bluuebunny/crossref_metadata_2025 huggingface dataset:
Preoperative pelvic obliquity: possible relation to postoperative coronal decompensation in thoracolumbar/lumbar adolescent idiopathic scoliosis
Authors: Banno Tomohiro , Yamato Yu , Oba Hiroki , Ohba Tetsuro , Hasegawa Tomohiko , Yoshida Go , Arima Hideyuki , Oe Shin , Mihara Yuki , Ushirozako Hiroki , Takahashi Jun , Haro Hirotaka , Matsuyama Yukihiro
Published: October 2021

OBJECTIVE

Pelvic obliquity is frequently observed in patients with adolescent idiopathic scoliosis with thoracolumbar/lumbar (TL/L) curve. This study aimed to assess pelvic obliquity changes and their effects on clinical outcomes of posterior fusion surgery.

METHODS

Data in 80 patients (69 with type 5C and 11 with type 6C adolescent idiopathic scoliosis) who underwent posterior fusion surgery were retrospectively analyzed. Pelvic obliquity was defined as an absolute pelvic obliquity angle (POA) value of ≥ 3°. The patients were divided into groups according to preoperative pelvic obliquity. Moreover, patients with preoperative pelvic obliquity were divided based on POA change from preoperative values versus 2 years postoperatively. Patients were divided based on the presence of selective or nonselective TL/L fusion. Radiographic parameters and clinical outcomes were compared between these groups.

RESULTS

Among 80 patients, 41 (51%) showed preoperative pelvic obliquity, and its direction was upward to the right for all cases. Coronal decompensation 2 years postoperatively was significantly elevated in patients with preoperative pelvic obliquity (p < 0.05). Thirty-two patients (40%) displayed pelvic obliquity 2 years postoperatively. Among 41 patients with preoperative pelvic obliquity, 22 patients (54%) were in the group with a decrease in POA, and 19 were in the group with no decrease. The group with no decrease in POA showed significant TL/L curve progression throughout the postoperative follow-up period. The patients with nonselective fusion showed a significantly lower incidence of pelvic obliquity at 2 years postoperatively.

CONCLUSIONS

Postoperative coronal decompensation more frequently occurred in patients with preoperative pelvic obliquity than in those without pelvic obliquity preoperatively. In addition, postoperative pelvic obliquity changes may be related to residual lumbar curve behavior.
Outcomes of epilepsy surgery in the older population: not too old, not too late
Authors: Kerezoudis Panagiotis , Singh Rohin , Parisi Veronica , Worrell Gregory A. , Miller Kai J. , Marsh W. Richard , Van Gompel Jamie J.
Published: October 2021

OBJECTIVE

The prevalence of epilepsy in the older adult population is increasing. While surgical intervention in younger patients is supported by level I evidence, the safety and efficacy of epilepsy surgery in older individuals is less well established. The aim of this study was to evaluate seizure freedom rates and surgical outcomes in older epilepsy patients.

METHODS

The authors’ institutional electronic database was queried for patients older than 50 who had undergone epilepsy surgery during 2002–2018. Cases were grouped into 50–59, 60–69, and 70+ years old. Seizure freedom at the last follow-up constituted the primary outcome of interest. The institutional analysis was supplemented by a literature review and meta-analysis (random effects model) of all published studies on this topic as well as by an analysis of complication rates, mortality rates, and cost data from a nationwide administrative database (Vizient Inc., years 2016–2019).

RESULTS

A total of 73 patients (n = 16 for 50–59 years, n = 47 for 60–69, and n = 10 for 70+) were treated at the authors’ institution. The median age was 63 years, and 66% of the patients were female. At a median follow-up of 24 months, seizure freedom was 73% for the overall cohort, 63% for the 50–59 group, 77% for the 60–69 group, and 70% for the 70+ group. The literature search identified 15 additional retrospective studies (474 cases). Temporal lobectomy was the most commonly performed procedure (73%), and mesial temporal sclerosis was the most common pathology (52%), followed by nonspecific gliosis (19%). The pooled mean follow-up was 39 months (range 6–114.8 months) with a pooled seizure freedom rate of 65% (95% CI 59%–72%). On multivariable meta-regression analysis, an older mean age at surgery (coefficient [coeff] 2.1, 95% CI 1.1–3.1, p < 0.001) and the presence of mesial temporal sclerosis (coeff 0.3, 95% CI 0.1–0.6, p = 0.015) were the most important predictors of seizure freedom. Finally, analysis of the Vizient database revealed mortality rates of 0.5%, 1.1%, and 9.6%; complication rates of 7.1%, 10.1%, and 17.3%; and mean hospital costs of $31,977, $34,586, and $40,153 for patients aged 50–59, 60–69, and 70+ years, respectively.

CONCLUSIONS

While seizure-free outcomes of epilepsy surgery are excellent, there is an expected increase in morbidity and mortality with increasing age. Findings in this study on the safety and efficacy of epilepsy surgery in the older population may serve as a useful guide during preoperative decision-making and patient counseling.
Transverse sinus stenting without surgical repair in idiopathic CSF rhinorrhea associated with transverse sinus stenoses: a pilot study
Authors: Lenck Stephanie , Nouet Aurelien , Shotar Eimad , Abi Jaoudé Samiya , Nicholson Patrick , Premat Kevin , Corcy Celine , Boch Anne-Laure , Sourour Nader Antoine , Tankere Frederic , Carpentier Alexandre , Clarençon Frederic
Published: October 2021

OBJECTIVE

Based on their clinical and radiological patterns, idiopathic CSF rhinorrhea and idiopathic intracranial hypertension can represent different clinical expressions of the same underlying pathological process. Transverse sinus stenoses are associated with both diseases, resulting in eventual restriction of the venous CSF outflow pathway. While venous sinus stenting has emerged as a promising treatment for idiopathic intracranial hypertension, its efficiency on idiopathic CSF leaks has not been very well addressed in the literature so far. The purpose of this study was to report the results of transverse sinus stenting in patients with spontaneous CSF rhinorrhea associated with transverse sinus stenoses.

METHODS

From a prospectively collected database, the authors retrospectively collected the clinical and radiological features of the patients with spontaneous CSF leakage who were treated with venous sinus stenting.

RESULTS

Five female patients were included in this study. Transverse sinus stenoses were present in all patients, and other radiological signs of idiopathic intracranial hypertension were present in 4 patients. The median transstenotic pressure gradient was 6.5 mm Hg (range 3–9 mm Hg). Venous stenting resulted in the disappearance of the leak in 4 patients with no recurrence and no subsequent meningitis during the follow-up (median 12 months, range 6–63 months).

CONCLUSIONS

According to the authors’ results, venous sinus stenting may result in the disappearance of the leak in many cases of idiopathic CSF rhinorrhea. Larger comparative studies are needed to assess the efficiency and safety of venous stenting as a first-line approach in patients with spontaneous CSF rhinorrhea associated with transverse sinus stenoses.
Utility of intraoperative neuromonitoring and outcomes of neurological complication in lower cervical and upper thoracic posterior-based three-column osteotomies for cervical deformity
Authors: Lau Darryl , Guo Lanjun , Deviren Vedat , Ames Christopher P.
Published: October 2021

OBJECTIVE

For severe and rigid adult cervical deformity, posterior-based three-column osteotomies (3COs) are warranted, but neurological complications are relatively high with such procedures. The performance measures of intraoperative neuromonitoring (IONM) during cervicothoracic 3CO have yet to be studied, and there remains a paucity of literature regarding the topic. Therefore, the authors of this study examined the performance of IONM in predicting new neurological weakness following lower cervical and upper thoracic 3CO. In addition, they report the 6-month, 1-year, and 2-year outcomes of patients who experienced new postoperative weakness.

METHODS

The authors performed a retrospective review of a single surgeon’s experience from 2011 to 2018 with all patients who had undergone posterior-based 3CO in the lower cervical (C7) or upper thoracic (T1–4) spine. Medical and neuromonitoring records were independently reviewed.

RESULTS

A total of 56 patients were included in the analysis, 38 of whom had undergone pedicle subtraction osteotomy and 18 of whom had undergone vertebral column resection. The mean age was 61.6 years, and 41.1% of the patients were male. Among the study cohort, 66.1% were myelopathic and 33.9% had preoperative weakness. Mean blood loss was 1565.0 ml, and length of surgery was 315.9 minutes. Preoperative and postoperative measures assessed were cervical sagittal vertical axis (6.5 and 3.8 cm, respectively; p < 0.001), cervical lordosis (2.3° and −6.7°, p = 0.042), and T1 slope (48.6° and 35.8°, p < 0.001). The complication rate was 49.0%, and the new neurological deficit rate was 17.9%. When stratifying by osteotomy level, there were significantly higher rates of neurological deficits at C7 and T1: C7 (37.5%), T1 (44.4%), T2 (16.7%), T3 (14.3%), and T4 (0.0%; p = 0.042). Most new neurological weakness was the nerve root pattern rather than the spinal cord pattern. Overall, there were 16 IONM changes at any threshold: 14 at 50%, 8 at 75%, and 13 if only counting patients who did not return to baseline (RTB). Performance measures for the various thresholds were accuracy (73.2% to 77.8%), positive predictive value (25.0% to 46.2%), negative predictive value (81.3% to 88.1%), sensitivity (18.2% to 54.5%), and specificity (77.8% to 86.7%). Sensitivity to detect a spinal cord pattern of weakness was 100% and 28.6% for a nerve root pattern of weakness. In patients with a new postoperative deficit, 22.2% were unchanged, 44.4% improved, and 33.3% had a RTB at the 2-year follow-up.

CONCLUSIONS

Complication rates are high following posterior 3CO for cervical deformity. 3CO at C7 and T1 has the highest rates of neurological deficit. Current IONM modalities have modest performance in predicting postoperative deficits, especially for nerve root neuropraxia. A large prospective multicenter study is warranted.
Clinical and radiographic characteristics of sacral arteriovenous fistulas: a multicenter experience
Authors: Domingo Ricardo A. , De Biase Gaetano , Navarro Ramon , Santos Jaime L. Martinez , Rivas Gabriella A. , Gupta Vivek , Miller David , Bendok Bernard R. , Brinjikji Waleed , Fox W. Christopher , Huynh Thien J. , Tawk Rabih G.
Published: October 2021

OBJECTIVE

Available data on management of sacral arteriovenous fistulas (sAVFs) are limited to individual case reports and small series. Management includes observation, endovascular embolization, or surgical ligation, with no clear guidelines on the optimal treatment modality. The authors’ objective was to report their multiinstitutional experience with management of sAVF patients, including clinical and radiographic characteristics and postprocedural outcomes.

METHODS

The electronic medical records of patients with a diagnosis of spinal arteriovenous fistula treated from January 2004 to December 2019 at the authors’ institutions were reviewed, and data were summarized using descriptive statistics, including percentage and count for categorical data, median as a measure of central tendency for continuous variables, and interquartile range (IQR) as a measure of dispersion.

RESULTS

A total of 26 patients with sAVFs were included. The median (IQR) age was 65 (57–73) years, and 73% (n = 19) of patients were male. Lower-extremity weakness was the most common presenting symptom (n = 24 [92%]), and half the patients (n = 13 [50%]) reported bowel and bladder sphincter dysfunction. The median (IQR) time from symptom onset to treatment was 12 (5.25–26.25) months. Radiographically, all patients had T2 hyperintensity at the level of the conus medullaris (CM) (n = 26 [100%]). Intradural flow voids were identified in 85% (n = 22) of patients. The majority of the lesions had a single identifiable arterial feeder (n = 19 [73%]). The fistula was located most commonly at the S1 level (n = 13 [50%]). The site where the draining vein connects to the pial venous plexus was seen predominantly at the lumbar level (n = 16 [62%]). In total, 29 procedures were performed: 10 open surgeries and 19 endovascular embolization procedures. Complete occlusion was achieved in 90% (n = 9) of patients after open surgery and 79% (n = 15) after endovascular embolization. Motor improvement was seen in 68% of patients (n = 15), and bladder and bowel function improved in 9 patients (41%). At last follow-up, 73% (n = 16) of patients had either resolution or improvement of the pretreatment intramedullary T2 signal hyperintensity.

CONCLUSIONS

T2 hyperintensity of the CM and a dilated filum terminale vein are consistent radiographic signs of sAVF, and delayed presentation is common. Complete occlusion was achieved in almost all patients after surgery, and endovascular embolization was effective in 70% of the patients. Further studies are needed to determine the best treatment modality based on case-specific characteristics.
Predictors of functional recovery following surgery for foot drop due to degenerative lumbar disease
Authors: Berger Assaf , Mangel Laurence , Basal Sharif , Lidar Zvi , Regev Gilad J , Khashan Morsi , Ofir Dror , Salame Khalil
Published: October 2021

OBJECTIVE

Surgery for foot drop secondary to lumbar degenerative disease is not always associated with postoperative functional improvement. It is still unclear whether early decompression results in better functional recovery and how soon surgery should be performed. This study aimed to evaluate predicting factors that affect short- and long-term recovery outcomes and to explore the relationship between timing of lumbar decompression and recovery from foot drop in an attempt to identify a cutoff time from symptom onset until decompression for optimal functional improvement.

METHODS

The authors collected demographic, clinical, and radiographic data on patients who underwent surgery for foot drop due to lumbar degenerative disease. Clinical data included tibialis anterior muscle (TAM) strength before and after surgery, duration of preoperative motor weakness, and duration of radicular pain until surgery. TAM strength was recorded at the immediate postoperative period and 1 month after surgery while long-term follow-up on functional outcomes were obtained at ≥ 2 years postsurgery by telephone interview. Data including degree and duration of preoperative motor weakness as well as the occurrence of pain and its duration were collected to analyze their impact on short- and long-term outcomes.

RESULTS

The majority of patients (70%) showed functional improvement within 1 month postsurgery and 40% recovered to normal or near-normal strength. Univariate analysis revealed a trend toward lower improvement rates in patients with preoperative weakness of more than 3 weeks (33%) compared with patients who were operated on earlier (76.5%, p = 0.034). In a multivariate analysis, the only significant predictor for maximal strength recovery was TAM strength before surgery (OR 6.80, 95% CI 1.38–33.42, p = 0.018). Maximal recovery by 1 month after surgery was significantly associated with sustained long-term functional improvement (p = 0.006).

CONCLUSIONS

Early surgery may improve the recovery rate in patients with foot drop caused by lumbar degenerative disease, yet the strongest predictor for the extent of recovery is the severity of preoperative TAM weakness. Maximal recovery in the short-term postoperative period is associated with sustained long-term functional improvement and independence.
Negative impact of short-level posterior lumbar interbody fusion in patients with diffuse idiopathic skeletal hyperostosis extending to the lumbar segment
Authors: Nakajima Hideaki , Honjoh Kazuya , Watanabe Shuji , Kubota Arisa , Matsumine Akihiko
Published: October 2021

OBJECTIVE

The development of diffuse idiopathic skeletal hyperostosis (DISH) often requires further surgery after posterior decompression without fusion because of postoperative intervertebral instability. However, there is no information on whether fusion surgery is recommended for these patients as the standard surgery. The aim of this study was to review the clinical and imaging findings in lumbar spinal canal stenosis (LSS) patients with DISH affecting the lumbar segment (L-DISH) and to assess the indication for fusion surgery in patients with DISH.

METHODS

A total of 237 patients with LSS underwent 1- or 2-level posterior lumbar interbody fusion (PLIF) at the authors’ hospital and had a minimum follow-up period of 2 years. Patients with L-DISH were classified as such (n = 27, 11.4%), whereas those without were classified as controls (non-L-DISH; n = 210, 88.6%). The success rates of short-level PLIF were compared in patients with and those without L-DISH. The rates of adjacent segment disease (ASD), pseudarthrosis, postoperative symptoms, and revision surgery were examined in the two groups.

RESULTS

L-DISH from L2 to L4 correlated significantly with early-onset ASD, pseudarthrosis, and the appearance of postsurgical symptoms, especially at a lower segment and one distance from the segment adjacent to L-DISH, which were associated with the worst clinical outcome. Significantly higher percentages of L-DISH patients developed ASD and pseudarthrosis than those in the non-L-DISH group (40.7% vs 4.8% and 29.6% vs 2.4%, respectively). Of those patients with ASD and/or pseudarthrosis, 69.2% were symptomatic and 11.1% underwent revision surgery.

CONCLUSIONS

The results highlighted the negative impact of short-level PLIF surgery for patients with L-DISH. Increased mechanical stress below the fused segment was considered the reason for the poor clinical outcome.
Two clinical tests assessing long thoracic nerve function to determine C5 and C6 root graft eligibility in patients with brachial plexus injury
Authors: Bertelli Jayme Augusto , Gasparelo Karine Rosa , Seltser Anna
Published: October 2021

OBJECTIVE

Identifying roots available for grafting is of paramount importance prior to reconstructing complex injuries involving the brachial plexus. This is traditionally achieved by combining input from both clinical examinations and imaging studies. In this paper, the authors describe and evaluate two new clinical tests to study long thoracic nerve function and, consequently, to predict the status of the C5 and C6 roots after global brachial plexus injuries.

METHODS

From March 2020 to December 2020, in 41 patients undergoing brachial plexus repair, preoperative clinical assessments were performed using modified C5 and C6 protraction tests, C5 and C6 Tinel’s signs, and MRI findings to predict whether graft-eligible C5 and C6 roots would be identified intraoperatively. Findings from these three assessments were then combined in a logistic regression model to predict graft eligibility, with overall predictive accuracies calculated as areas under receiver operating characteristic curves.

RESULTS

In the 41 patients, the pretest probability of C5 root availability for grafting was 85% but increased to 92% with a positive C5 protraction test and to 100% when that finding was combined with a positive C5 Tinel’s sign and favorable MRI findings. The pretest probability of C6 root availability was 40%, which increased to 84% after a positive C6 protraction test and to 93% when the protraction test result concurred with Tinel’s test and MRI findings.

CONCLUSIONS

Combining observations of the protraction tests with Tinel’s sign and MRI findings accurately predicts C5 and C6 root graft eligibility.
Patient complaints in the postoperative period following spine surgery
Authors: Ronald Andrew A. , Sadda Vineeth , Rabah Nicholas M. , Steinmetz Michael P.
Published: October 2021

OBJECTIVE

Patient complaints are associated with a number of surgical and medical outcomes. Despite high rates of patient complaints regarding spine surgeons and efforts to study patient complaints across medicine and surgery, few studies have analyzed the complaints of patients undergoing spinal surgery. The authors present a retrospective analysis that, to their knowledge, is the first study to directly investigate the complaints of spine surgery patients in the postoperative period.

METHODS

Institutional records were reviewed over a 5-year period (2015–2019) to identify patients who underwent spine surgery and submitted a complaint to the institution’s ombudsman’s office within 1 year of their surgery. A control group, comprising patients who underwent spine surgery without filing a complaint, was matched to the group that filed complaints by admission diagnosis and procedure codes through propensity score matching. Patient demographic and clinical data were obtained by medical record review and compared between the two groups. Patient complaints were reviewed and categorized using a previously established taxonomy.

RESULTS

A total of 52 patients were identified who submitted a complaint after their spine surgery. There were 56 total complaints identified (4 patients submitted 2 each) that reported on 82 specific issues. Patient complaints were most often related to the quality of care received and communication breakdown between the healthcare team and the patient. Patients who submitted complaints were more likely to be Black or African American, have worse baseline health status, and have had prior spine surgery. After their surgery, these patients were also more likely to have longer hospital stays, experience postoperative complications, and require reoperation.

CONCLUSIONS

Complaints were most often related to the quality of care received and communication breakdown. A number of patient-level demographic and clinical characteristics were associated with an increased likelihood of a complaint being filed after spine surgery, and patients who filed complaints were more likely to experience postoperative complications. Improving communication with patients could play a key role in working to address and reduce postoperative complaints. Further study is needed to better understand patient complaints after spine surgery and investigate ways to optimize the care of patients with risks for postoperative complaints.
FEBio finite element model of a pediatric cervical spine
Authors: Finley Sean M. , Astin J. Harley , Joyce Evan , Dailey Andrew T. , Brockmeyer Douglas L. , Ellis Benjamin J.
Published: October 2021

OBJECTIVE

The underlying biomechanical differences between the pediatric and adult cervical spine are incompletely understood. Computational spine modeling can address that knowledge gap. Using a computational method known as finite element modeling, the authors describe the creation and evaluation of a complete pediatric cervical spine model.

METHODS

Using a thin-slice CT scan of the cervical spine from a 5-year-old boy, a 3D model was created for finite element analysis. The material properties and boundary and loading conditions were created and model analysis performed using open-source software. Because the precise material properties of the pediatric cervical spine are not known, a published parametric approach of scaling adult properties by 50%, 25%, and 10% was used. Each scaled finite element model (FEM) underwent two types of simulations for pediatric cadaver testing (axial tension and cardinal ranges of motion [ROMs]) to assess axial stiffness, ROM, and facet joint force (FJF). The authors evaluated the axial stiffness and flexion-extension ROM predicted by the model using previously published experimental measurements obtained from pediatric cadaveric tissues.

RESULTS

In the axial tension simulation, the model with 50% adult ligamentous and annulus material properties predicted an axial stiffness of 49 N/mm, which corresponded with previously published data from similarly aged cadavers (46.1 ± 9.6 N/mm). In the flexion-extension simulation, the same 50% model predicted an ROM that was within the range of the similarly aged cohort of cadavers. The subaxial FJFs predicted by the model in extension, lateral bending, and axial rotation were in the range of 1–4 N and, as expected, tended to increase as the ligament and disc material properties decreased.

CONCLUSIONS

A pediatric cervical spine FEM was created that accurately predicts axial tension and flexion-extension ROM when ligamentous and annulus material properties are reduced to 50% of published adult properties. This model shows promise for use in surgical simulation procedures and as a normal comparison for disease-specific FEMs.
Dosimetric parameters associated with the long-term oncological outcomes of Gamma Knife surgery for sellar and parasellar tumors in pediatric patients
Authors: Lee Eun Jung , Lee Ji Yeoun , Kim Jin-Wook , Phi Ji Hoon , Kim Yong Hwy , Kim Seung-Ki , Chung Hyun-Tai , Wang Kyu-Chang , Kim Dong Gyu
Published: October 2021

OBJECTIVE

The authors aimed to investigate the dosimetric parameter and the minimally required dose associated with long-term control of sellar and parasellar tumors after Gamma Knife surgery (GKS) in children.

METHODS

A retrospective analysis was performed on pediatric patients younger than 19 years of age who were diagnosed with sellar and parasellar tumors and received GKS at the authors’ institution from 1998 to 2019. Cox proportional hazards regression analyses were used to investigate the dosimetric parameters associated with treatment outcome. The Kaplan-Meier method was used to analyze tumor control rates after GKS.

RESULTS

Overall, 37 patients with 40 sellar and parasellar tumors, including 22 craniopharyngiomas and 12 pituitary adenomas, had a mean follow-up of 85.8 months. The gross target volume was 0.05 cm3 to 15.28 cm3, and the mean marginal dose was 15.8 Gy (range 9.6–30.0 Gy). Ten patients experienced treatment failure at a mean of 28.0 ± 26.7 months. The actuarial 5- and 10-year tumor control rates were 79.0% and 69.8%, respectively. D98% was an independent predictive factor of tumor control (HR 0.846 [95% CI 0.749–0.956], p = 0.007), with a cutoff value of 11.5 Gy for the entire cohort and 10 Gy for the craniopharyngioma group. Visual deterioration occurred in 2 patients with the maximum point dose of 10.1 Gy and 10.6 Gy to the optic apparatus.

CONCLUSIONS

In pediatric patients, D98% was a reliable index of the minimum required dose for long-term control of sellar and parasellar tumors after GKS. The optimal D98% value for each tumor diagnosis needs to be elucidated in the future.
Intracranial neuromodulation with deep brain stimulation and responsive neurostimulation in children with drug-resistant epilepsy: a systematic review
Authors: Khan Mehdi , Paktiawal Jaber , Piper Rory J. , Chari Aswin , Tisdall Martin M.
Published: October 2021

OBJECTIVE

In children with drug-resistant epilepsy (DRE), resective, ablative, and disconnective surgery may not be feasible or may fail. Neuromodulation in the form of deep brain stimulation (DBS) and responsive neurostimulation (RNS) may be viable treatment options, however evidence for their efficacies in children is currently limited. This systematic review aimed to summarize the literature on DBS and RNS for the treatment of DRE in the pediatric population. Specifically, the authors focused on currently available data for reported indications, neuromodulation targets, clinical efficacy, and safety outcomes.

METHODS

PRISMA guidelines were followed throughout this systematic review (PROSPERO no. CRD42020180669). Electronic databases, including PubMed, Embase, Cochrane Library, OpenGrey, and CINAHL Plus, were searched from their inception to February 19, 2021. Inclusion criteria were 1) studies with at least 1 pediatric patient (age < 19 years) who underwent DBS and/or RNS for DRE; and 2) retrospective, prospective, randomized, or nonrandomized controlled studies, case series, and case reports. Exclusion criteria were 1) letters, commentaries, conference abstracts, and reviews; and 2) studies without full text available. Risk of bias of the included studies was assessed using the Cochrane ROBINS-I (Risk of Bias in Non-randomised Studies - of Interventions) tool.

RESULTS

A total of 35 studies were selected that identified 72 and 46 patients who underwent DBS and RNS, respectively (age range 4–18 years). Various epilepsy etiologies and seizure types were described in both cohorts. Overall, 75% of patients had seizure reduction > 50% after DBS (among whom 6 were seizure free) at a median (range) follow-up of 14 (1–100) months. In an exploratory univariate analysis of factors associated with favorable response, the follow-up duration was shorter in those patients with a favorable response (18 vs 33 months, p < 0.05). In the RNS cohort, 73.2% of patients had seizure reduction > 50% after RNS at a median (range) follow-up of 22 (5–39) months. On closer inspection, 83.3% of patients who had > 50% reduction in seizures actually had > 75% reduction, with 4 patients being seizure free.

CONCLUSIONS

Overall, both DBS and RNS showed favorable response rates, indicating that both techniques should be considered for pediatric patients with DRE. However, serious risks of overall bias were found in all included studies. Many research needs in this area would be addressed by conducting high-quality clinical trials and establishing an international registry of patients who have undergone pediatric neuromodulation, thereby ensuring robust prospective collection of predictive variables and outcomes.
The existence of betutu for supporting culinary tourism in Gianyar Bali
Authors:   Politeknik Negeri Bali, Suardani Made , Sagitarini Luh Linna ,   Politeknik Negeri Bali, Damayanti Ida Ayu Kade Werdika ,   Politeknik Negeri Bali
Published: October 2021

Gianyar Regency has local specialties menus such as Babi Guling, Bebek Betutu, Lawar, etc. However, betutu is the most menus ordered because it is halal menu which has its uniqueness, taste, and aromatic. Meanwhile, nowadays there are several culinary products which are seeked by guest such as KFC, Ayam Geprek, and chicken or duck roasted. It is needed to figure out whether betutu still exist or not and how can betutu still exist among society. This study was aimed to figure out whether betutu still exist or not and how to maintance betutu in order to support culinary tourism in Gianyar Regency. This study was qualitative research which used deep interview for collecting the data from the informants. For the result, it was revealed that betutu still exist among the tourists and local society. It was proven by the result of interview with six informants who revealed that 5 of them can produce more than 50 portion of betutu daily. They also gave positive response toward the questions given by the researchers that revealed betutu is still sought-after by the tourists. The betutu is still made by using the original recipes and served in traditional presentation. Not only tourists, betutu still exist among local society because betutu is used as a means in Hindu ceremonies.
Eco-spiritual tourism as alternative tourism in Taro Village: Opportunity and challenge
Authors:   Universitas Triatma Mulya, Yuni L.K. Herindiyah Kartika , Artana I Wayan Arta ,   Universitas Triatma Mulya
Published: October 2021

This study aims to analyze the opportunities and challenges faced by Taro Village in developing eco-spiritual tourism. The data in this study were collected through observation, interviews with key informants determined based on purposive sampling and documentation. The data were analyzed using qualitative descriptive analysis to obtain a complete picture of the opportunities and challenges faced by Taro Village as a village that develops eco-spiritual tourism. There are various opportunities that have been empowered such as high visits to several objects, support from the government and local communities as religious communities who uphold the sacred value of nature, and the attention of educational institutions realized through training to improve human resources. However, Taro Village still faces various challenges in its development such as the community does not have the same understanding of the vision of the Eco-spiritual village, community involvement has not been maximized because the majority of the community are farmers and consider tourism as a side job, weather with quite high rainfall often hampers tourist activities, which are mostly conducted in the open space, such as activities in traditional villages, in particular "metekap", "melukat", and firefly attractions. From these opportunities and challenges, it can be suggested that Taro Village should identify and evaluate opportunities and challenges on a regular basis, determine the target market with certain demographic characteristics, learning from competitors to improve product quality to compete, Preserving the quality of nature and the readiness of human resources in sustainable tourism in Taro Village.
ANALISIS HUKUM PERLINDUNGAN PERKAWINAN ANAK DI BAWAH UMUR
Authors: Hidayat Puti
Published: October 2021

Berbicara mengenai pernikahan anak di bawah umur, yang pertama disoroti mengenai batas usia seseorang. Di Indonesia belum ada kesamaan batas usia yang dikatakan sebagai anak, masih terdapat perbedaan. Misalnya Kitab Undang-Undang Hukum Perdata mengatur batas usia anak adalah 21 tahun, Undang-Undang No. 16 Tahun 2019 Tentang Perubahan atas Undang-Undang No. 1 Tahun 74 tentang Perkawinan mengatur batas usia anak adalah l9 th untuk laki-laki dan untuk perempuan, sedangkan perlindungan anak mengatur batas usia anak adalah di bawah 18 tahun.

Perkawinan menurut Undang-Undang No. 1 Tahun 1974 tentang perkawinan adalah ikatan lahir batin antara seorang pria dan seorang wanita sebagai suami istri dengan tujuan membentuk keluaga (rumah tangga) yang bahagia dan kekal berdasarkan ketuhanan yang Maha Esa. Peraturan mengenai perkawinan di dalam Undang-Undang tersebut mengenai dispensasi seorang laki-laki dan perempuan untuk dapat menikah di bawah usia 19 tahun, hal itu berdasarkan  Pasal 7 Ayat (2) Undang-Undang No. 16 Tahun 2019 Tentang Perubahan Atas Undang-Undang No. 1 Tahun 1974 tentang Perkawinan. Kita tahu bahwa anak menjadi subjek hukum yang utama di dalam Undang-Undang No. 35 Tahun 2014 tentang perlindungan anak. Di dalamnya terkandung batasan mengenai anak, yaitu di bawah 18 tahun. Bagaimana eksistensi Undang-Undang No. 35 Tahun 2014 tentang perlindungan anak terhadap pernikahan anak di bawah umur?

Eksistensi Undang-Undang No. 35 Tahun 2015 tentang Perlindungan anak terhadap Pernikahan di bawah umur dengan diatur di dalam Pasal 26 Undang-Undang No. 35 Tahun 2015 tentang Perlindungan Anak mengenai larangan orang tua untuk memberikan ijin kepada anaknya yang masih di bawah umur sesuai dengan Pasal 1 Undang-Undang No.35 Tahun 2015 tentang Perlindungan anak, yaitu Anak adalah seseorang yang belum berusia 18 (delapan belas) tahun, termasuk anak yang masih dalam kandungan. Selain itu di dalam Pasal 76B lebih ditegaskan lagi, yakni Setiap orang dilarang menempatkan, membiarkan, melibatkan, menyuruh melibatkan Anak dalam situasi perlakuan salah dan penelantaran.

Dengan demikian diharapkan untuk pernikahan di usia anak bisa diminimalisir secara optimal dan komprehensif.
Stability for the 2D MHD equations with horizontal dissipation
Authors: Chen Zhi , Feng Weixun , Qin Dongdong
Published: October 2021

In this paper we consider the following 2D MHD system with horizontal dissipation in a strip domain [Formula: see text]. [Formula: see text] A bootstrapping argument together with a more accurate energy functional is employed in order to get the stability for the above system. Moreover, using a suitable transform, we also investigate the 2D MHD system with vertical dissipation in a strip domain [Formula: see text].
The overview of utilizing complementary therapy to relieve stress or anxiety in emergency department patients: animal-assisted therapy, art therapy, and music therapy
Authors: Au Tsz Yuen , Assavarittirong Chanika
Published: October 2021

The Emergency Department could be a stressful environment for patients. Anxiety and depression may develop due to the atmosphere, in addition to patients’ concerns for their health conditions. The condition could potentially affect the experience of the patient in the Emergency Department and the quality of life after the visit. Pharmacological therapy could be administered to the patients. However, adverse effects may be associated with the treatment. Less aggressive complementary treatment approaches are presented in this article. Controlled clinical trials and randomized pilot studies of different complementary therapies, including animal-assisted therapy, art therapy, and music therapy, were conducted. The complementary therapies discussed in this article showed positive outcomes for patients with hospital-induced anxiety and has no adverse effect reported. Hence, hospitals may consider introducing complementary therapies, such as those mentioned in this study, to improve the patients’ experiences in the Emergency Department
Share Capital Management in the Context of Ensuring Competitive Advantages of the Retail Business Entity
Authors: Дядін А. С. , Бобро Н. В.
Published: October 2021

It has been proved that capital is a resource that is accumulated and is involved in the processes of reproduction and growth of value through mutual conversion of its various types, which are invested in the creation of assets, which is the total amount of financial resources of enterprises.

It has been demonstrated that it is possible to determine the most rational ratio of capital indicators calculated on the basis of factors of influence, risks and practical experience that brings the target capital structure as close as possible to its optimal value. Given that the capital structure affects the market value of the enterprise through the price of capital, the concept of capital structure is studied in the same theoretical complex with the concepts of capital value and market value of the enterprise.

The analysis has demonstrated that the first stage of optimizing the financial structure of enterprise’s capital as a specific object of anti-crisis retail business allows to determine the presence or absence of capital volume for a particular business entity. If the answer is positive, the optimization of the ratio of all sources of capital is carried out within this volume. If the available amount of capital is insufficient, it is necessary to find out whether the company has the opportunity to expand it and the sources to accomplish it. The second stage – assessing the capital structure by the criterion of financial stability – is carried out by comparing the actual values of the ratio of the current assets of business entities in retail trade in equity with the “normal” value, where its minimum level is 0.1. The capital structure is assessed during the third stage from the standpoint of the value of capital. Appropriate calculations are made by using the weighted average cost of capital of a business entity. The capital structure is evaluated during the fourth stage in terms of its efficiency. The basis for assessing the structure of capital by the criterion of its effectiveness is the calculation of the effect of financial leverage in previous periods and determining the impact of individual factors (return on assets, weighted average cost of debt, share of debt and equity) on this effect by using the method of chain substitutions regarding the weighted average cost of borrowed capital adjusted for the net operating result of the investment, the value of leased fixed assets, the amount of rent, as well as the share of financial loans, trade payables and long-term credit in the form of leased fixed assets in total borrowed capital. Finally, the target-oriented capital structure is formed during the fifth stage, taking into account the obtained results of optimization according to all the criteria and features of the components of capital and the factors that affect them. The fulfillment of this stage requires a thorough development of specific measures that should allow to form the necessary capital structure of the business entity in retail.
Problematic Issues of Calculating the Size of Damage from the Use of Land Plots for Other Purposes within the Practice of Law Enforcement Agencies
Authors: Бригадир І. В. , Панова І. В.
Published: October 2021

The authors have studied the land legislation and the practice of its application in regard to the calculation of the amount of damage from the use of land plots for other purposes. The method of calculating the amount of damage from the specified use of land plots has been improved.
The foundations of the research methodology constitute: comparative and legal method, which assisted to study the requirements of EU and Ukrainian legislative acts; the method of systematic analysis, which allowed to reveal the legal mechanisms for calculating the amount of damage caused to the state and territorial communities from the use of land plots for other purposes; method of mathematical modeling, which allowed to form propositions for improving the formula of calculating the damage caused by the misuse of land plots.
The result of the study was the justification for making changes to the Methodology of determining the amount of damage caused by unauthorized occupation of land plots, misuse of land plots, removal of soil cover (fertile soil layer) without special permission. It has been offered to include a coefficient that takes into account the term of land use for other purposes in the direction of increasing the multiple of the number of years of land use into the formulas № 3 and № 4 of the Methodology. The authors have proved the necessity of introducing a separate formula for calculating the amount of damage caused by the use of land plot for other purposes, in case of impossibility to return the land plot to a condition suitable for further use for its intended purpose, or failure to accomplish such a return for other reasons.
The results of the research can be used in law-enforcement practice to determine the amount of damage caused by unauthorized occupation of land plots, the use of land plots for other purposes, as well as in law-making activity to improve legal mechanisms to prevent misuse of land plots.
Impacto económico de la mortalidad por SIDA en Colombia 1997-2001
Authors: Alvis-Guzmán Nelson , Correa-Reyes Juan , López-Martelo Carlos , Pattigno-Orozco Guillermo
Published: October 2021

Objetivo. Determinar el impacto económico de la mortalidad por SIDA en Colombia, 1997 – 2001. Métodos. Estudio descriptivo que analizó los datos de mortalidad del Departamento Administrativo Nacional de Estadísticas de Colombia, estimó Años Perdidos de Vida Potencial –APVP- y Años Perdidos de Vida Potencial Productiva –APVPP- utilizando el Programa EPIDAT 3.0. Para valorar el impacto económico se usó la metodología desarrollada por el Grupo de Economía de la Salud de la Universidad de Cartagena. Resultados. Para el período se registraron 9,484 muertes por SIDA, 7,848 en hombres (87,7%) y 1,635 en mujeres (12.3%). La tasa de mortalidad por 100 mil personas fue de 4,6 (7,5 para hombres y 1,6 para mujeres) y la razón de mortalidad hombre mujer fue de 4,8:1. Los APVP fueron 363,911, (media anual de 72,782). La tasa de APVP por 1000 habitante fue 1,56 al inicio y 1,98 al final del periodo. La contribución media de cada caso fue de 38,4 APVP. Los APVPP por SIDA fueron 333,612 (91.7% del total) que representan una pérdida económica de entre 641 y 1,351 millones de dólares PPA de 2001 equivalentes a entre 1,5 a 2,9 del PIB de Colombia del 2001. Conclusiones. El presente estudio muestra como el SIDA genera pérdidas económicas debido a mermas en la productividad individual por disminución de capacidades en el trabajo y pérdidas del capital humano por muertes en la población económicamente activaPalabras Clave: (DeSC) SIDA; Mortalidad; Análisis Económico; Colombia
Agencias Mipymes, creación de empresas y desarrollo empresarial: Una lectura sobre Colombia y Puerto Rico
Authors: Gómez-Arcila Jairo Andrés
Published: October 2021

En las agendas políticas y económicas de los países tanto desarrollados como los emergentes (3er mundo), los planes de desarrollo económico son siempre relevantes, sin embargo, en algunos países como Colombia y Puerto Rico, que han aplicado modelos de desarrollo promoviendo la alta participación del sector privado, los modelos para el desarrollo económico se apoyan en el desarrollo empresarial, en la creación de empresas, en el estimulo a la inversión, a la cultura empresarial y por ende, al surgimiento de nuevos empresarios como vía para generar empleo, crecimiento y desarrollo económico. Este artículo presenta una lectura, sobre la situación actual en Colombia y Puerto Rico, en cuanto a la creación de empresas de capital nacional, enfocándonos principalmente en las micro, pequeñas y medianas empresas, en el proceso del surgimiento de estas unidades económicas, y del papel desempeñado por las agencias MIPYMES en el apoyo al surgimiento y fortalecimiento de las mismas (MIPYMES); denotando algunos contrastes entre estos países, tocando algunos aspectos investigados en el Informe Mundial de Resultados del General Entrepenuership Monitor –GEM-, y otras estadísticas relacionadas con la evolución de las mipymes en cuanto a la creación de empleos, crecimiento de estas unidades, impacto en el PIB, etc., revelando por último la existencia de otros elementos importantes (no económicos) que impactan en la creación de empresas y que muy poco se ha desarrollado en la literatura existente.Palabras Clave: Desarrollo económico, desarrollo empresarial, densidad empresarial, emprenderismo, agencias MIPYME.
Efecto Bullwhip y restricciones de capacidad productiva en las cadenas colaborativas
Authors: Ciancimino Elena , Cannella Salvatore , López-Campos Mónica , Canca-Ortiz José David
Published: October 2021

El objetivo del presente artículo es profundizar en el análisis de Evans y Naim (1) sobre la relación entre la capacidad de limitada producción y el efecto bullwhip, y actualizarlo en función de las recientes configuraciones de cadenas de suministro colaborativas. Se analizan tres cadenas de suministro con capacidad de producción limitada: la misma cadena de suministro tradicional estudiada por Evans y Naim (1), una cadena EPOS (Exchange Point of Sales) y una cadena sincronizada. Se adopta un sistema de métricas para evaluar los beneficios de los nodos de la cadena medidos en términos de estabilidad de la orden de pedido, estabilidad de los inventarios, y robustez del sistema, y en términos de beneficios para el cliente, medidos en términos de backlog. Los resultados sugieren (I) que la saturación de la demanda en una cadena tradicional puede generar un “doble riesgo”: satisfacer una demanda de mercado distorsionada y por lo tanto sobredimensionada a un coste de producción significativamente elevado. (II) que los efectos negativos de la capacidad limitada están significativamente reducidos en las cadenas colaborativas.Palabras Clave: Amplificación de la demanda; multi-step; métricas de rendimiento; Order-up-to; Periodic review; división de la información; reglas de pedido; subcontratación, simulación; ecuaciones diferenciales; mono-step Euler- Cauchy.