bluuebunny/crossref_metadata_2025_split huggingface dataset:
Acute Respiratory Distress and Its Risk Factors among Neonates Admitted in a Tertiary Care Center of Western Nepal
Authors: Adhikari Jyoti , Aryal Sajju , Gupta Veena 
Published: April 2019

Background: Neonatal period is defined as a period from birth to under 4 weeks (<28 days) of age. It is a highly vulnerable time for an infant, who is completing many of the physiologic adjustments required for extra uterine existence. The term Respiratory distress (RD) is used to indicate signs & symptoms of abnormal respiratory pattern.
Methods: All neonates admitted in neonatal intensive care unit of Nepalgunj Medical College, Kohalpur with respiratory distress were included. Same number of age and sex matched controls without RD were selected.
Results: The NICU based hospital incidence of RD was 9.1% with male: female ratio 1.4:1 The Most Common etiology was neonatal sepsis (51.6%), followed by hyaline membrane disease (17.8%), TTN (12.7%), meconium aspiration syndrome (6%), birth asphyxia (5.08%), tracheoesophageal fistula (2%) and pneumothorax (2%). Newborns with poor APGAR score requiring resuscitation were more likely to develop RD (p=0.025). Newborns with birth weight <2.5 kg and >4 kg were 2 times likely to develop RD as compared to control group (p<0.012). There was 7 times higher risk of developing MAS when a baby was born through thick MSL as compared to control group (P<0.022). Inadequate ANC visit significantly increased RD in newborns (p<0.001). Babies born to mother with PROM for more than 18 hours were 5.5 times likely to develop RD (p<0.001) whereas those born to mother who had any source of infection were about 6 times at risk of developing respiratory distress than control group (p=0.007).
Conclusion: Certain measures that could be taken to reduce the number of RD are: 1. discouraging early marriage and teenage pregnancy. 2. Increasing awareness regarding temporary and permanent contraceptive measures. 3. Promoting education of girls. 4. Increasing coverage of ANC visit in rural areas and 5. formulating integrated plan and policies from the Government level.
Effects of Adding Intrathecal Fentanyl as Adjunct to Hyperbaric Bupivacaine in Vaginal Hysterectomy: A Double Blinded Randomized Controlled Trial
Authors: Dhakal Yogesh 
Published: April 2019

Introduction: Spinal anesthesia is the preferred means for gynecological surgeries. Adjuvants to local anesthesia for spinal anesthesia may enhance quality and duration of analgesia. Our study aimed to evaluate efficacy and safety of fentanyl added to bupivacaine for spinal anesthesia.
Methods: A prospective, randomized, double blind study was conducted on 60 ASA I or II adult female patients undergoing vaginal hysterectomy under spinal anesthesia. Patients were randomly divided into two groups. Patients in Group B (n=30) were administered 3 mL of 0.5% hyperbaric bupivacaine with 0.4 ml NS and Group F (n=30) were given 3 mL of 0.5% hyperbaric bupivacaine with 0.4 ml (20μg) fentanyl intrathecally. Hemodynamic variables (i.e. heart rate, noninvasive blood pressure, oxygen saturation), onset of motor and sensory block, duration of sensory and motor blockade and any side effects observed were recorded intraoperatively and postoperatively.
Results: The duration of sensory and motor blockade was significantly prolonged (P<0.05) in fentanyl group (268.6±55.4 and 182.8±43.87) compared to control group (235.03±51.97 and 149.47±38.75). Similarly, the onset of sensory and motor block was significantly earlier (P<0.05) in group F (5.2±2.55 and 7.8±2.91) compared to group B (6.63±2.88 and 9.97±3.28). There was no significant statistical difference in the incidence of side effects and changes in hemodynamic variables in both the groups. No adverse events were observed during study.
Conclusion: Addition of fentanyl to hyperbaric bupivacaine for spinal anesthesia offers early onset, better surgical analgesia, prolongs the duration of analgesia without any significant adverse effects.
MAKNA SIMBOLIK SEBUTAN “AANG/AAH” DI KALANGAN UMAT ISLAM KECAMATAN GEKBRONG, CIANJUR (SUATU TELAAH PERSPEKTIF INTERAKSIONISME SIMBOLIK)
Authors: Zein Wiwin 
Published: April 2019

Tujuan dari penelitian ini adalah untuk mengetahui makna simbolik sebutan "Aang/Aah" di kalangan umat Islam Kecamatan Gekbrong, Kabupaten Cianjur, Provinsi Jawa Barat.
Hasil penelitian menunjukkan bahwa makna simbolik sebutan "Aang/Aah", bagi umat Islam di kecamatan Gekbrong memiliki makna simbolik yang subyektif, tergantung pada kepada siapa nama itu dilekatkan. Tapi makna simbolik nama "Aang/Aah" memiliki makna yang bersipat umum, yaitu merepresentasikan tokoh atau orang yang memiliki/menguasai ilmu agama yang luas dan mendalam, karismatik (otoritatif), berpengaruh, saleh, dan memiliki posisi tinggi/mulia. Makna simbolik nama "Aang/Aah" yang bersipat umum itu sipatnya permanen, kepada siapapun nama itu dilekatkan, akan memiliki makna yang sama.
Kata Kunci : simbolik, interaksionisme, Gekbrong, Aang, Aah.
Pengaruh Faktor Eksternal terhadap Piutang Tak Tertagih pada Koperasi Guru Rambate Rata (KGRR) Tinambung Kabupaten Polewali Mandar
Authors: Unsulbar Administrator Jepa , Purwati Wiwi , Dahlia Dahlia 
Published: April 2019

Penelitian ini bertujuan untuk mengetahui: pengaruh Faktor Eksternal terhadap Piutang Tak Tertagih pada Koperasi Guru Rambate Rata (KGRR) Tinambung Kabupaten Polewali Mandar. Populasi penelitian ini adalah 33 orang anggota koperasi yang terindikasi atau yang termasuk mempunyai piutang tak tertagih pada Koperasi Guru Rambate Rata (KGRR) Tinambung Kabupaten Polewali Mandar. Data penelitian di perolah dengan menggunakan instrument kuesioner dan wawancara. Uji hipotesis yang digunakan adalah regresi linier sederhana dan uji t. Hasil penelitian ini menunjukkan bahwa: Faktor Eksternal berpengaruh positif terhadap Piutang Tak Tertagih pada Koperasi Guru Rambate Rata (KGRR) Tinambung Kabupaten Polewali Mandar yang ditunjukkan dengan nilai koefisien determinasi sebesar 0,456, nilai signifikansi lebih kecil dari level of significant (0,000 < 0,050) dan persamaan garis regresinya.
Awake craniotomy with transcortical motor evoked potential monitoring for resection of gliomas in the precentral gyrus: utility for predicting motor function
Authors: Saito Taiichi , Muragaki Yoshihiro , Tamura Manabu , Maruyama Takashi , Nitta Masayuki , Tsuzuki Shunsuke , Fukuchi Satoko , Ohashi Mana , Kawamata Takakazu 
Published: April 2019

OBJECTIVEResection of gliomas in the precentral gyrus carries a risk of severe motor dysfunction. To prevent permanent, severe postoperative motor dysfunction, reliable intraoperative predictors of postoperative function are required. Since 2005, the authors have removed gliomas in the precentral gyrus with combined functional mapping and estimation of intraoperative voluntary movement (IVM) during awake craniotomy and transcortical motor evoked potentials (MEPs). The purpose of the current study was to evaluate whether intraoperative findings of combined monitoring of IVM during awake craniotomy and transcortical MEP monitoring were useful for predicting postoperative motor function of patients with gliomas in the precentral gyrus.METHODSThe current study included 30 patients who underwent resection of precentral gyrus gliomas during awake craniotomy from April 2000 to January 2018. All tumors were removed with monitoring of IVM during awake craniotomy and transcortical MEPs. Postoperative motor function was classified as stable or declined, with the extent of decline categorized as mild, moderate, or severe. We defined moderate and severe deficits were those that hindered daily life.RESULTSIn 28 of 30 cases, available waveforms were obtained with transcortical MEPs. The mean extent of resection (EOR) was 93%. Relative to preoperative status, motor function 6 months after surgery was considered stable in 20 patients and was considered to show mild decline in 7, moderate decline in 2, and severe decline in 1. Motor function 6 months after surgery was significantly correlated with IVM (p = 0.0096), changes in transcortical MEPs (decline ≤ or > 50%) (p = 0.0163), EOR, and ischemic lesions on postoperative MRI. Six patients with no change in IVM showed stable motor function 6 months after surgery. Only 2 patients with a decline in IVM and a decline in MEPs ≤ 50% had a decline in motor function 6 months after surgery (18%; 2/11 patients), whereas 11 patients with a decline in IVM and a decline in MEPs > 50% had such a decline in motor function (73%; 8/11 patients) including 2 patients with moderate and 1 with severe deficits. Three patients with moderate or severe motor deficits showed the lowest MEP values (< 100 µV).CONCLUSIONSCombined judgment from monitoring of IVM during awake craniotomy and transcortical MEPs is useful for predicting postoperative motor function during removal of gliomas in the precentral gyrus. Maximum resection was achieved with an acceptable morbidity rate. Thus, these tumors should not be considered unresectable.
Comparing two randomized deep brain stimulation trials for Parkinson’s disease
Authors: Deuschl Günther , Follett Kenneth A. , Luo Ping , Rau Joern , Weaver Frances M. , Paschen Steffen , Steigerwald Frank , Tonder Lisa , Stoker Valerie , Reda Domenic J. 
Published: April 2019

OBJECTIVESeveral randomized studies have compared the effect of deep brain stimulation (DBS) of the subthalamic nucleus with the best medical treatment in large groups of patients. Important outcome measures differ between studies. Two such major studies, the life-quality study of the German Competence Network for Parkinson’s disease (LQ study) and the US Veterans Affairs/National Institute of Neurological Disorders and Stroke trial (VA/NINDS trial), were compared here in order to understand their differences in outcomes.METHODSUnless otherwise noted, analyses were based on those subjects in each study who received a DBS implant (LQ study 76 patients, VA/NINDS trial 140 patients) and who had data for the measurement under consideration (i.e., no imputations for missing data), referred to hereafter as the “as-treated completers” (LQ 69 patients, VA/NINDS 125 patients). Data were prepared and analyzed by biostatisticians at the US Department of Veterans Affairs Cooperative Studies Program Coordinating Center, the Coordinating Center for Clinical Trials Marburg, and Medtronic, under the direction of two authors (G.D. and K.A.F.). Data were extracted from the respective databases into SAS data sets and analyzed using SAS software. Analyses were based on the 6-month follow-up data from both studies because this was the endpoint for the LQ study.RESULTSPre-DBS baseline demographics differed significantly between the studies, including greater levodopa responsiveness (LDR) in the LQ study population than in the VA/NINDS group. After DBS, LQ subjects demonstrated greater improvement in motor function (Unified Parkinson’s Disease Rating Scale, Motor Examination [UPDRS-III]), activities of daily living (ADLs), and complications of therapy. Medication reduction and improvements in life quality other than ADLs were not significantly different between LQ and VA/NINDS subjects. When the two populations were compared according to pre-DBS LDR, the “full responders” to levodopa (≥ 50% improvement on UPDRS-III with medication) in the two studies showed no significant difference in motor improvement with DBS (LQ 18.5 ± 12.0–point improvement on UPDRS-III vs VA/NINDS 17.7 ± 15.6–point improvement, p = 0.755). Among levodopa full responders, ADLs improved slightly more in the LQ group, but scores on other UPDRS subscales and the Parkinson’s Disease Questionnaire-39 were not significantly different between the two studies.CONCLUSIONSThis comparison suggests that patient selection criteria, especially preoperative LDR, are the most important source of differences in motor outcomes and quality of life between the two studies.
Associations between clinical outcome and tractography based on navigated transcranial magnetic stimulation in patients with language-eloquent brain lesions
Authors: Sollmann Nico , Fratini Alessia , Zhang Haosu , Zimmer Claus , Meyer Bernhard , Krieg Sandro M. 
Published: April 2019

OBJECTIVENavigated transcranial magnetic stimulation (nTMS) in combination with diffusion tensor imaging fiber tracking (DTI FT) is increasingly used to locate subcortical language-related pathways. The aim of this study was to establish nTMS-based DTI FT for preoperative risk stratification by evaluating associations between lesion-to-tract distances (LTDs) and aphasia and by determining a cut-off LTD value to prevent surgery-related permanent aphasia.METHODSFifty patients with left-hemispheric, language-eloquent brain tumors underwent preoperative nTMS language mapping and nTMS-based DTI FT, followed by tumor resection. nTMS-based DTI FT was performed with a predefined fractional anisotropy (FA) of 0.10, 0.15, 50% of the individual FA threshold (FAT), and 75% FAT (minimum fiber length [FL]: 100 mm). The arcuate fascicle (AF), superior longitudinal fascicle (SLF), inferior longitudinal fascicle (ILF), uncinate fascicle (UC), and frontooccipital fascicle (FoF) were identified in nTMS-based tractography, and minimum LTDs were measured between the lesion and the AF and between the lesion and the closest other subcortical language-related pathway (SLF, ILF, UC, or FoF). LTDs were then associated with the level of aphasia (no/transient or permanent surgery-related aphasia, according to follow-up examinations).RESULTSA significant difference in LTDs was observed between patients with no or only surgery-related transient impairment and those who developed surgery-related permanent aphasia with regard to the AF (FA = 0.10, p = 0.0321; FA = 0.15, p = 0.0143; FA = 50% FAT, p = 0.0106) as well as the closest other subcortical language-related pathway (FA = 0.10, p = 0.0182; FA = 0.15, p = 0.0200; FA = 50% FAT, p = 0.0077). Patients with surgery-related permanent aphasia showed the lowest LTDs in relation to these tracts. Thus, LTDs of ≥ 8 mm (AF) and ≥ 11 mm (SLF, ILF, UC, or FoF) were determined as cut-off values for surgery-related permanent aphasia.CONCLUSIONSnTMS-based DTI FT of subcortical language-related pathways seems suitable for risk stratification and prediction in patients suffering from language-eloquent brain tumors. Thus, the current role of nTMS-based DTI FT might be expanded, going beyond the level of being a mere tool for surgical planning and resection guidance.
Evaluation of cost and survival in intracranial gliomas using the Value Driven Outcomes database: a retrospective cohort analysis
Authors: Wilde Herschel , Azab Mohammed A. , Abunimer Abdullah M. , Abou-Al-Shaar Hussam , Karsy Michael , Guan Jian , Menacho Sarah T. , Jensen Randy L. 
Published: April 2019

OBJECTIVEGliomas occur in 3–4 individuals per 100,000 individuals and are one of the most common primary brain tumors. Treatment options are limited for gliomas despite the progressive nature of the disease. The authors used the Value Driven Outcomes (VDO) database to identify cost drivers and subgroups that are involved in the surgical treatment of gliomas.METHODSA retrospective cohort of patients with gliomas treated at the authors’ institution from August 2011 to February 2018 was evaluated using medical records and the VDO database.RESULTSA total of 263 patients with intracranial gliomas met the authors’ inclusion criteria and were included in the analysis (WHO grade I: 2.0%; grade II: 18.5%; grade III: 18.1%; and grade IV: 61.4%). Facility costs were the major (64.4%) cost driver followed by supplies (16.2%), pharmacy (10.1%), imaging (4.5%), and laboratory (4.7%). Univariate analysis of cost contributors demonstrated that American Society of Anesthesiologists physical status (p = 0.002), tumor recurrence (p = 0.06), Karnofsky Performance Scale score (p = 0.002), length of stay (LOS) (p = 0.0001), and maximal tumor size (p = 0.03) contributed significantly to the total costs. However, on multivariate analysis, only LOS (p = 0.0001) contributed significantly to total costs. More extensive tumor resection in WHO grade III and IV tumors was associated with significant improvement in survival (p = 0.004 and p = 0.02, respectively).CONCLUSIONSUnderstanding care costs is challenging because of the highly complex, fragmented, and variable nature of healthcare delivery. Adopting effective strategies that would reduce facility costs and limit LOS is likely the most important aspect in reducing intracranial glioma treatment costs.
Modulation of saccades in humans by electrical stimulation of the posterior subthalamic area
Authors: Bangash Omar K. , Dissanayake Arosha S. , Knight Shirley , Murray John , Thorburn Megan , Thani Nova , Bala Arul , Stell Rick , Lind Christopher R. P. 
Published: April 2019

OBJECTIVEPosterior subthalamic area (PSA) deep brain stimulation (DBS) targeting the zona incerta (ZI) is an emerging treatment for tremor syndromes, including Parkinson’s disease (PD) and essential tremor (ET). Evidence from animal studies has indicated that the ZI may play a role in saccadic eye movements via pathways between the ZI and superior colliculus (incerto-collicular pathways). PSA DBS permitted testing this hypothesis in humans.METHODSSixteen patients (12 with PD and 4 with ET) underwent DBS using the MRI-directed implantable guide tube technique. Active electrode positions were confirmed at the caudal ZI. Eye movements were tested using direct current electrooculography (EOG) in the medicated state pre- and postoperatively on a horizontal predictive task subtending 30°. Postoperative assessments consisted of stimulation-off, constituting a microlesion (ML) condition, and high-frequency stimulation (HFS; frequency = 130 Hz) up to 3 V.RESULTSWith PSA HFS, the first saccade amplitude was significantly reduced by 10.4% (95% CI 8.68%–12.2%) and 12.6% (95% CI 10.0%–15.9%) in the PD and ET groups, respectively. With HFS, peak velocity was reduced by 14.7% (95% CI 11.7%–17.6%) in the PD group and 27.7% (95% CI 23.7%–31.7%) in the ET group. HFS led to PD patients performing 21% (95% CI 16%–26%) and ET patients 31% (95% CI 19%–38%) more saccadic steps to reach the target.CONCLUSIONSPSA DBS in patients with PD and ET leads to hypometric, slowed saccades with an increase in the number of steps taken to reach the target. These effects contrast with the saccadometric findings observed with subthalamic nucleus DBS. Given the location of the active contacts, incerto-collicular pathways are likely responsible. Whether the acute finding of saccadic impairment persists with chronic PSA stimulation is unknown.
Sublaminar polyester bands as a salvage fixation method in the cervical spine: novel application in two patients
Authors: Smith Luke G. F. , Hoang Nguyen , Shaikhouni Ammar , Viljoen Stephanus 
Published: April 2019

Pedicle and lateral mass screws are the most common means of rigid fixation in posterior cervical spine fusions. Various other techniques such as translaminar screw placement, paravertebral foramen screw fixation, sublaminar and spinous process wiring, cement augmentation, and others have been developed for primary fixation or as salvage methods. Use of these techniques can be limited by a prior history of osteotomies, poor bone density, destruction of the bone-screw interface, and unfavorable vascular and osseous anatomy.Here, the authors report on the novel application of cervical sublaminar polyester bands as an adjunct salvage method or additional fixation point used with traditional methods in the revision of prior constructs. While sublaminar polyester bands have been used for decades in pediatric scoliosis surgery in the thoracolumbar spine, they have yet to be utilized as a method of fixation in the cervical spine. In both cases described here, sublaminar banding proved crucial for fixation points where traditional fixation techniques would have been less than ideal. Further study is required to determine the full application of sublaminar polyester bands in the cervical spine as well as its outcomes.
Machine learning for automated 3-dimensional segmentation of the spine and suggested placement of pedicle screws based on intraoperative cone-beam computer tomography
Authors: Burström Gustav , Buerger Christian , Hoppenbrouwers Jurgen , Nachabe Rami , Lorenz Cristian , Babic Drazenko , Homan Robert , Racadio John M. , Grass Michael , Persson Oscar , Edström Erik , Elmi Terander Adrian 
Published: April 2019

OBJECTIVEThe goal of this study was to develop and validate a system for automatic segmentation of the spine, pedicle identification, and screw path suggestion for use with an intraoperative 3D surgical navigation system.METHODSCone-beam CT (CBCT) images of the spines of 21 cadavers were obtained. An automated model-based approach was used for segmentation. Using machine learning methodology, the algorithm was trained and validated on the image data sets. For measuring accuracy, surface area errors of the automatic segmentation were compared to the manually outlined reference surface on CBCT. To further test both technical and clinical accuracy, the algorithm was applied to a set of 20 clinical cases. The authors evaluated the system’s accuracy in pedicle identification by measuring the distance between the user-defined midpoint of each pedicle and the automatically segmented midpoint. Finally, 2 independent surgeons performed a qualitative evaluation of the segmentation to judge whether it was adequate to guide surgical navigation and whether it would have resulted in a clinically acceptable pedicle screw placement.RESULTSThe clinically relevant pedicle identification and automatic pedicle screw planning accuracy was 86.1%. By excluding patients with severe spinal deformities (i.e., Cobb angle > 75° and severe spinal degeneration) and previous surgeries, a success rate of 95.4% was achieved. The mean time (± SD) for automatic segmentation and screw planning in 5 vertebrae was 11 ± 4 seconds.CONCLUSIONSThe technology investigated has the potential to aid surgeons in navigational planning and improve surgical navigation workflow while maintaining patient safety.
Makna dan Pengaruh Keberadaan dan Teknologi Teras Terhadap Keberlanjutan Rumah Adat Baduy Dalam
Authors: Theodora Rosalyn 
Published: April 2019

Esai ini membahas makna di balik keberadaan teras (golodok), teknologi teras, dan efek yang timbul pada keberlanjutan Rumah Adat Baduy sebagai salah satu elemen kehidupan yang vital bagi suku Baduy. Data bersumber dari hasil observasi dan wawancara selama tiga hari studi lapangan di Desa Cibeo, serta saduran dari bacaan-bacaan mengenai kehidupan suku Baduy Dalam. Penulis menggunakan metode kualitatif untuk menganalisis hubungan antara makna keberadaan teras dengan keberlangsungan suku Baduy sebagai suatu hubungan yang mutualis. Teras hadir untuk mempertahankan interaksi sosial antarwarga sehingga kebiasaan tersebut memungkinkan terjaganya budaya gotong royong dalam membangun tempat tinggal. Studi lebih lanjut menunjukkan hubungan antara keberadaan teras dengan kepercayaan lokal. Kepercayaan tersebut memengaruhi bentuk dan teknologi yang teraplikasikan pada teras, sehingga ada beberapa jenis teras yang melambangkan perbedaan kedudukan sosial pemilik rumah.
Kata kunci: Teras, Suku Baduy, Kepercayaan Lokal, Interaksi Sosial.