bluuebunny/crossref_metadata_2025 huggingface dataset:
Transplantation of infant kidneys - the surgical technique en bloc and transplant position variation: A case report
Authors: Popovic Vladan , Sekulic Vuk , Manojlovic Vladimir , Milosevic Djordje , Nikolic Dragan , Pasternak Janko
Published: October 2015

Introduction. Due to the ever-present lack of kidney transplant grafts, more
and more organs obtained from the so-called ?marginal donors? group are
accepted, which can provide suboptimal effect of transplantation, depending
on their characteristics and/or implantation techniques. Case report. We
presented a case with successful variation of kidney position with modified
approach of kidney transplantation from an infant to an adult female patient
with normal postoperative recovery. Urethral anastomosis was performed
without antireflux procedure and this has not led to the development of
reflux disease at an early stage. Conclusion. The position of a pair of
kidneys proved to be satisfactory despite the growth of the kidney to the
expected size and relatively small pelvis. There were no problems with venous
stasis and kidney function from the very beginning was good.
Influence of open surgical and endovascular abdominal aortic aneurysm repair on clot quality assessed by ROTEM® test
Authors: Sarac Momir , Marjanovic Ivan , Bezmarevic Mihailo , Sarac Sanja , Milic Rade , Obradovic Slobodan , Tomic Aleksandar
Published: October 2015

Introduction/Aim. The disturbances in hemostasis are often in open surgical
repair (OR) and endovascular repair (EVAR) of an abdominal aortic aneurysm
(AAA). These changes may influence the perioperative and early postoperative
period inducing serious complications. The aim of this study was to compare
the impact of OR and EVAR of AAA on clot quality assessed by rotational
thromboelastometry (ROTEM?) tests. Methods. The study included 40 patients
who underwent elective AAA surgery and were devided into two groups (the OR
and the EVAR group - 20 patients in each group). The ROTEM ? test was
performed in 4 points: point 1 - 10 min before starting anesthesia in both
groups; point 2 - 10 min after aortic clapming in the OR group and 10 min
after the stent-graft trunk release in the EVAR group; point 3 - 10 min after
the releasing of aortic clamp in the OR group and 10 min after stentgraft
placement and releasing the femoral clamp in the EVAR group; point 4 - one
hour after the procedure in both groups. Three ROTEM? tests were performed
as: extrinsically activated assay with tissue factor (EXTEM), intrinsically
activated test using kaolin (INTEM), and extrinsically activated test with
tissue factor and the platelet inhibitor cytochalasin D (FIBTEM). All tests
included the assessment of the maximum clot firmness (MCF) and the platelet
component of clot strength was presented as maximal clot elasticity (MCE).
Results. No significant difference in age, gender and diameter of AAA between
groups was found. The time required for the procedure was significantly
longer and loss of blood was greater in the OR group than in the EVAR group
(p < 0.001). The significant deviation of MCF values in EXTEM test was found
mainly in the point 3 (p ? 0.004) with significant difference between groups
(p < 0.001). A significant difference of MCF values in INTEM test between
groups was found in the points 3 and 4 (p < 0.001), which were dose-dependent
by heparin sulfate. The MCF values in FIBTEM test were more prominent in the
OR group than in the EVAR group without significant difference. The
significant changes of MCF values in the FIBTEM test were found during time
in both groups (p < 0.001). The values of MCE were lower in both groups, but
without significant changes and difference between groups (p = 0.105).
Conclusion. The disorders of hemostatic parameters assessed by ROTEM? tests
are present in both the OR and the EVAR groups being more prominent in OR of
AAA. Vigilant monitoring of hemostatic parameters evaluated by ROTEM? tests
could help in administration of the adequate and target therapy in patients
who underwent EVAR or OR of AAA.
Vendor-buyer coordination and supply chain optimization with deterministic demand function
Authors: Uddin Mohammed , Mondal Manik , Hussain Kazi
Published: October 2015

This paper presents a model that deals with a vendor-buyer multi-product,
multi-facility and multi-customer location selection problem, which subsume a
set of manufacturer with limited production capacities situated within a
geographical area. We assume that the vendor and the buyer are coordinated by
mutually sharing information. We formulate Mixed Integer Linear Fractional
Programming (MILFP) model that maximize the ratio of return on investment of
the distribution network, and a Mixed Integer Program (MIP), used for the
comparison. The performance of the model is illustrated by a numerical
example. In addition, product distribution and allocation of different
customers along with the sensitivity of the key parameters are analyzed. It
can be observed that the increment of the opening cost decreases the profit
in both MILFP and MIP models. If the opening cost of a location decreases or
increases, the demand and the capacity of that location changes accordingly.
The Efficacy of Shareholder Voting in Staggered and Non-Staggered Boards: The Case of Audit Committee Elections
Authors: Gal-Or Ronen , Hoitash Rani , Hoitash Udi
Published: October 2015

We examine whether shareholder votes can influence the audit committee and whether this influence is uniform across non-staggered and staggered boards. We find that through voting, shareholders can increase the efficacy of the audit committee, leading to improvements in audit committee structure, diligence, and financial reporting quality. These results hold only in firms with non-staggered boards, underscoring the need to separately examine staggered and non-staggered boards. Importantly, the non-responsiveness of staggered audit committees to shareholder disapproval presents an additional explanation for the weaker performance that is often documented for firms with staggered boards. Overall, our results support the movement to de-stagger boards.
Pain experience during initial alignment with three types of nickel-titanium archwires: A prospective clinical trial
Authors: Abdelrahman Reem Sh. , Al-Nimri Kazem S. , Al Maaitah Emad F.
Published: October 2015

Objective: 

To clinically evaluate the pain intensity during the week following initial placement of three different orthodontic aligning archwires.

Materials and Methods: 

A consecutive sample of 75 patients requiring upper and lower fixed orthodontic appliances were alternately allocated into three different archwires (0.014-inch superelastic NiTi, 0.014-inch thermoelastic NiTi or 0.014-inch conventional NiTi). Assessments of pain/discomfort were made on a daily basis over the first 7-day period after bonding by means of visual analog scale and consumption of analgesics. The maximum pain score was recorded. The possible associations between age, gender, degree of crowding, and teeth irregularity and the pain intensity were also examined. Demographic and clinical differences between the three groups were compared with chi-square test or analysis of variance (ANOVA) test.

Results: 

No statistically significant differences were found in the pain intensity when the three aligning NiTi archwires were compared (P  =  .63). No significant differences in pain perception were found in terms of gender, age, lower arch crowding, and incisor irregularity. The intake of analgesics was the least in the superelastic NiTi group.

Conclusion: 

The three forms of NiTi wires were similar in terms of pain intensity during the initial aligning stage of orthodontic fixed appliance therapy. Gender, age, and the degree of crowding have no effect on the perceived discomfort experienced by patients undergoing fixed orthodontic treatment.
Airway compartments volume and oxygen saturation changes after rapid maxillary expansion: A longitudinal correlation study
Authors: Fastuca Rosamaria , Perinetti Giuseppe , Zecca Piero Antonio , Nucera Riccardo , Caprioglio Alberto
Published: October 2015

Objective: 

To evaluate changes in airway volumes and respiratory performance in patients undergoing rapid maxillary expansion and determine whether any correlations exist between the morphological and respiratory functional modifications induced by rapid maxillary expansion and pretreatment airway stenosis.

Materials and Methods: 

Fifteen patients (11 females and 4 males; mean age, 7.5 ± 0.3 years) were enrolled in the study. Each patient underwent cone beam computed tomography and polysomnography examination before rapid maxillary expansion and after the removal of the maxillary expander 12 months later. The airway regions were segmented and the volumes were computed.

Results: 

The upper, middle, and lower airway volumes were significantly increased 2305 mm3, 1144 mm3, and 1915 mm3, respectively. Similarly, oxygen saturation was increased (+5.3%) and the apnea/hypopnea index was improved (−4.2 events). All the observed modifications were statistically significant (P < .05). Baseline middle and lower airway volume showed a significant negative correlation with the oxygen saturation modification.

Conclusions: 

The results of this study showed that when rapid maxillary expansion is performed in subjects having posterior crossbite, oxygen saturation is improved. The improvement is greater in subjects having more reduced middle and lower airway volumes.
Impact of malocclusion and dentofacial anomalies on the prevalence and severity of dental caries among adolescents
Authors: Feldens Carlos Alberto , dos Santos Dullius Angela Isabel , Kramer Paulo Floriani , Scapini Annarosa , Busato Adair Luiz Stefanello , Vargas-Ferreira Fabiana
Published: October 2015

Objectives: 

To investigate the association between malocclusion/dentofacial anomalies and dental caries among adolescents.

Materials and Methods: 

A cross-sectional study was conducted with 509 adolescents aged 11 to 14 years enrolled at public schools in the city of Osório in southern Brazil. Parents/caregivers answered a structured questionnaire on demographic and socioeconomic variables. A trained examiner recorded the presence of malocclusion (Dental Aesthetic Index [DAI]), traumatic dental injury, and dental caries. Data analysis involved the chi-square, Mann-Whitney, and Kruskal-Wallis tests. Poisson regression with robust variance was used for the multivariable analysis.

Results: 

A total of 44.8% of the adolescents had dental caries (mean DFMT  =  1.33 ± 1.84). The DAI index ranged from 15 to 77 (mean  =  29.0 ± 7.9); 43.6% of the sample had severe malocclusion and 11.6% had traumatic dental injury. The prevalence and severity of dental caries were significantly greater among adolescents with severe malocclusion. The multivariate analysis demonstrated that adolescents with severe or handicapping malocclusion had a 31% greater probability of having dental caries (prevalence ratio: 1.31; 95% CI: 1.02–1.67), independently of demographic, socioeconomic, or clinical aspects. The orthodontic characteristics associated with the occurrence and severity of caries were maxillary irregularity ≥3 mm (P  =  .021) and abnormal molar relationship (P  =  .021).

Conclusions: 

Handicapping malocclusion, maxillary irregularity, and abnormal molar relationship were associated with the occurrence and severity of dental caries. The findings suggest that the prevention and treatment of these conditions can contribute to a reduction in dental caries among adolescents.
Primitive Myxoid Mesenchymal Tumor of Infancy Involving Chest Wall in an Infant: A Case Report and Clinicopathologic Correlation
Authors: Foster Jennifer H. , Vasudevan Sanjeev A. , Hicks M. John , Schady Deborah , Chintagumpala Murali
Published: October 2015

Primitive myxoid mesenchymal tumor of infancy (PMMTI) is a rare mesenchymal tumor of early childhood characterized by aggressive local infiltration of surrounding structures, rare metastases, and poor response to chemotherapy. Surgery alone appears to be the most effective treatment given the lack of predilection for metastasis and poor response to traditional chemotherapy. Below we report a patient with PMMTI successfully managed with surgery and observation and summarize the existing literature on histopathologic features and treatment of this lesion.
A systematic review of the effects of euthanasia and occupational stress in personnel working with animals in animal shelters, veterinary clinics, and biomedical research facilities
Authors: Scotney Rebekah L. , McLaughlin Deirdre , Keates Helen L.
Published: October 2015

Background—The study of occupational stress and compassion fatigue in personnel working in animal-related occupations has gained momentum over the last decade. However, there remains incongruence in understanding what is currently termed compassion fatigue and the associated unique contributory factors. Furthermore, there is minimal established evidence of the likely influence of these conditions on the health and well-being of individuals working in various animal-related occupations.

Objective—To assess currently available evidence and terminology regarding occupational stress and compassion fatigue in personnel working in animal shelters, veterinary clinics, and biomedical research facilities.

Data Sources—Studies were identified by searching the following electronic databases with no publication date restrictions: ProQuest Research Library, ProQuest Social Science Journals, PsycARTICLES, Web of Science, Science Direct, Scopus, PsychINFO databases, and Google Scholar. Search terms included (euthanasia AND animals) OR (compassion fatigue AND animals) OR (occupational stress AND animals).

Study Appraisal and Synthesis—Only articles published in English in peer-reviewed journals that included use of quantitative or qualitative techniques to investigate the incidence of occupational stress or compassion fatigue in the veterinary profession or animal-related occupations were included. On the basis of predefined criteria, 1 author extracted articles, and the data set was then independently reviewed by the other 2 authors.

Results—12 articles met the selection criteria and included a variety of study designs and methods of data analysis. Seven studies evaluated animal shelter personnel, with the remainder evaluating veterinary nurses and technicians (2), biomedical research technicians (1), and personnel in multiple animal-related occupations (2). There was a lack of consistent terminology and agreed definitions for the articles reviewed. Personnel directly engaged in euthanasia reported significantly higher levels of work stress and lower levels of job satisfaction, which may have resulted in higher employee turnover, psychological distress, and other stress-related conditions.

Limitations and Conclusions—Results of this review suggested a high incidence of occupational stress and euthanasia-related strain in animal care personnel. The disparity of nomenclature and heterogeneity of research methods may contribute to general misunderstanding and confusion and impede the ability to generate high-quality evidence regarding the unique stressors experienced by personnel working with animals. The present systematic review provided insufficient foundation from which to identify consistent causal factors and outcomes to use as a basis for development of evidence-based stress management programs, and it highlights the need for further research.
Evaluation of an enzyme immunoassay for antibodies to a recombinant Blastomyces adhesin-1 repeat antigen as an aid in the diagnosis of blastomycosis in dogs
Authors: Mourning Alyssa C. , Patterson Edward E. , Kirsch Emily J. , Renschler Janelle S. , Wolf Linda A. , Paris Jasmin K. , Durkin Michelle M. , Wheat Lawrence J.
Published: October 2015

Objective—To evaluate the sensitivity and specificity of an enzyme immunoassay (EIA) for antibodies to a recombinant Blastomyces adhesin-1 repeat antigen (rBAD-1) to aid in the diagnosis of blastomycosis in dogs and compare the findings with results from other tests used for this purpose.

Design—Prospective analytic study.

Sample—Serum and urine from 70 dogs with and without blastomycosis.

Procedures—Serum and urine samples were collected from dogs with blastomycosis (n = 21), histoplasmosis (8), or nonfungal pulmonary disease (21) and from healthy control dogs living in a blastomycosis-endemic area (20). Serum was tested for antibodies against Blastomyces dermatitidis with the rBAD-1 antibody EIA and an A-antigen antibody agar gel immunodiffusion (AGID) assay. Serum and urine were tested for B dermatitidis antigen with a quantitative EIA.

Results—Sensitivity of the quantitative antigen EIA was 100% in serum and urine samples from dogs with blastomycosis, with specificity of 95% in urine samples from dogs with nonfungal pulmonary disease and 100% in urine samples from healthy dogs. Sensitivity of the rBAD-1 antibody EIA (95%) was significantly greater than that of the A-antigen antibody AGID assay (65%). Specificity of the antibody EIA was 88% in dogs with histoplasmosis, 95% in healthy dogs, and 100% in dogs with nonfungal pulmonary disease.

Conclusions and Clinical Relevance—The rBAD-1 antibody EIA had greater sensitivity than the A-antigen antibody AGID assay in dogs with blastomycosis. This antibody EIA may assist in distinguishing histoplasmosis from blastomycosis. Further evaluation in a larger prospective study is needed to verify these results.
Incidence rates and risk factors for owner-reported adverse events following vaccination of dogs that did or did not receive a Leptospira vaccine
Authors: Yao Peng Ju , Stephenson Nicole , Foley Janet E. , Toussieng Chuck R. , Farver Thomas B. , Sykes Jane E. , Fleer Katryna A.
Published: October 2015

Objective—To determine incidence rates (IRs) and potential risk factors for owner-reported adverse events (AEs) following vaccination of dogs that did or did not receive a Leptospira vaccine.

Design—Observational, retrospective cohort study.

Animals—130,557 dogs.

Procedures—Electronic records of mobile veterinary clinics from June 2012 to March 2013 were searched to identify dogs that received ≥ 1 vaccine in a given visit. Signalment data, vaccinations received, medications administered, and owner-reported clinical signs consistent with AEs that developed ≤ 5 days after vaccination were recorded. Associations between potential risk factors and owner-reported AEs were evaluated by logistic regression analysis.

Results—The IR/10,000 dogs for owner-reported postvaccination AEs was 26.3 (95% CI, 23.6 to 29.2), whereas that for dogs that received a Leptospira vaccine alone or with other vaccines was 53.0 (95% CI, 42.8 to 64.9). Significant factors for increasing or decreasing risk of AEs were as follows: receiving a Leptospira vaccine (adjusted OR, 2.13), age at vaccination 1 to < 7 or ≥ 7 years (vs a referent of < 6 months; adjusted OR, 0.54 and 0.44, respectively), and weight 13.6 to < 22.7 kg (30 to < 50 lb) and 22.7 to < 45.5 kg (50 to 100 lb [vs a referent of < 4.5 kg {10 lb}]; adjusted OR, 0.48 and 0.55, respectively). Hypersensitivity reactions were rare (IR, 6.5/10,000 dogs), and IRs for these events did not differ significantly between dogs vaccinated with or without a Leptospira component.

Conclusions and Clinical Relevance—The overall IR for owner-reported postvaccination AEs was low. Results suggested vaccination against Leptospira (an organism that can cause fatal disease) is safe in the majority of cases, slightly increasing the risk of owner-reported AEs but not associated with a significant increase in hypersensitivity reactions, compared with other vaccinations administered.
External skeletal fixator intramedullary pin tie-in for the repair of tibiotarsal fractures in raptors: 37 cases (1995–2011)
Authors: Bueno Irene , Redig Patrick T. , Rendahl Aaron K.
Published: October 2015

Objective—To evaluate the outcome of the application of an external skeletal fixator intramedullary pin tie-in (TIF) to tibiotarsal fractures in raptors.

Design—Retrospective case series.

Animals—Thirty-four raptors with 37 tibiotarsal fractures.

Procedures—Medical records and radiographs for raptors with tibiotarsal fractures that were treated at The Raptor Center at the University of Minnesota between 1995 and 2011 were reviewed. Descriptive statistics were generated and univariate logistic regression analyses were used to assess whether age, sex, body weight, location and nature of the fracture, and type of surgical reduction were significantly associated with whether the fracture healed following surgical reduction and TIF application.

Results—31 of 37 (84%) tibiotarsal fractures successfully healed following surgical reduction and TIF application. The mean healing time was 38 days (range, 15 to 70 days). None of the variables assessed were significantly associated with whether the tibiotarsal fracture healed. Twenty of the 34 (59%) raptors were eventually rehabilitated and released.

Conclusions and Clinical Relevance—Results indicated that most tibiotarsal fractures were successfully managed by surgical reduction and stabilization with a TIF. However, other comorbidities (eg, systemic infections and visual deficits) negatively affected the rehabilitation of raptors and sometimes resulted in euthanasia despite the fact that the tibiotarsal fracture had healed, and those comorbidities, along with the variables evaluated (eg, age, sex, and nature of the fracture), should be used as triage criteria and prognostic indicators.
Hijacked Narratives
Authors: Cole Barbara
Published: October 2015

This article examines public art’s relationship to urban mega-events through a case study of “The Games are Open,” a durational outdoor artwork that was constructed from Vancouver 2010 Winter Olympic–detritus by Berlin-based artists Folke Köbberling and Martin Kaltwasser. Taking the form of a larger-than-life bulldozer with shovel down, it faced the expanse of interim lands awaiting future development along Vancouver’s South East False Creek. Exposed to weather, soil, and the passing of time, the artwork was intended to give way to a process of gradual decomposition, its form providing fodder for new growth. Over the four years of the project’s existence, its form shifted from sculpture, to garden, to dirt pile, each transformation driven by the agendas of assumed owners. This article chronicles the artwork’s co-option within the context of land speculation that is embedded within Vancouver’s history of building up and tearing down. It relates how the protection and control of property spawned by mega-events influenced the project’s outcome.
Years of Challenge and Risk
Authors: Armour Norman
Published: October 2015

Festival curation and arts management in Vancouver is challenging at the best of times. One is always competing for money, audiences, equipment, and skilled production staff. These issues are only magnified when a “Big Show” like the Olympics comes to town, especially if its premiere cultural events coincide precisely with one’s own normal programming time slot. In this essay I reflect on what the PuSh International Performing Arts Festival, held every January–February in Vancouver, did to face the challenges and mitigate the risks of both competing against and collaborating with the 2010 Cultural Olympiad. I also offer some thoughts on what, if anything, has changed in the cultural landscape of Vancouver as a result of this mega-event.
Kickstart’s Experience of the 2010 Cultural Olympiad
Authors: McMurchy Geoff
Published: October 2015

Past Artistic Director of Kickstart Disability Arts and Culture, Geoff McMurchy, recounts Kickstart’s experience of incorporating its festival of disability arts into the 2010 Winter Olympics Cultural Olympiad.
The Show Must Go On: Birthing SFU Woodward’s Before and After the 2010 Olympics
Authors: Boucher Michael
Published: October 2015

Coincident with the Vancouver 2010 Olympics and Cultural Olympiad, Simon Fraser University relocated its Contemporary Arts program to the SFU Woodward’s (SFUW) building as part of a major redevelopment initiative, which included a promise of cultural/community engagement within a neighbourhood historically under social and economic distress. The implications of this new mandate involved much consultation on how best to proceed in such a challenging context—which included additional logistical and social constraints related to SFUW’s partnership with the Cultural Olympiad on a production of Robert Lepage’s The Blue Dragon. Five years later, with more than forty community cultural partners and distinct cultural programs, SFU Woodward’s has developed an engagement platform distinguished by a street smart approach. In this reflection, I focus on how SFUW has negotiated how best to support the notion of the right to culture for all in its many activities.
Who Pays for the Public to Play?
Authors: Hanson Nicholas
Published: October 2015

In Fair Play, Jen Harvie interrogates the proliferation of performance and art practices that socially engage audiences through a range of participatory, immersive, and interactive forms. Detailed examinations of artistic labour, creative industries, and arts funding highlight ways that contemporary artists and organizations have been absorbed into neoliberal capitalist structures.
Microsurgical anatomy and internal architecture of the brainstem in 3D images: surgical considerations
Authors: Párraga Richard Gonzalo , Possatti Lucas Loss , Alves Raphael Vicente , Ribas Guilherme Carvalhal , Türe Uğur , de Oliveira Evandro
Published: October 2015

OBJECT

Brainstem surgery remains a challenge for the neurosurgeon despite recent improvements in neuroimaging, microsurgical techniques, and electrophysiological monitoring. A detailed knowledge of the microsurgical anatomy of the brainstem surface and its internal architecture is mandatory to plan appropriate approaches to the brainstem, to choose the safest point of entry, and to avoid potential surgical complications.

METHODS

An extensive review of the literature was performed regarding the brainstem surgical approaches, and their correlations with the pertinent anatomy were studied and illustrated through dissection of human brainstems properly fixed with 10% formalin. The specimens were dissected using the fiber dissection technique, under ×6 to ×40 magnification. 3D stereoscopic photographs were obtained (anaglyphic 3D) for better illustration of this study.

RESULTS

The main surgical landmarks and their relationship with the cerebellum and vascular structures were identified on the surface of the brainstem. The arrangements of the white matter (ascending and descending pathways as well as the cerebellar peduncles) were demonstrated on each part of the brainstem (midbrain, pons, and medulla oblongata), with emphasis on their relationships with the surface. The gray matter, constituted mainly by nuclei of the cranial nerves, was also studied and illustrated.

CONCLUSIONS

The objective of this article is to review the microsurgical anatomy and the surgical approaches pertinent to the brainstem, providing a framework of its external and internal architecture to guide the neurosurgeon during its related surgical procedures.
Neurosurgery for schizophrenia: an update on pathophysiology and a novel therapeutic target
Authors: Mikell Charles B. , Sinha Saurabh , Sheth Sameer A.
Published: October 2015

The main objectives of this review were to provide an update on the progress made in understanding specific circuit abnormalities leading to psychotic symptoms in schizophrenia and to propose rational targets for therapeutic deep brain stimulation (DBS). Refractory schizophrenia remains a major unsolved clinical problem, with 10%–30% of patients not responding to standard treatment options. Progress made over the last decade was analyzed through reviewing structural and functional neuroimaging studies in humans, along with studies of animal models of schizophrenia. The authors reviewed theories implicating dysfunction in dopaminergic and glutamatergic signaling in the pathophysiology of the disorder, paying particular attention to neurosurgically relevant nodes in the circuit. In this context, the authors focused on an important pathological circuit involving the associative striatum, anterior hippocampus, and ventral striatum, and discuss the possibility of targeting these nodes for therapeutic neuromodulation with DBS. Finally, the authors examined ethical considerations in the treatment of these vulnerable patients. The functional anatomy of neural circuits relevant to schizophrenia remains of great interest to neurosurgeons and psychiatrists and lends itself to the development of specific targets for neuromodulation. Ongoing progress in the understanding of these structures will be critical to the development of potential neurosurgical treatments of schizophrenia.
Lower rates of symptom recurrence and surgical revision after primary compared with secondary endoscopic third ventriculostomy for obstructive hydrocephalus secondary to aqueductal stenosis in adults
Authors: Sankey Eric W. , Goodwin C. Rory , Jusué-Torres Ignacio , Elder Benjamin D. , Hoffberger Jamie , Lu Jennifer , Blitz Ari M. , Rigamonti Daniele
Published: October 2015

OBJECT

Endoscopic third ventriculostomy (ETV) is the treatment of choice for obstructive hydrocephalus; however, the success of ETV in patients who have previously undergone shunt placement remains unclear. The present study analyzed 103 adult patients with aqueductal stenosis who underwent ETV for obstructive hydrocephalus and evaluated the effect of previous shunt placement on post-ETV outcomes.

METHODS

This study was a retrospective review of 151 consecutive patients who were treated between 2007 and 2013 with ETV for hydrocephalus. One hundred three (68.2%) patients with aqueductal stenosis causing obstructive hydrocephalus were included in the analysis. Postoperative ETV patency and aqueductal and cisternal flow were assessed by high-resolution, gradient-echo MRI. Post-ETV Mini-Mental State Examination, Timed Up and Go, and Tinetti scores were compared with preoperative values. Univariate and multivariate analyses were performed comparing the post-ETV outcomes in patients who underwent a primary (no previous shunt) ETV (n = 64) versus secondary (previous shunt) ETV (n = 39).

RESULTS

The majority of patients showed significant improvement in symptoms after ETV; however, no significant differences were seen in any of the quantitative tests performed during follow-up. Symptom recurrence occurred in 29 (28.2%) patients after ETV, after a median of 3.0 (interquartile range 0.8–8.0) months post-ETV failure. Twenty-seven (26.2%) patients required surgical revision after their initial ETV. Patients who received a secondary ETV had higher rates of symptom recurrence (p = 0.003) and surgical revision (p = 0.003), particularly in regard to additional shunt placement/revision post-ETV (p = 0.005). These differences remained significant after multivariate analysis for both symptom recurrence (p = 0.030) and surgical revision (p = 0.043).

CONCLUSIONS

Patients with obstructive hydrocephalus due to aqueductal stenosis exhibit symptomatic improvement after ETV, with a relatively low failure rate. Patients with a primary history of shunt placement who undergo ETV as a secondary intervention are at increased risk of symptom recurrence and need for surgical revision post-ETV.
Endoscopic third ventriculostomy and choroid plexus cauterization with a rigid neuroendoscope in infants with hydrocephalus
Authors: Weil Alexander G. , Fallah Aria , Chamiraju Parthasarathi , Ragheb John , Bhatia Sanjiv
Published: October 2015

OBJECT

Combining endoscopic third ventriculostomy (ETV) with choroid plexus cauterization (CPC) has been shown to improve the success rate compared with ETV alone in infants (less than 24 months) with hydrocephalus who were treated in developing countries. The authors sought to evaluate the safety and efficacy of this procedure, using a rigid neuroendoscope, in a single North American center, and to assess whether the ETV success score (ETVSS), the CURE Children’s Hospital of Uganda ETVSS (CCHU ETVSS), and other pre- and intraoperative variables could predict success.

METHODS

The authors performed a retrospective review of consecutive ETV/CPC procedures performed using a rigid neuroendoscope to treat infantile hydrocephalus. The infants underwent the procedure at Miami Children’s Hospital between January 2007 and 2014, with at least one postoperative follow-up. Duration of follow-up or time to failure of ETV/CPC, the primary outcome measure, was documented. A repeat CSF diversion procedure or death was considered as a failure of ETV/CPC. The time to event was measured using a Kaplan-Meier analysis. The authors analyzed ETVSS, CCHU ETVSS, and pre- and intraoperative variables to determine their suitability to predict success.

RESULTS

Eighty-five patients (45 boys) with a mean age of 4.3 months (range 1 day to 20 months) underwent ETV/CPC. Etiology included intraventricular hemorrhage of prematurity in 44 patients (51.7%), myelomeningocele (MMC) in 7 (8.2%), congenital aqueductal stenosis in 12 (14.1%), congenital communicating hydrocephalus in 6 (7.1%), Dandy-Walker complex in 6 (7.1%), postinfectious hydrocephalus in 5 (5.8%), and other cause in 5 (5.8%). Six procedure-related complications occurred in 5 (5.8%) patients, including 2 hygromas, 1 CSF leak, and 3 infections. There were 3 mortalities in this cohort. ETV/CPC was successful in 42.1%, 37.7%, and 36.8% of patients at 6, 12, and 24 months follow-up, respectively. The median (95% CI) time to ETV/CPC failure was 4.0 months (0.9–7.1 months). In univariate analyses, both the ETVSS (hazard ratio [HR] 1.03; 95% CI 1.01–1.05; p = 0.004) and CCHU ETVSS (HR 1.48; 95% CI 1.04–2.09; p = .028) were predictive of outcome following ETV/CPC. In multivariate analysis, the presence of prepontine scarring was associated with ETV/CPC failure (HR 0.34; 95% CI 0.19–0.63; p < 0.001). Other variables, such as radiological criteria (prepontine interval, prepontine space, aqueductal stenosis, Third Ventricular Morphology Index) and intraoperative findings (ventriculostomy pulsations, extent of CPC), did not predict outcome.

CONCLUSIONS

ETV/CPC is a feasible alternative to ETV and ventriculoperitoneal shunt in infants with hydrocephalus. Both the ETVSS and CCHU ETVSS predicted success following ETV/CPC in this single-center North American cohort of patients.
Properties of convective delivery in spinal cord gray matter: laboratory investigation and computational simulations
Authors: Endo Toshiki , Fujii Yushi , Sugiyama Shin-ichiro , Zhang Rong , Ogita Shogo , Funamoto Kenichi , Saito Ryuta , Tominaga Teiji
Published: October 2015

OBJECT

Convection-enhanced delivery (CED) is a method for distributing small and large molecules locally into the interstitial space of the spinal cord. Delivering these molecules to the spinal cord is otherwise difficult due to the blood-spinal cord barrier. Previous research has proven the efficacy of CED for delivering molecules over long distances along the white matter tracts in the spinal cord. Conversely, the characteristics of CED for delivering molecules to the gray matter of the spinal cord remain unknown. The purpose of this study was to reveal regional distribution of macromolecules in the gray and white matter of the spinal cord with special attention to the differences between the gray and white matter.

METHODS

Sixteen rats (F344) underwent Evans blue dye CED to either the white matter (dorsal column, 8 rats) or the gray matter (ventral horn, 8 rats) of the spinal cord. The rates and total volumes of infusion were 0.2 μl/min and 2.0 μl, respectively. The infused volume of distribution was visualized and quantified histologically. Computational models of the rat spinal cord were also obtained to perform CED simulations in the white and gray matter.

RESULTS

The ratio of the volume of distribution to the volume of infusion in the gray matter of the spinal cord was 3.60 ± 0.69, which was comparable to that of the white matter (3.05 ± 0.88). When molecules were injected into the white matter, drugs remained in the white matter tract and rarely infused into the adjacent gray matter. Conversely, when drugs were injected into the gray matter, they infiltrated laterally into the white matter tract and traveled longitudinally and preferably along the white matter. In the infusion center, the areas were larger in the gray matter CED than in the white matter (Mann-Whitney U-test, p < 0.01). In computational simulations, the aforementioned characteristics of CED to the gray and white matter were reaffirmed.

CONCLUSIONS

In the spinal cord, the gray and white matter have distinct characteristics of drug distribution by CED. These differences between the gray and white matter should be taken into account when considering drug delivery to the spinal cord. Computational simulation is a useful tool for predicting drug distributions in the normal spinal cord.
Isadore Max Tarlov (1905–1977) and the controversial Tarlov cyst: historical perspective
Authors: Konar Subhas K. , Bir Shyamal C. , Maiti Tanmoy K. , Bollam Papireddy , Nanda Anil
Published: October 2015

Isadore Max Tarlov, an early neurosurgeon, made several important contributions to the field of spine surgery. He described sacral perineural cysts, now known as Tarlov cysts. Dr. Tarlov also introduced the knee-chest patient position to facilitate exposure and hemostasis in lumbar surgery. In addition, he developed the use of fibrin glue in nerve repair. His book on mechanisms of spinal compression was published in 1957. He published a book of essays titled Principles of Parsimony in Medical Practice that remains highly relevant in today's medical world.
Improvement of syrinx resolution after tonsillar cautery in pediatric patients with Chiari Type I malformation
Authors: Stanko Kevin M. , Lee Young M. , Rios Jennifer , Wu Adela , Sobrinho Giovanna W. , Weingart Jon D. , Jackson Eric M. , Ahn Edward S. , Chaichana Kaisorn L. , Jallo George I.
Published: October 2015

OBJECT

Chiari Type I malformation involves caudal displacement of the cerebellar tonsils below the foramen magnum, which obstructs normal cerebrospinal fluid flow and increases intracranial pressure. Certain aspects of its surgical treatment remain controversial. A retrospective study was conducted to assess the efficacy of tonsillar cautery on syrinx resolution among pediatric Chiari patients undergoing cervicomedullary decompression.

METHODS

A retrospective cohort study was performed for patients 0–18 years of age who underwent surgical correction for Chiari Type I malformation with syrinx between 1995 and 2013. Basic demographic information was collected as well as data for preoperative symptoms, prior surgical history, perioperative characteristics, and postsurgical outcomes. Descriptive statistics were performed in addition to bivariate analyses. Candidate predictor variables were identified based on an association with tonsillar cautery with p < 0.10. Forward stepwise likelihood ratio was used to select candidate predictors in a binary logistic regression model (Pin = 0.05, Pout = 0.10) most strongly associated with the outcome.

RESULTS

A total of 171 patients with Chiari Type I malformation with syrinx were identified, and 43 underwent tonsillar cautery. Patients who underwent tonsillar cautery had 6.11 times greater odds of improvement in their syrinx (95% CI 2.57–14.49, p < 0.001). There was no effect of tonsillar cautery on increased perioperative complications as well as the need for repeat decompressions.

CONCLUSIONS

Tonsillar cautery is safe and effective in the treatment of Chiari Type I malformation with syrinx and may decrease time to syrinx resolution after cervicomedullary decompression. Tonsillar cautery does not increase postoperative complications in pediatric Chiari Type I malformation patients.
Postoperative imaging for detection of recurrent arteriovenous malformations in children
Authors: Morgenstern Peter F. , Hoffman Caitlin E. , Kocharian Gary , Singh Ranjodh , Stieg Philip E. , Souweidane Mark M.
Published: October 2015

OBJECT

The optimal method for detecting recurrent arteriovenous malformations (AVMs) in children is unknown. An inherent preference exists for MR angiography (MRA) surveillance rather than arteriography. The validity of this strategy is uncertain.

METHODS

A retrospective chart review was performed on pediatric patients treated for cerebral AVMs at a single institution from 1998 to 2012. Patients with complete obliteration of the AVM nidus after treatment and more than 12 months of follow-up were included in the analysis. Data collection focused on recurrence rates, associated risk factors, and surveillance methods.

RESULTS

A total of 45 patients with a mean age of 11.7 years (range 0.5–18 years) were treated for AVMs via surgical, endovascular, radiosurgical, or combined approaches. Total AVM obliteration on posttreatment digital subtraction angiography (DSA) was confirmed in 27 patients, of whom the 20 with more than 12 months of follow-up were included in subsequent analysis. The mean follow-up duration in this cohort was 5.75 years (median 5.53 years, range 1.11–10.64 years). Recurrence occurred in 3 of 20 patients (15%). Two recurrences were detected by surveillance DSA and 1 at the time of rehemorrhage. No recurrences were detected by MRA. Median time to recurrence was 33.6 months (range 19–71 months). Two patients (10%) underwent follow-up DSA, 5 (25%) had DSA and MRI/MRA, 9 (45%) had MRI/MRA only, 1 (5%) had CT angiography only, and 3 (15%) had no imaging within the first 3 years of follow-up. After 5 years posttreatment, 2 patients (10%) were followed with MRI/MRA only, 2 (10%) with DSA only, and 10 (50%) with continued DSA and MRI/MRA.

CONCLUSIONS

AVM recurrence in children occurred at a median of 33.6 months, when MRA was more commonly used for surveillance, but failed to detect any recurrences. A recurrence rate of 15% may be an underestimate given the reliance on surveillance MRA over angiography. A new surveillance strategy is proposed, taking into account exposure to diagnostic radiation and the potential for catastrophic rehemorrhage.
Mass gains of the Antarctic ice sheet exceed losses
Authors: Zwally H. Jay , Li Jun , Robbins John W. , Saba Jack L. , Yi Donghui , Brenner Anita C.
Published: October 2015

Mass changes of the Antarctic ice sheet impact sea-level rise as climate changes, but recent rates have been uncertain. Ice, Cloud and land Elevation Satellite (ICESat) data (2003–08) show mass gains from snow accumulation exceeded discharge losses by 82 ± 25 Gt a−1, reducing global sea-level rise by 0.23 mm a−1. European Remote-sensing Satellite (ERS) data (1992–2001) give a similar gain of 112 61 Gt a−1. Gains of 136 Gt a−1 in East Antarctica (EA) and 72 Gt a−1 in four drainage systems (WA2) in West Antarctic (WA) exceed losses of 97 Gt a−1 from three coastal drainage systems (WA1) and 29 Gt a−1 from the Antarctic Peninsula (AP). EA dynamic thickening of 147 Gt a−1 is a continuing response to increased accumulation (>50%) since the early Holocene. Recent accumulation loss of 11 Gt a−1 in EA indicates thickening is not from contemporaneous snowfall increases. Similarly, the WA2 gain is mainly (60 Gt a−1) dynamic thickening. In WA1 and the AP, increased losses of 66 ± 16 Gt a−1 from increased dynamic thinning from accelerating glaciers are 50% offset by greater WA snowfall. The decadal increase in dynamic thinning in WA1 and the AP is approximately one-third of the long-term dynamic thickening in EA and WA2, which should buffer additional dynamic thinning for decades.
Olefin metathesis in air
Authors: Piola Lorenzo , Nahra Fady , Nolan Steven P
Published: October 2015

Since the discovery and now widespread use of olefin metathesis, the evolution of metathesis catalysts towards air stability has become an area of significant interest. In this fascinating area of study, beginning with early systems making use of high oxidation state early transition metal centers that required strict exclusion of water and air, advances have been made to render catalysts more stable and yet more functional group tolerant. This review summarizes the major developments concerning catalytic systems directed towards water and air tolerance.
The Giant Resin Bee, Megachile sculpturalis Smith: New Distributional Records for the Mid- and Gulf-south USA
Authors: Parys Katherine , Tripodi Amber , Sampson Blair
Published: October 2015

Megachile (Callomegachile) sculpturalis Smith, the giant resin bee, is an adventive species in the United States. First established in the United States during the early 1990s, records currently exist from most states east of the Mississippi River along with Iowa and Kansas.

New distributional records are presented for Megachile (Callomegachile) sculpturalis Smith, an introduced bee. Additional records presented here expand the known distribution southwest through Arkansas, Louisiana, Mississippi, Missouri, and Texas. An updated host plant list containing new records is also presented, expanding the number of known floral associations.
L es élèves ont des corps. Regards enseignants
Authors: Voléry Ingrid
Published: October 2015

Partant d’une enquête qualitative réalisée, entre 2009 et 2013, dans dix établissements scolaires d’Alsace et de Lorraine, nous montrerons comment les enseignants et l’institution scolaire transforment la nature et la densité du sexe prêté aux enfants à travers des dispositifs d’hétérosexualisation dont la portée gagne à être plus finement étudiée.
Un corps qui gêne. Les médecins face à la puberté
Authors: Vinel Virginie
Published: October 2015

Cet article décrit la prise en charge du corps, par les médecins (généralistes et pédiatres), des enfants lors de leurs transformations pubertaires. Face au protocole médical qui leur demande de se dévoiler tant verbalement que corporellement, il révèle la résistance des grands enfants comme les stratégies des professionnels pour aborder leur corps avec discrétion et respecter leur pudeur.
Manger comme un grand. La régulation des pratiques alimentaires
Authors: Mathiot Louis
Published: October 2015

À travers une enquête ethnographique, cet article étudie le changement des pratiques alimentaires à la fin de l’enfance. Les transformations observées chez les 9-12 ans sont marquées par une volonté de se différencier des plus jeunes mais répondent également à d’autres logiques relatives au contrôle de soi, au corps et à la santé qui se différencient selon le genre.
« Juste » prix et réputation professionnelle : un double enjeu pour les enchères de bois public
Authors: Marty Gérard
Published: October 2015

En France, la singularité des lots de bois public mis en vente aux enchères par l’Office national des forêts pose la question de la détermination de leur prix. À partir d’une enquête ethnographique, cet article démontre que l’enchère conduit les participants à construire collectivement un consensus sur le « juste » prix des lots. Cette pratique sociale est alors l’occasion pour les enchérisseurs de mettre en jeu leur réputation d’experts quant à l’estimation des lots et la maîtrise des procédures d’enchères.
Inceste, mensonge et filiation. Une perspective ethnologique de la relation entre frère et sœur en Europe
Authors: Jamous Raymond
Published: October 2015

Si en Inde notamment, la relation frère-sœur se définit en rapport à l’alliance du mariage et à la construction rituelle de la filiation, il en va différemment dans la parenté en Europe contemporaine. C’est à partir de trois romans et de trois films considérés comme des récits ethnographiques que nous l’analyserons. Dans ces fictions, c’est l’ambiguïté et la tension qui sont au cœur des relations entre ces germains de sexe opposé : dans les romans, c’est un amour fusionnel jusqu’à l’inceste entre frère et sœur, amour stérile qui dévalorise tout autre relation de parenté ; dans les films, c’est la prééminence de la sœur sur le frère, mensonge de la sœur pour éduquer son frère. Il apparaît bien à partir de ces exemples que l’alternative se situe entre l’inceste et la filiation, sans que le mariage soit considéré comme une dimension importante de la construction sociale de la parenté.