Scoliosis surgery in social media: a natural language processing approach to analyzing the online patient perspective.

PURPOSE: The purpose of this study is to analyze posts shared on Instagram, Twitter, and Reddit referencing scoliosis surgery to evaluate content, tone, and perspective. METHODS: Public posts from Instagram, Twitter, and Reddit were parsed in 2020-2021 and selected based on inclusion of the words 'scoliosis surgery' or '#scoliosissurgery. 100 Reddit posts, 5022 Instagram posts, and 1414 tweets were included in analysis. The Natural Language Toolkit (NLTK) python library was utilized to perform computational text analysis to determine content and sentiment analysis to estimate the tone of posts across each platform. RESULTS: 46.4% of Tweets were positive in tone, 39.4% were negative, and 13.8% were neutral. Positive content focused on patients, friends, or hospitals sharing good outcomes after a patient's surgery. Negative content focused on long wait times to receive scoliosis surgery. 64.7% of Instagram posts were positive in tone, 16.3% were negative, and 19.0% were neutral. Positive content centered around post-operative progress reports and educational resources, while negative content focused on long-term back pain. 37% of Reddit posts were positive in tone, 38% were negative, and 25% were neutral. Positive posts were about personal post-operative progress reports, while negative posts were about fears prior to scoliosis surgery and questions about risks of the procedure. CONCLUSION: This study highlights scoliosis surgery content in social media formats and stratifies how this content is portrayed based on the platform it is on. Surgeons can use this knowledge to better educate and connect with their own patients, thus harnessing the power and reach of social media. LEVEL OF EVIDENCE: IV.

Feasibility of Yttrium-90 Radioembolization Dose Calculation Utilizing Intra-procedural Open Trajectory Cone Beam CT.

PURPOSE: Dose calculation for transarterial radioembolization (TARE) with glass yttrium-90 (Y90) labeled microspheres is based on liver lobe and tumor volumes, currently measured from preprocedural MRI or CT. The variable time between MRI and radioembolization may not account for relevant tumor progression. Advances in cone beam computed tomography (CBCT) allow for intra-procedural assessment of these volumes that avoids this factor. Liver lobe and hepatocellular carcinoma tumor volume measurements and dose calculations using intra-procedural CBCT were compared to those using preprocedural MRI in order to determine feasibility. METHODS: Retrospective analysis was performed in 20 patients with proven hepatocellular carcinoma (HCC) who underwent planning angiography with open trajectory CBCT acquisitions prior to radioembolization, and an MRI performed within 6 weeks prior to treatment planning. Liver lobe and tumor burden volumes were measured based on CBCT using embolization planning and guidance software and measured on preprocedural MRI using standard volume analysis software. Y90 doses were subsequently calculated using each measured volume. Comparisons of volume measurements and calculated Y90 doses between the two modalities were evaluated for significance using paired t tests. RESULTS: All target liver lobes and all tumors were completely depicted on CBCT. Mean liver lobe and tumor burden volumes measured on intra-procedural CBCT and preprocedural MRI showed no significant difference (p = 0.71). Mean calculated Y90 dose based on each modality showed no significant difference (p = 0.18). CONCLUSIONS: Lobar and tumor volume measurement with CBCT is a reliable alternative to measurement with preprocedural MRI. Utilization of CBCT 3D segmentation software during planning angiography may be useful to provide up-to-date volume measurements and dose calculations prior to radioembolization.

5-HT2C receptors in the BNST are necessary for the enhancement of fear learning by selective serotonin reuptake inhibitors.

Selective serotonin reuptake inhibitors (SSRIs) are widely prescribed to treat anxiety and depression, yet they paradoxically increase anxiety during initial treatment. Acute administration of these drugs prior to learning can also enhance Pavlovian cued fear conditioning. This potentiation has been previously reported to depend upon the bed nucleus of the stria terminalis (BNST). Here, using temporary inactivation, we confirmed that the BNST is not necessary for the acquisition of cued or contextual fear memory. Systemic administration of the SSRI citalopram prior to fear conditioning led to an upregulation of the immediate early gene Arc (activity-regulated cytoskeleton-associated protein) in the oval nucleus of the BNST, and a majority of these neurons expressed the 5-HT2C receptor. Finally, local infusions of a 5-HT2C receptor antagonist directly into the oval nucleus of the BNST prevented the fear memory-enhancing effects of citalopram. These findings highlight the ability of the BNST circuitry to be recruited into gating fear and anxiety-like behaviors.