Neurosurgery
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Brain Machine Interface (BMI) systems allow patients with neurological injuries to control assistive devices using cortical signals produced during motor imagery (MI). To improve BMI performance, we sought to enhance cortical signals by training subjects in MI techniques that induce activation of mirror neuron networks (MNN). ⋯ Motor imagery training that activates mirror neuron networks enhances cortical signals during MI and during the performance of corresponding movements in healthy subjects. As MI-based signals are used to operate BMIs, our research suggests that MNN-based MI training may improve BMI performance. Additionally, VR-based imagery training may provide a benefit over AO training to induce bilateral activation of MNNs.
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The optimal site for placement of tissue oxygen probes following traumatic brain injury (TBI) remains unresolved. We studied brain tissue oxygen tension (PbtO2) at the sites of contusion, proximal and distal to contusion, and in the contralateral hemisphere to determine the effect of probe location on PbtO2 and to assess the effects of physiological interventions on PbtO2 at these different sites. ⋯ PbtO2 measurements are strongly influenced by the distance from the site of focal injury. Physiological alterations, including hyperoxia, hyperventilation, and hypoventilation substantially affect PbtO2 values distal to the site of injury, but have little effect in and around the site of contusion.
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In Parkinson patients in the OFF medication state, basal ganglia local field potentials exhibit characteristic changes in beta and gamma oscillations that may be directly related to the symptoms of rigidity and bradykinesia. However, magnetoencephalography and low-resolution electrocorticography (ECoG) studies of sensorimotor cortex suggest that changes in cortical oscillations in Parkinson patients may differ from those of the basal ganglia during the OFF medication state. ⋯ Our findings are suggestive of an inverse oscillatory profile in the sensorimotor cortex of Parkinson patients that, in contrast to basal ganglia, may act to facilitate movement in the face of an antikinetic bias inherent in the dopamine-depleted state.
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Value-base purchasing and pay-for-performance models are driving the development of bundle payment systems for reimbursement. To build a sustainable bundling system, it is important to identify the contributions of each component of index surgery total cost and determine the domain where targeted savings can occur. We determined the percent contribution of health care resource utilization, hospital fee, surgeon's fee, and readmission to total cost of index surgery following elective spine surgery. ⋯ Hospital fee had the largest contribution (75%) to the total cost of index surgery, followed by readmissions (21%). Surgeon's fee and health care resource utilization had much smaller contributions to total cost. True cost savings can occur through engagement and partnering between hospital and surgeon to decrease hospital fees. Reducing readmission episodes and understanding and reducing modifiable drivers of hospital fees have the potential to decrease total direct cost for elective spine surgery.
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Clinical observations of patients with both Chiari Malformation Type I (CIM) and tethered spinal cord (TSC), have led some to speculate that there may be an association between the two entities. However, the level of evidence for this association is anecdotal. We examined a large group of subjects to evaluate the association between CIM and TSC. ⋯ There was no statistically significant association between CIM and low conus position. We conclude that patients with CIM do not have lower conus position compared with matched normals, and that TSC is not associated with CIM for most patients.