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Article ; Online: Rescue therapy for symptomatic spinal cord ischemia after thoracic endovascular aortic repair.

Spratt, John R / Walker, Kristen L / Neal, Dan / Arnaoutakis, George J / Martin, Tomas D / Back, Martin R / Zasimovich, Yury / Franklin, Michael / Shahid, Zain / Upchurch, Gilbert R / Scali, Salvatore T / Beaver, Thomas M

The Journal of thoracic and cardiovascular surgery

2022

Abstract: Objective: Spinal cord ischemia (SCI) after thoracic endovascular aortic repair (TEVAR) can cause permanent neurologic deficits and poor long-term survival. Targeted treatment of new SCI symptoms after TEVAR (rescue therapy [RT]) might improve/resolve ... ...

Abstract	Objective: Spinal cord ischemia (SCI) after thoracic endovascular aortic repair (TEVAR) can cause permanent neurologic deficits and poor long-term survival. Targeted treatment of new SCI symptoms after TEVAR (rescue therapy [RT]) might improve/resolve neurologic symptoms but few data characterize the association of specific interventions with SCI outcomes. We evaluated the effectiveness of post-TEVAR RT at our tertiary aortic center. Methods: Our institutional TEVAR database was reviewed for SCI incidence and details of RT. This included cerebrospinal fluid drainage (CSFD), medical therapy, and optimization of spinal cord oxygen delivery. SCI outcomes were categorized at discharge as paralysis/paraparesis and temporary/permanent. Results: Nine hundred forty-three TEVAR procedures were performed in 869 patients from 2011 to 2020. Post-TEVAR SCI occurred in 7.8% (n = 74) with permanent paraplegia in 1.5%. Older patient age, chronic obstructive pulmonary disease, and previous abdominal aortic surgery were predictive of SCI. Half (n = 37) of SCI episodes resulted in only temporary paralysis/paraparesis. Rescue postoperative cerebrospinal fluid drains were implanted in 3.7% (n = 35) of procedures and was predicted by higher American Society of Anesthesiologists class, lower serum hemoglobin level, elevated international normalized ratio, bilateral iliac artery occlusion, nonelective procedures, and penetrating atherosclerotic ulcer/intramural hematoma indication. The most commonly used RTs were emergent placement of or increased drainage from an existing cerebrospinal fluid drain (87.8%), induced/permissive hypertension (77.0%), corticosteroid bolus (36.5%), and naloxone infusion (33.8%). Neurologic improvement occurred in 68.9% (n = 51/74). New/increased drainage was associated with improved SCI outcome. Conclusions: Permanent paraplegia from post-TEVAR SCI is rare (1.5%). Older patients with comorbidities carry greater post-TEVAR SCI risk. SCI symptoms improved/resolved with CSFD and multimodal RT in 68.9% of patients, but no intervention was independently associated with improvement. TEVAR centers should have robust protocols for timely and safe CSFD placement to augment RT strategies for SCI.
Language	English
Publishing date	2022-11-05
Publishing country	United States
Document type	Journal Article
ZDB-ID	3104-5
ISSN	1097-685X ; 0022-5223
ISSN (online)	1097-685X
ISSN	0022-5223
DOI	10.1016/j.jtcvs.2022.10.045
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Article ; Online: Destruction of white matter integrity in patients with mild cognitive impairment and Alzheimer disease.

Sun, Xiaoyan / Salat, David / Upchurch, Kristen / Deason, Rebecca / Kowall, Neil / Budson, Andrew

Journal of investigative medicine : the official publication of the American Federation for Clinical Research

2014 Volume 62, Issue 7, Page(s) 927–933

Abstract: Background: Accumulating evidence shows that gradual loss of white matter integrity plays an important role in the development of Alzheimer disease (AD).: Objective: The aim of this research was to study the microstructural integrity of white matter ... ...

Abstract	Background: Accumulating evidence shows that gradual loss of white matter integrity plays an important role in the development of Alzheimer disease (AD). Objective: The aim of this research was to study the microstructural integrity of white matter in AD in vivo. Methods: Global fractional anisotropy, global axial diffusivity (AxD), and global radial diffusivity (RD) were analyzed in subjects with normal controls (NC), mild cognitive impairment (MCI), and AD using Alzheimer's Disease Neuroimaging Initiative data (total N = 210). We further compared specific white matter tracts among the 3 groups. Results: Compared with the NC group, the MCI group had significantly increased global AxD and global RD. Compared with the NC and MCI groups, the AD group had significantly decreased global fractional anisotropy, increased global AxD, and increased global RD. With regard to specific white matter tracts, in the MCI group, we found increased AxD and increased RD in the external capsule, part of the lateral cholinergic pathway, in addition to the tracts connecting the limbic regions, predominantly in the left hemisphere. In the AD group, white matter abnormalities were widespread, including in the external capsule (cholinergic pathway) and limbic region tracts as well as tracts connecting anterior to posterior regions bilaterally. Conclusions: The radiographic manifestation of damaged white matter microstructural integrity in the cholinergic pathway in MCI patients may provide a rational basis for the use of cholinesterase inhibitor drugs in the MCI stage of AD.
MeSH term(s)	Aged ; Alzheimer Disease/pathology ; Anisotropy ; Case-Control Studies ; Cognitive Dysfunction/pathology ; Demography ; Diffusion Tensor Imaging ; Female ; Humans ; Male ; White Matter/pathology
Language	English
Publishing date	2014-07-19
Publishing country	England
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't ; Research Support, U.S. Gov't, Non-P.H.S.
ZDB-ID	1217870-6
ISSN	1708-8267 ; 0009-9279 ; 1081-5589
ISSN (online)	1708-8267
ISSN	0009-9279 ; 1081-5589
DOI	10.1097/JIM.0000000000000102
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Article ; Online: Endoscope-assisted placement of a multiperforated shunt catheter into the fourth ventricle via a frontal transventricular approach.

Upchurch, Kristen / Raifu, Murisiku / Bergsneider, Marvin

Neurosurgical focus

2007 Volume 22, Issue 4, Page(s) E8

Abstract: Object: Patients with symptomatic isolated fourth ventricle and multicompartmentalized hydrocephalus benefit from operative treatment, but the optimal surgical approach and technique have yet to be established. The authors report on their experience ... ...

Abstract	Object: Patients with symptomatic isolated fourth ventricle and multicompartmentalized hydrocephalus benefit from operative treatment, but the optimal surgical approach and technique have yet to be established. The authors report on their experience with the treatment of symptomatic adult patients by endoscope-assisted placement of a fourth ventricle shunt catheter via a frontal transventricular approach. Methods: The authors describe a retrospective series of four patients treated for isolated fourth ventricle. The surgical technique is described in detail: use of a flexible endoscope with dual-port intraventricular access for direct visualization and for mechanical manipulation of a multiperforated panventricular catheter guided by frameless stereotaxy. The transventricular approach allowed optimal catheter placement within the fourth ventricle. The use of the flexible endoscope permitted the neurosurgeon to use the endoscope as a tool to guide the ventricular catheter tip within the third ventricle and through the cerebral aqueduct. Clinical outcomes demonstrated neurological and radiographically verified improvement in all patients. Conclusions: The endoscope-assisted dual-port technique provides a solution to the technical difficulties of fourth ventricle shunt placement. The multiple advantages of this technique include a single ventricular catheter shunt system that equalizes ventricular pressures, a frontal location for the ventricular catheter that facilitates valve placement and programming, and ventricular catheter placement within the fourth ventricle that does not allow the catheter to impinge on the fourth ventricle floor and makes the catheter less prone to obstruction.
MeSH term(s)	Adult ; Aged ; Cerebrospinal Fluid Shunts/instrumentation ; Equipment Design ; Follow-Up Studies ; Fourth Ventricle/pathology ; Fourth Ventricle/surgery ; Humans ; Magnetic Resonance Imaging ; Middle Aged ; Neuroendoscopy ; Surgery, Computer-Assisted ; Third Ventricle/surgery ; Treatment Outcome ; Ventriculostomy
Language	English
Publishing date	2007-04-15
Publishing country	United States
Document type	Journal Article
ZDB-ID	2026589-X
ISSN	1092-0684 ; 1092-0684
ISSN (online)	1092-0684
ISSN	1092-0684
DOI	10.3171/foc.2007.22.4.10
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Article: Clinical features and diagnosis of primary central nervous system lymphoma.

Fitzsimmons, April / Upchurch, Kristen / Batchelor, Tracy

Hematology/oncology clinics of North America

2005 Volume 19, Issue 4, Page(s) 689–703, vii

Abstract: This article reviews the clinical features of primary central nervous system lymphoma (PCNSL) in immunocompetent and immunocompromised patients. Clinical presentation, differential diagnosis, diagnostic testing, and staging evaluation in both ... ...

Abstract	This article reviews the clinical features of primary central nervous system lymphoma (PCNSL) in immunocompetent and immunocompromised patients. Clinical presentation, differential diagnosis, diagnostic testing, and staging evaluation in both immunocompetent and AIDS patients who have PCNSL are discussed. The differing role of biopsy in these two populations also is addressed.
MeSH term(s)	Central Nervous System Neoplasms/diagnosis ; Central Nervous System Neoplasms/therapy ; Humans ; Lymphoma/diagnosis ; Lymphoma/therapy ; Neoplasm Staging
Language	English
Publishing date	2005-08
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	93115-9
ISSN	1558-1977 ; 0889-8588
ISSN (online)	1558-1977
ISSN	0889-8588
DOI	10.1016/j.hoc.2005.05.009
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Article ; Online: A narrative review of ergonomic problems, principles, and potential solutions in surgical operations.

Barrios, Evan L / Polcz, Valerie E / Hensley, Sara E / Sarosi, George A / Mohr, Alicia M / Loftus, Tyler J / Upchurch, Gilbert R / Sumfest, Jill M / Efron, Philip A / Dunleavy, Kim / Bible, Letitia / Terracina, Krista P / Al-Mansour, Mazen R / Gravina, Nicole

Surgery

2023 Volume 174, Issue 2, Page(s) 214–221

Abstract: Background: Ergonomic development and awareness are critical to the long-term health and well-being of surgeons. Work-related musculoskeletal disorders affect an overwhelming majority of surgeons, and various operative modalities (open, laparoscopic, ... ...

Abstract	Background: Ergonomic development and awareness are critical to the long-term health and well-being of surgeons. Work-related musculoskeletal disorders affect an overwhelming majority of surgeons, and various operative modalities (open, laparoscopic, and robotic surgery) differentially affect the musculoskeletal system. Previous reviews have addressed various aspects of surgical ergonomic history or methods of ergonomic assessment, but the purpose of this study is to synthesize ergonomic analysis by surgical modality while discussing future directions of the field based on current perioperative interventions. Methods: pubmed was queried for "ergonomics," "work-related musculoskeletal disorders," and "surgery," which returned 124 results. From the 122 English-language papers, a further search was conducted via the articles' sources for relevant literature. Results: Ninety-nine sources were ultimately included. Work-related musculoskeletal disorders culminate in detrimental effects ranging from chronic pain and paresthesias to reduced operative time and consideration for early retirement. Underreporting symptoms and a lack of awareness of proper ergonomic principles substantially hinder the widespread utilization of ergonomic techniques in the operating room, reducing the quality of life and career longevity. Therapeutic interventions exist at some institutions but require further research and development for necessary widespread implementation. Conclusion: Awareness of proper ergonomic principles and the detrimental effects of musculoskeletal disorders is the first step in protecting against this universal problem. Implementing ergonomic practices in the operating room is at a crossroads, and incorporating these principles into everyday life must be a priority for all surgeons.
MeSH term(s)	Humans ; Quality of Life ; Occupational Diseases/etiology ; Occupational Diseases/prevention & control ; Ergonomics/methods ; Musculoskeletal Diseases/epidemiology ; Musculoskeletal Diseases/etiology ; Musculoskeletal Diseases/prevention & control ; Surgeons
Language	English
Publishing date	2023-05-16
Publishing country	United States
Document type	Journal Article ; Review ; Research Support, N.I.H., Extramural
ZDB-ID	202467-6
ISSN	1532-7361 ; 0039-6060
ISSN (online)	1532-7361
ISSN	0039-6060
DOI	10.1016/j.surg.2023.04.003
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Article: Contrasting roles of neural firing rate and local field potentials in human memory.

Ekstrom, Arne / Viskontas, Indre / Kahana, Michael / Jacobs, Josh / Upchurch, Kristen / Bookheimer, Susan / Fried, Itzhak

Hippocampus

2007 Volume 17, Issue 8, Page(s) 606–617

Abstract: Recording the activity of neurons is a mainstay of animal memory research, while human recordings are generally limited to the activity of large ensembles of cells. The relationship between ensemble activity and neural firing rate during declarative ... ...

Abstract	Recording the activity of neurons is a mainstay of animal memory research, while human recordings are generally limited to the activity of large ensembles of cells. The relationship between ensemble activity and neural firing rate during declarative memory processes, however, remains unclear. We recorded neurons and local field potentials (LFPs) simultaneously from the same sites in the human hippocampus and entorhinal cortex (ERC) in patients with implanted intracranial electrodes during a virtual taxi-driver task that also included a memory retrieval component. Neurons increased their firing rate in response to specific passengers or landmarks both during navigation and retrieval. Although we did not find item specificity in the broadband LFP, both theta- and gamma-band LFPs increased power to specific items on a small but significant percent of channels. These responses, however, did not correlate with item-specific neural responses. To contrast item-specific responses with process-specific responses during memory, we compared neural and LFP responses during encoding (navigation) and retrieval (associative and item-specific recognition). A subset of neurons also altered firing rates nonspecifically while subjects viewed items during encoding. Interestingly, LFPs in the hippocampus and ERC increased in power nonspecifically while subjects viewed items during retrieval, more often during associative than item-recognition. Furthermore, we found no correlation between neural firing rate and broadband, theta-band, and gamma-band LFPs during process-specific responses. Our findings suggest that neuronal firing and ensemble activity can be dissociated during encoding, item-maintenance, and retrieval in the human hippocampal area, likely relating to functional properties unique to this region.
MeSH term(s)	Action Potentials/physiology ; Brain/pathology ; Brain Mapping ; Electrodes, Implanted ; Humans ; Memory/physiology ; Neurons/physiology ; Pattern Recognition, Visual/physiology ; Photic Stimulation/methods ; Seizures/pathology
Language	English
Publishing date	2007
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	1074352-2
ISSN	1098-1063 ; 1050-9631
ISSN (online)	1098-1063
ISSN	1050-9631
DOI	10.1002/hipo.20300
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Article ; Online: Nongalenic arteriovenous fistulas: history of treatment and technology.

Upchurch, Kristen / Feng, Lei / Duckwiler, Gary R / Frazee, John G / Martin, Neil A / Viñuela, Fernando

Neurosurgical focus

2006 Volume 20, Issue 6, Page(s) E8

Abstract: Nongalenic cerebral arteriovenous fistulas (AVFs) are uncommon, high-flow vascular lesions first treated by Walter Dandy and his colleagues by using open surgery with ligation of the feeding artery. Due to advances in endovascular technology over the ... ...

Abstract	Nongalenic cerebral arteriovenous fistulas (AVFs) are uncommon, high-flow vascular lesions first treated by Walter Dandy and his colleagues by using open surgery with ligation of the feeding artery. Due to advances in endovascular technology over the past four decades that make possible the control of high flow in AVFs, treatment has evolved from the sole option of surgery to include the alternative or adjunct option of endovascular embolization. The authors of this review discuss the history of nongalenic AVF treatment, including techniques of both surgery and interventional neuroradiology and the technological developments underlying them.
MeSH term(s)	Diagnostic Techniques, Neurological/history ; Embolization, Therapeutic/history ; History, 20th Century ; Humans ; Intracranial Arteriovenous Malformations/diagnosis ; Intracranial Arteriovenous Malformations/history ; Intracranial Arteriovenous Malformations/therapy ; Neurosurgery/history ; United States
Language	English
Publishing date	2006-06-15
Publishing country	United States
Document type	Biography ; Historical Article ; Journal Article
ZDB-ID	2026589-X
ISSN	1092-0684 ; 1092-0684
ISSN (online)	1092-0684
ISSN	1092-0684
DOI	10.3171/foc.2006.20.6.8
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Article ; Online: Epileptogenic temporal cavernous malformations: operative strategies and postoperative seizure outcomes.

Upchurch, Kristen / Stern, John M / Salamon, Noriko / Dewar, Sandra / Engel, Jerome / Vinters, Harry V / Fried, Itzhak

Seizure

2010 Volume 19, Issue 2, Page(s) 120–128

Abstract: Operative treatment of epileptogenic cavernous malformations (CM) continues under debate. Most studies focus on surgery for supratentorial CM in general. For temporal lobe CM, surgical decision-making concerns in particular whether to perform ... ...

Abstract	Operative treatment of epileptogenic cavernous malformations (CM) continues under debate. Most studies focus on surgery for supratentorial CM in general. For temporal lobe CM, surgical decision-making concerns in particular whether to perform lesionectomy alone or the additional excision of mesial temporal structures. The purpose of this case series was to evaluate operative strategies used to treat epileptogenic temporal CM and to report resultant postoperative seizure outcomes. Twelve consecutive cases of patients with medically intractable epilepsy who underwent operation for temporal CM between 1996 and 2006 were retrospectively reviewed. When the temporal CM directly invaded the hippocampus or amygdala, the affected structures were resected in addition to the lesion; when the CM was located in the superficial temporal cortex, and there was no radiographic evidence of hippocampal sclerosis, lesionectomy alone was done; with CM located between the superficial temporal cortex and the mesial temporal region, other factors were considered in decision-making, such as lesion proximity to the deep mesiotemporal structures and preoperative epilepsy duration. For six of the twelve patients, extended lesionectomy (EL) alone was done; for the other six, tailored anteromedial temporal resection with hippocampectomy and/or amygdalectomy was performed in addition to EL. Postoperatively, 11 patients - all with preoperative VEM demonstrating electroclinical seizure patterns concordant with lesion location - were seizure-free. We conclude that epileptogenic temporal CM are surgically remediable, when approached with the above operative strategies and presurgical VEM. On the basis of these postoperative seizure control results, we recommend consideration of concurrent resection of mesial temporal structures with EL for certain temporal CM.
MeSH term(s)	Adult ; Algorithms ; Anticonvulsants/therapeutic use ; Arteriovenous Malformations/complications ; Arteriovenous Malformations/surgery ; Electroencephalography/methods ; Epilepsy/complications ; Epilepsy/surgery ; Female ; Humans ; Magnetic Resonance Imaging/methods ; Male ; Middle Aged ; Neurosurgical Procedures/adverse effects ; Postoperative Complications/physiopathology ; Retrospective Studies ; Seizures/drug therapy ; Seizures/etiology ; Treatment Outcome ; Young Adult
Chemical Substances	Anticonvulsants
Language	English
Publishing date	2010-03
Publishing country	England
Document type	Case Reports ; Journal Article
ZDB-ID	1137610-7
ISSN	1532-2688 ; 1059-1311
ISSN (online)	1532-2688
ISSN	1059-1311
DOI	10.1016/j.seizure.2009.11.006
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Article ; Online: Slowed decomposition is biotically mediated in an ectomycorrhizal, tropical rain forest.

McGuire, Krista L / Zak, Donald R / Edwards, Ivan P / Blackwood, Christopher B / Upchurch, Rima

Oecologia

2010 Volume 164, Issue 3, Page(s) 785–795

Abstract: Bacteria and fungi drive the cycling of plant litter in forests, but little is known about their role in tropical rain forest nutrient cycling, despite the high rates of litter decay observed in these ecosystems. However, litter decay rates are not ... ...

Abstract	Bacteria and fungi drive the cycling of plant litter in forests, but little is known about their role in tropical rain forest nutrient cycling, despite the high rates of litter decay observed in these ecosystems. However, litter decay rates are not uniform across tropical rain forests. For example, decomposition can differ dramatically over small spatial scales between low-diversity, monodominant rain forests, and species-rich, mixed forests. Because the climatic patterns and soil parent material are identical in co-occurring mixed and monodominant forests, differences in forest floor accumulation, litter production, and decomposition between these forests may be biotically mediated. To test this hypothesis, we conducted field and laboratory studies in a monodominant rain forest in which the ectomycorrhizal tree Dicymbe corymbosa forms >80% of the canopy, and a diverse, mixed forest dominated by arbuscular mycorrhizal trees. After 2 years, decomposition was significantly slower in the monodominant forest (P < 0.001), but litter production was significantly greater in the mixed forest (P < 0.001). In the laboratory, we found microbial community biomass was greater in the mixed forest (P = 0.02), and the composition of fungal communities was distinct between the two rain forest types (P = 0.001). Sequencing of fungal rDNA revealed a significantly lower richness of saprotrophic fungi in the monodominant forest (19 species) relative to the species-rich forest (84 species); moreover, only 4% percent of fungal sequences occurred in both forests. These results show that nutrient cycling patterns in tropical forests can vary dramatically over small spatial scales, and that changes in microbial community structure likely drive the observed differences in decomposition.
MeSH term(s)	Biodiversity ; Ecosystem ; Mycorrhizae/physiology ; Picea/microbiology ; Soil Microbiology ; Trees/microbiology ; Trees/physiology ; Tropical Climate
Language	English
Publishing date	2010-06-25
Publishing country	Germany
Document type	Journal Article ; Research Support, Non-U.S. Gov't ; Research Support, U.S. Gov't, Non-P.H.S.
ZDB-ID	123369-5
ISSN	1432-1939 ; 0029-8549
ISSN (online)	1432-1939
ISSN	0029-8549
DOI	10.1007/s00442-010-1686-1
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Article: Slowed decomposition is biotically mediated in an ectomycorrhizal, tropical rain forest

McGuire, Krista L / Zak, Donald R / Edwards, Ivan P / Blackwood, Christopher B / Upchurch, Rima

Oecologia. 2010 Nov., v. 164, no. 3

2010

Abstract	Bacteria and fungi drive the cycling of plant litter in forests, but little is known about their role in tropical rain forest nutrient cycling, despite the high rates of litter decay observed in these ecosystems. However, litter decay rates are not uniform across tropical rain forests. For example, decomposition can differ dramatically over small spatial scales between low-diversity, monodominant rain forests, and species-rich, mixed forests. Because the climatic patterns and soil parent material are identical in co-occurring mixed and monodominant forests, differences in forest floor accumulation, litter production, and decomposition between these forests may be biotically mediated. To test this hypothesis, we conducted field and laboratory studies in a monodominant rain forest in which the ectomycorrhizal tree Dicymbe corymbosa forms >80% of the canopy, and a diverse, mixed forest dominated by arbuscular mycorrhizal trees. After 2 years, decomposition was significantly slower in the monodominant forest (P < 0.001), but litter production was significantly greater in the mixed forest (P < 0.001). In the laboratory, we found microbial community biomass was greater in the mixed forest (P = 0.02), and the composition of fungal communities was distinct between the two rain forest types (P = 0.001). Sequencing of fungal rDNA revealed a significantly lower richness of saprotrophic fungi in the monodominant forest (19 species) relative to the species-rich forest (84 species); moreover, only 4% percent of fungal sequences occurred in both forests. These results show that nutrient cycling patterns in tropical forests can vary dramatically over small spatial scales, and that changes in microbial community structure likely drive the observed differences in decomposition.
Keywords	degradation ; fungi ; tropical rain forests ; Guyana
Language	English
Dates of publication	2010-11
Size	p. 785-795.
Publisher	Springer-Verlag
Publishing place	Berlin/Heidelberg
Document type	Article
ZDB-ID	123369-5
ISSN	1432-1939 ; 0029-8549
ISSN (online)	1432-1939
ISSN	0029-8549
DOI	10.1007/s00442-010-1686-1
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