bluuebunny/crossref_metadata_2025 huggingface dataset:
Varnishing prostate cancer acinar (adenocarcinoma of the prostate gland pt0) in prostate biopsy specimen which subsequently becomes diagnosed as no prostate cancer or pt0 prostate cancer in a prostatectomy specimen: review and update
Authors: Kodzo-Grey Venyo Anthony
Published: June 2024

Taking into consideration the increased undertaking of screening tests for serum prostate-specific antigen (PSA), it would be envisaged that the diagnosis of prostate cancer at an early clinical stage and small tumour-size had been appreciably increased over recent years and as a consequence, the volume of tumour within radical prostatectomy (RP) specimens had decreased in size. Pathological stage pT0 is referred to as no evidence of residual tumour within a radical prostatectomy (RP) specimen from a patient in whom biopsy-proven prostate carcinoma had been histologically confirmed as a diagnosis. This entity was given a terminology of the "vanishing cancer phenomenon" by Goldstein and associates. The pT0 stage of prostate cancer had been noted ensuing hormone therapy or prior transurethral resection of the prostate (TURP) for benign prostatic hyperplasia before the undertaking of RP. Even though much research had addressed these two scenarios of pT0 stage prostate cancer, patients that manifest with pT0 status in cases other than the aforementioned two scenarios occur on very rare occasions which had been iterated to be in between 0.2% and 0.8% of all prostate cancer patients). Only few studies had examined such patients. The clinical significance of pT0 staging has remained not to be clear. Nevertheless, many reports had documented that that pT0 stage patients do portend a highly satisfactory clinical outcome. pT0 at RP is extremely rare. Although most pT0 patients had tended to have low serum PSA levels, low clinical stage, low biopsy Gleasson Score (GS), and only one positive biopsy core, those with more aggressive characteristics could still harbour pT0 at RP. In order to prevent the undertaking of unnecessary treatment of such clinically insignificant cancers, it would be important to ascertain preoperative clinical and pathologic characteristics which might help the Urologists and oncologist to pre-operatively ascertain patients with a high probability of pT0 staging upon RP specimens. The ensuing article has discussed general overview aspects as well as miscellaneous narrations and discussions from some case reports, case series and studies related to the varnishing prostate cancer in order to provide recent educative material on the varnishing prostate cancer to all readers.
Trileaflet Mechanical Valves: What Is Already Known? A Systematic Review
Authors: Langenaeken Tom
Published: June 2024

Background: Trileaflet mechanical valves were introduced in the late 90’s. Despite promising results, none have made it past preclinical testing. Ample in vitro, in vivo and computational testing have already been done. Methods: This systematic review is intended to summarize all available preclinical and clinical testing regarding trileaflet mechanical valves. A literature search of Pubmed, Embase and Web of Science (Core Collection) (from inception to August 2023) was performed using a search string that was well defined and not modified during the study. An extensive overview of the search terms used in each database can be found in the appendix. 24 publications were included in this review. Results: This systematic review serves as an overview evaluating the rationale behind a trileaflet mechanical valve as well as the computational, in vitro and in vivo testing. We aim to summarize all available knowledge on trileaflet mechanical valves. Conclusions: A trileaflet mechanical valve is a promising concept, with equal or even superior hemodynamics compared to conventional bileaflet valves based on computational, in vivo and in vitro data. First in men trials are warranted to elude the true potential of this design.
Hepatocellular Carcinoma Mimicking Focal Nodular Hyperplasia
Authors: Gröger Lisa-Katharina
Published: June 2024

Focal nodular hyperplasia (FNH) is a common benign liver lesion, mostly solitary, and with no evidence of malignant transformation over time. The diagnosis can usually be made by imaging modalities with distinct features in magnetic resonance imaging (MRI) and computed tomography (CT) scans. We present a case series of three patients with solitary liver tumors which were, based on radiological features, first diagnosed to be large FNH. The patients were sent to our center for second opinion and probable treatment. Indication for resection was given because of nonconclusive radiologic imaging in the first, substantial growth progression in the second and elevated alpha fetoprotein (AFP) in the third case. Histology revealed well to poor differentiated hepatocellular carcinoma (HCC). FNH tends to show a distinct pattern in imaging modalities, but HCC can mimic FNH. The MRI-scan using hepatotropic contrast agent is the most sensitive imaging modality to diagnose FNH. AFP is usually not elevated in FNH. Asymptomatic FNH does not require surgery but a reliable diagnosis is crucial. In case of an un-certain diagnosis surgery should be offered to patients. In cases with a progression in size, an elevated level of AFP should be suspicious. Generally, an over-therapy via surgery should be avoided and follow-ups of a newly diagnosed FNH including measurement of AFP are advisable to detect alterations.
Neoadjuvant Immunotherapy and Intestinal Microbiota: Unraveling Their Roles in Anastomotic Leakage and Fistula After Colorectal Cancer Surgery
Authors: Araújo-Filho Irami
Published: June 2024

This comprehensive review explores the multifaceted relationship between neoadjuvant immunotherapy, intestinal microbiota alterations, and anastomotic leakage risk in patients undergoing colectomy for colon neoplasia. With the advent of immunotherapy, remarkably immune checkpoint inhibitors, there has been a significant shift in the treatment paradigms for various cancers, including colon neoplasia. These treatments, while effective, have been associated with changes in the intestinal microbiome, which, in turn, may influence wound healing and the integrity of anastomotic sites. The review delves into the complex interactions between the immune system and the gut microbiota, examining how immunotherapy-induced dysbiosis could disrupt the delicate balance necessary for optimal anastomotic healing. It discusses the role of specific bacterial species in modulating the immune response to cancer and their impact on the efficacy of immunotherapeutic agents. Moreover, the review highlights the potential mechanisms through which the microbiota-immune system interaction could affect surgical outcomes, focusing on the development of anastomotic leaks. The implications of these findings for clinical practice are discussed, including the need for targeted strategies to modulate the gut microbiota in patients undergoing immunotherapy and colectomy. Through this discussion, the review aims to provide insights into improving patient outcomes by integrating microbiome management into colon neoplasia patients' treatment and perioperative care.
An era, by chance
Authors: Hinzpeter C Jaime
Published: June 2024

The Belle Époque, a period in European history from 1871 to 1914, was characterized by progress, optimism, and scientific development. Julian Barnes' book "The Man in the Red Coat" explores this era, with inspiration drawn from the famous Italian gynecologist Samuel Jean Pozzi. One significant medical advancement during this time was the discovery of X-rays by Wilhelm Conrad Röntgen in 1895. Initially used for examining.
Querer ser já não é, e aquilo que resta é você
Authors: Caiado Jessica
Published: June 2024

Existe um não querer saber que é próprio da neurose, a paixão do querer ser, daquilo que não se é, uma estrutura que tenta negar aquilo de mais radical em cada um, a própria castração. Não queremos saber dos nossos sintomas, daquilo que nos limita, daquele que aparece no atropelo da fala, o inconsciente. O sujeito deposita no Outro a resposta para sua existência, endereça isso para que diga aquilo que lhe falta e que o completaria na sua condição de sujeito faltante, castrado. Uma tentativa de reparação, de completude, do se fazer Um, e as paixões: amor, ódio e ignorância são respostas a isso. Assim, em relação ao amor, o sujeito se aliena a ele, o amor como tapeação à falta. Assim, é possível pensar o amor não enquanto resposta, mas, como diz Lacan dom ativo, que visa sempre, para além da cativação imaginária, o ser do sujeito ama­do, a marca mais radical da sua diferença enquanto sujeito falante, faltante.
tragédia petropolitana e a ignorância como estratégia do discurso capitalista
Authors: Garcia Joseane
Published: June 2024

O texto busca analisar a tragédia das chuvas no munícipio de Petrópolis (RJ), não como um desastre natural ou agravamento das questões climáticas, mas pela via da ignorância como estratégia do discurso capitalista. A situação de Petrópolis é pensada como uma forma de violência articulada com o conceito de necropolítica, descrito pelo filósofo Achille Mbembe. O poder político se apropria da morte como um objeto de gestão, ou seja, o poder não só estabelece normas sobre como devemos viver e agir, mas também decide e toma medidas a respeito de como devemos morrer e quem deve morrer. Utilizando o pensamento da socióloga Linsey McGoey que formula o conceito de ignorância estratégica, o artigo aborda a paixão da ignorância descrita por Lacan, para descrever uma das estratégias do discurso capitalista, que na cidade Imperial pode ser traduzida pela expressão difundida por lá: amnésia do céu azul. Uma estratégia de apagamento do saber sobre as políticas públicas que deveriam ser encaminhadas para evitar novos desastres. Para demonstrar o gozo da ignorância agenciado pelo discurso capitalista, é apresentada uma vinheta clínica de uma intervenção feita durante o período de emergência na tragédia de 2022. Por fim, o artigo aposta que o discurso da psicanálise pode subverter o discurso capitalista fazendo uma crítica a ele.
Tempos de ignoródio e o trabalho com povos originários no Brasil
Authors: Do Rego Barra Vanusa
Published: June 2024

Uma questão circulou a Terra: Onde estão Bruno e Dom? Quando o onde foi precisado, a facticidade real, desvelou o pior, tal como aquilo que na Proposição, Lacan nomeou: terceiro ponto de fuga, demandando a sustentação da psicanálise na sua extraterritorialidade, frente aos aniquiladores processos de segregação. Krenak considera que este conflito tem na colonização seus fundamentos. E o ódio, quando se amarra à ignorância, deflagra o que Quinet concerniu como ignoródio. Neste panorama, como a Psicanálise atualizará seu Ato em direção ao real, a fim de sustentar sua práxis à altura de seu tempo e lugar?
uberização do psicanalista e os perigos para a Psicanálise e a Escola: do amor pelo saber à paixão da ignorância
Authors: Pacheco Filho Raul Albino
Published: June 2024

Discutem-se os perigos, para a Psicanálise, seu discurso e a Escola: a) das constantes ameaças de regulamentação da profissão de psicanalista; b) da multiplicação de ofertas precárias pretensamente relacionadas à formação de psicanalista; c) das contratações de psicanalistas como trabalhadores prestadores de serviço por clínicas privadas, em regime de trabalho informalizado e remunerado por número de atendimentos realizados. Propõe-se que essas ameaças derivam-se do discurso capitalista, que funciona como um buraco negro exercendo força gravitacional imensa sobre qualquer formação discursiva distinta em seu raio de alcance: sugando e submetendo tudo à dominância hegemônica de sua estrutura de ordenamento de gozo. O capitalismo caracteriza-se pela aversão ao amor e ao saber, ao produzir um sujeito que: a) não se interroga sobre a fantasia de que a mercadoria dá conta do seu desejo e gozo; b) não questiona a origem da 'programação' que articula mercadorias ao objeto causa do desejo; c) desinteressa-se pelo inconsciente.  "Não quero saber nada disso" é o norte da sua vida, guiado pela "paixão da ignorância". Ainda que o ofício do psicanalista seja orientado pelo amor, pelo saber e pela ética do desejo, o discurso capitalista constitui uma ameaça sempre presente de cooptação e destruição de sua ética e discurso. Regulamentar a prática psicanalítica e padronizar sua formação nos moldes de uma profissão é a via para a sua mercadorização (ou pior: para sua uberização) e para a eliminação da subversão que ela sustenta como furo: a fissura que indica que, ao capitalismo, falta um coração.
manifestação do ódio e da ignorância nas massas de nossa época
Authors: Martinho Maria Helena Coelho
Published: June 2024

Este artigo destaca duas paixões do ser – o ódio e a ignorância – e interroga as possíveis razões que têm provocado a manifestação exacerbada dessas paixões nas massas brasileiras de nossa época. A teoria de Freud sobre a massa e a teoria de Lacan sobre o ódio e a ignorância articuladas esclarecem as causas que levam as massas brasileiras a seguirem cegas de ódio e saber. O texto verifica que as massas seguem hipnotizadas, dominadas pelo discurso de ódio e pelo discurso negacionista enunciados pelo chefe de Estado brasileiro dos últimos quatro anos. A ignorância assume a face do ódio ao saber. Através da Novillíngua, idioma pobre transmitido prioritariamente nas redes sociais como modelo de ação e propaganda política, memes, slogans e fake news, que remetem a supremacia dos discursos fascistas, são disparados, os imperativos de gozo do supereu ordenam: odeie e ignore a ciência, a cultura, a intelectualidade, os pobres, os negros, os índios, as mulheres, os homossexuais. A massa afetada se identifica aos ideais do líder que influencia, engana e manipula o povo. O artigo questiona: até quando as massas brasileiras vão seguir cegas de ódio e saber, hipnotizadas, disseminando o ódio ao saber, atacando a linguagem, atingindo a dialética, promovendo uma narrativa fascista, um discurso pestilento?
histéricas de hoje
Authors: Borges Pimenta de Azevedo Hannah Raquel
Published: June 2024

É de interesse do trabalho realizar uma análise multideterminada da nomenclatura histérica – conceito psicanalítico com grande repercussão teórica, compreendendo seu significado diagnóstico, sua íntima relação com o contexto da época, como se desenvolveu no cenário social e se popularizou como adjetivo feminino e estratégia de poder intimamente ligada ao questionamento da sanidade. Partindo do viés teórico, o problema de pesquisa está centrado no controle dos corpos femininos, diretamente ou sublimado pela cultura social e nas suas estratégias, que são capazes de forjar em nome dos seus interesses termos, diagnósticos médicos e o que quer que desejem. Foi possível evidenciar através da revisão de literatura a imperativa necessidade da promoção de debates sociais e científicos que questionem o local destinado e ocupado pela mulher, e a promoção de políticas públicas e ações sociais capazes de garantir direitos e proteção.
Palavras-chave: histeria, feminino, estratégias de poder, sociedade.
arte como acrópole e a mercantilização da poiésis
Authors: Pingarilho Batista Jéssica
Published: June 2024

Este artigo tem como objetivo articular as dimensões da captura da arte, sua relação com as torções do sujeito e a maneira com que, na atualidade, a máxima da mercantilização e consumo desenfreados ancorada no discurso capitalista distorce e esvazia o fazer poético. Propõe-se uma oposição radical a esta tentativa de esvaziar o fazer subjetivo através de dispositivos tecnológicos e jogos de poder encarnados no poder aquisitivo, a partir de uma leitura e postura psicanalítica, buscando resgatar o sujeito do fazer poético, furado e dividido entre a dimensão significante, da palavra e a dimensão indizível do Real que o atravessa.
Quem sabe faz a hora, não esperar acontecer
Authors: Prates Ana Laura
Published: June 2024

Esse artigo não tem resumo. É uma conferência.
que o amor vira quando chega o fim?
Authors: Costa Paulo
Published: June 2024

O trabalho se propõe a investigar as articulações possíveis do amor junto a psicanálise. Não se faz outra coisa em uma análise a não ser falar sobre amor, já dizia Lacan. Para isso, se destaca a importância do amor para o fenômeno da transferência e a atenção ética que o analista deve sustentar no manejo para a condução do tratamento, pois é sabido que a transferência não vem desacompanhada de resistências. Tais questões serão debatidas a partir de recortes de um caso clínico abordando fatores como as identificações, o amor dentro de uma perspectiva especular e imaginária, que em um primeiro momento auxiliam a conjuntura transferencial. Para contribuir a discussão, será apresentado as formulações inicias a respeito do esquema óptico, com o objetivo de nos interrogar a posição do analista na transferência.
Dimensão ética e estética do desejo do analista
Authors: Pedrosa Jéssica
Published: June 2024

O presente artigo investiga as dimensões éticas e estéticas do desejo do analista enquanto operador na clínica psicanalítica, analisando as aproximações entre o conceito de cura em psicanálise, da pré-história da clínica ao contemporâneo, o efeito do coro e da catarse na tragédia grega e do lamento na ópera. Com essas aproximações, constatou-se que os conceitos de desejo do analista, em Lacan, amor e transferência, em Freud, são interlaçados enquanto operadores lógicos fundamentais para a práxis analítica em busca de um bem-dizer possível a cada sujeito. Utilizando-se do exemplo de Antígona, na tragédia, e da mascarada, posição feminina também cara ao analista, concluiu-se que a ética da psicanálise circunda um não-saber e uma dimensão de falta, não visando uma verdade garantida, mas uma aposta criativa, na qual sempre sobra um resto incurável, assim como a estética na tragédia e no lamento feminino da ópera.
Provincial Legislation in the Light of the Eighteenth Constitutional Amendment Act: A Case Study of Khyber Pakhtunkhwa Assembly
Authors: Nosheen Aisha , Anwar Zahid
Published: June 2024

The 18th Constitutional Amendment Act of 2010 completely changed Pakistan`s federal system when considerable laws and legislative, executive, and authority for budget management were granted and handed over to provinces. This research investigates the effectiveness of provincial laws in the Khyber Pakhtunkhwa Assembly through the 18th Amendment. This research also shows the improvement in governance and legislative autonomy and KP's capabilities for managing this devolution of powers. The important laws and legislative measures are highlighted in this research which were carried out after the 18th amendment, with mainly and particular significance on the health care, education system, and local government as well. However, the KP Assembly has significantly exercised its authority and enhanced its legislative power to effectively address regional needs. Despite ongoing challenges and difficulties with interprovincial collaboration, they have managed to achieve this progress.
Analyzing the Coverage of Environment News in Major Newspapers of Sindh Pakistan
Authors: Shabir Arain Ghulam , Ali Chandio Dastar , Ali Kalhoro Yasir
Published: June 2024

The environment is the existing all living and non-living things surrounding us. The environment exists in both living and non-living matters. The environment is made up of ecology, chemicals, biological material, and other natural atmospheres. When we discuss the environment, we are referring to the many connections that exist between the bio-network and non-living entities. These connections are referred to as communication. The media needs to report on environmental issues and the ways in which they affect people since these issues have an effect on human lives and the standards of living. When it comes to reporting on the environment, environmental journalism, also known as scientific journalism, serves a distinct purpose. Ineffective management, precarious financial situations, a rising illiteracy rate in Pakistan, and a growing population all contribute to the negative effects that population increase has on the environment.
Usage of TikTok for Political Communication: A Systematic Literature Review
Authors: Ali Mukhtiar , Soomro Fozia , Razzaque Chhachhar Abdul
Published: June 2024

The onset of the Internet era and the digitalization of the past 20 years have reshaped political communication. Social networking sites have become a tools of political parties, candidates for various highest authorities, voters, civil society institutions, and the media. TikTok has also recently entered the world of politics, media, and election campaigns.The use of this app has spread in political campaigning, be it interaction and communication, debate broadcasting, seeing the opponent's view, or analyzing the public mood.The shift in using TikTok in political communication and electoral campaigning in the world has become a subject of interest for researchers. This research, in its early stage, has not reached a full scope either. This article is a report of a systematic literature review that searched for studies that examined the participation of political parties in the election campaign on TikTok.
Body Image Satisfaction and Eating Habits of the Students: A Case Study of the Facebook Users
Authors: - Asma , Munir Bakht , Khalid Shahzad
Published: June 2024

This study is conducted to investigate Facebook usage and its relation to the perception of male and female university students about their body image satisfaction and goals. The major findings were to explore the differences, relationships, and predictability of Facebook usage, eating habits, exercising habits, and physical fitness goals of students. Using the uses and gratification theory, the researcher examined the student’s perception of ideal body image satisfaction level and eating behaviors. The findings of this study show that there is a significant relationship between Facebook usage and student’s perception of their body image satisfaction-related goals. A significant difference is noted in male and female students about their eating habits while using Facebook dietary pages. The study also reveals that Facebook usage can be predicted in a significant way through exercise habits and physical fitness goals.
Gaming Addiction: Investigation of Motivation to Play PUBG Game
Authors: Hassan Ali , Irtaza Sadaf , Latif Tayyaba
Published: June 2024

American Psychiatric Association (APA) states that gaming addiction is an irresistible and compulsive drive by a person to be involved in a video game. We are going to find out what is the motive of a PUBG player to play for the game. This involves two hypotheses of the study. One is about whether religiosity level has any relationship with gaming addiction or not. The other is about motivation to play PUBG games. A survey technique was employed to collect the data. The Pearson correlation is -0.192. This value signifies a negative correlation between religion level and gaming addiction. A negative correlation suggests that as one variable (in this case, religion level) increases, the other variable (gaming addiction) tends to decrease, and vice versa. The magnitude of -0.192 indicates that the association is not extremely strong, but it is statistically significant. A strong association was observed between a high cultivation effect and a high motivation level.
Examining Framing Strategies in Health Vodcasts about Genetic Diseases and Pre-Marital Screening
Authors: Sohail Faryal , Raza Syed Hassan
Published: June 2024

This research delves into the evolving strategies for effectively communicating genetic information. Specifically, it explores health communication strategies as tools for enhancing health literacy. With the burgeoning role of digital media in disseminating public service messages, there is a growing emphasis on digital journalistic practices within health Vodcasts. However, despite the potential of health Vodcasts to promote preventive health behaviors against genetic disorders, their precise impact remains unclear. To address this gap, the study employs content analysis of health frames within digital health Vodcasts from popular media outlets in Pakistan. This research sheds light on journalistic practices related to genetic diseases, their preventive measures, and pre-marital screening. The findings reveal the prominence of the Health Severity frame, followed by the Consequence and Human-interest Frame, in Health Vodcasts. By advocating for more persuasive health campaigns on public health issues, this study contributes to advancing the field of health communication.
Semiotic Analysis of Political Cartoons of Urdu Print Media in Pakistan During Election 2024
Authors: Ram Marwari Badal , Laghari Abdullah , Laghari Tania
Published: June 2024

Among several modes of communication, the language of images and cartoons has also been frequently used by print media across the globe. It has drawn the attention of the masses also because of its sense of humor, satirical meaning, and interpretation. Thus, semiotic studies help viewers and readers decode the hidden meanings and agendas behind the images or cartoons. History shows that numerous attempts have been made to discover the main objective and essence. Therefore, the study explores and discovers the meaning hidden in the political cartoons in the Urdu print media of Pakistan before the general election in 2024 throughthe lens of social semiotic theory. The study focuses on van Leeuwen and Gunther Kress' Social Semiotic Theories. Around ten (10) political cartoons were selected and investigated by Daily Jung Newspaper which has vast circulation across the country.
Arteriovenous malformations in the cerebellopontine angle: assessment of the "backdoor resection" technique and microsurgical results in 38 patients
Authors: Hanalioglu Sahin , Graffeo Christopher S. , Srinivasan Visish M. , Ibrahim Sufyan , Garcia Joseph H. , Koester Stefan W. , Aabedi Alexander A. , Catapano Joshua S. , Winkler Ethan A. , Lawton Michael T.
Published: June 2024

OBJECTIVE

Posterior fossa arteriovenous malformations (AVMs) represent 7% to 15% of all intracranial AVMs and are associated with an increased risk of hemorrhage, morbidity, and mortality compared with supratentorial AVMs, thus prompting urgent and definitive treatment. Cerebellopontine angle (CPA) AVMs are a unique group of posterior fossa AVMs incorporating characteristics of brainstem and cerebellar lesions, which are particularly amenable to microsurgical resection. This study reports the clinical, radiological, operative, and outcome features of patients with CPA AVMs in a large cohort.

METHODS

The authors conducted a single-surgeon, 2-institution retrospective cohort study of all consecutive patients with CPA AVMs treated with microsurgical resection during a 25-year period.

RESULTS

CPA AVMs represented 22% (38 of 176) of all infratentorial AVMs resected by the senior author. Overall, 38 patients (22 [58%] male and 16 [42%] female) met the study inclusion criteria and were analyzed. Most patients presented with hemorrhage (n = 29, 76%). The median age at surgery was 56 (range 6–82) years. Subtypes included 22 (58%) petrosal cerebellar AVMs, 11 (29%) lateral pontine AVMs, and 5 (13%) AVMs involving both the brainstem and cerebellum. Most AVM niduses were small (< 3 cm; n = 35, 92%) and compact (n = 31, 82%). Fourteen (37%) patients harbored flow-related aneurysms. Twenty (53%) patients underwent preoperative embolization. Complete angiographic obliteration was achieved with microsurgery in 35 (92%) patients. Five (13%) patients with poor neurological conditions at presentation died before hospital discharge. Of the 7 (18%) patients with new postoperative neurological deficits, 5 had transient deficits. The median (interquartile range) follow-up was 1.7 (0.5–3.2) years; 32 (84%) patients were alive at last follow-up, and 30 (79%) had achieved a favorable neurological outcome (modified Rankin Scale [mRS] score 0–2). The only independent predictor of unfavorable postoperative outcome (mRS score 3–6) was the preoperative mRS score (p = 0.002).

CONCLUSIONS

CPA AVMs are unique posterior fossa lesions, including petrosal cerebellar and lateral pontine AVMs. The "backdoor resection" technique provides a safe and efficient strategy with high obliteration rates and a low risk of treatment-related morbidity. Microsurgical resection should be considered the frontline treatment for most CPA AVMs, except for those with a significant diffuse brainstem component.
Characterizing the safety profile of vagus nerve stimulation devices for epilepsy from 21,448 manufacturer and user reports
Authors: Yang Victor B. , Yang Andrew B. , Menta Arjun K. , Zhao Xiyu , Blum Jacob , Madsen Joseph R. , Anderson William S.
Published: June 2024

OBJECTIVE

This study summarizes medical device reports (MDRs) associated with adverse events for vagus nerve stimulation (VNS) devices indicated for epilepsy as reported by the Manufacturer and User Facility Device Experience (MAUDE) database of the US Food and Drug Administration.

METHODS

The MAUDE database was surveyed for MDRs from November 2013 to September 2022 regarding VNS devices for epilepsy. Event descriptions, device problems, correlated patient consequences, and device models were grouped and analyzed in Python. Based on event description, revision surgeries and other unique events were identified. Revenue from VNS device sales was used to approximate growth in their use over time.

RESULTS

A total of 21,448 MDRs met the inclusion criteria. High VNS impedance, the most prevalent device malfunction overall (17.0% of MDRs), was the most common factor for 18 of the 102 encountered patient problems and led to 1001 revision surgeries (3371 total revisions). Included in those 18 device malfunctions were 3 of the top 6 occurring patient problems: seizure recurrence (9.9% associated with high impedance; encompassed focal, absence, and grand mal subtypes), death (1.3%), and generalized pain (7.9%). The next 4 top cited device malfunctions—lead fracture (13.7% of MDRs), operational issue (6.6%), battery problem holding charge (4.2%), and premature end-of-life indicator (2.9%)—differed widely in their percentage of cases that did not impact patients (77.4%, 57.3%, 48.9%, and 92.2%, respectively), highlighting differing malfunction severities. Seizure recurrence, the most prevalent patient impact, was the outcome most associated with 32 of the 68 encountered device problems, including high impedance (12.8%), lead fracture (12.2%), operational issue (18.4%), battery problem holding charge (31.2%), and premature end-of-life indicator (8.9%), which comprised the top 5 occurring device problems. In general, MDRs spanned a diverse range including device age, hardware, software, and surgeon or manufacturer error. Trends were seen over time with declining annual MDRs coupled with a rise in the use of VNS devices as gauged by revenue growth. Shifting device and patient problem profiles were also seen in successive models, reflecting engineering updates.

CONCLUSIONS

This study characterizes the most common and consequential side effects of VNS devices for epilepsy while clarifying likely causes. In addition, the outcomes of 68 distinct device malfunctions were identified, including many not ubiquitously present in literature, lending critical perspective to clinical practice.
Intracranial Aneurysms Managed by Parent Artery Reconstruction Using Tubridge Flow Diverter study: 1-year outcomes
Authors: Li Qiang , Lv Nan , Li Li , Gu Yuxiang , Xu Liquan , Lv Ming , Huang Changren , Mao Guohua , Lu Hua , Zhong Shu , Duan Chuanzhi , Xie Xiaodong , Wan Jieqing , Wang Feng , Guan Sheng , Zhao Rui , Dai Dongwei , Zhou Yu , Huang Qinghai , Xu Yi , Miao Zhongrong , Li Tianxiao , Liu Jianmin
Published: June 2024

OBJECTIVE

Previous randomized controlled trials have reported a significantly higher occlusion rate of large and giant aneurysms when utilizing the Tubridge flow diverter (FD). In the present trial, the safety and efficacy of the Tubridge FD in treating unruptured internal carotid artery (ICA) or vertebral artery (VA) aneurysms were assessed in a real-world setting.

METHODS

The Intracranial Aneurysms Managed by Parent Artery Reconstruction Using Tubridge Flow Diverter (IMPACT) study is a prospective, multicenter, single-arm clinical trial assessing the efficacy of the Tubridge FD in the management of unruptured aneurysms located in the ICA or VA. The primary endpoint was the complete occlusion (Raymond-Roy class 1) rate at the 1-year follow-up. The secondary endpoints included the technical success rate, the successful occlusion rate of the aneurysm, which is the degree of aneurysm embolization scored as Raymond-Roy class 1 or 2, major (> 50%) in-stent stenosis, and incidence of disabling stroke or neurological death associated with the target aneurysms.

RESULTS

This study included 14 interventional neuroradiology centers, with 200 patients and 240 aneurysms. According to angiographic core laboratory assessment, 205 (85.4%) aneurysms were located in the ICA, 34 (14.2%) in the VA, and 1 (0.4%) in the middle cerebral artery. Additionally, 189 (78.8%) aneurysms were small (< 10 mm). At the 12-month follow-up, the total occlusion rate was 79.0% (166/210, 95% CI 72.91%–84.34%). Additionally, the occurrence of disabling stroke or neurological death related to the specified aneurysms was 1% (2/200).

CONCLUSIONS

The 1-year results from the IMPACT trial affirm the safety record of use of the Tubridge FD in the treatment of intracranial aneurysms in real-world scenarios. These results reveal low morbidity and mortality rates of 3.5% and 1.5%, respectively. Furthermore, they provide evidence of the effectiveness of the Tubridge FD, as demonstrated by the complete occlusion achieved in 166 of 210 (79%) cases.
Endoscopic transorbital approach to the petrous apex: is orbital rim removal worthwhile for the exposure? An anatomical study with illustrative case
Authors: Hong Chang-Ki , Mosteiro Alejandra , Kong Doo-Sik , Tafuto Roberto , Codes Marta , Ferres Abel , Matas Jessica , Manfrellotti Roberto , Prats-Galino Alberto , Di Somma Alberto , Enseñat Joaquim
Published: June 2024

OBJECTIVE

The endoscopic transorbital approach (ETOA) has been demonstrated to be a feasible ventral route to the petrous apex. Yet, it has been pointed to as a deep and narrow corridor for anterior petrosectomy; particularly, medialization of the instruments can become an issue when targeting the petroclival area. To overcome this limitation, an ETOA with orbital rim removal (ETOA-OR) has been suggested, but not de facto compared, with a transorbital approach without removal of the rim. This addition could augment the surgical exposure and freedom of movement when accessing the petrous apex area.

METHODS

Five human cadaveric heads (10 sides) were dissected. First, anterior petrosectomy was performed via a conventional ETOA (without orbital rim removal). Second, en bloc removal of the orbital rim was performed, with enlargement of the orbital craniectomy and, subsequently, further drilling of the medial petrous apex. Qualitative and quantitative comparisons are provided. An illustrative surgical case is also shown.

RESULTS

The transorbital route allowed the authors to perform an anterior petrosectomy in all specimens. The landmarks of bone removal are superposed onto those in the transcranial route. The ETOA-OR increased the volume of craniectomy (from 4.0 mL to 5.5 mL), the lateromedial angulation, and superoinferior angulation of the instruments within the petrous area. Thus, this approach improved the exposure of the medial petroclival area, allowing for an augmented petrosectomy (from 1.4 mL to 2.0 mL, 39.5% increase) and for increased maneuverability, both in the petrous area (from 44.1 cm2 to 76.5 cm2, 73.3% increase) and in the posterior fossa (from 20.2 cm2 to 52.0 cm2, 158% increase). The ETOA-OR was also pragmatically applied to treat a recurrent petroclival meningioma. Complete removal was achieved, the abducens nerve palsy improved, and the trigeminal neuralgia decreased in severity, yet still required medication.

CONCLUSIONS

The authors provide the first formal anatomical comparison between the transorbital approach with preservation of the orbital rim and a transorbital approach with removal of the rim to access the petrous apex. In addition, an illustrative case is used as a proof of concept and feasibility. According to the authors’ data, the ETOA-OR significantly improves surgical exposure and the surgeon’s comfort in this deep region. The bony defect can be reconstructed to avoid cosmetic deformities, maintaining the minimally disruptive concept of transorbital surgery.
Stereotactic radiosurgery for prostate cancer spine metastases: local control and fracture risk using a simultaneous integrated boost approach
Authors: Beckham Thomas H. , Rooney Michael K. , Cifter Gizem , Bernard Vincent , McAleer Mary Frances , De Brian S. , Tom Martin C. , Perni Subha , Wang Chenyang , Swanson Todd , Tatsui Claudio E. , Alvarez-Breckenridge Christopher , North Robert , Rhines Laurence D. , Tang Chad , Logothetis Christopher , Amini Behrang , Li Jing , Yeboa Debra N. , Ghia Amol J.
Published: June 2024

OBJECTIVE

Variation exists in approaches to delivery of spine stereotactic radiosurgery (SSRS). Here, the authors describe outcomes following single-fraction SSRS performed using a simultaneous integrated boost for the treatment of prostate cancer spine metastases.

METHODS

Health records of patients with prostate cancer spine metastases treated with single-fraction SSRS at the authors’ institution were reviewed. Treatment was uniform, with 16 Gy to the clinical tumor volume and 18 Gy to the gross tumor volume. The primary endpoint was local recurrence, with secondary endpoints including vertebral fracture and overall survival. Univariate and multivariate competing risk regression models made using the Fine and Gray method were used to identify factors predictive of local recurrence, considering death to be a competing event for local recurrence.

RESULTS

A total of 87 targets involving 108 vertebrae in 68 patients were included, with a median follow-up of 22.5 months per treated target. The 1-, 2-, and 4-year cumulative incidence rates of local failure for all targets were 4.6%, 8.4%, and 19%, respectively. The presence of epidural disease (subdistribution hazard ratio [sHR] 5.43, p = 0.04) and SSRS as reirradiation (sHR 16.5, p = 0.02) emerged as significant predictors of local failure in a multivariate model. Hormone sensitivity did not predict local control. Vertebral fracture incidence rates leading to symptoms or requiring intervention at 1, 2, and 4 years were 1.1%, 3.7%, and 8.4%, respectively. In an exploratory analysis of patterns of failure, 3 (25%) failures occurred in the epidural space and only 1 (8%) occurred clearly in the clinical tumor volume. There were several lesions for which the precise location of failure with regard to target volumes was unclear.

CONCLUSIONS

High rates of local control were observed, particularly for radiotherapy-naïve lesions without epidural disease. Hormone sensitivity was not predictive of local control in this cohort and fracture risk was low. Further research is needed to better predict which patients are at high risk of recurrence and who might benefit from treatment escalation.
Fueling the future of neurosurgery: increasing trends in female enrollment expanding the neurosurgical workforce from 2010 to 2019
Authors: Smith Eleanor C. , Calafiore Rebecca L. , Oravec Chesney S. , Kittel Carol , Wolfe Stacey Q. , White Jaclyn J.
Published: June 2024

OBJECTIVE

Regular reporting on recruitment of women into neurosurgery is a mechanism to track the progress of minority inclusion and diversity. For more than 20 years, half of US medical students have been women, yet a disproportionate minority pursue a career in neurosurgery. The authors previously published data tracking women in neurosurgery for the prior decade from 2000 to 2009, which showed an increasing match rate of women over time, from 18 women matched at the beginning of the decade to 36 matched at the end. They now present updated data on the matriculation of women into neurosurgical residencies across the most recent decade, from 2010 to 2019.

METHODS

Public databases from the Association of American Medical Colleges were analyzed for applicants to neurosurgical residency from 2010 to 2019. Demographic data for those matched was obtained from the American Medical Association Masterfile and analyzed for year of match and gender. Secondary outcomes included program location, age, and gap year(s) between medical school and residency.

RESULTS

Women made up 18.8% (394/2094) of residents matched into neurosurgery from 2010 to 2019, compared to 12% during the previous decade. There was an increase in overall match rate of 2.2% per year (male + female) from 2010 to 2019, representing the predicted need for expansion of the neurosurgical workforce to meet national needs. Women made up the majority of this expansion, rising by 5.5% over the time period (p = 0.002), compared to men increasing by 1.4% over the time period (p = 0.096). The percentage of women applicants who matched was 34.4%, compared to men at 38.6% (p = 0.009). There was no significant difference in gender with regard to age, number of gap years, or program location.

CONCLUSIONS

The number of women matching into neurosurgery has continued to increase across the last 2 decades. Despite this, there remains significant disparity between the number of men and women matching into neurosurgery. Ongoing mitigation of barriers to recruitment of women into neurosurgery is critical. The authors’ data highlight the fact that women are important to fueling the expansion of the neurosurgical workforce.
The role of genetics on behavioral outcomes in nonsyndromic sagittal synostosis
Authors: Alper David P. , Almeida Mariana N. , Hu Kevin G. , Yang Jenny F. , Timberlake Andrew T. , Shah Jinesh , Persing John A. , Alperovich Michael
Published: June 2024

OBJECTIVE

Previous work identified an association between genetics and neurodevelopmental delays in patients with nonsyndromic craniosynostosis. The authors investigated the role of genetic mutations on behavioral outcomes of patients with treated sagittal synostosis.

METHODS

Parents of children aged 6–18 years with surgically corrected sagittal synostosis were recruited to complete the Child Behavioral Checklist (overall behavioral problems), Conners 3rd Edition–Parent (attention-deficit/hyperactivity disorder), Social Responsiveness Scale 2nd Edition (autism spectrum disorder [ASD]), and Behavior Rating Inventory of Executive Function 2nd Edition (executive function). Genomic analysis was completed, and patients were identified if they had mutations in high probability of loss of function intolerant (pLI) genes (high pLI vs nonhigh pLI). Genetic burden was assessed relative to controls. Multivariate linear regression determined the association of mutations in high pLI genes with behavioral scores, while controlling for sociodemographic factors, age at surgery, surgery type, and IQ.

RESULTS

Sixteen of 45 patients were in the high pLI group. There were no differences between the groups in terms of sociodemographic factors. A greater proportion of children in the high pLI group scored at or above borderline clinical levels for aggression (18.8% vs 0.0%, p = 0.05) and externalizing problems (31.3% vs 3.7%, p = 0.02). Among children in the nonhigh pLI group, older age at surgery was associated with worse scores on the rule-breaking, aggression, and externalizing problems domains and four out of five ASD domains.

CONCLUSIONS

Children with treated nonsyndromic sagittal synostosis and mutations in high pLI genes had worse behavioral problems in externalizing behaviors and aggression, whereas older age at surgery was a significant predictor of worse behavioral outcomes in patients without mutations in high pLI genes.
Focal selective dorsal rhizotomy and concurrent deformity correction: a combined approach
Authors: Gadgil Nisha , Schwabe Aloysia L. , Wright Edward , Barbuto Amy , Dugan Eric L. , Thomas Sruthi P. , Shilt Jeffrey S. , Beauvais Dorothy , Shih Yushane , Smith Brian G. , Bauer David F. , Curry Daniel J.
Published: June 2024

OBJECTIVE

Selective dorsal rhizotomy (SDR) is a neurosurgical procedure to reduce spasticity in children with cerebral palsy and spastic diplegia. The authors developed a procedure called focal SDR for children with spasticity predominantly in the L5 or S1 motor distribution, which can be combined with orthopedic correction of fixed soft-tissue or bony deformity. The authors describe in detail the technique of minimally invasive focal SDR and propose selection criteria.

METHODS

The authors conducted a retrospective study of patients who underwent focal SDR at their institution and underwent baseline and 1-year postoperative 3D gait analysis. Modified Ashworth scale (MAS) and Gait Deviation Index (GDI) scores were the primary outcome measures.

RESULTS

Ten patients met the study criteria, all with an underlying diagnosis of cerebral palsy. All underwent focal SDR at the unilateral or bilateral S1 level, and 4 additionally underwent focal SDR at the L5 level unilaterally or bilaterally. All but 1 patient underwent concurrent orthopedic surgery. The improvement in spasticity of the plantar flexors, as measured by the MAS score, was 2.2 (p < 0.001). In the patients who underwent L5 focal SDR, there was an improvement in the hamstring MAS score of 1.4 (p = 0.004). The mean improvement in the GDI score following focal SDR was 11 (range −6 to 29, p < 0.001).

CONCLUSIONS

Focally impairing spasticity in the gastrocsoleus complex and/or hamstrings muscle group in the setting of less functionally impactful proximal tone is extremely common in cerebral palsy. The novel technique of focal SDR, combined with orthopedic intervention, improves spasticity scores and overall gait mechanics. Further investigation is warranted to define the ideal candidacy and outcomes.
Autonomia wspólnoty religijnej – głos w dyskusji w sprawie członkostwa osób małoletnich o ograniczonej zdolności do czynności prawnych w kolegialnych organach osób prawnych Kościoła Ewangelicko-Augsburskiego
Authors: Walencik Dariusz , Pluta Katarzyna
Published: June 2024

Autonomia wspólnot religijnych stanowi bezpośrednią wartość nie tylko dla wspólnoty jako takiej. Warunkuje również rzeczywiste korzystanie z prawa do wolności religii przez wszystkich jej członków. Tym samym kościół lub inny związek wyznaniowy, aby mógł prawidłowo i pełnowymiarowo funkcjonować, musi mieć możliwość korzystania z autonomii prawnej, której elementem może być także przyznanie w wewnętrznych regulacjach prawnych osobom małoletnim o ograniczonej zdolności do czynności prawnych biernego i czynnego prawa wyborczego do kolegialnych organów tej wspólnoty religijnej. Przyznanie małoletnim o ograniczonej zdolności do czynności prawnych praw wyborczych, a tym samym możliwości uczestnictwa w kolegialnych organach kościołów lub innych związków wyznaniowych, rodzi jednak szereg problemów praktycznych. Należą do nich np. ważność głosowań, ważność uchwał podjętych przez te organy, ewentualny wymóg uzyskania zgody przedstawiciela ustawowego małoletniego czy zgody sądu, skuteczność czynności prawnych dokonanych przez kościelne osoby prawne. W niniejszym artykule kwestie te zostały podjęte w odniesieniu do konkretnej wspólnoty religijnej, a mianowicie Kościoła Ewangelicko-Augsburskiego w Rzeczypospolitej Polskiej i jego prawa wewnętrznego (kanonicznego). Przeprowadzone analizy prowadzą do wniosku, że przepisy o ograniczonej zdolności do czynności prawnych małoletnich mają głównie charakter ochronny. Skoro – poza kilkoma wyjątkami – małoletni o ograniczonej zdolności do czynności prawnych nie może samodzielnie zajmować się własnymi sprawami majątkowymi, to tym bardziej nie jest w stanie racjonalnie zarządzać cudzymi sprawami jako piastun organów Kościoła Ewangelicko-Augsburskiego albo innych kościelnych osób prawnych. Tym samym de lege lata najkorzystniejszym rozwiązaniem wydaje się wprowadzenie przy wskazanych kolegialnych organach tegoż Kościoła albo innych kościelnych osób prawnych jednostek o charakterze konsultacyjno-doradczym składających się z osób małoletnich, które nie ukończyły 18 lat, lecz ukończyły lat 14. Niemniej koncepcja przyznania tym osobom praw wyborczych w określonym zakresie zasługuje na uwagę jako postulat de lege ferenda.