Notes

Educational encoding associated with hypothalamic neuroendocrine techniques.
Whistleblowers have significantly shaped the state of contemporary society; in this context, this research sheds light on a persistently neglected research area what are the key determinants of whistleblowing within government agencies? Taking a unique methodological approach, we combine evidence from two pieces of fieldwork, conducted using both primary and secondary data from the US and Indonesia. In Study 1, we use a large-scale survey conducted by the US Merit Systems Protection Board (MSPB). Additional tests are conducted in Study 1, making comparisons between those who have and those who do not have whistleblowing experience. In Study 2, we replicate the survey conducted by the MSPB, using empirical data collected in Indonesia. We find a mixture of corroboration of previous results and unexpected findings between the two samples (US and Indonesia). The most relevant result is that perceived organizational protection has a significant positive effect on whistleblowing intention in the US sample, but a similar result was not found in the Indonesian sample. We argue that this difference is potentially due to the weakness of whistleblowing protection in Indonesia, which opens avenues for further understanding the role of societal cultures in protecting whistleblowers around the globe.
The online version contains supplementary material available at 10.1007/s10551-022-05089-y.
The online version contains supplementary material available at 10.1007/s10551-022-05089-y.
To measure the degree of relative ischemia caused by skin closure, we explored the potential utility of intraoperative surface blood flow measurement with laser speckle imaging (LSI).

Prospective observational study of eight subjects that underwent intraoperative LSI during elective cranial neurosurgical procedures at the time of skin closure.

Seven 1
time incisions, with closure techniques including sutures (
= 3), staples (
= 3), and one after galeal sutures. When compared to the control region, there was a mean 63.7% reduction in flow across all seven subjects (range 18.7-95.32%). Comparing by closure type, a higher flow reduction in the three subjects with suture closure (80.7% reduction) compared to staples (61.9% reduction,
= 0.0379). One subject had a complex wound where tightening and loosening of sutures were performed to ensure adequate perfusion. Suturing resulted in significantly more local decreased flow compared to staples (
< 0.0001).

These findings demonstrate the relative feasibility of using LSI for preoperative vascular flow assessment in planning complex incision closure. These data also provide preliminary support for the hypothesis that skin closure itself causes relative ischemia compared to deep approximation or cautery of the skin edge and that the relative ischemia from staples closure is generally less than from suture closure.
These findings demonstrate the relative feasibility of using LSI for preoperative vascular flow assessment in planning complex incision closure. check details These data also provide preliminary support for the hypothesis that skin closure itself causes relative ischemia compared to deep approximation or cautery of the skin edge and that the relative ischemia from staples closure is generally less than from suture closure.
Spine surgeons rarely consider metal allergies when placing hardware, as implants are thought to be inert.

A 32-year-old male presented with a skin rash attributed to the trace metal in his spinal fusion instrumentation. Patch testing revealed sensitivities to cobalt, manganese, and chromium. He underwent hardware removal and replacement with constructs of commercially pure titanium. His skin findings resolved at 2 weeks after surgery and were stable at 6 weeks.

Hypersensitivity to metal (i.e., metal allergy) should be considered before performing instrumented spinal fusions.
Hypersensitivity to metal (i.e., metal allergy) should be considered before performing instrumented spinal fusions.
Intraventricular tumors can generally result in obstructive hydrocephalus as they grow. Rarely, however, some intraventricular tumors develop superficial siderosis (SS) and trigger hydrocephalus, even though the tumor has hardly grown. Here, we present an illustrative case of SS and nonocclusive hydrocephalus caused by subependymoma of the lateral ventricles.

A 78-year-old man with an intraventricular tumor diagnosed 7 years ago had been suffering from gait disturbance for 2 years. He also developed cognitive impairment. Intraventricular tumors showed little growth on annual magnetic resonance imaging (MRI). MRI T2-star weighted images (T2*WI) captured small intratumoral hemorrhages from the beginning of the follow-up. Three years before, at the same time as the onset of ventricular enlargement, T2*WI revealed low intensity in the whole tumor and cerebral surface. Subsequent follow-up revealed that this hemosiderin deposition had spread to the brain stem and cerebellar surface, and the ventricles had expailitating early intervention in patients with intraventricular lesions, not just subependymomas.
The evolution of syrinx formation has rarely been documented. Here, we report a patient whose "presyrinx" evolved on successive magnetic resonance (MR) images to a mature syrinx.

A patient had a lipoma and tethered cord at birth. At 3 weeks of age, he had undergone a partial removal of the lipoma and untethering of the spinal cord. At age 6, the thoracic MR images showed edema within the gray matter of the cord at the T7 level, consistent with a "presyrinx." In addition, subsequent MR studies (i.e., at age 7) showed a small cavity in the right posterior horn of the cord accompanied by further expansion throughout the right-sided gray matter. Despite repeated cord untethering at age 7, the T7 parenchymal cord change evolved into a mature syrinx by age 10.

An infant with a lipoma/tethered cord, despite two instances of cord detethering (i.e., ages 3 weeks and 7 years), showed continued MR evolution of a "presyrinx" to a mature syrinx by age 10.
An infant with a lipoma/tethered cord, despite two instances of cord detethering (i.e., ages 3 weeks and 7 years), showed continued MR evolution of a "presyrinx" to a mature syrinx by age 10.
Terminal myelocystocele (TMC) is an occult spinal dysraphism characterized by cystic dilatation of the terminal spinal cord in the shape of a trumpet (myelocystocele) filled with cerebrospinal fluid (CSF), which herniates into the extraspinal subcutaneous region. The extraspinal CSF-filled portion of the TMC, consisting of the myelocystocele and the surrounding subarachnoid space, may progressively enlarge, leading to neurological deterioration, and early untethering surgery is recommended.

We report a case of a patient with TMC associated with OEIS complex consisting of omphalocele (O), exstrophy of the cloaca (E), imperforate anus (I), and spinal deformity (S). The untethering surgery for TMC had to be deferred until 10 months after birth because of the delayed healing of the giant omphalocele and the respiration instability due to hypoplastic thorax and increased intra-abdominal pressure. The TMC, predominantly the surrounding subarachnoid space, enlarged during the waiting period, resulting in the expedes healing of the duraplasty. Early untethering surgery is recommended after recovery from the life-threatening conditions associated with OEIS complex.
Holospinal epidural abscesses (HEAs) are rare with potentially devastating consequences. Urgent bony decompression and abscess evacuation with long-term antibiotic therapy are typically the treatment of choice.

We reviewed cases of holospinal HEAs operated on between 2009 and 2018. Variables studied included preoperative laboratories, CT/MR studies plus clinical and radiographic follow-up for between 34 and 60 postoperative months.

We utilized skip hemilaminectomies to minimize the risks of segmental instability. Targeted antibiotic therapy was also started immediately and maintained for 6 postoperative weeks. MR/CT studies documented full radiographic and neurological recovery between 6 and 12-months later.

HEAs may be treated utilizing multilevel skip hemilaminectomies to help maintain spinal stability while offering adequate abscess decompression/resolution.
HEAs may be treated utilizing multilevel skip hemilaminectomies to help maintain spinal stability while offering adequate abscess decompression/resolution.
Interdural cysts are rare meningeal cysts with an unclear etiology. They are often mistaken for other mass lesions, including arachnoid cysts and tumors. Correctly identifying and classifying these cysts, as well as how they have formed in individual patients, are crucial to providing effective treatment options for patients.

We report a case of a patient with shunted idiopathic intracranial hypertension who developed a symptomatic Chiari malformation and was subsequently discovered to have a spinal interdural cyst. The Chiari malformation was likely due to intracranial hypotension secondary to lumbar cerebrospinal fluid (CSF) diversion. Once the shunt was removed, a spinal interdural cyst became clinically and radiographically evident, and the Chiari resolved, suggesting that both entities were effects of shared CSF flow dynamics.

This cyst likely originated due to the trauma from remote repeated lumbar punctures and lumboperitoneal shunt placement, allowing CSF to enter the interdural space after the catheter was removed.
This cyst likely originated due to the trauma from remote repeated lumbar punctures and lumboperitoneal shunt placement, allowing CSF to enter the interdural space after the catheter was removed.
Transvenous embolization through the inferior petrosal sinus (IPS) is the most common treatment procedure for cavernous sinus dural arteriovenous fistula (CSDAVF). When the IPS is inaccessible or the CSDAVF cannot be treated with transvenous embolization through the IPS, the superficial temporal vein (STV) is used as an alternative access route. However, the approach through the STV is often challenging because of its tortuous and abruptly angulated course. We report a case of recurrent CSDAVF which was successfully treated using a chronic total occlusion (CTO)-dedicated guidewire and by straightening the STV.

A 63-year-old woman was diagnosed with CSDAVF on examination for oculomotor and abducens nerve palsy. She was initially treated with transvenous embolization through the IPS. However, CSDAVF recurred, and transvenous embolization was performed through the STV. A microcatheter could not be navigated because of the highly meandering access route through the STV. By inserting a CTO-dedicated guidewire into the microcatheter, the STV was straightened and the microcatheter could be navigated into a shunted pouch of the CS. Finally, complete occlusion of the CSDAVF was achieved.

If an access route is highly meandering, the approach can be facilitated by straightening the access route with a CTO-dedicated guidewire.
If an access route is highly meandering, the approach can be facilitated by straightening the access route with a CTO-dedicated guidewire.
T2 scans are widely used to determine the prognosis for patients undergoing surgery for cervical myelopathy. In this study, we determined whether T1 MR changes in addition to T2 MR changes could have prognostic importance.

This retrospective analysis involved 182 patients undergoing surgery for cervical myelopathy (2017-2020). There were 110 patients in Group 1 (only T2 MR changes) and 72 in Group 2 (both T1 and T2 MR changes). In addition, demographic, visual analog score (VAS), modified Japanese Orthopaedic Association (mJOA) scores, and operative details were recorded at 1 month, 3 months, 6 months, and 1 year postoperatively.

Notably, VAS scores were comparable at each point in time and were significantly better than the preoperative scores at 1 year postoperatively. Although mJOA scores were comparable at 1 month in both groups, they were better thereafter for Group 1 patients.

The presence of T1 changes on the preoperative magnetic resonance imaging represented a poor prognostic indicator for the postoperative outcome compared to the presence of T2 changes alone.
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