bluuebunny/crossref_metadata_2025_split huggingface dataset:
Neuroblastoma with intracerebral metastases and the need for neurosurgery: a single-center experience
Authors: Fleck Steffen , Marx Sascha , Bobak Clara , Richter Victoria , Nowak Stephan , Rafaee Ehab El , Siebert Nikolai , Ehlert Karoline , Schroeder Henry W. S. , Lode Holger N. 
Published: October 2019

OBJECTIVEIntracerebral metastases in neuroblastoma patients are rare, and information about the indication for and the outcome of neurosurgical procedures in this setting is scarce in the literature. The authors’ aim in the present study was to report a single-center experience with the neurosurgical treatment of intracerebral metastases in neuroblastoma.METHODSThis study is a retrospective single-center analysis of all neurosurgical strategies used in the treatment of intracerebral metastases in neuroblastoma patients.RESULTSBetween 2009 and 2017, 237 pediatric patients (94 girls, 143 boys) with a mean age of 39 months at diagnosis were treated for neuroblastoma. Five (2.1%) of the 237 patients had a neurosurgical procedure for intracerebral metastases. The metastases occurred a mean of 46 months after initial diagnosis. All of these patients had neuroblastoma stage 4. Indications for surgery were recurrent metastases after initial successful oncological treatment or progression of the metastasis under oncological treatment as well as deterioration of neurological function. Intraoperatively, the tumor usually had a distinguishable dissection plane but was infiltrative to adjacent nerves in some spots. Mean overall survival after the neurosurgical procedure was 22 months. Furthermore, in another 3 patients, a neurosurgical procedure was done for an intracranial but extracerebral metastasis.CONCLUSIONSNeurosurgical procedures for intracerebral metastases in neuroblastoma patients are rare and were performed in 2.1% of patients in the present study. Intracerebral metastases occurred during disease progression, and the prognosis after surgery was very limited. The main indications for surgery were rapid neurological deterioration or recurrence of the metastasis after initial successful oncological treatment. Intraoperatively, the metastases usually had a distinguishable dissection plane from the normal brain tissue.
Association of cognitive function with cerebral blood flow in children with moyamoya disease
Authors: Kazumata Ken , Tokairin Kikutaro , Sugiyama Taku , Ito Masaki , Uchino Haruto , Osanai Toshiya , Kawabori Masahito , Nakayama Naoki , Houkin Kiyohiro 
Published: October 2019

OBJECTIVEThe cognitive effects of main cerebral artery occlusive lesions are unclear in children with moyamoya disease (MMD). The authors aimed to investigate cognitive function in the presurgical phase of pediatric patients with MMD with no apparent brain lesions.METHODSIn this prospective, observational, single-center study, 21 children (mean age 10 ± 3.0 years, range 5–14 years) diagnosed with MMD at Hokkaido University Hospital between 2012 and 2018 were enrolled. A cross-sectional evaluation of intellectual ability was performed using the Wechsler Intelligence Scale for Children—Fourth Edition at the initial diagnosis. rCBF was measured using [123I] N-isopropyl p-iodoamphetamine/SPECT. The associations among clinical factors, disease severity, regional cerebral blood flow (rCBF), and intelligence test scores were also examined.RESULTSThe mean full-scale intelligence quotient (FIQ) was 101.8 ± 12.5 (range 76–125) in children with no apparent brain lesions. A significant difference in the intelligence scale index score was observed, most frequently (42.9%) between working memory index (WMI) and verbal comprehension index (VCI; VCI − WMI > 11 points). Regional CBF was significantly reduced both in the left and right medial frontal cortices (left: 61.3 ± 5.3 ml/100 g/min, right 65.3 ± 5.3 ml/100 g/min; p < 0.001) compared to the cerebellum (77.8 ± 6.8 ml/100 g/min). There was a significant association of rCBF in the left dorsolateral prefrontal cortex (DLPFC) with FIQ (r = 0.46, p = 0.034), perceptual reasoning index (PRI; r = 0.44, p = 0.045), and processing speed index (PSI; r = 0.44, p = 0.045). There was an association between rCBF of the left medial frontal cortex and PSI (r = 0.49, p = 0.026). Age of onset, family history, ischemic symptoms, and angiographic severity were not associated with poor cognitive performance.CONCLUSIONSAlthough average intellectual ability was not reduced in children with MMD, the association of reduced rCBF in the left DLPFC and medial frontal cortex with FIQ, PRI, and PSI suggests mild cognitive dysfunction due to cerebral hypoperfusion.
Extraordinary case presentations in pediatric pituitary adenoma: report of 6 cases
Authors: Meyer Jenna , Perry Avital , Oushy Soliman , Graffeo Christopher S. , Carlstrom Lucas P. , Meyer Fredric B. 
Published: October 2019

Pediatric pituitary adenomas (PPAs) are rare neoplasms with a propensity for unusual presentations and an aggressive clinical course. Here, the authors describe 6 highly atypical PPAs to highlight this tendency and discuss unexpected management challenges.A 14-year-old girl presented with acute hemiparesis and aphasia. MRI revealed a pituitary macroadenoma causing internal carotid artery invasion/obliteration without acute apoplexy, which was treated via emergent transsphenoidal resection (TSR). Another 14-year-old girl developed precocious galactorrhea due to macroprolactinoma, which was medically managed. Several years later, she re-presented with acute, severe, bitemporal hemianopia during her third trimester of pregnancy, requiring emergent induction of labor followed by TSR. A 13-year-old boy was incidentally diagnosed with a prolactinoma after routine orthodontic radiographs captured a subtly abnormal sella. An 18-year-old male self-diagnosed pituitary gigantism through a school report on pituitary disease. A 17-year-old boy was diagnosed with Cushing disease by his basketball coach, a former endocrinologist. A 12-year-old girl with growth arrest and weight gain was diagnosed with Cushing disease, which was initially treated via TSR but subsequently recurred and ultimately required 12 operations, 5 radiation treatments involving 3 modalities, bilateral adrenalectomy, and chemotherapy. Despite these efforts, she ultimately died from pituitary carcinoma.
Teriparatide treatment increases Hounsfield units in the lumbar spine out of proportion to DEXA changes
Authors: Mikula Anthony L. , Puffer Ross C. , Jeor Jeffery D. St. , Bernatz James T. , Fogelson Jeremy L. , Larson A. Noelle , Nassr Ahmad , Sebastian Arjun S. , Freedman Brett A. , Currier Bradford L. , Bydon Mohamad , Yaszemski Michael J. , Anderson Paul A. , Elder Benjamin D. 
Published: October 2019

OBJECTIVEThe authors sought to assess whether Hounsfield units (HU) increase following teriparatide treatment and to compare HU increases with changes in bone mineral density (BMD) as measured by dual-energy x-ray absorptiometry (DEXA).METHODSA retrospective chart review was performed from 1997 to 2018 across all campuses at our institution. The authors identified patients who had been treated with at least 6 months of teriparatide and compared HU and BMD as measured on DEXA scans before and after treatment.RESULTSFifty-two patients were identified for analysis (46 women and 6 men, average age 67 years) who underwent an average of 20.9 ± 6.5 months of teriparatide therapy. The mean ± standard deviation HU increase throughout the lumbar spine (L1–4) was from 109.8 ± 53 to 133.9 ± 61 HU (+22%, 95% CI 1.2–46, p value = 0.039). Based on DEXA results, lumbar spine BMD increased from 0.85 to 0.93 g/cm2 (+9%, p value = 0.044). Lumbar spine T-scores improved from −2.4 ± 1.5 to −1.7 ± 1.5 (p value = 0.03). Average femoral neck T-scores improved from −2.5 ± 1.1 to −2.3 ± 1.0 (p value = 0.31).CONCLUSIONSTeriparatide treatment increased both HU and BMD on DEXA in the lumbar spine, without a change in femoral BMD. The 22% improvement in HU surpassed the 9% improvement determined with DEXA. These results support some surgeons’ subjective sense that intraoperative bone quality following teriparatide treatment is better than indicated by DEXA results. To the authors’ knowledge, this is the first study demonstrating an increase in HU with teriparatide treatment.
Outcomes in children undergoing posterior fossa decompression and duraplasty with and without tonsillar reduction for Chiari malformation type I and syringomyelia: a pilot prospective multicenter cohort study
Authors: Koueik Joyce , Sandoval-Garcia Carolina , Kestle John R. W. , Rocque Brandon G. , Frim David M. , Grant Gerald A. , Keating Robert F. , Muh Carrie R. , Oakes W. Jerry , Pollack Ian F. , Selden Nathan R. , Tubbs R. Shane , Tuite Gerald F. , Warf Benjamin , Rajamanickam Victoria , Broman Aimee Teo , Haughton Victor , Rebsamen Susan , George Timothy M. , Iskandar Bermans J. 
Published: October 2019

OBJECTIVEDespite significant advances in diagnostic and surgical techniques, the surgical management of Chiari malformation type I (CM-I) with associated syringomyelia remains controversial, and the type of surgery performed is surgeon dependent. This study’s goal was to determine the feasibility of a prospective, multicenter, cohort study for CM-I/syringomyelia patients and to provide pilot data that compare posterior fossa decompression and duraplasty (PFDD) with and without tonsillar reduction.METHODSParticipating centers prospectively enrolled children suffering from both CM-I and syringomyelia who were scheduled to undergo surgical decompression. Clinical data were entered into a database preoperatively and at 1–2 weeks, 3–6 months, and 1 year postoperatively. MR images were evaluated by 3 independent, blinded teams of neurosurgeons and neuroradiologists. The primary endpoint was improvement or resolution of the syrinx.RESULTSEight clinical sites were chosen based on the results of a published questionnaire intended to remove geographic and surgeon bias. Data from 68 patients were analyzed after exclusions, and complete clinical and imaging records were obtained for 55 and 58 individuals, respectively. There was strong agreement among the 3 radiology teams, and there was no difference in patient demographics among sites, surgeons, or surgery types. Tonsillar reduction was not associated with > 50% syrinx improvement (RR = 1.22, p = 0.39) or any syrinx improvement (RR = 1.00, p = 0.99). There were no surgical complications.CONCLUSIONSThis study demonstrated the feasibility of a prospective, multicenter surgical trial in CM-I/syringomyelia and provides pilot data indicating no discernible difference in 1-year outcomes between PFDD with and without tonsillar reduction, with power calculations for larger future studies. In addition, the study revealed important technical factors to consider when setting up future trials. The long-term sequelae of tonsillar reduction have not been addressed and would be an important consideration in future investigations.
Intrathecal baclofen versus selective dorsal rhizotomy for children with cerebral palsy who are nonambulant: a systematic review
Authors: Davidson Benjamin , Schoen Nathan , Sedighim Shaina , Haldenby Renée , Dalziel Blythe , Breitbart Sara , Fehlings Darcy , Milo-Manson Golda , Narayanan Unni G. , Drake James M. , Ibrahim George M. 
Published: October 2019

OBJECTIVECerebral palsy (CP) is the most common childhood physical disability. Historically, children with hypertonia who are nonambulatory (Gross Motor Function Classification System [GMFCS] level IV or V) were considered candidates for intrathecal baclofen (ITB) therapy to facilitate care and mitigate discomfort. Selective dorsal rhizotomy (SDR) was often reserved for ambulant children to improve gait. Recently, case series have suggested SDR as an alternative to ITB in selected children functioning at GMFCS level IV/V. The objective for this study was to systematically review the evidence for ITB and SDR in GMFCS level IV or V children.METHODSMedline, Embase, Web of Science, and Cochrane databases were systematically searched. Articles were screened using the following inclusion criteria: 1) peer-reviewed articles reporting outcomes after SDR or ITB; 2) outcomes reported using a quantifiable scale or standardized outcome measure; 3) patients were < 19 years old at the time of operation; 4) patients had a diagnosis of CP; 5) patients were GMFCS level IV/V or results were reported based on GMFCS status and included some GMFCS level IV/V patients; 6) article and/or abstract in English; and 7) primary indication for surgery was hypertonia. Included studies were assessed with the Risk of Bias in Non-Randomized Studies - of Interventions (ROBINS-I) tool.RESULTSTwenty-seven studies met inclusion criteria. The most commonly reported outcomes were spasticity (on the Mean Ashworth Scale) and gross motor function (using the Gross Motor Function Measure), although other outcomes including frequency of orthopedic procedures and complications were also reported. There is evidence from case series that suggests that both ITB and SDR can lower spasticity and improve gross motor function in this nonambulatory population. Complication rates are decidedly higher after ITB due in part to the ongoing risk of device-related complications. The heterogeneity among study design, patient selection, outcome selection, and follow-up periods was extremely high, preventing meta-analysis. There are no comparative studies, and meaningful health-related quality of life outcomes such as care and comfort are lacking. This review is limited by the high risk of bias among included studies. Studies of SDR or ITB that did not clearly describe patients as being GMFCS level IV/V or nonambulatory were excluded.CONCLUSIONSThere is a lack of evidence comparing the outcomes of ITB and SDR in the nonambulatory CP population. This could be overcome with standardized prospective studies using more robust methodology and relevant outcome measures.
A novel management proposal for intrinsic brainstem neurenteric cysts: case report
Authors: Agresta Gianluca , Sokol Drahoslav , Kaliaperumal Chandrasekaran , Kandasamy Jothy , Gallo Pasquale 
Published: October 2019

Neurenteric cysts (NCs) are rare congenital lesions with epithelial mucin-secreting walls. They can occur anywhere along the neural axis, and an intrinsic midbrain cyst is extraordinary. Surgical management may pose a challenge due to the location of the lesion and adhesion of the cyst wall to the surrounding brainstem. The authors describe the first case of pediatric NC that was treated successfully with intracystic interferon-α (IFN-α).A 16-month-old baby girl presented with a 2-week history of progressive croup, vomiting, and swallowing difficulty. MRI revealed a 1.8-cm cystic intrinsic lesion in the pontomedullary region. She initially underwent posterior fossa craniotomy and drainage of the cyst under intraoperative neurophysiology monitoring. Three weeks following the procedure, her symptoms recurred, and follow-up MRI demonstrated cystic recurrence. She underwent repeat aspiration of the cyst and biopsy of the cyst wall, and INF-α-2b was injected into the cystic cavity. Her symptoms improved and completely resolved after 5 months. A 9-month follow-up brain MRI study showed complete resolution of the NC. Intracystic IFN-α injection after cystic content aspiration may be a safe treatment option for the management of intrinsic brainstem NCs. Long-term clinical and radiological follow-up is recommended.
Early cephalad adjacent segment degeneration after posterior lumbar interbody fusion: a comparative study between cortical bone trajectory screw fixation and traditional trajectory screw fixation
Authors: Sakaura Hironobu , Ikegami Daisuke , Fujimori Takahito , Sugiura Tsuyoshi , Mukai Yoshihiro , Hosono Noboru , Fuji Takeshi 
Published: October 2019

OBJECTIVECortical bone trajectory (CBT) screw insertion through a caudomedial starting point provides advantages in limiting dissection of the superior facet joints and reducing muscle dissection and the risk of superior-segment facet violation by the screw. These advantages of the cephalad CBT screw can result in lower rates of early cephalad adjacent segment degeneration (ASD) after posterior lumbar interbody fusion (PLIF) with CBT screw fixation (CBT-PLIF) than those after PLIF using traditional trajectory screw fixation (TT-PLIF). Here, the authors investigated early cephalad ASD after CBT-PLIF and compared these results with those after TT-PLIF.METHODSThe medical records of all patients who had undergone single-level CBT-PLIF or single-level TT-PLIF for degenerative lumbar spondylolisthesis (DLS) and with at least 3 years of postsurgical follow-up were retrospectively reviewed. At 3 years postoperatively, early cephalad radiological ASD changes (R-ASD) such as narrowing of disc height (> 3 mm), anterior or posterior slippage (> 3 mm), and posterior opening (> 5°) were examined using lateral radiographs of the lumbar spine. Early cephalad symptomatic adjacent segment disease (S-ASD) was diagnosed when clinical symptoms such as leg pain deteriorated during postoperative follow-up and the responsible lesion suprajacent to the fused segment was confirmed on MRI.RESULTSOne hundred two patients underwent single-level CBT-PLIF for DLS and were followed up for at least 3 years (CBT group). As a control group, age- and sex-matched patients (77) underwent single-level TT-PLIF for DLS and were followed up for at least 3 years (TT group). The total incidence of early cephalad R-ASD was 12.7% in the CBT group and 41.6% in the TT group (p < 0.0001). The incidence of narrowing of disc height, anterior slippage, and posterior slippage was significantly lower in the CBT group (5.9%, 2.0%, and 4.9%) than in the TT group (16.9%, 13.0%, and 14.3%; p < 0.05). Early cephalad S-ASD developed in 1 patient (1.0%) in the CBT group and 3 patients (3.9%) in the TT group; although the incidence was lower in the CBT group than in the TT group, no significant difference was found between the two groups.CONCLUSIONSCBT-PLIF, as compared with TT-PLIF, significantly reduced the incidence of early cephalad R-ASD. One of the main reasons may be that cephalad CBT screws reduced the risk of proximal facet violation by the screw, which reportedly can increase biomechanical stress and lead to destabilization at the suprajacent segment to the fused segment.
Our Lady’s miracle-working icons and the semiotics of the world tree
Authors: Golovata N. 
Published: October 2019

The article is devoted to study of the modes of inheritance of cultural symbols. In particular, it is a research of perception in Christianity of preceding cultures’ archetypes. The study provides the analysis of semantic links between the symbols of the World Tree, the Vivifying Cross and the meaning of the Blessed Virgin image. The article shows how the pre-Christian symbols of the World Tree and the cross itself were merged and transformed in Christian theology, liturgy and iconography in the image of Golgotha Cross. The cross acquires the features of a Cosmic Tree, which combines the lower and the upper worlds – the heaven and the earth, life and death. The symbol of the tree is often substituted by the image of a woman appearing in this case as a symbol of life and fertility and evokes the associations with the genealogical tree. Therefore, the connection between the World Tree and the Blessed Virgin is proved to be natural.
On the basis of the historical sources the author analyzes the legends and evidences of the revelations and discoveries of the Blessed Mary’s icons on the trees of a certain kinds. The study explicates the symbolic meaning of those trees spread in a global world, in Slavic and Ukrainian cultural traditions. In particular, the research encloses the semantics of the following kinds of trees: fir tree, linden, pear tree, oak, willow, blackthorn. Every kind of those trees has a special symbolic meaning. The novelty of the research is that it for the first time proves the semantic connection of sacred meaning of miracle icons and of the certain kinds of trees. The study defines the limited range of those trees and, on the other hand, the kinds of other trees believed to be vile and thus never appeared in the legends about the discoveries of miracle icons.
As a conclusion, the research proves the existence of the autochtonal tradition of correlation of the semantics of miracle icons of Our Lady with the certain kinds of trees in the result of synthesis of the ancient symbolism and Christianity. In every case, the symbolic meanings of trees had archaic origin and connection with the ancient cosmogonical concepts. Depending on the particular semantic nuance emphasized in the World Tree, the priority of a certain kind of tree determined. On the whole, the study demonstrates the importance of the symbols in forming of cultural identity and for understanding of interrelations of cultures at the deep semantic level.
Flypaper Effect Pada Dana Alokasi Umum Dan Pendapatan Asli Daerah Terhadap Belanja Daerah
Authors: Tuaputimain Yohanis 
Published: October 2019

This study aimed to find out the flypaper effect on regencies/municipalities government in Maluku province. One of transfer fund is general allocation fund which can be freely used by regional government to operational expenditure and capital expenditure. Technique of data collection was conducted by using documentation and in depth interview with echelon III and IV of revenue, finance and asset department Maluku Province. The data was analyzed by using qualitative Method through interpretive approach. The results of the study revealed that the realization of the regional government budget, regional revenue in the regional government on average is smaller than the general allocation fund to regional expenditure, so that it happens a flypaper effect on regional finance. The solution from the regional government is to reduce the gap in the occurrence of flypaper effects by conducting supervision and management to increase regional income from regional taxes, regional levies, and revenue from natural resources and other legitimate revenues. Penelitian ini bertujuan untuk mengetahui terjadi dan tidaknya Flypaper Effect pada pemerintah daerah Kabupaten/Kota di Provinsi Maluku. Salah satu dana transfer adalah dana alokasi umum yang dapat secara bebas digunakan oleh pemerintah daerah baik untuk belanja operasional maupun belanja modal. Metode pengumpulan data dilakukan dengan dokumentasi dan wawancara mendalam dengan pimpinan dan Pejabat Eselon III dan IV Badan Pendapatan, Pengelolaan Keuangan, dan Aset Derah Provinsi Maluku. Hasil pengumpulan data dianalisis dengan metode kualitatif menggunakan pendekatan interpretif. Hasil penelitian menunjukkan bahwa realisasi anggaran dan pendapatan belanja daerah, pendapatan asli daerah di pemerintah daerah secara rata-rata lebih kecil dari dana alokasi umum terhadap belanja daerah, sehingga terjadinya flypaper effect pada keuangan daerah. Adapun solusi dari pemerintah daerah untuk mengurangi kesenjangan terjadinya flypaper effect dengan melakukan pengawasan dan pengelolaan untuk meningkatkan pendapatan daerah baik dari pajak daerah, retribusi daerah, dan pendapatan sumber kekayaan alam serta pendapatan lain yang sah.