bluuebunny/crossref_metadata_2025 huggingface dataset:
ANGLO-SAXON GUIDESTONES OF GROWING GLOBAL CONFRONTATION BETWEEN CIVILIZATIONS
Authors: Vasiliev Vladimir
Published: October 2022

The article analyzes the origins and implementation progress of the agreement between the United States, Great Britain and Australia on the formation of the triple military alliance AUKUS, which was announced on September 15, 2021. It is emphasized that the emerging military alliance is based on the concept of integrating the military-industrial complexes of the three Anglo-Saxon countries, aimed at containing and confronting the People’s Republic of China (PRC) in the Indo-Pacific region. The main program of action of the emerging military alliance is to equip the Australian Navy with 8 submarines with nuclear power plants. The serious military-technical difficulties that this program will face and is already facing are indicated. At the same time, the process of involving the Australian military-technical potential in the creation of a number of other weapons systems, in particular, hypersonic weapons, is also underway. The formation of AUKUS is considered in a broader aspect as a reflection of the desire of Great Britain and the United States to build a hierarchy of control of the global world order, subject to its subordination to the «collective West», in which the «closed club» of the Anglo-Saxon countries plays the main role. The transformation of the union of Anglo-Saxon countries into the main «bearing» element of the system of global hierarchical governance occurs in the context of the growing crisis of the neoliberal model of globalization, which was given universal civilizational significance at the turn of the 1980 s-1990 s. Thus, a new geopolitical and geo-economic fracture is implanted into the world civilizational space, based on the confrontation of the Western system of values and the Asian system of values, built on the synthesis of Confucianism, Buddhism and Taoism.
SOME ASPECTS OF GERMAN STRATEGIC PLANNING IN INDO-PACIFIC REGION FACING THE RETURN OF GREAT POWER RIVALRY
Authors: Arzamanova Tatiana
Published: October 2022

At least in the medium term, the matrix of international relations will be determined not only by the emerging global «geopolitical rift», such as tensions between the United States and China, but also by the return of competition between the great powers. At the same time, the Indo-Pacific Region (IPR) inevitably becomes the main arena for the global confrontation between the United States and China for the opportunity to influence the reformatting of the world order. For the ITR, the growing tension in the South China Sea, the issue of non-proliferation of nuclear and other types of WMD are becoming increasingly important, while the competition of interests of the most important players (USA - China, China - India) in this region generates new security risks and challenges. As a major export trading power, Germany is not going to be limited to the role of an additional player in the region, the economic and geopolitical importance of which is steadily growing, especially given that conflicts in the ITR can threaten the most important trade and transport arteries linking Europe with Asia and Africa. Berlin’s goal is to expand Germany’s presence in the Indo-Pacific, relying on intra-regional cooperation, because the consolidation of the «bipolar structures» of the United States and China in the region is one of the main risks for other major players, as the confrontation between Washington and Beijing could take the form of a proxy war, destroying global supply chains. The strategic planning of the FRG in the ITR, in contrast to the similar strategy of the United States, does not have a pronounced anti-Chinese orientation, although it is aimed, in fact, at «containment» of China. Moreover, a more balanced policy of Germany and its European allies (primarily France) in the region, based on the search for a balance of interests, could contribute to a softer structuring of zones of influence in the ITR with an emphasis on a multilateral approach.
SISTEM INFORMASI MUTASI PEGAWAI PADA DINAS PENDIDIKAN DAN KEBUDAYAAN KABUPATEN GORONTALO
Authors: Hasyim Wahyudin
Published: October 2022

An information systems of employee mutation is vitally nevessary. Because it is very helpful, facilitate the implementation of the tasks, especially in making the draft of SK teacher mutation or `employee mutation created using by visual basic version 6.0 is software commonly used by programmers to create application for a variety of needs. This application is made simple and completed with an employee database that will be used as a database for employee mutation. The last conclusion of this simple appliccation is expected to simplify the work creating a draft decree of employee mutation because it is supported by a database that is maintained.
ANALISIS PROSES BISNIS KENAIKAN PANGKAT PADA DINAS PERTANIAN, PERKEBUNAN DAN KETAHANAN PANGAN KABUPATEN BONE BOLANGO
Authors: Lamusu Rizal
Published: October 2022

In the process of filing the promotion of civil servants at the Office of Argriculture. Plantation and Food Security Bone Bolango regency experienced the problems because the data or file civil servants are not stored in the field officials in Agriculture, Plantation and Food Security, Bone Bolango regency and data collection on the promotion of civil servants still do manually or conventional so takes long time. This research aims to simplify and accelerate the process of conducted with using the Research and Development (R and D) as well as development of systems using Bussiness Process Model Natotation  (BPMN). The result in this reserach showed gaps and opportunities for increase the business process in the Office of Agriculture, Plantation and Food Security in Bone Bolango regenvy that includes major activities and supporting activity. This research can be developed in the form of base web, mobile web, and security system.
Aplikasi Media Pembelajaran Teknologi Augmented Reality Berbasis Android
Authors: Djaina Rizky Sahril , Syahrial Syahrial , Abas Mohamad Ilyas
Published: October 2022

This research was conducted at SMK N 3 Gorontalo, which aims to develop learning media applications using augmented reality technology. At first the teaching system only led to conventional teaching, namely through power point teaching materials and print media as well as the lack of available hardware or network equipment and the absence of computers that were ready to be disassembled and then developed using augmented reality technology. Through this research, it is hoped that the learning process will be more interactive. This application was developed using a prototype system development method that has a Requirements Gathering and Analysis phase, Quick Design, Build Prototype, User Evaluation, Refining Prototype and Engineer Product. The result of this study is a software application, namely an android-based augmented reality technology learning media application.
Be Free to Communicate on Social Media, but Respect the Values of Education!
Authors:   Universidade Autónoma de Lisboa (UAL), Center for Research and Development in Legal Sciences Ratio Legis in attention of the research group on Culture of Peace and Democracy, Palácio Dos Condes Do Redondo, R. de Santa Marta 56, 1169-023 Lisbon/Portugal, Sander Pires Alex , Dolezel Trindade Carla ,   Faculty Instituto Rio de Janeiro (FIURJ), Avenida Rio Branco, 277, 4th floor, Rio de Janeiro/Brazil, 20040-904, Aznar Filho Simão ,   Faculty Instituto Rio de Janeiro (FIURJ), Avenida Rio Branco, 277, 4th floor, Rio de Janeiro/Brazil, 20040-904
Published: October 2022

The technological revolution and the search for the “new post-pandemic normality” require a re-reading of the freedoms of communi­cation (freedom of expression and freedom of information), in order to con­ceive, in the face of the change of the paradigm of digital actors to three el­ements (individual, state and company), a new system that brings togeth­er the public and the particular which can be called collective and private, capable of forming awareness for peace in the face of the guarantee of the right to non-discrimination, centered on the balance between the legal and the civic possible through the binomial instruction-respect, that is, the indi­vidual recognition of respect for human dignity as guided by human rights in the perspective of fundamental freedoms in the posting and sharing of infor­mation on social networks, as oriented by the education values.
Tourism and COVID-19: Case of the Balkan Region
Authors:   Novi Sad School of Business, Serbia, Jovičić Vuković Ana
Published: October 2022

The crisis caused by the Covid-19 virus has had a significant im­pact on the tourism industry and brought numerous changes in travel pat­terns. Uncertainty, travel risks, restrictions, strict measures and limitations in terms of physical contact and mobility affected a re-evaluation of the exist­ing travel plans. The paper investigates travel plans among travelers in three Balkan countries (Serbia, Bosnia and Herzegovina, and Montenegro). Un­derstanding tourists’ preferences and future intentions are the essential ba­sis for creating a tourist offer, keeping tourists at the national and regional level, and mitigating the harmful effects of the crisis. These could contribute to the faster regional recovery of the tourism industry on the one hand and higher levels of tourist satisfaction on the other.
The Importance of Flexible Employment for Spatial-Functional Links between Settlements
Authors:   Univerzitet u Beogradu, Geografski fakultet, Studentski trg 3/3, Beograd, Srbija, Gligorijević Vera
Published: October 2022

The paper discusses urban-rural connections that arise from the geographical ap­proximation of place of residence and place of work (home-based business). The research was conducted on a sample of 310 entrepreneurs who work from home, and the locations of the respondents were classified according to the distance from the central market (Belgrade) into three zones: center, periphery and semi-periphery. The connections between these three zones and their spatial-functional relations were investigated by spatial analysis of the distribution of their main sources of equipment and raw materials, on the one hand, and the distribution of their consumers, on the other. The results showed that the flexibility of the location of work es­tablishes intensive connections between settlements, which implies new forms of interaction between the village and the city and the diversification of the rural economy.
Crude Oil Prices and the Chaotic Growth Model
Authors:   University of Belgrade, Faculty of Agriculture, Nemanjina 6, 11081 Belgrade, Serbia, Jablanovic Vesna
Published: October 2022

The basic aims of this paper are: firstly, to create the simple cha­otic crude oil prices growth model that is capable of generating stable equi­librium, cycles, or chaos; secondly, to discover a sequence of Elliot waves in crude oil prices movements in the period 1998-2015; and thirdly, to analyze the local stability of crude oil prices in the period 1998-2015. This paper con­firms the existence of the convergent fluctuations of crude oil prices in the ob­served period.
The Impact of Macroeconomic Indicators and FDI Inflows on the Economic Growth
Authors:   Novi Sad School of Business, Vladimira Perića Valtera 4, Novi Sad, Serbia, Ercegovac Dajana , Momčilović Mirela ,   Novi Sad School of Business, Vladimira Perića Valtera 4, Novi Sad, Serbia, Račić Željko ,   Novi Sad School of Business, Vladimira Perića Valtera 4, Novi Sad, Serbia
Published: October 2022

The focus of this paper is to test the relevance of chosen mac­roeconomic indicators and FDI net inflows on the economic growth stimu­lation in the sample of Emerging European Economies and sub-sample of Visegrad States in the period 1997-2017. This empirical research comprises from analysis of robust panel data modes on the total sample level and in the two analyzed sub-periods (before and after the Global Financial Crisis – GFC) with the use of a dummy variable for the Visegrad States. The results of robust estimations indicate that greater FDI net inflows are a relevant factor of economic growth on the total sample level and in the Visegrad States af­ter the GFC. Based on the empirical findings, the authors suggest that poli­cymakers in the Western Balkans should introduce the necessary promotion measures in order to attract greater FDI inflows and boost the economic de­velopment level.
International Student Mobility – Poland in Comparison with Selected European Union Countries
Authors:   Wroclaw University of Economics and Business, 53-345 Wroclaw, ul. Komandorska 118/120, Poland, Teneta-Skwiercz Dorota , Sobińska Małgorzata ,   Wroclaw University of Economics and Business, 53-345 Wroclaw, ul. Komandorska 118/120, Poland
Published: October 2022

The paper aimed to diagnose Poland’s position in terms of stu­dents’ mobility abroad compared with selected European Union countries and to identify the opinions of students from Polish public universities of economics on the benefits and barriers of international exchange. The re­search used a multimethod approach (desk research method and survey method), with data triangulation (secondary data – UNESCO statistical data and primary data, obtained in surveys). The research shows that Poland has the lowest outbound mobility rate and the most significant imbalance be­tween incoming and outgoing exchange students of all the countries sur­veyed. The top three benefits of international exchange include improved language skills, getting to know another culture and the opportunity to find out if a student wants to live and work abroad. The authors found the main barrier to be the cost of studying abroad.
Capital Market Efficiency in Asia: An Empirical Analysis
Authors:   School of Business and Administration, Polytechnic Institute of Setúbal, Portugal, Revez Catarina , Dias Rui ,   School of Business and Administration, Polytechnic Institute of Setúbal, Portugal; CEFAGE-UE, IIFA, University of Évora, Portugal, Horta Nicole ,   School of Business and Administration, Polytechnic Institute of Setúbal, Portugal, Heliodoro Paula ,   School of Business and Administration, Polytechnic Institute of Setúbal, Portugal, Alexandre Paulo ,   School of Business and Administration, Polytechnic Institute of Setúbal, Portugal
Published: October 2022

This paper aims to test efficiency, in its weak form, in the capi­tal markets of the Philippines (PSEi), South Korea (KOSPI), Indonesia (JKSE), Thailand (SET), Malaysia (KLCI), China (SSEC) and Hong Kong (HSI) over the period from January 2, 2017, to February 17, 2022. The return series shows signs of deviation from the normality hypothesis, given the skewness and kurtosis coefficients. The results, therefore, support the conclusion that the random walk hypothesis is not supported by the indices, the values of the variance ratios are in all cases less than unity, implying that the returns are autocorrelated over time and there is mean reversion in all indices. The re­sults obtained allow for the rejection of the random walk hypothesis and the informational efficiency hypothesis of financial markets. These findings also open room for market regulators to pursue measures to ensure better infor­mation in these regional markets.
The COVID-19 Pandemic, Government Response, and Serbian Stock Market: Evidence from ARDL Cointegration Model
Authors:   Megatrend University, Faculty of Management Zaječar, Zaječar, Serbia, Đorđević Bojan , Stanković Sunčica ,   Megatrend University, Faculty of Management Zaječar, Zaječar, Serbia
Published: October 2022

The existence of a real possibility that the current health crisis could lead to an economic crisis has prompted governments worldwide to make great efforts to sustain their markets. This paper explores the im­pact of COVID-19 and Serbian government anti-Covid activities on the do­mestic stock market using the Autoregressive Distributed Lag (ARDL) Coin­tegration model. In its research, the paper considers the impact of the num­ber of newly infected and the number of deaths from coronavirus daily, as well as measures taken by governments to combat viruses on the represent­ative Belgrade stock exchange index BELEX15. The results showed a signifi­cant long-term negative impact on the number of deaths per day and inter­national travel control on the BELEX15 index. In terms of reducing the neg­ative consequences of the crisis caused by the global pandemic, these re­sults could be a good guideline for effective management of government measures.
Yıldız Lejyonları’nın Dis(Ü)topik Kurgusunda Anaerkillik-Ataerkillik İkiliği
Authors: DAĞ Ülfet
Published: October 2022

Ütopya ve distopya geleceğe dönük olsa da temelde içinde bulunulan toplumsal sorunları gözler önüne seren iki türdür. Her ikisi de şimdinin eleştirisini yapar. Ütopya bunu daha iyi bir gelecek toplumu nasıl olur düşüncesinden hareketle kurgular. Distopya mevcut durumun kötüleşmesi hâlinde toplumu bekleyen tehlikeler konusunda uyarır. Feminist hareketlerin ortaya çıkışı ile beraber feminist perspektiften bakılan ütopyalar cinsiyet eşitsizliğinin olmadığı alternatif toplumlar yaratırken distopyalar kadınların ataerkil bir düzen tarafından tamamıyla tahakküm altına alındığı ve sınırlandırıldığı bir toplumu tasvir eder. Kameron Hurley Yıldız Lejyonları’nda alternatif bir alan açarak sadece kadınlardan oluşan farklı bir toplumsal düzen yaratır. Eşitlik, kardeşlik, yardımlaşma gibi unsurlar esere ütopik bir vizyon kazandırırken savaş, şiddet, mücadele ve hâkimiyet kurma gibi ayrıştırıcı unsurlar eseri distopyaya dönüştürür. Eserin bu özelliği karşılaştırmalı yöntemle incelenmesini mümkün hâle getirmiştir. Karşılaştırmalı bakış açısıyla eserdeki ütopik söylemler anaerki, yaratıcılık ve yaşamla ilişkilendirilirken distopik söylemler ataerki, yıkıcılık ve ölümle bağlantılıdır. Kadınlara rahimleri olduğu için iktidar ve güç veren şey aynı zamanda onları kadın karakterlerde gizil hâlde bulunan ataerkil bir ideolojinin kölesi hâline getirmiştir. Yazar rahmin işlevini bozarak anaerkil mitlerin parodisini yapmıştır. Böylelikle kadın bedeninin fallus merkezli temsillerinin muadili olduğunu göstermiştir. Anaerkil bir düzenin iktidara geldiğinde neler olacağına dair olumsuz izdüşümü olsa da anaerkil düzeni birlikte oluşturan eril ve dişil güçler olmuştur.
PRODUCTION PERFORMANCE AND VARIOUS IMPORTANT BEHAVIORS PERFORMED BY THE Apis mellifera scutellata BEE RACE
Authors: Tarekegn Alayu , Faji Mulisa , Abebe Alemayehu
Published: October 2022

Honey bee colonies exhibit a wide range of behavioral variations depending on genetic origin and environmental factors. Therefore, the performance evaluation of honey bee races is critical to laying a foundation for future selection and improvement in Ethiopia. Thirty colonies of Apis mellifera scutellata (A. m. scutellata) similar in resources contained in the hive were kept in improved box hives and evaluated through various behaviors (i.e. Reproductive swarming tendency, foraging activity, defensive behavior, hygienic behavior, brood population, honey production, and absconding behavior) during the active season and dearth season. In the study area, the A. m. scutellata race has a higher swarming tendency in the active season, with up to 3.42 queen caps per hive prepared per year. Defensive behavior during the active season takes an average of 25.41 seconds after disturbances and follows up to a 212.20-meter distance. But during the dearth season, the colony slightly took a long time to reach aggressiveness after disturbance (31.28 seconds) and followed the observer for a short distance (45.58 meters). The closed brood production is higher (149 units per hive) during the active season and nectar production units per hive are reduced by 50% as compared to the dearth season. The yielding performance of the race per frame ranged from 1.3 kg to 1.5 kg, and an average of 14 kg of honey per harvest. The A. m. scutellata exhibited an absconding tendency of 34.5% if there was any disruption. A. m. scutellata showed good performance in hygienic behaviors (>95%), but undesirable behaviors in defensive behavior, and swarming tendencies make it difficult to manage honey bees. However, the race has good performance in foraging and hygienic behaviors. Further, studies of the honey bee race through selection and breeding could be conducted to reduce the higher defensive and swarming tendency of A. m. scutellata to improve production performance.
Individual Dose Response and Radiation Origin of Childhood and Adolescent Thyroid Cancer in Fukushima II: Possibility of High I-131 Exposure as in Chernobyl
Authors: Kato Toshiko , Kato Toshiko , Yamada Kosaku
Published: October 2022

Background: Thyroid cancer incidence of individual dose groups in Fukushima residents exposed at ≤18 years of age demonstrated a linear response to thyroid dose estimated in the United Nations Scientific Committee on the effects of Atomic Radiation (UNSCEAR) 2020/2021. Increased childhood thyroid cancer in Fukushima was found to come dominantly from radiation exposure from the nuclear accident. The UNSCEAR 2020/2021 concluded that the apparent excess of thyroid cancers would not be expected at thyroid doses estimated by the UNSCEAR. The purpose of this paper is to solve the puzzle of the high childhood thyroid cancer incidence in Fukushima despite the estimated low thyroid dose.
Methods: The conversion coefficient k connecting thyroid doses estimated in UNSCEAR 2020/2021 and doses based on direct thyroid dose measurements in Chernobyl: 1 GyUN2021 = k × 1 Gy (gray), was estimated by comparing incidences and dose dependences of thyroid cancers in Fukushima and Chernobyl after nuclear disasters.
Results: The ratio of the observed cases /expected cases from cancer registry: of about 60 in Fukushima prefecture, was higher than the ratios observed after the Chernobyl accident. The thyroid doses estimated by UNSCEAR were corrected by adding a baseline dose to recover the severely underestimated ingestion dose. The conversion coefficients were: k =60~70 from the comparison of the excess absolute risks (EAR) and their dose dependences in Fukushima and in Chernobyl, and k =10~180 from the comparison of excess relative risk per gray (ERR/Gy) in Fukushima with those in Chernobyl. The thyroid doses might have been underestimated by about 1/50~1/100 in UNSCEAR 2020/2021.
Conclusion: The dozens-fold increase of childhood thyroid cancer cases after the Fukushima nuclear accident was found to arise from radioactive iodine exposure comparable to that in Chernobyl.
Prevalence and Associated Factors of Caries and Periodontal Diseases among Adolescents in Kunming: A Cross-sectional Study
Authors: Xu Jie , Naorungroj Supawadee , Pahumunto Nuntiya , Teanpaisan Rawee
Published: October 2022

Objective: To investigate the prevalence of dental caries, and periodontal diseases among adolescents in urban high schools of Kunming and associated factors. Material and Methods: This cross-sectional survey enrolled 560 adolescents (17.3±0.5 years old), with an equal gender ratio. Self-administered questionnaires obtained the sociodemographic and behavioral variables. All subjects were examined for their clinical parameters; including, Decayed, Missing, and Filled Teeth (DMFT), the Simplified Oral Hygiene Index (OHI-S), bleeding on probing (BOP), probing depth (PD) and clinical attachment level (CAL) by two dentists. The correlations of explanatory variables with dental caries and periodontal disease outcomes were investigated using bivariate analysis; via chi-square and t-test. Multivariate regression analysis; including linear regression and logistic regression models, were investigated for related factors of dental caries and periodontal diseases. Results: The prevalence of caries was 72.5%, with a mean DMFT of 3.70±3.65. The DMFT of females was higher than males (p-value<0.001); approximately 12.3% were periodontal healthy. The prevalence of gingivitis and periodontitis was 80.4% and 7.3%, respectively; with no statistical difference between genders (p-value=0.221). Multivariate regression analysis showed that the prevalence of dental caries and periodontal diseases were associated with females and fair/ poor oral hygiene. Additionally, high sugar consumption was a significant risk predictor for dental caries (p-value=0.008). Conclusion: The high prevalence of dental caries and periodontal disease in Kunming urban high school adolescents were associated with females and oral hygiene. Therefore, it is necessary for them to pay more attention to their oral health, and to focus on improving the efficiency of oral hygiene behavior.
Seizure outcome after resection of insular glioma: a systematic review, meta-analysis, and institutional experience
Authors: Zhang John J. Y. , Lee Keng Siang , Wang Doris D. , Hervey-Jumper Shawn L. , Berger Mitchel S.
Published: October 2022

OBJECTIVE

Gliomas arising from the insular cortex can be epileptogenic, with a significant proportion of patients having medically refractory epilepsy. The impact of surgery on seizure control for such tumors is not well established. In this study, the authors aimed to investigate seizure outcomes after resection of insular gliomas using a meta-analysis and institutional experience.

METHODS

Three databases (Ovid MEDLINE, Embase, and Cochrane Central Register of Controlled Trials) were systematically searched for published studies of seizure outcomes after insular glioma resection from database inception to March 27, 2021. In addition, data were retrospectively collected on all adults (age > 17 years) who had undergone insular glioma resection between June 1997 and June 2015 at the authors’ institution. Primary outcome measures were seizure freedom rates at 1 year and the last follow-up. Secondary outcome measures consisted of persistent postoperative neurological deficit beyond 90 days, mortality, and tumor progression or recurrence.

RESULTS

Eight studies reporting on 453 patients who had undergone 460 operations were included in the meta-analysis. The pooled mean age of the patients was 42 years. The pooled percentages of patients with extents of resection (EORs) ≥ 90%, 70%–89%, and < 70% were 55%, 33%, and 11%, respectively. The pooled seizure freedom rate at 1 year was 73% for Engel class IA and 78% for Engel class I. The pooled seizure freedom rate at the last follow-up was 60% for Engel class IA and 79% for Engel class I. The pooled percentage of persistent neurological deficit beyond 90 days was 3%. At the authors’ institution, 109 patients had undergone resection of insular glioma. A greater EOR was the only significant independent predictor of seizure freedom after surgery (HR 0.290, p = 0.017). The optimal threshold for seizure freedom corresponded to an EOR of 81%. Patients with an EOR > 81% had a significantly higher seizure freedom rate (OR 2.16, p = 0.048).

CONCLUSIONS

Maximal safe resection can be performed with minimal surgical morbidity to achieve favorable seizure freedom rates in both the short and long term. When gross-total resection is not possible, an EOR > 81% confers the greatest sensitivity and specificity for achieving seizure freedom.

Systematic review registration no.: CRD42021249404 (https://www.crd.york.ac.uk/prospero/)
Surgery for glioblastomas in the elderly: an Association des Neuro-oncologues d’Expression Française (ANOCEF) trial
Authors: Laigle-Donadey Florence , Metellus Philippe , Guyotat Jacques , Menei Philippe , Proust François , Dufour Henry , Chinot Olivier , Honnorat Jérôme , Faillot Thierry , Paquis Philippe , Peruzzi Philippe , Emery Evelyne , Guillamo Jean-Sébastien , Carpentier Alexandre , Wager Michel , Lebbah Said , Hajage David , Delattre Jean-Yves , Cornu Philippe
Published: October 2022

OBJECTIVE

The role of surgery in the treatment of malignant gliomas in the elderly is not settled. The authors conducted a randomized trial that compared tumor resection with biopsy only—both followed by standard therapy—in such patients.

METHODS

Patients ≥ 70 years of age with a Karnofsky Performance Scale (KPS) score ≥ 50 and presenting with a radiological suspicion of operable glioblastoma (GBM) were randomly assigned between tumor resection and biopsy groups. Subsequently, they underwent standard radiotherapy during the first years of the trial (2008–2017), with the addition of adjunct therapy with temozolomide when this regimen became standard (2017–2019). The primary endpoint was survival, and secondary endpoints were progression-free survival (PFS), cognitive status (Mini-Mental State Examination), autonomy (KPS), quality of life (European Organisation for Research and Treatment of Cancer [EORTC] QLQ-C30 and QLQ-BN20), and perioperative morbidity and mortality.

RESULTS

Between 2008 and 2019, 107 patients from 9 centers were enrolled in the study; 101 were evaluable for analysis because a GBM was histologically confirmed (50 in the surgery arm and 51 in the biopsy arm). There was no statistically significant difference in median survival between the surgery (9.37 months) and the biopsy (8.96 months, p = 0.36) arms (adjusted HR 0.79, 95% CI 0.52–1.21, p = 0.28). However, the surgery group had an increased PFS (5.06 vs 4.02 months; p = 0.034) (adjusted HR 0.50, 95% CI 0.32–0.78, p = 0.002). Less deterioration of quality of life and KPS score evolution than in the biopsy group was observed. Surgery was not associated with increased mortality or morbidity.

CONCLUSIONS

This study suggests that debulking surgery is safe, and—compared to biopsy—is associated with a less severe deterioration of quality of life and autonomy, as well as a significant although modest improvement of PFS in elderly patients suffering from newly diagnosed malignant glioma. Although resection does not provide a significant survival benefit in the elderly, the authors believe that the risk/benefit analysis favors an attempt at optimal tumor resection in this population, provided there is careful preoperative geriatric evaluation.

Clinical trial registration no.: NCT02892708 (ClinicalTrials.gov)
Management strategies in clival and craniovertebral junction chordomas: a 29-year experience
Authors: Passeri Thibault , Champagne Pierre-Olivier , Giammattei Lorenzo , Abbritti Rosaria , Cartailler Jérôme , Calugaru Valentin , Feuvret Loïc , Guichard Jean-Pierre , Polivka Marc , Adle-Biassette Homa , Mammar Hamid , Bresson Damien , Herman Philippe , Mandonnet Emmanuel , George Bernard , Froelich Sébastien
Published: October 2022

OBJECTIVE

Chordomas represent one of the most challenging subsets of skull base and craniovertebral junction (CVJ) tumors to treat. Despite extensive resection followed by proton-beam radiation therapy, the recurrence rate remains high, highlighting the importance of developing efficient treatment strategies. In this study, the authors present their experience in treating clival and CVJ chordomas over a 29-year period.

METHODS

The authors conducted a retrospective study of clival and CVJ chordomas that were surgically treated at their institution from 1991 to 2020. This study focuses on three aspects of the management of these tumors: the factors influencing the extent of resection (EOR), the predictors of survival, and the outcomes of the endoscopic endonasal approaches (EEAs) compared with open approaches (OAs).

RESULTS

A total of 265 surgical procedures were performed in 210 patients, including 123 OAs (46.4%) and 142 EEAs (53.6%). Tumors that had an intradural extension (p = 0.03), brainstem contact (p = 0.005), cavernous sinus extension (p = 0.004), major artery encasement (p = 0.01), petrous apex extension (p = 0.003), or high volume (p = 0.0003) were significantly associated with a lower EOR. The 5-year progression-free survival (PFS) and overall survival (OS) rates were 52.1% and 75.1%, respectively. Gross-total resection and Ki-67 labeling index < 6% were considered to be independent prognostic factors of longer PFS (p = 0.0005 and p = 0.003, respectively) and OS (p = 0.02 and p = 0.03, respectively). Postoperative radiation therapy correlated independently with a longer PFS (p = 0.006). Previous surgical treatment was associated with a lower EOR (p = 0.01) and a higher rate of CSF leakage after EEAs (p = 0.02) but did not have significantly lower PFS and OS compared with primary surgery. Previously radiation therapy correlated with a worse outcome, with lower PFS and OS (p = 0.001 and p = 0.007, respectively). EEAs were more frequently used in patients with upper and middle clival tumors (p = 0.002 and p < 0.0001, respectively), had a better rate of EOR (p = 0.003), and had a lower risk of de novo neurological deficit (p < 0.0001) compared with OAs. The overall rate of postoperative CSF leakage after EEAs was 14.8%.

CONCLUSIONS

This large study showed that gross-total resection should be attempted in a multidisciplinary skull base center before providing radiation therapy. EEAs should be considered as the gold-standard approach for upper/middle clival lesions based on the satisfactory surgical outcome, but OAs remain important tools for large complex chordomas.
Short- and long-term outcomes of moyamoya patients post-revascularization
Authors: Teo Mario , Abhinav Kumar , Bell-Stephens Teresa E. , Madhugiri Venkatesh S. , Sussman Eric S. , Azad Tej Deepak , Ali Rohaid , Esparza Rogelio , Zhang Michael , Steinberg Gary K.
Published: October 2022

OBJECTIVE

The post-bypass stroke risk factors and long-term outcomes of moyamoya patients are not well documented. Therefore, the authors studied 30-day stroke risks and patients’ long-term physical, functional, and social well-being.

METHODS

This was a single-institution combined moyamoya disease (MMD) database interrogation and questionnaire study. From 1991 to 2014, 1250 revascularization procedures (1118 direct bypasses, 132 indirect bypasses) were performed in 769 patients. Completed questionnaires were received from and available for analysis on 391 patients, and 6-month follow-up data were available for 96.4% (741/769) of the patients.

RESULTS

The patients consisted of 548 females and 221 males, with a mean age of 32 years (range 1–69 years). Three hundred fifty-eight bypasses were performed in 205 pediatric patients (73% direct bypasses), and 892 revascularizations were performed in 564 adults (96% direct bypasses). Fifty-two patients (6.8%) developed major strokes with a worsening modified Rankin Scale (mRS) score within 30 days postoperatively. The 30-day major stroke risk was 5.3% (41/769) and 2.6% (12/467) after the first and second bypasses, respectively. Logistic regression analysis revealed that older age, modified MRI (mMRI) score, and hemodynamic reserve (HDR) score are clearly associated with higher postoperative stroke risks. Over a mean follow-up of 7.3 years (range 0.5–26 years), the long-term stroke risk among 741 patients was 0.6% per patient-year; 75% of these patients had excellent outcomes (mRS score 0–1). The long-term outcome questionnaire study showed that 84% (234/277) of patients reported resolution or improvement in their preoperative headache, 83% (325/391) remained employed or in school, and 87% (303/348) were self-caring.

CONCLUSIONS

In this large, single-center surgical series, most of the adult and pediatric patients had direct revascularization, with a 4.2% per-bypass-procedure (6.8% per patient) 30-day major stroke risk and a 0.6% per-patient-year long-term stroke risk. The authors identified various risk factors that are highly correlated with postoperative morbidity (age, mMRI score, and HDR score) and are involved in ongoing work to develop the predictive modeling for future patient selection and treatment.
Predicting leptomeningeal disease spread after resection of brain metastases using machine learning
Authors: Tewarie Ishaan Ashwini , Senko Alexander W. , Jessurun Charissa A. C. , Zhang Abigail Tianai , Hulsbergen Alexander F. C. , Rendon Luis , McNulty Jack , Broekman Marike L. D. , Peng Luke C. , Smith Timothy R. , Phillips John G.
Published: October 2022

OBJECTIVE

The incidence of leptomeningeal disease (LMD) has increased as treatments for brain metastases (BMs) have improved and patients with metastatic disease are living longer. Sample sizes of individual studies investigating LMD after surgery for BMs and its risk factors have been limited, ranging from 200 to 400 patients at risk for LMD, which only allows the use of conventional biostatistics. Here, the authors used machine learning techniques to enhance LMD prediction in a cohort of surgically treated BMs.

METHODS

A conditional survival forest, a Cox proportional hazards model, an extreme gradient boosting (XGBoost) classifier, an extra trees classifier, and logistic regression were trained. A synthetic minority oversampling technique (SMOTE) was used to train the models and handle the inherent class imbalance. Patients were divided into an 80:20 training and test set. Fivefold cross-validation was used on the training set for hyperparameter optimization. Patients eligible for study inclusion were adults who had consecutively undergone neurosurgical BM treatment, had been admitted to Brigham and Women’s Hospital from January 2007 through December 2019, and had a minimum of 1 month of follow-up after neurosurgical treatment.

RESULTS

A total of 1054 surgically treated BM patients were included in this analysis. LMD occurred in 168 patients (15.9%) at a median of 7.05 months after BM diagnosis. The discrimination of LMD occurrence was optimal using an XGboost algorithm (area under the curve = 0.83), and the time to LMD was prognosticated evenly by the random forest algorithm and the Cox proportional hazards model (C-index = 0.76). The most important feature for both LMD classification and regression was the BM proximity to the CSF space, followed by a cerebellar BM location. Lymph node metastasis of the primary tumor at BM diagnosis and a cerebellar BM location were the strongest risk factors for both LMD occurrence and time to LMD.

CONCLUSIONS

The outcomes of LMD patients in the BM population are predictable using SMOTE and machine learning. Lymph node metastasis of the primary tumor at BM diagnosis and a cerebellar BM location were the strongest LMD risk factors.
Is intracranial electroencephalography mandatory for MRI-negative neocortical epilepsy surgery?
Authors: Guo Zhihao , Zhang Chao , Wang Xiu , Liu Chang , Zhao Baotian , Mo Jiajie , Zheng Zhong , Shao Xiaoqiu , Zhang Jianguo , Zhang Kai , Hu Wenhan
Published: October 2022

OBJECTIVE

MRI-negative focal epilepsy is one of the most challenging cases in surgical epilepsy treatment. Many epilepsy centers recommend intracranial electroencephalography (EEG) for MRI-negative cases, especially neocortical epilepsy. This retrospective study aimed to explore whether intracranial monitoring is mandatory in MRI-negative neocortical epilepsy surgery and the factors that significantly influence the decision on whether to perform intracranial recording.

METHODS

In this study, consecutive surgical patients with focal MRI-negative neocortical epilepsy were recruited. All patients underwent routine preoperative evaluation according to the dedicated protocol of the authors’ epilepsy center to determine the treatment strategy. Patients were divided into two groups according to the surgical strategy, i.e., a direct group and a stereo-EEG (SEEG)–guided group. History of epilepsy, seizure frequency, interictal and ictal EEG data, PET data, PET/MRI coregistration data, neuropathological findings, and surgical outcomes were compared between the two groups. Multivariate analysis was performed to identify factors influencing the decision to perform SEEG monitoring.

RESULTS

Sixty-four patients were included in this study, 19 and 45 of whom underwent direct and SEEG-guided cortical resection, respectively. At an average follow-up of 3.9 years postoperatively, 56 patients (87.5%) had Engel class I results without permanent neurological deficits. Surgical outcomes were not significantly different between the direct and SEEG-guided groups (94.7% vs 84.4%). PET hypometabolic abnormalities were detected in all patients. There were significant differences between the two groups in the extent of hypometabolism (focal vs nonfocal, p < 0.01) and pathological subtype (focal cortical dysplasia type II vs others, p = 0.03). Multivariate analysis revealed that the extent of hypometabolism (OR 0.01, 95% CI 0.00–0.15; p = 0.001) was the only independent factor affecting the treatment strategy.

CONCLUSIONS

Careful selection of patients with MRI-negative neocortical epilepsy may yield favorable outcomes after direct cortical resection without intracranial monitoring. PET/MRI coregistration plays an essential role in the preoperative evaluation and subsequent resection of these patients. Intracranial monitoring is not a mandatory requirement for surgery if the focal hypometabolic areas are consistent with the findings of semiology and scalp EEG.
Spinal injuries after ejection seat evacuation in fighter aircraft of the German Armed Forces between 1975 and 2021
Authors: Sommer Fabian , Gadjradj Pravesh Shankar , Pippig Torsten
Published: October 2022

OBJECTIVE

The ejection seat is one of the most important rescue tools for military aircrews. However, the high ejection speeds place high loads on the pilots, which is mainly absorbed by the pilot’s spine. The differentiated evaluation of spinal injuries is of particular importance because this has a decisive influence on the further personal life and career of the affected aircrew members. Factors influencing the occurrence of a fracture as well as the impact of a spinal injury on military flight certification have not been addressed sufficiently to date.

METHODS

The authors conducted a retrospective evaluation of ejection seat evacuations in German Armed Forces combat aircraft accidents between 1975 and 2021. The total number of aviation accidents with ejection seat initiations and the survived ejections were collected. Accident-specific data and pilot-specific data were collected. In addition, it was evaluated whether aircrew members were recertified for military flight after the accident. The type of spinal injury and the location of the injury were evaluated. In addition to the descriptive statistics, two logistic regression models were developed to assess prediction values of accident- and pilot-specific factors for spine injuries.

RESULTS

A total of 103 aircrew members were included in this retrospective analysis. The overall prevalence of spine injuries was 56.3%, and the overall prevalence of spine fractures was 33.0%. In the first regression model analysis, there was no association with pilot flight experience, age, height, weight, BMI, and being diagnosed with a spine fracture. Similarly, aircraft type, altitude, and airspeed were not associated with the occurrence of spine fractures. In the regression model analysis for predictors of rejection in military flight recertification after ejection seat evacuation, lumbar spine fractures were associated with higher odds of being rejected for recertification.

CONCLUSIONS

Military aircraft crew members have a high risk of suffering from a spine injury after emergency evacuation using an ejection seat. In the subsequent medical workup, special attention should be paid to the spine, and ideally a consultation with a spine surgeon should be performed. Lumbar spine fractures may have major consequences for military flight certification, and therefore special attention should be paid to successful rehabilitation.
A national stratification of the global macroeconomic burden of central nervous system cancer
Authors: Gerstl Jakob V. E. , Yearley Alexander G. , Kilgallon John L. , Lassarén Philipp , Robertson Faith C. , Herdell Vendela , Wang Andy Y. , Segar David J. , Bernstock Joshua D. , Laws Edward R. , Ranganathan Kavitha , Smith Timothy R.
Published: October 2022

OBJECTIVE

Country-by-country estimates of the macroeconomic disease burden of central nervous system (CNS) cancers are important when determining the allocation of resources related to neuro-oncology. Accordingly, in this study the authors investigated macroeconomic losses related to CNS cancer in 173 countries and identified pertinent epidemiological trends.

METHODS

Data for CNS cancer incidence, mortality, and disability-adjusted life years (DALYs) were collected from the Global Burden of Disease 2019 database. Gross domestic product data were combined with DALY data to estimate economic losses using a value of lost welfare approach.

RESULTS

The mortality-to-incidence ratio of CNS cancer in 2019 was 0.60 in high-income regions compared to 0.82 in Sub-Saharan Africa and 0.87 in Central Europe, Eastern Europe, and Central Asia. Welfare losses varied across both high- and low-income countries. Welfare losses attributable to CNS cancer in Japan represented 0.07% of the gross domestic product compared to 0.23% in Germany. In low- and middle-income countries, Iraq reported welfare losses of 0.20% compared to 0.04% in Angola. Globally, the DALY rate in 2019 was the same for CNS cancer as for prostate cancer at 112 per 100,000 person-years, despite a 75% lower incidence rate, equating to CNS cancer welfare losses of 182 billion US dollars.

CONCLUSIONS

Macroeconomic losses vary across high- and low-income settings and appear to be region specific. These differences may be explained by differences in regional access to screening and diagnosis, population-level genetic predispositions, and environmental risk factors. Mortality-to-incidence ratios are higher in low- and middle-income countries than in high-income countries, highlighting possible gaps in treatment access. Quantification of macroeconomic losses related to CNS cancer can help to justify the spending of finite resources to improve outcomes for neuro-oncological patients globally.
Phase II trial of icotinib in adult patients with neurofibromatosis type 2 and progressive vestibular schwannoma
Authors: Zhao Fu , Li Shi-wei , Zhang Shun , Li Peng , Zhao Chi , Zhao Xiao-bin , Wang Chun-Hong , Zhang Jing , Wang Bo , Liu Pi-nan
Published: October 2022

OBJECTIVE

Neurofibromatosis type 2 (NF2) is a rare autosomal dominant syndrome associated primarily with bilateral vestibular schwannomas (VSs). Conventional surgical or radiosurgical treatments for VS in NF2 usually result in high risks of hearing loss and facial nerve impairment, while there is no validated medical option to date. This single-institution phase II study evaluated the efficacy and safety of icotinib, an oral epidermal growth factor receptor tyrosine kinase inhibitor, in patients with NF2 and progressive VS.

METHODS

Icotinib was administered daily at 375 mg orally in a continuous 28-day course for up to 12 courses. The primary endpoint of the study was radiographic response assessed by brain MRI using 3D volumetric tumor analysis and defined as a ≥ 20% decrease in VS volume. Hearing function was evaluated as a secondary endpoint, with response defined as a statistically significant increase in word recognition scores.

RESULTS

Ten eligible patients with a mean age of 23.8 years were enrolled. One patient (10%) with bilateral tumors experienced an objective radiographic response (−23.58% and −22.01%). Three (43%) of 7 patients met the hearing response criteria. At 12 months, the estimated progression-free survival was 82.0% (95% CI 42.3%–95.5%) for volumetric progression and 69.2% (95% CI 37.3%−87.2%) for hearing progression. Common mild to moderate adverse events included rash (90%), diarrhea (50%), myalgia (20%), and nausea/gastrointestinal pain (20%).

CONCLUSIONS

Icotinib carries minor toxicity and is associated with radiographic and hearing responses in patients with NF2 and progressive VS.