Citations

Objectives/Goals: Digital recruitment can improve participant engagement in medical research, but its potential to introduce demographic and socioeconomic biases is unclear. This study investigates pathways participants took during a digital recruitment workflow in neurology, examining potential associations with socioeconomic and demographic factors. Methods/Study Population: As part of an ongoing study aiming to remotely capture speech from patients with neurologic disease, most participants seen in neurology on our campus are invited to complete a self-administered speech examination. We exported participant data from Epic (semi-automated identification and invitation), Qualtrics (eligibility screening), the participant tracking database (consent), and the recording platform (completion) for March to July 2024. Data visualization was performed using a Sankey diagram. Socioeconomic status was assessed using the housing-based socioeconomic status (HOUSES) index and area deprivation index (ADI) national rank. Kruskal–Wallis and Wilcoxon rank-sum tests were used to compare the median age, socioeconomic indices, and time taken to reach different steps of the study. Results/Anticipated Results: Of the 5846 invited participants, 57% were from urban areas, 23% from rural areas, and 20% from urban clusters. Most did not read/respond (2739) or declined (1749) the initial invitation via Epic. Of the 1358 interested participants, 415 completed the study. Participants from urban areas completed enrollment steps faster than those from rural areas and urban clusters, though the variance was large (42.6 ± 41.4 days vs. 50.6 ± 42.2 days and 50 ± 43.9 days, respectively; p = 0.030). Female participants took longer to complete enrollment than males (48.7 ± 44 days vs. 40.5 ± 38.8 days; p = 0.026). Participants who successfully finished the study had significantly lower ADI national ranks compared to other common pathways (40.6 ± 19; p = 0.0021). No associations were found with the HOUSES indices. Discussion/Significance of Impact: Our findings support differences in participant engagement, with urban participants and males more likely to complete enrollment steps. Those who finished the study were less disadvantaged suggesting potential bias in digital recruitment. These findings can inform strategies to improve digital recruitment in neurology research.

BACKGROUND Malignant peripheral nerve sheath tumors (MPNSTs) are rare and highly malignant tumors of neural crest origin. No matter their anatomical location, they are difficult to treat and carry a poor prognosis. OBSERVATIONS This report highlights the complexities of the diagnosis and management of a patient with MPNST of the cauda equina. The tumor retained the expression of H3K27me3, which is expected in spinal MPNSTs but uncommon in most sporadic and neurofibromatosis type 1–driven MPNSTs. LESSONS The described diagnostic nuance should be taken into consideration in patients with suspected MPNST of the cauda equina, as these tumors require swift neurosurgical intervention in order to maintain neurological function. Additional treatment modalities include neoadjuvant and adjuvant chemotherapy and radiotherapy. Although improvements in local control and progression-free survival have been reported, the role of radiation therapy and chemotherapy has been underinvestigated due to the rarity of MPNSTs presenting in this region. https://thejns.org/doi/10.3171/CASE24723

BACKGROUND Peripheral nerve injuries in the lower extremities impose significant functional and quality-of-life challenges. Loss of plantar flexion is a major deficit. Novel nerve transfers are being introduced to restore function. A novel nerve transfer—partial superficial peroneal to a gastrocnemius branch of the tibial nerve—aimed at restoring plantar flexion is presented in a patient with an incomplete proximal thigh-level sciatic nerve injury. OBSERVATIONS The case of a 27-year-old policeman with a right sciatic nerve injury from a gunshot wound sustained 11 months earlier, characterized by intact dorsiflexion and eversion but with complete loss of plantar flexion and inversion, is presented. The patient underwent a nerve transfer from the superficial peroneal nerve to the lateral gastrocnemius branch of the tibial nerve at 10 months postinjury. At the 2-year follow-up, the patient achieved M4 strength in plantar flexion while maintaining M5 strength in ankle eversion, dorsiflexion, and toe extension, with ongoing signs of reinnervation to the lateral gastrocnemius on electromyography. LESSONS Partial transfer of the superficial peroneal nerve to the lateral gastrocnemius branch of the tibial nerve offers a promising solution for restoring plantar flexion in partial sciatic nerve injuries affecting the tibial division. Tailored distal nerve transfers can enhance recovery, underscoring the importance of surgical innovation in treating complex peripheral nerve injuries. https://thejns.org/doi/10.3171/CASE24888

ACE2 protein binds heme, which we reasoned would promote heme entry into the kidney and, accordingly, heme protein-mediated acute kidney injury. Our findings support this hypothesis. This study is the first to demonstrate the biological relevance of ACE2-heme binding, uncover a new pathway of heme-dependent kidney injury, and identify myoglobin and heme as novel determinants of ACE2 expression. Our study explains why plasma levels of myoglobin and heme predict poor outcomes in patients with COVID-19.

ABSTRACTBackgroundDrug‐induced hypersensitivity syndrome (DiHS), or drug reaction with eosinophilia and systemic symptoms (DRESS), is a delayed and severe immune response to certain medications. We investigated vancomycin‐induced DiHS/DRESS, notable for frequent and severe organ involvement, to describe its specific histopathology and the correlations between histopathologic and clinical findings.MethodsA retrospective review was conducted to identify patients between 2006 and 2022 who received vancomycin, had archived skin biopsy specimens, and were scored as having probable or definite DiHS/DRESS. Clinical features were retrospectively collected, and biopsy specimens were reviewed by a board‐certified dermatopathologist. A subset of histopathologic and clinical features was analyzed for statistical correlation.ResultsTwenty‐three patients met the inclusion criteria. Most biopsy specimens (87%) showed an eczematous reaction pattern; 17 (74%) showed a secondary reaction pattern. Spongiosis (87%) and neutrophilic infiltration (91%) were common epidermal characteristics. The dermal inflammatory infiltrate was frequently superficial (87%) and consistently included plasma cells (96%). Eosinophils were present in the dermis in 70% of cases. Parakeratosis negatively correlated with liver involvement and positively correlated with desquamative rash. Epidermal lymphocytes were negatively correlated with the RegiSCAR score.ConclusionsVancomycin‐associated DiHS/DRESS histopathology was characterized by a frequent eczematous reaction pattern, multiple coexisting reaction patterns, and epidermal neutrophilic infiltration.

ABSTRACT Aims Muscle morphology provides important information in differentiating disease aetiology, but its measurement remains challenging because of the lack of an efficient and objective method. This study aimed to quantitatively refine the morphological features of muscle fibres in neuromuscular diseases using machine learning. Methods In this retrospective study, we analysed muscle biopsy specimens on haematoxylin and eosin‐staining. Machine learning–based software was developed to segment muscle fibre contours and perform automated muscle morphometry and subsequent graph theory–based spatial analysis of atrophied fibre grouping. A decision tree–based framework, LightGBM, was trained to predict underlying aetiologies based on morphometric and spatial variables. Results The study included 100 muscle samples, including 20 normal muscles, 49 myopathies and 19 neuropathies. The fine‐tuned segmentation model, YOLOv8, achieved a mask average precision of 0.819. The muscle morphometry revealed the significance of fibre circularity. The mean circularity was higher in the myopathy group, and the SD of circularity was elevated in the neuropathy group. Although most cases were consistent with textbook findings, atypical presentations, such as dermatomyositis with angular atrophy and amyotrophic lateral sclerosis with round atrophy, were objectively documented. Spatial analysis quantified grouped atrophy, showing the potential to feature specific atrophy patterns. The LightGBM model successfully predicted the final clinical diagnosis of the myopathies and neuropathies with an accuracy of 0.852, which exceeded that of 0.808 by human annotation. Conclusion Automated muscle morphometry and spatial analysis provide quantification of muscle morphology and patterns of atrophy, which will facilitate objective and efficient investigation of neuromuscular diseases.

The National Cancer Database (NCDB) is a large data set of cancer patients treated in the United States. In recent decades, many papers have utilized this database to study disparities in cancer care and outcomes. In this review, we present the strengths and limitations of using the NCDB to study cancer disparities, which should be taken into account by researchers who use the NCDB in this setting.

AbstractRegistered nurses increasingly work in remote care and digital interaction roles, offering flexibility and expansion of their scope of practice. These roles may expose nurses to digital compassion fatigue, a phenomenon proposed to be characterized by the negative psychological and emotional impact of caring for patients remotely through the use of technology.The first objective of this work is to propose the phenomenon of “digital compassion fatigue” as a potentially further evolved and differentiated form of “compassion fatigue.” The second objective is to produce a comparative analysis of attributes, antecedents, and consequences through literature reviews.An evolutionary concept analysis approach was selected as a guide for exploring, discussing, and defining the new concept of digital compassion fatigue. Concept analysis was selected given the need for a framework that accounts for the dynamic nature of technology and practice. The process of conducting a concept analysis includes consideration of diverse and multidisciplinary perspectives. As a result, those in caring, educational, and/or support service roles (e.g., social work, counseling, and teaching) for which distance suffering and technostress could feasibly be present were also included in the literature searches and reviews. Health care-specific studies often included nurses in the sample but may not have differentiated their specific insights or data points in the results.The concept analysis explored the attributes, antecedents, and consequences of digital compassion fatigue, differentiating it from its evolutionary parent, compassion fatigue. Key antecedents included technostress, distant suffering, and the unique challenges of delivering care remotely. A major confounding variable was the COVID-19 pandemic, which may have heightened or introduced new technology-related stressors or highlighted the existence of digital compassion fatigue.Further defining and understanding digital compassion fatigue is crucial for developing effective strategies to support nurses who may experience it or who are at risk.