Neurosurgical emergency management during the lockdown period in health care regions in Spain with different COVID-19 impact: lessons learned to improve outcomes on the future waves

Background COVID-19 has overloaded health care systems, testing the capacity and response in every European region. Concerns were raised regarding the impact of resources’ reorganization on certain emergency pathology management. The aim of the present study was to assess the impact of the outbreak (in terms of reduction of neurosurgical emergencies) during lockdown in different regions of Spain. Methods We analyzed the impact of the outbreak in four different affected regions by descriptive statistics and univariate comparison with same period of two previous years. These regions differed in their incidence level (high/low) and in the time of excess mortality with respect to lockdown declaration. That allowed us to analyze their influence on the characteristics of neurosurgical emergencies registered for every region. Results 1185 patients from 18 neurosurgical centers were included. Neurosurgical emergencies that underwent surgery dropped 24.41% and 28.15% in 2020 when compared with 2019 and 2018, respectively. A higher reduction was reported for the most affected regions by COVID-19. Non-traumatic spine experienced the most significant decrease in number of cases. Life-threatening conditions did not suffer a reduction in any health care region. Conclusions COVID-19 affected dramatically the neurosurgical emergency management. The most significant reduction in neurosurgical emergencies occurred on those regions that were hit unexpectedly by the pandemic, as resources were focused on fighting the virus. As a consequence, life-threating and non-life-threatening conditions’ mortality raised. Results in regions who had time to prepare for the hit were congruent with an organized and sensible neurosurgical decision-making.Peer reviewe

Productivity trends and collaboration patterns: A diachronic study in the eating disorders field

[EN] Objective The present study seeks to extend previous bibliometric studies on eating disorders (EDs) by including a time-dependent analysis of the growth and evolution of multi-author collaborations and their correlation with ED publication trends from 1980 to 2014 (35 years). Methods Using standardized practices, we searched Web of Science (WoS) Core Collection (WoSCC) (indexes: Science Citation Index-Expanded [SCIE], & Social Science Citation Index [SSCI]) and Scopus (areas: Health Sciences, Life Sciences, & Social Sciences and Humanities) to identify a large sample of articles related to EDs. We then submitted our sample of articles to bibliometric and graph theory analyses to identify co-authorship and social network patterns. Results We present a large number of detailed findings, including a clear pattern of scientific growth measured as number of publications per five-year period or quinquennium (Q), a tremendous increase in the number of authors attracted by the ED subject, and a very high and steady growth in collaborative work. Conclusions We inferred that the noted publication growth was likely driven by the noted increase in the number of new authors per Q. Social network analyses suggested that collaborations within ED follow patters of interaction that are similar to well established and recognized disciplines, as indicated by the presence of a ¿giant cluster¿, high cluster density, and the replication of the ¿small world¿ phenomenon¿the principle that we are all linked by short chains of acquaintances.This work was performed with a subsidy from Universidad Catolica de Valencia "San Vicente Martir" to resarch group INDOTEI: Evaluacion de la Ciencia, for the years 2016-2017. This work is benefited from Spanish Government assistance through Government Delegation for the National Drugs Plan of the Ministry of Health, Social Services and Equality (project 2016/028); and National R+D+I (projects: CS02012-39632-C02-01 and CS02015-65594-C2-2-R) and 2015-Networks of Excellence Call (project CS02015-71867-REDT) of the Ministry of Economy and Competitiveness.Valderrama Zurian, JC.; Aguilar-Moya, R.; Cepeda-Benito, A.; Melero-Fuentes, D.; Navarro-Moreno, MÁ.; Gandía-Balaguer, A.; Aleixandre-Benavent, R. (2017). Productivity trends and collaboration patterns: A diachronic study in the eating disorders field. PLoS ONE. 12(8):1-17. https://doi.org/10.1371/journal.pone.0182760S117128McClelland, J., Bozhilova, N., Campbell, I., & Schmidt, U. (2013). A Systematic Review of the Effects of Neuromodulation on Eating and Body Weight: Evidence from Human and Animal Studies. 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Aslib Journal of Information Management, 67(1), 55-73. doi:10.1108/ajim-09-2014-0116Barabási, A. ., Jeong, H., Néda, Z., Ravasz, E., Schubert, A., & Vicsek, T. (2002). Evolution of the social network of scientific collaborations. Physica A: Statistical Mechanics and its Applications, 311(3-4), 590-614. doi:10.1016/s0378-4371(02)00736-7Newman, M. E. J. (2004). Coauthorship networks and patterns of scientific collaboration. Proceedings of the National Academy of Sciences, 101(Supplement 1), 5200-5205. doi:10.1073/pnas.0307545100Aleixandre-Benavent, R., & Alonso-Arroyo, A. (2011). Indicadores bibliométricos, patología del aparato respiratorio y reducción del consumo de tabaco. Revista de Patología Respiratoria, 14(1), 1-3. doi:10.1016/s1576-9895(11)70095-9Pino-Díaz, J., Jiménez-Contreras, E., Ruíz-Baños, R., & Bailón-Moreno, R. (2011). Evaluación de redes tecnocientíficas: la red española sobre Áreas Protegidas, según la Web of Science. Revista española de Documentación Científica, 34(3), 301-333. doi:10.3989/redc.2011.3.804Valderrama-Zurián, J.-C., Aguilar-Moya, R., Melero-Fuentes, D., & Aleixandre-Benavent, R. (2015). A systematic analysis of duplicate records in Scopus. Journal of Informetrics, 9(3), 570-576. doi:10.1016/j.joi.2015.05.002Guardiola-Wanden-Berghe, R., Sanz-Valero, J., & Wanden-Berghe, C. (2012). Medical subject headings versus American Psychological Association Index Terms: indexing eating disorders. Scientometrics, 94(1), 305-311. doi:10.1007/s11192-012-0866-7Soh, N., Walter, G., Touyz, S., Russell, J., Malhi, G. S., & Hunt, G. E. (2012). Food for thought: Comparison of citations received from articles appearing in specialized eating disorder journals versus general psychiatry journals. International Journal of Eating Disorders, 45(8), 990-994. doi:10.1002/eat.22036Theander, S. S. (2004). Trends in the literature on eating disorders over 36 years(1965-2000): terminology, interpretation and treatment. European Eating Disorders Review, 12(1), 4-17. doi:10.1002/erv.559Kawamura, M., Thomas, C. D. L., Tsurumoto, A., Sasahara, H., & Kawaguchi, Y. (2000). Lotka’s law and productivity index of authors in a scientific journal. Journal of Oral Science, 42(2), 75-78. doi:10.2334/josnusd.42.75Lawani SM. Quality, collaboration and citations in cancer research: A bibliometric study. PhD thesis. Florida State University, Tallahassee. 1980.Watts, D. J., & Strogatz, S. H. (1998). Collective dynamics of ‘small-world’ networks. Nature, 393(6684), 440-442. doi:10.1038/30918Jacomy, M., Venturini, T., Heymann, S., & Bastian, M. (2014). ForceAtlas2, a Continuous Graph Layout Algorithm for Handy Network Visualization Designed for the Gephi Software. PLoS ONE, 9(6), e98679. doi:10.1371/journal.pone.0098679Pike, K. M., & Dunne, P. E. (2015). The rise of eating disorders in Asia: a review. Journal of Eating Disorders, 3(1). doi:10.1186/s40337-015-0070-2El Ghoch, M., Soave, F., Calugi, S., & Dalle Grave, R. (2013). Eating Disorders, Physical Fitness and Sport Performance: A Systematic Review. Nutrients, 5(12), 5140-5160. doi:10.3390/nu5125140Jones, A. W. (2007). The distribution of forensic journals, reflections on authorship practices, peer-review and role of the impact factor. Forensic Science International, 165(2-3), 115-128. doi:10.1016/j.forsciint.2006.05.013Baker, T., Hatsukami, D., Lerman, C., O’Malley, S., Shields, A., & Fiore, M. (2003). Transdisciplinary science applied to the evaluation of treatments for tobacco use. Nicotine & Tobacco Research, 5(6), 89-99. doi:10.1080/14622200310001625564González-Alcaide, G., Melero-Fuentes, D., Aleixandre-Benavent, R., & Valderrama-Zurián, J.-C. (2013). Productivity and Collaboration in Scientific Publications on Criminology. Journal of Criminal Justice Education, 24(1), 15-37. doi:10.1080/10511253.2012.664153López-Muñoz, F., Alamo, C., Rubio, G., García-García, P., Martín-Agueda, B., & Cuenca, E. (2003). Bibliometric analysis of biomedical publications on SSRI during 1980-2000. Depression and Anxiety, 18(2), 95-103. doi:10.1002/da.10121González-Alcaide, G., Aleixandre-Benavent, R., Navarro-Molina, C., & Valderrama-Zurián, J. C. (2008). Coauthorship networks and institutional collaboration patterns in reproductive biology. Fertility and Sterility, 90(4), 941-956. doi:10.1016/j.fertnstert.2007.07.1378González-Alcaide, G., Park, J., Huamaní, C., Belinchón, I., & Ramos, J. M. (2015). Evolution of Cooperation Patterns in Psoriasis Research: Co-Authorship Network Analysis of Papers in Medline (1942–2013). PLOS ONE, 10(12), e0144837. doi:10.1371/journal.pone.0144837Bordons, M., & Ángeles Zulueta, M. (2002). La interdisciplinariedad en los grupos españoles de investigación en el área cardiovascular. Revista Española de Cardiología, 55(9), 900-912. doi:10.1016/s0300-8932(02)76728-6Chan, H. F., Önder, A. S., & Torgler, B. (2015). The first cut is the deepest: repeated interactions of coauthorship and academic productivity in Nobel laureate teams. Scientometrics, 106(2), 509-524. doi:10.1007/s11192-015-1796-yBordons, M., Aparicio, J., González-Albo, B., & Díaz-Faes, A. A. (2015). The relationship between the research performance of scientists and their position in co-authorship networks in three fields. Journal of Informetrics, 9(1), 135-144. doi:10.1016/j.joi.2014.12.001Newman, M. E. J. (2001). The structure of scientific collaboration networks. Proceedings of the National Academy of Sciences, 98(2), 404-409. doi:10.1073/pnas.98.2.404Fatt, C. K., Ujum, E. A., & Ratnavelu, K. (2010). The structure of collaboration in the Journal of Finance. Scientometrics, 85(3), 849-860. doi:10.1007/s11192-010-0254-0Kretschmer, H. (2004). Author productivity and geodesic distance in bibliographic co-authorship networks, and visibility on the Web. Scientometrics, 60(3), 409-420. doi:10.1023/b:scie.0000034383.86665.22Yan, E., Ding, Y., & Zhu, Q. (2009). Mapping library and information science in China: a coauthorship network analysis. Scientometrics, 83(1), 115-131. doi:10.1007/s11192-009-0027-9Yin, L., Kretschmer, H., Hanneman, R. A., & Liu, Z. (2006). Connection and stratification in research collaboration: An analysis of the COLLNET network. Information Processing & Management, 42(6), 1599-1613. doi:10.1016/j.ipm.2006.03.021Lambiotte, R., & Panzarasa, P. (2009). Communities, knowledge creation, and information diffusion. Journal of Informetrics, 3(3), 180-190. doi:10.1016/j.joi.2009.03.007Leydesdorff, L. (2012). World shares of publications of the USA, EU-27, and China compared and predicted using the new Web of Science interface versus Scopus. El Profesional de la Informacion, 21(1), 43-49. doi:10.3145/epi.2012.ene.06Bartol, T., Budimir, G., Dekleva-Smrekar, D., Pusnik, M., & Juznic, P. (2013). Assessment of research fields in Scopus and Web of Science in the view of national research evaluation in Slovenia. Scientometrics, 98(2), 1491-1504. doi:10.1007/s11192-013-1148-8López-Illescas, C., de Moya-Anegón, F., & Moed, H. F. (2008). Coverage and citation impact of oncological journals in the Web of Science and Scopus. Journal of Informetrics, 2(4), 304-316. doi:10.1016/j.joi.2008.08.001Warren, C. S., Gleaves, D. H., Cepeda-Benito, A., Fernandez, M. del C., & Rodriguez-Ruiz, S. (2005). Ethnicity as a protective factor against internalization of a thin ideal and body dissatisfaction. International Journal of Eating Disorders, 37(3), 241-249. doi:10.1002/eat.20102Prince, R., & Thebaud, E. F. (1983). Is Anorexia Nervosa a Culture-Bound Syndrome? 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Metodologías avanzadas en el diagnóstico y pronóstico de gliomas cerebrales basadas en resonancia magnética

Tesis doctoral.-- Universidad Autónoma de Madrid. Programa de doctorado en Biociencias Moleculares.Esta Tesis Doctoral proporciona un estudio integrado de la Supervivencia Global (SG) postquirúrgica en pacientes (n=166) con glioma cerebral de diversos grados, combinando la información clínica e histopatológica, con el perfil metabólico y genético del tumor. Brevemente, se obtuvieron biopsias del glioma de cada paciente mediante intervención neuroquirúrgica, determinando sus características histopatológicas y su perfil metabolómico y genético. El metaboloma tumoral se investigó mediante Resonancia Magnética ex vivo y el perfil genético, mediante ensayos de expresión y mutación génica. Brevemente, se prepararon dos bases de datos, una retrospectiva (66 pacientes, 1992-1998), conteniendo principalmente biomarcadores clínicos y metabolómicos, y otra prospectiva (100 pacientes, 2015-2020) conteniendo, además de los anteriores, biomarcadores genéticos. Posteriormente, se realizaron análisis estadísticos univariante, multivariante e interactómico, para seleccionar jerárquicamente el biomarcador (o colección de biomarcadores) que mejor describen la SG y sus interacciones. El estudio retrospectivo demostró correlaciones positivas entre la SG y el contenido de myo-inositol y glicerol-fosforilcolina, y correlaciones negativas entre la SG y los niveles de alanina y fosforil-colina, desarrollando un Árbol de Clasificación y Regresión (Classification Regression Tree, CRT) con una precisión predictiva del 84.7%. El estudio prospectivo confirmó la correlación positiva entre el nivel de myo-inositol y la SG, con contribuciones bifásicas de Colina, Glutamato y Glicerol-fosforilcolina, mostrando una precisión predictiva de 78,5%. El estudio genético mostró una correlación positiva de la SG con la sobreexpresión de genes del metabolismo de glutamina (GLUL, GLS, GLUD1), producción de glicerol-fosforilcolina (SMPD1 y GLPD1), y síntesis de glicina (SHMT1) y una correlación negativa con la sobreexpresión de fosfolipasas PLAG2A. El estudio interactómico ayudó a comprender las relaciones entre ambos sistemas y fue capaz de clasificar los tumores IDH-mutados mediante análisis de componentes principales y análisis de clústers a partir de sus perfiles metabólicos y de expresión génica. En conclusión, los resultados de esta Tesis proporcionan, hasta donde conocemos, una de las bases de datos más extensas de SG en pacientes portadores gliomas, mostrando que es posible mejorar las predicciones previas combinando la información clínica e histopatológica con abordajes metabolómicos y genómicos avanzados, e identificando potenciales futuros marcadores pronósticos y terapéuticosThis work was supported in part by grants PI2017/00361 from Instituto de Investigación Carlos III to JR, grant B2017/BMD-3688 from the Community of Madrid to JR and SC, and grant PI-0143-2016 from the Regional Ministry of Health of the Regional Government of Andalucía to J

Can AI pass the written European Board Examination in Neurological Surgery? - Ethical and practical issues

Introduction: Artificial intelligence (AI) based large language models (LLM) contain enormous potential in education and training. Recent publications demonstrated that they are able to outperform participants in written medical exams. Research question: We aimed to explore the accuracy of AI in the written part of the EANS board exam. Material and methods: Eighty-six representative single best answer (SBA) questions, included at least ten times in prior EANS board exams, were selected by the current EANS board exam committee. The questions’ content was classified as 75 text-based (TB) and 11 image-based (IB) and their structure as 50 interpretation-weighted, 30 theory-based and 6 true-or-false. Questions were tested with Chat GPT 3.5, Bing and Bard. The AI and participant results were statistically analyzed through ANOVA tests with Stata SE 15 (StataCorp, College Station, TX). P-values of <0.05 were considered as statistically significant. Results: The Bard LLM achieved the highest accuracy with 62% correct questions overall and 69% excluding IB, outperforming human exam participants 59% (p = 0.67) and 59% (p = 0.42), respectively. All LLMs scored highest in theory-based questions, excluding IB questions (Chat-GPT: 79%; Bing: 83%; Bard: 86%) and significantly better than the human exam participants (60%; p = 0.03). AI could not answer any IB question correctly. Discussion and conclusion: AI passed the written EANS board exam based on representative SBA questions and achieved results close to or even better than the human exam participants. Our results raise several ethical and practical implications, which may impact the current concept for the written EANS board exam

Assessment of Pre-operative Measurements of Tumor Size by MRI Methods as Survival Predictors in Wild Type IDH Glioblastoma

© 2020 Palpan Flores, Vivancos Sanchez, Roda, Cerdán, Barrios, Utrilla, Royo and Gandía González.[Objective]: We evaluate the performance of three MRI methods to determine non-invasively tumor size, as overall survival (OS) and Progression Free Survival (PFS) predictors, in a cohort of wild type, IDH negative, glioblastoma patients. Investigated protocols included bidimensional (2D) diameter measurements, and three-dimensional (3D) estimations by the ellipsoid or semi-automatic segmentation methods. [Methods]: We investigated OS in a cohort of 44 patients diagnosed with wild type IDH glioblastoma (58.2 ± 11.4 years, 1.9/1 male/female) treated with neurosurgical resection followed by adjuvant chemo and radiotherapy. Pre-operative MRI images were evaluated to determine tumor mass area and volume, gadolinium enhancement volume, necrosis volume, and FLAIR-T2 hyper-intensity area and volume. We implemented then multivariate Cox statistical analysis to select optimal predictors for OS and PFS. [Results]: Median OS was 16 months (1–42 months), ranging from 9 ± 2.4 months in patients over 65 years, to 18 ± 1.6 months in younger ones. Patients with tumors carrying O6-methylguanin-DNA-methyltransferase (MGMT) methylation survived 30 ± 5.2 vs. 13 ± 2.5 months in non-methylated. Our study evidenced high and positive correlations among the results of the three methods to determine tumor size. FLAIR-T2 hyper-intensity areas (2D) and volumes (3D) were also similar as determined by the three methods. Cox proportional hazards analysis with the 2D and 3D methods indicated that OS was associated to age ≥ 65 years (HR 2.70, 2.94, and 3.16), MGMT methylation (HR 2.98, 3.07, and 2.90), and FLAIR-T2 ≥ 2,000 mm2 or ≥60 cm3 (HR 4.16, 3.93, and 3.72), respectively. Other variables including necrosis, tumor mass, necrosis/tumor ratio, and FLAIR/tumor ratio were not significantly correlated with OS. [Conclusion]: Our results reveal a high correlation among measurements of tumor size performed with the three methods. Pre-operative FLAIR-T2 hyperintensity area and volumes provided, independently of the measurement method, the optimal neuroimaging features predicting OS in primary glioblastoma patients, followed by age ≥ 65 years and MGMT methylation.This work was supported in part by grants PI 2017/00361 from Instituto de Salud Carlos III to JR, MG, and AP and by grant B2017/BMD3688 from the Community of Madrid to JR, MG, and SC

Assessment of overall survival in glioma patients as predicted by metabolomic criteria

© 2019 Gandía-González, Cerdán, Barrios, López-Larrubia, Feijoó, Palpan, Roda and Solivera.[Objective]: We assess the efficacy of the metabolomic profile from glioma biopsies in providing estimates of postsurgical Overall Survival in glioma patients.[Methods]: Tumor biopsies from 46 patients bearing gliomas, obtained neurosurgically in the period 1992–1998, were analyzed by high resolution 1H magnetic resonance spectroscopy (HR- 1H MRS), following retrospectively individual postsurgical Overall Survival up to 720 weeks.[Results]: The Overall Survival profile could be resolved in three groups; Short (shorter than 52 weeks, n = 19), Intermediate (between 53 and 364 weeks, n = 19) or Long (longer than 365 weeks, n = 8), respectively. Classical histopathological analysis assigned WHO grades II–IV to every biopsy but notably, some patients with low grade glioma depicted unexpectedly Short Overall Survival, while some patients with high grade glioma, presented unpredictably Long Overall Survival. To explore the reasons underlying these different responses, we analyzed HR-1H MRS spectra from acid extracts of the same biopsies, to characterize the metabolite patterns associated to OS predictions. Poor prognosis was found in biopsies with higher contents of alanine, acetate, glutamate, total choline, phosphorylcholine, and glycine, while more favorable prognosis was achieved in biopsies with larger contents of total creatine, glycerol-phosphorylcholine, and myo-inositol. We then implemented a multivariate analysis to identify hierarchically the influence of metabolomic biomarkers on OS predictions, using a Classification Regression Tree (CRT) approach. The CRT based in metabolomic biomarkers grew up to three branches and split into eight nodes, predicting correctly the outcome of 94.7% of the patients in the Short Overall Survival group, 78.9% of the patients in the Intermediate Overall Survival group, and 75% of the patients in the Long Overall Survival group, respectively.[Conclusion]: Present results indicate that metabolic profiling by HR-1H MRS improves the Overall Survival predictions derived exclusively from classical histopathological gradings, thus favoring more precise therapeutic decisions.This work was supported in part by grants PI2017/00361 from Instituto de Investigación Carlos III to JR, grant B2017/BMD-3688 from the Community of Madrid to JR and SC, and grant PI-0143-2016 from the Regional Ministry of Health of the Regional Government of Andalucía to JS

The influence of soil tillage system on Salsola kali

10 Pág.With the move towards conservation agriculture, we have seen an increase in weeds such as Salsola kali L., well known as Russian thistle, which are wind spread over fallow land. The emergence of this weed species seemed erratic, perhaps connected to climate conditions and management techniques. In order to shed some light on this issue, we carried out a field experiment over 3 years to monitor Russian thistle density in fallow plots, comparing three tillage systems. This study provides an insight about the limitations of assuming no-tillage techniques within a cropping system that include fallow in the rotation sequence. Our results show that no-tillage systems are more vulnerable to S. kali. Low spring rain leads to high S. kali density, especially in no-tillage plots. High spring rainfall reduced the emergence in all tillage systems because of soil water saturation. Minimum tillage technique served to maintain control over this species even in weather conditions that favoured its emergence in other systems. In order to reduce the need for herbicide in fallow lands under conservation systems, we recommend the implementation of minimum tillage to combat Russian thistle infestation.This work has been funded by Projects AT2017‐003, RTA 2017‐00006‐C03‐01 (Spanish Ministry of Science and Innovation) and Comunidad de Madrid (Spain) and Structural Funds 2014‐2020 (ERDF and ESF) for the financial support (project AGRISOST‐CM S2018/BAA‐4330). We are grateful to D. San Martín and J. Silveria for their helping managing the experiment. We are grateful to Charlotte Harvey for English editing.Peer reviewe

Successful Optimization of Adalimumab Therapy in Refractory Uveitis Due to Behçet's Disease.

To assess efficacy, safety, and cost-effectiveness of adalimumab (ADA) therapy optimization in a large series of patients with uveitis due to Behçet disease (BD) who achieved remission after the use of this biologic agent. Open-label multicenter study of ADA-treated patients with BD uveitis refractory to conventional immunosuppressants. Sixty-five of 74 patients with uveitis due to BD, who achieved remission after a median ADA duration of 6 (range, 3-12) months. ADA was optimized in 23 (35.4%) of them. This biologic agent was maintained at a dose of 40 mg/subcutaneously/2 weeks in the remaining 42 patients. After remission, based on a shared decision between the patient and the treating physician, ADA was optimized. When agreement between patient and physician was reached, optimization was performed by prolonging the ADA dosing interval progressively. Comparison between optimized and nonoptimized patients was performed. Efficacy, safety, and cost-effectiveness in optimized and nonoptimized groups. To determine efficacy, intraocular inflammation (anterior chamber cells, vitritis, and retinal vasculitis), macular thickness, visual acuity, and the sparing effect of glucocorticoids were assessed. No demographic or ocular differences were found at the time of ADA onset between the optimized and the nonoptimized groups. Most ocular outcomes were similar after a mean ± standard deviation follow-up of 34.7±13.3 and 26±21.3 months in the optimized and nonoptimized groups, respectively. However, relevant adverse effects were only seen in the nonoptimized group (lymphoma, pneumonia, severe local reaction at the injection site, and bacteremia by Escherichia coli, 1 each). Moreover, the mean ADA treatment costs were lower in the optimized group than in the nonoptimized group (6101.25 euros/patient/year vs. 12 339.48; P ADA optimization in BD uveitis refractory to conventional therapy is effective, safe, and cost-effective