bluuebunny/crossref_metadata_2025 huggingface dataset:
Promoted ozonation for the decomposition of 1,4-dioxane by activated carbon
Authors: Tian Gui-Peng , Wu Qian-Yuan , Li Ang , Wang Wen-Long , Hu Hong-Ying
Published: September 2016

Worldwide attention has been attracted to 1,4-dioxane because of its probable human carcinogenicity and frequent occurrence in surface waters and wastewaters. Thus, many countries and organizations have set limits for the amount of this material in drinking water and wastewater effluent. However, the removal of 1,4-dioxane during traditional treatment processes, even ozonation (pH < 7), has been limited. Therefore, 1,4-dioxane removal during catalytic ozonation was investigated in this study, and activated carbon was selected as the ideal catalyst. The removal efficiency of 1,4-dioxane by ozonation was promoted significantly using activated carbon compared with that of ozonation only. Tert-butyl alcohol significantly reduced the removal efficiency of 1,4-dioxane during catalytic ozonation, which suggested that hydroxyl radicals (·OH) were formed during catalytic ozonation and played an important role in decomposing 1,4-dioxane. Additionally, results concerning the stability of activated carbon indicated that the catalytic activity of this catalyst remained steady during ozonation.
A pós-graduação na Universidade Federal da Fronteira Sul: interiorização e redução de assimetrias em uma região de fronteira
Authors: Trevisol Joviles Vitório
Published: September 2016

A Universidade Federal da Fronteira Sul (UFFS) é uma das 18 universidades públicas federais criadas a partir de 2003 no Brasil. A criação da UFFS, numa região de fronteira, é parte e resultado de um processo singular, que pode ser considerado sui generis no conjunto das universidades públicas e no interior da própria história da educação superior brasileira. A UFFS incorpora o universo da fronteira (território, sociedade e cultura) em seu próprio nome, razão pela qual foi tomada como referência empírica para os propósitos deste artigo. Pretende-se descrever a experiência de implantação da UFFS, com o intuito de compreender como uma universidade sediada numa região de fronteira se concebe e se relaciona com as temáticas e as problemáticas de seu entorno. A descrição e a análise se concentrarão, em especial, no processo de concepção e implantação da pós-graduação.
Mestrado Profissional em Ensino na Saúde no Brasil: avanços e desafios a partir de políticas indutoras
Authors: Vilela Rosana Brandão , Batista Nildo Alves
Published: September 2016

Este estudo objetivou conhecer as repercussões da indução dos mestrados profissionais em Ensino na Saúde, procurando subsídios para o aprimoramento e a sustentabilidade dos programas. O trabalho teve caráter qualitativo exploratório, reunindo análise documental e realização de entrevistas semiestruturadas com coordenadores dos programas, predominando a análise temática dos dados coletados. Evidenciaram-se duas categorias: “Avanços dos programas em Ensino na Saúde na modalidade profissional” e “Desafios na implementação da política indutora”. Os avanços foram identificados pelo crescimento do número de programas, distribuição regional e agregação dos programas na área de Ensino da Capes. Os desafios remetem para a ausência de financiamento, pouca valorização do mestrado profissional e pouca clareza dos critérios de avaliação dos programas.
Changing Role of Teachers in the Present Society
Authors: Hepsiba Netala , Subhashini A. , Raju M.V.R. , Rao Y.F.W. Prasada
Published: September 2016

The young today are facing the world in which communication and information revolution has led to changes in all spheres: scientific, technological, political, economic, social, and cultural. To be able to prepare our young people to face the future with confidence purpose and responsibility, the crucial role of teachers cannot be overemphasized. Given these multidimensional demands, Role of teachers also has to change. In the past, teachers used to be a major source of knowledge, the leader, and educator of their students school life. The changes that took place in education have initiated to change the role of teachers. In this article, we will examine how the role of teachers in the present society has to change.
Consideraciones sobre la gestión metropolitana en México. Acercamiento al caso de la Bahía de Banderas
Authors: Baños Francia José Alfonso
Published: September 2016

El artículo aborda el tema de la gestión de las zonas metropolitanas en México, dada la importancia de estos conglomerados en el sistema urbano nacional. Se estudia el caso de la Bahía de Banderas en concreto, región turística cuya dinámica ejemplifica la complejidad de administrar el territorio que trasciende los límites municipales. Explicamos el fenómeno y la problemática de las metrópolis mexicanas, resaltando las deficiencias de la estructura institucional, normativa y gubernamental, que dificultan la innovación en la gestión de estas ciudades. Las conclusiones sugieren promover la asociación y coordinación entre los tres niveles del gobierno (Federal, Estatal y Municipal) para acceder a una gobernabilidad metropolitana efectiva y coherente.
Efeitos do estresse térmico na produção de vacas leiteiras: Revisão
Authors: Melo Aurélio , Moreira Juracy Mendes , Ataídes Daniela Silva , Guimarães Rosiane Aparecida Macedo , Loiola Jorge Lima , Sardinha Helbio Carlos
Published: September 2016

Brazil has highlighted the world's milk production, ranking fifth among the largest producers. Goiás ranks fourth in the ranking of states that produce milk with increased prospects over the years. The objective of this study describe about the effects of heat stress in the production of dairy cows. Heat stress influences the production and chemical composition of the milk, environment supply the making fundamental that provides thermal comfort to the animals. Seasonal variations influence the quality and quantity of milk produced, and animals of Indian origin (Bos indicus) are more tolerant to the tropical climate, when compared with European origin of animals (Bos Taurus), because of their greater ability to sweat and lower metabolic rate. However is right, the need for investment in facilities to enable environments with minimal conditions of temperature and relative humidity, which favors the production increase and improve the quality of milk produced.
O PESO DA MANUTENÇÃO HEGEMÔNICA
Authors: Cunha Daylhane
Published: September 2016

Resenha
A TEORIA DEMOCRÁTICA REFORMULADA ÀS NOVAS DEMANDAS GLOBALIZANTES
Authors: Cunha Daylhane
Published: September 2016

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INDIGANISMO, SOBERANIA E GEOPOLÍTICA NA REGIÃO DA RESERVA INDÍGENA RAPOSA SERRA DO SOL
Authors: Fontes Michelli Lima
Published: September 2016

Artigo
TRÊS DIAMANTES: COMO AS ZAIBATSU AJUDARAM A MANTER UM SENTIMENTO NACIONALISTA NA ERA DA GLOBALIZAÇÃO
Authors: Lott Danielle Maria Perez
Published: September 2016

Artigo
UM OLHAR DE EMBAIXADOR
Authors: Japiassu Ricardo
Published: September 2016

Ensaio
IMANUEL KANT À PAZ PERPÉTUA
Authors: Miranda Pedro Leal
Published: September 2016

Resenha
ENSAIO DA INTRODUÇÃO ÀS RELAÇÕES INTERNACIONAIS
Authors: Nascimento Renée Batista do
Published: September 2016

Resenha
CULTURA: UM CONCEITO ANTROPOLÓGICO
Authors: Camaroti Thabata
Published: September 2016

Resenha
UMA PERSPECTIVA GLOBAL DAS CRISES ECONÔMICAS
Authors: Souza Juan Domingo Teles de
Published: September 2016

Artigo
Cadherin-11 modulates cell morphology and collagen synthesis in periodontal ligament cells under mechanical stress
Authors: Feng Lishu , Zhang Yimei , Kou Xiaoxing , Yang Ruili , Liu Dawei , Wang Xuedong , Song Yang , Cao Haifeng , He Danqing , Gan Yehua , Zhou Yanheng
Published: September 2016

Objective: To examine the role of cadherin-11, an integral membrane adhesion molecule, in periodontal ligament cells (PDLCs) under mechanical stimulation.

Materials and Methods: Human PDLCs were cultured and subjected to mechanical stress. Cadherin-11 expression and cell morphology of PDLCs were investigated via immunofluorescence staining. The mRNA and protein expressions of cadherin-11 and type I collagen (Col-I) of PDLCs were evaluated by quantitative real-time polymerase chain reaction and Western blot, respectively. Small interfering RNA was used to knock down cadherin-11 expression in PDLCs. The collagen matrix of PDLCs was examined using toluidine blue staining.

Results: Cadherin-11 was expressed in PDLCs. Mechanical stress suppressed cadherin-11 expression in PDLCs with prolonged force treatment time and increased force intensity, accompanied by suppressed β-catenin expression. Simultaneously, mechanical stress altered cell morphology and repressed Col-I expression in a time- and dose-dependent manner in PDLCs. Moreover, knockdown of cadherin-11 with suppressed β-catenin expression resulted in altered PDLC morphology and repressed collagen expression, which were consistent with the changes observed under mechanical stress.

Conclusions: Results of this study suggest that cadherin-11 is expressed in PDLCs and modulates PDLC morphology and collagen synthesis in response to mechanical stress, which may play an important role in the homeostasis and remodeling of the PDL under mechanical stimulation.
Fractographical Analysis and Biomechanical Considerations of a Tooth Restored With Intracanal Fiber Post: Report of the Fracture and Importance of the Fiber Arrangements
Authors: Wandscher VF , Bergoli CD , Limberger IF , Cenci TP , Baldissara P , Valandro LF
Published: September 2016

Objective: This article aims to present a fractographic analysis of an anterior tooth restored with a glass fiber post with parallel fiber arrangement, taking into account force vectors, finite element analysis, and scanning electron microscopy (SEM).

Methods: A patient presented at the Faculty of Dentistry (Federal University of Santa Maria, Brazil) with an endodontically treated tooth (ETT), a lateral incisor that had a restorable fracture. The treatment was performed, and the fractured piece was analyzed using stereomicroscopy, SEM, and finite element analysis.

Results: The absence of remaining coronal tooth structure might have been the main factor for the clinical failure. We observed different stresses actuating in an ETT restored with a fiber post as well as their relationship with the ultimate fracture. Tensile, compression, and shear stresses presented at different levels inside the restored tooth. Tensile and compressive stresses acted together and were at a maximum in the outer portions and a minimum in the inner portions. In contrast, shear stresses acted concomitantly with tensile and compressive stresses. Shear was higher in the inner portions (center of the post), and lower in the outer portions. This was confirmed by finite element analysis. The SEM analysis showed tensile and compression areas in the fiber post (exposed fibers=tensile areas=lingual surface; nonexposed fibers=compression areas=buccal surface) and shear areas inside the post (scallops and hackle lines). Stereomicroscopic analysis showed brown stains in the crown/root interface, indicating the presence of microleakage (tensile area=lingual surface).

Conclusion: We concluded that glass fiber posts with parallel fibers (0°), when restoring anterior teeth, present a greater fracture potential by shear stress because parallel fibers are not mechanically resistant to support oblique occlusal loads. Factors such as the presence of remaining coronal tooth structure and occlusal stability assist in the biomechanical equilibrium of stresses that act upon anterior teeth.
The Association of Ankle Dorsiflexion Range of Motion With Hip and Knee Kinematics During the Lateral Step-down Test
Authors: Rabin Alon , Portnoy Sigal , Kozol Zvi
Published: September 2016

Study Design

Controlled laboratory study.

Background

Altered hip and knee kinematics have been associated with several knee disorders, including anterior cruciate ligament tear, patellofemoral pain, and iliotibial band syndrome. Limited ankle dorsiflexion (DF) range of motion (ROM), which has been linked with some of these disorders, has also been associated with altered knee kinematics.

Objective

To explore the association of ankle DF ROM with hip and knee kinematics during a step-down task.

Methods

Thirty healthy participants underwent a 3-D analysis of hip and knee kinematics during a lateral step-down test, followed by measurement of ankle DF ROM in weight bearing (WB) and non-weight bearing (NWB). Participants were dichotomized using the median values into low- and high-DF subgroups within both WB and NWB. Hip and knee kinematics were compared between the low- and high-DF subgroups.

Results

Participants in the low-DF subgroups exhibited greater peak hip adduction (WB, P = .02; NWB, P<.01) and greater peak knee external rotation (WB, P = .02; NWB, P<.01) compared with participants in the high-DF subgroups. In addition, participants in the low-DF WB subgroup exhibited decreased peak knee flexion compared with participants in the high-DF WB subgroup (P<.01).

Conclusion

Individuals with lower ankle DF ROM exhibited hip and knee kinematics previously associated with several knee disorders, suggesting that this impairment may be involved in the pathogenesis of the same disorders. Assessment of ankle DF ROM may be useful as part of a preparticipation screening. Furthermore, deficits in ankle DF ROM may need to be addressed in individuals with altered movement patterns. J Orthop Sports Phys Ther 2016;46(11):-1. Epub 29 Sep 2016. doi:10.2519/jospt.2016.6621
Pelvic Rotation in Femoroacetabular Impingement Is Decreased Compared to Other Symptomatic Hip Conditions
Authors: Azevedo Daniel Camara , Paiva Edson Barreto , Lopes Alexia Moura Abuhid , Santos Henrique de Oliveira , Carneiro Ricardo Luiz , Rodrigues André Soares , de Andrade Marco Antonio Percope , Novais Eduardo N. , Van Dillen Linda R.
Published: September 2016

Study Design

Cross-sectional, case-control design.

Background

Pelvic movement has been considered a possible discriminating parameter associated with femoroacetabular impingement (FAI) symptom onset. Decreased pelvic rotation has been found during squatting in people with FAI when compared to people with healthy hips. However, it is possible that changes in pelvic movement may occur in other hip conditions because of pain and may not be specific to FAI.

Objectives

To compare sagittal pelvic rotation during hip flexion and in sitting between people with FAI and people with other symptomatic hip conditions.

Methods

Thirty people with symptomatic FAI, 30 people with other symptomatic hip conditions, and 20 people with healthy hips participated in the study. Sagittal pelvic rotation was calculated based on measures of pelvic alignment in standing, hip flexion to 45° and 90°, and sitting.

Results

There were significant differences in sagittal pelvic rotation among the 3 groups in all conditions (P<.05). Post hoc analyses revealed that participants in the symptomatic FAI group had less pelvic rotation during hip flexion to 45° and 90° compared to participants in the other symptomatic hip conditions group and the hip-healthy group (mean difference, 1.2°–1.9°). In sitting, participants in the other symptomatic hip conditions group had less posterior pelvic rotation compared to those in the hip-healthy group (mean difference, 3.9°).

Conclusion

People with symptomatic FAI have less posterior pelvic rotation during hip flexion when compared to people with other symptomatic hip conditions and those with healthy hips.

Level of Evidence

Diagnosis, level 4. J Orthop Sports Phys Ther 2016;46(11):957–964. Epub 29 Sep 2016. doi:10.2519/jospt.2016.6713
Time-Discrete Vibrotactile Feedback Contributes to Improved Gait Symmetry in Patients With Lower Limb Amputations: Case Series
Authors: Crea Simona , Edin Benoni B. , Knaepen Kristel , Meeusen Romain , Vitiello Nicola
Published: September 2016

Background

Reduced sensory feedback from lower leg prostheses results in harmful gait patterns and entails a significant cognitive burden because users have to visually monitor their locomotion.

Objectives

The purpose of this study was to validate a sensory feedback device designed to help elderly patients with transfemoral amputation to improve their temporal gait symmetry after a training program aimed at associating the vibrotactile patterns with symmetrical walking.

Design

This was a prospective quasi-experimental study including 3 elderly patients walking with lower leg prostheses.

Methods

During training sessions, participants walked on a treadmill equipped with a feedback device that controlled vibrotactile stimulators based on signals from a sensorized insole while provided with visual feedback about temporal gait symmetry. The vibrotactile stimulators delivered short-lasting, low-intensity vibrations synchronously with certain gait-phase transitions. During pretraining and posttraining sessions, participants walked without visual feedback about gait symmetry under 4 conditions: with or without vibrotactile feedback while performing or not performing a secondary cognitive task. The primary outcome measure was temporal gait symmetry.

Results

With ≤2 hours of training, the participants improved their temporal gait symmetry from 0.82 to 0.84 during the pretraining evaluation session to 0.98 to 1.02 during the follow-up session across all conditions. Following training, participants were able to maintain good temporal gait symmetry, without any evidence of an increased cognitive burden.

Limitations

The small sample size and short follow-up time do not allow straightforward extrapolations to larger populations or extended time periods.

Conclusions

Low-cost, gait phase–specific vibrotactile feedback after training combined with visual feedback may improve the temporal gait symmetry in patients with transfemoral amputation without representing an additional cognitive burden.
Social Movements, Social Problems and Social Change
Authors: Yadav Ajay Kumar
Published: September 2016

Social movement is an organized effort by a significant number of people to change (or resist change in) some major aspect or aspects of society. Sociologists have usually been concerned to study the origins of such movements, their sources of recruitment, organizational dynamics, and their impact upon society. Social movements must be distinguished from collective behavior. Social movements are purposeful and organized; collective behavior is random and chaotic. Social movements include those supporting civil rights, gay rights, trade unionism, environmentalism, and feminism. Collective behaviors include riots, fads and crazes, panics, cultic religions, rumors. This paper deals with formation of social movement, emergence of social movement, social problems and social change.Academic Voices Vol.5 2015: 1-4
Asset Liability Management and Commercial Banks’ Profitability in Nepal
Authors: Shrestha Sanjay
Published: September 2016

This study examines the effect of ALM on commercial banks’ profitability in Nepal. ALM deals with the optimal investment of assets in view of meeting current goals and future liabilities. For this purpose top seven private commercial banks were taken as sample, which constitutes 49 percent share of total net profit of overall 30 commercial banks over 7 years time period from 2007-08 to 2013-14. The report emphasizes that the rate of return on assets is positive and varies across assets, and the rate of cost on liabilities is negative and varies across liabilities. The pooled OLS regression analysis result showed that all assets, including fixed assets, mainly loans and advances as well as other assets affect profitability positively, while all liabilities, mainly deposits, and other liabilities have negative effect on commercial banks profitability. With regard to macroeconomic variables, GDP and Inflation rate has negative effect on commercial banks profitability. As a result, the study recommended that commercial banks should focus on increasing public awareness to mobilize more saving and fixed deposits and this will enhance their performance in provision of loans and advance to customers.Academic Voices Vol.5 2015: 40-47
Birganjma Raheka Samudayeek Uchch Ma Bi Ka Shakshik Awastha
Authors: Shreshta Manju
Published: September 2016

Nepali abstract on the PDF.Academic Voices Vol.5 2015: 94-99
Multimodal Transportation Choices and Health: Exploratory Analysis Using Data Fusion Techniques
Authors: Lugo Miguel , Srinivasan Sivaramakrishnan
Published: September 2016

This study demonstrates the feasibility of fusing large-scale travel and health surveys and uses the new comprehensive data set generated to model the relationship between health and multimodal (walking, biking, transit, and vehicle usage) long-term (weekly, monthly, and yearly) travel choices. Two measures of health, the body-mass index (BMI) and a self-assessed physical health score (SAPHS), were fused from a health survey onto a travel survey at the disaggregate (individual) level. The probabilistic record linkage software, Link Plus, was used for the data fusion purposes. The methodology was validated by using the eating and health module (EH) of the American Time Use Surveys (ATUS). Subsequently, the algorithm was used to match the health information from the ATUS to the National Household Travel Surveys (NHTS) of 2008 to 2009, and the resulting master data set was used to develop models for multimodal travel choices and health. The statistical analysis indicates that although increasing walking and transit use were associated with better health (relative to nonusers of the mode), those with the highest levels of walking and transit use were also found to be in poor health relative to moderate users of the mode. Similarly, those at the two ends of the vehicle miles traveled spectrum (first and fourth quartiles) had higher BMI compared with those in the middle of the spectrum. There were no statistically significant effects of weekly bike trips on health measures. Overall, this study is envisioned as a proof-of-concept of how data fusion techniques may be used to integrate multiple data sets to facilitate a comprehensive study of multimodal travel choices and health.
Fleet Management and the Adoption of Innovations by Corporate Car Fleets: Exploratory Approach
Authors: Boutueil Virginie
Published: September 2016

Understanding the processes that guide fleet management by corporations is key to assessing the role that corporations could play in the transition toward a more sustainable mobility system and to drawing operational policy conclusions accordingly. Building on the information collected through 44 interviews with decision makers from 22 large organizations in the Paris region yields a much deeper understanding of the fleet management processes of large organizations. It was found that the prospects for global optimization of the corporate car fleet—from the perspectives of both purchase behaviors and daily operations—depend on the solutions that corporations can find to tackle the complexity of the decision-making processes for car fleet acquisition (e.g., through implementing car policies) and the shortcomings of information on fleet use and fleet costs (e.g., through deploying monitoring and tracking technologies). To discuss the outlook for electric vehicles and carsharing services in corporate car fleets, the specific barriers to, as well as drivers of, their adoption are analyzed, revealing some of the best practices.
Gender Differences in School and Work Commuting Mode Through the Life Cycle: Exploring Trends in the Greater Toronto and Hamilton Area, 1986 to 2011
Authors: Colley Michele , Buliung Ron N.
Published: September 2016

Reducing auto dependence and increasing the use of active and sustainable modes of transportation for school and work travel are necessary for alleviating traffic congestion issues that are typical in today’s North American cities and regions. While there is a growing interest in increasing the use of active and sustainable modes of travel for commuter trips in transportation planning, less attention has been paid in practice to gender differences in travel demand. This descriptive study explores gender differences in active transportation, public transit, and automobile use through the life cycle to assess temporal changes in gendered transport over the past 25 years in the greater Toronto and Hamilton area, Canada. Findings suggest that female children and youths are driven to school more frequently than males; however, males drive more than females during the years of labor force participation. Differences between female and male automobile use increase with age, but the gender gap has declined since the mid-1980s. Factors such as having one vehicle per household, more than six household members, and living and working in the city of Toronto are shown to associate with the largest differences in driving between full-time employed women and men. Distances between home and work have increased, particularly for women, and the percentage of women with a driver’s license has increased. Although driving remains higher for men than women during the part of the life course that includes labor force participation, the gender gap in active transportation, public transit, and automobile use appears to be lower today than in the mid-1980s.
PulseRider-assisted treatment of wide-necked intracranial bifurcation aneurysms: safety and feasibility study
Authors: Mukherjee Soumya , Chandran Arun , Gopinathan Anil , Putharan Mani , Goddard Tony , Eldridge Paul R. , Patankar Tufail , Nahser Hans-Christean
Published: September 2016

OBJECTIVE

The goal of this study was to assess the safety and feasibility of PulseRider, a novel endovascular stent, in the treatment of intracranial bifurcation aneurysms with wide necks. The authors present the initial results of the first 10 cases in which the PulseRider device was used.

METHODS

Patients whose aneurysms were intended to be treated with the PulseRider device at 2 institutions in the United Kingdom were identified prospectively. Patient demographics, procedural details, immediate neurological and clinical status, and immediate angiographic outcomes and 6-month clinical and imaging follow-up were recorded prospectively.

RESULTS

At the end of the procedure, all 10 patients showed complete aneurysm occlusion (Raymond Class 1). There were no significant intraprocedural complications except for an occurrence of thromboembolism without clinical sequelae. There was no occurrence of aneurysm rupture or vessel dissection. At 6-month follow-up, 7 and 3 patients had modified Rankin Scale scores of 0 and 1, respectively. All 10 patients had stable aneurysm occlusion (Raymond Class 1) and daughter vessel intraluminal patency on 6-month follow-up catheter angiography.

CONCLUSIONS

The authors' early experience with the PulseRider device demonstrates that it is a safe and effective adjunct in the treatment of bifurcation aneurysms with wide necks arising at the middle cerebral artery bifurcation, anterior cerebral artery, basilar apex, and carotid terminus. It works by providing a scaffold at the neck of the bifurcation aneurysm, enabling neck remodeling and coil support while maintaining parent vessel intraluminal patency. Early clinical and radiological follow-up showed good functional outcome and stable occlusion rates, respectively. Further data are needed to assess medium- and long-term outcomes with PulseRider.
Diffusion tensor imaging as a biomarker for assessing neuronal stem cell treatments affecting areas distal to the site of spinal cord injury
Authors: Jirjis Michael B. , Valdez Chris , Vedantam Aditya , Schmit Brian D. , Kurpad Shekar N.
Published: September 2016

OBJECTIVE

The aims of this study were to determine if the morphological and functional changes induced by neural stem cell (NSC) grafts after transplantation into the rodent spinal cord can be detected using MR diffusion tensor imaging (DTI) and, furthermore, if the DTI-derived mean diffusivity (MD) metric could be a biomarker for cell transplantation in spinal cord injury (SCI).

METHODS

A spinal contusion was produced at the T-8 vertebral level in 40 Sprague Dawley rats that were separated into 4 groups, including a sham group (injury without NSC injection), NSC control group (injury with saline injection), co-injection control group (injury with Prograf), and the experimental group (injury with NSC and Prograf injection). The NSC injection was completed 1 week after injury into the site of injury and the rats in the experimental group were compared to the rats from the sham, NSC control, and co-injection groups. The DTI index, MD, was assessed in vivo at 2, 5, and 10 weeks and ex vivo at 10 weeks postinjury on a 9.4-T Bruker scanner using a spin-echo imaging sequence. DTI data of the cervical spinal cord from the sham surgery, injury with saline injection, injury with injection of Prograf only, and injury with C17.2 NSC and Prograf injection were examined to evaluate if cellular proliferation induced by intrathoracic C17.2 engraftment was detectable in a noninvasive manner.

RESULTS

At 5 weeks after injury, the average fractional anisotropy, longitudinal diffusion (LD) and radial diffusion (RD) coefficients, and MD of water (average of the RD and LD eigenvalues in the stem cell line–treated group) increased to an average of 1.44 × 10−3 sec/mm2 in the cervical segments, while the control groups averaged 0.98 × 10−3 s/mm2. Post hoc Tukey's honest significant difference tests demonstrated that the transplanted stem cells had significantly higher MD values than the other groups (p = 0.032 at 5 weeks). In vivo and ex vivo findings at 10 weeks displayed similar results. This statistical difference between the stem cell line and the other groups was maintained at the 10-week postinjury in vivo and ex vivo time points.

CONCLUSIONS

These results indicate that the DTI-derived MD metric collected from noninvasive imaging techniques may provide useful biomarker indices for transplantation interventions that produce changes in the spinal cord structure and function. Though promising, the results demonstrated here suggest additional work is needed before implementation in a clinical setting.
Transcranial motor evoked potential waveform changes in corrective fusion for adolescent idiopathic scoliosis
Authors: Kobayashi Kazuyoshi , Imagama Shiro , Ito Zenya , Ando Kei , Hida Tetsuro , Ito Kenyu , Tsushima Mikito , Ishikawa Yoshimoto , Matsumoto Akiyuki , Nishida Yoshihiro , Ishiguro Naoki
Published: September 2016

OBJECTIVE

Corrective surgery for spinal deformities can lead to neurological complications. Several reports have described spinal cord monitoring in surgery for spinal deformity, but only a few have included patients younger than 20 years with adolescent idiopathic scoliosis (AIS). The goal of this study was to evaluate the characteristics of cases with intraoperative transcranial motor evoked potential (Tc-MEP) waveform deterioration during posterior corrective fusion for AIS.

METHODS

A prospective database was reviewed, comprising 68 patients with AIS who were treated with posterior corrective fusion in a prospective database. A total of 864 muscles in the lower extremities were chosen for monitoring, and acceptable baseline responses were obtained from 819 muscles (95%). Intraoperative Tc-MEP waveform deterioration was defined as a decrease in intraoperative amplitude of ≥ 70% of the control waveform. Age, Cobb angle, flexibility, operative time, estimated blood loss (EBL), intraoperative body temperature, blood pressure, number of levels fused, and correction rate were examined in patients with and without waveform deterioration.

RESULTS

The patients (3 males and 65 females) had an average age of 14.4 years (range 11–19 years). The mean Cobb angles before and after surgery were 52.9° and 11.9°, respectively, giving a correction rate of 77.4%. Fourteen patients (20%) exhibited an intraoperative waveform change, and these occurred during incision (14%), after screw fixation (7%), during the rotation maneuver (64%), during placement of the second rod after the rotation maneuver (7%), and after intervertebral compression (7%). Most waveform changes recovered after decreased correction or rest. No patient had a motor deficit postoperatively. In multivariate analysis, EBL (OR 1.001, p = 0.085) and number of levels fused (OR 1.535, p = 0.045) were associated with waveform deterioration.

CONCLUSIONS

Waveform deterioration commonly occurred during rotation maneuvers and more frequently in patients with a larger preoperative Cobb angle. The significant relationships of EBL and number of levels fused with waveform deterioration suggest that these surgical invasions may be involved in waveform deterioration.
Stereotactic radiosurgery for cerebellar arteriovenous malformations: an international multicenter study
Authors: Cohen-Inbar Or , Starke Robert M. , Kano Hideyuki , Bowden Gregory , Huang Paul , Rodriguez-Mercado Rafael , Almodovar Luis , Grills Inga S. , Mathieu David , Silva Danilo , Abbassy Mahmoud , Missios Symeon , Lee John Y. K. , Barnett Gene H. , Kondziolka Douglas , Lunsford L. Dade , Sheehan Jason P.
Published: September 2016

OBJECTIVE

Cerebellar arteriovenous malformations (AVMs) represent the majority of infratentorial AVMs and frequently have a hemorrhagic presentation. In this multicenter study, the authors review outcomes of cerebellar AVMs after stereotactic radiosurgery (SRS).

METHODS

Eight medical centers contributed data from 162 patients with cerebellar AVMs managed with SRS. Of these patients, 65% presented with hemorrhage. The median maximal nidus diameter was 2 cm. Favorable outcome was defined as AVM obliteration and no posttreatment hemorrhage or permanent radiation-induced complications (RICs). Patients were followed clinically and radiographically, with a median follow-up of 60 months (range 7–325 months).

RESULTS

The overall actuarial rates of obliteration at 3, 5, 7, and 10 years were 38.3%, 74.2%, 81.4%, and 86.1%, respectively, after single-session SRS. Obliteration and a favorable outcome were more likely to be achieved in patients treated with a margin dose greater than 18 Gy (p < 0.001 for both), demonstrating significantly better rates (83.3% and 79%, respectively). The rate of latency preobliteration hemorrhage was 0.85%/year. Symptomatic post-SRS RICs developed in 4.5% of patients (n = 7). Predictors of a favorable outcome were a smaller nidus (p = 0.0001), no pre-SRS embolization (p = 0.003), no prior hemorrhage (p = 0.0001), a higher margin dose (p = 0.0001), and a higher maximal dose (p = 0.009). The Spetzler-Martin grade was not found to be predictive of outcome. The Virginia Radiosurgery AVM Scale score (p = 0.0001) and the Radiosurgery-Based AVM Scale score (p = 0.0001) were predictive of a favorable outcome.

CONCLUSIONS

SRS results in successful obliteration and a favorable outcome in the majority of patients with cerebellar AVMs. Most patients will require a nidus dose of higher than 18 Gy to achieve these goals. Radiosurgical and not microsurgical scales were predictive of clinical outcome after SRS.
Occipital transtentorial/falcine approach, a “cross-court” trajectory to accessing contralateral posterior thalamic lesions: case report
Authors: Iwami Kenichiro , Fujii Masazumi , Saito Kiyoshi
Published: September 2016

Surgical treatment of lesions in the posterior thalamus, especially those extending laterally, is technically challenging because of a deep surgical field, narrow operative corridor, and the surrounding critical neurovascular structures. The authors describe an occipital transtentorial/falcine approach (OTFA) that was successfully used in the treatment of a cavernous malformation (CM) extending laterally from thalamus to midbrain. A 40-year-old man complained of progressive right hemiparesis and numbness. Radiological evaluation revealed a large CM in the left thalamus, surfacing on the pulvinar thalami, and extending 4 cm laterally from the midline. In addition to the usual procedures of a right-sided occipital transtentorial approach, the authors incised the falx cerebri to expand the operative corridor to the left thalamus. They achieved generous exposure of the left thalamus through a “cross-court” oblique trajectory while avoiding excessive retraction on the occipital lobe. The CM was completely removed, and no newly developed or worsening deficits were detected postoperatively. To better understand the OTFA and its application, the authors performed a cadaveric dissection. The OTFA provides increased exposure of the posterior thalamus without cortical incision and facilitates lateral access to this area through the “cross-court” operative corridor. This approach adds to the armamentarium for neurosurgeons treating thalamic lesions.
Clinical predictors of vestibulo-ocular dysfunction in pediatric sports-related concussion
Authors: Ellis Michael J. , Cordingley Dean M. , Vis Sara , Reimer Karen M. , Leiter Jeff , Russell Kelly
Published: September 2016

OBJECTIVE

There were 2 objectives of this study. The first objective was to identify clinical variables associated with vestibulo-ocular dysfunction (VOD) detected at initial consultation among pediatric patients with acute sports-related concussion (SRC) and postconcussion syndrome (PCS). The second objective was to reexamine the prevalence of VOD in this clinical cohort and evaluate the effect of VOD on length of recovery and the development of PCS.

METHODS

A retrospective review was conducted for all patients with acute SRC and PCS who were evaluated at a pediatric multidisciplinary concussion program from September 2013 to May 2015. Acute SRS was defined as presenting < 30 days postinjury, and PCS was defined according to the International Classification of Diseases, 10th Revision criteria and included being symptomatic 30 days or longer postinjury. The initial assessment included clinical history and physical examination performed by 1 neurosurgeon. Patients were assessed for VOD, defined as the presence of more than 1 subjective vestibular and oculomotor complaint (dizziness, diplopia, blurred vision, etc.) and more than 1 objective physical examination finding (abnormal near point of convergence, smooth pursuits, saccades, or vestibulo-ocular reflex testing). Poisson regression analysis was used to identify factors that increased the risk of VOD at initial presentation and the development of PCS.

RESULTS

Three hundred ninety-nine children, including 306 patients with acute SRC and 93 with PCS, were included. Of these patients, 30.1% of those with acute SRC (65.0% male, mean age 13.9 years) and 43.0% of those with PCS (41.9% male, mean age 15.4 years) met the criteria for VOD at initial consultation. Independent predictors of VOD at initial consultation included female sex, preinjury history of depression, posttraumatic amnesia, and presence of dizziness, blurred vision, or difficulty focusing at the time of injury. Independent predictors of PCS among patients with acute SRC included the presence of VOD at initial consultation, preinjury history of depression, and posttraumatic amnesia at the time of injury.

CONCLUSIONS

This study identified important potential risk factors for the development of VOD following pediatric SRC. These results provide confirmatory evidence that VOD at initial consultation is associated with prolonged recovery and is an independent predictor for the development of PCS. Future studies examining clinical prediction rules in pediatric concussion should include VOD. Additional research is needed to elucidate the natural history of VOD following SRC and establish evidence-based indications for targeted vestibular rehabilitation.
Preoperative mental health status may not be predictive of improvements in patient-reported outcomes following an anterior cervical discectomy and fusion
Authors: Mayo Benjamin C. , Massel Dustin H. , Bohl Daniel D. , Narain Ankur S. , Hijji Fady Y. , Long William W. , Modi Krishna D. , Basques Bryce A. , Yacob Alem , Singh Kern
Published: September 2016

OBJECTIVE

Prior studies have correlated preoperative depression and poor mental health status with inferior patient-reported outcomes following lumbar spinal procedures. However, literature regarding the effect of mental health on outcomes following cervical spinal surgery is limited. As such, the purpose of this study is to test for the association of preoperative SF-12 Mental Component Summary (MCS) scores with improvements in Neck Disability Index (NDI), SF-12 Physical Component Summary (PCS), and neck and arm pain following anterior cervical discectomy and fusion (ACDF).

METHODS

A prospectively maintained surgical database of patients who underwent a primary 1- or 2-level ACDF during 2014–2015 was reviewed. Patients were excluded if they did not have complete patient-reported outcome data for the preoperative or 6-week, 12-week, or 6-month postoperative visits. At baseline, preoperative SF-12 MCS score was assessed for association with preoperative NDI, neck visual analog scale (VAS) score, arm VAS score, and SF-12 PCS score. The preoperative MCS score was then tested for association with changes in NDI, neck VAS, arm VAS, and SF-12 PCS scores from the preoperative visit to postoperative visits. These tests were conducted using multivariate regression controlling for baseline characteristics as well as for the preoperative score for the patient-reported outcome being assessed.

RESULTS

A total of 52 patients were included in the analysis. At baseline, a higher preoperative MCS score was negatively associated with a lower preoperative NDI (coefficient: −0.74, p < 0.001) and preoperative arm VAS score (−0.06, p = 0.026), but not preoperative neck VAS score (−0.03, p = 0.325) or SF-12 PCS score (0.04, p = 0.664). Additionally, there was no association between preoperative MCS score and improvement in NDI, neck VAS, arm VAS, or SF-12 PCS score at any of the postoperative time points (6 weeks, 12 weeks, and 6 months, p > 0.05 for each). The percentage of patients achieving a minimum clinically important difference at 6 months did not differ between the bottom and top MCS score halves (p > 0.05 for each).

CONCLUSIONS

The results of this study suggest that better preoperative mental health status is associated with lower perceived preoperative disability but is not associated with severity of preoperative neck or arm pain. In contrast to other studies, the present study was unable to demonstrate that preoperative mental health is predictive of improvement in patient-reported outcomes at any postoperative time point following an ACDF.
Mental chronometry and mental rotation abilities in stroke patients with different degrees of sensory deficit
Authors: Liepert Joachim , Büsching Imke , Sehle Aida , Schoenfeld Mircea Ariel
Published: September 2016

Background: Motor imagery is used for treatment of motor deficits after stroke. Clinical observations suggested that motor imagery abilities might be reduced in patients with severe sensory deficits. This study investigated the influence of somatosensory deficits on temporal (mental chronometry, MC) and spatial aspects of motor imagery abilities.

Methods: Stroke patients ( n = 70; <6 months after stroke) were subdivided into 3 groups according to their somatosensory functions. Group 1 ( n = 31) had no sensory deficits, group 2 ( n = 27) had a mild to moderate sensory impairment and group 3 ( n = 12) had severe sensory deficits. Patients and a healthy age-matched control group ( n = 23) participated in a mental chronometry task (Box and Block Test, BBT) and a mental rotation task (Hand Identification Test, HIT). MC abilities were expressed as a ratio (motor execution time–motor imagery time/motor execution time).

Results: MC for the affected hand was significantly impaired in group 3 in comparison to stroke patients of group 1 ( p = 0.006), group 2 ( p = 0.005) and healthy controls ( p < 0.001). For the non-affected hand MC was similar across all groups. Stroke patients had a slower BBT motor execution than healthy controls ( p < 0.001), and group 1 executed the task faster than group 3 ( p = 0.002). The percentage of correct responses in the HIT was similar for all groups.

Conclusion: Severe sensory deficits impair mental chronometry abilities but have no impact on mental rotation abilities. Future studies should explore whether the presence of severe sensory deficits in stroke patients reduces the benefit from motor imagery therapy.
Disorders of sterol biosynthesis
Authors: Furtado Larissa V. , Kelley Richard I. , Opitz John M.
Published: September 2016

As a major component of the cell membrane of most eukaryotic cells, cholesterol assumes crucial roles in myelination of the central and peripheral nervous systems; in the synthesis of bile acids, steroids, and vitamin D; in sterol signaling; and in embryonic development. Inborn errors of cholesterol biosynthesis comprise a heterogeneous group of disorders characterized by developmental delays, increased tissue levels of specific sterol intermediates, and complex malformations involving many organ systems. Here we present the basics of cholesterol biosynthesis and review the clinical phenotype, biochemistry, molecular pathogenesis, and management of the 8 known errors of sterol metabolism in humans: Antley-Bixler syndrome, Greenberg dysplasia, X-linked dominant congenital hemidysplasia with ichthyosiform erythroderma and limb defects (CHILD syndrome), X-linked dominant chondrodysplasia punctacta (Conradi–Hünermann syndrome; CDPX2), lathosterolosis, Smith-Lemli-Opitz syndrome, desmosterolosis, and methyl sterol oxidase (MSOM1/SC4MOL) deficiency.
Lysosomal storage diseases
Authors: Ferreira Carlos R. , Gahl William A.
Published: September 2016

Lysosomes are cytoplasmic organelles that contain a variety of different hydrolases. A genetic deficiency in the enzymatic activity of one of these hydrolases will lead to the accumulation of the material meant for lysosomal degradation. Examples include glycogen in the case of Pompe disease, glycosaminoglycans in the case of the mucopolysaccharidoses, glycoproteins in the cases of the oligosaccharidoses, and sphingolipids in the cases of Niemann-Pick disease types A and B, Gaucher disease, Tay-Sachs disease, Krabbe disease, and metachromatic leukodystrophy. Sometimes, the lysosomal storage can be caused not by the enzymatic deficiency of one of the hydrolases, but by the deficiency of an activator protein, as occurs in the AB variant of GM2 gangliosidosis. Still other times, the accumulated lysosomal material results from failed egress of a small molecule as a consequence of a deficient transporter, as in cystinosis or Salla disease. In the last couple of decades, enzyme replacement therapy has become available for a number of lysosomal storage diseases. Examples include imiglucerase, taliglucerase and velaglucerase for Gaucher disease, laronidase for Hurler disease, idursulfase for Hunter disease, elosulfase for Morquio disease, galsulfase for Maroteaux-Lamy disease, alglucosidase alfa for Pompe disease, and agalsidase alfa and beta for Fabry disease. In addition, substrate reduction therapy has been approved for certain disorders, such as eliglustat for Gaucher disease. The advent of treatment options for some of these disorders has led to newborn screening pilot studies, and ultimately to the addition of Pompe disease and Hurler disease to the Recommended Uniform Screening Panel (RUSP) in 2015 and 2016, respectively.