Sample records for vesalius neurosurgery n1

  1. [Andreas Vesalius--the life]. (United States)

    De Caro, Raffaele; Goddeeris, Theodoor; Plessas, Pavlos; Biebrouck, Maurits; Steeno, Omer


    The details of Vesalius' life can be found in Charles O'Malley, Andreas Vesalius of Brussels, 1514-1564, (University of California Press, 1964) and in Stephen N Joffe, Andreas Vesalius: The Making, The Madman, and the Myth, (Persona Publishing, 2009). This session reviews the circumstances of his last voyage and his death and other aspects of his life.

  2. [Andreas Vesalius in Pisa]. (United States)

    Ciranni, Rosalba


    Andreas Vesalius is the most commanding figure in European medicine, after Galen and before Harvey. His dissections and lectures were in considerable demand. Having just published the De humani corporis fabrica, and before operating as a private physician of Emperor Charles V, the anatomist spent some months conducting demonstrations of anatomy at the universities of Bologna, Pisa and Florence. The present study aim to reconstruct the journey he made to Pisa, where he was invited by Duke Cosimo I De' Medici. The work of Andrea Corsini and O'Malley, the study of Vesalius' Epistola... rationem modumque propinandi radicis Chynae dedocti... , and other documents make possible a more detailed reconstruction of the period Vesalius spent in the Nuovo Studio Pisano, carrying out public human dissections, discussing and refuting most of the Galenic doctrine.

  3. Anatomic nomenclature by Vesalius. (United States)

    Ivanova, A; Holomanova, A


    Our paper deals with the situation of medieval anatomy language in the pre-Vesalian period. It also explains the necessity of terminology reform undertaken by Vesalius in his De humani corporis fabrica. It describes formation principles of the scientific language of anatomy based on pure classical Latin while eliminating Arabic and Greek elements. Emphasis is laid on Vesalius' effort to unify terms as far as their meaning is concerned, to record lexical items and to create a permanent nomenclature in order to eliminate discrepancies in this field of communication. Our paper contains a lot of information on terminology demonstrating Vesalius' language reform and reminding us of his great achievement, for which he is considered a forerunner of anatomy nomenclature codification. (Ref. 5.)

  4. Versions of vesalius. (United States)

    Fara, Patricia


    Andreas Vesalius reformed anatomical knowledge and teaching in the Renaissance by adopting Galenic methods from the classical past. His careful drawings revealed the human body in unprecedented and realistic detail, but the images of himself were more ambiguous. Copyright © 2011 Elsevier Ltd. All rights reserved.

  5. The eye of Vesalius. (United States)

    De Laey, Jean J


    In the time of Vesalius, knowledge of ocular anatomy was limited. The first description of the anatomy of the eye comes from Democrites, for whom the eye was surrounded by two 'coats', filled with a homogenous fluid. The optic nerve was hollow and the lens was considered to be a postmortem artefact. Until the 15th century AD, medicine was influenced by the writings of Galenus and the model of the eye he proposed was still considered valid, even after Vesalius. According to the Alexandrian tradition, the lens was considered as the seat of visual perception. Although Vesalius rightly deserves the title of father of modern anatomy, his description of ocular anatomy was rudimentary and often incorrect. He described a musculus retractorius bulbi, which is found only in lower mammals, not in primates. The lens, the role of which as an optical device he recognized correctly, was placed too centrally in the eye. The optic nerve was not correctly placed and, following Galenus, Vesalius described only seven cranial nerves. The Galenian concept of ocular anatomy was to endure until the development of the microscope by Anthony van Leeuwenhoek. Modern ocular anatomy, in fact, can be dated from the works of Zinn. © 2010 The Author. Journal compilation © 2010 Acta Ophthalmol.

  6. Anatomic characteristics of foramen vesalius. (United States)

    Gupta, N; Ray, B; Ghosh, S


    Foramen Vesalius is an inconstant foramen that gives passage to an emissary vein that connects pterygoid venous plexus with cavernous sinus, the importance of which lies in the fact that an infected thrombus from an extracranial source may reach cavernous sinus. This study presents some data on characteristics of foramen vesalius. We studied 70 sides of 35 dried adult human skulls available in the Department of Anatomy, Manipal College of Medical Sciences, Pokhara, Nepal. Variation in number and incidence of foramen Vesalius were noted. Differences between the right and the left side and between the male and the female sex are discussed. Foramen Vesalius was present in 23 sides (14 right, 9 left) out of the 70 sides observed, the incidence being 32.85% (20.0% right side, 12.85% left side) of all the sides observed. Incidence of bilateral and unilateral foramen vesalius was 22.85% (8 out of 35 skulls) and 20% (7 out of 35 skulls) respectively. Foramen vesalius was found in 10 sides in males and in 13 sides in females. No remarkable differences were observed in the incidence of foramen vesalius between the sides within same sex but the incidence was more in females compared to male skulls. SIGNIFICANCE OF FINDINGS: Anatomic variations of the foramen vesalius could be explained by developmental reasons. Knowledge about characteristics of foramen vesalius and its incidence is not only important for anatomists but equally essential for an operating surgeon.

  7. [Andreas Vesalius and surgery]. (United States)

    Van Hee, R


    By publishing De Humani Corporis Fabrica Libri Septem in 1543, Andries van Wesel (1514-1564) gave surgical science an immense impulse. The revolutionary renovation in the knowledge of man's anatomical structure changed slowly and progressively into topographical and physiological understanding of surgical diseases. At the same time, this made better aimed and more secure operations possible. Apart from the importance of this anatomical publication, Andreas Vesalius also won his spurs as a surgeon. He taught surgery in Padua for many years. He was appointed court physician and surgeon at the Habsburg Court of Charles V and Philip II. He personally performed lots of operations known at the time as major ones. He not only quickly adopted the surgical innovations of his fellow-surgeon Ambroise Paré, but he even performed operations that had been forgotten during several centuries, among which thoracocentesis for pleural empyema. His clinical perspicacity in discovering the indication for some operations was staggering and was appreciated by all great monarchs of Europe in the 16th century. In his several consilia, numerous pieces of advice were given for the treatment of surgical patients. The surgical practice which Vesalius had in Brussels for many years, consequently became most successful. Many publications by Vesalius about surgery and blood-letting are well-known. His Chirurgia magna in septem Libros digesta still remains controversial; these books were published by Prospero Borgarruccio (1560) in 1568 by the Venetian editor Valgrisi. This book gives an excellent survey of surgical pathology as it was taught and treated in the 16th century. The scientific method that Vesalius used, not only in his anatomical studies but also in his surgical practice, deserves not only our full appraisal but should still be studied in our own time.

  8. Andreas Vesalius' corpses. (United States)

    Biesbrouck, Maurits; Steeno, Omer


    Judging from his writings, Andreas Vesalius must have had dozens of bodies at his disposal, thirteen of which were definitely from before 1543. They came from cemeteries, places of execution or hospitals. Not only did his students help him obtain the bodies, but also public and judicial authorities. At first, he used the corpses for his own learning purposes, and later to teach his students and to write De humani corporis fabrica, his principal work. Clearly he had an eye for comparative anatomy. He observed anatomical variants and studied foetal anatomy. Occasionally, he would dissect a body to study physiological processes, while the post-mortems on the bodies brought in by the families of the deceased gave him an insight into human pathology. Some of his dissection reports have been preserved.

  9. Rhazes in the Renaissance of Andreas Vesalius


    Compier, Abdul Haq


    Andreas Vesalius' (1514–64) first publication was a Paraphrasis of the ninth book of the Liber ad Almansorem, written by the Arab–Persian physician and alchemist Rhazes (854–925). The role of Rhazes in Vesalius' oeuvre has thus far been much disregarded. The different ways Rhazes recurs reveal an intellectual evolution in Vesalius' work. In the Paraphrasis, Vesalius subjects Rhazes to the authority of Galen in the context of the early sixteenth-century humanist campaign for the substitution o...

  10. From Vesalius to tractography. (United States)

    Zemmoura, I; Vons, J; Velut, S; Destrieux, C


    The description of an anatomical specimen may look straightforward, but it appears that it depends in fact on several intermingled factors: technical methods for conservation, dissection and vascular injection and the anatomist skills are of course important. This is especially true when the studied organ, as for instance the brain, is subject to rapid putrefaction after death without any preservation technique. Nevertheless the possibility to reject, or at least criticize, the dominant paradigm is probably as important as these technical considerations: important changes occurred in brain representation between the early Middle Ages and the Early Modern Times, without major improvements of cadaveric preservation or dissection methods; Vesalius rejected the existence of the rete mirabile in human not only because he was a talented anatomist but also because he accepted and had the courage to fight the dominant tradition inherited from Galen. Such difficulties in the scientific approach obviously remain vivid, and should not be forgotten despite the development of modern tools for studying brain morphology and function.

  11. Functional neurosurgery

    African Journals Online (AJOL)

    It is a great honour to write the editorial for this month's CME component of the SAMJ. Functional neurosurgery is a subdivision of neurosurgery that does not always receive the recognition we feel that it deserves among general medical practitioners. It is definitely the less 'sexy' component of neurosurgery compared with ...

  12. Andreas Vesalius--the work. (United States)

    Cobolet, Guy; Garrison, Dan; Vons, Jacqueline; Velut, Stéphane; Nutton, Vivian; Williams, David J


    This session focuses on the Fabrica (1543). Karger Publishers of Basel are producing a new English translation, by Daniel Garrison and Malcom Hast, to coincide with the quincentenary while Vivian Nutton's scholarly analysis of a newly discovered second edition indicates that the annotations are of Vesalius himself.

  13. Rhazes in the renaissance of Andreas Vesalius. (United States)

    Compier, Abdul Haq


    Andreas Vesalius' (1514-64) first publication was a Paraphrasis of the ninth book of the Liber ad Almansorem, written by the Arab-Persian physician and alchemist Rhazes (854-925). The role of Rhazes in Vesalius' oeuvre has thus far been much disregarded. The different ways Rhazes recurs reveal an intellectual evolution in Vesalius' work. In the Paraphrasis, Vesalius subjects Rhazes to the authority of Galen in the context of the early sixteenth-century humanist campaign for the substitution of Arab influences by Greek 'originals'. Over the years Vesalius continues his work on Rhazes, but his approach becomes more internationalistic. Ultimately, Vesalius criticises Galen while expressing sympathy for the Arab author. This may be the more significant as Rhazes could have influenced Vesalius in the act of criticising Galen - critical discussions of Galen were available to Vesalius in Latin translations of Rhazes's Liber Continens. Although Vesalius never refers to the work, it is hardly possible he was unaware of it: similarities in structure, rhetoric and form between the Continens and the De humani corporis fabrica could support this hypothesis.

  14. [Andreas Vesalius in the Spanish Court]. (United States)

    Izumi, Hyonosuke


    After the publication of "Fabrica," Andreas Vesalius entered the Spanish court and became a court physician to Charles the Fifth, Holy Roman Emperor, and then to Philip the Second, Spanish king. The author studied this process and its historical background. The ancestors of Vesalius had close relations with the Hapsburgs and the dukes of BUrgundy, and served them as court physician or a court pharmacist. Vesalius was born in Brussels, obtained his degree at the University of Padua, Italy, became professor of anatomy and surgery there, and published "Tabulae Anatomicae Sex" and "Fabrica."In the ear of the Spanish court, the treatments of Henry the Second, French king, and of Don Carlos, Spanish crown prince, are famous among Vesalius' medical contributions. In the year of his resignation, Charles the Fifth conferred the title of count palatine on Vesalius.

  15. Renaissance Neurosurgery: Italy's Iconic Contributions. (United States)

    Nanda, Anil; Khan, Imad Saeed; Apuzzo, Michael L


    Various changes in the sociopolitical milieu of Italy led to the increasing tolerance of the study of cadavers in the late Middle Ages. The efforts of Mondino de Liuzzi (1276-1326) and Guido da Vigevano (1280-1349) led to an explosion of cadaver-centric studies in centers such as Bologna, Florence, and Padua during the Renaissance period. Legendary scientists from this era, including Leonardo Da Vinci, Andreas Vesalius, Bartolomeo Eustachio, and Costanzo Varolio, furthered the study of neuroanatomy. The various texts produced during this period not only helped increase the understanding of neuroanatomy and neurophysiology but also led to the formalization of medical education. With increased understanding came new techniques to address various neurosurgical problems from skull fractures to severed peripheral nerves. The present study aims to review the major developments in Italy during the vibrant Renaissance period that led to major progress in the field of neurosurgery. Published by Elsevier Inc.

  16. On the innovative genius of Andreas Vesalius

    NARCIS (Netherlands)

    Brinkman, R.J.C.


    Andreas Vesalius (1515 - 1564) is generally considered to be the founding father of modern human anatomy. To commemorate his 500th birthday, some of the most striking anatomical and physiological aspects of Vesalius’ major work De Humani Corporis Fabrica Libri Septem (De Fabrica) are presented and

  17. The kidney from Galen to Vesalius -- a first approach. (United States)

    Touwaide, Alain


    In 1543, Andreas Vesalius (1514 - ca. 1564) published de Humani corporis fabrica in Basel (Basel, 1543). In current literature, the work is interpreted as either an imitation or a refutation of previous anatomical knowledge, particularly the treatises by the classical Greek physician Galen (129 -- after 216 A.D. [?]). In this paper we focus on Vesalius' study of the kidneys (Book V, chapter 10). On the basis of a comparison of Vesalius' and Galen's Greek text, we reach the conclusion that Vesalius closely reproduced Galen's model and text, thus re-enacting the ancient practice of medicine and dissection.

  18. Andreas Vesalius' understanding of pulmonary ventilation. (United States)

    Hage, J Joris; Brinkman, Romy J


    The historical evolution of understanding of the mechanical aspects of respiration is not well recorded. That the anatomist Andreas Vesalius (1515-1564) first recorded many of these mechanics in De Humani Corporis Fabrica Libri Septem has received little attention. We searched a digital copy of De Fabrica (1543) and its English translation as provided by Richardson and Carman (1998-2009) for references to aspects of pulmonary ventilation. We found that Vesalius grasped the essentials of tidal and forced respiration. He recognized that atmospheric pressure carried air into the lungs, approximately 100 years before Borelli did. He described an in vivo experiment of breathing, some 120 years before John Mayow produced his artificial model. He reported on positive pressure ventilation through a tracheotomy and on its life-saving effect, some 100 years before Robert Hook did. In publicly recording his insights over 450 years ago, Vesalius laid a firm basis for our understanding of the physiology of respiration and the management of its disorders. Copyright © 2016 Elsevier B.V. All rights reserved.

  19. Andreas Vesalius--the reformer of anatomy. (United States)

    Holomanova, A; Ivanova, A; Brucknerova, I; Benuska, J


    This paper deals with two main topics. The first part provides data on the life of Andreas Vesalius, a scholar and anatomist of the 16th century, and describes the environment in which he lived and worked. It highlights his personality of a great doctor and teacher and points out the importance of his scientific methods and techniques as opposed to speculative methods that were prevalent in the scientific research in those days. The second part of the paper is devoted to the characteristics and description of his famous and, given the times he lived in, grand work called "De Humani Corporis Fabrica", which opened a new epoch in the history of anatomy. Andreas Vesalius is considered to be the founder of the science of anatomy which is based on observation and experience gained by using scalpel on dead bodies of humans. This is how he proved the then valid statements wrong. This complex view of life and work of Andreas Vesalius is aimed at highlighting the milestone which he represents in this traditional science of anatomy that has been conscientiously developed since the Classical times. (Fig. 4, Ref. 6.)

  20. Andreas Vesalius and his De humani corporis Fabrica libri septem. (United States)

    Steele, Lloyd


    Andreas Vesalius of Brussels (1514-1564) was a Renaissance physician and surgeon whose most famous work was the De humani corporis fabrica libri septem a monograph describing human anatomy, first published in 1543. The Fabrica precipitated advances both anatomical and pedagogical, and its influence was such that Vesalius has since been described as the 'founder of modern anatomy'.

  1. The statues of Andreas Vesalius: 'a capite ad calcem'. (United States)

    Biesbrouck, Maurits; Steeno, Omer P


    The number of statues of Vesalius, fully depicting the father of anatomy, is very limited world-wide. What follows is a summary and description of the statues in Brussels,Vienna, Leuven (Louvain), and Chicago. The three-dimensional representation of Vesalius's first 'muscle man' in Terneuzen is also included.

  2. Homage to genial anatomist - Andreas Vesalius. (United States)

    Brucknerova, Ingrid; Holomanova, Anna


    The paper highlights the personality of the founder of modern anatomy, who was able to use his knowledge and skills to change the view on the construction of the human body extending over centuries. He introduced a new scientific approach and highlighted the importance of autopsies for understanding of human body which carefully demonstrated and documented. De humani corporis fabrica - the spectacular work, in which he summarized results of his theoretical and practical findings, has opened a new path for the study of anatomy. Andreas Vesalius became a pioneer in the history of medical education. In 2014 will pass 500 years since his birth.

  3. The last months of Andreas Vesalius. (United States)

    Biesbrouck, Maurits; Steeno, Omer


    A good deal has already been written about the last months of Andreas Vesalius' life. Most of it has been fairly speculative, because the necessary primary sources have been lacking. Much of what was supposedly known for sure seemed bizarre, and various writers even frankly characterised their own accounts as 'legend'. It is only since the discovery of several letters in the archives of Simancas by Josh Baron in 1962 that various points have become somewhat clearer. Baron presented these letters at the 19th International Congress on the History of Medicine in Basel in September 1964.

  4. [Epitome, an ignored work of Andreas Vesalius]. (United States)

    Vons, Jacqueline


    A few days before De humani corporis fabrica libri septem publication, in 1543, from Oporinus' office at Basel, a very large but not too bulky in-folio was published, which Andreas Vesalius, the author; offered as the Epitome or Summary of the seven Fabricae books. This work, written in latin, is divided into two parts: the first of them includes six chapters describing the human body, the second is composed of eleven anatomical plates with indices; the reader is invited to cut up the last two and stick them onto the preceding, so as to make a human three-dimensional figure. This method inserts the work in a modern conception of anatomical learning. Vesalius involves himself patiently gives many explanations for learning the body in dissection order through plates and text as well. But these plates--and most of them are different from those in the Fabrica-, are not simple illustrations, but play an active part in anatomical knowledge acquisition, just as the text does, but through a different access. We will attract your attention on this originality, often ignored, of the Epitome.

  5. [The reception of Vesalius in Spain and England]. (United States)

    Portmann, Maria


    This paper discusses the depiction of engravings taken from Vesalius's, Valverde de Hamusco's and Casserio 's treatises in portraits during the 16th and the 17th centuries to understand better the reception of the Fabrica in Spain and England.

  6. The relationship between Vesalius and the Borgarucci family. (United States)

    Van Hee, Robrecht


    Two of the four brothers Borgarucci were medical doctors and in one way or another, be it distantly, connected with the great master Vesalius. Giulio Borgarucci was a physician, who became a Calvinist and emigrated to England where he treated many noblemen and friends of Queen Elisabeth I. He was present at a conversation between the Italian writer and traveler Pietro Bizzari and the Venetian jeweler who witnessed Vesalius' death in Zakynthos. Prospero Borgarucci became professor of anatomy and surgery in Padua, some 20 years after Vesalius. He published several treatises on anatomy, pestilential disease, and materia medica. Prospero Borgarucci became physician to Queen Catherine de Medicis in France, and to Archduke Karl II of Habsburg in Graz. His most important work is the so-called Chirurgia Magna of Vesalius. Text and illustrations of this spurious Vesalian work point to the use of passages of the Epitome, surgical college notes and copied Vesalian images in Borgarucci's Chirurgia Magna.

  7. [Andreas Vesalius, distinguished surgeon of the 16th century]. (United States)

    Van Hee, R


    The author gives here some considerations about A. Vesalius through his life and his works as a surgeon. He was the father of the anatomical revolution against Galen but was also an eminent clinician and surgeon. He was immediately able to adapt his surgical practice whenever the promising methodology was identified (see Consilia). The author concludes with a critical analysis of the Chirurgia magna in septem libros digesta attributed to A. Vesalius.

  8. Vesalius revised. His annotations to the 1555 Fabrica. (United States)

    Nutton, Vivian


    The De humani corporis fabrica [The Fabric of the Human Body], Basle, 1543, of Andreas Vesalius is deservedly famous as the first modern book of anatomy. A second edition was published in Basle in 1555, but little is known of Vesalius' activities after that date. This article discusses a recent find: Vesalius' own copy of the 1555 edition, heavily annotated in preparation for a never published third edition. Vesalius made hundreds of changes to the second edition, the great majority being stylistic, altering the Latin words but not the overall meaning. There are also changes to the plates to give greater clarity or to correct mistakes by the original block-cutter. There is little new anatomical material, although Vesalius continued to meditate about what he had earlier discovered. He shows no sign of being acquainted with the findings of others, like Colombo or Falloppia, that were published after he had moved his residence from Brussels to Spain in summer 1559, perhaps leaving this volume behind. The number of annotations shows Vesalius' passionate concern not only for accuracy but also for the most effective way of proclaiming his new anatomical message.

  9. History of Korean Neurosurgery. (United States)

    Hwang, Sung-nam


    The year 2012 was the 50th anniversary of the Korean Neurosurgical Society, and in 2013, the 15th World Congress of Neurosurgery took place in Seoul, Korea. Thus, it is an appropriate occasion to introduce the world to the history of the Korean Neurosurgical Society and the foundation, development, and growth of Korean neurosurgery. Historical materials and pictures were collected and reviewed from the history book and photo albums of the Korean Neurosurgical Society. During the last 50 years, the Korean Neurosurgical Society and Korean neurosurgery have developed and grown enormously not only in quantity but also in quality. In every aspect, the turning point from the old to the new era of the Korean Neurosurgical Society and Korean neurosurgery was the year 1980. Copyright © 2015. Published by Elsevier Inc.

  10. Computers and neurosurgery. (United States)

    Shaikhouni, Ammar; Elder, J Bradley


    At the turn of the twentieth century, the only computational device used in neurosurgical procedures was the brain of the surgeon. Today, most neurosurgical procedures rely at least in part on the use of a computer to help perform surgeries accurately and safely. The techniques that revolutionized neurosurgery were mostly developed after the 1950s. Just before that era, the transistor was invented in the late 1940s, and the integrated circuit was invented in the late 1950s. During this time, the first automated, programmable computational machines were introduced. The rapid progress in the field of neurosurgery not only occurred hand in hand with the development of modern computers, but one also can state that modern neurosurgery would not exist without computers. The focus of this article is the impact modern computers have had on the practice of neurosurgery. Neuroimaging, neuronavigation, and neuromodulation are examples of tools in the armamentarium of the modern neurosurgeon that owe each step in their evolution to progress made in computer technology. Advances in computer technology central to innovations in these fields are highlighted, with particular attention to neuroimaging. Developments over the last 10 years in areas of sensors and robotics that promise to transform the practice of neurosurgery further are discussed. Potential impacts of advances in computers related to neurosurgery in developing countries and underserved regions are also discussed. As this article illustrates, the computer, with its underlying and related technologies, is central to advances in neurosurgery over the last half century. Copyright © 2012 Elsevier Inc. All rights reserved.

  11. [Neurosurgery in the elderly patient: Geriatric neurosurgery]. (United States)

    González-Bonet, Luis Germán; Tarazona-Santabalbina, Francisco-José; Lizán Tudela, Luis


    Between 2000 and 2050, the proportion of the world's population over 60 years will double, and the number of people aged 80 and older will quadruple. Health professional training does not include instructions about specific care for older people. The World Health Organization maintains that all health providers should be trained on ageing issues. Thus, it is proposed to analyse the effect of ageing on Neurosurgery in our country. A retrospective historical cohort study was performed on individuals age 70 years or older admitted to the Neurosurgery or the Intensive Care Unit of our hospital, with neurosurgical disease, between two periods: 1999-2000 and 2010-2011. An analysis was made on variables such as: age, pathology, length of stay, comorbidity, performance status, re-admissions and mortality. Similar numbers of patients were admitted during the two periods: 409 and 413. However, there was an increase of 77.5% in patients older than 70 years: 80 versus 142. Statistically significant differences were observed in the Charlson Comorbidity Index, the admission Glasgow Coma Scale (GCS) score, length of stay, and re-admissions. Comorbidity and admission GCS score were particularly worse in the second period. Nevertheless, the mean length of stay was lower in that period, but showing more hospital re-admissions. After multivariate analysis, it was observed that re-admissions were associated with comorbidity, but not with early hospital discharge. No differences were found in performance status or mortality. A very considerable increase in percentage of patients older than 70 years old was found. There were no differences in performance status or mortality, which was probably due to the multidisciplinary management of these patients. The results of this study support the development of an interdisciplinary work group dedicated to Geriatric Neurosurgery. Copyright © 2015 Sociedad Española de Neurocirugía. Published by Elsevier España. All rights reserved.

  12. A historical vignette (16). Following in the footsteps of Vesalius around Brussels. (United States)

    Tainmont, J


    Following in the footsteps of Vesalius around Brussels. Every physician is indebted to Vesalius! Andreas Vesalius (1514-1564) lived in Brussels for about thirty years in all. First from birth until the age of sixteen years (1514-1530), and later as an adult (1544-1559). These two periods of time in Brussels can be described by walking around some areas of the city.

  13. Andreas Vesalius (1514-1564) - an unfinished life. (United States)

    Ambrose, Charles T


    The fame of Andreas Vesalius (1514-1564) rests on his anatomy text, De humani corporis fabrica, regarded as a seminal book in modern medicine. It was compiled while he taught anatomy at Padua, 1537-1543. Some of his findings challenged Galen's writings of the 2c AD, and caused De fabrica to be rejected immediately by classically trained anatomists. At age 29, Vesalius abandoned his studies and over the next two decades served as physician to Emperor Charles V of the Holy Roman Empire (HRE) and later to King Philip II of Spain in Madrid. In 1564, he sought to resume teaching anatomy in Padua, but release from royal service obliged him first to make a pilgrimage to Palestine. During the return voyage to Venice, he became ill and was put ashore alone on an Ionian island Zakynthos, where he died days later at age 50.

  14. The Last Months of Andreas Vesalius: a Coda. (United States)

    Biesbrouck, Maurits; Goddeeris, Theodoor; Steeno, Omer


    Since the publication in this journal of our two articles on the end of Andreas Vesalius' life, some very old sources have recently become available that we were unable to consult at the time of writing and that now prompt us to add a coda. These sources give an even better picture of both the circumstances of the disaster that led to Vesalius' death and the correct site of his burial. Firstly, there is a text by Reinerus Solenander that casts a completely different light on the circumstances in which his ship was at sea and the way in which it reached land; in addition, there is a new early eye-witness report of his burial-place by Christoph Fürer von Haimendorf, dating from 6 August 1565.

  15. The Vesalius Project: interactive computers in anatomical instruction. (United States)

    McCracken, T O; Spurgeon, T L


    The goal of the Vesalius Project is a high-resolution, interactive 3-D atlas of human/animal anatomy, stored on a laser videodisc and displayed on graphics workstations--an an "electronic Gray's Anatomy." Students will use this computerized atlas interactively to learn the structure of the body and to understand their own bodies in health and disease. The Human Factors Research Laboratory at Colorado State University has designed and is conducting a comprehensive evaluation program for the project.

  16. Vesalius Revised. His Annotations to the 1555 Fabrica1 (United States)

    Nutton, Vivian


    The De humani corporis fabrica [The Fabric of the Human Body], Basle, 1543, of Andreas Vesalius is deservedly famous as the first modern book of anatomy. A second edition was published in Basle in 1555, but little is known of Vesalius’ activities after that date. This article discusses a recent find: Vesalius’ own copy of the 1555 edition, heavily annotated in preparation for a never published third edition. Vesalius made hundreds of changes to the second edition, the great majority being stylistic, altering the Latin words but not the overall meaning. There are also changes to the plates to give greater clarity or to correct mistakes by the original block-cutter. There is little new anatomical material, although Vesalius continued to meditate about what he had earlier discovered. He shows no sign of being acquainted with the findings of others, like Colombo or Falloppia, that were published after he had moved his residence from Brussels to Spain in summer 1559, perhaps leaving this volume behind. The number of annotations shows Vesalius’ passionate concern not only for accuracy but also for the most effective way of proclaiming his new anatomical message. PMID:23112379

  17. The last months of Andreas Vesalius: Part II--From Jerusalem to Zakynthos (Zante). (United States)

    Biesbrouck, Maurits; Steeno, Omer


    Returning from his pilgrimage to the Holy Land Vesalius encountered serious trouble, as a consequence of which he died on the Greek island Zakynthos. Following a discussion of the circumstances of his death and what is known about his grave, we examine also Vesalius's intentions for the period after his journey.

  18. Andreas Vesalius and the Occo medals of Augsburg. Evidence of a professional friendship. (United States)

    Houtzager, H L


    The friendly connection that existed between Andreas Vesalius (1514-1564) and his learned friends in Augsburg comprised three periods in the life of the emperor's court physician. The close ties that must have connected Adolphus Occo II and III and Vesalius are expressed in a number of medals carrying their images.

  19. Vesalius and the emergence of veridical representation in Renaissance anatomy. (United States)

    Russell, Gül A


    The Renaissance marks the introduction of veridical representation of anatomical structure into printed books. For centuries, anatomy that had relied solely on textual description and the authority of the written word was transformed. An existing graphic tradition only visualized function within a humoral theory, schematically "naming the parts" or mapping the "uses of the parts" for mnemonic purposes. In the sixteenth century, anatomists and artist began to apply their knowledge and skills to present the "fabric" of the dissected human body with increasing detail and accuracy, exemplified by the naturalistic illustrations of the brain in Vesalius' De humani corporis fabrica (Basel, 1543). How did this transformation occur? Among the causal factors, the importance the humanist textual scholarship will be shown not only in the recovery of the anatomical writings of Galen (129-ca. 216), in particular, but also in providing a model in establishing anatomical "truth" by a method of "comparison." It will be argued that Vesalius' comparative approach in dissection, using both human and animal preparations against Galen's textual description, paved the way for cumulative observations of greater detail, which in turn required the representational skills of artists. An analysis of Vesalius' views between 1538 and 1543 shows a shift in the use of illustrations from serving as a visual record to compensate for limited access to cadavers in teaching, to becoming an indispensable tool to accurately convey detailed anatomical structure through the medium of printing. With the Fabrica, morphology became divorced from humoral function and enduring paradigms established that dominated until the nineteenth century. © 2013 Elsevier B.V. All rights reserved.

  20. [Vesalius' Fabrica and the anatomy of the masticatory system]. (United States)

    Gysel, C


    In this Tabulae sex, Vesalius does not dare contradict Galenus views too definitely: in the upper jaw he counts fifteen bones amongst which the Os intermaxillare, and two bones in the Mandibula. In the Fabrica, he maintains the unity of the Mandibula; he denies the presence in man of the Os intermaxillare and counts in the upper jaw twelve bones (amongst which the Os planum). He denies the existence of the Vomer and the lower nose-shells. He gives a lyrical description of the Sinus maxillaris, but without an evident image. The under-jaw is moved by four pairs of muscles, which he does not name but numbers. The Musculus pterygoideus lateralis is not described. Jaws, tongue and teeth are tended, not by the Nervus trigeminus, but by the third and fourth pairs of the seven "brain nerves". The thirty-two teeth are divided into "cutting-teeth", "eye-teeth" and "molars", but, with their roots they are pictured in a wrong occlusion. Vesalius declares more than once, that he discovered the pulp-chamber and also the chamber of the smaller bones and concludes hereby that teeth have got all the characters of bones. They consequently are made of only one substance. Their chamber lies as far of the chewing-surface as of the summit of the root and is filled with a kind of marrow. Blood-vessels and nerves penetrate into the side of the hard substance of the hidden part. Vesalius does not make any difference between milk teeth and the permanent dentition. Just like a long bone, a tooth possesses a diaphysis and an epiphysis, for which he uses the word "appendix". In both cases the two parts only join at the end of the growth. When about seven years, the "appendices" fall out, they are replaced by their "diaphyses". If this does not happen, for instance in the big molars, diaphysis and appendix grow firmly together. Vesalius' therapy for early caries is surprising. If, in a child a permanent tooth gets injured, and if only the crown is removed, the tooth is replaced by a "new" tooth.

  1. [From Vesalius to Descartes: the heart, the life]. (United States)

    Bitbol-Hespériès, Annie


    At the end of 1629, Descartes, settled in the Lower Countries, began studying anatomy and performing dissections in order to write L'Homme (The Treatise on Man). He acknowledged his debt towards "Vezalius and the others". In those years, in Europe, the influence of Vesalius was increasing, as shown by Rembrandt's Anatomy of Dr Tulp and by the Theatrum anatomicum by Caspar Bauhin. Descartes rejected the divisions of the soul, then a common place in medical treatises, and he stated a principle of life defined by the heath in the heart linked to the new demonstration of the circulation of the blood by William Harvey.

  2. A morphologic and morphometric study of foramen vesalius in dry adult human skulls of gujarat region. (United States)

    Raval, Binita B; Singh, Praveen R; Rajguru, Jaba


    The foramen Vesalius is located within bony plate between the foramen ovale and the foramen rotundum in the floor of middle cranial fossa. This foramen allows passage of emissary veins which communicate cavernous sinus and pterygoid plexus of veins. To study the morphological and morphometric variations of foramen Vesalius in dry adult human skulls. One hundred and fifty dry adult human skulls were studied for variations in size, shape, presence/absence and any duplication/multiplication of the foramen Vesalius. After collecting data, appropriate statistical analysis was done. The mean maximum dimension of foramen Vesalius was 0.98±0.67 mm on right side and 1.12±0.73 mm on left side. Foramen Vesalius was present in 90 (60%) skulls out of 150 observed. The incidence was 41(27.33%) on right side and 49 (32.67%) on left side. Foramen Vesalius was present unilaterally in 32 (35.56%) and bilaterally in 29 (32.23%) out of 90 skulls. Duplication of this foramen was observed in two skulls (one right side and one on left side). Foramen Vesalius was round in 72%, oval in 24% and irregular in 4% of total foramina present. Foramen Vesalius was present in 60% of total skulls studied. The foramen showed variations in incidence and shapes, while there was no statistically significant difference in the maximum dimension between foramen Vesalius on right and left side. There could be some developmental reasons to explain these variations. The findings of this study could be important to anatomists and also equally essential for clinicians who approach middle cranial cavity for various procedures.

  3. Discovering neurosurgery: new frontiers. (United States)

    Rutka, James T


    Over the centuries, discoveries of lands unknown, treasures lost and buried, and formulas to delineate physicochemical processes have led to advancements in our understanding of how the world is structured and governed. In science and medicine, discoveries are frequently made following deliberate periods of observation and experimentation to test hypotheses. However, in some instances, discoveries may arise either following a "eureka moment" that transcends rigorous scientific experimentation or following a serendipitous observation. In many instances, scientific discoveries will lead to new inventions that are aimed at improving the manner in which tasks or operations are performed. In this address, some of the key discoveries in science and medicine that have impacted significantly on the field of neurosurgery are described. Some of these include discoveries in neuroanatomy, anesthesiology, infectious diseases, antisepsis, and radiology. Discoveries in the field of molecular science, from the discovery of DNA to next-generation DNA sequencing, which have helped improve the diagnosis and prognosis of neurosurgical patients with conditions such as brain tumors, are also described. In the end, these discoveries have led us to new frontiers in the subspecialty practice of neurosurgery. Navigating our way through these new frontiers will undoubtedly lead to additional discoveries that are unimaginable at present but bound to improve the future care of neurosurgical patients.

  4. Medical errors in neurosurgery. (United States)

    Rolston, John D; Zygourakis, Corinna C; Han, Seunggu J; Lau, Catherine Y; Berger, Mitchel S; Parsa, Andrew T


    Medical errors cause nearly 100,000 deaths per year and cost billions of dollars annually. In order to rationally develop and institute programs to mitigate errors, the relative frequency and costs of different errors must be documented. This analysis will permit the judicious allocation of scarce healthcare resources to address the most costly errors as they are identified. Here, we provide a systematic review of the neurosurgical literature describing medical errors at the departmental level. Eligible articles were identified from the PubMed database, and restricted to reports of recognizable errors across neurosurgical practices. We limited this analysis to cross-sectional studies of errors in order to better match systems-level concerns, rather than reviewing the literature for individually selected errors like wrong-sided or wrong-level surgery. Only a small number of articles met these criteria, highlighting the paucity of data on this topic. From these studies, errors were documented in anywhere from 12% to 88.7% of cases. These errors had many sources, of which only 23.7-27.8% were technical, related to the execution of the surgery itself, highlighting the importance of systems-level approaches to protecting patients and reducing errors. Overall, the magnitude of medical errors in neurosurgery and the lack of focused research emphasize the need for prospective categorization of morbidity with judicious attribution. Ultimately, we must raise awareness of the impact of medical errors in neurosurgery, reduce the occurrence of medical errors, and mitigate their detrimental effects.

  5. Laser applications in neurosurgery (United States)

    Cerullo, Leonard J.


    The "false start" of the laser in neurosurgery should not be misconstrued as a denial of the inherent advantages of precision and gentleness in dealing with neural tissue. Rather, early investigators were frustrated by unrealistic expectations, cumbersome equipment, and a general ignorance of microtechnique. By the early 70s, microneurosurgery was well established, surgical laser equipment for free hand and microlinked application had been developed, and a more realistic view of the limitations of the laser had been established. Consequently, the late 70s really heralded the renaissance of the laser in neurosurgery. Since then, there has been an overwhelming acceptance of the tool in a variety of clinical situations, broadly categorized in five groups. 1)|Perhaps the most generally accepted area is in the removal of extra-axial tumors of the brain and spinal cord. These tumors, benign by histology but treacherous by location, do not present until a significant amount of neurological compensation has already occurred. The application of additional trauma to the neural tissue, whether by further tumor growth or surgical manipulation, frequently results in irreversible damage. Here, the ability of the laser to vaporize tissue, in a fairly hemostatic fashion, without mechanical or thermal damage to sensitive surrounding tissues, is essential. 2)|The ability to incise delicate neural tissue with minimal spread of thermal destruction to adjacent functioning tissue makes the laser the ideal instrument when tumors deep under the surface are encountered in the brain or spinal cord. Thus, the second group of applications is in the transgression of normal neural structures to arrive at deeper pathological tissue. 3)|The third area of benefit for the laser in neurosurgery has been in the performance of neuroablative procedures, calling for deliberate destruction of functioning neural tissue in a controlled fashion. Again, the precision and shape confinement of the destructive

  6. History of Neurosurgery in Palestine. (United States)

    Darwazeh, Rami; Darwazeh, Mazhar; Sun, Xiaochuan


    Palestinian neurosurgery started with Dr. Antone Tarazi as the first Palestinian neurosurgeon. Before that, there was no organized neurosurgery specialty, and general surgeons performed neurosurgical procedures. Here we review the history of neurosurgery and neurosurgical applications in Palestine, evaluate some limitations of the current system, and discuss major challenges to improving this system. We collected information from various sources in either English or Arabic. The development of neurosurgery and neurosurgical training in Palestine began in 1960 with the first center established in Jerusalem, which provided much-needed neurosurgical services and training in the fields of neurosurgery and neurology. Palestine has produced a number of its own neurosurgeons and has promoted further progress by establishing the Palestinian Neurosurgical Society in 2014. Today, there are 34 neurosurgeons (including 1 female neurosurgeon) and 17 residents providing expert care in 17 centers across Palestine, along with 1 neurosurgical residency program. Neurosurgery in Palestine has faced many challenges, some of which have been overcome. However, there remain many challenges, which will require much time and effort to surmount. Political stabilization is a significant factor in the progress of neurosurgery in Palestine. Copyright © 2017 Elsevier Inc. All rights reserved.

  7. Andreas Vesalius 500 years - A Renaissance that revolutionized cardiovascular knowledge

    Directory of Open Access Journals (Sweden)

    Evandro Tinoco Mesquita


    Full Text Available AbstractThe history of medicine and cardiology is marked by some geniuses who dared in thinking, research, teaching and transmitting scientific knowledge, and the Italian Andreas Vesalius one of these brilliant masters. His main scientific work "De Humani Corporis Fabrica" is not only a landmark study of human anatomy but also an artistic work of high aesthetic quality published in 1543. In the year 2014 we celebrated 500 years since the birth of the brilliant professor of Padua University, who with his courage and sense of observation changed the understanding of cardiovascular anatomy and founded a school to date in innovative education and research of anatomy. By identifying "the anatomical errors" present in Galen's book and speech, he challenged the dogmas of the Catholic Church, the academic world and the doctors of his time. However, the accuracy of his findings and his innovative way to disseminate them among his students and colleagues was essential so that his contributions are considered by many the landmark of modern medicine. His death is still surrounded by mysteries having different hypotheses, but a certainty, suffered sanctions of the Catholic Church for the spread of their ideas. The cardiologists, cardiovascular surgeons, interventional cardiologists, electrophysiologists and cardiovascular imaginologists must know the legacy of genius Andreas Vesalius that changed the paradigm of human anatomy.

  8. Andreas Vesalius 500 years - A Renaissance that revolutionized cardiovascular knowledge (United States)

    Mesquita, Evandro Tinoco; de Souza Júnior, Celso Vale; Ferreira, Thiago Reigado


    The history of medicine and cardiology is marked by some geniuses who dared in thinking, research, teaching and transmitting scientific knowledge, and the Italian Andreas Vesalius one of these brilliant masters. His main scientific work "De Humani Corporis Fabrica" is not only a landmark study of human anatomy but also an artistic work of high aesthetic quality published in 1543. In the year 2014 we celebrated 500 years since the birth of the brilliant professor of Padua University, who with his courage and sense of observation changed the understanding of cardiovascular anatomy and founded a school to date in innovative education and research of anatomy. By identifying "the anatomical errors" present in Galen's book and speech, he challenged the dogmas of the Catholic Church, the academic world and the doctors of his time. However, the accuracy of his findings and his innovative way to disseminate them among his students and colleagues was essential so that his contributions are considered by many the landmark of modern medicine. His death is still surrounded by mysteries having different hypotheses, but a certainty, suffered sanctions of the Catholic Church for the spread of their ideas. The cardiologists, cardiovascular surgeons, interventional cardiologists, electrophysiologists and cardiovascular imaginologists must know the legacy of genius Andreas Vesalius that changed the paradigm of human anatomy. PMID:26107459

  9. Andreas Vesalius' 500th Anniversary: First Description of the Mammary Suspensory Ligaments. (United States)

    Brinkman, Romy J; Hage, J Joris


    Sir Astley Paston Cooper has, to date, been acknowledged to be the first to describe the suspensory ligaments of the breast, or Cooper's ligaments, in 1840. We found these ligaments to be recorded in the first edition of 'De Humani Corporis Fabrica Libri Septem' by Andreas Vesalius, published in 1543. To commemorate Vesalius' 500th birthday, we quote and discuss this earlier record. Vesalius' record of the nature and function of the fleshy membrane between mammary gland and pectoral muscle, the hard fat intervening the mammary glands, and the fibers running from the fleshy membrane to the skin are a clear representation of posterior layer of the superficial fascial system, the fibro-adipose stroma surrounding and linking the mammary glandular elements, and the suspensory ligaments as we know them. Vesalius recorded the anatomy and function of the latter structures nearly 300 years before Sir Astley Paston Cooper did.

  10. Andreas Vesalius' 500th Anniversary: Initial Integral Understanding of Voice Production. (United States)

    Brinkman, Romy J; Hage, J Joris


    Voice production relies on the integrated functioning of a three-part system: respiration, phonation and resonance, and articulation. To commemorate the 500th anniversary of the great anatomist Andreas Vesalius (1515-1564), we report on his understanding of this integral system. The text of Vesalius' masterpiece De Humani Corporis Fabrica Libri Septum and an eyewitness report of the public dissection of three corpses by Vesalius in Bologna, Italy, in 1540, were searched for references to the voice-producing anatomical structures and their function. We clustered the traced, separate parts for the first time. We found that Vesalius recognized the importance for voice production of many details of the respiratory system, the voice box, and various structures of resonance and articulation. He stressed that voice production was a cerebral function and extensively recorded the innervation of the voice-producing organs by the cranial nerves. Vesalius was the first to publicly record the concept of voice production as an integrated and cerebrally directed function of respiration, phonation and resonance, and articulation. In doing so nearly 500 years ago, he laid a firm basis for the understanding of the physiology of voice production and speech and its management as we know it today. Copyright © 2017 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

  11. Animals, Pictures, and Skeletons: Andreas Vesalius's Reinvention of the Public Anatomy Lesson. (United States)

    Shotwell, R Allen


    In this paper, I examine the procedures used by Andreas Vesalius for conducting public dissections in the early sixteenth century. I point out that in order to overcome the limitations of public anatomical demonstration noted by his predecessors, Vesalius employed several innovative strategies, including the use of animals as dissection subjects, the preparation and display of articulated skeletons, and the use of printed and hand-drawn illustrations. I suggest that the examination of these three strategies for resolving the challenges of public anatomical demonstration helps us to reinterpret Vesalius's contributions to sixteenth-century anatomy. © The Author 2015. Published by Oxford University Press. All rights reserved. For permissions, please e-mail:

  12. Bilateral Osseous Interclinoid Bridges Associated with Foramina of Vesalius: A Case Report. (United States)

    Paraskevas, George; Nitsa, Zoi; Koutsouflianiotis, Konstantinos


    The current study displays a very rare combination of ossified interclinoid ligaments at the sella turcica region associated with bilateral foramina of Vesalius. In a macerated skull four osseous bars interconnecting the clinoid processes bilaterally were detected. Specifically, two bilateral osseous bars were observed bridging the gap between the anterior and middle clinoid processes forming the so called caroticoclinoid foramen on each side and two additional osseous bridges linked the anterior and posterior clinoid processes, bilaterally. Furthermore, two distinct bilateral foramina of Vesalius were documented just anterior and medial to the foramen ovale. The awareness of the osseous sellar bridges is crucial for the physician and especially the neurosurgeon since their presence may complicate the removal of clinoid processes and induce damage of the internal carotid artery and oculomotor nerves. Furthermore, the likely existence of the foramen of Vesalius may lead to transfer of an infected thrombus into the cranial cavity and complicate a percutaneous trigeminal rhizotomy.

  13. Andreas Vesalius' five hundreth anniversary: initiation of the rotator cuff concept. (United States)

    Brinkman, Romy J; Hage, J Joris


    The rotator cuff concept refers to the four scapulohumeral muscles that stabilize and rotate the humerus relative to the scapula. To date, the first description of the rotator cuff remained unidentified. In light of the 500th birthday of Andreas Vesalius (1515-1564) we searched his 1543 masterwork "Fabrica Corporis Humani Libri Septem" for references to the morphology and function of the rotator cuff muscles. Even though he distinguished three rather than four scapulohumeral muscles, Vesalius recognized the need for structures that prevent dislocation of the shoulder inherent to the morphology of the humeral caput and scapular socket. He recorded "three strong ligaments" and the "three muscles that rotate the arm" of which the tendons completely "embrace the ligaments of the joint" as such structures. Vesalius defined the rotator cuff concept avant la lettre.

  14. Andreas Vesalius' 500th Anniversary: Initiation of the Superficial Facial System and Superficial Musculoaponeurotic System Concepts. (United States)

    Brinkman, Romy J; Hage, J Joris


    Because of their relevance for liposuction and rhytidectomies, respectively, the superficial fascial system (SFS) and superficial musculoaponeurotic system (SMAS) have been thoroughly studied over the past decennia. Although it is well known that the SMAS concept was introduced by Tessier in 1974, it remains unknown who first properly described the stratum membranosum of the SFS. In light of the 500th birthday of Andreas Vesalius (1515-1564), we searched his 1543 masterwork De Humani Corporis Fabrica Libri Septem and related work for references to these structures. We found ample reference to both structures as the membrana carnosa (or fleshy membrane) in his works and concluded that Vesalius recognized the extension, nature, and functions of the stratum membranosum of the SFS, as well as its more musculous differentiation as the SMAS in the head and neck area, and the dartos in the perineogenital area. In doing so, Vesalius recorded most details of the SFS and SMAS concepts avant la lettre.

  15. [Legitimation of Andries Van Wesele, Andreas Vesalius's father, by the Holy Roman Emperor Charles the Fifth]. (United States)

    Izumi, Hyonosuke


    Andries van Wesele, Andreas Vesalius's father and a court pharmacist of the Holy Roman Emperor Charles the fifth, was an illegitimate son of Everard van Wesele, a court physician of the Hapsburgs. In the year of 1531, Andries was legitimated by the Emperor. The legitimation letter was written in French. The author tried to translate and analyze the letter. By this legitimation, not only Andries himself was legitimated but also his successors were approved to succeed Andries. By this letter, Andreas Vesalius obtained his position as a hereditary member of a family serving the court of the Hapsburgs, and as a result, he started his career as a physician of the court.

  16. Centennial ties: Harvey Cushing (1869-1939) and William Osler (1849-1919) on Andreas Vesalius (1514-1564). (United States)

    Toodayan, Nadeem


    Andreas Vesalius is often regarded as the founding father of modern anatomical study. The quincentennial anniversary of his birth - 31 December 2014 - has been very widely commemorated, and it is the purpose of this article to contrast these celebrations with what happened during the Vesalius quatercentenary year of 1914. More specifically, we look at how Vesalius was perceived a century ago by examining his influence on two of western medicine's most iconic gentlemen - Harvey Williams Cushing (1869-1939) and his larger than life mentor, Sir William Osler (1849-1919).

  17. Andreas Vesalius on the anatomy and function of the lower thoracic vertebrae. (United States)

    Biesbrouck, Maurits; Vanden Berghe, Alex


    Some remarkable statements made by Andreas Vesalius (1514-1564) in his principal work De Humani Corporis Fabrica (1543) about the anatomy and function of the lower thoracic vertebrae are discussed in the light of information from the literature. Their accuracy is evaluated on the basis of several pieces of anatomical evidence and clinical cases.

  18. Andreas Vesalius' 500th anniversary: the initiation of hand and forearm myology. (United States)

    Brinkman, R J; Hage, J J


    Andreas Vesalius (1515-1564) was the first to market an illustrated text on the freshly dissected muscular anatomy of the human hand and forearm when he published his De Fabrica Corporis Humani Libri Septem, in 1543. To commemorate his 500th birthday, we searched the second of seven books composing De Fabrica, the annotated woodcut illustrations of De Fabrica, the Tabulae Sex, and Epitome, and an eyewitness report of a public dissection by Vesalius for references to the morphology and functions of these muscles. We found Vesalius to have recognized all currently distinguished muscles except the palmaris brevis and he noted occasional absence of some muscles. Generally, he limited the origin and insertion to bones, largely disregarding attachments to membranes and fascia. Functionally, he recorded the muscles as having a single vector and operating on only one joint. We conclude that Vesalius was nearly completely correct about the anatomy of the muscles of the forearm, but much less accurate about their function. 5. © The Author(s) 2015.

  19. Andreas Vesalius and Thomas Willis: their anatomic brain illustrations and illustrators. (United States)

    Scatliff, J H; Johnston, S


    The brain illustrations of Vesalius and Willis were the first in anatomic history with pictorial accuracy. Their illustrations, illustrators, and methods are discussed. Woodcut blocks were used for the prints of figures in the Vesalian anatomy. Figures of the brain appear to be done after external fixation in the work of Willis.

  20. Cerebrovascular neurosurgery in evolution: the endovascular paradigm. (United States)

    Sorkin, Grant C; Dumont, Travis M; Eller, Jorge L; Mokin, Maxim; Snyder, Kenneth V; Levy, Elad I; Siddiqui, Adnan H; Hopkins, L Nelson


    Endovascular technique represents an important, minimally invasive approach to treating cerebrovascular disease. In this article, we discuss the origins of endovascular neurosurgery as a discipline in the context of important technical milestones, evidence-based medicine, and future cerebrovascular neurosurgical training. Cerebrovascular neurosurgery has seen a steady, convergent evolution toward the surgeon capable of seamless incorporation of open and endovascular approaches to any complex vascular disease affecting the central nervous system. Neurosurgery must assume the leadership role in the multidisciplinary neurovascular team.

  1. Neurosurgery apps: novel knowledge boosters. (United States)

    Tripathi, Manjul; Deo, Rama Chandra; Srivastav, Vinkle; Baby, Britty; Singh, Ramandeep; Damodaran, Natesan; Suri, Ashish


    The utilization of technology for purpose of imparting knowledge, especially in high-end branches like neurosurgery, has gained prominence in the contemporary academic scenario. The technological advancements have brought about outstanding transformation to education and patient care. The connectivity through smartphone applications (apps) has transcended the spatial and temporal limitations, thereby enabling easy access to virtually infinite storehouse of knowledge. Although there are numerous neurosurgery related apps, yet there is still a dearth of quality apps that may serve the purpose. Relevant apps were searched and evaluated on PlayStore and Apple App store, based on their content, user interface, performance, and utility in routine practice and compared with their cost, size and popularity. They were categorized into apps related to textbooks, scoring systems, patient education, operative procedures, blogs, journals, conferences and promotional. 159 relevant apps were hosted on App stores; 54.7% apps were free of cost. "Neuromind" was the most downloaded app because of its simplicity, free access and applicability. Students and practitioners prefer various apps linked to scoring systems, textbooks and operative illustrations. Apps have helped patients in better understanding of their diseases and management options. Development of web-based technologies has divided medical professionals into traditional and modernized learners. Mobile apps permit knowledge to be structured visually to facilitate its easy diffusion in the peer community. A technologically demanding branch like Neurosurgery inevitably needs innovative, cost effective apps with trust worthy content. Relevant apps have a high potential to be used as an excellent resource for effectual neurosurgical education beyond the limitations of time and place.

  2. [Andreas Vesalius: his rich imagination and colorful detail account in his book: 'Research of the anatomical observations of Gabriel Falloppius']. (United States)

    Gilias, Guy


    In a long letter, Andreas Vesalius reacts to the comments made by Gabriel Falloppius to his work 'De Humani Corporis Fabrica'. In this letter, he proves Falloppius wrong in a number of assertions and corrects him on more than one occasion. In doing so, Vesalius as a renaissance humanist uses a classic Latin language with long elegant sentences in the style of the old Roman orator Cicero. Remarkably interesting is the fact that this whole argumentation is spiced with comparisons and examples from daily life. To make it clear to the reader what a certain part of the skeleton looks like, he compares this part with an object everybody knows. All parts of the human body are depicted in such an almost graphic way that even an interested reader without any medical or anatomic education can picture them. And Vesalius is very creative in doing so, an artist as it were with a very rich imagination. Moreover, it's remarkable how the famous anatomist manages to put himself on the level of any ordinary person, using comparative images on that level. This last work of Vesalius, which he himself considers to be a supplement to his De Humani Corporis Fabrica, deserves special attention, not only because it illustrates the scientific evolution of the anatomist Vesalius, but also because it offers an insight in the psychology of that fascinating scientist Andreas Vesalius.

  3. Neurosurgery for Chronic Neuropathic Pain

    Directory of Open Access Journals (Sweden)

    Jung Y Park


    Full Text Available Neurosurgery can play a role in the management of patients with refractory chronic neuropathic pain. However, selecting patients as candidates for surgery and choosing the most appropriate surgical procedure is challenging, and surgical interventions often have limited efficacy. When considering surgery, neuroaugmentative or neuromodulative procedures (eg, peripheral, spinal, motor cortex or deep brain stimulation are generally preferred over ablative procedures as initial modalities. With better understanding of specific pain mechanisms, surgery will have more to offer patients with chronic neuropathic pain.


    African Journals Online (AJOL)

    . 37. • Passenger. 13. • Ejection from the cargo area of a open pick-up truck. 10. Falls. 57. 38. Assault. 20. 13.4. Bicycle accidents. 6. 4. Object falling on the head. 5. 3.3. Child abuse. 2. 1.3. *RTC= road traffic crashes. Table 2: CT scan findings.


    African Journals Online (AJOL)

    % for. DSC. Hospital mortality for NO was 33% versus 6% for DSC. Wound infection occurred in. NO in 46% versus 10% for DSC. At 2 years in NO, there were no survivors versus 52 surviving children in DSC. This study suggests treatment by ...

  6. Andreas Vesalius as a renaissance innovative neuroanatomist: his 5th centenary of birth. (United States)

    Gomes, Marleide da Mota; Moscovici, Mauricio; Engelhardt, Eliasz


    Andreas Vesalius (1514-1564) is considered the Father of Modern Anatomy, and an authentic representative of the Renaissance. His studies, founded on dissection of human bodies, differed from Galeno, who based his work on dissection of animals, constituted a notable scientific advance. Putting together science and art, Vesalius associated himself to artists of the Renaissance, and valued the images of the human body in his superb work De Humani Corporis Fabrica.This paper aims to honor this extraordinary European Renaissance physician and anatomist, who used aesthetic appeal to bind text and illustration, science and art. His achievements are highlighted, with an especial attention on neuroanatomy. Aspects about his personal life and career are also focused.

  7. A census of the edition of 1555 of Andreas Vesalius' De Humani Corporis Fabrica. (United States)

    Joffe, Stephen N


    The purpose of this study was to determine the locations of the second edition (1555) of the De Humani Corporis Fabrica written by Vesalius.Contacts were made with institutions of higher learning, museum libraries, and libraries of national collections, libraries of research institutions, cathedral libraries, antique book dealers, trade journals, book auctions and private collectors.A total of 113 copies of the 1555 Fabrica were found in University and Institutional Libraries. Of them, 33 (29%) were in the United Kingdom; 35 (31%) in Europe and 45 (40%) in the USA. Location of the second edition Vesalius in private collections was more difficult to objectively determine and accounts for approximately 10% of the second Edition books in the census.

  8. Iconography and provenance of versals in De humani corporis fabrica: Vesalius/Kalkar. (United States)

    Hilloowala, Rumy


    The most well known feature of Vesalius' De humani corporis fabrica (1543) are the ecorches (Fr. flayed human body) striding in the environs of Padua, Italy. These illustrations are the apex of an unsurpassed achievement in anatomical illustration. Not as obvious, striking or well known and oft neglected are the versals (the ornate capital letters at the beginning of a paragraph) in De fabrica. Not as well crafted, artistically, as the ecorches the versals transcend the realm of anatomy and science into mythological and iconographic interpretation. Did Vesalius have the artistic talent and was well versed in humanities to execute such ecorches and meaningful versals? Almost certainly there were other artists involved, well versed in art and humanities--more probably Johannes Stephanus Kalkar (c. 1499-1546).

  9. Andreas Vesalius as a renaissance innovative neuroanatomist: his 5th centenary of birth

    Directory of Open Access Journals (Sweden)

    Marleide da Mota Gomes


    Full Text Available Andreas Vesalius (1514-1564 is considered the Father of Modern Anatomy, and an authentic representative of the Renaissance. His studies, founded on dissection of human bodies, differed from Galeno, who based his work on dissection of animals, constituted a notable scientific advance. Putting together science and art, Vesalius associated himself to artists of the Renaissance, and valued the images of the human body in his superb work De Humani Corporis Fabrica.This paper aims to honor this extraordinary European Renaissance physician and anatomist, who used aesthetic appeal to bind text and illustration, science and art. His achievements are highlighted, with an especial attention on neuroanatomy. Aspects about his personal life and career are also focused.

  10. History of Chinese stereotactic and functional neurosurgery. (United States)

    Sun, B; Lang, L Q; Cong, P Y; Liu, K Y; Pan, L


    Chinese stereotactic and functional neurosurgery started in 1963. Dr. Jian-Ping Xu did stereotactic surgery for Parkinson's disease with a small Cartesian coordinate stereotactic device which he designed. In 1983, the first Chinese Institute of Stereotactic and Functional Neurosurgery was established by Dr. Jian-Ping Xu and Dr. Ye-Han Wang in the Anhui Provincial Hospital in the city of Hefei. Since then, the Institute has hosted an annual National Workshop on Stereotactic and Functional Neurosurgery, where more than 80% of the functional neurosurgeons now practicing in China have been trained. In 1986, the Chinese Society of Stereotactic and Functional Neurosurgery was established, and the first issue of the Chinese Journal of Stereotactic and Functional Neurosurgery was published. With more than 35 years of development, stereotactic and functional neurosurgery has become a very important branch of surgery in China. More than 5,000 functional neurosurgery procedures and more than 8,000 stereotactic radiosurgery procedures are now performed annually. Copyright 2002 S. Karger AG, Basel

  11. Juan Valverde de Hamusco's unauthorized reproduction of a brain dissection by Andreas Vesalius. (United States)

    Lanska, Douglas J; Lanska, John R


    The objective of the present work is to examine images of the brain dissection by Flemish-born anatomist Andreas Vesalius (1514-1564) as originally represented in the Fabrica (1543), and later copied without Vesalius' permission by Spanish anatomist Juan Valverde de Hamusco (c1525-c1587) in Historia de la composicion del cuerpo humano (1556). Illustrations of the brain dissection in the Fabrica were obtained in digital form, resized, and arranged in a comparable montage to that presented by Valverde. Computer manipulations were used to assess image correspondence. The Valverde illustrations are approximately half the size and are mirror images of those in the Fabrica, but otherwise show the same dissection stages, and identical transverse brain levels and structures. The Valverde illustrations lack shadowing and show minor variations in perspective and fine details (e.g., branching pattern of the middle meningeal artery) from those in the Fabrica. Craftsmen under the direction of Valverde copied the woodcut prints in the Fabrica in close but approximate form by freehand engraving onto copper plates. Differences in the sizes of the images, and in perspective and fine detail, preclude direct tracing of images as the means of copying. Because engravings are in effect "flipped over" to make further prints, subsequent prints made from Valverde's copperplate engravings are mirror images of the prints in Vesalius' Fabrica.

  12. The Andreas Vesalius woodblocks: a four hundred year journey from creation to destruction. (United States)

    Joffe, Stephen N; Buchanan, Veronica


    The purpose of this study was to trace the history of woodblocks created in 1542 by Andreas Vesalius (1514-1564). Carved by the Venetian workmen on pear tree boards, the woodblocks were used in the Basel printing of Vesalius' works De Humani Corporis Fabrica and Epitome from 1543, The China Root Epistle (1546), and the frontispiece of the Fabrica, the edition from 1555. The blocks remained with the printer Oporinus in Basel until his death in 1568 when they were sold to the Froben family. The woodblocks reappeared in 1706 in a publication by Maschenbauer and were subsequently used by Leveling in 1783. An incomplete set of woodblocks was moved from Inglostadt to Landshut and then to Munich where Roth in 1885 documented them. At the suggestion of an American physician, Samuel Lambert, the University of Munich found the "missing" woodblocks in the attic. This led Wiegand and the New York Academy of Medicine to publish the woodblocks in the Icones Anatomicae in 1934. The second edition frontispiece was returned to Louvain where it was destroyed by bombing in 1940 and all the remaining woodblocks were destroyed in Allied bombing between 1943 and 1945. Thus, the Vesalius woodblocks travelled a 400-year journey from their creation, through the use in eight publications with over 5000 prints and ended in their tragic destruction.

  13. Leonardo da Vinci and Andreas Vesalius; the shoulder girdle and the spine, a comparison. (United States)

    Ganseman, Y; Broos, P


    Leonardo Da Vinci and Andreas Vesalius were two important renaissance persons; Vesalius was a surgeon-anatomist who delivered innovative work on the study of the human body, Leonardo da Vinci was an artist who delivered strikingly accurate and beautiful drawings on the human body. Below we compare both masters with regard to their knowledge of the working of the muscles, their method and system of dissection and their system and presentation of the drawings. The investigation consisted of a comparison between both anatomists, in particular concerning their study on the shoulder girdle and spine, by reviewing their original work as well as already existing literature on this subject. The investigation led to the conclusion that the drawings mentioned meant a change in history, and were of high quality, centuries ahead of their time. Both were anatomists, both were revolutionary, only one changed history at the moment itself, while the other changed history centuries later. Leonardo has made beautiful drawings that are at a match with the drawings of today or are even better. Vesalius set the start for medicine as a science as it is until this day. Their lives differed as strongly as their impact. In the light of their time, the achievement they made was extraordinary.

  14. Smartphone use in neurosurgery? APP-solutely!


    Zaki, Michael; Drazin, Doniel


    Background: A number of smartphone medical apps have recently emerged that may be helpful for the neurosurgical patient, practitioner, and trainee. This study aims to review the current neurosurgery-focused apps available for the iPhone, iPad, and Android platforms as of December 2013. Methods: Two of the most popular smartphone app stores (Apple Store and Android Google Play Store) were surveyed for neurosurgery-focused apps in December 2013. Search results were categorized based on thei...

  15. Tracking Career Paths of Women in Neurosurgery. (United States)

    Renfrow, Jaclyn J; Rodriguez, Analiz; Wilson, Taylor A; Germano, Isabelle M; Abosch, Aviva; Wolfe, Stacey Quintero


    Women represent a growing cohort of US neurosurgeons. To describe postresidency fellowship, practice environment, and updated academic rank among female neurosurgeons. Databases from the American Association of Neurological Surgeons (AANS) and the American Board of Neurological Surgery (ABNS) from 1964 to 2013 were reviewed for female neurosurgery residency graduates. Data on postresidency fellowships, practice environment (private vs academic), academic rank, board certification, and AANS/CNS (Congress of Neurological Surgeons) Joint Section on Women in Neurosurgery (WINS) membership were collected in 2016. Academic rank was verified from program websites and electronic correspondence. Faculty members were asked to report directorships and tenure. The AANS/CNS Joint Section on Women in Neurosurgery verified WINS membership. A total of 379 female neurosurgery residency graduates were identified in this 50-yr span. Of these, 70% became ABNS certified, and 2.1% left neurosurgery. Twenty-seven percent of women (n = 103) pursued fellowships, with pediatric neurosurgery (33%) the most common. Regarding practice environment, 26% entered academic medicine (n = 91), with 42 at the rank of assistant professor, 33 at the rank of associate professor, and 16 reaching the rank of full professor. Upon completion of training, 27% of women pursue fellowships. The distribution of women in private vs academic practice environments is proportionate to male neurosurgeons; however, the number women in academic leadership positions remains exceedingly low, with disproportionate representation in higher academic ranks. Women in national organized neurosurgery are increasing. Tracking the career paths of women in neurosurgery is a necessary step to identifying current achievements and opportunities for future progress.

  16. Reflections on a career in neurosurgery


    Heimburger, Robert F.; Heimburger, Douglas C.


    Robert Heimburger recounts his career in neurosurgery, including some of the early years of modern neurosurgery and some of the contributions he made, particularly in the areas of early repair of myelomeningocele and spinal cord tethering, high-intensity focused ultrasound for the brain, stereotactic surgery, washing hair and scalps instead of shaving for cranial surgery, and neurosurgical consultation in Asian countries. Now aged 96, he continues to have a keen mind and thorough commitment t...

  17. Technological innovation in neurosurgery: a quantitative study. (United States)

    Marcus, Hani J; Hughes-Hallett, Archie; Kwasnicki, Richard M; Darzi, Ara; Yang, Guang-Zhong; Nandi, Dipankar


    Technological innovation within health care may be defined as the introduction of a new technology that initiates a change in clinical practice. Neurosurgery is a particularly technology-intensive surgical discipline, and new technologies have preceded many of the major advances in operative neurosurgical techniques. The aim of the present study was to quantitatively evaluate technological innovation in neurosurgery using patents and peer-reviewed publications as metrics of technology development and clinical translation, respectively. The authors searched a patent database for articles published between 1960 and 2010 using the Boolean search term "neurosurgeon OR neurosurgical OR neurosurgery." The top 50 performing patent codes were then grouped into technology clusters. Patent and publication growth curves were then generated for these technology clusters. A top-performing technology cluster was then selected as an exemplar for a more detailed analysis of individual patents. In all, 11,672 patents and 208,203 publications related to neurosurgery were identified. The top-performing technology clusters during these 50 years were image-guidance devices, clinical neurophysiology devices, neuromodulation devices, operating microscopes, and endoscopes. In relation to image-guidance and neuromodulation devices, the authors found a highly correlated rapid rise in the numbers of patents and publications, which suggests that these are areas of technology expansion. An in-depth analysis of neuromodulation-device patents revealed that the majority of well-performing patents were related to deep brain stimulation. Patent and publication data may be used to quantitatively evaluate technological innovation in neurosurgery.

  18. Establishing reconstructive neurosurgery as a subspecialty. (United States)

    Brown, Justin M; Mahan, Mark A; Mandeville, Ross; Carter, Bob S


    Neurosurgery is experiencing the emergence of a new subspecialty focused on function restoration. New, evolving, and reappraised surgical procedures have provided an opportunity to restore function to many patients with previously undertreated disorders. Candidates for reconstruction were previously limited to those with peripheral nerve and brachial plexus injuries, but this has been expanded to include stroke, spinal cord injury, and a host of other paralyzing disorders affecting both upper and lower motor neurons. Similar to the recent evolution of the well-established subdisciplines of spinal and vascular neurosurgery, reconstructive neurosurgery requires the adaptation of techniques and skills that were not traditionally a part of neurosurgical training. Neurosurgeons-as the specialists who already manage this patient population and possess the requisite surgical skills to master the required techniques-have a unique opportunity to lead the development of this field. The full development of this subspecialty will lay the foundation for the subsequent addition of emerging treatments, such as neuroprosthetics and stem cell-based interventions. As such, reconstructive neurosurgery represents an important aspect of neurosurgical training that can ameliorate many of the deficits encountered in the traditional practice of neurosurgery.

  19. [The copy of De humani corporis fabrica of Andreas Vesalius of the municipal library of Reims]. (United States)

    Ségal, Alain


    The author presents a copy of the De humani corporis fabrica by Andreas Vesalius; this book is preserved in the department of rare books of the municipal Library in Reims. This copy is a first edition as the author gives positive proofs. This book results of a donation to the Minimes's congregation of Reims by Seigneur Guillaume Le Vergeur, Count of Saint Souplet and Baillif of Vermandois in the 17th century. Guillaume Le Vergeur has also given other precious books to the monastery's library and his name is inscribed on the register of obituaries and on the pediment of the Minimes' Church.

  20. History of Mechanical Ventilation. From Vesalius to Ventilator-induced Lung Injury. (United States)

    Slutsky, Arthur S


    Mechanical ventilation is a life-saving therapy that catalyzed the development of modern intensive care units. The origins of modern mechanical ventilation can be traced back about five centuries to the seminal work of Andreas Vesalius. This article is a short history of mechanical ventilation, tracing its origins over the centuries to the present day. One of the great advances in ventilatory support over the past few decades has been the development of lung-protective ventilatory strategies, based on our understanding of the iatrogenic consequences of mechanical ventilation such as ventilator-induced lung injury. These strategies have markedly improved clinical outcomes in patients with respiratory failure.

  1. Vesalius on the anatomy and function of the recurrent laryngeal nerves: medical illustration and reintroduction of a physiological demonstration from Galen. (United States)

    Lanska, Douglas J


    The purpose of this article is to review the anatomical illustrations and physiological demonstrations of sixteenth-century Flemish-born anatomist and physician Andreas Vesalius concerning the recurrent laryngeal nerves. Although Vesalius was primarily an anatomist, he also used vivisection as a pedagogical device to help his students understand the function of structures within the fabric of the body that they had previously studied in anatomical detail. Vesalius's masterwork, De humani corporis fabrica or simply the Fabrica (1543, 1555), was ostensibly an anatomy text, but Vesalius included textual and figural references to his use of vivisection to explicate the function of specific structures. Even as he began to criticize the errors in Galen's anatomical works, Vesalius nevertheless adopted some of Galen's classic physiological demonstrations, in particular the ligation (and subsequent release) of the recurrent laryngeal nerves of a pig to demonstrate their role in generating the pig's squeal. Vesalius's illustrations concerning the recurrent laryngeal nerve in the Fabrica were of two types: elegant anatomical woodcut plates-unsurpassed for their clarity, accuracy, and detail - and the distinctly inelegant historiated initial Q, depicting a throng of putti busily engaged in vivisecting a pig. Vesalius' anatomical plates were heavily plagiarized while the historiated initials, showing the rough work of an anatomist or surgeon, were largely ignored and remain little recognized today. While Vesalius' anatomical illustrations of the recurrent laryngeal nerves contained some errors, they were a dramatic departure from prior meager efforts at medical illustration and indeed far surpassed all contemporary published illustrations by others. Vesalius was also influential in reviving Galen's approach to vivisection, at least for pedagogical purposes, if not really then yet as a full-fledged investigative technique.

  2. Simulation and resident education in spinal neurosurgery (United States)

    Bohm, Parker E.; Arnold, Paul M.


    Background: A host of factors have contributed to the increasing use of simulation in neurosurgical resident education. Although the number of simulation-related publications has increased exponentially over the past two decades, no studies have specifically examined the role of simulation in resident education in spinal neurosurgery. Methods: We performed a structured search of several databases to identify articles detailing the use of simulation in spinal neurosurgery education in an attempt to catalogue potential applications for its use. Results: A brief history of simulation in medicine is given, followed by current trends of spinal simulation utilization in residency programs. General themes from the literature are identified that are integral for implementing simulation into neurosurgical residency curriculum. Finally, various applications are reported. Conclusion: The use of simulation in spinal neurosurgery education is not as ubiquitous in comparison to other neurosurgical subspecialties, but many promising methods of simulation are available for augmenting resident education. PMID:25745588

  3. Simulation and resident education in spinal neurosurgery. (United States)

    Bohm, Parker E; Arnold, Paul M


    A host of factors have contributed to the increasing use of simulation in neurosurgical resident education. Although the number of simulation-related publications has increased exponentially over the past two decades, no studies have specifically examined the role of simulation in resident education in spinal neurosurgery. We performed a structured search of several databases to identify articles detailing the use of simulation in spinal neurosurgery education in an attempt to catalogue potential applications for its use. A brief history of simulation in medicine is given, followed by current trends of spinal simulation utilization in residency programs. General themes from the literature are identified that are integral for implementing simulation into neurosurgical residency curriculum. Finally, various applications are reported. The use of simulation in spinal neurosurgery education is not as ubiquitous in comparison to other neurosurgical subspecialties, but many promising methods of simulation are available for augmenting resident education.

  4. Andreas Vesalius 500 years--A Renaissance that revolutionized cardiovascular knowledge. (United States)

    Mesquita, Evandro Tinoco; Souza Júnior, Celso Vale de; Ferreira, Thiago Reigado


    The history of medicine and cardiology is marked by some geniuses who dared in thinking, research, teaching and transmitting scientific knowledge, and the Italian Andreas Vesalius one of these brilliant masters. His main scientific work "De Humani Corporis Fabrica" is not only a landmark study of human anatomy but also an artistic work of high aesthetic quality published in 1543. In the year 2014 we celebrated 500 years since the birth of the brilliant professor of Padua University, who with his courage and sense of observation changed the understanding of cardiovascular anatomy and founded a school to date in innovative education and research of anatomy. By identifying "the anatomical errors" present in Galen's book and speech, he challenged the dogmas of the Catholic Church, the academic world and the doctors of his time. However, the accuracy of his findings and his innovative way to disseminate them among his students and colleagues was essential so that his contributions are considered by many the landmark of modern medicine. His death is still surrounded by mysteries having different hypotheses, but a certainty, suffered sanctions of the Catholic Church for the spread of their ideas. The cardiologists, cardiovascular surgeons, interventional cardiologists, electrophysiologists and cardiovascular imaginologists must know the legacy of genius Andreas Vesalius that changed the paradigm of human anatomy.

  5. The future of neurosurgery: a white paper on the recruitment and retention of women in neurosurgery. (United States)

    Benzil, Deborah L; Abosch, Aviva; Germano, Isabelle; Gilmer, Holly; Maraire, J Nozipo; Muraszko, Karin; Pannullo, Susan; Rosseau, Gail; Schwartz, Lauren; Todor, Roxanne; Ullman, Jamie; Zusman, Edie


    The leadership of Women in Neurosurgery (WINS) has been asked by the Board of Directors of the American Association of Neurological Surgeons (AANS) to compose a white paper on the recruitment and retention of female neurosurgical residents and practitioners. Neurosurgery must attract the best and the brightest. Women now constitute a larger percentage of medical school classes than men, representing approximately 60% of each graduating medical school class. Neurosurgery is facing a potential crisis in the US workforce pipeline, with the number of neurosurgeons in the US (per capita) decreasing. The number of women entering neurosurgery training programs and the number of board-certified female neurosurgeons is not increasing. Personal anecdotes demonstrating gender inequity abound among female neurosurgeons at every level of training and career development. Gender inequity exists in neurosurgery training programs, in the neurosurgery workplace, and within organized neurosurgery. The consistently low numbers of women in neurosurgery training programs and in the workplace results in a dearth of female role models for the mentoring of residents and junior faculty/practitioners. This lack of guidance contributes to perpetuation of barriers to women considering careers in neurosurgery, and to the lack of professional advancement experienced by women already in the field. There is ample evidence that mentors and role models play a critical role in the training and retention of women faculty within academic medicine. The absence of a critical mass of female neurosurgeons in academic medicine may serve as a deterrent to female medical students deciding whether or not to pursue careers in neurosurgery. There is limited exposure to neurosurgery during medical school. Medical students have concerns regarding gender inequities (acceptance into residency, salaries, promotion, and achieving leadership positions). Gender inequity in academic medicine is not unique to neurosurgery

  6. Stereotactic imaging in functional neurosurgery

    Energy Technology Data Exchange (ETDEWEB)

    Hirabayashi, Hidehiro


    Background: The birth of stereotactic functional neurosurgery in 1947 was to a great extent dependent on the development of ventriculography. The last decades have witnessed a renaissance of functional stereotactic neurosurgery in the treatment of patients with movement disorders. Initially, these procedures were largely based on the same imaging technique that had been used since the birth of this technique, and that is still used in some centers. The introduction of new imaging modalities such as Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) provided new potentials, but also new challenges for accurate identification and visualisation of the targets in the basal ganglia and the thalamus with an urge to thoroughly evaluate and optimize the stereotactic targeting technique, as well as evaluate accurately in stereotactic space the location and extent of stereotactic Radiofrequency (RF) lesions and the position of deep brain stimulation (DBS) electrodes. Aims: To study the differences between CT and MRI regarding indirect atlas coordinates in thalamic and pallidal procedures and to evaluate and validate visualisation of the pallidum and the subthalamic nucleus in view of direct targeting irrespective of atlas-derived coordinates. Furthermore, to evaluate the contribution of RF parameters on the size of stereotactic lesions, as well as the impact of size and location on clinical outcome. Method: The coordinates in relation to the landmarks of the 3{sup rd} ventricle of the targets in the pallidum and ventrolateral thalamus were compared between CT and MRI in 34 patients. In another 48 patients direct visualization of the pallidum was evaluated and compared to indirect atlas based targeting. The possibility and versatility of visualizing the Subthalamic Nucleus (STN) on short acquisition MRI were evaluated in a multicentre study, and the use of alternative landmarks in identification of the STN was demonstrated in another study. In 46 patients CT and

  7. Frameless image-guided neurosurgery in motion

    NARCIS (Netherlands)

    Woerdeman, P.A.|info:eu-repo/dai/nl/304818844


    The general objective of this thesis was the enhancement of image-guidance system use by optimizing “man-machine” interaction in frameless image-guided neurosurgery. Part I. The application of frameless stereotaxy in the neurosurgical practice We aimed to compare three patient-to-image registration

  8. A relational database in neurosurgery. (United States)

    Sicurello, F; Marchetti, M R; Cazzaniga, P


    This paper describes teh automatic procedure for a clinical record management in a Neurosurgery ward. The automated record allows the storage, querying and effective management of clinical data. This is useful during the patient stay and also for data processing and analysis aiming at clinical research and statistical studies. The clinical record is problem-oriented. It contains a minimum data set regarding every patient and a data set which is defined by a classification nomenclature (using an inner protocol). The main parts of the clinical record are the following tables: PERSONAL DATA: contains the fields relating to personal and admission data of the patient. The compilation of some fields is compulsory because they serve as input for the automated discharge letter. This table is used as an identifier for patient retrieval. composed of five different tables according to the kind of data. They are: familiar anamnesis, physiological anamnesis, past and next pathology anamnesis, and trauma anamnesis. GENERAL OBJECTIVITY: contains the general physical information of a patient. The field hold default values, which quickens the compilation and assures the recording of normal values. NEUROLOGICAL EXAMINATION: contains information about the neurological status of the patient. Also in this table, ther are default values in the fields. COMA: contains standardized ata and classifications. The multiple choices are automated and driven and belong to homogeneous classes. SURGICAL OPERATIONS: the information recording is made defining the general kind of operation and then defining the peculiar kind of operation. INSTRUMENTAL EXAMINATIONS: some examination results are recorded in a free structure, while other ones (TAC, etc.) follow codified structure. In order to identify a pathology by means of TAC, it is enough to record three values corresponding to three variables. THis classification fully describes a lot of neurosurgical pathologies. DISCHARGE: contains conclusions

  9. Curriculum-based neurosurgery digital library. (United States)

    Langevin, Jean-Philippe; Dang, Thai; Kon, David; Sapo, Monica; Batzdorf, Ulrich; Martin, Neil


    Recent work-hour restrictions and the constantly evolving body of knowledge are challenging the current ways of teaching neurosurgery residents. To develop a curriculum-based digital library of multimedia content to face the challenges in neurosurgery education. We used the residency program curriculum developed by the Congress of Neurological Surgeons to structure the library and Microsoft Sharepoint as the user interface. This project led to the creation of a user-friendly and searchable digital library that could be accessed remotely and throughout the hospital, including the operating rooms. The electronic format allows standardization of the content and transformation of the operating room into a classroom. This in turn facilitates the implementation of a curriculum within the training program and improves teaching efficiency. Future work will focus on evaluating the efficacy of the library as a teaching tool for residents.

  10. Minimalism in Art, Medical Science and Neurosurgery. (United States)

    Okten, Ali Ihsan


    The word "minimalism" is a word derived from French the word "minimum". Whereas the lexical meaning of minimum is "the least or the smallest quantity necessary for something", its expression in mathematics can be described as "the lowest step a variable number can descend, least, minimal". Minimalism, which advocates an extreme simplicity of the artistic form, is a current in modern art and music whose origins go to 1960s and which features simplicity and objectivity. Although art, science and philosophy are different disciplines, they support each other from time to time, sometimes they intertwine and sometimes they copy each other. A periodic schools or teaching in one of them can take the others into itself, so, they proceed on their ways empowering each other. It is also true for the minimalism in art and the minimal invasive surgical approaches in science. Concepts like doing with less, avoiding unnecessary materials and reducing the number of the elements in order to increase the effect in the expression which are the main elements of the minimalism in art found their equivalents in medicine and neurosurgery. Their equivalents in medicine or neurosurgery have been to protect the physical integrity of the patient with less iatrogenic injury, minimum damage and the same therapeutic effect in the most effective way and to enable the patient to regain his health in the shortest span of time. As an anticipation, we can consider that the minimal approaches started by Richard Wollheim and Barbara Rose in art and Lars Leksell, Gazi Yaşargil and other neurosurgeons in neurosurgery in the 1960s are the present day equivalents of the minimalist approaches perhaps unconsciously started by Kazimir Malevich in art and Victor Darwin L"Espinasse in neurosurgery in the early 1900s. We can also consider that they have developed interacting with each other, not by chance.

  11. [The origins of the French neurosurgery]. (United States)

    Brunon, J


    Modern French neurosurgery starts at the beginning of the XXth century under the motivation of Joseph Babinski. He submitted his patients to Thierry de Martel who had learned this new specialized area of medicine with H. Cushing in the États-Unis and V. Horsey in Great Britain. His first successfully treated case of an intracranial tumor was published in 1909. But the true founding father was Clovis Vincent, initially a neurologist and collaborator of de Martel, who became the first chairman in 1933 of the neurosurgical department at the Pitié hospital of Paris and the first professor of neurosurgery in 1938. After the Second World War, many departments were created outside of Paris. Neurosurgery was definitively recognized as a specialized area in medicine in 1948. Currently, more than 400 neurosurgeons work in France. Because I had the very great privilege to be present at the birth of this society in 1970 and to still be in contact with some of the second and third generation of French neurosurgeons who led it to its high international recognition, the Chairman of the French Neurosurgical Society asked me to write this short historical vignette. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  12. Publication patterns of comparative effectiveness research in spine neurosurgery. (United States)

    Hueng, Dueng-Yuan; Tsai, Chia-Lin; Hsu, Shih-Wei; Ma, Hsin-I


    The purpose of this study was to investigate publication patterns for comparative effectiveness research (CER) on spine neurosurgery. The authors searched the PubMed database for the period 1980-2012 using the key words "cost analysis," "utility analysis," "cost-utility," "outcomes research," "practical clinical research," "comparator trial," and "comparative effectiveness research," linked with "effectiveness" and "spine neurosurgery." From 1980 through April 9, 2012, neurosurgery CER publications accounted for 1.38% of worldwide CER publications (8657 of 626,330 articles). Spine neurosurgery CER accounted for only 0.02%, with 132 articles. The journal with the greatest number of publications on spine neurosurgery CER was Spine, followed by the Journal of Neurosurgery: Spine. The average annual publication rate for spine neurosurgery CER during this period was 4 articles (132 articles in 33 years), with 68 (51.52%) of the 132 articles being published within the past 5 years and a rising trend beginning in 2008. The top 3 contributing countries were the US, Turkey, and Japan, with 68, 8, and 7 articles, respectively. Only 8 regular articles (6.06%) focused on cost analysis. There is a paucity of publications using CER methodology in spine neurosurgery. Few articles address the issue of cost analysis. The promotion of continuing medical education in CER methodology is warranted. Further investigations to address cost analysis in comparative effectiveness studies of spine neurosurgery are crucial to expand the application of CER in public health.

  13. Vesalius on the variability of the human skull: book I chapter V of De humani corporis fabrica. (United States)

    Hast, M H; Garrison, D H


    Vesalius' short chapter on craniology and the "unnatural" shapes that skulls could take is a uniquely interesting illustration of the young anatomist's position halfway between a traditional belief in a standard or canonical "natural" human anatomy and the host of variations confronted in his day-to-day observation of actual cadavers. His interest in variability is marked in both editions of De humani corporis fabrica (1543, 1555), and it is no coincidence that two of the anatomical features that today bear the great anatomist's name are atypical. In their shape, all of the five skulls that illustrate Chapter 5 of Book I of the Fabrica fall within margins of variability recognized as standard today, but even in Vesalius' own century it was noticed that the sutures in the four "unnatural" skulls do not occur in real life. The article considers the meaning of this unusual departure from his reliance upon observation and includes a translation of Vesalius' craniology chapter from the original Latin, with annotations and two appendices containing his 1555 revisions and clinical addenda. Copyright 2000 Wiley-Liss, Inc.

  14. Juan Valverde de Amusco (1525-1588): an eminent anatomist of the renaissance or a plagiarist of Vesalius? His work and its impact in renaissance anatomy. (United States)

    Markatos, Konstantinos; Arkoudi, Konstantina; Androutsos, Georgios


    The purpose of this study is to review and summarize the life and work of Juan Valverde de Amusco (1525-1588), his impact on the anatomy of the sixteenth century and focus on his controversy with Andreas Vesalius. A thorough search of the literature was undertaken in PubMed and Google Scholar as well as in history books through the internet and in History and Medical University libraries. Valverde took almost directly from Andreas Vesalius 38 pictures. Occasionally, however, Valverde corrected Vesalius' images, as in his depictions of the muscles of the eyes, nose and larynx. Valverde copied the work of Vesalius in many instances. Nevertheless, he had his fair share of contribution in the history of Anatomy; he managed to popularize and spread the new anatomy of the Rennaissance through his work which was far more cheaper than that of Vesalius; furthermore, his anatomic discoveries like the first depiction of the intracranial course of the carotid arteries (several decades before Willis's description), the extrinsic ocular muscles and the middle ear bones contribute to the spirit of the Scientific Revolution.

  15. Smartphone use in neurosurgery? APP-solutely! (United States)

    Zaki, Michael; Drazin, Doniel


    A number of smartphone medical apps have recently emerged that may be helpful for the neurosurgical patient, practitioner, and trainee. This study aims to review the current neurosurgery-focused apps available for the iPhone, iPad, and Android platforms as of December 2013. Two of the most popular smartphone app stores (Apple Store and Android Google Play Store) were surveyed for neurosurgery-focused apps in December 2013. Search results were categorized based on their description page. Data were collected on price, rating, app release date, target audience, and medical professional involvement in app design. A review of the top apps in each category was performed. The search resulted in 111 unique apps, divided into these 7 categories: 16 (14%) clinical tools, 17 (15%) conference adjunct, 27 (24%) education, 18 (16%) literature, 15 (14%) marketing, 10 (9%) patient information, and 8 (7%) reference. The average cost of paid apps was $23.06 (range: $0.99-89.99). Out of the 111 apps, 71 (64%) were free, 48 (43%) had reviews, and 14 (13%) had more than 10 reviews. Seventy-three (66%) apps showed evidence of medical professional involvement. The number of apps being released every year has been increasing since 2009. There are a number of neurosurgery-themed apps available to all audiences. There was a lack of patient information apps for nonspinal procedures. Most apps did not have enough reviews to evaluate their quality. There was also a lack of oversight to validate the accuracy of medical information provided in these apps.

  16. Hippocrates' influence on the origins of neurosurgery. (United States)

    Chang, Anna; Lad, Eleonora M; Lad, Shivanand P


    Hippocrates is widely considered the father of medicine. His contributions revolutionized the practice of medicine and laid the foundation for modern-day neurosurgery. He inspired several generations to follow his vision, by pioneering the rigorous clinical evaluation of cranial and spinal disorders and combining this approach with a humanistic and ethical perspective focused on the individuality of the patient. His legacy has forever shaped the field of medicine and his cumulative works on head injuries and spinal deformities led to the basic understanding of many of the fundamental neurosurgical principles in use today.

  17. Genealogy of training in vascular neurosurgery. (United States)

    Chowdhry, Shakeel A; Spetzler, Robert F


    Remarkable advances and changes in the landscape of neurovascular disease have occurred recently. Concurrently, a paradigm shift in training and resident education is underway. This crossroad of unique opportunities and pressures necessitates creative change in the training of future vascular neurosurgeons to allow incorporation of surgical advances, new technology, and supplementary treatment modalities in a setting of reduced work hours and increased public scrutiny. This article discusses the changing landscape in neurovascular disease treatment, followed by the recent changes in resident training, and concludes with our view of the future of training in vascular neurosurgery.

  18. Advances in functional neurosurgery for Parkinson's disease. (United States)

    Metman, Leo Verhagen; Slavin, Konstantin V


    Functional neurosurgery for Parkinson's disease has become a mainstream concept with DBS as the prime modality. This article reviews the latest and, in the eyes of the authors, the most important developments in DBS, lesioning and gene therapy. In DBS, emerging advances have focused on the timing of surgery relative to disease duration and severity, and new targets, technologies, and equipment. For lesions, new ultrasound techniques are emerging based on successes in other movement disorders. Gene and cellular therapies, including stem cells, remain only in the research realm. © 2015 International Parkinson and Movement Disorder Society.

  19. Resurgence of functional neurosurgery for Parkinson's disease: a historical perspective

    NARCIS (Netherlands)

    Speelman, J. D.; Bosch, D. A.


    The history of functional neurosurgery for the treatment of Parkinson's disease is reviewed. Two major stages may be distinguished: (1) open functional neurosurgery, which started in 1921 with bilateral cervical rhizotomy by Leriche. In 1937 Bucy performed the first motor cortectomy in a tremor

  20. Management of hyperglycemia in the neurosurgery patient. (United States)

    Daniel, Rene; Villuri, Satya; Furlong, Kevin


    Hyperglycemia is associated with adverse outcomes in patients who are candidates for or underwent neurosurgical procedures. Specific concerns and settings that relate to these patients are preoperative glycemic control, intraoperative control, management in the neurological intensive care unit (NICU), and postoperative control. In each of these settings, physicians have to ensure appropriate glycemic control to prevent or minimize adverse events. The glycemic control is usually managed by a neurohospitalist in co-management with the neurosurgery team pre- and post-operatively, and by the neurocritical care team in the setting of NICU. In this review article, we outline current standards of care for neurosurgery patients with diabetes mellitus and/or and hyperglycemia and discuss results of most recent clinical trials. We highlight specific concerns with regards to glycemic controls in these patients including enteral tube feeding and parenteral nutrition, the issues of the transition to the outpatient care, and management of steroid-induced hyperglycemia. We also note lack of evidence in some important areas, and the need for more research addressing these gaps. Where possible, we provide suggestions how to manage these patients when there is no underlying guideline.

  1. Reiner Solenander (1524-1601): an important 16th century medical practitioner and his original report of Vesalius' death in 1564. (United States)

    Biesbrouck, Maurits; Goddeeris, Theodoor; Steeno, Omer


    Reiner Solenander (1524-1601) was a physician born in the Duchy of Cleves, who got his education at the University of Leuven and at various universities in Italy and in France. Back at home he became the court physician of William V and later of his son John William. In this article his life and works are discussed. A report on the death of Andreas Vesalius (1514-1564), noted down by Solenander in May 1566, one year and seven months after the death of Vesalius, is discussed in detail. Due to the importance of that document a copy of its first publication is given, together with a transcription and a translation as well. It indicates that Vesalius did not die in a shipwreck.

  2. Occurrence of the foramen of Vesalius and its morphometry relevant to clinical consideration. (United States)

    Chaisuksunt, Vipavadee; Kwathai, Lanaprai; Namonta, Kritsana; Rungruang, Thanaporn; Apinhasmit, Wandee; Chompoopong, Supin


    All 377 dry skulls were examined for the occurrence and morphometry of the foramen of Vesalius (FV) both in the middle cranial fossa and at the extracranial view of the skull base. There were 25.9% and 10.9% of FV found at the extracranial view of the skull base and in the middle cranial fossa, respectively. Total patent FV were 16.1% (11.9% unilaterally and 4.2% bilaterally). Most FV were found in male and on the left side. Comparatively, FV at the extracranial view of the skull base had a larger maximum diameter. The distance between FV and the foramen ovale (FO) was as short as 2.05 ± 1.09 mm measured at the extracranial view of the skull base. In conclusion, although the existence of FV is inconstant, its occurrence could not be negligible. The proximity of FV to FO should remind neurosurgeons to be cautious when performing the surgical approach through FO.

  3. The Prevalence of Burnout Among US Neurosurgery Residents. (United States)

    Shakir, Hakeem J; McPheeters, Matthew J; Shallwani, Hussain; Pittari, Joseph E; Reynolds, Renée M


    Burnout is a syndrome of emotional exhaustion, depersonalization, and reduced personal accomplishment. Its prevalence among US physicians exceeds 50% and is higher among residents/fellows. This is important to the practice of neurosurgery, as burnout is associated with adverse physical health, increased risk of substance abuse, and increased medical errors. To date, no study has specifically addressed the prevalence of burnout among neurosurgery residents. To determine and compare the prevalence of burnout among US neurosurgery residents with published rates for residents/fellows and practicing physicians from other specialties. We surveyed 106 US neurosurgery residency training programs to perform a descriptive analysis of the prevalence of burnout among residents. Data on burnout among control groups were used to perform a cross-sectional analysis. Nonparametric tests assessed differences in burnout scores among neurosurgery residents, and the 2-tailed Fisher's exact test assessed burnout between neurosurgery residents and control populations. Of approximately 1200 US neurosurgery residents, 255 (21.3%) responded. The prevalence of burnout was 36.5% (95% confidence interval: 30.6%-42.7%). There was no significant difference in median burnout scores between gender (P = .836), age (P = .183), or postgraduate year (P = .963) among neurosurgery residents. Neurosurgery residents had a significantly lower prevalence of burnout (36.5%) than other residents/fellows (60.0%; P burnout than other residents/fellows and practicing physicians. The underlying causes for these findings were not assessed and are likely multifactorial. Future studies should address possible causes of these findings.

  4. The internal medicine specialist and neurosurgery

    Directory of Open Access Journals (Sweden)

    A. Pizzini


    Full Text Available BACKGROUND The neurosurgical patient is often a real challenge for the physicians, because of a frequent multimorbidity and a higher risk for severe complications. Cooperation between internal medicine specialist and neurosurgeon is essential to prevent the fatal effects of cranial and spinal injuries. The topic issues of medical interest in neurosurgery are the disorders of sodium balance, the glycemic control, the thromboembolic risk, the intracerebral bleeding management and the infective problems. The neurosurgeons could be worried by treating these complications that are mostly of internal medicine interest and that could unfortunately rise the risk of death or irreversible insults. AIM OF THE REVIEW This review summarizes the modality of diagnosis and therapy of the foremost concerns in neurosurgical field.

  5. Overview of intraoperative MRI in neurosurgery

    Energy Technology Data Exchange (ETDEWEB)

    Shiino, Akihiko; Matsuda, Masayuki [Shiga Univ. of Medical Science, Otsu (Japan)


    This review describes usefulness, prospect and present problems of intraoperative MRI in neurosurgery. MRI equipments for the surgery have to have a wide, open space and have those magnets of short cylindrical, biplanar (clam shell), dual air core superconducting solenoidal (double doughnut) and targeted FOV (field of view) type. Devices required for the surgery are specific and in author's facility, they are classified into 4 zones depending on the region of their use. Application of the surgery involves biopsy, drainage of cyst and abscess, hematoma evacuation, nerve block, thermotherapy (interstitial laser, RF ablation, focused untrasonic and cryosurgery), local drug therapy, chemoablation, vascular intervention and tumor extraction, of which actual procedures and pictures are presented together with, in particular, MR-guided thermotherapy, ablation therapy of brain tumors, endoscopic surgery and minimally invasive therapy of the spine. A navigation software, 3D SlicerTM system, is introduced for interventional imaging. Safety measures are emphasized for the operation. (K.H.)

  6. Applied N=1 Supergravity (United States)

    Nath, Pran

    A review of recent developments in the applications of N=1 Supergravity to the construction of unified models of elementary particle interactions is given. Couplings of N=1 Supergravity with matter consisting of an arbitrary set of l handed multiplets and a gauge multiplet are discussed. General formulation of spontaneous symmetry breaking and the criteria for breaking of internal symmetry and of local supersymmetry are described. Construction of specific Supergrvity GUT models, the gauge heirarchy in GUT models and a deduction of the low energy effective potential are discussed. The phenomena of SU(2)XU(1) electro-weak gauge invariance breakdown by Supergravity in tree models and by radiative corrections using renormalization group methods are described. Model independent formulations of low energy physics which encompass tree and the renormalization group methods of breaking SU(2)XU(1), but also allow more general scenarios are discussed. The particle content of Supergravity unified theories at low energy is given which includes predictions, for a class of supergravity models, of light gauge fermins, i.e. of a charged Dirac fermion, the Wino, with a mass below the W boson mass and a neutral fermion, the Zino, below the mass of the Z boson mass. "Direct" gaugino masses arising from loops for the photino and the gluino, (which are massless at the tree level) are exhibited. Decays of the W and Z into photino. Vino, and Zino modes and their branching ratios into various channels are given. Experimental signals for the supersymmetrie decays are discussed and some prominent signatures such as decays into one and two jets with unbalanced energy and momentum are pointed out. The current status of the ρ-parameter, including supergravity GUT effects is given. Other experimental consequences of supergravity unified theories are also discussed.

  7. an unusual self-damaging behavior mandating neurosurgery

    African Journals Online (AJOL)

    3. Neurosurgery related cases of Munchausen's syndrome generally involve chronic back pain4, post- surgery Munchausen's syndrome5, or head trauma and intracranial hemorrhage.6 These patients spend most of their lives in hospitals with ...

  8. The history of Latin terminology of human skeletal muscles (from Vesalius to the present). (United States)

    Musil, Vladimir; Suchomel, Zdenek; Malinova, Petra; Stingl, Josef; Vlcek, Martin; Vacha, Marek


    The aim of this literary search was to chart the etymology of 32 selected human skeletal muscles, representative of all body regions. In researching this study, analysis of 15 influential Latin and German anatomical textbooks, dating from the sixteenth to the nineteenth century, was undertaken, as well as reference to four versions of the official Latin anatomical terminologies. Particular emphasis has been placed on the historical development of muscular nomenclature, and the subsequent division of these data into groups, defined by similarities in the evolution of their names into the modern form. The first group represents examples of muscles whose names have not changed since their introduction by Vesalius (1543). The second group comprises muscles which earned their definitive names during the seventeenth and eighteenth century. The third group is defined by acceptance into common anatomical vernacular by the late nineteenth century, including those outlined in the first official Latin terminology (B.N.A.) of 1895. The final group is reserved for six extra-ocular muscles with a particularly poetic history, favoured and popularised by the anatomical giants of late Renaissance and 1,700 s. As this study will demonstrate, it is evident that up until introduction of the B.N.A. there was an extremely liberal approach to naming muscles, deserving great respect in the retrospective terminological studies if complete and relevant results are to be achieved. Without this knowledge of the vernacular of the ages past, modern researchers can find themselves 'reinventing the wheel' in looking for their answers.

  9. Medieval neurosurgery: contributions from the Middle East, Spain, and Persia. (United States)

    Rahimi, Scott Y; McDonnell, Dennis E; Ahmadian, Amir; Vender, John R


    Modern neurological and spinal surgical techniques have been developed on the foundations established by predecessors. Modern 21st century neurosurgery begins in the Babylonian period, with the Edwin Smith papyrus. Throughout history, periods of enlightenment have resulted in advances in knowledge and understanding that have served as stepping stones for generations to come. As in other fields, in neurosurgery these periods of "enlightenment" have occurred in a variety of civilizations and time periods.

  10. 500th birthday of Andreas Vesalius, the founder of modern anatomy: "vivitur ingenio, caetera mortis erunt" ("genius lives on, all else is mortal"). (United States)

    Hadzic, Admir; Sadeghi, Neda; Vandepitte, Catherine; Vandepitte, Walter; Van de Velde, Marc; Hadzic, Alen; Van Robays, Johan; Heylen, Rene; Herijgers, Paul; Vloka, Caroline; Van Zundert, Jan


    It is often said that regional anesthesia is the practice of applied anatomy. Therefore, it is fitting that on the occasion of his 500th birthday, we celebrate the life and work of the brilliant Flemish anatomist, Andreas Vesalius (1514-1564), the founder of modern anatomy.

  11. Leuven: birthplace of modern skeletology, thanks to Andreas Vesalius, with the help of Gemma Frisius, his friend and fellow-physician. (United States)

    Biesbrouck, M; Steeno, O


    The skeleton-making technique of Andreas Vesalius is described and is compared with that of others. An overview is added of the skeletons he constructed himself. The significance of his friend Gemma Frisius is discussed as well as the translations of the chapter of this technique in the De humani corporis fabrica.

  12. Introduction: military neurosurgery, past and present. (United States)

    Klimo, Paul; Ragel, Brian T


    For a physician has the worth of many other warriors, both for the excision of arrows and for the administration of soothing drugs. Homer, Iliad XI.514-515 Ever since armed conflict has been used as a means to settle disputes among men, there have been those who have been tasked to mend the wounds that ravage a soldier's body from the weapons of war. The Iliad portrays the pivotal 10th year of the legendary Trojan War, during which a schism in the Greek leadership prolongs the extended siege of the city of Troy. In the midst of this martial epic come the lines quoted above, quietly attesting to the value of the military physician, even under the crude conditions of the Greek Dark Age. They are uttered by Idomeneus, one of the foremost Greeks, when he is enjoining one of his comrades, Nestor, to rescue the injured Greek physician Machaon and take him back from the line to treat his wounds. He is afraid that Machaon will be captured by the Trojans, a loss far greater than that of any other single warrior. Duty to country has helped shape the careers of many neurosurgeons, including iconic US figures such as Harvey Cushing and Donald Matson. This issue of Neurosurgical Focus celebrates the rich history of military neurosurgery from the wars of yesterday to the conflicts of today. We have been humbled by the tremendous response to this topic. The 25 articles within this issue will provide the reader with both a broad and an in-depth look at the many facets of military neurosurgery. We have attempted to group articles based on their predominant topic. We also encourage our audience to read other recently published articles. The first 8 articles relate to the current conflicts in Afghanistan and Iraq. The lead article, written by Randy Bell and colleagues from the National Naval Medical Center and Walter Reed Army Medical Center, discusses what is arguably one of the most important contributions by military neurosurgeons from these 2 conflicts: the rapid and aggressive

  13. [Competency-based Neurosurgery Residency Programme]. (United States)

    Lobato, Ramiro D; Jiménez Roldan, Luis; Alen, José F; Castaño, Ana M; Munarriz, Pablo M; Cepeda, Santiago; Lagares, Alfonso


    A programme proposal for competency-based Neurosurgery training adapted to the specialization project is presented. This proposal has been developed by a group of neurosurgeons commissioned by the SENEC (Spanish Society of Neurosurgery) and could be modified to generate a final version that could come into force coinciding with the implementation of the specialization programme. This document aims to facilitate the test of the new programme included in the online version of our journal. Total training period is 6 years; initial 2 years belong to the surgery specialization and remaining 4 years belong to core specialty period. It is a competency-based programmed based on the map used by the US Accreditation Council for Graduate Medical Education (ACGME) including the following domains of clinical competency: Medical knowledge, patient care, communication skills, professionalism, practice-based learning and improvement, health systems, interprofessional collaboration and professional and personal development. Subcompetencies map in the domains of Knowledge and Patient care (including surgical competencies) was adapted to the one proposed by AANS and CNS (annex 1 of the programme). A subcompetency map was also used for the specialization rotations. Resident's training is based on personal study (self-learning) supported by efficient use of information sources and supervised clinical practice, including bioethical instruction, clinical management, research and learning techniques. Resident evaluation proposal includes, among other instruments, theoretical knowledge tests, objective and structured evaluation of the level of clinical competency with real or standardised patients, global competency scales, 360-degree evaluation, clinical record audits, milestones for residents progress and self-assessment (annex 2). Besides, residents periodically assess the teaching commitment of the department's neurosurgeons and other professors participating in rotations, and annually

  14. Assessing the Relevancy of "Citation Classics" in Neurosurgery. Part II: Foundational Papers in Neurosurgery. (United States)

    Bohl, Michael A; Turner, Jay D; Little, Andrew S; Nakaji, Peter; Ponce, Francisco A


    The second part of this study reanalyzes Ponce and Lozano's (2010) list of classics to create a new list of "foundational" articles in neurosurgery. Ponce and Lozano (2010) previously published a list of 106 neurosurgery classics, as defined by Garfield and his 400 citation criterion. We used the Web of Science citation reports to create graphs for each study showing the total citations it received as a function of time. Each graph was subjectively analyzed independently and scored as "foundational" or "classic only," based on whether the trend of citations received per year was uptrending, neutral, or downtrending. Of the 101 evaluated classics, 53 qualified as foundational. Over half of these studies were published in Journal of Neurosurgery (13), New England Journal of Medicine (12), or Lancet (5). Grading systems, randomized trials, and prospective studies were most likely to achieve foundational status. Only 30% of functional and 17% of endovascular classics qualified as foundational (compared with 100% of spine classics), suggesting that these fields are rapidly changing or less mature subspecialties still developing a foundational literature base. By assessing citation counts as a function of time, we are able to differentiate classic neurosurgical studies that are critical to modern-day practice from those that are primarily of historic interest. Given the exponential growth of literature in our field, analyses such as these will become increasingly important to both trainees and senior neurosurgeons who strive to educate themselves on the data that drive modern-day clinical decision making. Copyright © 2017 Elsevier Inc. All rights reserved.

  15. Neurosurgery in rural Nigeria: A prospective study

    Directory of Open Access Journals (Sweden)

    Taopheeq Bamidele Rabiu


    Full Text Available Background: Africa has very few neurosurgeons. These are almost exclusively in urban centers. Consequently, people in rural areas, most of the African population, have poor or no access to neurosurgical care. We have recently pioneered rural neurosurgery in Nigeria. Objectives: This report details our initial experiences and the profile of neurosurgical admissions in our center. Methods: A prospective observational study of all neurosurgical patients managed at a rural tertiary health institution in Nigeria from December 2010 to May 2012 was done. Simple descriptive data analysis was performed. Results: A total of 249 males (75.2% and 82 females (24.8% were managed. The median age was 37 years (range: Day of birth – 94 years. Trauma was the leading cause of presentation with 225 (68.0% and 35 (10.6% having sustained head and spinal injuries, respectively. Operative intervention was performed in 54 (16.3%. Twenty-four (7.2% patients discharged against medical advice, mostly for economic reasons. Most patients (208, 63.4% had satisfactory outcome while 30 (9.1% died. Conclusion: Trauma is the leading cause of rural neurosurgical presentations. There is an urgent need to improve access to adequate neurosurgical care in the rural communities.

  16. Options for perioperative pain management in neurosurgery

    Directory of Open Access Journals (Sweden)

    Vadivelu N


    Full Text Available Nalini Vadivelu,1 Alice M Kai,2 Daniel Tran,1 Gopal Kodumudi,3 Aron Legler,1 Eugenia Ayrian,4 1Department of Anesthesiology, Yale University School of Medicine, New Haven, CT, 2Stony Brook University School of Medicine, Stony Brook, NY, 3California Northstate University College of Medicine, Elk Grove, 4Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA Abstract: Moderate-to-severe pain following neurosurgery is common but often does not get attention and is therefore underdiagnosed and undertreated. Compounding this problem is the traditional belief that neurosurgical pain is inconsequential and even dangerous to treat. Concerns about problematic effects associated with opioid analgesics such as nausea, vomiting, oversedation, and increased intracranial pressure secondary to elevated carbon dioxide tension from respiratory depression have often led to suboptimal postoperative analgesic strategies in caring for neurosurgical patients. Neurosurgical patients may have difficulty or be incapable of communicating their need for analgesics due to neurologic deficits, which poses an additional challenge. Postoperative pain control should be a priority, because pain adversely affects recovery and patient outcomes. Inconsistent practices and the quality of current analgesic strategies for neurosurgical patients still leave room for improvement. Given the complexity of postoperative pain management for these patients, multimodal strategies are often required to optimize pain control and at the same time limit undesired side effects. Keywords: acute pain, post surgical pain, post craniotomy analgesia


    Directory of Open Access Journals (Sweden)

    V. I. Tsymbaliuk


    Full Text Available This article is about creating information system for the rehabilitation Department of Neurosurgery. To develop the information system needs to explore the work of department, examine the medical documentation and statistical reporting forms which doctors using in their work. Determine the sequence of making records into documentation. And finally make list of requirements for application with help of medical staff. The software was developed by using C# language and the database server MySQL. It has five major systems and several ancillary subsystems. The major systems are: saving personal and clinical patient information, editing inputted data, showing data, ensuring the integrity and accuracy of database, the implementation of access to the same database from different computers. Auxiliary subsystems include: creating medical documentation, blocking form’s elements, searching for patient through database, making statistic over some period of time, creating folders for every patient and others. There was designed user interface that allows doctors to reduce time for learning functionality of application. Information system has positive effect. It saves time for medical staff and reduces the possibility of inputting wrong information. Application does not require high hardware characteristics of computer.

  18. YouTube as a Source of Information on Neurosurgery. (United States)

    Samuel, Nardin; Alotaibi, Naif M; Lozano, Andres M


    The importance of videos in social media communications in the context of health care and neurosurgery is becoming increasingly recognized. However, there has not yet been a systematic analysis of these neurosurgery-related communications. Accordingly, this study was aimed at characterizing the online video content pertaining to neurosurgery. Neurosurgery-related videos uploaded on YouTube were collected using a comprehensive search strategy. The following metrics were extracted for each video: number of views, likes, dislikes, comments, shares, date of upload, and geographic region of origin where specified. A quantitative and qualitative evaluation was performed on all videos included in the study. A total of 713 nonduplicate videos met the inclusion criteria. The overall number of views for all videos was 90,545,164. Videos were most frequently uploaded in 2016 (n = 348), with a 200% increase in uploads compared with the previous year. Of the videos that were directly relevant to clinical neurosurgery, the most frequent video categories were "educational videos" (25%), followed by "surgical and procedure overview" (20%), "promotional videos" (17%), and "patient experience" (16%). The remainder of the videos consisted primarily of unrealistic simulations of cranial surgery for entertainment purposes (20%). The findings from this study highlight the increasing use of video communications related to neurosurgery and show that institutions, neurosurgeons, and patients are using YouTube as an educational and promotional platform. As online communications continue to evolve, it will be important to harness this tool to advance patient-oriented communication and knowledge dissemination in neurosurgery. Copyright © 2017 Elsevier Inc. All rights reserved.

  19. Neurosurgery and Music; Effect of Wolfgang Amadeus Mozart. (United States)

    Gasenzer, Elena Romana; Kanat, Ayhan; Neugebauer, Edmund


    The nervous system works like a great orchestra. Specifically, the music of Mozart with its "Mozart effect" is appropriate to use in neurosurgery. We investigated the relationship between Mozart's music and neurosurgery. We used digital catalogs like "PubMed" and the libraries of universities. Key words were "Wolfgang Amadeus Mozart" and "neurosurgery and music." In the first half of the 20th century, performing neurosurgery on some musicians, such as Maurice Ravel, Josef Hassid, and George Gershwin, resulted in a fatal outcome. The cause of this is probably that neurosurgery had not been developed yet in the first half of the 20th century. In the past 3 decades, the neurosurgical operations of musicians show that musicians have rich associations among auditory, somatic, and sensorial systems. It is clear that we have much to learn from studies about music and brain function that derive from our surgical experiences with patients. The neuronal plasticity of musicians' brains may be different from that of nonmusicians' brains. Musicians with enhanced motor skills have greater capacity for plasticity because of enriched interhemispheric connections. Listening to music and the effect of Mozart in neurosurgical practice, intensive care, or rehabilitation were documented in many studies. As authors, we mean something different: Its effectiveness should be studied. We concluded that in current neurosurgical practice, Mozart has an effect. More research and clinical studies are needed. Copyright © 2017 Elsevier Inc. All rights reserved.

  20. Attitudes and perceptions of medical students toward neurosurgery. (United States)

    Akhigbe, Taiwo; Sattar, Mohammad


    To evaluate the attitudes and perceptions of medical student toward neurosurgery. A cross-sectional survey comprising questions based on a Likert scale was used to analyze the attitudes and perceptions of third-year, fourth-year, and fifth-year medical students from the Royal College of Surgeons in Ireland. An anonymous questionnaire containing 15 items was administered and scored following a Likert ranking scale (1, disagree; 2, agree somewhat; 3, agree moderately; 4, agree strongly). This prospective study included 60 students 20-26 years old (mean age, 23 years old). Most of the students agreed that their neurosurgery teaching is inadequate, neurosurgical history is difficult to obtain, neurosurgical signs are difficult to elicit, the neurosurgery training period is long, neurosurgical illnesses have poor outcomes, and neurosurgery can impede family life (70%-100%). The findings identify some areas that may be targeted to stimulate and improve medical students' interest and passion toward the pursuit of neurosurgery as a specialty and ultimately to improve their learning experience. Crown Copyright © 2014. Published by Elsevier Inc. All rights reserved.

  1. Evidence-based medicine in neurosurgery: an academic publication view. (United States)

    Liu, Weiming; Ni, Ming; Jia, Wang; Wan, Weiqing; Tang, Jie


    Although evidence-based medicine (EBM) has been progressively developing for decades in neurosurgery, there remains a lack of data to fully understand this topic. This study was aimed to evaluate extensively EBM related to neurosurgery through the analysis of neurosurgical EBM publications. We searched the Web of Science (WoS) Core Collection database for all EBM publications related to neurosurgery. The number of publications and other information were obtained. Data were extracted from the search results to obtain the following information: document type, countries/territories, funding agencies, organizations, publication year, source of titles, and research area. From among all of the publications, we extracted randomized controlled trials (RCTs) for further analysis at RCT characteristic and funding agencies. According to the search strategy, 6907 publications were related to EBM in neurosurgery. A total of 91 countries/territories participated in neurosurgical EBM publications. English-speaking countries (USA, England, and Canada) contributed most of the publications. "University of Toronto" is the organization which published the most EBM publications. In total, 1654 neurosurgical RCTs were found. We summarize their characteristics and record the highest cited (more than 400) RCTs, which we descript the distribution in different neurosurgical fields and stages. We also found that more than half of the RCTs were directly funded by industrial companies, and government-funded agencies accounted for no more than one fifth of the RCTs. EBM in neurosurgery has a good foundation but also needs to be constantly revised and improved to synchronize with evidence-based medicine development.

  2. The history of neurosurgery at the University of Sao Paulo

    Directory of Open Access Journals (Sweden)

    Manoel Jacobsen Teixeira


    Full Text Available The history of neurosurgery at University of São Paulo comes from 1918, since its origins under the Department of Neurology from Chair of Psychiatric Clinic and Nervous Diseases. Professor Enjolras Vampré was the great inspiration for such medical specialty in the State of Sao Paulo. In 1929, the first neurosurgical procedures were performed in the recently (at time organized Section of Neurosurgery. The official inauguration of the Division of Functional Neurosurgery occurred at June 1977, with the presence of worldwide well-known neuroscientists. The division suffered a deep streamlining under the leadership of Professor Raul Marino Jr., between the decades of 1990 and 2000. At this time, it was structured with the sections of neurological surgery, functional neurosurgery and neurosurgical emergency. Since 2008, Professor Manoel Jacobsen Teixeira is the Chairman of the Division and has provided the Division with the best available technological resources, performing more than 3,000 surgeries a year and training professionals who will, certainly, be some of the future leaders of brazilian neurosurgery.

  3. The history of neurosurgery at the University of Sao Paulo. (United States)

    Teixeira, Manoel Jacobsen; Figueiredo, Eberval Gadelha; Taricco, Mario Augusto; Plese, José Píndaro P; Flores, Camila; Teixeira, Saulo A; Luzio, José


    The history of neurosurgery at University of São Paulo comes from 1918, since its origins under the Department of Neurology from Chair of Psychiatric Clinic and Nervous Diseases. Professor Enjolras Vampré was the great inspiration for such medical specialty in the State of Sao Paulo. In 1929, the first neurosurgical procedures were performed in the recently (at time) organized Section of Neurosurgery. The official inauguration of the Division of Functional Neurosurgery occurred at June 1977, with the presence of worldwide well-known neuroscientists. The division suffered a deep streamlining under the leadership of Professor Raul Marino Jr., between the decades of 1990 and 2000. At this time, it was structured with the sections of neurological surgery, functional neurosurgery and neurosurgical emergency. Since 2008, Professor Manoel Jacobsen Teixeira is the Chairman of the Division and has provided the Division with the best available technological resources, performing more than 3,000 surgeries a year and training professionals who will, certainly, be some of the future leaders of brazilian neurosurgery.

  4. Augmented reality in neurosurgery: a systematic review. (United States)

    Meola, Antonio; Cutolo, Fabrizio; Carbone, Marina; Cagnazzo, Federico; Ferrari, Mauro; Ferrari, Vincenzo


    Neuronavigation has become an essential neurosurgical tool in pursuing minimal invasiveness and maximal safety, even though it has several technical limitations. Augmented reality (AR) neuronavigation is a significant advance, providing a real-time updated 3D virtual model of anatomical details, overlaid on the real surgical field. Currently, only a few AR systems have been tested in a clinical setting. The aim is to review such devices. We performed a PubMed search of reports restricted to human studies of in vivo applications of AR in any neurosurgical procedure using the search terms "Augmented reality" and "Neurosurgery." Eligibility assessment was performed independently by two reviewers in an unblinded standardized manner. The systems were qualitatively evaluated on the basis of the following: neurosurgical subspecialty of application, pathology of treated lesions and lesion locations, real data source, virtual data source, tracking modality, registration technique, visualization processing, display type, and perception location. Eighteen studies were included during the period 1996 to September 30, 2015. The AR systems were grouped by the real data source: microscope (8), hand- or head-held cameras (4), direct patient view (2), endoscope (1), and X-ray fluoroscopy (1) head-mounted display (1). A total of 195 lesions were treated: 75 (38.46 %) were neoplastic, 77 (39.48 %) neurovascular, and 1 (0.51 %) hydrocephalus, and 42 (21.53 %) were undetermined. Current literature confirms that AR is a reliable and versatile tool when performing minimally invasive approaches in a wide range of neurosurgical diseases, although prospective randomized studies are not yet available and technical improvements are needed.

  5. Neurosurgery in the realm of 10(-9), Part 2: applications of nanotechnology to neurosurgery--present and future. (United States)

    Elder, James B; Liu, Charles Y; Apuzzo, Michael L J


    Neurosurgery in the future will witness an increasing influx of novel technologies, many of which will be based on developments in the emerging science of nanotechnology. Additionally, the continued trend in medicine toward minimally invasive diagnostic and surgical techniques will be aided by incorporation of applications of nanotechnology. Neurosurgeons of the future must facilitate the development of nanotechnology and nanomedicine in their clinical practice and research efforts to optimize patient benefit and facilitate scientific advancement. The fields of nanotechnology and nanomedicine remain in their infancy. Recently, however, the literature regarding nanoscience has rapidly expanded. This article is the second of two and provides a review of recent nanotechnology research relevant to clinical neurosurgery and neurology. The first article reviewed recent developments and issues in nanotechnology with a particular focus on applications to the neurosciences. This article also discusses current developments in nanotechnology and nanomedicine that may yield applications in neurosurgery in the future. Additional attention is given to other emerging technologies that are not truly nanotechnology, such as microelectromechanical systems, which will influence the future of medicine and neurosurgery. The goal is to provide the reader with a brief outline and description of some of the new developments in nanotechnology that may affect the clinical practice or operative experience of neurosurgeons. Continued innovation in nanotechnology presents novel opportunities for translation to the clinical arena. Neuroscience, neurology, and neurosurgery will be greatly affected by the influx of nanoscience and its applications. Through continued collaboration, physicians, scientists, and engineers will shape the futures of nanomedicine and nanoneurosurgery.

  6. Simulation in Neurosurgery-A Brief Review and Commentary. (United States)

    Cobb, Mary In-Ping Huang; Taekman, Jeffrey M; Zomorodi, Ali R; Gonzalez, L Fernando; Turner, Dennis A


    Neurosurgery is one of the most technically demanding and liable of all medical professionals. More than 75% of neurosurgical errors are deemed as preventable and technical in nature. Yet in a specialty that requires such high level of technical expertise, with large consequences for error, there are even fewer opportunities for residents in training to practice on the most complicated cases. Although there is no replacement for actual experiences in the operating room, interpersonal mentorship, coaching, and training, there is room to supplement residency education through simulation. Here we review the evidence to support surgical simulation, describe the strengths and weaknesses of existing technologies in direct neurosurgery specific and indirect simulation applications, and advocate for the development of more neurosurgery-specific applications using emerging kinetic technologies. Copyright © 2015 Elsevier Inc. All rights reserved.

  7. History of Neurosurgery in Democratic People's Republic of Korea. (United States)

    Park, Kee B; Roh, Young Han; Lee-Park, Owen; Park, Sophie


    Neurosurgery in Democratic People's Republic of Korea (DPRK) has undergone remarkable progress since its beginning in the 1950s. With the initial support from socialist countries of the Soviet bloc, especially Professor Constantin Arseni of Romania, the nation has consistently produced a number of its own neurosurgeons each year and fostered further advancement by establishing the Korean Neurosurgery Association (DPRK). Despite the recent international collaborative activity for North Korean neurosurgery-namely with Foundation for International Education in Neurological Surgery, World Federation of Neurological Surgeons, and Korean American Medical Association-the sparse exchange of information, knowledge, and surgical skills still remains largely inadequate. Copyright © 2015 The Authors. Published by Elsevier Inc. All rights reserved.

  8. Mobile pediatric neurosurgery: rapid response neurosurgery for remote or urgent pediatric patients. (United States)

    Owler, Brian K; Carmo, Kathryn A Browning; Bladwell, Wendy; Fa'asalele, T Arieta; Roxburgh, Jane; Kendrick, Tina; Berry, Andrew


    Time-critical neurosurgical conditions require urgent operative treatment to prevent death or neurological deficits. In New South Wales/Australian Capital Territory patients' distance from neurosurgical care is often great, presenting a challenge in achieving timely care for patients with acute neurosurgical conditions. A protocol was developed to facilitate consultant neurosurgery locally. Children with acute, time-critical neurosurgical emergencies underwent operations in hospitals that do not normally offer neurosurgery. The authors describe the developed protocol, the outcome of its use, and the lessons learned in the 9 initial cases where the protocol has been used. Three cases are discussed in detail. Nine children were treated by a neurosurgeon at 5 rural hospitals, and 2 children were treated at a smaller metropolitan hospital. Road ambulance, fixed wing aircraft, and medical helicopters were used to transport the Newborn and Paediatric Emergency Transport Service (NETS) team, neurosurgeon, and patients. In each case, the time to definitive neurosurgical intervention was significantly reduced. The median interval from triage at the initial hospital to surgical start time was 3:55 hours, (interquartile range [IQR] 03:29-05:20 hours). The median distance traveled to reach a patient was 232 km (range 23-637 km). The median interval from the initial NETS call requesting patient retrieval to surgical start time was 3:15 hours (IQR 00:47-03:37 hours). The estimated median "time saved" was approximately 3:00 hours (IQR 1:44-3:15 hours) compared with the travel time to retrieve the child to the tertiary center: 8:31 hours (IQR 6:56-10:08 hours). Remote urgent neurosurgical interventions can be performed safely and effectively. This practice is relevant to countries where distance limits urgent access for patients to tertiary pediatric care. This practice is lifesaving for some children with head injuries and other acute neurosurgical conditions.

  9. Minimizing brain shift in stereotactic functional neurosurgery. (United States)

    Petersen, Erika A; Holl, Etienne M; Martinez-Torres, Irene; Foltynie, Thomas; Limousin, Patricia; Hariz, Marwan I; Zrinzo, Ludvic


    Stereotactic functional neurosurgical interventions depend on precise anatomic targeting before lesioning or deep brain stimulation (DBS) electrode placement. To examine the degree of subcortical brain shift observed when adopting an image-guided approach to stereotactic functional neurosurgery. Coordinates for the anterior and posterior commissural points (AC and PC) were recorded on thin-slice stereotactic magnetic resonance imaging (MRI) scans performed before and immediately after DBS electrode implantation in 136 procedures. The changes in length of AC-PC and in stereotactic coordinates for AC and PC were calculated for each intervention. In patients with Parkinson disease undergoing bilateral subthalamic nucleus (STN) DBS with at least 6 months of follow-up, pre- and postoperative scores of the motor part of the Unified Parkinson's Disease Rating Scale (UPDRS-III) were reviewed. Mean (SD) change in AC-PC length (DeltaAC-PC) was 0.6 (0.4) mm. There was no statistically significant difference in DeltaAC-PC between groups when examining anatomic target subgroups (P =.95), age subgroups (P = .63), sex (P = .59), and unilateral versus bilateral implantation (P =.15). The mean (SD) vector changes for the commissural points were: -0.1 (0.3) mm in X, -0.4 (0.6) mm in Y, and -0.1 (0.7) mm in Z for the AC; and -0.1 (0.3) mm in X, -0.2 (0.7) mm in Y, and 0.0 (0.7) mm in Z for the PC. There was a negligible correlation between the magnitude of brain shift and percentage improvement in UPDRS-III off-medication in patients undergoing STN DBS for PD (R <0.01). Brain shift has long been considered an issue in stereotactic targeting during DBS procedures. However, with the image-guided approach and surgical technique used in this study, subcortical brain shift was extremely limited and did not appear to adversely affect clinical outcome.

  10. The Co-evolution of Neuroimaging and Psychiatric Neurosurgery. (United States)

    Dyster, Timothy G; Mikell, Charles B; Sheth, Sameer A


    The role of neuroimaging in psychiatric neurosurgery has evolved significantly throughout the field's history. Psychiatric neurosurgery initially developed without the benefit of information provided by modern imaging modalities, and thus lesion targets were selected based on contemporary theories of frontal lobe dysfunction in psychiatric disease. However, by the end of the 20th century, the availability of structural and functional magnetic resonance imaging (fMRI) allowed for the development of mechanistic theories attempting to explain the anatamofunctional basis of these disorders, as well as the efficacy of stereotactic neuromodulatory treatments. Neuroimaging now plays a central and ever-expanding role in the neurosurgical management of psychiatric disorders, by influencing the determination of surgical candidates, allowing individualized surgical targeting and planning, and identifying network-level changes in the brain following surgery. In this review, we aim to describe the coevolution of psychiatric neurosurgery and neuroimaging, including ways in which neuroimaging has proved useful in elucidating the therapeutic mechanisms of neuromodulatory procedures. We focus on ablative over stimulation-based procedures given their historical precedence and the greater opportunity they afford for post-operative re-imaging, but also discuss important contributions from the deep brain stimulation (DBS) literature. We conclude with a discussion of how neuroimaging will transition the field of psychiatric neurosurgery into the era of precision medicine.

  11. Unsung hero: Donald Darrow Matson's legacy in pediatric neurosurgery. (United States)

    Rehder, Roberta; Lohani, Subash; Cohen, Alan R


    Donald Darrow Matson made seminal contributions to the field of pediatric neurosurgery. Born in 1913 in Fort Hamilton, New York, Matson was the youngest of four sons of an army colonel. He graduated from Cornell University and, years later, from Harvard Medical School. Matson selected Peter Bent Brigham Hospital for his neurosurgical training, which was interrupted during World War II. As a neurosurgeon, he worked close to the front lines under Brigadier General Elliot Cutler in Europe, earning a Bronze Star. Matson returned to Boston to become Franc Ingraham's fellow and partner. He was a masterful surgeon and, with Ingraham, published Neurosurgery of Infancy and Childhood in 1954, the first pediatric neurosurgery textbook in the world. Upon Ingraham's retirement, Matson became chairman of the department of neurosurgery at Boston Children's Hospital and Peter Bent Brigham. In 1968, he became the inaugural Franc D. Ingraham Professor of Neurological Surgery at Harvard Medical School. Among his neurosurgical accomplishments, Matson served as President of the Harvey Cushing Society, later known as the American Association of Neurological Surgeons. He was unable to preside at the 1969 meeting that marked the 100th anniversary of Cushing's birth, having contracted Creutzfeldt-Jakob disease. Matson died at the age of 55, surviving his mentor Ingraham by only 4 years.

  12. Water balance disorders after neurosurgery: The triphasic response revisited

    NARCIS (Netherlands)

    E.J. Hoorn (Ewout); R. Zietse (Bob)


    textabstractWater balance disorders after neurosurgery are well recognized, but detailed reports of the triphasic response are scarce. We describe a 55-year-old woman, who developed the triphasic response with severe hyper- and hyponatraemia after resection of a suprasellar meningioma. The case

  13. Cranial nerve functional neurosurgery : Evaluation of surgical practice

    NARCIS (Netherlands)

    Le Guerinel, C.; Sindou, M.; Auque, J.; Blondet, E.; Brassier, G.; Chazal, J.; Cuny, E.; Devaux, B.; Fontaine, D.; Finiels, P. -J.; Fuentes, J. -M.; D'Haens, J.; Massager, N.; Mercier, Ph.; Mooij, J.; Nuti, C.; Rousseaux, P.; Serrie, A.; Stecken, J.; de Waele, L.; Keravel, Y.

    We report the results of an investigation carried out on the activity of functional neurosurgery of the cranial nerves in the French-speaking countries, based on the analysis of a questionnaire addressed to all the members of the SNCLF Eighteen centers responded to this questionnaire., which showed

  14. Infectious agents and antibiotic susceptibility in neurosurgery intensive care unit

    Directory of Open Access Journals (Sweden)

    Aslan Güzel


    Full Text Available Aim: Knowing the most frequent causative agents and their sensitivities to antibiotics may contribute to use of appropriate antibiotics. In this study, we aimed to inves-tigate the agents and their antibiotic sensitivity which is isolated from intensive care unit of neurosurgery clinic.Materials and Methods: This retrospective study was performed from 2001 to 2005 at the Neurosurgery inten-sive care unit of Dicle University, Diyarbakir. The pa-tients charts who were followed up more than 48 hours in intensive care unit and their culture results were inves-tigated.Results: There was 457 of 2197 patients which were operated in neurosurgery clinic and it was obtained 1155 culture samples from these patients in five years period. 317 positive cultures were obtained from 123 patients including 73 cerebrospinal fluid, 45 wound, 47 deep tra-cheal aspirate, 96 were urine samples, 27 blood sam-ples and 29 venous catheters samples. Mostly Staphilo-coccus aureus and coagulase negative staphylococcus (CNS were growth in cultures. From the cerebrospinal fluidd, blood and wound the most growth bacteria was coagulase negative staphilococcus, from the urine Es-chericha coli, from deep tracheal aspiration. Klebsiella pnömonia, and from venous catheters Pseudomonas au-reginosa was mostly showed reproduction.Conclusion: S. aureus, CNS and P. aureginosa were mostly isolated bacteria in neurosurgery intensive care unit. Nosocomial intensive care unit infections can be decreased by appropriate preventive measures

  15. [Stereotactic target identification for neurosurgery of Parkinson disease]. (United States)

    Fernández-González, F; Seijo, F; Menéndez-Guisasola, L; Salvador, C; Roger, R L; González-García, F J; Fernández-Martínez, J M; Bulla, B; Fernández-García, C; González-González, S; Galindo, A

    The use of applied neurophysiological methods to improve the stereotactic localization of devices in the deep human brain is a high and systematic technology in Parkinson's neurosurgery today. The available standard equipment for clinical neurophysiology practice may constitute the basic set for high tech functional neurosurgery. Free run and event related multiunit recording, naturalistic and electrical evoked potentials, and deep brain microstimulation responses are the basic methodological set to neurophysiological target localization. This article is concerned with the topic: set out a high technology using low cost equipment. So our 41 cases experienced in pallidal and thalamic nucleolisis and thalamus and subthalamus DBS results suggest that the proposed equipment and methods are the required to assure accuracy and safety for target location.

  16. Neurosurgery In Nigeria - An Evaluation Of The Perception Of ...

    African Journals Online (AJOL)

    Most of the respondents were females 59.1%, and most were in the 20 30 year age group, 57.3%; more than 96% stated that they have heard of neurosurgery previously, but rated the available services in Nigeria as inadequate 50.6%, and quality of services as fair 39.6% or poor 36.6%, respectively. In their opinion, political ...

  17. Three-dimensional, computer simulated navigation in endoscopic neurosurgery

    Directory of Open Access Journals (Sweden)

    Roberta K. Sefcik, BHA


    Conclusion: Three-dimensional, frameless neuronavigation systems are useful in endoscopic neurosurgery to assist in the pre-operative planning of potential trajectories and to help localize the pathology of interest. Neuronavigation appears to be accurate to <1–2 mm without issues related to brain shift. Further work is necessary in the investigation of the effect of neuronavigation on operative time, cost, and patient-centered outcomes.

  18. Simulation training in neurosurgery: advances in education and practice

    Directory of Open Access Journals (Sweden)

    Konakondla S


    Full Text Available Sanjay Konakondla, Reginald Fong, Clemens M Schirmer Department of Neurosurgery and Neuroscience Institute, Geisinger Medical Center, Geisinger Health System, Danville, PA, USA Abstract: The current simulation technology used for neurosurgical training leaves much to be desired. Significant efforts are thoroughly exhausted in hopes of developing simulations that translate to give learners the “real-life” feel. Though a respectable goal, this may not be necessary as the application for simulation in neurosurgical training may be most useful in early learners. The ultimate uniformly agreeable endpoint of improved outcome and patient safety drives these investments. We explore the development, availability, educational taskforces, cost burdens and the simulation advancements in neurosurgical training. The technologies can be directed at achieving early resident milestones placed by the Accreditation Council for Graduate Medical Education. We discuss various aspects of neurosurgery disciplines with specific technologic advances of simulation software. An overview of the scholarly landscape of the recent publications in the realm of medical simulation and virtual reality pertaining to neurologic surgery is provided. We analyze concurrent concept overlap between PubMed headings and provide a graphical overview of the associations between these terms. Keywords: residency education, simulation, neurosurgery training, virtual reality, haptic feedback, task analysis, ACGME 

  19. A technique to identify core journals for neurosurgery using citation scatter analysis and the Bradford distribution across neurosurgery journals. (United States)

    Madhugiri, Venkatesh S; Ambekar, Sudheer; Strom, Shane F; Nanda, Anil


    The volume of scientific literature doubles approximately every 7 years. The coverage of this literature provided by online compendia is variable and incomplete. It would hence be useful to identify "core" journals in any field and validate whether the h index and impact factor truly identify the core journals in every subject. The core journals in every medical specialty would be those that provide a current and comprehensive coverage of the science in that specialty. Identifying these journals would make it possible for individual physicians to keep abreast of research and clinical progress. The top 10 neurosurgical journals (on the basis of impact factor and h index) were selected. A database of all articles cited in the reference lists of papers published in issues of these journals published in the first quarter of 2012 was generated. The journals were ranked based on the number of papers cited from each. This citation rank list was compared with the h index and impact factor rank lists. The rank list was also examined to see if the concept of core journals could be validated for neurosurgical literature using Bradford's law. A total of 22,850 papers spread across 2522 journals were cited in neurosurgical literature over 3 months. Although the top 10 journals were the same, irrespective of ranking criterion (h index, impact factor, citation ranking), the 3 rank lists were not congruent. The top 25% of cited articles obeyed the Bradford distribution; beyond this, there was a zone of increased scatter. Six core journals were identified for neurosurgery. The core journals for neurosurgery were identified to be Journal of Neurosurgery, Neurosurgery, Spine, Acta Neurochirurgica, Stroke, and Journal of Neurotrauma. A list of core journals could similarly be generated for every subject. This would facilitate a focused reading to keep abreast of current knowledge. Collated across specialties, these journals could depict the current status of medical science.

  20. Bradford's law: identification of the core journals for neurosurgery and its subspecialties. (United States)

    Venable, Garrett T; Shepherd, Brandon A; Loftis, Christopher M; McClatchy, S Gray; Roberts, Mallory L; Fillinger, Meghan E; Tansey, James B; Klimo, Paul


    Bradford's law describes the scatter of citations for a given subject or field. It can be used to identify the most highly cited journals for a field or subject. The objective of this study was to use currently accepted formulations of Bradford's law to identify core journals of neurosurgery and neurosurgical subspecialties. All original research publications from 2009 to 2013 were analyzed for the top 25 North American academic neurosurgeons from each subspecialty. The top 25 were chosen from a ranked career h-index list identified from previous studies. Egghe's formulation and the verbal formulation of Bradford's law were applied to create specific citation density zones and identify the core journals for each subspecialty. The databases were then combined to identify the core journals for all of academic neurosurgery. Using Bradford's verbal law with 4 zone models, the authors were able to identify the core journals of neurosurgery and its subspecialties. The journals found in the most highly cited first zone are presented here as the core journals. For neurosurgery as a whole, the core included the following journals: Journal of Neurosurgery, Neurosurgery, Spine, Stroke, Neurology, American Journal of Neuroradiology, International Journal of Radiation Oncology Biology Physics, and New England Journal of Medicine. The core journals for each subspecialty are presented in the manuscript. Bradford's law can be used to identify the core journals of neurosurgery and its subspecialties. The core journals vary for each neurosurgical subspecialty, but Journal of Neurosurgery and Neurosurgery are among the core journals for each neurosurgical subspecialty.

  1. N =1 supergravitational heterotic galileons (United States)

    Deen, Rehan; Ovrut, Burt


    Heterotic M -theory consists of a five-dimensional manifold of the form S 1 / Z 2 × M 4. It has been shown that one of the two orbifold planes, the "observable" sector, can have a low energy particle spectrum which is precisely the N = 1 super-symmetric standard model with three right-handed neutrino chiral supermultiplets. The other orbifold plane constitutes a "hidden" sector which, since its communication with the observable sector is suppressed, will be ignored in this paper. However, the finite fifth-dimension allows for the existence of three-brane solitons which, in order to render the vacuum anomaly free, must appear. That is, heterotic M -theory provides a natural framework for brane-world cosmological scenarios coupled to realistic particle physics. The complete worldvolume action of such three-branes is unknown. Here, treating these solitons as probe branes, we construct their scalar worldvolume Lagrangian as a derivative expansion of the heterotic DBI action. In analogy with similar calculations in the M 5 and AdS 5 context, this leads to the construction of "heterotic Galileons". However, realistic vacua of heterotic M -theory are necessarily N = 1 supersymmetric in four dimensions. Hence, we proceed to supersymmetrize the three-brane worldvolume action, first in flat superspace and then extend the results to N = 1 supergravity. Such a worldvolume action may lead to interesting cosmology, such as "bouncing" universe models, by allowing for the violation of the Null Energy Condition (NEC).

  2. Planning and Executing the Neurosurgery Boot Camp: The Bolivia Experience. (United States)

    Ament, Jared D; Kim, Timothy; Gold-Markel, Judah; Germano, Isabelle M; Dempsey, Robert; Weaver, John P; DiPatri, Arthur J; Andrews, Russell J; Sanchez, Mary; Hinojosa, Juan; Moser, Richard P; Glick, Roberta


    The neurosurgical boot camp has been fully incorporated into U.S. postgraduate education. This is the first implementation of the neurosurgical boot in a developing country. To advance neurosurgical education, we developed a similar boot camp program, in collaboration with Bolivian neurosurgeons, to determine its feasibility and effectiveness in an international setting. In a collective effort, the Bolivian Society for Neurosurgery, Foundation for International Education in Neurological Surgery, Solidarity Bridge, and University of Massachusetts organized and executed the first South American neurosurgical boot camp in Bolivia in 2015. Both U.S. and Bolivian faculty led didactic lectures followed by a practicum day using mannequins and simulators. South American residents and faculty were surveyed after the course to determine levels of enthusiasm and their perceived improvement in fund of knowledge and course effectiveness. Twenty-four neurosurgery residents from 5 South American countries participated. Average survey scores ranged between 4.2 and 4.9 out of 5. Five Bolivian neurosurgeons completed the survey with average scores of 4.5-5. This event allowed for Bolivian leaders in the field to unify around education, resulting in the formation of an institute to continue similar initiatives. Total cost was estimated at $40 000 USD; however, significant faculty, industry, and donor support helped offset this amount. The first South American neurosurgical boot camp had significant value and was well received in Bolivia. This humanitarian model provides a sustainable solution to education needs and should be expanded to other regions as a means for standardizing the core competencies in neurosurgery. Copyright © 2017 Elsevier Inc. All rights reserved.

  3. eLearning resources to supplement postgraduate neurosurgery training. (United States)

    Stienen, Martin N; Schaller, Karl; Cock, Hannah; Lisnic, Vitalie; Regli, Luca; Thomson, Simon


    In an increasingly complex and competitive professional environment, improving methods to educate neurosurgical residents is key to ensure high-quality patient care. Electronic (e)Learning resources promise interactive knowledge acquisition. We set out to give a comprehensive overview on available eLearning resources that aim to improve postgraduate neurosurgical training and review the available literature. A MEDLINE query was performed, using the search term "electronic AND learning AND neurosurgery". Only peer-reviewed English-language articles on the use of any means of eLearning to improve theoretical knowledge in postgraduate neurosurgical training were included. Reference lists were crosschecked for further relevant articles. Captured parameters were the year, country of origin, method of eLearning reported, and type of article, as well as its conclusion. eLearning resources were additionally searched for using Google. Of n = 301 identified articles by the MEDLINE search, n = 43 articles were analysed in detail. Applying defined criteria, n = 28 articles were excluded and n = 15 included. Most articles were generated within this decade, with groups from the USA, the UK and India having a leadership role. The majority of articles reviewed existing eLearning resources, others reported on the concept, development and use of generated eLearning resources. There was no article that scientifically assessed the effectiveness of eLearning resources (against traditional learning methods) in terms of efficacy or costs. Only one article reported on satisfaction rates with an eLearning tool. All authors of articles dealing with eLearning and the use of new media in neurosurgery uniformly agreed on its great potential and increasing future use, but most also highlighted some weaknesses and possible dangers. This review found only a few articles dealing with the modern aspects of eLearning as an adjunct to postgraduate neurosurgery training. Comprehensive

  4. Neurosurgery Education and Development program to treat hydrocephalus and to develop neurosurgery in Africa using mobile neuroendoscopic training. (United States)

    Piquer, José; Qureshi, Mubashir Mahmood; Young, Paul H; Dempsey, Robert J


    OBJECT A shortage of neurosurgeons and a lack of knowledge of neuroendoscopic management of hydrocephalus limits modern care in sub-Saharan Africa. Hence, a mobile teaching project for endoscopic third ventriculostomy (ETV) procedures and a subsequent program to develop neurosurgery as a permanent specialty in Kenya and Zanzibar were created and sponsored by the Neurosurgery Education and Development (NED) Foundation and the Foundation for International Education in Neurological Surgery. The objective of this work was to evaluate the results of surgical training and medical care in both projects from 2006 to 2013. METHODS Two portable neuroendoscopy systems were purchased and a total of 38 ETV workshops were organized in 21 hospitals in 7 different countries. Additionally, 49 medical expeditions were dispatched to the Coast General Hospital in Mombasa, Kenya, and to the Mnazi Moja Hospital in Zanzibar. RESULTS From the first project, a total of 376 infants with hydrocephalus received surgery. Six-month follow-up was achieved in 22%. In those who received follow-up, ETV efficacy was 51%. The best success rates were achieved with patients 1 year of age or older with aqueductal stenosis (73%). The main causes of hydrocephalus were infection (56%) and spina bifida (23%). The mobile education program interacted with 72 local surgeons and 122 nurses who were trained in ETV procedures. The second project involved 49 volunteer neurosurgeons who performed a total of 360 nonhydrocephalus neurosurgical operations since 2009. Furthermore, an agreement with the local government was signed to create the Mnazi Mmoja NED Institute in Zanzibar. CONCLUSIONS Mobile endoscopic treatment of hydrocephalus in East Africa results in reasonable success rates and has also led to major developments in medicine, particularly in the development of neurosurgery specialty care sites.

  5. Big Data hvor N=1

    DEFF Research Database (Denmark)

    Bardram, Jakob Eyvind


    Forskningen vedrørende anvendelsen af ’big data’ indenfor sundhed er kun lige begyndt, og kan på sigt blive en stor hjælp i forhold til at tilrettelægge en mere personlig og helhedsorienteret sundhedsindsats for multisyge. Personlig sundhedsteknologi, som kort præsenteres i dette kapital, rummer et...... stor potentiale for at gennemføre ’big data’ analyser for den enkelte person, det vil sige hvor N=1. Der er store teknologiske udfordringer i at få lavet teknologier og metoder til at indsamle og håndtere personlige data, som kan deles, på tværs på en standardiseret, forsvarlig, robust, sikker og ikke...

  6. A Master-Slave Haptic System for Neurosurgery

    Directory of Open Access Journals (Sweden)

    Vanni Zanotto


    Full Text Available In recent years, new surgical tools have been designed to improve treatment results and lower patient trauma. Nevertheless, the dexterity and accuracy required for the positioning of new tools are often unreachable, if surgeons are not assisted by suitable systems. Significant advantages are derived from the introduction of computer and robot technologies. For that reason, the interaction between robotic systems and surgeons today is producing new interest worldwide both in medical and engineering fields. In particular, medical robotics has found fruitful ground in neurosurgical applications, since the high functional density of the central nervous system requires strict accuracy constraints on tool positioning. As a matter of fact, the major benefits of robots, such as precision, accuracy and repeatability, make them ideal as neurosurgeons’ assistants. This paper presents a master-slave haptic robotic system for minimally invasive neurosurgery, which can aid surgeons in performing safer and more accurate stereotactic neurosurgical treatments. The design of the proposed system is based on LANS (Linear Actuator for NeuroSurgery, which has been developed by our Research Group. Experimental test aimed at showing the added value of the DAANS system over its predecessor, the effectiveness of conformational caps and of the added rotational degree of freedom are scheduled for the upcoming months.

  7. The Current Use of Social Media in Neurosurgery. (United States)

    Alotaibi, Naif M; Badhiwala, Jetan H; Nassiri, Farshad; Guha, Daipayan; Ibrahim, George M; Shamji, Mohammed F; Lozano, Andres M


    To measure the presence and popularity of neurosurgical departments, journals, and nonprofit organizations on 3 major social networks. A systematic 2-pronged search strategy was used in June 2015 to identify all accounts on Facebook, Twitter, and YouTube that were relevant to neurosurgery. Online search was conducted by 2 independent authors. All accounts were ranked according to their popularity data. Our search yielded 158 social media accounts (86 Facebook, 59 Twitter, and 13 YouTube) of neurosurgical private and academic practice departments. Of the 158 accounts we retrieved, 117 were for private practice centers (74%). Accounts of academic and private departments had a similar median number of "likes" and "followers" on Facebook and Twitter, respectively. Seven neurosurgical journals only had active Facebook and Twitter accounts (of 20 screened journals). When compared with studies of social media in other medical subspecialties, the use of these networks in neurosurgery followed a similar pattern in their presence and popularity. The current study shows different uses of social media platforms and numbers of users of the online neurosurgical community. Content optimization, advanced metrics of user engagement, and their subsequent effects on academic impact remain unanswered queries and require further prospective study. Copyright © 2016 Elsevier Inc. All rights reserved.

  8. Supplementary Educational Models in Canadian Neurosurgery Residency Programs. (United States)

    Ryu, Won Hyung A; Chan, Sonny; Sutherland, Garnette R


    The proposed implementation of work hour restrictions has presented a significant challenge of maintaining the quality of resident education and ensuring adequate hands-on experience that is essential for novice surgeons. To maintain the level of resident surgical competency, revision of the apprentice model of surgical education to include supplementary educational methods, such as laboratory and virtual reality (VR) simulations, have become frequent topics of discussion. We aimed to better understand the role of supplementary educational methods in Canadian neurosurgery residency training. An online survey was sent to program directors of all 14 Canadian neurosurgical residency programs and active resident members of the Canadian Neurosurgical Society (N=85). We asked 16 questions focusing on topics of surgeon perception, current implementation and barriers to supplementary educational models. Of the 99 surveys sent, 8 out of 14 (57%) program directors and 37 out of 85 (44%) residents completed the survey. Of the 14 neurosurgery residency programs across Canada, 7 reported utilizing laboratory-based teaching within their educational plan, while only 3 programs reported using VR simulation as a supplementary teaching method. The biggest barriers to implementing supplementary educational methods were resident availability, lack of resources, and cost. Work-hour restrictions threaten to compromise the traditional apprentice model of surgical training. The potential value of supplementary educational methods for surgical education is evident, as reported by both program directors and residents across Canada. However, availability and utilization of laboratory and VR simulations are limited by numerous factors such as time constrains and lack of resources.

  9. Quantum computing: a prime modality in neurosurgery's future. (United States)

    Lee, Brian; Liu, Charles Y; Apuzzo, Michael L J


    With each significant development in the field of neurosurgery, our dependence on computers, small and large, has continuously increased. From something as mundane as bipolar cautery to sophisticated intraoperative navigation with real-time magnetic resonance imaging-assisted surgical guidance, both technologies, however simple or complex, require computational processing power to function. The next frontier for neurosurgery involves developing a greater understanding of the brain and furthering our capabilities as surgeons to directly affect brain circuitry and function. This has come in the form of implantable devices that can electronically and nondestructively influence the cortex and nuclei with the purpose of restoring neuronal function and improving quality of life. We are now transitioning from devices that are turned on and left alone, such as vagus nerve stimulators and deep brain stimulators, to "smart" devices that can listen and react to the body as the situation may dictate. The development of quantum computers and their potential to be thousands, if not millions, of times faster than current "classical" computers, will significantly affect the neurosciences, especially the field of neurorehabilitation and neuromodulation. Quantum computers may advance our understanding of the neural code and, in turn, better develop and program implantable neural devices. When quantum computers reach the point where we can actually implant such devices in patients, the possibilities of what can be done to interface and restore neural function will be limitless. Copyright © 2012 Elsevier Inc. All rights reserved.

  10. W. W. Keen and the dawn of American neurosurgery. (United States)

    Bingham, W F


    Before the turn of the century, W. W. Keen was the most celebrated neurosurgeon in the United States. During the Civil War he served as a surgeon in the Union Army. He collaborated with Mitchell and Morehouse in clinical studies that culminated in their publishing Gunshot Wounds and Other Injuries of Nerves. In 1887, he was the first surgeon in the Americas to remove a benign brain tumor. He perfected a technique for ventricular puncture, devised operations for spasmodic torticollis, microcephalus, and tic douloureaux, and introduced many European neurosurgical techniques to the United States. An astute clinician and excellent teacher, Keen had no research interests other than anatomical and pathological dissections. He published over 50 papers on neurosurgical topics, in addition to articles on numerous other subjects. Although recognized as a pioneer in neurosurgery, he is not usually considered a founder of neurosurgery in the United States because of his failure to develop the specialty further than his contemporaries in the remainder of the neurosurgical world. This failure related not to his abilities, but probably to the fact that he was elderly before it became technically possible to perform safe and effective intracranial procedures.

  11. [Current use of Social Media in Neurosurgery in Spain]. (United States)

    Mata-Gómez, Jacinto; Gilete-Tejero, Ignacio Javier; Rico-Cotelo, María; Royano-Sánchez, Manuel; Ortega-Martínez, Marta


    To analyze the current situation in Spain of the use of Social Media in Neurosurgery. We made an observational transversal study between February and March 2017, with a systematic search of the Facebook, Twitter and Youtube accounts from public and private neurosurgical units, scientific societies, peer-reviewed publications and patients groups in relation with Neurosurgical pathologies. We rank them according their popularity. According of our search only 5 public neurosurgical services have social media accounts, being their popularity inferior to the private units accounts. In relation with the scientific societies and neurosurgical publications their presence in social media is marginal, even more in comparison to the accounts of other medical specialities. The popularity of associations of patients and supporting groups is high, especially among patients, finding there more information about their disease. The use in Spain of Social Media about Neurosurgery is low in comparison to other medical specialities. There is a huge field to improve the popularity of the accounts, making in them promotion of health and extend the diffusion of the scientific society and the peer-reviewed publication Neurocirugía. Copyright © 2018 Sociedad Española de Neurocirugía. Publicado por Elsevier España, S.L.U. All rights reserved.

  12. Rhabdomyolysis after neurosurgery: a review and a framework for prevention. (United States)

    De Tommasi, Claudio; Cusimano, Michael D


    Rhabdomyolysis (RM) is a potentially fatal or disabling clinical syndrome resulting in muscle necrosis and leakage of muscle constituents into the blood. Lactic acidosis and more serious complications such as acute renal failure may occur in up to half of recognized cases, so accurate diagnosis is required. We present three cases in which RM occurred in patients undergoing neurosurgical procedures performed in the lateral position. A review of the literature is provided together with a framework for the prevention of this surgical complication. Three patients underwent neurosurgical procedures in the lateral position for left facial/glossopharyngeal neuralgia, for jugular foramen tumor, and for a petroclival meningioma, respectively. All patients were obese and all three showed massive postoperative elevation in creatine kinase (CK) levels characteristic of RM. Myoglobinuria was identified in two patients and all three showed hyperintensity of the hip gird muscles in the short tau inversion recovery sequence magnetic resonance imaging. All recovered spontaneously and none went on to develop renal failure. A literature review showed that RM has been rarely reported after neurosurgery. However, the duration of procedures of the cases of reported RM indicates that the prevalence of the condition is likely highly under-recognized in neurosurgery. This is particularly important given the rising obesity rates seen in many countries. Obese patients undergoing long neurosurgical procedures, particularly in the lateral position, should be suspected of RM and should be closely monitored for CK levels, myoglobinuria, and acidosis. We outline a framework of strategies for the prevention of the condition.

  13. Measurement accuracy of foramen of vesalius for safe percutaneous techniques using computer-assisted three-dimensional landmarks. (United States)

    Ozer, Mehmet Asim; Govsa, Figen


    The presence and description of anatomical findings about the foramen of Vesalius (FV) is important in the surgical procedure on the trigeminal nerve and/or trigeminal ganglion. This is an evaluation area for percutaneous techniques. A morphological analysis of the FVs was made in a total of 344 sides of the basis cranii of adult skulls by computerized photogrammetry using standardized digital photographs. The FV was identified in 60 specimens (34.8%). The FV was observed to be present bilaterally in 16 specimens (9.3%). The incidence of unilateral FV was 25.5% of the skulls, of which in 26 specimens (15.1%) it occurred on the left side, and in 18 specimens (10.4%) on the right side. The FV was observed to present a double opening in two specimens. The diameters of the FV were found to be 0.86 ± 0.21 (right) and 1.07 ± 0.37 mm (left). The incidence of openings with a diameter of FV 0.5 mm or more was found to be 45%. The area of the FV was calculated as 1.09 ± 0.51, and 1.4 ± 0.83 mm(2) on the right and the left, respectively. The mean distances of FV to the foramen ovale were measured as 2.30 ± 1.14 mm (right) and 2.46 ± 0.89 mm (left). The mean distances of FV to foramen spinosum were found to be 10.76 ± 1.26 mm (right) and 10.42 ± 1.29 mm (left). The findings suggest that the diameter of FV as <0.5 mm was safer to work with, while the opening types bigger than 0.5 mm opening types were highly risky for percutaneous techniques on the foramen ovale. In our study, a clear standardization has been achieved. The findings were the data obtained through computer-assisted three dimensional landmarks, appropriate for use in three dimensional planning.

  14. Experimental and clinical standards, and evolution of lasers in neurosurgery. (United States)

    Devaux, B C; Roux, F X


    From initial experiments of ruby, argon and CO2 lasers on the nervous system so far, dramatic progress was made in delivery systems technology as well as in knowledge of laser-tissue interaction effects and hazards through various animal experiments and clinical experience. Most surgical effects of laser light on neural tissue and the central nervous system (CNS) are thermal lesions. Haemostasis, cutting and vaporization depend on laser emission parameters--wavelength, fluence and mode--and on the exposed tissues optical and thermal properties--water and haemoglobin content, thermal conductivity and specific heat. CO2 and Nd-YAG lasers have today a large place in the neurosurgical armamentarium, while new laser sources such as high power diode lasers will have one in the near future. Current applications of these lasers derive from their respective characteristics, and include CNS tumour and vascular malformation surgery, and stereotactic neurosurgery. Intracranial, spinal cord and intra-orbital meningiomas are the best lesions for laser use for haemostasis, dissection and tissue vaporization. Resection of acoustic neuromas, pituitary tumours, spinal cord neuromas, intracerebral gliomas and metastases may also benefit from lasers as accurate, haemostatic, non-contact instruments which reduce surgical trauma to the brain and eloquent structures such as brain stem and cranial nerves. Coagulative lasers (1.06 microns and 1.32 microns Nd-YAG, argon, or diode laser) will find an application for arteriovenous malformations and cavernomas. Any fiberoptic-guided laser will find a use during stereotactic neurosurgical procedures, including image-guided resection of tumours and vascular malformations and endoscopic tumour resection and cysts or entry into a ventricle. Besides these routine applications of lasers, laser interstitial thermotherapy (LITT) and photodynamic therapy (PDT) of brain tumours are still in the experimental stage. The choice of a laser in a

  15. The prognostic value of histopathology on lingual nerve neurosensory recovery after micro-neurosurgery

    DEFF Research Database (Denmark)

    Hørberg, Mette; Reibel, Jesper; Kragelund, Camilla


    OBJECTIVE: Micro-neurosurgical repair is considered in permanent nerve damage but the outcome is unpredictable. We examined if histopathologic parameters of traumatic neuromas have a prognostic value for recovery in relation to lingual nerve micro-neurosurgery. MATERIALS AND METHODS: Retrospective...... case study on neurosensory recovery after micro-neurosurgery. Outcome variables were as follows: pain perception, two-point discrimination, and sum score of perception, before and 12 months after micro-neurosurgery. Predictive histopathology variables included size, nerve tissue, and inflammation...

  16. Simulation and augmented reality in endovascular neurosurgery: lessons from aviation. (United States)

    Mitha, Alim P; Almekhlafi, Mohammed A; Janjua, Major Jameel J; Albuquerque, Felipe C; McDougall, Cameron G


    Endovascular neurosurgery is a discipline strongly dependent on imaging. Therefore, technology that improves how much useful information we can garner from a single image has the potential to dramatically assist decision making during endovascular procedures. Furthermore, education in an image-enhanced environment, especially with the incorporation of simulation, can improve the safety of the procedures and give interventionalists and trainees the opportunity to study or perform simulated procedures before the intervention, much like what is practiced in the field of aviation. Here, we examine the use of simulators in the training of fighter pilots and discuss how similar benefits can compensate for current deficiencies in endovascular training. We describe the types of simulation used for endovascular procedures, including virtual reality, and discuss the relevant data on its utility in training. Finally, the benefit of augmented reality during endovascular procedures is discussed, along with future computerized image enhancement techniques.

  17. What Have We Learned About Movement Disorders from Functional Neurosurgery? (United States)

    Lozano, Andres M; Hutchison, William D; Kalia, Suneil K


    Modern functional neurosurgery for movement disorders such as Parkinson's disease, tremor, and dystonia involves the placement of focal lesions or the application of deep brain stimulation (DBS) within circuits that modulate motor function. Precise targeting of these motor structures can be further refined by the use of electrophysiological approaches. In particular, microelectrode recordings enable the delineation of neuroanatomic structures. In the course of these operations, there is an opportunity not only to map basal ganglia structures but also to gain insights into how disturbances in neural activity produce movement disorders. In this review, we aim to highlight what the field has uncovered thus far about movement disorders through DBS. The work to date lays the foundation for future studies that will shed further light on dysfunctional circuits mediating diseases of the nervous system and how we might modulate these circuits therapeutically.

  18. Balloons in endovascular neurosurgery: history and current applications. (United States)

    Alaraj, Ali; Wallace, Adam; Dashti, Reza; Patel, Prasad; Aletich, Victor


    The use of balloons in the field of neurosurgery is currently an essential part of our clinical practice. The field has evolved over the last 40 years since Serbinenko used balloons to test the feasibility of occluding cervical vessels for intracranial pathologies. Since that time, indications have expanded to include sacrificing cervical and intracranial vessels with detachable balloons, supporting the coil mass in wide-necked aneurysms (balloon remodeling technique), and performing intracranial and cervical angioplasty for atherosclerotic disease, as well as an adjunct to treat arteriovenous malformations. With the rapid expansion of endovascular technologies, it appears that the indications and uses for balloons will continue to expand. In this article, we review the history of balloons, the initial applications, the types of balloons available, and the current applications available for endovascular neurosurgeons.

  19. Intraoperative Eptifibatide Administration During Urgent Arterial Bypass in Neurosurgery. (United States)

    Stambolija, Vasilije; Mrak, Goran; Lozic, Marin; Ljevak, Josip; Miklic Bublic, Martina; Scap, Miroslav


    In some cases when risk of occlusion of a blood vessel is greater than risk of bleeding when patients undergo urgent or unplanned bypass during neurosurgery, the use of eptifibatide may be an option. We describe 2 patients who underwent arterial bypass in whom eptifibatide was used successfully intraoperatively during neurosurgery for prevention of bypass occlusion. The first patient presented with a right middle cerebral artery (MCA) aneurysm with subocclusive stenosis of the M1 branch. After right-sided osteoplastic frontotemporal craniotomy, the MCA bifurcation was exposed with a bifurcational 6-mm aneurysm with a wide neck. Prebifurcation stenosis was found, with yellow calcification of the vessel wall, and postbifurcation calcification was found on the upper M2 branch. Superficial temporal artery-MCA bypass and occlusion of the MCA aneurysm was done. Before the bypass, continuous intravenous infusion of eptifibatide 1 μg/kg/minute was administered. The patient recovered normally without hemorrhage or neurologic deficit. The second patient presented with a left-sided lateral sphenoid wing meningioma. Left-sided frontotemporal craniotomy was performed, and the tumor was completely removed from the arachnoid layer. The temporal M3 branch was invaded by the meningioma. As there was no flow through the invaded segment of the aforementioned artery, termino-terminal M3 arterial anastomosis was done. Continuous intravenous infusion of eptifibatide 1 μg/kg/minute was administered. Indocyanine green angiography showed normal flow through the anastomosis, and the patient recovered normally. Future studies are needed to test the safety and potential efficacy of eptifibatide in intraoperative settings. Copyright © 2017 Elsevier Inc. All rights reserved.

  20. H1N1 influenza (Swine flu) (United States)

    Swine flu; H1N1 type A influenza ... The H1N1 virus is now considered a regular flu virus. It is one of the three viruses included in the regular (seasonal) flu vaccine . You cannot get H1N1 flu virus from ...

  1. Harvey Cushing and "birth hemorrhage": early pediatric neurosurgery at The Johns Hopkins Hospital. (United States)

    Mehta, Vivek A; Wijesekera, Olindi; Pendleton, Courtney; Quiñones-Hinojosa, Alfredo; Jallo, George I; Ahn, Edward S


    Of Harvey Cushing's many contributions to neurosurgery, one of the least documented is his early surgical intervention in children and his pioneering efforts to establish pediatric neurosurgery as a subspecialty. Between 1896 and 1912 Cushing conducted nearly 200 operations in children at The Johns Hopkins Hospital. A review of his records suggests that the advances he made in neurosurgery were significantly influenced by his experience with children. In this historical article, the authors describe Cushing's treatment of 6 children, in all of whom Cushing established a diagnosis of "birth hemorrhage." By reviewing Cushing's operative indications, techniques, and outcomes, the authors aim to understand the philosophy of his pediatric neurosurgical management and how this informed his development of neurosurgery as a new specialty.

  2. Candida infection of the central nervous system following neurosurgery: a 12-year review.

    LENUS (Irish Health Repository)

    O'Brien, Deirdre


    Candida infection of the central nervous system (CNS) following neurosurgery is relatively unusual but is associated with significant morbidity and mortality. We present our experience with this infection in adults and discuss clinical characteristics, treatment options, and outcome.

  3. Zig-zag bicoronal scalp incision for cranio-facial cases in paediatric neurosurgery. (United States)

    Leach, Paul; Rutherford, S; Likhith, A; Leggate, J


    We present the use of a zig-zag bicoronal scalp incision for cranial-facial cases in paediatric neurosurgery. The authors believe that this technique leads to improved cosmesis, especially when the hair is wet.

  4. Utilizing virtual and augmented reality for educational and clinical enhancements in neurosurgery. (United States)

    Pelargos, Panayiotis E; Nagasawa, Daniel T; Lagman, Carlito; Tenn, Stephen; Demos, Joanna V; Lee, Seung J; Bui, Timothy T; Barnette, Natalie E; Bhatt, Nikhilesh S; Ung, Nolan; Bari, Ausaf; Martin, Neil A; Yang, Isaac


    Neurosurgery has undergone a technological revolution over the past several decades, from trephination to image-guided navigation. Advancements in virtual reality (VR) and augmented reality (AR) represent some of the newest modalities being integrated into neurosurgical practice and resident education. In this review, we present a historical perspective of the development of VR and AR technologies, analyze its current uses, and discuss its emerging applications in the field of neurosurgery. Copyright © 2016 Elsevier Ltd. All rights reserved.

  5. Postoperative intracranial neurosurgery infection rates in North America versus Europe: a systematic analysis. (United States)

    McClelland, Shearwood


    Postoperative wound infection (PWI) after intracranial neurosurgery remains a significant worldwide problem, resulting in substantial morbidity/mortality if not combatted quickly and energetically. Although the danger of PWI is universally recognized, the reported incidence of PWI after intracranial neurosurgery remains variable, ranging from 1% to 8% in published series. The impact of geography on this reported variability has not been previously investigated. To address this issue, published comprehensive intracranial neurosurgery series were reviewed, segregating findings geographically between North American and European series. A comprehensive literature search was conducted using the Entrez gateway of the PubMed database. Studies conducted in North America and Europe reporting the incidence of PWI after intracranial neurosurgery were subjected to a thorough review. Data from studies meeting inclusion criteria (minimum of 500 cases with no systematic exclusion of procedures) were categorized by origin (North American/European) and design (retrospective/prospective). Recorded incidences were then compared using chi(2) analysis, and estimates of the relative risk of PWI were calculated. Seven studies (4 North American, 3 European) met all of the inclusion criteria, with a 2.6-fold greater PWI incidence reported in the European studies (P PWI for Europeans versus North Americans per operative case was 2.60. PWI after intracranial neurosurgery was nearly 3 times more likely in European versus North American studies. These findings should be considered by clinicians when estimating the risks of intracranial neurosurgery, and highlight the need for future prospective studies to provide evidence-based explanations for these differences.

  6. Historical perspective on the Department of Neurosurgery at the Henry Ford Hospital. (United States)

    Kole, M K; O'Leary, S T; Malik, G M; Rosenblum, M L


    The Henry Ford Hospital (HFH) was founded in 1915 as a philanthropic gift from Henry Ford, the automobile magnate and inventor of the Model T. The hospital and its organizational structure represented a nonsectarian facility that would provide care for all members of society. The system was patterned after the newest and most modern medical centers at the time in Europe, Canada, and the United States, including the German Krankenhauser, the Johns Hopkins Hospital, the Mayo Clinic, and the Peter Bent Brigham Hospital in Boston. The HFH grew into the Henry Ford Health System in the 1970s to 1990s, with the acquisition of other hospitals, the development of a multiple-region-based clinic system through southeastern Michigan, and the development of comprehensive, vertically integrated health care systems. The Division of Neurosurgery at HFH was established by Albert Crawford in 1926. The tradition of training residents in neurosurgery began in 1946, and the residency training program was accredited by the American Board of Neurosurgery in 1954. In 1970, the Division of Neurosurgery of the Department of Surgery was combined with the Division of Neurology to create the joint Department of Neurology and Neurosurgery. A separate Department of Neurosurgery was established in 1981. Four individuals have served as chairmen of the Department of Neurosurgery at HFH, i.e., Albert Crawford (1926-1952), Robert Knighton (1952-1978), James Ausman (1978-1991), and Mark Rosenblum (1992 to the present). During the 1980s and 1990s, HFH evolved into the vertically integrated, regionally distributed Henry Ford Health System. Under the current direction of Dr. Rosenblum, the Department of Neurosurgery at HFH has grown to include 11 full-time neurosurgeons, 2 neuro-oncologists, and 3 investigators with Ph.D. degrees and has recently expanded into three additional hospitals in southeastern Michigan, paralleling the growth of the system. The faculty annually treats more than 2,000 cases in

  7. Avian Influenza A (H5N1)

    Centers for Disease Control (CDC) Podcasts


    In this podcast, CDC's Dr. Tim Uyeki discusses H5N1, a subtype of influenza A virus. This highly pathogenic H5N1 virus doesn't usually infect people, although some rare infections with H5N1 viruses have occurred in humans. We need to use a comprehensive strategy to prevent the spread of H5N1 virus among birds, including having human health and animal health work closely together.  Created: 5/27/2009 by Emerging Infectious Diseases.   Date Released: 5/27/2009.

  8. Surgical expertise in neurosurgery: integrating theory into practice. (United States)

    Gélinas-Phaneuf, Nicholas; Del Maestro, Rolando F


    : The development of technical skills is a major goal of any neurosurgical training program. Residency programs in North America are focused on achieving an adequate level of training to produce technically competent surgeons. The training requirements and educational environments needed to produce expert surgeons are incompletely understood. This review explores the theoretical implications of training technical skills to expertise rather than competency in a complex field such as neurosurgery. First, the terms technical expertise and technical competency are defined. Definitions of these qualities are lacking in all surgical specialties. Second, the assessment of technical skills of neurosurgeons are investigated using an expert performance approach. This approach entails the design of tasks that can capture the level of expertise in a reproducible manner. One method to accomplish this involves the use of novel simulators with validated performance metrics. Third, the training of technical skills using simulation is studied in the optic of developing training curricula that would target the development of expertise rather than simple competency. Such curricula should include objective assessments of technical skills, appropriate feedback, and a distributed schedule of deliberate practice. Implementing a focus on the development of expertise rather than simple competency in surgical performance will lead to innovative developments in the field of neurosurgical education. Novel technologies, such as simulation, will play important roles in the training of future expert surgeons, and focused technical skills curricula with a sound theoretical basis should guide the development of all such programs.

  9. Turkish Contribution to Journal of Neurosurgery and Acta Neurochirurgica. (United States)

    Altinors, Nur; Comert, Serhat; Sonmez, Erkin; Altinel, Faruk


    To evaluate the contribution of Turkish scientists to four journals published by Journal of Neurosurgery (JNS) Publishing Group and to Acta Neurochirurgica (AN) and to its Supplement (ANS). We reviewed every issue of those journals to December 2015 for the total number of articles, articles produced from studies performed entirely in Turkey, and for publications overseas co-authored by the Turkish scientists using the websites of these journals. Citations were searched using "Web of Science" and "Google Scholar" databases. The total number of articles published was 19822 for JNS, 3227 for JNS Spine, 2526 for JNS Pediatrics and 2997 for Neurosurgical Focus. Turkish contribution was 556 articles. 337 (60.61%) articles were the products of studies performed entirely in Turkey, while 219 (39.38%) articles came from overseas, co-authored by Turkish scientists. Overall contribution was 1.94%. A total of 6469 articles were published in AN. 340 papers were the products of studies performed entirely in Turkey. Turkish scientists working overseas co-authored 37 articles. Total contribution was 377 articles (5.82%). 4134 papers had been published in ANS. Contribution was 69 articles (1.66%). Turkish contribution to these journals has started late. The gap has been compensated with publications in the last two decades. Manuscripts of higher scientific level with greater number of citations are needed to increase Turkish contribution to such journals.

  10. Neurosurgery of the future: Deep brain stimulations and manipulations. (United States)

    Nicolaidis, Stylianos


    Important advances are afoot in the field of neurosurgery-particularly in the realms of deep brain stimulation (DBS), deep brain manipulation (DBM), and the newly introduced refinement "closed-loop" deep brain stimulation (CLDBS). Use of closed-loop technology will make both DBS and DBM more precise as procedures and will broaden their indications. CLDBS utilizes as feedback a variety of sources of electrophysiological and neurochemical afferent information about the function of the brain structures to be treated or studied. The efferent actions will be either electric, i.e. the classic excitatory or inhibitory ones, or micro-injection of such things as neural proteins and transmitters, neural grafts, implants of pluripotent stem cells or mesenchymal stem cells, and some variants of gene therapy. The pathologies to be treated, beside Parkinson's disease and movement disorders, include repair of neural tissues, neurodegenerative pathologies, psychiatric and behavioral dysfunctions, i.e. schizophrenia in its various guises, bipolar disorders, obesity, anorexia, drug addiction, and alcoholism. The possibility of using these new modalities to treat a number of cognitive dysfunctions is also under consideration. Because the DBS-CLDBS technology brings about a cross-fertilization between scientific investigation and surgical practice, it will also contribute to an enhanced understanding of brain function. Copyright © 2017. Published by Elsevier Inc.

  11. Three-dimensional printing: technologies, applications, and limitations in neurosurgery. (United States)

    Pucci, Josephine U; Christophe, Brandon R; Sisti, Jonathan A; Connolly, Edward S


    Three-dimensional (3D) printers are a developing technology penetrating a variety of markets, including the medical sector. Since its introduction to the medical field in the late 1980s, 3D printers have constructed a range of devices, such as dentures, hearing aids, and prosthetics. With the ultimate goals of decreasing healthcare costs and improving patient care and outcomes, neurosurgeons are utilizing this dynamic technology, as well. Digital Imaging and Communication in Medicine (DICOM) can be translated into Stereolithography (STL) files, which are then read and methodically built by 3D Printers. Vessels, tumors, and skulls are just a few of the anatomical structures created in a variety of materials, which enable surgeons to conduct research, educate surgeons in training, and improve pre-operative planning without risk to patients. Due to the infancy of the field and a wide range of technologies with varying advantages and disadvantages, there is currently no standard 3D printing process for patient care and medical research. In an effort to enable clinicians to optimize the use of additive manufacturing (AM) technologies, we outline the most suitable 3D printing models and computer-aided design (CAD) software for 3D printing in neurosurgery, their applications, and the limitations that need to be overcome if 3D printers are to become common practice in the neurosurgical field. Copyright © 2017 Elsevier Inc. All rights reserved.

  12. Integrating multimodal information for intraoperative assistance in neurosurgery

    Directory of Open Access Journals (Sweden)

    Eisenmann U.


    Full Text Available Computer-assisted planning of complex neurosurgical interventions benefits from a variety of specific functions and tools. However, commercial planning- and neuronavigation systems are rather restrictive concerning the availability of innovative methods such as novel imaging modalities, fiber tracking algorithms or electrical dipole mapping. In this respect there is a demand for modular neurosurgical planning systems offering flexible interfaces for easy enhancement. Furthermore all relevant planning information should be available within neuron-avigation. In this work we present a planning system providing these capabilities and its suitability and application in a clinical setting. Our Multimodal Planning System (MOPS 3D offers a variety of tools such as definition of trajectories for minimally invasive surgery, segmentation of ROIs, integration of functional information from atlas maps or magnetoencephalography. It also supplies plugin interfaces for future extensions. For intraoperative application MOPS is coupled with the neuronavigation system Brainlab Vector Vision Cranial/ENT (VVC. We evaluated MOPS in the Department of Neurosurgery at the University Hospital Heidelberg. Surgical planning and navigation was performed in 5 frequently occurring clinical cases. The time necessary for planning was between 5 and 15 minutes including data import, segmentation and planning tasks. The additional information intraoperatively provided by MOPS 3D was highly appreciated by the neurosurgeons and the performance was satisfactory.

  13. H1N1 update review. (United States)

    Alenzi, Faris Q


    There is worldwide concern on the spreading pandemic wave of the new swine influenza virus (S-OIV). The WHO has placed the pandemic threat alert to level 6. World leaders and scientists importantly stress that regulations and pandemic preparedness may lower the morbidity and mortality. This review describes the background, origin, epidemiology, signs and symptoms, methods of detecting H1N1, the risk of H1N1 pandemic control plans, immunity to H1N1, vaccination against H1N1, hospital management, patient management, and treatment of symptoms. It also describes in considerable detail the responsibilities of health professionals in navigating the complex areas of laboratory diagnosis, patient isolation procedures, and how to minimize and manage any accompanying staff infections, all of which are vital processes to help mitigate and minimize the seriousness of local and national de-novo outbreaks of emerging H1N1 infection.

  14. History of the Neurosurgery Department of Pontificia Universidad Catolica, Santiago, Chile. (United States)

    Sfeir, Felipe; Villanueva, Pablo; Tagle, Patricio


    Pontificia Universidad Católica de Chile's medical school was founded in 1929. An interest in neurosurgical development arose in the minds of the Dean, Dr. Cristobal Espíldora, and the Chief of Surgery, Dr. Rodolfo Rencoret, in 1946. They encouraged and supported Dr. J. Ricardo Olivares to specialize in Neurosurgery with Professor H. Olivecrona in Stockholm, Sweden. The first neurosurgical procedure in the Hospital Clínico de la Universidad Católica was performed in 1950. Since then, intensive efforts have been made to develop neurosurgery and its science. As a result, it is now a center capable of achieving high-quality standards in vascular, oncologic, and endoscopic neurosurgery; stereotactic and radiosurgery; complex spine surgery; pediatric neurosurgery; and epilepsy surgery. This article tells the story of a university hospital neurosurgery service in a country at the southern end of the world and how it became one of the most important neurosurgical centers in Chile and South America. Copyright © 2016 Elsevier Inc. All rights reserved.

  15. Crisis Management Simulation: Establishing a Dual Neurosurgery and Anesthesia Training Experience. (United States)

    Ciporen, Jeremy; Gillham, Haley; Noles, Michele; Dillman, Dawn; Baskerville, Mark; Haley, Caleb; Spight, Donn; Turner, Ryan C; Lucke-Wold, Brandon P


    Simulation training has been shown to be an effective teaching tool. Learner management of an intraoperative crisis such as a major cerebrovascular bleed requires effective teamwork, communication, and implementation of key skill sets at appropriate time points. This study establishes a first of a kind simulation experience in a neurosurgery/anesthesia resident (learners) team working together to manage an intraoperative crisis. Using a cadaveric cavernous carotid injury perfusion model, 7 neurosurgery and 6 anesthesia learners, were trained on appropriate vascular injury management using an endonasal endoscopic technique. Learners were evaluated on communication skills, crisis management algorithms, and implementation of appropriate skill sets at the right time. A preanatomic and postanatomic examination and postsimulation survey was administered to neurosurgery learners. Anesthesia learners provided posttraining evaluation through a tailored realism and teaching survey. Neurosurgery learners' anatomic examination score improved from presimulation (33.89%) to postsimulation (86.11%). No significant difference between learner specialties was observed for situation awareness, decision making, communications and teamwork, or leadership evaluations. Learners reported the simulation realistic, beneficial, and highly instructive. Realistic, first of kind, clinical simulation scenarios were presented to a neurosurgery/anesthesia resident team who worked together to manage an intraoperative crisis. Learners were effectively trained on crisis management, the importance of communication, and how to develop algorithms for future implementation in difficult scenarios. Learners were highly satisfied with the simulation training experience and requested that it be integrated more consistently into their residency training programs.

  16. Patient Satisfaction and Short-Term Outcome in Elective Cranial Neurosurgery. (United States)

    Reponen, Elina; Tuominen, Hanna; Hernesniemi, Juha; Korja, Miikka


    Patient-reported experience is often used as a measure for quality of care, but no reports on patient satisfaction after cranial neurosurgery exist. To study the association of overall patient satisfaction and surgical outcome and to evaluate the applicability of overall patient satisfaction as a proxy for quality of care in elective cranial neurosurgery. We conducted an observational study on the relationship of overall patient satisfaction at 30 postoperative days with surgical and functional outcome (modified Rankin Scale [mRS] score) in a prospective, consecutive, and unselected cohort of 418 adult elective craniotomy patients enrolled between December 2011 and December 2012 at Helsinki University Hospital, Helsinki, Finland. Postoperative overall (subjective and objective) morbidity was present in 194 (46.4%) patients; yet almost 94% of all study patients reported high overall satisfaction. Low overall patient satisfaction at 30 days was not associated with postoperative major morbidity in elective cranial neurosurgery. Dependent functional status (mRS score ≥3) at 30 days, minor infections, poor postoperative subjective overall health status, and patient-reported severe symptoms (double vision, poor balance) may contribute to unsatisfactory patient experience. Overall patient satisfaction with elective cranial neurosurgery is high. Even 9 of 10 patients with postoperative major morbidity rated high overall patient satisfaction at 30 days. Overall patient satisfaction may merely reflect patient experience and subjective postoperative health status, and therefore it is a poor proxy for quality of care in elective cranial neurosurgery.

  17. National survey on postoperative care and treatment circuits in neurosurgery. (United States)

    Valero, R; Carrero, E; Fàbregas, N; Iturri, F; Saiz-Sapena, N; Valencia, L


    The analysis of surgical processes should be a standard of health systems. We describe the circuit of care and postoperative treatment for neurosurgical interventions in the centres of our country. From June to October 2014, a survey dealing with perioperative treatments and postoperative circuits after neurosurgical procedures was sent to the chiefs of Anaesthesiology of 73 Spanish hospitals with neurosurgery and members of the Neuroscience Section of SEDAR. We obtained 45 responses from 30 centres (41.09%). Sixty percent of anaesthesiologists perform preventive locoregional analgesic treatment. Pain intensity is systematically assessed by 78%. Paracetamol, non-steroidal anti-inflammatory and morphine combinations are the most commonly used. A percentage of 51.1 are aware of the incidence of postoperative nausea after craniotomy and 86.7% consider multimodal prophylaxis to be necessary. Dexamethasone is given as antiemetic (88.9%) and/or anti-oedema treatment (68.9%). A percentage of 44.4 of anaesthesiologists routinely administer anticonvulsive prophylaxis in patients with supratentorial tumours (levetiracetam, 88.9%), and 73.3% of anaesthesiologists have postoperative surveillance protocols. The anaesthesiologist (73.3%) decides the patient's destination, which is usually ICU (83.3%) or PACU (50%). Postoperative neurological monitoring varied according to the type of intervention, although strength and sensitivity were explored in between 70-80%. There is great variability in the responses, probably attributable to the absence of guidelines, different structures and hospital equipment, type of surgery and qualified personnel. We need consensual protocols to standardize the treatment and the degree of monitoring needed during the postoperative period. Copyright © 2017 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.

  18. Smartphones in remote medicine and daily neurosurgery: The Sabah update. (United States)

    Perumall, Vinodh Vayara; Sellamuthu, Pulivendhan; Harun, Rahmat; Zenian, Mohd Sofan


    Healthcare costs continue to rise every day as the demand outgrows the supply of surgeons. The application of telephone consultation for immediate management is needed as most neurosurgeons are technology orientated. This enables a specialist at a remote mobile site to receive the necessary information and reduce transmission time, from the second the patient is seen till the management is obtained. We conducted a survey on smartphone ownership among doctors and gathered cases that needed neurosurgical input from 1(st) November 2012 till 30(th) April 2013 from all 24 district hospitals in Sabah, Malaysia. The percentage of smartphone ownership among doctors surveyed and usage of it for remote and daily medicine at various departments at Queen Elizabeth Hospital, Kota Kinabalu, which shows at least 90% smartphone ownership and proves 100% ownership of cross-platform instant messaging applications and its usage for remote and daily medicine. It also proves to be a more popular mode of referral compared to "teleconsultation" (TC). In Sabah, the TC service is used for remote medical consultation and only available at four hospitals. The sender needs direct access to a computer with the TC software, and it causes delay whereas doctors using smartphones will just need to discuss the case on the spot and obtain the appropriate management within minutes. Smartphone usage is also important in daily neurosurgery especially at the department level to promote efficient communication, organization, and interaction between all the staff. As for the department's administrative sector, it is useful to notify if anyone is on leave, attending courses or even meetings as the shortage can be avoided, and redistribution easily done. It also allows us to transfer simple intra-departmental data at any time, and any place whenever required. With all the given fact, it is clear that a day without utilizing this service in our daily life will leave us handicapped and struggling with time

  19. Sensors management in robotic neurosurgery: the ROBOCAST project. (United States)

    Vaccarella, Alberto; Comparetti, Mirko Daniele; Enquobahrie, Andinet; Ferrigno, Giancarlo; De Momi, Elena


    Robot and computer-aided surgery platforms bring a variety of sensors into the operating room. These sensors generate information to be synchronized and merged for improving the accuracy and the safety of the surgical procedure for both patients and operators. In this paper, we present our work on the development of a sensor management architecture that is used is to gather and fuse data from localization systems, such as optical and electromagnetic trackers and ultrasound imaging devices. The architecture follows a modular client-server approach and was implemented within the EU-funded project ROBOCAST (FP7 ICT 215190). Furthermore it is based on very well-maintained open-source libraries such as OpenCV and Image-Guided Surgery Toolkit (IGSTK), which are supported from a worldwide community of developers and allow a significant reduction of software costs. We conducted experiments to evaluate the performance of the sensor manager module. We computed the response time needed for a client to receive tracking data or video images, and the time lag between synchronous acquisition with an optical tracker and ultrasound machine. Results showed a median delay of 1.9 ms for a client request of tracking data and about 40 ms for US images; these values are compatible with the data generation rate (20-30 Hz for tracking system and 25 fps for PAL video). Simultaneous acquisitions have been performed with an optical tracking system and US imaging device: data was aligned according to the timestamp associated with each sample and the delay was estimated with a cross-correlation study. A median value of 230 ms delay was calculated showing that realtime 3D reconstruction is not feasible (an offline temporal calibration is needed), although a slow exploration is possible. In conclusion, as far as asleep patient neurosurgery is concerned, the proposed setup is indeed useful for registration error correction because the brain shift occurs with a time constant of few tens of minutes.

  20. MINOP: development of a miniaturized endoscopic operation system for neurosurgery (United States)

    Guber, Andreas E.; Wieneke, Paul


    Within the framework of R&D activities in the field of microsystems technology, the Institute for Microstructure Technology of Karlsruhe Research Center among others has started to improve the functionality of existing medicotechnical instruments by increased integration of microtechnical components. On the basis of microsystems fabrication techniques, completely novel medical endoscope systems have become feasible. In cooperation with clinical, technical and industrial partners, a novel endoscopic operation system based on microsystems technology is being developed by the Institute for Microstructure Technology and the Aesculap AG company, Tuttlingen within the framework of the MINOP joint project. This new system shall be applied above all in the field of neurosurgery. This newly conceived endosystem is characterized by a multitude of novelties. It can perform a number of both sensor and actor functions. Due to its extremely small outer diameter, it can be applied through minute openings. As a result of the integrated microfluidic control system, the flexible endoscope can be moved to the actual site of operation on a previously specified path. This will allow future bi- and triportal neuro-endoscopic interventions for critical operations in the brain area. The different lumina of the flexible endoscope fulfill various functions. Via the optical fibers, laser radiation may be led to the distal end of the endoscope. Using microtechnical fabrication methods, special plastic microlenses have been produced. The working channel can be applied for rinsing and removal. Furthermore, the cleaning of the optics or the taking of tissue samples are possible. If required, another laser fiber can be driven forward through the working channel for selective therapy. For the first time, high-performance microinstruments have been developed on the basis of novel materials. These instruments can be applied either through the working channel or through an additional trocar.

  1. Neurosurgery in Turkish poetry: three poets, two poems and two neurosurgeons. (United States)

    Kahilogullari, Gokmen


    Poems are essential in art and vital organs in literature. Similarly, surgery (and neurosurgery) is also regarded to be an art in medicine. From Hippocrates to nowadays, there is a debate on whether medicine -especially surgery- is a kind of an art or a field of science or a combination of both. This close relation becomes clearer during the practice of surgery, especially in neurosurgery. Herein, the relation between Turkish poetry and Turkish neurosurgery is being presented by researching the interesting and exciting stories about three poets (Can Yücel, Hasan Hüseyin Korkmazgil, Nazım Hikmet), their poems; and two Turkish neurosurgeons (Gazi Yaşargil, Yücel Kanpolat).

  2. Russell Meyers (1905-1999): pioneer of functional and ultrasonic neurosurgery. (United States)

    Abel, Taylor J; Walch, Timothy; Howard, Matthew A


    Advances in functional neurosurgery, including neuromodulation and more recently ultrasonic ablation of basal ganglia structures, have improved the quality of life for patients with debilitating movement disorders. What is little known, however, is that both of these neurosurgical advances, which remain on the cutting edge, have their origin in the pioneering work of Russell Meyers, whose contributions are documented in this paper. Meyers' published work and professional correspondence are reviewed, in addition to documents held by the Department of Neurosurgery at the University of Iowa. Meyers was born in Brooklyn, New York, and received his neurosurgical training at hospitals in New York City under Jefferson Browder. In 1939, a chance encounter with a young woman with damaged bilateral ventral striata convinced Meyers that the caudate could be resected to treat Parkinsonism without disrupting consciousness. Shortly thereafter, he performed the first caudate resection for postencephalitic Parkinsonism. In 1946, Meyers became the first chairman of neurosurgery at the State University of Iowa (now the University of Iowa), which led to the recruitment of 8 faculty members and the training of 18 residents during his tenure (1946-1963). Through collaboration with the Fry brothers at the University of Illinois, Meyers performed the first stereotactic ultrasonic ablations of deep brain structures to treat tremor, choreoathetosis, dystonia, intractable pain, and hypothalamic hamartoma. Meyers left academic neurosurgery in 1963 for reasons that are unclear, but he continued clinical neurosurgery work for several more years. Despite his early departure from academic medicine, Meyers' contributions to functional neurosurgery provided a lasting legacy that has improved the lives of many patients with movement disorders.

  3. Byron Stookey: "the old lion"--an unsung giant of neurosurgery. (United States)

    Kaufman, H H; Goodrich, J T


    BYRON POLK STOOKEY, an outstanding clinician and teacher, served as Director and Chief of Neurosurgery at the Neurological Institute of New York Columbia-Presbyterian Medical Center. Highlights of his clinical contributions include improved peripheral nerve and spine surgery and subtemporal trigeminal nerve section for tic douloureux. Through diverse activities in both the political and academic arenas of patient care, education, and research, stookey helped to build and strengthen neurosurgery between the world wars and helped to prepare the foundation for the accomplishments of recent decades.

  4. [Characteristics of perioperative period in Xenon-based combined general anaesthesia in neurosurgery]. (United States)

    Viatkin, A A; Petrosian, L G; Mizikov, V M; Vasil'ev, S A


    Neuroprotection could be the aim to use Xenon for general anesthesia. However the experience of Xenon anesthesia in neurosurgery is quite limited. The appraisal of Xenon based anesthesia was accomplished in 12 patients during various brain surgery. Xe in concentration 65% was used to maintenance of anesthesia, other medication was avoided. As a resuIt there were 8 cases of arterial hypertension and 2 cases of superficial hypnotic state. Excitation (n = 3), hyperdynamic reaction (n = 8), PONV (n = 8) were detected in early postoperative period. An analysis of this study suggests a conclusion that studied method of Xenon-based anesthesia is inexpedient for neurosurgery.

  5. Experiential Learning of Robotics Fundamentals Based on a Case Study of Robot-Assisted Stereotactic Neurosurgery (United States)

    Faria, Carlos; Vale, Carolina; Machado, Toni; Erlhagen, Wolfram; Rito, Manuel; Monteiro, Sérgio; Bicho, Estela


    Robotics has been playing an important role in modern surgery, especially in procedures that require extreme precision, such as neurosurgery. This paper addresses the challenge of teaching robotics to undergraduate engineering students, through an experiential learning project of robotics fundamentals based on a case study of robot-assisted…

  6. Neurosurgical Skills Assessment: Measuring Technical Proficiency in Neurosurgery Residents Through Intraoperative Video Evaluations. (United States)

    Sarkiss, Christopher A; Philemond, Steven; Lee, James; Sobotka, Stanislaw; Holloway, Terrell D; Moore, Maximillian M; Costa, Anthony B; Gordon, Errol L; Bederson, Joshua B


    Although technical skills are fundamental in neurosurgery, there is little agreement on how to describe, measure, or compare skills among surgeons. The primary goal of this study was to develop a quantitative grading scale for technical surgical performance that distinguishes operator skill when graded by domain experts (residents, attendings, and nonsurgeons). Scores provided by raters should be highly reliable with respect to scores from other observers. Neurosurgery residents were fitted with a head-mounted video camera while performing craniotomies under attending supervision. Seven videos, 1 from each postgraduate year (PGY) level (1-7), were anonymized and scored by 16 attendings, 8 residents, and 7 nonsurgeons using a grading scale. Seven skills were graded: incision, efficiency of instrument use, cauterization, tissue handling, drilling/craniotomy, confidence, and training level. A strong correlation was found between skills score and PGY year (P Technical skills of neurosurgery residents recorded during craniotomy can be measured with high interrater reliability. Surgeons and nonsurgeons alike readily distinguish different skill levels. This type of assessment could be used to coach residents, to track performance over time, and potentially to compare skill levels. Developing an objective tool to evaluate surgical performance would be useful in several areas of neurosurgery education. Copyright © 2016 Elsevier Inc. All rights reserved.


    NARCIS (Netherlands)


    Most patients treated for single or multiple brain metastases die from progression of extracranial tumor activity. This makes it uncertain whether the combination of neurosurgery and radiotherapy for treatment of single brain metastasis will lead to better results than less invasive treatment with

  8. Frugal Malleable Micro-Dissectors and Arachnoid Knives for Micro-neurosurgery. (United States)

    Jha, Deepak K


    Like most of the other medical and surgical fields, neurosurgery too has changed drastically in last couple of decades, especially in the fields of understanding, instrumentation and equipments. Safety, scope of treating initially considered non-treatable neurosurgical conditions, and prognosis of most of the neurosurgical procedures have improved significantly. Barrage of newer instruments and equipments are exponential for last many years leading to tremendous cost escalation of the treatment. However, equitable distribution of the neurosurgical services in the society is far from reality. There were many tools and techniques being used by our teachers and forefathers of neurosurgery, which we need to look back and learn their innovative ways to accomplish difficult procedures without advanced tools and techniques. Micro-neurosurgery is considered highly skilled job and instruments used for it are equally delicate, precise and at the same time costlier than similar macro-instruments of neurosurgery. Author shares his experience of using frugal innovative techniques and tools, for making stainless steel wire and plate-micro-dissectors, equally effective for microneurosurgical procedures and can be helpful for neurosurgeons working in the settings of scarce resources. Copyright © 2018 Elsevier Inc. All rights reserved.

  9. [Perceived quality in hospitals of the Andalusia Healthcare System. The case of neurosurgery departments]. (United States)

    Cordero Tous, N; Horcajadas Almansa, Á; Bermúdez González, G J; Tous Zamora, D


    To analyse the characteristics of the perceived quality in hospitals of the Andalusia healthcare system and compare this with that in Andalusian Neurosurgery departments. Randomised surveys, adjusted for working age, were performed in Andalusia using a telephone questionnaire based on the SERVQUAL model with the appropriate modification, with the subsequent selection of a subgroup associated with neurosurgery. Perceived quality was classified as; technical, functional and infrastructure quality. The overall satisfaction was 76.3%. Frequency analysis found that variables related to the technical quality (good doctors, successful operations, trained staff, etc.) obtained more favourable outcomes. Those related to time (wait, consulting, organizing schedules) obtained worse outcomes. The care of families variables obtained poor results. There was no difference between the overall Andalusian healthcare system and neurosurgery departments. In the mean analysis, women and older people gave more favourable responses, especially for variables related to infrastructure quality. In the "cluster" analysis, there were more favourable responses by elderly people, with no differences in gender (P<.009). There is no difference in perceived quality between the Andalusian healthcare system overall and neurosurgery departments. The perceived quality of the Andalusian healthcare system is higher in the elderly people. The analysis of perceived quality is useful for promoting projects to improve clinical management. Copyright © 2014 SECA. Published by Elsevier Espana. All rights reserved.

  10. The Spectrum of Altmetrics in Neurosurgery: The Top 100 "Trending" Articles in Neurosurgical Journals. (United States)

    Wang, Justin; Alotaibi, Naif M; Ibrahim, George M; Kulkarni, Abhaya V; Lozano, Andres M


    Social media are increasingly used for the dissemination of scientific publications by most medical journals. The role of social media in increasing awareness of published works in neurosurgery has not been previously explored. Here, we present a qualitative analysis of the highest trending works in neurosurgery along with a correlation analysis with their social media metrics. We performed a comprehensive search for neurosurgical publications using the Altmetric database. The Altmetric database provides a weighted total score of all online mentions for an article received on Facebook, Twitter, blogs, and mainstream media sources. Our search was limited to articles published within the social media era (January 2010-January 2017). Descriptive and correlational statistics were performed for all articles. The top 100 articles in altmetrics were selected for qualitative analysis. A total of 5794 articles were included in this study. The average Altmetric score in neurosurgical articles was 4.7 (standard deviation ±22.4). Journals with a social media account had significantly higher Altmetric scores for their articles compared with those without an account (P articles in altmetrics belonged primarily to the Journal of Neurosurgery (33%) followed by Neurosurgery (29%). This is the first study that details the spectrum of Altmetric scores among neurosurgical journals. Social media presence for journals is important for greater outreach and engagement. Prediction of traditional citation using altmetrics data requires a future prospective study. Copyright © 2017 Elsevier Inc. All rights reserved.

  11. Elevated Amylase and Lipase Levels in the Neurosurgery Intensive Care Unit

    Directory of Open Access Journals (Sweden)

    Cheng-Chia Lee


    Conclusion: Various neurosurgery events and diagnoses may lead to different degrees of serum pancreatic enzyme elevation. Patients with elevated pancreatic enzyme levels have a higher mortality rate than those with normal enzyme levels. We believe that abdominal CT should be indicated for patients if their amylase levels are more than 3-fold the upper normal limit and lipase levels are more than 5-fold.

  12. Antiviral Prophylaxis and H1N1

    Centers for Disease Control (CDC) Podcasts


    Dr. Richard Pebody, a consultant epidemiologist at the Health Protection Agency in London, UK, discusses the use of antiviral post-exposure prophylaxis and pandemic H1N1.  Created: 7/14/2011 by National Center for Emerging Zoonotic and Infectious Diseases (NCEZID).   Date Released: 7/18/2011.

  13. H1N1 and influenza viruses (United States)

    Mirdamadi, Kamelia; Einarson, Adrienne


    Abstract Question I have been encouraging pregnant women to receive both the H1N1 and influenza vaccines since I became aware of Health Canada’s guidelines. However, some of the women in my practice have heard conflicting information, often from media sources, and they are hesitant to be vaccinated. What is the evidence behind these guidelines, and should I really be convincing these women to be vaccinated? Answer Pregnant women and growing fetuses are considered a population vulnerable to H1N1 and influenza viruses. Health Canada published a report in late 2010 estimating that this population was at increased risk of hospitalization and severe outcomes of H1N1 infection. Recommendations included pregnant women as a priority group to receive the H1N1 vaccine as well as the influenza vaccine. This information should be explained unambiguously to pregnant women, and they should be made aware of the sensationalism of media reports, which are often based on opinion and not evidence. PMID:21918141

  14. Virtual reality training in neurosurgery: Review of current status and future applications. (United States)

    Alaraj, Ali; Lemole, Michael G; Finkle, Joshua H; Yudkowsky, Rachel; Wallace, Adam; Luciano, Cristian; Banerjee, P Pat; Rizzi, Silvio H; Charbel, Fady T


    Over years, surgical training is changing and years of tradition are being challenged by legal and ethical concerns for patient safety, work hour restrictions, and the cost of operating room time. Surgical simulation and skill training offer an opportunity to teach and practice advanced techniques before attempting them on patients. Simulation training can be as straightforward as using real instruments and video equipment to manipulate simulated "tissue" in a box trainer. More advanced virtual reality (VR) 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. A PubMed review of the literature was performed for the MESH words "Virtual reality, "Augmented Reality", "Simulation", "Training", and "Neurosurgery". Relevant articles were retrieved and reviewed. A review of the literature was performed for the history, current status of VR simulation in neurosurgery. Surgical organizations are calling for methods to ensure the maintenance of skills, advance surgical training, and credential surgeons as technically competent. The number of published literature discussing the application of VR simulation in neurosurgery training has evolved over the last decade from data visualization, including stereoscopic evaluation to more complex augmented reality models. With the revolution of computational analysis abilities, fully immersive VR models are currently available in neurosurgery training. Ventriculostomy catheters insertion, endoscopic and endovascular simulations are used in neurosurgical residency training centers across the world. Recent studies have shown the coloration of proficiency with those simulators and levels of experience in the real world. Fully immersive technology is starting to be applied to the practice of neurosurgery. In the near future, detailed VR neurosurgical modules

  15. Integration of patient specific modeling and advanced image processing techniques for image-guided neurosurgery (United States)

    Archip, Neculai; Fedorov, Andriy; Lloyd, Bryn; Chrisochoides, Nikos; Golby, Alexandra; Black, Peter M.; Warfield, Simon K.


    A major challenge in neurosurgery oncology is to achieve maximal tumor removal while avoiding postoperative neurological deficits. Therefore, estimation of the brain deformation during the image guided tumor resection process is necessary. While anatomic MRI is highly sensitive for intracranial pathology, its specificity is limited. Different pathologies may have a very similar appearance on anatomic MRI. Moreover, since fMRI and diffusion tensor imaging are not currently available during the surgery, non-rigid registration of preoperative MR with intra-operative MR is necessary. This article presents a translational research effort that aims to integrate a number of state-of-the-art technologies for MRI-guided neurosurgery at the Brigham and Women's Hospital (BWH). Our ultimate goal is to routinely provide the neurosurgeons with accurate information about brain deformation during the surgery. The current system is tested during the weekly neurosurgeries in the open magnet at the BWH. The preoperative data is processed, prior to the surgery, while both rigid and non-rigid registration algorithms are run in the vicinity of the operating room. The system is tested on 9 image datasets from 3 neurosurgery cases. A method based on edge detection is used to quantitatively validate the results. 95% Hausdorff distance between points of the edges is used to estimate the accuracy of the registration. Overall, the minimum error is 1.4 mm, the mean error 2.23 mm, and the maximum error 3.1 mm. The mean ratio between brain deformation estimation and rigid alignment is 2.07. It demonstrates that our results can be 2.07 times more precise then the current technology. The major contribution of the presented work is the rigid and non-rigid alignment of the pre-operative fMRI with intra-operative 0.5T MRI achieved during the neurosurgery.

  16. Incidence, morphology and morphometry of the foramen of Vesalius: complementary study for a safer planning and execution of the trigeminal rhizotomy technique. (United States)

    Shinohara, André Luis; de Souza Melo, Carina Guimarães; Silveira, Elcia Maria Varize; Lauris, José Roberto Pereira; Andreo, Jesus Carlos; de Castro Rodrigues, Antonio


    The foramen of Vesalius (FV) is located in the greater wing of the sphenoid bone between the foramen ovale (FO) and the foramen rotundum in an intracranial view. The FO allows the passage of the mandibular branch of trigeminal nerve, which is the target of the trigeminal radiofrequency rhizotomy. We analyzed its location, morphology, morphometry and interrelation among other foramina. 400 macerated adult human skulls were examined. A digital microscope (Dino-Lite plus) was used to capture images from the FV. A digital caliper was used to perform the measurements of the distance between the FV and other foramina (FO, foramen spinosum and the carotid canal) in an extracranial view of the skull base. In the 400 analyzed skulls, the FV was identified in 135 skulls (33.75%) and absent on both sides in 265 skulls (66.25%). The FV was observed present bilaterally in 15.5% of the skulls. The incidence of unilateral foramen was 18.25% of the skulls of which 7.75% on right side and 10.5% on left side. The diameter of the FV was measured and we found an average value of 0.65 mm, on right side 0.63 mm and on the left side 0.67 mm. We verified that positive correlations were statistically significant among the three analyzed distances. This study intends to offer specific anatomical data with morphological patterns (macroscopic and mesoscopic) to increase the understanding of the FV features as frequency, incidence and important distances among adjacent foramina.

  17. Quasi-Exact Coulomb Dynamics of n + 1 Charges n - 1 of which are Equal (United States)

    Skrypnik, W. I.


    For n + 1 ≥ 4 point charges n - 1 of which are negative and equal quasi-exact periodic solutions of their Coulomb equation of motion are found. These solutions describe a motion of the negative charges around the vertical axis in such a way that their coordinates coincide with vertices of a regular polygon in planes perpendicular to the axis along which two equal positive charges move.

  18. Some aspects of N = 1 SYM renormalization

    Directory of Open Access Journals (Sweden)

    Stepanyantz Konstantin


    Full Text Available Using the BRST invariant version of the higher covariant derivative regularization, we demonstrate that in N = 1 supersymmetric gauge theories the three-point vertices with two ghost legs and a single leg of the quantum gauge superfield are finite in all orders. This theorem is proved by the help of the Slavnov–Taylor identities and the supergraph technique. Its correctness is verified by explicit one-loop calculation. Using finiteness of the considered vertices we express the NSVZ relation in terms of the anomalous dimensions of the gauge superfield, of the Faddeev–Popov ghosts, and of the matter superfields.

  19. Augmented Reality in Neurosurgery: A Review of Current Concepts and Emerging Applications. (United States)

    Guha, Daipayan; Alotaibi, Naif M; Nguyen, Nhu; Gupta, Shaurya; McFaul, Christopher; Yang, Victor X D


    Augmented reality (AR) superimposes computer-generated virtual objects onto the user's view of the real world. Among medical disciplines, neurosurgery has long been at the forefront of image-guided surgery, and it continues to push the frontiers of AR technology in the operating room. In this systematic review, we explore the history of AR in neurosurgery and examine the literature on current neurosurgical applications of AR. Significant challenges to surgical AR exist, including compounded sources of registration error, impaired depth perception, visual and tactile temporal asynchrony, and operator inattentional blindness. Nevertheless, the ability to accurately display multiple three-dimensional datasets congruently over the area where they are most useful, coupled with future advances in imaging, registration, display technology, and robotic actuation, portend a promising role for AR in the neurosurgical operating room.

  20. 100 Years of British military neurosurgery: on the shoulders of giants. (United States)

    Roberts, S A G


    Death from head injuries has been a feature of conflicts throughout the world for centuries. The burden of mortality has been variously affected by the evolution in weaponry from war-hammers to explosive ordnance, the influence of armour on survivability and the changing likelihood of infection as a complicating factor. Surgery evolved from haphazard trephination to valiant, yet disjointed, neurosurgery by a variety of great historical surgeons until the Crimean War of 1853-1856. However, it was events initiated by the Great War of 1914-1918 that not only marked the development of modern neurosurgical techniques, but our approach to military surgery as a whole. Here the author describes how 100 years of conflict and the input and intertwining relationships between the 20th century's great neurosurgeons established neurosurgery in the United Kingdom and beyond.

  1. Stereotactic neurosurgery in the United Kingdom: the hundred years from Horsley to Hariz. (United States)

    Pereira, Erlick A C; Green, Alexander L; Nandi, Dipankar; Aziz, Tipu Z


    The history of stereotactic neurosurgery in the United Kingdom of Great Britain and Northern Ireland is reviewed. Horsley and Clarke's primate stereotaxy at the turn of the 20th century and events surrounding it are described, including Mussen's development of a human version of the apparatus. Stereotactic surgery after the Second World War is reviewed, with an emphasis on the pioneering work of Gillingham, Hitchcock, Knight, and Watkins and the contributions from Bennett, Gleave, Hughes, Johnson, McKissock, McCaul, and Dutton after the influences of Dott, Cairns, and Jefferson. Forster's introduction of gamma knife radiosurgery is summarized, as is the application of computed tomography by Hounsfield and Ambrose. Contemporary contributions to the present day from Bartlett, Richardson, Miles, Thomas, Gill, Aziz, Hariz, and others are summarized. The current status of British stereotactic neurosurgery is discussed.

  2. Dilaton effective action with N=1 supersymmetry

    Energy Technology Data Exchange (ETDEWEB)

    Bobev, Nikolay [Perimeter Institute for Theoretical Physics, 31 Caroline Street North, Waterloo, ON N2L 2Y5 (Canada); Elvang, Henriette; Olson, Timothy M. [Randall Laboratory of Physics, Department of Physics, University of Michigan,Ann Arbor, MI 48109 (United States)


    We clarify the structure of the four-dimensional low-energy effective action that encodes the conformal and U(1) R-symmetry anomalies in an N=1 supersymmetric field theory. The action depends on the dilaton, τ, associated with broken conformal symmetry, and the Goldstone mode, β, of the broken U(1) R-symmetry. We present the action for general curved spacetime and background gauge field up to and including all possible four-derivative terms. The result, constructed from basic principles, extends and clarifies the structure found by Schwimmer and Theisen in using superfield methods. We show that the Goldstone mode β does not interfere with the proof of the four-dimensional a-theorem based on 2→2 dilaton scattering. In fact, supersymmetry Ward identities ensure that a proof of the a-theorem can also be based on 2→2 Goldstone mode scattering when the low-energy theory preserves N=1 supersymmetry. We find that even without supersymmetry, a Goldstone mode for any broken global U(1) symmetry cannot interfere with the proof of the four-dimensional a-theorem.

  3. Neurosurgery in the realm of 10(-9), part 1: stardust and nanotechnology in neuroscience. (United States)

    Elder, James B; Liu, Charles Y; Apuzzo, Michael L J


    Nanotechnology as a science has evolved from notions and speculation to emerge as a prominent combination of science and engineering that stands to impact innumerable aspects of technology. Medicine in general and neurosurgery in particular will benefit greatly in terms of improved diagnostic and therapeutic capabilities. The recent explosion in nanotechnology products, including diverse applications such as beauty products and medical contrast agents, has been accompanied by an ever increasing volume of literature. Recent articles from our institution provided an historical and scientific background of nanotechnology, with a purposeful focus on nanomedicine. Future applications of nanotechnology to neuroscience and neurosurgery were briefly addressed. The present article is the first of two that will further this discussion by providing specific details of current nanotechnology applications and research related to neuroscience and clinical neurosurgery. This article also provides relevant perspective in scale, history, economics, and toxicology. Topics of specific importance to developments or advances of technologies used by neuroscientists and neurosurgeons are presented. In addition, advances in the field of microelectromechanical systems technology are discussed. Although larger than nanoscale, microelectromechanical systems technologies will play an important role in the future of medicine and neurosurgery. The second article will discuss current nanotechnologies that are being, or will be in the near future, incorporated into the armamentarium of the neurosurgeon. The goal of these articles is to keep the neuroscience community abreast of current developments in nanotechnology, nanomedicine, and, in particular, nanoneurosurgery, and to present possibilities for future applications of nanotechnology. As applications of nanotechnology permeate all forms of scientific and medical research, clinical applications will continue to emerge. Physicians of the

  4. Assessing residents' operative skills for external ventricular drain placement and shunt surgery in pediatric neurosurgery. (United States)

    Aldave, Guillermo; Hansen, Daniel; Briceño, Valentina; Luerssen, Thomas G; Jea, Andrew


    OBJECTIVE The authors previously demonstrated the use of a validated Objective Structured Assessment of Technical Skills (OSATS) tool for evaluating residents' operative skills in pediatric neurosurgery. However, no benchmarks have been established for specific pediatric procedures despite an increased need for meaningful assessments that can either allow for early intervention for underperforming trainees or allow for proficient residents to progress to conducting operations independently with more passive supervision. This validated methodology and tool for assessment of operative skills for common pediatric neurosurgical procedures-external ventricular drain (EVD) placement and shunt surgery- was applied to establish its procedure-based feasibility and reliability, and to document the effect of repetition on achieving surgical skill proficiency in pediatric EVD placement and shunt surgery. METHODS A procedure-based technical skills assessment for EVD placements and shunt surgeries in pediatric neurosurgery was established through the use of task analysis. The authors enrolled all residents from 3 training programs (Baylor College of Medicine, Houston Methodist Hospital, and University of Texas-Medical Branch) who rotated through pediatric neurosurgery at Texas Children's Hospital over a 26-month period. For each EVD placement or shunt procedure performed with a resident, the faculty and resident (for self-assessment) completed an evaluation form (OSATS) based on a 5-point Likert scale with 7 categories. Data forms were then grouped according to faculty versus resident (self) assessment, length of pediatric neurosurgery rotation, postgraduate year level, and date of evaluation ("beginning of rotation," within 1 month of start date; "end of rotation," within 1 month of completion date; or "middle of rotation"). Descriptive statistical analyses were performed with the commercially available SPSS statistical software package. A p value pediatric procedures. The

  5. Virtual reality training in neurosurgery: Review of current status and future applications (United States)

    Alaraj, Ali; Lemole, Michael G.; Finkle, Joshua H.; Yudkowsky, Rachel; Wallace, Adam; Luciano, Cristian; Banerjee, P. Pat; Rizzi, Silvio H.; Charbel, Fady T.


    Background: Over years, surgical training is changing and years of tradition are being challenged by legal and ethical concerns for patient safety, work hour restrictions, and the cost of operating room time. Surgical simulation and skill training offer an opportunity to teach and practice advanced techniques before attempting them on patients. Simulation training can be as straightforward as using real instruments and video equipment to manipulate simulated “tissue” in a box trainer. More advanced virtual reality (VR) 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. Methods: A PubMed review of the literature was performed for the MESH words “Virtual reality, “Augmented Reality”, “Simulation”, “Training”, and “Neurosurgery”. Relevant articles were retrieved and reviewed. A review of the literature was performed for the history, current status of VR simulation in neurosurgery. Results: Surgical organizations are calling for methods to ensure the maintenance of skills, advance surgical training, and credential surgeons as technically competent. The number of published literature discussing the application of VR simulation in neurosurgery training has evolved over the last decade from data visualization, including stereoscopic evaluation to more complex augmented reality models. With the revolution of computational analysis abilities, fully immersive VR models are currently available in neurosurgery training. Ventriculostomy catheters insertion, endoscopic and endovascular simulations are used in neurosurgical residency training centers across the world. Recent studies have shown the coloration of proficiency with those simulators and levels of experience in the real world. Conclusion: Fully immersive technology is starting to be applied to the practice of

  6. Diabetes insipidus following neurosurgery at a university hospital in Western Saudi Arabia. (United States)

    Qari, Faiza A; AbuDaood, Elaff A; Nasser, Tariq A


    To review the incidence, spectrum of clinical manifestation, course, risk factors, as well as treatment of diabetes insipidus (DI) following neurosurgery of the pituitary gland. The files of 24 patients that underwent neurosurgery for sellar lesions, or tumor near the hypothalamus or pituitary gland at the Department of Neurosurgery, King Abdulaziz University Hospital, Jeddah, Kingdom of Saudi Arabia were retrospectively reviewed between January 2011 to December 2014. A total of 24 patients were studied, and were divided into 2 groups namely; DI and non-DI. Patient characteristics were studied using descriptive statistics. The differences in proportion between the 2 groups were found out using Z-test for proportion in 2 populations. The mean differences in the hormonal abnormalities for the 2 groups were assessed using independent t-test. All statistics are considered statistically significant when p less than 0.05. During hospitalization, 13 (54.2%) out of 24 patient that underwent neurosurgery had manifestations of DI, which was transient in 5 (38.8%) and permanent in 8 (61.2%). The DI subgroup contained higher prevalence of prolactinoma, craniopharyngioma, pre-operative panhypopituitarism, and macroadenoma in MRI imaging and transphenoidal surgery. Furthermore, urine osmolality was significantly lower in the DI group post-operatively with a significant p=0.023. It was recognized that the permanent DI documented more significant numbers than other studies. In our study group, it was recognized that permanent DI meant that our patients needed desmopressin for more than 3 months, which documented a more significant number than other studies.

  7. Studying Behaviors Among Neurosurgery Residents Using Web 2.0 Analytic Tools. (United States)

    Davidson, Benjamin; Alotaibi, Naif M; Guha, Daipayan; Amaral, Sandi; Kulkarni, Abhaya V; Lozano, Andres M


    Web 2.0 technologies (e.g., blogs, social networks, and wikis) are increasingly being used by medical schools and postgraduate training programs as tools for information dissemination. These technologies offer the unique opportunity to track metrics of user engagement and interaction. Here, we employ Web 2.0 tools to assess academic behaviors among neurosurgery residents. We performed a retrospective review of all educational lectures, part of the core Neurosurgery Residency curriculum at the University of Toronto, posted on our teaching website ( Our website was developed using publicly available Web 2.0 platforms. Lecture usage was assessed by the number of clicks, and associations were explored with lecturer academic position, timing of examinations, and lecture/subspecialty topic. The overall number of clicks on 77 lectures was 1079. Most of these clicks were occurring during the in-training examination month (43%). Click numbers were significantly higher on lectures presented by faculty (mean = 18.6, standard deviation ± 4.1) compared to those delivered by residents (mean = 8.4, standard deviation ± 2.1) (p = 0.031). Lectures covering topics in functional neurosurgery received the most clicks (47%), followed by pediatric neurosurgery (22%). This study demonstrates the value of Web 2.0 analytic tools in examining resident study behavior. Residents tend to "cram" by downloading lectures in the same month of training examinations and display a preference for faculty-delivered lectures. Copyright © 2017 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

  8. Quantifying workspace and forces of surgical dissection during robot-assisted neurosurgery. (United States)

    Maddahi, Yaser; Gan, Liu Shi; Zareinia, Kourosh; Lama, Sanju; Sepehri, Nariman; Sutherland, Garnette R


    A prerequisite for successful robot-assisted neurosurgery is to use a hand-controller matched with characteristics of real robotic microsurgery. This study reports quantified data pertaining to the required workspace and exerted forces of surgical tools during robot-assisted microsurgery. A surgeon conducted four operations in which the neuroArm surgical system, an image-guided computer-assisted manipulator specifically designed to perform robot-assisted neurosurgery, was employed to surgically remove brain tumors. The position, orientation, and exerted force of surgical tools were measured during operations. Workspace of the neuroArm manipulators, for the cases studied, was 60×60×60 mm(3) while it offered orientation ranges of 103°, 62° and 112°. The surgical tools exerted a maximum force of 1.86 N with frequency band of less than 20 Hz. This data provides important information specific to neurosurgery that can be used to select among commercially available, or further design a customized, haptic hand-controller for robot-assisted neurosurgical systems. Copyright © 2015 John Wiley & Sons, Ltd. Copyright © 2015 John Wiley & Sons, Ltd.

  9. Laser neurosurgery: A systematic analysis of magnetic resonance-guided laser interstitial thermal therapies. (United States)

    Lagman, Carlito; Chung, Lawrance K; Pelargos, Panayiotis E; Ung, Nolan; Bui, Timothy T; Lee, Seung J; Voth, Brittany L; Yang, Isaac


    Magnetic resonance-guided laser interstitial thermal therapy (MRgLITT) is a novel minimally invasive modality that uses heat from laser probes to destroy tissue. Advances in probe design, cooling mechanisms, and real-time MR thermography have increased laser utilization in neurosurgery. The authors perform a systematic analysis of two commercially available MRgLITT systems used in neurosurgery: the Visualase® thermal therapy and NeuroBlate® Systems. Data extraction was performed in a blinded fashion. Twenty-two articles were included in the quantitative synthesis. A total of 223 patients were identified with the majority having undergone treatment with Visualase (n=154, 69%). Epilepsy was the most common indication for Visualase therapy (n=8 studies, 47%). Brain mass was the most common indication for NeuroBlate therapy (n=3 studies, 60%). There were no significant differences, except in age, wherein the NeuroBlate group was nearly twice as old as the Visualase group (plength-of-stay (LOS) were non-significant when adjusted for age and number of patients. Laser neurosurgery has evolved over recent decades. Clinical indications are currently being defined and will continue to emerge as laser technologies become more sophisticated. Head-to-head comparison of these systems was difficult given the variance in indications (and therefore patient population) and disparate literature. Copyright © 2016. Published by Elsevier Ltd.

  10. Bulgarian military neurosurgery: from Warsaw Pact to the North Atlantic Treaty Organization. (United States)

    Enchev, Yavor; Eftimov, Tihomir


    After 45 years as a closest ally of the Soviet Union in the Warsaw Pact, founded mainly against the US and the Western Europe countries, and 15 years of democratic changes, since 2004 Bulgaria has been a full member of NATO and an equal and trusted partner of its former enemies. The unprecedented transformation has affected all aspects of the Bulgarian society. As a function of the Bulgarian Armed Forces, Bulgarian military medicine and in particular Bulgarian military neurosurgery is indivisibly connected with their development. The history of Bulgarian military neurosurgery is the history of the transition from the Union of Soviet Socialist Republics military system and military medicine to NATO standards in every aspect. The career of the military neurosurgeon in Bulgaria is in many ways similar to that of the civilian neurosurgeon, but there are also many peculiarities. The purpose of this study was to outline the background and the history of Bulgarian military neurosurgery as well as its future trends in the conditions of world globalization.

  11. Neurosurgery and brain shift: review of the state of the art and main contributions of robotics

    Directory of Open Access Journals (Sweden)

    Karin Correa-Arana


    Full Text Available This paper presents a review about neurosurgery, robotic assistants in this type of procedure, and the approach to the problem of brain tissue displacement, including techniques for obtaining medical images. It is especially focused on the phenomenon of brain displacement, commonly known as brain shift, which causes a loss of reference between the preoperative images and the volumes to be treated during image-guided surgery. Hypothetically, with brain shift prediction and correction for the neuronavigation system, minimal invasion trajectories could be planned and shortened. This would reduce damage to functional tissues and possibly lower the morbidity and mortality in delicate and demanding medical procedures such as the removal of a brain tumor. This paper also mentions other issues associated with neurosurgery and shows the way robotized systems have helped solve these problems. Finally, it highlights the future perspectives of neurosurgery, a branch of medicine that seeks to treat the ailments of the main organ of the human body from the perspective of many disciplines.

  12. Candida infection of the central nervous system following neurosurgery: a 12-year review.

    LENUS (Irish Health Repository)

    O'Brien, Deirdre


    BACKGROUND: Candida infection of the central nervous system (CNS) following neurosurgery is relatively unusual but is associated with significant morbidity and mortality. We present our experience with this infection in adults and discuss clinical characteristics, treatment options, and outcome. METHODS: All episodes of Candida isolated from the central nervous system were identified by searching our laboratory database. Review of the cases was performed by means of a retrospective chart review. RESULTS: Eleven episodes of Candida CSF infection following neurosurgery were identified over a 12-year period. Candida albicans was the predominant species isolated (n = 8, 73%). All infections were associated with foreign intracranial material, nine with external ventricular drains (82%), one with a ventriculoperitoneal shunt, one with a lumbar drain, and one with Gliadel wafers (1,3-bis [2-chloroethyl]-1-nitrosurea). Fluconazole or liposomal amphotericin B were the most common anti-fungal agents used. The mortality rate identified in our series was 27%. CONCLUSIONS: Candida infection following neurosurgery remains a relatively rare occurrence but one that causes significant mortality. These are complex infections, the management of which benefits from a close liaison between the clinical microbiologist and neurosurgeon. Prompt initiation of antifungal agents and removal of infected devices offers the best hope of a cure.

  13. Advanced registered nurse practitioners and physician assistants in the practice of pediatric neurosurgery: a clinical report. (United States)

    James, Hector E; MacGregor, Teresa L; Postlethwait, Richard A; Hofrichter, Paul B; Aldana, Phillip R


    This report addresses the clinical experience of the Division of Pediatric Neurosurgery with dedicated nurse practitioners and a physician assistant (PA) in outpatient and inpatient health care delivery, including surgical activities, as well as participation with the neurosurgery call schedule, quality improvement, teaching, and clinical research activities. We report on the activities of allied health personnel in the Division of Pediatric Neurosurgery for the purpose of identifying the current and future role for health care delivery, related to the care of the child with a neurosurgical condition. This addresses the participation of 2 advanced registered nurse practitioners (ARNPs) and a PA in the outpatient and inpatient setting, call schedule, interventions in and out of the operating room, quality improvement sessions, continuing medical education, clinical research, clinical databases, presentations in meetings, teaching, and scientific publications. This report covers the period from September 2003 (when the division was initiated) to February 2011. The division currently consists of 3 pediatric neurosurgeons, 2 ARNPs and 1 PA. The ARNPs/PA have participated in the pediatric neurosurgery clinic held 5 half-days per week, the monthly multidisciplinary clinics (Spinal Defects Clinic, Pediatric Neurosciences Clinic, and the Fetal Diagnosis and Therapy Center working group), and inpatient care, as well as assisting in operative interventions. They participated in the on-call schedule and attended the monthly quality improvement sessions of the division in addition to presenting papers and topics in the monthly continuing medical education session. The PA maintained a computerized database of operative interventions, coding, morbidities, and outcomes. All were involved in teaching activities. They prepared preoperative and postoperative orders and practice guidelines, and they were also involved in the preparation of the database of institutional clinical

  14. Admissions for isolated nonoperative mild head injuries: Sharing the burden among trauma surgery, neurosurgery, and neurology. (United States)

    Zhao, Ting; Mejaddam, Ali Y; Chang, Yuchiao; DeMoya, Marc A; King, David R; Yeh, Daniel D; Kaafarani, Haytham M A; Alam, Hasan B; Velmahos, George C


    Isolated nonoperative mild head injuries (INOMHI) occur with increasing frequency in an aging population. These patients often have multiple social, discharge, and rehabilitation issues, which far exceed the acute component of their care. This study was aimed to compare the outcomes of patients with INOMHI admitted to three services: trauma surgery, neurosurgery, and neurology. Retrospective case series (January 1, 2009 to August 31, 2013) at an academic Level I trauma center. According to an institutional protocol, INOMHI patients with Glasgow Coma Scale (GCS) of 13 to 15 were admitted on a weekly rotational basis to trauma surgery, neurosurgery, and neurology. The three populations were compared, and the primary outcomes were survival rate to discharge, neurological status at hospital discharge as measured by the Glasgow Outcome Score (GOS), and discharge disposition. Four hundred eighty-eight INOMHI patients were admitted (trauma surgery, 172; neurosurgery, 131; neurology, 185). The mean age of the study population was 65.3 years, and 58.8% of patients were male. Seventy-seven percent of patients has a GCS score of 15. Age, sex, mechanism of injury, Charlson Comorbidity Index, Injury Severity Score, Abbreviated Injury Scale in head and neck, and GCS were similar among the three groups. Patients who were admitted to trauma surgery, neurosurgery and neurology services had similar proportions of survivors (98.8% vs 95.7% vs 94.7%), and discharge disposition (home, 57.0% vs 61.6% vs 55.7%). The proportion of patients with GOS of 4 or 5 on discharge was slightly higher among patients admitted to trauma (97.7% vs 93.0% vs 92.4%). In a logistic regression model adjusting for Charlson Comorbidity Index CCI and Abbreviated Injury Scale head and neck scores, patients who were admitted to neurology or neurosurgery had significantly lower odds being discharged with GOS 4 or 5. While the trauma group had the lowest proportion of repeats of brain computed tomography (61

  15. The application of quality control circle in neurosurgery ICU nurses in raising compliance of the head of a bed

    Directory of Open Access Journals (Sweden)

    Na LI


    Full Text Available Objective: To explore the application of quality control circle in raising compliance of the head of a bed in neurosurgery ICU nurses. Methods: The quality control circle was made up of 4 ICU nurses, determine the subject in order to improve the neurosurgery ICU nurses in raising compliance of the head of a bed, according to the QCC activity steps to formulate plans, including grasp the current situation, goal setting, through analysis, circle members develop strategy and plan implementation and review, finally compared the situation before and after neurosurgery ICU nurses raised bed activities compliance. Results: After implementation of QCC, neurosurgery ICU nurses raised bed to 30 ~ 45 degrees. After activities, circle members in the team cooperation ability, cohesion, to accept new things ability, and innovative thinking ability and to raise the understanding of the relevant knowledge of the head of a bed has improved significantly. Conclusion: The application of quality management circle activity improves the neurosurgery ICU nurses effectively raise the compliance of the head of a bed, improve the comprehensive quality of the clinical nurses.

  16. German Emergency Care in Neurosurgery and Military Neurology during World War II, 1939-1945. (United States)

    Stahnisch, Frank W


    A critical analysis of the historical involvement of neurology and neurosurgery in military emergency care services enables us to better contextualize and appreciate the development of modern neurology at large. Wartime neurosurgery and civil brain science during the German Nazi period tightly coalesced in examining the specific injury types, which military neurosurgeons such as Wilhelm Toennis, Klaus Joachim Zuelch, and Georg Merrem encountered and treated based on their neurophysiological understanding gained from earlier peacetime research. Collaborative associations with Dr. Toennis in particular proved to be highly beneficial to other military neurologists and neurosurgeons during World War II and beyond. This article also discusses the prewar developments and considers the fate of German neurosurgeons and military neurologists after the war. The envisaged dynamic concepts of fast action, reaction, and recycling, which contemporary physicians had intensively studied in the preceding scientific experiments in their neurophysiological laboratories, had already been introduced into neurological surgery during the interwar period. In retrospect, World War II emergency rescue units greatly strengthened military operations through an active process of 'recycling' indispensable army personnel. Neurosurgical emergency chains thereby introduced another decisive step in the modernization of warfare, in that they increased the momentum of military mobility in the field. Notwithstanding the violence of warfare and the often inhumane ways in which such knowledge in the field of emergency neurology was gained, the protagonists among the group of experts in military neurology and neurosurgery strongly contributed to the postwar clinical neuroscience community in Germany. In differing political pretexts, this became visible in both East Germany and West Germany after the war, while the specific military and political conditions under which this knowledge of emergency medicine

  17. Preoperative Frailty Score for 30-Day Morbidity and Mortality After Cranial Neurosurgery. (United States)

    Tomlinson, Samuel B; Piper, Keaton; Kimmell, Kristopher T; Vates, G Edward


    Evaluating preoperative frailty is critical for guiding shared surgical decision-making. The purpose of this study was to develop a novel preoperative frailty index for classification of adverse outcomes following cranial neurosurgery procedures. The American College of Surgeons National Surgical Quality Improvement Program database was queried for all cranial neurosurgery cases from 2006 to 2014. Sequential univariate and multivariate testing was used to identify significant independent predictors of 30-day mortality. Frailty scores were computed by summating across weighted predictors. Receiver operating characteristic curve analysis quantified the discriminative capacity of the frailty score for classifying mortality and other major adverse outcomes. List-wise exclusion of patients with incomplete datasets yielded a final sample of 27,098 patients (mortality rate = 3.9%). Multivariate regression testing identified 19 independent predictors of 30-day mortality. Receiver operating characteristic curve analysis revealed impressive outcome discrimination (area under the curve = 0.87, P mortality (15.4%) and major adverse outcomes (32.0%) compared with patients in the "low-risk" group (n = 21,943, mortality = 1.2%, major adverse outcomes = 4.0%). The frailty score remained highly discriminative across all age groups examined. Neurosurgical patients undergo extensive preoperative evaluation, but the field currently lacks a robust bedside scoring system for quantifying patient frailty. In this study, we introduced a novel preoperative frailty index capable of classifying 30-day morbidity and mortality outcomes following cranial neurosurgeries. Copyright © 2017 Elsevier Inc. All rights reserved.

  18. A novel augmented reality system of image projection for image-guided neurosurgery. (United States)

    Mahvash, Mehran; Besharati Tabrizi, Leila


    Augmented reality systems combine virtual images with a real environment. To design and develop an augmented reality system for image-guided surgery of brain tumors using image projection. A virtual image was created in two ways: (1) MRI-based 3D model of the head matched with the segmented lesion of a patient using MRIcro software (version 1.4, freeware, Chris Rorden) and (2) Digital photograph based model in which the tumor region was drawn using image-editing software. The real environment was simulated with a head phantom. For direct projection of the virtual image to the head phantom, a commercially available video projector (PicoPix 1020, Philips) was used. The position and size of the virtual image was adjusted manually for registration, which was performed using anatomical landmarks and fiducial markers position. An augmented reality system for image-guided neurosurgery using direct image projection has been designed successfully and implemented in first evaluation with promising results. The virtual image could be projected to the head phantom and was registered manually. Accurate registration (mean projection error: 0.3 mm) was performed using anatomical landmarks and fiducial markers position. The direct projection of a virtual image to the patients head, skull, or brain surface in real time is an augmented reality system that can be used for image-guided neurosurgery. In this paper, the first evaluation of the system is presented. The encouraging first visualization results indicate that the presented augmented reality system might be an important enhancement of image-guided neurosurgery.

  19. Fundamentals of neurosurgery: virtual reality tasks for training and evaluation of technical skills. (United States)

    Choudhury, Nusrat; Gélinas-Phaneuf, Nicholas; Delorme, Sébastien; Del Maestro, Rolando


    Technical skills training in neurosurgery is mostly done in the operating room. New educational paradigms are encouraging the development of novel training methods for surgical skills. Simulation could answer some of these needs. This article presents the development of a conceptual training framework for use on a virtual reality neurosurgical simulator. Appropriate tasks were identified by reviewing neurosurgical oncology curricula requirements and performing cognitive task analyses of basic techniques and representative surgeries. The tasks were then elaborated into training modules by including learning objectives, instructions, levels of difficulty, and performance metrics. Surveys and interviews were iteratively conducted with subject matter experts to delimitate, review, discuss, and approve each of the development stages. Five tasks were selected as representative of basic and advanced neurosurgical skill. These tasks were: 1) ventriculostomy, 2) endoscopic nasal navigation, 3) tumor debulking, 4) hemostasis, and 5) microdissection. The complete training modules were structured into easy, intermediate, and advanced settings. Performance metrics were also integrated to provide feedback on outcome, efficiency, and errors. The subject matter experts deemed the proposed modules as pertinent and useful for neurosurgical skills training. The conceptual framework presented here, the Fundamentals of Neurosurgery, represents a first attempt to develop standardized training modules for technical skills acquisition in neurosurgical oncology. The National Research Council Canada is currently developing NeuroTouch, a virtual reality simulator for cranial microneurosurgery. The simulator presently includes the five Fundamentals of Neurosurgery modules at varying stages of completion. A first pilot study has shown that neurosurgical residents obtained higher performance scores on the simulator than medical students. Further work will validate its components and use in a

  20. Evidence-based clinical management and utilization of new technology in European neurosurgery. (United States)

    Weber, Clemens; Jakola, Asgeir S; Gulati, Sasha; Nygaard, Oystein P; Solheim, Ole


    Evidence-based medicine (EBM) has become one of the pillars of modern patient care. However, neurosurgery has always been an experience-based and technology-driven discipline, and it remains unknown to which extent European neurosurgeons follow high-level evidence-based recommendations. We conducted a Web-based survey with a 15-item questionnaire about evidence-based clinical management and utilization of new technology among European neurosurgeons. Two different sum scores were calculated from the questions concerning clinical practice; evidence-based treatment score and new technology score. A high evidence-based treatment score means that more clinical conditions (i.e., study questions) were managed in compliance with the available highest levels of evidence from published clinical trials. A high new technology score reflects the use of a high number of modern tools in neurosurgical practice. A total of 239 neurosurgeons from 30 different European countries answered the questionnaire. There were large variations among European neurosurgeons in providing evidence-based care and in utilization of various modern tools. There were significant regional differences in evidence-based treatment scores and modern technology scores with higher scores in northern and western Europe. High-volume institutions were not associated with better evidence-based treatment scores, but had significantly higher new technology scores. There were significantly higher new technology scores at university hospitals and a trend towards higher evidence-based treatment scores compared to other hospitals. Clinical management in neurosurgery does not always comply with the best available evidence and there are large regional differences in clinical management and in utilization of various modern tools. The position of evidence-based medicine in European neurosurgery seems weak and this may be a threat to the quality of care.

  1. Innovation in Neurosurgery: Intellectual Property Strategy and Academia/Industrial Collaboration. (United States)

    Murayama, Yuichi


    Neurosurgery has tremendous possibilities for development of innovative medical devices. However, most of the neurosurgical devices used in Japan are imported products. Promotion and development of domestic medical devices is highly encouraged and it is one of the pillars of Prime Minister Shinzo Abe's growth strategy of Japanese economy. Innovative "Made in Japan" medical devices can be developed by interdisciplinary collaboration between industries and academic institutions. Proper orientation of medical and engineering education, social and administrative awareness of the need of facilitating the medical devices creative process with corresponding regulatory changes, and appropriate medical and technological infrastructure establishment are needed for stimulating medical device innovation.

  2. Objective skill analysis and assessment in neurosurgery by using an ultra-miniaturized inertial measurement unit WB-3--pilot tests. (United States)

    Lin, Z; Zecca, M; Sessa, S; Sasaki, T; Suzuki, T; Itoh, K; Iseki, H; Takanishi, A


    In recent years there has been an ever increasing amount of research and development of technologies and methods to improve the quality and the performance of advanced surgery. In several fields, such as laparoscopy, various training methods and metrics have been proposed, both to improve the surgeon's abilities and also to assess her/his skills. For neurosurgery, however, the extremely small movements and target operating space involved have prevented until now the development of similar methodologies and systems. In this paper we present the development of an ultra-miniaturized Inertial Measurement Unit (IMU) and its application for neurosurgery skill assessment in a simple pick and place scenario. This analysis is a preliminary yet fundamental step to realize a better training/evaluation system for neurosurgeons, and to objectively evaluate and understand how the neurosurgery is performed.

  3. Current Applications and Future Perspectives of the Use of 3D Printing in Anatomical Training and Neurosurgery. (United States)

    Baskaran, Vivek; Štrkalj, Goran; Štrkalj, Mirjana; Di Ieva, Antonio


    3D printing is a form of rapid prototyping technology, which has led to innovative new applications in biomedicine. It facilitates the production of highly accurate three dimensional objects from substrate materials. The inherent accuracy and other properties of 3D printing have allowed it to have exciting applications in anatomy education and surgery, with the specialty of neurosurgery having benefited particularly well. This article presents the findings of a literature review of the Pubmed and Web of Science databases investigating the applications of 3D printing in anatomy and surgical education, and neurosurgery. A number of applications within these fields were found, with many significantly improving the quality of anatomy and surgical education, and the practice of neurosurgery. They also offered advantages over existing approaches and practices. It is envisaged that the number of useful applications will rise in the coming years, particularly as the costs of this technology decrease and its uptake rises.

  4. Evidence for the use of preoperative risk assessment scores in elective cranial neurosurgery: a systematic review of the literature. (United States)

    Reponen, Elina; Tuominen, Hanna; Korja, Miikka


    Preoperative risk scores are designed to guide patient management by providing a means of predicting operative outcome. Several risk scores are used in neurosurgery, but studies on their clinical relevance are scarce. Therefore, it is not clear whether these risk scores are beneficial or helpful in predicting outcome after elective cranial neurosurgery. In this review, we summarize the current scientific evidence for using preoperative risk scores in elective cranial neurosurgery. A systematic review of the MEDLINE, Embase, and PubMed databases in November 2013 yielded 25 relevant studies with a minimum of 30 patients per study. The studies evaluated the value of the preoperative ASA physical status classification, the Karnofsky performance score (KPS), the Charlson comorbidity score, the modified Rankin Scale and the sex, KPS, ASA physical status classification, location, and edema (SKALE) score in assessing postoperative outcome in cranial neurosurgery. Surgery-related and nonsurgical complications were assessed separately whenever reported in the original article. For this purpose, the studies were placed into 4 categories based on the reported outcome: surgery-related outcome, nonsurgical outcome, morbidity, and mortality. The Preferred Reporting Items for Systematic reviews and Meta-analyses guidelines for systematic reviews were followed. KPS has the strongest support in the literature for predicting surgery-related outcomes. There is no strong support in the literature for the use of any preoperative scores in predicting nonsurgical outcomes after elective craniotomies. KPS and ASA physical status classification seem to predict early (≤ 30-day) morbidity of intracranial tumor patients. The Charlson comorbidity score may be applicable in predicting mortality of elective intracranial aneurysm patients. Only 4 studies were prospective in design. Large prospective studies are needed to validate the use of the reviewed risk scores in elective cranial

  5. Risk factors for the incidence of delirium in cerebrovascular patients in a Neurosurgery Intensive Care Unit: A prospective study. (United States)

    Wang, Jun; Ji, Yuanyuan; Wang, Ning; Chen, Wenjin; Bao, Yuehong; Qin, Qinpu; Xiao, Qian; Li, Shulan


    To explore the incidence of delirium in cerebrovascular patients admitted in our Neurosurgery Intensive Care Unit and analyse the risk factors leading to delirium. Delirium is one of the most common mental disorders in general hospitals, but the incidence of different kinds of diseases and studies varies. Cerebrovascular patients in our Neurosurgery Intensive Care Unit are high-risk groups for delirium; identifying risk factors for delirium and taking early interventions are crucial for patient prognosis. A prospective study. A convenience sampling method was used to collect data from 128 patients in the Neurosurgery Intensive Care Unit of Xuanwu Hospital, Capital Medical University, Beijing, China, between May 2016-January 2017. Researchers used Confusion Assessment Method for the Intensive Care Unit (Chinese version) to assess each patient's delirium statement twice a day at regular times. We also collected other independent data variables and followed up the short-term clinical outcomes daily. On the basis of Confusion Assessment Method for the Intensive Care Unit evaluation, patients were divided into a delirium group and a nondelirium group. The prevalence of delirium among the 128 patients was 42.2%. Multivariate analysis showed that severity of illness, fever, the use of physical restraints and sleep deprivation were independent predictors of delirium in cerebrovascular patients in the Neurosurgery Intensive Care Unit. Cerebrovascular patients in the Neurosurgery Intensive Care Unit with a critical condition, fever or use of physical restraints or experiencing sleep deprivation were more prone to delirium. Cerebrovascular patients in the Neurosurgery Intensive Care Unit showed a high incidence of delirium. There are many risk factors leading to delirium, some of which are independent predictors of intensive care delirium. Patients with delirium will suffer various adverse effects upon their short-term clinical outcomes. Therefore, nurses should pay close

  6. 2009 H1N1 Flu Vaccine Facts (United States)

    ... turn Javascript on. Feature: Flu 2009 H1N1 Flu Vaccine Facts Past Issues / Fall 2009 Table of Contents ... H1N1 flu vaccine. 1 The 2009 H1N1 flu vaccine is safe and well tested. Clinical trials conducted ...

  7. Straight trajectory planning for keyhole neurosurgery in sheep with automatic brain structures segmentation (United States)

    Favaro, Alberto; Lad, Akash; Formenti, Davide; Zani, Davide Danilo; De Momi, Elena


    In a translational neuroscience/neurosurgery perspective, sheep are considered good candidates to study because of the similarity between their brain and the human one. Automatic planning systems for safe keyhole neurosurgery maximize the probe/catheter distance from vessels and risky structures. This work consists in the development of a trajectories planner for straight catheters placement intended to be used for investigating the drug diffusivity mechanisms in sheep brain. Automatic brain segmentation of gray matter, white matter and cerebrospinal fluid is achieved using an online available sheep atlas. Ventricles, midbrain and cerebellum segmentation have been also carried out. The veterinary surgeon is asked to select a target point within the white matter to be reached by the probe and to define an entry area on the brain cortex. To mitigate the risk of hemorrhage during the insertion process, which can prevent the success of the insertion procedure, the trajectory planner performs a curvature analysis of the brain cortex and wipes out from the poll of possible entry points the sulci, as part of brain cortex where superficial blood vessels are naturally located. A limited set of trajectories is then computed and presented to the surgeon, satisfying an optimality criteria based on a cost function which considers the distance from critical brain areas and the whole trajectory length. The planner proved to be effective in defining rectilinear trajectories accounting for the safety constraints determined by the brain morphology. It also demonstrated a short computational time and good capability in segmenting gyri and sulci surfaces.

  8. The beginnings of neurosurgery in California during the pre-Cushing era: 1850-1900. (United States)

    Keller, T M


    The end of the present millennium marks the centennial of Harvey Cushing's European study year, after the completion of his surgical residency under William Stewart Halsted at the Johns Hopkins Hospital and just before beginning his surgical practice in Baltimore, Maryland. The year 2000 marks the sesquicentennial of California's admission to the Union as the 31st state. This report documents a number of the events and achievements that occurred during this "pre-Cushing era" (1850-1900) that contributed to the ultimate development of neurological surgery in California. The historical milestones of the California gold rush, the completion of the Transcontinental Railroad across the Sierra Nevada Mountains, and the careers of early California physicians and educators, including those of Hugh Toland and Levi Cooper Lane, were instrumental in building a foundation for the modern discipline of neurosurgery in the Golden State. This foundation would serve as a cornerstone for surgeons trained by Harvey Cushing (including Howard Naffziger, Carl Rand, and Edward Towne) who would arrive in California early in the 20th century and would define the specialty of neurosurgery. The legacy left by these physicians enhances the celebration of the closure of the millennium.

  9. Preresidency Publication Number Does Not Predict Academic Career Placement in Neurosurgery. (United States)

    Daniels, Marcus; Garzon-Muvdi, Tomas; Maxwell, Russell; Tamargo, Rafael J; Huang, Judy; Witham, Tim; Bettegowda, Chetan; Chaichana, Kaisorn L


    It is unclear if preresidency and/or residency research work impacts academic neurosurgery placement post residency. The goal of this study is to evaluate the impact that preresidency and residency research publication has on attaining academic faculty positions. Alumni information was collected from 65 of the 108 (60%) neurosurgery residency websites. Graduates from these programs between 2005 and 2015 (n = 949) were analyzed to determine factors associated with an academic career. Information on publications, citations, and H-index were obtained from Web of Science. Current position was designated as academic if the physician had a teaching position at a university hospital and private if the physician was not affiliated with a university hospital. Univariate and multivariate logistic regression models were used to identify factors associated with academic faculty positions post residency. Of the 949 physicians included in the analysis, 339 (36%) were in academic positions, 518 (55%) in private practice, and 92 (10%) were still in training. More than a fifth (212, or 22%) of physicians performed a research fellowship (8.2%) or attained a Ph.D. (14.1%) during medical school. Among those who had completed training, an academic career was associated with having 2 or more publications during residency (odds ratio [OR] [95% confidence interval, CI]: 3.87 [1.59-9.45]; P academic placement. These findings may help guide residency programs to identify and/or cultivate neurosurgeons to become academic neurosurgeons. Copyright © 2017 Elsevier Inc. All rights reserved.

  10. da Vinci robot-assisted keyhole neurosurgery: a cadaver study on feasibility and safety. (United States)

    Marcus, Hani J; Hughes-Hallett, Archie; Cundy, Thomas P; Yang, Guang-Zhong; Darzi, Ara; Nandi, Dipankar


    The goal of this cadaver study was to evaluate the feasibility and safety of da Vinci robot-assisted keyhole neurosurgery. Several keyhole craniotomies were fashioned including supraorbital subfrontal, retrosigmoid and supracerebellar infratentorial. In each case, a simple durotomy was performed, and the flap was retracted. The da Vinci surgical system was then used to perform arachnoid dissection towards the deep-seated intracranial cisterns. It was not possible to simultaneously pass the 12-mm endoscope and instruments through the keyhole craniotomy in any of the approaches performed, limiting visualization. The articulated instruments provided greater dexterity than existing tools, but the instrument arms could not be placed in parallel through the keyhole craniotomy and, therefore, could not be advanced to the deep cisterns without significant clashing. The da Vinci console offered considerable ergonomic advantages over the existing operating room arrangement, allowing the operating surgeon to remain non-sterile and seated comfortably throughout the procedure. However, the lack of haptic feedback was a notable limitation. In conclusion, while robotic platforms have the potential to greatly enhance the performance of transcranial approaches, there is strong justification for research into next-generation robots, better suited to keyhole neurosurgery.

  11. The Preferred Learning Styles of Neurosurgeons, Neurosurgery Residents, and Neurology Residents: Implications in the Neurosurgical Field. (United States)

    Lai, Hung-Yi; Lee, Ching-Yi; Chiu, Angela; Lee, Shih-Tseng


    To delineate the learning style that best defines a successful practitioner in the field of neurosurgery by using a validated learning style inventory. The Kolb Learning Style Inventory, a validated assessment tool, was administered to all practicing neurosurgeons, neurosurgical residents, and neurology residents employed at Chang Gung Memorial Hospital, an institution that provides primary and tertiary clinical care in 3 locations, Linkou, Kaohsiung, and Chiayi. There were 81 participants who entered the study, and all completed the study. Neurosurgeons preferred the assimilating learning style (52%), followed by the diverging learning style (39%). Neurosurgery residents were slightly more evenly distributed across the learning styles; however, they still favored assimilating (32%) and diverging (41%). Neurology residents had the most clearly defined preferred learning style with assimilating (76%) obtaining the large majority and diverging (12%) being a distant second. The assimilating and diverging learning styles are the preferred learning styles among neurosurgeons, neurosurgery residents, and neurology residents. The assimilating learning style typically is the primary learning style for neurosurgeons and neurology residents. Neurosurgical residents start off with a diverging learning style and progress toward an assimilating learning style as they work toward becoming practicing neurosurgeons. The field of neurosurgery has limited opportunities for active experimentation, which may explain why individuals who prefer reflective observation are more likely to succeed in this field. Copyright © 2014 Elsevier Inc. All rights reserved.

  12. Establishing a generic training programme for future junior doctors: a role for neurosurgery within the framework of clinical neurosciences. (United States)

    Nadarajah, Ramesh; Amin, Amit; Aldlyami, Ehabb; Kang, Niel; Wong, James Min-Leong; Selway, Richard; Gullan, Richard


    INTRODUCTION: To describe the opinion of junior doctors in neurosurgery in the UK and Eire about future reforms to training, and to relate this to the establishment of a generic neurosciences training programme. METHODS: A postal questionnaire survey of neurosurgery units in UK and Eire (36 units). All senior house officers (SHOs) taking part in a neurosurgery on-call rota during the 6 months between February and August 2003 (n=236); 190 respondents (response rate 81% overall, 90% neurosurgery SHOs and 55% neurology SHOs. The questionnaire covered most aspects of provision of training, working pattern and job satisfaction gained from the post. Also included were questions on future reforms for training. RESULTS: There is an overwhelming acceptance amongst SHOs for training to be centred on generic programmes. The audit also identified that there are many aspects of neurosurgical training which will be very suitable for trainees from other fields, thus supporting the establishment of a generic neurosciences training programme. CONCLUSIONS: The establishment of a generic training programme would encourage an improvement in training standards for the whole SHO grade. To ensure the success of this proposed generic training programme, support from junior doctors and all those involved in postgraduate education is required. Neurosciences teaching has the excellent potential to move towards the planning and formation of a generic neurosciences training programme in-line with the proposed reforms. PMID:16053687

  13. George Gershwin -- a case of new ways in neurosurgery as well as in the history of Western music. (United States)

    Gasenzer, Elena; Neugebauer, Edmund A M


    George Gershwin, the famous American composer, died in 1937 of a temporal lobe glioma. An emergency surgery was performed by R. Nafziger and W. E. Dandy. The case of George Gershwin indicates the beginning of a new era in music history as well as in the history of neurosurgery.

  14. A Three-Dimensional Image Of The Cerebral Blood Vessels And Tumor For Use In Stereotactic Neurosurgery (United States)

    Suetens, P.; Gybels, J.; Oosterlinck, A.; Haegemans, A.; Dierckx, P.


    A useful method that makes stereotactic neurosurgery safer, is developed. It yields an integrated stereoscopic image of the cerebral blood vessels, CT view of tumor and simulated electrode trajectory, allowing the surgeon to choose any electrode direction that looks convenient to him, without imminent danger of causing a haemorrhage.

  15. The dynamical system generated by the 3n+1 function

    CERN Document Server

    Wirsching, Günther J


    The 3n+1 function T is defined by T(n)=n/2 for n even, and T(n)=(3n+1)/2 for n odd. The famous 3n+1 conjecture, which remains open, states that, for any starting number n>0, iterated application of T to n eventually produces 1. After a survey of theorems concerning the 3n+1 problem, the main focus of the book are 3n+1 predecessor sets. These are analyzed using, e.g., elementary number theory, combinatorics, asymptotic analysis, and abstract measure theory. The book is written for any mathematician interested in the 3n+1 problem, and in the wealth of mathematical ideas employed to attack it.

  16. The historical origin of the term "meningioma" and the rise of nationalistic neurosurgery. (United States)

    Barthélemy, Ernest Joseph; Sarkiss, Christopher A; Lee, James; Shrivastava, Raj K


    The historical origin of the meningioma nomenclature unravels interesting social and political aspects about the development of neurosurgery in the late 19th century. The meningioma terminology itself was the subject of nationalistic pride and coincided with the advancement in the rise of medicine in Continental Europe as a professional social enterprise. Progress in naming and understanding these types of tumor was most evident in the nations that successively assumed global leadership in medicine and biomedical science throughout the 19th and 20th centuries, that is, France, Germany, and the United States. In this vignette, the authors delineate the uniqueness of the term "meningioma" as it developed within the historical framework of Continental European concepts of tumor genesis, disease states, and neurosurgery as an emerging discipline culminating in Cushing's Meningiomas text. During the intellectual apogee of the French Enlightenment, Antoine Louis published the first known scientific treatise on meningiomas. Like his father, Jean-Baptiste Louis, Antoine Louis was a renowned military surgeon whose accomplishments were honored with an admission to the Académie royale de chirurgie in 1749. His treatise, Sur les tumeurs fongueuses de la duremère, appeared in 1774. Following this era, growing economic depression affecting a frustrated bourgeoisie triggered a tumultuous revolutionary period that destroyed France's Ancien Régime and abolished its university and medical systems. The resulting anarchy was eventually quelled through legislation aiming to satisfy Napoleon's need for qualified military professionals, including physicians and surgeons. These laws laid the foundations for the subsequent flourishing of French medicine throughout the mid-19th century. Subsequent changes to the meningioma nomenclature were authored by intellectual giants of this postrevolutionary period, for example, by the Limogesborn pathologist Jean Cruveilhier known for the term

  17. Use of a formal assessment instrument for evaluation of resident operative skills in pediatric neurosurgery. (United States)

    Hadley, Caroline; Lam, Sandi K; Briceño, Valentina; Luerssen, Thomas G; Jea, Andrew


    OBJECT Currently there is no standardized tool for assessment of neurosurgical resident performance in the operating room. In light of enhanced requirements issued by the Accreditation Council for Graduate Medical Education's Milestone Project and the Matrix Curriculum Project from the Society of Neurological Surgeons, the implementation of such a tool seems essential for objective evaluation of resident competence. Beyond compliance with governing body guidelines, objective assessment tools may be useful to direct early intervention for trainees performing below the level of their peers so that they may be given more hands-on teaching, while strong residents can be encouraged by faculty members to progress to conducting operations more independently with passive supervision. The aims of this study were to implement a validated assessment tool for evaluation of operative skills in pediatric neurosurgery and determine its feasibility and reliability. METHODS All neurosurgery residents completing their pediatric rotation over a 6-month period from January 1, 2014, to June 30, 2014, at the authors' institution were enrolled in this study. For each procedure, residents were evaluated by means of a form, with one copy being completed by the resident and a separate copy being completed by the attending surgeon. The evaluation form was based on the validated Objective Structured Assessment of Technical Skills for Surgery (OSATS) and used a 5-point Likert-type scale with 7 categories: respect for tissue; time and motion; instrument handling; knowledge of instruments; flow of operation; use of assistants; and knowledge of specific procedure. Data were then stratified by faculty versus resident (self-) assessment; postgraduate year level; and difficulty of procedure. Descriptive statistics (means and SDs) were calculated, and the results were compared using the Wilcoxon signed-rank test and Student t-test. A p value evaluations for 299 procedures, including 32

  18. An Intelligent Robotic Hospital Bed for Safe Transportation of Critical Neurosurgery Patients Along Crowded Hospital Corridors. (United States)

    Wang, Chao; Savkin, Andrey V; Clout, Ray; Nguyen, Hung T


    We present a novel design of an intelligent robotic hospital bed, named Flexbed, with autonomous navigation ability. The robotic bed is developed for fast and safe transportation of critical neurosurgery patients without changing beds. Flexbed is more efficient and safe during the transportation process comparing to the conventional hospital beds. Flexbed is able to avoid en-route obstacles with an efficient easy-to-implement collision avoidance strategy when an obstacle is nearby and to move towards its destination at maximum speed when there is no threat of collision. We present extensive simulation results of navigation of Flexbed in the crowded hospital corridor environments with moving obstacles. Moreover, results of experiments with Flexbed in the real world scenarios are also presented and discussed.

  19. A novel registration method for image-guided neurosurgery system based on stereo vision. (United States)

    An, Yong; Wang, Manning; Song, Zhijian


    This study presents a novel spatial registration method of Image-guided neurosurgery system (IGNS) based on stereo-vision. Images of the patient's head are captured by a video camera, which is calibrated and tracked by an optical tracking system. Then, a set of sparse facial data points are reconstructed from them by stereo vision in the patient space. Surface matching method is utilized to register the reconstructed sparse points and the facial surface reconstructed from preoperative images of the patient. Simulation experiments verified the feasibility of the proposed method. The proposed method it is a new low-cost and easy-to-use spatial registration method for IGNS, with good prospects for clinical application.

  20. H1N1: pandemia e perspectiva atual H1N1: overview and perspectives

    Directory of Open Access Journals (Sweden)

    Nancy Bellei


    Full Text Available O vírus influenza de origem suína, A/California/04/2009 (H1N1, foi inicialmente detectado no México e determinou a pandemia de influenza de 2009. Em agosto de 2010, a Organização Mundial da Saúde (OMS declarou o início da fase pós-pandêmica. As características dessa última pandemia foram marcadamente diferentes das anteriores. O vírus emergiu de rearranjos genéticos originários em hospedeiro mamífero não humano, demonstrou transmissibilidade interespécies e afetou a população humana de forma diferente dos vírus pandêmicos anteriores (1918, 1957 e 1968 com maior morbidade e mortalidade em crianças e adultos jovens. Atualmente, o vírus apresenta padrão sazonal da mesma forma que o influenza A H3N2 e o influenza B, mantendo, até o momento, o mesmo perfil de patogenicidade, espectro clínico e sensibilidade a antivirais. A cepa foi incluída na vacina sazonal trivalente anual recomendada, principalmente para proteção dos grupos de risco mais vulneráveis a complicações pelas diferentes cepas de influenza.The swine origin influenza virus A/CALIFORNIA/04/2009 (H1N1 was first detected in Mexico and determined the 2009 influenza pandemic. In August 2010, World Health Organization (WHO declared the beginning of the post-pandemic period. This last pandemic was distinctly different from previous ones. The virus emerged from genetic rearrangement in non-human mammalian host. Moreover, its inter-species transmission is fully reported. However, it affected human population differently from previous pandemic viruses (1918, 1957, 1968, with increased morbidity and mortality among children and young adults. Currently, the virus has a seasonal pattern in the same way as influenza A H3N2 and influenza B, maintaining the same pathogenicity profile, clinical spectrum and sensitivity to antiviral agents. The strain was included in the annual trivalent seasonal vaccine formulation, mainly for risk groups, which are more vulnerable to

  1. Paediatric day-case neurosurgery in a resource challenged setting: Pattern and practice

    Directory of Open Access Journals (Sweden)

    Afolabi Muyiwa Owojuyigbe


    Full Text Available Background: It has been generally observed that children achieve better convalescence in the home environment especially if discharged same day after surgery. This is probably due to the fact that children generally tend to feel more at ease in the home environment than in the hospital setting. Only few tertiary health institutions provide routine day-case surgery for paediatric neurosurgical patients in our sub-region. Objective: To review the pattern and practice of paediatric neurosurgical day-cases at our hospital. Patients and Methods: A prospective study of all paediatric day-case neurosurgeries carried out between June 2011 and June 2014. Results: A total of 53 patients (34 males and 19 females with age ranging from 2 days to 14 years were seen. Majority of the patients (77.4% presented with congenital lesions, and the most common procedure carried out was spina bifida repair (32% followed by ventriculoperitoneal shunt insertion (26.4% for hydrocephalus. Sixty-eight percentage belonged to the American Society of Anesthesiologists physical status class 2, whereas the rest (32% belonged to class 1. General anaesthesia was employed in 83% of cases. Parenteral paracetamol was used for intra-operative analgesia for most of the patients. Two patients had post-operative nausea and vomiting and were successfully managed. There was no case of emergency re-operation, unplanned admission, cancellation or mortality. Conclusion: Paediatric day-case neurosurgery is feasible in our environment. With careful patient selection and adequate pre-operative preparation, good outcome can be achieved.

  2. Neurosurgical Resident Error: A Survey of U.S. Neurosurgery Residency Training Program Directors' Perceptions. (United States)

    Gupta, Raghav; Moore, Justin M; Adeeb, Nimer; Griessenauer, Christoph J; Schneider, Anna M; Gandhi, Chirag D; Harsh, Griffith R; Thomas, Ajith J; Ogilvy, Christopher S


    Efforts to address resident errors and to enhance patient safety have included systemic reforms, such as the Accreditation Council for Graduate Medical Education's (ACGME's) mandated duty-hour restrictions, and specialty-specific initiatives such as the neurosurgery Milestone Project. However, there is currently little data describing the basis for these errors or outlining trends in neurosurgical resident error. An online questionnaire was distributed to program directors of 108 U.S. neurosurgery residency training programs to assess the frequency, most common forms and causes of resident error, the resulting patient outcomes, and the steps taken by residency programs to address these errors. Thirty-one (28.7%) responses were received. Procedural/surgical error was the most commonly observed type of error. Transient injury and no injury to the patient were perceived to be the 2 most frequent outcomes. Inexperience or resident mistake despite adequate training were cited as the most common causes of error. Twenty-three (74.2%) respondents stated that a lower post graduate year level correlated with an increased incidence of errors. There was a trend toward an association between an increased number of residents within a program and the number of errors attributable to a lack of supervision (r = 0.36; P = 0.06). Most (93.5%) program directors do not believe that mandated duty-hour restrictions reduce error frequency. Program directors believe that procedural error is the most commonly observed form of error, with post graduate year level believed to be an important predictor of error frequency. The perceived utility of systemic reforms that aim to reduce the incidence of resident error remains unclear. Copyright © 2017. Published by Elsevier Inc.

  3. Impact of insurance precertification on neurosurgery practice and health care delivery. (United States)

    Menger, Richard P; Thakur, Jai Deep; Jain, Gary; Nanda, Anil


    OBJECTIVE Insurance preauthorization is used as a third-party tool to reduce health care costs. Given the expansion of managed care, the impact of the insurance preauthorization process in delaying health care delivery warrants investigation through a diversified neurosurgery practice. METHODS Data for 1985 patients were prospectively gathered over a 12-month period from July 1, 2014, until June 30, 2015. Information regarding attending, procedure, procedure type, insurance type, need for insurance approval, number of days for authorization, or insurance denial was obtained. Delay in authorization was defined as any wait period greater than 7 days. Some of the parameters were added retrospectively to enhance this study; hence, the total number of subjects may vary for different variables. RESULTS The most common procedure was back surgery with instrumentation (28%). Most of the patients had commercial insurance (57%) while Medicaid was the least common (1%). Across all neurosurgery procedures, insurance authorization, on average, was delayed 9 days with commercial insurance, 10.7 days with Tricare insurance, 8.5 days with Medicare insurance, 11.5 days with Medicaid, and 14.4 days with workers' compensation. Two percent of all patients were denied insurance preauthorization without any statistical trend or association. Of the 1985 patients, 1045 (52.6%) patients had instrumentation procedures. Independent of insurance type, instrumentation procedures were more likely to have delays in authorization (p = 0.001). Independent of procedure type, patients with Tricare (military) insurance were more likely to have a delay in approval for surgery (p = 0.02). Predictably, Medicare insurance was protective against a delay in surgery (p = 0.001). CONCLUSIONS Choice of insurance provider and instrumentation procedures were independent risk factors for a delay in insurance preauthorization. Neurosurgeons, not just policy makers, must take ownership to analyze, investigate, and

  4. Augmented reality-guided neurosurgery: accuracy and intraoperative application of an image projection technique. (United States)

    Besharati Tabrizi, Leila; Mahvash, Mehran


    An augmented reality system has been developed for image-guided neurosurgery to project images with regions of interest onto the patient's head, skull, or brain surface in real time. The aim of this study was to evaluate system accuracy and to perform the first intraoperative application. Images of segmented brain tumors in different localizations and sizes were created in 10 cases and were projected to a head phantom using a video projector. Registration was performed using 5 fiducial markers. After each registration, the distance of the 5 fiducial markers from the visualized tumor borders was measured on the virtual image and on the phantom. The difference was considered a projection error. Moreover, the image projection technique was intraoperatively applied in 5 patients and was compared with a standard navigation system. Augmented reality visualization of the tumors succeeded in all cases. The mean time for registration was 3.8 minutes (range 2-7 minutes). The mean projection error was 0.8 ± 0.25 mm. There were no significant differences in accuracy according to the localization and size of the tumor. Clinical feasibility and reliability of the augmented reality system could be proved intraoperatively in 5 patients (projection error 1.2 ± 0.54 mm). The augmented reality system is accurate and reliable for the intraoperative projection of images to the head, skull, and brain surface. The ergonomic advantage of this technique improves the planning of neurosurgical procedures and enables the surgeon to use direct visualization for image-guided neurosurgery.

  5. Functional lesional neurosurgery for tremor—a protocol for a systematic review and meta-analysis (United States)

    Krauss, Joachim K; Chang, Jin Woo; Bhatia, Kailash P; Kägi, Georg


    Introduction The recent introduction of incision-less lesional neurosurgery using Gamma Knife and MRI-guided focused ultrasound has revived interest in lesional treatment options for tremor disorders. Preliminary literature researches reveal that the consistency of treatment effects after lesional neurosurgery for tremor has not formally been assessed yet. Similarly, the efficacy of different targets for lesional treatment and incidence of persistent side effects of lesional neurosurgical interventions has not been comprehensively assessed. This work therefore aims to describe a suitable process how to review the existing literature on efficacy and persistent side effects of lesional neurosurgical treatment for tremor due to Parkinson’s disease, essential tremor, multiple sclerosis and midbrain/rubral tremor. Methods and analysis We will search electronic databases (Medline, Cochrane) and reference lists of included articles for studies reporting lesional interventions for tremor in cohorts homogeneous for tremor aetiology and intervention (technique and target). We will include cohorts with a minimum number of five subjects and follow-up of 2 months. One investigator will perform the initial literature search and two investigators then independently decide which references to include for final efficacy and safety analysis. After settling of disagreement, data will be extracted from articles using a standardised template. We will perform a random-effect meta-analysis calculating standardised mean differences (Hedge’s g) for comparison in Forest plots and subgroup analysis after assessment of heterogeneity using I2 statistics. Ethics and dissemination This study will summarise the available evidence on the efficacy of lesional interventions for the most frequent tremor disorders, as well as for the incidence rate of persisting side effects after unilateral lesional treatment. This data will be useful to guide future work on incision-less lesional interventions

  6. Integrating risk management data in quality improvement initiatives within an academic neurosurgery department. (United States)

    McLaughlin, Nancy; Garrett, Matthew C; Emami, Leila; Foss, Sarah K; Klohn, Johanna L; Martin, Neil A


    OBJECT While malpractice litigation has had many negative impacts on health care delivery systems, information extracted from lawsuits could potentially guide toward venues to improve care. The authors present a comprehensive review of lawsuits within a tertiary academic neurosurgical department and report institutional and departmental strategies to mitigate liability by integrating risk management data with quality improvement initiatives. METHODS The Comprehensive Risk Intelligence Tool database was interrogated to extract claims/suits abstracts concerning neurosurgical cases that were closed from January 2008 to December 2012. Variables included demographics of the claimant, type of procedure performed (if any), claim description, insured information, case outcome, clinical summary, contributing factors and subfactors, amount incurred for indemnity and expenses, and independent expert opinion in regard to whether the standard of care was met. RESULTS During the study period, the Department of Neurosurgery received the most lawsuits of all surgical specialties (30 of 172), leading to a total incurred payment of $4,949,867. Of these lawsuits, 21 involved spinal pathologies and 9 cranial pathologies. The largest group of suits was from patients with challenging medical conditions who underwent uneventful surgeries and postoperative courses but filed lawsuits when they did not see the benefits for which they were hoping; 85% of these claims were withdrawn by the plaintiffs. The most commonly cited contributing factors included clinical judgment (20 of 30), technical skill (19 of 30), and communication (6 of 30). CONCLUSIONS While all medical and surgical subspecialties must deal with the issue of malpractice and liability, neurosurgery is most affected both in terms of the number of suits filed as well as monetary amounts awarded. To use the suits as learning tools for the faculty and residents and minimize the associated costs, quality initiatives addressing the

  7. Factors associated with burnout among US neurosurgery residents: a nationwide survey. (United States)

    Attenello, Frank J; Buchanan, Ian A; Wen, Timothy; Donoho, Daniel A; McCartney, Shirley; Cen, Steven Y; Khalessi, Alexander A; Cohen-Gadol, Aaron A; Cheng, Joseph S; Mack, William J; Schirmer, Clemens M; Swartz, Karin R; Prall, J Adair; Stroink, Ann R; Giannotta, Steven L; Klimo, Paul


    OBJECTIVE Excessive dissatisfaction and stress among physicians can precipitate burnout, which results in diminished productivity, quality of care, and patient satisfaction and treatment adherence. Given the multiplicity of its harms and detriments to workforce retention and in light of the growing physician shortage, burnout has garnered much attention in recent years. Using a national survey, the authors formally evaluated burnout among neurosurgery trainees. METHODS An 86-item questionnaire was disseminated to residents in the American Association of Neurological Surgeons database between June and November 2015. Questions evaluated personal and workplace stressors, mentorship, career satisfaction, and burnout. Burnout was assessed using the previously validated Maslach Burnout Inventory. Factors associated with burnout were determined using univariate and multivariate logistic regression. RESULTS The response rate with completed surveys was 21% (346/1643). The majority of residents were male (78%), 26-35 years old (92%), in a stable relationship (70%), and without children (73%). Respondents were equally distributed across all residency years. Eighty-one percent of residents were satisfied with their career choice, although 41% had at some point given serious thought to quitting. The overall burnout rate was 67%. In the multivariate analysis, notable factors associated with burnout included inadequate operating room exposure (OR 7.57, p = 0.011), hostile faculty (OR 4.07, p = 0.008), and social stressors outside of work (OR 4.52, p = 0.008). Meaningful mentorship was protective against burnout in the multivariate regression models (OR 0.338, p = 0.031). CONCLUSIONS Rates of burnout and career satisfaction are paradoxically high among neurosurgery trainees. While several factors were predictive of burnout, including inadequate operative exposure and social stressors, meaningful mentorship proved to be protective against burnout. The documented negative effects of

  8. Influenza A (H1N1) 2009: a pandemic alarm

    Indian Academy of Sciences (India)


    The most recent updates given by WHO confirm a total of 2,67,105 reported cases of .... Diagnosis of the new reassortant virus needs to be updated accordingly. In response to the rise in H1N1 swine flu ..... Biological and epidemiological aspects of influenza virus H5N1 in context of India; Indian J. Exp. Biol. 44 265–278.

  9. Epidemiological characteristics of Pandemic Influenza A (H1N1 ...

    African Journals Online (AJOL)

    Background: A novel influenza A virus strain (H1N1-2009) spread first in Mexico and the United Stated in late April 2009, leading to the first influenza pandemic of the 21st century. The objective of this study was to determine the epidemiological and virological characteristics of the pandemic influenza A (H1N1-2009) in ...

  10. Ducks: the "Trojan horses" of H5N1 influenza

    National Research Council Canada - National Science Library

    Kim, Jeong-Ki; Negovetich, Nicholas J; Forrest, Heather L; Webster, Robert G


    .... While the HP Asian H5N1 viruses are 100% lethal for chickens and other gallinaceous poultry, the absence of disease signs in some duck species has led to the concept that ducks are the "Trojan horses" of H5N1 in their surreptitious...

  11. Heats of Formation for CF(sub n) (n = 1 - 4), CF(sup +, sub n) (n = 1 - 4), and CF(sup -, sub n) (n = 1 - 3) (United States)

    Ricca, Alessandra; Arnold, James (Technical Monitor)


    Accurate heats of formation are computed for CF(sub n) (n = 1 - 4), CF(sup +, sub n) (n = 1 - 4), and CF(sup -, sub n) (n = 1 - 3). The geometries and vibrational frequencies are determined at the B3LYP level of theory. The energetics are determined at the CCSD(T) level of theory. Basis set limit values are obtained by extrapolation. In those cases where the CCSD(T) calculations become prohibitively large, the basis set extrapolation is performed at the MP2 level. The temperature dependence of the heat of formation, heat capacity, and entropy are computed for the temperature range 300 to 4000 K and fit to a polynomial.

  12. Influenza A (H1N1) organising pneumonia. (United States)

    Torrego, Alfons; Pajares, Virginia; Mola, Anna; Lerma, Enrique; Franquet, Tomás


    In November 2009, countries around the world reported confirmed cases of pandemic influenza H1N1, including over 6000 deaths. No peak in activity has been seen. The most common causes of death are pneumonia and acute respiratory distress syndrome. We report a case of a 55-year-old woman who presented with organising pneumonia associated with influenza A (H1N1) infection confirmed by transbronchial lung biopsy. Organising pneumonia should also be considered as a possible complication of influenza A (H1N1) infection, given that these patients can benefit from early diagnosis and appropriate specific management.

  13. [A new operational method of functional neurosurgery combining micro-recording and MRI stereotaxy for the treatment of Parkinson's disease]. (United States)

    Nishimura, H; Hirai, T


    We have developed a new operational method for stereotactic functional neurosurgery using MRI stereotaxy combined with microelectrode recording. MRI stereotaxy shows us the individual variations of thalamic configurations. The tentative target points were determined using the MRI stereotaxy assisted software system which revised the distortion of MRI images. Consequently, the accuracy and safety of the microelectrode recording were increased. This, in turn, increased the accuracy of stereotactic thalamotomy while producing encouraging operational outcomes. The effectiveness of stereotactic thalamotomy for Parkinson's disease was confirmed by these excellent operative results. The symptoms improved and the dosage of medications, including L-DOPA, decreased. Furthermore, our results indicate that the distributing area of deep sensory neurons in the thalamus extended more posteriorly and upward than previously expected. Therefore, the functional and anatomical similarity between the human and monkey thalamus was reaffirmed. In this report, based on the above data, we reevaluated the neural mechanism of tremor and the role of stereotactic functional neurosurgery for Parkinson's disease.

  14. Prokofiev: Romeo and Juliet - Suite N1 / Ivan March

    Index Scriptorium Estoniae

    March, Ivan


    Uuest heliplaadist "Prokofiev: Romeo and Juliet - Suite N1, Op.64b, N2, Op.64c. Philharmonia Orchestra, Barry Wordsworth" Collins Classics cassette 1116-4. CD. Võrreldud Neeme Järvi plaadistustega 1116-2

  15. Barber. Symphony N 1, Op. 9 / Michael Oliver

    Index Scriptorium Estoniae

    Oliver, Michael


    Uuest heliplaadist "Barber. Symphony N 1, Op. 9. The School for Scandal Overture, Op. 5 Beach. Symphony in E minor, Op. 32, "Gaelic". Detroit Symphony Orchestra /Neeme Järvi" Chandes cassette ABTD 1550; CD CHAN 8958 (72 minutes)

  16. Combined x-ray and magnetic resonance imaging facility: application to image-guided stereotactic and functional neurosurgery. (United States)

    Hunsche, Stefan; Sauner, Dieter; Maarouf, Mohammad; Lackner, Klaus; Sturm, Volker; Treuer, Harald


    To assess the feasibility of a hybrid imaging setup combining x-ray and magnetic resonance imaging (MRI) in the setting of both stereotactic and functional neurosurgery. A combined x-ray and MRI scanning facility with a trolley system for a fast patient transfer between both modalities was installed in a neurosurgical setting. A registration algorithm for fusion of MRI scans and x-ray images was derived for augmentation of fluoroscopic x-ray projection images with MRI scan data, such as anatomic structures and planned probe trajectories. Phantom measurements were obtained between both modalities for estimation of registration accuracy. Practical application of our system in stereotactic and functional neurosurgery was tested in brachytherapy, deep brain stimulation, and motor cortex stimulation. Phantom measurements yielded a mean spatial deviation of 0.7 +/- 0.3 mm with a maximum deviation of 1.1 mm for MRI scans versus x-rays. Augmentation of x-ray images with MRI scan data allowed intraoperative verification of the planned trajectory and target in three types of neurosurgical procedures: positioning iodine seeds in brachytherapy in one case with cerebellar metastasis, placement of electrodes for deep brain stimulation in two cases of advanced Parkinson's disease, and placement of an epidural grid for motor cortex stimulation in two cases of intractable pain. Combined x-ray and MRI-guided stereotactic and functional neurosurgery is feasible. Augmentation of x-ray projection images with MRI scan data, such as planned probe trajectories and MRI scan segmented anatomic structures may be beneficial for probe guidance in stereotactic and functional neurosurgery.

  17. Ducks: the "Trojan horses" of H5N1 influenza. (United States)

    Kim, Jeong-Ki; Negovetich, Nicholas J; Forrest, Heather L; Webster, Robert G


    Wild ducks are the main reservoir of influenza A viruses that can be transmitted to domestic poultry and mammals, including humans. Of the 16 hemagglutinin (HA) subtypes of influenza A viruses, only the H5 and H7 subtypes cause highly pathogenic (HP) influenza in the natural hosts. Several duck species are naturally resistant to HP Asian H5N1 influenza viruses. These duck species can shed and spread virus from both the respiratory and intestinal tracts while showing few or no disease signs. While the HP Asian H5N1 viruses are 100% lethal for chickens and other gallinaceous poultry, the absence of disease signs in some duck species has led to the concept that ducks are the "Trojan horses" of H5N1 in their surreptitious spread of virus. An important unresolved issue is whether the HP H5N1 viruses are maintained in the wild duck population of the world. Here, we review the ecology and pathobiology of ducks infected with influenza A viruses and ducks' role in the maintenance and spread of HP H5N1 viruses. We also identify the key questions about the role of ducks that must be resolved in order to understand the emergence and control of pandemic influenza. It is generally accepted that wild duck species can spread HP H5N1 viruses, but there is insufficient evidence to show that ducks maintain these viruses and transfer them from one generation to the next.

  18. Minimally invasive neurosurgery with interventional magnetic resonance. Its present and future

    Energy Technology Data Exchange (ETDEWEB)

    Hashimoto, Takuo [Jikei Univ., Tokyo (Japan). School of Medicine


    We have used X-ray fluoroscopy, ultrasonography, and computed tomography in treatment. However, these methods do not provide precise image. Since magnetic resonance (MR) provides high-resolution images, it is more suitable in treatment. Recently open-type MR has been introduced for clinical diagnosis and treatment. Interventional MR provides a real-time images, high-resolutional images, and thermal distribution. Open MR can be used for minimally invasive neurosurgery. Interventional MR (I-MR) can be used in treatment and is extremely useful for minimally invasive surgery of the brain and spinal cord. We have used an open-type permanent MR scanner (Airis, Hitachi), for minimally invasive neurosurgery. Stereotactic brain tumor biopsy, aspiration of intracerebral hematoma, and percutaneous laser disc hernia ablation under MR guidance has been performed in our department. I-MR provided precise, and less-invasive treatment. Stereotactic biopsy was done in 12 patients with brain tumors. Precise, accurate biopsy is possible with MR fluoroscopic guidance. Hematomas were also aspirated safely and precisely by monitoring real-time image. Percutaneous laser disc hernia ablation (PLDA) was done in 201 patients with lumbar disc herniation (127 at L4/5 and 48 at L5/S1). Patients ranged in age from 17 to 72 years. A MR-compatible 18-gauge 15-cm-long titanium needle was clearly visualized and safety and accurately inserted into the disc herniation from multiple directions. Laser ablation was done (mean, 1,000 J). Signs and symptoms improved immediately after ablation. The overall success rate was 90.5% (MacNab's criteria). Two patients (1.0%) had discitis after PLDA. I-MR and fluoroscopy provide near-real-time images for treatment of brain tumors and hematoma. Precise treatment can be performed with the Patil MR-compatible stereotactic system. PLDA was performed safety and accurately with I-MR. The results were satisfactory. I-MR-PLDA is a safe, precise, and minimally

  19. Parental Evaluation of a Nurse Practitioner-Developed Pediatric Neurosurgery Website (United States)

    Vogel, Tina Kovacs; Kleib, Manal; Davidson, Sandra J


    Background Parents often turn to the Internet to seek health information about their child’s diagnosis and condition. Information, support, and resources regarding pediatric neurosurgery are scarce, hard to find, and difficult to comprehend. To address this gap, a pediatric nurse practitioner designed a website called the Neurosurgery Kids Fund (NKF). Analyzing the legitimacy of the NKF website for parents seeking health information and fulfilling their social and resource needs is critical to the website’s future development and success. Objective To explore parental usage of the NKF website, track visitor behavior, evaluate usability and design, establish ways to improve user experience, and identify ways to redesign the website. The aim of this study was to assess and evaluate whether a custom-designed health website could meet parents’ health information, support, and resource needs. Methods A multimethod approach was used. Google Analytic usage reports were collected and analyzed for the period of April 23, 2013, to November 30, 2013. Fifty-two online questionnaires that targeted the website’s usability were collected between June 18, 2014, and July 30, 2014. Finally, a focus group was conducted on August 20, 2014, to explore parents’ perceptions and user experiences. Findings were analyzed using an inductive content analysis approach. Results There were a total of 2998 sessions and 8818 page views, with 2.94 pages viewed per session, a 56.20% bounce rate, an average session duration of 2 minutes 24 seconds, and a 56.24% new sessions rate. Results from 52 eligible surveys included that the majority of NKF users were Caucasian (90%), females (92%), aged 36-45 years (48%), with a university or college degree or diploma (69%). Half plan to use the health information. Over half reported turning to the Internet for health information and spending 2 to 4 hours a day online. The most common reasons for using the NKF website were to (1) gather information

  20. Health impact and economic analysis of NGO-supported neurosurgery in Bolivia. (United States)

    Ament, Jared D; Greene, Kevin R; Flores, Ivan; Capobianco, Fernando; Salas, Gueider; Uriona, Maria Ines; Weaver, John P; Moser, Richard


    Bolivia, one of the poorest countries in the world, ranks 108th on the 2013 Human Development Index. With approximately 1 neurosurgeon per 200,000 people, access to neurosurgery in Bolivia is a growing health concern. Furthermore, neurosurgery in nonindustrialized countries has been considered both cost-prohibitive and lacking in outcomes evaluation. A non-governmental organization (NGO) supports spinal procedures in Bolivia (Solidarity Bridge), and the authors sought to determine its impact and cost-effectiveness. In a retrospective review of prospectively collected data, 19 patients were identified prior to spinal instrumentation and followed over 12 months. For inclusion, patients required interviewing prior to surgery and during at least 2 follow-up visits. All causes of spinal pathology were included. Sixteen patients met inclusion criteria and were therefore part of the analysis. Outcomes measured included assessment of activities of daily living, pain, ambulation, return to work/school, and satisfaction. Cost-effectiveness was determined by cost-utility analysis. Utilities were derived using the Health Utilities Index. Complications were incorporated into an expected value decision tree. Median (± SD) preoperative satisfaction was 2.0 ± 0.3 (on a scale of 0-10), while 6-month postoperative satisfaction was 7 ± 1.4 (p Bolivia appears to be cost-effective, especially when compared with the conventional $50,000/QALY benchmark and the WHO endorsed country-specific threshold of $16,026/QALY. However, with a gross domestic product per capita in Bolivia equaling $4800 per year and 30.3% of the population living on less than $2 per day, this cost continues to appear unrealistic. Additionally, the study has several significant limitations, namely its limited sample size, follow-up period, the assumption that patients not receiving surgical intervention would not make any clinical improvement, the reliance on the NGO for patient selection and sustainable practices

  1. The composite N1 component to gaps in noise. (United States)

    Pratt, Hillel; Bleich, Naomi; Mittelman, Nomi


    To indicate whether the double peaked N(1) to gaps in continuous white noise is a composite of onset and offset responses to transients or whether it reflects higher processing such as change or mismatch detection and to assess the role of attention in this process. Evoked potentials were recorded to two binaural stimulus types: (1) gaps of different durations randomly distributed in continuous white noise; and (2) click pairs at intervals identical to those between gap onsets and offsets in the continuous noise stimulus. Potentials to these stimuli were recorded while subjects read a text and while detecting gaps in noise or click pairs. Potentials were detected to all click pairs and to gaps of 5 ms or longer, corresponding to the subjects' psychoacoustic gap detection threshold. With long gap durations of 200-800 ms, distinct potentials to gap onset and gap offset were observed. The waveforms to all click pairs and to offsets of long gaps were similar and single-peaked, while potentials to gaps of 10 ms and longer, and potentials to onsets of long gaps were double-peaked, consisting of two N(1) negativities, 60 ms apart, irrespective of gap duration. The first (N(1a)), was more frontal in its distribution and similar to that of clicks. The second (N(1b)) peak's distribution was more central/temporal and its source locations and time course of activity were distinct. No effects of attention on any of the varieties and constituents of N(1) were observed. Comparing potentials to gap onsets, to click pairs and to gap offsets, suggests that potentials to gap onsets involve not only sound onset/offset responses (N(1), N(1a)) but also the subsequent pre-attentive perception of the cessation of an ongoing sound (N(1b)). We propose that N(1b) is distinct from change or mismatch detection and is associated with termination of an ongoing continuous stimulus. We propose to call it the N(egation)-process. A constituent of the N(1) complex is shown to be associated with the

  2. MicroRNA expression in mice infected with seasonal H1N1, swine H1N1 or highly pathogenic H5N1. (United States)

    Vela, Eric M; Kasoji, Manjula D; Wendling, Morgan Q; Price, Jennifer A; Knostman, Katherine A B; Bresler, Herbert S; Long, James P


    Influenza virus infections in humans remain a healthcare concern, and the need for vaccines, therapeutics and prophylactics remains a high priority. Understanding the molecular events associated with influenza-virus-induced pathology may lead to the identification of clinical disease biomarkers and novel antiviral targets. MicroRNAs (miRNAs) are well-conserved endogenous non-coding RNAs known to regulate post-transcriptional gene expression as well as play a major role in many biological processes and pathways. Animal studies have demonstrated that miRNAs are involved in viral disease and controlling inflammation. In this study, we examined the differences in the miRNA expression profiles associated with the lung in mice infected with influenza viruses that varied in virulence and pathogenicity. A statistical model was employed that utilized changes in miRNA expression to identify the virus that was used to infect the mice. This study identified a unique fingerprint of viral pathogenicity associated with seasonal H1N1, swine H1N1 and highly pathogenic H5N1 in the mouse model, and may lead to the identification of novel therapeutic and prophylactic targets. © 2014 The Authors.

  3. Fusion imaging for intra-operative ultrasound-based navigation in neurosurgery. (United States)

    Prada, Francesco; Del Bene, Massimiliano; Mattei, Luca; Casali, Cecilia; Filippini, Assunta; Legnani, Federico; Mangraviti, Antonella; Saladino, Andrea; Perin, Alessandro; Richetta, Carla; Vetrano, Ignazio; Moiraghi, Alessandro; Saini, Marco; DiMeco, Francesco


    The major shortcoming of image-guided navigation systems is the use of presurgically acquired image data, which does not account for intra-operative changes such as brain shift, tissue deformation and tissue removal occurring during the surgical procedure. Intra-operative ultrasound (iUS) is becoming widely used in neurosurgery but they lack orientation and panoramic view. In this article, we describe our procedure for US-based real-time neuro-navigation during surgery. We used fusion imaging between preoperative magnetic resonance imaging (MRI) and iUS for brain lesion removal in 67 patients so far. Surgical planning is based on preoperative MRI only. iUS images obtained during surgery are fused with the preoperative MRI. Surgery is performed under intra-operative US control. Relying on US imaging, it is possible to recalibrate navigated MRI imaging, adjusting distortion due to brain shift and tissue resection, continuously updating the two modalities. Ultrasound imaging provides excellent visualization of targets, their margins and surrounding structures. The use of navigated MRI is helpful in better understanding cerebral ultrasound images, providing orientation and panoramic view. Intraoperative US-guided neuro-navigation adjustments are very accurate and helpful in the event of brain shift. The use of this integrated system allows for a true real-time feedback during surgery.

  4. Recording stereoscopic 3D neurosurgery with a head-mounted 3D camera system. (United States)

    Lee, Brian; Chen, Brian R; Chen, Beverly B; Lu, James Y; Giannotta, Steven L


    Stereoscopic three-dimensional (3D) imaging can present more information to the viewer and further enhance the learning experience over traditional two-dimensional (2D) video. Most 3D surgical videos are recorded from the operating microscope and only feature the crux, or the most important part of the surgery, leaving out other crucial parts of surgery including the opening, approach, and closing of the surgical site. In addition, many other surgeries including complex spine, trauma, and intensive care unit procedures are also rarely recorded. We describe and share our experience with a commercially available head-mounted stereoscopic 3D camera system to obtain stereoscopic 3D recordings of these seldom recorded aspects of neurosurgery. The strengths and limitations of using the GoPro(®) 3D system as a head-mounted stereoscopic 3D camera system in the operating room are reviewed in detail. Over the past several years, we have recorded in stereoscopic 3D over 50 cranial and spinal surgeries and created a library for education purposes. We have found the head-mounted stereoscopic 3D camera system to be a valuable asset to supplement 3D footage from a 3D microscope. We expect that these comprehensive 3D surgical videos will become an important facet of resident education and ultimately lead to improved patient care.

  5. Santiago Ramón y Cajal and Harvey Cushing: two forefathers of neuroscience and neurosurgery. (United States)

    Zamora-Berridi, Grettel J; Pendleton, Courtney; Ruiz, Gabriel; Cohen-Gadol, Aaron A; Quiñones-Hinojosa, Alfredo


    To summarize the extraordinary accomplishments, and the commonalities, between Santiago Ramon y Cajal and Harvey Williams Cushing. Existing literature describing the lives and achievements of Ramón y Cajal and Cushing, as well as personal communication, and the surgical records of the Johns Hopkins Hospital, from 1896 to 1912, were reviewed. Both Ramón y Cajal and Cushing were men of unusually broad interests and talents, and these shared characteristics undoubtedly influenced the career paths and scientific investigations they pursued. Although Santiago Ramón y Cajal and Harvey Williams Cushing never directly interacted, the links between them can be traced through some of their disciples, including Pío del Río Hortega, Wilder Penfield, and Percival Bailey. Ramón y Cajal and Cushing are widely considered the forefathers of neuroscience and neurosurgery, respectively, and their discoveries have made lasting impressions on both the scientific and medical communities. Copyright © 2011 Elsevier Inc. All rights reserved.

  6. [Medico-economic analysis of a neurosurgery department at a university hospital]. (United States)

    Lemaire, J-J; Delom, C; Coste, A; Khalil, T; Jourdy, J-C; Pontier, B; Gabrillargues, J; Sinardet, D; Chabanne, A; Achim, V; Sakka, L; Coste, J; Chazal, J; Salagnac, A; Coll, G; Irthum, B


    Economic and societal constraints require to take into account the economic dimension and medical performance of hospital departments. We carried out a self-assessment study, which we thought could be useful to share with the neurosurgical community. Care and research activities were assessed from 2009 to 2013. We used institutional and assessment-body parameters in order to describe activities and perform a financial evaluation. It was a retrospective descriptive study based on the guidelines of the DHOS/O4 circular No. 2007/390 of October 29, 2007. The average annual, analytic income statement was +1.39 millions euros, for 63 beds with a 92% occupancy rate, including 6.7 full-time equivalent neurosurgeons (and assistants), for 2553 patients and 1975 surgeries. The average mortality rate was 2.74%. The annual mean length of stay was 6.82 days. Per year, on average 15.6% of patients were admitted in emergency and 76.9% returned home. The annual, act-related-pricing and publication-related incomes represented 77% and 0.6%, respectively of the total funding. Difficulties to find downstream beds for the most severe patients induced 1401 "waiting days" in 2012. Medico-economic analysis of a neurosurgery department at a university hospital was useful in order to take into account the care, teaching and research activities, as well as its related financial value. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  7. Augmented virtuality based on stereoscopic reconstruction in multimodal image-guided neurosurgery: methods and performance evaluation. (United States)

    Paul, Perrine; Fleig, Oliver; Jannin, Pierre


    Displaying anatomical and physiological information derived from preoperative medical images in the operating room is critical in image-guided neurosurgery. This paper presents a new approach referred to as augmented virtuality (AV) for displaying intraoperative views of the operative field over three-dimensional (3-D) multimodal preoperative images onto an external screen during surgery. A calibrated stereovision system was set up between the surgical microscope and the binocular tubes. Three-dimensional surface meshes of the operative field were then generated using stereopsis. These reconstructed 3-D surface meshes were directly displayed without any additional geometrical transform over preoperative images of the patient in the physical space. Performance evaluation was achieved using a physical skull phantom. Accuracy of the reconstruction method itself was shown to be within 1 mm (median: 0.76 mm +/- 0.27), whereas accuracy of the overall approach was shown to be within 3 mm (median: 2.29 mm +/- 0.59), including the image-to-physical space registration error. We report the results of six surgical cases where AV was used in conjunction with augmented reality. AV not only enabled vision beyond the cortical surface but also gave an overview of the surgical area. This approach facilitated understanding of the spatial relationship between the operative field and the preoperative multimodal 3-D images of the patient.

  8. Trajectory planning method for reduced patient risk in image-guided neurosurgery: concept and preliminary results (United States)

    Shamir, Reuben R.; Joskowicz, Leo; Antiga, Luca; Foroni, Roberto I.; Shoshan, Yigal


    We present a new preoperative planning method to quantify and help reduce the risk associated with needle and tool insertion trajectories in image-guided keyhole neurosurgery. The goal is to quantify the risk of a proposed straight trajectory, and/or to find the trajectory with the lowest risk to nearby brain structures based on pre-operative CT/MRI images. The method automatically computes the risk associated with a given trajectory, or finds the trajectory with the lowest risk to nearby brain structures based on preoperative image segmentation and on a risk volume map. The surgeon can revise the suggested trajectory, add a new one using interactive 3D visualization, and obtain a quantitative risk measure. The trajectory risk is evaluated based on the tool placement uncertainty, on the proximity of critical brain structures, and on a predefined table of quantitative geometric risk measures. Our preliminary results on a clinical dataset with eight targets show a significant reduction in trajectory risk and a shortening of the preoperative planning time as compared to the conventional method.

  9. Towards estimating fiducial localization error of point-based registration in image-guided neurosurgery. (United States)

    Zhi, Deng


    Fiducial Localization Error (FLE) is one of the major reasons of inaccuracy in point-based spatial registration of Image-Guided Neurosurgery System (IGNS), and minimizing FLE is the fundamental way to improve spatial registration accuracy. A reliable estimation of FLE is needed, as it cannot be measured directly in real application of IGNS. In this paper, we propose a method to estimate the FLE in a point-based registration of IGNS. Test fiducial point sets were generated in one coordinate system around the given fiducial point set by utilizing simple random sampling. Further, these points were registered to the fiducial point set in the other coordinate system. The average position of the test fiducial point sets with small FRE are calculated and its displacement from the given fiducial point set is the parameter used to estimate the FLE of each fiducial point. The correlation between the displacement and the FLE of each fiducial point is greater than 0.75 when nine or more fiducial points were utilized. This correlation gradually increases up to 0.9 with the increase of the number of fiducial points.

  10. Center of excellence in research reporting in neurosurgery--diagnostic ontology.

    Directory of Open Access Journals (Sweden)

    Amrapali Zaveri

    Full Text Available MOTIVATION: Evidence-based medicine (EBM, in the field of neurosurgery, relies on diagnostic studies since Randomized Controlled Trials (RCTs are uncommon. However, diagnostic study reporting is less standardized which increases the difficulty in reliably aggregating results. Although there have been several initiatives to standardize reporting, they have shown to be sub-optimal. Additionally, there is no central repository for storing and retrieving related articles. RESULTS: In our approach we formulate a computational diagnostic ontology containing 91 elements, including classes and sub-classes, which are required to conduct Systematic Reviews-Meta Analysis (SR-MA for diagnostic studies, which will assist in standardized reporting of diagnostic articles. SR-MA are studies that aggregate several studies to come to one conclusion for a particular research question. We also report high percentage of agreement among five observers as a result of the interobserver agreement test that we conducted among them to annotate 13 articles using the diagnostic ontology. Moreover, we extend our existing repository CERR-N to include diagnostic studies. AVAILABILITY: The ontology is available for download as an.owl file at:

  11. Cortically evoked responses of human pallidal neurons recorded during stereotactic neurosurgery. (United States)

    Nishibayashi, Hiroki; Ogura, Mitsuhiro; Kakishita, Koji; Tanaka, Satoshi; Tachibana, Yoshihisa; Nambu, Atsushi; Kita, Hitoshi; Itakura, Toru


    Responses of neurons in the globus pallidus (GP) to cortical stimulation were recorded for the first time in humans. We performed microelectrode recordings of GP neurons in 10 Parkinson's disease (PD) patients and 1 cervical dystonia (CD) patient during surgeries to implant bilateral deep brain stimulation electrodes in the GP. To identify the motor territories in the external (GPe) and internal (GPi) segments of the GP, unitary responses evoked by stimulation of the primary motor cortex were observed by constructing peristimulus time histograms. Neurons in the motor territories of the GPe and GPi responded to cortical stimulation. Response patterns observed in the PD patients were combinations of an early excitation, an inhibition, and a late excitation. In addition, in the CD patient, a long-lasting inhibition was prominent, suggesting increased activity along the cortico-striato-GPe/GPi pathways. The firing rates of GPe and GPi neurons in the CD patient were lower than those in the PD patients. Many GPe and GPi neurons of the PD and CD patients showed burst or oscillatory burst activity. Effective cathodal contacts tended to be located close to the responding neurons. Such unitary responses induced by cortical stimulation may be of use to target motor territories of the GP for stereotactic functional neurosurgery. Future findings utilizing this method may give us new insights into understanding the pathophysiology of movement disorders. Copyright © 2011 Movement Disorder Society.

  12. A retrospective case series of computer-controlled total intravenous anaesthesia in dogs presented for neurosurgery

    Directory of Open Access Journals (Sweden)

    K.E. Joubert


    Full Text Available This article describes the anaesthetic management and use of total intravenous anaesthesia (TIVA for neurosurgery in 4 dogs. Propofol in conjunction with morphine was used for the maintenance of anaesthesia. Anaesthesia was induced with either thiopentone or propofol. The program Stelpump (a target-controlled infusion program was run on a laptop and connected to a syringe driver via an RS 232 cable. The program was found to be reliable and safe for the administration of TIVA in dogs. Invasive monitoring was required in order to monitor cardiovascular changes during surgery. Ventilation was controlled to maintain the end-tidal carbon dioxide below 40 mm Hg. The anaesthesia was characterised by haemodynamic stability. The haemodynamic stability was probably the result of the choice of TIVA and balanced anaesthesia. Intracranial pressure and oedema was controlled with dexamethasone, mannitol and ventilatory management either in combination or alone. Three dogs survived to hospital discharge and 1 dog was euthanased 2 weeks later due to tumour metastasis. The development and characterisation of the anaesthetic effects of TIVA needs to be elucidated in order to provide clinicians with rational guidelines for the appropriate use of TIVA in veterinary medicine.

  13. Neurosurgery and Telemedicine in the United States: Assessment of the Risks and Opportunities. (United States)

    Kahn, Elyne N; La Marca, Frank; Mazzola, Catherine A


    Telemedicine has seen substantial growth in the past 20 years, related to technologic advancements and evolving reimbursement policies. The risks and opportunities of neurosurgical telemedicine are nuanced. We reviewed general and peer-reviewed literature as it relates to telemedicine and neurosurgery, with particular attention to best practices, relevant state and federal policy conditions, economic evaluations, and prospective clinical studies. Despite technologic development, growing interest, and increasing reimbursement opportunities, telemedicine's utilization remains limited because of concerns regarding an apparent lack of need for telemedicine services, lack of widespread reimbursement, lack of interstate licensure reciprocity, lack of universal access to necessary technology, concerns about maintaining patient confidentiality, and concerns and limited precedent regarding liability issues. The Veterans Health Administration, a component of the U.S. Department of Veterans Affairs, represents a setting in which these concerns can be largely obviated and is a model for telemedicine best practices. Results from the VA demonstrate substantial cost savings and patient satisfaction with remote care for chronic neurologic conditions. Overall, the economic and clinical benefits of telemedicine will likely come from 1) diminished travel times and lost work time for patients; 2) remote consultation of subspecialty experts, such as neurosurgeons; and 3) remote consultation to assist with triage and care in time-sensitive scenarios, including acute stroke care and "teletrauma." Telemedicine is effective in many health care scenarios and will become more relevant to neurosurgical patient care. We favor proceeding with legislation to reduce barriers to telemedicine's growth. Copyright © 2016 Elsevier Inc. All rights reserved.

  14. Cognitive eloquence in neurosurgery: Insight from graph theoretical analysis of complex brain networks. (United States)

    Lang, Stefan


    The structure and function of the brain can be described by complex network models, and the topological properties of these models can be quantified by graph theoretical analysis. This has given insight into brain regions, known as hubs, which are critical for integrative functioning and information transfer, both fundamental aspects of cognition. In this manuscript a hypothesis is put forward for the concept of cognitive eloquence in neurosurgery; that is regions (cortical, subcortical and white matter) of the brain which may not necessarily have readily identifiable neurological function, but if injured may result in disproportionate cognitive morbidity. To this end, the effects of neurosurgical resection on cognition is reviewed and an overview of the role of complex network analysis in the understanding of brain structure and function is provided. The literature describing network, behavioral, and cognitive effects resulting from lesions to, and disconnections of, centralized hub regions will be emphasized as evidence for the espousal of the concept of cognitive eloquence. Copyright © 2016 Elsevier Ltd. All rights reserved.

  15. "Extremely minimally invasive": recent advances in nanotechnology research and future applications in neurosurgery. (United States)

    Mattei, Tobias A; Rehman, Azeem A


    The term "nanotechnology" refers to the development of materials and devices that have been designed with specific properties at the nanometer scale (10(-9) m), usually being less than 100 nm in size. Recent advances in nanotechnology have promised to enable visualization and intervention at the subcellular level, and its incorporation to future medical therapeutics is expected to bring new avenues for molecular imaging, targeted drug delivery, and personalized interventions. Although the central nervous system presents unique challenges to the implementation of new therapeutic strategies involving nanotechnology (such as the heterogeneous molecular environment of different CNS regions, the existence of multiple processing centers with different cytoarchitecture, and the presence of the blood-brain barrier), numerous studies have demonstrated that the incorporation of nanotechnology resources into the armamentarium of neurosurgery may lead to breakthrough advances in the near future. In this article, the authors present a critical review on the current 'state-of-the-art' of basic research in nanotechnology with special attention to those issues which present the greatest potential to generate major therapeutic progresses in the neurosurgical field, including nanoelectromechanical systems, nano-scaffolds for neural regeneration, sutureless anastomosis, molecular imaging, targeted drug delivery, and theranostic strategies.

  16. Augmented-reality integrated robotics in neurosurgery: are we there yet? (United States)

    Madhavan, Karthik; Kolcun, John Paul G; Chieng, Lee Onn; Wang, Michael Y


    Surgical robots have captured the interest-if not the widespread acceptance-of spinal neurosurgeons. But successful innovation, scientific or commercial, requires the majority to adopt a new practice. "Faster, better, cheaper" products should in theory conquer the market, but often fail. The psychology of change is complex, and the "follow the leader" mentality, common in the field today, lends little trust to the process of disseminating new technology. Beyond product quality, timing has proven to be a key factor in the inception, design, and execution of new technologies. Although the first robotic surgery was performed in 1985, scant progress was seen until the era of minimally invasive surgery. This movement increased neurosurgeons' dependence on navigation and fluoroscopy, intensifying the drive for enhanced precision. Outside the field of medicine, various technology companies have made great progress in popularizing co-robots ("cobots"), augmented reality, and processor chips. This has helped to ease practicing surgeons into familiarity with and acceptance of these technologies. The adoption among neurosurgeons in training is a "follow the leader" phenomenon, wherein new surgeons tend to adopt the technology used during residency. In neurosurgery today, robots are limited to computers functioning between the surgeon and patient. Their functions are confined to establishing a trajectory for navigation, with task execution solely in the surgeon's hands. In this review, the authors discuss significant untapped technologies waiting to be used for more meaningful applications. They explore the history and current manifestations of various modern technologies, and project what innovations may lie ahead.

  17. Historical distribution of central nervous system tumors in the Mexican National Institute of Neurology and Neurosurgery. (United States)

    Aguirre-Cruz, Lucinda; Rangel-López, Edgar; Cruz-Aguilera, Dora Luz de la; Rodríguez-Pérez, Citlali Ekaterina; Ruano, Luis; Velásquez-Pérez, Leora; Martínez-Moreno, Mauricio; Garduño-Espinosa, Juan; Sotelo, Julio


    To determine the frequency of central nervous system (CNS) tumors in the first fifty years of the National Institute of Neurology and Neurosurgery of Mexico Manuel Velasco Suárez (Instituto Nacional de Neurología y Neurocirugía de México, INNN) from 1965 to 2014. A total of 16 116 institutional records of CNS tumors were analyzed. The frequency and distribution of CNS tumors were evaluated by tumor type, patient age and patient gender. The annual relationship between CNS tumors and surgical discharges (SD) over the last 20 years was estimated. The frequencies of most CNS tumors were consistent with those found worldwide, and the most common tumors were neuroepithelial tumors (33%), particularly astrocytic tumors (67%); meningeal tumors (26%); and pituitary tumors (20%). The incidence of pituitary tumors in these data was twice as high as that reported in other regions of the world, and the relationship between CNS tumors and SD was consistent over time (0.22-0.39). This study summarizes the largest sample of CNS tumor cases analyzed in Mexico and provides an important reference of the frequency of this tumor type in the country. This work will serve as a basis for conducting studies evaluating factors associated with the presence of CNS tumors and for identifying adequate public health interventions.

  18. Rivaling Paradigms in Psychiatric Neurosurgery: Adjustability versus Quick Fix versus Minimal-Invasiveness

    Directory of Open Access Journals (Sweden)

    Müller eSabine


    Full Text Available In the wake of deep brain stimulation (DBS development, ablative neurosurgical procedures are seeing a comeback, although they had been discredited and nearly completely abandoned in the 1970ies because of their unethical practice. Modern stereotactic ablative procedures as thermal or radiofrequency ablation, and particularly radiosurgery (e.g., Gamma Knife are much safer than the historical procedures, so that a re-evaluation of this technique is required. The different approaches of modern psychiatric neurosurgery refer to different paradigms: Microsurgical ablative procedures is based on the paradigm ‘quick fix’, radiosurgery on the paradigm ‘minimal-invasiveness’, and DBS on the paradigm ‘adjustability’.From a mere medical perspective, none of the procedures is absolutely superior; rather, they have different profiles of advantages and disadvantages. Therefore, individual factors are crucial in decision-making, particularly the patients’ social situation, individual preferences, and individual attitudes.The different approaches are not only rivals, but also enriching mutually. DBS is preferable for exploring new targets, which may become candidates for ablative microsurgery or radiosurgery.

  19. Worm Algorithm for CP(N-1) Model

    CERN Document Server

    Rindlisbacher, Tobias


    The CP(N-1) model in 2D is an interesting toy model for 4D QCD as it possesses confinement, asymptotic freedom and a non-trivial vacuum structure. Due to the lower dimensionality and the absence of fermions, the computational cost for simulating 2D CP(N-1) on the lattice is much lower than that for simulating 4D QCD. However, to our knowledge, no efficient algorithm for simulating the lattice CP(N-1) model has been tested so far, which also works at finite density. To this end we propose a new type of worm algorithm which is appropriate to simulate the lattice CP(N-1) model in a dual, flux-variables based representation, in which the introduction of a chemical potential does not give rise to any complications. In addition to the usual worm moves where a defect is just moved from one lattice site to the next, our algorithm additionally allows for worm-type moves in the internal variable space of single links, which accelerates the Monte Carlo evolution. We use our algorithm to compare the two popular CP(N-1) l...

  20. Worm algorithm for the CP N - 1 model (United States)

    Rindlisbacher, Tobias; de Forcrand, Philippe


    The CP N - 1 model in 2D is an interesting toy model for 4D QCD as it possesses confinement, asymptotic freedom and a non-trivial vacuum structure. Due to the lower dimensionality and the absence of fermions, the computational cost for simulating 2D CP N - 1 on the lattice is much lower than that for simulating 4D QCD. However, to our knowledge, no efficient algorithm for simulating the lattice CP N - 1 model for N > 2 has been tested so far, which also works at finite density. To this end we propose a new type of worm algorithm which is appropriate to simulate the lattice CP N - 1 model in a dual, flux-variables based representation, in which the introduction of a chemical potential does not give rise to any complications. In addition to the usual worm moves where a defect is just moved from one lattice site to the next, our algorithm additionally allows for worm-type moves in the internal variable space of single links, which accelerates the Monte Carlo evolution. We use our algorithm to compare the two popular CP N - 1 lattice actions and exhibit marked differences in their approach to the continuum limit.

  1. Formal kinetics of H1N1 epidemic

    Directory of Open Access Journals (Sweden)

    Gurevich Konstantin G


    Full Text Available Abstract Background The formal kinetics of the H1N1 epidemic seems to take the form of an exponential curve. There is a good correlation between this theoretical model and epidemiological data on the number of H1N1-infected people. But this formal model leads to paradoxes about the dates when everyone becomes infected: in Mexico this will happen after one year, then in the rest of the world. Further implications of the formal model The general limitations of this formal kinetics model are discussed. More detailed modeling is examined and the implications are examined in the light of currently available data. The evidence indicates that not more than 10% of the population is initially resistant to the H1N1 virus. Conclusion We are probably only at the initial stage of development of the H1N1 epidemic. Increasing the number of H1N1-resistant people in future (e.g. due to vaccination may influence the dynamics of epidemic development. At present, the development of the epidemic depends only on the number of people in the population who are initially resistant to the virus.

  2. H1N1 in dialysis units: Prevention and management

    Directory of Open Access Journals (Sweden)

    Karkar Ayman


    Full Text Available Dialysis patients are at increased risk of contracting influenza A H1N1 and deve-loping serious illness. Increasing the awareness of dialysis patients and continuous education and training of medical staff on early recognition and management of influenza A H1N1 can help in saving the life of patients. Antiviral drugs and influenza vaccines are effective in providing ade-quate immunity in dialysis patients with strict implementation of infection control policies and procedures can help in preventing and controlling the dissemination of influenza A H1N1 in dia-lysis units. We report a case of a patient who presented with HINI influenza and developed acute kidney injury during his hospitalization and his course with disease.

  3. H1N1, globalization and the epidemiology of inequality. (United States)

    Sparke, Matthew; Anguelov, Dimitar


    This paper examines the lessons learned from the 2009 H1N1 pandemic in relation to wider work on globalization and the epidemiology of inequality. The media attention and economic resources diverted to the threats posed by H1N1 were significant inequalities themselves when contrasted with weaker responses to more lethal threats posed by other diseases associated with global inequality. However, the multiple inequalities revealed by H1N1 itself in 2009 still provide important insights into the future of global health in the context of market-led globalization. These lessons relate to at least four main forms of inequality: (1) inequalities in blame for the outbreak in the media; (2) inequalities in risk management; (3) inequalities in access to medicines; and (4) inequalities encoded in the actual emergence of new flu viruses. Copyright © 2011 Elsevier Ltd. All rights reserved.

  4. On N=1 Mirror Symmetry for Open Type II Strings

    CERN Document Server

    Lerche, Wolfgang


    We study the open string extension of the mirror map for N=1 supersymmetric type II vacua with D-branes on non-compact Calabi-Yau manifolds. Its definition is given in terms of a system of differential equations that annihilate certain period and chain integrals. The solutions describe the flat coordinates on the N=1 parameter space, and the exact disc instanton corrected superpotential on the D-brane world-volume. A gauged linear sigma model for the combined open-closed string system is also given. It allows to use methods of toric geometry to describe D-brane phase transitions and the N=1 K\\"ahler cone. Applications to a variety of D-brane geometries are described in some detail.

  5. Black-Hole Attractors in N=1 Supergravity

    CERN Document Server

    Andrianopoli, L; Ferrara, Sergio; Trigiante, M; Andrianopoli, Laura; Auria, Riccardo D'; Ferrara, Sergio; Trigiante, Mario


    We study the attractor mechanism for N=1 supergravity coupled to vector and chiral multiplets and compute the attractor equations of these theories. These equations may have solutions depending on the choice of the holomorphic symmetric matrix f_{\\Lambda\\Sigma} which appears in the kinetic lagrangian of the vector sector. Models with non trivial electric-magnetic duality group which have or have not attractor behavior are exhibited. For a particular class of models, based on an N=1 reduction of homogeneous special geometries, the attractor equations are related to the theory of pure spinors.

  6. Tensor renormalization group analysis of CP(N-1) model

    CERN Document Server

    Kawauchi, Hikaru


    We apply the higher order tensor renormalization group to lattice CP($N-1$) model in two dimensions. A tensor network representation of the CP($N-1$) model in the presence of the $\\theta$-term is derived. We confirm that the numerical results of the CP(1) model without the $\\theta$-term using this method are consistent with that of the O(3) model which is analyzed by the same method in the region $\\beta \\gg 1$ and that obtained by Monte Carlo simulation in a wider range of $\\beta$. The numerical computation including the $\\theta$-term is left for future challenges.

  7. N=1 supersymmetric Yang-Mills theory on the lattice

    Energy Technology Data Exchange (ETDEWEB)

    Piemonte, Stefano


    Supersymmetry (SUSY) relates two classes of particles of our universe, bosons and fermions. SUSY is considered nowadays a fundamental development to explain many open questions about high energy physics. The N=1 super Yang-Mills (SYM) theory is a SUSY model that describes the interaction between gluons and their fermion superpartners called ''gluinos''. Monte Carlo simulations on the lattice are a powerful tool to explore the non-perturbative dynamics of this theory and to understand how supersymmetry emerges at low energy. This thesis presents new results and new simulations about the properties of N=1 SYM, in particular about the phase diagram at finite temperature.

  8. 1918 pandemic H1N1 DNA vaccine protects ferrets against 2007 H1N1 virus infection

    DEFF Research Database (Denmark)

    Bragstad, Karoline; Martel, Cyril Jean-Marie; Aasted, Bent

    Influenza vaccines with the ability to induce immune responses cross-reacting with drifted virus variants would be of great advantage for vaccine development against seasonal and emerging new strains. We demonstrate that gene gun administrated DNA vaccine encoding HA and NA and/or NP and M proteins...... of the H1N1 pandemic virus from 1918 induce protection in ferrets against infection with a H1N1 (A/New Caledonia/20/99(H1N1)) virus which was included in the conventional vaccine for the 2006-2007 season. The viruses are separated by a time interval of 89 years and differ by 21.2% in the HA1 protein....... These results suggest not only a unique ability of the DNA vaccines, but perhaps also natural infection, to induce cross-protective responses against even extremely drifted virus variants....

  9. Pneumococcal Pneumonia and Pandemic H1N1

    Centers for Disease Control (CDC) Podcasts


    Dr. George Nelson, a CDC medical officer, discusses the relationship between pneumococcal pneumonia and Pandemic H1N1.  Created: 6/6/2012 by National Center for Emerging and Zoonotic Infectious Diseases (NCEZID).   Date Released: 6/6/2012.

  10. H1N1 Influenza A hos mennesker og svin

    DEFF Research Database (Denmark)

    Larsen, Lars Erik


    Den nye pandemiske influenza A stamme H1N1 er hovedsagelig et nyt virus, som spredes mellem mennesker, men virusset er formodentlig opstået ved blanding af to svineinfluenza-virus og har derfor bibeholdt evnen til at kunne smitte fra mennesker til svin og fra svin til svin. Det er derfor vigtigt...

  11. Influenza A (H1N1) 2009: a pandemic alarm

    Indian Academy of Sciences (India)

    At this critical juncture when the world has not yet recovered from the threat of avian influenza, the virus has returned in the disguise of swine influenza, a lesser known illness common in pigs. It has reached pandemic proportions in a short time span with health personnel still devising ways to identify the novel H1N1 virus ...

  12. Campus Response to Novel Influenza H1N1 (United States)

    Journal of American College Health, 2009


    Colleges and universities have been engaged in pandemic planning since 2005 when the threat of H5N1 was brought to the attention of health care providers and organizations by the Centers for Disease Control and Prevention (CDC) and the World Health Organization. Schools developed plans, based on a 1918 scenario, that were centered on evacuation of…

  13. Influenza A (H1N1) pneumonia: HRCT findings

    Energy Technology Data Exchange (ETDEWEB)

    Amorim, Viviane Brandao; Rodrigues, Rosana Souza; Barreto, Miriam Menna; Marchiori, Edson, E-mail: [Universidade Federal do Rio de Janeiro (UFRJ), RJ (Brazil); Zanetti, Glaucia [Escola de Medicina de Petropolis, RJ (Brazil); Hochhegger, Bruno [Santa Casa de Misericordia de Porto Alegre, RS (Brazil)


    Objective: to describe aspects found on HRCT scans of the chest in patients infected with the influenza A (H1N1) virus. Methods: we retrospectively analyzed the HRCT scans of 71 patients (38 females and 33 males) with H1N1 infection, confirmed through laboratory tests, between July and September of 2009. The HRCT scans were interpreted by two thoracic radiologists independently, and in case of disagreement, the decisions were made by consensus. Results: the most common HRCT findings were ground-glass opacities (85%), consolidation (64%), or a combination of ground-glass opacities and consolidation (58%). Other findings were airspace nodules (25%), bronchial wall thickening (25%), interlobular septal thickening (21%), crazy-paving pattern (15%), perilobular pattern (3%), and air trapping (3%). The findings were frequently bilateral (89%), with a random distribution (68%). Pleural effusion, when observed, was typically minimal. No lymphadenopathy was identified. Conclusions: the most common findings were ground-glass opacities and consolidations, or a combination of both. Involvement was commonly bilateral with no axial or cranio caudal predominance in the distribution. Although the major tomographic findings in H1N1 infection are nonspecific, it is important to recognize such findings in order to include infection with the H1N1 virus in the differential diagnosis of respiratory symptoms. (author)

  14. Clinical vaccine development for H5N1 influenza. (United States)

    Clegg, Christopher H; Rininger, Joseph A; Baldwin, Susan L


    H5N1 is a highly pathogenic avian influenza virus that can cause severe disease and death in humans. H5N1 is spreading rapidly in bird populations and there is great concern that this virus will begin to transmit between people and cause a global crisis. Vaccines are the cornerstone strategy for combating avian influenza but there are complex challenges for pandemic preparedness including the unpredictability of the vaccine target and the manufacturing requirement for rapid deployment. The less-than-optimal response against the 2009 H1N1 pandemic unmasked the limitations associated with influenza vaccine production and in 2010, the President's Council of Advisors on Science and Technology re-emphasized the need for new recombinant-based vaccines and adjuvants that can shorten production cycles, maximize immunogenicity and satisfy global demand. In this article, the authors review the efforts spent in developing an effective vaccine for H5N1 influenza and summarize clinical studies that highlight the progress made to date.

  15. Visual Distance Cues Amplify Neuromagnetic Auditory N1m Responses

    Directory of Open Access Journals (Sweden)

    Christian F Altmann


    Full Text Available Ranging of auditory objects relies on several acoustic cues and is possibly modulated by additional visual information. Sound pressure level can serve as a cue for distance perception because it decreases with increasing distance. In this agnetoencephalography (MEG experiment, we tested whether psychophysical loudness judgment and N1m MEG responses are modulated by visual distance cues. To this end, we paired noise bursts at different sound pressure levels with synchronous visual cues at different distances. We hypothesized that noise bursts paired with far visual cues will be perceived louder and result in increased N1m amplitudes compared to a pairing with close visual cues. The rationale behind this was that listeners might compensate the visually induced object distance when processing loudness. Psychophysically, we observed no significant modulation of loudness judgments by visual cues. However, N1m MEG responses at about 100 ms after stimulus onset were significantly stronger for far versus close visual cues in the left auditory cortex. N1m responses in the right auditory cortex increased with increasing sound pressure level, but were not modulated by visual distance cues. Thus, our results suggest an audio-visual interaction in the left auditory cortex that is possibly related to cue integration for auditory distance processing.

  16. Avian Influenza H5N1 in Tigers and Leopards (United States)

    Keawcharoen, Juthatip; Oraveerakul, Kanisak; Kuiken, Thijs; Fouchier, Ron A.M.; Amonsin, Alongkorn; Payungporn, Sunchai; Noppornpanth, Suwanna; Wattanodorn, Sumitra; Theamboonlers, Apiradee; Tantilertcharoen, Rachod; Pattanarangsan, Rattapan; Arya, Nlin; Ratanakorn, Parntep; Osterhaus, Albert D.M.E.


    Influenza virus is not known to affect wild felids. We demonstrate that avian influenza A (H5N1) virus caused severe pneumonia in tigers and leopards that fed on infected poultry carcasses. This finding extends the host range of influenza virus and has implications for influenza virus epidemiology and wildlife conservation. PMID:15663858

  17. Narcolepsy and H1N1 Influenza Vaccination

    Directory of Open Access Journals (Sweden)

    J Gordon Millichap


    Full Text Available The incidence of narcolepsy between January 2000 and December 2010 in children in western Sweden and its relation to the Pandemrix H1N1 influenza vaccination were assessed by collection of data from hospital and clinic medical records and by parent telephone interviews.

  18. Geometrical approach to duality in N=1 supersymmetric theories

    CERN Document Server

    Brax, P; Savoy, C A; Brax, Ph


    We investigate the geometry of the moduli spaces of dual electric and magnetic N=1 supersymmetric field theories. Using the SU(N_c) gauge group as a guideline we show that the electric and magnetic moduli spaces coincide for a suitable choice of the Kahler potential of the magnetic theory. We analyse the Kahler structure of the dual moduli spaces.

  19. Perceived benefits and barriers to a career in pediatric neurosurgery: a survey of neurosurgical residents. (United States)

    Dias, Mark S; Sussman, Jeffrey S; Durham, Susan; Iantosca, Mark R


    Research suggests that there may be a growing disparity between the supply of and demand for both pediatric specialists and neurosurgeons. Whether pediatric neurosurgeons are facing such a disparity is disputable, but interest in pediatric neurosurgery (PNS) has waxed and waned as evidenced by the number of applicants for PNS fellowships. The authors undertook a survey to analyze current neurosurgical residents' perceptions of both benefits and deterrents to a pediatric neurosurgical career. All residents and PNS fellows in the United States and Canada during the academic year 2008-2009 were invited to complete a Web-based survey that assessed 1) demographic and educational information about residents and their residency training, particularly as it related to training in PNS; 2) residents' exposure to mentoring opportunities from pediatric neurosurgical faculty and their plans for the future; and 3) residents' perceptions about how likely 40 various factors were to influence their decision about whether to pursue a PNS career. Four hundred ninety-six responses were obtained: 89% of the respondents were male, 63% were married, 75% were in at least their 3rd year of postgraduate training, 61% trained in a children's hospital and 29% in a children's "hospital within a hospital," and 72% were in programs having one or more dedicated PNS faculty members. The residencies of 56% of respondents offered 6-11 months of PNS training and nearly three-quarters of respondents had completed 2 months of PNS training. During medical school, 92% had been exposed to neurosurgery and 45% to PNS during a clinical rotation, but only 7% identified a PNS mentor. Nearly half (43%) are considering a PNS career, and of these, 61% are definitely or probably considering post-residency fellowship. On the other hand, 68% would prefer an enfolded fellowship during residency. Perceived strengths of PNS included working with children, developing lasting relationships, wider variety of operations


    Directory of Open Access Journals (Sweden)

    Milena Veselinovic


    Full Text Available The World Health Organization (WHO regards avian influenza A/H5N1 as a global public health threat with pandemic potential. Between 2003 and October 12, 2007, WHO registered 331 laboratory-confirmed cases (202 fatal of human H5N1 infection. Human-to-human transmission has not been recorded yet. In the possible future, H5N1 pandemic, primary viral pneumonia would be the dominant clinical feature. Compli-cations include the development of acute respiratory distress syndrome, renal and multiorgan failure. The characteristic laboratory findings are lymphopenia, with the alteration of CD4+/CD8+ index, thrombocytopenia and ’’cytokine storm’’. Specimens for laboratory diagnosis include pharyngeal swabs, nasal swabs, tracheal aspirate (or bronchoalveolar lavage and serum (acute and convalescent. Virus isolation by cell culture is considered the "gold standard" of influenza diagnostics. Identification of infected cells is performed by direct or indirect immunofluorescence (DFA, IFA, enzyme-linked immunoassays (EIA or PCR-based methods. Mchip, a microarray which enables the detection and subtypisation based on M gene segment, is the recent breakthrough in H5N1 diagnostics. WHO Rapid Advice Guideline Panel on avian influenza, formed in 2006, defined the guidelines for chemoprophylaxis and therapy of human H5N1 infection. The most promissing primary treatment is oseltamivir. Vigorous antiviral activity against all subtypes of both A and B influenca viruses has been confirmed by in vitro studies. WHO has identified the antigenic and genetic characteristics of the viruses suitable for the development of the vaccine. More than 40 clinical trials have already been carried out or are ongoing. In spite of the promising results, WHO is expressing concern regarding inadequate global capacity for the vaccine production.

  1. Developing a new model for the invention and translation of neurotechnologies in academic neurosurgery. (United States)

    Leuthardt, Eric C


    There is currently an acceleration of new scientific and technical capabilities that create new opportunities for academic neurosurgery. To engage these changing dynamics, the Center for Innovation in Neuroscience and Technology (CINT) was created on the premise that successful innovation of device-related ideas relies on collaboration between multiple disciplines. The CINT has created a unique model that integrates scientific, medical, engineering, and legal/business experts to participate in the continuum from idea generation to translation. To detail the method by which this model has been implemented in the Department of Neurological Surgery at Washington University in St. Louis and the experience that has been accrued thus far. The workflow is structured to enable cross-disciplinary interaction, both intramurally and extramurally between academia and industry. This involves a structured method for generating, evaluating, and prototyping promising device concepts. The process begins with the "invention session," which consists of a structured exchange between inventors from diverse technical and medical backgrounds. Successful ideas, which pass a separate triage mechanism, are then sent to industry-sponsored multidisciplinary fellowships to create functioning prototypes. After 3 years, the CINT has engaged 32 clinical and nonclinical inventors, resulting in 47 ideas, 16 fellowships, and 12 patents, for which 7 have been licensed to industry. Financial models project that if commercially successful, device sales could have a notable impact on departmental revenue. The CINT is a model that supports an integrated approach from the time an idea is created through its translational development. To date, the approach has been successful in creating numerous concepts that have led to industry licenses. In the long term, this model will create a novel revenue stream to support the academic neurosurgical mission.

  2. Risk factors for surgical site infections after neurosurgery: A focus on the postoperative period. (United States)

    Cassir, Nadim; De La Rosa, Silvestre; Melot, Anthony; Touta, Adamou; Troude, Lucas; Loundou, Anderson; Richet, Hervé; Roche, Pierre-Hugues


    Surgical site infection (SSI) after neurosurgery has potentially devastating consequences. A prospective cohort study was conducted over a period of 24 months in a university center. All adult patients undergoing neurosurgical procedures, with exception of open skull fractures, were included. Multivariate logistic regression analysis was used to identify independent risk factors. We included 949 patients. Among them, 43 were diagnosed with SSI (4.5%). A significant reduction in postneurosurgical SSI from 5.8% in 2009 to 3.0% in 2010 (P = .04) was observed. During that period, an active surveillance with regular feedback was established. The most common microorganisms isolated from SSI were Staphylococcus aureus (23%), Enterobacteriaceae (21%), and Propionibacterium acnes (12%). We identified the following independent risk factors for SSI postcranial surgery: intensive care unit (ICU) length of stay ≥7 days (odds ratio [OR] = 6.1; 95% confidence interval [CI], 1.7-21.7), duration of drainage ≥3 days (OR = 3.3; 95% CI, 1.1-11), and cerebrospinal fluid leakage (OR = 5.6; 95% CI, 1.1-30). For SSIs postspinal surgery, we identified the following: ICU length of stay ≥7 days (OR = 7.2; 95% CI, 1.6-32.1), coinfection (OR = 9.9; 95% CI, 2.2-43.4), and duration of drainage ≥3 days (OR = 5.7; 95% CI, 1.5-22). Active surveillance with regular feedback proved effective in reducing SSI rates. The postoperative period is associated with overlooked risk factors for neurosurgical SSI. Infection control measures targeting this period are therefore promising. Copyright © 2015 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

  3. The 2009 devaluation of radiosurgery and its impact on the neurosurgery-radiation oncology partnership. (United States)

    Heilbrun, M Peter; Adler, John R


    Neurosurgeons, radiation oncologists, and, increasingly, other surgical specialists recognize that radiosurgery is an important tool for managing selected disorders throughout the body. The partnership between neurosurgeons and radiation oncologists has resulted in collaborative studies that have established the clinical benefits of radiosurgery. Today, however, a range of political and financial issues is straining this relationship and thereby undermining the practice of radiosurgery. Neurosurgeons and radiation oncologists recently restricted the definition of radiosurgery to include only cranial- and spine-focused radiation treatments. Meanwhile, organized radiation oncology decided unilaterally that radiosurgery administered to other parts of the body would be termed stereotactic body radiation therapy. Finally, neurosurgical and radiation oncology coding experts developed new Current Procedural Terminology codes for cranial vault and spine radiosurgery, which were approved for use by the Relative Value Scale Update Committee as of 2009. The authors suggest that the neurosurgery strategy-which included 1) reasserting that all of the tasks of a radiosurgery procedure remain bundled, and 2) agreeing to limit the definition of radiosurgery to cranial vault and spine-has failed neurosurgeons who perform radiosurgery, and it may jeopardize patient access to this procedure in the future. The authors propose that all of the involved medical specialties recognize that the application of image-guided, focused radiation therapy throughout the body requires a partnership between radiation and surgical disciplines. They also urge surgeons to reexamine their coding methods, and they maintain that Current Procedural Terminology codes should be consistent across all of the different specialties involved in these procedures. Finally, surgeons should consider appropriate training in medical physics and radiobiology to perform the tasks involved in these specific procedures

  4. Automatic deformable MR-ultrasound registration for image-guided neurosurgery. (United States)

    Rivaz, Hassan; Chen, Sean Jy-Shyang; Collins, D Louis


    In this work, we present a novel algorithm for registration of 3-D volumetric ultrasound (US) and MR using Robust PaTch-based cOrrelation Ratio (RaPTOR). RaPTOR computes local correlation ratio (CR) values on small patches and adds the CR values to form a global cost function. It is therefore invariant to large amounts of spatial intensity inhomogeneity. We also propose a novel outlier suppression technique based on the orientations of the RaPTOR gradients. Our deformation is modeled with free-form cubic B-splines. We analytically derive the derivatives of RaPTOR with respect to the transformation, i.e., the displacement of the B-spline nodes, and optimize RaPTOR using a stochastic gradient descent approach. RaPTOR is validated on MR and tracked US images of neurosurgery. Deformable registration of the US and MR images acquired, respectively, preoperation and postresection is of significant clinical significance, but challenging due to, among others, the large amount of missing correspondences between the two images. This work is also novel in that it performs automatic registration of this challenging dataset. To validate the results, we manually locate corresponding anatomical landmarks in the US and MR images of tumor resection in brain surgery. Compared to rigid registration based on the tracking system alone, RaPTOR reduces the mean initial mTRE over 13 patients from 5.9 to 2.9 mm, and the maximum initial TRE from 17.0 to 5.9 mm. Each volumetric registration using RaPTOR takes about 30 sec on a single CPU core. An important challenge in the field of medical image analysis is the shortage of publicly available dataset, which can both facilitate the advancement of new algorithms to clinical settings and provide a benchmark for comparison. To address this problem, we will make our manually located landmarks available online.

  5. Financial and clinical governance implications of clinical coding accuracy in neurosurgery: a multidisciplinary audit. (United States)

    Haliasos, N; Rezajooi, K; O'neill, K S; Van Dellen, J; Hudovsky, Anita; Nouraei, Sar


    Clinical coding is the translation of documented clinical activities during an admission to a codified language. Healthcare Resource Groupings (HRGs) are derived from coding data and are used to calculate payment to hospitals in England, Wales and Scotland and to conduct national audit and benchmarking exercises. Coding is an error-prone process and an understanding of its accuracy within neurosurgery is critical for financial, organizational and clinical governance purposes. We undertook a multidisciplinary audit of neurosurgical clinical coding accuracy. Neurosurgeons trained in coding assessed the accuracy of 386 patient episodes. Where clinicians felt a coding error was present, the case was discussed with an experienced clinical coder. Concordance between the initial coder-only clinical coding and the final clinician-coder multidisciplinary coding was assessed. At least one coding error occurred in 71/386 patients (18.4%). There were 36 diagnosis and 93 procedure errors and in 40 cases, the initial HRG changed (10.4%). Financially, this translated to pound111 revenue-loss per patient episode and projected to pound171,452 of annual loss to the department. 85% of all coding errors were due to accumulation of coding changes that occurred only once in the whole data set. Neurosurgical clinical coding is error-prone. This is financially disadvantageous and with the coding data being the source of comparisons within and between departments, coding inaccuracies paint a distorted picture of departmental activity and subspecialism in audit and benchmarking. Clinical engagement improves accuracy and is encouraged within a clinical governance framework.

  6. Human pallidothalamic and cerebellothalamic tracts: anatomical basis for functional stereotactic neurosurgery (United States)

    Gallay, Marc N.; Jeanmonod, Daniel; Liu, Jian


    Anatomical knowledge of the structures to be targeted and of the circuitry involved is crucial in stereotactic functional neurosurgery. The present study was undertaken in the context of surgical treatment of motor disorders such as essential tremor (ET) and Parkinson’s disease (PD) to precisely determine the course and three-dimensional stereotactic localisation of the cerebellothalamic and pallidothalamic tracts in the human brain. The course of the fibre tracts to the thalamus was traced in the subthalamic region using multiple staining procedures and their entrance into the thalamus determined according to our atlas of the human thalamus and basal ganglia [Morel (2007) Stereotactic atlas of the human thalamus and basal ganglia. Informa Healthcare Inc., New York]. Stereotactic three-dimensional coordinates were determined by sectioning thalamic and basal ganglia blocks parallel to stereotactic planes and, in two cases, by correlation with magnetic resonance images (MRI) from the same brains prior to sectioning. The major contributions of this study are to provide: (1) evidence that the bulks of the cerebellothalamic and pallidothalamic tracts are clearly separated up to their thalamic entrance, (2) stereotactic maps of the two tracts in the subthalamic region, (3) the possibility to discriminate between different subthalamic fibre tracts on the basis of immunohistochemical stainings, (4) correlations of histologically identified fibre tracts with high-resolution MRI, and (5) evaluation of the interindividual variability of the fibre systems in the subthalamic region. This study should provide an important basis for accurate stereotactic neurosurgical targeting of the subthalamic region in motor disorders such as PD and ET. PMID:18193279

  7. Computer-assisted neurosurgery system: Wayne State University hardware and software configuration. (United States)

    Zamorano, L; Jiang, Z; Kadi, A M


    Computer-assisted neurosurgery uses the latest technological advancements in imaging, computers, mechanics, and electronics to improve the accuracy and reduce the invasiveness and risk of neurosurgical procedures. We describe the Wayne State University, Detroit, Michigan, computer-assisted neurosurgical system with the emphasis on software and discuss the theory guiding the development of this system and its application in real-time position tracking systems. Our system consists of the Neurological Surgery Planning System (NSPS) software which we developed at our medical center and three types of position tracking systems: the Zamorano-Dujovny (Z-D) are digitizer for frame-based procedures, an articulated arm, and an infrared-based digitizer for frameless procedures. The NSPS software is designed to offer neurosurgeons a safe and accurate method to approach intracranial lesions by preoperatively planning a surgical trajectory. Software consisting of the most advanced technologies in computer vision, computer imaging/graphics, and stereotactic numeric analysis forms the core of the system. Capabilities for correlating data from imaging studies to facilitate image reconstruction, image mapping, and three-dimensional (3D) visualization of target volumes enable the neurosurgeon to simulate surgical procedures into a preoperative protocol to be used during surgery, both to follow the preplanned trajectory and to track the position of surgical instruments in real-time on the computer monitor. The tracking systems position and orient the surgical instruments relative to the patient's head. With these devices, the display of the surgical instruments together with the virtual images create an excellent intraoperative tool.

  8. Patient dose estimation from CT scans at the Mexican National Neurology and Neurosurgery Institute

    Energy Technology Data Exchange (ETDEWEB)

    Alva-Sánchez, Héctor, E-mail: [Unidad de Imagen Molecular PET/CT, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Insurgentes Sur 3877 Col. La Fama, 14269, México D.F. (Mexico); Reynoso-Mejía, Alberto [Unidad de Imagen Molecular PET/CT, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Insurgentes Sur 3877 Col. La Fama, 14269, México D.F., Mexico and Departamento de Neuroimagen, Instituto Nacional de (Mexico); Casares-Cruz, Katiuzka; Taboada-Barajas, Jesús [Departamento de Neuroimagen, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Insurgentes Sur 3877 Col. La Fama, 14269, México D.F. (Mexico)


    In the radiology department of the Mexican National Institute of Neurology and Neurosurgery, a dedicated institute in Mexico City, on average 19.3 computed tomography (CT) examinations are performed daily on hospitalized patients for neurological disease diagnosis, control scans and follow-up imaging. The purpose of this work was to estimate the effective dose received by hospitalized patients who underwent a diagnostic CT scan using typical effective dose values for all CT types and to obtain the estimated effective dose distributions received by surgical and non-surgical patients. Effective patient doses were estimated from values per study type reported in the applications guide provided by the scanner manufacturer. This retrospective study included all hospitalized patients who underwent a diagnostic CT scan between 1 January 2011 and 31 December 2012. A total of 8777 CT scans were performed in this two-year period. Simple brain scan was the CT type performed the most (74.3%) followed by contrasted brain scan (6.1%) and head angiotomography (5.7%). The average number of CT scans per patient was 2.83; the average effective dose per patient was 7.9 mSv; the mean estimated radiation dose was significantly higher for surgical (9.1 mSv) than non-surgical patients (6.0 mSv). Three percent of the patients had 10 or more brain CT scans and exceeded the organ radiation dose threshold set by the International Commission on Radiological Protection for deterministic effects of the eye-lens. Although radiation patient doses from CT scans were in general relatively low, 187 patients received a high effective dose (>20 mSv) and 3% might develop cataract from cumulative doses to the eye lens.

  9. 335 A Modular, Multimodality Integrative Pipeline for Neurosurgery Simulation and Visualization. (United States)

    Costa, Anthony Beardsworth; Bederson, Joshua B


    The practice of pre- and intraoperative interactive visualization and modeling continues to grow as its value to clinical practice is augmented by new technologies, such as virtual and augmented reality, or 3D printing. Current tools that extract the necessary structural information from medical imaging modalities and allow virtual or other interrogation of the data are either difficult to use in a practical clinical setting, or sufficiently simple as to limit the knowledge available to the operator. Nonetheless, the broader medical visualization and simulation communities have invented tools that enable automated segmentation and interrogation of structures critical to the success of surgery, such as cranial nerves, vasculature, and cortical and subcortical parcellations. We leverage these tools as inputs to a novel pipeline for neurosurgery simulation. Our pipeline is compatible with ATLAS-based subcortical volumetric segmentation (eg, Freesurfer, ANTS), or any structural input in mesh- or voxel-based formats, together with volumetric data. The visualizer, based on VTK7's OpenGL3x rendering backend, is efficient enough to display an arbitrary number of input structures or volumes at interactive refresh rates. Structures can be manipulated by adjusting parameters for each structure independently (eg, color, opacity). Standard ATLAS-based and ITK/VTK-based tools are included in the pipeline directly. Also included is a novel volumetric shift-based segmentation tool, allowing an operating scientist to easily include information detailing aberrant pathologies rapidly and with minimal semantic information. We demonstrate these tools for a variety of cases, including tumor, vascular, hemorrhagic stroke, and spine. Its performance sufficient to run and be used on a laptop computer and capabilities for preoperative planning through 3D printing the generated structures. We find that repurposing the power of existing segmentation tools within a novel modular, multimodal

  10. Max Brödel: his art, legacy, and contributions to neurosurgery through medical illustration. (United States)

    Patel, Smruti K; Couldwell, William T; Liu, James K


    Max Brödel is considered the father of modern medical illustration. This report reviews his contributions to neurosurgery as a medical illustrator. Max Brödel, a young artist from Leipzig, Germany, was hired at Johns Hopkins Hospital in 1894, where he illustrated an operative textbook of gynecology for Howard A. Kelly. Although Brödel did not have any formal medical training, he quickly acquired knowledge of anatomy, pathology, physiology, and surgery. Brödel's extraordinary illustrations were characterized by an aerial perspective that conveyed the surgeon's operative viewpoint and precise surgical anatomy. He masterfully incorporated tissue realism with cross-sectional anatomy to accentuate concepts while maintaining topographical accuracy. Brödel's reputation spread quickly and resulted in collaborations with prominent surgeons, such as Cushing, Halsted, and Dandy. Cushing, who also possessed artistic talent, became a pupil of Brödel and remained a very close friend. In 1911, Brödel was appointed the director of the Department of Art as Applied to Medicine at Johns Hopkins, the first academic department of its kind in the world. For the next several decades, he trained generations of renowned medical illustrators. Just as Osler, Halsted, and Cushing passed their skills and knowledge to future leaders of medicine and surgery, Brödel did the same for the field of medical illustration. The advancement of neurosurgical education has been greatly facilitated by Max Brödel's artistic contributions. His unique ability to synthesize art and medicine resulted in timeless illustrations that remain indispensable to surgeons. The art produced by his legacy of illustrators continues to flourish in neurosurgical literature today.

  11. Intracranial meningiomas managed at Memfys hospital for neurosurgery in Enugu, Nigeria

    Directory of Open Access Journals (Sweden)

    Wilfred C Mezue


    Full Text Available Introduction: The epidemiology and pathology of meningioma in Nigeria are still evolving and little has been published about this tumor in Nigeria, especially in the southeast region. The aim of this paper is to compare the characteristics of intracranial meningioma managed in our center with the pattern reported in the literature worldwide. Materials and Methods: Retrospective analysis of prospectively recorded data of patients managed for intracranial meningioma between January 2002 and December 2010 at a Private neurosurgery Hospital in Enugu, Nigeria. We excluded patients whose histology results were inconclusive. Results: Meningiomas constituted 23.8% of all intracranial tumors seen in the period. The male to female ratio was 1:1.1. The peak age range for males and females were in the fifth and sixth decades, respectively. The most common location is the Olfactory groove in 26.5% of patients followed by convexity in 23.5%. Presentation varied with anatomical location of tumor. Patients with olfactory groove meningioma (OGM mostly presented late with personality changes and evidence of raised ICP. Tuberculum sellar and sphenoid region tumors presented earlier with visual impairment with or without hormonal abnormalities. Seizures occurred in 30.9% of all patients and in 45% of those with convexity meningiomas. Only 57.4% of the patients were managed surgically and there was no gender difference in this group. WHO grade1 tumors were the most common histological types occurring in 84.6%. One patient had atypical meningioma and two had anaplastic tumors. Conclusion: The pattern of meningioma in our area may have geographical differences in location and histology. Childhood meningioma was rare.

  12. Patient dose estimation from CT scans at the Mexican National Neurology and Neurosurgery Institute (United States)

    Alva-Sánchez, Héctor; Reynoso-Mejía, Alberto; Casares-Cruz, Katiuzka; Taboada-Barajas, Jesús


    In the radiology department of the Mexican National Institute of Neurology and Neurosurgery, a dedicated institute in Mexico City, on average 19.3 computed tomography (CT) examinations are performed daily on hospitalized patients for neurological disease diagnosis, control scans and follow-up imaging. The purpose of this work was to estimate the effective dose received by hospitalized patients who underwent a diagnostic CT scan using typical effective dose values for all CT types and to obtain the estimated effective dose distributions received by surgical and non-surgical patients. Effective patient doses were estimated from values per study type reported in the applications guide provided by the scanner manufacturer. This retrospective study included all hospitalized patients who underwent a diagnostic CT scan between 1 January 2011 and 31 December 2012. A total of 8777 CT scans were performed in this two-year period. Simple brain scan was the CT type performed the most (74.3%) followed by contrasted brain scan (6.1%) and head angiotomography (5.7%). The average number of CT scans per patient was 2.83; the average effective dose per patient was 7.9 mSv; the mean estimated radiation dose was significantly higher for surgical (9.1 mSv) than non-surgical patients (6.0 mSv). Three percent of the patients had 10 or more brain CT scans and exceeded the organ radiation dose threshold set by the International Commission on Radiological Protection for deterministic effects of the eye-lens. Although radiation patient doses from CT scans were in general relatively low, 187 patients received a high effective dose (>20 mSv) and 3% might develop cataract from cumulative doses to the eye lens.

  13. Laser range scanning for image-guided neurosurgery: investigation of image-to-physical space registrations. (United States)

    Cao, Aize; Thompson, R C; Dumpuri, P; Dawant, B M; Galloway, R L; Ding, S; Miga, M I


    In this article a comprehensive set of registration methods is utilized to provide image-to-physical space registration for image-guided neurosurgery in a clinical study. Central to all methods is the use of textured point clouds as provided by laser range scanning technology. The objective is to perform a systematic comparison of registration methods that include both extracranial (skin marker point-based registration (PBR), and face-based surface registration) and intracranial methods (feature PBR, cortical vessel-contour registration, a combined geometry/intensity surface registration method, and a constrained form of that method to improve robustness). The platform facilitates the selection of discrete soft-tissue landmarks that appear on the patient's intraoperative cortical surface and the preoperative gadolinium-enhanced magnetic resonance (MR) image volume, i.e., true corresponding novel targets. In an 11 patient study, data were taken to allow statistical comparison among registration methods within the context of registration error. The results indicate that intraoperative face-based surface registration is statistically equivalent to traditional skin marker registration. The four intracranial registration methods were investigated and the results demonstrated a target registration error of 1.6 +/- 0.5 mm, 1.7 +/- 0.5 mm, 3.9 +/- 3.4 mm, and 2.0 +/- 0.9 mm, for feature PBR, cortical vessel-contour registration, unconstrained geometric/intensity registration, and constrained geometric/intensity registration, respectively. When analyzing the results on a per case basis, the constrained geometric/intensity registration performed best, followed by feature PBR, and finally cortical vessel-contour registration. Interestingly, the best target registration errors are similar to targeting errors reported using bone-implanted markers within the context of rigid targets. The experience in this study as with others is that brain shift can compromise extracranial

  14. Cerebrospinal fluid and blood propofol concentration during total intravenous anaesthesia for neurosurgery. (United States)

    Dawidowicz, A L; Fijałkowska, A; Nestorowicz, A; Kalityński, R; Trojanowski, T


    The aim of this paper is to compare the propofol concentration in blood and cerebrospinal fluid (CSF) in patients scheduled for different neurosurgical procedures and anaesthetized using propofol as part of a total intravenous anaesthesia technique. Thirty-nine patients (ASA I-III) scheduled for elective intracranial procedures, were studied. Propofol was infused initially at 12 mg kg(-1) h(-1) and then reduced in steps to 9 and 6 mg kg(-1) h(-1). During anaesthesia, bolus doses of fentanyl and cis-atracurium were administered as necessary. After tracheal intubation the lungs were ventilated to achieve normocapnia with an oxygen-air mixture (FI(O(2))=0.33). Arterial blood and CSF samples for propofol examination were obtained simultaneously directly after intracranial drainage insertion and measured using high-performance liquid chromatography. The patients were divided into two groups depending on the type of neurosurgery. The Aneurysm group consisted of 13 patients who were surgically treated for ruptured intracranial aneurysm. The Tumour group was composed of 26 patients who were undergoing elective posterior fossa extra-axial tumour removal. Blood propofol concentrations in both groups did not differ significantly (P>0.05). The propofol concentration in CSF was 86.62 (SD 37.99) ng ml(-1) in the Aneurysm group and 50.81 (26.10) ng ml(-1) in the Tumour group (P<0.005). Intracranial pathology may influence CSF propofol concentration. However, the observed discrepancies may also result from quantitative differences in CSF composition and from restricted diffusion of the drug in the CSF.

  15. Academic Productivity of US Neurosurgery Residents as Measured by H-Index: Program Ranking with Correlation to Faculty Productivity. (United States)

    Sarkiss, Christopher A; Riley, Kyle J; Hernandez, Christopher M; Oermann, Eric K; Ladner, Travis R; Bederson, Joshua B; Shrivastava, Raj K


    Engagement in research and academic productivity are crucial components in the training of a neurosurgeon. This process typically begins in residency training. In this study, we analyzed individual resident productivity as it correlated to publications across all Accreditation Council for Graduate Medical Education (ACGME)-accredited neurosurgery training programs in an attempt to identify how programs have developed and fostered a research culture and environment. We obtained a list of current neurosurgery residents in ACGME-accredited programs from the American Association of Neurological Surgeons database. An expanded PubMed and Scopus search was conducted for each resident through the present time. We tabulated all articles attributed to each resident. We then categorized the publications based on each neurosurgical subspecialty while in residency. A spreadsheet-based statistical analysis was performed. This formulated the average number of resident articles, h-indices, and most common subspecialty categories by training program. We analyzed 1352 current neurosurgery residents in 105 programs. There were a total of 10 645 publications, of which 3985 were resident first-author publications during the period of study. The most common subspecialties among all resident publications were vascular (24.9%), spine (16.9%), oncology (16.1%), pediatric (5.6%), functional (4.9%), and trauma (3.8%). The average resident published 2.9 first-author papers with average of 38.0 first-author publications by total residents at each program (range 0-241). The average h-index per resident is 2.47 ± 3.25. When comparing previously published faculty h-index program rankings against our resident h-index rankings, there is a strong correlation between the 2 datasets with a clear delineation between Top-20 productivity and that of other programs (average h-index 4.2 vs 1.7, respectively, P productivity on both the resident and faculty level (average h-index 1.6, 1.9, 3.9 for 1, 2, and

  16. Association of increased morbidity with the occurrence of hyperglycemia in the immediate postoperative period after elective pediatric neurosurgery. (United States)

    Filho, Nazel Oliveira; Alves, Rodrigo L; Fernandes, Adriano T; Castro, Fernanda S P; Melo, José Roberto Tude; Módolo, Norma S P


    OBJECTIVE The acute elevation of blood glucose in perioperative pediatric patients subjected to cardiac surgery and in victims of head trauma is associated with higher rates of postoperative complications. Data on the occurrence of hyperglycemia and its association with unfavorable outcomes among patients who have undergone elective neurosurgery are scarce in the literature. This study aimed to determine whether the occurrence of hyperglycemia during the perioperative period of elective neurosurgery for the resection of tumors of the CNS in children is associated with increased morbidity. METHODS This retrospective cohort analysis included 105 children up to 12 years of age who underwent elective neurosurgery for resection of supratentorial and infratentorial CNS tumors between January 2005 and December 2010 at the São Rafael Hospital, a tertiary care medical center in Salvador, Brazil. Demographic data and intraoperative and postoperative information were collected from the medical records. Differences in blood glucose levels during the perioperative period were evaluated with nonparametric tests. RESULTS The patients who developed postoperative complications exhibited higher blood glucose levels on admission to the intensive care unit (ICU) (162.0 ± 35.8 mg/dl vs 146.3 ± 43.3 mg/dl; p = 0.016) and peak blood glucose levels on postoperative Day 1 (171.9 ± 30.2 mg/dl vs 156.1 ± 43.2 mg/dl; p = 0.008). Multivariate analysis showed that peak blood glucose levels on postoperative Day 1 were independently associated with a higher odds ratio for postoperative complication (OR 1.05). The occurrence of hyperglycemia (>150 mg/dl) upon admission to the ICU was associated with longer ICU (p = 0.003) and hospital (p = 0.001) stays. CONCLUSIONS The occurrence of hyperglycemia during the postoperative period after elective pediatric neurosurgery for the resection of CNS tumors was associated with longer hospital and ICU stays. Postoperative complications were associated

  17. Evolutionary genomics of the pandemic 2009 H1N1 influenza viruses (pH1N 1v

    Directory of Open Access Journals (Sweden)

    Song Gang


    Full Text Available Abstract Background A new strain of human H1N1 influenza A viruses was broken out in the April 2009 and caused worldwide pandemic emergency. The present study is trying to estimate a temporal reassortment history of 2009 H1N1 viruses by phylogenetic analysis based on a total 394 sequences of H1N1viruses isolated from swine, human and avian. Results Phylogenetic trees of eight gene segments showed that viruses sampled from human formed a well-supported clade, whereas swine and avian lineages were intermixed together. A new divergence swine sublineage containing gene segments of 2009 H1N1 viruses was characterized, which were closely related with swine viruses collected from USA and South Korea during 2004 to 2007 in six segments (PB2, PB1, PA, HA, NP and NS, and to swine viruses isolated from Thailand during 2004 to 2005 in NA and M. Substitution rates were varied drastically among eight segments and the average substitution rate was generally higher in 2009 H1N1 than in swine and human viruses (F2,23 = 5.972, P dN/dS substitution ratios were identified in 2009 H1N1 than in swine and human viruses except M2 gene (F2, 25 = 3.779, P Conclusion Our results implied that at least four reassortments or transmissions probably occurred before 2009 H1N1 viruses. Initial reassortment arose in 1976 and avian-like Eurasian swine viruses emerged. The second transmission happened in Asia and North America between 1988 and 1992, and mostly influenced six segments (PB2, PB1, PA, HA, NP and NS. The third reassortment occurred between North American swine and avian viruses during 1998 to 2000, which involved PB2 and PA segments. Recent reassortments occurred among avian-to-swine reassortant, Eurasian and classical swine viruses during 2004 to 2005. South Korea, Thailand and USA, were identified as locations where reassortments most likely happened. The co-circulation of multiple swine sublineages and special lifestyle in Asia might have facilitated mixing of

  18. Molecular basis for broad neuraminidase immunity: conserved epitopes in seasonal and pandemic H1N1 as well as H5N1 influenza viruses. (United States)

    Wan, Hongquan; Gao, Jin; Xu, Kemin; Chen, Hongjun; Couzens, Laura K; Rivers, Katie H; Easterbrook, Judy D; Yang, Kevin; Zhong, Lei; Rajabi, Mohsen; Ye, Jianqiang; Sultana, Ishrat; Wan, Xiu-Feng; Liu, Xiufan; Perez, Daniel R; Taubenberger, Jeffery K; Eichelberger, Maryna C


    Influenza A viruses, including H1N1 and H5N1 subtypes, pose a serious threat to public health. Neuraminidase (NA)-related immunity contributes to protection against influenza virus infection. Antibodies to the N1 subtype provide protection against homologous and heterologous H1N1 as well as H5N1 virus challenge. Since neither the strain-specific nor conserved epitopes of N1 have been identified, we generated a panel of mouse monoclonal antibodies (MAbs) that exhibit different reactivity spectra with H1N1 and H5N1 viruses and used these MAbs to map N1 antigenic domains. We identified 12 amino acids essential for MAb binding to the NA of a recent seasonal H1N1 virus, A/Brisbane/59/2007. Of these, residues 248, 249, 250, 341, and 343 are recognized by strain-specific group A MAbs, while residues 273, 338, and 339 are within conserved epitope(s), which allows cross-reactive group B MAbs to bind the NAs of seasonal H1N1 and the 1918 and 2009 pandemic (09pdm) H1N1 as well as H5N1 viruses. A single dose of group B MAbs administered prophylactically fully protected mice against lethal challenge with seasonal and 09pdm H1N1 viruses and resulted in significant protection against the highly pathogenic wild-type H5N1 virus. Another three N1 residues (at positions 396, 397, and 456) are essential for binding of cross-reactive group E MAbs, which differ from group B MAbs in that they do not bind 09pdm H1N1 viruses. The identification of conserved N1 epitopes reveals the molecular basis for NA-mediated immunity between H1N1 and H5N1 viruses and demonstrates the potential for developing broadly protective NA-specific antibody treatments for influenza.

  19. Abelian tensor hierarchy in 4D, N=1 superspace

    Energy Technology Data Exchange (ETDEWEB)

    Becker, Katrin; Becker, Melanie; III, William D. Linch; Robbins, Daniel [George P. and Cynthia W. Mitchell Institute for Fundamental Physics and Astronomy,Texas A& M University, College Station, TX 77843 (United States)


    With the goal of constructing the supersymmetric action for all fields, massless and massive, obtained by Kaluza-Klein compactification from type II theory or M-theory in a closed form, we embed the (Abelian) tensor hierarchy of p-forms in four-dimensional, N=1 superspace and construct its Chern-Simons-like invariants. When specialized to the case in which the tensors arise from a higher-dimensional theory, the invariants may be interpreted as higher-dimensional Chern-Simons forms reduced to four dimensions. As an application of the formalism, we construct the eleven-dimensional Chern-Simons form in terms of four-dimensional, N=1 superfields.

  20. (N+1)-dimensional Lorentzian evolving wormholes supported by polytropic matter

    Energy Technology Data Exchange (ETDEWEB)

    Cataldo, Mauricio [Universidad del Bio-Bio, Departamento de Fisica, Facultad de Ciencias, Concepcion (Chile); Arostica, Fernanda; Bahamonde, Sebastian [Universidad de Concepcion, Departamento de Fisica, Concepcion (Chile)


    In this paper we study (N+1)-dimensional evolving wormholes supported by energy satisfying a polytropic equation of state. The considered evolving wormhole models are described by a constant redshift function and generalizes the standard flat Friedmann-Robertson-Walker spacetime. The polytropic equation of state allows us to consider in (3+1)-dimensions generalizations of the phantom energy and the generalized Chaplygin gas sources. (orig.)

  1. Spread of H1N1 within Households

    Centers for Disease Control (CDC) Podcasts


    This podcast describes an investigation into how H1N1 was spreading within households during the initial days of the pandemic in Texas. CDC's Dr. Oliver Morgan discusses what investigators learned about the role that children played in introducing the virus into households and spreading flu.  Created: 3/29/2010 by Emerging Infectious Diseases.   Date Released: 3/29/2010.

  2. More on DBI action in 4D N=1 supergravity

    Energy Technology Data Exchange (ETDEWEB)

    Aoki, Shuntaro [Department of Physics, Waseda University,Tokyo 169-8555 (Japan); Yamada, Yusuke [Stanford Institute for Theoretical Physics and Department of Physics, Stanford University,Stanford, CA 94305 (United States)


    We construct a Dirac-Born-Infeld (DBI) action coupled to a two-form field in four dimensional N=1 supergravity. Our superconformal formulation of the action shows a universal way to construct it in various Poincaré supergravity formulations. We generalize the DBI action to that coupled to matter sector. We also discuss duality transformations of the DBI action, which are useful for phenomenological and cosmological applications.

  3. Myastenia gravis following H1N1 infection


    Silva, Horta e; Nascimento, A.; Zwolinski, N.; André, A.


    Introduction: Myasthenia gravis is an auto-immune disease, resulting from the production of anti-Ach receptor antibodies at the neuromuscular junction. In spite of its unknown etiology, there seems to exist some factors which withstand its arise and/or the worsening of the patient's clinical condition.The mainstay of medical treatment relies on anticholinesterase drugs and immunosuppression. Thymectomy is considered the treatment of choice in selected cases.Influenza A (H1N1) viral infection ...

  4. N=1 Special Geometry, Mixed Hodge Variations and Toric Geometry

    CERN Document Server

    Lerche, Wolfgang; Warner, Nicholas P


    We study the superpotential of a certain class of N=1 supersymmetric type II compactifications with fluxes and D-branes. We show that it has an important two-dimensional meaning in terms of a chiral ring of the topologically twisted theory on the world-sheet. In the open-closed string B-model, this chiral ring is isomorphic to a certain relative cohomology group V, which is the appropriate mathematical concept to deal with both the open and closed string sectors. The family of mixed Hodge structures on V then implies for the superpotential to have a certain geometric structure. This structure represents a holomorphic, N=1 supersymmetric generalization of the well-known N=2 special geometry. It defines an integrable connection on the topological family of open-closed B-models, and a set of special coordinates on the space \\cal M of vev's in N=1 chiral multiplets. We show that it can be given a very concrete and simple realization for linear sigma models, which leads to a powerful and systematic method for comp...

  5. Infection with 2009 H1N1 influenza virus primes for immunological memory in human nose-associated lymphoid tissue, offering cross-reactive immunity to H1N1 and avian H5N1 viruses. (United States)

    Mahallawi, Waleed H; Kasbekar, Anand V; McCormick, Maxwell S; Hoschler, Katja; Temperton, Nigel; Leong, Samuel C; Beer, Helen; Ferrara, Francesca; McNamara, Paul S; Zhang, Qibo


    Influenza is a highly contagious mucosal infection in the respiratory tract. The 2009 pandemic H1N1 (pH1N1) influenza virus infection resulted in substantial morbidity and mortality in humans. Little is known on whether immunological memory develops following pH1N1 infection and whether it provides protection against other virus subtypes. An enzyme-linked immunosorbent spot assay was used to analyze hemagglutinin (HA)-specific memory B cell responses after virus antigen stimulation in nose-associated lymphoid tissues (NALT) from children and adults. Individuals with serological evidence of previous exposure to pH1N1 showed significant cross-reactive HA-specific memory B cell responses to pH1N1, seasonal H1N1 (sH1N1), and avian H5N1 (aH5N1) viruses upon pH1N1 virus stimulation. pH1N1 virus antigen elicited stronger cross-reactive memory B cell responses than sH1N1 virus. Intriguingly, aH5N1 virus also activated cross-reactive memory responses to sH1N1 and pH1N1 HAs in those who had previous pH1N1 exposure, and that correlated well with the memory response stimulated by pH1N1 virus antigen. These memory B cell responses resulted in cross-reactive neutralizing antibodies against sH1N1, 1918 H1N1, and aH5N1 viruses. The 2009 pH1N1 infection appeared to have primed human host with B cell memory in NALT that offers cross-protective mucosal immunity to not only H1N1 but also aH5N1 viruses. These findings may have important implications for future vaccination strategies against influenza. It will be important to induce and/or enhance such cross-protective mucosal memory B cells.

  6. Anatomy of the sphenopalatine artery and its implications for transnasal neurosurgery. (United States)

    Eordogh, M; Grimm, A; Gawish, I; Patonay, L; Reisch, R; Briner, H R; Baksa, G


    The knowledge of sinonasal vasculature is inevitable in transnasal neurosurgery. We performed an anatomical study on the sphenopalatine artery from the perspective of skull base procedures. To analyse the anatomical landmarks of the sphenopalatine artery, arterial skull corrosion casts (26 head halves) underwent endoscopic transnasal phantom surgery. Furthermore, we performed microsurgical dissection on formaldehyde-fixated cadavers with arterial perfusion (14 head halves) as well as studied Cone Beam CT-scans of anonymised patients and cadavers (115 head sides). In our cadaveric material, the sphenopalatine foramen is located at the transition of the superior and middle nasal meatus (95.0%) or in the superior nasal meatus (5.0%). It is the main entry point of the branches of the sphenopalatine artery into the nasal cavity. In most cadaveric cases (25.0%), at this level there are 2 branches superiorly and 1 vessel inferiorly to the ethmoid crest. An average of 2.4 vessels leave the sphenopalatine foramen superiorly to the ethmoid crest, 97.8% of them belong to the sphenopalatine arterys posterior septal branches. An average of 2.1 branches leave the sphenopalatine foramen inferiorly to the ethmoid crest; all of them belong to the posterior lateral nasal branches. There are no cases with a single artery at the plane of the sphenopalatine foramen. We describe a triangular bony structure bordering the sphenopalatine foramen anteriorly which is built up by the palatine and ethmoid bone as well as the maxilla. According to the radiographic studies, this triangular prominence is surrounded superiorly by a posterior ethmoid cell (57.4%), the sphenoid sinus (41.7%) or the orbit (0.9%) with a varying contribution of the superior nasal meatus; inferolaterally by the maxillary sinus (98.3%) or the pterygopalatine and infratemporal fossa (1.7%) and inferomedially by the middle nasal meatus. The medial vertex of the bony triangle corresponds to the ethmoid crest of the palatine

  7. Comparison between skin-mounted fiducials and bone-implanted fiducials for image-guided neurosurgery (United States)

    Rost, Jennifer; Harris, Steven S.; Stefansic, James D.; Sillay, Karl; Galloway, Robert L., Jr.


    Point-based registration for image-guided neurosurgery has become the industry standard. While the use of intrinsic points is appealing because of its retrospective nature, affixing extrinsic objects to the head prior to scanning has been demonstrated to provide much more accurate registrations. Points of reference between image space and physical space are called fiducials. The extrinsic objects which generate those points are fiducial markers. The markers can be broken down into two classifications: skin-mounted and bone-implanted. Each has distinct advantages and disadvantages. Skin-mounted fiducials require simply sticking them on the patient in locations suggested by the manufacturer, however, they can move with tractions placed on the skin, fall off and perhaps the most dangerous problem, they can be replaced by the patient. Bone implanted markers being rigidly affixed to the skull do not present such problems. However, a minor surgical intervention (analogous to dental work) must be performed to implant the markers prior to surgery. Therefore marker type and use has become a decision point for image-guided surgery. We have performed a series of experiments in an attempt to better quantify aspects of the two types of markers so that better informed decisions can be made. We have created a phantom composed of a full-size plastic skull [Wards Scientific Supply] with a 500 ml bag of saline placed in the brain cavity. The skull was then sealed. A skin mimicking material, DragonSkinTM [SmoothOn Company] was painted onto the surface and allowed to dry. Skin mounted fiducials [Medtronic-SNT] and bone-implanted markers [Z-Kat]were placed on the phantom. In addition, three additional bone-implanted markers were placed (two on the base of the skull and one in the eye socket for use as targets). The markers were imaged in CT and 4 MRI sequences (T1-weighted, T2 weighted, SPGR, and a functional series.) The markers were also located in physical space using an Optotrak

  8. A comparison of two surgical approaches in functional neurosurgery: individualized versus conventional stereotactic frames. (United States)

    Matzke, Cornelia; Lindner, Dirk; Schwarz, Johannes; Classen, Joseph; Hammer, Niels; Weise, David; Rumpf, Jost-Julian; Fritzsch, Dominik; Meixensberger, Jürgen; Winkler, Dirk


    The individualized Starfix® miniframe belongs to a new generation of stereotactic systems enabling high-precision electrode placement with considerably better time-efficiency in deep brain stimulation (DBS). We evaluated the usability and reliability of this novel technique in patients with idiopathic Parkinson's disease (IPD) and compared surgical and clinical results with those obtained in a historical group in which a conventional stereotactic frame was employed. Sixty patients underwent surgery for implantation of DBS electrodes in the subthalamic nucleus. In 31 of them (group I) a conventional Zamorano-Dujovny frame was used and in 29 of them (group II) a Starfix® miniframe was used. Image fusion of preoperatively acquired 3D T1w and T2w 1.5 T MR-image series was used for the targeting procedure. Placement of the test electrodes and permanent electrodes corresponded to standard functional neurosurgery and included microelectrode recording and macrostimulation. Clinical (L-Dopa equivalent dose, United Parkinson's disease rating scale part III) and time for surgical electrode implantation were evaluated postoperatively in a 3-, 6- and 12-month follow-up. Twelve months postoperatively, L-Dopa dose was significantly reduced from 685.19 to 205.88 mg/day and from 757.92 to 314.42 mg/day in groups I and II, respectively. A comparable reduction of the LED could be observed 1 year after surgery. Motor function has improved in a significant and identical manner with 59% (group I) and 61% (group II). Besides clinical effects by stimulation therapy there was a significantly reduced surgery time required for electrode implantation using the Starfix® miniframe (group I: 234.1 min, group II: 173.6 min; p < 0.001). Individualized miniframes such as the Starfix® miniframe allow implantation of DBS electrodes in IPD that is equally effective as conventional systems. The time efficiency achieved in surgery using of the Starfix® system helps to minimize

  9. [Deep brain recording and length of surgery in stereotactic and functional neurosurgery for movement disorders]. (United States)

    Teijeiro, Juan; Macías, Raúl J; Maragoto, Carlos; García, Iván; Alvarez, Mario; Quintanal, Nelson E


    Our objectives were to study the length of multi-unit recordings (MURs) of brain activity in 20 years of movement disorder neurosurgeries and to determine the number of times in which it was necessary for the teams using single-unit recording (SUR) to explore all the electrode tracks in the simultaneously recorded sites (SRS). This was a retrospective descriptive statistical analysis of MUR length on 4,296 tracks in 952 surgeries. The exclusion criteria were: tracks with fewer than 5 recorded signals, tracks that had a signal length different from the habitual 2s, or there being unusual situations not related to the MUR, as well as the first 20 surgeries of each surgical target. This yielded a total of 3,448 tracks in 805 surgeries. We also determined the number of the total 952 surgeries in which all the tracks in the SURs of the SRS were explored. The mean and its confidence interval (P=.05) of time per MUR track were 5.49±0.16min in subthalamic nucleus surgery, 8.82±0.24min in the medial or internal globus pallidus) and 18.51±1.31min in the ventral intermediate nucleus of the thalamus. For the total sum of tracks per surgery, in 75% of cases the total time was less than 39min in subthalamic nucleus, almost 42min in the medial or internal globus pallidus and less than 1h and 17min in ventral intermediate nucleus of the thalamus. All the tracks in the SUR SRS were explored in only 4.2% of the surgeries. The impact of MUR on surgical time is acceptable for this guide in objective localization for surgical targets, without having to use several simultaneous electrodes (not all indispensable in most of the cases). Consequently, there is less risk for the patient. Copyright © 2013 Sociedad Española de Neurocirugía. Published by Elsevier España. All rights reserved.

  10. Impact of a Vascular Neurosurgery Simulation-Based Course on Cognitive Knowledge and Technical Skills in European Neurosurgical Trainees. (United States)

    Zammar, Samer G; El Tecle, Najib E; El Ahmadieh, Tarek Y; Adelson, P David; Veznedaroglu, Erol; Surdell, Daniel L; Harrop, James S; Benes, Vladimir; Rezai, Ali R; Resnick, Daniel K; Bendok, Bernard R


    To assess microsurgical and diagnostic cerebral angiography modules and their corresponding objective assessment scales as educational tools for European neurosurgical residents at the European Association of Neurosurgical Societies Resident Vascular Neurosurgery course, which was held in Prague, Czech Republic, on September 2013. Microsurgical skills and cerebral angiography are fundamental skills in vascular neurosurgery. There is a need to develop a simulation-based curriculum focusing on these skills for neurosurgical trainees worldwide. The course consisted of 2 modules: microanastomosis and diagnostic cerebral angiography. In addition to an initial screening survey, each module was divided into 3 components: 1) a before didactic cognitive knowledge and technical skills testing, 2) a didactic lecture, and 3) an after didactic cognitive knowledge and technical skills testing. We compared the trainees' cognitive and technical scores from the before and after testing phases. Wilcoxon sum rank test was used to test statistical significance. The knowledge test median scores increased from 63% and 68% to 80% and 88% (P technical proficiency. Copyright © 2015. Published by Elsevier Inc.

  11. Topical vancomycin to reduce surgical-site infections in neurosurgery: Study protocol for a multi-center, randomized controlled trial. (United States)

    Jonokuchi, Alexander J; Knopman, Jared; Radwanski, Ryan E; Martinez, Moises A; Taylor, Blake Eaton Samuel; Rothbaum, Michael; Sullivan, Sean; Robison, Trae R; Lo, Eric; Christophe, Brandon R; Bruce, Eliza M; Khan, Sabrina; Kellner, Christopher P; Sigounas, Dimitri; Youngerman, Brett; Bagiella, Emilia; Angevine, Peter D; Lowy, Franklin D; Sander Connolly, E


    Surgical-site infections (SSIs) account for 20% of all healthcare-associated infections, are the most common nosocomial infection among surgical patients, and are a focus of quality improvement initiatives. Despite implementation of many quality care measures (e.g. prophylactic antibiotics), SSIs remain a significant cause of morbidity, mortality, and economic burden, particularly in the field of neurosurgery. Topical vancomycin is increasingly utilized in instrumented spinal and cardiothoracic procedures, where it has been shown to reduce the risk of SSIs. However, a randomized controlled trial assessing its efficacy in the general neurosurgical population has yet to be done. The principle aim of "Topical Vancomycin for Neurosurgery Wound Prophylaxis" (NCT02284126) is to determine whether prophylactic, topical vancomycin reduces the risk of SSIs in the adult neurosurgical population. This prospective, multicenter, patient-blinded, randomized controlled trial will enroll patients to receive the standard of care plus topical vancomycin, or the standard of care alone. The primary endpoint of this study is a SSI by postoperative day (POD) 30. Patients must be over 18years of age. Patients are excluded for renal insufficiency, vancomycin allergy, and some ineligible procedures. Univariate analysis and logistic regression will determine the effect of topical vancomycin on SSIs at 30days. A randomized controlled trial is needed to determine the efficacy of this treatment. Results of this trial are expected to directly influence the standard of care and prevention of SSIs in neurosurgical patients. Copyright © 2017 Elsevier Inc. All rights reserved.

  12. A real-time artifact reduction algorithm based on precise threshold during short-separation optical probe insertion in neurosurgery

    Directory of Open Access Journals (Sweden)

    Weitao Li


    Full Text Available During neurosurgery, an optical probe has been used to guide the micro-electrode, which is punctured into the globus pallidus (GP to create a lesion that can relieve the cardinal symptoms. Accurate target localization is the key factor to affect the treatment. However, considering the scattering nature of the tissue, the “look ahead distance (LAD” of optical probe makes the boundary between the different tissues blurred and difficult to be distinguished, which is defined as artifact. Thus, it is highly desirable to reduce the artifact caused by LAD. In this paper, a real-time algorithm based on precise threshold was proposed to eliminate the artifact. The value of the threshold was determined by the maximum error of the measurement system during the calibration procession automatically. Then, the measured data was processed sequentially only based on the threshold and the former data. Moreover, 100μm double-fiber probe and two-layer and multi-layer phantom models were utilized to validate the precision of the algorithm. The error of the algorithm is one puncture step, which was proved in the theory and experiment. It was concluded that the present method could reduce the artifact caused by LAD and make the real boundary sharper and less blurred in real-time. It might be potentially used for the neurosurgery navigation.

  13. S-duality in N = 1 orientifold SCFTs

    Energy Technology Data Exchange (ETDEWEB)

    Garcia-Etxebarria, Inaki [Max Planck Institute for Physics, Munich (Germany); Heidenreich, Ben [Perimeter Institute for Theoretical Physics, Waterloo, ON (Canada)


    We present a general solution to the problem of determining all S-dual descriptions for a specific (but very rich) class of N = 1 SCFTs. These SCFTs are indexed by decorated toric diagrams, and can be engineered in string theory by probing orientifolds of isolated toric singularities with D3 branes. The S-dual phases are described by quiver gauge theories coupled to specific types of conformal matter which we describe explicitly. We illustrate our construction with many examples, including S-dualities in previously unknown SCFTs. (copyright 2017 WILEY-VCH Verlag GmbH and Co. KGaA, Weinheim)

  14. /D=4, /N=1 orientifolds with vector structure (United States)

    Klein, M.; Rabadán, R.


    We construct compact type IIB orientifolds with discrete groups Z4, Z6, Z6' , Z8, Z12 and Z12' . These models are N=1 supersymmetric in D=4 and have vector structure. The possibility of having vector structure in ZN orientifolds with even N arises due to an alternative Ω-projection in the twisted sectors. Some of the models without vector structure are known to be inconsistent because of uncancelled tadpoles. We show that vector structure leads to a sign flip in the twisted Klein bottle contribution. As a consequence, all the tadpoles can be cancelled by introducing D9-branes and D5-branes.

  15. Qualitative analysis of the (N + 1)-body ring problem

    Energy Technology Data Exchange (ETDEWEB)

    Barrio, Roberto [GME, Depto. Matematica Aplicada, Universidad de Zaragoza, E-50009 Zaragoza (Spain)], E-mail:; Blesa, Fernando [GME, Depto. Fisica Aplicada, Universidad de Zaragoza, E-50009 Zaragoza (Spain)], E-mail:; Serrano, Sergio [GME, Depto. Informatica e Ingenieria de Sistemas, Universidad de Zaragoza, E-50015 Zaragoza (Spain)], E-mail:


    In this paper we present a complete study of the (N + 1)-body ring problem. In particular, we review and describe the evolution of the equilibrium points, their stability, their bifurcations, the zero velocity curves and we provide new techniques that give new views to this classical problem. Some of these techniques are the OFLI2 (a Chaos Indicator given in [Barrio R. Sensitivity tools vs. Poincare sections. Chaos, Solitons and Fractals 2005;25(3):711-26; Barrio R. Painting chaos: a gallery of sensitivity plots of classical problems. Int J Bifur Chaos Appl Sci Eng [in press

  16. Underreporting of 2009 H1N1 Influenza Cases

    Centers for Disease Control (CDC) Podcasts


    Influenza cases are difficult to track because many people don't go to the doctor or get tested for flu when they're sick. The first months of the 2009 H1N1 influenza pandemic were no different. In this podcast, CDC's Dr. Carrie Reed discusses a study in the December issue of Emerging Infectious Diseases that looked at the actual number of cases reported and estimated the true number of cases when correcting for underreporting.  Created: 12/8/2009 by Emerging Infectious Diseases.   Date Released: 12/8/2009.

  17. The role of Harvey Cushing and Walter Dandy in the evolution of modern neurosurgery in the Netherlands, illustrated by their correspondence Historical vignette

    NARCIS (Netherlands)

    Groen, Rob J. M.; Koehler, Peter J.; Kloet, Alfred

    The development of modern neurosurgery in the Netherlands, which took place in the 1920s, was highly influenced by the personal involvement of both Harvey Cushing and Walter Dandy, each in his own way. For the present article, the authors consulted the correspondence (kept at the Cushing/Whitney

  18. A Lorentz covariant holoraumy-induced “gadget” from minimal off-shell 4D, N = 1 $$ \\mathcal{N}=1 $$ supermultiplets

    National Research Council Canada - National Science Library

    Gates Jr, S James; Grover, Tyler; Miller-Dickson, Miles David; Mondal, Benedict A; Oskoui, Amir; Regmi, Shirash; Ross, Ethan; Shetty, Rajath


    Starting from three minimal off-shell 4D, N = 1 $$ \\mathcal{N}=1 $$ supermultiplets, using constructions solely defined within the confines of the four dimensional field theory we show the existence of a “gadget...

  19. Eigenfunction of the Laplace operator in n+1-dimentional simplex

    Directory of Open Access Journals (Sweden)

    Ovchintsev Mikhail Petrovich


    Full Text Available In order to find eigenfunction of the Laplace operator in regular n+1-dimensional simplex the barycentric coordinates are used. For obtaining this result we need some formulas of the analytical geometry. A similar result was obtained in the earlier papers of the author in a tetrahedron from R 3 and in gipertetrahedron from R 4. Let П be unlimited cylinder in the space R n, its cross-section with hyperplane has a special form. Let L be a second order linear differential operator in divergence form, which is uniformly elliptic and η is its ellipticity constant. Let u be a solution of the mixed boundary value problem in Π with homogeneous Dirichlet and Neumann data on the boundary of the cylinder. In some cases the eigenfunction of the Laplace operator allows us to continue this solution from the cylinder Π to the whole space R n with the same ellipticity constant. The obtained result allows us to get a number of various theorems on the solution growth for mixed boundary value problem for linear differential uniformly elliptical equation of the second order, given in unlimited cylinder with special cross-section. In addition we consider n-1-dimensional hill tetrahedron and the eigenfunction for an elliptic operator with constant coefficients in it.

  20. Characterization of avian influenza H5N1 virosome

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    Chatchai Sarachai


    Full Text Available The purpose of this study was to prepare and characterize virosome containing envelope proteins of the avian influenza (H5N1 virus. The virosome was prepared by the solubilization of virus with octaethyleneglycol mono (n-dodecyl ether (C12E8 followed by detergent removal with SM2 Bio-Beads. Biochemical analysis by SDS-PAGE and western blotting, indicated that avian influenza H5N1 virosome had similar characteristics to the parent virus and contained both the hemagglutinin (HA, 60-75 kDa and neuraminidase (NA, 220 kDa protein, with preserved biological activity, such as hemagglutination activity. The virosome structure was analyzed by negative stained transmission electron microscope (TEM demonstrated that the spherical shapes of vesicles with surface glycoprotein spikes were harbored. In conclusion, the biophysical properties of the virosome were similar to the parent virus, and the use of octaethyleneglycol mono (n-dodecyl ether to solubilize viral membrane, followed by removal of detergent using polymer beads adsorption (Bio-Beads SM2 was the preferable method for obtaining avian influenza virosome. The outcome of this study might be useful for further development veterinary virus vaccines.

  1. Pandemic H1N1 influenza virus in Chilean commercial turkeys with genetic and serologic comparisons to U.S. H1N1 avian influenza vaccine isolates (United States)

    Beginning in April 2009, a novel H1N1 influenza virus has caused acute respiratory disease in humans, first in Mexico and then spreading around the world. The resulting pandemic influenza A H1N1 2009 (pH1N1) virus was isolated in swine in Canada in June, 2009, and later in turkey breeders in Chile, ...

  2. [Klaus Joachim Zülch: Partner to neurosurgery, advocate of neurology and the neuropathological basis]. (United States)

    Mennel, H D


    well be compared to the team formed by Harvey Cushing and Percieval Bailey. Their respective philosophies were equally identical, namely to classify tumors of the central nervous system through a pragmatic approach that would facilitate the communication between neuropathologist, neurosurgeon, neurologist and of course be ultimately as helpful as possible to the patient. Since 1959 Zülchs research turned to the topics of brain hypoxia, circulatory disturbances and stroke, notwithstanding that his interest remained with the other items, whenever new or old questions came up. The occupation with tumors became even once more intense when the WHO installed a reference center for brain tumor classification at his place in Cologne. In the new field of brain circulation, Klaus Joachim Zülch tried once again to bring basic science and clinical practise together and to draw the neurologists attention upon these frequent and important conditions, a development that gained increasing importance under the heading of "stroke unit" in our days. Klaus Joachim Zülch therefore may be regarded as neurologist ahead of his time trying to cover the epidemiologically important and frequent themes and establishing equal partnership with neurosurgery The connection with the scientific basis, i.e. morphology in different variations at the time under a common roof was crucial in his understanding of the work as neurologist.

  3. Expression of Two N1 Clones with Single Amino Acid Dissimilarity of Avian Influenza H5N1 Virus

    Directory of Open Access Journals (Sweden)



    Full Text Available Two clones of N1 gene derived from isolate A/Dk/Tangerang/Bbalitvet-ACIAR-TE11/2007 (H5N1 exhibit single mismatch of amino acid sequence at position 242 that is threonine and methionine for the clone #3 and #5, respectively. In order to evaluate the effect of the amino acid substitution, these clones were inserted into two different expression vectors that are pEGFP-C1 and pcDNA-3.3 TOPO® TA cloning. Subsequently, the respective recombinant clones were transfected into eukaryotic cells, including CEF, RK13 and VERO using Lipofectamine ‘plus’ reagent. As a result, the clone #3 retaining atypical sequence showed lower expression level rather than the clone #15 in both vectors and all type of cells. The 3D conformational modelling revealed that the mutation occurs in the inner part of glycoprotein embedded within envelope or matrix. Therefore, the missense mutation seems has no effect on the antigenic properties of neuraminidase but this substitution by any means causes lethal mutagenesis in the individual gene expression by reducing level of protein transcript.

  4. Immunity to pre-1950 H1N1 influenza viruses confers cross-protection against the pandemic swine-origin 2009 A (H1N1) influenza virus. (United States)

    Skountzou, Ioanna; Koutsonanos, Dimitrios G; Kim, Jin Hyang; Powers, Ryan; Satyabhama, Lakshmipriyadarshini; Masseoud, Feda; Weldon, William C; Martin, Maria Del Pilar; Mittler, Robert S; Compans, Richard; Jacob, Joshy


    The 2009 H1N1 influenza virus outbreak is the first pandemic of the twenty-first century. Epidemiological data reveal that of all the people afflicted with H1N1 virus, 60 y old have pre-existing neutralizing Abs against the 2009 H1N1 virus. This finding suggests that influenza strains that circulated 50-60 y ago might provide cross-protection against the swine-origin 2009 H1N1 influenza virus. To test this, we determined the ability of representative H1N1 influenza viruses that circulated in the human population from 1930 to 2000, to induce cross-reactivity to and cross-protection against the pandemic swine-origin H1N1 virus, A/California/04/09. We show that exposure of mice to the 1947 virus, A/FM/1/47, or the 1934 virus, A/PR/8/34, induced robust cross-protective immune responses and these mice were protected against a lethal challenge with mouse-adapted A/California/04/09 H1N1 virus. Conversely, we observed that mice exposed to the 2009 H1N1 virus were protected against a lethal challenge with mouse-adapted 1947 or 1934 H1N1 viruses. In addition, exposure to the 2009 H1N1 virus induced broad cross-reactivity against H1N1 as well as H3N2 influenza viruses. Finally, we show that vaccination with the older H1N1 viruses, particularly A/FM/1/47, confers protective immunity against the 2009 pandemic H1N1 virus. Taken together, our data provide an explanation for the decreased susceptibility of the elderly to the 2009 H1N1 outbreak and demonstrate that vaccination with the pre-1950 influenza strains can cross-protect against the pandemic swine-origin 2009 H1N1 influenza virus.

  5. The soviet manned lunar program N1-L3 (United States)

    Lardier, Christian


    The conquest of space was marked by the Moon race in which the two superpowers, the United States and the Soviet Union, were engaged in the 1960s. On the American side, the Apollo program culminated with the Man on the Moon in July 1969, 50 years ago. At the same time, the Soviet Union carried out a similar program which was kept secret for 20 years. This N1-L3 program was unveiled in August 1989. Its goal was to arrive on the Moon before the Americans. It included an original super-rocket, development of which began in June 1960. But this program became a national priority only in August 1964 and the super-rocket failed four times between 1969 and 1972. This article analyses the reasons for these failures, which led to the cancellation of the program in 1974.

  6. Extended global symmetries for 4d N=1 SQCD theories

    Energy Technology Data Exchange (ETDEWEB)

    Gahramanov, Ilmar [Deutsches Elektronen-Synchrotron (DESY), Hamburg (Germany). Theory Group; Humboldt-Universitaet, Berlin (Germany). Inst. fuer Physik; Institute of Radiation Problems ANAS, Baku (Azerbaijan); Vartanov, Grigory [Humboldt-Universitaet, Berlin (Germany). Inst. fuer Physik


    In arXiv:0811.1909 Spiridonov and Vartanov, using the superconformal index technique, found that 4-dimensional N=1 SQCD theory with SU(2) gauge group and four flavors has 72 dual representations. Recently in arXiv:1209.1404 the authors showed that these dual theories, when coupled to 5d hypermultiplets with specific boundary conditions have an extended E{sub 7} global symmetry. In this work we find that for a reduced theory with 3 flavors the explicit SU(6) global symmetry is enhanced to an E{sub 6} symmetry in the presence of 5d hypermultiplets. We also show connections between indices of different theories in 3 and 4 dimensions.

  7. Methyl N-[1-(Benzoylamino-2-methoxy-2-oxoethyl]-tryptophanate

    Directory of Open Access Journals (Sweden)

    Oumaima Karai


    Full Text Available The title compound, methyl N-[1-(benzoylamino-2-methoxy-2-oxoethyl]tryptophanate 2, was synthesized in high yield, via N-alkylation reaction of methyl 2-azido-2-benzamidoacetate with methyl 2-amino-3-(1H-indol-3-ylpropanoate in acetone, with the presence of diisopropylethylamine as a base. The structure of the prepared compound was characterized by 1H, 13C NMR in addition to MS, X-Ray diffraction data, and elemental analysis. This compound was tested in vitro for its antibacterial activity against Gram-positive bacteria, Bacillus subtilis and Staphylococcus aureus, and Gram-negative bacteria, Escherichia coli, Pseudomonas aeruginosa, and Salmonella enteric. The MIC values showed that the synthesized compound had a bactericidal effect against the strains tested.

  8. The N = 1 Triplet Vertex Operator Superalgebras: Twisted Sector

    Directory of Open Access Journals (Sweden)

    Drazen Adamovic


    Full Text Available We classify irreducible σ-twisted modules for the N = 1 super triplet vertex operator superalgebra SW(m introduced recently [Adamovic D., Milas A., Comm. Math. Phys., to appear, arXiv:0712.0379]. Irreducible graded dimensions of σ-twisted modules are also determined. These results, combined with our previous work in the untwisted case, show that the SL(2,Z-closure of the space spanned by irreducible characters, irreducible supercharacters and σ-twisted irreducible characters is (9m + 3-dimensional. We present strong evidence that this is also the (full space of generalized characters for SW(m. We are also able to relate irreducible SW(m characters to characters for the triplet vertex algebra W(2m + 1, studied in [Adamovic D., Milas A., Adv. Math. 217 (2008, 2664-2699, arXiv:0707.1857].

  9. Avian Influenza H5N1 Transmission in Households, Indonesia (United States)

    Kusriastuti, Rita; Sampurno, Ondri Dwi; Purba, Wilfried; Misriyah; Santoso, Hari; Bratasena, Arie; Maruf, Anas; Sariwati, Elvieda; Setiawaty, Vivi; Glass, Kathryn; Lokuge, Kamalini; Kelly, Paul M.; Kandun, I. Nyoman


    Background Disease transmission patterns are needed to inform public health interventions, but remain largely unknown for avian influenza H5N1 virus infections. A recent study on the 139 outbreaks detected in Indonesia between 2005 and 2009 found that the type of exposure to sources of H5N1 virus for both the index case and their household members impacted the risk of additional cases in the household. This study describes the disease transmission patterns in those outbreak households. Methodology/Principal Findings We compared cases (n = 177) and contacts (n = 496) in the 113 sporadic and 26 cluster outbreaks detected between July 2005 and July 2009 to estimate attack rates and disease intervals. We used final size household models to fit transmission parameters to data on household size, cases and blood-related household contacts to assess the relative contribution of zoonotic and human-to-human transmission of the virus, as well as the reproduction number for human virus transmission. The overall household attack rate was 18.3% and secondary attack rate was 5.5%. Secondary attack rate remained stable as household size increased. The mean interval between onset of subsequent cases in outbreaks was 5.6 days. The transmission model found that human transmission was very rare, with a reproduction number between 0.1 and 0.25, and the upper confidence bounds below 0.4. Transmission model fit was best when the denominator population was restricted to blood-related household contacts of index cases. Conclusions/Significance The study only found strong support for human transmission of the virus when a single large cluster was included in the transmission model. The reproduction number was well below the threshold for sustained transmission. This study provides baseline information on the transmission dynamics for the current zoonotic virus and can be used to detect and define signatures of a virus with increasing capacity for human-to-human transmission. PMID

  10. An H5N1 M2e-based multiple antigenic peptide vaccine confers heterosubtypic protection from lethal infection with pandemic 2009 H1N1 virus

    Directory of Open Access Journals (Sweden)

    Yu Hong


    Full Text Available Abstract Background A 2009 global influenza pandemic caused by a novel swine-origin H1N1 influenza A virus has posted an increasing threat of a potential pandemic by the highly pathogenic avian influenza (HPAI H5N1 virus, driving us to develop an influenza vaccine which confers cross-protection against both H5N1 and H1N1 viruses. Previously, we have shown that a tetra-branched multiple antigenic peptide (MAP vaccine based on the extracellular domain of M2 protein (M2e from H5N1 virus (H5N1-M2e-MAP induced strong immune responses and cross-protection against different clades of HPAI H5N1 viruses. In this report, we investigated whether such M2e-MAP presenting the H5N1-M2e consensus sequence can afford heterosubtypic protection from lethal challenge with the pandemic 2009 H1N1 virus. Results Our results demonstrated that H5N1-M2e-MAP plus Freund's or aluminum adjuvant induced strong cross-reactive IgG antibody responses against M2e of the pandemic H1N1 virus which contains one amino acid variation with M2e of H5N1 at position 13. These cross-reactive antibodies may maintain for 6 months and bounced back quickly to the previous high level after the 2nd boost administered 2 weeks before virus challenge. H5N1-M2e-MAP could afford heterosubtypic protection against lethal challenge with pandemic H1N1 virus, showing significant decrease of viral replications and obvious alleviation of histopathological damages in the challenged mouse lungs. 100% and 80% of the H5N1-M2e-MAP-vaccinated mice with Freund's and aluminum adjuvant, respectively, survived the lethal challenge with pandemic H1N1 virus. Conclusions Our results suggest that H5N1-M2e-MAP has a great potential to prevent the threat from re-emergence of pandemic H1N1 influenza and possible novel influenza pandemic due to the reassortment of HPAI H5N1 virus with the 2009 swine-origin H1N1 influenza virus.

  11. Launching Effectiveness Research to Guide Practice in Neurosurgery: A National Institute Neurological Disorders and Stroke Workshop Report. (United States)

    Walicke, Patricia; Abosch, Aviva; Asher, Anthony; Barker, Fred G; Ghogawala, Zoher; Harbaugh, Robert; Jehi, Lara; Kestle, John; Koroshetz, Walter; Little, Roderick; Rubin, Donald; Valadka, Alex; Wisniewski, Stephen; Chiocca, E Antonio


    This workshop addressed challenges of clinical research in neurosurgery. Randomized controlled clinical trials (RCTs) have high internal validity, but often insufficiently generalize to real-world practice. Observational studies are inclusive but often lack sufficient rigor. The workshop considered possible solutions, such as (1) statistical methods for demonstrating causality using observational data; (2) characteristics required of a registry supporting effectiveness research; (3) trial designs combining advantages of observational studies and RCTs; and (4) equipoise, an identified challenge for RCTs. In the future, advances in information technology potentially could lead to creation of a massive database where clinical data from all neurosurgeons are integrated and analyzed, ending the separation of clinical research and practice and leading to a new "science of practice." Copyright © 2017 by the Congress of Neurological Surgeons.

  12. Speaking Secrets: Epilepsy, Neurosurgery, and Patient Testimony in the Age of the Explorable Brain, 1934-1960. (United States)

    Elder, Rachel


    This article examines the role of Wilder Penfield's patients in early neurosurgeries for epilepsy at the Montreal Neurological Institute from the 1930s to 1950s. Shifting the focus from scientific discoveries that emerged as a result of Penfield's unprecedented "exploration" of the brain, this piece considers how patients contributed to the creation of such knowledge through their spoken feedback, both within and beyond the operating room. Correspondingly, it examines the personal and social contexts under which patients elected for surgery. Tracing an underexplored social history of Penfield's patients through more than sixty clinical records, it suggests that making knowledge about the brain was a multidirectional process in which patients meaningfully participated, and in which their experiences of epilepsy and motivations for surgery were significant.

  13. Seeking tools for image fusion between computed tomography, structural and functional magnetic resonance methods for applications in neurosurgery

    Directory of Open Access Journals (Sweden)

    Liana Guerra Sanches da Rocha


    Full Text Available Objective: To evaluate tools for the fusion of images generatedby tomography and structural and functional magnetic resonanceimaging. Methods: Magnetic resonance and functional magneticresonance imaging were performed while a volunteer who hadpreviously undergone cranial tomography performed motor andsomatosensory tasks in a 3-Tesla scanner. Image data were analyzedwith different programs, and the results were compared. Results:We constructed a flow chart of computational processes that allowedmeasurement of the spatial congruence between the methods. Therewas no single computational tool that contained the entire set offunctions necessary to achieve the goal. Conclusion: The fusion ofthe images from the three methods proved to be feasible with the useof four free-access software programs (OsiriX, Register, MRIcro andFSL. Our results may serve as a basis for building software that willbe useful as a virtual tool prior to neurosurgery.

  14. Is the medicolegal issue avoidable in neurosurgery? A retrospective survey of a series of 115 medicolegal cases from public hospitals. (United States)

    Emery, Evelyne; Balossier, Anne; Mertens, Patrick


    Since the mid-1950s, neurosurgery has benefited from the remarkable progress due to tremendous advances in neuroimaging techniques, neuroanesthesia, neurostimulation, and brain-computer interfaces, as well as breakthroughs in operating microscopes and surgical instruments. Yet, this specialty has to do with delicate human structures and is hence considered as highly risky by insurance companies. In France, although neurosurgery's casualty rate (6%) is lower than in other specialties, the number of legal prosecutions has increased since 2002 because of easier access to medicolegal procedures. In order to avoid patients' resorting to the law courts, it becomes necessary to clearly identify the risk factors. From the data bank of the insurer Société Hospitalière d'Assurances Mutuelles (SHAM, main insurance company for public hospitals in France), we retrospectively analyzed 115 files (34 cranial and 81 spinal surgeries) covering the period 1997-2007 for the reasons for complaints against French neurosurgeons working in public hospitals. Five main causes were identified: surgical site infection (37%), technical error (22%), lack of information (14%), delayed diagnosis (11%), and lack of supervision (9%). Some causes are definitely avoidable at no cost to the hospital. Besides basic preventive safety procedures, we reiterate the mandatory steps for a good defense when being prosecuted. The evolution of patients' attitudes toward medical institutions observed in most countries has forced surgeons to adapt their practice. In this context, a common action certified by learned societies on sustainable health care quality, patient safety, and respect of good practices appears as the golden path to maintain a favorable legal, insurance, and financial environment. Copyright © 2014 Elsevier Inc. All rights reserved.

  15. Intravenous and oral levetiracetam in patients with a suspected primary brain tumor and symptomatic seizures undergoing neurosurgery: the HELLO trial. (United States)

    Bähr, Oliver; Hermisson, Mirjam; Rona, Sabine; Rieger, Johannes; Nussbaum, Susanne; Körtvelyessy, Peter; Franz, Kea; Tatagiba, Marcos; Seifert, Volker; Weller, Michael; Steinbach, Joachim P


    Levetiracetam (LEV) is a newer anticonvulsant with a favorable safety profile. There seem to be no relevant drug interactions, and an intravenous formulation is available. Therefore, LEV might be a suitable drug for the perioperative anticonvulsive therapy of patients with suspected brain tumors undergoing neurosurgery. In this prospective study (NCT00571155) patients with suspected primary brain tumors and tumor-related seizures were perioperatively treated with oral and intravenous LEV up to 4 weeks before and until 4 weeks after a planned neurosurgical procedure. Thirty patients with brain tumor-related seizures and intended neurosurgery were included. Three patients did not undergo the scheduled surgery after enrollment, and two patients were lost to follow-up. Therefore, 25 patients were fully evaluable. After initiation of therapy with LEV, 100% of the patients were seizure-free in the pre-surgery phase (3 days up to 4 weeks before surgery), 88% in the 48 h post-surgery phase and 84% in the early follow-up phase (48 h to 4 weeks post surgery). Treatment failure even after dose escalation to 3,000 mg/day occurred in three patients. No serious adverse events related to the treatment with LEV occurred. Our data show the feasibility and safety of oral and intravenous LEV in the perioperative treatment of tumor-related seizures. Although this was a single arm study, the efficacy of LEV appears promising. Considering the side effects and interactions of other anticonvulsants, LEV seems to be a favorable option in the perioperative treatment of brain tumor-related seizures.

  16. Clinical Outcomes of Wulingsan Subtraction Decoction Treatment of Postoperative Brain Edema and Fever as a Complication of Glioma Neurosurgery

    Directory of Open Access Journals (Sweden)

    Wei-rong Jin


    Full Text Available Objective. To evaluate the efficacy of Wulingsan subtraction (五苓散加减 WLSS decoction in the treatment of postoperative brain edema and fever as a complication of glioma neurosurgery. Methods. This retrospective study was conducted at the Department of Neurosurgery of Liaocheng People’s Hospital. Patients hospitalized between March 2011 and December 2014 were divided into three groups: Group A received WLSS oral liquid (50 mL, twice a day; Group B received an intravenous infusion of mannitol; and Group C received WLSS combined with mannitol (n=30 patients per group. All patients were treated for 10 days continuously. Therapeutic efficacy was evaluated by measuring body temperature and indicators of renal function before and 3, 5, and 10 days after treatment. Results. Compared to the other two groups, significantly greater clinical efficacy was observed in the patients treated with mannitol (Group B; P<0.05, although marked clinical efficacy was also observed over time in patients treated with WLSS (Group A. After 5 days, the quantifiable effects of the WLSS and mannitol combination group (Group C were substantial (P<0.05. The renal damage in Group B was more obvious after 5 days and 10 days. Conclusion. Compared with mannitol treatment alone, WLSS combined with mannitol induced a more rapid reduction in body temperature. Our findings suggest that patients should be started on mannitol for 3 days and then switched to WLSS to achieve obvious antipyretic effects and protect renal function. This method of treatment should be considered for clinical applications.

  17. Four-dimensional N=1F[R] supergravity

    Energy Technology Data Exchange (ETDEWEB)

    Nishino, Hitoshi, E-mail: hnishino@csulb.ed [Department of Physics and Astronomy, California State University, 1250 Bellflower Boulevard, Long Beach, CA 90840 (United States); Rajpoot, Subhash, E-mail: rajpoot@csulb.ed [Department of Physics and Astronomy, California State University, 1250 Bellflower Boulevard, Long Beach, CA 90840 (United States)


    We propose a supersymmetric generalization of f[R] gravity, calling it F[R] supergravity. We adopt the so-called unimodular supergravity (UMSG). We first give an explicitly invariant Lagrangian L{sub inv}ident toL{sub SG}+L{sub H} in dimensions 2<={sup forall} D<=11, where L{sub H} is linear in the D-form field strength H=dC, while L{sub SG} is the ordinary supergravity Lagrangian. We then establish the total Lagrangian L{sub tot}ident toeF[e{sup -1}L{sub inv}]+L{sub C}, with the constraint term L{sub C} for the UMSG formulation. As an explicit example, we study N=1 supergravity in four dimensions (4D). We show that the solutions to the field equations for conventional L{sub SG} satisfy the field equation of the new system with L{sub tot}. Since the function F[e{sup -1}L{sub inv}] is an arbitrary (non)polynomial function of e{sup -1}L{sub inv}, there can be many other solutions, including those for non-supersymmetric f[R] gravity.

  18. The Master Space of $N$=1 Gauge Theories

    CERN Document Server

    Forcella, Davide; He, Yang-Hui; Zaffaroni, Alberto


    The full moduli space M of a class of N=1 supersymmetric gauge theories is studied. For gauge theories living on a stack of D3-branes at Calabi-Yau singularities X, M is a combination of the mesonic and baryonic branches, the former being the symmetric product of X. In consonance with the mathematical literature, the single brane moduli space is called the master space F. Illustrating with a host of explicit examples, we exhibit many algebro-geometric properties of the master space such as when F is toric Calabi-Yau, behaviour of its Hilbert series, its irreducible components and its symmetries. In conjunction with the plethystic programme, we investigate the counting of BPS gauge invariants, baryonic and mesonic, using the geometry of F and show how its refined Hilbert series not only engenders the generating functions for the counting but also beautifully encode ``hidden'' global symmetries of the gauge theory which manifest themselves as symmetries of the complete moduli space M for arbitrary number of bra...

  19. Narcolepsy and H1N1 vaccination: a link? (United States)

    Thebault, Simon; Vincent, Angela; Gringras, Paul


    A number of European countries have reported a dramatic increase in the rates of childhood narcolepsy with cataplexy in children immunized with a split-virion adjuvanted swine flu vaccine. Here, we review the strengths and weaknesses of these epidemiological studies and possible neuroimmunological mechanisms. Initial concerns of a 13-fold increased relative risk of narcolepsy were raised by the Scandinavian health protection agencies in 2010. Subsequent retrospective studies support these findings in Canada, France, Ireland, England and Denmark. The cases are predominantly young children who present with severe and rapid onset of cataplexy as well as narcolepsy often within a few weeks of vaccination. The proposed mechanism for postvaccination narcolepsy is one in which an environmental trigger causes or enhances an antibody-mediated autoimmune response in patients with a preexisting genetic susceptibility. However, there have not yet been any reports of specific autoimmunity, either antibody or T-cell-mediated. There is a strong association between narcolepsy and H1N1 vaccination. However, whether this reflects a true increase in affected individuals or a hastening of disease onset in individuals who would otherwise have developed narcolepsy later will become clear in the coming years. The pathological explanation of this association and narcolepsy is likely to be autoimmune, although supportive evidence is lacking.Video abstract available: See the Video Supplementary Digital Content 1 (

  20. The N1-suppression effect for self-initiated sounds is independent of attention

    Directory of Open Access Journals (Sweden)

    Timm Jana


    Full Text Available Abstract Background If we initiate a sound by our own motor behavior, the N1 component of the auditory event-related brain potential (ERP that the sound elicits is attenuated compared to the N1 elicited by the same sound when it is initiated externally. It has been suggested that this N1 suppression results from an internal predictive mechanism that is in the service of discriminating the sensory consequences of one’s own actions from other sensory input. As the N1-suppression effect is becoming a popular approach to investigate predictive processing in cognitive and social neuroscience, it is important to exclude an alternative interpretation not related to prediction. According to the attentional account, the N1 suppression is due to a difference in the allocation of attention between self- and externally-initiated sounds. To test this hypothesis, we manipulated the allocation of attention to the sounds in different blocks: Attention was directed either to the sounds, to the own motor acts or to visual stimuli. If attention causes the N1-suppression effect, then manipulating attention should affect the effect for self-initiated sounds. Results We found N1 suppression in all conditions. The N1 per se was affected by attention, but there was no interaction between attention and self-initiation effects. This implies that self-initiation N1 effects are not caused by attention. Conclusions The present results support the assumption that the N1-suppression effect for self-initiated sounds indicates the operation of an internal predictive mechanism. Furthermore, while attention had an influence on the N1a, N1b, and N1c components, the N1-suppression effect was confined to the N1b and N1c subcomponents suggesting that the major contribution to the auditory N1-suppression effect is circumscribed to late N1 components.

  1. The N1-suppression effect for self-initiated sounds is independent of attention. (United States)

    Timm, Jana; SanMiguel, Iria; Saupe, Katja; Schröger, Erich


    If we initiate a sound by our own motor behavior, the N1 component of the auditory event-related brain potential (ERP) that the sound elicits is attenuated compared to the N1 elicited by the same sound when it is initiated externally. It has been suggested that this N1 suppression results from an internal predictive mechanism that is in the service of discriminating the sensory consequences of one's own actions from other sensory input. As the N1-suppression effect is becoming a popular approach to investigate predictive processing in cognitive and social neuroscience, it is important to exclude an alternative interpretation not related to prediction. According to the attentional account, the N1 suppression is due to a difference in the allocation of attention between self- and externally-initiated sounds. To test this hypothesis, we manipulated the allocation of attention to the sounds in different blocks: Attention was directed either to the sounds, to the own motor acts or to visual stimuli. If attention causes the N1-suppression effect, then manipulating attention should affect the effect for self-initiated sounds. We found N1 suppression in all conditions. The N1 per se was affected by attention, but there was no interaction between attention and self-initiation effects. This implies that self-initiation N1 effects are not caused by attention. The present results support the assumption that the N1-suppression effect for self-initiated sounds indicates the operation of an internal predictive mechanism. Furthermore, while attention had an influence on the N1a, N1b, and N1c components, the N1-suppression effect was confined to the N1b and N1c subcomponents suggesting that the major contribution to the auditory N1-suppression effect is circumscribed to late N1 components.

  2. Benzene-Water (BZWn (n = 1 - 10)) Clusters (United States)

    Prakash, M.; Samy, K. Gopal; Subramanian, V.


    The gas-phase geometries, binding energies (BEs), infrared spectra and electron density parameters of benzene (BZ)-water (W) clusters (BZWn, where n = 1-10) have been calculated using Truhlar's meta hybrid functional, M05-2X, employing 6-31+G** basis set. Both basis set superposition error (BSSE) and zero point energy corrected BEs are in close agreement with the previously reported high level ab initio and experimental values. Among all of the BZWn clusters, the same with inverted book conformer of water hexamer has the highest BE when compared to all other water clusters. The Bader's theory of atoms in molecule (AIM) provides evidence for the presence of O-H···π interactions in all of these clusters. In addition, the roles of C-H···O and lone pair···π (lp···π) interactions in the stabilization of BZWn clusters are also evident from the AIM analysis. The trend in the electron density at the hydrogen bond critical points varies as O-H···π < lp···π < C-H···O. Spectral signatures of these clusters further reinforce the existence of weak H-bond between BZ and Wn clusters. The red shift in all of these clusters ranges from 13 to 95 cm-1. The results clearly show that the presence of π-cloud does not affect the H-bonded network of water clusters except in the case of W6 ring.

  3. Management of Subarachnoid Hemorrhage in Two Important Italian Political Leaders: A Paradigm of Ethical and Technological Evolution of Neurosurgery During the Past Half-Century. (United States)

    Longatti, Pierluigi; Giombelli, Ermanno; Pavesi, Giacomo; Carteri, Alessandro; Feletti, Alberto


    For a curious and extraordinary coincidence, 5 of the 7 most relevant leaders of the Italian Communist Party (Partito Comunista Italiano, which was established in 1921, has been the biggest Communist Party in Western Countries) suffered a cerebral stroke. Cerebrovascular diseases afflicted also Stalin and Lenin, and a number of Presidents of the United States. We present the stories of 2 important Italian political leaders who shared both the leadership role of the major left Italian Party and the dramatic experience of a subarachnoid hemorrhage. Retracing their medical incidents, separated by 50 years of history, we show how a fatal medical disease has become neurosurgical and successfully cured thanks to the advances of neurosurgery, neuroradiology, and hospital organization. A neurologic disease that was disgraceful 50 years ago has lost any disquieting and embarrassing significance in the present time to the light of evolution of vascular neurosurgery. Copyright © 2016 Elsevier Inc. All rights reserved.

  4. Development of the ultra-miniaturized Inertial Measurement Unit WB3 for objective skill analysis and assessment in neurosurgery: preliminary results. (United States)

    Zecca, Massimiliano; Sessa, Salvatore; Lin, Zhuohua; Suzuki, Takashi; Sasaki, Tomoya; Itoh, Kazuko; Iseki, Hiroshi; Takanishi, Atsuo


    In recent years there has been an ever increasing amount of research and development of technologies and methodologies aimed at improving the safety of advanced surgery. In this context, several training methods and metrics have been proposed, in particular for laparoscopy, both to improve the surgeon's abilities and also to assess her/his skills. For neurosurgery, however, the extremely small movements and sizes involved have prevented until now the development of similar methodologies and systems. In this paper we present the development of the ultra-miniaturized Inertial Measurement Unit WB3 (at present the smallest, lightest, and best performing in the world) for practical application in neurosurgery as skill assessment tool. This paper presents the feasibility study for quantitative discrimination of movements of experienced surgeons and beginners in a simple pick and place scenario.

  5. Vesalius project: interactive computers in anatomical instruction (United States)

    McCracken, Thomas O.; Roper, Stephen D.; Spurgeon, Thomas L.


    This project is based on an entirely new concept for teaching the structure and function of the human body a concept which combines traditional approaches gained from centuries of study of human anatomy with the most recent sophisticated 3-dimensional computer graphics display systems and laser disc technology. The end-point of the project is a high resolution interactive 3-D atlas of human/animal anatomy stored on a laser video disc and displayed on graphics workstations--an " electronic Gray''s Anatomy" . These displays will be used to teach the structure of the body and to give students and instructors an understanding of their own body in health and disease. To evaluate the software developed undergraduate students from the anatomy courses at CSU wil be allowed to work with the computer-generated images from the earliest stages of development. Feedback from these students will be incorporated into the software development. Furthermore once a relatively complete series of images has been generated groups of students will be selected at random to study anatomy with this new methodology and will be compared with control groups who utilize more traditional techniques. METHODOLOGY This is a complex project that requires many individual facets to be developed simultaneously (figure 1). We have established an important collaboration with the Uniformed Services University in Bethesda that will allow us to utilize a large cryotome with photographic systems and the expertise to operate it already available there. Indeed most of the elaborate apparatus such as graphics workstations needed for the project is currently available either at CSU or through collaborative arrangements with other institutions.

  6. Creation of a novel simulator for minimally invasive neurosurgery: fusion of 3D printing and special effects. (United States)

    Weinstock, Peter; Rehder, Roberta; Prabhu, Sanjay P; Forbes, Peter W; Roussin, Christopher J; Cohen, Alan R


    OBJECTIVE Recent advances in optics and miniaturization have enabled the development of a growing number of minimally invasive procedures, yet innovative training methods for the use of these techniques remain lacking. Conventional teaching models, including cadavers and physical trainers as well as virtual reality platforms, are often expensive and ineffective. Newly developed 3D printing technologies can recreate patient-specific anatomy, but the stiffness of the materials limits fidelity to real-life surgical situations. Hollywood special effects techniques can create ultrarealistic features, including lifelike tactile properties, to enhance accuracy and effectiveness of the surgical models. The authors created a highly realistic model of a pediatric patient with hydrocephalus via a unique combination of 3D printing and special effects techniques and validated the use of this model in training neurosurgery fellows and residents to perform endoscopic third ventriculostomy (ETV), an effective minimally invasive method increasingly used in treating hydrocephalus. METHODS A full-scale reproduction of the head of a 14-year-old adolescent patient with hydrocephalus, including external physical details and internal neuroanatomy, was developed via a unique collaboration of neurosurgeons, simulation engineers, and a group of special effects experts. The model contains "plug-and-play" replaceable components for repetitive practice. The appearance of the training model (face validity) and the reproducibility of the ETV training procedure (content validity) were assessed by neurosurgery fellows and residents of different experience levels based on a 14-item Likert-like questionnaire. The usefulness of the training model for evaluating the performance of the trainees at different levels of experience (construct validity) was measured by blinded observers using the Objective Structured Assessment of Technical Skills (OSATS) scale for the performance of ETV. RESULTS A

  7. Spermidine/spermine-N(1)-acetyltransferase: a key metabolic regulator. (United States)

    Pegg, Anthony E


    Spermidine/spermine-N(1)-acetyltransferase (SSAT) regulates cellular polyamine content. Its acetylated products are either excreted from the cell or oxidized by acetylpolyamine oxidase. Since polyamines play critical roles in normal and neoplastic growth and in ion channel regulation, SSAT is a key enzyme in these processes. SSAT is very highly regulated. Its content is adjusted in response to alterations in polyamine content to maintain polyamine homeostasis. Certain polyamine analogs can mimic the induction of SSAT and cause a loss of normal polyamines. This may have utility in cancer chemotherapy. SSAT activity is also induced via a variety of other stimuli, including toxins, hormones, cytokines, nonsteroidal anti-inflammatory agents, natural products, and stress pathways, and by ischemia-reperfusion injury. These increases are initiated by alterations in Sat1 gene transcription reinforced by alterations at the other regulatory steps, including protein turnover, mRNA processing, and translation. Transgenic manipulation of SSAT activity has revealed that SSAT activity links polyamine metabolism to lipid and carbohydrate metabolism by means of alterations in the content of acetyl-CoA and ATP. A high level of SSAT stimulates flux through the polyamine biosynthetic pathway, since biosynthetic enzymes are induced in response to the fall in polyamines. This sets up a futile cycle in which ATP is used to generate S-adenosylmethionine for polyamine biosynthesis and acetyl-CoA is consumed in the acetylation reaction. A variety of other effects of increased SSAT activity include death of pancreatic cells, blockage of regenerative tissue growth, behavioral changes, keratosis follicularis spinulosa decalvans, and hair loss. These are very likely due to changes in polyamine and putrescine levels, although increased oxidative stress via the oxidation of acetylated polyamines may also contribute. Recently, it was found that the SSAT protein and/or a related protein, thialysine

  8. Development of Live-Attenuated Influenza Vaccines against Outbreaks of H5N1 Influenza

    Directory of Open Access Journals (Sweden)

    Yinglei Yi


    Full Text Available Several global outbreaks of highly pathogenic avian influenza (HPAI H5N1 virus have increased the urgency of developing effective and safe vaccines against H5N1. Compared with H5N1 inactivated vaccines used widely, H5N1 live-attenuated influenza vaccines (LAIVs have advantages in vaccine efficacy, dose-saving formula, long-lasting effect, ease of administration and some cross-protective immunity. Furthermore, H5N1 LAIVs induce both humoral and cellular immune responses, especially including improved IgA production at the mucosa. The current trend of H5N1 LAIVs development is toward cold-adapted, temperature-sensitive or replication-defective vaccines, and moreover, H5N1 LAIVs plus mucosal adjuvants are promising candidates. This review provides an update on the advantages and development of H5N1 live-attenuated influenza vaccines.

  9. Global behavior of the difference equation $x_{n+1}=\\frac{Ax_{n-1}} {B-Cx_{n}x_{n-2}}$

    Directory of Open Access Journals (Sweden)

    R. Abo-Zeid


    Full Text Available The aim of this work is to investigate the global stability, periodic nature, oscillation and the boundedness of all admissible solutions of the difference equation $x_{n+1}=\\frac{Ax_{n-1}} {B-Cx_{n}x_{n-2}}$, n=0,1,2,... where A, B, C are positive real numbers.

  10. Differential activation of NK cells by influenza A pseudotype H5N1 and 1918 and 2009 pandemic H1N1 viruses. (United States)

    Du, Ning; Zhou, Jianfang; Lin, Xiaojing; Zhang, Yonghui; Yang, Xiaoxing; Wang, Yue; Shu, Yuelong


    Natural killer (NK) cells are the effectors of innate immunity and are recruited into the lung 48 h after influenza virus infection. Functional NK cell activation can be triggered by the interaction between viral hemagglutinin (HA) and natural cytotoxicity receptors NKp46 and NKp44 on the cell surface. Recently, novel subtypes of influenza viruses, such as H5N1 and 2009 pandemic H1N1, transmitted directly to the human population, with unusual mortality and morbidity rates. Here, the human NK cell responses to these viruses were studied. Differential activation of heterogeneous NK cells (upregulation of CD69 and CD107a and gamma interferon [IFN-gamma] production as well as downregulation of NKp46) was observed following interactions with H5N1, 1918 H1N1, and 2009 H1N1 pseudotyped particles (pps), respectively, and the responses of the CD56(dim) subset predominated. Much stronger NK activation was triggered by H5N1 and 1918 H1N1 pps than by 2009 H1N1 pps. The interaction of pps with NK cells and subsequent internalization were mediated by NKp46 partially. The NK cell activation by pps showed a dosage-dependent manner, while an increasing viral HA titer attenuated NK activation phenotypes, cytotoxicity, and IFN-gamma production. The various host innate immune responses to different influenza virus subtypes or HA titers may be associated with disease severity.

  11. Differential Activation of NK Cells by Influenza A Pseudotype H5N1 and 1918 and 2009 Pandemic H1N1 Viruses▿ ‡ ‖ (United States)

    Du, Ning; Zhou, Jianfang; Lin, Xiaojing; Zhang, Yonghui; Yang, Xiaoxing; Wang, Yue; Shu, Yuelong


    Natural killer (NK) cells are the effectors of innate immunity and are recruited into the lung 48 h after influenza virus infection. Functional NK cell activation can be triggered by the interaction between viral hemagglutinin (HA) and natural cytotoxicity receptors NKp46 and NKp44 on the cell surface. Recently, novel subtypes of influenza viruses, such as H5N1 and 2009 pandemic H1N1, transmitted directly to the human population, with unusual mortality and morbidity rates. Here, the human NK cell responses to these viruses were studied. Differential activation of heterogeneous NK cells (upregulation of CD69 and CD107a and gamma interferon [IFN-γ] production as well as downregulation of NKp46) was observed following interactions with H5N1, 1918 H1N1, and 2009 H1N1 pseudotyped particles (pps), respectively, and the responses of the CD56dim subset predominated. Much stronger NK activation was triggered by H5N1 and 1918 H1N1 pps than by 2009 H1N1 pps. The interaction of pps with NK cells and subsequent internalization were mediated by NKp46 partially. The NK cell activation by pps showed a dosage-dependent manner, while an increasing viral HA titer attenuated NK activation phenotypes, cytotoxicity, and IFN-γ production. The various host innate immune responses to different influenza virus subtypes or HA titers may be associated with disease severity. PMID:20484512

  12. Chalcones as novel influenza A (H1N1) neuraminidase inhibitors from Glycyrrhiza inflata

    DEFF Research Database (Denmark)

    Dao, Trong Tuan; Nguyen, Phi Hung; Lee, Hong Sik


    -8) chalcones were isolated as active principles from the acetone extract of Glycyrrhiza inflata. Compounds 3 and 6 without prenyl group showed strong inhibitory effects on various neuraminidases from influenza viral strains, H1N1, H9N2, novel H1N1 (WT), and oseltamivir-resistant novel H1N1 (H274Y) expressed...

  13. 40 CFR 721.3821 - L-Glutamic acid, N-(1-oxododecyl)-. (United States)


    ... 40 Protection of Environment 30 2010-07-01 2010-07-01 false L-Glutamic acid, N-(1-oxododecyl... Substances § 721.3821 L-Glutamic acid, N-(1-oxododecyl)-. (a) Chemical substance and significant new uses subject to reporting. (1) The chemical substance identified as L-Glutamic acid, N-(1-oxododecyl)- (PMN P...

  14. Protection of mice against lethal challenge with 2009 H1N1 influenza A virus by 1918-like and classical swine H1N1 based vaccines.

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    Balaji Manicassamy


    Full Text Available The recent 2009 pandemic H1N1 virus infection in humans has resulted in nearly 5,000 deaths worldwide. Early epidemiological findings indicated a low level of infection in the older population (>65 years with the pandemic virus, and a greater susceptibility in people younger than 35 years of age, a phenomenon correlated with the presence of cross-reactive immunity in the older population. It is unclear what virus(es might be responsible for this apparent cross-protection against the 2009 pandemic H1N1 virus. We describe a mouse lethal challenge model for the 2009 pandemic H1N1 strain, used together with a panel of inactivated H1N1 virus vaccines and hemagglutinin (HA monoclonal antibodies to dissect the possible humoral antigenic determinants of pre-existing immunity against this virus in the human population. By hemagglutinination inhibition (HI assays and vaccination/challenge studies, we demonstrate that the 2009 pandemic H1N1 virus is antigenically similar to human H1N1 viruses that circulated from 1918-1943 and to classical swine H1N1 viruses. Antibodies elicited against 1918-like or classical swine H1N1 vaccines completely protect C57B/6 mice from lethal challenge with the influenza A/Netherlands/602/2009 virus isolate. In contrast, contemporary H1N1 vaccines afforded only partial protection. Passive immunization with cross-reactive monoclonal antibodies (mAbs raised against either 1918 or A/California/04/2009 HA proteins offered full protection from death. Analysis of mAb antibody escape mutants, generated by selection of 2009 H1N1 virus with these mAbs, indicate that antigenic site Sa is one of the conserved cross-protective epitopes. Our findings in mice agree with serological data showing high prevalence of 2009 H1N1 cross-reactive antibodies only in the older population, indicating that prior infection with 1918-like viruses or vaccination against the 1976 swine H1N1 virus in the USA are likely to provide protection against the 2009

  15. Drug-drug interaction between valproic acid and meropenem: a retrospective analysis of electronic medical records from neurosurgery inpatients. (United States)

    Wen, Z-P; Fan, S-S; Du, C; Yin, T; Zhou, B-T; Peng, Z-F; Xie, Y-Y; Zhang, W; Chen, Y; Xiao, J; Chen, X-P


    A series of studies have indicated that valproic acid (VPA) plasma concentration decreased rapidly when used concomitantly with carbapenem antibiotics, including meropenem (MEPM), imipenem and panipenem, which may increase the risk of seizure breakthrough. However, the cause for the change in VPA pharmacokinetics is unclear. A retrospective analysis of VPA therapeutic drug monitoring (TDM) records was performed to investigate this VPA pharmacokinetics drug-drug interaction. Three hundred and eighty one VPA TDM records from the Department of Neurosurgery of Xiangya Hospital from January 2012 to December 2014 were collected. The VPA TDM records were categorized by VPA and MEPM daily dosages in grams/day (g/day). A comparison of VPA plasma levels among different groups was performed to investigate the change in VPA level in this drug interaction. Remarkable decreases in VPA plasma level were observed when the drug was used concomitantly with MEPM in both 1.2 g/d and 1.6 g/d VPA groups (67·3 ± 4·6 μg/mL, n = 21 vs. 15·3 ± 1·9 μg/mL, n = 15, P drug concentration cannot be reversed by increasing VPA dose. Moreover, MEPM daily dose did not influence the drop in VPA plasma level. At least 7 days are required for the recovery of VPA plasma concentration after discontinuation of MEPM. © 2017 John Wiley & Sons Ltd.

  16. [A new human machine interface in neurosurgery: The Leap Motion(®). Technical note regarding a new touchless interface]. (United States)

    Di Tommaso, L; Aubry, S; Godard, J; Katranji, H; Pauchot, J


    Currently, cross-sectional imaging viewing is used in routine practice whereas the surgical procedure requires physical contact with an interface (mouse or touch-sensitive screen). This type of contact results in a risk of lack of aseptic control and causes loss of time. The recent appearance of devices such as the Leap Motion(®) (Leap Motion society, San Francisco, USA) a sensor which enables to interact with the computer without any physical contact is of major interest in the field of surgery. However, its configuration and ergonomics produce key challenges in order to adapt to the practitioner's requirements, the imaging software as well as the surgical environment. This article aims to suggest an easy configuration of the Leap Motion(®) in neurosurgery on a PC for an optimized utilization with Carestream(®) Vue PACS v11.3.4 (Carestream Health, Inc., Rochester, USA) using a plug-in (to download at: and a video tutorial ( Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  17. A new robust markerless method for automatic image-to-patient registration in image-guided neurosurgery system. (United States)

    Liu, Yinlong; Song, Zhijian; Wang, Manning


    Compared with the traditional point-based registration in the image-guided neurosurgery system, surface-based registration is preferable because it does not use fiducial markers before image scanning and does not require image acquisition dedicated for navigation purposes. However, most existing surface-based registration methods must include a manual step for coarse registration, which increases the registration time and elicits some inconvenience and uncertainty. A new automatic surface-based registration method is proposed, which applies 3D surface feature description and matching algorithm to obtain point correspondences for coarse registration and uses the iterative closest point (ICP) algorithm in the last step to obtain an image-to-patient registration. Both phantom and clinical data were used to execute automatic registrations and target registration error (TRE) calculated to verify the practicality and robustness of the proposed method. In phantom experiments, the registration accuracy was stable across different downsampling resolutions (18-26 mm) and different support radii (2-6 mm). In clinical experiments, the mean TREs of two patients by registering full head surfaces were 1.30 mm and 1.85 mm. This study introduced a new robust automatic surface-based registration method based on 3D feature matching. The method achieved sufficient registration accuracy with different real-world surface regions in phantom and clinical experiments.

  18. The science of medical decision making: neurosurgery, errors, and personal cognitive strategies for improving quality of care. (United States)

    Fargen, Kyle M; Friedman, William A


    During the last 2 decades, there has been a shift in the U.S. health care system towards improving the quality of health care provided by enhancing patient safety and reducing medical errors. Unfortunately, surgical complications, patient harm events, and malpractice claims remain common in the field of neurosurgery. Many of these events are potentially avoidable. There are an increasing number of publications in the medical literature in which authors address cognitive errors in diagnosis and treatment and strategies for reducing such errors, but these are for the most part absent in the neurosurgical literature. The purpose of this article is to highlight the complexities of medical decision making to a neurosurgical audience, with the hope of providing insight into the biases that lead us towards error and strategies to overcome our innate cognitive deficiencies. To accomplish this goal, we review the current literature on medical errors and just culture, explain the dual process theory of cognition, identify common cognitive errors affecting neurosurgeons in practice, review cognitive debiasing strategies, and finally provide simple methods that can be easily assimilated into neurosurgical practice to improve clinical decision making. Copyright © 2014 Elsevier Inc. All rights reserved.

  19. Robotic and artificial intelligence for keyhole neurosurgery: the ROBOCAST project, a multi-modal autonomous path planner. (United States)

    De Momi, E; Ferrigno, G


    The robot and sensors integration for computer-assisted surgery and therapy (ROBOCAST) project (FP7-ICT-2007-215190) is co-funded by the European Union within the Seventh Framework Programme in the field of information and communication technologies. The ROBOCAST project focuses on robot- and artificial-intelligence-assisted keyhole neurosurgery (tumour biopsy and local drug delivery along straight or turning paths). The goal of this project is to assist surgeons with a robotic system controlled by an intelligent high-level controller (HLC) able to gather and integrate information from the surgeon, from diagnostic images, and from an array of on-field sensors. The HLC integrates pre-operative and intra-operative diagnostics data and measurements, intelligence augmentation, multiple-robot dexterity, and multiple sensory inputs in a closed-loop cooperating scheme including a smart interface for improved haptic immersion and integration. This paper, after the overall architecture description, focuses on the intelligent trajectory planner based on risk estimation and human criticism. The current status of development is reported, and first tests on the planner are shown by using a real image stack and risk descriptor phantom. The advantages of using a fuzzy risk description are given by the possibility of upgrading the knowledge on-field without the intervention of a knowledge engineer.

  20. Nosocomial bloodstream infections in neurosurgery: a 10-year analysis in a center with high antimicrobial drug-resistance prevalence. (United States)

    Tsitsopoulos, Parmenion P; Iosifidis, Elias; Antachopoulos, Charalampos; Anestis, Dimitrios M; Karantani, Ekaterini; Karyoti, Angeliki; Papaevangelou, Georgios; Kyriazidis, Eftychios; Roilides, Emmanuel; Tsonidis, Christos


    Data on nosocomial bloodstream infections (NBSI) in neurosurgery is limited. This study aimed to analyze the epidemiology, microbiology, outcome, and risk factors for death in neurosurgical patients with NBSI in a multidrug resistant setting. Neurosurgical patients with a confirmed NBSI within the period 2003-2012 were retrospectively analyzed. NBSI was diagnosed when a pathogen was isolated from a blood sample obtained after the first 48 h of hospitalization. Patients' demographic, clinical, and microbiological data were recorded and analyzed using univariate and multivariate analysis. A total of 236 patients with NBSI were identified and 378 isolates were recovered from blood cultures. Incidence of NBSI was 4.3 infections/1000 bed-days. Gram-negative bacteria slightly predominated (54.5 %). The commonest bacteria were coagulase-negative staphylococci (CoNS, 26 %), Klebsiella pneumoniae (15.3 %), Pseudomonas aeruginosa (14.8 %), and Acinetobacter baumannii (13.2 %). Carbapenem resistance was found in 90 % of A. baumannii, in 66 % of P. aeruginosa, and in 22 % (2003-2007) to 77 % (2008-2012) of K. pneumoniae isolates (p risk factors for in-hospital mortality (p factors.

  1. N1-Src Kinase Is Required for Primary Neurogenesis in Xenopus tropicalis. (United States)

    Lewis, Philip A; Bradley, Isobel C; Pizzey, Alastair R; Isaacs, Harry V; Evans, Gareth J O


    The presence of the neuronal-specific N1-Src splice variant of the C-Src tyrosine kinase is conserved through vertebrate evolution, suggesting an important role in complex nervous systems. Alternative splicing involving an N1-Src-specific microexon leads to a 5 or 6 aa insertion into the SH3 domain of Src. A prevailing model suggests that N1-Src regulates neuronal differentiation via cytoskeletal dynamics in the growth cone. Here we investigated the role of n1-src in the early development of the amphibian Xenopus tropicalis, and found that n1-src expression is regulated in embryogenesis, with highest levels detected during the phases of primary and secondary neurogenesis. In situ hybridization analysis, using locked nucleic acid oligo probes complementary to the n1-src microexon, indicates that n1-src expression is highly enriched in the open neural plate during neurula stages and in the neural tissue of adult frogs. Given the n1-src expression pattern, we investigated a possible role for n1-src in neurogenesis. Using splice site-specific antisense morpholino oligos, we inhibited n1-src splicing, while preserving c-src expression. Differentiation of neurons in the primary nervous system is reduced in n1-src-knockdown embryos, accompanied by a severely impaired touch response in later development. These data reveal an essential role for n1-src in amphibian neural development and suggest that alternative splicing of C-Src in the developing vertebrate nervous system evolved to regulate neurogenesis.SIGNIFICANCE STATEMENT The Src family of nonreceptor tyrosine kinases acts in signaling pathways that regulate cell migration, cell adhesion, and proliferation. Srcs are also enriched in the brain, where they play key roles in neuronal development and neurotransmission. Vertebrates have evolved a neuron-specific splice variant of C-Src, N1-Src, which differs from C-Src by just 5 or 6 aa. N1-Src is poorly understood and its high similarity to C-Src has made it difficult to

  2. Prior infection of chickens with H1N1 or H1N2 avian influenza elicits partial heterologous protection against highly pathogenic H5N1.

    Directory of Open Access Journals (Sweden)

    Charles Nfon

    Full Text Available There is a critical need to have vaccines that can protect against emerging pandemic influenza viruses. Commonly used influenza vaccines are killed whole virus that protect against homologous and not heterologous virus. Using chickens we have explored the possibility of using live low pathogenic avian influenza (LPAI A/goose/AB/223/2005 H1N1 or A/WBS/MB/325/2006 H1N2 to induce immunity against heterologous highly pathogenic avian influenza (HPAI A/chicken/Vietnam/14/2005 H5N1. H1N1 and H1N2 replicated in chickens but did not cause clinical disease. Following infection, chickens developed nucleoprotein and H1 specific antibodies, and reduced H5N1 plaque size in vitro in the absence of H5 neutralizing antibodies at 21 days post infection (DPI. In addition, heterologous cell mediated immunity (CMI was demonstrated by antigen-specific proliferation and IFN-γ secretion in PBMCs re-stimulated with H5N1 antigen. Following H5N1 challenge of both pre-infected and naïve controls chickens housed together, all naïve chickens developed acute disease and died while H1N1 or H1N2 pre-infected chickens had reduced clinical disease and 70-80% survived. H1N1 or H1N2 pre-infected chickens were also challenged with H5N1 and naïve chickens placed in the same room one day later. All pre-infected birds were protected from H5N1 challenge but shed infectious virus to naïve contact chickens. However, disease onset, severity and mortality was reduced and delayed in the naïve contacts compared to directly inoculated naïve controls. These results indicate that prior infection with LPAI virus can generate heterologous protection against HPAI H5N1 in the absence of specific H5 antibody.

  3. Genetic correlation between current circulating H1N1 swine and human influenza viruses. (United States)

    Lu, Lu; Yin, Yanbo; Sun, Zhongsheng; Gao, Lei; Gao, George F; Liu, Sidang; Sun, Lei; Liu, Wenjun


    H1N1 is the main subtype influenza A virus circulating in human and swine population, and has long been a threat to economy and public health. To explore the genetic correlation between current circulating H1N1 swine and human influenza viruses. Three new H1N1 swine influenza viruses (SIVs) were isolated and genomes sequencing were conducted followed by phylogenetic and molecular analysis of all swine and human H1N1 influenza viruses isolated in China in the past five years. Homology and phylogenetic analysis revealed that the three isolates possessed different characteristics: the genome of A/Swine/Shandong/1112/2008 was closely related to that of classical H1N1 SIV, while A/Swine/Shandong/1123/2008 was a reassortant with NS gene from the human-like H3N2 influenza virus and other genes from the classical H1N1 SIV, and A/Swine/Fujian/0325/2008 fell into a lineage of seasonal human H1N1 influenza viruses. Genetically, 2009 H1N1 influenza A viruses (2009 H1N1) in China were contiguous to the SIV lineages rather than the seasonal H1N1 human influenza virus's lineage. Furthermore, molecular analysis among human and swine influenza viruses provided more detail information for understanding their genetic correlation. These results suggested that in China in the past five years, the classical, avian-like and human-like H1N1 SIV existed in swine herds and the reassortment between H1N1 swine and H3N2 human influenza viruses was identified. In addition, the present data showed no evidence to support a strong correlation between the 2009 H1N1 and the swine influenza virus circulating in China. Copyright © 2010 Elsevier B.V. All rights reserved.

  4. Multiple introductions of highly pathogenic avian influenza H5N1 viruses into Bangladesh (United States)

    Marinova-Petkova, Atanaska; Feeroz, Mohammed M; Rabiul Alam, SM; Kamrul Hasan, M; Akhtar, Sharmin; Jones-Engel, Lisa; Walker, David; McClenaghan, Laura; Rubrum, Adam; Franks, John; Seiler, Patrick; Jeevan, Trushar; McKenzie, Pamela; Krauss, Scott; Webby, Richard J; Webster, Robert G


    Highly pathogenic H5N1 and low pathogenic H9N2 influenza viruses are endemic to poultry markets in Bangladesh and have cocirculated since 2008. H9N2 influenza viruses circulated constantly in the poultry markets, whereas highly pathogenic H5N1 viruses occurred sporadically, with peaks of activity in cooler months. Thirty highly pathogenic H5N1 influenza viruses isolated from poultry were characterized by antigenic, molecular, and phylogenetic analyses. Highly pathogenic H5N1 influenza viruses from clades 2.2.2 and were isolated from live bird markets only. Phylogenetic analysis of the 30 H5N1 isolates revealed multiple introductions of H5N1 influenza viruses in Bangladesh. There was no reassortment between the local H9N2 influenza viruses and H5N1 genotype, despite their prolonged cocirculation. However, we detected two reassortant H5N1 viruses, carrying the M gene from the Chinese H9N2 lineage, which briefly circulated in the Bangladesh poultry markets and then disappeared. On the other hand, interclade reassortment occurred within H5N1 lineages and played a role in the genesis of the currently dominant H5N1 viruses in Bangladesh. Few ‘human-like' mutations in H5N1 may account for the limited number of human cases. Antigenically, clade H5N1 viruses in Bangladesh have evolved since their introduction and are currently mainly homogenous, and show evidence of recent antigenic drift. Although reassortants containing H9N2 genes were detected in live poultry markets in Bangladesh, these reassortants failed to supplant the dominant H5N1 lineage. PMID:26038508

  5. Vibrational spectroscopic studies of N1-ethyl-5‧-bromo-7-azaindirubin-3‧-oxime and N1-ethyl-indirubin-3‧-monooxime (United States)

    Li, Ying-Sing; Yao, Qi-Zheng; Wang, Zhao-Hui; Cheng, Jingcai; Truong, Tuyen Thi T.


    We have prepared N1-ethyl-5‧-bromo-7-azaindirubin-3‧-oxime due to its potential for being a pharmaceutical. Infrared and Raman spectra have been recorded and vibrational assignments have been suggested based mainly on our previous vibrational investigation of N1-isopropyl-5‧-chloro-7-azaindirubin-3‧-oxime and on group characteristic frequencies. Temperature variation study has revealed the presence of conformers due to the internal rotation of ethyl group. IR spectra collected for N1-ethyl-7-azaindirubin-3‧-oxime have shown rather similar spectral features with that of N1-ethyl-5‧-bromo-7-azaindirubin-3‧-oxime. IR spectra of these compounds have revealed the association through hydrogen bonding in the solid state. IR spectra recorded for these samples after annealing at high temperatures indicated the thermal conversion temperature to be lowered than 270 °C. Results from thermal analyses have determined the beginning decomposition temperatures to be 250 °C and the decomposition enthalpies to be 94 kJ/mol for both N1-ethyl-5‧-bromo-7-azaindirubin-3‧-oxime and N1-ethyl-7-azaindirubin-3‧-oxime.

  6. Prior infection with classical swine H1N1 influenza viruses is associated with protective immunity to the 2009 pandemic H1N1 virus. (United States)

    Kash, John C; Qi, Li; Dugan, Vivien G; Jagger, Brett W; Hrabal, Rachel J; Memoli, Matthew J; Morens, David M; Taubenberger, Jeffery K


    The 2009 H1N1 pandemic emerged even though seasonal H1N1 viruses have circulated for decades. Epidemiological evidence suggested that the current seasonal vaccine did not offer significant protection from the novel pandemic, and that people over the age of 50 were less susceptible to infection. In a mouse challenge study with the 2009 pandemic H1N1 virus, we evaluated protective immune responses elicited by prior infection with human and swine influenza A viruses. Mice infected with A/Mexico/4108/2009 (Mex09) showed significant weight loss and 40% mortality. Prior infection with a 1976 classical swine H1N1 virus resulted in complete protection from Mex09 challenge. Prior infection with either a 2009 or a 1940 seasonal H1N1 influenza virus provided partial protection and a >100-fold reduction in viral lung titers at day 4 post-infection. These findings indicate that in experimental animals recently induced immunity to 1918-derived H1N1 seasonal influenza viruses, and to a 1976 swine influenza virus, afford a degree of protection against the 2009 pandemic virus. Implications of these findings are discussed in the context of accumulating data suggesting partial protection of older persons during the 2009 pandemic.

  7. Initial experience with a robotically operated video optical telescopic-microscope in cranial neurosurgery: feasibility, safety, and clinical applications. (United States)

    Gonen, Lior; Chakravarthi, Srikant S; Monroy-Sosa, Alejandro; Celix, Juanita M; Kojis, Nathaniel; Singh, Maharaj; Jennings, Jonathan; Fukui, Melanie B; Rovin, Richard A; Kassam, Amin B


    OBJECTIVE The move toward better, more effective optical visualization in the field of neurosurgery has been a focus of technological innovation. In this study, the authors' objectives are to describe the feasibility and safety of a new robotic optical platform, namely, the robotically operated video optical telescopic-microscope (ROVOT-m), in cranial microsurgical applications. METHODS A prospective database comprising patients who underwent a cranial procedure between April 2015 and September 2016 was queried, and the first 200 patients who met the inclusion criteria were selected as the cohort for a retrospective chart review. Only adults who underwent microsurgical procedures in which the ROVOT-m was used were considered for the study. Preoperative, intraoperative, and postoperative data were retrieved from electronic medical records. The authors address the feasibility and safety of the ROVOT-m by studying various intraoperative variables and by reporting perioperative morbidity and mortality, respectively. To assess the learning curve, cranial procedures were categorized into 6 progressively increasing complexity groups. The main categories of pathology were I) intracerebral hemorrhages (ICHs); II) intraaxial tumors involving noneloquent regions or noncomplex extraaxial tumors; III) intraaxial tumors involving eloquent regions; IV) skull base pathologies; V) intraventricular lesions; and VI) cerebrovascular lesions. In addition, the entire cohort was evenly divided into early and late cohorts. RESULTS The patient cohort comprised 104 female (52%) and 96 male (48%) patients with a mean age of 56.7 years. The most common pathological entities encountered were neoplastic lesions (153, 76.5%), followed by ICH (20, 10%). The distribution of cases by complexity categories was 11.5%, 36.5%, 22%, 20%, 3.5%, and 6.5% for Categories I, II, II, IV, V, and VI, respectively. In all 200 cases, the surgical goal was achieved without the need for intraoperative conversion

  8. Risk of Deep vein thrombosis in neurosurgery: State of the art on prophylaxis protocols and best clinical practices. (United States)

    Ganau, Mario; Prisco, Lara; Cebula, Helene; Todeschi, Julien; Abid, Houssem; Ligarotti, Gianfranco; Pop, Raoul; Proust, Francois; Chibbaro, Salvatore


    To analytically discuss some protocols in Deep vein thrombosis (DVT)/pulmonary Embolism (PE) prophylaxis currently use in Neurosurgical Departments around the world. Analysis of the prophylaxis protocols in the English literature: An analytical and narrative review of literature concerning DVT prophylaxis protocols in Neurosurgery have been conducted by a PubMed search (back to 1978). 80 abstracts were reviewed, and 74 articles were extracted. The majority of DVT seems to develop within the first week after a neurosurgical procedure, and a linear correlation between the duration of surgery and DVT occurrence has been highlighted. The incidence of DVT seems greater for cranial (7.7%) than spinal procedures (1.5%). Although intermittent pneumatic compression (IPC) devices provided adequate reduction of DVT/PE in some cranial and combined cranial/spinal series, low-dose subcutaneous unfractionated heparin (UFH) or low molecular-weight heparin (LMWH) further reduced the incidence, not always of DVT, but of PE. Nevertheless, low-dose heparin-based prophylaxis in cranial and spinal series risks minor and major postoperative haemorrhages: 2-4% in cranial series, 3.4% minor and 3.4% major haemorrhages in combined cranial/spinal series, and a 0.7% incidence of major/minor haemorrhages in spinal series. This analysis showed that currently most of the articles are represented by case series and case reports. As long as clear guidelines will not be defined and universally applied to this diverse group of patients, any prophylaxis for DVT and PE should be tailored to the individual patient with cautious assessment of benefits versus risks. Copyright © 2017 Elsevier Ltd. All rights reserved.

  9. Preoperative imaging as the basis for image-guided neurosurgery. EN; Praeoperative Bildgebung. Grundlage der navigationsgestuetzten Neurochirurgie

    Energy Technology Data Exchange (ETDEWEB)

    Winkler, D. (Klinik und Poliklinik fuer Neurochirurgie, Universitaet Leipzig; Klinik fuer Neurochirurgie, Universitaet Leipzig, Liebigstrasse 20, 04103, Leipzig); Strauss, G. (Klinik fuer HNO-Krankheiten, Universitaet Leipzig); Hesse, S.; Sabri, O. (Klinik fuer Nuklearmedizin, Universitaet Leipzig); Goldammer, A.; Meixensberger, J. (Klinik und Poliklinik fuer Neurochirurgie, Universitaet Leipzig); Hund-Georgiadis, M. (Max-Planck-Institut fuer Neuropsychologische Forschung, Leipzig); Richter, A.; Kahn, T. (Klinik fuer Diagnostische Radiologie, Universitaet Leipzig)


    With the progressive development of soft- and hardware, the acceptance of image-guided neurosurgery has increased dramatically. Additional image data are required to analyze the nature and the dimensions of pathological processes and the surrounding tissue. In this context, fMRI, SPECT, PET, as well as special modalities of CT and MR imaging, are routinely used. Secondary post-processing options are used to detect intracerebral lesions as well as adjacent functional eloquent regions in the parenchymatous organ pre- and intraoperatively. The integration of different image information guarantees the precise planning and realization of surgical maneuvers. The segmentation of interesting structures and risk structures, as well as their implementation in the neuronavigation systems, help to avoid additional intraoperative traumatization and offer a higher level of safety and precision. In this article the value and limitations of presurgical imaging will be discussed. (orig.) [German] Die bildgestuetzte Neurochirurgie erfaehrt mit der Entwicklung von Soft- und Hardware eine sprunghafte Akzeptanz. Zusaetzliche Bilddaten dienen der Beurteilung von Charakter und Ausdehnung von pathologischen Prozessen und dem Umgebungsgewebe. In diesem Kontext sind fMRT, SPECT, PET und spezielle Modalitaeten der CT- und MRT-Diagnostik zu nennen. Mittels sekundaerer Bildbearbeitung koennen intrazerebrale Laesionen und benachbarte, funktionell eloquente Regionen im parenchymatoesen Organ Gehirn prae- und intraoperativ detektiert werden. Die Integration verschiedener Bildinformationen garantiert eine praezise Planung und Realisierung von chirurgischen Manoevern. Die Segmentation interessierender Strukturen, von Risikostrukturen und deren Implementation in Systeme der Neuronavigation helfen, eine zusaetzliche intraoperative Traumatisierung zu vermeiden, und bieten eine groessere Sicherheit und Praezision. Mit diesem Artikel werden der Wert und die Grenzen praeoperativer Bilddiagnostik

  10. MO-DE-202-02: Advances in Image Registration and Reconstruction for Image-Guided Neurosurgery

    Energy Technology Data Exchange (ETDEWEB)

    Siewerdsen, J. [Johns Hopkins University (United States)


    At least three major trends in surgical intervention have emerged over the last decade: a move toward more minimally invasive (or non-invasive) approach to the surgical target; the development of high-precision treatment delivery techniques; and the increasing role of multi-modality intraoperative imaging in support of such procedures. This symposium includes invited presentations on recent advances in each of these areas and the emerging role for medical physics research in the development and translation of high-precision interventional techniques. The four speakers are: Keyvan Farahani, “Image-guided focused ultrasound surgery and therapy” Jeffrey H. Siewerdsen, “Advances in image registration and reconstruction for image-guided neurosurgery” Tina Kapur, “Image-guided surgery and interventions in the advanced multimodality image-guided operating (AMIGO) suite” Raj Shekhar, “Multimodality image-guided interventions: Multimodality for the rest of us” Learning Objectives: Understand the principles and applications of HIFU in surgical ablation. Learn about recent advances in 3D–2D and 3D deformable image registration in support of surgical safety and precision. Learn about recent advances in model-based 3D image reconstruction in application to intraoperative 3D imaging. Understand the multi-modality imaging technologies and clinical applications investigated in the AMIGO suite. Understand the emerging need and techniques to implement multi-modality image guidance in surgical applications such as neurosurgery, orthopaedic surgery, vascular surgery, and interventional radiology. Research supported by the NIH and Siemens Healthcare.; J. Siewerdsen; Grant Support - National Institutes of Health; Grant Support - Siemens Healthcare; Grant Support - Carestream Health; Advisory Board - Carestream Health; Licensing Agreement - Carestream Health; Licensing Agreement - Elekta Oncology.; T. Kapur, P41EB015898; R. Shekhar, Funding: R42CA137886 and R41CA192504

  11. A cognitive engineering framework for the specification of information requirements in medical imaging: application in image-guided neurosurgery. (United States)

    Morineau, T; Morandi, X; Le Moëllic, N; Jannin, P


    This study proposes a framework coming from cognitive engineering, which makes it possible to define what information content has to be displayed or emphasised from medical imaging, for assisting clinicians according to their level of expertise in the domain. We designed a rating scale to assess visualisation systems in image-guided neurosurgery with respect to the depiction of the neurosurgical work domain. This rating scale was based on a neurosurgical work domain analysis. This scale has been used to evaluate visualisation modes among neurosurgeons, residents and engineers. We asked five neurosurgeons, ten medical residents and ten engineers to rate two visualisation modes from the same data (2D MR image vs. 3D computerised image). With this method, the amount of abstract and concrete work domain information displayed by each visualisation mode can be measured. A global difference in quantities of perceived information between both images was observed. Surgeons and medical residents perceived significantly more information than engineers for both images. Unlike surgeons, however, the amount of information perceived by residents and engineers significantly decreased as information abstraction increased. We demonstrated the possibility of measuring the amount of work domain information displayed by different visualisation modes of medical imaging according to different user profiles. Engineers in charge of the design of medical image-guided surgical systems did not perceive the same set of information as surgeons or even medical residents. This framework can constitute a user-oriented approach to evaluate the amount of perceived information from image-guided surgical systems and support their design from a cognitive engineering point of view.

  12. Faktor-faktor yang Mempengaruhi Hasil Belajar IPS Ekonomi Kelas VII di SMP N 1 Bayang


    Susanti, S.Pd, M.Si, Nora; Wahyuni, Sri; Rahmadani, Anisa


    ABSTRACT This study aims to determine: 1) How much influence student learning motivation on learning outcomes of students in social studies economics at SMP N 1 Bayang. 2) How much influence method learning on student learning outcomes in social studies economics at SMP N 1 Bayang. 3) How big is the influence of learning media on outcomes of students learning in social studies economics at SMP N 1 Bayang. 4) How much motivation influence, methods and instructional media on outcomes economic l...

  13. Reasons for Low Pandemic H1N1 2009 Vaccine Acceptance within a College Sample

    Directory of Open Access Journals (Sweden)

    Russell D. Ravert


    Full Text Available This study examined health beliefs associated with novel influenza A (H1N1 immunization among US college undergraduates during the 2009-2010 pandemic. Undergraduates (ages 18–24 years from a large Midwestern University were invited to complete an online survey during March, 2010, five months after H1N1 vaccines became available. Survey items measured H1N1 vaccine history and H1N1-related attitudes based on the health belief literature. Logistic regression was used to identify attitudes associated with having received an H1N1 vaccine, and thematic analysis of student comments was conducted to further understand influences on vaccine decisions. Among the 296 students who participated in the survey, 15.2% reported having received an H1N1 vaccine. In regression analysis, H1N1 immunization was associated with seasonal flu vaccine history, perceived vaccine effectiveness, perceived obstacles to vaccination, and vaccine safety concerns. Qualitative results illustrate the relationship of beliefs to vaccine decisions, particularly in demonstrating that students often held concerns that vaccine could cause H1N1 or side effects. Vaccine safety, efficacy, and obstacles to immunization were major considerations in deciding whether to accept the H1N1 pandemic vaccine. Therefore, focusing on those aspects might be especially useful in future vaccine efforts within the college population.

  14. Protection from avian influenza H5N1 virus infection with antibody-impregnated filters

    Directory of Open Access Journals (Sweden)

    Tsukamoto Masaya


    Full Text Available Abstract There is worldwide concern over the possibility of a new influenza pandemic originating from the highly pathogenic avian H5N1 influenza viruses. We herein demonstrate that functional air filters impregnated with ostrich antibodies against the hemagglutinin of the H5N1 virus protect chickens from death by H5N1 transmission. These results suggest that the use of ostrich antibody-impregnated filters might be a powerful way to prevent the transmission of H5N1.

  15. Novel Influenza A (H1N1)-Associated Acute Necrotizing Encephalopathy: A Case Report


    Kim, Ki Jung; Park, Eun Sook; Chang, Hyun Jung; Suh, Miri; Rha, Dong-Wook


    Several cases of acute necrotizing encephalopathy (ANE) with influenza A (H1N1) have been reported to date. The prognosis of ANE associated with H1N1 is variable; some cases resulted in severe neurologic complication, whereas other cases were fatal. Reports mostly focused on the diagnosis of ANE with H1N1 infection, rather than functional recovery. We report a case of ANE with H1N1 infection in a 4-year-old Korean girl who rapidly developed fever, seizure, and altered mentality, as well as ha...

  16. The role of Harvey Cushing and Walter Dandy in the evolution of modern neurosurgery in the Netherlands, illustrated by their correspondence. (United States)

    Groen, Rob J M; Koehler, Peter J; Kloet, Alfred


    The development of modern neurosurgery in the Netherlands, which took place in the 1920s, was highly influenced by the personal involvement of both Harvey Cushing and Walter Dandy, each in his own way. For the present article, the authors consulted the correspondence (kept at the Cushing/Whitney Medical Library in New Haven and the Alan Mason Chesney Medical Archives in Baltimore) of Cushing and Dandy with their Dutch disciples. The correspondence provides a unique inside view into the minds of both neurosurgical giants. After the neurologist Bernard Brouwer had paved the way for sending the Dutch surgeon Ignaz Oljenick overseas, Cushing personally took the responsibility to train him (1927-1929). On his return to Amsterdam, Oljenick and Brouwer established the first neurosurgical department in the country. Encouraged by Oljenick's favorable results, a number of Dutch general surgeons started asking Cushing for support. Cushing strategically managed and deflected these requests, probably aiming to increase the advantage of Oljenick and Brouwer. However, the University Hospital in Groningen persisted in the plans to establish its own neurosurgical unit and sent Ferdinand Verbeek to the US in 1932. Although staying at Cushing's department initially, Verbeek ultimately applied to Walter Dandy for a position of visiting voluntary assistant, staying until the end of 1934. Verbeek and Dandy became lifelong friends. On his return to Groningen, Verbeek started practicing neurosurgery, isolated in the northern part of the country. He relied on the support of Dandy, with whom he kept up a regular correspondence, discussing cases and seeking advice. Dandy, on his part, used Verbeek as the ambassador in Europe for his operative innovations. At the beginning of World War II, Oljenick had to flee the country, which concluded the direct line with the Cushing school in the Netherlands. After Dandy's death (1946), Verbeek continued practicing neurosurgery following his style and

  17. E-WIN Project 2016: Evaluating the Current Gender Situation in Neurosurgery Across Europe-An Interactive, Multiple-Level Survey. (United States)

    Steklacova, Anna; Bradac, Ondrej; de Lacy, Patricia; Benes, Vladimir


    The proportion of women among neurosurgeons appears to be growing worldwide with time. Official data concerning the current situation across Europe have not yet been published. Thus, there are still concerns about gender inequality. The European Women in Neurosurgery Project 2016 was designed to recognize the current situation across Europe. The office holders of the national neurosurgical societies of 39 countries forming the European Association of Neurosurgical Societies were contacted to provide data stating the proportion of women in neurosurgery. Obtained data were supplied with the results of an online survey. The response rate of national office holders was 90%. The number of reported neurosurgeons was 12,985, and overall proportion of women represented was 12%. Two hundred thirty-seven responses to online questionnaire were taken into account. The overall proportion of female respondents was 30%. There was no intergender variability in responses regarding amount of working time per week, exposure to surgeries, or administrative work. Male respondents reported dedicating significantly more time to scientific work and feeling more confident dictating own career direction. Female respondents reported being less often married, having fewer children, a stronger perception of gender significance level, and a higher appreciation of personal qualities. Neurosurgery is a challenging field of medicine. The results of our survey did not imply an overall feeling of gender inequality among European respondents, although women believe that the gender issue to be more important than men do and that they have to sacrifice more of their personal lives. Copyright © 2017 Elsevier Inc. All rights reserved.


    Directory of Open Access Journals (Sweden)

    V. M. Alifirova


    Full Text Available The history of the development of the Tomsk Scientific School Neurologists and the past and current events in the Department of Neurology and Neurosurgery of Siberian State Medical University are described. The Department of Neurology was established in 1881–1882. At a different times the department was headed by many great Russian physicians such as Michail G. Kurlov, Leonid I. Omorokov, Nikolay V. Schubin, Nikolay I. Komandenko. In addition to the academic work the department leads research in many fields of neurology, including movement disorders, cerebrovascular diseases, demyelinating and paroxysmal diseases. 

  19. Aprepitant versus ondansetron in preoperative triple-therapy treatment of nausea and vomiting in neurosurgery patients: study protocol for a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Bergese Sergio


    Full Text Available Abstract Background The incidence of postoperative nausea and vomiting (PONV is 50% to 80% after neurosurgery. The common prophylactic treatment for postoperative nausea and vomiting is a triple therapy of droperidol, promethazine and dexamethasone. Newer, more effectives methods of prophylaxis are being investigated. We designed this prospective, double-blind, single-center study to compare the efficacy of ondansetron, a neurokinin-1 antagonist, and aprepitant, as a substitute for droperidol, in the prophylactic treatment of postoperative nausea and vomiting after neurosurgery. Methods After obtaining institutional review board approval; 176 patients, 18 to 85 years of age with American Society of Anesthesiologists (ASA classifications I to III, who did not receive antiemetics 24 h before surgery and were expected to undergo general anesthesia for neurosurgery lasting longer than 2 h were included in this study. After meeting the inclusion and exclusion criteria and providing written informed consent, patients were randomly assigned in a 1:1 ratio to one of two treatment groups: aprepitant or ondansetron. The objective of this study was to conduct a randomized, double-blind, double-dummy, parallel-group and single-center trial to compare and evaluate the efficacies of aprepitant versus ondansetron. Patients received oral aprepitant 40 mg OR oral dummy pill within 2 h prior to induction. At induction, a combination of intravenous dexamethasone 10 mg, promethazine 25 mg, and ondansetron 4 mg OR dummy injection was administered. Therefore, all patients received one dummy treatment and three active PONV prophylactic medications: dexamethasone 10 mg, promethazine 25 mg, and either aprepitant 40 mg OR ondansetron 4 mg infusion. The primary outcome measures were the episodes and severity of nausea and vomiting; administration of rescue antiemetic; and opioid consumption for 120 h postoperatively. Standard safety assessments

  20. Novel influenza A(H1N1) 2009 in vitro reassortant viruses with oseltamivir resistance. (United States)

    Ottmann, Michèle; Duchamp, Maude Bouscambert; Casalegno, Jean-Sébastien; Frobert, Emilie; Moulès, Vincent; Ferraris, Olivier; Valette, Martine; Escuret, Vanessa; Lina, Bruno


    With the recent emergence of the novel A(H1N1) virus in 2009, the efficacy of available drugs, such as neuraminidase (NA) inhibitors, is of great concern for good patient care. Influenza viruses are known to be able to acquire resistance. In 2007, A(H1N1) viruses related to A/Brisbane/59/2007 (H1N1) (A[H1N1] Brisbane-like virus), which are naturally resistant to oseltamivir, emerged. Resistance to oseltamivir can be acquired either by spontaneous mutation in the NA (H275Y in N1), or by reassortment with a mutated NA. It is therefore crucial to determine the risk of pandemic A(H1N1) 2009 virus acquiring resistance against oseltamivir by reassortment. We estimated the capacity of reassortment between the A(H1N1) 2009 virus and an oseltamivir-resistant A(H1N1) Brisbane-like virus by in vitro coinfections of influenza-permissive cells. The screening and the analysis of reassortant viruses was performed by specific reverse transcriptase PCRs and by sequencing. Out of 50 analysed reassortant viruses, two harboured the haemagglutinin (HA) segment from the pandemic A(H1N1) 2009 virus and the mutated NA originated from the A(H1N1) Brisbane-like virus. The replicating capacities of these viruses were measured, showing no difference as compared to the two parental strains, suggesting that acquisition of the mutated NA segment did not impair viral fitness in vitro. Our results suggest that the novel A(H1N1) 2009 virus can acquire by in vitro genetic reassortment the H275Y mutated NA segment conferring resistance to oseltamivir.

  1. Genetic versus antigenic differences among highly pathogenic H5N1 avian influenza A viruses

    NARCIS (Netherlands)

    Peeters, Ben; Reemers, Sylvia; Dortmans, Jos; Vries, de Erik; Jong, de Mart; Zande, van de Saskia; Rottier, Peter J.M.; Haan, de Cornelis A.M.


    Highly pathogenic H5N1 avian influenza A viruses display a remarkable genetic and antigenic diversity. We examined to what extent genetic distances between several H5N1 viruses from different clades correlate with antigenic differences and vaccine performance. H5-specific antisera were generated,

  2. Serological Evidence of Influenza A virus serotypes (H1 N1 and H5 ...

    African Journals Online (AJOL)

    Keywords: H1N1 and H5N1 influenza A, chicken Sera, Nigeria. One hundred sera samples from chicken flocks showing respiratory distress but failed to respond to treatment against chronic respiratory disease (CRD) were tested for avian influenza virus antibodies. The sera samples were collected from 5, 32, and 21 weeks ...

  3. Pandemic H1N1 2009 virus in Danish pigs: Diagnosis and lack of surveillance

    DEFF Research Database (Denmark)

    Larsen, Lars Erik; Nielsen, L. P.; Breum, Solvej Østergaard

    in swine with a genetic profile similar to older circulating strains implied a challenge for the veterinary diagnostic laboratories. We report the development, validation and implementation of a diagnostic strategy for specific diagnosis of H1N1v in pigs and the results of tests of pigs performed...... likely would recognize the H1N1v virus and this was further confirmed in the laboratory by test of samples from pvH1N1 infected humans. However, these assays could not discriminate between the typical circulating strains and the H1N1v subtype. For specific detection of the H1N1v subtype, an rRT-PCR assay...... targeting the HA gene developed at the Staten Serum Institute for diagnosis of H1N1v in humans was validated for use on pig specimens. In silico analysis showed that the probe and primers had 100% identity to published H1N1v strains and 80- 95% identity to classical-swine H1N1 which do not circulate...

  4. Reactions of O-Amino-N-(1,1-Dimethylprop-2-Ynyl)-Benzamide

    African Journals Online (AJOL)

    Carbonylation of o-amino-N-(1,1-dimethylprop-2-ynyl)-benzamide 3 with ethyl chloroformate gave 2-carbethoxyamino-N-(1,1-dimethylprop- 2-ynyl)-benzamide 6. Attempted cyclization of 6 under basic conditions did not give the quinazoline 8 but an oxazole 7. When 3 was also refluxed in triethylorthoformate-acetic ...

  5. Life threatening severe Influenza A Virus (H1N1) infection in ...

    African Journals Online (AJOL)

    We report a case of H1N1 influenza in a 23-year old female with 28 weeks of gestation, who developed acute respiratory distress syndrome, required mechanical ventilation and eventually recovered. KEYWORDS: H1N1; Acute Respiratory Distress Syndrome; Pregnancy; Influenza Internet Journal of Medical Update 2012 ...

  6. In silico approach towards H5N1 virus protein and transcriptomics ...

    African Journals Online (AJOL)

    H5N1 influenza A virus is a serious threat to human population. With a considerable mortality rate, strategies for coping with the infection are being developed. Our research group and some others investigated the potential therapeutic and preventive measures for tackling H5N1 infections. Protein based and transcriptomics ...

  7. CAMK2N1 inhibits prostate cancer progression through androgen receptor-dependent signaling. (United States)

    Wang, Tao; Guo, Shuiming; Liu, Zhuo; Wu, Licheng; Li, Mingchao; Yang, Jun; Chen, Ruibao; Liu, Xiaming; Xu, Hua; Cai, Shaoxin; Chen, Hui; Li, Weiyong; Xu, Shaohua; Wang, Liang; Hu, Zhiquan; Zhuang, Qianyuan; Wang, Liping; Wu, Kongming; Liu, Jihong; Ye, Zhangqun; Ji, Jun-Yuan; Wang, Chenguang; Chen, Ke


    Castration resistance is a major obstacle to hormonal therapy for prostate cancer patients. Although androgen independence of prostate cancer growth is a known contributing factor to endocrine resistance, the mechanism of androgen receptor deregulation in endocrine resistance is still poorly understood. Herein, the CAMK2N1 was shown to contribute to the human prostate cancer cell growth and survival through AR-dependent signaling. Reduced expression of CAMK2N1 was correlated to recurrence-free survival of prostate cancer patients with high levels of AR expression in their tumor. CAMK2N1 and AR signaling form an auto-regulatory negative feedback loop: CAMK2N1 expression was down-regulated by AR activation; while CAMK2N1 inhibited AR expression and transactivation through CAMKII and AKT pathways. Knockdown of CAMK2N1 in prostate cancer cells alleviated Casodex inhibition of cell growth, while re-expression of CAMK2N1 in castration-resistant cells sensitized the cells to Casodex treatment. Taken together, our findings suggest that CAMK2N1 plays a tumor suppressive role and serves as a crucial determinant of the resistance of prostate cancer to endocrine therapies.

  8. A retrospective evaluation of critically ill patients infected with H1N1 ...

    African Journals Online (AJOL)

    Background: H1N1 influenza A virus infections were first reported in April 2009 and spread rapidly, resulting in mortality worldwide. The aim of this study was to evaluate patients with H1N1 infection treated in the intensive care unit (ICU) in Bursa, Turkey. Methods: Demographic characteristics, clinical features, and outcome ...

  9. Virulence of H5N1 Influenza Virus in Cattle Egrets (Bubulcus Ibis)

    DEFF Research Database (Denmark)

    Phuong, Do Quy; Dung, Nguyen Tien; Jørgensen, Poul Henrik


    for insect control in households. In this study, six Cattle Egrets were experimentally infected intranasally with highly pathogenic avian influenza (AI) A/duck/Vietnam/40D/04 (H5N1) to investigate a possible epidemiologic role for Cattle Egrets in outbreaks of H5N1 AI in Vietnam. The Cattle Egrets were...

  10. Avian influenza (H5N1) susceptibility and receptors in dogs

    NARCIS (Netherlands)

    Maas, van der R.; Tacken, M.G.J.; Ruuls-van Stalle, E.M.F.; Koch, G.; Rooij, van E.M.A.; Stockhofe-Zurwieden, N.


    Inoculation of influenza (H5N1) into beagles resulted in virus excretion and rapid seroconversion with no disease. Binding studies that used labeled influenza (H5N1) showed virus attachment to higher and lower respiratory tract tissues. Thus, dogs that are subclinically infected with influenza

  11. Genetic characterization of H5N1 influenza A viruses isolated from zoo tigers in Thailand. (United States)

    Amonsin, Alongkorn; Payungporn, Sunchai; Theamboonlers, Apiradee; Thanawongnuwech, Roongroje; Suradhat, Sanipa; Pariyothorn, Nuananong; Tantilertcharoen, Rachod; Damrongwantanapokin, Sudarat; Buranathai, Chantanee; Chaisingh, Arunee; Songserm, Thaweesak; Poovorawan, Yong


    The H5N1 avian influenza virus outbreak among zoo tigers in mid-October 2004, with 45 animals dead, indicated that the avian influenza virus could cause lethal infection in a large mammalian species apart from humans. In this outbreak investigation, six H5N1 isolates were identified and two isolates (A/Tiger/Thailand/CU-T3/04 and A/Tiger/Thailand/CU-T7/04) were selected for whole genome analysis. Phylogenetic analysis of the 8 gene segments showed that the viruses clustered within the lineage of H5N1 avian isolates from Thailand and Vietnam. The hemagglutinin (HA) gene of the viruses displayed polybasic amino acids at the cleavage site, identical to those of the 2004 H5N1 isolates, which by definition are highly pathogenic avian influenza (HPAI). In addition, sequence analyses revealed that the viruses isolated from tigers harbored few genetic changes compared with the viruses having infected chicken, humans, tigers and a leopard isolated from the early 2004 H5N1 outbreaks. Sequence analyses also showed that the tiger H5N1 isolated in October 2004 was more closely related to the chicken H5N1 isolated in July than that from January. Interestingly, all the 6 tiger H5N1 isolates contained a lysine substitution at position 627 of the PB2 protein similar to the human, but distinct from the original avian isolates.

  12. Influenza A (H1N1) neuraminidase inhibitors from Vitis amurensis

    DEFF Research Database (Denmark)

    Nguyen, Ngoc Anh; Dao, Trong Tuan; Tung, Bui Thanh


    Recently, a novel H1N1 influenza A virus (H1N1/09 virus) was identified and considered a strong candidate for a novel influenza pandemic. As part of an ongoing anti-influenza screening programme on natural products, eight oligostilbenes were isolated as active principles from the methanol extract...

  13. Safety of pandemic H1N1 vaccines in children and adolescents

    NARCIS (Netherlands)

    E.G. Wijnans (Leonoor); S. de Bie (Sandra); J.P. Dieleman (Jeanne); J. Bonhoeffer (Jan); M.C.J.M. Sturkenboom (Miriam)


    textabstractDuring the 2009 influenza A (H1N1) pandemic several pandemic H1N1 vaccines were licensed using fast track procedures, with relatively limited data on the safety in children and adolescents. Different extensive safety monitoring efforts were put in place to ensure timely detection of

  14. In silico approach towards H5N1 virus protein and transcriptomics ...

    African Journals Online (AJOL)

    Arli Parikesit


    May 22, 2013 ... integration of both protein-based and transcriptomics for H5N1 analysis are indeed feasible. Key words: H5N1, protein-based .... The fund-saving nature of in silico prediction of sequence specific therapeutics would .... therapeutic small interfering RNA molecules targeting diverse strains of influenza A virus.

  15. On the non-existence of orthogonal instanton bundles on P^{2n+1}

    Directory of Open Access Journals (Sweden)

    Łucja Farnik


    Full Text Available In this paper we prove that there do not exist orthogonal instanton bundles on P^{2n+1} . In order to demonstrate this fact, we propose a new way of representing the invariant, introduced by L. Costa and G. Ottaviani, related to a rank 2n instanton bundle on P^{2n+1}.

  16. A retrospective evaluation of critically ill patients infected with H1N1 ...

    African Journals Online (AJOL)


    Nov 12, 2009 ... Abstract. Background: H1N1 influenza A virus infections were first reported in April 2009 and spread rapidly, resulting in mortality worldwide. The aim of this study was to evaluate patients with H1N1 infection treated in the intensive care unit (ICU) in. Bursa, Turkey. Methods: Demographic characteristics ...

  17. Toroidal rotation braking with n = 1 magnetic perturbation field on JET

    DEFF Research Database (Denmark)

    Sun, Y; Liang, Y; Koslowski, H R


    A strong toroidal rotation braking has been observed in plasmas with application of an n = 1 magnetic perturbation field on the JET tokamak. Calculation results from the momentum transport analysis show that the torque induced by the n = 1 perturbation field has a global profile. The maximal value...

  18. 40 CFR 721.3820 - L-Glutamic acid, N-(1-oxododecyl)-, disodium salt. (United States)


    ... 40 Protection of Environment 30 2010-07-01 2010-07-01 false L-Glutamic acid, N-(1-oxododecyl... Specific Chemical Substances § 721.3820 L-Glutamic acid, N-(1-oxododecyl)-, disodium salt. (a) Chemical substance and significant new uses subject to reporting. (1) The chemical substance identified as L-Glutamic...

  19. H1N1 Flu & U.S. Schools: Answers to Frequently Asked Questions (United States)

    US Department of Education, 2009


    A severe form of influenza known as H1N1, commonly being called swine flu, has health officials around the world concerned. In the United States, the outbreak of H1N1 has prompted school closures and cancellation of school-related events. As the flu spreads, the Department of Education encourages school leaders, parents and students to know how to…

  20. Pandemic (H1N1) 2009 outbreak on pig farm, Argentina. (United States)

    Pereda, Ariel; Cappuccio, Javier; Quiroga, Maria A; Baumeister, Elsa; Insarralde, Lucas; Ibar, Mariela; Sanguinetti, Ramon; Cannilla, Maria L; Franzese, Debora; Escobar Cabrera, Oscar E; Craig, Maria I; Rimondi, Agustina; Machuca, Mariana; Debenedetti, Rosa T; Zenobi, Carlos; Barral, Leonardo; Balzano, Rodrigo; Capalbo, Santiago; Risso, Adriana; Perfumo, Carlos J


    In June-July 2009, an outbreak of pandemic (H1N1) 2009 infection occurred on a pig farm in Argentina. Molecular analysis indicated that the virus was genetically related to the pandemic (H1N1) 2009 influenza virus strain. The outbreak presumably resulted from direct human-to-pig transmission.

  1. Supply of neuraminidase inhibitors related to reduced influenza A (H1N1 mortality during the 2009-2010 H1N1 pandemic: an ecological study.

    Directory of Open Access Journals (Sweden)

    Paula E Miller

    Full Text Available BACKGROUND: The influenza A (H1N1 pandemic swept across the globe from April 2009 to August 2010 affecting millions. Many WHO Member States relied on antiviral drugs, specifically neuraminidase inhibitors (NAIs oseltamivir and zanamivir, to treat influenza patients in critical condition. Such drugs have been found to be effective in reducing severity and duration of influenza illness, and likely reduced morbidity during the pandemic. However, it is less clear whether NAIs used during the pandemic reduced H1N1 mortality. METHODS: Country-level data on supply of oseltamivir and zanamivir were used to predict H1N1 mortality (per 100,000 people from July 2009 to August 2010 in forty-two WHO Member States. Poisson regression was used to model the association between NAI supply and H1N1 mortality, with adjustment for economic, demographic, and health-related confounders. RESULTS: After adjustment for potential confounders, each 10% increase in kilograms of oseltamivir, per 100,000 people, was associated with a 1.6% reduction in H1N1 mortality over the pandemic period (relative rate (RR = 0.84 per log increase in oseltamivir supply. While the supply of zanamivir was considerably less than that of oseltamivir in each Member State, each 10% increase in kilogram of active zanamivir, per 100,000, was associated with a 0.3% reduction in H1N1 mortality (RR = 0.97 per log increase. CONCLUSION: While there are limitations to the ecologic nature of these data, this analysis offers evidence of a protective relationship between antiviral drug supply and influenza mortality and supports a role for influenza antiviral use in future pandemics.

  2. Efficacy of an AS03A-adjuvanted split H5N1 influenza vaccine against an antigenically distinct low pathogenic H5N1 virus in pigs. (United States)

    De Vleeschauwer, Annebel R; Baras, Benoît; Kyriakis, Constantinos S; Jacob, Valérie; Planty, Camille; Giannini, Sandra L; Mossman, Sally; Van Reeth, Kristien


    We used the pig model of influenza to examine the efficacy of an AS03(A)-adjuvanted split H5N1 (A/Indonesia/05/2005) vaccine against challenge with a low pathogenic (LP) H5N1 avian influenza (AI) virus (duck/Minnesota/1525/1981) with only 85% amino acid homology in its HA1. Influenza seronegative pigs were vaccinated twice intramuscularly with adjuvanted vaccine at 3 antigen doses, unadjuvanted vaccine or placebo. All pigs were challenged 4 weeks after the second vaccination and euthanized 2 days later. After 2 vaccinations, all pigs in the adjuvanted vaccine groups had high hemagglutination inhibiting (HI) antibody titers to the vaccine strain (160-640), and lower antibody titers to the A/Vietnam/1194/04 H5N1 strain and to 2 LP H5 viruses with 90-91% amino acid homology to the vaccine strain (20-160). Eight out of 12 pigs had HI titers (10-20) to the challenge virus immediately before challenge. Neuraminidase inhibiting antibodies to the challenge virus were detected in most pigs (7/12) and virus neutralizing antibodies in all pigs. There was no antigen-dose dependent effect on the antibody response among the pigs immunized with adjuvanted H5N1 vaccines. After challenge, these pigs showed a complete clinical protection, reduced lung lesions and a significant protection against virus replication in the respiratory tract. Though the challenge virus showed only moderate replication efficiency in pigs, our study suggests that AS03(A)-adjuvanted H5N1 vaccine may confer a broader protection than generally assumed. The pros and cons of the pig as an H5N1 challenge model are also discussed. Copyright © 2012 Elsevier Ltd. All rights reserved.

  3. Supply of neuraminidase inhibitors related to reduced influenza A (H1N1) mortality during the 2009-2010 H1N1 pandemic: an ecological study. (United States)

    Miller, Paula E; Rambachan, Aksharananda; Hubbard, Roderick J; Li, Jiabai; Meyer, Alison E; Stephens, Peter; Mounts, Anthony W; Rolfes, Melissa A; Penn, Charles R


    The influenza A (H1N1) pandemic swept across the globe from April 2009 to August 2010 affecting millions. Many WHO Member States relied on antiviral drugs, specifically neuraminidase inhibitors (NAIs) oseltamivir and zanamivir, to treat influenza patients in critical condition. Such drugs have been found to be effective in reducing severity and duration of influenza illness, and likely reduced morbidity during the pandemic. However, it is less clear whether NAIs used during the pandemic reduced H1N1 mortality. Country-level data on supply of oseltamivir and zanamivir were used to predict H1N1 mortality (per 100,000 people) from July 2009 to August 2010 in forty-two WHO Member States. Poisson regression was used to model the association between NAI supply and H1N1 mortality, with adjustment for economic, demographic, and health-related confounders. After adjustment for potential confounders, each 10% increase in kilograms of oseltamivir, per 100,000 people, was associated with a 1.6% reduction in H1N1 mortality over the pandemic period (relative rate (RR) = 0.84 per log increase in oseltamivir supply). While the supply of zanamivir was considerably less than that of oseltamivir in each Member State, each 10% increase in kilogram of active zanamivir, per 100,000, was associated with a 0.3% reduction in H1N1 mortality (RR = 0.97 per log increase). While there are limitations to the ecologic nature of these data, this analysis offers evidence of a protective relationship between antiviral drug supply and influenza mortality and supports a role for influenza antiviral use in future pandemics.

  4. The local Jahn-Teller effect in (La/Sr){sub n+1}Mn{sub n}O{sub 3n+1}

    Energy Technology Data Exchange (ETDEWEB)

    Louca, D.; Kwei, G.H. [Los Alamos National Lab., NM (United States); Egami, T. [Univ. of Pennsylvania, Philadelphia, PA (United States)


    Lattice polarons form an important constituent in the mechanism of magnetism and transport of the (La/Sr){sub n+1}Mn{sub n}O{sub 3n+1} (for n = 2 and {infinity}) colossal magnetoresistance manganites. The coupling of the polaronic distortions to the local Jahn-Teller (JT) effect has been characterized by the pulsed neutron pair density function (PDF) analysis. Distortions of equal magnitude to the ones found in perovskites arising from a JT effect are found in the 2-dimensional layer crystals. The coupling of the distortions to the lattice is similar in both systems suggesting that lattice polarons are formed independently to the crystal dimensionality.

  5. Replication and transcription activities of ribonucleoprotein complexes reconstituted from avian H5N1, H1N1pdm09 and H3N2 influenza A viruses.

    Directory of Open Access Journals (Sweden)

    Karry L K Ngai

    Full Text Available Avian influenza viruses pose a serious pandemic threat to humans. Better knowledge on cross-species adaptation is important. This study examined the replication and transcription efficiency of ribonucleoprotein complexes reconstituted by plasmid co-transfection between H5N1, H1N1pdm09 and H3N2 influenza A viruses, and to identify mutations in the RNA polymerase subunit that affect human adaptation. Viral RNA polymerase subunits PB1, PB2, PA and NP derived from influenza viruses were co-expressed with pPolI-vNP-Luc in human cells, and with its function evaluated by luciferase reporter assay. A quantitative RT-PCR was used to measure vRNA, cRNA, and mRNA levels for assessing the replication and transcription efficiency. Mutations in polymerase subunit were created to identify signature of increased human adaptability. H5N1 ribonucleoprotein complexes incorporated with PB2 derived from H1N1pdm09 and H3N2 viruses increased the polymerase activity in human cells. Furthermore, single amino acid substitutions at PB2 of H5N1 could affect polymerase activity in a temperature-dependent manner. By using a highly sensitive quantitative reverse transcription-polymerase chain reaction, an obvious enhancement in replication and transcription activities of ribonucleoproteins was observed by the introduction of lysine at residue 627 in the H5N1 PB2 subunit. Although less strongly in polymerase activity, E158G mutation appeared to alter the accumulation of H5N1 RNA levels in a temperature-dependent manner, suggesting a temperature-dependent mechanism in regulating transcription and replication exists. H5N1 viruses can adapt to humans either by acquisition of PB2 from circulating human-adapted viruses through reassortment, or by mutations at critical sites in PB2. This information may help to predict the pandemic potential of newly emerged influenza strains, and provide a scientific basis for stepping up surveillance measures and vaccine production.

  6. Implicações da influenza A/H1N1 no período gestacional = Implications of H1N1 influenza during pregnancy

    Directory of Open Access Journals (Sweden)

    Pastore, Ana Paula Winter


    Conclusões: Os estudos apontam que os possíveis fatores de morbidade e mortalidade entre gestantes acometidas pelo vírus influenza A/H1N1 foram síndrome de desconforto respiratório do adulto, embolia pulmonar, edema pulmonar, pneumonia bacteriana secundária e insuficiência renal. Além disso, as complicações durante a gravidez tendem a acontecer mais no segundo e terceiro trimestre. Medidas preventivas e um adequado tratamento provavelmente diminuirão o número de casos futuros de influenza pandêmica A/H1N1

  7. Novel Influenza A (H1N1)-Associated Acute Necrotizing Encephalopathy: A Case Report (United States)

    Kim, Ki Jung; Park, Eun Sook; Chang, Hyun Jung; Suh, Miri


    Several cases of acute necrotizing encephalopathy (ANE) with influenza A (H1N1) have been reported to date. The prognosis of ANE associated with H1N1 is variable; some cases resulted in severe neurologic complication, whereas other cases were fatal. Reports mostly focused on the diagnosis of ANE with H1N1 infection, rather than functional recovery. We report a case of ANE with H1N1 infection in a 4-year-old Korean girl who rapidly developed fever, seizure, and altered mentality, as well as had neurologic sequelae of ataxia, intentional tremor, strabismus, and dysarthria. Brain magnetic resonance imaging showed lesions in the bilateral thalami, pons, and left basal ganglia. To our knowledge, this is the first report of ANE caused by H1N1 infection and its long-term functional recovery in Korea. PMID:23705127

  8. Immunogenicity and protective efficacy of a live attenuated H5N1 vaccine in nonhuman primates.

    Directory of Open Access Journals (Sweden)

    Shufang Fan


    Full Text Available The continued spread of highly pathogenic H5N1 influenza viruses among poultry and wild birds, together with the emergence of drug-resistant variants and the possibility of human-to-human transmission, has spurred attempts to develop an effective vaccine. Inactivated subvirion or whole-virion H5N1 vaccines have shown promising immunogenicity in clinical trials, but their ability to elicit protective immunity in unprimed human populations remains unknown. A cold-adapted, live attenuated vaccine with the hemagglutinin (HA and neuraminidase (NA genes of an H5N1 virus A/VN/1203/2004 (clade 1 was protective against the pulmonary replication of homologous and heterologous wild-type H5N1 viruses in mice and ferrets. In this study, we used reverse genetics to produce a cold-adapted, live attenuated H5N1 vaccine (AH/AAca that contains HA and NA genes from a recent H5N1 isolate, A/Anhui/2/05 virus (AH/05 (clade 2.3, and the backbone of the cold-adapted influenza H2N2 A/AnnArbor/6/60 virus (AAca. AH/AAca was attenuated in chickens, mice, and monkeys, and it induced robust neutralizing antibody responses as well as HA-specific CD4+ T cell immune responses in rhesus macaques immunized twice intranasally. Importantly, the vaccinated macaques were fully protected from challenge with either the homologous AH/05 virus or a heterologous H5N1 virus, A/bar-headed goose/Qinghai/3/05 (BHG/05; clade 2.2. These results demonstrate for the first time that a cold-adapted H5N1 vaccine can elicit protective immunity against highly pathogenic H5N1 virus infection in a nonhuman primate model and provide a compelling argument for further testing of double immunization with live attenuated H5N1 vaccines in human trials.

  9. Health costs from hospitalization with H1N1 infection during the 2009–2010 influenza pandemic compared with non-H1N1 respiratory infections

    Directory of Open Access Journals (Sweden)

    Courcoutsakis N


    Full Text Available Paul Zarogoulidis1, Dimitrios Glaros2,3, Theodoros Kontakiotis1, Marios Froudarakis4, loannis Kioumis1, loannis Kouroumichakis3, Anastasios Tsiotsios1, Anastasios Kallianos5, Paschalis Steiropoulos4, Konstantinos Porpodis1, Evagelia Nena6, Despoina Papakosta1, Aggeliki Rapti5, Theodoros C Constantinidis6, Theodora Kerenidi7, Maria Panopoulou8, Georgia Trakada9, Nikolaos Courcoutsakis10, Evangelia Fouka11, Konstantinos Zarogoulidis1, Efstratios Maltezos2,31Aristotle University of Thessaloniki, Pulmonary Department, "G Papanikolaou" Hospital, Exochi, Thessaloniki, 2Unit of Infectious Diseases, General University Hospital of Alexandroupolis, 3Second Department of Internal Medicine, 4Pulmonary Department, General University Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, 52nd Pulmonology Clinic, Hospital of Chest Diseases "SOTIRIA," Athens, 6Laboratory of Hygiene and Environmental Protection, Occupational Medicine Section, Teaching Hospital of Alexandroupolis, Medical School, Democritus University of Thrace, Greece, Alexandroupolis, 7Pulmonary Department, University of Larissa, Larissa, 8Microbiology Department, General University Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, 9Pulmonary Department, University of Athens, Athens, 10Radiology Department, General University Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, 111st Pulmonary Department, "G Papanikolaou" Hospital, Exochi, Thessaloniki, GreeceBackground: The first positive patient with influenza A (H1N1 was recorded in March 2009 and the pandemic continued with new outbreaks throughout 2010. This study's objective was to quantify the total cost of inpatient care and identify factors associated with the increased cost of the 2009–2010 influenza A pandemic in comparison with nonviral respiratory infection.Methods: In total, 133 positive and 103 negative H1N1 patients were included from three tertiary

  10. Harvey Cushing and pituitary Case Number 3 (Mary D.): the origin of this most baffling problem in neurosurgery. (United States)

    Pascual, José María; Prieto, Ruth


    neurosurgery. In this paper the authors analyze the case of Mary D. and the great influence it had on Cushing's conceptions of the pituitary gland and its afflictions, and on the history of pituitary surgery.

  11. The National Neurosurgery Quality and Outcomes Database (N2QOD): general overview and pilot-year project description. (United States)

    McGirt, Matthew J; Speroff, Theodore; Dittus, Robert S; Harrell, Frank E; Asher, Anthony L


    Given the unsustainable costs of US health care, universal agreement exists among payers, regulatory agencies, and other health care stakeholders that reform must include substantial improvements in the quality, effectiveness, and value of health care delivery. The Institute of Medicine and the American Recovery and Reinvestment Act of 2009 have called for the establishment of prospective registries to capture patient-centered data from real-world practice as a high priority to guide evidence-based reform. As a result, the American Association of Neurological Surgeons launched the National Neurosurgery Quality and Outcomes Database (N(2)QOD) and began enrolling patients in March 2012 into its initial pilot project: a web-based lumbar spine module. As a nationwide, prospective longitudinal registry utilizing patient reported outcome instruments, the N(2)QOD lumbar spine surgery pilot aims to systematically measure and aggregate surgical safety and 1-year postoperative outcome data from approximately 30 neurosurgical practices across the US with the primary aim of demonstrating the feasibility and validity of standardized 1-year outcome measurement from everyday real-world practice. At the end of the pilot year, 1) risk-adjusted modeling will be developed for the safety, quality, and effectiveness of lumbar surgical care (morbidity, readmission, improvements in pain, disability, quality of life, and return to work); 2) data integrity and validation will be demonstrated via internal quality control analyses and auditing, and 3) the feasibility of obtaining a high level of follow-up (~80%) of nationwide 1-year outcome measurement will be established. N(2)QOD will use only prospective clinical data, will avoid the use of administrative data proxies, and will rely on neurosurgically relevant risk factors for risk adjustment. Once national benchmarks of quality and effectiveness are accurately established and validated utilizing practice-based data extractors in the pilot

  12. A Consult Is Just a Page Away: A Prospective Observational Study on the Impact of Jinxing on Call Karma in Neurosurgery. (United States)

    Joswig, Holger; Zarnett, Lauren; Steven, David A; Stienen, Martin N


    Our aim was to assess the impact of jinxing on "call karma" in neurosurgery. We conducted a prospective observational study on 15 residents on call for the neurosurgery service, recording the total number of admissions, consults, deaths encountered, surgeries performed, hours of sleep and subjective call rating on a numeric rating scale (NRS) of 0-10 in terms of general awfulness. Some 204 on-call nightshifts were analyzed, of which 61 (29.9%) were jinxed and 143 (70.1%) were nonjinxed. Jinxes seemed to occur in clusters. The baseline parameters (experience, type of call coverage and superstition level) of the study groups were well balanced. A trend toward more surgeries was observed during jinxed nights, where residents slept significantly less (mean 147.8±96.2 vs. 180.9±106.1 min, p=0.037) and rated their on-call experience worse on the NRS (4.4±2.2 vs. 3.5±2.0, p=0.011), while there was no significant difference in number of admissions, consults or deaths. The act of jinxing ought to be avoided in the neurosurgical setting, as it might be potentially harmful to resident call karma, irrespective of level of experience, resources and personal beliefs.

  13. Endoscopic endonasal transsphenoidal exposure of circle of Willis (CW); can it be applied in vascular neurosurgery in the near future? A cadaveric study of 26 cases. (United States)

    Chowdhury, Forhad H; Haque, Mohammod R; Kawsar, Khandkar A; Ara, Shamim; Mohammod, Quazi Deen; Sarker, Mainul H; Goel, Atul H


    Endonasal transsphenoidal approaches are getting rapidly popular in removing many midline skullbase lesions from crista galli to foramen magnum. For safe removal of these lesions, familiarity with endoscopic endonasal anatomy of circle of Willis is very important. Furthermore, for safe development of this approach in vascular neurosurgery in the near future, endoscopic endonasal exposure of circle of Willis is a fundamental step. The goals in this study were to dissect the circle of Willis completely through the endoscopic endonasal approach and to become more familiar with the views and skills associated with the technique by using fresh cadaveric specimens. After obtaining ethical clearance, 26 fresh cadaver heads were used without any preparation. Using a neuroendoscope, complete exposure of the circle of Willis was done endonasaly, and various observations including relation of circle of Willis was recorded. Complete exposure of the circle of Willis was made through an endonasal approach in all cases without injuring surrounding structures. Endoscopic endonasal extended transsphenoidal exposure of CW can make the surgeon more efficient in removing midline skullbase lesions with safe handling of different parts of circle of Willis and it may help in development of endonasal endoscopic vascular neurosurgery in the near future.

  14. Comparison of Continuous Noninvasive Blood Pressure Monitoring by TL-300 With Standard Invasive Blood Pressure Measurement in Patients Undergoing Elective Neurosurgery. (United States)

    Lin, Wen-Qian; Wu, Huang-Hui; Su, Chang-Sheng; Yang, Jian-Teng; Xiao, Jin-Rong; Cai, Yu-Ping; Wu, Xiao-Zhi; Chen, Guo-Zhong


    Intraoperative blood pressure (BP) is one of the basic vital signs monitoring. Compared with standard invasive BP measurement, TL-300 allows for a continuous and beat-to-beat noninvasive intraoperative BP monitoring. The current retrospective study compared the accuracy and precision of this noninvasive technique for continuous BP monitoring with that of standard invasive BP measurement in patients undergoing elective neurosurgery. BP records of 23 patients undergoing elective neurosurgery, measured by both noninvasive TL-300 and invasive radial arterial catheter method, were retrospectively analyzed. Variability in BP data was analyzed by using linear regressions and Bland-Altman analysis. Four thousand three hundred eighty-one pairs of BP measurements from a total of 23 patients were included. The coefficient of determination of systolic, diastolic, and mean BP were 0.908, 0.803, and 0.922, respectively. And their bias was found to be 1.3±5.87 mm Hg (95% limits of agreement: -10.2 to +12.8 mm Hg), 2.8±6.40 mm Hg (95% limits of agreement: -9.8 to +15.3 mm Hg), and 1.8±4.20 mm Hg (95% limits of agreement: -6.4 to +10.1 mm Hg), respectively. TL-300 system is a promising noninvasive alternative to the invasive arterial catheter method for intraoperative BP monitoring, with a high accuracy and precision. With the limitation of the current retrospective study, further prospective method comparison studies are needed.

  15. The 150th anniversary of Nagasaki University School of Medicine: recovery from the atomic disaster and evolution of the department of neurosurgery. (United States)

    Hayashi, Kentaro; Ushijima, Ryujiro; Matsuo, Takayuki; Kitagawa, Naoki; Suyama, Kazuhiko; Nagata, Izumi


    NAGASAKI IS LOCATED on the western edge of Japan, closer to the Asian continent. Because of this geographical proximity, Nagasaki became a gateway for the introduction of continental culture and civilization to Japan. After the port of Nagasaki was opened for trade with the Portuguese in 1571, Nagasaki had a central role in cultural exchange with the West and China until the latter half of the 19th century. As a result of the political situation, students came to Nagasaki from all over Japan to obtain information on Western science, especially in medicine, turning Nagasaki into a hub for modern academic studies. The first medical facility in Japan educating doctors in the Western style was founded in Nagasaki in 1857. Despite the tragedy of World War II, the medical school arose again. More than 10 000 physicians have completed their studies at the medical school since its founding. The Department of Neurosurgery at Nagasaki University had its origins within the Second Department of Surgery and became an independent department in 1973. The post of professor was assumed by Kazuo Mori and succeeded in 1991 by Shobu Shibata and in 2003 by Izumi Nagata, who holds the post at the time of this writing. Neurosurgery is dynamic and constantly changing at Nagasaki University with work in progress on technological, diagnostic, and surgical innovations that permit the treatment of highly complex cases. In 2007, the 150th anniversary of the founding of Nagasaki University School of Medicine was celebrated with a number of commemorative events.

  16. Normal saline versus balanced-salt solution as intravenous fluid therapy during neurosurgery: effects on acid-base balance and electrolytes. (United States)

    Hafizah, Mohamed; Liu, Chian Y; Ooi, Joanna S


    This prospective, randomized controlled study compared the changes in acid-base balance and serum electrolytes with the use of intravenous balanced and non-balanced crystalloid solutions intraoperatively during elective neurosurgery. Thirty consented adult patients who underwent craniotomy were randomly allocated into two groups of 15 patients each. The non-balanced group received 0.9% normal saline while the balanced group received Sterofundin®ISO as the intraoperative fluid for maintenance. Biochemical indices for acid-base balance and serum electrolytes were analyzed periodically. In the non-balanced group, significant changes were noted in the pH, base excess and bicarbonate values over time compared to its respective baseline values (P<0.01). Four patients (27.7%) also developed a pH<7.35 and 5 patients (33.3%) developed marked acidosis with base excess <-4.0 at the end of surgery. Both mean sodium and chloride levels were also significantly higher compared to its baseline values respectively (142.6±2.4 versus 138±2.7 mmol/L, P<0.01 and 105.7±4.1 versus 113.2±3.0 mmol/L (P<0.01). A balanced solution (Sterofundin®ISO) provided significantly better control over acid-base balance, sodium and chloride levels when used as intraoperative fluid maintenance and replacement during elective neurosurgery.

  17. Accounting and comparing of expenditure on the medical services given at neuro-surgery department of Imam Khomeyni Hospital in the year of 1994 (1373

    Directory of Open Access Journals (Sweden)

    Abasi Moghadam M


    Full Text Available This study was focused on analysis of expenditure on all the medical services given at Neuro-Surgery Department of Imam-Khomeini Hospital in the year of 1994 (1373. In this study, all the information on descriptive method and the techniques of cost analysis and cost per unit of service provided accountancy, were analysed. 573 patients were considered in this study. 522 of them underwent 13 different types of neuro-surgery operations. 92.6% of them total departmental costs were related to current expenditures and 7.4% of that was related to the capial expenditures. The personnel costs with 49% was the highest portion of the total costs. Percentage wise, the costs were as follows: Medicine, materials and equipment 22%, food 17.6%, depreciation 7.4%, fuel, water, electricity and telephone 3.5%. The mean duration of stay was 16.3 days for every in-patient. The percentage of occupied bed was 58% if the percentage of desired bed occupancy was supposed 80%, therefore, 22% of the bed, plus 3512 bed-day were gone wasted. The real cost of med-care policy need to be more rational for the operation and hospitalization. It should be mentioned that the wasted time was 886 hours and wasted cost was 71, 708, 410 Rials in operation room.

  18. Lemna (duckweed) expressed hemagglutinin from avian influenza H5N1 protects chickens against H5N1 high pathogenicity avian influenza virus challenge (United States)

    In the last two decades, transgenic plants have been explored as safe and cost effective alternative expression platforms for producing recombinant proteins. In this study, a synthetic hemagglutinin (HA) gene from the high pathogenicity avian influenza (HPAI) virus A/chicken/Indonesia/7/2003 (H5N1)...

  19. Vaccination of macaques with adjuvanted formalin-inactivated influenza A virus (H5N1) vaccines: Protection against H5N1 challenge without disease enhancement

    NARCIS (Netherlands)

    C. Ruat (Caroline); C. Caillet (Catherine); A. Bidaut (Alexandre); J.H. Simon (James); A.D.M.E. Osterhaus (Albert)


    textabstractWe investigated the ability of adjuvanted, inactivated split-virion influenza A virus (H5N1) vaccines to protect against infection and demonstrated that the disease exacerbation phenomenon seen with adjuvanted formaldehyde-inactivated respiratory syncytial virus and measles virus

  20. Endothelial cell tropism is a determinant of H5N1 pathogenesis in mammalian species.

    Directory of Open Access Journals (Sweden)

    Smanla Tundup


    Full Text Available The cellular and molecular mechanisms underpinning the unusually high virulence of highly pathogenic avian influenza H5N1 viruses in mammalian species remains unknown. Here, we investigated if the cell tropism of H5N1 virus is a determinant of enhanced virulence in mammalian species. We engineered H5N1 viruses with restricted cell tropism through the exploitation of cell type-specific microRNA expression by incorporating microRNA target sites into the viral genome. Restriction of H5N1 replication in endothelial cells via miR-126 ameliorated disease symptoms, prevented systemic viral spread and limited mortality, despite showing similar levels of peak viral replication in the lungs as compared to control virus-infected mice. Similarly, restriction of H5N1 replication in endothelial cells resulted in ameliorated disease symptoms and decreased viral spread in ferrets. Our studies demonstrate that H5N1 infection of endothelial cells results in excessive production of cytokines and reduces endothelial barrier integrity in the lungs, which culminates in vascular leakage and viral pneumonia. Importantly, our studies suggest a need for a combinational therapy that targets viral components, suppresses host immune responses, and improves endothelial barrier integrity for the treatment of highly pathogenic H5N1 virus infections.

  1. Antigenic Patterns and Evolution of the Human Influenza A (H1N1) Virus. (United States)

    Liu, Mi; Zhao, Xiang; Hua, Sha; Du, Xiangjun; Peng, Yousong; Li, Xiyan; Lan, Yu; Wang, Dayan; Wu, Aiping; Shu, Yuelong; Jiang, Taijiao


    The influenza A (H1N1) virus causes seasonal epidemics that result in severe illnesses and deaths almost every year. A deep understanding of the antigenic patterns and evolution of human influenza A (H1N1) virus is extremely important for its effective surveillance and prevention. Through development of antigenicity inference method for human influenza A (H1N1), named PREDAC-H1, we systematically mapped the antigenic patterns and evolution of the human influenza A (H1N1) virus. Eight dominant antigenic clusters have been inferred for seasonal H1N1 viruses since 1977, which demonstrated sequential replacements over time with a similar pattern in Asia, Europe and North America. Among them, six clusters emerged first in Asia. As for China, three of the eight antigenic clusters were detected in South China earlier than in North China, indicating the leading role of South China in H1N1 transmission. The comprehensive view of the antigenic evolution of human influenza A (H1N1) virus can help formulate better strategy for its prevention and control.

  2. N[1,3]-Sigmatropic shift in the benzidine rearrangement: experimental and theoretical investigation. (United States)

    Hou, Shili; Li, Xinyao; Xu, Jiaxi


    The N[1,3]-sigmatropic shift in the benzidine rearrangement has been studied in depth experimentally with the aid of density functional theory (DFT) calculations. The designed substituted N,N'-diaryl hydrazines rearrange exclusively to the expected o/p-semidines and diphenylines. Intercrossing experiments support the intramolecular rearrangement process. Radical trapping experiments exclude the intermediacy of biradicals in the rearrangements. Computational results demonstrate that the o-semidine rearrangement involves a novel N[1,3]-sigmatropic shift and the p-semidine rearrangement proceeds via tandem N[1,3]/N[1,3]-sigmatropic shifts, while the diphenyline rearrangement occurs through cascade N[1,3]/[3,3]-sigmatropic shifts. The proposed mechanism involving the key N[1,3]-sigmatropic shift as the rate-limiting step is in good agreement with reported kinetic isotope measurements. The combined methods provide new insight into the formation mechanism of o/p-semidines and diphenylines in the benzidine rearrangement and support the unprecedented suprafacial symmetry allowed N[1,3]-sigmatropic shift with an inversion of the configuration in the migrating nitrogen atom.

  3. Plasma metabolomics for the diagnosis and prognosis of H1N1 influenza pneumonia. (United States)

    Banoei, Mohammad M; Vogel, Hans J; Weljie, Aalim M; Kumar, Anand; Yende, Sachin; Angus, Derek C; Winston, Brent W


    Metabolomics is a tool that has been used for the diagnosis and prognosis of specific diseases. The purpose of this study was to examine if metabolomics could be used as a potential diagnostic and prognostic tool for H1N1 pneumonia. Our hypothesis was that metabolomics can potentially be used early for the diagnosis and prognosis of H1N1 influenza pneumonia. (1)H nuclear magnetic resonance spectroscopy and gas chromatography-mass spectrometry were used to profile the metabolome in 42 patients with H1N1 pneumonia, 31 ventilated control subjects in the intensive care unit (ICU), and 30 culture-positive plasma samples from patients with bacterial community-acquired pneumonia drawn within the first 24 h of hospital admission for diagnosis and prognosis of disease. We found that plasma-based metabolomics from samples taken within 24 h of hospital admission can be used to discriminate H1N1 pneumonia from bacterial pneumonia and nonsurvivors from survivors of H1N1 pneumonia. Moreover, metabolomics is a highly sensitive and specific tool for the 90-day prognosis of mortality in H1N1 pneumonia. This study demonstrates that H1N1 pneumonia can create a quite different plasma metabolic profile from bacterial culture-positive pneumonia and ventilated control subjects in the ICU on the basis of plasma samples taken within 24 h of hospital/ICU admission, early in the course of disease.

  4. Reassortant H1N1 influenza virus vaccines protect pigs against pandemic H1N1 influenza virus and H1N2 swine influenza virus challenge. (United States)

    Yang, Huanliang; Chen, Yan; Shi, Jianzhong; Guo, Jing; Xin, Xiaoguang; Zhang, Jian; Wang, Dayan; Shu, Yuelong; Qiao, Chuanling; Chen, Hualan


    Influenza A (H1N1) virus has caused human influenza outbreaks in a worldwide pandemic since April 2009. Pigs have been found to be susceptible to this influenza virus under experimental and natural conditions, raising concern about their potential role in the pandemic spread of the virus. In this study, we generated a high-growth reassortant virus (SC/PR8) that contains the hemagglutinin (HA) and neuraminidase (NA) genes from a novel H1N1 isolate, A/Sichuan/1/2009 (SC/09), and six internal genes from A/Puerto Rico/8/34 (PR8) virus, by genetic reassortment. The immunogenicity and protective efficacy of this reassortant virus were evaluated at different doses in a challenge model using a homologous SC/09 or heterologous A/Swine/Guangdong/1/06(H1N2) virus (GD/06). Two doses of SC/PR8 virus vaccine elicited high-titer serum hemagglutination inhibiting (HI) antibodies specific for the 2009 H1N1 virus and conferred complete protection against challenge with either SC/09 or GD/06 virus, with reduced lung lesions and viral shedding in vaccine-inoculated animals compared with non-vaccinated control animals. These results indicated for the first time that a high-growth SC/PR8 reassortant H1N1 virus exhibits properties that are desirable to be a promising vaccine candidate for use in swine in the event of a pandemic H1N1 influenza. Copyright © 2011 Elsevier B.V. All rights reserved.

  5. Spatio-temporal dynamics of global H5N1 outbreaks match bird migration patterns

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    Yali Si


    Full Text Available The global spread of highly pathogenic avian influenza H5N1 in poultry, wild birds and humans, poses a significant pandemic threat and a serious public health risk. An efficient surveillance and disease control system relies on the understanding of the dispersion patterns and spreading mechanisms of the virus. A space-time cluster analysis of H5N1 outbreaks was used to identify spatio-temporal patterns at a global scale and over an extended period of time. Potential mechanisms explaining the spread of the H5N1 virus, and the role of wild birds, were analyzed. Between December 2003 and December 2006, three global epidemic phases of H5N1 influenza were identified. These H5N1 outbreaks showed a clear seasonal pattern, with a high density of outbreaks in winter and early spring (i.e., October to March. In phase I and II only the East Asia Australian flyway was affected. During phase III, the H5N1 viruses started to appear in four other flyways: the Central Asian flyway, the Black Sea Mediterranean flyway, the East Atlantic flyway and the East Africa West Asian flyway. Six disease cluster patterns along these flyways were found to be associated with the seasonal migration of wild birds. The spread of the H5N1 virus, as demonstrated by the space-time clusters, was associated with the patterns of migration of wild birds. Wild birds may therefore play an important role in the spread of H5N1 over long distances. Disease clusters were also detected at sites where wild birds are known to overwinter and at times when migratory birds were present. This leads to the suggestion that wild birds may also be involved in spreading the H5N1 virus over short distances.

  6. The Neurological Manifestations of H1N1 Influenza Infection; Diagnostic Challenges and Recommendations

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    Ali Akbar Asadi-Pooya


    Full Text Available Background: World Health Organization declared pandemic phase of human infection with novel influenza A (H1N1 in April 2009. There are very few reports about the neurological complications of H1N1 virus infection in the literature. Occasionally, these complications are severe and even fatal in some individuals. The aims of this study were to report neurological complaints and/or complications associated with H1N1 virus infection. Methods: The medical files of all patients with H1N1 influenza infection admitted to a specified hospital in the city of Shiraz, Iran from October through November 2009 were reviewed. More information about the patients were obtained by phone calls to the patients or their care givers. All patients had confirmed H1N1 virus infection with real-time PCR assay. Results: Fifty-five patients with H1N1 infection were studied. Twenty-three patients had neurological signs and/or symptoms. Mild neurological complaints may be reported in up to 42% of patients infected by H1N1 virus. Severe neurological complications occurred in 9% of the patients. The most common neurological manifestations were headache, numbness and paresthesia, drowsiness and coma. One patient had a Guillain-Barre syndrome-like illness, and died in a few days. Another patient had focal status epilepticus and encephalopathy. Conclusions: The H1N1 infection seems to have been quite mild with a self-limited course in much of the world, yet there appears to be a subset, which is severely affected. We recommend performing diagnostic tests for H1N1influenza virus in all patients with respiratory illness and neurological signs/symptoms. We also recommend initiating treatment with appropriate antiviral drugs as soon as possible in those with any significant neurological presentation accompanied with respiratory illness and flu-like symptoms

  7. CD47-independent effects mediated by the TSP-derived 4N1K peptide.

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    Pascal Leclair

    Full Text Available 4N1K is a peptide fragment derived from the C-terminal, globular domain of thrombospondin which has been shown to mediate integrin-dependent cell adhesion and promote integrin activation acting via the cell-surface receptor, CD47. However, some studies found that 4N1K could act independently of CD47, putting in question the specificity of 4N1K for CD47. This led us to characterize the cellular and non-cellular effects of 4N1K. We found that 4N1K stimulated a potent increase in binding of a variety of non-specific IgG antibodies to cells in suspension. We also found that these same antibodies, as well as CD47-deficient cells, could bind substrate-immobilized 4N1K significantly better than a control peptide, 4NGG. Furthermore, we found that cells treated with 4N1K at higher concentrations inhibited, while lower concentrations promoted cell adhesion to immobilized fibronectin as an integrin substrate. Importantly, both the stimulatory and the inhibitory activity of 4N1K occurred as efficiently in the CD47-deficient JinB8 cells, as it did in the CD47-expressing parental or in JinB8 cells reconstituted with CD47 expression. Given these results, we suggest that 4N1K interacts non-specifically with epitopes commonly found on the cell surface, and conclude that it is not a suitable peptide for use to study the consequences of CD47 receptor ligation.

  8. Complete Genome Sequence of the Type Strain Cupriavidus necator N-1 ▿ † (United States)

    Poehlein, Anja; Kusian, Bernhard; Friedrich, Bärbel; Daniel, Rolf; Bowien, Botho


    Here we announce the complete genome sequence of the copper-resistant bacterium Cupriavidus necator N-1, the type strain of the genus Cupriavidus. The genome consists of two chromosomes and two circular plasmids. Based on genome comparison, the chromosomes of C. necator N-1 share a high degree of similarity with the two chromosomal replicons of the bioplastic-producing hydrogen bacterium Ralstonia eutropha H16. The two strains differ in their plasmids and the presence of hydrogenase genes, which are absent in strain N-1. PMID:21742890

  9. Synthesis of triated N1`-alkyl derivatives of the delta opioid receptor ligand naltrindole

    Energy Technology Data Exchange (ETDEWEB)

    Lever, J.R.; Johnson, S.M. [Johns Hopkins Univ. School of Hygiene and Public Health, Environmental Health Sciences Dept., Baltimore, MD (United States)


    Tritiated N1`-methyl and N1`-ethyl analogues of naltrindole (NTI) have been synthesized for evaluation as radioligands for studies of delta opioid receptors. The two N1`-alkyl-5`,7`-dibromoNTI precursors for radiolabeling were prepared by base-promoted alkylation of 2,4-dibromophenylhydrazine with either iodomethane or iodoethane followed by condensation with naltrexone using the Fischer indole synthesis. Catalytic debromotritiation followed by HPLC purification afforded [{sup 3}H]MeNTI (17.3 Ci/mmol) and [{sup 3}H]EtNTI (22.5 Ci/mmol) with high chemical and radiochemical purities ({>=} 99.8%). (author).

  10. The tumor suppressive role of CAMK2N1 in castration-resistant prostate cancer


    Wang, Tao; Liu, Zhuo; Guo, ShuiMing; Wu, Licheng; Li, Mingchao; Yang, Jun; Chen, Ruibao; Xu, Hua; Cai, Shaoxin; CHEN, Hui; LI, WEIYONG; Wang, Liang; Hu, Zhiquan; Zhuang, Qianyuan; Xu, Shaohua


    Prostate cancer at advanced stages including metastatic and castration-resistant cancer remains incurable due to the lack of effective therapies. The CAMK2N1 gene, cloned and characterized as an inhibitor of CaMKII (calcium/calmodulin-dependent protein kinase II), has been shown to affect tumorigenesis and tumor growth. However, it is still unknown whether CAMK2N1 plays a role in prostate cancer development. We first examined the protein and mRNA levels of CAMK2N1 and observed a significant d...

  11. The changing nature of avian influenza A virus (H5N1). (United States)

    Watanabe, Yohei; Ibrahim, Madiha S; Suzuki, Yasuo; Ikuta, Kazuyoshi


    Highly pathogenic avian influenza A virus subtype H5N1 has been endemic in some bird species since its emergence in 1996 and its ecology, genetics and antigenic properties have continued to evolve. This has allowed diverse virus strains to emerge in endemic areas with altered receptor specificity, including a new H5 sublineage with enhanced binding affinity to the human-type receptor. The pandemic potential of H5N1 viruses is alarming and may be increasing. We review here the complex dynamics and changing nature of the H5N1 virus that may contribute to the emergence of pandemic strains. Copyright © 2011 Elsevier Ltd. All rights reserved.

  12. Functional neurosurgery (part 2)

    African Journals Online (AJOL)

    are added, followed by pain-modification agents such as tricyclic antidepressants and some selective anticonvulsants. Throughout the treatment process, adjuncts to medication should be employed, such as psychotherapy, electrotherapy as used by physiotherapists, and play and music therapy. These contribute a great ...

  13. More about ... Neurosurgery

    African Journals Online (AJOL)

    usually occurs in the lumbo-sacral region, but can occur anywhere along the midline spinal axis (Fig. 3). It contains neural tissue with a delicate meningeal layer. There is invariably some form of neurological deficit in the lower limbs, ranging from paraplegia to mild weakness, depending on the level and size of the lesion.

  14. Bradycardia in neurosurgery. (United States)

    Agrawal, Amit; Timothy, Jake; Cincu, Rafael; Agarwal, Trisha; Waghmare, Lalit B


    Cushing reflex' is characterized by the occurrence of hypertension, bradycardia and apnoea secondary to raised increased intracranial pressure (ICP), leading to pressure on and or stretch, or both, of the brainstem. With the wide availability of monitoring facilities and advancements in investigation techniques, observation of increased intracranial pressure resulting in haemodynamic instability and bradycardia has been increasingly recognized in relation to many neurosurgical conditions and procedures. The causes of bradycardia include space occupying lesion involving or compressing the brain parenchyma (subdural haematoma, tumours, hydrocephalus), neurosurgical procedures (neuroendoscopy, placement of extradural drains), epileptic and non-epileptic seizures, trigemino-cardiac reflex, cerebellar lesions, spinal lesions (neurogenic shock, autonomic dysreflexia) and many other rare causes (Ventricular catheter obstruction in cases of hydrocephalus, colloid cysts related acute neurogenic cardiac dysfunction, Ondine's curse syndrome, etc.). This highlights that bradycardia can be a warning sign in many neurosurgical conditions and Cushing's reflex is a protective and effective action of the brain for preserving an adequate cerebral perfusion pressure despite an increased intracranial pressure. Management of these patients include identification and treatment of the underlying cause of bradycardia, anti-cholinergics and if necessary cardiac pacing, nevertheless, other causes of haemodynamic changes (i.e. anesthetic drugs, tumor manipulation) should also be considered and managed accordingly. We believe that this knowledge and understanding will help to identify the patients' at risk and will also help in the management of neurosurgical patients with bradycardia.

  15. Macroglossia in neurosurgery

    Directory of Open Access Journals (Sweden)

    Melissa Brockerville


    Full Text Available Macroglossia, an abnormal swelling of the tongue, is a rare post-operative complication often associated with serious airway obstruction and prolonged intubations. Currently, there is a paucity of information on the true incidence, aetiology, and complications associated with macroglossia. A thorough review of the literature was carried out so as to summarise the characteristics of reported cases of macroglossia and to present potential treatments and preventive strategies. A literature search was conducted in PubMed to identify human case reports of macroglossia after neurosurgical procedures including spine, published in English from 1974 to December 2015. A total of 26 reports with 36 cases of macroglossia were identified. Macroglossia was most commonly reported after sub-occipital and/or posterior fossa craniotomies and spine surgeries in prone or park-bench positions. It is more common after procedures lasting >8 h. The aetiology of macroglossia is multi-factorial and possible mechanisms included local mechanical tongue compression interfering with venous and/or lymphatic drainage, regional venous thrombosis and/or local trauma. Complications included airway obstruction, re-intubation, difficult re-intubation, prolonged intubation and Intensive Care Unit stay and tongue necrosis. Prevention, awareness of the possibility, and early recognition are the best forms of treatment.

  16. Medical errors in neurosurgery


    Rolston, John D.; Zygourakis, Corinna C.; Han, Seunggu J.; Lau, Catherine Y.; Berger, Mitchel S.; Parsa, Andrew T


    Background: Medical errors cause nearly 100,000 deaths per year and cost billions of dollars annually. In order to rationally develop and institute programs to mitigate errors, the relative frequency and costs of different errors must be documented. This analysis will permit the judicious allocation of scarce healthcare resources to address the most costly errors as they are identified. Methods: Here, we provide a systematic review of the neurosurgical literature describing medical errors...

  17. Pediatric Healthcare Response to Pandemic (H1N1) 2009 Influenza Stakeholder Meeting - Summary of Proceedings

    Energy Technology Data Exchange (ETDEWEB)



    The goal of the meeting was to bring together subject matter experts to develop tools and resources for use by the pediatric healthcare community in response to 2009 (H1N1) pandemic influenza activity during the 2009 influenza season.

  18. Monitoring Excitations of the N =1 Landau Level by Optical Emission at mK Temperatures (United States)

    Levy, Antonio; Wurstbauer, Ursula; Fields, Dov; Pinczuk, Aron; Watson, John; Mondal, Sumit; Manfra, Michael J.; West, Ken W.; Pfeiffer, Loren N.


    Optical emission experiments have proven to be powerful contactless probe of collective states of electrons in the second (N =1) Landau Level (LL). We report the emission spectrum from optical recombination in the N =0 and N =1 LL's the second LL. The 2DEG is confined in ultra-high-mobility GaAs quantum well structures. Optical emission red-shifted from the main luminescence of the N =0 and N =1 LL are interpreted as shakeup processes of quasiparticles in the N =1 LL. Results of two samples with different carrier densities measured in the temperature range of 42mK mK will be compared. The experimental observations will be discussed taking into account the striking quantum phases dominating the second LL. Supported by NSF and AvH

  19. Piezoresistive measurement of Swine H1N1 Hemagglutinin peptide binding with microcantilever arrays

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    N. Bajwa


    Full Text Available Effective detection of Swine H1N1 Hemagglutinin peptide is crucial as it could be used as a positive control to screen for highly infectious flu strains such as Swine-Origin Influenza A (H1N1. Piezoresistive microcantilever arrays present a pathway towards highly sensitive and label-free detection of biomolecules by transducing the antigen-antibody binding into change in resistivity via induced surface stress variation. We demonstrate a mechanical transduction of Swine H1N1 Hemagglutinin peptide binding and suggest the employed technique may offer a potential platform for detection of the H1N1 virus, which could be clinically used to diagnose and provide subsequent relief.

  20. Renormalizations in softly broken N = 1 theories: Slavnov-Taylor identities (United States)

    Kondrashuk, Igor


    Slavnov-Taylor identities have been applied to perform explicitly the renormalization procedure for the softly broken N = 1 SYM. The result is in accordance with the previous results obtained at the level of the supergraph technique.

  1. Renormalizations in softly broken N=1 theories: Slavnov-Taylor identities


    Kondrashuk, Igor


    Slavnov-Taylor identities have been applied to perform explicitly the renormalization procedure for the softly broken N=1 SYM. The result is in accordance with the previous results obtained at the level of supergraph technique.

  2. Renormalizations in softly broken N=1 theories: Slavnov-Taylor identities

    Energy Technology Data Exchange (ETDEWEB)

    Kondrashuk, Igor [SISSA-ISAS and INFN, Sezione di Trieste, Trieste (Italy)]. E-mail:


    Slavnov-Taylor identities have been applied to perform explicitly the renormalization procedure for the softly broken N=1 SYM. The result is in accordance with the previous results obtained at the level of the supergraph technique. (author)

  3. A Worm Algorithm for the Lattice CP(N-1) Model arXiv

    CERN Document Server

    Rindlisbacher, Tobias

    The CP(N-1) model in 2D is an interesting toy model for 4D QCD as it possesses confinement, asymptotic freedom and a non-trivial vacuum structure. Due to the lower dimensionality and the absence of fermions, the computational cost for simulating 2D CP(N-1) on the lattice is much lower than the one for simulating 4D QCD. However to our knowledge, no efficient algorithm for simulating the lattice CP(N-1) model has been tested so far, which also works at finite density. To this end we propose and test a new type of worm algorithm which is appropriate to simulate the lattice CP(N-1) model in a dual, flux-variables based representation, in which the introduction of a chemical potential does not give rise to any complications.

  4. Immunogenicity and protective efficacy of a live attenuated H5N1 vaccine in nonhuman primates

    National Research Council Canada - National Science Library

    Fan, Shufang; Gao, Yuwei; Shinya, Kyoko; Li, Chris Kafai; Li, Yanbing; Shi, Jianzhong; Jiang, Yongping; Suo, Yongbing; Tong, Tiegang; Zhong, Gongxun; Song, Jiasheng; Zhang, Ying; Tian, Guobin; Guan, Yuntao; Xu, Xiao-Ning; Bu, Zhigao; Kawaoka, Yoshihiro; Chen, Hualan


    The continued spread of highly pathogenic H5N1 influenza viruses among poultry and wild birds, together with the emergence of drug-resistant variants and the possibility of human-to-human transmission...

  5. Virtual screening of Indonesian flavonoid as neuraminidase inhibitor of influenza a subtype H5N1 (United States)

    Parikesit, A. A.; Ardiansah, B.; Handayani, D. M.; Tambunan, U. S. F.; Kerami, D.


    Highly Pathogenic Avian Influenza (HPAI) H5N1 poses a significant threat to animal and human health worldwide. The number of H5N1 infection in Indonesia is the highest during 2005-2013, with a mortality rate up to 83%. A mutation that occurred in H5N1 strain made it resistant to commercial antiviral agents such as oseltamivir and zanamivir, so the more potent antiviral agent is needed. In this study, virtual screening of Indonesian flavonoid as neuraminidase inhibitor of H5N1 was conducted. Total 491 flavonoid compound obtained from HerbalDB were screened. Molecular docking was performed using MOE 2008.10. This research resulted in Guajavin B as the best ligand.

  6. H1N1 infection in emergency surgery: A cautionary tale.

    LENUS (Irish Health Repository)

    Galbraith, J G


    Pandemic 2009 influenza A H1N1 has spread rapidly since its first report in Mexico in March 2009. This is the first influenza pandemic in over 40 years and it atypically affects previously healthy young adults, with higher rates of morbidity and mortality. The medical literature has been inundated with reports of H1N1 infection, the majority found in critical care and internal medicine journals with a relative paucity in the surgical literature. Despite this, it remains an important entity that can impact greatly on acute surgical emergencies. We present a case of previously healthy 31-year-old male who underwent open appendectomy. His post-operative recovery was complicated by acute respiratory distress syndrome secondary to H1N1 infection. This case report highlights the impact that H1N1 virus can have on acute surgical emergencies and how it can complicate the post-operative course.

  7. Structural Basis of Preexisting Immunity to the 2009 H1N1 Pandemic Influenza Virus

    Energy Technology Data Exchange (ETDEWEB)

    Xu, Rui; Ekiert, Damian C.; Krause, Jens C.; Hai, Rong; Crowe, Jr., James E.; Wilson, Ian A. (Sinai); (Scripps); (Vanderbilt)


    The 2009 H1N1 swine flu is the first influenza pandemic in decades. The crystal structure of the hemagglutinin from the A/California/04/2009 H1N1 virus shows that its antigenic structure, particularly within the Sa antigenic site, is extremely similar to those of human H1N1 viruses circulating early in the 20th century. The cocrystal structure of the 1918 hemagglutinin with 2D1, an antibody from a survivor of the 1918 Spanish flu that neutralizes both 1918 and 2009 H1N1 viruses, reveals an epitope that is conserved in both pandemic viruses. Thus, antigenic similarity between the 2009 and 1918-like viruses provides an explanation for the age-related immunity to the current influenza pandemic.

  8. H1N1 and influenza viruses: why pregnant women might be hesitant to be vaccinated. (United States)

    Mirdamadi, Kamelia; Einarson, Adrienne


    I have been encouraging pregnant women to receive both the H1N1 and influenza vaccines since I became aware of Health Canada's guidelines. However, some of the women in my practice have heard conflicting information, often from media sources, and they are hesitant to be vaccinated. What is the evidence behind these guidelines, and should I really be convincing these women to be vaccinated? Pregnant women and growing fetuses are considered a population vulnerable to H1N1 and influenza viruses. Health Canada published a report in late 2010 estimating that this population was at increased risk of hospitalization and severe outcomes of H1N1 infection. Recommendations included pregnant women as a priority group to receive the H1N1 vaccine as well as the influenza vaccine. This information should be explained unambiguously to pregnant women, and they should be made aware of the sensationalism of media reports, which are often based on opinion and not evidence.

  9. Tchaikovsky: Piano Concerto N1 in B flat minor, Op.23 / David J. Fanning

    Index Scriptorium Estoniae

    Fanning, David J.


    Uuest heliplaadist "Tchaikovsky: Piano Concerto N1 in B flat minor, Op.23, Suite N4 in G major, Op.61, "Mozartiana". Constantine Orbelian (pf), Philarmonia Orchestra, Neeme Järvi" Chandos ABTD 1413. CHAN 8777

  10. The seroprevalence of pandemic influenza H1N1 (2009 virus in China.

    Directory of Open Access Journals (Sweden)

    Cuiling Xu


    Full Text Available Mainland China experienced pandemic influenza H1N1 (2009 virus (pH1N1 with peak activity during November-December 2009. To understand the geographic extent, risk factors, and attack rate of pH1N1 infection in China we conducted a nationwide serological survey to determine the prevalence of antibodies to pH1N1.Stored serum samples (n = 2,379 collected during 2006-2008 were used to estimate baseline serum reactogenicity to pH1N1. In January 2010, we used a multistage-stratified random sampling method to select 50,111 subjects who met eligibility criteria and collected serum samples and administered a standardized questionnaire. Antibody response to pH1N1 was measured using haemagglutination inhibition (HI assay and the weighted seroprevalence was calculated using the Taylor series linearization method. Multivariable logistic regression analyses were used to examine risk factors for pH1N1 seropositivity. Baseline seroprevalence of pH1N1 antibody (HI titer ≥40 was 1.2%. The weighted seroprevalence of pH1N1 among the Chinese population was 21.5%(vaccinated: 62.0%; unvaccinated: 17.1%. Among unvaccinated participants, those aged 6-15 years (32.9% and 16-24 years (30.3% had higher seroprevalence compared with participants aged 25-59 years (10.7% and ≥60 years (9.9%, P<0.0001. Children in kindergarten and students had higher odds of seropositivity than children in family care (OR: 1.36 and 2.05, respectively. We estimated that 207.7 million individuals (15.9% experienced pH1N1 infection in China.The Chinese population had low pre-existing immunity to pH1N1 and experienced a relatively high attack rate in 2009 of this virus. We recommend routine control measures such as vaccination to reduce transmission and spread of seasonal and pandemic influenza viruses.

  11. Seroepidemiology of pandemic influenza A (H1N1 2009 virus infections in Pune, India

    Directory of Open Access Journals (Sweden)

    Tandale Babasaheb V


    Full Text Available Abstract Background In India, Pune was one of the badly affected cities during the influenza A (H1N1 2009 pandemic. We undertook serosurveys among the risk groups and general population to determine the extent of pandemic influenza A (H1N1 2009 virus infections. Methods Pre-pandemic sera from the archives, collected during January 2005 to March 2009, were assayed for the determination of baseline seropositivity. Serosurveys were undertaken among the risk groups such as hospital staff, general practitioners, school children and staff and general population between 15th August and 11th December 2009. In addition, the PCR-confirmed pandemic influenza A (H1N1 2009 cases and their household contacts were also investigated. Haemagglutination-inhibition (HI assays were performed using turkey red blood cells employing standard protocols. A titre of ≥1:40 was considered seropositive. Results Only 2 (0.9% of the 222 pre-pandemic sera were positive. The test-retest reliability of HI assay in 101 sera was 98% for pandemic H1N1, 93.1% for seasonal H1N1 and 94% for seasonal H3N2. The sera from 48 (73.8% of 65 PCR-confirmed pandemic H1N1 cases in 2009 were positive. Seropositivity among general practitioners increased from 4.9% in August to 9.4% in November and 15.1% in December. Among hospital staff, seropositivity increased from 2.8% in August to 12% in November. Seropositivity among the schools increased from 2% in August to 10.7% in September. The seropositivity among students (25% was higher than the school staff in September. In a general population survey in October 2009, seropositivity was higher in children (9.1% than adults (4.3%. The 15-19 years age group showed the highest seropositivity of 20.3%. Seropositivity of seasonal H3N2 (55.3% and H1N1 (26.4% was higher than pandemic H1N1 (5.7% (n = 2328. In households of 74 PCR-confirmed pandemic H1N1 cases, 25.6% contacts were seropositive. Almost 90% pandemic H1N1 infections were asymptomatic or mild

  12. Evolution and adaptation of the pandemic A/H1N1 2009 influenza virus

    Directory of Open Access Journals (Sweden)

    Ducatez MF


    Full Text Available Mariette F Ducatez, Thomas P Fabrizio, Richard J WebbyDepartment of Infectious Diseases, St Jude Children's Research Hospital, Memphis, TN, USAAbstract: The emergence of the 2009 H1N1 pandemic influenza virus [A(H1N1pdm09] has provided the public health community with many challenges, but also the scientific community with an opportunity to monitor closely its evolution through the processes of drift and shift. To date, and despite having circulated in humans for nearly two years, little antigenic variation has been observed in the A(H1N1pdm09 viruses. However, as the A(H1N1pdm09 virus continues to circulate and the immunologic pressure within the human population increases, future antigenic change is almost a certainty. Several coinfections of A(H1N1pdm09 and seasonal A(H1N1 or A(H3N2 viruses have been observed, but no reassortant viruses have been described in humans, suggesting a lack of fitness of reassortant viruses or a lack of opportunities for interaction of different viral lineages. In contrast, multiple reassortment events have been detected in swine populations between A(H1N1 pdm09 and other endemic swine viruses. Somewhat surprisingly, many of the well characterized influenza virus virulence markers appear to have limited impact on the phenotype of the A(H1N1pdm09 viruses when they have been introduced into mutant viruses in laboratory settings. As such, it is unclear what the evolutionary path of the pandemic virus will be, but the monitoring of any changes in the circulating viruses will remain a global public and animal health priority.Keywords: influenza, pandemic, evolution, adaptation

  13. CAMK2N1 inhibits prostate cancer progression through androgen receptor-dependent signaling


    Wang, Tao; Guo, ShuiMing; Liu, Zhuo; Wu, Licheng; Li, Mingchao; Yang, Jun; Chen, Ruibao; Liu, Xiaming; Xu, Hua; Cai, Shaoxin; CHEN, Hui; LI, WEIYONG; Xu, Shaohua; Wang, Liang; Hu, Zhiquan


    Castration resistance is a major obstacle to hormonal therapy for prostate cancer patients. Although androgen independence of prostate cancer growth is a known contributing factor to endocrine resistance, the mechanism of androgen receptor deregulation in endocrine resistance is still poorly understood. Herein, the CAMK2N1 was shown to contribute to the human prostate cancer cell growth and survival through AR-dependent signaling. Reduced expression of CAMK2N1 was correlated to recurrence-fre...

  14. Using Knowledge Fusion to Analyze Avian Influenza H5N1 in East and Southeast Asia (United States)

    Ge, Erjia; Haining, Robert; Li, Chi Pang; Yu, Zuguo; Waye, Miu Yee; Chu, Ka Hou; Leung, Yee


    Highly pathogenic avian influenza (HPAI) H5N1, a disease associated with high rates of mortality in infected human populations, poses a serious threat to public health in many parts of the world. This article reports findings from a study aimed at improving our understanding of the spatial pattern of the highly pathogenic avian influenza, H5N1, risk in East-Southeast Asia where the disease is both persistent and devastating. Though many disciplines have made important contributions to our understanding of H5N1, it remains a challenge to integrate knowledge from different disciplines. This study applies genetic analysis that identifies the evolution of the H5N1 virus in space and time, epidemiological analysis that determines socio-ecological factors associated with H5N1 occurrence, and statistical analysis that identifies outbreak clusters, and then applies a methodology to formally integrate the findings of the three sets of methodologies. The present study is novel in two respects. First it makes the initiative attempt to use genetic sequences and space-time data to create a space-time phylogenetic tree to estimate and map the virus' ability to spread. Second, by integrating the results we are able to generate insights into the space-time occurrence and spread of H5N1 that we believe have a higher level of corroboration than is possible when analysis is based on only one methodology. Our research identifies links between the occurrence of H5N1 by area and a set of socio-ecological factors including altitude, population density, poultry density, and the shortest path distances to inland water, coastlines, migrating routes, railways, and roads. This study seeks to lay a solid foundation for the interdisciplinary study of this and other influenza outbreaks. It will provide substantive information for containing H5N1 outbreaks. PMID:22615729

  15. Purification of the major group 1 allergen from Bahia grass pollen, Pas n 1. (United States)

    Drew, Alexander C; Davies, Janet M; Dang, Thanh D; Rolland, Jennifer M; O'Hehir, Robyn E


    Group 1 grass pollen allergens are glycoproteins of the β-expansin family. They are a predominant component of pollen and are potent allergens with a high frequency of serum IgE reactivity in grass pollen-allergic patients. Bahia grass is distinct from temperate grasses and has a prolonged pollination period and wide distribution in warmer climates. Here we describe the purification of the group 1 pollen allergen, Pas n 1, from Bahia grass (Paspalum notatum), an important subtropical aeroallergen source. Pas n 1 was purified from an aqueous Bahia grass pollen extract by ammonium sulphate precipitation, hydrophobic interaction and size exclusion chromatography, and assessed by one- and two-dimensional gel electrophoresis, immunoblotting and ELISA. Pas n 1 was purified to a single 29-kDa protein band containing two dominant isoforms detected by an allergen-specific monoclonal antibody and serum IgE of a Bahia grass pollen-allergic donor. The frequency of serum IgE reactivity with purified Pas n 1 in 51 Bahia grass pollen-allergic patients was 90.6%. Serum IgE reactivity with purified Pas n 1 was highly correlated with serum IgE reactivity with Bahia grass pollen extract and recombinant Pas n 1 (r = 0.821 and 0.913, respectively). Pas n 1 is a major allergen reactive at high frequency with serum IgE of Bahia grass pollen-allergic patients. Purified natural Pas n 1 has utility for improved specific diagnosis and immunotherapy for Bahia grass pollen allergy. Copyright © 2010 S. Karger AG, Basel.

  16. Bleeding Follicular Conjunctivitis due to Influenza H1N1 Virus

    Directory of Open Access Journals (Sweden)

    Maria Jesus Lopez-Prats


    Full Text Available Influenza H1N1 or A virus is a new virus serotype capable of human-to-human transmission. This infection causes a flu syndrome similar to that of seasonal influenza, with only one case of conjunctivitis described and no clinical details or microbiological confirmation. Its diagnosis is performed by PCR of pharyngeal smear of the patients affected. We report the first well-documented case in the medical literature of conjunctivitis by H1N1 virus.

  17. Radiologic Findings of Influenza A (H1N1) Pneumonia: Report of Two Cases

    Energy Technology Data Exchange (ETDEWEB)

    Oh, Jin Kyoung; Ahn, Myeong Im; Jung, Jung Im; Han, Dae Hee; Park, Seog Hee; Park, Chan Kwon; Kim, Young Kyoon [Seoul St. Mary' s Hospital, Seoul (Korea, Republic of)


    Novel influenza A (H1N1) infection is a highly infectious disease, which has been rapidly spreading worldwide since it was first documented in March of 2009 in Mexico. We experienced and report two cases of Influenza A (H1N1) pneumonia, accompanied by chest radiographic and CT findings. The chest radiographs revealed diffuse haziness and extensive airspace consolidation, whereas the CT scans demonstrated multifocal areas of ground glass opacity and airspace consolidation with a CT halo sign.

  18. Waterfowl potential as resevoirs of high pathogenic avian influenza H5N1 viruses

    Directory of Open Access Journals (Sweden)

    R Susanti


    Full Text Available The high population of waterfowl subsequently with the high case fatality of poultry and people in West Java regency caused by HPAI H5N1 can raise possibility that waterfowl was a natural reservoir. This research aimed to prove that waterfowl in West Java served as reservoir of AI virus (primarily H5N1 and also identify the virus pathotype based on cleavage site of amino acid sequence. Cloacal swab sample was obtained from healthy and unvaccinated waterfowl from Sukabumi and Bogor Regency. Cloacal swab was propagated in 9 days old embryonic chicken eggs. Allantoic fluid was harvested at the 4th day of incubation and then tested for hemagglutination, and positive isolate continued with virus sub-typing using PCR method. H5 gene from H5N1 isolate then sequenced using dideoxy termination method. Multiple alignment of nucleotide sequences were analysed using MEGA-3.1 program. Sub-typing using PCR method indicated the existence of 25 strain H5N1, 16 strain HxN1, 4 strain H5Nx and 9 virus ND. Characterization of cleavage site amino acid sequence indicated that all H5N1 sample were pathogenic with sequence QRERRRKKR (23 sample dan QRESRRKKR (2 sample. Waterfowl was HPAI H5N1 virus reservoir. Asymptomatic infection in waterfowl, but the virus shedding gradually occurred and therefore it became potential source of H5N1 virus infection. Our findings suggest that immediate action is needed to prevent the transmission of highly pathogenic avian influenza viruses from the apparently healthy waterfowl into terrestrial poultry or human.

  19. High dimensional bowling - n-dimensional ball rolling on (n-1)-dimensional surface

    DEFF Research Database (Denmark)

    Deryabin, M.V.; Hjorth, Poul G.


    We consider the non-holonomic system of a n-dimensional ball rolling on a (n - 1)-dimensional surface. We discuss the structure of the equations of motion, the existence of an invariant measure and some generalizations of the problem.......We consider the non-holonomic system of a n-dimensional ball rolling on a (n - 1)-dimensional surface. We discuss the structure of the equations of motion, the existence of an invariant measure and some generalizations of the problem....

  20. Pandemic (H1N1) 2009 and Hajj Pilgrims Who Received Predeparture Vaccination, Egypt (United States)

    Kandeel, Amr; Abdel Kereem, Eman; El-Refay, Samir; Afifi, Salma; Abukela, Mohammed; Earhart, Kenneth; El-Sayed, Nasr; El-Gabaly, Hatem


    In Egypt, vaccination against pandemic (H1N1) 2009 virus was required of pilgrims departing for the 2009 Hajj. A survey of 551 pilgrims as they returned to Egypt found 542 (98.1% [weighted]) reported receiving the vaccine; 6 (1.0% [weighted]) were infected with influenza virus A (H3N2) but none with pandemic (H1N1) 2009 virus. PMID:21762583

  1. Page 1 80 Manfred Denker and Henryk Hudzik Now let (n, 1) #M ...

    Indian Academy of Sciences (India)

    Now let (n, 1) #M. Then there exists t(l)e{+ 1} such that |x;(ſ) > Z,(l) — m/m. This implies that |x}(l) > Z,(l)—n for all 1 1 and Kek such that since otherwise condition (*) holds. Finally, let M1 = N*\\(MUMo), i.e. (n, 1)eM1 implies (p,(x;(l)) > 27” + š, for.

  2. H1N1 encephalitis with malignant edema and review of neurologic complications from influenza. (United States)

    Akins, Paul Taylor; Belko, John; Uyeki, Timothy M; Axelrod, Yekaterina; Lee, Kenneth K; Silverthorn, James


    Influenza virus infection of the respiratory tract is associated with a range of neurologic complications. The emergence of 2009 pandemic influenza A (H1N1) virus has been linked to neurological complications, including encephalopathy and encephalitis. Case report and literature review. We reviewed case management of a 20-year old Hispanic male who developed febrile upper respiratory tract signs and symptoms followed by a confusional state. He had rapid neurologic decline and his clinical course was complicated by refractory seizures and malignant brain edema. He was managed with oseltamavir and peramavir, corticosteroids, intravenous gamma globulin treatment, anticonvulsants, intracranial pressure management with external ventricular drain placement, hyperosmolar therapy, sedation, and mechanical ventilation. Reverse transcriptase polymerase chain reaction analysis of nasal secretions confirmed 2009 H1N1 virus infection; cerebrospinal fluid (CSF) was negative for 2009 H1N1 viral RNA. Follow-up imaging demonstrated improvement in brain edema but restricted diffusion in the basal ganglia. We provide a review of the clinical spectrum of neurologic complications of seasonal influenza and 2009 H1N1, and current approaches towards managing these complications. 2009 H1N1-associated acute encephalitis and encephalopathy appear to be variable in severity, including a subset of patients with a malignant clinical course complicated by high morbidity and mortality. Since the H1N1 influenza virus has not been detected in the CSF or brain tissue in patients with this diagnosis, the emerging view is that the host immune response plays a key role in pathogenesis.

  3. Seroprevalensi Avian influenza H5N1 pada Unggas di Kabupaten Aceh Utara

    Directory of Open Access Journals (Sweden)

    Darmawi Darmawi


    Full Text Available Seroprevalence of avian influenza H5N1 in birds in north aceh district ABSTRACT. Avian influenza virus H5N1 infections are an important cause of diseases in humans and several animal species, including birds. The present study conducted to investigate the seroprevalence Avian Influenza H5N1 in native birds from 15 sub-districts of North Aceh.  This study utilized 1108 serum samples collected from the axilaris vein (left or right of birds. The standard Hemaglutination Inhibition (HI assay was conducted at Microbiology Laboratory Faculty of Veterinary Medicine of Syiah Kuala University to determined serum antibody possitive or negative reaction against Avian influenza H5N1. The result showed that seroprevalence Avian influenza H5N1 virus was 4,7 % in North Aceh District. There were nine sub-districts were tested positively by HI test. However, the serum collected from six sub-districts did not react (negative against Avian influenza H5N1. Based on the results we obtained, a conclusion that natural infection by Avian influenza virus in native birds occured in part of North Aceh District.

  4. Insights into Human Astrocyte Response to H5N1 Infection by Microarray Analysis

    Directory of Open Access Journals (Sweden)

    Xian Lin


    Full Text Available Influenza virus infects not only the respiratory system but also the central nervous system (CNS, leading to influenza-associated encephalopathy and encephalitis. Astrocytes are essential for brain homeostasis and neuronal function. These cells can also be infected by influenza virus. However, genome-wide changes in response to influenza viral infection in astrocytes have not been defined. In this study, we performed gene profiling of human astrocytes in response to H5N1. Innate immune and pro-inflammatory responses were strongly activated at 24 h post-infection (hpi. Antiviral genes, as well as several cytokines and chemokines, including CXCL9, CXCL10, and CXCL11, were robustly induced. Phosphorylation of p65 and p38 can be activated by viral infection, suggesting their potential critical roles in H5N1-induced pro-inflammatory response. Moreover, H5N1 infection significantly upregulated the gene expressions related to the neuroactive ligand-receptor interaction pathway at 24 hpi, such as MC2R, CHRNG, P2RY13, GABRA1, and HRH2, which participant in synaptic transmission and may take part in CNS disorders induced by H5N1 infection. Targeting key components of innate immune response and the neuroactive ligand-receptor interaction pathway may provide a strategy to control H5N1-induced encephalopathy and encephalitis. This research can contribute to the understanding of H5N1 pathogenesis in astrocytes.

  5. [Epidemiology of Pandemic Influenza (H1N1) 2009 in Aichi Medical University Hospital]. (United States)

    Tani, Hiroya; Yamagishi, Yuka; Fuzimaki, Eriko; Kishi, Takahiko; Goto, Minehiro; Mikamo, Hiroshige


    We have analyzed epidemiology of pandemic influenza (H1N1) 2009 in Aichi Medical University hospital. As a result, the characteristics of pandemic influenza (H1N1) 2009 was as follows. (1) The number of ordered rapid diagnostic test was 2.8 times compared with the seasonal influenza period. The number of ordered rapid diagnostic test of the seasonal influenza period had the peak in January to March. However, the peak in pandemic influenza (H1N1) 2009 was November. Also, the number of samples on the weekend had been more than that of the weekday. (2) Positive rate of each diagnostic kit did not have the difference between the seasonal influenza (31.3 ± 1.8%) and pandemic influenza (H1N1) 2009 (29.6%). (3) Age on most ordered samples were less than ten years old, and the number of samples in 11 to 20 years old was twice in comparison with the seasonal influenza. (4) Pandemic influenza (H1N1) 2009 in influenza A accounted for 96.9%. (5) Sensitivity and specificity of ESPLINE Influenza A&B-N (FUJIREBIO, Inc., Tokyo, Japan) to the pandemic influenza (H1N1) 2009 were 100% and 100%, respectively. Also, sensitivity and specificity of prorasuto Flu (Mitsubishi Chemical Medience Corporation, Tokyo, Japan) were 77.3%and 98.5%, respectively.

  6. Respiratory failure presenting in H1N1 influenza with Legionnaires disease: two case reports. (United States)

    Iannuzzi, Michele; De Robertis, Edoardo; Piazza, Ornella; Rispoli, Fabio; Servillo, Giuseppe; Tufano, Rosalba


    Media sensationalism on the H1N1 outbreak may have influenced decisional processes and clinical diagnosis. We report two cases of patients who presented in 2009 with coexisting H1N1 virus and Legionella infections: a 69-year-old Caucasian man and a 71-year-old Caucasian woman. In our cases all the signs and symptoms, including vomiting, progressive respiratory disease leading to respiratory failure, refractory hypoxemia, leukopenia, lymphopenia, thrombocytopenia, and elevated levels of creatine kinase and hepatic aminotransferases, were consistent with critical illness due to 2009 H1N1 virus infection. Other infectious disorders may mimic H1N1 viral infection especially Legionnaires' disease. Because the swine flu H1N1 pandemic occurred in Autumn in Italy, Legionnaires disease was to be highly suspected since the peak incidence usually occurs in early fall. We do think that our immediate suspicion of Legionella infection based on clinical history and X-ray abnormalities was fundamental for a successful resolution. Our two case reports suggest that patients with H1N1 should be screened for Legionella, which is not currently common practice. This is particularly important since the signs and symptoms of both infections are similar.

  7. Respiratory failure presenting in H1N1 influenza with Legionnaires disease: two case reports

    Directory of Open Access Journals (Sweden)

    Iannuzzi Michele


    Full Text Available Abstract Introduction Media sensationalism on the H1N1 outbreak may have influenced decisional processes and clinical diagnosis. Case Presentation We report two cases of patients who presented in 2009 with coexisting H1N1 virus and Legionella infections: a 69-year-old Caucasian man and a 71-year-old Caucasian woman. In our cases all the signs and symptoms, including vomiting, progressive respiratory disease leading to respiratory failure, refractory hypoxemia, leukopenia, lymphopenia, thrombocytopenia, and elevated levels of creatine kinase and hepatic aminotransferases, were consistent with critical illness due to 2009 H1N1 virus infection. Other infectious disorders may mimic H1N1 viral infection especially Legionnaires' disease. Because the swine flu H1N1 pandemic occurred in Autumn in Italy, Legionnaires disease was to be highly suspected since the peak incidence usually occurs in early fall. We do think that our immediate suspicion of Legionella infection based on clinical history and X-ray abnormalities was fundamental for a successful resolution. Conclusion Our two case reports suggest that patients with H1N1 should be screened for Legionella, which is not currently common practice. This is particularly important since the signs and symptoms of both infections are similar.

  8. Potency of whole virus particle and split virion vaccines using dissolving microneedle against challenges of H1N1 and H5N1 influenza viruses in mice. (United States)

    Nakatsukasa, Akihiro; Kuruma, Koji; Okamatsu, Masatoshi; Hiono, Takahiro; Suzuki, Mizuho; Matsuno, Keita; Kida, Hiroshi; Oyamada, Takayoshi; Sakoda, Yoshihiro


    Transdermal vaccination using a microneedle (MN) confers enhanced immunity compared with subcutaneous (SC) vaccination. Here we developed a novel dissolving MN patch for the influenza vaccine. The potencies of split virion and whole virus particle (WVP) vaccines prepared from A/Puerto Rico/8/1934 (H1N1) and A/duck/Hokkaido/Vac-3/2007 (H5N1), respectively, were evaluated. MN vaccination induced higher neutralizing antibody responses than SC vaccination in mice. Moreover, MN vaccination with a lower dose of antigens conferred protective immunity against lethal challenges of influenza viruses than SC vaccination in mice. These results suggest that the WVP vaccines administered using MN are an effective combination for influenza vaccine to be further validated in humans. Copyright © 2017 Elsevier Ltd. All rights reserved.

  9. Uso de dexmedetomidina em neurocirurgia Uso de dexmedetomidina en neurocirugía The use of dexmedetomidine in neurosurgery

    Directory of Open Access Journals (Sweden)

    Bernardo Aloisio Grings Herbert


    aneurisma y la retirada de tumores va en aumento. Además, su uso en intervenciones quirúrgicas funcionales es promisorio.BACKGROUND AND OBJECTIVES: The use of alpha2-adrenergic agonists is increasingly more frequent in Anesthesiology, as adjuvant or the sole anesthetic drug. Currently, dexmedetomidine is gaining popularity due to its greater selectivity for the alpha2-adrenergic receptors and its pharmacokinetic profile. The aim of this review was to analyze the use of dexmedetomidine in neurosurgery. CONTENTS: Besides considerations and review of the literature regarding the use of dexmedetomidine, specifically in neurosurgical procedures, its effects on the different organ systems are described. CONCLUSIONS: The pharmacokinetic and pharmacodynamic profile of dexmedetomidine favors its use in several neurosurgical procedures. Its use in craniotomy for the treatment of aneurysms and tumor removal is recent. Besides, its use in functional surgical interventions is promising.

  10. Intense Seasonal A/H1N1 Influenza in Mexico, Winter 2013–2014 (United States)

    Dávila-Torres, Javier; Chowell, Gerardo; Borja-Aburto, Víctor H.; Viboud, Cécile; Grajalez-Muñiz, Concepción; Miller, Mark. A.


    Background and Aims A recrudescent wave of pandemic influenza A/H1N1 affected Mexico during the winter of 2013–2014 following a mild 2012–2013 A/H3N2 influenza season. Methods We compared the demographic and geographic characteristics of hospitalizations and inpatient deaths for severe acute respiratory infection (SARI) and laboratory-confirmed influenza during the 2013–2014 influenza season compared to previous influenza seasons, based on a large prospective surveillance system maintained by the Mexican Social Security health care system. Results A total of 14,236 SARI hospitalizations and 1,163 inpatient deaths (8.2%) were reported between October 1, 2013 and March 31, 2014. Rates of laboratory-confirmed A/H1N1 hospitalizations and deaths were significantly higher among individuals aged 30–59 years and lower among younger age groups for the 2013–2014 A/H1N1 season compared to the previous A/H1N1 season in 2011–2012 (χ2 test, p <0.001). The reproduction number for the winter 2013–2014 influenza season in central Mexico was estimated at 1.3–1.4, in line with that reported for the 2011–2012 A/H1N1 season but lower than during the initial waves of pandemic A/H1N1 activity in 2009. Conclusions We documented a substantial increase in the number of A/H1N1-related hospitalizations and deaths during the period from October 2013–March 2014 in Mexico and a proportionate shift of severe disease to middle-aged adults, relative to the preceding A/H1N1 2011–2012 season. In the absence of clear antigenic drift in globally circulating A/H1N1 viruses in the post-2009 pandemic period, the gradual change in the age distribution of A/H1N1 infections observed in Mexico suggests a slow build-up of immunity among younger populations, reminiscent of the age profile of past pandemics. PMID:25446616

  11. [Influenza H1N1 in obstetric population of a general hospital in Oaxaca]. (United States)

    Calvo Aguilar, Omar; Canalizo Mendoza, Yazmín Ruth; Hernández Cuevas, Maritza Jenny


    In April 2009 are reported the first cases of H1N1 influenza in Mexico, presenting the first death from this cause in the city of Oaxaca in the same month. Different epidemiological reports of pandemics brought to the pregnant and high risk population for complications secondary to infection with influenza H1N1 due to immune status. describe the obstetric population infected with H1N1 influenza in the Hospital General Dr. Aurelio Valdivieso of Oaxaca. Retrospective and observational study conducted in pregnant women with suspected infection by the virus of the influenza A/H1N1 served in the General Hospital Aurelio Valdivieso of Oaxaca, Oax in 13 patients with influenza H1N1 confirmed by RT-PCR during the pandemic occurred from May 2009 to April 2010. We reported 27 suspected cases of H1N1 influenza in pregnant women of which 13 were positive by RT-PCR, the cumulative incidence was 1.6 per 1000 pregnant women during the period. The fatality rate was 7.6 per hundred pregnant women affected, one case of maternal death indirectly by fluid and electrolyte imbalance occurred and the attack rate was 0.16 per 100 pregnant women, the main complication of atypical pneumonia occurred in four cases followed by three cases of preeclampsia, infants showed no defects and perinatal outcomes were good to present two cases of admission to the NICU for iatrogenic prematurity without deaths. H1N1 influenza infection has a high fatality rate in late pregnancy. Perinatal outcomes did not worsen the condition or management.

  12. Pandemic influenza (H1N1 2009 is associated with severe disease in India.

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    Akhilesh C Mishra

    Full Text Available BACKGROUND: Pandemic influenza A (H1N1 2009 has posed a serious public health challenge world-wide. In absence of reliable information on severity of the disease, the nations are unable to decide on the appropriate response against this disease. METHODS: Based on the results of laboratory investigations, attendance in outpatient department, hospital admissions and mortality from the cases of influenza like illness from 1 August to 31 October 2009 in Pune urban agglomeration, risk of hospitalization and case fatality ratio were assessed to determine the severity of pandemic H1N1 and seasonal influenza-A infections. RESULTS: Prevalence of pandemic H1N1 as well as seasonal-A cases were high in Pune urban agglomeration during the study period. The cases positive for pandemic H1N1 virus had significantly higher risk of hospitalization than those positive for seasonal influenza-A viruses (OR: 1.7. Of 93 influenza related deaths, 57 and 8 deaths from Pune (urban and 27 and 1 death from Pune (rural were from pandemic H1N1 positive and seasonal-A positive cases respectively. The case fatality ratio 0.86% for pandemic H1N1 was significantly higher than that of seasonal-A (0.13% and it was in category 3 of the pandemic severity index of CDC, USA. The data on the cumulative fatality of rural and urban Pune revealed that with time the epidemic is spreading to rural areas. CONCLUSIONS: The severity of the H1N1 influenza pandemic is less than that reported for 'Spanish flu 1918' but higher than other pandemics of the 20(th century. Thus, pandemic influenza should be considered as serious health threat and unprecedented global response seems justified.

  13. Clinical profile and outcome of critically ill pregnant females with H1N1 influenza

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    Minal Shastri


    Full Text Available Background Record based review of the 2009 H1N1 Influenza pandemic suggests that pregnant women are at higher risk for hospitalization and death due to H1N1 Influenza. Aims To study the clinical profile and outcome of critically ill pregnant females admitted in intensive care unit (ICU with real-time recombinant polymerase chain reaction (rRT-PCR proven positive H1N1 cases. Methods A retrospective record-review based study was conducted at Sir SayajiRao General Hospital (SSGH and Medical College, Vadodara on data of confirmed rRT-PCR H1N1 pregnant females admitted during the pandemics of 2010and 2015. Demographics, clinical profile and laboratory investigations were recorded and outcomes (survived or expired were analysed. Results There were a total of 20 H1N1 positive pregnant females requiring ICU admission. With equal demographic distribution among rural and urban population, cough and fever were the most common presenting complaints. 65 per cent were in third trimester, the subgroup which also had the highest mortality. Mean days from onset until presentation was 5.05 days. 12 (60 per cent patients’ required invasive mode of ventilation and all died. Average hospital stay was 7 days. Foetus had favourable outcome in patients who recovered from H1N1 acute illness. Conclusion Pregnant females in our study had 60 per cent mortality. Thus, awareness, early diagnosis and treatment should be provided to them. Guidelines, policy changes and government protocols are required specifically for pregnant females with H1N1 Influenza A infection. Our study was an observational study and comparisons with non-pregnant females were not done, conclusions applicable to entire pregnant population was not derived.

  14. The genesis of neurosurgery and the evolution of the neurosurgical operative environment: part II--concepts for future development, 2003 and beyond. (United States)

    Liu, Charles Y; Spicer, Mark; Apuzzo, Michael L J


    The future development of the neurosurgical operative environment is driven principally by concurrent development in science and technology. In the new millennium, these developments are taking on a Jules Verne quality, with the ability to construct and manipulate the human organism and its surroundings at the level of atoms and molecules seemingly at hand. Thus, an examination of currents in technology advancement from the neurosurgical perspective can provide insight into the evolution of the neurosurgical operative environment. In the future, the optimal design solution for the operative environment requirements of specialized neurosurgery may take the form of composites of venues that are currently mutually distinct. Advances in microfabrication technology and laser optical manipulators are expanding the scope and role of robotics, with novel opportunities for bionic integration. Assimilation of biosensor technology into the operative environment promises to provide neurosurgeons of the future with a vastly expanded set of physiological data, which will require concurrent simplification and optimization of analysis and presentation schemes to facilitate practical usefulness. Nanotechnology derivatives are shattering the maximum limits of resolution and magnification allowed by conventional microscopes. Furthermore, quantum computing and molecular electronics promise to greatly enhance computational power, allowing the emerging reality of simulation and virtual neurosurgery for rehearsal and training purposes. Progressive minimalism is evident throughout, leading ultimately to a paradigm shift as the nanoscale is approached. At the interface between the old and new technological paradigms, issues related to integration may dictate the ultimate emergence of the products of the new paradigm. Once initiated, however, history suggests that the process of change will proceed rapidly and dramatically, with the ultimate neurosurgical operative environment of the future

  15. Cost Effective Use of Free-to-Use Apps in Neurosurgery (FAN) in Developing Countries: From Clinical Decision Making to Educational Courses, Strengthening Health Care Delivery. (United States)

    Thapa, Amit; Kc, Bidur; Shakya, Bikram


    Financial limitations and the scarcity of technological knowledge are a major hurdle to good communication platforms, data storage, and dissemination of medical knowledge in developing countries. Out of necessity we used free-to-use apps in our practice. We studied the applicability and cost effective aspect of a systematic use of these apps in neurosurgery. We designed the Free-to-use apps in neurosurgery (FAN) module in 4 phases at Kathmandu Medical College Teaching Hospital over the last 3 years. We used free apps like Viber, Dropbox, Skype, and VLC media player on 3G and Wi-Fi network. Users were trained in ethics and measures to ensure confidentiality and privacy of patient-related data. Endpoints studied were feasibility, reliability, cost effectiveness, and overall satisfaction of the users. In the FAN module, the Viber app was used to send pictures of digital images via smartphones within 30 minutes, enabling quick decisions by the consultants. Dropbox not only helped store images but also helped quick verification of discharge summaries as early as 15 minutes increasing overall efficiency. With Skype, consultants could be contacted even when they were abroad, and with the use of FAN they remain updated of their patients. By the use of Skype and VLC media player, 2 operative live workshops from abroad were transmitted live with good visual and audio reception, allowing question-and-answer sessions with the faculties. User satisfaction was more than 90%. The FAN module helped in quick reliable decision making, allowing for instantaneous communication and storing data and exchange of knowledge across countries. Copyright © 2016 Elsevier Inc. All rights reserved.

  16. Nationwide molecular surveillance of pandemic H1N1 influenza A virus genomes: Canada, 2009.

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    Morag Graham

    Full Text Available BACKGROUND: In April 2009, a novel triple-reassortant swine influenza A H1N1 virus ("A/H1N1pdm"; also known as SOIV was detected and spread globally as the first influenza pandemic of the 21(st century. Sequencing has since been conducted at an unprecedented rate globally in order to monitor the diversification of this emergent virus and to track mutations that may affect virus behavior. METHODOLOGY/PRINCIPAL FINDINGS: By Sanger sequencing, we determined consensus whole-genome sequences for A/H1N1pdm viruses sampled nationwide in Canada over 33 weeks during the 2009 first and second pandemic waves. A total of 235 virus genomes sampled from unique subjects were analyzed, providing insight into the temporal and spatial trajectory of A/H1N1pdm lineages within Canada. Three clades (2, 3, and 7 were identifiable within the first two weeks of A/H1N1pdm appearance, with clades 5 and 6 appearing thereafter; further diversification was not apparent. Only two viral sites displayed evidence of adaptive evolution, located in hemagglutinin (HA corresponding to D222 in the HA receptor-binding site, and to E374 at HA2-subunit position 47. Among the Canadian sampled viruses, we observed notable genetic diversity (1.47 x 10⁻³ amino acid substitutions per site in the gene encoding PB1, particularly within the viral genomic RNA (vRNA-binding domain (residues 493-757. This genome data set supports the conclusion that A/H1N1pdm is evolving but not excessively relative to other H1N1 influenza A viruses. Entropy analysis was used to investigate whether any mutated A/H1N1pdm protein residues were associated with infection severity; however no virus genotypes were observed to trend with infection severity. One virus that harboured heterozygote coding mutations, including PB2 D567D/G, was attributed to a severe and potentially mixed infection; yet the functional significance of this PB2 mutation remains unknown. CONCLUSIONS/SIGNIFICANCE: These findings contribute to

  17. Characteristics of US public schools with reported cases of novel influenza A (H1N1). (United States)

    Hoen, Anne Gatewood; Buckeridge, David L; Chan, Emily H; Freifeld, Clark C; Keller, Mikaela; Charland, Katia; Donnelly, Christl A; Brownstein, John S


    The 2009 pandemic of influenza A (H1N1) has disproportionately affected children and young adults, resulting in attention by public health officials and the news media on schools as important settings for disease transmission and spread. We aimed to characterize US schools affected by novel influenza A (H1N1) relative to other schools in the same communities. A database of US school-related cases was obtained by electronic news media monitoring for early reports of novel H1N1 influenza between April 23 and June 8, 2009. We performed a matched case-control study of 32 public primary and secondary schools that had one or more confirmed cases of H1N1 influenza and 6815 control schools located in the same 23 counties as case schools. Compared with controls from the same county, schools with reports of confirmed cases of H1N1 influenza were less likely to have a high proportion of economically disadvantaged students (adjusted odds ratio (aOR) 0.385; 95% confidence interval (CI) 0.166-0.894) and less likely to have older students (aOR 0.792; 95% CI 0.670-0.938). We conclude that public schools with younger, more affluent students may be considered sentinels of the epidemic and may have played a role in its initial spread. Copyright © 2010 International Society for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

  18. Estimation of transmission parameters of H5N1 avian influenza virus in chickens.

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    Annemarie Bouma


    Full Text Available Despite considerable research efforts, little is yet known about key epidemiological parameters of H5N1 highly pathogenic influenza viruses in their avian hosts. Here we show how these parameters can be estimated using a limited number of birds in experimental transmission studies. Our quantitative estimates, based on Bayesian methods of inference, reveal that (i the period of latency of H5N1 influenza virus in unvaccinated chickens is short (mean: 0.24 days; 95% credible interval: 0.099-0.48 days; (ii the infectious period of H5N1 virus in unvaccinated chickens is approximately 2 days (mean: 2.1 days; 95%CI: 1.8-2.3 days; (iii the reproduction number of H5N1 virus in unvaccinated chickens need not be high (mean: 1.6; 95%CI: 0.90-2.5, although the virus is expected to spread rapidly because it has a short generation interval in unvaccinated chickens (mean: 1.3 days; 95%CI: 1.0-1.5 days; and (iv vaccination with genetically and antigenically distant H5N2 vaccines can effectively halt transmission. Simulations based on the estimated parameters indicate that herd immunity may be obtained if at least 80% of chickens in a flock are vaccinated. We discuss the implications for the control of H5N1 avian influenza virus in areas where it is endemic.

  19. The Visual N1 Is Sensitive to Deviations from Natural Texture Appearance. (United States)

    Balas, Benjamin; Conlin, Catherine


    Disruptions of natural texture appearance are known to negatively impact performance in texture discrimination tasks, for example, such that contrast-negated textures, synthetic textures, and textures depicting abstract art are processed less efficiently than natural textures. Presently, we examined how visual ERP responses (the P1 and the N1 in particular) were affected by violations of natural texture appearance. We presented participants with images depicting either natural textures or synthetic textures made from the original stimuli. Both stimulus types were additionally rendered either in positive or negative contrast. These appearance manipulations (negation and texture synthesis) preserve a range of low-level features, but also disrupt higher-order aspects of texture appearance. We recorded continuous EEG while participants completed a same/different image discrimination task using these images and measured both the P1 and N1 components over occipital recording sites. While the P1 exhibited no sensitivity to either contrast polarity or real/synthetic appearance, the N1 was sensitive to both deviations from natural appearance. Polarity reversal and synthetic appearance affected the N1 latency differently, however, suggesting a differential impact on processing. Our results suggest that stages of visual processing indexed by the P1 and N1 are sensitive to high-order statistical regularities in natural textures and also suggest that distinct violations of natural appearance impact neural responses differently.

  20. Isolation and characterization of highly pathogenic avian influenza virus subtype H5N1 from donkeys

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    Abdel-Ghany Ahmad E


    Full Text Available Abstract Background The highly pathogenic H5N1 is a major avian pathogen that crosses species barriers and seriously affects humans as well as some mammals. It mutates in an intensified manner and is considered a potential candidate for the possible next pandemic with all the catastrophic consequences. Methods Nasal swabs were collected from donkeys suffered from respiratory distress. The virus was isolated from the pooled nasal swabs in specific pathogen free embryonated chicken eggs (SPF-ECE. Reverse transcriptase polymerase chain reaction (RT-PCR and sequencing of both haemagglutingin and neuraminidase were performed. H5 seroconversion was screened using haemagglutination inhibition (HI assay on 105 donkey serum samples. Results We demonstrated that H5N1 jumped from poultry to another mammalian host; donkeys. Phylogenetic analysis showed that the virus clustered within the lineage of H5N1 from Egypt, closely related to 2009 isolates. It harboured few genetic changes compared to the closely related viruses from avian and humans. The neuraminidase lacks oseltamivir resistant mutations. Interestingly, HI screening for antibodies to H5 haemagglutinins in donkeys revealed high exposure rate. Conclusions These findings extend the host range of the H5N1 influenza virus, possess implications for influenza virus epidemiology and highlight the need for the systematic surveillance of H5N1 in animals in the vicinity of backyard poultry units especially in endemic areas.