bluuebunny/crossref_metadata_2025_split huggingface dataset:
Dosimetric characterization of hypofractionated Gamma Knife radiosurgery of large or complex brain tumors versus linear accelerator–based treatments
Authors: Dong Peng , Pérez-Andújar Angélica , Pinnaduwage Dilini , Braunstein Steve , Theodosopoulos Philip , McDermott Michael , Sneed Penny , Ma Lijun 
Published: April 2019

OBJECTIVENoninvasive Gamma Knife (GK) platforms, such as the relocatable frame and on-board imaging, have enabled hypofractionated GK radiosurgery of large or complex brain lesions. This study aimed to characterize the dosimetric quality of such treatments against linear accelerator–based delivery systems that include the CyberKnife (CK) and volumetric modulated arc therapy (VMAT).METHODSTen patients treated with VMAT at the authors' institution for large brain tumors (> 3 cm in maximum diameter) were selected for the study. The median prescription dose was 25 Gy (range 20–30 Gy) in 5 fractions. The median planning target volume (PTV) was 9.57 cm3 (range 1.94–24.81 cm3). Treatment planning was performed using Eclipse External Beam Planning V11 for VMAT on the Varian TrueBeam system, Multiplan V4.5 for the CyberKnife VSI System, and Leksell GammaPlan V10.2 for the Gamma Knife Perfexion system. The percentage of the PTV receiving at least the prescription dose was normalized to be identical across all platforms for individual cases. The prescription isodose value for the PTV, conformity index, Paddick gradient index, mean and maximum doses for organs at risk, and normal brain dose at variable isodose volumes ranging from the 5-Gy isodose volume (V5) to the 15-Gy isodose volume (V15) were compared for all of the cases.RESULTSThe mean Paddick gradient index was 2.6 ± 0.2, 3.2 ± 0.5, and 4.3 ± 1.0 for GK, CK, and VMAT, respectively (p < 0.002). The mean V15 was 7.5 ± 3.7 cm3 (range 1.53–13.29 cm3), 9.8 ± 5.5 cm3 (range 2.07–18.45 cm3), and 16.1 ± 10.6 cm3 (range 3.58–36.53 cm3) for GK, CK, and VMAT, respectively (p ≤ 0.03, paired 2-tailed t-tests). However, the average conformity index was 1.18, 1.12, and 1.21 for GK, CK, and VMAT, respectively (p > 0.06). The average prescription isodose values were 52% (range 47%–69%), 60% (range 46%–68%), and 88% (range 70%–94%) for GK, CK, and VMAT, respectively, thus producing significant variations in dose hot spots among the 3 platforms. Furthermore, the mean V5 values for GK and CK were similar (p > 0.79) at 71.9 ± 36.2 cm3 and 73.3 ± 31.8 cm3, respectively, both of which were statistically lower (p < 0.01) than the mean V5 value of 124.6 ± 67.1 cm3 for VMAT.CONCLUSIONSSignificantly better near-target normal brain sparing was noted for hypofractionated GK radiosurgery versus linear accelerator–based treatments. Such a result supports the use of a large number of isocenters or confocal beams for the benefit of normal tissue sparing in hypofractionated brain radiosurgery.
Stereotactic diffusion tensor imaging tractography for Gamma Knife radiosurgery
Authors: Gavin Cormac G. , Ian Sabin H. 
Published: April 2019

OBJECTIVEThe integration of modern neuroimaging into treatment planning has increased the therapeutic potential and safety of stereotactic radiosurgery. The authors report their method of integrating stereotactic diffusion tensor imaging (DTI) tractography into conventional treatment planning for Gamma Knife radiosurgery (GKRS). The aim of this study was to demonstrate the feasibility of this technique and to address some of the technical limitations of previously reported techniques.METHODSTwenty patients who underwent GKRS composed the study cohort. They consisted of 1 initial test case (a patient with a vestibular schwannoma), 5 patients with arteriovenous malformations, 9 patients with cerebral metastases, 1 patient with parasagittal meningioma, and 4 patients with vestibular schwannoma. DT images were obtained at the time of standard GKRS protocol MRI (T1 and T2 weighted) for treatment, with the patient's head secured by a Leksell stereotactic frame. All studies were performed using a 1.5-T magnet with a single-channel head coil. DTI was performed with diffusion gradients in 32 directions and coregistered with the volumetric T1-weighted study. DTI postprocessing by means of commercially available software allowed tensor computation and the creation of directionally encoded color–, apparent diffusion coefficient–, and fractional anisotropy–mapped sequences. In addition, the software allowed visualized critical tracts to be exported as a structural volume and integrated into GammaPlan as an “organ at risk” during shot planning. Combined images were transferred to GammaPlan and integrated into treatment planning.RESULTSStereotactic DT images were successfully acquired in all patients, with generation of correct directionally encoded color images. Tract generation with the software was straightforward and reproducible, particularly for axial tracts such as the optic radiation and the arcuate fasciculus. Corticospinal tract visualization was hampered by some artifacts from the base of the stereotactic frame, but this was overcome by a combination of frame/MRI volume adjustment and DTI seeding parameters. Coregistration of the DTI series with the T1-weighted treatment volume at the time of imaging was essential for the generation of correct tensor data. All patients with the exception of the vestibular schwannoma cases had treatment pathology in the vicinity of eloquent tracts and/or the cortex. No new neurological deficits due to radiation were recorded at the short-term follow-up.CONCLUSIONSRecent reports in the medical literature have suggested that white matter tracts (particularly the optic radiation and arcuate fasciculus) are more vulnerable to radiation during stereotactic radiosurgery than previously thought. Integration of stereotactic tractography into GKRS represents a promising tool for preventing GKRS complications by reduction in radiation doses to functional organs at risk, including critical cortical areas and subcortical white matter tracts.
Single-session Gamma Knife radiosurgery for optic pathway/hypothalamic gliomas
Authors: El-Shehaby Amr M. N. , Reda Wael A. , Abdel Karim Khaled M. , Emad Eldin Reem M. , Nabeel Ahmed M. 
Published: April 2019

OBJECTIVEBecause of their critical and central location, it is deemed necessary to fractionate when considering irradiating optic pathway/hypothalamic gliomas. Stereotactic fractionated radiotherapy is considered safer when dealing with gliomas in this location. In this study, the safety and efficacy of single-session stereotactic radiosurgery for optic pathway/hypothalamic gliomas were reviewed.METHODSBetween December 2004 and June 2014, 22 patients with optic pathway/hypothalamic gliomas were treated by single-session Gamma Knife radiosurgery. Twenty patients were available for follow-up for a minimum of 1 year after treatment. The patients were 5 to 43 years (median 16 years) of age. The tumor volume was 0.15 to 18.2 cm3 (median 3.1 cm3). The prescription dose ranged from 8 to 14 Gy (median 11.5 Gy).RESULTSThe mean follow-up period was 43 months. Five tumors involved the optic nerve only, and 15 tumors involved the chiasm/hypothalamus. Two patients died during the follow-up period. The tumors shrank in 12 cases, remained stable in 6 cases, and progressed in 2 cases, thereby making the tumor control rate 90%. Vision remained stable in 12 cases, improved in 6 cases, and worsened in 2 cases in which there was tumor progression. Progression-free survival was 83% at 3 years.CONCLUSIONSThe initial results indicate that single-session Gamma Knife radiosurgery is a safe and effective treatment option for optic pathway/hypothalamic gliomas.
Clinical predictors of symptom resolution for children and adolescents with sport-related concussion
Authors: Howell David R. , Potter Morgan N. , Kirkwood Michael W. , Wilson Pamela E. , Provance Aaron J. , Wilson Julie C. 
Published: April 2019

OBJECTIVEThe goal of this study was to determine which variables assessed during an initial clinical evaluation for concussion are independently associated with time until symptom resolution among pediatric patients.METHODSData collected from a prospective clinical registry of pediatric patients with concussion were analyzed. The primary outcome variable was time from injury until symptom resolution. Predictor variables assessed within 10 days after injury included preinjury factors, Health and Behavior Inventory scores, headache severity, and balance, vestibular, and oculomotor test performances. The researchers used univariate Cox proportional models to identify potential predictors of symptom resolution time and constructed a multivariate Cox proportional hazards model in which total duration of concussion symptoms remained the outcome variable.RESULTSThe sample consisted of 351 patients (33% female, mean age 14.6 ± 2.2 years, evaluated 5.6 ± 2.6 days after concussion). Univariate Cox proportional hazards models indicated that several variables were associated with a longer duration of symptoms, including headache severity (hazard ratio [HR] 0.90 [95% CI 0.85–0.96]), headache frequency (HR 0.83 [95% CI 0.71–0.96]), confusion (HR 0.79 [95% CI 0.69–0.92]), forgetfulness (HR 0.79 [95% CI 0.68–0.92]), attention difficulties (HR 0.83 [95% CI 0.72–0.96]), trouble remembering (HR 0.84 [95% CI 0.72–0.98]), getting tired often (HR 0.86 [95% CI 0.76–0.97]), getting tired easily (HR 0.86 [95% CI 0.76–0.98]), dizziness (HR 0.86 [95% CI 0.75–0.99]), and abnormal performance on the Romberg test (HR 0.59 [95% CI 0.40–0.85]). A multivariate Cox proportional hazards model indicated that an abnormal performance on the Romberg test was independently associated with a longer duration of symptoms (HR 0.65 [95% CI 0.44–0.98]; p = 0.038).CONCLUSIONSFor children and adolescents evaluated within 10 days after receiving a concussion, abnormal performance on the Romberg test was independently associated with a longer duration of symptoms during recovery. In line with findings of other recent studies investigating predictors of symptom resolution, postural stability tests may provide useful prognostic information for sports medicine clinicians.
Arachnoid web of the spine: a systematic literature review
Authors: Nisson Peyton L. , Hussain Ibrahim , Härtl Roger , Kim Samuel , Baaj Ali A. 
Published: April 2019

OBJECTIVEAn arachnoid web of the spine (AWS) is a rare and oftentimes challenging lesion to diagnose, given its subtle radiographic findings. However, when left untreated, this lesion can have devastating effects on a patient’s neurological function. To date, only limited case reports and series have been published on this topic. In this study, the authors sought to better describe this lesion, performing a systematic literature review and including 2 cases from their institution’s experience.METHODSA systematic literature search was performed in September 2018 that queried Ovid MEDLINE (1946–2018), PubMed (1946–2018), Wiley Cochrane Library: Central Register of Controlled Trials (1898–2018), and Thompson Reuters Web of Science: Citation Index (1900–2018), per PRISMA guidelines. Inclusion criteria specified all studies and case reports of patients with an AWS in which any relevant surgery types were considered and applied. Studies on arachnoid cysts and nonhuman populations, and those that did not report patient treatments or outcomes were excluded from the focus review.RESULTSA total of 19 records and 2 patients treated by the senior authors were included in the systematic review, providing a total of 43 patients with AWS. The mean age was 52 years (range 28–77 years), and the majority of patients were male (72%, 31/43). A syrinx was present in 67% (29/43) of the cases. All AWSs were located in the thoracic spine, and all but 2 (95%) were located dorsally (1 ventrally and 1 circumferentially). Weakness was the most frequently reported symptom (67%, 29/43), followed by numbness and/or sensory loss (65%, 28/43). Symptoms predominated in the lower extremities (81%, 35/43). It was found that nearly half (47%, 20/43) of patients had been experiencing symptoms for 1 year or longer before surgical intervention was performed, and 35% (15/43) of reports stated that symptoms were progressive in nature. The most commonly used surgical technique was a laminectomy with intradural excision of the arachnoid web (86%, 36/42). Following surgery, 91% (39/43) of patients had reported improvement in their neurological symptoms. The mean follow-up was 9.2 months (range 0–51 months).CONCLUSIONSAWS of the spine can be a debilitating disease of the spine with no more than an indentation of the spinal cord found on advanced imaging studies. The authors found this lesion to be reported in twice as many males than females, to be associated with a syrinx more than two-thirds of the time, and to only have been reported in the thoracic spine; over 90% of patients experienced improvement in their neurological function following surgery.
Natural history of neuromodulation devices and therapies: a patient-centered survival analysis
Authors: Teton Zoe E. , Blatt Daniel , AlBakry Amr , Obayashi James , Ozturk Gulsah , Hamzaoglu Vural , Magown Philippe , Selden Nathan R. , Burchiel Kim J. , Raslan Ahmed M. 
Published: April 2019

OBJECTIVEDespite rapid development and expansion of neuromodulation technologies, knowledge about device and/or therapy durability remains limited. The aim of this study was to evaluate the long-term rate of hardware and therapeutic failure of implanted devices for several neuromodulation therapies.METHODSThe authors performed a retrospective analysis of patients’ device and therapy survival data (Kaplan-Meier survival analysis) for deep brain stimulation (DBS), vagus nerve stimulation (VNS), and spinal cord stimulation (SCS) at a single institution (years 1994–2015).RESULTSDuring the study period, 450 patients underwent DBS, 383 VNS, and 128 SCS. For DBS, the 5- and 10-year initial device survival was 87% and 73%, respectively, and therapy survival was 96% and 91%, respectively. For VNS, the 5- and 10-year initial device survival was 90% and 70%, respectively, and therapy survival was 99% and 97%, respectively. For SCS, the 5- and 10-year initial device survival was 50% and 34%, respectively, and therapy survival was 74% and 56%, respectively. The average initial device survival for DBS, VNS, and SCS was 14 years, 14 years, and 8 years while mean therapy survival was 18 years, 18 years, and 12.5 years, respectively.CONCLUSIONSThe authors report, for the first time, comparative device and therapy survival rates out to 15 years for large cohorts of DBS, VNS, and SCS patients. Their results demonstrate higher device and therapy survival rates for DBS and VNS than for SCS. Hardware failures were more common among SCS patients, which may have played a role in the discontinuation of therapy. Higher therapy survival than device survival across all modalities indicates continued therapeutic benefit beyond initial device failures, which is important to emphasize when counseling patients.
Variation in hospital charges in patients with external ventricular drains: comparison between the intensive care and surgical floor settings
Authors: Chu Jason K. , Feroze Abdullah H. , Collins Kelly , McGrath Lynn B. , Young Christopher C. , Williams John R. , Browd Samuel R. 
Published: April 2019

OBJECTIVEPlacement of an external ventricular drain (EVD) is a common and potentially life-saving neurosurgical procedure, but the economic aspect of EVD management and the relationship to medical expenditure remain poorly studied. Similarly, interinstitutional practice patterns vary significantly. Whereas some institutions require that patients with EVDs be monitored strictly within the intensive care unit (ICU), other institutions opt primarily for management of EVDs on the surgical floor. Therefore, an ICU burden for patients with EVDs may increase a patient’s costs of hospitalization. The objective of the current study was to examine the expense differences between the ICU and the general neurosurgical floor for EVD care.METHODSThe authors performed a retrospective analysis of data from 2 hospitals within a single, large academic institution—the University of Washington Medical Center (UWMC) and Seattle Children’s Hospital (SCH). Hospital charges were evaluated according to patients’ location at the time of EVD management: SCH ICU, SCH floor, or UWMC ICU. Daily hospital charges from day of EVD insertion to day of removal were included and screened for days that would best represent baseline expenses for EVD care. Independent-samples Kruskal-Wallis analysis was performed to compare daily charges for the 3 settings.RESULTSData from a total of 261 hospital days for 23 patients were included in the analysis. Ten patients were cared for in the UWMC ICU and 13 in the SCH ICU and/or on the SCH neurosurgical floor. The median values for total daily hospital charges were $19,824.68 (interquartile range [IQR] $12,889.73–$38,494.81) for SCH ICU care, $8,620.88 (IQR $6,416.76–$11,851.36) for SCH floor care, and $10,002.13 (IQR $8,465.16–$12,123.03) for UWMC ICU care. At SCH, it was significantly more expensive to provide EVD care in the ICU than on the floor (p < 0.001), and the daily hospital charges for the UWMC ICU were significantly greater than for the SCH floor (p = 0.023). No adverse clinical event related to the presence of an EVD was identified in any of the settings.CONCLUSIONSICU admission solely for EVD care is costly. If safe EVD care can be provided outside of the ICU, it would represent a potential area for significant cost savings. Identifying appropriate patients for EVD care on the floor is multifactorial and requires vigilance in balancing the expenses associated with ICU utilization and optimal patient care.
Pengaruh Penyuluhan Teknik Pijat Bayi Terhadap Pengetahuan Dan Keterampilan Pijat Bayi Pada Ibu Di Kelurahan Tanjung Karang Tahun 2015
Authors: Andaruni Nurul Qamariah Rista 
Published: April 2019

Abstrak: Di Indonesia pelaksanaan pijat bayi di masyarakat masih dipegang peranannya oleh dukun bayi. Selama ini, pemijatan tidak hanya dilakukan bila bayi sehat, tetapi juga pada bayi sakit atau rewel dan sudah menjadi rutinitas perawatan bayi setelah lahir. Desain penelitian ini menggunakan rancangan eksperimen (Quasi eksperimen). Responden dalam penelitian ini berjumlah 30 responden dengan subyek penelitian ibu yang mempunyai bayi sehat usia 0-12 bulan. Ada peningkatan pengetahuan dan keterampilan ibu sebelum dan sesudah penyuluhan. Sebelum penyuluhan persentase pengetahuan dan keterampilan dalam kategori kurang yaitu 60% dan tidak memiliki keterampilan 80%, sedangkan setelah penyuluhan persentase pengetahuan dan keterampilan meningkat menjadi pengetahuan baik 100% dan memiliki keterampilan cukup 80%.Abstract: In Indonesia, the implementation of infant massage in the community is still held by the midwife role. During this time, the massage is not only done when the baby is healthy, but also on the sick or fussy babies and infants has become routine care after birth. The study design using the design of experiments (quasi experimen). Respondents in this study were 30 respondents to the research subjects healthy mothers with infants aged 0-12 months. There was an increase in knowledge and skills of the mother before and after counseling. Before the extension percentage of knowledge and skills in the category of less that 60% and 80% do not have the skills, whereas after the extension of knowledge and skills percentage increased to either 100% knowledge and 80% have enough skill.
EFEKTIFITAS PRODUKSI ASI PADA IBU POST PARTUM DENGAN MASSAGE ROLLING (PUNGGUNG)
Authors: Ari Shanti Elvika Fit 
Published: April 2019

Abstrak: Produksi ASI yang kurang dan lambat keluar dapat menyebabkan ibu tidak memberikan ASI pada bayinya dengan cukup. Selain hormon prolaktin, proses laktasi juga bergantung pada hormon oksitosin, yang dilepas dari hipofise posterior sebagai reaksi terhadap penghisapan putting. Rolling massage salah satu terapi relaksasi yang bertujuan menstimulasi saraf pusat pada hipofisis posterior dan anterior sehingga dapat meningkatkan produksi ASI khususnya pada ibu post partum dan memberikan kenyamanan dan rileksasi setelah persalinan. Adapun tujuan penelitian adalah mengetahui efektifitas produksi ASI pada ibu post partum dengan massage rolling (punggung) di BPM Sri Sukeni Sleman. Metode penelitian ini adalah Quasi Experimental Design dengan rancangan penelitian two group post test design. Kelompok kontrol adalah ibu postpartum tanpa dipijat Massage roliing dan kelompok perlakuan adalah kelompok ibu postpartum yang dipijat masssage Roliing. Analisis data menggunakan uji independent t test dan paired sample t test. Hasil penelitian uji t sampel menunjukkan bahwa ada perbedaan yang bermakna (p=0.023<) produksi ASI (berat badan bayi) antara kelompok kontrol ( 2687,07 ± 160,155) dengan kelompok perlakuan (2846,13± 198,968). Perbedaan ini terlihat pada rerata berat badan bayi pada kelompok perlakuan lebih besar dibandingkan dengan kelompok. Massage rolling memengaruhi produksi ASI di BPM Sri Sukeni Sleman Tahun 2017. Abstract: The inadequate, slow production of breast milk makes mothers unable to provide enough breast milk to their babies. Besides the prolactin hormone, the lactation process also depends on oxytocin hormone which is secreted from the posterior hypophysis as a reaction on nipple suckling. Rolling massage is one of the relaxation therapy which aims to stimulate the central nerve on posterior and anterior hypophysis, so the breast milk production can be increased, particularly in the postpartum mothers, and comfort and relaxation after childbirth can be provided. This research aims to investigate the effectiveness of breast milk production in the postpartum mothers with massage rolling (back) in Sri Sukeni Community Empowerment Agency, Sleman. The methodology in this research is Quasi-Experimental Design with two-group posttest design. The control group is postpartum mothers without massage rolling and the treatment group is postpartum mother treated with the massage rolling. Data analysis used the independent t-test and the paired sample t-test. The research shows the result that in samples of t-test, there is a meaningful difference (p = 0.023<) in breast milk production (weight of baby) between control group (2,687.07 ± 160.155) and treatment group (2,846.13 ± 198.968). This difference is shown in the average weight of baby in treatment group which is higher compared with the control group. Massage rolling affects breast milk production in Sri Sukeni Community Empowerment Agency, Sleman in 2017.