bluuebunny/crossref_metadata_2025 huggingface dataset:
The Journey to My Student Identity: A Grounded Theory Study on Supported Education for Young Adults with Mental Health Problems
Authors: Liljeholm Ulrika , Argentzell Elisabeth , Hillborg Helene , Lövgren Veronica , Rosenberg David , Bejerholm Ulrika
Published: December 2021

Support for developing a work identity has been shown to be essential for the recovery process of young adults with mental health problems. Since research shows that the development of a student role during the educational years for these young adults may be interrupted, this time period may be relevant to explore in order to support career development and the critical transition to adulthood for this target group. To explore young adults’ experiences of participating in supported education that is integrated with vocational and mental health services, reflecting the process of developing a student identity while struggling with mental health problems. A grounded theory design was used. The material consists of 17 individual interviews with young adults aged 18–29 years who were receiving supported education. Young adults who study while having mental health problems encountered structural barriers and challenged engagement in education that created a gap between the students and the regular education system. Access to supported education was reported to decrease this gap and formed a bridge that to facilitate educational achievements. The achievements were related to several personal benefits that were important for the experience of meaning and identity development in the future. Supported education can contribute to enabling the development of student identity for young adults with mental health problems. This involves an engagement process and positive identity formation that may reduce stigma and is therefore important for the personal recovery process and career advancement.
Impaired metabolic effects of metformin in men with early-onset androgenic alopecia
Authors: Krysiak Robert , Kowalcze Karolina , Okopień Bogusław
Published: December 2021

Background

Early-onset androgenic alopecia is considered the phenotypic equivalent of polycystic ovary syndrome in men. The purpose of the current study was to investigate whether the presence of early-onset male-pattern baldness modulates metabolic effects of metformin.

Methods

This prospective case–control study included 2 groups of men at high risk for type 2 diabetes: 72 individuals with androgenic alopecia (group A) and 75 subjects with normal hair growth (group B). Both groups were matched for age, blood pressure, body mass index, insulin sensitivity and plasma lipids. Glycated hemoglobin, glucose, plasma lipids, indices of insulin sensitivity/resistance, sex hormones, high-sensitivity C-reactive protein (hsCRP) and 25-hydroxyvitamin D were determined before and after metformin treatment (1.7 g daily).

Results

Twelve-month metformin treatment reduced fat content, waist circumference, glycated hemoglobin, glucose and triglycerides, as well as improved insulin sensitivity. Although observed in both study populations, these effects were more pronounced in group B. Moreover, metformin decreased hsCRP and bioavailable testosterone levels in group B, as well as reduced 25-hydroxyvitamin D concentration in group A. Treatment-induced changes in glucose homeostasis markers correlated with the impact of metformin on hsCRP and 25-hydroxyvitamin D levels.

Conclusions

Metabolic effects of metformin in males are attenuated if they have coexisting early-onset androgenic alopecia. This finding may be partially explained by differences in severity of low-grade systemic inflammation and vitamin D status. The obtained results, requiring confirmation in large prospective studies, suggest that men with early-onset male-pattern baldness benefit to a lesser degree from metformin treatment than other men at high risk for type 2 diabetes.
The Effect of Cervical Conization on Women’s’ Sexual Function and Psychological Health, A Prospective Observational Study
Authors: Michaan Nadav , Loboda Noa , Ochshorn Ifat , Tzur Yossi , Cohen Aviad , Grisaru Dan , Laskov Ido
Published: December 2021

Background

Diagnosis of cervical dysplasia and subsequent conization of the uterine cervix might affect women’s’ sexual health.

Aim

To assess the effect of cervical conization on women’s sexual function and psychological wellbeing.

Methods

Patients undergoing conization of the cervix were assessed before, and 6 months after conization. Assessment of sexual distress and function was done using the female sexual distress scale-revised (FSDS-r) and the female sexual function inventory (FSFI), respectively. Risk for anxiety and depression, was assessed using the Hospital Anxiety and Depression Scale (HADS).

Main Outcome Measures

FSDS-r, FSFI and HADS scores before and after conization

Results

From October 2018 to March 2021, 55 patients undergoing cervical conization were recruited. No significant differences were found in FSDS-r scores before and after conization. An equal number of patients indicated having sexual distress (29 patients, 53%, before and after conization, P=1.0). No significant changes were noticed on any FSDS domains or the total FSDS score before and after conization, (26.8 vs. 26.0, p=0.461). The percent of patients that indicated an overall sexual dysfunction, increased from 49 percent before conization, to 59 percent after conization, P=0.388. A high percent of patients indicated signs of anxiety on the HADS questionnaire, both before and after conization (49% and 47%, respectively). The median anxiety and depression scores did not change after conization, p=1.0.

Clinical implications

A high percent of patients undergoing conization suffer from sexual distress, sexual dysfunction and general anxiety, both before and after conization. The conization procedure itself did not seem to effect questionnaire scores.

Strengths and limitations

This was a prospective cohort, with comprehensive assessment of female sexual and psychological wellbeing after conization. Not all subjects reported sexual intercourse prior to questionnaire completion.

Conclusion

Gynecologists should be aware of the psychological and sexual effect of the diagnosis and treatment of cervical pre-cancerous lesions, patients should be counselled accordingly.
Camel whey protein (CWP) ameliorates liver injury in type 2 diabetes mellitus rats and insulin resistance (IR) in HepG2 cells via activation of the PI3K/Akt signaling pathway
Authors: Dou Zhihua , Liu Chen , Feng Xinhuan , Xie Yutong , Yue Haitao , Dong Jing , Zhao Zhongkai , Chen Gangliang , Yang Jie
Published: December 2021

CWP8, an active protein component isolated from camel milk, ameliorates liver injury in T2DM rats by activating the PI3K/Akt signaling pathway and stimulates glycogen synthesis to improve lipid accumulation in insulin-resistant HepG2 cells.
Droplet-assisted electrospray phase separation using an integrated silicon microfluidic platform
Authors: Zhang Yan , Kim Sungho , Shi Weihua , Zhao Yaoyao , Park Insu , Brenden Christopher , Iyer Hrishikesh , Jha Prasoon , Bashir Rashid , Sweedler Jonathan V. , Vlasov Yurii
Published: December 2021

We report on a silicon microfluidic platform that enables integration of transparent μm-scale microfluidic channels, an on-chip pL-volume droplet generator, and a nano-electrospray ionization emitter that enables spatial and temporal phase separation for mass spectrometry analysis.
K-doped CeO2–ZrO2 for CO2 thermochemical catalytic splitting
Authors: Portarapillo Maria , Russo Danilo , Landi Gianluca , Luciani Giuseppina , Di Benedetto Almerinda
Published: December 2021

K-doping enhances redox properties of ceria–zirconia towards thermochemical CO2 splitting, showing promising performances at about 7 wt% of K.
Quantification of Tumor Blush of Highly Vascularized Tumors with Slow Feeding System: Representative Use for Giant Pituitary Adenomas
Authors: Ogawa Yoshikazu , Sato Kenichi , Endo Toshiki , Tominaga Teiji
Published: December 2021

Background Modern imaging techniques can identify adverse factors for tumor removal such as cavernous sinus invasion before surgery, but surgeries for giant pituitary adenomas often reveal discrepancies between preoperative imaging and intraoperative findings because pituitary adenomas have feeding arteries with narrow diameters. Current imaging methods are not suitable for tumors with not only large vascular beds but also slow arterial filling.

Patients and Methods This prospective study recruited 13 male subjects and 9 female subjects with giant pituitary adenomas between November 2011 and 2018. All the patients were investigated with three-dimensional magnetic resonance (MR) imaging, bone image computerized tomography (CT), and digital subtraction angiography (DSA) using a C-arm cone-beam CT scanner with a flat-panel detector and 50% diluted contrast medium. Fine angioarchitecture was evaluated and the tumor blush was quantified using newly developed region of interest (ROI) analysis to establish surgical strategies.

Results Seven patients demonstrated no or very faint tumor blushes. In these patients, feeding arteries run centripetally from the surface of the tumor. Fifteen patients showed significant tumor blushes, and the feeding arteries penetrated centrifugally from the inferoposterior pole to the upper pole of the tumor. All the patients were treated according to the angiographic information with successful hemostasis. The patients showed improvement and/or disappearance of the neurologic deficits. The faint and significant blush groups showed significant differences in intraoperative bleeding (p < 0.01) and operation time (p < 0.05).

Conclusion Specialized evaluation focused on vascularization is required for successful therapy of giant pituitary adenomas.
Percutaneous Transforaminal Endoscopic Diskectomy for Lumbar Disk Herniation: Young (Age <60 years) versus Older (Age ≥60 years) Patients
Authors: Zhong-Sheng Zhu , Rui Fang , Yan-Long Kong , Hai-Jun Xiao , Ya-Dong Zhang , Feng Xue
Published: December 2021

Background We compare the differences in the efficacy of percutaneous transforaminal endoscopic diskectomy (PTED) between the younger (age <60 years) and older (age ≥60 years) patients with lumbar disk herniation (LDH).

Methods From December 2016 to December 2017, 128 patients with symptomatic LDH underwent PTED and were followed up. Forty-four 60 years old and above, including 19 males and 25 females with an average age of 68.7 (61–82) years, were classified as the elderly age group. Eighty-four patients younger than 60 years were classified as the young age group, which included 48 males and 36 females with an average age of 44.7 (16–58) years. The visual analog scale (VAS) scores, Japanese Orthopaedic Association (JOA) scores, and satisfaction rates of the two groups before and after surgery were compared.

Results The operation was completed successfully in both groups. The average follow-up times of the elderly and young age groups were 18.47 ± 2.62 (12–23) and 17.90 ± 3.27 (12–23) months, respectively. One patient in the young age group had recurrence 7 months after surgery, and the symptoms were relieved after PTED was performed again. Two patients with nerve root injury after surgery in the young age group completely recovered after 2 months of conservative treatment. There were no significant surgical complications in the elderly age group. There was no significant difference in postoperative VAS, JOA, and MacNab scores between the two groups. The MacNab scores in the elderly age group were excellent for 28 patients, good for 10 patients, and fair for 6 patients; the satisfaction rate was 86.3%. In the young age group, scores were excellent for 63 patients, good for 14 patients, fair for 5 patients, and poor for 2 patients; the satisfaction rate was 91.7%.

Conclusion The clinical effectiveness of PTED for treatment of LDH in both elderly and young patients is satisfactory. Age is not a predictor of poor outcomes of PTED.
Skull Base Meningiomas: Is Surgical Resection Enough? Outcome Evaluation and Prognostic Factors Analysis in a Single-Center Cohort
Authors: Pessina Federico , Navarria Pierina , Rossini Zefferino , Clerici Elena , Fornari Maurizio , Politi Letterio S. , Scorsetti Marta , Servadei Franco
Published: December 2021

Background Surgical resection represents the mainstay of treatment in skull base meningiomas (SBMs). Considering the high recurrence rate reported, an adjuvant radiation therapy (RT) treatment should be considered. The aim of this study was to evaluate the progression-free survival (PFS), overall survival (OS), and prognostic factors conditioning outcome.

Methods Patients receiving surgical resection for grade I SBMs were included. The extent of resection (EOR) was dichotomized as gross total resection (GTR) and subtotal resection (STR). RT was administered only in patients receiving STR. Clinical outcome was evaluated by brain magnetic resonance imaging (MRI) performed every 6 months for the first year and yearly thereafter.

Results From January 2000 to December 2015, 123 patients were treated. The majority were females (70.7%), with a Karnofsky Performance Score (KPS) ≥80 (95%), and symptoms at diagnosis (91%). GTR was performed in 30% of cases and STR in 70%. RT was performed in 18 (20.9%) patients at diagnosis and in 29 (33.7%) patients at progression. Improvement or stability of neurologic status was obtained in 78.9% of patients. The median follow-up time was 91 months (range: 40–230 months). Local recurrence occurred in 34 (27.6%) patients at a median time of 45 months (range: 6–214 months). The median, 2-, 5-, and 10-year PFS were 193 months, 89.3, 81.8, and 72.5%, respectively. On univariate and multivariate analyses, factors impacting on PFS were EOR, tumor location, neurologic postoperative status, and adjuvant RT in STR.

Conclusions A safe surgical resection followed by RT adjuvant treatment could represent the better choice to obtain local control maintaining neurologic integrity. Our data underlined the value of adjuvant RT in incompletely resected meningiomas.
Oxidative Stress Level in Patients with Subarachnoid Hemorrhage
Authors: Abdallah Anas , Guler Eray Metin , Çınar İrfan , Papaker Meliha Gündağ , Yapar Selçuk , Ozer Omer Faruk , Yurtsever Ismail , Dündar Tolga Turan
Published: December 2021

Background One of the antioxidant mechanisms is the dynamic balance between thiol and disulfide, which, in subarachnoid hemorrhage and other chronic diseases, is disrupted in favor of the latter. The two most commonly used oxidative stress (OS) biochemical markers are the oxidative stress index (OSI) value, which indicates the total oxidant status (TOS) and total antioxidant status (TAS) balance, and the thiol–disulfide (TDS) value, which indicates the total thiol (TT) and native thiol (NT) balance. High OS levels require further investigations. We aimed to investigate the OS level in aneurysmal SAH (aSAH) patients.

methods In this clinical prospective study, blood samples were collected from 50 consecutively treated patients with aSAH and 50 volunteers. Serum TOS, TAS, TT, and NT levels were measured using Erel's method via a spectrophotometer. The Glasgow Coma Scale (GCS) scores, Fisher grades, length of hospital stay (LOS), and the Glasgow Outcome Scale (GOS) scores were recorded. Consequently, the OSI and TDS values were calculated in all participants.

Results A statistically significant difference was observed in the TAS, TOS, OSI, and TDS values between the aSAH patients and the controls. The TT and NT values were significantly lower in aSAH patients than in the controls. A correlation was identified between the OSI values and the GCS scores. Although a correlation was observed between the TDS values and the LOS, no correlation was found between the OSI and the TDS values.

Conclusion The OSI and TDS, which are OS indicators, might serve as the additional objective nominal data to evaluate the treatment efficacy and follow-up for SAH patients. Moreover, decreasing the OSI values and increasing the TT values can be used as improvement indicators in the treated aSAH patients. If we can reduce the OS at the early stage of SAH, it could improve the prognosis by reducing both the morbidity and mortality rates. Further randomized investigations are required to prove the findings in this prospective study.
Ruptured Aneurysm of the Anterior Communicating Artery in a Newborn: A Case Report and Review of the Literature
Authors: Frič Radek , Nedregaard Bård , Heimdal Ketil Riddevold , Weber Clemens , Due-Tønnessen Bernt Johan
Published: December 2021

We report the case of a 3-week-old neonate who presented with massive subarachnoid and intraventricular hemorrhage from a ruptured aneurysm of the anterior communicating artery (ACommA). An attempt on endovascular treatment ended up with therapeutic closure of the parent artery. However, since further investigation revealed a disastrous supratentorial cerebral infarction as a result of the hemorrhage, active treatment was terminated and the neonate died a few days after the initial stroke. To the best of our knowledge and after reviewing available literature, this is one of only five cases of ACommA aneurysm in newborns reported to date. Bleeding from an ACommA aneurysm in a neonate thus represents an extreme clinical rarity. There are no available data comparing the efficacy and safety of microsurgical versus endovascular treatment in neonates and small infants, but the latter option may at least reduce the risk associated with open surgery and further blood loss in this age group.
Cortical Bone Trajectory Pedicle Screw Fixation in Surgical Treatment of Monosegmental Pyogenic Lumbar Spondylodiskitis
Authors: Shin Jae-Hyuk , Kim Sang-II , Jung Jiyoung , Rhyu Kee-Won
Published: December 2021

Background and Study Object Pedicle screw fixation has been widely used in surgical treatment for infective lumbar spondylodiskitis to prevent instability and deformity. The cortical bone trajectory pedicle screw (CBTPS) fixation is a minimally invasive posterior spinal fixation system that runs from the pedicle's entry point of the caudiomedial region toward the cephalad-divergent direction. Successful results with CBTPS fixation have been reported to treat degenerative and osteoporotic spinal diseases. This study aims to investigate the clinical feasibility of CBTPS in the surgical treatment of pyogenic lumbar spondylodiskitis.

Patient and Methods We retrospectively retrieved 20 consecutive patients from two academic centers who were surgically treated for monosegmental lumbar pyogenic spondylodiskitis. The primary surgical treatment was the anterior lumbar interbody fusion with decompression, debridement, and reconstruction using an autogenous iliac strut bone graft. One to 2 weeks after the primary surgery, patients underwent a second surgery for posterior instrumentation using conventional pedicle screws (CPS; group I) and CBTPS (group II). Radiographic parameters of the deformity angle at the fusion segment and clinical parameter of visual analog scale (VAS) scores were assessed preoperatively, postoperatively, and at the last follow-up.

Results There were 10 patients in each group. The mean follow-up periods of groups I and II were 51.10 ± 6.95 and 28.60 ± 9.31 months, respectively. Intergroup analysis indicated the two groups area age-matched (p = 0.38), but initial C-reactive protein (CRP; mg/dL, p = 0.04), CRP normalization (months, p = 0.00), and follow-up duration (months, p = 0.00) were heterogeneous. Meanwhile, deformity angles (segmental lordosis) between the two groups were not significantly different preoperatively (p = 0.25), postoperatively (p = 0.13), and at last follow-up (p = 0.38). The intragroup analysis indicated a significant postoperative increase of lordosis in both group I and II (p = 0.00 and 0.04, respectively) with subsequent subsidence. Lordosis remained increased at the last follow-up with or without significance (group I, p = 0.02; group II, p = 0.62). Both groups showed significant improvement in VAS scores (group I, p = 0.00; group II, p = 0.00).

Conclusion In monosegmental lumbar spondylodiskitis, posterior stabilization of the anterior strut bone graft by CBTPS and CPS was comparable via the radiographic parameter of segmental lordosis or deformity angle. Our observation suggests the clinical feasibility of CBTPS in the treatment of relatively mild monosegmental pyogenic lumbar spondylodiskitis.
Temporal Flaps in Head and Neck Reconstructive Surgery: A Systematic Review of Surgical Techniques
Authors: Gagliardi Filippo , Snider Silvia , Pompeo Edoardo , Medone Marzia , Piloni Martina , Giordano Leone , De Domenico Pierfrancesco , Roncelli Francesca , Mortini Pietro
Published: December 2021

The temporal region is a great source of vascularized flap, providing extremely variable and versatile options for reconstruction in head and neck surgery. Its popularity has led to the conception of a large variety of different flaps, in terms of contents and design. Temporal flaps are highly pliable and flexible, providing adequate bulk to obliterate dead spaces and improving engraftment, thus facilitating wound healing. The need to access different anatomical compartments, often far from the original flap anatomical site, has led surgeons to develop techniques to enlarge pedicles and bulk, by reverting and splitting flaps' contents, as well as through partial mandibular and zygomatic resection. To further increase versatility, a multilayered combination of different regional tissues and muscle segmentation techniques has been described. Historically, each flap has had its own proponents and opponents, but a pointy review systematizing techniques and comparatively analyzing different flaps was still missing in the literature. The field of use of some flaps has been progressively limited by the increasing relevance of free tissue transfers, which nowadays may provide success rates up to 95% with a constrained morbidity, thus offering an effective alternative, when available. Given the wide range of reconstructive strategies based on temporal flaps, there is still a great debate on nomenclature and surgical techniques. The present study systematizes the topic, classifying regional flaps according to contents and indications. Harvesting techniques are described stepwise and schematically illustrated, thus offering an indispensable tool to the armamentarium of reconstructive surgeons.
Vertebral Body Infarction after Transarterial Preoperative Embolization of a Vertebral Hemangioma
Authors: Fiore Giorgio , Bertani Giulio A. , Tariciotti Leonardo , Borsa Stefano , Paolucci Aldo , Taramasso Lucia , Locatelli Marco , Pluderi Mauro
Published: December 2021

Background Vertebral hemangioma resection can be a real challenge for spine surgeons, given the high potential of massive intraoperative bleeding. For this reason, preoperative transarterial embolization of this tumor is supported by the available literature. Here, we discuss our difficulties in interpreting an unusual clinical and radiologic picture related to the endovascular procedure.

Methods and Results A 45-year-old man was referred to our department due to chronic back pain and progressive lower extremity weakness. Radiologic assessment was obtained by means of spinal computed tomography (CT) and magnetic resonance imaging (MRI), which showed an aggressive vertebral hemangioma in T7, compressing the spinal cord. The patient underwent a combined therapeutic approach consisting of preoperative transarterial embolization followed by tumor resection, spinal cord decompression, and posterior thoracic arthrodesis. The patient was dismissed with neither strength nor sensory deficits. Two weeks later, he returned to our department with fever. A new MRI demonstrated multiple areas of altered signal in almost all vertebral bodies from T6 down to the sacrum. After a deep diagnostic process, including new MRI and infectious disease evaluations, the definitive diagnosis of multiple vertebral bone infarction was suggested.

Conclusion Vertebral infarctions are an extremely rare complication of spinal endovascular procedures. To our knowledge, this is the first case of multiple postembolization vertebral infarctions, without spinal cord involvement. This peculiarity was explained by the presence of direct anastomoses between a posterior intercostal artery and the underlying vertebral bodies.
Growth Analysis of Untreated Meningiomas under Observation
Authors: Opalak Charles F. , Sima Adam P. , Carr Matthew Thomas , Rock Andrew , Somasundaram Aravind , Workman Kathryn G. , Dincer Alper , Chandra Vyshak , Vega Rafael A. , Broaddus William C.
Published: December 2021

Background When meningiomas are small or asymptomatic, the decision to observe rather than treat requires balancing the growth potential of the lesion with the outcome and side effects of treatment. The aim of this study is to characterize the growth patterns of untreated meningiomas to better inform the clinical decision-making process.

Methods Patients with meningiomas were identified from 2005 to 2015. Those without treatment who had been followed for 1.5 years, with three magnetic resonance imaging (MRI) scans, were identified. Scans were measured with orthogonal diameters, geometric mean diameters, and volumes using the ABC/2 method. Regression modeling determined what growth pattern these parameters best approximated.

Results Two hundred and fifteen MRI scans for 34 female (82.9%) and 7 male (17%) patients with 43 tumors were evaluated. Initial tumor volumes ranged from 0.13 to 9.98 mL. The mean and median initial volumes were 2.44 and 1.52 mL, respectively. Follow-up times ranged from 21 to 144 months, with a median of 70 months. There were 12 tumors (28%) whose growth rates were significantly greater than zero. For all tumors, use of a linear regression model allowed accurate prediction of the future size using prior data.

Conclusion Three-quarters of presumptive meningiomas managed conservatively do not grow significantly. The remainder have significant growth over time, and the behavior could be approximated with linear regression models.
Intraneural Nodular Fasciitis of the Dorsal Scapular Nerve: Case Report and Review of the Literature
Authors: Domazet Ivan , Njiric Niko , Jakovcevic Antonia , Bitunjac Andrija , Domazet Krešimir , Pašalić Ivan , Mrak Goran
Published: December 2021

Background Nodular fasciitis is a benign neoplasm occurring predominantly in the subcutaneous tissue. There have been nine intraneural occurrences described in the literature.

Case report A 37-year-old woman presented with numbness and tenderness in her left shoulder and scapula and a slightly dropped left shoulder, without history of trauma. A magnetic resonance imaging (MRI) of the cervical spine showed a well-circumscribed oval mass deep to the levator scapula muscle. Due to persisting symptoms and an unknown nature of the process, surgical excision was performed, and histopathologic analysis confirmed diagnosis of a benign fibroblastic/myofibroblastic neoplasm, nodular fasciitis. The postoperative course was uneventful and the patient was without symptoms at 4 months of follow-up.

Methods We reviewed the available literature (PubMed, Google Scholar), with nine published cases of intraneural nodular fasciitis. The reported clinical, radiologic, and histopathologic parameters were evaluated and compared.

Discussion Most of the cases reported in the literature were symptomatic, with tenderness and palpability being the main symptoms. Six of the reported cases occurred in the forearm, whereas three were in the leg. To the best of our knowledge, ours is the first reported case of nodular fasciitis occurring in the trunk. Ours is the only case to display desmin positivity, which supports the reactive hypothesis of nodular fasciitis.

Conclusion Intraneural nodular fasciitis is an extremely rare diagnosis. Due to its benign natural course, a multidisciplinary approach with this extremely rare diagnosis in mind is needed to avoid overtreatment.
Alternative Dorsal Root Ganglion Neuromodulation Electrode Implantation: A Report of 2 Cases with 3 Different Techniques
Authors: Schultheis Björn Carsten , Wille Christian , Ross-Steinhagen Nikolas Eugenio , De Ridder Dirk , Vancamp Tim , Weidle Patrick A.
Published: December 2021

Background and Study Aims The traditional percutaneous placement of dorsal root ganglion (DRG) electrodes may not be eligible for every patient. In this tertiary spine surgery and interventional pain therapy center, alternative neurostimulation implantation techniques were developed and applied where standard percutaneous approaches failed or were contraindicated.

Case presentation Three alternative implantation techniques can be used: (1) open surgical placement of DRG leads, (2) two-lead insertion via a lateral to medial transforaminal approach (level L3), and (3) percutaneous approach with two leads close to the spinal nerves L4 (peripheral nerve stimulation).

Results The placement of the leads occurred without complications and resulted in similar expected outcomes as with the common percutaneous technique with long-term stable pain suppression at 7 months and 1 year.

Conclusions In patients in whom the DRG cannot be approached by the standard percutaneous approach, at least three alternatives may be used in experienced hands resulting in stable pain suppression of similar magnitude.
The Contralateral Approach to intra- and Extraforaminal Lumbar Disk Herniations: Surgical Technique and Review of Surgical Procedures
Authors: Jesse Christopher Marvin , Raabe Andreas , Ulrich Christian T.
Published: December 2021

Background Surgery for intra-/extraforaminal disk herniations (IEDH) is technically demanding due to the hidden location of the compressed nerve root section. Ipsilateral approaches (medial and lateral) are accompanied by extended resection of the facet joint and inadequate visualization of the pathology, especially at the L5–S1 level.

Methods We describe a microsurgical interlaminar contralateral approach (MICA) suitable for IEDH at the lumbosacral junction that can also be used at L4–L5 and L3–L4.

Conclusion The MICA provides access and sufficient intraforaminal visualization for IEDH in the lumbosacral region without resection of stability-relevant structures or manipulation of the nerve root ganglion.
Clinical Practice in Spine Surgery: An International Survey
Authors: Pérez-Bovet Jordi , Buxó Maria , Rimbau Muñoz Jordi
Published: December 2021

Background The availability of diverse and sophisticated surgical options to treat spine conditions is compounded by the scarcity of high-level evidence to guide decision-making. Although studies on discrete treatments are frequently published, little information is available regarding real-world surgical practice. We intended to survey spine surgeons to assess clinical management of common spine diagnosis in day-to-day settings.

Methods An online survey was distributed among neurosurgeons and orthopaedic surgeons worldwide. The obtained assessment of common surgical practice is contextualized in a review of the best available evidence.

Results The survey was answered by more than 310 members of several European, Australasian, and South African professional societies. The submitted responses translate a surgical practice generally grounded on evidence, favoring well-tried techniques, providing comprehensive treatment for the most severe diagnoses. Such practice comes mostly from neurosurgeons focused on spine surgery, practicing in teaching hospitals.

Conclusion We believe that the pragmatic, day-to-day approach to spine conditions captured in the present survey offers an informative insight to involved surgeons.
Declining Numbers of Neurosurgical Emergencies at a German University Medical Center during the Coronavirus Lockdown
Authors: Falter Johannes , Schebesch Karl-Michael , Schmidt Nils Ole
Published: December 2021

Background The coronavirus pandemic due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is posing unprecedented challenges to health care systems around the globe. Consequently, various lockdown scenarios have been politically imposed to get control over the spread of this disease. We examined the impact of the lockdown situation on the number of neurosurgical emergency patients admitted to our tertiary care center with a catchment area of ∼2.2 million inhabitants in the south of Germany to ensure adequate neurosurgical emergency care during a pandemic lockdown.

Methods All emergency admissions (with consecutive inpatient treatment) to the Department of Neurosurgery at the University Medical Center Regensburg, Germany, between March 1 and May 8 (69 days) of the years 2018, 2019, and 2020 were retrospectively identified and reviewed for this study. Demographic data, diagnoses, urgency of surgery, and duration of the journey to the emergency room were examined.

Results Between March 1 and May 8, 2020, 59 emergency patients were neurosurgically treated at our department. Compared with 2018 and 2019, emergency admissions in 2020 had thus declined by 37.2 and 27.1%, respectively. Regarding the year 2020, we found a significant drop from 1.71 and 1.52 emergency patients per day in January and February 2020, respectively, to 0.86 during lockdown (p < 0.001). The decline especially concerned nontraumatic spinal cases and also patients with other neurosurgical diagnoses such as intracranial hemorrhage. Evaluation of the overall disease severity of admitted patients by means of the urgency of surgery showed no difference between the baseline years and the lockdown period.

Conclusion Our findings are in line with other observational studies of neurosurgical, neurologic, and cardiologic centers in Europe that have described a drop in emergency cases. The reasons for this drop that seems to affect various medical fields and countries across Europe are still unidentified. Morbidity and mortality rates are still unknown, and efforts should be made to facilitate neurosurgical emergency care during a pandemic lockdown.
Comparative Analysis of Acute Levodopa Challenge Test and the Outcomes of Deep Brain Stimulation in Parkinson's Disease
Authors: Chen Yusheng , Zu Jie , Zhang Wei , Xu Chuanying , Cui Guiyun , Cui Chenchen , Xiao Qihua
Published: December 2021

Background We study the correlation between the preoperative levodopa challenge test and the efficacy of deep brain stimulation (DBS) surgery in Parkinson's disease (PD).

Methods Fifty patients with PD who underwent DBS treatment in our hospital from October 2016 to October 2017 were enrolled in this study. Using the Unified Parkinson Disease Rating Scale-III (UPDRS-III) as an indicator, we analyzed the improvement in motor symptoms on the levodopa challenge test and by DBS surgery. We also discussed the correlation between the effects of the levodopa challenge test and DBS surgery.

Results There was no correlation between the results of the levodopa challenge test and DBS surgery. There was a linear correlation between muscle rigidity and bradykinesia, whereas the linear correlation between other symptoms was weak.

Conclusion The levodopa challenge test can be used as a screening tool for patients undergoing DBS surgery, and can predict the degree of improvement in muscle rigidity and bradykinesia surgery. However, the prediction of the degree of improvement of total motor symptoms is poor.
Subjective and Objective Quality-of-Life Assessment of Outcome Measures in Cervical Spine Surgery for Degenerative Changes
Authors: Prokopienko Marek , Sobstyl Michał
Published: December 2021

Cervical spine diskectomy is a commonly used procedure in degenerative disease of cervical spine surgery. However, it is difficult to assess the quality of life after this widely applied and variously modified procedure. This literature review presents cervical diskectomy results, according to various scales and measures in multidirectional surgical strategies. Using relevant databases, we tried to find the best treatment options for degenerative disk disease and the best method of quality-of-life assessment, searching for modalities that may influence the outcome.
Preoperative ODI and Intake of Analgesics Predict Outcome after Lumbar Microdiskectomy: Results from a Prospective Register
Authors: Revollo Yessika De Leon Benito , Atassi Hermien , Fandino Javier , Kienzler Jenny C.
Published: December 2021

Background Lumbar disk herniation (LDH) typically causes leg pain and neurologic deficits, but can also be a source of low back pain (LBP). Lumbar microdiskectomy (LMD) is among the most common neurosurgical procedures to relieve radicular symptoms. It is important for both surgeon and patient to understand potential predictors of outcome after LMD. The aim of this study was to investigate if the presence and intensity of preoperative LBP, the ODI score, and analgesic intake can predict the outcome of patients undergoing LMD.

Methods This is a single-center retrospective study based on the analysis of prospectively acquired data of patients in the SwissDisc Registry. A total of 685 surgeries on 640 patients who underwent standardized LMD at our institution to treat LDH were included in this study. We performed multivariable linear regression analysis to determine preoperative predictors for patient outcomes based on the Oswestry Disability Index (ODI) scores, recorded on average 39.77 (±33.77) days after surgery.

Results Our study confirmed that surgery overall improves patient degree of disability as measured by ODI score. Following model selection using Aikake Information Criterion (AIC), we observed that higher preoperative ODI scores (β: 0.020 [95% CI: 0.008 to 0.031]) and higher number of analgesic medication usage by patients prior to surgery (β: 0.236 [95% CI: 0.057 to 0.415]) were both associated with an increased postoperative ODI score.

Conclusion LDH surgery generally improves patient degree of disability. The analysis of patients with a high preoperative ODI score and increased intake of analgesics before surgery predicted a worsening of patients' disability after LMD in this subgroup.
Overcoming barriers to HIV pre-exposure prophylaxis (PrEP) coverage in Australia among Medicare-ineligible people at risk of HIV: results from the MI-EPIC clinical trial
Authors: Chan Curtis , Fraser Doug , Vaccher Stefanie , Yeung Barbara , Jin Fengyi , Amin Janaki , Dharan Nila J. , Carr Andrew , Ooi Catriona , Vaughan Matthew , Holden Jo , Power Cherie , Grulich Andrew E. , Bavinton Benjamin R.
Published: December 2021

Background Overseas-born people who are ineligible for government-subsidised health care experience barriers to accessing HIV pre-exposure prophylaxis (PrEP) in Australia. This study aimed to assess a program providing free PrEP to overseas-born adults at risk of acquiring HIV. Methods Medicare-Ineligible Expanded Implementation in Communities (MI-EPIC) was a single-arm, open-label trial of daily tenofovir disoproxil fumarate/emtricitabine as PrEP. Six clinics recruited Medicare-ineligible adults who met HIV risk criteria in New South Wales, Australia. We recorded data on HIV and sexually transmitted infection (STI) diagnoses, and PrEP dispensing from July 2019 to June 2020. PrEP adherence as a medication possession ratio (MPR) was calculated as pills dispensed divided by days. We administered an optional survey on behaviours and attitudes to PrEP and sexual health. Results The 221 participants (206 men; 93.2%) had a median age of 29 years (IQR 26–34). Participants were mostly born in Asia (53.4%), Latin America or the Caribbean (25.3%), or Europe (10.9%). Adherence was high; 190 participants (86.0%) had an MPR of >60%. Of 121 survey participants, 42 (34.7%) completed the survey in a language other than English. Of participants who had not used PrEP in the 6 months before enrolment (n = 45, 37.2%), the most common reasons were cost (n = 22, 48.9%), and lack of knowledge about accessing PrEP (n = 20, 44.4%). Conclusions Medicare-ineligible people at risk of HIV demonstrate high adherence when given access to free PrEP and translated information. Increasing PrEP awareness and reducing barriers to accessing PrEP in this high-risk population should be priorities in HIV prevention.
How infrastructure contributes to fostering Regional Innovation System: The case of Pelalawan Regency – Indonesia
Authors: Kusharsanto Z S , Maninggar N , Suhandojo  , Maulidya D , Muzaki A R
Published: December 2021

Regional Innovation System (RIS) has been regarded by many regions in Indonesia as part of their smart development strategy. The system comprises various elements to be harmonised, including the urban infrastructure. However, despite its essential role in the system, how urban infrastructure contributes to the development of RIS is still unclear and needs to be measured. This paper tries to shed light on the role of urban infrastructure in RIS implementation especially its impact on the operationalization of local institutions and economic development. The case of Pelalawan Regency is examined where RIS has been implemented there since 2015. The mixed method is conducted to assess Pelalawan’s most prominent infrastructure, information and communications technology (ICT) and water supply system, by carrying out survey to Pelalawan’s government agencies and followed by deep interviews to validate it. The result shows that infrastructure only contributes less than 50% encouraging the ideal RIS development, in which ICT’s role outperforms the other.
Revitalization of property asset on the Dumilah Waterpark through the infill development of new activities
Authors: Santoso E B , Siswanto V K , Sulistyandari U
Published: December 2021

Property assets owned by the city government should provide high benefits as a source of regional income. The asset is aging so that its productivity will decrease. The government is trying to revitalize assets to make them more productive. The purpose of this study is to determine the best utilization that can provide the highest benefit. The method used to assess the development of these assets is through the high best use approach. Several alternatives to the use of assets compared with the analysis of financial feasibility include the calculation of IRR, NPV, PP, ROI. The utilization of property assets that is more profitable for landowners, based on the results of the FGDs that have been carried out there is an opportunity to build a supporting facility for the development of Dumilah Water Park as a Hotel and Convention Hall. Both of these facilities have considerable economic appeal to support the function of the city of Madiun as a center for trade and services on a regional scale. Based on the calculation of financial feasibility at Dumilah Water Park with an initial investment amount of Rp. 60,354,000,000.00 then the Net Present Value is obtained of Rp. 6,258,119. Likewise, the Internal Rate of Return was obtained at 11.41%, greater than the 10% interest rate. Meanwhile, the Payback Period of this investment is 8 years with an ROI of 10%.
Using confirmatory factor analysis to evaluate the factor determining the bus usage in Surabaya City, Indonesia
Authors: Larasati A F , Handayeni K D M E
Published: December 2021

Surabaya City is second biggest city in Indonesia which has a vital public transportation called as Suroboyo Bus. The city bus system provides route to connect the northern and southern part of the city with the central business district in the city centre. Policy of developing city bus system in north-south corridor aims to encourage the shifting of automobile to bus use as the traffic congestion is mainly caused by the high dependent of private mobility. The operation of Suroboyo Bus has been a concern because of the attractiveness of the quality with low deck and double-deck bus types, Suroboyo Bus also equipped a priority area, as well as a unique payment system with plastic bottle waste. This study aims to investigate the factors which influence the preference of Suroboyo Bus based on the user’s perceptions. Thus, the city bus system can be evaluated to achieve sustainable city mobility. Using the method of Confirmatory Factor Analysis (CFA), the result shows that there are nine significant factors determining the use of Suroboyo Bus. The city bus usage is mostly influenced by the user characteristic and the service performance of the mode offered.
The sustainability concept of Malay Kampong as tourism destination and urbanheritage in Semarang: dualism of modern transformation versus heritage
Authors: Ristianti N S , Kurniati R , Widjajanti R
Published: December 2021

The dualism of heritage kampong and urban physical development led to the excistence. One of the effort is maintaining kampong existence into a cultural tourism. Such as Malay Kampong, as a historical tourist destination in Semarang. However, the community has not been able to develop tourism potential. They have a high dependence on the government. Besides, people who are not yet powerless will be fundamental determinants of the program’s sustainability. This research aims to formulate a sustainability model of the heritage kampong preservation as a tourist destination of Malay Kampong Semarang. The research method is qualitative descriptive. The first stage is the identification of historical tourism potential. The second stage is formulating the development trend in the context of dualism. The third stage is formulating the concept of the sustainability of historical tourism villages based on dualism. The fourth stage is formulating a sustainability model of heritage kampong based on environmental, economic, and social aspects. Based on the environmental aspect, the ethnic cultural as a new potential of tourist destination and cooperation with investors. Based on the economic aspect, the development of local products and training. Based on the social aspect, the development of cultural tourism community.
Ekistics in plannned and unplanned settlement
Authors: Novitasari V , Hardiyati  , Miladan N
Published: December 2021

Doxiadis (1969) in ekistics states that settlements are where people life and existence. Ekistics is one of the efforts that must be made to address the increasingly complex problems due to the increasing population growth and increasing land use Therefore, a settlement consists of the content (the content) that is human and where the physical human lives that include natural and man-made elements (the container). The formation of settlement morphology consists of planned and unplanned settlements, the method used in ekistics research in planned and unplanned settlements is the study of literature with descriptive analysis. Sampling used in this study is a planned settlement Kelurahan Baluwarti in Solo and an unplanned settlement that is a Kelurahan Gentan in kabupaten Sukoharjo. The result of this study is (1) The Concept of Ekistics exists in planned or unplanned settlements (2) The very noticeable difference between planned and unplanned settlements is the social condition of the community.
Sustainable Development Goals for settlement around Lapindo mudflow
Authors: Nurafiah I , Sunoko K , Handayani K N
Published: December 2021

The Lapindo mudflow in the Porong area, Sidoarjo Regency has been 14 years old since it first occurred on May 29, 2006. The biggest loss from the Lapindo mudflow is the damage to infrastructure and residents’ homes which has an impact on the slowing down of Sidoarjo’s economy. One of the efforts made by the government is to establish a National Action Plan (RAN) for disaster risk reduction (PRB) as an effort to achieve the Sustainable Development Goals (SDGs). Considering that the Lapindo mudflow is still active and the expiration time cannot be estimated, a long-term management strategy is needed in settlements around the location that are adaptive to the existence of the disaster. The research was carried out using qualitative-descriptive methods. Data collection techniques are carried out by interview, observation and documentation study. The data obtained is then matched with the indicators for assessing the Sustainable Development Goals (SDGs). The results of the research will provide insights in the form of settlement strategies carried out by local governments and communities as part of sustainable development in accordance with the conditions of their respective regions.