bluuebunny/crossref_metadata_2025_split huggingface dataset:
Phase I/II study of resection and intraoperative cesium-131 radioisotope brachytherapy in patients with newly diagnosed brain metastases
Authors: Wernicke A. Gabriella , Yondorf Menachem Z. , Peng Luke , Trichter Samuel , Nedialkova Lucy , Sabbas Albert , Kulidzhanov Fridon , Parashar Bhupesh , Nori Dattatreyudu , Clifford Chao K. S. , Christos Paul , Kovanlikaya Ilhami , Pannullo Susan , Boockvar John A. , Stieg Philip E. , Schwartz Theodore H. 
Published: May 2014

Object
Resected brain metastases have a high rate of local recurrence without adjuvant therapy. Adjuvant whole-brain radiotherapy (WBRT) remains the standard of care with a local control rate > 90%. However, WBRT is delivered over 10–15 days, which can delay other therapy and is associated with acute and long-term toxicities. Permanent cesium-131 (131Cs) implants can be used at the time of metastatic resection, thereby avoiding the need for any additional therapy. The authors evaluated the safety, feasibility, and efficacy of a novel therapeutic approach with permanent 131Cs brachytherapy at the resection for brain metastases.

Methods
After institutional review board approval was obtained, 24 patients with a newly diagnosed metastasis to the brain were accrued to a prospective protocol between 2010 and 2012. There were 10 frontal, 7 parietal, 4 cerebellar, 2 occipital, and 1 temporal metastases. Histology included lung cancer (16), breast cancer (2), kidney cancer (2), melanoma (2), colon cancer (1), and cervical cancer (1). Stranded 131Cs seeds were placed as permanent volume implants. The prescription dose was 80 Gy at a 5-mm depth from the resection cavity surface. Distant metastases were treated with stereotactic radiosurgery (SRS) or WBRT, depending on the number of lesions. The primary end point was local (resection cavity) freedom from progression (FFP). Secondary end points included regional FFP, distant FFP, median survival, overall survival (OS), and toxicity.

Results
The median follow-up was 19.3 months (range 12.89–29.57 months). The median age was 65 years (range 45–84 years). The median size of resected tumor was 2.7 cm (range 1.5–5.5 cm), and the median volume of resected tumor was 10.31 cm3 (range 1.77–87.11 cm3). The median number of seeds used was 12 (range 4–35), with a median activity of 3.82 mCi per seed (range 3.31–4.83 mCi) and total activity of 46.91 mCi (range 15.31–130.70 mCi). Local FFP was 100%. There was 1 adjacent leptomeningeal recurrence, resulting in a 1-year regional FFP of 93.8% (95% CI 63.2%–99.1%). One-year distant FFP was 48.4% (95% CI 26.3%–67.4%). Median OS was 9.9 months (95% CI 4.8 months, upper limit not estimated) and 1-year OS was 50.0% (95% CI 29.1%–67.8%). Complications included CSF leak (1), seizure (1), and infection (1). There was no radiation necrosis.

Conclusions
The use of postresection permanent 131Cs brachytherapy implants resulted in no local recurrences and no radiation necrosis. This treatment was safe, well tolerated, and convenient for patients, resulting in a short radiation treatment course, high response rate, and minimal toxicity. These findings merit further study with a multicenter trial.
Suprajugular extension of the retrosigmoid approach: microsurgical anatomy
Authors: Matsushima Ken , Kohno Michihiro , Komune Noritaka , Miki Koichi , Matsushima Toshio , Rhoton Albert L. 
Published: May 2014

Object
Jugular foramen tumors often extend intra- and extracranially. The gross-total removal of tumors located both intracranially and intraforaminally is technically challenging and often requires a combined skull base approach. This study presents a suprajugular extension of the retrosigmoid approach directed through the osseous roof of the jugular foramen that allows the removal of tumors located in the cerebellopontine angle with extension into the upper part of the foramen, with demonstration of an illustrative case.

Methods
The cerebellopontine angles and jugular foramina were examined in dry skulls and cadaveric heads to clarify the microsurgical anatomy around the jugular foramen and to define the steps of the suprajugular exposure.

Results
The area drilled in the suprajugular approach is inferior to the acoustic meatus, medial to the endolymphatic depression and surrounding the superior half of the glossopharyngeal dural fold. Opening this area exposed the upper part of the jugular foramen and extended the exposure along the glossopharyngeal nerve below the roof of the jugular foramen. In the illustrative case, a schwannoma originating from the glossopharyngeal nerve in the cerebellopontine angle and extending below the roof of the jugular foramen and above the jugular bulb was totally removed without any postoperative complications.

Conclusions
The suprajugular extension of the retrosigmoid approach will permit removal of tumors located predominantly in the cerebellopontine angle but also extending into the upper part of the jugular foramen without any additional skull base approaches.
Hemorrhage risks and functional outcomes of untreated brainstem cavernous malformations
Authors: Li Da , Hao Shu-Yu , Jia Gui-Jun , Wu Zhen , Zhang Li-Wei , Zhang Jun-Ting 
Published: May 2014

Object
Cerebral cavernous malformations have been studied widely, but the natural history of brainstem cavernous malformations (CMs) is not well defined, and hemorrhages caused by brainstem CMs are devastating. The goal of this study was to quantify the hemorrhage risks and functional outcomes of patients with brainstem CMs.

Methods
This prospective, longitudinal, cohort study included patients with brainstem CMs diagnosed between 1985 and 2012. The clinical courses of all patients were recorded. Predictors of hemorrhage and the overall untreated outcomes were evaluated.

Results
A total of 331 patients (46.5% female) were included, with a mean follow-up duration of 6.5 years. The annual hemorrhage rates in patients initially presenting with hemorrhage with (n = 215) or without (n = 34) focal neurological deficits were 15.9% and 12.4%, respectively. However, the annual hemorrhage rate was 8.7% in patients initially presenting without hemorrhage (n = 82). The risk factors for hemorrhage were female sex (hazard ratio [HR] 1.445, p = 0.041), prior hemorrhage (HR 1.277, p = 0.029), and perilesional edema (HR 1.830, p = 0.002). Overall, neurological function at the most recent assessment was improved compared with neurological function at diagnosis. Additionally, 307 patients (92.7%) improved or stabilized, 268 (81.0%) lived independently, and 95 (28.7%) completely recovered. Predictors favoring complete recovery were no prospective hemorrhage (HR 1.958, p = 0.001), younger age (HR 1.268, p = 0.001), and small lesion size (HR 1.578, p = 0.004).

Conclusions
Patients' initial presentation predicts their prospective annual hemorrhage rate. This study suggests that several strong risk factors for hemorrhage and predictors of brainstem CM outcomes may enable clinicians to evaluate the potential hemorrhage risks of their patients and design personalized treatments.
Reducing perinatal complications and preterm delivery for patients undergoing in utero closure of fetal myelomeningocele: further modifications to the multidisciplinary surgical technique
Authors: Bennett Kelly A. , Carroll Mary Anne , Shannon Chevis N. , Braun Stephane A. , Dabrowiak Mary E. , Crum Alicia K. , Paschall Ray L. , Kavanaugh-McHugh Ann L. , Wellons John C. , Tulipan Noel B. 
Published: May 2014

ObjectAs more pediatric neurosurgeons become involved with fetal myelomeningocele closure efforts, examining refined techniques in the overall surgical approach that could maximize beneficial outcomes becomes critical. The authors compared outcomes for patients who had undergone a modified technique with those for patients who had undergone fetal repair as part of the earlier Management of Myelomeningocele Study (MOMS).MethodsDemographic and outcomes data were collected for a series of 43 delivered patients who had undergone in utero myelomeningocele closure at the Fetal Center at Vanderbilt from March 2011 through January 2013 (the study cohort) and were compared with data for 78 patients who had undergone fetal repair as part of MOMS (the MOMS cohort). For the study cohort, no uterine trocar was used, and uterine entry, manipulation, and closure were modified to minimize separation of the amniotic membrane. Weekly ultrasound reports were obtained from primary maternal–fetal medicine providers and reviewed. A test for normality revealed that distribution for the study cohort was normal; therefore, parametric statistics were used for comparisons.ResultsThe incidence of premature rupture of membranes (22% vs 46%, p = 0.011) and chorioamnion separation (0% vs 26%, p < 0.001) were lower for the study cohort than for the MOMS cohort. Incidence of oligohydramnios did not differ between the cohorts. The mean (± SD) gestational age of 34.4 (± 6.6) weeks for the study cohort was similar to that for the MOMS cohort (34.1 ± 3.1 weeks). However, the proportion of infants born at term (37 weeks or greater) was significantly higher for the study cohort (16 of 41; 39%) than for the MOMS cohort (16 of 78; 21%) (p = 0.030). Compared with 10 (13%) of 78 patients in the MOMS cohort, only 2 (4%) of 41 infants in the study cohort were delivered earlier than 30 weeks of gestation (p = 0.084, approaching significance). For the study cohort, 2 fetal deaths were attributed to the intervention, and both were believed to be associated with placental disruption; one of these mothers had previously unidentified thrombophilia. Mortality rates did not statistically differ between the cohorts.ConclusionsThese early results suggest that careful attention to uterine entry, manipulation, and closure by the surgical team can result in a decreased rate of premature rupture of membranes and chorioamnion separation and can reduce early preterm delivery. Although these results are promising, their confirmation will require further study of a larger series of patients.
Treatment of craniocervical instability using a posterior-only approach
Authors: Young Richard M. , Sherman Jonathan H. , Wind Joshua J. , Litvack Zachary , O'Brien Joseph 
Published: May 2014

The object of this study was to demonstrate that a posterior-only approach for craniocervical junction pathology is feasible with intraoperative reduction. The authors reviewed 3 cases of craniocervical instability. All patients had craniocervical instability according to radiological imaging and various methods of measurement, with results outside the normal range. Posterior instrumentation aided the intraoperative reduction techniques while maintaining structural integrity and the desired fusion construct. No anterior approach was necessary in any of the patients. Neurological symptoms resolved in two patients and significantly improved in another. Follow-up imaging demonstrated stable constructs.
There are many approaches to anterior cervical pathology at the craniocervical junction. Posterior instrumented reduction and stabilization of the occipitocervical spine can be safely achieved, obviating the need for a transoral approach in the setting of craniocervical junction settling.
Higher Expression of Whole Blood MicroRNA-21 in Patients with Ankylosing Spondylitis Associated with Programmed Cell Death 4 mRNA Expression and Collagen Cross-linked C-telopeptide Concentration
Authors: Huang Chun-Huang , Wei James Cheng-Chung , Chang Wei-Chiao , Chiou Shang-Yan , Chou Chia-Hsuan , Lin Yu-Jie , Hung Pei-Hsuan , Wong Ruey-Hong 
Published: May 2014

Objective.Bone loss is a recognized feature of ankylosing spondylitis (AS). The binding of microRNA-21 (miR-21) to programmed cell death 4 (PDCD4) could inhibit the expression of PDCD4 and further induce the activation of osteoclasts. In the present study, we compared the difference in miR-21 expression between patients with AS and healthy controls, and evaluated the relationships of miR-21, PDCD4 mRNA, and bone erosion in patients with AS. The influences of nonsteroidal antiinflammatory drugs (NSAID) and disease-modifying antirheumatic drugs (DMARD) on the expressions of miR-21 and PDCD4 mRNA in patients with AS were also assessed.Methods.Whole blood miR-21 and PDCD4 mRNA expression were evaluated by quantitative real-time PCR among 122 patients with AS and 122 healthy controls. The serum level of collagen cross-linked C-telopeptide (CTX) was measured using ELISA.Results.When compared to controls, patients with AS had significantly higher levels of miR-21, PDCD4 mRNA, and CTX. MiR-21 expression was negatively correlated with PDCD4 mRNA expression in patients with AS who were taking neither NSAID nor DMARD. Interestingly, significantly positive correlations between miR-21 expression with PDCD4 mRNA expression (r = 0.33, p = 0.01) and CTX level (r = 0.44, p < 0.01) were observed in patients with AS who were taking sulfasalazine. Positive correlations of miR-21 and CTX level were also observed in AS patients with disease duration < 7.0 years (r = 0.36, p = 0.004) and active disease (r = 0.42, p = 0.001).Conclusion.The expression of miR-21 might have a role in the development of AS.
Resistive Home Exercise in Patients with Recent-onset Polymyositis and Dermatomyositis — A Randomized Controlled Single-blinded Study with a 2-year Followup
Authors: Alexanderson Helene , Munters Li Alemo , Dastmalchi Maryam , Loell Ingela , Heimbürger Mikael , Opava Christina H. , Lundberg Ingrid E. 
Published: May 2014

Objective.To evaluate the outcome of resistive home exercise and its possible longterm influence on health, disability, and disease activity in patients with active polymyositis (PM) or dermatomyositis (DM).Methods.Nineteen patients with recent-onset PM/DM were included after introduction of high-dose prednisolone. They were assessed by independent assessors as to perceived health, muscle performance, aerobic capacity, and serum creatine phosphokinase (CPK) at baseline and after 24 weeks, including repeated muscle biopsies at 24 weeks (single-blinded randomized controlled study), and in an open-label followup at 52, 78, and 104 weeks. Patients were randomized to 12 weeks, 5 days/week resistive home exercise with telephone support and encouragement for another 12 weeks of twice-a-week home or gym exercise (EG, n = 10) or to 24 weeks, 5 days/week range of motion exercise (CG, n = 9). Patients in the CG group without inflammatory infiltrates in muscle biopsies at 24 weeks were invited to the 12-week resistive home exercises.Results.At baseline, the EG had poorer perceived health, but otherwise the groups were comparable. At 24 weeks, both groups improved in muscle performance and aerobic capacity (p < 0.001 to < 0.05) with no signs of increased inflammation assessed by CPK levels or muscle biopsies. Both groups improved in muscle performance and aerobic capacity up to 52 weeks (p < 0.05) lasting to 104 weeks in the EG (p < 0.05) and presented minor improvements in perceived health.Conclusion.Our study supports the safety of resistive exercise in patients with active PM/DM but did not reveal any between-group differences in exercise effects. An individually adapted physical therapist–supervised home exercise program might be recommended in early active PM/DM, with regular evaluation of muscle performance and health.
Nanoparticles and CNS Delivery of Therapeutic Agents in the Treatment of Primary Brain Tumors
Authors: Gerardo Caruso  , Daniele Marino  , Maria Caffo  
Published: May 2014

Patients affected by malignant brain tumor present an extremely poor prognosis, notwithstanding improvements in surgery techniques and therapeutic protocols. Late diagnosis and the limitation of conventional therapies are major reasons for this unsolved clinical problem. The blood-brain barrier formed by a complex of endothelial cells, astrocyte and pericytes reduces notably the diffusion of a large number of therapeutic agents. Nanotechnology involves the design, synthesis, and characterization of materials and devices that have a functional organization in at least one dimension on the nanometer scale. The nanoparticles have emerged as potential vectorsfor brain delivery able to overcome the difficulties of modern strategies. Nanoparticles drug delivery systems can be, also, used to provide targeted delivery of drugs, improve bioavailability, sustains release of drugs for systemic delivery.Moreover, multi-functionality can be engineered into a single nanoplatform so that it can provide tumor-specific detection, treatment, and follow-up monitoring. In this study we will focus on the blood-brain barrier role and possibilities of its therapeutic overcoming. Recent studies of some kinds of nanoparticles systems in brain tumors treatment are summarized.
Is endemic political corruption hampering provision of ART and PMTCT in developing countries?
Authors: Man Wing Young Nicola , Worth Heather , Kelly Angela , Wilson David P , Siba Peter 
Published: May 2014

IntroductionLeadership is a key factor in the success of HIV prevention and treatment. Positive HIV‐related outcomes are also affected by funding levels for HIV, health sector resources, disease burden and the socio‐economic environment. Leadership on HIV as well as these other factors are affected by the quality of political governance of the country, which may be an overarching factor that influences the making of effective responses to the HIV epidemic.AimThe aim of the study was to investigate the association between quality of political governance, on one hand, and coverage of antiretroviral therapy (ART) and prevention of mother‐to‐child transmission (PMTCT), on the other, in low‐ to middle‐income countries.MethodsThis investigation was carried out through a global review, online data sourcing and statistical analyses. We collected data on health burden and resources, the socio‐economic environment, HIV prevalence, ART and PMTCT coverage and indicators of political governance. Outcome variables were coverage of ART (from 2004) and PMTCT (from 2007) to 2009 as a percentage of persons needing it. Potential predictors of treatment coverage were fitted with a baseline multilevel model for univariable and multivariable analyses.ResultsCountries with higher levels of political voice and accountability, more political stability and better control of corruption have higher levels of ART coverage but not PMTCT coverage. Control of corruption (in standard deviation units) had a strong association with ART (AOR=1.82, p=0.002) and PMTCT (AOR=1.97, p=0.01) coverage. Indicators of economic development were not significant when control of corruption was included in the multivariable regression model. Many countries in all income groups had high ART but not PMTCT coverage (e.g. Mexico, Brazil and Romania in the upper‐middle‐income group; Papua New Guinea and Philippines in the lower‐middle‐income group; and Cambodia, Laos and Comoros in the low‐income group). Very few low‐income countries (notably, Haiti and Kenya) had high PMTCT coverage.ConclusionsOur research found a significant relationship between quality of political governance and treatment coverage. Measures and policies for improving the quality of political governance should be considered as a part of HIV programme implementation to more effectively improve the welfare of people living with HIV, particularly mothers living with HIV and their babies.
Backscattered energetic neutral atoms from the Moon in the Earth's plasma sheet observed by Chandarayaan‐1/Sub‐keV Atom Reflecting Analyzer instrument
Authors: Harada Yuki , Futaana Yoshifumi , Barabash Stas , Wieser Martin , Wurz Peter , Bhardwaj Anil , Asamura Kazushi , Saito Yoshifumi , Yokota Shoichiro , Tsunakawa Hideo , Machida Shinobu 
Published: May 2014

AbstractWe present the observations of energetic neutral atoms (ENAs) produced at the lunar surface in the Earth's magnetotail. When the Moon was located in the terrestrial plasma sheet, Chandrayaan‐1 Energetic Neutrals Analyzer (CENA) detected hydrogen ENAs from the Moon. Analysis of the data from CENA together with the Solar Wind Monitor (SWIM) onboard Chandrayaan‐1 reveals the characteristic energy of the observed ENA energy spectrum (the e‐folding energy of the distribution function) ∼100 eV and the ENA backscattering ratio (defined as the ratio of upward ENA flux to downward proton flux) <∼0.1. These characteristics are similar to those of the backscattered ENAs in the solar wind, suggesting that CENA detected plasma sheet particles backscattered as ENAs from the lunar surface. The observed ENA backscattering ratio in the plasma sheet exhibits no significant difference in the Southern Hemisphere, where a large and strong magnetized region exists, compared with that in the Northern Hemisphere. This is contrary to the CENA observations in the solar wind, when the backscattering ratio drops by ∼50% in the Southern Hemisphere. Our analysis and test particle simulations suggest that magnetic shielding of the lunar surface in the plasma sheet is less effective than in the solar wind due to the broad velocity distributions of the plasma sheet protons.
Capillary pressure overshoot for unstable wetting fronts is explained by Hoffman's velocity‐dependent contact‐angle relationship
Authors: Baver Christine E. , Parlange J.‐Yves , Stoof Cathelijne R. , DiCarlo David A. , Wallach Rony , Durnford Deanna S. , Steenhuis Tammo S. 
Published: May 2014

AbstractPore velocity‐dependent dynamic contact angles provide a mechanism for explaining the formation of fingers/columns in porous media. To study those dynamic contact angles when gravity is present, rectangular capillary tubes were used to facilitate observation of the complete interface without geometric distortion. Results show that the Hoffman (1975) relationship between dynamic contact angle and water velocity applies to gravity‐affected flow fields, and that it (when adjusted for nonzero static contact angles) can be used to model dynamic capillary pressures for unstable wettings fronts in porous media by assuming that (1) pressure at the wetting front is discontinuous, (2) the flow field behind the fingertip is highly heterogeneous, and (3) the front line advances one or a few pores at the time. We demonstrate the utility of the Hoffman relationship for porous media with a published infiltration experiment by calculating the capillary pressure successfully at the unstable wetting front as a function of the flux of water in the finger and the grain size diameter.