bluuebunny/crossref_metadata_2025_split huggingface dataset:
Surgical selection and outcomes among elderly patients with brain arteriovenous malformations
Authors: Burkhardt Jan-Karl , Winkler Ethan A. , Catapano Joshua S. , Spetzler Robert F. , Lawton Michael T. 
Published: October 2020

OBJECTIVEStudies of resection of brain arteriovenous malformations (AVMs) in the elderly population are scarce. This study examined factors influencing patient selection and surgical outcome among elderly patients.METHODSPatients 65 years of age and older who underwent resection of an unruptured or ruptured brain AVM treated by two surgeons at two centers were identified. Patient demographic characteristics, AVM characteristics, clinical presentation, and outcomes measured using the modified Rankin Scale (mRS) were analyzed. For subgroup analyses, patients were dichotomized into two age groups (group 1, 65–69 years old; group 2, ≥ 70 years old).RESULTSOverall, 112 patients were included in this study (group 1, n = 61; group 2, n = 51). Most of the patients presented with hemorrhage (71%), a small nidus (< 3 cm, 79%), and a low Spetzler-Martin (SM) grade (grade I or II, 63%) and were favorable surgical candidates according to the supplemented SM grade (supplemented SM grade < 7, 79%). A smaller AVM nidus was statistically significantly more likely to be present in patients with infratentorial AVMs (p = 0.006) and with a compact AVM nidus structure (p = 0.02). A larger AVM nidus was more likely to be treated with preoperative embolization (p < 0.001). Overall outcome was favorable (mRS scores 0–3) in 71% of the patients and was statistically independent from age group or AVM grading. Patients with ruptured AVMs at presentation had significantly better preoperative mRS scores (p < 0.001) and more favorable mRS scores at the last follow-up (p = 0.04) than patients with unruptured AVMs.CONCLUSIONSOutcomes were favorable after AVM resection in both groups of patients. Elderly patients with brain AVMs treated microsurgically were notable for small nidus size, AVM rupture, and low SM grades. Microsurgical resection is an important treatment modality for elderly patients with AVMs, and supplemented SM grading is a useful tool for the selection of patients who are most likely to achieve good neurological outcomes after resection.
Drain type after burr-hole drainage of chronic subdural hematoma in geriatric patients: a subanalysis of the cSDH-Drain randomized controlled trial
Authors: Greuter Ladina , Lutz Katharina , Fandino Javier , Mariani Luigi , Guzman Raphael , Soleman Jehuda 
Published: October 2020

OBJECTIVEChronic subdural hematoma (cSDH) occurs more frequently in elderly patients, while older patient age is associated with worse postoperative outcome following burr-hole drainage (BHD) of cSDH. The cSDH-Drain trial showed comparable recurrence rates after BHD and placement of either a subperiosteal drain (SPD) or subdural drain (SDD). Additionally, an SPD showed a significantly lower rate of infections as well as iatrogenic parenchymal injuries through drain misplacement. This post hoc analysis aims to compare recurrence rates and clinical outcomes following BHD of cSDH and the placement of SPDs or SDDs in elderly patients.METHODSThe study included 104 patients (47.3%) 80 years of age and older from the 220 patients recruited in the preceding cSDH-Drain trial. SPDs and SDDs were compared with regard to recurrence rate, morbidity, mortality, and clinical outcome. A post hoc analysis using logistic regression, comparing the outcome measurements for patients < 80 and ≥ 80 years old in a univariate analysis and stratified for drain type, was further completed.RESULTSPatients ≥ 80 years of age treated with an SDD showed higher recurrence rates (12.8%) compared with those treated with an SPD (8.2%), without a significant difference (p = 0.46). Significantly higher drain misplacement rates were observed for patients older than 80 years and treated with an SDD compared with an SPD (0% vs 20%, p = 0.01). Comparing patients older than 80 years to younger patients, significantly higher overall mortality (15.4% vs 5.2%, p = 0.012), 30-day mortality (3.8% vs 0%, p = 0.033), and surgical mortality (2.9% vs 1.7%, p = 0.034) rates were observed. Clinical outcome at the 12-month follow-up was significantly worse for patients ≥ 80 years old, and logistic regression showed a significant association of age with outcome, while drain type had no association with outcome.CONCLUSIONSThe initial findings of the cSDH-Drain trial and the findings of this subanalysis suggest that SPD may be warranted in elderly patients. As opposed to drain type, patient age (> 80 years) was significantly associated with worse outcome, as well as higher morbidity and mortality rates.
Blunt cerebrovascular injury in the geriatric population
Authors: Le Diana T. , Barhorst Kinsey A. , Castiglione James , Yang George L. , Shah Sanjit J. , Harlan Sarah S. , Keegan Shaun P. , Jandarov Roman A. , Ngwenya Laura B. , Prestigiacomo Charles J. 
Published: October 2020

OBJECTIVEBlunt cerebrovascular injury (BCVI) is associated with high rates of neurological morbidity and mortality. The detection and management of BCVI has improved with advances in imaging and sensitive screening protocols. Few studies have explored how these injuries specifically affect the geriatric population. The purpose of this retrospective analysis was to investigate the presentation and prognosis of BCVI in the elderly population and to assess its clinical implications in the management of these patients.METHODSAll patients presenting to the University of Cincinnati (UC) level I trauma center between February 2017 and December 2019 were screened for BCVI and entered into the prospectively maintained UC Neurotrauma Registry. Patients with BCVI confirmed by CT angiography underwent retrospective chart reviews to collect information regarding demographics, positive screening criteria, cause of injury, antithrombotic agent, injury location, Denver Grading Scale, hospital and ICU length of stay, and discharge disposition. Patients were divided into geriatric (age ≥ 65 years) and adult (age < 65 years) subgroups. Continuous variables were analyzed using the Student t-test and categorical variables with the Pearson chi-square test.RESULTSOf 124 patients with BCVI, stratification by age yielded 23 geriatric and 101 adult patients. Injury in the geriatric group was associated with significantly higher mortality (p = 0.0194). The most common cause of injury in the elderly was falls (74%, 17/23; p < 0.0001), whereas motor vehicle accidents were most common in the adult group (38%, 38/100; p = 0.0642). With respect to the location of injury, carotid (p = 0.1171) and vertebral artery (p = 0.6981) injuries did not differ significantly for the geriatric group. The adult population presented more often with Denver grade I injuries (p < 0.0001), whereas the geriatric population presented with grade IV injuries (p = 0.0247). Elderly patients were more likely to be discharged to skilled nursing facilities (p = 0.0403) and adults to home or self-care (p = 0.0148).CONCLUSIONSThis study is the first to characterize BCVI to all cervical and intracranial vessels in the geriatric population. Older age at presentation is significantly associated with greater severity, morbidity, and mortality from injury, with no preference for the particular artery injured. These findings carry important clinical implications for adapting practice in an aging population.
Neuromodulation of the lingual nerve: a novel technique
Authors: Zhao Kevin , Talbot Christopher E. , Mammis Antonios , Paskhover Boris 
Published: October 2020

The lingual nerve is a branch of the posterior trunk of the mandibular nerve. It provides sensation and taste to the ipsilateral anterior two-thirds of the tongue. Posttraumatic neuropathy of the lingual nerve can be chronic and debilitating long after the inciting trauma. In this operative video, the authors describe a novel technique for the treatment of lingual nerve neuropathy with neuromodulation. They present a case of a 69-year-old female with posttraumatic lingual nerve neuropathy after left molar extraction. The patient reported 95% symptom improvement after the procedure. This video demonstrates the feasibility of lingual nerve neuromodulation.The video can be found here: https://youtu.be/l-CKP8-8eqk
Surgical treatment of spasticity: intrathecal baclofen pump implantation under subarachnoid block
Authors: Scerrati Alba , De Bonis Pasquale , Norri Nicolò , Cavallo Michele Alessandro 
Published: October 2020

Most patients with spasticity, rigidity, and other symptoms of the upper motor neuron syndrome respond effectively to surgical treatment with an intrathecal baclofen pump when their symptoms become intractable to nonsurgical measures. Baclofen administered into the lumbar subarachnoid space produces a locally high concentration at the spinal level and a low concentration supraspinally, avoiding most of the central side effects associated with a high oral dose, such as drowsiness and confusion.The aim of surgical treatment is to provide the appropriate volume and concentration of the drug in the subarachnoid space, avoiding the main surgical complications, that is, infections, skin erosion, and catheter displacement.The video can be found here: https://youtu.be/HetelPwwwak
Teflon bridge technique for endoscopic-assisted microvascular decompression of ectatic basilar artery and anterior inferior cerebellar artery for trigeminal neuralgia: operative video and technical nuances
Authors: Liu James K. , Shafiq Asif 
Published: October 2020

In this illustrative operative video, the authors demonstrate a Teflon bridge technique to achieve safe transposition of a large, tortuous ectatic basilar artery (BA) and anterior inferior cerebellar artery (AICA) complex to decompress the root entry zone (REZ) of the trigeminal nerve in a 61-year-old woman with refractory trigeminal neuralgia via an endoscopic-assisted retractorless microvascular decompression. Postoperatively, the patient experienced immediate facial pain relief without requiring further medications. The Teflon bridge technique can be a safe alternative to sling techniques when working in narrow surgical corridors between delicate nerves and vessels. The operative technique and surgical nuances are demonstrated.The video can be found here: https://youtu.be/hIHX7EvZc1c
Microsurgical DREZ lesions for the control of cancer-related pain
Authors: Mazzucchi Edoardo , Brinzeu Andrei , Mertens Patrick , Sindou Marc 
Published: October 2020

Pain in patients with cancer is a major problem, and sometimes it is necessary to surgically interrupt pain pathways to effectively control refractory pain. Surgical lesion of the dorsal root entry zone (DREZ) was first performed in 1972 for the treatment of pain related to a Pancoast-Tobias tumor. The rationale of DREZotomy is to preferentially interrupt the nociceptive inputs in the lateral part of the DREZ and the ventrolateral (excitatory) part of the dorsal horn. Microsurgical DREZotomy is one technique for DREZ lesioning that is suited for tailored control of pain in patients in good general condition who are experiencing pain in a well-defined territory.The video can be found here: https://youtu.be/JtLQDP7gYSQ
Permainan Warna Anak Usia Dini Melalui Kreativitas Cotten Swabs Painting teknik Pointilis
Authors: Hedi Wibowo Devi Vionitta , Suyadi  
Published: October 2020

Pandemi covid 19 yang melanda dunia menjadi pokok permasalahan timbulnya pembelajaran daring yang diadakan didalam rumah. Dalam situasi ini anak-anak dapat merasakan kejenuhan dikarenakan faktor pembelajaran yang kurang kreatif dalam pengimplementasiannya. Kegiatan kreativitas seni warna anak usia dini ini dapat menjadi solusinya. Tujuan penelitian ini adalah agar dapat mengembangkan aspek kreativitas anak usia dini di era pandemi covid 19 ini. Metode yang digunakan adalah penelitian kualitatif deskripstif yang menganalisis persistiwa dari suatu tindakan yang dilakukan. Sampel yang digunakan dalam pengimplementasian kreativitas seni warna ini dapat berupa anak usia 3-5 tahun yang berada disekitar kompleks perumahan Sumber Mukti Indah Rembang. Adapun orangtua anak dapat dijadikan acuan dalam proses kegiatan kreativitas seni warna. Hasil penelitian yang didapat adalah adanya antusias anak dalam melakukan aktivitas kreativitas seni warna dengan menggunakan cat air. Anak merasa senang dan dapat menghasilkan hasil karya yang estetik. Adapun kegiatan yang diterapkan yaitu melukis menggunakan cotten bad, fingger painting, serta bercerita dengan menggunakan hasil karya masing-masing. Tujuan dari adanya kegiatan ini adalah agar dapat menumbuhkan jiwa kreativitas seni anak, emosional, bahasa, dan motorik anak.

Abstract
The Covid 19 that has hit the world has become the main problem of the emergence of online learning held at home. In this situation children can feel boredom due to less creative learning factors in its implementation. This early childhood color art creativity activity can be a solution. The purpose of this research is to develop the creative aspects of early childhood in the era of the Covid 19 pandemic. The method used is descriptive qualitative research that analyzes the events of an action taken. The sample used in the implementation of color art creativity can be in the form of 3-5 year old children around the Sumber Mukti Indah Rembang housing complex. The child's parents can be used as a reference in the process of color art creativity activities. The results obtained were the children's enthusiasm in doing color art creativity activities using watercolors. Children feel happy and can produce aesthetic works. The activities implemented were painting using cotten bad, fingger painting, and telling stories using their respective works. The purpose of this activity is to foster children's artistic creativity, emotional, language and motor skills.
Role of Two- Dimensional Speckle Tracking Strain versus Conventional Echocardiography in the Assessments of Left Ventricular Systolic Function in Middle-aged Hypertensive Patients.
Authors: Aldoori Mahasen , Mohammed Najeeb H. , Haj Ghazi F. 
Published: October 2020

Background: Global longitudinal strain (GLS) echocardiography is a new technique that can be used to detect an early left ventricular dysfunction in various heart diseases . Systemic hypertension is a major risk factor for cardiovascular accidents. The early management of its complication on the heart plays an
important role in the outcome of the disease. Hypertension is associated with changes in several aspects
of left ventricular structure, function, and systolic strains. Various echocardiographic techniques are used to evaluate left ventricular function in hypertensive patients.
Objectives: To evaluate the effectiveness of speckle tracking global left ventricular strain percentage (GLVS%) in the assessments of left ventricular systolic function in comparison to conventional echocardiography in middle -aged hypertensive patients.
Patients and Methods: The study was conducted from December 2017 till November 2018 at the Department of Echocardiography and Catheterization / Baghdad Teaching Hospital – Medical C ity,Baghdad, Iraq. One hundred and four hypertensive patients classified as ; group I that involved patients with reversed E/A ratio on PW Doppler with reversed Pulsed Wave ( PW) tissue Doppler study and group II with patients
having normal E/A ratio on PW Doppler and reversed Eprime/A prime on PW tissue Doppler study . The control (group III) recruited from the relative of the patients included 104 sex and age -matched healthy individuals . A detailed history with the recommended investigations and blood pressure measurements
was performed for all participants. Additionally, echocardiography examination was implemented using standard methods, considering eftventricle (LV) internal dimension, LVejection fraction percentage (LV EF%)
, LV diastolic function using PW Doppler and lateral mitralannular tissue Doppler Sprime,Mitral annular plane systolic excursion (MAPSE) and global LVspeckle tracking strain percentage (GLVS%).
Results: Group I included 76 patients with a mean age of (48 ± 6.6 years) and group II included 28 patients with a mean age of (48 ± 6.6 years). A ll the participants had normal EF% (> 60%), MAPSE (>13 mm), and S prime (> 9 cm /sec) while there were a significantly decreased GLVS% in the diseased groups in comparison to the control one (P < 0.005) being less in group II (-14 ± 1 %) than in Group I (- 16 ± 1 %) . In addition to a significant negative linear correlation between GL V S% with that of pulse pressure and IVST respectively ( p=0.04) and with that of E/A ratio and E/E prime ratio (p=0.001).
Conclusions: GLVS% is a better method in the assessment of LV systolic function in inmiddle- aged
hypertensive patients than conventional echo methods since it could detect an early impairment in LV
systolic function despite preserved LV systolic function measured by the conventional echo methods
Assessment of knowledge, behavior and attitude toward using antibiotics among non-medical students of University of Fallujah- Iraq.
Authors: Al Shawi Ameel 
Published: October 2020

Background: Antibiotics are medicines used to treat bacterial infections, Antibiotic resistance occurs when bacteria change in response to the use of these medicines. The world urgently needs to change the way that it prescribes and uses antibiotics.
Objective: To assess the knowledge, attitude, behavior toward antibiotic among non- medical students in University of Fallujah.
Method: A cross sectional study was done during the period from January to March 2019. Self-administered questionnaire was used that comprised 25 questions divided into four parts. The first part including demographic questions. Second part designed to assess the knowledge of respondents . Third part for assessment of attitude of respondents, . While Fourth to evaluate the behavior toward using antibiotics. The study subjects was non-medical students of University of Fallujah.
Results:Females represent 54.8 % of the sample , ages of subjects was between 19 year to 24 year. About two thirds 64.1 % believed that antibiotics work on most coughs and colds. 61.3 % of the participants stated “I will take antibiotic without prescription by doctor”, while 55.6 % of respondents prefer taking antibiotics with tea, only 39.1 % said that took antibiotics with water.
Conclusion:poor knowledge among the students towards antibiotic usage. Health education programs might be needed among universitystudents to improve the general knowledgeand attitudes towards antibiotic
HABITAT SELECTION BY EXOTIC DAMA GAZELLES (NANGER DAMA RUFICOLLIS) IN TEXAS
Authors: Mungall Elizabeth Cary , Cooper Susan M. 
Published: October 2020

Abstract
Habitat selection information is important for both breeding on Texas ranches and repatriation in Africa. This is especially true for the critically endangered dama gazelle (Nanger dama). Exotic dama gazelles of the eastern subspecies (N. dama ruficollis) wearing GPS-radio collars were tracked for one year on two Texas ranches. Three adult and two subadult males were collared from a large (8,996 ha) pasture in west Texas. Next, collars went on all males plus all females released into a 202 ha Edwards Plateau pasture (seven adult females, one maturing male, and one to three adult males). On both sites, the gazelles favored the less steep terrain of the Ector soil series. Adult male core areas averaged 440 ha in west Texas (vegetation sparse) and 57 ha on the Edwards Plateau (dense food stands). These relationships allowed for estimation of the number of adult males that could be stocked in the larger pasture while still allowing room for the males to spread out. No special affinity for water sources was found, although dama gazelles do drink during hot weather when water is available. There was no consistent seasonal distributional change noted. On both Texas sites, the gazelles survive on natural browse. Where there are feeders, competition from larger animals kept gazelles out. For breeding or restoring populations, flat-to-gently rolling terrain with ample browse is best. Shade and water are important, and any supplemental feed requires access. There also needs to be enough favored habitat to accommodate the adult males without dangerous conflict.
TREATMENT OF PATIENT WITH IRRITABLE BOWEL SYNDROME WITH DIET MODIFICATION – A CASE REPORT
Authors: Tejaswini Malayala , Ponugoti Tarun , Sahithreddy Anthireddy 
Published: October 2020

Irritable Bowel Syndrome (IBS) is characterized by chronic relapsing abdominal pain, bloating and changes in bowel habits. Despite very real symptoms, the gross and microscopy evaluation is normal in most IBS patients
Due to difficulty in diagnosis, incidence is not clearly known. Prevalence in developed countries is between 5% and 10 percent. Throughout the world about 10-20 percent of adults and adolescents have symptoms consistent with IBS.IBS is a disorder that effect all ages although most patients have their first symptom before age 45.Older individuals have a lover reporting frequency. Women are diagnosed with IBS 2-3 times as often as men and makeup 80 percent of population with severe IBS.
IBS is a bio-psychosocial disorder in which 3 major mechanicals interact: psychosocial factors, altered motility and heightened sensory function of intestine. Due to multifactorial etiology there is no single therapeutic option available with satisfactory efficiency.
Therefore, patients with high frequency of symptoms express high levels of frustration with their frequent hospital visits, decreased work & social life and food sensitivity. If treatment is carried out to improve symptoms, some people can control their symptoms by managing diet, lifestyle and stress. Others need medication and counselling.
In our case the patient wasn’t satisfied with the pharmacotherapy alone. He used diet modification and lifestyle modification as a main treatment strategy. Satisfactory results were observed with such changes.
Keywords: IBS, psychosocial, bio-psychosocial, lifestyle modification, diet modification, low FODMAP diet, high fiber diet, yoga, stress