bluuebunny/crossref_metadata_2025_split huggingface dataset:
Straight sinus: ultrastructural analysis aimed at surgical tumor resection
Authors: Amato Marcelo Campos Moraes , Tirapelli Luis Fernando , Carlotti Carlos Gilberto , Colli Benedicto Oscar 
Published: January 2016

OBJECTIVE
Accurate knowledge of the anatomy of the straight sinus (SS) is relevant for surgical purposes. During one surgical procedure involving the removal of part of the SS wall, the authors observed that the venous blood flow was maintained in the SS, possibly through a vein-like structure within the dural sinus or dural multiple layers. This observation and its divergence from descriptions of the histological features of the SS walls motivated the present study. The authors aimed to investigate whether it is possible to dissect the SS walls while keeping the lumen intact, and to describe the histological and ultrastructural composition of the SS wall.

METHODS
A total of 22 cadaveric specimens were used. The SS was divided into three portions: anterior, middle, and posterior. The characteristics of the SS walls were analyzed, and the feasibility of dissecting them while keeping the SS lumen intact was assessed. The thickness and the number of collagen fibers and other tissues in the SS walls were compared with the same variables in other venous sinuses. Masson's trichrome and Verhoeff's stains were used to assess collagen and elastic fibers, respectively. The data were analyzed using Zeiss image analysis software (KS400).

RESULTS
A vein-like structure independent of the SS walls was found in at least one of the portions of the SS in 8 of 22 samples (36.36%). The inferior wall could be delaminated in at least one portion in 21 of 22 samples (95.45%), whereas the lateral walls could seldom be delaminated. The inferior wall of the SS was thicker (p < 0.05) and exhibited less collagen and greater amounts of other tissues—including elastic fibers, connective tissue, blood vessels, and nerve fibers (p < 0.05)—compared with the lateral walls. Transmission electron microscopy revealed the presence of muscle fibers at a level deeper than that of the subendothelial connective tissue in the inferior wall of the SS, extending from its junction with the great cerebral vein to the confluence of sinuses.

CONCLUSIONS
The presence of a structure within the SS that can maintain the venous blood flow despite the dural wall might be considered an anatomical variation. The greater thickness of the inferior wall of the SS compared with the lateral walls is mainly due to the presence of larger amounts of tissues other than collagen. Delamination of the inferior wall of the SS was mostly possible in its inferior wall, but an attempt to delaminate the lateral walls is not recommended. Ultrastructural assessment corroborated a recent report of the presence of muscle fibers in the inferior wall of the SS.
Temporary surgical clipping of flow-diverted arteries in an experimental aneurysm model
Authors: Darsaut Tim E. , Salazkin Igor , Gentric Jean-Christophe , Magro Elsa , Gevry Guylaine , Bojanowski Michel W. , Raymond Jean 
Published: January 2016

OBJECTIVE
Surgical management of recurrent aneurysms following failed flow diversion may pose difficulties in securing vascular control with temporary clips. The authors tested the efficacy and impact of different types of aneurysm clips on flow-diverted arteries.

METHODS
Six wide-necked experimental aneurysms were created in canines and treated with Pipeline flow diverters. In 4 aneurysms, occlusion of the artery at the level of the proximal and distal landing zones (n = 2 per aneurysm) was attempted, using temporary, fenestrated, single, and double permanent aneurysm clips. Two aneurysms served as unclipped controls. Serial angiography was performed to investigate the efficacy of clip occlusion, flow diverter deformation, and thrombus formation. After the animals were killed, the flow-diverted aneurysm constructs were opened and photographed to determine neointimal or device damage as a result of clip placement.

RESULTS
Angiography-confirmed clip occlusion was only possible for 4 of 8 of the tested flow-diverted arterial segments. Clip application attempts led to filling defects consistent with thrombus formation in 2 of 4 flow-diverted constructs, and to minor damage of the flow diverter with neointimal fracture in 1 of 4 cases.

CONCLUSIONS
Aneurysm clips placed on canine parent arteries bearing a Pipeline flow diverter were unable to reliably stop blood flow. Application of aneurysm clips can cause mild damage to the device and neointima, which might translate into thromboembolic risks. If possible, vascular control should be sought beyond the terminal ends of the implanted device.
Supratentorial hemispheric ependymomas: an analysis of 109 adults for survival and prognostic factors
Authors: Hollon Todd , Nguyen Vincent , Smith Brandon W. , Lewis Spencer , Junck Larry , Orringer Daniel A. 
Published: January 2016

OBJECTIVE
Survival rates and prognostic factors for supratentorial hemispheric ependymomas have not been determined. The authors therefore designed a retrospective study to determine progression-free survival (PFS), overall survival (OS), and prognostic factors for hemispheric ependymomas.

METHODS
The study population consisted of 8 patients from our institution and 101 patients from the literature with disaggregated survival information (n = 109). Patient age, sex, tumor side, tumor location, extent of resection (EOR), tumor grade, postoperative chemotherapy, radiation, time to recurrence, and survival were recorded. Kaplan-Meier survival analyses and Cox proportional hazard models were completed to determine survival rates and prognostic factors.

RESULTS
Anaplastic histology/WHO Grade III tumors were identified in 62% of cases and correlated with older age. Three-, 5-, and 10-year PFS rates were 57%, 51%, and 42%, respectively. Three-, 5-, and 10-year OS rates were 77%, 71%, and 58%, respectively. EOR and tumor grade were identified on both Kaplan-Meier log-rank testing and univariate Cox proportional hazard models as prognostic for PFS and OS. Both EOR and tumor grade remained prognostic on multivariate analysis. Subtotal resection (STR) predicted a worse PFS (hazard ratio [HR] 4.764, p = 0.001) and OS (HR 4.216, p = 0.008). Subgroup survival analysis of patients with STR demonstrated a 5- and 10-year OS of 28% and 0%, respectively. WHO Grade III tumors also had worse PFS (HR 10.2, p = 0.004) and OS (HR 9.1, p = 0.035). Patients with WHO Grade III tumors demonstrated 5- and 10-year OS of 61% and 46%, respectively. Postoperative radiation was not prognostic for PFS or OS.

CONCLUSIONS
A high incidence of anaplastic histology was found in hemispheric ependymomas and was associated with older age. EOR and tumor grade were prognostic factors for PFS and OS on multivariate analysis. STR or WHO Grade III pathology, or both, predicted worse overall prognosis in patients with hemispheric ependymoma.
Results of a prospective study (CATS) on the effects of thalamic stimulation in minimally conscious and vegetative state patients
Authors: Magrassi Lorenzo , Maggioni Giorgio , Pistarini Caterina , Di Perri Carol , Bastianello Stefano , Zippo Antonio G. , Iotti Giorgio A. , Biella Gabriele E. M. , Imberti Roberto 
Published: January 2016

OBJECTIVE
Deep brain stimulation of the thalamus was introduced more than 40 years ago with the objective of improving the performance and attention of patients in a vegetative or minimally conscious state. Here, the authors report the results of the Cortical Activation by Thalamic Stimulation (CATS) study, a prospective multiinstitutional study on the effects of bilateral chronic stimulation of the anterior intralaminar thalamic nuclei and adjacent paralaminar regions in patients affected by a disorder of consciousness.

METHODS
The authors evaluated the clinical and radiological data of 29 patients in a vegetative state (unresponsive wakefulness syndrome) and 11 in a minimally conscious state that lasted for more than 6 months. Of these patients, 5 were selected for bilateral stereotactic implantation of deep brain stimulating electrodes into their thalamus. A definitive consensus for surgery was obtained for 3 of the selected patients. All 3 patients (2 in a vegetative state and 1 in a minimally conscious state) underwent implantation of bilateral thalamic electrodes and submitted to chronic stimulation for a minimum of 18 months and a maximum of 48 months.

RESULTS
In each case, there was an increase in desynchronization and the power spectrum of electroencephalograms, and improvement in the Coma Recovery Scale–Revised scores was found. Furthermore, the severity of limb spasticity and the number and severity of pathological movements were reduced. However, none of these patients returned to a fully conscious state.

CONCLUSIONS
Despite the limited number of patients studied, the authors confirmed that bilateral thalamic stimulation can improve the clinical status of patients affected by a disorder of consciousness, even though this stimulation did not induce persistent, clinically evident conscious behavior in the patients.
Clinical trial registration no.: NCT01027572 (ClinicalTrials.gov)
A new comorbidities index for risk stratification for treatment of unruptured cerebral aneurysms
Authors: Newman William C. , Neal Dan W. , Hoh Brian L. 
Published: January 2016

OBJECTIVE
Comorbidities have an impact on risk stratification for outcomes in analyses of large patient databases. Although the Charlson Comorbidity Index (CCI) and the Elixhauser Comorbidity Index (ECI) are the most commonly used comorbidity indexes, these have not been validated for patients with unruptured cerebral aneurysms; therefore, the authors created a comorbidity index specific to these patients.

METHODS
The authors extracted all records involving unruptured cerebral aneurysms treated with clipping, coiling, or both from the Nationwide Inpatient Sample (2002–2010). They assessed the effect of 37 variables on poor outcome and used the results to create a risk score for these patients. The authors used a validation data set and bootstrapping to evaluate the new index and compared it to CCI and ECI in prediction of poor outcome, mortality, length of stay, and hospital charges.

RESULTS
The index assigns integer values (−2 to 7) to 20 comorbidities: neurological disorder, renal insufficiency, gastrointestinal bleeding, paralysis, acute myocardial infarction, electrolyte disorder, weight loss, metastatic cancer, drug abuse, arrhythmia, coagulopathy, cerebrovascular accident, psychosis, alcoholism, perivascular disease, valvular disease, tobacco use, hypothyroidism, depression, and hypercholesterolemia. Values are summed to determine a patient's risk score. The new index was better at predicting poor outcome than CCI or ECI (area under the receiver operating characteristic curve [AUC] 0.814 [95% CI 0.798–0.830], vs 0.694 and 0.712, respectively, for the other indices), and it was also better at predicting mortality (AUC 0.775 [95% CI 0.754–0.792], vs 0.635 and 0.657, respectively, for CCI and ECI).

CONCLUSIONS
This new comorbidity index outperforms the CCI and ECI in predicting poor outcome, mortality, length of stay, and total charges for patients with unruptured cerebral aneurysm. Reevaluation of other patient cohorts is warranted to determine the impact of more accurate patient stratification.
Hearing subclassification may predict long-term auditory outcomes after radiosurgery for vestibular schwannoma patients with good hearing
Authors: Mousavi Seyed H. , Niranjan Ajay , Akpinar Berkcan , Huang Marshall , Kano Hideyuki , Tonetti Daniel , Flickinger John C. , Dade Lunsford L. 
Published: January 2016

OBJECTIVE
In the era of MRI, vestibular schwannomas are often recognized when patients still have excellent hearing. Besides success in tumor control rate, hearing preservation is a main goal in any procedure for management of this population. The authors evaluated whether modified auditory subclassification prior to radiosurgery could predict long-term hearing outcome in this population.

METHODS
The authors reviewed a quality assessment registry that included the records of 1134 vestibular schwannoma patients who had undergone stereotactic radiosurgery during a 15-year period (1997–2011). The authors identified 166 patients who had Gardner-Robertson Class I hearing prior to stereotactic radiosurgery. Fifty-three patients were classified as having Class I-A (no subjective hearing loss) and 113 patients as Class I-B (subjective hearing loss). Class I-B patients were further stratified into Class I-B1 (pure tone average ≤ 10 dB in comparison with the contralateral ear; 56 patients), and I-B2 (> 10 dB compared with the normal ear; 57 patients). At a median follow-up of 65 months, the authors evaluated patients' hearing outcomes and tumor control.

RESULTS
The median pure tone average elevations after stereotactic radiosurgery were 5 dB, 13.5 dB, and 28 dB in Classes I-A, I-B1, and I-B2, respectively. The median declines in speech discrimination scores after stereotactic radiosurgery were 0% for Class I-A (p = 0.33), 8% for Class I-B1 (p < 0.0001), and 40% for Class I-B2 (p < 0.0001). Serviceable hearing preservation rates were 98%, 73%, and 33% for Classes I-A, I-B1, and I-B2, respectively. Gardner-Robertson Class I hearing was preserved in 87%, 43%, and 5% of patients in Classes I-A, I-B1, and I-B2, respectively.

CONCLUSIONS
Long-term hearing preservation was significantly better if radiosurgery was performed prior to subjective hearing loss. In patients with subjective hearing loss, the difference in pure tone average between the affected ear and the unaffected ear was an important factor in long-term hearing preservation.
Epidural hematomas after the implantation of thoracic paddle spinal cord stimulators
Authors: Moufarrij Nazih A. 
Published: January 2016

OBJECTIVE
There is little information on the frequency of symptomatic epidural hematomas after the implantation of paddle spinal cord stimulators (SCSs) in the thoracic spine. The purpose of this paper is to provide this metric and compare it to the frequency of symptomatic epidural hematomas for all other thoracic laminectomies combined.

METHODS
This study involved retrospectively analyzing the experience of a single surgeon in a consecutive series of patients who underwent the implantation of a thoracic paddle SCS with respect to the occurrence of a symptomatic epidural hematoma. For comparison, the occurrence of a symptomatic epidural hematoma in non-SCS thoracic laminectomies done during the same period of time was determined.

RESULTS
One hundred fifty-four thoracic paddle SCSs were implanted between May 2002 and February 2015. Despite perfect hemostasis and no preoperative risk factors, 4 of 154 patients (2.60%) developed postoperative lower-extremity weakness caused by an epidural hematoma. There were no other causes of a neurological deficit. In 3 of the 4 patients, the symptoms were delayed. Over the same time period, only 1 of 119 patients (0.84%) developed a postoperative motor deficit from a symptomatic epidural hematoma after a non-SCS laminectomy.

CONCLUSIONS
The occurrence of epidural hematomas after thoracic paddle SCS implantation may be underreported. Suggestions are given to decrease its incidence. It seems paradoxical that an epidural hematoma occurred 3 times more often after small SCS thoracic laminectomies than after larger non-SCS thoracic laminectomies. If confirmed by future studies, this finding may suggest that the intrusion of instruments into a confined epidural sublaminar space or the presence of a paddle and a hematoma in this restricted space may account for this differential.
Submaximal angioplasty for symptomatic intracranial atherosclerosis: a prospective Phase I study
Authors: Dumont Travis M. , Sonig Ashish , Mokin Maxim , Eller Jorge L. , Sorkin Grant C. , Snyder Kenneth V. , Nelson Hopkins L. , Levy Elad I. , Siddiqui Adnan H. 
Published: January 2016

OBJECTIVE
Intracranial atherosclerotic disease (ICAD) accounts for approximately 10% of ischemic strokes. The recent Stenting and Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis (SAMMPRIS) study demonstrated a high incidence of perioperative complications (15%) for treatment of ICAD with stenting. Although the incidence of stroke was lower in the medical arm, recurrent stroke was found in 12% of patients despite aggressive medical management, suggesting that intervention may remain a viable option for ICAD if perioperative risk is minimized. Angioplasty without stenting represents an alternative and understudied revascularization treatment for ICAD. Submaximal angioplasty limits the risks of thromboembolism, vessel perforation, and reperfusion hemorrhage that were frequently reported with stenting in the SAMMPRIS trial. The authors conducted a prospective Phase I trial designed to assess the safety of submaximal angioplasty in patients with symptomatic ICAD.

METHODS
This study was approved by the local institutional review board. Demographic and clinical data were prospectively collected. Angioplasty was performed with a balloon undersized to approximately 50%–70% of the nondiseased vessel diameter in patients with symptomatic ICAD who had angiographically significant stenosis of ≥ 70%. The primary outcome measure was the incidence of periprocedural complications (combined rate of death, stroke, and hemorrhage occurring within 30 days and at 1 year).

RESULTS
Among the 65 patients with symptomatic ICAD who were screened, 24 had significant angiographic stenosis that met the inclusion criteria of this study. The mean age was 64.08 years (median 65 years; SD ± 11.24 years), most were men (62.5%), and most were white (66.67%). Many patients had concomitants of vascular disease, including hypertension (95.8%), hyperlipidemia (70.83%), smoking history (54.1%), and diabetes mellitus (50.0%). Coronary artery disease (41.66%) and previous stroke or transient ischemic attack (45.83%) were frequently present. Most patients (75%) had anterior circulation stenosis. The mean preprocedure stenosis was 80.16% (median 80%, range 70%–95%). Submaximal angioplasty was performed in patients who met the inclusion criteria, with a mean postangioplasty stenosis rate of 54.62% (median 55.5%, range 31%–78%). Rates of ischemic stroke in the territory of the treated artery were 0% within 30 days and 5.55% (in the only patient who presented with recurrent stroke) at 1 year. The mortality and hemorrhage rates in this series were 0%.

CONCLUSIONS
This study demonstrates the safety of the submaximal angioplasty technique, with no permanent periprocedural complications in 24 treated patients.
Waldertrag und Anbaurisiko in einer unsicheren Klimazukunft
Authors: Kölling Christian , Mette Tobias , Knoke Thomas 
Published: January 2016

Forest productivity and cultivation risk in an uncertain climate future
Changes in climate conditions will lead to strong yet uncertain changes concerning forest growth and cultivation risk. Economic success as an important criterion for management decisions depends on both aspects, natural yield and risk. This study presents a new concept how (potential) yield and risk can be estimated from large-scale inventory data. As a result, any stand can be plotted in a yield-risk coordinate system and its future yield expectancy can be described by a trajectory in the yield-risk space. This strictly analytical approach cannot take over silvicultural decisions, but facilitates them from an objective basis. The implementation of approved economic guidelines such as the caution principle or the principle of flexibility builds upon the yield-risk approach and demonstrates benefits of climate-adapted stable mixed forest silviculture.
A cline in seed dormancy helps conserve the environment experienced during reproduction across the range of Arabidopsis thaliana
Authors: Burghardt Liana T. , Metcalf C. Jessica E. , Donohue Kathleen 
Published: January 2016

PREMISE OF THE STUDY:Understanding the factors shaping range limits is critical given current changes in climate as well as human‐mediated introduction of species into novel environments. Phenological responses to climate influence range limits by allowing plants to avoid conditions that decrease population growth rates. Studying these processes is a challenge due to the joint contributions of both genetic and environmental variation to phenology.METHODS:Using a previously developed model that predicts phenology of three dormancy “genotypes” in four locations spanning the European range of Arabidopsis thaliana, we examined how variation in seed dormancy influences the environmental conditions experienced by reproductive individuals and how those conditions influence reproductive potential. We calculated two metrics: temperature experienced during reproduction and the length of thermal window available for reproduction.KEY RESULTS:Seed dormancy levels determine whether a spring‐flowering life cycle is expressed and thus determine the reproductive environment. A genetic cline in seed dormancy across the range reduces differences in reproductive environment and increases the thermal opportunity for reproduction before conditions become unfavorable for survival. Counter‐intuitively, these putatively local genotypes are predicted to reproduce in slightly cooler conditions in the south than in the north, suggesting that maternal environmental effects on average could induce deeper dormancy in southern seeds reinforcing the observed genetic cline. However, within a location, we found large individual level differences.CONCLUSIONS:Phenological adjustments of early life stages can contribute to the maintenance of consistent reproductive environments experienced by individual plants across ranges despite variable environmental conditions over time and space.
Les migrations internes des jeunes diplômés universitaires du Jura suisse : parcours, sélectivité et motivations
Authors: Rérat Patrick 
Published: January 2016

L’article présente une recherche menée auprès de jeunes diplômés universitaires en provenance d’une région rurale (canton du Jura en Suisse) et discute trois grands résultats. Tout d’abord, les parcours migratoires des jeunes diplômés sont majoritairement orientés vers les zones urbaines ; ils sont néanmoins accompagnés de migrations de retour non négligeables. Ensuite, la propension des jeunes diplômés à revenir dans leur région d’origine est un phénomène sélectif qui varie en fonction de leurs trajectoires socio-familiales, migratoires et professionnelles. Finalement, les migrations internes sont bien plus qu’une réponse automatique aux différentiels du marché de l’emploi ; elles renvoient à une conjonction variable de facteurs relatifs aux opportunités professionnelles, au lien social et au cadre de vie. Ces résultats ont une portée plus générale et demandent à être intégrés et testés dans l’analyse d’autres formes de migrations interrégionales.
L’impact conjugal du virtuel Éclatement des façons de faire couple à l’heure d’Internet
Authors: Neyrand Gérard 
Published: January 2016

Pour cet article de réflexion critique, il s’agit de montrer en quoi les sites de rencontre, en proposant un dispositif spécifique de mise en relation de possibles partenaires, contribuent à modifier à différents niveaux la façon de concevoir le couple et de réfléchir à ce qu’il représente. L’intellectualisation que représente la nécessité de présentation de soi avant même l’éventuelle rencontre, tout autant que la définition des attentes envers le possible partenaire, positionnent différemment l’individu par rapport à une rencontre « classique ». Les dimensions plus concrètes, physiques, et aussi inconscientes en jeu dans une rencontre « spontanée » semblent passer au second plan, au moins dans un premier temps. Mais ce processus de rationalisation porte en lui un certain nombre de contradictions, qui peuvent entrer en phase avec les paradoxes de l’hypermodernité : réalisation de soi dans l’autre et exacerbation des attentes envers autrui en parallèle avec l’affirmation individualiste de soi…