bluuebunny/crossref_metadata_2025 huggingface dataset:
Dynamic thiol/disulfide homeostasis and oxidant status in patients with hypoparathyroidism
Authors: Koca Arzu Or , Dağdeviren Murat , Akkan Tolga , Ateş İhsan , Neşelioğlu Salim , Erel Özcan , Altay Mustafa
Published: August 2019

Background

In this study, we aimed at determining the dynamic thiol/disulfide homeostasis and oxidant balance, and investigating the relation of these parameters to the severity of the disease and the serum calcium levels.

Methods

55 patients with iatrogenic hypoparathyroidism follow-ups and 40 healthy volunteers were included in the study. The blood dynamic thiol/sulfide balance, Total Antioxidant Status (TAS), Total Oxidant Status (TOS), Paraoxonase Enzyme Activity (PON) levels were measured in serum samples.

Results

In our study, it was found that the disulfide, disulfide/native thiol, disulfide/total thiol levels were higher in the hypoparathyroidism group. A negative correlation was found between 25-hydroxy vitamin D (25-OH vitamin D) and disulfide, disulfide/native thiol and disulfide/total thiol, and a positive correlation was found between native thiol and total thiol ratio; and the corrected calcium levels and PON levels were negatively correlated.

Conclusions

Consequently, a change in favour of disulfide was found in the dynamic thiol-disulfide homeostasis in the hypoparathyroidism group in our study.
Evaluation of urinary L-FABP as an early marker for diabetic nephropathy in type 2 diabetic patients
Authors: Ngan Duong Thi Thuy , Binh Nguyen Gia , Lan Le Thi Huong , Nguyen Cuc Thi Thu , Huong Phung Thanh
Published: August 2019

Background

Albuminuria is the standard biomarker for the diagnosis of diabetic nephropathy (DN). However, some patients with persistent microalbuminuria still progress to chronic kidney disease, raising the question of finding a better biomarker. This study aimed to evaluate the correlation of urinary liver-type fatty acid-binding protein (L-FABP) levels with renal function and to compare the role of urinary albumin-to-creatinine ratio (ACR) with urinary L-FABP in early detection of DN in type 2 diabetic patients.

Methods

The cross-sectional study was done on 106 type 2 diabetic patients and 30 non-diabetic people. L-FABP was measured with the Latex enhanced immunoturbidimetric technique.

Results

There was a strong and negative correlation between the urine L-FABP levels and eGFR (r = -0.606, p<0.001). The urinary L-FABP levels were significantly higher (p<0.001) in the normoalbuminuria diabetic group than the non-diabetic control group. The ROC-curve analyses in the diabetic patients and the normoalbuminuria diabetic patients showed that the AUCL-FABP was remarkably higher (p<0.001) than the AUCACR. An optimal cutoff value of 5 mg L-FABP/g Cr (with the sensitivity of 98.1% and specificity of 90%) and of 4.3 mg L-FABP/g Cr (with the sensitivity of 100% and specificity of 86.67%) was set to detect DN in the diabetic patients and the normoalbuminuria diabetic patients, respectively.

Conclusions

The change in urinary L-FABP levels happened earlier than in urinary albumin during renal function impairment. Urinary L-FABP can be used as a better indicator than ACR for early detection of DN in type 2 diabetes.
Interferometric Measurement of Heat Transfer above New Generation Foam Concrete
Authors: Pivarčiová Elena , Božek Pavol , Domnina Kséniia , Škultéty Emil , Fedosov Sergey
Published: August 2019

The contribution is focused on investigating the heat transfer via natural convection which originated as an effect of changed air density by heating the horizontal sample in the area given. For this research we used samples of a new material made in the Russian Federation – the foam concrete which was reinforced by PET fibres. The samples were heated by an electric heating device from the bottom. The temperature fields originating above the horizontal sample surface were visualised by means of the holographic interferometric contactless method in real time. The holographic interferograms of the temperature field were analysed, and then the local heat transfer parameters were calculated: the heat transfer coefficient α, and the heat conductivity coefficient λ.
Information-measuring System to Study the Thermocouple with Controlled Temperature Field
Authors: Wang Jinfei , Kochan Orest , Przystupa Krzysztof , Su Jun
Published: August 2019

Error due to inhomogeneity is the main problem of thermocouples (TCs), e.g., during the operation of a type K TC, this error can reach 11-30 °C. Thus, metrological reliability of TCs is threatened by this error because there is a high risk of exceeding the permissible error when the temperature distribution along the TC legs changes. Such a large error, in turn, can threaten a proper operation or even safety of a measured object. A TC with controlled temperature field was proposed to cope with this error. An information-measuring system to perform proper measurements, measurement data acquisition and collection to construct mathematical models is proposed. Its property is high diurnal stability of ±(0.0025+0,002(X/XMAX–1) %. The requirements for the information-measuring system and its structure are considered in this paper. In particular, one of the key problems of such a sensor is how stable is its own temperature field under the influence of the temperature field of a measured object. The experimental studies were carried out using the developed system. They showed that the coefficient of penetration of the temperature field of the measured object is about 0.04. This allows decreasing error due to inhomogeneity by about 10-20 times.
Fault Diagnosis of Ball Bearing Elements: A Generic Procedure based on Time-Frequency Analysis
Authors: Liu Meng-Kun , Weng Peng-Yi
Published: August 2019

Motor-driven machines, such as water pumps, air compressors, and fans, are prone to fatigue failures after long operating hours, resulting in catastrophic breakdown. The failures are preceded by faults under which the machines continue to function, but with low efficiency. Most failures that occur frequently in the motor-driven machines are caused by rolling bearing faults, which could be detected by the noise and vibrations during operation. The incipient faults, however, are difficult to identify because of their low signal-to-noise ratio, vulnerability to external disturbances, and non-stationarity. The conventional Fourier spectrum is insufficient for analyzing the transient and non-stationary signals generated by these faults, and hence a novel approach based on wavelet packet decomposition and support vector machine is proposed to distinguish between various types of bearing faults. By using wavelet and statistical methods to extract the features of bearing faults based on time-frequency analysis, the proposed fault diagnosis procedure could identify ball bearing faults successfully.
Facing Irregularities in Sport: Whistleblowing and Watchdog Journalism. The Romanian Case
Authors: Constantin Pompiliu-Nicolae , Stoicescu Marius
Published: August 2019

Mass-media is often called „the guard dog of society” due to its role in alerting the population when an issue is identified and this aspect is feasible also in sports media. This research analyses the media’s roles, responsibilities and its relationship with whistleblowers. The main focus of this presentation is on methods used by journalists in order to identify and research sensitive subjects such as corruption, doping and other cases of harmful irregularities in sport. Based on interviews with journalists from Romania, using a qualitative interpretation of their speech, it will be possible to see behind the façade of the journalist-sources relationship. „How could we increase the rate of investigations and the number of whistleblowers in sport?” is a central question of this research. The study examines also how to ensure a more critical approach to the task of exploring the influences in Romanian sports and in what manner this case could be framed in the global context. It helps to understand the potential of sports communication and educational journalism to influence in a positive manner the dynamics of reporting everyday issues and eruptive scandals in sport. An inquiring and sceptical media could help more to enhance transparency and encourage other sports stars or sports people to take action.
The “ECG modifications induced by the disturbance of the circadian rhythm in night-shift workers (ECGNoct)” study protocol
Authors: Oțelea Marina Ruxandra , Streinu-Cercel Anca , Manolache Daniela , Mutu Andreea , Călugăreanu Lavinia , Mateș Dana , Săndulescu Oana
Published: August 2019

In many large cohort studies, the night shift constitutes a risk factor for developing cardiovascular disease and diabetes in workers. Current screening tests for people working in night shift include fasting glycaemia and electrocardiography. In fact, there are few studies focused on the description of the electrocardiographic changes after the night shift. This article describes the protocol of the “ECG modifications induced by the disturbance of the circadian rhythm in night-shift workers (ECGNoct)” study, which was initiated by the National Institute for Infectious Diseases “Prof. Dr. Matei Balș”. Nurses represent the target population.

The protocol includes a full medical and occupational history, lifestyle habits (smoking, alcohol, nutrition), anthropometric and blood pressure measurements, blood tests (fasting glycemia, total cholesterol, triglycerides and high density lipoprotein cholesterol) and electrocardiogram recording. For nurses working in (night) shifts, we will record the electrocardiogram before and soon after the night shift. A cross sectional study will analyze the incidence of the metabolic syndrome criteria, the cardio-metabolic diseases and the electrocardiographic modifications and will compare the results between the group of nurses working and the group of nurse who do not. Based on these results, a longitudinal study will test the hypothesis that night shift increases the risk for cardio-metabolic diseases and that the electrocardiographic modifications precede the clinical symptoms. The results of the study will provide data on the association of night shifts and other non-occupational risk factors with the cardio-metabolic diseases in this specific population of healthcare workers that potentially will integrate into the occupational medicine policies.
Communication with superiors and colleagues and other occupational stressors. Correlations with work ability, self-efficacy and health in employees from primary and secondary education
Authors: Triff Dorin-Gheorghe , Triff Zorica , Bocoș Mușata-Dacia , Naghi Eugenia
Published: August 2019

During periodic occupational medical checkup, in a sample including all employees from two high schools, a secondary school and a kindergarten, we administered through voluntary completion, questionnaires which assessed the employees’ occupational stress in terms of individual characteristics, anxiety, sense of self-efficacy, work ability, emotional exhaustion and health status (using ShortForm 36 questionnaire). A number of 233 questionnaires were returned. Only the occupational stressor represented by communication with superiors correlates significantly negatively with work ability in all four units. Work ability and communication with superiors also have average scores which differ significantly and are concordant in all four units. In the secondary school, work ability has the highest average value and the lowest average value of “communication with superiors” stressor. The same values are decreasing for WAI in order, from high school 2 to high school 1 and kindergarten while the stressor represented by communication with superiors has increasing values in order from high school no 2 to high school no. 1, and kindergarten. These results show that programmes to reduce occupational stress in school units should primarily address the school unit leadership in order to improve their communication with employees.
Factors influencing the rationing of nursing care in Romania
Authors: Rașcu Agripina , Postolache Paraschiva , Mazilu Doina Carmen , Oțelea Marina Ruxandra
Published: August 2019

Understanding the factors influencing the rationing of nursing care is crucial for any quality control intervention in healthcare services. Occupational factors such as workload, night shifts, management style and organization of work have a potential influence. There are few studies specifically designed to evaluate these factors in relation with nurses’ work. In this study, we investigate several occupational factors influencing the quality of work in a sample of hospital nurses in order to identify the most important influencers of stress at work. The article describes the conceptual framework of the study, the population, the methods and the expected results. We also present a brief review of recent studies related to occupational risk factors and the perceived quality of care provided by Romanian nurse population.
Acrylic sculpting nails, an occupational hazard for contact dermatitis. Case reports and review of the literature
Authors: Moise Laura Georgiana , Bădulici Sonia , Rașcu Agripina , Rașcu Alexandra Maria
Published: August 2019

Acrylates are plastic materials formed by the polymerization of monomers, which are recognized as powerful sensitizers that may cause allergic contact dermatitis both in occupational and non-occupational environment. In the occupational setting, the most exposed workers are the dentists, dental technicians, prosthesis technicians, printers, painters, fiberglass workers and nail technicians. We describe four cases of occupational allergic contact dermatitis in nail technicians caused by acrylic compounds that illustrate numerous clinical manifestations. Clinical manifestations ranged from edema, erythema, scaling and fissuring fingertips to erythematous patches around the chin, mandible and abdomen. Patch testing results revealed positive reaction to 2-hydroxyethyl methacrylate in all patients. Of the four patients, two changed jobs, one stopped exposure because of pregnancy and one patient continued working, showing no improvement, despite undergoing treatment. These cases underline the importance of improvement of preventive measures in the workplace.
PENGARUH BREASTCARE DAN AIR SEDUHAN DAUN KELOR TERHADAP PRODUKSI
Authors: Adi Galih Setia , Saelan Saelan , Putriningrum Rahajeng , H.K Aria Nurahman
Published: August 2019

Pemberian ASI ekslusif  merupakan pemberian asi sejak bayi baru dilahirkan, dan disusui  selama 24 jam tanpa pemberian makanan dan minuman apapun selain ASI.  Saat ini cakupan pemberian ASI ekslusif  Pada bayi umur 0-6 bulan, di Indonesia terdapat 19 provinsi yang cakupannya berada di atas rata-rata angka nasional (54,3%).  Angka tersebut merupakan angka yang sudah bagus karena sudah berada di atas angka nasional. Namun angka tersebut belum bisa mencapai 100%, maka dari itu diperlukan cara untuk dapat meningkatkan angka cakupan pemberian ASI pada bayi 0-6 bulan.

Data tersebut memberikan bukti bahwa banyak ibu yang tidak memberikan ASInya. Para ibu tidak memberikan ASInya antara lain ASI tidak keluar di awal kelahiran bayi, keluarga yang tidak mensupport ibu dalam pemberian ASI, karena ibu bekerja sehingga sulit untuk menyusui. Tujuan untuk mengetahui pengaruh terapi hypnopunturbreastfeeding  dan air seduhan daun kelor terhadap produksi asi di kabupaten sukoharjo.

Desain penelitian ini adalah pre and post test without control group jumlah responden adalah 28 responden. Analisis bivariat selanjutnya menggunakan uji Paired sample t-test.

Hasil penelitian terdapat perbedaan antara sebelum dan sesudah diberikan terapi brest care dan air seduhan daun kelor hal tersebut tampak dari nilai sig 0.000 lebih kecil dari 0.005. sehingga dapat disimpulkan bahwa terapat pengaruh terapi brestcare dan air seduhan daun kelor terhadap produksi asi di kabupaten sukoharjo.
PENGARUH TERAPI KOMPRES HANGAT TERHADAP PENURUNAN NYERI SENDI OSTEOARTHRITIS PADA LANSIA DI POSYANDU LANSIA PUSKESMAS PANDIAN SUMENEP
Authors: Hannan Mujib , Suprayitno Emdat , Yuliyana Hesti
Published: August 2019

Along with the aging process, the body will experience various health problems. One of them osteoartrisis which is a disease of bones and joints that occur due to aging process. The purpose of this study was to study the effect of warm water compress therapy on the reduction of osteoarthritis joint pain in elderly at posyandu elderly puskesmas Pandian Sumenep.

The type of research is Pre Experimental, where the population amounted to 40 people and the sample amounted to 32 people with elderly characteristics who experience osteoarthritis joint pain. Sampling technique used is Type Probability sampling that is Simple Random Sampling. Data collection methods used were interviews and questionnaires. Presentation of data using pie chart and characteristic distribution table with T paired statistical test.

The results showed that more than half had osteoarthritis joint pain with moderate pain scale of 22 elderly (68.7%). Based on the result of T paired test, there is influence between warm water compress therapy to decrease osteoarthritis joint pain in elderly (ρ = 0,000 <α = 0,05).

Osteoarthritis pain in elderly in Puskesmas Pandian Sumenep mostly due to the activity of many or excess. Advice for health services to make warm compress therapy as a self-directed nursing intervention in treating joint pain patients with osteoarthritis.
Perilaku Masyarakat dalam Menggunakan Jamban Bersih Dan Sehat di Dusun Banglandek, Desa Gunung Kesan, Kecamatan Karang Penang
Authors: Musriyati Siti
Published: August 2019

One of the healthy behaviors can be realized by removing human waste (feces) / defecate in a healthy way or in place, such as a toilet. Early data collection in Banglandek Hamlet, Gunung Kesan Village, Karang Penang Subdistrictshows that in 15 families there were 10 families who had a habit when defecating in the river. The problem of the lack of use of latrines is influenced by the lack of environmental health behavior in the community.

This study aims to describe the behavior of the community in using clean and healthy latrines in Banglandek Hamlet, Gunung Kesan Village, Karang Penang Subdistrict. This study used a descriptive research method. The population in this study was all family leaders in Banglandek Village. There were 87 respondents in this study. Data collection using a questionnaire. The research was conducted in Banglandek Hamlet, Gunung Kesan Village, Karang Penang Subdistrict in December 2018.

The results showed that the community behavior of Banglandek Hamlet, Gunung Kesan Village, Karang Penang Subdistrict in using clean and healthy latrines of 87 respondents was (59%) or 51 respondents behaved negatively, while almost half (41%) or 36 respondents behaved positively .To increase ownership, use and use of clean and healthy toilets in the Benglandek Hamlet, Gunung Kesan Village, Karang Penang Subdistrict, motivation and guidance are needed.
الشروط القانونية لانحلال العقد الإداري اقتضاءً للمصلحة العامّة (دراسة تحليلية مقارنة)
Authors: M. Saeed Sarar E. , Ahmad Mukhlis M.
Published: August 2019

تلجأ الإدارة إلى أساليب عدة لكي تقوم بممارسة نشاطاتها وأعمالها، وهذه الأعمال قد تكون أعمالا مادية أو أعمال وتصرفات قانونية، ومن بين التصرّفات القانونيّة التي تمارسها الإدارة العقد الإداري. وبما أن العقد تصرّف قانوني نتيجة التقاء إرادتين، لذا يشترط أنْ تتّحد إرادة الإدارة في العقد الإداري مع إرادة المتعاقد، وأنْ يستهدف العقد المبرم إلى إحداث أثر قانوني، سواءً أكان إنشاء التزام أم نقله أو تعديله. ولما كان الهدف من العقد الإداري هو تحقيق المصلحة العامة التي تعلو على مصلحة الأفراد الخاصة، فمن المنطق أن تستهدف الإدارة ذات الهدف من وراء إلغاء العقد بإرادتها المنفردة ولو لم يصدر خطأ ما من جانب المتعاقد معها. الأمر الذي يستدعي إلى توافر شروط معينة في ذلك الهدف، أي في المصلحة العامة. وهذه الشروط بعضها موضوعية تتمثل بلزوم وجود مصلحة عامة على النحو المطلوب قانونا لتبرير إلغاء العقد، وأخرى إجرائية تتجسد في وجوب أن يتم الإلغاء بقرار صادر من الجهة المختصة وطبقا للأشكال والإجراءات المقررة قانونا، فضلا عن ضرورة إخطار المتعاقد بما تقدم عليه الإدارة على فعله، إلغاء العقد، بفترة زمنية محددة لترتيب أوضاعه إزاء ذلك.
الاعتراف المعيب في الدعوى الجزائية دراسة قانونية تحليلية مقارنة
Authors: Issa Talal , Al-gharaiba Zaid , Yousif Dilshad A.
Published: August 2019

يعتبر الاعتراف من أهم أدلة الإثبات على مر العصور، كونه يولد قناعة قوية لدى قاضي الموضوع فيصدر قراره بالاعتماد عليه. وقد حرمت الشرائع السماوية والوضعية الإكراه أو أي وسيلة غير مشروعة لانتزاع الاعتراف من المتهم.

ويتناول الباحث في دراسته هذه الوسائل التي تفقد الإرادة كوسيلة الإكراه أو استعمال العقاقير المخدرة والمسكرات لانتزاع الاعتراف كما ستتناول الدراسة بيان الوسائل التي تضعف الإرادة للمتهم مما يجعل الاعتراف الصادر منه اعترافاً معيباً كاستخدام أجهزة كشف الكذب أو استعمال الكلاب البوليسية وغيرها.

وقد تضمن البحث مجموعة من النتائج التي توصل إليها الباحث كما ضمّن البحث عدة توصيات أو مقترحات.
نظريات الستراتيجية في الجغرافيا السياسية
Authors: Karo Ibrahim A.
Published: August 2019

الجغرافيا السياسية، هي دراسة الاقاليم السياسية على سطح الكرة الارضية وصفاتها ومدى مقدرتها ، ودورها في حفظ السلم والامن الدوليين. وتعد العوامل الجغرافية والتكنولوجية من العوامل الاساسية لقوة الدولة، لذا ظهرت نظريات ستراتيجية في الجغرافية السياسية من قبل المفكرين راتزل ، ماكندر ، ماهان ، وهاوس هوفر ، حول أهمية دراستها و تحليلها وأثرها على صانع القرار السياسي عند صنع القرار .
التحول نحو العالمية في سياسة التجريم الاسس و المقتضيات دراسة تأصيلية للواقع التشريعي العراقي
Authors: Hasan Mohammed R.
Published: August 2019

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Using the K-means Method to Identify a User by Keyboard Handwriting
Authors: Eremenko Yu. I. , Olyunina Yu. S.
Published: August 2019

This article discusses the problem of protection against unauthorized access to data by identifying users by biometric characteristics – keyboard handwriting. To do this, the authors conducted a series of experiments to obtain a set of samples of keyboard handwriting, which are used as a biometric characteristic to identify the owner. To analyze the data and determine the author of a particular handwriting sample, the authors consider the k-means method. This method is one of the simplest and most effective statistical classification methods when the number of clusters is known in advance. To evaluate the effectiveness of this method for solving this problem, the authors propose using the coefficients of false access and false access denial, which are the main characteristics of biometric authentication systems. The results suggest that there are some limitations when using this method. They are related to the fact that
this problem is poorly formalized and depends on many factors that can not be mathematically described. For example, the instability of the keyboard handwriting, which is due to changes in the psycho-physiological state of the user, the ergonomics of the keyboard and others. Given these features,the authors propose to solve the problem using methods based on intelligent data processing, which allow to detect hidden patterns and dependencies in the data flow.
Web-Technologies Based Software for Oil and Gas Wells Geosteering
Authors: Danilovskiy K. N. , Dudaev A. R. , Glinskikh V. N. , Nikitenko M. N. , Moskaev I. A.
Published: August 2019

Accuracy of the horizontal well placement in the target reservoir becomes essential for efficient oilfield development. Geosteering of a well with a complex trajectory is performed using real-time geophysical data obtained while drilling. The presented work is devoted to the development of a new software for horizontal oil and gas wells geosteering. Algorithms based on logging data correlation and electromagnetic logging data numerical inversion methods are used for well placement. The developed application is based on web-technologies and has a client-server architecture. To optimize the resource-intensive calculations execution time, high-performance cloud computing is used.
A case of leptomeningeal metastases of human epidermal growth factor receptor 2-positive breast cancer that responded well to lapatinib plus capecitabine
Authors: Nakao Takayuki , Okuda Takeshi , Fujita Mitsugu , Kato Amami
Published: August 2019

Background:

Leptomeningeal metastases (LM) pose the most difficult form of cancer metastasis to treat and portend a poor prognosis. Standard treatment has yet to be established, and intrathecal chemotherapy and whole- brain radiotherapy are administered on an empirical basis.

Case Description:

We report on a 46-year-old woman with LM from human epidermal growth factor receptor 2 (HER2)-positive breast cancer. She was suffering from intractable headaches, severe nausea and vomiting, and cerebellar ataxia. Contrast-enhanced magnetic resonance imaging (MRI) revealed diffuse enhancement of the meninges, mainly in the posterior cranial fossa, and compression of the cerebellum by the profoundly thickened meninges. The first step in the treatment was decompression of the posterior cranial fossa to relieve intracranial hypertension. After surgery, her symptoms immediately improved. The second step was treatment with lapatinib at 1250 mg and capecitabine 1200 mg, which dramatically improved her symptoms and disappeared diffuse abnormal signal enhancement on MRI.

Conclusion:

We treated a patient with LM from primary HER2-positive breast cancer who responded well to lapatinib plus capecitabine.
Retroclival and spinal subdural hematoma after traumatic brain injury - A case report and literature review
Authors: Solorio-Pineda Saúl , Nieves-Valerdi Adriana Ailed , Franco-Jiménez José Alfonso , Gutiérrez-Aceves Guillermo Axayacalt , Buenrostro-Torres Luis Manuel , Ruíz-Flores Milton Inocencio
Published: August 2019

Background:

Retroclival hematomas are rare and occur mostly in the pediatric population. They are variously attributed to trauma, apoplexy, and vascular lesions. With motor vehicle accidents (MVAs), the mechanism of traumatic injury is forced flexion and extension. There may also be associated cervical spinal and/or clivus fractures warranting fusion.

Case Description:

A 35-year-old male sustained a traumatic brain injury after a fall of 5 m at work. His Glasgow coma scale (GCS) on admission was 13 (M6V3O4). He had no cranial nerve deficits. The brain computed tomography (CT) showed a retroclival subdural hematoma that extended to the C2 level.

Conclusions:

Most retroclival hematomas are attributed to MVAs, and cranial CT and magnetic resonance studies typically demonstrate a combination of posterior fossa hemorrhage with retroclival hematomas (intra or extradural). Patients with retroclival hematomas but high GCS scores on admission usually have better prognoses following traumatic brain injuries attributed to MVA. Notable however is the frequent association with additional cervical and/or craniocervical injuries (e.g. such as odontoid fracture) that may warrant surgery/fusión.
Cerebellar hemorrhage as a complication of spine surgery
Authors: Worm Paulo Valdeci , Dalla-Corte Amauri , Brasil Albert Vincent Berthier , Perondi Gerson , Sfreddo Ericson , Vial Antônio Delacy Martini , Gago Guilherme , da Costa Pablo Ramon Fruett
Published: August 2019

Background:

The association between remote cerebellar hematoma (RCH) and spinal surgery is poorly understood and rarely reported. We present seven cases of RCH after spinal surgery.

Methods:

Seven patients were diagnosed with RCH utilizing computed tomography and/or magnetic resonance, between 2012 and 2016. Their clinical presentations, imaging data, treatment modalities, and outcome were analyzed. There were five females and two males with an average age of 55.8 ± 8.4 years. The age of onset ranged from 43 to 67 years and the time to clinical presentation ranged from 3 h to 5 days. Patients presented with: diplopia/strabismus (one patient), dysphagia/urinary incontinence (one patient), respiratory arrest (one patient), meningismus (one patient), and dysarthria (two patients), along with other symptoms/signs.

Results:

Three patients were successfully managed without surgery, two required external ventricular drainage, and two were treated with posterior fossa decompression plus ventriculostomy. Four patients recovered completely, two showed mild residual deficits at discharge, while one expired 7 days postoperatively.

Conclusion:

RCH is an uncommon and underdiagnosed complication of spine surgery. It should be suspected when intracranial symptoms occur after spinal procedures.
Effects of electrodes length and insulation for transcranial electric stimulation
Authors: Tomio Ryosuke
Published: August 2019

Background:

The aim of this study is to investigate the effects of length and insulation of the corkscrew electrodes for transcranial motor evoked potential (tMEP) monitoring.

Methods:

We used the finite element method to visualize the electric field in the brain, which was generated by electrodes of different lengths (4, 7, and 12 mm). Two types of head models were generated: A model that included a subcutaneous fat layer and another without a fat layer. Two insulated needle types of conductive tip (5 and 2 mm) were studied. The stimulation threshold levels of hand tMEP were measured in a clinical setting to compare normal corkscrew and insulated 7-mm depth corkscrew.

Results:

The electric field in the brain depended on the electrode depths in the no fat layer model. The deeper the electrodes reached, the stronger the electric fields generated. Electrode insulation made a difference in the fat layer models. The threshold level recordings of tMEP revealed that the 7-mm insulated electrodes showed a lower threshold than the normal electrodes by one-side replacement in each patient: 33.6 ± 9.6 mA and 36.3 ± 11.0 mA (n =16, P < 0.001), respectively. The 7-mm insulated electrodes also showed a lower threshold than the normal electrodes when both sides, electrodes were replaced: 34.4 ± 8.6 mA and 37.5 ± 9.2 mA (n =10, P = 0.003), respectively.

Conclusions:

The electrodes depth reached enough to skull is considered to be efficient. Insulation of the electrodes with a conductive tip is efficient when there is subcutaneous fat layer.
Gamma knife radiosurgery on the trigeminal ganglion for idiopathic trigeminal neuralgia: Results and review of the literature
Authors: Somaza Salvador , Montilla Eglee M. , Mora Maria C.
Published: August 2019

Background:

In the present study, we evaluate the results of gamma knife surgery (GKS) for the treatment of trigeminal neuralgia (TN) using the trigeminal ganglion (TG’) and the adjacent fibers of trigeminal nerve as a target.

Methods:

From February 2013 to July 2017, we treated 30 cases of TN with GKS. In this group, all patients had an idiopathic typical TN. The radiosurgical target was conformed through two isocenters, 8 and 4 mm at the cavum de Meckel. The maximum dose was 86 Gy using the isodose line of 50%. The median age of the patients was 58.5 (range 28–94) years old, and the median time from diagnosis to GKS was 94 months (range 13–480 months). The median follow-up was 28.5 (range 12–49) months. Clinical outcomes were analyzed. Univariate and multivariate analyses were performed to evaluate factors that correlated with a favorable, pain-free outcome.

Results:

The mean time to relief of pain was 7 (range 1–40) days. The percentage of patients with significant pain relief was 93.3%. Relapse in pain was noted in four patients at 3, 16, 19, and 36 months. Nine patients were treated in acute status. Fourteen patients had intense pain between 1 and 7 days before the procedure. Among those with the recurrence of their symptoms, one patient had a microvascular decompression. Multivariate regression adjusted for age and sex suggests that, by 40 months, 70% of the patients treated with radiosurgery will remain pain free. At the last follow-up, GKS resulted in pain relief in 86.6% of patients. Our analysis suggests that, using this technique, we can expect that approximately 70% of patients with TN will have some degree of pain improvement at 3 years’ post radiosurgery.

Conclusions:

GKS on TG appears to be a reasonable treatment option with short latency period, minor collateral effects, and high percentage of pain control. The mechanism of action of radiosurgery could be related to the inactivation of the satellite glial cells in the TG.
Spinal cord ischemia/infarct after cauda equina syndrome from disc herniation – A case study and literature review
Authors: Kramer David C. , Aguirre-Alarcon Adela , Yassari Reza , Brook Allan L. , Kinon Merritt D.
Published: August 2019

Background:

Spinal cord infarction is rare and occurs in 12/100,000; it represents 0.3%–2% of central nervous system infarcts. Here, we present a patient who developed recurrent bilateral lower extremity paraplegia secondary to spinal cord infarction 1 day after a successful L4-5 microdiscectomy in a patient who originally presented with a cauda equina syndrome.

Case Description:

A 56-year-old patient presented with an acute cauda equina syndrome characterized by severe lower back pain, a right foot drop, saddle anesthesia, and acute urinary retention. When the lumbar magnetic resonance imaging (MRI) revealed a large right paracentral lumbar disc herniation at the L4-L5 level, the patient underwent an emergency minimally invasive right-sided L4-5 discectomy. Immediately, postoperatively, the patient regained normal function. However, 1 day later, while having a bowel movement, he immediately developed the recurrent paraplegia. The new lumbar MRI revealed acute ischemia and an infarct involving the distal conus medullaris. Further, workup was negative for a spinal cord vascular malformation, thus leaving an inflammatory postsurgical vasculitis as the primary etiology of delayed the conus medullaris infarction.

Conclusions:

Acute neurologic deterioration after spinal surgery which does not neurologically correlate with the operative level or procedure performed should prompt the performance of follow-up MR studies of the neuraxis to rule out other etiologies, including vascular lesions versus infarctions, as causes of new neurological deficits.
A case involving a giant aberrant craniocervical arteriovenous malformation
Authors: Sutiono Agung Budi , Banjarnahor Jusuf Desman
Published: August 2019

Background:

Spinal cord arteriovenous malformations (AVMs) comprise about 3%–4% of primary intraspinal masses and are only rarely found external to the C2–C7 cervical vertebral foramen.

Case Description:

A 21-year-old female presented with neck pain and a spastic quadriparesis of 1 year duration. The cervical magnetic resonance imaging and three-dimensional computed tomography angiograms documented an AVM/dural arteriovenous fistula on the right fed by multiple arteries located in the C5–C6 and C6–C7 foramen intervertebralis; utilizing a laminectomy, the large feeding arteries were double-clipped. This allowed for devascularization of the AVM and facilitated resection while preserving the aberrant vertebral artery. The patient was discharged within 1 week and, 2 months later, was able to ambulate to the outpatient clinic.

Conclusion:

Double clipping of the two main right-sided arterial feeders at the C5–C6 and C6–C7 levels allowed for devascularization and resection of this large cervical AVM while carefully preserving the aberrant vertebral artery.
The microsurgical management of benign pineal cysts: Helsinki experience in 60 cases
Authors: Choque-Velasquez Joham , Resendiz-Nieves Julio C. , Rezai Jahromi Behnam , Colasanti Roberto , Raj Rahul , Lopez-Gutierrez Kenneth , Tynninen Olli , Niemelä Mika , Hernesniemi Juha
Published: August 2019

Background:

Microsurgical resection represents a well-accepted management option for symptomatic benign pineal cysts. Symptoms such as a headache, hydrocephalus, and visual deficiency are typically associated with pineal cysts. However, more recent studies reported over the past years have characterized additional symptoms as a part of the clinical manifestation of this disease and represent additional indications for intervention.

Methods:

We present a retrospective review of patients with histologically confirmed benign pineal cysts that were operated on in our department between 1997 and 2015. A demographic analysis, evaluation of preoperative status, surgical treatment, as well as immediate and long-term clinical and radiological outcomes were conducted.

Results:

A total of 60 patients with benign pineal cysts underwent surgery between 1997 and 2015. Gross total resection was achieved in 58 cases. All patients except one improved in their clinical status or had made a full recovery at the time of the last follow-up. The key steps for surgical resection of pineal cysts are reported, based on an analysis of representative surgical videos.

Conclusions:

We describe in this paper one of the largest series of microsurgically treated pineal cysts. In our opinion, judicious microsurgery remains the most suitable technique to effectively deal with this disease.
Potential improvement of survival statistics for glioblastoma multiforme (WHO IV)
Authors: Goldsmith Harry S.
Published: August 2019

The present-day treatment of a glioblastoma multiforme IV (glioblast) is by surgery, radiation, and chemotherapy. Unfortunately, the current treatment has not significantly improved the survival statistics of this tumor. There are now two relatively new surgical procedures that may improve the survival statistics of this malignancy. One of these procedures is the intraoperative use of the drug 5-aminovolumic acid (ALA), which fluoresces a red color in malignant brain tissue that is not observed in normal brain tissue. This allows a neurosurgeon to distinguish brain tissue infiltrated by malignant cells, thus allowing a more complete resection of the tumor. Another procedure that has the potential to improve the survival statistics of glioblasts is the use of the omentum. Direct placement of the omentum on a brain infiltrated by malignant cells would allow omental blood vessels, known to be completely clear of endothelial cells, to penetrate directly into the underlying brain. The blood flow through omental blood vessels could be expected to carry chemotherapeutic agents throughout the involved brain, thereby totally bypassing the blood–brain barrier. Combining a tumor resection using 5-ALA and placing the omentum on the brain may prove instrumental in improving the survival statistics of patients suffering from a glioblast.
The interventional magnetic resonance imaging suite: Experience in the design, development, and implementation in a pre-existing radiology space and review of concepts
Authors: Azmi Hooman , Gibbons Mary , DeVito Michele C. , Schlesinger Mark , Kreitner Jason , Freguletti Terri , Banovic Joan , Ferrell Donald , Horton Michael , Pierce Sean , Roth Patrick
Published: August 2019

Background:

Intraoperative magnetic resonance imaging (ioMRI) has led to significant advancements in neurosurgery with improved accuracy, assessment of the extent of resection, less invasive surgical alternatives, and real-time confirmation of targeting as well delivery of therapies. The costs associated with developing ioMRI units in the surgical suite have been obstacles to the expansion of their use. More recently, the development of hybrid interventional MRI (iMRI) units has become a viable alternative. The process of designing, developing, and implementing operations for these units requires the careful integration of environmental, technical, and safety elements of both surgical and MR practices. There is a paucity of published literature providing guidance for institutions looking to develop a hybrid iMRI unit, especially with a limited footprint in the radiology department.

Methods:

The experience of designing, developing, and implementing an iMRI in a preexisting space for neurosurgical procedures at a single institution in light of available options and the literature is described.

Results:

The development of the unit was accomplished through the engagement of a multidisciplinary team of stakeholders who utilized existing guidelines and recommendations and their own professional experience to address issues including physical layout, equipment selection, operations planning, infection control, and oversight/review, among others.

Conclusion:

Successful creation of an iMRI program requires multidisciplinary collaboration in integrating surgical and MR practice. The authors’ aim is that the experience described in this article will serve as an example for facilities or neurosurgical departments looking to navigate the same process.
Intraoperative use of cone-beam computed tomography for the safe epidural blood patch: Technical case report
Authors: Kawahara Takashi , Awa Ryuji , Atsuchi Masamichi , Arita Kazunori
Published: August 2019

Background:

Epidural blood patch (EBP) is a common method utilized to treat intracranial hypotension, and secondarily, to treat unintentional dural puncture. The authors propose an effective technique for correct epidural needle positioning during EBP using cone-beam computed tomography (CB-CT) images.

Case Description:

A 31-year-old female underwent an EBP. Following confirmation of the spinal level of the cerebrospinal fluid leakage, the ideal trajectory for the proposed EBP was assessed from the entry point on the skin to the spinolaminar line under CB-CT imaging. The epidural needle was then gently advanced along the appropriate trajectory. At the 10 mm mark, behind the spinolaminar line, the inner needle was removed. This allowed for slow advancement of the outer needle until its tip reached the epidural space, and its location was confirmed by the “loss of resistance to the saline technique.” Using biplane epidurography, the spread of dye within the epidural space for appropriate localization was confirmed. In this case study, the patient’s postural headache immediately improved.

Conclusion:

Using the CB-CT technique described, a patient successfully underwent EBP without complications.
Survival and prognostic factors in childhood medulloblastoma: A Brazilian single center experience from 1995 to 2016
Authors: Bleil Cristina Birlem , Bizzi Jorge Wladimir Junqueira , Bedin Andre , de Oliveira Francine Hehn , Antunes Ápio Cláudio Martins
Published: August 2019

Background:

Medulloblastoma is the most common malignant brain tumor in the pediatric population. Despite prognosis improvement in the past two decades, one-third of the patients still remain incurable. New evidence suggests that medulloblastoma comprises four distinct entities; therefore, treatment de-escalation is required. The aim of this article is to evaluate epidemiological data from patients treated at our institution. The primary objective is to analyze overall survival (OS) and event-free survival (EFS) and the secondary objective is to identify prognostic factor from this cohort.

Methods:

We retrospectively analyzed 69 patients who underwent surgical resection for medulloblastoma among 423 children from the tumor registry data bank of Santo Antônio Children’s Hospital from 1995 to 2016. Kaplan–Meier method and Cox regression analysis were used to identify OS, EFS, and prognostic factors.

Results:

The 5-year OS and EFS rates found were 44.5% and 36.4%, respectively. The extent of resection and radiotherapy as adjuvant treatments was positively correlated to outcome while metastatic disease at diagnosis was negatively related to OS. Age younger than 3 years old did not have a worse outcome in our cohort.

Conclusion:

Similar results to population-based studies were found, but we still face difficulties due to living in a developing country. In the near future, we look forward to new diagnostic techniques that will enable us to classify medulloblastomas according to molecular subgroups.
Minimizing cortical disturbance to access ventricular subependymoma – A novel approach utilizing spinal minimally invasive tubular retractor system
Authors: Klotz Eric , Towers Wendy , Kurtom Khalid
Published: August 2019

Background:

Subependymomas are rare benign tumors found primarily in the lateral and fourth ventricles. Patients become symptomatic when the tumor obstructs cerebrospinal fluid pathways. We present a novel minimally invasive technique for lateral ventricular subependymoma resection.

Case Description:

A 57-year-old male presented after a period of progressive ataxia, right upper extremity tremor, and syncopal events. Emergent non-contrast computed tomography of the brain demonstrated a lobulated mass in the left lateral ventricle causing moderate-to-severe obstructive hydrocephalus. Emergent ventriculostomy was placed as a temporizing measure. Subsequent magnetic resonance imaging (MRI) illustrated a large benign appearing mass causing obstruction of the left foramen of Monroe. A small craniotomy was performed utilizing previous ventriculostomy twist hole. The left lateral ventricle was accessed through sequential dilation of ventriculostomy tract using a minimally invasive spine surgery tubular system. Tumor was resected en bloc under microscopic assistance. The patient had an excellent outcome with return to baseline mental status and was discharged from the hospital postoperative day 1. Follow-up MRI demonstrated gross total resection of the mass and decreasing lateral ventricle hydrocephalus with minimal cortical disturbance.

Conclusion:

A minimally invasive tubular system approach to ventricular tumors can be utilized to minimize cortical resection and brain retraction. Minimally invasive surgery also has the potential to decrease the length of stay and enhance postoperative recovery.
Treatment of intracranial vertebral artery dissecting aneurysms involving the posterior inferior cerebellar artery origin
Authors: Chen Jason A. , Garrett Matthew C. , Mlikotic Anton , Ausman James I.
Published: August 2019

Background:

Vertebral artery dissecting aneurysm (VADA) involving the origin of the posterior inferior cerebellar artery (PICA) is a complex disease entity in which the dual goals of preventing future rebleeding and maintaining perfusion of the lateral medulla must be considered. We present an illustrative case and review the literature surrounding treatment strategies.

Case Description:

We report a patient presenting with extensive subarachnoid hemorrhage due to rupture of an intracranial VADA involving the PICA origin. After consideration of the patient’s cerebral vasculature and robustness of collaterals, a flow-diverting stent was placed with angiographic resolution of the lesion and maintenance of antegrade PICA flow. Ultimately, the patient experienced a contralateral intraparenchymal hemorrhage leading to death. Review of the literature identified 124 cases of VADA involving the PICA origin described over the past decade. The methods of surgical and endovascular treatment of these cases were reviewed, with particular focus on the rationale of treatment, outcomes, and complications.

Conclusion:

Numerous treatment options for VADA involving PICA have been reported with different risk and benefit profiles. Flow-diverting stents appear to offer the most favorable balance of securing the aneurysm and avoiding medullary infarction, but the risks and optimal anti-thrombotic treatment strategy are incompletely understood. In select cases, in which the surgical risk is low or in which the anatomy is favorable (e.g., nondominant parent vessel or robust collateral circulation in the involved territories), parent artery trapping with or without microsurgical revascularization can be considered.