Oregon Clinic

BACKGROUNDThere is a paucity of literature to guide the surgical management of the simultaneous presentation of a diastematomyelia, two hemicords, and a unilateral bar unsegmented vertebra, a form of formation failure.OBSERVATIONSAn 11-year-old female presented with acute-onset back pain, urinary incontinence, and lower extremity numbness. Evaluation revealed T7 diastematomyelia with a tethered cord and a right-sided T6–11 nonsegmented unilateral bar, resulting in thoracolumbar levoscoliosis (maximal Cobb angle of 49°). Initial surgical decompression and spinal cord detethering were performed, including a T7 laminectomy. A bony septation attached to the lamina and projecting through the dura mater and cord was removed and the cord was detethered. The patient subsequently regained neurological function. Eight months later, repeat scoliosis radiographic imaging showed progression to a maximal Cobb angle of 58.4°. The patient then underwent a second-stage T2–L3 posterior lateral fixation and fusion with a pedicle screw-rod construction. The postoperative curve magnitude was 25.2°. Five years following operation, she required no revision surgery and remained neurologically intact.LESSONSThe authors present a successful surgical correction of concomitant diastematomyelia and a unilateral bar and unsegmented butterfly vertebra in a pediatric patient. While the curve magnitude at presentation warranted surgical correction, neurological deficits necessitated urgent decompression before stabilization.https://thejns.org/doi/10.3171/CASE25315

Background COVID-19, caused by SARS-CoV-2, triggers severe systemic inflammation and multiple organ dysfunction. Microvascular complications, potentially arising from endothelial cell infection and/or immunothrombosis, play a central role in the disease's pathophysiology. Upon cell activation and/or cell death, cells release cell-free DNA (cfDNA) into the circulation, and cfDNA derived specifically from endothelial cells may serve as a marker of microvascular damage severity. Objectives In this study, we aimed to develop an assay to specifically measure endothelial cell-derived DNA as a marker of microvascular damage in COVID-19 patients. Methods In this study, we developed a methylation-specific digital droplet polymerase chain reaction assay targeting the promoter of the NOS3 gene to quantify circulating endothelial cell-derived cfDNA in COVID-19 patients followed longitudinally at inclusion, day 11, and day 28. Results Total cfDNA and endothelial-specific cfDNA levels significantly increased with COVID-19 disease severity, with the highest levels in patients with severe COVID-19. Notably, patients with mild COVID-19 showed endothelial cfDNA levels comparable to those of healthy controls, and levels remained stable from inclusion through day 28. In contrast, patients with moderate disease severity showed significantly elevated endothelial cfDNA levels compared with controls, which declined over time. Patients with severe COVID-19 displayed persistently high endothelial cfDNA levels throughout the observation period. Conclusion Using a digital droplet polymerase chain reaction assay specific for cfDNA from endothelial cells, we demonstrated endothelial cell damage in patients with COVID-19 that correlated with disease severity.

Background: Meniscal preservation has been demonstrated to contribute to long-term knee health and has been a successful intervention in isolation and in patients with anterior cruciate ligament reconstruction (ACLR). The long-term results of meniscal repair in the setting of revision ACLR have yet to be documented. Purpose: To report the incidence of meniscal repair failures at the 6-year follow-up in a cohort of patients who underwent concurrent revision ACLR and primary meniscal repair. Study Design: Prospective cohort study; Level of evidence, 2. Methods: All revision ACLRs with concomitant primary meniscal repair cases from a multicenter group between 2006 and 2011 were selected. Six-year follow-up was obtained to determine whether any subsequent surgery had occurred since their initial revision ACLR. If so, operative reports were obtained, whenever possible, to verify pathological condition and treatment. Results: In total, 221 patients from 1234 revision ACLRs underwent concurrent primary meniscal repairs (18% of the cohort). There were 238 repairs performed: 173 medial and 65 lateral. The majority of these repairs (n = 181; 76%) were performed with an all-inside technique. Six-year surgical follow-up was obtained in 77% (171/221) of the cohort, or 189 of 238 (79%) of the repairs (136 medial, 53 lateral). The meniscal repair failure rate, defined as reoperation, was 16% (31/189) at 6 years. Of the 31 failures, 28 were medial (24 all-inside, 4 inside-out; 28/136 = 20.6% failure rate) and 3 were lateral (2 all-inside, 1 inside-out; 3/53 = 5.7% failure rate). Three medial failures were treated in conjunction with a subsequent repeat revision ACLR. Medial tears underwent reoperation for failure at a significantly higher rate than lateral tears (20.6% vs 5.7%; P = .01) and had a significantly shorter survival time compared with lateral tears (P = .02). No difference was found between the failure and nonfailure groups when it came to tear type, tear length, repair technique utilized, suture/implant type, or number of sutures used between the 2 groups. Conclusion: Meniscal repair in the revision ACLR setting has a 16% failure rate at 6 years. Failure rates for medial tears (20.6%) were found to be higher than that for lateral tears (5.7%), which aligns with previous studies in both the revision and primary ACLR setting.

Gastroduodenal artery aneurysms (GDAA) are a rare but potentially life-threatening vascular condition. They can vary in presentation from being found incidentally on imaging to devastating rupture. We describe a case of 2 gastroduodenal aneurysms causing obstructive jaundice and acute cholangitis in an elderly woman, which was treated with coil embolization.rupture. GDAA of any size should be highly considered for treatment given the high mortality of eventual rupture.

ABSTRACT The annual ImmunoRad Conference has established itself as a recurrent occasion to explore the possibility of combining radiation therapy (RT) and immunotherapy (IT) for clinical cancer management. Bringing together a number of preclinical and clinical leaders in the fields of radiation oncology, immuno-oncology and IT, this annual event fosters indeed essential conversations and fruitful exchanges on how to address existing challenges to expand the therapeutic value of RT-IT combinations. The 8th edition of the ImmunoRad Conference, which has been held in October 2024 at the Weill Cornell Medical College of New York City, highlighted exciting preclinical and clinical advances at the interface between RT and IT, setting the stage for extra progress toward extended benefits for patients with an increasing variety of tumor types. Here, we critically summarize the lines of investigation that have been discussed at the occasion of the 8th Annual ImmunoRad Conference.

Abstract Rationale: There are few quantitative reports of participants’ experiences after involvement in a neonatal randomized controlled trial (RCT). Objective: To assess participant-center outcomes from parents of offspring randomized in the eCPAP study (NCT#04295564) Methods: Infants born at ≤32 weeks gestational age (GA) and needing ≥24 hours of CPAP were randomized to an extended 2 weeks of eCPAP or to dCPAP to room air when meeting “CPAP stability criteria” (PMID: 22611116). Twin pairs were assigned to the same treatment arm. Analysis was intention to treat. 100 infants (11 sets of twins) were randomized. Functional residual capacity (FRC) was measured twice in the neonatal intensive care unit (NICU). Alveolar volume (VA), lung diffusion capacity (DLCO), and forced expiratory flows (FEFs) were measured under chloral hydrate sedation at 6 months of age. Monthly respiratory questionnaires were completed from month 1 to 12 of life and Bayley exams at 12 months of age. As previously reported (ATS 2024), the eCPAP group had significantly increased FRC and significantly increased outpatient VA, DLCO, and FEFs. 93 of an eligible 99 completed the outpatient lung function testing, a median of 12 monthly RQs were completed and 94 of 99 infants completed the Bayley exam. At the end of all study procedures, the standardized Research Participant Perception Survey-Short (RRP-S) consisting of 25 questions with Likert scale items to assess the participant's experience and satisfaction with the research study, team, and process were sent to the parents of enrolled offspring via DocuSign. The RRP-S results were entered into REDCap by personnel blinded to treatment allocation. Results: Of 89 pregnancies, 69 (34 eCPAP and 35 dCPAP) completed the RRP-S (78% completion). 64% were non-hispanic white female, 29% had college or 2-year degree, 58% were age 18-34. The score for the overall experience was 9.4 ± 1.1 (Mean ± SD) on a Likert scale of 0-10 (10 best) with comparable scores in both randomized arms. Table shows overall responses. 68 of 69 families would recommend joining a research study. The most important reason to join and stay in the study was to help others. Conclusion: This RCT scored a high RRP-S score overall and in both treatment arms despite occurring in a vulnerable population and requiring chloral hydrate sedation. We speculate that a well discussed informed consent and research staff that listened to families contributed to the high overall experience. These data are important for RCTs in fragile neonatal populations.

Relative to other Oregon counties, Klamath County experiences worse air quality due to wildfire smoke, as well as elevated rates of infant mortality and low birthweight. Klamath County Public Health (KCPH) raised concerns that wildfire smoke is a contributor to poor infant health. Thus, we built a multidisciplinary team and designed a community-engaged research (CEnR) project to capture community and individual-level exposure to wildfire smoke contaminants, alongside perinatal health outcomes. Through partnerships, we identified 24 individuals across academic, public health, and community organizations that met five times over three months to develop a study design. We initially used a modified Delphi method, but adjusted our approach to find multidisciplinary areas of agreement across a highly diverse team. Our team used structured meetings, surveys, and iterative feedback to build consensus on a study design. KCPH and our community partners reviewed and approved all proposed activities to ensure community input was integrated. The resultant study, trialed in Klamath County, included the use of environmental, residential, and personal samplers and health surveys with a cohort of pregnant individuals during the wildfire season. We discuss the advantages and challenges of building a multidisciplinary CEnR study in a rural county disproportionately impacted by wildfire smoke and infant mortality.