Sample records for neural surgical strategy

  1. Surgical strategies in childhood craniopharyngioma

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    Jörg eFlitsch


    Full Text Available Craniopharyngiomas are biologically benign lesions (WHO Grade 1 of the sellar and suprasellar region, associated with a serious morbidity. About 50% of these tumors become clinically apparent during childhood. Clinical symptoms include headaches, chiasm syndrome, hydrocephalus, pituitary insufficiencies, and obesity. Growth arrest is a typical symptom in children. The treatment of craniopharyngiomas includes surgery as well as radiotherapy. The goal of surgery varies according to the tumor location and extension and may range from complete resection to biopsy. Surgical complications are well known and cause constant evaluation of surgical strategies. Diencephalic obesity is related to surgical manipulation of hypothalamic tissue. Therefore, a classification system for craniopharyngiomas based on preoperative MRI is suggested by the authors, which may help assess the surgical risk. Recurrences are frequent in craniopharyngiomas, even after complete or gross-total resection. Radiotherapy is therefore recommended to patients with incomplete resections. However, the ideal time for radiotherapy after surgery is under discussion.The treatment of craniopharyngiomas requires an interdisciplinary and multimodal approach. Each patient should receive an individually tailored treatment. Surgically, different approaches as well as different degrees of resection can be considered, depending on tumor location and tumor extension.

  2. Multimodal strategies to improve surgical outcome

    DEFF Research Database (Denmark)

    Kehlet, Henrik; Wilmore, Douglas W


    OBJECTIVE: To evaluate the effect of modifying perioperative care in noncardiac surgical patients on morbidity, mortality, and other outcome measures. BACKGROUND: New approaches in pain control, introduction of techniques that reduce the perioperative stress response, and the more frequent use...... 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...... surgical procedures or require only 1 to 2 days of postoperative hospitalization. Reorganization of the perioperative team (anesthesiologists, surgeons, nurses, and physical therapists) will be essential to achieve successful fast track surgical programs. CONCLUSIONS: Understanding perioperative...

  3. Mechanical ventilation strategies for the surgical patient

    NARCIS (Netherlands)

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


    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:

  4. Surgical center: challenges and strategies for nurses in managerial activities. (United States)

    Martins, Fabiana Zerbieri; Dall'Agnoll, Clarice Maria


    Analyze the challenges and strategies of nurses performing managerial activities in a surgical center. Exploratory, descriptive study with a qualitative approach, involving six nurses by means of the Focus Group Technique, between April and August 2013. Data were submitted to thematic content analysis. The main challenges noted were deficiency of material resources, communication noise, adequacy of personnel downsizing, and relationships with the multidisciplinary team. Key strategies include construction of co-management spaces to promote integration among professionals, conflict resolution and exchange of knowledge. Managerial activities involve the promotion of dialogic moments to coordinate the different processes in the surgical center to provide inputs to expand safety and quality of services provided.

  5. ChainMail based neural dynamics modeling of soft tissue deformation for surgical simulation. (United States)

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


    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.

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


    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

  7. Learning in Neural Networks: VLSI Implementation Strategies (United States)

    Duong, Tuan Anh


    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.

  8. Navigating towards improved surgical safety using aviation-based strategies. (United States)

    Kao, Lillian S; Thomas, Eric J


    Safety practices in the aviation industry are being increasingly adapted to healthcare in an effort to reduce medical errors and patient harm. However, caution should be applied in embracing these practices because of limited experience in surgical disciplines, lack of rigorous research linking these practices to outcome, and fundamental differences between the two industries. Surgeons should have an in-depth understanding of the principles and data supporting aviation-based safety strategies before routinely adopting them. This paper serves as a review of strategies adapted to improve surgical safety, including the following: implementation of crew resource management in training operative teams; incorporation of simulation in training of technical and nontechnical skills; and analysis of contributory factors to errors using surveys, behavioral marker systems, human factors analysis, and incident reporting. Avenues and challenges for future research are also discussed.

  9. Surgical Management of Rib Fractures: Strategies and Literature Review. (United States)

    de Jong, M B; Kokke, M C; Hietbrink, F; Leenen, L P H


    Rib fractures can cause significant problems in trauma patients, often resulting in pain and difficulty with respiration. To prevent pulmonary complications and decrease the morbidity and mortality rates of patients with rib fractures, currently there is a trend to provide surgical management of patients with flail chest. However, the indications for rib fracture fixation require further specification. Past and current strategies are described according to a review of the medical literature. A systematic review was performed including current indications for rib fracture fixation. MEDLINE (2000-2013) was searched, as well as Embase (2000-2013) and Cochrane Databases, using the keywords rib, fracture, fixation, plate, repair, and surgery. Three retrospective studies were found that described different techniques for rib fracture fixation. The results demonstrated a reduced number of ventilation days, decreased long-term morbidity and pain, and satisfactory rehabilitation after surgical treatment. In addition to flail chest, age, Injury Severity Score, and the number of rib fractures were important predictive factors for morbidity and mortality. Surgical rib fracture fixation might be indicated in a broader range of cases than is currently performed. Prospective randomized trials are needed for further confirmation. © The Finnish Surgical Society 2014.

  10. Combined Orbital Fractures: Surgical Strategy of Sequential Repair

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    Su Won Hur


    Full Text Available BackgroundReconstruction of combined orbital floor and medial wall fractures with a comminuted inferomedial strut (IMS is challenging and requires careful practice. We present our surgical strategy and postoperative outcomes.MethodsWe divided 74 patients who underwent the reconstruction of the orbital floor and medial wall concomitantly into a comminuted IMS group (41 patients and non-comminuted IMS group (33 patients. In the comminuted IMS group, we first reconstructed the floor stably and then the medial wall by using separate implant pieces. In the non-comminuted IMS group, we reconstructed the floor and the medial wall with a single large implant.ResultsIn the follow-up of 6 to 65 months, most patients with diplopia improved in the first-week except one, who eventually improved at 1 year. All patients with an EOM limitation improved during the first month of follow-up. Enophthalmos (displacement, 2 mm was observed in two patients. The orbit volume measured on the CT scans was statistically significantly restored in both groups. No complications related to the surgery were observed.ConclusionsWe recommend the reconstruction of orbit walls in the comminuted IMS group by using the following surgical strategy: usage of multiple pieces of rigid implants instead of one large implant, sequential repair first of the floor and then of the medial wall, and a focus on the reconstruction of key areas. Our strategy of step-by-step reconstruction has the benefits of easy repair, less surgical trauma, and minimal stress to the surgeon.

  11. Can surgical simulation be used to train detection and classification of neural networks? (United States)

    Zisimopoulos, Odysseas; Flouty, Evangello; Stacey, Mark; Muscroft, Sam; Giataganas, Petros; Nehme, Jean; Chow, Andre; Stoyanov, Danail


    Computer-assisted interventions (CAI) aim to increase the effectiveness, precision and repeatability of procedures to improve surgical outcomes. The presence and motion of surgical tools is a key information input for CAI surgical phase recognition algorithms. Vision-based tool detection and recognition approaches are an attractive solution and can be designed to take advantage of the powerful deep learning paradigm that is rapidly advancing image recognition and classification. The challenge for such algorithms is the availability and quality of labelled data used for training. In this Letter, surgical simulation is used to train tool detection and segmentation based on deep convolutional neural networks and generative adversarial networks. The authors experiment with two network architectures for image segmentation in tool classes commonly encountered during cataract surgery. A commercially-available simulator is used to create a simulated cataract dataset for training models prior to performing transfer learning on real surgical data. To the best of authors' knowledge, this is the first attempt to train deep learning models for surgical instrument detection on simulated data while demonstrating promising results to generalise on real data. Results indicate that simulated data does have some potential for training advanced classification methods for CAI systems.

  12. Neural PID Control Strategy for Networked Process Control

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    Jianhua Zhang


    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.

  13. Training strategy for convolutional neural networks in pedestrian gender classification (United States)

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


    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.

  14. [The clinical features and surgical treatment strategies of cervical kyphosis]. (United States)

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


    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

  15. A novel surgical strategy for secondary hyperparathyroidism: Purge parathyroidectomy. (United States)

    Shan, Cheng-Xiang; Qiu, Nian-Cun; Zha, Si-Luo; Liu, Miao-E; Wang, Qiang; Zhu, Pei-Pei; Du, Zhi-Peng; Xia, Chun-Yan; Qiu, Ming; Zhang, Wei


    This study was intended to demonstrate the feasibility and efficacy of purge parathyroidectomy (PPTX) for patients with secondary hyperparathyroidism (SHPT). The "seed, environment, and soil" medical hypothesis was first raised, following review of the literatures, to demonstrate the possible causes of persistence or recurrence of SHPT after parathyroidectomy. Subsequently, the novel surgical strategy of PPTX was proposed, which involves comprehensive resection of the fibro-fatty tissues, including visible or invisible parathyroid, within the region surrounded by the thyroid cartilage, bilateral carotid artery sheath, and the brachiocephalic artery. The perioperative information and clinical outcomes of patients who underwent PPTX from June 2016 to December 2016 were analyzed. In total, PPTX was performed safely in nine patients with SHPT from June 2016 to December 2016. The operative time for PPTX ranged from 95 to 135 min, and blood loss ranged from 20 to 40 mL. No patients with perioperative death, bleeding, convulsions, or recurrent laryngeal nerve injury were reported. The preoperative concentration of PTH ranged from 1062 to 2879 pg/mL, and from 12.35 to 72.69 pg/mL on the first day after surgery. In total, 37 parathyroid glands were resected. The postoperative pathologic examination showed that supernumerary or ectopic parathyroid tissues were found within the "non-parathyroid" tissues in three patients. No cases encountered persistence or recurrence of SHPT, or severe hypocalcemia during the follow-up period. PPTX involves comprehensive resection of supernumerary and ectopic parathyroid tissues, which may provide a more permanent means of reducing PTH levels. Copyright © 2017. Published by Elsevier Ltd.

  16. Uso da rede neural artificial no planejamento cirúrgico da correção do estrabismo Neural network approach for planning surgical correction of strabismus

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    Murilo Barreto Souza


    Full Text Available OBJETIVO: Desenvolver uma rede neural artificial para planejar a estratégia cirúrgica em pacientes portadores de estrabismo sensorial, com desvio horizontal. MÉTODOS: Foi realizado estudo retrospectivo envolvendo 95 pacientes portadores de estrabismo sensorial, atendidos no Ambulatório de Motilidade Ocular Extrínseca do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. Foi construída uma rede neural artificial utilizando-se o Java Neural Network 1.1. Foram utilizados 68 pacientes para treinamento e validação da rede e 27 para testar o seu funcionamento. RESULTADOS: Dos 68 pacientes utilizados no treinamento da rede, 37 apresentavam exotropia e 31 esotropia. O método utilizado para treinamento da rede foi o "backpropagation". A taxa de aprendizado utilizada foi de 0,6, e a taxa de tolerância de erro 0,05. Dos 27 pacientes utilizados para avaliação da eficácia da rede, 18 apresentavam exotropia, e 9 esotropia. A eficácia da rede foi avaliada pela média da diferença entre os resultados fornecidos pela rede, e as indicações originais. Nos pacientes com exotropia o erro médio foi de 0,4 mm (±0,4, para o retrocesso do músculo reto lateral, e de 0,3 mm (±0,3, para a ressecção do músculo reto medial. Nas esotropias, o erro médio foi de 0,2 mm (±0,2, para o retrocesso do músculo reto medial e de 0,5 mm (±0,3, para ressecção do músculo reto lateral. CONCLUSÃO: A rede neural artificial, por sua característica de simular o sistema nervoso central biológico, e sua capacidade de realizar tarefas cognitivas, é opção viável para auxiliar no planejamento cirúrgico da cor-reção do estrabismo.PURPOSE: To develop a neural network model for planning of the surgical strategy of patients with sensorial strabismus. METHODS: In this retrospective study, medical records of 95 patients with sensorial strabismus were reviewed. All patients were seen at the Strabismus Sector of the Hospital das Cl

  17. Failed medial patellofemoral ligament reconstruction: Causes and surgical strategies (United States)

    Sanchis-Alfonso, Vicente; Montesinos-Berry, Erik; Ramirez-Fuentes, Cristina; Leal-Blanquet, Joan; Gelber, Pablo E; Monllau, Joan Carles


    Patellar instability is a common clinical problem encountered by orthopedic surgeons specializing in the knee. For patients with chronic lateral patellar instability, the standard surgical approach is to stabilize the patella through a medial patellofemoral ligament (MPFL) reconstruction. Foreseeably, an increasing number of revision surgeries of the reconstructed MPFL will be seen in upcoming years. In this paper, the causes of failed MPFL reconstruction are analyzed: (1) incorrect surgical indication or inappropriate surgical technique/patient selection; (2) a technical error; and (3) an incorrect assessment of the concomitant risk factors for instability. An understanding of the anatomy and biomechanics of the MPFL and cautiousness with the imaging techniques while favoring clinical over radiological findings and the use of common sense to determine the adequate surgical technique for each particular case, are critical to minimizing MPFL surgery failure. Additionally, our approach to dealing with failure after primary MPFL reconstruction is also presented. PMID:28251062

  18. Failed medial patellofemoral ligament reconstruction: Causes and surgical strategies


    Sanchis-Alfonso, Vicente; Montesinos-Berry, Erik; Ramirez-Fuentes, Cristina; Leal Blanquet, Joan; Gelber, Pablo-Eduardo; Monllau García, Juan Carlos


    Patellar instability is a common clinical problem encountered by orthopedic surgeons specializing in the knee. For patients with chronic lateral patellar instability, the standard surgical approach is to stabilize the patella through a medial patellofemoral ligament (MPFL) reconstruction. Foreseeably, an increasing number of revision surgeries of the reconstructed MPFL will be seen in upcoming years. In this paper, the causes of failed MPFL reconstruction are analyzed: (1) incorrect surgical ...

  19. Surgical strategies in patients with gallbladder cancer: nihilism to optimism. (United States)

    Sikora, Sadiq S; Singh, Rajneesh K


    Gallbladder cancer is an aggressive disease with dismal results of surgical treatment and a poor prognosis. However, over the last few decades selected groups have reported improved results with aggressive surgery for gallbladder cancer. Review of recent world literature was done to provide an update on the current concepts of surgical treatment of this disease. Long-term survival is possible in early stage gallbladder carcinoma. Tis and T1a gallbladder carcinoma can be treated with simple cholecystectomy only. However, in T1b and beyond cancers, aggressive surgery (extended cholecystectomy) is important in improving the long-term prognosis. Laparoscopic cholecystectomy should not be performed where there is a high index of suspicion of malignancy due to the frequent association with factors (such as gallbladder perforation and bile spill) which may lead to implantation of cancer cells and dissemination. Surgical resection for advanced carcinoma gallbladder is recommended only if a potentially curative R0 resection is possible. Aggressive surgery with vascular and multivisceral resection has been shown to be feasible albeit with an increase in mortality and morbidity. However, the true benefit of these radical resections is yet to be realized, as the actual number of long-term survivors of advanced gallbladder carcinoma is few. Surgery for gallbladder carcinoma, like other malignancies, has the potential to be curative only in local or regional disease. Pattern of loco-regional spread of disease dictates the surgical procedure. Radical surgery improves survival in early gallbladder carcinoma. The long-term benefit of aggressive surgery for advanced disease is unclear and may be offset by the high mortality and morbidity. Copyright 2006 Wiley-Liss, Inc.

  20. Strategies in the Surgical Management of Atrial Fibrillation

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    Leanne Harling


    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.

  1. [Surgery for pancreatic cancer: Evidence-based surgical strategies]. (United States)

    Sánchez Cabús, Santiago; Fernández-Cruz, Laureano


    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.

  2. Surgical Management of the Giant Pannus: Indications, Strategies, and Outcomes. (United States)

    Michaels, Joseph; Coon, Devin; Calotta, Nicholas A; Peter Rubin, J


    The obesity pandemic continues to produce an inexorable increase in the number of patients requiring surgical treatment of obesity and obesity-related complications. Along with this growing number of patients, there is a concomitant increase in the complexity of management. One particular example is the treatment of patients with an exceptionally large and morbid pannus. In this report, we detail the management of seven patients suffering from a giant pannus. Medical and surgical variables were assessed. A quality of life questionnaire was administered pre- and postoperatively. All seven patients suffered some obesity-related medical morbidity and six of seven (86%) had local complications of the giant pannus. Each patient underwent giant panniculectomy [resection weight > 13. 6 kg (30 lb)]. The mean resection weight was 20.0 kg. Four of seven (57%) patients experienced postoperative complications, with two (29%) requiring re-operation and blood transfusion. Six patients were available for long-term follow-up; 100% of participants indicated an increased quality of life while five (83%) reported additional postoperative weight loss, increase in exercise frequency and walking ability, and improved ability to work. Our results indicate that giant panniculectomy is a challenging and risky procedure, but careful patient selection and intraoperative scrutiny can ameliorate these risks and afford patients a dramatically improved quality of life. Level of Evidence IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors .

  3. Surgical treatment for central pain after stroke based on the neural mechanism

    International Nuclear Information System (INIS)

    Hirato, Masafumi; Takahashi, Akio; Watanabe, Katsushige; Kazama, Ken; Yoshimoto, Yuhei


    Previous neurophysiological and neuroimaging studies have suggested that functional changes might occur in the sensory thalamus, associated with reorganization of the thalamocortical system, in cases with central pain after stroke (thalamic pain). It might cause the misconduction of the sensory signal or a hyperactive response to peripheral natural stimulation on the thalamus, resulting in it playing an important roles in the genesis of central pain. Hyperactivity in the cerebral cortex adjacent to the central sulcus on the side ipsilateral to a cerebrovascular disease (CVD) lesion also might relate to central pain. We performed various kinds of surgical treatments in 29 cases with central pain after stroke based on the neural mechanism deserbed above. Epidural spinal cord stimulation was effective in 4 out of 7 cases with localized pain on the distal part of the leg and arm. We achieved pain control in these cases showing definite somatosensory evoked potential (SEP) originating in the sensory cortex before surgery. Stereotactic (Vim-Vcpc) thalamotomy with the aid of depth microrecording was effective in 4 out of 7 cases with diffuse pain. In good responders, we could find responses to natural peripheral stimulation and seldom encountered irregular burst discharges in the sensory thalamus during the operation. Preoperative positron emission tomography (PET) studies also revealed an increase of regional cerebral blood flow (rCBF) in the sensory cortex ipsilateral to the thalamic CVD lesion during contralateral thumb brushing. Gamma knife treatment was effective in 5 out of 7 cases after stereotactic thalamotomy. It became stable in 3 out of these 5 cases. Each case was treated with a maximum dose of 120-150 Gy using a 4 mm collimator. Precentral electrical cortical stimulation was performed in 8 cases. Sufficient pain relief was achieved in 3 out of 6 cases in which we could implant an importable pulse generator (IPG). In one of these cases, we found definite

  4. A review of current strategies to reduce intraoperative bacterial contamination of surgical wounds


    Dohmen, Pascal M.; Konertz, Wolfgang


    Surgical site infections are a mean topic in cardiac surgery, leading to a prolonged hospitalization, and substantially increased morbidity and mortality. One source of pathogens is the endogenous flora of the patient?s skin, which can contaminate the surgical site. A number of preoperative skin care strategies are performed to reduce bacterial contamination like preoperative antiseptic showering, hair removal, antisepsis of the skin, adhesive barrier drapes, and antimicrobial prophylaxis. Fu...

  5. Strategies influence neural activity for feedback learning across child and adolescent development. (United States)

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


    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.

  6. Current strategies in surgical myocardial revascularization: Indian perspective

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    Sameer Kumar


    A retrospective analysis was carried out of 172 patients who underwent CABG at INHS Asvini between 01 Jan 2008 and 31 May 2013.39% had Left Main Coronary artery disease, 85% patient had triple vessel disease, 56% were diabetics, 12% had undergone stenting in recent past. Beating heart strategy was used in 10%, average no of grafts per patient was 2.3 with LIMA and Radial artery being used as a conduit in 84% and 4% respectively. 4.6% patients succumbed in post-operative period.

  7. Neural Underpinnings of Decision Strategy Selection: A Review and a Theoretical Model. (United States)

    Wichary, Szymon; Smolen, Tomasz


    In multi-attribute choice, decision makers use 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 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 of this process. We also present the Bottom-Up Model of Strategy Selection (BUMSS). The model assumes that the use of the rational 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 neural signals.

  8. Neural Underpinnings of Decision Strategy Selection: A Review and a Theoretical Model (United States)

    Wichary, Szymon; Smolen, Tomasz


    In multi-attribute choice, decision makers use 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 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 of this process. We also present the Bottom-Up Model of Strategy Selection (BUMSS). The model assumes that the use of the rational 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 neural signals. PMID:27877103

  9. [Surgical treatment of Marfan syndrome; late results and new strategy]. (United States)

    Aomi, S; Nonoyama, M; Tomioka, H; Endo, M; Nagashima, H; Sakomura, Y; Aoka, Y; Kasanuki, H; Kurosawa, H


    deaths also occurred in 8 (13%) patients who underwent a replacement of the aortic arch, descending thoracic or thoracoabdominal aorta, with no cases of paraplegia reported. In all cases, the replacement was extensive. The observed 10-year survival rate was 70% with a freedom from reoperation of 64%. Although dissection did not reduce the observed survival rate, the 10-year freedom from reoperation was significantly decreased at 49% (p = 0.0007). (1) Surgery is indicated for AAE when the maximum diameter of the aneurysm prior to onset of dissection is 5 cm. In the case of aortic arch without dissection, the Bentall operation with simultaneous arch replacement should be aggressively performed in order to minimize the future risk of vascular events and to eliminate the need for extensive replacement in a reoperation, a procedure which is associated with a high level of risk. (2) Extensive replacement which is associated with poor results should be avoided where possible and, instead, scheduled staged surgery should be aggressively performed in the early stage when the maximum diameter of the aneurysm in the descending aorta is 5 cm or less. (3) By paying adequate attention to patient education, outpatient follow-up using detailed diagnostic imaging, drug therapy, periodic late surveillance, expedition of scheduled surgery, and to the basic approach as well as endeavoring to improve surgical results by the use of new methods of treatment, it is anticipated that further improvement will be observed in late results.

  10. Strategy over operation: neural activation in subtraction and multiplication during fact retrieval and procedural strategy use in children. (United States)

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


    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.

  11. Pectus bar removal: surgical technique and strategy to avoid complications. (United States)

    Park, Hyung Joo; Kim, Kyung Soo


    Pectus bar removal is the final stage of the procedure for minimally invasive repair of pectus excavatum. Based on our experience with one of the largest scale data, we would like to address the important issues in pectus bar removal, such as appropriate duration of bar maintenance, techniques for bar removal, and strategies to avoid complications. Between September 1999 and August 2015, we operated on 2,553 patients with pectus excavatum and carinatum using pectus bars for a minimally invasive approach. Among them, 1,821 patients (71.3%) underwent pectus bar removal as a final stage of pectus deformity repair, and their data were analyzed retrospectively to identify the outcomes and adverse effects of the pectus bar removal procedure. The mean age of the patients was 9.13 years (range, 16 months to 44 years) and the male to female ratio was 3.55. The study is approved by the Institutional Review Board (IRB), the ethical committee of Seoul St. Mary's Hospital. The IRB has exempted the informed consent from every patient in this study due to this is a retrospective chart review without revealing any patients' personal data. Our technique involved straightening of the bar in a supine position. The overall mean duration of pectus bar maintenance was 2.57 years (range, 4 months to 14 years). The mean duration was 2.02 years (range, 4 months to 7 years) for children under 12 years, 2.99 years (range, 7 months to 9 years) for teenagers aged 12-20 years, and 3.53 years (range, 3 months to 14 years) for adults over 20 years. Forty-eight patients (2.6%) underwent bar removal more than 5 years after bar insertion and 58 patients (3.2%) underwent bar removal earlier than initially planned. The most common adverse reaction after bar removal was wound seroma including infection (43 patients, 2.36%). Recurrence after bar removal occurred in nine patients (0.49%), and seven of these required redo repair (0.38%). Pectus bar removal is a safe and straightforward procedure with a

  12. 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.


    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.

  13. Nonlinear control strategy based on using a shape-tunable neural controller

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    Chen, C.; Peng, S. [Feng Chia Univ, Taichung (Taiwan, Province of China). Department of chemical Engineering; Chang, W. [Feng Chia Univ, Taichung (Taiwan, Province of China). Department of Automatic Control


    In this paper, a nonlinear control strategy based on using a shape-tunable neural network is developed for adaptive control of nonlinear processes. Based on the steepest descent method, a learning algorithm that enables the neural controller to possess the ability of automatic controller output range adjustment is derived. The novel feature of automatic output range adjustment provides the neural controller more flexibility and capability, and therefore the scaling procedure, which is usually unavoidable for the conventional fixed-shape neural controllers, becomes unnecessary. The advantages and effectiveness of the proposed nonlinear control strategy are demonstrated through the challenge problem of controlling an open-loop unstable nonlinear continuous stirred tank reactor (CSTR). 14 refs., 11 figs.

  14. Strategies to accommodate resident work-hour restrictions: impact on surgical education. (United States)

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


    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.

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

    Directory of Open Access Journals (Sweden)

    Szymon Wichary


    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.

  16. Investigation of Slow-wave Activity Saturation during Surgical Anesthesia Reveals a Signature of Neural Inertia in Humans. (United States)

    Warnaby, Catherine E; Sleigh, Jamie W; Hight, Darren; Jbabdi, Saad; Tracey, Irene


    Previously, we showed experimentally that saturation of slow-wave activity provides a potentially individualized neurophysiologic endpoint for perception loss during anesthesia. Furthermore, it is clear that induction and emergence from anesthesia are not symmetrically reversible processes. The observed hysteresis is potentially underpinned by a neural inertia mechanism as proposed in animal studies. In an advanced secondary analysis of 393 individual electroencephalographic data sets, we used slow-wave activity dose-response relationships to parameterize slow-wave activity saturation during induction and emergence from surgical anesthesia. We determined whether neural inertia exists in humans by comparing slow-wave activity dose responses on induction and emergence. Slow-wave activity saturation occurs for different anesthetics and when opioids and muscle relaxants are used during surgery. There was wide interpatient variability in the hypnotic concentrations required to achieve slow-wave activity saturation. Age negatively correlated with power at slow-wave activity saturation. On emergence, we observed abrupt decreases in slow-wave activity dose responses coincident with recovery of behavioral responsiveness in ~33% individuals. These patients are more likely to have lower power at slow-wave activity saturation, be older, and suffer from short-term confusion on emergence. Slow-wave activity saturation during surgical anesthesia implies that large variability in dosing is required to achieve a targeted potential loss of perception in individual patients. A signature for neural inertia in humans is the maintenance of slow-wave activity even in the presence of very-low hypnotic concentrations during emergence from anesthesia.

  17. Place of surgical resection in the treatment strategy of gastrointestinal neuroendocrine tumors. (United States)

    Gaujoux, Sébastien; Sauvanet, Alain; Belghiti, Jacques


    Neuroendocrine tumors (NET) are usually slow-growing neoplasms carrying an overall favorable prognosis. Surgery, from resection to transplantation, remains the only potential curative option for these patients, and should always be considered. Nevertheless, because of very few randomized controlled trials available, the optimal treatment for these patients remains controversial, especially regarding the place of surgery. We herein discuss the place of surgical resection in the treatment strategy in neuroendocrine tumors of the digestive tract.

  18. Modeling and simulation of permanent magnet synchronous motor based on neural network control strategy (United States)

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


    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.

  19. The application of digital surgical diagnosis and treatment technology: a promising strategy for surgical reconstruction of craniomaxillofacial defect and deformity. (United States)

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


    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.

  20. Inter-progenitor pool wiring: An evolutionarily conserved strategy that expands neural circuit diversity. (United States)

    Suzuki, Takumi; Sato, Makoto


    Diversification of neuronal types is key to establishing functional variations in neural circuits. The first critical step to generate neuronal diversity is to organize the compartmental domains of developing brains into spatially distinct neural progenitor pools. Neural progenitors in each pool then generate a unique set of diverse neurons through specific spatiotemporal specification processes. In this review article, we focus on an additional mechanism, 'inter-progenitor pool wiring', that further expands the diversity of neural circuits. After diverse types of neurons are generated in one progenitor pool, a fraction of these neurons start migrating toward a remote brain region containing neurons that originate from another progenitor pool. Finally, neurons of different origins are intermingled and eventually form complex but precise neural circuits. The developing cerebral cortex of mammalian brains is one of the best examples of inter-progenitor pool wiring. However, Drosophila visual system development has revealed similar mechanisms in invertebrate brains, suggesting that inter-progenitor pool wiring is an evolutionarily conserved strategy that expands neural circuit diversity. Here, we will discuss how inter-progenitor pool wiring is accomplished in mammalian and fly brain systems. Copyright © 2017 Elsevier Inc. All rights reserved.

  1. Neural Substrates of Similarity and Rule-based Strategies in Judgment

    Directory of Open Access Journals (Sweden)

    Bettina eVon Helversen


    Full Text Available Making accurate judgments is a core human competence and a prerequisite for success in many areas of life. Plenty of evidence exists that people can employ different judgment strategies to solve identical judgment problems. In categorization, it has been demonstrated that similarity-based and rule-based strategies are associated with activity in different brain regions. Building on this research, the present work tests whether solving two identical judgment problems recruits different neural substrates depending on people's judgment strategies. Combining cognitive modeling of judgment strategies at the behavioral level with functional magnetic resonance imaging (fMRI, we compare brain activity when using two archetypal judgment strategies: a similarity-based exemplar strategy and a rule-based heuristic strategy. Using an exemplar-based strategy should recruit areas involved in long-term memory processes to a larger extent than a heuristic strategy. In contrast, using a heuristic strategy should recruit areas involved in the application of rules to a larger extent than an exemplar-based strategy. Largely consistent with our hypotheses, we found that using an exemplar-based strategy led to relatively higher BOLD activity in the anterior prefrontal and inferior parietal cortex, presumably related to retrieval and selective attention processes. In contrast, using a heuristic strategy led to relatively higher activity in areas in the dorsolateral prefrontal and the temporal-parietal cortex associated with cognitive control and information integration. Thus, even when people solve identical judgment problems, different neural substrates can be recruited depending on the judgment strategy involved.

  2. Overview of current surgical strategies for aortic disease in patients with Marfan syndrome. (United States)

    Miyahara, Shunsuke; Okita, Yutaka


    Marfan syndrome is a heritable, systemic disorder of the connective tissue with a high penetrance, named after Dr. Antoine Marfan. The most clinically important manifestations of this syndrome are cardiovascular pathologies which cause life-threatening events, such as acute aortic dissections, aortic rupture and regurgitation of the aortic valve or other artrioventricular valves leading to heart failure. These events play important roles in the life expectancy of patients with this disorder, especially prior to the development of effective surgical approaches for proximal ascending aortic disease. To prevent such catastrophic aortic events, a lower threshold has been recommended for prophylactic interventions on the aortic root. After prophylactic root replacement, disease in the aorta beyond the root and distal to the arch remains a cause for concern. Multiple surgeries are required throughout a patient's lifetime that can be problematic due to distal lesions complicated by dissection. Many controversies in surgical strategies remain, such as endovascular repair, to manage such complex cases. This review examines the trends in surgical strategies for the treatment of cardiovascular disease in patients with Marfan syndrome, and current perspectives in this field.

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

    Directory of Open Access Journals (Sweden)

    Lejla Banjanovic-Mehmedovic


    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.

  4. Strategies to Prevent Surgical Site Infections in Acute Care Hospitals: 2014 Update (United States)

    Anderson, Deverick J.; Podgorny, Kelly; Berríos-Torres, Sandra I.; Bratzler, Dale W.; Dellinger, E. Patchen; Greene, Linda; Nyquist, Ann-Christine; Saiman, Lisa; Yokoe, Deborah S.; Maragakis, Lisa L.; Kaye, Keith S.


    PURPOSE Previously published guidelines are available that provide comprehensive recommendations for detecting and preventing healthcare-associated infections (HAIs). The intent of this document is to highlight practical recommendations in a concise format designed to assist acute care hospitals in implementing and prioritizing their surgical site infection (SSI) prevention efforts. This document updates “Strategies to Prevent Surgical Site Infections in Acute Care Hospitals,”1 published in 2008. This expert guidance document is sponsored by the Society for Healthcare Epidemiology of America (SHEA) and is the product of a collaborative effort led by SHEA, the Infectious Diseases Society of America (IDSA), the American Hospital Association (AHA), the Association for Professionals in Infection Control and Epidemiology (APIC), and The Joint Commission, with major contributions from representatives of a number of organizations and societies with content expertise. The list of endorsing and supporting organizations is presented in the introduction to the 2014 updates.2 PMID:24799638

  5. Addressing the burden of post-conflict surgical disease - strategies from the North Caucasus. (United States)

    Lunze, Karsten; Lunze, Fatima I


    The 2004 terror attack on a school in Beslan, North Caucasus, with more than 1300 children and their families taken hostage and 334 people killed, ended after extreme violence. Following the disaster, many survivors with blast ear injuries developed complications because no microsurgery services were available in the region. Here, we present our strategies in North Ossetia to strengthen subspecialty surgical care in a region of instable security conditions. Disaster modifies disease burden in an environment of conflict-related health-care limitations. We built on available secondary care and partnered international with local stakeholders to reach and treat victims of a humanitarian disaster. A strategy of mutual commitment resulted in treatment of all consenting Beslan victims with blast trauma sequelae and of non disaster-related patients. Credible, sustained partnerships and needs assessments beyond the immediate phases after a disaster are essential to facilitate a meaningful transition from humanitarian aid to capacity building exceeding existing insufficient standards. Psychosocial impacts of disaster might constitute a barrier to care and need to be assessed when responding to the burden of surgical disease in conflict or post-conflict settings. Involving local citizen groups in the planning process can be useful to identify and access vulnerable populations. Integration of our strategy into broader efforts might strengthen the local health system through management and leadership.

  6. Biomedical engineering strategies for peripheral nerve repair: surgical applications, state of the art, and future challenges. (United States)

    Pfister, Bryan J; Gordon, Tessa; Loverde, Joseph R; Kochar, Arshneel S; Mackinnon, Susan E; Cullen, D Kacy


    Damage to the peripheral nervous system is surprisingly common and occurs primarily from trauma or a complication of surgery. Although recovery of nerve function occurs in many mild injuries, outcomes are often unsatisfactory following severe trauma. Nerve repair and regeneration presents unique clinical challenges and opportunities, and substantial contributions can be made through the informed application of biomedical engineering strategies. This article reviews the clinical presentations and classification of nerve injuries, in addition to the state of the art for surgical decision-making and repair strategies. This discussion presents specific challenges that must be addressed to realistically improve the treatment of nerve injuries and promote widespread recovery. In particular, nerve defects a few centimeters in length use a sensory nerve autograft as the standard technique; however, this approach is limited by the availability of donor nerve and comorbidity associated with additional surgery. Moreover, we currently have an inadequate ability to noninvasively assess the degree of nerve injury and to track axonal regeneration. As a result, wait-and-see surgical decisions can lead to undesirable and less successful "delayed" repair procedures. In this fight for time, degeneration of the distal nerve support structure and target progresses, ultimately blunting complete functional recovery. Thus, the most pressing challenges in peripheral nerve repair include the development of tissue-engineered nerve grafts that match or exceed the performance of autografts, the ability to noninvasively assess nerve damage and track axonal regeneration, and approaches to maintain the efficacy of the distal pathway and targets during the regenerative process. Biomedical engineering strategies can address these issues to substantially contribute at both the basic and applied levels, improving surgical management and functional recovery following severe peripheral nerve injury.

  7. [Ladder step strategy for surgical repair of congenital concealed penis in children]. (United States)

    Wang, Fu-Ran; Zhong, Hong-Ji; Chen, Yi; Zhao, Jun-Feng; Li, Yan


    To assess the feasibility of the ladder step strategy in surgical repair of congenital concealed penis in children. This study included 52 children with congenital concealed penis treated in the past two years by surgical repair using the ladder step strategy, which consists of five main steps: cutting the narrow ring of the foreskin, degloving the penile skin, fixing the penile skin at the base, covering the penile shaft, and reshaping the prepuce. The perioperative data of the patients were prospectively collected and statistically described. Of the 52 patients, 20 needed remodeling of the frenulum and 27 received longitudinal incision in the penoscrotal junction to expose and deglove the penile shaft. The advanced scrotal flap technique was applied in 8 children to cover the penile shaft without tension, the pedicled foreskin flap technique employed in 11 to repair the penile skin defect, and excision of the webbed skin of the ventral penis performed in another 44 to remodel the penoscrotal angle. The operation time, blood loss, and postoperative hospital stay were 40-100 minutes, 5-30 ml, and 3-6 days, respectively. Wound bleeding and infection occurred in 1 and 5 cases, respectively. Follow-up examinations at 3 and 6 months after surgery showed that all the children had a satisfactory penile appearance except for some minor complications (2 cases of penile retraction, 2 cases of redundant ventral skin, and 1 case of iatrogenic penile curvature). The ladder step strategy for surgical repair of congenital concealed penis in children is a simple procedure with minor injury and satisfactory appearance of the penis.

  8. 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


    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

  9. Surgical management of spinal intramedullary tumors: radical and safe strategy for benign tumors. (United States)

    Takami, Toshihiro; Naito, Kentaro; Yamagata, Toru; Ohata, Kenji


    Surgery for spinal intramedullary tumors remains one of the major challenges for neurosurgeons, due to their relative infrequency, unknown natural history, and surgical difficulty. We are sure that safe and precise resection of spinal intramedullary tumors, particularly encapsulated benign tumors, can result in acceptable or satisfactory postoperative outcomes. General surgical concepts and strategies, technical consideration, and functional outcomes after surgery are discussed with illustrative cases of spinal intramedullary benign tumors such as ependymoma, cavernous malformation, and hemangioblastoma. Selection of a posterior median sulcus, posterolateral sulcus, or direct transpial approach was determined based on the preoperative imaging diagnosis and careful inspection of the spinal cord surface. Tumor-cord interface was meticulously delineated in cases of benign encapsulated tumors. Our retrospective functional analysis of 24 consecutive cases of spinal intramedullary ependymoma followed for at least 6 months postoperatively demonstrated a mean grade on the modified McCormick functional schema of 1.8 before surgery, deteriorating significantly to 2.6 early after surgery ( 6 months after surgery). The risk of functional deterioration after surgery should be taken into serious consideration. Functional deterioration after surgery, including neuropathic pain even long after surgery, significantly affects patient quality of life. Better balance between tumor control and functional preservation can be achieved not only by the surgical technique or expertise, but also by intraoperative neurophysiological monitoring, vascular image guidance, and postoperative supportive care. Quality of life after surgery should inarguably be given top priority.

  10. Idiopathic Intracranial Hypertension After Surgical Treatment of Cushing Disease: Case Report and Review of Management Strategies. (United States)

    Wagner, Jeffrey; Fleseriu, Cara M; Ibrahim, Aly; Cetas, Justin S


    Idiopathic intracranial hypertension (IIH) in patients with Cushing disease (CD), after treatment, is rarely described, in adults. The cause is believed to be multifactorial, potentially related to a relative decrease in cortisol after surgical resection or medical treatment of a corticotroph pituitary adenoma. We investigate our center's CD database (140 surgically and 60 medically [primary or adjunct] treated patients) for cases of IIH, describe our center's experience with symptomatic IIH, and review treatment strategies in adults with CD after transsphenoidal resection. We present the case of a 22-year-old woman who presented with worsening headache, nausea, vomiting, blurry vision, diplopia, visual loss, and facial numbness 14 weeks after surgical resection of adrenocorticotropic hormone-positive pituitary adenoma. Her CD had been in remission since surgery, with subsequent adrenal insufficiency (AI), which was initially treated with supraphysiologic glucocorticoid replacement, tapered down to physiologic doses at the time the IIH symptoms developed. Symptomatic IIH is rare in adult patients but can be severe and result in permanent vision loss. A high index of suspicion should be maintained and a fundus examination is necessary to exclude papilledema, whenever there are suggestive symptoms that initially may overlap with AI. It is possible that some cases of mild IIH are misdiagnosed as GC withdrawal or AI; however, further studies are needed. Treatment consists of reinitiation of higher steroid doses together with acetazolamide with or without cerebrospinal fluid diversion and the priority is to preserve vision and reverse any visual loss. Published by Elsevier Inc.

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

    Directory of Open Access Journals (Sweden)

    Y. D. Song


    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.



    Parisa Bazmi; Manijeh Keshtgary


    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 ...

  13. Simulation-Based Learning Strategies to Teach Undergraduate Students Basic Surgical Skills: A Systematic Review. (United States)

    Theodoulou, Iakovos; Nicolaides, Marios; Athanasiou, Thanos; Papalois, Apostolos; Sideris, Michail


    We aimed to identify and critically appraise all literature surrounding simulation-based learning (SBL) courses, to assess their relevance as tools for undergraduate surgical education, and create a design framework targeted at standardizing future SBL. We performed a systematic review of the literature using a specific keyword strategy to search at MEDLINE database. Of the 2371 potentially eligible titles, 472 were shortlisted and only 40 explored active interventions in undergraduate medical education. Of those, 20 were conducted in the United States, 9 in Europe and 11 in the rest of the world. Nineteen studies assessed the effectiveness of SBL by comparing students' attributes before and after interventions, 1 study assessed a new tool of surgical assessment and 16 studies evaluated SBL courses from the students' perspectives. Of those 40 studies, 12 used dry laboratory, 7 wet laboratory, 12 mixed, and 9 cadaveric SBL interventions. The extent to which positive results were obtained from dry, wet, mixed, and cadaveric laboratories were 75%, 57%, 92%, and 100%, respectively. Consequently, the SBL design framework was devised, providing a foundation upon which future SBL interventions can be designed such that learning outcomes are optimized. SBL is an important step in surgical education, investing in a safer and more efficient generation of surgeons. Standardization of these efforts can be accelerated with SBL design framework, a comprehensive guide to designing future interventions for basic surgical training at the undergraduate level. Copyright © 2018 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

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

    Directory of Open Access Journals (Sweden)

    Jilin Zhang


    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.

  15. Proposed health state awareness of helicopter blades using an artificial neural network strategy (United States)

    Lee, Andrew; Habtour, Ed; Gadsden, S. A.


    Structural health prognostics and diagnosis strategies can be classified as either model or signal-based. Artificial neural network strategies are popular signal-based techniques. This paper proposes the use of helicopter blades in order to study the sensitivity of an artificial neural network to structural fatigue. The experimental setup consists of a scale aluminum helicopter blade exposed to transverse vibratory excitation at the hub using single axis electrodynamic shaker. The intent of this study is to optimize an algorithm for processing high-dimensional data while retaining important information content in an effort to select input features and weights, as well as health parameters, for training a neural network. Data from accelerometers and piezoelectric transducers is collected from a known system designated as healthy. Structural damage will be introduced to different blades, which they will be designated as unhealthy. A variety of different tests will be performed to track the evolution and severity of the damage. A number of damage detection and diagnosis strategies will be implemented. A preliminary experiment was performed on aluminum cantilever beams providing a simpler model for implementation and proof of concept. Future work will look at utilizing the detection information as part of a hierarchical control system in order to mitigate structural damage and fatigue. The proposed approach may eliminate massive data storage on board of an aircraft through retaining relevant information only. The control system can then employ the relevant information to intelligently reconfigure adaptive maneuvers to avoid harmful regimes, thus, extending the life of the aircraft.

  16. Strategies for memory-based decision making: Modeling behavioral and neural signatures within a cognitive architecture. (United States)

    Fechner, Hanna B; Pachur, Thorsten; Schooler, Lael J; Mehlhorn, Katja; Battal, Ceren; Volz, Kirsten G; Borst, Jelmer P


    How do people use memories to make inferences about real-world objects? We tested three strategies based on predicted patterns of response times and blood-oxygen-level-dependent (BOLD) responses: one strategy that relies solely on recognition memory, a second that retrieves additional knowledge, and a third, lexicographic (i.e., sequential) strategy, that considers knowledge conditionally on the evidence obtained from recognition memory. We implemented the strategies as computational models within the Adaptive Control of Thought-Rational (ACT-R) cognitive architecture, which allowed us to derive behavioral and neural predictions that we then compared to the results of a functional magnetic resonance imaging (fMRI) study in which participants inferred which of two cities is larger. Overall, versions of the lexicographic strategy, according to which knowledge about many but not all alternatives is searched, provided the best account of the joint patterns of response times and BOLD responses. These results provide insights into the interplay between recognition and additional knowledge in memory, hinting at an adaptive use of these two sources of information in decision making. The results highlight the usefulness of implementing models of decision making within a cognitive architecture to derive predictions on the behavioral and neural level. Copyright © 2016 Elsevier B.V. All rights reserved.

  17. Age-specific neural strategies to maintain motor performance after an acute social stress bout. (United States)

    Mehta, Ranjana K; Rhee, Joohyun


    Stress due to cognitive demands and fatigue have shown to impair motor performance in older adults; however, the effect of social stress and its influence on prefrontal cortex (PFC) functioning in older adults during upper extremity motor performance tasks is not known. The present study explored the after-effects of an acute social stress bout on neural strategies, measured using PFC and hand/arm muscle activation, and adopted by younger and older adults to maintain handgrip force control. Nine older [74.1 (6.5) years; three men, six women] and ten younger [24.2 (5.0) years, four men, six women] adults performed handgrip force control trials at 30% maximum voluntary contractions before and after the Trier Social Stress Test (TSST). PFC activity was measured using functional near infrared spectroscopy and muscle activity from the flexor and extensor carpi radialis (FCR/ECR) was measured using electromyography. In general, aging was associated with decreased force steadiness and force complexity with a concomitant increase in bilateral PFC activity. While motor performance remained comparable before and after the TSST stress session in both age groups, the associated neural strategies differed between groups. While the stress condition was associated with lower FCR and ECR activity in younger adults despite no change in the PFC activation, stress was associated with increases in FCR activity in older adults. This stress-related compensatory neural strategy of increasing hand/arm muscle activation, potentially via the additional recruitment of the stress-motor neural circuitry, may have played a role in maintaining motor performance in older adults.

  18. Glycemic control strategies and the occurrence of surgical site infection: a systematic review. (United States)

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


    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

  19. Towards reducing thrombogenicity of LVAD therapy: optimizing surgical and patient management strategies (United States)

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


    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.

  20. Interventional and surgical therapeutic strategies for pulmonary arterial hypertension: Beyond palliative treatments. (United States)

    Sandoval, Julio; Gomez-Arroyo, Jose; Gaspar, Jorge; Pulido-Zamudio, Tomas


    Despite significant advances in pharmacological treatments, pulmonary arterial hypertension remains an incurable disease with an unreasonably high morbidity and mortality. Although specific pharmacotherapies have shifted the survival curves of patients and improved exercise endurance as well as quality of life, it is also true that these pharmacological interventions are not always accessible (particularly in developing countries) and, perhaps most importantly, not all patients respond similarly to these drugs. Furthermore, many patients will continue to deteriorate and will eventually require an additional, non-pharmacological, intervention. In this review we analyze the role of atrial septostomy and Potts anastomosis in the management of patients with pulmonary arterial hypertension, we summarize the current worldwide clinical experience (case reports and case series), and discuss why these interventional/surgical strategies might have a therapeutic role beyond that of a "bridge" to transplantation. Copyright © 2015 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.

  1. Oculomotor nerve palsy by posterior communicating artery aneurysms: influence of surgical strategy on recovery. (United States)

    Güresir, Erdem; Schuss, Patrick; Seifert, Volker; Vatter, Hartmut


    Resolution of oculomotor nerve palsy (ONP) after clipping of posterior communicating artery (PCoA) aneurysms has been well documented. However, whether additional decompression of the oculomotor nerve via aneurysm sac dissection or resection is superior to pure aneurysm clipping is the subject of much debate. Therefore, the objective in the present investigation was to analyze the influence of surgical strategy--specifically, clipping with or without aneurysm dissection--on ONP resolution. Between June 1999 and December 2010, 18 consecutive patients with ruptured and unruptured PCoA aneurysms causing ONP were treated at the authors' institution. Oculomotor nerve palsy was evaluated on admission and at follow-up. The electronic database MEDLINE was searched for additional data in published studies of PCoA aneurysms causing ONP. Two reviewers independently extracted data. Overall, 8 studies from the literature review and 6 patients in the current series (121 PCoA aneurysms) met the study inclusion criteria. Ninety-four aneurysms were treated with simple aneurysm neck clipping and 27 with clipping plus aneurysm sac decompression. The surgical strategy, simple aneurysm neck clipping versus clipping plus oculomotor nerve decompression, had no effect on full ONP resolution on univariate (p = 0.5) and multivariate analyses. On multivariate analysis, patients with incomplete ONP at admission were more likely to have full resolution of the palsy than were those with complete ONP at admission (p = 0.03, OR = 4.2, 95% CI 1.1-16). Data in the present study indicated that ONP caused by PCoA aneurysms improves after clipping without and with oculomotor nerve decompression. The resolution of ONP is inversely associated with the initial severity of ONP.

  2. Secular trends in mortality associated with new therapeutic strategies in surgical critical illness. (United States)

    Hartl, Wolfgang H; Wolf, Hilde; Schneider, Christian P; Küchenhoff, Helmut; Jauch, Karl-Walter


    Since 1999 randomized controlled trials have shown that new therapeutic strategies, such as strict glycemic control, increased use of noninvasive ventilation and of lung-protective ventilation, and early goal-oriented shock therapy, may reduce mortality in selected groups of critically ill patients. Whether these benefits can be translated to a surgical clinical setting is unclear. We wanted to evaluate longitudinally the successive routine implementation of new therapeutic measures and its effect on postsurgical patients admitted to the intensive care unit. We performed a retrospective analysis on data collected prospectively from March 1, 1993 through February 28, 2005. A cohort of 1,802 consecutive cases requiring intensive care therapy for more than 4 days was analyzed. A significant decrease in mortality was observed in the last years of the study. With adjustment for relevant covariates, treatment after the implementation of new therapeutic strategies was identified as an independent factor linked with a reduced risk of death (odds ratio [OR] .518; 95% confidence interval [CI] .337-.796), whereas older age (OR 1.030; 95% CI 1.015-1.045), a high severity score on admission (OR 1.155; 95% CI 1.113-1.198) or during intensive care unit stay (OR 1.187; 95% CI 1.145-1.231), a high number of failing organs (OR 1.918; 95% CI 1.635-2.250), and peritonitis (OR 3.277; 95% CI 2.046-5.246) were independently associated with death. Implementing of a variety of new therapeutic measures into routine care of critically ill surgical patients was associated with improved survival after 2001.

  3. Relationship between job stress level and coping strategies used by Hong Kong nurses working in an acute surgical unit. (United States)

    Wang, Wenru; Kong, Amelia Wai Man; Chair, Sek Ying


    The aim of this study is to explore the relationship between job stress and coping strategies of Hong Kong nurses working in an acute surgical unit. This is a descriptive correlational study. Data were collected from 98 Hong Kong surgical nurses using the Nursing Stress Scale and the Jalowiec Coping Scale. Results showed that workload (M = 15.36), lack of support (M = 13.32), and inadequate preparation (M = 12.33) are the most common stressors for Hong Kong surgical nurses. The most frequent strategies used by nurses to cope with stress can be characterized as evasive (M = 19.23), confrontive (M = 17.46), and optimistic (M = 15.81), all of which are also rated as the most effective strategies in reducing stress levels. Only the confrontive, optimistic, supportant, and emotive coping strategies reveal significant correlations (p stress levels of nurses, whereas the evasive, fatalistic, palliative, and self-reliant strategies showed no significant correlation with stress levels (p > .05). Recognizing the impacts of job-related stress and making use of effective coping methods play a vital role in reducing nurse's stress. A change in leadership styles from the managerial level and reallocation of manpower may help reduce job stress. The use of confrontive and optimistic coping strategies in reducing job-related stress for surgical nurses should be advocated and promoted in their daily work. Copyright © 2011 Elsevier Inc. All rights reserved.

  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 (United States)

    Lee, Inah; Kim, Jangjin


    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…

  5. 3D bioprinting: A new insight into the therapeutic strategy of neural tissue regeneration. (United States)

    Hsieh, Fu-Yu; Hsu, Shan-hui


    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.

  6. Identifying optimal postmarket surveillance strategies for medical and surgical devices: implications for policy, practice and research. (United States)

    Gagliardi, Anna R; Umoquit, Muriah; Lehoux, Pascale; Ross, Sue; Ducey, Ariel; Urbach, David R


    Non-drug technologies offer many benefits, but have been associated with adverse events, prompting calls for improved postmarket surveillance. There is little empirical research to guide the development of such a system. The purpose of this study was to identify optimal postmarket surveillance strategies for medical and surgical devices. Qualitative methods were used for sampling, data collection and analysis. Stakeholders from Canada and the USA representing different roles and perspectives were first interviewed to identify examples and characteristics of different surveillance strategies. These stakeholders and others they recommended were then assembled at a 1-day nominal group meeting to discuss and prioritise the components of a postmarket device surveillance system, and research needed to achieve such a system. Consultations were held with 37 participants, and 47 participants attended the 1-day meeting. They recommended a multicomponent system including reporting by facilities, clinicians and patients, supported with some external surveillance for validation and real-time trials for high-risk devices. Many considerations were identified that constitute desirable characteristics of, and means by which to implement such a system. An overarching network was envisioned to broker linkages, establish a shared minimum dataset, and support communication and decision making. Numerous research questions were identified, which could be pursued in tandem with phased implementation of the system. These findings provide unique guidance for establishing a device safety network that is based on existing initiatives, and could be expanded and evaluated in a prospective, phased fashion as it was developed.

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

    Directory of Open Access Journals (Sweden)

    Shigehisa Fumino


    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.

  8. Self-regulated learning strategies used in surgical clerkship and the relationship with clinical achievement. (United States)

    Turan, Sevgi; Konan, Ali


    Self-regulated learning indicates students' skills in controlling their own learning. Self-regulated learning, which a context-specific process, emphasizes autonomy and control. Students gain more autonomy with respect to learning in the clinical years. Examining the self-regulated learning skills of students in this period will provide important clues about the level at which students are ready to use these skills in real-life conditions. The self-regulated learning strategies used by medical students in surgical clerkship were investigated in this study and their relation with clinical achievement was analyzed. The study was conducted during the surgery clerkship of medical students. The participation rate was 94% (309 students). Motivated Strategies for Learning Questionnaire (MSLQ), a case-based examination, Objective Structured Clinical Examination (OSCE), and tutor evaluations for assessing achievement were used. The relationship between the Motivated Strategies for Learning Questionnaire scores of the students and clinical achievement was analyzed with multilinear regression analysis. The findings showed that students use self-regulated learning skills at medium levels during their surgery clerkship. A relationship between these skills and OSCE scores and tutor evaluations was determined. OSCE scores of the students were observed to increase in conjunction with increased self-efficacy levels. However, as students' beliefs regarding control over learning increased, OSCE scores decreased. No significant relationship was defined between self-regulated learning skills and case-based examination scores. We observed that a greater self-efficacy for learning resulted in higher OSCE scores. Conversely, students who believe that learning is a result of their own effort had lower OSCE scores. Copyright © 2012 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

  9. The surgical treatment strategy and results of parasellar meningiomas in the era of radiosurgery

    International Nuclear Information System (INIS)

    Iwai, Yoshiyasu; Yamanaka, Kazuhiro; Morikawa, Toshie; Ishiguro, Tomoya; Honda, Yuji; Matsuzaka, Yasuhiro; Komiyama, Masaki; Yasui, Toshihiro


    We evaluated the surgical treatment results of parasellar meningiomas in the era of radiosurgery. We treated 24 patients of parasellar meningiomas surgically. The median age was 60 yrs (ranging from 29 to 82 yrs). The most common tumor location was the sphenoid ridge in 12 patients and the tuberculum sellae in 7 patients. The pterional approach using fronto-temporal craniotomy was performed for all patients. The residual or recurrent tumors were treated by gamma knife radiosurgery (GKS). We are able to follow up these cases for a median of 3.8 yrs (ranging from 1 to 8 yrs) after the operations. The radicality of tumor resection was Simpson grade II in 13 patients (54%), grade III in 3 patients (13%) and grade IV in 7 patients (33%). Clinical improvement was achieved in 81% of the patients. Of the patients who had visual disturbance preoperatively, 8 patients (73%) showed improvement, but 3 patients suffered deterioration postoperatively. None of the patients died. One patient suffered transient memory disturbance and one patient suffered mild facial numbness postoperatively. Boost radiosurgery for the residual tumors was performed for six patients and tumor growth control was able to be achieved in all patients, with a median of 3.1 years follow-up period (ranging from 0.5 to 6 yrs). Five patients with tumor regrowth or recurrence were treated by GKS. We recommend fronto-temporal craniotomy with nonradical resection for parasellar meningiomas and radiosurgery for residual and recurrent tumors. This strategy will achieve good functional outcome with long-term tumor growth control. (author)

  10. Novel Strategy for Discrimination of Transcription Factor Binding Motifs Employing Mathematical Neural Network (United States)

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


    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.


    Directory of Open Access Journals (Sweden)

    Junta Zeniarja


    Full Text Available Pelanggan merupakan bagian penting dalam memastikan keunggulan dan kelangsungan hidup perusahaan. Oleh karena itu perlu untuk memiliki sistem manajemen untuk memastikan pelanggan tetap setia dan tidak pindah ke pesaing lain, yang dikenal sebagai manajemen churn. Prediksi churn pelanggan adalah bagian dari manajemen churn, yang memprediksi perilaku pelanggan dengan klasifikasi pelanggan setia dan mana yang cenderung pindah ke kompetitor lain. Keakuratan prediksi ini mutlak diperlukan karena tingginya tingkat migrasi pelanggan ke perusahaan pesaing. Hal ini penting karena biaya yang digunakan untuk meraih pelanggan baru jauh lebih tinggi dibandingkan dengan mempertahankan loyalitas pelanggan yang sudah ada. Meskipun banyak studi tentang prediksi churn pelanggan yang telah dilakukan, penelitian lebih lanjut masih diperlukan untuk meningkatkan akurasi prediksi. Penelitian ini akan membahas penggunaan teknik data mining Backpropagation Neural Network (BPNN in hybrid dengan Strategi Evolution (ES untuk atribut bobot. Validasi model dilakukan dengan menggunakan validasi Palang 10-Fold dan evaluasi pengukuran dilakukan dengan menggunakan matriks kebingungan dan Area bawah ROC Curve (AUC. Hasil percobaan menunjukkan bahwa hibrida BPNN dengan ES mencapai kinerja yang lebih baik daripada Basic BPNN. Kata kunci: data mining, churn, prediksi, backpropagation neural network, strategi evolusi.

  12. Surgical management of U-shaped sacral fractures: a systematic review of current treatment strategies. (United States)

    König, M A; Jehan, S; Boszczyk, A A; Boszczyk, B M


    U-shaped sacral fractures usually result from axial loading of the spine with simultaneous sacral pivoting due to a horizontal fracture which leads to a highly unstable spino-pelvic dissociation. Due to the rarity of these fractures, there is lack of an agreed treatment strategy. A thorough literature search was carried out to identify current treatment concepts. The studies were analysed for mechanism of injury, diagnostic imaging, associated injuries, type of surgery, follow-up times, complications, neurological, clinical and radiological outcome. Sixty-three cases were found in 12 articles. No Class I, II or III evidence was found in the literature. The most common mechanism of injury was a fall or jump from height. Pre-operative neurological deficit was noted in 50 (94.3%) out of 53 cases (not available in 10 patients). The most used surgical options were spino-pelvic fixation with or without decompression and ilio-sacral screws. Post-operative complications occurred in 24 (38.1%) patients. Average follow-up time was 18.6 months (range 2-34 months). Full neurological recovery was noted in 20 cases, partial recovery in 14 and 9 patients had no neurological recovery (5 patients were lost in follow-up). Fracture healing was mentioned in 7 articles with only 1 case of fracture reduction loss. From the current available data, an evidence based treatment strategy regarding outcome, neurological recovery or fracture healing could not be identified. Limited access and minimal-invasive surgery focussing on sacral reduction and restoration seems to offer comparable results to large spino-pelvic constructs with fewer complications and should be considered as the method of choice. If the fracture is highly unstable and displaced, spino-pelvic fixation might offer better stability.

  13. Connectivity strategies for higher-order neural networks applied to pattern recognition (United States)

    Spirkovska, Lilly; Reid, Max B.


    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.

  14. Clinical and Surgical Strategies for Avoiding or Reducing Allogeneic Blood Transfusions. (United States)

    Dos Santos, Antonio Alceu; Baumgratz, Jose Francisco; Vila, Jose Henrique Andrade; Castro, Rodrigo Moreira; Bezerra, Rodrigo Freire


    Blood transfusions have still been used as a standard therapy to treat severe anemia. Current evidences point to both excessive allogeneic blood consumption and decreased donations, which result in reduced stocks in blood banks. Several studies have increasingly suggested a more restrictive transfusion practice for blood products. Currently, a number of autologous blood conservation protocols in surgeries have been noted. We report a case of severe anemia with 2.9 g/dL hemoglobin, which was successfully handled without using the standard therapy to treat anemia with hemotransfusions. Such a case of severe anemia condition resulted after the patient was submitted to ascending aortic aneurism repair, valvar aortic replacement, reimplantation of right coronary ostium, followed by a coronary artery bypass grafting and several postoperative complications. The main clinical and surgical strategies used in this case to avoid blood transfusions were acute normovolemic hemodilution, intraoperative blood cell salvage, and meticulous hemostasis, beyond epsilon-aminocaproic acid, desmopressin, prothrombin complex concentrate, human fibrinogen concentrate, factor VIIa recombinant, erythropoietin and hyperoxic ventilation.

  15. Distinct neural and neuromuscular strategies underlie independent evolution of simplified advertisement calls. (United States)

    Leininger, Elizabeth C; Kelley, Darcy B


    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.

  16. Neuromuscular mechanisms and neural strategies in the control of time-varying muscle contractions. (United States)

    Erimaki, Sophia; Agapaki, Orsalia M; Christakos, Constantinos N


    The organization of the neural input to motoneurons that underlies time-varying muscle force is assumed to depend on muscle transfer characteristics and neural strategies or control modes utilizing sensory signals. We jointly addressed these interlinked, but previously studied individually and partially, issues for sinusoidal (range 0.5-5.0 Hz) force-tracking contractions of a human finger muscle. Using spectral and correlation analyses of target signal, force signal, and motor unit (MU) discharges, we studied 1) patterns of such discharges, allowing inferences on the motoneuronal input; 2) transformation of MU population activity (EMG) into quasi-sinusoidal force; and 3) relation of force oscillation to target, carrying information on the input's organization. A broad view of force control mechanisms and strategies emerged. Specifically, synchronized MU and EMG modulations, reflecting a frequency-modulated motoneuronal input, accompanied the force variations. Gain and delay drops between EMG modulation and force oscillation, critical for the appropriate organization of this input, occurred with increasing target frequency. According to our analyses, gain compensation was achieved primarily through rhythmical activation/deactivation of higher-threshold MUs and secondarily through the adaptation of the input's strength expected during tracking tasks. However, the input's timing was not adapted to delay behaviors and seemed to depend on the control modes employed. Thus, for low-frequency targets, the force oscillation was highly coherent with, but led, a target, this timing error being compatible with predictive feedforward control partly based on the target's derivatives. In contrast, the force oscillation was weakly coherent, but in phase, with high-frequency targets, suggesting control mainly based on a target's rhythm.

  17. Characterization of the disruption of neural control strategies for dynamic fingertip forces from attractor reconstruction.

    Directory of Open Access Journals (Sweden)

    Lorenzo Peppoloni

    Full Text Available The Strength-Dexterity (SD test measures the ability of the pulps of the thumb and index finger to compress a compliant and slender spring prone to buckling at low forces (<3N. We know that factors such as aging and neurodegenerative conditions bring deteriorating physiological changes (e.g., at the level of motor cortex, cerebellum, and basal ganglia, which lead to an overall loss of dexterous ability. However, little is known about how these changes reflect upon the dynamics of the underlying biological system. The spring-hand system exhibits nonlinear dynamical behavior and here we characterize the dynamical behavior of the phase portraits using attractor reconstruction. Thirty participants performed the SD test: 10 young adults, 10 older adults, and 10 older adults with Parkinson's disease (PD. We used delayed embedding of the applied force to reconstruct its attractor. We characterized the distribution of points of the phase portraits by their density (number of distant points and interquartile range and geometric features (trajectory length and size. We find phase portraits from older adults exhibit more distant points (p = 0.028 than young adults and participants with PD have larger interquartile ranges (p = 0.001, trajectory lengths (p = 0.005, and size (p = 0.003 than their healthy counterparts. The increased size of the phase portraits with healthy aging suggests a change in the dynamical properties of the system, which may represent a weakening of the neural control strategy. In contrast, the distortion of the attractor in PD suggests a fundamental change in the underlying biological system, and disruption of the neural control strategy. This ability to detect differences in the biological mechanisms of dexterity in healthy and pathological aging provides a simple means to assess their disruption in neurodegenerative conditions and justifies further studies to understand the link with the physiological changes.

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

    Directory of Open Access Journals (Sweden)

    SUN Li-yong


    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.

  19. The turn team: a novel strategy for reducing pressure ulcers in the surgical intensive care unit. (United States)

    Still, Mary D; Cross, Linda C; Dunlap, Martha; Rencher, Rugenia; Larkins, Elizabeth R; Carpenter, David L; Buchman, Timothy G; Coopersmith, Craig M


    Pressure ulcers cause significant morbidity and mortality in the surgical intensive care unit (SICU). The purpose of this study was to determine if a dedicated team tasked with turning and repositioning all hemodynamically stable SICU patients could decrease the formation of pressure ulcers. A total of 507 patients in a 20-bed SICU in a university hospital were assessed for pressure ulcers using a point prevalence strategy, between December 2008 and September 2010, before and after implementation of a team tasked with turning and repositioning all hemodynamically stable patients every 2 hours around the clock. At baseline, when frequent turning was encouraged but not required, a total of 42 pressure ulcers were identified in 278 patients. After implementation of the turn team, a total of 12 pressure ulcers were identified in 229 patients (p < 0.0001). The preintervention group included 34 stage I and II ulcers and 8 higher stage ulcers. After implementation of the turn team, there were 7 stage I and II ulcers and 5 higher stage ulcers. The average Braden score was 16.5 in the preintervention group and 13.4 in the postintervention group (p = 0.04), suggesting that pressure ulcers were occurring in higher risk patients after implementation of the turn team. A team dedicated to turning SICU patients every 2 hours dramatically decreased the incidence of pressure ulcers. The majority of stage I and stage II ulcers appear to be preventable with an aggressive intervention aimed at pressure ulcer prevention. Copyright © 2013 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

  20. [Deep alkali burns: Evaluation of a two-step surgical strategy]. (United States)

    Devinck, F; Deveaux, C; Bennis, Y; Deken-Delannoy, V; Jeanne, M; Martinot-Duquennoy, V; Guerreschi, P; Pasquesoone, L


    Chemical burns are rare but often lead to deep cutaneous lesions. Alkali agents have a deep and long lasting penetrating power, causing burns that evolve over several days. The local treatment for these patients is excision of the wound and split thickness skin graft. Early excision and immediate skin grafting of alkali burns are more likely to be complicated by graft failure and delayed wound healing. We propose a two-step method that delays skin grafting until two-three days after burn wound excision. Our population included 25 controls and 16 cases. Men were predominant with a mean age of 41.9 years. In 78% of cases, burns were located on the lower limbs. The mean delay between the burn and excision was 16.5 days. In cases, the skin graft was performed at a mean of 11.3 days after the initial excision. We did not unveil any significant difference between both groups for the total skin surface affected, topography of the burns and the causal agent. Wound healing was significantly shorter in cases vs controls (37.5 days vs 50.3 days; P<0.025). Furthermore, we observed a decreased number of graft failures in cases vs controls (13.3% vs 46.7%; P=0.059). Our study shows the relevance of a two-step surgical strategy in patients with alkali chemical burns. Early excision followed by interval skin grafting is associated with quicker wound healing and decreased rate of graft failure. Copyright © 2018 Elsevier Masson SAS. All rights reserved.

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

    Directory of Open Access Journals (Sweden)

    Jack Donati-Bourne


    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.

  2. Neural Signatures of Rational and Heuristic Choice Strategies: A Single Trial ERP Analysis

    Directory of Open Access Journals (Sweden)

    Szymon Wichary


    Full Text Available In multi-attribute choice, people use heuristics to simplify decision problems. We studied the use of heuristic and rational strategies and their electrophysiological correlates. Since previous work linked the P3 ERP component to attention and decision making, we were interested whether the amplitude of this component is associated with decision strategy use. To this end, we recorded EEG when participants performed a two-alternative choice task, where they could acquire decision cues in a sequential manner and use them to make choices. We classified participants’ choices as consistent with a rational Weighted Additive rule (WADD or a simple heuristic Take The Best (TTB. Participants differed in their preference for WADD and TTB. Using a permutation-based single trial approach, we analyzed EEG responses to consecutive decision cues and their relation to the individual strategy preference. The preference for WADD over TTB was associated with overall higher signal amplitudes to decision cues in the P3 time window. Moreover, the preference for WADD was associated with similar P3 amplitudes to consecutive cues, whereas the preference for TTB was associated with substantial decreases in P3 amplitudes to consecutive cues. We also found that the preference for TTB was associated with enhanced N1 component to cues that discriminated decision alternatives, suggesting very early attention allocation to such cues by TTB users. Our results suggest that preference for either WADD or TTB has an early neural signature reflecting differences in attentional weighting of decision cues. In light of recent findings and hypotheses regarding P3, we interpret these results as indicating the involvement of catecholamine arousal systems in shaping predecisional information processing and strategy selection.

  3. Neural Signatures of Rational and Heuristic Choice Strategies: A Single Trial ERP Analysis. (United States)

    Wichary, Szymon; Magnuski, Mikołaj; Oleksy, Tomasz; Brzezicka, Aneta


    In multi-attribute choice, people use heuristics to simplify decision problems. We studied the use of heuristic and rational strategies and their electrophysiological correlates. Since previous work linked the P3 ERP component to attention and decision making, we were interested whether the amplitude of this component is associated with decision strategy use. To this end, we recorded EEG when participants performed a two-alternative choice task, where they could acquire decision cues in a sequential manner and use them to make choices. We classified participants' choices as consistent with a rational Weighted Additive rule (WADD) or a simple heuristic Take The Best (TTB). Participants differed in their preference for WADD and TTB. Using a permutation-based single trial approach, we analyzed EEG responses to consecutive decision cues and their relation to the individual strategy preference. The preference for WADD over TTB was associated with overall higher signal amplitudes to decision cues in the P3 time window. Moreover, the preference for WADD was associated with similar P3 amplitudes to consecutive cues, whereas the preference for TTB was associated with substantial decreases in P3 amplitudes to consecutive cues. We also found that the preference for TTB was associated with enhanced N1 component to cues that discriminated decision alternatives, suggesting very early attention allocation to such cues by TTB users. Our results suggest that preference for either WADD or TTB has an early neural signature reflecting differences in attentional weighting of decision cues. In light of recent findings and hypotheses regarding P3, we interpret these results as indicating the involvement of catecholamine arousal systems in shaping predecisional information processing and strategy selection.

  4. Assessment of neural networks training strategies for histomorphometric analysis of synchrotron radiation medical images

    Energy Technology Data Exchange (ETDEWEB)

    Alvarenga de Moura Meneses, Anderson, E-mail: ameneses@lmp.ufrj.b [Federal University of Rio de Janeiro, COPPE, Nuclear Engineering Program, CP 68509, CEP 21.941-972, Rio de Janeiro, RJ (Brazil); IDSIA (Dalle Molle Institute for Artificial Intelligence), University of Lugano (Switzerland); Gomes Pinheiro, Christiano Jorge [State University of Rio de Janeiro, RJ (Brazil); Rancoita, Paola [IDSIA (Dalle Molle Institute for Artificial Intelligence), University of Lugano (Switzerland); Mathematics Department, Universita degli Studi di Milano (Italy); Schaul, Tom; Gambardella, Luca Maria [IDSIA (Dalle Molle Institute for Artificial Intelligence), University of Lugano (Switzerland); Schirru, Roberto [Federal University of Rio de Janeiro, COPPE, Nuclear Engineering Program, CP 68509, CEP 21.941-972, Rio de Janeiro, RJ (Brazil); Barroso, Regina Cely; Oliveira, Luis Fernando de [State University of Rio de Janeiro, RJ (Brazil)


    Micro-computed tomography ({mu}CT) obtained by synchrotron radiation (SR) enables magnified images with a high space resolution that might be used as a non-invasive and non-destructive technique for the quantitative analysis of medical images, in particular the histomorphometry (HMM) of bony mass. In the preprocessing of such images, conventional operations such as binarization and morphological filtering are used before calculating the stereological parameters related, for example, to the trabecular bone microarchitecture. However, there is no standardization of methods for HMM based on {mu}CT images, especially the ones obtained with SR X-ray. Notwithstanding the several uses of artificial neural networks (ANNs) in medical imaging, their application to the HMM of SR-{mu}CT medical images is still incipient, despite the potential of both techniques. The contribution of this paper is the assessment and comparison of well-known training algorithms as well as the proposal of training strategies (combinations of training algorithms, sub-image kernel and symmetry information) for feed-forward ANNs in the task of bone pixels recognition in SR-{mu}CT medical images. For a quantitative comparison, the results of a cross validation and a statistical analysis of the results for 36 training strategies are presented. The ANNs demonstrated both very low mean square errors in the validation, and good quality segmentation of the image of interest for application to HMM in SR-{mu}CT medical images.


    Directory of Open Access Journals (Sweden)

    Parisa Bazmi


    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.

  6. Neural substrates of male parochial altruism are modulated by testosterone and behavioral strategy. (United States)

    Reimers, Luise; Büchel, Christian; Diekhof, Esther K


    Parochial altruism refers to ingroup favoritism and outgroup hostility and has recently been linked to testosterone. Here, we investigated the neurobiological mechanism of parochial altruism in male soccer fans playing the ultimatum game (UG) against ingroup and outgroup members (i.e., fans of the favorite or of a rivalling team) using functional magnetic resonance imaging. Our results suggest that individual differences in altruistic tendency influence the tendency for parochialism. While altruistic subjects rejected unfair offers independent of team membership, the more self-oriented 'pro-selfs' displayed a stronger ingroup bias and rejected outgroup offers more often. However, during a second session that introduced a team competition the altruists adapted to this parochial pattern. Behavioral strategy was further characterized by dissociable and context-dependent correlations between endogenous testosterone and neural responses in the anterior insula and the ventromedial prefrontal cortex. In sum, the present findings indicate that parochial altruism is shaped by individual differences in testosterone and behavioral strategy. In that way the results are in line with evolutionary theories of both individual and group selection. Copyright © 2017 Elsevier Inc. All rights reserved.

  7. Assessment of neural networks training strategies for histomorphometric analysis of synchrotron radiation medical images

    International Nuclear Information System (INIS)

    Alvarenga de Moura Meneses, Anderson; Gomes Pinheiro, Christiano Jorge; Rancoita, Paola; Schaul, Tom; Gambardella, Luca Maria; Schirru, Roberto; Barroso, Regina Cely; Oliveira, Luis Fernando de


    Micro-computed tomography (μCT) obtained by synchrotron radiation (SR) enables magnified images with a high space resolution that might be used as a non-invasive and non-destructive technique for the quantitative analysis of medical images, in particular the histomorphometry (HMM) of bony mass. In the preprocessing of such images, conventional operations such as binarization and morphological filtering are used before calculating the stereological parameters related, for example, to the trabecular bone microarchitecture. However, there is no standardization of methods for HMM based on μCT images, especially the ones obtained with SR X-ray. Notwithstanding the several uses of artificial neural networks (ANNs) in medical imaging, their application to the HMM of SR-μCT medical images is still incipient, despite the potential of both techniques. The contribution of this paper is the assessment and comparison of well-known training algorithms as well as the proposal of training strategies (combinations of training algorithms, sub-image kernel and symmetry information) for feed-forward ANNs in the task of bone pixels recognition in SR-μCT medical images. For a quantitative comparison, the results of a cross validation and a statistical analysis of the results for 36 training strategies are presented. The ANNs demonstrated both very low mean square errors in the validation, and good quality segmentation of the image of interest for application to HMM in SR-μCT medical images.

  8. Neural correlates of strategy use during auditory working memory in musicians and non-musicians. (United States)

    Schulze, K; Mueller, K; Koelsch, S


    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.

  9. 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


    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.

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

    International Nuclear Information System (INIS)

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


    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.

  11. Implementation of Enhanced Recovery After Surgery: a strategy to transform surgical care across a health system. (United States)

    Gramlich, Leah M; Sheppard, Caroline E; Wasylak, Tracy; Gilmour, Loreen E; Ljungqvist, Olle; Basualdo-Hammond, Carlota; Nelson, Gregg


    Enhanced Recovery After Surgery (ERAS) programs have been shown to have a positive impact on outcome. The ERAS care system includes an evidence-based guideline, an implementation program, and an interactive audit system to support practice change. The purpose of this study is to describe the use of the Theoretic Domains Framework (TDF) in changing surgical care and application of the Quality Enhancement Research Initiative (QUERI) model to analyze end-to-end implementation of ERAS in colorectal surgery across multiple sites within a single health system. The ultimate intent of this work is to allow for the development of a model for spread, scale, and sustainability of ERAS in Alberta Health Services (AHS). ERAS for colorectal surgery was implemented at two sites and then spread to four additional sites. The ERAS Interactive Audit System (EIAS) was used to assess compliance with the guidelines, length of stay, readmissions, and complications. Data sources informing knowledge translation included surveys, focus groups, interviews, and other qualitative data sources such as minutes and status updates. The QUERI model and TDF were used to thematically analyze 189 documents with 2188 quotes meeting the inclusion criteria. Data sources were analyzed for barriers or enablers, organized into a framework that included individual to organization impact, and areas of focus for guideline implementation. Compliance with the evidence-based guidelines for ERAS in colorectal surgery at baseline was 40%. Post implementation compliance, consistent with adoption of best practice, improved to 65%. Barriers and enablers were categorized as clinical practice (22%), individual provider (26%), organization (19%), external environment (7%), and patients (25%). In the Alberta context, 26% of barriers and enablers to ERAS implementation occurred at the site and unit levels, with a provider focus 26% of the time, a patient focus 26% of the time, and a system focus 22% of the time. Using the

  12. Microvascular Decompression for Classical Trigeminal Neuralgia Caused by Venous Compression: Novel Anatomic Classifications and Surgical Strategy. (United States)

    Wu, Min; Fu, Xianming; Ji, Ying; Ding, Wanhai; Deng, Dali; Wang, Yehan; Jiang, Xiaofeng; Niu, Chaoshi


    Microvascular decompression of the trigeminal nerve is the most effective treatment for trigeminal neuralgia. However, when encountering classical trigeminal neuralgia caused by venous compression, the procedure becomes much more difficult, and failure or recurrence because of incomplete decompression may become frequent. This study aimed to investigate the anatomic variation of the culprit veins and discuss the surgical strategy for different types. We performed a retrospective analysis of 64 consecutive cases in whom veins were considered as responsible vessels alone or combined with other adjacent arteries. The study classified culprit veins according to operative anatomy and designed personalized approaches and decompression management according to different forms of compressive veins. Curative effects were assessed by the Barrow Neurological Institute (BNI) pain intensity score and BNI facial numbness score. The most commonly encountered veins were the superior petrosal venous complex (SPVC), which was artificially divided into 4 types according to both venous tributary distribution and empty point site. We synthetically considered these factors and selected an approach to expose the trigeminal root entry zone, including the suprafloccular transhorizontal fissure approach and infratentorial supracerebellar approach. The methods of decompression consist of interposing and transposing by using Teflon, and sometimes with the aid of medical adhesive. Nerve combing (NC) of the trigeminal root was conducted in situations of extremely difficult neurovascular compression, instead of sacrificing veins. Pain completely disappeared in 51 patients, and the excellent outcome rate was 79.7%. There were 13 patients with pain relief treated with reoperation. Postoperative complications included 10 cases of facial numbness, 1 case of intracranial infection, and 1 case of high-frequency hearing loss. The accuracy recognition of anatomic variation of the SPVC is crucial for the

  13. Intraoperative biopsy of the major cranial nerves in the surgical strategy for adenoid cystic carcinoma close to the skull base. (United States)

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


    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.

  14. [The "window" surgical exposure strategy of the upper anterior cervical retropharyngeal approach for anterior decompression at upper cervical spine]. (United States)

    Wu, Xiang-Yang; Zhang, Zhe; Wu, Jian; Lü, Jun; Gu, Xiao-Hui


    To investigate the "window" surgical exposure strategy of the upper anterior cervical retropharyngeal approach for the exposure and decompression and instrumentation of the upper cervical spine. From Jan. 2000 to July 2008, 5 patients with upper cervical spinal injuries were treated by surgical operation included 4 males and 1 female with and average age of 35 years old ranging from 16 to 68 years. There were 2 cases of Hangman's fractures (type II ), 2 of C2.3 intervertebral disc displacement and 1 of C2 vertebral body tuberculosis. All patients underwent the upper cervical anterior retropharyngeal approach through the "window" between the hypoglossal nerve and the superior laryngeal nerve and pharynx and carotid artery. Two patients of Hangman's fractures underwent the C2,3 intervertebral disc discectomy, bone graft fusion and internal fixation. Two patients of C2,3 intervertebral disc displacement underwent the C2,3 intervertebral disc discectomy, decompression bone graft fusion and internal fixation. One patient of C2 vertebral body tuberculosis was dissected and resected and the focus and the cavity was filled by bone autografting. C1 anterior arch to C3 anterior vertebral body were successful exposed. Lesion resection or decompression and fusion were successful in all patients. All patients were followed-up for from 5 to 26 months (means 13.5 months). There was no important vascular and nerve injury and no wound infection. Neutral symptoms was improved and all patient got successful fusion. The "window" surgical exposure surgical technique of the upper cervical anterior retropharyngeal approach is a favorable strategy. This approach strategy can be performed with full exposure for C1-C3 anterior anatomical structure, and can get minimally invasive surgery results and few and far between wound complication, that is safe if corresponding experience is achieved.

  15. Economic and clinical contributions of an antimicrobial barrier dressing: a strategy for the reduction of surgical site infections. (United States)

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


    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.

  16. How are things adding up? Neural differences between arithmetic operations are due to general problem solving strategies. (United States)

    Tschentscher, Nadja; Hauk, Olaf


    A number of previous studies have interpreted differences in brain activation between arithmetic operation types (e.g. addition and multiplication) as evidence in favor of distinct cortical representations, processes or neural systems. It is still not clear how differences in general task complexity contribute to these neural differences. Here, we used a mental arithmetic paradigm to disentangle brain areas related to general problem solving from those involved in operation type specific processes (addition versus multiplication). We orthogonally varied operation type and complexity. Importantly, complexity was defined not only based on surface criteria (for example number size), but also on the basis of individual participants' strategy ratings, which were validated in a detailed behavioral analysis. We replicated previously reported operation type effects in our analyses based on surface criteria. However, these effects vanished when controlling for individual strategies. Instead, procedural strategies contrasted with memory retrieval reliably activated fronto-parietal and motor regions, while retrieval strategies activated parietal cortices. This challenges views that operation types rely on partially different neural systems, and suggests that previously reported differences between operation types may have emerged due to invalid measures of complexity. We conclude that mental arithmetic is a powerful paradigm to study brain networks of abstract problem solving, as long as individual participants' strategies are taken into account. Copyright © 2014 Elsevier Inc. All rights reserved.

  17. Tracking-by-detection of surgical instruments in minimally invasive surgery via the convolutional neural network deep learning-based method. (United States)

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


    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.

  18. Influence of Preoperative Chemoradiotherapy on the Surgical Strategy According to the Clinical T Stage of Patients With Rectal Cancer (United States)

    Park, In Ja; Lee, Jong Lyul; Yoon, Yong Sik; Kim, Chan Wook; Lim, Seok-Byung; Lee, Jong Seok; Park, Seong Ho; Park, Jin Hong; Kim, Jong Hoon; Yu, Chang Sik; Kim, Jin Cheon


    Abstract The aim of this study was to evaluate the pathologic responses and changes to surgical strategies following preoperative chemoradiotherapy (PCRT) in rectal cancer patients according to their clinical T stage (cT). The use of PCRT has recently been extended to less advanced disease. The authors enrolled 650 patients with cT2 to 4 mid and low rectal cancer who received both PCRT and surgical resection. The rate of total regression and the proportion of local excision were compared according to the cT category. The 3-year recurrence-free survival (RFS) rate was compared using the log-rank test according to patient cT category, pathologic stage, and type of surgical treatment. Patients with cT2 were older (P = 0.001), predominately female (P = 0.028), and had low-lying rectal cancer (P = 0.008). Pathologic total regression was achieved most frequently in cT2 patients (54% of cT2 versus 17.6% of cT3 versus 8.2% of cT4; P rectal cancer, optimal surgical treatment may be achieved with the tailored use of PCRT. PMID:26717384

  19. Neural bases of different cognitive strategies for facial affect processing in schizophrenia. (United States)

    Fakra, Eric; Salgado-Pineda, Pilar; Delaveau, Pauline; Hariri, Ahmad R; Blin, Olivier


    To examine the neural basis and dynamics of facial affect processing in schizophrenic patients as compared to healthy controls. Fourteen schizophrenic patients and fourteen matched controls performed a facial affect identification task during fMRI acquisition. The emotional task included an intuitive emotional condition (matching emotional faces) and a more cognitively demanding condition (labeling emotional faces). Individual analysis for each emotional condition, and second-level t-tests examining both within-, and between-group differences, were carried out using a random effects approach. Psychophysiological interactions (PPI) were tested for variations in functional connectivity between amygdala and other brain regions as a function of changes in experimental conditions (labeling versus matching). During the labeling condition, both groups engaged similar networks. During the matching condition, schizophrenics failed to activate regions of the limbic system implicated in the automatic processing of emotions. PPI revealed an inverse functional connectivity between prefrontal regions and the left amygdala in healthy volunteers but there was no such change in patients. Furthermore, during the matching condition, and compared to controls, patients showed decreased activation of regions involved in holistic face processing (fusiform gyrus) and increased activation of regions associated with feature analysis (inferior parietal cortex, left middle temporal lobe, right precuneus). Our findings suggest that schizophrenic patients invariably adopt a cognitive approach when identifying facial affect. The distributed neocortical network observed during the intuitive condition indicates that patients may resort to feature-based, rather than configuration-based, processing and may constitute a compensatory strategy for limbic dysfunction.

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

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    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.

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

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    W. M. Rdeini


    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.

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

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    Theresa Krätzig

    Full Text Available 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 (p<0.001. When imaging detected a postoperative shift of the spinal cord at index segment C4/5, palsy rate increased significantly (33.3% vs. 12.5%, p = 0.034.Extended surgical strategies, such as dorsal laminectomies, multilevel corpectomies and procedures with extensive spinal cord shift were shown to display a high risk of C5 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.

  3. Different surgical strategies for chronic pancreatitis significantly improve long-term outcome: a comparative single center study

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    Hildebrand P


    Full Text Available Abstract Objective In general, chronic pancreatitis (CP primarily requires conservative treatment. The chronic pain syndrome and complications make patients seek surgical advice, frequently after years of progression. In the past, surgical procedures involving drainage as well as resection have been employed successfully. The present study compared the different surgical strategies. Patients and Methods From March 2000 until April 2005, a total of 51 patients underwent surgical treatment for CP at the Department of surgery, University of Schleswig-Holstein, Campus Lübeck. Out of those 51 patients, 39 (76.5% were operated according to the Frey procedure, and in 12 cases (23.5% the Whipple procedure was performed. Patient data were documented prospectively throughout the duration of the hospital stay. The evaluation of the postoperative pain score was carried out retrospectively with a validated questionnaire. Results Average operating time was 240 minutes for the Frey group and 411 minutes for the Whipple group. The medium number of blood transfusions was 1 in the Frey group and 4.5 in the Whipple group. Overall morbidity was 21% in the Frey group and 42% in the Whipple group. 30-day mortality was zero for all patients. During the median follow-up period of 50 months, an improvement in pain score was observed in 93% of the patients of the Frey group and 67% of the patients treated according to the Whipple procedure. Conclusion The results show that both the Frey procedure as well as partial pancreaticoduodenectomy are capable of improving chronic pain symptoms in CP. As far as later endocrine and exocrine pancreatic insufficiency is concerned, however, the extended drainage operation according to Frey proves to be advantageous compared to the traditional resection procedure by Whipple. Accordingly, the Frey procedure provides us with an organ-preserving surgical procedure which treats the complications of CP sufficiently, thus being an

  4. The introduction of an acute physiological support service for surgical patients is an effective error reduction strategy. (United States)

    Clarke, D L; Kong, V Y; Naidoo, L C; Furlong, H; Aldous, C


    Acute surgical patients are particularly vulnerable to human error. The Acute Physiological Support Team (APST) was created with the twin objectives of identifying high-risk acute surgical patients in the general wards and reducing both the incidence of error and impact of error on these patients. A number of error taxonomies were used to understand the causes of human error and a simple risk stratification system was adopted to identify patients who are particularly at risk of error. During the period November 2012-January 2013 a total of 101 surgical patients were cared for by the APST at Edendale Hospital. The average age was forty years. There were 36 females and 65 males. There were 66 general surgical patients and 35 trauma patients. Fifty-six patients were referred on the day of their admission. The average length of stay in the APST was four days. Eleven patients were haemo-dynamically unstable on presentation and twelve were clinically septic. The reasons for referral were sepsis,(4) respiratory distress,(3) acute kidney injury AKI (38), post-operative monitoring (39), pancreatitis,(3) ICU down-referral,(7) hypoxia,(5) low GCS,(1) coagulopathy.(1) The mortality rate was 13%. A total of thirty-six patients experienced 56 errors. A total of 143 interventions were initiated by the APST. These included institution or adjustment of intravenous fluids (101), blood transfusion,(12) antibiotics,(9) the management of neutropenic sepsis,(1) central line insertion,(3) optimization of oxygen therapy,(7) correction of electrolyte abnormality,(8) correction of coagulopathy.(2) CONCLUSION: Our intervention combined current taxonomies of error with a simple risk stratification system and is a variant of the defence in depth strategy of error reduction. We effectively identified and corrected a significant number of human errors in high-risk acute surgical patients. This audit has helped understand the common sources of error in the general surgical wards and will inform

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

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    Gillespie BM


    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

  6. The impact of surgical strategies on outcomes for pediatric chronic pancreatitis. (United States)

    Sacco Casamassima, Maria G; Goldstein, Seth D; Yang, Jingyan; Gause, Colin D; Abdullah, Fizan; Meoded, Avner; Makary, Martin A; Colombani, Paul M


    To review our institutional experience in the surgical treatment of pediatric chronic pancreatitis (CP) and evaluate predictors of long-term pain relief. Outcomes of patients ≤21 years surgically treated for CP in a single institution from 1995 to 2014 were evaluated. Twenty patients underwent surgery for CP at a median of 16.6 years (IQR 10.7-20.6 years). The most common etiology was pancreas divisum (n = 7; 35%). Therapeutic endoscopy was the first-line treatment in 17 cases (85%). Surgical procedures included: longitudinal pancreaticojejunostomy (n = 4, 20%), pancreatectomy (n = 9, 45%), total pancreatectomy with islet autotransplantation (n = 2; 10%), sphincteroplasty (n = 2, 10%) and pseudocyst drainage (n = 3, 15%). At a median follow-up of 5.3 years (IQR 4.2-5.3), twelve patients (63.2%) were pain free and five (26.3%) were insulin dependent. In univariate analysis, previous surgical procedure or >5 endoscopic treatments were associated with a lower likelihood of pain relief (OR 0.06; 95% CI 0.006-0.57; OR 0.07; 95%, CI 0.01-0.89). However, these associations were not present in multivariate analysis. In children with CP, the step-up practice including a limited trial of endoscopic interventions followed by surgery tailored to anatomical abnormalities and gene mutation status is effective in ensuring long-term pain relief and preserving pancreatic function.

  7. Strategy of Surgical Resection for Glioma Based on Intraoperative Functional Mapping and Monitoring (United States)

    TAMURA, Manabu; MURAGAKI, Yoshihiro; SAITO, Taiichi; MARUYAMA, Takashi; NITTA, Masayuki; TSUZUKI, Shunsuke; ISEKI, Hiroshi; OKADA, Yoshikazu


    A growing number of papers have pointed out the relationship between aggressive resection of gliomas and survival prognosis. For maximum resection, the current concept of surgical decision-making is in “information-guided surgery” using multimodal intraoperative information. With this, anatomical information from intraoperative magnetic resonance imaging (MRI) and navigation, functional information from brain mapping and monitoring, and histopathological information must all be taken into account in the new perspective for innovative minimally invasive surgical treatment of glioma. Intraoperative neurofunctional information such as neurophysiological functional monitoring takes the most important part in the process to acquire objective visual data during tumor removal and to integrate these findings as digitized data for intraoperative surgical decision-making. Moreover, the analysis of qualitative data and threshold-setting for quantitative data raise difficult issues in the interpretation and processing of each data type, such as determination of motor evoked potential (MEP) decline, underestimation in tractography, and judgments of patient response for neurofunctional mapping and monitoring during awake craniotomy. Neurofunctional diagnosis of false-positives in these situations may affect the extent of resection, while false-negatives influence intra- and postoperative complication rates. Additionally, even though the various intraoperative visualized data from multiple sources contribute significantly to the reliability of surgical decisions when the information is integrated and provided, it is not uncommon for individual pieces of information to convey opposing suggestions. Such conflicting pieces of information facilitate higher-order decision-making that is dependent on the policies of the facility and the priorities of the patient, as well as the availability of the histopathological characteristics from resected tissue. PMID:26185825

  8. Impact of Open Reduction on Surgical Strategies for Missed Monteggia Fracture in Children. (United States)

    Park, Hoon; Park, Kwang Won; Park, Kun Bo; Kim, Hyun Woo; Eom, Nam Kyu; Lee, Dong Hoon


    The aims of this study were to review our cases of missed Monteggia fracture treated by open reduction of the radial head with or without ulnar osteotomy and to investigate the indications for open reduction alone in surgical treatment of missed Monteggia fracture. We retrospectively reviewed 22 patients who presented with missed Monteggia fracture. The patients' mean age at the time of surgery was 7.6 years. The mean interval from injury to surgery was 16.1 months. The surgical procedure consisted of open reduction of the radiocapitellar joint followed by ulnar osteotomy without reconstruction of the annular ligament. The mean period of follow-up was 3.8 years. Radiographic assessment was performed for the maximum ulnar bow (MUB) and the location of the MUB. Clinical results were evaluated with the Mayo Elbow Performance Index and Kim's scores. Five patients underwent open reduction alone, and 17 patients underwent open reduction and ulnar osteotomy. When the MUB was less than 4 mm and the location of the MUB was in the distal 40% of the ulna, we could achieve reduction of the radial head without ulnar osteotomy. The radial head was maintained in a completely reduced position in 21 patients and was dislocated in one patient at final follow-up. Open reduction alone can be an attractive surgical option in select patients with missed Monteggia fracture with minimal bowing of the distal ulna. However, ulnar osteotomy should be considered in patients with a definite ulnar deformity. © Copyright: Yonsei University College of Medicine 2017

  9. Strategy and clinical significance of interventional management before surgical therapy for massive hemorrhage of gastrointestinal tract

    International Nuclear Information System (INIS)

    Hu Tingyang; Yu Wenqiang; Mao Yingmin; Yuan Jianhua; CChen Fanghong; Luo Zuyan; Ding Xiaonan; Zhou Bing; Ding Zhongxiang


    Objective: To discuss the clinical value of interventional management before surgical therapy for massive gastrointestinal hemorrhage, and to compare the clinical efficacy and re-bleeding rate between hypophysin infusion group and embolization group. Methods: During the period of June 1998-Apr. 2009, 31 patients with massive gastrointestinal hemorrhage in our institution underwent preoperative interventional managements before they received surgical treatment. According to DSA manifestations, the patients underwent transarterial hypophysin infusion or transcatheter embolization as interventional management. The clinical efficacy of interventional procedures and its influence on the surgery were evaluated, and the hemostasis rate and re-bleeding rate were compared the two kind of intervention managements. The numeration data were analyzed with Fisher's exact test, and the SPSS 11.0 was used as statistical software. Results: The interventional managements were successfully performed in all the 31 patients, with a total hemostasis rate of 83.9% (26/31) and a total re-bleeding rate 30.7% (8/26). The hemostasis rate and re-bleeding rate of hypophysin infusion group and embolization group were 69.2% (9/ 13), 94.4% (17/18) and 44.4% (4/9), 23.7% (4/17), respectively. All the 31 patients received surgery after interventional therapy, of which selective operation was carried out in 20. Neither surgery-related or intervention-related serious complications nor death occurred. Conclusion: Preoperative interventional managements can provide patients with massive gastrointestinal hemorrhage with valuable chance of a successful surgery, enable the physician to take a selective operation to replace an emergency one,as a result, the surgical risk will be greatly reduced. Therefore, it is worth popularizing the preoperative interventional managements in clinical practice. (authors)

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

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


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

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


    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)

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

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    Jacob Dietmar


    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.

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

    International Nuclear Information System (INIS)

    Iervolino, Leticia; Scalisse, Nilza Maria; Maeda, Sergio Setsuo


    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 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)

  14. Novel strategy for protein exploration: high-throughput screening assisted with fuzzy neural network. (United States)

    Kato, Ryuji; Nakano, Hideo; Konishi, Hiroyuki; Kato, Katsuya; Koga, Yuchi; Yamane, Tsuneo; Kobayashi, Takeshi; Honda, Hiroyuki


    To engineer proteins with desirable characteristics from a naturally occurring protein, high-throughput screening (HTS) combined with directed evolutional approach is the essential technology. However, most HTS techniques are simple positive screenings. The information obtained from the positive candidates is used only as results but rarely as clues for understanding the structural rules, which may explain the protein activity. In here, we have attempted to establish a novel strategy for exploring functional proteins associated with computational analysis. As a model case, we explored lipases with inverted enantioselectivity for a substrate p-nitrophenyl 3-phenylbutyrate from the wild-type lipase of Burkhorderia cepacia KWI-56, which is originally selective for (S)-configuration of the substrate. Data from our previous work on (R)-enantioselective lipase screening were applied to fuzzy neural network (FNN), bioinformatic algorithm, to extract guidelines for screening and engineering processes to be followed. FNN has an advantageous feature of extracting hidden rules that lie between sequences of variants and their enzyme activity to gain high prediction accuracy. Without any prior knowledge, FNN predicted a rule indicating that "size at position L167," among four positions (L17, F119, L167, and L266) in the substrate binding core region, is the most influential factor for obtaining lipase with inverted (R)-enantioselectivity. Based on the guidelines obtained, newly engineered novel variants, which were not found in the actual screening, were experimentally proven to gain high (R)-enantioselectivity by engineering the size at position L167. We also designed and assayed two novel variants, namely FIGV (L17F, F119I, L167G, and L266V) and FFGI (L17F, L167G, and L266I), which were compatible with the guideline obtained from FNN analysis, and confirmed that these designed lipases could acquire high inverted enantioselectivity. The results have shown that with the aid of

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

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    McDermott, F D


    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.

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

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


    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.

  17. Transperineal Ultrasound as a Tool to Plan Surgical Strategies in Pediatric Urology: Back to the Future? (United States)

    de Jesus, Lisieux Eyer; Fazecas, Tatiana; Ribeiro, Bianca G; Dekermacher, Samuel


    To demonstrate the usefulness and advantages of transperineal ultrasound (TPUS) on planning the surgical tactics to treat childhood pelviperineal disease (CPPD). A cohort of CPPD is reviewed to provide a pictorial review of TPUS as imaging method variety of CPPD. Other imaging methods are compared with TPUS. TPUS studies of patients showing different conditions on the spectrum of pelviperineal malformation are shown in detail (pictorial review, graphically shown-see figures in the article and as supplementary material), highlighting the advantages of the method and comparing TPUS findings with other imaging techniques. Magnetic resonance imaging, contrast genitograms, voiding cystourethrography, and genital or urologic endoscopy have some important disadvantages, especially radiation exposure, high cost, not easily available equipment, and the need of general anesthesia or deep sedation in children. TPUS is easily available, including in impoverished environments, portable, painless, reproducible, inexpensive, and capable of providing detailed and specific information about pelviperineal malformation with accuracy. Data provided by TPUS are comparable with other imaging techniques (Table 1). Its main disadvantage is the dependency on the expertise of the operator to obtain high-quality, well-interpreted images. Copyright © 2017 Elsevier Inc. All rights reserved.

  18. Preoperative diagnosis and surgical strategy in congenital auditory ossicular malformation of 26 ears

    International Nuclear Information System (INIS)

    Kanazawa, Yuji; Naito, Yasushi; Shinohara, Shogo; Fujiwara, Keizo; Kikuchi, Masahiro; Yamazaki, Hiroshi; Kurihara, Risa; Kishimoto, Ippei


    We retrospectively analyzed 26 ears of 21 subjects having auditory ossicular malformation and who had undergone auditory reconstruction between April 2004 and December 2010 at our clinic. We checked preoperative condition, pathological classification, surgical procedure, and hearing improvement. We could predict pathological conditions precisely from preoperative computed tomography (CT), including incudostapedial disconnection (9/12, 75%) and malleus and/or incus fixation (7/12, 58%), which tended to be present in external ear malformation, and stapes footplate fixation (0/12, 0%). We could not, however, predict complex malformation (0/8, 0%). Overall success was 90% (18/20) in the 20 ears observed for at least 1 year. In the 2 ears without improved hearing, the first had congenital cholesteatoma and no stapes superstructure, was treated with type IV tympanoplasty. The second had malleus, incus, and stapes fixation and discontinuity between the incus and stapes, and was treated with type III tympanoplasty and stapes mobilization. Preoperative diagnosis is difficult in mixed congenital auditory ossicular malformation, especially stapes footplate fixation, possibly requiring unexpected procedures, with a poor hearing outcome. Preoperative status must thus be evaluated precisely using hearing, tympanometry, acoustic reflex test, and CT. Temporal bone CT and external ear findings are useful in diagnosing middle-ear malformation. Subjects' informed consent should also be obtained due to the possible need for changing procedure based on findings during surgery. (author)

  19. Interrupting the natural history of diabetes mellitus: lifestyle, pharmacological and surgical strategies targeting disease progression. (United States)

    Khavandi, Kaivan; Brownrigg, Jack; Hankir, Mohammed; Sood, Harpreet; Younis, Naveed; Worth, Joy; Greenstein, Adam; Soran, Handrean; Wierzbicki, Anthony; Goldsmith, David J


    In recent decades we have seen a surge in the incidence of diabetes in industrialized nations; a threat which has now extended to the developing world. Type 2 diabetes is associated with significant microvascular and macrovascular disease, with considerable impact on morbidity and mortality. Recent evidence has cast uncertainty on the benefits of very tight glycaemic goals in these individuals. The natural history of disease follows an insidious course from disordered glucose metabolism in a pre-diabetic state, often with metabolic syndrome and obesity, before proceeding to diabetes mellitus. In the research setting, lifestyle, pharmacological and surgical intervention targeted against obesity and glycaemia has shown that metabolic disturbances can be halted and indeed regressed if introduced at an early stage of disease. In addition to traditional anti-diabetic medications such as the glinides, sulphonylureas and the glitazones, novel therapies manipulating the endocannabinoid system, neurotransmitters, intestinal absorption and gut hormones have shown dual benefit in weight loss and glycaemic control normalisation. Whilst these treatments will not and should not replace lifestyle change, they will act as invaluable adjuncts for weight loss and aid in normalising the metabolic profile of individuals at risk of diabetes. Utilizing novel therapies to prevent diabetes should be the focus of future research, with the aim of preventing the challenging microvascular and macrovascular complications, and ultimately cardiovascular death.

  20. 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)


    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.

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

    DEFF Research Database (Denmark)

    Bhowmik, Subrata


    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...... to determine the damper current based on the derived optimal damper force. For that reason an inverse MR damper model is also designed based on the neural network identification of the particular rotary MR damper. The performance of the proposed controller is compared to that of an optimal pure viscous damper...

  2. Surgical strategies in the treatment of chronic pancreatitis: An updated systematic review and meta-analysis of randomized controlled trials. (United States)

    Zhao, Xin; Cui, Naiqiang; Wang, Ximo; Cui, Yunfeng


    Chronic pancreatitis (CP) is a common and frequently occurring disease. Pancreaticoduodenectomy (PD), pylorus-preserving pancreaticoduodenectomy (PPPD), and duodenum-preserving pancreatic head resection (DPPHR) are important treatment options for patients with chronic pancreatitis. The Beger and Frey procedures are 2 main duodenum-preserving techniques in duodenum-preserving pancreatic head resection (DPPHR) strategies. We conducted this systematic review and meta-analysis to compare the clinical efficacy of DPPHR versus PD, the Beger procedure versus PD, the Frey procedure versus PD, and the Beger procedure versus the Frey procedure in the treatment of pancreatitis. The optimal surgical option for chronic pancreatitis is still under debate. The aim of this systematic review and meta-analysis was to evaluate the clinical efficacy of different surgical strategies for chronic pancreatitis. Five databases (PubMed, Medline, SinoMed, Embase, and Cochrane Library) were searched with the limitations of human subjects and randomized controlled trials (RCTs) text. Data were extracted by 2 of the coauthors independently and analyzed using the RevMan statistical software, version 5.3. Weighted mean differences (WMDs), risk ratios (RRs), and 95% confidence intervals (CIs) were calculated. Cochrane Collaboration's Risk of Bias Tool was used to assess the risk of bias. Seven studies involving a total of 385 patients who underwent the surgical treatments were assessed. The methodological quality of the trials ranged from low to moderate and included PD (n = 134) and DPPHR (n = 251 [Beger procedure = 100; Frey procedure = 109; Beger or Frey procedure = 42]). There were no significant differences between DPPHR and PD in post-operation mortality (RR = 2.89, 95% CI = 0.31-26.87, P = 0.36), pain relief (RR = 1.09, 95% CI = 0.94-1.25, P = 0.26), exocrine insufficiency (follow-up time > 60 months: RR = 0.91, 95% CI = 0.72-1.15, P

  3. Surgical orthodontics. (United States)

    Strohl, Alexis M; Vitkus, Lauren


    The article reviews some commonly used orthodontic treatments as well as new strategies to assist in the correction of malocclusion. Many techniques are used in conjunction with surgical intervention and are a necessary compliment to orthognathic surgery. Basic knowledge of these practices will aid in the surgeon's ability to adequately treat the patient. Many orthodontists and surgeons are eliminating presurgical orthodontics to adopt a strategy of 'surgery first' orthodontics in orthognathic surgery. This has the benefit of immediate improvement in facial aesthetics and shorter treatment times. The advent of virtual surgical planning has helped facilitate the development of this new paradigm by making surgical planning faster and easier. Furthermore, using intraoperative surgical navigation is improving overall precision and outcomes. A variety of surgical and nonsurgical treatments may be employed in the treatment of malocclusion. It is important to be familiar with all options available and tailor the patient's treatment plan accordingly. Surgery-first orthodontics, intraoperative surgical navigation, virtual surgical planning, and 3D printing are evolving new techniques that are producing shorter treatment times and subsequently improving patient satisfaction without sacrificing long-term stability.

  4. Two neural network based strategies for the detection of a total instantaneous blockage of a sodium-cooled fast reactor

    International Nuclear Information System (INIS)

    Martinez-Martinez, Sinuhe; Messai, Nadhir; Jeannot, Jean-Philippe; Nuzillard, Danielle


    The total instantaneous blockage (TIB) of an assembly in the core of a sodium-cooled fast reactor (SFR) is investigated. Such incident could appear as an abnormal rise in temperature on the assemblies neighbouring the blockage. Its detection relies on a dataset of temperature measurements of the assemblies making up the core of the French Phenix Nuclear Reactor. The data are provided by the French Commission of Atomic and Alternatives Energies (CEA). Here, two strategies are proposed depending on whether the sensor measurement of the suspected assembly is reliable or not. The proposed methodology implements a time-lagged feed-forward neural (TLFFN) Network in order to predict the one-step-ahead temperature of a given assembly. The incident is declared if the difference between the predicted process and the actual one exceeds a threshold. In these simulated conditions, the method is efficient to detect small gradients as expected in reality. - Highlights: • We study the total instantaneous blockage (TIB) of a sodium-cooled fast reactor. • The TIB symptom is simulated as an abrupt rise on temperature (0.1–1 °C/s). • The goal is to improve the early detection of the incident. • Two strategies laying on neural networks are proposed. • TIB is detected in 3 s for 1 °C/s and 18–21 s for 0.1 °C/s

  5. 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.


    strategy groups except for the best performing one. Strategy use was a mediator and largely explained the relation between age and variance in activation patterns in the DLPFC and the SPC, but not in the ACC. These findings are interpreted vis-à-vis age versus performance predictors of brain development....... Keywords: feedback learning, functional brain activation, development, latent mixture models, strategy use...

  6. 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


    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.

  7. "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.


    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

  8. "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.


    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

  9. Testicular neoplasia in undescended testes of cryptorchid boys-does surgical strategy have an impact on the risk of invasive testicular neoplasia?

    DEFF Research Database (Denmark)

    Cortes, Dina; Thorup, Jørgen Mogens; Petersen, Bodil Laub


    We investigated whether or not surgical strategy has an impact on the risk of invasive testicular neoplasia in cases of cryptorchidism. We made a database study of the incidence of testicular neoplasia at surgery for cryptorchidism in childhood, and evaluated if such abnormalities were found......, p placed...

  10. Strategies for memory-based decision making : Modeling behavioral and neural signatures within a cognitive architecture

    NARCIS (Netherlands)

    Fechner, Hanna B; Pachur, Thorsten; Schooler, Lael J; Mehlhorn, Katja; Battal, Ceren; Volz, Kirsten G; Borst, Jelmer P.


    How do people use memories to make inferences about real-world objects? We tested three strategies based on predicted patterns of response times and blood-oxygen-level-dependent (BOLD) responses: one strategy that relies solely on recognition memory, a second that retrieves additional knowledge, and

  11. Artificial neural network approach to predict surgical site infection after free-flap reconstruction in patients receiving surgery for head and neck cancer. (United States)

    Kuo, Pao-Jen; Wu, Shao-Chun; Chien, Peng-Chen; Chang, Shu-Shya; Rau, Cheng-Shyuan; Tai, Hsueh-Ling; Peng, Shu-Hui; Lin, Yi-Chun; Chen, Yi-Chun; Hsieh, Hsiao-Yun; Hsieh, Ching-Hua


    The aim of this study was to develop an effective surgical site infection (SSI) prediction model in patients receiving free-flap reconstruction after surgery for head and neck cancer using artificial neural network (ANN), and to compare its predictive power with that of conventional logistic regression (LR). There were 1,836 patients with 1,854 free-flap reconstructions and 438 postoperative SSIs in the dataset for analysis. They were randomly assigned tin ratio of 7:3 into a training set and a test set. Based on comprehensive characteristics of patients and diseases in the absence or presence of operative data, prediction of SSI was performed at two time points (pre-operatively and post-operatively) with a feed-forward ANN and the LR models. In addition to the calculated accuracy, sensitivity, and specificity, the predictive performance of ANN and LR were assessed based on area under the curve (AUC) measures of receiver operator characteristic curves and Brier score. ANN had a significantly higher AUC (0.892) of post-operative prediction and AUC (0.808) of pre-operative prediction than LR (both P <0.0001). In addition, there was significant higher AUC of post-operative prediction than pre-operative prediction by ANN (p<0.0001). With the highest AUC and the lowest Brier score (0.090), the post-operative prediction by ANN had the highest overall predictive performance. The post-operative prediction by ANN had the highest overall performance in predicting SSI after free-flap reconstruction in patients receiving surgery for head and neck cancer.

  12. 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


    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.

  13. Strategy of arm movement control is determined by minimization of neural effort for joint coordination. (United States)

    Dounskaia, Natalia; Shimansky, Yury


    Optimality criteria underlying organization of arm movements are often validated by testing their ability to adequately predict hand trajectories. However, kinematic redundancy of the arm allows production of the same hand trajectory through different joint coordination patterns. We therefore consider movement optimality at the level of joint coordination patterns. A review of studies of multi-joint movement control suggests that a 'trailing' pattern of joint control is consistently observed during which a single ('leading') joint is rotated actively and interaction torque produced by this joint is the primary contributor to the motion of the other ('trailing') joints. A tendency to use the trailing pattern whenever the kinematic redundancy is sufficient and increased utilization of this pattern during skillful movements suggests optimality of the trailing pattern. The goal of this study is to determine the cost function minimization of which predicts the trailing pattern. We show that extensive experimental testing of many known cost functions cannot successfully explain optimality of the trailing pattern. We therefore propose a novel cost function that represents neural effort for joint coordination. That effort is quantified as the cost of neural information processing required for joint coordination. We show that a tendency to reduce this 'neurocomputational' cost predicts the trailing pattern and that the theoretically developed predictions fully agree with the experimental findings on control of multi-joint movements. Implications for future research of the suggested interpretation of the trailing joint control pattern and the theory of joint coordination underlying it are discussed.

  14. Anterolateral Approach for Central Thoracic Disc Prolapse-Surgical Strategies Used to Tackle Differing Operative Findings: 3-Dimensional Operative Video. (United States)

    Patel, Krunal; Budohoski, Karol P; Kenyon, Olivia R P; Barone, Damiano G; Santarius, Thomas; Kirollos, Ramez W; Mannion, Richard J; Trivedi, Rikin A


    Thoracic disc prolapses causing cord compression can be challenging. For compressive central disc protrusions, a posterior approach is not suitable due to an unacceptable level of cord manipulation. An anterolateral transthoracic approach provides direct access to the disc prolapse allowing for decompression without disturbing the spinal cord. In this video, we describe 2 cases of thoracic myelopathy from a compressive central thoracic disc prolapse. In both cases, informed consent was obtained. Despite similar radiological appearances of heavy calcification, intraoperatively significant differences can be encountered. We demonstrate different surgical strategies depending on the consistency of the disc and the adherence to the thecal sac. With adequate exposure and detachment from adjacent vertebral bodies, soft discs can be, in most instances, separated from the theca with minimal cord manipulation. On the other hand, largely calcified discs often present a significantly greater challenge and require thinning the disc capsule before removal. In cases with significant adherence to dura, in order to prevent cord injury or cerebrospinal fluid leak a thinned shell can be left, providing total detachment from adjacent vertebrae can be achieved. Postoperatively, the first patient, with a significantly calcified disc, developed a transient left leg weakness which recovered by 3-month follow-up. This video outlines the anatomical considerations and operative steps for a transthoracic approach to a central disc prolapse, whilst demonstrating that computed tomography appearances are not always indicative of potential operative difficulties.

  15. Barrier Function-Based Neural Adaptive Control With Locally Weighted Learning and Finite Neuron Self-Growing Strategy. (United States)

    Jia, Zi-Jun; Song, Yong-Duan


    This paper presents a new approach to construct neural adaptive control for uncertain nonaffine systems. By integrating locally weighted learning with barrier Lyapunov function (BLF), a novel control design method is presented to systematically address the two critical issues in neural network (NN) control field: one is how to fulfill the compact set precondition for NN approximation, and the other is how to use varying rather than a fixed NN structure to improve the functionality of NN control. A BLF is exploited to ensure the NN inputs to remain bounded during the entire system operation. To account for system nonlinearities, a neuron self-growing strategy is proposed to guide the process for adding new neurons to the system, resulting in a self-adjustable NN structure for better learning capabilities. It is shown that the number of neurons needed to accomplish the control task is finite, and better performance can be obtained with less number of neurons as compared with traditional methods. The salient feature of the proposed method also lies in the continuity of the control action everywhere. Furthermore, the resulting control action is smooth almost everywhere except for a few time instants at which new neurons are added. Numerical example illustrates the effectiveness of the proposed approach.

  16. 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


    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.

  17. The effect of encoding strategy on the neural correlates of memory for faces. (United States)

    Bernstein, Lori J; Beig, Sania; Siegenthaler, Amy L; Grady, Cheryl L


    Encoding and recognition of unfamiliar faces in young adults were examined using positron emission tomography to determine whether different encoding strategies would lead to encoding/retrieval differences in brain activity. Three types of encoding were compared: a 'deep' task (judging pleasantness/unpleasantness), a 'shallow' task (judging right/left orientation), and an intentional learning task in which subjects were instructed to learn the faces for a subsequent memory test but were not provided with a specific strategy. Memory for all faces was tested with an old/new recognition test. A modest behavioral effect was obtained, with deeply-encoded faces being recognized more accurately than shallowly-encoded or intentionally-learned faces. Regardless of encoding strategy, encoding activated a primarily ventral system including bilateral temporal and fusiform regions and left prefrontal cortices, whereas recognition activated a primarily dorsal set of regions including right prefrontal and parietal areas. Within encoding, the type of strategy produced different brain activity patterns, with deep encoding being characterized by left amygdala and left anterior cingulate activation. There was no effect of encoding strategy on brain activity during the recognition conditions. Posterior fusiform gyrus activation was related to better recognition accuracy in those conditions encouraging perceptual strategies, whereas activity in left frontal and temporal areas correlated with better performance during the 'deep' condition. Results highlight three important aspects of face memory: (1) the effect of encoding strategy was seen only at encoding and not at recognition; (2) left inferior prefrontal cortex was engaged during encoding of faces regardless of strategy; and (3) differential activity in fusiform gyrus was found, suggesting that activity in this area is not only a result of automatic face processing but is modulated by controlled processes.

  18. Adaptive control strategy for ECRH negative high-voltage power supply based on CMAC neural network

    International Nuclear Information System (INIS)

    Luo Xiaoping; Du Pengying; Du Shaowu


    In order to solve the problem that the negative high-voltage power supply in an electron cyclotron resonance heating (ECRH) system can not satisfy the requirements because of the nonlinearity and sensitivity, the direct inverse model control strategy was proposed by using cerebellar model articulation controller(CMAC) for better control, and experiments were carried out to study the system performances with CMAC tracing dynamic signals. The results show that this strategy is strong in self-learning and self-adaptation and easy to be realized. (authors)

  19. [Relationship between Work Ⅱ type of congenital first branchial cleft anomaly and facial nerve and surgical strategies]. (United States)

    Zhang, B; Chen, L S; Huang, S L; Liang, L; Gong, X X; Wu, P N; Zhang, S Y; Luo, X N; Zhan, J D; Sheng, X L; Lu, Z M


    Objective: To investigate the relationship between Work Ⅱ type of congenital first branchial cleft anomaly (CFBCA) and facial nerve and discuss surgical strategies. Methods: Retrospective analysis of 37 patients with CFBCA who were treated from May 2005 to September 2016. Among 37 cases with CFBCA, 12 males and 25 females; 24 in the left and 13 in the right; the age at diagnosis was from 1 to 76 ( years, with a median age of 20, 24 cases with age of 18 years or less and 13 with age more than 18 years; duration of disease ranged from 1 to 10 years (median of 6 years); 4 cases were recurren after fistula resection. According to the classification of Olsen, all 37 cases were non-cyst (sinus or fistula). External fistula located over the mandibular angle in 28 (75.7%) cases and below the angle in 9 (24.3%) cases. Results: Surgeries were performed successfully in all the 37 cases. It was found that lesions located at anterior of the facial nerve in 13 (35.1%) cases, coursed between the branches in 3 cases (8.1%), and lied in the deep of the facial nerve in 21 (56.8%) cases. CFBCA in female with external fistula below mandibular angle and membranous band was more likely to lie deep of the facial nerve than in male with external fistula over the mandibular angle but without myringeal web. Conclusions: CFBCA in female patients with a external fistula located below the mandibular angle, non-cyst of Olsen or a myringeal web is more likely to lie deep of the facial nerve. Surgeons should particularly take care of the protection of facial nerve in these patients, if necessary, facial nerve monitoring technology can be used during surgery to complete resection of lesions.

  20. 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.

  1. Transmission Dynamics of Carbapenemase-Producing Klebsiella Pneumoniae and Anticipated Impact of Infection Control Strategies in a Surgical Unit (United States)

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


    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 R0 (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. R0 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. PMID:22859965

  2. Cognitive and Neural Determinants of Response Strategy in the Dual-Solution Plus-Maze Task (United States)

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


    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…

  3. Neural bases of a specific strategy for visuospatial processing in rugby players. (United States)

    Sekiguchi, Atsushi; Yokoyama, Satoru; Kasahara, Satoshi; Yomogida, Yukihito; Takeuchi, Hikaru; Ogawa, Takeshi; Taki, Yasuyuki; Niwa, Shin-Ichi; Kawashima, Ryuta


    Rugby is one of the most tactically complex sports. Rugby coaching theory suggests that rugby players need to possess various cognitive abilities. A previous study claimed that rugby players have high visuospatial awareness, which is induced by a strategy described as taking a "bird's eye view." To examine if there were differential cortical networks related to visuospatial processing tasks among top-level rugby players and control novices, we compared brain activities during a visuospatial processing task between 20 male top-level rugby players (Top) and 20 control novice males (Novice) using functional magnetic resonance imaging (fMRI). To avoid the effect of differential behavioral performances on brain activation, we recruited novices whose visuospatial ability was expected to match that of the rugby players. We adopted a 3-D mental rotation task during fMRI scanning as a visuospatial processing task. Significantly greater activations from baseline were observed for the Top group than for the Novice group in the right superior parietal lobe and lateral occipital cortex. Significantly greater deactivations from baseline were observed for the Top group than for the Novice group in the right medial prefrontal cortex. The discrepancy between psychobehavioral outputs and the fMRI results suggested the existence of a cognitive strategy among top-level rugby players that differs from that among control novices. The greater activation of the right superior parietal lobe and lateral occipital cortex in top-level rugby players suggested a strategy involving visuospatial cognitive processing with respect to the bird's eye view. In addition, the right medial prefrontal cortex is known to be a part of the default mode networks, suggesting an additional cognitive load for the Top group when using the bird's-eye-view strategy. This further supported the existence of a specific cognitive strategy among top-level rugby players.

  4. Neural Network-Based State Estimation for a Closed-Loop Control Strategy Applied to a Fed-Batch Bioreactor

    Directory of Open Access Journals (Sweden)

    Santiago Rómoli


    Full Text Available The lack of online information on some bioprocess variables and the presence of model and parametric uncertainties pose significant challenges to the design of efficient closed-loop control strategies. To address this issue, this work proposes an online state estimator based on a Radial Basis Function (RBF neural network that operates in closed loop together with a control law derived on a linear algebra-based design strategy. The proposed methodology is applied to a class of nonlinear systems with three types of uncertainties: (i time-varying parameters, (ii uncertain nonlinearities, and (iii unmodeled dynamics. To reduce the effect of uncertainties on the bioreactor, some integrators of the tracking error are introduced, which in turn allow the derivation of the proper control actions. This new control scheme guarantees that all signals are uniformly and ultimately bounded, and the tracking error converges to small values. The effectiveness of the proposed approach is illustrated on the basis of simulated experiments on a fed-batch bioreactor, and its performance is compared with two controllers available in the literature.

  5. Age-Related Differences in Neural Recruitment During the Use of Cognitive Reappraisal and Selective Attention as Emotion Regulation Strategies

    Directory of Open Access Journals (Sweden)

    Eric S Allard


    Full Text Available 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 X 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.

  6. Evaluation of the Influential Factors in Cancelling Surgical Operations and Developing Management Strategies to Reduce these Factors in Shahid Kamyab Hospital of Mashhad, Iran during 2012-2013

    Directory of Open Access Journals (Sweden)

    Amir Ashkan Nasiripour


    Conclusion: According to the results, most of the causes of surgery cancellation were patient-related. Therefore, it is suggested that patient evaluation be performed by surgeons and anesthesiologists prior to the surgical operation in order to prevent clinical problems during the surgery, offer insurance strategies, and solve the problems relating to the healthcare costs for the less privileged patients, especially those requiring surgery after accidents.

  7. Multi-mode energy management strategy for fuel cell electric vehicles based on driving pattern identification using learning vector quantization neural network algorithm (United States)

    Song, Ke; Li, Feiqiang; Hu, Xiao; He, Lin; Niu, Wenxu; Lu, Sihao; Zhang, Tong


    The development of fuel cell electric vehicles can to a certain extent alleviate worldwide energy and environmental issues. While a single energy management strategy cannot meet the complex road conditions of an actual vehicle, this article proposes a multi-mode energy management strategy for electric vehicles with a fuel cell range extender based on driving condition recognition technology, which contains a patterns recognizer and a multi-mode energy management controller. This paper introduces a learning vector quantization (LVQ) neural network to design the driving patterns recognizer according to a vehicle's driving information. This multi-mode strategy can automatically switch to the genetic algorithm optimized thermostat strategy under specific driving conditions in the light of the differences in condition recognition results. Simulation experiments were carried out based on the model's validity verification using a dynamometer test bench. Simulation results show that the proposed strategy can obtain better economic performance than the single-mode thermostat strategy under dynamic driving conditions.

  8. Two-phase strategy of neural control for planar reaching movements: II--relation to spatiotemporal characteristics of movement trajectory. (United States)

    Rand, Miya K; Shimansky, Yury P


    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

  9. Surgical Assisting (United States)

    ... instruction, including: Microbiology Pathophysiology Pharmacology Anatomy and physiology Medical terminology Curriculum . Course content includes: Advanced surgical anatomy Surgical microbiology Surgical pharmacology Anesthesia methods and agents Bioscience Ethical ...

  10. Horizontal infection control strategy decreases methicillin-resistant Staphylococcus aureus infection and eliminates bacteremia in a surgical ICU without active surveillance. (United States)

    Traa, Maria X; Barboza, Lorena; Doron, Shira; Snydman, David R; Noubary, Farzad; Nasraway, Stanley A


    Methicillin-resistant Staphylococcus aureus infection is a significant contributor to morbidity and mortality in hospitalized patients worldwide. Numerous healthcare bodies in Europe and the United States have championed active surveillance per the "search and destroy" model. However, this strategy is associated with significant economic, logistical, and patient costs without any impact on other hospital-acquired pathogens. We evaluated whether horizontal infection control strategies could decrease the prevalence of methicillin-resistant S. aureus infection in the ICU, without the need for active surveillance. Retrospective, observational study in the surgical ICU of a tertiary care medical center in Boston, MA, from 2005 to 2012. A total of 6,697 patients in the surgical ICU. Evidence-based infection prevention strategies were implemented in an iterative fashion, including 1) hand hygiene program with refresher education campaign, 2) chlorhexidine oral hygiene program, 3) chlorhexidine bathing, 4) catheter-associated bloodstream infection program, and 5) daily goals sheets. The prevalence of methicillin-resistant S. aureus infection fell from 2.66 to 0.69 per 1,000 patient days from 2005 to 2012, an average decrease of 21% per year. The biggest decline in rate of infection was detected in 2008, which may suggest that the catheter-associated bloodstream infection prevention program was particularly effective. Among 4,478 surgical ICU admissions over the last 5 years, not a single case of methicillin-resistant S. aureus bacteremia was observed. Aggressive multifaceted horizontal infection control is an effective strategy for reducing the prevalence of methicillin-resistant S. aureus infection and eliminating methicillin-resistant S. aureus bacteremia in the ICU without the need for active surveillance and decontamination.

  11. Abortion - surgical (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. Prostate segmentation in MRI using a convolutional neural network architecture and training strategy based on statistical shape models. (United States)

    Karimi, Davood; Samei, Golnoosh; Kesch, Claudia; Nir, Guy; Salcudean, Septimiu E


    Most of the existing convolutional neural network (CNN)-based medical image segmentation methods are based on methods that have originally been developed for segmentation of natural images. Therefore, they largely ignore the differences between the two domains, such as the smaller degree of variability in the shape and appearance of the target volume and the smaller amounts of training data in medical applications. We propose a CNN-based method for prostate segmentation in MRI that employs statistical shape models to address these issues. Our CNN predicts the location of the prostate center and the parameters of the shape model, which determine the position of prostate surface keypoints. To train such a large model for segmentation of 3D images using small data (1) we adopt a stage-wise training strategy by first training the network to predict the prostate center and subsequently adding modules for predicting the parameters of the shape model and prostate rotation, (2) we propose a data augmentation method whereby the training images and their prostate surface keypoints are deformed according to the displacements computed based on the shape model, and (3) we employ various regularization techniques. Our proposed method achieves a Dice score of 0.88, which is obtained by using both elastic-net and spectral dropout for regularization. Compared with a standard CNN-based method, our method shows significantly better segmentation performance on the prostate base and apex. Our experiments also show that data augmentation using the shape model significantly improves the segmentation results. Prior knowledge about the shape of the target organ can improve the performance of CNN-based segmentation methods, especially where image features are not sufficient for a precise segmentation. Statistical shape models can also be employed to synthesize additional training data that can ease the training of large CNNs.

  13. Biomechanical investigation of different surgical strategies for the treatment of rib fractures using a three-dimensional human respiratory model. (United States)

    Shih, Kao-Shang; Truong, Thanh An; Hsu, Ching-Chi; Hou, Sheng-Mou


    Rib fracture is a common injury and can result in pain during respiration. Conservative treatment of rib fracture is applied via mechanical ventilation. However, ventilator-associated complications frequently occur. Surgical fixation is another approach to treat rib fractures. Unfortunately, this surgical treatment is still not completely defined. Past studies have evaluated the biomechanics of the rib cage during respiration using a finite element method, but only intact conditions were modelled. Thus, the purpose of this study was to develop a realistic numerical model of the human rib cage and to analyse the biomechanical performance of intact, injured and treated rib cages. Three-dimensional finite element models of the human rib cage were developed. Respiratory movement of the human rib cage was simulated to evaluate the strengths and limitations of different scenarios. The results show that a realistic human respiratory movement can be simulated and the predicted results were closely related to previous study (correlation coefficient>0.92). Fixation of two fractured ribs significantly decreased the fixation index (191%) compared to the injured model. This fixation may provide adequate fixation stability as well as reveal lower bone stress and implant stress compared with the fixation of three or more fractured ribs.

  14. Expression of neuronal antigens and related ventral and dorsal proteins in the normal spinal cord and a surgically induced open neural tube defect of the spine in chick embryos: an immunohistochemical study. (United States)

    Lee, Do-Hun; Phi, Ji Hoon; Chung, You-Nam; Lee, Yun-Jin; Kim, Seung-Ki; Cho, Byung-Kyu; Kim, Dong Won; Park, Moon-Sik; Wang, Kyu-Chang


    The aims of this study were to elucidate the processes of neuronal differentiation and ventrodorsal patterning in the spinal cord of the chick embryo from embryonic day (E) 3 to E17 and to study the effect of a prenatal spinal open neural tube defect (ONTD) on these processes. Expression patterns of neuronal antigens (neuronal nuclear antigen, neurofilament-associated protein (NAP), and synaptophysin) and related ventral markers [sonic hedgehog, paired box gene (PAX)6, and islet-1], and dorsal markers (bone morphogenetic protein, Notch homolog 1, and PAX7) were investigated in the normal spinal cord and in a surgically induced spinal ONTD in chick embryos. Four normal and ONTD chick embryos were used for each antigen group. There were no differences in the expression of neuronal and ventrodorsal markers between the control and ONTD groups. NAP and synaptophysin were useful for identifying dorsal structures in the distorted anatomy of the ONTD chicks.

  15. Ca(2+) coding and decoding strategies for the specification of neural and renal precursor cells during development. (United States)

    Moreau, Marc; Néant, Isabelle; Webb, Sarah E; Miller, Andrew L; Riou, Jean-François; Leclerc, Catherine


    During embryogenesis, a rise in intracellular Ca(2+) is known to be a widespread trigger for directing stem cells towards a specific tissue fate, but the precise Ca(2+) signalling mechanisms involved in achieving these pleiotropic effects are still poorly understood. In this review, we compare the Ca(2+) signalling events that appear to be one of the first steps in initiating and regulating both neural determination (neural induction) and kidney development (nephrogenesis). We have highlighted the necessary and sufficient role played by Ca(2+) influx and by Ca(2+) transients in the determination and differentiation of pools of neural or renal precursors. We have identified new Ca(2+) target genes involved in neural induction and we showed that the same Ca(2+) early target genes studied are not restricted to neural tissue but are also present in other tissues, principally in the pronephros. In this review, we also described a mechanism whereby the transcriptional control of gene expression during neurogenesis and nephrogenesis might be directly controlled by Ca(2+) signalling. This mechanism involves members of the Kcnip family such that a change in their binding properties to specific DNA sites is a result of Ca(2+) binding to EF-hand motifs. The different functions of Ca(2+) signalling during these two events illustrate the versatility of Ca(2+) as a second messenger. Copyright © 2015 Elsevier Ltd. All rights reserved.

  16. Fronto-orbital feminization technique. A surgical strategy using fronto-orbital burring with or without eggshell technique to optimize the risk/benefit ratio. (United States)

    Villepelet, A; Jafari, A; Baujat, B


    The demand for facial feminization is increasing in transsexual patients. Masculine foreheads present extensive supraorbital bossing with a more acute glabellar angle, whereas female foreheads show softer features. The aim of this article is to describe our surgical technique for fronto-orbital feminization. The mask-lift technique is an upper face-lift. It provides rejuvenation by correcting collapsed features, and fronto-orbital feminization through burring of orbital rims and lateral canthopexies. Depending on the size of the frontal sinus and the thickness of its anterior wall, frontal remodeling is achieved using simple burring or by means of the eggshell technique. Orbital remodeling comprises a superolateral orbital opening, a reduction of ridges and a trough at the lateral orbital rim to support the lateral canthopexy. Frontal, corrugator and procerus myectomies, plus minimal scalp excision, complete the surgery. Our technique results in significant, natural-looking feminization. No complications were observed in our series of patients. The eggshell technique is an alternative to bone flap on over-pneumatized sinus. Fronto-orbital feminization fits into a wider surgical strategy. It can be associated to rhinoplasty, genioplasty, mandibular angle remodeling, face lift and laryngoplasty. Achieving facial feminization in 2 or 3 stages improves psychological and physiological tolerance. Copyright © 2018 Elsevier Masson SAS. All rights reserved.

  17. Strategies for net cost reductions with the expanded role and expertise of anesthesiologists in the perioperative surgical home. (United States)

    Dexter, Franklin; Wachtel, Ruth E


    The Perioperative Surgical Home is a model adopted by the American Society of Anesthesiologists to increase quality and patient safety and to decrease costs. This Special Article is about the latter topic. Using narrative review, we show that there are two principal opportunities for net cost reduction. One opportunity is to reduce unnecessary interventions that do not have potential to benefit patients (e.g., preoperative laboratory studies in healthy patients undergoing low-risk surgery and use of substantial fresh gas flows with volatile anesthetics). The other opportunity is to optimize staff scheduling, case scheduling, and staff assignment. These two are the same as the principal ways that a positive return on investment can be achieved from use of an anesthesia information management system. Three other opportunities are much less likely to achieve as large (if any) net cost reduction among all patients but may at some hospitals. These are to reduce cancellations, operating room times, and/or hospital postoperative lengths of stay.

  18. Surgical lighting

    NARCIS (Netherlands)

    Knulst, A.J.


    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,

  19. 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. (United States)

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


    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

  20. Predictive factors for lymph node metastasis in poorly differentiated early gastric cancer and their impact on the surgical strategy (United States)

    Li, Hua; Lu, Ping; Lu, Yang; Liu, Cai-Gang; Xu, Hui-Mian; Wang, Shu-Bao; Chen, Jun-Qing


    AIM: To identify the predictive clinicopathological factors for lymph node metastasis (LNM) in poorly differentiated early gastric cancer (EGC) and to further expand the possibility of using endoscopic mucosal resection (EMR) for the treatment of poorly differentiated EGC. METHODS: Data were collected from 85 poorly-differentiated EGC patients who were surgically treated. Association between the clinicopathological factors and the presence of LNM was retrospectively analyzed by univariate and multivariate logistic regression analyses. RESULTS: Univariate analysis showed that tumor size (OR = 5.814, 95% CI = 1.050 - 32.172, P = 0.044), depth of invasion (OR = 10.763, 95% CI = 1.259 - 92.026, P = 0.030) and lymphatic vessel involvement (OR = 61.697, 95% CI = 2.144 - 175.485, P = 0.007) were the significant and independent risk factors for LNM. The LNM rate was 5.4%, 42.9% and 50%, respectively, in poorly differentiated EGC patients with one, two and three of the risk factors, respectively. No LNM was found in 25 patients without the three risk factors. Forty-four lymph nodes were found to have metastasis, 29 (65.9%) and 15 (34.1%) of the lymph nodes involved were within N1 and beyond N1, respectively, in 12 patients with LNM. CONCLUSION: Endoscopic mucosal resection alone may be sufficient to treat poorly differentiated intramucosal EGC (≤ 2.0 cm in diameter) with no histologically-confirmed lymphatic vessel involvement. When lymphatic vessels are involved, lymph node dissection beyond limited (D1) dissection or D1+ lymph node dissection should be performed depending on the tumor location. PMID:18636670

  1. Non-surgical care in patients with hip or knee osteoarthritis is modestly consistent with a stepped care strategy after its implementation. (United States)

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


    To improve the management of hip or knee osteoarthritis (OA), a stepped care strategy (SCS) has been developed that presents the optimal sequence for care in three steps. This study evaluates the extent to which clinical practice is consistent with the strategy after implementation and identifies determinants of SCS-consistent care. A 2-year observational prospective cohort study. General practices in the region of Nijmegen in the Netherlands. Three hundred and thirteen patients with hip or knee OA and their general practitioner (GP). Multifaceted interventions were developed to implement the strategy. Consistency between clinical practice and the strategy was examined regarding three aspects of care: (i) timing of radiological assessment, (ii) sequence of non-surgical treatment options and (iii) making follow-up appointments. Out of the 212 patients who reported to have had an X-ray, 92 (44%) received it in line with the SCS. The sequence of treatment was inconsistent with the SCS in 58% of the patients, which was mainly caused by the underuse of lifestyle advice and dietary therapy. In 57% of the consultations, the patient reported to have been advised to make a follow-up appointment. No determinants that influenced all three aspects of care were identified. Consistency with the SCS was found in about half of the patients for each of the three aspects of care. Health care can be further optimized by encouraging GP s to use X-rays more appropriately and to make more use of lifestyle advice, dietary therapy and follow-up appointments. © The Author 2014. Published by Oxford University Press in association with the International Society for Quality in Health Care; all rights reserved.

  2. Behavioural and neural modulation of win-stay but not lose-shift strategies as a function of outcome value in Rock, Paper, Scissors. (United States)

    Forder, Lewis; Dyson, Benjamin James


    Competitive environments in which individuals compete for mutually-exclusive outcomes require rational decision making in order to maximize gains but often result in poor quality heuristics. Reasons for the greater reliance on lose-shift relative to win-stay behaviour shown in previous studies were explored using the game of Rock, Paper, Scissors and by manipulating the value of winning and losing. Decision-making following a loss was characterized as relatively fast and relatively inflexible both in terms of the failure to modulate the magnitude of lose-shift strategy and the lack of significant neural modulation. In contrast, decision-making following a win was characterized as relatively slow and relatively flexible both in terms of a behavioural increase in the magnitude of win-stay strategy and a neural modulation of feedback-related negativity (FRN) and stimulus-preceding negativity (SPN) following outcome value modulation. The win-stay/lose-shift heuristic appears not to be a unified mechanism, with the former relying on System 2 processes and the latter relying on System 1 processes. Our ability to play rationally appears more likely when the outcome is positive and when the value of wins are low, highlighting how vulnerable we can be when trying to succeed during competition.

  3. The effect of strategies, goals and stimulus material on the neural mechanisms of emotion regulation: A meta-analysis of fMRI studies. (United States)

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


    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.

  4. A risk to himself: attitudes toward psychiatric patients and choice of psychosocial strategies among nurses in medical-surgical units. (United States)

    MacNeela, Pádraig; Scott, P Anne; Treacy, Margaret; Hyde, Abbey; O'Mahony, Rebecca


    Psychiatric patients are liable to stereotyping by healthcare providers. We explored attitudes toward caring for psychiatric patients among 13 nurses working in general hospitals in Ireland. Participants thought aloud in response to a simulated patient case and described a critical incident of a patient for whom they had cared. Two attitudinal orientations were identified that correspond to stereotypical depictions of risk and vulnerability. The nurses described psychosocial care strategies that were pragmatic rather than authentically person-centered, with particular associations between risk-oriented attitudes and directive nursing care. Nurses had expectations likely to impede relationship building and collaborative care. Implications arising include the need for improved knowledge about psychiatric conditions and for access to professional development in targeted therapeutic communication skills. Copyright © 2012 Wiley Periodicals, Inc.

  5. Surgical smoke. (United States)

    Fan, Joe King-Man; Chan, Fion Siu-Yin; Chu, Kent-Man


    Surgical smoke is the gaseous by-product formed during surgical procedures. Most surgeons, operating theatre staff and administrators are unaware of its potential health risks. Surgical smoke is produced by various surgical instruments including those used in electrocautery, lasers, ultrasonic scalpels, high speed drills, burrs and saws. The potential risks include carbon monoxide toxicity to the patient undergoing a laparoscopic operation, pulmonary fibrosis induced by non-viable particles, and transmission of infectious diseases like human papilloma virus. Cytotoxicity and mutagenicity are other concerns. Minimisation of the production of surgical smoke and modification of any evacuation systems are possible solutions. In general, a surgical mask can provide more than 90% protection to exposure to surgical smoke; however, in most circumstances it cannot provide air-tight protection to the user. An at least N95 grade or equivalent respirator offers the best protection against surgical smoke, but whether such protection is necessary is currently unknown.

  6. Novel experimental surgical strategy to prevent traumatic neuroma formation by combining a 3D-printed Y-tube with an autograft. (United States)

    Bolleboom, Anne; de Ruiter, Godard C W; Coert, J Henk; Tuk, Bastiaan; Holstege, Jan C; van Neck, Johan W


    OBJECTIVE Traumatic neuromas may develop after nerve injury at the proximal nerve stump, which can lead to neuropathic pain. These neuromas are often resistant to therapy, and excision of the neuroma frequently leads to recurrence. In this study, the authors present a novel surgical strategy to prevent neuroma formation based on the principle of centro-central anastomosis (CCA), but rather than directly connecting the nerve ends to an autograft, they created a loop using a 3D-printed polyethylene Y-shaped conduit with an autograft in the distal outlets. METHODS The 3D-printed Y-tube with autograft was investigated in a model of rat sciatic nerve transection in which the Y-tube was placed on the proximal sciatic nerve stump and a peroneal graft was placed between the distal outlets of the Y-tube to form a closed loop. This model was compared with a CCA model, in which a loop was created between the proximal tibial and peroneal nerves with a peroneal autograft. Additional control groups consisted of the closed Y-tube and the extended-arm Y-tube. Results were analyzed at 12 weeks of survival using nerve morphometry for the occurrence of neuroma formation and axonal regeneration in plastic semi-thin sections. RESULTS Among the different surgical groups, the Y-tube with interposed autograft was the only model that did not result in neuroma formation at 12 weeks of survival. In addition, a 13% reduction in the number of myelinated axons regenerating through the interposed autograft was observed in the Y-tube with autograft model. In the CCA model, the authors also observed a decrease of 17% in the number of myelinated axons, but neuroma formation was present in this model. The closed Y-tube resulted in minimal nerve regeneration inside the tube together with extensive neuroma formation before the entrance of the tube. The extended-arm Y-tube model clearly showed that the majority of the regenerating axons merged into the Y-tube arm, which was connected to the autograft

  7. Surgical strategies in polytraumatized patients with femoral shaft fractures - comparing a German and an Australian level I trauma centre. (United States)

    Andruszkow, Hagen; Dowrick, Adam S; Frink, Michael; Zeckey, Christian; Krettek, Christian; Hildebrand, Frank; Edwards, Elton R; Mommsen, Philipp


    Femoral shaft fractures are one of the most common injuries in multiple trauma patients. Due to their prognostic relevance, there is an ongoing controversial discussion as to the optimal treatment strategy in terms of Damage Control Orthopaedics (DCO) and Early Total Care (ETC). We aimed to describe the differences in fracture management and clinical outcome of multiple trauma patients with concomitant femoral shaft fractures treated at a German and an Australian level I trauma centre using the same inclusion criteria. Polytraumatized patients (ISS ≥ 16) with a femoral shaft fracture aged ≥ 16 years treated at a German and an Australian trauma centre between 2003 and 2007 were included. According to ETC and DCO management principles, we evaluated demographic parameters as well as posttraumatic complications and clinical outcome. Seventy-three patients were treated at the German and 134 patients at the Australian trauma centre. DCO was performed in case of increased injury severity in both hospitals. Prolonged mechanical ventilation time, and length of ICU and hospital stay were demonstrated in DCO treatment regardless of the trauma centre. No differences concerning posttraumatic complications and survival were found between both centres. Survival of patients after DCO was similar to those managed using ETC despite a greater severity of injury and lower probability of survival. There was no difference in the incidence of ARDS. DCO was, however, associated with a greatly increased length of time on mechanical ventilation and length of stay in the ICU. We found no differences concerning patient demographics or clinical outcomes in terms of incidence of ARDS, MODS, or mortality. As such, we propose that comparability between German and Australian trauma populations is justified. Despite a higher ISS in the DCO group, there were no differences in posttraumatic complications and survival depending on ETC or DCO treatment. Further research is required to confirm

  8. An Evolutionary Perspective of the Relationship Between Corporate Strategy and Performance, Through the Use of Artificial Neural Networks and Genetic AlgorithmsHttp://Dx.Doi.Org/10.5585/Riae.V9i3.1689

    Directory of Open Access Journals (Sweden)

    Alexandre Teixeira Dias


    Full Text Available This study aims to contribute to the understanding of the relationship between Corporate Strategy and Performance, from the perspective of the Evolutionary Theory. As methods of data processing, obtained in secondary databases, we used artificial neural networks and genetic algorithms. The results of processing neural networks and genetic algorithms demonstrate the importance of corporate strategies in determining performance. The evolutionary perspective emphasizes the importance of investing in operations as a factor influencing the adequacy of the organization, in order to achieve an improved performance, in addition to establishing relationships with other organizations, through members of the board.

  9. Two-phase strategy of neural control for planar reaching movements: I. XY coordination variability and its relation to end-point variability. (United States)

    Rand, Miya K; Shimansky, Yury P


    A quantitative model of optimal transport-aperture coordination (TAC) during reach-to-grasp movements has been developed in our previous studies. The utilization of that model for data analysis allowed, for the first time, to examine the phase dependence of the precision demand specified by the CNS for neurocomputational information processing during an ongoing movement. It was shown that the CNS utilizes a two-phase strategy for movement control. That strategy consists of reducing the precision demand for neural computations during the initial phase, which decreases the cost of information processing at the expense of lower extent of control optimality. To successfully grasp the target object, the CNS increases precision demand during the final phase, resulting in higher extent of control optimality. In the present study, we generalized the model of optimal TAC to a model of optimal coordination between X and Y components of point-to-point planar movements (XYC). We investigated whether the CNS uses the two-phase control strategy for controlling those movements, and how the strategy parameters depend on the prescribed movement speed, movement amplitude and the size of the target area. The results indeed revealed a substantial similarity between the CNS's regulation of TAC and XYC. First, the variability of XYC within individual trials was minimal, meaning that execution noise during the movement was insignificant. Second, the inter-trial variability of XYC was considerable during the majority of the movement time, meaning that the precision demand for information processing was lowered, which is characteristic for the initial phase. That variability significantly decreased, indicating higher extent of control optimality, during the shorter final movement phase. The final phase was the longest (shortest) under the most (least) challenging combination of speed and accuracy requirements, fully consistent with the concept of the two-phase control strategy. This paper

  10. Exploring multiple feature combination strategies with a recurrent neural network architecture for off-line handwriting recognition (United States)

    Mioulet, L.; Bideault, G.; Chatelain, C.; Paquet, T.; Brunessaux, S.


    The BLSTM-CTC is a novel recurrent neural network architecture that has outperformed previous state of the art algorithms in tasks such as speech recognition or handwriting recognition. It has the ability to process long term dependencies in temporal signals in order to label unsegmented data. This paper describes different ways of combining features using a BLSTM-CTC architecture. Not only do we explore the low level combination (feature space combination) but we also explore high level combination (decoding combination) and mid-level (internal system representation combination). The results are compared on the RIMES word database. Our results show that the low level combination works best, thanks to the powerful data modeling of the LSTM neurons.

  11. 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


    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.

  12. Surgical strategies in endocrine tumors

    NARCIS (Netherlands)

    Schreinemakers, J.M.J.


    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

  13. Time-dependent fermentation control strategies for enhancing synthesis of marine bacteriocin 1701 using artificial neural network and genetic algorithm. (United States)

    Peng, Jiansheng; Meng, Fanmei; Ai, Yuncan


    The artificial neural network (ANN) and genetic algorithm (GA) were combined to optimize the fermentation process for enhancing production of marine bacteriocin 1701 in a 5-L-stirred-tank. Fermentation time, pH value, dissolved oxygen level, temperature and turbidity were used to construct a "5-10-1" ANN topology to identify the nonlinear relationship between fermentation parameters and the antibiotic effects (shown as in inhibition diameters) of bacteriocin 1701. The predicted values by the trained ANN model were coincided with the observed ones (the coefficient of R(2) was greater than 0.95). As the fermentation time was brought in as one of the ANN input nodes, fermentation parameters could be optimized by stages through GA, and an optimal fermentation process control trajectory was created. The production of marine bacteriocin 1701 was significantly improved by 26% under the guidance of fermentation control trajectory that was optimized by using of combined ANN-GA method. Copyright © 2013 Elsevier Ltd. All rights reserved.

  14. 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


    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.

  15. Surgical intervention in patients with necrotizing pancreatitis

    NARCIS (Netherlands)

    Besselink, MG; de Bruijn, MT; Rutten, JP; Boermeester, MA; Hofker, HS; Gooszen, HG

    Background: This study evaluated the various surgical strategies for treatment of (suspected) infected necrotizing pancreatitis (INP) and patient referrals for this condition in the Netherlands. Methods: This retrospective study included all 106 consecutive patients who had surgical treatment for

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

    DEFF Research Database (Denmark)

    Kehlet, H


    clinical trials have demonstrated a reduction in various aspects of postoperative morbidity by such a nociceptive blockade. Although a causal relationship has still to be demonstrated, these findings strongly argue the concept of "stress-free anesthesia and surgery" as an important instrument in improving......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 suppress the detrimental components of the stress response so as to improve postoperative outcome. Of the various techniques to reduce the surgical stress response, afferent neural blockade with regional anesthesia to relieve pain is the most effective, although not optimal. Data from numerous controlled...

  17. Favorable surgical outcomes of aldosterone-producing adenoma based on lateralization by CT imaging and hypokalemia: a non-AVS-based strategy. (United States)

    Li, Hai; Liu, Jianbin; Feng, Xiujuan; Liu, Liehua; Wei, Guohong; Cao, Xiaopei; Li, Yanbing


    To test the efficacy of a strategy based on CT imaging and clinical characteristics on lateralizing origin of excess aldosterone secretion in primary aldosteronism. Consecutive patients with diagnosed primary hyperaldosteronism from June 2006 to July 2012 in our center underwent adrenal surgeries without pre-operational adrenal venous sampling (AVS) if all the three criteria were met: (1) round- or oval-shaped occupational lesion of low density after contrast enhancement with diameter >1 cm on CT scan was located in one adrenal gland; (2) unequivocally normal contralateral adrenal gland; (3) serum potassium level lower than 3.5 mmol/L. Subjects who had received operation were taken into analysis and follow-ups. One hundred and twenty-five patients fulfilled the criteria and were recruited into our research. One hundred and twenty-two operated patients (97.6%) experienced complete resolution of hypokalemia as well as resolution or improvement in hypertension with reduction in antihypertensive medication, while 3 patients (2.4%) failed to obtain normal kalemia and continued on spironolactone therapy. At a median of 65-month (range 21-93) follow-up of these 122 subjects, 27 patients dropped out (22.1%). The 95 responding patients reported no episodes of paralysis or confirmed hypokalemia or any supplementation of potassium. Multivariate linear correlation analysis showed that plasma potassium level was correlated inversely with tumor diameter (r = -0.258, 95% CI -0.076, -0.514, p = 0.037) and basal plasma aldosterone level (r = -0.251, 95% CI -0.040, -0.464, p = 0.042). Most patients with typical unilateral adrenal macroadenomas, normal contralateral glands and hypokalemia could attain favorable surgical therapeutic outcomes without pre-operational AVS lateralization.

  18. 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, Ali Reza; Andersen, Mathias Neumann


    ) of the eight input variables: soil layer intervals (D), percentages of sand (Sa), silt (Si), and clay (Cl), bulk density of soil layers (Bd), weighted soil moisture deficit during the irrigation strategies period (SMD), geometric mean particle size diameter (dg), and geometric standard deviation (σg......). The results of the study showed that all the nine ANN models predicted the target RLD values satisfactorily with a correlation coefficient R2>0.98. The simplest and most complex ANN architectures were 3:2:1 and 5:5:1 consisting of D, SMD, dg, and D, Bd, SMD, σg, dg as the input variables, respectively. Low...

  19. A vehicle stability control strategy with adaptive neural network sliding mode theory based on system uncertainty approximation (United States)

    Ji, Xuewu; He, Xiangkun; Lv, Chen; Liu, Yahui; Wu, Jian


    Modelling uncertainty, parameter variation and unknown external disturbance are the major concerns in the development of an advanced controller for vehicle stability at the limits of handling. Sliding mode control (SMC) method has proved to be robust against parameter variation and unknown external disturbance with satisfactory tracking performance. But modelling uncertainty, such as errors caused in model simplification, is inevitable in model-based controller design, resulting in lowered control quality. The adaptive radial basis function network (ARBFN) can effectively improve the control performance against large system uncertainty by learning to approximate arbitrary nonlinear functions and ensure the global asymptotic stability of the closed-loop system. In this paper, a novel vehicle dynamics stability control strategy is proposed using the adaptive radial basis function network sliding mode control (ARBFN-SMC) to learn system uncertainty and eliminate its adverse effects. This strategy adopts a hierarchical control structure which consists of reference model layer, yaw moment control layer, braking torque allocation layer and executive layer. Co-simulation using MATLAB/Simulink and AMESim is conducted on a verified 15-DOF nonlinear vehicle system model with the integrated-electro-hydraulic brake system (I-EHB) actuator in a Sine With Dwell manoeuvre. The simulation results show that ARBFN-SMC scheme exhibits superior stability and tracking performance in different running conditions compared with SMC scheme.

  20. ANT Advanced Neural Tool

    Energy Technology Data Exchange (ETDEWEB)

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


    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.

  1. ANT Advanced Neural Tool

    International Nuclear Information System (INIS)

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


    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

  2. Cooperating attackers in neural cryptography. (United States)

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


    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.

  3. Surgical competence. (United States)

    Patil, Nivritti G; Cheng, Stephen W K; Wong, John


    Recent high-profile cases have heightened the need for a formal structure to monitor achievement and maintenance of surgical competence. Logbooks, morbidity and mortality meetings, videos and direct observation of operations using a checklist, motion analysis devices, and virtual reality simulators are effective tools for teaching and evaluating surgical skills. As the operating theater is also a place for training, there must be protocols and guidelines, including mandatory standards for supervision, to ensure that patient care is not compromised. Patients appreciate frank communication and honesty from surgeons regarding their expertise and level of competence. To ensure that surgical competence is maintained and keeps pace with technologic advances, professional registration bodies have been promoting programs for recertification. They evaluate performance in practice, professional standing, and commitment to ongoing education.

  4. 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.


    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

  5. Surgical Navigation

    DEFF Research Database (Denmark)

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


    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 indicatio...

  6. Surgical Instrument

    NARCIS (Netherlands)

    Dankelman, J.; Horeman, T.


    The present invention relates to a surgical instrument for minimall-invasive surgery, comprising a handle, a shaft and an actuating part, characterised by a gastight cover surrounding the shaft, wherein the cover is provided with a coupler that has a feed- through opening with a loskable seal,

  7. Surgical Strategies in the Treatment of Gynecomastia Grade I-II: The Combination of Liposuction and Subcutaneous Mastectomy Provides Excellent Patient Outcome and Satisfaction. (United States)

    Schröder, Lars; Rudlowski, Christian; Walgenbach-Brünagel, Gisela; Leutner, Claudia; Kuhn, Walther; Walgenbach, Klaus-Jürgen


    Gynecomastia (GM) is a benign condition with glandular tissue enlargement of the male breast. GM is classified into 4 grades of increasing severity. We describe a series of GM grade I-II, diagnosed, treated surgically and analyzed regarding feasibility, complication rate, and satisfaction. From 2005 to 2012, a chart review was performed for 53 patients. Preoperative examination included endocrine and urological examination and exclusion of other pathological conditions. The surgical technique consisted of liposuction through an inframammarian-fold incision and excision of the glandular tissue by a minimal periareolar approach. A total number of 53 male patients with 104 breasts were available for analysis. By liposuction, a median of 300 ml (range: 10-1000 ml) was aspirated from each breast and 25.1 g (range: 3-233 g) gland tissue was resected. Surgery lasted between 25 and 164 min per patient (median: 72 min). 2 postoperative hemorrhages occurred (n = 2, 3.8%). 2 patients underwent re-operation due to cosmetic reasons (n = 2, 3.8%). This analysis demonstrates that treatment of GM grade I-II can easily be performed by liposuction combined with subcutaneous resection of the glandular tissue as a minimally invasive and low-impact surgical treatment with a low rate of complications and excellent patient satisfaction. Preoperative workup is important to rule out specific diseases or malignancy causing the GM.

  8. Neural networks

    International Nuclear Information System (INIS)

    Denby, Bruce; Lindsey, Clark; Lyons, Louis


    The 1980s saw a tremendous renewal of interest in 'neural' information processing systems, or 'artificial neural networks', among computer scientists and computational biologists studying cognition. Since then, the growth of interest in neural networks in high energy physics, fueled by the need for new information processing technologies for the next generation of high energy proton colliders, can only be described as explosive

  9. Mirror image extradural hematoma in elderly population: management strategy with surgical bilateral or unilateral evacuation or conservative treatment modality with literature review

    Directory of Open Access Journals (Sweden)

    Satyarthee Guru Dutta


    Full Text Available Extradural hematomas (EDH represent one of common imaging findings in cases sustaining traumatic brain injury. Bilateral extradural haematoma is considered rare and even rarer in elder people male. Bilateral extradural hematoma is usually acute, and generally associated with severe traumatic head injury. Mirror-image extradural hematomas (MEDH constitute a special type of bilateral extradural hamatomas, which is placed anatomically symmetrically on both the sides of the intracranial compartment, requires prompt diagnosis and emergent surgical intervention as it carry high mortality if evacuation of hematoma is not carried out expeditely. The mortality rate still remains higher in comparison to unilateral single extradural hematomas. The postoperative outcome depends on preoperative neurological status, total volume of blood, accurate diagnosis and prompt shifting to neurosurgical facility, expatiation of surgical procedure, pre- hospital care. Authors report a case of a - 65-year-old man who presented with acute simultaneous bilateral extradural haematomas following road traffic accident, underwent bilateral trephine craniotomy and simultaneous evacuation on both side led to good recovery.

  10. Surgical data processing for smart intraoperative assistance systems

    Directory of Open Access Journals (Sweden)

    Stauder Ralf


    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.

  11. Influence of the social context on use of surgical-lengthening and group-empowering coping strategies among people with dwarfism. (United States)

    Fernández, Saulo; Branscombe, Nyla R; Gómez, Angel; Morales, J Francisco


    To assess the role that social contextual factors exert on the way people with disproportionate short stature (dwarfism) cope with the negative consequences of discrimination. Using multigroup structural equation modeling, we compare the coping process of people with dwarfism from Spain (N = 63) and the USA (N = 145), two countries that differ in the role played by organizations offering support to people with dwarfism. In Spain, where organizational support is recent, a coping approach aimed at achieving integration with the majority group through limb-lengthening surgery prevails; in the USA, where the long-standing organization of people with dwarfism encourages pride in being a "little person" and positive intragroup contact, a coping strategy based on empowering the minority group dominates. Both strategies, each in its own context, are effective at protecting psychological well-being from the negative consequences of stigmatization; however, they exert their positive effects through different processes.

  12. Neural Networks

    International Nuclear Information System (INIS)

    Smith, Patrick I.


    Physicists use large detectors to measure particles created in high-energy collisions at particle accelerators. These detectors typically produce signals indicating either where ionization occurs along the path of the particle, or where energy is deposited by the particle. The data produced by these signals is fed into pattern recognition programs to try to identify what particles were produced, and to measure the energy and direction of these particles. Ideally, there are many techniques used in this pattern recognition software. One technique, neural networks, is particularly suitable for identifying what type of particle caused by a set of energy deposits. Neural networks can derive meaning from complicated or imprecise data, extract patterns, and detect trends that are too complex to be noticed by either humans or other computer related processes. To assist in the advancement of this technology, Physicists use a tool kit to experiment with several neural network techniques. The goal of this research is interface a neural network tool kit into Java Analysis Studio (JAS3), an application that allows data to be analyzed from any experiment. As the final result, a physicist will have the ability to train, test, and implement a neural network with the desired output while using JAS3 to analyze the results or output. Before an implementation of a neural network can take place, a firm understanding of what a neural network is and how it works is beneficial. A neural network is an artificial representation of the human brain that tries to simulate the learning process [5]. It is also important to think of the word artificial in that definition as computer programs that use calculations during the learning process. In short, a neural network learns by representative examples. Perhaps the easiest way to describe the way neural networks learn is to explain how the human brain functions. The human brain contains billions of neural cells that are responsible for processing

  13. Evolvable synthetic neural system (United States)

    Curtis, Steven A. (Inventor)


    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.

  14. Central pancreatectomy for benign pancreatic pathology/trauma: is it a reasonable pancreas-preserving conservative surgical strategy alternative to standard major pancreatic resection? (United States)

    Johnson, Maria A; Rajendran, Shanmugasundaram; Balachandar, Tirupporur G; Kannan, Devy G; Jeswanth, Satyanesan; Ravichandran, Palaniappan; Surendran, Rajagopal


    The aim of this study was to assess the technical feasibility, safety and outcome of central pancreatectomy (CP) with pancreaticogastrostomy or pancreaticojejunostomy in appropriately selected patients with benign central pancreatic pathology/trauma. Benign lesions/trauma of the pancreatic neck and proximal body pose an interesting surgical challenge. CP is an operation that allows resection of benign tumours located in the pancreatic isthmus that are not suitable for enucleation. Between January 2000 and December 2005, eight central pancreatectomies were carried out. There were six women and two men with a mean age of 35.7 years. The cephalic pancreatic stump is oversewn and the distal stump is anastomosed end-to-end with a Roux-en-Y jejunal loop in two and with the stomach in six patients. The indications for CP were: non-functional islet cell tumours in two patients, traumatic pancreatic neck transection in two and one each for insulinoma, solid pseudopapillary tumour, splenic artery pseudoaneurysm and pseudocyst. Pancreatic exocrine function was evaluated by a questionnaire method. Endocrine function was evaluated by blood glucose level. Morbidity rate was 37.5% with no operative mortality. Mean postoperative hospital stay was 10.5 days. Neither of the patients developed pancreatic fistula nor required reoperations or interventional radiological procedures. At a mean follow up of 26.4 months, no patient had evidence of endocrine or exocrine pancreatic insufficiency, all the patients were alive and well without clinical and imaging evidence of disease recurrence. When technically feasible, CP is a safe, pancreas-preserving pancreatectomy for non-enucleable benign pancreatic pathology/trauma confined to pancreatic isthmus that allows for cure of the disease without loss of substantial amount of normal pancreatic parenchyma with preservation of exocrine/endocrine function and without interruption of enteric continuity.

  15. A review of trends in attrition rates for surgical faculty: a case for a sustainable retention strategy to cope with demographic and economic realities. (United States)

    Satiani, Bhagwan; Williams, Thomas E; Brod, Heather; Way, David P; Ellison, E Christopher


    Our aim was to compare trends in retention of academic surgeons by reviewing surgical faculty attrition rates (leaving academic surgery for any reason) of 3 cohorts at 5-year intervals between 1996 and 2011. The Association of American Medical Colleges' Faculty Administrative Management On-Line User System database was queried for a retention report of all tenure/clinical track full-time MD faculty within our academic medical center on July 1, 1996 (group 1), July 1, 2001 (group 2), and July 1, 2006 (group 3). Retention was tracked for 5 years post snapshot. The individual 5-year cohort attrition rates (observed frequencies) were compared with combined attrition rates for all 3 groups (expected frequencies). Overall, attrition trends for groups 2 (lower) and 3 (higher) were significantly different than the trends for all groups combined. Minorities and professors at the full or associate rank in group 3 contributed to this difference. Faculty in group 3 leaving our academic medical center were significantly more likely to transition into nonacademic practice compared with the other 2 groups. Greater attrition in the last 5-year cohort, despite the increase in faculty positions, is worrisome. A continuous retention life cycle is critical if academic medical centers hope to compete for talent. Retention planning should include on-boarding programs for enculturation, monitoring of professional satisfaction, formalized mentoring of younger surgeons, retaining academic couples and a part-time workforce, leadership and talent management, exit interviews, and competitive financial packages. Copyright © 2013 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

  16. 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


    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)....

  17. Problem-Solving Skills among Precollege Students in Clinical Immunology and Microbiology: Classifying Strategies with a Rubric and Artificial Neural Network Technology. (United States)

    Kanowith-Klein, Susan; Stave, Mel; Stevens, Ron; Casillas, Adrian M.


    Investigates methods for classifying problem solving strategies of high school students who studied infectious and non-infectious diseases by using a software system that can generate a picture of students' strategies in solving problems. (Contains 24 references.) (Author/YDS)

  18. Novel chemometric strategy based on the application of artificial neural networks to crossed mixture design for the improvement of recombinant protein production in continuous culture. (United States)

    Didier, Caroline; Forno, Guillermina; Etcheverrigaray, Marina; Kratje, Ricardo; Goicoechea, Héctor


    The optimal blends of six compounds that should be present in culture media used in recombinant protein production were determined by means of artificial neural networks (ANN) coupled with crossed mixture experimental design. This combination constitutes a novel approach to develop a medium for cultivating genetically engineered mammalian cells. The compounds were collected in two mixtures of three elements each, and the experimental space was determined by a crossed mixture design. Empirical data from 51 experimental units were used in a multiresponse analysis to train artificial neural networks which satisfy different requirements, in order to define two new culture media (Medium 1 and Medium 2) to be used in a continuous biopharmaceutical production process. These media were tested in a bioreactor to produce a recombinant protein in CHO cells. Remarkably, for both predicted media all responses satisfied the predefined goals pursued during the analysis, except in the case of the specific growth rate (mu) observed for Medium 1. ANN analysis proved to be a suitable methodology to be used when dealing with complex experimental designs, as frequently occurs in the optimization of production processes in the biotechnology area. The present work is a new example of the use of ANN for the resolution of a complex, real life system, successfully employed in the context of a biopharmaceutical production process.

  19. Open heart operations without transfusion using a multimodality blood conservation strategy in 50 Jehovah's Witness patients: implications for a "bloodless" surgical technique. (United States)

    Rosengart, T K; Helm, R E; DeBois, W J; Garcia, N; Krieger, K H; Isom, O W


    Blood transfusion persists as an important risk of open heart operations despite the recent introduction of a variety of new pharmacologic agents and blood conservation techniques as independent therapies. A comprehensive multimodality blood conservation program was developed to minimize this risk. To provide a strategy for operating without transfusion, this program was prospectively applied to 50 adult patients who are Jehovah's Witnesses and have undergone open heart operation at our institution since 1992. The blood conservation program used for these patients included the use of high-dose erythropoietin (800 U/kg load, 500 U/kg every other day), aprotinin (6 million U total dose full Hammersmith regimen), "maximal" volume intraoperative autologous blood donation, intraoperative cell salvage, continuous shed blood reinfusion, and drawing as few blood specimens as possible. Procedures performed included first-time coronary bypass operations (n = 30) and more complex operations, including reoperations, valve replacements, and multiple valve replacements with or without coronary bypass (n = 20). Despite the absence of transfusion, the mean discharge hematocrit in these patients was greater than 30 percent, and there was no anemia-related mortality rate in this group. The overall in-hospital mortality for the group was 4 percent. A subset analysis was performed between the 30 first-time coronary bypass patients (group 1) and a control group of 30 consecutive patients who were not Jehovah's Witnesses but had undergone first-time coronary bypass during the same period (group 2). The blood conservation program described in the previous paragraph was not used in group 2 patients and specific transfusion criteria were prospectively applied. The chest tube output in group 1 patients was less than 40 percent of that for group 2 patients at all points measured after operation (p blood products. These results suggest that even complex open heart operations can be performed

  20. Neural Network and Evidence Theory Based Improvements on Submarine Search Strategy of CGF%基于神经网络及证据理论的 CGF 搜潜策略改进

    Institute of Scientific and Technical Information of China (English)

    宦婧; 滕克难; 唐金国


    Since the Computer Generated Force ( CGF) can not take full advantage of battlefield information to optimize CGF submarine search strategy in the cooperative anti -submarine combat,the information fusion technology was introduced into the anti-submarine warfare simulation based on the effective interaction of the information between CGF .The basic confidence assignment of the evidence information was obtained using Back Propagation (BP) artificial neural network,and the information from antisubmarine CGF was synthesized by using the improved DS evidence theory .And thus the anti-submarine CGF mobile strategy was improved . Simulation results show that the introduction of artificial neural network and information fusion technology in antisubmarine CGF submarine search process can improve the anti -submarine efficiency .%针对目前多计算机生成兵力( Computer Generated Force ,CGF)协同反潜中无法充分利用战场信息实现CGF搜潜策略优化的问题,在CGF间可有效实现信息交互的前提下,将信息融合技术引入到反潜作战仿真中;利用BP (Back Propagation)人工神经网络获取证据信息的基本置信分配,通过改进的D-S(Dempster-Shafer)证据理论对反潜CGF获取的信息进行综合,以此改进反潜CGF的移动策略。仿真实验表明,在反潜CGF搜潜过程中引入人工神经网络和信息融合技术,可有效提高CGF搜潜的成功率。

  1. VEIL Surgical Steps. (United States)

    Raghunath, S K; Nagaraja, H; Srivatsa, N


    Inguinal lymphadenectomy remains the standard of care for metastatic nodal disease in cases of penile, urethral, vulval and vaginal cancers. Outcomes, including cure rates and overall and progression-free survivals, have progressively improved in these diseases with extending criteria to offer inguinal lymph node dissection for patients 'at-risk' for metastasis or loco-regional recurrence. Hence, despite declining incidence of advanced stages of these cancers, many patients will still need to undergo lymphadenectomy for optimal oncological outcomes. Inguinal node dissection is a morbid procedure with operative morbidity noted in almost two third of the patients. Video endoscopic inguinal lymphadenectomy (VEIL) was described and currently practiced with proven equivalent oncological outcomes. We describe our technique of VEIL using laparoscopic and robotic access as well as various new surgical strategies.

  2. Micro-surgical endodontics. (United States)

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


    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.

  3. Neural Networks

    Directory of Open Access Journals (Sweden)

    Schwindling Jerome


    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.

  4. Task instructions influence the cognitive strategies involved in line bisection judgements: evidence from modulated neural mechanisms revealed by fMRI

    NARCIS (Netherlands)

    Fink, G.R.; Marshall, J.C.; Weiss, P.H.; Toni, I.; Zilles, K.


    Manual line bisection and a perceptual variant thereof (the Landmark test) are widely used to assess visuospatial neglect in neurological patients, but little is known about the cognitive strategies involved. In the Landmark test, one could explicitly compare the lengths of the left and right line

  5. American Pediatric Surgical Association (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 / ...

  6. Abortion - surgical - aftercare (United States)

    ... this page: // 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 ...

  7. Urogynecologic Surgical Mesh Implants (United States)

    ... procedures performed to treat pelvic floor disorders with surgical mesh: Transvaginal mesh to treat POP Transabdominal mesh to treat ... address safety risks Final Order for Reclassification of Surgical Mesh for Transvaginal Pelvic Organ Prolapse Repair Final Order for Effective ...

  8. Neural Decoder for Topological Codes (United States)

    Torlai, Giacomo; Melko, Roger G.


    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.

  9. Principles of neural information processing

    CERN Document Server

    Seelen, Werner v


    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...

  10. Monitoring tool usage in surgery videos using boosted convolutional and recurrent neural networks. (United States)

    Al Hajj, Hassan; Lamard, Mathieu; Conze, Pierre-Henri; Cochener, Béatrice; Quellec, Gwenolé


    This paper investigates the automatic monitoring of tool usage during a surgery, with potential applications in report generation, surgical training and real-time decision support. Two surgeries are considered: cataract surgery, the most common surgical procedure, and cholecystectomy, one of the most common digestive surgeries. Tool usage is monitored in videos recorded either through a microscope (cataract surgery) or an endoscope (cholecystectomy). Following state-of-the-art video analysis solutions, each frame of the video is analyzed by convolutional neural networks (CNNs) whose outputs are fed to recurrent neural networks (RNNs) in order to take temporal relationships between events into account. Novelty lies in the way those CNNs and RNNs are trained. Computational complexity prevents the end-to-end training of "CNN+RNN" systems. Therefore, CNNs are usually trained first, independently from the RNNs. This approach is clearly suboptimal for surgical tool analysis: many tools are very similar to one another, but they can generally be differentiated based on past events. CNNs should be trained to extract the most useful visual features in combination with the temporal context. A novel boosting strategy is proposed to achieve this goal: the CNN and RNN parts of the system are simultaneously enriched by progressively adding weak classifiers (either CNNs or RNNs) trained to improve the overall classification accuracy. Experiments were performed in a dataset of 50 cataract surgery videos, where the usage of 21 surgical tools was manually annotated, and a dataset of 80 cholecystectomy videos, where the usage of 7 tools was manually annotated. Very good classification performance are achieved in both datasets: tool usage could be labeled with an average area under the ROC curve of A z =0.9961 and A z =0.9939, respectively, in offline mode (using past, present and future information), and A z =0.9957 and A z =0.9936, respectively, in online mode (using past and present

  11. Surgical Treatment of Hepatocellular Carcinoma (United States)

    Zamora-Valdes, Daniel; Taner, Timucin; Nagorney, David M.


    Hepatocellular carcinoma (HCC) is a major cause of cancer-related death worldwide. In select patients, surgical treatment in the form of either resection or transplantation offers a curative option. The aims of this review are to (1) review the current American Association for the Study of Liver Diseases/European Association for the Study of the Liver guidelines on the surgical management of HCC and (2) review the proposed changes to these guidelines and analyze the strength of evidence underlying these proposals. Three authors identified the most relevant publications in the literature on liver resection and transplantation for HCC and analyzed the strength of evidence according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) classification. In the United States, the liver allocation system provides priority for liver transplantation to patients with HCC within the Milan criteria. Current evidence suggests that liver transplantation may also be indicated in certain patient groups beyond Milan criteria, such as pediatric patients with large tumor burden or adult patients who are successfully downstaged. Patients with no underlying liver disease may also benefit from liver transplantation if the HCC is unresectable. In patients with no or minimal (compensated) liver disease and solitary HCC ≥2 cm, liver resection is warranted. If liver transplantation is not available or contraindicated, liver resection can be offered to patients with multinodular HCC, provided that the underlying liver disease is not decompensated. Many patients may benefit from surgical strategies adapted to local resources and policies (hepatitis B prevalence, organ availability, etc). Although current low-quality evidence shows better overall survival with aggressive surgical strategies, this approach is limited to select patients. Larger and well-designed prospective studies are needed to better define the benefits and limits of such approach. PMID:28975836

  12. Feedforward Nonlinear Control Using Neural Gas Network


    Machón-González, Iván; López-García, Hilario


    Nonlinear systems control is a main issue in control theory. Many developed applications suffer from a mathematical foundation not as general as the theory of linear systems. This paper proposes a control strategy of nonlinear systems with unknown dynamics by means of a set of local linear models obtained by a supervised neural gas network. The proposed approach takes advantage of the neural gas feature by which the algorithm yields a very robust clustering procedure. The direct model of the ...

  13. An overview of pre-surgical evaluation

    Directory of Open Access Journals (Sweden)

    Kurupath Radhakrishnan


    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.

  14. Deriving DICOM surgical extensions from surgical workflows (United States)

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


    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.

  15. Recognizing surgical patterns

    NARCIS (Netherlands)

    Bouarfa, L.


    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

  16. Surgical medical record

    DEFF Research Database (Denmark)

    Bulow, S.


    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...

  17. Update to the Centers for Disease Control and Prevention and the Healthcare Infection Control Practices Advisory Committee Guideline for the Prevention of Surgical Site Infection (2017): A summary, review, and strategies for implementation. (United States)

    O'Hara, Lyndsay M; Thom, Kerri A; Preas, Michael Anne


    Surgical site infections remain a common cause of morbidity, mortality, and increased length of stay and cost amongst hospitalized patients in the United States. This article summarizes the evidence used to inform the Centers for Disease Control and Prevention and the Healthcare Infection Control Practices Advisory Committee Guideline for the Prevention of Surgical Site Infection (2017), and highlights key updates and new recommendations. We also present specific suggestions for how infection preventionists can play a central role in guideline implementation by translating these recommendations into evidence-based policies and practices in their facility. Copyright © 2018. Published by Elsevier Inc.

  18. Surgical management of venous malformations. (United States)

    Loose, D A


    Among vascular malformations, the predominantly venous malformations represent the majority of cases. They form a clinical entity and therefore need clear concepts concerning diagnosis and treatment. This paper presents an overview of contemporary classification as well as tactics and techniques of treatment. According to the Hamburg Classification, predominantly venous malformations are categorized into truncular and extratruncular forms, with truncular forms distinguished as obstructions and dilations, and extratruncular forms as limited or infiltrating. The tactics of treatment represent surgical and non-surgical methods or combined techniques. Surgical approaches utilize different tactics and techniques that are adopted based on the pathologic form and type of the malformation: (I) operation to reduce the haemodynamic activity of the malformation; (II) operation to eliminate the malformation; and (III) reconstructive operation. As for (I), a type of a tactic is the operation to derive the venous flow. In (II), the total or partial removal of the venous malformation is demonstrated subdivided into three different techniques. In this way, the infiltrating as well as the limited forms can be treated. An additional technique is dedicated to the treatment of a marginal vein. Approach (III) involves the treatment of venous aneurysms, where a variety of techniques have been successful. Long-term follow-up demonstrates positive results in 91% of the cases. Congenital predominantly venous malformations should be treated according to the principles developed during the past decades in vascular surgery, interventional treatment and multidisciplinary treatment. The days of predominantly conservative treatment should be relegated to the past. Special skills and experiences are necessary to carry out appropriate surgical strategy, and the required operative techniques should be dictated by the location and type of malformation and associated findings.

  19. Secondary and Tertiary Hyperparathyroidism, State of the Art Surgical Management (United States)

    Pitt, Susan C.; Sippel, Rebecca S.


    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

  20. Surgical ethics: surgical virtue and more. (United States)

    Vercler, Christian J


    The encounter between a patient and her surgeon is unique for several reasons. The surgeon inflicts pain upon a patient for the patient's own good. An operative intervention is irreducibly personal, such that the decisions about and performance of operations are inseparable from the idiosyncrasies of the individual surgeon. Furthermore, there is a chasm of knowledge between the patient and surgeon that is difficult to cross. Hence, training in the discipline of surgery includes the inculcation of certain virtues and practices to safeguard against abuses of this relationship and to make sure that the best interests of the patient are prioritized. The stories in this issue are evidence that in contemporary practice this is not quite enough, as surgeons reflect on instances they felt were ethically challenging. Common themes include the difficulty in communicating surgical uncertainty, patient-surgeon relationships, ethical issues in surgical training, and the impact of the technological imperative on caring for dying patients.

  1. Neural Interfaces for Intracortical Recording: Requirements, Fabrication Methods, and Characteristics. (United States)

    Szostak, Katarzyna M; Grand, Laszlo; Constandinou, Timothy G


    Implantable neural interfaces for central nervous system research have been designed with wire, polymer, or micromachining technologies over the past 70 years. Research on biocompatible materials, ideal probe shapes, and insertion methods has resulted in building more and more capable neural interfaces. Although the trend is promising, the long-term reliability of such devices has not yet met the required criteria for chronic human application. The performance of neural interfaces in chronic settings often degrades due to foreign body response to the implant that is initiated by the surgical procedure, and related to the probe structure, and material properties used in fabricating the neural interface. In this review, we identify the key requirements for neural interfaces for intracortical recording, describe the three different types of probes-microwire, micromachined, and polymer-based probes; their materials, fabrication methods, and discuss their characteristics and related challenges.

  2. Neural Interfaces for Intracortical Recording: Requirements, Fabrication Methods, and Characteristics

    Directory of Open Access Journals (Sweden)

    Katarzyna M. Szostak


    Full Text Available Implantable neural interfaces for central nervous system research have been designed with wire, polymer, or micromachining technologies over the past 70 years. Research on biocompatible materials, ideal probe shapes, and insertion methods has resulted in building more and more capable neural interfaces. Although the trend is promising, the long-term reliability of such devices has not yet met the required criteria for chronic human application. The performance of neural interfaces in chronic settings often degrades due to foreign body response to the implant that is initiated by the surgical procedure, and related to the probe structure, and material properties used in fabricating the neural interface. In this review, we identify the key requirements for neural interfaces for intracortical recording, describe the three different types of probes—microwire, micromachined, and polymer-based probes; their materials, fabrication methods, and discuss their characteristics and related challenges.

  3. Morphological neural networks

    Energy Technology Data Exchange (ETDEWEB)

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


    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.

  4. Neural Tube Defects (United States)

    Neural tube defects are birth defects of the brain, spine, or spinal cord. They happen in the ... that she is pregnant. The two most common neural tube defects are spina bifida and anencephaly. In ...

  5. Surgical site infections

    African Journals Online (AJOL)

    Decrease the inflammatory response Vasodilatation leads to better perfusion and ... Must NOT be allowed to come in contact with brain, meninges, eyes or .... project (SCIP): Evolution of National Quality Measure. Surgical. Infection 2008 ...

  6. Surgical Critical Care Initiative (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....

  7. Ambulatory Surgical Measures - Facility (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...

  8. Surgical Management of Hemorrhoids (United States)

    Agbo, S. P.


    Hemorrhoids are common human afflictions known since the dawn of history. Surgical management of this condition has made tremendous progress from complex ligation and excision procedures in the past to simpler techniques that allow the patient to return to normal life within a short period. Newer techniques try to improve on the post-operative complications of older ones. The surgical options for the management of hemorrhoids today are many. Capturing all in a single article may be difficult if not impossible. The aim of this study therefore is to present in a concise form some of the common surgical options in current literature, highlighting some important post operative complications. Current literature is searched using MEDLINE, EMBASE and the Cochrane library. The conclusion is that even though there are many surgical options in the management of hemorrhoids today, most employ the ligature and excision technique with newer ones having reduced post operative pain and bleeding. PMID:22413048

  9. Surgical site infections

    African Journals Online (AJOL)

    Surgical site infections (SSIs) are a worldwide problem that has ... deep tissue is found on clinical examination, re-opening, histopathological or radiological investigation ..... Esposito S, Immune system and SSI, Journal of Chemotherapy, 2001.

  10. Surgical management of pain

    African Journals Online (AJOL)

    If these therapies fail, and with a thorough multidisciplinary approach involving carefully ... Generally, surgical pain management is divided into neuro- modulative .... 9 suggested. It is important to be sure that the underlying instability or.

  11. [Simulation in surgical training]. (United States)

    Nabavi, A; Schipper, J


    Patient safety during operations hinges on the surgeon's skills and abilities. However, surgical training has come under a variety of restrictions. To acquire dexterity with decreasingly "simple" cases, within the legislative time constraints and increasing expectations for surgical results is the future challenge. Are there alternatives to traditional master-apprentice learning? A literature review and analysis of the development, implementation, and evaluation of surgical simulation are presented. Simulation, using a variety of methods, most important physical and virtual (computer-generated) models, provides a safe environment to practice basic and advanced skills without endangering patients. These environments have specific strengths and weaknesses. Simulations can only serve to decrease the slope of learning curves, but cannot be a substitute for the real situation. Thus, they have to be an integral part of a comprehensive training curriculum. Our surgical societies have to take up that challenge to ensure the training of future generations.

  12. Neural tissue-spheres

    DEFF Research Database (Denmark)

    Andersen, Rikke K; Johansen, Mathias; Blaabjerg, Morten


    By combining new and established protocols we have developed a procedure for isolation and propagation of neural precursor cells from the forebrain subventricular zone (SVZ) of newborn rats. Small tissue blocks of the SVZ were dissected and propagated en bloc as free-floating neural tissue...... content, thus allowing experimental studies of neural precursor cells and their niche...


    Directory of Open Access Journals (Sweden)

    Sergey A. Sannikov


    Full Text Available Introduction: The use of neural networks for non-linear models helps to understand where linear model drawbacks, coused by their specification, reveal themselves. This paper attempts to find this out. The objective of research is to determine the meaning of “option prices calculation using neural networks”. Materials and Methods: We use two kinds of variables: endogenous (variables included in the model of neural network and variables affecting on the model (permanent disturbance. Results: All data are divided into 3 sets: learning, affirming and testing. All selected variables are normalised from 0 to 1. Extreme values of income were shortcut. Discussion and Conclusions: Using the 33-14-1 neural network with direct links we obtained two sets of forecasts. Optimal criteria of strategies in stock markets’ option pricing were developed.

  14. Surgical repair of idiopathic scrotal elephantiasis. (United States)

    Zacharakis, Evangelos; Dudderidge, Tim; Zacharakis, Emmanouil; Ioannidis, Evangelos


    Scrotal lymphedema (scrotal elephantiasis) is uncommon outside of filariasis endemic regions. We present a case of a 65-year-old with idiopathic lymphedema of the scrotum and functional impairment of the penis. The patient underwent surgical excision of the edematous subcutaneous tissues and plastic reconstruction of his penis and scrotum. Three years later, the patient showed no signs of local recurrence, had complete restoration of urinary and sexual function and was extremely satisfied with the result. Surgical management was an effective strategy in the management of scrotal lymphedema in this case.

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

    African Journals Online (AJOL)

    A retrospective study of post surgical complications was conducted on records of students' Large Animal Surgical Laboratories in the Faculty of Veterinary Medicine (F.V.M.), Ahmadu Bello University (A.B.U), Zaria from 1989 to 1993. Three hundred and eleven surgical complications were recorded from five surgical ...

  16. Neural electrical activity and neural network growth. (United States)

    Gafarov, F M


    The development of central and peripheral neural system depends in part on the emergence of the correct functional connectivity in its input and output pathways. Now it is generally accepted that molecular factors guide neurons to establish a primary scaffold that undergoes activity-dependent refinement for building a fully functional circuit. However, a number of experimental results obtained recently shows that the neuronal electrical activity plays an important role in the establishing of initial interneuronal connections. Nevertheless, these processes are rather difficult to study experimentally, due to the absence of theoretical description and quantitative parameters for estimation of the neuronal activity influence on growth in neural networks. In this work we propose a general framework for a theoretical description of the activity-dependent neural network growth. The theoretical description incorporates a closed-loop growth model in which the neural activity can affect neurite outgrowth, which in turn can affect neural activity. We carried out the detailed quantitative analysis of spatiotemporal activity patterns and studied the relationship between individual cells and the network as a whole to explore the relationship between developing connectivity and activity patterns. The model, developed in this work will allow us to develop new experimental techniques for studying and quantifying the influence of the neuronal activity on growth processes in neural networks and may lead to a novel techniques for constructing large-scale neural networks by self-organization. Copyright © 2018 Elsevier Ltd. All rights reserved.

  17. ELeaRNT: Evolutionary Learning of Rich Neural Network Topologies

    National Research Council Canada - National Science Library

    Matteucci, Matteo


    In this paper we present ELeaRNT an evolutionary strategy which evolves rich neural network topologies in order to find an optimal domain specific non linear function approximator with a good generalization performance...

  18. Applying Fuzzy Artificial Neural Network OSPF to develop Smart ...

    African Journals Online (AJOL)



    Mar 5, 2018 ... Fuzzy Artificial Neural Network to create Smart Routing. Protocol Algorithm. ... manufactured mental aptitude strategy. The capacity to study .... Based Energy Efficiency in Wireless Sensor Networks: A Survey",. International ...

  19. Pediatric surgical diseases. A radiological surgical case study approach

    International Nuclear Information System (INIS)

    Esposito, Ciro; Esposito, Giovanni


    Radiologic evaluation of an infant or child suspected of having a surgical disease can be a complex problem. With this volume, the editors have created a book focused on pediatric imaging written by pediatricians, pediatric surgeons and pediatric radiologists. This book is a collection of over 200 case reports. The concept is a case study approach: The reader is given radiologic images (plain radiography, computed tomography, magnetic resonance imaging, ultrasonography, etc.) and the clinical history of the patient. On the basis of this information, the reader is asked to identify a diagnostic and therapeutic strategy. Each case is complemented by information on the disease affecting the patient and the management of the case shown, including therapy and follow-up. This educational text is targeted at all medical professionals faced with a variety of diagnostic and therapeutic problems affecting infants and children. (orig.)

  20. Pediatric surgical diseases. A radiological surgical case study approach

    Energy Technology Data Exchange (ETDEWEB)

    Esposito, Ciro [Federico II Univ. of Naples (Italy). Chair of Pediatric Surgery; Esposito, Giovanni (eds.) [Federico II Univ. of Naples (Italy). School of Medicine


    Radiologic evaluation of an infant or child suspected of having a surgical disease can be a complex problem. With this volume, the editors have created a book focused on pediatric imaging written by pediatricians, pediatric surgeons and pediatric radiologists. This book is a collection of over 200 case reports. The concept is a case study approach: The reader is given radiologic images (plain radiography, computed tomography, magnetic resonance imaging, ultrasonography, etc.) and the clinical history of the patient. On the basis of this information, the reader is asked to identify a diagnostic and therapeutic strategy. Each case is complemented by information on the disease affecting the patient and the management of the case shown, including therapy and follow-up. This educational text is targeted at all medical professionals faced with a variety of diagnostic and therapeutic problems affecting infants and children. (orig.)

  1. Disc degeneration: current surgical options

    Directory of Open Access Journals (Sweden)

    C Schizas


    Full Text Available Chronic low back pain attributed to lumbar disc degeneration poses a serious challenge to physicians. Surgery may be indicated in selected cases following failure of appropriate conservative treatment. For decades, the only surgical option has been spinal fusion, but its results have been inconsistent. Some prospective trials show superiority over usual conservative measures while others fail to demonstrate its advantages. In an effort to improve results of fusion and to decrease the incidence of adjacent segment degeneration, total disc replacement techniques have been introduced and studied extensively. Short-term results have shown superiority over some fusion techniques. Mid-term results however tend to show that this approach yields results equivalent to those of spinal fusion. Nucleus replacement has gained some popularity initially, but evidence on its efficacy is scarce. Dynamic stabilisation, a technique involving less rigid implants than in spinal fusion and performed without the need for bone grafting, represents another surgical option. Evidence again is lacking on its superiority over other surgical strategies and conservative measures. Insertion of interspinous devices posteriorly, aiming at redistributing loads and relieving pain, has been used as an adjunct to disc removal surgery for disc herniation. To date however, there is no clear evidence on their efficacy. Minimally invasive intradiscal thermocoagulation techniques have also been tried, but evidence of their effectiveness is questioned. Surgery using novel biological solutions may be the future of discogenic pain treatment. Collaboration between clinicians and basic scientists in this multidisciplinary field will undoubtedly shape the future of treating symptomatic disc degeneration.

  2. Towards a magnetoresistive platform for neural signal recording (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.


    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.

  3. 3D Surgical Simulation (United States)

    Cevidanes, Lucia; Tucker, Scott; Styner, Martin; Kim, Hyungmin; Chapuis, Jonas; Reyes, Mauricio; Proffit, William; Turvey, Timothy; Jaskolka, Michael


    This paper discusses the development of methods for computer-aided jaw surgery. Computer-aided jaw surgery allows us to incorporate the high level of precision necessary for transferring virtual plans into the operating room. We also present a complete computer-aided surgery (CAS) system developed in close collaboration with surgeons. Surgery planning and simulation include construction of 3D surface models from Cone-beam CT (CBCT), dynamic cephalometry, semi-automatic mirroring, interactive cutting of bone and bony segment repositioning. A virtual setup can be used to manufacture positioning splints for intra-operative guidance. The system provides further intra-operative assistance with the help of a computer display showing jaw positions and 3D positioning guides updated in real-time during the surgical procedure. The CAS system aids in dealing with complex cases with benefits for the patient, with surgical practice, and for orthodontic finishing. Advanced software tools for diagnosis and treatment planning allow preparation of detailed operative plans, osteotomy repositioning, bone reconstructions, surgical resident training and assessing the difficulties of the surgical procedures prior to the surgery. CAS has the potential to make the elaboration of the surgical plan a more flexible process, increase the level of detail and accuracy of the plan, yield higher operative precision and control, and enhance documentation of cases. Supported by NIDCR DE017727, and DE018962 PMID:20816308

  4. Estratégia para o tratamento cirúrgico das anomalias da conexão ventrículo-arterial com comunicação interventricular: surgical strategy Repair of anomalies of ventriculo-arterial connections

    Directory of Open Access Journals (Sweden)

    José Caliani


    é-operatória das distâncias entre a valva tricúside e as válvulas semilunares é um critério essencial para a escolha da correção apropriada para as anomalias da conexão ventrículo-arterial associadas a uma comunicação interventricular. Esta estratégia não se opõe às outras classificações usuais, baseadas na posição das grandes artérias, ou na situação da comunicação interventricular, e ela nos fornece informações precisas quanto à possibilidade de realizar uma correção intraventricular.In our practice, we no longer use the terms of double-outlet right ventricle, Taussig-Bing anomaly, double outlet left ventricle, or transposition of the great arteries when associated with a ventricular septal defect. We call anomalous ventriculo-arterial connection any connection different from that of a normal heart. In these anomalies the aim of the repair is to connect theleft ventricle to the aorta and the right ventricle to the pulmonary trunk. The strategy we have chosen, for empirical reasons, is based on the hypothesis that the simplest methods which require no prosthetic conduit, no translocation of the coronary arteries and no complex partition of the ventricular cavity offer the best chances of optimal long term results. The feasibility of anatomic repair was investigated in 197 patients who underwent an operation for anomalies of ventriculo-arterial connection associated with ventricular septal defect. Three types of anatomic repair were used: intraventricular rerouting (35 patients, R.E.V. (association of intraventricular rerouting with translocation of the pulmonary arterial trunk on the right ventricle in 78 patients, and Jatene's operation with closure of the ventricular septal defect (49 patients. Our repair of choice is intraventriclar repair when it is possible to construct a straight and direct tunnel from the left ventricle to the aorta. Thus, the basic question is the feasibility of a simple intraventricular repair. We presently base our strategy

  5. Chaotic diagonal recurrent neural network

    International Nuclear Information System (INIS)

    Wang Xing-Yuan; Zhang Yi


    We propose a novel neural network based on a diagonal recurrent neural network and chaos, and its structure and learning algorithm are designed. The multilayer feedforward neural network, diagonal recurrent neural network, and chaotic diagonal recurrent neural network are used to approach the cubic symmetry map. The simulation results show that the approximation capability of the chaotic diagonal recurrent neural network is better than the other two neural networks. (interdisciplinary physics and related areas of science and technology)

  6. Anxiety in veterinary surgical students

    DEFF Research Database (Denmark)

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


    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...... 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...... and 28 students from 2010). Our results show that anxiety levels in veterinary students are significantly higher in a surgical course than in a non-surgical course (p...


    Directory of Open Access Journals (Sweden)

    P. H. M. Bonai


    Full Text Available Nosocomial infection or nosocomial infection (NI is one of the factors that increase the cost of maintaining patients in the health system, even in processes that should safely occur, such as hospital patients and performing simple and routine surgical procedures surgical centers and clinics leading to complications resulting from these infections that prolong hospital stay and promote pain and suffering to the patient, resulting in the defense of the quality of services and influencing negatively the hospitals. Therefore, the aim of this study was to review the factors that result in surgical site infection, with the purpose of better understanding of the subject and the possibility of preventive actions to better treatment outcome of the patient.

  8. Preliminary report of a new treatment strategy for advanced pelvic malignancy: surgical resection and radiation therapy using afterloading catheters plus an inflatable displacement prosthesis in the treatment of advanced primary and recurrent rectal cancer

    International Nuclear Information System (INIS)

    Edington, H.D.; Hancock, S.; Coe, F.L.; Sugarbaker, P.H.


    An unsolved problem in colon and rectal surgery involves the treatment of locally invasive primary and recurrent rectal cancer. An approach is described that uses intracavitary iridium-192 sources in combination with a pelvic displacement prosthesis to augment external beam radiation doses to sites of residual disease identified at surgery. This approach should permit administration of tumoricidal doses of radiation to positive surgical margins minimizing radiation toxicity to the small bowel. The radiation source and all prosthetic materials are removed at the bedside within 2 weeks of surgery, ensuring accurate radiation dosimetry, minimizing infectious complications, and sparing the patient the need for full high-dose pelvic irradiation

  9. Evolvable Neural Software System (United States)

    Curtis, Steven A.


    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.

  10. Retained surgical sponge

    International Nuclear Information System (INIS)

    Koyama, Masashi; Kurono, Kenji; Iida, Akihiko; Suzuki, Hirochika; Hara, Masaki; Mizutani, Hirokazu; Ohba, Satoru; Mizutani, Masaru; Nakajima, Yoichiro.


    The CT, US, and MRI findings of confirmed retained surgical sponges were reviewed. The CT examinations in eight lesions demonstrated round or oval masses with heterogeneous internal structures. The US examinations in 5 lesions demonstrated low echogenic masses with high echogenic internal structures, which suggested retained surgical sponges. MR imagings in three lesions showed slightly high intensity comparable to that of muscles on T1-weighted images and high signal intensity on T2-weighted images, suggesting fluid collections of high protein concentration. (author)

  11. Surgical infections with Mycoplasma

    DEFF Research Database (Denmark)

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


    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...... extragenital infection such as septicemia, septic arthritis, neonatal meningitis and encephalitis. We review 38 cases of surgical infections with Mycoplasma....

  12. [Surgical therapy of gynecomastia]. (United States)

    Heckmann, A; Leclère, F M; Vogt, P M; Steiert, A


    Nowadays surgical intervention is an essential part of the treatment of idiopathic gynecomastia. Choosing the right method is crucial and is based on the current status in the clinical and histological evaluation. Before finalizing the process of choosing a specific method a prior interdisciplinary evaluation of the patient is necessary to ascertain clear indications for a surgical intervention. Liposuction is one of the methods which have become popular in recent years. The advantages are the possible combination with traditional techniques, such as subcutaneous mastectomy or periareolar mastopexy. The main indication is for gynecomastia stage IIa/b and is justifiable due to the reduction in surgical complications and scarring. Furthermore this technique provides an excellent aesthetical outcome for the patient. A total of 162 patients suffering from gynecomastia stages I-III (according to Simon) were surgically treated between 2000 and 2010 and these cases were retrospectively evaluated. The results showed a decline in the use of a T-shaped incision in combination with subcutaneous mastectomy with periareolar tightening compared to an increase in the use of subcutaneous mastectomy in combination with liposuction. The excised tissue should always be sent for histological examination to make sure no malignant cells were present.

  13. Surgical manifestations of filariasis

    Directory of Open Access Journals (Sweden)

    Subrahmanyam M


    Full Text Available Surgical manifestations of filariasis as seen in 150 cases over a period of three years in the department of Surgery, Mahatma Gandhi Institute of Medical Sciences, Sevagram, Wardha are reviewed. The genital manifestations are more common than the elephantiasis in this endemic zone.

  14. Improving surgical weekend handover. (United States)

    Culwick, Caroline; Devine, Chris; Coombs, Catherine


    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.

  15. [Surgical complications of colostomies]. (United States)

    Ben Ameur, Hazem; Affes, Nejmeddine; Rejab, Haitham; Abid, Bassem; Boujelbene, Salah; Mzali, Rafik; Beyrouti, Mohamed Issam


    The colostomy may be terminal or lateral, temporary or permanent. It may have psychological, medical or surgical complications. reporting the incidence of surgical complications of colostomies, their therapeutic management and trying to identify risk factors for their occurrence. A retrospective study for a period of 5 years in general surgery department, Habib Bourguiba hospital, Sfax, including all patients operated with confection of a colostomy. Were then studied patients reoperated for stoma complication. Among the 268 patients who have had a colostomy, 19 patients (7%) developed surgical stoma complications. They had a mean age of 59 years, a sex ratio of 5.3 and a 1-ASA score in 42% of cases. It was a prolapse in 9 cases (reconfection of the colostomy: 6 cases, restoration of digestive continuity: 3 cases), a necrosis in 5 cases (reconfection of the colostomy), a plicature in 2 cases (reconfection of the colostomy) a peristomal abscess in 2 cases (reconfection of the colostomy: 1 case, restoration of digestive continuity: 1 case) and a strangulated parastomal hernia in 1 case (herniorrhaphy). The elective incision and the perineal disease were risk factors for the occurrence of prolapse stomial. Surgical complications of colostomies remain a rare event. Prolapse is the most common complication, and it is mainly related to elective approach. Reoperation is often required especially in cases of early complications, with usually uneventful postoperative course.

  16. A neural flow estimator

    DEFF Research Database (Denmark)

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


    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...... 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...

  17. Neural Systems Laboratory (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...

  18. [da Vinci surgical system]. (United States)

    Watanabe, Gou; Ishikawa, Norihiro


    The da Vinci surgical system was developed by Intuitive Surgical Inc. in the United States as an endoscopic surgical device to assist remote control surgeries. In 1998, the Da Vinci system was first used for cardiothoracic procedures. Currently a combination of robot-assisted internal thoracic artery harvest together with coronary artery bypass grafting (CABG) through a mini-incision (ThoraCAB) or totally endoscopic procedures including anastomoses under robotic assistance (TECAB) are being conducted for the treatment of coronary artery diseases. With the recent advances in catheter interventions, hybrid procedures combining catheter intervention with ThoraCAB or TECAB are anticipated in the future.On the other hand, with the decrease in number of coronary artery bypass surgeries, the share of valvular surgeries is expected to increase in the future. Among them, mitral valvuloplasty for mitral regurgitation is anticipated to be conducted mainly by low-invasive procedures, represented by minimally invasive cardiac surgery( MICS) and robot-assisted surgery. Apart from the intrinsic good surgical view, robotic-assisted systems offer additional advantages of the availability of an amplified view and the easy to observe the mitral valve in the physiological position. Thus, robotic surgical surgeries that make complicated procedures easier are expected to accomplish further developments in the future. Furthermore, while the number of surgeries for atrial septal defects has decreased dramatically following the widespread use of Amplatzer septal occluder, robotic surgery may become a good indication for cases in which the Amplatzer device is not indicated. In Japan, clinical trial of the da Vinci robotic system for heart surgeries has been completed. Statutory approval of the da Vinci system for mitral regurgitation and atrial septal defects is anticipated in the next few years.

  19. Top tagging with deep neural networks [Vidyo

    CERN Multimedia

    CERN. Geneva


    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.

  20. 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


    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.

  1. Neural Networks: Implementations and Applications


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


    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

  2. Paediatric Abdominal Surgical Emergencies in a General Surgical ...

    African Journals Online (AJOL)

    ... organized for general surgeons undertaking paediatric surgical emergencies. More paediatric surgeons should be trained and more paediatric surgical units should established in the country. Key Words: Paediatric Abdominal Surgical Emergencies; Paediatric Surgeons, General Surgeons. Journal of College of Medicine ...

  3. 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


    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

  4. Surgical camps: the Ugandan experience

    African Journals Online (AJOL)

    . The planned visits were advertised locally and in the national media. Screening of the patients was done first by the local medical teams and later by the visiting surgical teams. The surgical teams were comprised of the following personnel:.

  5. Critical Branching Neural Networks (United States)

    Kello, Christopher T.


    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…

  6. Consciousness and neural plasticity

    DEFF Research Database (Denmark)

    changes or to abandon the strong identity thesis altogether. Were one to pursue a theory according to which consciousness is not an epiphenomenon to brain processes, consciousness may in fact affect its own neural basis. The neural correlate of consciousness is often seen as a stable structure, that is...

  7. Surgical treatment analysis of idiopathic esophageal achalasia. (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


    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.

  8. Improving surgical weekend handover


    Culwick, Caroline; Devine, Chris; Coombs, Catherine


    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 unif...

  9. Acquiring minimally invasive surgical skills


    Hiemstra, Ellen


    Many topics in surgical skills education have been implemented without a solid scientific basis. For that reason we have tried to find this scientific basis. We have focused on training and evaluation of minimally invasive surgical skills in a training setting and in practice in the operating room. This thesis has led to an enlarged insight in the organization of surgical skills training during residency training of surgical medical specialists.

  10. Robotic surgical training. (United States)

    Ben-Or, Sharon; Nifong, L Wiley; Chitwood, W Randolph


    In July 2000, the da Vinci Surgical System (Intuitive Surgical, Inc) received Food and Drug Administration approval for intracardiac applications, and the first mitral valve repair was done at the East Carolina Heart Institute in May 2000. The system is now approved and used in many surgical specialties. With this disruptive technology and accepted use, surgeons and hospitals are seeking the most efficacious training pathway leading to safe use and responsible credentialing.One of the most important issues related to safe use is assembling the appropriate team of professionals involved with patient care. Moreover, proper patient selection and setting obtainable goals are also important.Creation and maintenance of a successful program are discussed in the article focusing on realistic goals. This begins with a partnership between surgeon leaders, hospital administrators, and industry support. Through this partnership, an appropriate training pathway and clinical pathway for success can be outlined. A timeline can then be created with periods of data analysis and adjustments as necessary. A successful program is attainable by following this pathway and attending to every detail along the journey.

  11. The neural basis of financial risk taking. (United States)

    Kuhnen, Camelia M; Knutson, Brian


    Investors systematically deviate from rationality when making financial decisions, yet the mechanisms responsible for these deviations have not been identified. Using event-related fMRI, we examined whether anticipatory neural activity would predict optimal and suboptimal choices in a financial decision-making task. We characterized two types of deviations from the optimal investment strategy of a rational risk-neutral agent as risk-seeking mistakes and risk-aversion mistakes. Nucleus accumbens activation preceded risky choices as well as risk-seeking mistakes, while anterior insula activation preceded riskless choices as well as risk-aversion mistakes. These findings suggest that distinct neural circuits linked to anticipatory affect promote different types of financial choices and indicate that excessive activation of these circuits may lead to investing mistakes. Thus, consideration of anticipatory neural mechanisms may add predictive power to the rational actor model of economic decision making.

  12. Electrospun Nanofibrous Materials for Neural Tissue Engineering

    Directory of Open Access Journals (Sweden)

    Yee-Shuan Lee


    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.

  13. Surgical experts: born or made? (United States)

    Sadideen, Hazim; Alvand, Abtin; Saadeddin, Munir; Kneebone, Roger


    The concept of surgical expertise and the processes involved in its development are topical, and there is a constant drive to identify reliable measures of expert performance in surgery. This review explores the notion of whether surgical experts are "born" or "made", with reference to educational theory and pertinent literature. Peer-reviewed publications, books, and online resources on surgical education, expertise and training were reviewed. Important themes and aspects of expertise acquisition were identified in order to better understand the concept of a surgical expert. The definition of surgical expertise and several important aspects of its development are highlighted. Innate talent plays an important role, but is insufficient on its own to produce a surgical expert. Multiple theories that explore motor skill acquisition and memory are relevant, and Ericsson's theory of the development of competence followed by deliberate self-practice has been especially influential. Psychomotor and non-technical skills are necessary for progression in the current climate in light of our training curricula; surgical experts are adaptive experts who excel in these. The literature suggests that surgical expertise is reached through practice; surgical experts are made, not born. A deeper understanding of the nature of expert performance and its development will ensure that surgical education training programmes are of the highest possible quality. Surgical educators should aim to develop an expertise-based approach, with expert performance as the benchmark. Copyright © 2013 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.

  14. Surgical navigation with QR codes

    Directory of Open Access Journals (Sweden)

    Katanacho Manuel


    Full Text Available The presented work is an alternative to established measurement systems in surgical navigation. The system is based on camera based tracking of QR code markers. The application uses a single video camera, integrated in a surgical lamp, that captures the QR markers attached to surgical instruments and to the patient.

  15. 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 ...

  16. Novel paths towards neural cellular products for neurological disorders. (United States)

    Daadi, Marcel M


    The prospect of using neural cells derived from stem cells or from reprogrammed adult somatic cells provides a unique opportunity in cell therapy and drug discovery for developing novel strategies for brain repair. Cell-based therapeutic approaches for treating CNS afflictions caused by disease or injury aim to promote structural repair of the injured or diseased neural tissue, an outcome currently not achieved by drug therapy. Preclinical research in animal models of various diseases or injuries report that grafts of neural cells enhance endogenous repair, provide neurotrophic support to neurons undergoing degeneration and replace lost neural cells. In recent years, the sources of neural cells for treating neurological disorders have been rapidly expanding and in addition to offering therapeutic potential, neural cell products hold promise for disease modeling and drug discovery use. Specific neural cell types have been derived from adult or fetal brain, from human embryonic stem cells, from induced pluripotent stem cells and directly transdifferentiated from adult somatic cells, such as skin cells. It is yet to be determined if the latter approach will evolve into a paradigm shift in the fields of stem cell research and regenerative medicine. These multiple sources of neural cells cover a wide spectrum of safety that needs to be balanced with efficacy to determine the viability of the cellular product. In this article, we will review novel sources of neural cells and discuss current obstacles to developing them into viable cellular products for treating neurological disorders.

  17. What is the superior surgical strategy for bi-level cervical spondylosis-anterior cervical disc replacement or anterior cervical decompression and fusion?: A meta-analysis from 11 studies. (United States)

    Zhao, He; Duan, Li-Jun; Gao, Yu-Shan; Yang, Yong-Dong; Tang, Xiang-Sheng; Zhao, Ding-Yan; Xiong, Yang; Hu, Zhen-Guo; Li, Chuan-Hong; Yu, Xing


    Nowadays, anterior cervical artificial disc replacement (ACDR) has achieved favorable outcomes in treatment for patients with single-level cervical spondylosis. However, It is still controversial that whether or not it will become a potent therapeutic alternation in treating 2 contiguous levels cervical spondylosis compared with anterior cervical decompression and fusion (ACDF). Therefore, we conducted a systematic review and meta-analysis to compare the efficacy and safety of ACDR and ACDF in patients with 2 contiguous levels cervical spondylosis. According to the computer-based online search, PubMed, Embase, Web of Science, and Cochrane Library for articles published before July 1, 2017 were searched. The following outcome measures were extracted: neck disability index (NDI), visual analog scale (VAS) neck, VAS arm, Short Form (SF)-12 mental component summary (MCS), SF-12 physical component summary (PCS), overall clinical success (OCS), patient satisfaction (PS), device-related adverse event (DRAE), subsequent surgical intervention (SSI), neurological deterioration (ND), and adjacent segment degeneration (ASD). Methodological quality was evaluated independently by 2 reviewers using the Furlan for randomized controlled trial (RCT) and MINORS scale for clinical controlled trials (CCT). The chi-squared test and Higgin I test were used to evaluate the heterogeneity. A P bi-level cervical spondylosis, ACDR appears to provide superior clinical effectiveness and safety effects than ACDF. In the future, more high-quality RCTs are warranted to enhance this conclusion.

  18. Cognitive deficits caused by prefrontal cortical and hippocampal neural disinhibition. (United States)

    Bast, Tobias; Pezze, Marie; McGarrity, Stephanie


    contributes to clinically relevant cognitive deficits, and we consider pharmacological strategies for ameliorating cognitive deficits by rebalancing disinhibition-induced aberrant neural activity. Linked Articles This article is part of a themed section on Pharmacology of Cognition: a Panacea for Neuropsychiatric Disease? To view the other articles in this section visit © 2017 The British Pharmacological Society.

  19. Neural decoding of collective wisdom with multi-brain computing. (United States)

    Eckstein, Miguel P; Das, Koel; Pham, Binh T; Peterson, Matthew F; Abbey, Craig K; Sy, Jocelyn L; Giesbrecht, Barry


    Group decisions and even aggregation of multiple opinions lead to greater decision accuracy, a phenomenon known as collective wisdom. Little is known about the neural basis of collective wisdom and whether its benefits arise in late decision stages or in early sensory coding. Here, we use electroencephalography and multi-brain computing with twenty humans making perceptual decisions to show that combining neural activity across brains increases decision accuracy paralleling the improvements shown by aggregating the observers' opinions. Although the largest gains result from an optimal linear combination of neural decision variables across brains, a simpler neural majority decision rule, ubiquitous in human behavior, results in substantial benefits. In contrast, an extreme neural response rule, akin to a group following the most extreme opinion, results in the least improvement with group size. Analyses controlling for number of electrodes and time-points while increasing number of brains demonstrate unique benefits arising from integrating neural activity across different brains. The benefits of multi-brain integration are present in neural activity as early as 200 ms after stimulus presentation in lateral occipital sites and no additional benefits arise in decision related neural activity. Sensory-related neural activity can predict collective choices reached by aggregating individual opinions, voting results, and decision confidence as accurately as neural activity related to decision components. Estimation of the potential for the collective to execute fast decisions by combining information across numerous brains, a strategy prevalent in many animals, shows large time-savings. Together, the findings suggest that for perceptual decisions the neural activity supporting collective wisdom and decisions arises in early sensory stages and that many properties of collective cognition are explainable by the neural coding of information across multiple brains. Finally

  20. Implementing Signature Neural Networks with Spiking Neurons. (United States)

    Carrillo-Medina, José Luis; Latorre, Roberto


    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

  1. Weather forecasting based on hybrid neural model (United States)

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


    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.

  2. Dynamics of neural cryptography. (United States)

    Ruttor, Andreas; Kinzel, Wolfgang; Kanter, Ido


    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.

  3. Dynamics of neural cryptography

    International Nuclear Information System (INIS)

    Ruttor, Andreas; Kinzel, Wolfgang; Kanter, Ido


    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

  4. Dynamics of neural cryptography (United States)

    Ruttor, Andreas; Kinzel, Wolfgang; Kanter, Ido


    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.

  5. [Changing surgical therapy because of clinical studies?]. (United States)

    Schwenk, W; Haase, O; Müller, J M


    The randomised controlled clinical trial (RCT) is a powerful instrument to evaluate different therapeutic regimens. In a survey among 115 physicians visiting the 25th annual meeting of the Surgical Society of Berlin and Brandenburg, the RCT was judged to be very important when changes of therapeutic strategies are discussed. 90 % of all participants claimed to use data from RCTs in the clinical routine and 89 % would participate in such a trial. In official (e. g. discussions during coffee breaks at scientific meetings) or non-medical (e. g. non-scientific press or media) sources of information were assessed as irrelevant for decisions regarding therapeutic strategies. However, in contrast to this view laparoscopic cholecystectomy was introduced into clinical practice rapidly because patients informed by external (non-medical) sources preferred to be operated on with the "modern" technique. Clinical trials with a high level of evidence had no relevant influence on the rapid distribution of laparoscopic cholecystectomy. Controversial discussions concerning the extent of lymphadenectomy with gastric resection for carcinoma demonstrate that the value of excellent clinical RCTs is low if their results challenge a stable paradigma of the surgical scientific society. To allow a rational judgement, new surgical technologies should undergo a scientific gradual evaluation in agreement with the principles of evidence based medicine.

  6. [Surgical assessment of complications after thyroid gland operations]. (United States)

    Dralle, H


    The extent, magnitude and technical equipment used for thyroid surgery has changed considerably in Germany during the last decade. The number of thyroidectomies due to benign goiter have decreased while the extent of thyroidectomy, nowadays preferentially total thyroidectomy, has increased. Due to an increased awareness of surgical complications the number of malpractice claims is increasing. In contrast to surgical databases the frequency of complications in malpractice claims reflects the individual impact of complications on the quality of life. In contrast to surgical databases unilateral and bilateral vocal fold palsy are therefore at the forefront of malpractice claims. As guidelines are often not applicable for the individual surgical expert review, the question arises which are the relevant criteria for the professional expert witness assessing the severity of the individual complication. While in surgical databases major complications after thyroidectomy, such as vocal fold palsy, hypoparathyroidism, hemorrhage and infections are equally frequent (1-3 %), in malpractice claims vocal fold palsy is significantly more frequent (50 %) compared to hypoparathyroidism (15 %), hemorrhage and infections (about 5 % each). To avoid bilateral nerve palsy intraoperative nerve monitoring has become of utmost importance for surgical strategy and malpractice suits alike. For surgical expert review documentation of individual risk-oriented indications, the surgical approach and postoperative management are highly important. Guidelines only define the treatment corridors of good clinical practice. Surgical expert reviews in malpractice suits concerning quality of care and causality between surgical management, complications and sequelae of complications are therefore highly dependent on the grounds and documentation of risk-oriented indications for thyroidectomy, intraoperative and postoperative surgical management.

  7. Short-term synaptic plasticity and heterogeneity in neural systems (United States)

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


    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.

  8. Surgical management of hyperthyroidism. (United States)

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


    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

  9. [Duane vertical surgical treatment]. (United States)

    Merino, M L; Gómez de Liaño, P; Merino, P; Franco, G


    We report 3 cases with a vertical incomitance in upgaze, narrowing of palpebral fissure, and pseudo-overaction of both inferior oblique muscles. Surgery consisted of an elevation of both lateral rectus muscles with an asymmetrical weakening. A satisfactory result was achieved in 2 cases, whereas a Lambda syndrome appeared in the other case. The surgical technique of upper-insertion with a recession of both lateral rectus muscles improved vertical incomitance in 2 of the 3 patients; however, a residual deviation remains in the majority of cases. Copyright © 2011 Sociedad Española de Oftalmología. Published by Elsevier Espana. All rights reserved.

  10. Video content analysis of surgical procedures. (United States)

    Loukas, Constantinos


    In addition to its therapeutic benefits, minimally invasive surgery offers the potential for video recording of the operation. The videos may be archived and used later for reasons such as cognitive training, skills assessment, and workflow analysis. Methods from the major field of video content analysis and representation are increasingly applied in the surgical domain. In this paper, we review recent developments and analyze future directions in the field of content-based video analysis of surgical operations. The review was obtained from PubMed and Google Scholar search on combinations of the following keywords: 'surgery', 'video', 'phase', 'task', 'skills', 'event', 'shot', 'analysis', 'retrieval', 'detection', 'classification', and 'recognition'. The collected articles were categorized and reviewed based on the technical goal sought, type of surgery performed, and structure of the operation. A total of 81 articles were included. The publication activity is constantly increasing; more than 50% of these articles were published in the last 3 years. Significant research has been performed for video task detection and retrieval in eye surgery. In endoscopic surgery, the research activity is more diverse: gesture/task classification, skills assessment, tool type recognition, shot/event detection and retrieval. Recent works employ deep neural networks for phase and tool recognition as well as shot detection. Content-based video analysis of surgical operations is a rapidly expanding field. Several future prospects for research exist including, inter alia, shot boundary detection, keyframe extraction, video summarization, pattern discovery, and video annotation. The development of publicly available benchmark datasets to evaluate and compare task-specific algorithms is essential.

  11. 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)


    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)

  12. Surgical Site Infections and Associated Operative Characteristics. (United States)

    Waltz, Paul K; Zuckerbraun, Brian S

    Surgical site infection (SSI) contributes significantly to surgical morbidity. Patient factors and operative factors contribute to the risk of development of SSI. This review focuses on understanding operative characteristics that are associated with an increased risk of SSI. Much attention has been given to protocol care to reduce SSI, such as hair removal, skin preparation, and pre-operative antibiotic agents. Even with this, the appropriate antibiotic and re-dosing regimens often remain a challenge. Other operative factors such as blood loss/transfusion, emergency/urgent cases, duration of the operation, type of anesthesia, and resident involvement are also potentially modifiable to reduce the risk of SSI. Data are reviewed to highlight the increased risk associated with such factors. Strategies to reduce risk, such as operative care bundles, have significant promise to reduce the incidence of SSI for any given procedure.

  13. Hidden neural networks

    DEFF Research Database (Denmark)

    Krogh, Anders Stærmose; Riis, Søren Kamaric


    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...

  14. Neural networks for aircraft control (United States)

    Linse, Dennis


    Current research in Artificial Neural Networks indicates that networks offer some potential advantages in adaptation and fault tolerance. This research is directed at determining the possible applicability of neural networks to aircraft control. The first application will be to aircraft trim. Neural network node characteristics, network topology and operation, neural network learning and example histories using neighboring optimal control with a neural net are discussed.

  15. Surgical Approaches to Chronic Pancreatitis: Indications and Techniques. (United States)

    Dua, Monica M; Visser, Brendan C


    There are a number of surgical strategies for the treatment of chronic pancreatitis. The optimal intervention should provide effective pain relief, improve/maintain quality of life, preserve exocrine and endocrine function, and manage local complications. Pancreaticoduodenectomy was once the standard operation for patients with chronic pancreatitis; however, other procedures such as the duodenum-preserving pancreatic head resections and its variants have been introduced with good long-term results. Pancreatic duct drainage via a lateral pancreaticojejunostomy continues to be effective in ameliorating symptoms and expediting return to normal lifestyle in many patients. This review summarizes operative indications and gives an overview of the different surgical strategies in treating chronic pancreatitis.

  16. [Surgical treatment of gynecomastia]. (United States)

    Târcoveanu, E; Lupaşcu, C; Vasilescu, A; Moldovanu, R; Ichim, Mihaela; Georgescu, St; Niculescu, D; Dănilă, N; Dimofte, G; Anton, Raluca; Crumpei, Felicia; Florea, Niculina; Ungureanu, Cristina


    Gynecomastia describes a benign increase of the mammary gland in men. When medical treatment fails, the surgical procedure is the treatment of choice. There are two main surgical procedures: subdermal mastectomy and liposuction. To evaluate the results after surgical treatment (mastectomy) performed in a general surgery unit. We performed a retrospective study; all the patients operated for gynecomastia were reviewed. The clinical, imaging, biological, intraoperative and histological data were included into a MS Access database and statistical analyzed. From 1990-2007, 114 patients were admitted in the First Surgical Clinic Iaşi for gynecomastia. Only 12.6% from the patients were with bilateral gynecomastia. The mean age was 40.54 +/- 1.83 years old (range 12-84). Mean body mass was 26.72 +/- 0.46 kg/m2 (range 18.5-41), and about 20% from the patients had a BMI of over 30 kg/m2. We also noted that 46.5% were smokers. Simon classification was used for preoperative staging: 2.6% from the cases (N = 3) were included in stage I, 16.7% (N = 19) in stage IIa, 50% (N = 57) in stage IIb and 30.7% in stage III. The patients included in stages IIa and I are younger then the patients included in stage III (p = 0.024). Mastodynia was noted in 46 cases (40.4%). Ultrasound exam was performed in all the cases, and the larger diameter of the nodule measured was 3.75 +/- 0.18 cm (range 0.5-9.7). Only three cases were preoperatively treated with tamoxifen. Most of the cases were operated using general anesthesia (53.5%). Mastectomy was performed by peri-areolar (70.2%), elliptical (28.9%) or radial (0.9%) incisions. The subdermal mastectomy using peri-areolar approach was performed especially for the cases included in stages I, IIa and IIb--p gynecomastia in 6 cases; the other cases presented dilated ducts. We also noted intraductal papillary hyperplasia in 87 cases and chronic inflammation in 35 cases. The histological exam also revealed intraductal papilloma--9 cases, fibro

  17. Active Neural Localization


    Chaplot, Devendra Singh; Parisotto, Emilio; Salakhutdinov, Ruslan


    Localization is the problem of estimating the location of an autonomous agent from an observation and a map of the environment. Traditional methods of localization, which filter the belief based on the observations, are sub-optimal in the number of steps required, as they do not decide the actions taken by the agent. We propose "Active Neural Localizer", a fully differentiable neural network that learns to localize accurately and efficiently. The proposed model incorporates ideas of tradition...

  18. Neural cryptography with feedback. (United States)

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


    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 responses to macronutrients: hedonic and homeostatic mechanisms. (United States)

    Tulloch, Alastair J; Murray, Susan; Vaicekonyte, Regina; Avena, Nicole M


    The brain responds to macronutrients via intricate mechanisms. We review how the brain's neural systems implicated in homeostatic control of feeding and hedonic responses are influenced by the ingestion of specific types of food. We discuss how these neural systems are dysregulated in preclinical models of obesity. Findings from these studies can increase our understanding of overeating and, perhaps in some cases, the development of obesity. In addition, a greater understanding of the neural circuits affected by the consumption of specific macronutrients, and by obesity, might lead to new treatments and strategies for preventing unhealthy weight gain. Copyright © 2015 AGA Institute. Published by Elsevier Inc. All rights reserved.

  20. Surgical Instrument Sets for Special Operations Expeditionary Surgical Teams. (United States)

    Hale, Diane F; Sexton, Justin C; Benavides, Linda C; Benavides, Jerry M; Lundy, Jonathan B

    The deployment of surgical assets has been driven by mission demands throughout years of military operations in Iraq and Afghanistan. The transition to the highly expeditious Golden Hour Offset Surgical Transport Team (GHOST- T) now offers highly mobile surgical assets in nontraditional operating rooms; the content of the surgical instrument sets has also transformed to accommodate this change. The 102nd Forward Surgical Team (FST) was attached to Special Operations assigned to southern Afghanistan from June 2015 to March 2016. The focus was to decrease overall size and weight of FST instrument sets without decreasing surgical capability of the GHOST-T. Each instrument set was evaluated and modified to include essential instruments to perform damage control surgery. The overall number of main instrument sets was decreased from eight to four; simplified augmentation sets have been added, which expand the capabilities of any main set. The overall size was decreased by 40% and overall weight decreased by 58%. The cardiothoracic, thoracotomy, and emergency thoracotomy trays were condensed to thoracic set. The orthopedic and amputation sets were replaced with an augmentation set of a prepackaged orthopedic external fixator set). An augmentation set to the major or minor basic sets, specifically for vascular injuries, was created. Through the reorganization of conventional FST surgical instrument sets to maintain damage control capabilities and mobility, the 102nd GHOST-T reduced surgical equipment volume and weight, providing a lesson learned for future surgical teams operating in austere environments. 2017.

  1. Global curriculum in surgical oncology. (United States)

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


    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.

  2. Surgical management of low grade isthmic spondylolisthesis; a randomized controlled study of the surgical fixation with and without reduction

    Directory of Open Access Journals (Sweden)

    Bashaireh Khaldoon M


    Full Text Available Abstract Background spondylolisthesis is a condition in which a vertebra slips out of the proper position onto the bone below it as a result of pars interarticularis defect. The slipped segment produces abnormal positioning of the vertebrae in relation to each other along the spinal column and causes mechanical back pain and neural breach. Materials and methods A randomized and double blinded study consisted of 41 patients aged 36-69 years (18 females and 28 males treated for symptomatic spondylolisthesis between December,2006 and December, 2009. All patients were randomly distributed into two groups I and II. Twenty patients were in Group I; they underwent reduction of the slipped vertebrae by using Reduction-Screw Technique and posterior lumbar interbody fixation (PLIF. Group II consisted of twenty one patients who underwent only surgical fixation (PLIF without reduction. All patients in this study had same pre and post operative management. Results only one case had broken rod in group I that required revision. Superficial wound infection was experienced in two patients and one patient, from group II, developed wound hematoma. The outcome in both groups was variable on the short term but was almost the same on the long term follow up. Conclusion surgical management of symptomatic low grade spondylolisthesis should include neural decompression and surgical fixation. Reduction of slipped vertebral bodies is unnecessary as the ultimate outcome will be likely similar.

  3. Aggressive surgical management of craniopharyngiomas

    Directory of Open Access Journals (Sweden)

    Manmohan Singh


    Full Text Available Surgical treatment of craniopharyngiomas is challenging and despite advancements it continues to pose a challenge. Proponents of subtotal resection in conjunction with radiotherapy argue that this less aggressive approach can yield appropriate results with the lower morbidity. On the contrary, other argument is that gross total resection is superior. Though surgical management of craniopharyngioma is challenging due to its location and important surrounding neurovascular structures, optimal surgical results can be expected following radical surgical excision. Radical excision of craniopharyngiomas is associated with excellent long-term recurrence free survival. Radiation induced long-term complications can be altogether avoided by excising these tumors completely.

  4. Surgical treatment of parastomal hernia

    International Nuclear Information System (INIS)

    Basti, Z.; Mayer, A.


    Stoma construction is among standard surgical skills and is performed for many indications. Every stoma means huge impact on quality of life for patients even with great improvement in surgical technique and ostomy devices. All patients are very sensitive to complication of stoma and the most frequent complication is parastomal hernia. Incidence reported in literature is very high and unacceptable, it is 30-70%. Surgical approach is very demanding on technical equipment and experiences of surgeon. Authors focus on each surgical approach for treating this complication weather it´s using mesh or laparoscopic or open approach. (author)

  5. Implementation of surgical quality improvement: auditing tool for surgical site infection prevention practices. (United States)

    Hechenbleikner, Elizabeth M; Hobson, Deborah B; Bennett, Jennifer L; Wick, Elizabeth C


    Surgical site infections are a potentially preventable patient harm. Emerging evidence suggests that the implementation of evidence-based process measures for infection reduction is highly variable. The purpose of this work was to develop an auditing tool to assess compliance with infection-related process measures and establish a system for identifying and addressing defects in measure implementation. This was a retrospective cohort study using electronic medical records. We used the auditing tool to assess compliance with 10 process measures in a sample of colorectal surgery patients with and without postoperative infections at an academic medical center (January 2012 to March 2013). We investigated 59 patients with surgical site infections and 49 patients without surgical site infections. First, overall compliance rates for the 10 process measures were compared between patients with infection vs patients without infection to assess if compliance was lower among patients with surgical site infections. Then, because of the burden of data collection, the tool was used exclusively to evaluate quarterly compliance rates among patients with infection. The results were reviewed, and the key factors contributing to noncompliance were identified and addressed. Ninety percent of process measures had lower compliance rates among patients with infection. Detailed review of infection cases identified many defects that improved following the implementation of system-level changes: correct cefotetan redosing (education of anesthesia personnel), temperature at surgical incision >36.0°C (flags used to identify patients for preoperative warming), and the use of preoperative mechanical bowel preparation with oral antibiotics (laxative solutions and antibiotics distributed in clinic before surgery). Quarterly compliance improved for 80% of process measures by the end of the study period. This study was conducted on a small surgical cohort within a select subspecialty. The

  6. Surgical treatment of chronic pancreatitis in young patients. (United States)

    Zhou, Feng; Gou, Shan-Miao; Xiong, Jiong-Xin; Wu, He-Shui; Wang, Chun-You; Liu, Tao


    The main treatment strategies for chronic pancreatitis in young patients include therapeutic endoscopic retrograde cholangio-pancreatography (ERCP) intervention and surgical intervention. Therapeutic ERCP intervention is performed much more extensively for its minimally invasive nature, but a part of patients are referred to surgery at last. Historical and follow-up data of 21 young patients with chronic pancreatitis undergoing duodenum-preserving total pancreatic head resection were analyzed to evaluate the outcomes of therapeutic ERCP intervention and surgical intervention in this study. The surgical complications of repeated therapeutic ERCP intervention and surgical intervention were 38% and 19% respectively. During the first therapeutic ERCP intervention to surgical intervention, 2 patients developed diabetes, 5 patients developed steatorrhea, and 5 patients developed pancreatic type B pain. During the follow-up of surgical intervention, 1 new case of diabetes occurred, 1 case of steatorrhea recovered, and 4 cases of pancreatic type B pain were completely relieved. In a part of young patients with chronic pancreatitis, surgical intervention was more effective than therapeutic ERCP intervention on delaying the progression of the disease and relieving the symptoms.

  7. Parallel consensual neural networks. (United States)

    Benediktsson, J A; Sveinsson, J R; Ersoy, O K; Swain, P H


    A new type of a neural-network architecture, the parallel consensual neural network (PCNN), is introduced and applied in classification/data fusion of multisource remote sensing and geographic data. The PCNN architecture is based on statistical consensus theory and involves using stage neural networks with transformed input data. The input data are transformed several times and the different transformed data are used as if they were independent inputs. The independent inputs are first classified using the stage neural networks. The output responses from the stage networks are then weighted and combined to make a consensual decision. In this paper, optimization methods are used in order to weight the outputs from the stage networks. Two approaches are proposed to compute the data transforms for the PCNN, one for binary data and another for analog data. The analog approach uses wavelet packets. The experimental results obtained with the proposed approach show that the PCNN outperforms both a conjugate-gradient backpropagation neural network and conventional statistical methods in terms of overall classification accuracy of test data.

  8. Neural network-based sensor signal accelerator.

    Energy Technology Data Exchange (ETDEWEB)

    Vogt, M. C.


    A strategy has been developed to computationally accelerate the response time of a generic electronic sensor. The strategy can be deployed as an algorithm in a control system or as a physical interface (on an embedded microcontroller) between a slower responding external sensor and a higher-speed control system. Optional code implementations are available to adjust algorithm performance when computational capability is limited. In one option, the actual sensor signal can be sampled at the slower rate with adaptive linear neural networks predicting the sensor's future output and interpolating intermediate synthetic output values. In another option, a synchronized collection of predictors sequentially controls the corresponding synthetic output voltage. Error is adaptively corrected in both options. The core strategy has been demonstrated with automotive oxygen sensor data. A prototype interface device is under construction. The response speed increase afforded by this strategy could greatly offset the cost of developing a replacement sensor with a faster physical response time.

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

    CERN Document Server

    Liu, Jinkun


    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...

  10. Access to Specialized Surgical Care

    African Journals Online (AJOL)

    The ANNALS of AFRICAN SURGERY. January 2016 Volume 13 Issue 1 1. EDITORIAL. Access to Specialized Surgical Care. Saidi H. University of Nairobi. Correspondence to: Prof Hassan Saidi, P.O Box 30196-00100, Nairobi. Email: Ann Afr Surg. 2016;13(1):1-2. The narrative of surgical disease in ...

  11. 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 ...

  12. Surgical innovations in canine gonadectomy

    NARCIS (Netherlands)

    Van Goethem, Bart


    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

  13. Acquiring minimally invasive surgical skills

    NARCIS (Netherlands)

    Hiemstra, Ellen


    Many topics in surgical skills education have been implemented without a solid scientific basis. For that reason we have tried to find this scientific basis. We have focused on training and evaluation of minimally invasive surgical skills in a training setting and in practice in the operating room.

  14. Feedforward Nonlinear Control Using Neural Gas Network

    Directory of Open Access Journals (Sweden)

    Iván Machón-González


    Full Text Available Nonlinear systems control is a main issue in control theory. Many developed applications suffer from a mathematical foundation not as general as the theory of linear systems. This paper proposes a control strategy of nonlinear systems with unknown dynamics by means of a set of local linear models obtained by a supervised neural gas network. The proposed approach takes advantage of the neural gas feature by which the algorithm yields a very robust clustering procedure. The direct model of the plant constitutes a piece-wise linear approximation of the nonlinear system and each neuron represents a local linear model for which a linear controller is designed. The neural gas model works as an observer and a controller at the same time. A state feedback control is implemented by estimation of the state variables based on the local transfer function that was provided by the local linear model. The gradient vectors obtained by the supervised neural gas algorithm provide a robust procedure for feedforward nonlinear control, that is, supposing the inexistence of disturbances.

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

    International Nuclear Information System (INIS)

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


    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

  16. Combined Surgical Treatment of Gynecomastia

    Directory of Open Access Journals (Sweden)

    Yordanov Y.


    Full Text Available Surgical treatment of gynecomastia could present unique challenges for the plastic surgeon. Achieving a good balance between effectiveness of the selected approach and the satisfactory aesthetic outcome often is a difficult endeavor. Optimal surgical treatment involves a combination of liposuction and direct excision. In the present study the charts of 11 patients treated with suction-assisted liposuction and direct surgical excision were retrospectively reviewed; a special emphasis is placed on the surgical technique. The mean follow-up period of the patients was 11.6 months. No infection, hematoma, nipple-areola complex necrosis and nipple retraction was encountered in this series. The combined surgical treatment of gynecomastia has shown to be a reliable technique in both small and moderate breast enlargement including those with skin excess.

  17. Surgical Scales: Primary Closure versus Gastric Resection for ...

    African Journals Online (AJOL)

    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 ...

  18. Neural Architectures for Control (United States)

    Peterson, James K.


    The cerebellar model articulated controller (CMAC) neural architectures are shown to be viable for the purposes of real-time learning and control. Software tools for the exploration of CMAC performance are developed for three hardware platforms, the MacIntosh, the IBM PC, and the SUN workstation. All algorithm development was done using the C programming language. These software tools were then used to implement an adaptive critic neuro-control design that learns in real-time how to back up a trailer truck. The truck backer-upper experiment is a standard performance measure in the neural network literature, but previously the training of the controllers was done off-line. With the CMAC neural architectures, it was possible to train the neuro-controllers on-line in real-time on a MS-DOS PC 386. CMAC neural architectures are also used in conjunction with a hierarchical planning approach to find collision-free paths over 2-D analog valued obstacle fields. The method constructs a coarse resolution version of the original problem and then finds the corresponding coarse optimal path using multipass dynamic programming. CMAC artificial neural architectures are used to estimate the analog transition costs that dynamic programming requires. The CMAC architectures are trained in real-time for each obstacle field presented. The coarse optimal path is then used as a baseline for the construction of a fine scale optimal path through the original obstacle array. These results are a very good indication of the potential power of the neural architectures in control design. In order to reach as wide an audience as possible, we have run a seminar on neuro-control that has met once per week since 20 May 1991. This seminar has thoroughly discussed the CMAC architecture, relevant portions of classical control, back propagation through time, and adaptive critic designs.

  19. Output control of da Vinci surgical system's surgical graspers. (United States)

    Johnson, Paul J; Schmidt, David E; Duvvuri, Umamaheswar


    The number of robot-assisted surgeries performed with the da Vinci surgical system has increased significantly over the past decade. The articulating movements of the robotic surgical grasper are controlled by grip controls at the master console. The user interface has been implicated as one contributing factor in surgical grasping errors. The goal of our study was to characterize and evaluate the user interface of the da Vinci surgical system in controlling surgical graspers. An angular manipulator with force sensors was used to increment the grip control angle as grasper output angles were measured. Input force at the grip control was simultaneously measured throughout the range of motion. Pressure film was used to assess the maximum grasping force achievable with the endoscopic grasping tool. The da Vinci robot's grip control angular input has a nonproportional relationship with the grasper instrument output. The grip control mechanism presents an intrinsic resistant force to the surgeon's fingertips and provides no haptic feedback. The da Vinci Maryland graspers are capable of applying up to 5.1 MPa of local pressure. The angular and force input at the grip control of the da Vinci robot's surgical graspers is nonproportional to the grasper instrument's output. Understanding the true relationship of the grip control input to grasper instrument output may help surgeons understand how to better control the surgical graspers and promote fewer grasping errors. Copyright © 2014 Elsevier Inc. All rights reserved.

  20. Sacred or Neural?

    DEFF Research Database (Denmark)

    Runehov, Anne Leona Cesarine

    Are religious spiritual experiences merely the product of the human nervous system? Anne L.C. Runehov investigates the potential of contemporary neuroscience to explain religious experiences. Following the footsteps of Michael Persinger, Andrew Newberg and Eugene d'Aquili she defines...... the terminological bounderies of "religious experiences" and explores the relevant criteria for the proper evaluation of scientific research, with a particular focus on the validity of reductionist models. Runehov's theis is that the perspectives looked at do not necessarily exclude each other but can be merged....... The question "sacred or neural?" becomes a statement "sacred and neural". The synergies thus produced provide manifold opportunities for interdisciplinary dialogue and research....

  1. Deconvolution using a neural network

    Energy Technology Data Exchange (ETDEWEB)

    Lehman, S.K.


    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.

  2. Introduction to Artificial Neural Networks

    DEFF Research Database (Denmark)

    Larsen, Jan


    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....

  3. Neural network-based nonlinear model predictive control vs. linear quadratic gaussian control (United States)

    Cho, C.; Vance, R.; Mardi, N.; Qian, Z.; Prisbrey, K.


    One problem with the application of neural networks to the multivariable control of mineral and extractive processes is determining whether and how to use them. The objective of this investigation was to compare neural network control to more conventional strategies and to determine if there are any advantages in using neural network control in terms of set-point tracking, rise time, settling time, disturbance rejection and other criteria. The procedure involved developing neural network controllers using both historical plant data and simulation models. Various control patterns were tried, including both inverse and direct neural network plant models. These were compared to state space controllers that are, by nature, linear. For grinding and leaching circuits, a nonlinear neural network-based model predictive control strategy was superior to a state space-based linear quadratic gaussian controller. The investigation pointed out the importance of incorporating state space into neural networks by making them recurrent, i.e., feeding certain output state variables into input nodes in the neural network. It was concluded that neural network controllers can have better disturbance rejection, set-point tracking, rise time, settling time and lower set-point overshoot, and it was also concluded that neural network controllers can be more reliable and easy to implement in complex, multivariable plants.

  4. Training situational awareness to reduce surgical errors in the operating room

    NARCIS (Netherlands)

    Graafland, M.; Schraagen, J.M.C.; Boermeester, M.A.; Bemelman, W.A.; Schijven, M.P.


    Background: Surgical errors result from faulty decision-making, misperceptions and the application of suboptimal problem-solving strategies, just as often as they result from technical failure. To date, surgical training curricula have focused mainly on the acquisition of technical skills. The aim

  5. 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.


    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

  6. 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)


    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)

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

    International Nuclear Information System (INIS)

    Martinez B, M.R.; Ortiz R, J.M.; Vega C, H.R.


    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)

  8. Spiking Neural P Systems with Communication on Request. (United States)

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


    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.

  9. Incidental regulation of attraction: The neural basis of the derogation of attractive alternatives in romantic relationships

    NARCIS (Netherlands)

    Meyer, M.L.; Berkman, E.T.; Karremans, J.C.T.M.; Lieberman, M.D.


    Although a great deal of research addresses the neural basis of deliberate and intentional emotion-regulation strategies, less attention has been paid to the neural mechanisms involved in implicit forms of emotion regulation. Behavioural research suggests that romantically involved participants

  10. Supervised Learning with Complex-valued Neural Networks

    CERN Document Server

    Suresh, Sundaram; Savitha, Ramasamy


    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...

  11. Efficiency turns the table on neural encoding, decoding and noise. (United States)

    Deneve, Sophie; Chalk, Matthew


    Sensory neurons are usually described with an encoding model, for example, a function that predicts their response from the sensory stimulus using a receptive field (RF) or a tuning curve. However, central to theories of sensory processing is the notion of 'efficient coding'. We argue here that efficient coding implies a completely different neural coding strategy. Instead of a fixed encoding model, neural populations would be described by a fixed decoding model (i.e. a model reconstructing the stimulus from the neural responses). Because the population solves a global optimization problem, individual neurons are variable, but not noisy, and have no truly invariant tuning curve or receptive field. We review recent experimental evidence and implications for neural noise correlations, robustness and adaptation. Copyright © 2016. Published by Elsevier Ltd.

  12. Neural Network Ensembles

    DEFF Research Database (Denmark)

    Hansen, Lars Kai; Salamon, Peter


    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....

  13. Neural correlates of consciousness

    African Journals Online (AJOL)

    neural cells.1 Under this approach, consciousness is believed to be a product of the ... possible only when the 40 Hz electrical hum is sustained among the brain circuits, ... expect the brain stem ascending reticular activating system. (ARAS) and the ... related synchrony of cortical neurons.11 Indeed, stimulation of brainstem ...

  14. Neural Networks and Micromechanics (United States)

    Kussul, Ernst; Baidyk, Tatiana; Wunsch, Donald C.

    The title of the book, "Neural Networks and Micromechanics," seems artificial. However, the scientific and technological developments in recent decades demonstrate a very close connection between the two different areas of neural networks and micromechanics. The purpose of this book is to demonstrate this connection. Some artificial intelligence (AI) methods, including neural networks, could be used to improve automation system performance in manufacturing processes. However, the implementation of these AI methods within industry is rather slow because of the high cost of conducting experiments using conventional manufacturing and AI systems. To lower the cost, we have developed special micromechanical equipment that is similar to conventional mechanical equipment but of much smaller size and therefore of lower cost. This equipment could be used to evaluate different AI methods in an easy and inexpensive way. The proved methods could be transferred to industry through appropriate scaling. In this book, we describe the prototypes of low cost microequipment for manufacturing processes and the implementation of some AI methods to increase precision, such as computer vision systems based on neural networks for microdevice assembly and genetic algorithms for microequipment characterization and the increase of microequipment precision.

  15. Introduction to neural networks

    International Nuclear Information System (INIS)

    Pavlopoulos, P.


    This lecture is a presentation of today's research in neural computation. Neural computation is inspired by knowledge from neuro-science. It draws its methods in large degree from statistical physics and its potential applications lie mainly in computer science and engineering. Neural networks models are algorithms for cognitive tasks, such as learning and optimization, which are based on concepts derived from research into the nature of the brain. The lecture first gives an historical presentation of neural networks development and interest in performing complex tasks. Then, an exhaustive overview of data management and networks computation methods is given: the supervised learning and the associative memory problem, the capacity of networks, the Perceptron networks, the functional link networks, the Madaline (Multiple Adalines) networks, the back-propagation networks, the reduced coulomb energy (RCE) networks, the unsupervised learning and the competitive learning and vector quantization. An example of application in high energy physics is given with the trigger systems and track recognition system (track parametrization, event selection and particle identification) developed for the CPLEAR experiment detectors from the LEAR at CERN. (J.S.). 56 refs., 20 figs., 1 tab., 1 appendix

  16. Learning from neural control. (United States)

    Wang, Cong; Hill, David J


    One of the amazing successes of biological systems is their ability to "learn by doing" and so adapt to their environment. In this paper, first, a deterministic learning mechanism is presented, by which an appropriately designed adaptive neural controller is capable of learning closed-loop system dynamics during tracking control to a periodic reference orbit. Among various neural network (NN) architectures, the localized radial basis function (RBF) network is employed. A property of persistence of excitation (PE) for RBF networks is established, and a partial PE condition of closed-loop signals, i.e., the PE condition of a regression subvector constructed out of the RBFs along a periodic state trajectory, is proven to be satisfied. Accurate NN approximation for closed-loop system dynamics is achieved in a local region along the periodic state trajectory, and a learning ability is implemented during a closed-loop feedback control process. Second, based on the deterministic learning mechanism, a neural learning control scheme is proposed which can effectively recall and reuse the learned knowledge to achieve closed-loop stability and improved control performance. The significance of this paper is that the presented deterministic learning mechanism and the neural learning control scheme provide elementary components toward the development of a biologically-plausible learning and control methodology. Simulation studies are included to demonstrate the effectiveness of the approach.

  17. Neural systems for control

    National Research Council Canada - National Science Library

    Omidvar, Omid; Elliott, David L


    ... 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...

  18. Neural underpinnings of music

    DEFF Research Database (Denmark)

    Vuust, Peter; Gebauer, Line K; Witek, Maria A G


    . According to this theory, perception and learning is manifested through the brain’s Bayesian minimization of the error between the input to the brain and the brain’s prior expectations. Fourth, empirical studies of neural and behavioral effects of syncopation, polyrhythm and groove will be reported, and we...

  19. Surgical therapy in chronic pancreatitis. (United States)

    Neal, C P; Dennison, A R; Garcea, G


    Chronic pancreatitis (CP) is an inflammatory disease of the pancreas which causes chronic pain, as well as exocrine and endocrine failure in the majority of patients, together producing social and domestic upheaval and a very poor quality of life. At least half of patients will require surgical intervention at some stage in their disease, primarily for the treatment of persistent pain. Available data have now confirmed that surgical intervention may produce superior results to conservative and endoscopic treatment. Comprehensive individual patient assessment is crucial to optimal surgical management, however, in order to determine which morphological disease variant (large duct disease, distal stricture with focal disease, expanded head or small duct/minimal change disease) is present in the individual patient, as a wide and differing range of surgical approaches are possible depending upon the specific abnormality within the gland. This review comprehensively assesses the evidence for these differing approaches to surgical intervention in chronic pancreatitis. Surgical drainage procedures should be limited to a small number of patients with a dilated duct and no pancreatic head mass. Similarly, a small population presenting with a focal stricture and tail only disease may be successfully treated by distal pancreatectomy. Long-term results of both of these procedure types are poor, however. More impressive results have been yielded for the surgical treatment of the expanded head, for which a range of surgical options now exist. Evidence from level I studies and a recent meta-analysis suggests that duodenum-preserving resections offer benefits compared to pancreaticoduodenectomy, though the results of the ongoing, multicentre ChroPac trial are awaited to confirm this. Further data are also needed to determine which of the duodenum-preserving procedures provides optimal results. In relation to small duct/minimal change disease total pancreatectomy represents the only

  20. Surgical Skills Beyond Scientific Management. (United States)

    Whitfield, Nicholas


    During the Great War, the French surgeon Alexis Carrel, in collaboration with the English chemist Henry Dakin, devised an antiseptic treatment for infected wounds. This paper focuses on Carrel's attempt to standardise knowledge of infected wounds and their treatment, and looks closely at the vision of surgical skill he espoused and its difference from those associated with the doctrines of scientific management. Examining contemporary claims that the Carrel-Dakin method increased rather than diminished demands on surgical work, this paper further shows how debates about antiseptic wound treatment opened up a critical space for considering the nature of skill as a vital dynamic in surgical innovation and practice.

  1. Virtual Reality Simulator Systems in Robotic Surgical Training. (United States)

    Mangano, Alberto; Gheza, Federico; Giulianotti, Pier Cristoforo


    The number of robotic surgical procedures has been increasing worldwide. It is important to maximize the cost-effectiveness of robotic surgical training and safely reduce the time needed for trainees to reach proficiency. The use of preliminary lab training in robotic skills is a good strategy for the rapid acquisition of further, standardized robotic skills. Such training can be done either by using a simulator or by exercises in a dry or wet lab. While the use of an actual robotic surgical system for training may be problematic (high cost, lack of availability), virtual reality (VR) simulators can overcome many of these obstacles. However, there is still a lack of standardization. Although VR training systems have improved, they cannot yet replace experience in a wet lab. In particular, simulated scenarios are not yet close enough to a real operative experience. Indeed, there is a difference between technical skills (i.e., mechanical ability to perform a simulated task) and surgical competence (i.e., ability to perform a real surgical operation). Thus, while a VR simulator can replace a dry lab, it cannot yet replace training in a wet lab or operative training in actual patients. However, in the near future, it is expected that VR surgical simulators will be able to provide total reality simulation and replace training in a wet lab. More research is needed to produce more wide-ranging, trans-specialty robotic curricula.

  2. The methodological quality of systematic reviews comparing temporomandibular joint disorder surgical and non-surgical treatment

    Directory of Open Access Journals (Sweden)

    Vasconcelos Belmiro CE


    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

  3. An evaluation of Irish general surgical research publications from 2000 to 2009.

    LENUS (Irish Health Repository)

    Robertson, I J


    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.


    African Journals Online (AJOL)

    Objective: To review factors influencing the choice of anaesthesia for ophthalmic surgical procedures. ... as risk associated with general anaesthesia (8) they are more .... Wilson ME, Pandey SK, Thakur J. Paediatric cataract blindness in the ...

  5. uniportal vats for surgical repair

    African Journals Online (AJOL)


    Mar 23, 2017 ... aDepartamet of Pediatric Surgery, Hospital Teresa Herrera, Complejo Hospitalario. Universitario de A ... Advances in anesthesia, neonatal intensive, surgical, and cardiac care have ... First, these patients are at risk of airway ...

  6. Spinal surgery: non surgical complications

    African Journals Online (AJOL)


    surgical procedure). Arterial cannulation ... Acute retinal necrosis syndrome after epidural corticos- teroid injections ... prevented, or respond to early recognition and treatment. ..... drugs should only be administered if there are no alternatives.

  7. Patient-specific surgical simulation. (United States)

    Soler, Luc; Marescaux, Jacques


    Technological innovations of the twentieth century have provided medicine and surgery with new tools for education and therapy definition. Thus, by combining Medical Imaging and Virtual Reality, patient-specific applications providing preoperative surgical simulation have become possible.

  8. Bioprinting for Neural Tissue Engineering. (United States)

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


    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.

  9. Surgical management of Crohn's disease. (United States)

    Lu, Kim C; Hunt, Steven R


    Although medical management can control symptoms in a recurring incurable disease, such as Crohn's disease, surgical management is reserved for disease complications or those problems refractory to medical management. In this article, we cover general principles for the surgical management of Crohn's disease, ranging from skin tags, abscesses, fistulae, and stenoses to small bowel and extraintestinal disease. Copyright © 2013 Elsevier Inc. All rights reserved.

  10. Surgical innovations in canine gonadectomy


    Van Goethem, Bart


    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 negative consequences (lengthy placement, impaired wound healing around bulky knots, and the effect of unsightly knots on cosmetics). A study in 9 dogs found that celiotomy closure was easily achiev...

  11. Evolution of surgical skills training (United States)

    Roberts, Kurt E; Bell, Robert L; Duffy, Andrew J


    Surgical training is changing: one hundred years of tradition is being challenged by legal and ethical concerns for patient safety, work hours restrictions, the cost of operating room time, and complications. Surgical simulation and skills training offers an opportunity to teach and practice advanced skills outside of the operating room environment before attempting them on living patients. Simulation training can be as straight forward as using real instruments and video equipment to manipulate simulated “tissue” in a box trainer. More advanced, virtual reality simulators are now available and ready for widespread use. Early systems have demonstrated their effectiveness and discriminative ability. Newer systems enable the development of comprehensive curricula and full procedural simulations. The Accreditation Council of Graduate Medical Education’s (ACGME) has mandated the development of novel methods of training and evaluation. Surgical organizations are calling for methods to ensure the maintenance of skills, advance surgical training, and to credential surgeons as technically competent. Simulators in their current form have been demonstrated to improve the operating room performance of surgical residents. Development of standardized training curricula remains an urgent and important agenda, particularly for minimal invasive surgery. An innovative and progressive approach, borrowing experiences from the field of aviation, can provide the foundation for the next century of surgical training, ensuring the quality of the product. As the technology develops, the way we practice will continue to evolve, to the benefit of physicians and patients. PMID:16718842

  12. Minimizing surgical skin incision scars with a latex surgical glove. (United States)

    Han, So-Eun; Ryoo, Suk-Tae; Lim, So Young; Pyon, Jai-Kyung; Bang, Sa-Ik; Oh, Kap-Sung; Mun, Goo-Hyun


    The current trend in minimally invasive surgery is to make a small surgical incision. However, the excessive tensile stress applied by the retractors to the skin surrounding the incision often results in a long wound healing time and extensive scarring. To minimize these types of wound problems, the authors evaluated a simple and cost-effective method to minimize surgical incision scars based on the use of a latex surgical glove. The tunnel-shaped part of a powder-free latex surgical glove was applied to the incision and the dissection plane. It was fixed to the full layer of the dissection plane with sutures. The glove on the skin surface then was sealed with Ioban (3 M Health Care, St. Paul, MN, USA) to prevent movement. The operation proceeded as usual, with the retractor running through the tunnel of the latex glove. It was possible to complete the operation without any disturbance of the visual field by the surgical glove, and the glove was neither torn nor separated by the retractors. The retractors caused traction and friction during the operation, but the extent of damage to the postoperative skin incision margin was remarkably less than when the operation was performed without a glove. This simple and cost-effective method is based on the use of a latex surgical glove to protect the surgical skin incision site and improve the appearance of the postoperative scar. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors .

  13. Bacterial migration through punctured surgical gloves under real surgical conditions

    Directory of Open Access Journals (Sweden)

    Heidecke Claus-Dieter


    Full Text Available Abstract Background The aim of this study was to confirm recent results from a previous study focussing on the development of a method to measure the bacterial translocation through puncture holes in surgical gloves under real surgical conditions. Methods An established method was applied to detect bacterial migration from the operating site through the punctured glove. Biogel™ double-gloving surgical gloves were used during visceral surgeries over a 6-month period. A modified Gaschen-bag method was used to retrieve organisms from the inner glove, and thus-obtained bacteria were compared with micro-organisms detected by an intra-operative swab. Results In 20 consecutive procedures, 194 gloves (98 outer gloves, 96 inner gloves were examined. The rate of micro-perforations of the outer surgical glove was 10% with a median wearing time of 100 minutes (range: 20-175 minutes. Perforations occurred in 81% on the non-dominant hand, with the index finger most frequently (25% punctured. In six cases, bacterial migration could be demonstrated microbiologically. In 5% (5/98 of outer gloves and in 1% (1/96 of the inner gloves, bacterial migration through micro-perforations was observed. For gloves with detected micro-perforations (n = 10 outer layers, the calculated migration was 50% (n = 5. The minimum wearing time was 62 minutes, with a calculated median wearing time of 71 minutes. Conclusions This study confirms previous results that bacterial migration through unnoticed micro-perforations in surgical gloves does occur under real practical surgical conditions. Undetected perforation of surgical gloves occurs frequently. Bacterial migration from the patient through micro-perforations on the hand of surgeons was confirmed, limiting the protective barrier function of gloves if worn over longer periods.

  14. Brachial plexus injury in adults: Diagnosis and surgical treatment strategies

    Directory of Open Access Journals (Sweden)

    Mukund R Thatte


    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.

  15. Surgical Strategy in Bouveret's Syndrome. A Case Report

    Directory of Open Access Journals (Sweden)

    Dénes Márton István


    Full Text Available Bouveret's syndrome is a high mechanical obstruction due to impaction of a gallstone into the duodenum, through a cholecystoduodenal fistula. It belongs to a larger group of gallstone ileus, a disease which occurs after developing a fistula between the gallbladder and the gastrointestinal tract. This is a rare complication of gallstones but because it appears in elderly people, it has a high morbidity and mortality. Patients have various symptoms and the treatment is individualized. We present here a case of a 67 years old patient, admitted in emergency, presenting symptoms of high bowel obstruction, with onset 5 days before admission. Abdominal ultrasound reveals a 5 cm stone that seems to be in the gallbladder, gastric stasis and at gastroscopy appears a foreign body impacted in the duodenum. After a short preparation the patient underwent surgery. We found a dilated stomach and a large cholecystoduodenal fistula with an impacted gallstone in the duodenum. We performed one stage surgery: cholecystectomy, extraction of the stone and suturing of the fistula. We reestablished the continuity of the intestinal tract. We performed also an ileostomy for feeding the patient and protecting the anastomoses. The postoperative evolution was favorable.

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

    DEFF Research Database (Denmark)

    Bendtsen, Jan Dimon; Izadi-Zamanabadi, Roozbeh


    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...

  17. [Principles of direct surgical procedures on the pancreas in surgical treatment of chronic pancreatitis]. (United States)

    Kopchak, V M; Khomiak, I V; Cheverdiuk, D A; Kopchak, K V; Duvalko, A V; Serdiuk, V P


    An analysis of treatment of 584 patients with complicated forms of chronic pancreatitis operated during 2000-2100 years was carried out. Quality of life of postoperative patients was estimated according to a technique of calculations of modules EORTC QLQ-C30 and EORTC QLQ-PAN26. The indicators of quality of life have improved by 19.7% in performance of saving duodenal outflow of operations of pancreatic juice. Change of the surgical strategy has led to decreased number of postoperative complications by 4.6% and to satisfactory long-term results in 92.6% of the patients.

  18. Analysis of neural data

    CERN Document Server

    Kass, Robert E; Brown, Emery N


    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.

  19. Deep Neural Yodelling


    Pfäffli, Daniel (Autor/in)


    Yodel music differs from most other genres by exercising the transition from chest voice to falsetto with an audible glottal stop which is recognised even by laymen. Yodel often consists of a yodeller with a choir accompaniment. In Switzerland, it is differentiated between the natural yodel and yodel songs. Today's approaches to music generation with machine learning algorithms are based on neural networks, which are best described by stacked layers of neurons which are connected with neurons...

  20. Neural networks for triggering

    International Nuclear Information System (INIS)

    Denby, B.; Campbell, M.; Bedeschi, F.; Chriss, N.; Bowers, C.; Nesti, F.


    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

  1. Artificial neural network modelling

    CERN Document Server

    Samarasinghe, Sandhya


    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. .

  2. Rotation Invariance Neural Network


    Li, Shiyuan


    Rotation invariance and translation invariance have great values in image recognition tasks. In this paper, we bring a new architecture in convolutional neural network (CNN) named cyclic convolutional layer to achieve rotation invariance in 2-D symbol recognition. We can also get the position and orientation of the 2-D symbol by the network to achieve detection purpose for multiple non-overlap target. Last but not least, this architecture can achieve one-shot learning in some cases using thos...

  3. Neural Mechanisms of Foraging


    Kolling, Nils; Behrens, Timothy EJ; Mars, Rogier B; Rushworth, Matthew FS


    Behavioural economic studies, involving limited numbers of choices, have provided key insights into neural decision-making mechanisms. By contrast, animals’ foraging choices arise in the context of sequences of encounters with prey/food. On each encounter the animal chooses to engage or whether the environment is sufficiently rich that searching elsewhere is merited. The cost of foraging is also critical. We demonstrate humans can alternate between two modes of choice, comparative decision-ma...

  4. Replicable Expansion and Differentiation of Neural Precursors from Adult Canine Skin

    Directory of Open Access Journals (Sweden)

    Thomas Duncan


    Full Text Available Repopulation of brain circuits by neural precursors is a potential therapeutic strategy for neurodegenerative disorders; however, choice of cell is critical. Previously, we introduced a two-step culture system that generates a high yield of neural precursors from small samples of adult canine skin. Here, we probe their gene and protein expression profiles in comparison with dermal fibroblasts and brain-derived neural stem cells and characterize their neuronal potential. To date, we have produced >50 skin-derived neural precursor (SKN lines. SKNs can be cultured in a highly replicable fashion and uniformly express a panel of identifying markers. Upon differentiation, they self-upregulate neural specification genes, generating neurons with basic electrophysiological functionality. This unique population of neural precursors, derived from mature skin, overcomes many of the practical issues that have limited clinical translation of alternative cell types. Easily accessible, neuronally committed, and patient specific, SKNs may have potential for the treatment of brain disorders.

  5. Automated surgical skill assessment in RMIS training. (United States)

    Zia, Aneeq; Essa, Irfan


    Manual feedback in basic robot-assisted minimally invasive surgery (RMIS) training can consume a significant amount of time from expert surgeons' schedule and is prone to subjectivity. In this paper, we explore the usage of different holistic features for automated skill assessment using only robot kinematic data and propose a weighted feature fusion technique for improving score prediction performance. Moreover, we also propose a method for generating 'task highlights' which can give surgeons a more directed feedback regarding which segments had the most effect on the final skill score. We perform our experiments on the publicly available JHU-ISI Gesture and Skill Assessment Working Set (JIGSAWS) and evaluate four different types of holistic features from robot kinematic data-sequential motion texture (SMT), discrete Fourier transform (DFT), discrete cosine transform (DCT) and approximate entropy (ApEn). The features are then used for skill classification and exact skill score prediction. Along with using these features individually, we also evaluate the performance using our proposed weighted combination technique. The task highlights are produced using DCT features. Our results demonstrate that these holistic features outperform all previous Hidden Markov Model (HMM)-based state-of-the-art methods for skill classification on the JIGSAWS dataset. Also, our proposed feature fusion strategy significantly improves performance for skill score predictions achieving up to 0.61 average spearman correlation coefficient. Moreover, we provide an analysis on how the proposed task highlights can relate to different surgical gestures within a task. Holistic features capturing global information from robot kinematic data can successfully be used for evaluating surgeon skill in basic surgical tasks on the da Vinci robot. Using the framework presented can potentially allow for real-time score feedback in RMIS training and help surgical trainees have more focused training.

  6. Natural language generation of surgical procedures. (United States)

    Wagner, J C; Rogers, J E; Baud, R H; Scherrer, J R


    A number of compositional Medical Concept Representation systems are being developed. Although these provide for a detailed conceptual representation of the underlying information, they have to be translated back to natural language for used by end-users and applications. The GALEN programme has been developing one such representation and we report here on a tool developed to generate natural language phrases from the GALEN conceptual representations. This tool can be adapted to different source modelling schemes and to different destination languages or sublanguages of a domain. It is based on a multilingual approach to natural language generation, realised through a clean separation of the domain model from the linguistic model and their link by well defined structures. Specific knowledge structures and operations have been developed for bridging between the modelling 'style' of the conceptual representation and natural language. Using the example of the scheme developed for modelling surgical operative procedures within the GALEN-IN-USE project, we show how the generator is adapted to such a scheme. The basic characteristics of the surgical procedures scheme are presented together with the basic principles of the generation tool. Using worked examples, we discuss the transformation operations which change the initial source representation into a form which can more directly be translated to a given natural language. In particular, the linguistic knowledge which has to be introduced--such as definitions of concepts and relationships is described. We explain the overall generator strategy and how particular transformation operations are triggered by language-dependent and conceptual parameters. Results are shown for generated French phrases corresponding to surgical procedures from the urology domain.

  7. Reconstruction of periodic signals using neural networks

    Directory of Open Access Journals (Sweden)

    José Danilo Rairán Antolines


    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.

  8. Neural Based Orthogonal Data Fitting The EXIN Neural Networks

    CERN Document Server

    Cirrincione, Giansalvo


    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

  9. Surgical Management of Localized Scleroderma. (United States)

    Lee, Jae Hyun; Lim, Soo Yeon; Lee, Jang Hyun; Ahn, Hee Chang


    Localized scleroderma is characterized by a thickening of the skin from excessive collagen deposits. It is not a fatal disease, but quality of life can be adversely affected due to changes in skin appearance, joint contractures, and, rarely, serious deformities of the face and extremities. We present six cases of localized scleroderma in face from our surgical practice. We reviewed six localized scleroderma cases that were initially treated with medication and then received follow-up surgery between April 2003 and February 2015. Six patients had facial lesions. These cases presented with linear dermal sclerosis on the forehead, oval subcutaneous and dermal depression in the cheek. En coup de sabre (n=4), and oval-shaped lesion of the face (n=2) were successfully treated. Surgical methods included resection with or without Z-plasty (n=3), fat graft (n=1), dermofat graft (n=1), and adipofascial free flap (n=1). Deformities of the affected parts were surgically corrected without reoccurrence. We retrospectively reviewed six cases of localized scleroderma that were successfully treated with surgery. And we propose an algorithm for selecting the best surgical approach for individual localized scleroderma cases. Although our cases were limited in number and long-term follow-up will be necessary, we suggest that surgical management should be considered as an option for treating scleroderma patients.

  10. Three-dimensional surgical simulation. (United States)

    Cevidanes, Lucia H C; Tucker, Scott; Styner, Martin; Kim, Hyungmin; Chapuis, Jonas; Reyes, Mauricio; Proffit, William; Turvey, Timothy; Jaskolka, Michael


    In this article, we discuss the development of methods for computer-aided jaw surgery, which allows us to incorporate the high level of precision necessary for transferring virtual plans into the operating room. We also present a complete computer-aided surgery system developed in close collaboration with surgeons. Surgery planning and simulation include construction of 3-dimensional surface models from cone-beam computed tomography, dynamic cephalometry, semiautomatic mirroring, interactive cutting of bone, and bony segment repositioning. A virtual setup can be used to manufacture positioning splints for intraoperative guidance. The system provides further intraoperative assistance with a computer display showing jaw positions and 3-dimensional positioning guides updated in real time during the surgical procedure. The computer-aided surgery system aids in dealing with complex cases with benefits for the patient, with surgical practice, and for orthodontic finishing. Advanced software tools for diagnosis and treatment planning allow preparation of detailed operative plans, osteotomy repositioning, bone reconstructions, surgical resident training, and assessing the difficulties of the surgical procedures before the surgery. Computer-aided surgery can make the elaboration of the surgical plan a more flexible process, increase the level of detail and accuracy of the plan, yield higher operative precision and control, and enhance documentation of cases. 2010 American Association of Orthodontists. Published by Mosby, Inc. All rights reserved.

  11. Differential neural network configuration during human path integration (United States)

    Arnold, Aiden E. G. F; Burles, Ford; Bray, Signe; Levy, Richard M.; Iaria, Giuseppe


    Path integration is a fundamental skill for navigation in both humans and animals. Despite recent advances in unraveling the neural basis of path integration in animal models, relatively little is known about how path integration operates at a neural level in humans. Previous attempts to characterize the neural mechanisms used by humans to visually path integrate have suggested a central role of the hippocampus in allowing accurate performance, broadly resembling results from animal data. However, in recent years both the central role of the hippocampus and the perspective that animals and humans share similar neural mechanisms for path integration has come into question. The present study uses a data driven analysis to investigate the neural systems engaged during visual path integration in humans, allowing for an unbiased estimate of neural activity across the entire brain. Our results suggest that humans employ common task control, attention and spatial working memory systems across a frontoparietal network during path integration. However, individuals differed in how these systems are configured into functional networks. High performing individuals were found to more broadly express spatial working memory systems in prefrontal cortex, while low performing individuals engaged an allocentric memory system based primarily in the medial occipito-temporal region. These findings suggest that visual path integration in humans over short distances can operate through a spatial working memory system engaging primarily the prefrontal cortex and that the differential configuration of memory systems recruited by task control networks may help explain individual biases in spatial learning strategies. PMID:24808849

  12. Therapeutic physical exercise in neural injury: friend or foe? (United States)

    Park, Kanghui; Lee, Seunghoon; Hong, Yunkyung; Park, Sookyoung; Choi, Jeonghyun; Chang, Kyu-Tae; Kim, Joo-Heon; Hong, Yonggeun


    [Purpose] The intensity of therapeutic physical exercise is complex and sometimes controversial in patients with neural injuries. This review assessed whether therapeutic physical exercise is beneficial according to the intensity of the physical exercise. [Methods] The authors identified clinically or scientifically relevant articles from PubMed that met the inclusion criteria. [Results] Exercise training can improve body strength and lead to the physiological adaptation of skeletal muscles and the nervous system after neural injuries. Furthermore, neurophysiological and neuropathological studies show differences in the beneficial effects of forced therapeutic exercise in patients with severe or mild neural injuries. Forced exercise alters the distribution of muscle fiber types in patients with neural injuries. Based on several animal studies, forced exercise may promote functional recovery following cerebral ischemia via signaling molecules in ischemic brain regions. [Conclusions] This review describes several types of therapeutic forced exercise and the controversy regarding the therapeutic effects in experimental animals versus humans with neural injuries. This review also provides a therapeutic strategy for physical therapists that grades the intensity of forced exercise according to the level of neural injury.

  13. Toward automatic time-series forecasting using neural networks. (United States)

    Yan, Weizhong


    Over the past few decades, application of artificial neural networks (ANN) to time-series forecasting (TSF) has been growing rapidly due to several unique features of ANN models. However, to date, a consistent ANN performance over different studies has not been achieved. Many factors contribute to the inconsistency in the performance of neural network models. One such factor is that ANN modeling involves determining a large number of design parameters, and the current design practice is essentially heuristic and ad hoc, this does not exploit the full potential of neural networks. Systematic ANN modeling processes and strategies for TSF are, therefore, greatly needed. Motivated by this need, this paper attempts to develop an automatic ANN modeling scheme. It is based on the generalized regression neural network (GRNN), a special type of neural network. By taking advantage of several GRNN properties (i.e., a single design parameter and fast learning) and by incorporating several design strategies (e.g., fusing multiple GRNNs), we have been able to make the proposed modeling scheme to be effective for modeling large-scale business time series. The initial model was entered into the NN3 time-series competition. It was awarded the best prediction on the reduced dataset among approximately 60 different models submitted by scholars worldwide.

  14. A fuzzy Hopfield neural network for medical image segmentation

    International Nuclear Information System (INIS)

    Lin, J.S.; Cheng, K.S.; Mao, C.W.


    In this paper, an unsupervised parallel segmentation approach using a fuzzy Hopfield neural network (FHNN) is proposed. The main purpose is to embed fuzzy clustering into neural networks so that on-line learning and parallel implementation for medical image segmentation are feasible. The idea is to cast a clustering problem as a minimization problem where the criteria for the optimum segmentation is chosen as the minimization of the Euclidean distance between samples to class centers. In order to generate feasible results, a fuzzy c-means clustering strategy is included in the Hopfield neural network to eliminate the need of finding weighting factors in the energy function, which is formulated and based on a basic concept commonly used in pattern classification, called the within-class scatter matrix principle. The suggested fuzzy c-means clustering strategy has also been proven to be convergent and to allow the network to learn more effectively than the conventional Hopfield neural network. The fuzzy Hopfield neural network based on the within-class scatter matrix shows the promising results in comparison with the hard c-means method

  15. Matrix regulators in neural stem cell functions. (United States)

    Wade, Anna; McKinney, Andrew; Phillips, Joanna J


    Neural stem/progenitor cells (NSPCs) reside within a complex and dynamic extracellular microenvironment, or niche. This niche regulates fundamental aspects of their behavior during normal neural development and repair. Precise yet dynamic regulation of NSPC self-renewal, migration, and differentiation is critical and must persist over the life of an organism. In this review, we summarize some of the major components of the NSPC niche and provide examples of how cues from the extracellular matrix regulate NSPC behaviors. We use proteoglycans to illustrate the many diverse roles of the niche in providing temporal and spatial regulation of cellular behavior. The NSPC niche is comprised of multiple components that include; soluble ligands, such as growth factors, morphogens, chemokines, and neurotransmitters, the extracellular matrix, and cellular components. As illustrated by proteoglycans, a major component of the extracellular matrix, the NSPC, niche provides temporal and spatial regulation of NSPC behaviors. The factors that control NSPC behavior are vital to understand as we attempt to modulate normal neural development and repair. Furthermore, an improved understanding of how these factors regulate cell proliferation, migration, and differentiation, crucial for malignancy, may reveal novel anti-tumor strategies. This article is part of a Special Issue entitled Matrix-mediated cell behaviour and properties. Copyright © 2014 Elsevier B.V. All rights reserved.

  16. Handwritten Digits Recognition Using Neural Computing

    Directory of Open Access Journals (Sweden)

    Călin Enăchescu


    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.

  17. Surgical management of third nerve palsy

    Directory of Open Access Journals (Sweden)

    Anupam Singh


    Full Text Available Third nerve paralysis has been known to be associated with a wide spectrum of presentation and other associated factors such as the presence of ptosis, pupillary involvement, amblyopia, aberrant regeneration, poor bell′s phenomenon, superior oblique (SO overaction, and lateral rectus (LR contracture. Correction of strabismus due to third nerve palsy can be complex as four out of the six extraocular muscles are involved and therefore should be approached differently. Third nerve palsy can be congenital or acquired. The common causes of isolated third nerve palsy in children are congenital (43%, trauma (20%, inflammation (13%, aneurysm (7%, and ophthalmoplegic migraine. Whereas, in adult population, common etiologies are vasculopathic disorders (diabetes mellitus, hypertension, aneurysm, and trauma. Treatment can be both nonsurgical and surgical. As nonsurgical modalities are not of much help, surgery remains the main-stay of treatment. Surgical strategies are different for complete and partial third nerve palsy. Surgery for complete third nerve palsy may involve supra-maximal recession - resection of the recti. This may be combined with SO transposition and augmented by surgery on the other eye. For partial third nerve, palsy surgery is determined according to nature and extent of involvement of extraocular muscles.

  18. Marfan Syndrome: Clinical, Surgical, and Anesthetic Considerations. (United States)

    Castellano, José M; Silvay, George; Castillo, Javier G


    Marfan syndrome is a multisystem connective tissue disorder, with primary involvement of the cardiovascular, ocular, and skeletal systems. This autosomal heritable disease is mainly attributable to a defect in the FBN1 gene. Clinical diagnosis of Marfan syndrome has been based on the Ghent criteria since 1996. In 2010, these criteria were updated, and the revised guidelines place more emphasis on aortic root dilation, ectopia lentis, and FBN1 mutation testing in the diagnostic assessment of Marfan syndrome. Among its many different clinical manifestations, cardiovascular involvement deserves special consideration, owing to its impact on prognosis. Recent molecular, surgical, and clinical research has yielded profound new insights into the pathological mechanisms that ultimately lead to tissue degradation and weakening of the aortic wall, which has led to exciting new treatment strategies. Furthermore, with the increasing life expectancy of patients with Marfan syndrome, there has been a subtle shift in the spectrum of medical problems. Consequently, this article focuses on recent advances to highlight their potential impact on future concepts of patient care from a clinical, surgical, and anesthetic perspective. © The Author(s) 2013.

  19. Surgical management of third nerve palsy (United States)

    Singh, Anupam; Bahuguna, Chirag; Nagpal, Ritu; Kumar, Barun


    Third nerve paralysis has been known to be associated with a wide spectrum of presentation and other associated factors such as the presence of ptosis, pupillary involvement, amblyopia, aberrant regeneration, poor bell's phenomenon, superior oblique (SO) overaction, and lateral rectus (LR) contracture. Correction of strabismus due to third nerve palsy can be complex as four out of the six extraocular muscles are involved and therefore should be approached differently. Third nerve palsy can be congenital or acquired. The common causes of isolated third nerve palsy in children are congenital (43%), trauma (20%), inflammation (13%), aneurysm (7%), and ophthalmoplegic migraine. Whereas, in adult population, common etiologies are vasculopathic disorders (diabetes mellitus, hypertension), aneurysm, and trauma. Treatment can be both nonsurgical and surgical. As nonsurgical modalities are not of much help, surgery remains the main-stay of treatment. Surgical strategies are different for complete and partial third nerve palsy. Surgery for complete third nerve palsy may involve supra-maximal recession - resection of the recti. This may be combined with SO transposition and augmented by surgery on the other eye. For partial third nerve, palsy surgery is determined according to nature and extent of involvement of extraocular muscles. PMID:27433033

  20. Trimaran Resistance Artificial Neural Network (United States)


    11th International Conference on Fast Sea Transportation FAST 2011, Honolulu, Hawaii, USA, September 2011 Trimaran Resistance Artificial Neural Network Richard...Trimaran Resistance Artificial Neural Network 5a. CONTRACT NUMBER 5b. GRANT NUMBER 5c. PROGRAM ELEMENT NUMBER 6. AUTHOR(S) 5d. PROJECT NUMBER 5e... Artificial Neural Network and is restricted to the center and side-hull configurations tested. The value in the parametric model is that it is able to

  1. [Surgical approaches to tibial plateau fractures]. (United States)

    Krause, Matthias; Müller, Gunnar; Frosch, Karl-Heinz


    Intra-articular tibial plateau fractures can present a surgical challenge due to complex injury patterns and compromised soft tissue. The treatment goal is to spare the soft tissue and an anatomical reconstruction of the tibial articular surface. Depending on the course of the fracture, a fracture-specific access strategy is recommended to provide correct positioning of the plate osteosynthesis. While the anterolateral approach is used in the majority of lateral tibial plateau fractures, only one third of the joint surface is visible; however, posterolateral fragments require an individual approach, e. g. posterolateral or posteromedial. If necessary, osteotomy of the femoral epicondyles can improve joint access for reduction control. Injuries to the posterior columns should be anatomically reconstructed and biomechanically correctly addressed via posterior approaches. Bony posterior cruciate ligament tears can be refixed via a minimally invasive posteromedial approach.

  2. Surgical Approaches to Chronic Pancreatitis

    Directory of Open Access Journals (Sweden)

    Daniel Hartmann


    Full Text Available Chronic pancreatitis is a progressive inflammatory disease resulting in permanent structural damage of the pancreas. It is mainly characterized by recurring epigastric pain and pancreatic insufficiency. In addition, progression of the disease might lead to additional complications, such as pseudocyst formation or development of pancreatic cancer. The medical and surgical treatment of chronic pancreatitis has changed significantly in the past decades. With regard to surgical management, pancreatic head resection has been shown to be a mainstay in the treatment of severe chronic pancreatitis because the pancreatic head mass is known to trigger the chronic inflammatory process. Over the years, organ-preserving procedures, such as the duodenum-preserving pancreatic head resection and the pylorus-preserving Whipple, have become the surgical standard and have led to major improvements in pain relief, preservation of pancreatic function, and quality of life of patients.

  3. Surgical management of Gerhardt syndrome. (United States)

    Chirilă, M; Mureşan, R; Cosgarea, M; Tomescu, E


    Adduction bilateral vocal fold immobility syndrome may be due by both recurrent laryngeal nerves paralysis--Gerhardt syndrome--and all intrinsic laryngeal muscles paralysis--Riegel syndrome. Etiology of Gerhardt syndrome is thyroid surgery, intubation's maneuver, trauma, neurological disorders, extrala-ryngeal malignancies. The manifestations of Gerhardt syndrome are inspiratory dyspnea and slightly influenced voicing by paramedian vocal folds paralysis with an important narrowing of the airway at the glottic level. The surgical procedures for enlargement of the glottic space can be classified in many ways and their major characteristics are: changes at the glottic level; surgical approach: open neck or endoscopic, with or without opening of the mucosal lining; the need for tracheostomy; the equipment used. The aim of this review is to expound the variety of interventions through the last century marked by the development of the diagnostic methods, the anesthesia and the surgical armament with sophisticated instruments and technologies.

  4. Surgical ethics: today and tomorrow. (United States)

    Sade, Robert M; Kavarana, Minoo N


    Ethical behavior has always been deeply ingrained in surgical culture, but ethical deliberation has only recently become an important component of cardiac surgical practice. In our earlier review, we covered a range of issues including several related to informed consent, conflict of interest, professional self-regulation and innovation, among many others. This update covers several topics of interest to cardiac surgeons and cardiologists, focusing on controversial issues specific to the practice of cardiothoracic surgery: informed consent, relations with hospitals and euthanasia and physician-assisted suicide. The future holds much uncertainty for cardiac surgical practice, research and culture, and we provide an update on ethical issues to serve as a platform for envisioning what is to come.

  5. Kontrol Kecepatan Motor Induksi menggunakan Algoritma Backpropagation Neural Network

    Directory of Open Access Journals (Sweden)



    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

  6. Surgically Assisted Rapid Maxillary Expansion: surgical and orthodontic aspects

    NARCIS (Netherlands)

    M.J. Koudstaal (Maarten)


    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

  7. Emotions in veterinary surgical students

    DEFF Research Database (Denmark)

    Langebæk, Rikke; Eika, Berit; Pedersen, Lene Tanggaard


    A surgical educational environment is potentially stressful and can negatively affect students' learning. The aim of the present study was to investigate the emotions experienced by veterinary students in relation to their first encounter with live-animal surgery and to identify possible sources...... of positive and negative emotions, respectively. During a Basic Surgical Skills course, 155 veterinary fourth-year students completed a survey. Of these, 26 students additionally participated in individual semi-structured interviews. The results of the study show that students often experienced a combination...

  8. Non-vascular surgical mediastinum

    International Nuclear Information System (INIS)

    Schiavon, S.; Trenaghi, P.; Nardini, S.; Pagan, V.


    A review was made of the chest X-ray features of 120 patients who underwent surgical treatment for mediastinal non-vascular pathologies over the past 12 years in the Mestre Hospital. A method of analysis is proposed which takes into account not only the differences between the immediate post-operative period and the follow-up, but also the anatomotopographic partition and the surgical practice. Normal and pathological patterns for both of the above periods are described. The ''dimness'' of the arial tracheogram is emphasized as a usefull and early sign of mediastinal recurrence

  9. Surgical options after Fontan failure

    DEFF Research Database (Denmark)

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


    by the European Congenital Heart Surgeons Association among 22 member centres. Outcome of surgery to address failing Fontan was collected in 225 patients among which were patients with Fontan takedown (n=38; 17%), Fontan conversion (n=137; 61%) or HTX (n=50; 22%). RESULTS: The most prevalent indication...... for failing Fontan surgery was arrhythmia (43.6%), but indications differed across the surgical groups (p...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...

  10. Innovation in pediatric surgical education. (United States)

    Clifton, Matthew S; Wulkan, Mark L


    Pediatric surgical training in the United States remained basically unchanged from the model developed by Ladd and Gross in the 1930s until recently. Standardized curriculum and novel evaluation methods are now being implemented. Pediatric Surgical education is currently undergoing a transition to competency-based evaluation and promotion. Unfortunately, there is little data on the efficacy of these changes. This presents an opportunity for further study of how we conduct training, and how we evaluate and promote our trainees. Copyright © 2015 Elsevier Inc. All rights reserved.

  11. Sub-meninges implantation reduces immune response to neural implants. (United States)

    Markwardt, Neil T; Stokol, Jodi; Rennaker, Robert L


    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. Published by Elsevier B.V.

  12. New treatment strategies for canine intervertebral disc degeneration

    NARCIS (Netherlands)

    Smolders, L.A.


    Degeneration of the intervertebral disc (IVD) is a common problem in dogs and humans. IVD degeneration can lead to herniation of the IVD with subsequent compression of neural structures and various clinical signs, including back pain. Current treatment of IVD disease is conservative or surgical.

  13. Optics in neural computation (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

  14. 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.

  15. Aging differentially affects male and female neural stem cell neurogenic properties

    Directory of Open Access Journals (Sweden)

    Jay Waldron


    Full Text Available Jay Waldron1, Althea McCourty1, Laurent Lecanu1,21The Research Institute of the McGill University Health Centre, Montreal, Canada; 2Department of Medicine, McGill University, Montreal, Quebec, CanadaPurpose: Neural stem cell transplantation as a brain repair strategy is a very promising technology. However, despite many attempts, the clinical success remains very deceiving. Despite clear evidence that sexual dimorphism rules many aspects of human biology, the occurrence of a sex difference in neural stem cell biology is largely understudied. Herein, we propose to determine whether gender is a dimension that drives the fate of neural stem cells through aging. Should it occur, we believe that neural stem cell sexual dimorphism and its variation during aging should be taken into account to refine clinical approaches of brain repair strategies.Methods: Neural stem cells were isolated from the subventricular zone of three- and 20-month-old male and female Long-Evans rats. Expression of the estrogen receptors, ERα and ERβ, progesterone receptor, androgen receptor, and glucocorticoid receptor was analyzed and quantified by Western blotting on undifferentiated neural stem cells. A second set of neural stem cells was treated with retinoic acid to trigger differentiation, and the expression of neuronal, astroglial, and oligodendroglial markers was determined using Western blotting.Conclusion: We provided in vitro evidence that the fate of neural stem cells is affected by sex and aging. Indeed, young male neural stem cells mainly expressed markers of neuronal and oligodendroglial fate, whereas young female neural stem cells underwent differentiation towards an astroglial phenotype. Aging resulted in a lessened capacity to express neuron and astrocyte markers. Undifferentiated neural stem cells displayed sexual dimorphism in the expression of steroid receptors, in particular ERα and ERβ, and the expression level of several steroid receptors increased

  16. Surgical approach to pineal tumours. (United States)

    Pluchino, F; Broggi, G; Fornari, M; Franzini, A; Solero, C L; Allegranza, A


    During a period of 10 years (1977-1986) 40 cases of tumour of the pineal region have been treated at the Istituto Neurologico "C. Besta"-of Milan. Out of these 40 cases, 27 (67.5%) were in the paediatric (10-15 years) or juvenile (15-20 years) age at the time of operation. Since 1983 a specific diagnostic and therapeutic protocol has been adopted and thereafter direct surgical removal of the tumour was performed only when the neuroradiological investigations were highly suggestive of a benign extrinsic lesion. Sixteen cases in this series underwent direct surgical removal; in the remaining 24 cases stereotactic biopsy of the tumour was performed in the first instance. On the basis of the histological diagnosis obtained by this procedure surgical excision of the tumour (9 cases) or radiotherapy (15 cases) was then performed. 25 cases underwent surgical removal of the lesion. In all the cases the infratentorial supracerebellar approach as introduced by Krause and then modified by Stein was adopted. On analysis of the data of this series it was observed that in 25% of the cases completely benign resectable tumours were found; in 25% of the cases astrocytoma (grade I-II) which could be treated at least by partial removal were present; in 30% of the cases radiosensitive lesions were encountered. In the remaining 20% of the cases highly malignant tumours were found which should be treated only by radiotherapy and/or chemotherapy.

  17. 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.


    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

  18. Surgical treatment of buried penis. (United States)

    Lipszyc, E; Pfister, C; Liard, A; Mitrofanoff, P


    The buried penis is a rare congenital entity, whose treatment is surgical. There are few publications concerning this matter. The authors report on their experience in 10 cases (1990-1995). In this abnormality, the tip of the glans does not project from the pubic or scrotal skin. It is due to: 1) an excessive development of the penile fascia which retracts the penis; 2) insufficient attachment of the penile skin at the base of the penis; 3) often excessive prepubic fat worsens the appearance of the abnormality but does not by itself totally explain it; 4) a tight phimosis is often present. Surgical treatment is necessary because this aspect tends to persist even after puberty. One cannot indeed count on the development at the age of puberty, neither on the diminution of the fat, nor on the simple cure of the phimosis. One must above all ban circumcision which causes the risk of eliminating the skin necessary for reconstruction. The surgical procedure will comprise: 1) a longitudinal dorsal incision extended circumferentially; 2) resection of the thickened fascia penis; 3) anchoring of the deep face of the dermis to the proximal part of the fascia penis at the base of the penis. This surgical procedure has always brought a significant improvement to the appearance of the penis.

  19. Surgical management of tubal pregnancy

    NARCIS (Netherlands)

    Mol, F.


    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

  20. 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.


    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

  1. Surgical smoke and infection control.

    NARCIS (Netherlands)

    Alp, E.; Bijl, D.; Bleichrodt, R.P.; Hansson, B.M.; Voss, A.


    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

  2. Surgical training in the Netherlands

    NARCIS (Netherlands)

    Borel-Rinkes, Inne H. M.; Gouma, Dirk J.; Hamming, Jaap F.


    Surgical training in the Netherlands has traditionally been characterized by learning on the job under the classic master-trainee doctrine. Over the past decades, it has become regionally organized with intensive structural training courses, and a peer-based quality control system. Recently, the

  3. Analysis of neural networks

    CERN Document Server

    Heiden, Uwe


    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. Neural Synchronization and Cryptography (United States)

    Ruttor, Andreas


    Neural networks can synchronize by learning from each other. In the case of discrete weights full synchronization is achieved in a finite number of steps. Additional networks can be trained by using the inputs and outputs generated during this process as examples. Several learning rules for both tasks are presented and analyzed. In the case of Tree Parity Machines synchronization is much faster than learning. Scaling laws for the number of steps needed for full synchronization and successful learning are derived using analytical models. They indicate that the difference between both processes can be controlled by changing the synaptic depth. In the case of bidirectional interaction the synchronization time increases proportional to the square of this parameter, but it grows exponentially, if information is transmitted in one direction only. Because of this effect neural synchronization can be used to construct a cryptographic key-exchange protocol. Here the partners benefit from mutual interaction, so that a passive attacker is usually unable to learn the generated key in time. The success probabilities of different attack methods are determined by numerical simulations and scaling laws are derived from the data. They show that the partners can reach any desired level of security by just increasing the synaptic depth. Then the complexity of a successful attack grows exponentially, but there is only a polynomial increase of the effort needed to generate a key. Further improvements of security are possible by replacing the random inputs with queries generated by the partners.

  5. Use of the 3D surgical modelling technique with open-source software for mandibular fibula free flap reconstruction and its surgical guides. (United States)

    Ganry, L; Hersant, B; Quilichini, J; Leyder, P; Meningaud, J P


    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.

  6. Surgical travellers: tapestry to Bayeux. (United States)

    Hedley-Whyte, John; Milamed, Debra R


    The planning for surgery in war was revisited in 1937 when Ian Fraser was elected a member of the Surgical Travellers. At their 1938 Surgical Travellers meeting in Vienna, Ian and Eleanor Fraser were evicted from their hotel room by the Nazis. The 1939 meeting in Belfast discussed the organization of surgery and the conduct of Emergency Medical Service Hospitals in the United Kingdom; the vast majority were to be under civilian government and military control. From 1943 lengthy and informative organizational meetings were held at least monthly under the chairmanship of Sir Alexander Hood, KBE, Head of the RAMC. Surgical Consultants, now Major Generals, Brigadiers or Full Colonels in the British and U.S. Armies stationed in the UK, prepared for the invasion of Europe. The allocation of medical, surgical, nursing and auxiliary responsibilities was delineated. Liaison with the RAF and US Army Air Force was close as it was with the proposed leaders, Ulstermen Brooke and Montgomery. Montgomery chose Arthur Porritt as Surgeon in Chief to Supreme Headquarters Allied Expeditionary Force (SHAEF), and Eisenhower, General Albert W. Kenner. Just after D-Day, Porritt met Ian Fraser, who had waded in on Arromanches Beach. The triage and evacuation plans for Allied casualties had been controversial, particularly as regards Landing Ship Tanks (LSTs). The dispute with the Hood-selected surgeons on one side, against medical and surgical deployment of LSTs, and Admiral Ernest King and Winston Churchill on the other, favouring LST use for surgery and evacuation. King and Churchill were correct but total Allied air superiority allowed wide use of many of the Allies' Dakotas; 10,000 DC-3s were eventually in service. Supported by forty Allied combat planes to each Luftwaffe, the dispute about Landing Ship Tank use in about a fortnight became moot. The multifaceted role of the Princess Royal in the Emergency Medical Services of the United Kingdom and her close liaison with the Consultant

  7. Virtual reality in surgical education. (United States)

    Ota, D; Loftin, B; Saito, T; Lea, R; Keller, J


    Virtual reality (VR) is an emerging technology that can teach surgeons new procedures and can determine their level of competence before they operate on patients. Also VR allows the trainee to return to the same procedure or task several times later as a refresher course. Laparoscopic surgery is a new operative technique which requires the surgeon to observe the operation on a video-monitor and requires the acquisition of new skills. VR simulation could duplicate the operative field and thereby enhance training and reduce the need for expensive animal training models. Our preliminary experience has shown that we have the technology to model tissues and laparoscopic instruments and to develop in real time a VR learning environment for surgeons. Another basic need is to measure competence. Surgical training is an apprenticeship requiring close supervision and 5-7 years of training. Technical competence is judged by the mentor and has always been subjective. If VR surgical simulators are to play an important role in the future, quantitative measurement of competence would have to be part of the system. Because surgical competence is "vague" and is characterized by such terms as "too long, too short" or "too close, too far," it is possible that the principles of fuzzy logic could be used to measure competence in a VR surgical simulator. Because a surgical procedure consists of a series of tasks and each task is a series of steps, we will plan to create two important tasks in a VR simulator and validate their use. These tasks consist of laparoscopic knot tying and laparoscopic suturing. Our hypothesis is that VR in combination with fuzzy logic can educate surgeons and determine when they are competent to perform these procedures on patients.

  8. Prediction of Bladder Cancer Recurrences Using Artificial Neural Networks (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.

  9. A qualitative study on perceptions of surgical careers in Rwanda: A gender-based approach. (United States)

    Yi, Sojung; Lin, Yihan; Kansayisa, Grace; Costas-Chavarri, Ainhoa


    Access to surgical care in low- and middle-income countries (LMICs) remains deficient without an adequate workforce. There is limited understanding of the gender gap in surgical trainees in LMICs. In Rwanda, females fill only one of 20 positions available. Understanding surgeons' experiences and perceptions of surgical careers may help facilitate support for females to contribute to the global surgical workforce. We performed qualitative analysis on perceptions of surgical careers through semi-structured interviews of all female surgeons (n = 6) and corresponding male surgeons (n = 6) who are training or have trained at University of Rwanda. Transcripts were analyzed with code structure formed through an integrated approach. Question categories formed the deductive framework, while theoretical saturation was reached through inductive grounded theory. Themes were organized within two key points of the career timeline. First, for developing interest in surgery, three main themes were identified: role models, patient case encounters, and exposure to surgery. Second, for selecting and sustaining surgical careers, four main themes emerged: social expectations about roles within the family, physical and mental challenges, professional and personal support, and finances. All female surgeons emphasized gender assumptions and surgical working culture as obstacles, with a corresponding strong sense of self-confidence and internal motivation that drew them to select and maintain careers in surgery. Family, time, and physical endurance were cited as persistent challenges for female participants. Our study reveals concepts for further exploration about gendered perceptions of surgical careers. Efforts to improve support for female surgical careers as a strategy for shaping surgical work culture and professional development in Rwanda should be considered. Such strategies may be beneficial for improving the global surgical workforce.

  10. Neural Networks for Optimal Control

    DEFF Research Database (Denmark)

    Sørensen, O.


    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....

  11. Neural networks at the Tevatron

    International Nuclear Information System (INIS)

    Badgett, W.; Burkett, K.; Campbell, M.K.; Wu, D.Y.; Bianchin, S.; DeNardi, M.; Pauletta, G.; Santi, L.; Caner, A.; Denby, B.; Haggerty, H.; Lindsey, C.S.; Wainer, N.; Dall'Agata, M.; Johns, K.; Dickson, M.; Stanco, L.; Wyss, J.L.


    This paper summarizes neural network applications at the Fermilab Tevatron, including the first online hardware application in high energy physics (muon tracking): the CDF and DO neural network triggers; offline quark/gluon discrimination at CDF; ND a new tool for top to multijets recognition at CDF

  12. Neural Networks for the Beginner. (United States)

    Snyder, Robin M.

    Motivated by the brain, neural networks are a right-brained approach to artificial intelligence that is used to recognize patterns based on previous training. In practice, one would not program an expert system to recognize a pattern and one would not train a neural network to make decisions from rules; but one could combine the best features of…

  13. Neural fields theory and applications

    CERN Document Server

    Graben, Peter; Potthast, Roland; Wright, James


    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 ...

  14. Artificial neural networks in NDT

    International Nuclear Information System (INIS)

    Abdul Aziz Mohamed


    Artificial neural networks, simply known as neural networks, have attracted considerable interest in recent years largely because of a growing recognition of the potential of these computational paradigms as powerful alternative models to conventional pattern recognition or function approximation techniques. The neural networks approach is having a profound effect on almost all fields, and has been utilised in fields Where experimental inter-disciplinary work is being carried out. Being a multidisciplinary subject with a broad knowledge base, Nondestructive Testing (NDT) or Nondestructive Evaluation (NDE) is no exception. This paper explains typical applications of neural networks in NDT/NDE. Three promising types of neural networks are highlighted, namely, back-propagation, binary Hopfield and Kohonen's self-organising maps. (Author)

  15. Neural stem cell sex dimorphism in aromatase (CYP19 expression: a basis for differential neural fate

    Directory of Open Access Journals (Sweden)

    Jay Waldron


    Full Text Available Jay Waldron1, Althea McCourty1, Laurent Lecanu1,21The Research Institute of the McGill University Health Centre, Montreal, Canada; 2Department of Medicine, McGill University, Quebec, CanadaPurpose: Neural stem cell (NSC transplantation and pharmacologic activation of endogenous neurogenesis are two approaches that trigger a great deal of interest as brain repair strategies. However, the success rate of clinical attempts using stem cells to restore neurologic functions altered either after traumatic brain injury or as a consequence of neurodegenerative disease remains rather disappointing. This suggests that factors affecting the fate of grafted NSCs are largely understudied and remain to be characterized. We recently reported that aging differentially affects the neurogenic properties of male and female NSCs. Although the sex steroids androgens and estrogens participate in the regulation of neurogenesis, to our knowledge, research on how gender-based differences affect the capacity of NSCs to differentiate and condition their neural fate is lacking. In the present study, we explored further the role of cell sex as a determining factor of the neural fate followed by differentiating NSCs and its relationship with a potential differential expression of aromatase (CYP19, the testosterone-metabolizing enzyme.Results: Using NSCs isolated from the subventricular zone of three-month-old male and female Long-Evans rats and maintained as neurospheres, we showed that differentiation triggered by retinoic acid resulted in a neural phenotype that depends on cell sex. Differentiated male NSCs mainly expressed markers of neuronal fate, including ßIII-tubulin, microtubule associated protein 2, growth-associated protein 43, and doublecortin. In contrast, female NSCs essentially expressed the astrocyte marker glial fibrillary acidic protein. Quantification of the expression of aromatase showed a very low level of expression in undifferentiated female NSCs

  16. Sequential and parallel image restoration: neural network implementations. (United States)

    Figueiredo, M T; Leitao, J N


    Sequential and parallel image restoration algorithms and their implementations on neural networks are proposed. For images degraded by linear blur and contaminated by additive white Gaussian noise, maximum a posteriori (MAP) estimation and regularization theory lead to the same high dimension convex optimization problem. The commonly adopted strategy (in using neural networks for image restoration) is to map the objective function of the optimization problem into the energy of a predefined network, taking advantage of its energy minimization properties. Departing from this approach, we propose neural implementations of iterative minimization algorithms which are first proved to converge. The developed schemes are based on modified Hopfield (1985) networks of graded elements, with both sequential and parallel updating schedules. An algorithm supported on a fully standard Hopfield network (binary elements and zero autoconnections) is also considered. Robustness with respect to finite numerical precision is studied, and examples with real images are presented.

  17. Neural-fuzzy control of adept one SCARA

    International Nuclear Information System (INIS)

    Er, M.J.; Toh, B.H.; Toh, B.Y.


    This paper presents an Intelligent Control Strategy for the Adept One SCARA (Selective Compliance Assembly Robot Arm). It covers the design and simulation study of a Neural-Fuzzy Controller (NFC) for the SCARA with a view of tracking a predetermined trajectory of motion in the joint space. The SCARA was simulated as a three-axis manipulator with the dynamics of the tool (fourth link) neglected and the mass of the load incorporated into the mass of the third link. The overall performance of the control system under different conditions, namely variation in playload, variations in coefficients of static, dynamic and viscous friction and different trajectories were studied and comparison made with an existing Neural Network Controller and two Computed Torque Controllers. The NFC was shown to be robust and is able to overcome the drawback of the existing Neural Network Controller

  18. Surgical Masculinization of the Breast: Clinical Classification and Surgical Procedures. (United States)

    Cardenas-Camarena, Lazaro; Dorado, Carlos; Guerrero, Maria Teresa; Nava, Rosa


    Aesthetic breast area improvements for gynecomastia and gender dysphoria patients who seek a more masculine appearance have increased recently. We present our clinical experience in breast masculinization and a classification for these patients. From July 2003 to May 2014, 68 patients seeking a more masculine thorax underwent surgery. They were divided into five groups depending on three factors: excess fatty tissue, breast tissue, and skin. A specific surgical treatment was assigned according to each group. The surgical treatments included thoracic liposuction, subcutaneous mastectomy, periareolar skin resection in one or two stages, and mastectomy with a nipple areola complex graft. The evaluation was performed 6 months after surgery to determine the degree of satisfaction and presence of complications. Surgery was performed on a total of 68 patients, 45 male and 22 female, with ages ranging from 18 to 49 years, and an average age of 33 years. Liposuction alone was performed on five patients; subcutaneous mastectomy was performed on eight patients; subcutaneous mastectomy combined with liposuction was performed on 27 patients; periareolar skin resection was performed on 11 patients; and mastectomy with NAC free grafts was performed on 16 patients. The surgical procedure satisfied 94% of the patients, with very few complications. All patients who wish to obtain a masculine breast shape should be treated with only one objective regardless patient's gender: to obtain a masculine thorax. We recommend a simple mammary gland classification for determining the best surgical treatment for these patients LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors .

  19. Optimizing patient flow in a large hospital surgical centre by means of discrete-event computer simulation models. (United States)

    Ferreira, Rodrigo B; Coelli, Fernando C; Pereira, Wagner C A; Almeida, Renan M V R


    This study used the discrete-events computer simulation methodology to model a large hospital surgical centre (SC), in order to analyse the impact of increases in the number of post-anaesthetic beds (PABs), of changes in surgical room scheduling strategies and of increases in surgery numbers. The used inputs were: number of surgeries per day, type of surgical room scheduling, anaesthesia and surgery duration, surgical teams' specialty and number of PABs, and the main outputs were: number of surgeries per day, surgical rooms' use rate and blocking rate, surgical teams' use rate, patients' blocking rate, surgery delays (minutes) and the occurrence of postponed surgeries. Two basic strategies were implemented: in the first strategy, the number of PABs was increased under two assumptions: (a) following the scheduling plan actually used by the hospital (the 'rigid' scheduling - surgical rooms were previously assigned and assignments could not be changed) and (b) following a 'flexible' scheduling (surgical rooms, when available, could be freely used by any surgical team). In the second, the same analysis was performed, increasing the number of patients (up to the system 'feasible maximum') but fixing the number of PABs, in order to evaluate the impact of the number of patients over surgery delays. It was observed that the introduction of a flexible scheduling/increase in PABs would lead to a significant improvement in the SC productivity.

  20. The pregnant female surgical resident

    Directory of Open Access Journals (Sweden)

    Shifflette V


    Full Text Available Vanessa Shifflette,1 Susannah Hambright,2 Joseph Darryl Amos,1 Ernest Dunn,3 Maria Allo4 1Associates in Surgical Acute Care, Methodist Dallas Medical Center, Dallas, TX, USA; 2Methodist Surgical Associates, Methodist Dallas Medical Center, Dallas, TX, USA; 3Graduate Medical Education - General Surgery, Methodist Dallas Medical Center, Dallas, TX, USA; 4Santa Clara Valley Medical Center, San Jose, CA, USA Background: Surgery continues to be an intense, time-consuming residency. Many medical students decide against surgery as a profession due to the long work hours and family strain. The pregnant female surgical resident has an added stress factor compared to her male counterpart. Methods: We distributed an electronic, online 26-question survey to 32 general surgery programs in the southwestern region of the United States. Each program distributed our survey to the female surgical residents who had been pregnant during residency in the last 5 years. Each program was re-contacted 6 weeks after the initial contact. Most questions were in a 5-point Likert scale format. The responses were collected and analyzed using the Survey Monkey website. Results: An unvalidated survey was sent to 32 general surgery programs and 26 programs responded (81%. Each program was asked for the total number of possible responses from female residents that met our criteria (60 female residents. Seven of the programs (27% stated that they have had zero residents pregnant. We had 22 residents respond (37%. Over half of the residents (55% were pregnant during their 2nd or 3rd year of residency, with only 18% pregnant during a research year. Thirty-one percent had a lower American Board of Surgery In-Training Exam (ABSITE score. Ninety percent of the residents were able to take 4 weeks or more for maternity leave. Most of the residents (95% stated that they would do this again during residency given the opportunity, but many of the residents felt that returning back to work

  1. Surgical waste audit of 5 total knee arthroplasties. (United States)

    Stall, Nathan M; Kagoma, Yoan M; Bondy, Jennifer N; Naudie, Douglas


    Operating rooms (ORs) are estimated to generate up to one-third of hospital waste. At the London Health Sciences Centre, prosthetics and implants represent 17% of the institution's ecological footprint. To investigate waste production associated with total knee arthroplasties (TKAs), we performed a surgical waste audit to gauge the environmental impact of this procedure and generate strategies to improve waste management. We conducted a waste audit of 5 primary TKAs performed by a single surgeon in February 2010. Waste was categorized into 6 streams: regular solid waste, recyclable plastics, biohazard waste, laundered linens, sharps and blue sterile wrap. Volume and weight of each stream was quantified. We used Canadian Joint Replacement Registry data (2008-2009) to estimate annual weight and volume totals of waste from all TKAs performed in Canada. The average surgical waste (excluding laundered linens) per TKA was 13.3 kg, of which 8.6 kg (64.5%) was normal solid waste, 2.5 kg (19.2%) was biohazard waste, 1.6 kg (12.1%) was blue sterile wrap, 0.3 kg (2.2%) was recyclables and 0.3 kg (2.2%) was sharps. Plastic wrappers, disposable surgical linens and personal protective equipment contributed considerably to total waste. We estimated that landfill waste from all 47 429 TKAs performed in Canada in 2008-2009 was 407 889 kg by weight and 15 272 m3 by volume. Total knee arthroplasties produce substantial amounts of surgical waste. Environmentally friendly surgical products and waste management strategies may allow ORs to reduce the negative impacts of waste production without compromising patient care. Level IV, case series.

  2. Global Strategy

    DEFF Research Database (Denmark)

    Li, Peter Ping


    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....

  3. Surgical versus non-surgical management of abdominal injury. (United States)

    Oyo-Ita, Angela; Chinnock, Paul; Ikpeme, Ikpeme A


    Injury to the abdomen can be blunt or penetrating. Abdominal injury can damage internal organs such as the liver, spleen, kidneys, intestine, and large blood vessels. There are controversies about the best approach to manage abdominal injuries. To assess the effects of surgical and non-surgical interventions in the management of abdominal trauma in a haemodynamically stable and non-peritonitic abdomen. We searched the Cochrane Injuries Group's Specialised Register, The Cochrane Library, Ovid MEDLINE(R), Ovid MEDLINE(R) In-Process & Other Non-Indexed Citations, Ovid MEDLINE(R) Daily and Ovid OLDMEDLINE(R), EMBASE Classic+EMBASE (Ovid), ISI WOS (SCI-EXPANDED, SSCI, CPCI-S & CPSI-SSH), CINAHL Plus (EBSCO), and clinical trials registers, and screened reference lists. We ran the most recent search on 17 September 2015. Randomised controlled trials of surgical interventions and non-surgical interventions involving people with abdominal injury who were haemodynamically stable with no signs of peritonitis. The abdominal injury could be blunt or penetrating. Two review authors independently applied the selection criteria. Data were extracted by two authors using a standard data extraction form, and are reported narratively. Two studies are included, which involved a total of 114 people with penetrating abdominal injuries. Both studies are at moderate risk of bias because the randomisation methods are not fully described, and the original study protocols are no longer available. The studies were undertaken in Finland between 1992 and 2002, by the same two researchers.In one study, 51 people were randomised to surgery or an observation protocol. None of the participants in the study died. Seven people had complications: 5 (18.5%) in the surgical group and 2 (8.3%) in the observation group; the difference was not statistically significant (P = 0.42; Fischer's exact). Among the 27 people who had surgery, 6 (22.2%) surgeries were negative laparotomies, and 15 (55.6%) were non

  4. Deep Neuromuscular Blockade Improves Laparoscopic Surgical Conditions

    DEFF Research Database (Denmark)

    Rosenberg, Jacob; Herring, W Joseph; Blobner, Manfred


    INTRODUCTION: Sustained deep neuromuscular blockade (NMB) during laparoscopic surgery may facilitate optimal surgical conditions. This exploratory study assessed whether deep NMB improves surgical conditions and, in doing so, allows use of lower insufflation pressures during laparoscopic cholecys...

  5. Interacting neural networks (United States)

    Metzler, R.; Kinzel, W.; Kanter, I.


    Several scenarios of interacting neural networks which are trained either in an identical or in a competitive way are solved analytically. In the case of identical training each perceptron receives the output of its neighbor. The symmetry of the stationary state as well as the sensitivity to the used training algorithm are investigated. Two competitive perceptrons trained on mutually exclusive learning aims and a perceptron which is trained on the opposite of its own output are examined analytically. An ensemble of competitive perceptrons is used as decision-making algorithms in a model of a closed market (El Farol Bar problem or the Minority Game. In this game, a set of agents who have to make a binary decision is considered.); each network is trained on the history of minority decisions. This ensemble of perceptrons relaxes to a stationary state whose performance can be better than random.

  6. Neural circuitry and immunity (United States)

    Pavlov, Valentin A.; Tracey, Kevin J.


    Research during the last decade has significantly advanced our understanding of the molecular mechanisms at the interface between the nervous system and the immune system. Insight into bidirectional neuroimmune communication has characterized the nervous system as an important partner of the immune system in the regulation of inflammation. Neuronal pathways, including the vagus nerve-based inflammatory reflex are physiological regulators of immune function and inflammation. In parallel, neuronal function is altered in conditions characterized by immune dysregulation and inflammation. Here, we review these regulatory mechanisms and describe the neural circuitry modulating immunity. Understanding these mechanisms reveals possibilities to use targeted neuromodulation as a therapeutic approach for inflammatory and autoimmune disorders. These findings and current clinical exploration of neuromodulation in the treatment of inflammatory diseases defines the emerging field of Bioelectronic Medicine. PMID:26512000

  7. Neural Darwinism and consciousness. (United States)

    Seth, Anil K; Baars, Bernard J


    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.

  8. Surgical treatment of cavernous malformations involving medulla oblongata. (United States)

    Zhang, Si; Lin, Sen; Hui, Xuhui; Li, Hao; You, Chao


    Surgical treatment of cavernous malformations (CMs) involving medulla oblongata is more difficult than the CMs in other sites because of the surrounding vital structures. However, the distinctive features and treatment strategies have not been well illustrated. Therefore, we enrolled a total of 19 patients underwent surgical treatment of CMs involving medulla oblongata in our hospital from August 2008 to August 2014. The clinical features, surgical management and clinical outcome of these patients were retrospectively analyzed, while our institutional surgical indications, approaches and microsurgical techniques were discussed. In our study, gross total resection was achieved in 17 patients and subtotal resection in 2. Two patients underwent emergency surgeries due to severe and progressive neurological deficits. The postoperative new-onset or worsened neurological deficits occurred in 6 patients. After a mean follow-up of 45.8±22.2months, the neurological status was improved in 10 patients and remained stable in 7. The mean modified Rankin Scale (mRS) was 2.58±1.26 preoperatively, 3.11±0.99 postoperatively and 1.84±1.42 at the recent follow-up, respectively. During the follow-up period, no rehemorrhage and recurrence occurred, and the residual lesions remained stable. We recommended surgical resection of symptomatic CMs involving medulla oblongata via optimal approaches, feasible entry zones and meticulous microsurgical techniques in attempting to achieve safe resection and favorable outcome. The clinical features, surgical indications, timing and microsurgical techniques of this special entity should be distinctive from the brainstem cavernous malformations in other sites. Copyright © 2016 Elsevier Ltd. All rights reserved.

  9. Standardization of surgical techniques used in facial bone contouring. (United States)

    Lee, Tae Sung


    Since the introduction of facial bone contouring surgery for cosmetic purposes, various surgical methods have been used to improve the aesthetics of facial contours. In general, by standardizing the surgical techniques, it is possible to decrease complication rates and achieve more predictable surgical outcomes, thereby increasing patient satisfaction. The technical strategies used by the author to standardize facial bone contouring procedures are introduced here. The author uses various pre-manufactured surgical tools and hardware for facial bone contouring. During a reduction malarplasty or genioplasty procedure, double-bladed reciprocating saws and pre-bent titanium plates customized for the zygomatic body, arch and chin are used. Various guarded oscillating saws are used for mandibular angloplasty. The use of double-bladed saws and pre-bent plates to perform reduction malarplasty reduces the chances of post-operative asymmetry or under- or overcorrection of the zygoma contours due to technical faults. Inferior alveolar nerve injury and post-operative jawline asymmetry or irregularity can be reduced by using a guarded saw during mandibular angloplasty. For genioplasty, final placement of the chin in accordance with preoperative quantitative analysis can be easily performed with pre-bent plates, and a double-bladed saw allows more procedural accuracy during osteotomies. Efforts by the surgeon to avoid unintentional faults are key to achieving satisfactory results and reducing the incidence of complications. The surgical techniques described in this study in conjunction with various in-house surgical tools and modified hardware can be used to standardize techniques to achieve aesthetically gratifying outcomes. Copyright © 2015 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

  10. Surgical Treatment of Tattoo Complications. (United States)

    Sepehri, Mitra; Jørgensen, Bo


    With a continuing increase in the number of tattoos performed worldwide, the need to treat tattoo complications is growing. Earlier treatments of chronic inflammatory tattoo reactions were dominated by a medical approach, or with no active intervention. In this chapter, we will address modern surgical approaches applied to situations when medical treatment is inefficient and lasers are not applicable. Dermatome shaving is positioned as first-line treatment of allergic tattoo reactions and also indicated in a number of other tattoo reactions, supplemented with excision in selected cases. The methods allow fundamental treatment with removal of the culprit pigment from the dermis. The different instruments, surgical methods, and treatment schedules are reviewed, and a guide to surgeons is presented. Postoperative treatments and the long-term outcomes are described in detail. An algorithm on specialist treatment and follow-up of tattoo reactions, which can be practiced in other countries, is presented. © 2017 S. Karger AG, Basel.

  11. Surgical tools and medical devices

    CERN Document Server

    Jackson, Mark


    This new edition presents information and knowledge on the field of biomedical devices and surgical tools. The authors look at the interactions between nanotechnology, nanomaterials, design, modeling, and tools for surgical and dental applications, as well as how nanostructured surfaces can be created for the purposes of improving cell adhesion between medical devices and the human body. Each original chapter is revised in this second edition and describes developments in coatings for heart valves, stents, hip and knee joints, cardiovascular devices, orthodontic applications, and regenerative materials such as bone substitutes. There are also 8 new chapters that address: Microvascular anastomoses Inhaler devices used for pulmonary delivery of medical aerosols Surface modification of interference screws Biomechanics of the mandible (a detailed case study) Safety and medical devices The synthesis of nanostructured material Delivery of anticancer molecules using carbon nanotubes Nano and micro coatings for medic...

  12. Surgical treatment of pathological obesity

    International Nuclear Information System (INIS)

    Portie Felix, Antonio; Navarro Sanchez, Gustavo; Hernandez Solar, Abel; Grass Baldoquin, Jorge Alberto; Domloge Fernandez, Joana


    The obesity is the chronic non-communicable disease with a higher rate of growth in past 20 years. It is a risk factor for type 2 diabetes mellitus, high blood pressure, cardiovascular and respiratory affections, infertility, sexual and functional impotence, metabolic syndrome, load joint disorders and some types of cancer (breast, colon, prostate). The metabolic bariatric surgery is the surgical treatment more effective for the morbid obesity at long -and medium- term and not the pharmacologic treatment and the isolated diets. The aim of present historical review of the international literature on the evolution of surgical techniques of the bariatric surgery (malabsorption techniques, gastric restrictive techniques and mixed techniques), is to make available to those interested in this subject, a valuable therapeutic tool to be rationally used. (author)

  13. [Surgical correction of cleft palate]. (United States)

    Kimura, F T; Pavia Noble, A; Soriano Padilla, F; Soto Miranda, A; Medellín Rodríguez, A


    This study presents a statistical review of corrective surgery for cleft palate, based on cases treated at the maxillo-facial surgery units of the Pediatrics Hospital of the Centro Médico Nacional and at Centro Médico La Raza of the National Institute of Social Security of Mexico, over a five-year period. Interdisciplinary management as performed at the Cleft-Palate Clinic, in an integrated approach involving specialists in maxillo-facial surgery, maxillar orthopedics, genetics, social work and mental hygiene, pursuing to reestablish the stomatological and psychological functions of children afflicted by cleft palate, is amply described. The frequency and classification of the various techniques practiced in that service are described, as well as surgical statistics for 188 patients, which include a total of 256 palate surgeries performed from March 1984 to March 1989, applying three different techniques and proposing a combination of them in a single surgical time, in order to avoid complementary surgery.

  14. Open surgical simulation--a review. (United States)

    Davies, Jennifer; Khatib, Manaf; Bello, Fernando


    Surgical simulation has benefited from a surge in interest over the last decade as a result of the increasing need for a change in the traditional apprentice model of teaching surgery. However, despite the recent interest in surgical simulation as an adjunct to surgical training, most of the literature focuses on laparoscopic, endovascular, and endoscopic surgical simulation with very few studies scrutinizing open surgical simulation and its benefit to surgical trainees. The aim of this review is to summarize the current standard of available open surgical simulators and to review the literature on the benefits of open surgical simulation. Open surgical simulators currently used include live animals, cadavers, bench models, virtual reality, and software-based computer simulators. In the current literature, there are 18 different studies (including 6 randomized controlled trials and 12 cohort studies) investigating the efficacy of open surgical simulation using live animal, bench, and cadaveric models in many surgical specialties including general, cardiac, trauma, vascular, urologic, and gynecologic surgery. The current open surgical simulation studies show, in general, a significant benefit of open surgical simulation in developing the surgical skills of surgical trainees. However, these studies have their limitations including a low number of participants, variable assessment standards, and a focus on short-term results often with no follow-up assessment. The skills needed for open surgical procedures are the essential basis that a surgical trainee needs to grasp before attempting more technical procedures such as laparoscopic procedures. In this current climate of medical practice with reduced hours of surgical exposure for trainees and where the patient's safety and outcome is key, open surgical simulation is a promising adjunct to modern surgical training, filling the void between surgeons being trained in a technique and a surgeon achieving fluency in that

  15. Robust Adaptive Neural Control of Morphing Aircraft with Prescribed Performance

    Directory of Open Access Journals (Sweden)

    Zhonghua Wu


    Full Text Available This study proposes a low-computational composite adaptive neural control scheme for the longitudinal dynamics of a swept-back wing aircraft subject to parameter uncertainties. To efficiently release the constraint often existing in conventional neural designs, whose closed-loop stability analysis always necessitates that neural networks (NNs be confined in the active regions, a smooth switching function is presented to conquer this issue. By integrating minimal learning parameter (MLP technique, prescribed performance control, and a kind of smooth switching strategy into back-stepping design, a new composite switching adaptive neural prescribed performance control scheme is proposed and a new type of adaptive laws is constructed for the altitude subsystem. Compared with previous neural control scheme for flight vehicle, the remarkable feature is that the proposed controller not only achieves the prescribed performance including transient and steady property but also addresses the constraint on NN. Two comparative simulations are presented to verify the effectiveness of the proposed controller.

  16. Towards Safe Robotic Surgical Systems

    DEFF Research Database (Denmark)

    Sloth, Christoffer; Wisniewski, Rafael


    a controller for motion compensation in beating-heart surgery, and prove that it is safe, i.e., the surgical tool is kept within an allowable distance and orientation of the heart. We solve the problem by simultaneously finding a control law and a barrier function. The motion compensation system is simulated...... from several initial conditions to demonstrate that the designed control system is safe for every admissible initial condition....

  17. Surgical treatment of chest instability

    International Nuclear Information System (INIS)

    Kitka, M.; Masek, M.


    Fractures of the ribs is the most common thoracic injury after blunt trauma. Chest wall instability (flail chest) is a common occurrence in the presence of multiple ribs fracture. Unilateral or bilateral fractures more ribs anteriorly or posteriorly will produce enough instability that paradoxical respiratory motion results in hypoventilation of an unacceptable degree. Open approach and surgical stabilisation of the chest preserved pulmonary function, improved pain control, minimized posttraumatic deformities and shorter back to work time. (author)

  18. Frugal Design and Surgical Robotics


    McKinley, Stephen Alan


    A new era of robotic surgery is poised to begin when critical patents held by Intuitive Surgical (IS) expire in 2016. IS market dominance for decades has led to an effective monopoly that will be challenged by several commercial enterprises working on next generation general robotic surgery systems. Robotic surgery has the potential to alleviate the skill-gap between experienced and inexperienced surgeons through the automation of sub-tasks within surgicalprocedures.The primary objective of...

  19. Surgical treatment of radiation proctitis

    Energy Technology Data Exchange (ETDEWEB)

    Maruyama, Izumi; Sato, Gohei; Okaue, Toyotake; Isobe, Yoshinari; Ohtsu, Akira; Sugimoto, Yuzo (Kansai Electric Power Co., Inc., Osaka (Japan))


    Severe radiation proctitis was surgically treated in 8 cases. Colostomy was performed in 2 cases, total resection of the rectum in 2 and proctectomy with colostomy in 4. Perineal abscess developed in the 2 cases with total resection of the rectum. Rather than completely resection of the lesion, a procedure leaving no dead space i.e. proctectomy with colostomy, is desirable for radiation proctitis. Complete preoperative examination of the condition of the underlying disease and possible urinary tract complications is important.

  20. Surgical checklists: the human factor.

    LENUS (Irish Health Repository)

    O Connor, Paul


    BACKGROUND: Surgical checklists has been shown to improve patient safety and teamwork in the operating theatre. However, despite the known benefits of the use of checklists in surgery, in some cases the practical implementation has been found to be less than universal. A questionnaire methodology was used to quantitatively evaluate the attitudes of theatre staff towards a modified version of the World Health Organisation (WHO) surgical checklist with relation to: beliefs about levels of compliance and support, impact on patient safety and teamwork, and barriers to the use of the checklist. METHODS: Using the theory of planned behaviour as a framework, 14 semi-structured interviews were conducted with theatre personnel regarding their attitudes towards, and levels of compliance with, a checklist. Based upon the interviews, a 27-item questionnaire was developed and distribute to all theatre personnel in an Irish hospital. RESULTS: Responses were obtained from 107 theatre staff (42.6% response rate). Particularly for nurses, the overall attitudes towards the effect of the checklist on safety and teamworking were positive. However, there was a lack of rigour with which the checklist was being applied. Nurses were significantly more sensitive to the barriers to the use of the checklist than anaesthetists or surgeons. Moreover, anaesthetists were not as positively disposed to the surgical checklist as surgeons and nurse. This finding was attributed to the tendency for the checklist to be completed during a period of high workload for the anaesthetists, resulting in a lack of engagement with the process. CONCLUSION: In order to improve the rigour with which the surgical checklist is applied, there is a need for: the involvement of all members of the theatre team in the checklist process, demonstrated support for the checklist from senior personnel, on-going education and training, and barriers to the implementation of the checklist to be addressed.

  1. [Surgical treatment of supraventricular tachycardia]. (United States)

    Vigano, A N; Minzioni, G; Graffigna, A; Paganini, F; Salerno, J A


    The article deals with the modern approaches to the treatment of supraventricular tachycardia . The authors analyse the results of operations in ectopic atrial tachycardias, the Wolff-Parkinson-White syndrome, modal re-entry tachycardias, and atrial fibrillation . The last-named is of most interest because the authors possess experience in a new operation for isolation of the internodal tracts. In all conditions the authors obtained convincing evidence on the efficacy of modern surgical treatment in supraventricular tachycardias.

  2. Quantification of surgical blood loss. (United States)

    Lee, Marcel H; Ingvertsen, Britt T; Kirpensteijn, Jolle; Jensen, Asger L; Kristensen, Annemarie T


    To compare gravimetric and colorimetric methods of quantifying surgical blood loss, and to determine if there is a correlation between preoperative hemostatic tests (buccal mucosa bleeding time [BMBT] and intraoperative blood loss). Prospective clinical study. Dogs (n=15) admitted for cutaneous tumor excision, orthopedic procedure, or exploratory laparotomy. Intraoperative blood loss was quantified by measuring irrigation fluid and weighing surgical sponges used for blood and fluid collection during surgery. Results of gravimetric measurements were then correlated to blood loss quantified using spectrophotometric analysis of hemoglobin (Hb) content. Hemostatic variables including BMBT were measured before surgery and compared with the calculated amount of blood loss. Blood loss quantified by gravimetric measurement showed a significant correlation with colorimetric determination of Hb content in surgical sponges and collected irrigation fluid (r=0.93, P<.0001). BMBT correlated weakly but significantly with intraoperative blood loss (r=0.56, P<.05). Quantifying intraoperative blood loss using spectrophotometric Hb analysis accurately assessed the amount of blood loss; however, it is a time-consuming procedure, primarily applicable as a research tool. Gravimetric evaluation of intraoperative blood loss was found to be an accurate method, which can be recommended for use in a clinical setting. Estimation of blood loss using a gravimetric method is accurate and applicable in the clinical setting and provides surgeons with a simple and objective tool to evaluate intraoperative blood loss.

  3. Is surgical workforce diversity increasing? (United States)

    Andriole, Dorothy A; Jeffe, Donna B; Schechtman, Kenneth B


    We sought to determine the extent to which recent increases in levels of gender and racial diversity in the overall resident-physician workforce were evident among core-surgical specialty resident workforces. Chi-square tests for trend assessed the importance of changes from 1996 to 2004 in proportions of women and African Americans in the surgery-resident workforce. Surgery-resident trends were compared with overall resident workforce trends using two-tailed t-tests to compare regression slopes that quantified rates of change over time. Chi-square tests assessed differences between proportions of women and African Americans in the current overall board-certified workforce and their proportions in the surgery board-certified workforce. From 1996 to 2004, proportions of women increased in all seven surgical specialties studied. Compared with the overall trend toward increasing proportions of women in the resident workforce, the trend in one surgical specialty was larger (obstetrics/gynecology, p 0.05), and two were smaller (each p 0.05). Proportions of African Americans decreased in three specialties (each p workforce, except obstetrics/gynecology, remained lower than in the overall board-certified workforce (each p workforces have persisted since 1996 and will likely perpetuate ongoing surgery board-certified workforce disparities.

  4. [Surgical managment of retinal detachment]. (United States)

    Haritoglou, C; Wolf, A


    The detachment of the neurosensory retina from the underlying retinal pigment epithelium can be related to breaks of the retina allowing vitreous fluid to gain access to the subretinal space, to exudative changes of the choroid such as tumours or inflammatory diseases or to excessive tractional forces exerted by interactions of the collagenous vitreous and the retina. Tractional retinal detachment is usually treated by vitrectomy and exudative detachment can be addressed by treatment of the underlying condition in many cases. In rhegmatogenous retinal detachment two different surgical procedures, vitrectomy and scleral buckling, can be applied for functional and anatomic rehabilitation of our patients. The choice of the surgical procedure is not really standardised and often depends on the experience of the surgeon and other more ocular factors including lens status, the number of retinal breaks, the extent of the detachment and the amount of preexisting PVR. Using both techniques, anatomic success rates of over 90 % can be achieved. Especially in young phakic patients scleral buckling offers the true advantage to prevent the progression of cataract formation requiring cataract extraction and intraocular lens implantation. Therefore, scleral buckling should be considered in selected cases as an alternative surgical option in spite of the very important technical refinements in modern vitrectomy techniques. Georg Thieme Verlag KG Stuttgart · New York.

  5. Surgical smoke and ultrafine particles

    Directory of Open Access Journals (Sweden)

    Nowak Dennis


    Full Text Available Abstract Background Electrocautery, laser tissue ablation, and ultrasonic scalpel tissue dissection all generate a 'surgical smoke' containing ultrafine ( Methods To measure the amount of generated particulates in 'surgical smoke' during different surgical procedures and to quantify the particle number concentration for operation room personnel a condensation particle counter (CPC, model 3007, TSI Inc. was applied. Results Electro-cauterization and argon plasma tissue coagulation induced the production of very high number concentration (> 100000 cm-3 of particles in the diameter range of 10 nm to 1 μm. The peak concentration was confined to the immediate local surrounding of the production side. In the presence of a very efficient air conditioning system the increment and decrement of ultrafine particle occurrence was a matter of seconds, with accumulation of lower particle number concentrations in the operation room for only a few minutes. Conclusion Our investigation showed a short term very high exposure to ultrafine particles for surgeons and close assisting operating personnel – alternating with longer periods of low exposure.

  6. Uncommon surgical emergencies in neonatology

    Directory of Open Access Journals (Sweden)

    R. Angotti


    Full Text Available Objective. Over the past decade, multiple factors have changed the pattern of neonatal surgical emergencies. An increase in prenatal screenings and the development of neonatal tertiary care centres have changed the clinical approach to these kids. Materials and methods. Between 1995 to 2011 were retrospectively reviewed 34 patients with diagnosis of uncommon rare neonatal surgical emergencies at our institute. We analyzed: sex, gestational age, weight at birth, primary pathology, prenatal diagnosis, associated anomalies, age and weight at surgery, clinical presentation, start of oral feeding and hospitalization. The follow-up was performed at 6,12, 24 and 36 months. Results. There were 21 male and 13 female. The gestational age ranged between 28 and 36 weeks. The weight at birth ranged between 700 and 1400 grams. Oral feeding was started between 4th and 10th postoperative day. The average hospitalization was about 70.47 days. To date, all patients have finished the followup. They are healthy. Conclusion. The outcome of the patients with uncommon surgical emergencies is different based on the etiology. Overall survival is generally good but is influenced by the associated anomalies.

  7. Surgical management of radiation enterocolitis

    International Nuclear Information System (INIS)

    Sakaguchi, Masahiro; Katsumi, Masaharu; Ishimoto, Kiwao; Yamamoto, Shinji; Yukawa, Hirofumi; Koh, Kenzo; Yamaguchi, Kazuya; Ohta, Masataka; Hayashido, Motonori


    Radiotherapy for malignant tumors is effective and established. However, there are many complications in radiotherapy. A typical complication is radiation enterocolitis. It is difficult to treat severe histological damage to the irradiated tissues. This paper reports our experience with 26 patients with radiation enterocolitis for whom surgical treatment was given during a period of 16 years in our surgical department. The most frequent original disease requiring irradiation was cancer of the cervix uteri (15 cases) which was followed by cancer of the urinary bladder (7 cases). All of these patients had received external 60 Co irradiation. The ileum was the most frequent site of the lesion, followed by the rectum, sigmoid and descending colon. The period between the end of irradiation and the onset of enterocolitis ranged from 2 months to 10 years, with an average of 28 months. The main symptoms were intestinal obstruction in the ileum, and melena and fistula in the rectum and sigmoid colon. Intestinal resection was performed in 10 patients, a bypass operation in 4, and colostomy in 12. As to types of intestinal suture in these cases, Gambee's single layer method was thought useful from our experience. Colostomy as surgical management of melena and fistula did not yield satisfactory results. (author)

  8. Simulation-based surgical education. (United States)

    Evgeniou, Evgenios; Loizou, Peter


    The reduction in time for training at the workplace has created a challenge for the traditional apprenticeship model of training. Simulation offers the opportunity for repeated practice in a safe and controlled environment, focusing on trainees and tailored to their needs. Recent technological advances have led to the development of various simulators, which have already been introduced in surgical training. The complexity and fidelity of the available simulators vary, therefore depending on our recourses we should select the appropriate simulator for the task or skill we want to teach. Educational theory informs us about the importance of context in professional learning. Simulation should therefore recreate the clinical environment and its complexity. Contemporary approaches to simulation have introduced novel ideas for teaching teamwork, communication skills and professionalism. In order for simulation-based training to be successful, simulators have to be validated appropriately and integrated in a training curriculum. Within a surgical curriculum, trainees should have protected time for simulation-based training, under appropriate supervision. Simulation-based surgical education should allow the appropriate practice of technical skills without ignoring the clinical context and must strike an adequate balance between the simulation environment and simulators. © 2012 The Authors. ANZ Journal of Surgery © 2012 Royal Australasian College of Surgeons.

  9. Surgical correction of postoperative astigmatism

    Directory of Open Access Journals (Sweden)

    Lindstrom Richard


    Full Text Available The photokeratoscope has increased the understanding of the aspheric nature of the cornea as well as a better understanding of normal corneal topography. This has significantly affected the development of newer and more predictable models of surgical astigmatic correction. Relaxing incisions effectively flatten the steeper meridian an equivalent amount as they steepen the flatter meridian. The net change in spherical equivalent is, therefore, negligible. Poor predictability is the major limitation of relaxing incisions. Wedge resection can correct large degrees of postkeratoplasty astigmatism, Resection of 0.10 mm of tissue results in approximately 2 diopters of astigmatic correction. Prolonged postoperative rehabilitation and induced irregular astigmatism are limitations of the procedure. Transverse incisions flatten the steeper meridian an equivalent amount as they steepen the flatter meridian. Semiradial incisions result in two times the amount of flattening in the meridian of the incision compared to the meridian 90 degrees away. Combination of transverse incisions with semiradial incisions describes the trapezoidal astigmatic keratotomy. This procedure may correct from 5.5 to 11.0 diopters dependent upon the age of the patient. The use of the surgical keratometer is helpful in assessing a proper endpoint during surgical correction of astigmatism.

  10. [Surgical tactics in duodenal trauma]. (United States)

    Ivanov, P A; Grishin, A V


    Results of surgical treatment of 61 patients with injuries of the duodenum are analyzed. The causes of injuries were stab-incised wounds in 24 patients, missile wound -- in 7, closed abdominal trauma -- in 26, trauma of the duodenum during endoscopic papillosphincterotomy -- in 4. All the patients underwent surgery. Complications were seen in 32 (52.5%) patients, 21 patients died, lethality was 34.4%. Within the first 24 hours since the trauma 7 patients died due to severe combined trauma, blood loss, 54 patients survived acute period of trauma, including 28 patients after open trauma, 26 -- after closed and 4 -- after trauma of the duodenum during endoscopic papillosphincterotomy. Diagnostic and surgical policies are discussed. Results of treatment depending on kind and time of surgery are regarded. It is demonstrated that purulent complications due to retroperitoneal phlegmona, traumatic pancreatitis, pneumonia are the causes of significant number of unfavorable outcomes. Therefore, it is important to adequately incise and drainage infected parts of retroperitoneal fat tissue with two-lumen drainages. Decompression through duodenal tube is the effective procedure for prophylaxis of suture insufficiency and traumatic pancreatitis. Suppression of pancreatic and duodenal secretion with octreotid improves significantly surgical treatment results.

  11. Surgical Management of Chronic Pancreatitis. (United States)

    Parekh, Dilip; Natarajan, Sathima


    Advances over the past decade have indicated that a complex interplay between environmental factors, genetic predisposition, alcohol abuse, and smoking lead towards the development of chronic pancreatitis. Chronic pancreatitis is a complex disorder that causes significant and chronic incapacity in patients and a substantial burden on the society. Major advances have been made in the etiology and pathogenesis of this disease and the role of genetic predisposition is increasingly coming to the fore. Advances in noninvasive diagnostic modalities now allow for better diagnosis of chronic pancreatitis at an early stage of the disease. The impact of these advances on surgical treatment is beginning to emerge, for example, patients with certain genetic predispositions may be better treated with total pancreatectomy versus lesser procedures. Considerable controversy remains with respect to the surgical management of chronic pancreatitis. Modern understanding of the neurobiology of pain in chronic pancreatitis suggests that a window of opportunity exists for effective treatment of the intractable pain after which central sensitization can lead to an irreversible pain syndrome in patients with chronic pancreatitis. Effective surgical procedures exist for chronic pancreatitis; however, the timing of surgery is unclear. For optimal treatment of patients with chronic pancreatitis, close collaboration between a multidisciplinary team including gastroenterologists, surgeons, and pain management physicians is needed.

  12. Surgical management of anterior chamber epithelial cysts. (United States)

    Haller, Julia A; Stark, Walter J; Azab, Amr; Thomsen, Robert W; Gottsch, John D


    To review management strategies for treatment of anterior chamber epithelial cysts. Retrospective review of consecutive interventional case series. Charts of patients treated for epithelial ingrowth over a 10-year period by a single surgeon were reviewed. Cases of anterior chamber epithelial cysts were identified and recorded, including details of ocular history, preoperative and postoperative acuity, intraocular pressure (IOP), and ocular examination, type of surgical intervention, and details of further procedures performed. Seven eyes with epithelial cysts were identified. Patient age ranged from 1.5 to 53 years at presentation. Four patients were children. In four eyes, cysts were secondary to trauma, one case was presumably congenital, one case developed after corneal perforation in an eye with Terrien's marginal degeneration, and one case developed after penetrating keratoplasty (PK). Three eyes were treated with vitrectomy, en bloc resection of the cyst and associated tissue, fluid-air exchange and cryotherapy. The last four eyes were treated with a new conservative strategy of cyst aspiration (three cases) or local excision (one keratin "pearl" cyst), and endolaser photocoagulation of the collapsed cyst wall/base. All epithelial tissue was successfully eradicated by clinical criteria; one case required repeat excision (follow-up, 9 to 78 months, mean 45). Two eyes required later surgery for elevated IOP, two for cataract extraction and one for repeat PK. Final visual acuity ranged from 20/20 to hand motions, depending on associated ocular damage. Best-corrected visual results were obtained in the more conservatively managed eyes. Anterior chamber epithelial cysts can be managed conservatively in selected cases with good results. This strategy may be particularly useful in children's eyes, where preservation of the lens, iris, and other structures may facilitate amblyopia management. Copyright 2003 by Elsevier Science Inc.

  13. Fighting surgical site infections in small animals

    DEFF Research Database (Denmark)

    Verwilghen, Denis; Singh, Ameet


    A diverse array of pathogen-related, patient-related, and caretaker-related issues influence risk and prevention of surgical site infections (SSIs). The entire surgical team involved in health care settings in which surgical procedures are performed play a pivotal role in the prevention of SSIs. ...

  14. 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 ... Anterior palatal island advancement flap for bone graft coverage: technical note · EMAIL FREE FULL TEXT EMAIL FREE FULL TEXT

  15. Surgical versus non-surgical management for pleural empyema. (United States)

    Redden, Mark D; Chin, Tze Yang; van Driel, Mieke L


    Empyema refers to pus in the pleural space, commonly due to adjacent pneumonia, chest wall injury, or a complication of thoracic surgery. A range of therapeutic options are available for its management, ranging from percutaneous aspiration and intercostal drainage to video-assisted thoracoscopic surgery (VATS) or thoracotomy drainage. Intrapleural fibrinolytics may also be administered following intercostal drain insertion to facilitate pleural drainage. There is currently a lack of consensus regarding optimal treatment. To assess the effectiveness and safety of surgical versus non-surgical treatments for complicated parapneumonic effusion or pleural empyema. We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (2016, Issue 9), MEDLINE (Ebscohost) (1946 to July week 3 2013, July 2015 to October 2016) and MEDLINE (Ovid) (1 May 2013 to July week 1 2015), Embase (2010 to October 2016), CINAHL (1981 to October 2016) and LILACS (1982 to October 2016) on 20 October 2016. We searched and WHO International Clinical Trials Registry Platform for ongoing studies (December 2016). Randomised controlled trials that compared a surgical with a non-surgical method of management for all age groups with pleural empyema. Two review authors independently assessed trials for inclusion and risk of bias, extracted data, and checked the data for accuracy. We contacted trial authors for additional information. We assessed the quality of the evidence using the GRADE approach. We included eight randomised controlled trials with a total of 391 participants. Six trials focused on children and two on adults. Trials compared tube thoracostomy drainage (non-surgical), with or without intrapleural fibrinolytics, to either VATS or thoracotomy (surgical) for the management of pleural empyema. Assessment of risk of bias for the included studies was generally unclear for selection and blinding but low for attrition and reporting bias. Data analyses compared

  16. Neural networks for genetic epidemiology: past, present, and future

    Directory of Open Access Journals (Sweden)

    Motsinger-Reif Alison A


    Full Text Available Abstract During the past two decades, the field of human genetics has experienced an information explosion. The completion of the human genome project and the development of high throughput SNP technologies have created a wealth of data; however, the analysis and interpretation of these data have created a research bottleneck. While technology facilitates the measurement of hundreds or thousands of genes, statistical and computational methodologies are lacking for the analysis of these data. New statistical methods and variable selection strategies must be explored for identifying disease susceptibility genes for common, complex diseases. Neural networks (NN are a class of pattern recognition methods that have been successfully implemented for data mining and prediction in a variety of fields. The application of NN for statistical genetics studies is an active area of research. Neural networks have been applied in both linkage and association analysis for the identification of disease susceptibility genes. In the current review, we consider how NN have been used for both linkage and association analyses in genetic epidemiology. We discuss both the successes of these initial NN applications, and the questions that arose during the previous studies. Finally, we introduce evolutionary computing strategies, Genetic Programming Neural Networks (GPNN and Grammatical Evolution Neural Networks (GENN, for using NN in association studies of complex human diseases that address some of the caveats illuminated by previous work.

  17. Neural substrate expansion for the restoration of brain function

    Directory of Open Access Journals (Sweden)

    Han-Chiao Isaac Chen


    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.

  18. Methodology for neural networks prototyping. Application to traffic control

    Energy Technology Data Exchange (ETDEWEB)

    Belegan, I.C.


    The work described in this report was carried out in the context of the European project ASTORIA (Advanced Simulation Toolbox for Real-World Industrial Application in Passenger Management and Adaptive Control), and concerns the development of an advanced toolbox for complex transportation systems. Our work was focused on the methodology for prototyping a set of neural networks corresponding to specific strategies for traffic control and congestion management. The tool used for prototyping is SNNS (Stuggart Neural Network Simulator), developed at the University of Stuggart, Institute for Parallel and Distributed High Performance Systems, and the real data from the field were provided by ZELT. This report is structured into six parts. The introduction gives some insights about traffic control and its approaches. The second chapter discusses the various control strategies existing. The third chapter is an introduction to the field of neural networks. The data analysis and pre-processing is described in the fourth chapter. In the fifth chapter, the methodology for prototyping the neural networks is presented. Finally, conclusions and further work are presented. (author) 14 refs.

  19. Application of neural networks to seismic active control

    International Nuclear Information System (INIS)

    Tang, Yu.


    An exploratory study on seismic active control using an artificial neural network (ANN) is presented in which a singledegree-of-freedom (SDF) structural system is controlled by a trained neural network. A feed-forward neural network and the backpropagation training method are used in the study. In backpropagation training, the learning rate is determined by ensuring the decrease of the error function at each training cycle. The training patterns for the neural net are generated randomly. Then, the trained ANN is used to compute the control force according to the control algorithm. The control strategy proposed herein is to apply the control force at every time step to destroy the build-up of the system response. The ground motions considered in the simulations are the N21E and N69W components of the Lake Hughes No. 12 record that occurred in the San Fernando Valley in California on February 9, 1971. Significant reduction of the structural response by one order of magnitude is observed. Also, it is shown that the proposed control strategy has the ability to reduce the peak that occurs during the first few cycles of the time history. These promising results assert the potential of applying ANNs to active structural control under seismic loads

  20. Program Helps Simulate Neural Networks (United States)

    Villarreal, James; Mcintire, Gary


    Neural Network Environment on Transputer System (NNETS) computer program provides users high degree of flexibility in creating and manipulating wide variety of neural-network topologies at processing speeds not found in conventional computing environments. Supports back-propagation and back-propagation-related algorithms. Back-propagation algorithm used is implementation of Rumelhart's generalized delta rule. NNETS developed on INMOS Transputer(R). Predefines back-propagation network, Jordan network, and reinforcement network to assist users in learning and defining own networks. Also enables users to configure other neural-network paradigms from NNETS basic architecture. Small portion of software written in OCCAM(R) language.

  1. Artificial Neural Network Analysis System (United States)


    Contract No. DASG60-00-M-0201 Purchase request no.: Foot in the Door-01 Title Name: Artificial Neural Network Analysis System Company: Atlantic... Artificial Neural Network Analysis System 5b. GRANT NUMBER 5c. PROGRAM ELEMENT NUMBER 6. AUTHOR(S) Powell, Bruce C 5d. PROJECT NUMBER 5e. TASK NUMBER...34) 27-02-2001 Report Type N/A Dates Covered (from... to) ("DD MON YYYY") 28-10-2000 27-02-2001 Title and Subtitle Artificial Neural Network Analysis

  2. Surgical management for displaced pediatric proximal humeral fractures: a cost analysis


    Shore, Benjamin J.; Hedequist, Daniel J.; Miller, Patricia E.; Waters, Peter M.; Bae, Donald S.


    Purpose The purpose of this investigation was to determine which of the following methods of fixation, percutaneous pinning (PP) or intramedullary nailing (IMN), was more cost-effective in the treatment of displaced pediatric proximal humeral fractures (PPHF). Methods: A retrospective cohort of surgically treated PPHF over a 12-year period at a single institution was performed. A decision analysis model was constructed to compare three surgical strategies: IMN versus percutaneous pinning leav...

  3. Surgical treatment of pancreatic endocrine tumors in multiple endocrine neoplasia type 1

    Directory of Open Access Journals (Sweden)

    Marcel Cerqueira Cesar Machado

    Full Text Available Surgical approaches to pancreatic endocrine tumors associated with multiple endocrine neoplasia type 1 may differ greatly from those applied to sporadic pancreatic endocrine tumors. Presurgical diagnosis of multiple endocrine neoplasia type 1 is therefore crucial to plan a proper intervention. Of note, hyperparathyroidism/multiple endocrine neoplasia type 1 should be surgically treated before pancreatic endocrine tumors/multiple endocrine neoplasia type 1 resection, apart from insulinoma. Non-functioning pancreatic endocrine tumors/multiple endocrine neoplasia type 1 >1 cm have a high risk of malignancy and should be treated by a pancreatic resection associated with lymphadenectomy. The vast majority of patients with gastrinoma/multiple endocrine neoplasia type 1 present with tumor lesions at the duodenum, so the surgery of choice is subtotal or total pancreatoduodenectomy followed by regional lymphadenectomy. The usual surgical treatment for insulinoma/multiple endocrine neoplasia type 1 is distal pancreatectomy up to the mesenteric vein with or without spleen preservation, associated with enucleation of tumor lesions in the pancreatic head. Surgical procedures for glucagonomas, somatostatinomas, and vipomas/ multiple endocrine neoplasia type 1 are similar to those applied to sporadic pancreatic endocrine tumors. Some of these surgical strategies for pancreatic endocrine tumors/multiple endocrine neoplasia type 1 still remain controversial as to their proper extension and timing. Furthermore, surgical resection of single hepatic metastasis secondary to pancreatic endocrine tumors/multiple endocrine neoplasia type 1 may be curative and even in multiple liver metastases surgical resection is possible. Hepatic trans-arterial chemo-embolization is usually associated with surgical resection. Liver transplantation may be needed for select cases. Finally, pre-surgical clinical and genetic diagnosis of multiple endocrine neoplasia type 1 syndrome and

  4. [Surgical treatment of Marfan syndrome; analysis of the patients required multiple surgical interventions]. (United States)

    Yamazaki, F; Shimamoto, M; Fujita, S; Nakai, M; Aoyama, A; Chen, F; Nakata, T; Yamada, T


    Without treatment, the life expectancy of patients with Marfan syndrome is reduced by the associated cardiovascular abnormalities. In this study, we reviewed our experience of the patients with Marfan syndrome who required multiple surgical interventions to identify the optimal treatment for these patients. Between January 1986 and December 2000, 44 patients with Marfan syndrome were operated on at Shizuoka City Hospital (SCH). Among them, 10 patients (22.7%) underwent multiple surgical interventions. There were 5 male and 5 female patients with a mean age of 40.6 +/- 16.1 years at the initial surgery. Only one patient was operated on at another hospital for his first, second, and third operations. His fourth operation was carried out at SCH. The remaining 9 patients underwent a total of 14 additional surgical procedures at SCH. Computed tomography (CT) scans were taken every 6 months postoperatively, and aortic diameter greater than 60 mm was considered as the indication for the additional surgery. There were no early death and one late death. The causes of additional surgery were enlargement of true aneurysm in 6, enlargement of residual dissection in 4, new dissection in 4, false aneurysm at the coronary anastomosis of Bentall procedure in 1. In 9 patients, both ascending and descending aorta were replaced. Among these 9 patients, only 3 patients underwent total arch replacement, and remaining 6 patients had their arch left in place with or without dissection. Our current strategy of the treatment of Marfan patients with acute type A dissection is total arch replacement with an elephant trunk at the initial emergent surgery.

  5. Creative-Dynamics Approach To Neural Intelligence (United States)

    Zak, Michail A.


    Paper discusses approach to mathematical modeling of artificial neural networks exhibiting complicated behaviors reminiscent of creativity and intelligence of biological neural networks. Neural network treated as non-Lipschitzian dynamical system - as described in "Non-Lipschitzian Dynamics For Modeling Neural Networks" (NPO-17814). System serves as tool for modeling of temporal-pattern memories and recognition of complicated spatial patterns.

  6. Selection for Surgical Training: An Evidence-Based Review. (United States)

    Schaverien, Mark V


    The predictive relationship between candidate selection criteria for surgical training programs and future performance during and at the completion of training has been investigated for several surgical specialties, however there is no interspecialty agreement regarding which selection criteria should be used. Better understanding the predictive reliability between factors at selection and future performance may help to optimize the process and lead to greater standardization of the surgical selection process. PubMed and Ovid MEDLINE databases were searched. Over 560 potentially relevant publications were identified using the search strategy and screened using the Cochrane Collaboration Data Extraction and Assessment Template. 57 studies met the inclusion criteria. Several selection criteria used in the traditional selection demonstrated inconsistent correlation with subsequent performance during and at the end of surgical training. The following selection criteria, however, demonstrated good predictive relationships with subsequent resident performance: USMLE examination scores, Letters of Recommendation (LOR) including the Medical Student Performance Evaluation (MSPE), academic performance during clinical clerkships, the interview process, displaying excellence in extracurricular activities, and the use of unadjusted rank lists. This systematic review supports that the current selection process needs to be further evaluated and improved. Multicenter studies using standardized outcome measures of success are now required to improve the reliability of the selection process to select the best trainees. Published by Elsevier Inc.

  7. Efficacy of Surgical Therapy for Carotid Body Tumors

    Institute of Scientific and Technical Information of China (English)

    Li-shan Lian; Chang-wei Liu; Heng Guan; Yue-hong Zheng; Xing-ming Chen; Yong-jun Li


    Objective To evaluate the efficacy of surgical therapy for carotid body tumors.Methods A retrospective analysis was conducted,covering the diagnosis,surgical procedure,post-operative complications,and prognosis of 120 cases of carotid body tumors in Peking Union Medical College Hospital from 1949 to May,2011.Results Surgical excision was successfully performed in 111 cases with 117 tumors.In all those cases,50 underwent simple tumor resection,42 underwent resection of tumors and ligation of the external carotid arteries,7 underwent co-resection of tumors and common carotid arteries,internal carotid arteries,as well as external arteries without vascular reconstruction,and the other 12 cases experienced tumor resection and vascular reconstruction as internal carotid arteries were involved.After operation,3 cases developed cerebral infarction,30 cases showed cranial nerve palsy,including 15 cases of hypoglossal nerve damage,10 cases of vagus paralysis,and 5 cases of Horner's syndrome.Conclusion It is essential to make a proper surgical strategy,which can reduce postoperative complications.

  8. Surgical approach in patients with hyperparathyroidism in multiple endocrine neoplasia type 1: total versus partial parathyroidectomy

    Directory of Open Access Journals (Sweden)

    Francesco Tonelli


    Full Text Available Usually, primary hyperparathyroidism is the first endocrinopathy to be diagnosed in patients with multiple endocrine neoplasia type 1, and is also the most common one. The timing of the surgery and strategy in multiple endocrine neoplasia type 1/hyperparathyroidism are still under debate. The aims of surgery are to: 1 correct hypercalcemia, thus preventing persistent or recurrent hyperparathyroidism; 2 avoid persistent hypoparathyroidism; and 3 facilitate the surgical treatment of possible recurrences. Currently, two types of surgical approach are indicated: 1 subtotal parathyroidectomy with removal of at least 3-3 K glands; and 2 total parathyroidectomy with grafting of autologous parathyroid tissue. Transcervical thymectomy must be performed with both of these procedures. Unsuccessful surgical treatment of hyperparathyroidism is more frequently observed in multiple endocrine neoplasia type 1 than in sporadic hyperparathyroidism. The recurrence rate is strongly influenced by: 1 the lack of a pre-operative multiple endocrine neoplasia type 1 diagnosis; 2 the surgeon's experience; 3 the timing of surgery; 4 the possibility of performing intra-operative confirmation (histologic examination, rapid parathyroid hormone assay of the curative potential of the surgical procedure; and, 5 the surgical strategy. Persistent hyperparathyroidism seems to be more frequent after subtotal parathyroidectomy than after total parathyroidectomy with autologous graft of parathyroid tissue. Conversely, recurrent hyperparathyroidism has a similar frequency in the two surgical strategies. To plan further operations, it is very helpful to know all the available data about previous surgery and to undertake accurate identification of the site of recurrence.

  9. Evaluating the optimal timing of surgical antimicrobial prophylaxis: study protocol for a randomized controlled trial. (United States)

    Mujagic, Edin; Zwimpfer, Tibor; Marti, Walter R; Zwahlen, Marcel; Hoffmann, Henry; Kindler, Christoph; Fux, Christoph; Misteli, Heidi; Iselin, Lukas; Lugli, Andrea Kopp; Nebiker, Christian A; von Holzen, Urs; Vinzens, Fabrizio; von Strauss, Marco; Reck, Stefan; Kraljević, Marko; Widmer, Andreas F; Oertli, Daniel; Rosenthal, Rachel; Weber, Walter P


    Surgical site infections are the most common hospital-acquired infections among surgical patients. The administration of surgical antimicrobial prophylaxis reduces the risk of surgical site infections . The optimal timing of this procedure is still a matter of debate. While most studies suggest that it should be given as close to the incision time as possible, others conclude that this may be too late for optimal prevention of surgical site infections. A large observational study suggests that surgical antimicrobial prophylaxis should be administered 74 to 30 minutes before surgery. The aim of this article is to report the design and protocol of a randomized controlled trial investigating the optimal timing of surgical antimicrobial prophylaxis. In this bi-center randomized controlled trial conducted at two tertiary referral centers in Switzerland, we plan to include 5,000 patients undergoing general, oncologic, vascular and orthopedic trauma procedures. Patients are randomized in a 1:1 ratio into two groups: one receiving surgical antimicrobial prophylaxis in the anesthesia room (75 to 30 minutes before incision) and the other receiving surgical antimicrobial prophylaxis in the operating room (less than 30 minutes before incision). We expect a significantly lower rate of surgical site infections with surgical antimicrobial prophylaxis administered more than 30 minutes before the scheduled incision. The primary outcome is the occurrence of surgical site infections during a 30-day follow-up period (one year with an implant in place). When assuming a 5% surgical site infection risk with administration of surgical antimicrobial prophylaxis in the operating room, the planned sample size has an 80% power to detect a relative risk reduction for surgical site infections of 33% when administering surgical antimicrobial prophylaxis in the anesthesia room (with a two-sided type I error of 5%). We expect the study to be completed within three years. The results of this

  10. The influence of stress responses on surgical performance and outcomes: Literature review and the development of the surgical stress effects (SSE) framework. (United States)

    Chrouser, Kristin L; Xu, Jie; Hallbeck, Susan; Weinger, Matthew B; Partin, Melissa R


    Surgical adverse events persist despite several decades of system-based quality improvement efforts, suggesting the need for alternative strategies. Qualitative studies suggest stress-induced negative intraoperative interpersonal dynamics might contribute to performance errors and undesirable patient outcomes. Understanding the impact of intraoperative stressors may be critical to reducing adverse events and improving outcomes. We searched MEDLINE, psycINFO, EMBASE, Business Source Premier, and CINAHL databases (1996-2016) to assess the relationship between negative (emotional and behavioral) responses to acute intraoperative stressors and provider performance or patient surgical outcomes. Drawing on theory and evidence from reviewed studies, we present the Surgical Stress Effects (SSE) framework. This illustrates how emotional and behavioral responses to stressors can influence individual surgical provider (e.g. surgeon, nurse) performance, team performance, and patient outcomes. It also demonstrates how uncompensated intraoperative threats and errors can lead to adverse events, highlighting evidence gaps for future research efforts. Published by Elsevier Inc.

  11. Decorrelated Jet Substructure Tagging using Adversarial Neural Networks

    CERN Multimedia

    CERN. Geneva


    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...

  12. Neural components of altruistic punishment

    Directory of Open Access Journals (Sweden)

    Emily eDu


    Full Text Available Altruistic punishment, which occurs when an individual incurs a cost to punish in response to unfairness or a norm violation, may play a role in perpetuating cooperation. The neural correlates underlying costly punishment have only recently begun to be explored. Here we review the current state of research on the neural basis of altruism from the perspectives of costly punishment, emphasizing the importance of characterizing elementary neural processes underlying a decision to punish. In particular, we emphasize three cognitive processes that contribute to the decision to altruistically punish in most scenarios: inequity aversion, cost-benefit calculation, and social reference frame to distinguish self from others. Overall, we argue for the importance of understanding the neural correlates of altruistic punishment with respect to the core computations necessary to achieve a decision to punish.

  13. Neural complexity, dissociation, and schizophrenia

    Czech Academy of Sciences Publication Activity Database

    Bob, P.; Šusta, M.; Chládek, Jan; Glaslová, K.; Fedor-Ferybergh, P.


    Roč. 13, č. 10 (2007), HY1-5 ISSN 1234-1010 Institutional research plan: CEZ:AV0Z20650511 Keywords : neural complexity * dissociation * schizophrenia Subject RIV: FH - Neurology Impact factor: 1.607, year: 2007

  14. 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...... study of the networks themselves. With this end in view the following restrictions have been made: - Amongst numerous neural network structures, only the Multi Layer Perceptron (a feed-forward network) is applied. - Amongst numerous training algorithms, only four algorithms are examined, all...... in a recursive form (sample updating). The simplest is the Back Probagation Error Algorithm, and the most complex is the recursive Prediction Error Method using a Gauss-Newton search direction. - Over-fitting is often considered to be a serious problem when training neural networks. This problem is specifically...

  15. Complex-Valued Neural Networks

    CERN Document Server

    Hirose, Akira


    This book is the second enlarged and revised edition of the first successful monograph on complex-valued neural networks (CVNNs) published in 2006, which lends itself to graduate and undergraduate courses in electrical engineering, informatics, control engineering, mechanics, robotics, bioengineering, and other relevant fields. In the second edition the recent trends in CVNNs research are included, resulting in e.g. almost a doubled number of references. The parametron invented in 1954 is also referred to with discussion on analogy and disparity. Also various additional arguments on the advantages of the complex-valued neural networks enhancing the difference to real-valued neural networks are given in various sections. The book is useful for those beginning their studies, for instance, in adaptive signal processing for highly functional sensing and imaging, control in unknown and changing environment, robotics inspired by human neural systems, and brain-like information processing, as well as interdisciplina...

  16. Artificial intelligence: Deep neural reasoning (United States)

    Jaeger, Herbert


    The human brain can solve highly abstract reasoning problems using a neural network that is entirely physical. The underlying mechanisms are only partially understood, but an artificial network provides valuable insight. See Article p.471

  17. Optical Neural Network Classifier Architectures

    National Research Council Canada - National Science Library

    Getbehead, Mark


    We present an adaptive opto-electronic neural network hardware architecture capable of exploiting parallel optics to realize real-time processing and classification of high-dimensional data for Air...

  18. Memristor-based neural networks

    International Nuclear Information System (INIS)

    Thomas, Andy


    The synapse is a crucial element in biological neural networks, but a simple electronic equivalent has been absent. This complicates the development of hardware that imitates biological architectures in the nervous system. Now, the recent progress in the experimental realization of memristive devices has renewed interest in artificial neural networks. The resistance of a memristive system depends on its past states and exactly this functionality can be used to mimic the synaptic connections in a (human) brain. After a short introduction to memristors, we present and explain the relevant mechanisms in a biological neural network, such as long-term potentiation and spike time-dependent plasticity, and determine the minimal requirements for an artificial neural network. We review the implementations of these processes using basic electric circuits and more complex mechanisms that either imitate biological systems or could act as a model system for them. (topical review)

  19. Sequential neural models with stochastic layers

    DEFF Research Database (Denmark)

    Fraccaro, Marco; Sønderby, Søren Kaae; Paquet, Ulrich


    How can we efficiently propagate uncertainty in a latent state representation with recurrent neural networks? This paper introduces stochastic recurrent neural networks which glue a deterministic recurrent neural network and a state space model together to form a stochastic and sequential neural...... generative model. The clear separation of deterministic and stochastic layers allows a structured variational inference network to track the factorization of the model's posterior distribution. By retaining both the nonlinear recursive structure of a recurrent neural network and averaging over...

  20. Adaptive coordination in surgical teams: an interview study. (United States)

    Bogdanovic, Jasmina; Perry, Juliana; Guggenheim, Merlin; Manser, Tanja


    Effective teamwork has been recognised as a major contributor to safe patient care in surgery. Previous research has highlighted the importance of adaptive coordination for effective performance in acute care settings. Expanding this line of research this study explores the coordination behaviours and adaptive coordination strategies employed by surgical teams and identifies relevant situational characteristics influencing those coordination processes. We conducted a qualitative content analysis of semi-structured interviews with 33 surgical team members (nurses and physicians) from different specialties and hospitals. We identified coordination behaviours (i.e. task management, information management, teaching and leadership) and adaptive coordination strategies triggered by varying requirements due to non-routine events, intraoperative complications and differing level of experience among operating room staff. Interviewees highlighted the importance of effectively managing challenging moments and the supporting effect of positive climate on teamwork. This study complements previous research on the non-technical skills underpinning safe performance in surgical teams. It highlights the central role of coordination and points out the ways in which situational variability requires the team to behave adaptively.

  1. Patients at High-Risk for Surgical Site Infection. (United States)

    Mueck, Krislynn M; Kao, Lillian S

    Surgical site infections (SSIs) are a significant healthcare quality issue, resulting in increased morbidity, disability, length of stay, resource utilization, and costs. Identification of high-risk patients may improve pre-operative counseling, inform resource utilization, and allow modifications in peri-operative management to optimize outcomes. Review of the pertinent English-language literature. High-risk surgical patients may be identified on the basis of individual risk factors or combinations of factors. In particular, statistical models and risk calculators may be useful in predicting infectious risks, both in general and for SSIs. These models differ in the number of variables; inclusion of pre-operative, intra-operative, or post-operative variables; ease of calculation; and specificity for particular procedures. Furthermore, the models differ in their accuracy in stratifying risk. Biomarkers may be a promising way to identify patients at high risk of infectious complications. Although multiple strategies exist for identifying surgical patients at high risk for SSIs, no one strategy is superior for all patients. Further efforts are necessary to determine if risk stratification in combination with risk modification can reduce SSIs in these patient populations.

  2. Alcohol skin preparation causes surgical fires. (United States)

    Rocos, B; Donaldson, L J


    Surgical fires are a rare but serious preventable safety risk in modern hospitals. Data from the US show that up to 650 surgical fires occur each year, with up to 5% causing death or serious harm. This study used the National Reporting and Learning Service (NRLS) database at the National Patient Safety Agency to explore whether spirit-based surgical skin preparation fluid contributes to the cause of surgical fires. The NRLS database was interrogated for all incidents of surgical fires reported between 1 March 2004 and 1 March 2011. Each report was scrutinised manually to discover the cause of the fire. Thirteen surgical fires were reported during the study period. Of these, 11 were found to be directly related to spirit-based surgical skin preparation or preparation soaked swabs and drapes. Despite manufacturer's instructions and warnings, surgical fires continue to occur. Guidance published in the UK and US states that spirit-based skin preparation solutions should continue to be used but sets out some precautions. It may be that fire risk should be included in pre-surgical World Health Organization checklists or in the surgical training curriculum. Surgical staff should be aware of the risk that spirit-based skin preparation fluids pose and should take action to minimise the chance of fire occurring.

  3. Implantable Neural Interfaces for Sharks (United States)


    technology for recording and stimulating from the auditory and olfactory sensory nervous systems of the awake, swimming nurse shark , G. cirratum (Figures...overlay of the central nervous system of the nurse shark on a horizontal MR image. Implantable Neural Interfaces for Sharks ...Neural Interfaces for Characterizing Population Responses to Odorants and Electrical Stimuli in the Nurse Shark , Ginglymostoma cirratum.” AChemS Abs

  4. What are artificial neural networks?

    DEFF Research Database (Denmark)

    Krogh, Anders


    Artificial neural networks have been applied to problems ranging from speech recognition to prediction of protein secondary structure, classification of cancers and gene prediction. How do they work and what might they be good for? Udgivelsesdato: 2008-Feb......Artificial neural networks have been applied to problems ranging from speech recognition to prediction of protein secondary structure, classification of cancers and gene prediction. How do they work and what might they be good for? Udgivelsesdato: 2008-Feb...

  5. An artificial neural network for modeling reliability, availability and maintainability of a repairable system

    International Nuclear Information System (INIS)

    Rajpal, P.S.; Shishodia, K.S.; Sekhon, G.S.


    The paper explores the application of artificial neural networks to model the behaviour of a complex, repairable system. A composite measure of reliability, availability and maintainability parameters has been proposed for measuring the system performance. The artificial neural network has been trained using past data of a helicopter transportation facility. It is used to simulate behaviour of the facility under various constraints. The insights obtained from results of simulation are useful in formulating strategies for optimal operation of the system

  6. Accomplishments and challenges of surgical simulation. (United States)

    Satava, R M


    For nearly a decade, advanced computer technologies have created extraordinary educational tools using three-dimensional (3D) visualization and virtual reality. Pioneering efforts in surgical simulation with these tools have resulted in a first generation of simulators for surgical technical skills. Accomplishments include simulations with 3D models of anatomy for practice of surgical tasks, initial assessment of student performance in technical skills, and awareness by professional societies of potential in surgical education and certification. However, enormous challenges remain, which include improvement of technical fidelity, standardization of accurate metrics for performance evaluation, integration of simulators into a robust educational curriculum, stringent evaluation of simulators for effectiveness and value added to surgical training, determination of simulation application to certification of surgical technical skills, and a business model to implement and disseminate simulation successfully throughout the medical education community. This review looks at the historical progress of surgical simulators, their accomplishments, and the challenges that remain.

  7. Using dummies for surgical skills training

    DEFF Research Database (Denmark)

    Langebæk, Rikke


    Effective acquisition of a skill requires practise. Therefore it is of great importance to provide veterinary students with opportunities to practice their surgical skills before carrying out surgical procedures on live patients. Some veterinary schools let students perform entire surgical...... procedures on research animals, in order to learn the basic skills along the way. From an ethical point of view it is questionable however to use live research animals for the sole purpose of practising surgery, and also, research animals are very costly. It is therefore necessary to identify alternative...... 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...

  8. Neural pathways in 'emotional approach' as experiential emotion regulation strategy. (United States)

    Vandekerckhove, M; Van Hecke, W; Quirin, M; De Mey, J


    Current research on emotion shows an increasing interest in the neuronal correlates of emotion regulation (ER). While previous research on ER has focused on gray matter correlates, this study represents the first exploratory study on white matter integrity and brain networks of ER. Responding to the gap between cognitive and affective approaches of ER, pertaining to some of the daily emotional stressors, the present study investigates a complementary experiential approach such as 'Emotional approach' or the tendency to affectively acknowledge, understand and express emotional experience (cf. Stanton et al., 2000). Diffusion tensor magnetic resonance imaging (DTI-MRI) measures of fractional anisotropy (FA) and mean diffusivity (MD) evaluated dispositional ER in a group of 21 women with (1) a 'high emotional approach' (HEA) (N = 11) and (2) a 'low emotional approach' (LEA) (N= 10). HEA exhibited more FA of the cingulum supporting emotion processing and regulation, whereas LEA showed a higher FA in the right corticospinal tracts supporting automatic action tendencies and, together with a higher FA in the superior longitudinal fasciculus (SLF), cognitive control tasks and monitoring of emotion. LEA also correlated with a significant increase in MD in the body (p. = 0.05) and in the splenium of the corpus callosum (CC). A higher FA in the inferior longitudinal fasciculus (IFL) may indicate higher visual- affective integration within emotion processing, whereas more MD in the body and splenium of the CC may decrease the interhemispheric integration of emotional information within emotion processing and regulation. Copyright © 2018. Published by Elsevier B.V.

  9. The role of student surgical interest groups and surgical Olympiads in anatomical and surgical undergraduate training in Russia. (United States)

    Dydykin, Sergey; Kapitonova, Marina


    Traditional department-based surgical interest groups in Russian medical schools are useful tools for student-based selection of specialty training. They also form a nucleus for initiating research activities among undergraduate students. In Russia, the Departments of Topographical Anatomy and Operative Surgery play an important role in initiating student-led research and providing learners with advanced, practical surgical skills. In tandem with department-led activities, student surgical interest groups prepare learners through surgical competitions, known as "Surgical Olympiads," which have been conducted in many Russian centers on a regular basis since 1988. Surgical Olympiads stimulate student interest in the development of surgical skills before graduation and encourage students to choose surgery as their postgraduate specialty. Many of the participants in these surgical Olympiads have become highly qualified specialists in general surgery, orthopedic surgery, neurosurgery, urology, gynecology, and emergency medicine. The present article emphasizes the role of student interest groups and surgical Olympiads in clinical anatomical and surgical undergraduate training in Russia. © 2015 American Association of Anatomists.

  10. Surgical management of spasmodic torticollis

    Directory of Open Access Journals (Sweden)

    Wael Fouad


    Full Text Available Introduction: Spasmodic torticollis (ST is a neuromuscular disorder characterized by uncontrolled clonic and intermittently tonic spasm of the neck muscles. Objective: This retrospective study was done to study clinical picture and to evaluate the surgical results of different surgical procedures in 11 patients who had spasmodic torticollis. Methods: The male to female ratio was 1–2 (4 males and 7 females and their ages ranged from 18 to 65 years. The X-ray of the cervical spine was performed before the operation to exclude cervical disorders that can cause symptoms similar to spasmodic torticollis. MRI of the head and neck was performed in all patients, without finding significant brain lesions. Electromyography of the cervical muscles was performed preoperatively and postoperatively. All cases underwent surgery in the form of variable combinations of ventral rhizotomy of C1, C2+ selective peripheral denervation of neck muscles involved according to the type of torticollis. Mean postoperative follow up period was 24 months. Results: There was no operative mortality. As regards the morbidity, one patient had deficiency of shoulder elevation that was transient and improved after 3 months; one patient had wound infection that responded well to antibiotics after culture and sensitivity. Postoperative dysphagia was found in two cases that improved in one of them after two months. At the last follow up examination period, excellent results were obtained in 55% of patients, good results in 18% of patients, fair results in 18% of patients, and poor results in 9% of cases. Conclusion: There is no standard surgical procedure for treatment of ST; this is adapted to each patient according to type of torticollis. Better results were obtained in simple torticollis (excellent results in 100%, than in complex type (excellent and good results in 33.3%. Keywords: Focal dystonia, Spasmodic torticollis, Anterior rhizotomy, Selective denervation

  11. The surgical treatment of acromegaly. (United States)

    Buchfelder, Michael; Schlaffer, Sven-Martin


    Surgical extraction of as much tumour mass as possible is considered the first step of treatment in acromegaly in many centers. In this article the potential benefits, disadvantages and limitations of operative acromegaly treatment are reviewed. Pertinent literature was selected to provide a review covering current indications, techniques and results of operations for acromegaly. The rapid reduction of tumour volume is an asset of surgery. To date, in almost all patients, minimally invasive, transsphenoidal microscopic or endoscopic approaches are employed. Whether a curative approach is feasible or a debulking procedure is planned, can be anticipated on the basis of preoperative magnetic resonance imaging. The radicality of adenoma resection essentially depends on localization, size and invasive character of the tumour. The normalization rates of growth hormone and IGF-1 secretion, respectively, depend on tumour-related factors such as size, extension, the presence or absence of invasion and the magnitude of IGF-1 and growth hormone oversecretion. However, also surgeon-related factors such as experience and patient load of the centers have been shown to strongly affect surgical results and the rate of complications. As compared to most medical treatments, surgery is relatively cheap since the costs occur only once and not repeatedly. There are several new technical gadgets which aid in the surgical procedure: navigation and variants of intraoperative imaging. For the mentioned reasons, current algorithms of acromegaly management suggest an initial operation, unless the patients are unfit for surgery, refuse an operation or only an unsatisfactory resection is anticipated. A few suggestions are made when a re-operation could be considered.

  12. Quantized Synchronization of Chaotic Neural Networks With Scheduled Output Feedback Control. (United States)

    Wan, Ying; Cao, Jinde; Wen, Guanghui

    In this paper, the synchronization problem of master-slave chaotic neural networks with remote sensors, quantization process, and communication time delays is investigated. The information communication channel between the master chaotic neural network and slave chaotic neural network consists of several remote sensors, with each sensor able to access only partial knowledge of output information of the master neural network. At each sampling instants, each sensor updates its own measurement and only one sensor is scheduled to transmit its latest information to the controller's side in order to update the control inputs for the slave neural network. Thus, such communication process and control strategy are much more energy-saving comparing with the traditional point-to-point scheme. Sufficient conditions for output feedback control gain matrix, allowable length of sampling intervals, and upper bound of network-induced delays are derived to ensure the quantized synchronization of master-slave chaotic neural networks. Lastly, Chua's circuit system and 4-D Hopfield neural network are simulated to validate the effectiveness of the main results.In this paper, the synchronization problem of master-slave chaotic neural networks with remote sensors, quantization process, and communication time delays is investigated. The information communication channel between the master chaotic neural network and slave chaotic neural network consists of several remote sensors, with each sensor able to access only partial knowledge of output information of the master neural network. At each sampling instants, each sensor updates its own measurement and only one sensor is scheduled to transmit its latest information to the controller's side in order to update the control inputs for the slave neural network. Thus, such communication process and control strategy are much more energy-saving comparing with the traditional point-to-point scheme. Sufficient conditions for output feedback control

  13. Neural correlates of hate.

    Directory of Open Access Journals (Sweden)

    Semir Zeki

    Full Text Available In this work, we address an important but unexplored topic, namely the neural correlates of hate. In a block-design fMRI study, we scanned 17 normal human subjects while they viewed the face of a person they hated and also faces of acquaintances for whom they had neutral feelings. A hate score was obtained for the object of hate for each subject and this was used as a covariate in a between-subject random effects analysis. Viewing a hated face resulted in increased activity in the medial frontal gyrus, right putamen, bilaterally in premotor cortex, in the frontal pole and bilaterally in the medial insula. We also found three areas where activation correlated linearly with the declared level of hatred, the right insula, right premotor cortex and the right fronto-medial gyrus. One area of deactivation was found in the right superior frontal gyrus. The study thus shows that there is a unique pattern of activity in the brain in the context of hate. Though distinct from the pattern of activity that correlates with romantic love, this pattern nevertheless shares two areas with the latter, namely the putamen and the insula.

  14. neural control system

    International Nuclear Information System (INIS)

    Elshazly, A.A.E.


    Automatic power stabilization control is the desired objective for any reactor operation , especially, nuclear power plants. A major problem in this area is inevitable gap between a real plant ant the theory of conventional analysis and the synthesis of linear time invariant systems. in particular, the trajectory tracking control of a nonlinear plant is a class of problems in which the classical linear transfer function methods break down because no transfer function can represent the system over the entire operating region . there is a considerable amount of research on the model-inverse approach using feedback linearization technique. however, this method requires a prices plant model to implement the exact linearizing feedback, for nuclear reactor systems, this approach is not an easy task because of the uncertainty in the plant parameters and un-measurable state variables . therefore, artificial neural network (ANN) is used either in self-tuning control or in improving the conventional rule-based exper system.the main objective of this thesis is to suggest an ANN, based self-learning controller structure . this method is capable of on-line reinforcement learning and control for a nuclear reactor with a totally unknown dynamics model. previously, researches are based on back- propagation algorithm . back -propagation (BP), fast back -propagation (FBP), and levenberg-marquardt (LM), algorithms are discussed and compared for reinforcement learning. it is found that, LM algorithm is quite superior

  15. Surgical castration, coercion and ethics

    DEFF Research Database (Denmark)

    Ryberg, Jesper; Petersen, Thomas Søbirk


    the only means by which these offenders are likely to be released from prison, it is reasonable—and close to the heart of modern medical ethics—to consider whether the offer involves some kind of coercion. However, despite McMillan's seemingly careful consideration of this question, it appears to us......John McMillan's detailed ethical analysis concerning the use of surgical castration of sex offenders in the Czech Republic and Germany is mainly devoted to considerations of coercion.1 This is not surprising. When castration is offered as an option to offenders and, at the same time, constitutes...

  16. Surgical treatment of cleft lip

    Directory of Open Access Journals (Sweden)

    Mateus Domingues Miachon

    Full Text Available 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. We conducted a literature cross-sectional search that analyzed publications in books, articles and on the databases SciELO - Scientific Electronic Library Online, PubMed, of the National Center for Biotechnology Information. We conclude that: 1 the severity of the cleft will indicate the technique presenting more advantages; 2 the different approaches indicate that there is no consensus on the optimal technique; and 3 the surgeon experience contributes to choosing the best option.

  17. Surgical treatment of radiation proctitis

    International Nuclear Information System (INIS)

    Maruyama, Izumi; Sato, Gohei; Okaue, Toyotake; Isobe, Yoshinari; Ohtsu, Akira; Sugimoto, Yuzo


    Severe radiation proctitis was surgically treated in 8 cases. Colostomy was performed in 2 cases, total resection of the rectum in 2 and proctectomy with colostomy in 4. Perineal abscess developed in the 2 cases with total resection of the rectum. Rather than completely resection of the lesion, a procedure leaving no dead space i.e. proctectomy with colostomy, is desirable for radiation proctitis. Complete preoperative examination of the condition of the underlying disease and possible urinary tract complications is important. (Chiba, N.)

  18. Surgical packages for laparoscopic surgery

    Directory of Open Access Journals (Sweden)

    Bhattacharya K


    Full Text Available ′Packages′ are in fashion today for most surgical procedures in various corporate hospitals and this has included laparoscopic procedures too. A package system enables the hospitals to get cost settlements done more easily. Also, it is more convenient for the patients who are aware upfront of the charges. The principal disadvantages seems to be for the surgeon, who may face displeasure of the patient, hospital or insurance agencies apart from forfeiting his personal charges if (a he is a novice in laparoscopic surgery and takes extra time to complete a procedure, (b unforeseen problems occur during surgery, or (c new pathologies are discovered on exploration.

  19. Non-surgical radiofrequency facelift. (United States)

    Narins, David J; Narins, Rhoda S


    There has been considerable interest in using non-ablative methods to rejuvenate the skin. The ThermaCool TC (Thermage Inc.) is a radiofrequency (RF) device that has been introduced to induce tightening of the address the problem of skin via a uniform volumetric heating into the deep dermis tightening, resulting in a 'non-surgical facelift'. Radiofrequency produces a uniform volumetric heating into the deep dermis. Twenty treatment areas in 17 patients were treated to evaluate the efficacy and safety of RF treatment to the brow and jowls. The technique was found to produce gradual tightening in most patients, and there were no adverse effects.

  20. Non-Viral Generation of Neural Precursor-like Cells from Adult Human Fibroblasts

    Directory of Open Access Journals (Sweden)

    Maucksch C


    Full Text Available Recent studies have reported direct reprogramming of human fibroblasts to mature neurons by the introduction of defined neural genes. This technology has potential use in the areas of neurological disease modeling and drug development. However, use of induced neurons for large-scale drug screening and cell-based replacement strategies is limited due to their inability to expand once reprogrammed. We propose it would be more desirable to induce expandable neural precursor cells directly from human fibroblasts. To date several pluripotent and neural transcription factors have been shown to be capable of converting mouse fibroblasts to neural stem/precursor-like cells when delivered by viral vectors. Here we extend these findings and demonstrate that transient ectopic insertion of the transcription factors SOX2 and PAX6 to adult human fibroblasts through use of non-viral plasmid transfection or protein transduction allows the generation of induced neural precursor (iNP colonies expressing a range of neural stem and pro-neural genes. Upon differentiation, iNP cells give rise to neurons exhibiting typical neuronal morphologies and expressing multiple neuronal markers including tyrosine hydroxylase and GAD65/67. Importantly, iNP-derived neurons demonstrate electrophysiological properties of functionally mature neurons with the capacity to generate action potentials. In addition, iNP cells are capable of differentiating into glial fibrillary acidic protein (GFAP-expressing astrocytes. This study represents a novel virus-free approach for direct reprogramming of human fibroblasts to a neural precursor fate.