bluuebunny/crossref_metadata_2025 huggingface dataset:
Creencias sobre el aprendizaje de las ciencias de los estudiantes del máster de profesorado de enseñanza secundaria
Authors: Pontes Pedrajas Alfonso , Poyato López Francisco José , Oliva Martínez José María
Published: February 2017

En este trabajo se muestran los resultados de un estudio empírico sobre las creencias de futuros docentes de enseñanza secundaria acerca de los procesos de aprendizaje de la ciencia, registradas mediante un cuestionario de escala likert que han cumplimentado 188 estudiantes del Máster de Profesorado de Educación Secundaria, de las especialidades de ciencia y tecnología. En primer lugar se han clasificado las diversas creencias por su relación con diferentes modelos didácticos y se ha realizadoun estudio descriptivo para conocer cuáles son las creencias más extendidas entre tales estudiantes. Posteriormente se ha desarrollado un análisis de las relaciones internas entre tales creencias y hemos observado que algunas ideas presentan cierto grado de articulación, pero en general no parecen formar esquemas de pensamiento coherentes.
La salida de campo, una posibilidad en la formación inicial docente
Authors: Álvarez Piñeros Dayanna , Vásquez Ortiz Wilson Fernando , Rodríguez Pizzinato Liliana Angélica
Published: February 2017

El artículo presenta una reflexión sobre una experiencia reciente de realización de salidas de campo en el ámbito universitario, en las que se ha creado una figura denominada estudiante de apoyo, para aportar desde otros referentes en su proceso de formación inicial como docente. Así, participa en el proceso logístico y académico de la preparación, desarrollo y finalización del trabajo de campo. De igual manera, realiza una sistematización de la experiencia en su conjunto, asumiendo un rol activo, participativo y de producción de conocimiento al realizar un proceso reflexivo que junto con la docente titular de la actividad, implica repensar no solo la salida de campo sino los saberes escolares que pueden jugar un papel significativo en ella.
¿Qué opinan los adolescentes sobre los museos y la didáctica?
Authors: Santacana Mestre Joan , Martínez Gil Tània , Llonch Molina Nayra , López Benito Victoria
Published: February 2017

El trabajo presenta parte de los resultados obtenidos en la segunda fase de una investigación sobre exclusión e inclusión cultural de los adolescentes respecto a los espacios patrimoniales. En concreto, analiza la percepción que tienen los estudiantes de 14 a 16 años sobre las acciones didácticas que se llevan a cabo en los museos poniendo especial énfasis en el trabajo de mediadores y educadores, en las fórmulas y grados de participación que se les brinda y en la naturaleza de las actividades que los museos les ofrecen. El artículo pone de manifiesto que los adolescentes no se siente partícipes del espacio museístico y que esto cambiaría si en lugar de exposiciones y explicaciones pasivas fuesen laboratorios y experiencias activos.
The emblem tradition in Shakespeare’s plays: mirror-effects and anamorphoses
Authors: Chardin Jean-Jacques
Published: February 2017

ABSTRACT: An emblem is a witty combination of various texts and one image which delivers a moral message. The emblem is an art of the gaze, the purpose of which is to lead the eye to the transcendent ideas lying behind the veil of worldly appearances. Shakespeare was obviously sensitive to the visual potential of emblems. This paper aims to show that Shakespeare drew upon the modus operandi of emblems but rejected the emblem as a fixed ideological discourse. Shakespeare used the emblem in an anamorphic way to confront the spectator with the shifting world he lives in. KEYWORDS: emblems; theater; Shakespeare.  RESUMEN: Un emblema es una ingeniosa combinación de varios textos y una imagen que esconden un mensaje moral. El emblema es un arte de la mirada cuyo propósito es conducir el ojo a las ideas trascendentes que se encuentran detrás del velo de las apariencias mundanas. Shakespeare era obviamente sensible al potencial visual de los emblemas. Este trabajo pretende mostrar que Shakespeare se basó en el modus operandi de los emblemas, pero rechazó el emblema como un discurso ideológico fijo. Shakespeare utilizó el emblema de manera anamórfica para confrontar al espectador con el mundo cambiante en el que vive. PALABRAS CLAVES: emblemas; teatro; Shakespeare.
Morales Folguera, José M., Escalera Pérez, Reyes y Talavera Esteso, Francisco J. (eds.). Confluencia de la imagen y la palabra.
Authors: Cazalla Canto Silvia
Published: February 2017

Recensión del libro:MORALES FOLGUERA, José M., ESCALERA PÉREZ, Reyes y TALAVERA ESTESO, Francisco J. (eds.) [2015]. Confluencia de la imagen y la palabra, Valencia, Universitat de València, pp. 468.
Maturandum
Authors: Editorial Equipo
Published: February 2017

IMAGO: revista de emblemática y cultura visual ha logrado dar recientemente un gran salto en la clasificación circ, hoy por hoy el sistema de clasificación de revistas más importante de España, en donde hemos sido evaluados y clasificados en la posición B.También esto repercute sobre la colección de «Anejos» de la revista, que recientemente ha publicado dos monografías.Lo puede «emblematizar» todo aquel emblema de Alciato cuyo mote reza: Maturandum, y que la edición italiana (Lyon, 1549) le daba un sentido muy claro: Che le buone deliberationi si debbono mettere in opera à tempo, sentido que también asumía la traducción española del mismo editor y año: Que todo se deue hazer con sazon. Evidentemente, van a cumplirse casi diez años desde que se aprobó la creación de la revista por la Asamblea General de la SEE (Gandía, octubre de 2007). El primer número correspondió a 2009, y vamos ya por el octavo.
Cervantes
Authors: Bernat Vistarini Antonio , T. Cull John
Published: February 2017

Si la intución de vincular a Shakespeare con el mundo de los emblemas fue rastreada por la crítica anglosajona desde antiguo, dando lugar a estudios extensos y minuciosos, no ha sido así con la obra de Cervantes. De hecho, no podemos hablar en rigor de unos primeros —y aún tímidos— análisis de este enlace hasta principios de los años ochenta del siglo pasado, y habrá que esperar a que acabe prácticamente el siglo para contar con una mínima bibliografía dedicada. Sin duda, la multiplicación de estudios coincide con el nuevo interés que gana en nuestro país la literatura de emblemas a impulsos de la Sociedad Española de Emblemática, de sus congresos y las publicaciones de sus miembros. Pero hay que destacar que, aún así, y hasta hoy, la figura de Cervantes se presenta escurridiza para la consolidación de esta bibliografía.
Shakespeare
Authors: Cull John T. , Bernat Vistarini Antonio
Published: February 2017

If scholarship devoted to the influence of emblematics on Cervantes is a relatively new field, the same cannot be said for Shakespeare. The study of the debt owed by Shakespeare to emblem books began in earnest over a century ago with the publication of Henry Green's pioneering Shakespeare and the Emblem Writers: An Exposition of their Similarities of Thought and Expression. Preceded by a View of Emblem-Literature Down to A.D. 1616 (London: Trübner and Co., 1870). One constant in the approach of Shakespeare critics in their handling of possible emblematic influence is to urge caution and prudence when considering emblem literature as a possible source or influence on Shakespeare.Si la investigación dedicada a la influencia de la emblemática en Cervantes es un campo relativamente nuevo, no podemos decir lo mismo en relación a Shakespeare. El estudio de las deudas del dramaturgo con los libros de emblemas se remonta a más o menos un siglo, con la publicación del estudio pionero de Henry Green, Shakespeare and the Emblem Writers: An Exposition of their Similarities of Thought and Expression. Preceded by a View of Emblem-Literature Down to A.D. 1616 (Londres: Trübner and Co., 1870). Una constante del acercamiento de la crítica a este asunto siempre ha sido recomendar la mayor cautela y prudencia en la consideración de la literatura emblemática como fuente o influencia posible sobre los textos de Shakespeare.
García Mahíques, Rafael, Doménech García, Sergi (eds.) [2015]. Valor discursivo del cuerpo en el Barroco hispánico.
Authors: Chiva Beltrán Juan
Published: February 2017

Recensión del libro:GARCÍA MAHÍQUES, Rafael, DOMÉNECH GARCÍA, Sergi (eds.) [2015]. Valor discursivo del cuerpo en el Barroco hispánico. Anejos de Imago. Revista de Emblemática y Cultura Visual, n. 4. Valencia, Universitat de València, 464 pp.
Equation‐derived body fat percentage indicates metabolic abnormalities among normal‐weight adults in a rural Chinese population
Authors: Liu Xin , Zhao Yaling , Li Qiang , Dang Shaonong , Yan Hong
Published: February 2017

Objectives

Obesity classification using body mass index (BMI) may miss subjects with elevated body fat percentage (BF%) and related metabolic risk factors. We aimed to evaluate whether BF% calculated by equations could provide more information about metabolic risks, in addition to BMI classification, in a cross‐sectional rural Chinese population.

Methods

A total of 2,990 men and women aged 18–80 years were included in this study. BF% was calculated using previously validated Chinese‐specific equations. Metabolic syndrome was defined according to the updated National Cholesterol Education Program Panel III criteria for Asian Americans.

Results

In total, 33.6% men and 32.9% women were overweight/obese according to BMI classification. Among those within the normal BMI range, 25.4% men and 54.7% women were indicated as overweight or obese given their elevated BF% (men: BF% ≥ 20%; women: BF% ≥ 30%). In both men and women, compared with those with normal BMI and BF% (NBB), subjects with normal BMI but elevated BF% (NBOB) were more likely to carry abnormal serum lipid profile and to have higher risks of metabolic syndrome. The multivariable adjusted odds ratios (95% confidence intervals) for metabolic syndrome were 5.45 (2.37–9.53, P < 0.001) and 5.65 (3.36–9.52, P < 0.001) for men and women, respectively. Moreover, the women with NBOB also showed higher blood pressure and serum uric acid than women with NBB.

Conclusions

Our study suggested that high BF% based on equations may indicate adverse metabolic profiles among rural Chinese adults with a normal BMI.
Weight, gender, and depressive symptoms in South Korea
Authors: Brewis Alexandra A. , Han Seung Yong , SturtzSreetharan Cindi L.
Published: February 2017

Objectives

Obesity consistently predicts depression risk, but the underlying mechanisms are poorly understood. Body concerns are proposed as key. South Korean society is characterized by extremely high levels of explicit weight stigma, possibly the highest globally. Using cross‐sectional Korean 2014 National Health Examination Survey (KNHANES) data, we test this proposition in a nationally representative sample of South Korean adults (N = 5,632).

Methods

Depressive symptoms (outcome variable), was based on the PHQ‐9. Weight status (predictor variable), was based on direct measures of height and weight converted to BMI. Weight concern was self‐reported. Mediation analyses tested how weight concern mediated the influence of weight status on depressive symptoms for women and men.

Results

Current weight status influenced depressive symptoms in Korean adults, but not always directly. Concerns of being “fat” mediated that relationship. The effect increased significantly as BMI increased within “normal” and overweight/obese categories for women, and in overweight/obese categories for men. Even though women classified as underweight were significantly more depressed than those in other weight categories, there was no similar mediation effect related to weight concerns.

Conclusion

For South Koreans, the stress of adhering to social norms and avoiding stigma related to body weight seems to explain the relationship between higher body weight and more depressive symptoms. Women are more vulnerable overall, but men are not immune. This study demonstrates that body concerns help explain why weight predicts depression, and more broadly supports the proposition that widespread weight‐related stigma is a potentially major, if unrecognized, driver of population‐level health disparities.
Total and central obesity in elderly associated with a marker of undernutrition in early life – sitting height‐to‐stature ratio: A nutritional paradox
Authors: Silveira Erika Aparecida , Ferreira Carla Cristina da Conceição , Pagotto Valéria , Santos Annelisa Silva e Alves de Carvalho , Velasquez‐Melendez Gustavo
Published: February 2017

Objectives

The purpose of this study was to investigate whether sitting height‐to‐stature ratio (SHSR) is associated with total and central obesity in the elderly.

Methods

This was a cross‐sectional study with 133 noninstitutionalized elderly. High SHSR (≥ 1SD above the mean) was used as a marker of undernutrition (MU) in early life. Poisson's multiple regression was used to determine the association between variables.

Results

The prevalence of high SHSR was 21.0%, total obesity 43.6% and central obesity 50.4%. Elderly with high SHSR presented a statistically significant association with total obesity (PR 1.50; 95% CI 1.04–2.18) and central obesity (PR 1.42; 95% CI 1.03–1.95) after adjustment for sex, age, educational level and income in the multivariate analysis.

Conclusion

The occurrence of total and central obesity in the elderly was associated with a MU in early life. This result indicates that nutritional deficiencies in childhood may increase the risk of obesity in the elderly, a nutritional paradox.
Milder Alzheimer's disease pathology in heart failure and atrial fibrillation
Authors: Sposato Luciano A. , Ruíz Vargas Estefanía , Riccio Patricia M. , Toledo Jon B. , Trojanowski John Q. , Kukull Walter A. , Cipriano Lauren E. , Nucera Antonia , Whitehead Shawn N. , Hachinski Vladimir
Published: February 2017

Introduction

Heart failure (HF) and atrial fibrillation (AF) have been associated with a higher risk of Alzheimer's disease (AD). Whether HF and AF are related to AD by enhancing AD neuropathological changes is unknown.

Methods

We applied network analyses and multiple logistic regression models to assess the association between HF and AF with severity of AD neuropathology in patients from the National Alzheimer's Coordinating Center database with primary neuropathological diagnosis of AD.

Results

We included 1593 patients, of whom 129 had HF and 250 had AF. HF and AF patients were older and had milder AD pathology. In the network analyses, HF and AF were associated with milder AD neuropathology. In the regression analyses, age (odds ratio [OR] 0.94, 95% confidence interval [CI] 0.93–0.95 per 1‐year increase in age, P < .001) and the interaction term HF × AF (OR 0.61, 95% CI 0.40–0.91, P = .014) were inversely related to severe AD pathology, whereas APOE ε4 genotype showed a direct association (OR 1.68, 95% CI 1.31–2.16). Vascular neuropathology was more frequent in patient with HF and AF patients than in those without.

Discussion

HF and AF had milder AD neuropathology. Patients with milder AD lived longer and had more exposure to vascular risk factors. HF and AF patients showed a higher frequency of vascular neuropathology, which could have contributed to lower the threshold for clinically evident dementia.
Survival after dementia diagnosis in five racial/ethnic groups
Authors: Mayeda Elizabeth R. , Glymour M. Maria , Quesenberry Charles P. , Johnson Julene K. , Pérez‐Stable Eliseo J. , Whitmer Rachel A.
Published: February 2017

Introduction

Information on anticipated survival time after dementia diagnosis among racially/ethnically diverse patients is needed to plan for care and evaluate disparities.

Methods

Dementia‐free health care members aged ≥64 years were followed (1/1/2000–12/31/2013) for dementia diagnosis and subsequent survival (n = 23,032 Asian American; n = 18,778 African American; n = 21,000 Latino; n = 4543 American Indian/Alaska Native; n = 206,490 white). Kaplan–Meier curves were estimated for survival after dementia diagnosis by race/ethnicity. We contrasted mortality patterns among people with versus without dementia using Cox proportional hazards models.

Results

After dementia diagnosis (n = 59,494), whites had shortest median survival (3.1 years), followed by American Indian/Alaska Natives (3.4 years), African Americans (3.7 years), Latinos (4.1 years), and Asian Americans (4.4 years). Longer postdiagnosis survival among racial/ethnic minorities compared with whites persisted after adjustment for comorbidities. Racial/ethnic mortality inequalities among dementia patients mostly paralleled mortality inequalities among people without dementia.

Discussion

Survival after dementia diagnosis differs by race/ethnicity, with shortest survival among whites and longest among Asian Americans.
Setting Foundations for Developing Disaster Response Metrics
Authors: Abir Mahshid , Bell Sue Anne , Puppala Neha , Awad Osama , Moore Melinda
Published: February 2017

There are few reported efforts to define universal disaster response performance measures. Careful examination of responses to past disasters can inform the development of such measures. As a first step toward this goal, we conducted a literature review to identify key factors in responses to 3 recent events with significant loss of human life and economic impact: the 2003 Bam, Iran, earthquake; the 2004 Indian Ocean tsunami; and the 2010 Haiti earthquake. Using the PubMed (National Library of Medicine, Bethesda, MD) database, we identified 710 articles and retained 124 after applying inclusion and exclusion criteria. Seventy-two articles pertained to the Haiti earthquake, 38 to the Indian Ocean tsunami, and 14 to the Bam earthquake. On the basis of this review, we developed an organizational framework for disaster response performance measurement with 5 key disaster response categories: (1) personnel, (2) supplies and equipment, (3) transportation, (4) timeliness and efficiency, and (5) interagency cooperation. Under each of these, and again informed by the literature, we identified subcategories and specific items that could be developed into standardized performance measures. The validity and comprehensiveness of these measures can be tested by applying them to other recent and future disaster responses, after which standardized performance measures can be developed through a consensus process. (Disaster Med Public Health Preparedness. 2017;11:505–509)
Bob Dingle (1920–2016)
Authors: Dartnall H J G
Published: February 2017

Bob Dingle (1920–2016). Bob Dingle (Fig 1), who was involved with the establishment of Australia's continental Antarctic stations in the 1950’s, has died in Swansea, Tasmania, aged 95. He was born William Robert John Dingle in 1920 in Cornwall, England and left school in 1936 to join the General Post Office. With the advent of the Second World War he enlisted in the RAFVR and trained as a Wireless Operator. He flew operationally with Nos 78 and 35 Squadrons, was awarded the Distinguished Flying Medal and was commissioned. On his 39th operation the starboard inner engine of the Halifax bomber in which he was flying inexplicably caught fire. The flames quickly spread and the pilot gave the order to bale out. Unfortunately his pilot and rear gunner stayed on board and died in the crash and the navigators parachute failed to open. Bob landed safely and quickly linked up with the Belgian underground but was captured, a couple of weeks later on 6 January 1944, in a random Gestapo check of identity documents whilst boarding a train to Brussels. He spent the rest of the war as a POW.
Child, maternal and household-level correlates of nutritional status: a cross-sectional study among young Samoan children
Authors: Choy Courtney C , Desai Mayur M , Park Jennifer J , Frame Elizabeth A , Thompson Avery A , Naseri Take , Reupena Muagututia S , Duckham Rachel L , Deziel Nicole C , Hawley Nicola L
Published: February 2017

Objective

Young children are particularly vulnerable to malnutrition as nutrition transition progresses. The present study aimed to document the prevalence, coexistence and correlates of nutritional status (stunting, overweight/obesity and anaemia) in Samoan children aged 24–59 months.

Design

A cross-sectional community-based survey. Height and weight were used to determine prevalence of stunting (height-for-age Z-score <−2) and overweight/obesity (BMI-for-age Z-score >+2) based on WHO growth standards. Anaemia was determined using an AimStrip Hemoglobin test system (Hb <110 g/l).

Setting

Ten villages on the Samoan island of Upolu.

Subjects

Mother–child pairs (n 305) recruited using convenience sampling.

Results

Moderate or severe stunting was apparent in 20·3 % of children, 16·1 % were overweight/obese and 34·1 % were anaemic. Among the overweight/obese children, 28·6 % were also stunted and 42·9 % anaemic, indicating dual burden of malnutrition. Stunting was significantly less likely among girls (OR=0·41; 95 % CI 0·21, 0·79, P<0·01) than boys. Overweight/obesity was associated with higher family socio-economic status and decreased sugar intake (OR per 10 g/d=0·89, 95 % CI 0·80, 0·99, P=0·032). The odds of anaemia decreased with age and anaemia was more likely in children with an anaemic mother (OR=2·20; 95 % CI 1·22, 3·98, P=0·007). No child, maternal or household characteristic was associated with more than one of the nutritional status outcomes, highlighting the need for condition-specific interventions in this age group.

Conclusions

The observed prevalences of stunting, overweight/obesity and anaemia suggest that it is critical to invest in nutrition and develop health programmes targeting early childhood growth and development in Samoa.
Compact dual‐band microstrip filtering power divider using T‐junction structure and quarter‐wavelength SIR
Authors: Shao Chuan , Li Yang , Chen Jian‐Xin
Published: February 2017

This Letter presents a design of microstrip filtering power divider for dual‐band application. The proposed dual‐band filtering power divider is based on the traditional Wilkinson power divider and employs T‐junction structures and quarter‐wavelength stepped impedance resonators (SIRs) to realise dual‐band power allocation and bandpass response simultaneously. The design process is simple and effective. For validation, a dual‐band microstrip filtering power divider with centre frequencies of 0.9 and 2.1 GHz for the GSM and WCDMA applications is designed, fabricated and measured. The measured results indicate that the proposed dual‐band filtering power divider showcases low‐loss characteristics, high isolation as well as good selectivity.
Modified transformer winding ladder network model to assess non‐dominant frequencies
Authors: Nosratian Ahour Jafar , Seyedtabaie Saeed , Gharehpetian Gevork B.
Published: February 2017

In this study, the challenging problem of computing the frequency‐dependent lumped parameter ladder network model for transformer winding based on impedance frequency response is investigated. It is shown that the existing conventional model is not capable of simulating the non‐dominant resonances; rather, this phenomenon can be adequately modelled using extra intersection capacitors. As usual, this large‐scale non‐linear optimisation problem is addressed using properly lined‐up genetic algorithm. To accelerate the success of the estimation, the dimension of the problem and the search space is reduced by using logical and real constraints and equations derived from the transformer geometry and its electromagnetic specifications; if this is not done, the optimisation fails. The test results on a 20/0.4 kV, 1600 kVA transformer indicates that the computed model, which is improved and detailed, is superior to the conventional one in terms of simulating the non‐dominant resonances of the transformer winding. Therefore, it is more reliable for the transformer transient behaviour analysis.
Series‐connected multi‐half‐bridge modules converter for integrating multi‐megawatt wind multi‐phase permanent magnet synchronous generator with dc grid
Authors: Elserougi Ahmed A. , Daoud Mohamed I. , Abdel‐Khalik Ayman S. , Mohamed Massoud Ahmed , Ahmed Shehab
Published: February 2017

In this study, a new transformerless wind energy conversion system to integrate high‐power multi‐phase permanent magnet wind generators to medium‐voltage local grids is presented. The proposed converter topology consists of multi‐half‐bridge modules with a high ac–direct current (dc) boosting capability. Each phase of an open winding multi‐phase generator is connected to the ac side of a half‐bridge module, whereas the dc sides of the half‐bridge modules are connected in series forming the high‐voltage dc‐link output. The proposed architecture facilitates the employment of semiconductor switches with a relatively low‐voltage rating, which equals the dc‐link voltage divided by the number of generator phases. A detailed analysis of the proposed architecture along with the required closed‐loop control is presented. The proposed architecture is simulated under different operating conditions using a typical 2 MW system, while the experimental validation is carried out using a low‐scale prototype converter.
Syntheses and Structure Investigations of 3d Transition Metal Complexes with a Flexible N4O2-Donor Hexadentate Schiff-Base Ligand
Authors: Howard-Smith Kyle J. , Craze Alexander R. , Badbhade Mohan , Marjo Christopher E. , Murphy Timothy D. , Castignolles Patrice , Wuhrer Richard , Li Feng
Published: February 2017

The syntheses and structure investigations of four new 3d transition metal complexes (1–4) with a flexible N4O2-donor hexadentate Schiff-base ligand are described; three complexes (1, 2, and 4) of FeIII, CoIII, and CuII metal ions have been investigated by UV-vis, FT-IR, high-resolution mass spectrometry (HR-MS), and scanning electron microscopy–electron dispersive spectroscopy, as well as single crystal X-ray diffraction. The X-ray structure of NiII complex 3 is also reported. The molecular structures of the complexes (1–3) demonstrate distorted octahedral coordination geometry, each exhibiting 1 : 1 (M : L) ratios and the CuII complex 4 shows a trinuclear structure with a CuII : L ratio of 3 : 2 in the solid state, which has been proven by X-ray diffraction. On the other hand, a mononuclear species of the CuII complex is formed in solution, which has been identified by electrospray ionization HR-MS.
Occipitocervical Instability After Far-Lateral Transcondylar Surgery: A Biomechanical Analysis
Authors: Mazur Marcus D. , Couldwell William T. , Cutler Aaron , Shah Lubdha M. , Brodke Darrel S. , Bachus Kent , Dailey Andrew T.
Published: February 2017

BACKGROUND: After a far-lateral transcondylar approach, patients may maintain neutral alignment in the immediate postoperative period, but severe occipitoatlantal subluxation may occur gradually with cranial settling and possible neurological injury. Previous research is based on assumptions regarding the extent of condylar resection and the change in biomechanics that produces instability.

OBJECTIVE: To quantify the extent of bone removal during a far-lateral transcondylar approach, determine the changes in range of motion (ROM) and stiffness that occur after condylar resection, and identify the threshold of condylar resection that predicts alterations in occipitocervical biomechanics.

METHODS: Nine human cadaveric specimens were biomechanically tested before and after far-lateral transcondylar resection extending into the hypoglossal canal (HC). The extent of condylar resection was quantified using volumetric comparison between pre- and postresection computed tomography scans. ROM and stiffness testing were performed in intact and resected states. The extent of resection that produced alterations in occipitocervical biomechanics was assessed with sensitivity analysis.

RESULTS: Bone removal during condylar resection into the HC was 15.4%-63.7% (mean 35.7%). Sensitivity analysis demonstrated that changes in biomechanics may occur when just 29% of the occipital condyle was resected (area under the curve 0.80-1.00).

CONCLUSION: Changes in occipitocervical biomechanics may be observed if one-third of the occipital condyle is resected. During surgery, the HC may not be a reliable landmark to guide the extent of resection. Patients who undergo condylar resections extending into or beyond the HC require close surveillance for occipitocervical instability.
From Russian Refugee to Iowa's First Neurosurgeon and Pioneer of Cranial Hemostasis: The Legacy of Anatole Kolodny (1892-1948)
Authors: Abel Taylor , Zanaty Mario , Walch Timothy , Howard Matthew A.
Published: February 2017

After immigrating to the United States from Russia in the wake of the First World War, Anatole Kolodny became the first surgeon in Iowa to specialize in neurological surgery. Kolodny was vital to the initial practice of neurosurgery in the state of Iowa and to the specific development of academic neurosurgery at the University of Iowa. In an effort to improve his surgical outcomes, Kolodny invented a hemostat that bears his name and is still used for cranial hemostasis. He also provided early outcomes of myelomenigocele repair and wrote extensively on bone sarcoma. Kolodny's achievements brought favorable attention to the university and altered the course of neurosurgery at the University of Iowa. Of significant importance, Kolodny influenced and trained Iowa's second neurosurgeon, Olan Hyndman, and this action led the way to the eventual recruitment of the university's first division head of neurosurgery. The purpose of this manuscript is to shed light on Kolodny's important contributions to the development of neurosurgery not only at Iowa, but also in the profession as a whole.
Sellar and Parasellar Imaging
Authors: Zamora Carlos , Castillo Mauricio
Published: February 2017

The skull base is a complex anatomical region that harbors many important neurovascular structures in a relatively confined space. The pathology that can develop at this site is varied, and many disease processes may present with similar clinical and neuroimaging findings. While computed tomography maintains a role in the evaluation of many entities and can, for instance, delineate osseous erosion with great detail and characterize calcified tumor matrices, magnetic resonance imaging (MRI) is the mainstay in the neuroimaging assessment of most pathology occurring at the skull base. Various MRI sequences have proven to be robust tools for tissue characterization and can provide information on the presence of lipids, paramagnetic and diamagnetic elements, and tumor cellularity, among others. In addition, currently available MRI techniques are able to generate high spatial resolution images that allow visualization of cranial nerves and their involvement by adjacent pathology. The information obtained from such examinations may aid in the distinction of these disease processes and in the accurate delineation of their extent prior to biopsy or treatment planning.
Long-Term Clinical and Angiographic Outcomes Following Pipeline Embolization Device Treatment of Complex Internal Carotid Artery Aneurysms: Five-Year Results of the Pipeline for Uncoilable or Failed Aneurysms Trial
Authors: Becske Tibor , Brinjikji Waleed , Potts Matthew B. , Kallmes David F. , Shapiro Maksim , Moran Christopher J. , Levy Elad I. , McDougall Cameron G. , Szikora István , Lanzino Giuseppe , Woo Henry H. , Lopes Demetrius K. , Siddiqui Adnan H. , Albuquerque Felipe C. , Fiorella David J. , Saatci Isil , Cekirge Saruhan H. , Berez Aaron L. , Cher Daniel J. , Berentei Zsolt , Marosfői Miklós , Nelson Peter K.
Published: February 2017

BACKGROUND: Early and mid-term safety and efficacy of aneurysm treatment with the Pipeline Embolization Device (PED) has been well demonstrated in prior studies.

OBJECTIVE: To present 5-yr follow-up for patients treated in the Pipeline for Uncoilable or Failed Aneurysms clinical trial.

METHODS: In our prospective, multicenter trial, 109 complex internal carotid artery (ICA) aneurysms in 107 subjects were treated with the PED. Patients were followed per a standardized protocol at 180 d and 1, 3, and 5 yr. Aneurysm occlusion, in-stent stenosis, modified Rankin Scale scores, and complications were recorded.

RESULTS: The primary endpoint of complete aneurysm occlusion at 180 d (73.6%) was previously reported. Aneurysm occlusion for those patients with angiographic follow-up progressively increased over time to 86.8% (79/91), 93.4% (71/76), and 95.2% (60/63) at 1, 3, and 5 yr, respectively. Six aneurysms (5.7%) were retreated. New serious device-related events at 1, 3, and 5 yr were noted in 1% (1/96), 3.5% (3/85), and 0% (0/81) of subjects. There were 4 (3.7%) reported deaths in our trial. Seventy-eight (96.3%) of 81 patients with 5-yr clinical follow-up had modified Rankin Scale scores ≤2. No delayed neurological deaths or hemorrhagic or ischemic cerebrovascular events were reported beyond 6 mo. No recanalization of a previously occluded aneurysm was observed.

CONCLUSION: Our 5-yr findings demonstrate that PED is a safe and effective treatment for large and giant wide-necked aneurysms of the intracranial ICA, with high rates of complete occlusion and low rates of delayed adverse events.
Surgical Indications to Maintain Quality of Life in Elderly Patients with Ruptured Intracranial Aneurysms
Authors: Yano Shigetoshi , Hamada Jun-ichiro , Kai Yutaka , Todaka Tatemi , Hara Tsuyoshi , Mizuno Takamasa , Morioka Motohiro , Ushio Yukitaka
Published: February 2017

OBJECTIVE

We performed a retrospective study to assess long-term outcomes in very old patients with ruptured intracranial aneurysms. The aim of the study was to develop guidelines for choosing surgical or conservative treatment with the goal of maintaining patients' quality of life.

METHODS

Between 1996 and 1999, 76 consecutive patients, aged 80 to 89 years, with ruptured intracranial aneurysms were treated at 18 participating centers. They were divided retrospectively into operated and nonoperated groups, and their preoperative characteristics and treatment outcomes were analyzed. Their Glasgow Outcome Scale and Barthel Index scores at least 2 years after the insult were recorded and analyzed from the perspective of their admission Hunt and Hess grade.

RESULTS

Our retrospective review encompassed 5.9 years. Of the original 76 patients, 54 (71.1%) died, 13 (17.1%) had a good outcome (Barthel Index ≥60), and 9 (11.8%) had a poor outcome (Barthel Index <60). All patients with Hunt and Hess grades of III or higher at admission had poor outcomes irrespective of treatment. Of 32 patients with an initial Hunt and Hess grade of I or II, 19 (59.4%) underwent surgery; 9 of these patients (47.4%) had good outcomes. Conversely, of 13 nonoperated patients (40.6%), only 2 (15.4%) experienced good outcomes. In seven of the nine operated patients with good outcomes, the aneurysm was small (<12 mm) and located at the internal carotid artery-posterior communicating artery junction.

CONCLUSION

Our results suggest that patients in the 9th decade of life with ruptured intracranial aneurysms can be considered for surgical treatment if they have a Hunt and Hess grade of I or II. The highest rate of favorable results was achieved in patients with small internal carotid artery-posterior communicating artery aneurysms.
Pulmonary Complications of Aneurysmal Subarachnoid Hemorrhage
Authors: Friedman Jonathan A. , Pichelmann Mark A. , Piepgras David G. , McIver Jon I. , Toussaint L. Gerard , McClelland Robyn L. , Nichols Douglas A. , Meyer Fredric B. , Atkinson John L.D. , Wijdicks Eelco F.M.
Published: February 2017

OBJECTIVE

Pulmonary complications challenge the medical management of patients who have sustained aneurysmal subarachnoid hemorrhage (SAH). We assessed the frequency and types of pulmonary complications after aneurysmal SAH and analyzed the impact of pulmonary complications on patient outcome.

METHODS

We reviewed the records of all patients with acute SAH treated at our institution between 1990 and 1997. Three hundred five consecutive patients with an aneurysmal hemorrhage source documented by angiography and treated within 7 days of ictus were analyzed. Outcomes at longest follow-up (mean, 16 mo) were measured by use of the Glasgow Outcome Scale.

RESULTS

Pulmonary complications were documented in 66 patients (22%). The pulmonary complications were nosocomial pneumonia in 26 patients (9%), congestive heart failure in 23 (8%), aspiration pneumonia in 17 (6%), neurogenic pulmonary edema in 5 (2%), pulmonary embolus in 2 (<1%), and other pulmonary disorders in 4 (1%); 11 patients had two pulmonary complications. The incidence of symptomatic vasospasm was greater in patients with pulmonary complications (63%) than in patients without pulmonary complications (31%) (P= 0.001), and this association was independent of age and clinical grade at admission (odds ratio, 3.68; P< 0.001). Overall clinical outcomes were worse in patients with pulmonary complications (mean Glasgow Outcome Scale score, 3.3) than in patients without pulmonary complications (mean Glasgow Outcome Scale score, 4.0; P= 0.0001), but pulmonary complications were not an independent predictor of worse outcome when adjusted for age and clinical grade at admission (odds ratio, 1.38; P= 0.315).

CONCLUSION

Patients who experience pulmonary complications after aneurysmal SAH have a higher incidence of symptomatic vasospasm than do patients without pulmonary complications. This most likely reflects both the failure to maintain aggressive hypervolemic and hyperdynamic therapy in patients with pulmonary compromise and the possible precipitation of congestive heart failure by hypervolemic therapy in patients with preexisting delayed ischemic neurological deficit. Although patients with pulmonary complications have worse overall clinical outcomes than do patients without pulmonary complications, this is attributable to older age and worse clinical grades at admission.
Radiosurgery Followed by Planned Observation in Patients with One to Three Brain Metastases
Authors: Lutterbach Johannes , Cyron Donatus , Henne Karl , Ostertag Christoph B.
Published: February 2017

OBJECTIVE

To analyze the role of radiosurgery alone in patients with brain metastases. There were three specific study goals: 1) to determine whether survival of patients selected for this treatment approach can be predicted successfully by use of the recursive partitioning analysis classification defined by the Radiation Therapy Oncology Group; 2) to evaluate local control; and 3) to identify risk factors of cerebral failure.

METHODS

A total of 101 patients with Karnofsky Performance Scale scores of at least 50 and up to three brain metastases, each 3 cm or less in maximum diameter, were treated with radiosurgery alone. Survival, local control, distant brain freedom from progression (FFP), and overall brain FFP were evaluated according the method of Kaplan and Meier. Risk factors for survival and overall brain FFP were analyzed using the Cox model.

RESULTS

Median survival was 13.4 months, 9.3 months, and 1.5 months for patients in recursive partitioning analysis Classes 1, 2, and 3, respectively (P< 0.0001). At 1 year, local control, distant brain FFP, and overall brain FFP were 91, 53, and 51%, respectively. An interval greater than 2 years between diagnosis of the primary tumor and diagnosis of brain metastases and the presence of a single brain metastasis were associated with significantly higher overall brain FFP.

CONCLUSION

Recursive partitioning analysis classification successfully predicted survival. Radiosurgery alone yielded high local control. Overall brain FFP was highest in patients with an interval greater than 2 years between primary diagnosis and diagnosis of a single brain metastasis.
Anterior Screw Fixation in Type II Odontoid Fractures: Is There a Difference in Outcome between Age Groups?
Authors: Börm Wolfgang , Kast Erich , Richter Hans-Peter , Mohr Klaus
Published: February 2017

OBJECTIVE

Optimal treatment of elderly patients with Type II odontoid fractures is controversial. Suggestions vary between conservative management and different types of early surgery. Recent data confirm that early surgery may be warranted because conservative treatment has a high rate of failure in the elderly.

METHODS

We performed a case-control study of 27 patients with Type II odontoid fracture who were treated with anterior odontoid double-screw fixation at our institution. The aim of the study was to determine whether patients aged 70 years or older have a less favorable outcome than younger patients with this operative technique. Cases were defined as patients with Type II odontoid fracture aged 70 years or older. All patients younger than 70 years served as controls.

RESULTS

There were 15 patients aged 70 years or older (Group 1) and 12 patients younger than 70 years of age (Group 2). Mean follow-up was 16.6 months. Mean interval between fracture and surgery was 10 days. All patients were treated with anterior odontoid screw fixation by use of two compression screws. Fusion rates were 73% in Group 1 and 75% in Group 2. Additional dorsal stabilization was performed in 13% of cases in Group 1 and 17% of cases in Group 2. Complications occurred in 20% of cases in Group 1 and 8% of cases in Group 2. The only death occurred in Group 1, leading to 7% mortality in this group. Neurological status at admission and after treatment was similar in both groups. Statistical analysis did not reveal significant differences between groups for the factors studied.

CONCLUSION

Outcome after anterior odontoid screw fixation is not affected by patient age. Slightly higher rates of medical complications did not reach statistical significance. Because conservative management of odontoid fractures in the elderly has a high rate of failure, anterior stabilization for Type II odontoid fractures can be recommended.
Use of Tisseel Fibrin Sealant in Neurosurgical Procedures: Incidence of Cerebrospinal Fluid Leaks and Cost-Benefit Analysis in a Retrospective Study
Authors: Kassam Amin , Horowitz Michael , Carrau Ricardo , Snyderman Carl , Welch William , Hirsch Barry , Chang Yue Fang
Published: February 2017

OBJECTIVE

To determine the clinical efficacy and cost effectiveness of using the fibrin sealant (FS) Tisseel (Baxter Healthcare Corp., Deerfield, IL) for patients undergoing anterior cranial base, infratemporal, and retromastoid surgical procedures.

METHODS

A retrospective review was performed, comparing two matched populations of patients who underwent surgical procedures using anterior cranial, infratemporal, or retromastoid approaches to intracranial pathological lesions. The incidences of cerebrospinal fluid (CSF) leaks in matched groups treated with the FS Tisseel or treated without FS were compared. The costs of Tisseel use were examined in comparison with the costs of postoperative management of CSF leaks and/or tension pneumocranium with spinal drainage and occasionally surgical reexploration, when lumbar drainage failed.

RESULTS

Patients who received the FS Tisseel exhibited no detectable postoperative CSF leaks or tension pneumocranium. Patients who did not receive Tisseel demonstrated 4 to 16% incidences of postoperative leaks, depending on the surgical approach used. The costs of treating those leaks far exceeded the costs of using Tisseel, even if it were used indiscriminately for all patients.

CONCLUSION

This retrospective review indicates that the FS Tisseel reduces the incidence of postoperative CSF leaks and tension pneumocranium while reducing overall management costs. Further prospective study is needed to determine which patients can benefit most from FS use.
Intrasellar Schwannomas: Report of Two Cases
Authors: Maartens Nicholas F. , Ellegala Dilantha B. , Vance Mary Lee , Lopes M. Beatriz S. , Laws Edward R.
Published: February 2017

OBJECTIVE AND IMPORTANCE

The complex regional anatomic features surrounding the sella turcica make the differential diagnosis of intrasellar and parasellar lesions complicated. Sellar and parasellar schwannomas are rare. With the exclusion of parasellar schwannomas arising from cranial nerves within the cavernous sinus and extending into the sella, there have been only two reported cases of true intrasellar schwannomas.

CLINICAL PRESENTATION

We describe the clinical, radiological, and pathological features of two cases in which the histopathological diagnosis of schwannoma was confirmed with immunohistochemical analyses and/or electron microscopy.

INTERVENTION

The two cases were grossly resected via a transsphenoidal approach. Follow-up monitoring revealed no evidence of recurrence.

CONCLUSION

Schwannomas may atypically occur in the sellar region, in which they demonstrate the typical light microscopic, immunohistochemical, and ultrastructural features observed in the peripheral nervous system. New and existing hypotheses regarding the histopathogenesis of intrasellar and parasellar schwannomas are presented.
Leptomeningeal Hemangioblastomatosis in a Case of von Hippel-Lindau Disease: Case Report
Authors: Reyns Nicolas , Assaker Richard , Louis Etienne , Lejeune Jean-Paul
Published: February 2017

OBJECTIVE AND IMPORTANCE

We report a unique case of extended leptomeningeal hemangioblastomatosis in a patient presenting with clinical von Hippel-Lindau disease.

CLINICAL PRESENTATION

A 50-year-old male patient had a history of three surgical procedures for the removal of a cerebellar hemangioblastoma, initially considered to be a recurrence of a sporadic form at the same location. Seven years after the last operation, he developed chronic hydrocephalus. Despite a ventriculoperitoneal shunt procedure, he experienced progressive worsening of gait disturbances, associated with touch numbness of the lower limbs and Parinaud's syndrome. Magnetic resonance imaging of the brain and spine showed evidence of leptomeningeal contrast enhancement around the brainstem, spinal cord, and cauda equina and enlarged tortuous vessels around the mesencephalon.

INTERVENTION

A lumbar laminectomy allowed a leptomeningeal biopsy. Pathological examination revealed leptomeningeal spread of the hemangioblastoma. It is assumed that the tumor arose in the pia mater and that its direction of growth was purely extramedullary, invading all subarachnoid spaces. The patient had a poor outcome as a result of progressive tetraplegia and died 6 months after diagnosis as a result of respiratory failure.

CONCLUSION

To the best of our knowledge, the clinical course of our patient, consistent with a thick leptomeningeal spread of hemangioblastoma from the posterior fossa to the sacrum, is unique. Nevertheless, the short life expectancy of our patient is usual in von Hippel-Lindau disease. This case report illustrates the crucial challenge to develop a specific drug therapy related to angiogenesis in von Hippel-Lindau disease.