bluuebunny/crossref_metadata_2025_split huggingface dataset:
Reduced long-term cost and increased patient satisfaction with rechargeable implantable pulse generators for deep brain stimulation
Authors: Hitti Frederick L. , Vaughan Kerry A. , Ramayya Ashwin G. , McShane Brendan J. , Baltuch Gordon H. 
Published: September 2018

OBJECTIVEDeep brain stimulation (DBS) has revolutionized the treatment of neurological disease, but its therapeutic efficacy is limited by the lifetime of the implantable pulse generator (IPG) batteries. At the end of the battery life, IPG replacement surgery is required. New IPGs with rechargeable batteries (RC-IPGs) have recently been introduced and allow for decreased reoperation rates for IPG replacements. The authors aimed to examine the merits and limitations of these devices.METHODSThe authors reviewed the medical records of patients who underwent DBS implantation at their institution. RC-IPGs were placed either during initial DBS implantation or during an IPG change. A cost analysis was performed that compared RC-IPGs with standard IPGs, and telephone patient surveys were conducted to assess patient satisfaction.RESULTSThe authors identified 206 consecutive patients from 2011 to 2016 who underwent RC-IPG placement (mean age 61 years; 67 women, 33%). Parkinson’s disease was the most common indication for DBS (n = 144, 70%), followed by essential tremor (n = 41, 20%), dystonia (n = 13, 6%), depression (n = 5, 2%), multiple sclerosis tremor (n = 2, 1%), and epilepsy (n = 1, 0.5%). DBS leads were typically placed bilaterally (n = 192, 93%) and targeted the subthalamic nucleus (n = 136, 66%), ventral intermediate nucleus of the thalamus (n = 43, 21%), internal globus pallidus (n = 21, 10%), ventral striatum (n = 5, 2%), or anterior nucleus of the thalamus (n = 1, 0.5%). RC-IPGs were inserted at initial DBS implantation in 123 patients (60%), while 83 patients (40%) were converted to RC-IPGs during an IPG replacement surgery. The authors found that RC-IPG implantation resulted in $60,900 of cost savings over the course of 9 years. Furthermore, patient satisfaction was high with RC-IPG implantation. Overall, 87.3% of patients who responded to the survey were satisfied with their device, and only 6.7% found the rechargeable component difficult to use. In patients who were switched from a standard IPG to RC-IPG, the majority who responded (70.3%) preferred the rechargeable IPG.CONCLUSIONSRC-IPGs can provide DBS patients with long-term therapeutic benefit while minimizing the need for battery replacement surgery. The authors have implanted rechargeable stimulators in 206 patients undergoing DBS surgery, and here they demonstrate the cost-effectiveness and high patient satisfaction associated with this procedure.
The distribution of brachial plexus lesions after experimental traction: a cadaveric study
Authors: Zapałowicz Krzysztof , Radek Maciej 
Published: September 2018

OBJECTIVEThe objective of the present study was to determine experimentally the distribution of lesions caused in the cadaveric brachial plexus (BP) by excessive stretching. The authors attempted to delineate the correlation between the direction of stretching and sites of lesions.METHODSFifteen specimens (each comprised the spinal segment C4–T2 with 2 BPs) were harvested from adult cadavers. Each BP was stretched in a mechanical testing machine at a constant speed of 200 mm/min. Specimens were divided into 3 groups: in group A the BPs were stretched caudally at a 45° angle to the spinal midline; in group B they were stretched perpendicularly to the spinal midline; and in group C the stretching was caudally parallel to the midline. Lesions of each BP were identified and analyzed. A graph of load against dislocation was registered when stretching to delineate the maximal force (Fmax), defined as the maximum load at which BP failure occurs.RESULTSBased on macroscopic examination, 140 sites of mechanical damage were identified in 30 BPs. Preganglionic injuries (63.6% of lesions), defined as avulsions of the spinal ganglia with their rootlets, were found in 89 spinal nerves. In group B—in which specimens were stretched perpendicularly to the spinal segment—preganglionic injuries were significantly more frequent (41 avulsed spinal nerves) than in groups A and C (21 and 27 avulsed spinal nerves, respectively). Postganglionic lesions equivalent to neurotmesis were found in 51 sites (36.4% of all lesions) along spinal nerves, trunks, divisions, and cords. Postganglionic lesions in group B were much less frequent (8) as compared with groups A and C (24 and 19, respectively).CONCLUSIONSPredominance of preganglionic lesions suggests that attachments of the BP to the spine are more susceptible to traction than postganglionic elements. Preganglionic lesions were mainly produced in C7, C8, and T1 spinal nerves, suggesting their weaker attachment to the spine than in the case of C5 and C6 nerves. Preganglionic lesions were highly correlated with a traction perpendicular to the spine, whereas postganglionic lesions were provoked mainly by traction directed at 45° caudally or by means of caudal traction parallel to the midline. This discrepancy implies a relationship between mechanical resistance of pre- and postganglionic elements of the BP and the vector of force.
Spinal arachnoid cysts in adults: diagnosis and management. A single-center experience
Authors: Fam Maged D. , Woodroffe Royce W. , Helland Logan , Noeller Jennifer , Dahdaleh Nader S. , Menezes Arnold H. , Hitchon Patrick W. 
Published: September 2018

OBJECTIVEAdult spinal arachnoid cysts (SACs) are rare entities of indistinct etiology that present with pain or myelopathy. Diagnosis is made on imaging studies with varying degrees of specificity. In symptomatic cases, the standard treatment involves surgical exploration and relief of neural tissue compression. The aim of this study was to illustrate features of SACs in adults, surgical management, and outcomes.METHODSThe authors searched medical records for all SACs in adults in the 10-year period ending in December 2016. Radiology and pathology reports were reviewed to exclude other spine cystic disorders. Recurrent or previously treated patients were excluded. Demographic variables (age, sex) and clinical presentation (symptoms, duration, history of infection or trauma, and examination findings) were extracted. Radiological features were collected from radiology reports and direct interpretation of imaging studies. Operative reports and media were reviewed to accurately describe the surgical technique. Finally, patient-reported outcomes were collected at every clinic visit using the SF-36.RESULTSThe authors’ search identified 22 patients with SACs (mean age at presentation 53.5 years). Seventeen patients were women, representing an almost 3:1 sex distribution. Symptoms comprised back pain (n = 16, 73%), weakness (n = 10, 45%), gait ataxia (n = 11, 50%), and sphincter dysfunction (n = 4, 18%). The mean duration of symptoms was 15 months. Seven patients (32%) exhibited signs of myelopathy. All patients underwent preoperative MRI; in addition, 6 underwent CT myelography. SACs were located in the thoracic spine (n = 17, 77%), and less commonly in the lumbar spine (n = 3, 14%) and cervical/cervicothoracolumbar region (n = 2, 9%). Based on imaging findings, the cysts were interpreted as intradural SACs (n = 11, 50%), extradural SACs (n = 6, 27%), or ventral spinal cord herniation (n = 2, 9%); findings in 3 patients (14%) were inconclusive. Nineteen patients underwent surgical treatment consisting of laminoplasty in addition to cyst resection (n = 13, 68%), ligation of the connecting pedicle (n = 4, 21%), or fenestration/marsupialization (n = 2, 11%). Postoperatively, patients were followed up for an average of 8.2 months (range 2–30 months). Postoperative MRI showed complete resolution of the SAC in 14 of 16 patients. Patient-reported outcomes showed improvement in SF-36 parameters. One patient suffered a delayed wound infection.CONCLUSIONSIn symptomatic patients with imaging findings suggestive of spinal arachnoid cyst, surgical exploration and complete resection is the treatment of choice. Treatment is usually well tolerated, carries low risks, and provides the best chances for optimal recovery.
First experience in using Novalis shaped beam radiosurgery in Korea
Authors: Whang Choong Jin , Yee Gi Taek , Choi Chan Young , Sohn Moon-Jun , Lee Dong Joon 
Published: September 2018

Object. The role of radiosurgery has become increasingly important in the treatment of intracranial lesions. In this study the authors evaluated the efficacy of the Novalis shaped beam radiosurgery system (dedicated linear accelerator) for various brain and spinal lesions.
Methods. Between November 2000 and October 2003 the authors treated 356 cases of various intracranial and extracranial lesions with Novalis shaped beam radiosurgery. Of these 356 cases, 109 cases were followed for more than a 2-year period. Fifty patients underwent fractionated stereotactic radiosurgery. Twenty patients (40%) harbored benign tumors (two acoustic neuromas, seven meningiomas, five pituitary adenomas, four optic gliomas, and two craniopharyngiomas), 18 patients (36%) harbored malignant tumors (16 glioblastoma multiforme [GBM], and two metastases), and the others included five with brainstem gliomas, one chordoma, five gliomas, and one with an arteriovenous malformation (AVM). Eighteen of 20 patients with benign tumors had good tumor control. Of 59 patients treated with single-dose stereotactic radiosurgery, 24 had benign intracranial tumors (12 acoustic neuromas, 11 meningiomas, and one pituitary adenoma), 20 had malignant tumors (two GBMs and 18 metastases), and the others were eight AVMs, two glomus jugulare tumors, three lymphomas, one pineal tumor, and one spinal tumor.
Conclusions. Stereotactic radiosurgery and fractionated stereotactic radiosurgery using the Novalis shaped beam radiosurgery system are effective and safe noninvasive treatment modalities for various intracranial and extracranial lesions.
Stereotactic radiotherapy for the treatment of acoustic neuromas
Authors: Selch Michael T. , Pedroso Alessandro , Lee Steve P. , Solberg Timothy D. , Agazaryan Nzhde , Cabatan-Awang Cynthia , Desalles Antonio A. F. 
Published: September 2018

Object. The authors sought to assess the safety and efficacy of stereotactic radiotherapy when using a linear accelerator equipped with a micromultileaf collimator for the treatment of patients with acoustic neuromas.
Methods. Fifty patients harboring acoustic neuromas were treated with stereotactic radiotherapy between September 1997 and June 2003. Two patients were lost to follow-up review. Patient age ranged from 20 to 76 years (median 59 years), and none had neurofibromatosis. Forty-two patients had useful hearing prior to stereotactic radiotherapy. The fifth and seventh cranial nerve functions were normal in 44 and 46 patients, respectively. Tumor volume ranged from 0.3 to 19.25 ml (median 2.51 ml). The largest tumor dimension varied from 0.6 to 4 cm (median 2.2 cm). Treatment planning in all patients included computerized tomography and magnetic resonance image fusion and beam shaping by using a micromultileaf collimator. The planning target volume included the contrast-enhancing tumor mass and a margin of normal tissue varying from 1 to 3 mm (median 2 mm). All tumors were treated with 6-MV photons and received 54 Gy prescribed at the 90% isodose line encompassing the planning target volume. A sustained increase greater than 2 mm in any tumor dimension was defined as local relapse. The follow-up duration varied from 6 to 74 months (median 36 months).
The local tumor control rate in the 48 patients available for follow up was 100%. Central tumor hypodensity occurred in 32 patients (67%) at a median of 6 months following stereotactic radiotherapy. In 12 patients (25%), tumor size increased 1 to 2 mm at a median of 6 months following stereotactic radiotherapy. Increased tumor size in six of these patients was transient. In 13 patients (27%), tumor size decreased 1 to 14 mm at a median of 6 months after treatment. Useful hearing was preserved in 39 patients (93%). New facial numbness occurred in one patient (2.2%) with normal fifth cranial nerve function prior to stereotactic radiotherapy. New facial palsy occurred in one patient (2.1%) with normal seventh cranial nerve function prior to treatment. No patient's pretreatment dysfunction of the fifth or seventh cranial nerve worsened after stereotactic radiotherapy. Tinnitus improved in six patients and worsened in two.
Conclusions. Stereotactic radiotherapy using field shaping for the treatment of acoustic neuromas achieves high rates of tumor control and preservation of useful hearing. The technique produces low rates of damage to the fifth and seventh cranial nerves. Long-term follow-up studies are necessary to confirm these findings.
A feasibility study of 18F-fluorodeoxyglucose positron emission tomography targeting and simultaneous integrated boost for intensity-modulated radiosurgery and radiotherapy
Authors: Solberg Timothy D. , Agazaryan Nzhde , Goss Bryan W. , Dahlbom Magnus , Lee Steve P. 
Published: September 2018

Object. The authors hypothesized that the efficacy of intensity-modulated radiation therapy (IMRT) can be enhanced by selectively increasing the radiation dose to the biologically active positron emission tomography (PET)-documented positive tumor subregions while simultaneously maintaining the overall clinically established target dose.
Methods. The authors undertook a feasibility study to evaluate IMRT PET/computerized tomography (CT) protocol for boost treatment in selected cancer patients. Prior to treatment, FDG-PET and CT scans were acquired using an integrated PET/CT scanner, ensuring accurate correlation between image sets. After acquisition, tumor volume and objects-at-risk (OARs) were outlined on the CT scans; any PET-positive tumor subregions were similarly outlined. Daily dosages of 1.8 to 2 Gy were prescribed to tumor volume and the margin whereas additional dosages of 10 to 20% were delivered to PET-positive subregions. Dosage—volume histogram—derived constraints were used in inverse planning to specify the desired dose to one or more PET-positive tumor subregions, CT-delineated tumor volume, and OARs. The IMRT treatment was delivered using a micromultileaf collimator.
Simultaneous integrated boost radiation was successfully delivered using IMRT with PET/CT planning. Excellent dose conformality was achieved in the tumor volume and the dose to PET-positive tumor subregions was increased while minimizing the dose to OARs.
Conclusions. When coupled with IMRT, PET/CT scanning allows dose escalation to biologically active subregions within the tumor volume. Further study is needed to determine if dose escalation to FDG-PET—active sites correlates with improved treatment outcome. Finally, in extracranial sites, PET scanning should only be performed with a dedicated PET/CT device because present image fusion technologies are inadequate for accurately registering deformable objects.
Safety and efficacy of stereotactic radiosurgery for tumors of the spine
Authors: Benzil Deborah L. , Saboori Mehran , Mogilner Alon Y. , Rocchio Ronald , Moorthy Chitti R. 
Published: September 2018

Object. The extension of stereotactic radiosurgery treatment of tumors of the spine has the potential to benefit many patients. As in the early days of cranial stereotactic radiosurgery, however, dose-related efficacy and toxicity are not well understood. The authors report their initial experience with stereotactic radiosurgery of the spine with attention to dose, efficacy, and toxicity.
Methods. All patients who underwent stereotactic radiosurgery of the spine were treated using the Novalis unit at Westchester Medical Center between December 2001 and January 2004 are included in a database consisting of demographics on disease, dose, outcome, and complications. A total of 31 patients (12 men, 19 women; mean age 61 years, median age 63 years) received treatment for 35 tumors. Tumor types included 26 metastases (12 lung, nine breast, five other) and nine primary tumors (four intradural, five extradural). Thoracic tumors were most common (17 metastases and four primary) followed by lumbar tumors (four metastases and four primary). Lesions were treated to the 85 to 90% isodose line with spinal cord doses being less than 50%. The dose per fraction and total dose were selected on the basis of previous treatment (particularly radiation exposure), size of lesion, and proximity to critical structures.
Conclusions. Rapid and significant pain relief was achieved after stereotactic radiosurgery in 32 of 34 treated tumors. In patients treated for metastases, pain was relieved within 72 hours and remained reduced 3 months later. Pain relief was achieved with a single dose as low as 500 cGy. Spinal cord isodoses were less than 50% in all patients except those with intradural tumors (mean single dose to spinal cord 268 cGy and mean total dose to spinal cord 689 cGy). Two patients experienced transient radiculitis (both with a biological equivalent dose (BED) > 60 Gy). One patient who suffered multiple recurrences of a conus ependymoma had permanent neurological deterioration after initial improvement. Pathological evaluation of this lesion at surgery revealed radiation necrosis with some residual/recurrent tumor. No patient experienced other organ toxicity.
Stereotactic radiosurgery of the spine is safe at the doses used and provides effective pain relief. In this study, BEDs greater than 60 Gy were associated with an increased risk of radiculitis.
Novalis Shaped Beam Radiosurgery of arteriovenous malformations
Authors: Pedroso Alessandra G. , De Salles Antonio A. F. , Tajik Katayoun , Golish Raymond , Smith Zachary , Frighetto Leonardo , Solberg Timothy , Cabatan-Awang Cynthia , Selch Michael T. 
Published: September 2018

Object. The authors studied outcomes and complications in patients who harbored arteriovenous malformations (AVMs) and underwent stereotactic radiosurgery involving the Novalis shaped beam unit.
Methods. Between January 1998 and January 2002, 83 patients were treated with radiosurgery at University of California, Los Angeles. The mean patient age was 37.8 years. Forty-four patients completed follow up. There were 24 women. Sixteen patients underwent repeated radiosurgery. Embolization was performed in 13 patients and radiosurgery alone in 31. The mean follow-up period after embolization was 54.4 ± 21.9 months and 37.4 ± 14.6 months for radiosurgery alone. The mean peripheral dose was 15 Gy (range 12–18 Gy). The mean preradiosurgery lesion volume was 9.7 ± 11.9 ml for radiosurgery alone and 16.2 ± 11.3 ml for embolization. The AVMs in 13 patients (29.8%) were Spetzler—Martin Grade II, 12 (27.5%) were Grade III, eight (18.2%) Grade IV, and five (11.3%) were Grade V and VI each. Spetzler—Martin grade, volume, and peripheral dose were analyzed in consideration to outcome.
A positive trend (p = 0.086) was observed between Spetzler—Martin grade and obliteration rate. Volume per se did not predict obliteration (p = 0.48). A peripheral dose of 18 Gy was shown to be the most important predictor for occlusion (p = 0.007). The overall obliteration rate was 52.5%. A transient complication was noticed in one case (2.3%) and but no permanent deficits due to radiosurgery have been detected so far. Three patients (6.8%) bled after radiosurgery.
Conclusions. The range of the prescribed peripheral dose was narrow. An association between the mean peripheral dose of 15 Gy, high conformality, and homogeneous dose distribution permitted no permanent complications. Volume per se did not correlate with outcome. The next step will be to increase the peripheral dose shaping the beam and to achieve higher obliteration rates without increasing complications.
MENINGKATKAN KEMAMPUAN MENDENGAR MELALUI AUDIO-VISUAL UNTUK MENAMBAH VOCABULARY (KOSA KATA) BAHASA INGGRIS
Authors: Marianova Yefni 
Published: September 2018

This study aims to improve the interest and quality of teaching and learning process of English students, especially on listening skills. Increased interest is done through the use of audio-visual media by displaying videos or listening to movies in the form of audio-visual which is expected to provide opportunities for the creation of fun learning conditions and to determine whether the Audio-Visual learning model can improve student activity and student achievement. This research method using TOD in three cycles in students of class VII-9 and VII-3 SMP N 21 Pekanbaru in three cycles. The three cycles cover the same stages, but with different media. Cycle 1 using notebook displays videos according to Chapter / title, KD and teaching materials, cycle 2 using notebook media with in focus listening to animation films, and cycle 3 using VCD media, consisting of four stages: planning, action execution, observation, and reflection. Actions can be done by applying learning with audio visual media. Learning process by utilizing different media then students become active to listen, record important words (vocabulary) from being heard and seen, recite, understand the meaning of words, train memory, and using vocabulary in simple sentences, student learning activeness looks more active. Based on the results of the research, it can be seen that the students 'learning mastery on the mastery of vocabulary by using audio-visual experience improvement. Where is known from the average value of students' ability on the initial data is 76.4 (enough) with 38.6% complete students or 17 0rang. The first cycle obtained an average of 79.4 (good) with a mastery of 65.9% students or 29 people. The results of the process of the learning process of the students of Class VII-9 SMPN 21 Pekanbaru City in the second cycle increased by an average of 83.2 (good) with a completeness of 44 students or 100%. Based on the results of the data then this research is said to be successful, because more than 85% of students have obtained a value of 78 - 100. Both cycles of action was apparently many students who are interested in learning English with audio visual media. Qualitatively, the atmosphere of English learning becomes more fun and creates positive effects on student learning development
Analisis Pengaruh Informativeness, Credibility, Entertainment, dan Irritation Terhadap Advertising Value Serta Implikasinya Terhadap Purchase Intention (Telaah Pada Iklan Gillette Mach 3 di Youtube)
Authors: Rivaldo Gregorius 
Published: September 2018

With the growth of YouTube users, it’s advertising features gave an opportunitiy for many manufacturers and companies to market their products. One of the companies that advertise through YouTube is Gillette. Gillette uses YouTube to advertise one of their main products Gillette Mach 3 Turbo. The issues raised in this study is to determine whether or not the customer’s intention to purchase of Gillette Mach 3 Turbo inflicted by their Youtube Ad is influenced by informativeness, credibility, entertainment, and irritation through advertising value. The theoretical model presented in this study includes 5 hypotheses and to be tested using Structural Equation Model. The sample in this study were 120 respondents, androgynous male, shaved at least 3 days, have a minimum age of 17 years, a YouTube user, and have never bought Gillette Mach 3 Turbo razor. A questionnaire is designed to gather information from prospective buyers of Gillette Mach 3 Turbo razor based on the YouTube ad. Results of the analysis showed that informativeness, credibility and entertainment positive effect on purchase intention through advertising value. While irritation negative effect on purchase intention through advertising value. The conclusion of this study is that Gillette Mach 3 Turbo advertisement provides high value to prospective customers that is YouTube users.
Keywords: informativeness, credibility, irritation, entertainment, advertising value, purchase intention