bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impact of pathological complete response following neoadjuvant chemotherapy (gemcitabine, nab-paclitaxel, S-1) and radiation for borderline resectable pancreatic cancer: a case report and review of literature
Authors: Kinoshita Mitsuru , Watanabe Sota , Mizojiri Gaku , Sada Akitada , Kai Hiroki , Masuike Yasunori , Nagasawa Yoshinobu , Maruyama Kentaro , Lee Kyowon , Ohata Mai , Ishikawa Osamu , Oka Hiroshi 
Published: September 2022

Abstract
Background
Pancreatic cancer (PC) is a highly lethal malignancy, even if surgical resection is possible (median survival: < 30 months). The prognosis of borderline resectable pancreatic cancer (BR-PC) is even worse. There is no clear consensus on the optimal treatment strategy, including pre/postoperative therapy, for BR-PC. We report a patient with BR-PC who achieved clinical partial response with neoadjuvant chemoradiation therapy (NACRT) and underwent curative resection, resulting in pathological complete response (pCR).

Case presentation
A 71-year-old man with jaundice and liver dysfunction was referred to our department because of a 48-mm hypo-vascular mass in the pancreatic head with obstruction of the pancreatic and bile ducts and infiltration of superior mesenteric vein and portal vein. The lesion was identified as atypical cells which suggested adenocarcinoma by biopsy, and he was administered NACRT: gemcitabine and nab-paclitaxel, following S-1 and intensity modulated radiation therapy. After reduction in the tumor size (clinical partial response), pancreaticoduodenectomy was performed, and pCR achieved. Postoperative adjuvant chemotherapy with S-1 was initially administered and the patient is currently alive with no recurrence as of 2 years after surgery.

Conclusions
NACRT is a potentially useful treatment for BR-PC that may lead to pCR and help improve prognosis.
Exploring the inner roots of discharge against medical advice (DAMA) in an academic psychiatric hospital: a qualitative study
Authors: Alidoust Fatemeh , Yahyavi Seyyed Taha 
Published: September 2022

Abstract
Background
To explore the roots of DAMA in the Roozbeh Hospital, an academic mental hospital located in Tehran, Iran, the authors conducted a simple qualitative study. Twenty-four in-depth semi-structured interviews with families and eight with patients who were discharged against medical advice were done about the inner motivation and roots of DAMA. The sampling was convenient in trying to reach the maximum variation. The transcribed verbatim of the interviews was coded and categorized inductively by discussion. Ethical consideration was approved by the TUMS ethical committee.

Results
Findings were classified into six categories: The patient’s insistence, miss the beloved one, sense of improvement, outside hospital concerns, dissatisfaction with the quality of medical care, and worries about the hospitalization consequences.

Conclusions
Addressing the inner roots of DAMA can be an opportunity to understand better patients and their families’/relatives’ experiences and feelings. This will give a deep perspective and insight into the subject.
The need for clinical ethics consultation: a monocentric observational survey study in the intensive care unit (Consul.E.T.I. study)
Authors: Filippini Matteo , Nicoli Federico , Picozzi Mario , Latronico Nicola 
Published: September 2022

AbstractBackgroundThe current organizational structure of the Italian healthcare system does not include the institutionalization of clinical ethics services.To describe the need for structured clinical ethics consultation services for ICU staff members in the intensive care unit (ICU), a monocentric observational survey study was performed utilizing a paper-based questionnaire.ResultsA total of 73 healthcare professionals (HCPs) responded out of a team of 84 people (87%). The results showed that the need for ethics consultation in the ICU is urgent, the institutionalization of the clinical ethics service is perceived as useful and should be a priority, and the issues on which the HCPs would like ethics consultation to focus are various and belong to “end of life” topics.ConclusionsHCPs believe that the clinical ethicist should become an integral part of ICU healthcare teams, offering consultations similar to the other specialistic consultations carried out in hospitals.
Evaluation of a Health Care Worker Training Intervention to Improve the Early Diagnosis and Referral of Childhood Cancers in Ghana: A Qualitative Descriptive Study
Authors: Fowokan Adeleke , Afungchwi Glenn Mbah , Renner Lorna , Freccero Piera , Gupta Sumit , Denburg Avram 
Published: September 2022

PURPOSE This study sought to (1) evaluate the perceived effectiveness of an early childhood cancer warning signs and symptoms (EWSS) training intervention on health care worker (HCW) knowledge, attitudes, and clinical practice; (2) evaluate the ease of implementation of training received, including potential barriers and facilitators; and (3) provide insights into program improvements for future iterations of the intervention. METHOD Using a qualitative descriptive study design, we conducted in-depth, semistructured interviews with 23 purposively sampled Ghanaian HCW recipients of the EWSS training intervention. We undertook iterative thematic analysis of data concurrently with interviews and used a modified version of the theoretical framework of acceptability to guide the evaluation of the training intervention. RESULTS We identified six themes—affective attitude, burden, intervention coherence, perceived effectiveness, self-efficacy, and quality improvement—that structure participant perceptions of the effectiveness of the EWSS training. Participants generally had a positive attitude to the training intervention, found the content relatively easy to understand, and communicated the positive impacts of the training on their day-to-day practice. However, they also identified patient- and system-level challenges to the real-world implementation of intervention components, including patients' cultural and religious beliefs about illnesses, patients' financial constraints, and inadequately funded health systems. CONCLUSION Our findings suggest that although an HCW-focused training intervention has the potential to improve timely diagnosis and referral for childhood cancers in Ghana and comparable health system contexts, complementary interventions to address patient- and system-level implementation challenges are required to translate improvements in HCW knowledge to sustained impact on health outcomes for children with cancer.
Addition of Germline Testing to Tumor-Only Sequencing Improves Detection of Pathogenic Germline Variants in Men With Advanced Prostate Cancer
Authors: Berchuck Jacob E. , Boiarsky Daniel , Silver Rebecca , Sunkara Rajitha , McClure Heather M. , Tsai Harrison K. , Siegmund Stephanie , Tewari Alok K. , Nowak Jonathan A. , Lindeman Neal I. , Rana Huma Q. , Choudhury Atish D. , Pomerantz Mark M. , Freedman Matthew L. , Van Allen Eliezer M. , Taplin Mary-Ellen 
Published: September 2022

PURPOSE Guidelines recommend somatic and germline testing for men with advanced prostate cancer (PCa). Barriers to widespread implementation result in underutilization of germline testing. Somatic testing alone risks missing pathogenic germline variants (PGVs). We sought to determine whether the addition of germline testing to tumor-only sequencing improves detection of PGVs in men with advanced PCa. Secondarily, we sought to define the added value of combining somatic and germline testing to optimize detection of clinically actionable alterations. PATIENTS AND METHODS We analyzed results of independent germline testing and tumor-only sequencing from 100 men with advanced PCa from a prospective clinical trial (ClinicalTrials.gov identifier: NCT03328091 ). The primary outcome was the proportion of PGVs not reported with tumor-only sequencing. The secondary outcome was the association of locus-specific loss of heterozygosity for PGVs in homologous recombination genes with clinical-genomic features. RESULTS In the 100 men who underwent germline testing and tumor-only sequencing, 24 PGVs were identified, 17 of which were clinically actionable, in 23 patients. Tumor-only sequencing failed to report four (17%) of the PGVs. One additional PGV (4.2%) had variant allele frequency on tumor-sequencing below the threshold for follow-up germline testing. When integrating tumor-only sequencing with germling testing results, 33% of patients harbored clinically actionable alterations. Rates of locus-specific loss of heterozygosity were higher for BRCA2 PGVs in castration-resistant PCa than PGVs in other homologous recombination genes in hormone-sensitive PCa ( P = .029). CONCLUSION Tumor-only sequencing failed to report more than 20% of PGVs in men with advanced PCa. These findings strongly support guideline recommendations for universal germline and somatic testing in this population. Combining tumor and germline sequencing doubled the chance of detecting a clinically actionable alteration.
New CrOX (X = Cl, Br, I) monolayer with ultra-wide single spin states
Authors: Deng Xiaohui , Tang Zhenkun 
Published: September 2022

Abstract
The ultra-wide single spin states are of importance for ideal magnetic storage materials and spin injection sources. Here, a new type of CrOX (X = Cr, Br, I) monolayer has been revealed. We find that the basic constructive units for such new monolayers are four-coordinated, almost never being reported until now. More interestingly, they are half-metals and have an ultra-wide single spin channel in their electronic band structures. Monte Carlo simulations show that the Curie temperatures of three monolayers are relatively low, however they can be enhanced to exceed the liquid nitrogen temperature under strain or hole doping. The four-coordinated Cr compounds predicted here may open a new windows for exploring high spin-polarized half-metals.
The Scanning Fiber Endoscope: A Novel Surgical and High-Resolution Imaging Device for Intracranial Neurosurgery
Authors: Walker Gregory , Wang Alick P. , McVeigh Patrick Z. , Ivanishvilli Zurab , Siu William , Seibel Eric J. , Lesiuk Howard , Alkherayf Fahad , Drake Brian J. 
Published: September 2022

BACKGROUND:
The scanning fiber endoscope (SFE) is a novel medical imaging device that has been used in various vascular beds as a form of angioscopy, as well as in tracts and duct systems for endoluminal imaging. Owing to its miniaturized form, high resolution, and flexibility, it has demonstrated success in imaging across a wide range of diagnostic applications.

OBJECTIVE:
To demonstrate, by performing a third ventriculostomy and visualizing the cranial nerves and brainstem anatomy, that, without modification, the SFE can be used through a transcranial approach in a therapeutic intraventricular neurosurgical application.

METHODS:
A 3.7 French SFE system was used without modification on a live porcine model to perform a third ventriculostomy and acquire high-resolution images of the animal's ventricular system, cranial nerves, and brainstem. A side-by-side comparison was made with one of the current standard-of-care rigid endoscopes as a context for size and image quality.

RESULTS:
High-resolution video-rate imaging was used to assist the successful, uncomplicated performance of a third ventriculostomy. High-resolution endoscopic images of the brainstem and cranial nerves were acquired.

CONCLUSION:
Although the SFE has been shown to be a superior device for imaging, here we demonstrate its first use as a potential therapeutic device in intracranial neurosurgery.
Image Segmentation of Operative Neuroanatomy Into Tissue Categories Using a Machine Learning Construct and Its Role in Neurosurgical Training
Authors: Witten Andrew J. , Patel Neal , Cohen-Gadol Aaron 
Published: September 2022

BACKGROUND:
The complexity of the relationships among the structures within the brain makes efficient mastery of neuroanatomy difficult for medical students and neurosurgical residents. Therefore, there is a need to provide real-time segmentation of neuroanatomic images taken from various perspectives to assist with training.

OBJECTIVE:
To develop the initial foundation of a neuroanatomic image segmentation algorithm using artificial intelligence for education.

METHODS:
A pyramidal scene-parsing network with a convolutional residual neural network backbone was assessed for its ability to accurately segment neuroanatomy images. A data set of 879 images derived from The Neurosurgical Atlas was used to train, validate, and test the network. Quantitative assessment of the segmentation was performed using pixel accuracy, intersection-over-union, the Dice similarity coefficient, precision, recall, and the boundary F
1 score.

RESULTS:
The network was trained, and performance was assessed class wise. Compared with the ground truth annotations, the ensembled results for our artificial intelligence framework for the pyramidal scene-parsing network during testing generated a total pixel accuracy of 91.8%.

CONCLUSION:
Using the presented methods, we show that a convolutional neural network can accurately segment gross neuroanatomy images, which represents an initial foundation in artificial intelligence gross neuroanatomy that will aid future neurosurgical training. These results also suggest that our network is sufficiently robust, to an unprecedented level, for performing anatomic category recognition in a clinical setting.
Dura Management Strategies in the Surgical Treatment of Adult Chiari Type I Malformation: A Retrospective, Multicenter, Population-Based Parallel Cohort Case Series
Authors: Kristiansson Helena , Fletcher-Sandersjöö Alexander , Cesarini Kristina , Fransson Marcus , Vlachogiannis Pavlos , Burström Gustav , Hessington Amel , Bartek Jiri , Edström Erik , Holmgren Rafael T. , Sköld Mattias K. , Elmi-Terander Adrian 
Published: September 2022

BACKGROUND:
Symptomatic Chiari I malformation is treated with suboccipital decompression and C1 laminectomy. However, whether the dura should be opened (durotomy) or enlarged with a graft (duraplasty) remains unclear.

OBJECTIVE:
To compare outcomes in adult Chiari I malformation patients treated with duraplasty, durotomy, or without dural opening (“mini-decompression”).

METHODS:
A retrospective, multicenter, population-based cohort study was performed of all adult patients surgically treated for a Chiari I malformation at 3 regional neurosurgical centers between 2005 and 2017. Three different dura management strategies were favored by the participating hospitals, with data stratified accordingly. The primary outcome was measured using the Chicago Chiari Outcome Scale (CCOS), dichotomized into favorable (CCOS ≥13) or unfavorable (CCOS ≤12). Propensity score matching was used to adjust for potential confounders in outcome comparisons.

RESULTS:
In total, 318 patients were included, of whom 52% were treated with duraplasty, 37% with durotomy, and 11% with mini-decompression. In total, 285 (90%) showed a favorable surgical outcome (CCOS ≥13). Duraplasty was associated with more favorable CCOS and shorter hospital stay compared with durotomy, both in unadjusted (93% vs 84%. P = .018 and 6.0 vs 8.0 days, P < .001) and adjusted analyses (92% vs 84%, P = .044 and 6.0 vs 8.0 days, P < .001). Mini-decompression was excluded from the adjusted analyses because of its small sample size.

CONCLUSION:
In this study of adult Chiari I malformation, posterior fossa decompression with duraplasty was associated with more favorable postoperative outcome, as determined by the CCOS, compared with posterior fossa decompression with durotomy alone.
Microsurgical Tubular Resection of Intradural Extramedullary Spinal Tumors With 3-Dimensional-Navigated Localization
Authors: McGrath Lynn B. , Kirnaz Sertac , Goldberg Jacob L. , Sommer Fabian , Medary Branden , Hussain Ibrahim , Härtl Roger 
Published: September 2022

BACKGROUND:
The safety and efficacy of minimally invasive spine surgical (MISS) approaches have stimulated interest in adapting MISS principles for more complex pathology including intradural extramedullary (IDEM) tumors. No study has characterized a repeatable approach integrating the MISS surgical technique and 3-dimensional intraoperative navigated localization for the treatment of IDEM tumors.

OBJECTIVE:
To describe a safe and reproducible technical guide for the navigated MISS technique for the treatment of benign intradural and extradural spinal tumors.

METHODS:
Retrospective review of prospectively collected data on 20 patients who underwent navigated microsurgical tubular resection of intradural extramedullary tumors over a 5-year period. We review our approach to patient selection and report demographic and outcomes data for the cohort.

RESULTS:
Our experience demonstrates technical feasibility and safety with a 100% rate of gross total resection with no patients demonstrating recurrence during an average follow-up of 20.2 months and no instances of perioperative complications. We demonstrate favorable outcomes regarding blood loss, operative duration, and hospital length of stay.

CONCLUSION:
Navigated localization and microsurgical tubular resection of IDEM tumors is safe and effective. Adherence to MISS principles and thoughtful patient selection facilitate successful management of these patients.
Kyphoplasty of C2 Pathological Fractures Using an Anterior Midline Approach and Steerable Osteotome: Technical Note and Case Series
Authors: Krafft Paul R. , Peto Ivo , Flores-Milan Gabriel , Reeves Corey , Klein Sierra , Alikhani Puya , Tran Nam D. 
Published: September 2022

BACKGROUND:
Malignant lesions involving the C2 vertebral body (axis) may be challenging to treat, and not all patients with cancer are good candidates for posterior cervical or occipitocervical instrumentation.

OBJECTIVE:
To describe a modified technique of the direct anterolateral C2 kyphoplasty using a steerable osteotome, commonly used for the treatment of thoracolumbar spinal lesions. We also report a case series of 11 patients treated with this technique at our institution.

METHODS:
The authors performed a retrospective review of all patients who underwent a C2 kyphoplasty using the anterior midline approach from 2010 to 2020. Patient demographics, tumor characteristics, pain severity (visual analog scale), Karnofsky performance status , perioperative complications, and postoperative spinal stability were assessed.

RESULTS:
The main indication for a C2 kyphoplasty was refractory neck pain. All patients tolerated the procedure well. There were no intraoperative complications. One patient developed transient dysphagia. Visual analog scale scores were 9.00 ± 1.10 preoperative and 3.73 ± 1.85 at 2 weeks and 1.67 ± 1.66 at 3 months after the procedure and continued to stay low during the remainder of the follow-up (4-60 months). The Karnofsky performance status improved from 72.73 ± 11.04 preoperatively to 82.22 ± 8.33 at 2 weeks and 86.67 ± 5.00 at 3 months after the procedure. There was no evidence of new occurrence or progression of C2 fractures.

CONCLUSION:
The anterior kyphoplasty using a steerable osteotome for tumors of the axis can result in lasting pain reduction and improved cervical stability while demonstrating a low complication rate.
Calcium and activity-dependent signaling in the developing cerebral cortex
Authors: Arjun McKinney Arpana , Petrova Ralitsa , Panagiotakos Georgia 
Published: September 2022

ABSTRACT
Calcium influx can be stimulated by various intra- and extracellular signals to set coordinated gene expression programs into motion. As such, the precise regulation of intracellular calcium represents a nexus between environmental cues and intrinsic genetic programs. Mounting genetic evidence points to a role for the deregulation of intracellular calcium signaling in neuropsychiatric disorders of developmental origin. These findings have prompted renewed enthusiasm for understanding the roles of calcium during normal and dysfunctional prenatal development. In this Review, we describe the fundamental mechanisms through which calcium is spatiotemporally regulated and directs early neurodevelopmental events. We also discuss unanswered questions about intracellular calcium regulation during the emergence of neurodevelopmental disease, and provide evidence that disruption of cell-specific calcium homeostasis and/or redeployment of developmental calcium signaling mechanisms may contribute to adult neurological disorders. We propose that understanding the normal developmental events that build the nervous system will rely on gaining insights into cell type-specific calcium signaling mechanisms. Such an understanding will enable therapeutic strategies targeting calcium-dependent mechanisms to mitigate disease.
Geodziedzictwo w lesie – o śladach lądolodu na Pałukach
Authors: Górska-Zabielska Maria 
Published: September 2022

The aim of the research is to make an inventory of nine large erratic boulders lying in situ in the forested areas of Pałuki in the north-east Wielkopolska (West Poland). Due to their location unchanged since the deglaciation times, they can be used to establish the chronology of the deglaciation of the last ice sheet in north-western Poland. The knowledge of large erratic boulders along with other elements of geodiversity of Pałuki, a peripheral tourist region, is a potential for the development of geotourism, which in turn can be a driving force for the sustainable development of the region. Field work was used to collect data characterizing individual boulders and indicating their source area in Scandinavia, if they represent the indicator type of an erratic. Attention was paid to the record of sub/inglacial and periglacial processes affecting the foreland of the melting ice sheet, as well as contemporary morphogenetic processes. The detailed description of the boulders emphasized their scientific, cognitive, educational, upbringing, cultural, conservation, pro-environmental and recreational importance. The location of the erratic boulders in the forest makes them interesting targets for tourism in naturally valuable areas. In the age of changing social expectations with regard to forest functions in favor of social, educational (ecological education) and tourist and recreational functions, their good promotion is necessary, preceded by expert research. This paper provides such knowledge transfer.
Different modalities of the treatment of Rasmussen encephalitis: A systematic review of case reports of a rare disease
Authors: Chamlagain Rajan , Shah Sangam , Thapa Sangharsha , Kandel Bipin , Dhital Roman , Sharma Paudel Basanta , Poudel Sujan , Ishak Angela , Aryal Vinayak , Youssef Pamela , J. Nedd Kester 
Published: September 2022

Background: Rasmussen’s encephalitis (RE) is a rare chronic neurological disorder that presents with progressive neurological and cognitive deterioration, and intractable seizures that lacks definitive management. We aimed to identify case reports of RE in the literature to assess the treatment based on the symptoms and outcomes after the treatment. Methods: We searched the databases PubMed, Google Scholar, and the Cochrane Library from 1990 to 22nd February 2022 in order to review the case reports that included the treatment options and clinical outcomes of RE. A pre-established protocol was registered on the International Prospective Register of Systematic Reviews (PROSPERO) database (ID: CRD42021261999). Results: The mean age of onset of seizure was 31.44 and 6.87 years in adult onset RE and children (below 15 years of age) with RE respectively. A total of four (44.44%) out of nine adult patients and 81 (66.39%) out of 122 children underwent surgery. Tacrolimus was used in 17 (13.93%) and steroid therapy was used in 11 (9.01%) of the children. Conclusions: Large scale-controlled trials are needed to study the beneficial effect of tacrolimus, IV Ig, and plasma therapy. Hemispherectomy should be opted as a treatment modality by assessing the impairment of patients’ motor or language functions following the treatment procedure.