bluuebunny/crossref_metadata_2025 huggingface dataset:
Technological Advances in Infant Formula Ingredients
Authors: Claro da Silva Roberta , Jannatul Ferdaus Md.
Published: July 2023

The best source of nutrients for babies is breast milk. However, the baby formula offers a crucial alternative to nursing when it is not practical or viable to meet the growing child’s nutritional needs. Bovine milk has traditionally been used as a primary component in baby formula production. It is then prepared with additional nutrients and bioactive substances to resemble the makeup of human breastmilk closely. Bovine-based baby formula is the most accessible type of formula, but it is not appropriate for all newborns; thus, alternatives, including those based on caprine milk, soy, and rice protein, are becoming more readily available. The composition of baby formula made from soy, rice, caprine milk, and cow’s milk is thoroughly examined in this chapter. In addition, we cover the literature that is currently available on nutrient bio-accessibility and features of protein functioning that are pertinent to baby formula.
The Influence of Climate Warming on the Hydrological Regime of Thermokarst Lakes in the Subarctic (Chukotka, Russia)
Authors: D. Tregubov Oleg , Ya. Konstantinov Pavel , V. Shamov Vladimir , K. Uyagansky Konstantin
Published: July 2023

Using remote methods and materials for meteorological observations, climate changes and the area of 36 thermokarst lakes located in the Anadyr lowland in Chukotka over a 65-year period were analyzed. More than 20 lakes were studied by field methods. With an increase in the average annual air temperature by 1.8°C and an increase in the amount of annual precipitation by 135 mm, the total area of the lakes mirror decreased by 24%. Cryogenic processes have had a significant impact on the decrease in the water quantity of lakes. Thermal erosion in drainage channels has led to multiple discharges of water in abnormally warm years. The heaving of permafrost in the coastal zone affected the reduction of the lake catchment area. If the trends of climate change continue, further drainage of large lakes and an increase in the number of small sag pond is expected in the next 25 years.
Subclinical Endometritis in Dairy Cattle
Authors: Rahim Ahmadi Mohammad
Published: July 2023

Subclinical Endometritis (SCE) is a postpartum uterine disease that is characterized by inflammation of the uterus without any apparent clinical signs. This condition, despite lacking overt symptoms, has a significant impact on reproductive performance by decreasing pregnancy rates following the first insemination and prolonging the median days open. Risk factors for metritis include the metabolic status of the cow during the prepartum period and issues occurring at or after parturition, such as dystocia (difficult calving) and retained placenta. Elevated concentrations of haptoglobin during the postpartum period have been associated with metritis, cytological endometritis, and purulent vaginal discharge. Subclinical endometritis is a major contributor to the repeat breeder syndrome of bovine subfertility. Treatment of endometritis can cause the production of biofilm in the uterus. Biofilms inherently possess resistance to antibiotics as well as to cellular and humoral immune defenses. Treatment of subclinical endometritis is usually performed as clinical endometritis. Antibiotic infusion is a routine treatment method in dairy farms. But the use of alternative treatments such as hypertonic dextrose and hyperimmune serum mayhelp to improve treatment results. Management of pre- and postpartum periods of dairy cows is the best method for the control of subclinical endometritis.
Determinan Kelelahan Mata pada Siswa SMA di Tangerang Selatan Tahun 2022
Authors: Sukmayanti Zanastia , Dela Aristi  , Raihana Nadra Alkaff
Published: July 2023

Kelelahan mata merupakan gangguan pada otot siliaris akibat penggunaan otot mata secara berlebihan. Siswa pada era globalisasi saat ini dituntut aktif menggunakan komputer/laptop dan ponsel layar sentuh demi memenuhi kebutuhan akademik dan non akademik. Namun, penggunaan komputer/laptop dan ponsel layar yang sentuh yang dinilai bermanfaat, menyebabkan siswa mengalami kelelahan mata. Kelelahan mata yang diabaikan akan berdampak pada penurunan fungsi penglihatan, penurunan produktivitas dan penurunan kecerdasan. Penelitian dilakukan di SMAN 8 Tangerang Selatan pada Februari—Juli 2022. Total responden 110 siswa yang dipilih menggunakan teknik simple random sampling. Pada penelitian ini diketahui 66 siswa dari 110 siswa mengalami kelelahan mata (60%). Variabel yang berhubungan pada penelitian ini adalah tidak menggunakan anti glare pada ponsel layar sentuh dengan kelelahan mata (p-value 0,044, OR 2,400 95% CI: 1,096-5,254). Variabel yang tidak berhubungan, tetapi ditemukan adanya risiko kelelahan mata dari hasil odds ratio (OR) yaitu, siswa perempuan, siswa yang tidak istirahat mata dan siswa yang memiliki durasi screen time yang buruk. Upaya yang dapat dilakukan untuk mengurangi kelelahan mata pada siswa yaitu, menggunakan anti glare pada ponsel layar sentuh, melakukan istirahat mata secara rutin setiap 10—30 menit sekali, tetap menggunakan kacamata refleksi dan kacamata anti radiasi saat menggunakan komputer/laptop dan ponsel layar sentuh.
Media, Ecology and Technology
Authors: Elango Elango
Published: July 2023

Today we are in the Hyperreal World in the Post Modern Era, bound to meet media, ecology and Technology. We need Mother Earth to have Ecological balance for Human and living organisms' Survival. To Every Individual to have a Holistic Life, we need eco-friendly Technology and an excellent environment to lead a pleasant, harmonious life. Ecology are the scientific study of the relationships between living organisms and their physical and biology environments. It encompasses the study of the distribution and abundance of living things, the interactions between organisms, and the relationships between organisms and their physical and chemical surroundings. The ecology perspective is a way of looking at the world that emphasizes the interconnectedness and interdependence of all living things and their environments. To have an Ecological Perspective, we need technological development and support to handle the issues and problems from a social perspective. This research study analyses the role of ecology, Technology and media and their interconnectedness in the holistic approach. The researcher conducted in-depth interviews with media specialists and Teachers in Environmental Studies and gathered valuable insights on media, ecology and Technology and their connectivity in bringing a holistic approach. Media and ecology today give a Hyperreal experience for the audience with the advancement in Technology. Media Creates a Hyperreal Environment in day-to-day life for the social well-being of humans and living organisms and awareness of environmental problems created. Environmental Activists use media platforms for their activist activities.
Effects Of Fan Activity And Views On Purchase Decision In The Genshin Impact Fanwork Market: a Literature Synthesis
Authors: Nathania Gabriella Callista Firsty , Aprilianty Fitri
Published: July 2023

Since the beginning of the industry, role-playing games (RPGs) have been among the most widely played game categories. As one of the worldwide top-grossing role-playing games in 2022, Genshin Impact is currently the 4th most popular game In Indonesia. With this popularity, many commercialized Genshin Impact fanworks circulated daily in the fan community, more popularly known as fandom. However, not all fanworks are accepted in the fandom and are considered "problematic works." Therefore, this research aims to know what factors support the purchase decision of Genshin Impact fanworks in Indonesia and the impact of negative factors of Genshin Impact fanworks on the purchase decision of Indonesian Genshin Impact fans. The findings of this study are expected to be of help to Genshin Impact fan workers in Indonesia.
Empathies” Rather than “Empathy” in The Clinical Context Of General Medicine: Acute Or Chronic Diseases, Physical Or Mental Health Problems and Types Of Doctor-Patient Relationships
Authors:   Specialist in Family and Community Medicine  Health Center Santa Maria de Benquerencia. Regional Health Service of Castilla la Mancha (SESCAM), Toledo, Spain
Published: July 2023

Empathy has been a widely discussed topic in practice, education, and research. Understanding and recognizing this concept is considered fundamental to medical practice. Thus, it has acquired the status of "ideal" in modern medicine. But, in reality it is a complex and heterogeneous phenomenon. Furthermore, the idealization of empathy has made it difficult to reach a consensus on a definition and the effects of its different components. Thus, it is important to reflect on several aspects: 1. Empathic tendencies can be "risky strengths." Excessive empathy can also be dangerous for the patient. A high level of empathy without a corresponding high level of assertiveness can harm the patient as the doctor forgets her / his professional tasks. Empathy and assertiveness are two axes of the same plane: a high level of empathy must be associated with a high level of assertiveness. There is a certain point where the doctor should no longer adjust to the patient; 2. Empathy must be conceptualized within a broader biopsychosocial approach that includes (in addition to assertiveness) other psychological phenomena that occur in the consultation, and that are interconnected, such as doctor-patient relationship, transference and countertransference and the placebo effect; 3. The empathy-assertiveness of the doctor depends on multiple conditions, some related to the doctor, others to the patient, as such or as people, others to the disease, others to the context. Thus, this empathy-assertiveness can be different in different pathologies, modes of doctor-patient relationship, and in acute disease or chronic disease; 4. Empathy must be rebalanced by a "doctor-centered empathy."
Anorexia and Amenorrhea: A Comprehensive Review of Their Relationship, Diagnosis, and Management
Authors:   Chairman Central Specialist Committee Royal College of Paediatrics &Child Health, Vice Chairman CESR Committee, Royal College of Paediatrics Ex-Chairman Regional Consultant Committee BMA, Recent Chairman Regional Council British Medical Association, Barnsley Foundation Hospital, United Kingdom.
Published: July 2023

Anorexia nervosa and amenorrhea are commonly associated conditions with complex interactions. This review aims to provide an in-depth understanding of the relationship between anorexia nervosa and amenorrhea, the diagnostic approach, and current management strategies. We will discuss the underlying physiological mechanisms, consequences of this association, and the importance of a multidisciplinary approach to treatment.
Why Is Every Cancer Only the “Tip” of The Iceberg?
Authors:   Infectious Diseases, General Practice, Nutrition, Acupuncture, and Pain Management Specialist. Medical Acupuncture and Pain Management Clinic, Franca, São Paulo, Brazil.
Published: July 2023

If we look at the oldest medical systems that we had in the past, we can see that they see cancer formation differently from what we are doing nowadays [1, 2]. According to some studies in Ayurvedic medicine, we can see that they understand that cancer comes when there is an imbalance between the doshas (Vata, Pitta, and Kapha), leading to imbalances between them that get out of control and forming in their final stage cancer [1].
Etika Sosial dalam Pandangan Islam dan Kristen (Studi Kasus Desa Baru, Kecamatan Batang Kuis, Kabupaten Deli Serdang
Authors: Irham Nazmul , Kamaluddin Kamaluddin , Fitriani Fitriani
Published: July 2023

This research is entitled Social Ethics in the View of Islam and Christianity (Case Study of Baru Village, Batang Kuis District, Deli Serdang District The purpose of this study is to find out social ethics in Islam and Christianity, to find out how social ethics is in the perspective of Muslim and Christian communities in Baru Village, and to add to the contribution of ideas for scientists in the field of Religious Studies, especially regarding social ethics in Islam and Christianity.In this study, the researcher used a qualitative method that is descriptive by seeking actual and detailed data and information.The research approach used by the researcher was the sociology of religion approach, while the theoretical approach the researcher used was the ethnic approach.The data source of this research are primary and secondary. The data collection technique is by observation, interviews and documentation. The results of this study are; that social ethics is an order that regulates a person's behavior related to association with the environment. This rule is related to the issue of decency, something that is permissible or not to do, as well as about what that person should do. Social ethics in the view of Islamic society says that; Social ethics is an order of individual behavior with society in interacting or socializing which functions to teach and guide people to good behavior and distance themselves from bad behavior. Meanwhile, the Christian view says that social ethics is the order of living together and how a person makes decisions and acts in everyday life, both personally and for others. which means that consciously everything stems from one's conscience, one must feel obliged to do good for the benefit of other human beings besides one's own interests, not personal interests in the sense of being selfish and harming others.
Pentingnya Mengembangkan Media Pembelajaran Berbasis Argumen Driven Inquiry (ADI)
Authors: Melinda Sarah , Fuadiyah Sa’diatul
Published: July 2023

21st century learning is required to always be able to adapt to the times and apply 4C abilities. But in fact, the learning process tends to be still teacher-centered, the learning media used are also still not varied and students have not used 4C abilities in learning. This causes students to be passive, monotonous, and bored. The innovation of learning media based on Argument Driven Inquiry (ADI) is expected to be able to increase students' 4C abilities and learning motivation. Viruses are material that is difficult for students to understand, because many foreign terms are used. The purpose of this study was to analyze the need to develop learning media based on Argument Driven Inquiry (ADI) on Virus material. The method used is descriptive research and literature study. Types of data collection from the results of observations of the distribution of questionnaires to students and teachers as well as the results of the Student Daily Assessment. Based on the results of observations made 100% of teachers agree in the development of biology learning media based on Argument Driven Inquiry (ADI). A total of  68% of students are happy to carry out discussion activities in biology learning and 61.11% of students are happy to investigate a problem in biology material. The development of ADI-based biology learning media is one of the alternative media in the learning process in the 21st century as teaching materials, practical and technological developments in accordance with the demands of the times. ADI-based learning media will increase students' ability to communicate, collaborate, and critical thinking.
Pemanfaatan Metode Pembelajaran Bahasa Inggris melalui Media Lagu-lagu untuk Siswa
Authors: Sukmawati Anis , Faruq Salsabila , Asy’ari Abu Musa
Published: July 2023

English is a language that the whole world has started to learn. Thus the language is also called an international language. In addition, this language has become one of the subjects taught to students in schools, institutions up to universities. Song media will motivate and increase students' learning interest in order to create a pleasant learning atmosphere so that students can understand the material easily. The purpose of this research is to improve English learning methods through song media. The results of this study are that learning English through songs can be a powerful means of improving students' memory and ability to speak English. Song media also influences students' pronunciation and listening skills. this can be proven by the ease with which songs are followed and remembered by students so that the language will stick with itself.
The ritualistic nuances of Efumbo: The Mystical Bukusu Drum
Authors: Barasa David , Mandillah Lucy , Anyonje Lydia , Matseshe James
Published: July 2023

Communities in Western Kenya have over time used drums and drumming for education, emotional expression, aesthetics, communication, symbolic validation, condemnation, information, therapeutic, and religious rituals, contributing to the continuity and stability of culture. However, critical aspects of traditions and rituals around the drums are likely to be lost due to a lack of sufficient documentation and the dwindling social institutions for which they were initially known (such as traditional circumcision ceremonies). This article investigated the ritualistic nuances associated with Efumbo ‘the mystical Bukusu drum’. The article argues that there is a rich cultural expression of the rituals of the Bukusu manifested through the drum tradition. As such, Efumbo in the Bukusu community is played in various functions such as circumcision, weddings, funerals, invoking spirits of barrenness, and prayer sessions when a spirit possesses one. The documentation of Efumbo and the traditions associated with it will improve and preserve the creative and cultural works of the drummers, drum makers, and allied.
Analysis of Budgets of Some Communities of the Martuni Province in 2019-2021
Authors: Barseghyan Lyudmila , Avagyan Roza , Harutyunyan Irena , Harutyunyan Susanna , Galstyan Gyulchora , Dolukhanyan Nelli
Published: July 2023

Key words: state budget, municipal budget, special income, own income, expenses, interest, implementation
This article presents the planned and actual budgets of some communities of Martuni province, as well as the subsidies allocated from the state budget. The pre-war/2020/ and post-war periods were studied, including those communities that remained occupied by the enemy after the war. The article includes the private incomes of the studied communities, which are important in the formation of budget incomes.
In 2019, the total revenues of the 35 municipal budgets of Martuni province amounted to 96.4% of the plan, of which the own revenues actually made up 98.2%, the planned provision was 144075.8 thousand drams, 134,500.0 thousand drams were financed from the state budget: the implementation is 93.4%. The expenses in the specified time-period were planned for 388411.2 thousand drams, as a result 354325.2 thousand drams or 91.2% were used.
In 2020, the total revenues of the budgets of the communities of Martuni province actually amounted to 69.8% compared to the plan. At the same time, the implemantation of own revenues was 42.9%. Allocations from the state budget made up 99.9%.
The expenses of the communal budgets actually amounted to 75.6% of the plan. It should be noted that the pandemic since the beginning of the year, the war in Karabakh on September 27 affected the formation and use of municipal budgets. In 2021, the income implementation of the budgets of 35 rural areas of Martuni province was actually 80.9%, of which only 66.4% compiled the own incomes. 95.2% of subsidized allocations were made. In 2021, out of the planned 410689.0 thousand drams, 343646.8 thousand drams were actually used for the expenses of the budgets of the communities of the Martuni province; the implementation was 83.7%.
Mathematical Logical Problems as a Means of Developing Creative Thinking
Authors: Nikoghosyan Gagik
Published: July 2023

Key words: prove, refute, parity, divisibility, invariant, spatial body, development, skill

It is known that one of the educational goals of the school course in mathematics is the formation and development of creative and logical thinking of students. Unfortunately, we have to state that in the development and implementation of new forms of training organization, sufficient attention is not paid to improving the content of training and, accordingly, to increasing efficiency. In the learning process, due attention is not paid to the formation and development of students’ intuition, analytical thinking, conjecture, the ability to draw reasonable conclusions, which is a serious obstacle to the development of their exploratory and creative thinking, scientific intuition.
In this work, the task is to identify the contributing role of the logical tasks of proof or refutation, regarding spatial bodies and their developments in the process of formation and development of exploratory skills, logical and creative thinking of students, which is the scientific pedagogical novelty of the work.
In particular, such logical problems of proof or refutation are considered, the solution of which is based on the method of using an invariant. In the first part of the article, the essence of the method of applying the invariant through the law of elimination of the middle is stated, then the problems of proof or refutation based on the principle of gradual complication are discussed, in the solution of which the invariant is directly applied. The second part of the work is devoted to logical problems related to spatial bodies. We consider logical tasks based on the principle of gradual complication, associated with spatial bodies and their sweeps, with the aim of developing the spatial and creative thinking of students through the latter.
The evolving treatment landscape of higher-risk MDS
Authors: Elemary Mohamed
Published: July 2023

Myelodysplastic neoplasms (MDS) are a group of clonal hematopoietic stem cell disorders characterized by ineffective hematopoiesis, cytopenia, and morphologic dysplasia. Most cases of MDS are de novo, and a minority are post cytotoxic therapy About 30% of the cases will eventually progress to acute myeloid leukemia (AML), with a higher incidence among the higher-risk MDS group. MDS is a rare disorder with an overall incidence of 3.7-4.8/100,000; the rate increases with age.
Reliability-based evaluation of seismic design and numerical studies of Self-centering moment resisting steel frames
Authors: Sukaj Silvana , Abiuso Pierluigi , Paterna Paola , Abruzzese Donato
Published: July 2023

Recently developed self – centering moment resisting steel frames have been analytically and experimentally validated as having the potential to eliminate structural damage under a design basis earthquake and return to their original vertical position following a major earthquake. The objective of this research is to develop an understanding of behavior and performance of steel Self Centering – Moment Resisting Frame (SC – MRF) systems. This study examines the response numerically simulated of a 3, 8, and 19 story SC-MRF subject to dynamic time – domain analysis, using a database of different terms, as for instance the recorded earthquake of El Centro 1940, one of the most powerful recorded in history. Peak structural demand responses such as story drift and beam-column relative rotation has been evaluated. This data is used to examine the sensitivity of the SC – MRF behavior to structural properties and geometry. The results could be used to develop a reliability-based seismic design procedure for these SCMRF connection details.
Reviewing the role of dietary lipids in coronary heart disease
Authors: DHAMO Klodiola , SHKRELI Rezarta , BALLATA Amilda
Published: July 2023

It has been shown that coronary heart disease (CHD) is related to high serum total cholesterol (TC) levels. In all the urban population compared with the rural population is showed a rise of serum TC. This is reflected in the trend of CHD morbidity and mortality as well. In spite of a declining trend in serum TC level, CHD morbidity and mortality are still high year after year. In general, there is still a rising trend in serum TC level and in CHD mortality in many countries. However it may be controlled and managed. This may be attributed to a better control of other CHD risk factors such as hypertension and smoking. More than a century of laboratory and human findings cholesterol levels with a propensity to develop atherosclerosis. Low-density lipoprotein (LDL) is the major atherogenic lipoprotein, and numerous clinical trials have shown the efficacy of lowering LDL-cholesterol (LDL-C) for reducing CHD 127 risk. The rising trend in serum TC level remains a cause for concern, as this will emerge as a major problem for CHD morbidity and mortality in the future.
Vivências de universitárias com deficiência em tempos de ensino remoto em decorrência da COVID-19
Authors: Silva Samara Louise da Cunha , Ferreira Raíssa Matos , Fumes Neiza de Lourdes Frederico
Published: July 2023

Esta pesquisa versa sobre as vivências de universitárias com deficiência em relação ao ensino remoto. Teve como objetivo analisar as vivências de universitárias com deficiência de uma universidade da Região Nordeste brasileira acerca do ensino remoto implementado em decorrência da pandemia da COVID-19, além de apreender as diferentes mediações desse processo, respaldando-se nos pressupostos da Psicologia Sócio-Histórica. Trata-se de um estudo quali-quantitativo. Para tanto, 12 universitárias com deficiência responderam a um questionário on-line, cujos dados foram analisados por meio da análise de conteúdo temática, e interpretados a partir do referencial teórico-metodológico adotado neste estudo. Os resultados apontaram para a falta de assistência e de acompanhamento especializado provenientes da gestão da universidade e do Núcleo de Acessibilidade (NAC), além de mostrarem as barreiras enfrentadas no acesso à tecnologia, aulas on-line, recursos e materiais acessíveis. Como conclusão, constatou-se que a pandemia da COVID-19 impactou na formação profissional das universitárias, agravando as desigualdades existentes e provocando ainda mais invisibilidade das mulheres com deficiência.
Desenvolvimento de Audiogames acessíveis às pessoas com deficiência visual: uma revisão sistemática da literatura
Authors: Piloti Jason Scalco Scalco , Silva Régio Pierre da , Silva Tânia Luisa Koltermann da
Published: July 2023

Frente aos avanços na área dos jogos digitais, os audiogames, conhecidos por utilizarem o áudio como principal interface com o jogador, têm ganhado notoriedade não só por pessoas com deficiência visual, mas também pelo público em geral. Este nicho de mercado tem-se mostrado promissor diante ao cenário atual de desenvolvimento de jogos digitais tradicionais. Deste modo, este trabalho buscou analisar com maior profundidade, por meio de uma revisão sistemática da literatura, técnicas, modelos, métodos e/ou diretrizes que contribuíssem no processo de design e desenvolvimento de jogos digitais às pessoas com deficiência visual. Com base no método adaptado da Design Science Research e o PRISMA, esta revisão sistemática elegeu a partir de 4 bases de dados, um portfólio de 12 artigos em língua inglesa diretamente relacionados ao tema. Os relatos levantados demonstraram a concentração de estudos por grupos de pesquisa, com foco na área de jogos digitais acessíveis, especificamente o tipo abordado por essa revisão: “audiogames”. Por fim, esta revisão permitiu, além das contribuições para o referencial teórico deste trabalho, a compilação de 8 considerações de design e desenvolvimento com recorrência entre os autores investigados, um levantamento de técnicas de navegação e modelos de mecânicas utilizados em jogos digitais acessíveis.
Ajustamento entre educação e trabalho: análise para os graduados da UAB/UFSM
Authors: Ribeiro Victor Matheus Portela , Bender Filho Reisoli
Published: July 2023

Neste estudo, são analisados os determinantes do ajuste entre educação e trabalho entre os graduados da Universidade Aberta do Brasil, na Universidade Federal de Santa Maria. Metodologicamente, foram aplicadas análise descritiva, análise fatorial e regressão logística. A maior parte dos egressos estão desempenhando atividades relacionadas ao seu estudo, com 84,6% em ajuste horizontal, 81,9% em ajuste vertical e 74,5% em ajuste total. As características do trabalho que influenciaram, tanto o ajuste vertical, quanto o horizontal, foram o tipo de empregador, o setor econômico do emprego e o grupo de ocupação. Para o ajuste horizontal, o principal impacto foi estar empregado na ocupação de professor, já para os ajustes vertical e total, o setor econômico do emprego foi principal determinante.
Aneurismas intracraneanos. Nuestra experiencia en 53 casos operados en 3 años
Authors: Mendiondo Ignacio , Mendiondo Eulogio
Published: July 2023

Se realizó una revisión clínico-quirúrgica de 53 casos operados por aneurismas intracraneales entre enero de 1997 y diciembre de 1999.Objetivos: analizar las relaciones entre la gradación de Hunt-Hess, la escala de Fisher tornográfica, la incidencia de vasoespasmo , la estrategia y la técnica quirúrgica como factores relevantes en la evolución.Material y métodos: nuestros 53 pacientes se distribuyeron de la siguiente manera:- Score de Hunt-Hess : grado O: un paciente ; grado I : 17 pacientes ; grado II: 25 pacientes; grado III: 8 pacientes; grado IV ninguno, y grado V :un paciente.- Escala de Fisher: grado I: 3 casos ; grado II: 28 casos, grado III : 11 casos y grado IV: 11 casos.- Vasoespasmo clínico y / o angiográfico : en 17 pacientes.- Estrategia quirúrgica: cirugía precoz en 25 casos.Resultados: la mortalidad en los casos con Hunt-Hess grados 1 y 2 fue del 2,7%, en 33 pacientes se constató una muy buena evolución y en 8 casos una buena evolución. La mortalidad fue del 50 % en los grados 3 a 5.Conclusión: se observó evolución favorable en los pacientes intervenidos con Hunt­Hess 1 y 2, en comparación con aquellos en grados 3 a 5. Se evidencia como elemento singular relevante en el pronóstico el nivel de conciencia prequirúrgico con respecto a las demás variables.
“Técnica 2 en 2 pasos” para cateterización oftálmica en quimio infusión intra-arterial superselectiva de retinoblastoma. 11 años de experiencia en argentina.
Authors: Navarro Fernando , Villasante Francisco , Ceciliano Alejandro , Pereira Mariano , Fandiño Adriana , Chantada Guillermo
Published: July 2023

Objetivo:

Descripción de una técnica original para el tratamiento de retinoblastoma ocular avanzado.Materiales y método:

820 sesiones de quimioinfusión intra arterial superselectiva en 176 pacientes pediátricos fueron analizadas. Describimos la técnica 2 en 2 pasos para cateterización oftálmica, su utilidad, seguridad y eficacia principalmente para primeras sesiones de quimiocirugía.Resultados:

La primer quimioinfusión de Argentina fue en junio 2010 y hasta junio 2021 fueron realizadas 820 sesiones (4.6 sesiones por paciente). En todos los casos la arteria oftálmica pudo ser cateterizada (535 directamente y 285 por arteria meníngea media) con una opacificación coroidea aceptable. Se utilizó un abordaje femoral 3 F en 83% de los casos (pacientes <15 meses), microcatéter Marathon® 1.5 y Magic® 1.5 y 1.2 en el 78%. Tiempo de fluoroscopía en primera sesión entre 0:41 y 4:13 min en tumores unilaterales, 1:12 y 7:34 en bilaterales. No se observaron complicaciones relacionadas con la técnica.Conclusión:

Es una técnica simple, segura y con excelentes resultados. Permite la posibilidad de realizar quimiocirugía en pacientes pediátricos con poca instrumentación y sin la necesidad de utilizar acceso 4 F, catéteres guía ni microbalones.
¿Cómo entrenar para el uso del exoscopio? Utilización de un novedoso simulador de exoscopía de bajo costo por residentes de neurocirugía
Authors: Ezequiel Yasuda  , Federico Minghinelli  , Daniela Renedo  , Pablo Devoto  , Lucas Pina  , Ana Lovaglio
Published: July 2023

Introducción: Analizar el impacto del entrenamiento en una estación de simulación en exoscopía (ESA) de bajo costo, utilizado por un grupo de residentes de neurocirugía.Materiales y métodos: Se reclutaron 6 residentes de neurocirugía, todos ellos sin experiencia previa en exoscopía. Se desarrolló una estación de simulación en exoscopía compuesta por una computadora, una webcam y una fuente de luz. Todos los participantes realizaron un tutorial introductorio, un ejercicio inicial de 5 suturas (cada sutura fue clasificada en forma binaria como correcta e incorrecta), evaluando el tiempo necesario para completar dicho ejercicio y la eficacia (definida como la relación entre suturas correctas y el total). Posteriormente se realizaron 3 sesiones de entrenamiento semanal de 1 hora cada una y una evaluación final con las mismas características que la inicial. Ambas evaluaciones fueron estudiadas por un neurocirujano senior que realizó un análisis, así como la puntuación de cada ejercicio de los participantes.Resultados: El tiempo promedio de realización del ejercicio inicial fue de 31 minutos con 59 segundos, con una eficacia promedio del 70%. Luego del entrenamiento el promedio de tiempo fue 18 minutos y 12 segundos, con una eficacia del 80%.Conclusión: El entrenamiento en este simulador demostró una notable mejoría en los tiempos y la calidad de la técnica exoscópica si se compara el principio del entrenamiento con su final. Por los beneficios obtenidos y su bajo costo creemos que será útil su implementación para acercar dicha técnica a todos los neurocirujanos que se encuentren interesados en ella.
Neurocitoma central: a propósito de un caso
Authors: Wellerson Sabat Rodrigues  , Matias Baldoncini  , Santiago Giusta  , Maria V. Montero  , Maximiliano Zarco  , Luciana Perren  , Agustin Conde
Published: July 2023

Introducción: El neurocitoma central fue descripto por primera vez en 1982 por Hassoun et al. Se trata de una neoplasia rara, bien diferenciada del sistema nervioso central de origen neuroectodermico, ubicado más comúnmente a nivel del sistema ventricular, típicamente adyacente al foramen de Monro. Cursa generalmente con síntomas de hipertensión intracraneal secundaria a hidrocefalia no comunicante. Afecta generalmente a adultos jóvenes, con edad de presentación media de 29 años en las mayores series descriptas.Objetivos: Describir y presentar un caso de tumor cerebral específico, cuya importancia se da debido a su baja prevalencia y escasa casuística relatada en la literatura.Descripción del caso: En el presente artículo describimos un caso de una paciente de 35 años diagnosticada incidentalmente con una lesión ocupante de espacio a nivel del ventrículo lateral izquierdo redondeada, heterogénea, de bordes netos con dimensiones de 40x30x30 mm. La paciente fue intervenida quirúrgicamente para su resección. Se realizó abordaje interhemisférico transcalloso homolateral. Sin intercurrencias post-quirúrgicas fue dada de alta 4 días luego de la cirugía. El informe anatomo-patológico demostró tratarse de un Neurocitoma Central. Se comparó nuestro caso con lo descripto en la literatura.Conclusión: El neurocitoma central a pesar de no ser una patología prevalente, debe ser conocido en profundidad por los neurocirujanos, ya que su correcto manejo afecta directamente al pronóstico de los pacientes.
Craneofaringiomas: cirugía transnasal via endoscópica
Authors: Ajler Pablo , Castro Barros Fabian , Massa Daniela
Published: July 2023

Introducción: Debido a su ubicación anatómica, los craneofaringiomas son tumores complejos en su tratamiento. Una resección completa tiene riesgos elevados de morbimortalidad y si se opta por una resección parcial la tasa de recurrencia es alta. Según su extensión supraselar y su relación con el tallo hipofisario, pueden dividirse en preinfundibulares, transinfundibulares y retroinfundibulares. Objetivo: El objetivo de este video es describir la técnica vía endoscópica para la resección de un craneofaringioma preinfundibular.Materiales y Métodos: Se seleccionó un caso de un paciente con un craneofaringioma preinfundibular operado en el Servicio de Neurocirugía del Hospital Italiano de Buenos Aires, por vía endoscópica transnasal.Resultados: Se realizó una exéresis completa de la masa tumoral, sin evidenciar complicaciones tales como, diabetes insípida o fistula de líquido cefalorraquídeo y con recuperación completa del déficit campimétrico. Conclusión: El tratamiento quirúrgico de los craneofaringiomas requiere un conocimiento detallado de la anatomía de base de cráneo así como de las diferentes técnicas quirurgicas. El uso de la endoscopia ha permitido un mejor acceso a éste tipo de lesiones, disminuyendo las comorbilidades en el paciente y la estadía hospitalaria. Un resultado quirúrgico satisfactorio se obtiene con la resección completa y la menor morbilidad posible para el paciente.
Metástasis sintomáticas en cerebro superiores a 8.5 cm3 manejados con radiocirugía
Authors: Lovo Eduardo , Campos Fidel , Caceros Víctor , Minervini Mario , Reyes William
Published: July 2023

Introducción: Las recomendaciones en el manejo de metástasis superiores a 2 cm especialmente las sintomáticas sugieren cirugía como primera opción. En el presente artículo se discute el papel de radiocirugía como primer manejo de estos pacientes.Material y método: Se evaluaron 37 pacientes sintomáticos con lesiones metastásicas superiores a 8.5 cc tratados con radiocirugía entre el 2011 y el 2018.Resultados: La media de volumen fue de 12.5 cc (8.5-78.4), 9 (24%) pacientes fueron tratados utilizando LINAC, el volumen medio fue de 20 cc (9.2-70 cc). Los tratamientos con Gamma-Ray fueron administrados a 28 (76%) pacientes, 9 (32%) de ellos en protocolo de radiocirugía adaptativa, la dosis para todo el grupo fue de 13.8 Gy (7.5-18 Gy), con dosis media de 17.9 Gy, el volumen medio fue de 16.3 cc (8.5-78.4 cc) para gamma. El Karnofsky al inicio era de 60 (50-70) y de 80 (60-100) a los 30 días (P=0.0001). A los 30 días, 95% de las lesiones habían reducido su tamaño en un 74% (11-95%). La sobrevida media de la serie fue de 19 meses (4-34), el riesgo acumulado de muerte del SNC fue de 5.4%.Conclusiones: Radiocirugía en nuestra experiencia ha mostrado ser eficaz en el control de metástasis a cerebro de gran tamaño, reduciendo la necesidad de cirugía.
Abordaje retrosigmoideo para clipaje de aneurisma distal de la AICA
Authors: Espinosa Mora José Alfredo , Becerra Escobedo Guillermo , Barrios Garcia Sergio , Ramirez Aguilar Ricardo , Ordoñez Granja Jaime , Castillo Rangel Carlos
Published: July 2023

Introducción: Los aneurismas cerebrales de la circulación posterior, representan solo del 8 al 10 % del total de los aneurismas cerebrales, y de estos los de la arteria cerebelosa anteroinferior (AICA) son muy poco frecuentes, por lo que no hay algoritmo de manejo para estas lesiones, se requieren conocimientos anatómicos de vascular y de base de cráneo para el tratamiento de estos, hablando del abordaje quirúrgico, podemos mencionar, el extremo lateral, retrosigmoideo, orbitozigomatico y presigmoideo, que depende del tamaño y localización del aneurisma, ya sea distal o proximal. Presentamos este caso, que tratamos mediante un abordaje retrosigmoideo convencional, el cual nos ofreció un corredor quirúrgico suficiente, sin necesidad de un abordaje mas amplio, en este caso fue un aneurisma distal de la AICA, localizado en el segmento meatal, que se encontró en el complejo neurovascular medio del ángulo pontocerebeloso, muy próximo a los nervios craneales V, VII y VIII.Objetivos: Demostrar que los aneurismas distales de la AICA se pueden manejar mediante un abordaje retrosigmodeo convencional con éxito.Materiales y métodos: El paciente se colocó en posición park bench, bajo fijación esquelética de 3 puntos, con el asterion como punto mas elevado. Se realizo una incisión en forma de C en la mastoides y se realizo un abordaje dirigido hacia el ángulo pontocerebeloso.Resultados: Se logró realizar el clipaje del aneurisma de forma satisfactoria, con un buen resultado clínico del paciente, quien fue egresada a los 4 días sin déficit neurológico.Conclusión: El abordaje retrosigmoideo es una opción terapéutica para el manejo de los aneurismas ubicados en el ángulo pontocerebeloso, específicamente del AICA distal y también se puede usar incluso para los aneurismas distales del PICA.
Craneoplastías post-TEC en un único centro del Noroeste Argentino. Comparación de dos materiales
Authors: Reyes Cano Rocio , Agüero Juan José , Tapicha Angela M. , Villalonga Juan F. , Campero Alvaro
Published: July 2023

Introducción: Diversos estudios demuestran que la tasa de complicaciones asociadas a craneoplastías ha sido subestimada. A mediados de 2016 advertimos una serie de complicaciones asociadas a este procedimiento en nuestro Hospital. Por esto, se decidió cambiar el material que se utilizaba hasta entonces (i.e. polimetilmetracrilato de metilo, PMMAM) por otro distinto (i.e. Titanio). El objetivo del presente trabajo es analizar los resultados post-operatorios obtenidos con PMMAM versus Titanio.Materiales y Métodos: Estudio retrospectivo que incluye a 99 pacientes a los que se les realizó una craneoplastia en nuestro Hospital desde octubre de 2015 a octubre de 2018. Criterios de inclusión: defecto óseo causado tras una craniectomía post-TEC cerrado, sin signos infecciosos, operados en la misma sala operatoria, por el mismo quirúrgico y utilizando la misma técnica para cada material. Para el análisis estadístico se dividió a la muestra en 2 grupos: PMMAM (n= 44) versus Titanio (n=55).Resultados: El 85% (n=86) eran de sexo masculino y la edad promedio fue 29 años (rango: 17-63 años). Se observó una diferencia estadísticamente significativa respecto a los pacientes que desarrollaron determinadas complicaciones entre el grupo PMMAM y el grupo Titanio: colección líquida inflamatoria epidural (14% vs 0%; p=0,006); infección del sitio quirurgico (9% vs 0%; p=0,036) y remoción quirúrgica de la plaqueta (16% vs 0%; p=0,003).Conclusión: Con el uso de malla de titanio se disminuyeron significativamente las complicaciones post-operatorias, respecto al uso de PMMAM.
Una revisión sistemática de la terapia endovascular en pacientes con accidente cerebrovascular isquémico
Authors: Florez Perdomo MD William A. , Duran MD Miguel A. , Laiseca MD Edgar F. , Quesada Mario F.
Published: July 2023

Objetivo: Revisar sistemáticamente la evidencia de la terapia endovascular comparado con el manejo estándar.Criterios de inclusión: Ensayos clínicos aleatorizados que incluyan a: pacientes adultos mayores de 18 años, haber sufrido accidente cerebrovascular isquémico manejados con terapia endovascular en comparación con manejo médico.Métodos: Se realizó la búsqueda en las siguientes bases de datos: MEDLINE, the Central Register of Controlled Trials (CENTRAL); PubMed, HINARI, EMBASE; Cochrane Injuries group y lista de referencia de los artículos.Resultados: La trombectomía se asoció con disminución de la mortalidad (OR 0,78, IC del 95%: 0,63-0,95 p= 0,01), aumento de la tasa de revascularización (OR 6,16, IC del 95%: 4,39-8,64 p= <0,0001), mejoría de desenlace funcional (OR 1,78, IC del 95%: 1,52 – 2,08 p= <0,0001). No hubo diferencia en cuanto a la recurrencia de isquemia cerebral ni de la aparición de hemorragia intracerebral (OR 0,86, IC del 95%: 0,51 – 1,47 p= 0,59; OR 1,13, IC del 95%: 0,79 – 1,62 p= 0,5, respectivamente).Conclusiones: La terapia endovascular comparada con la fibrinólisis endovenosa mejora el pronóstico funcional, aunque se necesitan más estudios.
Manejo preoperatorio de los adenomas hipofisarios. Lo que un residente de neurocirugía debe conocer
Authors: Bourilhon Facundo , Villalonga Juan F. , Martínez Font Agustín , Pailler José I. , Romano Adán A. , Campero Álvaro
Published: July 2023

Las lesiones selares son una patología con una incidencia de 3,2 a 4 / 100,000 y una prevalencia de 78 a 94 / 100,000. Un 10% son incidentalomas en la población adulta. Se cree que su prevalencia en el orden mundial actualmente va en aumento.En relación a las manifestaciones clínicas, cabe destacar que es una de las pocas enfermedades que pueden manifestarse tanto por signos y síntomas neurológicos (por ejemplo: hemianopsia bitemporal, síndrome de hipertensión endocraneana debido a hidrocefalia, entre otros), como también por síndromes endocrinológicos (por ejemplo: síndrome de Cushing, acromegalia, amenorrea-galactorrea, infertilidad).Todo paciente debe presentar un estudio clínico-radiológico completo, lo que permitirá un correcto diagnóstico y categorización del mismo.El objetivo del presente trabajo es proporcionar al neurocirujano en formación los conceptos claves que servirán de sustento para el manejo preoperatorio de un paciente con adenoma hipofisario.
Aneurismas no rotos. Consideraciones sobre su manejo
Authors: Spagnuolo Edgardo , Jaume Alejandra
Published: July 2023

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Entrevista Dr. Casasco
Authors: Casasco
Published: July 2023

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“Este caso me desorientó…”
Authors: Martinez Silvina A , Montilla Florencia , Álvarez Caicedo Diana , Costa Carla , Casco Alejandro , Feldman Santiago
Published: July 2023

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“Qué hay de nuevo…” “Osseous Remodeling Technique of the Sella Turcica: A New Surgical Option for Primary Empty Sella Syndrome”
Authors: Guinto Gerardo , Nettel Barbara , Hernández Eli , Gallardo David , Aréchiga Norma , Mercado Moisés
Published: July 2023

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Inusual caso de migración de un catéter atrial a las arterias pulmonares
Authors: Villamil Facundo
Published: July 2023

La migración cardíaca del catéter distal del Shunt Ventrículo Atrial es una complicación poco frecuente y potencialmente grave. Se presenta el caso de un paciente femenino con antecedente de enfermedad de Dandy-Walker válvula dependiente, con 3 recambios valvulares previos, que se presentó con un cuadro de ascitis de LCR con peritonitis. Su cuadro fue resuelto mediante la colocación de Shunt Ventrículo Atrial. 6 meses más tarde se presentó con cuadro de Hidrocefalia aguda. La TC de cerebro y la radioscopía muestran ausencia de catéter atrial y migración a las arterias pulmonares. El segmento migrado fue enlazado y rescatado mediante un abordaje endovascular endovenoso transfemoral. Una vez retirado el catéter migrado se recolocó el catéter distal al atrio y los síntomas de hidrocefalia cesaron. Se discuten el manejo de esta complicación inusual y su manejo interdisciplinario.
Clipado Microquirúrgico de Aneurismas del Segmento A1: Anatomía y estrategias quirúrgicas
Authors: Baldoncini Matias
Published: July 2023

Introducción:Los aneurismas originados del segmento proximal de la arteria cerebral anterior, son extremadamente infrecuentes. El objetivo del siguiente trabajo es el análisis de la anatomía de la arteria cerebral anterior en su segmento A1, describiendo las estrategias quirúrgicas en dos pacientes.

Material y Métodos:En una cabeza adulta formolizada se realize un abordaje pterional derecho y disección del valle silviano, exponiendo las principales estructuras vasculares. Se presentan además dos pacientes jovenes operados de aneurismas en la arteria cerebral anterior, segmento A1.

Resultados:En el trabajo anatómico de laboratorio se lograron exponer las estructuras vasculares, detallando especialmente el segmento A1 de la arteria cerebral anterior y sus ramos colaterales. En ambos pacientes se logró el correcto clipado microquirurgico, con oclusión completa del aneurisma y buenos resultados postoperatorios.

Discusión:Algunas de las características de estos aneurismas que los diferencian del resto son las arterias perforantes que los rodean, el riesgo de ruptura en tamaños pequeños, las variantes y anomalias vasculares entre otras. Dependiendo la proyección del aneurisma y la relación de este con las arterias lenticuloestriadas, se debe elegir la mejor trayectoria para el clipado entre los ángulos vasculares de la zona.

Conclusiones:La localización anatómica preoperatoria adecuada y la planificación quirúrgica son la clave para el manejo exitoso de esta patología.
Meningioma incidental de base de cráneo en mi consultorio
Authors: Mural Miguel , Feldman Santiago
Published: July 2023

Los meningiomas son los tumores benignos intracraneanos de mayor incidencia. Se originan en cualquier lugar donde hallemos células aracnoideas, por lo que pueden ser clasificados según su localización. Los síntomas van a estar determinados por el efecto de masa a las estructuras subyacentes y, en el caso de los de base de cráneo, debemos prestar atención a los síntomas de pares craneanos que pueden pasar inadvertidos según el nivel de alarma de cada paciente. En este artículo nos enfocaremos en analizar la conducta terapéutica de los meningiomas incidentales originados en la base del cráneo.