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This article, titled "Cavernous Sinus Exenteration for Invasive Mucormycosis," discusses a case study of a 61-year-old woman with HIV and diabetes mellitus who experienced vision loss due to invasive rhino-orbito-cerebral mucormycosis. Despite initial surgery and antifungal therapy, the disease progressed into the cavernous sinus and trigeminal nerve branches. The authors performed a STA-to-MCA bypass and a middle fossa approach for cavernous sinus exenteration, which successfully controlled the disease. The article highlights the technical aspects of cavernous sinus exenteration. [Extracted from the article]

This article, published in the Journal of Neurological Surgery, explores the pterygoid-sphenoidal fissure (PSF) as a key landmark for accessing the foramen lacerum in pediatric endoscopic endonasal surgery. The study evaluates the morphometry and developmental variations of the PSF in a general pediatric population using computed tomography scans. The results show that the length, width, and morphology of the PSF vary significantly across different age groups. Understanding these radiological findings is important for preoperative planning and intraoperative guidance in pediatric endoscopic endonasal surgery. [Extracted from the article]

This article discusses the outcomes of endoscopic endonasal transcavernous surgery for pituitary adenomas. The study analyzed data from patients who underwent this surgery between 2018 and 2023. The results showed that transcavernous surgery was more common in repeat surgery patients and those with functioning adenomas. The study also examined the invasion patterns of the cavernous sinus compartments and found that the medial wall was the most frequently involved. The authors concluded that the outcomes of transcavernous surgery can vary depending on the specific compartments involved. [Extracted from the article]

This article discusses the surgical management and outcomes of pituitary adenomas with subarachnoid invasion. The study analyzed data from 321 patients who underwent an endoscopic endonasal approach for pituitary adenoma resection, and identified 13 patients with subarachnoid invasion. The surgical approach for these tumors involved careful dissection from surrounding neurovascular structures to achieve safe resection. Patients with subarachnoid invasion were more likely to have subtotal tumor resection and require additional treatment, such as medical therapy, radiation, or repeat resection. They also experienced higher rates of intra-operative CSF leak, postoperative diabetes insipidus, post-operative hematomas, and the need for adjuvant interventions. Overall, pituitary adenomas with subarachnoid invasion present unique challenges and require specialized surgical techniques. [Extracted from the article]

This article, published in the Journal of Neurological Surgery, explores the microsurgical anatomy of the "true" petrous apex and the feasibility of accessing it through the endoscopic endonasal approach. The study conducted detailed dissections of post-mortem human specimens and identified key anatomical landmarks and neurovascular structures. The authors found that the endoscopic endonasal petrosectomy approach provides access to the "true" petrous apex, with two variants based on its relationship with the internal carotid artery. The study concludes that this approach is an effective surgical alternative for accessing lesions in this region. [Extracted from the article]

The article discusses the extreme lateral supracerebellar infratentorial and transtentorial (ELSIT) approach for accessing lesions in the ambient cistern, a challenging area due to its deep location and vital neurovascular structures. The study conducted a systematic dissection on post-mortem human specimens to investigate the anatomical landmarks and measurements of this approach. The ELSIT approach provides a narrow corridor leading to the ambient cistern, with specific landmarks such as the superior petrous vein and posterior root of the trigeminal nerve. Understanding these anatomical nuances is crucial for optimizing surgical outcomes and minimizing complications. [Extracted from the article]

TE measures liver stiffness to assess fibrosis. Its use in post‐transplant patients was reported in few small pediatric studies. We evaluated TE ability to predict liver graft fibrosis in a large cohort while comparing it to the performance of APRI and FIB‐4. We also investigated the effect of graft type on LSMs. Patients at Boston Children's Hospital who underwent LT and LSM ≤ 1 year from biopsy (2007‐2018) were eligible. Ninety‐four patients (45%M) aged 1‐21 years (89% < 18 years; 13% < 2 years) were eligible. Median time between transplant/biopsy and LSM was 5.1 years and 52 days, respectively. Thirty‐nine percent received whole‐liver grafts, 54% TV grafts, and 6% as part of MV. At LSM, median ALT was 25 [IQR 16‐33] IU/L. Twenty‐one percent had METAVIR ≥ F2. LSM was statistically higher among those with significant fibrosis (METAVIR ≥ F2) compared to those with METAVIR F0/F1 (median [IQR] 7.5 [4.6, 13.6] vs 5.1 [4.0, 6.4] kPa, respectively) (P =.005 by Wilcoxon rank‐sum test). APRI and FIB‐4 distributions were not different across METAVIR stages. The AUROC for LSM was 0.71 (95% CI 0.56‐0.85) with an optimal cut‐point of 6.5 kPa. Graft type had no influence on the AUROC for LSM. TE is useful for assessing significant graft fibrosis in children and young adult LT recipients and performs better than APRI and FIB‐4. TV grafts demonstrate similar correlation with histology as whole‐liver grafts. [ABSTRACT FROM AUTHOR]

This article discusses seven different techniques for pituitary transposition in endoscopic endonasal surgery. The techniques are categorized based on their relationship with the dura mater and include extradural, hybrid extradural/intradural, interdural transcavernous, extended interdural transcavernous, intradural hemitransposition, intradural, and pituitary sacrifice. The article evaluates the clinical application and selection of these techniques in different anatomical regions and types of pathology. The authors emphasize the importance of selecting the most appropriate technique based on the specific case and preoperative pituitary function for successful surgical outcomes. [Extracted from the article]

Prediction models of post-liver transplant mortality are crucial so that donor organs are not allocated to recipients with unreasonably high probabilities of mortality. Machine learning algorithms, particularly deep neural networks (DNNs), can often achieve higher predictive performance than conventional models. In this study, we trained a DNN to predict 90-day post-transplant mortality using preoperative variables and compared the performance to that of the Survival Outcomes Following Liver Transplantation (SOFT) and Balance of Risk (BAR) scores, using United Network of Organ Sharing data on adult patients who received a deceased donor liver transplant between 2005 and 2015 (n = 57,544). The DNN was trained using 202 features, and the best DNN's architecture consisted of 5 hidden layers with 110 neurons each. The area under the receiver operating characteristics curve (AUC) of the best DNN model was 0.703 (95% CI: 0.682-0.726) as compared to 0.655 (95% CI: 0.633-0.678) and 0.688 (95% CI: 0.667-0.711) for the BAR score and SOFT score, respectively. In conclusion, despite the complexity of DNN, it did not achieve a significantly higher discriminative performance than the SOFT score. Future risk models will likely benefit from the inclusion of other data sources, including high-resolution clinical features for which DNNs are particularly apt to outperform conventional statistical methods. • Liver transplant mortality can be predicted by using deep neural networks that use UNOS data. • Deep neural networks outperformed the BAR score in predicting mortality. • Deep neural networks did not significantly outperform the SOFT score. • Deep learning using higher resolution features may achieve superior performance. [ABSTRACT FROM AUTHOR]

What We Already Know About This Topic: WHAT THIS ARTICLE TELLS US THAT IS NEW: BACKGROUND:: The authors tested the hypothesis that deep neural networks trained on intraoperative features can predict postoperative in-hospital mortality.Methods: The data used to train and validate the algorithm consists of 59,985 patients with 87 features extracted at the end of surgery. Feed-forward networks with a logistic output were trained using stochastic gradient descent with momentum. The deep neural networks were trained on 80% of the data, with 20% reserved for testing. The authors assessed improvement of the deep neural network by adding American Society of Anesthesiologists (ASA) Physical Status Classification and robustness of the deep neural network to a reduced feature set. The networks were then compared to ASA Physical Status, logistic regression, and other published clinical scores including the Surgical Apgar, Preoperative Score to Predict Postoperative Mortality, Risk Quantification Index, and the Risk Stratification Index.Results: In-hospital mortality in the training and test sets were 0.81% and 0.73%. The deep neural network with a reduced feature set and ASA Physical Status classification had the highest area under the receiver operating characteristics curve, 0.91 (95% CI, 0.88 to 0.93). The highest logistic regression area under the curve was found with a reduced feature set and ASA Physical Status (0.90, 95% CI, 0.87 to 0.93). The Risk Stratification Index had the highest area under the receiver operating characteristics curve, at 0.97 (95% CI, 0.94 to 0.99).Conclusions: Deep neural networks can predict in-hospital mortality based on automatically extractable intraoperative data, but are not (yet) superior to existing methods. [ABSTRACT FROM AUTHOR]

Background Posterior fossa decompression surgeries for Chiari malformations are susceptible to postoperative complications such as pseudomeningocele, external cerebrospinal fluid (CSF) leak, and meningitis. Various dural substitutes have been used to improve surgical outcomes. Objective This study examined whether the collagen matrix dural substitute type correlated with the incidence of postoperative complications after posterior fossa decompression in adult patients with Chiari I malformations. Methods A retrospective cohort study was conducted of 81 adult patients who underwent an elective decompressive surgery for treatment of symptomatic Chiari I malformations, with duraplasty involving a dural substitute derived from either bovine or porcine collagen matrix. Demographics and treatment characteristics were correlated with surgical outcomes. Results A total of 81 patients were included in the study. Compared with bovine dural substitute, porcine dural substitute was associated with a significantly higher risk of pseudomeningocele occurrence (odds ratio, 5.78; 95% confidence interval, 1.65–27.15; P = 0.01) and a higher overall complication rate (odds ratio, 3.70; 95% confidence interval, 1.23–12.71; P = 0.03) by univariate analysis. There was no significant difference in the rate of meningitis, repeat operations, or overall complication rate between the 2 dural substitutes. In addition, estimated blood loss was a significant risk factor for meningitis ( P = 0.03). Multivariate analyses again showed that porcine dural substitute was associated with pseudomeningocele occurrence, although the association with higher overall complication rate did not reach significance. Conclusions Dural substitutes generated from porcine collagen, compared with those from bovine collagen, were associated with a higher likelihood of pseudomeningocele development in adult patients undergoing Chiari I malformation decompression and duraplasty. [ABSTRACT FROM AUTHOR]

Summary: Background: Data on oral vancomycin for primary sclerosing cholangitis (PSC)‐associated inflammatory bowel disease (IBD) are limited. Aims: Using data from the Paediatric PSC Consortium, to examine the effect of vancomycin on IBD activity. Methods: In this retrospective multi‐centre cohort study, we matched vancomycin‐treated and untreated patients (1:3) based on IBD duration at the time of primary outcome assessment. The primary outcome was Physician Global Assessment (PGA) of IBD clinical activity after 1 year (±6 months) of vancomycin. We used generalised estimating equations (GEE) to examine the association between vancomycin and PGA remission, adjusting for IBD type, severity and medication exposures. Secondary outcomes included serum labs and endoscopic remission (global rating of no activity) among those with available data and also analysed with GEE. Results: 113 PSC‐IBD patients received vancomycin (median age 12.7 years, 63% male). The matched cohort included 70 vancomycin‐treated and 210 untreated patients. Vancomycin was associated with greater odds of IBD clinical remission (odds ratio [OR] 3.52, 95% CI 1.97–6.31; adjusted OR [aOR] 5.24, 95% CI 2.68–10.22). Benefit was maintained in sensitivity analyses restricted to non‐transplanted patients and those with baseline moderate–severe PGA. Vancomycin was associated with increased odds of endoscopic remission (aOR 2.76, 95% CI 1.002–7.62; N = 101 with data), and with lower CRP (p = 0.03) and higher haemoglobin and albumin (both p < 0.01). Conclusion: Vancomycin was associated with greater odds of IBD clinical and endoscopic remission. Additional, preferably randomised, controlled studies are needed to characterise efficacy using objective markers of mucosal inflammation, and to examine safety and define optimal dosing. [ABSTRACT FROM AUTHOR]

This paper estimates the sampling error variances of gridded monthly U.S. Historical Climatology Network, version 2 (USHCN V2), time-of-observation-biases (TOB)-adjusted data. The analysis of mean surface air temperature (SAT) assesses uncertainties, trends, and the rankings of the hottest and coldest years for the contiguous United States in the period of 1895-2008. Data from the USHCN stations are aggregated onto a 2.5° × 3.5° latitude-longitude grid by an arithmetic mean of the stations inside a grid box. The sampling error variances of the gridded monthly data are estimated for every month and every grid box with data. The gridded data and their sampling error variances are used to calculate the contiguous U.S. averages and their trends and associated uncertainties. The sampling error variances are smaller (mostly less than 0.2°C2) over the eastern United States, where the station density is greater and larger (with values of 1.3°C2 for some grid boxes in the earlier period) over mountain and coastal areas. In the period of 1895-2008, every month from January to December has a positive linear trend. February has the largest trend of 0.162°C (10 yr)−1, and September has the smallest trend at 0.020°C (10 yr)−1. The three hottest (coldest) years measured by the mean SAT over the United States were ranked as 1998, 2006, and 1934 (1917, 1895, and 1912). [ABSTRACT FROM AUTHOR]

The specificity of connections made by inhibitory interneurons in the neocortex is not well understood. In this issue of Neuron, use an enhanced version of two-photon glutamate uncaging, which preserves inhibitory synaptic transmission, to demonstrate that somatostatin-positive interneurons form densely convergent connections onto pyramidal cells in layer 2/3 of mouse frontal cortex. [ABSTRACT FROM AUTHOR]

Learning a visuomotor skill involves a distributed network which includes the primary motor cortex (M1). Despite multiple lines of evidence supporting the role of M1 in motor learning and memory, it is unclear whether M1 plays distinct roles in different aspects of learning such as acquisition and retention. Here, we investigated the nature and chronometry of that processing through a temporally specific disruption of M1 activity using single-pulse transcranial magnetic stimulation (TMS). We applied single-pulse TMS to M1 or dorsal premotor cortex (PMd) during adaptation of rapid arm movements (~150 ms duration) to a visuomotor rotation. When M1 was stimulated either immediately after the end of each trial or with a 700 ms delay, subjects exhibited normal adaptation. However, whereas the memory of the subjects who received delayed-TMS showed normal rates of forgetting during deadaptation, the memory of those who received immediate TMS was more fragile: in the deadaptation period, they showed a faster rate of forgetting. Stimulation of PMd with adjusted (reduced) intensity to rule out the possibility of coactivation of this structure caused by the current spread from M1 stimulation did not affect adaptation or retention. The data suggest that, during the short time window after detection of movement errors, neural processing in M1 plays a crucial role in formation of motor memories. This processing in M1 may represent a slow component of motor memory which plays a significant role in retention. [ABSTRACT FROM AUTHOR]

Key Points: ETD symptoms are present in 16% patients with underlying skull base pathology.Preoperative ETD symptoms improve following surgical treatment of skull base pathology.ETD symptoms may worsen in patients with central, posterior, or malignant skull base pathology. [ABSTRACT FROM AUTHOR]

This article, published in the Journal of Neurological Surgery, discusses a case presentation of a 2-year-old boy with a tubero-infundibular craniopharyngioma. The boy had a history of previous surgeries and developed visual abnormalities due to the growth of the tumor. The authors used an endoscopic endonasal transplanum approach to completely remove the tumor, resulting in improvement of visual symptoms. However, the patient did develop diabetes insipidus postoperatively. The article provides valuable insights into the treatment of pediatric patients with craniopharyngioma. [Extracted from the article]

This article discusses the surgical anatomy of the transmastoid transcervical intradural approach to the jugular foramen, which is a challenging area for skull base surgeons due to the presence of critical structures. The approach is versatile and allows for modifications to tailor it to specific tumors. The article provides a detailed description of the surgical steps and relevant anatomy, including variations such as vertebral artery transposition and facial nerve rerouting. The transmastoid transcervical intradural approach provides excellent exposure to the jugular foramen and surrounding areas, but precise knowledge of the anatomy is crucial due to the complex relationships of vital structures in this region. [Extracted from the article]

This article, published in the Journal of Neurological Surgery, examines the impact of the transcavernous extension of the endonasal endoscopic approach on posterior pituitary function for the resection of pituitary adenomas. The study retrospectively reviewed 290 patients who underwent endoscopic endonasal resection of pituitary adenomas and compared the incidence of postoperative diabetes insipidus (DI) between groups based on the occurrence of transcavernous extension. The results showed that the transcavernous approach with medial wall of the cavernous sinus (MWCS) resection did not increase the risk of postoperative DI. [Extracted from the article]

This article, published in the Journal of Neurological Surgery, explores the patency of the cavernous sinus (CS) after medial wall resection. The study included 66 patients who underwent endoscopic endonasal approach (EEA) surgeries to resect CS-invading tumors. The results showed that CS patency was achieved in 85% of patients within the first 12 months and 92% by 18 months. Bilateral resection of the CS medial wall and resection for the removal of meningiomas were associated with increased rates of nonpatency. However, the study found that patency versus nonpatency did not have any significant difference in postoperative adverse events or effects. [Extracted from the article]

This article, published in the Journal of Neurological Surgery, examines the use of indocyanine green (ICG) fluorescence angiography to evaluate the impact of surgical and patient factors on the vascular perfusion of nasoseptal flaps (NSFs) in endoscopic skull base surgery (ESBS). The study found that tobacco smokers had lower baseline fluorescence intensity compared to nonsmokers, and patients who underwent a transpterygoid approach had a greater decrease in fluorescence intensity following reconstruction. Other factors, such as revision case, timing of flap harvest, and concurrent septoplasty, did not significantly influence fluorescence intensity. The article concludes that tobacco use and transpterygoid approaches may be associated with decreased vascular perfusion of NSFs. [Extracted from the article]

This article, titled "Outcomes of the Middle Turbinate Swing Technique during the Expanded Endonasal Approach (EEA): A Tertiary Center Experience," explores the use of the middle turbinate (MT) swing technique in skull base surgery. The MT swing technique involves detaching the posterior and lateral attachments of the middle turbinate to allow it to swing laterally into the maxillary sinus, providing better access to the skull base. The study analyzed surgeries performed between January 2021 and August 2023, finding that the MT swing technique did not compromise skull base exposure or tumor resection and had low rates of complications. The authors suggest that further research is needed to investigate the long-term benefits of preserving the middle turbinate during skull base surgery. [Extracted from the article]

Routine use of transanastomotic biliary stents (RTBS) for biliary reconstruction in liver transplantation ( LT) is controversial, with conflicting outcomes in adult randomized trials. Pediatric literature contains limited data. This study is a retrospective review of 99 patients who underwent first LT (2005-2014). In 2011, RTBS was discontinued at our center. This study describes biliary complications following LT with and without RTBS. 56 (56%) patients had RTBS. Median age at LT was 1.9 yr ( IQR 0.7, 8.6); 55% were female. Most common indication for LT was biliary atresia (36%). Most common biliary reconstruction was Roux-en-Y choledochojejunostomy (75% with RTBS, 58% without RTBS, p = 0.09). Biliary complications (strictures, bile leaks, surgical revision) occurred in 23% without significant difference between groups (20% with RTBS, 28% without RTBS, p = 0.33). Patients with RTBS had routine cholangiography via the tube at 6-8 wk; thus, significantly more patients with RTBS had cholangiograms (91% vs. 19%, p < 0.0001). There was no difference in the number of patients who required therapeutic intervention via endoscopic or percutaneous transhepatic cholangiography (11% with RTBS, 19% no RTBS, p = 0.26). Routine use of RTBS for biliary reconstruction in pediatric LT may not be necessary, and possibly associated with need for costlier, invasive imaging without improvement in outcomes. [ABSTRACT FROM AUTHOR]

A subset of patients with IDH-mutant glioma respond to inhibitors of mutant IDH (IDHi), yet the molecular underpinnings of such responses are not understood. Here, we profiled by single-cell or single-nucleus RNA-sequencing three IDH-mutant oligodendrogliomas from patients who derived clinical benefit from IDHi. Importantly, the tissues were sampled on-drug, four weeks from treatment initiation. We further integrate our findings with analysis of single-cell and bulk transcriptomes from independent cohorts and experimental models. We find that IDHi treatment induces a robust differentiation toward the astrocytic lineage, accompanied by a depletion of stem-like cells and a reduction of cell proliferation. Furthermore, mutations in NOTCH1 are associated with decreased astrocytic differentiation and may limit the response to IDHi. Our study highlights the differentiating potential of IDHi on the cellular hierarchies that drive oligodendrogliomas and suggests a genetic modifier that may improve patient stratification. [Display omitted] • Single-cell analysis of on-treatment gliomas reveals cellular basis of drug responses • In responders, mutant IDH inhibitors induce lineage differentiation • The differentiation favors astrocytic-like over stem/progenitor-like states • NOTCH1 mutations modify the response and may serve to stratify patients The molecular response of IDH-mutant glioma to mutant IDH inhibitors is poorly understood. Spitzer et al. show that, in patients with clinical response, mutant IDH inhibitors induce lineage differentiation of cancer cells and deplete cells in a stem/progenitor-like state. They further highlight potential modifiers of such differentiation response in glioma. [ABSTRACT FROM AUTHOR]

Abstract Background Hepatic steatosis is a common manifestation of CF-related liver disease(CFLD). Controlled attenuation parameter(CAP) measurement during transient elastography(TE) semiquantifies liver steatosis. We examined the relationship between CAP and CFLD severity, clinical factors and liver stiffness measurements(LSM). Methods This is a cross-sectional study of CF patients seen for outpatient care between January 2013–March 2014. CFLD severity was categorized as no CFLD, CFLD without portal hypertension(PHTN) and CFLD with PHTN, based on published criteria. Results 129 patients (median 18.4y; 57% male) had valid CAP. 70(54%) had no CFLD, 44(34%) CFLD without PHTN, and 15(12%) CFLD with PHTN. The median CAP was 210 dB/m (IQR 181–239). Steatosis(CAP ≥230 dB/m) was seen in 27% of subjects without CFLD, 48% in CFLD but no PHTN, and 20% in with CFLD and PHTN(P =.04). CAP was higher for subjects with CFLD without PHTN (P <.05). There was no CAP difference between subjects with no CFLD and those with CFLD and PHTN (P ≥.65). LSM was not different between no CFLD and CFLD without PHTN (P =.07), but each of these groups had lower LSM compared to subjects with CFLD and PHTN(P <.001 for each). Except for direct bilirubin, CAP was not associated with clinical markers of liver disease. Conclusion CAP was normal in 86(67%) of patients with CF and was not associated with standard clinical markers of liver disease. CAP was higher in patients with liver disease, which could possibly reflect the loss of steatosis observed with progression to cirrhosis and portal hypertension. Highlights • CAP is a non-invasive tool to assess liver steatosis. • CAP was normal in a majority of children/young adults with Cystic Fibrosis. • CAP is higher in patients with CFLD without portal hypertension. [ABSTRACT FROM AUTHOR]

The article presents a study which examines the gridded daily precipitation data in Texas from January 1, 1901 to December 31, 2000. It states that the data gridding had used the hybrid method that blends the inverse distance weighing (IDW) method with the nearest station assignment (NSA) mehod. Results show that hybrid method is useful for the assessment of climate changes, applications of weather risk management, and weather conditions prediction.

In areas of the world where human herpesvirus 8 (HHV‐8) is endemic, Kaposi sarcoma (KS) is a common SOT‐associated cancer. In the United States, where the virus is not prevalent, PTKS is rare, and there is little literature on pediatric PTKS. We present a North American female who underwent deceased donor, left lateral segment liver transplant for biliary atresia at age 11 months. The donor was a male with no known history of KS, originally from an HHV‐8‐endemic country. Three months after transplantation, the patient developed liver nodules and portal vein thrombosis. Analysis of needle biopsy established the diagnosis of KS and confirmed that the transformed cells were donor‐derived. HHV‐8 viremia was detected, and ganciclovir dosing (which had been started prophylactically) was increased. Immunosuppression was changed from tacrolimus to sirolimus. After further disease progression, 8 cycles of paclitaxel were administered. Under this treatment, her nodules regressed, HHV‐8 viremia resolved, and she had marked clinic improvement. Notably, the adult recipient of the right liver lobe from the same donor also developed PTKS. This is one of few pediatric PTKS cases described in the literature. It contributes to the mechanistic understanding of PTKS development, illustrating the risk posed by donors from HHV‐8‐endemic countries, as well as the potential for strong PTKS correlation between multiple recipients of organs from a single shared donor. [ABSTRACT FROM AUTHOR]