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WUSTL Neuroscience Publications Archive - October 2013

Scopus Weekly Report:

October 25, 2013


October 25, 2013

Derdeyn, C.P.a , Fiorella, D.b , Lynn, M.J.c , Barnwell, S.L.d , Zaidat, O.e , Meyers, P.M.f , Gobin, Y.P.g , Dion, J.h , Lane, B.F.c , Turan, T.N.i , Janis, L.S.j , Chimowitz, M.I.i
Impact of operator and site experience on outcomes after angioplasty and stenting in the SAMMPRIS trial
(2013) Journal of NeuroInterventional Surgery, 5 (6), pp. 528-533. 

a Mallinckrodt Institute of Radiology and the Departments of Neurology and Neurosurgery, Washington University School of Medicine, St Louis, MO 010386, United States
b Department of Neurosurgery, State University of New York, Stony Brook NY, United States
c Department of Biostatistics and Bioinformatics, Emory University Rollins School of Public Health, Atlanta GA, United States
d Department of Neurological Surgery and the Dotter Interventional Institute, Oregon Health Sciences University, Portland, OR, United States
e Departments of Neurology, Radiology, and Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, United States
f Department of Radiology, Columbia University, New York, NY, United States
g Department of Radiology, Cornell University, New York, NY, United States
h Department of Radiology and Neurosurgery, Emory University, Atlanta GA, United States
i Department of Neurosciences, Medical University of South Carolina, Charleston, SC, United States
j National Institute of Neurological Disorders and Stroke, National Institute of Health, Bethesda, MD, United States

Background and purpose To investigate the relationship between physician and site experience and the risk of 30 day hemorrhagic and ischemic strokes in the stenting arm of the Stenting and Aggressive Medical Management for the Prevention of Recurrent Ischemic Stroke (SAMMPRIS) trial. Methods Study records and an investigator survey were examined for physician and site related factors, including: number of Wingspan and aneurysm stents submitted for credentialing, number of study procedures performed in SAMMPRIS, years in practice after training, primary specialty, and site enrollment. Bivariate and multivariate analyses were performed to determine if these factors were associated with the 30 day rate of cerebrovascular events after angioplasty and stenting. Results 213 patients underwent angioplasty alone (n=5) or angioplasty and stenting (n=208) with study devices by 63 interventionists at 48 sites. For credentialing, the median number of Wingspan and similar aneurysm stent cases submitted by study interventionists were 10 and 6, respectively. Interventionists with higher numbers (>10) of Wingspan cases submitted for credentialing tended to have higher rates of 30 day events (19.0% vs 9.9%) than those with <10 cases. High enrolling sites in the trial tended to have lower rates of hemorrhagic stroke (9.8% at sites enrolling <12 patients vs 2.7% at sites enrolling >12 patients). Conclusions Interventionists credentialed with less Wingspan experience were not responsible for the high rate of periprocedural stroke in SAMMPRIS. Hemorrhagic stroke may be related to low enrollment in the trial but not previous Wingspan experience.

Document Type: Article
Source: Scopus

Burrows, A.M., Zipfel, G., Lanzino, G.
Treatment of a pediatric recurrent fusiform middle cerebral artery (MCA) aneurysm with a flow diverter
(2013) Journal of NeuroInterventional Surgery, 5 (6), pp. e47. 

Department of Neurosurgery, Washington University, St Louis, MI, United States

Pediatric patients with aneurysm often have different localizations and morphologies from adults and recurrences are not uncommon after successful clip reconstruction/obliteration. Treatment of a recurrent pediatric aneurysm after clip ligation is a technical challenge. We present the case of an adolescent with a middle cerebral artery (MCA) fusiform aneurysm which recurred following clip reconstruction and bypass. The aneurysm was successfully treated with endovascular flow diversion.

Document Type: Article
Source: Scopus

Waters, E.A.a , Kincaid, C.a , Kaufman, A.R.b , Stock, M.L.c , Peterson, L.M.d , Muscanell, N.L.e , Guadagno, R.E.e
Concerns about unintended negative consequences of informing the public about multifactorial risks may be premature for young adult smokers
(2013) British Journal of Health Psychology, . Article in Press. 

a Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, Saint Louis, Missouri, USA
b Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, Maryland, USA
c Department of Psychology, George Washington University, Washington, District of Columbia, USA
d Department of Psychiatry, University of Pittsburgh, Pennsylvania, USA
e Department of Psychology, The University of Alabama, Tuscaloosa, Alabama, USA

Background: Many health risks are associated with both genetic and behavioural factors. Concerns have been raised that learning about such multifactorial risks might have detrimental effects on health-related beliefs, cognitions, and affect. However, experimental evidence is sparse. Objective: To explore the effects of reading an online news article about the discovery of a genetic basis for nicotine addiction. Methods: Smokers (N = 333) were recruited from the psychology subject pools of two major universities. Participants were randomly assigned to read one of three news articles: one describing a genetic basis for nicotine addiction and lung cancer obtained from a national news source, one altered to indicate no genetic basis for nicotine addiction and lung cancer, or one unrelated attention control. Participants then completed an online questionnaire, which assessed smoking-related cognitions and affect, and beliefs about nicotine addiction, quitting smoking, and whether the harms of tobacco use are delayed. Results: There was no statistically significant influence of experimental condition on smoking-related cognitions/affect (ps &gt; .05, η2 &lt; .002), beliefs about addiction and quitting (Wilks' λ = .98, p = .66, η2 = .01), or delayed harm (ps &gt; .05, η2 &lt; .002). Conclusion: Reading an online news article about the presence or absence of a genetic basis for nicotine addiction was not found to change smoking-related cognitions/affect or beliefs among young adult smokers. Concerns about negative effects of multifactorial risk information on health beliefs may be premature. Nevertheless, to effectively translate basic genomics research into effective public health practice, further research should investigate these issues in different populations, via different communication modalities, and for different health outcomes. © 2013 The British Psychological Society.

Author Keywords
Attitudes;  Behaviour;  Gene-by-environment;  Genetic;  Multifactorial;  Smoking;  Tobacco use

Document Type: Article in Press
Source: Scopus

Christensen, D.a , Van Naarden Braun, K.a , Doernberg, N.S.a , Maenner, M.J.b c , Arneson, C.L.b , Durkin, M.S.b c , Benedict, R.E.b d , Kirby, R.S.e , Wingate, M.S.f , Fitzgerald, R.g , Yeargin-Allsopp, M.a
Prevalence of cerebral palsy, co-occurring autism spectrum disorders, and motor functioning - Autism and Developmental Disabilities Monitoring Network, USA, 2008
(2013) Developmental Medicine and Child Neurology, . Article in Press. 

a Division of Birth Defects and Developmental Disabilities National Center on Birth Defects and Developmental Disabilities Centers for Disease Control and Prevention Atlanta, GA
b Waisman Center University of Wisconsin-Madison Madison, WI USA
c Department of Population Health Sciences University of Wisconsin-Madison Madison, WI USA
d Occupational Therapy Program Department of Kinesiology University of Wisconsin-Madison Madison, WI USA
e Department of Community and Family Health College of Public Health University of South Florida Tampa, FL USA
f Department of Health Care Organization and Policy School of Public Health University of Alabama at Birmingham Birmingham, AL USA
g Department of Psychiatry Washington University in St. Louis St. Louis, MO USA

Aim: The aim of this study was to report the prevalence and characteristics of children with cerebral palsy (CP). Method: Children with CP (n=451) were ascertained by the Autism and Developmental Disabilities Monitoring (ADDM) Network, a population-based, record-review surveillance system monitoring CP in four areas of the USA. Prevalence was calculated as the number of children with CP among all 8-year-old children residing in these areas in 2008. Motor function was categorized by Gross Motor Function Classification System level and walking ability. Co-occurring autism spectrum disorders (ASD) and epilepsy were ascertained using ADDM Network surveillance methodology. Results: The period prevalence of CP for 2008 was 3.1 per 1000 8-year-old children (95% confidence interval 2.8-3.4). Approximately 58% of children walked independently. Co-occurring ASD frequency was 6.9% and was higher (18.4%) among children with non-spastic CP, particularly hypotonic CP. Co-occurring epilepsy frequency was 41% overall, did not differ by ASD status or CP subtype, and was highest (67%) among children with limited or no walking ability. Interpretation: The prevalence of CP in childhood from US surveillance data has remained relatively constant, in the range of 3.1 to 3.6 per 1000, since 1996. The higher frequency of ASD in non-spastic than in spastic subtypes of CP calls for closer examination. © 2013 Mac Keith Press.

Document Type: Article in Press
Source: Scopus

Budelli, G.a , Geng, Y.b , Butler, A.a , Magleby, K.L.b , Salkoff, L.a c
Properties of Slo1 K+ channels with and without the gating ring
(2013) Proceedings of the National Academy of Sciences of the United States of America, 110 (41), pp. 16657-16662. 

a Department of Anatomy and Neurobiology, United States
b Department of Physiology and Biophysics, University of Miami Miller School of Medicine, Miami, FL 33136, United States
c Genetics, Washington University School of Medicine in St. Louis, St. Louis, MO 63110, United States

High-conductance Ca2+- and voltage-activated K+ (Slo1 or BK) channels (KCNMA1) play key roles in many physiological processes. The structure of the Slo1 channel has two functional domains, a core consisting of four voltage sensors controlling an ion-conducting pore, and a larger tail that forms an intracellular gating ring thought to confer Ca2+ and Mg 2+ sensitivity as well as sensitivity to a host of other intracellular factors. Although the modular structure of the Slo1 channel is known, the functional properties of the core and the allosteric interactions between core and tail are poorly understood because it has not been possible to study the core in the absence of the gating ring. To address these questions, we developed constructs that allow functional cores of Slo1 channels to be expressed by replacing the 827-amino acid gating ring with short tails of either 74 or 11 amino acids. Recorded currents from these constructs reveals that the gating ring is not required for either expression or gating of the core. Voltage activation is retained after the gating ring is replaced, but all Ca 2+- and Mg2+-dependent gating is lost. Replacing the gating ring also right-shifts the conductancevoltage relation, decreases mean open-channel and burst duration by about sixfold, and reduces apparent mean single-channel conductance by about 30%. These results show that the gating ring is not required for voltage activation but is required for Ca2+ and Mg2+ activation. They also suggest possible actions of the unliganded (passive) gating ring or added short tails on the core.

Author Keywords
β1 subunit;  BK channel;  Iberiotoxin;  Kv1.4;  Tetraethylammonium

Document Type: Article
Source: Scopus

Shah, M.N.a , Stoev, I.T.a , Sanford, D.E.b , Gao, F.c , Santiago, P.a , Jaques, D.P.d , Dacey Jr., R.G.a
Are readmission rates on a neurosurgical service indicators of quality of care?
(2013) Journal of Neurosurgery, 119 (4), pp. 1043-1049. 

a Department of Neurosurgery, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, MO 63110, United States
b Department of Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, MO, United States
c Division of Biostatistics, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, MO, United States
d Department of Surgical Services, Barnes-Jewish Hospital, St. Louis, MO, United States

Object. The goal of this study was to examine the reasons for early readmissions within 30 days of discharge to a major academic neurosurgical service. Methods. A database of readmissions within 30 days of discharge between April 2009 and September 2010 was retrospectively reviewed. Clinical and administrative variables associated with readmission were examined, including age, sex, race, days between discharge and readmission, and insurance type. The readmissions were then assigned independently by 2 neurosurgeons into 1 of 3 categories: scheduled, adverse event, and unrelated. The adverse event readmissions were further subcategorized into patients readmitted although best practices were followed, those readmitted due to progression of their underlying disease, and those readmitted for preventable causes. These variables were compared descriptively. Results. A total of 348 patients with 407 readmissions were identified, comprising 11.5% of the total 3552 admissions. The median age of readmitted patients was 55 years (range 16-96 years) and patients older than 65 years totaled 31%. There were 216 readmissions (53% of 407) for management of an adverse event that was classified as either preventable (149 patients; 37%) or unpreventable (67 patients; 16%). There were 113 patients (28%) who met readmission criteria but who were having an electively scheduled neurosurgical procedure. Progression of disease (48 patients; 12%) and treatment unrelated to primary admission (30 patients; 7%) were additional causes for readmission. There was no significant difference in the proportion of early readmissions by payer status when comparing privately insured patients and those with public or no insurance (p = 0.09). Conclusions. The majority of early readmissions within 30 days of discharge to the neurosurgical service were not preventable. Many of these readmissions were for adverse events that occurred even though best practices were followed, or for progression of the natural history of the neurosurgical disease requiring expected but unpredictably timed subsequent treatment. Judicious care often requires readmission to prevent further morbidity or death in neurosurgical patients, and penalties for readmission will not change these patient care obligations. © AANS, 2013.

Author Keywords
Centers for Medicare and Medicaid Services;  Early readmission;  Neurosurgery;  Quality improvement

Document Type: Article
Source: Scopus

Menatti, A.R.a , Weeks, J.W.a , Levinson, C.A.b , McGowan, M.M.a
Exploring the relationship between social anxiety and bulimic symptoms: Mediational effects of perfectionism among females
(2013) Cognitive Therapy and Research, 37 (5), pp. 914-922. Cited 2 times.

a Ohio University, 200 Porter Hall, Athens, OH 45701, United States
b Washington University in St. Louis, St. Louis, MO, United States

Previous findings indicate that social anxiety and bulimia co-occur at high rates; one mechanism that has been proposed to link these symptom clusters is perfectionism (Silgado et al. in Cogn Ther Res 34(5):487-492, 2010). We tested meditational models among 167 female undergraduates in which maladaptive evaluative perfectionism concerns (MEPC; i.e.; critical self-evaluative perfectionism) mediated the relationship between social anxiety and bulimic symptoms. Results from a first model indicated that MEPC mediated the relationship between fear of public scrutiny and bulimia symptoms. This indirect effect was significant above and beyond the indirect effects of maladaptive body-image cognitions and perfectionism specific to pure personal standards. A second model was tested with MEPC mediating the relationship between social interaction anxiety and bulimia symptoms. Similar results were obtained; however, in this model, a significant direct effect remained after partialing out the indirect effect of the mediators. Theoretical implications are discussed. © 2013 Springer Science+Business Media New York.

Author Keywords
Anxiety disorders;  Bulimia;  Eating disorders;  Perfectionism;  Social anxiety

Document Type: Article
Source: Scopus

Reynolds, M.R.a , Grubb Jr., R.L.a c , Clarke, W.R.d , Powers, W.J.e , Zipfel, G.J.a b c , Adams Jr., H.P.f , Derdeyn, C.P.a b c
Investigating the mechanisms of perioperative ischemic stroke in the Carotid Occlusion Surgery Study
(2013) Journal of Neurosurgery, 119 (4), pp. 988-995. 

a Barnes-Jewish Hospital, Departments of Neurological Surgery, Washington University School of Medicine, 660 S. Euclid Ave., St. Louis, MO 63110, United States
b Departments of Neurology, Washington University School of Medicine, St. Louis, MO, United States
c Departments of Radiology, Washington University School of Medicine, St. Louis, MO, United States
d Clinical Trials Statistics and Data Management Center, University of Iowa College of Public Health, Iowa City, IA, United States
e Department of Neurology, University of North Carolina School of Medicine, Chapel Hill, NC, United States
f Department of Neurology, University of Iowa Carver School of Medicine, Iowa City, IA, United States

Object. The Carotid Occlusion Surgery Study (COSS) was a large, prospective clinical trial that examined whether superficial temporal artery-middle cerebral artery (STA-MCA) bypass, in addition to best medical therapy, reduced the risk of ipsilateral ischemic stroke in patients with carotid artery occlusion and hemodynamic cerebral ischemia. Despite improved cerebral hemodynamics and excellent bypass graft patency rates, COSS failed to show a benefit for the surgical group with respect to ipsilateral stroke recurrence at 2 years after treatment. This was due to a lower than expected rate of recurrent ipsilateral stroke in the medically treated group and a high rate of perioperative ipsilateral strokes in the surgical group. Critics of the trial have cited surgeon inexperience and technical difficulties related to the performance of the bypass graft as a leading cause of failure of the trial. Methods. The authors retrospectively identified all patients from the COSS with an ipsilateral, perioperative (< 30 days) ischemic stroke after STA-MCA cortical branch anastomosis. Study records, operative notes, stroke adjudication forms, and imaging studies were reviewed. Ischemic strokes were characterized as bypass graft related or non-bypass graft related based on clinical and radiographic findings. Results. Fourteen of 93 surgically treated patients experienced an ipsilateral, perioperative ischemic stroke. Postoperatively, the mean oxygen extraction fraction (OEF) ratio between the symptomatic and asymptomatic cerebral hemisphere significantly improved in these patients (1.30 ± 0.18 preoperative vs 1.12 ± 0.11 postoperative; p = 0.02), but did not normalize. In this cohort, total MCA occlusion time during the anastomosis (54.3 ± 23.5 minutes) was no different from the MCA occlusion time in those surgical patients who did not have a perioperative stroke (45.4 ± 24.2 minutes, p = 0.2). Bypass graft patency rates in patients with a perioperative stroke were 92% at 30 days (11 of 12 patients with patency data) and 83% at last follow-up visit (10 of 12 patients with patency data). These patency rates were not significantly different from those achieved at 30 days (100%; 76 of 76 patients with patency data; p = 0.14) and at last follow-up (99%; 71 of 72 patients with patency data; p = 0.052) in patients without a perioperative stroke. Eighty-six percent (12 of 14 patients) of strokes were likely attributable to factors unrelated to the STA-MCA anastomosis. Only 21% of strokes (3 of 14 patients) were in the territory of the recipient vessel and likely related to technical performance of the anastomosis itself. One patient was thought to have dual stroke mechanisms. Conclusions. Only a small minority of ipsilateral, perioperative ischemic strokes in the COSS could be attributed to technical problems of the bypass anastomosis. The majority of ischemic strokes could not be ascribed to this cause and were most likely due to patient hemodynamic fragility and the inability of patients to tolerate surgery. © AANS, 2013.

Author Keywords
Carotid Occlusion Surgery Study;  COSS;  EC-IC bypass;  Ischemic stroke;  Perioperative;  STA-MCA bypass;  Vascular disorders

Document Type: Article
Source: Scopus

Ostendorf, A.P.a , Connolly, A.M.a b
Medical management of eosinophilic meningitis following bovine graft duraplasty for Chiari malformation Type i repair
(2013) Journal of Neurosurgery: Pediatrics, 12 (4), pp. 357-359. 

a Department of Neurology, Washington University School of Medicine, Box 8111, 660 S. Euclid Ave, St. Louis, MO 63110, United States
b Departments of Pediatrics, Washington University School of Medicine, St. Louis, MO, United States

Eosinophilic meningitis is a known complication of duraplasty, including that using bovine tissues. Previous authors have relied on surgical removal of the graft for treatment. Authors of the present report describe a 7-year-old girl with eosinophilic meningitis following duraplasty with a bovine pericardium graft who was successfully treated using corticosteroid therapy alone.

Author Keywords
Bovine graft;  Chiari malformation;  Corticosteroid;  Duraplasty;  Eosinophilic meningitis;  Pediatric neurosurgery

Document Type: Article
Source: Scopus