Neurosurgical Outcomes Among Non-English Speakers: A Systematic Review and a Framework for Future Research

非英语国家的神经外科结果: 系统综述和未来研究框架

In 2019, 22% of adults in the United States reported speaking a language other than English at home, representing 52% growth since 2000. This diversity in languages - and resulting possible communication barriers - represents a potential challenge to effective care. In this manuscript, we summarize clinical outcomes and healthcare utilization patterns of adult and pediatric neurosurgical patients who are non-English primary language speakers (NEPLS). There is a paucity of literature reporting outcomes among NEPLS. It is critical to examine NEPLS patients' outcomes and experiences, as language barriers are potentially modifiable demographic factors. We present a framework that demonstrates opportunities for further research to improve quality of care.

2019，22% % 的美国成年人报告说在家说英语以外的语言，这是自2000年以来的52% 增长。这种语言的多样性-以及由此产生的可能的沟通障碍-代表了有效护理的潜在挑战。在本手稿中，我们总结了非英语主要语言使用者 (nepl) 的成人和儿科神经外科患者的临床结果和医疗保健利用模式。在NEPLS中，缺乏文献报告结果。检查nepl患者的结果和经验至关重要，因为语言障碍是潜在的可改变的人口因素。我们提出了一个框架，展示了进一步研究以提高护理质量的机会。

REF: Ruiz Colón GD, Barros Guinle MI, Wu A, Grant GA, Prolo LM. Neurosurgical Outcomes Among Non-English Speakers: A Systematic Review and a Framework for Future Research. World Neurosurg. Published online February 20, 2024. doi:10.1016/j.wneu.2024.02.068 PMID: 38387790

Utilizing the International Normalized Ratio-Platelet Index for Predicting Hospital Outcomes After Spontaneous Supratentorial Intracerebral Hemorrhage

利用国际标准化比率-血小板指数预测自发性幕上脑出血后的医院结局

Spontaneous intracerebral hemorrhage (ICH) poses a public health issue due to its elevated mortality rates. The International Normalized Ratio-platelet index (INR-Plt index) has recently been recognized as a predictive factor for liver disease progression. The potential of applying the INR-Plt index in forecasting ICH prognosis presents an intriguing subject. This study endeavors to examine the correlation between the INR-Plt index and hospital outcomes in patients with spontaneous supratentorial ICH. The INR-Plt index is a predictor of hospital mortality in patients with spontaneous supratentorial ICH. A higher INR-Plt index value is associated with an increased risk of mortality, underlining the potential usefulness of this composite index in guiding clinical decision-making and enabling risk stratification.

自发性脑内出血 (ICH) 由于其死亡率升高而成为公共卫生问题。国际标准化比率-血小板指数 (inr-plt指数) 最近被认为是肝脏疾病进展的预测因素。应用inr-plt指数预测ICH预后的潜力是一个有趣的主题。本研究旨在探讨自发性幕上ICH患者的inr-plt指数与医院结局之间的相关性。Inr-plt指数是自发性幕上ICH患者住院死亡率的预测指标。较高的inr-plt指数值与死亡风险增加相关，强调了该综合指数在指导临床决策和实现风险分层方面的潜在有用性。

REF: Ting CW, Lee TH, Huang YH. Utilizing the International Normalized Ratio-Platelet Index for Predicting Hospital Outcomes After Spontaneous Supratentorial Intracerebral Hemorrhage. World Neurosurg. Published online February 19, 2024. doi:10.1016/j.wneu.2024.02.073 PMID: 38382762

Comparison of the Effects of Blood Pressure Parameters on Rebleeding and Outcomes in Unsecured Aneurysmal Subarachnoid Hemorrhage

血压参数对未固定动脉瘤性蛛网膜下腔出血再出血和预后影响的比较

Elevated systolic blood pressure (SBP) has been linked to preprocedural rebleeding risk and poor outcome in patients with aneurysmal subarachnoid hemorrhage (aSAH). This study seeks to compare the effects of SBP and mean arterial pressure (MAP) on rebleeding and functional outcomes in aSAH patients. MAP may appear to be slightly better correlated with rebleeding and poor outcomes in unsecured aSAH compared to SBP. Larger prospective studies are needed to identify and mitigate risk factors for rebleeding and poor outcome in aSAH patients.

收缩压升高 (SBP) 与动脉瘤性蛛网膜下腔出血 (aSAH) 患者术前再出血风险和不良预后有关。本研究旨在比较SBP和平均动脉压 (MAP) 对aSAH患者再出血和功能结局的影响。与SBP相比，MAP似乎与无担保aSAH的再出血和不良预后的相关性稍好。需要更大规模的前瞻性研究来识别和减轻aSAH患者再出血和不良预后的危险因素。

REF: Haripottawekul A, Persad-Paisley EM, Paracha S, et al. Comparison of the Effects of Blood Pressure Parameters on Rebleeding and Outcomes in Unsecured Aneurysmal Subarachnoid Hemorrhage. World Neurosurg. Published online February 19, 2024. doi:10.1016/j.wneu.2024.02.078 PMID: 38382760

Sudden Hearing Loss as an Initial Symptom of Vestibular Schwannoma

突发性听力损失是前庭神经鞘瘤的初始症状

This study aims to determine the prevalence of vestibular schwannoma (VS) among patients presenting with sudden hearing loss (SHL) and to characterize the clinical features of individuals diagnosed with both VS and SHL. VS is a rare etiology of SHL, accounting for slightly over 2% of cases. Its symptomatology, severity, and audiometric patterns do not significantly differ from SHL caused by other factors. Tumor size does not correlate with hearing characteristics. Treatment modalities resemble those for other SHL cases, and hearing improvement does not obviate the necessity for follow-up magnetic resonance imaging (MRI) scans.

这项研究旨在确定患有突发性听力损失 (SHL) 的患者中前庭神经鞘瘤 (VS) 的患病率，并表征被诊断为VS和SHL的个体的临床特征。VS是SHL的罕见病因，占病例的2% % 以上。其症状，严重程度和听力模式与其他因素引起的SHL没有显着差异。肿瘤大小与听力特征无关。治疗方式类似于其他SHL病例，听力改善并不能消除后续磁共振成像 (MRI) 扫描的必要性。

REF: Rodriguez-Martín M, González-Aguado R, Salvatierra-Vicario B, Dierssen-Sotos T, Morales-Angulo C. Sudden Hearing Loss as an Initial Symptom of Vestibular Schwannoma. World Neurosurg. Published online February 19, 2024. doi:10.1016/j.wneu.2024.02.072 PMID: 38382763

European Medical Students' Views on Neurosurgery, with Emphasis on South-East Europe (Albania, Greece, Serbia, and Turkey)

欧洲医学生对神经外科的看法，重点是东南欧 (阿尔巴尼亚，希腊，塞尔维亚和土耳其)

Neurosurgery, an intricate and dynamic surgical specialty, faces challenges in attracting medical graduates. Despite its potential appeal, a decreasing trend in medical students opting for surgical specialties, including neurosurgery, is noted. This study aims to assess European medical students' perceptions of neurosurgery, focusing on South-East Europe, and address concerns about the declining interest in this field. The findings underscore the need for targeted interventions to address concerns influencing medical students' decisions regarding neurosurgery. Improving neurosurgical education, dispelling misconceptions, and creating a supportive work environment are crucial steps to attract and retain diverse talented individuals in neurosurgery. These efforts will be vital in narrowing the gap between the demand for neurosurgeons and the number of medical graduates entering the field, ensuring a sustainable future for this essential surgical specialty.

神经外科是一个复杂而充满活力的外科专业，在吸引医学毕业生方面面临挑战。尽管具有潜在的吸引力，但注意到选择包括神经外科在内的外科专业的医学生的趋势有所下降。这项研究旨在评估欧洲医学生对东南欧神经外科的看法，并解决对该领域兴趣下降的担忧。研究结果强调了有针对性的干预措施的必要性，以解决影响医学生对神经外科决策的担忧。改善神经外科教育，消除误解，创造一个支持性的工作环境是吸引和留住神经外科人才的关键步骤。这些努力对于缩小神经外科医生的需求与进入该领域的医学毕业生数量之间的差距至关重要，确保这一基本外科专业的可持续未来。

REF: Esen Aydin A, Gazioglu N, Tasiou A, et al. European Medical Students' Views on Neurosurgery, with Emphasis on South-East Europe (Albania, Greece, Serbia, and Turkey). World Neurosurg. Published online February 19, 2024. doi:10.1016/j.wneu.2024.02.065 PMID: 38382757

Prognostic Nutritional Index and the Risk of Postoperative Complications After Spine Surgery: A Meta-Analysis

脊柱手术后预后营养指数与术后并发症风险的Meta分析

A low prognostic nutritional index (PNI) may reflect malnutrition, which has been associated with poor prognosis in patients with various clinical conditions. The aim of the systematic review and meta-analysis was to investigate the association between preoperative PNI and risk of postoperative complications in adult patients after spine surgery. A preoperative low prognostic nutritional index (PNI) may be a risk factor of increased incidence of overall postoperative complications, postoperative delirium, and surgical site infection in adult patients after spine surgeries.

低预后营养指数 (PNI) 可能反映营养不良，这与各种临床状况患者的不良预后有关。系统回顾和荟萃分析的目的是调查术前PNI与成人脊柱手术后并发症风险之间的关系。术前低预后营养指数 (PNI) 可能是成年患者脊柱手术后总体术后并发症，术后谵妄和手术部位感染发生率增加的危险因素。

REF: Guo H, Yang L, Liu J, Yu X, Chen L, Huang Y. Prognostic Nutritional Index and the Risk of Postoperative Complications After Spine Surgery: A Meta-Analysis. World Neurosurg. Published online February 19, 2024. doi:10.1016/j.wneu.2024.02.077 PMID: 38382761

Does Body Mass Index Influence Intraoperative Costs and Operative Times for Anterior Cervical Discectomy and Fusion? A Time-Driven Activity-Based Costing Analysis

体重指数是否会影响颈椎前路椎间盘切除术和融合术的术中费用和手术时间？基于时间驱动的作业成本分析

Spine surgeons are often unaware of drivers of cost variation for anterior cervical discectomy and fusion (ACDF). We used time-driven activity-based costing to assess the relationship between body mass index (BMI), total cost, and operating room (OR) times for ACDFs. Time-driven activity-based costing is a feasible and scalable methodology for understanding the true intraoperative costs of ACDF. Although higher BMI was not associated with increased total cost, it was associated with increased preparatory time in the OR.

脊柱外科医生通常不知道颈椎前路椎间盘切除术和融合术 (ACDF) 的成本变化的驱动因素。我们使用时间驱动的基于活动的成本来评估ACDFs的体重指数 (BMI)，总成本和手术室 (OR) 时间之间的关系。时间驱动的基于活动的成本计算是一种可行且可扩展的方法，可用于了解ACDF的真实术中成本。尽管较高的BMI与总费用增加无关，但与OR的准备时间增加有关。

REF: Tecce E, Sarikonda A, Leibold A, et al. Does Body Mass Index Influence Intraoperative Costs and Operative Times for Anterior Cervical Discectomy and Fusion? A Time-Driven Activity-Based Costing Analysis. World Neurosurg. Published online February 19, 2024. doi:10.1016/j.wneu.2024.02.074 PMID: 38382758

Factors Affecting Outcomes of Poor-Grade Subarachnoid Hemorrhage

影响高分级蛛网膜下腔出血预后的因素

Poor-grade subarachnoid hemorrhage (SAH) accounts for 20% of all SAH and is associated with poor outcomes. The first step in improving outcomes is to analyze the factors that contribute to poor outcomes. Nonelderly patients who are not in grade V and Fisher group 4 should undergo aneurysm treatment as soon as possible because they are more likely to have a good outcome, whereas elderly patients in grade V and Fisher group 4 are unlikely to benefit from aneurysm treatment at present. The development of a treatment for early brain injury may be important to improve the outcomes of patients with poor-grade SAH.

分级不良的蛛网膜下腔出血 (SAH) 占所有SAH的20%，并与不良预后相关。改善结果的第一步是分析导致不良结果的因素。非V级和Fisher 4组的非老年患者应尽快接受动脉瘤治疗，因为他们更有可能获得良好的结果，而V级和Fisher 4组的老年患者目前不太可能从动脉瘤治疗中受益。开发早期脑损伤的治疗方法对于改善不良SAH患者的预后可能很重要。

REF: Sasaki T, Naraoka M, Shimamura N, et al. Factors Affecting Outcomes of Poor-Grade Subarachnoid Hemorrhage. World Neurosurg. Published online February 19, 2024. doi:10.1016/j.wneu.2024.02.064 PMID: 38382759

Single Surgeon Comparison of Midline Versus Overlapping Locoregional Flap Closure Following Spinal Instrumentation

脊柱器械后中线与重叠局部皮瓣闭合的单个外科医生比较

Two techniques for paraspinous muscle flap closure of spine surgeries have been described: one with tension-free mobilization of the muscle flaps approximated at the midline and one with perforators more aggressively dissected to allow for overlapping of the flaps. We seek to compare the surgical outcomes in patients who underwent either type of complex spinal closure as no investigation has yet evaluated a superior technique. The present study demonstrates that both the overlapping and midline approximation of muscle flaps are equally safe and effective strategies for locoregional closure of spinal wounds.

已经描述了两种用于脊柱手术的脊柱旁肌瓣闭合的技术: 一种是在中线接近的肌瓣无张力动员，另一种是更积极地解剖穿支以允许皮瓣重叠。我们试图比较接受任何一种复杂脊柱闭合术的患者的手术结果，因为尚无研究评估一种更好的技术。本研究表明，肌瓣的重叠和中线逼近对于局部区域闭合脊柱伤口同样是安全有效的策略。

REF: Francalancia S, Spake CSL, Soliman L, et al. Single Surgeon Comparison of Midline Versus Overlapping Locoregional Flap Closure Following Spinal Instrumentation. World Neurosurg. Published online February 17, 2024. doi:10.1016/j.wneu.2024.02.070 PMID: 38373687