopyov, Oleg / Brown, Noah A / Dayalu, Praveen / Lieberman, Andrew P

Acta neuropathologica

2021 Volume 141, Issue 6, Page(s) 979–981

MeSH term(s)	Aged ; Brain/pathology ; Brain Tissue Transplantation/adverse effects ; Brain Tissue Transplantation/methods ; Cell Transplantation/adverse effects ; Cell Transplantation/methods ; Fetal Tissue Transplantation/adverse effects ; Fetal Tissue Transplantation/methods ; Humans ; Huntington Disease/pathology ; Huntington Disease/therapy ; Male ; Time Factors ; Tissue Donors ; Treatment Outcome
Language	English
Publishing date	2021-03-08
Publishing country	Germany
Document type	Case Reports ; Letter ; Research Support, N.I.H., Extramural
ZDB-ID	1079-0
ISSN	1432-0533 ; 0001-6322
ISSN (online)	1432-0533
ISSN	0001-6322
DOI	10.1007/s00401-021-02292-5
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Article ; Online: Developing Predictive Models to Anticipate Shunt Complications in 33,248 Pediatric Patients with Shunted Hydrocephalus Utilizing Machine Learning.

Shahrestani, Shane / Shlobin, Nathan / Gendreau, Julian L / Brown, Nolan J / Himstead, Alexander / Patel, Neal A / Pierzchajlo, Noah / Chakravarti, Sachiv / Lee, Darrin Jason / Chiarelli, Peter A / Bullis, Carli L / Chu, Jason

Pediatric neurosurgery

2023 Volume 58, Issue 4, Page(s) 206–214

Abstract: Introduction: Hydrocephalus is a common pediatric neurosurgical pathology, typically treated with a ventricular shunt, yet approximately 30% of patients experience shunt failure within the first year after surgery. As a result, the objective of the ... ...

Abstract	Introduction: Hydrocephalus is a common pediatric neurosurgical pathology, typically treated with a ventricular shunt, yet approximately 30% of patients experience shunt failure within the first year after surgery. As a result, the objective of the present study was to validate a predictive model of pediatric shunt complications with data retrieved from the Healthcare Cost and Utilization Project (HCUP) National Readmissions Database (NRD). Methods: The HCUP NRD was queried from 2016 to 2017 for pediatric patients undergoing shunt placement using ICD-10 codes. Comorbidities present upon initial admission resulting in shunt placement, Johns Hopkins Adjusted Clinical Groups (JHACG) frailty-defining criteria, and Major Diagnostic Category (MDC) at admission classifications were obtained. The database was divided into training (n = 19,948), validation (n = 6,650), and testing (n = 6,650) datasets. Multivariable analysis was performed to identify significant predictors of shunt complications which were used to develop logistic regression models. Post hoc receiver operating characteristic (ROC) curves were created. Results: A total of 33,248 pediatric patients aged 6.9 ± 5.7 years were included. Number of diagnoses during primary admission (OR: 1.05, 95% CI: 1.04-1.07) and initial neurological admission diagnoses (OR: 3.83, 95% CI: 3.33-4.42) positively correlated with shunt complications. Female sex (OR: 0.87, 95% CI: 0.76-0.99) and elective admissions (OR: 0.62, 95% CI: 0.53-0.72) negatively correlated with shunt complications. ROC curve for the regression model utilizing all significant predictors of readmission demonstrated area under the curve of 0.733, suggesting these factors are possible predictors of shunt complications in pediatric hydrocephalus. Conclusion: Efficacious and safe treatment of pediatric hydrocephalus is of paramount importance. Our machine learning algorithm delineated possible variables predictive of shunt complications with good predictive value.
MeSH term(s)	Child ; Humans ; Female ; Ventriculoperitoneal Shunt/adverse effects ; Ventriculoperitoneal Shunt/methods ; Retrospective Studies ; Hydrocephalus/etiology ; Neurosurgical Procedures/methods ; Comorbidity
Language	English
Publishing date	2023-06-30
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	1091757-3
ISSN	1423-0305 ; 1016-2291
ISSN (online)	1423-0305
ISSN	1016-2291
DOI	10.1159/000531754
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Article ; Online: Intraneural Peroneal Ganglion Cyst Excision in a Pediatric Patient: A Case Report.

Apel, Peter J / Zielinski, Julie A / Grider, Douglas J / Brown, Ralph D / Orfield, Noah J

JBJS case connector

2020 Volume 10, Issue 1, Page(s) e0272

Abstract: Case: A 14-year-old female presented with a profound foot drop after trauma to the right leg. Clinical examination and electrodiagnostic studies demonstrated a dense palsy of the common peroneal nerve. Magnetic resonance imaging revealed an intraneural ... ...

Abstract	Case: A 14-year-old female presented with a profound foot drop after trauma to the right leg. Clinical examination and electrodiagnostic studies demonstrated a dense palsy of the common peroneal nerve. Magnetic resonance imaging revealed an intraneural peroneal ganglion cyst at the fibular neck. Surgical treatment included decompression and transection of the articular branch to the proximal tibiofibular joint. At the 1-year follow-up, the patient demonstrated complete recovery of peroneal nerve function. Conclusions: This case demonstrates a rare finding of a pediatric intraneural peroneal ganglion cyst. The presentation and treatment is well-documented and adds depth to the literature on a sparsely reported condition.
MeSH term(s)	Adolescent ; Female ; Ganglion Cysts/pathology ; Ganglion Cysts/surgery ; Humans ; Peroneal Nerve/pathology ; Peroneal Nerve/surgery
Language	English
Publishing date	2020-01-13
Publishing country	United States
Document type	Case Reports ; Journal Article
ISSN	2160-3251
ISSN (online)	2160-3251
DOI	10.2106/JBJS.CC.19.00272
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Article ; Online: Implementation of Physical Therapist Services for Men Undergoing Radical Prostatectomy: An Administrative Case Report.

Wolden, Mitchell / Brown, Scott / Carlsson, Sigrid V / Noah, Thomas A / Mungovan, Sean F

Physical therapy

2023 Volume 104, Issue 4

Abstract: Objective: Prostate cancer is the most commonly diagnosed cancer among men in the USA, and radical prostatectomy (RP) is the primary surgical treatment option. With an increasing number of men undergoing RP and surviving prostate cancer, clinical ... ...

Abstract	Objective: Prostate cancer is the most commonly diagnosed cancer among men in the USA, and radical prostatectomy (RP) is the primary surgical treatment option. With an increasing number of men undergoing RP and surviving prostate cancer, clinical management strategies have broadened to improve the preoperative and postoperative patient experience and minimize treatment-related functional consequences. Urinary incontinence is a predictable functional consequence of RP. Recent reviews recommend preoperative and postoperative physical therapist services as the standard of care for men undergoing RP to decrease the severity of urinary incontinence and improve patients' quality of life. Despite compelling evidence, the routine provision of physical therapist services preoperatively and postoperatively for men undergoing RP is limited. The purpose of this case report is to describe the implementation of preoperative and postoperative physical therapist services for men undergoing RP in a US health care system using the knowledge-to-action process and the Consolidated Framework for Implementation Research frameworks. Case description: The implementation process included 4 steps: (1) development of a preoperative and postoperative physical therapist services program; (2) identification of barriers and enablers for implementation; (3) implementation of the program; and (4) evaluation of the effectiveness of the implemented program. Results: Outcomes from the implementation of a physical therapist services program for men undergoing RP included lower urinary incontinence rates, improved patient satisfaction, and increased physical therapist utilization. Conclusion: This case report documents the implementation of physical therapist services for men undergoing RP. The use of implementation frameworks enabled the identification of unique enablers, barriers, and strategies for the implementation of physical therapist services for men undergoing RP. Impact: Implementing preoperative and postoperative physical therapist services for men undergoing RP improves patient outcomes. The implementation process and outcomes can be considered by other health care systems when developing preoperative and postoperative physical therapist services for men undergoing RP.
MeSH term(s)	Humans ; Male ; Physical Therapists ; Prostatectomy/adverse effects ; Prostatic Neoplasms/surgery ; Prostatic Neoplasms/complications ; Quality of Life ; Urinary Incontinence/etiology ; Urinary Incontinence/therapy
Language	English
Publishing date	2023-11-25
Publishing country	United States
Document type	Journal Article
ZDB-ID	415886-6
ISSN	1538-6724 ; 0031-9023
ISSN (online)	1538-6724
ISSN	0031-9023
DOI	10.1093/ptj/pzad163
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