Background: Over 1.3 million people in North America participate in tackle football annually. Football players experience a disproportionately higher risk for repetitive non-concussive impacts (NCIs) compared to other high-contact sports athletes. Quantifying how this exposure influences a player’s cognitive function is imperative. While NCIs share the same mechanism as concussions, they do not elicit immediate symptoms. Methods: This study tracked impact exposure in 13 male Queen’s Varsity Football players using six-axis mouthguard accelerometers throughout the season. Electroencephalography (EEG) recordings were conducted at two time points (pre-season and post-season) to measure event-related potentials (ERPs), evaluating auditory sensation, basic attention, and cognitive processing. Results: Analysis of pre- and post-season EEGs revealed group differences in N100 and N400 wave amplitudes but found no correlation between impact exposure metrics (including varying magnitudes, frequencies, and linear and angular accelerations) and deficits in attention or cognitive processing. Conclusions: These findings suggest that a single season of football-related NCIs may not be sufficient to produce detectable changes in cognitive function as measured through ERPs, despite the variation in impact exposure. Further longitudinal studies spanning multiple seasons and additional neurophysiological measures may be necessary to fully understand the cumulative effects of NCIs on cognitive function in football players.

Background: Molecular characterization of spatially heterogeneous tumors, such as primary brain tumors, requires precise, contamination-free tissue collection. This study develops a novel biopsy instrument enabling efficient, spatially registered tissue collection across tumors and surgical cavities, advancing personalized tumor characterization and treatment. Methods: Iterative modeling and 3D printing were used to develop prototypes, which underwent proof-of-concept and phantom testing. Final device evaluation compared the novel capsule biopsy tool to Yasargil tumor grasping forceps, with six neurosurgeons and six students conducting tests on porcine brain. Additionally, intraoperative samples were collected, with spatial coordinates recorded on preoperative scans. Results: The design features a capsule that attaches to the end of a Frazier suction. When suction is applied, an internal piston secures the sample, which can later be released before or after tissue fixation. The capsule method reduced variability in sample weight and collection time compared to Yasargil forceps, maintaining tissue integrity without contamination or instrument failure. Notably, students demonstrated proficiency comparable to experienced surgeons, highlighting the tool’s ease of use. Conclusions: This low-cost, optically tracked biopsy tool provides an efficient, reliable method for spatially precise tissue collection, meeting the demands of precision medicine and translational research.

Reparations for African Americans reflect both material concerns aimed at eliminating the Black–White racial wealth gap and symbolic political aspirations, including the end of structural racism. But do material or symbolic considerations drive policy evaluations across racial and partisan divides? What knowledge and experiences undergird processes through which individuals weigh the symbolic importance of a policy against its actual benefits? Leveraging a set of forty-one in-depth interviews with Black and White residents of Evanston, Illinois—the first municipality in the United States to approve a publicly-funded reparations-related ordinance—we highlight a mechanism through which individuals develop their opinions about reparations: political socialization. Black interviewees linked their understanding of reparations to robust financial compensation while White Democrats viewed their support for Evanston’s policy as symbolic of their longstanding, affective commitments to racial equality. Drawing from these observations, we present a framework highlighting policy attributes that frame how different constituencies respond to reparations-related policies. We test this framework using a conjoint experiment about reparations policies fielded in the 2022 Cooperative Election Study. We find Americans—especially White Republicans—possess less familiarity about reparations and remain strongly opposed to these policies, regardless of the form they take. While White Democrats are more familiar with reparations and more supportive of policies mirroring Evanston’s, Black Americans—those who are most familiar with reparations—support direct cash payments regardless of their political identification.

Background: This study evaluates the utility of CT angiography (CTA) and the Expanded Denver Criteria (EDC) in detecting blunt cerebrovascular injuries (BCVI) in blunt cervical trauma, assaults, and strangulation. Methods: A retrospective review of 748 patients undergoing CTA for blunt cervical trauma, assaults, and strangulation (2013–2023) was conducted. After exclusions, 344 CTA reports were analyzed. Inclusion criteria: patients ≥18 years with complete medical records who underwent CTA for trauma evaluation. Exclusions: penetrating injuries, preexisting cerebrovascular abnormalities, incomplete records, or CTA not performed. Results: BCVI was identified in 38/344 cases (11%), with 55% classified as Grade I (Biffl). Posterior circulation (71%) and internal carotid arteries (36.8%) were most affected. Eight BCVI cases (21%) did not meet EDC; MVCs accounted for seven. MVCs (68%) and falls (29%) were the leading causes, while no BCVIs were observed in assaults or strangulations. Conclusions: MVCs and high-impact falls pose the highest BCVI risk, warranting CTA beyond EDC indications. In contrast, CTA may be less necessary for assaults and strangulations. Further studies across trauma centers are needed to confirm these findings.

Background: Glioblastoma (GB) is the most malignant primary brain tumor. Isolated restricted diffusion (IRD) is restricted diffusion outside the confines of enhancing tumor with no corresponding enhancement on post contrast study. The aim of our study was to prospectively assess the incidence of IRD in GB patients, determine how often these foci proceed to contrast enhancement on follow up, and analyze the survival pattern. Methods: In a prospective pilot cohort study, consecutive adult patients with GB on initial MRI of brain, were included and screened for IRD. All images were independently analyzed by two experienced radiologists. The survival pattern of patients with IRD was assessed with Cox-regression and Kaplan-Meier curve analysis. Results: Of the 52 patients (median age- 63 years; male-63.5%), 21% (11 of 52) exhibited IRD. Inter-rater agreement on the diagnosis of IRD foci was fair (kappa=0.29). Seven (64%) showed enhancement in the IRD focus. The Kaplan Meier analysis revealed a significant decrease (p=0.035) in the survival was observed among patients with IRD focus. Conclusions: IRD focus was seen in 21% of patients with GB, with 64% of these demonstrating enhancement at the IRD focus on follow up imaging. A shorter survival was associated with IRD foci.

Impaired glycaemic control is a major risk factor for developing type 2 diabetes (T2D), a worldwide health epidemic intrinsically linked to diet and obesity. Whey proteins (WP) are increasingly popular supplements that are a rich source of branched-chain amino acids (BCAA), essential for muscle protein synthesis and metabolic regulation. In humans, fasting plasma concentrations of BCAA are maintained around 350 µM but become chronically elevated by 10–25% in persons with T2D. Little is known about whether BCAA from WP impacts circulating BCAA concentrations and contributes to this phenomenon. This narrative review used a systematic search approach with relevant keywords to identify evidence from randomised controlled trials in normoglycaemic humans and those with insulin resistance or T2D, on the effects of WP intake on plasma BCAA and glycaemic control. This review is, to the authors’ knowledge, the first to specifically examine the effects of WP intake on plasma BCAA concentrations in relation to glycaemic control. Whilst the majority of acute studies identified (n = 6) reported that WP consumption between 10 and 50 g significantly elevates postprandial BCAA and insulin responses (as evidenced by peak concentration and/or area under the curve), evidence from chronic studies (n = 3) report inconsistent findings on the impact of 9–51 g of WP/d on fasting BCAA and glycaemic control (for example, fasting glucose and insulin, insulin clearance). Findings from this literature review highlight the need for further studies that investigate the relationship between WP consumption with BCAA and glycaemic control, and to determine underlying mechanisms of action.

Background: Fluorescence-guided surgery (FGS) with 5-aminolevulinic acid (5-ALA) is a well-established tool for improving tumor visualization in glioma surgery. However, its applications in non-glioma pathologies remain underexplored and require further investigation. Methods: A retrospective review of patients who underwent FGS with 5-ALA between January 2022 and September 2024 was conducted to assess its utility in non-glioma tumors. Results: Among 232 FGS procedures, 13 (5.6%) involved non-glioma pathologies. We categorized our patients into three different levels: high, moderate, and no response based on intra-operative 5-ALA fluorescence visualization. Our patients showed a high 5-ALA fluorescence in 10 cases (77%), mainly in the following tumors: choroid plexus papilloma, atypical teratoid rhabdoid tumor, metastatic adenocarcinoma as well as atypical meningiomas. Moderate 5-ALA fluorescence was seen in 2 cases (15%). While no 5-ALA fluorescence was seen in one case of CNS lymphoma. 90% of procedures with high response had total resection. Conclusions: Fluorescence-guided surgery (FGS) using 5-ALA has demonstrated effectiveness in enhancing tumor visualization beyond gliomas. This retrospective review highlights the potential applications of 5-ALA in various non-glioma pathologies. These findings emphasize the need for further research to refine the use of 5-ALA FGS in diverse pathologies, optimize patient selection, and expand its utility in neurosurgical oncology.

Background: While developing a differentiation therapy for Sonic Hedgehog Medulloblastoma (MB), we discovered a potential paradoxical feedback cycle between Ezh2, a protein that temporarily keeps differentiation genes silenced via trimethylating H3K27, and Cyclin D1, a protein that regulates cell cycle entry. Methods: We quantified H3K27me3 in P7 purified cerebral GNPs using chromatin immunoprecipitation sequencing and correlated it with gene expression via RNA sequencing (RNAseq). To assess transcriptional effects of Ezh2 loss, we purified P7 GNPs from Math1-Cre, Ezh2-flox knockout mice. MB cells were cultured in suspension spheres and imaged using the ImageXpress Micro XLS system, with nuclei segmented based on DAPI staining. Results: Cyclin D1 ranked among the top 7.37% of expressed genes but was heavily marked by the repressive histone mark H3K27me3 (top 5.5%) in GNPs. Ezh2 overexpression increased G0-arrested MB cells 2.7-fold, while, in GNPs, RNAseq showed significant Cyclin D1 upregulation in Ezh2 knockout mice (Log2FC: 1.301). Cyclin D1 regulates the pRb/E2F1 complex, and we observe that Ezh2 expression depends on pRb/E2F1 complex abundance, forming a feedback loop. Notably, combining the Hedgehog inhibitor Vismodegib with an Ezh2 inhibitor rescued MB cells from Vismodegib-induced death. Conclusions: Our study introduces a model that promotes GNP differentiation, leading tumor cells to differentiate into neurons.

Background: Diffusion tensor imaging (DTI) tractography enables detailed visualization of white matter tracts (WMT) relevant to surgical planning. Head-to-head performance of clinically available DTI software has not been assessed. We retrospectively compared Synaptive’s Modus Plan™(vers. 2.0.1.1743) and Medtronic’s StealthViz™(vers. 1.4) software, focusing on workflow, usability, stability, and capacity to generate WMT reconstructions. Methods: Retrospective evaluation of patients (n=13) with intrinsic brain lesions (01/2021-12/2023) with MP and SV software. Corticospinal and optic radiation WMT reconstruction was attempted according to the manufacturers specifications and was rated as clinically useful or not, based on anatomic plausibility. Duration of each analysis step (image importing, post-processing, segmentation, fine-tuning and tract export) was recorded. Ease of use, degree of clinician input, program stability, and tract output type were also assessed. Results: 13 patients (31±;19 yrs; 6F) were included. Mean workflow duration was significantly longer for MP (22:51 min) versus SV (7:35 min) (p<0.0001). Successful WMT reconstruction occurred in 9/13 (69.2%) with MP, versus 5/13 (38.5%) for SV. MP was rated to have superior usability, stability and required less clinician input but technical parameters (e.g. FA) or export object type was inflexible. Conclusions: Synaptive’s MP permitted more robust WMT reconstruction with enhanced usability and stability but with significantly longer workflow.

Background: Surgical access to the clival region is challenging, but advanced endoscopic endonasal approaches (EEA) provide a minimally invasive corridor. This study aimed to review the clinical outcomes of patients who underwent EEA for skull base lesions involving the clivus and to analyze prognostic factors. Methods: A retrospective review was conducted of patients who underwent EEA for resection of clival lesions between October 2001 and October 2023. Data on demographics, approach type, reconstruction technique, tumor pathology and outcomes were collected. Results: Forty-six patients underwent transclival EEA. The majority had ASA scores II and III (71.7%), with clival chordomas being the most common pathology (37%). Cranial nerve impairment was present in 65% of patients, and 80% showed improvement post-surgery. The mean procedure duration was 308 minutes, with a mean blood loss of 424 mL. A lumbar drain was used in 10.9%, and 76.1% received a pedicled nasoseptal flap for reconstruction. Complete tumor resection was achieved in 74% of malignant cases. Postoperative CSF leaks occurred in 4.3%, and the mean length of stay was 12.2 days. Higher readmission rates were associated with ASA IV classification (p=0.006). Conclusions: EEA to the clival region is safe and effective, with low perioperative complications and high rates of postoperative improvement.

Background: We previously developed a DNA methylation-based risk predictor for meningioma, which has been used locally in a prospective fashion. As a follow-up, we validate this model using a large prospective cohort and introduce a streamlined next-generation model compatible with newer methylation arrays. Methods: The performance of our next-generation predictor was compared with our original model and standard-of-care 2021 WHO grade using time-dependent receiver operating characteristic curves. A nomogram was generated by incorporating our methylation predictor with WHO grade and extent of resection. Results: A total of 1347 meningioma cases were utilized in the study, including 469 prospective cases from 3 institutions and a retrospective cohort of 100 WHO grade 2 cases for model validation. Both the original and next-generation models significantly outperformed 2021 WHO grade in predicting postoperative recurrence. Dichotomizing into grade-specific risk subgroups was predictive of outcome within both WHO grades 1 and 2 tumours (log-rank p<0.05). Multivariable Cox regression demonstrated benefit of adjuvant radiotherapy in high-risk cases specifically, reinforcing its informative role in clinical decision making. Conclusions: This next-generation DNA methylation-based meningioma outcome predictor significantly outperforms 2021 WHO grading in predicting time to recurrence. This will help improve prognostication and inform patient selection for RT.

Background: Neurofibromatosis 1 (NF1) is a multisystem neurocutaneous disorder. Treatment involves multiple specialists. There are currently no multidisciplinary clinics for adults with NF1 in BC, which impacts communication between subspecialties. We sought perspectives of patients and providers to identify the impact of and solutions to gaps in care. Methods: Focus groups with patients (2 groups; 9 patients) and physicians (10) who see people with NF1 were conducted. Thematic content analysis was applied to the data to derive major themes. Concurrently, quarterly NF multidisciplinary rounds were initiated to enhance coordination of care. Results: Major themes emerged around the need for increased coordination and communication amongst providers. Specifically, physicians identified working in “siloed care structures”, and patients and providers identified lack of awareness of expertise and barriers to accessing care. Conclusions: Focus groups enable inclusion of patient and provider perspectives in developing solutions to gaps in care. The importance of supporting interdisciplinary communication in caring for NF1 patients was confirmed in focus groups. To date, we have held multidisciplinary NF rounds, with 12 cases discussed. Disciplines represented include neurology, pediatrics, radiology, neuro-ophthalmology, neuro-otology, pathology, orthopedic plastic and neurosurgery, medical and radiation oncology, and the hereditary cancer program. Telehealth format enables participation from distributed centres across BC.

Background: Generalized myasthenia gravis (gMG) is a rare, chronic, autoimmune disease characterized by muscle weakness and fatigue. This study aims to describe the natural history, disease burden and treatment patterns of gMG patients in Canada. Methods: Data was analyzed from the Adelphi MG II DSP™, a gMG patient-level cross-sectional database, collected through surveys between February-June 2024. Neurologists provided sociodemographic, symptomatology, and treatments data. Results: Fifteen neurologists provided data for 46 gMG patients. The cohort’s mean (SD) age was 58.1 (14.7) years, 52.2% male, 82.6% White/Caucasian and 89.1% were anti-AChR Ab positive. Mean time since diagnosis was 3.4 (3.1) years, 22% reported a change in employment status due to gMG. Most had public insurance (68.9%). Disease severity was mostly MGFA class II (78.2%) patients. Common symptoms included eyelid ptosis (76.1%), dysarthria (50.0%), and dyspnea (54.3%) – mean MG-ADL was 5.6 (5.1). During their disease course, 34.9% experienced ≥1 myasthenic crisis, while 25.6% reported symptom exacerbation. At time of survey, patients had used 1.8 (0.9) lines of maintenance treatment. Most prescribed treatments (alone or in combinations) were pyridostigmine (95.6%), corticosteroids (48.9%), non-steroidal immunosuppressants (42.2%), Immunoglobulins (31.1%), and biologics (22.2%). Conclusions: gMG patients continue to experience symptoms burden and crisis/exacerbations. These findings highlight an unmet need for new, safe and effective therapeutics that are publicly covered to manage gMG-related clinical manifestations.

Background: Presence of right-to-left shunt has been proposed as a mechanism of paradoxical embolism in patients with active cancer. Our study thus aims to investigate the role of shunting in stroke occurrence among cancer patients. Methods: This is a retrospective study with our population consisting of patients presenting to the Ottawa Hospital with ischemic stroke between January 01, 2020, and December 31, 2022. Presence of right-to-left shunting is identified in patients with and without cancer diagnosis within one year of ischemic stroke. The prevalence of shunt is assessed using 95% confidence intervals (CI). Results: Among654 patients, 495 (37% female, median age 53 years) were included in the study, in which 47 (9.5%) had active cancer, with 12 patients (25.5%, 95% CI 14 - 40) diagnosed with a shunt. In contrast, among 448 patients (90.5%) without active cancer, 133 patients (30%, 95% CI 25 - 34) were found to have a shunt. Conclusions: The prevalence of right-to-left shunting tends to be lower in patients with ischemic stroke and active cancer diagnosis. Our results are similar to a recent study indicating a higher rate of shunt among patients without cancer. Our finding does not support the hypothesis that cancer-associated stroke is related to right-to-left shunting.

Background: Absence epilepsy is a common epilepsy syndrome in children. This can have a negative impact on the cognitive abilities of preschool and school-age children. The objective was to study in the Guinean context, the epidemiological, clinical, electrophysiological, therapeutic and evolutionary aspects of this syndrome. Methods: The study included all children diagnosed with absence epilepsy based on evidence obtained from history, clinical, and electroencephalogram. Results: The cohort was made up of 41 girls and 28 boys with a sex ratio (F/M) equal to 1.46. The mean age was 8 ± 2 years with extremes of 2 and 14 years. The simple absences were observed in 42.02% of cases. The components : tonic was associated in 11.59%, clonic in 10.14%, atonic in 13.04%, automatisms in 15.94% and vegetative in 7.25%. EEG was typical in 75.36%. As monotherapy, sodium valproate was used in 92.75% and ethosuximide in 2.9%. The evolution was marked by a remission of seizures in 85.51%. During follow-up, the appearance of tonic-clonic convulsions was noted in 4.3%, myoclonus in 2.9%, a combination of myoclonus and tonic-clonic convulsions noted in 4.3%. Conclusions: Effective and efficient collaboration between stakeholders is essential for the best overall management of this syndrome with serious cognitive repercussions in children.

Background: Body image research in young people with physical disabilities like cerebral palsy (CP) has received very little attention. The goal of this pilot study is to ask youth with CP (of all levels of disability) directly about body image to learn their perspective. Methods: Our study includes quantitative data of quality-of-life measures, along with qualitative interview data summarized via thematic analysis. Our data is augmented with input from siblings (without CP) of our primary participants to represent a control group in the same family unit. Results: Twelve youths with CP (7 male, 5 female) participated in the study. Withe the higher score representing more positive the body image, scores averaged 17.93/25 (SD 4.73) for those with CP, 18.62/25 (SD 5.45) for those without CP. There were higher scores for males and those ≤13yo compared to 14-18yo. Interview thematic analysis uncovers themes of functional capability, the wish to reduce burden on family, pride in the CP identity, and mixed desirability of media representation. Conclusions: There is greater difference between age groups and genders than there is between those with CP and not. Interviews with participants revealed the important recurring theme of functional capacity connected to positive self-image, which may be considered justification for interventions.