bluuebunny/crossref_metadata_2025_split huggingface dataset:
Unstable os odontoideum contributing to cervical myelopathy and obstructive sleep apnea
Authors: Rahimizadeh Abolfazl , Malekmohammadi Zahed , Karimi Mona , Rahimizadeh Ava , Asgari Naser 
Published: August 2019

Background:Sleep apnea is characterized by repetitive cessation of breathing during sleep. It may be attributed to obstructive, central, or mixed pathologies close to the upper airway resulting in a decreased diameter of the oropharyngeal tract.Case Description:A 36-year-old male with progressive cervicomedullary myelopathy/quadriparesis exhibited obstructive sleep apnea (OSA) attributed to an anteriorly displaced os odontoideum (OO). Atlantoaxial screw-rod stabilization resulted in improvement of both neurological function and OSA.Conclusion:A symptomatic unstable OO may contribute to suboccipital pain, progressive quadriparesis, vertebrobasilar insufficiency, and OSA. Appropriate operative intervention utilizing atlantoaxial screw-rod stabilization may help to resolve these deficits.
Transradial approach for endovascular diagnosis and treatment of ruptured cerebral aneurysms: A descriptive study
Authors: Goland Javier , Doroszuk Gustavo 
Published: August 2019

Background:
For cardiovascular procedures, the transradial approach has been documented to yield fewer complications than the femoral approach. It has become the approach of choice for diagnostic and therapeutic interventions involving the coronary arteries. However, few published data exist on using this approach for neuroendovascular procedures and we describe a series of ruptured cerebral aneurysms diagnosed and treated using the transradial approach.

Methods:
All patients scheduled for cerebral angiography to diagnose and treat subarachnoid hemorrhages at our hospital from June 2016 to May 2018, by right radial artery access, were recruited and followed prospectively. The main outcomes of interest were the length of the procedure (in minutes), the success of treatment, and the incidence of postprocedural complications.

Results:
Over the observation period, 59 patients (66% women, mean age = 48 years) with a combined 61 aneurysms treated were identified who met inclusion criteria. Of the 61 aneurysms treated, eight (13%) were within the posterior circulation (13%) and 53 (87%) the anterior circulation. Average procedural duration was 64.9 min. No occlusion or spasm of the radial artery was observed during any procedure. All patients had immediate pre- and post-embolization angiography, which revealed the guide catheter coming from the right subclavian artery. A radial pulse was evident after all interventions. All procedures were considered successful at treating the ruptured aneurysm, and no patient experienced a clinically significant complication related to the approach.

Conclusions:
The transradial approach is a viable option for the diagnosis and endovascular treatment of acute cerebral aneurysms in different locations.
Thoracic cryptococcal osteomyelitis mimicking tuberculosis: A case report
Authors: Adsul Nitin , Kalra K. L. , Jain Nikhil , Haritwal Mukesh , Chahal R. S. , Acharya Shankar , Jain Sunila 
Published: August 2019

Background:
Isolated cryptococcal osteomyelitis of the spine is extremely uncommon; there have been only seven cases identified in literature. The majority were originally misdiagnosed as tuberculosis. Here, we present a patient with cryptococcal osteomyelitis of the thoracic spine with associated fungal retinal deposits.

Case Description:
A 45-year-old, type II diabetic female presented with a 5-month history of severe back pain. Her magnetic resonance imaging (MRI) revealed osteomyelitis involving the T4 vertebral body with epidural and prevertebral extension; notably, the intervertebral disc spaces were not involved. Although the fine-needle aspiration cytologic examination was inconclusive, the patient was empirically placed on antitubercular drug therapy. One month later, she became fully paraplegic. The MRI now demonstrated osteolytic lesions involving the T4 vertebral body with cord compression. She underwent biopsy of the T4 vertebral body and a transfacet T4 decompression with T2-T6 pedicle screw fixation. Culture and histopathological examinations both documented a cryptococcal infection, and she was placed on appropriate antifungal therapy. Notably, 3 weeks after surgery, she developed a sudden loss of vision loss due to retinal fungal endophthalmitis. She recovered vision in one eye after the administration of intravitreal voriconazole but lost vision in the other eye despite a vitrectomy. Over the next 8 months, she gradually recovered with motor function of 4/5 in both lower extremities without evidence of recurrent disease.

Conclusion:
Cryptococcal infection should be among the differential diagnostic considerations for patients with vertebral osteomyelitis. Notably, diagnostic delay can lead to devastating neurological deficits and involvement of other organ systems.
Type I split cord malformation and tethered cord syndrome in an adult patient: A case report and literature review
Authors: D’Agostino Erin N. , Calnan Daniel R. , Makler Vyacheslav I. , Khan Imad , Kanter John H. , Bauer David F. 
Published: August 2019

Background:
In a split cord malformation (SCM), the spinal cord is divided longitudinally into two distinct hemicords that later rejoin. This can result in a tethered cord syndrome (TCS). Rarely, TCS secondary to SCM presents in adulthood. Here, we present an adult female with Type I SCM resulting in TCS and a review of literature.

Case Description:
A 57-year-old female with a history of spina bifida occulta presented with a 2-year history of worsening back and left leg pain, difficulty with ambulation, and intermittent urinary incontinence; she had not responded to conservative therapy. Magnetic resonance imaging (MRI) revealed a tethered cord secondary to lumbar type I SCM. The patient underwent an L1–S1 laminectomy for resection of the bony septum with cord detethering. At 2-month follow-up, the patient had improvement in her motor symptoms and less pain. In literature, 25 cases of adult-onset surgically managed SCM with TCS were identified (between 1936 and 2018). Patients averaged 37 years of age at the time of diagnosis, and 56% were female.

Conclusion:
TCS can present secondary to SCM in adulthood and is characterized predominantly by back and leg pain.
Conditions associated with giant pituitary tumors at the time of surgery effecting outcome morbidity and mortality
Authors: Billings Marc , Dahlin Robert , Zampella Bailey , Sweiss Raed , Lawandy Shokry , Miulli Dan 
Published: August 2019

Background:
Surgical outcome prediction has assisted physicians in discussing surgical intervention or expectant management. While increasing pituitary tumor size would seem to be associated with increasing challenge of removal and associated complications, that relationship has not been borne in the literature.

Methods:
We performed a retrospective review of a consecutive cohort of pituitary surgeries completed at our institution. Data included age at the time of surgery, presenting symptoms and Glasgow Coma scale (GCS), GCS at discharge or 7 days postoperatively, GCS at 6 months, adenoma size, imaging characteristics of the tumor and brain before resection, postoperative complications, the presence of preoperative hydrocephalus, brainstem compression, and patient mortality.

Results:
Patients with giant adenomas were more likely to present with a cranial nerve palsy (P = 0.019), altered mental status (P = 0.0001), hydrocephalus (P = 0.002), and mass effect on the brainstem (P = 0.020). Patients who experienced a postoperative decline in mental status were more likely to present with altered mental (P = 0.006), had an increased prevalence of mass effect on the brainstem (P = 0.005), and were more likely to have either an ischemic stroke (P = 0.0001) and vasospasms or new intraparenchymal hemorrhage (P = 0.013).

Conclusion:
The results of this study demonstrate that postoperative mental status declines after pituitary adenoma resection can be directly related to brainstem compression and further surgical irritation of the surrounding vasculature. The intraoperative irritation can be multifactorial and may result as the decompressed brain structures assume their anatomical position.
A challenging case of concurrent multiple sclerosis and anaplastic astrocytoma
Authors: Sinclair Georges , Al-saffar Yahya , Johnstone Philippa , Hatiboglu Mustafa Aziz , Shamikh Alia 
Published: August 2019

Background:
Cases of gliomas coexisting with multiple sclerosis (MS) have been described over the past few decades. However, due to the complex clinical and radiological traits inherent to both entities, this concurrent phenomenon remains difficult to diagnose. Much has been debated about whether this coexistence is incidental or mirrors a poorly understood neoplastic phenomenon engaging glial cells in the regions of demyelination.

Case Description:
We present the case of a 41-year-old patient diagnosed with a left-sided frontal contrast enhancing lesion initially assessed as a tumefactive MS. Despite systemic treatment, the patient gradually developed signs of mass effect, which led to decompressive surgery. The initial microscopic evaluation demonstrated the presence of MS and oligodendroglioma; the postoperative evolution proved complex due to a series of MS-relapses and tumor recurrence. An ulterior revaluation of the samples for the purpose of this report showed an MS-concurrent anaplastic astrocytoma. We describe all relevant clinical aspects of this case and review the medical literature for possible causal mechanisms.

Conclusion:
Although cases of concurrent glioma and MS remain rare, we present a case illustrating this phenomenon and explore a number of theories behind a potential causal relationship.
Resection of a lateral supratentorial endodermal cyst complicated by postoperative seizures: A case report
Authors: Nagata Keisuke , Kiyofuji Satoshi , Yokoyama Munehiro , Sora Shigeo 
Published: August 2019

Background:
Endodermal cysts are uncommon cystic lesions usually located at the ventral aspects of the spine. A lateral supratentorial location of such cysts is extremely rare. A unique case of a lateral supratentorial endodermal cyst that required surgical intervention due to uncal herniation, complicated with postoperative seizures, is presented.

Case Description:
A 48-year-old man presented with transient motor aphasia and diplopia. Magnetic resonance imaging showed a cystic lesion occupying the left frontal and temporal convexity with midline shift and uncal herniation. Cyst resection was performed, and cyst contents with mucous-like components were aspirated. Histopathological examination showed an endodermal cyst. The patient showed no neurological deficits immediately after surgery but developed tonic-clonic seizures 9 h after surgery. Sedation and intubation were required to control the seizures. After administering multiple antiepileptic drugs, he was extubated on the 5th day after surgery. He was discharged home in a month with mild impairment in dexterity of his right hand.

Conclusions:
Surgical intervention for endodermal cysts can be complicated by postoperative seizures caused by chemical irritation of brain cortex due to spillage of cyst contents. It is important to irrigate the cyst wall very well intraoperatively and pay attention not to spill the cyst fluid to unaffected locations. Preoperative administration of antiepileptic drugs should also be considered if endodermal cysts, not simple arachnoid cysts, are suspected preoperatively.
Cranioplasty following decompressive craniectomy – Analysis of complication rates and neurological outcomes: A single center study
Authors: Singh Saraj , Singh Rakesh , Jain Kapil , Walia Bipin 
Published: August 2019

Background:Cranioplasty is the surgical intervention to repair cranial defects in both cosmetic and functional ways. Despite the fact that cranioplasty is a simple procedure, it is still associated with a relatively high complication rate, ranging between series from 12% to 50%.Methods:The author did a prospective cohort study of patients from August 2015 to December 2017, who had undergone decompressive craniectomy followed by cranioplasty after 6 weeks at our institution. All patients were followed up to 6 months after cranioplasty and complications were recorded both by imaging and clinically. The complications were classified as minor (subgaleal collection, seizures) who did not require the second surgery and major (hydrocephalus, bone flap infection) who required the second surgery. To find out neurological outcome, Glasgow coma score (GCS) and Glasgow outcome scale extended (GOSE) were recorded at 1 month, 3 months, and 6 months.Results:Overall complication rate in this study was 22.4% (16/72). Subgaleal collection was the most common complication (5.6%), followed by hydrocephalus (4.2%), seizure (4.2%), bone flap infection (2.8%), intracerebral hematoma (2.8%), empyema (1.4%), and subdural hematoma (SDH) (1.4%). Of these, 8.4% (n= 6/72) were major complication (hydrocephalusn= 3, bone flap infectionn= 2, and SDHn= 1) which required the second surgery. GCS and GOSE were assessed preoperatively and in postoperative period at 1 month, 3 months, and 6 months. Both mean values of GCS and GOSE showed a significant improvement at 3 and 6 months after cranioplasty.Conclusion:Cranioplasty after decompressive craniectomy is associated with higher complication rate, but good neurological outcome after surgery always outweighs the complications.Key Message:Cranioplasty after decompressive craniectomy is associated with higher complication rate, but good neurological outcome after surgery always outweighs the complications. However, complications rate can be brought down by meticulous timing of cranioplasty in a patient of well-controlled comorbidities and precise surgical techniques. However, storing bone in bone bank is not an additional factor for any postcranioplasty complications which was considered previously.
Intraoperative tension pneumothorax during posterior vertebral column resection in a child with congenital scoliosis
Authors: Rahimizadeh Abolfazl , Hassani Valiollah , Mohsenikabir Nima , Rahimizadeh Ava , Karimi Mona , Asgari Naser 
Published: August 2019

Background:Intraoperative tension pneumothorax (TPT) is extremely rare in spinal surgery overall and particularly in extensive deformity procedures. Here, we report a TPT occurring in conjunction with posterior vertebral column resection (pVCR) for the treatment of congenital scoliosis.Case Description:A 12-year-old female undergoing congenital thoracic scoliosis surgery (e.g., pVCR) developed abrupt intraoperative increases in airway pressure and compromised hemodynamics that led to a TPT. This was directly attributed to an inadvertent pleural tear. Temporary drainage of the accumulated air was accomplished with a urethral catheter inserted directly into the pleural cavity. This was later supplemented with a standard chest tube. The child quickly improved and was routinely discharged a few days later.Conclusion:In patients undergoing pVCR, if the surgical team is faced with unexplained hemodynamic instability and increased airway resistance, a TPT should be strongly suspected and appropriately managed.
Cervical alignment following laminoplasty for cervical spondylotic myelopathy
Authors: Sharma Ravi , Borkar Sachin A. , Phalak Manoj , Joseph S. Leve , Kale Shashank S. 
Published: August 2019

Background:
Laminoplasty can result in the loss of cervical lordosis (LOCL) or the development of kyphosis after surgery. Here, we evaluated the clinical and radiological parameters involved in predicting the postoperative LOCL following laminoplasty in patients with cervical spondylotic myelopathy (CSM) and ossification of the posterior longitudinal ligament (OPLL).

Methods:
For 50 patients with CSM and 35 with OPLL undergoing laminoplasty, preoperative and 1-year postoperative X-rays were obtained to determine the incidence and risk factors contributing to postoperative LOCL. The patients were divided into two groups depending on whether the preoperative T1 slope was above or below the median preoperative T1S (26°); Group A – high T1 slope group (n = 40) and Group B – low T1 slope group (n = 45).

Results:
Following laminoplasty, Group A patients had significantly higher preoperative lordosis (C2-C7 Cobb’s angle) (P = 0.001) and significantly higher LOCL (P = 0.02) versus Group B patients with low T1 slopes. The preoperative T1 slope was also found to be significantly correlated with the preoperative C2-C7 Cobb’s angles (R = 0.619, P = 0.001), LOCL (R = 0.487, P = 0.001), and preoperative C2-C7 sagittal vertical axis (R = 0.480, P = 0.001). Utilizing multivariate analysis and a generalized linear model, the preoperative T1 slope significantly impacted the Oswestry disability index (ODI) index (P = 0.002) and frequency of LOCL (P = 0.001) following laminoplasty.

Conclusion:
The preoperative T1 slope is a significant predictor of the LOCL and change in ODI following laminoplasty for CSM/OPLL utilizing a cutoff value of 29.5°.
Technical report: Simple method of animal stroke model of luminal occlusion of middle cerebral artery in Indonesia
Authors: Makkiyah Feda Anisah , Sadewo Wismaji 
Published: August 2019

Background:
Although there are many experimental studies describing the suture method of middle cerebral artery occlusion (MCAO) in rats, this is still a new procedure in Indonesia and the techniques for applying this stroke model in animal research are not well known. There has been a perception in Indonesian scientific community that the technique would be difficult and require advanced equipment. The aim of this study is to demonstrate that it is possible to perform the technique with minimal resources using simple method and basic surgical loupe equipment.

Methods:
A total of 30 male Wistar rats, aged 6 months, weighing 250 g–400 g Wistar rats, were obtained from the Bandung Biofarma Pasteur. Preliminary trials were performed to gain an understanding of the detailed anatomy of the animals and to master the techniques. An ×8 loupe magnification was used for all surgical steps in this study except taking of surgical operation photos. The procedures applied simple methods, using two loop temporary knots instead of any animal vascular clips.

Results:
After an extensive training period, two of the 30 rats died within 4 weeks after the procedure. The effects of MCAO were confirmed clinically and by hematoxylin-eosin staining pathology slides.

Conclusion:
With simple methods, this MCAO procedure could be implemented in developing countries such as Indonesia without the requirement for advanced equipment.
Enterovirus D68 serosurvey: evidence for endemic circulation in the Netherlands, 2006 to 2016
Authors: Karelehto Eveliina , Koen Gerrit , Benschop Kimberley , van der Klis Fiona , Pajkrt Dasja , Wolthers Katja 
Published: August 2019

Background
Enterovirus D68 (EV-D68) has caused major outbreaks of severe respiratory illness worldwide since 2010.

Aim
Our aim was to evaluate EV-D68 circulation in the Netherlands by conducting a serosurvey of EV-D68 neutralising antibodies (nAb) among the Dutch general population.

Methods
We screened 280 sera from children and adults in the Netherlands and used two independent sets of samples collected in the years 2006 and 2007 and in the years 2015 and 2016, time points before and after the first EV-D68 upsurge in 2010. Neutralisation capacity of the sera was tested against the prototype Fermon EV-D68 strain isolated in 1962 and against a recent EV-D68 strain (genotype B3) isolated in France in 2016.

Results
Regardless of the time of serum collection, we found remarkably high overall seropositivity (94.3–98.3%) for nAb against both EV-D68 strains. Geometric mean titres increased in an age-dependent manner.

Conclusions
Our data suggest that EV-D68 has been circulating in the Netherlands for decades and that the enterovirus surveillance does not accurately capture the prevalence of this clinically relevant pathogen.
Optimum Efficiency of PV Panel Using Genetic Algorithms to Touch Proximate Zero Energy House (NZEH)
Authors: Ahmed Bdoor Majed , Farman ALhialy Nibal Fadel 
Published: August 2019

By optimizing the efficiency of a modular simulation model of the PV module structure by genetic algorithm, under several weather conditions, as a portion of recognizing the ideal plan of a Near Zero Energy Household (NZEH), an ideal life cycle cost can be performed. The optimum design from combinations of NZEH-variable designs, are construction positioning, window-to-wall proportion, and glazing categories, which will help maximize the energy created by photovoltaic panels. Comprehensive simulation technique and modeling are utilized in the solar module I-V and for P-V output power. Both of them are constructed on the famous five-parameter model. In addition, the efficiency of the PV panel is established by the genetic algorithm under the standard test conditions (STC) and a comparison between the theoretical and experimental results is done to achieve maximum performance ranging from 0.15 to 0.16, particularly with an error of about - 0.333 for an experimental power of 30 Watts compared with the theoretical power of 30.1 Watts. The results obtained by the genetic algorithm give the best value for efficiency at the range of 16% to 17% of solar radiation, from 500–600 W/m2. These values are almost identical to the efficiency obtained from the results of the operation, where the best value for efficiency in the experimental results was seen to be 15.7%.
Digital Performance of OCTO Layout Style on SOI MOSFET at High Temperature Environment
Authors: Galembeck Egon Henrique Salerno , Flandre Denis , Renaux Christian , Gimenez Salvador Pinillos 
Published: August 2019

This present paper performs an experimental comparative study of the main digital parameters and figures of merit of the octagonal layout style for the planar Silicon-On-Insulator (SOI) Metal-Oxide-Semiconductor (MOS) Field Effect Transistors (MOSFET), named OCTO SOI MOSFETs (OSM) in comparison with the typical rectangular one at high temperature environments. The devices were manufactured with the 1 mm SOI (CMOS) technology. The results demonstrate that the OSM is capable of keeping active the Longitudinal Corner Effect (LCE), the PArallel Connection of MOSFETs with Different Channel Lengths Effect (PAMDLE) and the Deactivate the Parasitic MOSFETs of the Bird’s Beak Regions Effect (DEPAMBBRE) at high temperature conditions. Therefore, the OSM is able to continue to have a better electrical performance than the one found in the rectangular SOI MOSFET (RSM) counterparts, regarding the same gate areas and bias conditions. To illustrate, its on-state drain current (ION) and off-state drain current (IOFF) are respectively 186% higher and 64% smaller in relation to its RSM counterparts at high temperature conditions.
Media Compact Disk Interaktif Berbudaya Sehat untuk Meningkatkan Kosa Kata Anak Usia Dini
Authors: Prahesti Swantyka Ilham , Taulany Himmah , Fauziah Syifa 
Published: August 2019

Tujuan penelitian ini yaitu menentukan perbedaan hasil belajar pengembangan menggunakan media pembelajaran CD interaktif dan media konvensional. Penelitian ini menggunakan pendekatan kuantitatif dengan desain penelitian eksperimen tipe nonequevalen control group design. Simpulan penelitian ini adalah: media CD Interaktif Kosa Kata Berbudaya Sehat dapat meningkatkan kosa kata pada anak usia 5-6 tahun, dibuktikan dengan hasil nilai thitung = 11,691 dengan ttabel = -2,045, ada perbedaan rata-rata sebelum dan sesudah dilaksanakan penelitian pada kelompok 1; media konvensional untuk meningkatkan kosa kata pada anak usia 5-6 tahun, dibuktikan dengan hasil nilai thitung = 11,691 dengan ttabel = -2,045, ada perbedaan rata-rata hasil pretes dan postes kelompok 2; Hasil belajar kosa kata menggunakan media CD Interaktif lebih besar dari pada Hasil Belajar kosa kata menggunakan media konvensional dibuktikan melalui uji t Independent bahwa data postes antara kelompok 1 dan kelompok 2 adalah H0 ditolak karena memiliki nilai thitung = 9,863 dengan ttabel = -2,048