bluuebunny/crossref_metadata_2025 huggingface dataset:
Towards a framework for identifying and engaging rural tourism route stakeholders in southern Africa
Authors: Mclaren Linde , Heath Ernie
Published: November 2018

Several southern African governments view rural tourism development as a strategy for employment creation in rural areas where few other opportunities for poverty alleviation exist. Rural tourism routes can attract tourists from developed tourism nodes to rural areas. On both the strategic and operational levels, rural tourism routes can only function effectively if they have the support and co-operation of the wide range of stakeholders in the route. While some stakeholders are readily identified, others are not immediately apparent or may not be recognised as stakeholders in the route. Based on a qualitative study, a framework is developed to identify and link the range of stakeholders in southern African rural tourism routes. Three different groups of stakeholders are identified; each play different roles in the sustainable success of a rural tourism route, namely demand-side stakeholders or visitors, core stakeholders or tourism service providers on the route, and enabling stakeholders, who influence both the route operations and the environment in which the route operates. Finally, recommendations are made for rural tourism route organisations to engage with a range of stakeholders through an inclusive membership structure of the route organisation. Further research is also suggested on the nature and format of route organisation and membership structures to ensure sustainable route development.
Food aid for internally displaced persons in Manicaland, Zimbabwe
Authors: Sithole Wonesai , Coetzee Jan K
Published: November 2018

Internally displaced persons (IDPs) are among the most neglected and vulnerable populations in the world. There are few laws that protect them as the government is the instigator of the displacement and no government can be both perpetrator and protector. Food aid has become one of the major protective interventions aimed to enhance stability in settings of displacement. However, a major question is how food aid affects IDPs. The study on which this article is based, was designed to investigate and evaluate how food aid affects the lives of displaced persons. The focus is on understanding the effects of food aid on households' food security, migration trends and asset loss during periods of displacement. The study employs the sustainable livelihood framework in analyzing the role of food aid on IDPs. It focuses on the relationship between food aid and livelihoods assets, and indicates how the transforming structures can be linked to food aid interventions. The findings show that food aid plays a significant role in cushioning displaced households provided that it is integrated with other sustainable livelihood interventions (such as those that promote the value of household assets and land holding). Due to denied access to land, IDPs are dependent on food aid for their household food security. Increased school attendance is noted because of food aid to IDPs but the absence of security of tenure hinders community driven effective alternatives to a food aid programme. If security of tenure is not addressed IDPs in Manicaland will find it difficult to deal with their food insecurity.
Democratic decentralisation, citizen engagement and service delivery in South Africa: A critique of legislative and policy considerations
Authors: Reddy Purshottama S , Govender Jayanathan
Published: November 2018

Negotiations to restructure and transform local government in South Africa commenced in 1993. Key roleplayers and stakeholders in local government were instrumental in adopting a negotiated local government model comprising three distinct phases during the constitutional development process. The Local Government Transition Act, 1993 (Act 209 of 1993) facilitated the process for the introduction of transitional local and metropolitan councils which constituted the first phase. Local government elections were held for the first time in November 1995 and May/June 1996 in seven provinces (and thereafter Western Cape and KwaZulu-Natal) constituted the second phase. Three fundamental legislative enactments, i.e. Local Government: Municipal Demarcation Act, 1998 (Act 27 of 1998); Local Government Municipal Structures Act, 1998 (Act 117 of 1998) and the Local Government: Municipal Systems Act, 2000 (Act 32 of 2000), were critical to the final phase. Elections held in December 2000 marked the end of the transition period resulting in a reduction of municipalities from 843 to 283. There were two successful local government elections held thereafter on 26 March 2006 and more recently on 18 May 2011. Regular elections and the plethora of legislation introduced to consolidate the new dispensation have resulted in local democracy and decentralisation being deeply rooted in the local governance system. The latter is an integral component of the local governance policy framework as the country has a diverse population of almost 50 million people. It is believed that a democratic and decentralised governance system will promote local development, address poverty reduction, facilitate civic engagement and ensure national integration. Local democracy, introduced seventeen years ago following the ushering in of the developmental state in 1994, has since been tried and tested. Despite 'world class' legislation and a 'best practice' local governance system, which has as its basis people centred development, engagement and decentralisation, several governance challenges has emerged. This includes inter alia, unfunded mandates; rampant corruption and nepotism; violent service delivery protests; capacity constraints; crime, lack of communication, transparency and accountability; limited civic engagement and a significant number of municipalities that are not financially viable. These issues will have to be addressed if Chapter 7 of the Constitution has to become more meaningful to the majority of the populace in terms of discharging its developmental mandate.
Bifluoride Ion Catalyzed Late-Stage SuFEx Trifluoromethylation of Sulfonyl Fluorides and Iminosulfur Oxydifluorides
Authors: Smedley Christopher J. , Gao Bing , Li Suhua , Zheng Qinheng , Molino Andrew , Duivenvoorden Hendrika M. , Parker Belinda S. , Wilson David J. D. , Sharpless K. Barry , Moses John E.
Published: November 2018

Sulfur-Fluoride Exchange (SuFEx) is a new generation click chemistry transformation that exploits the unique properties of S-F bonds and their ability to undergo near-perfect reactions with nucleophiles. We report here the first SuFEx based protocol for the efficient late-stage synthesis of pharmaceutically important trifluoromethyl sulfones and bis(trifluoromethyl)sulfur oxyimines from the corresponding sulfonyl fluorides and iminosulfur oxydifluorides, respectively. The new protocol involves the rapid exchange of the S-F bond with trifluoromethyltrimethylsilane (TMSCF3, Ruppert’s reagent), upon activation with catalytic potassium bifluoride in anhydrous DMSO. The reaction tolerates a wide selection of substrates and proceeds under mild conditions without need for chromatographic purification. DFT calculations provide the first reported mechanism of anhydrous SuFEx reactivity, which confirms catalytic bifluoride behaviour with a five-coordinate sulfur intermediate. The preparation of a benzothiazole derived bis(trifluoromethyl)sulfur oxyimine with cytotoxic selectivity for MCF7 breast cancer cells demonstrates the utility of this methodology for the late stage functionalization of bioactive molecules.
La función docente y la planificación para el logro del perfil de egreso en ingeniería química
Authors: Vélez Jiménez Dolores , Soto Licona Manuel
Published: November 2018

La función docente y el perfil de egreso en ingeniería química pretendió ser un estudio que sirva de ejemplo para investigar acerca de otras carreras profesionales, de tal forma que la educación superior se fortalezca en la función sustantiva de la docencia y la eficacia en el perfil de sus egresados. Para la investigación se plantearon tres dimensiones de la función docente: la planificación de clase, la implementación de estrategias de enseñanza y la actualización profesional. La metodología que enmarcó esta investigación educativa utiliza el paradigma positivista, el método cuantitativo de razonamiento deductivo y enfoque empírico-analítico El perfil de egreso debe ser evidencia de haber cursado todo un plan de estudios dentro de una institución de educación superior. Se encuestaron a estudiantes terminales en esta carrera pertenecientes a cinco instituciones en México. Los resultados en relación de la función docente mostraron que prevalece de mayor forma la planificación de clase para la adquisición de conocimiento, más que el desarrollo de habilidades referentes al propio perfil de egreso en la carrera de ingeniería química. La didáctica y las estrategias de enseñanza son elementos importantes para lograr los objetivos en cada asignatura de un programa de estudios. La actualización por parte del profesorado no es más relevante que la planificación y la aplicación de estrategias, sin embargo; refiere una parte enriquecedora para la formación de los estudiantes, por tanto; se recomienda reforzar los programas de formación docente en el nivel superior.
Antimicrobial use in European long-term care facilities: results from the third point prevalence survey of healthcare-associated infections and antimicrobial use, 2016 to 2017
Authors: Ricchizzi Enrico , Latour Katrien , Kärki Tommi , Buttazzi Rossella , Jans Béatrice , Moro Maria Luisa , Nakitanda Olivia Aya , Plachouras Diamantis , Monnet Dominique L , Suetens Carl , Kinross Pete ,   the HALT Study Group
Published: November 2018

Antimicrobials are commonly prescribed and contribute to the development of antimicrobial resistance in long-term care facilities (LTCFs). In 2010, the European Centre for Disease Prevention and Control initiated point prevalence surveys (PPS) of healthcare-associated infections and antimicrobial use in European LTCFs, performed by external contractors as the Healthcare-Associated infections in Long-Term care facilities (HALT) projects. Here, we investigated prevalence and characteristics of antimicrobial use and antimicrobial stewardship indicators in European LTCFs in 2016–17. Twenty-four European Union/European Economic Area (EU/EEA) countries, the former Yugoslav Republic of Macedonia and Serbia participated in the third PPS in European LTCFs. Overall, 4.9% (95% confidence interval: 4.8–5.1) of LTCF residents in the EU/EEA participating countries received at least one antimicrobial. The most commonly reported Anatomical Therapeutic Chemical (ATC) groups were beta-lactam antibacterials/penicillins (J01C), other antibacterials (J01X) (e.g. glycopeptide antibacterials, polymyxins), quinolones (J01M), sulfonamides and trimethoprim (J01E), and other beta-lactams (J01D). Urinary tract infections and respiratory tract infections were the main indications for antimicrobial prescription. This PPS provides updated and detailed information on antimicrobial use in LTCFs across the EU/EEA that can be used to identify targets for future interventions, follow-up of these interventions and promote prudent use of antimicrobials in European LTCFs.
Okuma ve Zihinsel Esneklik
Authors: GÜNEŞ Firdevs
Published: November 2018

Günlük yaşamda bireyin
yeni durumlara uyum sağlama becerisine zihinsel esneklik denilmektedir. Yeni
bilgileri kabul etme, öğrenmeye açık olma, esnek düşünme, sorunlara farklı
çözümler bulma, hatalarını düzeltme,
öğrenme yöntemlerini değiştirme gibi çeşitli becerileri kapsamaktadır. Bunlar bakış açısını ve düşünme yollarını değiştirmeye
doğrudan katkı sağlamaktadır. Zihinsel
esneklik doğuştan gelen bir beceri değildir. Bireyin yoğun çabaları
sonucunda öğrenilmekte ve geliştirilmektedir. Zihinsel esneklik becerileri okuma ve öğrenme sırasında ayrı bir önem
taşımakta, bilgiyi alma, kullanma ve yeni bilgiler üretme sürecine yardım
etmektedir. Ayrıca öğrencinin kişililiğini geliştirme ve toplumla sağlıklı ilişkiler
kurmasını getirmektedir. Zihinsel esneklik becerileri küçük yaşlarda oyunlarla,
eğitsel etkinliklerle ve okuma yoluyla geliştirilmektedir. Okuma, zihinsel
esneklik gelişimine doğrudan katkı sağlayan bir etkinliktir. Okuma
sırasında okuyucunun okuma amacına, metin düzeyine ve içeriğe göre okuma yöntem
ve düşünme modellerini değiştirme becerilerini kapsamaktadır. Okumanın hızlı,
etkili ve verimli olmasını sağlamaktadır. Öğrencilerin akademik başarılarını etkilemektedir. Okuma
becerisi geliştikçe zihinsel esneklik beceri düzeyi de artmaktadır. Eğitim
programlarında okuma ve zihinsel esneklik becerilerine yer verilmeli, kitap ve yazar seçimine dikkat edilmelidir.
Developing a New Research Agenda on Post-Soviet De Facto States
Authors: Comai Giorgio
Published: November 2018

The scholarship on post-Soviet de facto states has structurally focused on issues related to their contested status, and has long assumed that these entities are transient phenomena. In this article I propose a path towards a new research agenda on post-Soviet de facto states based on two main arguments. Firstly, scholars researching post-Soviet de facto states should start from the working assumption that these entities will continue to exist in the current configuration for the foreseeable future, and proceed in their integration with the patron. Secondly, they should seek new terms of comparison beyond contested territories and conflict regions, and they should apply the same terminology to these entities and ask at least some of the same research questions as they would do when studying uncontested territories.
Право на жизнь как ценность
Authors: Шабанова Анастасия Сергеевна
Published: November 2018

The right to life is the highest value, is the basis of all other human rights and freedoms, but Russian legislation does not contain a definition of a person's life. In legal science, the right to life is interpreted as the right of the individual to freedom and personal integrity, health protection, reducing the problem to the abolition of the death penalty and euthanasia. The article deals with issues that are especially relevant in connection with the development of artificial methods of reproduction: from when does the right to life arise and whether the embryo has a legal value.
Development of Predictive Responses in Theory of Mind Brain Regions
Authors: Richardson Hilary , Saxe Rebecca
Published: November 2018

When we watch movies, we consider the characters’ mental states in order to understand and predict the narrative. Recent work in fMRI uses movie-viewing paradigms to measure functional responses in brain regions recruited for such mental state reasoning (the Theory of Mind (“ToM”) network). Here, two groups of young children (n=30 3-4yo, n=26 6-7yo) viewed a short animated movie twice while undergoing fMRI. As children get older, ToM brain regions were recruited earlier in time during the second presentation of the movie. This “narrative anticipation” effect is specific: there was no such effect in a control network of brain regions that responds just as robustly to the movie (the “Pain Matrix”). These results complement prior studies in adults that suggest that ToM brain regions play a role not just in inferring, but in actively predicting, other people's thoughts and feelings, and provide novel evidence that as children get older, their ToM brain regions increasingly make such predictions. This is a post-peer-review, pre-copyedit version of an article published in Developmental Science. The final authenticated version is available online at: https://doi.org/10.1111/desc.12863 .
HOW FILTERS IMPACT TO ACIDIFICATION AND URANIUM PRODUCTION
Authors:   Master Satpaev University, Almaty, Kazakhstan. E-mail: mm.satanov@gmail.com, Satanov Mukhagaly
Published: November 2018

In article proved significance of master’s scientific-and-research work about a choosing type of filter during acidification and uranium production. Tests were carried out on 3 neighbor sectors (blocks) of «Kharasan-2» deposit and 3 type of filters were used. According results of the experiment, the optimal type of filter was determined, which is advisable to use and more useful in carrying out for repairing works, acidification and production.
ADAPTATION POTENTIAL OF THE ORGANISM OF EMPLOYEES OF THE CONSTRUCTION INDUSTRY
Authors:   Ph.D., and. about the Deputy General director of scientific work Republican State Enterprise ", Eselkhanova Gulzhayna Abdygassenovna ,   Republican ResearchInstitute for Labor ProtectionMinistry of Labor and Socialprotection of the populationRepublic of Kazakhstan",   , Astana. E-mail: nauka@rniiot.kz
Published: November 2018

The article is devoted to the actual problem related to the professional activity, and the assessment of risks to the health of workers as a necessary element of the effective functioning of the labor protection management system in the enterprise in the light of modern requirements for it. An assessment of the functional state of the body of construction workers is given, recommendations aimed at managing risks in the field of labor protection are developed, ways of applying the results of the study to managing risks of the working environment and the work process are proposed.
THE METHOD OF ISOMETRIC SHAPE BITUMEN DEPOSITS DEVELOPMENT
Authors: Faizullin V. A. , Soloviov V. A. , Khafizov I. I.
Published: November 2018

The article describes the development of the engineering solutions complex adapted to the specific geological and technical conditions aimed at effective completion of bitumen wells. These solutions are based on the whole set of thermal properties of the reservoir.
IMPROVEMENT OF FIRE EXTINGUISHING EFFICIENCY BY USING THE METHOD OF FOAM STABILITY INCREASE
Authors: Khafizov F. Sh. , Nasibullin I. R. , Khafizov I. F. , Smirnova E. A. , Khalikova O. D. , Karimov R. R. , Krasnov A. V.
Published: November 2018

It is stated that fire protection of facilities for oil and petrochemical industries is greatly facilitated by using foams with a different multiplicity factor as a tool for fighting fires. The main aspects of the inert gases influence on the foam stability, a multiplicity factor and the time of its complete destruction are studied. It is shown that when using the inert gas as an additive, the foam stability and the time of its collapse increase. It is also found that when adding an inert gas to the foaming agent the time of the foam complete destruction is doubled.
TECHNOLOGIES OF EXPOSING THE VALANGIAN DEPOSITS
Authors: Panikarovski E. V. , Panikarovski V. V.
Published: November 2018

The problems arising when drilling horizontal and gently sloping wells in the Valanginian deposits are considered. The analysis of technologies of drilling-in the Valanginian reservoirs by sideholes using water-base clay drilling muds and the aerated muds ensuring the high-quality exposure of productive layers is carried out. The most perspective for drilling side holes of wells in these conditions are hydrocarbon-base drilling muds which maintain the filtration properties of productive layers and reduce the accident rate of drilling operations.
CATAGENETIC ALTERATION HYDROGEOCHEMISTRY OF SEDIMENTARY ROCKS OF HYDROCARBON OCCURRENCES IN ARCTIC AREASOF THE WESTERN SIBERIAN MEGABASIN
Authors: Novikov D. A.
Published: November 2018

For the first time a detailed analysis of the equilibrium-non-equilibrium state of ground waters of hydrocarbon occurrences in Arctic areas of the West Siberian megabasin based on physico-chemical modeling of equilibria in the «water-rock» revealed hydrogeochemical and thermodynamic conditions for the formation of authigenic minerals. For the first time equilibrated compositions of groundwaters and parameters of geochemical environment were identified, being a prerequisite for the mineral neoformations.
DETERMINATION OF THE GAS STREAM FLOW AT CONDUCTING HYDRODYNAMIC INVESTIGATION OF WELLS. PART 3
Authors: Rogalev M. S. , Saranchin N. V. , Maslov V. N. , Derendyaev A. B.
Published: November 2018

The paper presents a method for calculating the gas stream flow rate during well tests of gas and gas condensate wells using a diaphragm gauge of critical flow. The above method compensates the disadvantages of the described in the scientific and technical literature gas stream flow rate calculation methods during its flow through the diaphragm in the critical regime. For the proposed method are presented the testing results on gas and gas condensate wells of the north of the Tyumen region.
POSSIBILITIES OF WASTE MANGEMENT WHILE FORMING SOIL-LIKE ENVIRONMENT
Authors: Gaevaya E. V. , Bogaychuk Ya. E. , Tarasova S. S. , Zakharova E. V.
Published: November 2018

The research results on the recovery of drilled solids and spent drilling mud with the use of phosphogypsum in combination with the humicagent «Rostok» showed that the resulting soillike environment can be used while recultivating slurry ponds and disturbed lands. Adding extra 5-20 % of spent drilling mud didn’t affect the chemical composition of the soil significantly. Using the humicagent «Rostok» favorably impacts the development of plants, besides the formation of a viable phytocenosis takes place with the significant increase of phytomass of vegetative aerial shoots by 28-31 %.
ASSESSMENT OF INFLOW OF GAS TO THE WELL IN THE PRESENCEOF THE SANDY STOPPER ON THE FACE
Authors: Nasyrova A. I. , Khairullin A. A.
Published: November 2018

Work of a gas well in the conditions of formation of a sandy stopper is considered. On the basis of the dvukhchlenny law of nonlinear filtering gas to a well, the mathematical model of growth of a sandy stopper is shown. The prepositional model will be approved with trade data. The inversion point on a graphics of dependence of an output of gas on the specified height of a sandy stopper is shown.
ANALYSIS OF EFFICENCY OF MULTI-STAGE HYDRAULIC FRACTURING IN HORIZONTAL WELLS AT VYNGAPUROVSKOYE GAS FIELD
Authors: Shkryaba I. T. , Mulyavin S. F. , Kleshchenko I. I. , Kusakin V. Yu.
Published: November 2018

The analysis of efficiency at engaging into development of hard-to-recover reserves of oil of horizontal wells using multistage hydraulic fracturing has been conducted. The results are presented as a comparison of the dynamics of their work to directional wells, in which also hydraulic fracturing had been held.
KINETICS OF A BINARY MIXTURE DECOMPOSITION IN RELATIONTO THE EFFECTS ON OIL RESERVOIR
Authors: Varavva A. I. , Vershinin V. E. , Idiatullin R. A.
Published: November 2018

The kinetic constants of the decomposition reaction of an aqueous solution of a binary mixture used for thermal-pressure induced impact on the bottomhole zone during stimulation of oil inflow are determined. The obtained constants allow predicting the effects of pressure and temperature growth in the reaction zone. A mathematical model is proposed that makes it possible to describe the kinetics of the reaction taking into account the escape of gas.
USAGE OF BREAKERS FOR COMPLETION HORIZONTAL WELLS ON THE VOSTOCHNO-MESSOYAKHSKOE FIELD
Authors: Misbakhov R. Zh. , Martynov M. E. , Kovalenko I. V. , Sokhoshko S. K.
Published: November 2018

The problem of completion the horizontal wells on stable production after drilling associated with the removal of the filter cake formed during the well drilling by contact of the mud with the reservoir is considered.
MANAGEMENT OF OIL RECTIFICATION PROCESS BY USING OF MODELS OF PROCESS AND VIRTUAL ANALYZERS
Authors: Tugashova L. G. , Goncharov A. A.
Published: November 2018

The article considers the management of an atmospheric column by using of dynamic rectification model. The criteria of management are defined. The method the optimization is chosen. Management of temperatures provides the set quality of oil products at light fractions selection corresponding selection from potential.
PERFORMANCE OF THE VARIABLE CONDUCTIVITY DAMAGED FRACTURE AND FRACTURE OPTIMIZATION
Authors: Faiq S. A. , Sarancha A. V.
Published: November 2018

The article presents the results of the variable or non-uniform conductivity (width, permeability or both profiles) in the fracture. This allows predict performance of damaged fracture, and so on. Usage the average conductivity of fractures to represent an equivalent constant value has shown that it works well for high conductivity, reduces conduction (i.e ellipsoidal or wedge-shaped fractures) with maximum conductivity in the wellbore. For inverted wedge cracks (conductivity in the well is less than an average) the fracture efficiency will be significantly reduced, and the average conductivity will greatly overestimate the effective value. Moreover, for low-conductivity fractures in the well the equivalent conductivity is weighed more relative to the value of the well than the average. Also the article presents the optimal conductivity of fractures (and fracture sizes) for a given amount of proppant to maximize productivity.
CLASSIFICATION OF OILS. SULFUR CONTENT AS GENETIC CLASSIFICATION SIGN
Authors: Lur’E M. A. , Shmidt F. K.
Published: November 2018

In the article we considered the following variants of oil classification: technological, chemical, and geochemical (genetic). Applicability of the classification indicators (hydrocarbon composition, fractional composition of oils, asphaltic-resinous components, sulfur content, metal content) is discussed to separate oils to different chemical types Stable direct correlations between sulfur concentration in oils and diverse characteristics of oils allow to consider the sulfur content as an indicator of genetic nature.
Predictors of recovery in moderate to severe traumatic brain injury
Authors: Muballe Kadhaya David , Sewani-Rusike Constance R. , Longo-Mbenza Benjamin , Iputo Jehu
Published: November 2018

OBJECTIVE

Traumatic brain injury (TBI) is a significant cause of morbidity and mortality worldwide. Clinical outcomes in TBI are determined by the severity of injury, which is dependent on the primary and secondary brain injury processes. Whereas primary brain injury lesions are related to the site of impact, secondary brain injury results from physiological changes caused by oxidative stress and inflammatory responses that occur after the primary insult. The aim of this study was to identify important clinical and biomarker profiles that were predictive of recovery after moderate to severe TBI. A good functional outcome was defined as a Glasgow Outcome Scale (GOS) score of ≥ 4.

METHODS

This was a prospective study of patients with moderate to severe TBI managed at the Nelson Mandela Academic Hospital during the period between March 2014 and March 2016. Following admission and initial management, the patient demographic data (sex, age) and admission Glasgow Coma Scale score were recorded. Oxidative stress and inflammatory biomarkers in blood and CSF were sampled on days 1–7. On day 14, only blood was sampled for the same biomarkers. The primary outcome was the GOS score—due to its simplicity, the GOS was used to assess clinical outcomes at day 90. Because of difficulty in performing regular follow-up due to the vastness of the region, difficult terrain, and long travel distances, a 3-month follow-up period was used to avoid default.

RESULTS

Sixty-four patients with Glasgow Coma Scale scores of ≤ 12 were seen and managed. Among the 56 patients who survived, 42 showed significant recovery (GOS score ≥ 4) at 3 months. Important predictors of recovery included antioxidant activity in the CSF (superoxide dismutase and total antioxidant capacity).

CONCLUSIONS

Recovery after TBI was dependent on the resolution of oxidative stress imbalance.
Does lumbar drainage reduce postoperative cerebrospinal fluid leak after endoscopic endonasal skull base surgery? A prospective, randomized controlled trial
Authors: Zwagerman Nathan T. , Wang Eric W. , Shin Samuel S. , Chang Yue-Fang , Fernandez-Miranda Juan C. , Snyderman Carl H. , Gardner Paul A.
Published: November 2018

OBJECTIVE

Based on a null hypothesis that the use of short-term lumbar drainage (LD) after endoscopic endonasal surgery (EES) for intradural pathology does not prevent postoperative CSF leaks, a trial was conducted to assess the effect of postoperative LD on postoperative CSF leak following standard reconstruction.

METHODS

A prospective, randomized controlled trial of lumbar drain placement after endoscopic endonasal skull base surgery was performed from February 2011 to March 2015. All patients had 3-month follow-up data. Surgeons were blinded to which patients would or would not receive the drain until after closure was completed. An a priori power analysis calculation assuming 80% of power, 5% postoperative CSF leak rate in the no-LD group, and 16% in the LD group determined a planned sample size of 186 patients. A routine data and safety check was performed with every 50 patients being recruited to ensure the efficacy of randomization and safety. These interim tests were run by a statistician who was not blinded to the arms they were evaluating. This study accrued 230 consecutive adult patients with skull base pathology who were eligible for endoscopic endonasal resection. Inclusion criteria (high-flow leak) were dural defect greater than 1 cm2 (mandatory), extensive arachnoid dissection, and/or dissection into a ventricle or cistern. Sixty patients were excluded because they did not meet the inclusion criteria. One hundred seventy patients were randomized to either receive or not receive a lumbar drain.

RESULTS

One hundred seventy patients were randomized, with a mean age of 51.6 years (range 19–86 years) and 38% were male. The mean BMI for the entire cohort was 28.1 kg/m2. The experimental cohort with postoperative LD had an 8.2% rate of CSF leak compared to a 21.2% rate in the control group (odds ratio 3.0, 95% confidence interval 1.2–7.6, p = 0.017). In 106 patients in whom defect size was measured intraoperatively, a larger defect was associated with postoperative CSF leak (6.2 vs 2.9 cm2, p = 0.03). No significant difference was identified in BMI between those with (mean 28.4 ± 4.3 kg/m2) and without (mean 28.1 ± 5.6 kg/m2) postoperative CSF leak (p = 0.79). Furthermore, when patients were grouped based on BMI < 25, 25–29.9, and > 30 kg/m2, no difference was noted in the rates of CSF fistula (p = 0.97).

CONCLUSIONS

Among patients undergoing intradural EES judged to be at high risk for CSF leak as defined by the study’s inclusion criteria, perioperative LD used in the context of vascularized nasoseptal flap closure significantly reduced the rate of postoperative CSF leaks.

Clinical trial registration no.: NCT03163134 (clinicaltrials.gov).
Fully endoscopic microvascular decompression for hemifacial spasm
Authors: Flanders Tracy M. , Blue Rachel , Roberts Sanford , McShane Brendan J. , Wilent Bryan , Tambi Vijay , Petrov Dmitriy , Lee John Y. K.
Published: November 2018

OBJECTIVE

Hemifacial spasm (HFS) is characterized by involuntary tonic and/or clonic contractions of facial nerve muscles. Fully endoscopic microvascular decompression (E-MVD) for HFS has not been widely adopted. This paper aims to illustrate the safety and efficacy of the fully endoscopic technique for HFS treatment.

METHODS

The authors conducted a single-center retrospective study of 27 patients (28 separate E-MVD cases; 1 patient had bilateral E-MVD) diagnosed with HFS who underwent fully E-MVD from January 2013 to October 2016. Intraoperative brainstem auditory evoked potentials and lateral spread resolution were reviewed. Outcome was based on the clinical status of the patient at the last contact point with the senior author. Complications were categorized as facial weakness, hearing loss, ataxia, dysphagia, or any adverse event able to be attributed to the surgical procedure.

RESULTS

HFS was relieved either completely or partially in the majority of cases (24 of 28, 85.7%). Of the 28 separate procedures, 17 (60.7%) resulted in complete resolution of symptoms, 4 (14.3%) resulted in near-complete resolution, 2 (7.1%) resulted in 50% reduction of symptoms, 1 (3.6%) resulted in minimal reduction, and 4 (14.3%) resulted in no relief. Of the 27 patients, 26 (96%) had no permanent postoperative complications. In multivariate logistic regression, the best predictor of greater than 50% resolution of spasm was resolution of intraoperative lateral spread response.

CONCLUSIONS

A fully E-MVD for HFS provides a safe and comprehensive view of the neurovascular conflict. Exclusive use of the endoscope in MVD is both safe and feasible in the treatment of HFS. Attention to lateral spread response monitoring remains an integral part of comprehensive neurosurgical management.
Hypoxia accelerates intraplaque neovascularization derived from endothelial progenitor cells in carotid stenosis
Authors: Kashiwazaki Daina , Koh Masaki , Uchino Haruto , Akioka Naoki , Kuwayama Naoya , Noguchi Kyo , Kuroda Satoshi
Published: November 2018

OBJECTIVE

The relationship between intraplaque hypoxia and intraplaque hemorrhage (IPH) has been reported, but the details remain obscure. In this study, the authors aimed to clarify the relationship among intraplaque hypoxia, endothelial progenitor cells (EPCs), and neovascularization, which causes IPH. The histological findings of specimens obtained from carotid endarterectomy were assessed.

METHODS

This study included 49 patients who underwent carotid endarterectomy. Magnetic resonance plaque imaging was performed to analyze the components of the carotid plaques, and surgical specimens were subjected to immunohistochemical analysis. The numbers of hypoxia-inducible factor-1 alpha (HIF-1α)–, CD34-, CD133-, and vascular endothelial growth factor receptor-2 (VEGFR-2)–positive cells in the carotid plaques were precisely quantified, as were the number and maximum diameter of CD31-positive microvessels.

RESULTS

Plaque components were judged as fibrous in 7 samples, lipid-rich in 22, and IPH in 20. The number of CD34-, VEGFR-2–, and CD133-positive cells as an EPC-specific marker was significantly correlated with the number of HIF-1α–positive cells (r = 0.9, r = 0.82, and r = 0.81, respectively). These numbers varied among the 3 plaque components (IPH > lipid-rich > fibrous). The number and maximum luminal diameter of CD31-positive microvessels were also significantly correlated with the number of HIF-1α–positive cells (r = 0.85 and r = 0.89, respectively) and varied among the 3 plaque components (IPH > lipid-rich > fibrous).

CONCLUSIONS

The present findings suggest that intraplaque hypoxia may accelerate abnormal microvessel formation derived from EPCs, which in turn promotes IPH. The results also suggest that microvessel enlargement is a pivotal characteristic of IPH and these enlarged microvessels are immature endothelial tubes with disorganized branching and are fragile and prone to rupture.
A wearable mixed-reality holographic computer for guiding external ventricular drain insertion at the bedside
Authors: Li Ye , Chen Xiaolei , Wang Ning , Zhang Wenyao , Li Dawei , Zhang Lei , Qu Xin , Cheng Weitao , Xu Yueqiao , Chen Wenjin , Yang Qiumei
Published: November 2018

OBJECTIVE

The goal of this study was to explore the feasibility and accuracy of using a wearable mixed-reality holographic computer to guide external ventricular drain (EVD) insertion and thus improve on the accuracy of the classic freehand insertion method for EVD insertion. The authors also sought to provide a clinically applicable workflow demonstration.

METHODS

Pre- and postoperative CT scanning were performed routinely by the authors for every patient who needed EVD insertion. Hologram-guided EVD placement was prospectively applied in 15 patients between August and November 2017. During surgical planning, model reconstruction and trajectory calculation for each patient were completed using preoperative CT. By wearing a Microsoft HoloLens, the neurosurgeon was able to visualize the preoperative CT-generated holograms of the surgical plan and perform EVD placement by keeping the catheter aligned with the holographic trajectory. Fifteen patients who had undergone classic freehand EVD insertion were retrospectively included as controls. The feasibility and accuracy of the hologram-guided technique were evaluated by comparing the time required, number of passes, and target deviation for hologram-guided EVD placement with those for classic freehand EVD insertion.

RESULTS

Surgical planning and hologram visualization were performed in all 15 cases in which EVD insertion involved holographic guidance. No adverse events related to the hologram-guided procedures were observed. The mean ± SD additional time before the surgical part of the procedure began was 40.20 ± 10.74 minutes. The average number of passes was 1.07 ± 0.258 in the holographic guidance group, compared with 2.33 ± 0.98 in the control group (p < 0.01). The mean target deviation was 4.34 ± 1.63 mm in the holographic guidance group and 11.26 ± 4.83 mm in the control group (p < 0.01).

CONCLUSIONS

This study demonstrates the use of a head-mounted mixed-reality holographic computer to successfully perform hologram-assisted bedside EVD insertion. A full set of clinically applicable workflow images is presented to show how medical imaging data can be used by the neurosurgeon to visualize patient-specific holograms that can intuitively guide hands-on operation. The authors also provide preliminary confirmation of the feasibility and accuracy of this hologram-guided EVD insertion technique.
Spindle cell oncocytoma of the pituitary gland
Authors: Giantini Larsen Alexandra M. , Cote David J. , Zaidi Hasan A. , Bi Wenya Linda , Schmitt Paul J. , Iorgulescu J. Bryan , Miller Michael B. , Smith Timothy R. , Lopes M. Beatriz , Jane John A. , Laws Edward R.
Published: November 2018

OBJECTIVE

The authors report the diagnosis, management, and outcomes of 6 cases of spindle cell oncocytoma (SCO) in an effort to guide clinical diagnosis and management of these uncommon lesions.

METHODS

This study is a retrospective review of cases involving adult patients who underwent resection of pituitary lesions at the authors’ institutions between January 2000 and October 2017. The authors identified patients with histopathological confirmation of SCO and collected clinical data, including preoperative, perioperative, and postoperative management, complications, and outcomes.

RESULTS

Six patients with SCO were identified. Clinical findings at initial presentation included visual disturbances, dizziness, and headache. All patients underwent resection. Four resections were initially performed by the transsphenoidal approach, and 2 resections were performed by craniotomy at an outside institution with subsequent transsphenoidal reoperations. Neither necrosis nor increased mitotic activity was seen in the tumor samples. All samples stained positive for S100 protein and thyroid transcription factor 1 and negative for glial fibrillary acidic protein and pituitary hormones. Five of the samples stained positive for epithelial membrane antigen. The average MIB-1 index was 8.3% (range 2–17). Postoperatively, 3 of the 6 patients received further treatment for progression of residual tumor or for recurrence, 2 have stable residual tumor, and 1 has had no recurrence after gross-total resection. Two patients developed postoperative complications of transient sixth cranial nerve palsy and diplopia. There were no other complications.

CONCLUSIONS

SCO poses both a diagnostic and therapeutic challenge. These tumors are often initially misdiagnosed as nonfunctional pituitary adenomas because of their sellar location and nonspecific symptomatology. Postoperatively, SCO must also be distinguished from other neoplasms of the posterior pituitary gland through histopathological examination. Resection of SCO can be challenging, given its highly vascular and adherent nature. Long-term follow-up is critical, as the tumor is associated with higher recurrence and progression rates compared to other benign neoplasms of the sella.
Targeting the posterior subthalamic area for essential tremor: proposal for MRI-based anatomical landmarks
Authors: Nowacki Andreas , Debove Ines , Rossi Frédéric , Schlaeppi Janine Ai , Petermann Katrin , Wiest Roland , Schüpbach Michael , Pollo Claudio
Published: November 2018

OBJECTIVE

Deep brain stimulation (DBS) of the posterior subthalamic area (PSA) is an alternative to thalamic DBS for the treatment of essential tremor (ET). The dentato-rubro-thalamic tract (DRTT) has recently been proposed as the anatomical substrate underlying effective stimulation. For clinical purposes, depiction of the DRTT mainly depends on diffusion tensor imaging (DTI)–based tractography, which has some drawbacks. The objective of this study was to present an accurate targeting strategy for DBS of the PSA based on anatomical landmarks visible on MRI and to evaluate clinical effectiveness.

METHODS

The authors performed a retrospective cohort study of a prospective series of 11 ET patients undergoing bilateral DBS of the PSA. The subthalamic nucleus and red nucleus served as anatomical landmarks to define the target point within the adjacent PSA on 3-T T2-weighted MRI. Stimulating contact (SC) positions with reference to the midcommissural point were analyzed and projected onto the stereotactic atlas of Morel. Postoperative outcome assessment after 6 and 12 months was based on change in Tremor Rating Scale (TRS) scores.

RESULTS

Actual target position corresponded to the intended target based on anatomical landmarks depicted on MRI. The total TRS score was reduced (improved) from 47.2 ± 15.7 to 21.3 ± 10.7 (p < 0.001). No severe complication occurred. The mean SC position projected onto the PSA at the margin of the cerebellothalamic fascicle and the zona incerta.

CONCLUSIONS

Targeting of the PSA based on anatomical landmarks representable on MRI is reliable and leads to accurate lead placement as well as good long-term clinical outcome.
Efficacy of limited hippocampal radiofrequency thermocoagulation for mesial temporal lobe epilepsy
Authors: Lee Ching-Yi , Li Han-Tao , Wu Tony , Cheng Mei-Yun , Lim Siew-Na , Lee Shih-Tseng
Published: November 2018

OBJECTIVE

Radiofrequency thermocoagulation (RFTC), which has been developed for drug-resistant epilepsy patients, involves less brain tissue loss due to surgery, fewer surgical adverse effects, and generally good seizure control. This study demonstrates the effectiveness of RFTC performed at limited hippocampal locations.

METHODS

Daily seizure diaries were prospectively maintained for at least 6 months by 9 patients (ages 30–59 years) with drug-resistant mesial temporal lobe epilepsy (MTLE) before treatment with RFTC. The limited target for stereotactic RFTC was chosen based on intraoperative electroencephalography (EEG) recording and was initially tested with a Radionics electrode at a low temperature, 45°C, for 60 seconds. The therapeutic RFTC heating parameters were 78°C–80°C for 90 seconds. All patients who received the RFTC treatment underwent both MRI and EEG recording immediately postoperatively and at the 3-month follow-up. Monthly outpatient clinic visits were arranged over 6 months to document seizure frequency and severity to clarify the changes noted in imaging studies and EEG patterns.

RESULTS

Two patients were excluded from our analysis because one had undergone multiple seizure surgeries and the other had a poor recording of seizure frequency, before the RFTC surgery. Five and two patients underwent left-sided and right-sided RFTC, respectively. None of the patients had generalized tonic-clonic attacks postoperatively, and no adverse effects or complications occurred. According to MRI data, the effect of coagulation was limited to less than 1.0 cm in diameter and perifocal edema was also in limited range. The seizure frequency within 6 months decreased postoperatively with a mean reduction in seizures of 78% (range 36%–100%). Only two patients had a temporary increase in seizure frequency within 2 weeks of the surgery, and over 50% of all patients showed a decrease in average seizure frequency.

CONCLUSIONS

The study results confirm that limited RFTC provides a more effective surgery with similar seizure control but fewer complications than resective surgery for drug-resistant MTLE patients.
Long-term pain outcomes for recurrent idiopathic trigeminal neuralgia after stereotactic radiosurgery: a prospective comparison of first-time microvascular decompression and repeat stereotactic radiosurgery
Authors: Raygor Kunal P. , Wang Doris D. , Ward Mariann M. , Barbaro Nicholas M. , Chang Edward F.
Published: November 2018

OBJECTIVE

Microvascular decompression (MVD) and stereotactic radiosurgery (SRS) are common surgical treatments for trigeminal neuralgia (TN). Many patients who receive SRS have pain recurrence; the ideal second intervention is unknown. The authors directly compared pain outcomes after MVD and repeat SRS in a population of patients in whom SRS failed as their first-line procedure for TN, and they identified predictors of pain control.

METHODS

The authors reviewed a prospectively collected database of patients undergoing surgery for TN between 1997 and 2014 at the University of California, San Francisco (UCSF). Standardized data collection focused on preoperative clinical characteristics, surgical characteristics, and postoperative outcomes. Patients with typical type 1, idiopathic TN with ≥ 1 year of follow-up were included.

RESULTS

In total, 168 patients underwent SRS as their first procedure. Of these patients, 90 had residual or recurrent pain. Thirty of these patients underwent a second procedure at UCSF and had ≥ 1 year of follow-up; 15 underwent first-time MVD and 15 underwent repeat SRS. Patients undergoing MVD were younger than those receiving repeat SRS and were more likely to receive ≥ 80 Gy during the initial SRS. The average follow-up was 44.9 ± 33.6 months for MVD and 48.3 ± 45.3 months for SRS. All patients achieved complete pain freedom without medication at some point during their follow-up. At last follow-up, 80% of MVD-treated patients and 33.3% of SRS-treated patients had a favorable outcome, defined as Barrow Neurological Institute Pain Intensity scores of I–IIIa (p < 0.05). Percentages of patients with favorable outcome at 1 and 5 years were 86% and 75% for the MVD cohort and 73% and 27% for the SRS cohort, respectively (p < 0.05). Multivariate Cox proportional hazards analysis demonstrated that performing MVD was statistically significantly associated with favorable outcome (HR 0.12, 95% CI 0.02–0.60, p < 0.01). There were no statistically significant predictors of favorable outcome in the MVD cohort; however, the presence of sensory changes after repeat SRS was associated with pain relief (p < 0.01).

CONCLUSIONS

Patients who received MVD after failed SRS had a longer duration of favorable outcome compared to those who received repeat SRS; however, both modalities are safe and effective. The presence of post-SRS sensory changes was predictive of a favorable pain outcome in the SRS cohort.