bluuebunny/crossref_metadata_2025 huggingface dataset:
Clival Chordomas in the Endoscopic Endonasal Era: Clinical Management, Outcomes, and Complications
Authors: Schnurman Zane , Benjamin Carolina Gesteira , Miceli Mary , Sen Chandranath
Published: January 2023

BACKGROUND:

Surgical management of skull base chordomas has changed significantly in the past 2 decades, most notably with use of the endoscopic endonasal approach (EEA), although high quality outcome data using these modern approaches remain scarce.

OBJECTIVE:

To evaluate outcomes in a large series of patients treated by a single surgeon, using primarily the EEA.

METHODS:

Between 2006 and 2020, 68 patients with skull base chordoma underwent resection using mostly the EEA. Complications, outcomes, and potential contributing factors were evaluated using Kaplan-Meier survival analysis and univariable and multivariable Cox proportional hazards models.

RESULTS:

Overall 5-year survival was 76.3% (95% CI 61.5%-86.0%), and 5-year progression-free survival was 55.9% (95% CI 40.0%-69.0%). In multivariable analysis, radical resection was associated with significant reduction in risk of death (hazard ratio [HR] 0.04, 95% CI 0.005-0.33, P = .003) and disease progression (HR 0.05, 95% CI 0.01-0.18, P < .001). Better preoperative function status reduced risk of death (HR 0.42 per 10-point increase in Karnofsky Performance Scale, 95% CI 0.28-0.63, P < .001) and progression (HR 0.60 per 10-point increase in Karnofsky Performance Scale, 95% CI 0.45-0.78, P < .001). Localization at the clivus reduced risk of death (HR 0.02, 95% CI 0.002-0.15, P < .001) and progression (HR 0.24, 95% CI 0.09-0.68, P = .007) compared with tumors at the craniovertebral junction.

CONCLUSION:

In multivariable analysis, overall survival and progression-free survival of chordoma resection was most positively affected by radical resection, better preoperative functional status, and tumor location at the clivus rather than craniovertebral junction.
Neurosurgical Utilization, Charges, and Reimbursement After the Affordable Care Act: Trends From 2011 to 2019
Authors: Hersh Andrew M. , Dedrickson Tara , Gong Jung Ho , Jimenez Adrian E. , Materi Joshua , Veeravagu Anand , Ratliff John K. , Azad Tej D.
Published: January 2023

BACKGROUND:

An estimated 50 million Americans receive Medicare health care coverage. Prior studies have established a downward trend in Medicare reimbursement for commonly billed surgical procedures, but it is unclear whether these trends hold true across all neurosurgical procedures.

OBJECTIVE:

To assess trends in utilization, charges, and reimbursement by Medicare for neurosurgical procedures after passage of the Affordable Care Act in 2010.

METHODS:

We review yearly Physician/Supplier Procedure Summary datasets from the Centers for Medicare and Medicaid Services for all procedures billed by neurosurgeons to Medicare Part B between 2011 and 2019. Procedural coding was categorized into cranial, spine, vascular, peripheral nerve, and radiosurgery cases. Weighted averages for charges and reimbursements adjusted for inflation were calculated. The ratio of the weighted mean reimbursement to weighted mean charge was calculated as the reimbursement-to-charge ratio, representing the proportion of charges reimbursed by Medicare.

RESULTS:

Overall enrollment-adjusted utilization decreased by 12.1%. Utilization decreased by 24.0% in the inpatient setting but increased by 639% at ambulatory surgery centers and 80.2% in the outpatient setting. Inflation-adjusted, weighted mean charges decreased by 4.0% while reimbursement decreased by 4.6%. Procedure groups that saw increases in reimbursement included cervical spine surgery, cranial functional and epilepsy procedures, cranial pain procedures, and endovascular procedures. Ambulatory surgery centers saw the greatest increase in charges and reimbursements.

CONCLUSION:

Although overall reimbursement declined across the study period, substantial differences emerged across procedural categories. We further find a notable shift in utilization and reimbursement for neurosurgical procedures done in non-inpatient care settings.
Postoperative Gravity Line-Hip Axis Offset as a Substantial Risk Factor for Mechanical Failure After Adult Spinal Deformity Correction Surgery
Authors: An Sungjae , Hyun Seung-Jae , Lee Jae-Koo , Yang Seung Heon , Kim Ki-Jeong
Published: January 2023

BACKGROUND:

Mechanical failure (MF) is a serious burden for patients with adult spinal deformity (ASD) who have undergone deformity correction surgery. Surgeons have sought to understand the mechanism and prevent this problematic complication, but this goal remains to be achieved. The gravity line (GL) of the whole body is a noteworthy parameter that represents global sagittal balance, for which normative values for the axial skeleton have been studied.

OBJECTIVE:

To assess postoperative GL-hip axis (GL-HA) offset as a critical risk factor for MF after ASD correction surgery.

METHODS:

Consecutive patients who underwent initial surgery for ASD at a single academic center were retrospectively included. Demographics, operative details, preoperative and postoperative spinopelvic parameters, global sagittal balance parameters, and Scoliosis Research Society-22 score were evaluated. These variables were analyzed for differences and correlations with MF.

RESULTS:

Thirty-five patients without MF and 30 patients with MF were identified in the study. Two groups showed no significant differences in baseline demographics, operative characteristics, preoperative global sagittal balance parameters, or preoperative and postoperative Scoliosis Research Society-22 scores. Significant differences and correlations with MF were observed for postoperative GL-HA offset using a cutoff value of 49.3 mm from logistic regression analysis, with an odds ratio of 11.0 (95% confidence interval: 3.45-35.01, P < .0001).

CONCLUSION:

Postoperative GL-HA offset is a substantial risk factor for MF after ASD surgery. Surgical correction of ASD with a GL-HA offset greater than 5 cm is significantly related to MF. The GL should be located near the HA after ASD surgery.
Pipeline Embolization Device for Small and Medium Vertebral Artery Aneurysms: A Multicenter Study
Authors: Zhang Hongyun , Zhang Hongqi , Liu Jianmin , Song Donglei , Zhao Yuanli , Guan Sheng , Maimaitili Aisha , Wang Yunyan , Feng Wenfeng , Wang Yang , Wan Jieqing , Mao Guohua , Shi Huaizhang , Luo Bin , Shao Qiuji , Chang Kaitao , Zhang Qianqian , He Yingkun , Zhang Peng , Yang Xinjian , Li Li , Li Tian xiao
Published: January 2023

BACKGROUND:

Pipeline embolization devices (PEDs) have been increasingly used for the treatment of posterior circulation aneurysms.

OBJECTIVE:

To investigate the safety and efficacy of PED in the treatment of small to medium unruptured vertebral artery intracranial aneurysms (VAIAs).

METHODS:

Data from 76 patients with 78 unruptured small and medium (≤12 mm) VAIAs were analyzed. Data for this study come from the PLUS study, which was conducted at 14 centers in China from 2014 to 2019. Univariate analyses were performed to evaluate predictors of the occlusion and complication.

RESULTS:

Seventy-eight aneurysms in 76 patients were treated with PED. The mean aneurysm size was 8.28 ± 2.13 mm, and all PEDs were successfully placed. The median follow-up was 7 months and available for 67 (85.9%) aneurysms. Complete occlusion was seen in 60 (89.6%) aneurysms, which 86.6% met the primary efficacy outcome. All patients received clinical follow-up, the combined major morbidity and mortality was 2.6%, and 98.7% of patients had a good prognosis. Ischemic stroke occurred in 10.5% of patients, and adjuvant coil and successful after adjustment were predictors of ischemic stroke in the early postoperative and follow-up, respectively. There was no significant difference in the occlusion rate of aneurysm involving posterior inferior cerebellar artery (P = .78). In cases where posterior inferior cerebellar artery was covered by PED, there was no significant difference in ischemic stroke.

CONCLUSION:

In the treatment of unruptured ≤12 mm VAIAs, PED has a high surgical success rate, a high degree of occlusion, and low morbidity and mortality. PED may be a promising endovascular technique.
Reinnervation of Paralyzed Limb Muscle by Nerve-Muscle-Endplate Grafting Technique
Authors: Sobotka Stanislaw , Mu Liancai , Chen Jingming , Li Jing , Nyirenda Themba
Published: January 2023

BACKGROUND:

We have developed a novel reinnervation technique called nerve-muscle-endplate grafting in the native motor zone (NMEG-NMZ). However, it remains unknown whether the NMEG-NMZ is effective for limb reinnervation.

OBJECTIVE:

To evaluate the efficacy of the NMEG-NMZ in limb muscle reinnervation.

METHODS:

Forty-five adult rats were divided into 3 groups: NMEG, end-to-end anastomosis (EEA, technique control), and denervation control (DC). The left tibialis anterior muscle was denervated by resecting its nerve. For NMEG-NMZ, the denervated tibialis anterior was reinnervated by transferring a NMEG pedicle from the lateral gastrocnemius muscle. Three months after surgery, static toe spread analysis was performed for all rats and muscle force was measured for the rats treated with NMEG and EEA. Muscle weight, myofiber morphology, regenerated axons, and reinnervated motor endplates in the treated muscles were also quantified and compared with those in the DC group.

RESULTS:

NMEG-NMZ technique resulted in better muscle force recovery (79% of the control) compared with EEA (51% of the control, P = .048). Toe spread analysis in NMEG-NMZ reinnervated muscles showed static sciatic index = −16.8, whereas −41.4 in EEA, P < .0001). The average weight of the NMEG-NMZ reinnervated muscles (86%) was greater than those of the EEA treated (71%) and DC (26%) muscles (all P < .0001). The mean count of the regenerated axons in the muscles with NMEG-NMZ was 76% of the control, which was larger than that in the muscles with EEA (46%), P < .0001.

CONCLUSION:

NMEG-NMZ technique has unique advantages and is superior to EEA for muscle reinnervation and functional recovery.
Quality of Life After Poor-Grade Aneurysmal Subarachnoid Hemorrhage
Authors: Goldberg Johannes , Z'Graggen Werner J. , Hlavica Martin , Branca Mattia , Marbacher Serge , D'Alonzo Donato , Fandino Javier , Stienen Martin N. , Neidert Marian C. , Burkhardt Jan-Karl , Regli Luca , Seule Martin , Roethlisberger Michel , Guzman Raphael , Zumofen Daniel Walter , Maduri Rodolfo , Daniel Roy Thomas , El Rahal Amir , Corniola Marco V. , Bijlenga Philippe , Schaller Karl , Rölz Roland , Scheiwe Christian , Shah Mukesch , Heiland Dieter Henrik , Schnell Oliver , Beck Jürgen , Raabe Andreas , Fung Christian
Published: January 2023

BACKGROUND:

Poor-grade aneurysmal subarachnoid hemorrhage (aSAH) is associated with high mortality and poor disability outcome. Data on quality of life (QoL) among survivors are scarce because patients with poor-grade aSAH are underrepresented in clinical studies reporting on QoL after aSAH.

OBJECTIVE:

To provide prospective QoL data on survivors of poor-grade aSAH to aid clinical decision making and counseling of relatives.

METHODS:

The herniation World Federation of Neurosurgical Societies scale study was a prospective observational multicenter study in patients with poor-grade (World Federation of Neurosurgical Societies grades 4 & 5) aSAH. We collected data during a structured telephone interview 6 and 12 months after ictus. QoL was measured using the EuroQoL - 5 Dimensions - 3 Levels (EQ-5D-3L) questionnaire, with 0 representing a health state equivalent to death and 1 to perfect health. Disability outcome for favorable and unfavorable outcomes was measured with the modified Rankin Scale.

RESULTS:

Two hundred-fifty patients were enrolled, of whom 237 were included in the analysis after 6 months and 223 after 12 months. After 6 months, 118 (49.8%) patients were alive, and after 12 months, 104 (46.6%) patients were alive. Of those, 95 (80.5%) and 89 (85.6%) reached a favorable outcome with mean EQ-5D-3L index values of 0.85 (±0.18) and 0.86 (±0.18). After 6 and 12 months, 23 (19.5%) and 15 (14.4%) of those alive had an unfavorable outcome with mean EQ-5D-3L index values of 0.27 (±0.25) and 0.19 (±0.14).

CONCLUSION:

Despite high initial mortality, the proportion of poor-grade aSAH survivors with good QoL is reasonably large. Only a minority of survivors reports poor QoL and requires permanent care.
Thirty-Day Outcomes of Resolute Onyx Stent for Symptomatic Intracranial Stenosis: A Multicenter Propensity Score–Matched Comparison With Stenting Versus Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis Trial
Authors: Siddiq Farhan , Nunna Ravi S. , Beall Jonathan M. , Khan Inamullah , Khan Musharaf , Tekle Wondwossen G. , Ezzeldin Mohamad , Tanweer Omar , Burkhardt Jan-Karl , Jabbour Pascal M. , Tjoumakaris Stavropoula I. , Herial Nabeel A. , Siddiqui Adnan H. , Grandhi Ramesh , Martin Renee L. , Qureshi Adnan I. , Hassan Ameer E.
Published: January 2023

BACKGROUND:

Symptomatic intracranial atherosclerotic disease (sICAD) is estimated to cause 10% of strokes annually in the United States. However, treatment remains a challenge with several different stenting options studied in the past with unfavorable results.

OBJECTIVE:

To report the 30-day stroke and/or death rate associated with intracranial stent placement for sICAD using Resolute Onyx Zotarolimus-Eluting Stent (RO-ZES) and provide a comparison with the results of Stenting Versus Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis (SAMMPRIS) trial.

METHODS:

Prospectively maintained databases across 8 stroke centers were used to identify adult patients treated with RO-ZES for sICAD between January 2019 and December 2021. Primary end point was composite of 30-day stroke, intracerebral hemorrhage, and/or death. Propensity score matching was performed using age, hypertension, lipid disorder, cigarette smoking, and symptomatic target vessel to create a matched group for comparison between RO-ZES and the SAMMPRIS medical management and treatment groups (SAMMPRIS percutaneous angioplasty and stenting [S-PTAS]).

RESULTS:

A total of 132 patients met the inclusion criteria for analysis (mean age: 64.2 years). Mean severity of stenosis was 81.4% (±11.4%). A total of 4 (3.03%) stroke and/or deaths were reported within 30 days of treatment in the RO-ZES group compared with 6.6% in the SAMMPRIS medical management group (OR [odds ratio] 2.26, 95% CI 0.7-9.56, P = .22) and 15.6% in the S-PTAS group (OR 5.9, 95% CI 2.04-23.4, P < .001). Propensity score match analysis of 115 patients in each group demonstrated 30-day stroke and/or death rate of 2.6% in the RO-ZES group and 15.6% in the S-PTAS group (OR 6.88, 95% CI 1.92-37.54, P < .001).

CONCLUSION:

Patients treated with RO-ZES had a relatively low 30-day stroke and/or death rate compared with the S-PTAS group. Further large-scale prospective studies are warranted to evaluate the safety and efficacy of RO-ZES for the treatment of sICAD.
Surgical Strategy and Application of Robotic-Assisted Benign Sacral Neurogenic Tumor Resection
Authors: Wu Hui , Fu Yi-wei , Gao Zhen-hua , Zhong Zhi-hai , Shen Jing-nan , Yin Jun-qiang
Published: January 2023

BACKGROUND:

Robotic surgery may be advantageous in neurogenic sacral tumor resection but only a few studies reported robotic-assisted neurogenic sacral tumor resection.

OBJECTIVE:

To propose a new surgical strategy for robotic-assisted benign sacral neurogenic tumor resection and introduce the ultrasonic osteotomy surgical system in robotic surgery.

METHODS:

Twelve patients who had robotic-assisted primary benign sacral neurogenic tumor resection between May 2015 and March 2021 were included. Our surgical strategy divides tumors into 4 types. Type I: Presacral tumors with diameter <10 cm. Type II: Narrow-base tumors involving the sacrum with diameter <10 cm. Type III: Broad-base tumors involving the sacrum with diameter <10 cm. Type IV: Tumors involving sacral nerve roots ≥2 levels and/or with diameter ≥10 cm.

RESULTS:

Five type I, 5 type II, and 1 type III patients underwent tumor resection via an anterior approach, and 1 type IV patient via a combined approach. The median operation time, blood loss, and postoperative hospital stay of type I and II were much less than those of type IV. The ultrasonic osteotomy surgical system facilitated osteotomy in 2 type II and 1 type III patients. Eleven patients had total resections, and 1 type III patient had a partial resection. During the follow-up period of 7.9 to 70.9 months (median: 28.5 months), no local recurrences or deaths were noted.

CONCLUSION:

With the largest single-center series to our knowledge, this surgical strategy helped to guide robotic-assisted benign sacral neurogenic tumor resection. The ultrasonic osteotomy surgical system was effective for type II and III.
Interhemispheric Transcingulate Sulcus Approach to Deep-Seated Medial Frontal and Parietal Lesions—Fiber Dissection Study With Illustrative Cases
Authors: Gungor Abuzer , Gurses Muhammet Enes , Dogan Eray , Varol Eyup , Gökalp Elif , Etli Mustafa Umut , Ozoner Baris
Published: January 2023

BACKGROUND:

Surgery for lesions located in the medial frontal and parietal lobes can be quite challenging for neurosurgeons because of morbidities that may arise from damage to critical midline structures or intact neural tissue that need to be crossed to reach the lesion. In our anatomic studies, the cingulate sulcus was observed as an alternative access route for lesions located in medial frontal and parietal lobes.

OBJECTIVE:

To explain the microsurgical anatomy of the medial hemisphere and cingulate sulcus and to demonstrate the interhemispheric transcingulate sulcus approach (ITCSA) with 3 clinical cases.

METHODS:

Five formalin-fixed brain specimens, which were frozen at −18 °C for at least 2 weeks and then thawed under tap water, were gradually dissected from medial to lateral. Diffusion fiber tracking performed using DSI Studio software in data was provided by the Human Connectome Project. Clinical data of 3 patients who underwent ITCSA were reviewed.

RESULTS:

Cingulate sulcus is an effortlessly identifiable continuous sulcus on the medial surface of the brain. Our anatomic dissection study revealed that the lesions located in the deep medial frontal and parietal lobes can be reached through the cingulate sulcus with minor injury only to the cingulum and callosal fibers. Three patients were treated with ITCSA without any neurological morbidity.

CONCLUSION:

Deep-seated lesions in the medial frontal lobe and parietal lobe medial to the corona radiata can be approached by using microsurgical techniques based on anatomic information. ITCSA offers an alternative route to these lesions besides the known lateral transcortical/transsulcal and interhemispheric transcingulate gyrus approaches.
Quantitative Comparative Analysis of the Endoscope-Assisted Expanded Retrosigmoid Approach and the Far-Lateral Approach to the Inframeatal Area: An Anatomic Study With Surgical Implications
Authors: Revuelta Barbero J. Manuel , Porto Edoardo , Prevedello Daniel M. , Noiphithak Raywat , Yanez-Siller Juan C. , Martinez-Perez Rafael , Pradilla Gustavo
Published: January 2023

BACKGROUND:

The inframeatal area (IFMA) is a complex anatomic region of the posterior cranial fossa. Given its deep-seated location, tumors involving the IFMA represent a surgical challenge.

OBJECTIVE:

To objectively compare the endoscope-assisted expanded retrosigmoid approach (ERSA) and the far-lateral supracondylar transtubercular approach (FLTA) to address the IFMA.

METHODS:

Anatomic dissections were performed on 5 cadaveric heads (10 sides). The ERSAs were performed before and after the FLTAs. The surgical exposure, surgical freedom, and angles of attack to the IFMA were measured and compared for each approach. In addition, 2 illustrative clinical cases are reported.

RESULTS:

Compared with FLTA, ERSA yielded a nonsignificantly smaller mean area of exposure, whereas FLTA provided a significantly larger mean area of surgical freedom, compared with ERSA (P = .002). The mean horizontal and vertical angles of attack were significantly different between the approaches. In the vertical plane, FLTA yielded the broadest angle of attack at the root entry zone of the lower cranial nerves (CN; P < .004), whereas ERSA did so at the dural entry zone of CN VII/VIII (P = .006). In the horizontal plane, FLTA achieved its broadest angle of attack at the root entry zone of the lower CNs (P = 1.83) while ERSA at the dural entry zone of CN VII/VIII (P = .37).

CONCLUSION:

ERSA and FLTA granted a comparable exposure with the IFMA. Although FLTA may afford a larger area of surgical freedom, ERSA may be a suitable alternative to approach the IFMA, particularly to reach the most medial and superior aspects of this region. Conversely, FLTA may facilitate access to more caudally targets.
Minimally Invasive Preganglionic C2 Root Section for Occipital Neuralgia: 2 Case Reports and Operative Video
Authors: Shahin Maryam N. , Ross Donald A.
Published: January 2023

BACKGROUND:

Occipital neuralgia is a painful condition that is believed to occur from processes that affect the greater, lesser, or third occipital nerves. Diagnosis is often made with a combination of classical symptoms, tenderness over the occipital region, and response to occipital nerve blocks. Cervical computed tomography or MRI may be obtained in multiple positions to detect any impingement. Diagnosis can be made with MRI tractography. Nonsurgical treatments include local anesthetic and steroid injections, anticonvulsant medications, botulinum toxin injections, physical therapy, acupuncture, transcutaneous electrical stimulation, cryoneurolysis, and radiofrequency ablation. Surgical treatments include greater occipital nerve decompression, C2 root section, intradural dorsal root rhizotomy, C1-2 fusion, and occipital nerve stimulation. Although stimulation has been favored in the past decade, complications and maintenance of the devices have led us to return to C2 ganglionectomy.

OBJECTIVE:

To report on the use of a minimally invasive technique for C2 ganglionectomy to treat occipital neuralgia.

METHODS:

Review demographic, surgery, and outcome data of a minimally invasive C2 root ganglionectomy used to treat to 2 patients with occipital neuralgia.

RESULTS:

We report on 2 patients with clinically stereotypical unilateral occipital neuralgia confirmed by greater occipital nerve block, but with no imaging correlate. Both were successfully managed by C2 ganglionectomy through an 18-mm tubular retractor and outpatient surgery. Accompanying text, still photographs, and video describe the technique in detail.

CONCLUSION:

Minimally invasive C2 ganglionectomy can be used to successfully treat occipital neuralgia.
Clip Ligation and Disconnection of a Ruptured Ventral Subaxial Cervical Isolated Spinal Aneurysm Using Tailored Access Osteotomies: An Operative Technique
Authors: Scullen Tyler , Ng Christina , Mathkour Mansour , Tubbs R. Shane , Bui Cuong , Kalyvas James
Published: January 2023

BACKGROUND:

Isolated spinal aneurysms (iSAs) are lesions of the spinal vasculature with no associated vascular malformation with difficult management paradigms limited by safe access.

OBJECTIVE:

To describe a case of an irregular fusiform ruptured distal subaxial cervical spine iSA with a complex angioarchitecture intimately associated with the ventral pial plexus (VPP), treated using open clip ligation and disconnection.

METHODS:

A 51-year-old woman presented with complete spinal cord injury with a C8 sensory level and ventral subarachnoid hemorrhage at the C6-T1 vertebral levels. After emergent anterior evacuation and fusion, angiography revealed a small iSA around the VPP. A total laminectomy spanning C5 to T3 was completed, and bilateral C7 pedicle resections were performed. A temporary clip was placed from the left for proximal control, and a permanent clip was placed across the dome of the distal vessel for disconnection. The dura was then closed, and a cervicothoracic fusion completed.

RESULTS:

Postoperative angiography confirmed iSA disconnection and obliteration with anterior spinal artery preservation. The patient had intermittent numbness in the right C8 dermatome. On postoperative day 1, she regained proprioception in the right foot and movement in the lower extremities on command. On postoperative day 3, she regained full sensation and voluntary movement in both lower extremities.

CONCLUSION:

iSA is a rare and morbid condition with nonstandardized guidelines regarding management. We promote the concept of using tailored osteotomies to establish safe corridors for the open treatment of difficult subaxial cervical ventral lesions not amenable to transarterial treatment. Multidisciplinary collaboration is promising, and further investigation is highly warranted.
Intraoperative Predictor of Remission in Cushing Disease
Authors: Zachariah Marcus A. , Cua Santino , Muhlestein Whitney E. , Otto Bradley A. , Carrau Ricardo L. , Kirschner Lawrence S. , Ghalib Luma M. , Lonser Russell R. , Hardesty Douglas A. , Prevedello Daniel M.
Published: January 2023

BACKGROUND:

Cushing disease represents a challenge for neurosurgeons, with high recurrence rates reported. Characteristics associated with remission are incompletely understood; thus, an intraoperative predictor for outcome would be valuable for assessing resection of adrenocorticotropic hormone (ACTH) secreting tissue.

OBJECTIVE:

To evaluate whether intraoperative ACTH measurement could predict outcome after surgery for Cushing disease.

METHODS:

Retrospective cohort study of 55 consecutive encounters with Cushing disease who had peripheral plasma ACTH levels measured intraoperatively before, during, and after tumor resection. The primary outcome measure was remission, defined by either 2 negative 24-hour urine free cortisol or 2 negative midnight salivary cortisol measurements. A logistic regression machine learning model was generated using recursive feature elimination.

RESULTS:

Fifty-five operative encounters, comprising 49 unique patients, had a mean follow-up of 2.73 years (±2.11 years) and a median follow-up of 2.07 years. Remission was achieved in 69.1% (n = 38) of all operations and in 78.0% (n = 32) of those without cavernous sinus invasion. The final ACTH level measured intraoperatively correctly predicted outcome (area under the curve = 0.766; P value = .002). The odds ratio of remission in patients with the lowest quartile vs highest quartile final intraoperative ACTH was 23.4 (P value = .002). Logistic regression machine learning model resulted in incorporating postoperative day 1 morning cortisol, final intraoperative ACTH that predicted outcome with an average area under the curve of 0.80 (P = .0027).

CONCLUSION:

Intraoperative ACTH may predict outcome after surgery in Cushing disease; furthermore, investigation is warranted.
Prognostic Factors for Surgically Managed Spontaneous Spinal Epidural Hematoma: A Single-Center Case Series of 18 Patients
Authors: Baig Mirza Asfand , Pedro Lavrador Jose , Gebreyohanes Axumawi , Vastani Amisha , China Musa , Kalaitzoglou Dimitrios , Bartram James , Eid Hazem , Bleil Christina , Bell David , Thomas Nicholas , Malik Irfan , Grahovac Gordan
Published: January 2023

BACKGROUND:

Spontaneous spinal epidural hematoma (SSEH) is a rare pathology, which carries a significant morbidity.

OBJECTIVE:

To review our institutional experience of surgically managed patients with SSEH, seeking to better understand clinical prognostic factors related to postoperative outcomes and thereby improve counseling of patients before treatment.

METHODS:

All patients who underwent surgical management of SSEH between September 2011 and 2021. Baseline and postoperative clinical and radiological characteristics are presented, including the American Spinal Injury Association grade (ASIA). Statistical analyses were performed using Stata 13.1.

RESULTS:

Eighteen patients were identified in total (11 male patients and 7 female patients) with a median age of 59.5 (range 3-83) years. The most common spinal region affected was cervicothoracic (33.3%). Limb weakness (94.4%) and urinary dysfunction (83.3%) represented the most common presenting symptoms. Preoperatively, the presence of spinal cord edema on imaging was associated with worse preoperative Medical Research Council (MRC) grade (P = .033), female sex was associated with preserved saddle sensation (P = .04), and patients receiving antiplatelet medication were associated with a higher risk of preoperative axial back pain (P = .005). Higher postoperative MRC grade was associated with higher preoperative ASIA (P = .012) and MRC grade (P = .005), and preservation of saddle sensation (P = .018). Postoperative improvements in axial back pain were associated with higher preoperative ASIA grade (P = .035) and anticoagulation treatment (P = .029).

CONCLUSION:

Neurosurgical intervention for SSEH yields positive outcomes and benefits patients. Patients with higher preoperative ASIA, MRC grade, and those presenting with preserved saddle sensation may experience further improved clinical outcomes after intervention.
Choledochal Cyst in Children, presentation and outcome - 10 years’ experience from a tertiary care center in Pakistan
Authors: Muhammad Arslan Farooq  , Khan Sabeen Abid , Malik Munir Iqbal
Published: January 2023

Objectives: This study was done to compare the clinical features, laboratory findings and surgical outcomes of pediatric patients with choledochal cysts.

Methods: Retrospective review of the hospital records of all pediatric patients admitted with choledochal cysts from 2011 to 2021 were collected and analyzed. Patients were divided into two groups; infant (less than one year age) and pediatric (1 to 16 years) for statistical comparison of two groups.

Results: The study included 34 children, 9 (26.5%) were infant (<1 year) and 25 (73.5%) were more than one year old. Mean age at diagnosis was 15 months with age ranging from 14 days to 16 years. Females were 19 (55.9%) and males were 15 (44.1%). Type-I choledochal cyst was the most common (73.5%), presentation followed by Type-IVA (26.5%) in our patients. Patients from infant group presented with jaundice in 7 (77.7%), and clay-colored stool in 3 (33.3%) as the most common clinical features, while abdominal pain (88%), vomiting (72%), fever (32%) and pancreatitis (32%) were the frequent presentations among older age group. Post-surgical complications of excision of choledochal cyst were observed in 4 (11.7%) patients.

Conclusion: Choledochal cysts have variable presentations depending upon age of the patients. Complete surgical excision of choledochal cyst is the treatment modality of choice and timely surgical management can prevent complications.

doi: https://doi.org/10.12669/pjms.39.2.6196

How to cite this: Farooq MA, Khan SA, Malik MI. Choledochal Cyst in Children, presentation and outcome - 10 years’ experience from a tertiary care center in Pakistan. Pak J Med Sci. 2023;39(2):---------. doi: https://doi.org/10.12669/pjms.39.2.6196

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Islamic legal perspectives on digital currencies and how they apply to Jordanian legislation
Authors: Albalawee Nasir , Al Fahoum Amjed S.
Published: January 2023

Background: The industrial transformation requires a speedy shift to financial digitization. One of the needs for financial digitalization in the study of Islamic contracts and Islamic business law is the use of digital platforms with digital currencies. Regarding the merits and downsides of its Sharia restrictions and its halal certification, which is currently under discussion, digital currencies and perks have generated controversy in Jordan and other Islamic countries.

Methods: This study intends to analyze the legal foundations of digital currency from Jordanian and Islamic legal perspectives. The descriptive-qualitative research approach was utilized, and data collection processes included documentation and a literature review. All legal possibilities that may be drawn from Islamic law in order to investigate the legality of digital currencies are explored further and used to obtain the conclusions of this study.

Results: A review of Sharia reasons and consideration for the wellbeing of the people suggests that digital currencies in their current form are incompatible with it and must adhere to the stipulations of Islamic finance. Therefore, digital currencies are unsuitable as a store of value or wealth due to their erratic swings, lack of purchasing power, and instant responsiveness to any technical problem, technical penetration, or official circumstance. Due to market instability, digital currencies can't be utilized to defer payments, settle debts, or repay loans.

Conclusions: Digital currencies are speculative; not real money. Most of those who have this money are speculators seeking a quick payoff. Sharia views digital currency trading as gambling due to its high degree of volatility. Jordan's government should regulate digital currency use to meet demand. Digital currencies must be addressed under e-commerce laws.
IMPROVEMENT OF THE METHODOLOGICAL APPROACH TO THE ASSESSMENT OF REPRODUCTION OF FIXED ASSETS OF RURAL FARMS
Authors: Aleksandrova Natal'ya , Subaeva Asiya , Gaynutdinov Ilgizar
Published: January 2023

The digital transformation of agribusiness served as the main goal of developing a methodology for assessing the reproduction of fixed assets of agricultural organizations. To determine the type of reproduction, an integral assessment is proposed, including the calculation of group indices by the level and efficiency of reproduction of fixed assets. Based on this methodology, agricultural organizations of Ulyanovsk region are divided into 6 types of reproduction of fixed assets: narrowed extensive, narrowed intensive, simple extensive, simple intensive, expanded extensive, expanded intensive. Agricultural organizations with an expanded type of reproduction are characterized by a higher value of the indicators of renewal and growth of funds, and a lower cost of retired funds. The excess of the value of the renewal coefficients of fixed assets of organizations with extended types of reproduction compared to narrowed types of reproduction is 0.072 ... groups in terms of reproduction efficiency also revealed a significant advantage of organizations with an expanded type of reproduction of funds over organizations with a narrowed type of reproduction in terms of capital productivity ratios by 0.161 ... 0.310 p., capital intensity ratios - by 0.184 ... 0.637 p. for organizations with an intensive direction of reproduction from narrowed to expanded type - from 0.153 to 0.238. The developed methodology for assessing the reproduction of fixed assets of agricultural organizations allows you to determine the priority areas for the reproduction of fixed assets of agricultural organizations based on a comparative analysis of selected groups in terms of the level and efficiency of the use of means of production.
THE ROLE OF THE VARIETY AND THE MAIN ELEMENTS OF TECHNOLOGY IN THE FORMATION OF THE YIELD OF SPRING SOFT WHEAT IN THE CONDITIONS OF THE PRE-VOLGA ZONE OF THE REPUBLIC OF TATARSTAN
Authors: Shaykhutdinov Farit , Serzhanov Igor , Serzhanova Al'bina , Garaev Razil , Zalyalov Ranis
Published: January 2023

The purpose of the study is to determine the effectiveness of the use of fertilizers, plant protection products, increasing yields and applying quality based on the selection of soft wheat varieties. Reserve study in 2020-2021 on chernozem soils of Avangard LLC, Buinsky district of the Republic of Tatarstan. The agrochemical characteristics of the soil of the experimental plot are as follows: in the presence of 0-20 cm of humus (7.0-8.5%), P2O5 - 182-255 mg/kg, K2O - 159-193 mg/kg and soil acidity (pHsalt) - 5.5-5.8. Chemical analyzes of soils were implemented in the Federal State Budgetary Institution, the Central Agrochemical Service “Tatarsky” for the impact of methods: humus content (GOST 26213-91), pHsol. (GOST 26484-85), R2O5 and K2O (GOST 26207-91). The meteorological conditions during the years of research differed sharply. In 2020, the HTC amounted to 1.18 during the growing season of spring wheat, and in 2021 - 0.37, which had a very negative impact on the formation of the spring wheat crop. In the years of research, such varieties as Yoldyz and Ekada 109 turned out to be the most early-ripening. The duration of the growing season in 2020 was 96-102 days, in 2021 - 86-88 days. On average, over two years, the varieties Ekada 109 turned out to be more responsive to fertilization, yield increase, compared to the natural background - 0.81 t/ha, Arkhat - 0.48 t/ha, Balkysh - 0.46 t/ha and Burlak – 0.45 t/ha. For 2020-2021, in relation to the standard variety, the maximum increase in yield was provided by the varieties Ekada 109 - 0.93 t/ha, Yoldyz - 0.46 and Burlak - 0.44 t/ha against an unfertilized background, and with the introduction of NRK - 1,5; 0.66 and 0.49 t/ha, respectively. Spring wheat grains with a high content of protein and a mass fraction of gluten were formed against the background of the use of fertilizers in such varieties as Ekada 109 - 14.3 -14.8 and 28.0-28.6%, Yoldyz - 14.0 - 14.2 and 26.0-26.3%, Burlak - 14.7-15.0 and 25.7-26.1%. The quality of gluten (according to IDK) in the same varieties on both backgrounds of nutrition, belonged to groups I-II.
Is Alzhezimer’s disease a New Type Diabetes? Crosstalk between two serious disorders: review
Authors: Dobosz Maciej , Rudziński Gracjan , Chilimoniuk Zuzanna , Więsyk Piotr , Kusak Natalia , Chałupnik Aleksandra
Published: January 2023

Introduction and purpose: More and more reports suggest that diabetes plays an important role in the pathogenesis of Alzheimer's disease (AD). Understanding this link may provide a new approach to modulating the onset and progression of sporadic AD cases. The aim of the study is to present the current state of knowledge on the basic mechanisms and factors influencing the development of AD in patients with type 2 diabetes in the context of clinical practice.

State of knowledge: It is estimated that up to 80% of Alzheimer's patients have glucose intolerance or diabetes. Impaired insulin signaling can lead to abnormal processing and accumulation of beta-amyloid protein, which can result in memory deficits and cognitive decline. Insulin deficiency can also cause over-activity of the GSK3 enzyme, leading to tau hyperphosphorylation and senile plaque accumulation. Diabetes can also cause fibrotic changes in cerebral vessels, disrupting brain metabolism and potentially leading to hippocampus atrophy. The release of cytokines during the metabolic syndrome can also cause oxidative stress and neuroinflammation, which may contribute to neuronal atrophy. It has been reported that healthy diet, physical exercises and prevention of metabolic diseases may reduce the incidence of AD.

Conclusions: Epidemiological data and pathophysiological studies indicate a significant relationship between these diseases that AD is sometimes called Type 3 diabetes. Early detection of hyperglycemia and its proper management, may be crucial in the context of the clinical prevention of dementia diseases. It is essential to pay attention to the cognitive abilities of patients with metabolic diseases.
Realization of a graph as the Reeb graph of a height function on an embedded surface
Authors: Gelbukh Irina
Published: January 2023

We show that for a given finite graph $G$ without loop edges and isolated vertices, there exists an embedding of a closed orientable surface in $\mathbb{R}^3$
such that the Reeb graph of the associated height function has the structure of $G$.
In particular, this gives a positive answer to the corresponding question posed by Masumoto and Saeki in 2011.
We also give a criterion for a given surface to admit such a realization of a given graph, and study the problem in the class of Morse functions
and in the class of round Morse-Bott functions.
In the case of realization up to homeomorphism, the height function can be chosen Morse-Bott;
we estimate from below the number of its critical circles and the number of its isolated critical points in terms of the graph structure.
Existence of solutions for the Brezis-Nirenberg problem
Authors: De Paiva Francisco Odair , Miyagaki Olímpio H. , Presoto Adilson E.
Published: January 2023

We are concerned with of existence of solutions to the semilinear elliptic problem
$$
\begin{cases}
- \Delta u=\lambda_{k}u+u^3 &\text{in } \Omega, \\
u= 0 &\text{on }\partial \Omega,
\end{cases}
$$%
in a bounded domain $\Omega \subset \mathbb{R}^{4}$. Here $\lambda_k$
is an eigenvalue of the $-\Delta$ in $H_0^1(\Omega)$. We prove that this problem has a nontrivial solution.
LA ALGODONERA DE PARQUE ALCOSA: REIVINDICACIÓN Y REINVENCIÓN DE ESPACIOS A TRAVÉS DE ESTRATEGIAS DE PATRIMONIALIZACIÓN.
Authors: Asencio García Juan Diego
Published: January 2023

En este texto queremos dar luz a la movilización surgida de un grupo vecinal del barrio de Parque Alcosa, en Sevilla, por la patrimonialización de la antigua fábrica de algodón “Virgen de los Reyes” y en contra del proyecto de urbanización que se está desarrollando sobre la misma. Con ello, queremos conocer la relación existente entre las demandas sociales que han motivado las acciones de determinados colectivos por la definición y apropiación de este espacio, y el contexto urbano, producto de políticas neoliberales como es el Distrito Este de Sevilla, en el que aquella tiene lugar. Desde una perspectiva antropológica, queremos comprender la estrategia de patrimonialización como reivindicación del derecho a la ciudad en este caso concreto y atendiendo a su encaje en dinámicas globales.
Rękopiśmienny śpiewnik benedyktynki ormiańskiej Antoniny Grzegorzowiczówny z 1757 roku jako przykład alografii ormiańsko-polskiej
Authors: Zięba Andrzej A.
Published: January 2023

THE HANDWRITTEN PRAYER BOOK OF THE BENEDICTINE NUN ANTONINA GRZEGORZOWICZÓWNA FROM 1757 The collections of the library of the Armenian patriarchate in Jerusalem (St. Toros Manuscript Library) include a valuable souvenir of the cultural heritage of the Polish Armenians – the handwritten prayer book of Antonina Grzegorzowiczów na, a Benedictine nun from Lwów (ref. number 3856). It is the oldest collection of songs from the monastery of the Armenian Benedictines nuns in Lwów, which has been preserved until our times. It dates back to 1757 and comprises the colophon written by Asvadzadur, a son of Ovanes. It provides information that the songbook was to be a gift for his sister, whose name had been written with the Polish letters under the copyist’s colophon. The consecration of Antonina, which took place a month later, on 13th November, in the Armenian cathedral of Lwów, was a reason of the gift. The article characterises the figure of the owner, analyses the content of the songbook – its usefulness for research on cultural (linguistic and religious) relations in Lwów in the 18th century – and determines the fate of the manuscript.
Plany utworzenia nowej unii kościelnej słowiańsko-ormiańskokatolickiej w Polsce w latach trzydziestych XX wieku
Authors: Krzyżowski Tomasz
Published: January 2023

PLANS FOR THE CREATION OF A NEW CHURCH SLAVIC ARMENIAN CATHOLIC UNION IN POLAND IN THE 1930S In the second half of the 1930s, a group of Old Catholic and Orthodox priests and believers from Zamość Region and Volhynia tried to join the Catholic Church. Ignacy Jan Wysoczański (1901-1975) was the framer of this plan. A new church structure was to be under the jurisdiction of the Armenian archbishop of Lwów, Józef Teodorowicz (1864-1938), who accepted the idea with enthusiasm. Efforts undertaken to achieve the confirmation of the union in 1935 were negatively assessed by the Vatican Congregation for Eastern Churches, mainly due to formal questions, because – according to the canon law and the concordat signed with Poland – priests and believers expressing willingness to join the Catholic Church should be subordinate to the bishop of the place. It soon turned out that Ignacy Wysoczański was a controversial and unsteady person, which ultimately shattered the plan.
Seminaria naukowe Ośrodka Badań nad Kulturą Ormiańską w Polsce w latach 2019-2022 – przyczynek do poznania najnowszego etapu kształtowania się armenologii polskiej
Authors: Wasyl Franciszek , Zięba Andrzej A.
Published: January 2023

SEMINARS OF THE RESEARCH CENTER FOR ARMENIAN CULTURE IN POLAND IN THE YEARS 2019-2022

This is the thematic analysis of tutorial meetings, organised in the Research Center for Armenian Culture in Poland (Polish Academy of Arts and Sciences in Krakow) in the years 2019-2022.
The Effect of Coding Education on Analytical Thinking of Gifted Students
Authors: Kocaman Berrak
Published: January 2023

This research aims to examine the effect of coding education on the analytical thinking skills of gifted students. The participants are 18 students, 11 to 12 years old. An embedded experimental mixed design was used in the research. The data collection was carried out with the Analytical Thinking Skill Scale to determine the difference in the analytical thinking skills of the study group before and after the coding training; the Analytical Thinking Skill Observation Form to determine the analytical thinking skill levels during the implementation process; and the semi-structured interview form to get their opinions on the coding training. The data were analyzed with a pre-test-post-test quasi-experimental design, descriptive analysis, and content analysis. The results show that coding education developed the participants' analytical thinking skills. The difference in the analytical thinking skills of the study group was not statistically significant in terms of gender. According to the students' views on the coding education application process, there was an improvement in the sub-dimensions of sorting, classification, comparison, and evaluation in analytical thinking skills; coding education developed problem-solving and thinking skills, was useful, encouraged students to choose a profession, and was entertaining, as well as negative opinions such as being difficult, boring, and requiring a lack of time.