bluuebunny/crossref_metadata_2025 huggingface dataset:
RESPON STRES AYAM BROILER YANG DISUPLEMENTASI NIRA AREN (Arenga pinnata Merr.) SELAMA FASE STARTER
Authors: Sipahutar Luky Wahyu
Published: October 2019

Penelitian bertujuan mengetahui respon stres ayam broiler yang disuplementasi nira aren (Arenga pinnata Merr.) selama periode pemeliharaan fase starter. Sampel yang diamati sebanyak 100 ekor ayam broiler pada umur DOC sampai akhir fase starter (1-14 hari). Digunakan Rancangan Acak Lengkap yang terdiri dari 5 kelompok perlakuan (P) dan 4 ulang (U) dimana sampel ayam dibagi secara homogen. Suplementasi yang digunakan yaitu nira aren segar, dikonsentrasikan pada masing-masing kelompok perlakuan secara ad libitum yaitu 0% (P1), 5% (P2), 10% (P3), 15% (P4) dan 20% (P5) dalam air minum v/v. Data yang damati berupa indikator stres dari respon fisiologi tubuh meliputi temperatur rektal, frekuensi pernafasan, dan frekuensi denyut jantung yang dianalisis menggunakan ANAVA, serta persentase mortalitas pada akhir pemeliharaan dianalisis secara deskriptif. Hasil penelitian menunjukkan suplementasi nira aren tidak berpengaruh nyata terhadap temperatur rektal (P>0,05) dan berpengaruh nyata terhadap frekuensi pernafasan dan frekuensi denyut jantung (P<0,05). Selama program pemeliharaan periode fase starter, tingkat mortalitas pada pemberian suplementasi nira aren berada di kisaran 5% (≤5%) sedangkan pada kelompok kontrol tingkat mortalitas berada di 10% (>5%).Kata kunci: stres, respon fisiologis, ayam broiler, nira aren, mortalitas
PERBANDINGAN HASIL PRODUKSI JERUK MANIS (Citrus sinensis osbec) DENGAN MENGGUNAKAN PUPUK TUNGGAL (UREA) DAN PUPUK KOMPOS DIDESA SIHEPENG
Authors: Ritonga Eka Nurwani , Nasution Erti Kumala Indah
Published: October 2019

Tujuan dari penelitian ini adalah untuk mengetahui perbandingan hasil produksi jeruk manis (Citrus sinensis osbec)dengan menggunakan pupuk tunggal (Urea) dan pupuk kompos didesa Sihepeng. penelitian ini menggunakan rancangan acak kelompok dengan dua faktor perlakuan dan tiga ulangan, faktor merupakan hasil produksi jeruk manis (Citrus sinensis osbec) dengan menggunakan pupuk tunggal (Urea) dan pupuk kompos. Hasil Penelitian menunjukkan bahwa pemberian pupuk tunggal (Urea) berpengaruh nyata pada jumlah buah per tanaman sampel, berat buah per tanaman, jumlah buah per plot, berat buah per plot pada saat panen dan besar buah pada pasca panen. Hasil uji duncan’s menunjukkan pertumbuhan tanaman yang lebih baik dengan perlakuan terbaik adalah T² yaitu pupuk urea 125 gr. Keragaman pengamatan dari semua karakter menunjukkan kriteria pada jumlah buah pertanaman sampel, berat buah pertanaman sampel per plot, berat buah per plot.  Kata kunci : Pupuk Tunggal, Pupuk Komos, Jeruk Manis
The effect of blend copolymers on physico-mechanical properties of mortar
Authors:   Satbayev University, Almaty, Kazakhstan, Bekbayeva L. , Negim E.-S. ,   Kazakh-British Technical University, Yeligbayeva G. ,   Satbayev University, Almaty, Kazakhstan, Ganjian E. ,   Coventry University, Coventry
Published: October 2019

The present study investigates the effect of blend copolymers on the physico-mechanical properties of mortar mixes. Blend copolymers were synthesized based on poly vinyl alcohol (PVA) and urea (U) in aqueous solution with different blend ratios 65/35, 50/50 and 35/65 respectively, using glacial acetic acid as crosslinking. Physico-mechanical properties of mortar examined included water/cement ratio, setting time, workability, water absorption and compressive strength. The addition of blend copolymers to the mortar affected the physico-mechanical properties of mortar mixes. As the content of PVA increases in the blend copolymers, the water of consistency decrease, whereas the setting times (initial & final) were shortened. The compressive strength of the hardened cement pastes was increased at all ages of hydration while water absorption decreased.
Disposal of slag of refined ferrochromium by obtaining a sintered and carbonized construction products
Authors:   K.Zhubanov Aktobe regional state university, Sariyev O.R. , Musabekov Z.B. ,   K.Zhubanov Aktobe regional state university, Dossekenov M.S. ,   K.Zhubanov Aktobe regional state university
Published: October 2019

The article investigates the material composition of refined ferrochromium slag. It has been confirmed that the main compound in the slag is dicalcium silicate. The disposal problem of self-disintegration slag in the current production of refined ferrochromium can be solved by controlling its basic capacity with obtaining stabilized lump slag that is not influenced to silicate decomposition. This became the basis to researches the production of non-disintegrating burnt construction products from slags using low-melting silica-containing additives that reduce the slag basicity. Briquettes roasting containing from 20 to 30% additives in the temperature range of 1200-1225 °C showed the possibility of obtaining ceramic construction products. Material analysis of the slag also showed that the slag components, such as calcium oxide and magnesium oxide, are compounds prone to the formation of carbonates, which leads to the setting between the slag particles. Which makes it possible to obtain construction products in the process of autoclaving processing of bricks from the slag in the carbon dioxide environment. The influence of fineness, slag moisture, and the dwell time of products in an autoclave in the carbon dioxide environment on the strength of the resulting pellets were evaluated in this paper. It was determined that moderate humidity, in addition to increasing ductility during pellet molding, also increases the strength of products after carbonization. Excessive grinding of slag negatively affected on the quality of the pellets. The increase in compression force during the pellets formation, on the contrary, increased the strength of the products. An increase in the duration of carbonization at constant pressure had a positive effect on the strength increase of pellets.
Pediatric firearm-related traumatic brain injury in United States trauma centers
Authors: Deng Hansen , Yue John K. , Winkler Ethan A. , Dhall Sanjay S. , Manley Geoffrey T. , Tarapore Phiroz E.
Published: October 2019

OBJECTIVE

Pediatric firearm injury is a leading cause of death and disability in the youth of the United States. The epidemiology of and outcomes following gunshot wounds to the head (GSWHs) are in need of systematic characterization. Here, the authors analyzed pediatric GSWHs from a population-based sample to identify predictors of prolonged hospitalization, morbidity, and death.

METHODS

All patients younger than 18 years of age and diagnosed with a GSWH in the National Sample Program (NSP) of the National Trauma Data Bank (NTDB) in 2003–2012 were eligible for inclusion in this study. Variables of interest included injury intent, firearm type, site of incident, age, sex, race, health insurance, geographic region, trauma center level, isolated traumatic brain injury (TBI), hypotension in the emergency department, Glasgow Coma Scale (GCS) score, and Injury Severity Score (ISS). Risk predictors for a prolonged hospital stay, morbidity, and mortality were identified. Odds ratios, mean increases or decreases (B), and 95% confidence intervals were reported. Statistical significance was assessed at α < 0.001 accounting for multiple comparisons.

RESULTS

In a weighted sample of 2847 pediatric patients with GSWHs, the mean age was 14.8 ± 3.3 years, 79.2% were male, and 59.0% had severe TBI (GCS score 3–8). The mechanism of assault (63.0%), the handgun as firearm (45.6%), and an injury incurred in a residential area (40.6%) were most common. The mean hospital length of stay was 11.6 ± 14.4 days for the survivors, for whom suicide injuries involved longer hospitalizations (B = 5.9-day increase, 95% CI 3.3–8.6, p < 0.001) relative to those for accidental injuries. Mortality was 45.1% overall but was greater with injury due to suicidal intent (mortality 71.5%, p < 0.001) or caused by a shotgun (mortality 56.5%, p < 0.001). Lower GCS scores, higher ISSs, and emergency room hypotension predicted poorer outcomes. Patients with private insurance had lower mortality odds than those with Medicare/Medicaid (OR 2.4, 95% CI 1.7–3.4, p < 0.001) or government insurance (OR 3.6, 95% CI 2.2–5.8, p < 0.001). Management at level II centers, compared to level I, was associated with lower odds of returning home (OR 0.3, 95% CI 0.2–0.5, p < 0.001).

CONCLUSIONS

From 2003 to 2012, with regard to pediatric TBI hospitalizations due to GSWHs, their proportion remained stable, those caused by accidental injuries decreased, and those attributable to suicide increased. Overall mortality was 45%. Hypotension, cranial and overall injury severity, and suicidal intent were associated with poor prognoses. Patients treated at level II trauma centers had lower odds of being discharged home. Given the spectrum of risk factors that predispose children to GSWHs, emphasis on screening, parental education, and standardization of critical care management is needed to improve outcomes.
Complete recovery following transorbital penetrating head injury traversing the brainstem: case report
Authors: MacLean Mark A. , Mukhida Karim , Shankar Jai J. S. , Schmidt Matthias H. , Clarke David B.
Published: October 2019

Transorbital penetration accounts for one-quarter of the penetrating head injuries (PHIs) in adults and half of those in children. Injuries that traverse (with complete penetration of) the brainstem are often fatal, with survivors rarely seen in clinical practice. Here, the authors describe the case of a 16-year-old male who suffered and recovered from an accidental transorbital PHI traversing the brainstem—the first case of complete neurological recovery following such injury. Neuroimaging captured the trajectory of the initial injury. A delayed-onset carotid cavernous fistula and the subsequent development of internal carotid artery pseudoaneurysms were managed by endovascular embolization.

The authors also review the relevant literature. Sixteen cases of imaging-confirmed PHI traversing the brainstem have been reported, 14 involving the pons and 12 penetrating via the transorbital route. Management and outcome of PHI are informed by object velocity, material, entry point, trajectory, relationship to neurovascular structures, and the presence of a retained foreign body. Trauma resuscitation is followed by a careful neurological examination and appropriate neuroimaging. Ophthalmological examination is performed if transorbital penetration is suspected, as injuries may be occult; the potential for neurovascular complications highlights the value of angiography. The featured case shows that complete recovery is possible following injury that traverses the brainstem.
Surgical outcomes for pediatric moyamoya: a systematic review and meta-analysis
Authors: Ravindran Krishnan , Wellons John C. , Dewan Michael C.
Published: October 2019

OBJECTIVE

The optimal revascularization for pediatric moyamoya for reducing the incidence of future stroke events remains to be determined.

METHODS

The authors conducted a search of PubMed, MEDLINE, Embase, and Web of Science electronic databases from inception until January 2019. The primary endpoint was the presence of a future ischemic stroke event. Secondary endpoints were angiographic outcomes as measured by postoperative Matsushima grade and clinical symptom persistence. Patients who underwent either direct or combined direct/indirect revascularization were classified into the direct cohort. Data from each study on presence of postoperative stroke events were used to generate standardized mean differences and 95% confidence intervals, which were combined using inverse variance-weighted averages of standardized mean differences in a random effects model.

RESULTS

Twenty-nine studies met the inclusion criteria for analysis, comprising 2258 patients (1011 males, mean age 8.3 ± 1.8 years) who were followed up clinically for an average of 71.4 ± 51.3 months. One hundred fifty-four patients underwent direct bypass alone, 680 patients underwent either direct or combined direct/indirect revascularization procedures, while 1424 patients underwent indirect bypass alone. The frequencies of future stroke events in patients undergoing direct bypass alone, combined bypass, or indirect bypass alone were 1 per 190.3 patient-years, 1 per 108.9 patient-years, and 1 per 61.1 patient-years, respectively, in each cohort. The estimated stroke rates were 9.0% with indirect revascularization, 4.5% with direct revascularization alone, and 6.0% with combined revascularization. A forest plot did not reveal any significant differences in the incidence of future stroke events or angiographic outcomes following direct-only, combined, or indirect-only revascularization.

CONCLUSIONS

Direct, indirect, and combined indirect/direct bypass techniques are all effective revascularization options for pediatric moyamoya disease. A relative paucity of granular studies—and inherent surgical selection bias—limits direct comparison between interventions. Suitably designed prospective cohort studies may be useful in identifying patients likely to receive benefit from specific procedures.
The utility of intraoperative MRI during pediatric brain tumor surgery: a single-surgeon case series
Authors: Day Emily L. , Scott R. Michael
Published: October 2019

OBJECTIVE

The authors sought to evaluate the utility of intraoperative MRI (ioMRI) during brain tumor excision in pediatric patients and to suggest guidelines for its future use.

METHODS

All patients who underwent brain tumor surgery by the senior author at Boston Children’s Hospital using ioMRI between 2005 and 2009 were included in this retrospective review of hospital records and the neurosurgeon’s operative database. Prior to the review, the authors defined the utility of ioMRI into useful and not useful categories based on how the technology affected operative management. They determined that ioMRI was useful if it 1) effectively guided the extent of resection; 2) provided a baseline postoperative scan during the same anesthesia session; or 3) demonstrated or helped to prevent an intraoperative complication. The authors determined that ioMRI was not useful if 1) the anatomical location of the tumor had precluded a tumor’s total resection, even though the surgeon had employed ioMRI for that purpose; 2) the tumor’s imaging characteristics prevented an accurate assessment of resection during intraoperative imaging; 3) the surgeon deemed the technology not required for tumor resection; or 4) the intraoperative MR images were uninterpretable for technical reasons. Follow-up data provided another gauge of the long-term benefit of ioMRI to the patient.

RESULTS

A total of 53 brain tumor patients were operated on using ioMRI, 6 of whom had a second ioMRI procedure during the study period. Twenty-six patients were female, and 27 were male. The mean follow-up was 4.8 ± 3.85 years (range 0–12 years). By the criteria outlined above, ioMRI technology was useful in 38 (64.4%) of the 59 cases, most frequently for its help in assessing extent of resection.

CONCLUSIONS

Intraoperative MRI technology was useful in the majority of brain tumor resections in this series, especially in those tumors that were contrast enhancing and located largely within accessible areas of the brain. The percentage of patients for whom ioMRI is useful could be increased by preoperatively evaluating the tumor’s imaging characteristics to determine if ioMRI would accurately assess the extent of tumor resection, and by the surgeon’s preoperative understanding that use of the ioMRI will not lead to resection of an anatomically unresectable tumor. The ioMRI can prove useful in unresectable tumors if specific operative goals are defined preoperatively.
Neuroblastoma with intracerebral metastases and the need for neurosurgery: a single-center experience
Authors: Fleck Steffen , Marx Sascha , Bobak Clara , Richter Victoria , Nowak Stephan , Rafaee Ehab El , Siebert Nikolai , Ehlert Karoline , Schroeder Henry W. S. , Lode Holger N.
Published: October 2019

OBJECTIVE

Intracerebral metastases in neuroblastoma patients are rare, and information about the indication for and the outcome of neurosurgical procedures in this setting is scarce in the literature. The authors’ aim in the present study was to report a single-center experience with the neurosurgical treatment of intracerebral metastases in neuroblastoma.

METHODS

This study is a retrospective single-center analysis of all neurosurgical strategies used in the treatment of intracerebral metastases in neuroblastoma patients.

RESULTS

Between 2009 and 2017, 237 pediatric patients (94 girls, 143 boys) with a mean age of 39 months at diagnosis were treated for neuroblastoma. Five (2.1%) of the 237 patients had a neurosurgical procedure for intracerebral metastases. The metastases occurred a mean of 46 months after initial diagnosis. All of these patients had neuroblastoma stage 4. Indications for surgery were recurrent metastases after initial successful oncological treatment or progression of the metastasis under oncological treatment as well as deterioration of neurological function. Intraoperatively, the tumor usually had a distinguishable dissection plane but was infiltrative to adjacent nerves in some spots. Mean overall survival after the neurosurgical procedure was 22 months. Furthermore, in another 3 patients, a neurosurgical procedure was done for an intracranial but extracerebral metastasis.

CONCLUSIONS

Neurosurgical procedures for intracerebral metastases in neuroblastoma patients are rare and were performed in 2.1% of patients in the present study. Intracerebral metastases occurred during disease progression, and the prognosis after surgery was very limited. The main indications for surgery were rapid neurological deterioration or recurrence of the metastasis after initial successful oncological treatment. Intraoperatively, the metastases usually had a distinguishable dissection plane from the normal brain tissue.
Association of cognitive function with cerebral blood flow in children with moyamoya disease
Authors: Kazumata Ken , Tokairin Kikutaro , Sugiyama Taku , Ito Masaki , Uchino Haruto , Osanai Toshiya , Kawabori Masahito , Nakayama Naoki , Houkin Kiyohiro
Published: October 2019

OBJECTIVE

The cognitive effects of main cerebral artery occlusive lesions are unclear in children with moyamoya disease (MMD). The authors aimed to investigate cognitive function in the presurgical phase of pediatric patients with MMD with no apparent brain lesions.

METHODS

In this prospective, observational, single-center study, 21 children (mean age 10 ± 3.0 years, range 5–14 years) diagnosed with MMD at Hokkaido University Hospital between 2012 and 2018 were enrolled. A cross-sectional evaluation of intellectual ability was performed using the Wechsler Intelligence Scale for Children—Fourth Edition at the initial diagnosis. rCBF was measured using [123I] N-isopropyl p-iodoamphetamine/SPECT. The associations among clinical factors, disease severity, regional cerebral blood flow (rCBF), and intelligence test scores were also examined.

RESULTS

The mean full-scale intelligence quotient (FIQ) was 101.8 ± 12.5 (range 76–125) in children with no apparent brain lesions. A significant difference in the intelligence scale index score was observed, most frequently (42.9%) between working memory index (WMI) and verbal comprehension index (VCI; VCI − WMI > 11 points). Regional CBF was significantly reduced both in the left and right medial frontal cortices (left: 61.3 ± 5.3 ml/100 g/min, right 65.3 ± 5.3 ml/100 g/min; p < 0.001) compared to the cerebellum (77.8 ± 6.8 ml/100 g/min). There was a significant association of rCBF in the left dorsolateral prefrontal cortex (DLPFC) with FIQ (r = 0.46, p = 0.034), perceptual reasoning index (PRI; r = 0.44, p = 0.045), and processing speed index (PSI; r = 0.44, p = 0.045). There was an association between rCBF of the left medial frontal cortex and PSI (r = 0.49, p = 0.026). Age of onset, family history, ischemic symptoms, and angiographic severity were not associated with poor cognitive performance.

CONCLUSIONS

Although average intellectual ability was not reduced in children with MMD, the association of reduced rCBF in the left DLPFC and medial frontal cortex with FIQ, PRI, and PSI suggests mild cognitive dysfunction due to cerebral hypoperfusion.
Posterior transdural approach for odontoidectomy in a child: case report
Authors: Archer Jacob , Thatikunta Meena , Jea Andrew
Published: October 2019

The transoral transpharyngeal approach is the standard approach to resect the odontoid process and decompress the cervicomedullary spinal cord. There are some significant risks associated with this approach, however, including infection, CSF leak, prolonged intubation or tracheostomy, need for nasogastric tube feeding, extended hospitalization, and possible effects of phonation. Other ventral approaches, such as transmandibular and circumglossal, endoscopic transcervical, and endoscopic transnasal, are also viable alternatives but are technically challenging or may still traverse the nasopharyngeal cavity. Far-lateral and posterior extradural approaches to the craniocervical junction require extensive soft-tissue dissection. Recently, a posterior transdural approach was used to resect retro-odontoid cysts in 3 adult patients. The authors present the case of a 12-year-old girl with Down syndrome and significant spinal cord compression due to basilar invagination and a retro-flexed odontoid process. A posterior transdural odontoidectomy prior to occiptocervical fusion was performed. At 12 months after surgery, the authors report satisfactory clinical and radiographic outcomes with this approach.
Extraordinary case presentations in pediatric pituitary adenoma: report of 6 cases
Authors: Meyer Jenna , Perry Avital , Oushy Soliman , Graffeo Christopher S. , Carlstrom Lucas P. , Meyer Fredric B.
Published: October 2019

Pediatric pituitary adenomas (PPAs) are rare neoplasms with a propensity for unusual presentations and an aggressive clinical course. Here, the authors describe 6 highly atypical PPAs to highlight this tendency and discuss unexpected management challenges.

A 14-year-old girl presented with acute hemiparesis and aphasia. MRI revealed a pituitary macroadenoma causing internal carotid artery invasion/obliteration without acute apoplexy, which was treated via emergent transsphenoidal resection (TSR). Another 14-year-old girl developed precocious galactorrhea due to macroprolactinoma, which was medically managed. Several years later, she re-presented with acute, severe, bitemporal hemianopia during her third trimester of pregnancy, requiring emergent induction of labor followed by TSR. A 13-year-old boy was incidentally diagnosed with a prolactinoma after routine orthodontic radiographs captured a subtly abnormal sella. An 18-year-old male self-diagnosed pituitary gigantism through a school report on pituitary disease. A 17-year-old boy was diagnosed with Cushing disease by his basketball coach, a former endocrinologist. A 12-year-old girl with growth arrest and weight gain was diagnosed with Cushing disease, which was initially treated via TSR but subsequently recurred and ultimately required 12 operations, 5 radiation treatments involving 3 modalities, bilateral adrenalectomy, and chemotherapy. Despite these efforts, she ultimately died from pituitary carcinoma.
Teriparatide treatment increases Hounsfield units in the lumbar spine out of proportion to DEXA changes
Authors: Mikula Anthony L. , Puffer Ross C. , Jeor Jeffery D. St. , Bernatz James T. , Fogelson Jeremy L. , Larson A. Noelle , Nassr Ahmad , Sebastian Arjun S. , Freedman Brett A. , Currier Bradford L. , Bydon Mohamad , Yaszemski Michael J. , Anderson Paul A. , Elder Benjamin D.
Published: October 2019

OBJECTIVE

The authors sought to assess whether Hounsfield units (HU) increase following teriparatide treatment and to compare HU increases with changes in bone mineral density (BMD) as measured by dual-energy x-ray absorptiometry (DEXA).

METHODS

A retrospective chart review was performed from 1997 to 2018 across all campuses at our institution. The authors identified patients who had been treated with at least 6 months of teriparatide and compared HU and BMD as measured on DEXA scans before and after treatment.

RESULTS

Fifty-two patients were identified for analysis (46 women and 6 men, average age 67 years) who underwent an average of 20.9 ± 6.5 months of teriparatide therapy. The mean ± standard deviation HU increase throughout the lumbar spine (L1–4) was from 109.8 ± 53 to 133.9 ± 61 HU (+22%, 95% CI 1.2–46, p value = 0.039). Based on DEXA results, lumbar spine BMD increased from 0.85 to 0.93 g/cm2 (+9%, p value = 0.044). Lumbar spine T-scores improved from −2.4 ± 1.5 to −1.7 ± 1.5 (p value = 0.03). Average femoral neck T-scores improved from −2.5 ± 1.1 to −2.3 ± 1.0 (p value = 0.31).

CONCLUSIONS

Teriparatide treatment increased both HU and BMD on DEXA in the lumbar spine, without a change in femoral BMD. The 22% improvement in HU surpassed the 9% improvement determined with DEXA. These results support some surgeons’ subjective sense that intraoperative bone quality following teriparatide treatment is better than indicated by DEXA results. To the authors’ knowledge, this is the first study demonstrating an increase in HU with teriparatide treatment.
Outcomes in children undergoing posterior fossa decompression and duraplasty with and without tonsillar reduction for Chiari malformation type I and syringomyelia: a pilot prospective multicenter cohort study
Authors: Koueik Joyce , Sandoval-Garcia Carolina , Kestle John R. W. , Rocque Brandon G. , Frim David M. , Grant Gerald A. , Keating Robert F. , Muh Carrie R. , Oakes W. Jerry , Pollack Ian F. , Selden Nathan R. , Tubbs R. Shane , Tuite Gerald F. , Warf Benjamin , Rajamanickam Victoria , Broman Aimee Teo , Haughton Victor , Rebsamen Susan , George Timothy M. , Iskandar Bermans J.
Published: October 2019

OBJECTIVE

Despite significant advances in diagnostic and surgical techniques, the surgical management of Chiari malformation type I (CM-I) with associated syringomyelia remains controversial, and the type of surgery performed is surgeon dependent. This study’s goal was to determine the feasibility of a prospective, multicenter, cohort study for CM-I/syringomyelia patients and to provide pilot data that compare posterior fossa decompression and duraplasty (PFDD) with and without tonsillar reduction.

METHODS

Participating centers prospectively enrolled children suffering from both CM-I and syringomyelia who were scheduled to undergo surgical decompression. Clinical data were entered into a database preoperatively and at 1–2 weeks, 3–6 months, and 1 year postoperatively. MR images were evaluated by 3 independent, blinded teams of neurosurgeons and neuroradiologists. The primary endpoint was improvement or resolution of the syrinx.

RESULTS

Eight clinical sites were chosen based on the results of a published questionnaire intended to remove geographic and surgeon bias. Data from 68 patients were analyzed after exclusions, and complete clinical and imaging records were obtained for 55 and 58 individuals, respectively. There was strong agreement among the 3 radiology teams, and there was no difference in patient demographics among sites, surgeons, or surgery types. Tonsillar reduction was not associated with > 50% syrinx improvement (RR = 1.22, p = 0.39) or any syrinx improvement (RR = 1.00, p = 0.99). There were no surgical complications.

CONCLUSIONS

This study demonstrated the feasibility of a prospective, multicenter surgical trial in CM-I/syringomyelia and provides pilot data indicating no discernible difference in 1-year outcomes between PFDD with and without tonsillar reduction, with power calculations for larger future studies. In addition, the study revealed important technical factors to consider when setting up future trials. The long-term sequelae of tonsillar reduction have not been addressed and would be an important consideration in future investigations.
Intrathecal baclofen versus selective dorsal rhizotomy for children with cerebral palsy who are nonambulant: a systematic review
Authors: Davidson Benjamin , Schoen Nathan , Sedighim Shaina , Haldenby Renée , Dalziel Blythe , Breitbart Sara , Fehlings Darcy , Milo-Manson Golda , Narayanan Unni G. , Drake James M. , Ibrahim George M.
Published: October 2019

OBJECTIVE

Cerebral palsy (CP) is the most common childhood physical disability. Historically, children with hypertonia who are nonambulatory (Gross Motor Function Classification System [GMFCS] level IV or V) were considered candidates for intrathecal baclofen (ITB) therapy to facilitate care and mitigate discomfort. Selective dorsal rhizotomy (SDR) was often reserved for ambulant children to improve gait. Recently, case series have suggested SDR as an alternative to ITB in selected children functioning at GMFCS level IV/V. The objective for this study was to systematically review the evidence for ITB and SDR in GMFCS level IV or V children.

METHODS

Medline, Embase, Web of Science, and Cochrane databases were systematically searched. Articles were screened using the following inclusion criteria: 1) peer-reviewed articles reporting outcomes after SDR or ITB; 2) outcomes reported using a quantifiable scale or standardized outcome measure; 3) patients were < 19 years old at the time of operation; 4) patients had a diagnosis of CP; 5) patients were GMFCS level IV/V or results were reported based on GMFCS status and included some GMFCS level IV/V patients; 6) article and/or abstract in English; and 7) primary indication for surgery was hypertonia. Included studies were assessed with the Risk of Bias in Non-Randomized Studies - of Interventions (ROBINS-I) tool.

RESULTS

Twenty-seven studies met inclusion criteria. The most commonly reported outcomes were spasticity (on the Mean Ashworth Scale) and gross motor function (using the Gross Motor Function Measure), although other outcomes including frequency of orthopedic procedures and complications were also reported. There is evidence from case series that suggests that both ITB and SDR can lower spasticity and improve gross motor function in this nonambulatory population. Complication rates are decidedly higher after ITB due in part to the ongoing risk of device-related complications. The heterogeneity among study design, patient selection, outcome selection, and follow-up periods was extremely high, preventing meta-analysis. There are no comparative studies, and meaningful health-related quality of life outcomes such as care and comfort are lacking. This review is limited by the high risk of bias among included studies. Studies of SDR or ITB that did not clearly describe patients as being GMFCS level IV/V or nonambulatory were excluded.

CONCLUSIONS

There is a lack of evidence comparing the outcomes of ITB and SDR in the nonambulatory CP population. This could be overcome with standardized prospective studies using more robust methodology and relevant outcome measures.
A novel management proposal for intrinsic brainstem neurenteric cysts: case report
Authors: Agresta Gianluca , Sokol Drahoslav , Kaliaperumal Chandrasekaran , Kandasamy Jothy , Gallo Pasquale
Published: October 2019

Neurenteric cysts (NCs) are rare congenital lesions with epithelial mucin-secreting walls. They can occur anywhere along the neural axis, and an intrinsic midbrain cyst is extraordinary. Surgical management may pose a challenge due to the location of the lesion and adhesion of the cyst wall to the surrounding brainstem. The authors describe the first case of pediatric NC that was treated successfully with intracystic interferon-α (IFN-α).

A 16-month-old baby girl presented with a 2-week history of progressive croup, vomiting, and swallowing difficulty. MRI revealed a 1.8-cm cystic intrinsic lesion in the pontomedullary region. She initially underwent posterior fossa craniotomy and drainage of the cyst under intraoperative neurophysiology monitoring. Three weeks following the procedure, her symptoms recurred, and follow-up MRI demonstrated cystic recurrence. She underwent repeat aspiration of the cyst and biopsy of the cyst wall, and INF-α-2b was injected into the cystic cavity. Her symptoms improved and completely resolved after 5 months. A 9-month follow-up brain MRI study showed complete resolution of the NC. Intracystic IFN-α injection after cystic content aspiration may be a safe treatment option for the management of intrinsic brainstem NCs. Long-term clinical and radiological follow-up is recommended.
Early cephalad adjacent segment degeneration after posterior lumbar interbody fusion: a comparative study between cortical bone trajectory screw fixation and traditional trajectory screw fixation
Authors: Sakaura Hironobu , Ikegami Daisuke , Fujimori Takahito , Sugiura Tsuyoshi , Mukai Yoshihiro , Hosono Noboru , Fuji Takeshi
Published: October 2019

OBJECTIVE

Cortical bone trajectory (CBT) screw insertion through a caudomedial starting point provides advantages in limiting dissection of the superior facet joints and reducing muscle dissection and the risk of superior-segment facet violation by the screw. These advantages of the cephalad CBT screw can result in lower rates of early cephalad adjacent segment degeneration (ASD) after posterior lumbar interbody fusion (PLIF) with CBT screw fixation (CBT-PLIF) than those after PLIF using traditional trajectory screw fixation (TT-PLIF). Here, the authors investigated early cephalad ASD after CBT-PLIF and compared these results with those after TT-PLIF.

METHODS

The medical records of all patients who had undergone single-level CBT-PLIF or single-level TT-PLIF for degenerative lumbar spondylolisthesis (DLS) and with at least 3 years of postsurgical follow-up were retrospectively reviewed. At 3 years postoperatively, early cephalad radiological ASD changes (R-ASD) such as narrowing of disc height (> 3 mm), anterior or posterior slippage (> 3 mm), and posterior opening (> 5°) were examined using lateral radiographs of the lumbar spine. Early cephalad symptomatic adjacent segment disease (S-ASD) was diagnosed when clinical symptoms such as leg pain deteriorated during postoperative follow-up and the responsible lesion suprajacent to the fused segment was confirmed on MRI.

RESULTS

One hundred two patients underwent single-level CBT-PLIF for DLS and were followed up for at least 3 years (CBT group). As a control group, age- and sex-matched patients (77) underwent single-level TT-PLIF for DLS and were followed up for at least 3 years (TT group). The total incidence of early cephalad R-ASD was 12.7% in the CBT group and 41.6% in the TT group (p < 0.0001). The incidence of narrowing of disc height, anterior slippage, and posterior slippage was significantly lower in the CBT group (5.9%, 2.0%, and 4.9%) than in the TT group (16.9%, 13.0%, and 14.3%; p < 0.05). Early cephalad S-ASD developed in 1 patient (1.0%) in the CBT group and 3 patients (3.9%) in the TT group; although the incidence was lower in the CBT group than in the TT group, no significant difference was found between the two groups.

CONCLUSIONS

CBT-PLIF, as compared with TT-PLIF, significantly reduced the incidence of early cephalad R-ASD. One of the main reasons may be that cephalad CBT screws reduced the risk of proximal facet violation by the screw, which reportedly can increase biomechanical stress and lead to destabilization at the suprajacent segment to the fused segment.
Dorsal spinal cord herniation at the thoracolumbar junction presenting with scalloping of ossification of the ligamentum flavum: case report
Authors: Makino Takahiro , Takenaka Shota , Okamura Gensuke , Sakai Yusuke , Yoshikawa Hideki , Kaito Takashi
Published: October 2019

Dorsal spinal cord herniation is reportedly a rare condition. Here, the authors report an unusual case of dorsal spinal cord herniation at the thoracolumbar junction presenting with scalloping of ossification of the ligamentum flavum (OLF). A 75-year-old woman with a 2-year history of bilateral leg dysesthesia presented with progressive gait ataxia. Neurological examination showed bilateral patellar tendon hyperreflexia with loss of vibratory sensation and proprioception in her bilateral lower extremities. CT myelography revealed a posterior kink and dorsal herniation of the spinal cord at T11–12, with OLF between T10–11 and T12–L1. In addition, scalloping of the OLF was observed at T11–12 at the site of the herniated spinal cord. This scalloping was first noted 9 years previously and had been gradually progressing. The patient underwent surgical repair of the spinal cord herniation. Subsequently, her spinal cord herniation and vibratory sensation and proprioception in both legs partly improved, but gait ataxia remained unchanged. Dorsal spinal cord herniation reportedly occurs under conditions of vulnerability of the dorsal dura mater. In this case, acquired vulnerability of the dorsal dura mater owing to previous epidural catheter placement into the thoracolumbar space may have resulted in dorsal spinal cord herniation.
Our Lady’s miracle-working icons and the semiotics of the world tree
Authors: Golovata N.
Published: October 2019

The article is devoted to study of the modes of inheritance of cultural symbols. In particular, it is a research of perception in Christianity of preceding cultures’ archetypes. The study provides the analysis of semantic links between the symbols of the World Tree, the Vivifying Cross and the meaning of the Blessed Virgin image. The article shows how the pre-Christian symbols of the World Tree and the cross itself were merged and transformed in Christian theology, liturgy and iconography in the image of Golgotha Cross. The cross acquires the features of a Cosmic Tree, which combines the lower and the upper worlds – the heaven and the earth, life and death. The symbol of the tree is often substituted by the image of a woman appearing in this case as a symbol of life and fertility and evokes the associations with the genealogical tree. Therefore, the connection between the World Tree and the Blessed Virgin is proved to be natural.

On the basis of the historical sources the author analyzes the legends and evidences of the revelations and discoveries of the Blessed Mary’s icons on the trees of a certain kinds. The study explicates the symbolic meaning of those trees spread in a global world, in Slavic and Ukrainian cultural traditions. In particular, the research encloses the semantics of the following kinds of trees: fir tree, linden, pear tree, oak, willow, blackthorn. Every kind of those trees has a special symbolic meaning. The novelty of the research is that it for the first time proves the semantic connection of sacred meaning of miracle icons and of the certain kinds of trees. The study defines the limited range of those trees and, on the other hand, the kinds of other trees believed to be vile and thus never appeared in the legends about the discoveries of miracle icons.

As a conclusion, the research proves the existence of the autochtonal tradition of correlation of the semantics of miracle icons of Our Lady with the certain kinds of trees in the result of synthesis of the ancient symbolism and Christianity. In every case, the symbolic meanings of trees had archaic origin and connection with the ancient cosmogonical concepts. Depending on the particular semantic nuance emphasized in the World Tree, the priority of a certain kind of tree determined. On the whole, the study demonstrates the importance of the symbols in forming of cultural identity and for understanding of interrelations of cultures at the deep semantic level.
Review of the monograph of Tytarenko V.V. "From Prophecy in Religion to Projections in Religious Studies: History, Theory, Prospects."
Authors: Yemets-Dobronosova Yuliya
Published: October 2019

The scholar analyzes the religious, social, utopian, and philosophical-historical concepts of the future and pays particular attention to the perspectives of religion in contemporary futuristic prognosis. The author examines the features and approbation of scientific approaches to prediction in religious studies. There is a section devoted to religious scholarly expertise that will encourage dialogue not only among religious scholars or philosophers, but also with sociologists, historians, psychologists, mass media and managers.
Chemical constituents isolated from the whole plant of Solanum procumbens
Authors: Xuan Hai Nguyen , Trung Nhan Nguyen , Thi Thanh Mai Nguyen
Published: October 2019

Solanum procumbens L. is a medicinal plant belonging to the Solanaceae family. In Vietnam, it is known as "Ca gai leo", and it cultivated in some tropical countries in China, Laos, Cambodia, and Vietnam. From the stem of the ethyl acetate extract of Solanum procumbens, we had isolated one anthraquinone (1), four polyphenols (2-5), and one indole (6). By spectroscopic methods as well as comparing with data in the literature, their chemical structures were elucidated as ziganein (1), benzoic acid (2), salicylic acid (3), 4-hydroxybenzaldehyde (4), vanillic acid (5), and indole-3-carbaldehyde (6). These compounds were isolated for the first time from the genus Solanum.
ROLE OF SERIN/ THREONINE KINASE INHIBITOR IN THERAPY NON-ALCOHOLIC STEATOHEPATITIS AND ALCOHOLIC HEPATITIS
Authors: Lestari Novriantika
Published: October 2019

Liver fibrosis is a reversible response to a wound healing with marked accumulation of extracellular matrix which caused by injury to the liver. Liver fibrosis can be caused by various factors including alcohol and non-alcohol steatohepatitis. The process of fibrosis serves to localize the inflammation during chronic exposure. The hepatic stem cell (HSC) has a key role in the pathogenesis of liver fibrosis. The HSC activation is characterized by increased profibrogenic mediators including members of the TGF-? superfamily. In order to enable signal transduction, the mediator needs to bind to its receptors. The serine/ threonine kinase receptor is a receptor that binds to the TGF-? superfamily ligand, including TGF-?, BMP, activin and other mediators. The ligand receptor-binding activity will stimulate signal transduction that will translocate into the nucleus and phosphorylate various transcription factors that play a role in cell proliferation, differentiation, or apoptosis. There is currently no standard therapy for liver fibrosis. Based on the central role of the serine/ threonine kinase receptor in the pathogenesis of liver fibrosis, it is thought that the use of serine/ threonine kinase inhibitors is a promising therapy.
Flypaper Effect Pada Dana Alokasi Umum Dan Pendapatan Asli Daerah Terhadap Belanja Daerah
Authors: Tuaputimain Yohanis
Published: October 2019

This study aimed to find out the flypaper effect on regencies/municipalities government in Maluku province. One of transfer fund is general allocation fund which can be freely used by regional government to operational expenditure and capital expenditure. Technique of data collection was conducted by using documentation and in depth interview with echelon III and IV of revenue, finance and asset department Maluku Province. The data was analyzed by using qualitative Method through interpretive approach. The results of the study revealed that the realization of the regional government budget, regional revenue in the regional government on average is smaller than the general allocation fund to regional expenditure, so that it happens a flypaper effect on regional finance. The solution from the regional government is to reduce the gap in the occurrence of flypaper effects by conducting supervision and management to increase regional income from regional taxes, regional levies, and revenue from natural resources and other legitimate revenues. Penelitian ini bertujuan untuk mengetahui terjadi dan tidaknya Flypaper Effect pada pemerintah daerah Kabupaten/Kota di Provinsi Maluku. Salah satu dana transfer adalah dana alokasi umum yang dapat secara bebas digunakan oleh pemerintah daerah baik untuk belanja operasional maupun belanja modal. Metode pengumpulan data dilakukan dengan dokumentasi dan wawancara mendalam dengan pimpinan dan Pejabat Eselon III dan IV Badan Pendapatan, Pengelolaan Keuangan, dan Aset Derah Provinsi Maluku. Hasil pengumpulan data dianalisis dengan metode kualitatif menggunakan pendekatan interpretif. Hasil penelitian menunjukkan bahwa realisasi anggaran dan pendapatan belanja daerah, pendapatan asli daerah di pemerintah daerah secara rata-rata lebih kecil dari dana alokasi umum terhadap belanja daerah, sehingga terjadinya flypaper effect pada keuangan daerah. Adapun solusi dari pemerintah daerah untuk mengurangi kesenjangan terjadinya flypaper effect dengan melakukan pengawasan dan pengelolaan untuk meningkatkan pendapatan daerah baik dari pajak daerah, retribusi daerah, dan pendapatan sumber kekayaan alam serta pendapatan lain yang sah.
Pengaruh Corporate Governance, Investment Opportunity Set, Ukuran Perusahaan, Dan Penerapan Psak 55 Terhadap Konservatisme Akuntansi
Authors: Hakiki Lutviana Nur , Solikhah Badingatus
Published: October 2019

The purpose of the study is to determine and analyze the influence of managerial ownership, institutional ownership, the proportion of independent commissioners, investment opportunity set, company size and the implementation of PSAK 55 on accounting conservatism. This research based on quantitative methods using panel data regression. The population of this research is banking companies listed on the Indonesia Stock Exchange (IDX) in 2015-2017 periods. The data analysis tool used is the Eviews 9 program. The results of the study show that  company size had a positive and significant effect on accounting conservatism. Meanwhile, managerial ownership, institutional ownership, the proportion of independent commissioners, investment opportunity set, and the implementation of PSAK 55 have no effect on accounting conservatism Tujuan penelitian ini adalah untuk mengetahui dan menganalisis pengaruh kepemilikan manajerial, kepemilikan institusional, proporsi dewan komisaris independen, investment opportunity set, ukuran perusahaan, dan penerapan PSAK 55 terhadap konservatisme akuntansi. Penelitian ini didasarkan pada metode kuantitatif dengan menggunakan analisis regresi data panel. Populasi dalam penelitian ini adalah perusahaan perbankan yang terdaftar di Bursa Efek Indonesia (BEI) pada tahun 2015-2017. Alat analisis data yang digunakan yaitu program Eviews 9. Hasil penelitian menunjukkan bahwa ukuran perusahaan berpengaruh positif dan signifikan terhadap konservatisme akuntansi. Kepemilikan manajerial, kepemilikan institusional, proporsi dewan komisaris independen, investment opportunity set, dan penerapan PSAK 55 tidak berpengaruh terhadap konservatisme akuntansi.