bluuebunny/crossref_metadata_2025 huggingface dataset:
دور إدارة المعرفة في إحداث التطوير التنظيمي ورفع مستوى أداء العاملين في مؤسسات التعليم الجامعي "دراسة ميدانية في كليات مجمع المحالة بخميس مشيط – جامعة الملك خالد"
Authors: عبدالفتاح إبراهيم محمد رضا
Published: May 2021

مؤسسات التعليم الجامعي تتسم باتساع حجم أنشطتها وتنوع مجالاتها وتعدد الإدارات والأقسام بداخلها، الأمر الذي يدفع إلى الاهتمام بتطوير إدارتها لتتناسب مع زيادة مستوى الخدمات التي تقدمها للمستفيدين، وتعد إدارة المعرفة من أهم الركائز التي تساعد على التطوير المؤسسي حيث أثرت بشكل كبير في مستوى أداء مختلف القطاعات التعليمية، واتضح من خلال نتائج العديد من الدراسات الاستطلاعية وجود العديد من الظواهر التي يعاني منها القطاع التعليمي بمنطقة خميس مشيط، وترى الباحثة أنها تمثل عرضاً لمشكلة الدراسة، وهدفت الدراسة الحالية إلى توضيح مفهوم إدارة المعرفة ودورها في تطوير أداء العاملين، ومن ثم تطوير قطاع التعليم الجامعي، وقد استخدمت الباحثة المنهج الوصفي التحليلي لتحقيق هذ الهدف.
دور الصناديق العربية في تمويل التنمية الاقتصادية في السودان (2000-2020)
Authors: ساتي محمدالامين فوزية , حسين متعب المزيد عبد العزيز
Published: May 2021

يعتبر توفر التمويل شرط ضروري لحدوث التنمية الاقتصادية، لذا خصصت هذه الورقة للكشف عن دور الصناديق العربية في تمويل التنمية الاقتصادية في السودان، وذلك من خلال التطور التاريخي للتمويل المقدم منها ومبررات اللجؤ إليه، ترجع أهمية الورقة إلى أنها تقدم تفصيلاً كاملاً للمشاريع التي مولتها هذه الصناديق، وإلى قياسها لمدى مساهمتها في إحداث التنمية من خلال مساهمتها في الإنفاق على التنمية الاقتصادية، كما يوضح التوزيع القطاعي للتمويل المقدم منها. وقد تم إستخدام المنهج التاريخي الوصفي، للوقوف على التطور التاريخي للتمويل، والمنهج التحليلي الإحصائي لمعرفة دور هذه الصناديق في تمويل التنمية . وقد اعتمدت الورقة على المصادر الثانوية من المراجع والوثائق الرسمية الحكومية والتقارير وشبكة المعلومات الدولية (الإنترنت). توصلت الورقة إلى عدة نتائج أهمها: العلاقة طردية بين التمويل المقدم من الصناديق العربية والإنفاق على التنمية الاقتصادية في السودان، إلا أنها علاقة ضعيفة إذ تبلغ 0.09. كما أن التمويل المقدم من الصناديق العربية يمثل حوالي 0.09 من الإنفاق على التنمية الاقتصادية. أما أهم التوصيات التي توصي بها الورقة فهي ضرورة تخفيض الاعتماد على التمويل الخارجي والاعتماد بصورة أساسية على الذات وعلى الإمكانات المحلية، وإيجاد بدائل جديدة تعمل إلى جانبه وذلك لما له من مشاكل متعلقة بالديون والتبعية السياسية.
دور الرضا الوظيفي في تعزيز المواطنة التنظيمية في الوزارات الحكومية في دولة الكويت
Authors: احمد احمد الكندري ياسر
Published: May 2021

هدفت هذه الدراسة إلى التعرف على دور الرضا الوظيفي في تعزيز المواطنة التنظيمية، اتبعت الدراسة المنهج الوصفي التحليلي، وقد تكون مجتمع الدراسة الميدانية من الوزارات الحكومية في دولة الكويت، أما عينة الدراسة فتكونت من (117) مستجيباً من الموظفين الذين يشغلون المناصب العليا في الإدارات العليا في هذه الوزارات. وقد أظهرت الدراسة أنه يوجد دور للرضا الوظيفي في تعزيز الالتزام العام في الوزارات الحكومية في دولة الكويت. كذلك تبين أنه يوجد دوراً للرضا الوظيفي في تعزيز السلوك الحضاري في الوزارات الحكومية في دولة الكويت. وأوصت الدراسة بضرورة بذل الجهود التي من شانها مساعدة العاملين على تلبية احتياجاتهم وحل المشكلات التي تواجههم في العمل لكونها تسهم في زيادة رضاهم. والعمل على غرس سلوك المواطنة التنظيمية لدى العاملين في الوزارات الحكومية في دولة الكويت من خلال تشجيعهم على مساعدة زملائهم، وتجنب إثارة الخلافات في العمل، واستغلال وقتهم في العمل.
Single-center outcomes for percutaneous pedicle screw fixation in metastatic spinal lesions: can spontaneous facet fusion occur?
Authors: Meleis Ahmed , Larkin M. Benjamin , Bastos Dhiego Chaves de Almeida , Muir Matthew T. , Rao Ganesh , Rhines Laurence D. , Cowles Charles E. , Tatsui Claudio E.
Published: May 2021

OBJECTIVE

Survival of cancer patients continues to improve with systemic treatment advancements, leading to an increase in cancer-related complications such as pathological spinal fractures. In this study, the authors aimed to evaluate the outcome of percutaneous stabilization with cement augmentation of the pedicle screws in the management of patients with metastatic cancer to the spine.

METHODS

The authors reviewed a retrospective case series of 74 patients with symptomatic pathological spine fractures treated with cement-augmented pedicle screws implanted with a percutaneous technique. The mean imaging follow-up was 11.3 months. Data on demographics, clinical outcomes, and complications were collected. Cement extravasation, spinal hardware integrity, and fusion rates were assessed on CT scans.

RESULTS

Among 50 patients with follow-up imaging, 23 patients (46%) showed facet joint fusion. The length of segmental stabilization was not a significant predictor of the occurrence of fusion. Pre- or postoperative radiation therapy, postoperative chemotherapy, and the location of spinal lesions did not have a statistically significant effect on the occurrence of fusion. Patients older than 60 years of age were more likely to have fusion across facet joints compared with younger patients. There was a significant difference in the mean visual analog scale pain score, with 6.28 preoperatively and 3.41 postoperatively, regardless of fusion status (p < 0.001). Cement extravasation was seen in 51% of the cohort, but in all instances, patients remained asymptomatic. Most importantly, the incidence of hardware failure was low (4%).

CONCLUSIONS

Percutaneous fixation with cement-augmented pedicle screws in patients with pathological spine fractures provides an improvement in mechanical back pain, with a low incidence of failure, and in some patients, spontaneous facet fusion was observed. Further research is necessary with regard to both short-term benefits and long-term outcomes.
Vertebral multiple myeloma with pathological fracture: the most common etiology for emergency spine surgery in patients with no cancer diagnosis on admission
Authors: Burks Joshua D. , Elarjani Turki , Jamshidi Aria M. , Govindarajan Vaidya , Levi Allan D.
Published: May 2021

OBJECTIVE

Vertebral compression fractures are common in multiple myeloma (MM). Modern treatment paradigms place emphasis on treatment with radiation, with surgery reserved for cases involving frank instability or severe neural compression. However, experience at the authors’ institution has led them to suspect a more prominent role for surgical intervention in some settings. The authors undertook the present study to better understand the incidence of MM in undiagnosed patients who require urgent surgery for pathological vertebral fracture.

METHODS

The authors reviewed a prospectively collected database of all patients who underwent surgery with the senior author at their main hospital between June 1, 1998, and June 30, 2020. Patients admitted from the emergency room or after transfer from another hospital who then underwent surgery for pathological fracture during the same admission were included in the final analysis. Patients scheduled for elective surgery and those with previous cancer diagnoses were excluded.

RESULTS

Forty-three patients were identified as having undergone urgent surgical decompression and/or stabilization for pathological fracture. Histopathology confirmed diagnosis of MM in 22 (51%) patients, lung metastasis in 5 (12%) patients, and breast metastasis in 4 (9%) patients. Twelve (28%) patients were diagnosed with other types of metastatic carcinoma or undifferentiated disease. Sixteen of 29 (55%) men and 6 of 14 (42%) women were diagnosed with MM (p = 0.02). Seventeen of 34 (50%) patients who underwent surgery for neurological deficit, 5 of 6 (83%) patients who underwent surgery for spinal instability, and 0 (0%) patients who underwent surgery for pain with impending spinal cord injury were diagnosed with MM (p = 0.12).

CONCLUSIONS

A majority of patients presenting to the authors’ hospital with no history of malignancy who required urgent surgery for pathological compression fracture were found to have MM or plasmacytoma. This disease process may affect a significant portion of patients requiring decompressive or stabilizing surgery for compression fracture in academic medical centers.
Interhospital transfer status for spinal metastasis patients in the United States is associated with more severe clinical presentations and higher rates of inpatient complications
Authors: De la Garza Ramos Rafael , Park Christine , McCray Edwin , Price Meghan , Wang Timothy Y. , Dalton Tara , Baëta César , Erickson Melissa M. , Foster Norah , Pennington Zach , Shin John H. , Sciubba Daniel M. , Than Khoi D. , Karikari Isaac O. , Shaffrey Christopher I. , Abd-El-Barr Muhammad M. , Yassari Reza , Goodwin C. Rory
Published: May 2021

OBJECTIVE

In patients with metastatic spinal disease (MSD), interhospital transfer can potentially impact clinical outcomes as the possible benefits of transferring a patient to a higher level of care must be weighed against the negative effects associated with potential delays in treatment. While the association of clinical outcomes and transfer status has been examined in other specialties, the relationship between transfer status, complications, and risk of mortality in patients with MSD has yet to be explored. The purpose of this study was to examine the impact of transfer status on in-hospital mortality and clinical outcomes in patients diagnosed with MSD.

METHODS

The National (Nationwide) Inpatient Sample (NIS) database was retrospectively queried for adult patients diagnosed with vertebral pathological fracture and/or spinal cord compression in the setting of metastatic disease between 2012 and 2014. Demographics, baseline characteristics (e.g., metastatic spinal cord compression [MSCC] and paralysis), comorbidities, type of intervention, and relevant patient outcomes were controlled in a multivariable logistic regression model to analyze the association of transfer status with patient outcomes.

RESULTS

Within the 10,360 patients meeting the inclusion and exclusion criteria, higher rates of MSCC (50.2% vs 35.9%, p < 0.001) and paralysis (17.3% vs 8.4%, p < 0.001) were observed in patients transferred between hospitals compared to those directly admitted. In univariable analysis, a higher percentage of transferred patients underwent surgical intervention (p < 0.001) when compared with directly admitted patients. After controlling for significant covariates and surgical intervention, transferred patients were more likely to develop in-hospital complications (OR 1.34, 95% CI 1.18–1.52, p < 0.001), experience prolonged length of stay (OR 1.33, 95% CI 1.16–1.52, p < 0.001), and have a discharge disposition other than home (OR 1.70, 95% CI 1.46–1.98, p < 0.001), with no significant difference in inpatient mortality rates.

CONCLUSIONS

Patients with MSD who were transferred between hospitals demonstrated more severe clinical presentations and higher rates of inpatient complications compared to directly admitted patients, despite demonstrating no difference in in-hospital mortality rates.
Posterior vertebral column resection as a safe procedure leading to solid bone fusion in metastatic epidural spinal cord compression
Authors: Viezens Lennart , Dreimann Marc , Eicker Sven Oliver , Heuer Annika , Koepke Leon-Gordian , Mohme Malte , Krätzig Theresa , Stangenberg Martin
Published: May 2021

OBJECTIVE

Cancer is one of the leading causes of death and greatly decreases a patient’s quality of life. Vertebral metastases often lead to epidural spinal cord compression (ESCC) requiring surgical therapy. It has previously been shown that in patients with metastatic ESCC (MESCC), a surgical intervention leads to an improved outcome. Although the treatment paradigms in spinal metastases have changed and separation surgery followed by stereotactic radiosurgery is considered the best strategy, there are still cases in which 360° decompression with stabilization is indicated. In these patients, a proper bone fusion should be the treatment goal to guarantee good clinical results in extended survival times through progressions in oncological therapies. The aim of this study was to examine the safety and feasibility of posterior vertebral column resection (pVCR) in everyday clinical practice, achievement of bone fusion, and midterm outcome in patients with MESCC.

METHODS

All patients treated with pVCR due to MESCC between 2013 and 2020 were enrolled in this observational single-center study. Demographics, outcome parameters, numeric rating scale (NRS) score, Frankel grade, and Karnofsky Performance Scale (KPS) score were evaluated. Radiological images routinely acquired during follow-up were reviewed and screened for the presence of bone fusion.

RESULTS

Sixty-six patients were treated by eight surgeons. The mean follow-up period was 549 ± 739 days. At baseline, the average age was 64.4 ± 10.9 years. Reported NRS scores (preoperative 6.2 ± 1.7 vs postoperative 3.4 ± 1.6) and segmental kyphosis as measured on sagittal CT images (preoperative 13.5° ± 8.6° vs postoperative 3.8° ± 5.4°) decreased significantly (p < 0.001). In only 2 patients (3%), the Frankel grade worsened postoperatively, whereas in 12 patients (18.2%) an improvement was documented. The KPS score remained constant during the observation period (preoperative 73.2% ± 18.2% vs 78.3% ± 18% at last follow-up). Bone fusion was observed in 26 patients (86.7%) receiving CT more than 100 days after the index surgery.

CONCLUSIONS

pVCR is a reliable surgical technique in daily clinical practice, which proves to be beneficial in terms of short- as well as midterm outcome, as judged by the KPS and NRS. The overall improvement in the Frankel grade shows patient safety. A bone fusion was observed regularly in oncological patients undergoing pVCR. The authors therefore conclude that pVCR is a safe, fast, and efficient strategy to achieve stability and pain relief by achievement of bone fusion in cancer patients.
Factors associated with adjacent-level tumor progression in patients receiving surgery followed by radiosurgery for metastatic epidural spinal cord compression
Authors: Chakravarthy Vikram B. , Khan Hammad A. , Srivatsa Shaarada , Emch Todd , Chao Samuel T. , Krishnaney Ajit A.
Published: May 2021

OBJECTIVE

Separation surgery followed by spine stereotactic radiosurgery (SSRS) has been shown to achieve favorable rates of local tumor control and patient-reported outcomes in patients with metastatic epidural spinal cord compression (MESCC). However, rates and factors associated with adjacent-level tumor progression (ALTP) in this population have not yet been characterized. The present study aimed to identify factors associated with ALTP and examine its association with overall survival (OS) in patients receiving surgery followed by radiosurgery for MESCC.

METHODS

Thirty-nine patients who underwent separation surgery followed by SSRS for MESCC were identified using a prospectively collected database and were retrospectively reviewed. Radiological measurements were collected from preoperative, postoperative, and post-SSRS MRI. Statistical analysis was conducted using the Kaplan-Meier product-limit method and Cox proportional hazards test. Subgroup analysis was conducted for patients who experienced ALTP into the epidural space (ALTP-E).

RESULTS

The authors’ cohort included 39 patients with a median OS of 14.7 months (range 2.07–96.3 months). ALTP was observed in 16 patients (41.0%) at a mean of 6.1 ± 5.4 months postradiosurgery, of whom 4 patients (10.3%) experienced ALTP-E. Patients with ALTP had shorter OS (13.0 vs 17.1 months, p = 0.047) compared with those without ALTP. Factors associated with an increased likelihood of ALTP included the amount of bone marrow infiltrated by tumor at the index level, amount of residual epidural disease following separation surgery, and prior receipt of radiotherapy at the index level (p < 0.05). Subgroup analysis revealed that primary tumor type, amount of preoperative epidural disease, time elapsed between surgery and radiosurgery, and prior receipt of radiotherapy at the index level were significantly associated with ALTP-E (p < 0.05).

CONCLUSIONS

To the authors’ knowledge, this study is the first to identify possible risk factors for ALTP, and they suggest that it may be associated with shorter OS in patients receiving surgery followed by radiosurgery for MESCC. Future studies with higher power should be conducted to further characterize factors associated with ALTP in this population.
An analysis of tumor-related potential spinal column instability (Spine Instability Neoplastic Scores 7–12) eventually requiring surgery with a 1-year follow-up
Authors: Vargas Enrique , Lockney Dennis T. , Mummaneni Praveen V. , Haddad Alexander F. , Rivera Joshua , Tan Xiao , Jamieson Alysha , Mahmoudieh Yasmine , Berven Sigurd , Braunstein Steve E. , Chou Dean
Published: May 2021

OBJECTIVE

Within the Spine Instability Neoplastic Score (SINS) classification, tumor-related potential spinal instability (SINS 7–12) may not have a clear treatment approach. The authors aimed to examine the proportion of patients in this indeterminate zone who later required surgical stabilization after initial nonoperative management. By studying this patient population, they sought to determine if a clear SINS cutoff existed whereby the spine is potentially unstable due to a lesion and would be more likely to require stabilization.

METHODS

Records from patients treated at the University of California, San Francisco, for metastatic spine disease from 2005 to 2019 were retrospectively reviewed. Seventy-five patients with tumor-related potential spinal instability (SINS 7–12) who were initially treated nonoperatively were included. All patients had at least a 1-year follow-up with complete medical records. A univariate chi-square test and Student t-test were used to compare categorical and continuous outcomes, respectively, between patients who ultimately underwent surgery and those who did not. A backward likelihood multivariate binary logistic regression model was used to investigate the relationship between clinical characteristics and surgical intervention. Recursive partitioning analysis (RPA) and single-variable logistic regression were performed as a function of SINS.

RESULTS

Seventy-five patients with a total of 292 spinal metastatic sites were included in this study; 26 (34.7%) patients underwent surgical intervention, and 49 (65.3%) did not. There was no difference in age, sex, comorbidities, or lesion location between the groups. However, there were more patients with a SINS of 12 in the surgery group (55.2%) than in the no surgery group (44.8%) (p = 0.003). On multivariate analysis, SINS > 11 (OR 8.09, CI 1.96–33.4, p = 0.004) and Karnofsky Performance Scale (KPS) score < 60 (OR 0.94, CI 0.89–0.98, p = 0.008) were associated with an increased risk of surgery. KPS score was not correlated with SINS (p = 0.4). RPA by each spinal lesion identified an optimal cutoff value of SINS > 10, which were associated with an increased risk of surgical intervention. Patients with a surgical intervention had a higher incidence of complications on multivariable analysis (OR 2.96, CI 1.01–8.71, p = 0.048).

CONCLUSIONS

Patients with a mean SINS of 11 or greater may be at increased risk of mechanical instability requiring surgery after initial nonoperative management. RPA showed that patients with a KPS score of 60 or lower and a SINS of greater than 10 had increased surgery rates.
Refining the treatment of spinal cord lesions: experience from 500 cases
Authors: Westphal Manfred , Mende Klaus C. , Eicker Sven O.
Published: May 2021

OBJECTIVE

Tumorous lesions of the spinal cord, as well as some vascular lesions like cavernous hemangiomas, demand careful consideration as to the indication and approach for surgery. As these lesions are rare in any departmental series, refinement of treatment strategies evolves over long periods. In this context, the authors evaluated a series of 500 intramedullary lesions for approach, technique, outcome, complications, and follow-up.

METHODS

Five hundred intramedullary lesions in 460 patients were treated with a continuously evolving departmental strategy between 1985 and 2020. No lesions of the cauda equina or filum terminale were included. The focus of the evaluation was on the adaptation of exposure, resective methodology, sequelae, imaging, and rate of recurrence. Thirty-seven patients were children at the time of diagnosis.

RESULTS

Among the 348 neoplastic lesions, the largest subtype was ependymoma (n = 192, 55.2%), followed by astrocytoma (n = 89, 25.6%). As a trend, metastases (n = 21) have become more frequent and more apparent only in the past 15 years. Reoperations for recurrent or progressive cases or referrals after incomplete resection were performed in 56 cases, mostly for progressive diffuse or pilocytic astrocytomas. Among the vascular lesions, 68 (54.8%) were hemangioblastomas, followed by 56 (45.2%) cavernous hemangiomas. All intramedullary tumors were approached through a midline myelotomy, refining an en bloc resection technique for endophytic tumors to increase the rate of radical resection. Cavernous hemangiomas reaching the surface and hemangioblastomas were approached directly. Complete removal was possible in 77.2% of endophytic tumors but in only 41.7% of diffuse tumors. All WHO grade II diffuse astrocytomas, WHO grade III tumors, and glioblastoma progressed despite treatment according to standard regimens. Vascular lesions were regularly removed completely, with only 1 recurrence of a large hemorrhagic thoracic cavernous hemangioma. The major sequelae were sensory deficits and neuropathic pain. Stabilizing instrumentation was placed in 5 cases of spinal deformity, mostly when more than 4 levels were affected, and in the pediatric population.

CONCLUSIONS

In a large series of intramedullary surgeries, refinement of treatment strategies related to exposure, implementation of intraoperative adjuncts such as ultrasound, intraoperative neuromonitoring, resective strategies, and reconstruction were evaluated. The authors found that for almost any defined, endophytic medullary lesion, a safe and complete removal can be offered.
Performance assessment of the metastatic spinal tumor frailty index using machine learning algorithms: limitations and future directions
Authors: Massaad Elie , Williams Natalie , Hadzipasic Muhamed , Patel Shalin S. , Fourman Mitchell S. , Kiapour Ali , Schoenfeld Andrew J. , Shankar Ganesh M. , Shin John H.
Published: May 2021

OBJECTIVE

Frailty is recognized as an important consideration in patients with cancer who are undergoing therapies, including spine surgery. The definition of frailty in the context of spinal metastases is unclear, and few have studied such markers and their association with postoperative outcomes and survival. Using national databases, the metastatic spinal tumor frailty index (MSTFI) was developed as a tool to predict outcomes in this specific patient population and has not been tested with external data. The purpose of this study was to test the performance of the MSTFI with institutional data and determine whether machine learning methods could better identify measures of frailty as predictors of outcomes.

METHODS

Electronic health record data from 479 adult patients admitted to the Massachusetts General Hospital for metastatic spinal tumor surgery from 2010 to 2019 formed a validation cohort for the MSTFI to predict major complications, in-hospital mortality, and length of stay (LOS). The 9 parameters of the MSTFI were modeled in 3 machine learning algorithms (lasso regularization logistic regression, random forest, and gradient-boosted decision tree) to assess clinical outcome prediction and determine variable importance. Prediction performance of the models was measured by computing areas under the receiver operating characteristic curve (AUROCs), calibration, and confusion matrix metrics (positive predictive value, sensitivity, and specificity) and was subjected to internal bootstrap validation.

RESULTS

Of 479 patients (median age 64 years [IQR 55–71 years]; 58.7% male), 28.4% had complications after spine surgery. The in-hospital mortality rate was 1.9%, and the mean LOS was 7.8 days. The MSTFI demonstrated poor discrimination for predicting complications (AUROC 0.56, 95% CI 0.50–0.62) and in-hospital mortality (AUROC 0.69, 95% CI 0.54–0.85) in the validation cohort. For postoperative complications, machine learning approaches showed a greater advantage over the logistic regression model used to develop the MSTFI (AUROC 0.62, 95% CI 0.56–0.68 for random forest vs AUROC 0.56, 95% CI 0.50–0.62 for logistic regression). The random forest model had the highest positive predictive value (0.53, 95% CI 0.43–0.64) and the highest negative predictive value (0.77, 95% CI 0.72–0.81), with chronic lung disease, coagulopathy, anemia, and malnutrition identified as the most important predictors of postoperative complications.

CONCLUSIONS

This study highlights the challenges of defining and quantifying frailty in the metastatic spine tumor population. Further study is required to improve the determination of surgical frailty in this specific cohort.
Functional outcome and morbidity after microsurgical resection of spinal meningiomas
Authors: Kilinc Fatma , Setzer Matthias , Marquardt Gerhard , Keil Fee , Dubinski Daniel , Bruder Markus , Seifert Volker , Behmanesh Bedjan
Published: May 2021

OBJECTIVE

The aim of this study was to evaluate functional outcome, surgical morbidity, and factors that affect outcomes of surgically treated patients.

METHODS

The authors retrospectively analyzed patients who underwent microsurgical resection for spinal meningiomas between 2009 and 2020. Patient data and potential variables were collected and evaluated consecutively. Functional outcomes were evaluated using univariate and multivariate analyses.

RESULTS

A total of 119 patients underwent microsurgical resection of spinal meningioma within the study period. After a mean follow-up of 25.4 ± 37.1 months, the rates of overall complication, tumor recurrence, and poor functional outcome were 9.2%, 7.6%, and 5%, respectively. Age, sex, revision surgery, and tumor recurrence were identified as independent predictors of poor functional outcome. Obesity and surgeon’s experience had an impact on the complication rate, whereas extent of resection and tumor calcification affected the rate of tumor recurrence.

CONCLUSIONS

Microsurgical resection of spinal meningiomas remains safe. Nevertheless, some aspects, such as obesity and experience of the surgeons that result in a higher complication rate and ultimately affect clinical outcome, should be considered when performing surgery.
Intraoperative blood loss in oncological spine surgery
Authors: Mohme Malte , Mende Klaus C. , Pantel Tobias , Viezens Lennart , Westphal Manfred , Eicker Sven Oliver , Dreimann Marc , Krätzig Theresa , Stangenberg Martin
Published: May 2021

OBJECTIVE

Intraoperative blood loss in patients undergoing oncological spine surgery poses a major challenge for vulnerable patients. The goal of this study was to assess how the surgical procedure, tumor type, and tumor anatomy, as well as anesthesiological parameters, affect intraoperative blood loss in oncological spine surgery and to use this information to generate a short preoperative checklist for spine surgeons and anesthesiologists to identify patients at risk for increased intraoperative blood loss.

METHODS

The authors performed a retrospective analysis of 430 oncological patients who underwent spine surgery between 2013 and 2018 at the university medical spine center. Enrolled patients had metastatic tumor of the spine requiring surgical decompression of neural structures and/or stabilization including tumor biopsy using an open, percutaneous, and/or combined dorsoventral approach. Patients requiring vertebro- and kyphoplasty or biopsy only were excluded. Statistical analyses performed included a multiple linear regression analysis.

RESULTS

The mean intraoperative blood loss in the study patient cohort was 1176 ± 1209 ml. In total, 33.8% of patients received intraoperative red blood cell transfusions. The statistical analyses showed that tumor histology indicating myeloma, operative procedure length, epidural spinal cord compression (ESCC) score, tumor localization, BMI, and surgical strategy were significantly associated with increased intraoperative blood loss or risk of needing allogeneic blood transfusions. Anesthesiological parameters such as the American Society of Anesthesiologists (ASA) Physical Status classification score were not associated with blood loss. Multiple linear regression analysis demonstrated good predictive value (r = 0.437) for a five-item preoperative checklist to identify patients at risk for high intraoperative blood loss.

CONCLUSIONS

The analyses performed in this study demonstrated key factors affecting intraoperative blood loss and showed that a simple preoperative checklist including these factors can be used to identify patients undergoing surgery for metastatic spine tumors who are at risk for increased intraoperative blood loss.
Safety and efficacy of cement augmentation with fenestrated pedicle screws for tumor-related spinal instability
Authors: Massaad Elie , Rolle Myron , Hadzipasic Muhamed , Kiapour Ali , Shankar Ganesh M. , Shin John H.
Published: May 2021

OBJECTIVE

Achieving rigid spinal fixation can be challenging in patients with cancer-related instability, as factors such as osteopenia, radiation, and immunosuppression adversely affect bone quality. Augmenting pedicle screws with cement is a strategy to overcome construct failure. This study aimed to assess the safety and efficacy of cement augmentation with fenestrated pedicle screws in patients undergoing posterior, open thoracolumbar surgery for spinal metastases.

METHODS

A retrospective review was performed for patients who underwent surgery for cancer-related spine instability from 2016 to 2019 at the Massachusetts General Hospital. Patient demographics, surgical details, radiographic characteristics, patterns of cement extravasation, complications, and prospectively collected Patient-Reported Outcomes Measurement Information System Pain Interference and Pain Intensity scores were analyzed using descriptive statistics. Logistic regression was performed to determine factors associated with cement extravasation.

RESULTS

Sixty-nine patients underwent open posterior surgery with a total of 502 cement-augmented screws (mean 7.8 screws per construct). The median follow-up period for those who survived past 90 days was 25.3 months (IQR 10.8–34.6 months). Thirteen patients (18.8%) either died within 90 days or were lost to follow-up. Postoperative CT was performed to assess the instrumentation and patterns of cement extravasation. There was no screw loosening, pullout, or failure. The rate of cement extravasation was 28.9% (145/502), most commonly through the segmental veins (77/145, 53.1%). Screws breaching the lateral border of the pedicle but with fenestrations within the vertebral body were associated with a higher risk of leakage through the segmental veins compared with screws without any breach (OR 8.77, 95% CI 2.84–29.79; p < 0.001). Cement extravasation did not cause symptoms except in 1 patient who developed a symptomatic thoracic radiculopathy requiring decompression. There was 1 case of asymptomatic pulmonary cement embolism. Patients experienced significant pain improvement at the 3-month follow-up, with decreases in Pain Interference (mean change 15.8, 95% CI 14.5–17.1; p < 0.001) and Pain Intensity (mean change 28.5, 95% CI 26.7–30.4; p < 0.001).

CONCLUSIONS

Cement augmentation through fenestrated pedicle screws is a safe and effective option for spine stabilization in the cancer population. The risk of clinically significant adverse events from cement extravasation is very low.
A transpedicular approach to complex ventrally situated thoracic intradural extramedullary tumors: technique, indications, and multiinstitutional case series
Authors: Visco Zachary R. , Liu David D. , Leary Owen P. , Oyelese Adetokunbo A. , Gokaslan Ziya L. , Camara-Quintana Joaquin Q. , Galgano Michael A.
Published: May 2021

OBJECTIVE

Ventrally situated thoracic intradural extramedullary tumors are surgically challenging and difficult to access, and they may be complicated by extensive adhesions and calcifications. Selecting an approach for adequate ventral access is key to complete resection and optimization of outcomes. The authors present a case series of patients who underwent resection of ventral thoracic intradural extramedullary tumors and discuss indications and considerations for this technique. Additionally, they describe the use of a posterolateral transpedicular approach for resection of ventral thoracic intradural extramedullary tumors compared with other techniques, and they summarize the literature supporting its application.

METHODS

From May 2017 to August 2020, 5 patients with ventral thoracic intradural extramedullary tumors underwent resection at one of the two academic institutions.

RESULTS

Patient ages ranged from 47 to 75 (mean 63.4) years. All tumors were diagnosed as meningiomas or schwannomas by histological examination. Three of the 5 patients had evidence of partial or extensive tumor calcification. Four of the 5 patients underwent an initial posterolateral transpedicular approach for resection, with positive radiographic and clinical outcomes from surgery. One patient initially underwent an unsuccessful traditional direct posterior approach and required additional resection 2 years later after interval disease progression. There were no postoperative wound infections, CSF leaks, or other complications related to the transpedicular approach.

CONCLUSIONS

Posterolateral transpedicular tumor resection is a safe technique for the treatment of complex ventrally situated thoracic intradural extramedullary tumors compared with the direct posterior approach. Anecdotally, this approach appears to be particularly beneficial in patients with calcified tumors.
Clinical characteristics and long-term outcomes for patients who undergo cytoreductive surgery for thoracic meningiomas: a retrospective analysis
Authors: Ampie Leonel , Snyder M. Harrison , Dominguez Jose F. , Buchholz Avery , Yen Chun-Po , Shaffrey Mark E. , Syed Hasan R. , Shaffrey Christopher I. , Smith Justin S.
Published: May 2021

OBJECTIVE

Primary spinal meningiomas represent a rare indolent neoplasm usually situated in the intradural-extramedullary compartment. They have a predilection for afflicting the thoracic spine and most frequently present with sensory and/or motor symptoms. Resection is the first-line treatment for symptomatic tumors, whereas other clinical factors will determine the need for adjuvant therapy. In this study, the authors aimed to elucidate clinical presentation, functional outcomes, and long-term outcomes in this population in order to better equip clinicians with the tools to counsel their patients.

METHODS

This is a retrospective analysis of patients treated at the authors’ institution between 1998 and 2018. All patients with thoracic meningiomas who underwent resection and completed at least one follow-up appointment were included. Multiple preoperative clinical variables, hospitalization details, and long-term outcomes were collected for the cohort.

RESULTS

Forty-six patients who underwent resection for thoracic meningiomas were included. The average age of the cohort was 59 years, and the median follow-up was 53 months. Persistent sensory and motor symptoms were present in 29 patients (63%). Fifteen lesions were ventrally positioned. There were 43 WHO grade I tumors, 2 WHO grade II tumors, and 1 WHO grade III tumor; the grade III tumor was the only case of recurrence. The median length of hospitalization was 4 days. Seventeen patients (37%) were discharged to rehabilitation facilities. Thirty patients (65.2%) experienced resolution or improvement of symptoms, and there were no deaths within 30 days of surgery. Only 1 patient developed painful kyphosis and was managed medically. Ventral tumor position, new postoperative deficits, and length of stay did not correlate with disposition to a facility. Age, ventral position, blood loss, and increasing WHO grade did not correlate with length of stay.

CONCLUSIONS

Outcomes are overall favorable for patients who undergo resection of thoracic meningiomas. Symptomatic patients often experience improvement, and patients generally do not require significant future operations. Tumors located ventrally, while anatomically challenging, do not necessarily herald a significantly worse prognosis or limit the extent of resection.
Short-segment cement-augmented fixation in open separation surgery of metastatic epidural spinal cord compression: initial experience
Authors: Newman William C. , Amin Anubhav G. , Villavieja Jemma , Laufer Ilya , Bilsky Mark H. , Barzilai Ori
Published: May 2021

OBJECTIVE

High-grade metastatic epidural spinal cord compression from radioresistant tumor histologies is often treated with separation surgery and adjuvant stereotactic body radiation therapy. Historically, long-segment fixation is performed during separation surgery with posterior transpedicular fixation of a minimum of 2 spinal levels superior and inferior to the decompression. Previous experience with minimal access surgery techniques and percutaneous stabilization have highlighted reduced morbidity as an advantage to the use of shorter fixation constructs. Cement augmentation of pedicle screws is an attractive option for enhanced stabilization while performing shorter fixation. Herein, the authors describe their initial experience of open separation surgery using short-segment cement-augmented pedicle screw fixation for spinal reconstruction.

METHODS

The authors performed a retrospective chart review of patients undergoing open (i.e., nonpercutaneous, minimal access surgery) separation surgery for high-grade epidural spinal cord compression using cement-augmented pedicle screws at single levels adjacent to the decompression level(s). Patient demographics, treatment data, operative complications, and short-term radiographic outcomes were evaluated.

RESULTS

Overall, 44 patients met inclusion criteria with radiographic follow-up at a mean of 8.5 months. Involved levels included 19 thoracic, 5 thoracolumbar, and 20 lumbar. Cement augmentation through fenestrated pedicle screws was performed in 30 patients, and a vertebroplasty-type approach was used in the remaining 14 patients to augment screw purchase. One (2%) patient required an operative revision for a hardware complication. Three (7%) nonoperative radiographic hardware complications occurred, including 1 pathologic fracture at the index level causing progressive kyphosis and 2 incidences of haloing around a single screw. There were 2 wound complications that were managed conservatively without operative intervention. No cement-related complications occurred.

CONCLUSIONS

Open posterolateral decompression utilizing short-segment cement-augmented pedicle screws is a viable alternative to long-segment instrumentation for reconstruction following separation surgery for metastatic spine tumors. Studies with longer follow-up are needed to determine the rates of delayed complications and the durability of these outcomes.
Pengaruh Opini Audit, Profitabilitas, dan Kompleksitas Operasi Perusahaan Terhadap Audit Report Lag pada Perusahaan Pertambangan yang Terdaftar di BEI Periode 2014 - 2018
Authors: Wada Shania El , Subaki Ahmad , Zulpahmi Zulpahmi
Published: May 2021

Penelitian ini bertujuan untuk mengetahui bagaimana pengaruh opini audit, profitabilitas dan kompleksitas operasi perusahaan terhadap audit report lag pada perusahaan pertambangan yang terdaftar di Bursa Efek Indonesia (BEI). Dalam penelitian ini digunakan metode eksplanasi. Metode pemilihan sampel menggunakan purposive sampling dan diperoleh sampel sebanyak 7 perusahaan. Teknik pengumpulan data yang digunakan adalah metode telaah dokumen yaitu menelaah laporan keuangan yang diperoleh dari website Bursa Efek Indonesia (BEI) (www.idx.co.id). Teknik pengolahan dan analisis data yang digunakan adalah analisis akuntansi, analisis regresi linear berganda, uji asumsi klasik (uji normalitas, uji multikolinearitas, uji heteroskedastisitas, dan uji autokorelasi), uji hipotesis, analisis koefisien korelasi, analisis koefisien determinasi. Hasil penelitian menunjukan bahwa secara parsial variabel profitabilitas berpengaruh secara signifikan terhadap audit report lag hal ini dibuktikan dengan nilai signifikansi profitabilitas 0.02 < 0.05.
The Health Assessment of Vultures (Gyps bengalnesis) From Changa Manga, Lahore: A case Study
Authors: Khan Dr. Asif
Published: May 2021

Vultures are considered as an important indicator of a healthy environment, and they play a vital ecological role as scavengers. The present study was designed to estimate the health of critically endangered Gyps bengalensis in Changa Manga, Lahore, using a technique that does not require drawing blood. Fecal matter of seven pairs were examined and analyzed for protozoan or helminth infections. Gross examination involved checking consistency and color of feces, presence of blood in feces and gross parasites. Obtained samples had different colors and consistency but no blood was found in them. Pair 1 was infested with oocytes, but in pairs 5 and 6 only males were infested, while the female was infested in pair 7. Pair 2, 3, and 4 was completely healthy. Gram staining was also performed to assess the presence or absence of bacteria culture in digestive tracks of Gyps bengalensis. All pairs were infected with either gram positive or negative except Pair 5 which was negative for all gram staining. The present work introduced a technique to assess the health of vultures without drawing blood samples, a process that causes disturbances to their life cycle.
Antibacterial Effects of Some Common Spices against the Growth of Staphylococcus aureus Under Laboratory Conditions
Authors: Saeed Saba
Published: May 2021

Large variety of botanical extracts are being used for remedial purposes as they are inexpensive, safe and effective. The present study was designed to assess the antimicrobial effects of different spices; black pepper (Piper nigrum), fennel seed (Foeniculum vulgare), carom (Trachyspermum ammi), cinnamon (Cinnamomum verum), and turmeric (Curcuma longa) against Staphylococcus aureus. The effectiveness of different spices against S. aureus was evaluated using Minimum Inhibitory Concentration (MIC) method. It was found by statistical analysis regression method that C. verum possessed significantly higher (p < 0.00) antimicrobial effects followed by C. longa (p = 0.005) against Staphylococcus aureus, while F. vulgare (p = 0.90) and T. ammi (p = 0.78) had non- significant effect against S. aureus. Furthermore, P. nigrum (p = N.A) had no effects against the bacteria. The purpose of this research is to ascertain the antibacterial action of easily cultivated spices against Staphylococcus aureus and will be helpful to treat gastrointestinal infections using common spices instead of antibiotics
OSTEONECROSIS OF THE JAW (ONJ) IN PROSTATE CANCER PATIENTS: EFFECT OF PREVENTIVE MEASURES IN A MONOINSTITUTIONAL EXPERIENCE
Authors: Tartara Daniela , Fusco Vittorio , Fasciolo Antonella , Guglielmini Pamela Francesca , Vincenti Maura , Brigo Paola , Rossi Maura , Ferrero Elisabetta , Alessio Manuela , De Martino Iolanda , Riccio Carmela , Traverso Elena
Published: May 2021

Background. Osteonecrosis of the Jaw (ONJ) frequency after antiresorptive treatment in prostate cancer patients largely varied in literature. 

Patients and Methods. Charts of all prostate cancer patients affected by bone metastases observed at the Oncology Unit of Alessandria Hospital in years 2005-2020 have been reviewed.  ONJ frequency after antiresorptive treatment (bisphosphonates and/or denosumab) was investigated in prostate cancer patients with bone metastases undergoing preventive (before start of treatment) and/or screening (during treatment) evaluations, including oral inspection and panoramic dental radiography. Patients received antiresorptive agents according to international guidelines. Results. We examined charts of 120 patients receiving bisphosphonates (mostly zoledronic acid, or pamidronate or ibandronate) or denosumab or sequences of drugs, and evaluated for oral health, 112 being treated since 2006 after pre-treatment oral evaluation. Out of 120 total patients, 8 cases of Osteonecrosis of the Jaw (ONJ) were registered among prostate cancer patients treated at Alessandria Hospital: 2 ONJ cases were detected among 8 patients starting antiresorptive treatment before 2006 and without preventive visit, whereas 6 cases were found among 112 cases receiving dental visit before treatment start (6/112, 5.3%). Furthermore, other 8 ONJ cases in prostate cancer patients were referred by neighbour hospitals to the ONJ multidisciplinary group. Conclusions.  Our preliminary data confirm that prostate cancer patients receiving bisphosphonates or denosumab are at not irrelevant risk of ONJ, even if in last decade less intensive schedules of antiresorptive drugs and measures of pre-treatment evaluation were adopted. Further evaluations have been planned to investigate if higher ONJ risk was associated to drug (denosumab versus zoledronic acid), prolonged treatment (> 2 years), pre-existing oral disease (periodontal disease, need for tooth extraction, ill-fitting dentures), and other potential predictive factors.
The factors affecting the student’s decision to continue to rent accommodation in Thu Duc district
Authors: Lệ Uyển Võ Thị , Tường Vi Đinh Hoàng , Trung Trần Đức , Bích Chi Trần Thị , Kim Chung Đỗ Thị
Published: May 2021

The authors have carried out a study to determine and evaluate the impact of the factors affecting students' decisions to continue renting accommodation in Thu Duc District. The research model is built on Maslow's theory of demand hierarchy, Mankiw's theory of choice in consumption, Le Bon's theory of crowd psychology, Hoang Huu Phe and Wakely's theory of position and quality. The study is conducted through 2 phases: Qualitative research and quantitative research with the answer sheets of 668 students. Preliminary research results with responses from 30 students conducted by the direct interview method show that all students agree 7 factors are affecting the decision to continue renting. The primary research was performed with answer sheets of 668 students, all valid votes were filtered, coded, and then analyzed for the reliability of Cronbach's Alpha, EFA method, Logit analysis method, correct forecast rate of the Logit model, Logit model defect test, and Logit model conformity test. Logit's analysis results show that there are 4 factors affecting the decision to continue renting, including (1) Social relations, (2) Facilities, (3) Environment, (4) Price. The results show the needs and concerns of students in Thu Duc District when making the decision to continue renting, through which the authors give recommendations to improve the quality of accommodation for homeowners and student awareness.