bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pediatric ganglioglioma of the brainstem and cervicomedullary junction: a retrospective cohort study
Authors: Oushy Soliman , Perry Avital , Graffeo Christopher S. , Raghunathan Aditya , Carlstrom Lucas P. , Daniels David J. 
Published: October 2019

OBJECTIVEGanglioglioma is a low-grade central nervous system neoplasm with a pediatric predominance, accounting for 10% of all brain tumors in children. Gangliogliomas of the cervicomedullary junction (GGCMJs) and brainstem (GGBSs) present a host of management challenges, including a significant risk of surgical morbidity. At present, understanding of the prognostic factors—including BRAF V600E status—is incomplete. Here, the authors report a single-institution GGCMJ and GGBS experience and review the pertinent literature.METHODSA prospectively maintained neurosurgical database at a large tertiary care academic referral center was retrospectively queried for cases of GGCMJ pathologically confirmed in the period from 1995 to 2015; appropriate cases were defined by diagnosis codes and keywords. Secondary supplemental chart review was conducted to confirm or capture relevant data. The primary study outcome was treatment failure as defined by evidence of radiographic recurrence or progression and/or clinical or functional decline. A review of the literature was conducted as well.RESULTSFive neurosurgically managed GGBS patients were identified, and the neoplasms in 4 were classified as GGCMJ. All 5 patients were younger than 18 years old (median 15 years, range 4–16 years) and 3 (60%) were female. One patient underwent gross-total resection, 2 underwent aggressive subtotal resection (STR), and 2 underwent stereotactic biopsy only. All patients who had undergone STR or biopsy required repeat resection for tumor control or progression. Progressive disease was treated with radiotherapy in 2 patients, chemotherapy in 2, and chemoradiotherapy alone in 1. Immunostaining for BRAF V600E was positive in 3 patients (60%). All 5 patients experienced at least one major complication, including wound infection, foot drop, hemiparesis, quadriparesis, cranial neuropathy, C2–3 subluxation, syringomyelia, hydrocephalus, aspiration, and coma. Overall mortality was 20%, with 1 death observed over 11 years of follow-up.CONCLUSIONSGGBS and GGCMJ are rare, benign posterior fossa tumors that carry significant perioperative morbidity. Contemporary management strategies are heterogeneous and include combinations of resection, radiotherapy, and chemotherapy. The BRAF V600E mutation is frequently observed in GGBS and GGCMJ and appears to have both prognostic and therapeutic significance with targeted biological agents.
Analysis of adjacent-segment cervical kinematics: the role of construct length and the dorsal ligamentous complex
Authors: Lubelski Daniel , Healy Andrew T. , Mageswaran Prasath , Colbrunn Robb , Schlenk Richard P. 
Published: October 2019

OBJECTIVELateral mass fixation stabilizes the cervical spine while causing minimal morbidity and resulting in high fusion rates. Still, with 2 years of follow-up, approximately 6% of patients who have undergone posterior cervical fusion have worsening kyphosis or symptomatic adjacent-segment disease. Based on the length of the construct, the question of whether to extend the fixation system to undisrupted levels has not been answered for the cervical spine. The authors conducted a study to quantify the role of construct length and the terminal dorsal ligamentous complex in the adjacent-segment kinematics of the subaxial cervical spine.METHODSIn vitro flexibility testing was performed using 6 human cadaveric specimens (C2–T8), with the upper thoracic rib cage and osseous and ligamentous integrity intact. An industrial robot was used to apply pure moments and to measure segmental motion at each level. The authors tested the intact state, followed by 9 postsurgical permutations of laminectomy and lateral mass fixation spanning C2 to C7.RESULTSConstructs spanning a single level exerted no significant effects on immediate adjacent-segment motion. The addition of a second immobilized segment, however, created significant changes in flexion-extension range of motion at the supradjacent level (+164%). Regardless of construct length, resection of the terminal dorsal ligaments did not greatly affect adjacent-level motion except at C2–3 and C7–T1 (increasing by +794% and +607%, respectively).CONCLUSIONSDorsal ligamentous support was found to contribute significant stability to the C2–3 and C7–T1 segments only. Construct length was found to play a significant role when fixating two or more segments. The addition of a fused segment to support an undisrupted cervical level is not suggested by the present data, except potentially at C2–3 and C7–T1. The study findings emphasize the importance of the C2–3 segment and its dorsal support.
Applicability of cervical sagittal vertical axis, cervical lordosis, and T1 slope on pain and disability outcomes after anterior cervical discectomy and fusion in patients without deformity
Authors: Lau Darryl , DiGiorgio Anthony M. , Chan Andrew K. , Dalle Ore Cecilia L. , Virk Michael S. , Chou Dean , Bisson Erica F. , Mummaneni Praveen V. 
Published: October 2019

OBJECTIVEUnderstanding what influences pain and disability following anterior cervical discectomy and fusion (ACDF) in patients with degenerative cervical spine disease is critical. This study examines the timing of clinical improvement and identifies factors (including spinal alignment) associated with worse outcomes.METHODSConsecutive adult patients were enrolled in a prospective outcomes database from two academic centers participating in the Quality Outcomes Database from 2013 to 2016. Demographics, surgical details, radiographic data, arm and neck pain (visual analog scale [VAS] scores), and disability (Neck Disability Index [NDI] and EQ-5D scores) were reviewed. Multivariate analysis was used.RESULTSA total of 186 patients were included, and 48.4% were male. Their mean age was 55.4 years, and 45.7% had myelopathy. Preoperative cervical sagittal vertical axis (cSVA), cervical lordosis (CL), and T1 slope values were 24.9 mm (range 0–55 mm), 10.4° (range −6.0° to 44°), and 28.3° (range 14.0°–51.0°), respectively. ACDF was performed at 1, 2, and 3 levels in 47.8%, 42.0%, and 10.2% of patients, respectively. Preoperative neck and arm VAS scores were 5.7 and 5.4, respectively. NDI and EQ-5D scores were 22.1 and 0.5, respectively. There was significant improvement in all outcomes at 3 months (p < 0.001) and 12 months (p < 0.001). At 3 months, neck VAS (3.0), arm VAS (2.2), NDI (12.7), and EQ-5D (0.7) scores were improved, and at 12 months, neck VAS (2.8), arm VAS (2.3), NDI (11.7), and EQ-5D (0.8) score improvements were sustained. Improvements occurred within the first 3-month period; there was no significant difference in outcomes between the 3-month and 12-month mark. There was no correlation among cSVA, CL, or T1 slope with any outcome endpoint. The most consistent independent preoperative factors associated with worse outcomes were high neck and arm VAS scores and a severe NDI result (p < 0.001). Similar findings were seen with worse NDI and EQ-5D scores (p < 0.001). A significant linear trend of worse NDI and EQ-5D scores at 3 and 12 months was associated with worse baseline scores. Of the 186 patients, 171 (91.9%) had 3-month follow-up data, and 162 (87.1%) had 12-month follow-up data.CONCLUSIONSACDF is effective in improving pain and disability, and improvement occurs within 3 months of surgery. cSVA, CL, and T1 slope do not appear to influence outcomes following ACDF surgery in the population with degenerative cervical disease. Therefore, in patients with relatively normal cervical parameters, augmenting alignment or lordosis is likely unnecessary. Worse preoperative pain and disability were independently associated with worse outcomes.
Spinal dural resection for oncological purposes: a systematic analysis of risks and outcomes in patients with malignant spinal tumors
Authors: Barber Sean M. , Konakondla Sanjay , Nakhla Jonathan , Fridley Jared S. , Xia Jimmy , Oyelese Adetokunbo A. , Telfeian Albert E. , Gokaslan Ziya L. 
Published: October 2019

OBJECTIVEOncological outcomes for many malignant primary spinal tumors and isolated spinal metastases have been shown to correlate with extent of resection. For tumors with dural involvement, some authors have described spinal dural resection at the time of tumor resection in the interest of improving oncological outcomes. The complication profile associated with resection of the spinal dura for oncological purposes, however, and the relative influence of resecting tumor-involved dura on progression-free survival are not well defined. The authors performed a systematic review of the literature and identified cases in which the spinal dura was resected for oncological purposes in the interest of better understanding the associated risks and outcomes of this technique.METHODSElectronic databases (PubMed/MEDLINE, Scopus) were systematically searched to identify studies that reported clinical and/or oncological outcomes of patients with malignant spinal neoplasms undergoing resection of tumor-involved dura at the time of surgical intervention.RESULTSTen articles describing 15 patients were included in the analysis. The most common tumor histologies were chordoma (3/15, 20%), giant cell tumor (3/15, 20%), epithelioid sarcoma (2/15, 13.3%), osteosarcoma (2/15, 13.3%), and metastasis (2/15, 13.3%). Procedure-related complications were reported in 40% of patients. A trend was seen toward an increased complication rate in redo (66.7%) versus index (16.7%) operations, but this trend did not reach statistical significance (p = 0.24). New, unexpected postoperative neurological deficits were seen in 3 patients (of 14 reporting, 21.4%). A single patient experienced a profound, unexpected neurological deterioration (paraparesis/paraplegia) after surgery, which reportedly improved considerably at latest follow-up. Tumor recurrence was seen in 3 cases (of 12 reporting, 25%) at a mean of 28.34 ± 21.1 months postoperatively. The overall mean radiographic follow-up period was 49.6 ± 36.5 months.CONCLUSIONSResection of the spinal dura for oncological purposes is rarely performed, although a limited number of reports and small series have demonstrated that it is feasible. Spinal dural resection is primarily performed in patients with isolated, primary spinal neoplasms with an intent to cure. The risk associated with spinal dura resection is nontrivial and the complication profile is significant. The influence of dural resection on oncological outcomes is not well defined, and further study is needed before definitive conclusions may be drawn regarding the oncological benefit of dural resection for any particular patient or pathology.
Long-term outcomes of high-dose single-fraction radiosurgery for chordomas of the spine and sacrum
Authors: Jin Chunzi Jenny , Berry-Candelario John , Reiner Anne S. , Laufer Ilya , Higginson Daniel S. , Schmitt Adam M. , Lis Eric , Barzilai Ori , Boland Patrick , Yamada Yoshiya , Bilsky Mark H. 
Published: October 2019

OBJECTIVEThe current treatment of chordomas is associated with significant morbidity, high rates of local recurrence, and the potential for metastases. Stereotactic radiosurgery (SRS) as a primary treatment could reduce the need for en bloc resection to achieve wide or marginal margins. Spinal SRS outcomes support the exploration of SRS’s role in the durable control of these conventionally radioresistant tumors. The goal of the study was to evaluate outcomes of patients with primary chordomas treated with spinal SRS alone or in combination with surgery.METHODSClinical records were reviewed for outcomes of patients with primary chordomas of the mobile spine and sacrum who underwent single-fraction SRS between 2006 and 2017. Radiographic local recurrence-free survival (LRFS), overall survival (OS), symptom response, and toxicity were assessed in relation to the extent of surgery.RESULTSIn total, 35 patients with de novo chordomas of the mobile spine (n = 17) and sacrum (n = 18) received SRS and had a median post-SRS follow-up duration of 38.8 months (range 2.0–122.9 months). The median planning target volume dose was a 24-Gy single fraction (range 18–24 Gy). Overall, 12 patients (34%) underwent definitive SRS and 23 patients (66%) underwent surgery and either neoadjuvant or postoperative adjuvant SRS. Definitive SRS was selectively used to treat both sacral (n = 7) and mobile spine (n = 5) chordomas. Surgical strategies for the mobile spine were either intralesional, gross-total resection (n = 5) or separation surgery (n = 7) and for the sacrum en bloc sacrectomy (n = 11). The 3- and 5-year LRFS rates were 86.2% and 80.5%, respectively. Among 32 patients (91%) receiving 24-Gy radiation doses, the 3- and 5-year LRFS rates were 96.3% and 89.9%, respectively. The 3- and 5-year OS rates were 90.0% and 84.3%, respectively. The symptom response rate to treatment was 88% for pain and radiculopathy. The extent or type of surgery was not associated with LRFS, OS, or symptom response rates (p > 0.05), but en bloc resection was associated with higher surgical toxicity, as measured using the Common Terminology Criteria for Adverse Events (version 5.0) classification tool, than epidural decompression and curettage/intralesional resection (p = 0.03). The long-term rate of toxicity ≥ grade 2 was 31%, including 20% grade 3 tissue necrosis, recurrent laryngeal nerve palsy, myelopathy, fracture, and secondary malignancy.CONCLUSIONSHigh-dose spinal SRS offers the chance for durable radiological control and effective symptom relief with acceptable toxicity in patients with primary chordomas as either a definitive or adjuvant therapy.
Repair of a large primary subtemporal encephalocele in a 3-year-old child: case report
Authors: Thatikunta Meena , Bumpous Jeffrey , Little Jarrod , Karia Samir , Herring Nicole R. , Nuru Mohammed , Engineer Nitin , Mutchnick Ian 
Published: October 2019

Primary encephaloceles (PEs) present only rarely in the temporal region; in the rare instance that they project through the floor of the middle fossa they are secondary. In this case report the authors report on the management of a giant PE extending through the floor of the middle fossa.An 8-month-old boy presented to the authors’ service with a large PE projecting into his neck through a missing left middle fossa floor; the lesion was causing significant meta-, dys-, and hypoplasia of the structures of the anterolateral neck on that side. Surgical goals for this patient included the following: 1) removal of potentially epileptogenic and dysfunctional tissue; 2) preservation of cranial nerves; 3) prevention of cognitive decline or iatrogenic deficit; 4) prevention of CSF leak; 5) reconstruction of skull base; 6) prevention of airway and swallowing compromise; and 7) cosmesis. After a multidisciplinary evaluation with ENT, plastic surgery, and neurology, an operation was performed using a preauricular infratemporal approach when the patient was 3 years old. Gliotic tissue was resected and amygdala, hippocampus, and middle cerebral artery were preserved.The immediate results of the operation showed good immediate outcome. Seizure freedom and neurodevelopment outcomes remain to be seen at follow-up.
Interrater reliability of a method to assess hypothalamic involvement in pediatric adamantinomatous craniopharyngioma
Authors: Whelan Ros , Prince Eric , Mirsky David M. , Naftel Robert , Bhatia Aashim , Pettorini Benedetta , Avula Shivaram , Staulcup Susan , Alexander Allyson L. , Meier Maxene , Hankinson Todd C. 
Published: October 2019

OBJECTIVEPediatric adamantinomatous craniopharyngiomas (ACPs) are histologically benign brain tumors that confer significant neuroendocrine morbidity. Previous studies have demonstrated that injury to the hypothalamus is associated with worsened quality of life and a shorter lifespan. This insight helps many surgeons define the goals of surgery for patients with ACP. Puget and colleagues proposed a 3-tiered preoperative and postoperative grading system based on the degree of hypothalamic involvement identified on MRI. In a prospective cohort from their institution, the authors found that use of the system to guide operative goals was associated with decreased morbidity. To date, however, the Puget system has not been externally validated. Here, the authors present an interrater reliability study that assesses the generalizability of this system for surgeons planning initial operative intervention for children with craniopharyngiomas.METHODSA panel of 6 experts, consisting of pediatric neurosurgeons and pediatric neuroradiologists, graded 30 preoperative and postoperative MRI scans according to the Puget system. Interrater reliability was calculated using Fleiss’ κ and Krippendorff’s α statistics.RESULTSInterrater reliability in the preoperative context demonstrated moderate agreement (κ = 0.50, α = 0.51). Interrater reliability in the postoperative context was 0.27 for both methods of statistical evaluation.CONCLUSIONSInterrater reliability for the system as defined is moderate. Slight refinements of the Puget MRI grading system, such as collapsing the 3 grades into 2, may improve its reliability, making the system more generalizable.
Analisis Abnormal Return Disekitar Tanggal Pengumuman Stock Split
Authors: Yunawati Sri 
Published: October 2019

The purpose of this study is to prove how the effect of the stock split on abnormal returns and whether there are differences in average abnormal returns before and after the stock split. This research was conducted at a company that conducted a stock split which was listed on the Indonesia Stock Exchange in 2017. The method used by a statistical test is one sample t-test (t-test for one sample) at a significance level of a = 5%. Research results show that there is no significant abnormal return when the stock split. And the tests performed on abnormal return averages before and after the stock split using paired sample t-test (t-test for two paired samples) showed that there were no significant differences in the average abnormal return before and after the stock split. Tujuan penelitian ini adalah untuk membuktikan bagaimana pengaruh stock split terhadap abnormal return dan apakah terdapat perbedaan rata-rata abnormal return sebelum dan setelah stock split. Penelitian ini dilakukan pada perusahaan yang melakukan pemecahan saham yang terdaftar di Bursa Efek Indonesia tahun 2017. Metode yang digunakan dengan uji statistik one sampel t-test (uji t untuk satu sampel) pada tingkat signifikansi a =5%. Hasil Penelitian menunjukkan bahwa tidak terdapat abnormal retum yang signifikan pada saat stock split. Dan pengujian yang dilakukan terhadap rata-rata abnormal retun sebelum dan setelah stock split dengan menggunakan paired sample t test (uji t untuk dua sampel berpasangan) diperoleh hasil bahwa tidak terdapat perbedaan yang signifikan pada rata-rata abnormal return sebelum dan sesudah stock split.
Students' Assertive Behavior Differences Based On from Gender and Parenting Parents and Their Implications in Guidance and Counseling
Authors: Anggraini Resi , Yusuf A. Muri , Bentri Alwen 
Published: October 2019

This research is based on the lack of development of assertive behavior of students in school. Students who have good assertive behavior can be seen from the ability of students to make decisions, able to express feelings of honesty and comfort, be able to defend themselves, be able to express opinions, and not ignore the rights of others. Factors that influence students' assertive behavior include gender and parenting parents. Assertive behavior of students in terms of male and female sex and parenting parents will be different, the difference in assertive behavior of students is influenced by several factors both internal factors and external factors. This study aims to describe and distinguish students' assertive behavior in terms of gender and parenting style and its implications in Guidance and Counseling services. The population in this study were all students in SMA N 1 Payung Sekaki Kabupaten Solok. The sampling technique uses stratified random sampling. The instrument used is a Likert scale model. Data analysis using two-way variance analysis (ANAVA) technique.The results of data analysis show that: (1) Assertive behavior of students in terms of gender, namely men and women are in the moderate category, there are significant differences where the average score of men is higher than women, (2) Assertive behavior students in terms of parenting, namely authoritarian, permissive, and authoritative parenting, are in the moderate category, but there are no significant differences, meaning there is no difference in assertive behavior of students in terms of parenting, (3) sex and parenting style in explaining the description of student assertive behavior. The implications of the results of the research for implementing guidance and counseling are as material for consideration of the preparation of BK service programs in developing and enhancing student assertive behavior.
BUDIDAYA TANAMAN MAHONI (Sweitenia macrophylla) DAN PEMANFAATANNYA SEBAGAI TANAMAN OBAT
Authors: Suardana AA Komang 
Published: October 2019

Batukau Mount with its dense forest as the lungs of Tabanan Regency. As a buffer zone, water sources can irrigate existing subak, one of them is Jatiluwih Subak which is a World Cultural Heritage. At the south foothill of Mount Batukau Mount there is Sad Kahyangan Temple, Batukau Temple. Nature preservation around the temple is still maintained, but over time there are areas that need to be greened. Based on this situation, community service around Batukau Temple is carried out with the theme "Mahogany Cultivation (Sweitenia macrophylla) and Its Use as Medicinal Plants". The community service method was carried out with a lecture system to several community members in Batukau Temple. Conclusions obtained in the cultivation of mahogany plants that need to be considered are hatcheries and nurseries, planting and maintenance. As a medicinal plant, mahogany seed extract can be used as an environmentally friendly vegetable pesticide to control Plutella xylostella and Crosidolomia binolalis in cabbage when pests were in the larval stage and seeds of mahogany fruit contain various substances including flavonoids and saponins that function as bacteriocytes.
Key Word : cultivation, Mahogany plant, medicinal plants