bluuebunny/crossref_metadata_2025 huggingface dataset:
Obsolescence technologique et survivance musicale : le cas des Ondes Martenot
Authors: Vaiedelich Stéphane , Quartier Laurent
Published: August 2023

L’instrumentarium du xxe siècle acquiert avec l’apparition et l’emploi de l’électricité des spécificités techniques qui le mettent à part dans l’histoire de la facture instrumentale. Si aujourd’hui, certains instruments ne sont clairement plus employés par les musiciens, cela n’est pas le cas des Ondes Martenot qui sont encore enseignées au sein des classes de conservatoires. Pour autant, certains composants et savoir-faire tendent à disparaitre, rendant fragile la survivance de cette expression musicale. Ainsi, le maintien en état de jeu de ce corpus apporte des problématiques particulières en lien direct avec l’obsolescence de certains composants électriques. On se propose ici de présenter brièvement les méthodes de documentation et les études mises en place au musée de la Musique visant à apporter des réponses en termes de conservation et d’intervention face à cet enjeu qui pourrait aboutir à la disparition d’un pan entier du répertoire musical.
CALL and the Aspiring EFL Teacher in the Arab world
Authors: Al-Ahdal Arif Ahmed Mohammed Hassan
Published: August 2023

This chapter discusses the technology pedagogy and content knowledge (TPACK) framework, which integrates content knowledge, pedagogical knowledge, and technological knowledge in effective teaching. It emphasizes the importance of developing a strong understanding of all three domains and how they relate to teaching subject matter. It also explores English as a foreign language (EFL) as a subject matter, discussing its various aspects, including language acquisition theories, teaching methodologies, language assessment techniques, linguistic features, cultural factors, and technology applications. The knowledge of EFL is crucial for individuals who aim to teach English to non-native speakers. Understanding EFL methodology, which comprises principles, techniques, and approaches, is also vital for effective EFL teaching, TPACK of teachers before they enter the classroom can make the big difference between learner success and failure. This chapter discusses these very issues to bring about improvement in teacher preparation in the Arab EFL classroom.
Advances in Innovative and Emerging Technologies in Food Processing
Authors: Pattabhiramaiah Mahesh , Mallikarjunaiah Shanthala
Published: August 2023

Conventional nutrition research provides more information on how food promotes health and preventative medicine. Modern lifestyles encourage sustainable packaged food production. Current food technology uses fermentation, encapsulation, extraction, fat replacement, and enzyme processing to create nutritious food products, reduce, or eliminate unnecessary ingredients, add nutrients or fortified foods, alter ingredients, mask artificial flavors, and stabilize ingredients. 3D printing-compatible food ingredients promote these cost-effective, productive, user-friendly, and environmentally friendly food technology breakthroughs.
Breakthrough of Cutting-Edge Technologies Into the Culinary World
Authors: Raghavan Ananiyasri , Vijayabanu Chidambaram
Published: August 2023

Technology has undoubtedly revamped the food industry into its current glory. The food industry, through a complex network of diverse businesses, has managed to maintain its momentum and massive domination over other industries by adapting and modifying technology to pique the interests of its customers. The object of the chapter is trace the impact of various technologies on the food industry including the internet, social media, and the recently adopted technologies namely Artificial Intelligence (AI) and Augmented Reality (AR). The current chapter aims to equip the targeted audience with global food and food service trends, challenges, and continued innovation due to competition. The chapter will further deal with recent technological inventions and new trends and discuss the long-term impact technology will have on the future of the food industry. The chapter will facilitate the learning of trends and innovations in the food industry and provide insight to hoteliers, chefs, entrepreneurs, engineers, software technicians, data analysts, economists, and other learned audiences.
Which Barriers Need More Attention in Food Waste Management and Blockchain Integration?
Authors: Aka Salih
Published: August 2023

Blockchain is a digital innovative technology that is decentralized, open to the use of all stakeholders, does not allow data manipulation, and has many more features. Blockchain, which has the potential to solve problems in food safety, is attracting more and more attention from researchers in this field. In this study, a conceptual model for the integration of blockchain and food waste management is proposed. The combination of blockchain and food waste management has economic, social, and environmental dimensions that will serve the purpose of reducing food waste. However, some blockchain barriers make it difficult to integrate with food waste management. Blockchain barriers that affect the success of this integration are examined with the BEST-Worst Method (BWM). As a result of the analysis, infrastructure setup and adaptation challenges stand out as the most important barrier. The study would be a starting point for practitioners working on food waste management and the blockchain system, and government officials planning regulations in this area.
Integrating Climate Change Education Into the Curriculum in Kenya
Authors: Syallow Maureen , Dimba Magdalene , King'ori Esther Muthoni
Published: August 2023

The effects of climate change are a major global concern. In Kenya, the impact of climate change has been felt in perennial droughts which sometimes result into conflict as communities fight for pasture and water. In a bid to address climate change issues, Kenya has developed policies that focus on mitigation and adaptation measures borrowed from ideas outlined in global climate change strategies. One such strategy is the employment of education as a tool to create awareness on climate change issues. This chapter will examine the climate change policies developed by bodies in charge of higher education in Kenya. The chapter will further analyze attempts that have been made to integrate climate change education into curricula. In addition, the chapter will trace the history of discourse that saw the introduction of climate change education in institutions of higher learning. Finally, the chapter will analyze pedagogical strategies that can be employed in teaching climate change content.
Building Bridges to Sustainability
Authors: Emekci Seyda
Published: August 2023

The consideration of environmental factors plays a key part in the design of sustainable buildings within their respective contexts. The global community is currently grappling with the adverse impacts of climate change, which can be attributed to the release of greenhouse gases into the atmosphere. Architecture is a unique area of study that enables the development of spatial solutions to address human requirements, while also carrying the essential duty of ensuring the creation of a sustainable built environment. Although the inclusion of sustainability in architectural education is widely acknowledged, the majority of curricula lack a comprehensive integration of this topic. In order to conceptualize a sustainable built environment, it is imperative for the architectural curriculum to incorporate a foundational comprehension of the interconnection between sustainability, technology, and design. This chapter analyzes the barriers to sustainable environmental design in architectural education. It also identifies worldwide integration promotion efforts.
Promoting Environmental Sustainability Among Students and Citizens for a Sustainable Future
Authors: Yadav Seema
Published: August 2023

Climate change is a dangerous problem that endangers the continuation of life. The sixth major extinction catastrophe in recorded history is being brought on by climate change. There is an existential threat to life on Earth from the climate changes brought on by the use of fossil fuels. Education increases young people's knowledge while simultaneously fostering awareness, enabling informed decision-making, and fostering changes in attitudes and behaviors. Education is essential to the global response to climate change. Climate change education (CCE) is one of the most significant approaches to increasing awareness of mitigating climate change. The majority of students must receive the knowledge, critical thinking skills, scientific understanding, and ethical frameworks necessary to prevent, adapt, and reverse climate change as a result of climate change education. Climate change education initiatives can play a significant role in developing communities of the kind of pragmatic visionaries needed to address new issues as they emerge and build on the successes of others.
Navigating the Crossroads
Authors: Hosek Vicki A.
Published: August 2023

Political polarization is impacting the United States' public education system. School boards, administrators, and teachers are being asked to explain and support their decisions surrounding what is being taught, or not taught. The unrest that we are witnessing at school board meetings and in the media is often due to contrasting belief systems. What if the guiding belief systems of those in charge do not align with your own? As an instructional professor for a large public university as well as an academic researcher, the author has witnessed ideological pressures firsthand. As a Christian, the author has found those personal theological beliefs often at odds with components of the educational frameworks that are the most accepted and expected in the field of education. This autoethnographic study examines the author's navigation of this crossroads between beliefs and practices. Pedagogical and theoretical frameworks are considered in light of Christian theological frameworks. Implications and suggested practices are provided with the hope of moving toward a middle ground in this currently polarized field.
DEI and Imago Dei
Authors: Loomis Stephanie , Fruchey Kelly
Published: August 2023

Diversity, equity, and inclusion policies drive education. The stakes are high and teachers of certain faith traditions are often seen as an enemy of modern definitions of diversity, equity, and inclusion. Christian teachers, especially, often must bear the burden of having to choose between their sincerely held religious convictions and a secular process sometimes antithetical to a Christian belief system. Christians view humanity as the Imago Dei, the image of God. DEI began as a noble pursuit, but in truth, it uses a philosophic framework that creates an “us vs them” approach. Imago Dei seeks reconciliation and equal value and dignity for all people because of their place in creation. DEI and Imago Dei are not the same, but they can coexist if dialogue precedes dictates and teachers of faith are granted freedom to practice treating all students as image bearers of God.
Die Casting Process Using Automated Machine Learning
Authors: Koushik Abhinav , Miraclin Denisha , Patil Swapnil , Dangate Milind
Published: August 2023

Castings that are near to net forms are made using the extremely complex manufacturing technique known as die casting. Despite the method's lengthy history—more than a century—a system engineering method for characterizing it as well as the information that each cycle of die casting can create has not yet been completed. Instead, a tiny subset of knowledge deemed to be essential for die castings has attracted the attention of industry and academia. The majority of the research that has been published on artificial intelligence in die casting has a specific focus, which restricts its usefulness and efficacy in an industrial casting. This study will examine the die casting process through the perspective of systems design and show practical uses of machine learning. In terms of technical definition and how people interact with the system, the die casting process satisfies the criteria for complex systems. The die casting system is an adaptive, self-organizing network structure, according to the technical definition.
Developing a South Asian Version of an Implementation Instrument for Understanding the Policy Implementation
Authors: Nazir Muhammad Fayyaz , Wayenberg Ellen , Qureshi Shahzadah Fahed
Published: August 2023

This study is divided into two phases: translation and the testing of NoMAD. Researchers adopted a four-step approach: forward and backward translation, expert reviews for the test, and improvement of content validity. The translated version was then adopted for understanding the implementation of social distancing in the context of Covid-19 in Pakistan. To analyze the scale validity of U-NoMAD, researchers calculated the Cronbach alpha value through the Confirmatory Factor Analysis approach and analyzed the U-NoMAD strength through a step-wise evaluation process – convergent validity and individual item validity, discriminant validity, and model significance. The initial factor analysis model showed a good fit for coherence and cognitive participation and an unsatisfactory fit for collective action and reflexive monitoring. The results confirmed the NoMAD structure in the Pakistani healthcare settings to acceptable standards. So, the U-NoMAD instrument is valuable in evaluating complex and innovative healthcare interventions.
Enhancing Employee Resilience in the Face of Disruption
Authors: Kumar Sunil , Kumar A. Dushyanth
Published: August 2023

This case study examines employees' resilience at the Chamera power plant in Himachal Pradesh, India, during the COVID-19 pandemic. It investigates the impact of e-Training initiatives as catalysts for organizational change. The study utilizes a focus group interview method with nine participants, including executives and non-executives who actively engaged in e-Training. Findings reveal that the implementation of e-Training programs resulted in attributes such as time management, goal focus, self-driven orientation, collaboration, capacity building, positive mindset, and improved self-efficacy. These attributes contributed to employee resilience. The study highlights the importance of e-Training interventions and technology adoption in fostering employee resilience and bridging gaps in understanding organizational resilience.
The Governance of Public Education Institutions in Portugal
Authors: Maia Isabel Cristina Guerreiro Pimentel
Published: August 2023

Governance models evolved dynamically, complex, global, and interactive. The aim of this study was to analyze non-superior public education institutions in Portugal, with the new model of governance, in which the school opened for society. The work of the multiple case study presented followed a qualitative methodology and the principles of the founded theory analyzing the elements of the General Council: their participation and shame. The authors consider four school groups, with different academic and socioeconomic profiles. The data collected in interviews, document analysis and unmarked observation were subject to content analysis. Obstacles to the execution of the GC's competences and the effective participation of its members highlight pressures exercised by the director in decision making, monopolizing the information provided to the GC, aggravating during the pandemic. The authors ended up with recommendations for the operation of the most effective and democratic GC.
Exploring Sustainable Leadership Practices and Their Influence on Employee Engagement in South India's Financial Service Sectors
Authors: Rath Kali Charan , Agrawal Animesh , Mukti Suraj Kumar
Published: August 2023

This chapter explores sustainable leadership's impact on employee engagement in South India's financial services sector. It delves into dimensions of sustainable leadership and their influence on engagement. Through an exploratory research design, it investigates practices like transparency, ethical decision-making, well-being, work-life balance, employee involvement, and learning culture. The chapter also evaluates the practices' effect on employee engagement, a vital factor for organizational success. By examining this relationship, it offers insights to enhance leadership strategies in South India's financial services, fostering a motivated workforce.
Blockchain and Intelligent Computing Framework for Sustainable Agriculture
Authors: Das Saumendra , Saibabu N. , Pranaya D.
Published: August 2023

Any country's economy must prioritise the sustainable development of agriculture and related services. Understanding the effect of intelligent computing on sustainable agriculture requires examining the different challenges this study has brought up. About 600 research papers on intelligent computing for sustainable agriculture were gathered for the qualitative study. Additionally, 66 papers from the research papers that took a proper screening for relevance were selected. These papers have been divided into three categories: blockchain applications for sustainable agriculture, blockchain applications for IoT in agriculture, and the impact of machine learning and blockchain on agriculture. It was noted in all of the studies that there is growing interest in using technology for sustainable agriculture, and it was also noted that the majority of the study has only recently been started. Therefore, the application of modern technologies for security, trust, and confidentiality among stockholders may make sustainable agriculture viable.
A case of overlap between eosinophilic fasciitis and generalized morphea
Authors: Koizumi Shigeru , Inafuku Kazuhiro
Published: August 2023

Not available
Compliance with Long-Term Use of Orthoses Following Spinal Cord Injury
Authors: Yemisci Oya U , Ozen Selin , Saracgil Cosar Sacide N , Afsar Sevgi I
Published: August 2023

Background:

Prescription of orthoses and assistive devices that facilitate physical function is a major component of the rehabilitation process in spinal cord injury (SCI).

Objective:

To evaluate the long-term use of orthoses prescribed during inpatient rehabilitation in people with SCI and investigate the factors related to discarding the device.

Materials and Methods:

Medical records of 202 SCI patients who were included in an inpatient rehabilitation program of a tertiary research hospital were reviewed retrospectively. Patients' demographic data, neurological level of spinal cord injury functional state and use of assistive devices for ambulation (orthoses, walkers, etc.) at discharge were recorded. At follow-up, study participants were contacted by telephone and queried regarding the frequency and duration of use of orthoses; if the individual had discontinued using the orthoses, the reasons for discarding the device were sought.

Results:

The majority of the study participants (62.7%) had been prescribed a knee-ankle-foot orthosis during their inpatient stay. At follow-up, the regular use of orthoses was ongoing in 67.6% of the participants, and nonuse was determined in 32.4%. The most common cited reasons for discarding the device were difficulty in donning and doffing, functional improvement, and mechanical problems of the orthoses.

Conclusions:

A significant number of patients had discarded their orthoses at the long-term follow-up and the main reasons for discarding the devices were orthotic factors. Timely reevaluation of the patient and orthosis modification according to patients' needs is necessary to achieve long-term compliance.
Cerebrospinal Fluid Procalcitonin—A Potential Biomarker for Post-Craniotomy Bacterial Meningitis
Authors: Moorthy Ranjith K , Job Victoria , Rebekah Grace , Rajshekhar Vedantam
Published: August 2023

Background:

The literature regarding the utility of cerebrospinal fluid (CSF) procalcitonin (PCT) in the diagnosis of post-craniotomy bacterial meningitis and differentiating it from aseptic meningitis is sparse.

Materials and Methods:

CSF total WBC count, sugar, protein, and PCT were measured in febrile patients with suspected post-craniotomy meningitis during the first 30 days following an intradural cranial procedure for non-trauma indications. Patients were diagnosed as postoperative bacterial meningitis if CSF culture was positive (PBM, n = 28) or postoperative aseptic meningitis if CSF culture was sterile and there was no evidence of systemic infection (PAM, n = 31). CSF cytochemical parameters and PCT values were compared between the groups. Normal values of CSF PCT were obtained from 14 patients with noninfectious indications with hydrocephalus.

Results:

There was no significant difference in CSF total WBC count, sugar, and protein levels between PAM and PBM groups. The median PCT level in CSF in the normal group was 0.03 ng/mL (interquartile range [IQR] 0.02–0.07 ng/mL). CSF PCT in the PBM group (median 0.37 ng/mL, IQR 0.2–1.4 ng/mL) was significantly higher than normal values as well as PAM group (median 0.12 ng/mL, IQR 0.07–0.26 ng/mL (P = 0.0004). The area under the receiver operating characteristic (ROC) curve for CSF PCT was 0.767. A cutoff value of 0.12 ng/mL yielded a sensitivity of 85.7% (95% CI: 67.3% to 96%), specificity of 51.6% (95% CI: 33% to 69.9%), positive predictive value of 61.5% (95% CI: 51.9% to 70.3%), and negative predictive value of 80% (95% CI: 60.3.8% to 91.3%).

Conclusions:

CSF PCT assay in patients who are febrile during the first 30 days post-non-trauma neurosurgical procedures has a role in the early diagnosis of bacterial meningitis.
Spinal Cord Stimulation Improved Freezing of Gait and Hypokinetic Dysarthria of a Patient with Dopamine-Resistant Multiple System Atrophy-Parkinsonian Type
Authors: Gong Huijun , Liu Yi , Zhu Xiaosong , Gong Xingjian
Published: August 2023

Background:

Multiple system atrophy parkinsonian type (MSA-P) patients with resistance to dopamine have highly limited treatment options. This calls for further study of spinal cord stimulation (SCS) as a potential nondopaminergic therapy to improve motor and speech functions of patients with dopamine-resistant parkinsonism.

Case Presentation:

A 58-year-old male with MSA-P had hypokinetic dysarthria, freezing of gait (FOG), and spinal disc herniation with refractory back pain. SCS was used to treat his refractory back pain. Serendipitously, after the surgery, the patient reported not only a reduction in pain but also rapid improvement of FOG and hypokinetic dysarthria.

Conclusion:

SCS has been found in some cases to improve FOG and hypokinetic dysarthria. It is necessary to further study the potential of and the mechanism behind SCS as a potential nondopaminergic therapy to improve motor and speech functions of patients with dopamine-resistant parkinsonism.
Diffuse intrinsic pontine gliomas in adults
Authors: Kandregula Sandeep , Konar Subhas , Sadashiva Nishanth , Nagesh Madhusudhan , Kalahasti Sathya Rao , Krishna Uday , Saini Jitender , Shukla Dhaval , Santosh Vani
Published: August 2023

Background:

Brainstem gliomas (BSG) constitutes very small proportion in adults brain tumors with pons as most common location. There is significant paucity in literature for adult diffuse intrinsic pontine gliomas (DIPG).

Objective:

In this study, we attempt to review the outcomes of DIPG in single institute.

Methods:

We performed a retrospective chart review of adult DIPG from last 8 years (2010-2018) in a tertiary institute. DIPG was defined as expansile lesions involving more than 50% of the greatest diameter in the pons.

Results:

We found a total 46 patients with the diagnosis of adult BSG. Based on the definition, 23 patients with adult DIPG qualified to be included in the study. The median age was 32 years (IQR: 22-41), with a sex ratio of 16/7 (M/F). Cranial palsies were found in 17 (73%) patients. The median duration of symptoms was 6 months. On magnetic resonance imaging (MRI), contrast enhancement was found in seven (30%) patients. Biopsy was done in five patients. Median follow up was 11 months (IQR: 7-15). Median overall survival (OS) was 15 months (95%, CI 8.3-21.6). Fourteen patients had succumbed to death at the latest follow-up, and seven patients were alive. Median OS for the patients with age less than 40 years and more than 40 years was 7 and 22 months, respectively (p = 0.016). Rest of the variables did not effect OS significantly.

Conclusion:

Adult DIPG's significantly differs from pediatric counterparts in clinical characteristics, as well as OS. Age was the only factor which was significantly associated with survival in our study. Long-term studies with molecular profiling may help in further characterizing these lesions.
Proximal Dominant Hereditary Motor and Sensory Neuropathy with TFG Mutation
Authors: Ansari Afroz F. , Jagiasi Kamlesh , Ojha Pawan , Ansari Raahil , Nagendra Shashank , Kharat Sumit
Published: August 2023

Hereditary motor and sensory neuropathy with proximal predominance (HMSN-P) is a rare degenerative disorder inherited in an autosomal dominant fashion. This disease was described first in Japanese descendants from Okinawa and Shiga prefectures in mainland Honshu in 1997. The disease is characterized by adult onset of proximal weakness and atrophy, muscle cramps, fasciculations, areflexia, high incidence of elevated creatine kinase, hyperlipidemia, and diabetes mellitus, resembling Kennedy disease, though the mode of inheritance is autosomal dominant, rather than X linked. We examined a 56-year-old male patient with clinical features suggestive of HMSN-P and positive family history in an autosomal dominant fashion. Clinical, electrophysiological, and genetic factors were also reviewed. The appearance of HMSN-P in India and elsewhere calls for clinicians in nonendemic regions to be familiar with this rare disorder, which has typically been geographically confined.
Feasibility of Tailored Unilateral Disconnection vs Callosotomy for Refractory Epilepsy in Patients with Bilateral Parieto-Occipital Gliosis Following Perinatal Insult
Authors: Agrawal Mohit , Chandra Sarat P. , Doddamani Ramesh S. , Samala Raghu , Garg Ajay , Gaikwad Shailesh , Sharma Ravi , Ramanujan Bhargavi , Tripathi Madhavi , Bal Chandrashekar , Tripathi Manjari
Published: August 2023

Background:

Patients with perinatal hypoxia (PH) and drug-refractory epilepsy (DRE) often have bilateral parieto-occipital gliosis. Surgical management of such patients is a dilemma.

Objective:

To identify preoperative determinants for unilateral disconnection vs callosotomy, and analyze the surgical outcome in such patients.

Methods and Material:

This was a retrospective analysis of patients with DRE and history of PH, with MRI abnormalities restricted to bilateral posterior quadrants. Preoperative semiology, epilepsy duration and seizure frequency were recorded. Based on the concordance between the results of non-invasive tests, patients underwent either posterior quadrant disconnection (PQD) or corpus callosotomy (CC). Preoperative variables were analyzed and corelated to the postoperative seizure freedom.

Results:

Fourteen patients were identified, 6 underwent PQD and 8 underwent CC. At follow up of 39.17 ± 23.75 months, 66.66% of patients (4/6) in the PQD subgroup had an ILAE Class I outcome. While none in the CC group attained seizure freedom, 87.5% (7/8) had more than 50% reduction in seizure frequency (follow up: 42 ± 27.31 months). Patients with a poor outcome had significantly greater seizure frequency (P = 0.05) and history of drop attacks (P = 0.04) in both the groups. Magnetoencephalography (MEG) accurately localized the epileptogenic zone in all of the patients with good outcome (P = 0.015). Concordance with single photon emission tomography (SPECT) was also a predictor of favorable outcome (P = 0.041).

Conclusions:

A history of drop attacks with high seizure frequency is associated with poor postoperative seizure outcome. Unilateral PQD is feasible and leads to superior seizure-free outcomes, even in cases with widespread and bilateral imaging and electrical abnormalities, provided the other preoperative investigations are concordant in localizing the epileptogenic zone.
Morvan's syndrome Presenting with Psychiatric Manifestations - A Case Report and Review of the Literature
Authors: Suresh Kumar P N , Sajithlal E , Shamsudeen M , Kumar R Praveen
Published: August 2023

The term “la chorιe fibrillare” was used by the French physician Augustine Marie Morvan to describe a syndrome showing hyperactivity features involving the central, autonomic, and peripheral nervous system. The central hyperactivity symptoms are confusion, behavioral problems, hallucinations, myoclonus, and insomnia; the autonomic hyperactivity symptoms are hyperhidrosis and variations in blood pressure; and peripheral hyperexcitability is characterized by painful cramps, myokymia, and neuromyotonia. Here, we present a case that has typical features of Morvan's syndrome and provides a brief description based on available literature.
Endoscopic Endonasal Excision of a Meckel's Cave Dermoid Cyst
Authors: Patel Biren K , Darshan HR , Binu Anand , George Tobin , Easwer HV , Nair Prakash
Published: August 2023

Background:

Meckel's cave dermoid cyst is an extremely rare and a technically challenging lesion. The objective of the study is to show that endoscopic endonasal approach (EEA) has recently emerged as a better alternative to transcranial approach for this formidable tumor, owing to minimal retraction-related morbidity.

Method:

A 52-year-old male presented with numbness over the right side of the face and temporal area for the last 3 years. On examination, there was decreased sensation to touch, pain, and temperature over the right V1, V2, and V3 areas with an absent right corneal reflex. Imaging revealed a heterogenous extra-axial lesion in the right Meckel's cave. The tumor was resected by an extended endonasal transpterygoid approach.

Results:

The patient had improvement in his symptoms with no endocrine complication.

Conclusion:

This case demonstrates the surgical techniquenof endoscopic endonasal transpterygoid resection of a Meckel's cave dermoid cyst.
Preoperative 3D Image Evaluation of EC–IC Bypass by 3D Visualization Analysis Software Amira®
Authors: Tanaka Riki , Liew Boon Seng , Yamada Yasuhiro , Okubo Mai , Katayama Tomoka , Sasaki Kento , Miyatani Kyosuke , Komatsu Fuminari , Kato Yoko , Hirose Yuichi
Published: August 2023

Background:

Careful evaluation of the preoperative imaging for extracranial–intracranial bypass performed for conditions like intracranial stenosis and Moya disease is important. The traditional use of 2D imaging has a significant limitation for neurosurgeons, primarily to determine the optimal location of the recipient artery for performing the surgical bypass. Therefore, many neurosurgeons use 3D angiograms more frequently to overcome these shortcomings.

Materials And Methods:

We performed the preoperative evaluation of the possibility of performing an anastomosis between the superficial temporal artery and the middle cerebral artery (STA–MCA) bypass by synthesizing images of computerized tomography (CT), magnetic resonance imaging (MRI), and digital subtraction angiography (DSA) using Amira® of 3D visualization analysis software (Thermo Scientific Co.).

Results:

The 3D images prepared before surgery using this software showed good agreement with the intraoperative findings.

Conclusion:

Preoperative image processing using tools like Amira provide optimal information for good planning and communication for performing STA–MCA bypass and may become a helpful tool.
Gamut of Orbital Lesions in a Tertiary Neurocenter—A Clinicopathological Study of Lesions Seen Over a Period of One Decade
Authors: Bhatt Anusha S , Nandeesh Bevinahalli N , Mhatre Radhika , Mahadevan Anita , Santosh Vani , Yasha T Chickabasaviah
Published: August 2023

Background:

The orbital region is an anatomically complex area comprising crucial contiguous/adjacent structures. Since the eye has a neuroectodermal basis of embryogenesis, many of the lesions may be similar to those arising in the central nervous system.

Objective:

To record and describe the clinicopathological spectrum of orbital lesions presenting to a neurology center.

Study Setting:

The retrospective study included biopsy/resected specimens of patients with orbital/ophthalmic lesions referred to the Department of Neuropathology, between February 2007 and February 2018.

Materials and Methods

: The demographic, clinical, and radiological details were retrieved from the departmental archives and the slides were reviewed.

Results:

There were 99 cases in the period of the study (2007–2018) with a peak in fourth and fifth decades (age range: 5 months to 68 years; mean: 37.2 years; M: F =1.06: 1). Eighty-six (86.8%) cases had epicenter in the orbit, whereas 13 (13.13%) cases were extraorbital with orbital extension. The benign neoplasms predominated (50/99, 50.5%) followed by malignant neoplasms (24/99, 24.24%), infective conditions (11/99, 11.11%) and tumor like conditions (7/99, 7.07%). The most common benign tumor was vascular tumor (17/50, 34%) followed by meningioma (12/50, 24%), while epithelial malignant tumor (6/24, 25%) was the most common malignancy. Fungal infection was the most frequent infective condition (6/11, 54.5%).

Conclusion:

The spectrum of ocular-orbital lesions varies with the geographic area and the nature of the institute catering to the needs of patients. The spectrum of lesions that we encountered from a neurological institute was vastly different from that reported from ophthalmic centers with very low frequency of retinoblastomas.
Calcific Miliary Brain Metastasis in Adenocarcinoma Lung Treated with Gefitinib
Authors: Divya K P , Cherian Ajith , Prabhakaran Pranab K , Thomas Bejoy , Shetty Kuldeep
Published: August 2023

Calcific miliary brain metastasis is an extremely rare form of brain secondaries. A 52-year-old man diagnosed with lung adenocarcinoma, on oncotherapy with gefitinib had a partial initial response to treatment. Later he was readmitted with seizures and cognitive dysfunction. His initial brain computed tomography (CT) and magnetic resonance imaging (MRI) were normal. However, his later CT images revealed multiple small calcified lesions over both hemispheres and contrast MRI revealed scattered tiny miliary nodules enhanced by gadolinium over bilateral cerebral, cerebellar hemispheres, thalami, and basal ganglia with foci of hypointensity in susceptibility-weighted images (SWI) and phase imaging suggesting calcification. A diagnosis of calcific miliary brain metastasis was made. Miliary calcification as an initial presentation of brain metastases in patients with lung cancer is uncommon. Use of oral tyrosine kinase inhibitor like gefitinib increases the likelihood development of calcific brain metastases due to the prolonged survival time contributed by its use.
An Unusual Case Presenting with New Onset Epileptic Seizure and Unilateral Temporal Lobe Lesion Diagnosed as Influenza Type A Associated Encephalitis
Authors: Aykac Seyma Ciftci , Uludag Burhanettin
Published: August 2023

Influenza A viruses, known etiological agents of seasonal outbreaks, epidemics, and pandemics, are RNA viruses of the Orthomyxoviridae family. They can manifest with a wide range of neurological complications. Influenza related encephalitis is rarely reported and poorly characterized in adults. Its diagnosis is hampered by significant variation in clinical presentation and difficulties in virus detection in the cerebrospinal fluid. Diffuse brain edema, symmetric involvement of thalamus, brain stem, and cerebellum, or normal findings in the acute phase followed by the appearance of diffuse low attenuation and mild brain atrophy are reported cranial magnetic resonance imaging findings, but unilateral temporal lobe involvement has not been observed before. Here we describe an unusual adult case who presented with new-onset epileptic seizures and unilateral temporal lobe lesion mimicking herpes simplex encephalitis but a polymerase chain reaction of cerebrospinal fluid confirmed influenza type A associated encephalitis.
Factors Predicting Poor Surgical Outcome in Patients with Thoracic Ossified Ligamentum Flavum – Analysis Of 106 Patients in a Tertiary Care Hospital in South India
Authors: Ramesh Chandra Venkata Vemula , M Prasad Bodapati C , Rajesh Paradesi , Agarwal Sudharsan , Krishna Mohana Murali
Published: August 2023

Background:

Ossified ligamentum flavum (OLF) is the major cause of thoracic myelopathy in our locality. Surgical outcomes and their related factors for patients with thoracic OLF (T-OLF) remain unclear because of the few studies on this condition.

Objectives:

The present study aimed to examine the factors predicting poor surgical outcomes and the effectiveness of decompressive laminectomy and OLF resection in patients with T-OLF.

Material and Methods:

A total of 106 patients with T-OLF operated at our institute from 2007 to 2018 were included. The mJOA score was used in neurological assessment preoperatively and during the follow-up. Multiple regression analysis was conducted to know the best correlation between factors and surgical outcomes.

Results:

The mean mJOA score was 5.67 ± 2.13 preoperatively and 7.50 ± 2.60 postoperatively at the end of follow-up. The recovery rate was 43.29 ± 30.55%. After decompressive laminectomy, the mean mJOA score, modified Nurick score, and Ashworth's grade showed significant improvement (P< 0.001). Multiple regression analysis showed that the age of the patient, associated trauma, OLF level, tuberous type OLF, intramedullary signal change on T2WI, preoperative severity of myelopathy, pre-op mJOA score, and pre-op Nurick grade were significantly correlated with the surgical outcome (P< 0.001). No correlation was identified with the duration of symptoms, dural ossification, dural tear, and CSF leak (P> 0.05).

Conclusion:

It is important to identify preventable risk factors for poor surgical outcomes for T-OLF. Age of the patient, associated trauma, OLF level, tuberous type OLF, intramedullary signal change on T2WI, preoperative severity of myelopathy, preoperative mJOA score, and Nurick grade were important predictors of surgical outcome in our study series.
‘White Cord Syndrome’
Authors: Goyal Nishant , Chaturvedi Jitender , Kandwal Pankaj , Gupta Priyanka , Kaushal Ashutosh , Kumar Mritunjai
Published: August 2023

Background:

'White-cord syndrome' is an extremely rare entity following decompression of cervical cord in which post-operative reperfusion injury results in worsening of patient's neurology and MRI reveals signal changes in spinal cord in absence of cord compression. We wish to report a case of 'white-cord syndrome' following a 'routine' ACDF.

Case Description:

A 39-year-old woman with paresthesias and spastic quadriparesis was found to have C5-C6 PIVD on MRI. ACDF was performed at C5-C6, after which worsening of quadriparesis was noted, for which intravenous high-dose steroids were started. An urgent MRI was done, which revealed findings of white-cord syndrome, without compression on underlying cord. With conservative management, her ASIA grade improved from C to D and the features of white-cord syndrome disappeared on follow-up imaging.

Conclusion:

It is important for surgeons and patients to be aware of this rare but potentially catastrophic entity as this needs to be discussed while taking consent for surgery.
Transplantation of NEP1-40 and NT-3 Gene-Co-Transduced Neural Stem Cells Improves Function and Neurogenesis after Spinal Cord Injury in a Rat Model
Authors: Chen Feng , Zhang Zhuang , Wang Lin-nan , Yang Xi , Zhou Chun-Guang , Zhu Ce , Wang Lei , Liu Li-min , Song Yue-ming
Published: August 2023

Background:

Spinal cord injury (SCI) generally results in necrosis, scarring, cavitation, and a release of inhibitory molecules of the nervous system, which lead to disruption of neurotransmission and impede nerve fiber regeneration. This study was intended to evaluate the therapeutic efficacy rates of the transplantation of NEP
1–40- and NT-3 gene-co-transduced neural stem cells (NSCs) in a rat model of SCI.

Methods:

Ninety Sprague–Dawley rats were subdivided randomly into six groups: sham-operated, SCI model, SCI + NSCs-NC, SCI + NEP1-40-NSCs, SCI + NT-3-NSCs, and SCI + NEP1-40/NT-3-NSCs. Motor function at different time points was evaluated using the Basso, Beattie, and Bresnahan locomotor activity scoring system (BBB). At 8 weeks post-transplantation, histological analysis, a terminal deoxynucleotidyl transferase-mediated dUTP nick-end labeling (TUNEL) assay, immunofluorescent assay, immunocytochemical staining, and cholera toxin subunit B (CTB) retrograde tracing were performed.

Results:

BBB scores of the co-transduction group significantly surpassed those of other transplantation groups and of the SCI-model group after 2 weeks post-transplantation. The apoptotic rate of neurocytes was significantly lower in the co-transduction group than in other experimental groups. Expression of NF-200, MBP, and ChAT was significantly higher in the SCI + NEP1-40/NT-3-NSCs group than in other transplantation groups, whereas the expression of GFAP and GAD67 was the second lowest after the sham-operated group. CTB retrograde tracing showed that CTB-positive neural fibers on the caudal side of the hemisected site were more numerous in the SCI + NEP1-40/NT-3-NSCs group than in other experimental groups.

Conclusion:

Transplantation of NEP
1–40- and NT-3-gene-co-transduced NSCs can modify the protein expression following acute SCI and promote neuron formation and axonal regeneration, thus having a neuroprotective effect. Furthermore, this effect surpasses that of transplantation of single-gene-transduced NSCs. Transplantation of NEP
1–40- and NT-3-gene-co-transduced NSCs is effective at the neural recovery of the rat model of SCI and may be a novel strategy for clinical treatment of SCI.
Post-Vaccination/Post-COVID Immune-Mediated Demyelination of the Brain and Spinal Cord
Authors: Mahajan Ashima , Nayak Manoj K , Gaikwad Shailesh B. , Sharma Kalyan , Padma Srivastava M Vasantha , Anand Pooja , Oinam Rahul , Mishra Biswa Mohan
Published: August 2023

Introduction:

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes coronavirus disease 2019 (COVID-19), which not only produces respiratory symptoms but is known to involve almost every system, and its neuroinvasive properties have been well demonstrated throughout the pandemic. Also, to combat the pandemic, there was rapid development and induction of various vaccination drives, following which many adverse events following immunization (AEFIs) have been reported, which include neurological complications as well.

Method:

We present a series of three cases, post vaccination, with and without a history of COVID illness that showed remarkably similar findings on magnetic resonance imaging (MRI).

Result:

A 38-year-old male presented with complaints of weakness of the bilateral lower limbs with sensory loss and bladder disturbance a day after receiving his first dose of ChadOx1 nCoV-19 (COVISHIELD) vaccine. A 50-year-old male with hypothyroidism characterized by autoimmune thyroiditis and impaired glucose tolerance experienced difficulty in walking 11.5 weeks after being administered with COVID vaccine (COVAXIN). A 38-year-old male presented with subacute onset progressive symmetric quadriparesis 2 months after their first dose of a COVID vaccine. The patient also had sensory ataxia, and his vibration sensation was impaired below C7. All three patients had typical pattern of involvement of the brain and spine on MRI with signal changes in bilateral corticospinal tracts, trigeminal tracts in the brain, and both lateral and posterior columns in the spine.

Conclusion:

This pattern of brain and spine involvement on MRI is a novel finding and is likely a result of post-vaccination/post-COVID immune-mediated demyelination.
The Legal Void Outside Brain Death in India
Authors: Deora Harsh , Yagnick Nishant S. , Gupta Ayan , Tripathi Manjul , Gupta Sanjay Kumar , Mohindra Sandeep , Ganapathy Krishnan
Published: August 2023

Objective:

The legal definitions of brain death are tantamount for legal dogmas and sometimes criminal intimidation of the treating doctors. The tests for brain death are only applicable to patients planned for organ transplantation. We intend to discuss the necessity of the “Do Not Resuscitate (DNR)” legislature in cases of brain death patients and applicability of tests for brain death irrespective of the intention for organ donation.

Methods:

A comprehensive review of the literature was performed till May 31, 2020 from the MEDLINE (1966 to July 2019) and Web of Science (1900 to July 2019). Search criteria included all publications with the MESH terms: “Brain Death/legislation and jurisprudence”[Mesh] OR “Brain Death/organization and administration”[Mesh] AND “India” [Mesh]. We also discuss the different opinions and implications of brain death versus brain stem death in India with the senior author (KG) who was responsible for South Asia's first multi-organ transplant after certifying brain death. Additionally, a hypothetical scenario of a DNR case is discussed in the current legal paradigm of India.

Results:

The systematic search yielded only five articles reporting a series of brain stem death cases with an acceptance rate of organ transplant among brain stem deaths being 34.8%. The most common solid organs transplanted were the kidney (73%) and liver (21%). A hypothetical scenario of a DNR and possible legal implications of the same under the current 'Transplantation of Human Organs Act (THOA)' of India remains unclear. A comparison of brain death laws in most Asian countries shows a similar pattern regarding the declaration of brain death and the lack of knowledge or legislature regarding DNR cases.

Conclusion:

After the determination of brain death, discontinuation of organ support requires the consent of the family. The lack of education and the lack of awareness have been major impediments in this medico-legal battle. There is also an urgent need to make laws for cases that do not qualify for brain death. This would help in not only realistic realization but also better triage of the health care resources while legally safeguarding the medical fraternity.
Role of Stereotactic Radiosurgery in the Management of Dural AV Fistula
Authors: Garg Kanwaljeet , Agrawal Deepak
Published: August 2023

Dural arteriovenous fistulas (DAVFs) are a relatively rare intracranial vascular malformation. The various treatment options for DAVFs include observation, compression therapy, endovascular therapy, radiosurgery, or surgery. A combination of these therapies may also be used. The treatment choice for DAVFs depends on the type of fistula, the severity of symptoms, DAVF angioarchitecture, and the efficacy and safety of treatments. The use of stereotactic radiosurgery (SRS) in DAVFs started in the late 1970s. There is a delay before the fistula gets obliterated after SRS and there is a risk of hemorrhage from the fistula till the fistula gets obliterated. Initial reports described the role of SRS in small DAVFs without severe symptoms, which were inaccessible by endovascular or surgical measures or in combination with embolization in larger DAVFs. SRS can be appropriate for indirect cavernous sinus DAVF fistulas (Barrow type B, C, and D). Borden types II and III and Cognard types IIb–V DAVFs have a high risk of hemorrhage and are traditionally considered less favorable to be treated with SRS as immediate treatment is required to decrease the risk of hemorrhage. However, recently SRS has been tried in these high-grade DAVF as a monotherapy. Factors that have a positive impact on the obliteration rates of DAVF following SRS are the location of DAVF with the cavernous sinus DAVF having much better obliteration rates than DAVF located at other locations, Borden Type I or Cognard Types III or IV DAVFs, absence of CVD, hemorrhage at the time of initial presentation, and target volume lesser than 1.5 mL.