bluuebunny/crossref_metadata_2025_split huggingface dataset:
CONTROLLED DRUG RELEASE OF GRAFTED PECTIN
Authors: Firyal Mohammed Ali , Hameed Muthanna Ahmed 
Published: November 2018

Modification of Pectin as natural polymer was accepted as new bio adhesive polymer, which was grafted with Maleic anhydride as vinylic monomore and insertion by using ceric ion it, was substituted with amino drugs produced amide polymer which do not lose their biological properties. This design carries controlled delivery which could release the entrapped drug over an extended period of time due to its slow digesting nature. The prepared adhesive drug polymer was characterized by FTIR, 1H-NMR spectroscopes, thermo gravimetric analysis TGA and DSC were careful. Physical properties of prepared polymer was quiet, Biological activity was studied for adhesive drug polymer, this new adhesive drug biological polymers were applied on different infected mice and wounds, It gave outstanding results and compliance mice infected with a full recovery by a short period of time. The prepared drug copolymer was analyzed in different pH values at 37 0C in vitro study and controlled drug release was messured through three days. The rate of hydrolysis in basic medium was found higher than acidic medium. It was concluded that modified drug release with extended drug action via slow release and in vivo performance was renowned to be talented.
Keywords: Pectin, controlled delivery, adhesive drug polymers, Graft Copolymer
TRADITIONAL USES, PHYTOCHEMISTRY AND PHARMACOLOGICAL ACTIVITIES OF PAPAVER SOMNIFERUM WITH SPECIAL REFERENCE OF UNANI MEDICINE AN UPDATED REVIEW
Authors: Masihuddin Masihuddin , Jafri MA , Siddiqui Aisha , Chaudhary Shahid 
Published: November 2018

Papaver somniferum commonly known as Khashkhash /Afyon, belongs to family Papaveraceae. It is one of those traditional plants, which have a long history of usage as medicine. The opium poppy (Papaver somniferum) produces some of the most widely used medicinal alkaloids like morphine, codeine, thebain and porphyroxine which are the most important component of this plant. Apart from these alkaloids, opium poppy produces approximately eighty alkaloids belonging to various tetrahydrobenzylisoquinolinederived classes. It has been known for over a century that morphinan alkaloids accumulate in the latex of opium poppy. According to Unani literature, it possesses most important theurapeutic values as modern literature and research studies also prove its therapeutical importance. It is used as analgesic, narcotic, sedative, stimulant as well as nutritive, etc. It is also useful in headache, cough, insomnia, cardiac asthma, and biliary colic. In this paper we have provide a review on habitate, pharmacological actions, phytochemical with special refrence to Unani Medicine. In this review, an attempt is made to explore the complete information of Papaver somniferum including its phytochemistry and pharmacology.
Key words: Khashkhash, Biliary colic, Alkaloid, phytochemistry.
Enhancing COMLEX-USA: Evidence-Based Redesign of the Osteopathic Medical Licensure Examination Program
Authors: Horber Dorothy T. , Gimpel John R. 
Published: November 2018

ABSTRACT
To ensure the Comprehensive Osteopathic Medical Licensing Examination of the United States of America (COMLEX-USA) remains relevant and current in meeting the needs of the state licensing boards and other constituents, the National Board of Osteopathic Medical Examiners (NBOME) has developed a new blueprint for an enhanced, competency-based examination program to be implemented with the COMLEX-USA Level 3 examination in late 2018. This article summarizes the evidence-based design processes on which the new blueprint is built, how it differs from the previous blueprint, and the evidence supporting its validity for the primary and intended purpose of COMLEX-USA — osteopathic physician licensure. It concludes with the changes being implemented by the NBOME to ensure COMLEX-USA remains current and meets the needs of its stakeholders, the state licensing boards.
Gamma Knife surgery in patients harboring orbital cavernous hemangiomas that were diagnosed on the basis of imaging findings
Authors: Liu Xiaomin , Xu Desheng , Zhang Yipei , Liu Dong , Song Guoxiang 
Published: November 2018

Object
This study was undertaken to evaluate clinical outcomes and tumor control in patients harboring orbital cavernous hemangiomas (OCHs) that had been diagnosed based on findings of imaging studies and treated by Gamma Knife surgery (GKS).

Methods
Between 1995 and 2008, 23 patients harboring OCHs that had been diagnosed on the basis of imaging findings were treated using GKS; complete follow-up data are available in all cases. The median treatment volume was 1.5 cm3 (range 0.15–10.10 cm3), the median tumor margin dose was 15 Gy (range 12–20 Gy), and the median follow-up period was 12 months (range 6–120 months).

Results
A decrease in tumor size was found in 20 patients, and no tumor progression was observed after GKS. Eleven of 14 patients whose visual function had been adversely affected prior to treatment had improved visual acuity at the last assessment. Side effects of the procedure included orbital pain in 3 patients and chemosis in 2 patients.

Conclusions
In this preliminary experience, GKS proved to be an effective treatment for OCHs diagnosed on the basis of imaging findings. Additional follow-up is necessary, and the long-term side effects of the procedure still need to be determined.
Gamma Knife surgery for trigeminal neuralgia: a review of 450 consecutive cases
Authors: Verheul Jeroen B. , Hanssens Patrick E. J. , Lie Suan Te , Leenstra Sieger , Piersma Hendrik , Beute Guus N. 
Published: November 2018

Object
The success rates and side effects of Gamma Knife surgery (GKS) in patients with trigeminal neuralgia (TN) are not fully clear. A comparison of data across previous reports is hampered by differences in treatment protocols, lengths of follow-up, and outcome criteria. The purpose of this paper is to contribute to knowledge of the efficacy of GKS in TN by reviewing data in a large group of patients with this disorder, who were treated with a uniform treatment protocol and evaluated using a well-established pain scale and Kaplan-Meier analysis.

Methods
The authors reviewed 450 treatments in 365 patents with medically refractory TN who were treated between June 2002 and October 2009 at the Gamma Knife Center Tilburg. In all patients 80 Gy was prescribed, with a single 4-mm isocenter located at the root entry zone (REZ). In 79 patients repeated GKS was performed using a uniform dose of 80 Gy, which was delivered, in a highly standardized manner, to a spot anterior to the position of the first treatment. Follow-up was obtained by reviewing the patients' medical records and conducting telephone interviews. Outcome was assessed using the Barrow Neurological Institute (BNI) pain scale and the BNI facial numbness scale.

Results
The median follow-up period was 28 months. In the idiopathic TN group, rates of adequate pain relief, defined as BNI Pain Scores I–IIIB, were 75%, 60%, and 58% at 1, 3, and 5 years, respectively. In the multiple sclerosis (MS)–related TN group the rates of adequate pain relief were 56%, 30%, and 20% at 1, 3, and 5 years, respectively. Repeated GKS was as successful as the first. An analysis of our treatment strategy of repeated GKS showed rates of adequate pain relief of 75% at 5 years in the idiopathic TN and 46% in the MS-related TN group. Somewhat bothersome numbness was reported by 6% of patients after the first treatment and by 24% after repeated GKS. Very bothersome numbness was reported in 0.5% after the first GKS and in 2% after the second treatment.

Conclusions
In this study the authors analyzed outcomes of GKS in a large cohort of patients with TN; uniform treatment consisted of 80 Gy delivered to the REZ. The initial and long-term outcomes of pain relief and sensory dysfunction are comparable to recently published results at other institutions, where similar outcome criteria were used. These data should prove helpful to assist patients and clinicians in their TN management decisions.
Repeat Gamma Knife surgery for trigeminal neuralgia: long-term results
Authors: Kimball Brent Y. , Sorenson Jeffrey M. , Cunningham David 
Published: November 2018

Object
The purpose of this study was to assess the long-term outcome achieved after repeat Gamma Knife surgery (GKS) for trigeminal neuralgia (TN) using a uniform treatment plan.

Methods
Between 1985 and 2010, 53 patients underwent repeat GKS for refractory TN. In the initial GKS, which involved targeting the root entry zone of the trigeminal nerve, a maximal dose of 80 Gy was used with a 4-mm collimator so that the 50% isodose line abutted the pons. In the second GKS, the treatment plan consisted of a 70-Gy dose directed at a target 4–5 mm distal to the first target on the trigeminal nerve. The mean follow-up duration in these patients was 42 months. Outcomes were defined using the Marseille scale: excellent (Class I or II, no pain with or without medications), good (Class III or IV, ≥ 50% relief), and poor (Class V, < 50% relief).

Results
Trigeminal neuralgia pain was controlled (≥ 50% improvement with or without medications) after repeat GKS in 70% of patients at 1 year, 50% at 3 years, 50% at 5 years, and 50% at 10 years, as defined by a Kaplan-Meier analysis. A correlation was found between facial numbness and pain relief (p = 0.047). No difference was found between patients with Type 1 TN and those with Type 2 TN, and there was no correlation between the best relief obtained and long-term durability of relief from pain. Twenty-two patients (47.8%) described their trigeminal dysfunction in the following manner: numbness (45.6%), dry eye (10.9%), taste change (8.7%), or jaw weakness (2.2%). In only 8.7% of cases did the patient experience facial numbness that was regarded as bothersome.

Conclusions
Repeat GKS for TN at the doses used provides substantial long-term relief. Treatment failure occurred up to 28 months after the second GKS. Facial numbness correlated with more durable pain relief after repeat GKS in this series.
Pituitary insufficiency as a side effect after radiosurgery for pituitary adenomas: the role of the hypothalamus
Authors: Feigl Guenther Christian , Pistracher Karin , Berghold Andrea , Mokry Michael 
Published: November 2018

Object
Causes of pituitary insufficiencies as a side effect of Gamma Knife surgery (GKS) following irradiation of the hypothalamopituitary axis are still under debate. In an investigation of pituitary insufficiencies after GKS, the authors' main focus is on what role can be attributed to the hypothalamus with regard to endocrinological changes in hypothalamopituitary function following GKS.

Methods
A total of 108 patients consecutively treated between April 1992 and July 2003 were included in this retrospective study. All patients had undergone either transsphenoidal or transcranial surgery prior to GKS. The spot dosimetry method was used to determine doses delivered to structures of the hypothalamopituitary axis. For statistical analyses, endocrine insufficiency and deterioration in pituitary function were defined as a decrease in hormonal blood levels below the normal range for 1 or more anterior pituitary lobe hormones. Additionally, an analysis of the rate of patients requiring hormone replacement therapy after GKS due to new endocrinopathies was performed.

Results
Complete patient records of 61 male and 47 female patients with a mean age of 51.9 years (range 9.1–81.2 years) were available for our investigation. The overall tumor control rate was 97% and the endocrinological cure rate was 61.2%. Mean treatment doses in patients with and without new endocrine insufficiencies (shown as with/without insufficiencies and followed by probability values) were as follows: 1.3/0.8 Gy to the hypothalamus (p = 0.2); 2.2/1.6 Gy to the median eminence (p = 0.1); 6.5/4.1 Gy to the pituitary stalk (p = 0.004); and 12.4/9.5 Gy to the pituitary gland (p = 0.05). The median overall duration of follow-up after GKS was 6.7 years, with 84 patients (77.7%) whose follow-up was longer than 12 months. The median follow-up time after GKS in patients who developed a new pituitary dysfunction was 79.5 months (6.6 years, SD 3.8 years), and the median follow-up time in patients with no new insufficiencies was 78.4 months (6.5 years, SD 4 years).

Conclusions
Gamma Knife surgery is a safe and effective treatment for patients with residual and recurrent pituitary adenomas. The rate of pituitary insufficiencies after GKS is still lower than that after conventional radiotherapy. Very low radiation doses are directed to the hypothalamus, and thus this structure does not play a major role in the development of pituitary insufficiencies after GKS. The results of this study show that patients in whom the pituitary stalk and pituitary gland receive a high mean point dose are more likely to develop pituitary insufficiencies after GKS than those who receive a lower dose.
Gamma Knife surgery for central neurocytomas
Authors: Karlsson Bengt , Guo Wan-Yuo , Kejia Teo , Dinesh Nivedh , Pan David Hung-Chi , Jokura Hidefumi , Kawagishi Jun , van Eck Albertus T. C. J. , Horstmann Gerhard A. , Yeo Tseng Tsai , Yamamoto Masaaki 
Published: November 2018

Object
The optimal management of central neurocytoma (CN) remnants and recurrences is still not clear. To date no large series of patients treated with Gamma Knife surgery (GKS) for CNs has been published. For that reason the authors decided to combine data from 5 different centers so that they could analyze the largest population of patients treated with GKS for CN currently available.

Methods
Data obtained in 42 patients who were treated for CN with GKS before July 1, 2010, were retrospectively collected and analyzed. The median prescribed dose was 13 Gy (range 11–25 Gy). The follow-up time in these patients ranged from 0.5 to 14.7 years (mean 6.1 years, median 4.9 years). Eleven patients were followed up for 5–10 years and 9 patients for more than 10 years. All patients were alive and well at the closing of the study except 1 patient, who died of injuries sustained in a traffic accident.

Results
Two cases of local tumor progression and 2 cases of distant tumor recurrence occurred among the patient population, yielding 5- and 10-year tumor control rates of 91% and 81%, respectively. No permanent complications occurred. The findings were in line with results reported in earlier publications. Despite the high tumor control rate, enlargement of part of or the whole ventricular system was seen in 45% of patients.

Conclusions
The high tumor control rate and the low complication rate following GKS indicate that GKS is the preferred treatment for CN tumor remnants or recurrences following microsurgery. However, data from longer follow-up times in more patients are needed before this conclusion can be validated. The patients need to be closely monitored and potential hydrocephalus managed despite tumor control.
Proposed mechanism for cyst formation and enlargement following Gamma Knife Surgery for arteriovenous malformations
Authors: Shuto Takashi , Ohtake Makoto , Matsunaga Shigeo 
Published: November 2018

Object
The authors retrospectively studied the mechanism of cyst formation and enlargement after Gamma Knife surgery (GKS) for arteriovenous malformations (AVMs).

Methods
Eighteen patients in whom cyst formation developed following GKS for AVM were retrospectively identified among 775 patients who underwent GKS for AVM at Yokohama Rosai Hospital. The study group was composed of 12 male and 6 female patients ranging in age from 17 to 47 years.

Results
Chronic encapsulated expanding hematoma was associated with the cyst in 5 patients. The AVM nidus volume at the time of GKS ranged from 1.9 to 36 cm3, and the prescription radiation dose was 18–25 Gy. Complete obliteration of the AVM nidus was obtained in 13 patients and partial obliteration in 5 patients. Cyst formation was detected between 2.6 and 15 years after GKS. Craniotomy was performed in 10 patients, including 2 patients in whom the incompletely obliterated nidus was removed at the same time, and an Ommaya reservoir was placed in 2 patients. Spontaneous regression of the cyst was observed in 1 patient. Serial MR imaging was performed in the other patients because the size of the cyst was stable or the lesion was asymptomatic. Histological examination of the cyst wall revealed linear hemosiderin deposits with gliosis. The nodular lesion, which was enhanced on MR images, contained granulation tissue with chronic hemorrhage from newly developed capillary vessels.

Conclusions
Cysts developing after GKS for AVM enlarge mainly due to repeated minor hemorrhages from a reddish nodular angiomatous lesion that develops within an adjacent brain area. Thus, the optimal treatment is wide opening of the cyst with removal of the associated angiomatous lesion by craniotomy.
Comparative study of Gamma Knife surgery and percutaneous retrogasserian glycerol rhizotomy for trigeminal neuralgia in patients with multiple sclerosis
Authors: Mathieu David , Effendi Khaled , Blanchard Jocelyn , Séguin Mario 
Published: November 2018

Object
Among patients with multiple sclerosis (MS) there is a high incidence of trigeminal neuralgia (TN), and outcomes after treatment seem inferior to those in patients suffering from idiopathic TN. The goal of this study was to evaluate clinical outcomes in patients with MS-related TN after Gamma Knife surgery (GKS) and compare them with those obtained using percutaneous retrogasserian glycerol rhizotomy (PRGR).

Methods
The authors retrospectively reviewed the charts of 45 patients with MS-related TN. The first procedure undertaken was GKS in 27 patients and PRGR in 18 patients. Pain had been present for a median of 60 months (range 12–276 months) in patients who underwent GKS and 48 months (range 12–240 months) in patients who underwent PRGR. The following outcome measures were assessed in both groups of patients: pain relief (using the Barrow Neurological Institute [BNI] Pain Scale), procedure-related morbidity, time to pain relief and recurrence, and subsequent procedures that were performed.

Results
The median duration of follow-up was 39 months (range 13–69 months) in the GKS group and 38 months (range 2–75 months) in the PRGR group. Reasonable pain control (BNI Pain Scale Scores I–IIIb) was noted in 22 patients (81.5%) who underwent GKS and in 18 patients (100%) who underwent PRGR. For patients who underwent GKS, the median time to pain relief was 6 months; for those who underwent PRGR, pain relief was immediate. In the GKS group12 patients required subsequent procedures (3 patients for absence of response and 9 patients for pain recurrence), whereas in the PRGR group 6 patients required subsequent procedures (all for pain recurrence). As of the last follow-up, complete or reasonable pain control was finally achieved in 23 patients (85.2%) in the GKS group and in 16 patients (88.9%) in the PRGR group. The morbidity rate was 22.2% in the GKS group (all due to sensory loss and paresthesia) and 66.7% in the PRGR group (mostly hypalgesia, with 2 patients having corneal reflex loss and 1 patient suffering from meningitis).

Conclusions
Both GKS and PRGR are satisfactory strategies for treating MS-related TN. Gamma Knife surgery has a lower rate of sensory and overall morbidity than PRGR, but requires a delay before pain relief occurs. The authors propose that patients with extreme pain in need of fast relief should undergo PRGR. For other patients, both management strategies can lead to satisfactory pain relief, and the choice should be made based on patient preference and expectations.
Interfraction and intrafraction performance of the Gamma Knife Extend system for patient positioning and immobilization
Authors: Schlesinger David , Xu Zhiyuan , Taylor Frances , Yen Chun-Po , Sheehan Jason 
Published: November 2018

Object
The Extend system for the Gamma Knife Perfexion makes possible multifractional Gamma Knife treatments. The Extend system consists of a vacuum-monitored immobilization frame and a positioning measurement system used to determine the location of the patient's head within the frame at the time of simulation imaging and before each treatment fraction. The measurement system consists of a repositioning check tool (RCT), which attaches to the Extend frame, and associated digital measuring gauges. The purpose of this study is to evaluate the performance of the Extend system for patient repositioning before each treatment session (fraction) and patient immobilization between (interfraction) and during (intrafraction) each session in the first 10 patients (36 fractional treatments) treated at the University of Virginia.

Methods
The RCT was used to acquire a set of reference measurements for each patient position at the time of CT simulation. Repositioning measurements were acquired before each fraction, and the patient position was adjusted until the residual radial difference from the reference position measurements was less than 1 mm. After treatment, patient position measurements were acquired, and the difference between those measurements and the ones obtained for patient position before the fraction was calculated as a measure of immobilization capability.
Analysis of patient setup and immobilization performance included calculation of the group mean, standard deviation (SD), and distribution of systematic (components affecting all fractions) and random (per fraction) uncertainty components.

Results
Across all patients and fractions, the mean radial setup difference from the reference measurements was 0.64 mm, with an SD of 0.24 mm. The distribution of systematic uncertainty (Σ) was 0.17 mm, and the distribution of random uncertainty (σ) was 0.16 mm. The root mean square (RMS) differences for each plate of the RCT were as follows: right = 0.35 mm; left = 0.41 mm; superior = 0.28 mm; and anterior = 0.20 mm.
The mean intrafractional positional difference across all treatments was 0.47 mm, with an SD of 0.30 mm. The distribution of systematic uncertainty was 0.18 mm, and the distribution of random uncertainty was 0.22 mm. The RMS differences for each plate of the RCT were 0.24 mm for the right plate, 0.22 mm for the left plate, 0.24 mm for the superior plate, and 0.34 mm for the anterior plate. Data from 1 fraction were excluded from the analysis because the vacuum-monitoring interlock detected patient motion, which in turn required repositioning in the middle of the fraction.

Conclusions
The Extend system can be used to reposition and immobilize patients in a radiosurgical setting. However, care should be taken to acquire measurements that can implicitly account for rotations of the patient's head. Further work is required to determine the sensitivity of the vacuum interlock to detect patient motion.