bluuebunny/crossref_metadata_2025 huggingface dataset:
NUMERICAL ANALYSIS OF THE LEVERETT FUNCTION FORM INFLUENCE FOR THE RAPPOPORT - LEAS EQUATION SOLUTIONS
Authors: Telegin I. G. , Bocharov O. B.
Published: November 2018

The article deals with the classical mathematical model of filtration of two immiscible liquids in a non-deformable porous medium taking into account capillary forces. It is the Muskat - Leverett model. The model is based on the experimentally determined functions of water saturation - relative phase permeability and the Leverett’s function of capillary pressure. In the article we study numerically the one-dimensional radial flow with a given flow rate of the mixture. In this case, the Muskat - Leverett model equations are reduced to one quasilinear hyperbolic-parabolic equation for water saturation - Rappoport-Leas equation. The article investigates the influence of the representation of capillary forces in porous media of different structures on the behavior of solutions in the isothermal case.
Association between vasoactive peptide urotensin II in plasma and cerebral vasospasm after aneurysmal subarachnoid hemorrhage: a potential therapeutic target
Authors: Clavier Thomas , Mutel Alexandre , Desrues Laurence , Lefevre-Scelles Antoine , Gastaldi Gioia , El Amki Mohamad , Dubois Martine , Melot Anthony , Wurtz Véronique , Curey Sophie , Gérardin Emmanuel , Proust François , Compère Vincent , Castel Hélène
Published: November 2018

OBJECTIVE

Cerebral vasospasm (VS) is a severe complication of aneurysmal subarachnoid hemorrhage (SAH). Urotensin II (UII) is a potent vasoactive peptide activating the urotensin (UT) receptor, potentially involved in brain vascular pathologies. The authors hypothesized that UII/UT system antagonism with the UT receptor antagonist/biased ligand urantide may be associated with post-SAH VS. The objectives of this study were 2-fold: 1) to leverage an experimental mouse model of SAH with VS in order to study the effect of urotensinergic system antagonism on neurological outcome, and 2) to investigate the association between plasma UII level and symptomatic VS after SAH in human patients.

METHODS

A mouse model of SAH was used to study the impacts of UII and the UT receptor antagonist/biased ligand urantide on VS and neurological outcome. Then a clinical study was conducted in the setting of a neurosurgical intensive care unit. Plasma UII levels were measured in SAH patients daily for 9 days, starting on the 1st day of hospitalization, and were compared with plasma UII levels in healthy volunteers.

RESULTS

In the mouse model, urantide prevented VS as well as SAH-related fine motor coordination impairment. Seventeen patients with SAH and external ventricular drainage were included in the clinical study. The median plasma UII level was 43 pg/ml (IQR 14–80 pg/ml). There was no significant variation in the daily median plasma UII level (median value for the 17 patients) from day 0 to day 8. The median level of plasma UII during the 9 first days post-SAH was higher in patients with symptomatic VS than in patients without VS (77 pg/ml [IQR 33.5–111.5 pg/ml] vs 37 pg/ml [IQR 21–46 pg/ml], p < 0.05). Concerning daily measures of plasma UII levels in VS, non-VS patients, and healthy volunteers, we found a significant difference between SAH patients with VS (median 66 pg/ml [IQR 30–110 pg/ml]) and SAH patients without VS (27 pg/ml [IQR 15–46 pg/ml], p < 0.001) but no significant difference between VS patients and healthy volunteers (44 pg/ml [IQR 27–51 pg/ml]) or between non-VS patients and healthy volunteers.

CONCLUSIONS

The results of this study suggest that UT receptor antagonism with urantide prevents VS and improves neurological outcome after SAH in mice and that an increase in plasma UII is associated with cerebral VS subsequent to SAH in humans. The causality link between circulating UII and VS after SAH remains to be established, but according to our data the UT receptor is a potential therapeutic target in SAH.
Founder of modern hydrocephalus diagnosis and therapy: Walter Dandy at the Johns Hopkins Hospital
Authors: Blitz Ari M. , Ahmed A. Karim , Rigamonti Daniele
Published: November 2018

Because of his exceptional and pioneering contributions to the understanding and treatment of neurosurgical conditions, Walter Dandy is considered to be one of the founders of both neurosurgery and neuroradiology. In the field of hydrocephalus, Dandy developed revolutionary research models, imaging modalities, and operative procedures. His laboratory and clinical experiences at the Johns Hopkins Hospital, including the surgical treatment of hydrocephalus, are well illustrated in the publications he authored. Archival materials housed at the Johns Hopkins University School of Medicine provide a window into Dandy’s clinical experience and supplement the work published during his lifetime. His operative experience with hydrocephalus spanned 1915–1946 and comprised 381 surgeries. From this clinical experience, Dandy created much of the framework for modern diagnostic imaging and treatment of hydrocephalus.
In vivo histotripsy brain treatment
Authors: Sukovich Jonathan R. , Cain Charles A. , Pandey Aditya S. , Chaudhary Neeraj , Camelo-Piragua Sandra , Allen Steven P. , Hall Timothy L. , Snell John , Xu Zhiyuan , Cannata Jonathan M. , Teofilovic Dejan , Bertolina James A. , Kassell Neal , Xu Zhen
Published: November 2018

OBJECTIVE

Histotripsy is an ultrasound-based treatment modality relying on the generation of targeted cavitation bubble clouds, which mechanically fractionate tissue. The purpose of the current study was to investigate the in vivo feasibility, including dosage requirements and safety, of generating well-confined destructive lesions within the porcine brain utilizing histotripsy technology.

METHODS

Following a craniectomy to open an acoustic window to the brain, histotripsy pulses were delivered to generate lesions in the porcine cortex. Large lesions with a major dimension of up to 1 cm were generated to demonstrate the efficacy of histotripsy lesioning in the brain. Gyrus-confined lesions were generated at different applied dosages and under ultrasound imaging guidance to ensure that they were accurately targeted and contained within individual gyri. Clinical evaluation as well as MRI and histological outcomes were assessed in the acute (≤ 6 hours) and subacute (≤ 72 hours) phases of recovery.

RESULTS

Histotripsy was able to generate lesions with a major dimension of up to 1 cm in the cortex. Histotripsy lesions were seen to be well demarcated with sharp boundaries between treated and untreated tissues, with histological evidence of injuries extending ≤ 200 µm from their boundaries in all cases. In animals with lesions confined to the gyrus, no major hemorrhage or other complications resulting from treatment were observed. At 72 hours, MRI revealed minimal to no edema and no radiographic evidence of inflammatory changes in the perilesional area. Histological evaluation revealed the histotripsy lesions to be similar to subacute infarcts.

CONCLUSIONS

Histotripsy can be used to generate sharply defined lesions of arbitrary shapes and sizes in the swine cortex. Lesions confined to within the gyri did not lead to significant hemorrhage or edema responses at the treatment site in the acute or subacute time intervals.
Riskier-than-expected occlusive treatment of ruptured posterior communicating artery aneurysms: treatment and outcome of 620 consecutive patients
Authors: Huhtakangas Justiina , Lehecka Martin , Lehto Hanna , Rezai Jahromi Behnam , Niemelä Mika , Kivisaari Riku
Published: November 2018

OBJECTIVE

Occlusive treatment of posterior communicating artery (PCoA) aneurysms has been seen as a fairly uncomplicated procedure. The objective here was to determine the radiological and clinical outcome of patients after PCoA aneurysm rupture and treatment and to evaluate the risk factors for impaired outcome.

METHODS

In a retrospective clinical follow-up study, data were collected from 620 consecutive patients who had been treated for ruptured PCoA aneurysms at a single center between 1980 and 2014. The follow-up was a minimum of 1 year after treatment or until death.

RESULTS

Of the 620 patients, 83% were treated with microsurgical clipping, 8% with endovascular coiling, 2% with the two procedures combined, 1% with indirect surgical methods, and 6% with conservative methods. The most common procedural complications were treatment-related brain infarctions (15%). The occurrence of artery occlusions (10% microsurgical, 8% endovascular) was higher than expected. Most patients made a good recovery at 1 year after aneurysmal subarachnoid hemorrhage (modified Rankin Scale [mRS] score 0–2: 386 patients [62%]). A fairly small proportion of patients were left severely disabled (mRS score 4–5: 27 patients [4%]). Among all patients, 20% died during the 1st year. Independent risk factors for an unfavorable outcome, according to the multivariable analysis, were poor preoperative clinical condition, intracerebral or subdural hematoma due to aneurysm rupture, age over 65 years, artery occlusion on postoperative angiography, occlusive treatment–related ischemia, delayed cerebral vasospasm, and hydrocephalus requiring a shunt.

CONCLUSIONS

Even though most patients made a good recovery after PCoA aneurysm rupture and treatment during the 1st year, the occlusive treatment–related complications were higher than expected and caused morbidity even among initially good-grade patients. Occlusive treatment of ruptured PCoA aneurysms seems to be a high-risk procedure, even in a high-volume neurovascular center.
Three types of dural suturing for closure of CSF leak after endoscopic transsphenoidal surgery
Authors: Ishikawa Takayuki , Takeuchi Kazuhito , Nagata Yuichi , Choo Jungsu , Kawabata Teppei , Ishizaki Tomotaka , Wakabayashi Toshihiko
Published: November 2018

OBJECTIVE

Transsphenoidal surgery (TSS) is commonly used for anterior skull base surgery, especially in the sella turcica (sellar) region. However, because of its anatomical position, CSF leakage is a major complication of this approach. The authors introduced a new grading reconstruction strategy for anterior skull base surgery with continuous dural suturing in 2013. In this paper the authors report on their methods and results.

METHODS

All patients with sellar or anterior skull base lesions that were removed with TSS or extended TSS by a single neurosurgeon between April 2013 and March 2017 at Nagoya University Hospital and several cooperating hospitals were retrospectively identified. Three methods of suturing dura were considered, depending on the dural defect.

RESULTS

There were 176 TSS cases (141 conventional TSS cases and 35 extended endoscopic TSS cases) and 76 cases of Esposito’s grade 2 or 3 intradural high-flow CSF leakage. In the high-flow CSF leak group, there were 3 cases of CSF leakage after the operation. The rates of CSF leakage after surgery corresponding to grades 2 and 3 were 2.9% (1/34) and 4.7% (2/42), respectively.

CONCLUSIONS

Dural suturing is a basic and key method for reconstruction of the skull base, and continuous suturing is the most effective approach. Using this approach, the frequency of cases requiring a nasoseptal flap and lumbar drainage can be reduced.
ReStNeuMap: a tool for automatic extraction of resting-state functional MRI networks in neurosurgical practice
Authors: Zacà Domenico , Jovicich Jorge , Corsini Francesco , Rozzanigo Umberto , Chioffi Franco , Sarubbo Silvio
Published: November 2018

OBJECTIVE

Resting-state functional MRI (rs-fMRI) represents a promising and cost-effective alternative to task-based fMRI for presurgical mapping. However, the lack of clinically streamlined and reliable rs-fMRI analysis tools has prevented wide adoption of this technique. In this work, the authors introduce an rs-fMRI processing pipeline (ReStNeuMap) for automatic single-patient rs-fMRI network analysis.

METHODS

The authors provide a description of the rs-fMRI network analysis steps implemented in ReStNeuMap and report their initial experience with this tool after performing presurgical mapping in 6 patients. They verified the spatial agreement between rs-fMRI networks derived by ReStNeuMap and localization of activation with intraoperative direct electrical stimulation (DES).

RESULTS

The authors automatically extracted rs-fMRI networks including eloquent cortex in spatial proximity with the resected lesion in all patients. The distance between DES points and corresponding rs-fMRI networks was less than 1 cm in 78% of cases for motor, 100% of cases for visual, 87.5% of cases for language, and 100% of cases for speech articulation mapping.

CONCLUSIONS

The authors’ initial experience with ReStNeuMap showed good spatial agreement between presurgical rs-fMRI predictions and DES findings during awake surgery. The availability of the rs-fMRI analysis tools for clinicians aiming to perform noninvasive mapping of brain functional networks may extend its application beyond surgical practice.
Surgical management and long-term outcomes of intracranial giant cell tumors: a single-institution experience with a systematic review
Authors: Weng Jian-Cong , Li Da , Wang Liang , Wu Zhen , Wang Jun-Mei , Li Gui-Lin , Jia Wang , Zhang Li-Wei , Zhang Jun-Ting
Published: November 2018

OBJECTIVE

Intracranial giant cell tumors (GCTs) are extremely rare neoplasms with dismal survival and recurrence rates. The authors aimed to confirm independent adverse factors for progression-free survival (PFS) and to propose an optimal treatment algorithm.

METHODS

The authors reviewed the clinical data of 43 cases of intracranial GCTs in their series. They also reviewed 90 cases of previously reported GCTs in the English language between 1982 and 2017 using Ovid MEDLINE, Embase, PubMed, and Cochrane databases with keywords of “giant cell tumor” or “osteoclastoma” and “skull,” “skull base,” “temporal,” “frontal,” “sphenoid,” or “occipital.” These prior publication data were processed and used according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Aforementioned risk factors for the authors’ series and the pooled cases were evaluated in patients not lost to follow-up (m = 38 and n = 128, respectively).

RESULTS

The authors’ cohort included 28 males and 15 females with a mean age of 30.5 years. Gross-total resection (GTR) was achieved in 15 (34.9%) patients. Fifteen patients (39.5%) who did not undergo GTR received postoperative radiotherapy with a mean total dose of 54.7 ± 4.1 Gy. After a mean follow-up of 71.3 months, 12 (31.6%) patients experienced recurrence, and 4 (10.5%) died of disease. The actuarial 5-year PFS and overall survival (OS) were 68.6% and 90.0% in the authors’ cohort, respectively. A multivariate Cox regression analysis verified that partial resection (HR 7.909, 95% CI 2.296–27.247, p = 0.001), no radiotherapy (HR 0.114, 95% CI 0.023–0.568, p = 0.008), and Ki-67 ≥ 10% (HR 7.816, 95% CI 1.584–38.575, p = 0.012) were independent adverse factors for PFS. Among the 90 cases in the literature, GTR was achieved in 49 (54.4%) cases. Radiotherapy was administered to 33 (36.7%) patients with a mean total dose of 47.1 ± 5.6 Gy. After a mean follow-up of 31.5 months, recurrence and death occurred in 17 (18.9%) and 5 (5.6%) cases, respectively. Among the pooled cases, the 5-year PFS and OS were 69.6% and 89.2%, respectively. A multivariate model demonstrated that partial resection (HR 4.792, 95% CI 2.909–7.893, p < 0.001) and no radiotherapy (HR 0.165, 95% CI 0.065–0.423, p < 0.001) were independent adverse factors for poor PFS.

CONCLUSIONS

GTR and radiotherapy were independent favorable factors for PFS of intracranial GCTs. Based on these findings, GTR alone or GTR plus radiotherapy was advocated as an optimal treatment; otherwise, partial resection plus radiotherapy with a dose ≥ 45 Gy, if tolerable, was a secondary alternative. Lack of randomized data of the study was stressed, and future studies with larger cohorts are necessary to verify these findings.

Systematic review no.: CRD42018090878 (crd.york.ac.uk/PROSPERO/)
Repurposing propranolol as an antitumor agent in von Hippel-Lindau disease
Authors: Shepard Matthew J. , Bugarini Alejandro , Edwards Nancy A. , Lu Jie , Zhang Qi , Wu Tianxia , Zhuang Zhengping , Chittiboina Prashant
Published: November 2018

OBJECTIVE

Von Hippel-Lindau disease (VHL) is a tumor predisposition syndrome characterized by CNS hemangioblastomas (HBs) and clear cell renal cell carcinomas (RCCs) due to hypoxia-inducible factor activation (pseudohypoxia). Because of the lack of effective medical therapies for VHL, HBs and RCCs account for significant morbidity and mortality, ultimately necessitating numerous neurological and renal surgeries. Propranolol is an FDA-approved pan-beta adrenergic antagonist with antitumor effects against infantile hemangiomas (IHs) and possibly VHL HBs. Here, the authors investigated the antitumor efficacy of propranolol against pseudohypoxia-driven VHL-HBs and VHL-RCCs.

METHODS

Patient-derived VHL-associated HBs (VHL-HBs) or 786-O-VHL−/− RCC cells were treated with clinically relevant concentrations of propranolol in vitro and assessed with viability assays, flow cytometry, quantitative real-time polymerase chain reaction, and western blotting. In vivo confirmation of propranolol antitumor activity was confirmed in athymic nude mice bearing 786-O xenograft tumors. Lastly, patients enrolled in a VHL natural history study (NCT00005902) were analyzed for incidental propranolol intake. Propranolol activity against VHL-HBs was assessed retrospectively with volumetric HB growth kinetic analysis.

RESULTS

Propranolol decreased HB and RCC viability in vitro with IC50 (half maximal inhibitory concentration) values of 50 µM and 200 µM, respectively. Similar to prior reports in infantile hemangiomas, propranolol induced apoptosis and paradoxically increased VEGF-A mRNA expression in patient-derived VHL-HBs and 786-O cells. While intracellular VEGF protein levels were not affected by propranolol treatment, propranolol decreased HIF expression in 786-O cells (7.6-fold reduction, p < 0.005). Propranolol attenuated tumor progression compared with control (33% volume reduction at 7 days, p < 0.005) in 786-O xenografted tumor-bearing mice. Three patients (harboring 25 growing CNS HBs) started propranolol therapy during the longitudinal VHL-HB study. HBs in these patients tended to grow slower (median growth rate 27.1 mm3/year vs 13.3 mm3/year) during propranolol treatment (p < 0.0004).

CONCLUSIONS

Propranolol decreases VHL-HB and VHL-related RCC viability in vitro likely by modulation of VEGF expression and by inducing apoptosis. Propranolol abrogates 786-O xenograft tumor progression in vivo, and retrospective clinical data suggest that propranolol curtails HB growth. These results suggest that propranolol may play a role in the treatment of VHL-related tumors.
Immunohistochemical analysis of histone H3 acetylation in the trigeminal root entry zone in an animal model of trigeminal neuralgia
Authors: Lin Ren , Luo Lili , Gong Yiran , Zheng Jingsheng , Wang Shuiyue , Du Junjie , Luo Daoshu
Published: November 2018

OBJECTIVE

The trigeminal root entry zone (TREZ) is a transitional zone between the central nervous system (CNS) and peripheral nervous system (PNS), adjacent to the brainstem. Microvascular compression of the TREZ has been considered to be the primary etiology in most cases of trigeminal neuralgia (TN), but whether epigenetic regulation is involved in the pathogenesis of TN is still unclear. Therefore, this study was designed to investigate the epigenetic regulation of histone H3 acetylation in the TREZ in an animal model of TN.

METHODS

An animal model of TN was established, and adult male Sprague-Dawley rats were randomly assigned to a TN group with trigeminal nerve root compression, sham operation group, TN+HDACi group (TN plus selective histone deacetylase inhibitor injection into the TREZ), or TN+Veh group (TN plus vehicle injection into the TREZ). To measure the length of the central portion of the TREZ from the junction of the trigeminal nerve root entering the pons to the interface of the dome-shaped CNS-PNS transitional zone, immunofluorescent staining of glia and glial nuclei was performed using glial fibrillary acidic protein (GFAP) antibody and DAPI, respectively. To investigate the acetylation of histone H3 within the TREZ in a TN animal model group and a sham operation group, localization of histone H3K9, H3K18, and H3K27 acetylation was examined via immunohistochemical staining methods.

RESULTS

Measurements of the CNS-PNS transitional zone in the TREZ revealed that the average length from the junction of the trigeminal nerve root connecting the pons to the glial fringe of the TREZ in the TN group was longer than that in the sham operation group (p < 0.05) and that the interface gradually migrated distally. Cells that stained positive for acetylated histone H3K9, H3K18, and H3K27 were distributed around both sides of the border of the CNS-PNS junction in the TREZ. The ratio of immunoreactive H3K9-, H3K18- and H3K27-positive cells in the TN group was obviously higher than that in the sham operation group on postoperative days 7, 14, 21, and 28 (p < 0.05).

CONCLUSIONS

These results suggested that chronic compression of the trigeminal nerve root may be involved in the pathogenesis of TN in an animal model by influencing the plasticity of the CNS-PNS transitional zone and the level of histone acetylation in the TREZ.
Intracranial hypertension after Chiari decompression resolving after removal of a levonorgestrel-releasing intrauterine device: case report
Authors: Maragkos Georgios A. , Motiei-Langroudi Rouzbeh , Filippidis Aristotelis S. , Papavassiliou Efstathios
Published: November 2018

Levonorgestrel-releasing intrauterine devices (LIUDs) are thought to release this progestin locally in the uterus to limit side effects. Authors here present a case of treatment-refractory hydrocephalus and pseudomeningocele (PMC), both of which fully resolved after LIUD removal.

A 35-year-old woman with an implanted LIUD developed symptomatic PMC and hydrocephalus after suboccipital craniectomy for Chiari malformation type I. Over the next 8 months, she underwent ventriculoperitoneal shunt placement and two attempts at needle decompression of the fluid collection, which did not relieve her symptoms or the PMC, except for a few days at a time. Subsequently, she had her LIUD removed. Three weeks after removal of the LIUD, her symptoms as well as the fluid collection resolved completely without any further intervention. Thus, the increased intracranial pressure and associated persistence of the PMC may be partially attributed to the LIUD.

This case indicates that a persistent problem (PMC and intracranial hypertension) that may be associated with the LIUD rapidly resolves after its removal. Implication of LIUDs as the cause of intracranial hypertension is still a matter of controversy. Further studies are needed to evaluate any potential causal relationship between LIUDs and intracranial hypertension, and physicians are advised to consider this scenario in their differential diagnosis.
Hypopituitarism after Gamma Knife radiosurgery for pituitary adenomas: a multicenter, international study
Authors: Cordeiro Diogo , Xu Zhiyuan , Mehta Gautam U. , Ding Dale , Vance Mary Lee , Kano Hideyuki , Sisterson Nathaniel , Yang Huai-che , Kondziolka Douglas , Lunsford L. Dade , Mathieu David , Barnett Gene H. , Chiang Veronica , Lee John , Sneed Penny , Su Yan-Hua , Lee Cheng-chia , Krsek Michal , Liscak Roman , Nabeel Ahmed M. , El-Shehaby Amr , Abdel Karim Khaled , Reda Wael A. , Martinez-Moreno Nuria , Martinez-Alvarez Roberto , Blas Kevin , Grills Inga , Lee Kuei C. , Kosak Mikulas , Cifarelli Christopher P. , Katsevman Gennadiy A. , Sheehan Jason P.
Published: November 2018

OBJECTIVE

Recurrent or residual adenomas are frequently treated with Gamma Knife radiosurgery (GKRS). The most common complication after GKRS for pituitary adenomas is hypopituitarism. In the current study, the authors detail the timing and types of hypopituitarism in a multicenter, international cohort of pituitary adenoma patients treated with GKRS.

METHODS

Seventeen institutions pooled clinical data obtained from pituitary adenoma patients who were treated with GKRS from 1988 to 2016. Patients who had undergone prior radiotherapy were excluded. A total of 1023 patients met the study inclusion criteria. The treated lesions included 410 nonfunctioning pituitary adenomas (NFPAs), 262 cases of Cushing’s disease (CD), and 251 cases of acromegaly. The median follow-up was 51 months (range 6–246 months). Statistical analysis was performed using a Cox proportional hazards model to evaluate factors associated with the development of new-onset hypopituitarism.

RESULTS

At last follow-up, 248 patients had developed new pituitary hormone deficiency (86 with NFPA, 66 with CD, and 96 with acromegaly). Among these patients, 150 (60.5%) had single and 98 (39.5%) had multiple hormone deficiencies. New hormonal changes included 82 cortisol (21.6%), 135 thyrotropin (35.6%), 92 gonadotropin (24.3%), 59 growth hormone (15.6%), and 11 vasopressin (2.9%) deficiencies. The actuarial 1-year, 3-year, 5-year, 7-year, and 10-year rates of hypopituitarism were 7.8%, 16.2%, 22.4%, 27.5%, and 31.3%, respectively. The median time to hypopituitarism onset was 39 months.

In univariate analyses, an increased rate of new-onset hypopituitarism was significantly associated with a lower isodose line (p = 0.006, HR = 8.695), whole sellar targeting (p = 0.033, HR = 1.452), and treatment of a functional pituitary adenoma as compared with an NFPA (p = 0.008, HR = 1.510). In multivariate analyses, only a lower isodose line was found to be an independent predictor of new-onset hypopituitarism (p = 0.001, HR = 1.38).

CONCLUSIONS

Hypopituitarism remains the most common unintended effect of GKRS for a pituitary adenoma. Treating the target volume at an isodose line of 50% or greater and avoiding whole-sellar radiosurgery, unless necessary, will likely mitigate the risk of post-GKRS hypopituitarism. Follow-up of these patients is required to detect and treat latent endocrinopathies.
Software-based simulation for preprocedural assessment of braided stent sizing: a validation study
Authors: Joshi Krishna Chaitanya , Larrabide Ignacio , Saied Ahmed , Elsaid Nada , Fernandez Hector , Lopes Demetrius K.
Published: November 2018

OBJECTIVE

The authors sought to validate the use of a software-based simulation for preassessment of braided self-expanding stents in the treatment of wide-necked intracranial aneurysms.

METHODS

This was a retrospective, observational, single-center study of 13 unruptured and ruptured intracranial aneurysms treated with braided self-expanding stents. Pre- and postprocedural angiographic studies were analyzed. ANKYRAS software was used to compare the following 3 variables: the manufacturer-given nominal length (NL), software-calculated simulated length (SL), and the actual measured length (ML) of the stent. Appropriate statistical methods were used to draw correlations among the 3 lengths.

RESULTS

In this study, data obtained in 13 patients treated with braided self-expanding stents were analyzed. Data for the 3 lengths were collected for all patients. Error discrepancy was calculated by mean squared error (NL to ML −22.2; SL to ML −6.14, p < 0.05), mean absolute error (NL to ML 3.88; SL to ML −1.84, p < 0.05), and mean error (NL to ML −3.81; SL to ML −1.22, p < 0.05).

CONCLUSIONS

The ML was usually less than the NL given by the manufacturer, indicating significant change in length in most cases. Computational software-based simulation for preassessment of the braided self-expanding stents is a safe and effective way for accurately calculating the change in length to aid in choosing the right-sized stent for optimal placement in complex intracranial vasculature.
Language lateralization with resting-state and task-based functional MRI in pediatric epilepsy
Authors: Desai Virendra R. , Vedantam Aditya , Lam Sandi K. , Mirea Lucia , Foldes Stephen T. , Curry Daniel J. , Adelson P. David , Wilfong Angus A. , Boerwinkle Varina L.
Published: November 2018

OBJECTIVE

Determining language laterality in patients with intractable epilepsy is important in operative planning. Wada testing is the gold standard, but it has a risk of stroke. Both Wada and task-based functional MRI (tb-fMRI) require patient cooperation. Recently, resting-state fMRI (rs-fMRI) has been explored for language lateralization. In the present study, the correlation between rs-fMRI and tb-fMRI in language lateralization is estimated in a pediatric population with intractable epilepsy.

METHODS

rs-fMRI and tb-fMRI language lateralization testing performed as part of epilepsy surgery evaluation was retrospectively reviewed.

RESULTS

Twenty-nine patients underwent rs-fMRI and tb-fMRI; a total of 38 rs-fMRI studies and 30 tb-fMRI studies were obtained. tb-fMRI suggested left dominance in 25 of 30 cases (83%), right in 3 (10%), and in 2 (7%) the studies were nondiagnostic. In rs-fMRI, 26 of 38 studies (68%) suggested left dominance, 3 (8%) right dominance, 6 (16%) bilateral, and 3 (8%) were nondiagnostic. When tb-fMRI lateralized to the left hemisphere (25 cases), rs-fMRI was lateralized to the left in 23 patients (92%) and it was bilateral/equal in 2 (8%). When tb-fMRI lateralized to the right (3 cases), rs-fMRI lateralized to the right in all cases (100%). The overall concordance rate was 0.93 (95% CI 0.76–0.99) when considering cases with tb-fMRI and rs-fMRI performed within 6 months of each other, and tb-fMRI results were not nondiagnostic.

CONCLUSIONS

rs-fMRI significantly correlated with tb-fMRI in lateralizing language and suggests the potential role for identifying hemispheric dominance via rs-fMRI. Further investigation and validation studies are warranted.
Clinical evaluation and surveillance imaging of children with myelomeningocele and shunted hydrocephalus: a follow-up study
Authors: Wetzel Jeremy S. , Heaner David P. , Gabel Brandon C. , Tubbs R. Shane , Chern Joshua J.
Published: November 2018

OBJECTIVE

The majority of children with myelomeningocele undergo implantation of CSF shunts. The efficacy of adding surveillance imaging to clinical evaluation during routine follow-up as a means to minimize the hazard associated with future shunt failure has not been thoroughly studied.

METHODS

A total of 300 spina bifida clinic visits during the calendar years between 2012 and 2016 were selected for this study (defined as the index clinic visit). Each index visit was preceded by a 6-month period during which no shunt evaluation of any kind was performed. At the index clinic visit, all patients were evaluated by a neurosurgeon. Seventy-four patients underwent previously scheduled surveillance CT or shunt series scans in addition to clinical evaluation (surveillance imaging group), and 226 patients did not undergo surveillance imaging (clinical evaluation group). Subsequent unexpected events, defined as emergency department visits, caregiver-requested clinic visits, and shunt revision surgeries were reviewed. The timing and likelihood of an unexpected event in each of the 2 groups were compared using Cox proportional hazard survival analysis. The rate of shunt revision surgery in the follow-up period as well as the associated outcomes and rate of complications were analyzed.

RESULTS

The clinical characteristics of the 2 groups were similar. In the clinical evaluation group, 4 of 226 (1.8%) patients underwent shunt revision based on clinical findings during the index visit, compared to 8 of 74 (10.8%) patients in the surveillance imaging group who underwent shunt revision based on clinical and imaging findings at that visit (p < 0.05). In the subsequent follow-up period, there were 74 unexpected events resulting in 10 shunt revisions in the clinical evaluation group, for an event rate of 33% and operation rate of 13.5%. In the surveillance imaging group there were 23 unexpected events resulting in 2 shunt revisions, for an event rate of 34.8% and an operation rate of 8.7%; neither difference was statistically significant. The complication rate for shunt revision surgery was also not different between the groups.

CONCLUSIONS

Obtaining predecided, routine surveillance imaging in children with myelomeningocele and shunted hydrocephalus resulted in more shunt revisions in asymptomatic patients. For patients who had negative results on surveillance imaging, the rate of shunt revision in the follow-up period was not significantly decreased compared to patients who underwent clinical examination only at the index visit.
Fourth ventricle stent placement for treatment of recurrent syringomyelia in patients with type I Chiari malformations
Authors: Riordan Coleman P. , Scott R. Michael
Published: November 2018

OBJECTIVE

In patients with syringomyelia and type I Chiari malformation (CM-I) who have required reoperation because of persistent, recurrent, or expanding syrinx, the senior author placed a stent from the fourth ventricle to the cervical subarachnoid space in hopes of promoting circulation of CSF out of the ventricle and away from the central canal of the spinal cord. This study was undertaken to determine the long-term success of this operative stratagem in eliminating the syrinx, as well as to document the complications that occurred following stent placement. The technique utilized for placement of fourth ventricle stents is presented.

METHODS

The surgical database of the senior author was reviewed to identify all patients who underwent stent placement at a reexploration of a suboccipital decompression for a CM-I conducted for a recurrent or ineffectively treated syringomyelia. The clinical and radiological data of these patients were analyzed to determine long-term efficacy and complications of the procedure.

RESULTS

Fourteen patients (average age 10.7 ± 5.2 years, range 2.6–20.1 years) were identified who met these inclusion criteria. They each presented with recurrent, residual, or expanding syringomyelia following a prior decompression for a CM-I. The reoperation with stent placement was complicated by late stent dislodgement and recurrence or persistence of the syrinx in 2 patients (14%) and by neurological deficit in 1 patient (7%). There was 1 perioperative CSF leak (7%). In 1 other patient (7%), the stent dislodged after surgery but required no further intervention, as the syrinx remained collapsed. Two patients (14%) required late reoperation for stent replacement when syrinxes recurred. At the most recent imaging follow-up, the stent was positioned appropriately in 12 patients (86%; average follow-up 6.9 years, range 0.5–18.1 years), and the recurrent or residual syrinx was eliminated or reduced in size by 75% or greater in 13 patients (93%).

CONCLUSIONS

The placement of a stent from the fourth ventricle to the cervical subarachnoid space was a highly effective treatment for patients with recurrent, residual, or expanding syringomyelia following an initial decompression of an associated CM-I. The sole neurological complication in this series was related to lysis of arachnoid scar rather than stent placement itself, but inability to maintain fixation of the stent in situ led to further surgery to replace the stent in 2 patients.
Using an artificial neural network to predict traumatic brain injury
Authors: Hale Andrew T. , Stonko David P. , Lim Jaims , Guillamondegui Oscar D. , Shannon Chevis N. , Patel Mayur B.
Published: November 2018

OBJECTIVE

Pediatric traumatic brain injury (TBI) is common, but not all injuries require hospitalization. A computational tool for ruling in patients who will have a clinically relevant TBI (CRTBI) would be valuable, providing an evidence-based way to safely discharge children who are at low risk for a CRTBI. The authors hypothesized that an artificial neural network (ANN) trained on clinical and radiologist-interpreted imaging metrics could provide a tool for identifying patients likely to suffer from a CRTBI.

METHODS

The authors used the prospectively collected, publicly available, multicenter Pediatric Emergency Care Applied Research Network (PECARN) TBI data set. All patients under the age of 18 years with TBI and admission head CT imaging data were included. The authors constructed an ANN using clinical and radiologist-interpreted imaging metrics in order to predict a CRTBI, as previously defined by PECARN: 1) neurosurgical procedure, 2) intubation > 24 hours as direct result of the head trauma, 3) hospitalization ≥ 48 hours and evidence of TBI on a CT scan, or 4) death due to TBI.

RESULTS

Among 12,902 patients included in this study, 480 were diagnosed with CRTBI. The authors’ ANN had a sensitivity of 99.73% with precision of 98.19%, accuracy of 97.98%, negative predictive value of 91.23%, false-negative rate of 0.0027%, and specificity for CRTBI of 60.47%. The area under the receiver operating characteristic curve was 0.9907.

CONCLUSIONS

The authors are the first to utilize artificial intelligence to predict a CRTBI in a clinically meaningful manner, using radiologist-interpreted CT information, in order to identify pediatric patients likely to suffer from a CRTBI. This proof-of-concept study lays the groundwork for future studies incorporating iterations of this algorithm directly into the electronic medical record for real-time, data-driven predictive assistance to physicians.
Impaired functional recovery of endothelial colony-forming cells from moyamoya disease in a chronic cerebral hypoperfusion rat model
Authors: Choi Seung Ah , Chong Sangjoon , Kwak Pil Ae , Moon Youn Joo , Jangra Anshika , Phi Ji Hoon , Lee Ji Yeoun , Park Sung-Hye , Kim Seung-Ki
Published: November 2018

OBJECTIVE

Endothelial colony-forming cells (ECFCs) isolated from pediatric patients with moyamoya disease (MMD) have demonstrated decreased numbers and defective functioning in in vitro experiments. However, the function of ECFCs has not been evaluated using in vivo animal models. In this study, the authors compared normal and MMD ECFCs using a chronic cerebral hypoperfusion (CCH) rat model.

METHODS

A CCH rat model was made via ligation of the bilateral common carotid arteries (2-vessel occlusion [2-VO]). The rats were divided into three experimental groups: vehicle-treated (n = 8), normal ECFC-treated (n = 8), and MMD ECFC-treated (n = 8). ECFCs were injected into the cisterna magna. A laser Doppler flowmeter was used to evaluate cerebral blood flow, and a radial arm maze test was used to examine cognitive function. Neuropathological examinations of the hippocampus and agranular cortex were performed using hematoxylin and eosin and Luxol fast blue staining in addition to immunofluorescence with CD31, von Willebrand factor, NeuN, myelin basic protein, glial fibrillary acidic protein, and cleaved caspase-3 antibodies.

RESULTS

The normal ECFC-treated group exhibited improvement in the restoration of cerebral perfusion and in behavior compared with the vehicle-treated and MMD ECFC-treated groups at the 12-week follow-up after the 2-VO surgery. The normal ECFC-treated group showed a greater amount of neovasculogenesis and neurogenesis, with less apoptosis, than the other groups.

CONCLUSIONS

These results support the impaired functional recovery of MMD ECFCs compared with normal ECFCs in a CCH rat model. This in vivo study suggests the functional role of ECFCs in the pathogenesis of MMD.
Genetic diversity computation in sesame genotypes using morphological traits and genic SSR markers
Authors: Iqbal Adil , Bhattacharyya Udayan , Akhtar Rumana , Dasgupta Tapash
Published: November 2018

Sesame (Sesamum indicum L.), the most ancient and important oilseed crop, with rich source of protein, highquality seed oil and many antioxidant properties is extensively grown in India. In the present study, 235 genic markers developed through data mining of expressed sequence tags from the NCBI database were used to assess the molecular genetic diversity at molecular level of 70 genotypes, belonging to different eco-geographical regions of the world. Of the developed markers, 35 (15%) showed polymorphism with a total of 151 alleles identified across genotypes. The alleles detected by the markers varied from 3 to 6 with an average of 4.36 along with 69% of average genetic diversity. The polymorphic information content (PIC) ranged from 0.36 to 0.82, with an average of 0.61. Neighbor-Joining (NJ) analysis revealed the five major groups, and clustering was independent to geographic origin. By using UPGMA, 70 genotypes at 70% similarity coefficient among the morphological traits were classified into four distinct clusters and the clustering pattern was different than based on molecular markers.
Expression studies of transcription factors under moisture stress in Cotton (Gossypium hirsutum L.)
Authors: Katageri I. S. , Pooja S. K. , Vamadevaiah H. M. , Yadav S. A. , Jadhav M. P. , Adiger Sateesh , Singh Sonam , Solanke Amolkumar U.
Published: November 2018

The process of plant adaptation to the environmental stresses is controlled by orchestration of complex molecular networks regulated by transcription factor (TF) genes. In the present study, JK-4(G11), CPD-433(G15) and 5433A2A03 N83(G16) recGenetic diversity computation in sesame genotypes using morphological traits and genic SSR markers
orded higher relative water content under moisture stress condition as compared to other genotypes with higher level of proline content indicating their role in drought tolerance. Further, expression analysis of TF genes from cotton (GhWRKY19, GhLIM, GhNAC, GhGeBP, GhWRKY70 and GhC2H2) through qRT-PCR in 27 different cotton genotypes showed differential expression under stress condition indicating their role in stress tolerance.
Candidate gene based characterization of common bean genotypes
Authors: Zargar Sajad Majeed , Gupta Nancy , Mahajan Reetika , Sharma Susheel , Nehvi F. A. , Salgotra R. K.
Published: November 2018

A set of 96 common bean genotypes were characterized using 25 candidate gene based SSR markers associated with yield traits. Twenty three SSR markers were found polymorphic and their discriminatory power estimation was performed on the basis of PIC, resolving power and marker index that mainly explain ability of molecular markers to distinguish genotypes. An average of 0.33 PIC was observed where highest value was exhibited by the primer BM184. The primers BM170 and Bmd8 generated four alleles whereas BM170 showed maximum marker index of 1.28 and highest resolving power of 1.89 was found in case of primer BM180. Further, the genotypes were grouped in three major clusters based on DARwin5 software. High level of genetic diversity observed within the genotypes could be used to accelerate genetic improvement of germplasm in common bean targeting yield attributing traits.
Validation of molecular marker associated with powdery mildew resistance in mungbean
Authors: Bhat Sumangala , Pooja S. K. , Sarkale A. P.
Published: November 2018

Powdery mildew caused by Erysiphe polygoni, is one of the major diseases of mungbean (Vigna radiata L. Wilczek), causes yield loss up to 20-40%. The present investigation was undertaken to study the SSR markers associated with powdery mildew resistance in mungbean. The resistant line, TARM1 was crossed with highly susceptible, but popular variety DGGV2 and the F1s were selfed to obtain F2. F2 population was evaluated for response to PM under field conditions. Of the 64 SSR markers studied, only four were found to be polymorphic between two parents (TARM1 and DGGV2). Single marker analysis indicated that one SSR marker (MB-SSR238) showed association with powdery mildew resistance in mungbean, explaining the phenotypic variance of 11.64%.
Utjecaj klimatskih promjena
na turističke tijekove
Authors: Šverko Grdić Zvonimira , Špoljarić Tatjana
Published: November 2018

Klimatske promjene predstavljaju jedinstveni izazov cjelokupnoj ljudskoj
civilizaciji i utječu na sve aspekte ljudskog života, pa tako i na turizam. Zemlja je u ovom trenutku toplija za 0.7 °C u odnosu na 1900. godinu, a ako se sve emisije stopiraju danas, Zemlja će se u idućem desetljeću zagrijati za daljnjih 0.5 – 1 ºC. Posljednjih nekoliko desetljeća sve se više pažnje pridaje promjenama vezanim uz klimu. Istraživanja pokazuju da najveći utjecaj na te promjene ima ispuštanje ugljikova dioksida u atmosferu, koji zbog svojih svojstava pojačava učinak staklenika na Zemlji. Turistička industrija, kao jedna od gospodarskih aktivnosti, zauzima velik udio u cjelokupnim emisijama CO2 koje nastaju ljudskom aktivnošću, a najveći utjecaj na to imaju promet, smještaj i ostale aktivnosti. Isto kao što turizam ima utjecaj na klimatske promjene, tako i klimatske promjene imaju utjecaj na turizam. U
radu je korištena regresijska analiza s ciljem utvrđivanja učinka nezavisne varijable (temperatura zraka) na zavisnu varijablu (noćenja gostiju). Osnovni cilj istraživanja je ispitati utjecaj temperature na broj noćenja u odabranim gradovima Republike Hrvatske te utvrditi hoće li se buduće planirano povećanje temperature negativno odraziti na turistička ostvarenja u promatranim područjima. Na temelju provedene analize može se zaključiti kako klimatske promjene, iskazane pomoću temperature zraka, zaista utječu na turizam, i to pozitivno. No, potrebno je naglasiti da postoji ograničenje u smislu optimalne temperature, odnosno, kada ona prijeđe tu granicu, broj turista će se (ako se ne poduzmu određene mjere prilagodbe turističkog sektora) početi
smanjivati.
Izuzeća za vozače i vozila – posebice u odnosu na prijevoz
putnika na linijskim vožnjama na udaljenosti do 50 kilometara
Authors: Gočin Miljenko , Debeljak Sandra
Published: November 2018

Exemptions from the application of certain provisions on working time, obligatory breaks for mobile workers and recording equipment in road transport applies to certain drivers who operate the excluded categories
of vehicles and to vehicles which are partially or entirely exempted from the obligation to install a road vehicle recording device – a tachograph. Through this research, this paper answers the question what exactly the exemptions are, what law sources appertain to these exceptions, whether they apply in practice and what the novelties are in
their practical implementation. The paper also explains the legal rules
that determine the working hours and obligatory breaks of excluded drivers and how to keep records for such workers and their working hours. At the end of the paper, authors indicate advantages and disadvantages of applying these exemptions for both drivers and employers, and provide a concluding assessment of the benefits of these exemptions, as well as the need for additional interventions through acts, but even more, through practical knowledge of the rights and obligations of drivers and employers in order to overcome the vagueness and insecurities of these major participants in the transport of goods and passengers in road transport.
Pregled alata za modeliranje baza podataka – MySQL Workbench, Open ModelSphere, Dia
Authors: Bjelić Marjana , Poščić Patrizia , Jakšić Danijela
Published: November 2018

Rad prikazuje usporedbu i analizu triju alata za modeliranje baza podataka – MySQL Workbench (MW), Open ModelSphere i Dia. Uvriježena mišljenja su da je MW spor, da Open ModelSphere nije dizajnerski lijep, a
dodavanje atributa zahtjevno, te da je Dia najbolji i najjednostavniji alat od ponuđenih. Alate ćemo usporediti i testirati na istom primjeru kako bismo iz prve ruke vidjeli jesu li uvriježena mišljenja točna te slažemo li se s njima. Nakon analize različitih mišljenja i međusobne usporedbe alata, glavni doprinos ovog rada je sama usporedba i analiza te zaključak da sva tri alata imaju svoje prednosti i mane, a na korisniku je da izabere koji će alat odabrati za daljnje korištenje.