bluuebunny/crossref_metadata_2025 huggingface dataset:
PENGARUH IKLIM ORGANISASI TERHADAP MOTIVASI KERJA PEGAWAI PADA PT. BANK MANDIRI KC LAPANGAN IMAM BONJOL PADANG
Authors: Wahyudi Hendra , Dewi Aminar Sutra
Published: April 2019

The purpose of this study was to analyze the influence of organization climate on employee motivation of Bank Mandiri KC Lapangan Imam Bonjol Padang. The sampling technique used is propotionate cluster random sampling, while the number of samples used for the analysis is 60 respondents. The data analysis technique used to test the hypothesis is simple linear regression. In research there is one variable, is organizational climate. Organizational climate significant influence on employee motivation of Bank Mandiri KC Lapangan Imam Bonjol Padang. While the value of correlation coefficient obtained in this study amounted is 49.2% These results show that, of employee motivation in Bank Mandiri KC Lapangan Imam Bonjol Padang, this shows that there is a very strong relationship between organization climate on on employee motivation of Bank Mandiri KC Lapangan Imam Bonjol Padang. While the remaining 50,8% thought to be explained by other factors not examined in this study, such as leadership, organizational culture, orgnization commitment, and discipline. Based on the findings of a simple linear regression, it was found that the organizational climate as well as the positive influence on employee motivation of Bank Mandiri KC Lapangan Imam Bonjol Padang. This study provides practical recommendations for the management of Bank Mandiri KC Lapangan Imam Bonjol Padang to continue to improve organizational climate, because organizational climate have a significant impact on employee motivation of Bank Mandiri KC Lapangan Imam Bonjol Padang.
Permasalahan Pendapatan Asli Daerah (PAD)
Authors: Aldiansyah Nur Fajri
Published: April 2019

Pendapatan asli daerah merupakan salah satu faktor yang penting dalam pelaksanaan roda pemerintahan suatu daerah yang berdasar pada prinsip otonomi yang nyata, luas dan bertanggung jawab. Peranan pendapatan asli daerah dalam keuangan daerah menjadi salah satu tolak ukur penting dalam pelaksanaan otonomi daerah dalam arti semakin besar suatu daerah memperoleh dan menghimpun Pendapatan Asli Daerah (PAD), maka akan semakin besar pula tersedia jumlah keuangan daerah yang dapat digunakan untuk membiayai penyelenggarakan otonomi daerah.
Permasalahan Pendapatan Asli Daerah (PAD)
Authors: Zakiah Firdha
Published: April 2019

Pendapatan asli daerah merupakan salah satu faktor yang penting dalam pelaksanaan roda pemerintahan suatu daerah yang berdasar pada prinsip otonomi yang nyata, luas dan bertanggung jawab. Peranan pendapatan asli daerah dalam keuangan daerah menjadi salah satu tolak ukur penting dalam pelaksanaan otonomi daerah dalam arti semakin besar suatu daerah memperoleh dan menghimpun Pendapatan Asli Daerah (PAD), maka akan semakin besar pula tersedia jumlah keuangan daerah yang dapat digunakan untuk membiayai penyelenggarakan otonomi daerah.
PENGARUH RELATIONSHIP QUALITY TERHADAP LOYALITAS NASABAH TABUNGAN SIKOCI PADA BANK NAGARI CABANG SOLOK
Authors: Yanti Beni Eka , Dewi Aminar Sutra
Published: April 2019

The purpose of this study was to determine and analyze the influence relationship quality that consists of trust, satisfaction, perception, communication, and social cohesion on customer loyalty Savings Sikoci at Bank Nagari Branch Solok. Type of research is quantitative research. The sample size used was 100 customers Sikoci Savings in Bank Nagari Branch Solok. Data analysis technique used is in the form of research instrument test the validity and reliability test, descriptive analysis, the classical assumption test, multiple linear regression analysis, F test, t test and coefficient of determination. Research conducted generating trust, satisfaction, perception, communication, and social cohesion significant effect on customer loyalty Savings Sikoci at Bank Nagari Branch Solok because t value trust (2,006), satisfaction (2.254), perception (2,308), communications (2,056), and social cohesion (2.030) > t table 1.984. The amount of influence relationship quality variable that consists of trust, satisfaction, perception, communication, and social cohesion describes customer loyalty Savings Sikoci at Bank Nagari Branch Solok was 51.1% and 48.9% explained by other variables such as quality of service, and marketing mix, etc
Theoretical study of the potential energy surface of N-formyl-L-cysteine-amide by using a genetic algorithm multi niche crowding
Authors: Int Chem , Bourjila Malika
Published: April 2019

The generation of molecular structures constituting the conformational space of trans-N-For-L-Cys-NH2 was accomplished using the genetic algorithm MNC coupled to the semi-empirical AM1 method, AM1/GA-MNC. The structural and energy analysis of the obtained conformational space E=E(,ψ) locates 7 regions or minima ɣL, ɣD, L, D, L, ɛD and ɛL. The combination of these folds to structuring modes adopted by the side chain CH2-SH has allowed us to identify 27 stable geometric structures. The regions corresponding to helical folds αD and αL are not favorable for the system that is the subject of current study.
Leachates and physicochemical characteristics of Rumuodumaya dumpsites, Niger-Delta, Nigeria
Authors: Int Chem , Iwuoha Godson Ndubuisi
Published: April 2019

The physicochemical characteristics and heavy metal levels of leachates at the Rumuodumaya dumpsites and the surface water of its adjacent river was investigated by appropriate field instrument for in situ measurement, standard procedures and AGILENT 55B spectra for the heavy metals. The results from the dumpsites and surface water of the river generally indicate that as of the time of analysis, there is no serious threat to its immediate environment except the nickel concentrations in the dumpsites and surface water of the river, respectively and whose values were beyond the recommended limit of WHO/USEPA (0.05 mg/L) for safe drinking water. The trend of the results also indicates that the dumpsites are sources of numerous soil and water pollutants capable of depleting oxygen levels in the river and this could pose several and serious health risk to humans and aquatic life. Adequate solid waste disposal technique should be adopted by the appropriate agency to forestall this threat to the Rumuodumaya environment.
Reactors functional parameters for sodium benzoate production: A comparative study
Authors: Int Chem , Ukpaka Chukwuemeka Peter
Published: April 2019

The various process performances of the Batch Reactor, Continuous Stirred-Tank Reactor (CSTR) and Plug Flow Reactor (PFR) for the production of sodium benzoate from the reaction of sodium hydroxide and benzoic acid were investigated. The performance equations for the operation of Batch reactor, CSTR and PFR were developed for the analysis of the reactor’s functional dimensions and parameters. The analysis of the reactor’s functional parameters was performed at molar ratio of benzoic acid to sodium hydroxide of 1.5 to 3.0 at intervals of 0.5 and at the same reactor operating conditions. The set of reactors’ performance equations were solved simultaneously and then, simulated with the aid of MATLAB R2015a computer program. However, in terms of comparison at the same operating conditions, the size of the batch reactor was greater than that of CSTR which in turn was greater than that of the PFR, while the reverse was the case for heat generated per reactor volume. Also, the space time for CSTR was greater than that of the PFR while the space velocity for PFR was greater than that of CSTR. Following the results obtained from the analysis, the production of sodium benzoate from sodium hydroxide and benzoic acid can be executed in either of batch reactor, CSTR or PFR depending on the capacity of production and conditions of operation and the optimum performance was observed at molar feed ratio of 3.0.
The first independent study on the complex trial protocol version of the P300-based concealed information test: Corroboration of previous findings and highlights on vulnerabilities
Authors: Lukács Gáspár , Katalin Huszár , Dalos Vera Daniella , Kilencz Tünde , Tudja Szabina , Csifcsák Gábor
Published: April 2019

More than a dozen studies of the Complex Trial Protocol (CTP) version of the P300-based Concealed Information Test have been published since its introduction (Rosenfeld et al., 2008), and it has been fairly consistently proven to provide high accuracy and strong resistance to countermeasures (Rosenfeld et al., 2013). However, no independent authors have verified these findings until now. In the present, first independent study, we corroborate the accuracy and countermeasure-resistance of the CTP, when the probe item (critical presented information, e.g., crime detail; P) vs. all irrelevant items (Iall) comparison is used for classifying participants as guilty or innocent, but we also show that the CTP is severely vulnerable to countermeasures, when the P vs. the irrelevant item with the largest P300 responses (Imax) comparison is used. This latter measure can be defeated by creating “oddball” items among the irrelevant items (through targeting them with covert responses), and thereby making their P300 responses statistically indistinguishable from those of the probe item. Practical implications are discussed.
Accounting for the build-up of proactive interference across lists in a list length paradigm reveals a dominance of item-noise in recognition memory
Authors: Fox Julian , Dennis Simon , Osth Adam F
Published: April 2019

There has been a longstanding debate concerning whether interference in recognition memory is attributable to other items on the study list (i.e., item-noise) or to prior memories (i.e., context-noise and background-noise). Recently, Osth and Dennis (2015) devised a global matching model that could estimate the magnitude of each interference contribution and they found that context-noise and background-noise were dominant in recognition. In the present investigation, data from a list length experiment were analysed using variants of the Osth, Jansson, Dennis and Heathcote (2018) model, that integrates the memory retrieval components of the Osth and Dennis (2015) model with the diffusion decision model (Ratcliff, 1978) to jointly account for choice probabilities and RT distributions. The standard version of the model, like existing recognition models, treated each condition as if no proactive interference had accumulated over the session. A more comprehensive version of the model allowed both study and test items from prior conditions to contribute proactive interference (PI) to future conditions. While the standard model estimated a dominance of background-noise, the PI model estimated a dominance of item-noise, reversing the conclusions made by Osth and Dennis (2015). Along with list length, the experimental design provided a measure of the test position effect (TPE). While the standard model attributed the TPE to context drift, the PI model attributed the TPE to both context drift and increases in item-noise.
The practical alternative to the p-value is the correctly used p-value
Authors: Lakens Daniel
Published: April 2019

Due to the strong overreliance on p-values in the scientific literature some researchers have argued that p-values should be abandoned or banned, and that we need to move beyond p-values and embrace practical alternatives. When proposing alternatives to p-values statisticians often commit the ‘Statistician’s Fallacy’, where they declare which statistic researchers really ‘want to know’. Instead of telling researchers what they want to know, statisticians should teach researchers which questions they can ask. In some situations, the answer to the question they are most interested in will be the p-value. As long as null-hypothesis tests have been criticized, researchers have suggested to include minimum-effect tests and equivalence tests in our statistical toolbox, and these tests (even though they return p-values) have the potential to greatly improve the questions researchers ask. It is clear there is room for improvement in how we teach p-values. If anyone really believes p-values are an important cause of problems in science, preventing the misinterpretation of p-values by developing better evidence-based education and user-centered statistical software should be a top priority. Telling researchers which statistic they should use has distracted us from examining more important questions, such as asking researchers what they want to know when they do scientific research. Before we can improve our statistical inferences, we need to improve our statistical questions.
Association-based Concealed Information Test: A Novel Reaction Time-Based Deception Detection Method
Authors: Lukács Gáspár , Gula Bartosz , Szegedi-Hallgató Emese , Csifcsák Gábor
Published: April 2019

In recent years, numerous studies were published on the reaction time (RT)-based Concealed Information Test (CIT). However, an important limitation of the CIT is the reliance on the recognition of the probe item, and therefore the limited applicability when an innocent person is aware of this item. In the present paper, we introduce an RT-based CIT that is based on item-category associations: the Association-based Concealed Information Test (A-CIT). Using the participants’ given names as probe items and self-referring “inducer” items (e.g., “MINE” or “ME”) that establish an association between ownership and responses choices, in Experiment 1 (within-subject design; n = 27), this method differentiated with high accuracy between guilty and innocent conditions. Experiment 2 (n = 25) replicated Experiment 1, except that the participants were informed of the probe item in the innocent condition—nonetheless, the accuracy rate remained high. Implications and future possibilities are discussed.
Fixed Effects Individual Slopes: Accounting and Testing for Heterogeneous Effects in Panel Data or Other Multilevel Models
Authors: Rüttenauer Tobias , Ludwig Volker
Published: April 2019

Fixed effects (FE) panel models have been used extensively in the past, as those models control for all stable heterogeneity between units. Still, the conventional FE estimator relies on the assumption of parallel trends between treated and untreated groups. It returns biased results in the presence of heterogeneous slopes or growth curves that are related to the parameter of interest (e.g., selection into treatment is based on individual growth of the outcome). In this study, we derive the bias in conventional FE models, and show that fixed effects individual slope (FEIS) models can overcome this problem. This is a more general version of the conventional FE model, which accounts for heterogeneous slopes or trends, thereby providing a powerful tool for panel data and other multilevel data in general. We propose two versions of the Hausman test that can be used to identify misspecification in FE models. The performance of the FEIS estimator and the specification tests is evaluated in a series of Monte Carlo experiments. Using the examples of the marital wage premium and returns to preschool education (Head Start), we demonstrate how taking heterogeneous effects into account can seriously change the conclusions drawn from conventional FE models. Thus, we propose to test for bias in FE models in practical applications and to apply FEIS if indicated by the specification tests.
Sea Voyages to Paracel Islands in the South China Sea Under Emperor Minh Mang (1833-1838), the analyses of historical data - description
Authors: Ngo-Hoang Dai-Long
Published: April 2019

The Official Documentation of the Nguyen dynasty is a type of administrative documentation of the House of Nguyen (1802-1945) on which reserved the king's handwritten feedback in red ink. The Official documentation about the implementation of Vietnam's sovereignty over Paracel Islands (Paracel) and Truong Sa (Spratly) archipelagos includes 19 documents, 12 of that (from document no. 5 to no. 16) reflect mission sea voyages of the fleet heading to Paracel Islands archipelagos from late March to late June, from 1833 to 1838. The following are the main features of these activities include: (i) in each sea voyage, they had different tasks such as measuring and mapping; bringing materials to build the temple…; (ii) The activities during this period under King Minh Menh clearly showed the strict management and the responsibility of the national leader to the national territory in general and islands in particular; (iii) the territory acquire the nationality in Paracel Islands from 1833 to 1838, which was the continuity of a process established by the Nguyen Lords from hundreds of years ago.
Évaluer les psychothérapies durant et après un cancer
Authors: Ninot G. , Guerdoux-Ninot E.
Published: April 2019

Il est couramment admis que les bénéfices d’une psychothérapie sur la santé psychique et la qualité de vie dépendent du psychologue, du patient et de la qualité de leur relation. Si ces observations restent vraies, de récentes études interventionnelles montrent que la méthode psychothérapeutique utilisée compte autant, et de plus en plus au fil des séances. L’article invite les psychothérapeutes à contribuer davantage aux études interventionnelles d’efficience et d’implémentation pour améliorer les pratiques spécifiques en oncologie, pour garantir le respect de la subjectivité, pour optimiser les bénéfices des patients et pour mieux se différencier de pratiques non pertinentes, voire dangereuses, propagées par des professionnels de santé, des réseaux sociaux ou des médias sous influence.
« La psychanalyse, à l’hôpital, c’est comme l’amour : ça se fait, ça se vit… et le reste est littérature ! »
Authors: Ben Soussan P.
Published: April 2019

Qu’est-ce qu’être psychiatre, psychologue, psychothérapeute ou psychanalyste à l’hôpital ? D’autant en cancérologie ? L’auteur apporte à ce questionnement quelques bribes de réponses, très personnelles mais très partageables et expose un setting singulier, la séance pensée comme unique ou one shot thérapie.
Des psychothérapies à l’hôpital en oncologie pédiatrique : quel cadre thérapeutique ? Quelles modalités ?
Authors: Seigneur E. , Dugert M. , Rodriguez-Cortina M.
Published: April 2019

Les cancers de l’enfant et de l’adolescent sont des événements rares, mais qui entraînent des bouleversements psychiques profonds et durables pour le patient et ses proches. À partir de trois vignettes cliniques, nous interrogeons les spécificités du travail du psychologue ou psychiatre dans ces services d’oncologie pédiatrique adolescents–jeunes adultes et les modalités particulières de soutien psychothérapeutique qu’il est possible de proposer et de mettre en place. Notre référence théorique, ici la psychanalyse, nous permet à la fois de disposer d’un cadre interne solide, autorisant la souplesse et la créativité que requiert le travail auprès de ces jeunes patients à l’hôpital.
Menace de mort et relance désirante. Un possible destin pour Éros en fin de vie
Authors: Alric J.
Published: April 2019

Lorsque la mort menace, la vie psychique est déstabilisée. Thanatos trouve alors l’occasion rêvée de prendre le pas sur Éros et il n’est pas rare que se produisent alors des changements mortifères. La conséquence est que le sujet s’arrête dans sa dimension désirante ; il se retrouve bien souvent dans une sorte de deuil anticipé de lui-même. À partir d’une vignette clinique et en articulant théorie psychodynamique et certains énoncés de Spinoza, je montrerai comment la rencontre psychothérapeutique peut transformer la menace de mort en relance désirante. En fin de vie, il arrive parfois qu’ Éros se remobilise en vue d’un destin plus favorable.
Un dispositif innovant en psycho-oncologie pour accompagner les jeunes enfants endeuillés :La Petite Fille aux allumettes
Authors: Ducos Suares M. , Duriez N.
Published: April 2019

Objectif: Perdre un parent d’un cancer à un âge précoce est un facteur de risque pour le développement psychique de l’enfant. L’objectif de cette étude qualitative est d’évaluer l’efficacité d’un groupe thérapeutique pour les enfants endeuillés, La Petite Fille aux allumettes.

Méthode: Les outils utilisés pour cette étude sont le Family Adaptation and Cohesion Scales IV pour estimer la cohésion et la flexibilité familiales, l’ERC-vf pour examiner la régulation émotionnelle des enfants avant et après la prise en charge et la théorisation ancrée pour analyser les comptes rendus des séances.

Résultats: Le cas de Tom illustre le poids des caractéristiques familiales dans l’efficacité du dispositif. Le fonctionnement rigide de la famille, avec des règles strictes qui ne peuvent être remises en question, ne favorise pas la communication parent–enfant.

Conclusion: Dans certains cas, une thérapie systémique est recommandée.
Transnational Cultural Propaganda
Authors: Faucher Charlotte
Published: April 2019

The Second World War challenged the well-established circulation
of cultural practices between France and Britain. But it also gave individuals,
communities, states, and aspiring governments opportunities to invent new
forms of international cultural promotion that straddled the national
boundaries that the war had disrupted. Although London became the capital
city of the main external Resistance movement Free France, the latter
struggled to establish its cultural agenda in Britain, owing, on the one hand,
to the British Council’s control over French cultural policies and, on the
other hand, to the activities of anti-Gaullist Resistance fighters based in London
who ascribed different purposes to French arts. While the British Council
and a few French individuals worked towards prolonging French cultural
policies that had been in place since the interwar period, Free French promoted
rather conservative and traditional images of France so as to reclaim
French culture in the name of the Resistance.
International Cooperation, Transnational Circulation
Authors: Deacon Valerie
Published: April 2019

The rescue of downed Anglo-American aircrews in France during
the Second World War highlights the transnational nature of this kind of
resistance. From their training to their evasion, flight crews themselves experienced
the Second World War without traditional national borders. Moreover,
their successful rescue in Occupied France depended on the ability of
civilian helpers to think transnationally and to operate with little regard for
the nation-state. This article focuses on evasion training, rescue, and postwar
attempts to honor civilians for their assistance to highlight these themes of
transnational resistance.
An Inconvenient Expertise
Authors: Nasiali Minayo
Published: April 2019

In the 1950s, French shipping companies began to replace their old
fleet of steamships with new diesel ships. They also began to lay off sailors
from French Africa, claiming that the changing technology rendered their
labor obsolete. The industry asserted that African sailors did not have the
aptitude to do other, more skilled jobs aboard diesel vessels. But unemployed
colonial sailors argued differently, claiming that they were both able and
skilled. This article explores how unemployed sailors from French Africa cast
themselves as experts, capable of producing technological knowledge about
shipping. In so doing, they shaped racialized and gendered notions about
labor and skill within the French empire. The arguments they made were
inconvenient, I argue, because colonial sailors called into question hegemonic
ideas about who could be modern and who had the right to participate
in discourse about expertise.
Of Traiteurs and Tsars
Authors: Silverman Willa Z.
Published: April 2019

Between 1893 and 1901, the Parisian traiteur Potel et Chabot catered a series of
gala meals celebrating the recent Franco-Russian alliance, which was heralded in France as
ending its diplomatic isolation following the Franco-Prussian War. The firm was well adapted
to the particularities of the unlikely alliance between Tsarist Russia and republican France.
On the one hand, it represented a tradition of French luxury production, including haute
cuisine, that the Third Republic was eager to promote. On the other, echoing the Republic’s
championing of scientific and technological progress, it relied on innovative transportation
and food conservation technologies, which it deployed spectacularly during a 1900 banquet
for over twenty-two thousand French mayors, a modern “mega-event.” Culinary discourse
therefore signaled, and palliated concerns about, the improbable nature of the alliance at
the same time as it revealed important changes taking place in the catering profession.
"You’re a Trickster”
Authors: Laws Megan
Published: April 2019

The trickster has held a prominent place in the study of folklore,
as much as it has been central to anthropological understandings of egalitarianism.
In both, the trickster embodies an insoluble tension between
the repressed, amoral desires of the individual and the moral demands
of social life. This tension, so it goes, is visible in the ambiguity of the
figure—a protean indeterminate being, neither good nor bad. Among
the Jú|’hoànsi of northeastern Namibia, the trickster is similarly ambiguous.
The figure conveys not a clash of values, but rather the doubt and
uncertainty people feel toward those with whom they share resources, or
about different ways of sharing and how they might relate to one another.
This article approaches such uncertainty through a focus on the mocking
phrase “you’re a trickster” and the moral discourses that accompany it.
How definitive treatment affects the rupture rate of unruptured cerebral aneurysms: a competing risk survival analysis
Authors: Kimura Toshikazu , Ochiai Chikayuki , Kawai Kensuke , Morita Akio , Saito Nobuhito
Published: April 2019

OBJECTIVE

To investigate the risk of bleeding from unruptured cerebral aneurysms (UCAs), previous studies have used Kaplan-Meier analyses without treating the definitive treatment as a competing risk event, which may underestimate the rupture rate. The authors analyzed the survival of patients with UCAs alongside the occurrence of aneurysm bleeding and its competing risk events.

METHODS

A retrospective analysis was conducted on 722 patients diagnosed with UCAs in the period from 2000 to 2009 using an institution’s electronic medical records and telephone interviews. The cumulative incidence of aneurysm rupture was examined, and factors contributing to rupture were assessed using regression analyses.

RESULTS

By 2014, 19 patients had experienced aneurysm rupture, with an overall rupture rate of 0.57% per year over 3320.8 person-years. However, cumulative incidence analysis indicated that 1.3% of all patients had a rupture within 2 years after aneurysm identification, and 38.4% of the patients underwent definitive treatment in the same period. Among the patients who experienced rupture, regression analysis revealed that an aneurysm size greater than 5 mm, a location in the anterior or posterior communicating arteries, and an irregular shape contributed to aneurysm rupture, with HRs of 4.4 (95% CI 1.2–15.7), 3.5 (95% CI 1.4–8.7), and 2.1 (95% CI 0.7–6.0), respectively.

CONCLUSIONS

Rupture rate analyses using the person-year or standard Kaplan-Meier method are not as informative without consideration of the competing risks. The incidence of aneurysm rupture should be presented clearly with those of competing risks.
Kranion, an open-source environment for planning transcranial focused ultrasound surgery: technical note
Authors: Sammartino Francesco , Beam Dylan W. , Snell John , Krishna Vibhor
Published: April 2019

Transcranial focused ultrasound (FUS) ablation is an emerging incision-less treatment for neurological disorders. The factors affecting FUS treatment efficiency are not well understood. Kranion is open-source software that allows the user to simulate the planning stages of FUS treatment and to “replay” previous treatments for off-line analysis. This study aimed to investigate the relationship between skull parameters and treatment efficiency and to create a metric to estimate temperature rise during FUS. CT images from 28 patients were analyzed to validate the use of Kranion. For stereotactic targets within each patient, individual transducer element incident angles, skull density ratio, and skull thickness measurements were recorded. A penetration metric (the “beam index”) was calculated by combining the energy loss from incident angles and the skull thickness. Kranion accurately estimated the patient’s skull and treatment parameters. The authors observed significant changes in incident angles with different targets in the brain. Using the beam index as a predictor of temperature rise in a linear-mixed-effects model, they were able to predict the average temperature rise at the focal point during ablation with < 21% error (55°C ± 3.8°C) in 75% of sonications, and with < 44% (55°C ± 7.9°C) in 97% of sonications. This research suggests that the beam index can improve the prediction of temperature rise during FUS. Additional work is required to study the relationship between temperature rise and lesion shape and clinical outcomes.
A novel proposed grading system for cerebellar arteriovenous malformations
Authors: Nisson Peyton L. , Fard Salman A. , Walter Christina M. , Johnstone Cameron M. , Mooney Michael A. , Tayebi Meybodi Ali , Lang Michael , Kim Helen , Jahnke Heidi , Roe Denise J. , Dumont Travis M. , Lemole G. Michael , Spetzler Robert F. , Lawton Michael T.
Published: April 2019

OBJECTIVE

The objective of this study was to evaluate the existing Spetzler-Martin (SM), Spetzler-Ponce (SP), and Lawton-Young (LY) grading systems for cerebellar arteriovenous malformations (AVMs) and to propose a new grading system to estimate the risks associated with these lesions.

METHODS

Data for patients with cerebellar AVMs treated microsurgically in two tertiary medical centers were retrospectively reviewed. Data from patients at institution 1 were collected from September 1999 to February 2013, and at institution 2 from October 2008 to October 2015. Patient outcomes were classified as favorable (modified Rankin Scale [mRS] score 0–2) or poor (mRS score 3–6) at the time of discharge. Using chi-square and logistic regression analysis, variables associated with poor outcomes were assigned risk points to design the proposed grading system. The proposed system included neurological status prior to treatment (poor, +2 points), emergency surgery (+1 point), age > 60 years (+1 point), and deep venous drainage (deep, +1 point). Risk point totals of 0–1 comprised grade 1, 2–3 grade 2, and 4–5 grade 3.

RESULTS

A total of 125 cerebellar AVMs of 1328 brain AVMs were reviewed in 125 patients, 120 of which were treated microsurgically and included in the study. With our proposed grading system, we found poor outcomes differed significantly between each grade (p < 0.001), while with the SM, SP, and LY grading systems they did not (p = 0.22, p = 0.25, and p = 1, respectively). Logistic regression revealed grade 2 had 3.3 times the risk of experiencing a poor outcome (p = 0.008), while grade 3 had 9.9 times the risk (p < 0.001). The proposed grading system demonstrated a superior level of predictive accuracy (area under the receiver operating characteristic curve [AUROC] of 0.72) compared with the SM, SP, and LY grading systems (AUROC of 0.61, 0.57, and 0.51, respectively).

CONCLUSIONS

The authors propose a novel grading system for cerebellar AVMs based on emergency surgery, venous drainage, preoperative neurological status, and age that provides a superior prognostication power than the formerly proposed SM, SP, and LY grading systems. This grading system is clinically predictive of patient outcomes and can be used to better guide vascular neurosurgeons in clinical decision-making.
Hemorrhage risk of cerebral dural arteriovenous fistulas following Gamma Knife radiosurgery in a multicenter international consortium
Authors: Starke Robert M. , McCarthy David J. , Chen Ching-Jen , Kano Hideyuki , McShane Brendan J. , Lee John , Patibandla Mohana Rao , Mathieu David , Vasas Lucas T. , Kaufmann Anthony M. , Wang Wei Gang , Grills Inga S. , Cifarelli Christopher P. , Paisan Gabriella , Vargo John , Chytka Tomas , Janouskova Ladislava , Feliciano Caleb E. , Sujijantarat Nanthiya , Matouk Charles , Chiang Veronica , Hess Judith , Rodriguez-Mercado Rafael , Tonetti Daniel A. , Lunsford L. Dade , Sheehan Jason P.
Published: April 2019

OBJECTIVE

The authors performed a study to evaluate the hemorrhagic rates of cerebral dural arteriovenous fistulas (dAVFs) and the risk factors of hemorrhage following Gamma Knife radiosurgery (GKRS).

METHODS

Data from a cohort of patients undergoing GKRS for cerebral dAVFs were compiled from the International Radiosurgery Research Foundation. The annual posttreatment hemorrhage rate was calculated as the number of hemorrhages divided by the patient-years at risk. Risk factors for dAVF hemorrhage prior to GKRS and during the latency period after radiosurgery were evaluated in a multivariate analysis.

RESULTS

A total of 147 patients with dAVFs were treated with GKRS. Thirty-six patients (24.5%) presented with hemorrhage. dAVFs that had any cortical venous drainage (CVD) (OR = 3.8, p = 0.003) or convexity or torcula location (OR = 3.3, p = 0.017) were more likely to present with hemorrhage in multivariate analysis. Half of the patients had prior treatment (49.7%). Post-GRKS hemorrhage occurred in 4 patients, with an overall annual risk of 0.84% during the latency period. The annual risks of post-GKRS hemorrhage for Borden type 2–3 dAVFs and Borden type 2–3 hemorrhagic dAVFs were 1.45% and 0.93%, respectively. No hemorrhage occurred after radiological confirmation of obliteration. Independent predictors of hemorrhage following GKRS included nonhemorrhagic neural deficit presentation (HR = 21.6, p = 0.027) and increasing number of past endovascular treatments (HR = 1.81, p = 0.036).

CONCLUSIONS

Patients have similar rates of hemorrhage before and after radiosurgery until obliteration is achieved. dAVFs that have any CVD or are located in the convexity or torcula were more likely to present with hemorrhage. Patients presenting with nonhemorrhagic neural deficits and a history of endovascular treatments had higher risks of post-GKRS hemorrhage.
Receptor tyrosine kinase gene amplification is predictive of intraoperative seizures during glioma resection with functional mapping
Authors: Choi Bryan D. , Lee Daniel K. , Yang Jimmy C. , Ayinon Caroline M. , Lee Christine K. , Maus Douglas , Carter Bob S. , Barker Fred G. , Jones Pamela S. , Nahed Brian V. , Cahill Daniel P. , See Reiner B. , Simon Mirela V. , Curry William T.
Published: April 2019

OBJECTIVE

Intraoperative seizures during craniotomy with functional mapping is a common complication that impedes optimal tumor resection and results in significant morbidity. The relationship between genetic mutations in gliomas and the incidence of intraoperative seizures has not been well characterized. Here, the authors performed a retrospective study of patients treated at their institution over the last 12 years to determine whether molecular data can be used to predict the incidence of this complication.

METHODS

The authors queried their institutional database for patients with brain tumors who underwent resection with intraoperative functional mapping between 2005 and 2017. Basic clinicopathological characteristics, including the status of the following genes, were recorded: IDH1/2, PIK3CA, BRAF, KRAS, AKT1, EGFR, PDGFRA, MET, MGMT, and 1p/19q. Relationships between gene alterations and intraoperative seizures were evaluated using chi-square and two-sample t-test univariate analysis. When considering multiple predictive factors, a logistic multivariate approach was taken.

RESULTS

Overall, 416 patients met criteria for inclusion; of these patients, 98 (24%) experienced an intraoperative seizure. Patients with a history of preoperative seizure and those treated with antiepileptic drugs prior to surgery were less likely to have intraoperative seizures (history: OR 0.61 [95% CI 0.38–0.96], chi-square = 4.65, p = 0.03; AED load: OR 0.46 [95% CI 0.26–0.80], chi-square = 7.64, p = 0.01). In a univariate analysis of genetic markers, amplification of genes encoding receptor tyrosine kinases (RTKs) was specifically identified as a positive predictor of seizures (OR 5.47 [95% CI 1.22–24.47], chi-square = 5.98, p = 0.01). In multivariate analyses considering RTK status, AED use, and either 2007 WHO tumor grade or modern 2016 WHO tumor groups, the authors found that amplification of the RTK proto-oncogene, MET, was most predictive of intraoperative seizure (p < 0.05).

CONCLUSIONS

This study describes a previously unreported association between genetic alterations in RTKs and the occurrence of intraoperative seizures during glioma resection with functional mapping. Future models estimating intraoperative seizure risk may be enhanced by inclusion of genetic criteria.
Accuracy of frameless image-guided implantation of depth electrodes for intracranial epilepsy monitoring
Authors: Gross Robert E. , Sung Edward K. , Mulligan Patrick , Laxpati Nealen G. , Mayo Darlene A. , Rolston John D.
Published: April 2019

OBJECTIVE

Various techniques are available for stereotactic implantation of depth electrodes for intracranial epilepsy monitoring. The goal of this study was to evaluate the accuracy and effectiveness of frameless MRI-guided depth electrode implantation.

METHODS

Using a frameless MRI-guided stereotactic approach (Stealth), depth electrodes were implanted in patients via burr holes or craniotomy, mostly into the medial temporal lobe. In all cases in which it was possible, postoperative MR images were coregistered to planning MR images containing the marked targets for quantitative analysis of intended versus actual location of each electrode tip. In the subset of MR images done with sufficient resolution, qualitative assessment of anatomical accuracy was performed. Finally, the effectiveness of implanted electrodes for identifying seizure onset was retrospectively examined.

RESULTS

Sixty-eight patients underwent frameless implantation of 413 depth electrodes (96% to mesial temporal structures) via burr holes by one surgeon at 2 institutions. In 36 patients (203 electrodes) planning and postoperative MR images were available for quantitative analysis; an additional 8 procedures with 19 electrodes implanted via craniotomy for grid were also available for quantitative analysis. The median distance between intended target and actual tip location was 5.19 mm (mean 6.19 ± 4.13 mm, range < 2 mm–29.4 mm). Inaccuracy for transtemporal depths was greater along the electrode (i.e., deep), and posterior, whereas electrodes inserted via an occipital entry deviated radially. Failure to localize seizure onset did not result from implantation inaccuracy, although 2 of 62 patients (3.2%)—both with electrodes inserted occipitally—required reoperation. Complications were mostly transient, but resulted in long-term deficit in 2 of 68 patients (3%).

CONCLUSIONS

Despite modest accuracy, frameless depth electrode implantation was sufficient for seizure localization in the medial temporal lobe when using the orthogonal approach, but may not be adequate for occipital trajectories.
T3 infantile hemangioma: first case of a tumor involving epidural, intradural extramedullary, and intradural intramedullary spaces
Authors: Steinberger Jeremy , Nistal Dominic A. , Ghatan Saadi
Published: April 2019

Infantile hemangiomas (IHs) are the most common benign neoplasm of the neonatal and newborn period, affecting approximately 5% of infants. However, true IHs presenting in the neuraxis are quite rare with only 15 documented cases in the literature. Management of IH consists of utilizing steroids and immunomodulatory therapies to reduce the size of the tumor and surgery to remove the tumor to decrease symptoms and the risk of bleeding. Operative management of epidural and intradural extramedullary spinal hemangiomas has been described; however, management of intradural intramedullary IH has not been detailed in the literature. In this report, the authors describe the case of a 3-year-old girl who presented with multiple hemangiomas involving the liver, lung, and spine, with one component of the tumor involving the posterior intramedullary aspect of the spinal cord at the level of T3. After medical therapies had failed, the patient underwent endovascular embolization of the spinal hemangioma followed by resection of the tumor. While there is extensive literature on IH throughout many organ systems, only a handful of cases involving the neuraxis have been described. Operative management of refractory IH seems to allow for the reduction of tumor burden and the prevention of hemorrhagic injury.
Urgent surgery for spinal instability or neurological impairment caused by spinal brown tumors occurring in the context of end-stage renal disease
Authors: Jia Qi , Gao Xin , Zhou Zhenhua , Lan Bin , Zhao Jian , Liu Tielong , Yang Xinghai , Wei Haifeng , Xiao Jianru
Published: April 2019

OBJECTIVE

Spinal instability or neurological impairment caused by spinal brown tumors (BTs) with end-stage renal disease (ESRD) is an acute condition that needs urgent surgery. There is not much published information on BTs of the mobile spine given the rarity of the disease, and the literature shows inconsistent treatment options and ambiguous follow-up information. The aim of the present study was to elucidate the clinical features, anesthesia management, and surgical treatment for this rare disease through long-term follow-up observations.

METHODS

Clinical, laboratory, radiological, and perioperative data on 6 consecutive patients with spinal BTs who had been admitted to the authors’ institution between 2010 and 2016 were retrospectively reviewed. The literature on spinal BT with secondary hyperparathyroidism was also reviewed. Summaries of the clinical features and anesthesia management are provided.

RESULTS

The mean age of the 6 patients was 45.5 years (range 35–62 years). Lesions were located in the cervical segment (2 cases) and thoracic segment (4 cases). Localized pain was the most common complaint, and pathological fracture occurred in 5 patients. Elevation of serum alkaline phosphate (AKP) and parathyroid hormone (PTH) was a common phenomenon. Four patients underwent circumferential resection and 2 underwent laminectomy, with parathyroidectomy performed in all patients. The anesthesia process was uneventful for all patients. The mean follow-up was 33 months (range 26–40 months). No spinal lesion progression occurred in any patient. The Karnofsky Performance Status score improved to 80–90 by 3 months after surgery.

CONCLUSIONS

Although uncommon, spinal BTs should be a diagnostic consideration in patients with ESRD. The thoracic spine is the most frequently affected site. ESRD is not a contraindication for surgery; with the assistance of experienced anesthesiologists, urgent surgery is the preferred option to alleviate neurological impairment and restore spinal stability.
Surgical approaches and long-term outcomes of intramedullary spinal cord cavernous malformations: a single-center consecutive series of 219 patients
Authors: Ren Jian , Hong Tao , He Chuan , Li Xiaoyu , Ma Yongjie , Yu Jiaxing , Ling Feng , Zhang Hongqi
Published: April 2019

OBJECTIVE

Optimal surgical strategies for intramedullary spinal cord cavernous malformations (ISCCMs) are not optimized and remain problematic. In this study the authors identify rational surgical strategies for ISCCMs and predictors of outcomes after resection.

METHODS

A single-center study was performed with 219 consecutive surgically treated patients who presented from 2002 to 2017 and were analyzed retrospectively. The American Spinal Injury Association (ASIA) Impairment Scale was used to evaluate neurological functions. Patient characteristics, surgical approaches, and immediate and long-term postoperative outcomes were identified.

RESULTS

The average ISCCM size was 10.5 mm. The spinal level affected was cervical in 24.8% of patients, thoracic in 73.4%, and lumbar in 1.8%. The locations of the lesions in the horizontal plane were 30.4% ventral, 41.6% dorsal, and 28.0% central. Of the 214 patients included in the cohort for operative evaluation, 62.6% had superficially located lesions, while 37.4% were embedded. Gross-total resection was achieved in 98.1% of patients. The immediate postoperative neurological condition worsened in 10.3% of the patients. Multivariate logistic regression identified mild preoperative function (p = 0.014, odds ratio [OR] 4.5, 95% confidence interval [CI] 1.4–14.8) and thoracolumbar-level lesions (p = 0.01, OR 15.7, 95% CI 1.9–130.2) as independent predictors of worsening. The mean follow-up duration in 187 patients was 45.9 months. Of these patients, 63.1% were stable, 33.2% improved, and 3.7% worsened. Favorable outcomes were observed in 86.1% of patients during long-term follow-up and were significantly associated with preoperative mild neurological and disability status (p = 0.000) and cervically located lesions (p = 0.009). The depths of the lesions were associated with worse long-term outcomes (p = 0.001), and performing myelotomy directly through a yellowish abnormal surface in moderate-depth lesions was an independent predictor of worsening (p = 0.023, OR 35.3, 95% CI 1.6–756.3).

CONCLUSIONS

Resection performed with an individualized surgical approach remains the primary therapeutic option in ISCCMs. Performing surgery in patients with mild symptoms at the thoracolumbar level and embedded located lesions requires more discretion.
Natural history of ventriculomegaly in adults: a cluster analysis
Authors: Craven Claudia L. , Ramkumar Roshini , D’Antona Linda , Thompson Simon D. , Thorne Lewis , Watkins Laurence D. , Toma Ahmed K.
Published: April 2019

OBJECTIVE

Chronic ventriculomegaly in the absence of raised intracranial pressure (ICP) is a known entity in adult hydrocephalus practice. The natural history and indication for treatment is, however, poorly defined. A highly heterogeneous group, some adults with ventriculomegaly are asymptomatic, while others have life-threatening deteriorations. The authors hypothesized that the various presentations can be subtyped and represent different stages of decompensation. A cluster analysis was performed on a cohort of patients with chronic ventriculomegaly with the aim of elucidating typical clinical characteristics and outcomes in chronic ventriculomegaly in adults.

METHODS

Data were collected from 79 patients with chronic ventriculomegaly referred to a single center, including demographics, presenting symptoms, and 24-hour ICP monitoring (ICPM). A statistical cluster analysis was performed to determine the presence of subgroups.

RESULTS

Four main subgroups and one highly dissimilar group were identified. Patients with ventriculomegaly commonly have a perinatal event followed by one of four main presentations: 1) incidental ventriculomegaly with or without headache; 2) highly symptomatic presentation (including reduced consciousness) and raised ICP; 3) early presenting with symptoms of headache and nausea (with abnormal pulsatility); and 4) late presenting with features common to normal pressure hydrocephalus. Each symptomatic group has characteristic radiological features, ICPM, and responses to treatment.

CONCLUSIONS

Cluster analysis has identified subgroups of adult patients with ventriculomegaly. Such groups may represent various degrees of decompensation. Surgical interventions may not be equally effective across the subgroups, presenting an avenue for further research. The identified subtypes provide further insight into the natural history of this lesser studied form of hydrocephalus.