Abstract Flow diversion using a Pipeline embolization device (PED; Medtronic, Dublin, Ireland) is an effective therapy for treating cavernous aneurysms. Currently, flow diverters require a 0.027-inch microcatheter for deployment. To navigate across these aneurysms, a 0.014-inch microwire is used, which often does not offer a sturdy enough rail to advance a 0.027-inch microcatheter past dissecting artery aneurysm ostia. We present a patient with a right cavernous dissecting carotid artery aneurysm. A step off between the 0.027-inch VIA microcatheter (MicroVention Terumo, Tustin, California) and 0.014-inch Synchro 2 microwire (Stryker Neurovascular, Fremont, California) resulted in difficulty with navigation of the microcatheter across the dissected portion of the aneurysm. A dual microwire rail technique involving two 0.014-inch Synchro 2 microwires was used to advance the VIA microcatheter past the dissecting artery aneurysm ostia for PED deployment. The introduction of the second microwire eliminated the step off between the microwire and microcatheter, providing a stronger rail and easier navigation of the microcatheter, without aggressive pushing. Postembolization runs showed optimal wall apposition and contrast stasis within the aneurysm, with successful flow diversion of the aneurysm. The patient gave informed consent for surgery and video recording. Institutional review board approval was deemed unnecessary.
Since 1976, 10 cases of intradiploic encephaloceles have been reported in the literature. This case is the first report of a spontaneous intradiploic meningoencephalocele of the frontal bone hypothesized to be secondary to distant head trauma.A 60-year-old female with a history of multiple traumatic head injuries as a child presenting with new onset generalized tonic-clonic seizures. Work-up revealed a right frontal epileptic focus. Imaging showed a right frontal intradiploic lesion. The patient underwent surgical resection, which during exploration was found to be an intradiploic encephalocele. She had an uneventful postoperative course with a resolution of seizures.The authors hypothesize that the rare nature of posttraumatic frontal intradiploic encephaloceles is due to the increased thickness of the frontal bone compared to the parietal bone.
Despite the importance of case logs in evaluating residents, no studies assess their accuracy in neurological surgery. Studies from other specialties reveal variations in reporting. This study assesses the accuracy of neurological surgery resident case logs at a single institution.Data was collected from three databases: billing data and two separate resident-managed case logs [department log and Accreditation Council for Graduate Medical Education (ACGME) case logs], containing records of procedures performed by 14 neurological surgery residents at a single institution over a 1-year period. The billing data was used as a proxy for a census of procedures performed during the study period. The difference between the number of procedures logged by residents and the number of procedures billed was calculated to determine the accuracy of the resident case logs.Over the study period, 2150 procedures were billed at the institution, whereas 1749 procedures were logged in the ACGME case log and 1873 in the department log, representing an error rate of -18.65% and -12.88%, respectively. The error rate varied significantly (-1150% to +50.23%) between ACGME procedure categories. In 13 of the 22 ACGME procedure categories, the procedures were under-logged by residents in both resident-managed case logs. No category demonstrated over-logging in both case log systems.Resident managed case logs are an incomplete representation of clinical work. The cause for inaccuracy is multifactorial. The authors suggested that further research is necessary to validate their results and to identify means by which the accuracy of case logs can be increased.
PURPOSE: To compare whey and casein protein combined with a 12-week resistance training program on systemic and cellular mechanisms regulating skeletal muscle hypertrophy in older males. METHODS: Thirty-six non-resistance trained males (62.5±6.8 yrs, 177±6.32 cm, 95.25±16.9 kg) were randomized in a double blind manner to ingest either whey protein (WP) [20g/d WP + 5g carbohydrate (CHO)], casein protein (CAS) (20g/d CAS + 5g CHO) or maltodextrose placebo (CHO) [25g/d CHO] while participating in a supervised high intensity resistance training program (3 sets x 10 repetitions at 75% of 1RM), 3 days per week for 12 weeks. Testing sessions were completed prior to (0 weeks), 4 weeks, 8 weeks and 12 weeks post resistance training and supplementation. Each testing session included blood collection and vastus lateralis muscle biopsy. The blood serum was analyzed for insulin-like growth factor 1 (IGF-1), free testosterone and hepatocyte growth factor (HGF) and the muscle tissue for phosphorylated mesenchymal-epithelial transition factor (c-Met). Data was analyzed using repeated measures ANOVA. RESULTS: A significant time effect was observed for serum free testosterone (0 weeks:14.26±9.78pg/ml vs. 12 weeks: 17.01±13.10pg/ml, p<0.05), with subsequent post-hoc analysis revealing significantly higher serum free testosterone levels at 4 weeks (18.61±15.20pg/ml, p=0.021) and 8 weeks (17.67±14.04pg/ml, p=0.028) compared to 0 weeks (14.26±9.78pg/ml). No time effects were evident for serum IGF-1 (0 weeks:0.841±0.487pg/ml vs. 12 weeks:0.824±0.448pg/ml, p=0.309), HGF (0 weeks:332.33±705.17pg/ml vs. 12 weeks:306.52±586.03pg/ml, p=0.483), or phosphorylated c-Met (0 weeks:0.109±0.242ng/mg vs. 12 weeks:0.038±0.039ng/mg, p=0.316). A significant group effect was observed for serum IGF-1 (p<0.05), with subsequent post-hoc analysis revealing significantly higher serum IGF-1 levels in the WP (0.684±0.381, p<0.05) and CAS groups (0.925±0.437, p<0.01) compared to CHO placebo (0.353±0.267). No other group or group by time interactions were observed. CONCLUSIONS: Whey protein and casein supplementation in conjunction with 12-weeks of resistance training were unable to enhance serum IGF-1 and testosterone levels and/or markers of satellite cell activation in older males.
Human gliomas are among the most difficult tumors to treat. Current animal models are limited to small animal models that may or may not be fully relevant to aspects of human disease. We provide data for naturally occurring canine gliomas, which are a more similar model to human disease allowing for evaluation of combined medical and surgical therapies. We reviewed our case series of dogs with any type of glioma that underwent surgery as part of the Canine Brain Tumor Clinical Trials Program at the University of Minnesota. Breed, date of surgery, median progression-free (PFS) and overall survival (OS) times and cause of death were recorded for multivariate analysis. A total of 95 dogs (39 female, 56 male; mean age = 8.3 years) were included in the analysis. Gross total resection was reported in 81 cases based on postoperative MRI imaging. 70 were found to have high grade tumors (grade III or grade IV), 8 were excluded as final pathology was not tumor. Seizure was the most common presenting symptom, being present in 83 dogs. The average survival after surgery was >200 days. Grade II tumors had longer OS when compared high-grade tumors (474 days, 95% CI 249-698 for grade II; 191 days, 95% CI 119-264 for grade IV; p=0.032), but age (cox regression, p-value=0.14) and sex (Kaplan-Meier test, p-value 0.22) did not. This abstract offers descriptive data for a naturally occurring canine glioma model, which can be used to test different therapies prior to human trials. The classification of tumor grading did correlate with median survival after surgery. The survival did not correlate with age, sex, or breed. Further work will focus on the effects of different therapies, including chemotherapy, radiation therapy immunotherapy, or other targeted therapies.
PURPOSE: To examine the chronic effects of whey and casein protein supplementation in conjunction with supervised resistance-training on muscle strength and body composition in older males. METHODS: Thirty-six non-resistance trained males (62.5±6.8 yrs, 177±6.32 cm, 95.25±16.9 kg) were randomized in a double blind manner to ingest either whey protein (WP) [20g/d WP + 5g carbohydrate (CHO)], casein (CAS) [20g/d CAS + 5g CHO] or maltodextrose placebo [25g/d CHO] while participating in a supervised high-intensity resistance training program (3 sets × 10 repetitions at 75% of 1 repetition maximum (RM)), 3 days per week for 12 weeks. Testing sessions were completed prior to 0 weeks, 4 weeks, 8 weeks and 12 weeks post resistance training and supplementation. Each testing session included body composition measurement as determined by Dual Energy X-Ray Absorptiometry and muscle strength measurements as determined by 1 RM on leg press and bench press. Data was analyzed using repeated measures ANOVA. RESULTS: A significant time effect was observed for 1 RM bench press (0 weeks: 59.06kg ± 14.38kg vs. 12 weeks: 77.51 ± 22.02kg, p<0.001), 1 RM leg press (0 weeks: 241.03kg ± 78.45kg vs. 12 weeks: 383.81kg ± 108.22kg, p<0.001) and fat free mass (FFM) (0 weeks: 60.55kg ± 9.17kg vs. 12 weeks: 61.66kg ± 8.91kg, p<0.05). A significant group × time interaction was also observed for 1 RM leg press (p = 0.001), with subsequent analysis demonstrating a trend towards significantly higher 1 RM leg press strength in the WP (413.02kg ± 108.65kg, p=0.053) and CAS (408.18kg ± 130.77kg, p=0.086) groups compared to the CHO (330.23kg ± 85.23kg) group at 12 weeks. No other group by time interactions or group effects were identified. CONCLUSION: The present study suggests that whey and casein protein supplementation in conjunction with supervised high-intensity resistance training may be important in combating sarcopenia.
The perception of a steep learning curve associated with transradial access has resulted in its limited adoption in neurointervention despite the demonstrated benefits, including decreased access-site complications.To compare learning curves of transradial versus transfemoral diagnostic cerebral angiograms obtained by five neurovascular fellows as primary operator.The first 100-150 consecutive transradial and transfemoral angiographic scans performed by each fellow between July 2017 and March 2020 were identified. Mean fluoroscopy time per artery injected (angiographic efficiency) was calculated as a marker of technical proficiency and compared for every 25 consecutive procedures performed (eg, 1-25, 26-50, 51-75).We identified 1242 diagnostic angiograms, 607 transradial and 635 transfemoral. The radial cohort was older (64.3 years vs 62.3 years, p=0.01) and demonstrated better angiographic efficiency (3.4 min/vessel vs 3.7 min/vessel, p=0.03). For three fellows without previous endovascular experience, proficiency was obtained between 25 and 50 transfemoral angiograms. One fellow achieved proficiency after performing 25-50 transradial angiograms; and the two other fellows, in <25 transradial angiograms. The two fellows with previous experience had flattened learning curves for both access types. Two patients experienced transient neurologic symptoms postprocedure. Transradial angiograms were associated with significantly fewer access-site complications (3/607, 0.5% vs 22/635, 3.5%, p<0.01). Radial-to-femoral conversion occurred in 1.2% (7/607); femoral-to-radial conversion occurred in 0.3% (2/635). Over time, the proportion of transradial angiographic procedures increased.Technical proficiency improved significantly over time for both access types, typically requiring between 25 and 50 diagnostic angiograms to achieve asymptomatic improvement in efficiency. Reduced access-site complications and decreased fluoroscopy time were benefits associated with transradial angiography.
Abstract BACKGROUND Trends in mechanical thrombectomy have emphasized larger bore aspiration catheters that may be difficult to deploy from a radial access point due to size constraints or need to obtain sheathless access. As such, many neurointerventionists are reticent to attempt thrombectomy through transradial access (TRA) for fear of worse outcomes. OBJECTIVE To explore whether mechanical thrombectomy could be achieved safely and effectively through the transradial route. METHODS We retrospectively analyzed the records of patients undergoing mechanical thrombectomy at our academic institute between January 2018 and January 2019, which corresponded to a time when we began to transition to TRA for neurointerventions, including mechanical thrombectomy. We compared the procedural details and clinical outcomes of patients undergoing mechanical thrombectomy using TRA with those using transfemoral access (TFA). RESULTS During the study period, 44 patients underwent mechanical thrombectomy with TRA and 129 with TFA. There was no statistically significant difference in door-to-access time, door-to-reperfusion time, or first-pass recanalization rate. There was no significant difference in modified Rankin Scale (mRS) score at discharge, mRS score at last follow-up, or length of stay. There were 7 access-site complications in the TFA group and none in the TRA group. One patient in the TRA group required crossover to TFA. CONCLUSION Mechanical thrombectomy can be performed safely and effectively from a TRA site without compromising recanalization times or rates. TRA has superior access-site complication profiles compared to TFA.
PURPOSE: Examine the chronic effects of combined creatine monohydrate supplementation and resistance training on body composition and muscle strength in older males. METHODS: Twenty non-ressitance trained males (61.05±4.95 yrs, 176.17±6.21 cm, 69.15±2.44 kg) were randomized in a double blind manner. Participants ingested either creatine monoydrate [20g/d CrM + 5g Carbohydrate (CHO) × 7 days, then 5g/d CrM +5g CHO × 77 days] or carbohydrate placebo (20g/d CHO × 7 days, then 5g/d CHO × 77 days) while participating in a high intensity resistance training program (3 sets × 10 repetitions at 75% of 1RM), 3 days per week for 12 weeks. Testing sessions were completed prior to, 4 weeks, 8 weeks and 12 weeks post resistance training and supplementation. Each testing session included body composition measurement as determined by Dual Energy X-Ray Absorptiometry (DEXA), muscle strength measurement as determined by 1 repetition maximum (RM) on leg press and bench press. Data were analyzed using repeated measures ANOVA. RESULTS: A significant time effect was observed for 1RM bench press (0 weeks: 66.02kg ± 16.41kg vs. 12 weeks: 73.29kg ± 17.19 kg, p=0.016), leg press (0 weeks: 272.72kg ± 70.51kg vs. 12 weeks: 338.06kg ± 78.27kg, p<0.05), body mass (0 weeks: 91.31kg ± 13.91kg vs. 12 weeks: 92.49kg ± 13.68kg, p=0.030), and fat free mass (0 weeks: 57.75kg ± 9.19kg vs. 12 weeks: 59.00 kg ± 9.18 kg, p<0.005). However, no significant group or group by time interaction was observed. CONCLUSION: Creatine supplementation when combined with 12-weeks of high intensity resistance training does not enhance body composition and muscle strength in older males. Supplement was donated by Alzchem LLC-A Degussa Company.
