bluuebunny/crossref_metadata_2025 huggingface dataset:
Theological Librarianship at 10
Authors: Woodruff Tait Jennifer
Published: November 2018

Theological Librarianship was the result of careful planning and part of a long history of ATLA members writing about their profession. It has committed itself over the years to  talking about issues relevant to the profession; thinking through the implications of new technology; and publishing articles that appeal to a variety of librarians and come from a variety of sources. This editorial surveys its first decade of history and concludes with some thoughts for the future of the journal.
The origin of the sporadic prion
Authors: Damavandi Pardis Tabaee
Published: November 2018

This is a perspective.
Teacher’s Attitude And Peer Acceptance To Children With Special Needs In Inclusive Primary Schools
Authors: Marlina Marlina -
Published: November 2018

The success of inclusion of children with special needs in inclusive schools largely depends on teachers’ attitudes towards students with special needs and their knowledge on how to properly educate them. Regular teachers have different views about the inclusion of students with special needs. The type and level of the children’s disabilities affect teachers’ willingness to accommodate students with special needs and effective classroom management. The research used descriptive survey method to know the attitude and level of peer acceptance to children with special needs in Padang inclusive schools, West Sumatera, Indonesia in year 2015. The subjects of research consist of 150 regular school teachers and special education teachers who worked full-time in inclusive schools and 85 children with special needs that had been identified with the Kit of Identification Children with Special Needs. The data were collected with teacher attitudes and sociometric nomination scales. The results show that teacher attitudes on integration are not related to teaching experience, teacher educational background is positively related to their attitudes, and teachers’ teaching experiences are related to attitudes. Other findings indicate that the level of peer acceptance in children with special needs is largely in the category of being ignored and even rejected by their peers.
Effect of Palm Oil and Cattle Wastes Combination on Growth and Production of Sweet Corn
Authors: Siahaan Andysah Putera Utama , Rusiadi
Published: November 2018

The purpose of this study was to determine liquid palm oil mill waste (LPKS) combined with cattle waste (LTS) on the growth and yield of sweet corn plants. The field trial was conducted in Complete Randomized Block Design (CRBD) with three replication and two factors. Whereas, first factor was used palm oil mill waste (LPKS) mixing with cattle waste (LTS) at 2 levels namely: P1 (Solid: Solid), P2 (Liquid: Liquid) and the second factor was used the combined of LPKS and LTS in percentage (%) which consists of 5 various namely; C1 (100: 0), C2 (70: 30), C3 (50: 50), C4 (30: 70) and C5 (0: 100). Land with 125 meters square was divided 30 subplots into three replications which 1.25 m x 1.5 m every subplot. The corn crops were planted direct system in the hole with two seeds. The plot was given basic fertilizer with Urea (150 kg/ha), TSP (100 kg/ha) and KCl (100 kg/ha). Application of fertilizers was conducted one week after planting. Parameters were measured plant height, yield component (cob diameter) and yield. Data were analyzed using ANOVA if the founded significant was continued with DMRT at p < 0.05. The results showed that there was a significant effect for all parameters measured; plant height, yield component (cob diameter) and yield. The first factor was shown that P1 its’ better than P2. The same result with the second factor was the significant difference among various treatment with C1 was better as compared among them, respectively. Unlike interaction of two factors, there was unsignificantly in p > 0.05 at DMRT. In this study, our suggested that the application of P1 (solid: solid) and C1 (100:0) can be used the application in sweet corn to increase the yield increase the yield.
Impact of Cybercrime on Technological and Financial Developments
Authors: Siahaan Andysah Putera Utama
Published: November 2018

The more sophisticated the technology, the higher the level of criminal activity. Before there was digital data, the world only had physical threats. However, the emergence of the internet and the global network creates cybercrime everywhere. The emergence of this crime is because many companies or organizations are involved in the internet network. For example, purchasing with a credit card requires a manual swipe tool, while now the credit card itself can be transacted online. Cyber attack is one of the crimes that can be experienced by anyone, especially with the increasing number of organizations connected to the Internet to make way for hackers to be able to work on an organization. Large developing markets are not spared from the cybercriminals. The higher their role in the global supply chain increases their attractiveness to attack through cyberspace. Attackers will use it if their site's security management is weak. Cybercrime is too easy to do. Many technology users are failing to perform the most basic protection measures. Many companies only think about their economic circulation without having adequate defense products, while cybercriminals use sophisticated and straightforward technology to identify targets, automate the creation and delivery of software, and easy monetization of what they steal. Cybercrime affects technology and finances a lot in the present. Many individuals, companies or banks suffer huge losses. Cybercrime can be anticipated by increasing security in the corporate network when communicating to the outside world.
Perbaikan Iklim Kelas untuk Peningkatan Kualitas Pembelajaran di Perguruan Tinggi
Authors: Hadiyanto Hadiyanto , Syahril Syahril
Published: November 2018

Classroom climate in universities is actually a study that has been done in many universities in other countries, but not much done by researchers at universities in Indonesia. The underlying theories, followed by relevant studies, the development and validation of measuring tools have been widely used and developed to improve the learning process. This article describes the study followed by steps that can be undertaken by researchers and those interested in improving learning through improved classroom climate in universities. Similar research has been conducted at the primary and secondary level in Indonesia, but has not triggered and inspired lecturers, so it is necessary to be undertaken in universities.
7 Easy Steps to Open Science: An Annotated Reading List
Authors: Crüwell Sophia , van Doorn Johnny , Etz Alexander , Makel Matthew C. , Moshontz Hannah , Niebaum Jesse C , Orben Amy , Parsons Sam , Schulte-Mecklenbeck Michael
Published: November 2018

The Open Science movement is rapidly changing the scientific landscape. Because exact definitions are often lacking and reforms are constantly evolving, accessible guides to open science are needed. This paper provides an introduction to open science and related reforms in the form of an annotated reading list of seven peer-reviewed articles, following the format of Etz et al. (2018). Written for researchers and students - particularly in psychological science - it highlights and introduces seven topics: understanding open science; open access; open data, materials, and code; reproducible analyses; preregistration and registered reports; replication research; and teaching open science. For each topic, we provide a detailed summary of one particularly informative and actionable article and suggest several further resources. Supporting a broader understanding of open science issues, this overview should enable researchers to engage with, improve, and implement current open, transparent, reproducible, replicable, and cumulative scientific practices.
Dental Age Estimation by Demirjian’s and Nolla’s Method in Children of Jorpati, Kathmandu
Authors: Khanal Sanskriti , Acharya Jemish , Shah Priyanka
Published: November 2018

Background: Growing individuals not only differ in the timing of the maturational events, but also in the sequence of these events. Age is one of the essential factors, which play an important role in every aspect of life like in clinical, medico-legal, forensic and anthropological applications and in planning treatment of   orthodontic and pedodontic patients. The aim of the study was to determine dental age from                       orthopantomogram using Demirjian’s method and Nolla’s method and to evaluate the interrelationship     between chronological and dental age according to both these methods. Materials and Methods: A cross sectional study was carried out in 177 orthopantomograms of the patient aged between 5 to 15 years. Dental age estimation was done with Demirjian’s and Nolla’s method. Results: The mean chronological age 10.14 + 3.16 compared with the mean Demirjian age 9.58 + 3.39 was statistically non significant p > 0.05 whereas comparision with mean Nolla age 7.88+ 1.56 was significant statistically. Conclusions: Both methods showed delayed dental age compared to chronological age. Demirjian’s method was more  applicable to    assess the dental age in Nepalese children compared to Nolla’s method.Keywords: chronological age; dental age; Demirjian’s method; Nolla’s method.
Health Seeking Behaviour Among Elderly People of Bharatpur Municipality of Chitwan, Nepal
Authors: Baral Rojina , Sapkota Pramila
Published: November 2018

ABSTRACTBackground: Individuals have different opinion regarding willingness to seek help from health care services. Some go readily for treatment, others only when in great pain and in advance state of ill health. This is especially true for people with advance age who have to face many physiological changes which act as a barrier to seek immediate help in health care setting. Thus, a study was conducted to analyse the health seeking behaviour among elderly. Materials and Methods: A cross-sectional analytical study was conducted among 104 elderly aged 60 years and above. Non- probability convenience sampling technique was used to collect the data. Data was collected by interviewing the elderly at their residence. The data gathered was analyzed using both descriptive and inferential statistics in SPSS software. Results: Assessment of the health status of elderly people revealed that, majority of the participant’s 86.5% were suffering from chronic health problem, among them 37.8% suffered from hypertension 11.1% suffered from diabetic mellitus. Whereas, assessment of the practice of health seeking behaviour among elderly stated that all the participant’s 100%  were seeking help for health problem in which 83.7% seek help from modern medication and still 16.3% seek help from alternative medication.  Also, the health seeking behavior was found to be statistically significant with health problem (p=0.002), ethnicity (0.007) and religion (p=0.007) respectively. Conclusions: Elderly are aware of seeking help from the health care center, but still elderly believe in alternative medication rather than modern medication which may be an alarming  truth in the health care setting.Keywords: alternative medication; elderly; health seeking behaviour; modern medication.
Antibiotic Susceptibility Pattern of Nalidixic Acid Resistant Salmonella Isolates in Shree Birendra Hospital Chhauni
Authors: Kunwar Dhirendra , Bhatta Sabita , Chaudhary Raina , Rijal Komal Raj
Published: November 2018

Objectives: This study was aimed to know the prevalence of Nalidixic acid resistant Salmonella isolates and their antibiotic susceptibility pattern.Methods: A total of 4619 febrile patients suspecting the cases of typhoid fever by clinician, attending at Shree Birendra hospital during May- November 2013 were subjected to culture. Blood sample (5ml) was collected from the suspected cases and inoculated immediately into 45ml of Brain heart infusion broth (BHI) and further processed for the identification of Salmonella Typhi and S. Paratyphi. Antimicrobial susceptibility pattern of S. Typhi and S. Paratyphi isolates were determined by the modified Kirby-Bauer disc diffusion method.Results: Out of 4619 blood sample, 8.7% (n= 403) sample were culture positive. Among culture positive, 66.3%(n=267) cases were S. Typhi, 26.1% (n=105) cases were S. Paratyphi and 7.7% (n=31) were other than Salmonella isolates respectively. Out of 372 Salmonella isolates, most of the S. Typhi isolates i.e. 95.51%(n=255) and S. Paratyphi isolates i.e. 97.14%(n=102) are highly resistant to nalidixic acid. Most of these isolates were also found resistant to ciprofloxacin and ofloxacin.Conclusion: Therefore, screening of nalidixic acid susceptibility might be done prior to prescribe the drug for the treatment of enteric fever.
Pembelajaran Berbicara Interaktif Bahasa Inggris di SMP
Authors: Mufliharsi Risa , Candra Eva Nurul
Published: November 2018

Tujuan yang dicapai pada kegiatan ini adalah meningkatkan kompetensi para guru sekolah menengah pertama terutama pembelajaran berbicara bahasa Inggris secara interaktif dan transaksional. Luaran yang akan dihasilkan adalah berupa jurnal berisikan penerapan berbagai pembelajaran berbicara yang disesuaikan untuk sekolah menegah pertama. Selain itu, juga booklet untuk para guru dalam mengajarkan berbicara bahasa Inggris yang bisa diterapkan di kelas ataupun ekstrakurikuler English Club di SMPIT Yayasan Tunas Harapan  Ilahi dan SMP Negeri 9 Bekasi.  Kegiatan yang dilakukan antara lain: 1) Melakukan presentasi dan memberikan penjelasan mengenai bagaimana pembelajaran berbicara interaktif melalui berbagai teknik maupun metode pembelajaran, 2) Melakukan presentasi dan memberikan penjelasan mengenai klasifikasi capaian aspek yang ditekankan, 3) Membimbing dan mendampingi para guru SMPIT Tunas Harapan Ilahi dan SMP Negeri 9 Bekasi dalam melakukan praktek atau simulasi sederhana dalam sosialisasi tersebut. 4) Melakukan sesi tanya jawab mengenai pelatihan yang tergambar dari awal hingga akhir
ALEKSANDR DOBROLYUBOV ON HIS WAY TO THE ‘MOST EXALTED BROTHERHOOD’. WHAT DOES IT MEAN NOT TO BE LEO TOLSTOY
Authors: Sluzhaeva O.
Published: November 2018

Based on letters, archived documents and the works written by A. Dobrolyubov during his religious exploration, after he set off on a pilgrimage across Russia, this article considers the foundations of the poet’s religious teaching and its perception by peasants and ‘literate’ society. The researcher focuses on A. Dobrolyubov’s collections of poetry From the Invisible Book [Iz knigi Nevidimoy], My Eternal Fellow-Travellers [Moi vechnie sputniki] and the songs he composed for group performance during community/brotherhood gatherings. A particularly valuable input is provided by I. Yarkov’s archive about Dobrolyubov and his followers (kept at the manuscripts departments of the Russian State Library and the Samara M. Gorky Literary Museum).

The researcher points out that Dobrolyubov’s religious teaching, which used to enjoy a big following across a wide geography, was either ignored or misinterpreted in literary circles, and that, once he cut off his ties with the intellectuals, his contemporaries began to compare Dobrolyubov with Leo Tolstoy and those characters of classical Russian literature whose devoted their lives to the search for God and the truth. Dobrolyubov’s ideas of refusal to perform military service, genuine emancipation of peasants, the inner revolution as a prerequisite for progress, a universal unity, and respect for folk culture are not unlike the values that shaped European democracies.
HAMLET’S APPROPRIATION IN AUTEUR AND INDEPENDENT CINEMA
Authors: Rybina P.
Published: November 2018

The article focuses on the priorities in contemporary studies of cinematic adaptations. Looking at the various appropriations of this Shakespeare’s tragedy in art and indie movies, the researcher reveals how by underscoring the director’s visual imagination and the ‘power’ of a cinematic tradition one can revise the scope of adaptation studies. Concentrating on the signature elements of A. Kaurismäki’s and M. Almereyda’s cinematography, the author emphasizes the productivity of the audience’s ‘entrancement’ with the visual and sonic interpretation of the classical piece (through the use of the American film noir stylistics by Kaurismäki, and through Almereyda’s interplay of multiple on-screen realities). In the viewers’ memory, literary meanings are expelled rather aggressively by new cinematographic ones. Kaurismäki turns the tragedy into a tastefully stylized noir whodunit, while Almereyda went for a reflective narrative about neo-Hamletism at an age of expanding virtual realities. In her demonstration of how the directors achieved such effects, the author argues the priority of the cinematographic auteurship (including the case of collective auteurship) in the analysis of contemporary film adaptations.
IN VIA VERITAS. IRINA BOGATYREVA
Authors: Lebedeva M.
Published: November 2018

In this review of the novels and stories by the contemporary Russian author I. Bogatyreva, winner of numerous literary awards, including The Student Booker 2016, the critic highlights the principal motifs of her plots, including the motif of travel, pilgrimage, and the search of a certain human common ground: be it age, philosophy, or nationality. The paper also examines the chronotope and the writer’s use of mythological allusions, which permeate both her historical and modern day-based novels, only to conclude that ‘emerging adulthood’, a term from the psychological studies of young adults, is the most apt way to describe Bogatyreva’s prose. That the writer maintains keen interest in the subject is not only because of her role as ‘a real master of innovation in young Russian prose’ (quoted from the blurb on the cover of her prize-winning novel Kadyn), but due to its relevance for contemporary young adult readers, themselves in search of their models growing up and their future destiny.
THE DEVELOPMENT OF A MOBILE APPLICATION FOR FITNESS
Authors:   Master student L.N.Gumilyov Eurasian National University Astana, the Republic of Kazakhstan. E-mail: dilyarabolatovna@gmail.com, Beisekeyeva Dilyara , Boranbayev Seilhan ,   Doctor of Technical Sciences, professor L.N.Gumilyov Eurasian National University Astana, the Republic of Kazakhstan. E-mail: sboranba@yandex.kz
Published: November 2018

The article is devoted to the development of a mobile fitness app. The application contains many functions for people of different ages, facilitates the search for an appropriate gym, including those or other suitable for them individual areas of fitness programs. The main functions of the application: search for existing fitness programs, according to user data entered during registration; record for training in the chosen direction of the fitness program; feedback (complaints and wishes of the user); nutrition diary for daily monitoring of diets and proper nutrition during trainings prescribed by the trainer; training page with videos for training and motivating users.
IFRS 17: SUBSEQUENT MEASUREMENTS OF INSURANCE CONTRACTS
Authors:   Phd student of the University Narhoz Almaty, the Republic of Kazakhstan. E-mail: mishell_a@mail.ru, Kulustayeva A.М.
Published: November 2018

According to IFRS 17, insurance contracts can be assessed using a common model. Upon initial recognition, a company must evaluate a group of contracts on the total amount of future cash flows and contract margins. Cash flows should be calculated with an adjustment reflecting the cost of money over time. In addition, the financial risks associated with future cash flows should be taken into account. Risk adjustment should also take into account non-financial risks. The subsequent assessment of the balance sheet value of a group of insurance contracts at the end of each reporting period should consist of the amount of obligations for the remaining insurance coverage and obligations for losses incurred. The first part of these obligations should include cash flows related to future services and the group's contract margin at that date. The second part of the liabilities includes cash flows that are associated with past services assigned to the group at that date.
RESEARCH STRUCTURAL FEATURES OF EUROPIUM DOPED ZINK OXIDE FILMS
Authors:   PhD Satbayev University, Almaty, Kazakhstan. E-mail: a.kemelbekova@mail.ru, Kemelbekova Ainagul Erzhanovna
Published: November 2018

This article deals with the structural properties of europium doped zink oxide films prepared by different tehnologies. were studied samples from the magnetron sputtering method, chemical vapor deposition and hydrothermal deposition
The Effects of Elusive Knowledge
Authors: Widmer Alexandra
Published: November 2018

In this article, I discuss two roles of documents in the creation and enforcement
of public health laws in early colonial Vanuatu and their implication in colonial
attempts to transform ni-Vanuatu societies and subjectivities. Colonial officials
of the British-French Condominium based their projects on their admittedly
partial knowledge in reports generated by experts studying depopulation. This
knowledge, I argue, produced a ‘population’ by categorizing people according
to their relationship with a reified notion of culture. The Condominium
enforced health laws by sending letters to people categorized as Christian who
would, the Condominium hoped, adhere to the regulations as self governing
subjects. Officials would engage in persuasive conversations when they
enforced the regulations in ‘bush’ villages. I conclude by reflecting on ni-
Vanuatu knowledge of well-being and illness that could not be represented or
documented and its centrality for subjectivities that might elude, if not subvert,
the modern subject presumed by colonial strategies of governance.
Radiosurgery for dural carotid-cavernous sinus fistulas: Gamma Knife compared with XKnife radiosurgery
Authors: Pan Hung-Chuan , Sun Ming-Hsi , Sheehan Jason , Sheu Meei-Ling , Chen Clayton Chi-Chang , Lee Hsu-Tung , Chiu Wen-Ta , Yang Dar-Yu
Published: November 2018

Object

In the modern era, stereotactic radiosurgery is an important part of the multidisciplinary and multimodality approach used to treat dural carotid-cavernous fistulas (DCCFs). Based on the ease of performance of techniques to fuse cerebral angiography studies with MR images or CT scans during the radiosurgical procedure, the Gamma Knife and XKnife are 2 of the most popular radiosurgical instruments for patients with DCCF. In this study, the authors compared the efficacy, neurological results, and complications associated with these 2 radiosurgical devices when used for DCCF.

Methods

Records for 41 patients with DCCF (15 treated using the XKnife and 26 with Gamma Knife surgery [GKS]) were retrieved from a radiosurgical database encompassing the period of September 2000 to August 2008. Among these patients, at least 2 consecutive MR imaging or MR angiography studies obtained after radiosurgery were available for determining radiological outcome of the fistula. All patients received regular follow-up to evaluate the neurological and ophthalmological function at an interval of 1–3 months. The symptomatology, obliteration rate, radiation dose, instrument accuracy, and adverse effects were determined for each group and compared between 2 groups. The data were analyzed using the Student t-test.

Results

The mean age of the patients was 63 ± 2.6 years, and the mean follow-up period was 63.1 ± 4.4 months (mean ± SD). Thirty-seven patients (90%) achieved an obliteration of the DCCF (93% in the XKnife cohort and 88% for the GKS cohort). In 34 of 40 patients (85%) with chemosis and proptosis of the eyes, these symptoms were resolved after treatment (4 had residual fistula and 2 had arterializations of sclera). All 5 patients with high intraocular pressure demonstrated clinical improvement. Ten (71%) of 14 patients with cranial nerve palsy demonstrated improvement following radiosurgery. Significant discrepancies of treatment modalities existed between the XKnife and GKS groups, such as radiation volume, conformity index, number of isocenters, instrument accuracy, peripheral isodose line, and maximum dosage. The XKnife delivered significantly higher radiation dosage to the lens, optic nerve, optic chiasm, bilateral temporal lobe, and brainstem. Few adverse events occurred, but included 1 patient with optic neuritis (GKS group), 1 intracranial hemorrhage (XKnife group), 1 brainstem edema (XKnife), and 3 temporal lobe radiation edemas (XKnife).

Conclusions

Radiosurgery affords a substantial chance of radiological and clinical improvement in patients with DCCFs. The Gamma Knife and XKnife demonstrated similar efficacy in the obliteration of DCCFs. However, a slightly higher incidence of complications occurred in the XKnife group.
Gamma Knife surgery as sole treatment for multiple brain metastases: 2-center retrospective review of 1508 cases meeting the inclusion criteria of the JLGK0901 multi-institutional prospective study
Authors: Serizawa Toru , Yamamoto Masaaki , Sato Yasunori , Higuchi Yoshinori , Nagano Osamu , Kawabe Takuya , Matsuda Shinji , Ono Junichi , Saeki Naokatsu , Hatano Manabu , Hirai Tatsuo
Published: November 2018

Object

The authors retrospectively reviewed the results of Gamma Knife surgery (GKS) used as the sole treatment for brain metastases in patients who met the eligibility criteria for the ongoing JLGK0901 multi-institutional prospective trial. They also discuss the anticipated results of the JLGK0901 study.

Methods

Data from 1508 consecutive cases were analyzed. All of the patients were treated at the Gamma Knife House of Chiba Cardiovascular Center or the Mito Gamma House of Katsuta Hospital between 1998 and 2007 and met the following JLGK0901 inclusion criteria: 1) newly diagnosed brain metastases, 2) 1–10 brain lesions, 3) less than 10 cm3 volume of the largest tumor, 4) no more than 15 cm3 total tumor volume, 5) no findings of CSF dissemination, and 6) no impairment of activities of daily living (Karnofsky Performance Scale score < 70) due to extracranial disease. At the initial treatment, all visible lesions were irradiated with GKS without upfront whole-brain radiation therapy. Thereafter, gadolinium-enhanced MR imaging was performed every 2–3 months, and new distant lesions were appropriately retreated with GKS. Patients were divided into groups according to numbers of tumors: Group A, single lesions (565 cases); Group B, 2–4 tumors (577 cases); and Group C, 5–10 tumors (366 cases). The differences in overall survival (OS) were compared between groups.

Results

The median age of the patients was 66 years (range 19–96 years). There were 963 men and 545 women. The primary tumors were in the lung in 1114 patients, gastrointestinal tract in 179, breast in 105, urinary tract in 66, and other sites in 44. The overall mean survival time was 0.78 years (0.99 years for Group A, 0.68 years for Group B, and 0.62 years for Group C). The differences between Groups A and B (p < 0.0001) and between Groups B and C (p = 0.0312) were statistically significant. Multivariate analysis revealed significant prognostic factors for OS to be sex (poor prognostic factor: male, p < 0.0001), recursive partitioning analysis class (Class I vs Class II and Class II vs III, both p < 0.0001), primary site (lung vs breast, p = 0.0047), and number of tumors (Group A vs Group B, p < 0.0001). However, no statistically difference was detected between Groups B and C (p = 0.1027, hazard ratio 1.124, 95% CI 0.999–1.265).

Conclusions

The results of this retrospective analysis revealed an upper CI of 1.265 for the hazard ratio, which was lower than the 1.3 initially set by the JLGK0901 study. The JLGK0901 study is anticipated to show noninferiority of GKS as sole treatment for patients with 5–10 brain metastases compared with those with 2–4 in terms of OS.
Testing different brain metastasis grading systems in stereotactic radiosurgery: Radiation Therapy Oncology Group's RPA, SIR, BSBM, GPA, and modified RPA
Authors: Serizawa Toru , Higuchi Yoshinori , Nagano Osamu , Hirai Tatsuo , Ono Junichi , Saeki Naokatsu , Miyakawa Akifumi
Published: November 2018

Object

The authors conducted validity testing of the 5 major reported indices for radiosurgically treated brain metastases— the original Radiation Therapy Oncology Group's Recursive Partitioning Analysis (RPA), the Score Index for Radiosurgery in Brain Metastases (SIR), the Basic Score for Brain Metastases (BSBM), the Graded Prognostic Assessment (GPA), and the subclassification of RPA Class II proposed by Yamamoto—in nearly 2500 cases treated with Gamma Knife surgery (GKS), focusing on the preservation of neurological function as well as the traditional endpoint of overall survival.

Methods

The authors analyzed data from 2445 cases treated with GKS by the first author (T.S.), the primary surgeon. The patient group consisted of 1716 patients treated between January 1998 and March 2008 (the Chiba series) and 729 patients treated between April 2008 and December 2011 (the Tokyo series). The interval from the date of GKS until the date of the patient's death (overall survival) and impaired activities of daily living (qualitative survival) were calculated using the Kaplan-Meier method, while the absolute risk for two adjacent classes of each grading system and both hazard ratios and 95% confidence intervals were estimated using the Cox proportional hazards model.

Results

For overall survival, there were highly statistically significant differences between each two adjacent patient groups characterized by class or score (all p values < 0.001), except for GPA Scores 3.5–4.0 and 3.0. The SIR showed the best statistical results for predicting preservation of neurological function. Although no other grading systems yielded statistically significant differences in qualitative survival, the BSBM and the modified RPA appeared to be better than the original RPA and GPA.

Conclusions

The modified RPA subclassification, proposed by Yamamoto, is well balanced in scoring simplicity with respect to case number distribution and statistical results for overall survival. However, a new or revised grading system is necessary for predicting qualitative survival and for selecting the optimal treatment for patients with brain metastasis treated by GKS.
New nidus formation adjacent to the target site of an arteriovenous malformation treated by Gamma Knife surgery
Authors: Yun Jung-Ho , Kwon Do Hoon , Lee Eun Jung , Lee Do Heui , Ahn Jae Sung , Kwun Byung Duk
Published: November 2018

New nidi are rarely found adjacent to the resection margin following treatment for an arteriovenous malformation (AVM), especially in adults. In addition, there are no reports in adults of new nidus formation adjacent to the targeted site of an AVM that angiography has verified to be completely obliterated by radiosurgery. The authors present their experience with recurrent AVMs following AVM radiosurgery in 3 patients whose ages were 9 years, 10 years, and 33 years. None of the patients had been treated with embolization before radiosurgery. Two patients had a history of intracerebral hemorrhage before radiosurgery. New lesions developed around the obliterated nidi in all 3 cases. Angiography performed after the first radiosurgery confirmed complete removal of the nidus in all 3 patients, and new nidus formation was detected 31, 132, and 36 months after the initial GKS. The new lesions were also treated by GKS. Occasionally, in patients with recurrent AVMs, such as those described in this paper, long-term clinical and angiographic follow-up may be required, even if complete occlusion is originally shown on angiograms.
Repeat Gamma Knife surgery for recurrent trigeminal neuralgia: long-term outcomes and systematic review
Authors: Tuleasca Constantin , Carron Romain , Resseguier Noémie , Donnet Anne , Roussel Philippe , Gaudart Jean , Levivier Marc , Régis Jean
Published: November 2018

Object

The purpose of this study was to establish the safety and efficacy of repeat Gamma Knife surgery (GKS) for recurrent trigeminal neuralgia (TN).

Methods

Using the prospective database of TN patients treated with GKS in Timone University Hospital (Marseille, France), data were analyzed for 737 patients undergoing GKS for TN Type 1 from July 1992 to November 2010. Among the 497 patients with initial pain cessation, 34.4% (157/456 with ≥ 1-year follow-up) experienced at least 1 recurrence. Thirteen patients (1.8%) were considered for a second GKS, proposed only if the patients had good and prolonged initial pain cessation after the first GKS, with no other treatment alternative at the moment of recurrence. As for the first GKS, a single 4-mm isocenter was positioned in the cisternal portion of the trigeminal nerve at a median distance of 7.6 mm (range 4–14 mm) anterior to the emergence of the nerve (retrogasserian target). A median maximum dose of 90 Gy (range 70–90 Gy) was delivered. Data for 9 patients with at least 1-year followup were analyzed. A systematic review of literature was also performed, and results are compared with those of the Marseille study.

Results

The median time to retreatment in the Marseille study was 72 months (range 12–125 months) and in the literature it was 17 months (range 3–146 months). In the Marseille study, the median follow-up period was 33.9 months (range 12–96 months), and 8 of 9 patients (88.9%) had initial pain cessation with a median of 6.5 days (range 1–180 days). The actuarial rate for new hypesthesia was 33.3% at 6 months and 50% at 1 year, which remained stable for 7 years. The actuarial probabilities of maintaining pain relief without medication at 6 months and 1 year were 100% and 75%, respectively, and remained stable for 7 years. The systematic review analyzed 20 peer-reviewed studies reporting outcomes for repeat GKS for recurrent TN, with a total of 626 patients. Both the selection of the cases for retreatment and the way of reporting outcomes vary widely among studies, with a median rate for initial pain cessation of 88% (range 60%–100%) and for new hypesthesia of 33% (range 11%–80%).

Conclusions

Results from the Marseille study raise the question of surgical alternatives after failed GKS for TN. The rates of initial pain cessation and recurrence seem comparable to, or even better than, those of the first GKS, according to different studies, but toxicity is much higher, both in the Marseille study and in the published data. Neither the Marseille study data nor literature data answer the 3 cardinal questions regarding repeat radiosurgery in recurrent TN: which patients to retreat, which target is optimal, and which dose to use.
Minimally invasive techniques for epilepsy surgery: stereotactic radiosurgery and other technologies
Authors: Quigg Mark , Harden Cynthia
Published: November 2018

Minimally invasive surgical techniques for the treatment of medically intractable epilepsy, which have been developed by neurosurgeons and epileptologists almost simultaneously with standard open epilepsy surgery, provide benefits in the traditional realms of safety and efficacy and the more recently appreciated realms of patient acceptance and costs. In this review, the authors discuss the shortcomings of the gold standard of open epilepsy surgery and summarize the techniques developed to provide minimally invasive alternatives. These minimally invasive techniques include stereotactic radiosurgery using the Gamma Knife, stereotactic radiofrequency thermocoagulation, laser-induced thermal therapy, and MRI-guided focused ultrasound ablation.
Fivefold higher rate of pseudarthrosis with polyetheretherketone interbody device than with structural allograft used for 1-level anterior cervical discectomy and fusion
Authors: Krause Katie L. , Obayashi James T. , Bridges Kelly J. , Raslan Ahmed M. , Than Khoi D.
Published: November 2018

OBJECTIVE

Common interbody graft options for anterior cervical discectomy and fusion (ACDF) include structural allograft and polyetheretherketone (PEEK). PEEK has gained popularity due to its radiolucency and its elastic modulus, which is similar to that of bone. The authors sought to compare the rates of pseudarthrosis, a lack of solid bone growth across the disc space, and the need for revision surgery with the use of grafts made of allogenic bone versus PEEK.

METHODS

The authors retrospectively reviewed 127 cases in which patients had undergone a 1-level ACDF followed by at least 1 year of radiographic follow-up. Data on age, sex, body mass index, tobacco use, pseudarthrosis, and the reoperation rate for pseudarthrosis were collected. These data were analyzed by performing a Pearson’s chi-square test.

RESULTS

Of 127 patients, 56 had received PEEK implants and 71 had received allografts. Forty-six of the PEEK implants (82%) were stand-alone devices. There were no significant differences between the 2 treatment groups with respect to patient age, sex, or body mass index. Twenty-nine (52%) of 56 patients with PEEK implants demonstrated radiographic evidence of pseudarthrosis, compared to 7 (10%) of 71 patients with structural allografts (p < 0.001, OR 9.82; 95% CI 3.836–25.139). Seven patients with PEEK implants required reoperation for pseudarthrosis, compared to 1 patient with an allograft (p = 0.01, OR 10.00; 95% CI 1.192–83.884). There was no significant difference in tobacco use between the PEEK and allograft groups (p = 0.586).

CONCLUSIONS

The results of this study demonstrate that the use of PEEK devices in 1-level ACDF is associated with a significantly higher rate of radiographically demonstrated pseudarthrosis and need for revision surgery compared with the use of allografts. Surgeons should be aware of this when deciding on interbody graft options, and reimbursement policies should reflect these discrepancies.
Gamma knife radiosurgery in the treatment of Cushing disease: long-term results
Authors: Kobayashi Tatsuya , Kida Yoshihisa , Mori Yoshimasa
Published: November 2018

Object. The authors sought to analyze the long-term outcome of patients with Cushing disease who underwent gamma knife radiosurgery (GKS) as either an adjuvant or primary treatment.

Methods. Twenty-five patients with Cushing disease were treated by GKS and followed for more than 2.5 years (mean 5.3 years).

The overall results showed a complete response rate of 30%, a response rate of 85%, and a tumor control rate of 100%. Tumor size and radiation dose were the most important factors related to the treatment response. The complete response rate for microadenomas and small adenomas was significantly higher than that for macroadenomas. An 83.2% complete response rate was obtained using a maximum dose of more than 55 Gy and/or a margin dose of more than 40 Gy. Serum adrenocorticotropic hormone and cortisol levels were normalized in 35% of patients, decreased significantly in 60%, and decreased in 85%. Fifty-one of 85 characteristic signs and symptoms of Cushing disease improved without any side effects. The overall outcome was excellent in seven cases, good in six, fair in four, and poor in four cases; one patient died. The initial treatment was GKS in four patients, two of whom had a complete response and two of whom had a partial response. Hormone levels returned to normal in the patients in whom there was a complete response. The results in the six patients in whom Nelson syndrome was present were less favorable; the response rate was only 33%, although the control rate was 100%. Hormone levels decreased in two patients.

Conclusions. Gamma knife radiosurgery is safe and effective for the treatment of Cushing disease as an adjuvant or initial therapy when selective and accurate dose planning is performed.
Effect of a single high-dose gamma irradiation on cultured cells in human cerebral arteriovenous malformation
Authors: Major Otto , Szeifert György T. , Fazekas Ilona , Vitanovics Dusan , Csonka Éva , Kocsis Béla , Bori Zoltán , Kemeny Andras A. , Nagy Zoltán
Published: November 2018

Object. The purpose of this study was to analyze the effect of single high-dose gamma irradiation at a cellular biological level on tissue cultures obtained in patients who underwent surgery for cerebral arteriovenous malformation (AVM).

Methods. The cell proliferation indices and changes in activation of p53, p21Waf-1, and mdm-2 were determined. Additionally, immunohistochemical investigations for vimentin, desmin, α—smooth muscle actin (α-SMA), glial fibrillary acidic protein, Factor VIII—related antigen (F-VIII), cytokeratin, S100, and transforming growth factor—β (TGFβ) were performed on cultured AVM cells after a single high-dose irradiation. Normal human brain microvessel endothelial (HBE) cells and aortic smooth muscle cells served as controls.

The proliferation index decreased on the 5th day after irradiation and remained depressed over the observation period in the irradiated AVM cultures. The p53, p21Waf-1, and mdm-2 messenger RNA measurements showed considerable elevation both in AVM cultures and HBE cells after 15-Gy irradiation, which indicated apoptosis. Immunohistochemistry revealed strong vimentin positivity in the nonirradiated cultures, which gradually decreased in the irradiated cultures. Transforming growth factor—β positivity was demonstrated in the irradiated specimens, indicating transformation of fibroblastic cells into activated myofibroblastic elements. This transformation was confirmed by demonstrating elevated SMA expression as well in the radiation-treated fibroblasts.

Conclusions. The presence of TGFβ and α-SMA activity in the irradiated AVM cells suggests that along with the genetically confirmed apoptotic activity, fibroblast transformation into myofibroblasts might be one of the mechanisms leading to shrinkage and obliteration of AVMs after single high-dose gamma irradiation.
Can magnetic resonance imaging alone accurately define the arteriovenous nidus for gamma knife radiosurgery?
Authors: St. George E. J. , Butler P. , Plowman P. N.
Published: November 2018

Object. Current radiosurgical treatment of arteriovenous malformations (AVMs) relies on planning protocols that integrate data from both magnetic resonance (MR) imaging and stereotactic angiography studies. Angiography, however, is invasive and associated with a small but well-defined risk of neurological and systemic complications. Magnetic resonance imaging, on the other hand, is noninvasive with multiplanar capability, demonstrates good anatomical detail, and has been shown to be superior to angiography in the delineation of selected AVMs.

Methods. In this study, MR imaging—related accuracy of defining the AVM nidus in gamma knife radiosurgery is investigated using only T1- and T2-weighted sequences.

Conclusions. Little interobserver variability was observed and AVM nidi, as demonstrated on T1- and T2-weighted MR images, were well correlated in terms of size. The displacement of the new target, however, from the original nidus, was not predictable and occasionally was significant, thus precluding safe radiosurgical planning.
Gamma knife radiosurgery for intracranial metastatic melanoma: a 6-year experience
Authors: Gonzalez-martinez Jorge , Hernandez Laura , Zamorano Lucia , Sloan Andrew , Levin Kenneth , Lo Simon , Li Qinghang , Diaz Fernando
Published: November 2018

Object. The purpose of this study was to evaluate retrospectively the effectiveness of stereotactic radiosurgery for intracranial metastatic melanoma and to identify prognostic factors related to tumor control and survival that might be helpful in determining appropriate therapy.

Methods. Twenty-four patients with intracranial metastases (115 lesions) metastatic from melanoma underwent radiosurgery. In 14 patients (58.3%) whole-brain radiotherapy (WBRT) was performed, and in 12 (50%) chemotherapy was conducted before radiosurgery. The median tumor volume was 4 cm3 (range 1–15 cm3). The mean dose was 16.4 Gy (range 13–20 Gy) prescribed to the 50% isodose at the tumor margin. All cases were categorized according to the Recursive Partitioning Analysis classification for brain metastases. Univariate and multivariate analyses of survival were performed to determine significant prognostic factors affecting survival.

The mean survival was 5.5 months after radiosurgery. The analyses revealed no difference in terms of survival between patients who underwent WBRT or chemotherapy and those who did not. A significant difference (p < 0.05) in mean survival was observed between patients receiving immunotherapy or those with a Karnofsky Performance Scale (KPS) score of greater than 90.

Conclusions. The treatment with systemic immunotherapy and a KPS score greater than 90 were factors associated with a better prognosis. Radiosurgery for melanoma-related brain metastases appears to be an effective treatment associated with few complications.
The integration of metabolic imaging in stereotactic procedures including radiosurgery: a review
Authors: Levivier Marc , Wikler David , Massager Nicolas , David Philippe , Devriendt Daniel , Lorenzoni Jose , Pirotte Benoit , Desmedt Françoise , Simon Stephane , Goldman Serge , Van Houtte Paul , Brotchi Jacques
Published: November 2018

Object. The authors review their experience with the clinical development and routine use of positron emission tomography (PET) during stereotactic procedures, including the use of PET-guided gamma knife radiosurgery (GKS).

Methods. Techniques have been developed for the routine use of stereotactic PET, and accumulated experience using PET-guided stereotactic procedures over the past 10 years includes more than 150 stereotactic biopsies, 43 neuronavigation procedures, and 34 cases treated with GKS. Positron emission tomography—guided GKS was performed in 24 patients with primary brain tumors (four pilocytic astrocytomas, five low-grade astrocytomas or oligodendrogliomas, seven anaplastic astrocytomas or ependymomas, five glioblastomas, and three neurocytomas), five patients with metastases (single or multiple lesions), and five patients with pituitary adenomas.

Conclusions. Data obtained with PET scanning can be integrated with GKS treatment planning, enabling access to metabolic information with high spatial accuracy. Positron emission tomography data can be successfully combined with magnetic resonance imaging data to provide specific information for defining the target volume for the radiosurgical treatment in patients with recurrent brain tumors, such as glioma, metastasis, and pituitary adenoma. This approach is particularly useful for optimizing target selection for infiltrating or ill-defined brain lesions. The use of PET scanning contributed data in 31 cases (93%) and information that was specifically utilized to adapt the target volume in 25 cases (74%). It would seem that the integration of PET data into GKS treatment planning may represent an important step toward further developments in radiosurgery: this approach provides additional information that may open new perspectives for the optimization of the treatment of brain tumors.