bluuebunny/crossref_metadata_2025 huggingface dataset:
Atividade física para idosos: diretrizes para implantação de programas e ações
Authors: Salin Mauren da Silva , Mazo Giovana Zarpellon , Cardoso Adilson Sant'Ana , Garcia Guilherme da Silva
Published: September 2012

O estudo objetivou descrever as diretrizes necessárias para a formulação de programas e ações de atividade física (AF) para idosos de grupos de convivência do município de São José, SC. Trata-se de pesquisa do tipo qualitativa, na qual foram entrevistados 116 idosos, 19 coordenadores de grupos, dois dirigentes administrativos do município e um representante do Conselho Estadual do Idoso (CEI) de Santa Catarina. Os sujeitos foram abordados com questões sobre conhecimento, participação, disponibilidade, necessidades, dificuldades e sugestões em relação aos atuais programas de atividade física (PAFs) oferecidos para a população idosa no município de São José, SC; o presidente do CEI foi indagado sobre a importância da implementação de programas e ações de AF para idosos, como parte das políticas públicas de promoção de saúde municipal. Também foram utilizados documentos, relatórios e projeto do Centro de Atenção à Terceira Idade (CATI) referentes ao atendimento à população idosa do município. Para o tratamento das informações, utilizou-se a técnica de análise de conteúdo. Diante das respostas, concluiu-se que para melhorar e ampliar os PAFs do município é necessário: descentralizar os PAFs; contratar profissionais de Educação Física; conscientizar sobre um envelhecimento ativo e os benefícios da prática regular de atividade física; estabelecer as parcerias com instituições públicas e privadas e divulgar o atendimento prestado.
Aspectos afetivos relacionados ao comportamento alimentar dos idosos frequentadores de um centro de convivência
Authors: Santos Glenda Dias dos , Ribeiro Sandra Maria Lima
Published: September 2012

Instituições direcionadas à alimentação de idosos têm-se tornado mais numerosas, e poucos estudos são realizados nesses locais. Hipotetizamos que a maneira pela qual a alimentação é realizada nesses locais pode interferir negativamente na relação afetiva que o idoso estabelece com a alimentação. OBJETIVOS: compreender o significado e o componente afetivo da alimentação na vida dos idosos que frequentam um centro de convivência direcionado à alimentação; identificar os aspectos situacionais que envolvem o comportamento alimentar desses idosos. MÉTODOS: foram estudadas pessoas com 60 anos ou mais de idade, frequentadoras de um Núcleo de Convivência da zona leste de São Paulo-SP, a partir de uma entrevista semiestruturada, interpretada pelo Discurso do Sujeito Coletivo. As questões norteadoras da entrevista foram: Por que o Sr(a). se alimenta aqui? Como o se sente comendo aqui? Fale-me como era a sua alimentação antes de entrar no centro de convivência e agora. Houve mudanças? Qual a importância da alimentação na sua vida? O sr(a) acha que a comida é capaz de fazer amigos? RESULTADOS: a hipótese inicialmente estabelecida não foi comprovada, observandose na verdade a presença de uma nova situação de vida para o idoso, que pareceu agradável e desvinculada de fatos passados. Os entrevistados no presente estudo não demonstram muita relação pregressa com a alimentação. CONCLUSÕES: locais que ofereçam alimentação coletiva ao idoso mostram-se importantes para o suporte social, facilitam a socialização e a aquisição de alimentação para os idosos que vivem em situações desfavorecidas.
Comportamento reológico de néctares mistos de caju, manga e acerola descritos pelo Modelo de Casson
Authors: Silva Larissa Morais Ribeiro da , Maia Geraldo Arraes , Sousa Paulo Henrique Machado de , Ramos Afonso Mota , Afonso Marcos Rodrigues Amorim , Figueiredo Raimundo Wilane de
Published: September 2012

A abordagem do comportamento reológico de néctares mistos de frutas tem fornecido importantes informações para o processamento dos mesmos, resultando em benefícios para a indústria e, consequentemente, para o consumidor. Portanto, neste trabalho, se estudou o comportamento reológico de néctares mistos de caju, manga e acerola, nas temperaturas de 8 °C e 25 °C. As medidas experimentais foram realizadas em reômetro rotacional de cilindros concêntricos e os dados experimentais foram ajustados ao modelo de Casson. A tensão inicial apresentou ajuste ao modelo cúbico especial, para a temperatura de 8 °C. Para a temperatura de 25 °C, observou-se ajuste ao modelo cúbico especial para a viscosidade plástica de Casson. O aumento nas proporções de polpas de caju, manga e acerola resultou no aumento da viscosidade plástica de Casson e o aumento da quantidade de polpa de caju proporcionou aumento na tensão inicial.
The Role of Cancer Stem Cells in Breast Cancer Initiation and Progression: Potential Cancer Stem Cell-Directed Therapies
Authors: Economopoulou Panagiota , Kaklamani Virginia G. , Siziopikou Kalliopi
Published: September 2012

Recent studies have identified a small population of highly tumorigenic cells with stem cell properties in human breast and other solid tumors that are considered to be the source of tumor initiation and maintenance; these cells are referred to as cancer stem cells (CSCs). Preclinical data suggest that current breast cancer treatment strategies lead to CSC enrichment, contributing to chemotherapy and radiotherapy resistance, although a strong correlation with clinical parameters and prognosis is yet to be established. Importantly, overcoming treatment failure by effective targeting of CSCs may be an appealing approach, potentially leading to improved clinical outcomes for patients with breast cancer. Several preclinical studies provide promising results that support this hypothesis. The purpose of this review is to summarize the role of CSCs in breast cancer recurrence and resistance and to discuss current attempts of CSC targeting.
Centre-line optimisation of buried arch bridges
Authors: Foglar Marek , Kristek Vladimir
Published: September 2012

The arch is the oldest structural shape that mankind has invented. The Romans constructed a large number of stone arch bridges on roads or water supply routes (aqueducts), many of which have survived to the present day. Arch bridges were constructed throughout medieval times; some of them represent masterpieces of the world´s cultural heritage. Buried concrete arch bridges are built with spans from 2 m up to 40 m on roads and railways, both as underbridges or overbridges, and as pre-cast and cast-in-place structures. Owing to low construction costs, great durability and endurance, they are favoured by contractors and owners. This paper focuses on the structure–soil interaction of buried arch bridges both in operation and under construction. Based on analytical derivation, a method of centre-line optimisation of cast-in-place buried concrete arch bridges is proposed and applied on an existing structure. The method leads to reduction of bending moments and deflections, thus making the structural system more effective. The impact of the construction phases on the distribution of internal forces is studied. Based on the acquired knowledge, modifications of the construction process are proposed and evaluated.
Stiffness and damage in masonry bridges
Authors: Harvey Bill
Published: September 2012

Load-related damage to masonry bridges is relatively uncommon. The author is aware of only a small number of cases and nearly all of them are in structures carrying high railway loads. Current assessment tools do not deliver any indication of the failure mechanisms that actually occur. Those mechanisms are characterised by the progressive development of cracks in various positions. Recent observations have made it clear that: bridges with internal spandrel walls create complex stiffness issues; so-called spandrel cracks and apparent ring separation are different manifestations of the same issue; the construction of some small bridges is not as assumed but often includes internal spandrel walls. This paper describes the damage observed, the construction to which it is related and the mechanisms creating damage. No calculations of any form are offered. This paper merely provides a first step in identifying the cause of a problem and a potential approach to analysis. The discussion begins with stone masonry viaducts, progresses to brick viaducts and concludes with problems in small span bridges.
New concrete arch bridge at Victoria Avenue, Lincoln, Canada
Authors: Ellis Brittany , Ellis Brian J. J.
Published: September 2012

The replacement of the Victoria Avenue Bridge in the town of Lincoln, Ontario, Canada was a unique civil engineering project. The cast-in-place construction design was a more costly, but more appropriate and efficient method of replacement for this structure. The alternative pre-cast box units would mar the historical and aesthetic significance of the location in scenic Vineland, Ontario. The design combined elements of new technology while retaining some physical elements of the old bridge. Glass fibre reinforced polymer reinforcing bars and a concrete form liner were used to compliment the reinstated parapet wall features. This project is relevant to civil engineering practice as an example of successfully melding old and new in bridge design. These contrasting characteristics have been blended well with the use of concrete colourisation and finishing techniques. The visual appeal and character created with the reinstated balustrades and end posts have added beauty to a structure engineered for a long lifespan using new reinforcing techniques.
Mitigation of creep deformations by preloading: laboratory study
Authors: Venda Oliveira P. J. , Correia A. A. S. , Mira E. S. P.
Published: September 2012

The effect of applying preloading on the creep behaviour of a soft soil is studied by one-dimensional and drained triaxial creep tests. The results show that the application of preloading is very efficient, especially in the short term. Although oedometer test results, in the long term, showed an increase of the secondary compression index over time, the effectiveness of the preloading is maintained. These results are supported by drained triaxial creep tests, which show a reduction of creep strains when preloading is applied, increasing this effect over time. Moreover, the application of preloading does not affect the post-shear behaviour in terms of the ultimate strength, the effective stress path or the stiffness of the soil.
Investigating Child Participation in the Everyday Talk of a Teacher and Children in a Preparatory Year
Authors: Theobald Maryanne , Kultti Anne
Published: September 2012

In early years research, policy and education, a democratic perspective that positions children as participants and citizens is increasingly emphasised. These ideas take seriously listening to children's opinions and respecting children's influence over their everyday affairs. While much political and social investment has been made in the inclusion of participatory approaches, little has been reported on the practical achievement of such approaches in the day-to-day of early childhood education within school settings. This article investigates talk and interaction in the everyday activities of a teacher and children in an Australian preparatory class (for children aged four to six years) to see how ideas of child participation are experienced. The authors use an interactional analytic approach to demonstrate how participatory methods are employed in practical ways to manage routine interactions. Analysis shows that whilst the teacher seeks the children's opinion and involves them in decision-making, child participation is at times constrained by the context and institutional categories of ‘teacher’ and ‘student’ that are jointly produced in their talk. The article highlights tensions that arise for teachers as they balance a pedagogical intent of ‘teaching’ and the associated institutional expectations with efforts to engage children in decision-making. Recommendations include adopting a variety of conversational styles when engaging with children, consideration of temporal concerns and the need to acknowledge the culture of the school.
Are the Traditional Curricula Dispensable? A Feature Pattern to Compare Different Types of Curriculum and a Critical View of Educational Standards and Essential Curricula in Germany
Authors: Scholl Daniel
Published: September 2012

The results of international school achievement studies had major educational implications in many European countries, especially for the control concepts of education. This becomes exemplarily apparent in Germany, in which a large-scale educational reform was set in motion. Thereby, the education system was set from an input- to output-oriented control. Part of this reform involved the adoption of new curriculum types. A striking feature of this enactment was, among other things, that while it initiated studies of school curricula, it was shown at the same time that there are currently no established sophisticated theoretical tools for analysis of curricula — neither in Europe in general nor in Germany in particular. In this article, therefore, a curriculum-theoretical instrument is presented, which allows a systematic analysis of the structure of curricula. This instrument was developed based on German curricula, which are taken as examples. There should be generalisable impetus for European curriculum research.
Balancing Curriculum Freedom and Regulation in the Netherlands
Authors: Nieveen Nienke , Kuiper Wilmad
Published: September 2012

The extent to which the goals and contents of (compulsory) education should to be regulated has been a complicated balancing act in the Netherlands. Against a background of a longstanding statutory tradition of freedom of education, governmental decisions about ‘what knowledge is of most worth’ have been delicate. The purpose of the analysis described in this article is to disentangle, interpret and discuss this complicated balancing act between curriculum regulation and curriculum freedom during the past 40 years and to learn from other countries by putting the results into a wider European curriculum policy perspective. The contribution will end with discussing issues that need to be carefully considered with respect to the recent Dutch policy shift towards output regulation by means of mandatory achievement tests for mathematics, mother tongue and English at the end of lower secondary education.
The European Qualification Framework: Skills, Competences or Knowledge?
Authors: Méhaut Philippe , Winch Christopher
Published: September 2012

The European Qualification Framework (EQF) is intended to transform European national qualification frameworks (NQFs) by moulding them into a learning outcomes framework. Currently adopted as an enabling law by the European Union, the EQF has now operated for several years. In order to secure widespread adoption, however, it will be necessary for it to be anchored at the sectoral and occupational levels in the European labour market as well as at the European and national levels. The article assesses the progress made so far, identifies difficulties encountered and modifications that need to be made and provides an appraisal of the likely evolution of the EQF. It is argued that it is likely that some key design features, such as the ‘strong’ approach to learning outcomes and a narrow conception of competence will not survive modification and adaptation in the context of the European labour market. The argument is illustrated with some recent research on the EQF.
Facing the Changing Demands of Europe: Integrating Entrepreneurship Education in Finnish Teacher Training Curricula
Authors: Seikkula-Leino Jaana , Ruskovaara Elena , Hannula Heikki , Saarivirta Tuija
Published: September 2012

The European Union (EU) considers the learning of entrepreneurial skills to be an essential factor in creating welfare. Therefore, in the EU, one of the latest core aspects is to develop entrepreneurship education in teacher education. However, entrepreneurship education still seems to be, across the countries, a quite uncommon theme. This article describes the ways in which entrepreneurship education is included in the curricula of Finnish teacher training. The curricula for academic and vocational teacher education were obtained in autumn 2010, either online or by requesting them in paper or electronic format. The inclusion of entrepreneurship education has developed relatively effectively in the curricula of vocational teacher education units. Academic teacher education units have not really increased the quantity of entrepreneurship education in their curricula. In the curricula of the teacher training schools, entrepreneurship education is mentioned at least as a formality. The current unstable situation in the EU requires not only economic arrangements, but also new approaches in other areas, such as education and its reform. As an implication for practice, we propose there could be more support for curriculum design of higher education at both national and EU level.
The Epistemological Fog in Realising Learning to Learn in European Curriculum Policies
Authors: Leat David , Thomas Ulrike , Reid Anna
Published: September 2012

The European Union is concerned about the economic prospects of its member states as they have to compete against newly emerging economies with lower wages and high ambitions. Part of the strategy to deal with this economic shadow is to create a knowledge economy, but in order to achieve this, a shift to a competence-based curriculum model is seen as critical. Since the Lisbon strategy in 2000, policy documents have provided guidelines and tools for member states, but progress has been limited and in several states curriculum reforms which favoured competences have been reversed. This article uses interview data from school students from two projects in England focused on enquiry and learning competence, and analysis which draws on the theories of Bernstein, to illustrate their accounts of the difference between traditional and competence-based models. The data demonstrate the tensions caused by pupils' perceptions of the demands of summative assessment systems, which reflect a very different epistemology from experiential/competence models. The authors conclude that greater pedagogical literacy, attention to professional development, assessment reform and engaging students as partners in curriculum reform are needed.
Comparison as Curriculum Governance: Dynamics of the European-Wide Governance Technology of Comparison within England's National Curriculum Reforms
Authors: Papanastasiou Natalie
Published: September 2012

The curriculum is a governance technology of knowledge production and is also itself governed by complex dynamics within European education policy space. This article focuses on how the curriculum is governed by comparative knowledge; in particular, it identifies how this facet of governance has manifested itself within the policy space of England's National Curriculum reforms. Critical discourse analysis of four key policy documents reveals how understanding the governing power of comparative knowledge involves considering dynamics originating from multiple spaces and times. While international comparative logic within England's National Curriculum could be regarded as a manifestation of a European-wide governing technology, the article suggests that the distinctiveness of ‘Europe’ is at risk of being lost to dominant global knowledge paradigms which are also an integral part of the ‘governance by comparison’ process.
Simple scheme for multiqubit quantum controlled phase-flip gate with singlet-triplet spin qubits in nanowire double quantum dots
Authors: Fu Cheng-Zhi , Song Ming-Yu
Published: September 2012

We propose an alternative scheme for one-step implementing three-qubit controlled phase-flip gate of spin qubits in spatially separated double quantum dots with a superconducting stripline resonator (SSR). Due to the switchable coupling effect between the double quantum dots and SSR, the present scheme could be easily generalized for multi-qubits. The feasibility of the present scheme is characterized by exact numerical simulations that incorporate various sources of experimental noise. Our results show the possibility to realize this proposed scheme within current experimental technologies.
Probing the QCD chiral cross-over transition in heavy ion collisions
Authors: Redlich Krzysztof
Published: September 2012

We argue that by measuring higher moments of the net proton number fluctuations in heavy ion collisions (HIC) one can probe the QCD chiral cross-over transition experimentally. We discuss the properties of fluctuations of the net baryon number in the vicinity of the chiral cross-over transition within the Polyakov loop extended quark-meson model at finite temperature and baryon density. The calculation includes non-perturbative dynamics implemented within the functional renormalization group approach. We find a clear signal for the chiral cross-over transition in the fluctuations of the net baryon number. We address our theoretical findings to experimental data of the STAR Collaboration on energy and centrality dependence of the net proton number fluctuations and their probability distributions in HIC.
Urban morbidity in summer: ambulance dispatch data, periodicity and weather
Authors: Petralli Martina , Morabito Marco , Cecchi Lorenzo , Crisci Alfonso , Orlandini Simone
Published: September 2012

Over recent years the impact of weather on human health has become more severe, especially for people living in urban areas. Even though many studies have analysed the impact of weather on human mortality, few have quantified the impact of heat on morbidity, including ambulance response calls. In this study, 13,354 calls collected in the city of Florence (Italy) during summer were analyzed by month, day of the week, hour, and time slot of the day. An objective air mass classification was used to classify days and time slots with similar weather characteristics and a multiple variable analysis was applied to evaluate the relationship between emergency calls and weather. A positive trend was observed in the morning and a negative one during the night for all emergency calls, but only for food poisoning and alcoholic diseases. Calls for cardiovascular events increased in the morning and on hot days. Calls for psychiatric disorders rose significantly with temperature during the afternoon. The total number of calls and those for alcoholic diseases rose during the hottest nights. Our results, which show a clear relationship between ambulance response calls, periodicity, and weather, could contribute to an understanding the impact of weather on morbidity.
Unrecognized acute lithium toxicity: a case report
Authors: Ristic Dragana , Siapera Marianna , Jovic Jelena , Marjanovic Vesna , Radovanovic Milan , Fountoulakis Konstantinos
Published: September 2012

We report a case of a 63-year-old male who has been admitted to the Emergency department with nonspecific symptoms. Lithium toxicity was not at first recognized. When we obtained sufficient information about previous medication and medical history, we measured lithium levels found to be 1.46 mmol/L. Although the value of lithium was mildly elevated, nephrotoxicity was produced leading to severe renal insufficiency and neurological symptoms. Hemodialysis was started, and we succeed to treat the patient without squeals. This case illustrates some of the factors that lead to lithium toxicity as well as the need to consider lithium toxicity to the differential diagnosis of a patient presenting with renal insufficiency with or without change in mental status and neurologic symptom.
Effects of lead chloride on human erythrocyte membranes and on kinetic anion sulphate and glutathione concentrations
Authors: Gugliotta Tiziana , Luca Grazia , Romano Pietro , Rigano Caterina , Scuteri Adriana , Romano Leonardo
Published: September 2012

Our study concerns the effects of exposure to lead chloride on the morphology, K+ efflux, SO4 − influx and GSH levels of the human erythrocyte. Blood was collected in heparinized tubes and washed three times. The cells were suspended at 3% hematocrit and incubated for 1 h at 25°C in a medium containing increasing concentrations of lead chloride (0, 0.3, 0.5 and 1 μM). After incubation, the suspensions were centrifuged and the erythrocyte pellets were divided into three aliquots for testing. The results show: an increase in the permeability of erythrocytes treated with lead chloride with consequent damage and cellular death, especially in the presence of high concentrations; an increase in potassium ion efflux; alterations in the morphology and membrane structure of the red blood cells; and a decrease in sulphate uptake, due either to the oxidative effect of this compound on the band 3 protein, which loses its biological valence as a carrier of sulphate ions, or to a decrease in the ATP erythrocyte concentration. In conclusion, the exposure of erythrocytes to Pb2+ ions leads to a reduction in the average lifetime of the erythrocytes and the subsequent development of anemia. These data are discussed in terms of the possible effect of lead on the reduction-oxidation systems of the cell. Oxidant agents, such as lead, are known to cross-link integral membrane proteins, leading to K/Cl-cotransport. The increased K+ efflux affects the altered redox state.
Cloning of the human activated leukocyte cell adhesion molecule promoter and identification of its tissue-independent transcriptional activation by Sp1
Authors: Tan Fang , Mbunkui Flaubert , Ofori-Acquah Solomon
Published: September 2012

Activated leukocyte cell adhesion molecule (ALCAM) belongs to the immunoglobulin cell adhesion molecule super family. ALCAM is implicated in tumor progression, inflammation, and the differentiation of hematopoietic stem cells. Hitherto, the identity of regulatory DNA elements and cognate transcription factors responsible for ALCAM gene expression remained unknown. In this report, the human ALCAM promoter was cloned and its transcriptional mechanisms elucidated. The promoter is TATA-less and contains multiple GC-boxes. A proximal 650-bp promoter fragment conferred tissue-independent activation, whereas two contiguous regions upstream of this region negatively influenced promoter activity in a tissue-specific manner. The positive regulatory promoter region was mapped to a core 50 base pair sequence containing a conical Sp1 element. Mutation analysis revealed that this element alone or in tandem with elements immediately upstream was required for maximal promoter activity. Chromatin analysis revealed that Sp1 binds exclusively to the canonical binding sequence in vivo, but not to DNA sequence immediately upstream. Finally, we showed that over-expression of Sp1 significantly increased the basal promoter activity. Thus, Sp1 activated the ALCAM promoter in most cells. These findings have important ramifications for unraveling the roles of ALCAM in inflammation and tumorigenesis.
Modulation bandwidth of planar waveguide laser with 1D photonic crystal mirrors
Authors: Mossakowska-Wyszyńska A.
Published: September 2012

An analysis of the 3-dB modulation bandwidth in planar waveguide laser based on 1D photonic crystal structures is presented. The theoretical model takes into account the gain saturation effect, transverse and longitudinal field distribution. A small-signal perturbation solution of the coupled laser rate equation is used to obtain relations describing the dynamic operation. In paper, the distributed Bragg resonator DBR created as 1D photonic crystal is considered. The active waveguide is surrounded by 1D photonic crystal mirrors consisting of alternately placed stripes with different refractive indices. In particular, the influence of the photonic crystal parameters on the 3-dB modulation bandwidth is investigated.
Er-doped fibre laser mode-locked by mechanically exfoliated graphene saturable absorber
Authors: Sotor J. , Sobon G. , Abramski K.
Published: September 2012

Erbium-doped fibre laser mode-locked by a graphene saturable absorber is presented. Pulses with 630-fs duration and 41.9-MHz repetition frequency were achieved at the centre wavelength of 1562 nm and 9-nm FWHM bandwidth. Multilayer graphene was obtained by mechanical exfoliation from a pure graphite block by using the scotch-tape method and deposited on a fibre ferrule to form a saturable absorber. The laser operated in a mode-locked regime with 37-mW pumping and 4-mW output power.
An update on unilateral sporadic small vestibular schwannoma
Authors: Thakur Jai Deep , Banerjee Anirban Deep , Khan Imad Saeed , Sonig Ashish , Shorter Cedric D. , Gardner Gale L. , Nanda Anil , Guthikonda Bharat
Published: September 2012

Advances in neuroimaging have increased the detection rate of small vestibular schwannomas (VSs, maximum diameter < 25 mm). Current management modalities include observation with serial imaging, stereotactic radiosurgery, and microsurgical resection. Selecting one approach over another invites speculation, and no standard management consensus has been established. Moreover, there is a distinct clinical heterogeneity among patients harboring small VSs, making standardization of management difficult. The aim of this article is to guide treating physicians toward the most plausible therapeutic option based on etiopathogenesis and the highest level of existing evidence specific to the different cohorts of hypothetical case scenarios.

Hypothetical cases were created to represent 5 commonly encountered scenarios involving patients with sporadic unilateral small VSs, and the literature was reviewed with a focus on small VS. The authors extrapolated from the data to the hypothetical case scenarios, and based on the level of evidence, they discuss the most suitable patient-specific treatment strategies. They conclude that observation and imaging, stereotactic radiosurgery, and microsurgery are all important components of the management strategy. Each has unique advantages and disadvantages best suited to certain clinical scenarios. The treatment of small VS should always be tailored to the clinical, personal, and social requirements of an individual patient, and a rigid treatment protocol is not practical.
Fascial sling technique for dural reconstruction after translabyrinthine resection of acoustic neuroma: technical note
Authors: Liu James K. , Patel Smruti K. , Podolski Amanda J. , Jyung Robert W.
Published: September 2012

Reconstruction of presigmoid dural defects after resection of acoustic neuromas via the translabyrinthine approach is paramount to prevent postoperative CSF leakage. However, primary dural reapproximation and achieving a watertight closure of the dural defect in this anatomical region are quite difficult. Standard closure techniques after the translabyrinthine approach often involve packing an abdominal fat graft that plugs the dural defect and mastoidectomy cavity. This technique, however, may pose the risk of direct compression of the fat graft on the facial nerve and brainstem. Nonetheless, even with the evolution in dural repair techniques, postoperative CSF leaks can still occur and provide a route for infection and meningitis. In this report, the authors describe a novel dural “sling” reconstruction technique using autologous fascia lata to repair presigmoid dural defects created after translabyrinthine resection of acoustic neuromas. The fascia lata is sewn to the edges of the presigmoid dural defect to create a sling to suspend the fat graft within the mastoidectomy defect. A titanium mesh plate embedded in porous polyethylene is secured over the mastoidectomy defect to apply pressure to the fat graft. In the authors' experience, this has been a successful technique for dural reconstruction after translabyrinthine removal of acoustic neuromas to prevent postoperative CSF leakage. There were no cases of CSF leakage in the first 8 patients treated using this technique. The operative details and preliminary results of this technique are presented.
Surgical approaches for resection of vestibular schwannomas: translabyrinthine, retrosigmoid, and middle fossa approaches
Authors: Chamoun Roukoz , MacDonald Joel , Shelton Clough , Couldwell William T.
Published: September 2012

Surgical removal remains one of the key treatment modalities for vestibular schwannomas. A team approach between a neurotologist and a neurosurgeon offers the patient the expertise of both specialties and maximizes the chances for an optimal outcome. Vestibular schwannomas can typically be resected through 1 of 3 main surgical approaches: the translabyrinthine, the retrosigmoid, or the middle fossa approaches. In this report and videos, the authors describe and illustrate the indications and surgical techniques for the removal of these tumors.
Pitfalls in intraoperative nerve monitoring during vestibular schwannoma surgery
Authors: Kircher Matthew L. , Kartush Jack M.
Published: September 2012

Despite the widespread acceptance of intraoperative neurophysiological monitoring in skull base surgery over the last 2 decades, surgeon training in the technical and interpretive aspects of nerve monitoring has been conspicuously lacking. Inadequate fundamental knowledge of neurophysiological monitoring may lead to misinterpretations and an inability to troubleshoot system errors. Some surgeons perform both the technical and interpretive aspects of monitoring themselves while others enjoin coworkers (surgical residents, nurses, anesthetists, or a separate monitoring service) to perform the technical portion. Regardless, the surgeon must have a thorough understanding to avoid potential medical and legal pitfalls because poor monitoring is worse than no monitoring. A structured curriculum and protocol in both the technical and interpretive aspects of monitoring is recommended for all personnel involved in the monitoring process. This paper details the technical, interpretive, and surgical correlates necessary for optimal intraoperative nerve monitoring during vestibular schwannoma surgery with an emphasis on electromyographic monitoring for facial and recurrent laryngeal nerves. Just as the American Society of Anesthesiologists' 1986 “Standards for Basic Anesthetic Monitoring” became a useful tool for both patients and anesthesiologists, impending guidelines in intraoperative neurophysiological monitoring should likewise become an important instrument for optimizing intraoperative neurophysiological monitoring.
Cognitive functioning early after surgery of gliomas in eloquent areas
Authors: Satoer Djaina , Vork Judith , Visch-Brink Evy , Smits Marion , Dirven Clemens , Vincent Arnaud
Published: September 2012

Object

Patients with gliomas frequently have cognitive deficits, and surgery can exacerbate these deficits. Preoperative assessment is therefore crucial in patients undergoing surgery for glioma in eloquent areas, because the proximity of functional areas increases the risk of permanent postoperative cognitive disturbances. Although pre- and postoperative language and motor function in patients with glioma have been investigated frequently, data on good cognition studies are scarce. Most studies have focused on clinical neurological functioning or have only used brief neurological instruments. The authors investigated whether surgery for glioma in eloquent areas influences cognition early after surgery, by using an elaborate test protocol.

Methods

Twenty-eight patients with gliomas of the left hemisphere in language and nonlanguage areas were assessed before and 3 months after surgery with a comprehensive neuropsychological test protocol. The authors performed a correlation analysis between change in cognitive performance and tumor characteristics (that is, location, volume, pathological features, and histological grade) and between cognitive change and treatment-related factors (the extent of the resection and postoperative treatment with chemo- and radiotherapy).

Results

Both pre- and postoperatively, the mean performance of the patients was worse than the performance of the normal population in the language domain, the memory domain, and the executive functions (p < 0.05). Postoperatively, a decline was found in the language domain (t = 2.34, p = 0.027) and in the executive functions (t = 2.45, p = 0.022). However, cognitive change postsurgery was influenced by the location of the tumor; the decrease of cognitive score in the language domain was only observed in patients with tumors in or close to language areas (t = 2.33, p = 0.029). No effect on cognitive change was found for the other tumor characteristics and treatment-related factors.

Conclusions

This study underlines the importance of the use of a neuropsychological test protocol before and after surgery in patients with glioma, because several tasks in the domains of language, memory, and executive functions appeared to deteriorate after surgery. Tumor resection in language areas increases the risk of cognitive deficits in the language domain postoperatively.
Union rates and prognostic variables of osteoporotic vertebral fractures treated with a rigid external support
Authors: Murata Kenji , Watanabe Goichi , Kawaguchi Satoshi , Kanaya Kohei , Horigome Keiko , Yajima Hideki , Morita Tomonori , Yamashita Toshihiko
Published: September 2012

Object

External supports serve as a traditional treatment option for osteoporotic vertebral fractures (OVFs). However, the role of external supports in the treatment of OVF remains inconclusive. The purpose of this study was to determine the role of a rigid external support in the healing of OVFs by prospectively evaluating union (fracture settling) rates and prognostic variables for patients suffering from an incident OVF.

Methods

Fifty-five patients with acute back pain were enrolled in this study after being diagnosed with an OVF based on MRI findings. Patients were treated using a plastic thoracolumbosacral orthosis (TLSO) and underwent follow-up at 2, 3, and 6 months. Vertebrae were referred to as “settled” when there was no dynamic mobility on sitting lateral and supine lateral radiographs. At the time of the 3- and 6-month follow-up visits, the patients were divided into 2 groups, the “settled group” and the “unsettled group.” Patients in these groups were compared with regard to clinical and radiographic features.

Results

Of the 55 patients enrolled, 53 patients were followed up for 6 months. There were 14 men and 39 women with an average age of 75.3 years. Fracture settling of the affected vertebra was defined in 54.7% of the patients at 2 months, in 79.2% at 3 months, and in 88.7% at 6 months. All 5 components of the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire improved significantly both at 3 months and 6 months. Patients in the unsettled group exhibited a statistically greater likelihood of having fractures at the thoracolumbar junction, Type A3 fractures, and fractures with a diffuse low-intensity area on T2-weighted MRI studies at 3 months. In contrast, at 6 months, the only statistically significant difference between the groups was patient age.

Conclusions

The biomechanical disadvantages of OVFs (location, type, and size) adversely influencing the fracture healing were overcome by the treatment using a TLSO within 6 months. The authors' findings show that a TLSO plays a biomechanical role in the healing of OVFs.
Oculomotor nerve palsy by posterior communicating artery aneurysms: influence of surgical strategy on recovery
Authors: Güresir Erdem , Schuss Patrick , Seifert Volker , Vatter Hartmut
Published: September 2012

Object

Resolution of oculomotor nerve palsy (ONP) after clipping of posterior communicating artery (PCoA) aneurysms has been well documented. However, whether additional decompression of the oculomotor nerve via aneurysm sac dissection or resection is superior to pure aneurysm clipping is the subject of much debate. Therefore, the objective in the present investigation was to analyze the influence of surgical strategy—specifically, clipping with or without aneurysm dissection—on ONP resolution.

Methods

Between June 1999 and December 2010, 18 consecutive patients with ruptured and unruptured PCoA aneurysms causing ONP were treated at the authors' institution. Oculomotor nerve palsy was evaluated on admission and at follow-up. The electronic database MEDLINE was searched for additional data in published studies of PCoA aneurysms causing ONP. Two reviewers independently extracted data.

Results

Overall, 8 studies from the literature review and 6 patients in the current series (121 PCoA aneurysms) met the study inclusion criteria. Ninety-four aneurysms were treated with simple aneurysm neck clipping and 27 with clipping plus aneurysm sac decompression. The surgical strategy, simple aneurysm neck clipping versus clipping plus oculomotor nerve decompression, had no effect on full ONP resolution on univariate (p = 0.5) and multivariate analyses. On multivariate analysis, patients with incomplete ONP at admission were more likely to have full resolution of the palsy than were those with complete ONP at admission (p = 0.03, OR = 4.2, 95% CI 1.1–16).

Conclusions

Data in the present study indicated that ONP caused by PCoA aneurysms improves after clipping without and with oculomotor nerve decompression. The resolution of ONP is inversely associated with the initial severity of ONP.
Correlation between language function and the left arcuate fasciculus detected by diffusion tensor imaging tractography after brain tumor surgery
Authors: Hayashi Yutaka , Kinoshita Masashi , Nakada Mitsutoshi , Hamada Jun-ichiro
Published: September 2012

Object

Disturbance of the arcuate fasciculus in the dominant hemisphere is thought to be associated with language-processing disorders, including conduction aphasia. Although the arcuate fasciculus can be visualized in vivo with diffusion tensor imaging (DTI) tractography, its involvement in functional processes associated with language has not been shown dynamically using DTI tractography. In the present study, to clarify the participation of the arcuate fasciculus in language functions, postoperative changes in the arcuate fasciculus detected by DTI tractography were evaluated chronologically in relation to postoperative changes in language function after brain tumor surgery.

Methods

Preoperative and postoperative arcuate fasciculus area and language function were examined in 7 right-handed patients with a brain tumor in the left hemisphere located in proximity to part of the arcuate fasciculus. The arcuate fasciculus was depicted, and its area was calculated using DTI tractography. Language functions were measured using the Western Aphasia Battery (WAB).

Results

After tumor resection, visualization of the arcuate fasciculus was increased in 5 of the 7 patients, and the total WAB score improved in 6 of the 7 patients. The relative ratio of postoperative visualized area of the arcuate fasciculus to preoperative visualized area of the arcuate fasciculus was increased in association with an improvement in postoperative language function (p = 0.0039).

Conclusions

The role of the left arcuate fasciculus in language functions can be evaluated chronologically in vivo by DTI tractography after brain tumor surgery. Because increased postoperative visualization of the fasciculus was significantly associated with postoperative improvement in language functions, the arcuate fasciculus may play an important role in language function, as previously thought. In addition, postoperative changes in the arcuate fasciculus detected by DTI tractography could represent a predicting factor for postoperative language-dependent functional outcomes in patients with brain tumor.
Gamma Knife surgery for pediatric arteriovenous malformations: a 25-year retrospective study
Authors: Dinca Eduard B. , de Lacy Patricia , Yianni John , Rowe Jeremy , Radatz Matthias W. R. , Preotiuc-Pietro Daniel , Kemeny Andras A.
Published: September 2012

Object

The authors present their 25-year experience in treating pediatric arteriovenous malformations (AVMs) to allow comparisons with other historic studies and data in adults.

Methods

Data were collected from a prospectively maintained departmental database selected for age and supplemented by case note review and telephone interviews as appropriate.

Results

Three hundred sixty-three patients, ages 1–16 years (mean ± SD, 12 ± 3.2 years), underwent 410 treatments; 4 had planned 2-stage treatments and 43 were retreated subsequent to an initial partial response. Fifty-eight percent received general anesthesia for the procedure. Sixteen percent had previously undergone embolization. The most common presenting symptoms were as follows: hemorrhage (80.2%), epilepsy (8.3%; overall seizure prevalence 19.9%), and migrainous headaches (6.3%). Only 0.28% of the AVMs were incidental findings. The mean lesion volume was 3.75 ± 5.3 cm3 (range 0.01–32.8 cm3), with a median Spetzler-Martin grade of III (range I–V). The mean peripheral (therapeutic) dose was 22.7 ± 2.3 Gy (range 15–25 Gy), corresponding to a mean maximum dose of 43.6 ± 6 Gy (range 25–51.4 Gy).

The obliteration rate was 71.3% in patients who received one treatment and 62.5% for retreated patients, with a mean obliteration time of 32.4 and 79.6 months, respectively. The overall obliteration rate was 82.7%. No follow-up data are as yet available for the 4 patients who underwent the staged treatments. Only 4 patients received peripheral doses below 20 Gy, and the AVM was obliterated in 3 of these patients. The other patients received 20, 22.5, or 25 Gy and had obliteration rates of 82.6%, 77.7%, and 86.3%, respectively. The bleeding rate postradiosurgery was 2.2%, and the cumulative complication rate was 3.6%, with radionecrosis being the most common complication (1.1%).

Conclusions

Surprisingly, there was no correlation (p = 0.43) between outcome and radiosurgical dose when that dose was between 20 and 25 Gy, thus suggesting that the lower of these 2 doses may be effective. Radiosurgery for pediatric AVM is safe and effective.
Outcomes after surgery for spinal metastatic leiomyosarcoma
Authors: Ziewacz John E. , Lau Darryl , La Marca Frank , Park Paul
Published: September 2012

Object

Leiomyosarcoma is a smooth-muscle sarcoma that rarely metastasizes to the spine. Its clinical course is variable, although patients with metastatic leiomyosarcoma can experience prolonged survival as compared with patients with more aggressive metastatic tumors. The authors report their single-institution experience in the surgical treatment of patients with leiomyosarcoma metastatic to the spine.

Methods

A retrospective review of the electronic medical records was performed to obtain details on clinical management and outcomes for patients who had undergone surgical intervention for metastatic leiomyosarcoma of the spine. The few articles available in the current literature on this topic were also analyzed.

Results

Eight patients with metastatic leiomyosarcoma of the spine underwent surgical management between 2005 and 2011. Six patients (75%) had improvement in their Nurick grade. Patients who had presented with pain as a primary symptom experienced significant relief. Five patients (63%) had lesion recurrence, and 4 underwent repeat surgery at a mean of 10.2 months after their initial surgery. The mean duration of survival was 11.7 months (range 3.3–23.0 months).

Conclusions

Leiomyosarcoma rarely metastasizes to the spine. However, surgical intervention can relieve pain and improve neurological function. Given the potential for prolonged survival, aggressive management should be considered in well-selected patients.