Dual catheter and double-lumen cerebrospinal fluid shunt systems with backflow mechanisms.

PURPOSE: We previously developed a novel functional benchtop apparatus to simulate catheter occlusion in vitro utilizing avian vitelline membrane and chalaza to test catheter designs and de-obstruction techniques. Here, we study the integration of double-lumen catheter-mediated backflow in the shunt system assembly and its potential for an in-line de-obstruction of an obstructed ventricular catheter. METHODS: A double-lumen catheter was connected to a standard proximal shunt catheter for all trials. One limb of the double-lumen catheter was connected to the backflow mechanisms and allowed to loop back for fluid access. A micropump and a bi-corporal electromagnetic pump were utilized to provide various degrees of backflow at predetermined intervals. Flow rates were measured after initial occlusion and after implementation of the backflow mechanisms, and degrees of catheter blockage was calculated as a percentage of the unoccluded flow rate. Flow visualization was also used. RESULTS: In baseline blockage of less than 50%, the average occluding agent weighed 0.3-0.6 g with baseline flow rates of 8.5-11.9 mL/min. After 5 min of backflow using a micropump, the degree of blockage was reduced in 50% of trials. Additional backflow for 5 min did not provide further improvements in flow rate. In baseline blockage of greater than 50%, the average occluding agent weighed 0.8-1.3 g with baseline flow rates of 1.1-4.2 mL/min. After 5 min of backflow, the system demonstrated a decreased blockage in 20% of trials; additional backflow for 5 min further improved the flow rate in 40% of the total trials. Only magnetic plates provided enough force to provide pulsatile backflow in the bi-corporal electromagnetic system. CONCLUSIONS: The preliminary results of connecting a standard proximal catheter in series with a double-lumen catheter show a slight change in the percent occlusion from the baseline status several times when the retrograde flow occurred via one limb of the catheter. Additionally, the de-obstruction seems related to the length of the interval of the backflow and the initial percentage occlusion of the proximal catheter. The statistical analysis does not reveal a statistically significant reduction in occlusion in the proximal catheter with either backflow interval.

Long-term exposure to low-level particulate air pollution and Parkinson's disease diagnosis - A Finnish register-based study.

BACKGROUND: There is mixed evidence for an association between particulate matter air pollution and Parkinson's disease despite biological plausibility. OBJECTIVES: We studied the association between particulate air pollution, its components and Parkinson's disease (PD) risk. METHODS: We conducted a nested case-control study within the population of Finland using national registers. A total of 22,189 incident PD cases diagnosed between 1996 and 2015 were matched by age, sex and region with up to seven controls (n = 148,009) per case. Time weighted average air pollution exposure to particulate matter and its components was modelled at the residential addresses, accounting for move history, for the 16 years preceding diagnosis. Conditional logistic regression analysis was used to evaluate the association between air pollution and PD. Different exposure periods (6-16 years, 11-16 years, 5-10 years, 0-5 years) before the index date (date of PD diagnosis) were applied. RESULTS: Time-weighted average exposures were relatively low at 12.1 ± 6.5 µg/m3 (mean ± SD) for PM10 and 7.7 ± 3.2 µg/m3 for PM2.5. No associations were found between PM2.5 or PM10 exposure 6-16 years before index date and PD (OR: 0.99; 95% CI: 0.96, 1.02; per IQR of 3.9 µg/m3 and OR: 0.99; 95% CI: 0.96, 1.01; per IQR of 7.8 µg/m3, respectively). However, inverse associations were observed for the same exposure period with black carbon (OR: 0.96; 95% CI: 0.93, 0.99; per IQR of 0.6 µg/m3), sulphate (OR: 0.79; 95% CI: 0.68, 0.92; per IQR of 1.2 µg/m3), secondary organic aerosols (OR: 0.86; 95% CI: 0.80, 0.93; per IQR of 0.1 µg/m3) and sea salt (OR: 0.92; 95% CI: 0.87, 0.98; per IQR of 0.1 µg/m3). DISCUSSION: Low-level particulate matter air pollution was not associated with increased risk of incident PD in this Finnish nationwide population. The observed weak inverse associations with specific particle components should be investigated further.

Proximal ventricular shunt catheter occlusion model.

PURPOSE: Proximal ventricular shunt catheter occlusion remains a problematic cause of shunt malfunction, and there is no consistent in vivo or in vitro model to help clinicians and researchers study this phenomenon. METHODS: An in vitro model utilizing standard proximal ventricular catheter and biological occluding agents mimicking choroid plexus was designed, constructed, and calibrated to occlude consistently within a specified timeframe. Hydrostatic pressure differential of 100 cmH2O was used as a driving force to generate flow through the catheter. Chalaza and vitelline membranes were harvested from avian eggs and used as occluding agents. Successful occlusion was defined as a greater than 90% reduction in volumetric flow rate through distal outlet. Histological sections of occluded catheters were performed and interpreted by a neuropathologist. RESULTS: Initial trials demonstrated successful standard catheter occlusion within 24 h using chalaza, vitelline membrane, and combination treatments. Repeat trials demonstrated consistency in successful occlusion within 5 min utilizing only vitelline membrane treatment. Histopathology demonstrated the vitelline membrane to consist of a thin, superficial layer of extraembryonic ectoderm; the chalaza was observed to consist of strands of mucin protein. CONCLUSIONS: An in vitro model of proximal ventricular shunt catheter occlusion was developed and calibrated for successful occlusion within 5 min. Future studies may utilize this model to rapidly test occlusion-resistant shunt designs and de-obstruction techniques.

Diagnostic groups of hospital stays and outpatient visits during 10 years before Alzheimer's disease.

BACKGROUND: Alzheimer's disease (AD) is a major determinant of healthcare costs and increase in the healthcare service use occur already before the AD diagnosis. However, little is known how the different diagnosis categories contribute to this increase in healthcare use. We investigated how the hospitalizations and specialized healthcare outpatient visits from different diagnosis categories, based on the International Classification of Diseases (ICD-10) chapters, contribute to increased specialized healthcare service use during ten-year period preceding AD diagnosis. METHODS: A register-based nationwide cohort of 42,934 community-dwelling persons who received clinically verified AD diagnosis in between 2008 and 2011 in Finland and 1:1 age, sex and hospital district- matched comparison cohort were included. Hospitalizations and specialized healthcare visits were categorized by the main diagnosis, according to the ICD-10 chapters. AD and dementia were separated to their own category. The number of persons with visits and stays was calculated for every 6 months, irrespective of the frequency of visits/stays individual had during that time window. Furthermore, the relative distribution of the diagnosis categories was computed. RESULTS: AD cohort was more likely to have visits and stays during the 10-year period (OR 1.19, 95% CI 1.17-1.21). The number of persons with visits and stays peaked in AD cohort from 1.5 years before the diagnosis when the differences in relative distribution of different diagnosis categories also became evident. The largest differences were observed for visits/stays with cognitive disorders, symptoms of unspecified diseases and psychiatric disorders diagnoses, and those with missing diagnosis codes in the last time window before AD diagnosis. CONCLUSIONS AND IMPLICATIONS: Increased healthcare service use before AD diagnosis does not seem to arise from differences in specific diagnosis categories of ICD-10 such as diseases of the circulatory system, but from the higher frequency of visits and stays among persons with AD across diagnosis categories. Based on the relative distribution of diagnosis categories, the steep increase in healthcare service use just before and during the diagnostic process is likely due to prodromal symptoms and visits related to cognition.

Health Orientation as a Psychographic Framework for Understanding Physical Exercise Behavior.

The consistent association between regular physical exercise and positive health outcomes presents a compelling case for investigating the differences between individuals who exercise regularly and those who do not. Based on a randomized cross-sectional survey of 1,201 households, this study adopts a psychographic framework to investigate the role of health orientation in physical exercise behavior. This study extends the concept of health orientation, operationalized as five psychographic subscales (health information orientation, preventative orientation, exercise orientation, healthy eating orientation, and health information efficacy) as well as three behavioral constructs (sedentary behavior, BMI and cigarette smoking) to understand physical exercise behavior. The results show significant differences between regular exercisers and non-exercisers, and suggest that a psychographic framework based on health orientation could offer a more holistic approach for understanding physical exercise behavior by highlighting the treatment of the whole individual. Physical exercise, as a specific health behavior, is in fact interlinked with other health behaviors through an underlying health orientation toward health issues in general.

High-resistance proximal "scaled" ventricular catheters.

PURPOSE: Prove the concept of high-resistance proximal catheters for valve-independent treatment of hydrocephalus. METHODS: A preliminary design process yielded optimal high-resistance proximal ventricular catheters with a "scaled" design and parallel-oriented, U-shaped inlets. Prototypes were manually constructed using carving tools to stamp through silicone tubings. A testing apparatus was developed to simulate cerebrospinal fluid flow through a catheter, and the prototypes were tested against a control catheter for exhibition of an "on/off" phenomenon whereby no flow occurs at low pressures, and flow begins beyond a pressure threshold. Flow distribution was visualized with India ink. Regression analysis was performed to determine linearity. RESULTS: The new designs showed varying amounts of improved flow control with the "scaled" design showing the most practical flow rate control across various pressures, compared to the standard catheter; however, no true "on/off" phenomenon was observed. The "scaled" design showed various degrees of dynamism; its flow rate can be time dependent, and certain maneuvers such as flushing and bending increased flow rate temporarily. Variation in the number of inlets within each "scaled" prototype also affected flow rate. Contrastingly, the flow rate of standard catheters was found to be independent of the number of inlet holes. Ink flow showed even flow distribution in "scaled" prototypes. CONCLUSIONS: This initial feasibility study showed that high-resistance ventricular catheters can be designed to mimic the current/valved system. The "scaled" design demonstrated the best flow control, and its unique features were characterized.

A Rare Neonatal Intramedullary Immature Teratoma Undiagnosed in utero: A Case Report.

BACKGROUND AND IMPORTANCE: Immature teratoma is a known pediatric tumor. However, spinal variants are rare and can present both a diagnostic and therapeutic challenge, particularly regarding aggression as it pertains to extent of resection, likelihood of recurrence and concordant prognosis, and the need and efficacy of adjuvant therapies. CLINICAL PRESENTATION: The patient is a 27-day-old female who presented with 10 days of poor feeding, irritability, and progressive hypotonia. Although upon immediate presentation emergency providers' differential diagnoses included meningitis, inborn error of metabolism, and genetic neurodegenerative disease, a subsequent magnetic resonance (MR) imaging of the total spine revealed a large intradural intramedullary mass extending from the medulla to the thoracic cord at T12. The patient underwent multilevel cervical and thoracic laminectomies/laminoplasty for maximal safe resection. Histopathology revealed mostly mature tissue elements originating from all 3 germ layers, interspersed with foci of immature neuroepithelium, consistent with grade 1 immature teratoma. Following surgical intervention, the patient regained strength and spontaneous movement and underwent physical therapy. Follow-up MR imaging of the total spine was obtained every 3 months, and at 9 months, recurrence was demonstrated, which was successfully treated with chemotherapy. Further surveillance MR imaging of the total spine has demonstrated cystic myelomalacia changes without definite tumor recurrence, at 5-year follow-up. Clinically, the patient has developed scoliosis without weakness, pain, or urinary symptoms. CONCLUSION: This case demonstrates an exceptionally rare and unusual variant neoplasm in a neonate and highlights the difficulty of diagnosis and the important role of MR imaging. It also illustrates the importance of gross total resection, the risk of recurrence, and the need for close radiographic follow-up of these lesions. It also provides a useful example of the efficacy of adjuvant chemotherapy in treating recurrence.

Simulation of proximal catheter occlusion and design of a shunt tap aspiration system.

PURPOSE: Total and partial proximal catheter occlusions are well-known complications of ventriculoperitoneal shunts (VPS). When this occurs, surgeons often attempt to perform a shunt tap. However, the degree of obstruction in a proximal catheter that ultimately leads to shunt malfunction is unknown. METHODS: We developed a benchtop model to simulate proximal catheter occlusion with two hydrostatic reservoirs connected by a VPS catheter system. The Centurion compass device was used to measure pressure across the valve digitally. Wires of varying diameters (equalling different occlusion percentages) were inserted into the catheter's proximal end to stimulate obstruction. A mock shunt tap aspiration was then performed by incorporating a pressure transducer. RESULTS: As a general trend, pressure reading on the device decreases as occlusion increases. At higher levels of occlusion (> 45%), the blockage begins to significantly impede the flow through the catheter, and the pressure drops at a faster rate compared with lower occlusion percentages. The pressure reading converges quickly to 0 with increasing blockage after about 70%. The Centurion compass is able to detect large changes in pressure as evidenced by the major differences in pressure readings between no occlusion, 45%, and 84%. The shunt will not function at 84%. In order to determine the threshold for occlusion beyond which fluid cannot be withdrawn, we tested five levels of occlusion (0%, 33%, 63%, 84%, and 100%) at various aspiration pressures and determined that fluid can still be produced with 0-84% occlusion, but no fluid could be produced at 100% occlusion. CONCLUSIONS: We developed a model of proximal shunt obstruction and found that cerebrospinal fluid (CSF) flow through a VPS is unaffected up to 33% occlusion, begins to become impaired at 45% occlusion, and is miniscule at 84% occlusion. Shunt aspiration was not possible at 84% occlusion. Pressure measured at the reservoir is accurate and correlates with intracranial pressure (ICP) up to approximately 60% proximal occlusion. With partial occlusion up to 70%, ventricular pressure will dictate shunt function.

The Influence of Offline and Online Intrinsic Motivations on Online Health Information Seeking.

We examine how intrinsic motivations in two health interaction contexts - online and doctor's office visit - influence online health information seeking (OHIS). Many studies have approached OHIS through short-term gratification of informational needs. Our study uses a conceptual framework of intrinsic human motivation to better understand OHIS as a form of sustained behavior. We applied Self Determination Theory's three key constructs (Autonomy, Competence, and Relatedness) within a locus of patient-physician relations. Our findings, based on a survey of 993 online health information seekers in India, show that support for Autonomy in the online context explains all three categories of OHIS behaviors: Diagnosis and Treatment Information Seeking, General Health Information Seeking, and Office Visit Information Seeking. Support for Relatedness in the online context explains only Office Visit Information Seeking. However, support for Autonomy, Competence, and Relatedness in the office visit experience could not explain why people engage in OHIS overall. Motivations for the office visit are not associated with the online experience, suggesting that online and offline are not just two kinds of substitute health interaction contexts.

Applying the Modified Comprehensive Model of Information Seeking to Online Health Information Seeking in the Context of India.

This study extends the Comprehensive Model of Information Seeking (CMIS) to online health information seeking in the context of India. This study considers the Internet (i.e., media) use an antecedent factor and the personal relevance factor salience is separated into two dimensions - susceptibility and severity. Structural equation modeling analysis (N = 990) tested the associations between health-related antecedents, information-carrier factors, and their direct effects on online information seeking. The results among online health information seekers in India showed significant relationships between length and frequency of media use and self-efficacy to engage in preventive behavior to the information carrier utility. As predicted, demographics have no significant relationship with utility of the Internet, and direct experience with illness resulted in negative relationship with the Internet utility. Contrary to expectations, susceptibility and severity produced negative relationships with the Internet utility. Result shows that both information-carrier factors - characteristics related to trust and utility related to perceived usefulness and relevance of information - directly affect online health-information-seeking behavior. Unlike the original CMIS that primarily focused on specific illnesses, the current modified CMIS can be adapted and tailored to general online health-information-seeking behavior.

Trust Ecologies and Channel Complementarity for Information Seeking in Cancer Prevention.

Our paper extends channel complementarity theory, which has focused on evidence of complementarity and patterns of channel use, by elucidating the notion of trust complementarity. We examined trust, an information-carrier characteristic and a core construct in health-focused decision-making to understand cancer information seeking, based on data from two nationally representative surveys in Singapore. Trust is found to be differential, relational, and ecological, with implications for individuals' access to and reliance on doctors, family/friends, newspapers/magazines, radio, TV, and the Internet for cancer prevention information. In an ideal trust complementarity environment, an individual should be able to traverse a range of communication channels seamlessly. Our findings however suggest that although individuals trust different channels complementarily, their trust patterns are limited and fettered. We identified two types of trust ecologies shaped by dual-channel and polymorphic complementarity patterns that suggest that health information seekers are trapped within specific trust ecologies that prevent them from navigating a broader range of communication channels for cancer prevention.

Health Information Seeking Among Singaporeans: Roles and Collective Contexts.

This article seeks to contribute to the literature on health information seeking (HIS) by culturally locating the search for health information within the local contexts of everyday life in Singapore, and within the meaning-making processes that individuals participate in. Based on in-depth interviews with 100 participants selected through stratified sampling, it asks: How do Singaporeans make sense of HIS in the realm of their everyday lived experiences? The study contributes to the literature on the roles familial ties play in information gathering and sharing in a collective context. More importantly, these familial ties provide perspective on the ways in which culture spatio-temporally constitutes HIS. HIS is informed by familial role expectations in a collectivist context where filial piety and "respect for the elderly" are guiding anchors for behavior. Moreover, harmony and community well-being define societal roles and responsibilities of caregiving, directed broadly at communal care. These collective-oriented contexts therefore inform HIS.

A Replication of Channel Complementarity Theory among Internet Users in India.

This article examined channel complementarity in health information seeking among Internet users in India. It posited that online users complementarily use different channels to search for health information. Based on the existing literature, it suggested that age is an important moderator of different channels as health information sources. Data regarding the consumption of 11 different channels were collected from nearly 1,000 Internet users. The results demonstrated complementary use of different channels as health information sources in relationship to the Internet as a health information source, except for newspapers and family members. Moreover, not supporting our hypothesis regarding the sources of health information among online users, the Internet was surprisingly not the primary source of health information, being shadowed by the predominant and significantly greater use of newspapers as sources of health information among online users in India. Extending the theory of channel complementarity, we found that age is an important moderator of complementary relationships among various channels as health information sources, demonstrating that younger users were more likely to use greater numbers of channels complementarily as compared to older users. Contributions to channel complementarity and implications of research are discussed on the basis of the findings.

Hand1 overexpression inhibits medulloblastoma metastasis.

Medulloblastoma (MB) is the most frequent malignant pediatric brain tumor. Current treatment includes surgery, radiation and chemotherapy. However, ongoing treatment in patients is further classified according to the presence or absence of metastasis. Since metastatic medulloblastoma are refractory to current treatments, there is need to identify novel biomarkers that could be used to reduce metastatic potential, and more importantly be targeted therapeutically. Previously, we showed that ionizing radiation-induced uPAR overexpression is associated with increased accumulation of ß-catenin in the nucleus. We further demonstrated that uPAR protein act as cytoplasmic sequestration factor for a novel basic helix-loop-helix transcription factor, Hand1. Among the histological subtypes classical and desmoplastic subtypes account for the majority while large cell/anaplastic variant is most commonly associated with metastatic disease. In this present study using immunohistochemical approach and patient data mining for the first time, we demonstrated that Hand1 expression is observed to be downregulated in all the subtypes of medulloblastoma. Previously we showed that Hand1 overexpression regulated medulloblastoma angiogenesis and here we investigated the role of Hand1 in the context of Epithelial-Mesenchymal Transition (EMT). Moreover, UW228 and D283 cells overexpressing Hand1 demonstrated decreased-expression of mesenchymal markers (N-cadherin, ß-catenin and SOX2); metastatic marker (SMA); and increased expression of epithelial marker (E-cadherin). Strikingly, human pluripotent stem cell antibody array showed that Hand1 overexpression resulted in substantial decrease in pluripotency markers (Nanog, Oct3/4, Otx2, Flk1) suggesting that Hand1 expression may be essential to attenuate the EMT and our findings underscore a novel role for Hand1 in medulloblastoma metastasis.

A Self-Determination Perspective on Online Health Information Seeking: The Internet vs. Face-to-Face Office Visits With Physicians.

This study elucidates the experiential and motivational aspects of online health information beyond the theoretically limited instrumental perspective that dominates the extant literature. Based on a sample of 993 online health information seekers in India, the survey found that online health information seeking offers individuals greater autonomy, competence, and relatedness compared to face-to-face office visits with physicians. According to self-determination theory, individuals are motivated to act by a sense of volition and experience of willingness, validation of one's skills and competencies, and feeling of connection with others who shaped one's decisions. These 3 psychological needs, which motivate individuals to pursue what they innately seek as human beings, help explain why individuals turn online for health information. T tests showed that all 3 self-determination theory constructs -autonomy, competence, and relatedness-were higher for online health information seeking than for face-to-face office visits with physicians. A regression analysis found that 2 variables, autonomy and relatedness, explained online health information seeking. Competence was not a significant factor, likely because of competency issues faced by individuals in interpreting, understanding, and making use of online health information. The findings, which do not suggest that online health information seeking would displace physicians as many have feared, offer promise for an integrated system of care. Office visits with physicians would necessarily evolve into an expanded communicative space of health information seeking instead of an alternative channel for health information.

Clinical outcomes of temporary shunting for infants with cerebral pseudomeningocele.

OBJECTIVE: Although in the case of subdural collections temporary shunting has been suggested as a viable alternative for definitive drainage of the accumulated fluid until restoration of the normal CSF dynamics, there is no agreement on the best management strategy for pseudomeningocele. METHODS: The authors performed a retrospective chart review in order to evaluate the clinical outcomes of infants temporarily shunted for pseudomeningocele without encephalocele at our institution (The University of Illinois at Peoria/Illinois Neurological Institute) in the period from 2004 to 2012. The epidemiological characteristics, clinical management, and final outcomes of such subpopulation were compared with a control group which received temporary shunting for subdural hematomas (SDH) during the same period. RESULTS: Four patients (100% male) ranging in age from 8.9 to 27.1 months (mean = 13.88) with pseudomeningocele and 17 patients (64.7% male) ranging in age from 1.9 to 11.8 months (mean = 4.15) with SDH were identified. Although the initial management included sequential percutaneous subdural tapping in 82% of the patients, all children ultimately failed such strategy, requiring either subdural-peritoneal (81% of the cases) or subgaleal-peritoneal (19% of the cases) shunting. The mean implant duration was 201 days for the pseudomeningocele group and 384 days for the SDH one. Mean post-shunt hospitalization was 2 days for patients with pseudomeningocele and 4 days for patients with SDH. There was no statistical difference in terms of complications, length of hospitalization post-shunting, or clinical outcomes between the patients with pseudomeningocele and those with SDH. CONCLUSIONS: Temporary shunting of infants with pseudo-meningocele constitutes a viable therapeutic alternative with favorable clinical outcomes and a low risk of shunt dependency similar to those of children with SDH.

Predicting Alzheimer's disease from cognitive footprints in mid and late life: How much can register data and machine learning help?

BACKGROUND: Real-world data with decades-long medical records are increasingly available alongside the growing adoption of machine learning in healthcare research. We evaluated the performance of machine learning models in predicting the risk of Alzheimer's disease (AD) using data from the Finnish national registers. METHODS: We conducted a case-control study using data from the Finnish MEDALZ (Medication use and Alzheimer's disease) study. Altogether 56,741 individuals with incident AD diagnosis (age ≥ 65 years at diagnosis and born after 1922) and their 1:1 age-, sex-, and region of residence-matched controls were included. The association of risk factors, evaluated at different age periods (45-54, 55-64, 65+), and AD were assessed with logistic regression. Predictive accuracies of logistic regressions were compared with seven machine learning models (L1-regularized logistic regression, Naive bayes, Decision tree, Random Forest, Multilayer perceptron, XGBoost, and LightGBM). FINDINGS: 63.5 % of cases and controls were females and the mean age was 79.1 (SD = 5.1). The strongest associations with AD were observed for head injuries at age 55-64 (OR, 95 % CI 1.33, 1.19-1.48) and 65+ (1.31, 1.23-1.40), followed by antidepressant use (1.30, 1.22-1.38) at 55-64 and antipsychotic use (1.27, 1.19-1.35) at 65+. The predictive accuracies of all models were low, with the best performance (AUC 0.603) observed in Random Forest for predicting AD onset at age 65-69. INTERPRETATION: Although significant associations were identified between many risk factors and AD, the low predictive accuracies suggest that specialised healthcare diagnosis data is not sufficient for predicting AD and linkage with other data sources is needed.

We Tabulated and Organized American Board of Neurological Surgeons Primary Exam Keywords (2015-2023) so You Don't Have to.

Background Passing the American Board of Neurological Surgeons (ABNS) Primary Exam is required for residents in training. Both the program directors and residents are given keywords of the exam afterward in the hope to help program directors determine their relative strengths and weakness. We have organized and tabulated these keywords for neurosurgery residents' benefit. Methodology We collected and analyzed ABNS Primary Exam keywords (2015-2023) in each of the exam's main categories for trends and recurrences. We examined the overall passing rates among first-time credit test takers. The frequency of each subcategory was calculated as a percentage within its corresponding category. Recurrent keywords were grouped together with their corresponding years and categorized as once, twice, or thrice and greater occurrences; the last category was considered to be high-yield keywords. Results The number of questions in Neurosciences and Neurology has decreased over the years while Neurosurgery and Critical Care questions have increased. Similarly, there are fewer keyword repeats in Neurosciences and Neurology. The most repeated keywords are in Neuroimaging. The most common keywords are presented and listed along with the years of occurrences. Overall, the passing rate among first-time credit test takers is over 90%. Conclusions Neurosurgery residents can consider the common keywords as a guide in preparation for the ABNS Primary Exam.

Global Epidemiology of Hip Fractures: Secular Trends in Incidence Rate, Post-Fracture Treatment, and All-Cause Mortality.

In this international study, we examined the incidence of hip fractures, postfracture treatment, and all-cause mortality following hip fractures, based on demographics, geography, and calendar year. We used patient-level healthcare data from 19 countries and regions to identify patients aged 50 years and older hospitalized with a hip fracture from 2005 to 2018. The age- and sex-standardized incidence rates of hip fractures, post-hip fracture treatment (defined as the proportion of patients receiving anti-osteoporosis medication with various mechanisms of action [bisphosphonates, denosumab, raloxifene, strontium ranelate, or teriparatide] following a hip fracture), and the all-cause mortality rates after hip fractures were estimated using a standardized protocol and common data model. The number of hip fractures in 2050 was projected based on trends in the incidence and estimated future population demographics. In total, 4,115,046 hip fractures were identified from 20 databases. The reported age- and sex-standardized incidence rates of hip fractures ranged from 95.1 (95% confidence interval [CI] 94.8-95.4) in Brazil to 315.9 (95% CI 314.0-317.7) in Denmark per 100,000 population. Incidence rates decreased over the study period in most countries; however, the estimated total annual number of hip fractures nearly doubled from 2018 to 2050. Within 1 year following a hip fracture, post-hip fracture treatment ranged from 11.5% (95% CI 11.1% to 11.9%) in Germany to 50.3% (95% CI 50.0% to 50.7%) in the United Kingdom, and all-cause mortality rates ranged from 14.4% (95% CI 14.0% to 14.8%) in Singapore to 28.3% (95% CI 28.0% to 28.6%) in the United Kingdom. Males had lower use of anti-osteoporosis medication than females, higher rates of all-cause mortality, and a larger increase in the projected number of hip fractures by 2050. Substantial variations exist in the global epidemiology of hip fractures and postfracture outcomes. Our findings inform possible actions to reduce the projected public health burden of osteoporotic fractures among the aging population. © 2023 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).

Identification of Drugs Associated with Lower Risk of Parkinson's Disease Using a Systematic Screening Approach in a Nationwide Nested Case-Control Study.

Introduction: Drugs for other indications may be repurposable as disease-modifying drugs for Parkinson's disease (PD). A systematic hypothesis-free approach can enable identification of candidates for repurposing. We applied a hypothesis-free systematic approach to identify drugs associated with lower risk of PD to discover candidates with potential for repurposing as disease-modifying drugs for PD and to illustrate challenges in observational studies that simultaneously investigate multiple repurposing candidates. Methods: The Finnish Parkinson's disease study (FINPARK), a nationwide nested case-control study, was randomized to screening (10,183 cases, 67,849 controls) and replication (10,184 cases, 67,754 controls) samples, including cases diagnosed in 1998-2015. After screening all univariable associations of register-derived exposure to individual-drug, group- and subgroup level since 1995 (exposure ≥3 years before outcome, threshold P = 0.1), different exposure periods were used in confounder-adjusted replication analyses. Results: In screening stage, the group-level (antipsoriatics and antigout preparations) and subgroup-level (cicatrizants, topical antipsoriatics, antigout preparations and mydriatics and cycloplegics) associations were mainly due to individual drugs. Seven other drugs (eg methotrexate, drugs for chronic obstructive pulmonary disease, COPD and/or asthma) were associated with lower risk. Associations of antigout preparations and antipsoriatics were replicated. COPD/asthma drugs, methotrexate and diabetes drugs were studied in separate, indication-restricted designs. Discussion: The results reflect the known risk factors and the implied role of the immune system in PD pathogenesis and spurious associations. They underline the importance of controlling for confounding by indication, which is challenging to apply to systematic screening.