bluuebunny/crossref_metadata_2025_split huggingface dataset:
Predictors of long-term clinical outcomes in adult patients after lumbar total disc replacement: development and validation of a prediction model
Authors: Coric Domagoj , Zigler Jack , Derman Peter , Braxton Ernest , Situ Aaron , Patel Leena 
Published: November 2021

OBJECTIVE
Long-term outcomes of single-level lumbar arthroplasty are understood to be very good, with the most recent Investigational Device Exemption (IDE) trial showing a < 5% reoperation rate at the close of the 7-year study. This post hoc analysis was conducted to determine whether specific patients from the activL IDE data set had better outcomes than the mean good outcome of the IDE trial, as well as to identify contributing factors that could be optimized in real-world use.

METHODS
Univariable and multivariable logistic regression models were developed using the randomized patient set (n = 283) from the activL trial and used to identify predictive factors and to derive risk equations. The models were internally validated using the randomized patient set and externally validated using the nonrandomized patient set (n = 52) from the activL trial. Predictive power was assessed using area under the receiver operating characteristic curve analysis.

RESULTS
Two factors were significantly associated with achievement of better than the mean outcomes at 7 years. Randomization to receive the activL device was positively associated with better than the mean visual analog scale (VAS)–back pain and Oswestry Disability Index (ODI) scores, whereas preoperative narcotics use was negatively associated with better than the mean ODI score. Preoperative narcotics use was also negatively associated with return to unrestricted full-time work. Other preoperative factors associated with positive outcomes included unrestricted full-time work, working manual labor after index back injury, and decreasing disc height. Older age, greater VAS–leg pain score, greater ODI score, female sex, and working manual labor before back injury were identified as preoperative factors associated with negative outcomes. Preoperative BMI, VAS–back pain score, back pain duration ≥ 1 year, SF-36 physical component summary score, and recreational activity had no effect on outcomes.

CONCLUSIONS
Lumbar total disc replacement for symptomatic single-level lumbar degenerative disc disease is a well-established option for improving long-term patient outcomes. Discontinuing narcotics use may further improve patient outcomes, as this analysis identified associations between no preoperative narcotics use and better ODI score relative to the mean score of the activL trial at 7 years and increased likelihood of return to work within 7 years. Other preoperative factors that may further improve outcomes included unrestricted full-time work, working manual labor despite back injury, sedentary work status before back injury, and randomization to receive the activL device. Tailoring patient care before total disc replacement may further improve patient outcomes.
Hemodynamic changes after intracranial aneurysm growth
Authors: Cornelissen Bart M. W. , Leemans Eva L. , Slump Cornelis H. , van den Berg René , Marquering Henk A. , Majoie Charles B. L. M. 
Published: November 2021

OBJECTIVE
For accurate risk assessment of unruptured intracranial aneurysms, it is important to understand the underlying mechanisms that lead to rupture. It is known that hemodynamic anomalies contribute to aneurysm growth and rupture, and that growing aneurysms carry higher rupture risks. However, it is unknown how growth affects hemodynamic characteristics. In this study, the authors assessed how hemodynamic characteristics change over the course of aneurysm growth.

METHODS
The authors included patients with observed aneurysm growth on longitudinal MRA in the period between 2012 and 2016. Patient-specific vascular models were created from baseline and follow-up images. Subsequently, intraaneurysmal hemodynamic characteristics were computed using computational fluid dynamics. The authors computed the normalized wall shear stress, oscillatory shear index, and low shear area to quantify hemodynamic characteristics. Differences between baseline and follow-up measurements were analyzed using paired t-tests.

RESULTS
Twenty-five patients with a total of 31 aneurysms were included. The aneurysm volume increased by a median (IQR) of 26 (9–39) mm3 after a mean follow-up period of 4 (range 0.4–10.9) years. The median wall shear stress decreased significantly after growth. Other hemodynamic parameters did not change significantly, although large individual changes with large variability were observed.

CONCLUSIONS
Hemodynamic characteristics change considerably after aneurysm growth. On average, wall shear stress values decrease after growth, but there is a large variability in hemodynamic changes between aneurysms.
Supraorbital and mini-pterional keyhole craniotomies for brain tumors: a clinical and anatomical comparison of indications and outcomes in 204 cases
Authors: Avery Michael B. , Mallari Regin Jay , Barkhoudarian Garni , Kelly Daniel F. 
Published: November 2021

OBJECTIVE
The authors’ objective was to compare the indications, outcomes, and anatomical limits of supraorbital (SO) and mini-pterional (MP) craniotomies in patients with intra- and extraaxial brain tumors, and to assess approach selection, utility of endoscopy, and surgical field overlap.

METHODS
A retrospective analysis was conducted of all brain tumor patients who underwent an SO or MP approach. The analyzed characteristics included pathology, endoscopy use, extent of resection, length of stay (LOS), and complications. On the basis of preoperative MRI data, tumor heatmaps were constructed to compare surgical access provided by both routes, including coronal projection heatmaps for parasellar tumors.

RESULTS
From 2007 to 2020, 158 patients underwent 173 (84.8%) SO craniotomies and 30 patients underwent 31 (15.2%) MP craniotomies; 71 (34.8%) procedures were reoperations. Of these 204 operations, 110 (63.6%) SO and 21 (67.7%) MP approaches were for extraaxial tumors (meningiomas in 65% and 76.2%, respectively). Gliomas and metastases together represented 84.1% and 70% of intraaxial tumors accessed with SO and MP approaches, respectively. Overall, 56.1% of tumors accessed with the SO approach and 41.9% of those accessed with the MP approach were in the parasellar region. Axial projection heatmaps showed that SO access extended along the entire ipsilateral and medial contralateral anterior cranial fossa, parasellar region, ipsilateral sylvian fissure, medial middle cranial fossa, and anterior midbrain, whereas MP access was limited to the ipsilateral middle cranial fossa, sylvian fissure, lateral parasellar region, and posterior aspect of anterior cranial fossa. Coronal projection heatmaps showed that parasellar access extended further superiorly with the SO approach compared with that of the MP approach. Endoscopy was utilized in 98 (56.6%) SO craniotomies and 7 (22.6%) MP craniotomies, with further tumor resection in 48 (49%) and 5 (71.4%) cases, respectively. Endoscope-assisted tumor removal was clustered in areas that were generally at farther distances from the craniotomy or in angled locations such as the cribriform plate region where microscopic visualization is limited. Gross-total or near-total resection was achieved in 120/173 (69%) SO approaches and 21/31 (68%) MP approaches. Major complications occurred in 11 (6.4%) SO approaches and 1 (3.2%) MP approach (p = 0.49). The median LOS decreased to 2 days in the last 2 years of the study.

CONCLUSIONS
This clinical experience suggests the SO and MP craniotomies are versatile, safe, and complementary approaches for tumors located in the anterior and middle cranial fossae and perisylvian and parasellar regions. The SO route, used in 85% of cases, achieved greater overall reach than the MP route. Both approaches may benefit from expanded visualization with endoscopy.
Influence of dexamethasone on visible 5-ALA fluorescence and quantitative protoporphyrin IX accumulation measured by fluorescence lifetime imaging in glioblastomas: is pretreatment obligatory before fluorescence-guided surgery?
Authors: Wadiura Lisa I. , Reichert David , Sperl Veronika , Lang Alexandra , Kiesel Barbara , Erkkilae Mikael , Wöhrer Adelheid , Furtner Julia , Roetzer Thomas , Leitgeb Rainer , Mischkulnig Mario , Widhalm Georg 
Published: November 2021

OBJECTIVE
Fluorescence-guided surgery using 5-aminolevulinic acid (5-ALA) is nowadays widely applied for improved resection of glioblastomas (GBMs). Initially, pretreatment with dexamethasone was considered to be essential for optimal fluorescence effect. However, recent studies reported comparably high rates of visible fluorescence in GBMs despite absence of dexamethasone pretreatment. Recently, the authors proposed fluorescence lifetime imaging (FLIM) for the quantitative analysis of 5-ALA–induced protoporphyrin IX (PpIX) accumulation. The aim of this study was thus to investigate the influence of dexamethasone on visible fluorescence and quantitative PpIX accumulation.

METHODS
The authors prospectively analyzed the presence of visible fluorescence during surgery in a cohort of patients with GBMs. In this study, patients received dexamethasone preoperatively only if clinically indicated. One representative tumor sample was collected from each GBM, and PpIX accumulation was analyzed ex vivo by FLIM. The visible fluorescence status and mean FLIM values were correlated with preoperative intake of dexamethasone.

RESULTS
In total, two subgroups with (n = 27) and without (n = 20) pretreatment with dexamethasone were analyzed. All patients showed visible fluorescence independent from preoperative dexamethasone intake. Furthermore, the authors did not find a statistically significant difference in the mean FLIM values between patients with and without dexamethasone pretreatment (p = 0.097).

CONCLUSIONS
In this first study to date, the authors found no significant influence of dexamethasone pretreatment on either visible 5-ALA fluorescence during GBM surgery or PpIX accumulation based on FLIM. According to these preliminary data, the authors recommend administering dexamethasone prior to fluorescence-guided surgery of GBMs only when clinically indicated.
Stereotactic radiosurgery for glioblastoma considering tumor genetic profiles: an international multicenter study
Authors: Bunevicius Adomas , Pikis Stylianos , Kondziolka Douglas , Patel Dev N. , Bernstein Kenneth , Sulman Erik P. , Lee Cheng-chia , Yang Huai-che , Delabar Violaine , Mathieu David , Cifarelli Christopher P. , Arsanious David E. , Dahshan Basem A. , Weir Joshua S. , Speckter Herwin , Mota Angel , Tripathi Manjul , Kumar Narendra , Warnick Ronald E. , Sheehan Jason P. 
Published: November 2021

OBJECTIVE
Molecular profiles, such as isocitrate dehydrogenase (IDH) mutation and O6-methylguanine-DNA methyltransferase (MGMT) methylation status, have important prognostic roles for glioblastoma patients. The authors studied the efficacy and safety of stereotactic radiosurgery (SRS) for glioblastoma patients with consideration of molecular tumor profiles.

METHODS
For this retrospective observational multiinstitutional study, the authors pooled consecutive patients who were treated using SRS for glioblastoma at eight institutions participating in the International Radiosurgery Research Foundation. They evaluated predictors of overall and progression-free survival with consideration of IDH mutation and MGMT methylation status.

RESULTS
Ninety-six patients (median age 56 years) underwent SRS (median dose 15 Gy and median treatment volume 5.53 cm3) at 147 tumor sites (range 1 to 7). The majority of patients underwent prior fractionated radiation therapy (92%) and temozolomide chemotherapy (98%). Most patients were treated at recurrence (85%), and boost SRS was used for 12% of patients. The majority of patients harbored IDH wild-type (82%) and MGMT-methylated (62%) tumors. Molecular data were unavailable for 33 patients. Median survival durations after SRS were similar between patients harboring IDH wild-type tumors and those with IDH mutant tumors (9.0 months vs 11 months, respectively), as well as between those with MGMT-methylated tumors and those with MGMT-unmethylated tumors (9.8 vs. 9.0 months, respectively). Prescription dose > 15 Gy (OR 0.367, 95% CI 0.190–0.709, p = 0.003) and treatment volume > 5 cm3 (OR 1.036, 95% CI 1.007–1.065, p = 0.014) predicted overall survival after controlling for age and IDH status. Treatment volume > 5 cm3 (OR 2.215, 95% CI 1.159–4.234, p = 0.02) and absence of gross-total resection (OR 0.403, 95% CI 0.208–0.781, p = 0.007) were associated with inferior local control of SRS-treated lesions in multivariate models. Nine patients experienced adverse radiation events after SRS, and 7 patients developed radiation necrosis at 59 to 395 days after SRS.

CONCLUSIONS
Post-SRS survival was similar as a function of IDH mutation and MGMT promoter methylation status, suggesting that molecular profiles of glioblastoma should be considered when selecting candidates for SRS. SRS prescription dose > 15 Gy and treatment volume ≤ 5 cm3 were associated with longer survival, independent of age and IDH status. Prior gross-total resection and smaller treatment volume were associated with superior local control.
Spinal anesthesia in contemporary and complex lumbar spine surgery: experience with 343 cases
Authors: Breton Jeffrey M. , Ludwig Calvin G. , Yang Michael J. , Nail T. Jayde , Riesenburger Ron I. , Liu Penny , Kryzanski James T 
Published: November 2021

OBJECTIVE
Spinal anesthesia (SA) is an alternative to general anesthesia (GA) for lumbar spine surgery, including complex instrumented fusion, although there are relatively few outcome data available. The authors discuss their experience using SA in a modern complex lumbar spine surgery practice to describe its utility and implementation.

METHODS
Data from patients receiving SA for lumbar spine surgery by one surgeon from March 2017 to December 2020 were collected via a retrospective chart review. Cases were divided into nonfusion and fusion procedure categories and analyzed for demographics and baseline medical status; pre-, intra-, and postoperative events; hospital course, including Acute Pain Service (APS) consults; and follow-up visit outcome data.

RESULTS
A total of 345 consecutive lumbar spine procedures were found, with 343 records complete for analysis, including 181 fusion and 162 nonfusion procedures and spinal levels from T11 through S1. The fusion group was significantly older (mean age 65.9 ± 12.4 vs 59.5 ± 15.4 years, p < 0.001) and had a significantly higher proportion of patients with American Society of Anesthesiologists (ASA) Physical Status Classification class III (p = 0.009) than the nonfusion group. There were no intraoperative conversions to GA, with infrequent need for a second dose of SA preoperatively (2.9%, 10/343) and rare preoperative conversion to GA (0.6%, 2/343) across fusion and nonfusion groups. Rates of complications during hospitalization were comparable to those seen in the literature. The APS was consulted for 2.9% (10/343) of procedures. An algorithm for the integration of SA into a lumbar spine surgery practice, from surgical and anesthetic perspectives, is also offered.

CONCLUSIONS
SA is a viable, safe, and effective option for lumbar spine surgery across a wide range of age and health statuses, particularly in older patients and those who want to avoid GA. The authors’ protocol, based in part on the largest set of data currently available describing complex instrumented fusion surgeries of the lumbar spine completed under SA, presents guidance and best practices to integrate SA into contemporary lumbar spine practices.
Combinación de Clozapina + Aripiprazol en esquizofrenia de inicio muy precoz resistente. A propósito de un caso
Authors: Osorio Ángela , Antúnez María B. , Hernando Segura R. , Gordo Seco R. 
Published: November 2021

La Esquizofrenia de Inicio Precoz es un cuadro infrecuente pero muy grave, que requiere de la instauración temprana de un tratamiento eficaz. La Clozapina es el estándar en el tratamiento de la psicosis refractaria y su eficacia en niños y en adolescentes es similar a la de los adultos, aunque esta población tiene más riesgo de sufrir efectos adversos potencialmente graves que comprometan su funcionamiento y calidad de vida. Una estrategia para sortear estos inconvenientes habitualmente utilizada en la práctica clínica, es la combinación de antipsicóticos que se sustenta en que al disminuir la dosis de los fármacos respecto a la monoterapia se disminuyen los efectos adversos que se producen a dosis más altas. Presentamos el caso de un paciente varón, de 13 años, diagnosticado de Esquizofrenia Paranoide de Inicio Muy Precoz, resistente a tratamiento, en el que se utilizó la combinación de Clozapina+Aripiprazol con buenos resultados a nivel de eficacia y tolerancia. El paciente presentaba, además, sintomatología obsesivo-compulsiva que se relacionó con la Clozapina, que remitió tras la adición al tratamiento de Aripiprazol.
URGENSI PEMBENTUKAN PERATURAN DAERAH DI ERA OTONOMI DAERAH
Authors: Lesmana Indra 
Published: November 2021

Pelaksanaan desentralisasi dalam negara kesatuan berarti memberikan hak untuk mengatur dan mengurus kepentingan dan aspirasi masyarakat setempat pembentukan daerah otonom dan penyerahan kewenangan secara hukum dari pemerintah pusat ke pemerintah daerah untuk mengatur, mengurus dan/atau bagian dari urusan pemerintahan tertentu. Untuk itu daerah otonom diberikan kewenangan untuk membentuk peraturan daerah. Penelitian ini merupakan penelitian hukum normatif yang membahas tentang urgensi pembentukan peraturan daerah pada era otonomi daerah ialah sebagai rule dari pelaksanaan otonomi daerah, utamanya menyangkut urusan-urusan pemerintahan sebagaimana dimaksud pada Undang-Undang Pemerintahan Daerah dan Peraturan Pemerintah Nomor 38 Tahun Tahun 2007 tentang Pembagian Urusan Pemerintahan antara Pemerintah, Pemerintahan daerah Provinsi, dan Pemerintahan Daerah Kabupaten/Kota. Serta konsep ideal peraturan daerah pada era otonomi daerah dikembalikan kepada asas formil dan materil pembentukan peraturan perundang-undangan sebagaimana termuat didalam Undang-Undang Nomor 12 Tahun 2011 tentang Pembentukan Peraturan Perundang-Undangan.
URGENCE FOR ESTABLISHING REGIONAL REGULATIONS IN THE ERA REGIONAL AUTONOMY
The implementation of decentralization in a unitary state means giving the right to regulate and manage the interests and aspirations of the local community, the formation of an autonomous region and the delegation of legal authority from the central government to the regional government to regulate, manage and/or part of certain government affairs. For this reason, autonomous regions are given the authority to form regional regulations. This research is a normative legal research that discusses the urgency of the formation of regional regulations in the era of regional autonomy, namely as a rule for the implementation of regional autonomy, especially regarding government affairs as referred to in the Regional Government Law and Government Regulation Number 38 of 2007 concerning Division of Affairs. Government between the Government, Provincial Government, and Regency/City Regional Government. And the ideal concept of regional regulations in the era of regional autonomy was returned to the formal and material principles of the formation of laws and regulations as contained in Law Number 12 of 2011 concerning the Establishment of Legislations.
KONSEP PERLINDUNGAN PACU JALUR KABUPATEN KUANTAN SINGINGI
Authors: Tiaraputri Adi , Diana Ledy 
Published: November 2021

Pacu jalur merupakan salah satu tradisi dari Kabupaten Kuantan Singingi Provinsi Riau. Pacu jalur juga termasuk dalam ruang lingkup kebudayaan. Untuk ada kelestarian kebudayaan tentunya harus ada perlindungan terhadap kebudyaan tersebut. Tulisan ini mengkali terkat konsep perlindungan yang dapat diberikan pada tradisi pacu jalur. Metode penelitian dalam tulisan ini melalui pendekatan yuridis normatif. Dalam tulisan ini mengkaji konsep perlindungan untuk pacu jalur dapat melalui perlindungan warisan budaya tak benda dan kekayaan intelektual komunal.
Pacu Jalur is one of the traditions of Kuantan Singingi Regency, Riau Province. Pacu jalur is also included in the scope of culture. For there to be preservation of culture, of course, there must be protection of that culture. This paper examines the concept of protection that can be given to the tradition of racing lanes. The research method in this paper is through a normative juridical approach. In this paper, we examine the concept of protection for the runway through the protection of intangible cultural heritage and communal intellectual property.
PEMERIKSAAN SAKSI DALAM PERKARA PIDANA BERDASARKAN IUS CONTITUM INDONESIA
Authors: Parlindungan S Toni 
Published: November 2021

Proses pemeriksaan saksi dimulai dari penyidikan sampai pada tingkat penuntutan di pengadilan. Di tingkat penyidikan maka terlebih dahulu saksi diperiksa oleh penyidik dengan memperhatikan perlindungan terhadap saksi yaitu tanpa ancaman atau tekanan.dari pihak manapun. Kemudian saksi dapat diperiksa di tempat kediaman saksi dan saksi diperiksa tanpa disumpah. Sedangkan pada tingkat penuntutan atau pesidangan maka terlebih dahulu saksi dipanggil untuk didengar keterangannya. Penelitian ini bertujuan untuk memenuhi kebutuhan terhadap objek penulisan atau suatu karya ilmiah guna mendapatkan data-data, pokok-pokok pikiran, serta pendapat lainnya dari pakar atau media apapun, yaitu terkait pemeriksaan saksi dalam perkara pidana berdasarkan ius contitum indonesia. Dalam penelitian ini penulis menggunakan metode penelitian hukum normative.

Abstract
The process of examining witnesses starts from the investigation to the level of prosecution in court. At the level of investigation, the investigator first examines witnesses by paying attention to the protection of witnesses, namely without threats or pressure from any party. Then the witness can be examined at the witness' residence and the witness can be examined without being sworn in. Meanwhile, at the level of prosecution or trial, witnesses are first called to be heard. This study aims to meet the need for the object of writing or a scientific work in order to obtain data, main ideas, and other opinions from experts or any media, which is related to the examination of witnesses in criminal cases based on ius contitum indonesia. This research the authors use normative legal research methods