bluuebunny/crossref_metadata_2025_split huggingface dataset:
Ophthalmological outcome after resection of tumors based on the pineal gland
Authors: Hart Michael G. , Sarkies Nicholas J. , Santarius Thomas , Kirollos Ramez W. 
Published: May 2013

Object
Descriptions of visual dysfunction in pineal gland tumors tend to focus on upward gaze palsy alone. The authors aimed to characterize the nature, incidence, and functional significance of ophthalmological dysfunction after resection of tumors based on the pineal gland.

Methods
Review of a retrospective case series was performed and included consecutive patients who underwent surgery performed by a consultant neurosurgeon between 2002 and 2011. Only tumors specifically based on the pineal gland were included; tumors encroaching on the pineal gland from other regions were excluded. All patients with visual signs and/or symptoms were reviewed by a specialist consultant neuroophthalmologist to accurately characterize the nature of their deficits. Visual disturbance was defined as visual symptoms caused by a disturbance of ocular motility.

Results
A total of 20 patients underwent resection of pineal gland tumors. Complete resection was obtained in 85%, and there were no perioperative deaths. Visual disturbance was present in 35% at presentation; of those who had normal ocular motility preoperatively 82% had normal motility postoperatively. In total, 55% of patients had residual visual disturbance postoperatively. Although upward gaze tended to improve, significant functional deficits remained, particularly with regard to complex convergence and accommodation dysfunction. Prisms were used in 25% but were only ever partially effective. Visual outcome was only related to preoperative visual status and tumor volume (multivariate analysis).

Conclusions
Long-term visual morbidity after pineal gland tumor resection is common and leads to significant functional impairment. Improvement in deficits rarely occurs spontaneously, and prisms only have limited effectiveness, probably due to the dynamic nature of supranuclear ocular movement coordination.
Outcomes in treatment for primary spinal anaplastic ependymomas: a retrospective series of 20 patients
Authors: Liu XiaoDong , Sun Bing , Xu QiWu , Che XiaoMing , Hu Jie , Gu ShiXin , Shou JiaJun 
Published: May 2013

Object
Little is known regarding the anaplastic variant of primary ependymomas that involve the spinal cord. The aim of this study was to evaluate the clinical characteristics and treatment outcomes of primary spinal anaplastic ependymomas (PSAEs).

Methods
Medical records were reviewed in 20 patients with pathologically proven PSAEs who underwent surgical treatment at the Department of Neurosurgery in Huashan Hospital between 1999 and 2008.

Results
This series included 7 women and 13 men between the ages of 2 and 67 years (mean 31.9 years). The mean preoperative course was 9.3 months (range 20 days to 48 months). The most common PSAE locations were the cervical and thoracic spinal cords. The most common presenting symptom was weakness, followed by numbness, bowel or bladder dysfunction, and pain. Gross-total resection (GTR) was achieved in 17 patients, and a subtotal removal was performed in 3 patients. Nine patients received radiation therapy and/or chemotherapy. The mean follow-up duration was 83.5 months. Functional assessment of the 10 patients available at the latest follow-up evaluation showed that 2 had worsened and 8 remained unchanged from their preoperative status. There were 2 local recurrences and 1 lung metastasis.

Conclusions
Patients with PSAEs presented with a much shorter preoperative course than patients with Grade II ependymomas in previous studies. Patients with tumors that involved the cervical spinal cord experienced a worse outcome. Surgical removal of PSAEs, with the goal of GTR, is beneficial to patients. The role of radiation therapy and chemotherapy in PSAEs remains to be determined in further studies.
Comparison of operative and nonoperative management of spinal epidural abscess: a retrospective review of clinical and laboratory predictors of neurological outcome
Authors: Connor David E. , Chittiboina Prashant , Caldito Gloria , Nanda Anil 
Published: May 2013

Object
Spinal epidural abscess (SEA), once considered a rare occurrence, has showed a rapid increase in incidence over the past 20–30 years. Recent reports have advocated for conservative, nonoperative management of this devastating disorder with appropriate risk stratification. Crucial to a successful management strategy are decisive diagnosis, prompt intervention, and consistent follow-up care. The authors present a review of their institutional experience with operative and nonoperative management of SEA to assess morbidity and mortality and the accuracy of microbiological diagnosis.

Methods
A retrospective analysis of patient charts, microbiology reports, operative records, and radiology reports was performed on all cases involving patients admitted with the diagnosis of SEA between July 1998 and May 2009.

Results
Seventy-seven cases were reviewed (median patient age 51.4 years, range 17–78 years). Axial pain was the most common presenting symptom (67.5% of cases). Presenting signs included focal weakness (55.8%), radiculopathy (28.6%), and myelopathy (5.2%). Abscesses were localized to the lumbar, thoracic, and cervical spine, respectively, in 39 (50.6%), 20 (26.0%), and 18 (23.4%) of the patients. Peripheral blood cultures were negative in 32 (45.1%) of 71 patients. Surgical site or interventional biopsy cultures were diagnostic in 52 cases (78.8%), with concordant blood culture results in 36 (60.0%). Methicillin-resistant Staphylococcus aureus (MRSA) was the most frequent isolate in 24 cases (31.2%). The mean time from admission to surgery was 5.5 days (range 0–42 days; within 72 hours in 66.7% of cases). Outcome data were available in 72 cases. At discharge, patient condition had improved or resolved in 57 cases (79.2%), improved minimally in 6 (8.3%), and showed no improvement or worsening in 9 (12.5%). Patient age and premorbid weakness were the only factors found to be significantly associated with outcome (p = 0.04 and 0.012, respectively).

Conclusions
These results strongly support immediate surgical decompression combined with appropriately tailored antibiotic therapy for the treatment of symptomatic SEA presenting with focal neurological deficit. The nonsuperiority discovered in other patient subsets may be due to allocation biases between surgically treated and nonsurgically treated cohorts. The present data demonstrate the accuracy of peripheral blood culture for the prediction of causative organisms and confirm patient age as a predictor of outcomes.
Treatment of a carotid cavernous fistula via direct transovale cavernous sinus puncture
Authors: Gil Alberto , López-Ibor Luis , Lopez-Flores Gerardo , Cuellar Hugo , Murias Eduardo , Rodríguez-Boto Gregorio 
Published: May 2013

Endovascular treatment is the treatment of choice for indirect carotid cavernous fistulas (CCFs). Direct surgical obliteration of CCFs is recommended in highly symptomatic patients or in those with an aggressive pattern of venous drainage. However, this is a technically challenging approach associated with significant procedural morbidity. The authors present a case in which they decided to attempt a novel access to the cavernous sinus through the foramen ovale before recommending surgery for an otherwise untreatable dural CCF.
This 52-year-old man with an indirect CCF and neurological deficit had undergone several attempts to embolize the shunt by means of the standard approaches. Ultimately direct cavernous sinus access was obtained through the foramen ovale, resulting in complete obliteration of the shunt. The occlusion was radiographically stable at the 6-month follow-up evaluation, and the patient has remained asymptomatic. Percutaneous transovale puncture of a CCF is a feasible alternative to accessing the cavernous sinus when traditional transvenous catheterization or direct superior ophthalmic vein approach is not possible.
Attempted bladder reinnervation and creation of a scratch reflex for bladder emptying through a somatic-to-autonomic intradural anastomosis
Authors: Tuite Gerald F. , Storrs Bruce B. , Homsy Yves L. , Gaskill Sarah J. , Polsky Ethan G. , Reilly Margaret A. , Gonzalez-Gomez Ignacio , Winesett S. Parrish , Rodriguez Luis F. , Carey Carolyn M. , Perlman Sharon A. , Tetreault Lisa 
Published: May 2013

An intradural somatic-to-autonomic anastomosis, or Xiao procedure, has been described to create a “skin-CNS-bladder” reflex that improves bladder and bowel function in patients with neurogenic bladder and bowel dysfunction. The authors present their experience with a 10-year-old boy with chronic neurogenic bladder and bowel dysfunction related to spinal cord injury who underwent the Xiao procedure. After undergoing a left L-5 ventral root to left S2–3 intradural anastomosis, the patient reported that his bladder and bowel dysfunction improved between 6 and 12 months. Two years after the procedure, however, he reported that there was no change in his bladder or bowel dysfunction as compared with his condition prior to the procedure. Frequent, systematic multidisciplinary evaluations produced conflicting data.
Electrophysiological and histological evaluation of the previously performed anastomosis during surgical reexploration 3 years after the Xiao procedure revealed that the anastomosis was in anatomical continuity but neuroma formation had prevented reinnervation. Nerve action potentials were not demonstrable across the anastomosis, and stimulation of the nerve above and below the anastomosis created no bladder or perineal contractions.
This is the first clinical report on the outcome of the Xiao procedure in a child with spinal cord injury outside of China. It is impossible to draw broad conclusions about the efficacy of the procedure based on a single patient with no demonstrable benefit. However, future studies should carefully interpret transient improvements in bladder function, urodynamic findings, and the patient's ability to void in response to scratching after the Xiao procedure. The authors' experience with the featured patient, in whom reinnervation could not be demonstrated, suggests that such changes could be related to factors other than the establishment of a skin-CNS-bladder reflex as a result of a somatic-to-autonomic anastomosis.
Longitudinal quantitative analysis of the tuber-to-brain proportion in patients with tuberous sclerosis
Authors: Hersh David S. , Chun Jonathan , Weiner Howard L. , Pulitzer Steven , Rusinek Henry , Roth Jonathan , Devinsky Orrin , Milla Sarah S. 
Published: May 2013

Object
In patients with tuberous sclerosis complex (TSC), the tuber-to-brain proportion (TBP) is a marker of seizure severity and cognitive function. However, few studies have quantified the TBP. Furthermore, authors of these studies have measured the TBP at only a single time point, despite the fact that tuber cells were found to express proliferation markers, suggesting that they may be dynamic lesions. Authors of the present study used a semi-automated tuber segmentation program to determine whether the TBP changes over time.

Methods
Axial FLAIR MR images were retrospectively identified for patients with TSC who had undergone imaging at the authors' institution between February 1998 and June 2009. Using FireVoxel software, the TBP was measured for each patient at a minimum interval of 2 years.

Results
Twelve patients meeting the study inclusion criteria were identified. The mean TBP was 1.88% (range 0.38%–3.70%). Eight patients demonstrated minimal changes and 3 patients demonstrated small increases in TBP. The remaining patient exhibited a decrease of 1.00%, which correlated with a visible decrease in the size of 2 cerebellar lesions.

Conclusions
Semi-automated brain segmentation is a valuable tool in the longitudinal study of tubers. A subset of patients with TSC, particularly those with cerebellar lesions, may exhibit changes in the TBP over time.
A Fast Accurate Boundary Integral Method for Potentials on Closely Packed Cells
Authors: Ying Wenjun , Beale J. Thomas 
Published: May 2013

AbstractBoundary integral methods are naturally suited for the computation of harmonic functions on a region having inclusions or cells with different material properties. However, accuracy deteriorates when the cell boundaries are close to each other. We present a boundary integral method in two dimensions which is specially designed to maintain second order accuracy even if boundaries are arbitrarily close. The method uses a regularization of the integral kernel which admits analytically determined corrections to maintain accuracy. For boundaries with many components we use the fast multipole method for efficient summation. We compute electric potentials on a domain with cells whose conductivity differs from that of the surrounding medium. We first solve an integral equation for a source term on the cell interfaces and then find values of the potential near the interfaces via integrals. Finally we use a Poisson solver to extend the potential to a regular grid covering the entire region. A number of examples are presented. We demonstrate that increased refinement is not needed to maintain accuracy as interfaces become very close.
The Fiscal Pressure Endured by Trading Companies
Authors: Cucoşel Constantin 
Published: May 2013

In order to carry out the extremely complex and diverse tasks it has to perform, the state needs important financial resources it can obtain either from within the country, from its taxpayers, physical persons or legal entities, or from external sources when internal resources are insufficient. The society cannot exist in the absence of the duties and taxes whose necessity is, on one hand stipulated by the Constitution, and on the other, proved by historical reality. It is only logical for these taxes to be imposed to the taxpayers. Fiscal pressure is a concept closely related to the notion of taxation and is often used to describe its level. Keywords: taxes, fees, taxation, fiscal pressure, tax evasion
Identification of the Problems Faced by Exceptional Children at Primary level in Khyber Pakhtunkhwa (Pakistan)
Authors: Suleman Qaiser , Hussain Ishtiaq , Nisa Zaib-Un- 
Published: May 2013

The purpose of the study was to identify the problems faced by exceptional children at primary level in Khyber Pakhtunkhwa. All the government institutions for persons with disabilities in Khyber Pakhtunkhwa constituted the population of the study. The study was delimited to physically handicapped students only. The study was further delimited to seven government institutions for persons with disabilities. From each institute, five teachers and ten students were randomly selected. The study was descriptive in nature therefore a single questionnaire was developed as research instrument for the collection of data. Data was collected through personal visits. After collection of the data, it was organized, tabulated, analyzed and interpreted. Percentage and chi square were applied for the statistical treatment of the data. After statistical analysis of the data, the researchers concluded that curriculum was not designed to meet the needs of special children. Special children were not being taught according to Individualized Educational Programme (I.E.P). Basic educational facilities were not available. Mobility aids were not present in the institutions. Therefore it is strongly recommended that special children should be taught through individualized educational programmes to strengthen their educational attainment. Curriculum should be designed according to the needs of the special children. Mobility aids i.e., crutches, wheelchairs, artificial limbs etc should be provided to each special education institution on priority basis. KEYWORDS: Identification, Problems, Exceptional Children, Primary Level
Extracorporeal Membrane Oxygenation Cannula Malposition in the Azygos Vein in an Infant
Authors: Balmaks Reinis , Sufficool Kari E. , White Frances V. , Byrge Melissa M. , Kolovos Nikoleta S. 
Published: May 2013

Introduction Misplacement of extracorporeal membrane oxygenation (ECMO) venous cannula in the azygos vein has previously been described only in newborns. Case For the first time, we report an aberrant ECMO cannula placement in the azygos vein in a child outside neonatal period. History of chronic lung disease and ligation of persistent ductus arteriosus leading to elevated right ventricular pressure was the potential risk factor. Conclusions This rare complication should be considered whenever the patient has inadequate venous return on ECMO and it can be easily ruled out with a lateral chest radiograph.
Intravesical Chemotherapy
Authors: Curotto Antonio Gerardo 
Published: May 2013

Bladder cancer care continues to represent a significant financial burden on the population and on the healthcare system. The incidence of bladder cancer has increased over the last two decades. Therapeutic advances have occurred in bladder cancer care, but at an increased cost to payers, providers, and patients. Intravesical treatment of non-muscle invasive tumors represents one of the main costs. For this reason therapeutic schedules need to be rationalized. In this perspective, we present some critical remarks on: the use of gemcitabine in clinical practice; the real impact of the perioperative chemotherapy, emphasizing the cost and effectiveness in high-risk patients, and finally the optimization of intravesical treatments. There is a need for the scientific community to focus on their resources and convey efforts not in the treatment of low-risk cancers (present in significant numbers in various studies), which the Anglo-Saxons call “nuisance tumor” since they can be treated easily and effectively at low cost, but definitely to engage in the study of the treatment of cancer at high risk of recurrence and progression, and it is on this field that the cost (economic, management, subjective) / benefit ratio must be assessed.
African Politics and Moral Vision
Authors: Hoekema David A. 
Published: May 2013

Abstract
Political life without common ideals or a compelling vision of the future loses its vitality and descends into a predatory struggle—a danger all too often evident in postcolonial Africa. Yet in the era of liberation, a distinctly African political and philosophical ideal emerged, a hybrid philosophy of nationhood that drew on three distinct sources: Western ideals of democracy and the rule of law, a socialist vision of mutual aid and responsibility, and the vitality of African communitarian traditions. It was also a deeply religious vision, in ways seldom acknowledged even by its adherents. After review of recent developments in Ghana, Kenya, and South Africa, it is suggested that a distinctively African political and economic order may still be available as a guiding vision for African nations.
Erotic Perfectionism in Jewish Rationalist Philosophy
Authors: Strawser Michael 
Published: May 2013

AbstractIt is a view commonly held that within the Jewish rationalist tradition epitomized by Baruch Spinoza the snares of erotic love are something that a rational person would actively seek to avoid. But is love a thing for fools? Is this truly the view of Spinoza and the rationalist tradition in medieval Jewish philosophy that he inherited, or can we find a way to conceive of erotic love that accords with the life of reason? In this article I will attempt to answer these questions within the context of an analysis of Isaac Bashevis Singer's “The Spinoza of Market Street” and by considering the erotic perfectionist ethic as it is expressed primarily in Saadia Gaon's Book of Beliefs and Opinions and Spinoza's Ethics. I will show that the significant points of convergence and divergence between these two thinkers serve to illuminate our thinking about erotic perfectionism. Both Saadia and Spinoza are careful, systematic Jewish thinkers developing ethical theories in which reason plays a pronounced role in cultivating a virtuous life. Consequently, like other ethicists for whom the virtues are key, both Saadia and Spinoza are intent on expressing the ideal human conduct of the moral exemplar. In just what way does erotic love fit into the ideal human life?
Body Size and Diet of Amphiuma Means (Caudata: Amphiumidae) From Southeastern Virginia
Authors: Mitchell Joseph C. 
Published: May 2013

Abstract
Body size relationships and diet was obtained largely from a sample of Two-toed Amphiuma (Amphiuma means) from the Great Dismal Swamp in southeastern Virginia. Maximum body size (842 mm total length) was similar to that reported for other locations farther south in the species' range but less than the maximum known size. Adult males (x̄ SVL  =  489 mm) were significantly larger than adult females (x̄ SVL  =  424 mm). Tail length was linearly related to total length and was not sexually dimorphic. Log transformed body size explains 93.7% of log-body weight; the relationship did not differ between sexes. Prey consisted of several insect taxa (including bees), crayfish (Procambarus), tadpoles (Lithobates), and small fish (Umbra), further confirming that amphiumas have catholic diets.
Risk of Venous Thromboembolism in Patients With Rheumatoid Arthritis
Authors: Kim Seoyoung C. , Schneeweiss Sebastian , Liu Jun , Solomon Daniel H. 
Published: May 2013

ObjectiveRheumatoid arthritis (RA) is associated with cardiovascular disease (CVD), but little is known about its association with another form of vascular disorder, venous thromboembolism (VTE).MethodsA retrospective cohort study was conducted using US insurance claims. RA and non‐RA patients were matched on age, sex, and index date. Incidence rates (IRs) and rate ratios (RRs) of VTE, defined as the composite of deep vein thrombosis (DVT) or pulmonary embolism (PE), were calculated. Cox proportional hazards models compared VTE risks between RA and non‐RA patients, adjusting for VTE risk factors such as CVD, surgery, hospitalization, medications, and acute‐phase reactants.ResultsOver the mean followup of 2 years, the IR for VTE among RA patients was 6.1 per 1,000 person‐years, 2.4 times higher (95% confidence interval [95% CI] 2.1–2.8) than the rate of non‐RA patients. The IRs for both DVT (RR 2.2, 95% CI 1.9–2.6) and PE (RR 2.7, 95% CI 2.2–3.5) were higher in RA patients compared with non‐RA patients. After adjusting for risk factors of VTE, the VTE risk remained elevated in RA patients (hazard ratio 1.4, 95% CI 1.1–1.7) compared to non‐RA patients. The result was similar after further adjustment for elevated acute‐phase reactants (hazard ratio 1.5, 95% CI 0.3–6.5). One‐third of patients who developed VTE had at least 1 major VTE risk factor 90 days before and after the VTE event.ConclusionOur results showed an increased risk of developing VTE for RA patients compared with non‐RA patients. The risk was attenuated but remained elevated even after adjusting for various risk factors for VTE.