Neurosurgery
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Astrocyte-specific glial fibrillary acidic protein (GFAP) and neuron-specific ubiquitin C-terminal hydrolase-L1 (UCH-L1) are biomarkers, which may help to detect traumatic brain injury (TBI), assess its severity, and improve outcome prediction. We investigated the relation of the GFAP and UCH-L1 levels to the severity of TBI and their prognostic value during the first week after the injury. ⋯ These results support the prior findings of the potential role of GFAP and UCH-L1 in acute phase and prognostic diagnostics of TBI. The novel finding is that GFAP and UCH-L1 levels correlated with the initial severity of TBI during the first 2 days after the injury, thus enabling a window for TBI diagnostics with latency.
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Previous studies have documented dysfunctional cerebral metabolism following traumatic brain injury (TBI), characterized by reduction in cerebral metabolic rates (CMRs) of glucose and oxygen. In our largest series to date, here, we provide further evidence and time courses of these metabolic changes. ⋯ In our largest series of patients to date, we have demonstrated that posttraumatic cerebral metabolism is characterized by depressed glucose and oxygen metabolism that is persistent for at least 6 days postinjury. There is mismatch between glucose and oxygen utilization, indicated by diminished metabolic ratio, and frequent lactate uptake. Further study is required to fully characterize the dysfunctional metabolism, which may be a source of further secondary injury in the early postinjury period.
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Brain mapping has undergone a paradigm shift from functional localization to focusing on complex network connectivity. Central to this has been the search for the connectome or the brain's wiring diagram. Modeling the effects of focal lesions using graph theory allows consideration of how important a region is to network function and the effects of its removal. Our aim is to determine the feasibility of applying connectomics to neurosurgery and determine the key topological characteristics of patients with real lesion. ⋯ Our refined analysis pipeline confirms the feasibility of performing complex network analysis with graph theory in patients with real lesions and is a novel approach to preoperative brain mapping. Potential discrepancies between the effects of real and simulated lesions may allow identification of mechanisms behind network plasticity. Preoperative mapping of network hubs and robustness is a novel approach for understanding the mechanisms of how higher cognitive processes are affected by and recover from real lesions.
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Concussion remains a clinical diagnosis with the lack of objective changes on standard brain imaging. Failure to document concussion delays appropriate intervention in this at-risk population. Magnetoencephalography (MEG) is a powerful, noninvasive imaging modality which may offer unique insight into functional brain networks affected in concussed patients. ⋯ These results suggest that short-duration MEG recording may be used to diagnose concussion. MEG can be used to calculate an objective measure quantifying the degree of global dysfunction that potentially can be used to predict functional outcomes or symptom severity. This is the first study to apply graph theory on MEG-acquired data in concussion.
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Surgical costs are very high, but most surgeons have little knowledge of their operating room (OR) costs. A recent study of orthopedic surgeons found that their cost estimates for commonly used orthopedic devices ranged from 1.8% to 24.6 times the actual price. The goal of OR SCORE is to determine whether a price transparency initiative will reduce costs in the surgical departments at University of California San Francisco (UCSF). ⋯ To the best of our knowledge, there are no publications demonstrating cost reduction through a price transparency initiative directed at surgeons, and our work represents one of the first attempts to do this.