bluuebunny/crossref_metadata_2025_split huggingface dataset:
Surgical Indication Optimization of Brain Metastases Based on the Evolutionary Analysis of Karnofsky Performance Status
Authors: Rasmussen Jorge , Ajler Pablo , Massa Daniela , Plou Pedro , Baccanelli Matteo , Yampolsky Claudio 
Published: January 2021

Abstract
Background and Objective Surgical resection of brain metastases (BM) offers the highest rates of local control and survival; however, it is reserved for patients with good functional status. In particular, the presence of BM tends to oversize the detriment of the overall functional status, causing neurologic deterioration, potentially reversible following symptomatic pharmacological treatment. Thus, a timely indication of surgical resection may be dismissed. We propose to identify and quantify these variations in the functional status of patients with symptomatic BM to optimize the indication of surgical resection.
Patients and Methods Historic, retrospective cohort analysis of adult patients undergoing BM microsurgical resection, consecutively from January 2012 to May 2016, was conducted. The Karnofsky performance status (KPS) variation was recorded according to the symptomatic evolution of each patient at specific moments of the diagnostic–therapeutic algorithm. Finally, survival curves were delineated for the main identified factors.
Results One hundred and nineteen resection surgeries were performed. The median overall survival was 243 days, while on average it was 305.7 (95% confidence interval [CI]: 250.6–360.9) days. The indication of surgical resection of 10% of the symptomatic patients in our series (7.5% of overall) could have been initially rejected due to pharmacologically reversible neurologic impairment. Survival curves showed statistically significant differences when KPS was stratified following pharmacological symptomatic treatment (p < 0.0001), unlike when they were estimated at the time of BM diagnosis (p = 0.1128).
Conclusion The preoperative determination of the functional status by KPS as an evolutive parameter after the nononcologic symptomatic pharmacological treatment allowed us to optimize the surgical indication of patients with symptomatic BM.
Health Economic Aspects of Aneurysmal Subarachnoid Hemorrhage: Factors Determining First Year In-Hospital Treatment Expenses
Authors: Ridwan Sami , Urbach Horst , Greschus Susanne , Hagen Johanna Von , Esche Jonas , Boström Azize 
Published: January 2021

AbstractBackground Spontaneous aneurysmal subarachnoid hemorrhage (SAH) is a common neurosurgical emergency with a high case fatality rate. The clinical course of SAH generates high health economic expenses. Here we highlight possible cost-driving factors for in-hospital care expenses for the first year. Furthermore, results are compared with ischemic stroke treatment.Methods One hundred and one patients with aneurysmal SAH treated in our hospital from 2007 through 2009 were included. The Hunt and Hess (HH) scale, World Federation of Neurosurgical Societies (WFNS) scale, Fisher Scale, and further outcome-relevant data were recorded. Expenses were calculated using the German fixed case rate classification system consisting of Diagnosis-Related Groups (DRG) and the Operation and Procedure catalogue (OPS). Overall acute length of stay (LOS) and LOS on the intensive care unit (ICU) were separately evaluated. Expenses were compared with formerly published first-year costs of ischemic stroke.Results Fifty-four percent of the patients (median age 52 years, 69% females) received coiling and 46% clipping. Acute in-hospital treatment accounted for 82% of total in-hospital expenses, while consequential in-hospital treatment accounted only for 18%. Altogether, the total first-year in-hospital expenses for all patients were as high as €2,650,002, resulting in average SAH in-hospital treatment expenses of €26,238 per patient for the first year. Poor clinical condition on admission and longer stay in ICU are the main cost-driving factors. The impact of the aneurysm treatment method is debatable. Only a poor HH grade and longer ICU stay are independent cost-driving factors. SAH treatment expenses are far higher than treatment costs for ischemic stroke in the literature (€6,731 for first-year inpatient and €3,287 for outpatient treatment).Conclusions Clinical condition and LOS determine in-hospital expenses after SAH. Aneurysmal SAH prevalently results in a relevant economic impact on the health system exceeding formerly published treatment expenses for ischemic stroke.
Comparison of the Minimally Invasive Tubular Transmuscular Approach with the Conventional Microsurgical Approach for Microsurgical Treatment of Lumbar Disk Herniation: A Prospective Randomized Study
Authors: Pintea Bogdan , Krämer Nadine , Müller Andreas , Geiger Matthias Florian , Podlogar Martin , Weber Patrick , Kristof Rudolf Andreas 
Published: January 2021

Abstract
Background The aim of this study is to compare the outcome of the minimally invasive transmuscular approach using a tubular retractor system (Metrx) with the conventional microsurgical standard approach (CM) for microsurgical treatment of lumbar disk herniation.
Methods This is a prospective randomized controlled study with a 1:1 distribution of patients in CM and Metrx study groups. Two hundred and twenty-seven (117 CM and 110 Metrx) patients were included. The primary outcome parameters are postoperative pain intensity reduction, length of hospitalization, postoperative quality of life, and daily life performance based on the standardized questionnaires: Visual Analog Scale (VAS), 36-Item Short Form Survey (SF-36), Oswestry Disability Index (ODI), and Prolo scores. The secondary outcome parameters are intraoperative variables: surgery duration, blood loss, and fluoroscopy dose.
Results There were no significant statistical differences in the primary outcome measures between the two groups with respect to postoperative pain relief (median VAS pre-op to 3 months post-op for sciatica: 9–2 [CM] vs. 8–2 [Metrx]; for lumbago: 7–2.5 [CM] vs. 6–3 [Metrx]), the length of hospitalization (median of 5 days), or the frequency of occupational reintegration after 3 months (59.1 vs. 60.7%).
Conclusion The microsurgical therapy of lumbar disk herniation via a Metrx approach is a safe and effective treatment option and is equivalent to the CM approach.
The Effects of Local Food-Based Enteral Nutrition to Improve Nutritional Status of Post-Stroke Patients
Authors: Setyopranoto Ismail , Susetyowati  , Lestari Lily Arsanti , Probosuseno  , Wijayanti Punik Mumpuni , Rochmah Mawaddah Ar 
Published: January 2021

Abstract

Objective We used local-based enteral formula for post-stroke patients to see its effects on the nutritional status.

Materials and Methods This is an experimental research with a pre- and post-test study design in post-stroke patients. Participants underwent clinical and laboratory examinations to assess their nutritional status before and after the enteral nutrition supplementation. The enteral formula preparation, containing arrowroot powder, cork fish, tempeh (fermented soybeans), nondairy creamer, and pumpkin, was performed in a nationally standardized Food Processing Technology Laboratory in Yogyakarta, Indonesia. The enteral formula was given twice a day for 3 consecutive weeks in addition to the patients’ daily meal.

Statistical Analysis Nutritional indices before and after enteral nutrition supplementation were analyzed using t-test. All statistical analyses were at 5% significance level.

Results Of the 22 post-stroke patients, we used the cutoff point of National Institutes of Health Stroke Scale ≥3 and Barthel Index <90 to represent dependency. Our findings showed significantly reduced mid-upper arm circumference and increased body mass index in independent post-stroke patients after the enteral nutrition supplementation. The tendency of increasing total cholesterol level should be carefully watched in dependent post-stroke patients.

Conclusion Local food-based enteral nutrition supplementation for 3 consecutive weeks in post-stroke patients may improve their nutritional status.
Migraine in Nursing Students—A Study from a Tertiary Care Center in South India
Authors: Menon Bindu , Remadevi Nikethana 
Published: January 2021

Abstract

Objective Nursing profession is subject to occupational stress, which can be a trigger for headaches. Our study aimed to study the prevalence of migraine, its characteristics, triggers, and relieving factors among nursing students in a tertiary care center.

Materials and Methods This study was performed in a super-specialty hospital in South India. A structured questionnaire captured data on the occurrence of headache, demographics, aura, triggering factors, relieving factors, and lifestyle habits. Results are presented in numbers and percentage.

Results A total of 20% of nursing students in the study had headache of which 85% had migraine. Weekly and daily attacks were reported in 12 and 4% students, respectively. Twenty-two percent had headache severity of more than 5 visual analogue scale. Most common accompanying symptoms were photophobia (80%), phonophobia (70%), nausea (75%), vomiting (71%), neck pain (25%), and vertigo (20%). Thirty-nine percent had auras. Ninety-five percent reported triggers with 70% students having more than one trigger. Sleep was the relieving factor in 69%, head massage in 50%, and relaxing from work in 48%.

Conclusion The most common type of primary headache in nurses in our study was migraine. More than three-fourths nurses reported triggers and relieving factors. Addressing these factors could help in managing migraines and help in improving the quality of life and increased work productivity of nurses.
Epidemiological Profiling and Trends of Primary Intracranial Tumors: A Hospital-Based Brain Tumor Registry from a Tertiary Care Center
Authors: Meel Mukta , Choudhary Nikita , Kumar Mukesh , Mathur Kusum 
Published: January 2021

Abstract

Background and Objectives Hospital-based cancer registry is an essential tool for augmentation of the standard of care, administration motive, and resource for population-based cancer registries. Here, we presented hospital-based brain tumor registry (HBBTR) to outline a comprehensive epidemiological data, both clinical and histopathological, as well as trends of central nervous system tumors. In addition, we compare this data with national brain tumor data as well as an international brain tumor registry.

Materials and Methods For the generation of this 7-year HBBTR data of all primary intracranial tumors operated, diagnosed, and registered at the Department of Pathology, Sawai ManSingh, between January 1, 2013 and December 31, 2019, was collected, analyzed, and compared with Tata Memorial Hospital, National Institute of Mental Health and Neurosciences, and Central Brain Tumor Registry of the United States.

Results A total of 3,526 patients were of primary intracranial tumors. Out of which, male patients were 1,982 (56.2%), while 1,544 (43.8%) were female patients. Maximum proportion of tumors was in fifth decade. Overall, pediatric and adult patients constituted of 15.5 and 84.5% of the cases, respectively. Among all primary intracranial tumors, meningiomas (20%) were most common followed by glioblastoma multiformat (18%) and least common were germ cell tumors (0.1%) followed by pineal tumors (0.3%). In pediatric cohort astrocytic tumors (30.1%) are most common followed by embryonal tumors (20.8%), while in adults meningiomas (23.1%) were most common followed by glioblastomas (20.3%). Our registry showed similar trends of tumors with national data as compared with international data in median age of presentation.

Conclusion This HBBTRs provide prevalence of primary intracranial tumors at a tertiary care center and could be a part of population-based registry.
Mannitol Dosing Error during Pre-neurosurgical Care of Head Injury: A Neurosurgical In-Hospital Survey from Ibadan, Nigeria
Authors: Adeleye Amos Olufemi , Oyemolade Toyin Ayofe , Malomo Toluyemi Adefolarin , Okere Oghenekevwe Efe 
Published: January 2021

Abstract

Objectives Inappropriate use of mannitol is a medical error seen frequently in pre-neurosurgical head injury (HI) care that may result in serious adverse effects. This study explored this medical error amongst HI patients in a Nigerian neurosurgery unit.

Methods We performed a cross-sectional analysis of a prospective cohort of HI patients who were administered mannitol by their initial non-neurosurgical health care givers before referral to our center over a 22-month period.

Statistical Analysis A statistical software was used for the analysis with which an α value of <0.05 was deemed clinically significant.

Results Seventy-one patients were recruited: 17 (23.9%) from private hospitals, 13 (18.3%) from primary health facilities (PHFs), 20 (28.2%) from secondary health facilities (SHFs), and 21 (29.6%) from tertiary health facilities (THFs). Thirteen patients (18.3%) had mild HI; 29 (40.8%) each had moderate and severe HI, respectively. Pupillary abnormalities were documented in five patients (7.04%) with severe HI and neurological deterioration in two with mild HI.
Mannitol administration was deemed appropriate in only 43.7% (31/71). Data on mannitol dosing in 60.6% (43/71) of the patients showed 8/43 (18.6%) receiving continuous 10% mannitol infusion. The remaining 35/43 received mannitol as a 20% solution but also showing dosing error in 62.9% (22/35): overdosing in 7/35 (20%), and nonbolus administration in 15/35 (42.9%). The distribution of the dosing error among the referring health facilities (all the 13 [100%] patients from private hospitals, 66.7% from PHF, 60% from SHF, and 45.5% from THF) showed a trend of better performance (p = 0.002) by the THFs.

Conclusion Mannitol use is apparently fraught with an understudied medical error in the pre-neurosurgical care of the head injured.
Bilaminate Synthetic Dermal Matrix versus Free Fascial Flaps: A Cost-Effectiveness Analysis for Full-Thickness Hand Reconstruction
Authors: Miller Travis J. , Lin Walter C. , Watt Andrew J. , Sheckter Clifford C. 
Published: January 2021

Abstract
Background Full-thickness injuries to the hand require durable soft tissue coverage to preserve tendon gliding and hand motion. We aim to investigate the cost effectiveness of hand resurfacing comparing free fascial flap reconstruction versus bilaminate synthetic dermal matrices.
Methods Cost effectiveness was modeled using decision tree analysis with the rollback method. Total active range of motion was modeled as the common outcome variable based on systematic literature review. Costing was performed from a payer perspective using national Medicare reimbursements. The willingness to pay threshold was determined by average worker's compensation for hand disability. Probabilistic sensitivity analysis was conducted for range of motion outcomes and the costs using 10,000 Monte Carlo simulations.
Results The average cost of free fascial flap reconstruction was $14,201.24 compared with $13,674.20 for Integra, yielding an incremental cost difference of $527.04. Incremental range of motion improvement was 18.0 degrees with free fascial flaps, yielding an incremental cost effectiveness ratio of $29.30/degree of motion. Assuming willingness to pay thresholds of $557.00/degree of motion, free-fascial flaps were highly cost effective. On probabilistic sensitivity analysis, free fascial flaps were dominant in 25.5% of simulations and cost effective in 32.1% of simulations. Thus, microsurgical reconstruction was the economically sound technique in 57.5% of scenarios.
Conclusion Free fascial flap reconstruction of complex hand wounds was marginally more expensive than synthetic dermal matrix and yielded incrementally better outcomes. Both dermal matrix and microsurgical techniques were cost effective in the base case and in sensitivity analysis. In choosing between dermal matrix and microsurgical reconstruction of complex hand wounds, neither technique has a clear economic advantage.
Combining application of wavelet analysis and genetic algorithm in wind tunnel simulation of unidirectional natural wind field near a sand ground surface
Authors: Bo Zhang , Xiaosi Zhou , Yuxin Liu , Bin Yang , Yang Zhang 
Published: January 2021

This study proposes a method for the approximate simulation of field gust in an atmospheric boundary layer wind tunnel driven by an axial fan. Wavelet analysis and genetic algorithm have been adopted to convert actual field gust data into a series of simplified and smooth control signals. One frequency converter is used to receive the signals via a programmable logic controller and change the fan speed correspondingly. Results show that the low-frequency energetic part of field gust on top of a saltation layer has been almost reproduced in the wind tunnel with energy fluctuations ±3.26% from the mean compared with the field data in terms of energy. The appropriate filter frequency for field gust velocity history is 1/32 Hz. A unidirectional natural wind field near a sand bed surface can be approximately simulated in the tunnel by adjusting carefully the roughness element arrangement. The time-averaged velocity profile of the simulated wind, which satisfies the logarithmic law, is nearly equivalent to the steady flow with the same average velocity.
Magnetic measurement and analysis of c-type amorphous by an improved adjustable air gap tester
Authors: Li Yongjian , Wan Zhenyu , Sun He , Liu Huan 
Published: January 2021

A novel magnetic properties tester is designed to accurately and conveniently change the air gap of the core, which can fix cores of various types. The dynamic magnetic characteristics of the amorphous core under sinusoidal excitation within 20 kHz is measured with different air gap lengths and magnetic flux density. It is found that in the case of the small air gap, the total loss decreases as the air gap increases. When the frequency is 20 kHz and the flux density is 0.1 T, the loss can even be reduced by 7%. This paper analyzes the experimental data and summarizes the influence of the air gap and magnetic flux density about the core loss. Besides, the influence of air gap on magnetic flux density distribution is illustrated and analyzed by the means of FEM (Finite Element Method). It is valuable for the design of high frequency transformer and inductor.
Adenovirus-vectored vaccine containing multidimensionally conserved parts of the HIV proteome is immunogenic in rhesus macaques
Authors: Murakowski Dariusz K. , Barton John P. , Peter Lauren , Chandrashekar Abishek , Bondzie Esther , Gao Ang , Barouch Dan H. , Chakraborty Arup K. 
Published: January 2021

Significance
HIV is a highly mutable pathogen that can mutate to evade vaccine-induced immune responses, thus negating the vaccine’s protective effects. If mutations that evade immune responses incur a fitness penalty for the virus, other mutations can evolve to partially compensate for fitness loss. Accounting for such effects, we designed a single long peptide immunogen comprised of parts of HIV proteins wherein mutations would be difficult to evolve without fitness penalties for the virus. This designed immunogen was expressed in adenovirus vectors, which are in clinical development (e.g., for COVID-19). Monkeys immunized with our vaccine exhibited strong T-cell responses directed toward regions contained in our immunogen. This suggests that further exploration of this vaccine for use in humans is warranted.
Explosion analysis from images: Trinity and Beirut*
Authors: Díaz Jorge S. 
Published: January 2021

Abstract
Images of an explosion can be used to study some of its physical properties. After reviewing the key aspects of the method originally developed to study the first nuclear detonation and analyzing the Trinity blast data, the method is applied to the Beirut explosion of August 2020 by using images from videos posted online. The applicability of the method is discussed and the process of selection, extraction, and analysis of the data is presented. The estimate for the energy yield of the Beirut explosion is found to be

2
.

3

−
1.1

+
1.1

TJ or

0
.

6

−
0.3

+
0.3

kt of TNT equivalent. The result is consistent with others recently appeared in the literature using different methods. Notice that this article includes content that some readers may find distressing.
Progress in state-of-the-art technologies of Ga2O3devices
Authors: Wang Chenlu , Zhang Jincheng , Xu Shengrui , Zhang Chunfu , Feng Qian , Zhang Yachao , Ning Jing , Zhao Shenglei , Zhou Hong , Hao Yue 
Published: January 2021

AbstractGallium oxide (Ga2O3), an emerging ultra-wide-bandgap semiconductor, has the desirable properties of a large bandgap of 4.6–4.9 eV, an estimated critical breakdown field of 8 MV cm−1, decent electron mobility of 250 cm2V s−1and high theoretical Baliga figures of merit (BFOMs) of around 3000. Bolstered by their capability of an economical growth technique for high-quality bulk substrate,β-Ga2O3-based materials and devices have been highly sought after in recent years for power electronics and solar-blind ultraviolet photodetectors. This article reviews the most recent advances inβ-Ga2O3power device technologies. It will begins with a summary of the field and underlying semiconductor properties of Ga2O3, followed by a review of the growth methods of high-qualityβ-Ga2O3bulk substrates and epitaxial thin films. Then, brief perspectives on the advanced technologies and measurements in terms of ohmic contact and interface state are provided. Furthermore, some state-of-the-artβ-Ga2O3photoelectronic devices, power devices and radiofrequency devices with distinguished performance are fully described and discussed. Some solutions to alleviating challenging issues, including the difficulty in p-type doping, low thermal conductivity and low mobility, are also presented and explored.
Facile synthesis of β–Ga2O3 nanowires network for solar-blind ultraviolet photodetector
Authors: Zhang Miaomiao , Kang Shuai , Wang Liang , Zhang Kun , Wu Yutong , Feng Shuanglong , Lu Wenqiang 
Published: January 2021

Abstract
Gallium oxide (Ga2O3) has become a viable candidate for certain types of high-power devices due to its large energy bandgap of 4.9 eV, which has attracted widespread attention. In particular, Ga2O3 nanowire structures have more unique properties due to its larger specific surface area for the high performance solar-blind ultraviolet (UV) photodetectors. In this work, the ultrafine Ga2O3 nanowire network structure is obtained on the sapphire substrate with an Au catalyst by chemical vapor deposition method at 960 °C for 10 min. We can confirm that the growth of the nanowire follows the vapor–liquid–solid growth mechanism and is a β-type Ga2O3 crystal through the performance test results. A solar-blind UV photodetector based on the nanowires network shows an apparent response to solar-blind UV light and almost no response to 365 nm wavelength. Furthermore, the on–off ratio, light responsivity, and response time are also measured under a 254 nm wavelength UV light irradiation, respectively. This work provides a new preparation method to improve the performance of solar-blind UV photodetector.