bluuebunny/crossref_metadata_2025 huggingface dataset:
Lessons learned in the evolution of endoscopic skull base surgery
Authors: Schwartz Theodore H. , Morgenstern Peter F. , Anand Vijay K.
Published: February 2019

OBJECTIVE

Endoscopic skull base surgery (ESBS) is a relatively recent addition to the neurosurgical armamentarium. As with many new approaches, there has been significant controversy regarding its value compared with more traditional approaches to ventral skull base pathology. Although early enthusiasm for new approaches that appear less invasive is usually high, these new techniques require rigorous study to ensure that widespread implementation is in the best interest of patients.

METHODS

The authors compared surgical results for ESBS with transcranial surgery (TCS) for several different pathologies over two different time periods (prior to 2012 and 2012–2017) to see how results have evolved over time. Pathologies examined were craniopharyngioma, anterior skull base meningioma, esthesioneuroblastoma, chordoma, and chondrosarcoma.

RESULTS

ESBS offers clear advantages over TCS for most craniopharyngiomas and chordomas. For well-selected cases of planum sphenoidale and tuberculum sellae meningiomas, ESBS has similar rates of resection with higher rates of visual improvement, and more recent results with lower CSF leaks make the complication rates similar between the two approaches. TCS offers a higher rate of resection with fewer complications for olfactory groove meningiomas. ESBS is preferred for lower-grade esthesioneuroblastomas, but higher-grade tumors often still require a craniofacial approach. There are few data on chondrosarcomas, but early results show that ESBS appears to offer clear advantages for minimizing morbidity with similar rates of resection, as long as surgeons are familiar with more complex inferolateral approaches.

CONCLUSIONS

ESBS is maturing into a well-established approach that is clearly in the patients’ best interest when applied by experienced surgeons for appropriate pathology. Ongoing critical reevaluation of outcomes is essential for ensuring optimal results.
Hearing preservation after Gamma Knife radiosurgery for cerebellopontine angle meningiomas
Authors: El-Shehaby Amr M. N. , Reda Wael A. , Abdel Karim Khaled M. , Nabeel Ahmed M. , Emad Eldin Reem M. , Tawadros Sameh R.
Published: February 2019

OBJECTIVE

The objective of this study was to assess hearing function after Gamma Knife treatment of cerebellopontine angle (CPA) meningiomas and assess factors affecting hearing outcome. Additionally, the authors opted to compare these results with those after Gamma Knife treatment of vestibular schwannomas (VSs), because most of the information on hearing outcome after stereotactic radiosurgery (SRS) comes from reports on VS treatment. Hearing preservation, to the best of the authors’ knowledge, has never been separately addressed in studies involving Gamma Knife radiosurgery (GKRS) for CPA meningiomas.

METHODS

This study included all patients who underwent a single session of GKRS between 2002 and 2014. The patients were divided into two groups. Group A included 66 patients with CPA meningiomas with serviceable hearing and tumor extension into the region centered on the internal auditory meatus. Group B included 144 patients with VSs with serviceable hearing. All patients had serviceable hearing before treatment (Gardner-Robertson [GR] Grades I and II). The median prescription dose was 12 Gy (range 10–12 Gy) in both groups. The median follow-up of groups A and B was 42 months (range 6–149 months) and 49 months (range 6–149 months), respectively.

RESULTS

At the last follow-up, the tumor control rate was 97% and 94% in groups A and B, respectively. Hearing preservation was defined as maintained serviceable hearing according to GR hearing score. The hearing preservation rate was 98% and 66% and the 7-year actuarial serviceable hearing preservation rate was 75% and 56%, respectively, between both groups. In group A, the median maximum cochlear dose in the patients with stable and worsened hearing grade was 6.3 Gy and 5.5 Gy, respectively. In group B, factors affecting hearing preservation were cochlear dose ≤ 7 Gy, follow-up duration, and tumor control. The only determinant of hearing preservation between both groups was tumor type.

CONCLUSIONS

GKRS for CPA meningiomas provides excellent hearing preservation in addition to high tumor control rate. Hearing outcome is better with CPA meningiomas than with VSs. Further long-term prospective studies on determinants of hearing outcome after GKRS for CPA meningiomas should be conducted.
Prognostic grading system specifically for elderly patients with brain metastases after stereotactic radiosurgery: a 2-institution study
Authors: Yamamoto Masaaki , Serizawa Toru , Higuchi Yoshinori , Nagano Osamu , Aiyama Hitoshi , Koiso Takao , Watanabe Shinya , Kawabe Takuya , Sato Yasunori , Kasuya Hidetoshi
Published: February 2019

OBJECTIVE

With the aging of the population, increasing numbers of elderly patients with brain metastasis (BM) are undergoing stereotactic radiosurgery (SRS). Among recently reported prognostic grading indexes, only the basic score for brain metastases (BSBM) is applicable to patients 65 years or older. However, the major weakness of this system is that no BM-related factors are graded. This prompted the authors to develop a new grading system, the elderly-specific (ES)–BSBM.

METHODS

For this IRB-approved, retrospective cohort study, the authors used their prospectively accumulated database comprising 3267 consecutive patients undergoing Gamma Knife SRS for BMs during the 1998–2016 period at the Mito GammaHouse. Among these 3267 patients, 1789 patients ≥ 65 years of age were studied (Yamamoto series [Y-series]). Another series of 1785 patients ≥ 65 years of age in whom Serizawa and colleagues performed Gamma Knife SRS during the same period (Serizawa series [S-series]) was used for validity testing of the ES-BSBM.

RESULTS

Two factors were identified as strongly impacting longer survival after SRS by means of multivariable analysis using the Cox proportional hazard model with a stepwise selection procedure. These factors are the number of tumors (solitary vs multiple: HR 1.450, 95% CI 1.299–1.621; p < 0.0001) and cumulative tumor volume (≤ 15 cm3 vs > 15 cm3: HR 1.311, 95% CI 1.078–1.593; p = 0.0067). The new index is the addition of scores 0 and 1 for these 2 factors to the BSBM. The ES-BSBM system is based on categorization into 3 classes by adding these 2 scores to those of the original BSBM. Each ES-BSBM category has 2 possible scores. For the category ES-BSBM 4–5, the score is either 4 or 5; for ES-BSBM 2–3, the score is either 2 or 3; and for ES-BSBM 0–1, the score is either 0 or 1. In the Y-series, the median survival times (MSTs, months) after SRS were 17.5 (95% CI 15.4–19.3) in ES-BSBM 4–5, 6.9 (95% CI 6.4–7.4) in ES-BSBM 2–3, and 2.8 (95% CI 2.5–3.6) in ES-BSBM 0–1 (p < 0.0001). Also, in the S-series, MSTs were, respectively, 20.4 (95% CI 17.2–23.4), 7.9 (95% CI 7.4–8.5), and 3.2 (95% CI 2.8–3.6) (p < 0.0001). The ES-BSBM system was shown to be applicable to patients with all primary tumor types as well as to those 80 years or older.

CONCLUSIONS

The authors found that the addition of the number of tumors and cumulative tumor volume as scoring factors to the BSBM system significantly improved the prognostic value of this index. The present study is strengthened by testing the ES-BSBM in a different patient group.
Stereotactic radiosurgery for pituitary adenoma invading the cavernous sinus
Authors: Shin Masahiro , Kurita Hiroki , Sasaki Tomio , Tago Masao , Morita Akio , Ueki Keisuke , Kirino Takaaki
Published: February 2019

Object. The purpose of this study is to determine the efficacy of gamma knife radiosurgery (GKS) treatment of pituitary adenomas that have invaded the cavernous sinus.

Methods. Sixteen patients were treated with GKS: three with nonfunctional adenomas and 13 with hormone-secreting (seven growth hormone [GH] and six adrenocorticotropic hormone [ACTH]) adenomas. More than 16 Gy and 30 Gy were delivered to the tumor margin for nonfunctioning tumors and functioning tumors, respectively, keeping the dose to the optic pathways below 10 Gy. The median follow up was 3 years.

Tumor growth control was achieved in all cases. In GH-producing tumors, four of six cases evaluated were endocrinologically normalized (serum GH < 10 mIU/L, somatomedin C < 450 ng/ml), and the remaining two cases also showed a steady decrease in the GH and somatomedin level. In ACTH-producing tumors, three of six cases were endocrinologically normalized (24-hour urinary-free cortisol < 90 mg/day), two were unchanged, and one showed hormonal recurrence 3 years after radiosurgery. Notably, there were no cases of permanent hypopituitarism or visual symptoms caused by radiosurgery.

Conclusions. The authors data indicate that GKS can be a safe salvage therapy for invading pituitary adenomas, with effectiveness equivalent to conventional radiation therapy but with less risk of causing radiation-induced injury to the surrounding structures.
Gamma knife radiosurgery for pituitary adenomas
Authors: Izawa Masahiro , Hayashi Motohiro , Nakaya Kohtarou , Satoh Hiroyuki , Ochiai Taku , Hori Tomokatsu , Takakura Kintomo
Published: February 2019

Object. The purpose of this study was the analysis of a large series of patients treated with gamma knife radiosurgery for pituitary adenoma in a single institution.

Methods. One hundred eight patients with pituitary adenomas were treated over the last 7 years. Seventy-four patients have been followed for more than 6 months and form the basis of this report.

Conclusions. Twenty-three patients harbored nonfunctioning adenomas, and 56 harbored functioning adenomas. The mean margin dose was 22.5 Gy (nonfunctioning adenomas, 19.5 Gy; functioning adenomas, 23.8 Gy). Control of tumor growth was achieved in 91%. A significant decrease of excessive hormone production was seen in 80% of patients, and the endocrinological normalization rate was 30.3%. Postradiosurgical complications were seen in 2.5%.
Gamma knife radiosurgery for simultaneous multiple metastatic brain tumors
Authors: Suzuki Satoshi , Omagari Junichi , Nishio Shunji , Nishiye Eiichiro , Fukui Masashi
Published: February 2019

Object. The authors assessed the efficacy of gamma knife radiosurgery (GKS) in the treatment of patients with 10 or more simultaneous metastatic brain tumors.

Methods. Gamma knife radiosurgery was performed for the treatment of 10 or more simultaneous metastatic brain tumors in 24 patients. The performance status before and after GKS was expressed using the Karnofsky Performance Scale (KPS). The cumulative survival rate was analyzed using the Kaplan—Meier method. The level of satisfaction with the procedure was assessed by telephone interview.

No patient has died due to brain metastasis—related symptoms, and all patients and/or their families were satisfied with the GKS. In 12 patients who had brain metastasis—related symptoms, five improved, six were unchanged, and one deteriorated, as reflected by the KPS scores. The cumulative survival rate calculated by the Kaplan—Meier method was 70.4%, 49.3%, and 12.3% at 12 weeks, 24 weeks, and 36 weeks, respectively. The median survival time was 11 weeks.

Conclusions. Single-fraction GKS can achieve acceptable tumor control, low morbidity, and good quality of life in the treatment of multiple metastatic brain tumors even in cases with 10 or more simultaneous metastases.
Immediate neurological deterioration after gamma knife radiosurgery for acoustic neuroma
Authors: Tago Masao , Terahara Atsuro , Nakagawa Keiichi , Aoki Yukimasa , Ohtomo Kuni , Shin Masahiro , Kurita Hiroki
Published: February 2019

✓ The authors describe acute deterioration in facial and acoustic neuropathies following radiosurgery for acoustic neuromas.

In May 1995, a 26-year-old man, who had no evidence of neurofibromatosis Type 2, was treated with gamma knife radiosurgery (GKS; maximum dose 20 Gy and margin dose 14 Gy) for a right-sided intracanalicular acoustic tumor. Two days after the treatment, he developed headache, vomiting, right-sided facial weakness, tinnitus, and right hearing loss. There was a deterioration of facial nerve function and hearing function from pretreatment values. The facial function worsened from House—Brackmann Grade 1 to 3. Hearing deteriorated from Grade 1 to 5. Magnetic resonance (MR) images, obtained at the same time revealed an obvious decrease in contrast enhancement of the tumor without any change in tumor size or peritumoral edema. Facial nerve function improved gradually and increased to House—Brackmann Grade 2 by 8 months post-GKS. The tumor has been unchanged in size for 5 years, and facial nerve function has also been maintained at Grade 2 with unchanged deafness.

This is the first detailed report of immediate facial neuropathy after GKS for acoustic neuroma and MR imaging revealing early possibly toxic changes. Potential explanations for this phenomenon are presented.
Stereotactic radiosurgery versus stereotactic radiotherapy for patients with vestibular schwannoma: a Leksell Gamma Knife Society 2000 debate
Authors: Linskey Mark E.
Published: February 2019

✓ By definition, the term “radiosurgery” refers to the delivery of a therapeutic radiation dose in a single fraction, not simply the use of stereotaxy. Multiple-fraction delivery is better termed “stereotactic radiotherapy.” There are compelling radiobiological principles supporting the biological superiority of single-fraction radiation for achieving an optimal therapeutic response for the slowly proliferating, late-responding, tissue of a schwannoma. It is axiomatic that complication avoidance requires precise three-dimensional conformality between treatment and tumor volumes. This degree of conformality can only be achieved through complex multiisocenter planning. Alternative radiosurgery devices are generally limited to delivering one to four isocenters in a single treatment session. Although they can reproduce dose plans similar in conformality to early gamma knife dose plans by using a similar number of isocenters, they cannot reproduce the conformality of modern gamma knife plans based on magnetic resonance image—targeted localization and five to 30 isocenters.

A disturbing trend is developing in which institutions without nongamma knife radiosurgery (GKS) centers are championing and/or shifting to hypofractionated stereotactic radiotherapy for vestibular schwannomas. This trend appears to be driven by a desire to reduce complication rates to compete with modern GKS results by using complex multiisocenter planning. Aggressive advertising and marketing from some of these centers even paradoxically suggests biological superiority of hypofractionation approaches over single-dose radiosurgery for vestibular schwannomas. At the same time these centers continue to use the term radiosurgery to describe their hypofractionated radiotherapy approach in an apparent effort to benefit from a GKS “halo effect.” It must be reemphasized that as neurosurgeons our primary duty is to achieve permanent tumor control for our patients and not to eliminate complications at the expense of potential late recurrence. The answer to minimizing complications while maintaining maximum tumor control is improved conformality of radiosurgery dose planning and not resorting to homeopathic radiosurgery doses or hypofractionation radiotherapy schemes.
Gamma knife radiosurgery using 90 Gy for trigeminal neuralgia
Authors: Nicol Bradley , Regine William F. , Courtney Claire , Meigooni Ali , Sanders Michael , Young Byron
Published: February 2019

Object. The purpose of this paper was to assess the treatment of trigeminal neuralgia (TN) with the higher than normal dose of 90 Gy.

Methods. Forty-two patients with typical TN were treated over a 3-year period with gamma knife radiosurgery. Every patient received a maximum dose of 90 Gy in a single 4-mm isocenter targeted to the root entry zone of the trigeminal nerve. Thirty of 42 patients had undergone no prior treatments. The median follow-up period was 14 months (range 2–30 months).

Thirty-one patients (73.8%) achieved complete relief of pain. Nine patients (21.4%) obtained good pain control. Complications were limited to increased facial paresthesia in seven patients (16.7%) and dysgeusia in four patients (9.5%).

Conclusions. The authors conclude that the use of 90 Gy is a safe and effective dose for the treatment of TN.
Results of repeated gamma knife radiosurgery for medically unresponsive trigeminal neuralgia
Authors: Pollock Bruce E. , Foote Robert L. , Stafford Scott L. , Link Michael J. , Gorman Deborah A. , Schomberg Paula J.
Published: February 2019

Object. Gamma knife radiosurgery (GKS) is being increasing performed in the management of patients with medically unresponsive trigeminal neuralgia. The authors report the results of repeated GKS in patients with recurrent facial pain after their initial procedure.

Methods. Between April 1997 and December 1999, 100 patients with idiopathic trigeminal neuralgia underwent GKS at the authors' center. To date, 26 patients have required additional surgery because GKS provided no significant pain relief (15 patients) or because they had recurrent facial pain (11 patients). Ten of these patients underwent repeated GKS at a median of 13 months (range 4–27 months). All patients undergoing repeated GKS had a significant reduction in their facial pain after the first procedure (eight were pain free); no patient developed facial numbness or paresthesias. Initially, nine of 10 patients became pain free 1 to 4 weeks following repeated GKS. At a median follow up of 15 months (range 3–32 months), eight patients remained pain free and required no medication. All eight patients with persistent pain relief developed minor neurological dysfunction after repeated GKS (six patients had facial numbness and two had paresthesias).

Conclusions. Repeated GKS can be associated with a high rate of pain relief for patients with trigeminal neuralgia who experienced a significant reduction in their facial pain after the first operation. However, every patient with sustained pain relief after the second operation also developed some degree of trigeminal dysfunction. These findings of improved pain relief for patients who develop facial numbness after GKS for trigeminal neuralgia support the experimental data currently available.
Gamma knife radiosurgery for torsion spasm
Authors: Pan Li , Zhang Nan , Dai Jia Zhong , Wang En Min
Published: February 2019

✓ The authors report on two patients who underwent radiosurgery for torsion spasm and evaluate the efficiency of gamma knife radiosurgery (GKS) as an alternative treatment.

The first patient was a 33-year-old woman with severe right-sided lower-limb torsion dystonia. The second patient was a 20-year-old man with right-sided upper-limb torsion dystonia. The target was located at the anterior portion of the ventrolateral nucleus. The maximum doses were 150 Gy and 145 Gy, respectively. Double isocenters with a 4-mm collimator were used. Follow up lasted for 18 months and 8 months, respectively. Both patients had excellent clinical improvement 2 to 3 months after GKS, respectively.

The authors believe that GKS may be a safe and efficient treatment for torsion spasm.
A simple scoring ratio to index the conformity of radiosurgical treatment plans
Authors: Paddick Ian
Published: February 2019

✓ A conformity index is a measure of how well the volume of a radiosurgical dose distribution conforms to the size and shape of a target volume. Because the success of radiosurgery is related to the extremely conformal irradiation of the target, an accurate method for describing this parameter is important. Existing conformity ratios and indices used in radiosurgery are reviewed and criticized. It will be demonstrated that previously proposed measurements of conformity can, under certain conditions, give false perfect scores. A new conformity index is derived that gives an objective score of conformity for a treatment plan and gives no false scores.

An analysis of five different treatment plans is made using both the existing scoring methods and the new conformity index.
Comparison of geometric distortion in digital angiography with and without a correction program
Authors: Zheng Zhen , Shearer Douglas , Norén Georg , Chougule Prakash , Friehs Gerhard
Published: February 2019

✓ This study was conducted to evaluate the geometric distortion of angiographic images created from a commonly used digital x-ray imaging system and the performance of a commercially available distortion-correction computer program.

A 12 × 12 × 12—cm wood phantom was constructed. Lead shots, 2 mm in diameter, were attached to the surfaces of the phantom. The phantom was then placed inside the angiographic localizer. Cut films (frontal and lateral analog films) of the phantom were obtained. The films were analyzed using GammaPlan target series 4.12. The same procedure was repeated with a digital x-ray imaging system equipped with a computer program to correct the geometric distortion. The distortion of the two sets of digital images was evaluated using the coordinates of the lead shots from the cut films as references.

The coordinates of all lead shots obtained from digital images and corrected by the computer program coincided within 0.5 mm of those obtained from cut films. The average difference is 0.28 mm with a standard deviation of 0.01 mm. On the other hand, the coordinates obtained from digital images with and without correction can differ by as much as 3.4 mm. The average difference is 1.53 mm, with a standard deviation of 0.67 mm.

The investigated computer program can reduce the geometric distortion of digital images from a commonly used x-ray imaging system to less than 0.5 mm. Therefore, they are suitable for the localization of arteriovenous malformations and other vascular targets in gamma knife radiosurgery.
Integration of the metabolic data of positron emission tomography in the dosimetry planning of radiosurgery with the Leksell gamma knife: early experience with brain tumors
Authors: Levivier Marc , Wikier David , Goldman Serge , David Philippe , Metens Thierry , Massager Nicolas , Gerosa Massimo , Devriendt Daniel , Desmedt Françoise , Simon Stephane , Van Houtte Paul , Brotchi Jacques
Published: February 2019

✓ The purpose of this study was to assess the use of positron emission tomography (PET) as a stereotactic planning modality for gamma knife radiosurgery (GKS).

The authors developed and validated a technique for fiducial marker imaging, importation, and handling of PET data for integration into GammaPlan planning software. The clinical feasibility in applying this approach to a selected group of patients presenting with recurrent glial tumors or metastases was evaluated.

Positron emission tomography data can be integrated into GammaPlan, allowing a high spatial accuracy, as validated using a phantom. Positron emission tomography data were successfully combined with magnetic resonance (MR) images to define the target volume for the radiosurgical treatment of patients with recurrent glioma or metastasis. This approach may contribute to optimizing target selection for infiltrating or ill-defined brain lesions. Because PET is also useful for the pretreatment and follow-up evaluation, the use of stereotactic PET in these patients can enable an accurate comparison of PET-based metabolic data with MR-based anatomical data. This could give a better understanding of the metabolic changes following radiosurgery.

The ability to use PET data in GKS represents a crucial step toward further developments in radiosurgery, as this approach provides additional information that may open new perspectives for the optimization of the treatment of brain tumors.
New dosimetric approach for multidimensional dose evaluation in gamma knife radiosurgery
Authors: Foroni R. , Gambraini G. , Danesi U. , Mauri M. , Pompilio E. , Pirola L. , Nicolato A. , Ferraresi P. , Gerosa M.
Published: February 2019

✓ During the past two decades, the progress in computerized treatment planning systems has led to more accurate imaging and therapy by using the gamma knife, especially with the smallest collimators (4 mm). However, the ionization chambers that have been used to calibrate the gamma knife are not useful with the smallest collimators because the chambers are too big compared with the irradiated volume. Therefore, it is important to develop more suitable dosimeters. This study proposes a new dosimeter method.

The FriXyGel method proposed here is based on a phantom dosimeter, an acquisition chain, and dedicated software. This dosimeter uses an agarose gel into which a ferrous sulphate solution (Fricke solution) and a metal ion indicator (xylenol orange) are incorporated. The absorbed dose is detected through measurements of visible light transmission, imaged by means of a charge-coupled device camera provided with a suitable optical filter. Gel layers are imaged before and after irradiation, and the differences in light absorption are related to the absorbed dose. By choosing convenient thickness of gel layers and by building up a phantom with different gel slices, it is possible to obtain a three-dimensional (3D) representation of the absorbed dose.

The final 3D representation is reached after several mathematical processes have been applied to the images. The first step identifies and reduces all factors that could alter the original data, such as nonuniformity in illumination. Then, after calibration procedures, it is possible to obtain absorbed dose values and to discover their 3D representation. This goal has been reached by developing appropriate software that performs all the calculations necessary for spatial representation routines and prompt comparison with theoretical calculations.
First experience in using Novalis shaped beam radiosurgery in Korea
Authors: Whang Choong Jin , Yee Gi Taek , Choi Chan Young , Sohn Moon-Jun , Lee Dong Joon
Published: February 2019

Object. The role of radiosurgery has become increasingly important in the treatment of intracranial lesions. In this study the authors evaluated the efficacy of the Novalis shaped beam radiosurgery system (dedicated linear accelerator) for various brain and spinal lesions.

Methods. Between November 2000 and October 2003 the authors treated 356 cases of various intracranial and extracranial lesions with Novalis shaped beam radiosurgery. Of these 356 cases, 109 cases were followed for more than a 2-year period. Fifty patients underwent fractionated stereotactic radiosurgery. Twenty patients (40%) harbored benign tumors (two acoustic neuromas, seven meningiomas, five pituitary adenomas, four optic gliomas, and two craniopharyngiomas), 18 patients (36%) harbored malignant tumors (16 glioblastoma multiforme [GBM], and two metastases), and the others included five with brainstem gliomas, one chordoma, five gliomas, and one with an arteriovenous malformation (AVM). Eighteen of 20 patients with benign tumors had good tumor control. Of 59 patients treated with single-dose stereotactic radiosurgery, 24 had benign intracranial tumors (12 acoustic neuromas, 11 meningiomas, and one pituitary adenoma), 20 had malignant tumors (two GBMs and 18 metastases), and the others were eight AVMs, two glomus jugulare tumors, three lymphomas, one pineal tumor, and one spinal tumor.

Conclusions. Stereotactic radiosurgery and fractionated stereotactic radiosurgery using the Novalis shaped beam radiosurgery system are effective and safe noninvasive treatment modalities for various intracranial and extracranial lesions.
Safety and efficacy of stereotactic radiosurgery for tumors of the spine
Authors: Benzil Deborah L. , Saboori Mehran , Mogilner Alon Y. , Rocchio Ronald , Moorthy Chitti R.
Published: February 2019

Object. The extension of stereotactic radiosurgery treatment of tumors of the spine has the potential to benefit many patients. As in the early days of cranial stereotactic radiosurgery, however, dose-related efficacy and toxicity are not well understood. The authors report their initial experience with stereotactic radiosurgery of the spine with attention to dose, efficacy, and toxicity.

Methods. All patients who underwent stereotactic radiosurgery of the spine were treated using the Novalis unit at Westchester Medical Center between December 2001 and January 2004 are included in a database consisting of demographics on disease, dose, outcome, and complications. A total of 31 patients (12 men, 19 women; mean age 61 years, median age 63 years) received treatment for 35 tumors. Tumor types included 26 metastases (12 lung, nine breast, five other) and nine primary tumors (four intradural, five extradural). Thoracic tumors were most common (17 metastases and four primary) followed by lumbar tumors (four metastases and four primary). Lesions were treated to the 85 to 90% isodose line with spinal cord doses being less than 50%. The dose per fraction and total dose were selected on the basis of previous treatment (particularly radiation exposure), size of lesion, and proximity to critical structures.

Conclusions. Rapid and significant pain relief was achieved after stereotactic radiosurgery in 32 of 34 treated tumors. In patients treated for metastases, pain was relieved within 72 hours and remained reduced 3 months later. Pain relief was achieved with a single dose as low as 500 cGy. Spinal cord isodoses were less than 50% in all patients except those with intradural tumors (mean single dose to spinal cord 268 cGy and mean total dose to spinal cord 689 cGy). Two patients experienced transient radiculitis (both with a biological equivalent dose (BED) > 60 Gy). One patient who suffered multiple recurrences of a conus ependymoma had permanent neurological deterioration after initial improvement. Pathological evaluation of this lesion at surgery revealed radiation necrosis with some residual/recurrent tumor. No patient experienced other organ toxicity.

Stereotactic radiosurgery of the spine is safe at the doses used and provides effective pain relief. In this study, BEDs greater than 60 Gy were associated with an increased risk of radiculitis.
Image-guided procedures for intensity-modulated spinal radiosurgery
Authors: Yin Fang-Fang , Ryu Samuel , Ajlouni Munther , Yan Hui , Jin Jian-Yue , Lee Sung-Woo , Kim Jinkoo , Rock Jack , Rosenblum Mark , Kim Jae Ho
Published: February 2019

✓ Radiosurgery for brain tumors has been well established in the radiation oncology and neurosurgery fields. Radiosurgery of extracranial tumors such as those involving the spine is, however, still in the early stage because of difficulties in patient immobilization and organ motion. The authors describe an image-guided procedure for intensity-modulated spinal radiosurgery that was developed at Henry Ford Hospital.
KAJIAN PERSENTASE PENAMBAHAN GULA TERHADAP KOMPONEN MUTU SIRUP BUAH NAGA MERAH
Authors: Asmawati Asmawati , Sunardi Hamzan , Ihromi Syirril
Published: February 2019

Buah naga (Dragon Fruit) merupakan tanaman musiman yang biasanya dikonsumsi dalam bentuk segar. Buah naga termasuk dalam buah yang eksotik karena penampilannya yang menarik ,rasanya asam manis menyegarkan dan memiliki beragam manfaat untuk kesehatan. Manfaat buah naga antara lain adalah sebagai anti hiperkolesterolemik, anti radikal bebas karena mengandung betasianin.Untuk meningkatkan nilai tambah dari buah naga merah ,maka dapat diolah menjadi beberapa jenis olahan,diantaranya jus, selai, es goyang, jelly dan sirup. Penelitian ini bertujuan untuk mengetahu ipengaruh persentase penambahan gulaterhadap sifat kimia dan organoleptik sirup buah naga merah.Rancangan yang digunakan dalam penelitian ini adalah Rancangan Acak Lengkap (RAL) dengan perlakuan satu factor yaitu persentase penambahan gula dalam pembuatan sirup buah naga merah gula yang terdiri dari 5 perlakuan (P1: 45 %, P2 : 50 % P3 : 55 % P4 : 60 %, P5 : 65 %). Masing-masing perlakuan diulang sebanyak 3 (tiga) kali sehingga diperoleh 15 unit percobaan. Data hasil pengamatan dianalisis dengan analisis keragaman (Analisis of variance) pada taraf nyata 5 %.Bila terdapat pengaruh bedanyata dilanjutkan dengan uji Beda Nyata Jujur (BNJ) pada taraf nyata yang sama.Hasil penelitian menunjukkan bahwa Persentase penambahan gula berpengaruh secara nyata terhadap sifat kimia yaitu kadar gula reduksi, kadar air, dan sifat organoleptik rasa dan kekentalan,  tetap tidak berpengaruh secara nyata terhadap sifat kimia vitamin c dan sifat organoleptik warna,dan aroma sirup buah naga merah yang diamati. Semakin tinggi persentase penambahan gula dalam pembuatan sirup  buah naga merah maka kadar gula reduksi semakin tinggi sedangkan kadar air semakin menurun. Persentase penambahan gula sampai perlakuan P5 (penambahan gula 65 %) cenderung masih disukai panelis dari segi aroma, rasa dan kekentalan.
On Backlash: Emotion and the Politicisation of Security
Authors: Van Rythoven Eric
Published: February 2019

This article explores the role of emotion in the politicisation of security through the concept of backlash: the idea of visceral and reactionary episodes where security claims are adamantly rejected and the subject of ‘security’ becomes intensely controversial. Starting by examining the role of emotion in politicisation, I make the case for viewing emotions as playing a key role in the distribution of certainty in security discourse. Building on this epistemic view of emotion, I review how backlash is understood in other fields before tailoring a definition for security studies centered around four constitutive features: reaction, hostility, emotion, and contagion. The final section focuses on the politicising effects of backlash including the mobilisation of backlash movements, the intensification of controversy, and arena shifting. The discussion concludes by suggesting that the concept of backlash offers a promising research agenda for those inquiring into the politicisation of security.
An investigation on power loss of an out-to-in body wireless radio frequency link
Authors: Chen Xingguang , Chen Zhiying , Gao Yueming , Liu Wenzhu , Jiang Ruixin , Du Min , Jiang Haiyan
Published: February 2019

BACKGROUND: Implantable medical sensors for monitoring and transmitting physiological signals like blood glucose, blood oxygen, electrocardiogram, and endoscopic video present a new way for health care and disease prevention. Nevertheless, the signals transmitted by implantable sensors undergo significant attenuation as they propagate through various biological tissue layers. OBJECTIVE: This paper mainly aims to investigate the power loss of an out-to-in body wireless radio frequency link at 2.45 GHz. METHODS: Two simulation models including the single-layer human tissue model and three-layer human tissue model were established, applying the finite element method (FEM). Two experiments using physiological saline and excised porcine tissue were conducted to measure the power loss of a wireless radio frequency link at 2.45 GHz. Various communication distances and implantation depths were investigated in our study. RESULTS: The results from our measurements show that each 2 cm increase in implantation depth will result in an additional power loss of about 10 dB. The largest difference in values obtained from the measurements and the simulations is within 4 dB, which indicates that the experiments are in good agreement with the simulations. CONCLUSIONS: These results are significant for the estimate of how electromagnetic energy changes after propagating through human tissues, which can be used as a reference for the link budget of transceivers or other implantable medical devices.
La antropología teológica de Populorum Progressio
Authors: Amos Usanos Rafael
Published: February 2019

Pablo VI en Populorum Progressio dibuja una imagen del hombre en diálogo con las corrientes de pensamiento que hicieron del debate antropológico el centro de la discusión. Conocer esa descripción y su contenido teológico, identificar las influencias que ha recibido y apuntar su proyección en los problemas actuales es el objetivo de este trabajo.
La evolución del modelo de desarrollo humano integral desde la Populorum progressio en diálogo interdisciplinar con otras escuelas de desarrollo
Authors: Larrú Ramos José María
Published: February 2019

El trabajo caracteriza la “escuela católica de desarrollo” con los siguientes ochos rasgos identitarios: trascendente–vocacionado, humano, integral, solidario, caritativo–verdadero, igualador, endógeno y sostenible. Además se destacan los siguientes elementos diferenciales respecto a otras escuelas: en la dimensión política, el ejercicio del poder como servicio, la participación de la sociedad civil para lograr un bien común promovido por el Estado bajo el principio de subsidiariedad y la posibilidad de que una autoridad supranacional fuera el garante de los “bienes comunes globales” (LS 174) contenidos en la Agenda 2030 del Desarrollo Sostenible; en la dimensión económica, la lógica del don, el trabajo subjetivo, el emprendimiento y la obligación de ayudar a los países menos desarrollados; en la dimensión sociocultural, la opción preferencial por los pobres, las estructuras de pecado y el ejercicio de la caridad política; en la dimensión ecológica, la “ecología integral” y la “conversión ecológica”, a la luz de la encíclica Laudato si’.
Social Justice as Environmental Justice. An interpretation of the Social Teaching of the Church from the practices
Authors: Otano Jiménez Guillermo
Published: February 2019

The Social Teaching of the Church has a long and rich history which started in the middle of the nineteenth century, in a time characterised by the rise of industrial capitalism and the need to address the “social question” in most European societies. Since the very beginning it was understood by many as an attempt to interpret the idea of social justice through the prism of Catholic religion. However, an interpretation of this kind is not a theoretical exercise that can be detached from social reality, but a reflection on social reality that focuses the attention on the worldly life of those who suffer the injustice. In this sense, the doctrinal body of the Church is alive and constantly evolving to adapt the teachings of the Gospel to the “signs of time”.
¿Tiene cabida en la empresa el desarrollo humano integral?
Authors: Melé Dòmenec
Published: February 2019

El desarrollo humano integral –desarrollo de todo el hombre y de todos los hombres– abarca la vida entera y, por tanto, no queda excluido de la empresa. El desarrollo humano en la empresa tiene lugar por el trabajo y la convivencia dentro de la organización empresarial. Mejorar tal desarrollo es, en primer lugar, responsabilidad de cada persona, pero las condiciones de trabajo pueden favorecerlo o dificultarlo. En este contexto, los directivos de empresa, en primer lugar, tienen la responsabilidad, de no impedirlo ya sea mandando o motivando de modo contrario al verdadero desarrollo humano. Cumplido este requisito, la segunda responsabilidad es favorecerlo, de modo que se estimule el sentido de servicio y la adquisición de virtudes humanas. Esto último está relacionado con la organización del trabajo, la convivencia y la cultura organizativa y el modo de liderar.
Hybrid Contract According to Sharia Economic Law
Authors: Jamaludin Ijang
Published: February 2019

Sharia law is charged with guiding how to conduct economic activities in order to be safe and happy to the afterlife. Sharia economic activities especially in sharia financial institutions are increasingly varied following the global economic development, the innovation of Sharia Financial Institution products become a necessity. Single agreement as the core of a transaction is not able to accommodate the increasingly complex needs of transactions, the presence of hybrid contact as a transformation of the contract leads to the development of LKS on the one hand and generate a spicy criticism related to its validity on the other side. This paper through literature approach trying to analyze hybrid contact in terms of ijtihad methodology related to the theory used madhab Hanafi in view the legal consequences. The result that the Hybrid contract is al-mukharij min al-mazaiq / hilah as a way out as well as the benefit to avoid the practice of usury, and resulted in legal consequences as a contract.
The Review of Opening Procedures of Sharia Based Saving in Sharia Financial Services Cooperation BMT Mitra Sadaya Branch of Purwakarta
Authors: Jalaludin Jalaludin
Published: February 2019

This article describes the variation of syariah savings in the institution of the temple al-Maal wa al-Tamwil (BMT) Mitra sadaya. The approach used in this study is a qualitative approach and the type of data used in this study is descriptive. The object of this research is the analysis of the opening procedure of sharia savings at the institution of bait al-Maal wa al-Tamwil (BMT) Mitra Sadaya Purwakarta branch. The subject of the research is the source of data asked for the information according to the research problem. This study aims to determine the form of procedures, implementation procedures, the benefits of procedures and factors in running procedures in the opening of syariah savings. The results of this study are: Variations of Islamic savings at the institution of the temple al-Maal wa al-Tamwil (BMT) Mitra sadaya there are three contracts used: (1) principle akad wadi'ah, (2) Mudharabah contract principle, (3) Qard. Then for the opening procedure of syariah savings as follows: (1) Prospective customers / members come to the office or hold an appointment with marketing bait al-Maal wa al-Tamwil (BMT); (2) The prospective customer / member meets with the Customer Service section bait al-Maal wa al-Tamwil (BMT) Mitra sadaya; (3) Prospective customers / members fill out the application form of syariah account opening or savings account; (4) Prospective client / member shall sign the approval for opening of syariah saving account; (5) Entered and checked by the teller section; (6) Print sharia savings book in accordance with customer / member application; (7) The signing of officials related to the institution of al-Maal wa al-Tamwil (BMT) Mitra sadaya; (8) Calculate and give the first deposit money to the teller; (9) Input of initial deposit and deposit of deposit; (10) Re-check the nominal deposit with the amount of balance and stamp teller; (11) Account opening is completed and customers / members are welcome to go home. Shariah-compliant profit sharing of bait al-Maal wa al-Tamwil (BMT) Partners sadaya partner, if the form of ordinary sharia savings (other than deposits) gifts or profits are given equivalent to 35% of office income. However, if included in the category of gift deposits granted equivalent to 9% -13% per year. As well as deposits that fall into the category of capital of the institution of bait al-Maal wa al-Tamwil (BMT). Sadaya Partners that last from 4-5 years, the profits are equal to 30% -110%.
The Sharia Bank Syndication Financing in The Economic Law Perspective
Authors: Sholihin Riadhus
Published: February 2019

The development is carried out by the state aimed at public welfare, especially with the presence of large-scale projects that require large funds as well. But this is constrained by capital. Islamic banking can take the opportunity by financing. However, Islamic banking is limited in providing capital to debtors and there are also rules regarding the maximum limit of financing. To answer these problems, syndicated banking cooperation with other financial institutions is needed in fulfilling financing capital needs. However, arrangements regarding syndication of Islamic banks are inadequate with the needs of Islamic banking in conducting sharia syndicated financing. This paper examines the legal aspects of Islamic economics in syndicated bank financing
Khawarij dan Sunnah Nabi
Authors: Taufik Wildan
Published: February 2019

Sebagai sekte Islam awal, Khawarij selain sebagai gerakan pemberontakan fisik, seiring waktu mereka bertransformasi diri menjadi gerakan intelektual. Produk intelektual yang dihasilkan di antaranya diktum la hukm illa lillah. Tersirat dari frase ini, mereka mengutamakan al-Qur’an sebagai pandangan keagamaan dan berpandangan minor terhadap sunnah Nabi. Oleh karena itu, beberapa ulama menyebutkan Khawarij berpandangan ingkar Sunnah. Klaim qur’aniyyin, disematkan kepada mereka karena berpandangan hitam-putih terhadap diskursus keagamaan. Pembahasan berikut merupakan telusur historis-analisis terhadap genealogi Khawarij dan pandangan keagamaannya.
Hadis Larangan terhadap Wanita Pergi Tanpa Mahram
Authors: Ulummudin Ulummudin
Published: February 2019

Tulisan ini mengkaji hadis larangan terhadap wanita pergi tanpa mahram menggunakan hermeneutika Gracia. Pembacaan tekstual melalui tiga fungsi penafsiran diperoleh hasil sebagai berikut: analisis fungsi historis hadis ini berkaitan dengan haji dan peperangan. Fungsi makna membolehkan wanita pergi tanpa mahram dengan asumsi perubahan konteks. Fungsi implikasi dari hadis ini adalah wanita mampu berperan lebih di masyarakat tidak terikat hanya pada ranah domestik. Sementara itu, untuk pembacaan non tekstual, gagasan utama hadis ini adalah perlindungan yang bertujuan untuk keamanan dan keselamatan. Dengan demikian, dalam konteks ini konsep mahram pun bergeser menjadi pihak keamanan yang dapat dimintai pertolongan.
АНАЛІЗ ПРИЧИН РУЙНУВАННЯ БАНДАЖНОГО КІЛЬЦЯ ТУРБОГЕНЕРАТОРА
Authors: Третьяк Алексей Владимирович , Кобзарь Константин Александрович , Шевчук Павел Алексеевич , Шуть Александр Юрьевич , Репетенко Михаил Владимирович , Полиенко Владислав Русланович
Published: February 2019

Description of the destruction (emergency) of a retaining ring of a pre-series Turbogenerator of medium power is submitted in the scientific work. The following destructions were detected: rupture of the back part of the rotor retaining ring as per the generatrix, complete destruction of the external ring of the fan, blades, diffuser, tearing-off of the rotor coils, cutting of the rotor winding and its fastening parts, severe damage of the whole overhang part of the stator winding, complete destruction of the top row of the stator winding bars in the overhang part, rupture of the elementary conductors. The causes of destruction (emergency) are submitted: availability of cracks on the external surface of the rotor ring of Turbogenerator, nonconformity to the specifications on the plastic properties of the retaining rings metal, admission of the defects at manufacturing of the Turbogenerator rotor retaining ring at the manufacturer-plant (rough treatment of the retaining ring surface, availability of nicks and scratches, eight-fold heating of the retaining ring, fire in the generator). The design peculiarities of the rotor retaining ring of Turbogenerators. The causality analysis of the retaining ring damage was carried out. It is shown that the cause of the emergency can be a chain of events not related to each other and individually each leading to a failure or emergency. It is found that the events, the probability of which lies on the edges of the power-series distribution, the so-called "heavy tail" distributions shall become the most probable if they can cause maximum loss due to damage. One approach is considered in an attempt to answer the question: whether there are objective regularities in describing the consequences of major emergencies and catastrophes in the technosphere and in nature. Since the probability of a defect in the part shall be inherent for all stages of the service life cycle of the design (design working out and studying, technological preparation, manufacturing of the part, testing for compliance with the technical parameters, assembly, testing of the general design), then for the most unfavorable event with "heavy tails" the decisive factor shall be the human factor, to predict the change and behavior of which is almost impossible. The sequence of execution of technological operations for the elimination of rejection is established.