bluuebunny/crossref_metadata_2025_split huggingface dataset:
Results of a prospective multicenter controlled study comparing surgical outcomes of microscopic versus fully endoscopic transsphenoidal surgery for nonfunctioning pituitary adenomas: the Transsphenoidal Extent of Resection (TRANSSPHER) Study
Authors: Little Andrew S. , Kelly Daniel F. , White William L. , Gardner Paul A. , Fernandez-Miranda Juan C. , Chicoine Michael R. , Barkhoudarian Garni , Chandler James P. , Prevedello Daniel M. , Liebelt Brandon D. , Sfondouris John , Mayberg Marc R. , _ _ 
Published: April 2019

OBJECTIVEMany surgeons have adopted fully endoscopic over microscopic transsphenoidal surgery for nonfunctioning pituitary tumors, although no high-quality evidence demonstrates superior patient outcomes with endoscopic surgery. The goal of this analysis was to compare these techniques in a prospective multicenter controlled study.METHODSExtent of tumor resection was compared after endoscopic or microscopic transsphenoidal surgery in adults with nonfunctioning adenomas. The primary end point was gross-total tumor resection determined by postoperative MRI. Secondary end points included volumetric extent of tumor resection, pituitary hormone outcomes, and standard quality measures.RESULTSSeven pituitary centers and 15 surgeons participated in the study. Of the 530 patients screened, 260 were enrolled (82 who underwent microscopic procedures, 177 who underwent endoscopic procedures, and 1 who cancelled surgery) between February 2015 and June 2017. Surgeons who used the microscopic technique were more experienced than the surgeons who used the endoscopic technique in terms of years in practice and number of transsphenoidal surgeries performed (p < 0.001). Gross-total resection was achieved in 80.0% (60/75) of microscopic surgery patients and 83.7% (139/166) of endoscopic surgery patients (p = 0.47, OR 0.8, 95% CI 0.4–1.6). Volumetric extent of resection, length of stay, surgery-related deaths, and unplanned readmission rates were similar between groups (p > 0.2). New hormone deficiency was present at 6 months in 28.4% (19/67) of the microscopic surgery patients and 9.7% (14/145) of the endoscopic surgery patients (p < 0.001, OR 3.7, 95% CI 1.7–7.7). Microscopic surgery cases were significantly shorter in duration than endoscopic surgery cases (p < 0.001).CONCLUSIONSExperienced surgeons who performed microscopic surgery and less experienced surgeons who performed endoscopic surgery achieved similar extents of tumor resection and quality outcomes in patients with nonfunctioning pituitary adenomas. The endoscopic technique may be associated with lower rates of postoperative pituitary gland dysfunction. This study generally supports the transition to endoscopic pituitary surgery when the procedure is performed by proficient surgeons, although both techniques yield overall acceptable surgical outcomes.■ CLASSIFICATION OF EVIDENCE Type of question: therapeutic; study design: prospective cohort trial; evidence: class III.Clinical trial registration no.: NCT02357498 (clinicaltrials.gov)
Revascularization and functional outcomes after mechanical thrombectomy for acute ischemic stroke in elderly patients
Authors: Andrews Carrie E. , Mouchtouris Nikolaos , Fitchett Evan M. , Al Saiegh Fadi , Lang Michael J. , Romo Victor M. , Herial Nabeel , Jabbour Pascal , Tjoumakaris Stavropoula I. , Rosenwasser Robert H. , Gooch M. Reid 
Published: April 2019

OBJECTIVEMechanical thrombectomy (MT) is now the standard of care for acute ischemic stroke (AIS) secondary to large-vessel occlusion, but there remains a question of whether elderly patients benefit from this procedure to the same degree as the younger populations enrolled in the seminal trials on MT. The authors compared outcomes after MT of patients 80–89 and ≥ 90 years old with AIS to those of younger patients.METHODSThe authors retrospectively analyzed records of patients undergoing MT at their institution to examine stroke severity, comorbid conditions, medical management, recanalization results, and clinical outcomes. Univariate and multivariate logistic regression analysis were used to compare patients < 80 years, 80–89 years, and ≥ 90 years old.RESULTSAll groups had similar rates of comorbid disease and tissue plasminogen activator (tPA) administration, and stroke severity did not differ significantly between groups. Elderly patients had equivalent recanalization outcomes, with similar rates of readmission, 30-day mortality, and hospital-associated complications. These patients were more likely to have poor clinical outcome on discharge, as defined by a modified Rankin Scale (mRS) score of 3–6, but this difference was not significant when controlled for stroke severity, tPA administration, and recanalization results.CONCLUSIONSOctogenarians, nonagenarians, and centenarians with AIS have similar rates of mortality, hospital readmission, and hospital-associated complications as younger patients after MT. Elderly patients also have the capacity to achieve good functional outcome after MT, but this potential is moderated by stroke severity and success of treatment.
Preoperative laboratory testing before pediatric neurosurgery: an NSQIP-Pediatrics analysis
Authors: Dasenbrock Hormuzdiyar H. , Smith Timothy R. , Robinson Shenandoah 
Published: April 2019

OBJECTIVESThe goal of this study was to evaluate clinical predictors of abnormal preoperative laboratory values in pediatric neurosurgical patients.METHODSData obtained in children who underwent a neurosurgical operation were extracted from the prospective National Surgical Quality Improvement Program–Pediatrics (NSQIP-P, 2012–2013) registry. Multivariable logistic regression evaluated predictors of preoperative laboratory values that might require further evaluation (white blood cell count < 2000/μl, hematocrit < 24%, platelet count < 100,000/μl, international normalized ratio > 1.4, or partial thromboplastin time > 45 seconds) or a preoperative transfusion (within 48 hours prior to surgery). Variables screened included patient demographics; American Society of Anesthesiologists (ASA) physical designation classification; comorbidities; recent steroid use, chemotherapy, or radiation therapy; and admission type. Predictive score validation was performed using the NSQIP-P 2014 data.RESULTSOf the 6556 patients aged greater than 2 years, 68.9% (n = 5089) underwent laboratory testing, but only 1.9% (n = 125) had a critical laboratory value. Predictors of a laboratory abnormality were ASA class III–V; diabetes mellitus; hematological, hypothrombotic, or oncological comorbidities; nutritional support; recent chemotherapy; systemic inflammatory response syndrome; and a nonelective hospital admission. These 9 variables were used to create a predictive score, with a single point assigned for each predictor. The prevalence of critical values in the validation population (NSQIP-P 2014) of patients greater than 2 years of age was 0.3% with a score of 0, 1.0% in those with a score of 1, 1.6% in those with a score of 2, and 6.2% in those with a score ≥ 3. Higher score was predictive of a critical value (OR 2.33, 95% CI 1.91–2.83, p < 0.001, C-statistic 0.76) and with the requirement of a perioperative transfusion (intraoperatively or within 72 hours postoperatively; OR 1.42, 95% CI 1.22–1.67, p < 0.001) in the validation population. Moreover, when the same score was applied to children aged 2 years or younger, a greater score was predictive of a critical value (OR 2.47, 95% CI 2.15–2.84, p < 0.001, C-statistic 0.76).CONCLUSIONSCritical laboratory values in pediatric neurosurgical patients are largely predicted by clinical characteristics, and abnormal preoperative laboratory results are rare in patients older than 2 years of age without comorbidities who are undergoing elective surgery. The NSQIP-P critical preoperative laboratory value scale is proposed to indicate patients with the highest odds of an abnormal value. The scale can assist with triaging preoperative testing based on the surgical risk, as determined by the treating surgeon and anesthesiologist.
Clinical outcomes of normal pressure hydrocephalus in 116 patients: objective versus subjective assessment
Authors: Wu Eva M. , El Ahmadieh Tarek Y. , Kafka Benjamin , Caruso James P. , Neeley Om J. , Plitt Aaron R. , Aoun Salah G. , Olson Daiwai , Ruchinskas Robert A. , Cullum C. Munro , Welch Babu G. , Batjer H. Hunt , White Jonathan A. 
Published: April 2019

OBJECTIVEObjective assessment tests are commonly used to predict the response to ventriculoperitoneal (VP) shunting in patients with normal pressure hydrocephalus (NPH). Whether subjective reports of improvement after a lumbar drain (LD) trial can predict response to VP shunting remains controversial. The goal in this study was to compare clinical characteristics, complication rates, and shunt outcomes of objective and subjective LD responders who underwent VP shunt placement.METHODSThis was a retrospective review of patients with NPH who underwent VP shunt placement after clinical improvement with the LD trial. Patients who responded after the LD trial were subclassified into objective LD responders and subjective LD responders. Clinical characteristics, complication rates, and shunt outcomes between the 2 groups were compared with chi-square test of independence and t-test.RESULTSA total of 116 patients received a VP shunt; 75 were objective LD responders and 41 were subjective LD responders. There was no statistically significant difference in patient characteristics between the 2 groups, except for a shorter length of stay after LD trial seen with subjective responders. The complication rates after LD trial and VP shunting were not significantly different between the 2 groups. Similarly, there was no significant difference in shunt response between objective and subjective LD responders. The mean duration of follow-up was 1.73 years.CONCLUSIONSReports of subjective improvement after LD trial in patients with NPH can be a reliable predictor of shunt response. The currently used objective assessment scales may not be sensitive enough to detect subtle changes in symptomatology after LD trial.
Surgical approaches for the lateral mesencephalic sulcus
Authors: Cavalcanti Daniel Dutra , Morais Bárbara Albuquerque , Figueiredo Eberval Gadelha , Spetzler Robert F. , Preul Mark C. 
Published: April 2019

OBJECTIVEThe brainstem is a compact, delicate structure. The surgeon must have good anatomical knowledge of the safe entry points to safely resect intrinsic lesions. Lesions located at the lateral midbrain surface are better approached through the lateral mesencephalic sulcus (LMS). The goal of this study was to compare the surgical exposure to the LMS provided by the subtemporal (ST) approach and the paramedian and extreme-lateral variants of the supracerebellar infratentorial (SCIT) approach.METHODSThese 3 approaches were used in 10 cadaveric heads. The authors performed measurements of predetermined points by using a neuronavigation system. Areas of microsurgical exposure and angles of the approaches were determined. Statistical analysis was performed to identify significant differences in the respective exposures.RESULTSThe surgical exposure was similar for the different approaches—369.8 ± 70.1 mm2 for the ST; 341.2 ± 71.2 mm2 for the SCIT paramedian variant; and 312.0 ± 79.3 mm2 for the SCIT extreme-lateral variant (p = 0.13). However, the vertical angular exposure was 16.3° ± 3.6° for the ST, 19.4° ± 3.4° for the SCIT paramedian variant, and 25.1° ± 3.3° for the SCIT extreme-lateral variant craniotomy (p < 0.001). The horizontal angular exposure was 45.2° ± 6.3° for the ST, 35.6° ± 2.9° for the SCIT paramedian variant, and 45.5° ± 6.6° for the SCIT extreme-lateral variant opening, presenting no difference between the ST and extreme-lateral variant (p = 0.92), but both were superior to the paramedian variant (p < 0.001). Data are expressed as the mean ± SD.CONCLUSIONSThe extreme-lateral SCIT approach had the smaller area of surgical exposure; however, these differences were not statistically significant. The extreme-lateral SCIT approach presented a wider vertical and horizontal angle to the LMS compared to the other craniotomies. Also, it provides a 90° trajectory to the sulcus that facilitates the intraoperative microsurgical technique.
Cerebral blood flow augmentation using a cardiac-gated intracranial pulsating balloon pump in a swine model of elevated ICP
Authors: Doron Omer , Or Tal , Battino Limor , Rosenthal Guy , Barnea Ofer 
Published: April 2019

OBJECTIVEAugmenting brain perfusion or reducing intracranial pressure (ICP) dose is the end target of many therapies in the neuro-critical care unit. Many present therapies rely on aggressive systemic interventions that may lead to untoward effects. Previous studies have used a cardiac-gated intracranial balloon pump (ICBP) to model hydrocephalus or to flatten the ICP waveform. The authors sought to sought to optimize ICBP activation parameters to improve cerebral physiological parameters in a swine model of raised ICP.METHODSThe authors developed a cardiac-gated ICBP in which the volume, timing, and duty cycle (time relative to a single cardiac cycle) of balloon inflation could be altered. They studied the ICBP in a swine model of elevated ICP attained by continuous intracranial fluid infusion with continuous monitoring of systemic and cerebral physiological parameters, and defined two specific protocols of ICBP activation.RESULTSEleven swine were studied, 3 of which were studied to define the optimal timing, volume, and duty cycle of balloon inflation. Eight swine were studied with two defined protocols at baseline and with ICP gradually raised to a mean of 30.5 mm Hg. ICBP activation caused a consistent modification of the ICP waveform. Two ICBP activation protocols were used. Balloon activation protocol A led to a consistent elevation in cerebral blood flow (8%–25% above baseline, p < 0.00001). Protocol B resulted in a modest reduction of ICP over time (8%–11%, p < 0.0001) at all ICP levels. Neither protocol significantly affected systemic physiological parameters.CONCLUSIONSThe preliminary results indicate that optimized protocols of ICBP activation may have beneficial effects on cerebral physiological parameters, with minimal effect on systemic parameters. Further studies are warranted to explore whether ICBP protocols may be of clinical benefit in patients with brain injuries with increased ICP.
A CASE ON EMPLOYABILITY AND WORK LIFE BALANCE ISSUES OF WORKING WOMEN IN INDONESIA
Authors: SEMWAL PANKKHURRI 
Published: April 2019

Indonesia - a diverse nation of more than 300 ethnic groups. The largest economy in Southeast Asia. At present, Indonesia is the world’s fourth most populous nation, the world’s 10th largest economy in terms of purchasing power parity. Out of a total population of 252 million, more than 28 million people in Indonesia are still living below the poverty line. Approximately 40% of the total population of the country remains vulnerable of falling into poverty, as their income hover marginally above the national poverty line.
Which can be largely be because of the slower pace of job creation as another challenge to efforts at reducing poverty, largely affecting the 1.7 million youth who enter the workforce each year.
While there have been greater efforts at improving basic public services, the quality of health clinics and schools is uneven by middle income standards, contributing to alarming indicators, particularly in health.
THE DEVELOPMENT AND APPLICATION OF TONGUE DIAGNOSIS CABIN
Authors: Ma Yu- Hui , Li Lin- Feng , Zhang Yu- Xuan , Zhang Yu , Wang Yu- Ting , Han Si- Yuan , Liang Yu- Rong 
Published: April 2019

On the basis of a large number of previous studies, we develop the TCM Tongue diagnosis mobile phone software based on artificial intelligence technology which is named Tongue Diagnosis Cabin. The software utilizes and improves the digital objectification technology of modern tongue image to overcome the influence of the pixel limitation of the mobile phone, the complex shooting environment, the unstable light source and other conditions on the color and definition of the original tongue image, and reduces the total difference between the remote tongue image and the original tongue image color, so as to achieve clinical visual equivalence. The software is based on the mobile phone, which is easy to operate with intelligently guidance and superior performance, and can promote the development of digitalization and telemedicine of tongue diagnosis.
Keywords: tongue diagnosis cabin; tongue diagnosis; intelligence; mobile; telemedicine
Maldonado: tierra de encanto, paraíso de las orquídeas
Authors: Chiriboga Chamorro Gerardo Jovani , Mafla Jaramillo Trajano Miguel 
Published: April 2019

La familia Orchidaceae es una de las más grandes y diversas del planeta, se estima entre 25 000 y 30 000 especies. El Ecuador es el país con mayor variedad de orquídeas, en el planeta existen 4 125 especies que representan el 25% de la flora nativa. El cantón Tulcán abarca una supeificie de 1 818 Km2; constituyendo la parroquia de Maldonado el 1O,13 % de la misma, con una supeificie de 170 Km2. Presenta una orografía muy irregular, lo que ha generado una gran variedad de climas y tipos de vegetación. Altitudinalmente, la parroquia presenta un marcado declive como los puntos más altos: el volcán Chiles a 4 723 msnm y el otro extremo el río Cumbe que está a 1 238 msnm y el río San Juan a 1 472 msnm, siendo así una de las parroquias más biodiversas del cantón, la provincia y el país. En este contexto, la parroquia de Maldonado es la que mayor diversidad de orquídeas presenta; se han registrado 70 especies. Esta gran diversidad convierte a la parroquia como la más rica en este grupo de plantas y por eso no es dificil encontrarlas desde los fríos páramos, hasta las zonas más bajas; muchas de ellas son muy diminutas, como el tamaño de un alfiler. Esta investigación es una invitación a descubrir todo este fascinante mundo de diversas joyas, las cuales pueden ser encontradas a lo largo de todo el territorio de la parroquia de Maldonado.
Estudio de la problemática socio-económica del sector artesanal en el Carchi
Authors: Montenegro Obando Blanca Liliana , Realpe Cabrera Iván Alirio , Carvajal Pérez Luis Alfredo 
Published: April 2019

El presente documento ha sido desarrollado en el marco de los proyectos de investigación establecidos en la Universidad Politécnica Estatal del Carchi [UPEC], considerando que la Constitución del Ecuador (2008) incluye como una de las finalidades del Sistema de Educación Superior a la investigación científica y tecnológica (Art. 350), además, en el marco del Plan Nacional para el Buen Vivir (2009-2013) existe una concepción ampliada de la economía rural, incorporando a la artesanía como una potencialidad por desarrollar en nuestro país. (p.128). El objetivo del proyecto es promover una visión valorada y compartida del sector artesanal en el Carchi y su perspectiva de mercado internacional. La investigación se centra en la artesanía patrimonial (indígena, tradicional o popular y contemporánea) definida como “aquello que una sociedad considera propio, aquello de que se apropia; y, dentro de ello, lo que considera relevante, digno de conservarse y trans- mitirse” (Sandoval, et al., 2011, p. 9), y es analizada bajo el modelo de caracterización del sector artesanal propuesto por la Red Iberoamericana de Innovación y Transferencia de Tecnología para el Fortalecimiento Artesanal (RITFA), considerando factores intraorgani- zacionales y extra organizacionales. Para abarcar el problema se analizó información de estudios realizados a nivel general del entorno socioeconómico de las unidades de estudio y sus familias en Latinoamérica, Ecua- dor y el Carchi; además, se estableció la fundamentación metodológica, teórica, el marco legal ecuatoriano que rige al sector y su perspectiva de mercado internacional.
Papsmear Examination for Diagnosing PreCancer Lesion in Invisible SquamoColumnar Junction
Authors: Nuranna Laila , Daud Sulaeman , Purwoto Gatot , Winarto Hariyono , Nuryanto Kartiwa H 
Published: April 2019

Objective: To know the concealed pre-cancer lesion in women with
invisible squamo-columnar junction (SCJ) by Papsmear examination.

Method: This study was a descriptive cross-sectional design starting
from August 2014 to March 2015 at several Public Health Cares in
Jakarta. A total of 1,682 subjects were screened by Acetoacetate
Visual Inspection (AVI) examination. After the data was collected,
the process was continued by verification, editing, and coding. The
descriptive analysis showed the percentage of SCJ in age distribution,
the percentage of AVI examination based on SCJ, and the percentage
of Papsmear examination in invisible SCJ according to negative
AVI result.

Result: There were 1,484 (88.2%) women with the visible SCJ and
198 (11.8%) women with invisible SCJ. The percentage of invisible
SCJ in the menopausal women group was 122 (61,6%); meanwhile,
in the non-menopausal women group, it was 76 (38.4%). Almost
half of the percentage from visible SCJ was found in menopausal
women group 45.8% (103/225 women). The positive AVI result
was 4 (7.1%) in the menopausal women group and 52 (92.9%) in
non-menopausal women group. The result of Papsmear examination
with invisible SCJ were 197 (100%) normal.

Conclusion: Almost half of visible SCJ was found in menopausal
women group. Most of positive AVI result was found in the nonmenopausal
women group. All women with the invisible SCJ have a
normal Papsmear result.

Keywords: acetoacetate visual inspection, papsmear, pre-cancer lesion,
squamo-columnar junction
(القيادة الخادمة وتأثيرها في الثقة التنظيمية) دراسة تحليلية في شركة توزيع المنتجات النفطية / بغداد
Authors: سعيد هديل كاظم , عبد نور باسم 
Published: April 2019

يهدف البحث الى اختبار العلاقة بين القيادة الخادمة كمتغير مستقل والثقة التنظيمية كمتغير معتمد. وبذلك كان لابد من الاجابة عن تساؤل اساس مفاده: هل هناك علاقة ارتباط وتأثير بين ابعاد القيادة الخادمة والثقة التنظيمية؟ وللتحقق من مضامين الاجابة، اختيرت عينة من المديرين في شركة توزيع المنتجات النفطية / بغداد وانطلاقا من اهمية موضوع البحث, والاهمية التي تنطوي عليها عينة البحث والمنظمة المبحوثة اعتمدت الباحث المنهج الوصفي التحليلي في انجاز بحثها الذي تناول عينة عشوائية طبقية بلغ عددها (190 ) فردا, يمثلون عينة البحث من مجموع المجتمع البالغ عدده (376) فردا, والمتمثل مجموعة من القيادات العليا والوسطى من هم بمنصب (مدير عام– معاون مدير عام– مدير هيئة– مدير قسم– مسئول شعبة), باعتماد الاستبانة كأداة رئيسة في جمع البيانات والتي تضمنت (39) فقرة, اذ وزعت (245 ) استمارة وتم استرجاع (240) استمارة منها كانت صالحة للتحليل الاحصائي, فضلا عن اجراء المقابلات المفتوحة كأداة مساعدة في جمع البيانات والتي حللت بأعتماد البرنامج الاحصائي (Spss V.21, Amos V.18) مع الاساليب الاحصائية المناسبة للبحث ومنها (التوزيع التكراري, والوسط الحسابي, ومعامل التحديد(R² ), والتحليل العاملي التوكيدي وغيرها) لاختبار فرضياته ، وتوصلت الدراسة الى مجموعة استنتاجات اهمها وجود علاقة ارتباط وتأثير مباشر بين ابعاد القيادة الخادمة والثقة التنظيمية .