bluuebunny/crossref_metadata_2025 huggingface dataset:
A Multicenter Cross-Sectional Study on Quality of Life and Work Productivity among Women with Skin Disease
Authors: Mazlan Siti Amalina , Ahmad  Sharoni Siti Khuzaimah
Published: June 2024

The most visible organ of a human being is considered to be the skin. The effects of visible skin disorders on quality of life (QoL) and productivity at work go far beyond their clinical manifestations, especially among women. The objective of this research is to evaluate the quality of life and work productivity of women with skin conditions who attend public hospitals. Methods:ACross-sectional study was carried out from March 2023 to May 2023 at the dermatology clinics of Kuala Lumpur Hospital and Selayang Hospital. With 404 respondents, the researcher used a proportionate and random sampling technique. The Dermatology Life Quality Index (DLQI) and Work Productivity and Activity Impairment - General Health (WPAI- GH) scales were included in the self-administered questionnaire. The data in this study were analyzed using Statistical Packages for the Social Sciences (SPSS) Version 28. Results: Eczema was frequently diagnosed in the respondents (42.1%) aged 18–30 (53.7%) followed by acne vulgaris (30.9%) and psoriasis (27%). Patients with eczema had the most significant effect on the DLQI score (35.9%). The outcome for WPAI-GH observed psoriasis patients showed the highest absenteeism (M=8.6, SD=15.4). There was no significant difference between types of skin diseases with WPAI-GH subscales (p>0.05). Activity impairment was significantly associated with the DLQI score (p<0.05). Conclusion:These results demonstrated the need for dermatologists and nurses to develop comprehensive care approaches that address the multidimensional impact of skin diseases on patients to improve their quality of life and productivity at work by putting into practice strategies to overcome the issues. Since the nurses are at the forefront of patient care, they possess the expertise to recognize how skin diseases may influence patients' daily functioning and professional productivity; thus, specific strategies can be planned, which will improve the patient's overall health outcomes.
Effects of Psychosocial Intervention on the Level of Stress: A Pre-ExperimentalResearchonSchoolChildrenWho Experienced Displacement in Marawi City, Philippines
Authors: Datukali Tashmera P. , Pangandaman Hamdoni K.
Published: June 2024

Armed conflicts have a profound impact on the psychosocial well-being of children, particularly those belonging to the most vulnerable displaced groups. Understanding and addressing the psychosocial needs of these children is of paramount importance. Aim: This study aimed to investigate the effectiveness of a psychosocial intervention in mitigating stress levels among school-aged children displaced from their homes within the conflict zone of Marawi City.Methods:Employing a pre-experimental design with a single group and utilizing a pre-post-test approach, 38 displaced children aged 7-12 were selected based on specified criteria. The participants underwent a 13-session psychosocial intervention guided by predetermined criteria. Data were collected using three questionnaires encompassing personal and socio-demographic details (part 1), an adapted children's stress symptom scale (part 2), and an assessment of children's emotions before and after the psychosocial interventions (part 3). Results:The results demonstrated a statistically significant difference between pre-test and post-test stress levels among the displaced children who participated in the psychosocial intervention. Conclusion:Participation in various psychosocial interventions was associated with a significant decrease in displacement-related stress levels among the children. This underscores the potential effectiveness of targeted psychosocial interventions in ameliorating the stress experienced by displaced children. Recommendation:Future research endeavors should focus on further enhancing therapeutic approaches tailored to the unique needs of displaced children, particularly those susceptible to the adverse effects of stress. Aconcerted effort is needed to develop and implement interventions that can comprehensively address the psychosocial well-being of children affected by armed conflicts and displacement.
Assessment of Relationship between Lifestyle Behaviors and Severity of Perimenopausal Symptoms among Women
Authors: Abd Elmoneem Abd Allah Hasnaa Gamal , Khahmis Mervat Ali , Al-DienAbdel-Hafez Hameeda Aalam , Abbas Ahmed Mohamed
Published: June 2024

Menopause is a stage of transition from a reproductive to a non-reproductive state in the life of a woman. The perimenopause transition is defined as the period immediately before the menopause. The most common symptoms of menopause can be broken down into vasomotor, physical, emotional, or sexual complaints. Lifestyle behaviors play a significant role in women's experiencing menopausal symptoms during the perimenopause. Aims:It aims to assess the relationship between women's lifestyle behaviors and the severity of perimenopausal symptoms. Methods:Adescriptive correlational study of 120 perimenopausal women using a purposive sample was conducted at gynecology outpatient clinics and general medicine outpatient clinics at Assuit University hospitals from the first of January to the end of June 2023. Three tools were used for this study: a structured interview questionnaire, a modified menopausal rating scale, and a health promotion lifestyle profile. Results:This study reveals that 85.8% of perimenopausal women's lifestyle was poor. Also, 31.6% of perimenopausal women reported moderate perimenopausal symptoms. Somatic symptoms were the most prevalent symptoms on the menopausal rating scale, followed by psychological symptoms and, lastly, urogenital symptoms. There has been a highly statistically significant difference as regards the relationship between the severity of perimenopausal symptoms and women's lifestyle behaviors (p>0.001). Conclusion:There has been an intense negative correlation between women's lifestyle behaviors and the severity of perimenopausal symptoms. So, women need to get health education from the nurse specialists during perimenopause and nurses should plan and implement educational programs for the perimenopausal women about the healthy life style behaviors to reduce and manage their menopausal symptoms. Recommendation: Plan and implement a necessary educational program for perimenopausal women about healthy lifestyle behaviors to manage menopausal symptoms.
Effectiveness of Acupoint Therapy on Swallowing Ability among Patients with Post-Stroke Dysphagia
Authors: Purnama Agus , Nursanti Irna , Irawati Diana , Agung Rizki Nugraha , Putri Anggie Pradana , Koto Yeni , Susaldi Saldi , Irawan AM Ady
Published: June 2024

Stroke is the disease that causes the greatest death and disability every year, and the sequelae of stroke often include swallowing disorders or dysphagia. Conventional interventions remaintheprimarychoiceintherehabilitationprocessforpost-strokepatients.However, incorporating acupoint therapy interventions as an alternative within the nursing context is anticipated to maximize the recovery process of dysphagia patients. Purpose:The purpose of this study is to determine the effect of acupoint therapy and modality therapy on the restoration of swallowing ability in post-stroke dysphagia patients. Methods:The research design in this study was to use a quasy experiment. Patients were given intervention for two months or eight treatment sessions to measure swallowing ability using the GUSS (Gugging Swallowing Screen). The criteria for respondents in this study are patients with strokes experiencing swallowing disorders. Results: After eight sessions of treatment, respondents showed a very significant increase in swallowing ability; the average value before treatment was 4.2 and after treatment in session 8 was 19.07. The results of the influence test give a p-value of <0.001. Acupoint therapy interventions are effective in improving the swallowing ability of post-stroke dysphagia patients. Conclusion: The application of Acupoint Therapy interventions in post-stroke dysphagia patients has significantly improved swallowing ability; we recommend that this intervention be a supporting option in addition to conventional interventions obtained by post-stroke dysphagia patients.
Enhancing Cultural Awareness : A Qualitative Exploration of Nurses' Perspectives on Application of Cultural Competence in Elder Care
Authors: Mojini Christina Binti , Abdullah Bibi Florina , Dioso Regidor III
Published: June 2024

Cultural competence and awareness are indispensable in contemporary healthcare, particularly in our diverse and multicultural society. Understanding the influence of culture on individuals' values, beliefs, preferences, and behaviours is crucial for providing culturally sensitive care.Objective: This qualitative study aims to explore the significance of enhanced intercultural communication skills in healthcare professions, particularly those involving interactions across diverse cultural backgrounds, with a specific focus on aged care.Methods:Thirteen narrative interviews were conducted with newly graduated nurses employed in private healthcare settings, using semi-structured interview techniques. Qualitative thematic analysis was employed to analyse the collected data. Results:The overarching themes highlight the crucial role of cultural competence and awareness in translating theoretical knowledge into practical application. Key factors such as effective communication, building rapport, and respecting language preferences are emphasized. Consistent interactions are essential for establishing trust and delivering individualized care to diverse cultural backgrounds. Understanding the cultural influences on health beliefs and behaviours is paramount for tailoring care plans effectively. The study also addresses challenges faced by newly graduated nurses, especially in caring for older adults and engaging with culturally diverse family caregivers, with a focus on language and communication barriers. Despite these obstacles, nurses exhibit adaptability by leveraging skills and tools such as smartphone apps, while embracing a person-centered approach that involves family members. Conclusion: This study highlights the crucial role of cultural awareness in healthcare to enhance nurses' cultural competence and elevate patient care standards. It advocates for the integration of cultural considerations into nursing education, specifically addressing the needs of indigenous communities
Sociodemographic and Clinical Profile, Adherence to Treatment, and Perceived Social Support among Hemodialysis Patients
Authors: B. Nuñez Baby Danica
Published: June 2024

The presence of social support and medication adherence have a significant impact on the management of chronic renal disease. Aim:The objective of this study was to assess the correlation between sociodemographic and clinical characteristics, perceived social support, and treatment adherence in hemodialysis patients at a provincial hospital in Biliran during the last quarter of 2022. Methods:The present study employed a quantitative research approach utilizing a descriptive-correlational design. Data collection was conducted through the administration of a three-part survey questionnaire. Results:The study's findings indicate a moderate correlation between the job position's sociodemographic profile and the perceived social support from significant others. Similarly, a moderate correlation was observed between the clinical profile of the kind of vascular utilized and the perceived social support from significant others. Astrong and statistically significant association was seen between marital status and compliance with therapy. There was a lack of statistically significant correlation seen between the perceived level of social support and adherence to medication, attendance at hemodialysis sessions, and adherence to food and fluid restrictions in the context of therapy. In general, the findings indicate a lack of statistically meaningful association between perceived social support and treatment adherence. Conclusion:The perceived social support of a significant other is influenced by both employment level and the type of vascular used. When an individual secures employment and develops an arteriovenous fistula, it leads to a heightened perception of social support from their significant other. Consequently, an adherence improvement strategy was established
Parental Stress among Family Caregivers of Children with Autism in a Teaching Hospital
Authors: Hamidon Nur Ashida , Mohd Anuar Nur Ily Shazwany , Ahmad Sharoni Siti Khuzaimah , Mohd Isa Nur Azah
Published: June 2024

Parenting is a journey that may bring joy, happiness, challenges, and frustration. However, raising children with autism with unpredictable behavior may elevate parental stress among parents and family caregivers. Objective: The study aims to assess parental stress among family caregivers of children with autism in a teaching hospital. Methods:This quantitative cross-sectional study was conducted at Hospital Al-Sultan Abdullah (HASA), University Technology MARA(UiTM), using a convenient sampling technique with a total sample size of 110 parents and family caregivers of children with autism (n= 110). An online questionnaire consisting of the Parental Stress Scale (PSS) and the Childhood Autism Spectrum Test (CAST) was used in this study to assess the level of parental stress and identify the severity of probable autistic behavior. Results:The finding shows that 75.5% of the participants were female and 94.5% were Malay. Most autistic children were male (63.6%), and most children (n= 81, 73.6%) had severe autistic behavior. However, 82.7% of participants reported low parental stress (mean = 34.41±13.06). Caregivers were found to have higher stress levels t(108) = -2.16; p=0.033). Besides, there was no significant association between the level of parental stress and the severity of autism (r=0.035, p=0.715). Conclusion:Special intervention is needed for the caregiver to improve stress management strategies by involving health care professionals for counseling and assistance to address the effects of stress. Alarger sample size is recommended for future research to enhance external validity.
Psychoeducational and Psychological Distress Levels in Women with Breast Cancer: A Systematic Review
Authors: Mustikaningsih Dewi , Prajoko Yan Wisnu , Anggorowati Anggorowati , Wilandika Angga , Puteri Utomo Shella Febrita , Alamsyah Ridwan Maulana
Published: June 2024

Psychoeducation has become a popular intervention for women who have been patients with breast cancer (BC). The effectiveness of psychoeducation on the psychological distress levels of patients with breast cancer was assessed in this systematic review comparison. The aim is a systematic review to assess the effects of psychoeducation on anxiety and depression in women with BC diagnoses. Methods:The Cochrane Library, Ebsco, Embase, and PubMed databases were used for RCTdata collection, using various keyword combinations such as "psychoeducation," “breast cancer diagnosis," "anxiety," "depression," "psychological distress," and randomized controlled trial." Only papers focusing on interventions related to psychoeducation and psychological distress in patients with BC diagnoses were collected. Furthermore, the inclusion criteria include breast cancer women over 18 years of age who have had breast cancer diagnosis. The selected articles were all published between 2001 and 2022. Results:A total of 2,181 participants from fifteen RCTs (1,158 psychoeducation and 1,023 controls) were included. The risk of bias (ROB) study used the Joanna Briggs Institute (JBI) for RCT, with results in the 89.74% good category. Analysis data will describe characteristic studies, ROB, and outcome psychoeducation. Psychoeducation significantly decreased the psychological distress level associated with BC diagnosis when compared to controls. Conclusion:Psychoeducation has the potential to be used as an intervention to assist patients in their pathways of primary breast cancer treatment after surgery. It was discovered that psychoeducation lowers psychological distress, which benefits the patients.
Oncology Nurses' Knowledge, Attitudes, and Factors in Cancer Pain – A Systematic Review
Authors: Baalann Krishna Prasanth , Joseph Danti , Bhandari Ashni , Kulkarni Pallavi , Agarwal Gaurav , Agarwal Shilpi
Published: June 2024

This systematic study thoroughly examines the detailed knowledge, attitudes, and complex aspects influencing oncology nurses' cancer pain treatment. This study aims to investigate the challenges and potential avenues confronted by oncology nurses specializing in cancer pain treatment; a thorough exploration of diverse scholarly resources was undertaken. Methods:The inquiry encompassed an exhaustive literature review from prominent databases, including Web of Science,SCI,Scopus,ScienceDirect,andProQuest.Employinganethicalandsystematic methodology, a comprehensive examination was conducted into a broad spectrum of studies encompassing the understanding, attitudes, and variables related to addressing pain in cancer patients among oncology nurses. Results:The evaluation focused on improving oncology nurses' knowledge and attitudes towards cancer pain management. Nurses' knowledge levels were assessed, revealing a wide range from 5.13% to 84%. Doctors demonstrated superior knowledge and attitudes compared to nurses. Nurses showed a mean score of 20.08 out of 39 (51.5%) in pain management, while doctors scored 24.3 out of 39 (62.3%). The study emphasizes the need for tailored educational interventions toaddressknowledgegapsandimprovecancerpainmanagementpracticesamongnurses. Conclusion:This systematic analysis underscores the need for accurate cancer pain treatments, highlighting gaps in oncology nurses' knowledge and the need for tailored educational programs.
Morphological Analysis of Urban Slums: A Case Study of Gaushala-Marrian, Faisalabad
Authors: Manzoor Bazla , Gulzar Saima , Mahmood Ayaz
Published: June 2024

Slums are the densely populated areas which are present in all the developed cities of the world. Pakistan is a third-world country and people from the rural areas prefer to live in the urban areas which are relatively better. This gave rise to urbanization and city space began to decrease. The development of slums in Pakistan initiated since the time of its establishment. Two of the earliest established slums are Goshala-Marrian in Faisalabad (the third largest city of Pakistan), Punjab. The built area of the city is greatly influenced by the establishment and growth of slums. This unplanned urbanization is required to be analyzed with respect to its physical elements, so that, the living quality of the inhabitants can be enhanced. The current living conditions were observed to plan for a better environment. Legalization of these areas is a mandate to be followed. The administration and the inhabitants need to put in joint efforts to upgrade the area.
Effect of Printed and Digital Instructional Material on Germane Cognitive Load of Students in the Subject of General Science at the Elementary Level
Authors: Jan Afroz , Ambreen Munazza , Abbas Qaisar
Published: June 2024

The current study employed an experimental design with a quantitative approach to examine the impact of digital and printed instructional media on the germane cognitive load of elementary school students for the subject of General Science. The participants were 7th-grade students enrolled in high schools located in a district of Punjab. The digital instructional media utilized in the study included instructional videos and PowerPoint presentations, while textbooks were used as the printed instructional media. The researchers adopted the test developed by Leppink, Paas, Van der Vleuten, & Van Merriënboer after obtaining permission. The results revealed that the group exposed to instructional videos exhibited the lowest germane cognitive load, followed by the group that used textbooks. In contrast, the group that received instruction through PowerPoint presentations demonstrated the highest germane cognitive load. The observed differences in germane cognitive load across the three groups were found to be statistically significant.
Revisiting the microsurgical anatomy of the sagittal stratum and surgical implications: fiber microdissection and tractography study
Authors: Gülsuna Beste , Güngör Abuzer , Yazgan Pınar , Erol Gökberk , Middlebrooks Erik H. , Börcek Alp Özgün , Weninger Wolfgang J. , Türe Uğur
Published: June 2024

OBJECTIVE

The term "sagittal stratum" was coined by Heinrich Sachs in 1892 to define a parasagittally oriented white matter layer at the temporo-occipital cortex. Although this term has been widely used for more than 100 years, the description, classification, borders, and involved fibers of the structure vary among authors and remain imprecise. Through fiber microdissection and tractography, the authors aimed to define the sagittal stratum and resolve the uncertainty by revealing the relationship of this structure to other cerebral white matter pathways and the orientation of fibers in it.

METHODS

Twenty postmortem human cerebral hemispheres were prepared according to Klingler’s method. Fiber dissections were performed under a surgical microscope and with microsurgical techniques. The results of dissection at each step were photographed with 2D and 3D imaging techniques, and 3D photogrammetry techniques were used to create a 360° model. Diffusion tensor imaging and 7T high-resolution MRI were used to confirm the findings.

RESULTS

This study revisited the 3D organization of white matter tracts in the sagittal stratum through fiber microdissection and tractography. The microneuroanatomical structure of the sagittal stratum and its special organization with fibers from all three fiber systems are demonstrated. The authors’ findings revealed that the sagittal stratum has two layers consisting of four different fiber tracts. Its external layer consists of a long association fiber and a commissural fiber, while its internal layer consists of intertwined projection fibers, including temporo-parieto-occipitopontine fibers and the posterior thalamic peduncle. Detailed microdissection also showed the location of the posterior thalamic peduncle in the most medial site of all posterior hemispheric projection fibers.

CONCLUSIONS

The structure of the sagittal stratum is distinctive in that it contains all three main fiber systems: association, commissural, and projection. Because of its expansive location in the temporal and occipital lobes, it can be damaged by most neurosurgical pathologies and procedures. The authors emphasize the significance of preserving the sagittal stratum during surgical interventions while also challenging the notion of a "silent" brain, suggesting that the current inability to fully comprehend cerebral function contributes to this misconception. Detailed knowledge of the complex white matter anatomy of the sagittal stratum can guide neurosurgeons in surgical planning and the selection of appropriate surgical approaches with intraoperative orientation for safe surgery and less comorbidity.
Hoffmann’s sign in cervical spondylotic myelopathy patients: pathological insights from neuroimaging
Authors: Chang Jianchao , Zhu Kun , Wang Ying , Zhang Siya , Li Yan , Zuo Junxun , Xie Bingyong , Ni Haoyu , Yao Jiyuan , Xu Zhibin , Bian Sicheng , Yan Tingfei , Wu Xianyong , Chen Senlin , Xu Peng , Song Peiwen , Wu Yuanyuan , Shen Cailiang , Zhu Jiajia , Yu Yongqiang , Dong Fulong
Published: June 2024

OBJECTIVE

Hoffmann’s sign testing is a commonly used physical examination in clinical practice for patients with cervical spondylotic myelopathy (CSM). However, the pathophysiological mechanisms underlying its occurrence and development have not been thoroughly investigated. Therefore, the present study aimed to explore whether a positive Hoffmann’s sign (PHS) in CSM patients is associated with spinal cord and brain remodeling and to identify potential neuroimaging biomarkers with diagnostic value.

METHODS

Seventy-six patients with CSM and 40 sex- and age-matched healthy controls (HCs) underwent multimodal MRI. Based on the results of the Hoffmann’s sign examination, patients were divided into two groups: those with a PHS (n = 38) and those with a negative Hoffmann’s sign (NHS; n = 38). Quantification of spinal cord and brain structural and functional parameters of the participants was performed using various methods, including functional connectivity analysis, voxel-based morphometry, and atlas-based analysis based on functional MRI and structural MRI data. Furthermore, this study conducted a correlation analysis between neuroimaging metrics and neurological function and utilized a support vector machine (SVM) algorithm for the classification of PHS and NHS.

RESULTS

In comparison with the NHS and HC groups, PHS patients exhibited significant reductions in the cross-sectional area and fractional anisotropy (FA) of the lateral corticospinal tract (CST), reticulospinal tract (RST), and fasciculus cuneatus, concomitant with bilateral reductions in the volume of the lateral pallidum. The functional connectivity analysis indicated a reduction in functional connectivity between the left lateral pallidum and the right angular gyrus in the PHS group. The correlation analysis indicated a significant positive association between the CST and RST FA and the volume of the left lateral pallidum in PHS patients. Furthermore, all three variables exhibited a positive correlation with the patients’ motor function. Finally, using multimodal neuroimaging metrics in conjunction with the SVM algorithm, PHS and NHS were classified with an accuracy rate of 85.53%.

CONCLUSIONS

This research revealed a correlation between structural damage to the pallidum and RST and the presence of Hoffmann’s sign as well as the motor function in patients with CSM. Features based on neuroimaging indicators have the potential to serve as biomarkers for assessing the extent of neuronal damage in CSM patients.
Long-term follow-up of pallidal deep brain stimulation for craniocervical dystonia: is the globus pallidus internus the best target?
Authors: Zhao Zhuoling , Ren Zhiwei , Hu Yongsheng , Yu Kaijia , Yin Fangzhao , Li Jianyu , Zhang Guojun
Published: June 2024

OBJECTIVE

Craniocervical dystonia (CCD) is a common type of segmental dystonia, which is a disabling disease that has been frequently misdiagnosed. Blepharospasm or cervical dystonia is the most usual symptom initially. Although deep brain stimulation (DBS) of the globus pallidus internus (GPi) has been widely used for treating CCD, its clinical outcome has been primarily evaluated in small-scale studies. This research examines the sustained clinical effectiveness of DBS of the GPi in individuals diagnosed with CCD.

METHODS

The authors report 24 patients (14 women, 10 men) with refractory CCD who underwent DBS of the GPi between 2016 and 2023. The severity and disability of the dystonia were evaluated using the Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS). The BFMDRS scores were collected preoperatively, 6 months postoperatively, and at the most recent follow-up visit.

RESULTS

The mean age at onset was 52.0 ± 11.0 years (range 33–71 years) and the mean disease duration was 63.3 ± 73.3 months (range 7–360 months) (values for continuous variables are expressed as the mean ± SD). The mean follow-up period was 37.5 ± 23.5 months (range 6–84 months). The mean total BFMDRS motor scores at the 3 different time points were 13.3 ± 9.4 preoperatively, 5.0 ± 4.7 (55.3% improvement, p < 0.001) at 6 months, and 4.5 ± 3.6 (56.6% improvement, p < 0.001) at last follow-up. The outcomes were deemed poor in 6 individuals.

CONCLUSIONS

Inferences drawn from the findings suggest that DBS of the GPi has long-lasting effectiveness and certain limitations in managing refractory CCD. The expected stability of the clinical outcome is not achieved. Patients with specific types of dystonia might consider targets other than GPi for a more precise therapy.
Ventral intermediate nucleus of the thalamus, dentatorubrothalamic tract, and caudal zona incerta: stimulation of which structure provides ongoing tremor control in patients with essential tremor?
Authors: Remore Luigi G. , Rifi Ziad , Tsolaki Evangelia , Ward Michael J. , Wei Wenxin , Tolossa Meskerem , Locatelli Marco , Bari Ausaf A.
Published: June 2024

OBJECTIVE

Essential tremor (ET) is the most common movement disorder. Deep brain stimulation (DBS) targeting the ventral intermediate nucleus (VIM) is known to improve symptoms in patients with medication-resistant ET. However, the clinical effectiveness of VIM-DBS may vary, and other targets have been proposed. The authors aimed to investigate whether the same anatomical structure is responsible for tremor control both immediately after VIM-DBS and at later follow-up evaluations.

METHODS

Of 68 electrodes from 41 patients with ET, the authors mapped the distances of the active contact from the VIM, the dentatorubrothalamic tract (DRTT), and the caudal zona incerta (cZI) and compared them using Friedman’s ANOVA and the Wilcoxon signed-rank follow-up test. The same distances were also compared between the initially planned target and the final implantation site after intraoperative macrostimulation. Finally, the comparison among the three structures was repeated for 16 electrodes whose active contact was changed after a mean 37.5 months follow-up to improve tremor control.

RESULTS

After lead implantation, the VIM was statistically significantly closer to the active contact than both the DRTT (p = 0.008) and cZI (p < 0.001). This result did not change if the target was moved based on intraoperative macrostimulation. At the last follow-up, the active contact distance from the VIM was always significantly less than that of the cZI (p < 0.001), but the distance from the DRTT was reduced and even less than the distance from the VIM.

CONCLUSIONS

In patients receiving VIM-DBS, the VIM itself is the structure driving the anti-tremor effect and remains more effective than the cZI, even years after implantation. Nevertheless, the role of the DRTT may become more important over time and may help sustain the clinical efficacy when the habituation from the VIM stimulation ensues.
Uncovering the rate and risk factors of intrathecal baclofen pump–associated complications in the adult population
Authors: Tiefenbach Jakov , Machado Andre G. , Bethoux Francois
Published: June 2024

OBJECTIVE

The aim of this study was 1) to describe the rate of intrathecal baclofen (ITB)–associated complications at a large tertiary center, and 2) to evaluate the impact of patient-related factors on the likelihood of developing such complications.

METHODS

A retrospective single-center study was carried out. A total of 301 eligible patients were included in the analysis. Univariate regression models were used to evaluate the impact of age, sex, diagnosis, ambulation status, modified Ashworth scale score, body mass index, diabetes status, and pain level on the likelihood of developing a device-related infection, pump malfunction, catheter malfunction, and other clinically significant complications.

RESULTS

Overall, 27% of patients experienced an ITB-related complication. The most common complications included infection (6%, 18/301), pump malfunction (7.3%, 22/301), and catheter malfunction (14%, 42/301). The univariate analyses revealed that the patient’s ambulatory status had a significant impact on the likelihood of developing a catheter-related malfunction. Furthermore, a trend toward significance was identified between patients’ preoperative body mass index and device-related infection. Finally, the risk of suffering any ITB-related complications was statistically correlated with the number of years that had passed since the initial pump implantation.

CONCLUSIONS

The authors’ analysis reveals a previously underrecognized association between ambulatory status at the time of ITB pump implantation and the incidence of catheter-related complications, and confirms the impact of time since surgery on the risk of developing any ITB-related complication. The patient’s age, sex, diagnosis, diabetes status, or pain level at baseline were not associated with the risk of complications. Collectively, these insights contribute novel information to the existing literature, providing practical value for physicians in guiding patient selection for ITB therapy.
Nonselective lumbosacral ventral-dorsal rhizotomy for the management of lower-limb hypertonia in nonambulatory children with cerebral palsy
Authors: Abdelmageed Sunny , Dalmage Mahalia , Mossner James M. , Trierweiler Robin , Krater Timothy , Raskin Jeffrey S.
Published: June 2024

OBJECTIVE

Children with cerebral palsy (CP) often experience medically refractory hypertonia, for which there are surgical therapies including neuromodulation and rhizotomy. Traditional surgical treatment for medically refractory mixed hypertonia or dystonia includes intrathecal baclofen pumps and selective dorsal rhizotomy. A nonselective lumbosacral ventral-dorsal rhizotomy (VDR; ventral and dorsal roots lesioned by 80%–90%) has the potential to address the limitations of traditional surgical options. The authors highlighted the institutional safety and efficacy of nonselective lumbosacral VDR for palliative tone management in nonambulatory patients with more severe CP.

METHODS

The authors performed a retrospective analysis of patients who had undergone lumbosacral VDR between 2022 and 2023. Demographic factors, clinical variables, and operative characteristics were collected. The primary outcomes of interest included tone control and quality of life improvement. Secondary outcome measures included, as a measure of safety, perioperative events such as paresthesias. Postoperative complications were also noted.

RESULTS

Fourteen patients (7 female) were included in the study. All patients had undergone a T12–L2 osteoplastic laminoplasty and bilateral L1–S1 VDR. Nine patients had quadriplegic mixed hypertonia, 4 had quadriplegic spasticity, and 1 had generalized secondary dystonia. Following VDR, there was a significant decrease in both lower-extremity modified Ashworth Scale (mAS) scores (mean difference [MD] −2.77 ± 1.0, p < 0.001) and upper-extremity mAS scores (MD −0.71 ± 0.76, p = 0.02), with an average follow-up of 3 months. In the patient with generalized dystonia, the lower-extremity Barry-Albright Dystonia Scale score decreased from 8 to 0, and the overall score decreased from 32 to 13. All parents noted increased ease in caregiving, particularly in terms of positioning, transfers, and changing. The mean daily enteral baclofen dose decreased from 47 mg preoperatively to 24.5 mg postoperatively (p < 0.001). Three patients developed wound dehiscence, 2 of whom had concurrent infections.

CONCLUSIONS

Lumbosacral VDR is safe, is effective for tone control, and can provide quality of life improvements in patients with medically refractory lower-limb mixed hypertonia. Lumbosacral VDR can be considered for palliative tone control in nonambulatory patients with more severe CP. Larger studies with longer follow-ups are necessary to further determine safety and long-term benefits in these patients.
Palliative single-level selective dorsal rhizotomy for children with spastic cerebral palsy Gross Motor Function Classification System level IV and V: a case series and systematic review of the literature
Authors: Licci Maria , Frank Nicole Alexandra , Greuter Ladina , Rasadurai Abeelan , Fernandes Arroteia Isabel , Juenemann Stephanie , Guzman Raphael , Soleman Jehuda
Published: June 2024

OBJECTIVE

Single-level selective dorsal rhizotomy (SDR), typically indicated for ambulatory patients, is a controversial topic for severe spastic cerebral palsy (CP) with Gross Motor Function Classification System (GMFCS) level IV or V. The objective of this case series and systematic literature review was to outline the indication and outcome of palliative SDR for nonambulatory patients with CP and GMFCS level IV and V, focusing on improvement of spasticity and of patient and caregiver reported quality of life assessment.

METHODS

A retrospective case series of patients with CP and GMFCS level IV or V who underwent single-level SDR at the authors’ institution is presented. Furthermore, two databases (PubMed and Embase) were searched and a systematic review with a search string based on the terms "selective dorsal rhizotomy," "cerebral palsy," and "outcome" was conducted. The primary outcome was the reduction of spasticity based on the modified Ashworth scale (MAS). Secondary outcomes were change on the Gross Motor Function Measure-66 (GMFM-66), evaluation of patient-reported outcome measures (PROMs), surgical morbidity, and mortality.

RESULTS

Eleven consecutive children under the age of 25 years undergoing palliative single-level SDR were included. All patients showed a reduction in MAS score (mean 1.09 ± 0.66 points) and no surgical morbidity and mortality occurred. For the systematic review results from our case series, in addition to 4 reports, 274 total patients were included. Reduction of spasticity based on MAS score was noted in all studies (mean range 1.09–3.2 points). Furthermore, in 2 studies spasticity of the upper extremities showed a MAS score reduction as well (range 1.7–2.8 points). The GMFM-66 score improved in 72% of the patients, while bladder function improved in 78% of the patients. Based on the PROMs, 92% of the patients/caregivers were satisfied with the outcome and their quality of life after the procedure. Two wound infections (2.7%) and one CSF leak (1.3%) occurred, while no surgery-related deaths were described.

CONCLUSIONS

This analysis showed an improvement in spasticity, daily care, and comfort for patients with CP and GMFCS levels IV and V. Larger cohorts analyzing the outcome of palliative single-level SDR, based on the MAS, GMFM-66, and PROMs, are still needed and should be the focus of future studies.

Systematic review registration no.: CRD42024495762 (https://www.crd.york.ac.uk/prospero/)
Robotic thoracic surgery for neurogenic tumors
Authors: Niedermaier Benedikt , Griffo Raffaella , Grott Matthias , Deissner Henrike , Muley Thomas , Neumann Jan-Oliver , Winter Hauke , Eichhorn Martin
Published: June 2024

OBJECTIVE

Thoracic neurogenic tumors usually present as benign nerve sheath tumors that can be resected via transthoracic or posterior approaches, depending on the anatomical location. Robot-assisted thoracic surgery (RATS) is increasingly being used for the transthoracic approach, but evidence is very limited. The authors initiated the current study to evaluate the efficacy and safety of RATS for thoracic neurogenic tumors.

METHODS

This retrospective study is based on a prospectively created database that includes all RATS surgeries between 2018 and 2023. All patients with histologically confirmed neurogenic tumors were included in the study. The patients’ medical and surgical records as well as radiological and pathological findings were analyzed.

RESULTS

During a 5-year period, 27 patients underwent robotic resection of neurogenic tumors at a high-volume thoracic surgery center. Two patients had previously undergone posterior laminectomy for resection of the intraspinal components. The pathologies included schwannomas (18, 64%), ganglioneuromas (8, 29%), 1 paraganglioma, and 1 neurofibroma occurring close to a schwannoma unilaterally in the same patient. The median tumor size was 4.7 cm (range 0.9–11.4 cm). The median operating time was 69 minutes (range 27–169 minutes), and the median postoperative stay was 3 days (range 1–19 days). There was one conversion due to adhesions after a previous surgery. No major bleeding occurred. There was no perioperative mortality. Morbidity included a lymphatic fistula (n = 1), pneumonia (n = 1), prolonged air leak (n = 1), and 4 cases of postoperative pain persisting for more than 4 weeks. Neurological complications were mostly observed in patients with tumors located at the thoracic apex: 2 cases of Horner’s syndrome, 2 cases with compensatory hyperhidrosis, 1 patient with paresis of the recurrent laryngeal nerve, and a T1 lesion resulting in a minor motor deficit of the small hand muscles (Medical Research Council grade 4) and hypoesthesia of the respective dermatome.

CONCLUSIONS

RATS for thoracic neurogenic tumors is feasible and safe. Tumors at the thoracic apex are at high risk of neurological deficit and should be approached with care. Close interdisciplinary collaboration between neurosurgeons and thoracic surgeons is necessary for optimal patient selection and a good postoperative outcome.
Phantom and in vivo accuracy of frameless optical navigation in stereotactic laser interstitial thermal therapy
Authors: Viozzi Ilaria , Schoonbrood Maxime J. P. , Ribbens Vincent J. , Laan Mark ter , Overduin Christiaan G.
Published: June 2024

OBJECTIVE

Targeting accuracy presents a key factor in achieving maximal safe ablation in laser interstitial thermal therapy (LITT). The VarioGuide system has proven precise for brain biopsies, but data showing its accuracy in combination with LITT are limited. The aim of this study was to determine the phantom and in vivo accuracy of LITT probe placement using the VarioGuide system and to evaluate the effect of targeting error on maximum possible ablation volume.

METHODS

Stereotactic LITT probe placement was performed using the VarioGuide system in 3 phantom skulls. The same system was used in 10 patients treated with LITT, for which data were retrospectively analyzed. Target point error (TPE), target depth deviation (TDD), target lateral deviation (TLD), and angular deviation (AD) were derived from intraprocedural MRI scans of both the phantom and in vivo trajectories. In vivo, the effect of targeting error on the maximum reachable ablation was calculated as the difference between the planned maximal achievable tumor ablation (PTA) and the actual maximal achievable tumor ablation (ATA).

RESULTS

In total, 24 phantom and 16 in vivo trajectories were analyzed. In the phantom setting, the median TPE was 3.3 mm and median AD was 1.9°. Targeting accuracy significantly decreased for longer trajectories and those less perpendicular to the skull. In patients, the authors observed a comparable median TPE of 4.0 mm but significantly higher AD of 3.2°. In vivo, targeting inaccuracy resulted in a median decrease in maximum achievable ablation volume of 6% as compared to the planned trajectory.

CONCLUSIONS

The authors’ study indicates that utilizing the VarioGuide system in combination with LITT yields an average targeting error as large as 4 mm, which was smaller for shorter and straighter trajectories. In patients, targeting inaccuracy resulted in a median 6% decrease of the planned tumor ablation volume. These are important factors that should be considered in optimal case planning and patient selection in LITT.
Laser interstitial thermal therapy in neurosurgery: a single-surgeon experience of 313 patients
Authors: Gurses Muhammet Enes , Lu Victor M. , Gecici Neslihan Nisa , Gökalp Elif , Shah Khushi Hemendra , Metzler Ashley Rose , Chandar Jay , Merenzon Martin A. , Shah Ashish H. , Ivan Michael E. , Komotar Ricardo J.
Published: June 2024

OBJECTIVE

Real-time MRI-guided focused laser interstitial thermal therapy (LITT) is a minimally invasive surgical treatment choice for challenging intracranial lesions that are either resistant to conventional therapies or located in deep or critical areas of the brain. However, existing studies on LITT within surgical neuro-oncology are relatively small and have limited follow-up periods. The authors aimed to present a comprehensive analysis of their experiences with LITT in surgical neuro-oncology, with the intent to provide a clearer understanding of the safety and efficacy of this procedure.

METHODS

This study was an exploratory cohort analysis encompassing all patients who underwent LITT for brain tumors at a single center between 2013 and 2023. The primary focus was extent of ablation (EOA), time to recurrence (TTR), and overall survival (OS). Secondary outcomes, including the rate of complications, were also evaluated. Comparative analyses were conducted based on lesion subtypes, and factors predicting outcomes were identified.

RESULTS

Three hundred thirteen patients underwent LITT procedures. During a mean follow-up of 10.4 months, 66.8% of patients remained alive and 26.2% of the ablated lesions recurred. The mean age of the cohort was 60.4 ± 13.3 years (58.5% female). The lesion subtypes that were treated comprised metastases (30%), glioblastoma (GBM; 41.6%), low-grade glioma (9.1%), radiation necrosis (11.4%), and meningioma (2.2%). The permanent neurological deficit rate was 14% (n = 44), with 25 (8%) of them new-onset deficits and 19 deficits (6.1%) that were present preoperatively and did not resolve after LITT. The mean TTR and OS were 12.2 and 38.1 months, respectively. TTR and OS varied significantly by lesion subtype (p < 0.001, log-rank analysis). A high-grade lesion was identified as the single factor linked to tumor recurrence. Age, high-grade lesion, preoperative lesion volume, and readmission within 30 days were identified as factors significantly associated with OS in the multivariable Cox regression analysis. EOA > 100% predicted longer OS in metastases and GBM by log-rank analysis.

CONCLUSIONS

LITT stands as a secure and feasible ablative treatment choice for intracranial lesions, potentially suitable for specific patient cases otherwise not amenable to surgical intervention. These findings further corroborate the safety of the procedure and its favorable outcomes, underscoring its potential significance in clinical practice.
Defining light transmission aggregometry cutoff values for clopidogrel and aspirin resistance in flow diversion treatment of intracranial aneurysms
Authors: Enriquez-Marulanda Alejandro , Filo Jean , Ramirez-Velandia Felipe , Fodor Thomas , Sconzo Daniel , Young Michael , Muram Sandeep , Shutran Max , Granstein Justin , Taussky Philipp , Ogilvy Christopher S.
Published: June 2024

OBJECTIVE

Concern about thromboembolic events after flow diversion (FD) warrants dual antiplatelet therapy for 3 to 6 months. Platelet function tests are routinely performed prior to the procedure to detect clopidogrel responsiveness, as resistance is associated with CYP2C19 gene polymorphisms. This study aimed to identify optimal cutoff values in light transmission aggregometry (LTA) for clopidogrel and aspirin as predictive indicators of thromboembolic complications.

METHODS

The authors conducted a retrospective analysis of aneurysms treated with FD between 2013 and 2023 at a single academic institution. Patients with LTA data for adenosine diphosphate (ADP) and arachidonic acid (ARA) were included, excluding those with aborted procedures. Receiver operating characteristic curves were plotted for ADP and ARA assays to determine optimal cutoff values.

RESULTS

A total of 442 patients harboring 552 aneurysms treated in 485 procedures were selected for this analysis. Complete and near-complete aneurysm occlusion on the last radiological follow-up was achieved in 81.8% of aneurysms in a median last imaging follow-up of 13.9 months. A good functional outcome (modified Rankin Scale score ≤ 2) was achieved in 96.3% of patients on the last follow-up. Thromboembolic complications occurred in 4.9% of procedures, and intracranial hemorrhagic complications in 1.9%. For the ADP assay, a value ≥ 40% reached a sensitivity of 82.1% and a specificity of 42.9% with a positive likelihood ratio (LR) of 1.50. For the ARA assay, a value ≥ 13.5% reached a sensitivity of 82.1% and a specificity of 45.6% with a positive LR of 1.51.

CONCLUSIONS

This study analyzed the largest FD-treated cohort in which optimal LTA platelet function thresholds for clopidogrel were evaluated and is the first to assess LTA values for aspirin. The authors found that values ≥ 40% for clopidogrel and ≥ 13.5% for aspirin were optimal for predicting thromboembolic complications after FD in treating aneurysms.