bluuebunny/crossref_metadata_2025 huggingface dataset:
CHARLES MAURRAS AND THE LITERATURE OF ACTION FRANCAISE
Authors: Fokin S.
Published: November 2018

The paper sets out to examine the literary impulses at the heart of Charles Maurras’ (1868-1952) philosophy, namely, the doctrine of integral nationalism, which signified French literary nationalism in the 20th century. The author finds that, in Maurras’ view, the concept of ‘integral’ was inseparable from the ‘monarchy’, with the latter destined to blend together the real social oppositions spawned by various anarchies, be it political, religious, familial, university-based, economic or even literary ones.
THE METAPHYSICAL THEME IN YOURI MANDELSTAMM’S ARTICLES
Authors: Dubrovina Y.
Published: November 2018

This issue includes four literary essays: an introductory article by Yelena Dubrovina, and three essays by Youri Mandelstamm from the archives of his granddaughter, Marie Stravinsky: ‘A Call for Metaphysics’ in Émigré Literature [ ‘Metafizicheskiy zakaz’ v emigrantskoy literature], The Fate of the Novel [Sud’ba romana] and Love in the Modern Novel [Lyubov’ v sovremennom romane].

In the late 1920s and the early 1930s, the centre of Russian cultural life moved from St. Petersburg to Paris. A human tragedy in a foreign land, with life as a constant struggle for survival, intensified the perception of the world and the interaction with the creative process, and made young émigré writers take a profound look inward. Freed from Soviet repression, their creative process was liberated. Based on numerous philosophical studies of that period, a metaphysical theme began to dominate the work of émigré writers. A new metaphysical approach, a spiritual and religious awakening are clearly traced in Russian émigré literature. The importance of such an approach was a key theme in the critical essays of Youri Mandelstamm, a Russian poet and literary critic. His inner emotional wealth and his ability to look into the core of surrounding events, his philosophical approach to life, love, religion and creative process were the essence of his work.
Y. G. Fridstein. Inner Circle. Y. G. Fridstein. The Fifth Book. Y. G. Fridstein. Back to Theatre Reviews
Authors: Egorova L.
Published: November 2018

Y. G. Fridstein. Inner Circle. Y. G. Fridstein. The Fifth Book. Y. G. Fridstein. Back to Theatre Reviews.
E. L. Demenok. ‘Odessa has very many shores’
Authors: Kudrin O.
Published: November 2018

E. L. Demenok. ‘Odessa has very many shores’.
‘EVERY WORD BREATHES THE WARMTH OF HIS HEART...’ LETTERS OF A. TVARDOVSKY FROM THE WAR
Authors: Ermakov O.
Published: November 2018

The article is devoted to the book Letters from the War, 1941-1945 [Pis’ma s voyny. 1941-1945], which comprises 139 letters written by A. Tvardovsky to his wife while he was on the front lines. The letters offer a sequence of insights into the poet’s soul affected by the violence of yet another whirlwind of history. They reveal a lot about the poet’s personality and creative method. These 139 letters are a testimony of a great love as well as creativity in times of war. The paper has a very straightforward plot: the author examines the letters in chronological order, starting with the first one, written in 1941, all the way to the last one, dated 1945. The research cites other resources, including ancient Indian poetry, Homer’s Odyssey, a story by a contemporary journalist about the life of evacuees (famous writers) in the small town of Chistopol, A. Kondratovich’ book Aleksandr Tvardovsky, Three Soldiers by J. Dos Passos, A. Bek’s reminiscences, and V. Akatkin’s article A. T. Tvardovsky’s Finnish Sketches in the Dialogue of Epochs [Finskie zapisi A. T. Tvardovskogo v dialoge vremen]. What sets this paper apart from other studies is the use of personal observations and insights collected by the author during his service in Afghanistan in the 1980s.
KONSTANTIN FEDIN. A PORTRAIT OF A PUBLISHER
Authors: Kabanova I. , Kasovich K. , Poznyakova E.
Published: November 2018

The paper deals with the little-known aspects of the famous writer K. Fedin’s publishing activities. In the years from 1927 until 1934 he held an uninterrupted record as chairman of the editorial board at the Publishing House of Writers in Leningrad [Izdatelstvo pisateley v Leningrade, IPL], a cooperative that printed works of contemporary authors. Despite dramatic turns in history, the press enjoyed a steady growth in output, expanding its range of authors and genres; the story of the covert struggle between literature and politics is examined by the team of research fellows of the Saratov-based state museum of K. Fedin. With the help of their open archives, particularly letters and journals, they meticulously reconstruct Fedin’s activities as publisher: from the creation of the new publishing house, which united the poputchiks (satellites, fellow-travellers): authors who advocated preservation of the Russian literary tradition, free of ideological pressure, until the moment when Fedin’s much-cherished project was cannibalized by the mammoth publishing institution called The Soviet Writer [Sovetskiy Pisatel].
ESTIMATION OF THE MENTAL WORKING CAPACITY OF EMPLOYEES UNDER THE WATCH METHOD OF LABOR ORGANIZATION
Authors:   Ph.D., Associate Professor, Senior Researcher, Laboratory of Regulation Republican State Enterprise ", Bekeyeva Saulemay Aydarovna ,   Republican Research Labor Protection Institute of the Ministry of Labor and social protection of the population Republic of Kazakhstan",   , Astana. E-mail: nauka@rniiot.kz
Published: November 2018

In the study of workers of the gold ore processing plant in the dynamics of work shifts and shift work period, it was found that the interchangeable nature of labor leads to disruption of habitual biorhythms, more rapid development of fatigue and reduced mental performance. The reduction of physiological indicators for certain hours of work shifts justifies the need for maintaining regulated breaks in order to prevent professionally caused diseases and reduce the risk of industrial accidents.
Populist Transparency
Authors: Hetherington Kregg
Published: November 2018

This article is an ethnographic account of the politics of transparency in
Paraguay that focuses on the circulation of a particular binder full of
photocopies from the land registry during Paraguay’s embattled “transition
to democracy.” The concept of transparency posits a representational
relationship between documents and reality – i.e. governments are transparent
to the extent that they generate faithful and accessible documentary
representations of their activities. The article suggests that the difficulty of
creating a critical analysis of transparency has less to do with representations
than with contention over what counts as reality. The Paraguayan case
suggests that we might benefit from rethinking transparency through the logic
of populism, in which reality is itself created in the relationship between
leaders and their followers.
Voter Registration Cards, Political Subjectivity, and Trust in Paper in the Gambia
Authors: Hultin Niklas
Published: November 2018

This article examines the voter registration card and the social context of voter
registrations in the Gambia, West Africa. Drawing on recent ethnographies of
documents and using data on worries over foreigners’ efforts to fraudulently
obtain voter registration cards, a public information campaign on the Gambian
electoral process, international legal material on the Gambian democracy, and
observations at voter registration stations, the article argues that the voter
registration card delineates not only a national subject but also a generic
political subject. This subject is characterized by a commitment to a
bureaucratic process and an appreciation of the card as an official identification
document inseparable from the person it identifies. The article also considers
how the voter registration process allows Gambians to compare their
experiences to citizens of other countries. In a political context of an
authoritarian government and a weak rule of law, this comparison offers an
ideal of a modern democratic state that both enables criticism of the Gambia’s
present situation and confirms the centrality of a generic political subject to the
realization of that ideal.
Riding Along with Police
Authors: Waters Anita M. , Robben Antonius C.G.M. , Giacomantonio Chris , Herbert Steve
Published: November 2018

In the summer of 2008 I sent out a call to thirty former students from three
semesters between 2000 and 2005, to reflect on what they learned from the
“ride-alongs” with police, whether the project has changed their views on
social order and the state, on the practice of law enforcement, and on the
process of gathering knowledge about social life in general. Ten responded,
and their ideas show that the experience of police ethnography had a
considerable impact.
Convivencia and Securitization
Authors: Moffette David
Published: November 2018

Ceuta is a Spanish city in Northern Morocco. It is thus situated at a
European Union border on the African continent. In this context, I contend
that migration is generally considered a potential threat to the pacified local
order of things by the Christian majority. In order to protect this order of
things referred to as convivencia, Christian Ceutíes tend to prefer depoliticizing
strategies to manage migration. Nonetheless, migration
sometimes becomes highly politicized and is framed as a security issue. This
essay thus suggests that the concept of securitization is relevant to grasp the
problematization of migration in times of crisis in Ceuta and analyzes three
occurrences of local processes of securitization.
Contested Representations
Authors:   Halme-Tuomisaari,   Miia
Published: November 2018

As states become parties to international human rights treaties, they
undertake the obligation to provide periodic state reports to UN human
rights treaty bodies. Officially, state reports are paramount vehicles of
factual information of a given state’s human rights situation. Unofficially
their status may be contested and their data reduced to state propaganda.
This article examines this transformation through the submission of
China’s first state report to the Committee on Economic, Social and
Cultural Rights. The article shows how human rights documents of diverse
genres join together in a continual ceremony of dialogue. It connects
minute details of treaty body proceedings to more general developments in
the international human rights field, and argues that beneath the veneer of
diplomatic conduct accompanying human rights dialogue lays an intense
struggle for representation and legitimacy. It further discusses how this
struggle reflects the recent rise of Kantian theories of international law.
These theories seek to re-evaluate the foundational concept of international
law, namely ‘sovereign equality’, and, thus continue the mission civilisatrice
that has characterized elements of international collaboration for centuries.
Sentimentalising Persons and Things
Authors: Bens Jonas
Published: November 2018

In The Prosecutor v. Ahmad Al Faqi Al Mahdi, the International Criminal Court (ICC) tried the destruction of UNESCO World Heritage sites as a war crime for the first time. In this case, the value of things in relation to the value of persons became the central issue. Based on courtroom ethnography conducted during the proceedings and informed by affect and emotion research, this article identifies the rhetorical practice of sentimentalising persons and things as an important process of legal meaning making. Through sentimentalising, all parties rhetorically produce normative arrangements of bodies by way of emotionally differentiating the relevant persons, things and other entities from and affectively relating them to each other. Sentimentalising provides an affective-emotional frame in which to determine the degree of guilt and innocence, justice and injustice.
Justice, Loyalty and Cosmopolitan Politesse in Mauritius
Authors: Eriksen Thomas Hylland
Published: November 2018

It is a privilege and a pleasure to have the opportunity to comment on this issue’s forum, which is yet another challenging and beautifully written piece on cosmopolitanism and anthropology from Nigel Rapport. Taking his concept of cosmopolitan politesse as a departure point, Rapport here discusses the possibilities of cosmopolitanism as something which is not reducible to a specifically Western or European philosophical trajectory or political persuasion, as well as comparing justice with loyalty.
Long-term results of Gamma Knife surgery for optic nerve sheath meningioma
Authors: Liu Dong , Xu Desheng , Zhang Zhiyuan , Zhang Yipei , Li Yanhe , Liu Xiaomin , Jia Qiang , Zheng Ligao , Song Guoxiang
Published: November 2018

Object

The goal of this study was to assess the long-term results of Gamma Knife surgery (GKS) in patients harboring an optic nerve sheath meningioma (ONSM).

Methods

Thirty patients harboring an ONSM were treated with GKS between 1998 and 2003. Gamma Knife surgery was performed as the sole treatment option in 21 of these patients and resection had been performed previously in 9 patients. The mean volume of the tumor at the time of GKS was 3.6 cm3 (range 1.4–9.7 cm3), and the mean prescription peripheral dose was 13.3 Gy (range 10–17 Gy). The mean number of isocenters used to treat these lesions was 8 (range 5–14 isocenters).

Results

At a median follow-up of 56 months, visual acuity improved in 11 patients, remained stable in 13 patients (including 4 patients who were completely blind before GKS), and deteriorated in 6 patients. Follow-up images were available in all patients and showed tumor regression in 20 patients and stable tumor in 8 patients. Persistent imaging evidence of progression was only present in 2 patients. With the exception of reversible conjunctival edema in 4 cases, no other serious acute side effect was observed.

Conclusions

Gamma Knife surgery provides long-term tumor control for ONSM. The results of this study add substantial evidence that GKS may definitely become a standard treatment approach in selected cases of ONSM.
Safety and efficacy of Gamma Knife surgery for brain metastases in eloquent locations
Authors: Dea Nicolas , Borduas Martin , Kenny Brendan , Fortin David , Mathieu David
Published: November 2018

Object

Brain metastases are the most frequently occurring cerebral tumors. Tumors that are located in eloquent cerebral parenchyma can cause considerable morbidity and may pose a significant challenge during surgery. Gamma Knife surgery (GKS) is a recognized treatment modality for brain metastases. This study was undertaken to assess the safety and efficacy of GKS, specifically for brain metastases in eloquent locations.

Methods

Charts of patients harboring brain metastases that were treated by GKS at the Centre Hospitalier Universitaire de Sherbrooke between August 2004 and April 2008 were reviewed. Planning images were assessed by an independent neurosurgeon to assess tumor location. Eloquent locations included the primary motor, somatosensory, speech, and visual cortices; the basal ganglia; the thalamus; and the brainstem. Data on survival, tumor response, and complications were analyzed and compared with data published on surgical treatment of these lesions.

Results

During the study period, 650 metastases in 295 patients were treated with GKS; of these, 164 metastases in 95 patients were located in eloquent areas. In this subgroup, the median age of patients was 59 years and women constituted 57.9% of the population. The median Karnofsky Performance Scale score was 80% (range 50%–100%). Patients were categorized according to their recursive partitioning analysis class: Class 1, 22.1%; Class 2, 70.5%; and Class 3, 7.4% of patients. Non–small cell lung cancer was the most common primary tumor (63.2% of metastases), followed by small cell lung (8.4%), breast (7.4%), colorectal (5.3%), and renal cell (4.2%) cancers, as well as melanoma (4.2%). The median dose to the tumor margin was 18 Gy (range 14–24 Gy). The median duration of survival after GKS was 8.2 months. The recursive partitioning analysis class was the most significant variable affecting survival (p < 0.0001). Immediate control was achieved in 92.9% of tumors, and 68.6% of tumors were still controlled at the last follow-up. The median time to tumor progression was 16 months. Higher margin dose (p = 0.002), the absence of edema (p = 0.009), and the non–small cell lung cancer tissue type (p = 0.035) positively affected response rates. Steroid medications were no longer used in 46% of patients after GKS. New neurological deficits occurred in 5.7% of patients and seizures in 5.7%. All these deficits were transient and patients completely recovered in response to a temporary course of steroids. Imaging studies showed that new edema occurred in 8.6% of treated metastases and biopsy-proven radiation necrosis in 1.4%.

Conclusions

Gamma Knife surgery is safe and effective for brain metastases located in eloquent areas.
Analysis of radiosurgical results in patients with brain metastases according to the number of brain lesions: is stereotactic radiosurgery effective for multiple brain metastases?
Authors: Chang Won Seok , Kim Hae Yu , Chang Jin Woo , Park Yong Gou , Chang Jong Hee
Published: November 2018

Object

Whole-brain radiation therapy (WBRT), open resection, and stereotactic radiosurgery (SRS) are widely used for treatment of metastatic brain lesions, and many physicians recommend WBRT for multiple brain metastases. However, WBRT can be performed only once per patient, with rare exceptions. Some patients may require SRS for multiple metastatic brain lesions, particularly those patients harboring more than 10 lesions. In this paper, treatment results of SRS for brain metastasis were analyzed, and an attempt was made to determine whether SRS is effective, even in cases involving multiple metastatic brain lesions.

Methods

The authors evaluated the cases of 323 patients who underwent SRS between October 2005 and October 2008 for the treatment of metastatic brain lesions. Treatment was performed using the Gamma Knife model C or Perfexion. The patients were divided into 4 groups according to the number of lesions visible on MR images: Group 1, 1–5 lesions; Group 2, 6–10 lesions: Group 3, 11–15 lesions; and Group 4, > 15 lesions. Patient survival and progression-free survival times, taking into account both local and distant tumor recurrences, were analyzed.

Results

The patients consisted of 172 men and 151 women with a mean age at SRS of 59 years (range 30–89 years). The overall median survival time after SRS was 10 months (range 8.7–11.4 months). The median survival time of each group was as follows: Group 1, 10 months; Group 2, 10 months; Group 3, 13 months; and Group 4, 8 months. There was no statistical difference between survival times after SRS (log-rank test, p = 0.554), although the probability of development of new lesions in the brain was greater in Group 4 (p = 0.014). Local tumor control rates were not statistically different among the groups (log-rank test, p = 0.989); however, remote disease progression was more frequent in Group 4 (log-rank test, p = 0.014).

Conclusions

In this study, patients harboring more than 15 metastatic brain lesions were found to have faster development of new lesions in the brain. This may be due to the biological properties of the patients' primary lesions, for example, having a greater tendency to disseminate hematogenously, especially to the brain, or a higher probability of missed or invisible lesions (microscopic metastases) to treat on stereotactic MR images at the time of radiosurgery. However, the mean survival times after SRS were not statistically different between groups. According to the aforementioned results, SRS may be a good treatment option for local control of metastatic lesions and for improved survival in patients with multiple metastatic brain lesions, even those patients who harbor more than 15 metastatic brain lesions, who, after SRS, may have early and easily detectable new metastatic lesions.
Low-dose Gamma Knife surgery for nonfunctioning pituitary adenomas
Authors: El-Shehaby Amr M. N. , Reda Wael A. , Tawadros Sameh R. , Abdel Karim Khaled M.
Published: November 2018

Object

The primary concern when performing Gamma Knife surgery for pituitary adenoma is preservation of vision and pituitary function while achieving tumor growth control. Higher prescribed radiation doses are typically correlated with higher incidences of postradiosurgical hormone deficiencies. The goal of the present study was to retrospectively analyze the feasibility of using a lower prescribed radiation dose in the treatment of nonfunctioning pituitary adenomas and the effect of this dose on vision, pituitary function, and tumor growth control.

Methods

The study was conducted in 38 patients with nonfunctioning pituitary adenomas, who were treated between January 2002 and July 2008. Twenty-one patients were available for follow-up (13 men and 8 women). The mean follow-up period was 44 months (range 24–90 months). Nineteen patients had previously undergone surgery. Pituitary dysfunction developed after surgery in 3 patients. One patient had an abnormal pituitary hormone profile before radiosurgery due to an attack of pituitary apoplexy. Visual field defects were present in 12 patients. The prescribed radiation dose was 12 Gy in all patients. The tumor volume ranged from 0.5 to 11.8 cm3 (mean 4.8 cm3). The maximum dose to the visual pathway was kept below 10 Gy. The mean maximum dose delivered to the visual pathway was 7.9 Gy.

Results

The patients were followed up for a period of 24 to 90 months (mean 44 months). The size of the tumor decreased in 11 patients (52%) and remained stable in 9 patients (43%). In 1 patient there was tumor growth outside the previous radiation field (on the contralateral side). Among the 12 patients with visual field defects, 9 (75%) experienced an improvement and the remaining patients' vision remained stable. In only 4 patients was the visual improvement associated with tumor shrinkage. The hormone profile remained normal in all patients except for the 4 patients who had pituitary dysfunction before radiosurgery.

Conclusions

The 12-Gy prescribed dose used in this study seems to be sufficient for producing tumor control while sparing the patient from radiation-induced pituitary dysfunction. In addition, visual improvement was reported in a number of cases. A larger series and longer follow-up are required to confirm these results.
Gamma Knife surgery for patients with brainstem metastases
Authors: Kawabe Takuya , Yamamoto Masaaki , Sato Yasunori , Barfod Bierta E. , Urakawa Yoichi , Kasuya Hidetoshi , Mineura Katsuyoshi
Published: November 2018

Object

Because brainstem metastases are not deemed resectable, stereotactic radiosurgery (SRS) is the only treatment modality expected to achieve a radical cure. The authors describe their treatment results, focusing particularly on how long patients can survive without neurological deterioration following SRS for brainstem metastases.

Methods

This was an institutional review board–approved, retrospective cohort study in which the authors pulled from their database information on 2553 consecutive patients with brain metastases who underwent Gamma Knife surgery (GKS) at the Mito GammaHouse between July 1998 and July 2011. Among the 2553 patients, excluding cases in which there was meningeal dissemination, 200 cases of brainstem metastases (78 women and 122 men with a mean age of 64 years [range 36–86 years]) were identified and analyzed. The most common primary site was the lung (137 patients) followed by the gastrointestinal tract (24 patients), breast (17 patients), kidney (12 patients), and others (10 patients). Among the 200 patients, 15 patients (7.5%) harbored at least 2 tumors in the brainstem: 11 patients had 2 tumors, 2 patients had 3 tumors, and 1 patient each had 4 or 5 tumors. Therefore, a total of 222 tumors were irradiated. These 222 tumors were located in the pons (121 lesions), the midbrain (65 lesions), and the medulla oblongata (36 lesions). The mean and median tumor volumes were 1.3 and 0.2 cm3 (range 0.005–10.7 cm3), and the median peripheral radiation dose was 18.0 Gy (range 12.0–25.0 Gy).

Results

The overall median survival time (MST) was 6.0 months. Distribution of MSTs across Recursive Partitioning Analysis (RPA) classes showed that the MSTs were 9.4 months in Class I (20 patients), 6.0 months in Class II (171 patients), and 1.9 months in Class III (9 patients). Better Karnofsky Performance Scale score, single metastasis, and well-controlled primary tumor were significant predictive factors for longer survival. The neurological and qualitative survival rates were 90.8% and 89.2%, respectively, at 24 months post-GKS. Better KPS score and smaller tumor volume tended to be associated with prolonged qualitative survival. Follow-up imaging studies were available for 129 patients (64.5%). The tumor control rate was 81.8% at 24 months post-GKS. Smaller tumor volume tended to contribute to tumor control.

Conclusions

The present results indicate that GKS is effective in the treatment of brainstem metastases, particularly from the viewpoint of maintaining a good neurological condition in the patient.
Stereotactic radiosurgery to the resection bed for intracranial metastases and risk of leptomeningeal carcinomatosis
Authors: Ojerholm Eric , Lee John Y. K. , Thawani Jayesh P. , Miller Denise , O'Rourke Donald M. , Dorsey Jay F. , Geiger Geoffrey A. , Nagda Suneel , Kolker James D. , Lustig Robert A. , Alonso-Basanta Michelle
Published: November 2018

Object

Following resection of a brain metastasis, stereotactic radiosurgery (SRS) to the cavity is an emerging alternative to postoperative whole-brain radiation therapy (WBRT). This approach attempts to achieve local control without the neurocognitive risks associated with WBRT. The authors aimed to report the outcomes of a large patient cohort treated with this strategy.

Methods

A retrospective review identified 91 patients without a history of WBRT who received Gamma Knife (GK) SRS to 96 metastasis resection cavities between 2007 and 2013. Patterns of intracranial control were examined in the 86 cases with post-GK imaging. Survival, local failure, and distant failure were estimated by the Kaplan-Meier method. Prognostic factors were tested by univariate (log-rank test) and multivariate (Cox proportional hazards model) analyses.

Results

Common primary tumors were non–small cell lung (43%), melanoma (14%), and breast (13%). The cases were predominantly recursive partitioning analysis Class I (25%) or II (70%). Median preoperative metastasis diameter was 2.8 cm, and 82% of patients underwent gross-total resection. A median dose of 16 Gy was delivered to the 50% isodose line, encompassing a median treatment volume of 9.2 cm3. Synchronous intact metastases were treated in addition to the resection bed in 43% of cases. Patients survived a median of 22.3 months from the time of GK. Local failure developed in 16 cavities, for a crude rate of 18% and 1-year actuarial local control of 81%. Preoperative metastasis diameter ≥ 3 cm and residual or recurrent tumor at the time of GK were associated with local failure (p = 0.04 and 0.008, respectively). Distant intracranial failure occurred in 55 cases (64%) at a median of 7.3 months from GK. Salvage therapies included WBRT and additional SRS in 33% and 31% of patients, respectively. Leptomeningeal carcinomatosis developed in 12 cases (14%) and was associated with breast histology and infratentorial cavities (p = 0.024 and 0.012, respectively).

Conclusions

This study bolsters the existing evidence for SRS to the resection bed. Local control rates are high, but patients with larger preoperative metastases or residual/recurrent tumor at the time of SRS are more likely to fail at the cavity. While most patients develop distant intracranial failure, an SRS approach spared or delayed WBRT in the majority of cases. The risk of leptomeningeal carcinomatosis does not appear to be elevated with this strategy.
To fractionate or not to fractionate? That is the question for the radiosurgery of hypoxic tumors
Authors: Toma-Dasu Iuliana , Sandström Helena , Barsoum Pierre , Dasu Alexandru
Published: November 2018

Object

This study aimed to investigate the impact of tumor hypoxia on treatment outcome for metastases commonly treated with radiosurgery using 1 fraction of radiation and the potential gain from reoxygenation if the treatment is delivered in a few radiation fractions.

Methods

In silico metastasis-like radiosurgery targets were modeled with respect to size, density of clonogenic cells, and oxygenation. Treatment plans were produced for the targets using Leksell GammaPlan, delivering clinically relevant doses and evaluating the tumor control probability (TCP) that could be expected in each case. Fractionated schedules with 3, 4, and 5 fractions resulting in similar biological effective doses were also considered for the larger target, and TCP was determined under the assumption that local reoxygenation takes place between fractions.

Results

The results showed that well-oxygenated small- and medium-size metastases are well controlled by radiosurgery treatments delivering 20 or 22 Gy at the periphery, with TCPs ranging from 90% to 100%. If they are moderately hypoxic, the TCP could decrease to 60%. For large metastases, the TCPs from single-fraction treatments ranged from 0% to 19%, depending on tumor oxygenation. However, for fractionated treatments, the TCP for hypoxic tumors could significantly increase up to 51%, if reoxygenation occurs between fractions.

Conclusions

This study shows that hypoxia worsens the response to single-fraction radiosurgery, especially for large tumors. However, fractionated therapy for large hypoxic tumors might considerably improve the TCP and might constitute a simple way to improve the outcome of radiosurgery for patients with hypoxic tumors.
Factors associated with venous thromboembolic events following ICU admission in patients undergoing spinal surgery: an analysis of 1269 consecutive patients
Authors: Cloney Michael Brendan , Goergen Jack , Hopkins Benjamin S. , Dhillon Ekamjeet Singh , Dahdaleh Nader S.
Published: November 2018

OBJECTIVE

Venous thromboembolic events (VTEs) are a common cause of morbidity and mortality after spine surgery. Patients admitted to the intensive care unit (ICU) following spine surgery exhibit high-risk clinical characteristics.

METHODS

The authors retrospectively analyzed 1269 ICU patients who had undergone spine surgery between January 1, 2009, and May 31, 2015. Relevant demographic, procedural, and outcome variables were collected.

RESULTS

Patients admitted to the ICU postoperatively had a postoperative VTE rate of 10.2%, compared to 2.5% among all spine surgery patients during the study period. ICU patients had a higher comorbid disease burden (odds ratio [OR] 1.45, p < 0.001), and were more likely to have a history of a bleeding disorder (2.60% vs 0.46%, OR 2.85, p = 0.028), receive a transfusion (OR 4.81, p < 0.001), have a fracture repaired (OR 4.30, p < 0.001), have an estimated blood loss > 500 ml (OR 1.95, p = 0.009), have an osteotomy (OR 20.47, p = 0.006), or have a corpectomy (OR 3.48, p = 0.007) than patients not admitted to the ICU. There was a significant difference in time to VTE between patients undergoing osteotomy and patients undergoing scoliosis corrections without osteotomy (p = 0.0431), patients with fractures (p = 0.0113), and patients undergoing fusions for indications other than scoliosis or fracture (p = 0.0056). Patients who developed a deep vein thrombosis (DVT) during their ICU stay were more likely to have received a prophylactic inferior vena cava filter placement (OR 8.98, p < 0.001), have undergone an interbody fusion procedure (OR 2.38, p = 0.037), have a history of DVT (OR 3.25, p < 0.001), and have shorter surgery times (OR 0.30, p = 0.002). Patients who developed a pulmonary embolism (PE) during the ICU stay were more likely to have a history of PE (OR 12.68 p = 0.015), history of DVT (OR 5.11, p = 0.042), fracture diagnosis (OR 7.02, p = 0.040), and diagnosis of scoliosis (OR 7.78, p = 0.024). Patients with higher BMIs (OR 0.85, p = 0.036) and those who received anticoagulation treatment (OR 0.16, p = 0.031) were less likely to develop a PE during their ICU stay.

CONCLUSIONS

Patients admitted to the ICU following spine surgery have a higher rate of VTE than non-ICU patients. Time to VTE varied by pathology. Factors independently associated with VTE in the ICU are distinct from factors otherwise associated with VTE. Some factors are independently associated with VTE throughout the 30-day postoperative period, while others are associated with VTE specifically during the initial ICU stay or after leaving the ICU.
C2 neurofibromas in neurofibromatosis type 1: genetic and imaging characteristics
Authors: Waqar Mueez , Huson Susan , Evans D. Gareth , Ealing John , Karabatsou Konstantina , George K. Joshi , Soh Calvin
Published: November 2018

OBJECTIVE

C2 nerve root neurofibromas have been reported frequently in patients with neurofibromatosis type 1 (NF1), although their genetic and imaging characteristics are unexplored. The aim of this study was to characterize genetic and spinal imaging findings in a large cohort of NF1 patients with C2 neurofibromas.

METHODS

The authors performed a review of national NF1 referrals between 2009 and 2016. Inclusion criteria were at least 1 C2 root neurofibroma and cervical-spine or whole-spine MRI scans available for analysis. Blinded imaging review was performed by a neuroradiologist with an interest in NF1.

RESULTS

Fifty-four patients with 106 C2 neurofibromas were included. The median age was 32.5 years (range 15–61 years), and there were slightly more male patients (33 vs 21 female patients). Splice-site (30%) and missense (20%) variants were frequent. Spinal neurofibromas were distributed in all spine regions (65%) or in the cervical spine alone (22%). Most (93%) C2 neurofibromas were visible on MRI scans of the head. Intradural invasion and cord compression in the cervical spine included the C2 level in 95% and 80% of patients, respectively. Compared with all other cervical spine neurofibromas in these patients, C2 neurofibromas had higher rates of intraspinal extension (75% vs 32%; OR 6.20, 95% CI 3.85–9.97; p < 0.001), intradural invasion (53% vs 26%; OR 3.20, 95% CI 2.08–4.92; p < 0.001), and cord compression (25% vs 13%; OR 2.26, 95% CI 1.35–3.79; p = 0.002). However, C2 neurofibromas had lower rates of extraforaminal growth beyond the transverse process (12% vs 62%; OR 0.09, 95% CI 0.05–0.16; p < 0.001).

CONCLUSIONS

C2 neurofibromas are associated with an aggressive intraspinal phenotype, limited growth outside the spinal canal, and an uncommon genetic profile. These observations require future study.
Biomechanical assessment of proximal junctional semi-rigid fixation in long-segment thoracolumbar constructs
Authors: Viswanathan Vibhu K. , Ganguly Ranjit , Minnema Amy J. , DeVries Watson Nicole A. , Grosland Nicole M. , Fredericks Douglas C. , Grossbach Andrew J. , Viljoen Stephanus V. , Farhadi H. Francis
Published: November 2018

OBJECTIVE

Proximal junctional kyphosis (PJK) and failure (PJF) are potentially catastrophic complications that result from abrupt changes in stress across rigid instrumented and mobile non-fused segments of the spine (transition zone) after adult spinal deformity surgery. Recently, data have indicated that extension (widening) of the transitional zone via use of proximal junctional (PJ) semi-rigid fixation can mitigate this complication. To assess the biomechanical effectiveness of 3 semi-rigid fixation constructs (compared to pedicle screw fixation alone), the authors performed cadaveric studies that measured the extent of PJ motion and intradiscal pressure changes (ΔIDP).

METHODS

To measure flexibility and ΔIDP at the PJ segments, moments in flexion, extension, lateral bending (LB), and torsion were conducted in 13 fresh-frozen human cadaveric specimens. Five testing cycles were conducted, including intact (INT), T10–L2 pedicle screw-rod fixation alone (PSF), supplemental hybrid T9 Mersilene tape insertion (MT), hybrid T9 sublaminar band insertion (SLB1), and hybrid T8/T9 sublaminar band insertion (SLB2).

RESULTS

Compared to PSF, SLB1 significantly reduced flexibility at the level rostral to the upper-instrumented vertebral level (UIV+1) under moments in 3 directions (flexion, LB, and torsion, p ≤ 0.01). SLB2 significantly reduced motion in all directions at UIV+1 (flexion, extension, LB, torsion, p < 0.05) and at UIV+2 (LB, torsion, p ≤ 0.03). MT only reduced flexibility in extension at UIV+1 (p = 0.02). All 3 constructs revealed significant reductions in ΔIDP at UIV+1 in flexion (MT, SLB1, SLB2, p ≤ 0.02) and torsion (MT, SLB1, SLB2, p ≤ 0.05), while SLB1 and SLB2 significantly reduced ΔIDP in extension (SLB1, SLB2, p ≤ 0.02) and SLB2 reduced ΔIDP in LB (p = 0.05). At UIV+2, SLB2 similarly significantly reduced ΔIDP in extension, LB, and torsion (p ≤ 0.05).

CONCLUSIONS

Compared to MT, the SLB1 and SLB2 constructs significantly reduced flexibility and ΔIDP in various directions through the application of robust anteroposterior force vectors at UIV+1 and UIV+2. These findings indicate that semi-rigid sublaminar banding can most effectively expand the transition zone and mitigate stresses at the PJ levels of long-segment thoracolumbar constructs.
Intramedullary spinal cord ependymoma and astrocytoma: intraoperative frozen-section diagnosis, extent of resection, and outcomes
Authors: Hongo Hiroki , Takai Keisuke , Komori Takashi , Taniguchi Makoto
Published: November 2018

OBJECTIVE

The intraoperative differentiation of ependymomas from astrocytomas is important because neurosurgical strategies differ between these two tumor groups. Previous studies have reported that the diagnostic accuracy of intraoperative frozen sections of intracranial central nervous system (CNS) tumors is higher than 83%–97%, whereas that for spinal intramedullary tumors remains unknown. Herein, authors tested the hypothesis that intraoperative frozen-section diagnosis is the gold standard for a differential diagnosis of intramedullary spinal cord tumors.

METHODS

The clinical characteristics, intraoperative histological diagnosis from frozen sections, extent of tumor resection, progression-free survival (PFS), and overall survival (OS) of 49 cases of intramedullary spinal cord ependymomas (n = 32) and astrocytomas (n = 17) were retrospectively evaluated.

RESULTS

The frozen-section diagnosis and final diagnosis with permanent sections agreed in 23 (72%) of 32 cases of ependymoma. Of the 9 cases of ependymoma in which the frozen-section diagnosis disagreed with the final diagnosis, 4 were incorrectly diagnosed as astrocytoma and the other 5 cases had a nonspecific diagnosis, such as glioma. Nonetheless, gross-total resection was achieved in 6 of these 9 cases given the presence of a dissection plane. The frozen-section diagnosis and final diagnosis agreed in 12 (71%) of 17 cases of astrocytoma. Of the 5 cases of astrocytoma in which the frozen-section diagnosis disagreed with the final diagnosis, 1 was incorrectly diagnosed as ependymoma and the other 4 had a nonspecific diagnosis. Gross-total resection was achieved in only 1 of these 5 cases.

A relationship between the size of tumor specimens and the diagnostic accuracy of frozen sections was not observed. Ependymal rosettes and perivascular pseudorosettes were observed in 30% and 57% of ependymomas, respectively, but were absent in astrocytomas.

Progression-free survival and OS were both significantly longer in cases of ependymoma than in cases of astrocytoma (p < 0.001). Gross-total resection was achieved in 69% of ependymomas and was associated with longer PFS (p = 0.041). In the astrocytoma group, gross-total resection was achieved in only 12% and there was no relationship between extent of resection and OS. Tumor grades tended to correlate with OS in astrocytomas (p = 0.079).

CONCLUSIONS

The diagnostic accuracy of intraoperative frozen sections was lower for intramedullary spinal cord ependymomas and astrocytomas in the present study than that for intracranial CNS tumors reported on in the literature. Surgical strategies need to be selected based on multiple factors, such as clinical characteristics, preoperative imaging, frozen-section diagnosis, and intraoperative findings of the tumor plane.
The impact of adding posterior instrumentation to transpsoas lateral fusion: a systematic review and meta-analysis
Authors: Alvi Mohammed Ali , Alkhataybeh Redab , Wahood Waseem , Kerezoudis Panagiotis , Goncalves Sandy , Murad M. Hassan , Bydon Mohamad
Published: November 2018

OBJECTIVE

Transpsoas lateral interbody fusion is one of the lateral minimally invasive approaches for lumbar spine surgery. Most surgeons insert the interbody cage laterally and then insert pedicle or cortical screw and rod instrumentation posteriorly. However, standalone cages have also been used to avoid posterior instrumentation. To the best of the authors’ knowledge, the literature on comparison of the two approaches is sparse.

METHODS

The authors performed a systematic review and meta-analysis of the available literature on transpsoas lateral interbody fusion by an electronic search of the PubMed, EMBASE, and Scopus databases using PRISMA guidelines. They compared patients undergoing transpsoas standalone fusion (TP) with those undergoing transpsoas fusion with posterior instrumentation (TPP).

RESULTS

A total of 28 studies with 1462 patients were included. Three hundred and seventy-four patients underwent TPP, and 956 patients underwent TP. The mean patient age ranged from 45.7 to 68 years in the TP group, and 50 to 67.7 years in the TPP group. The incidence of reoperation was found to be higher for TP (0.08, 95% confidence interval [CI] 0.04–0.11) compared to TPP (0.03, 95% CI 0.01–0.06; p = 0.057). Similarly, the incidence of cage movement was found to be greater in TP (0.18, 95% CI 0.10–0.26) compared to TPP (0.03, 95% CI 0.00–0.05; p < 0.001). Oswestry Disability Index (ODI) and visual analog scale (VAS) scores and postoperative transient deficits were found to be comparable between the two groups.

CONCLUSIONS

These results appear to suggest that addition of posterior instrumentation to transpsoas fusion is associated with decreased reoperations and cage movements. The results of previous systematic reviews and meta-analyses should be reevaluated in light of these results, which seem to suggest that higher reoperation and subsidence rates may be due to the use of the standalone technique.
Gamma knife model C with the automatic positioning system and its impact on the treatment of vestibular schwannomas
Authors: Horstmann Gerhard A. , Van Eck Albertus T. C. J.
Published: November 2018

Object. The aim of this study was to assess the effects of the gamma knife automatic positioning system (APS) on the treatment of patients, particularly effects of this system on the treatment of patients with vestibular schwannomas (VSs), with a view to reducing loss of hearing.

Methods. The dose delivery with an increased number of shots was checked with GAFChromic Film for various numbers of shots (one to 129). The results in the first 549 patients were recorded. In addition a series of 59 patients with VSs treated with 13 Gy to the 65% isodose is presented. The authors have termed this the “13 on 65” concept.

The film dosimetry showed that a large number of small shots did not materially affect the dose and dose distribution produced by gamma knife treatment.

The APS was used alone in 72% of arteriovenous malformations, 71% of meningiomas, 94% of VSs, and 84% of pituitary adenomas. Metastatic tumors were accessible in a pure APS mode in 59% of all cases, glioma in 58%, and uveal melanoma in 10% of the cases. Thus two thirds of patients could be treated using APS alone. It was possible to use the APS and manual systems together for complex or very eccentrically placed targets. The APS resulted in the use of a larger number of isocenters.

After a mean follow-up period of 15 months, the results in patients with the VSs in whom 13 Gy was delivered to the 65% isodose were similar to those in patients treated with the more conventional 50% margin isodose. There was no change in the incidence of hearing loss within the study period, and the incidence of trigeminal and facial neuropathies remained unchanged after treatment as well.

Conclusions. The APS encourages the design of more conformal dose plans. The greater use of smaller collimators results in a steeper dose gradient with a smaller amount of radiation outside the target volume. Because the APS is able to apply a large number of smaller isocenters in an acceptable time, the number of isocenters used is increased. An increased number of isocenters can also be used to reduce the maximum radiation dose and increase the homogeneity in a given dose plan.
Gamma knife radiosurgery for metastatic brain tumors from lung cancer: a comparison between small cell and non—small cell carcinoma
Authors: Serizawa Toru , Ono Junichi , Iichi Toshihiko , Matsuda Shinji , Sato Makoto , Odaki Masaru , Hirai Shinji , Osato Katsunobu , Saeki Naokatsu , Yamaura Akira
Published: November 2018

Object. The purpose of this retrospective study was to evaluate the effectiveness of gamma knife radiosurgery (GKS) for the treatment of metastatic brain tumors from lung cancer, with particular reference to small cell lung carcinoma (SCLC) compared with non-SCLC (NSCLC).

Methods. Two hundred forty-five consecutive patients meeting the following five criteria were evaluated in this study: 1) no prior brain tumor treatment; 2) 25 or fewer lesions; 3) a maximum of three tumors with a diameter of 20 mm or larger; 4) no surgically inaccessible tumor 30 mm or greater in diameter; and 5) more than 3 months of life expectancy. According to the same treatment protocol, large tumors (≥ 30 mm) were surgically removed and the other small lesions (< 30 mm) were treated with GKS. New lesions were treated with repeated GKS. Chemotherapy was administered, according to the primary physician's protocol, as aggressively as possible. Progression-free, overall, neurological, qualitative, and new lesion—free survival were calculated with the Kaplan—Meier method and were compared in the SCLC and NSCLC groups by using the log-rank test. The poor prognostic factors for each type of survival were also analyzed with the Cox proportional hazard model.

Conclusions. Tumor control rate at 1 year was 94.5% in the SCLC group and 98% in the NSCLC group. The median survival time was 9.1 months in the SCLC group and 8.6 months in the NSCLC group. The 1-year survival rates in the SCLC group were 86.5% for neurological survival and 68.9% for qualitative survival; those in the NSCLC group were 87.9% for neurological and 78.9% for qualitative survival. The estimated median interval to emergence of a new lesion was 6.9 months in the SCLC group and 9.8 months in the NSCLC group. There was no significant difference between the two groups for any type of survival; this finding was verified by multivariate analysis. The results of this study suggest that GKS appears to be as effective in treating brain metastases from SCLC as for those from NSCLC.