bluuebunny/crossref_metadata_2025_split huggingface dataset:
Experimental analysis on concrete blocks reinforced with <em>Arundo donax</em> fibers
Authors: Manniello Canio , Cillis Giuseppe , Statuto Dina , Di Pasquale Andrea , Picuno Pietro 
Published: December 2021

Over the last decades, there has been a growing attention in research and development on non-conventional building materials, such as vegetable fibers (e.g., flax; hemp; jute; etc.), to be used as eco-friendly materials in a wide range of applications in civil construction. The main reasons of this interest are related to the specific properties, price and sustainability of natural fibers, which can be considered as “green” building materials. In this article, the tensile strength of a new type of fibers extracted from stem of the Giant Reed Arundo donax L., has been investigated. These fibers, which widely grow in Mediterranean areas, but that are diffused all around the world as well, have been extracted from the outer part of the plant stem. Then, in order to have an initial idea of their influence on the mechanical properties of concrete, some experimental bricks have been prepared, with the addition of different weight percentages of this vegetal fiber. To assess the mechanical properties of these bricks, compression and tensile tests on the whole block has been performed. Hence, the differences between concrete bricks without any fiber and those reinforced with different weight percentages of natural fiber have been analyzed, then assessing their potential applications in bio-architecture.
Customized and Cost-Effective 3D Printed Mold for Cranioplasty
Authors: Gopal Swaroop , Rudrappa Satish , Sekar Arunkumar , Preethish-Kumar Veeramani , Masapu Dheeraj 
Published: December 2021

Context:
Autologous bone is the most commonly used flap in cranioplasty to repair the defect; however, synthetic materials are available. Poly methyl methacrylate (PMMA) is an effective polymer owing to its thermoplastic and radiolucent properties comparable to bone strength. Three-dimensional (3D) printing combined with computer-assisted design (CAD) is a simple, low-cost method to print molds that ensure surgical success.

Materials and Methods:
A total of 114 patients underwent cranioplasty (July 2015–April 2018), and 25 of them using 3D printed template molds due to unavailability of autologous bone. The clinical features, patient demographics, and surgical parameters were analyzed. The visual analog score for cosmesis (VASC) and Odom's score was obtained pre and post-op.

Results:
The mean age of the patients is 38.4 ± 14.6 years (Range, 9–66). The primary pathology for undergoing craniectomy is stroke (n = 13; 52%), traumatic brain injury (10; 40%) and tumor (2; 8%). The reason for nonavailability of flap was infection (n = 14;56%), flap resorption (4;16%), and trauma or tumor (7;28%). The mean time for manufacturing the 3D printed template is 13.2 ± 2.1 h. On follow-up, median Odom's score is excellent in 52% of cases, good in 40%, and fair in 8%. The mean VASC score on follow up is 8.2 ± 1.3. Three patients developed minor postoperative complications.

Conclusion:
This is the first study from a single tertiary care center in India to systematically evaluate the outcomes in 3D cranioplasty using CAD and 3D printing technology. This method would be optimal especially in developing countries since PMMA is cost effective and also gives an ideal cosmetic effect.
Transnasal Endoscopic Surgery for Suprasellar Meningiomas
Authors: Gupta Prasheelkumar P , Shaikh Salman T , Deopujari Chandrashekhar E , Shah Nishit J 
Published: December 2021

Aim:
Endoscopic trans-nasal surgery has evolved a long way from the days of narrow corridors with high rates of cerebrospinal fluid (CSF) leak to the present state of HD optics with better tissue differentiation, extended approaches, and use of vascularized flaps for defect closure. Trans-nasal approach is an established technique for pituitary tumors practiced worldwide. However, trans-nasal endoscopic excision of suprasellar meningiomas provides a tougher challenge in terms of instrument manipulation, tumor excision with good visual outcome, and a robust defect closure to prevent CSF leaks.

Materials and Methods:
Out of 83 cases of midline anterior cranial fossa meningiomas operated over 14 years, our experience in 12 cases of suprasellar meningiomas for radical resection via the trans-nasal endoscopic route is discussed.

Results:
Amongst these, six were excised via primary extended endoscopic trans-sphenoidal surgery, four cases had a residual lesion or recurrence after primary transcranial surgery, and two cases involved a combined transcranial and extended endoscopic approach. Visual improvement along with resolution of headache was seen in all patients postoperatively. None of the patients had CSF leak requiring further repair. Syndrome of inappropriate antidiuretic hormone was found in one patient, which was transient and easily corrected.

Conclusion:
Trans-nasal endoscopic surgery for suprasellar meningiomas is an effective technique that provides results of tumor excision comparable to the transcranial approach in suitable cases. Visual outcome was found to be superior, and rates of CSF leak were remarkably reduced with vascularized flap. However, each case must be assessed individually and lateral extension beyond the optic canals with internal carotid artery encasement must be considered before planning surgery.
Shunt Complications – Staying Out of Trouble
Authors: Balasubramaniam Chidambaram 
Published: December 2021

Abstract

Background and Objective:
To analyze the common problems in shunt surgery and measures to avoid them. Management of hydrocephalus takes up as much as 50% of a pediatric ‘ ‘neurosurgeon's time, and these are notoriously prone to complications. In this article, the author analysis his series of ventriculoperitoneal shunts and discusses his technique, nuances and avoidance of shunt complications.

Methods and Materials:
The author will review common issues related to hydrocephalus shunt management with a review of 549 procedures and associated complications.

Results:
Key features and basic principles of complication avoidance in shunt surgery is provided. The analysis looks into the complications and ways to avoid them based on the author's experience

Conclusions:
Specific measures may be adopted to minimize or avoid these complications. These will be discussed based on the author's series and experiences.
Hydrocephalus Research
Authors: Mahapatra Ashok K 
Published: December 2021

Abstract

Objective:
This paper highlights the hydrocephalus research efforts undertaken at AIIMS, New Delhi, supporting progress in the field.

Material:
Over a period of three decades, basic research, clinical investigations, and multicentric studies were undertaken. This report will review the work mainly to emphasize the need for future generations to pursue further research. Studies that impacted hydrocephalus care (mainly in India) are described, and some of these findings may be useful in other resource-challenged situations.

Results:
Investigative studies on the effect of shunting on brainstem auditory evoked responses (BAER), transcranial Doppler (TCD), and CT-SPECT were published offering management options for patients. Participation in the International Infant Hydrocephalus Study (IIHS) study offered opportunities to compare our approaches and develop modifications in patient care. This effort proved shunting was equal or better for young children with congenital aqueductal stenosis. Shunt infection protocols and changes made in a systematic manner helped develop local protocols to reduce postoperative shunt infections.

Conclusions:
Hydrocephalus research over three decades at AIIMS, New Delhi was productive and educational, confirming that locally performed investigative work can help in decision making. Further studies and active participation in international efforts are necessary to advance the field.
Techniques and Nuances in Ventriculoperitoneal Shunt Surgery
Authors: Pillai Shibu V 
Published: December 2021

Abstract

Background:
Ventriculoperitoneal shunt surgery (VPS) is a simple solution to the problem of hydrocephalus. However, it is associated with significant complications. Meticulous attention to a variety of factors, techniques, and nuances in VPS can reduce these complications.

Objective:
To review the various techniques and nuances during the different stages of VPS.

Methods and Material:
PubMed search for original and review articles dealing with various techniques used during VPS.

Results:
Thorough preoperative planning for VPS reduces operative time and complications. A standardized shunt surgery protocol significantly reduces shunt infection. Good and appropriate surgical technique can enhance the safety of the procedure. Anterior entry point is better than posterior entry point. Shunt tip should be away from choroid plexus, but the exact location is not vital for shunt survival. Proper placement of the shunt in the subgaleal and subcutaneous plane reduces wound and skin breakdown over the shunt. The trocar and laparoscopic methods to access the peritoneum are associated with fewer distal obstructions compared to mini-laparotomy. Perioperative antibiotic prophylaxis, use of antibiotic-impregnated shunts, and sutures are proven techniques to reduce shunt infection.

Conclusions:
Preoperative planning, a standardized shunt surgery protocol, good surgical technique, gentle tissue handling, and short surgery duration are essential to reduce VPS complications. Specifically, use of anterior entry point, correct tunneling of the shunt in the subgaleal and subcutaneous plane, appropriate antibiotic prophylaxis, use of antibiotic-impregnated shunts, and meticulous skin closure using antimicrobial sutures can lead to a reduction in shunt malfunction and infection.
Normal-Pressure Hydrocephalus - Patient Evaluation and Decision-Making
Authors: Vibha Deepti , Tripathi Manjari 
Published: December 2021

Abstract

Background:
Normal-pressure hydrocephalus (NPH) presents with the triad of gait difficulty, urinary incontinence, and cognitive decline. However, the definitive diagnosis and treatment may be challenging at times due to secondary causes of NPH (sNPH) versus idiopathic NPH (iNPH), co-existing other degenerative, vascular, and metabolic causes of similar clinical presentations.

Objective:
The objective of this narrative review is to outline the approach to patient evaluation and decision-making in cases where there is clinical suspicion of iNPH.

Methods:
This review article intends to provide a practical approach to the patients with a suspected diagnosis of iNPH.

Results:
The cardinal clinical features with a guide from investigations like magnetic resonance imaging (MRI) brain and cerebrospinal fluid (CSF) analysis, and CSF tap assessment have been outlined. The interpretation of conflicting MRI brain findings or CSF analysis may need resolution by further tests. The decision algorithm following the examination and investigations has been included to address the dilemma in the case of a non-supportive MRI and/or CSF tap test.

Conclusion:
iNPH is a treatable cause of the cognitive decline and gait disorder. While neurodegenerative causes may accompany iNPH, any patient with improvement after CSF drainage deserves therapeutic intervention.
Controversies in Hydrocephalus
Authors: Udayakumaran Suhas , Pattisapu Jogi V 
Published: December 2021

Abstract

Background:
Hydrocephalus is a complex issue characterized by increased intracranial pressure secondary to obstruction of cerebrospinal fluid flow and occasionally due to overproduction. As a result, the entity has challenges of different dimensions at the level of understanding and management.

Methods:
A literature search, systematic review, and meta-analysis of eligible studies were conducted in the major databases. The literature review included relevant articles on hydrocephalus published until June 1, 2021 (no starting date), databases being the only limitation considering the broadness of the subthemes. Controversies themes were chosen among the literature, not including treatment dilemmas and hydrocephalus research. The further detailed search included these selected themes and an updated literature review on the subjects.

Results and Discussion:
Controversies are a hallmark of incomplete science; most complex concepts harbor several debates at various levels. This article reviews controversies in hydrocephalus, offering some updates on popular discussions. It is not meant to be an exposition of the topics themselves but to collect the status quo of unresolved concepts in hydrocephalus.

Conclusions:
As with most chronic and complex disorders, hydrocephalus welcomes controversy as a healthy discussion platform to exist until we understand the disorder to its minutest.
Clinical Outcome, Cognitive Function, and Quality of Life after Endoscopic Third Ventriculostomy versus Ventriculo-Peritoneal Shunt in Non-Tumor Hydrocephalus
Authors: Dhandapani Manju , Yagnick Nishant S. , Mohanty Manju , Ahuja Chirag K. , Dhandapani Sivashanmugam 
Published: December 2021

Abstract

Background:
Endoscopic Third Ventriculostomy (ETV) is increasingly being accepted as the treatment of choice in place of Ventriculo-Peritoneal (VP) Shunt for hydrocephalus. However, their differences in cognitive and Quality of Life (QOL) scores have not been studied much in children.

Objective:
To compare the outcome, cognitive function, and QOL between ETV and VP shunt.

Methods:
Patients of non-tumor hydrocephalus treated with ETV or/and VP shunt underwent cognitive assessment (using modified child MMSE standardized as per the age group) and QOL (using PedsQL as per the age group in Physical, Emotional, Social, and School Functioning domains) in addition to the outcome of not requiring additional intervention.

Results:
Out of 139 patients, there were 29 infants and 40 children upto 14 years. Among these children, ETV was the primary intervention in 45, VP shunt in 24, and could be studied for a mean follow-up of 1.7 years. Though ETV required lesser additional intervention than VP shunt (19.2% vs. 28.6%) in toddlers and older children, there was no overall significant difference. Subnormal cognitive scores were noted in 25%, 40%, and 50% after ETV, single shunt procedure, and multiple shunt procedures, respectively, with no statistically significant difference. Among the different domains of QOL, the child reported scores in the social domain were significantly better after ETV than VP shunt (475[+13] vs. 387[+43], P value 0.03), whereas most other scores were non-significantly better following ETV.

Conclusion:
Patients who underwent ETV show a trend for better clinical outcome, cognitive function, and QOL with significantly better child-reported QOL scores in the social domain.
Post-Infective Hydrocephalus
Authors: Garg Kanwaljeet , Gupta Deepak 
Published: December 2021

Abstract

Background:
Post-infective hydrocephalus (PIH) arises as a complication of any CNS infection, and can be either communicating or noncommunicating.

Objective:
The aim of this article is to study the various causes of PIH and its pathophysiology and treatment.

Material and Methods:
The literature was searched for articles describing the causes of PIH.

Results:
Common causes of PIH are CNS tuberculosis (TB), neurocysticercosis, and perinatal or neonatal infection. TBM is most likely to result in hydrocephalus out of all these manifestations of CNS TB, and hydrocephalus is more likely to occur early in the course, typically 4–6 weeks after the onset of TBM, and is more common among children as compared to adults. A trial of medical management (antitubercular therapy, steroids, and decongestants) can be given to patients with communicating hydrocephalus. Ventriculoperitoneal shunt is the most employed method of CSF diversion in these patients. Though traditionally considered contraindicated, many recent studies have found ETV to be a reasonable option in patients with PIH. HCP in patients with neurocysticercosis can be associated with intraventricular cysts and racemose cysts in the basal subarachnoid cisterns. Surgical intervention is required either for cyst removal or CSF diversion. Endoscopic approaches can be used to remove the intraventricular cysts, which takes care of the HCP. PIH in infants can result either from antenatal infections (TORCH infections) or postnatal infections such as meningitis.

Conclusions:
Management of PIH can be challenging. Management has to be individualized.
Hydrocephalus in Tuberculous Meningitis - Pearls and Nuances
Authors: Paliwal Vimal K , Garg Ravindra K 
Published: December 2021

Abstract
Tuberculous meningitis (TBM) is associated with high mortality. A large proportion of patients with TBM, who survive, live with disabling neurological sequelae. Hydrocephalus is one of the common complications of TBM, seen in up to 80% of patients. Hydrocephalus may be a presenting feature or may develop paradoxically after the commencement of antituberculosis treatment. The Hallmark pathological feature of TBM is a thick gelatinous exudate, dominantly present at basal parts of the brain. Exudate encases and strangulates cranial nerve trunks like optic nerve, optic chiasma, and vessels of the circle of Willis. Basal exudate also blocks the cerebrospinal fluid (CSF) flow in the brain, resulting in ventriculomegaly. It is often difficult to differentiate between two common types (communicating and obstructive) of hydrocephalus on basis of routine neuroimaging. Progressive hydrocephalus, clinically manifests with a potentially life-threatening high intracranial pressure. Patients with deteriorating vision loss and deteriorating consciousness, often need a surgical CSF diversion procedure (ventriculoperitoneal shunt or endoscopic third ventriculostomy) to be performed. CSF diversion may be life-saving. However, the long-term benefits of CSF diversion are largely unknown.
Lamotrigine-Associated Movement Disorder
Authors: Rissardo Jamir Pitton , Caprara Ana L Fornari 
Published: December 2021

Abstract

Background:
Lamotrigine (LMT) is a phenyltriazine derivative that was originally described as an antiepileptic drug.

Objective:
This literature review aims to evaluate the clinical epidemiological profile, pathological mechanisms, and management of lamotrigine-associated movement disorders.

Methods:
Relevant reports in six databases were identified and assessed by two reviewers without language restriction. Reports that the individuals only developed tremor or ataxia after LMT use were not included.

Results:
In total 48 reports of 108 cases from 19 countries were assessed. The movement disorders associated with LMT found were 29 tics, 21 dyskinesias, 14 myoclonus, 13 parkinsonism, 10 dystonia, and 1 stuttering. The not clearly defined cases included 10 akathisia, 4 myoclonus, 4 cerebellar syndromes, 1 hypertonia, 1 dyskinesia, and an unknown number of dystonia cases. The mean reported age was 33.34 years (range: 1.574 years). The male was the predominant sex and the most common LMT indication was epilepsy. The mean LMT-dose at the movement disorder onset was 228 mg. The time from LMT start to the onset of movement disorder was within 6 months in 81%. The time from LMT withdrawal to complete recovery was within 1 month in 83%. The most common management was LMT withdrawal.

Conclusions:
In the literature, the majority of the cases did not give a clear picture of the individual, and the times of movement disorder onset and recovery are not described. We believe that before withdrawal LMT, a dose adjustment based on the benefits and adverse events with careful evaluation case-by-case can be done.
The Relationship between Patterns of Remodeling and Degree of Enhancement in Patients with Atherosclerotic Middle Cerebral Artery Stenosis
Authors: Zhang Dan-Feng , Wu Xin-Ying , Zhang Wei-Dong , Wang Mi , Yin Xindao , Chen Yu-Chen 
Published: December 2021

Abstract

Purpose:
The aim of this research was to investigate the relationship between remodeling patterns and degree of enhancement in patients with atherosclerotic middle cerebral artery (MCA) stenosis using high-resolution magnetic resonance imaging (HR-MRI).

Materials and Methods:
From August 2015 to May 2016, 38 consecutive patients with unilateral MCA stenosis on time-of-flight (TOF) MR angiography were prospectively enrolled. The routine MR scan and cross-sectional images of the stenotic MCA vessel wall on HR-MRI were performed in all patients. Among them, 17 patients displayed positive remodeling (PR) and the other 21 patients displayed negative remodeling or non-remodeling (non-PR). The patients displaying hyperintense on diffusion-weighted imaging (DWI) in the territory of ipsilateral stenotic MCA were considered to have had acute stroke. Subsequently, the differences in the degree of enhancement and the number of acute stroke patients between the PR group and the non-PR group were compared. The Spearman rank correlation analysis of the enhancement degree (ED) and the remodeling index (RI) was calculated. Then, receiver operating curve (ROC) was used to evaluate diagnostic efficiency of RI and ED for acute infarction.

Results:
The PR group had more obvious enhancement plaques than the non-PR group (10 versus 3, P = 0.006). The PR group also had a larger number of acute stroke patients than the non-PR group (15 versus 4, P = 0.000). The spear-man rank correlation analysis showed that the degree of enhancement had a weak positive correlation with the remodeling index (r = 0.379, P = 0.019). The area under the curve (AUC) of RI and ED was higher than that of RI (0.924: 0.842).

Conclusion:
The PR, obvious enhancement predicted vulnerable plaques that were more prone to causing acute stroke. RI and ED had valuable diagnostic efficiency for acute infarction.
Science and Art of Reviewing Papers to Maintain Standards in Academia
Authors: Ganapathy Krishnan 
Published: December 2021

Abstract
This review article highlights the necessity and importance of peer review of articles submitted to journals. Publication in a peer reviewed, good impact indexed journal is an indirect endorsement of the article contents. The editor and the readership depend on the integrity and total involvement of reviewers. What is expected of the reviewer and the authors is discussed. Reviewers need to be sensitive to authors' reactions. Authors should also respond, not react or be hypersensitive.
Skull Base Chordoma
Authors: Roy Amrit , Warade Anshu , Jha Ashish K , Misra Basant K 
Published: December 2021

Abstract

Background:
Skull base chordoma (SBC) is relatively rare and data on its clinical outcome after surgical resection and adjuvant radiotherapy are still limited.

Objective:
Analyzing the clinical postoperative outcome of SBC patients and defining prognostic factors regarding current treatment modalities.

Methods and Material:
In this study, 41 SBC patients from 2001 to 2017 were retrospectively analyzed in this single-center study.

Results:
The most common clinical symptoms were headache (63%) and problems concerning vision (54%) like diplopia. The follow-up controls took place from 1 to 192 months. The mean survival time for the patients was 123.37 months (95% CI 90.89–155.86). The 5- and 10-year survival rates were 73.3 and 49%, respectively. Regarding the Karnofsky-Performance Scale (KPS), Cox regression showed a significant relationship between the survival rates in the overall study population and pre-surgery KPS (P = 0.004). This was further supported with a positive significant correlation between the pre-surgery KPS and the KPS at the last follow-up (P = 0.039).

Conclusion:
Statistical analysis showed that repeat surgical resection and radiotherapy could be prognostic factors. Furthermore, we were able to show that mortality decreased by 4.5% with each 10 points increase of pre-surgery KPS. This could be a major prognostic factor when deciding treatment modalities. Nevertheless, further standardized clinical studies with a larger patient population should be carried out to extrapolate prognostic factors and improve treatment modalities.