Translational Medical Research Commons^™

Applications Of Deep Learning With Detecting Intracranial Aneurysms On Ct Angiograms: A Literature Review, Christian Fang, Emily Wang

Rowan-Virtua Research Day

INTRODUCTION

Deep learning is a method of artificial intelligence involving progressively layered neural networks to extrapolate patterns from data to provide predictions. Moreover, given the arduous nature required for examining CT scans for intracranial aneurysms, discovering ways to expedite this process is beneficial. The use of deep learning to evaluate CT angiograms for intracranial aneurysms has been sparsely studied. This literature review aims to determine the accuracy and reliability of deep learning to analyze CT angiograms in patients suspected to have intracranial aneurysms.

METHODS

A qualitative review of literature using PubMed, SCOPUS, and EMBASE was conducted. Inclusion criteria comprised articles …

Shedding Light On Hearing In Coma: Investigating The Applicability Of Functional Near-Infrared Spectroscopy For Assessing Auditory Function And Aiding Prognosis In Patients With Acute Disorders Of Consciousness, Reza Moulavi Ardakani

Electronic Thesis and Dissertation Repository

There is a critical need for a bedside neuroimaging tool to aid in the prediction of functional recovery outcomes for patients with acute disorders of consciousness (DoC) in the early days following severe brain injury. Current neurobehavioral examinations and prognosis tools have limitations in predicting good outcomes, leading to potential mistreatment or premature withdrawal of life support. Functional near-infrared spectroscopy (fNIRS) is a viable candidate for such purposes due to its portability and cost-effectiveness. Auditory processing, viewed as a multi-level and multifaceted brain function, could provide a sensitive and specific marker of residual cognitive function in unresponsive patients. This study …

Targeting Metabolic Alterations Associated With Smooth Muscle Α-Actin Pathogenic Variant Attenuates Moyamoya-Like Cerebrovascular Disease, Anita Kaw

Dissertations & Theses (Open Access)

Heterozygous pathogenic variants in ACTA2, encoding smooth muscle α-actin (α-SMA), predispose to thoracic aortic aneurysms and dissections. De novo missense variants disrupting ACTA2 arginine 179 (p.Arg179) cause a multisystemic disease termed smooth muscle dysfunction syndrome (SMDS), which is characterized by early onset thoracic aortic disease and moyamoya disease-like (MMD) cerebrovascular disease. The MMD-like cerebrovascular disease in SMDS patients is marked by bilateral steno-occlusive lesions in the distal internal carotid arteries (ICAs) and their branches. To study the molecular mechanisms that underlie the ACTA2 p.Arg179 variants, a smooth muscle-specific Cre-lox knock-in mouse model of the heterozygous Acta2 R179C variant, termed …

Evaluation Of Respiratory Function Using Blood Gas Parameters In Yucatan Minipigs Following Spinal Cord Injury, Jackson Gallagher, Monique Morgan, Chase Knibbe, Destiny Gibson, Maxwell Boakye

The Cardinal Edge

There are approximately 17,810 new spinal cord injuries (SCI) in the U.S. each year [1]. Physical damage to the spinal cord has the potential to interfere with normal motor, sensory, and/or autonomic function, such as impairment of the respiratory system. In fact, respiratory insufficiency is the number one cause of mortality and morbidity after SCI. The more rostral the injury, the more likely there will be disruption to normal ventilation (generally rostral to T6) [2]. To conduct relevant preclinical research, it has been shown that large animal models, such as the Yucatan minipig, have a better success rate of translating …

Conference Proceedings: Select Abstracts Presented At 2021 Advocate Aurora Health Scientific Day

Journal of Patient-Centered Research and Reviews

Abstracts published within this supplement were presented at the 47th annual Advocate Aurora Health Scientific Day, held virtually on May 26, 2021. This research symposium provides a forum for disseminating results from studies conducted by faculty, fellows, residents, and other allied health professionals associated with Midwest-based health system Advocate Aurora Health, which publishes the Journal of Patient-Centered Research and Reviews.

Conference Proceedings: Aurora Scientific Day 2020

Journal of Patient-Centered Research and Reviews

Abstracts published in this supplement were among those presented at the 46th annual Aurora Scientific Day research symposium, held virtually on May 20, 2020. The symposium provides a forum for describing research studies conducted by faculty, fellows, residents, and allied health professionals affiliated with Wisconsin-based Aurora Health Care, a part of the Advocate Aurora Health health system, which publishes the Journal of Patient-Centered Research and Reviews.

Subcutaneous Immunoglobulin Proves To Be An Effective Alternative To Intravenous Immunoglobulin In The Treatment Of Chronic Inflammatory Demyelinating Polyneuropathy, Benjamin Ross

Clinical Research in Practice: The Journal of Team Hippocrates

A clinical decision report appraising van Schaik IN, Bril V, van Geloven N, et al. Subcutaneous immunoglobulin for maintenance treatment in chronic inflammatory demyelinating polyneuropathy (PATH): a randomised, double-blind, placebo-controlled, phase 3 trial. Lancet Neurol. 2018;17(1):35-46. https://doi.org/10.1016/S1474-4422(17)30378-2

Transanal Irrigation Is More Beneficial In Symptomatic Management Of Neurogenic Bowel Disease Than Conservative Bowel Management, Chi-Lan Tran

Clinical Research in Practice: The Journal of Team Hippocrates

A clinical decision report appraising Christensen P, Bazzocchi G, Coggrave M, et al. A Randomized, Controlled Trial of Transanal Irrigation Versus Conservative Bowel Management in Spinal Cord–Injured Patients. Gastroenterology. 2006;131(3):738-747. https://doi.org/10.1053/j.gastro.2006.06.004

Diagnostic Accuracy Of Procalcitonin In Differentiating Sepsis From Noninfectious Sirs In Adult Patients With Subarachnoid Hemorrhage, Keshav Choudhuri, Umer Mukhtar, Md, M. Kamran Athar, Md, David Boorman, Ms, Fred Rincon, Md, Matthew Vibbert, Md, Syed O. Shah, Md, Jacqueline S. Urtecho, Md, Jack Jallo, Md

Phase 1

Background: Subarachnoid hemorrhage (SAH) is a frequent diagnosis in the neuro-intensive care unit (NICU) that can result in the development of systemic inflammatory response syndrome (SIRS) and fever. The differentiation between central fever and infectious fever is paramount in order to prevent superfluous diagnostic testing and overuse of empiric antibiotics.

Methods: A prospective chart review study conducted in the NICU between December 2012 and September 2015. Patients with SAH, fever (≥101.0°F) and/or who were SIRS positive and had PCT levels measured were included. The primary outcome was clinical infection defined as any positive culture or infiltrate on chest X-ray within …

Marked Circadian Variation In Number And Type Of Hyperacute Strokes During The 24 Hour Day-Night Cycle, Eeman Khorramian, Sidney Starkman, Nerses Sanossian, David Liebeskind, Gilda Avila, Samuel Stratton, Marc Eckstein, Frank Pratt, Latisha Sharma, Lucas Restrepo, Miguel Valdes-Sueiras, May Kim-Tenser, Pablo Villablanca, Robin Conwit, Scott Hamilton, Jeffrey L. Saver, Fast-Mag Trial Investigators And Coordinators

Phase 1

Introduction: Circadian variations in stroke onset provide critical information for the allocation of pre-hospital and hospital resources in clinical care. Confining analysis to patients with defined onset in waking and clearly distinguished ischemic and hemorrhagic stroke subtypes, would substantial benefit our understanding of stroke etiology.

Methods: We analyzed patients enrolled in the NIH FAST-MAG phase 3 trial of field-initiated neuroprotective agents in patients with hyperacute stroke within 2h of onset. Onset times were analyzed in 1h time blocks throughout the 24h day-night cycle. Patient demographic and clinical features, medical history, imaging characteristics, and stroke deficit severity were correlated with …

Surgical Resection Of Convexity Meningiomas: A Single Center Retrospective Analysis, Haley Wendt, Michael Baldassari, Donald Ye, Kevin Judy

Phase 1

Introduction: Dural convexity meningiomas (CMs) are the most common primary intracranial tumors. Although surgical resection carries relatively low risk, it is necessary to quantify perioperative risks from a large patient cohort and identify factors contributing to short-term and long-term outcomes.

Methods: Patients who underwent craniotomy for resection of CMs between January 2012-December 2018 at a single large academic center were reviewed for pre-operative demographics, radiographic characteristics, and post-operative outcomes.

Results: 122 cases of CMs were identified. Common presenting symptoms included headache (39.3%), seizure (27.0%) and weakness/paralysis (18%). CMs were located over frontal, parietal, temporal, and occipital lobes in 57.4%, …

Improving The Accuracy Of Dat Scan Interpretation: A Retrospective Study To Identify Variables That Standardize The Review Of Dat Scans For Idiopathic Parkinson’S Disease, Hannah Hackbart, Andrew B. Newberg, Md, Tsao-Wei Liang, Md

Phase 1

Introduction: Until recently, the diagnosis of Parkinson’s disease (PD) has been based solely on clinical observation. The DaT scan is a tool that allows clinicians to visualize areas of neurodegeneration in PD and can help guide diagnosis. However, there is a discordance between clinical judgement and interpretation of DaT scans. In this study, we aim to improve the utility of DaT scans in the diagnosis of PD by identifying factors that can lead to a misdiagnosis and determine which image findings predict a clinical syndrome of parkinsonism.

Methods: We will conduct a retrospective chart review to analyze DaT scans of …

Brainwave Nets: Are Sparse Dynamic Models Susceptible To Brain Manipulation Experimentation?, Diego C. Nascimento, Marco A. Pinto-Orellana, Joao P. Leite, Dylan J. Edwards, Francisco Louzada, Taiza E.G. Santos

Research outputs 2014 to 2021

© Copyright © 2020 Nascimento, Pinto-Orellana, Leite, Edwards, Louzada and Santos. Sparse time series models have shown promise in estimating contemporaneous and ongoing brain connectivity. This paper was motivated by a neuroscience experiment using EEG signals as the outcome of our established interventional protocol, a new method in neurorehabilitation toward developing a treatment for visual verticality disorder in post-stroke patients. To analyze the [complex outcome measure (EEG)] that reflects neural-network functioning and processing in more specific ways regarding traditional analyses, we make a comparison among sparse time series models (classic VAR, GLASSO, TSCGM, and TSCGM-modified with non-linear and iterative optimizations) …

Measuring The Efficacy Of Medical Management Versus Decompressive Hemicraniectomy In Acute Stroke, Colton Hemphill, Franziska Herpich, Muhammad Athar, Eunice Lee

Phase 1

Introduction: Stroke is a life-threatening condition requiring immediate treatment in order to optimize patient survival and functionality post-hospitalization. At present, the primary treatment modalities used are intensive medical management and surgical decompressive hemicraniectomy. We believe that application of skilled medical management can result in a lower mortality rate and higher functional score at 12 months than aggressive surgical decompressive hemicraniectomy.

Methods: Epic data from Thomas Jefferson University will be used to identify patients with a large stroke (as defined by ischemic area on MRI) managed by the neurology department from 2016 to 2019. A survey will be administered by phone …

Amelioration Of The Neuroinhibitory Local Environment After Ischemic Injury Through In Situ Astrocyte-To-Neuron Conversion, Abhinav K. Rao, Yu-Chen Chen, Ning-Xin Ma, Zi-Fei Pei, Susan Keefe, Emma Yellin, Miranda Chen, Fu-Han Yang, Xiao-Song He, Gong Chen

Phase 1

Ischemic injury in central nervous system (CNS) often causes severe neuronal loss and activates glial cells. We showed earlier that NeuroD1-mediated astrocyte-to-neuron (AtN) conversion can regenerate a substantial proportion of neurons (~40% of the total) and reconstruct the ischemic injured neural circuits. In this study, we focus on glial changes and blood vessel recovery following AtN conversion. Specifically, we found that ectopic expression of NeuroD1 in the reactive astrocytes after ischemic injury significantly reduced glial reactivity, as shown by less hypertrophic morphology, along with reduced secretion of neuroinhibitory factors such as CSPG and LCN2. As for microglia, we found less …

Structural Brain Plasticity In Epilepsy Patients Selected For Laser Interstitial Thermal Therapy: A Study Of Diffusion Tensor Imaging Based Assessment Of Tract Alterations, Umma Fatema, Mahdi Alizadeh

Phase 1

Introduction: The standard of care for drug resistant temporal lobe epilepsy (TLE) involve surgical approaches including anterior temporal lobectomy (ATL) and laser interstitial thermal therapy (LiTT). White matter alterations following ATL are often studied using diffusion tensor imaging (DTI) which utilizes properties of water diffusion to obtain parameters (such as fractional anisotropy or FA) that can be used to detect neural plasticity. Despite being a common procedure, there are very few studies that explore post-surgical neural changes after LiTT. The objective of this study is to evaluate and explore the DTI parameter changes in patients who underwent LiTT.

Methods: DTI …

Neoangiogenesis And Blood-Brain Barrier Dysfunction In Human Tsc Brain Lesions, Kimberly Sansalone, Pelin Dilsiz, Howard Weiner, Orrin Devinsky, Delia M. Talos

Phase 1

Introduction: Tuberous sclerosis complex (TSC) is a genetic disorder characterized by the presence of multiple benign tumors throughout the body and brain. Patients with TSC experience severe cognitive dysfunction and therapy-resistant seizures, which can be associated with refractory epilepsy and poor developmental outcomes. We hypothesize that neoangiogenesis, disruption of the blood-brain barrier, and leakage of serum proteins into the brain parenchyma play vital roles in the pathogenesis of TSC.

Methods: In order to assess blood-brain barrier integrity, cortical tissue samples from TSC patients with intractable seizures, non-TSC patients with therapy-resistant epilepsy, and control subjects were immunolabeled for the serum …

Middle Fossa Extension Of Posterior Fossa Meningiomas Is Associated With Poorer Clinical Outcomes, David Morgan, Donald Y. Ye, Md, Michael P. Baldassari, Omaditya Khanna, Md, Aria Mahtabfar, Md, Tyler Henry, Haley Wendt, David W. Andrews, Md, Christopher J. Farrell, Md, James J. Evans, Md, Kevin D. Judy, Md

Phase 1

Introduction: Progression of posterior fossa meningiomas (PFMs) can lead to extension into the middle cranial fossa. Pre-operative imaging allows for quantification of middle fossa extension (MFE). We aimed to determine the clinical impact of MFE on surgical and clinical outcomes during resection of PFMs.

Methods: Craniotomies for meningiomas performed at a large single center academic institution from January 2012 to December 2018 were identified. Preoperative MRI and CT imaging was reviewed to determine the presence of MFE of posterior fossa meningiomas and correlated to post-operative outcomes.

Results: 65 PFMs were identified and mean follow-up was 28.8 ± 20.1 months. 13/65 …

Evaluating The Migration Rates In Percutaneous Spinal Cord Stimulation Trials, William Hirsch, Nikolaos Mouchtouris, Md, Ashwini Sharan Md

Phase 1

Introduction: Spinal cord stimulation (SCS) provides symptom reduction in patients with chronic low back pain. The most common complication in SCS is percutaneous lead migration from initial placement site. It is our goal to determine whether using skin anchors during trial implantation reduces SCS trial lead migration rates compared to historical controls.

Methods: 197 patients who underwent SCS trial placement at Thomas Jefferson University Hospital between 2015 and 2018 were considered for this study. Complete data including device impedance measurements and pre and post trial x-rays was collected on 12 historical control patients and 19 patients with leads secured using …

Neurostimulants To Improve Consciousness In Acute Comatose Patients, Lyena Birkenstock, Mohammed Kananeh

Phase 1

Patients in the neurology intensive care unit (NICU) suffering from coma have variable outcomes, even once the underlying condition has been treated. Coma is a detrimental condition with a high risk for mortality and disability. Currently, there is not a specific treatment regimen to treat, or even improve, comatose patients. In this study, we set out to compare the efficacy and side effect profile of different neurostimulants, including modafinil, adderall, and zolpidem. The target population includes adult patients in the Jefferson NICU with a diagnosis of persistent encephalopathy, despite the resolution of their admitting diagnoses. Patients are administered medication as …

Falls And Traumatic Brain Injury In The Elderly On Aspirin Or Anticoagulant Therapy, Jonathan Bassig, David Nauheim, Stanton Miller, Patricia Williams, Tingting Zhan

Phase 1

Introduction: Traumatic brain injury (TBI) after a fall in individuals aged 65 and older is a leading cause of morbidity and mortality, but the effect of aspirin and anticoagulant therapy on TBI severity is not fully understood. This study evaluated whether the severity of TBI is associated with use of aspirin or anticoagulant therapy or in combination.

Methods: Using retrospective chart review, we identified patients age 65 or older who fell and sustained head trauma that were admitted to Thomas Jefferson University Hospital trauma service from 2017-2018. Based on final diagnosis, patients were classified into three groups of TBI …

Avoiding Antiplatelet Reversal In Non-Operative Intracranial Hemorrhages: Functional Outcomes Of Guideline-Based Practice, Angelo D'Antonio-Bertagnolli, Lyena Birkenstock, Ariya Mobaraki, Christine Hammer, Md, Syed O. Shah, Md, Jack Jallo, Md, Phd, Courtney Pendleton, Md

Phase 1

Introduction: Intracranial hemorrhage (ICH) is a common, life-threatening neurological pathology in aging patients, many of whom take antiplatelet medications with potential to worsen the hemorrhage. In the event of ICH, Thomas Jefferson University Hospital (TJUH) follows a protocol modeling the 2016 Neurocritical Care Society (NCS) joint guidelines for antiplatelet medication reversal. We analyzed pre- and post-NCS guideline data from TJUH for outcomes of non-operative ICH patients in order to tease out the potential benefits of this protocol.

Methods: This retrospective cohort study took place from January 2016 – Jan. 2018 at a tertiary care center: TJUH. Patients included were …

Conditions For Combining Gene Therapy With Bone Marrow Transplantation In Murine Krabbe Disease., Mohammad Rafi, Paola Luzi, David A Wenger

Department of Neurology Faculty Papers

No abstract provided.

Evidence Doesn’T Change Prescribing Patterns…So What Does?, Ali Rida, Anthony Brooks

Clinical Research in Practice: The Journal of Team Hippocrates

The authors write in support of critical analysis of clinical research, as a corrective to the physician's urge to "do something" even when no evidence of benefit exists.

Autologous Peripheral Nerve Grafts To The Brain For The Treatment Of Parkinson's Disease, Andrew Welleford

Theses and Dissertations--Neuroscience

Parkinson’s disease (PD) is a disorder of the nervous system that causes problems with movement (motor symptoms) as well as other problems such as mood disorders, cognitive changes, sleep disorders, constipation, pain, and other non-motor symptoms. The severity of PD symptoms worsens over time as the disease progresses, and while there are treatments for the motor and some non-motor symptoms there is no known cure for PD. Thus there is a high demand for therapies to slow the progressive neurodegeneration observed in PD. Two clinical trials at the University of Kentucky College of Medicine (NCT02369003, NCT01833364) are currently underway that …

Hemostatic Nanoparticles Increase Survival, Mitigate Neuropathology And Alleviate Anxiety In A Rodent Blast Trauma Model, W. Brad Hubbard, Margaret Lashof-Sullivan, Shaylen Greenberg, Carly Norris, Joseph Eck, Erin Lavik, Pamela Vandevord

Spinal Cord and Brain Injury Research Center Faculty Publications

Explosions account for 79% of combat related injuries and often lead to polytrauma, a majority of which include blast-induced traumatic brain injuries (bTBI). These injuries lead to internal bleeding in multiple organs and, in the case of bTBI, long term neurological deficits. Currently, there are no treatments for internal bleeding beyond fluid resuscitation and surgery. There is also a dearth of treatments for TBI. We have developed a novel approach using hemostatic nanoparticles that encapsulate an anti-inflammatory, dexamethasone, to stop the bleeding and reduce inflammation after injury. We hypothesize that this will improve not only survival but long term functional …

Letter To The Editor: Management Of Pfo: More Evidence, Same Recommendation, Halima Ali, Md

Clinical Research in Practice: The Journal of Team Hippocrates

The author offers more evidence to support Zhang's assertion in CRP 3(2) that closure of patent foramen ovale or medical therapy alone are both appropriate choices for preventing recurrent cryptogenic strokes (https://doi.org/10.22237/crp/1518739380).

Cognitive Behavioral Therapy For Patients With Psychogenic Non-Epileptic Seizures, Andrew Brown

Clinical Research in Practice: The Journal of Team Hippocrates

A critical appraisal and clinical application of Goldstein L., Chalder T., et al. Cognitive-behavioral therapy for psychogenic non-epileptic seizures: A pilot RCT. Neurology. 2010;74(24):1986-1994. doi: 10.1212/WNL.0b013e3181e39658

Generation Of A Patient-Derived Brain Metastasis Breast Cancer Cell Line Via Novel Orthotopic Injection Placement And Serial Mouse Transplantation To Develop Pdx Mouse Model, Amber L. Lacrosse, Denise M. Coley, Paul J. Mintz, Santhi D. Konduri, Richard A. Rovin, Amin B. Kassam

Journal of Patient-Centered Research and Reviews

Background: The incidence of brain metastasis appears to be increasing, potentially due to advanced technology that aids early diagnosis. Patient-derived xenografts (PDX) have high translational value, as these models retain key functional characteristics of the patient tumor. PDX models are useful to understand the molecular basis of tumorigenesis and to identify new treatment targets. However, generating a first-line PDX model is challenging as engraftment failure is high. Serial transplanting tumor tissue via mouse-to-mouse propagation increases engraftment rates and decreases PDX development time. Herein we report methods to generate a PDX cell line from patient-derived tumor tissue that includes the cerebral …

Clopidogrel Alone Is Safer Than Clopidogrel And Aspirin For Secondary Prevention Of Acute Ischemic Stroke., Bradford J. Woelke, Daniel Angell Do, Katherine Litow Md

Clinical Research in Practice: The Journal of Team Hippocrates

A critical appraisal and clinical application of Diener HC, Bogousslavsky J, Brass LM, et al. Aspirin and clopidogrel compared with clopidogrel alone after recent ischaemic stroke or transient ischaemic attack in high-risk patients (MATCH): randomised, double-blind, placebo-controlled trial. Lancet. 2004;364(9431):331-337. doi: 10.1016/s0140-6736(04)16721-4