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Sample records for neural surgical strategy

  1. Strategies for Building Peer Surgical Coaching Relationships.

    Science.gov (United States)

    Beasley, Heather L; Ghousseini, Hala N; Wiegmann, Douglas A; Brys, Nicole A; Pavuluri Quamme, Sudha R; Greenberg, Caprice C

    2017-04-19

    Peer surgical coaching is a promising approach for continuing professional development. However, scant guidance is available for surgeons seeking to develop peer-coaching skills. Executive coaching research suggests that effective coaches first establish a positive relationship with their coachees by aligning role and process expectations, establishing rapport, and cultivating mutual trust. To identify the strategies used by peer surgical coaches to develop effective peer-coaching relationships with their coachees. Drawing on executive coaching literature, a 3-part framework was developed to examine the strategies peer surgical coaches (n = 8) used to initially cultivate a relationship with their coachees (n = 11). Eleven introductory 1-hour meetings between coaching pairs participating in a statewide surgical coaching program were audiorecorded, transcribed, and coded on the basis of 3 relationship-building components. Once coded, thematic analysis was used to organize coded strategies into thematic categories and subcategories. Data were collected from October 10, 2014, to March 20, 2015. Data analysis took place from May 26, 2015, to July 20, 2016. Strategies and potentially counterproductive activities for building peer-coaching relationships in the surgical context to inform the future training of surgical coaches. Coaches used concrete strategies to align role and process expectations about the coaching process, to establish rapport, and to cultivate mutual trust with their coachees during introductory meetings. Potential coaching pitfalls are identified that could interfere with each of the 3 relationship-building components. Peer-nominated surgical coaches were provided with training on abstract concepts that underlie effective coaching practices in other fields. By identifying the strategies used by peer surgical coaches to operationalize these concepts, empirically based strategies to inform other surgical coaching programs are provided.

  2. Surgical Strategies for Cervical Spinal Neurinomas.

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    Ito, Kiyoshi; Aoyama, Tatsuro; Miyaoka, Yoshinari; Horiuchi, Tetsuyoshi; Hongo, Kazuhiro

    2015-01-01

    Cervical spinal neurinomas are benign tumors that arise from nerve roots. Based on their location, these tumors can also take the form of a dumbbell-shaped mass. Treatment strategies for these tumors have raised several controversial issues such as appropriate surgical indications and selection of surgical approaches for cervical dumbbell-shaped spinal neurinomas. In this report, we review previous literature and retrospectively analyze cervical spinal neurinoma cases that have been treated at our hospital. Surgical indications and approaches based on tumor location and severity are discussed in detail. Thus, with advances in neuroimaging and neurophysiological monitoring, we conclude that appropriate surgical approaches and intraoperative surgical manipulations should be chosen on a case-by-case basis.

  3. Coping strategies in anxious surgical patients

    OpenAIRE

    Aust, Hansjoerg; R?sch, Dirk; Schuster, Maike; Sturm, Theresa; Brehm, Felix; Nestoriuc, Yvonne

    2016-01-01

    Background Anaesthesia and surgery provoke preoperative anxiety and stress. Patients try to regain control of their emotions by using coping efforts. Coping may be more effective if supported by specific strategies or external utilities. This study is the first to analyse coping strategies in a large population of patients with high preoperative anxiety. Methods We assessed preoperative anxiety and coping preferences in a consecutive sample of 3087 surgical patients using validated scales (Am...

  4. Neural network adapted to wound cell analysis in surgical patients.

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    Viljanto, Jouko; Koski, Antti

    2011-01-01

    Assessment of the real state of wound healing of closed surgical wounds is uncertain both clinically and from conventional laboratory tests. Therefore, a novel approach based on early analysis of exactly timed wound cells, computerized further with an artificial neural network, was developed. At the end of routine surgery performed on 481 children under 18 years of age, a specific wound drain Cellstick™ was inserted subcutaneously between the wound edges to harvest wound cells. The Cellsticks™ were removed from 1 to 50 hours, mainly at hour 3 or 24 postsurgery. Immediately, the cellular contents were washed out using a pump constructed for the purpose. After cytocentrifugation, the cells were stained and counted differentially. Based on their relative proportions at selected time intervals, an artificial self-organizing neural map was developed. This was further transformed to a unidirectional linear graph where each node represents one set of relative cell quantities. As early as 3 hours, but more precisely 24 hours after surgery, the location of the nodes on this graph showed individually the patients' initial speed of wound inflammatory cell response. Similarly, timed Cellstick™ specimens from new surgical patients could be analyzed, computerized, and compared with these node values to assess their initial speed in wound inflammatory cell response. Location of the node on the graph does not express the time lapse after surgery but the speed of wound inflammatory cell response in relation to that of other patients. © 2011 by the Wound Healing Society.

  5. Coping strategies in anxious surgical patients.

    Science.gov (United States)

    Aust, Hansjoerg; Rüsch, Dirk; Schuster, Maike; Sturm, Theresa; Brehm, Felix; Nestoriuc, Yvonne

    2016-07-12

    Anaesthesia and surgery provoke preoperative anxiety and stress. Patients try to regain control of their emotions by using coping efforts. Coping may be more effective if supported by specific strategies or external utilities. This study is the first to analyse coping strategies in a large population of patients with high preoperative anxiety. We assessed preoperative anxiety and coping preferences in a consecutive sample of 3087 surgical patients using validated scales (Amsterdam Preoperative Anxiety and Information Scale/Visual Analogue Scale). In the subsample of patients with high preoperative anxiety, patients' dispositional coping style was determined and patients' coping efforts were studied by having patients rate their agreement with 9 different coping efforts on a four point Likert scale. Statistical analysis included correlational analysis between dispositional coping styles, coping efforts and other variables such as sociodemographic data. Statistical significance was considered for p preoperative anxiety. According to the initial self-assessment, about two thirds of the patients believed that information would help them to cope with their anxiety ("monitors"); the remainder declined further education/information and reported self-distraction to be most helpful to cope with anxiety ("blunters"). There was no significant difference between these two groups in anxiety scores. Educational conversation was the coping effort rated highest in monitors whereas calming conversation was the coping effort rated highest in blunters. Coping follows no demographic rules but is influenced by the level of education. Anxiolytic Medication showed no reliable correlation to monitoring and blunting disposition. Both groups showed an exactly identical agreement with this coping effort. Demand for medical anxiolysis, blunting or the desire for more conversation may indicate increased anxiety. The use of the internet was independent of the anxiety level and the demand of

  6. [Surgical strategy for postburn cervical scar contracture].

    Science.gov (United States)

    Feng, Shaoqing; Su, Weijie; Xi, Wenjing; Min, Peiru; Pu, Zheming; Zhang, Yan; Zhang, Yixin

    2015-08-01

    To explore the surgical strategy for postburn cervical scar contracture. Sixty-five patients with scar contracture as a result of burn injury in the neck were hospitalized from July 2013 to July 2014. Release of cervical scar contracture was conducted according to different demands of the 3 anatomic subunits of neck, i.e. lower lip vermilion border-supramaxillary region, submaxillary region, and anterior region of neck. After release of contracture, platysma was released. For some cases with chin retrusion, genioplasty with horizontal osteotomy was performed. The coverage of wound followed the principle of similarity, i.e. the skin tissue covering the wound in the neck should be similar to the characters of skin around the wound in terms of color, texture, and thickness. Based on this principle, except for the preschool children in whom skin grafting was performed, the wounds of the other patients were covered by local skin flaps, adjacent skin flaps, or free skin flaps. All patients underwent release of scar and platysma, while 9 patients underwent genioplasty with horizontal osteotomy. Wounds were covered with local skin flaps in 32 patients, with adjacent skin flaps in 7 patients, with free skin flaps in 11 patients, and with skin grafts in 15 patients. All skin grafts and flaps survived. Good range of motion was achieved in the neck of all patients, with the cervicomental angle after reconstruction ranging from 90 to 120°. All patients were followed up for 6 to 24 months. Six patients who had undergone skin grafting were found to have some degrees of skin contracture, while none of the patients who had undergone flap coverage showed any signs of contracture recurrence. Restoration of the cervicomental angle is critical in the treatment of postburn cervical scar contracture, and the release of scar contracture should conform to the subunit principle. The coverage of wound should be based on the principle of similarity, with repair by skin flaps as the first

  7. Neural Mechanisms Underlying Compensatory and Noncompensatory Strategies in Risky Choice

    NARCIS (Netherlands)

    van Duijvenvoorde, A.C.K.; Figner, B.; Weeda, W.D.; van der Molen, M.W.; Jansen, B.R.J.; Huizenga, H.M.

    Individuals may differ systematically in their applied decision strategies, which has critical implications for decision neuroscience but is yet scarcely studied. Our study's main focus was therefore to investigate the neural mechanisms underlying compensatory versus noncompensatory strategies in

  8. Neural mechanisms underlying compensatory and noncompensatory strategies in risky choice

    NARCIS (Netherlands)

    Duijvenvoorde, A.C.K. van; Figner, B.; Weeda, W.D.; Molen, M.W. van der; Jansen, B.R.J.; Huizenga, H.M.

    2016-01-01

    Individuals may differ systematically in their applied decision strategies, which has critical implications for decision neuroscience but is yet scarcely studied. Our study's main focus was therefore to investigate the neural mechanisms underlying compensatory versus noncompensatory strategies in

  9. Mechanical ventilation strategies for the surgical patient

    NARCIS (Netherlands)

    Schultz, Marcus J.; Abreu, Marcelo Gama de; Pelosi, Paolo

    2015-01-01

    Purpose of review To summarize clinical evidence for intraoperative ventilation settings, which could protect against postoperative pulmonary complications (PPCs) in surgical patients with uninjured lungs. Recent findings There is convincing evidence for protection against PPCs by low tidal volumes:

  10. Multimodal strategies to improve surgical outcome

    DEFF Research Database (Denmark)

    Kehlet, Henrik; Wilmore, Douglas W

    2002-01-01

    anesthesia in elective operations, and pilot studies of fast track surgical procedures using the multimodality approach. RESULTS: The introduction of newer approaches to perioperative care has reduced both morbidity and mortality in surgical patients. In the future, most elective operations will become day...... pathophysiology and implementation of care regimes to reduce the stress of an operation, will continue to accelerate rehabilitation associated with decreased hospitalization and increased satisfaction and safety after discharge. Developments and improvements of multimodal interventions within the context of "fast...

  11. Learning in Neural Networks: VLSI Implementation Strategies

    Science.gov (United States)

    Duong, Tuan Anh

    1995-01-01

    Fully-parallel hardware neural network implementations may be applied to high-speed recognition, classification, and mapping tasks in areas such as vision, or can be used as low-cost self-contained units for tasks such as error detection in mechanical systems (e.g. autos). Learning is required not only to satisfy application requirements, but also to overcome hardware-imposed limitations such as reduced dynamic range of connections.

  12. ChainMail based neural dynamics modeling of soft tissue deformation for surgical simulation.

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    Zhang, Jinao; Zhong, Yongmin; Smith, Julian; Gu, Chengfan

    2017-07-20

    Realistic and real-time modeling and simulation of soft tissue deformation is a fundamental research issue in the field of surgical simulation. In this paper, a novel cellular neural network approach is presented for modeling and simulation of soft tissue deformation by combining neural dynamics of cellular neural network with ChainMail mechanism. The proposed method formulates the problem of elastic deformation into cellular neural network activities to avoid the complex computation of elasticity. The local position adjustments of ChainMail are incorporated into the cellular neural network as the local connectivity of cells, through which the dynamic behaviors of soft tissue deformation are transformed into the neural dynamics of cellular neural network. Experiments demonstrate that the proposed neural network approach is capable of modeling the soft tissues' nonlinear deformation and typical mechanical behaviors. The proposed method not only improves ChainMail's linear deformation with the nonlinear characteristics of neural dynamics but also enables the cellular neural network to follow the principle of continuum mechanics to simulate soft tissue deformation.

  13. Neural correlates of arithmetic calculation strategies.

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    Rosenberg-Lee, Miriam; Lovett, Marsha C; Anderson, John R

    2009-09-01

    Recent research into math cognition has identified areas of the brain that are involved in number processing (Dehaene, Piazza, Pinel, & Cohen, 2003) and complex problem solving (Anderson, 2007). Much of this research assumes that participants use a single strategy; yet, behavioral research finds that people use a variety of strategies (LeFevre et al., 1996; Siegler, 1987; Siegler & Lemaire, 1997). In the present study, we examined cortical activation as a function of two different calculation strategies for mentally solving multidigit multiplication problems. The school strategy, equivalent to long multiplication, involves working from right to left. The expert strategy, used by "lightning" mental calculators (Staszewski, 1988), proceeds from left to right. The two strategies require essentially the same calculations, but have different working memory demands (the school strategy incurs greater demands). The school strategy produced significantly greater early activity in areas involved in attentional aspects of number processing (posterior superior parietal lobule, PSPL) and mental representation (posterior parietal cortex, PPC), but not in a numerical magnitude area (horizontal intraparietal sulcus, HIPS) or a semantic memory retrieval area (lateral inferior prefrontal cortex, LIPFC). An ACT-R model of the task successfully predicted BOLD responses in PPC and LIPFC, as well as in PSPL and HIPS.

  14. Seven Strategies That Encourage Neural Branching.

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    Cardellichio, Thomas; Field, Wendy

    1997-01-01

    Teaching strategies that overcome the brain's natural tendency to limit information can open students' minds to new ideas and creative mental habits. Seven strategies to provoke divergent thinking and deepen understanding are hypothetical thinking, reversal, application of different symbol systems, analogy, viewpoint analysis, completion, and web…

  15. A Literature Review of Renal Surgical Anatomy and Surgical Strategies for Partial Nephrectomy.

    Science.gov (United States)

    Klatte, Tobias; Ficarra, Vincenzo; Gratzke, Christian; Kaouk, Jihad; Kutikov, Alexander; Macchi, Veronica; Mottrie, Alexandre; Porpiglia, Francesco; Porter, James; Rogers, Craig G; Russo, Paul; Thompson, R Houston; Uzzo, Robert G; Wood, Christopher G; Gill, Inderbir S

    2015-12-01

    A detailed understanding of renal surgical anatomy is necessary to optimize preoperative planning and operative technique and provide a basis for improved outcomes. To evaluate the literature regarding pertinent surgical anatomy of the kidney and related structures, nephrometry scoring systems, and current surgical strategies for partial nephrectomy (PN). A literature review was conducted. Surgical renal anatomy fundamentally impacts PN surgery. The renal artery divides into anterior and posterior divisions, from which approximately five segmental terminal arteries originate. The renal veins are not terminal. Variations in the vascular and lymphatic channels are common; thus, concurrent lymphadenectomy is not routinely indicated during PN for cT1 renal masses in the setting of clinically negative lymph nodes. Renal-protocol contrast-enhanced computed tomography or magnetic resonance imaging is used for standard imaging. Anatomy-based nephrometry scoring systems allow standardized academic reporting of tumor characteristics and predict PN outcomes (complications, remnant function, possibly histology). Anatomy-based novel surgical approaches may reduce ischemic time during PN; these include early unclamping, segmental clamping, tumor-specific clamping (zero ischemia), and unclamped PN. Cancer cure after PN relies on complete resection, which can be achieved by thin margins. Post-PN renal function is impacted by kidney quality, remnant quantity, and ischemia type and duration. Surgical renal anatomy underpins imaging, nephrometry scoring systems, and vascular control techniques that reduce global renal ischemia and may impact post-PN function. A contemporary ideal PN excises the tumor with a thin negative margin, delicately secures the tumor bed to maximize vascularized remnant parenchyma, and minimizes global ischemia to the renal remnant with minimal complications. In this report we review renal surgical anatomy. Renal mass imaging allows detailed delineation of the

  16. Rethinking neural efficiency : Effects of controlling for strategy use

    NARCIS (Netherlands)

    Toffanin, Paolo; Johnson, Addie; de Jong, Ritske; Martens, Sander

    2007-01-01

    A sentence verification task (SVT) was used to test whether differences in neural activation patterns that have been attributed to IQ may actually depend on differential strategy use between IQ groups. Electroencephalograms were recorded from 14 low (89

  17. Cellular neural network modelling of soft tissue dynamics for surgical simulation.

    Science.gov (United States)

    Zhang, Jinao; Zhong, Yongmin; Smith, Julian; Gu, Chengfan

    2017-07-20

    Currently, the mechanical dynamics of soft tissue deformation is achieved by numerical time integrations such as the explicit or implicit integration; however, the explicit integration is stable only under a small time step, whereas the implicit integration is computationally expensive in spite of the accommodation of a large time step. This paper presents a cellular neural network method for stable simulation of soft tissue deformation dynamics. The non-rigid motion equation is formulated as a cellular neural network with local connectivity of cells, and thus the dynamics of soft tissue deformation is transformed into the neural dynamics of the cellular neural network. Results show that the proposed method can achieve good accuracy at a small time step. It still remains stable at a large time step, while maintaining the computational efficiency of the explicit integration. The proposed method can achieve stable soft tissue deformation with efficiency of explicit integration for surgical simulation.

  18. Novel surgical classification and treatment strategy for atlantoaxial dislocations.

    Science.gov (United States)

    Wang, Shenglin; Wang, Chao; Yan, Ming; Zhou, Haitao; Dang, Gengting

    2013-10-01

    Retrospective study of 904 patients with a diagnosis of atlantoaxial dislocation (AAD), using a novel surgical classification and treatment strategy. To describe a novel surgical classification and treatment strategy for AADs. AADs can result from a variety of etiologies, yet no comprehensive classification has been accepted that guides treatment. Because of the rarity of the cases, however, the treatment strategy has also been debated. During a period of 12 years, a total of 904 patients with a diagnosis of AAD were recruited from a single academic institution. According to the treatment algorithm that included preoperative evaluation using dynamic radiograph, reconstructive computed tomography, and skeletal traction test, the cases were classified into 4 types: I to IV. Types I and II were fused in the reduced position from a posterior approach. Type III, which were irreducible dislocations, were converted to reducible dislocations using a transoral atlantoaxial release, followed by a posterior fusion. Type IV presented with bony dislocations and required transoral osseous decompressions prior to posterior fusion. Four hundred seventy-two cases were classified as type I, 160 as type II, 268 as type III, and 4 cases as type IV. Follow-up was in the range of 2 to 12 years (average: 60.5 mo). Eight hundred and ninety-nine cases (99.4%) achieved a solid atlantoaxial fusion. Anatomic atlantoaxial reduction was achieved in 892 cases (98.7%), whereas 12 cases had a partial reduction. Neurological improvement was seen in 84.1% (512/609) of the patients with myelopathy. The overall complication rate was 9.1% (82/949). Our surgical classification and treatment strategy for AADs was applied in those 904 cases and associated with excellent clinical results with a minimal risk of complications. 4.

  19. Surgical-tools detection based on Convolutional Neural Network in laparoscopic robot-assisted surgery.

    Science.gov (United States)

    Bareum Choi; Kyungmin Jo; Songe Choi; Jaesoon Choi

    2017-07-01

    Laparoscopic surgery, a type of minimally invasive surgery, is used in a variety of clinical surgeries because it has a faster recovery rate and causes less pain. However, in general, the robotic system used in laparoscopic surgery can cause damage to the surgical instruments, organs, or tissues during surgery due to a narrow field of view and operating space, and insufficient tactile feedback. This study proposes real-time models for the detection of surgical instruments during laparoscopic surgery by using a CNN(Convolutional Neural Network). A dataset included information of the 7 surgical tools is used for learning CNN. To track surgical instruments in real time, unified architecture of YOLO apply to the models. So as to evaluate performance of the suggested models, degree of recall and precision is calculated and compared. Finally, we achieve 72.26% mean average precision over our dataset.

  20. Surgical tool detection in cataract surgery videos through multi-image fusion inside a convolutional neural network.

    Science.gov (United States)

    Al Hajj, Hassan; Lamard, Mathieu; Charriere, Katia; Cochener, Beatrice; Quellec, Gwenole

    2017-07-01

    The automatic detection of surgical tools in surgery videos is a promising solution for surgical workflow analysis. It paves the way to various applications, including surgical workflow optimization, surgical skill evaluation and real-time warning generation. A solution based on convolutional neural networks (CNNs) is proposed in this paper. Unlike existing solutions, the proposed CNN does not analyze images independently. it analyzes sequences of consecutive images. Features extracted from each image by the CNN are fused inside the network using the optical flow. For improved performance, this multi-image fusion strategy is also applied while training the CNN. The proposed framework was evaluated in a dataset of 30 cataract surgery videos (6 hours of videos). Ten tool categories were defined by surgeons. The proposed system was able to detect each of these categories with a high area under the ROC curve (0.953 ≤ Az ≤ 0.987). The proposed detector, based on multi-image fusion, was significantly more sensitive and specific than a similar system analyzing images independently (p = 2.98 × 10(-6) and p = 2.07 × 10(-3), respectively).

  1. Neural PID Control Strategy for Networked Process Control

    Directory of Open Access Journals (Sweden)

    Jianhua Zhang

    2013-01-01

    Full Text Available A new method with a two-layer hierarchy is presented based on a neural proportional-integral-derivative (PID iterative learning method over the communication network for the closed-loop automatic tuning of a PID controller. It can enhance the performance of the well-known simple PID feedback control loop in the local field when real networked process control applied to systems with uncertain factors, such as external disturbance or randomly delayed measurements. The proposed PID iterative learning method is implemented by backpropagation neural networks whose weights are updated via minimizing tracking error entropy of closed-loop systems. The convergence in the mean square sense is analysed for closed-loop networked control systems. To demonstrate the potential applications of the proposed strategies, a pressure-tank experiment is provided to show the usefulness and effectiveness of the proposed design method in network process control systems.

  2. Surgical treatment of post-infarction left ventricular pseudoaneurysm: Case series highlighting various surgical strategies

    Directory of Open Access Journals (Sweden)

    Edvin Prifti, MD, PhD

    2017-04-01

    Conclusion: In conclusion, this study revealed that surgical repair of post infarct left ventricular pseudoaneurysm was associated with an acceptable surgical mortality rate, that cardiac rupture did not occur in surgically treated patients.

  3. Training strategy for convolutional neural networks in pedestrian gender classification

    Science.gov (United States)

    Ng, Choon-Boon; Tay, Yong-Haur; Goi, Bok-Min

    2017-06-01

    In this work, we studied a strategy for training a convolutional neural network in pedestrian gender classification with limited amount of labeled training data. Unsupervised learning by k-means clustering on pedestrian images was used to learn the filters to initialize the first layer of the network. As a form of pre-training, supervised learning for the related task of pedestrian classification was performed. Finally, the network was fine-tuned for gender classification. We found that this strategy improved the network's generalization ability in gender classification, achieving better test results when compared to random weights initialization and slightly more beneficial than merely initializing the first layer filters by unsupervised learning. This shows that unsupervised learning followed by pre-training with pedestrian images is an effective strategy to learn useful features for pedestrian gender classification.

  4. Control strategies for underactuated neural ensembles driven by optogenetic stimulation

    Directory of Open Access Journals (Sweden)

    ShiNung eChing

    2013-04-01

    Full Text Available Motivated by experiments employing optogenetic stimulation of cortical regions, we consider spike control strategies for ensembles of uncoupled integrate and fire neurons with a common conductance input. We construct strategies for control of spike patterns, that is, multineuron trains of action potentials, up to some maximal spike rate determined by the neural biophysics. We emphasize a constructive role for parameter heterogeneity, and find a simple rule for controllability in pairs of neurons. In particular, we determine parameters for which common drive is not limited to inducing synchronous spiking. For large ensembles, we determine how the number of controllable neurons varies with the number of observed (recorded neurons, and what collateral spiking occurs in the full ensemble during control of the subensemble. While complete control of spiking in every neuron is not possible with a single input, we find that a degree of subensemble control is made possible by exploiting dynamical heterogeneity. As most available technologies for neural stimulation are underactuated, in the sense that the number of target neurons far exceeds the number of independent channels of stimulation, these results suggest partial control strategies that may be important in the development of sensory neuroprosthetics and other neurocontrol applications.

  5. Control strategies for underactuated neural ensembles driven by optogenetic stimulation.

    Science.gov (United States)

    Ching, ShiNung; Ritt, Jason T

    2013-01-01

    Motivated by experiments employing optogenetic stimulation of cortical regions, we consider spike control strategies for ensembles of uncoupled integrate and fire neurons with a common conductance input. We construct strategies for control of spike patterns, that is, multineuron trains of action potentials, up to some maximal spike rate determined by the neural biophysics. We emphasize a constructive role for parameter heterogeneity, and find a simple rule for controllability in pairs of neurons. In particular, we determine parameters for which common drive is not limited to inducing synchronous spiking. For large ensembles, we determine how the number of controllable neurons varies with the number of observed (recorded) neurons, and what collateral spiking occurs in the full ensemble during control of the subensemble. While complete control of spiking in every neuron is not possible with a single input, we find that a degree of subensemble control is made possible by exploiting dynamical heterogeneity. As most available technologies for neural stimulation are underactuated, in the sense that the number of target neurons far exceeds the number of independent channels of stimulation, these results suggest partial control strategies that may be important in the development of sensory neuroprosthetics and other neurocontrol applications.

  6. Abdominal Colpopexy: Comparison of Endoscopic Surgical Strategies (ACCESS)☆

    Science.gov (United States)

    Mueller, E.R.; Kenton, K.; Tarney, C.; Brubaker, L.; Rosenman, A.; Smith, B.; Stroupe, K.; Bresee, C.; Pantuck, A.; Schulam, P.; Anger, J.T.

    2014-01-01

    Introduction Robotic assistance during laparoscopic surgery for pelvic organ prolapse rapidly disseminated across the United States without level I data to support its benefit over traditional open and laparoscopic approaches. This manuscript describes design and methodology of the Abdominal Colpopexy: Comparison of Endoscopic Surgical Strategies (ACCESS) Trial [1]. Methods ACCESS is a randomized comparative effectiveness trial enrolling patients at two academic teaching facilities, UCLA (Los Angeles, CA) and Loyola University (Chicago, IL). The primary aim is to compare costs of robotic assisted versus pure laparoscopic abdominal sacrocolpopexy (RASC vs LASC). Following a clinical decision for minimally-invasive abdominal sacrocolpopexy (ASC) and research consent, participants with symptomatic stage≥II pelvic organ prolapse are randomized to LASC or RASC on the day of surgery. Costs of care are based on each patient’s billing record and equipment costs at each hospital. All costs associated with surgical procedure including costs for robot and initial hospitalization and any re-hospitalization in the first 6 weeks are compared between groups. Secondary outcomes include post-operative pain, anatomic outcomes, symptom severity and quality of life, and adverse events. Power calculation determined that 32 women in each arm would provide 95% power to detect a $2500 difference in total charges, using a two-sided two sample t-test with a significance level of 0.05. Results Enrollment was completed in May 2011. The 12-month follow-up will end in May 2012. Conclusions This is a multi-center study to assess cost as a primary outcome in a comparative effectiveness trial of LASC versus RASC. PMID:22643040

  7. [The clinical features and surgical treatment strategies of cervical kyphosis].

    Science.gov (United States)

    Fang, Jia-hu; Jia, Lian-shun; Zhou, Xu-hui; Song, Li-jun; Cai, Wei-hua; Li, Xiang

    2010-10-15

    To analyze the clinical characteristics and the surgical treatment strategy of cervical kyphosis. From March 2006 to October 2009, 31 cases of cervical kyphosis were treated. According to the clinical features and imaging findings, different treatment methods were used. There were 9 patients in operation group, including 4 male and 5 female patients, aged from 17 to 72 years (average age of 35 years). Among them, 5 cases were idiopathic kyphosis and 4 cases were caused by laminectomy or other reasons. There were 22 patients in conservative treatment group, including 11 male and 11 female patients, aged from 14 to 40 years (average age of 29 years), who were all idiopathic cervical kyphosis. Before and 1 week after operation, clinical assessment were taken for the patients in operation group using Spinal Cord Injuries Classification Standard of American Spinal Injury Association (AISA). During the periodic review, the anteroposterior, normal sagittal films of cervical spine were taken. At 1 week and every 6 months after operation, MRI films were also taken. These films were studied to evaluate the effects of the operations. In the conservative group, assessment of treatment results by studying anteroposterior and normal lateral views of cervical spine were were taken every month. The clinical characteristics and the surgical treatment strategies of these patients were analyzed. In operation group, 9 cases were followed up for 6 to 18 months, all patients did not failed in internal fixation and fusion. AISA neurological score and neurological function significantly improved. Three days after operation the average Cobb angle was -1.29 ° (preoperative 54.24 °). In conservative group, the average Cobb angle was -5.41 ° (before treatment 11.20 °) 4 months after the treatment. The symptoms of neck shoulder and back pain disappeared, and all patients were followed up for 3 to 24 months, with no recurrence of symptoms. In the early period of cervical kyphosis, adopt

  8. Improved probabilistic neural networks with self-adaptive strategies for transformer fault diagnosis problem

    Directory of Open Access Journals (Sweden)

    Jiao-Hong Yi

    2016-01-01

    Full Text Available Probabilistic neural network has successfully solved all kinds of engineering problems in various fields since it is proposed. In probabilistic neural network, Spread has great influence on its performance, and probabilistic neural network will generate bad prediction results if it is improperly selected. It is difficult to select the optimal manually. In this article, a variant of probabilistic neural network with self-adaptive strategy, called self-adaptive probabilistic neural network, is proposed. In self-adaptive probabilistic neural network, Spread can be self-adaptively adjusted and selected and then the best selected Spread is used to guide the self-adaptive probabilistic neural network train and test. In addition, two simplified strategies are incorporated into the proposed self-adaptive probabilistic neural network with the aim of further improving its performance and then two versions of simplified self-adaptive probabilistic neural network (simplified self-adaptive probabilistic neural networks 1 and 2 are proposed. The variants of self-adaptive probabilistic neural networks are further applied to solve the transformer fault diagnosis problem. By comparing them with basic probabilistic neural network, and the traditional back propagation, extreme learning machine, general regression neural network, and self-adaptive extreme learning machine, the results have experimentally proven that self-adaptive probabilistic neural networks have a more accurate prediction and better generalization performance when addressing the transformer fault diagnosis problem.

  9. Surgical treatment of post-infarction left ventricular pseudoaneurysm: Case series highlighting various surgical strategies.

    Science.gov (United States)

    Prifti, Edvin; Bonacchi, Massimo; Baboci, Arben; Giunti, Gabriele; Veshti, Altin; Demiraj, Aurel; Zeka, Merita; Rruci, Edlira; Bejko, Ervin

    2017-04-01

    The left ventricular pseudoaneurysm (LVP) is rare, the surgical experience is limited and its surgical treatment remains still a challenge with an elevated mortality. Herein, it is presented a retrospective analysis of our experience with acquired post infarct LVP over a10-year period. Between January 2006 through August 2016, a total of 13 patients underwent operation for post infarct pseudoaneurysm of the left ventricle. There were 10 men and 3 women and the mean age was 61 ± 7.6 years. 4 patients presented acute LVP. Two patients had preoperative intraortic balloon pump implantation. Various surgical techniques were used to obliterate the pseudoaneurysm such as direct pledgeted sutures buttressed by polytetrafluoroethylene felt, a Gore-Tex or Dacron patch, transatrial closure of LVP neck in submitral pseudoaneurysm, or linear closure in cases presenting associated postinfarct ventricular septal defect. Concomitant coronary artery bypasses were performed for significant stenoses in 12 patients, ventricular septal defect closure in 4 patients, mitral valve replacement in 3 and aortic valve replacement in 1 patient. Operative mortality was 30.8% (4 patients). Three of them were acute LVP. Three patients required the continuous hemodyalisis and 8 patients required intra-aortic balloon pump. At follow-up two deaths occurred at 1 and 3 years after surgery. In conclusion, this study revealed that surgical repair of post infarct left ventricular pseudoaneurysm was associated with an acceptable surgical mortality rate, that cardiac rupture did not occur in surgically treated patients.

  10. [Surgical strategy in multimodal treatment of gastric and esophageal cancer].

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    Hoeppner, J

    2017-12-01

    The majority of curatively treatable esophageal and gastric carcinomas are currently diagnosed in a locally advanced stage in Western Europe. The vast majority of patients in Western Europe and the USA are now treated in multimodal treatment protocols. These protocols consist of neoadjuvant chemoradiation or perioperative chemotherapy plus radical surgical resection including lymphadenectomy. Radical esophagectomy and gastrectomy are still the main curative therapeutic step in these  multimodal protocols. The current surgical recommendations and guidelines were, however, based on experience and studies from almost exclusively unimodal treatment of patient groups. The validity for the patients, particularly those who undergo multimodal treatment, therefore urgently needs to be reviewed. In particular, there are results and indirect indications from recent studies that show a difference between unimodal surgical therapy and multimodal therapy in the efficacy of radical lymphadenectomy on the oncological results. Against the background of these studies, the question arises whether it is possible to adapt surgical resection to the multimodal overall concept under the influence of the additional therapeutic modalities. Future prospective randomized surgical trials should have a tailor-made adaptation to the multimodal therapy concepts concerning primary tumor and locoregional tumor compartments. The different histological tumor entities of the upper gastrointestinal tract must also be included.

  11. Didactic Strategy Discussion Based on Artificial Neural Networks Results.

    Science.gov (United States)

    Andina, D.; Bermúdez-Valbuena, R.

    2009-04-01

    Artificial Neural Networks (ANNs) are a mathematical model of the main known characteristics of biological brian dynamics. ANNs inspired in biological reality have been useful to design machines that show some human-like behaviours. Based on them, many experimentes have been succesfully developed emulating several biologial neurons characteristics, as learning how to solve a given problem. Sometimes, experimentes on ANNs feedback to biology and allow advances in understanding the biological brian behaviour, allowing the proposal of new therapies for medical problems involving neurons performing. Following this line, the author present results on artificial learning on ANN, and interpret them aiming to reinforce one of this two didactic estrategies to learn how to solve a given difficult task: a) To train with clear, simple, representative examples and feel confidence in brian generalization capabilities to achieve succes in more complicated cases. b) To teach with a set of difficult cases of the problem feeling confidence that the brian will efficiently solve the rest of cases if it is able to solve the difficult ones. Results may contribute in the discussion of how to orientate the design innovative succesful teaching strategies in the education field.

  12. Surgical Strategies in the Correction of the Tuberous Breast.

    Science.gov (United States)

    Brown, Mitchell H; Somogyi, Ron B

    2015-10-01

    Management of the tuberous breast represents one of the greatest surgical challenges in aesthetic breast surgery, requiring careful assessment and a methodical approach to obtain an acceptable result. The surgeon must be familiar with multiple techniques that can be performed individually or may be combined to address various aspects of the tuberous deformity. This article describes the etiology, anatomic features, identification, and classification of the tuberous breast, focusing on surgical management and potential pitfalls. Through case study, expected outcomes in the management of this complex problem are described. Copyright © 2015 Elsevier Inc. All rights reserved.

  13. Real-Time Control Strategy of Elman Neural Network for the Parallel Hybrid Electric Vehicle

    Directory of Open Access Journals (Sweden)

    Ruijun Liu

    2014-01-01

    Full Text Available Through researching the instantaneous control strategy and Elman neural network, the paper established equivalent fuel consumption functions under the charging and discharging conditions of power batteries, deduced the optimal control objective function of instantaneous equivalent consumption, established the instantaneous optimal control model, and designs the Elman neural network controller. Based on the ADVISOR 2002 platform, the instantaneous optimal control strategy and the Elman neural network control strategy were simulated on a parallel HEV. The simulation results were analyzed in the end. The contribution of the paper is that the trained Elman neural network control strategy can reduce the simulation time by 96% and improve the real-time performance of energy control, which also ensures the good performance of power and fuel economy.

  14. Surgical strategy for bile duct cancer: Advances and current limitations

    Science.gov (United States)

    Akamatsu, Nobuhisa; Sugawara, Yasuhiko; Hashimoto, Daijo

    2011-01-01

    The aim of this review is to describe recent advances and topics in the surgical management of bile duct cancer. Radical resection with a microscopically negative margin (R0) is the only way to cure cholangiocarcinoma and is associated with marked survival advantages compared to margin-positive resections. Complete resection of the tumor is the surgeon’s ultimate aim, and several advances in the surgical treatment for bile duct cancer have been made within the last two decades. Multidetector row computed tomography has emerged as an indispensable diagnostic modality for the precise preoperative evaluation of bile duct cancer, in terms of both longitudinal and vertical tumor invasion. Many meticulous operative procedures have been established, especially extended hepatectomy for hilar cholangiocarcinoma, to achieve a negative resection margin, which is the only prognostic factor under the control of the surgeon. A complete caudate lobectomy and resection of the inferior part of Couinaud’s segment IV coupled with right or left hemihepatectomy has become the standard surgical procedure for hilar cholangiocarcinoma, and pylorus-preserving pancreaticoduodenectomy is the first choice for distal bile duct cancer. Limited resection for middle bile duct cancer is indicated for only strictly selected cases. Preoperative treatments including biliary drainage and portal vein embolization are also indicated for only selected patients, especially jaundiced patients anticipating major hepatectomy. Liver transplantation seems ideal for complete resection of bile duct cancer, but the high recurrence rate and decreased patient survival after liver transplant preclude it from being considered standard treatment. Adjuvant chemotherapy and radiotherapy have a potentially crucial role in prolonging survival and controlling local recurrence, but no definite regimen has been established to date. Further evidence is needed to fully define the role of liver transplantation and adjuvant

  15. Posterior inferior cerebellar artery aneurysms: Anatomical variations and surgical strategies

    Science.gov (United States)

    Singh, Rohit K.; Behari, Sanjay; Kumar, Vijendra; Jaiswal, Awadhesh K.; Jain, Vijendra K.

    2012-01-01

    Context: Posterior inferior cerebellar artery (PICA) aneurysms are associated with multiple anatomical variations of the parent vessel. Complexities in their surgical clipping relate to narrow corridors limited by brain-stem, petrous-occipital bones, and multiple neurovascular structures occupying the cerebellomedullary and cerebellopontine cisterns. Aims: The present study focuses on surgical considerations during clipping of saccular PICA aneurysms. Setting and Design: Tertiary care, retrospective study. Materials and Methods: In 20 patients with PICA aneurysms, CT angiogram/digital substraction angiogram was used to correlate the site and anatomical variations of aneurysms located on different segments of PICA with the approach selected, the difficulties encountered and the final outcome. Statistical Analysis: Comparison of means and percentages. Results: Aneurysms were located on PICA at: vertebral artery/basilar artery (VA/BA)-PICA (n=5); anterior medullary (n=4); lateral medullary (n=3); tonsillomedullary (n=4); and, telovelotonsillar (n=4) segments. The Hunt and Hess grade distribution was I in 15; II in 2; and, III in 3 patients (mean ictus-surgery interval: 23.5 days; range: 3-150 days). Eight patients had hydrocephalus. Anatomical variations included giant, thrombosed aneurysms; 2 PICA aneurysms proximal to an arteriovenous malformation; bilobed or multiple aneurysms; low PICA situated at the foramen magnum with a hypoplastic VA; and fenestrated PICA. The approaches included a retromastoid suboccipital craniectomy (n=9); midline suboccipital craniectomy (n=6); and far-lateral approach (n=5). At a follow-up (range 6 months-2.5 years), 13 patients had no deficits (modified Rankin score (mRS) 0); 2 were symptomatic with no significant disability (mRS1); 1 had mild disability (mRS2); 1 had moderately severe disability (mRS4); and 3 died (mRS6). Three mortalities were caused by vasospasm (2) and, rupture of unclipped second VA-BA junctional aneurysm (1

  16. Strategies influence neural activity for feedback learning across child and adolescent development.

    Science.gov (United States)

    Peters, Sabine; Koolschijn, P Cédric M P; Crone, Eveline A; Van Duijvenvoorde, Anna C K; Raijmakers, Maartje E J

    2014-09-01

    Learning from feedback is an important aspect of executive functioning that shows profound improvements during childhood and adolescence. This is accompanied by neural changes in the feedback-learning network, which includes pre-supplementary motor area (pre- SMA)/anterior cingulate cortex (ACC), dorsolateral prefrontal cortex (DLPFC), superior parietal cortex (SPC), and the basal ganglia. However, there can be considerable differences within age ranges in performance that are ascribed to differences in strategy use. This is problematic for traditional approaches of analyzing developmental data, in which age groups are assumed to be homogenous in strategy use. In this study, we used latent variable models to investigate if underlying strategy groups could be detected for a feedback-learning task and whether there were differences in neural activation patterns between strategies. In a sample of 268 participants between ages 8 to 25 years, we observed four underlying strategy groups, which were cut across age groups and varied in the optimality of executive functioning. These strategy groups also differed in neural activity during learning; especially the most optimal performing group showed more activity in DLPFC, SPC and pre-SMA/ACC compared to the other groups. However, age differences remained an important contributor to neural activation, even when correcting for strategy. These findings contribute to the debate of age versus performance predictors of neural development, and highlight the importance of studying individual differences in strategy use when studying development. Copyright © 2014 Elsevier Ltd. All rights reserved.

  17. [Surgery for pancreatic cancer: Evidence-based surgical strategies].

    Science.gov (United States)

    Sánchez Cabús, Santiago; Fernández-Cruz, Laureano

    2015-01-01

    Pancreatic cancer surgery represents a challenge for surgeons due to its technical complexity, the potential complications that may appear, and ultimately because of its poor survival. The aim of this article is to summarize the scientific evidence regarding the surgical treatment of pancreatic cancer in order to help surgeons in the decision making process in the management of these patients .Here we will review such fundamental issues as the need for a biopsy before surgery, the type of pancreatic anastomosis leading to better results, and the need for placement of drains after pancreatic surgery will be discussed. Copyright © 2014 AEC. Publicado por Elsevier España, S.L.U. All rights reserved.

  18. Strategies in the Surgical Management of Atrial Fibrillation

    Directory of Open Access Journals (Sweden)

    Leanne Harling

    2011-01-01

    Full Text Available Atrial fibrillation (AF is associated with substantial morbidity, mortality, and economic burden and confers a lifetime risk of up to 25%. Current medical management involves thromboembolism prevention, rate, and rhythm control. An increased understanding of AF pathophysiology has led to enhanced pharmacological and medical therapies; however this is often limited by toxicity, variable symptom control, and inability to modulate the atrial substrate. Surgical AF ablation has been available since the original description of the Cox Maze procedure, either as a standalone or concomitant intervention. Advances in novel energy delivery systems have allowed the development of less technically demanding procedures potentially eliminating the need for median sternotomy and cardiopulmonary bypass. Variations in the definition, duration, and reporting of AF have produced methodological limitations impacting on the validity of interstudy comparisons. Standardization of these parameters may, in future, allow us to further evaluate clinical endpoints and establish the efficacy of these techniques.

  19. Surgical Strategy for the Chronic Achilles Tendon Rupture

    Directory of Open Access Journals (Sweden)

    Yangjing Lin

    2016-01-01

    Full Text Available Background. Chronic Achilles tendon rupture is usually misdiagnosed and treated improperly. This study aims to better understand the treatment of chronic Achilles tendon rupture. Methods. Patients who were not able to perform a single-limb heel rise were chosen. Pre- and postoperative magnetic resonance imaging (MRI were conducted. By evaluating the presence or absence of Achilles tendon stumps and the gap length of rupture, V-Y advancement, gastrocnemius fascial turndown flap, or flexor halluces longus tendon transfer were selected for tendon repair. The function of ankle and foot was assessed by American Orthopaedic Foot & Ankle Society (AOFAS ankle-hindfoot scores and Achilles Tendon Total Rupture Score (ATRS. Results. Twenty-nine patients were followed up. One patient had superficial incision infection, which was healed after debridement and oral antibiotics. Three months postoperatively, MRI showed some signs of inflammation, which disappeared at one or two years postoperatively. All patients were able to perform a single-limb heel rise. Mean AOFAS scores and ATRS scores were increased at the latest follow-up. Conclusion. Surgical options can be determined by evaluating the presence of the Achilles tendon stumps and the gap length, which can avoid using the nearby tendon and yield satisfactory functional results.

  20. Surgical Strategy for the Chronic Achilles Tendon Rupture

    Science.gov (United States)

    Yang, Liu; Yin, Li

    2016-01-01

    Background. Chronic Achilles tendon rupture is usually misdiagnosed and treated improperly. This study aims to better understand the treatment of chronic Achilles tendon rupture. Methods. Patients who were not able to perform a single-limb heel rise were chosen. Pre- and postoperative magnetic resonance imaging (MRI) were conducted. By evaluating the presence or absence of Achilles tendon stumps and the gap length of rupture, V-Y advancement, gastrocnemius fascial turndown flap, or flexor halluces longus tendon transfer were selected for tendon repair. The function of ankle and foot was assessed by American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot scores and Achilles Tendon Total Rupture Score (ATRS). Results. Twenty-nine patients were followed up. One patient had superficial incision infection, which was healed after debridement and oral antibiotics. Three months postoperatively, MRI showed some signs of inflammation, which disappeared at one or two years postoperatively. All patients were able to perform a single-limb heel rise. Mean AOFAS scores and ATRS scores were increased at the latest follow-up. Conclusion. Surgical options can be determined by evaluating the presence of the Achilles tendon stumps and the gap length, which can avoid using the nearby tendon and yield satisfactory functional results. PMID:27847806

  1. Strategy over operation: neural activation in subtraction and multiplication during fact retrieval and procedural strategy use in children.

    Science.gov (United States)

    Polspoel, Brecht; Peters, Lien; Vandermosten, Maaike; De Smedt, Bert

    2017-09-01

    Arithmetic development is characterized by strategy shifts between procedural strategy use and fact retrieval. This study is the first to explicitly investigate children's neural activation associated with the use of these different strategies. Participants were 26 typically developing 4th graders (9- to 10-year-olds), who, in a behavioral session, were asked to verbally report on a trial-by-trial basis how they had solved 100 subtraction and multiplication items. These items were subsequently presented during functional magnetic resonance imaging. An event-related design allowed us to analyze the brain responses during retrieval and procedural trials, based on the children's verbal reports. During procedural strategy use, and more specifically for the decomposition of operands strategy, activation increases were observed in the inferior and superior parietal lobes (intraparietal sulci), inferior to superior frontal gyri, bilateral areas in the occipital lobe, and insular cortex. For retrieval, in comparison to procedural strategy use, we observed increased activity in the bilateral angular and supramarginal gyri, left middle to inferior temporal gyrus, right superior temporal gyrus, and superior medial frontal gyrus. No neural differences were found between the two operations under study. These results are the first in children to provide direct evidence for alternate neural activation when different arithmetic strategies are used and further unravel that previously found effects of operation on brain activity reflect differences in arithmetic strategy use. Hum Brain Mapp 38:4657-4670, 2017. © 2017 Wiley Periodicals, Inc. © 2017 Wiley Periodicals, Inc.

  2. A structured strategy to combine education for advanced MIS training in surgical oncology training programs.

    Science.gov (United States)

    Brar, S S; Wright, F; Okrainec, A; Smith, A J

    2011-09-01

    Changing realities in surgery and surgical technique have heightened the need for agile adaptation in training programs. Current guidelines reflect the growing acceptance and adoption of the use of minimally invasive surgery (MIS) in oncology. North American general surgery residents are often not adequately skilled in advanced laparoscopic surgery skills at the completion of their residency. Presently, advanced laparoscopic surgery training during surgical oncology fellowship training occurs on an ad-hoc basis in many surgical oncology programs. We present a rational and template for a structured training in advanced minimally invasive surgical techniques during surgical oncology fellowship training. The structure of the program seeks to incorporate evidence-based strategies in MIS training from a comprehensive review of the literature, while maintaining essential elements of rigorous surgical oncology training. Fellows in this stream will train and certify in the Fundamentals of Laparoscopic Surgery (FLS) course. Fellows will participate in the didactic oncology seminar series continuously throughout the 27 months training period. Fellows will complete one full year of dedicated MIS training, followed by 15 months of surgical oncology training. Minimal standards for case volume will be expected for MIS cases and training will be tailored to meet the career goals of the fellows. We propose that a formalized MIS-Surgical Oncology Fellowship will allow trainees to benefit from an effective training curriculum and furthermore, that will allow for graduates to lead in a cancer surgery milieu increasingly focused on minimally invasive approaches. Copyright © 2011 Elsevier Ltd. All rights reserved.

  3. Neural underpinnings of decision strategy selection: a review and a theoretical model

    Directory of Open Access Journals (Sweden)

    Szymon Wichary

    2016-11-01

    Full Text Available In multi-attribute choice, decision makers use various decision strategies to arrive at the final choice. What are the neural mechanisms underlying decision strategy selection? The first goal of this paper is to provide a literature review on the neural underpinnings and cognitive models of decision strategy selection and thus set the stage for a unifying neurocognitive model of this process. The second goal is to outline such a unifying, mechanistic model that can explain the impact of noncognitive factors (e.g. affect, stress on strategy selection. To this end, we review the evidence for the factors influencing strategy selection, the neural basis of strategy use and the cognitive models explaining this process. We also present the neurocognitive Bottom-Up Model of Strategy Selection (BUMSS. The model assumes that the use of the rational, normative Weighted Additive strategy and the boundedly rational heuristic Take The Best can be explained by one unifying, neurophysiologically plausible mechanism, based on the interaction of the frontoparietal network, orbitofrontal cortex, anterior cingulate cortex and the brainstem nucleus locus coeruleus. According to BUMSS, there are three processes that form the bottom-up mechanism of decision strategy selection and lead to the final choice: 1 cue weight computation, 2 gain modulation, and 3 weighted additive evaluation of alternatives. We discuss how these processes might be implemented in the brain, and how this knowledge allows us to formulate novel predictions linking strategy use and neurophysiological indices.

  4. The uncertainty room: strategies for managing uncertainty in a surgical waiting room.

    Science.gov (United States)

    Stone, Anne M; Lammers, John C

    2012-01-01

    To describe experiences of uncertainty and management strategies for staff working with families in a hospital waiting room. A 288-bed, nonprofit community hospital in a Midwestern city. Data were collected during individual, semistructured interviews with 3 volunteers, 3 technical staff members, and 1 circulating nurse (n = 7), and during 40 hours of observation in a surgical waiting room. Interview transcripts were analyzed using constant comparative techniques. The surgical waiting room represents the intersection of several sources of uncertainty that families experience. Findings also illustrate the ways in which staff manage the uncertainty of families in the waiting room by communicating support. Staff in surgical waiting rooms are responsible for managing family members' uncertainty related to insufficient information. Practically, this study provided some evidence that staff are expected to help manage the uncertainty that is typical in a surgical waiting room, further highlighting the important role of communication in improving family members' experiences.

  5. [Technical aspects and surgical strategy for removal of corticotroph pituitary adenoma].

    Science.gov (United States)

    Perrin, G; Stevenaert, A; Jouanneau, E

    2002-05-01

    resection and total hypophysectomy. Methods for preoperative guidance of total tumor removal are proposed including histological or biological assessment of normal adjacent pituitary tissue. the strategy of surgical intrasellar exploration and tumor resection is outlined using a set of algorithms. The first is devoted to positive preoperative documentation of the tumor. The second is proposed for the surgical scenario where there is no preoperative MRI evidence of the tumor. Special strategies are discussed for ectopic adenoma or multiple tumors. Revision surgical management after surgical failure or tumor recurrence is described. Special guidelines for surgical treatment of large clinically silent corticotroph macroadenomas are given with emphasis on the high risk of recurrence in comparison with other silent pituitary tumors such as gonadotroph or immunonegative adenomas.

  6. Surgical strategy for giant pituitary adenoma based on evaluation of fine feeding system and angioarchitecture

    Directory of Open Access Journals (Sweden)

    Yoshikazu Ogawa, M.D., Ph.D.

    2017-06-01

    Conclusion: Major blood supply was different from the normal supply to the anterior pituitary gland and did not necessarily correspond to tumor shape and extension. Surgical strategy should be established based on the tumor feeding systems and hemodynamics in giant pituitary adenomas.

  7. Strategies to accommodate resident work-hour restrictions: impact on surgical education.

    Science.gov (United States)

    Freiburg, Carter; James, Ted; Ashikaga, Takamura; Moalem, Jacob; Cherr, Greg

    2011-01-01

    The introduction of duty-hour restrictions has impacted surgical training. Several strategies were introduced by training programs in response to these restrictions. The purpose of this study was to assess the various strategies employed by residency programs to comply with work-hour restrictions with respect to the impact on the quality of surgical education. A national survey was developed and distributed to resident members of the Resident and Associate Society of the American College of Surgeons in all accredited residency programs across North America. Questions in the survey addressed 10 separate accommodation strategies used by training programs to adhere to resident work-hour restrictions. Resident respondents completed a 5-point Likert scale rating each strategy according to its impact on surgical education (detrimental, not very helpful, neutral, somewhat helpful, and very helpful). A total of 599 (9.7%) responses were received from 6186 members of the Resident Associate Society. The use of health information technology (IT), nurse practitioners, and physician assistants were most highly rated. Hiring clinical fellows, establishing nonteaching services, and shift-work scheduling were the three most poorly rated accommodations to work-hour restrictions with respect to resident education. Hospital IT and nonphysician care providers were rated by residents to optimize surgical education in the current work-hour limitation environment. We infer that strategies which lead to increased efficiency and redistribution of resident workload allow surgical trainees to spend more time on activities perceived to have higher educational value. Copyright © 2011 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

  8. Disclosure of adverse events and errors in surgical care: challenges and strategies for improvement.

    Science.gov (United States)

    Lipira, Lauren E; Gallagher, Thomas H

    2014-07-01

    The disclosure of adverse events to patients, including those caused by medical errors, is a critical part of patient-centered healthcare and a fundamental component of patient safety and quality improvement. Disclosure benefits patients, providers, and healthcare institutions. However, the act of disclosure can be difficult for physicians. Surgeons struggle with disclosure in unique ways compared with other specialties, and disclosure in the surgical setting has specific challenges. The frequency of surgical adverse events along with a dysfunctional tort system, the team structure of surgical staff, and obstacles created inadvertently by existing surgical patient safety initiatives may contribute to an environment not conducive to disclosure. Fortunately, there are multiple strategies to address these barriers. Participation in communication and resolution programs, integration of Just Culture principles, surgical team disclosure planning, refinement of informed consent and morbidity and mortality processes, surgery-specific professional standards, and understanding the complexities of disclosing other clinicians' errors all have the potential to help surgeons provide patients with complete, satisfactory disclosures. Improvement in the regularity and quality of disclosures after surgical adverse events and errors will be key as the field of patient safety continues to advance.

  9. Code generation: a strategy for neural network simulators.

    Science.gov (United States)

    Goodman, Dan F M

    2010-10-01

    We demonstrate a technique for the design of neural network simulation software, runtime code generation. This technique can be used to give the user complete flexibility in specifying the mathematical model for their simulation in a high level way, along with the speed of code written in a low level language such as C+ +. It can also be used to write code only once but target different hardware platforms, including inexpensive high performance graphics processing units (GPUs). Code generation can be naturally combined with computer algebra systems to provide further simplification and optimisation of the generated code. The technique is quite general and could be applied to any simulation package. We demonstrate it with the 'Brian' simulator ( http://www.briansimulator.org ).

  10. Utilising reinforcement learning to develop strategies for driving auditory neural implants

    Science.gov (United States)

    Lee, Geoffrey W.; Zambetta, Fabio; Li, Xiaodong; Paolini, Antonio G.

    2016-08-01

    Objective. In this paper we propose a novel application of reinforcement learning to the area of auditory neural stimulation. We aim to develop a simulation environment which is based off real neurological responses to auditory and electrical stimulation in the cochlear nucleus (CN) and inferior colliculus (IC) of an animal model. Using this simulator we implement closed loop reinforcement learning algorithms to determine which methods are most effective at learning effective acoustic neural stimulation strategies. Approach. By recording a comprehensive set of acoustic frequency presentations and neural responses from a set of animals we created a large database of neural responses to acoustic stimulation. Extensive electrical stimulation in the CN and the recording of neural responses in the IC provides a mapping of how the auditory system responds to electrical stimuli. The combined dataset is used as the foundation for the simulator, which is used to implement and test learning algorithms. Main results. Reinforcement learning, utilising a modified n-Armed Bandit solution, is implemented to demonstrate the model’s function. We show the ability to effectively learn stimulation patterns which mimic the cochlea’s ability to covert acoustic frequencies to neural activity. Time taken to learn effective replication using neural stimulation takes less than 20 min under continuous testing. Significance. These results show the utility of reinforcement learning in the field of neural stimulation. These results can be coupled with existing sound processing technologies to develop new auditory prosthetics that are adaptable to the recipients current auditory pathway. The same process can theoretically be abstracted to other sensory and motor systems to develop similar electrical replication of neural signals.

  11. Modeling and simulation of permanent magnet synchronous motor based on neural network control strategy

    Science.gov (United States)

    Luo, Bingyang; Chi, Shangjie; Fang, Man; Li, Mengchao

    2017-03-01

    Permanent magnet synchronous motor is used widely in industry, the performance requirements wouldn't be met by adopting traditional PID control in some of the occasions with high requirements. In this paper, a hybrid control strategy - nonlinear neural network PID and traditional PID parallel control are adopted. The high stability and reliability of traditional PID was combined with the strong adaptive ability and robustness of neural network. The permanent magnet synchronous motor will get better control performance when switch different working modes according to different controlled object conditions. As the results showed, the speed response adopting the composite control strategy in this paper was faster than the single control strategy. And in the case of sudden disturbance, the recovery time adopting the composite control strategy designed in this paper was shorter, the recovery ability and the robustness were stronger.

  12. Sparse Data Analysis Strategy for Neural Spike Classification

    Directory of Open Access Journals (Sweden)

    Vincent Vigneron

    2014-01-01

    Full Text Available Many of the multichannel extracellular recordings of neural activity consist of attempting to sort spikes on the basis of shared characteristics with some feature detection techniques. Then spikes can be sorted into distinct clusters. There are in general two main statistical issues: firstly, spike sorting can result in well-sorted units, but by with no means one can be sure that one is dealing with single units due to the number of neurons adjacent to the recording electrode. Secondly, the waveform dimensionality is reduced in a small subset of discriminating features. This shortening dimension effort was introduced as an aid to visualization and manual clustering, but also to reduce the computational complexity in automatic classification. We introduce a metric based on common neighbourhood to introduce sparsity in the dataset and separate data into more homogeneous subgroups. The approach is particularly well suited for clustering when the individual clusters are elongated (that is nonspherical. In addition it does need not to select the number of clusters, it is very efficient to visualize clusters in a dataset, it is robust to noise, it can handle imbalanced data, and it is fully automatic and deterministic.

  13. Neural network-based sliding mode control for atmospheric-actuated spacecraft formation using switching strategy

    Science.gov (United States)

    Sun, Ran; Wang, Jihe; Zhang, Dexin; Shao, Xiaowei

    2018-02-01

    This paper presents an adaptive neural networks-based control method for spacecraft formation with coupled translational and rotational dynamics using only aerodynamic forces. It is assumed that each spacecraft is equipped with several large flat plates. A coupled orbit-attitude dynamic model is considered based on the specific configuration of atmospheric-based actuators. For this model, a neural network-based adaptive sliding mode controller is implemented, accounting for system uncertainties and external perturbations. To avoid invalidation of the neural networks destroying stability of the system, a switching control strategy is proposed which combines an adaptive neural networks controller dominating in its active region and an adaptive sliding mode controller outside the neural active region. An optimal process is developed to determine the control commands for the plates system. The stability of the closed-loop system is proved by a Lyapunov-based method. Comparative results through numerical simulations illustrate the effectiveness of executing attitude control while maintaining the relative motion, and higher control accuracy can be achieved by using the proposed neural-based switching control scheme than using only adaptive sliding mode controller.

  14. Optimal Search Strategy of Robotic Assembly Based on Neural Vibration Learning

    Directory of Open Access Journals (Sweden)

    Lejla Banjanovic-Mehmedovic

    2011-01-01

    Full Text Available This paper presents implementation of optimal search strategy (OSS in verification of assembly process based on neural vibration learning. The application problem is the complex robot assembly of miniature parts in the example of mating the gears of one multistage planetary speed reducer. Assembly of tube over the planetary gears was noticed as the most difficult problem of overall assembly. The favourable influence of vibration and rotation movement on compensation of tolerance was also observed. With the proposed neural-network-based learning algorithm, it is possible to find extended scope of vibration state parameter. Using optimal search strategy based on minimal distance path between vibration parameter stage sets (amplitude and frequencies of robots gripe vibration and recovery parameter algorithm, we can improve the robot assembly behaviour, that is, allow the fastest possible way of mating. We have verified by using simulation programs that search strategy is suitable for the situation of unexpected events due to uncertainties.

  15. Surgical Strategy Toward Biventricular Repair for Severe Ebstein Anomaly in Neonates and Infancy.

    Science.gov (United States)

    Huang, Shu-Chien; Wu, En-Ting; Chen, Shyh-Jye; Huang, Chi-Hsiang; Shih, Jin-Chung; Chou, Hen-Wen; Chang, Chung-I; Chiu, Ing-Sh; Chen, Yih-Sharng

    2017-09-01

    Neonates with severe forms of Ebstein anomaly present a surgical challenge, and the Starnes operation as single ventricle palliation is highly advocated. Cone reconstruction for tricuspid valvuloplasty (TVP) has become a widely accepted technique, although very few cases of TVP have been reported in neonates. This report describes a surgical strategy for neonatal Ebstein anomaly, with an aim toward biventricular repair. Since 2007, 7 neonates or young infants with severe Ebstein anomalies have received TVP at the National Taiwan University Hospital, Taipei, Taiwan. The principle of cone reconstruction was applied with mobilization of all three leaflets and reattachment to the normal tricuspid annulus. The atrialized right ventricle was not plicated. In patients with pulmonary stenosis, the interatrial communication was not totally closed (n = 5), and a systemic-pulmonary shunt was added if needed (n = 3). All patients presented with intractable heart failure or severe cyanosis requiring mechanical ventilation, or both. All patients had marked adherence of the anterior leaflet to the right ventricular free wall. Intracardiac anomalies including ventricular septal defect (n = 2) and tetralogy of Fallot (n = 1) were also repaired simultaneously. Six of the 7 patients (86%) survived. There were no late deaths or repeat TVPs for a median follow-up of 4.3 years (range, 0.8 to 9.9 years). Reconstruction of the tricuspid valve is an acceptable surgical strategy in patients with severe neonatal Ebstein anomaly. Fenestrated atrial septal defect and systemic-pulmonary shunt can help overcome anatomic pulmonary stenosis and high pulmonary resistance in the neonatal period. This surgical strategy has a good survival outcome and preserves the possibility of complete biventricular repair. Copyright © 2017 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  16. The application of digital surgical diagnosis and treatment technology: a promising strategy for surgical reconstruction of craniomaxillofacial defect and deformity.

    Science.gov (United States)

    Wang, Li-ya; Du, Hong-ming; Zhang, Gang; Tang, Wei; Liu, Lei; Jing, Wei; Long, Jie

    2011-12-01

    The craniomaxillofacial defect and deformity always leads to serious dysfunction in mastication and facial contour damage, significantly reducing patients' quality of life. However, surgical reconstruction of a craniomaxillofacial hard tissue defect or deformity is extremely complex and often does not result in desired facial morphology. Improving the result for patients with craniomaxillofacial defect and deformity remains a challenge for surgeons. Using digital technology for surgical diagnosis and treatment may help solve this problem. Computer-assisted surgical technology and surgical navigation technology are included in the accurate digital diagnosis and treatment system we propose. These technologies will increase the accuracy of the design of the operation plan. In addition, the intraoperative real-time navigating location system controlling the robotic arm or advanced intelligent robot will provide accurate, individualized surgical treatment for patients. Here we propose the hypothesis that a digital surgical diagnosis and treatment technology may provide a new approach for precise surgical reconstruction of complicated craniomaxillofacial defect and deformity. Our hypothesis involves modern digital surgery, a three-dimensional navigation surgery system and modern digital imaging technology, and our key aim is to establish a technological platform for customized digital surgical design and surgical navigation for craniomaxillofacial defect and deformity. If the hypothesis is proven practical, this novel therapeutic approach could improve the result of surgical reconstruction for craniomaxillofacial defect and deformity for many patients. Copyright © 2011 Elsevier Ltd. All rights reserved.

  17. Intraoperative parathyroid hormone in strategy of surgical treatment of a primary hyperparathyreosis

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    N S Kuznetsov

    2011-06-01

    Full Text Available Problem of surgical treatment of patients with a primary hyperparathyreosis – normalisation of level of a parathyroid hormone and calcium after operation. Any of diagnostics methods before operation does not allow to prognosticate authentically necessary volume of an operative measure in each specific case in this connection, was considered obligatory bilateral intraoperative revision of regions of a typical locating of parathyroids. Appearance of a method of definition of an quick parathyroid hormone during operation has allowed to estimate adequacy of a surgical intervention already on an operating table. Besides, it is a method allows to minimise an operational trauma and duration of a surgical intervention, and also widely to use the video-assisted operative measures in treatment of a primary hyperparathyreosis. We make the retrospective analysis of results of definition intraoperative parathyroid hormone at 230 patients with the primary hyperparathyreosis, operated in Endocrinologic centre of science in Moscow (Russia from 2006 for 2009. Depending on success of the operative measure, all patients are parted on 4 bunches, according to the received results of concordance and research discordance. The analysed results have shown high sensitivity (93.3%, high specificity (85.7%, and also high predictive value of a positive take (99.5% definitions intraoperative parathyroid hormone that allows to be oriented on its indexes at a choice of operational strategy in surgical treatment of a primary hyperparathyreosis.

  18. Surgical strategy according to the anatomical types of congenital portosystemic shunts in children.

    Science.gov (United States)

    Matsuura, Toshiharu; Takahashi, Yoshiaki; Yanagi, Yusuke; Yoshimaru, Koichiro; Yamamura, Kenichiro; Morihana, Eiji; Nagata, Hazumu; Uike, Kiyoshi; Takada, Hidetoshi; Taguchi, Tomoaki

    2016-12-01

    Congenital portosystemic shunts (CPSS) with intrahepatic portal vein (IHPV) hypoplasia or absence cause encephalopathy or pulmonary hypertension (PH). Acute shunt closure may result in postoperative portal hypertension. The aim of this study was to propose a surgical strategy according to the anatomical types of CPSS and IHPV. Twenty-three CPSS patients were diagnosed from1990 to 2015. All patients were evaluated by computed tomography, angiography, and PV pressure monitoring under a shunt occlusion test. CPSS were categorized into 5 types according to the anatomical shunt location. The median age at diagnosis was 34months. Three of 23 total patients, who had an extrahepatic portosystemic shunt with a hypoplastic IHPV, died before treatment initiation because of severe PH. Fourteen cases received surgical or interventional treatment at the median age of 5years. A total of 6 cases received surgical therapy, including liver transplants for 2 absent IHPV cases. The remaining 8 cases received interventional coiling. All shunt ligations were successfully accomplished in 1-stage ligation without any complications. After the treatment, the hypoplastic IHPV gradually enlarged with an efficient portal inflow. A precise pretreatment anatomical evaluation of CPSS and IHPV types is mandatory for the selection of surgical treatment. Diagnostic study - level II and treatment study - level III. Copyright © 2016 Elsevier Inc. All rights reserved.

  19. Bile duct cyst type V (Caroli's disease): surgical strategy and results.

    Science.gov (United States)

    Lendoire, Javier; Barros Schelotto, Pablo; Alvarez Rodríguez, Juan; Duek, Fernando; Quarin, Carlos; Garay, Verónica; Amante, Marcelo; Cassini, Eduardo; Imventarza, Oscar

    2007-01-01

    Caroli's disease (CD) is a benign congenital disorder characterized by segmental cystic dilatation of the intrahepatic biliary ducts. Therapeutic strategy includes medical treatment, percutaneous, endoscopic or surgical drainage of the affected bile ducts, liver resection or transplantation. The aim of this study was to analyse the results and long-term follow-up of a consecutive series of patients who underwent surgical treatment for CD. Between 1995 and 2005, 10 patients were surgically treated for CD. Variables evaluated were: age, gender, clinical presentation, diagnostic procedures, percutaneous and surgical treatments, histopathological analysis and outcome. The average age of the patients was 45.8 years. Recurrent cholangitis was the main clinical manifestation (70%). In unilateral CD a liver resection was performed in nine patients (left lateral sectionectomy in seven, left hepatectomy in one and right hepatectomy in one). In bilateral disease a cholecystectomy, duct exploration, hepaticojejunostomy and liver biopsy of both lobes were performed. Average follow-up was 60 months. All the patients are alive and free of symptoms without recurrence in the remnant liver. Liver resection is the preferred therapeutic option for unilateral CD, demonstrating good results in long-term follow-up. In bilateral disease, hepaticojejunostomy could be considered as an alternative or a previous step to liver transplantation, which still remains the ultimate option.

  20. Surgical Treatment in Patients with Spinal Tumors - Differences in Surgical Strategies and Malignancy-Associated Problems. An Analysis of 474 Patients.

    Science.gov (United States)

    Guzik, Grzegorz

    2015-01-01

    Surgical treatment of spinal tumors, especially metastatic disease, is becoming increasingly popular, and its results are encouraging. However, good knowledge of clinical aspects of tumors and surgical techniques is essential. The aim of this paper was to analyze the problems of and differences in surgical strategies for spinal tumor surgery. The objectives of this paper were accomplished on the basis of a retrospective evaluation of the surgical records of 474 patients with spinal tumors treated at the Oncological Orthopedics Department in Brzozów in the years 2010-2014. Preoperative and postoperative pain intensity, motor skills and neurological function were evaluated. Surgical strategies, operative approach to the spine, extent of bone resection, methods of filling bone voids and spinal fixation methods were analyzed. Pain intensity, measured with a VAS scale, decreased in most patients (84%). Motor skills, assessed with the Karnofsky score, improved in 67% of patients. Neurological deficits decreased in 36 out of 105 patients. 369 surgeries were performed from a posterior approach with a preference for long segment fixation. Anterior approach surgeries with tumor resection and implantation of a vertebral body prosthesis or cement were performed in 61 patients. 25 patients with upper thoracic spine pathology were operated from a posterolateral approach. The tumors were resected, prostheses or cement were implanted and transepiphyseal fixation of the spine was performed. Dual-approach surgery was performed in 19 patients, of whom two underwent simultaneous procedures. Laminectomy-associated damage to the dura mater was the most common complication. 34 patients were operated on due to infections of the surgical site. Seven patients died in the perioperative period. 1. Surgical treatment with adjuvant radiotherapy should be a first-line choice for spinal metastases. 2. Qualification for the procedure involves several factors and should be individualized. 3. The

  1. Control Strategy Based on Wavelet Transform and Neural Network for Hybrid Power System

    Directory of Open Access Journals (Sweden)

    Y. D. Song

    2013-01-01

    Full Text Available This paper deals with an energy management of a hybrid power generation system. The proposed control strategy for the energy management is based on the combination of wavelet transform and neural network arithmetic. The hybrid system in this paper consists of an emulated wind turbine generator, PV panels, DC and AC loads, lithium ion battery, and super capacitor, which are all connected on a DC bus with unified DC voltage. The control strategy is responsible for compensating the difference between the generated power from the wind and solar generators and the demanded power by the loads. Wavelet transform decomposes the power difference into smoothed component and fast fluctuated component. In consideration of battery protection, the neural network is introduced to calculate the reference power of battery. Super capacitor (SC is controlled to regulate the DC bus voltage. The model of the hybrid system is developed in detail under Matlab/Simulink software environment.

  2. A Parallel Strategy for Convolutional Neural Network Based on Heterogeneous Cluster for Mobile Information System

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    Jilin Zhang

    2017-01-01

    Full Text Available With the development of the mobile systems, we gain a lot of benefits and convenience by leveraging mobile devices; at the same time, the information gathered by smartphones, such as location and environment, is also valuable for business to provide more intelligent services for customers. More and more machine learning methods have been used in the field of mobile information systems to study user behavior and classify usage patterns, especially convolutional neural network. With the increasing of model training parameters and data scale, the traditional single machine training method cannot meet the requirements of time complexity in practical application scenarios. The current training framework often uses simple data parallel or model parallel method to speed up the training process, which is why heterogeneous computing resources have not been fully utilized. To solve these problems, our paper proposes a delay synchronization convolutional neural network parallel strategy, which leverages the heterogeneous system. The strategy is based on both synchronous parallel and asynchronous parallel approaches; the model training process can reduce the dependence on the heterogeneous architecture in the premise of ensuring the model convergence, so the convolution neural network framework is more adaptive to different heterogeneous system environments. The experimental results show that the proposed delay synchronization strategy can achieve at least three times the speedup compared to the traditional data parallelism.

  3. How Do Efficient Coding Strategies Depend on Origins of Noise in Neural Circuits?

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    Brinkman, Braden A W; Weber, Alison I; Rieke, Fred; Shea-Brown, Eric

    2016-10-01

    Neural circuits reliably encode and transmit signals despite the presence of noise at multiple stages of processing. The efficient coding hypothesis, a guiding principle in computational neuroscience, suggests that a neuron or population of neurons allocates its limited range of responses as efficiently as possible to best encode inputs while mitigating the effects of noise. Previous work on this question relies on specific assumptions about where noise enters a circuit, limiting the generality of the resulting conclusions. Here we systematically investigate how noise introduced at different stages of neural processing impacts optimal coding strategies. Using simulations and a flexible analytical approach, we show how these strategies depend on the strength of each noise source, revealing under what conditions the different noise sources have competing or complementary effects. We draw two primary conclusions: (1) differences in encoding strategies between sensory systems-or even adaptational changes in encoding properties within a given system-may be produced by changes in the structure or location of neural noise, and (2) characterization of both circuit nonlinearities as well as noise are necessary to evaluate whether a circuit is performing efficiently.

  4. How Do Efficient Coding Strategies Depend on Origins of Noise in Neural Circuits?

    Directory of Open Access Journals (Sweden)

    Braden A W Brinkman

    2016-10-01

    Full Text Available Neural circuits reliably encode and transmit signals despite the presence of noise at multiple stages of processing. The efficient coding hypothesis, a guiding principle in computational neuroscience, suggests that a neuron or population of neurons allocates its limited range of responses as efficiently as possible to best encode inputs while mitigating the effects of noise. Previous work on this question relies on specific assumptions about where noise enters a circuit, limiting the generality of the resulting conclusions. Here we systematically investigate how noise introduced at different stages of neural processing impacts optimal coding strategies. Using simulations and a flexible analytical approach, we show how these strategies depend on the strength of each noise source, revealing under what conditions the different noise sources have competing or complementary effects. We draw two primary conclusions: (1 differences in encoding strategies between sensory systems-or even adaptational changes in encoding properties within a given system-may be produced by changes in the structure or location of neural noise, and (2 characterization of both circuit nonlinearities as well as noise are necessary to evaluate whether a circuit is performing efficiently.

  5. Unlocking the "black box" of practice improvement strategies to implement surgical safety checklists: a process evaluation.

    Science.gov (United States)

    Gillespie, Brigid M; Hamilton, Kyra; Ball, Dianne; Lavin, Joanne; Gardiner, Therese; Withers, Teresa K; Marshall, Andrea P

    2017-01-01

    Compliance with surgical safety checklists (SSCs) has been associated with improvements in clinical processes such as antibiotic use, correct site marking, and overall safety processes. Yet, proper execution has been difficult to achieve. The objective of this study was to undertake a process evaluation of four knowledge translation (KT) strategies used to implement the Pass the Baton (PTB) intervention which was designed to improve utilization of the SSC. As part of the process evaluation, a logic model was generated to explain which KT strategies worked well (or less well) in the operating rooms of a tertiary referral hospital in Queensland, Australia. The KT strategies implemented included change champions/opinion leaders, education, audit and feedback, and reminders. In evaluating the implementation of these strategies, this study considered context, intervention and underpinning assumptions, implementation, and mechanism of impact. Observational and interview data were collected to assess implementation of the KT strategies relative to fidelity, feasibility, and acceptability. Findings from 35 structured observations and 15 interviews with 96 intervention participants suggest that all of the KT strategies were consistently implemented. Of the 220 staff working in the department, that is, nurses, anesthetists, and surgeons, 160 (72.7%) knew about the PTB strategies. Qualitative analysis revealed that implementation was generally feasible and acceptable. A barrier to feasibility was physician engagement. An impediment to acceptability was participants' skepticism about the ability of the KT strategies to effect behavioral change. Overall, results of this evaluation suggest that success of implementation was moderate. Given the probable impact of contextual factors, that is, team culture and the characteristics of participants, the KT strategies may need modification prior to widespread implementation.

  6. Minimally Invasive Thoracic Corpectomy: Surgical Strategies for Malignancy, Trauma, and Complex Spinal Pathologies

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    Rohan R. Lall

    2012-01-01

    Full Text Available The rapid expansion of minimally invasive techniques for corpectomy in the thoracic spine provides promise to redefine treatment options in this region. Techniques have evolved permitting anterior, lateral, posterolateral, and midline posterior corpectomy in a minimally invasive fashion. We review the numerous techniques that have been described, including thoracoscopy, tubular retraction, and various instrumentation techniques. Minimally invasive techniques are compared to their open predecessors from a technical and complication standpoint. Advantages and disadvantages of different approaches are also considered, with an emphasis on surgical strategies and nuance.

  7. The incidence, root-causes, and outcomes of adverse events in surgical units: implication for potential prevention strategies

    Directory of Open Access Journals (Sweden)

    Groenewegen Peter P

    2011-05-01

    Full Text Available Abstract Background We need to know the scale and underlying causes of surgical adverse events (AEs in order to improve the safety of care in surgical units. However, there is little recent data. Previous record review studies that reported on surgical AEs in detail are now more than ten years old. Since then surgical technology and quality assurance have changed rapidly. The objective of this study was to provide more recent data on the incidence, consequences, preventability, causes and potential strategies to prevent AEs among hospitalized patients in surgical units. Methods A structured record review study of 7,926 patient records was carried out by trained nurses and medical specialist reviewers in 21 Dutch hospitals. The aim was to determine the presence of AEs during hospitalizations in 2004 and to consider how far they could be prevented. Of all AEs, the consequences, responsible medical specialty, causes and potential prevention strategies were identified. Surgical AEs were defined as AEs attributable to surgical treatment and care processes and were selected for analysis in detail. Results Surgical AEs occurred in 3.6% of hospital admissions and represented 65% of all AEs. Forty-one percent of the surgical AEs was considered to be preventable. The consequences of surgical AEs were more severe than for other types of AEs, resulting in more permanent disability, extra treatment, prolonged hospital stay, unplanned readmissions and extra outpatient visits. Almost 40% of the surgical AEs were infections, 23% bleeding, and 22% injury by mechanical, physical or chemical cause. Human factors were involved in the causation of 65% of surgical AEs and were considered to be preventable through quality assurance and training. Conclusions Surgical AEs occur more often than other types of AEs, are more often preventable and their consequences are more severe. Therefore, surgical AEs have a major impact on the burden of AEs during hospitalizations

  8. [The clinical characteristics and surgical treatment strategy of acute gangrenous cholecystitis after biliary tract stenting].

    Science.gov (United States)

    Ma, J; Lü, S C; Kou, J T; Li, X L; Zhu, J Q; Dong, H M; He, Q

    2016-12-13

    Objective: To analysis of the possible cause and surgical diagnosis and treatment strategies of acute gangrenous cholecystitis (AGC) after biliary stent drainage. Methods: The clinical data of 273 patients who received biliary stent drainage in Beijing Chaoyang Hospital from January 2015 to March 2016 were analyzed retrospectively. Among them, 22 patients who underwent surgical treatment were divided into two groups: 9 cases of AGC group and 13 cases of non-AGC group. The risk factors of AGC and surgical approach were analyzed. Result: All 22 patients underwent laparoscopic surgery. In AGC group, 1 patient with toxic shock died of multiple organ viscera function failure caused by infection, and 1 patient with gallbladder triangle inflammatory adhesion suffered from biliary leakage. The postoperative pathology of 2 patients was acute gangrenous cholecystitis. Non-AGC group had no death, bile duct injury and bleeding, with postoperative pathology of chronic cholecystitis. Patients were followed up for 2 month to restore well, without biliary calculi residual. Operation time, intraoperative blood loss, hospitalization days and hospitalization expenses of AGC group were higher than those of non-AGC group. Conclusion: The advocated AGC after biliary stent drainage should actively surgery after early diagnosis and endoscopic therapy should not be repeated. Laparoscopic surgery is a safe and effective treatment for AGC after carotid stenting.

  9. Retrospective analysis of surgical strategies for traumatic lens dislocation in 105 cases

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    Sheng-Xiang Guo

    2016-06-01

    Full Text Available AIM: To retrospectively analyze the surgical strategies and outcome of traumatic lens dislocation. METHODS: Retrospective study. Clinical data of 105 cases(105 eyesdiagnosed with traumatic lens dislocation from April to June 2014 in our hospital were recruited. According to position of dislocated lens and complicated situations, different surgical approaches were performed, including intracapsular lens extraction, phacoemulsification, vitrectomy through pars plana and lensectomy.Meanwhile, vitreo-retinal or anti-glaucoma surgeries were performed in complicated cases.Preoperative and postoperative LogMar(Logarithm of the Minimum Angle of Resolutionvisual acuity were compared by paired t-test. Perioperative complications including expulsive choroidal hemorrhages and recurrent retinal detachment were recorded and assessed. RESULTS: All 105 dislocated lenses were removed completely. Visual acuity of 91 eyes(86.7%were significantly improved postoperatively.The visual acuity of most patients was 0.1-0.3(42 eyes, 40.0%and 1 patient's visual acuity with lens subluxation reached more than 0.8 postoperatively. Expulsive choroidal hemorrhages occurred in 1 eye intraoperatively and 1 eye postoperatively. Recurrent retinal detachment was observed in 2 eyes postoperatively. CONCLUSION: According to position of the lens dislocation, personalized surgery strategy is critical for therapy of traumatic lens dislocation.Expulsive choroidal hemorrhage is one of most several complications and should be managed properly.

  10. Glycemic control strategies and the occurrence of surgical site infection: a systematic review.

    Science.gov (United States)

    Domingos, Caroline Maria Herrero; Iida, Luciana Inaba Senyer; Poveda, Vanessa de Brito

    2016-01-01

    To analyze the evidence available in the scientific literature regarding the relationship between the glycemic control strategies used and the occurrence of surgical site infection in adult patients undergoing surgery. This is a systematic review performed through search on the databases of CINAHL, MEDLINE, LILACS, Cochrane Database of Systematic Reviews and EMBASE. Eight randomized controlled trials were selected. Despite the diversity of tested interventions, studies agree that glycemic control is essential to reduce rates of surgical site infection, and should be maintained between 80 and 120 mg/dL during the perioperative period. Compared to other strategies, insulin continuous infusion during surgery was the most tested and seems to get better results in reducing rates of surgical site infection and achieving success in glycemic control. Tight glycemic control during the perioperative period benefits the recovery of surgical patients, and the role of the nursing team is key for the successful implementation of the measure. Analisar as evidências disponíveis na literatura científica sobre a relação entre as estratégias de controle glicêmico efetuadas e a ocorrência de infecção do sítio cirúrgico em pacientes adultos submetidos à cirurgia. Trata-se de revisão sistemática, por meio das bases de dados CINAHL, MEDLINE, LILACS, Cochrane Database of Systematic Reviews e EMBASE. Foram selecionados oito ensaios clínicos randomizados. Apesar da diversidade de intervenções testadas, os estudos concordam que o controle glicêmico é essencial para a redução das taxas de infecção do sítio cirúrgico e deve ser mantido entre 80 e 120 mg/dL durante o perioperatório. A infusão contínua de insulina no transoperatório foi a mais testada e parece obter melhores resultados na redução das taxas de infecção do sítio cirúrgico e sucesso no controle glicêmico comparada às demais estratégias. O controle glicêmico rigoroso durante o perioperat

  11. 3D bioprinting: A new insight into the therapeutic strategy of neural tissue regeneration.

    Science.gov (United States)

    Hsieh, Fu-Yu; Hsu, Shan-hui

    2015-01-01

    Acute traumatic injuries and chronic degenerative diseases represent the world's largest unmet medical need. There are over 50 million people worldwide suffering from neurodegenerative diseases. However, there are only a few treatment options available for acute traumatic injuries and neurodegenerative diseases. Recently, 3D bioprinting is being applied to regenerative medicine to address the need for tissues and organs suitable for transplantation. In this commentary, the newly developed 3D bioprinting technique involving neural stem cells (NSCs) embedded in the thermoresponsive biodegradable polyurethane (PU) bioink is reviewed. The thermoresponsive and biodegradable PU dispersion can form gel near 37 °C without any crosslinker. NSCs embedded within the water-based PU hydrogel with appropriate stiffness showed comparable viability and differentiation after printing. Moreover, in the zebrafish embryo neural deficit model, injection of the NSC-laden PU hydrogels promoted the repair of damaged CNS. In addition, the function of adult zebrafish with traumatic brain injury was rescued after implantation of the 3D-printed NSC-laden constructs. Therefore, the newly developed 3D bioprinting technique may offer new possibilities for future therapeutic strategy of neural tissue regeneration.

  12. 3D bioprinting: A new insight into the therapeutic strategy of neural tissue regeneration

    Science.gov (United States)

    Hsieh, Fu-Yu; Hsu, Shan-hui

    2015-01-01

    ABSTRACT Acute traumatic injuries and chronic degenerative diseases represent the world’s largest unmet medical need. There are over 50 million people worldwide suffering from neurodegenerative diseases. However, there are only a few treatment options available for acute traumatic injuries and neurodegenerative diseases. Recently, 3D bioprinting is being applied to regenerative medicine to address the need for tissues and organs suitable for transplantation. In this commentary, the newly developed 3D bioprinting technique involving neural stem cells (NSCs) embedded in the thermoresponsive biodegradable polyurethane (PU) bioink is reviewed. The thermoresponsive and biodegradable PU dispersion can form gel near 37°C without any crosslinker. NSCs embedded within the water-based PU hydrogel with appropriate stiffness showed comparable viability and differentiation after printing. Moreover, in the zebrafish embryo neural deficit model, injection of the NSC-laden PU hydrogels promoted the repair of damaged CNS. In addition, the function of adult zebrafish with traumatic brain injury was rescued after implantation of the 3D-printed NSC-laden constructs. Therefore, the newly developed 3D bioprinting technique may offer new possibilities for future therapeutic strategy of neural tissue regeneration. PMID:26709633

  13. Towards reducing thrombogenicity of LVAD therapy: optimizing surgical and patient management strategies

    Science.gov (United States)

    Chivukula, Venkat Keshav; Lafzi, Ali; Mokadam, Nahush; Beckman, Jennifer; Mahr, Claudius; Aliseda, Alberto

    2017-11-01

    Unfavourable hemodynamics in heart failure patients implanted with left ventricular assist devices (LVAD), due to non-optimal surgical configurations and patient management, strongly influence thrombogenicity. This is consistent with the increase in devastating thromboembolic complications (specifically thrombosis and stroke) in patients, even as the risk of thrombosis inside the device decreases with modern designs. Inflow cannula and outflow graft surgical configurations have been optimized via patient-specific modeling that computes the thrombogenic potential with a combination of Eulerian (endothelial) wall shear stress and Lagrangian (platelet shear history) tracking. Using this view of hemodynamics, the benefits of intermittent aortic valve opening (promoting washout and reducing stagnant flow in the aortic valve region) have been assessed in managing the patient's residual native cardiac output. The use of this methodology to understand the contribution of the hemodynamics in the flow surrounding the LVAD itself to thrombogenesis show promise in developing holistic patient-specific management strategies to minimize stroke risk and enhance efficacy of LVAD therapy. Funded in part by an AHA postdoctoral fellowship 16POST30520004.

  14. Novel Strategy for Discrimination of Transcription Factor Binding Motifs Employing Mathematical Neural Network

    Science.gov (United States)

    Sugimoto, Asuka; Sumi, Takuya; Kang, Jiyoung; Tateno, Masaru

    2017-07-01

    Recognition in biological macromolecular systems, such as DNA-protein recognition, is one of the most crucial problems to solve toward understanding the fundamental mechanisms of various biological processes. Since specific base sequences of genome DNA are discriminated by proteins, such as transcription factors (TFs), finding TF binding motifs (TFBMs) in whole genome DNA sequences is currently a central issue in interdisciplinary biophysical and information sciences. In the present study, a novel strategy to create a discriminant function for discrimination of TFBMs by constituting mathematical neural networks (NNs) is proposed, together with a method to determine the boundary of signals (TFBMs) and noise in the NN-score (output) space. This analysis also leads to the mathematical limitation of discrimination in the recognition of features representing TFBMs, in an information geometrical manifold. Thus, the present strategy enables the identification of the whole space of TFBMs, right up to the noise boundary.

  15. Gender-specific strategy use and neural correlates in a spatial perspective taking task.

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    Kaiser, Stefan; Walther, Stephan; Nennig, Ernst; Kronmüller, Klaus; Mundt, Christoph; Weisbrod, Matthias; Stippich, Christoph; Vogeley, Kai

    2008-08-01

    In the context of the present study spatial perspective taking refers to the ability to translocate one's own egocentric viewpoint to somebody else's viewpoint in space. We adopted a spatial perspective taking paradigm and performed a functional magnetic resonance imaging study to assess gender differences of neural activity during perspective taking. 24 healthy subjects (12 male/12 female) were asked to systematically either take their own (first-person-perspective, 1PP) or another person's perspective (third-person-perspective, 3PP). Presented stimuli consisted of a virtual scenery with an avatar and red balls around him that had to be counted, if visible, from 1PP or 3PP. Reaction time was increased and correctness scores were decreased during the cognitively more effortful 3PP condition. Correctness scores showed a trend towards a more pronounced decline of performance during 3PP as compared to 1PP in female subjects. Female subjects correctness scores declined by 6.7% from 1PP to 3PP, while in male subjects this performance decline was only 2.7%. Debriefings after the experiment, reaction times depending on angle of rotation and error rates suggest that males are more likely to employ an object-based strategy in contrast to a consistently employed egocentric perspective transformation in females. In the whole group, neural activity was increased in the parieto-occipital, right inferior frontal and supplementary motor areas, confirming previous studies. With respect to gender, male subjects showed stronger activation in the precuneus and the right inferior frontal gyrus than female subjects in a region-of-interest approach. In a subgroup of male subjects whose strategy reports suggest object-based strategies these differences seem to be more pronounced. In conclusion, the differential recruitment of brain regions most likely reflects different strategies in solving this spatial perspective taking task.

  16. Connectivity strategies for higher-order neural networks applied to pattern recognition

    Science.gov (United States)

    Spirkovska, Lilly; Reid, Max B.

    1990-01-01

    Different strategies for non-fully connected HONNs (higher-order neural networks) are discussed, showing that by using such strategies an input field of 128 x 128 pixels can be attained while still achieving in-plane rotation and translation-invariant recognition. These techniques allow HONNs to be used with the larger input scenes required for practical pattern-recognition applications. The number of interconnections that must be stored has been reduced by a factor of approximately 200,000 in a T/C case and about 2000 in a Space Shuttle/F-18 case by using regional connectivity. Third-order networks have been simulated using several connection strategies. The method found to work best is regional connectivity. The main advantages of this strategy are the following: (1) it considers features of various scales within the image and thus gets a better sample of what the image looks like; (2) it is invariant to shape-preserving geometric transformations, such as translation and rotation; (3) the connections are predetermined so that no extra computations are necessary during run time; and (4) it does not require any extra storage for recording which connections were formed.

  17. Comparative analysis of 3 surgical strategies for adult spinal deformity with mild to moderate sagittal imbalance.

    Science.gov (United States)

    Bae, Junseok; Theologis, Alexander A; Strom, Russell; Tay, Bobby; Burch, Shane; Berven, Sigurd; Mummaneni, Praveen V; Chou, Dean; Ames, Christopher P; Deviren, Vedat

    2018-01-01

    OBJECTIVE Surgical treatment of adult spinal deformity (ASD) is an effective endeavor that can be accomplished using a variety of surgical strategies. Here, the authors assess and compare radiographic data, complications, and health-related quality-of-life (HRQoL) outcome scores among patients with ASD who underwent a posterior spinal fixation (PSF)-only approach, a posterior approach combined with lateral lumbar interbody fusion (LLIF+PSF), or a posterior approach combined with anterior lumbar interbody fusion (ALIF+PSF). METHODS The medical records of consecutive adults who underwent thoracolumbar fusion for ASD between 2003 and 2013 at a single institution were reviewed. Included were patients who underwent instrumentation from the pelvis to L-1 or above, had a sagittal vertical axis (SVA) of spinal deformity parameters, complications, and HRQoL outcome scores (Oswestry Disability Index [ODI], Scoliosis Research Society 22-question Questionnaire [SRS-22], 36-Item Short Form Health Survey [SF-36], visual analog scale [VAS] for back/leg pain) from each group were assessed and compared with each other using ANOVA. The minimal clinically important differences used were -1.2 (VAS back pain), -1.6 (VAS leg pain), -15 (ODI), 0.587/0.375/0.8/0.42 (SRS-22 pain/function/self-image/mental health), and 5.2 (SF-36, physical component summary). RESULTS A total of 221 patients (58 LLIF, 91 ALIF, 72 PSF only) met the inclusion criteria. Average deformities consisted of a SVA of 10°, a pelvic tilt of > 20°, a lumbar Cobb angle of > 20°, and a thoracic Cobb angle of > 15°. Preoperative SVA, LL, pelvic incidence-LL mismatch, and lumbar and thoracic Cobb angles were similar among the groups. Patients in the PSF-only group had more comorbidities, those in the ALIF+PSF group were, on average, younger and had a lower body mass index than those in the LLIF+PSF group, and patients in the LLIF+PSF group had a significantly higher mean number of interbody fusion levels than those in

  18. Surgical and therapeutic strategy of recurrent malignant gliomas in intractable location

    Directory of Open Access Journals (Sweden)

    LU Yun-tao

    2012-12-01

    Full Text Available Objective Recurrent malignant gliomas often violate important neurological function parts or deep brain structures due to tumor invasion, further increasing the difficulty of reoperation and treatment. Therefore, how to develop a reasonable treatment strategy, maximize the removal of the tumor, and ensure a basic quality of life of the patient, is nowadays hotly debated by scholars from various countries. This article aims to explore the reasonable treatment and optimal surgical strategy of recurrent malignant gliomas. Methods Four cases of recurrent malignant glioma were collceted. A comprehensive assessment on preoperative imaging, intraoperative operation, postoperative complications and long-term follow-up was made, and treatment strategy was elaborated. Results Postoperative MRI in 2 cases showed the recurrent tumors located in remnant edema parts, which were revealed by T2WI after first resections. One case underwent expanded resection of edema parts according to T2WI. This patient suffered short-sensory aphasia and weakness of right limbs, but recovered by improving cerebral circulation, hyperbaric oxygen, auxiliary acupuncture and physical rehabilitation trainings. One case with brainstem glioma underwent precise resection by laser knife, without postoperative neurological disorders. All the 4 cases received postoperative chemotherapy with TMZ (200 mg/kg, 5 d/28 d. The average follow-up period was (14.00 ± 12.50 months. Conclusion For obvious recurrence of malignant glioma, reoperation is still the key factor to lengthen the survival of patients, and expanded resection of the edema area supplemented by T2WI can reduce recurrence. Under the precondition of maintaining the basic postoperative quality of life of patients (KPS > 70, expanded resection should be used. As for tumors adjacent to the eloquent areas, precise engraving resection should be used to minimize residual tumor cells.

  19. Advanced surgical strategy for giant mediastinal germ cell tumor in children

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    Shigehisa Fumino

    2017-12-01

    Conclusions: Resectability is the most important predictor of outcomes for MGCTs. Preoperative 3D-CT and CPS can enable complete resection and ensure surgical safety. Well-functioned surgical team is critical success factor in such advanced surgery.

  20. Distinct neural and neuromuscular strategies underlie independent evolution of simplified advertisement calls.

    Science.gov (United States)

    Leininger, Elizabeth C; Kelley, Darcy B

    2013-04-07

    Independent or convergent evolution can underlie phenotypic similarity of derived behavioural characters. Determining the underlying neural and neuromuscular mechanisms sheds light on how these characters arose. One example of evolutionarily derived characters is a temporally simple advertisement call of male African clawed frogs (Xenopus) that arose at least twice independently from a more complex ancestral pattern. How did simplification occur in the vocal circuit? To distinguish shared from divergent mechanisms, we examined activity from the calling brain and vocal organ (larynx) in two species that independently evolved simplified calls. We find that each species uses distinct neural and neuromuscular strategies to produce the simplified calls. Isolated Xenopus borealis brains produce fictive vocal patterns that match temporal patterns of actual male calls; the larynx converts nerve activity faithfully into muscle contractions and single clicks. In contrast, fictive patterns from isolated Xenopus boumbaensis brains are short bursts of nerve activity; the isolated larynx requires stimulus bursts to produce a single click of sound. Thus, unlike X. borealis, the output of the X. boumbaensis hindbrain vocal pattern generator is an ancestral burst-type pattern, transformed by the larynx into single clicks. Temporally simple advertisement calls in genetically distant species of Xenopus have thus arisen independently via reconfigurations of central and peripheral vocal neuroeffectors.

  1. Nanofibers implant functionalized by neural growth factor as a strategy to innervate a bioengineered tooth.

    Science.gov (United States)

    Eap, Sandy; Bécavin, Thibault; Keller, Laetitia; Kökten, Tunay; Fioretti, Florence; Weickert, Jean-Luc; Deveaux, Etienne; Benkirane-Jessel, Nadia; Kuchler-Bopp, Sabine

    2014-03-01

    Current strategies for jaw reconstruction require multiple procedures, to repair the bone defect, to offer sufficient support, and to place the tooth implant. The entire procedure can be painful and time-consuming, and the desired functional repair can be achieved only when both steps are successful. The ability to engineer combined tooth and bone constructs, which would grow in a coordinated fashion with the surrounding tissues, could potentially improve the clinical outcomes and also reduce patient suffering. A unique nanofibrous and active implant for bone-tooth unit regeneration and also the innervation of this bioengineered tooth are demonstrated. A nanofibrous polycaprolactone membrane is functionalized with neural growth factor, along with dental germ, and tooth innervation follows. Such innervation allows complete functionality and tissue homeostasis of the tooth, such as dentinal sensitivity, odontoblast function, masticatory forces, and blood flow. © 2013 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

  2. Diagnosis and surgical strategy for sacral meningeal cysts with check-valve mechanism: technical note

    OpenAIRE

    Asamoto, Shunji; Fukui, Yasuyuki; Nishiyama, Makoto; Ishikawa, Masayuki; Fujita, Nobuyuki; Nakamura, Satoshi; Muto, Jun; Shiono, Yuta; Doi, Hiroshi; Kubota, Motoo; Ishii, Kazuhiko

    2012-01-01

    Objective There is agreement that symptomatic sacral meningeal cysts with a check-valve mechanism and/or large cysts representing space-occupying lesions should be treated surgically. This study investigated factors indicating a need for surgical intervention and surgical techniques for sacral meningeal cysts with a check-valve mechanism. Methods In ten patients presenting with sciatica and neurological deficits, myelography, computed tomography (CT) myelography, and magnetic resonance imagin...

  3. Simultaneous occurrence of coronary artery disease and lung cancer: what is the best surgical treatment strategy?

    Science.gov (United States)

    Tourmousoglou, Christos E; Apostolakis, Efstratios; Dougenis, Dimitrios

    2014-10-01

    A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether combined surgical procedures in one or two stages are the best surgical treatment strategy in patients with simultaneous coronary artery disease and lung cancer. Altogether, 264 papers were found using the reported search; of which, 15 represented the best evidence to answer the clinical question. The authors, journal, date, country of publication, patient group, study type, outcomes and results of papers are tabulated. The outcomes of the reported studies provided interesting results. All the studies were retrospective. Ten papers reported the results of combined and staged operations. The operative mortality rate of combined procedures was 0-20.8% and of staged procedures was 0-10%. The reoperation rate for bleeding of combined procedures was 0-11% and of staged procedures was 0%. The survival rate of combined procedures at 1 year was 79-100%, at 5 years was 34.9-85% and at 7 years was 61%. The survival rate of staged procedures at 1 year was 72.7% and at 5 years was 53%. Five studies reported the results of off-pump coronary artery bypass grafting (OPCABG) and lung surgery versus on-pump and lung surgery. The operative mortality rate of OPCABG and lung surgery was 0-6.6%. The 2-year survival rate of OPCABG and lung surgery was 47% and the 5-year survival rate was 13-68%. The re-exploration rate for bleeding of OPCABG was 4%. Simultaneous lung surgery and CABG could be safely performed with adequate cancer-free survival in patients with Stage I or II lung cancer. Lung surgery is better performed before institution of cardiopulmonary bypass, avoiding the complications of such a technique. Long-term survival after combined treatment is mostly related to the predicted survival after lung resection. This depends on the T stage and mostly on the patient's nodal status. In certain high-risk groups (if the cardiac procedure is difficult or if the

  4. A NEURAL NETWORK BASED TRAFFIC-AWARE FORWARDING STRATEGY IN NAMED DATA NETWORKING

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    Parisa Bazmi

    2016-11-01

    Full Text Available Named Data Networking (NDN is a new Internet architecture which has been proposed to eliminate TCP/IP Internet architecture restrictions. This architecture is abstracting away the notion of host and working based on naming datagrams. However, one of the major challenges of NDN is supporting QoS-aware forwarding strategy so as to forward Interest packets intelligently over multiple paths based on the current network condition. In this paper, Neural Network (NN Based Traffic-aware Forwarding strategy (NNTF is introduced in order to determine an optimal path for Interest forwarding. NN is embedded in NDN routers to select next hop dynamically based on the path overload probability achieved from the NN. This solution is characterized by load balancing and QoS-awareness via monitoring the available path and forwarding data on the traffic-aware shortest path. The performance of NNTF is evaluated using ndnSIM which shows the efficiency of this scheme in terms of network QoS improvementof17.5% and 72% reduction in network delay and packet drop respectively.

  5. Neural correlates of strategy use during auditory working memory in musicians and non-musicians.

    Science.gov (United States)

    Schulze, K; Mueller, K; Koelsch, S

    2011-01-01

    Working memory (WM) performance in humans can be improved by structuring and organizing the material to be remembered. For visual and verbal information, this process of structuring has been associated with the involvement of a prefrontal-parietal network, but for non-verbal auditory material, the brain areas that facilitate WM for structured information have remained elusive. Using functional magnetic resonance imaging, this study compared neural correlates underlying encoding and rehearsal of auditory WM for structured and unstructured material. Musicians and non-musicians performed a WM task on five-tone sequences that were either tonally structured (with all tones belonging to one tonal key) or tonally unstructured (atonal) sequences. Functional differences were observed for musicians (who are experts in the music domain), but not for non-musicians - The right pars orbitalis was activated more strongly in musicians during the encoding of unstructured (atonal) vs. structured (tonal) sequences. In addition, data for musicians showed that a lateral (pre)frontal-parietal network (including the right premotor cortex, right inferior precentral sulcus and left intraparietal sulcus) was activated during WM rehearsal of structured, as compared with unstructured, sequences. Our findings indicate that this network plays a role in strategy-based WM for non-verbal auditory information, corroborating previous results showing a similar network for strategy-based WM for visual and verbal information. © 2010 The Authors. European Journal of Neuroscience © 2010 Federation of European Neuroscience Societies and Blackwell Publishing Ltd.

  6. Cognitive and neural strategies during control of the anterior cingulate cortex by fMRI neurofeedback in patients with schizophrenia.

    Science.gov (United States)

    Cordes, Julia S; Mathiak, Krystyna A; Dyck, Miriam; Alawi, Eliza M; Gaber, Tilman J; Zepf, Florian D; Klasen, Martin; Zvyagintsev, Mikhail; Gur, Ruben C; Mathiak, Klaus

    2015-01-01

    Cognitive functioning is impaired in patients with schizophrenia, leading to significant disabilities in everyday functioning. Its improvement is an important treatment target. Neurofeedback (NF) seems a promising method to address the neural dysfunctions underlying those cognitive impairments. The anterior cingulate cortex (ACC), a central hub for cognitive processing, is one of the brain regions known to be dysfunctional in schizophrenia. Here we conducted NF training based on real-time functional magnetic resonance imaging (fMRI) in patients with schizophrenia to enable them to control their ACC activity. Training was performed over 3 days in a group of 11 patients with schizophrenia and 11 healthy controls. Social feedback was provided in accordance with the evoked activity in the selected region of interest (ROI). Neural and cognitive strategies were examined off-line. Both groups learned to control the activity of their ACC but used different neural strategies: patients activated the dorsal and healthy controls the rostral subdivision. Patients mainly used imagination of music to elicit activity and the control group imagination of sports. In a stepwise regression analysis, the difference in neural control did not result from the differences in cognitive strategies but from diagnosis alone. Based on social reinforcers, patients with schizophrenia can learn to regulate localized brain activity. However, cognitive strategies and neural network location differ from healthy controls. These data emphasize that for therapeutic interventions in patients with schizophrenia compensatory strategies may emerge. Specific cognitive skills or specific dysfunctional networks should be addressed to train impaired skills. Social NF based on fMRI may be one method to accomplish precise learning targets.

  7. Cognitive and neural strategies during control of the anterior cingulate cortex by fMRI neurofeedback in patients with schizophrenia

    Directory of Open Access Journals (Sweden)

    Julia S Cordes

    2015-06-01

    Full Text Available Cognitive functioning is impaired in patients with schizophrenia, leading to significant disabilities in everyday functioning. Its improvement is an important treatment target. Neurofeedback (NF seems a promising method to address the neural dysfunctions underlying those cognitive impairments. The anterior cingulate cortex (ACC, a central hub for cognitive processing, is one of the dysfunctional brain regions in schizophrenia. Here we conducted NF training based on real-time functional magnetic resonance imaging (fMRI in patients with schizophrenia to enable them to control their ACC activity. Training was performed over three days in a group of 11 patients with schizophrenia and 11 healthy controls. Social feedback was provided in accordance with the evoked activity in the selected region of interest (ROI. Neural and cognitive strategies were examined off-line. Both groups learned to control the activity of their ACC but used different neural strategies: Patients activated the dorsal and healthy controls the rostral subdivision. Patients mainly used imagination of music to elicit activity and the control group imagination of sports. However, the difference in neural control did not result from the differences in cognitive strategies but from diagnosis alone. Based on social reinforcers, schizophrenia patients can learn to regulate localized brain activity. Cognitive strategies and neural network location differ, however, from healthy controls. These data emphasize that for therapeutic interventions in schizophrenia compensatory strategies may emerge. Specific cognitive skills or specific dysfunctional networks should be addressed to train impaired skills. Social neurofeedback based on fMRI may be one method to accomplish precise learning targets.

  8. Physics strategies for sparing neural stem cells during whole-brain radiation treatments.

    Science.gov (United States)

    Kirby, Neil; Chuang, Cynthia; Pouliot, Jean; Hwang, Andrew; Barani, Igor J

    2011-10-01

    Currently, there are no successful long-term treatments or preventive strategies for radiation-induced cognitive impairments, and only a few possibilities have been suggested. One such approach involves reducing the dose to neural stem cell compartments (within and outside of the hippocampus) during whole-brain radiation treatments for brain metastases. This study investigates the fundamental physics issues associated with the sparing of neural stem cells during photon radiotherapy for brain metastases. Several factors influence the stem cell dose: intracranial scattering, collimator leakage, beam energy, and total number of beams. The relative importance of these factors is investigated through a set of radiation therapy plans, which are all variations of an initial 6 MV intensity-modulated radiation therapy (IMRT) plan designed to simultaneously deliver a whole-brain dose of 30 Gy and maximally reduce stem cell compartment dose. Additionally, an in-house leaf segmentation algorithm was developed that utilizes jaw motion to minimize the collimator leakage. The plans are all normalized such that 50% of the PTV receives 30 Gy. For the initial 6 MV IMRT plan, 50% of the stem cells receive a dose greater than 6.3 Gy. Calculations indicate that 3.6 Gy of this dose originates from intracranial scattering. The jaw-tracking segmentation algorithm, used in conjunction with direct machine parameter optimization, reduces the 50% stem cell dose to 4.3 and 3.7 Gy for 6 and 10 MV treatment beams, respectively. Intracranial scattering alone is responsible for a large dose contribution to the stem cell compartment. It is, therefore, important to minimize other contributing factors, particularly the collimator leakage, to maximally reduce dose to these critical structures. The use of collimator jaw tracking in conjunction with modern collimators can minimize this leakage.

  9. Physics strategies for sparing neural stem cells during whole-brain radiation treatments

    Energy Technology Data Exchange (ETDEWEB)

    Kirby, Neil; Chuang, Cynthia; Pouliot, Jean; Hwang, Andrew; Barani, Igor J. [Department of Radiation Oncology, University of California San Francisco, San Francisco, California 94143-1708 (United States)

    2011-10-15

    Purpose: Currently, there are no successful long-term treatments or preventive strategies for radiation-induced cognitive impairments, and only a few possibilities have been suggested. One such approach involves reducing the dose to neural stem cell compartments (within and outside of the hippocampus) during whole-brain radiation treatments for brain metastases. This study investigates the fundamental physics issues associated with the sparing of neural stem cells during photon radiotherapy for brain metastases. Methods: Several factors influence the stem cell dose: intracranial scattering, collimator leakage, beam energy, and total number of beams. The relative importance of these factors is investigated through a set of radiation therapy plans, which are all variations of an initial 6 MV intensity-modulated radiation therapy (IMRT) plan designed to simultaneously deliver a whole-brain dose of 30 Gy and maximally reduce stem cell compartment dose. Additionally, an in-house leaf segmentation algorithm was developed that utilizes jaw motion to minimize the collimator leakage. Results: The plans are all normalized such that 50% of the PTV receives 30 Gy. For the initial 6 MV IMRT plan, 50% of the stem cells receive a dose greater than 6.3 Gy. Calculations indicate that 3.6 Gy of this dose originates from intracranial scattering. The jaw-tracking segmentation algorithm, used in conjunction with direct machine parameter optimization, reduces the 50% stem cell dose to 4.3 and 3.7 Gy for 6 and 10 MV treatment beams, respectively. Conclusions: Intracranial scattering alone is responsible for a large dose contribution to the stem cell compartment. It is, therefore, important to minimize other contributing factors, particularly the collimator leakage, to maximally reduce dose to these critical structures. The use of collimator jaw tracking in conjunction with modern collimators can minimize this leakage.

  10. Surgical strategy for intra- and extra-vertebral dumbbell-shaped tumors

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    SUN Li-yong

    2013-12-01

    Full Text Available Objective To investigate the clinical features and surgical strategy of intra- and extra-vertebral dumbbell-shaped tumors. Methods Clinical data of 39 patients with intra- and extra-vertebral tumor were retrospectively studied. The tumors were removed via posterior midline approach in 33 patients, and via posterior combined with anterior approach in 6 patients. Thirty patients underwent tumor resection and internal fixation. Lateral mass screw fixation was performed in the level of C3-7, while the pedicular screw fixation was performed in the level of C2 and thoracic and lumbar segment. Results Tumors were totally excised in all the cases. The patients were followed-up for 6 months to 5 years with an average of 18.67 months. Pain relief occured in 29 cases, of whom the average Visual Analogue Scale (VAS score decreased from (7.51 ± 1.05 before surgery to (3.17 ± 1.17 24 h after surgery (P < 0.05. The numbness area emerged or enlarged in 12 cases and was unchanged in 3 cases. The average American Spinal Injury Association (ASIA sensation score decreased from (218.67 ± 2.80 before surgery to (213.33 ± 2.16 24 h after surgery (P < 0.05, but it increased to (216.78 ± 1.47 6 months after operation (P < 0.05. The motor function improved in 18 cases, and ASIA motor function score improved from (92.33 ± 1.63 before surgery to (95.05 ± 1.41 6 months after operation (P < 0.05. No tumor recurrence and secondary spinal deformity were found. Conclusion Most cases of dumbbell-shaped intra- and extra-vertebral tumor can be totally removed with one-session microsurgery. In the cases with bony erosion caused by tumor and facetectomy, concurrent internal fixation and fusion were recommended in order to maintain spinal stability.

  11. Complete Expulsion of Testicular Prosthesis via the Scrotum: A Case-Based Review of the Preventive Surgical Strategies

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    Jack Donati-Bourne

    2015-01-01

    Full Text Available Testicular prostheses are regularly used in urological surgery and are important for postoperative psychological well-being in many patients undergoing orchiectomy. One of the recognised complications of this procedure is graft extrusion, which can result in significant morbidity for patients and require operative reintervention. Whilst most cases of extrusion involve upward graft migration to the external inguinal ring or direct displacement through the scrotal skin, we present an unusual case of complete expulsion of testicular implant three weeks postoperatively through a previously healthy scrotum. During surgical insertion of testicular prostheses, the urological surgeon must carefully consider the different surgical strategies at each step of the operation to prevent future extrusion of the graft. A stepwise review of the preventive surgical strategies to reduce the risk of graft extrusion encompasses the choice of optimal surgical incision, the technique of dissection to create the receiving anatomical pouch, the method of fixation of the implant within the receiving hemiscrotum, and the adoption of good postoperative care measures in line with the principles of sound scrotal surgery.

  12. Surgical strategy to minimize ischemia during trapping/resection of giant extracranial carotid artery aneurysm stratified by collateral evaluation.

    Science.gov (United States)

    Hongo, Hiroki; Inoue, Tomohiro; Tamura, Akira; Saito, Isamu

    2017-01-01

    Extracranial carotid artery aneurysm (ECAA) is a rare clinical entity, and no standard treatment strategy has been established for this condition. Data from three patients who underwent surgical treatment of enlarging giant ECAAs were retrospectively reviewed. Based on the collateral status, as evaluated by preoperative digital subtraction angiography (DSA), surgical strategy was stratified into (1) high flow bypass followed by cervical ICA (internal carotid artery) ligation, when the collateral status was judged as poor/fair or (2) direct cervical repair with patch application after aneurysmal wall resection when the collateral status was judged as robust. Postoperative results were evaluated by magnetic resonance imaging (MRI). Postoperative follow-up (day 0 to 1, as well as midterm at approximately 6 months) confirmed completely trapped aneurysm with successful robust bypass and robust anterograde flow of the reconstructed cervical carotid artery on magnetic resonance angiography with no additional ischemic lesions on diffusion weighted imaging and T2-weighted imaging when compared with preoperative imaging in all three patients. Postoperatively, there was no stroke event during the midterm follow-up at 6 months. Clinical results of ECAAs treated by a surgical strategy stratified based on collateral status, as evaluated by preoperative DSA, were favorable, without postoperative ischemic event, and with satisfactory mid-term MRI results.

  13. Surgical strategies for nonenhancing slow-growing gliomas with special reference to functional reorganization: review with own experience.

    Science.gov (United States)

    Hayashi, Yutaka; Nakada, Mitsutoshi; Kinoshita, Masashi; Hamada, Jun-Ichiro

    2013-01-01

    Nonenhancing intrinsic brain tumors have been empirically treated with a strategy that has been adopted for World Health Organization (WHO) grade II gliomas (low-grade gliomas: LGGs), even though small parts of the tumors might have been diagnosed as WHO grade III gliomas after surgery. However, the best surgical strategy for nonenhancing gliomas, including LGGs, is still debatable. LGGs have the following features: slow growth, high possibility of histologically malignant transformation, and no clear border between the tumor and adjacent normal brain. We retrospectively examined 26 consecutive patients with nonenhancing gliomas who were surgically treated at Kanazawa University Hospital between January 2006 and May 2012, with special reference to functional reorganization, extent of resection (EOR), and functional mapping during awake surgery. These categories are closely related with the features of LGG, i.e. functional reorganization due to slow-growing nature, EOR with related malignant transformation, and functional mapping for delineating the unclear tumor border. Finally, we discuss surgical strategies for slow-growing gliomas that are represented by LGGs and nonenhancing gliomas. In conclusion, slow-growing gliomas tend to undergo functional reorganization, and the functional reorganization affects the presurgical evaluation for resectability based on tumor location related to eloquence. In the clinical setting, to definitely identify the reorganized functional regions, awake surgery is recommended. Therefore, awake surgery could increase the extent of the resection of the tumor without deficits, resulting in the delay of malignant transformation and increase in overall survival.

  14. A deep convolutional neural network-based automatic delineation strategy for multiple brain metastases stereotactic radiosurgery.

    Science.gov (United States)

    Liu, Yan; Stojadinovic, Strahinja; Hrycushko, Brian; Wardak, Zabi; Lau, Steven; Lu, Weiguo; Yan, Yulong; Jiang, Steve B; Zhen, Xin; Timmerman, Robert; Nedzi, Lucien; Gu, Xuejun

    2017-01-01

    Accurate and automatic brain metastases target delineation is a key step for efficient and effective stereotactic radiosurgery (SRS) treatment planning. In this work, we developed a deep learning convolutional neural network (CNN) algorithm for segmenting brain metastases on contrast-enhanced T1-weighted magnetic resonance imaging (MRI) datasets. We integrated the CNN-based algorithm into an automatic brain metastases segmentation workflow and validated on both Multimodal Brain Tumor Image Segmentation challenge (BRATS) data and clinical patients' data. Validation on BRATS data yielded average DICE coefficients (DCs) of 0.75±0.07 in the tumor core and 0.81±0.04 in the enhancing tumor, which outperformed most techniques in the 2015 BRATS challenge. Segmentation results of patient cases showed an average of DCs 0.67±0.03 and achieved an area under the receiver operating characteristic curve of 0.98±0.01. The developed automatic segmentation strategy surpasses current benchmark levels and offers a promising tool for SRS treatment planning for multiple brain metastases.

  15. A deep convolutional neural network-based automatic delineation strategy for multiple brain metastases stereotactic radiosurgery.

    Directory of Open Access Journals (Sweden)

    Yan Liu

    Full Text Available Accurate and automatic brain metastases target delineation is a key step for efficient and effective stereotactic radiosurgery (SRS treatment planning. In this work, we developed a deep learning convolutional neural network (CNN algorithm for segmenting brain metastases on contrast-enhanced T1-weighted magnetic resonance imaging (MRI datasets. We integrated the CNN-based algorithm into an automatic brain metastases segmentation workflow and validated on both Multimodal Brain Tumor Image Segmentation challenge (BRATS data and clinical patients' data. Validation on BRATS data yielded average DICE coefficients (DCs of 0.75±0.07 in the tumor core and 0.81±0.04 in the enhancing tumor, which outperformed most techniques in the 2015 BRATS challenge. Segmentation results of patient cases showed an average of DCs 0.67±0.03 and achieved an area under the receiver operating characteristic curve of 0.98±0.01. The developed automatic segmentation strategy surpasses current benchmark levels and offers a promising tool for SRS treatment planning for multiple brain metastases.

  16. Low Grade Gliomas in Eloquent Locations – Implications for Surgical Strategy, Survival and Long Term Quality of Life

    Science.gov (United States)

    Jakola, Asgeir S.; Unsgård, Geirmund; Myrmel, Kristin S.; Kloster, Roar; Torp, Sverre H.; Lindal, Sigurd; Solheim, Ole

    2012-01-01

    Background Surgical management of suspected LGG remains controversial. A key factor when deciding a surgical strategy is often the tumors’ perceived relationship to eloquent brain regions Objective To study the association between tumor location, survival and long-term health related quality of life (HRQL) in patients with supratentorial low-grade gliomas (LGG). Methods Adults (≥18 years) operated due to newly diagnosed LGG from 1998 through 2009 included from two Norwegian university hospitals. After review of initial histopathology, 153 adults with supratentorial WHO grade II LGG were included in the study. Tumors’ anatomical location and the relationship to eloquent regions were graded. Survival analysis was adjusted for known prognostic factors and the initial surgical procedure (biopsy or resection). In long-term survivors, HRQL was assessed with disease specific questionnaires (EORTC QLQ-C30 and BN20) as well as a generic questionnaire (EuroQol 5D). Results There was a significant association between eloquence and survival (log-rank, peloquent tumors, 71% in intermediate located tumors and 54% in eloquent tumors. In the adjusted analysis the hazard ratio of increasing eloquence was 1.5 (95% CI 1.1–2.0, p = 0.022). There were no differences in HRQL between patients with eloquent and non-eloquent tumors. The most frequent self-reported symptoms were related to fatigue, cognition, and future uncertainty. Conclusion Eloquently located LGGs are associated with impaired survival compared to non-eloquently located LGG, but in long-term survivors HRQL is similar. Although causal inference from observational data should be done with caution, the findings illuminate the delicate balance in surgical decision making in LGGs, and add support to the probable survival benefits of aggressive surgical strategies, perhaps also in eloquent locations. PMID:23251537

  17. Low grade gliomas in eloquent locations - implications for surgical strategy, survival and long term quality of life.

    Science.gov (United States)

    Jakola, Asgeir S; Unsgård, Geirmund; Myrmel, Kristin S; Kloster, Roar; Torp, Sverre H; Lindal, Sigurd; Solheim, Ole

    2012-01-01

    Surgical management of suspected LGG remains controversial. A key factor when deciding a surgical strategy is often the tumors' perceived relationship to eloquent brain regions To study the association between tumor location, survival and long-term health related quality of life (HRQL) in patients with supratentorial low-grade gliomas (LGG). Adults (≥18 years) operated due to newly diagnosed LGG from 1998 through 2009 included from two Norwegian university hospitals. After review of initial histopathology, 153 adults with supratentorial WHO grade II LGG were included in the study. Tumors' anatomical location and the relationship to eloquent regions were graded. Survival analysis was adjusted for known prognostic factors and the initial surgical procedure (biopsy or resection). In long-term survivors, HRQL was assessed with disease specific questionnaires (EORTC QLQ-C30 and BN20) as well as a generic questionnaire (EuroQol 5D). There was a significant association between eloquence and survival (log-rank, peloquent tumors, 71% in intermediate located tumors and 54% in eloquent tumors. In the adjusted analysis the hazard ratio of increasing eloquence was 1.5 (95% CI 1.1-2.0, p = 0.022). There were no differences in HRQL between patients with eloquent and non-eloquent tumors. The most frequent self-reported symptoms were related to fatigue, cognition, and future uncertainty. Eloquently located LGGs are associated with impaired survival compared to non-eloquently located LGG, but in long-term survivors HRQL is similar. Although causal inference from observational data should be done with caution, the findings illuminate the delicate balance in surgical decision making in LGGs, and add support to the probable survival benefits of aggressive surgical strategies, perhaps also in eloquent locations.

  18. The Incremental Induction of Neuroprotective Properties by Multiple Therapeutic Strategies for Primary and Secondary Neural Injury

    Directory of Open Access Journals (Sweden)

    Seunghoon Lee

    2015-08-01

    Full Text Available Neural diseases including injury by endogenous factors, traumatic brain injury, and degenerative neural injury are eventually due to reactive oxygen species (ROS. Thus ROS generation in neural tissues is a hallmark feature of numerous forms of neural diseases. Neural degeneration and the neural damage process is complex, involving a vast array of tissue structure, transcriptional/translational, electrochemical, metabolic, and functional events within the intact neighbors surrounding injured neural tissues. During aging, multiple changes involving physical, chemical, and biochemical processes occur from the molecular to the morphological levels in neural tissues. Among many recommended therapeutic candidates, melatonin also plays a role in protecting the nervous system from anti-inflammation and efficiently safeguards neuronal cells via antioxidants and other endogenous/exogenous beneficial factors. Therefore, given the wide range of mechanisms responsible for neuronal damage, multi-action drugs or therapies for the treatment of neural injury that make use of two or more agents and target several pathways may have greater efficacy in promoting functional recovery than a single therapy alone.

  19. Intraoperative biopsy of the major cranial nerves in the surgical strategy for adenoid cystic carcinoma close to the skull base.

    Science.gov (United States)

    Tarsitano, Achille; Pizzigallo, Angelo; Gessaroli, Manlio; Sturiale, Carmelo; Marchetti, Claudio

    2012-02-01

    Adenoid cystic carcinoma of the salivary glands has a propensity for perineural invasion, which could favor spread along the major cranial nerves, sometimes to the skull base and through the foramina to the brain parenchyma. This study evaluated the relationship between neural spread and relapse in the skull base. During surgery, we performed multiple biopsies with extemporaneous examination of the major nerves close to the tumor to guide the surgical resection. The percentage of actuarial local control at 5 years for patients with a positive named nerve and skull base infiltration was 12.5%, compared with 90.0% in patients who were named nerve-negative and without infiltration of the skull base (P = .001). Our study shows that local control of disease for patients who are named nerve-positive with skull base infiltration is significantly more complex compared with patients who are named nerve-negative without infiltration of the skull base. Copyright © 2012. Published by Mosby, Inc.

  20. Economic and clinical contributions of an antimicrobial barrier dressing: a strategy for the reduction of surgical site infections.

    Science.gov (United States)

    Leaper, David; Nazir, Jameel; Roberts, Chris; Searle, Richard

    2010-01-01

    In patients at risk of surgical site infection (SSI), there is evidence that an antimicrobial barrier dressing (Acticoat* ) applied immediately post-procedure is effective in reducing the incidence of infection. The objective of this study was to assess when it is appropriate to use an antimicrobial barrier dressing rather than a post-operative film dressing, by evaluating the net cost and budget impact of the two strategies. An economic model was developed, which estimates expected expenditure on dressings and the expected costs of surgical site infection during the initial inpatient episode, based on published literature on the pre-discharge costs of surgical infection and the efficacy of an antimicrobial barrier dressing in preventing SSI. At an SSI risk of 10%, an antimicrobial barrier dressing strategy is cost neutral if the incidence of infection is reduced by at least 9% compared with a post-operative film dressing. At 35% efficacy, expenditure on dressings would be higher by £30,760 per 1000 patients, and the cost of treating infection would be lower by £111,650, resulting in a net cost saving of £80,890. The break-even infection risk for cost neutrality is 2.6%. Although this cost analysis is based on published data, there are limitations in methodology: the model is dependent on and subject to the limitations of the data used to populate it. Further studies would be useful to increase the robustness of the conclusions, particularly in a broader range of surgical specialties. A strategy involving the use of an antimicrobial barrier dressing in patients at moderate (5-10%) or high (>10%) risk of infection appears reasonable and cost saving in light of the available clinical evidence.

  1. Decision making in the treatment of tuberous and tubular breasts: volume adjustment as a crucial stage in the surgical strategy.

    Science.gov (United States)

    Persichetti, Paolo; Cagli, Barbara; Tenna, Stefania; Simone, Pierfranco; Marangi, Giovanni Francesco; Li Vecchi, Giancarlo

    2005-01-01

    Tuberous and tubular breasts, two distinct deformities based on the same anatomic anomaly, are characterized by several morphologic alterations with a wide spectrum of expression. The classifications reported in the literature are based primarily on deformity of shape, but other parameters such as breast volume and symmetry often are underrated. This study aimed to define tuberous and tubular breasts and their management accurately on the basis of multiple anatomic alterations involving breast volume and symmetry as well as shape. The records of 30 patients affected by tubular and tuberous breast were reviewed. Surgical strategy included correction of breast shape through areola and gland alterations, correction of volume asymmetry through parenchyma resection, and volume augmentation through permanent expandable breast implant insertion. All the patients were treated bilaterally. Evaluation using a visual analogic scale confirmed high patient satisfaction with a mean value of 92.6% in the assessment of shape, volume, and symmetry. Correct diagnosis, careful preoperative evaluation, and a comprehensive surgical strategy can achieve, in one surgical procedure, good and long-lasting outcomes in terms of breast shape and volume symmetry.

  2. Surgical Strategies for Management of Mitral Regurgitation: Recent Evidence from Randomized Controlled Trials.

    Science.gov (United States)

    Tolis, George; Sundt, Thoralf M

    2015-12-01

    In contrast to mitral regurgitation (MR) caused by structural abnormality of the valve ("primary" MR), about which there is increasing consensus regarding treatment, there is increasing controversy around the management of functional or "secondary" MR, of which "ischemic mitral regurgitation" (IMR) is a common cause. While the trend in the management of primary MR is increasingly aggressive, with wide agreement on the preference for repair over replacement such that debate centers on earlier and earlier repair even among asymptomatic patients, the situation is reversed in the setting of secondary MR with uncertainly beyond the mode of management (repair or replacement) to the value of intervening at all. This is, in part, because the term IMR has been somewhat loosely applied by the medical and surgical communities to include regurgitation secondary to active myocardial ischemia, as well as that resulting from a completed myocardial infarct. As a result, there is considerable variability in reported outcomes of surgical interventions for IMR. In addition, the natural history of IMR is quite adverse-more so than that of many solid organ malignancies-and its surgical treatment has traditionally carried a higher operative mortality than many cardiac surgical procedures, including similar operations for primary MR and incidental coronary artery disease. Added to this, with recent advances in both the medical and surgical treatment of heart failure improving nonoperative outcomes and simultaneously reducing operative risk compared to reports from previous decades, the landscape has been quite dynamic. Here, we review the issues surrounding surgical treatment for IMR, along with available evidence supporting different approaches, to lend an informed perspective on the divergent opinions among experts in this field and guide the appropriate management of the individual patient.

  3. Tracking-by-detection of surgical instruments in minimally invasive surgery via the convolutional neural network deep learning-based method.

    Science.gov (United States)

    Zhao, Zijian; Voros, Sandrine; Weng, Ying; Chang, Faliang; Li, Ruijian

    2017-12-01

    Worldwide propagation of minimally invasive surgeries (MIS) is hindered by their drawback of indirect observation and manipulation, while monitoring of surgical instruments moving in the operated body required by surgeons is a challenging problem. Tracking of surgical instruments by vision-based methods is quite lucrative, due to its flexible implementation via software-based control with no need to modify instruments or surgical workflow. A MIS instrument is conventionally split into a shaft and end-effector portions, while a 2D/3D tracking-by-detection framework is proposed, which performs the shaft tracking followed by the end-effector one. The former portion is described by line features via the RANSAC scheme, while the latter is depicted by special image features based on deep learning through a well-trained convolutional neural network. The method verification in 2D and 3D formulation is performed through the experiments on ex-vivo video sequences, while qualitative validation on in-vivo video sequences is obtained. The proposed method provides robust and accurate tracking, which is confirmed by the experimental results: its 3D performance in ex-vivo video sequences exceeds those of the available state-of -the-art methods. Moreover, the experiments on in-vivo sequences demonstrate that the proposed method can tackle the difficult condition of tracking with unknown camera parameters. Further refinements of the method will refer to the occlusion and multi-instrumental MIS applications.

  4. The shift from a response strategy to object-in-place strategy during learning is accompanied by a matching shift in neural firing correlates in the hippocampus.

    Science.gov (United States)

    Lee, Inah; Kim, Jangjin

    2010-08-01

    Hippocampal-dependent tasks often involve specific associations among stimuli (including egocentric information), and such tasks are therefore prone to interference from irrelevant task strategies before a correct strategy is found. Using an object-place paired-associate task, we investigated changes in neural firing patterns in the hippocampus in association with a shift in strategy during learning. We used an object-place paired-associate task in which a pair of objects was presented in two different arms of a radial maze. Each object was associated with reward only in one of the arms, thus requiring the rats to consider both object identity and its location in the maze. Hippocampal neurons recorded in CA1 displayed a dynamic transition in their firing patterns during the acquisition of the task across days, and this corresponded to a shift in strategy manifested in behavioral data. Specifically, before the rats learned the task, they chose an object that maintained a particular egocentric relationship with their body (response strategy) irrespective of the object identity. However, as the animal acquired the task, it chose an object according to both its identity and the associated location in the maze (object-in-place strategy). We report that CA1 neurons in the hippocampus changed their prospective firing correlates according to the dominant strategy (i.e., response versus object-in-place strategy) employed at a given stage of learning. The results suggest that neural firing pattern in the hippocampus is heavily influenced by the task demand hypothesized by the animal and the firing pattern changes flexibly as the perceived task demand changes.

  5. Comparison of strategies for combining dynamic linear models with artificial neural networks for detecting diarrhea in slaughter pigs

    DEFF Research Database (Denmark)

    Jensen, Dan Børge; Kristensen, Anders Ringgaard

    2016-01-01

    , can provide early and automatic detection of diarrhea. To determine the best approach to achieve this goal, we compared 36 different strategies for combining a multivariate dynamic linear model (DLM) with an artificial neural network (ANN). We used data collected in 16 pens between November 2013...... (SP), and the sensitivity (SE). The best performance was seen when using a training window with a total of 42 hours for the numerical forecast errors, which produced an error rate=0.16, a specificity=0.88, and a sensitivity=0.80. For the other tested strategies, the ranges of error rates...

  6. Lumbar hyperlordosis of neuromuscular origin: pathophysiology and surgical strategy for correction

    OpenAIRE

    Vialle, Raphaël; Khouri, Nejib; Glorion, Christophe; Lechevallier, Joël; Morin, Christian

    2006-01-01

    Lumbar hyperlordosis of neuromuscular origin is rare and requires surgical treatment in order to preserve a good sitting posture. We report twenty-seven cases of a preponderantly sagittal hyperlordosis deformity of the lumbar spine in patients with neuromuscular disorders and identify the indications and results of treatment.

  7. Diagnosis and surgical strategy for sacral meningeal cysts with check-valve mechanism: technical note.

    Science.gov (United States)

    Asamoto, Shunji; Fukui, Yasuyuki; Nishiyama, Makoto; Ishikawa, Masayuki; Fujita, Nobuyuki; Nakamura, Satoshi; Muto, Jun; Shiono, Yuta; Doi, Hiroshi; Kubota, Motoo; Ishii, Kazuhiko

    2013-02-01

    There is agreement that symptomatic sacral meningeal cysts with a check-valve mechanism and/or large cysts representing space-occupying lesions should be treated surgically. This study investigated factors indicating a need for surgical intervention and surgical techniques for sacral meningeal cysts with a check-valve mechanism. In ten patients presenting with sciatica and neurological deficits, myelography, computed tomography (CT) myelography, and magnetic resonance imaging (MR imaging) detected sacral meningeal cysts with a check-valve mechanism. One patient had two primary cysts. Ten cysts were type 2 and one cyst was type 1. Nine of the ten patients had not undergone previous surgery, while the remaining case involved recurrent cyst. For the seven patients with normal (i.e., not huge or recurrent) type 2 cysts and no previous surgery (eight cysts), suture after collapse of the cyst wall was performed. For the recurrent type 2 cyst, duraplasty and suture with collapse of the cyst wall were performed to eliminate the check-valve mechanism. For the remaining type 2 cyst, a primary root was sacrificed because of the huge size of the cyst. For the type 1 cyst, the neck of the cyst was ligated. In all cases, chief complaints disappeared immediately postoperatively and no deterioration of clinical symptoms has been seen after a mean follow-up of 27 months. The presence or absence of a check-valve mechanism is very important in determining the need for surgical intervention for sacral meningeal cysts.

  8. Strategy of Surgical Management of Peripheral Neuropathy Form of Diabetic Foot Syndrome in Ghana

    Directory of Open Access Journals (Sweden)

    W. M. Rdeini

    2014-01-01

    Full Text Available Introduction. Foot disorders such as ulceration, infection, and gangrene which are often due to diabetes mellitus are some major causes of morbidity and high amputation. Aim. This study aims to use a group of methods for the management of diabetic foot ulcers (DFU in order to salvage the lower limb so as to reduce the rate of high amputations of the lower extremity. Materials and Methods. A group of different advanced methods for the management of DFU such as sharp debridement of ulcers, application of vacuum therapy, and other forms of reconstructive plastic surgical procedures were used. Data collection was done at 3 different hospitals where the treatments were given. Results. Fifty-four patients with type 2 diabetes mellitus were enrolled in the current study: females n=37 (68.51% and males n=17 (31.49% with different stages of PEDIS classification. They underwent different methods of surgical management: debridement, vacuum therapy (some constructed from locally used materials, and skin grafting giving good and fast results. Only 4 had below knee amputations. Conclusion. Using advanced surgical wound management including reconstructive plastic surgical procedures, it was possible to reduce the rate of high amputations of the lower limb.

  9. Neural strategies for selective attention distinguish fast-action video game players.

    Science.gov (United States)

    Krishnan, Lavanya; Kang, Albert; Sperling, George; Srinivasan, Ramesh

    2013-01-01

    We investigated the psychophysical and neurophysiological differences between fast-action video game players (specifically first person shooter players, FPS) and non-action players (role-playing game players, RPG) in a visual search task. We measured both successful detections (hit rates) and steady-state visually evoked EEG potentials (SSVEPs). Search difficulty was varied along two dimensions: number of adjacent attended and ignored regions (1, 2 and 4), and presentation rate of novel search arrays (3, 8.6 and 20 Hz). Hit rates decreased with increasing presentation rates and number of regions, with the FPS players performing on average better than the RPG players. The largest differences in hit rate, between groups, occurred when four regions were simultaneously attended. We computed signal-to-noise ratio (SNR) of SSVEPs and used partial least squares regression to model hit rates, SNRs and their relationship at 3 Hz and 8.6 Hz. The following are the most significant results: RPG players' parietal responses to the attended 8.6 Hz flicker were predictive of hit rate and were positively correlated with it, indicating attentional signal enhancement. FPS players' parietal responses to the ignored 3 Hz flicker were predictive of hit rate and were positively correlated with it, indicating distractor suppression. Consistent with these parietal responses, RPG players' frontal responses to the attended 8.6 Hz flicker, increased as task difficulty increased with number of regions; FPS players' frontal responses to the ignored 3 Hz flicker increased with number of regions. Thus the FPS players appear to employ an active suppression mechanism to deploy selective attention simultaneously to multiple interleaved regions, while RPG primarily use signal enhancement. These results suggest that fast-action gaming can affect neural strategies and the corresponding networks underlying attention, presumably by training mechanisms of distractor suppression.

  10. Advanced biomaterial strategies to transplant preformed micro-tissue engineered neural networks into the brain

    Science.gov (United States)

    Harris, J. P.; Struzyna, L. A.; Murphy, P. L.; Adewole, D. O.; Kuo, E.; Cullen, D. K.

    2016-02-01

    Objective. Connectome disruption is a hallmark of many neurological diseases and trauma with no current strategies to restore lost long-distance axonal pathways in the brain. We are creating transplantable micro-tissue engineered neural networks (micro-TENNs), which are preformed constructs consisting of embedded neurons and long axonal tracts to integrate with the nervous system to physically reconstitute lost axonal pathways. Approach. We advanced micro-tissue engineering techniques to generate micro-TENNs consisting of discrete populations of mature primary cerebral cortical neurons spanned by long axonal fascicles encased in miniature hydrogel micro-columns. Further, we improved the biomaterial encasement scheme by adding a thin layer of low viscosity carboxymethylcellulose (CMC) to enable needle-less insertion and rapid softening for mechanical similarity with brain tissue. Main results. The engineered architecture of cortical micro-TENNs facilitated robust neuronal viability and axonal cytoarchitecture to at least 22 days in vitro. Micro-TENNs displayed discrete neuronal populations spanned by long axonal fasciculation throughout the core, thus mimicking the general systems-level anatomy of gray matter—white matter in the brain. Additionally, micro-columns with thin CMC-coating upon mild dehydration were able to withstand a force of 893 ± 457 mN before buckling, whereas a solid agarose cylinder of similar dimensions was predicted to withstand less than 150 μN of force. This thin CMC coating increased the stiffness by three orders of magnitude, enabling needle-less insertion into brain while significantly reducing the footprint of previous needle-based delivery methods to minimize insertion trauma. Significance. Our novel micro-TENNs are the first strategy designed for minimally invasive implantation to facilitate nervous system repair by simultaneously providing neuronal replacement and physical reconstruction of long-distance axon pathways in the brain

  11. Unlocking the “black box” of practice improvement strategies to implement surgical safety checklists: a process evaluation

    Science.gov (United States)

    Gillespie, Brigid M; Hamilton, Kyra; Ball, Dianne; Lavin, Joanne; Gardiner, Therese; Withers, Teresa K; Marshall, Andrea P

    2017-01-01

    Background Compliance with surgical safety checklists (SSCs) has been associated with improvements in clinical processes such as antibiotic use, correct site marking, and overall safety processes. Yet, proper execution has been difficult to achieve. Objectives The objective of this study was to undertake a process evaluation of four knowledge translation (KT) strategies used to implement the Pass the Baton (PTB) intervention which was designed to improve utilization of the SSC. Methods As part of the process evaluation, a logic model was generated to explain which KT strategies worked well (or less well) in the operating rooms of a tertiary referral hospital in Queensland, Australia. The KT strategies implemented included change champions/opinion leaders, education, audit and feedback, and reminders. In evaluating the implementation of these strategies, this study considered context, intervention and underpinning assumptions, implementation, and mechanism of impact. Observational and interview data were collected to assess implementation of the KT strategies relative to fidelity, feasibility, and acceptability. Results Findings from 35 structured observations and 15 interviews with 96 intervention participants suggest that all of the KT strategies were consistently implemented. Of the 220 staff working in the department, that is, nurses, anesthetists, and surgeons, 160 (72.7%) knew about the PTB strategies. Qualitative analysis revealed that implementation was generally feasible and acceptable. A barrier to feasibility was physician engagement. An impediment to acceptability was participants’ skepticism about the ability of the KT strategies to effect behavioral change. Conclusion Overall, results of this evaluation suggest that success of implementation was moderate. Given the probable impact of contextual factors, that is, team culture and the characteristics of participants, the KT strategies may need modification prior to widespread implementation. PMID

  12. Unlocking the “black box” of practice improvement strategies to implement surgical safety checklists: a process evaluation

    Directory of Open Access Journals (Sweden)

    Gillespie BM

    2017-04-01

    Full Text Available Brigid M Gillespie,1–3 Kyra Hamilton,4 Dianne Ball,5 Joanne Lavin,6 Therese Gardiner,6 Teresa K Withers,7 Andrea P Marshall1–3 1School of Nursing & Midwifery, Griffith University, Gold Coast, 2Gold Coast University Hospital and Health Service, Southport, 3Nursing & Midwifery Education & Research Unit (NMERU, National Centre of Research Excellence in Nursing, Menzies Health Institute of Queensland, Griffith University, Gold Coast, 4School of Applied Psychology, Griffith University, Mt Gravatt, 5Communio Pty Ltd, Sydney, 6Nursing & Midwifery Education & Research Unit, 7Surgical and Procedural Services, Gold Coast University Hospital and Health Service, Southport, Australia Background: Compliance with surgical safety checklists (SSCs has been associated with improvements in clinical processes such as antibiotic use, correct site marking, and overall safety processes. Yet, proper execution has been difficult to achieve.Objectives: The objective of this study was to undertake a process evaluation of four knowledge translation (KT strategies used to implement the Pass the Baton (PTB intervention which was designed to improve utilization of the SSC. Methods: As part of the process evaluation, a logic model was generated to explain which KT strategies worked well (or less well in the operating rooms of a tertiary referral hospital in Queensland, Australia. The KT strategies implemented included change champions/opinion leaders, education, audit and feedback, and reminders. In evaluating the implementation of these strategies, this study considered context, intervention and underpinning assumptions, implementation, and mechanism of impact. Observational and interview data were collected to assess implementation of the KT strategies relative to fidelity, feasibility, and acceptability. Results: Findings from 35 structured observations and 15 interviews with 96 intervention participants suggest that all of the KT strategies were consistently

  13. [Late complications after chemical burns of the ocular surface. Surgical strategies for ocular surface reconstruction].

    Science.gov (United States)

    Bachmann, B; Cursiefen, C

    2011-10-01

    Severe chemical burns of the ocular surface frequently result in long-standing and ongoing disorders of the conjunctiva and the cornea including conjunctival scarring with shortening of the fornix, cicatricial entropion, complications caused by trichiasis and scarring or chronic ulceration of the cornea. Advanced destruction of limbal stem cells leads to limbal stem cell deficiency with conjunctivalization of the cornea. Surgical therapy aims at the correction of malpositioning of the lids, the reconstruction of the conjunctiva and the fornix utilizing applicable tissue grafts and the reestablishment of a stable, avascular and transparent corneal epithelium by e.g. transplantation of epithelial stem cells. Progressive corneal ulcerations unresponsive to medical therapy can be treated by amniotic membrane transplantation, corneal transplantation or by conjunctival covering depending on the extent of damaged tissue. The surgical therapy of patients after severe chemical burns of the ocular surface is generally performed in specialized centers and occasionally requires a multidisciplinary approach.

  14. The extraction of neural strategies from the surface EMG: an update

    Science.gov (United States)

    Merletti, Roberto; Enoka, Roger M.

    2014-01-01

    A surface EMG signal represents the linear transformation of motor neuron discharge times by the compound action potentials of the innervated muscle fibers and is often used as a source of information about neural activation of muscle. However, retrieving the embedded neural code from a surface EMG signal is extremely challenging. Most studies use indirect approaches in which selected features of the signal are interpreted as indicating certain characteristics of the neural code. These indirect associations are constrained by limitations that have been detailed previously (Farina D, Merletti R, Enoka RM. J Appl Physiol 96: 1486–1495, 2004) and are generally difficult to overcome. In an update on these issues, the current review extends the discussion to EMG-based coherence methods for assessing neural connectivity. We focus first on EMG amplitude cancellation, which intrinsically limits the association between EMG amplitude and the intensity of the neural activation and then discuss the limitations of coherence methods (EEG-EMG, EMG-EMG) as a way to assess the strength of the transmission of synaptic inputs into trains of motor unit action potentials. The debated influence of rectification on EMG spectral analysis and coherence measures is also discussed. Alternatively, there have been a number of attempts to identify the neural information directly by decomposing surface EMG signals into the discharge times of motor unit action potentials. The application of this approach is extremely powerful, but validation remains a central issue. PMID:25277737

  15. The extraction of neural strategies from the surface EMG: an update.

    Science.gov (United States)

    Farina, Dario; Merletti, Roberto; Enoka, Roger M

    2014-12-01

    A surface EMG signal represents the linear transformation of motor neuron discharge times by the compound action potentials of the innervated muscle fibers and is often used as a source of information about neural activation of muscle. However, retrieving the embedded neural code from a surface EMG signal is extremely challenging. Most studies use indirect approaches in which selected features of the signal are interpreted as indicating certain characteristics of the neural code. These indirect associations are constrained by limitations that have been detailed previously (Farina D, Merletti R, Enoka RM. J Appl Physiol 96: 1486-1495, 2004) and are generally difficult to overcome. In an update on these issues, the current review extends the discussion to EMG-based coherence methods for assessing neural connectivity. We focus first on EMG amplitude cancellation, which intrinsically limits the association between EMG amplitude and the intensity of the neural activation and then discuss the limitations of coherence methods (EEG-EMG, EMG-EMG) as a way to assess the strength of the transmission of synaptic inputs into trains of motor unit action potentials. The debated influence of rectification on EMG spectral analysis and coherence measures is also discussed. Alternatively, there have been a number of attempts to identify the neural information directly by decomposing surface EMG signals into the discharge times of motor unit action potentials. The application of this approach is extremely powerful, but validation remains a central issue. Copyright © 2014 the American Physiological Society.

  16. Uniform and Non-uniform Perturbations in Brain-Machine Interface Task Elicit Similar Neural Strategies.

    Science.gov (United States)

    Armenta Salas, Michelle; Helms Tillery, Stephen I

    2016-01-01

    The neural mechanisms that take place during learning and adaptation can be directly probed with brain-machine interfaces (BMIs). We developed a BMI controlled paradigm that enabled us to enforce learning by introducing perturbations which changed the relationship between neural activity and the BMI's output. We introduced a uniform perturbation to the system, through a visuomotor rotation (VMR), and a non-uniform perturbation, through a decorrelation task. The controller in the VMR was essentially unchanged, but produced an output rotated at 30° from the neurally specified output. The controller in the decorrelation trials decoupled the activity of neurons that were highly correlated in the BMI task by selectively forcing the preferred directions of these cell pairs to be orthogonal. We report that movement errors were larger in the decorrelation task, and subjects needed more trials to restore performance back to baseline. During learning, we measured decreasing trends in preferred direction changes and cross-correlation coefficients regardless of task type. Conversely, final adaptations in neural tunings were dependent on the type controller used (VMR or decorrelation). These results hint to the similar process the neural population might engage while adapting to new tasks, and how, through a global process, the neural system can arrive to individual solutions.

  17. Lumbar hyperlordosis of neuromuscular origin: pathophysiology and surgical strategy for correction.

    Science.gov (United States)

    Vialle, Raphaël; Khouri, Nejib; Glorion, Christophe; Lechevallier, Joël; Morin, Christian

    2007-08-01

    Lumbar hyperlordosis of neuromuscular origin is rare and requires surgical treatment in order to preserve a good sitting posture. We report twenty-seven cases of a preponderantly sagittal hyperlordosis deformity of the lumbar spine in patients with neuromuscular disorders and identify the indications and results of treatment. Seventeen males and ten females, aged 13 to 27 years, underwent operations for a lumbar hyperlordosis of neuromuscular origin responsible for major difficulties in sitting. In all patients, the sacrum was horizontal and associated in twenty-six cases with marked pelvic anteversion. Eleven patients were treated surgically by a posterior approach. The sixteen remaining patients had a preliminary discectomy, followed by posterior correction and fusion. Lumbar hyperlordosis was reduced from 8 degrees to 77 degrees between L1 and S1. The horizontal sacrum was partially reduced with an improvement from 8 degrees to 50 degrees . Consequently, patients recovered a comfortable sitting position. One patient died of respiratory complications six weeks after surgery. Surgical correction is a demanding procedure which can be performed by a posterior approach. It is mandatory to analyse the spino-pelvic balance to avoid iliac retroversion and the loss of the role of the ischia in the sitting position.

  18. Neural correlates of emotion regulation deficits in remitted depression: the influence of regulation strategy, habitual regulation use, and emotional valence.

    Science.gov (United States)

    Kanske, Philipp; Heissler, Janine; Schönfelder, Sandra; Wessa, Michèle

    2012-07-02

    Regulating emotions through reappraisal has been shown to elicit abnormal neural activation patterns in currently depressed patients. It is, however, unclear if this deficit generalizes to other emotion regulation strategies, if it persists when patients recover, and if it is related to habitual use of reappraisal strategies. Therefore, we measured the neural responses to emotional images with functional magnetic resonance imaging in remitted patients with previous episodes of major depression and healthy controls. While viewing the images participants regulated the elicited emotions using either a reappraisal or a distraction strategy. Habitual reappraisal use was measured with the Cognitive Emotion Regulation Questionnaire. Depressed patients showed a selective deficit in down-regulating amygdala responses to negative emotional stimuli using reappraisal. This down-regulation of amygdala activity was strongest in participants high in habitual reappraisal use. Activity in the regulating control-network including anterior cingulate and lateral orbitofrontal cortex was increased during both emotion regulation strategies. The findings in remitted patients with previous episodes of major depression suggest that altered emotion regulation is a trait-marker for depression. This interpretation is supported by the relation of habitual reappraisal use to amygdala down-regulation success. Copyright © 2012 Elsevier Inc. All rights reserved.

  19. Temporal lobe epilepsy and cavernous malformations: surgical strategies and long-term outcomes.

    Science.gov (United States)

    Vale, Fernando L; Vivas, Andrew C; Manwaring, Jotham; Schoenberg, Mike R; Benbadis, Selim R

    2015-11-01

    Cerebral cavernous malformations (CCM) of the temporal lobe often present with seizures. Surgical resection of these lesions can offer durable seizure control. There is, however, no universally accepted methodology for assessing and surgically treating these patients. We propose an algorithm to maximize positive surgical outcomes (seizure control) while minimizing post-surgical neurological deficit. A retrospective review of 34 patients who underwent epilepsy surgery for radiographically proven temporal lobe CCM was conducted. Patients underwent a relatively standard work-up for seizure localization. In patients with mesial temporal lobe epilepsy (MTLE), a complete resection of the epileptogenic zone was performed including amygdalo-hippocampectomy in addition to a lesionectomy if not contraindicated by pre-operative work-up. Patients with neocortical epilepsy underwent intraoperative electrocorticography (ECoG)-guided lesionectomy. Seizure-free rate for mesial and neocortical (anterior, lateral, and basal) location was 90 vs. 83 %, respectively. Complete resection of the lesion, irrespective of location, was statistically significant for seizure control (p = 0.018). There was no difference in seizure control based on disease duration or location (p > 0.05). Patients with mesial temporal CCM who presented with MTLE were presumed to also have mesial temporal sclerosis (MTS), or dual pathology. These patients underwent routine resection of the mesial structures. Interestingly, patients who had MTLE and basal (neocortical) lesions who underwent a mesial resection for suspected MTS were found not to have dual pathology. Patients with temporal lobe CCM should be offered resection for durable seizure control, prevention of secondary epileptogenic foci, and elimination of hemorrhage risk. The preoperative work-up should follow a team approach. Surgical intervention should include complete lesionectomy in all cases. Intra or extra-operative ECoG for neocortical

  20. Impact of the surgical strategy on the incidence of C5 nerve root palsy in decompressive cervical surgery.

    Science.gov (United States)

    Krätzig, Theresa; Mohme, Malte; Mende, Klaus C; Eicker, Sven O; Floeth, Frank W

    2017-01-01

    Our aim was to identify the impact of different surgical strategies on the incidence of C5 palsy. Degenerative cervical spinal stenosis is a steadily increasing morbidity in the ageing population. Postoperative C5 nerve root palsy is a common complication with severe impact on the patients´ quality of life. We identified 1708 consecutive patients who underwent cervical decompression surgery due to degenerative changes. The incidence of C5 palsy and surgical parameters including type and level of surgery were recorded to identify predictors for C5 nerve palsy. The overall C5 palsy rate was 4.8%, with 18.3% of cases being bilateral. For ACDF alone the palsy rate was low (1.13%), compared to 14.0% of C5 palsy rate after corpectomy. The risk increased with extension of the procedures. Hybrid constructs with corpectomy plus ACDF at C3-6 showed significantly lower rates of C5 palsy (10.7%) than corpectomy of two vertebrae (p = 0.005). Multiple regression analysis identified corpectomy of C4 or C5 as a significant predictor. We observed a lower overall incidence for ventral (4.3%) compared to dorsal (10.9%) approaches (pC5 palsy. The use of extended procedures should therefore be employed cautiously. Switching to combined surgical methods like ACDF plus corpectomy can reduce the rate of C5 palsy.

  1. [Burden and coping strategies of women suffering from breast cancer during their surgical primary therapy--the view of nurses].

    Science.gov (United States)

    Holtgräwe, Martina; Pinkert, Christiane; Remmers, Hartmut

    2007-04-01

    The findings illustrated in this article, are part of a larger research project funded/financed by the Deutsche Krebshilfe e.V., with the aim of gaining understanding of the stresses and strains, coping strategies and needs of women suffering from breast cancer during their surgical primary treatment. Breast cancer leads to a variety of burden for women and their families. To cope with the disease women use different strategies. External assessment and self-assessment of burden and coping sometimes result in different outcomes, such as experts overestimating their patients' fear or depression or uncovering coping strategies oblivious to the interviewees. Qualitative interviews with twelve nurses in three Northern German hospitals were conducted. The content analysis of the interviews followed Mayring's approach. Uncertainty and anxiety are common characteristics for the affected women. The observed strategies can be classified into five categories: to deny the disease, to withdraw from others, to communicate, to comprehend the disease, to accept the disease. Coping strategies such as withdrawal and denial present a challenge to the nurses' communication behaviour. The findings of the survey at hand indicate a demand for suitable care interventions, further education, and training for professionals nursing women with breast cancer. Scientifically supported nursing concepts and specialised nurses are expected to comply with the affected women's special requirements.

  2. Influence of Acoustic Feedback on the Learning Strategies of Neural Network-Based Sound Classifiers in Digital Hearing Aids

    Directory of Open Access Journals (Sweden)

    Lorena Álvarez

    2009-01-01

    Full Text Available Sound classifiers embedded in digital hearing aids are usually designed by using sound databases that do not include the distortions associated to the feedback that often occurs when these devices have to work at high gain and low gain margin to oscillation. The consequence is that the classifier learns inappropriate sound patterns. In this paper we explore the feasibility of using different sound databases (generated according to 18 configurations of real patients, and a variety of learning strategies for neural networks in the effort of reducing the probability of erroneous classification. The experimental work basically points out that the proposed methods assist the neural network-based classifier in reducing its error probability in more than 18%. This helps enhance the elderly user's comfort: the hearing aid automatically selects, with higher success probability, the program that is best adapted to the changing acoustic environment the user is facing.

  3. Synchronous colorectal liver metastasis: a network meta-analysis review comparing classical, combined, and liver-first surgical strategies.

    Science.gov (United States)

    Kelly, M E; Spolverato, G; Lê, G N; Mavros, M N; Doyle, F; Pawlik, T M; Winter, D C

    2015-03-01

    In recent years, the management of synchronous colorectal liver metastasis has changed significantly. Alternative surgical strategies to the classical colorectal-first approach have been proposed. These include the liver-first and combined resections approaches. The objectives of this review were to compare the short- and long-term outcomes for all three approaches. A systematic review of comparative studies was performed. Evaluated endpoints included surgical outcomes (5-year overall survival, 30-day mortality, and post-operative complications). Pair-wise and network meta-analysis (NMA) were performed to compare survival outcomes. Eighteen studies were included in this review, reporting on 3,605 patients. NMA and pair-wise meta-analysis of the 5-year overall survival did not show significant difference between the three surgical approaches: combined versus colorectal-first, mean odds ratio (OR) 1.02 (95% CI 0.8-1.28, P = 0.93); liver-first versus colorectal-first, mean OR 0.81 (95% CI 0.53-1.26, P = 0.37); liver-first versus combined, mean OR 0.80 (95% CI 0.52-1.24, P = 0.41). In addition NMA of the 30-day mortality among the three approaches also did not observe statistical difference. Analysis of variance showed that mean post-operative complications of all approaches were comparable (P = 0.51). There are considerable differences in the peri-operative management of synchronous CLM patients. This meta-analysis demonstrated no clear statistical surgical outcome or survival advantage towards any of the three approaches. © 2014 Wiley Periodicals, Inc.

  4. The role of molecular strategies in the evaluation of surgical margins in oropharyngeal squamous cell carcinoma

    Directory of Open Access Journals (Sweden)

    Anastasios N. Kanatas

    2011-12-01

    Full Text Available The recurrence of a tumour at the resection margins in head and neck squamous cell carcinoma (HNSCC has profound implications on the morbidity and mortality of the patient. At present HNSCC does not undergo any form of molecular analysis to aid treatment strategy and prognosticate for those individuals at higher risk of recurrence. This article aims to review current research into molecular strategies for tumour evaluation, highlighting conflicting evidence and possible novel concepts for further exploration.

  5. Matrix measure strategies for stability and synchronization of inertial BAM neural network with time delays.

    Science.gov (United States)

    Cao, Jinde; Wan, Ying

    2014-05-01

    A single inertial BAM neural network with time-varying delays and external inputs is concerned in this paper. First, by choosing suitable variable substitution, the original system can be transformed into first-order differential equations. Then, we present several sufficient conditions for the global exponential stability of the equilibrium by using matrix measure and Halanay inequality, these criteria are simple in form and easy to verify in practice. Furthermore, when employing an error-feedback control term to the response neural network, parallel criteria regarding to the exponential synchronization of the drive-response neural network are also generated. Finally, some examples are given to illustrate our theoretical results. Copyright © 2014 Elsevier Ltd. All rights reserved.

  6. Surgical Strategy for Lung Transplantation in Adults With Small Chests: Lobar Transplant Versus a Pediatric Donor.

    Science.gov (United States)

    Mahesh, Balakrishnan; Bhama, Jay K; Odell, David D; Hayanga, Awori J; Bermudez, Christian A; Morrell, Matthew R; Crespo, Maria M; Pilewski, Joseph M; Johnson, Bruce A; Luketich, James D; D'Cunha, Jonathan; Shigemura, Norihisa

    2016-12-01

    Adult lung transplant recipients with small chests have traditionally received lungs from pediatric donors, placing an additional strain on the already restricted pediatric donor pool. Performing lobar lung transplantation (LLT) can circumvent issues with donor-recipient size mismatch; however, LLT imparts additional risks. Here, we review our experience using LLT and standard lung transplantation using a pediatric donor (PDLT) for adults with small chests. We retrospectively reviewed consecutive patients with end-stage lung disease and a height of 65 inches or less who underwent LLT (n = 15) or PDLT (n = 15) between 2006 and 2012 at our institution, a high-volume lung transplant center. Lobar lung transplantation recipients were older (54 ± 10 vs 48 ± 8 years) and had higher pulmonary pressure (57 ± 11 vs 52 ± 27 mmHg) and higher lung allocation scores (70 ± 9 vs 51 ± 8) than PDLT recipients (all P insufficiency were higher, and the mean intensive care unit stay was longer in the LLT group, but the incidence of bronchial anastomotic complications was higher in the PDLT group because of significant size discrepancy in the main bronchus (P < 0.05). Interestingly, long-term functional outcomes and survival rates were similar between the groups. Both LLT and PDLT are viable surgical options for adult patients with small chests. Because of the potential impact on posttransplant outcomes, the technical complexity of transplantation, decisions regarding the best surgical approach should be made by experienced surgeons.

  7. Can SPECT change the surgical strategy in patients with primary hyperparathyroidism?

    Energy Technology Data Exchange (ETDEWEB)

    Iervolino, Leticia; Scalisse, Nilza Maria; Maeda, Sergio Setsuo, E-mail: leiervolino@hotmail.com [Discipline of Endocrinology, Department of Medicine, Faculdade de Medicina da Santa Casa de Sao Paulo (FMSCSP), Sao Paulo, SP (Brazil)

    2012-06-15

    Primary hyperparathyroidism (PHPT) is the most common cause of hypercalcaemia in outpatients. It is more common in females, after menopause, and the prevalence is 1 to 4:1000 in the general population. Patients with PHPT have abnormal regulation of PTH secretion, resulting in elevated serum calcium and inappropriately high or normal PTH in relation to the calcium value. Sporadic PTH-secreting adenoma alone accounts for 90% of cases of PHPT, while multiglandular hyperplasia is more common in familial hyperparathyroidism syndromes (5%) and parathyroid carcinomas represent less than 1% of cases. Only after making sure there is functional autonomy of one or more parathyroid glands, localization imaging tests should be performed to guide a possible surgical procedure. It is important to highlight that these tests have limitations and can yield false-positive and false-negative results. There are cases in which the parathyroid gland is difficult to be located, requiring a combination of imaging methods for pre-operative localization, such as {sup 99m}Tc-pertechnetate, SPECT, SPECT/CT, and US. We describe the case of a 50-year-old female patient diagnosed with PHPT, who underwent a surgical procedure without success, with maintenance of hypercalcaemia and hyperparathyroidism. In this case, the hyper functioning parathyroid was located in the retrotracheal region only after scintigraphy combined with SPECT/CT were used. (author)

  8. Synovial cysts of the lumbar spine--pathological considerations and surgical strategy.

    Science.gov (United States)

    Ganau, Mario; Ennas, Franco; Bellisano, Giulia; Ganau, Laura; Ambu, Rossano; Faa, Gavino; Maleci, Alberto

    2013-01-01

    Symptomatic lumbar synovial cysts (LSCs) are a rare cause of degenerative narrowing of the spinal canal, with thecal sac or nerve root compression. True synovial cysts have a thick wall lined by synovial cells, containing granulation tissue, numerous histiocytes, and giant cells. In contrast, pseudo-cysts lack specialized epithelium, have a collagenous capsule filled with myxoid material, and may be classified into ganglion cysts, originating from periarticular fibrous tissues, and ligamentous cysts, arising from the ligamentum flavum or even from the posterior longitudinal ligament. Here we present the surgical series of the Chair of Neurosurgery at the University of Cagliari (Italy) including a total of 17 LSCs. Surgical technique consisted of facet sparing excision of LSC, achieved by simple hemilaminectomy/laminectomy, and diagnosis was always confirmed by histological specimen examination, which detected the typical synovial epithelium, the intracystic presence of hemosiderin, histiocytes, and calcifications. Further immunohistochemical investigation revealed positive staining for cytokeratin: CK5, CK6, and AE1/AE3. Clinically, our cohort experienced rapid and complete resolution of symptoms, without perioperative complications, or recurrence of cysts or vertebral instability at a median follow up of 28 months, when the MacNab score was generally excellent. A review of the literature, retrieving articles published from 1973, collected a total of 101 articles concerning all the cases of LSC scientifically described to date. Both clinical and histological findings described in our study support the theory of degenerative microtraumatic pathogenesis of synovial cysts.

  9. Surgical strategies for treatment of malignant pancreatic tumors: extended, standard or local surgery?

    Directory of Open Access Journals (Sweden)

    Jacob Dietmar

    2008-11-01

    Full Text Available Abstract Tumor related pancreatic surgery has progressed significantly during recent years. Pancreatoduodenectomy (PD with lymphadenectomy, including vascular resection, still presents the optimal surgical procedure for carcinomas in the head of pancreas. For patients with small or low-grade malignant neoplasms, as well as small pancreatic metastases located in the mid-portion of pancreas, central pancreatectomy (CP is emerging as a safe and effective option with a low risk of developing de-novo exocrine and/or endocrine insufficiency. Total pancreatectomy (TP is not as risky as it was years ago and can nowadays safely be performed, but its indication is limited to locally extended tumors that cannot be removed by PD or distal pancreatectomy (DP with tumor free surgical margins. Consequently, TP has not been adopted as a routine procedure by most surgeons. On the other hand, an aggressive attitude is required in case of advanced distal pancreatic tumors, provided that safe and experienced surgery is available. Due to the development of modern instruments, laparoscopic operations became more and more successful, even in malignant pancreatic diseases. This review summarizes the recent literature on the abovementioned topics.

  10. A Case Study on Neural Inspired Dynamic Memory Management Strategies for High Performance Computing.

    Energy Technology Data Exchange (ETDEWEB)

    Vineyard, Craig Michael [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States); Verzi, Stephen Joseph [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States)

    2017-09-01

    As high performance computing architectures pursue more computational power there is a need for increased memory capacity and bandwidth as well. A multi-level memory (MLM) architecture addresses this need by combining multiple memory types with different characteristics as varying levels of the same architecture. How to efficiently utilize this memory infrastructure is an unknown challenge, and in this research we sought to investigate whether neural inspired approaches can meaningfully help with memory management. In particular we explored neurogenesis inspired re- source allocation, and were able to show a neural inspired mixed controller policy can beneficially impact how MLM architectures utilize memory.

  11. Minimally invasive and surgical management strategies tailored to the severity of acute diverticulitis.

    LENUS (Irish Health Repository)

    McDermott, F D

    2014-01-01

    The severity of acute diverticulitis ranges from mild, simple inflammation to pericolic abscesses, or perforation with faeculent peritonitis. Treatment of diverticulitis has evolved towards more conservative and minimally invasive strategies. The aim of this review is to highlight recent concepts and advances in management.

  12. Systematic OR Block Allocation at a Large Academic Medical Center: Comprehensive Review on a Data-driven Surgical Scheduling Strategy.

    Science.gov (United States)

    Zenteno, Ana Cecilia; Carnes, Tim; Levi, Retsef; Daily, Bethany J; Dunn, Peter F

    2016-12-01

    To alleviate the surgical patient flow congestion in the perioperative environment without additional resources. Massachusetts General Hospital experienced increasing overcrowding of the perioperative environment in 2008. The Post-Anesthesia Care Unit would often be at capacity, forcing patients to wait in the operating room. The cause of congestion was traced back to significant variability in the surgical inpatient-bed occupancy across the days of the week due to elective surgery scheduling practices. We constructed an optimization model to find a rearrangement of the elective block schedule to smooth the average inpatient census by reducing the maximum average occupancy throughout the week. The model was revised iteratively as it was used in the organizational change process that led to an implementable schedule. Approximately 21% of the blocks were rearranged. The setting of study is very dynamic. We constructed a hypothetical scenario to analyze the patient population most representative of the circumstances under which the model was built. For this group, the patient volume remained constant, the average census peak decreased by 3.2% (P < 0.05), and the average weekday census decreased by 2.8% (P < 0.001). When considering all patients, the volume increased by 9%, the census peak increased 1.6% (P < 0.05), and the average weekday census increased by 2% (P < 0.001). This work describes the successful implementation of a data-driven scheduling strategy that increased the effective capacity of the surgical units. The use of the model as an instrument for change and strong managerial leadership was paramount to implement and sustain the new scheduling practices.

  13. Clinical results of a new strategy (modified CHIVA) for surgical treatment of anterior accessory great saphenous varicose veins.

    Science.gov (United States)

    Maldonado-Fernández, Nicolás; Linares-Palomino, Jose Patricio; López-Espada, Cristina; Martínez-Gámez, Francisco Javier; Ros-Díe, Eduardo

    2016-03-01

    Traditionally, anterior accessory great saphenous vein insufficiency was managed by crossectomy and resection of varicose veins. The aim of this paper is to show the safety and efficacy of a new therapeutic strategy for anterior accessory great saphenous varicose veins. This non-randomised prospective study included 65 patients with varicose veins from the anterior accessory great saphenous vein. The novelty of the technique is to avoid the great saphenous vein crossectomy and perform just flebectomy of the visible veins. Venous duplex studies were performed preoperatively, a month and a year postoperatively. The clinical assessment was done by the Fligelstone scale. The baseline CEAP clinical classification was: 58% C2, 26% C3 and 15% C4-6. The new strategy was applied to all cases. 3 haematomas, 7 cases of asymptomatic partial anterior saphenous thrombosis. Reduction of the initial average diameter was from 6.4 mm anterior saphenous to 3.4 mm by one year (p <0.001). At twelve months a forward flow is maintained in 82% of cases. Recurrence of varicose veins was 8%. All patients improved their clinical status based on the Fligelstone scale. Cases with saphenous diameter bigger than 7.5 mm and obesity were identified as predictors of worse clinical and hemodynamic outcome. This modified surgical strategy for anterior saphenous varicose veins results in better clinical outcomes at one year postoperatively. Copyright © 2015 AEC. Publicado por Elsevier España, S.L.U. All rights reserved.

  14. The left atrioventricular valve in partial atrioventricular septal defect: management strategy and surgical outcome.

    Science.gov (United States)

    Al-Hay, Amira A A; Lincoln, Christopher R; Shore, Darryl F; Shinebourne, Elliot A

    2004-10-01

    To test the hypothesis that in patients with a partial atrioventricular septal defect (PAVSD) and a competent left atrioventricular valve (LAVV), sutures should be placed across the line of apposition of the superior and inferior bridging leaflets, septal commissure (SC), to prevent the development of regurgitation. Outcome of surgery and risk factors for the need for LAVV reoperation of patients with mild or no LAVV regurgitation (LAVVR) were evaluated. Controversy over management of the LAVV in PAVSD. One hundred and forty seven children with PAVSD underwent surgical repair at the Royal Brompton Hospital between January 1983 and December 1999. Of this group, 21 (16.7%) had LAVVR of sufficient severity to require surgical intervention and were therefore excluded from analysis. The median age and weight at repair of those with mild or no LAVVR was 4.1 years and 15.4 kg. One hundred and eight had normal chromosomes, 13 Down syndrome and five other syndromes. The interatrial communication was closed using a pericardial patch in 62.7% and with synthetic material in the remainder. Intraoperative testing of LAVV competence was undertaken using saline injection into the left ventricle. In 80.9%, sutures were placed across the line of apposition of the left sided superior and inferior bridging leaflets partially to close the SC (sometimes incorrectly named the mitral valve cleft). The overall hospital mortality was 3.2% (95% confidence interval (CI) 1, 8.4%), which did not differ statistically in the last 20 years. No specific risk factors for early death were identified. Eleven patients (8.7%, 95% CI 4.7, 15.4%) required reoperation, 10 for LAVV repair and 1 resection of subaortic stenosis. Univariate analysis of risk factors for LAVV reoperation were low weight, relatively small size LAVV, the presence of a small preoperative interventricular interchordal communication and duration of ventilation. Ten (9.8%) of 102 patients in whom SC was sutured required LAVV

  15. Surgical strategies of re-operation for non-anastomotic biliary duct stricture after liver transplantation

    Directory of Open Access Journals (Sweden)

    Shao-ping WANG

    2015-10-01

    Full Text Available Objective To investigate the re-operation timing and surgical modality for non-anastomotic biliary stricture (NABS after orthotopic liver transplantation (OLT. Methods The clinical data of 14 NABS patients hospitalized in our center from August 2003 to April 2014 were analyzed retrospectively. The patients were treated with different modalities of re-operation according to cholangiographic results, and the outcomes of re-operation were noted by postoperative follow-up. Results Among 421 OLT patients, NABS was seen in 14 (3.3%, 14/421, and it was accompanied by stenosis of hepatic artery in 4. Their total bilirubin, ALP and r-GGT levels were significantly higher in NABS patients than in non-NABS patients (P<0.01. According to cholangiographic findings, NABS was divided into 3 types: hepatic bile duct strictures (4 patients, type Ⅰ, multiple extrahepatic and intrahepatic biliary strictures (8 patients, type Ⅱ, intrahepatic biliary stricture (2 patients, type Ⅲ. The cure rate of interventional treatment in this study was 57.1% (8/14, and 6 patients eventually required surgical treatment again. The type Ⅰ patient was treated with Roux-en-Y anastomosis, and re-transplantation for other 5 patients (type Ⅱ in 4 and type Ⅲ in 1. Among these 5 patients receiving liver re-transplantation, 1 patient died of perioperative fungal infection. The blood loss (2570±851ml and operation time (492±173min in those re-transplantation patients were almost the same as their previous-transplantation (P> 0.05. More than half of type Ⅱ and Ⅲ patients needed re-transplantation, but the probability of re-transplantation was especially higher for those with hepatic artery stenosis (75%, 3/4. Cholangitis disappeared and the total bilirubin significantly reduced from 123.4µmol/L to 31.6µmol/L after resurgery. Conclusions For those NABS patients who may fail to be improved after a minimally invasive treatment, especially when it was combined with

  16. [Tissue regeneration strategies: cells, biochemical inductors, bionanomaterials and bioconstructions. Clinical and surgical achievements].

    Science.gov (United States)

    Valdespino-Gómez, Víctor Manuel; Valdespino-Castillo, Patricia Margarita; Valdespino-Castillo, Víctor Edmundo

    2014-01-01

    Regenerative medicine is a medical multidisciplinary area with the aim of morphologic and functional restoration of tissues or organs in order to re-establish normal function. The main bases of regenerative medicine are the use of autologous stem or progenitor cells and the ex vivo construction of physical-mechanical tissue structuring organization, which with stem cells may form bioartificial organs. Another eventual strategy is in vivo stem or progenitor cell stimulation for proliferation. Tissue engineering entirely combines the use of cells, biochemical and physicochemical factors, nanomaterials and bioengineering methods to improve or replace biological functions of tissues and organs. The progressive understanding of the proliferation and differentiation of the process of stem cells and their in vitro manipulation has been the launching platform for the field of regenerative medicine. In this review we describe the main strategies used for regenerative medicine in tissue regeneration along with the main obtained clinicalsurgical benefits.

  17. Treatment Strategies for Paradoxical Hypertension Following Surgical Correction of Coarctation of the Aorta in Children

    OpenAIRE

    Roeleveld, Peter P.; Zwijsen, Eline G.

    2017-01-01

    Background: Paradoxical hypertension after repair of coarctation of the aorta is a well-known phenomenon. The pathogenesis involves the activation of the sympathetic nervous system (first phase) and renin?angiotensin system (second phase). Only a limited number of different treatment strategies have been published in the literature, without any comparative studies. Methods: Our aim was to describe the current international practice variation surrounding pharmacological treatment currently bei...

  18. Neural network based semi-active control strategy for structural vibration mitigation with magnetorheological damper

    DEFF Research Database (Denmark)

    Bhowmik, Subrata

    2011-01-01

    This paper presents a neural network based semi-active control method for a rotary type magnetorheological (MR) damper. The characteristics of the MR damper are described by the classic Bouc-Wen model, and the performance of the proposed control method is evaluated in terms of a base exited shear...... frame structure. As demonstrated in the literature effective damping of flexible structures is obtained by a suitable combination of pure friction and negative damper stiffness. This damper model is rate-independent and fully described by the desired shape of the hysteresis loops or force...... mode of the structure. The neural network control is then developed to reproduce the desired force based on damper displacement and velocity as network input, and it is therefore referred to as an amplitude dependent model reference control method. An inverse model of the MR damper is needed...

  19. Neural networkbased semi-active control strategy for structural vibration mitigation with magnetorheological damper

    DEFF Research Database (Denmark)

    Bhowmik, Subrata

    2011-01-01

    This paper presents a neural network based semi-active control method for a rotary type magnetorheological (MR) damper. The characteristics of the MR damper are described by the classic Bouc-Wen model, and the performance of the proposed control method is evaluated in terms of a base exited shear...... frame structure. As demonstrated in the literature effective damping of flexible structures is obtained by a suitable combination of pure friction and negative damper stiffness. This damper model is rate-independent and fully described by the desired shape of the hysteresis loops or force...... mode of the structure. The neural network control is then developed to reproduce the desired force based on damper displacement and velocity as network input, and it is therefore referred to as an amplitude dependent model reference control method. An inverse model of the MR damper is needed...

  20. Clinical Pathological Analysis of Surgically Resected Superficial Esophageal Carcinoma to Determine Criteria for Deciding on Treatment Strategy

    Directory of Open Access Journals (Sweden)

    H. Makuuchi

    1997-01-01

    Full Text Available We performed a clinical pathological study of conventionally resected superficial esophageal carcinomas since this type of lesion has been increasing, in order to develop criteria of determination for therapeutic strategies. Pathological studies were performed on specimens obtained by radical surgical resection in 133 cases of superficial esophageal cancer. Evaluation was performed in terms of the gross classification of the lesion type, depth of invasion, lymph node metastasis, vascular invasion, size of the lesion, outcome, etc. In 0-I, 0-IIc+0-IIa, and 0-III type submucosal cancer lesions the rate of metastasis to lymph nodes was more than 40%, but in 0-IIa and 0-IIb mucosal cancer cases no lymph node metastasis was observed. 0-IIc type lesions showed a wide range of invasiveness, ranging from m1 to sm3. In cases with m1 or m2 invasion, no lymph node or lymph-vessel invasion was recognized, but in m3, sm1, sm2, and sm3 cases lymph node metastasis was recognized in 12.5%, 22.2%, 44.0% and 47.4%, respectively. In 47% of lesions with a greatest dimension of less than 30 mm invasion was limited to the mucosa. Seventy-two percent of m1 and m2 cases were 30 mm in size or less. Lymph node metastasis was recognized in only 16.7% of cases less than 30 mm in size, but in cases of lesions 30 mm or more the rate of lymph node metastasis was 35.8%. 0-IIb and 0-IIa type lesions are indications for endoscopic esophageal mucosal resection (EEMR, while 0-I, 0-IIc+0-IIa, and 0-III lesions should be candidates for radical surgical resection. In the 0-IIc category, lesions in which the depression is relatively flat and with a finely granular surface are indications for EEMR, but those cases in which the surface of depression shows granules of varying sizes should be treated with radical surgical resection. Cases of 0-IIa type 30 mm or larger in greatest dimension which have a gently sloping protruding margin shoulder or reddening should be treated with caution

  1. Application of CMAC Neural Network Coupled with Active Disturbance Rejection Control Strategy on Three-motor Synchronization Control System

    Directory of Open Access Journals (Sweden)

    Hui Li

    2014-04-01

    Full Text Available Three-motor synchronous coordination system is a MI-MO nonlinear and complex control system. And it often works in poor working condition. Advanced control strategies are required to improve the control performance of the system and to achieve the decoupling between main motor speed and tension. Cerebellar Model Articulation Controller coupled with Active Disturbance Rejection Control (CMAC-ADRC control strategy is proposed. The speed of the main motor and tensions between two motors is decoupled by extended state observer (ESO in ADRC. ESO in ADRC is used to compensate internal and external disturbances of the system online. And the anti interference of the system is improved by ESO. And the same time the control model is optimized. Feedforward control is implemented by the adoption of CMAC neural network controller. And control precision of the system is improved in reason of CMAC. The overshoot of the system can be reduced without affecting the dynamic response of the system by the use of CMAC-ADRC. The simulation results show that: the CMAC- ADRC control strategy is better than the traditional PID control strategy. And CMAC-ADRC control strategy can achieve the decoupling between speed and tension. The control system using CMAC-ADRC have strong anti-interference ability and small regulate time and small overshoot. The magnitude of the system response incited by the interference using CMAC-ADRC is smaller than the system using conventional PID control 6.43 %. And the recovery time of the system with CMAC-ADRC is shorter than the system with traditional PID control 0.18 seconds. And the triangular wave tracking error of the system with CMAC-ADRC is smaller than the system with conventional PID control 0.24 rad/min. Thus the CMAC-ADRC control strategy is a good control strategy and is able to fit three-motor synchronous coordinated control.

  2. From distraction to mindfulness : Psychological and neural mechanisms of attention strategies in self-regulation

    NARCIS (Netherlands)

    Van Dillen, Lotte F.; Papies, Esther K.

    2015-01-01

    The current chapter examines attention strategies that may facilitate self-regulation. In particular, we focus on the attention strategies of distraction and mindfulness. By distraction, we mean shifting attention from the original object of attention onto a different focal object. Mindfulness, on

  3. Treatment Strategies for Paradoxical Hypertension Following Surgical Correction of Coarctation of the Aorta in Children.

    Science.gov (United States)

    Roeleveld, Peter P; Zwijsen, Eline G

    2017-05-01

    Paradoxical hypertension after repair of coarctation of the aorta is a well-known phenomenon. The pathogenesis involves the activation of the sympathetic nervous system (first phase) and renin-angiotensin system (second phase). Only a limited number of different treatment strategies have been published in the literature, without any comparative studies. Our aim was to describe the current international practice variation surrounding pharmacological treatment currently being employed to treat paradoxical hypertension following the repair of coarctation of the aorta in children. We performed an online survey among 197 members of the Pediatric Cardiac Intensive Care Society. We also conducted a systematic review of the literature regarding the treatment of paradoxical hypertension. Eighty-eight people (45%), from 62 different centers, responded and answered the questions regarding blood pressure control. Nitroprusside is the first drug of choice for initial blood pressure control in 66% of respondents, esmolol in 11%, labetalol in 11%, and angiotensin-converting enzyme inhibitors (ACEIs) are used by 3% of respondents. For oral blood pressure control after discharge from the pediatric intensive care unit, 75% of respondents use ACEIs, 18% use labetalol, and 12% use other beta-blockers (propranolol, carvedilol, atenolol, metoprolol). The systematic review identified 14 articles reporting pharmacological treatment of direct postoperative hypertension following coarctation repair. There is wide practice variability, due to the lack of sufficient compelling evidence. The majority (66%) of caregivers use nitroprusside to control blood pressure in the acute postoperative phase. The ACEIs are the drug of choice for chronic blood pressure control.

  4. Cognitive and Neural Effects of Semantic Encoding Strategy Training in Older Adults

    Science.gov (United States)

    Anderson, B. A.; Barch, D. M.; Jacoby, L. L.

    2012-01-01

    Prior research suggests that older adults are less likely than young adults to use effective learning strategies during intentional encoding. This functional magnetic resonance imaging (fMRI) study investigated whether training older adults to use semantic encoding strategies can increase their self-initiated use of these strategies and improve their recognition memory. The effects of training on older adults' brain activity during intentional encoding were also examined. Training increased older adults' self-initiated semantic encoding strategy use and eliminated pretraining age differences in recognition memory following intentional encoding. Training also increased older adults' brain activity in the medial superior frontal gyrus, right precentral gyrus, and left caudate during intentional encoding. In addition, older adults' training-related changes in recognition memory were strongly correlated with training-related changes in brain activity in prefrontal and left lateral temporal regions associated with semantic processing and self-initiated verbal encoding strategy use in young adults. These neuroimaging results demonstrate that semantic encoding strategy training can alter older adults' brain activity patterns during intentional encoding and suggest that young and older adults may use the same network of brain regions to support self-initiated use of verbal encoding strategies. PMID:21709173

  5. Study on Maritime Logistics Warehousing Center Model and Precision Marketing Strategy Optimization Based on Fuzzy Method and Neural Network Model

    Directory of Open Access Journals (Sweden)

    Xiao Kefeng

    2017-08-01

    Full Text Available The bulk commodity, different with the retail goods, has a uniqueness in the location selection, the chosen of transportation program and the decision objectives. How to make optimal decisions in the facility location, requirement distribution, shipping methods and the route selection and establish an effective distribution system to reduce the cost has become a burning issue for the e-commerce logistics, which is worthy to be deeply and systematically solved. In this paper, Logistics warehousing center model and precision marketing strategy optimization based on fuzzy method and neural network model is proposed to solve this problem. In addition, we have designed principles of the fuzzy method and neural network model to solve the proposed model because of its complexity. Finally, we have solved numerous examples to compare the results of lingo and Matlab, we use Matlab and lingo just to check the result and to illustrate the numerical example, we can find from the result, the multi-objective model increases logistics costs and improves the efficiency of distribution time.

  6. Cognitive Strategy Use as an Index of Developmental Differences in Neural Responses to Feedback

    DEFF Research Database (Denmark)

    Andersen, Lau M.; Visser, Ingmar; Crone, Eveline A.

    2014-01-01

    Developmental differences in dorsolateral prefrontal cortex (DLPFC), anterior cingulate cortex (ACC) and superior parietal cortex (SPC) activation are associated with differences in how children, adolescents, and adults learn from performance feedback in rule-learning tasks (Crone, Zanolie....... by the application of latent mixture models (McLachlan & Peel, 2000). We found four categorically different strategies, which were divided across age groups. Both adults and adolescents were distributed among all strategy groups except for the worst performing one, whereas children were distributed among all....... Keywords: feedback learning, functional brain activation, development, latent mixture models, strategy use...

  7. The incidence, root-causes, and outcomes of adverse events in surgical units: implication for potential prevention strategies.

    NARCIS (Netherlands)

    Zegers, M.; Bruijne, M.C. de; Keizer, B. de; Merten, H.; Groenewegen, P.P.; Wal, G. van der; Wagner, C.

    2011-01-01

    Background: We need to know the scale and underlying causes of surgical adverse events (AEs) in order to improve the safety of care in surgical units. However, there is little recent data. Previous record review studies that reported on surgical AEs in detail are now more than ten years old. Since

  8. The incidence, root-causes, and outcomes of adverse events in surgical units: implications for potential prevention strategies.

    NARCIS (Netherlands)

    Zegers, M.; Bruijne, M.C. de; Keizer, B. de; Merten, H.; Groenewegen, P.P.; Wal, G. van der

    2011-01-01

    Background: We need to know the scale and underlying causes of surgical adverse events (AEs) in order to improve the safety of care in surgical units. However, there is little recent data. Previous record review studies that reported on surgical AEs in detail are now more than ten years old. Since

  9. Modeling Root Length Density of Field Grown Potatoes under Different Irrigation Strategies and Soil Textures Using Artificial Neural Networks

    DEFF Research Database (Denmark)

    Ahmadi, Seyed Hamid; Sepaskhah, A R; Andersen, Mathias Neumann

    2014-01-01

    Root length density (RLD) is a highly wanted parameter for use in crop growth modeling but difficult to measure under field conditions. Therefore, artificial neural networks (ANNs) were implemented to predict the RLD of field grown potatoes that were subject to three irrigation strategies and three...... soil textures with different soil water status and soil densities. The objectives of the study were to test whether soil textural information, soil water status, and soil density might be used by ANN to simulate RLD at harvest. In the study 63 data pairs were divided into data sets of training (80......% of the data) and testing (20% of the data). A feed forward three-layer perceptron network and the sigmoid, hyperbolic tangent, and linear transfer functions were used for the ANN modeling. The RLDs (target variable) in different soil layers were predicted by nine ANNs representing combinations (models...

  10. "Beating osteoARThritis": Development of a stepped care strategy to optimize utilization and timing of non-surgical treatment modalities for patients with hip or knee osteoarthritis

    NARCIS (Netherlands)

    Smink, A.J.; Ende, C.H.M. van den; Vliet Vlieland, T.P.M.; Swierstra, B.A.; Kortland, J.H.; Bijlsma, J.W.J.; Voorn, T.B.; Schers, H.J.; Bierma-Zeinstra, S.M.; Dekker, J.

    2011-01-01

    Inadequacies in health care practices have been reported despite existing guidelines to manage hip or knee osteoarthritis. To facilitate guideline implementation and improve utilization of non-surgical treatment options a care strategy should be developed. This study describes the development of an

  11. "Beating osteoARThritis": development of a stepped care strategy to optimize utilization and timing of non-surgical treatment modalities for patients with hip or knee osteoarthritis

    NARCIS (Netherlands)

    Smink, A.J.; Ende, C.H.; Vliet-Vlieland, Th.P.M.; Swierstra, B.A.; Kortland, J.H.; Bijlsma, J.W.; Voorn, T.B.; Schers, H.J.; Bierma-Zeinstra, S.M.; Dekker, J.

    2011-01-01

    Inadequacies in health care practices have been reported despite existing guidelines to manage hip or knee osteoarthritis. To facilitate guideline implementation and improve utilization of non-surgical treatment options a care strategy should be developed. This study describes the development of an

  12. Investigation of neural-net based control strategies for improved power system dynamic performance

    Energy Technology Data Exchange (ETDEWEB)

    Sobajic, D.J. [Electric Power Research Institute, Palo Alto, CA (United States)

    1995-12-31

    The ability to accurately predict the behavior of a dynamic system is of essential importance in monitoring and control of complex processes. In this regard recent advances in neural-net base system identification represent a significant step toward development and design of a new generation of control tools for increased system performance and reliability. The enabling functionality is the one of accurate representation of a model of a nonlinear and nonstationary dynamic system. This functionality provides valuable new opportunities including: (1) The ability to predict future system behavior on the basis of actual system observations, (2) On-line evaluation and display of system performance and design of early warning systems, and (3) Controller optimization for improved system performance. In this presentation, we discuss the issues involved in definition and design of learning control systems and their impact on power system control. Several numerical examples are provided for illustrative purpose.

  13. Portal Vein Embolization as an Oncosurgical Strategy Prior to Major Hepatic Resection: Anatomic, Surgical and Technical Considerations for Successful Outcomes

    Directory of Open Access Journals (Sweden)

    Sonia Tewani Orcutt

    2016-03-01

    Full Text Available Preoperative portal vein embolization (PVE is used to extend the indications for major hepatic resection, and it has become the standard of care for selected patients with hepatic malignancies treated at major hepatobiliary centers. To date, various techniques with different embolic materials have been used with similar results in the degree of liver hypertrophy. Regardless of the specific strategy used, both surgeons and interventional radiologists must be familiar with each other’s techniques to be able to create the optimal plan for each individual patient. Knowledge of the segmental anatomy of the liver is paramount to fully understand the liver segments that need to be embolized and resected. Understanding the portal vein anatomy and the branching variations, along with the techniques used to transect the portal vein during hepatic resection, is important because these variables can affect the PVE procedure and the eventual surgical resection. Comprehension of the advantages and disadvantages of approaches to the portal venous system and the various embolic materials used for PVE is essential to best tailor the procedures for each patient and to avoid complications. Before PVE, meticulous assessment of the portal vein branching anatomy is performed with cross-sectional imaging, and embolization strategies are developed based on the patient’s anatomy. The PVE procedure consists of several technical steps, and knowledge of these technical tips, potential complications and how to avoid the complications in each step is of great importance for safe and successful PVE, and ultimately successful hepatectomy. Because PVE is used as an adjunct to planned hepatic resection, priority must always be placed on safety, without compromising the integrity of the future liver remnant, and close collaboration between interventional radiologists and hepatobiliary surgeons is essential to achieve successful outcomes.

  14. Category and design fluency in mild cognitive impairment: Performance, strategy use, and neural correlates.

    Science.gov (United States)

    Peter, Jessica; Kaiser, Jannis; Landerer, Verena; Köstering, Lena; Kaller, Christoph P; Heimbach, Bernhard; Hüll, Michael; Bormann, Tobias; Klöppel, Stefan

    2016-12-01

    The exploration and retrieval of words during category fluency involves different strategies to improve or maintain performance. Deficits in that task, which are common in patients with amnestic mild cognitive impairment (aMCI), mirror either impaired semantic memory or dysfunctional executive control mechanisms. Relating category fluency to tasks that place greater demands on either semantic knowledge or executive functions might help to determine the underlying cognitive process. The aims of this study were to compare performance and strategy use of 20 patients with aMCI to 30 healthy elderly controls (HC) and to identify the dominant component (either executive or semantic) for better task performance in category fluency. Thus, the relationship between category fluency, design fluency and naming was examined. As fluency tasks have been associated with the superior frontal gyrus (SFG), the inferior frontal gyrus (IFG), and the temporal pole, we further explored the relationship between gray matter volume in these areas and both performance and strategy use. Patients with aMCI showed significantly lower performance and significantly less strategy use during fluency tasks compared to HC. However, both groups equally improved their performance when repeatedly confronted with the same task. In aMCI, performance during category fluency was significantly predicted by design fluency performance, while in HC, it was significantly predicted by naming performance. In HC, volume of the SFG significantly predicted both category and design fluency performance, and strategy use during design fluency. In aMCI, the SFG and the IFG predicted performance during both category and design fluency. The IFG significantly predicted strategy use during category fluency in both groups. The reduced category fluency performance in aMCI seems to be primarily due to dysfunctional executive control mechanisms rather than impaired semantic knowledge. This finding is directly relevant to

  15. Surgical Strategy and Techniques for Low-Profile Dorsal Plating in Treating Dorsally Displaced Unstable Distal Radius Fractures.

    Science.gov (United States)

    Hamada, Yoshitaka; Gotani, Hiroyuki; Hibino, Naohito; Tanaka, Yoshitaka; Satoh, Ryousuke; Sasaki, Kousuke; Kanchanathepsak, Thepparat

    2017-05-01

    Background The low-profile dorsal locking plating (DLP) technique is useful for treating dorsally comminuted intra-articular distal radius fractures; however, due to the complications associated with DLP, the technique is not widely used. Methods A retrospective review of 24 consecutive cases treated with DLP were done. Results All cases were classified into two types by surgical strategy according to the fracture pattern. In type 1, there is a volar fracture line distal to the watershed line in the dorsally displaced fragment, and this type is treated by H-framed DLP. In type 2, the displaced dorsal die-punch fragment is associated with a minimally displaced styloid shearing fracture or a transverse volar fracture line. We found that the die-punch fragment was reduced by the buttress effect of small l-shaped DLP after stabilization of the styloid shearing for the volar segment by cannulated screws from radial styloid processes. At 6 months after surgery, outcomes were good or excellent based on the modified Mayo wrist scores with no serious complications except one case. The mean range of motion of each type was as follows: the palmar flexion was 50, 65 degrees, dorsiflexion was 70, 75 degrees, supination was 85, 85 degrees, and pronation was 80, 80 degrees; in type 1 and 2, respectively. Conclusion DLP is a useful technique for the treatment of selected cases of dorsally displaced, comminuted intra-articular fractures of the distal radius with careful soft tissue coverage.

  16. Minimizing cardiac surgery risks in a Hepatitis C patient: Changing surgical strategy after evaluation by modern imaging technologies

    Directory of Open Access Journals (Sweden)

    Felix Kur

    2009-05-01

    Full Text Available Felix Kur1, Andres Beiras-Fernandez1, Martin Oberhoffer1, Konstantin Nikolaou2, Calin Vicol1, Bruno Reichart11Department of Cardiac Surgery, 2Department of Radiology, University Hospital Grosshadern, Munich, GermanyAbstract: Minimizing operative risks for the surgical team in infectious patients is crucial. We report on a patient suffering from Hepatitis C undergoing re-operative aortic valve and ascending aorta replacement for aortic aneurysm and paravalvular leakage due to recurrent endocarditis of a Smeloff–Cutter aortic ball prosthesis. Preoperative multi-slice computed tomography and real-time three-dimensional echocardiography proved helpful in changing operative strategy by detecting a previously unknown aortic aneurysm, assessing its extent, and demonstrating the close proximity of the right coronary artery, right ventricle, and the aortic aneurysm to the sternum. Thus, cardiopulmonary bypass was instituted via the femoral vessels, instead of conventionally. Location, morphology, and extent of the paravalvular defect could also be assessed.Keywords: aortic valve replacement, aorta, surgery, risk analysis

  17. Cognitive and Neural Determinants of Response Strategy in the Dual-Solution Plus-Maze Task

    Science.gov (United States)

    De Leonibus, Elvira; Costantini, Vivian J. A.; Massaro, Antonio; Mandolesi, Georgia; Vanni, Valentina; Luvisetto, Siro; Pavone, Flaminia; Oliverio, Alberto; Mele, Andrea

    2011-01-01

    Response strategy in the dual-solution plus maze is regarded as a form of stimulus-response learning. In this study, by using an outcome devaluation procedure, we show that it can be based on both action-outcome and stimulus-response habit learning, depending on the amount of training that the animals receive. Furthermore, we show that…

  18. Modified Learning Strategy for Neural Networks to Support Spectroscopic Ellipsometric Data Evaluation

    NARCIS (Netherlands)

    Redei, L.; Fried, Miklós; Barsony, I.; Barsony, István; Wallinga, Hans

    1998-01-01

    It has been shown that worst-case learning, a slightly modified strategy in backpropagation network (BPN) training, results in constrained maximal error at the expense of slightly increased root mean squared error (RMSE) using BPN in spectroscopic ellipsometry (SE). Traditionally the evaluation of

  19. Neural modulation of muscle-tendon control strategy after a single practice session.

    Science.gov (United States)

    Hirayama, Kuniaki; Yanai, Toshimasa; Kanehisa, Hiroaki; Fukunaga, Tetsuo; Kawakami, Yasuo

    2012-08-01

    The purpose of the present study was to examine a hypothesis that the musculotendinous behavior during a propelling action with a countermovement can be altered by a single practice session through modulation of neuromuscular activities. Eight males performed unilateral maximal plantarflexion with (CMJ) and without (noCMJ) countermovement before and after a practice consisting of six sets of three repetitions of unilateral CMJ exercises. Measurements included EMG activities of the triceps surae and tibialis anterior muscles and the fascicle behavior of the gastrocnemius by ultrasonography, and impulse was calculated from the force-time data. The change in tendon length was also estimated. The impulse in CMJ increased after the practice, but that in noCMJ did not. After the practice, the magnitude of fascicle lengthening and shortening in CMJ decreased, which was accompanied by an increase in tendon shortening without change in the ankle joint range of motion. The time lag from the onset of reaction force to that of EMG activities of the triceps surae muscles was shortened after the practice. The results support the hypothesis and indicate that, as a neural modulation through a single practice, the muscle-tendon unit behavior during CMJ can be optimized to improve the performance.

  20. Age-related differences in neural recruitment during the use of cognitive reappraisal and selective attention as emotion regulation strategies

    Science.gov (United States)

    Allard, Eric S.; Kensinger, Elizabeth A.

    2014-01-01

    The present study examined age differences in the timing and neural recruitment within lateral and medial PFC while younger and older adults hedonically regulated their responses to unpleasant film clips. When analyses focused on activity during the emotional peak of the film clip (the most emotionally salient portion of the film), several age differences emerged. When comparing regulation to passive viewing (combined effects of selective attention and reappraisal) younger adults showed greater regulation related activity in lateral PFC (DLPFC, VLPFC, OFC) and medial PFC (ACC) while older adults showed greater activation within a region DLPFC. When assessing distinct effects of the regulation conditions, an ANOVA revealed a significant Age × Regulation Condition interaction within bilateral DLPFC and ACC; older adults but not young adults showed greater recruitment within these regions for reappraisal than selective attention. When examining activity at the onset of the film clip and at its emotional peak, the timing of reappraisal-related activity within VLPFC differed between age groups: younger adults showed greater activity at film onset while older adults showed heightened activity during the peak. Our results suggest that older adults rely more heavily on PFC recruitment when engaging cognitively demanding reappraisal strategies while PFC-mediated regulation might not be as task-specific for younger adults. Older adults' greater reliance on cognitive control processing during emotion regulation may also be reflected in the time needed to implement these strategies. PMID:24782800

  1. Combination of multifaceted strategies to maximize the therapeutic benefits of neural stem cell transplantation for spinal cord repair.

    Science.gov (United States)

    Hwang, Dong H; Kim, Hyuk M; Kang, Young M; Joo, In S; Cho, Chong-Su; Yoon, Byung-Woo; Kim, Seung U; Kim, Byung G

    2011-01-01

    Neural stem cells (NSCs) possess therapeutic potentials to reverse complex pathological processes following spinal cord injury (SCI), but many obstacles remain that could not be fully overcome by NSC transplantation alone. Combining complementary strategies might be required to advance NSC-based treatments to the clinical stage. The present study was undertaken to examine whether combination of NSCs, polymer scaffolds, neurotrophin-3 (NT3), and chondroitinase, which cleaves chondroitin sulfate proteoglycans at the interface between spinal cord and implanted scaffold, could provide additive therapeutic benefits. In a rat hemisection model, poly(ɛ-caprolactone) (PCL) was used as a bridging scaffold and as a vehicle for NSC delivery. The PCL scaffolds seeded with F3 NSCs or NT3 overexpressing F3 cells (F3.NT3) were implanted into hemisected cavities. F3.NT3 showed better survival and migration, and more frequently differentiated into neurons and oligodendrocytes than F3 cells. Animals with PCL scaffold containing F3.NT3 cells showed the best locomotor recovery, and motor evoked potentials (MEPs) following transcranial magnetic stimulation were recorded only in PCL-F3.NT3 group in contralateral, but not ipsilateral, hindlimbs. Implantation of PCL scaffold with F3.NT3 cells increased NT3 levels, promoted neuroplasticity, and enhanced remyelination of contralateral white matter. Combining chondroitinase treatment after PCL-F3.NT3 implantation further enhanced cell migration and promoted axonal remodeling, and this was accompanied by augmented locomotor recovery and restoration of MEPs in ipsilateral hindlimbs. We demonstrate that combining multifaceted strategies can maximize the therapeutic benefits of NSC transplantation for SCI. Our results may have important clinical implications for the design of future NSC-based strategies.

  2. A new learning strategy for the two-time-scale neural controller with its application to the tracking control of rigid arms

    Science.gov (United States)

    Cheng, W.; Wen, J. T.

    1992-01-01

    A novel fast learning rule with fast weight identification is proposed for the two-time-scale neural controller, and a two-stage learning strategy is developed for the proposed neural controller. The results of the stability analysis show that both the tracking error and the fast weight error will be uniformly bounded and converge to a bounded region which depends only on the accuracy of the slow learning if the system is sufficiently excited. The efficiency of the two-stage learning is also demonstrated by a simulation of a two-link arm.

  3. Problem-Solving Skills Among Precollege Students in Clinical Immunology and Microbiology: Classifying Strategies with a Rubric and Artificial Neural Network Technology

    Science.gov (United States)

    KANOWITH-KLEIN, SUSAN; STAVE, MEL; STEVENS, RON; CASILLAS, ADRIAN M.

    2001-01-01

    Educators emphasize the importance of problem solving that enables students to apply current knowledge and understanding in new ways to previously unencountered situations. Yet few methods are available to visualize and then assess such skills in a rapid and efficient way. Using a software system that can generate a picture (i.e., map) of students’ strategies in solving problems, we investigated methods to classify problem-solving strategies of high school students who were studying infectious and noninfectious diseases. Using maps that indicated items students accessed to solve a software simulation as well as the sequence in which items were accessed, we developed a rubric to score the quality of the student performances and also applied artificial neural network technology to cluster student performances into groups of related strategies. Furthermore, we established that a relationship existed between the rubric and neural network results, suggesting that the quality of a problem-solving strategy could be predicted from the cluster of performances in which it was assigned by the network. Using artificial neural networks to assess students’ problem-solving strategies has the potential to permit the investigation of the problem-solving performances of hundreds of students at a time and provide teachers with a valuable intervention tool capable of identifying content areas in which students have specific misunderstandings, gaps in learning, or misconceptions. PMID:23653541

  4. Transmission dynamics of carbapenemase-producing Klebsiella pneumoniae and anticipated impact of infection control strategies in a surgical unit.

    Science.gov (United States)

    Sypsa, Vana; Psichogiou, Mina; Bouzala, Georgia-Aikaterina; Hadjihannas, Linos; Hatzakis, Angelos; Daikos, Georgios L

    2012-01-01

    Carbapenemase-producing Klebsiella pneumoniae (CPKP) has been established as important nosocomial pathogen in many geographic regions. Transmission from patient to patient via the hands of healthcare workers is the main route of spread in the acute-care setting. Epidemiological and infection control data were recorded during a prospective observational study conducted in a surgical unit of a tertiary-care hospital in Greece. Surveillance culture for CPKP were obtained from all patients upon admission and weekly thereafter. The Ross-Macdonald model for vector-borne diseases was applied to obtain estimates for the basic reproduction number R(0) (average number of secondary cases per primary case in the absence of infection control) and assess the impact of infection control measures on CPKP containment in endemic and hyperendemic settings. Eighteen of 850 patients were colonized with CPKP on admission and 51 acquired CPKP during hospilazation. R(0) reached 2 and exceeded unity for long periods of time under the observed hand hygiene compliance (21%). The minimum hand hygiene compliance level necessary to control transmission was 50%. Reduction of 60% to 90% in colonized patients on admission, through active surveillance culture, contact precautions and isolation/cohorting, in combination with 60% compliance in hand hygiene would result in rapid decline in CPKP prevalence within 8-12 weeks. Antibiotics restrictions did not have a substantial benefit when an aggressive control strategy was implemented. Surveillance culture on admission and isolation/cohorting of colonized patients coupled with moderate hand hygiene compliance and contact precautions may lead to rapid control of CPKP in endemic and hyperendemic healthcare settings.

  5. Transmission dynamics of carbapenemase-producing Klebsiella pneumoniae and anticipated impact of infection control strategies in a surgical unit.

    Directory of Open Access Journals (Sweden)

    Vana Sypsa

    Full Text Available BACKGROUND: Carbapenemase-producing Klebsiella pneumoniae (CPKP has been established as important nosocomial pathogen in many geographic regions. Transmission from patient to patient via the hands of healthcare workers is the main route of spread in the acute-care setting. METHODOLOGY/PRINCIPAL FINDINGS: Epidemiological and infection control data were recorded during a prospective observational study conducted in a surgical unit of a tertiary-care hospital in Greece. Surveillance culture for CPKP were obtained from all patients upon admission and weekly thereafter. The Ross-Macdonald model for vector-borne diseases was applied to obtain estimates for the basic reproduction number R(0 (average number of secondary cases per primary case in the absence of infection control and assess the impact of infection control measures on CPKP containment in endemic and hyperendemic settings. Eighteen of 850 patients were colonized with CPKP on admission and 51 acquired CPKP during hospilazation. R(0 reached 2 and exceeded unity for long periods of time under the observed hand hygiene compliance (21%. The minimum hand hygiene compliance level necessary to control transmission was 50%. Reduction of 60% to 90% in colonized patients on admission, through active surveillance culture, contact precautions and isolation/cohorting, in combination with 60% compliance in hand hygiene would result in rapid decline in CPKP prevalence within 8-12 weeks. Antibiotics restrictions did not have a substantial benefit when an aggressive control strategy was implemented. CONCLUSIONS/SIGNIFICANCE: Surveillance culture on admission and isolation/cohorting of colonized patients coupled with moderate hand hygiene compliance and contact precautions may lead to rapid control of CPKP in endemic and hyperendemic healthcare settings.

  6. Two-phase strategy of neural control for planar reaching movements: II--relation to spatiotemporal characteristics of movement trajectory.

    Science.gov (United States)

    Rand, Miya K; Shimansky, Yury P

    2013-09-01

    In the companion paper utilizing a quantitative model of optimal motor coordination (Part I, Rand and Shimansky, in Exp Brain Res 225:55-73, 2013), we examined coordination between X and Y movement directions (XYC) during reaching movements performed under three prescribed speeds, two movement amplitudes, and two target sizes. The obtained results indicated that the central nervous system (CNS) utilizes a two-phase strategy, where the initial and the final phases correspond to lower and higher precision of information processing, respectively, for controlling goal-directed reach-type movements to optimize the total cost of task performance including the cost of neural computations. The present study investigates how two different well-known concepts used for describing movement performance relate to the concepts of optimal XYC and two-phase control strategy. First, it is examined to what extent XYC is equivalent to movement trajectory straightness. The data analysis results show that the variability, the movement trajectory's deviation from the straight line, increases with an increase in prescribed movement speed. In contrast, the dependence of XYC strength on movement speed is opposite (in total agreement with an assumption of task performance optimality), suggesting that XYC is a feature of much higher level of generality than trajectory straightness. Second, it is tested how well the ballistic and the corrective components described in the traditional concept of two-component model of movement performance match with the initial and the final phase of the two-phase control strategy, respectively. In fast reaching movements, the percentage of trials with secondary corrective submovement was smaller under larger-target shorter-distance conditions. In slower reaching movements, meaningful parsing was impossible due to massive fluctuations in the kinematic profile throughout the movement. Thus, the parsing points determined by the conventional submovement analysis

  7. Nomogram Prediction of Anastomotic Leakage and Determination of an Effective Surgical Strategy for Reducing Anastomotic Leakage after Laparoscopic Rectal Cancer Surgery

    Directory of Open Access Journals (Sweden)

    Chang Hyun Kim

    2017-01-01

    Full Text Available Background. Although many surgical strategies have been used to reduce the anastomotic leak (AL rate after laparoscopic rectal cancer surgery, limited data are available on the risk factors for AL and the effective strategy to reduce AL. Methods. The present study enrolled 736 consecutive patients who underwent laparoscopic resection without a diverting stoma for rectal adenocarcinoma. A nomogram was constructed to predict AL. Based on the nomogram, personalized risk was calculated and sequential surgical strategies were monitored using risk-adjusted cumulative sum (RA-CUSUM analysis. Results. Among the 736 patients, clinical AL occurred in 65 patients (8.8%. Sex, an American Society of Anesthesiologists score, operation time, blood transfusion, and tumor location were identified as significant predictive factors for AL. Based on these factors, a nomogram was created to predict AL, with a concordance index (C-index of 0.753 (95% confidence interval, 0.690–0.816. A calibration plot showed good statistical performance on internal validation (bias-corrected C-index of 0.742. The RA-CUSUM curve showed that extended splenic flexure mobilization (SFM could be the most influential strategy to reduce AL. Conclusions. Our nomogram for predicting AL after laparoscopic rectal cancer surgery might be helpful to identify the individual risk of AL. Furthermore, extended SFM might be the most appropriate strategy for reducing AL.

  8. Variable Myocardial Response to Load Stresses in Infants with Single Left Ventricular Anatomy: Influence of Initial Physiology and Surgical Palliative Strategy.

    Science.gov (United States)

    Horriat, Narges L; Deatsman, Sara L; Stelter, Jessica; Frommelt, Peter C; Hill, Garick D

    2016-12-01

    Initial surgical strategies in neonates with single left ventricular (LV) anatomy vary based on adequacy of pulmonary and systemic blood flow. Differing myocardial responses to these strategies, as reflected in indices of systolic function, ventricular size, and mass have not been well defined. We sought to evaluate single LV myocardial response to varied physiology and initial palliation and determine whether the response is consistent and predictable. Infants with single LV physiology were divided based on neonatal palliation: no palliation/PA band (NO); BT shunt only (BT); or Norwood procedure (NP). Echo measures were obtained at presentation, early post-bidirectional Glenn (BDG), late post-BDG follow-up, and post-Fontan procedure. Measures included ejection fraction, LV mass indexed to height(2.7) and end diastolic volume indexed to body surface area, and mass/volume ratio. The cohort included 38 children (13 NO, 13 BT, 12 NP). Ejection fraction was similar but depressed in all groups at all stages. LV mass was higher in the NP group than the BT group at early post-BDG (p = 0.03) and higher than both BT and NO groups (p < 0.01) at late post-BDG, but the difference was resolved by post-Fontan follow-up. The NP group had the most remarkable remodeling in LV size from BDG to Fontan, suggesting that volume unloading is most valuable in this subgroup. Ventricular remodeling can be identified by echocardiography in children with single LV physiology, despite variable initial surgical palliative strategies. Importantly, these initial surgical strategies do not result in significant differences after Fontan palliation during early childhood.

  9. "Beating osteoARThritis": development of a stepped care strategy to optimize utilization and timing of non-surgical treatment modalities for patients with hip or knee osteoarthritis.

    Science.gov (United States)

    Smink, Agnes J; van den Ende, Cornelia H M; Vliet Vlieland, Thea P M; Swierstra, Bart A; Kortland, Joke H; Bijlsma, Johannes W J; Voorn, Theo B; Schers, Henk J; Bierma-Zeinstra, Sita M A; Dekker, Joost

    2011-12-01

    Inadequacies in health care practices have been reported despite existing guidelines to manage hip or knee osteoarthritis. To facilitate guideline implementation and improve utilization of non-surgical treatment options a care strategy should be developed. This study describes the development of an evidence-based, multidisciplinary, patient-centered, stepped care strategy. A national, multidisciplinary, steering group developed the strategy in three phases: (1) consensus among steering group members (first draft); (2) written consultation of 23 representatives of patient organizations and professional associations involved in osteoarthritis care (second draft); (3) consensus of the final draft after discussion in two rounds during a conference with representatives from the different disciplines. The final stepped care strategy presents, in three tiers, the optimal order for non-surgical treatment modalities. It recommends that more advanced options should only be considered if options listed in previous steps failed to produce satisfactory results. Hence, the first step treatment options can be offered to all patients but may also be provided through self care (education, life style advice, and acetaminophen). The second step (exercise therapy, dietary therapy, and non-steroidal anti-inflammatory drugs) and third step treatment options (multidisciplinary care, intra-articular injections, and transcutaneous electrical nerve stimulation) can be considered for people with persisting complaints. Trough a consensus procedure, we succeeded to develop a multidisciplinary, patient-centered, stepped care strategy based on national guidelines. This strategy provides a framework for health care providers and patients with hip or knee osteoarthritis to discuss the optimal timing of the various treatment options.

  10. Surgical management of pain

    African Journals Online (AJOL)

    music therapy, physiotherapy, and cognitive behavioural therapy, the pain team should consider surgery. The techniques available in the surgical management of pain are summarised in Table 1.[5-12]. Surgery can help in the management of pain in the following ways: • by modulating neural function:[5-8] TENS, spinal cord ...

  11. Abortion - surgical

    Science.gov (United States)

    Suction curettage; Surgical abortion; Elective abortion - surgical; Therapeutic abortion - surgical ... Surgical abortion involves dilating the opening to the uterus (cervix) and placing a small suction tube into the uterus. ...

  12. Evaluation of Fine Feeding System and Angioarchitecture of Giant Pituitary Adenoma--Implications for Establishment of Surgical Strategy.

    Science.gov (United States)

    Ogawa, Yoshikazu; Sato, Kenichi; Matsumoto, Yasushi; Tominaga, Teiji

    2016-01-01

    Giant pituitary adenomas carry higher surgical risks despite recent advances in microsurgical and/or endoscopic surgery, and postoperative acute catastrophic changes without major vessel disturbance are still extremely difficult to predict, may manifest as postoperative pituitary apoplexy, and are associated with poor outcomes. Eight males and 4 females aged 31-72 years (mean 50.7 years) with giant pituitary adenomas underwent preoperative investigation of fine angioarchitecture using C-arm cone-beam computed tomography with a flat-panel detector. Angiographical findings were used to decide the surgical routes and compared with clinical outcome. Feeding arteries were verified in 10 of 12 patients, whereas no feeding arteries were evident in 2 patients. The patients were divided into the faint tumor staining group and the significant staining group, which was reconfirmed by region of interest analysis. The former group had faint supply from the ipsilateral superior hypophyseal arteries and meningohypophyseal trunk, and the latter group had significant supply from the meningohypophyseal and inferolateral trunks, which passed centrifugally from the inferoposterior pole of the tumor. All patients were treated through the extended transsphenoidal approach. Intraoperative bleeding was significantly greater in the latter group (P = 0.013). All patients had improvement of neurologic deficit and were released from the intensive care unit within a few days. Major blood supply of giant pituitary adenomas originates from branches of the infraclinoidal portion of the internal carotid artery, different from the normal anterior pituitary gland. Surgical route should depend on not only tumor shape and extension but also feeding systems. Copyright © 2016 Elsevier Inc. All rights reserved.

  13. Surgical strategies: lateral ligament reconstruction as part of the management of varus ankle deformity with ankle replacement.

    Science.gov (United States)

    Coetzee, J Chris

    2010-03-01

    Improved designs and surgical technique has led to much better mid-term and longer term outcomes than the first generation ankle replacements of the 1970's. However, there remains multiple recent papers discussing the many potential complications with total ankle replacement surgery. As we proceed into the future, one should be cognizant of the pitfalls and know how to deal with the difficult ankles, especially varus and valgus deformities. There should also be a clear understanding that the greater the varus or valgus, the more challenging the procedure, and the less predictable the outcome of a total ankle replacement.

  14. Primary Drivers of Adult Cervical Deformity: Prevalence, Variations in Presentation, and Effect of Surgical Treatment Strategies on Early Postoperative Alignment.

    Science.gov (United States)

    Passias, Peter G; Jalai, Cyrus M; Lafage, Virginie; Lafage, Renaud; Protopsaltis, Themistocles; Ramchandran, Subaraman; Horn, Samantha R; Poorman, Gregory W; Gupta, Munish; Hart, Robert A; Deviren, Vedat; Soroceanu, Alexandra; Smith, Justin S; Schwab, Frank; Shaffrey, Christopher I; Ames, Christopher P

    2017-08-05

    Primary drivers (PDs) of adult cervical deformity (ACD) have not been described in relation to pre- and early postoperative alignment or degree of correction. To define the PDs of ACD to understand the impact of driver region on global postoperative compensatory mechanisms. Primary cervical deformity driver/vertebral apex level were determined: CS = cervical; CTJ = cervicothoracic junction; TH = thoracic; SP = spinopelvic. Patients were evaluated if surgery included PD apex, based on the lowest instrumented vertebra (LIV): CS: LIV ≤ C7, CTJ: LIV ≤ T3, TH: LIV ≤ T12. Cervical and thoracolumbar alignment was measured preoperatively and 3 mo (3M) postoperatively. PD groups were compared with analysis of variance/Pearson χ 2 , paired t -tests. Eighty-four ACD patients met inclusion criteria. Thoracic drivers (n = 26) showed greatest preoperative cervical and global malalignment against other PD: higher thoracic kyphosis, pelvic incidence-lumbar lordosis (PI-LL), T1 slope C2-T3 sagittal vertical axis (SVA), and C0-2 angle ( P 3M alignment changes were observed between surgical PD groups, in PI-LL, LL, T1 slope minus cervical lordosis (TS-CL), cervical SVA, C2-T3 SVA ( P 3M correction. CTJ drivers trended toward greater LL correction compared to CS drivers (-6.00° vs 0.88°, P = .050). Patients operated at CS driver level had a difference in the prevalence of 3M TS-CL modifier grades (0 = 35.7%, 1 = 0.0%, 2 = 13.3%, P = .030). There was a significant difference in 3M chin-brow vertical angle modifier grade distribution in TH drivers (0 = 0.0%, 1 = 35.9%, 2 = 14.3%, P = .049). Characterizing ACD patients by PD type reveals differences in pre- and postoperative alignment. Evaluating surgical alignment outcomes based on PD inclusion is important in understanding alignment goals for ACD correction.

  15. The effect of strategies, goals and stimulus material on the neural mechanisms of emotion regulation: A meta-analysis of fMRI studies.

    Science.gov (United States)

    Morawetz, Carmen; Bode, Stefan; Derntl, Birgit; Heekeren, Hauke R

    2017-01-01

    Emotion regulation comprises all extrinsic and intrinsic control processes whereby people monitor, evaluate and modify the occurrence, intensity and duration of emotional reactions. Here we sought to quantitatively summarize the existing neuroimaging literature to investigate a) whether different emotion regulation strategies are based on different or the same neural networks; b) which brain regions in particular support the up- and down-regulation of emotions, respectively; and c) to which degree the neural networks realising emotion regulation depend on the stimulus material used to elicit emotions. The left ventrolateral prefrontal cortex (VLPFC), the anterior insula and the supplementary motor area were consistently activated independent of the regulation strategy. VLPFC and posterior cingulate cortex were the main regions consistently found to be recruited during the up-regulation as well as the down-regulation of emotion. The down-regulation compared to the up-regulation of emotions was associated with more right-lateralized activity while up-regulating emotions more strongly modulated activity in the ventral striatum. Finally, the process of emotion regulation appeared to be unaffected by stimulus material. Copyright © 2016 Elsevier Ltd. All rights reserved.

  16. The American College of Surgeons/Association of Program Directors in Surgery National Skills Curriculum: adoption rate, challenges and strategies for effective implementation into surgical residency programs.

    Science.gov (United States)

    Korndorffer, James R; Arora, Sonal; Sevdalis, Nick; Paige, John; McClusky, David A; Stefanidis, Dimitris

    2013-07-01

    The American College of Surgeons/Association of Program Directors in Surgery (ACS/APDS) National Skills Curriculum is a 3-phase program targeting technical and nontechnical skills development. Few data exist regarding the adoption of this curriculum by surgical residencies. This study attempted to determine the rate of uptake and identify implementation enablers/barriers. A web-based survey was developed by an international expert panel of surgical educators (5 surgeons and 1 psychologist). After piloting, the survey was sent to all general surgery program directors via email link. Descriptive statistics were used to determine the residency program characteristics and perceptions of the curriculum. Implementation rates for each phase and module were calculated. Adoption barriers were identified quantitatively and qualitatively using free text responses. Standardized qualitative methodology of emergent theme analysis was used to identify strategies for success and details of support required for implementation. Of the 238 program directors approached, 117 (49%) responded to the survey. Twenty-one percent (25/117) were unaware of the ACS/APDS curriculum. Implementation rates for were 36% for phase I, 19% for phase II, and 16% for phase III. The most common modules adopted were the suturing, knot-tying, and chest tube modules of phase I. Over 50% of respondents identified lack of faculty protected time, limited personnel, significant costs, and resident work-hour restrictions as major obstacles to implementation. Strategies for effective uptake included faculty incentives, adequate funding, administrative support, and dedicated time and resources. Despite the availability of a comprehensive curriculum, its diffusion into general surgery residency programs remains low. Obstacles related to successful implementation include personnel, learner, and administrative issues. Addressing these issues may improve the adoption rate of the curriculum. Copyright © 2013 Mosby, Inc

  17. Non-pharmacological and non-surgical strategies to promote sexual recovery for men with erectile dysfunction

    Science.gov (United States)

    Wibowo, Erik

    2017-01-01

    Erectile dysfunction (ED), the most commonly reported sexual problem for men, reduces the quality of life for both patients and their partners. Even when physiologically effective, long-term adherence to ED treatments is poor. We review here the implication of having patients’ partners involved in ED treatment, starting with treatment selection. We suggest that having partners engaged from the outset may promote an erotic association of the treatment with the partner, i.e., conceptually linking the aid to the sexual pleasure that the partner provides. We hypothesize that this erotic association should enhance the sexual aid’s effectiveness and might potentially help improve long-term adherence. The primary focus of this review, though, is non-pharmacological and non-surgical options for maintaining sexual activity for men with ED. Though not ED treatments per se, anecdotal data suggest that these options may be effective for some patients and their partners in regaining a satisfying sex life. The aids discussed include external penile prostheses, penile sleeves, and penile support devices. These devices can allow men to participate in penetrative sexual intercourse despite moderate to severe ED. External penile prostheses can be personalized so they match in size and shape a man’s normal full erection. Penile sleeves can similarly be customized with a lumen that fits best a patient’s penis for optimal tactile stimulation. We review how multi-sensory integration can enhance sexual arousal for men who use such devices, allowing them to achieve orgasm despite intractable ED. Patients are not always advised within ED clinics about these options nor why and how they can facilitate non-erection dependent sexual recovery. Clinicians need to be aware of these devices and their positive attributes, so they can objectively counsel and encourage couples to explore their use as an alternative to more invasive treatments. The most commonly promoted non-medical ED aid

  18. Evaluation of surgical strategy of conventional vs. percutaneous robot-assisted spinal trans-pedicular instrumentation in spondylodiscitis.

    Science.gov (United States)

    Keric, Naureen; Eum, David J; Afghanyar, Feroz; Rachwal-Czyzewicz, Izabela; Renovanz, Mirjam; Conrad, Jens; Wesp, Dominik M A; Kantelhardt, Sven R; Giese, Alf

    2017-03-01

    Robot-assisted percutaneous insertion of pedicle screws is a recent technique demonstrating high accuracy. The optimal treatment for spondylodiscitis is still a matter of debate. We performed a retrospective cohort study on surgical patients treated with pedicle screw/rod placement alone without the application of intervertebral cages. In this collective, we compare conventional open to a further minimalized percutaneous robot-assisted spinal instrumentation, avoiding a direct contact of implants and infectious focus. 90 records and CT scans of patients treated by dorsal transpedicular instrumentation of the infected segments with and without decompression and antibiotic therapy were analysed for clinical and radiological outcome parameters. 24 patients were treated by free-hand fluoroscopy-guided surgery (121 screws), and 66 patients were treated by percutaneous robot-assisted spinal instrumentation (341 screws). Accurate screw placement was confirmed in 90 % of robot-assisted and 73.5 % of free-hand placed screws. Implant revision due to misplacement was necessary in 4.95 % of the free-hand group compared to 0.58 % in the robot-assisted group. The average intraoperative X-ray exposure per case was 0.94 ± 1.04 min in the free-hand group vs. 0.4 ± 0.16 min in the percutaneous group (p = 0.000). Intraoperative adverse events were observed in 12.5 % of free-hand placed pedicle screws and 6.1 % of robot robot-assisted screws. The mean postoperative hospital stay in the free-hand group was 18.1 ± 12.9 days, and in percutaneous group, 13.8 ± 5.6 days (p = 0.012). This study demonstrates that the robot-guided insertion of pedicle screws is a safe and effective procedure in lumbar and thoracic spondylodiscitis with higher accuracy of implant placement, lower radiation dose, and decreased complication rates. Percutaneous spinal dorsal instrumentation seems to be sufficient to treat lumbar and thoracic spondylodiscitis.

  19. Surgical lighting

    NARCIS (Netherlands)

    Knulst, A.J.

    2017-01-01

    The surgical light is an important tool for surgeons to create and maintain good visibility on the surgical task. Chapter 1 gives background to the field of (surgical) lighting and related terminology. Although the surgical light has been developed strongly since its introduction a long time ago,

  20. Surgical lighting

    OpenAIRE

    Knulst, A.J.

    2017-01-01

    The surgical light is an important tool for surgeons to create and maintain good visibility on the surgical task. Chapter 1 gives background to the field of (surgical) lighting and related terminology. Although the surgical light has been developed strongly since its introduction a long time ago, the last decades only minor developments have been made. This lack of significant development suggests that the current state of surgical lighting is perfectly developed and functions without any fla...

  1. Electrosensory processing in Apteronotus albifrons: implications for general and specific neural coding strategies across wave-type weakly electric fish species.

    Science.gov (United States)

    Martinez, Diana; Metzen, Michael G; Chacron, Maurice J

    2016-12-01

    Understanding how the brain processes sensory input to generate behavior remains an important problem in neuroscience. Towards this end, it is useful to compare results obtained across multiple species to gain understanding as to the general principles of neural coding. Here we investigated hindbrain pyramidal cell activity in the weakly electric fish Apteronotus albifrons We found strong heterogeneities when looking at baseline activity. Additionally, ON- and OFF-type cells responded to increases and decreases of sinusoidal and noise stimuli, respectively. While both cell types displayed band-pass tuning, OFF-type cells were more broadly tuned than their ON-type counterparts. The observed heterogeneities in baseline activity as well as the greater broadband tuning of OFF-type cells were both similar to those previously reported in other weakly electric fish species, suggesting that they constitute general features of sensory processing. However, we found that peak tuning occurred at frequencies ∼15 Hz in A. albifrons, which is much lower than values reported in the closely related species Apteronotus leptorhynchus and the more distantly related species Eigenmannia virescens In response to stimuli with time-varying amplitude (i.e., envelope), ON- and OFF-type cells displayed similar high-pass tuning curves characteristic of fractional differentiation and possibly indicate optimized coding. These tuning curves were qualitatively similar to those of pyramidal cells in the closely related species A. leptorhynchus In conclusion, comparison between our and previous results reveals general and species-specific neural coding strategies. We hypothesize that differences in coding strategies, when observed, result from different stimulus distributions in the natural/social environment. Copyright © 2016 the American Physiological Society.

  2. Developing Generic Image Search Strategies for Large Astronomical Data Sets and Archives using Convolutional Neural Networks and Transfer Learning

    Science.gov (United States)

    Peek, Joshua E. G.; Hargis, Jonathan R.; Jones, Craig R.

    2018-01-01

    Astronomical instruments produce petabytes of images every year, vastly more than can be inspected by a member of the astronomical community in search of a specific population of structures. Fortunately, the sky is mostly black and source extraction algorithms have been developed to provide searchable catalogs of unconfused sources like stars and galaxies. These tools often fail for studies of more diffuse structures like the interstellar medium and unresolved stellar structures in nearby galaxies, leaving astronomers interested in observations of photodissociation regions, stellar clusters, diffuse interstellar clouds without the crucial ability to search. In this work we present a new path forward for finding structures in large data sets similar to an input structure using convolutional neural networks, transfer learning, and machine learning clustering techniques. We show applications to archival data in the Mikulski Archive for Space Telescopes (MAST).

  3. Unique TTC repeat base pair loss mutation in cases of pure neural leprosy: A survival strategy of Mycobacterium leprae?

    Directory of Open Access Journals (Sweden)

    Abhishek De

    2015-01-01

    Full Text Available Background: Genomic reduction helps obligate intracellular microbes to survive difficult host niches. Adaptation of Mycobacterium leprae in cases of pure neural leprosy (PNL in the intracellular niche of peripheral nerves can be associated with some gene loss. Recently, a stable but variable number of tandem repefzats (TTC have been reported in strains of M. leprae. FolP and rpoB genes are the two common mutation sites which deal with the susceptibility of the bacteria to drugs. Aim: We attempted to find if genomic reduction of M. leprae in context of these TTC repeats or mutations in folP1 and rpoB can be the reason for the restriction of M. leprae in the nerves in PNL. Materials and Methods: DNA extracts taken from fine needle aspiration of affected nerves of 24 PNL cases were studied for tandem repeats with 21TTC primer in multiplex-PCR. Mutations were also studied by PCR Amplification of SRDR (Sulphone Resistance Determining Region of the folP1 and multiple primer PCR amplification refractory mutation system (MARS of the rpoB. Results: Of the 24 PNL, only 1 patient showed mutation in the rpoB gene and none in the folp1 gene. Studying the mutation in TTC region of the M. leprae gene we found that all the cases have a loss of a few bases in the sequence. Conclusion: We can conclude that there is consistent loss in the bases in the TTC region in all cases of pure neural Hansen and we postulate that it may be an adaptive response of the bacteria to survive host niche resulting in its restriction to peripheral nerves.

  4. Brain-machine interface control of a manipulator using small-world neural network and shared control strategy.

    Science.gov (United States)

    Li, Ting; Hong, Jun; Zhang, Jinhua; Guo, Feng

    2014-03-15

    The improvement of the resolution of brain signal and the ability to control external device has been the most important goal in BMI research field. This paper describes a non-invasive brain-actuated manipulator experiment, which defined a paradigm for the motion control of a serial manipulator based on motor imagery and shared control. The techniques of component selection, spatial filtering and classification of motor imagery were involved. Small-world neural network (SWNN) was used to classify five brain states. To verify the effectiveness of the proposed classifier, we replace the SWNN classifier by a radial basis function (RBF) networks neural network, a standard multi-layered feed-forward backpropagation network (SMN) and a multi-SVM classifier, with the same features for the classification. The results also indicate that the proposed classifier achieves a 3.83% improvement over the best results of other classifiers. We proposed a shared control method consisting of two control patterns to expand the control of BMI from the software angle. The job of path building for reaching the 'end' point was designated as an assessment task. We recorded all paths contributed by subjects and picked up relevant parameters as evaluation coefficients. With the assistance of two control patterns and series of machine learning algorithms, the proposed BMI originally achieved the motion control of a manipulator in the whole workspace. According to experimental results, we confirmed the feasibility of the proposed BMI method for 3D motion control of a manipulator using EEG during motor imagery. Copyright © 2013 Elsevier B.V. All rights reserved.

  5. Neural-Fuzzy Digital Strategy of Continuous-Time Nonlinear Systems Using Adaptive Prediction and Random-Local-Optimization Design

    Directory of Open Access Journals (Sweden)

    Zhi-Ren Tsai

    2013-01-01

    Full Text Available A tracking problem, time-delay, uncertainty and stability analysis of a predictive control system are considered. The predictive control design is based on the input and output of neural plant model (NPM, and a recursive fuzzy predictive tracker has scaling factors which limit the value zone of measured data and cause the tuned parameters to converge to obtain a robust control performance. To improve the further control performance, the proposed random-local-optimization design (RLO for a model/controller uses offline initialization to obtain a near global optimal model/controller. Other issues are the considerations of modeling error, input-delay, sampling distortion, cost, greater flexibility, and highly reliable digital products of the model-based controller for the continuous-time (CT nonlinear system. They are solved by a recommended two-stage control design with the first-stage (offline RLO and second-stage (online adaptive steps. A theorizing method is then put forward to replace the sensitivity calculation, which reduces the calculation of Jacobin matrices of the back-propagation (BP method. Finally, the feedforward input of reference signals helps the digital fuzzy controller improve the control performance, and the technique works to control the CT systems precisely.

  6. Comparison of stenting and surgical revascularization strategy in non-ST elevation acute coronary syndromes and complex coronary artery disease (from the Milestone Registry).

    Science.gov (United States)

    Buszman, Pawel E; Buszman, Piotr P; Bochenek, Andrzej; Gierlotka, Marek; Gąsior, Mariusz; Milewski, Krzysztof; Orlik, Bartłomiej; Janas, Adam; Wojakowski, Wojciech; Kiesz, R Stefan; Zembala, Marian; Poloński, Lech

    2014-10-01

    The optimal revascularization strategy in patients with complex coronary artery disease and non-ST-segment elevation acute coronary syndromes is undetermined. In this multicenter, prospective registry, 4,566 patients with non-ST-segment elevation myocardial infarctions, unstable angina, and multivessel coronary disease, including left main disease, were enrolled. After angiography, 3,033 patients were selected for stenting (10.3% received drug-eluting stents) and 1,533 for coronary artery bypass grafting. Propensity scores were used for baseline characteristic matching and result adjustment. Patients selected for percutaneous coronary intervention (PCI) were younger (mean age 64.4±10 vs 65.2±9 years, p=0.03) and more frequently presented with non-ST-segment elevation myocardial infarctions (32.0% vs 14.5%, p=0.01), cardiogenic shock (1.5% vs 0.7%, p65 years, women, patients with unstable angina, those with European System for Cardiac Operative Risk Evaluation scores>5, those with Thrombolysis In Myocardial Infarction (TIMI) risk scores >4, those receiving drug-eluting stents, and those with 2-vessel disease. In conclusion, in patients presenting with non-ST-segment elevation acute coronary syndromes and complex coronary artery disease, immediate stenting was associated with lower mortality risk in the long term compared with surgical revascularization, especially in subgroups at high clinical risk. Copyright © 2014 Elsevier Inc. All rights reserved.

  7. Surgical Technologists

    Science.gov (United States)

    ... State & Area Data Explore resources for employment and wages by state and area for surgical technologists. Similar Occupations Compare the job duties, education, job growth, and pay of surgical technologists with ...

  8. Surgical strategies in endocrine tumors

    NARCIS (Netherlands)

    Schreinemakers, J.M.J.

    2010-01-01

    Endocrine surgery has become more custom-made throughout the years. Endocrine tumors can be sporadic or develop as part of familial syndromes. Several familial syndromes are known to cause endocrine tumors. The most common are multiple endocrine neoplasia (MEN) syndromes type 1, 2A and 2B. This

  9. Use of corporate Six Sigma performance-improvement strategies to reduce incidence of catheter-related bloodstream infections in a surgical ICU.

    Science.gov (United States)

    Frankel, Heidi L; Crede, William B; Topal, Jeffrey E; Roumanis, Sarah A; Devlin, Marie W; Foley, Andrea B

    2005-09-01

    Corporate performance-improvement methodologies can outperform traditional ones in addressing ICU-based adverse events. My colleagues and I used Six Sigma methodology to address our catheter-related bloodstream infection (CR-BSI) rate, which considerably exceeded the nationally established median over a 9-year period. We hypothesized that use of Six Sigma methodology would result in a substantial and sustainable decrease in our CR-BSI rate. All patients were directly cared for by a geographically localized surgical ICU team in an academic tertiary referral center. CR-BSIs were identified by infection control staff using CDC definitions. Personnel trained in Six Sigma techniques facilitated performance-improvement efforts. Interventions included barrier precaution kits, new policies for catheter changes over guide wires, adoption of a new site-preparation antiseptic, direct attending supervision of catheter insertions, video training for housestaff, and increased frequency of dressing changes. After additional data analysis, chlorhexidine-silver catheters were used selectively in high-risk patients. The impact of interventions was assessed by monitoring the number of catheters placed between CR-BSIs. Before the intervention period, 27 catheters were placed, on average, between individual CR-BSIs, a CR-BSI rate of 11 per 1,000 catheter days. After all operations were implemented, 175 catheters were placed between line infections, and average CR-BSI rate of 1.7/1,000 catheter days, a 650% improvement (p Six Sigma corporate performance-improvement method impacting purely clinical outcomes. CR-BSI reduction was highly substantial and sustained after other traditional strategies had failed.

  10. ANT Advanced Neural Tool

    Energy Technology Data Exchange (ETDEWEB)

    Labrador, I.; Carrasco, R.; Martinez, L.

    1996-07-01

    This paper describes a practical introduction to the use of Artificial Neural Networks. Artificial Neural Nets are often used as an alternative to the traditional symbolic manipulation and first order logic used in Artificial Intelligence, due the high degree of difficulty to solve problems that can not be handled by programmers using algorithmic strategies. As a particular case of Neural Net a Multilayer Perception developed by programming in C language on OS9 real time operating system is presented. A detailed description about the program structure and practical use are included. Finally, several application examples that have been treated with the tool are presented, and some suggestions about hardware implementations. (Author) 15 refs.

  11. Pharmacologically active microcarriers delivering BDNF within a hydrogel: Novel strategy for human bone marrow-derived stem cells neural/neuronal differentiation guidance and therapeutic secretome enhancement.

    Science.gov (United States)

    Kandalam, Saikrishna; Sindji, Laurence; Delcroix, Gaëtan J-R; Violet, Fabien; Garric, Xavier; André, Emilie M; Schiller, Paul C; Venier-Julienne, Marie-Claire; des Rieux, Anne; Guicheux, Jérôme; Montero-Menei, Claudia N

    2017-02-01

    Stem cells combined with biodegradable injectable scaffolds releasing growth factors hold great promises in regenerative medicine, particularly in the treatment of neurological disorders. We here integrated human marrow-isolated adult multilineage-inducible (MIAMI) stem cells and pharmacologically active microcarriers (PAMs) into an injectable non-toxic silanized-hydroxypropyl methylcellulose (Si-HPMC) hydrogel. The goal is to obtain an injectable non-toxic cell and growth factor delivery device. It should direct the survival and/or neuronal differentiation of the grafted cells, to safely transplant them in the central nervous system, and enhance their tissue repair properties. A model protein was used to optimize the nanoprecipitation conditions of the neuroprotective brain-derived neurotrophic factor (BDNF). BDNF nanoprecipitate was encapsulated in fibronectin-coated (FN) PAMs and the in vitro release profile evaluated. It showed a prolonged, bi-phasic, release of bioactive BDNF, without burst effect. We demonstrated that PAMs and the Si-HPMC hydrogel increased the expression of neural/neuronal differentiation markers of MIAMI cells after 1week. Moreover, the 3D environment (PAMs or hydrogel) increased MIAMI cells secretion of growth factors (b-NGF, SCF, HGF, LIF, PlGF-1, SDF-1α, VEGF-A & D) and chemokines (MIP-1α & β, RANTES, IL-8). These results show that PAMs delivering BDNF combined with Si-HPMC hydrogel represent a useful novel local delivery tool in the context of neurological disorders. It not only provides neuroprotective BDNF but also bone marrow-derived stem cells that benefit from that environment by displaying neural commitment and an improved neuroprotective/reparative secretome. It provides preliminary evidence of a promising pro-angiogenic, neuroprotective and axonal growth-promoting device for the nervous system. Combinatorial tissue engineering strategies for the central nervous system are scarce. We developed and characterized a novel

  12. SURGICAL TECHNIQUE

    African Journals Online (AJOL)

    We describe a simple posterior spinal approach tuberculosis, difficulties in surgical treatment of consisting of foraminotomy and discectomy for tuberculous spondylitis are made more complex by lumbar T B spondylosis. The patients' good response neurological deficit, bony deformities, unaffordability to this simple surgical ...

  13. Cooperating attackers in neural cryptography.

    Science.gov (United States)

    Shacham, Lanir N; Klein, Einat; Mislovaty, Rachel; Kanter, Ido; Kinzel, Wolfgang

    2004-06-01

    A successful attack strategy in neural cryptography is presented. The neural cryptosystem, based on synchronization of neural networks by mutual learning, has been recently shown to be secure under different attack strategies. The success of the advanced attacker presented here, called the "majority-flipping attacker," does not decay with the parameters of the model. This attacker's outstanding success is due to its using a group of attackers which cooperate throughout the synchronization process, unlike any other attack strategy known. An analytical description of this attack is also presented, and fits the results of simulations.

  14. Cooperating attackers in neural cryptography

    Science.gov (United States)

    Shacham, Lanir N.; Klein, Einat; Mislovaty, Rachel; Kanter, Ido; Kinzel, Wolfgang

    2004-06-01

    A successful attack strategy in neural cryptography is presented. The neural cryptosystem, based on synchronization of neural networks by mutual learning, has been recently shown to be secure under different attack strategies. The success of the advanced attacker presented here, called the “majority-flipping attacker,” does not decay with the parameters of the model. This attacker’s outstanding success is due to its using a group of attackers which cooperate throughout the synchronization process, unlike any other attack strategy known. An analytical description of this attack is also presented, and fits the results of simulations.

  15. Pattern, outcome and challenges of neonatal surgical cases in a ...

    African Journals Online (AJOL)

    ... 460 (6.2%) had a surgical condition. Of the 1,657 babies that died within the same period, 196 (11.8%) of them were those with surgical conditions. Congenital abnormalities accounted for 408 (88.7%) of all the surgical cases. Intestinal obstruction 129 (31.6%), neural tube defects 101 (24.8%) and anterior abdominal wall ...

  16. Concurrent inhibition of TGF-beta and mitogen driven signaling cascades in Dupuytren's disease - Non-surgical treatment strategies from a signaling point of view

    NARCIS (Netherlands)

    Krause, C.; Kloen, P.

    2012-01-01

    Dupuytren's disease (DD) is a benign progressive fibro-proliferative disorder of the fascia palmaris of the hand. Currently, treatment consists of surgical excision with a relatively high recurrence rate and risk of complications. To improve long-term outcome of DD treatment, research focus has

  17. SURGICAL EMBRYOLOGY '

    African Journals Online (AJOL)

    SURGICAL EMBRYOLOGY ' t. Foetal alcohol syndrome: an osteometric evaluation in the wistar rat animal model. S. S. Adebisi. Department of Human Anatomy, Faculty of Medicine, Ahmadu Bello University, Zaria,. Nigeria. Reprint requests to: Dr. S. S. Adebisi. E—mail.' .s'runln'si@tzlgu.adultg,. Abstract. Background: ...

  18. Surgical Audit

    African Journals Online (AJOL)

    2010-01-06

    Jan 6, 2010 ... Key performance indicators like major complications, readmissions, reoperations, transfers, incident reports, complaints and mortalities must also be included. Surgical audits bear very similar relationship to opera- tional research. There is a critical need for the results to be representative and accurate.

  19. SURGICAL ANATOMY

    African Journals Online (AJOL)

    SURGICAL ANATOMY. Rare high origin of the radial artery: a bilateral, symmetrical ease. I. O. ()koro and B. C. J iburum. Department of Anatomy, College of Medicine, lrno State University, Owerri, Nigeria. Reprint requests to: Dr I. O. 0k0r0, Department of Anatomy, [mo State University, P. M. B. 2000. Owerri, Nigeria.

  20. Surgical Navigation

    DEFF Research Database (Denmark)

    Azarmehr, Iman; Stokbro, Kasper; Bell, R. Bryan

    2017-01-01

    body removal, respectively. The average technical system accuracy and intraoperative precision reported were less than 1 mm and 1 to 2 mm, respectively. In general, SN is reported to be a useful tool for surgical planning, execution, evaluation, and research. The largest numbers of studies and patients......Purpose: This systematic review investigates the most common indications, treatments, and outcomes of surgical navigation (SN) published from 2010 to 2015. The evolution of SN and its application in oral and maxillofacial surgery have rapidly developed over recent years, and therapeutic indications...... surgery, skull-base surgery, and foreign body removal were the areas of interests. Results: The search generated 13 articles dealing with traumatology; 5, 6, 2, and 0 studies were found that dealt with the topics of orthognathic surgery, cancer and reconstruction surgery, skull-base surgery, and foreign...

  1. The Evolution of Surgical Strategies for Pancreatic Neuroendocrine Tumors (Pan-NENs): Time-trend and Outcome Analysis From 587 Consecutive Resections at a High-volume Institution.

    Science.gov (United States)

    Landoni, Luca; Marchegiani, Giovanni; Pollini, Tommaso; Cingarlini, Sara; D'Onofrio, Mirko; Capelli, Paola; De Robertis, Riccardo; Davì, Maria V; Amodio, Antonio; Impellizzeri, Harmony; Malpaga, Anna; Miotto, Marco; Boninsegna, Letizia; Crepaz, Lorenzo; Nessi, Chiara; Zingaretti, Caterina C; Paiella, Salvatore; Esposito, Alessandro; Casetti, Luca; Malleo, Giuseppe; Tuveri, Massimiliano; Butturini, Giovanni; Salvia, Roberto; Scarpa, Aldo; Falconi, Massimo; Bassi, Claudio

    2017-11-16

    The objective of the present analysis is 2-fold: first, to define the evolution of time trends on the surgical approach to pancreatic neuroendocrine neoplasms (Pan-NENs); second, to perform a complete analysis of the predictors of oncologic outcome. Reflecting their rarity and heterogeneity, Pan-NENs represent a clinical dilemma. In particular, there is a scarcity of data regarding their long-term follow-up after surgical resection. From the Institutional Pan-NEN database, 587 resected cases from 1990 to 2015 were extracted. The time span was arbitrarily divided into 3 discrete clusters enabling a balanced comparison between patient groups. Analyses for predictors of recurrence and survival were performed, together with conditional survival analyses. Among the 587 resected Pan-NENs, 75% were nonfunctioning tumors, and 5% were syndrome-associated tumors. The mean age was 54 years (±14 years), and 51% of the patients were female. The median tumor size was 20 mm (range 4 to 140), 62% were G1, 32% were G2, and 4% were G3 tumors. Time trends analysis revealed that the number of resected Pan-NENs constantly increased, while the size (from 25 to 20 mm) and G1 proportion (from 65% to 49%) decreased during the study period. After a mean follow-up of 75 months, recurrence analysis revealed that nonfunctioning tumors, tumor grade, N1 status, and vascular invasion were all independent predictors of recurrence. Regardless of size, G1 nonfunctioning tumors with no nodal involvement and vascular invasion had a negligible risk of recurrence at 5 years. Pan-NENs have been increasingly diagnosed and resected during the last 3 decades, revealing reliable predictors of outcome. Functioning and nodal status, tumor grade, and vascular invasion accurately predict survival and recurrence with resulting implications for patient follow-up.

  2. Surgical endodontics.

    Science.gov (United States)

    Carrotte, P

    2005-01-22

    Root canal treatment usually fails because infection remains within the root canal. An orthograde attempt at re-treatment should always be considered first. However, when surgery is indicated, modern microtechniques coupled with surgical magnification will lead to a better prognosis. Careful management of the hard and soft tissues is essential, specially designed ultrasonic tips should be used for root end preparation which should ideally be sealed with MTA. All cases should be followed up until healing is seen, or failure accepted, and should form a part of clinical audit.

  3. Evolvable synthetic neural system

    Science.gov (United States)

    Curtis, Steven A. (Inventor)

    2009-01-01

    An evolvable synthetic neural system includes an evolvable neural interface operably coupled to at least one neural basis function. Each neural basis function includes an evolvable neural interface operably coupled to a heuristic neural system to perform high-level functions and an autonomic neural system to perform low-level functions. In some embodiments, the evolvable synthetic neural system is operably coupled to one or more evolvable synthetic neural systems in a hierarchy.

  4. Tratamento híbrido com endoprótese não recoberta nas dissecções agudas da aorta tipo A New surgical strategy for acute type A aortic dissection: hybrid procedure

    Directory of Open Access Journals (Sweden)

    Ricardo Ribeiro Dias

    2007-12-01

    Full Text Available O tratamento da dissecção aguda da aorta tipo A de Stanford, com a utilização de um novo dispositivo (stent de aorta não recoberto em associação à interposição de tubo supracoronariano para a substituição da aorta ascendente e hemiarco permitem que o arco aórtico e porção da aorta descendente sejam tratados, sem acrescentar complexidade ao procedimento operatório, nem prolongar o tempo de isquemia cerebral ou sistêmica.The new surgical strategy to treat patients with acute type A aortic dissection, the hybrid procedure with an uncovered aortic stent, allows surgeons to treat the aortic arch and the proximal descending aorta, besides the ascending segment, without extension of cerebral or systemic ischemia.

  5. Less invasive surgical treatment of traumatic thoracolumbar fractures

    NARCIS (Netherlands)

    Verlaan, J.J.

    2004-01-01

    Less invasive surgical treatment of traumatic thoracolumbar fractures. In this thesis various strategies were employed to evaluate the posibilities of reducing the invasiveness of the surgical treatment of traumatic thoracolumbar fractures. A systematic review of the literature suggested that

  6. Surgical data processing for smart intraoperative assistance systems

    Directory of Open Access Journals (Sweden)

    Stauder Ralf

    2017-09-01

    Full Text Available Different components of the newly defined field of surgical data science have been under research at our groups for more than a decade now. In this paper, we describe our sensor-driven approaches to workflow recognition without the need for explicit models, and our current aim is to apply this knowledge to enable context-aware surgical assistance systems, such as a unified surgical display and robotic assistance systems. The methods we evaluated over time include dynamic time warping, hidden Markov models, random forests, and recently deep neural networks, specifically convolutional neural networks.

  7. SURGICAL NUTRITION

    Directory of Open Access Journals (Sweden)

    Danny Kurniawan Darianto

    2015-07-01

    Full Text Available A patient undergoing surgery faces great physiologic and psychologic stress. so nutritional demands are greatly increased during this period and deficiencies can easily develop. If these deficiencies are allowed to develop and are not in screening, serious malnutrition and clinical problem can occur. Therefore careful attention must be given to a patient's nutritional status in preparation of surgery, as well as to the individual nutritional needs. If these needs are met, complications are less likely developing. Natural resources provide for rapid recovery. Proper nutrition can speed healing in surgical patients with major trauma, severe malnutition, burns, and other severe illnesses. New techniques for tube feeding, intravenous nutrition for patients with serious weight loss due to gastrointestinal disorders, and use of supplements can hasten wound healing and shorten recovery times.

  8. Surgical videos for accident analysis, performance improvement, and complication prevention: time for a surgical black box?

    Science.gov (United States)

    Gambadauro, Pietro; Magos, Adam

    2012-03-01

    Conventional audit of surgical records through review of surgical results provides useful knowledge but hardly helps identify the technical reasons lying behind specific outcomes or complications. Surgical teams not only need to know that a complication might happen but also how and when it is most likely to happen. Functional awareness is therefore needed to prevent complications, know how to deal with them, and improve overall surgical performance. The authors wish to argue that the systematic recording and reviewing of surgical videos, a "surgical black box," might improve surgical care, help prevent complications, and allow accident analysis. A possible strategy to test this hypothesis is presented and discussed. Recording and reviewing surgical interventions, apart from helping us achieve functional awareness and increasing the safety profile of our performance, allows us also to effectively share our experience with colleagues. The authors believe that those potential implications make this hypothesis worth testing.

  9. Tissue engineering as a potential alternative or adjunct to surgical reconstruction in treating pelvic organ prolapse

    DEFF Research Database (Denmark)

    Boennelycke, M; Gräs, Søren; Lose, G

    2013-01-01

    Cell-based tissue engineering strategies could potentially provide attractive alternatives to surgical reconstruction of native tissue or the use of surgical implants in treating pelvic organ prolapse (POP).......Cell-based tissue engineering strategies could potentially provide attractive alternatives to surgical reconstruction of native tissue or the use of surgical implants in treating pelvic organ prolapse (POP)....

  10. Neural Networks

    Directory of Open Access Journals (Sweden)

    Schwindling Jerome

    2010-04-01

    Full Text Available This course presents an overview of the concepts of the neural networks and their aplication in the framework of High energy physics analyses. After a brief introduction on the concept of neural networks, the concept is explained in the frame of neuro-biology, introducing the concept of multi-layer perceptron, learning and their use as data classifer. The concept is then presented in a second part using in more details the mathematical approach focussing on typical use cases faced in particle physics. Finally, the last part presents the best way to use such statistical tools in view of event classifers, putting the emphasis on the setup of the multi-layer perceptron. The full article (15 p. corresponding to this lecture is written in french and is provided in the proceedings of the book SOS 2008.

  11. Surgical Treatment of Facial Paralysis

    Science.gov (United States)

    2009-01-01

    The management of facial paralysis is one of the most complex areas of reconstructive surgery. Given the wide variety of functional and cosmetic deficits in the facial paralysis patient, the reconstructive surgeon requires a thorough understanding of the surgical techniques available to treat this condition. This review article will focus on surgical management of facial paralysis and the treatment options available for acute facial paralysis (facial paralysis (3 weeks to 2 yr) and chronic facial paralysis (>2 yr). For acute facial paralysis, the main surgical therapies are facial nerve decompression and facial nerve repair. For facial paralysis of intermediate duration, nerve transfer procedures are appropriate. For chronic facial paralysis, treatment typically requires regional or free muscle transfer. Static techniques of facial reanimation can be used for acute, intermediate, or chronic facial paralysis as these techniques are often important adjuncts to the overall management strategy. PMID:19434284

  12. Neurally-mediated sincope.

    Science.gov (United States)

    Can, I; Cytron, J; Jhanjee, R; Nguyen, J; Benditt, D G

    2009-08-01

    Syncope is a syndrome characterized by a relatively sudden, temporary and self-terminating loss of consciousness; the causes may vary, but they have in common a temporary inadequacy of cerebral nutrient flow, usually due to a fall in systemic arterial pressure. However, while syncope is a common problem, it is only one explanation for episodic transient loss of consciousness (TLOC). Consequently, diagnostic evaluation should start with a broad consideration of real or seemingly real TLOC. Among those patients in whom TLOC is deemed to be due to ''true syncope'', the focus may then reasonably turn to assessing the various possible causes; in this regard, the neurally-mediated syncope syndromes are among the most frequently encountered. There are three common variations: vasovagal syncope (often termed the ''common'' faint), carotid sinus syndrome, and the so-called ''situational faints''. Defining whether the cause is due to a neurally-mediated reflex relies heavily on careful history taking and selected testing (e.g., tilt-test, carotid massage). These steps are important. Despite the fact that neurally-mediated faints are usually relatively benign from a mortality perspective, they are nevertheless only infrequently an isolated event; neurally-mediated syncope tends to recur, and physical injury resulting from falls or accidents, diminished quality-of-life, and possible restriction from employment or avocation are real concerns. Consequently, defining the specific form and developing an effective treatment strategy are crucial. In every case the goal should be to determine the cause of syncope with sufficient confidence to provide patients and family members with a reliable assessment of prognosis, recurrence risk, and treatment options.

  13. Neural Decoder for Topological Codes

    Science.gov (United States)

    Torlai, Giacomo; Melko, Roger G.

    2017-07-01

    We present an algorithm for error correction in topological codes that exploits modern machine learning techniques. Our decoder is constructed from a stochastic neural network called a Boltzmann machine, of the type extensively used in deep learning. We provide a general prescription for the training of the network and a decoding strategy that is applicable to a wide variety of stabilizer codes with very little specialization. We demonstrate the neural decoder numerically on the well-known two-dimensional toric code with phase-flip errors.

  14. Micro-surgical endodontics.

    Science.gov (United States)

    Eliyas, S; Vere, J; Ali, Z; Harris, I

    2014-02-01

    Non-surgical endodontic retreatment is the treatment of choice for endodontically treated teeth with recurrent or residual disease in the majority of cases. In some cases, surgical endodontic treatment is indicated. Successful micro-surgical endodontic treatment depends on the accuracy of diagnosis, appropriate case selection, the quality of the surgical skills, and the application of the most appropriate haemostatic agents and biomaterials. This article describes the armamentarium and technical procedures involved in performing micro-surgical endodontics to a high standard.

  15. Perioperative Palliative Care Considerations for Surgical Oncology Nurses.

    Science.gov (United States)

    Sipples, Rebecca; Taylor, Richard; Kirk-Walker, Deborah; Bagcivan, Gulcan; Dionne-Odom, J Nicholas; Bakitas, Marie

    2017-02-01

    To explore the opportunities to incorporate palliative care into perioperative oncology patient management and education strategies for surgical oncology nurses. Articles related to palliative care and surgical oncology to determine the degree of integration, gaps, and implications for practice. Although evidence supports positive patient outcomes when palliative care is integrated in the perioperative period, uptake of palliative care into surgical settings is slow. Palliative care concepts are not adequately integrated into surgical and nursing education. With appropriate palliative care education and training, surgical oncology nurses will be empowered to foster surgical-palliative care collaborations to improve patient outcomes. Copyright © 2016 Elsevier Inc. All rights reserved.

  16. Neural Tube Defects

    Science.gov (United States)

    ... vitamin, before and during pregnancy prevents most neural tube defects. Neural tube defects are usually diagnosed before the infant is ... or imaging tests. There is no cure for neural tube defects. The nerve damage and loss of function ...

  17. Surgical strategies for glioma involving language areas.

    Science.gov (United States)

    Zhang, Zhong; Jiang, Tao; Xie, Jian; Liu, Fu-sheng; Li, Shou-wei; Qiao, Hui; Wang, Zhong-cheng

    2008-09-20

    Successful treatment of gliomas in or adjacent to language areas constitutes a major challenge to neurosurgery. The present study was performed to evaluate the procedure of language mapping via intraoperative direct cortical electrical stimulation under awake anaesthesia when performed prior to resective glioma surgery. Thirty patients with gliomas and left-hemisphere dominance and, who underwent language mapping via intraoperative direct cortical electrical stimulation under awake anaesthesia before resective glioma surgery, were analyzed retrospectively. All patients had tumors in or adjacent to cortical language areas. The brain lesions were removed according to anatomic-functional boundaries with preservation of areas of language function. Both preoperative and postoperative functional findings were evaluated. Intraoperative language areas were detected in 20 patients but not in four patients. Language mapping failure for reasons attributable to the anaesthesia or to an intraoperative increase in intracranial pressure occurred in six cases. Seven patients presented with moderate or severe language deficits after six months of follow-up. Total resection was achieved in 14 cases, near-total resection in 12 cases and subtotal resection in four cases. Intraoperative cortical electrical stimulation is an accurate and safe approach to identification of the language cortex. Awake craniotomy intraoperative cortical electrical stimulation, in combination with presurgical neurological functional imaging to identify the anatomic-functional boundaries of tumor resection, permits extensive tumor excision while preserving normal language function and minimizing the risk of postoperative language deficits.

  18. Neural plasticity: the biological substrate for neurorehabilitation.

    Science.gov (United States)

    Warraich, Zuha; Kleim, Jeffrey A

    2010-12-01

    Decades of basic science have clearly demonstrated the capacity of the central nervous system (CNS) to structurally and functionally adapt in response to experience. The field of neurorehabilitation has begun to use this body of work to develop neurobiologically informed therapies that harness the key behavioral and neural signals that drive neural plasticity. The present review describes how neural plasticity supports both learning in the intact CNS and functional improvement in the damaged or diseased CNS. A pragmatic, interdisciplinary definition of neural plasticity is presented that may be used by both clinical and basic scientists studying neurorehabilitation. Furthermore, a description of how neural plasticity may act to drive different neural strategies underlying functional improvement after CNS injury or disease is provided. The understanding of the relationship between these different neural strategies, mechanisms of neural plasticity, and changes in behavior may facilitate the development of novel, more effective rehabilitation interventions. Copyright © 2010 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.

  19. Principles of neural information processing

    CERN Document Server

    Seelen, Werner v

    2016-01-01

    In this fundamental book the authors devise a framework that describes the working of the brain as a whole. It presents a comprehensive introduction to the principles of Neural Information Processing as well as recent and authoritative research. The books´ guiding principles are the main purpose of neural activity, namely, to organize behavior to ensure survival, as well as the understanding of the evolutionary genesis of the brain. Among the developed principles and strategies belong self-organization of neural systems, flexibility, the active interpretation of the world by means of construction and prediction as well as their embedding into the world, all of which form the framework of the presented description. Since, in brains, their partial self-organization, the lifelong adaptation and their use of various methods of processing incoming information are all interconnected, the authors have chosen not only neurobiology and evolution theory as a basis for the elaboration of such a framework, but also syst...

  20. Optimized color decomposition of localized whole slide images and convolutional neural network for intermediate prostate cancer classification

    Science.gov (United States)

    Zhou, Naiyun; Gao, Yi

    2017-03-01

    This paper presents a fully automatic approach to grade intermediate prostate malignancy with hematoxylin and eosin-stained whole slide images. Deep learning architectures such as convolutional neural networks have been utilized in the domain of histopathology for automated carcinoma detection and classification. However, few work show its power in discriminating intermediate Gleason patterns, due to sporadic distribution of prostate glands on stained surgical section samples. We propose optimized hematoxylin decomposition on localized images, followed by convolutional neural network to classify Gleason patterns 3+4 and 4+3 without handcrafted features or gland segmentation. Crucial glands morphology and structural relationship of nuclei are extracted twice in different color space by the multi-scale strategy to mimic pathologists' visual examination. Our novel classification scheme evaluated on 169 whole slide images yielded a 70.41% accuracy and corresponding area under the receiver operating characteristic curve of 0.7247.

  1. Síndrome da hipoplasia do coração esquerdo: a influência da estratégia cirúrgica nos resultados Hypoplastic left heart syndrome: the influence of surgical strategy on outcomes

    Directory of Open Access Journals (Sweden)

    José Pedro da Silva

    2007-03-01

    Full Text Available OBJETIVOS: Relatar uma estratégia cirúrgica para a operação de Norwood na síndrome de hipoplasia do coração esquerdo (SHCE, que possibilite tempo curto de parada circulatória hipotérmica e reconstrução do arco aórtico com pericárdio autólogo. Comparar os resultados das técnicas anastomose de Blalock-Taussig modificado (B-Tm e tubo ventrículo direito para artéria pulmonar (VD-AP no restabelecimento da circulação pulmonar. MÉTODOS: Estudo retrospectivo compreendendo 71 neonatos portadores de SHCE, consecutivamente operados entre março de 1999 e fevereiro de 2006. Foi usada a mesma técnica de reconstrução da neo-aorta e duas técnicas diferentes de restabelecimento da circulação pulmonar: anastomose de B-Tm nos primeiros 37 neonatos e tubo VD-AP nos últimos 34. A canulação do canal arterial para a perfusão arterial foi a parte principal da estratégia cirúrgica para diminuir o tempo de parada circulatória hipotérmica. RESULTADOS: A sobrevida geral foi de 74,64%, sendo de 67,57% no grupo B-Tm e de 82,35% no grupo tubo VD-AP (p = 0,1808. Os índices de mortalidade entre o primeiro e o segundo estágios foram de 40% e de 4,4%, respectivamente, nos grupo B-Tm e tubo VD-AP (p = 0,0054. Os tempos de parada circulatória hipotérmica foram, respectivamente, de 45,79 + 1,99 minutos e de 36,62 + 1,62 minutos (p = 0,0012. Coarctação tardia da aorta ocorreu em cinco pacientes (7,2%. CONCLUSÃO: Essa estratégia cirúrgica resultou em tempo curto de parada circulatória, baixa mortalidade e boa morfologia da neo-aorta, com baixa incidência tardia de coarctação aórtica. A maior sobrevida ao primeiro estágio com o tubo VD-AP não foi significante, mas a mortalidade interestágios foi estatisticamente menor na comparação com o procedimento B-Tm.OBJECTIVES: To report a surgical strategy for the Norwood procedure in the hypoplastic left heart syndrome (HLHS that enables short hypothermic circulatory arrest time and aortic

  2. [Neural repair].

    Science.gov (United States)

    Kitada, Masaaki; Dezawa, Mari

    2008-05-01

    Recent progress of stem cell biology gives us the hope for neural repair. We have established methods to specifically induce functional Schwann cells and neurons from bone marrow stromal cells (MSCs). The effectiveness of these induced cells was evaluated by grafting them either into peripheral nerve injury, spinal cord injury, or Parkinson' s disease animal models. MSCs-derived Schwann cells supported axonal regeneration and re-constructed myelin to facilitate the functional recovery in peripheral and spinal cord injury. MSCs-derived dopaminergic neurons integrated into host striatum and contributed to behavioral repair. In this review, we introduce the differentiation potential of MSCs and finally discuss about their benefits and drawbacks of these induction systems for cell-based therapy in neuro-traumatic and neuro-degenerative diseases.

  3. Neural strategies for reading Japanese and Chinese sentences: a cross-linguistic fMRI study of character-decoding and morphosyntax.

    Science.gov (United States)

    Huang, Koongliang; Itoh, Kosuke; Kwee, Ingrid L; Nakada, Tsutomu

    2012-09-01

    Japanese and Chinese share virtually identical morphographic characters invented in ancient China. Whereas modern Chinese retained the original morphographic functionality of these characters (hanzi), modern Japanese utilizes these characters (kanji) as complex syllabograms. This divergence provides a unique opportunity to systematically investigate brain strategies for sentence reading in Japanese-Chinese bi-literates. Accordingly, we investigated brain activation associated with Japanese and Chinese reading in 14 native Japanese speakers literate in Mandarin and 14 native Mandarin speakers literate in Japanese using functional magnetic resonance imaging performed on a 3T system. The activation pattern exhibited clearly distinct features specific for each language. Regardless of the subject's native language literacy, Chinese reading activated an area significantly larger than Japanese reading, suggesting that brain processes involved in Chinese reading were much more complex than Japanese reading. Significant recruitment of corresponding cortical areas in the right hemisphere with Chinese reading was also apparent. The activation patterns associated with Japanese reading by native Japanese literates was highly consistent with previous reports, and included the left inferior frontal gyrus (IFG), left posterior temporal lobe (PTL), and left ventral premotor cortex (PMv). The activation pattern associated with Chinese reading by native Chinese literates was also highly consistent with previous reports, namely the left IFG, left PTL, left PMv, left anterior temporal lobe (ATL), and bilateral parieto occipital lobes (LPOL). The activation pattern associated with Chinese reading by native Japanese literates was virtually identical to that by native Chinese literates, whereas the activation pattern associated with Japanese reading by native Chinese literates was signified by additional activation of LPOL compared to that by native Japanese literate. The study indicated

  4. Abortion - surgical - aftercare

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/patientinstructions/000658.htm Abortion - surgical - aftercare To use the sharing features on ... please enable JavaScript. You have had a surgical abortion. This is a procedure that ends pregnancy by ...

  5. IC Treatment: Surgical Procedures

    Science.gov (United States)

    ... Profile Home Diagnosis & Treatment IC Treatments Surgical Procedures Surgical Procedures For people with interstitial cystitis (IC), the ... latest stories, news and events. Please leave this field empty Interstitial Cystitis Association 7918 Jones Branch Drive, ...

  6. American Pediatric Surgical Association

    Science.gov (United States)

    American Pediatric Surgical Association Search for: Login Resources + For Members For Professionals For Training Program Directors For Media For ... Surgical Outcomes Surveys & Results Publications Continuing Education + ExPERT Pediatric Surgery NaT Annual Meeting CME MOC Requirements Residents / ...

  7. Surgical wound care -- closed

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/patientinstructions/000738.htm Surgical wound care - closed To use the sharing features on ... made during surgery. It is also called a "surgical wound." Some incisions are small. Others are very long. ...

  8. Hernia Surgical Mesh Implants

    Science.gov (United States)

    ... Procedures Implants and Prosthetics Hernia Surgical Mesh Implants Hernia Surgical Mesh Implants Share Tweet Linkedin Pin it ... between patients and their surgeons. What is a Hernia? A hernia occurs when an organ, intestine or ...

  9. What Metrics Accurately Reflect Surgical Quality?

    Science.gov (United States)

    Ibrahim, Andrew M; Dimick, Justin B

    2018-01-29

    Surgeons are increasingly under pressure to measure and improve their quality. While there is broad consensus that we ought to track surgical quality, there is far less agreement about which metrics matter most. This article reviews the important statistical concepts of case mix and chance as they apply to understanding the observed wide variation in surgical quality. We then discuss the benefits and drawbacks of current measurement strategies through the framework of structure, process, and outcomes approaches. Finally, we describe emerging new metrics, such as video evaluation and network optimization, that are likely to take on an increasingly important role in the future of measuring surgical quality.

  10. Does arsenic increase the risk of neural tube defects among a highly exposed population? A new case-control study in Bangladesh.

    Science.gov (United States)

    Mazumdar, Maitreyi

    2017-01-30

    Neural tube defects are debilitating birth defects that occur when the developing neural plate fails to close in early gestation. Arsenic induces neural tube defects in animal models, but whether environmental arsenic exposure increases risk of neural tube defects in humans is unknown. We describe a new case-control study in Bangladesh, a country currently experiencing an epidemic of arsenic poisoning through contaminated drinking water. We plan to understand how arsenic influences risk of neural tube defects in humans through mechanisms that include disruption of maternal glucose and folate metabolism, as well as epigenetic effects. We also investigate whether sweat chloride concentration, a potential new biomarker for arsenic toxicity, can be used to identify women at higher risk for having a child affected by neural tube defect. We will collect dural tissue from cases, obtained at the time of surgical closure of the defect, and believe investigation of these samples will provide insight into the epigenetic mechanisms by which prenatal arsenic exposure affects the developing nervous system. These studies explore mechanisms by which arsenic may increase risk of neural tube defects in humans and use a unique population with high arsenic exposure to test hypotheses. If successful, these studies may assist countries with high arsenic exposure such as Bangladesh to identify populations at high risk of neural tube defects, as well as direct development of novel screening strategies for maternal risk.Birth Defects Research 109:92-98, 2017.© 2016 The Authors Birth Defects Research Published by Wiley Periodicals, Inc. © 2016 The Authors Birth Defects Research Published by Wiley Periodicals, Inc.

  11. Surgical options for intrahepatic cholangiocarcinoma

    Science.gov (United States)

    Wang, Kui; Zhang, Han; Xia, Yong; Liu, Jian

    2017-01-01

    Intrahepatic cholangiocarcinoma (ICC) is the second most common primary liver cancer, accounting for 10–15% of primary hepatic malignancy. The incidence and cancer-related mortality of ICC continue to increase worldwide. At present, hepatectomy is still the most effective treatment for ICC patients to achieve long-term survival, although its overall efficacy may not be as good as that for patients with hepatocellular carcinoma (HCC) due to the unique pathogenesis and clinical-pathological profiles of ICC. Viral infection, lithiasis and metabolic factors may all be associated with the pathogenesis of ICC. Poor blood supply, cirrhosis (in rare cases), surrounding organ invasion, and lymph node/distal metastasis have significant impacts on the selection of surgical strategies, surgical resection rate, postoperative complications, recurrence and metastasis. Surgical treatment for ICC includes R0 resection, lymphadenectomy, total gross resection of the involved biliary tracts, blood vessels and surrounding tissues in adjacent organs, and reconstruction. Postoperative adjuvant therapy and local-regional therapy after recurrence may improve survival. Liver transplantation (LT) is reported to have a moderate treatment effect on early ICC although its efficacy remains controversial. In this article, we reviewed the epidemiology and staging of ICC and highlighted the selection of surgical modalities and postoperative outcomes of ICC patients via literature review. PMID:28503555

  12. Surgical Lasers In Gynecology

    Science.gov (United States)

    Schellhas, Helmut F.; Barnes, Alfonso E.

    1982-12-01

    Multipurpose surgical CO2 lasers marketed in the USA have been developed to be applicable to a variety of surgical procedures in many surgical fields. They are all suited for endoscopic surgical procedures and can be fitted to all standard surgical microscopes. They all can adjust the focal length of the laser beam to the different standard focal lengths of the surgical microscope which for instance in laryngoscopy is 400 mm and in colposcopy 300 mm. One laser instrument can even change the spot size in a given focal distance which is very advantageous for some microsurgical procedures (Merrimack Laboratories 820). All multipurpose surgical CO2 laser systems provide a multi-articulated surgical arm for free-hand surgery. The surgical arms are cumbersome to use but they are adapted to the surgeons needs with ingenuity. The practicality of the multi-articulated surgical arms depends mostly on the distance of the handpiece from the surgical console which now is also overbridged by the laser tube in most surgical laser system. The spot size of the beam is variable in most handpieces by interchangeable lenses which modify the focal distance of the beam and the power density. Another common feature in all systems is a coaxial He-Ne pilot light which provides a red spot which unfortunately becomes invisible in a bleeding surgical field. Most surgical laser systems have a spacial mode of TEM 00 which is essential for incisional surgery. The continuous mode of beam delivery is used for incisional surgery and also for most endoscopic procedures.

  13. [Infantile cataract and surgical management].

    Science.gov (United States)

    Milazzo, S; Turut, P; Brémond-Gignac, D

    2011-03-01

    The cataract or opacification of the lens raises, in the child, two problems: of clinical diagnosis but especially of action to be taken therapeutic in particular surgical in front of a juvenille lens. This leads to a step and a therapeutic strategy, which must, individually, weigh the advantages and the disadvantages of the surgery. It is a frequent cause of visual handicap in the child. In the event of unilaterality, the major risks are the amblyopia and the aniseiconia. The elements to be analyzed are linked or the bilaterality, the type and the importance of opacity, local or general associated malformations, precocity diagnoses, and with regard to the treatment, the potential surgical complications, the quality of the optical correction, the postoperative assumption of responsibility and the cooperation of the parents. In all the cases, it will always be necessary to treat the functional part of the amblyopia. Copyright © 2011. Published by Elsevier Masson SAS.

  14. Surgical planning for cervical deformity based on a 3D model

    Directory of Open Access Journals (Sweden)

    Juan Barges-Coll

    2017-01-01

    Full Text Available The treatment of fixed cervical deformity is complex, but the principles guiding its correction remain the same as in deformity of other spinal regions, with the goal of deformity correction that results in a solid fusion with adequate decompression of the neural elements. In these challenging cases, osteotomies are necessary to mobilize the rigid spine and to obtain the desired correction, but they can be associated with increased risk of complications. Therefore, careful preoperative planning and a complete understanding of the anatomic variations allow patient-tailored approaches with and case specific techniques for the optimal and safe treatment of a variety of complex cervical deformities. We present a case report with a complex spinal deformity where a 3D model was used for surgical strategy that allowed us to “simulate” the osteotomies and get a better correction of the cervical deformity.

  15. Surgical planning for cervical deformity based on a 3D model

    Science.gov (United States)

    Barges-Coll, Juan; Peciu-Florianu, Iulia; Martiniere, Sébastien; Duff, John Michael

    2017-01-01

    The treatment of fixed cervical deformity is complex, but the principles guiding its correction remain the same as in deformity of other spinal regions, with the goal of deformity correction that results in a solid fusion with adequate decompression of the neural elements. In these challenging cases, osteotomies are necessary to mobilize the rigid spine and to obtain the desired correction, but they can be associated with increased risk of complications. Therefore, careful preoperative planning and a complete understanding of the anatomic variations allow patient-tailored approaches with and case specific techniques for the optimal and safe treatment of a variety of complex cervical deformities. We present a case report with a complex spinal deformity where a 3D model was used for surgical strategy that allowed us to “simulate” the osteotomies and get a better correction of the cervical deformity. PMID:29021678

  16. Surgical never events in the United States.

    Science.gov (United States)

    Mehtsun, Winta T; Ibrahim, Andrew M; Diener-West, Marie; Pronovost, Peter J; Makary, Martin A

    2013-04-01

    Surgical never events are being used increasingly as quality metrics in health care in the United States. However, little is known about their costs to the health care system, the outcomes of patients, or the characteristics of the providers involved. We designed a study to describe the number and magnitude of paid malpractice claims for surgical never events, as well as associated patient and provider characteristics. We used the National Practitioner Data Bank, a federal repository of medical malpractice claims, to identify malpractice settlements and judgments of surgical never events, including retained foreign bodies, wrong-site, wrong-patient, and wrong-procedure surgery. Payment amounts, patient outcomes, and provider characteristics were evaluated. We identified a total of 9,744 paid malpractice settlement and judgments for surgical never events occurring between 1990 and 2010. Malpractice payments for surgical never events totaled $1.3 billion. Mortality occurred in 6.6% of patients, permanent injury in 32.9%, and temporary injury in 59.2%. Based on literature rates of surgical adverse events resulting in paid malpractice claims, we estimated that 4,082 surgical never event claims occur each year in the United States. Increased payments were associated with severe patient outcomes and claims involving a physician with multiple malpractice reports. Of physicians named in a surgical never event claim, 12.4% were later named in at least 1 future surgical never event claim. Surgical never events are costly to the health care system and are associated with serious harm to patients. Patient and provider characteristics may help to guide prevention strategies. Copyright © 2013 Mosby, Inc. All rights reserved.

  17. Palliative surgical oncology.

    Science.gov (United States)

    Hanna, Nader N; Bellavance, Emily; Keay, Timothy

    2011-04-01

    Palliative surgical oncology is a relatively new concept, but builds on a long tradition in surgery. As the field of palliative medicine grows and becomes its own specialty, surgeons have been receiving some specialized training in palliative care; devising specific palliative surgical procedures; and reevaluating the ethics of their interactions with patients, especially for the selection of palliative surgical procedures. This is leading to a new form of surgical practice in which the emphasis is on relief of present or anticipated symptoms, even if the interventions do not prolong a patient's life span. Copyright © 2011 Elsevier Inc. All rights reserved.

  18. Role of lumbar interspinous distraction on the neural elements.

    Science.gov (United States)

    Alfieri, Alex; Gazzeri, Roberto; Prell, Julian; Scheller, Christian; Rachinger, Jens; Strauss, Christian; Schwarz, Andreas

    2012-10-01

    The interspinous distraction devices are used to treat variable pathologies ranging from facet syndrome, diskogenic low back pain, degenerative spinal stenosis, diskopathy, spondylolisthesis, and instability. The insertion of a posterior element with an interspinous device (ISD) is commonly judged responsive to a relative kyphosis of a lumbar segment with a moderate but persistent increase of the spinal canal and of the foraminal width and area, and without influence on low-grade spondylolisthesis. The consequence is the need of shared specific biomechanical concepts to give for each degenerative problem the right indication through a critical analysis of all available experimental and clinical biomechanical data. We reviewed systematically the available clinical and experimental data about kyphosis, enlargement of the spinal canal, distraction of the interspinous distance, increase of the neural foramina, ligamentous structures, load of the posterior annulus, intradiskal pressure, strength of the spinous processes, degeneration of the adjacent segment, complications, and cost-effectiveness of the ISD. The existing literature does not provide actual scientific evidence over the superiority of the ISD strategy, but most of the experimental and clinical data show a challenging potential. These considerations are applicable with different types of ISD with only few differences between the different categories. Despite--or because of--the low invasiveness of the surgical implantation of the ISD, this technique promises to play a major role in the future degenerative lumbar microsurgery. The main indications for ISD remain lumbar spinal stenoses and painful facet arthroses. A clear documented contraindication is the presence of an anterolisthesis. Nevertheless, the existing literature does not provide evidence of superiority of outcome and cost-effectiveness of the ISD strategy over laminectomy or other surgical procedures. At this time, the devices should be used in

  19. An overview of pre-surgical evaluation

    Directory of Open Access Journals (Sweden)

    Kurupath Radhakrishnan

    2014-01-01

    Full Text Available The success of an epilepsy surgery program depends upon the early identification of potential surgical candidates and selecting from them, ideal candidates for surgery, who are destined to have a post-operative seizure-free outcome without any unacceptable neurological deficits. Since epilepsy surgery centers in resource-poor countries will lack the full range of state-of-the-art technologies usually available in resource-rich countries to perform pre-surgical evaluation, cost-effectively utilization of the locally available investigative facilities to select the surgical candidates becomes challenging. In the present era of rapid electronic communications and telemedicine, it has become possible for epilepsy surgery centers to pool their technological and human resources and to partner with centers nationally and internationally in implementing pre-surgical evaluation strategies.

  20. Introduction to neural networks

    CERN Document Server

    James, Frederick E

    1994-02-02

    1. Introduction and overview of Artificial Neural Networks. 2,3. The Feed-forward Network as an inverse Problem, and results on the computational complexity of network training. 4.Physics applications of neural networks.

  1. Morphological neural networks

    Energy Technology Data Exchange (ETDEWEB)

    Ritter, G.X.; Sussner, P. [Univ. of Florida, Gainesville, FL (United States)

    1996-12-31

    The theory of artificial neural networks has been successfully applied to a wide variety of pattern recognition problems. In this theory, the first step in computing the next state of a neuron or in performing the next layer neural network computation involves the linear operation of multiplying neural values by their synaptic strengths and adding the results. Thresholding usually follows the linear operation in order to provide for nonlinearity of the network. In this paper we introduce a novel class of neural networks, called morphological neural networks, in which the operations of multiplication and addition are replaced by addition and maximum (or minimum), respectively. By taking the maximum (or minimum) of sums instead of the sum of products, morphological network computation is nonlinear before thresholding. As a consequence, the properties of morphological neural networks are drastically different than those of traditional neural network models. In this paper we consider some of these differences and provide some particular examples of morphological neural network.

  2. Control tower to surgical theater

    Directory of Open Access Journals (Sweden)

    Buccioli Matteo

    2016-09-01

    Full Text Available The main social priority is to reduce public debt and to streamline national health service (NHS costs. Consequently, health managers need to acquire operating methods within their managerial structures so that all available resources are better planned in terms of effectiveness and efficiency, without compromising patient safety. In order to identify the information categories needed to know the whole surgical process is necessary to divide these in two main categories, supply and demand. Demand Information Group (DIG contains the information that identify patients and its needs in terms of care. Instead Supply Information Group (SIG contains information about hospital resources in order to cover the supply. The surgical process analyzed in terms such as industrial production process has the goal of produce the “health product for the patient” and its central part is performed in the operating room by a surgical team. This does not mean that the precedent and subsequent phases of the operating room have minor importance, in fact to obtain a high quality “health product” and reduce to a minimum the clinical risks related to the patient it is necessary that each phase of the process is carried out in the right way. The implementation of a Control Tower Approach allows for the management of productive process, able to guide hospital managers to identify the best strategies and to improve the risk management of patient safety in response to the guidelines of the World Health Organization.

  3. Surgical treatment of degenerative spondylolisthesis.

    Science.gov (United States)

    Guigui, P; Ferrero, E

    2017-02-01

    Degenerative spondylolisthesis is a common pathology, often causing lumbar canal stenosis. There is, however, no strong consensus regarding the various medical and surgical treatments available. Surgery is indicated mainly for perceived functional impairment; when the indication is accepted, several questions determine the choice of surgical strategy. Improvement in neurological symptoms is one of the main treatment objectives. For this, it is useful to perform radicular decompression. Some authors recommend indirect decompression by interbody fusion (ALIF, TLIF, XLIF), others by means of an interspinous spacer but the most frequent technique is direct posterior decompression. In degenerative spondylolisthesis, functional results seem to be improved by associating stabilization to decompression, to prevent secondary destabilization. The following risk factors for destabilization are recognized: anteroposterior hypermobility, angular hypermobility and large disc height. Two stabilization techniques have been described: "dynamic" stabilization and (more frequently) fusion. Spinal instrumentation is frequently associated to fusion, in which case, it is essential for fusion position and length to take account of pelvic incidence and the patient's overall pattern of balance. Posterolateral fusion may be completed by interbody fusion (PLIF or TLIF). This has the theoretic advantage of increasing graft area and stability, restoring local lordosis and opening the foramina. Surgical treatment of degenerative spondylolisthesis usually consists in posterior release associated to instrumented fusion, but some cases can be more complex. It is essential for treatment planning to take account of the patient's general health status as well as symptomatology and global and segmental alignment. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  4. Pharmaceutical care in surgical patients: Tools for measurement and intervention

    OpenAIRE

    M. Boer

    2015-01-01

    Assessing and improving the quality of pharmaceutical care is a major issue in hospitals nowadays. Medication safety strategies are being developed and widely introduced in hospitals to reduce medication-related harm. Surgical patients are at risk for medication-related harm, also called adverse drug events. Their type of medication used, their multiple transfers along the surgical pathway and the surgical procedure itself might play an important role considering medication safety. Quality as...

  5. Surgical anatomy of the pterygopalatine fossa.

    Science.gov (United States)

    Wentges, R T

    1975-01-01

    The pterygopalatine fossa is the distribution centre for the main vessels and nerves of the middle third of the face. Its surgical anatomy is discussed, with particular emphasis on the relationship between the medical plate of the pterygoid process of the sphenoid bone and the vertical plate of the palatine bone; the position of the several foramina is reviewed also. It is stressed that the vascular contents of the pterygopalatine fossa lie in a coronal plane, anterior to the neural contents. Finally, a short review is given of the different surgical approaches to the pterygopalatine fossa. It is concluded that the transantral approach to the fossa, as originally described by Carnochan (1858), still seems to be the best way to gain access to this space.

  6. Surgical emergencies of the respiratory system.

    Science.gov (United States)

    Ludwig, L L

    2000-05-01

    Management of the patient in respiratory distress requires an efficient and accurate diagnostic and therapeutic strategy. This article describes the approach to patients with respiratory compromise, including the indications and techniques for performing emergency surgical procedures. The clinical features of upper airway obstruction, thoracic wall trauma, and pleural space disease are discussed.

  7. Deriving DICOM surgical extensions from surgical workflows

    Science.gov (United States)

    Burgert, O.; Neumuth, T.; Gessat, M.; Jacobs, S.; Lemke, H. U.

    2007-03-01

    The generation, storage, transfer, and representation of image data in radiology are standardized by DICOM. To cover the needs of image guided surgery or computer assisted surgery in general one needs to handle patient information besides image data. A large number of objects must be defined in DICOM to address the needs of surgery. We propose an analysis process based on Surgical Workflows that helps to identify these objects together with use cases and requirements motivating for their specification. As the first result we confirmed the need for the specification of representation and transfer of geometric models. The analysis of Surgical Workflows has shown that geometric models are widely used to represent planned procedure steps, surgical tools, anatomical structures, or prosthesis in the context of surgical planning, image guided surgery, augmented reality, and simulation. By now, the models are stored and transferred in several file formats bare of contextual information. The standardization of data types including contextual information and specifications for handling of geometric models allows a broader usage of such models. This paper explains the specification process leading to Geometry Mesh Service Object Pair classes. This process can be a template for the definition of further DICOM classes.

  8. Surgical Technology Program Guide.

    Science.gov (United States)

    Georgia Univ., Athens. Dept. of Vocational Education.

    This surgical technology program guide presents the standard curriculum for technical institutes in Georgia. The curriculum addresses the minimum competencies for a surgical technology program. The program guide is designed to relate primarily to the development of those skills needed by individuals in the field to provide services in the…

  9. Surgical medical record

    DEFF Research Database (Denmark)

    Bulow, S.

    2008-01-01

    A medical record is presented on the basis of selected linguistic pearls collected over the years from surgical case records Udgivelsesdato: 2008/12/15......A medical record is presented on the basis of selected linguistic pearls collected over the years from surgical case records Udgivelsesdato: 2008/12/15...

  10. Recognizing surgical patterns

    NARCIS (Netherlands)

    Bouarfa, L.

    2012-01-01

    In the Netherlands, each year over 1700 patients die from preventable surgical errors. Numerous initiatives to improve surgical practice have had some impact, but problems persist. Despite the introduction of checklists and protocols, patient safety in surgery remains a continuing challenge. This is

  11. Secondary and Tertiary Hyperparathyroidism, State of the Art Surgical Management

    Science.gov (United States)

    Pitt, Susan C.; Sippel, Rebecca S.

    2010-01-01

    Synopsis This article reviews the current surgical management of patients with secondary and tertiary hyperparathyroidism. The focus is on innovative surgical strategies that have improved the care of these patients over the past 10 to 15 years. Modalities such as intraoperative parathyroid hormone monitoring and radioguided probe utilization are discussed. PMID:19836494

  12. Surgical treatment of osteochondritis dissecans of the talus

    DEFF Research Database (Denmark)

    Zwingmann, Jörn; Südkamp, Norbert P; Schmal, Hagen

    2012-01-01

    PURPOSE: Osteochondritis dissecans (OCD) is an aseptic bone necrosis and represents pathology of high clinical relevance, which is frequently located on the talus. Various treatment strategies including non-surgical and surgical approaches have been described. An evidence-based treatment algorith...

  13. The surgical stress response: should it be prevented?

    DEFF Research Database (Denmark)

    Kehlet, H

    1991-01-01

    Postoperative complications such as myocardial infarction, pulmonary infection, thromboembolism and fatigue are probably related to increased demands, hypermetabolism, catabolism and other physiologic changes included in the global "surgical stress response." Strategies have been developed to sup...

  14. Rescue surgical pulmonary embolectomy for acute massive pulmonary embolism

    Directory of Open Access Journals (Sweden)

    Ahmed Abdulrahman Elassal

    2016-08-01

    Conclusion: Surgical pulmonary embolectomy is a rescue operation in high-risk PE. It could save patients with preoperative cardiac arrest. Early diagnosis, interdisciplinary team action, appropriate and emergent treatment strategy are necessary for favorable outcome.

  15. Towards a magnetoresistive platform for neural signal recording

    Science.gov (United States)

    Sharma, P. P.; Gervasoni, G.; Albisetti, E.; D'Ercoli, F.; Monticelli, M.; Moretti, D.; Forte, N.; Rocchi, A.; Ferrari, G.; Baldelli, P.; Sampietro, M.; Benfenati, F.; Bertacco, R.; Petti, D.

    2017-05-01

    A promising strategy to get deeper insight on brain functionalities relies on the investigation of neural activities at the cellular and sub-cellular level. In this framework, methods for recording neuron electrical activity have gained interest over the years. Main technological challenges are associated to finding highly sensitive detection schemes, providing considerable spatial and temporal resolution. Moreover, the possibility to perform non-invasive assays would constitute a noteworthy benefit. In this work, we present a magnetoresistive platform for the detection of the action potential propagation in neural cells. Such platform allows, in perspective, the in vitro recording of neural signals arising from single neurons, neural networks and brain slices.

  16. Prevention of neural tube defects with folic acid: The Chinese experience.

    Science.gov (United States)

    Ren, Ai-Guo

    2015-08-08

    Neural tube defects (NTDs) are a group of congenital malformations of the central nervous system that are caused by the closure failure of the embryonic neural tube by the 28(th) day of conception. Anencephaly and spina bifida are the two major subtypes. Fetuses with anencephaly are often stillborn or electively aborted due to prenatal diagnosis, or they die shortly after birth. Most infants with spina bifida are live-born and, with proper surgical treatment, can survive into adulthood. However, these children often have life-long physical disabilities. China has one of the highest prevalence of NTDs in the world. Inadequate dietary folate intake is believed to be the main cause of the cluster. Unlike many other countries that use staple fortification with folic acid as the public health strategy to prevent NTDs, the Chinese government provides all women who have a rural household registration and who plan to become pregnant with folic acid supplements, free of charge, through a nation-wide program started in 2009. Two to three years after the initiation of the program, the folic acid supplementation rate increased to 85% in the areas of the highest NTD prevalence. The mean plasma folate level of women during early and mid-pregnancy doubled the level before the program was introduced. However, most women began taking folic acid supplements when they knew that they were pregnant. This is too late for the protection of the embryonic neural tube. In a post-program survey of the women who reported folic acid supplementation, less than a quarter of the women began taking supplements prior to pregnancy, indicating that the remaining three quarters of the fetuses remained unprotected during the time of neural tube formation. Therefore, staple food fortification with folic acid should be considered as a priority in the prevention of NTDs.

  17. Multiscale Surgical Telerobots

    Energy Technology Data Exchange (ETDEWEB)

    Miles, R R; Seward, K P; Benett, W J; Tendick, F; Bentley, L; Stephan, P L

    2002-01-23

    A project was undertaken to improve robotic surgical tools for telerobotic minimally invasive surgery. The major objectives were to reduce the size of the tools to permit new surgical procedures in confined spaces such as the heart and to improve control of surgical tools by locating positional sensors and actuators at the end effector rather than external to the patient as is currently the state of the technology. A new compact end-effector with wrist-like flexibility was designed. Positional sensors based on MEMS microfabrication techniques were designed.

  18. Essential Tremor (ET): Surgical Options

    Science.gov (United States)

    ... Next IETF > Treatment Options > Surgical Treatments > Surgical Options Surgical Options Click to share on Facebook (Opens in ... Magnetic resonance imaging (MRI) uses a powerful magnetic field and radio frequency pulses to produce detailed pictures ...

  19. Evolvable Neural Software System

    Science.gov (United States)

    Curtis, Steven A.

    2009-01-01

    The Evolvable Neural Software System (ENSS) is composed of sets of Neural Basis Functions (NBFs), which can be totally autonomously created and removed according to the changing needs and requirements of the software system. The resulting structure is both hierarchical and self-similar in that a given set of NBFs may have a ruler NBF, which in turn communicates with other sets of NBFs. These sets of NBFs may function as nodes to a ruler node, which are also NBF constructs. In this manner, the synthetic neural system can exhibit the complexity, three-dimensional connectivity, and adaptability of biological neural systems. An added advantage of ENSS over a natural neural system is its ability to modify its core genetic code in response to environmental changes as reflected in needs and requirements. The neural system is fully adaptive and evolvable and is trainable before release. It continues to rewire itself while on the job. The NBF is a unique, bilevel intelligence neural system composed of a higher-level heuristic neural system (HNS) and a lower-level, autonomic neural system (ANS). Taken together, the HNS and the ANS give each NBF the complete capabilities of a biological neural system to match sensory inputs to actions. Another feature of the NBF is the Evolvable Neural Interface (ENI), which links the HNS and ANS. The ENI solves the interface problem between these two systems by actively adapting and evolving from a primitive initial state (a Neural Thread) to a complicated, operational ENI and successfully adapting to a training sequence of sensory input. This simulates the adaptation of a biological neural system in a developmental phase. Within the greater multi-NBF and multi-node ENSS, self-similar ENI s provide the basis for inter-NBF and inter-node connectivity.

  20. Neural networks and perceptual learning

    Science.gov (United States)

    Tsodyks, Misha; Gilbert, Charles

    2005-01-01

    Sensory perception is a learned trait. The brain strategies we use to perceive the world are constantly modified by experience. With practice, we subconsciously become better at identifying familiar objects or distinguishing fine details in our environment. Current theoretical models simulate some properties of perceptual learning, but neglect the underlying cortical circuits. Future neural network models must incorporate the top-down alteration of cortical function by expectation or perceptual tasks. These newly found dynamic processes are challenging earlier views of static and feedforward processing of sensory information. PMID:15483598

  1. Ambulatory Surgical Measures - Facility

    Data.gov (United States)

    U.S. Department of Health & Human Services — The Ambulatory Surgical Center Quality Reporting (ASCQR) Program seeks to make care safer and more efficient through quality reporting. ASCs eligible for this...

  2. Surgical Treatments for Fibroids

    Science.gov (United States)

    ... NICHD Research Information Find a Study More Information Preeclampsia and Eclampsia About NICHD Research Information Find a ... Treatments Share Facebook Twitter Pinterest Email Print Surgical Treatments for Fibroids If you have moderate or severe ...

  3. Guide to Surgical Specialists

    Science.gov (United States)

    ... glaucoma, neuro-ophthalmology, ophthalmic pathology, ophthalmic plastic surgery, pediatric ophthalmology and vitreoretinal diseases. Oral and Maxillofacial Surgery An oral and maxillofacial surgeon specializes in dentistry which includes the diagnosis and surgical and adjunctive ...

  4. Surgical Critical Care Initiative

    Data.gov (United States)

    Federal Laboratory Consortium — The Surgical Critical Care Initiative (SC2i) is a USU research program established in October 2013 to develop, translate, and validate biology-driven critical care....

  5. Surgical treatment of choledochocystolithiasis

    NARCIS (Netherlands)

    Reinders, J.S.K.

    2013-01-01

    The studies presented in this thesis focus on surgical aspect of patients with complicated gallstone disease, with an emphasis on choledochocystolithiasis. Studies presented in the first part of this thesis investigated the influence of timing of laparoscopic cholecystectomy after endoscopic

  6. [Surgical treatment of ulcer].

    Science.gov (United States)

    Ungeheuer, E; Schröder, D; Lüders, K

    1978-04-27

    The standard of today in surgical treatment of the duodenal and gastric ulcer in Germany is shown. Positive and negative aspects of the different methods are discussed. Special technics are recommended for the different types of gastroduodenal ulcera.

  7. Surgical wound care

    Science.gov (United States)

    ... closing before the wound underneath fills in. Proper Handwashing It is important to clean your hands before ... 5°F (38°C) or higher. Alternative Names Surgical incision care; Open wound care Images Proper hand ...

  8. Ambulatory Surgical Measures - National

    Data.gov (United States)

    U.S. Department of Health & Human Services — The Ambulatory Surgical Center Quality Reporting (ASCQR) Program seeks to make care safer and more efficient through quality reporting. ASCs eligible for this...

  9. Ambulatory Surgical Measures - State

    Data.gov (United States)

    U.S. Department of Health & Human Services — The Ambulatory Surgical Center Quality Reporting (ASCQR) Program seeks to make care safer and more efficient through quality reporting. ASCs eligible for this...

  10. Laparoscopic adrenalectomy: Surgical techniques

    Directory of Open Access Journals (Sweden)

    Matthew J Mellon

    2008-01-01

    Full Text Available Since its first description in 1992, laparoscopic adrenalectomy has become the gold standard for the surgical treatment of most adrenal conditions. The benefits of a minimally invasive approach to adrenal resection such as decreased hospital stay, shorter recovery time and improved patient satisfaction are widely accepted. However, as this procedure becomes more widespread, critical steps of the operation must be maintained to ensure expected outcomes and success. This article reviews the surgical techniques for the laparoscopic adrenalectomy.

  11. Recycling the surgical audit

    OpenAIRE

    Johnston

    2010-01-01

    Edward W JohnstonDepartment of Hepatobiliary Surgery, Southampton General Hospital, Southampton, Hampshire, UKBackground: Clinical audit is a process used to improve the quality of care provided to patients. With an increasing body of evidence to question the effectiveness of audit, this study aims to evaluate the standard of surgical audits carried out in a large teaching hospital.Methods: All surgically orientated audits proposed to the hospital’s audit office over a 5-year period...

  12. Microtubules, polarity and vertebrate neural tube morphogenesis.

    Science.gov (United States)

    Cearns, Michael D; Escuin, Sarah; Alexandre, Paula; Greene, Nicholas D E; Copp, Andrew J

    2016-07-01

    Microtubules (MTs) are key cellular components, long known to participate in morphogenetic events that shape the developing embryo. However, the links between the cellular functions of MTs, their effects on cell shape and polarity, and their role in large-scale morphogenesis remain poorly understood. Here, these relationships were examined with respect to two strategies for generating the vertebrate neural tube: bending and closure of the mammalian neural plate; and cavitation of the teleost neural rod. The latter process has been compared with 'secondary' neurulation that generates the caudal spinal cord in mammals. MTs align along the apico-basal axis of the mammalian neuroepithelium early in neural tube closure, participating functionally in interkinetic nuclear migration, which indirectly impacts on cell shape. Whether MTs play other functional roles in mammalian neurulation remains unclear. In the zebrafish, MTs are important for defining the neural rod midline prior to its cavitation, both by localizing apical proteins at the tissue midline and by orienting cell division through a mirror-symmetric MT apparatus that helps to further define the medial localization of apical polarity proteins. Par proteins have been implicated in centrosome positioning in neuroepithelia as well as in the control of polarized morphogenetic movements in the neural rod. Understanding of MT functions during early nervous system development has so far been limited, partly by techniques that fail to distinguish 'cause' from 'effect'. Future developments will likely rely on novel ways to selectively impair MT function in order to investigate the roles they play. © 2016 Anatomical Society.

  13. Feedback in surgical education.

    Science.gov (United States)

    El Boghdady, Michael; Alijani, Afshin

    2017-04-01

    The positive effect of feedback has long been recognized in surgical education. Surgical educators convey feedback to improve the performance of the surgical trainees. We aimed to review the scientific classification and application of feedback in surgical education, and to propose possible future directions for research. A literature search was performed using Pubmed, OVID, CINAHL, Web of science, EMBASE, ERIC database and Google Scholar. The following search terms were used: 'feedback', 'feedback in medical education', 'feedback in medical training' and 'feedback in surgery'. The search was limited to articles in English. From 1157 citations, 12 books and 43 articles met the inclusion criteria and were selected for this review. Feedback comes in a variety of types and is an essential tool for learning and developing performance in surgical education. Different methods of feedback application are evolving and future work needs to concentrate on the value of each method as well as the role of new technologies in surgical education. Copyright © 2016 Royal College of Surgeons of Edinburgh (Scottish charity number SC005317) and Royal College of Surgeons in Ireland. Published by Elsevier Ltd. All rights reserved.

  14. Bias in surgical research.

    Science.gov (United States)

    Paradis, Carmen

    2008-08-01

    The aim is to discuss the various forms of bias in surgical research, including how it impacts validity and how to recognize and avoid it. The various factors affecting bias in surgical research's design, execution, and reporting were explored. The impact of these factors on internal and external validity in both observational and randomized controlled trials was examined, and recommendations were made for ameliorating the various biases. Identifying bias when interpreting a trial enables surgeons to assess surgical research's internal and external validity. Avoiding bias and/or using methods that minimize bias helps surgeons design and conduct trials with enhanced validity, which can be reliably translated into practice. To accomplish this, surgeons need to be cognizant of susceptibility bias, the applicability of surrogate endpoints, and the use of inappropriate comparators in trial design. They must also be aware of detection, ascertainment, performance and transfer bias in trial execution, and of citation bias in trial reporting. Familiarity with clinical trials' potential biases helps surgeons assess the believability and applicability of research results. Though these biases may sometimes be ameliorated by randomization, blinding, and intervention standardization, these remedies can present distinctive problems to surgical research. This poses a unique need and opportunity for innovation in surgical research design and evaluation. It necessitates that further research be done on methods to improve not only the internal and external validity of surgical trials but also their assessment.

  15. Consciousness and neural plasticity

    DEFF Research Database (Denmark)

    In contemporary consciousness studies the phenomenon of neural plasticity has received little attention despite the fact that neural plasticity is of still increased interest in neuroscience. We will, however, argue that neural plasticity could be of great importance to consciousness studies....... If consciousness is related to neural processes it seems, at least prima facie, that the ability of the neural structures to change should be reflected in a theory of this relationship "Neural plasticity" refers to the fact that the brain can change due to its own activity. The brain is not static but rather...... a dynamic entity, which physical structure changes according to its use and environment. This change may take the form of growth of new neurons, the creation of new networks and structures, and change within network structures, that is, changes in synaptic strengths. Plasticity raises questions about...

  16. Fuzzy and neural control

    Science.gov (United States)

    Berenji, Hamid R.

    1992-01-01

    Fuzzy logic and neural networks provide new methods for designing control systems. Fuzzy logic controllers do not require a complete analytical model of a dynamic system and can provide knowledge-based heuristic controllers for ill-defined and complex systems. Neural networks can be used for learning control. In this chapter, we discuss hybrid methods using fuzzy logic and neural networks which can start with an approximate control knowledge base and refine it through reinforcement learning.

  17. Post surgical complications from students' large animal surgical ...

    African Journals Online (AJOL)

    Surgical site debridement and surgical reconstruction coupled with antibiotic therapy were used in the management of complications. Responses from questionnaires administered to instructors of the surgical laboratories, revealed that post surgical complications were due to poor health status of sheep and goats used, ...

  18. What Is Neural Plasticity?

    Science.gov (United States)

    von Bernhardi, Rommy; Bernhardi, Laura Eugenín-von; Eugenín, Jaime

    2017-01-01

    "Neural plasticity" refers to the capacity of the nervous system to modify itself, functionally and structurally, in response to experience and injury. As the various chapters in this volume show, plasticity is a key component of neural development and normal functioning of the nervous system, as well as a response to the changing environment, aging, or pathological insult. This chapter discusses how plasticity is necessary not only for neural networks to acquire new functional properties, but also for them to remain robust and stable. The article also reviews the seminal proposals developed over the years that have driven experiments and strongly influenced concepts of neural plasticity.

  19. Neural Systems Laboratory

    Data.gov (United States)

    Federal Laboratory Consortium — As part of the Electrical and Computer Engineering Department and The Institute for System Research, the Neural Systems Laboratory studies the functionality of the...

  20. A neural flow estimator

    DEFF Research Database (Denmark)

    Jørgensen, Ivan Harald Holger; Bogason, Gudmundur; Bruun, Erik

    1995-01-01

    is implemented using switched-current technique and is capable of estimating flow in the μl/s range. The neural estimator is built around a multiplierless neural network, containing 96 synaptic weights which are updated using the LMS1-algorithm. An experimental chip has been designed that operates at 5 V......This paper proposes a new way to estimate the flow in a micromechanical flow channel. A neural network is used to estimate the delay of random temperature fluctuations induced in a fluid. The design and implementation of a hardware efficient neural flow estimator is described. The system...

  1. Neural simulations on multi-core architectures

    Directory of Open Access Journals (Sweden)

    Hubert Eichner

    2009-07-01

    Full Text Available Neuroscience is witnessing increasing knowledge about the anatomy and electrophysiological properties of neurons and their connectivity, leading to an ever increasing computational complexity of neural simulations. At the same time, a rather radical change in personal computer technology emerges with the establishment of multi-cores: high-density, explicitly parallel processor architectures for both high performance as well as standard desktop computers. This work introduces strategies for the parallelization of biophysically realistic neural simulations based on the compartmental modeling technique and results of such an implementation, with a strong focus on multi-core architectures and automation, i. e. user-transparent load balancing.

  2. Top tagging with deep neural networks [Vidyo

    CERN Multimedia

    CERN. Geneva

    2017-01-01

    Recent literature on deep neural networks for top tagging has focussed on image based techniques or multivariate approaches using high level jet substructure variables. Here, we take a sequential approach to this task by using anordered sequence of energy deposits as training inputs. Unlike previous approaches, this strategy does not result in a loss of information during pixelization or the calculation of high level features. We also propose new preprocessing methods that do not alter key physical quantities such as jet mass. We compare the performance of this approach to standard tagging techniques and present results evaluating the robustness of the neural network to pileup.

  3. Neural Networks: Implementations and Applications

    NARCIS (Netherlands)

    Vonk, E.; Veelenturf, L.P.J.; Jain, L.C.

    1996-01-01

    Artificial neural networks, also called neural networks, have been used successfully in many fields including engineering, science and business. This paper presents the implementation of several neural network simulators and their applications in character recognition and other engineering areas

  4. Isokinetic muscle assessment after treatment of pectoralis major muscle rupture using surgical or non-surgical procedures

    Directory of Open Access Journals (Sweden)

    Anna Maria Fleury

    2011-01-01

    Full Text Available INTRODUCTION: Rupture of the pectoralis major muscle appears to be increasing in athletes. However, the optimal treatment strategy has not yet been established. OBJECTIVES: To compare the isokinetic shoulder performance after surgical treatment to that after non-surgical treatment for pectoralis major muscle rupture. METHODS: We assessed 33 pectoralis major muscle ruptures (18 treated non-surgically and 15 treated surgically. Horizontal abduction and adduction as well as external and internal rotation at 60 and 120 degrees/s were tested in both upper limbs. Peak torque, total work, contralateral deficiency, and the peak torque agonist-to-antagonist ratio were measured. RESULTS: Contralateral muscular deficiency did not differ between the surgical and non-surgical treatment modalities. However, the surgical group presented twice the number of athletes with clinically acceptable contralateral deficiency (<20% for internal rotators compared to the non-surgical group. The peak torque ratio between the external and internal rotator muscles revealed a similar deficit of the external rotation in both groups and on both sides (surgical, 61.60% and 57.80% and non-surgical, 62.06% and 54.06%, for the dominant and non-dominant sides, respectively. The peak torque ratio revealed that the horizontal adduction muscles on the injured side showed similar weakness in both groups (surgical, 86.27%; non-surgical, 98.61%. CONCLUSIONS: This study included the largest single series of athletes reported to date for this type of injury. A comparative analysis of muscular strength and balance showed no differences between the treatment modalities for pectoralis major muscle rupture. However, the number of significant clinical deficiencies was lower in the surgical group than in the non-surgical group, and both treatment modalities require greater attention to the rehabilitation process, especially for the recovery of muscle strength and balance.

  5. Anxiety in veterinary surgical students

    DEFF Research Database (Denmark)

    Langebæk, Rikke; Eika, Berit; Jensen, Asger Lundorff

    2012-01-01

    in a Surgical Skills Lab (SSL) has an anxiety reducing effect. Investigations were carried out as a comparative study and a parallel group study. Potential participants were fourth-year veterinary students who attended a surgical course (Basic Surgical Skills) and a non-surgical course (Clinical Examination......The surgical educational environment is potentially stressful and this can negatively affect students' learning. The aim of this study was to investigate whether veterinary students' level of anxiety is higher in a surgical course than in a non-surgical course and if pre-surgical training...... anxiety questionnaires (Spielberger's state-trait anxiety inventory and Cox and Kenardy's performance anxiety questionnaire) were used. Anxiety levels were measured before the non-surgical course (111 students from 2009) and before live-animal surgery during the surgical course (153 students from 2009...

  6. Critical Branching Neural Networks

    Science.gov (United States)

    Kello, Christopher T.

    2013-01-01

    It is now well-established that intrinsic variations in human neural and behavioral activity tend to exhibit scaling laws in their fluctuations and distributions. The meaning of these scaling laws is an ongoing matter of debate between isolable causes versus pervasive causes. A spiking neural network model is presented that self-tunes to critical…

  7. Kunstige neurale net

    DEFF Research Database (Denmark)

    Hørning, Annette

    1994-01-01

    Artiklen beskæftiger sig med muligheden for at anvende kunstige neurale net i forbindelse med datamatisk procession af naturligt sprog, specielt automatisk talegenkendelse.......Artiklen beskæftiger sig med muligheden for at anvende kunstige neurale net i forbindelse med datamatisk procession af naturligt sprog, specielt automatisk talegenkendelse....

  8. NON SURGICAL A BIOLOGICAL; APPROACH

    OpenAIRE

    Maita Véliz, Luis; Profesor Principal de Periodoncia UNMSM. Coordinador de la 2da especialidad de Periodolicia UNMSM.; Maita Castañeda, Luis M.

    2014-01-01

    Periodontal therapy can be broadly classified as surgical and non surgical therapy. Non surgical therapy includes: patient's motivation, plaque control, supra and subgigival acaling, root planning and complementary use of chemical agents. Non surgical therapy is an effective method of periodontal therapy. Longitudinal studies have found that non surgical therapy was effective for single rooted teeth, and multi rooted teeth and also, in shallow deep pockets. It must be pointed out that non sur...

  9. Context-dependent neural activation: internally and externally guided rhythmic lower limb movement in individuals with and without neurodegenerative disease

    Directory of Open Access Journals (Sweden)

    Madeleine Eve Hackney

    2015-12-01

    Full Text Available Parkinson’s Disease (PD is a neurodegenerative disorder that has received considerable attention in allopathic medicine over the past decades. However, it is clear that, to date, pharmacological and surgical interventions do not fully address symptoms of PD and patients’ quality of life. As both an alternative therapy and as an adjuvant to conventional approaches, several types of rhythmic movement (e.g., movement strategies, dance, tandem biking, tai chi have shown improvements to motor symptoms, lower limb control and postural stability in people with PD (Amano, Nocera, Vallabhajosula, Juncos, Gregor, Waddell et al., 2013; Earhart, 2009; M. E. Hackney & Earhart, 2008; Kadivar, Corcos, Foto, & Hondzinski, 2011; Morris, Iansek, & Kirkwood, 2009; Ridgel, Vitek, & Alberts, 2009. However, while these programs are increasing in number, still little is known about the neural mechanisms underlying motor improvements attained with such interventions. Studying limb motor control under task specific contexts can help determine the mechanisms of rehabilitation effectiveness. Both internally guided (IG and externally guided (EG movement strategies have evidence to support their use in rehabilitative programs. However, there appears to be a degree of differentiation in the neural substrates involved in IG versus EG designs. Because of the potential task specific benefits of rhythmic training within a rehabilitative context, this report will consider the use of IG and EG movement strategies, and observations produced by functional magnetic resonance imaging (fMRI and other imaging techniques. This review will present findings from lower limb imaging studies, under IG and EG conditions for populations with and without movement disorders. We will discuss how these studies might inform movement disorders rehabilitation (in the form of rhythmic, music-based movement training and highlight research gaps. We believe better understanding of lower limb neural

  10. Back to basics: implementing the surgical checklist.

    Science.gov (United States)

    Spruce, Lisa

    2014-11-01

    Surgery is complex and technically demanding for all team members. Surgical checklists have been implemented with different degrees of success in the perioperative setting. There is a wealth of evidence that they are effective at preventing patient safety events and helping team members master the complexities of modern health care. Implementation is key to successful use of the surgical checklist in all invasive procedural settings. Key strategies for successful checklist implementation include establishing a multidisciplinary team to implement the checklist, involving surgeon leaders, pilot testing the checklist, incorporating feedback from team members to improve the process, recognizing and addressing barriers to implementation, and offering coaching and continuous feedback to team members who use the checklist. Using these strategies will give the perioperative nurse, department leaders, and surgeons the tools to implement a successful checklist. Copyright © 2014 AORN, Inc. Published by Elsevier Inc. All rights reserved.

  11. Pharmacological treatment and regional anesthesia techniques for pain management after completion of both conservative and surgical treatment of endometriosis and pelvic adhesions in women with chronic pelvic pain as a mandated treatment strategy.

    Science.gov (United States)

    Malec-Milewska, Małgorzata; Horosz, Bartosz; Sękowska, Agnieszka; Kolęda, Iwona; Kosson, Dariusz; Jakiel, Grzegorz

    2015-01-01

    Chronic pelvic pain syndrome occurs in 4-14% of women. Pain pathomechanism in this syndrome is complex, as it is common to observe the features of nociceptive, inflammatory, neuropathic and psychogenic pain. The common findings in women with pelvic pain are endometriosis and pelvic adhesions. Aim of the study was to test the effectiveness of pharmacological treatment and regional anesthesia techniques for pain control as the next step of treatment after the lack of clinical results of surgical and pharmacological methods normally used in the management of endometriosis and pelvic adhesions. 18 women were treated between January 2010 - October 2013 in the Pain Clinic of the Department of Anaesthesiology and Intensive Care at the Centre for Postgraduate Education in Warsaw due to chronic pelvic pain syndrome related to either endometriosis or pelvic adhesions. During the previous step of management, both conservative and surgical treatments were completed without achieving satisfactory results. Initial constant pain severity was 3-9 points on the Numeric Rating Scale, while the reported paroxysmal pain level was 7-10. The pharmacological treatment implemented was based on oral gabapentinoids and antidepressants, aided by neurolytic block of ganglion of Walther, pudendal nerve blocks and topical treatment (5% lidocaine, 10% amitriptyline, 10% gabapentin). In 17 women, a significant reduction of both constant and paroxysmal pain was achieved, of which complete and permanent cessation of pain occurred in 6 cases. One patient experienced no improvement in the severity of her symptoms. The combination of pain management with pharmacological treatment, pudendal nerve blocks, neurolysis of ganglion impar (Walther) and topical preparations in cases of chronic pelvic pain syndrome seems to be adequate medical conduct after failed or otherwise ineffective causative therapy.

  12. Pharmacological treatment and regional anesthesia techniques for pain management after completion of both conservative and surgical treatment of endometriosis and pelvic adhesions in women with chronic pelvic pain as a mandated treatment strategy

    Directory of Open Access Journals (Sweden)

    Małgorzata Malec-Milewska

    2015-05-01

    Full Text Available Introduction. Chronic pelvic pain syndrome occurs in 4–14% of women. Pain pathomechanism in this syndrome is complex, as it is common to observe the features of nociceptive, inflammatory, neuropathic and psychogenic pain. The common findings in women with pelvic pain are endometriosis and pelvic adhesions. Objective. Aim of the study was to test the effectiveness of pharmacological treatment and regional anesthesia techniques for pain control as the next step of treatment after the lack of clinical results of surgical and pharmacological methods normally used in the management of endometriosis and pelvic adhesions. Materials and method. 18 women were treated between January 2010 – October 2013 in the Pain Clinic of the Department of Anaesthesiology and Intensive Care at the Centre for Postgraduate Education in Warsaw due to chronic pelvic pain syndrome related to either endometriosis or pelvic adhesions. During the previous step of management, both conservative and surgical treatments were completed without achieving satisfactory results. Initial constant pain severity was 3–9 points on the Numeric Rating Scale, while the reported paroxysmal pain level was 7–10. The pharmacological treatment implemented was based on oral gabapentinoids and antidepressants, aided by neurolytic block of ganglion of Walther, pudendal nerve blocks and topical treatment (5% lidocaine, 10% amitriptyline, 10% gabapentin. Results. In 17 women, a significant reduction of both constant and paroxysmal pain was achieved, of which complete and permanent cessation of pain occurred in 6 cases. One patient experienced no improvement in the severity of her symptoms. Conclusions. The combination of pain management with pharmacological treatment, pudendal nerve blocks, neurolysis of ganglion impar (Walther and topical preparations in cases of chronic pelvic pain syndrome seems to be adequate medical conduct after failed or otherwise ineffective causative therapy.

  13. Electrospun Nanofibrous Materials for Neural Tissue Engineering

    Directory of Open Access Journals (Sweden)

    Yee-Shuan Lee

    2011-02-01

    Full Text Available The use of biomaterials processed by the electrospinning technique has gained considerable interest for neural tissue engineering applications. The tissue engineering strategy is to facilitate the regrowth of nerves by combining an appropriate cell type with the electrospun scaffold. Electrospinning can generate fibrous meshes having fiber diameter dimensions at the nanoscale and these fibers can be nonwoven or oriented to facilitate neurite extension via contact guidance. This article reviews studies evaluating the effect of the scaffold’s architectural features such as fiber diameter and orientation on neural cell function and neurite extension. Electrospun meshes made of natural polymers, proteins and compositions having electrical activity in order to enhance neural cell function are also discussed.

  14. [Surgical treatment of spinal bone metastases].

    Science.gov (United States)

    Saqui, Abderrazzak El; Aggouri, Mohamed; Benzagmout, Mohamed; Chakour, Khalid; Chaoui, Mohamed El Faiz

    2017-01-01

    Surgery for metastatic tumor is usually a palliative surgery, especially for spinal metastases, due to their anatomical localization. Surgical procedure should be accurately established to have simple outcomes and to start adjuvant treatment as soon as clinically possible. Therapeutic strategy should proceed after multidisciplinary consultation meeting (RCP). The main risk of spinal bone metastases is neurological, hence this surgery should be most commonly preventive. Its main objective is to improve patient's quality of life.

  15. Surgical management of spasticity

    African Journals Online (AJOL)

    of gradual escalation of therapy; only when the preceding step is shown to be ineffective, should more invasive options be considered. It is especially important to remember that the presence of spasticity in itself is not an indication for surgical management − only when spasticity becomes troublesome does surgery become ...

  16. Simulation and surgical training.

    Science.gov (United States)

    Sarker, S K; Patel, B

    2007-12-01

    The aim of this review was to outline current forms of surgical simulation and methods of assessing technical skills using these forms of simulation. To review this subject, a literature search was done using key words 'assessment', 'simulation', 'surgery', 'technical skills' and 'virtual reality'. Simulation in surgery has several forms, inorganic (synthetic & computer) and organic (animal or cadaver). Surgical simulation is a mode of training which is promising and may be effective. Technical errors in the simulated environment do not have clinical consequences and does not have a morbidity or mortality. We must ensure that the competent skills learnt in the simulation environment are translated to the real environment. This can be achieved if the same assessment tools are used in both environments. Surgical training is entering a new era, with increased scrutiny and an evolving work and training environment. We as surgical teachers must ensure that the surgeons of the future are as competent as or better than their predecessors using these new modes of training which we have access to.

  17. Surgical wound infection - treatment

    Science.gov (United States)

    ... page: //medlineplus.gov/ency/article/007645.htm Surgical wound infection - treatment To use the sharing features on this page, ... the organ and space where you had surgery Treatment Antibiotics are used to treat most wound infections. Sometimes, you also may need surgery to ...

  18. Ancient Egyptian surgical heritage.

    Science.gov (United States)

    Saber, Aly

    2010-12-01

    Egyptian medicine influenced the medicine of neighboring cultures, including the culture of ancient Greece. From Greece, its influence spread onward, thereby affecting Western civilization significantly. The oldest extant Egyptian medical texts are six papyri: The Edwin Smith Surgical Papyrus and the Ebers Medical Papyrus are famous.

  19. Surgical site infections

    African Journals Online (AJOL)

    Surgical site infections (SSIs) are a worldwide problem that has far reaching implications on patient morbidity and ... was complicated by a SSI had a 2-11% higher risk of death. In those patients who died, 75% was directly .... genital and uninfected urinary tract is not entered. In addition, clean wounds are primarily closed ...

  20. Improving surgical weekend handover

    Science.gov (United States)

    Culwick, Caroline; Devine, Chris; Coombs, Catherine

    2014-01-01

    Effective handovers are vital to patient safety and continuity of care, and this is recognised by several national bodies including the GMC. The existing model at Great Western Hospital (GWH) involved three general surgical teams and a urology team placing their printed patient lists, complete with weekend jobs, in a folder for the on-call team to collect at the weekend. We recognised a need to reduce time searching for patients, jobs and reviews, and to streamline weekend ward rounds. A unified weekend list ordering all surgical patients by ward and bed number was introduced. Discrepancies in the layout of each team's weekday list necessitated the design of a new weekday list to match the weekend list to facilitate the easy transfer of information between the two lists. A colour coding system was also used to highlight specific jobs. Prior to this improvement project only 7.1% of those polled were satisfied with the existing system, after a series of interventions satisfaction increased to 85.7%. The significant increase in overall satisfaction with surgical handover following the introduction of the unified weekend list is promising. Locating patients and identifying jobs is easier and weekend ward rounds can conducted in a more logical and timely fashion. It has also helped facilitate the transition to consultant ward rounds of all surgical inpatients at the weekends with promising feedback from a recent consultants meeting. PMID:26734294

  1. Surgical infections with Mycoplasma

    DEFF Research Database (Denmark)

    Levi-Mazloum, Niels Donald; Prag, Jørgen Brorson; Jensen, J S

    1997-01-01

    Mycoplasma hominis and Ureaplasma urealyticum are common inhabitants of the human genital tract. Evidence for an aetiological role in pyelonephritis, pelvic inflammatory disease, post-abortion and post-partum fever has been presented. There are sporadic reports of Mycoplasma causing serious extra...... extragenital infection such as septicemia, septic arthritis, neonatal meningitis and encephalitis. We review 38 cases of surgical infections with Mycoplasma....

  2. Implementing Signature Neural Networks with Spiking Neurons.

    Science.gov (United States)

    Carrillo-Medina, José Luis; Latorre, Roberto

    2016-01-01

    Spiking Neural Networks constitute the most promising approach to develop realistic Artificial Neural Networks (ANNs). Unlike traditional firing rate-based paradigms, information coding in spiking models is based on the precise timing of individual spikes. It has been demonstrated that spiking ANNs can be successfully and efficiently applied to multiple realistic problems solvable with traditional strategies (e.g., data classification or pattern recognition). In recent years, major breakthroughs in neuroscience research have discovered new relevant computational principles in different living neural systems. Could ANNs benefit from some of these recent findings providing novel elements of inspiration? This is an intriguing question for the research community and the development of spiking ANNs including novel bio-inspired information coding and processing strategies is gaining attention. From this perspective, in this work, we adapt the core concepts of the recently proposed Signature Neural Network paradigm-i.e., neural signatures to identify each unit in the network, local information contextualization during the processing, and multicoding strategies for information propagation regarding the origin and the content of the data-to be employed in a spiking neural network. To the best of our knowledge, none of these mechanisms have been used yet in the context of ANNs of spiking neurons. This paper provides a proof-of-concept for their applicability in such networks. Computer simulations show that a simple network model like the discussed here exhibits complex self-organizing properties. The combination of multiple simultaneous encoding schemes allows the network to generate coexisting spatio-temporal patterns of activity encoding information in different spatio-temporal spaces. As a function of the network and/or intra-unit parameters shaping the corresponding encoding modality, different forms of competition among the evoked patterns can emerge even in the absence

  3. Implementing Signature Neural Networks with Spiking Neurons

    Science.gov (United States)

    Carrillo-Medina, José Luis; Latorre, Roberto

    2016-01-01

    Spiking Neural Networks constitute the most promising approach to develop realistic Artificial Neural Networks (ANNs). Unlike traditional firing rate-based paradigms, information coding in spiking models is based on the precise timing of individual spikes. It has been demonstrated that spiking ANNs can be successfully and efficiently applied to multiple realistic problems solvable with traditional strategies (e.g., data classification or pattern recognition). In recent years, major breakthroughs in neuroscience research have discovered new relevant computational principles in different living neural systems. Could ANNs benefit from some of these recent findings providing novel elements of inspiration? This is an intriguing question for the research community and the development of spiking ANNs including novel bio-inspired information coding and processing strategies is gaining attention. From this perspective, in this work, we adapt the core concepts of the recently proposed Signature Neural Network paradigm—i.e., neural signatures to identify each unit in the network, local information contextualization during the processing, and multicoding strategies for information propagation regarding the origin and the content of the data—to be employed in a spiking neural network. To the best of our knowledge, none of these mechanisms have been used yet in the context of ANNs of spiking neurons. This paper provides a proof-of-concept for their applicability in such networks. Computer simulations show that a simple network model like the discussed here exhibits complex self-organizing properties. The combination of multiple simultaneous encoding schemes allows the network to generate coexisting spatio-temporal patterns of activity encoding information in different spatio-temporal spaces. As a function of the network and/or intra-unit parameters shaping the corresponding encoding modality, different forms of competition among the evoked patterns can emerge even in the

  4. Surgical site infections in spine surgery: identification of microbiologic and surgical characteristics in 239 cases.

    Science.gov (United States)

    Abdul-Jabbar, Amir; Berven, Sigurd H; Hu, Serena S; Chou, Dean; Mummaneni, Praveen V; Takemoto, Steven; Ames, Christopher; Deviren, Vedat; Tay, Bobby; Weinstein, Phil; Burch, Shane; Liu, Catherine

    2013-10-15

    Retrospective analysis. The objective of this study was to describe the microbiology of surgical site infection (SSI) in spine surgery and relationship with surgical management characteristics. SSI is an important complication of spine surgery that results in significant morbidity. A comprehensive and contemporary understanding of the microbiology of postoperative spine infections is valuable to direct empiric antimicrobial treatment and prophylaxis and other infection prevention strategies. All cases of spinal surgery associated with SSI between July 2005 and November 2010 were identified by the hospital infection control surveillance program using Centers for Disease Control National Health Safety Network criteria. Surgical characteristics and microbiologic data for each case were gathered by direct medical record review. Of 7529 operative spine cases performed between July 2005 and November 2010, 239 cases of SSI were identified. The most commonly isolated pathogen was Staphylococcus aureus (45.2%), followed by Staphylococcus epidermidis (31.4%). Methicillin-resistant organisms accounted for 34.3% of all SSIs and were more common in revision than in primary surgical procedures (47.4% vs. 28.0%, P = 0.003). Gram-negative organisms were identified in 30.5% of the cases. Spine surgical procedures involving the sacrum were significantly associated with gram-negative organisms (P spine. Cefazolin-resistant gram-negative organisms accounted for 61.6% of all gram-negative infections and 18.8% of all SSIs. Although gram-positive organisms predominated, gram-negative organisms accounted for a sizeable portion of SSI, particularly among lower lumbar and sacral spine surgical procedures. Nearly half of infections in revision surgery were due to a methicillin-resistant organism. These findings may help guide choice of empiric antibiotics while awaiting culture data and antimicrobial prophylaxis strategies in specific spine surgical procedures. 3.

  5. RBF neural network based H∞ synchronization for unknown chaotic ...

    Indian Academy of Sciences (India)

    MS received 9 February 2010; accepted 24 May 2010. Abstract. In this paper, we propose a new H∞ synchronization strategy, called a. Radial Basis Function Neural Network H∞ synchronization (RBFNNHS) strategy, for unknown chaotic systems in the presence of external disturbance. In the pro- posed framework, a ...

  6. Weather forecasting based on hybrid neural model

    Science.gov (United States)

    Saba, Tanzila; Rehman, Amjad; AlGhamdi, Jarallah S.

    2017-02-01

    Making deductions and expectations about climate has been a challenge all through mankind's history. Challenges with exact meteorological directions assist to foresee and handle problems well in time. Different strategies have been investigated using various machine learning techniques in reported forecasting systems. Current research investigates climate as a major challenge for machine information mining and deduction. Accordingly, this paper presents a hybrid neural model (MLP and RBF) to enhance the accuracy of weather forecasting. Proposed hybrid model ensure precise forecasting due to the specialty of climate anticipating frameworks. The study concentrates on the data representing Saudi Arabia weather forecasting. The main input features employed to train individual and hybrid neural networks that include average dew point, minimum temperature, maximum temperature, mean temperature, average relative moistness, precipitation, normal wind speed, high wind speed and average cloudiness. The output layer composed of two neurons to represent rainy and dry weathers. Moreover, trial and error approach is adopted to select an appropriate number of inputs to the hybrid neural network. Correlation coefficient, RMSE and scatter index are the standard yard sticks adopted for forecast accuracy measurement. On individual standing MLP forecasting results are better than RBF, however, the proposed simplified hybrid neural model comes out with better forecasting accuracy as compared to both individual networks. Additionally, results are better than reported in the state of art, using a simple neural structure that reduces training time and complexity.

  7. Weather forecasting based on hybrid neural model

    Science.gov (United States)

    Saba, Tanzila; Rehman, Amjad; AlGhamdi, Jarallah S.

    2017-11-01

    Making deductions and expectations about climate has been a challenge all through mankind's history. Challenges with exact meteorological directions assist to foresee and handle problems well in time. Different strategies have been investigated using various machine learning techniques in reported forecasting systems. Current research investigates climate as a major challenge for machine information mining and deduction. Accordingly, this paper presents a hybrid neural model (MLP and RBF) to enhance the accuracy of weather forecasting. Proposed hybrid model ensure precise forecasting due to the specialty of climate anticipating frameworks. The study concentrates on the data representing Saudi Arabia weather forecasting. The main input features employed to train individual and hybrid neural networks that include average dew point, minimum temperature, maximum temperature, mean temperature, average relative moistness, precipitation, normal wind speed, high wind speed and average cloudiness. The output layer composed of two neurons to represent rainy and dry weathers. Moreover, trial and error approach is adopted to select an appropriate number of inputs to the hybrid neural network. Correlation coefficient, RMSE and scatter index are the standard yard sticks adopted for forecast accuracy measurement. On individual standing MLP forecasting results are better than RBF, however, the proposed simplified hybrid neural model comes out with better forecasting accuracy as compared to both individual networks. Additionally, results are better than reported in the state of art, using a simple neural structure that reduces training time and complexity.

  8. Dynamics of neural cryptography.

    Science.gov (United States)

    Ruttor, Andreas; Kinzel, Wolfgang; Kanter, Ido

    2007-05-01

    Synchronization of neural networks has been used for public channel protocols in cryptography. In the case of tree parity machines the dynamics of both bidirectional synchronization and unidirectional learning is driven by attractive and repulsive stochastic forces. Thus it can be described well by a random walk model for the overlap between participating neural networks. For that purpose transition probabilities and scaling laws for the step sizes are derived analytically. Both these calculations as well as numerical simulations show that bidirectional interaction leads to full synchronization on average. In contrast, successful learning is only possible by means of fluctuations. Consequently, synchronization is much faster than learning, which is essential for the security of the neural key-exchange protocol. However, this qualitative difference between bidirectional and unidirectional interaction vanishes if tree parity machines with more than three hidden units are used, so that those neural networks are not suitable for neural cryptography. In addition, the effective number of keys which can be generated by the neural key-exchange protocol is calculated using the entropy of the weight distribution. As this quantity increases exponentially with the system size, brute-force attacks on neural cryptography can easily be made unfeasible.

  9. Surgical smoke evacuation systems.

    Science.gov (United States)

    1997-04-01

    Surgical smoke evacuation systems are high-flow vacuum sources used to capture, at the surgical site, the smoke aerosols and gases generated during the use of lasers and electrosurgical units (ESUs). In this study, we evaluated 16 evacuation systems, from 10 suppliers, designed and marketed for use in the operating room for general surgery. For our testing, we focused on the performance of the systems (particularly their ability to capture smoke particles under simulated surgical conditions) and their ease of use and quality of construction. We also examined the projected costs of each system over a seven-year life cycle. We rated the systems separately for two different evacuation applications (1) general-purpose applications, for which the system would, in many cases, be used with a handheld nozzle (the traditional capture device used with these systems), and (2) ESU-pencil-based evacuation applications only, for which the system would always be used with a pencil-based wand. (We report on ESU-pencil-based smoke evacuation wands in a separate Evaluation in this issue.) While we found most units to be Acceptable, we did rate two units Acceptable-Not Recommended for both applications and one unit Unacceptable for general-purpose applications. In addition to our findings for the evaluated models, this study features several sections providing generic information and guidance about smoke evacuation technology. The Technology Overview describes the basics: what these systems do and how they do it. The Technology Management Guide, "Clearing the Air-Should Surgical Smoke Be Evacuated?," discusses the issues healthcare facilities should consider when determining whether, when, and how surgical smoke should be evacuated. Finally, the Selection, Purchasing, and Use Guide offers guidance on how facilities can most effectively implement this technology, from identifying models that will meet their needs to ensuring that the systems are used properly to provide adequate staff

  10. An artificial neural network strategy for monitoring of gas/oil systems in slug flow pattern; Aplicacao de redes neurais artificiais no monitoramento do escoamento de sistemas gas/oleo em regime de golfadas

    Energy Technology Data Exchange (ETDEWEB)

    Cardoso, Fernando H.B. [Universidade Tiradentes (UNIT), Aracaju, SE (Brazil). Instituto de Tecnologia e Pesquisa; Universidade Federal de Campina Grande (UFCG), PB (Brazil); Silva, Rosivania P.; Fortuny, Montserrat; Santos, Alexandre F. [Universidade Tiradentes (UNIT), Aracaju, (Brazil). Instituto de Tecnologia e Pesquisa; Nunes, Giovani C. [PETROBRAS S.A., Rio de Janeiro, RJ (Brazil). Centro de Pesquisas (CENPES)

    2008-07-01

    In the petroleum industry, the design of multiphase production systems requires an accurate estimation of the gas-oil ratio (GOR) in the transporting pipelines. However, existing GOR estimation methods are often inadequate in terms of desired accuracy and application range, due to the complex phase distributions and the wide range of fluid properties encountered in production operations. In this paper, the effectiveness of using artificial neural networks in determining GOR values is evaluated, proving to be a reasonable way to monitor this property during oil transportation. (author)

  11. Short-term synaptic plasticity and heterogeneity in neural systems

    Science.gov (United States)

    Mejias, J. F.; Kappen, H. J.; Longtin, A.; Torres, J. J.

    2013-01-01

    We review some recent results on neural dynamics and information processing which arise when considering several biophysical factors of interest, in particular, short-term synaptic plasticity and neural heterogeneity. The inclusion of short-term synaptic plasticity leads to enhanced long-term memory capacities, a higher robustness of memory to noise, and irregularity in the duration of the so-called up cortical states. On the other hand, considering some level of neural heterogeneity in neuron models allows neural systems to optimize information transmission in rate coding and temporal coding, two strategies commonly used by neurons to codify information in many brain areas. In all these studies, analytical approximations can be made to explain the underlying dynamics of these neural systems.

  12. A Bionic Neural Link for peripheral nerve repair.

    Science.gov (United States)

    Xu, Yong Ping; Yen, Shih-Cheng; Ng, Kian Ann; Liu, Xu; Tan, Ter Chyan

    2012-01-01

    Peripheral nerve injuries with large gaps and long nerve regrowth paths are difficult to repair using existing surgical techniques, due to nerve degeneration and muscle atrophy. This paper proposes a Bionic Neural Link (BNL) as an alternative way for peripheral nerve repair. The concept of the BNL is described, along with the hypothetical benefits. A prototype monolithic single channel BNL has been developed, which consists of 16 neural recording channels and one stimulation channel, and is implemented in a 0.35-µm CMOS technology. The BNL has been tested in in-vivo animal experiments. Full function of the BNL chip has been demonstrated.

  13. Neural control of energy balance: translating circuits to therapies.

    Science.gov (United States)

    Gautron, Laurent; Elmquist, Joel K; Williams, Kevin W

    2015-03-26

    Recent insights into the neural circuits controlling energy balance and glucose homeostasis have rekindled the hope for development of novel treatments for obesity and diabetes. However, many therapies contribute relatively modest beneficial gains with accompanying side effects, and the mechanisms of action for other interventions remain undefined. This Review summarizes current knowledge linking the neural circuits regulating energy and glucose balance with current and potential pharmacotherapeutic and surgical interventions for the treatment of obesity and diabetes. Copyright © 2015 Elsevier Inc. All rights reserved.

  14. Surgical treatment analysis of idiopathic esophageal achalasia.

    Science.gov (United States)

    Aquino, José Luis Braga de; Said, Marcelo Manzano; Pereira, Douglas Rizzanti; Amaral, Paula Casals do; Lima, Juliana Carolina Alves; Leandro-Merhi, Vânia Aparecida

    2015-01-01

    strategy proposed for the surgical treatment of idiopathic esophageal achalasia according to the stages of the disease was of great value, due to post-surgical low morbidity complications and proper recovery of swallowing.

  15. Hidden neural networks

    DEFF Research Database (Denmark)

    Krogh, Anders Stærmose; Riis, Søren Kamaric

    1999-01-01

    A general framework for hybrids of hidden Markov models (HMMs) and neural networks (NNs) called hidden neural networks (HNNs) is described. The article begins by reviewing standard HMMs and estimation by conditional maximum likelihood, which is used by the HNN. In the HNN, the usual HMM probability...... parameters are replaced by the outputs of state-specific neural networks. As opposed to many other hybrids, the HNN is normalized globally and therefore has a valid probabilistic interpretation. All parameters in the HNN are estimated simultaneously according to the discriminative conditional maximum...... likelihood criterion. The HNN can be viewed as an undirected probabilistic independence network (a graphical model), where the neural networks provide a compact representation of the clique functions. An evaluation of the HNN on the task of recognizing broad phoneme classes in the TIMIT database shows clear...

  16. [Neural codes for perception].

    Science.gov (United States)

    Romo, R; Salinas, E; Hernández, A; Zainos, A; Lemus, L; de Lafuente, V; Luna, R

    This article describes experiments designed to show the neural codes associated with the perception and processing of tactile information. The results of these experiments have shown the neural activity correlated with tactile perception. The neurones of the primary somatosensory cortex (S1) represent the physical attributes of tactile perception. We found that these representations correlated with tactile perception. By means of intracortical microstimulation we demonstrated the causal relationship between S1 activity and tactile perception. In the motor areas of the frontal lobe is to be found the connection between sensorial and motor representation whilst decisions are being taken. S1 generates neural representations of the somatosensory stimuli which seen to be sufficient for tactile perception. These neural representations are subsequently processed by central areas to S1 and seem useful in perception, memory and decision making.

  17. Neural Oscillators Programming Simplified

    Directory of Open Access Journals (Sweden)

    Patrick McDowell

    2012-01-01

    Full Text Available The neurological mechanism used for generating rhythmic patterns for functions such as swallowing, walking, and chewing has been modeled computationally by the neural oscillator. It has been widely studied by biologists to model various aspects of organisms and by computer scientists and robotics engineers as a method for controlling and coordinating the gaits of walking robots. Although there has been significant study in this area, it is difficult to find basic guidelines for programming neural oscillators. In this paper, the authors approach neural oscillators from a programmer’s point of view, providing background and examples for developing neural oscillators to generate rhythmic patterns that can be used in biological modeling and robotics applications.

  18. Neural cryptography with feedback.

    Science.gov (United States)

    Ruttor, Andreas; Kinzel, Wolfgang; Shacham, Lanir; Kanter, Ido

    2004-04-01

    Neural cryptography is based on a competition between attractive and repulsive stochastic forces. A feedback mechanism is added to neural cryptography which increases the repulsive forces. Using numerical simulations and an analytic approach, the probability of a successful attack is calculated for different model parameters. Scaling laws are derived which show that feedback improves the security of the system. In addition, a network with feedback generates a pseudorandom bit sequence which can be used to encrypt and decrypt a secret message.

  19. Neural cryptography with feedback

    Science.gov (United States)

    Ruttor, Andreas; Kinzel, Wolfgang; Shacham, Lanir; Kanter, Ido

    2004-04-01

    Neural cryptography is based on a competition between attractive and repulsive stochastic forces. A feedback mechanism is added to neural cryptography which increases the repulsive forces. Using numerical simulations and an analytic approach, the probability of a successful attack is calculated for different model parameters. Scaling laws are derived which show that feedback improves the security of the system. In addition, a network with feedback generates a pseudorandom bit sequence which can be used to encrypt and decrypt a secret message.

  20. Neural network applications

    Science.gov (United States)

    Padgett, Mary L.; Desai, Utpal; Roppel, T.A.; White, Charles R.

    1993-01-01

    A design procedure is suggested for neural networks which accommodates the inclusion of such knowledge-based systems techniques as fuzzy logic and pairwise comparisons. The use of these procedures in the design of applications combines qualitative and quantitative factors with empirical data to yield a model with justifiable design and parameter selection procedures. The procedure is especially relevant to areas of back-propagation neural network design which are highly responsive to the use of precisely recorded expert knowledge.

  1. Building Neural Net Software

    OpenAIRE

    Neto, João Pedro; Costa, José Félix

    1999-01-01

    In a recent paper [Neto et al. 97] we showed that programming languages can be translated on recurrent (analog, rational weighted) neural nets. The goal was not efficiency but simplicity. Indeed we used a number-theoretic approach to machine programming, where (integer) numbers were coded in a unary fashion, introducing a exponential slow down in the computations, with respect to a two-symbol tape Turing machine. Implementation of programming languages in neural nets turns to be not only theo...

  2. NEMEFO: NEural MEteorological FOrecast

    Energy Technology Data Exchange (ETDEWEB)

    Pasero, E.; Moniaci, W.; Meindl, T.; Montuori, A. [Polytechnic of Turin (Italy). Dept. of Electronics

    2004-07-01

    Artificial Neural Systems are a well-known technique used to classify and recognize objects. Introducing the time dimension they can be used to forecast numerical series. NEMEFO is a ''nowcasting'' tool, which uses both statistical and neural systems to forecast meteorological data in a restricted area close to a meteorological weather station in a short time range (3 hours). Ice, fog, rain are typical events which can be anticipated by NEMEFO. (orig.)

  3. Ship Benchmark Shaft and Engine Gain FDI Using Neural Network

    DEFF Research Database (Denmark)

    Bendtsen, Jan Dimon; Izadi-Zamanabadi, Roozbeh

    2002-01-01

    This paper concerns fault detection and isolation based on neural network modeling. A neural network is trained to recognize the input-output behavior of a nonlinear plant, and faults are detected if the output estimated by the network differs from the measured plant output by more than a specified...... threshold value. In the paper a method for determining this threshold based on the neural network model is proposed, which can be used for a design strategy to handle residual sensitivity to input variations. The proposed method is used for successful FDI of a diesel engine gain fault in a ship propulsion...

  4. Axis instrumentation: surgical results

    Directory of Open Access Journals (Sweden)

    Andrei F. Joaquim

    2012-11-01

    Full Text Available OBJECTIVE: Evaluate the surgical results of axis screw instrumentation. METHODS: Retrospective evaluation of the clinical and radiological data of patients submitted to axis fixation using screws. RESULTS: Seventeen patients were surgically treated. The mean age was 41.8 years (range: 12-73. Spinal cord trauma was the most common cause of instability (8 patients - 47%. Bilateral axis fixation was performed in all cases, except one, with laminar screw (total of 33 axis screws. Seven patients (41.1% underwent bilateral pars screws; laminar screws were used in six cases and pedicular screws were used in two. In two cases, we performed a hybrid construction (laminar + pars and pedicle + pars. There was no neurological worsening or death, nor complications directly related to use axis screws. CONCLUSION: Axis instrumentation was effective and safe, regardless of the technique used for stabilization. Based on our learnt experience, we proposed an algorithm to choose the best technique for axis screw fixation.

  5. Surgical management of pterygium.

    Science.gov (United States)

    Janson, Ben J; Sikder, Shameema

    2014-04-01

    Pterygia are noncancerous growths of conjunctiva that may require surgical removal because of discomfort, cosmesis, or obstruction of vision. Pterygia often recur after excision. The major goal of pterygium treatment is avoiding recurrence, but complication rates and cosmetic results are also considered. Despite the number of techniques available, there is no consensus on the best procedure. Even the best techniques carry risk of recurrence and complications. In this review, different surgical techniques, graft attachment methods, and adjuvant therapies in current use are discussed. Also discussed are newer techniques that early studies have shown to be promising, but require more investigation before becoming a recommended treatment. The review is intended to provide an overview of the current research to inform surgeons with regard to their decisions and aid researchers in hypothesis generation. Copyright © 2014 Elsevier Inc. All rights reserved.

  6. Surgical management of presbyopia

    Science.gov (United States)

    Torricelli, André AM; Junior, Jackson B; Santhiago, Marcony R; Bechara, Samir J

    2012-01-01

    Presbyopia, the gradual loss of accommodation that becomes clinically significant during the fifth decade of life, is a physiologic inevitability. Different technologies are being pursued to achieve surgical correction of this disability; however, a number of limitations have prevented widespread acceptance of surgical presbyopia correction, such as optical and visual distortion, induced corneal ectasia, haze, anisometropy with monovision, regression of effect, decline in uncorrected distance vision, and the inherent risks with invasive techniques, limiting the development of an ideal solution. The correction of the presbyopia and the restoration of accommodation are considered the final frontier of refractive surgery. The purpose of this paper is to provide an update about current procedures available for presbyopia correction, their advantages, and disadvantages. PMID:23055664

  7. The Surgical Treatment of Mycetoma

    OpenAIRE

    Suleiman Hussein Suleiman; El Sammani Wadaella; Ahmed Hassan Fahal

    2016-01-01

    Surgical intervention is an integral component in the diagnosis and management of mycetoma. Surgical treatment is indicated for small, localised lesions and massive lesions to reduce the mycetoma load and to enable better response to medical therapy. It is also a life-saving procedure in patients with massive disease and sepsis. Surgical options for mycetoma treatment range from a wide local surgical excision to repetitive debridement excisions to amputation of the affected part. Adequate ana...

  8. Surgical management of presbyopia

    OpenAIRE

    Torricelli AA; Junior JB; de Santhiago, MR; Bechara SJ

    2012-01-01

    André AM Torricelli, Jackson B Junior, Marcony R Santhiago, Samir J BecharaDivision of Ophthalmology, University of São Paulo Medical School, São Paulo, BrazilAbstract: Presbyopia, the gradual loss of accommodation that becomes clinically significant during the fifth decade of life, is a physiologic inevitability. Different technologies are being pursued to achieve surgical correction of this disability; however, a number of limitations have prevented widespre...

  9. Surgical treatment of acute pancreatitis.

    Science.gov (United States)

    Gooszen, Hein G; Besselink, Marc G H; van Santvoort, Hjalmar C; Bollen, Thomas L

    2013-08-01

    Acute pancreatitis remains an unpredictable, potentially lethal disease with significant morbidity and mortality rates. New insights in the pathophysiology of acute pancreatitis have changed management concepts. In the first phase, characterized by a systemic inflammatory response syndrome, organ failure, not related to infection but rather to severe inflammation, dominates the focus of treatment. In the second phase, secondary infectious complications largely determine the clinical outcome. As infection is associated with increased mortality in acute pancreatitis, numerous prophylactic strategies have been explored in the past two decades. This review describes the strategies that have been developed to lower the infection rate, in an attempt to lower mortality. Antibiotic prophylaxis has been the subject of many RCT's without showing convincing evidence of their efficacy. Probiotics, although theoretically capable of lowering the rate of infection, also had no effect on infectious complications, and consequently, no effective strategy to lower the rate of infectious complications is currently available. In the second part of this review, new approaches for necrosectomy that have been designed by different centers around the world are discussed. All the interventional techniques have in common their aim to lower the invasive character, hypothesizing that lowering the surgical trauma will improve survival and lower complication rates. Recent advances include postponing intervention as a strategy to facilitate necrosectomy and improve prognosis and the "step-up approach" in case of infected necrosis. The step-up approach includes percutaneous catheter drainage as the first step, to be followed by necrosectomy, either through a minimally invasive approach or by open necrosectomy, as the next step. All attempts to develop treatment strategies to lower the infection rate in acute pancreatitis have failed. Accumulating evidence is emerging to show that the combination

  10. Nigerian Journal of Surgical Research

    African Journals Online (AJOL)

    The Nigerian Journal of Surgical Research is a publication of the Surgical Research Society with main office in Zaria, Nigeria. Zaria is home to Ahmadu Bello University (ABU), a premier university in Nigeria. The aim of The Nigerian Journal of Surgical Research is to cover developments and advances in the broad field of ...

  11. Surgical camps: the Ugandan experience

    African Journals Online (AJOL)

    of Surgeons of Uganda (ASOU) organised a pilot project in which surgical teams travelled to three hospitals in the Lira and Apac districts of Norhern. Uganda. The objectives of this project or 'Surgical Camp' were the following: 1 to offer free specialised surgical services in three hospitals which had no specialists or regular.

  12. Significance of surgical management for cystic prolactinoma.

    Science.gov (United States)

    Ogiwara, Toshihiro; Horiuchi, Tetsuyoshi; Nagm, Alhusain; Goto, Tetsuya; Hongo, Kazuhiro

    2017-04-01

    It is generally accepted that dopamine agonists (DA) represent the first-line treatment for most patients with prolactinoma, and patients become candidates for surgical intervention when DA is contraindicated. Surgical indication for cystic prolactinoma remains controversial. This study was performed to investigate the significance of surgery for cystic prolactinoma. A total of 28 patients that underwent transsphenoidal resection of prolactinoma between February 2004 and May 2016 were reviewed. Five consecutive patients with cystic prolactinoma were included in this study. Our surgical strategy for cystic prolactinoma was categorized as follows: first, when the purpose of surgical resection was normalization of the prolactin level, aggressive resection was performed; second, when volume reduction was essential to relieve the visual symptoms and headache, internal decompression was performed followed by DA therapy. The clinical outcomes were analyzed accordingly. All cystic prolactinoma were resected via the transsphenoidal approach without any complications, and all symptoms including visual impairment and hypogonadal activity were finally relieved combined with medication. Surgery for cystic prolactinoma could be a better option. Transsphenoidal surgery is relatively safe to remove the cystic prolactinoma, additionally it can normalize the prolactine level and achieve adequate and rapid decompression of optic chiasm. The risk of transsphenoidal surgery is highly dependent on the skill of the surgeon and treatment decision for cystic prolactinoma needs to be individualized for each patient.

  13. [Maxillary sinusitis of odontogenic origin: surgical treatment].

    Science.gov (United States)

    Chemli, H; Mnejja, M; Dhouib, M; Karray, F; Ghorbel, A; Abdelmoula, M

    2012-04-01

    The frequency of maxillary sinusitis of dental origin (MSDO) is under estimated. The medical and surgical treatment has improved thanks to endoscopic guidance. We report our experience and strategy in the treatment of MSDO. Twenty-two patients presenting with MSDO were treated between 1998 and 2008. The results were evaluated on clinical, functional, sinusal, and odontologic signs. MSDO accounted for 16% of surgically managed sinusitis. CT was performed in 95% of cases. The etiologies were apical leakage in seven patients, migration of a tooth or root during extraction, or presence of ectopic tooth in the sinus in nine patients, a cyst in three patients, and oroantral communication in three patients. Surgery was performed after antibiotic and NSAID treatment. The first surgical step was the treatment of the odontogenic source. The second step was sinus drainage by endoscopic treatment in 64%, Caldwell-Luc in 23%, and drainage by oroantral communication enlarged then closed in the same operative time in 13%. The follow up ranged from 3 months to 10 years. Early postoperative superinfection was observed in two patients. Two patients presented with recurrent sinusitis. The postoperative sequels were hyposmia in three patients, dental pulpotomy, and trigeminal neuralgia in five patients treated by Caldwell-Luc surgery. Nasal endoscopy has improved the surgical management of MSDO. It makes curettage and exclusion of sinus cavities obsolete. It is reliable and has a low rate of complications. The best treatment remains prevention. Copyright © 2012 Elsevier Masson SAS. All rights reserved.

  14. Eye metrics as an objective assessment of surgical skill.

    Science.gov (United States)

    Richstone, Lee; Schwartz, Michael J; Seideman, Casey; Cadeddu, Jeffrey; Marshall, Sandra; Kavoussi, Louis R

    2010-07-01

    Currently, surgical skills assessment relies almost exclusively on subjective measures, which are susceptible to multiple biases. We investigate the use of eye metrics as an objective tool for assessment of surgical skill. Eye tracking has helped elucidate relationships between eye movements, visual attention, and insight, all of which are employed during complex task performance (Kowler and Martins, Science. 1982;215:997-999; Tanenhaus et al, Science. 1995;268:1632-1634; Thomas and Lleras, Psychon Bull Rev. 2007;14:663-668; Thomas and Lleras, Cognition. 2009;111:168-174; Schriver et al, Hum Factors. 2008;50:864-878; Kahneman, Attention and Effort. 1973). Discovery of associations between characteristic eye movements and degree of cognitive effort have also enhanced our appreciation of the learning process. Using linear discriminate analysis (LDA) and nonlinear neural network analyses (NNA) to classify surgeons into expert and nonexpert cohorts, we examine the relationship between complex eye and pupillary movements, collectively referred to as eye metrics, and surgical skill level. Twenty-one surgeons participated in the simulated and live surgical environments. In the simulated surgical setting, LDA and NNA were able to correctly classify surgeons as expert or nonexpert with 91.9% and 92.9% accuracy, respectively. In the live operating room setting, LDA and NNA were able to correctly classify surgeons as expert or nonexpert with 81.0% and 90.7% accuracy, respectively. We demonstrate, in simulated and live-operating environments, that eye metrics can reliably distinguish nonexpert from expert surgeons. As current medical educators rely on subjective measures of surgical skill, eye metrics may serve as the basis for objective assessment in surgical education and credentialing in the future. Further development of this potential educational tool is warranted to assess its ability to both reliably classify larger groups of surgeons and follow progression of surgical

  15. Optimizing Surgical Margins in Breast Conservation

    Directory of Open Access Journals (Sweden)

    Preya Ananthakrishnan

    2012-01-01

    Full Text Available Adequate surgical margins in breast-conserving surgery for breast cancer have traditionally been viewed as a predictor of local recurrence rates. There is still no consensus on what constitutes an adequate surgical margin, however it is clear that there is a trade-off between widely clear margins and acceptable cosmesis. Preoperative approaches to plan extent of resection with appropriate margins (in the setting of surgery first as well as after neoadjuvant chemotherapy, include mammography, US, and MRI. Improvements have been made in preoperative lesion localization strategies for surgery, as well as intraoperative specimen assessment, in order to ensure complete removal of imaging findings and facilitate margin clearance. Intraoperative strategies to accurately assess tumor and cavity margins include cavity shave techniques, as well as novel technologies for margin probes. Ablative techniques, including radiofrequency ablation as well as intraoperative radiation, may be used to extend tumor-free margins without resecting additional tissue. Oncoplastic techniques allow for wider resections while maintaining cosmesis and have acceptable local recurrence rates, however often involve surgery on the contralateral breast. As systemic therapy for breast cancer continues to improve, it is unclear what the importance of surgical margins on local control rates will be in the future.

  16. [History of surgical intervention in severe acute pancreatitis treatment].

    Science.gov (United States)

    Wang, Chunyou; Gou, Shanmiao

    2015-09-01

    Severe acute pancreatitis (SAP) is hard to treat for the abrupt onset, critical condition and complicated pathophysiology. Historically, the treatment strategy of SAP hovered between surgical intervention and conservative treatment. At the turn of the 20(th) century, SAP was reported to be cured by surgical intervention in a series cases, which lead to the dominance of surgical intervention in SAP treatment. Subsequently, SAP was documented to respond to nonoperative therapy. A wave of conservatism emerged, and surgical intervention for SAP was rarely practiced for the next 3 decades. However, surgeons refined the indications and considered new approaches for surgical treatment in 1960s because of the poor outcomes of conservation, and surgical interventions was mainly performed at early stage of SAP. However, a series of prospective studies showed that conservative treatment of patients with sterile pancreatic necrosis is superior to surgical intervention, and that delayed intervention provide improved outcomes in 1990s, which changed the treatment concept of SAP again. The modern treatment concept formed during the progression: organ supportive care dominates in the early stage of the disease, and surgical intervention should be performed at late stage with proper indications. Despite the advances in treatment, the morbidity of SAP is still 5%-20%, which suggests the pancreatic surgeons' exploration in the future.

  17. Surgical resilience: a review of resilience biomarkers and surgical recovery.

    Science.gov (United States)

    Graham, David; Becerril-Martinez, Guillermo

    2014-12-01

    Two distinct and large bodies of literature exist on resilience that are of potential interest for surgical outcomes. First is the literature on the impact of resilience on surgical recovery and wound-healing. Second is the literature on biomarkers for resilience, which largely focuses on neuropeptide Y (NPY), testosterone and dehydroepiandrosterone (DHEA). Despite this activity, there is a dearth of literature linking these two bodies of research by investigating biomarkers for surgical resilience and its impact on surgical recovery. This paper reviews both bodies of literature within the context of surgical recovery. Literature searches within Medline and Embase were conducted for studies and previous reviews of resilience biomarkers and for the impact of individual resilience on surgical recovery. Reference lists of the reviews were searched for additional papers. No systematic review is yet possible due to the novelty of the use of resilience biomarkers within a surgical context. This is the first review to explore a potential link between resilience biomarkers and surgical recovery. There are a number of biomarkers that correlate with individual resilience levels and resilient individuals exhibit better recovery trajectories following surgery, suggesting a novel use of such biomarkers for the identification of "surgical resilience". By identifying surgical resilience, there is potential for utilising these biomarkers as prognostic indicators of likely recovery trajectories from surgery, which in turn complement individualised peri-operative management. Copyright © 2014 Royal College of Surgeons of Edinburgh (Scottish charity number SC005317) and Royal College of Surgeons in Ireland. Published by Elsevier Ltd. All rights reserved.

  18. Surgical management of hyperthyroidism.

    Science.gov (United States)

    Quérat, C; Germain, N; Dumollard, J-M; Estour, B; Peoc'h, M; Prades, J-M

    2015-04-01

    Hyperthyroidism includes several clinical and histopathological situations. Surgery is commonly indicated after failure of medical treatment. The aim of this study was to analyze the indications and complications of surgery as well as endocrine results. Patients operated on for hyperthyroidism between 2004 and 2012 were included in a retrospective study. Total thyroidectomy was performed for Graves' disease, toxic multinodular goiter and amiodarone-associated thyrotoxicosis; patients with toxic nodule underwent hemithyroidectomy. Pathologic analysis assessed surgical specimens; postoperative complications and resolution of hyperthyroidism were noted. Two hundred patients from 15 to 83 years old were included. One hundred and eighty-eight underwent primary surgery and 12 were re-operated for recurrent goiter (6 with subtotal thyroidectomy for multinodular goiter 25 years previously; 6 with hemithyroidectomy for solitary nodule 15 years previously). Eighty-two patients suffered from toxic multinodular goiter, 78 from Graves' disease, 35 from solitary toxic nodules and 5 from amiodarone-associated thyrotoxicosis. Fourteen papillary carcinomas (including 11 papillary microcarcinomas) and 34 healthy parathyroid glands (17%) were identified in the pathological specimens. Postoperative complications comprised 4% permanent recurrent laryngeal nerve palsy (1 year follow-up), 9% hematoma requiring surgical revision, and 3% definitive hypocalcemia. Normalization of thyroid hormone levels was observed in 198 patients. Two recurrences occurred due to incomplete resection (1 case of Graves' disease and 1 intrathoracic toxic goiter that occurred respectively 18 and 5 months after resection). Postoperative complications were more frequent in multinodular goiter (23%) than in Graves' disease (13%) (ns: P>0.05). Surgical management of hyperthyroidism enables good endocrinal control if surgery is complete. Patients need to be fully informed of all possible postoperative complications

  19. Surgical versus non-surgical management for primary patellar dislocations: an up-to-date meta-analysis.

    Science.gov (United States)

    Zheng, Xiaozuo; Kang, Kai; Li, Tong; Lu, Bo; Dong, Jiangtao; Gao, Shijun

    2014-12-01

    The aim of this up-to-date meta-analysis was to compare the effects of surgical versus non-surgical treatment of patients following primary patellar dislocation and to provide the best evidence currently available. A comprehensive literature search was conducted using multiple databases, including Medline, Embase, and Cochrane Registry of Clinical Trials. All databases were searched from the earliest records to May 2013. Eligible studies were selected, and data were extracted by two independent investigators. The primary outcome variable was the frequency of recurrent patellar dislocation. The other outcomes included knee function scores, patient-rated outcomes, and radiographic examination. If appropriate, meta-analysis of these variables was performed. Nine independent trials were found to match the inclusion criteria. The pooled results demonstrated that the incidence of recurrent patellar dislocation and Hughston visual analog scale was significantly lower in the surgical treatment group than that in the non-surgical treatment group (P 0.05). This up-to-date meta-analysis indicates that surgical treatment was associated with a lower risk of recurrent patellar dislocation, but a lower Hughston VAS than non-surgical treatment for primary patellar dislocation. More large high-quality trials and further studies are needed to overcome the limitations of small sample sizes, and varieties of different surgical procedures or non-surgical management strategies adopted in the included trials.

  20. [Surgical methods of abortion].

    Science.gov (United States)

    Linet, T

    2016-12-01

    A state of the art of surgical method of abortion focusing on safety and practical aspects. A systematic review of French-speaking or English-speaking evidence-based literature about surgical methods of abortion was performed using Pubmed, Cochrane and international recommendations. Surgical abortion is efficient and safe regardless of gestational age, even before 7 weeks gestation (EL2). A systematic prophylactic antibiotics should be preferred to a targeted antibiotic prophylaxis (grade A). In women under 25 years, doxycycline is preferred (grade C) due to the high prevalence of Chlamydia trachomatis. Systematic cervical preparation is recommended for reducing the incidence of complications from vacuum aspiration (grade A). Misoprostol is a first-line agent (grade A). When misoprostol is used before a vacuum aspiration, a dose of 400 mcg is recommended. The choice of vaginal route or sublingual administration should be left to the woman: (i) the vaginal route 3 hours before the procedure has a good efficiency/safety ratio (grade A); (ii) the sublingual administration 1 to 3 hours before the procedure has a higher efficiency (EL1). The patient should be warned of more common gastrointestinal side effects. The addition of mifepristone 200mg 24 to 48hours before the procedure is interesting for pregnancies between 12 and 14 weeks gestations (EL2). The systematic use of nonsteroidal anti-inflammatory drugs is recommended for limiting the operative and postoperative pain (grade B). Routine vaginal application of an antiseptic prior to the procedure cannot be recommended (grade B). The type of anesthesia (general or local) should be left up to the woman after explanation of the benefit-risk ratio (grade B). Paracervical local anesthesia (PLA) is recommended before performing a vacuum aspiration under local anesthesia (grade A). The electric or manual vacuum methods are very effective, safe and acceptable to women (grade A). Before 9 weeks gestation

  1. Conducting Polymers for Neural Prosthetic and Neural Interface Applications

    Science.gov (United States)

    2015-01-01

    Neural interfacing devices are an artificial mechanism for restoring or supplementing the function of the nervous system lost as a result of injury or disease. Conducting polymers (CPs) are gaining significant attention due to their capacity to meet the performance criteria of a number of neuronal therapies including recording and stimulating neural activity, the regeneration of neural tissue and the delivery of bioactive molecules for mediating device-tissue interactions. CPs form a flexible platform technology that enables the development of tailored materials for a range of neuronal diagnostic and treatment therapies. In this review the application of CPs for neural prostheses and other neural interfacing devices are discussed, with a specific focus on neural recording, neural stimulation, neural regeneration, and therapeutic drug delivery. PMID:26414302

  2. Biliary atresia. A surgical perspective.

    Science.gov (United States)

    Ohi, R

    2000-11-01

    The combination of portoenterostomy with subsequent liver transplantation is the treatment of choice for patients with biliary atresia. It is important, however, to attempt to keep the patient's own organ by continuing efforts to achieve the best possible results with portoenterostomy. Additional basic research, perhaps concerning on the role of cytokines and apoptosis in the control of biliary atresia, may provide insight into possible new medical strategies for treating patients with biliary atresia. For example, in addition to portoenterostomy, control of apoptosis at various cellular levels and of bile duct cell proliferation and maturation by manipulation of the growth factors and cytokines may become part of future treatment modalities. Another direction of research should be the control of fibrogenesis, which might be accomplished by blocking TGF-beta 1 and platelet-derived growth factor and by HGF gene therapy. The author's current strategy for surgical treatment for patients with biliary atresia include (1) early diagnosis, including prenatal diagnosis and broader use of mass screening programs, (2) hepatic portoenterostomy, without stoma formation; (3) close postoperative care, especially for prevention of postoperative cholangitis; (4) revision of portoenterostomy only in selected cases; (5) early liver transplantation in patients with absolutely failed portoenterostomy; (6) avoidance of laparotomy for the treatment of esophageal varices and hypersplenism; (7) consideration of exploratory laparotomy or primary liver transplantation for patients with advanced liver disease at the time of referral. The development of new treatment modalities based on the understanding of the pathogenesis of the disease, and especially on the biology of intrahepatic bile ducts and hepatic fibrosis, is essential.

  3. Radial basis function (RBF) neural network control for mechanical systems design, analysis and Matlab simulation

    CERN Document Server

    Liu, Jinkun

    2013-01-01

    Radial Basis Function (RBF) Neural Network Control for Mechanical Systems is motivated by the need for systematic design approaches to stable adaptive control system design using neural network approximation-based techniques. The main objectives of the book are to introduce the concrete design methods and MATLAB simulation of stable adaptive RBF neural control strategies. In this book, a broad range of implementable neural network control design methods for mechanical systems are presented, such as robot manipulators, inverted pendulums, single link flexible joint robots, motors, etc. Advanced neural network controller design methods and their stability analysis are explored. The book provides readers with the fundamentals of neural network control system design.   This book is intended for the researchers in the fields of neural adaptive control, mechanical systems, Matlab simulation, engineering design, robotics and automation. Jinkun Liu is a professor at Beijing University of Aeronautics and Astronauti...

  4. Role of ciliary neurotrophic factor in the proliferation and differentiation of neural stem cells.

    Science.gov (United States)

    Ding, Jun; He, Zhili; Ruan, Juan; Ma, Zilong; Liu, Ying; Gong, Chengxin; Iqbal, Khalid; Sun, Shenggang; Chen, Honghui

    2013-01-01

    Ciliary neurotrophic factor (CNTF) is a pleiotropic cytokine that has been fully studied for its structure, receptor, and signaling pathways and its multiplex effects on neural system, skeletal muscle, and weight control. Recent research demonstrates that CNTF also plays an important role in neurogenesis and the differentiation of neural stem cells. In this article, we summarize the general characteristics of CNTF and its function on neural stem cells, which could be a valuable therapeutic strategy in treating neurological disorders.

  5. Hyperbolic Hopfield neural networks.

    Science.gov (United States)

    Kobayashi, M

    2013-02-01

    In recent years, several neural networks using Clifford algebra have been studied. Clifford algebra is also called geometric algebra. Complex-valued Hopfield neural networks (CHNNs) are the most popular neural networks using Clifford algebra. The aim of this brief is to construct hyperbolic HNNs (HHNNs) as an analog of CHNNs. Hyperbolic algebra is a Clifford algebra based on Lorentzian geometry. In this brief, a hyperbolic neuron is defined in a manner analogous to a phasor neuron, which is a typical complex-valued neuron model. HHNNs share common concepts with CHNNs, such as the angle and energy. However, HHNNs and CHNNs are different in several aspects. The states of hyperbolic neurons do not form a circle, and, therefore, the start and end states are not identical. In the quantized version, unlike complex-valued neurons, hyperbolic neurons have an infinite number of states.

  6. Neural Semantic Encoders.

    Science.gov (United States)

    Munkhdalai, Tsendsuren; Yu, Hong

    2017-04-01

    We present a memory augmented neural network for natural language understanding: Neural Semantic Encoders. NSE is equipped with a novel memory update rule and has a variable sized encoding memory that evolves over time and maintains the understanding of input sequences through read, compose and write operations. NSE can also access multiple and shared memories. In this paper, we demonstrated the effectiveness and the flexibility of NSE on five different natural language tasks: natural language inference, question answering, sentence classification, document sentiment analysis and machine translation where NSE achieved state-of-the-art performance when evaluated on publically available benchmarks. For example, our shared-memory model showed an encouraging result on neural machine translation, improving an attention-based baseline by approximately 1.0 BLEU.

  7. [Stomata--surgical standards].

    Science.gov (United States)

    Wagner, M; Malayeri, V; Seiler, C A; Candinas, D

    2003-01-01

    The placement of an intestinal stoma is still a common procedure despite the recent advantages in intestinal surgery. It is mandatory to apply meticulously sound surgical principles in order to achieve good results. Nevertheless, intestinal stomas are envisioned with a high perioperative morbidity which is mostly caused by surgical inadequacy. This can lead to considerable problems in management of the stoma in the long term and ultimately will affect quality of life of the patient. The cumulative morbidity can be given by 50% with prolaps, hernia, stenosis and necrosis as well as stoma retraction being the most relevant. In contrast, an adequate intestinal stoma will positively affect the quality of life of the patient. The availability of devices developed by the industry and the inauguration of a professional service in certain hospitals simplified the management of patients with a stoma. This significantly improved the standards of care especially regarding preoperative preparation and postoperative management. Thus, most patients are able to maintain an active and socially integrated life with minimal physical and psychical limitations.

  8. Attracting students to surgical careers: preclinical surgical experience.

    Science.gov (United States)

    Antiel, Ryan M; Thompson, Scott M; Camp, Christopher L; Thompson, Geoffrey B; Farley, David R

    2012-01-01

    Along with a decline in interest in general surgery among United States medical school graduates, reports indicate a decrease in the amount of time students are spending on their surgical clerkship. In an effort to offer early exposure to general surgery as well as to equip students with the basic surgical skills that will enhance their third-year clerkship experience, we developed a preclinical surgical experience. Students were surveyed to determine whether the surgical selective changed student level of comfort with basic surgical skills. Surveys were administered, preexperience and postexperience to the medical students enrolled in the surgery selective. The students were asked to rate their comfort level with 12 unique surgical skills. Comfort with the task was evaluated using a 10-point Likert scale. Analyses were conducted to evaluate the impact of the surgical experience on student comfort levels with the surgical skills. The self-reported comfort levels of students increased significantly after the experience in all 12 areas. The greatest change in comfort level (greater than or equal to mean difference of 4) occurred in the surgical technique categories: knot tying (mean difference: 4.9, p < 0.0001), suturing (mean difference: 4.85, p < 0.0001), correctly making an incision (mean difference: 4.95, p < 0.0001), using a needle driver (mean difference: 5.35, p < 0.0001), holding pickups (mean difference: 4.6, p < 0.0001), use of laparoscopic instruments (mean difference: 4.8, p < 0.0001), and use of surgical simulators (mean difference: 6.0, p < 0.0001). Our preclinical surgical experience serves as a model of an effective modality providing early exposure to general surgery. The experience provides trainees with basic surgical skills well before they begin their third-year clerkships. Copyright © 2012 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

  9. Journal of Surgical Technique and Case Report

    African Journals Online (AJOL)

    The aim of Journal of Surgical Technique and Case Report is to advance surgical knowledge and practice by promoting the reporting of innovative and reproducible surgical techniques and illustrative surgical cases on various surgical disciplines. The journal encourages authoritative synthesis of current surgical literature ...

  10. The neural crest and neural crest cells: discovery and significance ...

    Indian Academy of Sciences (India)

    In this paper I provide a brief overview of the major phases of investigation into the neural crest and the major players involved, discuss how the origin of the neural crest relates to the origin of the nervous system in vertebrate embryos, discuss the impact on the germ-layer theory of the discovery of the neural crest and of ...

  11. System events: readily accessible features for surgical phase detection.

    Science.gov (United States)

    Malpani, Anand; Lea, Colin; Chen, Chi Chiung Grace; Hager, Gregory D

    2016-06-01

    Surgical phase recognition using sensor data is challenging due to high variation in patient anatomy and surgeon-specific operating styles. Segmenting surgical procedures into constituent phases is of significant utility for resident training, education, self-review, and context-aware operating room technologies. Phase annotation is a highly labor-intensive task and would benefit greatly from automated solutions. We propose a novel approach using system events-for example, activation of cautery tools-that are easily captured in most surgical procedures. Our method involves extracting event-based features over 90-s intervals and assigning a phase label to each interval. We explore three classification techniques: support vector machines, random forests, and temporal convolution neural networks. Each of these models independently predicts a label for each time interval. We also examine segmental inference using an approach based on the semi-Markov conditional random field, which jointly performs phase segmentation and classification. Our method is evaluated on a data set of 24 robot-assisted hysterectomy procedures. Our framework is able to detect surgical phases with an accuracy of 74 % using event-based features over a set of five different phases-ligation, dissection, colpotomy, cuff closure, and background. Precision and recall values for the cuff closure (Precision: 83 %, Recall: 98 %) and dissection (Precision: 75 %, Recall: 88 %) classes were higher than other classes. The normalized Levenshtein distance between predicted and ground truth phase sequence was 25 %. Our findings demonstrate that system events features are useful for automatically detecting surgical phase. Events contain phase information that cannot be obtained from motion data and that would require advanced computer vision algorithms to extract from a video. Many of these events are not specific to robotic surgery and can easily be recorded in non-robotic surgical modalities. In future

  12. Introduction to Artificial Neural Networks

    DEFF Research Database (Denmark)

    Larsen, Jan

    1999-01-01

    The note addresses introduction to signal analysis and classification based on artificial feed-forward neural networks.......The note addresses introduction to signal analysis and classification based on artificial feed-forward neural networks....

  13. Deconvolution using a neural network

    Energy Technology Data Exchange (ETDEWEB)

    Lehman, S.K.

    1990-11-15

    Viewing one dimensional deconvolution as a matrix inversion problem, we compare a neural network backpropagation matrix inverse with LMS, and pseudo-inverse. This is a largely an exercise in understanding how our neural network code works. 1 ref.

  14. Surgical scar revision: An overview

    Directory of Open Access Journals (Sweden)

    Shilpa Garg

    2014-01-01

    Full Text Available Scar formation is an inevitable consequence of wound healing from either a traumatic or a surgical intervention. The aesthetic appearance of a scar is the most important criteria to judge the surgical outcome. An understanding of the anatomy and wound healing along with experience, meticulous planning and technique can reduce complications and improve the surgical outcome. Scar revision does not erase a scar but helps to make it less noticeable and more acceptable. Both surgical and non-surgical techniques, used either alone or in combination can be used for revising a scar. In planning a scar revision surgeon should decide on when to act and the type of technique to use for scar revision to get an aesthetically pleasing outcome. This review article provides overview of methods applied for facial scar revision. This predominantly covers surgical methods.

  15. Guideline Implementation: Surgical Smoke Safety.

    Science.gov (United States)

    Fencl, Jennifer L

    2017-05-01

    Research conducted during the past four decades has demonstrated that surgical smoke generated from the use of energy-generating devices in surgery contains toxic and biohazardous substances that present risks to perioperative team members and patients. Despite the increase in information available, however, perioperative personnel continue to demonstrate a lack of knowledge of these hazards and lack of compliance with recommendations for evacuating smoke during surgical procedures. The new AORN "Guideline for surgical smoke safety" provides guidance on surgical smoke management. This article focuses on key points of the guideline to help perioperative personnel promote smoke-free work environments; evacuate surgical smoke; and develop education programs and competency verification tools, policies and procedures, and quality improvement initiatives related to controlling surgical smoke. Perioperative RNs should review the complete guideline for additional information and for guidance when writing and updating policies and procedures. Copyright © 2017 AORN, Inc. Published by Elsevier Inc. All rights reserved.

  16. Neutron spectrometry and dosimetry by means of Bonner spheres system and artificial neural networks applying robust design of artificial neural networks

    Energy Technology Data Exchange (ETDEWEB)

    Martinez B, M.R.; Ortiz R, J.M.; Vega C, H.R. [UAZ, Av. Ramon Lopez Velarde No. 801, 98000 Zacatecas (Mexico)

    2006-07-01

    An Artificial Neural Network has been designed, trained and tested to unfold neutron spectra and simultaneously to calculate equivalent doses. A set of 187 neutron spectra compiled by the International Atomic Energy Agency and 13 equivalent doses were used in the artificial neural network designed, trained and tested. In order to design the neural network was used the robust design of artificial neural networks methodology, which assures that the quality of the neural networks takes into account from the design stage. Unless previous works, here, for first time a group of neural networks were designed and trained to unfold 187 neutron spectra and at the same time to calculate 13 equivalent doses, starting from the count rates coming from the Bonner spheres system by using a systematic and experimental strategy. (Author)

  17. Spiking Neural P Systems with Communication on Request.

    Science.gov (United States)

    Pan, Linqiang; Păun, Gheorghe; Zhang, Gexiang; Neri, Ferrante

    2017-12-01

    Spiking Neural [Formula: see text] Systems are Neural System models characterized by the fact that each neuron mimics a biological cell and the communication between neurons is based on spikes. In the Spiking Neural [Formula: see text] systems investigated so far, the application of evolution rules depends on the contents of a neuron (checked by means of a regular expression). In these [Formula: see text] systems, a specified number of spikes are consumed and a specified number of spikes are produced, and then sent to each of the neurons linked by a synapse to the evolving neuron. [Formula: see text]In the present work, a novel communication strategy among neurons of Spiking Neural [Formula: see text] Systems is proposed. In the resulting models, called Spiking Neural [Formula: see text] Systems with Communication on Request, the spikes are requested from neighboring neurons, depending on the contents of the neuron (still checked by means of a regular expression). Unlike the traditional Spiking Neural [Formula: see text] systems, no spikes are consumed or created: the spikes are only moved along synapses and replicated (when two or more neurons request the contents of the same neuron). [Formula: see text]The Spiking Neural [Formula: see text] Systems with Communication on Request are proved to be computationally universal, that is, equivalent with Turing machines as long as two types of spikes are used. Following this work, further research questions are listed to be open problems.

  18. Global curriculum in surgical oncology.

    Science.gov (United States)

    Are, C; Berman, R S; Wyld, L; Cummings, C; Lecoq, C; Audisio, R A

    2016-06-01

    The significant global variations in surgical oncology training paradigms can have a detrimental effect on tackling the rising global cancer burden. While some variations in training are essential to account for the differences in types of cancer and biology, the fundamental principles of providing care to a cancer patient remain the same. The development of a global curriculum in surgical oncology with incorporated essential standards could be very useful in building an adequately trained surgical oncology workforce, which in turn could help in tackling the rising global cancer burden. The leaders of the Society of Surgical Oncology and European Society of Surgical Oncology convened a global curriculum committee to develop a global curriculum in surgical oncology. A global curriculum in surgical oncology was developed to incorporate the required domains considered to be essential in training a surgical oncologist. The curriculum was constructed in a modular fashion to permit flexibility to suit the needs of the different regions of the world. Similarly, recognizing the various sociocultural, financial and cultural influences across the world, the proposed curriculum is aspirational and not mandatory in intent. A global curriculum was developed which may be considered as a foundational scaffolding for training surgical oncologists worldwide. It is envisioned that this initial global curriculum will provide a flexible and modular scaffolding that can be tailored by individual countries or regions to train surgical oncologists in a way that is appropriate for practice in their local environment. Copyright © 2016 Society of Surgical Oncology, European Society of Surgical Oncology. Published by Elsevier Ltd.. All rights reserved.

  19. Surgical treatment of the Charcot foot.

    Science.gov (United States)

    Pinzur, Michael S

    2016-01-01

    With the increased number of diabetics worldwide and the increased incidence of morbid obesity in more prosperous cultures, there has become an increased awareness of Charcot arthropathy of the foot and ankle. Outcome studies would suggest that patients with deformity associated with Charcot Foot arthropathy have impaired health related quality of life. This awareness has led reconstructive-minded foot and ankle surgeons to develop surgical strategies to treat these acquired deformities. This article outlines the current clinical approach to this disabling medical condition. Copyright © 2016 John Wiley & Sons, Ltd.

  20. Urinary tract infections in surgical patients.

    Science.gov (United States)

    Ramanathan, Rajesh; Duane, Therese M

    2014-12-01

    Catheter-associated urinary tract infections (CAUTI) are common in surgical patients. CAUTI are associated with adverse patient outcomes, and negatively affects public safety reporting and reimbursement. Inappropriate catheter use and prolonged catheter duration are major risk factors for CAUTI. CAUTI pathogenesis and treatment are complicated by the presence of biofilms. Prevention strategies include accurate identification and tracking of CAUTIs, and the development of institutional guidelines for the appropriate use, duration, alternatives, and removal of indwelling urinary catheters. Copyright © 2014 Elsevier Inc. All rights reserved.

  1. Neural Control System in Obstacle Avoidance in Mobile Robots Using Ultrasonic Sensors

    Directory of Open Access Journals (Sweden)

    A. Medina-Santiago

    2014-02-01

    Full Text Available This paper presents the development and implementation of neural control systems in mobile robots in obstacle avoidance in real time using ultrasonic sensors with complex strategies of decision-making in development (Matlab and Processing. An Arduino embedded platform is used to implement the neural control for field results.

  2. Surgical proctoring for gynecologic surgery.

    Science.gov (United States)

    Heit, Michael

    2014-02-01

    Surgical proctoring allows a hospital's credentialing committee to objectively monitor, regulate, or oversee surgical privileging for its medical staff to ensure the safety and quality of care for its patients. The surgical proctor does not participate directly in patient care and does not establish a patient-physician relationship before the procedure and therefore is under no obligation to intervene if an intraoperative complication occurs or substandard care is witnessed. Good Samaritan legislation enacted in every state should provide immunity for the proctoring physician if intervention is necessary. Teleproctoring may become the most cost-effective method for institutions that are unable to identify a local proctor for surgical privileging.

  3. Neuronavigation. Principles. Surgical technique.

    Science.gov (United States)

    Ivanov, Marcel; Ciurea, Alexandru Vlad

    2009-01-01

    Neuronavigation and stereotaxy are techniques designed to help neurosurgeons precisely localize different intracerebral pathological processes by using a set of preoperative images (CT, MRI, fMRI, PET, SPECT etc.). The development of computer assisted surgery was possible only after a significant technological progress, especially in the area of informatics and imagistics. The main indications of neuronavigation are represented by the targeting of small and deep intracerebral lesions and choosing the best way to treat them, in order to preserve the neurological function. Stereotaxis also allows lesioning or stimulation of basal ganglia for the treatment of movement disorders. These techniques can bring an important amount of confort both to the patient and to the neurosurgeon. Neuronavigation was introduced in Romania around 2003, in four neurosurgical centers. We present our five-years experience in neuronavigation and describe the main principles and surgical techniques.

  4. Tophi - surgical treatment.

    Science.gov (United States)

    Słowińska, Iwona; Słowiński, Radosław; Rutkowska-Sak, Lidia

    2016-01-01

    Gout is an inflammatory joint disease associated with deposition of monosodium urate crystals in the bones forming the joints, in periarticular tissues and in other organs. The disease is one of the most frequent causes of disability. This paper presents the case of a 57-year-old male patient treated for generalised gout. A "clinical mask" suggesting another disease was the cause of making the correct diagnosis only six years after the occurrence of the first manifestations. The patient, with high values of inflammatory markers, severe pain and advanced joint destruction, was given an aggressive anti-inflammatory treatment. The unsatisfactory effect of the conservative treatment forced the authors to perform surgical resection of the gouty nodules in the hands. After several operations the function of the hand joints operated on, appearance of the hands and the quality of the patient's life improved significantly.

  5. Rapid three dimensional two photon neural population scanning.

    Science.gov (United States)

    Schuck, Renaud; Quicke, Peter; Copeland, Caroline; Garasto, Stefania; Annecchino, Luca A; Hwang, June Kyu; Schultz, Simon R

    2015-08-01

    Recording the activity of neural populations at high sampling rates is a fundamental requirement for understanding computation in neural circuits. Two photon microscopy provides one promising approach towards this. However, neural circuits are three dimensional, and functional imaging in two dimensions fails to capture the 3D nature of neural dynamics. Electrically tunable lenses (ETLs) provide a simple and cheap method to extend laser scanning microscopy into the relatively unexploited third dimension. We have therefore incorporated them into our Adaptive Spiral Scanning (SSA) algorithm, which calculates kinematically efficient scanning strategies using radially modulated spiral paths. We characterised the response of the ETL, incorporated its dynamics using MATLAB models of the SSA algorithm and tested the models on populations of Izhikevich neurons of varying size and density. From this, we show that our algorithms can theoretically at least achieve sampling rates of 36.2Hz compared to 21.6Hz previously reported for 3D scanning techniques.

  6. Supervised Learning with Complex-valued Neural Networks

    CERN Document Server

    Suresh, Sundaram; Savitha, Ramasamy

    2013-01-01

    Recent advancements in the field of telecommunications, medical imaging and signal processing deal with signals that are inherently time varying, nonlinear and complex-valued. The time varying, nonlinear characteristics of these signals can be effectively analyzed using artificial neural networks.  Furthermore, to efficiently preserve the physical characteristics of these complex-valued signals, it is important to develop complex-valued neural networks and derive their learning algorithms to represent these signals at every step of the learning process. This monograph comprises a collection of new supervised learning algorithms along with novel architectures for complex-valued neural networks. The concepts of meta-cognition equipped with a self-regulated learning have been known to be the best human learning strategy. In this monograph, the principles of meta-cognition have been introduced for complex-valued neural networks in both the batch and sequential learning modes. For applications where the computati...

  7. Surgical management of bronchiectasis

    Directory of Open Access Journals (Sweden)

    Shanker Bhandari

    2016-07-01

    Full Text Available Background: Bronchiectasis is the permanent dilatation of the bronchi due to destruction of bronchial wall. Bronchi­ectasis still remains a serious problem in developing countries despite of modern medical facilities.Objectives: This study aims to demonstrate our surgical experience for bronchiectasis and analyze the risk factors related with the surgery outcome.Methods: Hospital based analyses of 39 patients were done who were underwent surgery for bronchiectasis and were on follow up in National Institute of Diseases of Chest hospital (NIDCH in September 2014 to February 2015 were included in this study. All 39 patients had surgery for the bronchiectasis in the period of January 2014 to December 2014.Results: The mean age of the patients were 22.2 years. Twenty four patients were females and 15 were male. Symptoms were recurrent infection with cough, copious sputum in all patients and hemoptysis in 31 patients. The etiology was recur­rent childhood infection in 17 patients, pneumonia in 11 patients, PTB in 6 patients, Aspiration in 2 patients, foreign body obstruction in 1 patient, and unknown etiology in 2 patients. Chest x-ray, CT scan and rigid bronchoscope were done for all patients. Bronchiectasis was left-sided in 17 patients. It was mainly confined to the lower lobes either alone in 9 patients and in conjunction with middle lobe or lingual in 8 patients. Indications for resection were failure of conservative therapy in 22 patients, hemoptysis in 8 patients, destroyed lung in 9 patients. Surgery was lobectomy in 24 patients, Bilobectomy in 5 patients, and pneumonectomy in 10 patients. Complications occurred in 10 patients with no operative mortality. Thirty four patients had relief of their preoperative symptoms after surgery in follow up periods.Conclusions: Surgical resection for bronchiectasis should be reserved for patients with localised disease who have failed medical management and have persistent symptoms that negatively affect

  8. Neural Network Ensembles

    DEFF Research Database (Denmark)

    Hansen, Lars Kai; Salamon, Peter

    1990-01-01

    We propose several means for improving the performance an training of neural networks for classification. We use crossvalidation as a tool for optimizing network parameters and architecture. We show further that the remaining generalization error can be reduced by invoking ensembles of similar...... networks....

  9. Neural systems for control

    National Research Council Canada - National Science Library

    Omidvar, Omid; Elliott, David L

    1997-01-01

    ... is reprinted with permission from A. Barto, "Reinforcement Learning," Handbook of Brain Theory and Neural Networks, M.A. Arbib, ed.. The MIT Press, Cambridge, MA, pp. 804-809, 1995. Chapter 4, Figures 4-5 and 7-9 and Tables 2-5, are reprinted with permission, from S. Cho, "Map Formation in Proprioceptive Cortex," International Jour...

  10. Neural Tube Defects

    Science.gov (United States)

    ... pregnancies each year in the United States. A baby’s neural tube normally develops into the brain and spinal cord. ... fluid in the brain. This is called hydrocephalus. Babies with this condition are treated with surgery to insert a tube (called a shunt) into the brain. The shunt ...

  11. Genetics and development of neural tube defects

    Science.gov (United States)

    Copp, Andrew J.; Greene, Nicholas D. E.

    2014-01-01

    Congenital defects of neural tube closure (neural tube defects; NTDs) are among the commonest and most severe disorders of the fetus and newborn. Disturbance of any of the sequential events of embryonic neurulation produce NTDs, with the phenotype (e.g. anencephaly, spina bifida) varying depending on the region of neural tube that remains open. While mutation of more than 200 genes is known to cause NTDs in mice, the pattern of occurrence in humans suggests a multifactorial polygenic or oligogenic aetiology. This emphasises the importance of gene-gene and gene-environment interactions in the origin of these defects. A number of cell biological functions are essential for neural tube closure, with defects of the cytoskeleton, cell cycle and molecular regulation of cell viability prominent among the mouse NTD mutants. Many transcriptional regulators and proteins that affect chromatin structure are also required for neural tube closure, although the downstream molecular pathways regulated by these proteins is unknown. Some key signalling pathways for NTDs have been identified: over-activation of sonic hedgehog signalling and loss of function in the planar cell polarity (non-canonical Wnt) pathway are potent causes of NTD, with requirements also for retinoid and inositol signalling. Folic acid supplementation is an effective method for primary prevention of a proportion of NTDs, in both humans and mice, although the embryonic mechanism of folate action remains unclear. Folic acid-resistant cases can be prevented by inositol supplementation in mice, raising the possibility that this could lead to an additional preventive strategy for human NTDs in future. PMID:19918803

  12. Cherubism: A Case Report with Surgical Intervention.

    Science.gov (United States)

    Friedrich, Reinhard E; Scheuer, Hanna A; Zustin, Jozef; Grob, Tobias

    2016-06-01

    Cherubism is a rare benign, autosomal-dominant hereditary fibro-osseous condition predominantly affecting the jaws. Symmetrical cyst-like expansions of the jaws cause the characteristic facial swellings. The disease is often associated with severe malposition of teeth. The gene for cherubism is src homology 3 binding protein 2 (SH3BP2) located on chromosome 4p16.3. The repeated experience of this self-limiting disorder in affected individuals published in the medical literature has resulted in a wait-and-see strategy regarding therapeutic options. Indeed, cessation and regression of even large bone expansions can be expected in early adulthood. Nevertheless, severe facial disfiguring and functional impairment can make surgical intervention necessary. This report details the surgical procedures carried out in a patient with progressive and disfiguring jaw expansions at the end of adolescence, the mutation of SH3BP2 gene, and the limited effect of surgically assisted orthodontic tooth movement in a patient with disease-associated impaired tooth development and tooth eruption. Copyright© 2016 International Institute of Anticancer Research (Dr. John G. Delinassios), All rights reserved.

  13. Green surgical practices for health care.

    Science.gov (United States)

    Kwakye, Gifty; Brat, Gabriel A; Makary, Martin A

    2011-02-01

    The objective of this study was to identify leading practices to promote environmentally friendly and efficient efforts in the provision of surgical health care. Health care is the second leading contributor to waste in the United States. Despite widespread enthusiasm for "going green" in the US economy, little substantive information is available to the medical community, to our knowledge. We explore safe and efficient strategies for hospitals and providers to protect the environment while delivering high-quality care. We performed a systematic review of the literature using relevant PubMed search terms and surveyed a panel of hospital managers and chief executive officers of health care organizations pursuing green initiatives. Recommendations were itemized and reviewed by a 7-member panel to generate a consensus agreement. We identified 43 published articles and used interview data from the panel. The following 5 green recommendations for surgical practices were identified: operating room waste reduction and segregation, reprocessing of single-use medical devices, environmentally preferable purchasing, energy consumption management, and pharmaceutical waste management. The medical community has a large opportunity to implement green practices in surgical units. These practices can provide significant benefits to the health care community and to the environment. Additional research and advocacy are needed to further explore green practices in health care.

  14. Can Probiotics Improve Your Surgical Outcomes?

    Science.gov (United States)

    Ward, Tina; Nichols, Misty; Nutter, Julie

    2016-01-01

    Despite ongoing advances in medical technology, postoperative infections and infectious complications continue to be a significant cause of morbidity and mortality. Surgical trauma and prophylactic antibiotics disrupt the balance of the intestinal microbiota and barrier function of the gut, potentiating an enhanced inflammatory response and further immune system depression. With the increasing costs of health care and emergence of multidrug-resistant bacteria, alternative approaches must be explored. Many clinical studies have demonstrated that the use of probiotics, prebiotics, or a combination of both (synbiotics) as a part of innovative strategies can improve outcomes of elective abdominal and gastrointestinal surgical procedures. It has been demonstrated that probiotics play a role in gut barrier improvement and immunomodulation. However, it is evident that additional research is needed including larger, multicenter, randomized controlled trials to validate the safety and efficacy of their use in surgical patients. The purpose of this article is to discuss background of probiotic use in abdominal/gastrointestinal surgery, risk and benefits, clinical relevance for health care providers, and further implications for research.

  15. Surgical consideration of cervical dumbbell tumors.

    Science.gov (United States)

    Tomii, Masato; Itoh, Yasunobu; Numazawa, Shinichi; Watanabe, Kazuo

    2013-10-01

    Nineteen patients with cervical dumbbell tumors treated surgically were analyzed retrospectively. Surgical strategies for dumbbell tumor were discussed from the perspective of safe, less-invasive surgery. Patients included 6 men and 13 women, with a mean age at the time of surgery of 48.3 years (range, 25-70 years). Underlying pathologies included 16 schwannomas, 2 neurofibromas, and 1 double tumor (schwannoma and meningioma). According to Eden's classification, one patient was classified as Type 1, 5 as Type 2, 8 as Type 3, and 5 as Type 4. In 13 cases, tumors were excised through the posterior approach alone, compared to five cases using the anterior approach. One case was excised using combined anterior and posterior approaches. Facetectomy was not performed in 18 cases. In one case, the facet joint on one side had already destroyed and needed instrumentation. Tumors were totally excised in all cases. Postoperatively, the patients did not display any further neurological deficit, with the exception of transient radiculopathy in two patients. Major surgical complications and cerebrospinal fluid leakage were not seen. Tumor recurrence and spinal segmental instability were not found during follow-up period (mean, 41.6 months). Dumbbell tumor surgery requires sufficient debulking of the epidural and paravertebral mass, using intraoperative nerve stimulation and Doppler ultrasonography to detect the vertebral artery. When using a posterior approach, recapping laminoplasty using an ultrasonic bone curette is very useful to remove tumor without sacrificing facet joints.

  16. Surgical telementoring: A new model for surgical training.

    Science.gov (United States)

    Snyderman, Carl H; Gardner, Paul A; Lanisnik, Bostjan; Ravnik, Janez

    2016-06-01

    To assess the efficacy of a surgical telementoring program for endoscopic skull base surgery. Prospective case series with surveys of surgeons. A surgical telementoring program was established for mentoring of a skull base team at the University of Maribor in Slovenia by an experienced skull base team at the University of Pittsburgh Medical Center in Pennsylvania. Two-way video and audio streaming provided real-time communication with the surgical team. Over a period of 3 years, 10 endoscopic endonasal surgeries of the skull base were mentored preoperatively and during the key part of the procedure. Following each procedure, an evaluation form was used to document the mentoring interventions and rate the experience. Procedures included endoscopic endonasal approaches to the sella, anterior cranial fossa, posterior cranial fossa, and orbit. Diagnoses included benign and malignant neoplasms, cerebrospinal fluid leak, and inflammatory disease. In nine of 10 cases, adequate audio and video communications were maintained. The most frequent mentoring interventions were for identification of anatomy, extent of exposure, extent of resection, and surgical technique. The median perceived value by the junior surgical team was 9.5 (range 8-10). A model for surgical telementoring is proposed. Surgical telementoring provides the ability to help surgeons develop their surgical skills to a greater level of proficiency for complex surgeries when experienced mentors are not available locally. The technology is reliable and available at most institutions. Perceived benefits of surgical telementoring include improved surgical exposure, increased extent of tumor resection, and decreased duration of surgery. N/A. Laryngoscope, 126:1334-1338, 2016. © 2016 The American Laryngological, Rhinological and Otological Society, Inc.

  17. Surgical anatomy of the minimally invasive lateral lumbar approach.

    Science.gov (United States)

    Bina, Robert W; Zoccali, Carmine; Skoch, Jesse; Baaj, Ali A

    2015-03-01

    The lateral lumbar interbody fusion approach (LLIF), which encompasses the extreme lateral interbody fusion or direct lateral interbody fusion techniques, has gained popularity as an alternative to traditional posterior approaches. With rapidly expanding applications, this minimally invasive surgery (MIS) approach is now utilized in basic degenerative pathologies as well as complex lumbar degenerative deformities and tumors. Given the intimate relationship of the psoas muscle, and hence the lumbar plexus, to this MIS approach, several authors have examined the surgical anatomy of this approach. Understanding this regional neural anatomy is imperative given the potential for serious injuries to both the motor and sensory nerves of the lumbar plexus. In this review, we critically and comprehensively discuss all published studies detailing the surgical anatomy of the lateral lumbar approach with respect to the MIS LLIF techniques. This is a timely review given the rapidly growing number of surgeons utilizing this technique. Copyright © 2014 Elsevier Ltd. All rights reserved.

  18. CT of lumbar spine disk herniation: correlation with surgical findings

    Energy Technology Data Exchange (ETDEWEB)

    Firooznia, H.; Benjamin, V.; Kricheff, I.I.; Rafii, M.; Golimbu, C.

    1984-03-01

    Computed tomography (CT) of the lumbar spine was performed with selectively positioned 5-mm-thick axial cross sections to examine each disk level from the top of the neural foramen to the pedicle of the next caudad vertebra. One hundred consecutive patients with 116 surgical disk explorations were reviewed. There was agreement between the CT and surgical findings in 89 patients (104 explorations) in determination of presence or absence of a herniated nucleus pulposus (HNP). Discrepancy occurred in 12 instances (11 patients): two because of incorrect interpretations, five in previously operated patients, three in spondylolisthesis, and two in spinal stenosis. There were 97 true-positives, eight false-negatives, seven true-negatives, and four false-positives. If nine previously operated patients are excluded from the study, then CT was accurate in detection of presence or absence of an HNP in 93% of the disk explorations.

  19. A concept paper: Using the outcomes of common surgical conditions ...

    African Journals Online (AJOL)

    The disparities between the developed and developing world in terms of wealth and social indicators are reflected in disparities in access to surgical care. Health administrators must develop plans and strategies to reduce these disparities. However, any strategic plan that addresses deficits in healthcare must have a ...

  20. Pharmaceutical care in surgical patients: Tools for measurement and intervention

    NARCIS (Netherlands)

    de Boer, M.

    2015-01-01

    Assessing and improving the quality of pharmaceutical care is a major issue in hospitals nowadays. Medication safety strategies are being developed and widely introduced in hospitals to reduce medication-related harm. Surgical patients are at risk for medication-related harm, also called adverse

  1. Bioprinting for Neural Tissue Engineering.

    Science.gov (United States)

    Knowlton, Stephanie; Anand, Shivesh; Shah, Twisha; Tasoglu, Savas

    2018-01-01

    Bioprinting is a method by which a cell-encapsulating bioink is patterned to create complex tissue architectures. Given the potential impact of this technology on neural research, we review the current state-of-the-art approaches for bioprinting neural tissues. While 2D neural cultures are ubiquitous for studying neural cells, 3D cultures can more accurately replicate the microenvironment of neural tissues. By bioprinting neuronal constructs, one can precisely control the microenvironment by specifically formulating the bioink for neural tissues, and by spatially patterning cell types and scaffold properties in three dimensions. We review a range of bioprinted neural tissue models and discuss how they can be used to observe how neurons behave, understand disease processes, develop new therapies and, ultimately, design replacement tissues. Copyright © 2017 Elsevier Ltd. All rights reserved.

  2. Towards Safe Robotic Surgical Systems

    DEFF Research Database (Denmark)

    Sloth, Christoffer; Wisniewski, Rafael

    2015-01-01

    A proof of safety is paramount for an autonomous robotic surgical system to ensure that it does not cause trauma to patients. However, a proof of safety is rarely constructed, as surgical systems are too complex to be dealt with by most formal verification methods. In this paper, we design...

  3. Surgical innovation : The ethical agenda

    NARCIS (Netherlands)

    Broekman, Marike L.|info:eu-repo/dai/nl/343152347; Carrière, Michelle E.; Bredenoord, Annelien L.|info:eu-repo/dai/nl/240834666

    2016-01-01

    The aim of the present article was to systematically review the ethics of surgical innovation and introduce the components of the learning health care system to guide future research and debate on surgical innovation. Although the call for evidence-based practice in surgery is increasingly high on

  4. Access to Specialized Surgical Care

    African Journals Online (AJOL)

    The narrative of surgical disease in Africa is changing. Long neglected from health interventions to reduce ... For DALYs (Disability Adjusted Life Years) lost due to surgical conditions, Africa has the highest rate of 38 ... story of surgery in continent more in order to record progress (4, 5). The Bellagio Essential Surgery Group ...

  5. Surgical innovations in canine gonadectomy

    NARCIS (Netherlands)

    Van Goethem, Bart

    2016-01-01

    In this thesis some recent technological developments in human surgery are evaluated for their potential use in veterinary medicine by introducing them as surgical innovations for canine gonadectomy. Barbed sutures achieve wound apposition without surgical knot tying and thus avoid knot-associated

  6. Surgical options after Fontan failure

    DEFF Research Database (Denmark)

    van Melle, Joost P; Wolff, Djoeke; Hörer, Jürgen

    2016-01-01

    OBJECTIVE: The objective of this European multicenter study was to report surgical outcomes of Fontan takedown, Fontan conversion and heart transplantation (HTX) for failing Fontan patients in terms of all-cause mortality and (re-)HTX. METHODS: A retrospective international study was conducted...... for failing Fontan surgery was arrhythmia (43.6%), but indications differed across the surgical groups (p

  7. Surgical residency: A tenant's view

    African Journals Online (AJOL)

    'To sleep: perchance to dream', is the frequent mantra of the surgical resident. However, unlike. Hamlet, there is no ensuing speculation as to what dreams may come as there are seldom any!! Surgical residency has been both vilified and immortalized, but the fact remains that it is one of the most challenging, provocative ...

  8. Surgical Management of Calcaneal Malunion

    Directory of Open Access Journals (Sweden)

    Guang-Rong Yu

    2013-06-01

    Full Text Available Calcaneal malunion is a common complication after conservative treatment or incorrect surgical treatment of calcaneal fracture. The typical pathoanatomies of calcaneal malunion are subtalar joint incongruity, loss of calcaneal height, arch collapse, varus or valgus deformity of the calcaneus, heel widening and so on. Calcaneal malunion often needs to be treated surgically. The classification of calcaneal malunion and the detailed clinical and radiographical assessment play important roles for surgical option. The main surgical methods include in situ subtalar arthrodesis, reconstruction of calcaneal thalamus and subtalar arthrodesis, calcaneal osteotomy with subtalar arthrodesis, corrective calcaneal osteotomy without subtalar arthrodesis. Each option has its different indications, advantages and disadvantages. Thus, the surgical treatment should be individualised.

  9. Requirements for the design and implementation of checklists for surgical processes

    NARCIS (Netherlands)

    Verdaasdonk, E.G.G.; Stassen, L.P.S.; Widhiasmara, P.P.; Dankelman, J.

    2008-01-01

    Background- The use of checklists is a promising strategy for improving patient safety in all types of surgical processes inside and outside the operating room. This article aims to provide requirements and implementation of checklists for surgical processes. Methods- The literature on checklist use

  10. How to Perform a Late Surgical Explantation of a CoreValve Aortic Bioprothesis.

    Science.gov (United States)

    Hernandez-Vaquero, Daniel; Pascual, Isaac; Diaz, Rocío; Álvarez-Cabo, Rubén; Moris, César; Silva, Jacobo

    2017-06-01

    As transcatheter techniques expand to younger patients, cardiac surgeons need to know a safe surgical technique to extract these kinds of prostheses. We describe here an adequate surgical strategy for the explantation of a CoreValve prosthesis that was implanted more than 5 years previously. Copyright © 2017 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  11. Retrospective Study on the Treatment Outcome of Surgical Closure of Oroantral Communications

    NARCIS (Netherlands)

    Visscher, Susan H.; van Roon, Marije R. F.; Sluiter, Wim J.; van Minnen, Baucke; Bos, Ruud R. M.

    2011-01-01

    Purpose: A retrospective cohort study concerning the surgical closure of oroantral communications (OACs) was carried out to facilitate a comparison between treatment outcomes of conventional surgical treatment and new strategies for closure of OACs. Data were statistically analyzed to gather insight

  12. Surgical infection in art.

    Science.gov (United States)

    Meakins, J L

    1996-12-01

    The earliest images of medicine and surgery in Western art are from the late Middle Ages. Although often attractive, at that time they were illustrative and mirrored the text on how to diagnose or treat a specific condition. These drawings in medieval manuscripts represent management of abscesses, perianal infection and fistulas, amputation, and wound dressings. With the Renaissance, art in all its forms flourished, and surgeons were represented at work draining carbuncles, infected bursae, and mastoiditis; managing ulcers, scrofula, and skin infections; and performing amputations. Specific diagnosis can be made, such as streptococcal infection in the discarded leg of the miraculous transplantation performed by Saints Cosmas and Damian and in the works of Rembrandt van Rijn and Frederic Bazille. Evocations of cytokine activity are evident in works by Albrecht Dürer, Edvard Munch, and James Tissot. The iconography of society's view of a surgeon is apparent and often not complimentary. The surgeon's art is a visual art. Astute observation leads to early diagnosis and better results in surgical infection and the septic state. Learning to see what we look at enhances our appreciation of the world around us but, quite specifically, makes us better clinicians.

  13. Neural network technologies

    Science.gov (United States)

    Villarreal, James A.

    1991-01-01

    A whole new arena of computer technologies is now beginning to form. Still in its infancy, neural network technology is a biologically inspired methodology which draws on nature's own cognitive processes. The Software Technology Branch has provided a software tool, Neural Execution and Training System (NETS), to industry, government, and academia to facilitate and expedite the use of this technology. NETS is written in the C programming language and can be executed on a variety of machines. Once a network has been debugged, NETS can produce a C source code which implements the network. This code can then be incorporated into other software systems. Described here are various software projects currently under development with NETS and the anticipated future enhancements to NETS and the technology.

  14. Analysis of neural data

    CERN Document Server

    Kass, Robert E; Brown, Emery N

    2014-01-01

    Continual improvements in data collection and processing have had a huge impact on brain research, producing data sets that are often large and complicated. By emphasizing a few fundamental principles, and a handful of ubiquitous techniques, Analysis of Neural Data provides a unified treatment of analytical methods that have become essential for contemporary researchers. Throughout the book ideas are illustrated with more than 100 examples drawn from the literature, ranging from electrophysiology, to neuroimaging, to behavior. By demonstrating the commonality among various statistical approaches the authors provide the crucial tools for gaining knowledge from diverse types of data. Aimed at experimentalists with only high-school level mathematics, as well as computationally-oriented neuroscientists who have limited familiarity with statistics, Analysis of Neural Data serves as both a self-contained introduction and a reference work.

  15. Neural tube defects

    Directory of Open Access Journals (Sweden)

    M.E. Marshall

    1981-09-01

    Full Text Available Neural tube defects refer to any defect in the morphogenesis of the neural tube, the most common types being spina bifida and anencephaly. Spina bifida has been recognised in skeletons found in north-eastern Morocco and estimated to have an age of almost 12 000 years. It was also known to the ancient Greek and Arabian physicians who thought that the bony defect was due to the tumour. The term spina bifida was first used by Professor Nicolai Tulp of Amsterdam in 1652. Many other terms have been used to describe this defect, but spina bifida remains the most useful general term, as it describes the separation of the vertebral elements in the midline.

  16. Risk factors, diagnosis and non-surgical treatment for meniscal tears

    DEFF Research Database (Denmark)

    Thorlund, Jonas Bloch; Juhl, Carsten Bogh; Ingelsrud, Lina Holm

    2018-01-01

    This statement aimed at summarising and appraising the available evidence for risk factors, diagnostic tools and non-surgical treatments for patients with meniscal tears. We systematically searched electronic databases using a pragmatic search strategy approach. Included studies were synthesised ...

  17. Surgical treatment of Dupuytren's disease - outcome and health economy in relation to smoking and diabetes

    National Research Council Canada - National Science Library

    Eckerdal, David; Nivestam, Axel; Dahlin, Lars B

    2014-01-01

    The conventional treatment for Dupuytren's disease is surgery. The introduction of alternative treatment strategies creates a need to track outcomes and costs relating to surgical treatment and risk factors, such as smoking and diabetes...

  18. Neural networks for triggering

    Energy Technology Data Exchange (ETDEWEB)

    Denby, B. (Fermi National Accelerator Lab., Batavia, IL (USA)); Campbell, M. (Michigan Univ., Ann Arbor, MI (USA)); Bedeschi, F. (Istituto Nazionale di Fisica Nucleare, Pisa (Italy)); Chriss, N.; Bowers, C. (Chicago Univ., IL (USA)); Nesti, F. (Scuola Normale Superiore, Pisa (Italy))

    1990-01-01

    Two types of neural network beauty trigger architectures, based on identification of electrons in jets and recognition of secondary vertices, have been simulated in the environment of the Fermilab CDF experiment. The efficiencies for B's and rejection of background obtained are encouraging. If hardware tests are successful, the electron identification architecture will be tested in the 1991 run of CDF. 10 refs., 5 figs., 1 tab.

  19. Artificial neural network modelling

    CERN Document Server

    Samarasinghe, Sandhya

    2016-01-01

    This book covers theoretical aspects as well as recent innovative applications of Artificial Neural networks (ANNs) in natural, environmental, biological, social, industrial and automated systems. It presents recent results of ANNs in modelling small, large and complex systems under three categories, namely, 1) Networks, Structure Optimisation, Robustness and Stochasticity 2) Advances in Modelling Biological and Environmental Systems and 3) Advances in Modelling Social and Economic Systems. The book aims at serving undergraduates, postgraduates and researchers in ANN computational modelling. .

  20. The Neural Noisy Channel

    OpenAIRE

    Yu, Lei; Blunsom, Phil; Dyer, Chris; Grefenstette, Edward; Kocisky, Tomas

    2016-01-01

    We formulate sequence to sequence transduction as a noisy channel decoding problem and use recurrent neural networks to parameterise the source and channel models. Unlike direct models which can suffer from explaining-away effects during training, noisy channel models must produce outputs that explain their inputs, and their component models can be trained with not only paired training samples but also unpaired samples from the marginal output distribution. Using a latent variable to control ...

  1. Neural remodeling in retinal degeneration.

    Science.gov (United States)

    Marc, Robert E; Jones, Bryan W; Watt, Carl B; Strettoi, Enrica

    2003-09-01

    Mammalian retinal degenerations initiated by gene defects in rods, cones or the retinal pigmented epithelium (RPE) often trigger loss of the sensory retina, effectively leaving the neural retina deafferented. The neural retina responds to this challenge by remodeling, first by subtle changes in neuronal structure and later by large-scale reorganization. Retinal degenerations in the mammalian retina generally progress through three phases. Phase 1 initiates with expression of a primary insult, followed by phase 2 photoreceptor death that ablates the sensory retina via initial photoreceptor stress, phenotype deconstruction, irreversible stress and cell death, including bystander effects or loss of trophic support. The loss of cones heralds phase 3: a protracted period of global remodeling of the remnant neural retina. Remodeling resembles the responses of many CNS assemblies to deafferentation or trauma, and includes neuronal cell death, neuronal and glial migration, elaboration of new neurites and synapses, rewiring of retinal circuits, glial hypertrophy and the evolution of a fibrotic glial seal that isolates the remnant neural retina from the surviving RPE and choroid. In early phase 2, stressed photoreceptors sprout anomalous neurites that often reach the inner plexiform and ganglion cell layers. As death of rods and cones progresses, bipolar and horizontal cells are deafferented and retract most of their dendrites. Horizontal cells develop anomalous axonal processes and dendritic stalks that enter the inner plexiform layer. Dendrite truncation in rod bipolar cells is accompanied by revision of their macromolecular phenotype, including the loss of functioning mGluR6 transduction. After ablation of the sensory retina, Müller cells increase intermediate filament synthesis, forming a dense fibrotic layer in the remnant subretinal space. This layer invests the remnant retina and seals it from access via the choroidal route. Evidence of bipolar cell death begins in

  2. Surgical Scales: Primary Closure versus Gastric Resection for Perforated Gastric Ulcer - A Surgical Debate.

    Science.gov (United States)

    Gachabayov, Mahir; Babyshin, Valentin; Durymanov, Oleg; Neronov, Dmitriy

    2017-01-01

    Perforated gastric ulcer is one of the most life-threatening complications of peptic ulcer disease with high morbidity and mortality rates. The surgical strategy for gastric perforation in contrast with duodenal perforations often requires consilium and intraoperative debates. The subject of the debate is a 59-year-old male patient who presented with perforated giant gastric ulcer complicated by generalized peritonitis and severe sepsis. The debate is based on a systematized table dividing all factors into three groups and putting them on surgical scales. Pathology-related factors influencing the decision-making are size and site of perforation, local tissue inflammation, signs of malignancy, simultaneous complications of peptic ulcer, peritonitis, and sepsis. Besides these factors, patient- and healthcare-related factors should also be considered.

  3. Neural-networks-based feedback linearization versus model predictive control of continuous alcoholic fermentation process

    Energy Technology Data Exchange (ETDEWEB)

    Mjalli, F.S.; Al-Asheh, S. [Chemical Engineering Department, Qatar University, Doha (Qatar)

    2005-10-01

    In this work advanced nonlinear neural networks based control system design algorithms are adopted to control a mechanistic model for an ethanol fermentation process. The process model equations for such systems are highly nonlinear. A neural network strategy has been implemented in this work for capturing the dynamics of the mechanistic model for the fermentation process. The neural network achieved has been validated against the mechanistic model. Two neural network based nonlinear control strategies have also been adopted using the model identified. The performance of the feedback linearization technique was compared to neural network model predictive control in terms of stability and set point tracking capabilities. Under servo conditions, the feedback linearization algorithm gave comparable tracking and stability. The feedback linearization controller achieved the control target faster than the model predictive one but with vigorous and sudden controller moves. (Abstract Copyright [2005], Wiley Periodicals, Inc.)

  4. Reconstruction of periodic signals using neural networks

    Directory of Open Access Journals (Sweden)

    José Danilo Rairán Antolines

    2014-01-01

    Full Text Available In this paper, we reconstruct a periodic signal by using two neural networks. The first network is trained to approximate the period of a signal, and the second network estimates the corresponding coefficients of the signal's Fourier expansion. The reconstruction strategy consists in minimizing the mean-square error via backpro-pagation algorithms over a single neuron with a sine transfer function. Additionally, this paper presents mathematical proof about the quality of the approximation as well as a first modification of the algorithm, which requires less data to reach the same estimation; thus making the algorithm suitable for real-time implementations.

  5. The Surgical Treatment of Mycetoma.

    Directory of Open Access Journals (Sweden)

    Suleiman Hussein Suleiman

    2016-06-01

    Full Text Available Surgical intervention is an integral component in the diagnosis and management of mycetoma. Surgical treatment is indicated for small, localised lesions and massive lesions to reduce the mycetoma load and to enable better response to medical therapy. It is also a life-saving procedure in patients with massive disease and sepsis. Surgical options for mycetoma treatment range from a wide local surgical excision to repetitive debridement excisions to amputation of the affected part. Adequate anaesthesia, a bloodless field, wide local excision with adequate safety margins in a suitable surgical facility, and expert surgeons are mandatory to achieve the best surgical outcome. Surgical intervention in mycetoma is associated with considerable morbidity, deformities, and disabilities, particularly in advanced disease. These complications can be reduced by educating patients to seek medical advice earlier when the lesion is small, localised, and amenable to surgery. There is no evidence for mycetoma hospital cross infection. This communication is based on the authors' experience in managing over 7,200 mycetoma patients treated at the Mycetoma Research Centre, University of Khartoum, Sudan.

  6. The Surgical Treatment of Mycetoma.

    Science.gov (United States)

    Suleiman, Suleiman Hussein; Wadaella, El Sammani; Fahal, Ahmed Hassan

    2016-06-01

    Surgical intervention is an integral component in the diagnosis and management of mycetoma. Surgical treatment is indicated for small, localised lesions and massive lesions to reduce the mycetoma load and to enable better response to medical therapy. It is also a life-saving procedure in patients with massive disease and sepsis. Surgical options for mycetoma treatment range from a wide local surgical excision to repetitive debridement excisions to amputation of the affected part. Adequate anaesthesia, a bloodless field, wide local excision with adequate safety margins in a suitable surgical facility, and expert surgeons are mandatory to achieve the best surgical outcome. Surgical intervention in mycetoma is associated with considerable morbidity, deformities, and disabilities, particularly in advanced disease. These complications can be reduced by educating patients to seek medical advice earlier when the lesion is small, localised, and amenable to surgery. There is no evidence for mycetoma hospital cross infection. This communication is based on the authors' experience in managing over 7,200 mycetoma patients treated at the Mycetoma Research Centre, University of Khartoum, Sudan.

  7. Brachial plexus injury in adults: Diagnosis and surgical treatment strategies

    Directory of Open Access Journals (Sweden)

    Mukund R Thatte

    2013-01-01

    Full Text Available Adult post traumatic Brachial plexus injury is unfortunately a rather common injury in young adults. In India the most common scenario is of a young man injured in a motorcycle accident. Exact incidence figures are not available but of the injuries presenting to us about 90% invole the above combination This article reviews peer-reviewed publications including clinical papers, review articles and Meta analysis of the subject. In addition, the authors′ experience of several hundred cases over the last 15 years has been added and has influenced the ultimate text. Results have been discussed and analysed to get an idea of factors influencing final recovery. It appears that time from injury and number of roots involved are most crucial.

  8. Brachial plexus injury in adults: Diagnosis and surgical treatment strategies

    Science.gov (United States)

    Thatte, Mukund R.; Babhulkar, Sonali; Hiremath, Amita

    2013-01-01

    Adult post traumatic Brachial plexus injury is unfortunately a rather common injury in young adults. In India the most common scenario is of a young man injured in a motorcycle accident. Exact incidence figures are not available but of the injuries presenting to us about 90% invole the above combination This article reviews peer-reviewed publications including clinical papers, review articles and Meta analysis of the subject. In addition, the authors′ experience of several hundred cases over the last 15 years has been added and has influenced the ultimate text. Results have been discussed and analysed to get an idea of factors influencing final recovery. It appears that time from injury and number of roots involved are most crucial. PMID:23661959

  9. An evaluation of Irish general surgical research publications from 2000 to 2009.

    LENUS (Irish Health Repository)

    Robertson, I J

    2010-12-01

    Maintaining a high standard of research, and being competitive in the funding application process requires a coordinated and focused research strategy. The first step in the formulation of such a strategy is the identification of those centres, and specifically those areas of study, in which Irish surgical research has previously performed strongly. The aim of this paper was to evaluate all surgical research produced in the Republic of Ireland in the first ten years of the new millennium.

  10. Movement decoding using neural synchronization and inter-hemispheric connectivity from deep brain local field potentials.

    Science.gov (United States)

    Mamun, K A; Mace, M; Lutman, M E; Stein, J; Liu, X; Aziz, T; Vaidyanathan, R; Wang, S

    2015-10-01

    Correlating electrical activity within the human brain to movement is essential for developing and refining interventions (e.g. deep brain stimulation (DBS)) to treat central nervous system disorders. It also serves as a basis for next generation brain-machine interfaces (BMIs). This study highlights a new decoding strategy for capturing movement and its corresponding laterality from deep brain local field potentials (LFPs). LFPs were recorded with surgically implanted electrodes from the subthalamic nucleus or globus pallidus interna in twelve patients with Parkinson's disease or dystonia during a visually cued finger-clicking task. We introduce a method to extract frequency dependent neural synchronization and inter-hemispheric connectivity features based upon wavelet packet transform (WPT) and Granger causality approaches. A novel weighted sequential feature selection algorithm has been developed to select optimal feature subsets through a feature contribution measure. This is particularly useful when faced with limited trials of high dimensionality data as it enables estimation of feature importance during the decoding process. This novel approach was able to accurately and informatively decode movement related behaviours from the recorded LFP activity. An average accuracy of 99.8% was achieved for movement identification, whilst subsequent laterality classification was 81.5%. Feature contribution analysis highlighted stronger contralateral causal driving between the basal ganglia hemispheres compared to ipsilateral driving, with causality measures considerably improving laterality discrimination. These findings demonstrate optimally selected neural synchronization alongside causality measures related to inter-hemispheric connectivity can provide an effective control signal for augmenting adaptive BMIs. In the case of DBS patients, acquiring such signals requires no additional surgery whilst providing a relatively stable and computationally inexpensive control

  11. Neural Based Orthogonal Data Fitting The EXIN Neural Networks

    CERN Document Server

    Cirrincione, Giansalvo

    2008-01-01

    Written by three leaders in the field of neural based algorithms, Neural Based Orthogonal Data Fitting proposes several neural networks, all endowed with a complete theory which not only explains their behavior, but also compares them with the existing neural and traditional algorithms. The algorithms are studied from different points of view, including: as a differential geometry problem, as a dynamic problem, as a stochastic problem, and as a numerical problem. All algorithms have also been analyzed on real time problems (large dimensional data matrices) and have shown accurate solutions. Wh

  12. Handwritten Digits Recognition Using Neural Computing

    Directory of Open Access Journals (Sweden)

    Călin Enăchescu

    2009-12-01

    Full Text Available In this paper we present a method for the recognition of handwritten digits and a practical implementation of this method for real-time recognition. A theoretical framework for the neural networks used to classify the handwritten digits is also presented.The classification task is performed using a Convolutional Neural Network (CNN. CNN is a special type of multy-layer neural network, being trained with an optimized version of the back-propagation learning algorithm.CNN is designed to recognize visual patterns directly from pixel images with minimal preprocessing, being capable to recognize patterns with extreme variability (such as handwritten characters, and with robustness to distortions and simple geometric transformations.The main contributions of this paper are related to theoriginal methods for increasing the efficiency of the learning algorithm by preprocessing the images before the learning process and a method for increasing the precision and performance for real-time applications, by removing the non useful information from the background.By combining these strategies we have obtained an accuracy of 96.76%, using as training set the NIST (National Institute of Standards and Technology database.

  13. The methodological quality of systematic reviews comparing temporomandibular joint disorder surgical and non-surgical treatment

    Directory of Open Access Journals (Sweden)

    Vasconcelos Belmiro CE

    2008-09-01

    Full Text Available Abstract Background Temporomandibular joint disorders (TMJD are multifactor, complex clinical problems affecting approximately 60–70% of the general population, with considerable controversy about the most effective treatment. For example, reports claim success rates of 70% and 83% for non-surgical and surgical treatment, whereas other reports claim success rates of 40% to 70% for self-improvement without treatment. Therefore, the purpose of this study was to (1 identify systematic reviews comparing temporomandibular joint disorder surgical and non-surgical treatment, (2 evaluate their methodological quality, and (3 evaluate the evidence grade within the systematic reviews. Methods A search strategy was developed and implemented for MEDLINE, Cochrane Library, LILACS, and Brazilian Dentistry Bibliography databases. Inclusion criteria were: systematic reviews (± meta-analysis comparing surgical and non-surgical TMJD treatment, published in English, Spanish, Portuguese, Italian, or German between the years 1966 and 2007(up to July. Exclusion criteria were: in vitro or animal studies; narrative reviews or editorials or editorial letters; and articles published in other languages. Two investigators independently selected and evaluated systematic reviews. Three different instruments (AMSTAR, OQAQ and CASP were used to evaluate methodological quality, and the results averaged. The GRADE instrument was used to evaluate the evidence grade within the reviews. Results The search strategy identified 211 reports; of which 2 were systematic reviews meeting inclusion criteria. The first review met 23.5 ± 6.0% and the second met 77.5 ± 12.8% of the methodological quality criteria (mean ± sd. In these systematic reviews between 9 and 15% of the trials were graded as high quality, and 2 and 8% of the total number of patients were involved in these studies. Conclusion The results indicate that in spite of the widespread impact of TMJD, and the multitude of

  14. Neural Correlates of Stimulus Reportability

    OpenAIRE

    Hulme, Oliver J.; Friston, Karl F.; Zeki, Semir

    2009-01-01

    Most experiments on the “neural correlates of consciousness” employ stimulus reportability as an operational definition of what is consciously perceived. The interpretation of such experiments therefore depends critically on understanding the neural basis of stimulus reportability. Using a high volume of fMRI data, we investigated the neural correlates of stimulus reportability using a partial report object detection paradigm. Subjects were presented with a random array of circularly arranged...

  15. Symbolic processing in neural networks

    OpenAIRE

    Neto, João Pedro; Hava T Siegelmann; Costa,J.Félix

    2003-01-01

    In this paper we show that programming languages can be translated into recurrent (analog, rational weighted) neural nets. Implementation of programming languages in neural nets turns to be not only theoretical exciting, but has also some practical implications in the recent efforts to merge symbolic and sub symbolic computation. To be of some use, it should be carried in a context of bounded resources. Herein, we show how to use resource bounds to speed up computations over neural nets, thro...

  16. Surgical repair of an asymptomatic giant right coronary artery aneurysm.

    Science.gov (United States)

    Jahangeer, Saleem; Anjum, Nadeem; O'Donnell, Aonghus; Doddakula, Kishore

    2013-12-01

    Background Coronary artery aneurysm (CAA) is a rare finding, being mostly diagnosed on angiography or at autopsies. It is defined as being a dilation of the coronary artery that exceeds the diameter of the patient's largest coronary vessel by 1.5 to 2 times. Case Report We describe the operative correction of a giant right CAA measuring in excess of 10 cm. Conclusion Management of giant CAAs is not standardized and surgical strategy remains controversial. In our case, the patient has a successful surgical repair with no postoperative shunts on follow-up investigations.

  17. [Surgically curable hypertension (author's transl)].

    Science.gov (United States)

    Gilloz, A; Tostain, J; Richard, A; Peyrard, A; Drogue, M

    A case of hypertension was cured by simultaneous surgical treatment of an obstructive urolithiasis associated with a pheochromocytoma. Primary devascularization of the adrenal tumor, reducing blood pressure and cardiac rhythm variations was allowed by preoperative arteriography.

  18. Surgical treatment of cleft lip

    National Research Council Canada - National Science Library

    Miachon, Mateus Domingues; Leme, Pedro Luiz Squilacci

    2014-01-01

    We performed a systematic review of the literature on the surgical treatment of cleft lip, emphasizing the prevalence, complications associated with the treatment and the points of disagreement between authors...

  19. [Surgical approach in Peyronie's disease].

    Science.gov (United States)

    Carmignani, G; De Rose, A F; Simonato, A; Galli, S; Corbu, C

    1997-02-01

    The goal of surgical treatment of Induratio Penis Plastica should be the achievement of the best aesthetic and functional result with the lowest side-effects. During the last two years different techniques have been proposed for the cases with conserved erectile function, such as Nesbit's technique, excision or incision of the plaque followed by implants of autologous (dermal, saphena vein) or heterologous (dura madre, gore-tex) patches. The criteria for the choice of the most appropriated surgical technique include the curvature degree, the plaque dimension and the penis length. In our experience 6 months after the surgical correction a remaining curvature was observed in 4/38 patients (10%), only 1 of whom needed a new surgical treatment. One case of erectile disfunction occurred, treated by intra-cavernous injection of PgE1.

  20. [Artificial neural networks in Neurosciences].

    Science.gov (United States)

    Porras Chavarino, Carmen; Salinas Martínez de Lecea, José María

    2011-11-01

    This article shows that artificial neural networks are used for confirming the relationships between physiological and cognitive changes. Specifically, we explore the influence of a decrease of neurotransmitters on the behaviour of old people in recognition tasks. This artificial neural network recognizes learned patterns. When we change the threshold of activation in some units, the artificial neural network simulates the experimental results of old people in recognition tasks. However, the main contributions of this paper are the design of an artificial neural network and its operation inspired by the nervous system and the way the inputs are coded and the process of orthogonalization of patterns.

  1. Neural Correlates of Face Detection

    National Research Council Canada - National Science Library

    Xu, Xiaokun; Biederman, Irving

    2014-01-01

    Although face detection likely played an essential adaptive role in our evolutionary past and in contemporary social interactions, there have been few rigorous studies investigating its neural correlates...

  2. Quality in surgical pathology communication and reporting

    National Research Council Canada - National Science Library

    Nakhleh, Raouf E

    2011-01-01

    Communication in surgical pathology is complex and includes multiple facets. To discuss different aspects of pathology practice that represent quality communication in surgical pathology. Literature review...

  3. Neural reconstruction methods of restoring bladder function.

    Science.gov (United States)

    Gomez-Amaya, Sandra M; Barbe, Mary F; de Groat, William C; Brown, Justin M; Tuite, Gerald F; Corcos, Jacques; Fecho, Susan B; Braverman, Alan S; Ruggieri, Michael R

    2015-02-01

    During the past century, diverse studies have focused on the development of surgical strategies to restore function of a decentralized bladder after spinal cord or spinal root injury via repair of the original roots or by transferring new axonal sources. The techniques included end-to-end sacral root repairs, transfer of roots from other spinal segments to sacral roots, transfer of intercostal nerves to sacral roots, transfer of various somatic nerves to the pelvic or pudendal nerve, direct reinnervation of the detrusor muscle, or creation of an artificial reflex pathway between the skin and the bladder via the central nervous system. All of these surgical techniques have demonstrated specific strengths and limitations. The findings made to date already indicate appropriate patient populations for each procedure, but a comprehensive assessment of the effectiveness of each technique to restore urinary function after bladder decentralization is required to guide future research and potential clinical application.

  4. Kontrol Kecepatan Motor Induksi menggunakan Algoritma Backpropagation Neural Network

    Directory of Open Access Journals (Sweden)

    MUHAMMAD RUSWANDI DJALAL

    2017-07-01

    Full Text Available ABSTRAKBanyak strategi kontrol berbasis kecerdasan buatan telah diusulkan dalam penelitian seperti Fuzzy Logic dan Artificial Neural Network (ANN. Tujuan dari penelitian ini adalah untuk mendesain sebuah kontrol agar kecepatan motor induksi dapat diatur sesuai kebutuhan serta membandingkan kinerja motor induksi tanpa kontrol dan dengan kontrol. Dalam penelitian ini diusulkan sebuah metode artificial neural network untuk mengontrol kecepatan motor induksi tiga fasa. Kecepatan referensi motor diatur pada kecepatan 140 rad/s, 150 rad/s, dan 130 rad/s. Perubahan kecepatan diatur pada setiap interval 0.3 detik dan waktu simulasi maksimum adalah 0,9 detik. Kasus 1 tanpa kontrol, menunjukkan respon torka dan kecepatan dari motor induksi tiga fasa tanpa kontrol. Meskipun kecepatan motor induksi tiga fasa diatur berubah pada setiap 0,3 detik tidak akan mempengaruhi torka. Selain itu, motor induksi tiga fasa tanpa kontrol memiliki kinerja yang buruk dikarenakan kecepatan motor induksi tidak dapat diatur sesuai dengan kebutuhan. Kasus 2 dengan control backpropagation neural network, meskipun kecepatan motor induksi tiga fasa berubah pada setiap 0.3 detik tidak akan mempengaruhi torsi. Selain itu, kontrol backpropagation neural network memiliki kinerja yang baik dikarenakan kecepatan motor induksi dapat diatur sesuai dengan kebutuhan.Kata kunci: Backpropagation Neural Network (BPNN, NN Training, NN Testing, Motor.ABSTRACTMany artificial intelligence-based control strategies have been proposed in research such as Fuzzy Logic and Artificial Neural Network (ANN. The purpose of this research was design a control for the induction motor speed that could be adjusted as needed and compare the performance of induction motor without control and with control. In this research, it was proposed an artificial neural network method to control the speed of three-phase induction motors. The reference speed of motor was set at the rate of 140 rad / s, 150 rad / s, and 130

  5. Surgical Robotics Under Fluid Power

    OpenAIRE

    Berg, Devin

    2013-01-01

    Existing robotic surgical platforms face limitations which include the balance between the scale of the robot and its capability. These limitations can be overcome by taking advantage of fluid power as an enabling technology with its inherent power density and controllability. The adaptation of fluid power for this purpose involves many challenges such as miniaturization of the necessary components and identifying the unique requirements of the surgical field. These challenges were explored t...

  6. Surgical Treatment of Calcaneal Spur.

    OpenAIRE

    Eduardo Sarmiento Sánchez; Horacio Suárez Monzón; Rolando Delgado Figueredo; Juan Carlos Cabrera Suárez

    2007-01-01

    Background: Pain in the plantar region of the heel is technically known as talalgia, and it is a very frequent complaint in the orthopaedic service in Guyana. Due to its frequent mortality, the current investigation was carried out. Objectives: To characterize the application of the surgical treatment to a group of patients in Guyana. Method: 70 patients surgically treated were studied presenting rebel talalgia with no responses to the conservative treatment. Age, sex, race, educational level...

  7. Surgical treatment of primary hyperparathyroidism

    DEFF Research Database (Denmark)

    Brasso, K; Karstrup, S; Lundby, C M

    1994-01-01

    One hundred and two patients with primary hyperparathyroidism underwent a total of 108 bilateral neck explorations with attempted identification and biopsy of all four glands. Hypercalcaemia was surgically eliminated in 97 of 102 patients (95%). Of the remaining hypercalcaemic patients one.......9%). Permanent paralysis of the recurrent nerve occurred in three patients (2.9%). Twenty-one patients developed other postoperative complications from which they all recovered without sequelae. No postoperative deaths occurred. Our results show that surgical treatment of primary hyperparathyroidism...

  8. Surgical Treatment of Facial Paralysis

    OpenAIRE

    Mehta, Ritvik P.

    2009-01-01

    The management of facial paralysis is one of the most complex areas of reconstructive surgery. Given the wide variety of functional and cosmetic deficits in the facial paralysis patient, the reconstructive surgeon requires a thorough understanding of the surgical techniques available to treat this condition. This review article will focus on surgical management of facial paralysis and the treatment options available for acute facial paralysis (2 yr). For acute facial paralysis, the main surgi...

  9. Percutaneous injuries during surgical procedures.

    Science.gov (United States)

    Tokars, J I; Bell, D M; Culver, D H; Marcus, R; Mendelson, M H; Sloan, E P; Farber, B F; Fligner, D; Chamberland, M E; McKibben, P S

    1992-06-03

    To study the numbers and circumstances of percutaneous injuries (eg, needle sticks, cuts) that occur during surgical procedures. Surgical personnel risk infection with blood-borne pathogens from percutaneous injuries; some injuries might also place patients at risk by exposing them to a health care worker's blood. Observers present at 1382 surgical procedures recorded information about the procedure, the personnel present, and percutaneous injuries that occurred. Four US teaching hospitals during 1990. Operating room personnel in five surgical specialties. Numbers and circumstances of percutaneous injuries among surgical personnel and instances in which surgical instruments that had injured a worker recontacted the patient's surgical wound. Ninety-nine injuries occurred during 95 (6.9%) of the 1382 procedures. Seventy-six injuries (77%) were caused by suture needles and affected the nondominant hand (62 injuries [63%]), especially the distal forefinger. The risk of injury adjusted for confounding variables by logistic regression was higher during vaginal hysterectomy (odds ratio [OR], 3.5; 95% confidence interval [CI], 1.6 to 7.5) and lower during certain orthopedic procedures (OR, 0.2; CI, 0.1 to 0.7) than during 11 other types of procedures (reference group; OR, 1.0). Use of fingers rather than an instrument to hold the tissue being sutured was associated with 35 injuries (35%). Eighty-eight injuries (89%) were sustained by resident or attending surgeons; in 28 (32%) of the 88 injuries in surgeons, the sharp object that caused the injury recontacted the patient. Percutaneous injuries occur regularly during surgery, placing surgical personnel and, to a lesser extent, patients at risk for infection with blood-borne pathogens. Many such injuries may be preventable with changes in devices, techniques, or protective equipment; all such measures require careful evaluation to determine their efficacy in reducing injury and their effect on patient care.

  10. Regional anaesthesia and surgical morbidity

    DEFF Research Database (Denmark)

    Scott, N B; Kehlet, H

    1988-01-01

    This review assesses the results of studies examining the influence of regional anaesthesia on surgical morbidity. Morbidity appears to be reduced when procedures below the umbilicus are concerned, but evidence is less convincing for upper abdominal and thoracic procedures.......This review assesses the results of studies examining the influence of regional anaesthesia on surgical morbidity. Morbidity appears to be reduced when procedures below the umbilicus are concerned, but evidence is less convincing for upper abdominal and thoracic procedures....

  11. The neural correlates of emotion regulation by implementation intentions.

    Directory of Open Access Journals (Sweden)

    Glyn P Hallam

    Full Text Available Several studies have investigated the neural basis of effortful emotion regulation (ER but the neural basis of automatic ER has been less comprehensively explored. The present study investigated the neural basis of automatic ER supported by 'implementation intentions'. 40 healthy participants underwent fMRI while viewing emotion-eliciting images and used either a previously-taught effortful ER strategy, in the form of a goal intention (e.g., try to take a detached perspective, or a more automatic ER strategy, in the form of an implementation intention (e.g., "If I see something disgusting, then I will think these are just pixels on the screen!", to regulate their emotional response. Whereas goal intention ER strategies were associated with activation of brain areas previously reported to be involved in effortful ER (including dorsolateral prefrontal cortex, ER strategies based on an implementation intention strategy were associated with activation of right inferior frontal gyrus and ventro-parietal cortex, which may reflect the attentional control processes automatically captured by the cue for action contained within the implementation intention. Goal intentions were also associated with less effective modulation of left amygdala, supporting the increased efficacy of ER under implementation intention instructions, which showed coupling of orbitofrontal cortex and amygdala. The findings support previous behavioural studies in suggesting that forming an implementation intention enables people to enact goal-directed responses with less effort and more efficiency.

  12. Optics in neural computation

    Science.gov (United States)

    Levene, Michael John

    In all attempts to emulate the considerable powers of the brain, one is struck by both its immense size, parallelism, and complexity. While the fields of neural networks, artificial intelligence, and neuromorphic engineering have all attempted oversimplifications on the considerable complexity, all three can benefit from the inherent scalability and parallelism of optics. This thesis looks at specific aspects of three modes in which optics, and particularly volume holography, can play a part in neural computation. First, holography serves as the basis of highly-parallel correlators, which are the foundation of optical neural networks. The huge input capability of optical neural networks make them most useful for image processing and image recognition and tracking. These tasks benefit from the shift invariance of optical correlators. In this thesis, I analyze the capacity of correlators, and then present several techniques for controlling the amount of shift invariance. Of particular interest is the Fresnel correlator, in which the hologram is displaced from the Fourier plane. In this case, the amount of shift invariance is limited not just by the thickness of the hologram, but by the distance of the hologram from the Fourier plane. Second, volume holography can provide the huge storage capacity and high speed, parallel read-out necessary to support large artificial intelligence systems. However, previous methods for storing data in volume holograms have relied on awkward beam-steering or on as-yet non- existent cheap, wide-bandwidth, tunable laser sources. This thesis presents a new technique, shift multiplexing, which is capable of very high densities, but which has the advantage of a very simple implementation. In shift multiplexing, the reference wave consists of a focused spot a few millimeters in front of the hologram. Multiplexing is achieved by simply translating the hologram a few tens of microns or less. This thesis describes the theory for how shift

  13. Síndrome do coração esquerdo hipoplásico: estratégia cirúrgica e comparação de resultados com técnicas de Norwood x Sano Hypoplastic left heart syndrome: the report of a surgical strategy and comparative results of Norwood x Norwood-Sano approach

    Directory of Open Access Journals (Sweden)

    José Pedro da Silva

    2007-06-01

    Full Text Available OBJETIVOS: Relatar estratégia cirúrgica na síndrome do coração esquerdo hipoplásico (SCEH, que possibilita tempo curto de parada circulatória hipotérmica e reconstrução do arco aórtico com pericárdio autólogo. Comparar os resultados das técnicas de restabelecimento da circulação pulmonar: anastomose Blalock-Taussig modificado e tubo ventrículo direito para artéria pulmonar. MÉTODOS: Estudo retrospectivo de 78 neonatos com SCEH, consecutivamente operados entre março de 1999 e junho de 2006. Foi usada a mesma técnica de reconstrução da neoaorta e duas técnicas diferentes de restabelecimento da circulação pulmonar: anastomose BTm, nos primeiros 37 neonatos, e tubo VD-AP, nos últimos 41. A canulação do canal arterial para a perfusão sistêmica foi a parte principal da estratégia cirúrgica para diminuir o tempo de parada circulatória hipotérmica. RESULTADOS: A sobrevida imediata foi de 74,35%, sendo de 67,57% no grupo BTm e de 80,49% no grupo Tubo VD-AP (p=0,21. O tempo de parada circulatória hipotérmica foi de 45,79%±1,99 min e 36,8±1,52 min (p=0,0012 e a mortalidade entre o primeiro e segundo estágios foi de 40% e 6,9%, respectivamente, nos grupos BTm e Tubo VD-AP (p=0,007. Coarctação da aorta ocorreu em cinco pacientes. A comparação das curvas de sobrevida (Kaplan-Meier mostrou melhor resultado com o Tubo VD-AP (p=0,003. CONCLUSÕES: Essa estratégia cirúrgica resultou em tempo curto de parada circulatória, baixa mortalidade e baixa incidência de coarctação aórtica. Embora o melhor resultado imediato com o Tubo VD-AP não tenha sido significante, a menor mortalidade interestágios e a maior sobrevida em médio prazo no grupo VD-AP foram vantagens que atingiram significância estatística.OBJECTIVES: To report a surgical strategy for the Norwood procedure in the hypoplastic left heart syndrome (HLHS that enables short hypothermic circulatory arrest time and aortic arch reconstruction with autologous

  14. Neural stem cell transplantation in experimental contusive model of spinal cord injury.

    Science.gov (United States)

    Carelli, Stephana; Giallongo, Toniella; Gerace, Claudio; De Angelis, Anthea; Basso, Michele D; Di Giulio, Anna Maria; Gorio, Alfredo

    2014-12-17

    Spinal cord injury is a devastating clinical condition, characterized by a complex of neurological dysfunctions. Animal models of spinal cord injury can be used both to investigate the biological responses to injury and to test potential therapies. Contusion or compression injury delivered to the surgically exposed spinal cord are the most widely used models of the pathology. In this report the experimental contusion is performed by using the Infinite Horizon (IH) Impactor device, which allows the creation of a reproducible injury animal model through definition of specific injury parameters. Stem cell transplantation is commonly considered a potentially useful strategy for curing this debilitating condition. Numerous studies have evaluated the effects of transplanting a variety of stem cells. Here we demonstrate an adapted method for spinal cord injury followed by tail vein injection of cells in CD1 mice. In short, we provide procedures for: i) cell labeling with a vital tracer, ii) pre-operative care of mice, iii) execution of a contusive spinal cord injury, and iv) intravenous administration of post mortem neural precursors. This contusion model can be utilized to evaluate the efficacy and safety of stem cell transplantation in a regenerative medicine approach.

  15. 1991 IEEE International Joint Conference on Neural Networks, Singapore, Nov. 18-21, 1991, Proceedings. Vols. 1-3

    Energy Technology Data Exchange (ETDEWEB)

    1991-01-01

    The present conference the application of neural networks to associative memories, neurorecognition, hybrid systems, supervised and unsupervised learning, image processing, neurophysiology, sensation and perception, electrical neurocomputers, optimization, robotics, machine vision, sensorimotor control systems, and neurodynamics. Attention is given to such topics as optimal associative mappings in recurrent networks, self-improving associative neural network models, fuzzy activation functions, adaptive pattern recognition with sparse associative networks, efficient question-answering in a hybrid system, the use of abstractions by neural networks, remote-sensing pattern classification, speech recognition with guided propagation, inverse-step competitive learning, and rotational quadratic function neural networks. Also discussed are electrical load forecasting, evolutionarily stable and unstable strategies, the capacity of recurrent networks, neural net vs control theory, perceptrons for image recognition, storage capacity of bidirectional associative memories, associative random optimization for control, automatic synthesis of digital neural architectures, self-learning robot vision, and the associative dynamics of chaotic neural networks.

  16. Epidural anaesthesia and analgesia - effects on surgical stress responses and implications for postoperative nutrition

    DEFF Research Database (Denmark)

    Holte, Kathrine; Kehlet, H

    2002-01-01

    BACKGROUND: Surgical injury leads to an endocrine-metabolic and inflammatory response with protein catabolism, increased cardiovascular demands, impaired pulmonary function and paralytic ileus, the most important release mechanisms being afferent neural stimuli and inflammatory mediators. RESULTS...... for improved mobilization and oral nutrition, and preservation of body composition and muscle function. Studies integrating continuous epidural local anaesthetics with enforced early nutrition and mobilization uniformly suggest an improved recovery, decreased hospital stay and convalescence. CONCLUSIONS......: Epidural local anaesthetics should be included in a multi-modal rehabilitation programme after major surgical procedures in order to facilitate oral nutrition, improve recovery and reduce morbidity....

  17. Neural Networks for Mindfulness and Emotion Suppression.

    Directory of Open Access Journals (Sweden)

    Hiroki Murakami

    Full Text Available Mindfulness, an attentive non-judgmental focus on "here and now" experiences, has been incorporated into various cognitive behavioral therapy approaches and beneficial effects have been demonstrated. Recently, mindfulness has also been identified as a potentially effective emotion regulation strategy. On the other hand, emotion suppression, which refers to trying to avoid or escape from experiencing and being aware of one's own emotions, has been identified as a potentially maladaptive strategy. Previous studies suggest that both strategies can decrease affective responses to emotional stimuli. They would, however, be expected to provide regulation through different top-down modulation systems. The present study was aimed at elucidating the different neural systems underlying emotion regulation via mindfulness and emotion suppression approaches. Twenty-one healthy participants used the two types of strategy in response to emotional visual stimuli while functional magnetic resonance imaging was conducted. Both strategies attenuated amygdala responses to emotional triggers, but the pathways to regulation differed across the two. A mindful approach appears to regulate amygdala functioning via functional connectivity from the medial prefrontal cortex, while suppression uses connectivity with other regions, including the dorsolateral prefrontal cortex. Thus, the two types of emotion regulation recruit different top-down modulation processes localized at prefrontal areas. These different pathways are discussed.

  18. Sub-meninges Implantation Reduces Immune Response to Neural Implants

    Science.gov (United States)

    Markwardt, Neil T.; Stokol, Jodi; Rennaker, Robert L.

    2013-01-01

    Glial scar formation around neural interfaces inhibits their ability to acquire usable signals from the surrounding neurons. To improve neural recording performance, the inflammatory response and glial scarring must be minimized. Previous work has indicated that meningeally derived cells participate in the immune response, and it is possible that the meninges may grow down around the shank of a neural implant, contributing to the formation of the glial scar. This study examines whether the glial scar can be reduced by placing a neural probe completely below the meninges. Rats were implanted with sets of loose microwire implants placed either completely below the meninges or implanted conventionally with the upper end penetrating the meninges, but not attached to the skull. Histological analysis was performed 4 weeks following surgical implantation to evaluate the glial scar. Our results found that sub-meninges implants showed an average reduction in reactive astrocyte activity of 63% compared to trans-meninges implants. Microglial activity was also reduced for sub-meninges implants. These results suggest that techniques that isolate implants from the meninges offer the potential to reduce the encapsulation response which should improve chronic recording quality and stability. PMID:23370311

  19. Global Strategy

    DEFF Research Database (Denmark)

    Li, Peter Ping

    2013-01-01

    Global strategy differs from domestic strategy in terms of content and process as well as context and structure. The content of global strategy can contain five key elements, while the process of global strategy can have six major stages. These are expounded below. Global strategy is influenced...... by rich and complementary local contexts with diverse resource pools and game rules at the national level to form a broad ecosystem at the global level. Further, global strategy dictates the interaction or balance between different entry strategies at the levels of internal and external networks....

  20. Targeted muscle reinnervation a neural interface for artificial limbs

    CERN Document Server

    Kuiken, Todd A; Barlow, Ann K

    2013-01-01

    Implement TMR with Your Patients and Improve Their Quality of Life Developed by Dr. Todd A. Kuiken and Dr. Gregory A. Dumanian, targeted muscle reinnervation (TMR) is a new approach to accessing motor control signals from peripheral nerves after amputation and providing sensory feedback to prosthesis users. This practical approach has many advantages over other neural-machine interfaces for the improved control of artificial limbs. Targeted Muscle Reinnervation: A Neural Interface for Artificial Limbs provides a template for the clinical implementation of TMR and a resource for further research in this new area of science. After describing the basic scientific concepts and key principles underlying TMR, the book presents surgical approaches to transhumeral and shoulder disarticulation amputations. It explores the possible role of TMR in the prevention and treatment of end-neuromas and details the principles of rehabilitation, prosthetic fitting, and occupational therapy for TMR patients. The book also describ...

  1. Multiple neural injuries in a pediatric supracondylar humerus fracture

    Directory of Open Access Journals (Sweden)

    Mehmet Erdil

    2012-09-01

    Full Text Available Neurological problems following paediatric elbow fracture is a clinically challenging problem. The main causes of neurological injury are traction injuries, impingement or direct trauma related with bony fragments and iatrogenic injuries. Anterior interosseous nerve is most commonly injured nerve in cases of extension fractures. At flexion type fractures ulnar nerve is the major traumatised nerve by iatrogenic manuplation. Multiple neural injuries related with these types of fractures are extremely rare. Neural injuries of paediatric cases have tendency to recover easily. In cases of persisting functional impairment surgical intervention may be needed. Herein a pediatric case with both medial and ulnar nerve injuries following elbow fracture was presented. J Clin Exp Invest 2012; 3 (3: 438-442Key words: Supracondylar humerus fracture, child elbow trauma, nevre injury, iatrogenic

  2. Surgical versus non-surgical interventions for vocal cord nodules.

    Science.gov (United States)

    Pedersen, Mette; McGlashan, Julian

    2012-06-13

    This is an update of a Cochrane review first published in The Cochrane Library in Issue 2, 2001 and previously updated in 2007 and 2009.Vocal cord nodules are bilateral, benign, callous-like growths of the mid-portion of the membranous vocal folds. They are of variable size and are characterised histologically by thickening of the epithelium with a variable degree of inflammation in the underlying superficial lamina propria. They characteristically produce hoarseness, discomfort and an unstable voice when speaking or singing. To assess the effectiveness of surgery versus non-surgical interventions for vocal cord nodules. We searched the Cochrane Ear, Nose and Throat Disorders Group Trials Register; the Cochrane Central Register of Controlled Trials (CENTRAL); PubMed; EMBASE; CINAHL; Web of Science; BIOSIS Previews; Cambridge Scientific Abstracts; ISRCTN and additional sources for published and unpublished trials. The date of the most recent search was 9 April 2012. Randomised and quasi-randomised trials comparing any surgical intervention for vocal cord nodules with non-surgical treatment or no treatment. No suitable trials were identified. No studies fulfilled the inclusion criteria. There is a need for high-quality randomised controlled trials to evaluate the effectiveness of surgical and non-surgical treatment of vocal cord nodules.

  3. Analysis of neural networks

    CERN Document Server

    Heiden, Uwe

    1980-01-01

    The purpose of this work is a unified and general treatment of activity in neural networks from a mathematical pOint of view. Possible applications of the theory presented are indica­ ted throughout the text. However, they are not explored in de­ tail for two reasons : first, the universal character of n- ral activity in nearly all animals requires some type of a general approach~ secondly, the mathematical perspicuity would suffer if too many experimental details and empirical peculiarities were interspersed among the mathematical investigation. A guide to many applications is supplied by the references concerning a variety of specific issues. Of course the theory does not aim at covering all individual problems. Moreover there are other approaches to neural network theory (see e.g. Poggio-Torre, 1978) based on the different lev­ els at which the nervous system may be viewed. The theory is a deterministic one reflecting the average be­ havior of neurons or neuron pools. In this respect the essay is writt...

  4. Artificial Neural Networks·

    Indian Academy of Sciences (India)

    differences between biological neural networks (BNNs) of the brain and ANN s. A thorough understanding of ... neurons. Artificial neural models are loosely based on biology since a complete understanding of the .... A learning scheme for updating a neuron's connections (weights) was proposed by Donald Hebb in 1949.

  5. Neural Networks for Optimal Control

    DEFF Research Database (Denmark)

    Sørensen, O.

    1995-01-01

    Two neural networks are trained to act as an observer and a controller, respectively, to control a non-linear, multi-variable process.......Two neural networks are trained to act as an observer and a controller, respectively, to control a non-linear, multi-variable process....

  6. The Neural Support Vector Machine

    NARCIS (Netherlands)

    Wiering, Marco; van der Ree, Michiel; Embrechts, Mark; Stollenga, Marijn; Meijster, Arnold; Nolte, A; Schomaker, Lambertus

    2013-01-01

    This paper describes a new machine learning algorithm for regression and dimensionality reduction tasks. The Neural Support Vector Machine (NSVM) is a hybrid learning algorithm consisting of neural networks and support vector machines (SVMs). The output of the NSVM is given by SVMs that take a

  7. Neural fields theory and applications

    CERN Document Server

    Graben, Peter; Potthast, Roland; Wright, James

    2014-01-01

    With this book, the editors present the first comprehensive collection in neural field studies, authored by leading scientists in the field - among them are two of the founding-fathers of neural field theory. Up to now, research results in the field have been disseminated across a number of distinct journals from mathematics, computational neuroscience, biophysics, cognitive science and others. Starting with a tutorial for novices in neural field studies, the book comprises chapters on emergent patterns, their phase transitions and evolution, on stochastic approaches, cortical development, cognition, robotics and computation, large-scale numerical simulations, the coupling of neural fields to the electroencephalogram and phase transitions in anesthesia. The intended readership are students and scientists in applied mathematics, theoretical physics, theoretical biology, and computational neuroscience. Neural field theory and its applications have a long-standing tradition in the mathematical and computational ...

  8. The Neural Correlates of Race

    Science.gov (United States)

    Ito, Tiffany A.; Bartholow, Bruce D.

    2009-01-01

    Behavioral analyses are a natural choice for understanding the wide-ranging behavioral consequences of racial stereotyping and prejudice. However, neuroimaging and electrophysiological research has recently considered the neural mechanisms that underlie racial categorization and the activation and application of racial stereotypes and prejudice, revealing exciting new insights. Work reviewed here points to the importance of neural structures previously associated with face processing, semantic knowledge activation, evaluation, and self-regulatory behavioral control, allowing for the specification of a neural model of race processing. We show how research on the neural correlates of race can serve to link otherwise disparate lines of evidence on the neural underpinnings of a broad array of social-cognitive phenomena, and consider implications for effecting change in race relations. PMID:19896410

  9. Neural Networks in Control Applications

    DEFF Research Database (Denmark)

    Sørensen, O.

    The intention of this report is to make a systematic examination of the possibilities of applying neural networks in those technical areas, which are familiar to a control engineer. In other words, the potential of neural networks in control applications is given higher priority than a detailed...... examined, and it appears that considering 'normal' neural network models with, say, 500 samples, the problem of over-fitting is neglible, and therefore it is not taken into consideration afterwards. Numerous model types, often met in control applications, are implemented as neural network models...... Kalmann filter) representing state space description. The potentials of neural networks for control of non-linear processes are also examined, focusing on three different groups of control concepts, all considered as generalizations of known linear control concepts to handle also non-linear processes...

  10. Current Surgical Treatment of Knee Osteoarthritis

    Directory of Open Access Journals (Sweden)

    Karolin Rönn

    2011-01-01

    Full Text Available Osteoathritis (OA of the knee is common, and the chances of suffering from OA increase with age. Its treatment should be initially nonoperative—and requires both pharmacological and nonpharmacological treatment modalities. If conservative therapy fails, surgery should be considered. Surgical treatments for knee OA include arthroscopy, cartilage repair, osteotomy, and knee arthroplasty. Determining which of these procedures is most appropriate depends on several factors, including the location, stage of OA, comorbidities on the one side and patients suffering on the other side. Arthroscopic lavage and débridement is often carried out, but does not alter disease progression. If OA is limited to one compartment, unicompartmental knee arthroplasty or unloading osteotomy can be considered. They are recommended in young and active patients in regard to the risks and limited durability of total knee replacement. Total arthroplasty of the knee is a common and safe method in the elderly patients with advanced knee OA. This paper summarizes current surgical treatment strategies for knee OA, with a focus on the latest developments, indications and level of evidence.

  11. The Correlation Between Poverty and Access to Essential Surgical Care in Ghana: A Geospatial Analysis.

    Science.gov (United States)

    Tansley, Gavin; Stewart, Barclay T; Gyedu, Adam; Boakye, Godfred; Lewis, Daniel; Hoogerboord, Marius; Mock, Charles

    2017-03-01

    Surgical disease burden falls disproportionately on individuals in low- and middle-income countries. These populations are also the least likely to have access to surgical care. Understanding the barriers to access in these populations is therefore necessary to meet the global surgical need. Using geospatial methods, this study explores the district-level variation of two access barriers in Ghana: poverty and spatial access to care. National survey data were used to estimate the average total household expenditure (THE) in each district. Estimates of the spatial access to essential surgical care were generated from a cost-distance model based on a recent surgical capacity assessment. Correlations were analyzed using regression and displayed cartographically. Both THE and spatial access to surgical care were found to have statistically significant regional variation in Ghana (p access to essential surgical care (β -5.15 USD, p access to surgical care were found to co-localize in the northwest of the country. Multiple barriers to accessing surgical care can coexist within populations. A careful understanding of all access barriers is necessary to identify and target strategies to address unmet surgical need within a given population.

  12. Functional recordings from awake, behaving rodents through a microchannel based regenerative neural interface

    Science.gov (United States)

    Gore, Russell K.; Choi, Yoonsu; Bellamkonda, Ravi; English, Arthur

    2015-02-01

    Objective. Neural interface technologies could provide controlling connections between the nervous system and external technologies, such as limb prosthetics. The recording of efferent, motor potentials is a critical requirement for a peripheral neural interface, as these signals represent the user-generated neural output intended to drive external devices. Our objective was to evaluate structural and functional neural regeneration through a microchannel neural interface and to characterize potentials recorded from electrodes placed within the microchannels in awake and behaving animals. Approach. Female rats were implanted with muscle EMG electrodes and, following unilateral sciatic nerve transection, the cut nerve was repaired either across a microchannel neural interface or with end-to-end surgical repair. During a 13 week recovery period, direct muscle responses to nerve stimulation proximal to the transection were monitored weekly. In two rats repaired with the neural interface, four wire electrodes were embedded in the microchannels and recordings were obtained within microchannels during proximal stimulation experiments and treadmill locomotion. Main results. In these proof-of-principle experiments, we found that axons from cut nerves were capable of functional reinnervation of distal muscle targets, whether regenerating through a microchannel device or after direct end-to-end repair. Discrete stimulation-evoked and volitional potentials were recorded within interface microchannels in a small group of awake and behaving animals and their firing patterns correlated directly with intramuscular recordings during locomotion. Of 38 potentials extracted, 19 were identified as motor axons reinnervating tibialis anterior or soleus muscles using spike triggered averaging. Significance. These results are evidence for motor axon regeneration through microchannels and are the first report of in vivo recordings from regenerated motor axons within microchannels in a small

  13. Barriers to staff adoption of a surgical safety checklist

    Science.gov (United States)

    Blache, Jean-Louis; Grenier, Catherine; Bourgain, Jean-Louis; Minvielle, Etienne

    2011-01-01

    Objective Implementation of a surgical checklist depends on many organisational factors and on socio-cultural patterns. The objective of this study was to identify barriers to effective implementation of a surgical checklist and to develop a best use strategy. Setting 18 cancer centres in France. Design The authors first assessed use compliance and completeness rates of the surgical checklist on a random sample of 80 surgical procedures performed under general or loco-regional anaesthesia in each of the 18 centres. They then developed a typology of the organisational and cultural barriers to effective checklist implementation and defined each barrier's contents using data from collective and semi-structured individual interviews of key staff, the results of an email questionnaire sent to the 18 centres, and direct observations over 20 h in two centres. Results The study consisted of 1440 surgical procedures, 1299 checklists, and 28 578 items. The mean compliance rate was 90.2% (0, 100). The mean completion rate was 61% (0, 84). 11 barriers to effective checklist implementation were identified. Their incidence varied widely across centres. The main barriers were duplication of items within existing checklists (16/18 centres), poor communication between surgeon and anaesthetist (10/18), time spent completing the checklist for no perceived benefit, and lack of understanding and timing of item checks (9/18), ambiguity (8/18), unaccounted risks (7/18) and a time-honoured hierarchy (6/18). Conclusions Several of the barriers to the successful implementation of the surgical checklist depended on organisational and cultural factors within each centre. The authors propose a strategy for change for checklist design, use and assessment, which could be used to construct a feedback loop for local team organisation and national initiatives. PMID:22069112

  14. 21 CFR 878.4580 - Surgical lamp.

    Science.gov (United States)

    2010-04-01

    ... surgical field or the patient. (b) Classification. Class II. ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Surgical lamp. 878.4580 Section 878.4580 Food and... GENERAL AND PLASTIC SURGERY DEVICES Surgical Devices § 878.4580 Surgical lamp. (a) Identification. A...

  15. Surgical Templates for Dental Implant Positioning; Current ...

    African Journals Online (AJOL)

    applicability of surgical templates used in the placement of dental implants. KEYWORDS: Dental implants, surgical templates, surgical procedure, stent. Access this .... ended up with the identification of basic three‑fabrication design concepts; (1) ... surgical guide on mounted diagnostic models of patient's mouth. He also ...

  16. Using dummies for surgical skills training

    DEFF Research Database (Denmark)

    Langebæk, Rikke

    2011-01-01

    teaching methods for veterinary surgical training. At the Department of Small Animal Clinical Sciences, Faculty of Life Sciences, a number of low fidelity, stuffed toy animal dummies was developed for the Surgical Skills Lab in order to teach 4th year students the basic surgical skills. In the Surgical...... this a relatively low budget solution with a big ethical benefit....

  17. Surgical innovation: the ethical agenda

    Science.gov (United States)

    Broekman, Marike L.; Carrière, Michelle E.; Bredenoord, Annelien L.

    2016-01-01

    Abstract The aim of the present article was to systematically review the ethics of surgical innovation and introduce the components of the learning health care system to guide future research and debate on surgical innovation. Although the call for evidence-based practice in surgery is increasingly high on the agenda, most surgeons feel that the format of the randomized controlled trial is not suitable for surgery. Innovation in surgery has aspects of, but should be distinguished from both research and clinical care and raises its own ethical challenges. To answer the question “What are the main ethical aspects of surgical innovation?”, we systematically searched PubMed and Embase. Papers expressing an opinion, point of view, or position were included, that is, normative ethical papers. We included 59 studies discussing ethical aspects of surgical innovation. These studies discussed 4 major themes: oversight, informed consent, learning curve, and vulnerable patient groups. Although all papers addressed the ethical challenges raised by surgical innovation, surgeons hold no uniform view of surgical innovation, and there is no agreement on the distinction between innovation and research. Even though most agree to some sort of oversight, they offer different alternatives ranging from the formation of new surgical innovation committees to establishing national registries. Most agree that informed consent is necessary for innovative procedures and that surgeons should be adequately trained to assure their competence to tackle the learning curve problem. All papers agree that in case of vulnerable patients, alternatives must be found for the informed consent procedure. We suggest that the concept of the learning health care system might provide guidance for thinking about surgical innovation. The underlying rationale of the learning health care system is to improve the quality of health care by embedding research within clinical care. Two aspects of a learning health

  18. Structured learning via convolutional neural networks for vehicle detection

    Science.gov (United States)

    Maqueda, Ana I.; del Blanco, Carlos R.; Jaureguizar, Fernando; García, Narciso

    2017-05-01

    One of the main tasks in a vision-based traffic monitoring system is the detection of vehicles. Recently, deep neural networks have been successfully applied to this end, outperforming previous approaches. However, most of these works generally rely on complex and high-computational region proposal networks. Others employ deep neural networks as a segmentation strategy to achieve a semantic representation of the object of interest, which has to be up-sampled later. In this paper, a new design for a convolutional neural network is applied to vehicle detection in highways for traffic monitoring. This network generates a spatially structured output that encodes the vehicle locations. Promising results have been obtained in the GRAM-RTM dataset.

  19. The value of surgical history.

    Science.gov (United States)

    Rutkow, I M

    1991-08-01

    It remains a rhetorical question whether or not an understanding of surgical history is important to the maturation and continued education of a surgeon. Conversely, it is hardly necessary to dwell on the heuristic value that an appreciation of history provides in developing adjunctive humanistic, literary, and philosophic tastes. Unfortunately, modern medical historians usually hold nonmedical degrees and basically restrict themselves to research concerning medical or public health aspects of social history. Clinical surgical history is increasingly avoided because the professional medical historian has no clinical background. However, practicing surgeons, who can serve as amateur medical historians, have knowledge and experience that place them in a unique position to assess historic facts and direct surgical historic inquiry. It is my belief that if medicine were taught with a greater emphasis on the historic approach, our country's physicians would be better prepared to cope with the health care problems of the future. By increasing the number of surgeons, who as an avocation, research and write about surgical history, our ability to provide better surgical care in our nation's coming years will be enhanced.

  20. Surgical management of splenic marginal zone lymphoma.

    Science.gov (United States)

    Kennedy, N D; Lê, G N; Kelly, M E; Harding, T; Fadalla, K; Winter, D C

    2017-10-17

    Splenic marginal zone lymphoma (SMZL) is a rare indolent B-cell lymphoma with variable prognosis. As a result, there is sparse knowledge on the role of splenectomy and best management approaches. We aim to explore management strategies and outcomes amongst the cohort of SMZL patients at our centre. A retrospective review of all splenectomies performed at a tertiary referral unit over a 23-year period was assessed. Immunohistochemical and pathological results of splenic samples, bone marrow biopsies, and peripheral blood were compiled. Operative management, surgical, and survival outcomes were assessed. Prognostic stratifications were applied and survival rates were calculated. Eight cases of SMZL from a database of 693 splenectomies were identified. All patients had intermediate/high-risk disease. All patients underwent splenectomy with one patient receiving preoperative rituximab. All patients had progression-free survival and resolution of disease. Based on the data obtained, current practice requires defined guidelines and centralised care.

  1. Prediction of Bladder Cancer Recurrences Using Artificial Neural Networks

    Science.gov (United States)

    Zulueta Guerrero, Ekaitz; Garay, Naiara Telleria; Lopez-Guede, Jose Manuel; Vilches, Borja Ayerdi; Iragorri, Eider Egilegor; Castaños, David Lecumberri; de La Hoz Rastrollo, Ana Belén; Peña, Carlos Pertusa

    Even if considerable advances have been made in the field of early diagnosis, there is no simple, cheap and non-invasive method that can be applied to the clinical monitorisation of bladder cancer patients. Moreover, bladder cancer recurrences or the reappearance of the tumour after its surgical resection cannot be predicted in the current clinical setting. In this study, Artificial Neural Networks (ANN) were used to assess how different combinations of classical clinical parameters (stage-grade and age) and two urinary markers (growth factor and pro-inflammatory mediator) could predict post surgical recurrences in bladder cancer patients. Different ANN methods, input parameter combinations and recurrence related output variables were used and the resulting positive and negative prediction rates compared. MultiLayer Perceptron (MLP) was selected as the most predictive model and urinary markers showed the highest sensitivity, predicting correctly 50% of the patients that would recur in a 2 year follow-up period.

  2. [Structured training strategy for robot surgery].

    Science.gov (United States)

    Xi, H Q; Zhang, K C; Wei, B; Chen, L

    2016-12-01

    With surgical strategy progresses towarding to precision and minimally invasive surgery, the Da Vinci robotic surgical system comes into being. Compared with conventional surgery, the Da Vinci robotic surgical system enjoys several advantages including clear operation field, flexibility and tremor filtration.Normative operation plays an important role in translating such advantages into clinical benefits.Training physicians systematically and comprehensively is very important. Compared with conventional training strategy, multi-modal simulation training is more preferred for the Da Vinci robotic surgical system training.Based on comprehensive literature retrieval and the current development of the robotic surgery, training modalities, learning curve, training of young surgeons as well as teamwork are included to provide evidence for future establishment and implement of structured training programs of the robotic surgery.

  3. [Surgical treatment of de-novo scoliosis].

    Science.gov (United States)

    Putzier, M; Pumberger, M; Halm, H; Zahn, R K; Franke, J

    2016-09-01

    De-novo scoliosis is most commonly associated with chronic back pain and in 70 % of cases with neurological symptoms of the lower extremities. In recent literature, the occurrence and severity of segmental lateral listhesis has been discussed as being an important prognostic factor of sagittal and frontal deformity progression. In general, operative interventions in patients with de-novo scoliosis are associated with a high rate of complications. Therefore, conservative treatment modalities are recommended at early stages of the disease. If conservative management fails and a sufficient reduction of the patient's symptoms cannot be achieved, depending on the symptoms, a selective decompression, short-segment fusion or long-instrumented reduction and fusion are indicated. Additionally to the patient's symptoms, specific imaging diagnostics are necessary to develop an adequate surgical treatment strategy. Selective decompression without fusion is indicated in patients with a fixed deformity and primarily neurologic pain or deficits. In conditions of a focal pathology as cause of significant low back pain and/or neurologic symptoms at early stages of deformity, a short segment fusion is the treatment of choice. However, short-segment fusion as a less-invasive procedure must not be performed in biplanar unbalanced patients and/or advanced de-novo scoliosis. In advanced degenerative de-novo scoliosis a long-segment reposition and fusion following an alignment correction are needed. Standardized pre-operative planning and perioperative management are highly critical to the post-operative success. All operative treatment strategies in patients with de-novo scoliosis can be successful but they require sophisticated and individual surgical indication.

  4. Surgical treatment of primary malignant tumors of the sacrum.

    Science.gov (United States)

    Varga, Peter Paul; Szövérfi, Zsolt; Lazary, Aron

    2014-06-01

    The objective of the authors was to provide an up-to-date review about the epidemiology, diagnosis, and surgical management of the malignant primary sacral tumors. A PubMed search was conducted using a combination of the following items: (('Spinal Neoplasms'[Mesh]) AND 'Sacrum'[Mesh]) NOT ('Metastasis' OR 'Metastases' OR 'Benign'). The literature review and the author's own surgical experiences were used to assess the current treatment strategies of the malignant sacral tumors. Twenty case series were identified, which studies discuss in detail the surgical strategies, the postoperative complications, the functional and oncologic outcome, and the recurrence-free and disease-specific survival of this rare patient category. Sacral tumors are rare pathologies. Their management generates a complex medical problem, as they usually are diagnosed in advanced stages with extended dimensions involving the sacral nerves and surrounding organs. The evaluation and complex treatment of these rare tumors require a multidisciplinary approach, optimally at institutions with comprehensive care and experience. Although conventional oncologic therapeutic methods should be used as neoadjuvant or adjuvant therapies in certain histological types, en bloc resection with wide surgical margins is essential for long-term local oncologic control. This is often technically difficult to achieve, as just a few centers in the world perform sacral tumor surgeries on a regular basis, and have enough wide experience. Therefore international cooperation and organization of multicenter tumor registries are essential to develop evidence based treatment protocols.

  5. Aneurysmatic bone cyst of the craniocervical region: Surgical technique

    Directory of Open Access Journals (Sweden)

    Andrei Fernandes Joaquim

    2014-01-01

    Full Text Available Aneurysmal bone cysts (ABCs are nonneoplastic bone lesions that may originate of any site of skeleton. The spine can be affect up to 30% of the cases, leading to pain, neurological deficits, and pathological fractures in symptomatic patients. The incidence of craniocervical (occipito-C1-2 occurrence is not known. We describe the surgical technique and clinical results of two patients with craniocervical ABCs that underwent primary surgical resection: An 11-year-old girl with a lesion in the posterior aspect of the atlas, and a 28-year-old man with an important hydrocephalus and a posterior expansible lesion on the left side of his posterior fossa. Total resection was achieved on both lesions, with no surgical morbidity. Even though ABCs are nonneoplastic lesions, subtotal resection is associated with early recurrence. The knowledge of the anatomy of the region in order to achieve the occlusion of arterial feeders prior to surgical resection itself is the key point of the surgical strategy.

  6. Surgical interventions for treating pectus excavatum.

    Science.gov (United States)

    de Oliveira Carvalho, Paulo Eduardo; da Silva, Marcos Vinícius Muriano; Rodrigues, Olavo Ribeiro; Cataneo, Antonio José Maria

    2014-10-29

    Pectus excavatum is characterized by a depression of the anterior chest wall (sternum and lower costal cartilages) and is the most frequently occurring chest wall deformity. The prevalence ranges from 6.28 to 12 cases per 1000 around the world. Generally pectus excavatum is present at birth or is identified after a few weeks or months; however, sometimes it becomes evident only at puberty. The consequence of the condition on a individual's life is variable, some live a normal life and others have physical and psychological symptoms such as: precordial pain after exercises; impairments of pulmonary and cardiac function; shyness and social isolation. For many years, sub-perichondrial resection of the costal cartilages, with or without transverse cuneiform osteotomy of the sternum and placement of a substernal support, called conventional surgery, was the most accepted option for surgical repair of these patients. From 1997 a new surgical repair called, minimally invasive surgery, became available. This less invasive surgical option consists of the retrosternal placement of a curved metal bar, without resections of the costal cartilages or sternum osteotomy, and is performed by videothoracoscopy. However, many aspects that relate to the benefits and harms of both techniques have not been defined. To evaluate the effectiveness and safety of the conventional surgery compared with minimally invasive surgery for treating people with pectus excavatum. With the aim of increasing the sensitivity of the search strategy we used only terms related to the individual's condition (pectus excavatum); terms related to the interventions, outcomes and types of studies were not included. We searched the Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, Embase, LILACS, and ICTPR. Additionally we searched yet reference lists of articles and conference proceedings. All searches were done without language restriction.Date of the most recent searches: 14 January 2014. We

  7. An Optoelectronic Neural Network

    Science.gov (United States)

    Neil, Mark A. A.; White, Ian H.; Carroll, John E.

    1990-02-01

    We describe and present results of an optoelectronic neural network processing system. The system uses an algorithm based on the Hebbian learning rule to memorise a set of associated vector pairs. Recall occurs by the processing of the input vector with these stored associations in an incoherent optical vector multiplier using optical polarisation rotating liquid crystal spatial light modulators to store the vectors and an optical polarisation shadow casting technique to perform multiplications. Results are detected on a photodiode array and thresholded electronically by a controlling microcomputer. The processor is shown to work in autoassociative and heteroassociative modes with up to 10 stored memory vectors of length 64 (equivalent to 64 neurons) and a cycle time of 50ms. We discuss the limiting factors at work in this system, how they affect its scalability and the general applicability of its principles to other systems.

  8. Neural Darwinism and consciousness.

    Science.gov (United States)

    Seth, Anil K; Baars, Bernard J

    2005-03-01

    Neural Darwinism (ND) is a large scale selectionist theory of brain development and function that has been hypothesized to relate to consciousness. According to ND, consciousness is entailed by reentrant interactions among neuronal populations in the thalamocortical system (the 'dynamic core'). These interactions, which permit high-order discriminations among possible core states, confer selective advantages on organisms possessing them by linking current perceptual events to a past history of value-dependent learning. Here, we assess the consistency of ND with 16 widely recognized properties of consciousness, both physiological (for example, consciousness is associated with widespread, relatively fast, low amplitude interactions in the thalamocortical system), and phenomenal (for example, consciousness involves the existence of a private flow of events available only to the experiencing subject). While no theory accounts fully for all of these properties at present, we find that ND and its recent extensions fare well.

  9. Cortical neural prosthetics.

    Science.gov (United States)

    Schwartz, Andrew B

    2004-01-01

    Control of prostheses using cortical signals is based on three elements: chronic microelectrode arrays, extraction algorithms, and prosthetic effectors. Arrays of microelectrodes are permanently implanted in cerebral cortex. These arrays must record populations of single- and multiunit activity indefinitely. Information containing position and velocity correlates of animate movement needs to be extracted continuously in real time from the recorded activity. Prosthetic arms, the current effectors used in this work, need to have the agility and configuration of natural arms. Demonstrations using closed-loop control show that subjects change their neural activity to improve performance with these devices. Adaptive-learning algorithms that capitalize on these improvements show that this technology has the capability of restoring much of the arm movement lost with immobilizing deficits.

  10. Impact of surgical training on incidence of surgical site infection.

    Science.gov (United States)

    Rosenthal, Rachel; Weber, Walter P; Zwahlen, Marcel; Misteli, Heidi; Reck, Stefan; Oertli, Daniel; Widmer, Andreas F; Marti, Walter R

    2009-06-01

    Despite availability of other training forms, tutorial assistance cannot be entirely replaced in surgical education. Concerns exist that tutorial assistance may lead to an increased rate of surgical site infection (SSI). The purpose of the present study was to investigate whether the risk of SSI is higher after surgery with tutorial assistance than after surgery performed autonomously by a fully trained surgeon. All consecutive visceral, vascular, and traumatological inpatient procedures at a Swiss University Hospital were prospectively recorded during a 24-month period, and the patients were followed for 12 months to ascertain the occurrence of SSI. Using univariable and multivariable logistic regressions, we assessed the association of tutorial assistance surgery with SSI in 6,103 interventions. Autonomously performed surgery was associated with SSI in univariable analysis (5.36% SSI vs. 3.81% for tutorial assistance, p = 0.006). In multivariable analysis, the odds of SSI for tutorial assistance was no longer significantly lower (Odds Ratio [OR] = 0.82; 95% Confidence Interval [CI]: 0.62-1.09; p = 0.163). Surgical training does not lead to higher SSI rate if trainees are adequately supervised and interventions are carefully selected. Although other forms of training are useful, tutorial assistance in the operating room continues to be the mainstay of surgical education.

  11. Surgically Assisted Rapid Maxillary Expansion: surgical and orthodontic aspects

    NARCIS (Netherlands)

    M.J. Koudstaal (Maarten)

    2008-01-01

    textabstractThe scope of this thesis is to shed more light, from a number of perspectives, on surgically assisted rapid maxillary expansion (SARME). The primary questions this thesis set out to answer were; ‘is there a difference in stability between bone-borne and tooth-borne distraction?’ and ‘can

  12. Tuberous breast: a surgical challenge.

    Science.gov (United States)

    Choupina, Miguel; Malheiro, Edgardo; Pinho, Carlos; Ferreira, António; Pinto, Armindo; Cardoso, Augusta; Reis, Jorge; Amarante, José

    2002-01-01

    Since the presentation of the tuberous breast deformity by Rees and Aston in 1976, many surgical procedures have been developed, but the correction of such a deformity still remains a surgical challenge. The authors report the last cases treated in the Department of Plastic and Reconstructive Surgery of São João Hospital-Porto and discuss about the ideal procedure which should be used according to the type of deformity. They emphasize the periareolar approach and the good results obtained by the Liacyr Ribeiro technique.

  13. Surgical treatment of low vision.

    Science.gov (United States)

    Gorfinkel, John

    2006-06-01

    Recent advances in technology are driving a renewed search to find surgical solutions for low vision rehabilitation. The scope of surgery is now being pushed beyond the initial goal of repairing existing anatomical structures. Today, the goal for vision rehabilitation is no less than replacing damaged ocular tissues with artificial ones. Surgical management of low vision may be subdivided into two categories, those procedures aimed at restoring ultrastructural visual function and those aimed at enhancing visual acuity of the residual retina with various levels of magnification. This paper briefly reviews advances in ultrastructural restoration by repair and considers in more detail enhanced acuity through magnification or replacement.

  14. Environmental enrichment promotes neural plasticity and cognitive ability in fish.

    Science.gov (United States)

    Salvanes, Anne Gro Vea; Moberg, Olav; Ebbesson, Lars O E; Nilsen, Tom Ole; Jensen, Knut Helge; Braithwaite, Victoria A

    2013-09-22

    Different kinds of experience during early life can play a significant role in the development of an animal's behavioural phenotype. In natural contexts, this influences behaviours from anti-predator responses to navigation abilities. By contrast, for animals reared in captive environments, the homogeneous nature of their experience tends to reduce behavioural flexibility. Studies with cage-reared rodents indicate that captivity often compromises neural development and neural plasticity. Such neural and behavioural deficits can be problematic if captive-bred animals are being reared with the intention of releasing them as part of a conservation strategy. Over the last decade, there has been growing interest in the use of environmental enrichment to promote behavioural flexibility in animals that are bred for release. Here, we describe the positive effects of environmental enrichment on neural plasticity and cognition in juvenile Atlantic salmon (Salmo salar). Exposing fish to enriched conditions upregulated the forebrain expression of NeuroD1 mRNA and improved learning ability assessed in a spatial task. The addition of enrichment to the captive environment thus promotes neural and behavioural changes that are likely to promote behavioural flexibility and improve post-release survival.

  15. Strategie podniku

    OpenAIRE

    Gerlašinský, Marcel

    2009-01-01

    The aim of theoretic part of the thesis is to define the term of a strategy, specify the way how to create the strategy, what approach, methods and instruments are used for the strategy determination. Part of the definicions and further focus will be the area of strategic analysis,competetive advantage and the Enterprise's resources. In the application part, the present strategy of Airport Prague company, that is the the international Prague Ruzyne airport operator, will be specified. On the ...

  16. Surgical wound morbidity in an austere surgical environment.

    Science.gov (United States)

    Lucha, Paul A; Wallace, Douglas; Pasque, Charles; Brickhouse, Neal; Olsen, David; Styk, Stan; Dortch, Myra; Beckman, William A

    2010-05-01

    Surgical wound morbidity was analyzed for a U.S. military field hospital deployed to the Republic of Haiti in support of Operation New Horizons 1998. The purpose of the analysis was to determine whether procedures performed in the field hospital had greater infectious risks as a result of the environment compared with historical reports for traditional hospital or clinic settings. Acceptable historical infection rates of 1.5% for clean surgical cases, 7.7% for clean contaminated cases, 15.2% for contaminated cases, and 40% for dirty cases have been noted. There were 827 operations performed during a 6-month period, with the majority of patients assigned American Society of Anesthesiologists (ASA) Physical Status Classification class I or II. The distribution of these cases was: 72% clean cases, 5% clean contaminated cases, 4% contaminated cases, and 19% dirty cases. The overall wound complication rate was 3.6%, which included 5 wound infections, 11 wound hematomas, 8 superficial wound separations, and 6 seromas. The infectious morbidity for clean cases, the index for evaluation of infectious complications, was 0.8%, well within the accepted standards. There were two major complications that required a return to the operating room: a wound dehiscence with infection in an orchiectomy and a postoperative hematoma with airway compromise in a subtotal thyroidectomy. There were no surgical mortalities. The infectious wound morbidity for operations performed in the field hospital environment was found to be equivalent to that described for the fixed hospital or clinic settings. No special precautions were necessary to ensure a low infection rate. The safety for patients undergoing elective surgical procedures has been established. Further training using these types of facilities should not be limited based on concerns for surgical wound morbidity.

  17. Surgical decision-making for managing complex intracranial aneurysms

    OpenAIRE

    Esposito, Giuseppe; Regli, Luca

    2014-01-01

    The treatment of complex intracranial aneurysms remains a therapeutic challenge. These lesions are frequently not amenable to selective clipping or coiling or other endovascular procedures and surgery still has a predominant role. We illustrate our “surgical decision making” for managing complex intracranial aneurysmal lesions. The best strategy is decided on the basis of pre-operative neuroradiological and intra-operative main determinants such as anatomical location, peri-aneurysmal ang...

  18. Neural substrate expansion for the restoration of brain function

    Directory of Open Access Journals (Sweden)

    Han-Chiao Isaac Chen

    2016-01-01

    Full Text Available Restoring neurological and cognitive function in individuals who have suffered brain damage is one of the principal objectives of modern translational neuroscience. Electrical stimulation approaches, such as deep-brain stimulation, have achieved the most clinical success, but they ultimately may be limited by the computational capacity of the residual cerebral circuitry. An alternative strategy is brain substrate expansion, in which the computational capacity of the brain is augmented through the addition of new processing units and the reconstitution of network connectivity. This latter approach has been explored to some degree using both biological and electronic means but thus far has not demonstrated the ability to reestablish the function of large-scale neuronal networks. In this review, we contend that fulfilling the potential of brain substrate expansion will require a significant shift from current methods that emphasize direct manipulations of the brain (e.g., injections of cellular suspensions and the implantation of multi-electrode arrays to the generation of more sophisticated neural tissues and neural-electric hybrids in vitro that are subsequently transplanted into the brain. Drawing from neural tissue engineering, stem cell biology, and neural interface technologies, this strategy makes greater use of the manifold techniques available in the laboratory to create biocompatible constructs that recapitulate brain architecture and thus are more easily recognized and utilized by brain networks.

  19. [Complete lower urinary tract duplication with true diphallia associated to anorrectal and neural malformations].

    Science.gov (United States)

    Guirao, M J; Zambudio, G; Nortes, L; Jiménez, J I Ruiz

    2008-10-01

    We report a case of complete urinary tract duplication with true diphallia associated to intestinal and neural anomalies. Complete penile duplication with hypospadias and bifidum scrotum were showed. Moreover, he had got anorrectal disease (anterior anus) and neural tube defects (myelomeningocele). Radiological and functional studies were performed and complete duplication lower urinary tract with coordinate miction were found. Combined surgical approach were used: perineal to remove lateralized and hypospadic penile and abdominal for cystoplasty. We report a case due to the extremely low prevalence. Only 15 cases have been described in the literature.

  20. Neural Computations in Binaural Hearing

    Science.gov (United States)

    Wagner, Hermann

    Binaural hearing helps humans and animals to localize and unmask sounds. Here, binaural computations in the barn owl's auditory system are discussed. Barn owls use the interaural time difference (ITD) for azimuthal sound localization, and they use the interaural level difference (ELD) for elevational sound localization. ITD and ILD and their precursors are processed in separate neural pathways, the time pathway and the intensity pathway, respectively. Representation of ITD involves four main computational steps, while the representation of ILD is accomplished in three steps. In the discussion neural processing in the owl's auditory system is compared with neural computations present in mammals.

  1. Use of the 3D surgical modelling technique with open-source software for mandibular fibula free flap reconstruction and its surgical guides.

    Science.gov (United States)

    Ganry, L; Hersant, B; Quilichini, J; Leyder, P; Meningaud, J P

    2017-06-01

    Tridimensional (3D) surgical modelling is a necessary step to create 3D-printed surgical tools, and expensive professional software is generally needed. Open-source software are functional, reliable, updated, may be downloaded for free and used to produce 3D models. Few surgical teams have used free solutions for mastering 3D surgical modelling for reconstructive surgery with osseous free flaps. We described an Open-source software 3D surgical modelling protocol to perform a fast and nearly free mandibular reconstruction with microvascular fibula free flap and its surgical guides, with no need for engineering support. Four successive specialised Open-source software were used to perform our 3D modelling: OsiriX ® , Meshlab ® , Netfabb ® and Blender ® . Digital Imaging and Communications in Medicine (DICOM) data on patient skull and fibula, obtained with a computerised tomography (CT) scan, were needed. The 3D modelling of the reconstructed mandible and its surgical guides were created. This new strategy may improve surgical management in Oral and Craniomaxillofacial surgery. Further clinical studies are needed to demonstrate the feasibility, reproducibility, transfer of know how and benefits of this technique. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  2. Common Synaptic Input to Motor Neurons and Neural Drive to Targeted Reinnervated Muscles.

    Science.gov (United States)

    Farina, Dario; Castronovo, Anna Margherita; Vujaklija, Ivan; Sturma, Agnes; Salminger, Stefan; Hofer, Christian; Aszmann, Oskar

    2017-11-15

    biologically inspired prosthetic control strategies. Moreover, targeted muscle reinnervation offers a human experimental framework for studying the control and behavior of motor neurons when changing their target innervated muscle fibers and sensory feedback. Here, we show that the control of motor neurons and their synaptic input, following reinnervation, was remarkably similar to that of the physiological innervation, although with reduced common drive at some frequencies. The results advance our knowledge on the role of sensory input in the generation of the neural drive to muscles and provide the basis for designing physiologically inspired methods for prosthesis control. Copyright © 2017 the authors 0270-6474/17/3711285-08$15.00/0.

  3. [Humanitarian missions and surgical training].

    Science.gov (United States)

    Fourrier, P; Herlemont, P

    1991-01-01

    The surgeons that ensure humanitarian assignments (in non-governmental organizations) must operate, most often in difficult material conditions, injured and ill patients whose conditions belong the most various fields of surgery, in both war and peace practice. The evolution of surgical training towards overspecialization proves to be less and less compatible with the requirements of such assignments.

  4. Surgical Lasers In Veterinary Medicine

    Science.gov (United States)

    Newman, H. C.

    1987-03-01

    Veterinary medicine is a latecomer in benefiting from the advent of surgical lasers. It is ironic that although most of the basic work in lasers is carried out in animal species with which we are most conversant, veterinary medicine as a profession has not been very extensively involved.

  5. Surgical management of tubal pregnancy

    NARCIS (Netherlands)

    Mol, F.

    2013-01-01

    The work presented in this thesis first addresses the magnitude of the clinical problem of surgically treated tubal pregnancy in The Netherlands. Next, we studied the adherence to recommendations from the Dutch guideline on diagnosis and management of ectopic pregnancy. A systematic review and

  6. Posterior fossa meningioma (surgical experiences)

    African Journals Online (AJOL)

    Wael M. Moussa

    2012-08-27

    Aug 27, 2012 ... Morbidity included decreased level of consciousness, cranial nerve palsy and wound infection. Conclusion: ..... Evolution of surgical approaches in the treatment of petroclival meningio- mas. Neurosurgery 2007;61(Suppl 2):202–11. 47. Baugh Andrew, Hillman Todd A, Shelton Clough. Combined petrosal ...

  7. [Surgical education has its price].

    Science.gov (United States)

    Schröder, W; Krones, C J

    2012-04-01

    The radical economisation of the German health-care system has caused an increasing cost awareness. Following this trend, medical education has been identified as a possible expense factor. The theoretical and practical training of young doctors needs time and costs money. However, a detailed cost analysis is still not available, since the complex daily work schedule of young professionals only allows the calculation of single cost factors. Investigations in the USA estimate the costs of surgical training at US$ 80 000 per year and per resident. At present in Germany, surgical training is indirectly financed by the DRG flat rates of the health insurance companies. Possible alternatives include the implementation of a "training fond" which is financed by a percentage fee of the DRG's as well as an on-top funding by the federal government. This "training fond" would support only those surgical units that offer a structured and certified training to surgical residents. However, a systematic cost analysis of such a structured curriculum is necessary for any further discussion. © Georg Thieme Verlag KG Stuttgart · New York.

  8. ANAESTHESIA FOR OPHTHALMIC SURGICAL PROCEDURES

    African Journals Online (AJOL)

    East African Medical Journal Vol. 91 No. 3 March 2014. ANAESTHESIA FOR OPHTHALMIC SURGICAL PROCEDURES. O. H. Onakpoya, MBBS, FWACS, FMCOphth, Ophthalmology Unit, Department of Surgery, College of Health Sciences,. Obafemi Awolowo University, F. D. Asudo, FDBSBCH (Dip Anaesth), FWACS, ...

  9. Surgical correction of pinna malformations.

    Science.gov (United States)

    Papacharalampous, G; Nikolopoulos, T P; Manolopoulos, L; Gamatsi, I; Yiotakis, I; Leandros, M; Korres, S

    2007-01-01

    Auricle reconstruction is a surgical procedure described in the medical literature as early as 600 BC. The aim of the present paper is to review these attempts and their results. Literature search and medical history books were used as scientific sources. More than 40 different cartilagenous, osseous or other alloplastic frame materials (autogenous tibial bone, iliac bone, mastoid bone, maternal auricular cartilage, autogenous nasoseptal cartilage, allogenous meniscus, autogenous meniscus and many more) have been used since 1891. From approximately 40 reconstruction procedures that had been proposed, only eight were still in use in the 1980s. The reason for abandoning the majority of these surgical techniques was the unacceptable aesthetic result. However, at the end of the 20th Century two new techniques were introduced. These techniques were designed by Satoru Nagata and Burt Brent. Both techniques provide cosmetic and functional results that are acceptable both to the patient and to the surgeon. Although the outcome of surgical auricle reconstruction was in general disappointing through the centuries, at the end of the 20th Century new surgical methods were established and at the present time auricle reconstruction can be attempted with acceptable results.

  10. Posterior fossa meningioma (surgical experiences)

    African Journals Online (AJOL)

    Wael M. Moussa

    2012-08-27

    Aug 27, 2012 ... All patients had preoperative complete general and neurological examination, MRI of the brain with and without Gadolinium. Different surgical approaches were utilized in the study depending on the tumor location and the surgeon's preference. Postoperatively, all patients had a postopera- tive CT scan of ...

  11. Surgical treatment of undescended testes

    DEFF Research Database (Denmark)

    Thorup, Jørgen Mogens; Haugen, S; Kollin, C

    2007-01-01

    The mainstay of therapy for undescended testes is operative treatment within the first years of life in order to avoid ongoing testicular degenerative changes. The surgical therapy for the palpable undescended testis is orchiopexy and when the testis is non-palpable, a supplementary laparoscopic...

  12. Surgical Treatment of Mirizzi Syndrome

    Directory of Open Access Journals (Sweden)

    Е.М. Goch

    2010-06-01

    Full Text Available The results of treatment of 53 patients with Mirizzi syndrome are presented in the work. The article focuses on the modern classification of syndrome, diagnostics and surgical approach according to the severity of duct damage. Mirizzi syndrome proves to be the complication of cholelithiasis. It is one of the most complicated problems of biliary surgery

  13. The dutch surgical colorectal audit

    NARCIS (Netherlands)

    Leersum, N.J. van; Snijders, H.S.; Henneman, D.; Kolfschoten, N.E.; Gooiker, G.A.; Berge, M.G. Ten; Eddes, E.H.; Wouters, M.W.; Tollenaar, R.A.E.M.; Bemelman, W.A.; Dam, R.M. van; Elferink, M.A.; Karsten, T.M.; Krieken, J.H. van; Lemmens, V.E.; Rutten, H.J.; Manusama, E.R.; Velde, C.J. van de; Meijerink, W.J.H.J.; Wiggers, T.; Harst, E. van der; Dekker, J.W.T.; Boerma, D.

    2013-01-01

    INTRODUCTION: In 2009, the nationwide Dutch Surgical Colorectal Audit (DSCA) was initiated by the Association of Surgeons of the Netherlands (ASN) to monitor, evaluate and improve colorectal cancer care. The DSCA is currently widely used as a blueprint for the initiation of other audits, coordinated

  14. The Dutch surgical colorectal audit

    NARCIS (Netherlands)

    van Leersum, N. J.; Snijders, H. S.; Henneman, D.; Kolfschoten, N. E.; Gooiker, G. A.; ten Berge, M. G.; Eddes, E. H.; Wouters, M. W. J. M.; Tollenaar, R. A. E. M.; Bemelman, W. A.; van Dam, R. M.; Elferink, M. A.; Karsten, Th M.; van Krieken, J. H. J. M.; Lemmens, V. E. P. P.; Rutten, H. J. T.; Manusama, E. R.; van de Velde, C. J. H.; Meijerink, W. J. H. J.; Wiggers, Th; van der Harst, E.; Dekker, J. W. T.; Boerma, D.

    2013-01-01

    In 2009, the nationwide Dutch Surgical Colorectal Audit (DSCA) was initiated by the Association of Surgeons of the Netherlands (ASN) to monitor, evaluate and improve colorectal cancer care. The DSCA is currently widely used as a blueprint for the initiation of other audits, coordinated by the Dutch

  15. Surgical smoke and infection control.

    NARCIS (Netherlands)

    Alp, E.; Bijl, D.; Bleichrodt, R.P.; Hansson, B.M.; Voss, A.

    2006-01-01

    Gaseous byproducts produced during electrocautery, laser surgery or the use of ultrasonic scalpels are usually referred to as 'surgical smoke'. This smoke, produced with or without a heating process, contains bio-aerosols with viable and non-viable cellular material that subsequently poses a risk of

  16. Surgical treatment for incessant pericarditis

    Science.gov (United States)

    Hota, Susy S; Chow, ChiMing; Bonneau, Daniel; Chisholm, Robert J

    2009-01-01

    A case of chronic relapsing pericarditis is presented in which all forms of medical therapy failed. Pericardectomy was performed as a last resort, with complete resolution of symptoms. Incessant pericarditis, as distinguished from recurrent intermittent pericarditis, may respond favourably to surgical removal, especially in the presence of recurrent pericardial effusion. PMID:19279984

  17. Neuropsychological Definition of Learning: Strategies for Rewiring Neural Networks

    Science.gov (United States)

    Barwegen, Laura

    2008-01-01

    For many years, most scientists believed that the physical structure of our brains, and by definition the people we had become, was set after the initial developmental period of early childhood and adolescence. New research in the area of neurology and neuropsychology is revealing that our brain is a much more open system than ever thought…

  18. Pattern, outcome and challenges of neonatal surgical cases in a tertiary teaching hospital

    Directory of Open Access Journals (Sweden)

    Rosemary O Ugwu

    2013-01-01

    Full Text Available Background: Globally, the major causes of neonatal deaths are birth asphyxia, prematurity and severe infections. Little attention is paid to deaths contributed by surgically amenable conditions. This study was undertaken to determine the burden and types of surgical problems encountered in the neonatal period, their outcome and challenges encountered. Patients and Methods: This was a retrospective study. The case notes of all neonates admitted into the newborn unit of our centre between April 2002 and March 2010 with surgical conditions were retrieved and the following information extracted: Sex, diagnosis, age at presentation, surgical intervention and outcome. Results: Out of 7,401 neonates admitted within the study period, 460 (6.2% had a surgical condition. Of the 1,657 babies that died within the same period, 196 (11.8% of them were those with surgical conditions. Congenital abnormalities accounted for 408 (88.7% of all the surgical cases. Intestinal obstruction 129 (31.6%, neural tube defects 101 (24.8% and anterior abdominal wall defect 58 (14.2% were the commonest congenital abnormalities, while fracture of the long bones following birth trauma 15 (28.8% and perforated NEC 14 (26.9% were the commonest acquired conditions. Surgery was performed in 166 (36.1% and 98 (59% had postoperative complications. Significantly, more deaths occurred in preterms than in term babies (P = 0.003 and in those delivered outside the hospital than in in-born babies (P = 0.02. The major cause of death was infection in 92 (47%. Conclusion: Neonatal surgical conditions contributed significantly to both neonatal admissions and overall neonatal mortality and thus highlights the need for investments in newborn surgical care in developing countries.

  19. Neural Manifolds for the Control of Movement.

    Science.gov (United States)

    Gallego, Juan A; Perich, Matthew G; Miller, Lee E; Solla, Sara A

    2017-06-07

    The analysis of neural dynamics in several brain cortices has consistently uncovered low-dimensional manifolds that capture a significant fraction of neural variability. These neural manifolds are spanned by specific patterns of correlated neural activity, the "neural modes." We discuss a model for neural control of movement in which the time-dependent activation of these neural modes is the generator of motor behavior. This manifold-based view of motor cortex may lead to a better understanding of how the brain controls movement. Copyright © 2017 Elsevier Inc. All rights reserved.

  20. Decorrelated Jet Substructure Tagging using Adversarial Neural Networks

    CERN Multimedia

    CERN. Geneva

    2017-01-01

    We describe a strategy for constructing a neural network jet substructure tagger which powerfully discriminates boosted decay signals while remaining largely uncorrelated with the jet mass. This reduces the impact of systematic uncertainties in background modeling while enhancing signal purity, resulting in improved discovery significance relative to existing taggers. The network is trained using an adversarial strategy, resulting in a tagger that learns to balance classification accuracy with decorrelation. As a benchmark scenario, we consider the case where large-radius jets originating from a boosted Z' decay are discriminated from a background of nonresonant quark and gluon jets. We show that in the presence of systematic uncertainties on the background rate, our adversarially-trained, decorrelated tagger considerably outperforms a conventionally trained neural network, despite having a slightly worse signal-background separation power. We generalize the adversarial training technique to include a paramet...