bluuebunny/crossref_metadata_2025 huggingface dataset:
Analisis Potensi dan Arahan Strategi Kebijakan Pengembangan Desa Ekowisata di Wilayah Muria
Authors: Velasufah Whasfi , Setiawan Adib Rifqi
Published: September 2019

Muria adalah sebuah gunung berketinggian relatif 1594 m dpl yang terletak di wilayah utara Jawa Tengah bagian timur. Wilayah ini termasuk ke dalam wilayah Kabupaten Kudus di sisi selatan, di sisi barat laut berbatasan dengan Kabupaten Jepara, dan di sisi timur berbatasan dengan Kabupaten Pati. Di kawasan ini terdapat tempat yang sangat legendaris peninggalan Wali Songo, yaitu pesanggrahan di kawasan puncak Gunung Muria yang dalam sejarah negeri ini merupakan basis pesanggrahan tempat Kanjeng Sunan Muria menyebarkan agama Islam di tanah Jawa. Di sini pulalah Sunan Muria dimakamkan. Nama Gunung Muria dan daerah Kudus dinamakan berdasarkan nama Bukit Moria di Yerusalem. Saat ini, masyarakat di wilayah Muria banyak yang mengandalkan sektor pariwisata untuk meningkatkan pendapatan asli daerah (PAD). Pengembangan pariwisata lebih mengarah pada objek wisata artifisial atau buatan yang dibangun oleh investor namun menimbulkan permasalahan lingkungan. Perlu alternatif lain pengembangan pariwisata yaitu obyek wisata yang mampu menekan dampak kerusakan lingkungan sekaligus meningkatkan peran masyarakat lokal dan kesejahteraannya yaitu pengembangan desa ekowisata berbasis komunitas. Penelitian ini bertujuan untuk melakukan penilaian potensi wisata dan obyek daya tarik wisata, menganalisis kesiapan terhadap pengembangan desa ekowisata, serta menentukan arahan strategi kebijakan pengembangan desa ekowisata di di wilayah Muria, bagian Kudus. Penelitian ini merupakan penelitian deskriptif, yang data terkait dikumpulkan melalui survei. Pembahasan difokuskan terhadap analisis potensi wisata dan obyek daya tarik wisata, penilaian kesiapan pengembangan desa ekowisata berbasis komunitas, analisis SWOT terhadap ruang lingkup tempat dan proyeksi rentang waktu. Hasil penelitian menunjukkan bahwa beberapa desa yang termasuk wilayah Muria memiliki potensi wisata dan obyek daya tarik wisata berupa atraksi alam, sumberdaya pertanian, dan budaya yang dapat lebih dikembangkan.
PTEN Status Alters the Molecular Route to Resistance to BRAF Inhibitor in Melanoma
Authors: Zuo Qiang , Yu Yanlin
Published: September 2019

Although targeted treatment by BRAF inhibitors (BRAFi) achieved a
remarkable clinical response for patients with BRAF mutation, the
strength of efficacy is short and limited by acquired drug resistance [1].
Recent studies identified many mechanisms of acquired resistance to
BRAFi, such as mutations in NRAS or MEK1 and overexpression of
COT, EGFR, PDGFRβ, IGF1R or MET, lead the reactivation of MAPK
pathway and drive the cell proliferation, suggesting that co-targeting this
hyperactivated survival pathway by combination inhibitors might gain
the maximum clinical benefits for melanoma patients [2]. Based on
these findings, FDA approved the combination of dabrafenib (BRAFi)
with trametinib (MEK inhibitor) or vemurafenib (BRAFi) with
cobimetinib (MEK inhibitor) to inhibit the MAPK signaling pathway in
2014 and 2015 more effectively. Indeed, the dual inhibitors of MEK and
mutant BRAF kinases have shown a higher overall survival rate and
exciting results in initial tumor response in clinical.
Lipœdème
Authors: Vignes S.
Published: September 2019

Le lipœdème est une entité clinique mal connue, dont la prévalence est inconnue et qui est souvent confondue avec un lymphœdème. Il s’agit d’une répartition anormale du tissu adipeux, également pathologique, allant des hanches jusqu’aux chevilles en respectant les pieds. Il touche presque exclusivement les femmes obèses et débute généralement vers la puberté. Il s’accompagne de douleurs spontanées cutanées ou lors d’une stimulation modérée (pression, pincement), d’ecchymoses spontanées et d’œdèmes après orthostatisme prolongé. Le retentissement sur l’image corporelle et sur la qualité de vie est très important. Les examens complémentaires (scanner, IRM, lymphoscintigraphie) peuvent être utiles en cas de doute diagnostique ou pour confirmer le lipœdème. Après une longue évolution, le système lymphatique est atteint avec l’apparition d’un lipolymphœdème touchant alors le dos du pied et pouvant se compliquer d’érysipèle. La prise en charge n’est pas codifiée et comprend une perte de poids (qui améliore peu la morphologie des membres inférieurs), un soutien psychologique, la compression élastique, souvent mal tolérée et les activités physiques, en particulier en milieu aquatique. La liposuccion par tumescence réduit le volume, les douleurs spontanées et provoquées, les ecchymoses spontanées, et améliore l’apparence mais aussi la qualité de vie. La poursuite de la recherche clinique et physiopathologique du lipœdème est nécessaire pour pouvoir prendre en charge les femmes qui en sont atteintes.
Role of Learning Management Systems (LMS) in Developing Learning Skills
Authors: Alokluk Jamilah , Al-Amri Aisha
Published: September 2019

The current study aimed at measuring the efficiency of Blackboard in developing the collaborative and individual learning skills for Taibah University students. Moreover, it sought to unravel the differences (if any) in the effectiveness of the system in developing the above-mentioned skills according to the change of the user (student, staff member), gender (male, female), and the change of college to which the user belongs (scientific, humanitarian). The study adopted an analytical descriptive approach as it suits the nature of the study and its variables. Doing so, the researchers have built a learning tool which consists of two lists of e-learning skills; the first is for the individual e-learning skills and is divided into three main focuses including 45 paragraphs, and the second for the collaborative e-learning skills and is divided into three main focuses including 26 paragraphs. The study sample consisted of members of staff, students (males and females) distributed across colleges of Taibah University (n= 17).

The study came up with some results of which the most significant were: the Blackboard’s efficiency in developing the individual e-learning skills for the students is high with an efficiency average of..... And its efficiency in developing the collaborative e-learning skills for the students is also high with an efficiency average of.. Which reflects the importance of integrating the electronic systems within the learning and teaching processes and underlines its positive role in achieving the quality learning at low cost and effort. In addition, the study came up with the absence of indicative differences statistically in developing the individual and collaborative e-learning skills as per the user's change (student - member staff), or per the gender’s change (male-female), or per the sort of college change to which the user belongs (scientific - humanitarian). The study recommends the conduct of periodic assessment processes for the system’s efficiency in developing students’ various learning skills and calls for conducting similar studies to determine the necessary technological requirements for developing Blackboard on the basis of the individual and collaborative e-learning skills.
POULTRY AND CONSTRUCTION OF ADOLESCENT IDENTITY IN SOCIAL VULNERABILITY SITUATION SENATOR POMPEY – CE
Authors: MENDES VASCONCELOS FRANCISCO JOSÉ , VICTOR ANTONIA APARECIDA , FARIAS CÂMARA CANDIDA MARIA , FAGUNDES BEZERRA ANNA PAULA , HOLANDA BEZERRA OLIVEIRA MILENA , VASCONCELOS CARNEIRO STANIA NAGILA , DE CASTRO COUTINHO ELANE MARIA , Bezerra Bruna de Oliveira , Vidal Andréa Alexandre
Published: September 2019

Social vulnerability still affects many people, especially if there are no public policies on education, welfare, health and safety. It can have negative consequences both physical, and psychic. Amidst this scenario, it is clear that art can bring benefits to the individual. We chose to roost for this research to be a wide artistic expression, involving various expressions, as well as being one of the largest and oldest art forms in Brazil, with traces of the black community that was enslaved in colonial and imperial Brazil. This study aimed to understand how participation in the Santa Terezinha Foundation capoeira group in Pompey-EC Senator interfere in the construction of identity of adolescents in socially vulnerable. It is a country and qualitative research, as well as descriptive and exploratory, using case study. Data were collected in Santa Terezinha Foundation in Senador Pompeu, from March to May. Made use of questionnaire and semi-structured interviews conducted with 2 teenager’s capoeira group. Content analysis revealed categories like "Capoeira and its personal meaning", "capoeira teacher Meaning" and "Identity and (m) metamorphosis." It was noticed several positive changes in the lives of these subjects, where this article can be effective in targeted intervention practices for this audience, and demonstrate the importance of public policies that encourage the poultry, especially in unfavourable contexts and social vulnerability.
Body as Object of Historical Research: Bibliographic Review
Authors: Honorato Eduardo Sant’Ana Jorge , Fernandes Cássio Péres , Souza Daniel Cerdeira de , Lemos Sônia Maria , Silva Tirza Almeida da , Carvalho Érica da Silva , Monteiro Ângela Xavier , Cruz Clarissa Santana , Costa Luziane Vitoriano da , Martins Kenne Samara Andrade , Oliveira Rômulo Chaves Pereira de
Published: September 2019

This study aimed at describing, by means of a literature review, some possible meanings of the body through history. This study was conducted by collected bibliographic data of published books in Portuguese in the last 10 years, from known authors, mentioned in articles of anthropology, sociology and psychology. The articles found were organized as research and review articles and later categorized according to the theme. We discussed the possible understanding the meaning of body according with time, looking for its modification and impact.
Endangered languages, social subjects and mediatization:
Authors: Azzari Eliane Fernandes
Published: September 2019

This paper discusses possible roles of midia/midiatization in the face of processes of linguistic changes and/in endagered languages in contemporary society. It is grounded on a social and historical approach to language and it finds support in Bakhtinian propositions about discourse, subjects and chronotopes. It assumes a sociolinguistic perspective to the interface between linguistic landscape, digital media and discursive agency. The study adopts the digital ethnography as a methodological procedure that grants the investigation of human actions and interactions in digital contexts. In order to explore the target theme, it presents a brief analysis of the case of Wikitongues – a non-profit organization that offers several digital platforms/media for individuals to share, divulge and comment on endangered language and cultural diversity. The analysis suggests that, by resorting to free online digital spaces and their affordances, spontaneous and activist video communities were created, showing that mediatization processes supported by the internet might help promote language diversity, discursive agency and cultural awareness.
Phase I trial of caudate deep brain stimulation for treatment-resistant tinnitus
Authors: Cheung Steven W. , Racine Caroline A. , Henderson-Sabes Jennifer , Demopoulos Carly , Molinaro Annette M. , Heath Susan , Nagarajan Srikantan S. , Bourne Andrea L. , Rietcheck John E. , Wang Sarah S. , Larson Paul S.
Published: September 2019

OBJECTIVE

The objective of this open-label, nonrandomized trial was to evaluate the efficacy and safety of bilateral caudate nucleus deep brain stimulation (DBS) for treatment-resistant tinnitus.

METHODS

Six participants underwent DBS electrode implantation. One participant was removed from the study for suicidality unrelated to brain stimulation. Participants underwent a stimulation optimization period that ranged from 5 to 13 months, during which the most promising stimulation parameters for tinnitus reduction for each individual were determined. These individual optimal stimulation parameters were then used during 24 weeks of continuous caudate stimulation to reach the endpoint. The primary outcome for efficacy was the Tinnitus Functional Index (TFI), and executive function (EF) safety was a composite z-score from multiple neuropsychological tests (EF score). The secondary outcome for efficacy was the Tinnitus Handicap Inventory (THI); for neuropsychiatric safety it was the Frontal Systems Behavior Scale (FrSBe), and for hearing safety it was pure tone audiometry at 0.5, 1, 2, 3, 4, and 6 kHz and word recognition score (WRS). Other monitored outcomes included surgery- and device-related adverse events (AEs). Five participants provided full analyzable data sets. Primary and secondary outcomes were based on differences in measurements between baseline and endpoint.

RESULTS

The treatment effect size of caudate DBS for tinnitus was assessed by TFI [mean (SE), 23.3 (12.4)] and THI [30.8 (10.4)] scores, both of which were statistically significant (Wilcoxon signed-rank test, 1-tailed; alpha = 0.05). Based on clinically significant treatment response categorical analysis, there were 3 responders determined by TFI (≥ 13-point decrease) and 4 by THI (≥ 20-point decrease) scores. Safety outcomes according to EF score, FrSBe, audiometric thresholds, and WRS showed no significant change with continuous caudate stimulation. Surgery-related and device-related AEs were expected, transient, and reversible. There was only one serious AE, a suicide attempt unrelated to caudate neuromodulation in a participant in whom stimulation was in the off mode for 2 months prior to the event.

CONCLUSIONS

Bilateral caudate nucleus neuromodulation by DBS for severe, refractory tinnitus in this phase I trial showed very encouraging results. Primary and secondary outcomes revealed a highly variable treatment effect size and 60%–80% treatment response rate for clinically significant benefit, and no safety concerns. The design of a phase II trial may benefit from targeting refinement for final DBS lead placement to decrease the duration of the stimulation optimization period and to increase treatment effect size uniformity.

Clinical trial registration no.: NCT01988688 (clinicaltrials.gov).
The connectivity index: an effective metric for grading epileptogenicity
Authors: Yan Qi , Gaspard Nicolas , Zaveri Hitten P. , Blumenfeld Hal , Hirsch Lawrence J. , Spencer Dennis D. , Alkawadri Rafeed
Published: September 2019

OBJECTIVE

The aim of this study was to investigate the performance of a metric of functional connectivity to classify and grade the excitability of brain regions based on evoked potentials in response to single-pulse electrical stimulation (SPES).

METHODS

Patients who underwent 1-Hz frequency stimulation at prospectively selected contacts between 2003 and 2014 at the Yale Comprehensive Epilepsy Center were included. The stimulated contacts were classified as the seizure onset zone (SOZ), highly irritative zone (possibly epileptogenic irritative zone [IZp]), and control contacts not involved in the epileptic activity. Response contacts were classified as SOZ, active interictal irritative zone (IZ), quiet, or other. The normalized number of responses was defined as the number of contacts with any evoked responses divided by the total number of recorded contacts, and the normalized distance is the ratio of the average distance between the site of stimulation and sites of evoked responses to the average distances between the site of stimulation and all other recording contacts. A new metric that the authors labeled the connectivity index (CI) is defined as the product of the 2 values.

RESULTS

A total of 57 stimulation sessions in 22 patients were analyzed. The CI of the SOZ was higher than for control contacts (median CI of 0.74 vs 0.16, p = 0.0002). The evoked responses after stimulation of SOZ were seen at further distances compared to control (median normalized distance 0.96 vs 0.62, p = 0.0005). It was 1.8 times more likely that a response would be recorded at the SOZ than in nonepileptic contacts after stimulation of a control site. Habitual seizures were triggered in 27% of patients and 35% of SOZ contacts (median stimulation intensity 4 mA) but in none of the control or IZp contacts. Non-SOZ contacts in multifocal or poor surgical outcome cases had a higher CI than non-SOZ contacts in patients with localizable onsets (median CI of 0.5 vs 0.12, p = 0.04). There was a correlation between the stimulation current intensity and the normalized number of evoked responses (r = + 0.49, p = 0.01) but not with distance (r = + 0.1, p = 0.64).

CONCLUSIONS

The authors found enhanced connectivity when stimulating the SOZ compared to stimulating control contacts; responses were more distant as well. Habitual auras and seizures provoked by SPES were highly predictive of brain sites involved in seizure generation.
Endoscopic transmastoid posterior petrosal approach for locally aggressive tumors in the petrous part of the temporal bone involving the internal auditory canal, jugular foramen, and hypoglossal canal
Authors: Shin Masahiro , Hasegawa Hirotaka , Miyawaki Satoru , Kakigi Akinobu , Takizawa Tsuguto , Kondo Kenji , Shiode Taketo , Kin Taichi , Saito Nobuhito
Published: September 2019

OBJECTIVE

The posterior petrosal approach is an established surgical method offering wide access to skull base lesions through mastoid air cells. The authors describe their experience with the endoscopic transmastoid “posterior petrosal” approach (EPPAP) for skull base tumors involving the internal auditory canal (IAC), jugular foramen, and hypoglossal canal.

METHODS

The EPPAP was performed for 7 tumors (3 chordomas, 2 chondrosarcomas, 1 schwannoma, and 1 solitary fibrous tumor). All surgical procedures were performed under endoscopic visualization with mastoidectomy. The compact bone of the mastoid air cells and posterior surface of the petrous bone are carefully removed behind the semicircular canals. When removal of cancellous bone is extended superomedially through the infralabyrinthine space, the surgeon can expose the IAC and petrous portion of the internal carotid artery to reach the petrous apex (infralabyrinthine route). When removal of cancellous bone is extended inferomedially along the sigmoid sinus, the surgeon can safely reach the jugular foramen (transjugular route). Drilling of the inferior surface of petrous bone is extended further inferoposteriorly behind the jugular bulb to approach the hypoglossal canal and parapharyngeal space through the lateral aspect of the occipital condyle (infrajugular route).

RESULTS

Of the 7 tumors, gross-total resection was achieved in 4 (57.1%), subtotal resection (> 95% removal) in 2 (28.6%), and partial resection (90% removal) in 1 (14.2%). Postoperatively, 2 of 3 patients with exudative otitis media showed improvement of hearing deterioration, as did 2 patients with tinnitus. Hypoglossal nerve palsy and swallowing difficulty were improved after surgery in 2 patients and 1 patient, respectively. In 1 patient with severe cranial nerve deficits before surgery, symptoms did not show any improvement.

CONCLUSIONS

The authors present their preliminary experience with EPPAP for skull base tumors in the petrous part of the temporal bone and the lateral part of the occipital condyle involving the cranial nerves and internal carotid arteries. The microscope showed a higher-quality image and illumination in the low-power field. However, the endoscope could offer wider visualization of the surgical field and contribute to minimizing the size of the surgical pathways, necessity of brain retraction, and eventually the invasiveness of surgery. Thus, the EPPAP may be safe and effective for skull base tumors in the petrous region, achieving balance between the radicality and invasiveness of the skull base surgery.
Clip-first policy versus coil-first policy for the exclusion of middle cerebral artery aneurysms
Authors: Berro David Hassanein , L’Allinec Vincent , Pasco-Papon Anne , Emery Evelyne , Berro Mada , Barbier Charlotte , Fournier Henri-Dominique , Gaberel Thomas
Published: September 2019

OBJECTIVE

Middle cerebral artery (MCA) aneurysms are a particular subset of intracranial aneurysms that can be excluded by clipping or coiling. A comparison of the results between these two methods is often limited by a selection bias in which wide-neck and large aneurysms are frequently treated with surgery. Here, the authors report the results of two centers using opposing policies in the management of MCA aneurysms: one center used a clip-first policy while the other used a coil-first policy, which limited the selection bias and ensured a good comparison of these two treatment modalities.

METHODS

All patients treated for either ruptured or unruptured MCA aneurysms at one of two institutions between January 2012 and December 2015 were eligible for inclusion in this study. At one center a clip-first policy was applied, whereas the other applied a coil-first policy. The authors retrospectively reviewed the medical records of these patients and compared their clinical and radiological outcomes.

RESULTS

A total of 187 aneurysms were treated during the inclusion period; 88 aneurysms were treated by coiling and 99 aneurysms by clipping. The baseline patient and radiological characteristics were similar between the two groups, but the clinical presentation of the ruptured aneurysm cohort differed slightly. In the ruptured cohort (n = 90), although patients in the coiling group had a higher rate of additional surgery, the complication rate, functional outcome, and risk of death were similar between the two treatment groups. In the unruptured cohort (n = 97), the complication rate, functional outcome, and risk of death were also similar between the two treatment groups, although the risk of discomfort related to the temporal muscle atrophy was higher in the surgical group. Overall, the rate of complete occlusion was higher in the clipping group (84.2%) than in the coiling group (31%), which led to a higher risk in the coiling group of aneurysm retreatment within the first 2 years (p = 0.04).

CONCLUSIONS

Clipping and coiling for MCA aneurysm treatment provide the same clinical outcome for ruptured and unruptured aneurysms. However, clipping provides higher short- and long-term rates of complete exclusion, which in turn decreases the risk of aneurysm retreatment. Whether this lower occlusion rate can have a clinical impact in the long-term must be further evaluated.
Inflammation and obstruction of distal catheter slits in ventriculoperitoneal shunts: likely role of graphite
Authors: Del Bigio Marc R. , Sidhu Ravinder K. , Kazina Colin J. , Serletis Demitre
Published: September 2019

OBJECTIVE

Tissue reactions that contribute to obstruction of peritoneal catheters in ventriculoperitoneal shunt systems are not well characterized. Several recent rapid obstructions in children prompted a retrospective quality assurance review.

METHODS

The authors conducted a detailed investigation of 22 surgically explanted peritoneal shunt catheters and 8 autopsy cases with documented distal shunt obstruction. Patients’ medical histories were reviewed, and the catheters and/or tissues were subjected to conventional histological and immunohistochemical evaluations. In addition, 3 cases were subjected to electron microscopic examination including elemental analysis.

RESULTS

The majority of symptomatic obstructions were associated with distal slit catheters (17 slit, 3 open-end, and 2 unknown type). Among the autopsy cases, deaths were attributed to shunt failure in 2 cases of slit catheter obstruction, 1 case of open-end catheter obstruction, and 1 case of catheter withdrawal from the peritoneal cavity. The early tissue response consisted of a predominantly T lymphocyte accumulation with phagocytosis of graphite particles by macrophages. This is associated with proliferation of fibroblasts, mesothelial cells, and blood vessels, which can grow through the slits and occlude the catheter lumen. As the inflammation subsides after approximately 1 year, the tissue plug becomes collagenized and calcified.

CONCLUSIONS

This study, supported by experimental literature in other organ systems, indicates that graphite used to coat the slit openings of distal catheters from ventriculoperitoneal shunts likely predisposes to obstruction. Neurosurgeons and manufacturers should consider the potential negative consequences of this shunt design. The authors concur with previous recommendations that slit-valve distal catheters should not be used for ventriculoperitoneal shunting unless they can be proven safe and efficacious in a controlled trial.
Dr. Dwight Parkinson: a Canadian neurosurgical pioneer
Authors: Ajisebutu Andrew , Del Bigio Marc R. , Kazina Colin J. , West Michael , Serletis Demitre
Published: September 2019

In 1950, Dwight Parkinson was the first qualified neurosurgeon to arrive in Winnipeg, Manitoba. He played a monumental role in developing one of the earliest neurosurgical training programs in Western Canada. Parkinson was a pioneering neurosurgeon who served as the first president of the Canadian Neurosurgical Society in 1965. He was the epitome of the skull base neurosurgeon, which was not recognized as a distinct discipline at that time. He contributed to its development through detailed neuroanatomical study of the lateral sellar compartment (housing the parasellar venous plexus, a term he emphasized as more accurate than “cavernous sinus”). Parkinson also made seminal contributions to the management of cerebrovascular disease and offered new insights on cerebral concussion. Parkinson’s dedication to clinical excellence and education laid a cornerstone for the development of neurosurgery and the neurosciences in Manitoba, making him a key figure in Canadian neurosurgery. Using published materials, online resources, hospital archives, and personal interviews, the authors conducted a systematic review of Parkinson’s formative years, his development of the Section of Neurosurgery at the University of Manitoba, his achievements, and his legacy. This updated biography captures the exploits of this remarkable, and at times strictly disciplinarian, neurosurgeon-anatomist.
Impact of facility type and volume in low-grade glioma outcomes
Authors: Zhu Ping , Du Xianglin L. , Blanco Angel I. , Ballester Leomar Y. , Tandon Nitin , Berger Mitchel S. , Zhu Jay-Jiguang , Esquenazi Yoshua
Published: September 2019

OBJECTIVE

The object of this study was to investigate the impact of facility type (academic center [AC] vs non-AC) and facility volume (high-volume facility [HVF] vs low-volume facility [LVF]) on low-grade glioma (LGG) outcomes.

METHODS

This retrospective cohort study included 5539 LGG patients (2004–2014) from the National Cancer Database. Patients were categorized by facility type and volume (non-AC vs AC, HVF vs LVF). An HVF was defined as the top 1% of facilities according to the number of annual cases. Outcomes included overall survival, treatment receipt, and postoperative outcomes. Kaplan-Meier and Cox proportional-hazards models were applied. The Heller explained relative risk was computed to assess the relative importance of each survival predictor.

RESULTS

Significant survival advantages were observed at HVFs (HR 0.67, 95% CI 0.55–0.82, p < 0.001) and ACs (HR 0.84, 95% CI 0.73–0.97, p = 0.015), both prior to and after adjusting for all covariates. Tumor resection was 41% and 26% more likely to be performed at HVFs vs LVFs and ACs vs non-ACs, respectively. Chemotherapy was 40% and 88% more frequently to be utilized at HVFs vs LVFs and ACs vs non-ACs, respectively. Prolonged length of stay (LOS) was decreased by 42% and 24% at HVFs and ACs, respectively. After tumor histology, tumor pattern, and codeletion of 1p19q, facility type and surgical procedure were the most important contributors to survival variance. The main findings remained consistent using propensity score matching and multiple imputation.

CONCLUSIONS

This study provides evidence of survival benefits among LGG patients treated at HVFs and ACs. An increased likelihood of undergoing resections, receiving adjuvant therapies, having shorter LOSs, and the multidisciplinary environment typically found at ACs and HVFs are important contributors to the authors’ finding.
The role of NLRP3 in traumatic brain injury and its regulation by pioglitazone
Authors: Yi Ho Jun , Lee Jung Eun , Lee Dong Hoon , Kim Young Il , Cho Chul Bum , Kim Il Sup , Sung Jae Hoon , Yang Seung Ho
Published: September 2019

OBJECTIVE

Perilesional edema is a predominant mechanism underlying secondary brain injury after traumatic brain injury (TBI). Perilesional edema is characterized by inflammation, production of proinflammatory cytokines, and migration of peripheral immune cells into the brain. The nucleotide-binding domain and leucine-rich repeat (NLR) family pyrin domain–containing 3 protein (NLRP3) is a key component of secondary injury. Pioglitazone regulates NLRP3 and other inflammatory cytokines. In the present study, the role of NLRP3 and the pharmacological effects of pioglitazone were investigated in animal TBI models.

METHODS

Brain contusion was induced in a weight drop model involving 3 groups of mice: C57 BL/6 (sham group), NLRP3 knockout (K/O group), and pioglitazone-treated mice (treatment group). The percentage of brain water content of the 3 groups of mice was compared over a period of time. Western blot, immunohistochemistry, and immunofluorescence analyses were conducted to investigate NLRP3-related inflammasomes and the effects of pioglitazone in the TBI models.

RESULTS

Brain edema was the highest on day 3 after TBI in the sham group. Brain edema in both the K/O and the treatment groups was lower than in the sham group. In Western blot, the expression of inflammasomes was higher after TBI in the sham group, but the expression of interleukin-1β, caspase-1, and NLRP3 was decreased significantly following treatment with pioglitazone. The expression of GFAP (glial fibrillary acidic protein) and Iba1 was decreased in both the K/O and treatment groups. In addition, confocal microscopy revealed a decrease in microglial cell and astrocyte activation following pioglitazone therapy.

CONCLUSIONS

The inflammasome NLRP3 plays a pivotal role in regulating cerebral edema and secondary inflammation. Interestingly, pioglitazone reduced cerebral edema and immune response after TBI by downregulating the effects of NLRP3. These results suggest that the clinical application of pioglitazone may be a neuroprotective strategy in TBI.
Relationship between ophthalmic artery flow direction and visual deterioration after carotid angioplasty and stenting
Authors: Park Yung Ki , Lee Kijeong , Jung Byung Ju , Koo Jaseong , Kim Bum-Soo , Shin Yong Sam , Choi Jai Ho
Published: September 2019

OBJECTIVE

Visual deterioration is one of the disabling complications that can occur after carotid angioplasty and stenting (CAS). The purpose of this study was to evaluate the risk factors for newly developed visual symptoms after CAS, focusing on ophthalmic artery (OA) flow pattern and etiology of visual loss.

METHODS

A retrospective review of 127 patients with 138 internal carotid artery (ICA) stenosis lesions that were treated with CAS from February 2009 to October 2017 in a single institution was performed. The flow pattern of the OA was evaluated with digital subtraction angiography and classified into 3 types: type I, antegrade OA flow before and after CAS; type II, antegrade OA flow reversal after CAS; and type III, retained nonantegrade OA flow after CAS.

RESULTS

The degree of ipsilateral ICA stenosis was significantly higher in the nonantegrade group than that in the antegrade group (81.73% ± 9.87% vs 75.74% ± 10.27%, p = 0.001). Independent risk factors for newly developed visual symptoms after CAS were visual symptoms before CAS (OR 65.29, 95% CI 5.14–827.2; p = 0.001) and type III OA flow pattern (OR 55.98, 95% CI 2.88–1088.0; p = 0.008). The post-CAS visual symptoms in 10 patients were related to acute elevation of intraocular pressure in 6 patients and retinal artery occlusion in 3 patients.

CONCLUSIONS

Maintained retrograde or undetected OA flow after CAS and initial visual symptoms before CAS were related to post-CAS visual symptoms. Thus, careful attention is needed for these patients during the perioperative period, and immediate evaluation and management are required for patients with post-CAS visual loss.
Detailed analysis of 5-aminolevulinic acid induced fluorescence in different brain metastases at two specialized neurosurgical centers: experience in 157 cases
Authors: Marhold Franz , Mercea Petra A. , Scheichel Florian , Berghoff Anna S. , Heicappell Patricia , Kiesel Barbara , Mischkulnig Mario , Borkovec Martin , Wolfsberger Stefan , Woehrer Adelheid , Preusser Matthias , Knosp Engelbert , Ungersboeck Karl , Widhalm Georg
Published: September 2019

OBJECTIVE

Incomplete neurosurgical resection of brain metastases (BM) due to insufficient intraoperative visualization of tumor tissue is a major clinical challenge and might result in local recurrence. Recently, visible 5-aminolevulinic acid (5-ALA) induced fluorescence was first reported in patients with BM. The aim of this study was thus to investigate, for the first time systematically, the value of 5-ALA fluorescence for intraoperative visualization of BM in a large patient cohort.

METHODS

Adult patients (≥ 18 years) with resection of suspected BM after preoperative 5-ALA administration were prospectively recruited at two specialized neurosurgical centers. During surgery, the fluorescence status (visible or no fluorescence); fluorescence quality (strong, vague, or none); and fluorescence homogeneity (homogeneous or heterogeneous) of each BM was investigated. Additionally, these specific fluorescence characteristics of BM were correlated with the primary tumor type and the histopathological subtype. Tumor diagnosis was established according to the current WHO 2016 criteria.

RESULTS

Altogether, 157 BM were surgically treated in 154 patients. Visible fluorescence was observed in 104 BM (66%), whereas fluorescence was absent in the remaining 53 cases (34%). In detail, 53 tumors (34%) showed strong fluorescence, 51 tumors (32%) showed vague fluorescence, and 53 tumors (34%) had no fluorescence. The majority of BM (84% of cases) demonstrated a heterogeneous fluorescence pattern. According to primary tumor, visible fluorescence was less frequent in BM of melanomas compared to all other tumors (p = 0.037). According to histopathological subtype, visible fluorescence was more common in BM of ductal breast cancer than all other subtypes (p = 0.008). It is of note that visible fluorescence was observed in the surrounding brain tissue after the resection of BM in 74 (67%) of 111 investigated cases as well.

CONCLUSIONS

In this largest series to date, visible 5-ALA fluorescence was detected in two-thirds of BM. However, the characteristic heterogeneous fluorescence pattern and frequent lack of strong fluorescence limits the use of 5-ALA in BM and thus this technique needs further improvements.
Perioperative adverse events following surgery for primary bone tumors of the spine and en bloc resection for metastases
Authors: Charest-Morin Raphaële , Flexman Alana M. , Srinivas Shreya , Fisher Charles G. , Street John T. , Boyd Michael C. , Ailon Tamir , Dvorak Marcel F. , Kwon Brian K. , Paquette Scott J. , Dea Nicolas
Published: September 2019

OBJECTIVE

Surgical treatment of primary bone tumors of the spine and en bloc resection for isolated metastases are complex and challenging. Operative care is fraught with complications, though the true incidence and predictors of adverse events (AEs), length of stay (LOS), and mortality in this population remain poorly understood. The primary objective of this study was to describe the incidence and predictors of perioperative AEs in these patients. Secondary objectives included the determination of the incidence and predictors of admission to the intensive care unit (ICU), unanticipated reoperation during the same admission, hospital LOS, and mortality.

METHODS

In this retrospective analysis of prospectively collected data, the authors included consecutive patients at a single quaternary care referral center (January 1, 2009, to September 30, 2018) who underwent either surgery for a primary bone tumor of the spine or an en bloc resection for an isolated spinal metastasis. Information on perioperative AEs, demographic data, primary tumor histology, neurological status, surgical variables, pathological margins, Enneking appropriateness, LOS, ICU stay, reoperation during the same admission period, and in-hospital mortality was collected prospectively in the institutional database. The modified frailty score was extracted retrospectively.

RESULTS

One hundred thirteen patients met the inclusion criteria: 98 with primary bone tumors and 15 with isolated metastases. The cohort was 59% male, and the mean age was 49 years (SD 19 years). Overall, 79% of the patients experienced at least 1 AE. The median number of AEs per patient was 2 (IQR 0–4 AEs), and the median LOS was 16 days (IQR 9–32 days). No in-hospital deaths occurred in the cohort. Thirty-two patients (28%) required an ICU stay and 19% underwent an unanticipated second surgery during their admission. A longer surgical duration was associated with a higher likelihood of AEs (OR 1.21/hour, 95% CI 1.06–1.37, p = 0.005), longer ICU stay (OR 1.35/hour, 95% CI 1 1.20–1.52, p < 0.001), and reoperation (OR 1.001/hour, 95% CI 1.0003–1.003, p = 0.012). Longer hospital LOS was independently predicted by older age, female sex, upper cervical and sacral location of the tumor, surgical duration, preoperative neurological deficit, presence of AEs, and higher modified frailty index score.

CONCLUSIONS

Surgeries for primary bone tumors and en bloc resection for metastatic tumors are associated with a high incidence of perioperative AEs. Surgical duration predicts complications, reoperation, LOS, and ICU stay.
Complete resolution of postherpetic neuralgia following pallidotomy: case report
Authors: De Vloo Philippe , Milosevic Luka , Gramer Robert M. , Aguirre-Padilla David Hernán , Dallapiazza Robert F. , Lee Darrin J. , Hutchison William D. , Fasano Alfonso , Lozano Andres M.
Published: September 2019

The authors report on a female patient with left-dominant Parkinson’s disease with motor fluctuations and levodopa-induced dyskinesias and comorbid postherpetic neuralgia (PHN), who underwent a right-sided pallidotomy. Besides a substantial improvement in her Parkinson’s symptoms, she reported an immediate and complete disappearance of PHN. This neuralgia had been long-standing, pharmacologically refractory, and severe (preoperative Brief Pain Inventory [BPI] pain severity score of 8.0, BPI pain interference score of 7.3, short-form McGill Pain Questionnaire sensory pain rating index of 7 and affective pain rating index of 10, Present Pain Intensity rank value of 4, and visual analog scale score of 81 mm; all postoperative scores were 0). She continued to be pain free at 16 months postoperatively.

This peculiar finding adds substantially to the largely unrecognized evidence for the role of the pallidum in pain processing, based on previous electrophysiological, metabolic, anatomical, pharmacological, and clinical observations. Therefore, the potential of the pallidum as a neurosurgical target for neuropathic pain warrants further investigation.
Aplikasi Ensiklopedia Lagu dan Tarian Tradisional Indonesia Berbasis Android
Authors: Amalia Resti
Published: September 2019

Pengenalan lagu dan tarian tradisional di Indonesia sangat  penting untuk dikenalkan kepada generasi penerus bangsa. Dengan memperkenalkan berbagai lagu dan tarian daerah; bisa membangkitkan rasa nasionalisme dan rasa ke Bhineka-an. Perkembangan smartphone saat ini sangat pesat dan cepat; tidak hanya digunakan oleh pengguna sebagai media komunikasi; tetapi juga sebagai media informasi. Oleh karena itu; penulis berusaha membuat solusi pembelajaran lagu dan tarian tradisional yang praktis menggunakan smartphone android sebagai media informasinya. Keragaman tarian dan lagu daerah dari 31 propinsi bisa kita dapatkan didalam aplikasi ini. Aplikasi ini dapat berjalan dengan baik pada perangkat berbasis android dengan versi 4.0 keatas.
Komparasi Metode Simple Additive Weightin (SAW) dan Metode Weighted Product (WP) dalam Menentukan Karyawan Terbaik (Studi Kasus: PT. Matrixnet Global Indonesia)
Authors: Nardiono Nardiono
Published: September 2019

Karyawan adalah tenaga kerja yang melakukan pekerjaan dan memberikan hasil kerjanya kepada pengusaha. Pemilihan karyawan terbaik merupakan kegiatan dalam perusahaan guna untuk memberi motivasi dan penghargaan agar karyawan bekerja lebih baik dan produktif.  Salah satu sistem yang dapat digunakan dalam menentukan karyawan terbaik adalah dengan menggunakan sistem pendukung keputusan. Sistem pendukung keputusan adalah sistem yang digunakan untuk mendukung dan membantu pihak manajemen dalam melakukan pengambilan keputusan pada kondisi semi terstruktur dan tidak terstruktur. Sistem pendukung keputusan ini menggunakan metode SAW (Simple Additive Weighting) dan metode WP (Weighted Product). Kedua metode ini bertujuan memilih alternative karyawan terbaik dari beberapa alternatife karyawan berdasarkan kriteria-kriteria (kedisiplinan; sikap; kerjasama tim; prestasi; ketelatenan; penampilan ) yang telah ditentukan. Proses perhitungan dilakukan dengan mencari nilai bobot pada setiap alternative pada setiap kriteria. Karyawan yang terpilih yaitu yang memiliki nilai terbesar sebagai alternative terbaik. Dari hasil perhitungan metode SAW (Simple Additive Weighting) dan WP (Weighted Product); di dapatkan hasil perbandingan kedua metode. Metode SAW yang mendapatkan hasil lebih baik dibandingkan dengan metode WP; karena mendapat hasil yang lebih besar; tepat dan akurat.
Strategi Pemanfaatan Media Audio Visual untuk Peningkatan Hasil Belajar Bahasa Inggris
Authors: Purnaningsih Pari
Published: September 2019

Di dunia pendidikan; kemampuan berbahasa Inggris mahasiswa tak dapat dipisahkan dalam proses pembelajaran yang diberikan oleh dosen. Dosen sebagai fasilitator berusaha memberikan proses belajar mengajar yang terbaik untuk mahasiswanya. Bahasa Inggris merupakan mata kuliah yang mengembangkan keterampilan berkomunikasi baik secara lisan maupun tulisan; memahami dan mengungkapkan informasi. Mata kuliah ini tidak lagi sekedar mata kuliah yang terbatas pada ilmu tata bahasanya saja; namun juga dapat mengembangkan keterampilan mahasiswa dalam berkomunikasi bahasa Inggris secara lisan dan tulisan. Untuk itu diperlukan pendekatan kreatif yang dapat membawa mahasiswa lebih aktif dan menarik dalam pembelajaran bahasa Inggris. Salah satu proses pendekatan yang diberikan dosen adalah pembelajaran bahasa Inggris dengan memanfaatkan media audio visual; yaitu menggunakan video; film; dan musik. Dalam pengajaran materi bahasa Inggris; penggunaan media pembelajaran ini merupakan salah satu media pembelajaran yang tepat untuk digunakan. Tujuan jurnal ini adalah memberikan strategi dalam memanfaatkan media audio visual untuk meningkatkan hasil belajar bahasa Inggris mahasiswa. Secara teknis strategi pemanfaatan  media audio visual dalam proses kegiatan belajar mengajar bahasa Inggris dibagai menjadi tiga tahapan; yaitu persiapan; penggunaan dan yang terakhir adalah tindak lanjut setelah penggunaan. Strategi pemanfaatan media ini akan menjadikan pembelajaran bahasa Inggris lebih efektif; interaktif dan menarik. Dosen akan lebih optimal dalam penyampaian materi dan mahasiswa menjadi lebih mudah memahaminya.
Pengaruh Penggunaan Media Pembelajaran dan Konsep Diri Siswa Terhadap Hasil Belajar Matematika Siswa
Authors: Firdaus Indra Cahya
Published: September 2019

Media penelitian yang digunakan adalah survey dan eksperimen dengan media analisis teatment by level. Jenis pungujian yang digunakan adalah Anova Dua Arah. Eksperimen dilakukan pada dua kelompok/sampel dimana masing-masing kelompok diberi perlakuan (treatment) yang berbeda. Kelompok pertama diajar dengan menggunakan media pembelajaran pesona matematika; sedangkan kelompok kedua diajar dengan menggunakan media pembelajaran konvensional. Masing-masing kelompok dibagi lagi menjadi dua kategori menurut Konsep Diri; yaitu kelompok yang mempunyai Konsep Diri kategori tinggi dan kelompok yang mempunyai Konsep Diri kategori rendah. Tujuan dari penelitian ini adalah untuk mengetahui sejauh mana pengaruh penggunaan media pembelajaran; dalam penelitian ini adalah media pembelajaran dan Konsep Diri terhadap hasil belajar matematika siswa; khususnya untuk siswa XI MA. Ada pengaruh yang positif dan signifikan maka seberapa kuat pengaruh penggunaan penggunaan media pembelajaran pesona matematika dan Konsep Diri terhadap hasil belajar matematika siswa.
Pembelajaran Bahasa Inggris Melalui Multimedia
Authors: Sulasih Sulasih
Published: September 2019

Kegiatan pembelajaran di dalam kelas mempunyai peranan yang sangat penting bagi keberhasilan peserta didik. Hanya melalui kegiatan pembelajaran yang efektif peserta didik akan dapat dicapai. Kemajuan teknologi dewasa ini telah banyak memberikan kontribusi dalam berbagai hal termasuk dalam rangka meningkatkan efektifitas pembelajaran dalam bahasa Inggris. Penelitian ini mencoba membahas hal yang dapat dilakukan dalam pembelajaran bahasa Inggris melalui multimedia yaitu diantaranya: komputer; gadget; internet; skype; youtube; televisi; game dan radio. Dengan menggunakan multimedia sebagai media dalam kegiatan belajar mengajar diharapkan dapat mempermudah peserta didik dalam belajar bahasa Inggris.
Sistem Pendukung Keputusan Seleksi Penerima Beasiswa dengan Metode Weighted Product pada SMP Negeri 1 Parung Berbasis Web
Authors: Oktavia Petricia
Published: September 2019

Sistem pendukung keputusan sebagai sebuah sistem berbasis komputer yang membantu dalam proses pengambilan keputusan. Sistem pendukung keputusan sebagai sistem informasi berbasis komputer yang adaptif, interaktif, flaksibel, yang secara kusus dikembangkan untuk mendukung solusi dari permasalahan manajemen yang tidak terstruktur untuk meningkatkan kualitas pengambilan keputusan. Sistem pendukung ini membantu dalam proses pengambilan keputusan dalam seleksi penerima beasiswa di SMP Negeri 1 Parung. Pada sistem pendukung keputusan ini diperlukan kriteria-kriteria untuk menentukan siapa yang akan dipilih untuk menerima beasiswa. Dalam pembangunan sistem pendukung keputusan ini penulis menggunakan metode Weighted Product sebagai metode pengambilan keputusan. Metode Weighted Product ini dipilih karena merupakan penjumlahan terbobot untuk mencari penjumlahan terbobot dari rating kinerja pada setiap alternatif pada semua atribut. Maka hasil keputusan pemilihan beasiswa yaitu pada alternatif ke 2 dari 5 alternatif dengan nilai 0.2104.