bluuebunny/crossref_metadata_2025 huggingface dataset:
Tell Me Who Is Your Friend
Authors:   Acting Head of the Department of Applied International Analysis, MGIMO University, Istomin Igor A.
Published: November 2023

Relying on the fear of the nuclear Armageddon rids Russia’s strategy of the safety factor. Its military alliance with China and a network of informal contra-sanctions coalitions would give it flexibility in its confrontation with the West.
From National Ruling Elite to Global Political Class
Authors:   Fellow of the Academy of Social Sciences (Britain), Lane David ,   Emeritus Fellow of Emmanuel College, Cambridge University
Published: November 2023

The global political class has new coordinating, political and ideological bodies. These groups form a bundle of interests that reinforce each other, which can be viewed as a transnational political class.
Assumptive Foreword
Authors:   Research Professor, Faculty of World Economy and International Affairs, National Research University–Higher School of Economics, Lukyanov Fyodor A. ,   Editor-in-Chief, Russia in Global Affairs
Published: November 2023

Remarkably, it is nuclear powers (Russia, the U.S. and Israel) that are actively involved in confrontations—direct or indirect. Possession of nuclear weapons deters them from head-on collision, but by no means reduces the intensity of the antagonism.
“Japanese Monroe Doctrine”: The Root and the Fruit
Authors:   Professor, Takushoku University, Tokyo, Molodyakov Vasily E.
Published: November 2023

Japan had its own conception of the natural sphere of influence, but the attempt to materialize it turned out to be much more harmful for everyone than its American original.
About Spheres of Influence
Authors:   Visiting Research Fellow, Watson Institute for International and Public Affairs, Brown University, USA, Freeman Chas W.
Published: November 2023

Spheres of influence have been an abiding phenomenon of statecraft and diplomacy that deserves a great deal more study than it has so far received. It is time to consider alternatives to them.
"Bilingual Always": A Study of Second Language Writing's Influence on Writing Studies in the Canadian Association for the Study of Discourse and Writing/Redactologie
Authors: Wright-Taylor Christin
Published: November 2023

A neoliberal agenda has driven the evolution of internationalization in Canadian Higher Education since the early 2000s. This agenda positions translingual, visa students as human capital and influences educational policy particularly for writing classes and writing instruction. My research asks what pre-existing, cross-disciplinary partnerships between second language writing and writing studies exist to support translingual, visa students in the modern Canadian writing classroom. This article reports findings from archival research exploring the cross-disciplinary history of writing studies and second language writing as this history manifested in one of Canada’s two writing studies organizations: the Canadian Association for the Study of Discourse and Writing/Redactologie (CASDW), formally known as the Canadian Association of Teachers of Technical Writing (CATTW). This history reveals writing studies as a decentralized discipline that utilized resourcefulness and resilience to reach across disciplinary lines in order to establish itself as a full-fledged field in a Canadian context.
Development and Evaluation of Ranitidine Floating Tablet for Ulcer Healing and Soothing
Authors:   Department of Pharmaceutics, Government Pharmacy Institute, Patna, Bihar-800007, India, Nirala Nitish
Published: November 2023

In this current work floating tablets of ranitidine and aloe vera was prepared. The objective behind the work was to develop a formulation of H2 antagonist in collaboration with aloe vera to produce an ulcer soothing and ulcer protective effect. Ranitidine is a histamine H2-receptor antagonist. It is widely prescribed in active duodenal ulcers, gastric ulcers, Zollinger-Ellison syndrome, gastroesophageal reflux disease, and erosive esophagitis. The effective treatment of erosive esophagitis requires administration of 150 mg of Ranitidine, four times a day. A conventional dose of 150 mg can inhibit gastric acid whereas aloe vera will produce ulcer soothing affect and laxative effect too. In- vitro buoyancy studies were performed for all the ten formulations as per the method described by Rosa et al. The randomly selected tablets from each formulation were kept in a 100ml beaker containing simulated gastric fluid, pH 1.2 as per USP. The time taken for the tablet to rise to the surface and float was taken as floating lag time (FLT).
Calibration of Medical Devices: Method and Impact on Operation Quality
Authors:   Department of Pharmaceutics, Government Pharmacy Institute, Patna, Bihar-800007, India, Kumar Rupesh
Published: November 2023

Medical devices play a pivotal role in modern healthcare, aiding in accurate diagnosis, monitoring, and treatment of patients. The reliability and accuracy of these devices are indispensable for ensuring patient safety and well-being. This project highlights the critical importance of calibrating medical devices to maintain their accuracy, precision, and performance, ultimately safeguarding the lives of patients. Calibration of medical devices is a systematic process that verifies and adjusts their measurements to a known standard. This process ensures that medical devices consistently provide accurate data and results. In the absence of proper calibration, there is a significant risk of incorrect readings, misdiagnoses, and inappropriate treatment plans, all of which can lead to patient harm. Regular calibration is essential not only for maintaining patient safety but also for meeting regulatory requirements and quality assurance standards. It helps identify and rectify deviations or drifts in device performance, preventing potential hazards in healthcare settings. Compliance with calibration protocols ensures that medical institutions and professionals can deliver reliable and effective care. Moreover, calibrated medical devices enhance the efficiency and cost-effectiveness of healthcare systems by minimizing the need for repeated tests and procedures due to inaccurate results. Patients can have confidence in the reliability of the devices used in their care, fostering trust in healthcare providers and institutions.
Adult Onset of Pyruvate Dehydrogenase Deficiency Presenting with Dystonia and Chorea in Female Patient from India - A Very Rare Case
Authors:   Senior Neurologist and Movement Disorder Specialist, Jain Institute of Movement Disorder, Bhagvan Mahavir Jain Hospital, Bengaluru 560 004, Karnataka, India, Chamraj Sanjiv
Published: November 2023

We reported a very rare case of pyruvate dehydrogenase complex E1α (PDHA1) gene deficiency presenting as cervical dystonia and chorea in an adult female patient from India. Patient was presented with a history of involuntary rhythmic repetitive movements of both hands, legs, and head, lips and stammering of speech with tilting of neck to one side along with orofacial dyskinetic movements since past 6 years and gait changes since past 4 years. Her symptoms were progressive in nature. Her physical examination and systemic examinations were normal. Neurological examinations suggestive of cervical dystonia with chorea form movements. Brain MRI investigations revealed marked atrophy of bilateral caudate nuclei and putamina. Patient had a familial history of father and second brother had mild hand tremors. Patient has been referred for whole exome sequencing. The exome data analysis identified a very rare and unusual heterozygous indel variant c.-20_-19delinsCT, (chrX:19344018_19344019delinsCT) in 5’UTR region of PDHA1 gene caused late phenotypic onset of cervical dystonia as major clinical manifestation of PDHA1 deficiency along with chorea form movement disorders at the age of 24 year. In conclusion, to the best of our literature knowledge this is the novel and unusual case of adult female patient wherein we are reporting a novel heterozygous indel variant c.-20_-19delinsCT, (chrX:19344018_19344019delinsCT) in 5’UTR region of PDHA1 gene responsible for PDHA1 deficiency presenting with cervical dystonia and chorea as major clinical manifestations. Hence, dystonia and chorea as major clinical manifestations of PDH deficiency could be considered in adult patients also rather than only in paediatric patients.
Development and Evaluation of Polyherbal Face Pack with Antibacterial Effect
Authors:   Department of Pharmaceutics, Nibha Institute of Pharmaceutical Sciences, Rajgir, Nalanda, India, Kumar Pankaj
Published: November 2023

Cosmetics are the fastest-growing segment in the cosmetics industry, experiencing unparalleled growth. Cosmeceuticals, which combine medicinal and cosmetic qualities, have emerged as a key factor in the pursuit of healthier, more beautiful skin. Natural substances have been critical in the creation of cosmetics, providing efficacy without the negative side effects associated with synthetic compounds. The trend towards herbal-based goods is gaining attraction, motivated by a need for purity and safety. This study focuses on the ability of certain herbal compounds, such as Aloe vera, Neem, Papaya fruit, Almond, and Tulsi, to address a variety of skincare conditions, such as antioxidants, hyperpigmentation, blemishes, wrinkles, and deep cleansing. With their distinct chemical constituents, these herbs provide treatments for pimples, acne, blemishes, pigmentation, and skin suppleness. All powder ingredients created fine powder with using sieve mesh no. 44. The formulation procedure, which entailed properly mixing all of the formulation using a geometrical method with variable powder weights, was subjected to thorough testing, which included organoleptic, rheological, physicochemical, irritancy, and washability studies. All formulations such as F1, F2, F3, and F4 were created. The findings corroborate the face pack's quality, safety, and usability. Formulation F1 was chosen as the best option across all studies, demonstrating its commercialization and market availability potential. Additional research and development routes may be pursued to investigate its prolonged performance and effectiveness.
Development and Evaluation of Transdermal Gel for Pain Relief
Authors:   Department of Pharmaceutics, Nibha Institute of Pharmaceutical Sciences, Rajgir, Nalanda, India, Kumar Manish
Published: November 2023

The study was to develop transdermal gel formulations for the delivery of aspirin and paracetamol. Compared to more conventional approaches like oral, injectable, and inhaler administration, transdermal medication delivery through the skin has a number of benefits. These benefits include self-administering simplicity, non-intrusiveness, usability, cost, and the capacity to maintain sustained plasma drug concentrations over prolonged periods of time. Two polymers in creating transdermal gels Carbopol-934 and Sodium Alginate were assessed. Carbopol-934 was chosen because of its capacity to improve drug retention and limit drainage, allowing for the drug's sustained release. The gel compositions were thickened and stabilized using sodium alginate. Pre-formulation tests, rheological characteristics, spread-ability, pH levels, homogeneity, and potential for skin irritation were assessed for both Carbopol-934 and Sodium Alginate gel formulations. In order to avoid application-related skin irritation, the pH levels of the gel formulations were closely checked to make sure they stayed within the permitted range. In comparison to other Carbopol-934 and Sodium Alginate formulations tested, Carbopol-934 gel formulation F3 showed the best spread-ability (S=95.9). Due to its constant qualities, including acceptable spread-ability, pH range, and homogeneity, without producing any skin irritation, this formulation was deemed satisfactory. In conclusion, the creation of a transdermal gel formulation using Carbopol-934 as the main polymer matrix shows potential for delivering these medications through the skin. This study highlights the potential of transdermal drug delivery devices as a practical and efficient replacement for conventional methods of administering painkillers.
Estado-nación y soberanía en Hobbes y Locke
Authors:   Universidad Autónoma Metropolitana, Unidad Azcapotzalco, Castillejos Rodríguez Francisco Javier
Published: November 2023

The aim of this paper is to discuss the concepts of Nation-State and sovereignty in Hobbes and Locke. From a philosophical point of view, the main objective of modern contractarianism was the justification of political authority. However, Hobbes and Locke came to divergent conclusions. In Hobbes’s argument, the end of the State was the achievement of peace. In Locke’s argument, instead, the end of the State was the protection of Natural Rights of the individuals: life, freedom and property. From a Lockean perspective, the argument of absolute sovereignty is inadmissible. The State, in Lockean contract theory, must be a limited government. In this way, Locke set the grounds and principles of contemporary Rule of Law.
Fréderic Bastiat. La urgenci de su filosofía en hispanoamérica y más allá
Authors:   Universidad Goethe de Frankfurt, Oblitas Mollinedo Benjamin
Published: November 2023

The article highlights the enduring relevance of Frédéric Bastiat's ideas in Hispanoamerica. It explains the paradox of the widespread ignorance of Bastiat's work, both in his native France and among Spanish speakers. Despite his significant contributions to philosophical and economic thought, Bastiat's legacy suffered obscurity, hindering the understanding of timeless principles advocating for individual rights, economic freedom, and free trade. Comparisons are drawn between Bastiat's comprehensive economic understanding and the limitations of Marx's perspective, emphasizing Bastiat's contribution to the theory of value and his nuanced view of private property and the market. The article underscores the necessity for Hispanic academic circles to engage with Bastiat's works, promoting translations, analyses, and discussions to counter prevalent economic ignorance and challenge authoritarian doctrines. It also emphasizes the importance of Bastiat's ideas in confronting contemporary economic challenges in Spanish-speaking nations, advocating for rectifying this academic omission to foster economic growth, intellectual enlightenment, and combat the historical legacies of colonial centralism and feudal prejudices.
Role of Social Media in Branding Tourism Destinations in Khyber Pakhtunkhwa: A Quantitative Analysis
Authors: Anwar Muhammad Naseem , Syed Hassan Raza
Published: November 2023

E-commerce has spurred digital tourism entrepreneurship. Digital tourism companies must create unique and shareable destination brands to attract customers. Scholars advocated increasing brand perceptions as value enhancers to increase destination brand equity (DBE) which has been previously overlooked in research. This study examines digital tourism entrepreneurship's digital media marketing. This study shows how companies' marketing communications boost the destination's brand and less-studied traits like digital tourism entrepreneurial trust. This study employed a quantitative or deductive method to map communicative and branding features that decrease tourist visits since previous work covers integrated marketing communication and brand equity. The study employed deductive hypotheses in a quantitative quasi-experimental research design. An online survey was conducted with 497 participants who were international travellers. Partial Least Squares Structural Equation Modeling (PLS-SEM) results indicated a significant relationship between destination brand equity and visitor intention. Our study highlights the significance of social and digital media in promoting tourism through digital tourism entrepreneurs in Pakistan's lesser-known areas.
Long-term clinical outcomes of hypofractionated stereotactic radiotherapy using the CyberKnife robotic radiosurgery system for jugular foramen schwannomas
Authors: Zou Wei , Guan Yun , Zhu Huaguang , Gong Xiu , Wang Enmin , Yao Chengjun , Wang Xin
Published: November 2023

OBJECTIVE

Jugular foramen schwannomas (JFSs) are rarely seen, benign tumors with slow growth. Today, management options for JFSs include observation, surgery, and radiation. However, the optimal treatment strategy remains controversial. Stereotactic radiosurgery serves as a minimally invasive alternative or adjuvant therapeutic regimen of microsurgery. Gamma Knife radiosurgery is suitable for patients with JFS who have small- and medium-sized tumors and normal cranial nerve (CN) function. Hypofractionated stereotactic radiotherapy (HSRT) offers a potential radiobiological advantage and may result in better preservation of normal structures compared to single-fraction stereotactic radiosurgery. The aim of the article was to review the clinical and radiographic outcomes of patients with JFS who were treated using HSRT.

METHODS

The authors retrospectively analyzed 74 patients with JFS who received HSRT between January 2009 and January 2020 in the authors’ center. Among them, 53 patients were newly diagnosed with JFS, 19 patients had a previous history of microsurgical resection, and the other 2 patients underwent CyberKnife because of tumor recurrence after Gamma Knife radiosurgery. A total of 73 patients had preexisting CN symptoms and signs. The median tumor volume was 14.8 cm3 (range 0.5–41.2 cm3), and most of them (70.3%) were ≥ 10 cm3. The radiation dose regimen was prescribed depending on the tumor size, and more fractions were used in larger tumors. The median margin doses prescribed were 18.2 Gy/2 fractions, 21.0 Gy/3 fractions, and 21.6 Gy/4 fractions.

RESULTS

The median follow-up was 103 months (range 18–158 months). After treatment, 42 (56.8%) patients had tumor regression, 27 (36.5%) patients had stable tumors, and 5 (6.8%) experienced tumor progression. Among them, MRI revealed that 1 patient had a complete response. Three patients received surgery at a median of 25 months because of tumor progression. One patient underwent ventriculoperitoneal shunt insertion for hydrocephalus that developed after HSRT independent of tumor progression. The 5-year progression-free survival rate was 93.2%. Preexisting cranial neuropathies improved in 46 patients, remained stable in 14, and worsened in 14.

CONCLUSIONS

HSRT proved to be a safe and effective primary or adjuvant treatment strategy for JFSs, although 14 patients (18.9%) experienced some degree of delayed symptomatic deterioration posttreatment. This therapeutic option was demonstrated to provide both excellent tumor control and improvement in CN function.
Focal brain oxygen, blood flow, and intracranial pressure measurements in relation to optimal cerebral perfusion pressure
Authors: Pelah Adam I. , Czosnyka Marek , Menacho Sarah , Nwachuku Enyinna , Hawryluk Gregory W. J.
Published: November 2023

OBJECTIVE

Different paradigms for neurocritical care of traumatic brain injury (TBI) have emerged in conjunction with advanced neuromonitoring technologies and derived metrics. The priority for optimizing these metrics is not currently clear. The goal of this study was to determine whether achieving cerebral perfusion pressure (CPPopt) also improves other metrics like brain oxygenation and brain blood flow.

METHODS

The authors performed a retrospective analysis of high-frequency data from patients with TBI who were treated at a single center and who had partial pressure of brain oxygen (PbtO2) measurements and/or brain blood flow measurements, while also undergoing intracranial pressure (ICP) monitoring. CPPopt was not calculated or targeted during patient care, but was retrospectively computed, as was the difference between the observed CPP and CPPopt.

RESULTS

A total of 22 patients with ICP, PbtO2, and/or brain blood flow monitoring were included in the analysis, and 245.7 days of measurements obtained every second were analyzed including 6,748,866 PbtO2 measurements, 3,296,405 blood flow measurements, and 10,264,770 ICP measurements. The data obtained every second were averaged by minute for analysis. In summative data, PbtO2 measurements peaked near CPPopt and were not improved above CPPopt. Blood flow measurements remained stable near CPPopt, decreased below it, and increased when CPP exceeded CPPopt. ICP decreased linearly with CPP without a specific relationship with CPPopt. In an inverse analysis, the percentage of CPP values at CPPopt, although significantly higher on the favorable side of contemporary treatment thresholds of PbtO2, ICP, and blood flow, was not found to be strongly correlated with the mean values of the physiological measurements obtained every minute (r = 0.27, r = 0.11, and r = 0.47 for ICP, PbtO2, and blood flow, respectively; p < 0.0001).

CONCLUSIONS

Although CPPopt was not targeted in the patients in this study, CPPopt was a physiologically significant value based on concurrent measurements of PbtO2 and blood flow. In summative data, achievement of CPPopt was associated with optimized PbtO2 and blood flow. Conversely, the correlation between achievement of CPPopt and the mean measurement value was not strong, strengthening the significance of CPPopt. In individual patients, achieving CPPopt is not always associated with optimal PbtO2 or blood flow. Further research should explore these relationships in treatment paradigms that specifically target CPPopt. These data do not support the premise that targeting and achieving CPPopt obviates the need for concurrent PbtO2 and blood flow monitoring. Although these data suggest that targeting CPPopt may be an appropriate initial treatment strategy, they do not provide evidence that CPPopt should be targeted with highest priority.
Transcriptomics of intracranial aneurysms: current state and opportunities in flow diversion
Authors: Srinivasan Visish M. , Shekhtman Oleg , Kandregula Sandeep , Mannam Sneha Sai , Yu Ling Fai Charles , Kan Peter
Published: November 2023

Over the last 2 decades, the field of transcriptomics has emerged as a major subdiscipline in biology. Transcriptomic techniques have been used by many groups over this time to better understand intracranial aneurysm development, rupture, and treatment. However, only a few studies have applied transcriptomics to understand the mechanisms behind flow diversion (FD) specifically, despite its increasing importance in the neurointerventional armamentarium.

FD is an increasingly safe and effective treatment option for intracranial aneurysms. However, the clinical understanding and use of FD has far outpaced the understanding of the underlying mechanisms. To make FD more predictable, clinically efficacious, and safe, it is important to understand the biological mechanisms at play that lead to successful and unsuccessful FD.

In this review, the authors focus on the current understanding of FD biology, the recent advances in transcriptomics, and what future studies could be performed to deepen the understanding of FD. They propose the new concept of the FD microenvironment to be studied, which may unlock a deeper biological understanding. This review provides the background for prospective studies into the development of targeted aneurysm therapy, whether by modified devices or by medical adjuncts.
Volumetric effect of shunt adjustments in normal pressure hydrocephalus: a randomized, double-blind trial
Authors: Lidén Simon , Farahmand Dan , Laurell Katarina
Published: November 2023

OBJECTIVE

MRI volumetry could be used as an alternative to invasive tests of shunt function. In this study, the authors aimed to assess the difference in ventricular volume (VV) before and after surgery and at different performance levels (PLs) of the shunt.

METHODS

This study was a randomized, double-blind trial with a crossover design. The study sample consisted of 36 patients (25 men, 11 women) with a median age of 76 years. All patients had idiopathic normal pressure hydrocephalus (iNPH) and received a Strata shunt at the regional hospital in Östersund, Sweden, with an initial PL of 1.5. Participants underwent MRI with volumetric sequences before surgery and four times postoperatively: at 1 month before randomization to either PL 1.0 (n = 15) or 2.5 (n = 17); at 2 months before crossover to PL 2.5 or 1.0; at 3 months before lowering the PL to 0.5; and finally, at 3 months and 1 day after surgery before resetting the PL to 1.5. VV was measured semiautomatically using quantitative MRI. Both the patient and the examiner of clinical tests and volumetry were blinded to the PL.

RESULTS

VV changed significantly between the presurgical level (median 129 ml) and the different shunt settings, i.e., PL 1.0 (median 115 ml), 1.5 (median 120 ml), and 2.5 (median 128 ml; p < 0.001). A unidirectional change in VV was observed for all participants between PL 1.0 and PL 2.5 (median 12 ml, range 2.1–40.7 ml, p < 0.001). No significant change was noted in VV after 24 hours at PL 0.5. Eight participants had asymptomatic subdural effusions at PL 1.0.

CONCLUSIONS

The consistent decrease in VV after shunt surgery and between PL 2.5 and 1.0 supports the idea that MRI volumetry could be a noninvasive method for evaluating shunt function in iNPH, preventing unnecessary shunt revisions. However, further studies on retest variability of VV as well as verification against advanced testing of shunt function are needed before a clinical implementation of this method can be performed.

Clinical trial registration no.: NCT04599153 (ClinicalTrials.gov)
Acute psychological symptom profiles in high school football players following sport-related concussion
Authors: Jawid Maryam Y. , Williams Kristen L. , Jo Jacob , Hill Tyler M. , Prosak Olivia L. , Amedy Amad , Anesi Trevor J. , Terry Douglas P. , Zuckerman Scott L.
Published: November 2023

OBJECTIVE

In a cohort of high school football athletes, the authors sought to 1) describe the proportion of those with acute psychological symptoms postconcussion, 2) determine predictors of more acute psychological symptoms postconcussion, and 3) determine if acute psychological symptoms impact recovery.

METHODS

A retrospective cohort study of high school football athletes (14–18 years of age) who sustained a sport-related concussion between November 2017 and April 2022 and presented to a multidisciplinary concussion center was performed. Based on their Post-Concussion Symptom Scale (PCSS) scores at the initial clinic visit, their total psychological symptom cluster score was calculated by summing their scores for the four affective symptoms (irritability, sadness, nervousness, and feeling more emotional). The psychological symptom ratio was defined as the ratio of the psychological symptom cluster score to the total initial PCSS score. Primary outcomes included time to return to learn (RTL), symptom resolution, and return to play (RTP). Uni- and multivariable regression analyses were performed controlling for demographic factors, learning disabilities, attention-deficit/hyperactivity disorder, and personal and/or family history of psychological diagnoses and migraine.

RESULTS

A total of 195 male football players (mean age 16.2 ± 1.2 years) were included in the study. About one-third of the sample (n = 70, 35.9%) reported at least one psychological symptom. Of these 70 athletes, their psychological symptom scores were 1 (10.3%), 2 (7.7%), and ≥ 3 (17.9%). Irritability was the most endorsed psychological symptom (25.1%), followed by nervousness (15.9%), feeling more emotional (12.8%), and sadness (11.8%). The multivariable regression model showed that a positive psychological history (B = 2.66, 95% CI 0.74–4.58, p = 0.007) and family psychological history (B = 2.43, 95% CI 0.98–3.88, p = 0.001) were significant predictors of a higher psychological symptom cluster score. Multivariable linear regression analysis showed that a higher psychological symptom cluster score was associated with a longer time to RTP (B = 1.22, 95% CI 0.17–2.264, p = 0.023) but not with time to symptom resolution or RTL. The psychological symptom ratio was not a significant predictor.

CONCLUSIONS

In a cohort of male football players, 36% reported at least one psychological symptom, with irritability being most commonly reported. Athletes with a personal and/or family history of psychological disorders experienced more acute psychological symptoms following a sport-related concussion. A higher psychological symptom cluster score was associated with delayed time to RTP but not time to RTL or symptom resolution.
Prevention of postoperative stroke in pediatric moyamoya patients: a standardized perioperative care protocol
Authors: Judge Jennifer , Kappel Ari D. , Isibor Christopher , O’Hara Jill E. , Larson Anna , Kleinman Monica , See Alfred P. , Lehman Laura L. , Smith Edward R.
Published: November 2023

OBJECTIVE

Perioperative stroke is a major complication of revascularization surgery in patients with moyamoya. Vomiting is common after neurosurgical procedures and may result in acute changes in intracranial pressure and cerebral blood flow. The authors instituted a standardized perioperative nausea and vomiting protocol for children with moyamoya undergoing indirect bypass surgery at their institution and analyzed its association with perioperative stroke. They hypothesized that instituting a standardized perioperative nausea and vomiting protocol would be associated with reduction in the number of perioperative strokes in children with moyamoya undergoing indirect bypass surgery.

METHODS

The authors retrospectively reviewed consecutive cases of children and young adults with moyamoya who underwent indirect bypass surgery before and after implementation of a new perioperative nausea and vomiting protocol at a single institution. They compared the rate of strokes in the perioperative period (postoperative days 0 and 1) in the 31 months following implementation to 31 months prior to implementation using Fisher’s exact test.

RESULTS

The median ages pre- and postimplementation were 8.5 (IQR 4–12) years and 8.3 (IQR 5–15) years, respectively. There were no significant differences between the cohorts in disease severity or other potentially confounding factors. In the 31 months prior to initiation of the perioperative nausea and vomiting protocol, there were 5 strokes in 137 surgically treated hemispheres (3.6%). After initiation of the protocol, there were no strokes in 114 surgically treated hemispheres (p = 0.065).

CONCLUSIONS

Instituting a standardized perioperative nausea and vomiting protocol was associated with reduction in perioperative strokes in children with moyamoya treated with indirect bypass surgery.
Incidence of postoperative neurological deficit with the use of an intraoperative neuromonitoring protocol for lateral lumbar interbody fusion
Authors: Mundis Gregory M. , Record Nicole C. , Shahidi Bahar , Lakomkin Nikita , Carnelian Alissa , Brady Kristina C. , Jelousi Michael , Akbarnia Behrooz A. , Eastlack Robert K.
Published: November 2023

OBJECTIVE

Intraoperative neuromonitoring (IONM) has become commonplace in assessing neurological integrity during lateral approaches to lumbar interbody fusion surgeries. Neuromonitoring is designed to aid surgeons in identifying the potential for intraoperative nerve injury and reducing associated postoperative complications. However, standardized protocols for neuromonitoring have not been provided, and outcomes are not well described. The purpose of this study was to provide a standardized protocol for IONM, and to describe clinical outcomes in a cohort of individuals who underwent lateral lumbar interbody fusion (LLIF) surgery.

METHODS

A retrospective review of 169 consecutive patients who underwent LLIF surgery at a single institution from October 2014 to October 2016 was performed. Patient characteristics, intraoperative details, clinical outcomes, and postoperative deficits (PODs) were compared between patients who did and did not trigger IONM alerts, and between patients who did and did not demonstrate a POD. A protocol for IONM decision-making was generated based on these observations.

RESULTS

Most patients (91.7%) underwent surgery for a degenerative spine condition. Twenty-three patients (13.6%) triggered neuromonitoring alerts, and 16 patients (9.5%) demonstrated a POD. Leg pain, back pain, and disability improved significantly (p < 0.045), and 2 patients had both motor and sensory deficits at the 12-week postoperative time point. Patients with a POD demonstrated greater operating room time (p = 0.034) and a greater number of interbody fusion levels (p = 0.015) but were less likely to have triggered a neuromonitoring alert (p = 0.04). There was no association between retractor time and POD (p = 0.98). When an IONM protocol was followed, individuals who experienced a POD were less likely to trigger an alert than those who did not experience a POD (p = 0.04).

CONCLUSIONS

This study provides a protocol algorithm for IONM alert responses in patients undergoing LLIF surgery. PODs are most associated with multilevel fusion, and patients with alerts had a low rate of persistent deficit. Future research is needed to validate these findings using a more rigorous comparative study design.
Lumbar lordosis restoration by minimally invasive short-segment fusion with anterior column realignment for adult spinal deformity: minimum 2-year follow-up
Authors: Tani Yoichi , Naka Nobuhiro , Ono Naoto , Kawashima Koki , Paku Masaaki , Ishihara Masayuki , Adachi Takashi , Taniguchi Shinichirou , Ando Muneharu , Saito Takanori
Published: November 2023

OBJECTIVE

The efficacy of anterior column realignment (ACR) remains relatively unclear, possibly because some safety concerns have limited its adoption and extensive evaluation. The authors aimed to study whether a minimally invasive surgery (MIS) triad consisting of ACR, lateral lumbar interbody fusion, and percutaneous pedicle screw fixation in a select group of adult spinal deformity (ASD) patients helps shorten fusion length without compromising clinical and radiographic outcomes over a minimum 2-year follow-up period.

METHODS

A series of 61 ASD patients (mean age 72.8 years) with pelvic incidence (PI) − lumbar lordosis (LL) (PI-LL) mismatch > 10° underwent the short-segment MIS triad (mean fusion length 3.0 levels) as a single-stage operation with a mean operative time and estimated blood loss of 157 minutes and 127 mL, respectively. Exclusion criteria were 1) thoracic scoliosis as the main deformity, 2) thoracolumbar junction kyphosis > 25°, 3) ankylosed facet joints, and 4) previous spinal fusion surgery. Seven patients, who needed fusion to be extended to S1, underwent mini-open transforaminal lumbar interbody fusion at L5–S1.

RESULTS

The segmental disc angle at the ACR level more than quintupled, averaging from 2.9° preoperatively to 18.9° at the latest follow-up (p < 0.0001). LL, in turn, nearly doubled from 17.0° to 32.8° (p < 0.0001) and PI-LL decreased by nearly half from 28.8° to 13.2° (p < 0.0001). At the same time, other spinopelvic deformity parameters as well as Oswestry Disability Index (ODI) scores significantly improved. Patients were divided into two groups at the latest postoperative evaluation: 36 patients whose PI-LL improved to < 10° and 25 patients who maintained a PI-LL mismatch > 10°. Binary logistic regression revealed preoperative PI-LL mismatch as the only factor that significantly influenced this dichotomous separation postoperatively. Receiver operating characteristic curve analysis identified the critical preoperative mismatch of 26.4° with 68% sensitivity and 84% specificity. Despite this different radiographic consequence, the two groups had an equally successful clinical outcome with no significant difference in ODI scores.

CONCLUSIONS

As long as the ASD characteristics are consistent with the authors’ exclusion criteria, the short-segment MIS triad served as an excellent surgical option in the patients with preoperative PI-LL mismatch < 26.4°, but the technique also worked well even in those with a mismatch > 26.4°, although ideal spinopelvic alignment targets were not necessarily achieved in these patients.
EDUKASI EFEK SAMPING OBAT MELALUI KAJIAN FARMAKOVIGILANS PADA MASYARAKAT DI KOTA MATARAM
Authors: Pradiningsih Anna , Nopitasari Baiq Leny , Qiyaam Nurul , Adikusuma Wirawan , Safwan Safwan , Rahmawati Cyntiya , Anjani Baiq Lenysia Puspita , Aisy Rihhadatul , Ningsih Risma Widia
Published: November 2023

ABSTRAKKegiatan pengabdian kepada masyarakat ini memiliki judul Edukasi Efek Samping Obat Melalui Kajian Farmakovigilans Pada Masyarakat. Kegiatan ini berlokasi di Taman Sangkareang pada hari Jumat, 30 Maret 2023. Mayarakat yang terdapat pada Taman Sangkareang sejumlah 30 orang. Masyarakat yang menjadi mitra meliputi usia produktif dari rentang 15-65 tahun. Pendidikan terakhir responden memiliki variasi yang beragam. Pendidikan terakhir SMA memiliki jumlah tertinggi yaitu 60%, S1 sebesar 16,67%, dan SMK sebesar 13,33 %. Sedangkan jumlah terendah yaitu D3, SMP dan SD dengan persentase masing-masing 3,33%. Masyarakat yang berkenan menjadi responden diberikan pretest, kemudian responden diberikan leaflet berupa penjelasan mengenai Efek Smaping obat melalui Kajian Farmakovigilans. Setelah itu, responden diberikan posttest. Pemberian pretest dan postetst ini bertujuan agar dapat mengetahui tingkap pemahaman responden terhadap materi yang diberikan. Hasil pretest didapatkan peresentase sebesar 69,67% jawaban yang sesuai. Sedangkan setelah pemberian edukasi, pengetahuan masyarakat dapat meningkat dilihat dari hasil posttest sebesar 83,08%. Hal ini menyatakan bahwa pemberian edukasi memberikan dampak yang baik bagi peningkatan pengetahuan masyarakat mengenai efek samping obat. Kata kunci: farmakovigilans; obat; edukasi ABSTRACTThis community service activity has the title Education of Drug Side Effects through Pharmacovigilance Studies in the Community. This activity will be located at Taman Sangkareang on Friday, March 30, 2023. The community in Sangkareang Park is 30 people. The communities that become partners include the productive age from the range of 15-65 years. The respondents' recent education has a variety of variations. The last high school education has the highest number of 60%, S1 at 16.67%, and SMK at 13.33%. While the lowest number is D3, junior high school and elementary school with a percentage of 3.33% each. People who wish to be respondents are given a pretest, then respondents are given a leaflet in the form of an explanation of the Smaping Effects of drugs through Pharmacovigilance Studies. After that, respondents were given a posttest. The provision of pretest and postetst aims to be able to find out the window of respondents' understanding of the material provided. The pretest results obtained a percentage of 69.67% of the corresponding answers. Meanwhile, after providing education, public knowledge can increase as seen from the posttest results by 83.08%. This states that providing education has a good impact on increasing public knowledge about drug side effects. Keywords: pharmacovigilance; medicine; education
UPAYA PENINGKATAN OMSET SALE ROLL NAZARIO SEBAGAI PRODUK UNGGULAN DAERAH CIKALONGKULON KABUPATEN CIANJUR
Authors: Halimah Halimah , Setiawan Erwan , Saepulah Asep , Darwati Jaenudin , Aisah Aisah
Published: November 2023

ABSTRAKSale Roll Nazario merupakan salah satu produk unggulan kecamatan Cikalongkulon karena memiliki keunikan tersendiri. Meskipun sudah 10 tahun produksi, produk Sale Roll Nazario belum mampu menembus pasar nasional. Kondisi tersebut disebabkan oleh 1) belum terpenuhinya persyaratan edar nasional, 2) kemasan yang tidak menarik, 3) proses pembuatan sale masih bergantung pada cuaca, 4) baru membuat 1 varian, 5) sistem pemasaran yang masih konvensional. PKM ini dilaksanakan dengan tujuan untuk mengedukasi salah satu pelaku Usaha Mikro Kecil dan Menengah (UMKM) yang berdomisili di Cikalongkulon Kabupaten Cianjur Provinsi Jawa Barat melalui kegiatan penyuluhan menggunakan prosedur: 1) identifikasi masalah, 2) perencanaan program, 3) implementasi program, dan monitoring program. Hasil pengabdian menunjukkan bahwa masyarakat telah diedukasi tentang 1) pemenuhan persyaratan edar nasional. Di antaranya cara memiliki PIRT, memiliki sertifikat Halal, dan informasi kadaluarsa, 2) cara membuat kemasan yang menarik, 3) membuat berbagai varian, 5) mengubah sistem pemasaran konvensional menjadi digital. Kata Kunci: omset; peningkatan; penyuluhan; UMKM; ABSTRACTSale Roll Nazario is one of the superior products of the Cikalongkulon sub-district because it has its own uniqueness. Even though it has been in production for 10 years, the Sale Roll Nazario product has not been able to penetrate the national market. This condition was caused by 1) the national distribution requirements had not been met, 2) the packaging was unattractive, 3) the sales process was still dependent on the weather, 4) only 1 variant had been made, 5) the marketing system was still conventional. This PKM was carried out with the aim of educating one of the Micro, Small and Medium Enterprises (MSMEs) domiciled in Cikalongkulon, Cianjur Regency, West Java Province through counseling activities using the following procedures: 1) problem identification, 2) program planning, 3) program implementation, and program monitoring. The results of the service show that the community has been educated about 1) fulfilling national distribution requirements. Among them are how to have a PIRT, have a Halal certificate, and expire information, 2) how to make attractive packaging, 3) make various variants, 5) change the conventional marketing system to digital Key words: education; increasing; turnover; MSME
STIMULASI KEPEDULIAN TERHADAP PENCEGAHAN HIPERTENSI MELALUI EDUKASI KESEHATAN DI KAMPUNG PUNGKUR, KABUPATEN GARUT, JAWA BARAT
Authors: Isni Khoiriyah , Allafia Dea Nurrizza , Oktavianti Amalia Ulfa
Published: November 2023

ABSTRAKSelama masa pandemi COVID-19 mengakibatkan peningkatan prevalensi dan jumlah kasus hipertensi di kampung Pungkur, desa Pamekarsari, Kabupaten Garut, Jawa Barat. Pemicunya adalah terhentinya kegiatan Posbindu sejak awal pandemi. Kondisi ini membuat masyarakat kurang peduli untuk mengukur tekanan darah dan melakukan screening hipertensi. Oleh karena itu, perlu dilakukan kegiatan yang bertujuan untuk mendorong niat kesadaran masyarakat untuk mencari layanan Kesehatan dalam rangka upaya pencegahan hipertensi. Metode pelaksanaan kegiatan melalui edukasi kesehatan dengan proses ceramah dan diskusi yang dilaksanakan secara daring dan luring. Sasaran pelatihan difokuskan pada masyarakat usia produktif (15-49 tahun), terdiri dari 25 remaja dan 20 orang tua (ayah dan ibu). Hasil kegiatan menunjukkan adanya niat kesadaran masyarakat untuk mengukur tekanan darah dan pemeriksaan kesehatan di Posbindu (62%), di Puskesmas terdekat (33%), dan rumah sakit (5%). Sehingga dapat dikatakan bahwa tujuan dari kegiatan pengabdian masyarakat ini telah tercapai dengan baik. Harapannya, kegiatan ini dapat memberikan dampak positif bagi perubahan perilaku hidup sehat bagi masyarakat setempat. Kata kunci: edukasi kesehatan; hipertensi; pencegahan; stimulasi. ABSTRACTDuring the COVID-19 pandemic, the prevalence and number of cases of hypertension increased in Kampung Pungkur, desa Pamekarsari, Garut Regency, West Java Province. The trigger was the cessation of Posbindu activities since the beginning of the pandemic. This condition makes people less concerned about measuring blood pressure and screening for hypertension. Therefore, it is necessary to carry out activities aimed at encouraging public awareness to seek health services in the context of efforts to prevent hypertension. Activities are carried out through health education, with lectures and discussions online and offline. The training target is people of productive age (15-49 years), consisting of 25 adolescents and 20 parents (fathers and mothers). The results of the activity show that there is an intention of public awareness to measure blood pressure and health checks at Posbindu (62%), at the nearest Health Center (33%), and hospital (5%). So it can be said that the purpose of this community service activity has been well achieved. The hope is that this activity can positively impact changing healthy lifestyle behaviours for the local community. Keywords: health education; hypertension; prevention; stimulation.
PELATIHAN METODE SLOW DEEP BREATHING RELAXATION GUNA MENGURANGI NYERI PUNGGUNG PADA IBU HAMIL
Authors: Amin Dewita Rahmatul
Published: November 2023

ABSTRAKNyeri punggung merupakan perasaan tidak nyaman yang terjadi selama kehamilan , umum terjadi pada 45 % wanita hamil dan meningkat sebesar 69% pada 28 minggu . Salah satu cara meredakan nyeri punggung adalah dengan slow deep breathing relaxation yang dapat meredakan ketegangan. otot, kecemasan, meningkatkan oksigen darah dan mengurangi stres dan nyeri dengan menghambat stimulus nyeri. Pengabdian masyarakat ini berlangsung di desa Karangraharja Kecamatan Cikarang utara. Tujuan  pengabdian kepada masyarakat ini adalah untuk meningkatkan pengetahuan kader dan ibu hamil tentang nyeri punggung dengan melakukan slow deep breathing relaxation. Metode yang digunakan dalam kegiatan ini adalah penyuluhan dan pelatihan. Penilaian pre-test dan post-test mengenai slow deep breathing relaxation dilakukan untuk menilai keberhasilan program. Hasil dari kegiatan ini yaitu kader dan ibu hamil dapat secara mandiri melakukan slow deep breathing relaxation dan pengetahuan kader meningkat dari (53,4%) menjadi (83,3%), pengetahuan ibu hamil meningkat dari (56,6%), menjadi (93,3%). Kata kunci: slow deep breathing relaxation; nyeri punggung; ibu hamil; kader ABSTRACTBack pain is an uncomfortable feeling that occurs during pregnancy, is common in 45% of pregnant women and increases by 69% at 28 weeks. One way to relieve back pain is by slow deep breathing relaxation which can relieve tension. muscles, anxiety, increases blood oxygen and reduces stress and pain by inhibiting painful stimuli. This community service took place in the village of Karangraharja, North Cikarang District. The purpose of this community service is to increase the knowledge of cadres and pregnant women about back pain by doing slow deep breathing relaxation. The method used in this activity is counseling and training. Pre-test and post-test assessments regarding slow deep breathing relaxation were carried out to assess the success of the program. The results of this activity were that cadres and pregnant women could independently do slow deep breathing relaxation and the knowledge of cadres increased from (53.4%) to (83.3%), knowledge of pregnant women increased from (56.6%) to ( 93.3%). Keywords: slow deep breathing relaxation; back pain; pregnant women; cadres.