bluuebunny/crossref_metadata_2025 huggingface dataset:
Adiponectin Is Associated with Changes in Bone Markers during Glycemic Control in Type 2 Diabetes Mellitus
Authors: Kanazawa Ippei , Yamaguchi Toru , Yamauchi Mika , Yamamoto Masahiro , Kurioka Soichi , Yano Shozo , Sugimoto Toshitsugu
Published: May 2009

Objective: Although several experiments show that adiponectin is associated with bone metabolism, a relationship between adiponectin and bone markers is still unclear. We monitored chronological changes in hyperglycemia, serum adiponectin, and bone markers during glycemic control in type 2 diabetes and analyzed relationships among these parameters.

Subjects and Results: A total of 50 Japanese patients with poorly controlled type 2 diabetes [initial hemoglobin A1c (HbA1c) = 10.0 ± 2.5%] were recruited, and biochemical data were collected before and after glycemic control for a month. Of bone formation markers, bone-specific alkaline phosphatase was decreased with a mean change of −3.11 [95% confidence interval (CI), −5.03 to −1.20; P < 0.01], whereas osteocalcin (OC) was increased with a mean change of 1.94 (95% CI, 1.45–2.42; P < 0.001) and undercarboxylated OC (ucOC)/OC ratio was decreased with a mean change of −0.15 (95% CI, −0.27 to −0.03; P < 0.01). Although adiponectin level was not significantly different before and after glycemic control, baseline adiponectin level, but not HbA1c, was positively correlated with changes in OC, ucOC, and urinary N-terminal cross-linked telopeptide of type I collagen (uNTX) (r = 0.30, P =0.04; r = 0.32, P = 0.03; and r = 0.36, P = 0.01, respectively). Changes in adiponectin were also negatively correlated with changes in OC and uNTX (r = −0.42, P < 0.01; and r = −0.38, P < 0.01, respectively). Changes in HbA1c were negatively correlated with changes in OC (r = −0.30, P = 0.03).

Conclusion: These findings show that treatments for hyperglycemia enhance OC level and suggest that serum adiponectin level before starting to compensate poorly controlled diabetics could predict the subsequent improvement of bone remodeling markers during glycemic control.
Hybrid Photoreactive Magnet Obtained from Fe3O4/TiO2 Composite Nanoparticles
Authors: Song Hyon Min , Ko Jang Myoun , Park Jeong Ho
Published: May 2009

Fe3O4/TiO2 composite nanoparticles (NPs) were synthesized by a reverse micelle microemulsion method with Igepal CO-550 as a stabilizer. Annealed samples have distinct two stage band gap energies of 3.2 and 2.1 eV. In addition to the optical red-shift effect of absorption band, Fe3O4/TiO2 composite NPs maintain soft ferromagnetism with saturation magnetization of 36 emu g−1 at room temperature, which makes them heterogeneous catalysts for the photochemical reactions.
A Simple H2O2-assisted Method for the Synthesis of Intestine-like SnO2 Nanostructures at Room Temperature
Authors: Liu Shunqiang , Xie Mingjiang , Li Yanxing , Guo Xuefeng , Ji Weijie , Ding Weiping
Published: May 2009

Highly crystalline intestine-like SnO2 nanostructures with hollow interior have been synthesized by a one-step H2O2-assisted method at room temperature. A possible growth mechanism has been proposed. In the synthesis, H2O2 fulfills important functions in both forming the intestine-like morphology and promoting the formation of hollow structure.
The roots and branches of human altruism
Authors: Hay Dale F.
Published: May 2009

The authors' rigorous and ingenious programme of work documents young humans' capacity for prosocial action (Warneken & Tomasello, 2009). Their laboratory findings are corroborated by centuries of observational data, spanning cultures, and historical epochs. Two general questions are raised. Firstly, what are the rules of evidence needed in using comparative data to make claims about the evolution of human social behaviours? Secondly, what ontogenetic processes contribute to the transformation of toddlers' helpfulness into mature, cognitively informed and rule‐governed altruism? These findings alone do not provide complete evidence for the phylogenetic roots of altruism. I argue that selective pressures in human evolution have favoured sociability, which could lead to aggression or altruism, depending on context and the nature of the rearing environment. Any social behaviour shown in infancy may have multiple functions, at phylogenetic, ontogenetic and episodic levels of analysis.
Discovery of the element with atomic number 112 (IUPAC Technical Report)
Authors: Barber Robert C. , Gäggeler Heinz W. , Karol Paul J. , Nakahara Hiromichi , Vardaci Emanuele , Vogt Erich
Published: May 2009

The IUPAC/IUPAP Joint Working Party (JWP) on the priority of claims to the discovery of new elements has reviewed the relevant literature pertaining to several claims. In accordance with the criteria for the discovery of elements previously established by the 1992 IUPAC/IUPAP Transfermium Working Group (TWG), and reiterated by the 1999 and 2003 IUPAC/IUPAP JWPs, it was determined that the 1996 and 2002 claims by the Hofmann et al. research collaborations for the discovery of the element with atomic number 112 at Gesellschaft für Schwerionenforschung (GSI) share in the fulfillment of those criteria. A synopsis of Z = 112 experiments and related efforts is presented. A subsequent report will address identification of higher-Z elements including those of odd atomic number.
Akt Signals through the Mammalian Target of Rapamycin Pathway to Regulate CNS Myelination
Authors: Narayanan S. Priyadarshini , Flores Ana I. , Wang Feng , Macklin Wendy B.
Published: May 2009

Mammalian target of rapamycin (mTOR), a well known Akt substrate, regulates multiple cellular functions including cell growth and protein synthesis. The current study identifies a novel role of the Akt/mTOR pathway as a regulator of CNS myelination. Previously, we showed that overexpressing constitutively active Akt in oligodendrocytes in a transgenic mouse model induces enhanced CNS myelination, with no changes in the proliferation or survival of oligodendrocyte progenitor or mature cells. The present study focused on the signaling mechanisms regulating this hypermyelination induced by Akt. Activation of mTOR and its downstream substrates (p70S6 kinase and S6 ribosomal protein) was observed in Akt-overexpressing oligodendrocytes. When mTOR signaling was inhibited chronicallyin vivowith rapamycin starting at 6 weeks of age, the observed hypermyelination was reduced to approximately the amount of myelin seen in wild-type mice. mTOR inhibition had little impact on wild-type myelination between 6 and 12 weeks of age, suggesting that, in normal adults, myelination is relatively complete and is no longer regulated by mTOR signaling. However, when mTOR was chronically inhibited in young adult wild-type mice, myelination was reduced. These results suggest that, during active myelination, the major Akt signal regulating CNS myelination is the mTOR pathway.
The Liberation of Fractalkine in the Dorsal Horn Requires Microglial Cathepsin S
Authors: Clark Anna K. , Yip Ping K. , Malcangio Marzia
Published: May 2009

Understanding of the sequence and nature of the events that govern neuron–microglia communication is critical for the discovery of new mechanisms and targets for chronic pain treatment. The neuronal chemokine fractalkine (FKN) and its microglial receptor CX3CR1 may mediate such a function in the dorsal horn of the spinal cord after cleavage of the extracellular domain of this transmembrane chemokine by a protease. Here we report that in neuropathic rat dorsal horn, with dorsal root-attached preparations, soluble FKN (sFKN) contents are increased in the superfusates collected after noxious-like electrical stimulation of ipsilateral primary afferent fibers. The increase of sFKN is prevented by morpholinurea-leucine-homophenylalanine-vinyl sulfone-phenyl (LHVS), an irreversible inhibitor of cathepsin S (CatS) whose proteolytic activity is also increased in the superfusates. The source of CatS activity is microglial cells activated by the peripheral nerve injury and secreting the enzyme, as a result of primary afferent fiber stimulation. Indeed, the acute activation of dorsal horn microglia by lipopolysaccharide results in increased CatS activity in the superfusates, followed by increased sFKN contents. Consistent with these observationsex vivo, the levels of both sFKN and CatS activity in CSF samples increased significantly after peripheral nerve injury, associated with spinal microglial activation. Finally, because we found that both FKN immunoreactivity and mRNA are confined to dorsal horn neurons, we suggest that under neuropathic conditions, noxious stimulation of primary afferent fibers induces release of CatS from microglia, which liberates FKN from dorsal horn neurons, thereby contributing to the amplification and maintenance of chronic pain.
Cortical Lesion-Induced Visual Hemineglect Is Prevented by NMDA Antagonist Pretreatment
Authors: Jiang Huai , Stein Barry E. , McHaffie John G.
Published: May 2009

Large unilateral visual cortex lesions produce enduring contralesional visual orientation deficits. To examine whether glutamate excitotoxicity is involved in establishing these deficits, cats were pretreated with the NMDA receptor antagonist dizocilpine (MK-801) 30 min before unilateral visual cortex ablation. Pretreated MK-801 animals were trained first in an orientation task in which they were required to fixate directly ahead and then orient to stimuli introduced at various eccentricities throughout the visual field. They did not display the characteristic ipsilesional head and neck asymmetries and/or spontaneous ipsiversive rotational behaviors or show the profound contralesional visual neglect seen postoperatively in nonpretreated control animals. Rather, pretreated animals were able to orient to visual stimuli in the contralesional hemifield immediately following surgical recovery. Postmortem histology revealed severe retrograde degeneration of the ipsilesional lateral geniculate nucleus in both experimental groups, suggesting that postlesion visuomotor behavioral competencies in pretreated animals are attributable to preserved function in nongeniculocortical visual pathways. These observations are consistent with the hypothesis that visual cortex lesions normally induce secondary alterations via NMDA-mediated excitotoxicity in these other pathways that prevents them from supporting visuomotor behaviors. The similar behavioral competencies of MK-801-pretreated animals and those whose lesion-induced deficits are ameliorated by removing basal ganglia afferents to the ipsilesional superior colliculus are consistent with this hypothesis and highlight the normal functional capabilities of this circuit. It is likely that MK-801 pretreatment acts, at least in part, by preserving the normal interhemispheric control dynamics with which the basal ganglia influence superior colliculus-mediated orientation behaviors.
The voice system of Estonian
Authors: Torn-Leesik Reeli
Published: May 2009

This article discusses the two main Estonian voice constructions, the impersonal and the 'resultative′ passive, and their status in the grammatical system of Estonian. Both constructions are subject-oriented; however, the passive is a valence-reducing operation, while the impersonal merely constrains argument realization. Both constructions are subject to distinctive lexical, syntactic and semantic constraints. A comparison of the role of these constructions in Estonian demonstrates that passive constructions need not be treated as universal and that languages can employ different grammatical means to achieve very similar communicative results. The fact that impersonals in Estonian and in other languages are frequently misclassified as passives shows how typological biases can distort grammatical descriptions. The comparison of impersonals and passives in Estonian also shows how constructions can differ in terms of whether they are sensitive to subjects at 'logical′ or 'grammatical′ levels of analysis.
Pronouns and reference in Estonian
Authors: Pajusalu Renate
Published: May 2009

The article gives an overview of functions of Estonian frequent pronouns (demonstratives, personal, indefinite and quantificational pronouns) from typological point of view. Both deictic and anaphoric usages are discussed. The main purpose of the article is to present categories which influence the choice of a pronoun for the particular point of ongoing discourse. These categories are: activation status and animacy of the referent, pragmatic contrast, type of syntactic construction, definiteness/indefiniteness of the noun phrase, the status of the referred person in the ongoing narrative and pragmatic plenitude (for quantificational pronouns).
Taboo intensifiers as polarity items: evidence from Estonian
Authors: Kehayov Petar
Published: May 2009

This paper discusses the development of expressions such as who/God knows wh into negative degree adverbs in Estonian. The study provides an answer to the question of how certain negative polarity items emerge in a language. This question is rarely answered in the literature focused on polarity; hence, the case-study at hand is an attempt to contribute to the general understanding of the grammaticalization/lexicalization of polarity items. Two issues are studied in detail: first, the pragmatic prerequisites, and second, the structural idiosyncrasies triggering the lexicalization of these types of expressions into NPIs. The insights obtained allow challenging the view (see VON BERGEN & VON BERGEN 1993: 130) according to which the historical change in the meaning of the linguistic elements is not relevant for the synchronic description of polarity items.
Female roles and conflicts in health care professions
Authors: Feith Helga Judit
Published: May 2009

A gyógyító- és ápolómunka fizikai és pszichés terheit női munkavállalók esetében fokozzák a gyermekvállalás és a családi szerepek ellátásából következő kötelezettségek.
Célkitűzés:
Kutatásunk elsődleges célja az volt, hogy megismerjük és összehasonlítsuk hallgatói és dolgozói szinten a diplomás ápolónők és orvosnők család- és karrierszerep(terv)eit, összefüggésben testi és lelki jóllétükkel, konfliktusaikkal.
Módszer:
Keresztmetszeti, önkitöltős kérdőíves vizsgálatainkat egészségügyi felsőoktatásban tanuló diplomás ápoló- (N = 226) és orvostanhallgató-nők (N = 117) körében, valamint fekvőbeteg-ellátásban dolgozó diplomás ápolónők és orvosnők (N = 409) körében készítettük.
Eredmények:
A hallgatónők leendő családi és munkahelyi szerepeiket egyaránt nélkülözhetetlennek tartják. Gyermekszámterveik nem térnek el a magyar populáció hasonló eredményeitől. Diplomás ápolónők és orvosnők számára fontosak a családi és munkahelyi szerepek. A szerepek közötti konfliktusok összefüggésben állnak a karrierrel és életúttal kapcsolatos elégedettségükkel, egészségi állapotukkal, pszichoszomatikus tüneteik prevalenciájával. Megállapítható, hogy egészség- és rizikó-magatartásuk nem kielégítő szintű.
Következtetések:
A leendő és a már magyar egészségügyi viszonyok között dolgozó egészségügyi diplomás nők szerepterveiben, szerepeinek ellátásában számos ponton feszültség figyelhető meg. Sok esetben nem kielégítő a társadalmi szerepeikből adódó kötelezettségek teljesítése. A diplomásápoló-hallgatók és dolgozók hátránya kifejezettebb, ezért fontosnak tartjuk további elemző és összehasonlító vizsgálatok végzését.
The Differential Risk Factors of Physically Forced and Alcohol- or Other Drug-Enabled Sexual Assault Among University Women
Authors: Krebs Christopher P. , Lindquist Christine H. , Warner Tara D. , Fisher Bonnie S. , Martin Sandra L.
Published: May 2009

The Campus Sexual Assault Study examined whether undergraduate women’s victimization experiences prior to college and lifestyle activities during college were differentially associated with the type of sexual assault they experienced: physically forced sexual assault and incapacitated sexual assault. Self-reported data collected using a Web-based survey administered to more than 5,000 undergraduate women at two large public universities indicated that victimization experiences before college were differentially associated with the risk of experiencing these two types of sexual assault during college. Women who experienced forced sexual assault before college were at very high risk of experiencing forced sexual assault during college (odds ratio [OR] = 6.6). Women who experienced incapacitated sexual assault before college were also at very high risk of experiencing incapacitated sexual assault during college (OR = 3.7). Moreover, women’s substance use behaviors during college, including getting drunk and using marijuana, were strongly associated with experiencing incapacitated sexual assault but were not associated with experiencing forced sexual assault. Implications for education and prevention programs, as well as future research directions, are discussed.
Victimization and the General Theory of Crime
Authors: Nofziger Stacey
Published: May 2009

Theories of victimization developed independently of theories of offending, in spite of consistent findings of similarities between offenders and victims of crime. This study examines whether Gottfredson and Hirschi’s (1990) general theory of crime, typically used to predict offending, also has relevance in understanding juvenile victimization. The data for this project are drawn from a sample of over 1,200 middle and high school students. Using structural equation models, the findings suggest that higher self-control does directly decrease victimization and that self-control also affects victimization indirectly though opportunities (peer deviance). Implications for the studies of victimization as well as the general theory of crime are discussed.
Nonalbuminuric Renal Impairment in Type 2 Diabetic Patients and in the General Population (National Evaluation of the Frequency of Renal Impairment cO-existing with NIDDM [NEFRON] 11)
Authors: Thomas Merlin C. , MacIsaac Richard J. , Jerums George , Weekes Andrew , Moran John , Shaw Jonathan E. , Atkins Robert C.
Published: May 2009

OBJECTIVE

Most diabetic patients with impaired renal function have a urinary albumin excretion rate in the normal range. In these patients, the etiology of renal impairment is unclear, and it is also unclear whether this nonalbumunuric renal impairment is unique to diabetes.

RESEARCH DESIGN AND METHODS

In this study, we examined the frequency and predictors of nonalbumunuric renal impairment (estimated glomerular filtration rate [eGFR] <60 ml/min per 1.73 m2) in a nationally representative cohort of 3,893 patients with type 2 diabetes and compared our findings with rates observed in the general population from the Australian Diabetes, Obesity and Lifestyle Study (AusDiab) survey (n = 11,247).

RESULTS

Of the 23.1% of individuals with type 2 diabetes who had eGFR <60 ml/min per 1.73 m2 (95% CI 21.8–24.5%), more than half (55%) had a urinary albumin excretion rate that was persistently in the normal range. This rate of renal impairment was predictably higher than that observed in the general population (adjusted odds ratio 1.3, 95% CI 1.1–1.5, P < 0.01) but was solely due to chronic kidney disease associated with albuminuria. In contrast, renal impairment in the absence of albuminuria was less common in those with diabetes than in the general population, independent of sex, ethnicity, and duration of diabetes (0.6, 0.5–0.7, P < 0.001).

CONCLUSIONS

Nonalbuminuric renal impairment is not more common in those with diabetes. However, its impact may be more significant. New studies are required to address the pathogenesis, prevention, and treatment of nonalbuminuric renal disease.
Multiple congenital urogenital abnormalities in a Tennessee Walking Horse colt
Authors: Waldridge B. M. , Lenz S. D. , Hudson J. , Rodriguez‐Hurtado I.
Published: May 2009

A 9‐month‐old, Tennessee Walking Horse colt was examined for urinary incontinence. Cystoscopy revealed a single identifiable ureter that appeared abnormal, and sabulous urolithiasis. Only the left kidney, which appeared lobulated and hydronephrotic, could be located using ultrasound. Results of serum chemistries were consistent with renal failure. Necropsy revealed unilateral agenesis of the right kidney and ureter with severe left ureterolithiasis, bilateral cryptorchidism and segmental aplasia of the ductus deferens. Histopathological examination revealed cystitis and diffuse interstitial fibrosis of the left kidney. Congenital malformations should be included as differential diagnoses for urinary incontinence and urogenital disease. Ultrasonography and cystoscopy can be useful to diagnose suspected agenesis of the urinary system in adult horses.
Surgical correction of a medial patellar luxation in a foal using a modified recession trochleoplasty technique
Authors: Hart J. C. A. , Jann H. W. , Moorman V. J.
Published: May 2009

A 24‐hour‐old male Shetland pony was presented for evaluation of unilateral hindlimb lameness of unknown duration. Physical and radiographic findings confirmed a diagnosis of medial luxation of the patella. A traumatic or congenital aetiology was suspected but could not be confirmed. Surgical correction of the luxation, using a modified recession trochleoplasty technique, was carried out. At 6 months follow‐up, no discernbile lameness could be observed. In the literature, descriptions of medially luxated patellae in equids are rare. Published reports describing the use of peri‐ and intra‐articular surgical techiques for the correction of luxated patellae in equids are widely available. The modified recession trochleoplasty employed in this case may offer advantages over previously published techniques.
Computed tomography in the diagnosis of malignant sinonasal tumours in three horses
Authors: Veraa S. , Dijkman R. , Klein W. R. , van den Belt A. J. M.
Published: May 2009

Malignant tumours are uncommon in horses, but when they do occur, they are most frequently found in the head. Clinical findings, such as facial swelling and nasal discharge, are frequently encountered but are nonspecific. To highlight the usefulness of a computed tomography (CT) examination in malignancy in the equine head, this Case Report describes the CT features of a leiomyosarcoma, an osteosarcoma and a sarcoma in 3 horses. CT of the equine head was able to provide more information about the extent and severity of lesions than conventional radiography in these cases.
Editorial
Authors: Welch Penny , Wright Susan
Published: May 2009

Welcome to the first issue of the second volume of Learning and Teaching: The International Journal of Higher Education in the Social Sciences. Our thanks go to the authors of articles and reviews, the anonymous referees who read the articles, the publishers who provided review copies of the books, our own publisher Berghahn and the Editorial Board.
Endothelin-1 of canine basilar artery in vasospasm
Authors: Yamaura Ikuya , Tani Eiichi , Maeda Yukio , Minami Nobutaka , Shindo Hideki
Published: May 2009

✓ Cerebral vasospasm was induced in adult mongrel dogs by a two-hemorrhage method. The basilar arteries were quickly frozen after careful removal of surrounding blood clot and their level of immunoreactive endothelin-1, a strong vasoconstrictor produced by the endothelial and vascular smooth-muscle cells, was measured by sandwich-enzyme immunoassay. The levels of immunoreactive endothelin-1 (mean ± standard deviation) were 112.9 ± 7.0 pg/mg protein prior to vasospasm, 180.4 ± 24.7 pg/mg protein on Day 2 after vasospasm, and 115.0 ± 24.0 pg/mg protein on Day 7, showing a significant increase (p < 0.01) in immunoreactive endothelin-1 only on Day 2. In addition, vasospasm was moderately reversed by the topical application of monoclonal antibody against endothelin-1 on Day 2 but rather resistant to topical monoclonal antibody on Day 7. It is suggested that endothelin-1 could act as a trigger in the early stages of cerebral vasospasm, but that the maintenance of cerebral vasospasm at later stages might be independent of endothelin-1.
Surgical excision of giant cerebellar hemispheric arteriovenous malformations following preoperative embolization
Authors: Mizol Kazuo , Takahashi Akira , Yoshimoto Takashi , Sugawara Takayuki , Saito Keiichi
Published: May 2009

✓ The authors present two cases of giant cerebellar hemispheric arteriovenous malformation (AVM) managed with staged preoperative embolization and surgical resection. A new embolization technique is described, combining injection of estrogen alcohol and polyvinyl acetate into AVM's by superselective catheterization of feeding arteries. Polyvinyl acetate proved to be an ideal liquid embolic material; because it polymerizes quickly and remains in a gelatinous state after injection, there was no difficulty in cutting and retracting the obliterated AVM during surgery. Intraoperative digital subtraction angiography was useful for confirming complete excision of the large and complex AVM.
Infection of cerebrospinal fluid shunts in infants: a study of etiological factors
Authors: Pople Ian K. , Bayston Roger , Hayward Richard D.
Published: May 2009

✓ The aim of this study was to find reasons for the high incidence of cerebrospinal fluid shunt infections seen in neonates. Four-hundred sixty-six consecutive shunt operations were analyzed retrospectively in 294 children, and 60 children were studied prospectively by quantitative sampling of skin bacteria before surgery and by sampling open wounds, shunt catheters, surgical gloves, and airborne bacteria. In total, 110 strains of coagulase-negativeStaphylococcusisolated from the skin of 53 children before surgery were then tested for bacterial adherence.

Retrospectively, the infection rate for infants younger than 6 months old was 15.7% (28 of 178 procedures), compared with 5.6% (16 of 288 procedures) for older children (p = 0.0005). Of all infections, 67% were due to coagulase-negativeStaphylococcus.Age was the only major factor influencing the infection rate. Three of the 60 children studied prospectively developed postoperative shunt infections. All were younger than 6 months and all had high skin bacterial densities before surgery. Contamination during surgery was generally low, but correlated with the preoperative skin bacterial density. Strains of coagulase-negativeStaphylococcuswith high bacterial adherence were more commonly found in neonates than in older children.

High skin bacterial density in neonates before surgery was a risk factor for infection in this study. These results also suggest that there is selection of more virulent strains of coagulase-negativeStaphylococcuson the skin of neonates. Prevention of shunt infections in this high-risk group could be facilitated by the reduction of skin bacterial density before surgery using chlorhexidine shampoos and by the elimination of contamination by skin bacteria during surgery using packs soaked in an antiseptic agent to isolate wound edges and glove-changing before handling the shunt.
Control of tremor and involuntary movement disorders by chronic stereotactic stimulation of the ventral intermediate thalamic nucleus
Authors: Blond Serge , Caparros-Lefebvre Dominique , Parker Fabrice , Assaker Richard , Petit Henri , Guieu Jean-Daniel , Christiaens Jean-Louis
Published: May 2009

✓ The authors report on the long-term results of chronic stereotactic stimulation of the ventralis intermedius thalamic nucleus performed in 14 cases of disabling and intractable tremor. There were 10 patients with parkinsonian tremor and four with essential tremor. Three of the 10 parkinsonian patients had previously undergone contralateral thalamotomy. Tremor was assessed by clinical evaluation, surface electromyography, accelerometer, and videotape recordings before and after stimulation. The deep-brain electrode was implanted in the ventralis intermedius nucleus according to stereotactic procedure and connected to a subcutaneous pulse generator after a stimulation test period. Tremor suppression or reduction was obtained in all cases with high-frequency (130 Hz) stimulation. Marked functional improvement was maintained in 11 patients with a mean follow-up interval of 17 months. Levodopa-induced dyskinesias observed in five parkinsonian patients prior to surgery were improved or suppressed in four cases by thalamic stimulation. Stimulation was continued during the day and stopped at night in eight cases. Six patients were stimulated night and day to avoid a rebound effect which appeared as soon as the pulse generator was stopped. The only side effects were hand tonic posture in one case and persistent paresthesia in another case. The mechanism of action of this attractive treatment may be a functional alteration of the thalamic discharging area. The authors conclude that this technique is a good alternative to thalamotomy, especially when the risks of high-frequency coagulation are severe in frail and older patients.
Long-term follow-up study after extracranial-intracranial bypass surgery for anterior circulation ischemia in childhood moyamoya disease
Authors: Karasawa Jun , Touho Hajime , Ohnishi Hideyuki , Miyamoto Susumu , Kikuchi Haruhiko
Published: May 2009

✓ Between May, 1974, and March, 1991, 104 patients with moyamoya disease, all under 16 years old at the time of first surgery, underwent superficial temporal-to-middle cerebral artery anastomosis and/or encephalomyosynangiosis. The mean follow-up period was 9.6 years (range 4.8 to 16.0 years). Hemiplegia was the most frequent symptom before the first operation. Transient ischemic attacks (TIA's) were noted in 57 patients and minor stroke with hemiplegia in 44. The most frequent type of cortical dysfunction was aphasia (21 cases). Postoperatively, the incidence of TIA's and/or completed stroke with motor weakness of the extremities was markedly decreased, but visual disturbance progressed and major or minor stroke with visual disturbance was found in two cases. In patients under the age of 3 years, a major stroke prior to surgery resulted in a poor outcome in 36% of cases. Preoperative major stroke in patients between the ages of 3 and 7 years was less frequent, and poor outcomes were seen in 17% of this group. There were no major preoperative strokes in patients with surgery after the age of 7 years, and no poor outcomes were recorded in this group. A major preoperative stroke prior to surgery had adverse impact on the ultimate patient intelligence quotient (IQ) following surgery. All patients operated on after the age of 7 years had a normal or borderline IQ at follow-up examination.
Moderate head injury: a guide to initial management
Authors: Stein Sherman C. , Ross Steven E.
Published: May 2009

✓ The purpose of this study is to determine the initial treatment of patients who appear to have sustained moderate head injuries when first evaluated. The authors reviewed the records of 341 patients whose initial Glasgow Coma Scale (GCS) scores ranged from 9 to 12, as well as another 106 patients with GCS scores of 13. All patients underwent cranial computerized tomography (CT) at the time of admission.

In 40.3% of these patients the CT scans were abnormal (30.6% had intracranial lesions), and 8.1 % required neurosurgical intervention (craniotomies for hematoma in 12, elevation of depressed fractures in five, and insertion of intracranial pressure monitors in 19). Four patients died of their intracranial injuries. A similar incidence of lesions found on CT and at surgery suggests that an initial GCS score of 13 be classified with the moderate head injury group. Skull fractures were found to be poor indicators of intracranial abnormalities.

These results suggest that all patients with head injury thought to be moderate on initial examination be admitted to the hospital and undergo urgent CT scanning. Patients with intracranial lesions require immediate neurosurgical consultation, surgery as needed, and admission to a critical-care unit. Scans should be repeated in patients whose recovery is less rapid than expected and in all patients with evidence of clinical deterioration; this was necessary in almost half of the patients in this group, and 32% were found to have progression of radiological abnormalities on serial CT scans.
Expanded spectrum of viral therapy in the treatment of nervous system tumors
Authors: Markert James M. , Coen Donald M. , Malick Amy , Mineta Toshihiro , Martuza Robert L.
Published: May 2009

✓ Despite aggressive therapy, many nervous system neoplasms, including malignant gliomas, medulloblastomas, malignant meningiomas, and neurofibrosarcomas, maintain high mortality rates. The authors recently utilized a thymidine kinase-negative herpes simplex-1 mutant virus,dlsptk, with reduced neurovirulence, for the effective treatment of malignant human gliomas in cell culture and in nude mousein vivomodels. The range of human nervous system tumors that might be responsive to viral therapy is now expanded. Three medulloblastoma, four malignant or atypical meningioma, and five neurofibrosarcoma cell lines or early-passage tumors were treated with thedlsptk virus in cell culture. A cell death rate of at least 99% was evident in every tumor tested for at least one multiplicity of infection within 14 days after treatment. Control tumor cell cultures remained viable. To testdlsptk therapyin vivo, the authors treated human medulloblastoma subcutaneous xenografts with two doses ofdlsptk. Mean growth ratios were significantly inhibited in the treated group when compared to control tumors, and there was a significant number of tumor regressions in the treated animals. Similar results were seen with human malignant meningioma xenografts in a subrenal capsule study. These results encourage the further investigation of viral therapy in the treatment of a broad spectrum of nervous system tumors refractory to conventional treatment methods.
Classic, atypical, and anaplastic meningioma: three histopathological subtypes of clinical relevance
Authors: Maier Hans , Öfner Dietmar , Hittmair Anton , Kitz Klaus , Budka Herbert
Published: May 2009

✓ This study correlates the histopathological classification of meningiomas with clinicopathological features of biological activity. A retrospective evaluation of 1799 surgical specimens of meningiomas from 1582 patients was made. The classic histopathological type, atypical meningiomas defined by increased cellularity and at least five mitotic figures in 10 high-power fields, anaplastic (malignant) meningiomas, and hemangiopericytic or papillary meningiomas were seen in 87.6%, 7.2%, 2.4%, and 2.8% of operations, respectively. The rates of recurrence in surgically treated patients with classic, atypical, anaplastic, and hemangiopericytic or papillary meningiomas were 6.96%, 34.6%, 72.7%, and 68.2%, respectively. The extent of surgery and the tumor size and site were studied in detail in 252 tumors of all histopathological types. Recurrences were rare in classic meningiomas after complete resection, whereas atypical and anaplastic tumors recurred after complete resection much more frequently. Classic meningiomas, hemangiopericytomas, and papillary meningiomas were smaller at surgery than atypical and malignant meningiomas. Atypical and malignant tumors were operated on more often in falcine and lateral convexity regions than were classic meningiomas.

To support the authors' subjective categorization by a quantitative parameter related to proliferation, 112 meningiomas comprising all histopathological subtypes were investigated for staining of argyrophilic nucleolar organizer region proteins (Ag-NOR's). The Ag-NOR counts showed significant differences between classic, atypical, and anaplastic tumors but no significant differences between primary and recurrent tumors. Hemangiopericytomas and papillary meningiomas had lower Ag-NOR values than anaplastic meningiomas.

A correlation of Ag-NOR numbers with the authors' histopathological scale of malignancy supports the introduction of atypical meningiomas with intermediate biological behavior on the classification scale between classic and anaplastic meningiomas. Overlapping of Ag-NOR numbers among all groups of malignancy may restrict the prognostic value of Ag-NOR counting in the individual case.
Seizure control after surgery on cerebral arteriovenous malformations
Authors: Yeh Hwa-shain , Tew John M. , Gartner Maureen
Published: May 2009

✓ Prediction of seizure control after surgery on cerebral arteriovenous malformations (AVM's) is currently unavailable. Between 1982 and 1990, 54 patients (30 males, 24 females) with epilepsy caused by a supratentorial cerebral AVM, without prior manifestation of intracranial hemorrhage, were surgically treated. Patients ranged in age from 11 to 59 years at seizure onset and from 13 to 70 years at surgery; the duration of seizure history ranged from several months to 27 years. The AVM's were located in the temporal (17 cases), frontal (15), parietal (10), rolandic (two), and occipital (two) regions; eight were multilobular. All patients underwent preoperative electroencephalography, intraoperative electrocorticography, and total excision of the AVM; additional cortical excision was performed in 25 cases. Remote seizure foci were identified in the ipsilateral mesial temporal structure in 10 patients with AVM's located in the lateral or posterior temporal lobe and in one with an AVM in the anterior frontal region. Two patients required a second operation to remove a remote seizure focus. Among the 54 patients, there were no operative deaths. After surgical treatment, two patients developed hemiparesis, one had contralateral paresthesia of limbs, two suffered partial visual field defects, and five experienced temporary speech disturbances.

Postoperative results of seizure control during follow-up study (mean duration 4.8 years) were excellent in 38 patients (70.4%), good in 10 (18.5%), fair in five (9.3%), and poor in one (1.9%). Results appear to correlate with age at seizure onset, duration of seizures, location of lesions, and cortical excision. Excellent results were shown in 18 (60%) of 30 patients whose age at seizure onset was 30 years or less and in 20 (83.3%) of 24 whose age at seizure onset was greater than 30 years. Eighteen (90%) of 20 patients had excellent results when seizure duration was 1 year or less; only 25% of these underwent cortical excision. Twelve (71%) of the 17 temporal AVM's were associated with demonstrable epileptic foci. Secondary epileptogenesis can occur in humans with supratentorial cerebral AVM's; cortical excision in selected patients can improve the outcome of seizure control. Early surgery of a cerebral AVM in young patients presenting with epilepsy is an important consideration.
Complications of surgery for arteriovenous malformations of the brain
Authors: Morgan Michael K. , Johnston Ian H. , Hallinan John M. , Weber Neville C.
Published: May 2009

✓ A series of 112 patients undergoing complete surgical resection of arteriovenous malformations (AVM's) of the brain between 1974 and 1990 were analyzed for complications and 12-month outcomes. The cohort consisted of 44 patients with small AVM's (< 2 cm in diameter), 43 patients with medium-sized AVM's (2 to 4 cm in diameter), and 25 patients with large AVM's (> 4 cm in diameter). There was a 3.6% series mortality rate and an 18% morbidity rate. One of the four deaths was caused by normal perfusion pressure breakthrough. Analysis of logistic regression found that the most important factor influencing the occurrence of complications in this series was AVM size (p = 0.005) and that the occurrence of complications (p < 0.001) and the neurological grade at the time of surgery (p < 0.004) both significantly contributed to the outcome at 12 months.

This study stresses the importance of defining complications in terms of rigid criteria when analyzing AVM series in order to allow for a correct evaluation of the risk:benefit ratio of surgery. Furthermore, it emphasizes the need for a separate analysis of the importance of complications upon outcome.
The perioperative use of corticosteroids and bupivacaine in the management of lumbar disc disease
Authors: Glasser Ryan S. , Knego Robert S. , Delashaw Johnny B. , Fessler Richard G.
Published: May 2009

✓ The introduction of microdiscectomy to lumbar spine surgery has resulted in a significant decrease in postoperative pain and length of hospital stay. Intraoperative application of long-acting local anesthetic agents has been used for many general and neurosurgical procedures for the management of postoperative pain. In addition, many surgeons routinely use intraoperative corticosteroids during lumbar discectomy to reduce traumatic nerve root inflammation. However, the efficacy of intraoperative long-acting local anesthetic agents and corticosteroids for reduction of postoperative discomfort has not been reported for lumbar discectomy. This study evaluated 32 patients at a university-based Veterans Administration hospital undergoing lumbar microdiscectomy. All 32 patients presented with radicular symptoms and had radiographic confirmation of a herniated nucleus pulposus. These patients were divided into three groups. Group 1 (12 patients) received 160 mg intramuscular Depo-Medrol (methylprednisolone acetate) and 250 mg intravenous Solu-Medrol (methylprednisolone sodium succinate) at the start of the operation. A macerated fat graft soaked in 80 mg Depo-Medrol was placed over the affected nerve root following discectomy. In addition, 30 ml of 0.25% bupivacaine was infiltrated into the paraspinal musculature at skin incision and during closure. Group 2 (10 patients) received 30 ml of 0.25% bupivacaine infiltrated into the paraspinal musculature at skin incision and at closure. In this group of patients, a saline-soaked fat graft was placed over the affected nerve root. Group 3 (10 patients) acted as a control group, undergoing lumbar microdiscectomy without corticosteroids or bupivacaine. Patients receiving bupivacaine and corticosteroids (Group 1) had a statistically significantly shorter hospital stay (1.4 days) compared to the control group (4.0 days) (p = 0.0004, Mann-Whitney U-test). Patients in Group 1 required less postoperative narcotic analgesia than the other groups. Finally, a larger percentage of patients in Group 1 reported complete relief of back and radicular pain on postoperative Day 1 compared to other groups. Postoperative complications and functional outcome were not different between the groups. These results indicate that the combination of long-acting anesthetic agents and corticosteroids can reduce postoperative discomfort and subsequently the length of postoperative hospital stay.
Sclerosteosis: neurosurgical experience with 14 cases
Authors: du Plessis Jacques J.
Published: May 2009

✓ Fourteen cases of sclerosteosis seen during a 14-year period have been reviewed. Sclerosteosis is a craniotubular bone modeling disorder and presents with cranial nerve palsies and raised intracranial pressure; sudden death may occur without neurosurgical intervention. Experience gained from the management of these patients suggests that bifrontal decompressive craniotomy followed by a posterior fossa decompression should be performed in all cases, preferably in the second decade of life. Cerebrospinal fluid diversion procedures to reduce elevated intracranial pressure are unsatisfactory. Patients should be followed closely since the regrowth of bone may necessitate repeated decompressive procedures. Technical problems related to the surgical management are discussed.
Brain-stem glioma growth patterns
Authors: Epstein Fred J. , Farmer Jean-Pierre
Published: May 2009

✓ During the last decade, several authors have reported that certain brain-stem gliomas may be associated with a better prognosis than others. In this paper, retrospective correlations between the pathological findings and the magnetic resonance (MR) imaging appearance of 88 brain-stem gliomas are established. The authors propose an anatomical hypothesis that helps identify glioma growth patterns in general and that clarifies why cervicomedullary, dorsally exophytic, and focal tumors have a more favorable prognosis. According to this hypothesis, growth of benign gliomas of the brain stem is guided by secondary structures such as the pia, fiber tracts, and the ependyma, which in turn leads to stereotypical growth patterns that are clearly identified on MR images. The authors believe that this hypothesis, in conjunction with clinical data, may help establish selection criteria for the surgical treatment of specific brain-stem lesions.
Drilling the posterior wall of the petrous pyramid: a microneurosurgical anatomical study
Authors: Ammirati Mario , Ma Jianya , Cheatham Melvin L. , Maxwell David , Bloch Joseph , Becker Donald P.
Published: May 2009

✓ Posterior approaches to the petroclival area requiring extensive drilling of the posterior pyramidal wall have been described in the last 10 years. If hearing is to be preserved, damage to the inner-ear structures must be avoided; however, the fine points of this pyramidal drilling technique have never been reported in detail. A microneurosurgical anatomical study was undertaken in 15 cadavers to determine the relationships between bone landmarks and labyrinthine structures that could be used to give some practical drilling guidelines. Drilling of the posterior pyramidal wall is facilitated on identification of the intersection of the petrous ridge with the most anterior portion of the bone ledge covering the sigmoid sinus (petrosigmoid intersection), the bony operculum of the endolymphatic sac, and the petrous ridge. Drilling may proceed rather safely at a minimum depth of 2.5 mm in an area 0.9 cm anterior and 1 cm inferior to the petrosigmoid intersection and petrous ridge, respectively. From there, identification of the vestibular aqueduct, genu, and horizontal portion is necessary to safely open the posterior wall of the internal auditory canal. The vestibular aqueduct represents the lateral and superior limits of drilling. The bone between these areas may then be safely drilled to a depth of at least 2.5 mm. A microneurosurgical dissection of the posterior pyramidal wall conducted in cadaveric material according to these guidelines did not violate any inner-ear structures.
Inhibitory effect of trapidil on human meningioma cell proliferation via interruption of autocrine growth stimulation
Authors: Todo Tomoki , Adams Eric F. , Fahlbusch Rudolf
Published: May 2009

✓ In a previous study, the authors demonstrated that meningioma cells secrete platelet-derived growth factor (PDGF)-like molecules that stimulate their own growth in an autocrine manner. Based on that finding, a study was undertaken to examine the effect of trapidil, a drug known to have an antagonistic action against PDGF, on cell proliferation of human meningiomas in culture. Trapidil showed a dose-dependent inhibition of meningioma cell proliferation in the absence of any exogenous mitogenic stimulation. The maximum effect was observed at a concentration of 100 µg/ml, with the decrease in cell growth ranging from 16% to 54% compared to control samples. Trapidil similarly inhibited the basal deoxyribonucleic acid (DNA) synthesis assessed by [3H]-thymidine incorporation in three of seven meningiomas. While the conditioned medium generated from meningioma cells remarkably stimulated the proliferation of meningioma cells (166% to 277% of control), this effect was strikingly inhibited by the addition of trapidil. Trapidil also inhibited conditioned medium-stimulated DNA synthesis, even when there was no effect on basal DNA synthesis. Furthermore, trapidil significantly inhibited the epidermal growth factor (EGF)-stimulated proliferation of meningioma cells. This inhibitory effect on EGF-stimulated cell proliferation was also observed in nontumorous fibroblasts, demonstrating that trapidil is not an antagonist specific to PDGF. The addition of trapidil (30 µg/ml) in combination with bromocriptine (1 µM) showed an additive inhibitory effect on the meningioma cell growth compared to trapidil or bromocriptine alone. The overall results suggest that trapidil exhibits an inhibitory effect on meningioma cell proliferation through blocking the mitogenic stimulation induced by autocrine or exogenous growth factors, and may be considered as a possible new approach to the medical treatment of meningiomas.