bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Hitchhiker Position in Endoscopic Pituitary Surgery
Authors: Kilgallon John L. , Thorne Alison , Laws Edward R. 
Published: October 2022

BACKGROUND:
Technically and ergonomically correct positioning is essential in endoscopic transsphenoidal pituitary surgery.

OBJECTIVE:
To propose a safe, ergonomic approach to conduct endoscopic endonasal pituitary and skull base surgery in large patients without sacrificing important aspects of current standard practice.

METHODS:
The patient's right arm is outstretched and secured in a supine position, with the primary surgeon standing in the axillary area. Considerations include maintaining comfort, immobility, anesthesia access, endotracheal tube fixation, intravenous lines, thorax elevated 25° to 30° for optimization of respiration, free and exposed abdomen for fat graft, legs positioned with no sciatic stretch or venous strain, and the patient's head in parallel with the surrounding area to sustain a strict midline.

RESULTS:
Ten patients who underwent transsphenoidal pituitary tumor resections conducted using the hitchhiker position from October 2019 to June 2021 comprised our study cohort. The patients' mean height was 168.70 ± 9.29 cm, their mean weight was 114.35 ± 19.32 kg, and their mean body mass index was 40.19 ± 6.39 kg/m2. Twenty percent (n = 2) patients had a body mass index classified as “obesity class 1,” 50% (n = 5) as “obesity class 2,” and 30% (n = 3) as “extreme obesity class 3.” The primary surgeon consistently reported decreased bodily strain and improved ergonomic access to the surgical site using the hitchhiker position.

CONCLUSION:
The hitchhiker position offers the opportunity to improve both patient and physician well-being in the context of endoscopic pituitary surgery.
Nerve Transfers for Elbow Reconstruction in Upper and Extended Upper-Type Brachial Plexus Injuries: A Case Series
Authors: Estrella Emmanuel P. , Montales Tristram D. 
Published: October 2022

BACKGROUND:
Nerve transfers for elbow flexion in brachial plexus injuries have been used with increasing frequency because of the higher rate of success and acceptable morbidity. This is especially true in upper and extended upper-type brachial plexus injuries.

OBJECTIVE:
To present the clinical outcomes of nerve transfers for elbow flexion in patients with upper and extended upper-type brachial plexus injuries.

METHODS:
A retrospective cohort review was done on all patients with upper and extended upper-type brachial plexus injuries from 2006 to 2017, who underwent nerve transfers for the restoration of elbow flexion. Outcome variables include Filipino version of the disability of the arm, shoulder, and hand (FIL-DASH) score, elbow flexion strength and range of motion, and pain. All statistical significance was set at P < .05.

RESULTS:
Fifty-six patients with nerve transfers to restore elbow flexion were included. There was a significant improvement in FIL-DASH scores in 28 patients after the nerve transfer procedure. Patients with C56 nerve root injuries and those with more than 2 years' follow-up have a higher percentage of regaining ≥M4 elbow flexion strength. Those with double nerve transfers had a higher percentage of ≥M4 elbow flexion strength, greater range of elbow flexion, and better FIL-DASH scores compared with single nerve transfers, but this did not reach statistical significance.

CONCLUSION:
Nerve transfer procedures improve FIL-DASH scores in upper and upper-type brachial plexus injuries. After nerve transfer, stronger elbow flexion can be expected in patients with C56 injuries, and those with longer follow-up.
Contactless Ultrasonic Cavitation for the Prevention of Shunt Obstruction in Hydrocephalus: A Proof-of-Concept Study
Authors: Gomez-Gonzalez Emilio , Munoz-Gonzalez Francisco Javier , Barriga-Rivera Alejandro , Perales-Esteve Manuel A. , Guerrero-Claro Manuel , Fernandez-Lizaranzu Isabel , Requena-Lancharro Desirée , Rosales-Martinez Marina , Marquez-Rivas Javier 
Published: October 2022

BACKGROUND:
Obstructive failure of implanted shunts is the most common complication in the treatment of hydrocephalus. Biological material and debris accumulate in the inner walls of the valve and catheters block the normal flow of the drained cerebrospinal fluid causing severe symptoms with high morbidity and mortality. Unfortunately, at present, there is no effective preventive protocol or cleaning procedure available.

OBJECTIVE:
To assess whether externally applied, focused ultrasound beams can be used to resuspend deposits accumulated in brain shunts safely.

METHODS:
A computational model of an implanted brain shunt was implemented to test the initial design parameters of a system comprising several ultrasound transducers. Under laboratory conditions, configurations with 3 and 4 transducers were arranged in a triangle and square pattern with their radiation axis directed towards a target model of the device, 2 catheters and a brain shunt filled with water and deposited graphite powder. The ultrasound beams were then concentrated on the device across a head model.

RESULTS:
The computational model revealed that by using only 3 transducers, the acoustic field intensity on the valve was approximately twice that on the brain surface suggesting that acoustic cavitation could be selectively achieved. Resuspension of graphite deposits inside the catheters and the valve were then physically demonstrated and video-recorded with no temperature increase.

CONCLUSION:
The technology presented here has the potential to be used routinely as a noninvasive, preventive cleaning procedure to reduce the likelihood of obstruction-related events in patients with hydrocephalus treated with an implanted shunt.
Use of Cannulated Reamers to Facilitate Thoracic Diskectomy Using a Minimally Invasive Retropleural Thoracotomy Approach—Surgical Technique
Authors: Nemani Venu M. , Shen Jesse , Sethi Rajiv K. , Leveque Jean-Christophe 
Published: October 2022

BACKGROUND:
The surgical treatment of symptomatic thoracic disk herniations is technically challenging. In the past decade, a minimally invasive retropleural thoracotomy approach has become more popular to treat this pathology. However, efficient bone removal to safely perform the diskectomy and spinal cord decompression is difficult with this technique because of the small incision size and long working distance in the thoracic cavity and the proximity of the compressed thoracic cord.

OBJECTIVE:
To describe a novel surgical technique for performing a thoracic diskectomy using a minimally invasive lateral approach using cannulated reamers to facilitate bone removal.

METHODS:
This technique was used in 7 consecutive patients who presented with thoracic myelopathy from a thoracic disk herniation. First, a standard lateral minimally invasive retropleural approach to the thoracic spine was performed. Partially threaded guide wires were placed in the posterior aspect of the vertebral bodies adjacent to the affected disk space, and sequential cannulated reamers were passed over the guidewires to perform partial corpectomies. The posterior annulus, posterior longitudinal ligament, and herniated disk material were then resected using Penfield dissectors and Kerrison rongeurs to complete the decompression.

RESULTS:
All 7 patients who underwent thoracic diskectomy using this approach had stable or improved neurologic function postoperatively. There were no complications related to the use of the cannulated reamer technique.

CONCLUSION:
The use of cannulated reamers provides a simple and efficient method for safe bone removal to facilitate minimally invasive thoracic diskectomy using a lateral approach. This is an easily reproducible technique using commonly available equipment.
A Patient-Specific Reference Tracker for Noninvasive Electromagnetic Navigation of Endoscopic Skull Base Surgery
Authors: Micko Alexander , Minchev Georgi , Wurzer Ayguel , Kronreif Gernot , Wolfsberger Stefan 
Published: October 2022

BACKGROUND:
Owing to the possibility of nonrigid head fixation, electromagnetic navigation (EM) is a mainstay for endoscopic skull base surgery. The currently available dynamic reference trackers (RTs) are invasive or inaccurate.

OBJECTIVE:
To investigate the feasibility and stability of this innovative oral tracker (OT), which is adhesive to the hard palate in comparison with a commercially available skin adhesive tracker (ST).

METHODS:
A prospective series of 31 patients with intrasellar lesions who underwent surgery between 2019 and 2021 using a pure endoscopic transsphenoidal approach were evaluated. A patient-specific palatal mold was designed from preoperative computed tomography data. The OT was cast using a biocompatible algin with an integrated EM tracker assembly. In comparison with a skull-mounted RT, which served as a gold standard, the deviations of OT vs those of the ST with the RT were continuously assessed.

RESULTS:
The OT showed significantly lower deviations from the RT than the ST during the surgical steps: start of endoscopic surgery (OT vs ST: 0.62 mm, IQR 0.36-0.89 vs 1.65 mm, IQR 1.35-2.32, P < .001), drilling phase (OT vs ST: 0.81 mm, IQR 0.51-1.32 vs 1.89 mm, IQR 1.6-2.74, P < .001), and end of endoscopic surgery (OT vs ST: 1.1 mm, IQR 0.68-1.64 vs 1.9 mm, IQR 1.6-2.72, P < .001).

CONCLUSION:
The OT showed significantly higher intraoperative stability than the ST. Therefore, this noninvasive and patient-specific tool could be used to achieve accurate EM guidance during endoscopic skull base surgeries.
High-Fidelity Virtual Reality Simulation for the Middle Cranial Fossa Approach—Modules for Surgical Rehearsal and Education
Authors: Lai Carolyn , Lui Justin T. , Chen Joseph M. , Lin Vincent Y. , Agrawal Sumit K. , Blevins Nikolas H. , Ladak Hanif M. , Pirouzmand Farhad 
Published: October 2022

BACKGROUND:
Virtual reality simulation has gained prominence as a valuable surgical rehearsal and education tool in neurosurgery. Approaches to the internal auditory canal, cerebellopontine angle, and ventral brainstem region using the middle cranial fossa are not well explored by simulation.

OBJECTIVE:
We hope to contribute to this paucity in simulation tools devoted to the lateral skull base, specifically the middle cranial fossa approach.

METHODS:
Eight high-resolution microcomputed tomography scans of human cadavers were used as volumetric data sets to construct a high-fidelity visual and haptic rendering of the middle cranial fossa using CardinalSim software. Critical neurovascular structures related to this region of the skull base were segmented and incorporated into the modules.

RESULTS:
The virtual models illustrate the 3-dimensional anatomic relationships of neurovascular structures in the middle cranial fossa and allow a realistic interactive drilling environment. This is facilitated by the ability to render bone opaque or transparent to reveal the proximity to critical anatomy allowing for practice of the virtual dissection in a graduated fashion.

CONCLUSION:
We have developed a virtual library of middle cranial fossa approach models, which integrate relevant neurovascular structures with aims to improve surgical training and education. A ready extension is the potential for patient-specific application and pathology.
Continuous Tissue Plasminogen Activator Infusion Using a Minimally Invasive Irrigating Catheter for the Treatment of Intraparenchymal Hemorrhage Within the Basal Ganglia: Case Reports
Authors: Varela Samantha , Carrera Diego , Elazim Ahmed Abd , Robinson Myranda B. , Torbey Michel , Carlson Andrew P. 
Published: October 2022

BACKGROUND AND IMPORTANCE:
Intraparenchymal hemorrhage (IPH) is a debilitating and highly morbid type of stroke with limited effective treatment modalities. Minimally invasive evacuation with tissue plasminogen activator (rt-PA) has demonstrated promise for mortality/functional improvements with adequate clot volume reduction. In this study, we report 2 cases of continuous rt-PA infusion using a closed circuit, dual lumen catheter, and irrigation system (IRRAflow) for IPH treatment.

CLINICAL PRESENTATION:
A 55-year-old man was admitted for acute onset left hemiparesis; he was found to have right basal ganglia IPH. He was treated with continuous rt-PA irrigation using the IRRAflow device, at a rate of 30 mL/h for 119 hours, with a total volume reduction of 87.8 mL and post-treatment volume of 1.2 mL. At 3-month follow-up, he exhibited a modified Rankin score of 4 and improved hemiparesis. A 39-year-old woman was admitted for acute onset left facial droop, left hemianopsia, and left hemiparesis; she was diagnosed with a right basal ganglia IPH. She was treated with drainage and continuous rt-PA irrigation at 30 mL/h for 24 hours, with a total hematoma volume reduction of 41 mL and with a final post-treatment volume of 9.1 mL. At 3-month follow-up, she exhibited a modified Rankin score of 3 with some improvement in left hemiparesis.

CONCLUSION:
Continuous rt-PA infusion using a minimally invasive catheter with saline irrigation was feasible and resulted in successful volume reduction in 2 patients with IPH. This technique is similar to the Minimally Invasive Surgery Plus rt-PA for Intracerebral Hemorrhage Evacuation (MISTIE) approach but offers the potential advantages of less breaks in the sterile circuit, continuous intracranial pressure monitoring, and may provide more efficient clot lysis compared with intermittent bolusing.
Epidural Pretemporal Transcavernous Approach Double-Barrel Superficial Temporal Artery-Posterior Cerebral Artery/Superior Cerebellar Artery Bypass for a Ruptured Anterior Spinal Artery Aneurysm
Authors: Hu Peng 
Published: October 2022

BACKGROUND:
Rostral posterior circulation bypass is technically challenging. Pretemporal approach has been reported to facilitate the bypass procedure within the oculomotor-tentorial triangle. However, bridging veins converging into cavernous sinus at the temporal pole usually need to be sacrificed.

OBJECTIVE:
To report operative nuances of rostral posterior circulation bypass with an emphasis on preserving the Sylvian veins and enlarging surgical space, we use a double-barrel superficial temporal artery-posterior cerebral artery/superior cerebellar artery anastomosis using an epidural pretemporal transcavernous approach.

METHODS:
A 54-year-old man had a subarachnoid hemorrhage attack 1 month before the admission. A flow-related anterior spinal artery aneurysm with bilateral vertebral artery occlusive diseases was indicated. The aneurysm was difficult to be directly treated, either by the endovascular approach or by the microsurgical clipping. A double-barrel superficial temporal artery-superior cerebellar artery/posterior cerebral artery bypass was performed using an epidural pretemporal transcavernous approach.

RESULTS:
The anastomoses were successfully accomplished in a large surgical space. The patient recovered well with no events, except a transient right cranial nerve III paralysis. The aneurysm was demonstrated to be completely regressed at the 5-month follow-up.

CONCLUSION:
An epidural pretemporal transcavernous approach could be an alternative for rostral posterior circulation bypass.
Exposure of the Lumbosacral Plexus by Using the Pararectus Approach: A Technical Note
Authors: Häckel Sonja , Christen Samuel , Vögelin Esther , Keel Marius J. B. 
Published: October 2022

BACKGROUND:
Surgical exploration of the lumbosacral plexus is challenging. Previously described approaches reach from invasive open techniques with osteotomy of the ilium to laparoscopic techniques.

OBJECTIVE:
To describe a novel surgical technique to explore lumbosacral plexopathies such as benign nerve tumors or iatrogenic lesions of the lumbosacral plexus in 4 case examples.

METHODS:
We retrospectively evaluated 4 patients suffering from pathologies or injuries of the lumbosacral plexus between 2017 and 2019. The mean follow-up period after surgery was 23.5 (range 11-52) months. All patients underwent neurolysis of the lumbosacral plexus using the single incision, intrapelvic, extraperitoneal pararectus approach.

RESULTS:
In all patients, the pathology of the lumbosacral plexus was successfully visualized, proving feasibility of the extraperitoneal pararectus approach for this indication. There were no major complications, and all patients recovered well.

CONCLUSION:
The pararectus approach allows excellent visualization of the lumbar plexus and intrapelvic lesions of the femoral and sciatic nerves.
A New Noninvasive Frameless Registration System for Stereotactic Cranial Biopsy: A Technical Note
Authors: Almairac Fabien , Leplus Aurélie , Mondot Lydiane , Fontaine Denys 
Published: October 2022

BACKGROUND:
Although frame-based stereotactic biopsy is still considered the gold standard for brain biopsies, frameless robot-assisted stereotactic systems are now able to provide an equal level of safety and accuracy. However, both systems suffer from a lack of efficiency of the operative workflow.

OBJECTIVE:
To describe the technique of a new frameless and noninvasive registration tool Neurolocate (Renishaw). This tool, combined with an intraoperative cone-beam computed tomography imaging system like O-ARM (Medtronic), might facilitate the achievement and workflow of robot-assisted stereotactic intracranial biopsies.

METHODS:
Neurolocate is a 3-dimensional fiducial tool fixed directly on the Neuromate (Renishaw) robot arm. It consists of 5 radio-opaque spherical fiducials, whose geometry is constant. This tool made it possible to carry out the coregistration then the biopsy in the same operating time, following a five-step procedure described here. We retrospectively extracted selected preliminary results from our initial experience.

RESULTS:
Over 1 year, 23 consecutive adult patients were biopsied with Neurolocate in our center. The mean overall operative time, from patient's installation to skin closure, was 97 minutes ± 27 (SD). The entire procedure took place in a single location unit (operating room), which facilitated workflow and surgical planning. No invasive gesture was performed outside of the operating time.

CONCLUSION:
Neurolocate is a new frameless and noninvasive registration tool that could improve workflow and flexibility for operating room management and surgical planning. It may also increase the comfort of patients undergoing robot-assisted intracranial stereotactic biopsies. The accuracy and safety profile should be addressed in specific studies.
Pavlovian conditioning of gentoo penguins (Pygoscelis papua) to underwater sound
Authors: Rasmussen Maria S. , Sørensen Kenneth , Vittrup Malou F. , Wahlberg Magnus 
Published: October 2022

ABSTRACTPenguins are known to react to underwater noise, but it is unknown if they make use of sound cues while diving. We tested whether captive gentoo penguins (Pygoscelis papua) can pair underwater sounds with food through Pavlovian conditioning. Two seconds after an underwater sound (a 1-4 kHz sweep with a received level of 130 dB re 1 µPa RMS) was played back to one or two unidentifiable penguins, a dead fish was flushed into the water close to the underwater sound source. After 8 weeks of conditioning, one or more individual penguins approached the sound source after sound emission in 78.3% out of 230 trials. In 43 intermixed control trials with no sound preceding the fish, the penguins did not show any reaction in the pre-flush period. In an additional experiment, three identified penguins reacted to the sound in 66.7-100% out of 30 trials, with 0% reactions in five intermixed control trials. Our experiments demonstrate that gentoo penguins can be conditioned to underwater sound and that they associate underwater sounds with food. It is possible that gentoos, as well as other species of penguins, use sound cues while foraging. This may explain why penguins have been observed to react negatively to anthropogenic noise.
Fluoxetine pharmacokinetics and tissue distribution quantitatively supports a therapeutic role in COVID-19 at a minimum dose of 20 mg per day
Authors: Eugene Andy R. 
Published: October 2022

Background. Various in vitro studies have shown fluoxetine inhibits multiple variants of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pathogen causing the coronavirus disease 2019 (COVID-19) worldwide pandemic and multiple observational clinical studies have shown that patients receiving fluoxetine experienced clinical benefit by lowering the risk of intubation and death. The aim of this study is to conduct population pharmacokinetic dosing simulations to quantify the percentage of patients achieving a trough level for the effective concentration resulting in 50% (EC50) and 90% (EC90) inhibition of SARS-CoV-2 as reported in Calu-3 human lung cells. Methods. Pharmacometric parameter estimates used in this study were obtained from the U.S. FDA website from a new drug application for fluoxetine hydrochloride. A population of 1,000 individuals were simulated at standard fluoxetine antidepressant doses (20 mg/day, 30 mg/day, 40 mg/day, 50 mg/day, and 60 mg/day) to estimate the percentage of the patients achieving a trough plasma level for the EC50 and EC90 SARS-CoV-2 inhibition. All analyses were conducted in R. Results. By day-10 at 20 mg/day, 93.2% and 47% of the population will achieve the trough target plasma EC50 and EC90 concentrations, respectively, which translates to a lung tissue distribution coefficient of 60-times higher EC50 (283.6 ng/ml [0.82 mM]) and EC90 (1390.1 ng/ml [4.02 mM]). Further, by day-10 at an ideal dose of 40 mg/day, 99% and 93% of patients will reach the trough EC50 and EC90 concentrations, respectfully. Lastly, only a dose of 60 mg/day will reach the SARS-CoV-2 EC90 inhibitory concentration in the brain at pharmacokinetic steady-state. Conclusion. Overall, with a minimum treatment period of 10-days and a minimum dose of 20 mg/day, this study corroborates in vitro studies reporting fluoxetine inhibiting SARS-CoV-2 titers and also multiple observational clinical studies showing therapeutic benefit of fluoxetine in COVID-19 patients.
Lwowski okres twórczości Wasyla Simowycza
Authors: Szeluch Olha , Kazan Emilia 
Published: October 2022

THE LVIV PERIOD OF VASYL SIMOVYCH’S CREATIVITY
aVasyl Simovych was a full member of the National Association of Taras Shevchenko, professor and rector of the Ukrainian Higher Pedagogical Institute in Prague, head of the Ukrainian language department and dean of the philological faculty of Lviv University (1939- 1941). The article discusses the scientific and organisational, publishing, cultural and educational activities of Vasyl Simovych in Lviv and Prague. His influence is shown not only in the context of the scientific, social and public life of Lviv but also of Galicia.
Learning Product Rankings Robust to Fake Users
Authors: Golrezaei Negin , Manshadi Vahideh , Schneider Jon , Sekar Shreyas 
Published: October 2022

Analytics in the Face of Fraudulent Data This article presents a novel online learning algorithm for identifying optimal product rankings in the presence of fake users and corrupted data. In recent years, e-commerce platforms, such as Amazon, have witnessed a growing number of fake users and click farms. These fraudulent actors seek to boost the position of certain products in the display ordering (i.e., product ranking). Further, platforms’ reliance on data analytics exacerbates the effect of these fake users as machine learning algorithms leverage user feedback to determine product rankings. In the face of these challenges, the present article departs from the status quo that is based on detecting fake users and instead proposes a robust learning methodology. More specifically, the article presents a robust online learning algorithm that converges to the optimal product ranking even when it is impossible to distinguish between real and fake users in the data.