YouTube as a Source of Information on Neurosurgery.

Science.gov (United States)

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

2017-09-01

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.

History of Korean Neurosurgery.

Science.gov (United States)

Hwang, Sung-nam

2015-08-01

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.

History of Mechanical Ventilation. From Vesalius to Ventilator-induced Lung Injury.

Science.gov (United States)

Slutsky, Arthur S

2015-05-15

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.

NEUROSURGERY

African Journals Online (AJOL)

our experience with management and outcomes of this condition in children treated in the Neurosurgery Unit at Inkosi. Albert Luthuli Central .... The mean duration ..... Jennet B, Bond M. Assessment of outcome after severe brain damage.

Department of Neurosurgery, Madurai Medical College and the development of neurosurgery in South Tamil Nadu.

Science.gov (United States)

Thiruppathy, Subbiah; Manimaran, Ramiah; Niban, Gopalakrishnan M; Muthukumar, Natarajan

2018-01-01

The development of neurosurgery in South Tamil Nadu can be traced to the Department of Neurosurgery, Madurai Medical College and Government Rajaji Hospital, Madurai, Tamil Nadu, India. The hospital was established in the year 1940 and Madurai Medical College was started in 1954. Prof. M. Natarajan founded this department in September, 1963. This department has a Neurosurgery Residency Program that is 50 years old. The establishment of this department and its growth to its present stature is documented here.

The history of neurosurgery in Bolivia and pediatric neurosurgery in Santa Cruz de la Sierra

OpenAIRE

Dabdoub, Carlos F.; Dabdoub, Carlos B.

2013-01-01

The practice of neurosurgery in Bolivia began thousands of years ago with skull trepanation. This procedure dates from the earliest period of the Tiwanaku culture, a preInca civilization. Neurosurgical development in Bolivia has its origins in the late 19th century and can be divided in two stages. At the beginning, before the advent of neurosurgery as a discipline, some general surgeons performed procedures on the skull and brain. Formal neurosurgery in Bolivia was developed with the arrival...

Neurosurgery Elective for Preclinical Medical Students: Early Exposure and Changing Attitudes.

Science.gov (United States)

Zuckerman, Scott L; Mistry, Akshitkumar M; Hanif, Rimal; Chambless, Lola B; Neimat, Joseph S; Wellons, John C; Mocco, J; Sills, Allen K; McGirt, Matthew J; Thompson, Reid C

2016-02-01

Exposure to surgical subspecialties is limited during the preclinical years of medical school. To offset this limitation, the authors created a neurosurgery elective for first- and second-year medical students. The objective was to provide each student with early exposure to neurosurgery by combining clinical experience with faculty discussions about the academic and personal realities of a career in neurosurgery. From 2012 to 2013, the authors offered a neurosurgery elective course to first- and second-year medical students. Each class consisted of the following: 1) peer-reviewed article analysis; 2) student presentation; 3) faculty academic lecture; 4) faculty personal lecture with question and answer period. Thirty-five students were enrolled over a 2-year period. After completing the elective, students were more likely to: consider neurosurgery as a future career (P life to be higher (P life, and family-work balance, while not altering the students' views about the difficulty of training. Adopting a neurosurgery elective geared towards preclinical medical students can significantly change attitudes about the field of neurosurgery and has potential to increase interest in pursuing a career in neurosurgery. Copyright © 2016 Elsevier Inc. All rights reserved.

NASA Robotic Neurosurgery Testbed

Science.gov (United States)

Mah, Robert

1997-01-01

The detection of tissue interface (e.g., normal tissue, cancer, tumor) has been limited clinically to tactile feedback, temperature monitoring, and the use of a miniature ultrasound probe for tissue differentiation during surgical operations, In neurosurgery, the needle used in the standard stereotactic CT or MRI guided brain biopsy provides no information about the tissue being sampled. The tissue sampled depends entirely upon the accuracy with which the localization provided by the preoperative CT or MRI scan is translated to the intracranial biopsy site. In addition, no information about the tissue being traversed by the needle (e.g., a blood vessel) is provided. Hemorrhage due to the biopsy needle tearing a blood vessel within the brain is the most devastating complication of stereotactic CT/MRI guided brain biopsy. A robotic neurosurgery testbed has been developed at NASA Ames Research Center as a spin-off of technologies from space, aeronautics and medical programs. The invention entitled "Robotic Neurosurgery Leading to Multimodality Devices for Tissue Identification" is nearing a state ready for commercialization. The devices will: 1) improve diagnostic accuracy and precision of general surgery, with near term emphasis on stereotactic brain biopsy, 2) automate tissue identification, with near term emphasis on stereotactic brain biopsy, to permit remote control of the procedure, and 3) reduce morbidity for stereotactic brain biopsy. The commercial impact from this work is the potential development of a whole new generation of smart surgical tools to increase the safety, accuracy and efficiency of surgical procedures. Other potential markets include smart surgical tools for tumor ablation in neurosurgery, general exploratory surgery, prostate cancer surgery, and breast cancer surgery.

Neurosurgery. Fourth edition

International Nuclear Information System (INIS)

Simon, L.; Thomas, D.G.T.; Clark, W.K.

1987-01-01

The Fourth Edition of this volume in the Operative Surgery Series has been considerably revised to accommodate the many changes which have changed the practice of neurosurgery in the past eight years. There have been advances in technology, such as the wider application of CT scanning, in surgical technique, and in the design of new implantable materials. All these developments have substantially affected both the practice of neurosurgery and the prognosis for the patient and are fully reflected in the new edition

The history of neurosurgery in Bolivia and pediatric neurosurgery in Santa Cruz de la Sierra.

Science.gov (United States)

Dabdoub, Carlos F; Dabdoub, Carlos B

2013-09-25

The practice of neurosurgery in Bolivia began thousands of years ago with skull trepanation. This procedure dates from the earliest period of the Tiwanaku culture, a preInca civilization. Neurosurgical development in Bolivia has its origins in the late 19(th) century and can be divided in two stages. At the beginning, before the advent of neurosurgery as a discipline, some general surgeons performed procedures on the skull and brain. Formal neurosurgery in Bolivia was developed with the arrival of neurosurgeons trained in the United States and some countries of South America. The Bolivian Neurosurgical Society was created in 1975. Nowadays, our national society has 74 members. It is affiliated with the World Federation of Neurosurgical Societies and the Latin American Federation of Neurosurgical Societies. Presently, neurosurgery in Bolivia is similar to that seen in developed countries. In this sense, government programs should dedicate more financial support to establish specialized healthcare centers where the management of complex central nervous system lesions could be offered. In contrast, we believe that encouraging the local training of young neurosurgeons is one of the most important factors in the development of neurosurgery in Bolivia or any other country.

Augmented reality in neurosurgery.

Science.gov (United States)

Tagaytayan, Raniel; Kelemen, Arpad; Sik-Lanyi, Cecilia

2018-04-01

Neurosurgery is a medical specialty that relies heavily on imaging. The use of computed tomography and magnetic resonance images during preoperative planning and intraoperative surgical navigation is vital to the success of the surgery and positive patient outcome. Augmented reality application in neurosurgery has the potential to revolutionize and change the way neurosurgeons plan and perform surgical procedures in the future. Augmented reality technology is currently commercially available for neurosurgery for simulation and training. However, the use of augmented reality in the clinical setting is still in its infancy. Researchers are now testing augmented reality system prototypes to determine and address the barriers and limitations of the technology before it can be widely accepted and used in the clinical setting.

Standards for reporting randomized controlled trials in neurosurgery.

Science.gov (United States)

Kiehna, Erin N; Starke, Robert M; Pouratian, Nader; Dumont, Aaron S

2011-02-01

The Consolidated Standards for Reporting of Trials (CONSORT) criteria were published in 1996 to standardize the reporting and improve the quality of clinical trials. Despite having been endorsed by major medical journals and shown to improve the quality of reported trials, neurosurgical journals have yet to formally adopt these reporting criteria. The purpose of this study is to evaluate the quality and reporting of randomized controlled trials (RCTs) in neurosurgery and the factors that may affect the quality of reported trials. The authors evaluated all neurosurgical RCTs published in 2006 and 2007 in the principal neurosurgical journals (Journal of Neurosurgery; Neurosurgery; Surgical Neurology; Journal of Neurology, Neurosurgery, and Psychiatry; and Acta Neurochirurgica) and in 3 leading general medical journals (Journal of the American Medical Association, Lancet, and the New England Journal of Medicine). Randomized controlled trials that addressed operative decision making or the treatment of neurosurgical patients were included in this analysis. The RCT quality was evaluated using the Jadad score and the CONSORT checklist. In 2006 and 2007, 27 RCTs relevant to intracranial neurosurgery were reported. Of these trials, only 59% had a Jadad score ≥ 3. The 3 major medical journals all endorsed the CONSORT guidelines, while none of the neurosurgical journals have adopted these guidelines. Randomized controlled trials published in the 3 major medical journals had a significantly higher mean CONSORT score (mean 41, range 39-44) compared with those published in neurosurgical journals (mean 26.4, range 17-38; p journals (mean 3.42, range 2-5) than neurosurgical journals (mean 2.45, range 1-5; p = 0.05). Despite the growing volume of RCTs in neurosurgery, the quality of reporting of these trials remains suboptimal, especially in the neurosurgical journals. Improved awareness of the CONSORT guidelines by journal editors, reviewers, and authors of these papers could

21 CFR 882.4800 - Self-retaining retractor for neurosurgery.

Science.gov (United States)

2010-04-01

... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Self-retaining retractor for neurosurgery. 882...-retaining retractor for neurosurgery. (a) Identification. A self-retaining retractor for neurosurgery is a self-locking device used to hold the edges of a wound open during neurosurgery. (b) Classification...

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

NARCIS (Netherlands)

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

1998-01-01

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

Past, Present, and Future of Neurosurgery in Uganda.

Science.gov (United States)

Haglund, Michael M; Warf, Benjamin; Fuller, Anthony; Freischlag, Kyle; Muhumuza, Michael; Ssenyonjo, Hussein; Mukasa, John; Mugamba, John; Kiryabwire, Joel

2017-04-01

Neurosurgery in Uganda was virtually non-existent up until late 1960s. This changed when Dr. Jovan Kiryabwire spearheaded development of a neurosurgical unit at Mulago Hospital in Kampala. His work ethic and vision set the stage for rapid expansion of neurosurgical care in Uganda.At the beginning of the 2000s, Uganda was a country of nearly 30 million people, but had only 4 neurosurgeons. Neurosurgery's progress was plagued by challenges faced by many developing countries, such as difficulty retaining specialists, lack of modern hospital resources, and scarce training facilities. To combat these challenges 2 distinct programs were launched: 1 by Dr. Benjamin Warf in collaboration with CURE International, and the other by Dr. Michael Haglund from Duke University. Dr. Warf's program focused on establishing a facility for pediatric neurosurgery. Dr. Haglund's program to increase neurosurgical capacity was founded on a "4 T's Paradigm": Technology, Twinning, Training, and Top-Down. Embedded within this paradigm was the notion that Uganda needed to train its own people to become neurosurgeons, and thus Duke helped establish the country's first neurosurgery residency training program.Efforts from overseas, including the tireless work of Dr. Benjamin Warf, have saved thousands of children's lives. The influx of the Duke Program caused a dynamic shift at Mulago Hospital with dramatic effects, as evidenced by the substantial increase in neurosurgical capacity. The future looks bright for neurosurgery in Uganda and it all traces back to a rural village where 1 man had a vision to help the people of his country. Copyright © 2017 by the Congress of Neurological Surgeons.

The Prevalence of Burnout Among US Neurosurgery Residents.

Science.gov (United States)

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

2017-10-27

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. Copyright © 2017 by the Congress of Neurological Surgeons

Progress of women in neurosurgery.

Science.gov (United States)

Spetzler, Robert F

2011-01-01

Despite advances in issues related to gender equity, barriers to recruiting and retaining women in neurosurgery continue to exist. At the same time, the overall projected shortage of neurosurgeons suggests that women will be vital to the long-term success of the field. Attracting women to neurosurgery can capitalize on strategies, such as mentoring, teaching leadership and negotiating skills, and job sharing or dual training tracks to name a few, that would benefit both men and women passionate about pursuing neurosurgery. Ultimately, personal and institutional accountability must be evaluated to ensure that the best and brightest candidates, regardless of gender, are recruited to neurosurgical programs to promote the health of our challenging but most satisfying profession.

Challenges in paediatric neurosurgery

Directory of Open Access Journals (Sweden)

Pragati Ganjoo

2017-01-01

Full Text Available Improvements in technique, knowledge and expertise have brought about rapid advances in the fields of paediatric neurosurgery and anaesthesia, and many procedures limited earlier to adults are now being increasingly attempted in neonates and small children, with good outcomes. This article highlights the challenges faced by the operating team while handling some of the technically complex procedures like awake craniotomy, interventional neuroradiology, minimally invasive neurosurgery, procedures in intraoperative magnetic resonance imaging suites, and neonatal emergencies in the paediatric population.

Functional neurosurgery (part 2)

African Journals Online (AJOL)

This month's CME includes the final two articles that review func- tional neurosurgical topics, i.e. surgery for movement disorders,[1] where deep brain stimulation plays a major role, and surgical man- agement of pain.[2] From these articles, which give an overview of the respective topics, it is clear that neurosurgery forms a ...

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

Science.gov (United States)

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

2015-01-01

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.

Unplanned readmission within 90 days after pediatric neurosurgery.

Science.gov (United States)

Chotai, Silky; Guidry, Bradley S; Chan, Emily W; Sborov, Katherine D; Gannon, Stephen; Shannon, Chevis; Bonfield, Christopher M; Wellons, John C; Naftel, Robert P

2017-12-01

OBJECTIVE Readmission and return to operating room after surgery are increasingly being used as a proxy for quality of care. Nearly 60% of these readmissions are unplanned, which translates into billions of dollars in health care costs. The authors set out to analyze the incidence of readmission at their center, to define causes of unplanned readmission, and to determine the preoperative and surgical variables associated with readmissions following pediatric neurosurgery. METHODS A total of 536 children who underwent operations for neurosurgical diagnoses between 2012 and 2015 and who were later readmitted were included in the final analysis. Unplanned readmissions were defined to have occurred as a result of complications within 90 days after index surgery. Patient records were retrospectively reviewed to determine the primary diagnosis, surgery indication, and cause of readmission and return to operating room. The cost for index hospitalization, readmission episode, and total cost were derived based on the charges obtained from administrative data. Bivariate and multivariable analyses were conducted. RESULTS Of 536 patients readmitted in total, 17.9% (n = 96) were readmitted within 90 days. Of the overall readmissions, 11.9% (n = 64) were readmitted within 30 days, and 5.97% (n = 32) were readmitted between 31 and 90 days. The median duration between discharge and readmission was 20 days (first quartile [Q1]: 9 days, third quartile [Q3]: 36 days). The most common reason for readmission was shunt related (8.2%, n = 44), followed by wound infection (4.7%, n = 25). In the risk-adjusted multivariable logistic regression model for total 90-day readmission, patients with the following characteristics: younger age (p = 0.001, OR 0.886, 95% CI 0.824-0.952); "other" (nonwhite, nonblack) race (p = 0.024, OR 5.49, 95% CI 1.246-24.2); and those born preterm (p = 0.032, OR 2.1, 95% CI 1.1-4.12) had higher odds of being readmitted within 90 days after discharge. The total

Big Data Research in Neurosurgery: A Critical Look at this Popular New Study Design.

Science.gov (United States)

Oravec, Chesney S; Motiwala, Mustafa; Reed, Kevin; Kondziolka, Douglas; Barker, Fred G; Michael, L Madison; Klimo, Paul

2018-05-01

The use of "big data" in neurosurgical research has become increasingly popular. However, using this type of data comes with limitations. This study aimed to shed light on this new approach to clinical research. We compiled a list of commonly used databases that were not specifically created to study neurosurgical procedures, conditions, or diseases. Three North American journals were manually searched for articles published since 2000 utilizing these and other non-neurosurgery-specific databases. A number of data points per article were collected, tallied, and analyzed.A total of 324 articles were identified since 2000 with an exponential increase since 2011 (257/324, 79%). The Journal of Neurosurgery Publishing Group published the greatest total number (n = 200). The National Inpatient Sample was the most commonly used database (n = 136). The average study size was 114 841 subjects (range, 30-4 146 777). The most prevalent topics were vascular (n = 77) and neuro-oncology (n = 66). When categorizing study objective (recognizing that many papers reported more than 1 type of study objective), "Outcomes" was the most common (n = 154). The top 10 institutions by primary or senior author accounted for 45%-50% of all publications. Harvard Medical School was the top institution, using this research technique with 59 representations (31 by primary author and 28 by senior).The increasing use of data from non-neurosurgery-specific databases presents a unique challenge to the interpretation and application of the study conclusions. The limitations of these studies must be more strongly considered in designing and interpreting these studies.

Samii's essentials in neurosurgery

International Nuclear Information System (INIS)

Ramina, Ricardo; Pontifical Catholic Univ. of Parana, Curitiba; Pires Aguiar, Paulo Henrique; Sao Paulo Univ.; Hospital Santa Paula, Sao Paulo; Tatagiba, Marcos

2008-01-01

'Samii's Essentials in Neurosurgery' contains selected papers written by internationally recognized contributors who were trained by Professor Madjid Samii in Hannover, Germany. The main topics deal with cutting-edge technology in neurosurgery, skull-base surgery, and specific peripheral nerve, spine, and vascular surgeries. The texts and a wealth of illustrations review and reinforce guidelines on the diagnosis and management of situations that readers are likely to encounter in everyday practice. This book will be of great interest to neurosurgeons, neurologists, ENT surgeons, neuroradiologists, and neurophysiotherapists. (orig.)

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

LENUS (Irish Health Repository)

O'Brien, Deirdre

2012-02-01

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.

Chronic Pain in Neurosurgery.

Science.gov (United States)

Grodofsky, Samuel

2016-09-01

This review includes a summary of contemporary theories of pain processing and advocates a multimodal analgesia approach for providing perioperative care. A summary of various medication classes and anesthetic techniques is provided that highlights evidence emerging from neurosurgical literature. This summary covers opioid management, acetaminophen, nonsteroidal antiinflammatories, ketamine, lidocaine, dexmedetomidine, corticosteroids, gabapentin, and regional anesthesia for neurosurgery. At present, there is not enough investigation into these areas to describe best practices for treating or preventing chronic pain in neurosurgery; but providers can identify a wider range of options available to personalize perioperative care strategies. Copyright © 2016 Elsevier Inc. All rights reserved.

History of Neurosurgery in Malaysia.

Science.gov (United States)

Raffiq, Azman; Abdullah, Jafri Malin; Haspani, Saffari; Adnan, Johari Siregar

2015-12-01

The development of neurosurgical services and training in Malaysia began in 1963, with the first centre established in its capital city at Hospital Kuala Lumpur, aimed to provide much needed neurosurgical services and training in the field of neurology and neurosurgery. This center subsequently expanded in 1975 with the establishment of the Tunku Abdul Rahman Neuroscience Institute (IKTAR); which integrated the three allied interdependent disciplines of neurosurgery, neurology and psychiatry. The establishment of this institute catalysed the rapid expansion of neurosurgical services in Malaysia and paved the way for development of comprehensive training for doctors, nurses, and paramedics. This culminated in the establishments of a local comprehensive neurosurgery training program for doctors in 2001; followed by a training program for nurses and paramedics in 2006. To date, there are more than 60 neurosurgeons providing expert care in 11 centers across Malaysia, along with trained personnel in the field of neurosciences.

Publication misrepresentation among neurosurgery residency applicants: an increasing problem.

Science.gov (United States)

Kistka, Heather M; Nayeri, Arash; Wang, Li; Dow, Jamie; Chandrasekhar, Rameela; Chambless, Lola B

2016-01-01

OBJECT Misrepresentation of scholarly achievements is a recognized phenomenon, well documented in numerous fields, yet the accuracy of reporting remains dependent on the honor principle. Therefore, honest self-reporting is of paramount importance to maintain scientific integrity in neurosurgery. The authors had observed a trend toward increasing numbers of publications among applicants for neurosurgery residency at Vanderbilt University and undertook this study to determine whether this change was a result of increased academic productivity, inflated reporting, or both. They also aimed to identify application variables associated with inaccurate citations. METHODS The authors retrospectively reviewed the residency applications submitted to their neurosurgery department in 2006 (n = 148) and 2012 (n = 194). The applications from 2006 were made via SF Match and those from 2012 were made using the Electronic Residency Application Service. Publications reported as "accepted" or "in press" were verified via online search of Google Scholar, PubMed, journal websites, and direct journal contact. Works were considered misrepresented if they did not exist, incorrectly listed the applicant as first author, or were incorrectly listed as peer reviewed or published in a printed journal rather than an online only or non-peer-reviewed publication. Demographic data were collected, including applicant sex, medical school ranking and country, advanced degrees, Alpha Omega Alpha membership, and USMLE Step 1 score. Zero-inflated negative binomial regression was used to identify predictors of misrepresentation. RESULTS Using univariate analysis, between 2006 and 2012 the percentage of applicants reporting published works increased significantly (47% vs 97%, p < 0.001). However, the percentage of applicants with misrepresentations (33% vs 45%) also increased. In 2012, applicants with a greater total of reported works (p < 0.001) and applicants from unranked US medical schools (those not

The 2015 AANS Presidential Address: Neurosurgery's founding principles.

Science.gov (United States)

Harbaugh, Robert E

2015-12-01

These are turbulent times for American neurosurgery. It is important to look ahead and prepare for the future but it is also important to look back-for it is memory and tradition that prevent the tyranny of the present. It is impossible to know where we are going if we don't remember where we were. In this paper I want to discuss the founding principles of neurosurgery-the principles that have allowed neurosurgery to prosper in its first century-and to stress the importance of adhering to these principles in times of change. I also want to talk to you about how the American Association of Neurological Surgeons (AANS) is helping neurosurgeons honor our founding principles, while preparing neurosurgery for its second century.

[History of world neurosurgery].

Science.gov (United States)

Wang, X

2017-05-28

In 5000 BC, South American tribes digged the bones in the living head to seek ways to communicate with the gods, which was primitive trephination and may be the first neurosurgical behavior. In 2600 BC, Imhotep in ancient Egypt took the brain out of the head from the nose, for a better preserve of the mummy, which was a prototype of modern transsphenoidal surgery. And the development of anatomy in ancient Greek laid a solid foundation for neurosurgery. From 500 to 1500 AD, the rise of religion and the occurrence of war, prompted a large number of craniocerebral trauma, which contributed greatly to the early development of neurosurgery as a distinct specialty. In 1861, Brocca astutely localized the language function to the third left frontal convolution in a series of studies, which was considered to be of landmark importance in the understanding of cerebral localization. In 1878, William Macewen performed a successful surgery to remove an en plaque meningioma with intrathecal anesthesia, representing the first modern neurosurgical operation. However, the contributions of the Americans, starting with Harvey Cushing, exerted a definitive force. Portuguese Moritz performed the first cerebral angiogram on a living schizophrenia patient in 1926. And he established the Moniz-Lima prefrontal leucotomy for the treatment of schizophrenia, for which he won the Nobel Prize in Physiology and Medicine in 1949. In 1968, the Swiss scholar Yassagir firstly carried out neurosurgical surgeries under the microscope. China's neurosurgery was founded by Zhao Yicheng in 1952 in Tianjin, and the gap in neurosurgery between China and the world gradually narrowed after 60 years of development.

Influence of intraoperative magnetic resonance imaging used in neurosurgery on anesthesia

Directory of Open Access Journals (Sweden)

Mao-wei GONG

2011-09-01

Full Text Available Objective To observe the influcences of intraoperative magnetic resonance imaging(iMRI used in neurosurgery on anesthesia.Methods Sixty patients with glioma were randomly divided into two groups(30 each,the patients in iMRI group underwent craniotomy and glioma ablation under the guidance of iMRI and functional neuro-navigation,and in N group with the functional neuro-navigation only.The patients’ general status and concerning parameters were observed and recorded,including anesthesia duration,preparation time for surgery,duration of surgery,blood loss,volume of fluid administration,number of patients who needed blood transfusion,preoperative and postoperative hemoglobin,postoperative body temperature,dosage of muscle relaxant,and the unforeseen incidents related to iMRI and anesthesia.Results No significant differences existed between the two groups(P > 0.05 in patients’ general status,anesthesia duration,blood loss,volume of fluid administration,numbers of patients who needed blood transfusion,preoperative and postoperative hemoglobin,and body temperature.However,the preparation time for and duration of surgery were longer,the dosage of muscle relaxant was larger in iMRI group than in N group(P < 0.05.No inadvertent incident related to iMRI and anesthesia occurred in both groups.Conclusions The application of iMRI in neurosurgery may improve the accuracy in operative manipulation and make the tumor resection more thorough,but it may prolong duration of surgery.Other perimoperative care related to iMRI surgery is similar to that of traditional functional neuro-navigation surgery.Besides the basic rules of neurosurgery anesthetic management for neurosurgery,anesthetist should focus on anesthetic adjustment for a long operation.

Technological innovation in neurosurgery: a quantitative study.

Science.gov (United States)

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

2015-07-01

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.

Case-control studies in neurosurgery.

Science.gov (United States)

Nesvick, Cody L; Thompson, Clinton J; Boop, Frederick A; Klimo, Paul

2014-08-01

/intervention and true case-control studies was strengthened (OR 0.053, 95% CI 0.0064-0.44). There was a trend toward a negative association between the use of survival analysis or Kaplan-Meier curves and true case-control studies (OR 0.13, 95% CI 0.015-1.12). True case-control studies were no more likely than their counterparts to use a potential study design "expert" (OR 1.50, 95% CI 0.57-3.95). The overall average STROBE score was 72% (range 50-86%). Examples of reporting deficiencies were reporting of bias (28%), missing data (55%), and funding (44%). The results of this analysis show that the majority of studies in the neurosurgical literature that identify themselves as "case-control" studies are, in fact, labeled incorrectly. Positive and negative predictors were identified. The authors provide several recommendations that may reverse the incorrect and inappropriate use of the term "case-control" and improve the quality of design and reporting of true case-control studies in neurosurgery.

Demographics, Interests, and Quality of Life of Canadian Neurosurgery Residents.

Science.gov (United States)

Iorio-Morin, Christian; Ahmed, Syed Uzair; Bigder, Mark; Dakson, Ayoub; Elliott, Cameron; Guha, Daipayan; Kameda-Smith, Michelle; Lavergne, Pascal; Makarenko, Serge; Taccone, Michael S; Tso, Michael K; Wang, Bill; Winkler-Schwartz, Alexander; Fortin, David

2018-03-01

Neurosurgical residents face a unique combination of challenges, including long duty hours, technically challenging cases, and uncertain employment prospects. We sought to assess the demographics, interests, career goals, self-rated happiness, and overall well-being of Canadian neurosurgery residents. A cross-sectional survey was developed and sent through the Canadian Neurosurgery Research Collaborative to every resident enrolled in a Canadian neurosurgery program as of April 1, 2016. We analyzed 76 completed surveys of 146 eligible residents (52% response rate). The median age was 29 years, with 76% of respondents being males. The most popular subspecialties of interest for fellowship were spine, oncology, and open vascular neurosurgery. The most frequent self-reported number of worked hours per week was the 80- to 89-hour range. The majority of respondents reported a high level of happiness as well as stress. Sense of accomplishment and fatigue were reported as average to high and overall quality of life was low for 19%, average for 49%, and high for 32%. Satisfaction with work-life balance was average for 44% of respondents and was the only tested domain in which significant dissatisfaction was identified (18%). Overall, respondents were highly satisfied with their choice of specialty, choice of program, surgical exposure, and work environment; however, intimidation was reported in 36% of respondents and depression by 17%. Despite a challenging residency and high workload, the majority of Canadian neurosurgery residents are happy and satisfied with their choice of specialty and program. However, work-life balance, employability, resident intimidation, and depression were identified as areas of active concern.

Highly cited works in neurosurgery. Part II: the citation classics.

Science.gov (United States)

Ponce, Francisco A; Lozano, Andres M

2010-02-01

The term "citation classic" has been used in reference to an article that has been cited more than 400 times. The purpose of this study is to identify such articles that pertain to clinical neurosurgery. A list of search phrases relating to neurosurgery was compiled. A topic search was performed using the Institute for Scientific Information Web of Science for phrases. Articles with more than 400 citations were identified, and nonclinical articles were omitted. The journals, year of publication, topics, and study types were analyzed. There were 106 articles with more than 400 citations relating to clinical neurosurgery. These articles appeared in 28 different journals, with more than half appearing in the Journal of Neurosurgery or the New England Journal of Medicine. Fifty-three articles were published since 1990. There were 38 articles on cerebrovascular disease, 21 on stereotactic and functional neurosurgery, 21 on neurooncology, 19 on trauma, 4 on nontraumatic spine, 2 on CSF pathologies, and 1 on infection. There were 29 randomized trials, of which 86% appeared in the New England Journal of Medicine, Lancet, or the Journal of the American Medical Association, and half concerned the prevention or treatment of stroke. In addition, there were 16 prospective studies, 15 classification or grading systems, and 7 reviews. The remaining 39 articles were case series, case reports, or technical notes. More than half of the citation classics identified in this study have been published in the past 20 years. Case series, classifications, and reviews appeared more frequently in neurosurgical journals, while randomized controlled trials tended to be published in general medical journals.

History, Current Situation, and Future Development of Endoscopic Neurosurgery in China.

Science.gov (United States)

Li, Chuzhong; Zhu, Haibo; Zong, Xuyi; Wang, Xinsheng; Gui, Songbai; Zhao, Peng; Zhang, Yazhuo

2018-02-01

During the past few decades, Chinese endoscopic neurosurgery has rapidly developed in synchrony with the rest of the world. The aim of this article is to review the development of Chinese endoscopic neurosurgery, including its birth, growth, current situation, and prospects. The history of Chinese endoscopic neurosurgery development can be divided into 3 stages: cognition and initial stage (1964-1995), exploration and maturity stage (1995-2006), and rapid development and promotion stage (2006-present). In the first stage, we mainly began to become aware of endoscopic neurosurgery from the translation and review of literature. In the mid to late 1990s, Chinese neurosurgery pioneers began using neuroendoscopic techniques. In the following decade, many leading neurosurgeons made persistent efforts to push the development of Chinese endoscopic neurosurgery forward, focusing on advocating for and promoting and popularizing neuroendoscopic technology. In the rapid development and promotion stage, many representative national and regional neurosurgical centers became skilled and efficient in the application of neuroendoscopic technology and became new advocates of the technology. The number of cases, level of technology, and treatment effectiveness are gradually nearing international standards. However, future development requires promotion of balanced development to decrease regional disparities, further strengthen international exchanges, follow the latest developments, and constantly innovate for continuous improvement. Following the dramatic efforts of several pioneers, development of Chinese endoscopic neurosurgery has been considerable, and it has become an important component of neurosurgery worldwide. Copyright © 2017 Elsevier Inc. All rights reserved.

New CT-aided stereotactic neurosurgery technique

International Nuclear Information System (INIS)

Shao, H.M.; Truong, T.K.; Reed, I.S.; Slater, R.A.

1985-01-01

In this communication, a new technique for CT-aided stereotactic neurosurgery is presented. The combination of specially designed hardware and software provides a fast, simple, and versatile tool for the accurate insertion of a probe into the human brain. This system is portable and can be implemented on any CT computer system. The complete procedure to perform the CT-aided stereotactic neurosurgery technique is presented. Experimental results are given which demonstrate the power of the method. Finally, the key algorithms for realizing this technique are described in the Appendix

Bradford's law: identification of the core journals for neurosurgery and its subspecialties.

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

2016-02-01

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.

Neurosurgery and Music; Effect of Wolfgang Amadeus Mozart.

Science.gov (United States)

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

2017-06-01

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.

The history of neurosurgery at the University of Sao Paulo

Directory of Open Access Journals (Sweden)

Manoel Jacobsen Teixeira

2014-03-01

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.

Dr. Lenke Horvath (1917-1991): Creator of Pediatric Neurosurgery in Romania.

Science.gov (United States)

Mohan, Dumitru; Moisa, Horatiu Alexandru; Nica, Dan Aurel; Ciurea, Alexandru Vlad

2016-04-01

The development of neurosurgery as an independent specialty took place with great difficulty in Romania. In this respect, the most revered personalities are those of Professor Alexandru Moruzzi (1900-1957) (in Iasi) and Professor Dimitrie Bagdasar (1893-1946) (in Bucharest), who are the fathers of modern neurosurgery in Romania. Professor Bagdasar was schooled in Professor Harvey Cushing's clinic in Boston and is credited with creating the first completely independent neurosurgical unit in Romania. His legacy was carried on with honor by Professor Constantin Arseni (1912-1994), who, in 1975, tasked Dr. Lenke Horvath (1917-1991) with creating the first autonomous pediatric neurosurgery unit in Bucharest. This article is a small tribute to the founder of pediatric neurosurgery in Romania and one of the female pioneer neurosurgeons, who, by personal example of dedication and hard work, radically changed medical thinking and neurosurgery in Romania. Copyright © 2016 Elsevier Inc. All rights reserved.

Interactive computer graphics for stereotactic neurosurgery

International Nuclear Information System (INIS)

Goodman, J.H.; Davis, J.R.; Gahbauer, R.A.

1986-01-01

A microcomputer (IBM PC/AT) system has been developed to incorporate multiple image sources for stereotactic neurosurgery. Hard copy data is calibrated and captured with a video camera and frame grabber. Line contours are generated automatically on the basis of gray scale density or digitized manually. Interactive computer graphics provide a format with acceptable speed and accuracy for stereotactic neurosurgery. The ability to dimensionally integrate existing image data from multiple sources for target selection makes preoperative scans and scanner compatible head holders unnecessary. The system description and examples of use for brain tumor biopsy and brachytherapy ware presented

Stereotactic neurosurgery for tremor

NARCIS (Netherlands)

Speelman, Johannes D.; Schuurman, Richard; de Bie, Rob M. A.; Esselink, Rianne A. J.; Bosch, D. Andries

2002-01-01

The role of the motor thalamus as surgical target in stereotactic neurosurgery for different kinds of tremor is discussed. For tremor in Parkinson's disease. the subthalamic nucleus becomes more and more often the surgical target, because this target also gives relief of other and more

Advanced technology in neurosurgery

International Nuclear Information System (INIS)

Pluchino, F.; Broggi, G.

1987-01-01

Technological improvements in neurosurgery are discussed. The use of surgical lasers, ultrasound aspirators, bipolar coagulator and operative microscopes for surgery of deep-seated neoplasms and vascular malformations is discussed. Intraoperative monitoring, chronotherapy, chronic neurostimulation and stereotactic interstitial irradiation are covered and indications for interventional neuroradiology are reviewed

Neurosurgical Skills Assessment: Measuring Technical Proficiency in Neurosurgery Residents Through Intraoperative Video Evaluations.

Science.gov (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

2016-05-01

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.

The Co-evolution of Neuroimaging and Psychiatric Neurosurgery.

Science.gov (United States)

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

2016-01-01

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.

The history of neurosurgery at the University of Alabama at Birmingham.

Science.gov (United States)

Foreman, Paul M; Markert, James M; Diethelm, Arnold G; Hadley, Mark N

2014-10-01

: The Division of Neurosurgery at the University of Alabama at Birmingham was formally founded in 1954 under the leadership of James Garber Galbraith. The following 60 years would see neurosurgery at the forefront of the development of a nationally recognized medical center in the heart of Birmingham, Alabama. The Department of Neurosurgery now employs 14 faculty members, performs more than 4500 neurosurgical procedures annually, is active in clinical and laboratory research, and boasts a contemporary, comprehensive residency training program.

Endovascular Neurosurgery: Personal Experience and Future Perspectives.

Science.gov (United States)

Raymond, Jean

2016-09-01

From Luessenhop's early clinical experience until the present day, experimental methods have been introduced to make progress in endovascular neurosurgery. A personal historical narrative, spanning the 1980s to 2010s, with a review of past opportunities, current problems, and future perspectives. Although the technology has significantly improved, our clinical culture remains a barrier to methodologically sound and safe innovative care and progress. We must learn how to safely practice endovascular neurosurgery in the presence of uncertainty and verify patient outcomes in real time. Copyright © 2016 Elsevier Inc. All rights reserved.

Studying Behaviors Among Neurosurgery Residents Using Web 2.0 Analytic Tools.

Science.gov (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 (www.TheBrainSchool.net). 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.

Preoperative anemia increases postoperative morbidity in elective cranial neurosurgery

Science.gov (United States)

Bydon, Mohamad; Abt, Nicholas B.; Macki, Mohamed; Brem, Henry; Huang, Judy; Bydon, Ali; Tamargo, Rafael J.

2014-01-01

Background: Preoperative anemia may affect postoperative mortality and morbidity following elective cranial operations. Methods: The American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database was used to identify elective cranial neurosurgical cases (2006-2012). Morbidity was defined as wound infection, systemic infection, cardiac, respiratory, renal, neurologic, and thromboembolic events, and unplanned returns to the operating room. For 30-day postoperative mortality and morbidity, adjusted odds ratios (ORs) were estimated with multivariable logistic regression. Results: Of 8015 patients who underwent elective cranial neurosurgery, 1710 patients (21.4%) were anemic. Anemic patients had an increased 30-day mortality of 4.1% versus 1.3% in non-anemic patients (P neurosurgery was independently associated with an increased risk of 30-day postoperative mortality and morbidity when compared to non-anemic patients. A hematocrit level below 33% (Hgb 11 g/dl) was associated with a significant increase in postoperative morbidity. PMID:25422784

Curriculum-based neurosurgery digital library.

Science.gov (United States)

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

2010-11-01

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.

[The origins of the French neurosurgery].

Science.gov (United States)

Brunon, J

2016-06-01

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.

Application of fiber tractography for neurosurgery

International Nuclear Information System (INIS)

Hashimoto, Naoya; Yoshimine, Toshiki

2007-01-01

This review describes about the fiber tractography (FT) for its basic principle, method, and application to neurosurgery involving usefulness, pitfall, validation needed and future perspective. MR diffusion weighted image exhibits the diffusion (Brownian movement) of water molecules and its multiple images taken by different angles of magnetic field can also give information of their diffusion anisotropy, whereby diffusion tensor image is yielded as FT owing to their high anisotropy, with use of appropriate softwares assuming an ellipsoid of anisotropic water (single tensor model). FT thus presents an image of a specific and functional neurofiber bundle. Recently, FT in neurosurgery has been recognized to have pitfalls in tracing the bundle at its crossing and branch, e.g., suggested avoidance of surgery of eloquent area navigated with FT alone. For this, developed and considered are the multi-tensor models based on multiple ellipsoids and on probabilistic one on probability, and combination of electrophysiological mapping is thought necessary as well. Application of FT is also actively in progress to understand neurological diseases like cerebral vascular lesion, hemiplegia, epilepsy, injury and many others. FT navigation without other validation is thus limited in neurosurgery, but FT is surely one of means to improve patients' prognosis and quality of life (QOL). (R.T.)

Laser applications in neurosurgery

Science.gov (United States)

Cerullo, Leonard J.

1985-09-01

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

Intraoperative ultrasound in neurosurgery

International Nuclear Information System (INIS)

Velasco, J.; Manzanares, R.; Fernandez, L.; Hernando, A.; Ramos, M. del Mar; Garcia, R.

1996-01-01

The present work is a review of the major indications for intraoperative ultrasound in the field of neurosurgery, stressing the exploratory method and describing what we consider to be the most illustrative cases. We attempt to provide a thorough view of this constantly developing technique which, despite its great practical usefulness, may be being underemployed. (Author) 47 refs

Third-generation cephalosporins as antibiotic prophylaxis in neurosurgery : What's the evidence?

NARCIS (Netherlands)

Liu, Weiming; Neidert, Marian Christoph; Groen, Rob J. M.; Woernle, Christoph Michael; Grundmann, Hajo

To analyze the role of third-generation cephalosporins as prophylactic antibiotics in neurosurgery. We reviewed the literature for data from randomized controlled trials (RCTs) on third-generation cephalosporins compared to other antibiotic regimen in neurosurgery. End point of the RCTs was the

Intraoperative Image Guidance in Neurosurgery: Development, Current Indications, and Future Trends

International Nuclear Information System (INIS)

Schulz, Ch.; Mauer, U.M.; Waldeck, S.

2012-01-01

Introduction. As minimally invasive surgery becomes the standard of care in neurosurgery, it is imperative that surgeons become skilled in the use of image-guided techniques. The development of image-guided neurosurgery represents a substantial improvement in the microsurgical treatment of tumors, vascular malformations, and other intracranial lesions. Objective. There have been numerous advances in neurosurgery which have aided the neurosurgeon to achieve accurate removal of pathological tissue with minimal disruption of surrounding healthy neuronal matter including the development of microsurgical, endoscopic, and endovascular techniques. Neuro navigation systems and intraoperative imaging should improve success in cranial neurosurgery. Additional functional imaging modalities such as PET, SPECT, DTI (for fiber tracking), and fMRI can now be used in order to reduce neurological deficits resulting from surgery; however the positive long-term effect remains questionable for many indications. Method. Pub Med database search using the search term “image guided neurosurgery.” More than 1400 articles were published during the last 25 years. The abstracts were scanned for prospective comparative trials. Results and Conclusion. 14 comparative trials are published. To date significant data amount show advantages in intraoperative accuracy influencing the perioperative morbidity and long-term outcome only for cerebral glioma surgery.

Patient Satisfaction and Short-Term Outcome in Elective Cranial Neurosurgery.

Science.gov (United States)

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

2015-11-01

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.

A study on CT-guided stereotactic technique for functional neurosurgery

International Nuclear Information System (INIS)

Uetsuhara, Koichi; Asakura, Tetsuhiko; Hirahara, Kazuho; Gondo, Masazumi; Oda, Hiroshige

1987-01-01

Recently, CT-guided stereotactic surgery has become of major interest, and some authors have discussed its potential in functional neurosurgery. The following is a comparative study of the CT-guided stereotactic technique and the conventional roentogenographic stereotactic technique. The Brown-Roberts-Wells apparatus was used for both types of procedures. 37 stereotactic procedures were performed on 35 patients under local anesthesia; 16 for stereotactic biopsy and 21 for stereotactic functional neurosurgery. Target points for stereotactic biopsy were determined by the CT-guided technique and target points for functional neurosurgery were determined by the conventional roentogenographic technique. The correlation with the position of target point determined by both techniques was investigated in the 21 functional neurosurgical procedures. On these occasions the authors used the reformatted horizontal and sagittal CT through the anterior and posterior commissure to determine the position of target point by the CT-guided technique. Results: It was found that the AC-PC line crossed with Reid's base line at angle of 11 ± 1 deg, and therefore it is important to obtain a CT images including AC-PC line at this angle. When applying the CT guided stereotactic procedure for functional surgery, it should be known that there could be a discrepancy within 2 mm from the conventional target determination. (author)

Minimalism in Art, Medical Science and Neurosurgery.

Science.gov (United States)

Okten, Ali Ihsan

2018-01-01

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.

Surgical site infections after elective neurosurgery: a survey of 1747 patients.

Science.gov (United States)

Valentini, Laura G; Casali, Cecilia; Chatenoud, Liliane; Chiaffarino, Francesca; Uberti-Foppa, Caterina; Broggi, Giovanni

2008-01-01

To evaluate the incidence and risk factors of postsurgical site infections (SSIs) in elective neurosurgical procedures in patients treated with an ultrashort antibiotic protocol. In this consecutive series of 1747 patients treated with elective neurosurgery and ultrashort prophylactic antibiotic therapy at the Fondazione Istituto Nazionale Neurologico "Carlo Besta" in Milan, the rate of SSIs was 0.7% (13 patients). When only clean neurosurgery was considered, there were 11 such SSIs (1.52%) in 726 craniotomies and one SSI (0.15) in 663 spinal operations. The antibiotic protocol was prolonged in every case of external communication as cerebrospinal fluid leaks or external drainages. The infection rate of the whole series was low (0.72%), and a risk factor identified for SSIs in clean neurosurgery was longer surgery duration. The relative risk estimate was 12.6 for surgeries lasting 2 hours and 24.3 for surgeries lasting 3 or more hours. Patients aged older than 50 years had a lower risk of developing SSI with a relative risk of 0.23 when compared with patients aged younger than 50 years. The present series reports a low incidence of SSIs for elective neurosurgery, even for high-risk complex craniotomies performed for tumor removal. Given that an antibiotic protocol prolongation was used to pretreat any early signs of infection and external communication, the protocol was appropriate for the case mix. The two identified risk factors (surgical duration > 2 hours and middle-aged patients [16-50 yr]) may be indicators of other factors, such as the level of surgical complexity and poor neurological outcome.

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

DEFF Research Database (Denmark)

Hørberg, Mette; Reibel, Jesper; Kragelund, Camilla

2016-01-01

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...

Three-dimensional, computer simulated navigation in endoscopic neurosurgery

Directory of Open Access Journals (Sweden)

Roberta K. Sefcik, BHA

2017-06-01

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.

Mobile pediatric neurosurgery: rapid response neurosurgery for remote or urgent pediatric patients.

Science.gov (United States)

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

2015-09-01

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.

Preresidency Publication Number Does Not Predict Academic Career Placement in Neurosurgery.

Science.gov (United States)

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

2017-05-01

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 < 0.003), H-index ≥ 2 during residency (OR [95% CI]: 2.32 [1.40-1.69]; P < 0.0001) and having devoted research time before residency (OR [95% CI]: 1.56 [1.10-2.22]; P < 0.012). Notably, publications before residency were not an independent indicator of 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.

Crisis Management Simulation: Establishing a Dual Neurosurgery and Anesthesia Training Experience.

Science.gov (United States)

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

2018-01-01

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.

Fundamentals of neurosurgery: virtual reality tasks for training and evaluation of technical skills.

Science.gov (United States)

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

2013-11-01

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

Free-access open-source e-learning in comprehensive neurosurgery skills training.

Science.gov (United States)

Jotwani, Payal; Srivastav, Vinkle; Tripathi, Manjul; Deo, Rama Chandra; Baby, Britty; Damodaran, Natesan; Singh, Ramandeep; Suri, Ashish; Bettag, Martin; Roy, Tara Sankar; Busert, Christoph; Mehlitz, Marcus; Lalwani, Sanjeev; Garg, Kanwaljeet; Paul, Kolin; Prasad, Sanjiva; Banerjee, Subhashis; Kalra, Prem; Kumar, Subodh; Sharma, Bhavani Shankar; Mahapatra, Ashok Kumar

2014-01-01

Since the end of last century, technology has taken a front seat in dispersion of medical education. Advancements of technology in neurosurgery and traditional training methods are now being challenged by legal and ethical concerns of patient safety, resident work-hour restriction and cost of operating-room time. To supplement the existing neurosurgery education pattern, various e-learning platforms are introduced as structured, interactive learning system. This study focuses on the concept, formulation, development and impact of web based learning platforms dedicated to neurosurgery discipline to disseminate education, supplement surgical knowledge and improve skills of neurosurgeons. 'Neurosurgery Education and Training School (NETS), e-learning platform' has integration of web-based technologies like 'Content Management System' for organizing the education material and 'Learning Management System' for updating neurosurgeons. NETS discussion forum networks neurosurgeons, neuroscientists and neuro-technologists across the globe facilitating collaborative translational research. Multi-authored neurosurgical e-learning material supplements the deficiencies of regular time-bound education. Interactive open-source, global, free-access e-learning platform of NETS has around 1) 425 visitors/month from 73 countries; ratio of new visitors to returning visitors 42.3; 57.7 (2); 64,380 views from 190 subscribers for surgical videos, 3-D animation, graphics based training modules (3); average 402 views per post. The e-Learning platforms provide updated educational content that make them "quick, surf, find and extract" resources. e-Learning tools like web-based education, social interactive platform and question-answer forum will save unnecessary expenditure of time and travel of neurosurgeons seeking knowledge. The need for free access platforms is more pronounced for the neurosurgeons and patients in developing nations.

Smartphone use in neurosurgery? APP-solutely!

Science.gov (United States)

Zaki, Michael; Drazin, Doniel

2014-01-01

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.

From idea to publication: Publication rates of theses in neurosurgery from Turkey.

Science.gov (United States)

Öğrenci, Ahmet; Ekşi, Murat Şakir; Özcan-Ekşi, Emel Ece; Koban, Orkun

2016-01-01

Thesis at the end of residency is considered as the complementary component of postgraduate training. In this respect, thesis helps the residents learn how to ask structured questions, set up the most appropriate study design, conduct the study, retrieve study results and write conclusions with clinical implications. To the best of our knowledge, the publication rates of theses in the field of neurosurgery have not been reported before. Our aim was to find out publication rates of theses in neurosurgery specialty, in this descriptive study. The database of Higher Education Council of Turkey, which includes the theses of residents in only university hospitals, was screened between years 2004 and 2013. After retrieving the theses from the database; we used search engines to find out the theses published in any SCI/SCI-E-indexed journals. For this purpose, the title of the theses and the author names were used as keywords for searching. Data was presented in a descriptive form as absolute numbers and percentages. We retrieved 164 theses written by former residents in neurosurgery using the database. Among 164 theses, 18% (national journals: 9; international journals: 21) were published in SCI/SCI-E indexed journals. Publication rates of theses in neurosurgery are low as they are in the other specialties of medicine. Our study is a descriptive research, to give an idea about publication rates of theses in neurosurgery. Further studies are required to understand the underlying factors, which are responsible for the limited success in publication of theses in neurosurgery. Copyright © 2015 Polish Neurological Society. Published by Elsevier Urban & Partner Sp. z o.o. All rights reserved.

Smartphone Usage Patterns by Canadian Neurosurgery Residents: A National Cross-Sectional Survey.

Science.gov (United States)

Kameda-Smith, Michelle Masayo; Iorio-Morin, Christian; Winkler-Schwartz, Alexander; Ahmed, Uzair S; Bergeron, David; Bigder, Mark; Dakson, Ayoub; Elliott, Cameron A; Guha, Daipayan; Lavergne, Pascal; Makarenko, Serge; Taccone, Michael S; Tso, Michael; Wang, Bill; Fortin, David

2018-03-01

Smartphones and their apps are used ubiquitously in medical practice. However, in some cases their use can be at odds with current patient data safety regulations such as Canada's Personal Health Information Protection Act of 2004. To assess current practices and inform mobile application development, we sought to better understand mobile device usage patterns among Canadian neurosurgery residents. Through the Canadian Neurosurgery Research Collaborative, an online survey characterizing smartphone ownership and usage patterns was developed and sent to all Canadian neurosurgery resident in April of 2016. Questionnaires were collected and completed surveys analyzed. Of 146 eligible residents, 76 returned completed surveys (52% response rate). Of these 99% of respondents owned a smartphone, with 79% running on Apple's iOS. Four general mobile uses were identified: 1) communication between members of the medical team, 2) decision support, 3) medical reference, and 4) documentation through medical photography. Communication and photography were areas where the most obvious breaches in the Canadian Personal Health Information Protection Act were noted, with 89% of respondents taking pictures of patients' radiologic studies and 75% exchanging them with Short Message System. Hospital policies had no impact on user behaviors. Smartphones are used daily by most neurosurgery residents. Identified usage patterns are associated with perceived gains in efficacy and challenges in privacy and data reliability. We believe creating and improving workflows that address these usage patterns has a greater potential to improve privacy than changing policies and enforcing regulations. Copyright © 2017 Elsevier Inc. All rights reserved.

Evolving virtual reality simulation in neurosurgery.

Science.gov (United States)

Schirmer, Clemens M; Mocco, J; Elder, J Bradley

2013-10-01

Virtual reality (VR) applications promise the safe, efficacious, and valid replication of scenarios encountered in modern neurosurgery, and a number of navigation- or dissection-related and endovascular simulators have been successfully deployed in the last 2 decades. Concurrently, neurosurgical training is changing, and VR simulations are expected to play a part in future training. To give an overview of currently available neurosurgical VR applications in the spectrum of desired applications and the outlook of the requirements to be met by future applications. The available literature was analyzed using structured Medline and PubMed searches. Relevant articles were retrieved and reviewed. When quantitative results were available, effect sizes were collated or estimated to check for publication bias. There has been a significant increase in publications concerning the use of VR in neurosurgery in the last 22 years (P < .001). Thirty-eight of 117 publications (32%) identified reported data regarding the use of a simulator by practitioners; 35 of these were reported as positive trials (92%). Twenty-two of 38 studies (58%) reported quantitative data with mostly small positive effect sizes (median, 1.41; interquartile range, 1.08-2). The use of VR simulators in endovascular surgery has the most robust basis, with 65% of studies reporting quantitative outcomes. Current neurosurgical VR applications focus on basic procedural skill acquisition and are valid and efficacious adjuncts to neurosurgical training. In the future, the development of complex procedural simulators, teamwork, and focus on validated measures will lead to robust framework of the use of VR over the entire career of a neurosurgeon.

[Changing the teaching of neurosurgery with information technology].

Science.gov (United States)

Moreau, Jean-Jacques; Caire, François; Kalamarides, Michel; Mireau, Etienne; Dauger, Frédéric; Coignac, Marie-Jo; Charlin, Bernard

2009-10-01

A digital campus is a distance learning site that uses the potential of information and communication technologies to disseminate and improve educational services. This website, with open and free access, is built from free software with Web 2.0 technology. It is hosted at the University of Limoges. It functions as a digital library, containing scanned books, slide shows, more than 200 hours of recorded courses and round tables accessible by streaming video. The site is indexed according to the users' needs, by level of knowledge, specialty, keywords, and supplementary MeSH terms. The campus is organized as the College of Neurosurgery (http://college.neurochirurgie.fr). The durability of this type of training (in existence for 9 years now) is made possible by a powerful and committed consortium: the French Society of Neurosurgery, which has created high-quality intellectual and scientific resources, the University of Limoges, the Dupuytren University Hospital Center in Limoges, the region of Limousin, and the French-language Virtual Medical University, which have provided logistic and financial support. To target appropriate levels at various users, we distinguished four groups: medical students, neurosurgery students, neurosurgeons (continuing medical education), and students in allied health fields. All areas of neurosurgery are concerned. All the courses, including tests for self-evaluation and scientific meetings (organized with information and communication technologies) are digitally recorded for the site. The principles that make it possible for a medical discipline to organize around an online project are: a pedagogical conception of projects built in the form of models reusable by other health specialties; a stronghold within professional societies of the relevant specialties able to create high-quality intellectual and scientific resources; an organization by educational levels that can be extended transversally to other health disciplines; and free

Practical guidelines for setting up neurosurgery skills training cadaver laboratory in India.

Science.gov (United States)

Suri, Ashish; Roy, Tara Sankar; Lalwani, Sanjeev; Deo, Rama Chandra; Tripathi, Manjul; Dhingra, Renu; Bhardwaj, Daya Nand; Sharma, Bhawani Shankar

2014-01-01

Though the necessity of cadaver dissection is felt by the medical fraternity, and described as early as 600 BC, in India, there are no practical guidelines available in the world literature for setting up a basic cadaver dissection laboratory for neurosurgery skills training. Hands-on dissection practice on microscopic and endoscopic procedures is essential in technologically demanding modern neurosurgery training where ethical issues, cost constraints, medico-legal pitfalls, and resident duty time restrictions have resulted in lesser opportunities to learn. Collaboration of anatomy, forensic medicine, and neurosurgery is essential for development of a workflow of cadaver procurement, preservation, storage, dissection, and disposal along with setting up the guidelines for ethical and legal concerns.

Free-access open-source e-learning in comprehensive neurosurgery skills training

OpenAIRE

Payal Jotwani; Vinkle Srivastav; Manjul Tripathi; Rama Chandra Deo; Britty Baby; Natesan Damodaran; Ramandeep Singh; Ashish Suri; Martin Bettag; Tara Sankar Roy; Christoph Busert; Marcus Mehlitz; Sanjeev Lalwani; Kanwaljeet Garg; Kolin Paul

2014-01-01

Background: Since the end of last century, technology has taken a front seat in dispersion of medical education. Advancements of technology in neurosurgery and traditional training methods are now being challenged by legal and ethical concerns of patient safety, resident work-hour restriction and cost of operating-room time. To supplement the existing neurosurgery education pattern, various e-learning platforms are introduced as structured, interactive learning system. Materials and Methods: ...

Smartphone-assisted minimally invasive neurosurgery.

Science.gov (United States)

Mandel, Mauricio; Petito, Carlo Emanuel; Tutihashi, Rafael; Paiva, Wellingson; Abramovicz Mandel, Suzana; Gomes Pinto, Fernando Campos; Ferreira de Andrade, Almir; Teixeira, Manoel Jacobsen; Figueiredo, Eberval Gadelha

2018-03-13

OBJECTIVE Advances in video and fiber optics since the 1990s have led to the development of several commercially available high-definition neuroendoscopes. This technological improvement, however, has been surpassed by the smartphone revolution. With the increasing integration of smartphone technology into medical care, the introduction of these high-quality computerized communication devices with built-in digital cameras offers new possibilities in neuroendoscopy. The aim of this study was to investigate the usefulness of smartphone-endoscope integration in performing different types of minimally invasive neurosurgery. METHODS The authors present a new surgical tool that integrates a smartphone with an endoscope by use of a specially designed adapter, thus eliminating the need for the video system customarily used for endoscopy. The authors used this novel combined system to perform minimally invasive surgery on patients with various neuropathological disorders, including cavernomas, cerebral aneurysms, hydrocephalus, subdural hematomas, contusional hematomas, and spontaneous intracerebral hematomas. RESULTS The new endoscopic system featuring smartphone-endoscope integration was used by the authors in the minimally invasive surgical treatment of 42 patients. All procedures were successfully performed, and no complications related to the use of the new method were observed. The quality of the images obtained with the smartphone was high enough to provide adequate information to the neurosurgeons, as smartphone cameras can record images in high definition or 4K resolution. Moreover, because the smartphone screen moves along with the endoscope, surgical mobility was enhanced with the use of this method, facilitating more intuitive use. In fact, this increased mobility was identified as the greatest benefit of the use of the smartphone-endoscope system compared with the use of the neuroendoscope with the standard video set. CONCLUSIONS Minimally invasive approaches

Interstitial laser thermotherapy in neurosurgery: a review

NARCIS (Netherlands)

Menovsky, T.; Beek, J. F.; van Gemert, M. J.; Roux, F. X.; Bown, S. G.

1996-01-01

One of the most recent laser treatment modalities in neurosurgery is interstitial laser thermotherapy (ILTT). In this review, experimental and clinical studies concerning intracranial ILTT are discussed. Two methods for intra-operative control of the laser induced lesions are described; i.e.,

eLearning resources to supplement postgraduate neurosurgery training.

Science.gov (United States)

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

2017-02-01

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

Reoperations within 48 hours following 7942 pediatric neurosurgery procedures.

Science.gov (United States)

Roy, Anil K; Chu, Jason; Bozeman, Caroline; Sarda, Samir; Sawvel, Michael; Chern, Joshua J

2017-06-01

OBJECTIVE Various indicators are used to evaluate the quality of care delivered by surgical services, one of which is early reoperation rate. The indications and rate of reoperations within a 48-hour time period have not been previously reported for pediatric neurosurgery. METHODS Between May 1, 2009, and December 30, 2014, 7942 surgeries were performed by the pediatric neurosurgery service in the operating rooms at a single institution. Demographic, socioeconomic, and clinical characteristics associated with each of the operations were prospectively collected. The procedures were grouped into 31 categories based on the nature of the procedure and underlying diseases. Reoperations within 48 hours at the conclusion of the index surgery were reviewed to determine whether the reoperation was planned or unplanned. Multivariate logistic regression was employed to analyze risk factors associated with unplanned reoperations. RESULTS Cerebrospinal fluid shunt-and hydrocephalus-related surgeries accounted for 3245 (40.8%) of the 7942 procedures. Spinal procedures, craniotomy for tumor resections, craniotomy for traumatic injury, and craniofacial reconstructions accounted for an additional 8.7%, 6.8%, 4.5%, and 4.5% of surgical volume. There were 221 reoperations within 48 hours of the index surgery, yielding an overall incidence of 2.78%; 159 of the reoperation were unplanned. Of these 159 unplanned reoperations, 121 followed index operations involving shunt manipulations. Using unplanned reoperations as the dependent variable (n = 159), index operations with a starting time after 3 pm and admission through the emergency department (ED) were associated with a two- to threefold increase in the likelihood of reoperations (after-hour surgery, odds ratio [OR] 2.01 [95% CI 1.43-2.83, p < 0.001]; ED admission, OR 1.97 (95% CI 1.32-2.96, p < 0.05]). CONCLUSIONS Approximately 25% of the reoperations within 48 hours of a pediatric neurosurgical procedure were planned. When

Simulating tumour removal in neurosurgery.

Science.gov (United States)

Radetzky, A; Rudolph, M

2001-12-01

In this article the software system ROBO-SIM is described. ROBO-SIM is a planning and simulation tool for minimally invasive neurosurgery. Different to the most other simulation tools, ROBO-SIM is able to use actual patient's datasets for simulation. Same as in real neurosurgery a planning step, which provides more functionality as up-to-date planning systems on the market, is performed before undergoing the simulated operation. The planning steps include the definition of the trepanation point for entry into the skull and the target point within the depth of the brain, checking the surgical track and doing virtual trepanations (virtual craniotomy). For use with an intra-operative active manipulator, which is guided by the surgeon during real surgery (robotic surgery), go- and non-go-areas can be defined. During operation, the robot restricts the surgeon from leaving these go-areas. After planning, an additional simulation system, which is understood as an extension to the planning step, is used to simulate whole surgical interventions directly on the patient's anatomy basing on the planning data and by using the same instruments as for the real intervention. First tests with ROBO-SIM are performed on a phantom developed for this purpose and on actual patient's datasets with ventricular tumours.

Perioperative complications in endovascular neurosurgery: Anesthesiologist's perspective

Science.gov (United States)

Sharma, Megha U.; Ganjoo, Pragati; Singh, Daljit; Tandon, Monica S.; Agarwal, Jyotsna; Sharma, Durga P.; Jagetia, Anita

2017-01-01

Background: Endovascular neurosurgery is known to be associated with potentially serious perioperative complications that can impact the course and outcome of anesthesia. We present here our institutional experience in the anesthetic management of various endovascular neurosurgical procedures and their related complications over a 10-year period. Methods: Data was obtained in 240 patients pertaining to their preoperative status, details of anesthesia and surgery, perioperative course and surgery-related complications. Information regarding hemodynamic alterations, temperature variability, fluid-electrolyte imbalance, coagulation abnormalities and alterations in the anesthesia course was specifically noted. Results: Among the important complications observed were aneurysm rupture (2.5%), vasospasm (6.67%), thromboembolism (4.16%), contrast reactions, hemodynamic alterations, electrolyte abnormalities, hypothermia, delayed emergence from anesthesia, groin hematomas and early postoperative mortality (5.14%). Conclusion: Awareness of the unique challenges of endovascular neurosurgery and prompt and appropriate management of the associated complications by an experienced neuroanesthesiologist is vital to the outcome of these procedures. PMID:28413524

Simulation training in neurosurgery: advances in education and practice

Directory of Open Access Journals (Sweden)

Konakondla S

2017-07-01

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 

Guest Editorial: Functional neurosurgery | Enslin | South African ...

African Journals Online (AJOL)

South African Medical Journal. Journal Home · ABOUT · Advanced Search · Current Issue · Archives · Journal Home > Vol 106, No 8 (2016) >. Log in or Register to get access to full text downloads. Username, Password, Remember me, or Register. Guest Editorial: Functional neurosurgery. JMN Enslin. Abstract. No Abstract.

Utilizing virtual and augmented reality for educational and clinical enhancements in neurosurgery.

Science.gov (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

2017-01-01

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.

Virtual reality training in neurosurgery: Review of current status and future applications.

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

2011-01-01

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

Neurosurgery for management of severe head injury

International Nuclear Information System (INIS)

Seitz, K.; Richter, H.P.

1998-01-01

Neurosurgery as a treatment of severe head injuries is not restricted to invasive surgery but also includes peri-operative intensive care medicine. Thanks to the technological progress and advanced diagnostic tools, especially drug treatments and their efficiency as well as risks can be far better monitored and analysed today. (orig./CB) [de

Vitom-3D for Exoscopic Neurosurgery: Initial Experience in Cranial and Spinal Procedures.

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Oertel, Joachim M; Burkhardt, Benedikt W

2017-09-01

The authors describe the application of a new exoscope that offers 3-dimensional (3D) visualization in cranial and spinal neurosurgery in detail. Five cranial and 11 spinal procedures were performed with a 3D exoscope. Instrument handling, repositioning of the exoscope, handling of the image control unit, the adjustment of magnification and focal length, the depth perception, the image quality, the illumination, and the comfort level of the posture during the procedure were assessed via a questionnaire. The following procedures were performed: Microvascular decompression (n = 1), craniotomy and tumor resection (n = 4), anterior cervical discectomy and fusion with cervical plating (n = 2), cervical laminectomy and lateral mass fixation (n = 1), shear cervical lateral mass osteosynthesis (n = 1), lumbar canal decompression (n = 1), transforaminal lumbar interbody fusion (n = 2), thoracic intraspinal extradural tumor resection (n = 1), and lumbar discectomy (n = 3). Instrument handling, the intraoperative repositioning and handling of the VITOM-3D, and the comfort level of the intraoperative posture was rated excellent in 100% of procedures. The image quality was rated equal to the operating microscope in 68.75% of procedures. None of the procedures had to be stopped because of technical problems. No surgical complications were noted that could be related to the use of the exoscope. The 3D-exoscopic system is safe and effective tool to perform spinal procedures and less demanding cranial procedures. The image quality and 3D visualization were comparable with the operating microscope. The technique harbors the unique advantage of excellent comfort for the involved surgical team during the procedure. Copyright © 2017 Elsevier Inc. All rights reserved.

The First Neurosurgery Boot Camp in Southeast Asia: Evaluating Impact on Knowledge and Regional Collaboration in Yangon, Myanmar.

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Rock, Jack; Glick, Roberta; Germano, Isabelle M; Dempsey, Robert; Zervos, John; Prentiss, Tyler; Davis, Matthew; Wright, Ernest; Hlaing, Kyi; Thu, Myat; Soe, Zaw Wai; Myaing, Win

2018-05-01

For the first time in Southeast Asia, a Fundamentals of Neurosurgery Boot Camp was held at the University of Medicine 1 in Yangon, Myanmar, February 24-26, 2017. The aim of this course was to teach and train fundamental skills to neurosurgery residents. The Myanmar Neurosurgical Society, Foundation for International Education in Neurosurgery, Society for Neurological Surgeons, The University of Medicine 1 in Yangon, Myanmar, and the Henry Ford Department of Neurosurgery developed a 2-day resident training course. Day 1 activities consisted of lectures by faculty, small group case discussions, and industry-supported demonstrations of surgical techniques. Day 2 activities consisted of hands-on skill stations for common neurosurgical procedures with each station supervised by attending faculty. Written evaluations were distributed before the meeting, immediately after the meeting, and 6 months after the meeting. Boot camp attendees included 40 residents and 24 neurosurgical faculty from Myanmar, Cambodia, Nepal, Singapore, South Korea, Thailand, and Vietnam. There were 35 evaluations completed before the boot camp, 34 completed immediately after boot camp, and 20 completed 6 months after boot camp. Knowledge of participants improved from 62.75% before boot camp to 71.50% 6 months after boot camp (P = 0.046). Boot camps provide fundamental didactic and technical exposure to trainees in developed and developing countries and help standardize training in basic neurosurgical competencies, while exposing local faculty to important teaching methods. This model provides a sustainable solution to educational needs and demonstrates to local neurosurgeons how they can take ownership of the educational process. Copyright © 2018 Elsevier Inc. All rights reserved.

Complications in Endovascular Neurosurgery: Critical Analysis and Classification.

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Ravindra, Vijay M; Mazur, Marcus D; Park, Min S; Kilburg, Craig; Moran, Christopher J; Hardman, Rulon L; Couldwell, William T; Taussky, Philipp

2016-11-01

Precisely defining complications, which are used to measure overall quality, is necessary for critical review of delivery of care and quality improvement in endovascular neurosurgery, which lacks common definitions for complications. Furthermore, in endovascular interventions, events that may be labeled complications may not always negatively affect outcome. Our objective is to provide precise definitions for quality evaluation within endovascular neurosurgery. Thus, we propose an endovascular-specific classification system of complications based on our own patient series. This single-center review included all patients who had endovascular interventions from September 2013 to August 2015. Complication types were analyzed, and a descriptive analysis was undertaken to calculate the incidence of complications overall and in each category. Two hundred and seventy-five endovascular interventions were performed in 245 patients (65% female; mean age, 55 years). Forty complications occurred in 39 patients (15%), most commonly during treatment of intracranial aneurysms (24/40). Mechanical complications (eg, device deployment, catheter, or closure device failure) occurred in 8/40, technical complications (eg, failure to deploy flow diverter, unintended embolization, air emboli, retroperitoneal hemorrhage, dissection) in 11/40, judgment errors (eg, patient or equipment selection) in 9/40, and critical events (eg, groin hematoma, hemorrhagic or thromboembolic complications) in 12/40 patients. Only 12/40 complications (30%) resulted in new neurologic deficits, vessel injury requiring surgery, or blood transfusion. We propose an endovascular-specific classification system of complications with 4 categories: mechanical, technical, judgment errors, and critical events. This system provides a framework for future studies and quality control in endovascular neurosurgery. Copyright © 2016 Elsevier Inc. All rights reserved.

Versatile intraoperative MRI in neurosurgery and radiology.

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Yrjänä, S K; Katisko, J P; Ojala, R O; Tervonen, O; Schiffbauer, H; Koivukangas, J

2002-03-01

Several models for the application of intra-operative magnetic resonance imaging (IMRI) have recently been reported, most of them unique. Two fundamental issues need to be addressed: optimal use of the scanner to ensure a wide base for research, development and clinical application, and an organisational model that facilitates such use. While in our setting the IMRI project was initiated by the neurosurgeons, the need for wider use of the facilities was recognised since the beginning of the planning phase in 1996. An organisational model was developed that allowed for development of neurosurgical applications, radiological imaging, and radiological interventions and for the research and development work of the vendor. A resistive 0.23 T MR scanner was installed in a dedicated operating room environment. Unique to this scanner is the ability to turn off the magnet, allowing for normal OR activities and devices, and to turn on the magnet as needed with a relatively short six-minute ramp up time. A staged surgical technique was perfected, allowing for transfer of data to the neuronavigator outside the scanner during surgery. In neurosurgery, IMRI was used as one part of a neuronavigational system that included ultrasound imaging, intra-operative cortical stimulation during awake procedures, electrocorticography and two neuronavigators. 34 neurosurgical cases included 27 brain tumour resections, 5 brain tumour biopsies, 1 extirpation of an arterio-venous malformation, and 1 haematoma evacuation. The scanner could also be used for normal clinical imaging where obese patients, children, claustophobic patients and postoperative control examinations were the major groups. The radiologists performed 110 interventions, including bone and abdominal biopsies, nerve root infiltrations and local pain therapies, with the optical needle tracking system under continuous MRI guidance. The organisational model allowed frequent use of the facilities for both neurosurgery and radiology

Target localization on standard axial images in computed tomography (CT) stereotaxis for functional neurosurgery - a technical note

International Nuclear Information System (INIS)

Patil, A.-A.

1986-01-01

A simple technique for marking functional neurosurgery target on computed tomography (CT) axial image is described. This permits the use of standard axial image for computed tomography (CT) stereotaxis in functional neurosurgery. (Author)

A glance at live interventional neuroradiology and neurosurgery course 2009

International Nuclear Information System (INIS)

Li Qiang; Hong Bo; Liu Jianmin

2010-01-01

The annual Live Interventional Neuroradiology and Neurosurgery Course (LINNC) is one of the most important congresses in the neurosurgery and neuroradiology field. LINNC 2009 was held on May 25th this year and lasted for 3 days. In this article, the authors introduced the main points of the congress. The congress mainly discussed some hot topics at present time, including both the clinical and fundamental studies of cerebral arteriovenous malformation, ischemic cerebral disease and intracranial aneurysm, etc. Both neurological and neuroradiological case demonstrations related to the topics, and the main course of the congress were alternately performed. Recent advances in imaging technique and clinical application, such as Dyna-CT and Xper-CT, were also presented on the congress. (authors)

Cerenkov and radioluminescence imaging of brain tumor specimens during neurosurgery

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Spinelli, Antonello Enrico; Schiariti, Marco P.; Grana, Chiara M.; Ferrari, Mahila; Cremonesi, Marta; Boschi, Federico

2016-05-01

We presented the first example of Cerenkov luminescence imaging (CLI) and radioluminescence imaging (RLI) of human tumor specimens. A patient with a brain meningioma localized in the left parietal region was injected with 166 MBq of Y90-DOTATOC the day before neurosurgery. The specimens of the tumor removed during surgery were imaged using both CLI and RLI using an optical imager prototype developed in our laboratory. The system is based on a cooled electron multiplied charge coupled device coupled with an f/0.95 17-mm C-mount lens. We showed for the first time the possibility of obtaining CLI and RLI images of fresh human brain tumor specimens removed during neurosurgery.

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

Challenges in contemporary academic neurosurgery.

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Black, Peter M

2006-03-01

Traditionally, the ideal academic neurosurgeon has been a "quadruple threat," with excellence in clinical work, teaching, research, and administration. This tradition was best exemplified in Harvey Cushing, who developed the field of neurosurgery 90 years ago. This paradigm will probably have to change as academic neurosurgeons face major challenges. In patient care, these include increasing regulatory control, increasing malpractice costs, consolidation of expensive care in academic centers, and decreasing reimbursement; in resident teaching, work hour limitations and a changing resident culture; in research, the increasing dominance of basic scientists in governmental funding decisions and decreased involvement of neurosurgeons in scientific review committees; and in administration, problems of relationships in the workplace, patient safety, and employment compliance in an increasingly bureaucratic system. To meet these challenges, the new academic neurosurgeon will probably not be a quadruple threat personally but will be part of a quadruple threat in a department and institution. Neurosurgeons in such a setting will have to work with hospital, medical school, and national and international groups to address malpractice, reimbursement, subspecialization, and training problems; find supplemental sources of income through grants, development funds, and hospital support; lead in the development of multidisciplinary centers for neuroscience, brain tumor, spine, and other initiatives; and focus on training leaders for hospital, regional, and national groups to reconfigure neurosurgery. Collaboration, flexibility, and leadership will be characteristic of the academic neurosurgeon in this new era.

Frameless neuronavigation in modern neurosurgery.

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Spetzger, U; Laborde, G; Gilsbach, J M

1995-12-01

A fundamental effort in neurosurgery is to reduce surgical trauma. Microneurosurgical technique combined with precise localization of lesions, can minimize the invasiveness of neurosurgical procedures. This report summarizes the utility of frameless neuronavigator systems and examines their value in reducing operative invasiveness. The basic principle of neuronavigation is the virtual linkage between digitized neuroradiological data and real anatomical structures, allowing an excellent three-dimensional orientation by real-time graphic-anatomic interaction. As frameless graphic interactive neuronavigation is developed further, these devices should become an important component of the modern microneurosurgical armamentarium and reduce surgical morbidity.

The Establishment and Development of Neurosurgery Services in Papua New Guinea.

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Kaptigau, W Matui; Rosenfeld, Jeffrey V; Kevau, Ikau; Watters, David A

2016-02-01

Papua New Guinea (PNG) is a developing Pacific Nation of 7.3 million people. Although neurosurgery training was introduced to PNG in the year 2000, it was in 2003 that a neurosurgery service was established. Prior to this time, neurosurgery in PNG was performed by general surgeons, with some assistance from visiting Australian neurosurgeons. Neurosurgical training was introduced to PNG in 2000. The model involved a further 3 years of training for a surgeon who had already completed 4 years of general surgical training. We aim to review the output, outcomes and impact achieved by training the first national neurosurgeon. The data on activity (output) and outcomes were collected prospectively from 2003–2012. Ongoing mentoring and continuing professional development were provided through annual neurosurgical visits from Australia. There were serious limitations in the provision of equipment, with a lack of computerized tomographic or MR imaging, and adjuvant oncological services. There were 1618 neurosurgery admissions, 1020 neurosurgical procedures with a 5.74 % overall mortality. Seventy percent of cases presented as emergencies. There were improved outcomes, particularly for head injuries, whilst hydrocephalus was managed with an acceptable morbidity and revision rate. The training of a neurosurgeon resulted in PNG patients receiving a better range of surgical services, with a lower mortality. The outcomes able to be delivered were limited by late presentations of patients and lack of resources including imaging. These themes are familiar to all low- and middle-income countries (LMICs) and this may serve as a model for other LMIC neurosurgical services to adopt as they consider whether to establish and develop neurosurgical and other sub-specialist surgical services.

The Practice of Cranial Neurosurgery and the Malpractice Liability Environment in the United States

Science.gov (United States)

Wong, Kendrew; MacKenzie, Todd A.

2015-01-01

Object The potential imbalance between malpractice liability cost and quality of care has been an issue of debate. We investigated the association of malpractice liability with unfavorable outcomes and increased hospitalization charges in cranial neurosurgery. Methods We performed a retrospective cohort study involving patients who underwent cranial neurosurgical procedures from 2005-2010, and were registered in the National Inpatient Sample (NIS) database. We used data from the National Practitioner Data Bank (NPDB) from 2005 to 2010 to create measures of volume and size of malpractice claim payments. The association of the latter with the state-level mortality, length of stay (LOS), unfavorable discharge, and hospitalization charges for cranial neurosurgery was investigated. Results During the study period, there were 189,103 patients (mean age 46.4 years, with 48.3% females) who underwent cranial neurosurgical procedures, and were registered in NIS. In a multivariable regression, higher number of claims per physician in a state was associated with increased ln-transformed hospitalization charges (beta 0.18; 95% CI, 0.17 to 0.19). On the contrary, there was no association with mortality (OR 1.00; 95% CI, 0.94 to 1.06). We observed a small association with unfavorable discharge (OR 1.09; 95% CI, 1.06 to 1.13), and LOS (beta 0.01; 95% CI, 0.002 to 0.03). The size of the awarded claims demonstrated similar relationships. The average claims payment size (ln-transformed) (Pearson’s rho=0.435, P=0.01) demonstrated a positive correlation with the risk-adjusted hospitalization charges but did not demonstrate a correlation with mortality, unfavorable discharge, or LOS. Conclusions In the present national study, aggressive malpractice environment was not correlated with mortality but was associated with higher hospitalization charges after cranial neurosurgery. In view of the association of malpractice with the economics of healthcare, further research on its impact is

Treatment of malignant brain tumor. Today and tomorrow. Image-guided neurosurgery for brain tumor. A current perspective

International Nuclear Information System (INIS)

Kajita, Yasukazu; Fujii, Masazumi; Yoshida, Jun; Maesawa, Satoshi

2008-01-01

Although usefulness of the image-guided neurosurgery is well documented, there are scarce facilities having the actually operating system in Japan. Since 2006, authors' Nagoya University Hospital has had an operating room named ''Brain THEATER'', where an open MRI system APERTO (Hitachi-Medical Co.) and a navigation system Vector Vision (BrainLAB) are connected to conduct the complete image-guided neurosurgery for brain tumor by using the intraoperative MRI for continuously updating the residual tumor tissue to be dissected out. The room is pre- and intra-operatively supported by Departments of image analysis and of radiation technology in the University, and as well, is connected by net-working with another image-guided surgical room ''Brain Suite'' (Siemens 1.5 T MRI system: BrainLAB) in the neighboring facility, Nagoya Central Hospital. This paper describes the circumstances of the introduction of these systems in the Hospital, details of the image-guided surgery in the operation rooms with illustration of actual photos of the rooms and of pre-, intra- and post-operative images, outcomes of image-guided neurosurgery for brain tumor reported hitherto, image-guided neurosurgery for brain tumor's future perspectives involving robotic surgery and operation on the virtual 3D image including the net-worked one. Efforts should be made to further spread the system for performing the more non-invasive and precise surgery, and for conducting the diagnosis united with treatment. (R.T.)

Quantifying cortical surface harmonic deformation with stereovision during open cranial neurosurgery

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Ji, Songbai; Fan, Xiaoyao; Roberts, David W.; Paulsen, Keith D.

2012-02-01

Cortical surface harmonic motion during open cranial neurosurgery is well observed in image-guided neurosurgery. Recently, we quantified cortical surface deformation noninvasively with synchronized blood pressure pulsation (BPP) from a sequence of stereo image pairs using optical flow motion tracking. With three subjects, we found the average cortical surface displacement can reach more than 1 mm and in-plane principal strains of up to 7% relative to the first image pair. In addition, the temporal changes in deformation and strain were in concert with BPP and patient respiration [1]. However, because deformation was essentially computed relative to an arbitrary reference, comparing cortical surface deformation at different times was not possible. In this study, we extend the technique developed earlier by establishing a more reliable reference profile of the cortical surface for each sequence of stereo image acquisitions. Specifically, fast Fourier transform (FFT) was applied to the dynamic cortical surface deformation, and the fundamental frequencies corresponding to patient respiration and BPP were identified, which were used to determine the number of image acquisitions for use in averaging cortical surface images. This technique is important because it potentially allows in vivo characterization of soft tissue biomechanical properties using intraoperative stereovision and motion tracking.

Diabetes insipidus following neurosurgery at a university hospital in Western Saudi Arabia

Directory of Open Access Journals (Sweden)

Faiza A. Qari

2016-02-01

Full Text Available Objectives: 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. Methods: 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. Results: 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. Conclusion: 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.

Diabetes insipidus following neurosurgery at a university hospital in Western Saudi Arabia.

Science.gov (United States)

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

2016-02-01

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.

A systematic review of 30-day readmission after cranial neurosurgery.

Science.gov (United States)

Cusimano, Michael D; Pshonyak, Iryna; Lee, Michael Y; Ilie, Gabriela

2017-08-01

OBJECTIVE The 30-day readmission rate has emerged as an important marker of the quality of in-hospital care in several fields of medicine. This review aims to summarize available research reporting readmission rates after cranial procedures and to establish an association with demographic, clinical, and system-related factors and clinical outcomes. METHODS The authors conducted a systematic review of several databases; a manual search of the Journal of Neurosurgery, Neurosurgery, Acta Neurochirurgica, Canadian Journal of Neurological Sciences; and the cited references of the selected articles. Quality review was performed using the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) criteria. Findings are reported according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. RESULTS A total of 1344 articles published between 1947 and 2015 were identified; 25 were considered potentially eligible, of which 12 met inclusion criteria. The 30-day readmission rates varied from 6.9% to 23.89%. Complications arising during or after neurosurgical procedures were a prime reason for readmission. Race, comorbidities, and longer hospital stay put patients at risk for readmission. CONCLUSIONS Although readmission may be an important indicator for good care for the subset of acutely declining patients, neurosurgery should aim to reduce 30-day readmission rates with improved quality of care through systemic changes in the care of neurosurgical patients that promote preventive measures.

Admissions for isolated nonoperative mild head injuries: Sharing the burden among trauma surgery, neurosurgery, and neurology.

Science.gov (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

2016-10-01

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

Water balance disorders after neurosurgery: The triphasic response revisited

NARCIS (Netherlands)

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

2010-01-01

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

Statement of Ethics in Neurosurgery of the World Federation of Neurosurgical Societies.

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Umansky, Felix; Black, Peter L; DiRocco, Concenzio; Ferrer, Enrique; Goel, Atul; Malik, Ghaus M; Mathiesen, Tiit; Mendez, Ivar; Palmer, James D; Juanotena, Jorge Rodriguez; Fraifeld, Shifra; Rosenfeld, Jeffrey V

2011-01-01

This Statement of Ethics in Neurosurgery was developed by the Committee for Ethics and Medico-Legal Affairs of the World Federation of Neurosurgical Societies to help neurosurgeons resolve problems in the treatment of individual patients and meet obligations to the larger society. This document is intended as a framework rather than a set of rules. It cannot cover every situation and should be used with flexibility. However, it is our intent that the fundamental principles enunciated here should serve as a guide in the day-to-day practice of neurosurgery. Copyright © 2011 Elsevier Inc. All rights reserved.

Virtual endoscopy in neurosurgery: a review.

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Neubauer, André; Wolfsberger, Stefan

2013-01-01

Virtual endoscopy is the computerized creation of images depicting the inside of patient anatomy reconstructed in a virtual reality environment. It permits interactive, noninvasive, 3-dimensional visual inspection of anatomical cavities or vessels. This can aid in diagnostics, potentially replacing an actual endoscopic procedure, and help in the preparation of a surgical intervention by bridging the gap between plain 2-dimensional radiologic images and the 3-dimensional depiction of anatomy during actual endoscopy. If not only the endoscopic vision but also endoscopic handling, including realistic haptic feedback, is simulated, virtual endoscopy can be an effective training tool for novice surgeons. In neurosurgery, the main fields of the application of virtual endoscopy are third ventriculostomy, endonasal surgery, and the evaluation of pathologies in cerebral blood vessels. Progress in this very active field of research is achieved through cooperation between the technical and the medical communities. While the technology advances and new methods for modeling, reconstruction, and simulation are being developed, clinicians evaluate existing simulators, steer the development of new ones, and explore new fields of application. This review introduces some of the most interesting virtual reality systems for endoscopic neurosurgery developed in recent years and presents clinical studies conducted either on areas of application or specific systems. In addition, benefits and limitations of single products and simulated neuroendoscopy in general are pointed out.

The Bandung neurosurgery patient outcomes project, Indonesia (Part II): Patient pathways and feasibility and acceptability of telephone follow-up.

Science.gov (United States)

Sutiono, Agung Budi; Faried, Ahmad; McAllister, Susan; Ganefianty, Amelia; Sarjono, Kalih; Arifin, Muhammad Zafrullah; Derrett, Sarah

2018-01-01

Support of neurosurgery patients following discharge from hospital is important. Currently, little is known about patients' in low- and middle-income countries before and after their hospital treatment. This companion paper reports patients' pathways before and after hospital admission and the feasibility of following up this ill-patient population by telephone. Eligible patients were aged ≥18 years admitted to the Neurosurgery Department in Dr. Hasan Sadikin Hospital-a regional referral hospital in Bandung City, Indonesia. Clinical data were collected on admission by clinicians. In-person interviews were undertaken with a clinical research nurse 1 to 2 days pre-discharge, and telephone follow-up interviews at 1, 2, and 3 months post-discharge. Information was also collected on pathways prior to admission and following discharge. The number of contact attempts for each patient interview was documented, as was the overall acceptability of undertaking a telephone interview. Of 178 patients discharged from hospital, 12 later died. Of the remaining 166 patients, 95% were able to be followed up to 3 months. Two-thirds of patients had been referred from another hospital. Patients came from, and were discharged to, locations throughout the West Java region. At the 1-month interview, 84% participants reported that they had had a follow-up consultation with a health professional-mostly with a neurosurgeon. This study has shown that, with a neurosurgery nurse delegated to the role, it is feasible to conduct follow-up telephone interviews with patients after discharge from a neurosurgery ward and that in fact such follow-up was appreciated by patients. Copyright © 2017 John Wiley & Sons, Ltd.

BOOK REVIEW: Neurosurgery in the Tropics: A practical approach ...

African Journals Online (AJOL)

BOOK REVIEW: Neurosurgery in the Tropics: A practical approach to common problems By Jeffrey V. Rosenfeld MBBS, MS, FRACS, FRCS (Ed), FACS, FACTM and David A.K Watters ChM, FRACS, FRCS (Ed) Macmillan Education LTD 2000, Price $ 50 US ISBN 0-333-68412-5.

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

2014-11-01

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.

Teleradiology in neurosurgery, based on the experience of the Department of Neurosurgery, Polish Academy of Sciences

International Nuclear Information System (INIS)

Glowacki, M.; Czernicki, Z.; Jurkiewicz, J.; Walasek, N.; Czernicki, Z.; Jurkiewicz, J.

2005-01-01

The aim of the study was to analyze experience with the teleconsulting system applied at the Department of Neurosurgery, Polish Academy of Sciences (PAN) and to establish the best medical and economic conditions for teleradiological networks. The presented system is based on frame-grabbing technology and is operated by MultiView TM 2.0D (eMeD, Tech.) software. Computed tomography (CT) examinations performed in the hospitals in Ciechanow or Ostroleka are transmitted to the teleconsulting center in the Department of Neurosurgery, PAN. Regular telephone lines with a transmission speed of 56 kbps are utilized. One whole CT examination is transmitted in 5 to 7 minutes. All clinical information is reported during telephone conversation optimized by a specific questionnaire which helps improve arrangements for neurosurgical intervention and to document consultations. The usefulness of mobile phones and e mail in teleradiology was also evaluated.The period from December 1996 to April 2002 was studied. During this time, 931 transmission were performed. The most common were control examinations (26%), followed by neurotrauma (19%), spontaneous intracerebral hemorrhage (18%), neurooncology (13%), subarachnoidal hemorrhage (7%), hydrocephalus (5%), cerebral ischemia (3%), and those without any intracranial pathologies (4%). Disturbances were observed in 4% of transmissions. Seventy percent of the consulted patients were treated conservatively in remote hospitals. Thirty percent of the cases were admitted to our department, of whom 86% were operated. Mobile phones were found to be a useful tool in urgent neurosurgical consultations. Sending compressed CT images via e mail provided sufficient quality,but requires a particular technical background. The system allows for: 1) proper qualification for neurosurgical treatment, 2) fast and easy access to consultations with specialists, 3) patient follow-up (repeated consultations),4) avoidance of unnecessary transportation, and 5

The Reasons Of Patients With Headache Chosing The Neurosurgery Outpatient Clinic

Directory of Open Access Journals (Sweden)

Halil Murat Şen

2014-09-01

Full Text Available OBJECTIVE: We aimed to investigate the preference causes of the patients who were admitted to the neurosurgery clinic with complaints of headache for admission in this clinic. METHODS: The study population has been selected from brain surgery department outpatient clinic. One hundred patients with complaints of headache were enrolled in this study. RESULTS: Questioned the reasons for choosing the neurosurgical and most preferred cause of including word for brain surgery of the brain named (n=54, 54%. Patients were questioned about the information of the neurology and demostrated that there was not any knowledge about neurology (n=66, 66%. CONCLUSION: Headache causes loss of the financial and workforce. Preferences in the wrong departments of the patients, as a result of misdiagnosis and inadequate treatment, increasing the number of hospital admissions. This shows that how important names and introduction of the departments

[Perceived quality in hospitals of the Andalusia Healthcare System. The case of neurosurgery departments].

Science.gov (United States)

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

2014-01-01

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.

Neurosurgery and prognosis in patients with radiation-induced brain injury after nasopharyngeal carcinoma radiotherapy: a follow-up study

International Nuclear Information System (INIS)

Li, Yi; Shi, Xiaolei; Rong, Xiaoming; Peng, Ying; Tang, Yamei

2013-01-01

Radiotherapy is the standard radical treatment for nasopharyngeal carcinoma (NPC) and may cause radiation-induced brain injury (RI). Treatment for RI remains a challenge. We conducted this study to investigate the indications of neurosurgery, operation time and prognosis of patients with RI after NPC radiotherapy who underwent neurosurgical management. This was a follow-up study between January 2005 and July 2011. Fifteen NPC cases of RI who underwent neurosurgery were collected. Brain Magnetic resonance imaging (MRI), surgery and histology were studied. The outcome was assessed by LENT/SOMA scales and modified Rankin scale. Brain lesion resection (86.7%) was more common than decompressive craniotomy (13.3%). According to LENT/SOMA scale before and six months after surgery, 13 of 15, 12 of 15, 14 of 15, and 14 of 15 cases showed improvement at subjective, objective, management and analytic domains, respectively. 12 of 15 patients showed improvement of modified Rankin scale after surgery. Three patients who underwent emergency surgery showed significant improvement (average score increment of 2, 2.7, 2.7, 3 and 2 at LENT/SOMA scale subjective, objective, management, analytic, and modified Rankin scale, respectively), as compared with 12 cases underwent elective surgery (average score increment of 1, 1, 1.4, 1.8 and 1 at LENT SOMA scale subjective, objective, management, analytic, and modified Rankin scale, respectively). Neurosurgery, including brain necrotic tissue resection and decompressive craniotomy, improves the prognosis for RI patients, especially for those with indications of emergency surgery

Mythological and Prehistorical Origins of Neurosurgery.

Science.gov (United States)

Nanda, Anil; Filis, Andreas; Kalakoti, Piyush

2016-05-01

Mythology has a cultural appeal, and the description of some neurosurgical procedures in the Hindu, Greek, Egyptian, and Chinese mythology has a bearing to the origins of our professions. The traces to some of our modern-day practices also can be linked back to the ancient prehistoric eras of the Siberian, Persian, and the Andean region. In this historical perspective, we briefly dwell into individual accounts through the prism of different cultures to highlight the development of neurosurgery in mythology and prehistoric era. Published by Elsevier Inc.

Numerical simulations of clinical focused ultrasound functional neurosurgery

Science.gov (United States)

Pulkkinen, Aki; Werner, Beat; Martin, Ernst; Hynynen, Kullervo

2014-04-01

A computational model utilizing grid and finite difference methods were developed to simulate focused ultrasound functional neurosurgery interventions. The model couples the propagation of ultrasound in fluids (soft tissues) and solids (skull) with acoustic and visco-elastic wave equations. The computational model was applied to simulate clinical focused ultrasound functional neurosurgery treatments performed in patients suffering from therapy resistant chronic neuropathic pain. Datasets of five patients were used to derive the treatment geometry. Eight sonications performed in the treatments were then simulated with the developed model. Computations were performed by driving the simulated phased array ultrasound transducer with the acoustic parameters used in the treatments. Resulting focal temperatures and size of the thermal foci were compared quantitatively, in addition to qualitative inspection of the simulated pressure and temperature fields. This study found that the computational model and the simulation parameters predicted an average of 24 ± 13% lower focal temperature elevations than observed in the treatments. The size of the simulated thermal focus was found to be 40 ± 13% smaller in the anterior-posterior direction and 22 ± 14% smaller in the inferior-superior direction than in the treatments. The location of the simulated thermal focus was off from the prescribed target by 0.3 ± 0.1 mm, while the peak focal temperature elevation observed in the measurements was off by 1.6 ± 0.6 mm. Although the results of the simulations suggest that there could be some inaccuracies in either the tissue parameters used, or in the simulation methods, the simulations were able to predict the focal spot locations and temperature elevations adequately for initial treatment planning performed to assess, for example, the feasibility of sonication. The accuracy of the simulations could be improved if more precise ultrasound tissue properties (especially of the

Effect of hypoxia-inducible factor 1-alpha (HIF-1α) on proliferation ...

African Journals Online (AJOL)

Jane

2011-07-25

Jul 25, 2011 ... Full Length Research Paper. Effect of hypoxia-inducible factor 1-alpha ... 1Department of Neurosurgery, Ruijin Hospital, Shanghai JiaoTong University School of Medicine, Shanghai 200025,. China. 2Department of Neurosurgery, Chaoyang Hospital, Huainan, Anhui, China. 3Department of Neurosurgery ...

Genealogy of training in vascular neurosurgery.

Science.gov (United States)

Chowdhry, Shakeel A; Spetzler, Robert F

2014-02-01

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.

MR-guided stereotactic neurosurgery-comparison of fiducial-based and anatomical landmark transformation approaches

International Nuclear Information System (INIS)

Hunsche, S; Sauner, D; Maarouf, M; Hoevels, M; Luyken, K; Schulte, O; Lackner, K; Sturm, V; Treuer, H

2004-01-01

For application in magnetic resonance (MR) guided stereotactic neurosurgery, two methods for transformation of MR-image coordinates in stereotactic, frame-based coordinates exist: the direct stereotactic fiducial-based transformation method and the indirect anatomical landmark method. In contrast to direct stereotactic MR transformation, indirect transformation is based on anatomical landmark coregistration of stereotactic computerized tomography and non-stereotactic MR images. In a patient study, both transformation methods have been investigated with visual inspection and mutual information analysis. Comparison was done for our standard imaging protocol, including t2-weighted spin-echo as well as contrast enhanced t1-weighted gradient-echo imaging. For t2-weighted spin-echo imaging, both methods showed almost similar and satisfying performance with a small, but significant advantage for fiducial-based transformation. In contrast, for t1-weighted gradient-echo imaging with more geometric distortions due to field inhomogenities and gradient nonlinearity than t2-weighted spin-echo imaging, mainly caused by a reduced bandwidth per pixel, anatomical landmark transformation delivered markedly better results. Here, fiducial-based transformation yielded results which are intolerable for stereotactic neurosurgery. Mean Euclidian distances between both transformation methods were 0.96 mm for t2-weighted spin-echo and 1.67 mm for t1-weighted gradient-echo imaging. Maximum deviations were 1.72 mm and 3.06 mm, respectively

MR-guided stereotactic neurosurgery-comparison of fiducial-based and anatomical landmark transformation approaches

Energy Technology Data Exchange (ETDEWEB)

Hunsche, S [Department of Stereotaxy and Functional Neurosurgery, University of Cologne, Cologne (Germany); Sauner, D [Institute for Diagnostic and Interventional Radiology, Friedrich-Schiller-University of Jena, Jena (Germany); Maarouf, M [Department of Stereotaxy and Functional Neurosurgery, University of Cologne, Cologne (Germany); Hoevels, M [Department of Stereotaxy and Functional Neurosurgery, University of Cologne, Cologne (Germany); Luyken, K [Department of Stereotaxy and Functional Neurosurgery, University of Cologne, Cologne (Germany); Schulte, O [Department of Radiology, University of Cologne, Cologne (Germany); Lackner, K [Department of Radiology, University of Cologne, Cologne (Germany); Sturm, V [Department of Stereotaxy and Functional Neurosurgery, University of Cologne, Cologne (Germany); Treuer, H [Department of Stereotaxy and Functional Neurosurgery, University of Cologne, Cologne (Germany)

2004-06-21

For application in magnetic resonance (MR) guided stereotactic neurosurgery, two methods for transformation of MR-image coordinates in stereotactic, frame-based coordinates exist: the direct stereotactic fiducial-based transformation method and the indirect anatomical landmark method. In contrast to direct stereotactic MR transformation, indirect transformation is based on anatomical landmark coregistration of stereotactic computerized tomography and non-stereotactic MR images. In a patient study, both transformation methods have been investigated with visual inspection and mutual information analysis. Comparison was done for our standard imaging protocol, including t2-weighted spin-echo as well as contrast enhanced t1-weighted gradient-echo imaging. For t2-weighted spin-echo imaging, both methods showed almost similar and satisfying performance with a small, but significant advantage for fiducial-based transformation. In contrast, for t1-weighted gradient-echo imaging with more geometric distortions due to field inhomogenities and gradient nonlinearity than t2-weighted spin-echo imaging, mainly caused by a reduced bandwidth per pixel, anatomical landmark transformation delivered markedly better results. Here, fiducial-based transformation yielded results which are intolerable for stereotactic neurosurgery. Mean Euclidian distances between both transformation methods were 0.96 mm for t2-weighted spin-echo and 1.67 mm for t1-weighted gradient-echo imaging. Maximum deviations were 1.72 mm and 3.06 mm, respectively.

Virtual reality training in neurosurgery: Review of current status and future applications

Science.gov (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.

2011-01-01

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

The Spectrum of Altmetrics in Neurosurgery: The Top 100 "Trending" Articles in Neurosurgical Journals.

Science.gov (United States)

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

2017-07-01

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.

Planning and Executing the Neurosurgery Boot Camp: The Bolivia Experience.

Science.gov (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

2017-08-01

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.

A neurosurgery/stereotactic radiotherapy dedicated PACS for conformal radiotherapy

International Nuclear Information System (INIS)

Lefkopoulos, D.; Bocquiault, P.; Levrier, M.; Merienne, L.; Schlienger, M.

1995-01-01

To realise conformal cerebral stereotactic irradiations we use a Neurosurgery/stereotactic dedicated PACS between two distant hospitals. It connects the stereotactic neurosurgery planification imaging system NEUROAXIS (Sopelem-Sofretec/Ste Anne Hospital) with the dosimetric TPS ARTEMIS-3D/Dosigray (Tenon Hospital). NEUROAXIS is a computer aided stereotactic biopsies and stereo-electroencephalographies, used by surgeons in operating room. The system determines the precise location data for Talairach radiological equipment (X ray source at 5 meters from film) and the geometry of scanner and MRI stereotactical referentials. It provides a full set of features for lesion localization, geometrical computations, surgical planifications, picture archiving, stereotactic angiography, CT and MRI image processing and networking. It sends images through the French public digital network ISDN (NUMERIS/France Telecom : 2x64 Kbits/s) from Ste Anne to Tenon Hospital. Stereotactic angiographic and CT images are reformatted into the DOSIGRAY image processing environment where 3-D dose distributions, displays and DVHs are computed to determine the optimal treatment. ARTEMIS-3D/Dosigray is a TPS for stereotactic radiotherapy devised by the Tenon Hospital for clinical methodology and 3D dose calculations, optimization software development and the Dosigray company for multimodality imaging, (2D(3D)) computer graphics for dose and anatomical representation and data networking. Communication within the radiation oncology department is provided by local area ETHERNET network, linking heterogeneous systems (Vaxstations-3200; Decstation (5000(240))) by means of different protocols. The works in progress are to send back via the same network the 3-D dose matrix to Neurosurgery department NEUROAXIS system. Our PACS is used since six months to treat patients. It has permitted to improve the treatment quality in comparison with our first version TPS ARTEMIS-3D

Anaesthesia and analgesia in Göttingen minipigs - examples of protocols used for neurosurgery and scanning procedures

DEFF Research Database (Denmark)

Alstrup, Aage Kristian Olsen

Neurosurgery in Göttingen minipigs is often a welfare challenge, and therefore, the main goal of my talk will be to discuss how to improve animal welfare during brain surgery and the days following surgery. A combination of inhalation/infusion anaesthesia with opioids such as injections with bupr......Neurosurgery in Göttingen minipigs is often a welfare challenge, and therefore, the main goal of my talk will be to discuss how to improve animal welfare during brain surgery and the days following surgery. A combination of inhalation/infusion anaesthesia with opioids such as injections......, especially ensuring sufficient analgesia and water/food intake during the first hours and days. Compared to neurosurgery, scanning procedures are normally unproblematic from a welfare point of view. However, anaesthesia may influence the results of brain scans, particularly functional scans, such as positron...

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

Science.gov (United States)

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

2017-06-01

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

The contributions of W.D. Stevenson to the development of neurosurgery in Atlantic Canada.

Science.gov (United States)

Mukhida, K; Mendez, I

1999-08-01

The establishment of a neurosurgical department in Halifax in January 1948 marked the beginnings of the first dedicated neurosurgical service in Atlantic Canada. The development of neurosurgery in Halifax occurred in a receptive place and time. The Victoria General Hospital, the region's largest tertiary care centre, and the Dalhousie University Faculty of Medicine were in a period of growth associated with medical specialization and departmentalization, changes inspired in part by the Flexner Report of 1910. Atlantic Canadians during this period were increasingly looking to specialists for their medical care. Although this social environment encouraged the establishment of surgical specialty services, the development of neurosurgery in Halifax, as in other parts of Canada, was closely associated with the efforts of individual neurosurgeons, such as William D. Stevenson. After training with Kenneth G. McKenzie in Toronto, Stevenson was recruited to Halifax and established the first neurosurgical department in Atlantic Canada. From the outset and over his twenty-six years as Department Head at the Victoria General Hospital and Dalhousie University, Stevenson worked to maintain the department's commitment to clinical practice, medical education, and research. Although Stevenson single-handedly ran the service for several years after its inception, by the time of his retirement in 1974 the neurosurgery department had grown to include five attending staff surgeons who performed over two thousand procedures each year. This paper highlights the importance of Stevenson's contributions to the development of neurosurgery in Atlantic Canada within the context of the social and medical environment of the region.

The Current Use of Social Media in Neurosurgery.

Science.gov (United States)

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

2016-04-01

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.

Evolution in Practice: How has British Neurosurgery Changed in the Last 10 Years?

Science.gov (United States)

Tarnaris, A; Arvin, B; Ashkan, K

2008-01-01

INTRODUCTION Neurosurgery is a fast-evolving surgical subspecialty driven by technological advances, socio-economic factors and patient expectations. In this study, we have compared the work-load volume in a single institution in the years of 1994 and 2004 and commented on the possible reasons for the changes and the impacts they may have for the future. PATIENTS AND METHODS A retrospective, log-book review of all operations performed in the years 1994 and 2004 in a single, tertiary, neurosurgical centre was performed. RESULTS Neurosurgical practice has evolved over this period. Current practice has moved away from clipping of aneurysms and towards coil embolisation performed by interventional radiologists. Electrode stimulation of deep brain regions for movement disorders is the current practice, whereas 10 years ago the same disorders were dealt with by lesioning of the relevant regions. In spinal neurosurgery, instrumentation is increasingly favoured currently. In the field of neuro-oncology, current practice favours minimal access to the target area by the use of stereotactic localisation. CONCLUSIONS Changes were most pronounced in the subspecialties of vascular, functional and spinal neurosurgery within this 10-year period. Knowledge of such dynamics is valuable in health resource management as well as planning for neurosurgical training programmes. PMID:18765031

Aura of technology and the cutting edge: a history of lasers in neurosurgery.

Science.gov (United States)

Ryan, Robert W; Spetzler, Robert F; Preul, Mark C

2009-09-01

In this historical review the authors examine the important developments that have led to the availability of laser energy to neurosurgeons as a unique and sometimes invaluable tool. They review the physical science behind the function of lasers, as well as how and when various lasers based on different lasing mediums were discovered. They also follow the close association between advances in laser technology and their application in biomedicine, from early laboratory experiments to the first clinical experiences. Because opinions on the appropriate role of lasers in neurosurgery vary widely, the historical basis for some of these views is explored. Initial enthusiasm for a technology that appears to have innate advantages for safe resections has often given way to the strict limitations and demands of the neurosurgical operating theater. However, numerous creative solutions to improve laser delivery, power, safety, and ergonomics demonstrate the important role that technological advances in related scientific fields continue to offer neurosurgery. Benefiting from the most recent developments in materials science, current CO(2) laser delivery systems provide a useful addition to the neurosurgical armamentarium when applied in the correct circumstances and reflect the important historical advances that come about from the interplay between neurosurgery and technology.

Health-related quality of life outcomes and level of evidence in pediatric neurosurgery.

Science.gov (United States)

Hansen, Daniel; Vedantam, Aditya; Briceño, Valentina; Lam, Sandi K; Luerssen, Thomas G; Jea, Andrew

2016-10-01

OBJECTIVE The emphasis on health-related quality of life (HRQOL) outcomes is increasing, along with an emphasis on evidence-based medicine. However, there is a notable paucity of validated HRQOL instruments for the pediatric population. Furthermore, no standardization or consensus currently exists concerning which HRQOL outcome measures ought to be used in pediatric neurosurgery. The authors wished to identify HRQOL outcomes used in pediatric neurosurgery research over the past 10 years, their frequency, and usage trends. METHODS Three top pediatric neurosurgical journals were reviewed for the decade from 2005 to 2014 for clinical studies of pediatric neurosurgical procedures that report HRQOL outcomes. Similar studies in the peer-reviewed journal Pediatrics were also used as a benchmark. Publication year, level of evidence, and HRQOL outcomes were collected for each article. RESULTS A total of 31 HRQOL studies were published in the pediatric neurosurgical literature over the study period. By comparison, there were 55 such articles in Pediatrics. The number of publications using HRQOL instruments showed a significant positive trend over time for Pediatrics (B = 0.62, p = 0.02) but did not increase significantly over time for the 3 neurosurgical journals (B = 0.12, p = 0.5). The authors identified a total of 46 different HRQOL instruments used across all journals. Within the neurosurgical journals, the Hydrocephalus Outcome Questionnaire (HOQ) (24%) was the most frequently used, followed by the Health Utilities Index (HUI) (16%), the Pediatric Quality of Life Inventory (PedsQL) (12%), and the 36-Item Short Form Health Survey (SF-36) (12%). Of the 55 articles identified in Pediatrics, 22 (40%) used a version of the PedsQL. No neurosurgical study reached above Level 4 on the Oxford Centre for Evidence-Based Medicine (OCEBM) system. However, multiple studies from Pediatrics achieved OCEBM Level 3, several were categorized as Level 2, and one reached Level 1

Augmented Reality in Neurosurgery: A Review of Current Concepts and Emerging Applications.

Science.gov (United States)

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

2017-05-01

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.

Informed consent in neurosurgery--translating ethical theory into action.

Science.gov (United States)

Schmitz, Dagmar; Reinacher, Peter C

2006-09-01

Although a main principle of medical ethics and law since the 1970s, standards of informed consent are regarded with great scepticism by many clinicans. By reviewing the reactions to and adoption of this principle of medical ethics in neurosurgery, the characteristic conflicts that emerge between theory and everyday clinical experience are emphasised and a modified conception of informed consent is proposed. The adoption and debate of informed consent in neurosurgery took place in two steps. Firstly, respect for patient autonomy was included into the ethical codes of the professional organisations. Secondly, the legal demands of the principle were questioned by clinicians. Informed consent is mainly interpreted in terms of freedom from interference and absolute autonomy. It lacks a constructive notion of physician-patient interaction in its effort to promote the best interest of the patient, which, however, potentially emerges from a reconsideration of the principle of beneficence. To avoid insufficient legal interpretations, informed consent should be understood in terms of autonomy and beneficence. A continuous interaction between the patient and the given physician is considered as an essential prerequisite for the realisation of the standards of informed consent.

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

2017-09-01

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.

Checklists in Neurosurgery to Decrease Preventable Medical Errors: A Review

Science.gov (United States)

Enchev, Yavor

2015-01-01

Neurosurgery represents a zero tolerance environment for medical errors, especially preventable ones like all types of wrong site surgery, complications due to the incorrect positioning of patients for neurosurgical interventions and complications due to failure of the devices required for the specific procedure. Following the excellent and encouraging results of the safety checklists in intensive care medicine and in other surgical areas, the checklist was naturally introduced in neurosurgery. To date, the reported world experience with neurosurgical checklists is limited to 15 series with fewer than 20,000 cases in various neurosurgical areas. The purpose of this review was to study the reported neurosurgical checklists according to the following parameters: year of publication; country of origin; area of neurosurgery; type of neurosurgical procedure-elective or emergency; person in charge of the checklist completion; participants involved in completion; whether they prevented incorrect site surgery; whether they prevented complications due to incorrect positioning of the patients for neurosurgical interventions; whether they prevented complications due to failure of the devices required for the specific procedure; their specific aims; educational preparation and training; the time needed for checklist completion; study duration and phases; number of cases included; barriers to implementation; efforts to implementation; team appreciation; and safety outcomes. Based on this analysis, it could be concluded that neurosurgical checklists represent an efficient, reliable, cost-effective and time-saving tool for increasing patient safety and elevating the neurosurgeons’ self-confidence. Every neurosurgical department must develop its own neurosurgical checklist or adopt and modify an existing one according to its specific features and needs in an attempt to establish or develop its safety culture. The world, continental, regional and national neurosurgical societies

Operative volume and outcomes of cerebrovascular neurosurgery in children.

Science.gov (United States)

Bekelis, Kimon; Connolly, Ian D; Do, Huy M; Choudhri, Omar

2016-11-01

OBJECTIVE The impact of procedural volume on the outcomes of cerebrovascular surgery in children has not been determined. In this study, the authors investigated the association of operative volume on the outcomes of cerebrovascular neurosurgery in pediatric patients. METHODS The authors performed a cohort study of all pediatric patients who underwent a cerebrovascular procedure between 2003 and 2012 and were registered in the Kids' Inpatient Database (KID). To control for confounding, the authors used multivariable regression models, propensity-score conditioning, and mixed-effects analysis to account for clustering at the hospital level. RESULTS During the study period, 1875 pediatric patients in the KID underwent cerebrovascular neurosurgery and met the inclusion criteria for the study; 204 patients (10.9%) underwent aneurysm clipping, 446 (23.8%) underwent coil insertion for an aneurysm, 827 (44.1%) underwent craniotomy for arteriovenous malformation resection, and 398 (21.2%) underwent bypass surgery for moyamoya disease. Mixed-effects multivariable regression analysis revealed that higher procedural volume was associated with fewer inpatient deaths (OR 0.58; 95% CI 0.40-0.85), a lower rate of discharges to a facility (OR 0.87; 95% CI 0.82-0.92), and shorter length of stay (adjusted difference -0.22; 95% CI -0.32 to -0.12). The results in propensity-adjusted multivariable models were robust. CONCLUSIONS In a national all-payer cohort of pediatric patients who underwent a cerebrovascular procedure, the authors found that higher procedural volume was associated with fewer deaths, a lower rate of discharges to a facility, and decreased lengths of stay. Regionalization initiatives should include directing children with such rare pathologies to a center of excellence.

Interrupted time-series analysis: studying trends in neurosurgery.

Science.gov (United States)

Wong, Ricky H; Smieliauskas, Fabrice; Pan, I-Wen; Lam, Sandi K

2015-12-01

OBJECT Neurosurgery studies traditionally have evaluated the effects of interventions on health care outcomes by studying overall changes in measured outcomes over time. Yet, this type of linear analysis is limited due to lack of consideration of the trend's effects both pre- and postintervention and the potential for confounding influences. The aim of this study was to illustrate interrupted time-series analysis (ITSA) as applied to an example in the neurosurgical literature and highlight ITSA's potential for future applications. METHODS The methods used in previous neurosurgical studies were analyzed and then compared with the methodology of ITSA. RESULTS The ITSA method was identified in the neurosurgical literature as an important technique for isolating the effect of an intervention (such as a policy change or a quality and safety initiative) on a health outcome independent of other factors driving trends in the outcome. The authors determined that ITSA allows for analysis of the intervention's immediate impact on outcome level and on subsequent trends and enables a more careful measure of the causal effects of interventions on health care outcomes. CONCLUSIONS ITSA represents a significant improvement over traditional observational study designs in quantifying the impact of an intervention. ITSA is a useful statistical procedure to understand, consider, and implement as the field of neurosurgery evolves in sophistication in big-data analytics, economics, and health services research.

[Virtual reality in neurosurgery].

Science.gov (United States)

Tronnier, V M; Staubert, A; Bonsanto, M M; Wirtz, C R; Kunze, S

2000-03-01

Virtual reality enables users to immerse themselves in a virtual three-dimensional world and to interact in this world. The simulation is different from the kind in computer games, in which the viewer is active but acts in a nonrealistic world, or on the TV screen, where we are passively driven in an active world. In virtual reality elements look realistic, they change their characteristics and have almost real-world unpredictability. Virtual reality is not only implemented in gambling dens and the entertainment industry but also in manufacturing processes (cars, furniture etc.), military applications and medicine. Especially the last two areas are strongly correlated, because telemedicine or telesurgery was originated for military reasons to operate on war victims from a secure distance or to perform surgery on astronauts in an orbiting space station. In medicine and especially neurosurgery virtual-reality methods are used for education, surgical planning and simulation on a virtual patient.

The Preferred Learning Styles of Neurosurgeons, Neurosurgery Residents, and Neurology Residents: Implications in the Neurosurgical Field.

Science.gov (United States)

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

2014-01-01

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.

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

Science.gov (United States)

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

2016-01-01

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.

Current Applications and Future Perspectives of the Use of 3D Printing in Anatomical Training and Neurosurgery

Science.gov (United States)

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

2016-01-01

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. PMID:27445707

Current use of Social Media in Neurosurgery in Spain.

Science.gov (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.

Quantum computing: a prime modality in neurosurgery's future.

Science.gov (United States)

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

2012-11-01

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.

The incidentaloma of the pituitary gland: Is neurosurgery required

Energy Technology Data Exchange (ETDEWEB)

Reincke, M.; Allolio, B.; Saeger, W.; Menzel, J.; Winkelmann, W. (Univ. of Cologne (West Germany))

1990-05-23

The authors describe a series of 18 patients with an intrasellar mass incidentally discovered by computed tomography or magnetic resonance imaging. The average size of the mass was 13 mm, with a range from 5 to 25 mm. Initial ophthalmologic examination revealed bitemporal hemianopia in 2 patients. Results of routine endocrine testing showed partial hypopituitarism in 5 patients and growth hormone hypersecretion without signs and symptoms of acromegaly in 1 patient. Four patients underwent neurosurgery. Histologically, one chondroid chordoma and three pituitary adenomas were found. In the remaining 14 patients treated conservatively, repeated computed tomography and magnetic resonance imaging revealed no significant change in tumor size at the time of follow-up. The results suggest that the incidentaloma of the pituitary gland is a benign condition that does not necessarily require neurosurgical intervention.

The incidentaloma of the pituitary gland: Is neurosurgery required?

International Nuclear Information System (INIS)

Reincke, M.; Allolio, B.; Saeger, W.; Menzel, J.; Winkelmann, W.

1990-01-01

The authors describe a series of 18 patients with an intrasellar mass incidentally discovered by computed tomography or magnetic resonance imaging. The average size of the mass was 13 mm, with a range from 5 to 25 mm. Initial ophthalmologic examination revealed bitemporal hemianopia in 2 patients. Results of routine endocrine testing showed partial hypopituitarism in 5 patients and growth hormone hypersecretion without signs and symptoms of acromegaly in 1 patient. Four patients underwent neurosurgery. Histologically, one chondroid chordoma and three pituitary adenomas were found. In the remaining 14 patients treated conservatively, repeated computed tomography and magnetic resonance imaging revealed no significant change in tumor size at the time of follow-up. The results suggest that the incidentaloma of the pituitary gland is a benign condition that does not necessarily require neurosurgical intervention

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

LENUS (Irish Health Repository)

O'Brien, Deirdre

2011-06-01

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.

The internal medicine specialist and neurosurgery

Directory of Open Access Journals (Sweden)

A. Pizzini

2013-05-01

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.

Innovations in Functional Neurosurgery and Anesthetic Implications.

Science.gov (United States)

Dunn, Lauren K; Durieux, Marcel E; Elias, W Jeffrey; Nemergut, Edward C; Naik, Bhiken I

2018-01-01

Functional neurosurgery has undergone rapid growth over the last few years fueled by advances in imaging technology and novel treatment modalities. These advances have led to new surgical treatments using minimally invasive and precise techniques for conditions such as Parkinson's disease, essential tremor, epilepsy, and psychiatric disorders. Understanding the goals and technological issues of these procedures is imperative for the anesthesiologist to ensure safe management of patients presenting for functional neurosurgical procedures. In this review, we discuss the advances in neurosurgical techniques for deep brain stimulation, focused ultrasound and minimally invasive laser-based treatment of refractory epilepsy and provide a guideline for anesthesiologists caring for patients undergoing these procedures.

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

Science.gov (United States)

Owojuyigbe, Afolabi Muyiwa; Komolafe, Edward O.; Adenekan, Anthony T.; Dada, Muyiwa A.; Onyia, Chiazor U.; Ogunbameru, Ibironke O.; Owagbemi, Oluwafemi F.; Talabi, Ademola O.; Faponle, Fola A.

2016-01-01

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. PMID:27251657

[An automatic system for anatomophysiological correlation in three planes simultaneously during functional neurosurgery].

Science.gov (United States)

Teijeiro, E J; Macías, R J; Morales, J M; Guerra, E; López, G; Alvarez, L M; Fernández, F; Maragoto, C; Seijo, F; Alvarez, E

The Neurosurgical Deep Recording System (NDRS) using a personal computer takes the place of complex electronic equipment for recording and processing deep cerebral electrical activity, as a guide in stereotaxic functional neurosurgery. It also permits increased possibilities of presenting information in direct graphic form with automatic management and sufficient flexibility to implement different analyses. This paper describes the possibilities of automatic simultaneous graphic representation in three almost orthogonal planes, available with the new 5.1 version of NDRS so as to facilitate the analysis of anatomophysiological correlation in the localization of deep structures of the brain during minimal access surgery. This new version can automatically show the spatial behaviour of signals registered throughout the path of the electrode inside the brain, superimposed simultaneously on sagittal, coronal and axial sections of an anatomical atlas of the brain, after adjusting the scale automatically according to the dimensions of the brain of each individual patient. This may also be shown in a tridimensional representation of the different planes themselves intercepting. The NDRS system has been successfully used in Spain and Cuba in over 300 functional neurosurgery operations. The new version further facilitates analysis of spatial anatomophysiological correlation for the localization of brain structures. This system has contributed to increase the precision and safety in selecting surgical targets in the control of Parkinson s disease and other disorders of movement.

State of Global Pediatric Neurosurgery Outreach: Survey by the International Education Subcommittee

Science.gov (United States)

Davis, Matthew C.; Rocque, Brandon G.; Singhal, Ash; Ridder, Tom; Pattisapu, Jogi V.; Johnston, James M.

2017-01-01

Object Neurosurgical services are increasingly recognized as essential components of surgical care worldwide. Degree of interest among neurosurgeons regarding international work, and barriers to involvement in global neurosurgical outreach, are largely unexplored. We distributed a survey to members of the AANS/CNS Joint Section on Pediatric Neurosurgery to assess the state of global outreach among its members and identify barriers to involvement. Methods An internet-based questionnaire was developed by the International Education Subcommittee of the AANS/CNS Joint Section on Pediatric Neurosurgery, and distributed to pediatric neurosurgeons via the AANS/CNS Joint Section email contact list. Participants were surveyed on involvement in global neurosurgical outreach, geographic location, nature of participation, and barriers to further involvement. Results A 35.3% response rate was obtained, with 116 respondents completed the survey. 61% performed or taught neurosurgery in a developing country, 49% traveling at least annually. Africa was the most common region (54%), followed by South America (30%), through 29 separate organizing entities. Hydrocephalus was the most commonly treated condition (88%), followed by spinal dysraphism (74%) and tumor (68%). Most respondents obtained follow-up through communication from local surgeons (77%). 71% believed the international experience improved their practice, and 74% were very or extremely interested in working elsewhere. Interference with current practice (61%), cost (44%), and difficulty identifying international partners (43%) were the most commonly cited barriers to participation. Conclusion Any coordinated effort to expand global neurosurgical capacity begins with appreciation for the current state of outreach efforts. Increasing participation in global outreach will require addressing both real and perceived barriers to involvement. Creation and curation of a centralized online database of ongoing projects to facilitate

Neurosurgery in Egypt: past, present, and future-from pyramids to radiosurgery.

Science.gov (United States)

El Gindi, Sayed

2002-09-01

THE CONTEMPORARY DEVELOPMENT of neurosurgery in Egypt is described, with reference to the ancient past and recent American and European influences. This article traces the steps taken by several leading Egyptian pioneers. Egypt, one of the key countries in the Middle East, has led the development of the specialty in the region and has maintained close ties with the international body of neurological surgeons and surgical societies.

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

International Nuclear Information System (INIS)

Hashimoto, Takuo

2000-01-01

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 invasive

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

2000-01-01

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

Defining Innovation in Neurosurgery: Results from an International Survey.

Science.gov (United States)

Zaki, Mark M; Cote, David J; Muskens, Ivo S; Smith, Timothy R; Broekman, Marike L

2018-06-01

Innovation is a part of the daily practice of neurosurgery. However, a clear definition of what constitutes innovation is lacking and opinions vary from continent to continent, from hospital to hospital, and from surgeon to surgeon. In this study, we distributed an online survey to neurosurgeons from multiple countries to investigate what neurosurgeons consider innovative, by gathering opinions on several hypothetical cases. The anonymous survey consisted of 52 questions and took approximately 10 minutes to complete. A total of 355 neurosurgeons across all continents excluding Antarctica completed the survey. Neurosurgeons achieved consensus (>75%) in considering specific cases to be innovative, including laser resection of meningioma, focused ultrasonography for tumor, oncolytic virus, deep brain stimulation for addiction, and photodynamic therapy for tumor. Although the new dura substitute case was not considered innovative, there was consensus among neurosurgeons indicating that institutional review board approval was still necessary to maintain ethical standards. Furthermore, although 90% of neurosurgeons considered an oncolytic virus for glioblastoma multiforme to be innovative, only 78% believed that institutional review board approval was necessary before treatment. Our results indicate that innovation is a heterogeneous concept among neurosurgeons that necessitates standardization to ensure appropriate patient safety without stifling progress. We discuss both the ethical drawbacks of not having a clear definition of innovation and the challenges in achieving a unified understanding of innovation in neurosurgery and offer suggestions for uniting the field. Copyright © 2018 Elsevier Inc. All rights reserved.

History of functional neurosurgery.

Science.gov (United States)

Iskandar, B J; Nashold, B S

1995-01-01

Whereas in the early days of evil spirits, electric catfish, and phrenology, functional neurosurgery was based on crude observations and dogma, the progress made in neurophysiology at the turn of the century gave the field a strong scientific foundation. Subsequently, the advent of stereotaxis allowed access to deep brain regions and contributed an element of precision. Future directions include the development of frameless stereotaxy; the use of MRI-generated anatomic data, which would circumvent the serious problem of individual variations seen with standard brain atlases; the introduction of various chemicals into brain structures, in an attempt to influence neurochemically mediated disease processes; and finally, the use of the promising techniques of neural transplantation. On hearing of Penfield's intraoperative brain stimulations, Sherrington commented: "It must be great fun to have the physiological preparation speak to you." The idea of therapeutic neurophysiologic interventions is appealing, especially because many disorders show no obvious treatable pathologic cause (e.g., tumor, vascular malformation). As stereotactic technology becomes less cumbersome and more precise, more sophisticated in vivo neurophysiologic preparations become possible. In turn, as our understanding of nervous system physiology grows, our ability to understand pathophysiology and treat disease processes increases.

Investigating the Scope of Resident Patient Care Handoffs within Neurosurgery

OpenAIRE

Babu, Maya A.; Nahed, Brian Vala; Heary, Robert F.

2012-01-01

Introduction: Handoffs are defined as verbal and written communications during patient care transitions. With the passage of recent ACMGE work hour rules further limiting the hours interns can spend in the hospital, many fear that more handoffs will occur, putting patient safety at risk. The issue of handoffs has not been studied in the neurosurgical literature. Methods: A validated, 20-question online-survey was sent to neurosurgical residents in all 98 accredited U.S. neurosurgery programs....

Patterns in neurosurgical adverse events: endovascular neurosurgery.

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Wong, Judith M; Ziewacz, John E; Panchmatia, Jaykar R; Bader, Angela M; Pandey, Aditya S; Thompson, B Gregory; Frerichs, Kai; Gawande, Atul A

2012-11-01

As part of a project to devise evidence-based safety interventions for specialty surgery, the authors sought to review current evidence in endovascular neurosurgery concerning the frequency of adverse events in practice, their patterns, and current methods of reducing the occurrence of these events. This review represents part of a series of papers written to consolidate information about these events and preventive measures as part of an ongoing effort to ascertain the utility of devising system-wide policies and safety tools to improve neurosurgical practice. Based on a review of the literature, thromboembolic events appeared to be the most common adverse events in endovascular neurosurgery, with a reported incidence ranging from 2% to 61% depending on aneurysm rupture status and mode of detection of the event. Intraprocedural and periprocedural prevention and rescue regimens are advocated to minimize this risk; however, evidence on the optimal use of anticoagulant and antithrombotic agents is limited. Furthermore, it is unknown what proportion of eligible patients receive any prophylactic treatment. Groin-site hematoma is the most common access-related complication. Data from the cardiac literature indicate an overall incidence of 9% to 32%, but data specific to neuroendovascular therapy are scant. Manual compression, compression adjuncts, and closure devices are used with varying rates of success, but no standardized protocols have been tested on a broad scale. Contrast-induced nephropathy is one of the more common causes of hospital-acquired renal insufficiency, with an incidence of 30% in high-risk patients after contrast administration. Evidence from medical fields supports the use of various preventive strategies. Intraprocedural vessel rupture is infrequent, with the reported incidence ranging from 1% to 9%, but it is potentially devastating. Improvements in device technology combined with proper endovascular technique play an important role in reducing

[The woman in neurosurgery at the national institute of neurology and neurosurgery].

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Mejía-Pérez, Sonia Iliana; Cervera-Martínez, Claudia; Sánchez-Correa, Thalía Estefanía; Corona-Vázquezo, Teresa

Women have always had a hard time in the history of medicine; Dr. Isabel Blackwell was the first woman in history to practice medicine. Dr. Diana Beck became the world´s first female neurosurgeon. The first Latin American female neurosurgeon was Dr. María Cristina García Sancho y Álvarez-Tostado. All of these women had to face a large number of social, cultural, and economic obstacles in their path; however, this situation has changed gradually. Dr. Ana Lilia Siordia Karam was the first neurosurgeon to graduate from INNN. Nineteen years later the second female neurosurgeon at this institute was Dr. María Petra Herrera Guerrero. During their time at this institute they endured a lot of difficulties, especially with most of their coworkers; however, some coworkers treated them with respect and no gender distinction. Nowadays, four of the 25 total neurosurgery residents at INNN are women, and even though some of them have had to endure acts of gender discrimination, the general situation has changed. With work and respect, women have managed to have a larger role in the surgical field. We hope that in the near future a gender discrimination-free environment will be achieved in medicine and its specialties.

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

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Afolabi Muyiwa Owojuyigbe

2016-01-01

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.

Feasibility of Protective Ventilation During Elective Supratentorial Neurosurgery: A Randomized, Crossover, Clinical Trial.

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Ruggieri, Francesco; Beretta, Luigi; Corno, Laura; Testa, Valentina; Martino, Enrico A; Gemma, Marco

2017-06-30

Traditional ventilation approaches, providing high tidal volumes (Vt), produce excessive alveolar distention and lung injury. Protective ventilation, employing lower Vt and positive end-expiratory pressure (PEEP), is an attractive alternative also for neuroanesthesia, when prolonged mechanical ventilation is needed. Nevertheless, protective ventilation during intracranial surgery may exert dangerous effects on intracranial pressure (ICP). We tested the feasibility of a protective ventilation strategy in neurosurgery. Our monocentric, double-blind, 1:1 randomized, 2×2 crossover study aimed at studying the effect size and variability of ICP in patients undergoing elective supratentorial brain tumor removal and alternatively ventilated with Vt 9 mL/kg-PEEP 0 mm Hg and Vt 7 mL/kg-PEEP 5 mm Hg. Respiratory rate was adjusted to maintain comparable end-tidal carbon dioxide between ventilation modes. ICP was measured through a subdural catheter inserted before dural opening. Forty patients were enrolled; 8 (15%) were excluded after enrollment. ICP did not differ between traditional and protective ventilation (11.28±5.37, 11 [7 to 14.5] vs. 11.90±5.86, 11 [8 to 15] mm Hg; P=0.541). End-tidal carbon dioxide (28.91±2.28, 29 [28 to 30] vs. 28.00±2.17, 28 [27 to 29] mm Hg; Pprotective ventilation. Blood pressure, heart rate, and body temperature did not differ between ventilation modes. Dural tension was "acceptable for surgery" in all cases. ICP differences between ventilation modes were not affected by ICP values under traditional ventilation (coefficient=0.067; 95% confidence interval, -0.278 to 0.144; P=0.523). Protective ventilation is a feasible alternative to traditional ventilation during elective neurosurgery.

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

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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

2015-08-01

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.

A comparative cost analysis of polytrauma and neurosurgery Intensive Care Units at an apex trauma care facility in India.

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Kumar, Parmeshwar; Jithesh, V; Gupta, Shakti Kumar

2016-07-01

Although Intensive Care Units (ICUs) only account for 10% of the hospital beds, they consume nearly 22% of the hospital resources. Few definitive costing studies have been conducted in Indian settings that would help determine appropriate resource allocation. The aim of this study was to evaluate and compare the cost of intensive care delivery between multispecialty and neurosurgery ICUs at an apex trauma care facility in India. The study was conducted in a polytrauma and neurosurgery ICU at a 203-bedded Level IV trauma care facility in New Delhi, India, from May 1, 2012 to June 30, 2012. The study was cross-sectional, retrospective, and record-based. Traditional costing was used to arrive at the cost for both direct and indirect cost estimates. The cost centers included in the study were building cost, equipment cost, human resources, materials and supplies, clinical and nonclinical support services, engineering maintenance cost, and biomedical waste management. Statistical analysis was performed by Fisher's two tailed t-test. Total cost/bed/day for the multispecialty ICU was Rs. 14,976.9/- and for the neurosurgery ICU, it was Rs. 14,306.7/-, workforce constituting nearly half of the expenditure in both ICUs. The cost center wise and overall difference in the cost among the ICUs were statistically significant. Quantification of expenditure in running an ICU in a trauma center would assist health-care decision makers in better allocation of resources. Although multispecialty ICUs are more cost-effective, other factors will also play a role in defining the kind of ICU that needs to be designed.

Graph theory analysis of complex brain networks: new concepts in brain mapping applied to neurosurgery.

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Hart, Michael G; Ypma, Rolf J F; Romero-Garcia, Rafael; Price, Stephen J; Suckling, John

2016-06-01

Neuroanatomy has entered a new era, culminating in the search for the connectome, otherwise known as the brain's wiring diagram. While this approach has led to landmark discoveries in neuroscience, potential neurosurgical applications and collaborations have been lagging. In this article, the authors describe the ideas and concepts behind the connectome and its analysis with graph theory. Following this they then describe how to form a connectome using resting state functional MRI data as an example. Next they highlight selected insights into healthy brain function that have been derived from connectome analysis and illustrate how studies into normal development, cognitive function, and the effects of synthetic lesioning can be relevant to neurosurgery. Finally, they provide a précis of early applications of the connectome and related techniques to traumatic brain injury, functional neurosurgery, and neurooncology.

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: http://bioportal.bioontology.org/ontologies/3013.

Development of automatic navigation measuring system using template-matching software in image guided neurosurgery

International Nuclear Information System (INIS)

Watanabe, Yohei; Hayashi, Yuichiro; Fujii, Masazumi; Wakabayashi, Toshihiko; Kimura, Miyuki; Tsuzaka, Masatoshi; Sugiura, Akihiro

2010-01-01

An image-guided neurosurgery and neuronavigation system based on magnetic resonance imaging has been used as an indispensable tool for resection of brain tumors. Therefore, accuracy of the neuronavigation system, provided by periodic quality assurance (QA), is essential for image-guided neurosurgery. Two types of accuracy index, fiducial registration error (FRE) and target registration error (TRE), have been used to evaluate navigation accuracy. FRE shows navigation accuracy on points that have been registered. On the other hand, TRE shows navigation accuracy on points such as tumor, skin, and fiducial markers. This study shows that TRE is more reliable than FRE. However, calculation of TRE is a time-consuming, subjective task. Software for QA was developed to compute TRE. This software calculates TRE automatically by an image processing technique, such as automatic template matching. TRE was calculated by the software and compared with the results obtained by manual calculation. Using the software made it possible to achieve a reliable QA system. (author)

In vivo porcine training model for cranial neurosurgery.

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Regelsberger, Jan; Eicker, Sven; Siasios, Ioannis; Hänggi, Daniel; Kirsch, Matthias; Horn, Peter; Winkler, Peter; Signoretti, Stefano; Fountas, Kostas; Dufour, Henry; Barcia, Juan A; Sakowitz, Oliver; Westermaier, Thomas; Sabel, Michael; Heese, Oliver

2015-01-01

Supplemental education is desirable for neurosurgical training, and the use of human cadaver specimen and virtual reality models is routine. An in vivo porcine training model for cranial neurosurgery was introduced in 2005, and our recent experience with this unique model is outlined here. For the first time, porcine anatomy is illustrated with particular respect to neurosurgical procedures. The pros and cons of this model are described. The aim of the course was to set up a laboratory scenery imitating an almost realistic operating room in which anatomy of the brain and neurosurgical techniques in a mentored environment free from time constraints could be trained. Learning objectives of the course were to learn about the microsurgical techniques in cranial neurosurgery and the management of complications. Participants were asked to evaluate the quality and utility of the programme via standardized questionnaires by a grading scale from A (best) to E (worst). In total, 154 residents have been trained on the porcine model to date. None of the participants regarded his own residency programme as structured. The bleeding and complication management (97%), the realistic laboratory set-up (89%) and the working environment (94%) were favoured by the vast majority of trainees and confirmed our previous findings. After finishing the course, the participants graded that their skills in bone drilling, dissecting the brain and preserving cerebral vessels under microscopic magnification had improved to level A and B. In vivo hands-on courses, fully equipped with microsurgical instruments, offer an outstanding training opportunity in which bleeding management on a pulsating, vital brain represents a unique training approach. Our results have shown that education programmes still lack practical training facilities in which in vivo models may act as a complementary approach in surgical training.

Evaluation of Sensory and Motor Skills in Neurosurgery Applicants Using a Virtual Reality Neurosurgical Simulator: The Sensory-Motor Quotient.

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Roitberg, Ben Z; Kania, Patrick; Luciano, Cristian; Dharmavaram, Naga; Banerjee, Pat

2015-01-01

Manual skill is an important attribute for any surgeon. Current methods to evaluate sensory-motor skills in neurosurgical residency applicants are limited. We aim to develop an objective multifaceted measure of sensory-motor skills using a virtual reality surgical simulator. A set of 3 tests of sensory-motor function was performed using a 3-dimensional surgical simulator with head and arm tracking, collocalization, and haptic feedback. (1) Trajectory planning: virtual reality drilling of a pedicle. Entry point, target point, and trajectory were scored-evaluating spatial memory and orientation. (2) Motor planning: sequence, timing, and precision: hemostasis in a postresection cavity in the brain. (3) Haptic perception: touching virtual spheres to determine which is softest of the group, with progressive difficulty. Results were analyzed individually and for a combined score of all the tasks. The University of Chicago Hospital's tertiary care academic center. A total of 95 consecutive applicants interviewed at a neurosurgery residency program over 2 years were offered anonymous participation in the study; in 2 cohorts, 36 participants in year 1 and 27 participants in year 2 (validation cohort) agreed and completed all the tasks. We also tested 10 first-year medical students and 4 first- and second-year neurosurgery residents. A cumulative score was generated from the 3 tests. The mean score was 14.47 (standard deviation = 4.37), median score was 13.42, best score was 8.41, and worst score was 30.26. Separate analysis of applicants from each of 2 years yielded nearly identical results. Residents tended to cluster on the better performance side, and first-year students were not different from applicants. (1) Our cumulative score measures sensory-motor skills in an objective and reproducible way. (2) Better performance by residents hints at validity for neurosurgery. (3) We were able to demonstrate good psychometric qualities and generate a proposed sensory

Augmented reality in neurosurgery: a systematic review.

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

2017-10-01

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.

CT-MR image data fusion for computer assisted navigated neurosurgery of temporal bone tumors

International Nuclear Information System (INIS)

Nemec, Stefan Franz; Donat, Markus Alexander; Mehrain, Sheida; Friedrich, Klaus; Krestan, Christian; Matula, Christian; Imhof, Herwig; Czerny, Christian

2007-01-01

Purpose: To demonstrate the value of multi detector computed tomography (MDCT) and magnetic resonance imaging (MRI) in the preoperative work up of temporal bone tumors and to present, especially, CT and MR image fusion for surgical planning and performance in computer assisted navigated neurosurgery of temporal bone tumors. Materials and methods: Fifteen patients with temporal bone tumors underwent MDCT and MRI. MDCT was performed in high-resolution bone window level setting in axial plane. The reconstructed MDCT slice thickness was 0.8 mm. MRI was performed in axial and coronal plane with T2-weighted fast spin-echo (FSE) sequences, un-enhanced and contrast-enhanced T1-weighted spin-echo (SE) sequences, and coronal T1-weighted SE sequences with fat suppression and with 3D T1-weighted gradient-echo (GE) contrast-enhanced sequences in axial plane. The 3D T1-weighted GE sequence had a slice thickness of 1 mm. Image data sets of CT and 3D T1-weighted GE sequences were merged utilizing a workstation to create CT-MR fusion images. MDCT and MR images were separately used to depict and characterize lesions. The fusion images were utilized for interventional planning and intraoperative image guidance. The intraoperative accuracy of the navigation unit was measured, defined as the deviation between the same landmark in the navigation image and the patient. Results: Tumorous lesions of bone and soft tissue were well delineated and characterized by CT and MR images. The images played a crucial role in the differentiation of benign and malignant pathologies, which consisted of 13 benign and 2 malignant tumors. The CT-MR fusion images supported the surgeon in preoperative planning and improved surgical performance. The mean intraoperative accuracy of the navigation system was 1.25 mm. Conclusion: CT and MRI are essential in the preoperative work up of temporal bone tumors. CT-MR image data fusion presents an accurate tool for planning the correct surgical procedure and is a

Overview of intraoperative MRI in neurosurgery

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

2002-01-01

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.)

Overview of intraoperative MRI in neurosurgery

International Nuclear Information System (INIS)

Shiino, Akihiko; Matsuda, Masayuki

2002-01-01

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.)

The impact of several craniotomies on transcranial motor evoked potential monitoring during neurosurgery.

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Tomio, Ryosuke; Akiyama, Takenori; Toda, Masahiro; Ohira, Takayuki; Yoshida, Kazunari

2017-09-01

OBJECTIVE Transcranial motor evoked potential (tMEP) monitoring is popular in neurosurgery; however, the accuracy of tMEP can be impaired by craniotomy. Each craniotomy procedure and changes in the CSF levels affects the current spread. The aim of this study was to investigate the influence of several craniotomies on tMEP monitoring by using C3-4 transcranial electrical stimulation (TES). METHODS The authors used the finite element method to visualize the electric field in the brain, which was generated by TES, using realistic 3D head models developed from T1-weighted MR images. Surfaces of 5 layers of the head (brain, CSF, skull, subcutaneous fat, and skin layer) were separated as accurately as possible. The authors created 5 models of the head, as follows: normal head; frontotemporal craniotomy; parietal craniotomy; temporal craniotomy; and occipital craniotomy. The computer simulation was investigated by finite element methods, and clinical recordings of the stimulation threshold level of upper-extremity tMEP (UE-tMEP) during neurosurgery were also studied in 30 patients to validate the simulation study. RESULTS Bone removal during the craniotomy positively affected the generation of the electric field in the motor cortex if the motor cortex was just under the bone at the margin of the craniotomy window. This finding from the authors' simulation study was consistent with clinical reports of frontotemporal craniotomy cases. A major decrease in CSF levels during an operation had a significantly negative impact on the electric field when the motor cortex was exposed to air. The CSF surface level during neurosurgery depends on the body position and location of the craniotomy. The parietal craniotomy and temporal craniotomy were susceptible to the effect of the changing CSF level, based on the simulation study. A marked increase in the threshold following a decrease in CSF was actually recorded in clinical reports of the UE-tMEP threshold from a temporal craniotomy

Augmented reality-guided neurosurgery: accuracy and intraoperative application of an image projection technique.

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Besharati Tabrizi, Leila; Mahvash, Mehran

2015-07-01

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.

Mythology and Neurosurgery.

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Ökten, Ali İhsan

2016-06-01

Myths are the keystone of mythology. They are interpretations of events that have been told as stories and legends for thousands of years, inherited from generation to generation, and have reached the present day. Although most myths are considered figments of the imagination or fictitious legends, all of them contain references to facts from the time they occurred. Mythology, which is a collection of figments of imagination concerning nature and human beings, is a product of human effort to perceive, explain, and interpret the universe and the world, much like science. The interaction between mythology and science dates back to the early days of civilization. Mythology, a reflection of human creativity, is extensively used in modern science, particularly in a terminological context. This article aims to reveal the texture of mythology in neurosurgery, by analyzing the birth of medicine in mythology; heroes such as Apollo and Asklepios, the gods of healing and medicine, as well as Hygieia, the goddess of health and hygiene; and mythological terms and phrases such as Achilles tendon, atlas vertebra, gigantism, priapism syndrome, hippocampus, lethargy, syrinx, and arachnoid. Through the use of symbols, mythology has attempted to explain several subjects, such as human nature, disease, birth, and death. In this respect, mythology and medicine dance arm in arm, and this dance has been going on for centuries. As a result, mythology has manifested itself in many fields within medicine, either anatomically or by giving names to various diseases. Copyright © 2016 Elsevier Inc. All rights reserved.

Roots of neuroanatomy, neurology, and neurosurgery as found in the Bible and Talmud.

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Tubbs, R Shane; Loukas, Marios; Shoja, Mohammadali M; Cohen-Gadol, Aaron A; Wellons, John C; Oakes, W Jerry

2008-07-01

Historical observations and interpretations regarding the treatment of components of the nervous system can be found in the writings of the Bible and Talmud. A review of topics germane to modern neuroanatomy, neurology, and neurosurgery from these early, rich writings is presented herein. These historic writings provide a glimpse into the early understanding, description, and treatment of pathologies of the nervous system.

Introduction: military neurosurgery, past and present.

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Klimo, Paul; Ragel, Brian T

2010-05-01

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

[New approaches in neurosurgery and hyperbaric medicine--the importance of preventive and industrial medicine].

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Kohshi, K; Munaka, M; Abe, H; Tosaki, T

1999-12-01

Neurosurgical patients have been mainly treated by surgical procedures over the past decades. In addition, hyperbaric oxygen (HBO) therapy in neurosurgery has been used in patients with ischemic cerebrovascular diseases, head trauma, spinal damage, postoperative brain edema and others. However, the main therapeutic methods for neurosurgical diseases have changed dramatically due to developments in radiological techniques, such as radiosurgery and intravascular surgery. With changes in therapeutic methods, HBO therapy may become a very important treatment option for neurosurgical patients. For example, HBO therapy combined with radiotherapy (UOEH regimen) and anticoagulant therapy appear to be very effective in the treatments of malignant brain tumors and ischemic cerebrovascular diseases, respectively. On the other hand, medical examinations under hyper- and hypobaric environments have not yet been fully studied in the central nervous system compared to those in the cardiopulmonary systems. Moreover, the mechanisms of cerebral lesions in decompression sickness and acute mountain sickness remain unclear. Clinical neurologic approaches are very important in these fields. Hence, clinicians and researchers skilled in both neurosurgery and hyperbaric medicine will be required for advanced treatment and preventive and industrial medicine.

Image-guided neurosurgery. Global concept of a surgical tele-assistance using obstacle detection robotics

International Nuclear Information System (INIS)

Desgeorges, M.; Bellegou, N.; Faillot, Th.; Cordoliani, Y.S.; Dutertre, G.; Blondet, E.; Soultrait, F. de; Boissy, J.M.

2000-01-01

Surgical tele-assistance significantly increases accuracy of surgical gestures, especially in the case of brain tumor neurosurgery. The robotic device is tele-operated through a microscope and the surgeon's gestures are guided by real-time overlaying of the X-ray imagery in the microscope. During the device's progression inside the brain, the focus is ensured by the microscope auto-focus feature. The surgeon can thus constantly check his position on the field workstation. Obstacles to avoid or dangerous areas can be previewed in the operation field. This system is routinely used for 5 years in the neurosurgery division of the Val de Grace hospital. More than 400 brain surgery operations have been done using it. An adaptation is used for rachis surgery. Other military hospitals begin to be equipped with similar systems. It will be possible to link them for data transfer. When it will be operational, such a network it will show what could be, in the future, a medical/surgical remote-assistance system designed to take care of wounded/critical conditions people, including assistance to surgical gestures. (authors)

da Vinci robot-assisted keyhole neurosurgery: a cadaver study on feasibility and safety.

Science.gov (United States)

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

2015-04-01

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.

Thin-film electroencephalographic electrodes using multi-walled carbon nanotubes are effective for neurosurgery.

Science.gov (United States)

Awara, Kousuke; Kitai, Ryuhei; Isozaki, Makoto; Neishi, Hiroyuki; Kikuta, Kenichiro; Fushisato, Naoki; Kawamoto, Akira

2014-12-15

Intraoperative morphological and functional monitoring is essential for safe neurosurgery. Functional monitoring is based on electroencephalography (EEG), which uses silver electrodes. However, these electrodes generate metal artifacts as silver blocks X-rays, creating white radial lines on computed tomography (CT) images during surgery. Thick electrodes interfere with surgical procedures. Thus, thinner and lighter electrodes are ideal for intraoperative use. The authors developed thin brain electrodes using carbon nanotubes that were formed into thin sheets and connected to electrical wires. The nanotube sheets were soft and fitted the curve of the head very well. When attached to the head using paste, the impedance of the newly developed electrodes was 5 kΩ or lower, which was similar to that of conventional metal electrodes. These electrodes can be used in combination with intraoperative CT, magnetic resonance imaging (MRI), or cerebral angiography. Somatosensory-evoked potentials, auditory brainstem responses, and visually evoked potentials were clearly identified in ten volunteers. The electrodes, without any artifacts that distort images, did not interfere with X-rays, CT, or MR images. They also did not cause skin damage. Carbon nanotube electrodes may be ideal for neurosurgery.

Use of a formal assessment instrument for evaluation of resident operative skills in pediatric neurosurgery.

Science.gov (United States)

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

2015-08-28

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 assessment scores overall or in any of the 7 domains scores

Experiential Learning of Robotics Fundamentals Based on a Case Study of Robot-Assisted Stereotactic Neurosurgery

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

2016-01-01

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…

Review of 3-Dimensional Printing on Cranial Neurosurgery Simulation Training.

Science.gov (United States)

Vakharia, Vejay N; Vakharia, Nilesh N; Hill, Ciaran S

2016-04-01

Shorter working times, reduced operative exposure to complex procedures, and increased subspecialization have resulted in training constraints within most surgical fields. Simulation has been suggested as a possible means of acquiring new surgical skills without exposing patients to the surgeon's operative "learning curve." Here we review the potential impact of 3-dimensional printing on simulation and training within cranial neurosurgery and its implications for the future. In accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines, a comprehensive search of PubMed, OVID MEDLINE, Embase, and the Cochrane Database of Systematic Reviews was performed. In total, 31 studies relating to the use of 3-dimensional (3D) printing within neurosurgery, of which 16 were specifically related to simulation and training, were identified. The main impact of 3D printing on neurosurgical simulation training was within vascular surgery, where patient-specific replication of vascular anatomy and pathologies can aid surgeons in operative planning and clip placement for reconstruction of vascular anatomy. Models containing replicas of brain tumors have also been reconstructed and used for training purposes, with some providing realistic representations of skin, subcutaneous tissue, bone, dura, normal brain, and tumor tissue. 3D printing provides a unique means of directly replicating patient-specific pathologies. It can identify anatomic variation and provide a medium in which training models can be generated rapidly, allowing the trainee and experienced neurosurgeon to practice parts of operations preoperatively. Future studies are required to validate this technology in comparison with current simulators and show improved patient outcomes. Copyright © 2016 Elsevier Inc. All rights reserved.

Phantom study and accuracy evaluation of an image-to-world registration approach used with electro-magnetic tracking system for neurosurgery

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Li, Senhu; Sarment, David

2015-12-01

Minimally invasive neurosurgery needs intraoperative imaging updates and high efficient image guide system to facilitate the procedure. An automatic image guided system utilized with a compact and mobile intraoperative CT imager was introduced in this work. A tracking frame that can be easily attached onto the commercially available skull clamp was designed. With known geometry of fiducial and tracking sensor arranged on this rigid frame that was fabricated through high precision 3D printing, not only was an accurate, fully automatic registration method developed in a simple and less-costly approach, but also it helped in estimating the errors from fiducial localization in image space through image processing, and in patient space through the calibration of tracking frame. Our phantom study shows the fiducial registration error as 0.348+/-0.028mm, comparing the manual registration error as 1.976+/-0.778mm. The system in this study provided a robust and accurate image-to-patient registration without interruption of routine surgical workflow and any user interactions involved through the neurosurgery.

Operative Duration and Risk of Surgical Site Infection in Neurosurgery.

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Bekelis, Kimon; Coy, Shannon; Simmons, Nathan

2016-10-01

The association of surgical duration with the risk of surgical site infection (SSI) has not been quantified in neurosurgery. We investigated the association of operative duration in neurosurgical procedures with the incidence of SSI. We performed a retrospective cohort study involving patients who underwent neurosurgical procedures from 2005 to 2012 and were registered in the American College of Surgeons National Quality Improvement Project registry. To control for confounding, we used multivariable regression models and propensity score conditioning. During the study period there were 94,744 patients who underwent a neurosurgical procedure and met the inclusion criteria. Of these patients, 4.1% developed a postoperative SSI within 30 days. Multivariable logistic regression showed an association between longer operative duration with higher incidence of SSI (odds ratio [OR], 1.18; 95% confidence interval [CI], 1.16-1.20). Compared with procedures of moderate duration (third quintile, 40th-60th percentile), patients undergoing the longest procedures (>80th percentile) had higher odds (OR, 2.07; 95% CI, 1.86-2.31) of developing SSI. The shortest procedures (operative duration was associated with increased incidence of SSI for neurosurgical procedures. These results can be used by neurosurgeons to inform operative management and to stratify patients with regard to SSI risk. Copyright © 2016 Elsevier Inc. All rights reserved.

Solitary Giant Neurofibroma of the Scalp with Calvarial Defect in a ...

African Journals Online (AJOL)

2010-06-29

Jun 29, 2010 ... Neurosurgery and 1Department of Pathology, Usmanu Dan. Fodiyo University, Teaching Hospital Sokoto, Nigeria. Address for correspondence: Dr. N. J. Ismail, Department of. Neurosurgery, Regional Center for Neurosurgery, Usmanu ... with complete tumor excision, and frontal cranioplasty with antibiotic ...

Pre-operative planning and intra-operative guidance in modern neurosurgery: a review of 300 cases.

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Wadley, J.; Dorward, N.; Kitchen, N.; Thomas, D.

1999-01-01

Operative neurosurgery has recently entered an exciting era of image guided surgery or neuronavigation and application of this novel technology is beginning to have a significant impact in many ways in a variety of intracranial procedures. In order to fully assess the advantages of image guided techniques over conventional planning and surgery in selected cases, detailed prospective evaluation has been carried out during the advanced development of an optically tracked neuronavigation system. Over a 2-year period, 300 operative neurosurgical procedures have been performed with the assistance of interactive image guidance, as well as the development of new software applications and hardware tools. A broad range of intracranial neurosurgical procedures were seen to benefit from image guidance, including 163 craniotomies, 53 interactive stereotactic biopsies, 7 tracked neuroendoscopies and 37 complex skull base procedures. The most common pathological diagnoses were cerebral glioma in 98 cases, meningioma in 64 and metastasis in 23. Detailed analysis of a battery of postoperative questions revealed benefits in operative planning, appreciation of anatomy, lesion location, safety of surgery and greatly enhanced surgical confidence. The authors believe that image guided surgical technology, with new developments such as those described, has a significant role to play in contemporary neurosurgery and its widespread adoption in practice will be realised in the near future. Images Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Figure 7 Figure 8 Figure 9 PMID:10615186

Role of gamma knife radiosurgery in neurosurgery. Past and future perspectives

International Nuclear Information System (INIS)

Koga, Tomoyuki; Shin, Masahiro; Saito, Nobuhito

2010-01-01

The gamma knife was the first radiosurgical device developed at the Karolinska Institute in 1967. Stereotactic radiosurgery using the gamma knife has been widely accepted in clinical practice and has contributed to the development of neurosurgery. More than 500,000 patients have been treated by gamma knife stereotactic radiosurgery so far, and the method is now an indispensable neurosurgical tool. Here we review long-term outcomes and development of stereotactic radiosurgery using the gamma knife and discuss its future perspectives. The primary role of stereotactic radiosurgery is to control small well-demarcated lesions such as metastatic brain tumors, meningiomas, schwannomas, and pituitary adenomas while preserving the function of surrounding brain tissue. The gamma knife has been used as a primary treatment or in combination with surgery, and some applications have been accepted as standard treatment in the field of neurosurgery. Treatment of cerebral arteriovenous malformations has also been drastically changed after emergence of this technology. Controlling functional disorders is another role of stereotactic radiosurgery. There is a risk of radiation-induced adverse events, which are usually mild and less frequent. However, especially in large or invasive lesions, those risks are not negligible and pose limitations. Advancement of irradiation technology and dose planning software have enabled more sophisticated and safer treatment, and further progress will contribute to better treatment outcomes not only for brain lesions but also for cervical lesions with less invasive treatment. (author)

Readiness for practice: a survey of neurosurgery graduates and program directors.

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Haji, Faizal A; Steven, David A

2014-11-01

Postgraduate neurosurgical education is undergoing significant reform, including transition to a competency-based training model. To support these efforts, the purpose of this study was to determine neurosurgical graduates' and program directors' (PDs) opinions about graduates' level of competence in reference to the 2010 Royal College Objectives of Training in Neurosurgery. An electronic survey was distributed to Canadian neurosurgery PDs and graduates from 2011. The questionnaire addressed graduates' abilities in nonprocedural knowledge and skills, CanMEDS roles, proficiency with core neurosurgical procedures and knowledge of complex neurosurgical techniques. Thirteen of 22 (59%) graduate and 17/25 (65%) PD surveys were completed. There were no significant differences between PD and graduate responses. Most respondents agreed that these graduates possess the knowledge and skills expected of an independently practicing neurosurgeon across current objectives of training. A small proportion felt some graduates did not achieve this level of proficiency on specific vascular, functional, peripheral nerve and endoscopic procedures. This was partially attributed to limited exposure to these procedures during training and perceptions that some techniques required fellowship-level training. Graduating neurosurgical residents are perceived to possess a high level of proficiency in the majority of neurosurgical practice domains. Inadequate exposure during training or a perception that subspecialists should perform some procedures may contribute to cases where proficiency is not as high. The trends identified in this study could be monitored on an ongoing basis to provide supplemental data to guide curricular decisions in Canadian neurosurgical training.

Health impact and economic analysis of NGO-supported neurosurgery in Bolivia.

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

2014-04-01

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

Prophylactic antibiotics and anticonvulsants in neurosurgery.

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Ratilal, B; Sampaio, C

2011-01-01

The prophylactic administration of antibiotics to prevent infection and the prophylactic administration of anticonvulsants to prevent first seizure episodes are common practice in neurosurgery. If prophylactic medication therapy is not indicated, the patient not only incurs the discomfort and the inconvenience resulting from drug treatment but is also unnecessarily exposed to adverse drug reactions, and incurs extra costs. The main situations in which prophylactic anticonvulsants and antibiotics are used are described and those situations we found controversial in the literature and lack further investigation are identified: anticonvulsants for preventing seizures in patients with chronic subdural hematomas, antiepileptic drugs for preventing seizures in those suffering from brain tumors, antibiotic prophylaxis for preventing meningitis in patients with basilar skull fractures, and antibiotic prophylaxis for the surgical introduction of intracranial ventricular shunts.In the following we present systematic reviews of the literature in accordance with the standard protocol of The Cochrane Collaboration to evaluate the effectiveness of the use of these prophylactic medications in the situations mentioned. Our goal was to efficiently integrate valid information and provide a basis for rational decision-making.

Innovation in Neurosurgery: Intellectual Property Strategy and Academia/Industrial Collaboration.

Science.gov (United States)

Murayama, Yuichi

2016-09-15

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.

Medical Department, United States Army. Surgery in World War 2. Neurosurgery. Volume 2

Science.gov (United States)

1959-01-01

extension, without respect for such anatonlic barriers as fascia , peri- osteuni, or the serosal mnenmbranes or the capsules of viscera. T[ie appearance...NEUROSURGERY a bilateral atypical plantar response was obtained in complete lesions, in the form of a delayed, weak, slow, vermicular type of plantar ...wound after closure of the dura, and closure was effected in layers. Because this was a re- opened wound, a slip drain was left beneath the fascia for

From Structure to Circuits: The Contribution of MEG Connectivity Studies to Functional Neurosurgery.

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Pang, Elizabeth W; Snead Iii, O C

2016-01-01

New advances in structural neuroimaging have revealed the intricate and extensive connections within the brain, data which have informed a number of ambitious projects such as the mapping of the human connectome. Elucidation of the structural connections of the brain, at both the macro and micro levels, promises new perspectives on brain structure and function that could translate into improved outcomes in functional neurosurgery. The understanding of neuronal structural connectivity afforded by these data now offers a vista on the brain, in both healthy and diseased states, that could not be seen with traditional neuroimaging. Concurrent with these developments in structural imaging, a complementary modality called magnetoencephalography (MEG) has been garnering great attention because it too holds promise for being able to shed light on the intricacies of functional brain connectivity. MEG is based upon the elemental principle of physics that an electrical current generates a magnetic field. Hence, MEG uses highly sensitive biomagnetometers to measure extracranial magnetic fields produced by intracellular neuronal currents. Put simply then, MEG is a measure of neurophysiological activity, which captures the magnetic fields generated by synchronized intraneuronal electrical activity. As such, MEG recordings offer exquisite resolution in the time and oscillatory domain and, as well, when co-registered with magnetic resonance imaging (MRI), offer excellent resolution in the spatial domain. Recent advances in MEG computational and graph theoretical methods have led to studies of connectivity in the time-frequency domain. As such, MEG can elucidate a neurophysiological-based functional circuitry that may enhance what is seen with MRI connectivity studies. In particular, MEG may offer additional insight not possible by MRI when used to study complex eloquent function, where the precise timing and coordination of brain areas is critical. This article will review the

The historical origin of the term "meningioma" and the rise of nationalistic neurosurgery.

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

2016-11-01

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

Risk factors for local failure requiring salvage neurosurgery after radiosurgery for brain metastases

International Nuclear Information System (INIS)

Weltman, Eduardo; Hanriot, Rodrigo de Morais; Prisco, Flavio Eduardo; Nadalin, Wladimir; Brandt, Reynaldo Andre; Moreira, Frederico Rafael

2004-01-01

Objective: the aim of this study is to select the risk factors for local failure requiring salvage neurosurgery in patients with brain metastases treated with stereotactic radiosurgery in a single institution. Methods: the follow-up of 123 patients, with 255 brain metastases treated with radiosurgery at the Radiation Oncology Department of the Hospital Israelita Albert Einstein from July 1993 to August 2001, was retrospectively analyzed. The criteria for salvage neurosurgery were tumor volume enlargement, or tumor persistence leading to severe neurological symptoms, life threatening situation or critical steroid dependence. We considered the case as local failure when the histopathologic evaluation showed morphologically preserved cancer cells (tumor recurrence, persistence or progression). We applied the Fisher's exact test to evaluate the statistical correlation between local failure and primary tumor histology, volume of the brain metastases, prescribed radiosurgery dose, and whole brain radiotherapy. Results: fourteen of 123 patients (11%) underwent salvage neurosurgery. Histology showed preserved cancer cells with necrosis and/or bleeding in 11 cases (9% of the total accrual), and only necrosis with or without bleeding (without preserved cancer cells) in three cases. The primary tumor histology among the 11 patients considered with active neoplasia was malignant melanoma in five cases (21% of the patients with melanoma), breast adenocarcinoma in three (16% of the patients with breast cancer), and other histology in the remaining three. Breast cancer diagnosis, non-elective whole brain irradiation, volume of the brain metastases, and the prescribed radiosurgery dose did not correlate with the risk of local failure. Patients treated with elective whole brain radiotherapy showed fewer local failures, when compared to all patients receiving whole brain radiotherapy, and to the patients not receiving this treatment, with incidence of failure in 4%,7% and 14

[Brain metastasis from breast cancer: who?, when? and special considerations about the role of technology in neurosurgery].

Science.gov (United States)

Dutertre, Guillaume; Pouit, Bruno

2011-04-01

Questions about both the place and the role of surgery on brain metastasis from breast cancer are arising more and more frequently in practice due to the increase of brain metastasis in patients suffering from a form of cancer recognized as one of the most recurrent cancers in adults but also one of the most sensitive to general treatments of the systemic disease. With improvements in anaesthesia, in surgical instruments, and in global care, neurosurgery has taken advantage of new techniques such as pre- and even per-operative imagery and also neuronavigation. These techniques enable radical and effective surgical intervention with a high level of safety for the patient, making neurosurgery perfectly competitive with other therapeutic modalities, particularly on functional grounds. As for symptomatic treatments or other anti-metastasis treatments, most situations allow a reflection on the global therapeutic strategy which can be adapted to individual cases depending on the patient's general prognosis. In developing this global therapeutic strategy, surgical treatment is still as relevant as ever.

[In the 100 birth anniversary of the pioneer of stereotactic brain surgery in Poland professor Oskar Liszka. Functional neurosurgery in Poland and in Krakow].

Science.gov (United States)

Stachura, Krzysztof

2016-01-01

This article is the report from the meeting of the Medical Society of Cracow, that has been devoted to the 100 birth anniversary of Oskar Liszka, Assoc. Prof., MD. In the course of the meeting Professor Oskar Liszka's figure has been reminded and his work as a pioneer of stereotactic surgery in Poland has been discussed. In the next two sections, the development of functional neurosurgery in Poland and achievements in this field in the Department of Neurosurgery and Neurotraumatology of Jagiellonian University Collegium Medicum in Krakow have been presented.

Patients' views on priority setting in neurosurgery: A qualitative study.

Science.gov (United States)

Gunaratnam, Caroline; Bernstein, Mark

2016-01-01

Accountability for Reasonableness is an ethical framework which has been implemented in various health care systems to improve and evaluate the fairness of priority setting. This framework is grounded on four mandatory conditions: relevance, publicity, appeals, and enforcement. There have been few studies which have evaluated the patient stakeholders' acceptance of this framework; certainly no studies have been done on patients' views on the prioritization system for allocating patients for operating time in a system with pressure on the resource of inpatient beds. The aim of this study is to examine neurosurgical patients' views on the prioritization of patients for operating theater (OT) time on a daily basis at a tertiary and quaternary referral neurosurgery center. Semi-structured face-to-face interviews were conducted with thirty-seven patients, recruited from the neurosurgery clinic at Toronto Western Hospital. Family members and friends who accompanied the patient to their clinic visit were encouraged to contribute to the discussion. Interviews were audio recorded, transcribed verbatim, and subjected to thematic analysis using open and axial coding. Overall, patients are supportive of the concept of a priority-setting system based on fairness, but felt that a few changes would help to improve the fairness of the current system. These changes include lowering the level of priority given to volume-funded cases and providing scheduled surgeries that were previously canceled a higher level of prioritization. Good communication, early notification, and rescheduling canceled surgeries as soon as possible were important factors that directly reflected the patients' confidence level in their doctor, the hospital, and the health care system. This study is the first clinical qualitative study of patients' perspective on a prioritization system used for allocating neurosurgical patients for OT time on a daily basis in a socialized not-for-profit health care system with

Postoperative Central Nervous System Infection After Neurosurgery in a Modernized, Resource-Limited Tertiary Neurosurgical Center in South Asia.

Science.gov (United States)

Chidambaram, Swathi; Nair, M Nathan; Krishnan, Shyam Sundar; Cai, Ling; Gu, Weiling; Vasudevan, Madabushi Chakravarthy

2015-12-01

Postoperative central nervous system infections (PCNSIs) are rare but serious complications after neurosurgery. The purpose of this study was to examine the prevalence and causative pathogens of PCNSIs at a modernized, resource-limited neurosurgical center in South Asia. A retrospective analysis was conducted of the medical records of all 363 neurosurgical cases performed between June 1, 2012, and June 30, 2013, at a neurosurgical center in South Asia. Data from all operative neurosurgical cases during the 13-month period were included. Cerebrospinal fluid (CSF) analysis indicated that 71 of the 363 surgical cases had low CSF glucose or CSF leukocytosis. These 71 cases were categorized as PCNSIs. The PCNSIs with positive CSF cultures (9.86%) all had gram-negative bacteria with Pseudomonas aeruginosa (n = 5), Escherichia coli (n = 1), or Klebsiella pneumoniae (n = 1). The data suggest a higher rate of death (P = 0.031), a higher rate of CSF leak (P < 0.001), and a higher rate of cranial procedures (P < 0.001) among the infected patients and a higher rate of CSF leak among the patients with culture-positive infections (P = 0.038). This study summarizes the prevalence, causative organism of PCNSI, and antibiotic usage for all of the neurosurgical cases over a 13-month period in a modernized yet resource-limited neurosurgical center located in South Asia. The results from this study highlight the PCNSI landscape in an area of the world that is often underreported in the neurosurgical literature because of the paucity of clinical neurosurgical research undertaken there. This study shows an increasing prevalence of gram-negative organisms in CSF cultures from PCNSIs, which supports a trend in the recent literature of increasing gram-negative bacillary meningitis. Copyright © 2015 Elsevier Inc. All rights reserved.

Genetics Home Reference: COL4A1-related brain small-vessel disease

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... hemorrhage Johns Hopkins Medicine Department of Neurology and Neurosurgery: Intracerebral Hemorrhage Johns Hopkins Medicine Department of Neurology and Neurosurgery: Stroke MalaCards: col4a1-related brain small-vessel disease ...

E-WIN Project 2016: Evaluating the Current Gender Situation in Neurosurgery Across Europe-An Interactive, Multiple-Level Survey.

Science.gov (United States)

Steklacova, Anna; Bradac, Ondrej; de Lacy, Patricia; Benes, Vladimir

2017-08-01

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.

Automated location detection of injection site for preclinical stereotactic neurosurgery procedure

Science.gov (United States)

Abbaszadeh, Shiva; Wu, Hemmings C. H.

2017-03-01

Currently, during stereotactic neurosurgery procedures, the manual task of locating the proper area for needle insertion or implantation of electrode/cannula/optic fiber can be time consuming. The requirement of the task is to quickly and accurately find the location for insertion. In this study we investigate an automated method to locate the entry point of region of interest. This method leverages a digital image capture system, pattern recognition, and motorized stages. Template matching of known anatomical identifiable regions is used to find regions of interest (e.g. Bregma) in rodents. For our initial study, we tackle the problem of automatically detecting the entry point.

Non-rigid registration of 3D ultrasound for neurosurgery using automatic feature detection and matching.

Science.gov (United States)

Machado, Inês; Toews, Matthew; Luo, Jie; Unadkat, Prashin; Essayed, Walid; George, Elizabeth; Teodoro, Pedro; Carvalho, Herculano; Martins, Jorge; Golland, Polina; Pieper, Steve; Frisken, Sarah; Golby, Alexandra; Wells, William

2018-06-04

The brain undergoes significant structural change over the course of neurosurgery, including highly nonlinear deformation and resection. It can be informative to recover the spatial mapping between structures identified in preoperative surgical planning and the intraoperative state of the brain. We present a novel feature-based method for achieving robust, fully automatic deformable registration of intraoperative neurosurgical ultrasound images. A sparse set of local image feature correspondences is first estimated between ultrasound image pairs, after which rigid, affine and thin-plate spline models are used to estimate dense mappings throughout the image. Correspondences are derived from 3D features, distinctive generic image patterns that are automatically extracted from 3D ultrasound images and characterized in terms of their geometry (i.e., location, scale, and orientation) and a descriptor of local image appearance. Feature correspondences between ultrasound images are achieved based on a nearest-neighbor descriptor matching and probabilistic voting model similar to the Hough transform. Experiments demonstrate our method on intraoperative ultrasound images acquired before and after opening of the dura mater, during resection and after resection in nine clinical cases. A total of 1620 automatically extracted 3D feature correspondences were manually validated by eleven experts and used to guide the registration. Then, using manually labeled corresponding landmarks in the pre- and post-resection ultrasound images, we show that our feature-based registration reduces the mean target registration error from an initial value of 3.3 to 1.5 mm. This result demonstrates that the 3D features promise to offer a robust and accurate solution for 3D ultrasound registration and to correct for brain shift in image-guided neurosurgery.

Localization and registration accuracy in image guided neurosurgery: a clinical study

Energy Technology Data Exchange (ETDEWEB)

Shamir, Reuben R.; Joskowicz, Leo [Hebrew University of Jerusalem, School of Engineering and Computer Science, Jerusalem (Israel); Spektor, Sergey; Shoshan, Yigal [Hadassah University Hospital, Department of Neurosurgery, School of Medicine, Jerusalem (Israel)

2009-01-15

To measure and compare the clinical localization and registration errors in image-guided neurosurgery, with the purpose of revising current assumptions. Twelve patients who underwent brain surgeries with a navigation system were randomly selected. A neurosurgeon localized and correlated the landmarks on preoperative MRI images and on the intraoperative physical anatomy with a tracked pointer. In the laboratory, we generated 612 scenarios in which one landmark pair was defined as the target and the remaining ones were used to compute the registration transformation. Four errors were measured: (1) fiducial localization error (FLE); (2) target registration error (TRE); (3) fiducial registration error (FRE); (4) Fitzpatrick's target registration error estimation (F-TRE). We compared the different errors and computed their correlation. The image and physical FLE ranges were 0.5-2.0 and 1.6-3.0 mm, respectively. The measured TRE, FRE and F-TRE were 4.1{+-}1.6, 3.9{+-}1.2, and 3.7{+-}2.2 mm, respectively. Low correlations of 0.19 and 0.37 were observed between the FRE and TRE and between the F-TRE and the TRE, respectively. The differences of the FRE and F-TRE from the TRE were 1.3{+-}1.0 mm (max=5.5 mm) and 1.3{+-}1.2 mm (max=7.3 mm), respectively. Contrary to common belief, the FLE presents significant variations. Moreover, both the FRE and the F-TRE are poor indicators of the TRE in image-to-patient registration. (orig.)

Defensive Medicine in U.S. Spine Neurosurgery.

Science.gov (United States)

Din, Ryan S; Yan, Sandra C; Cote, David J; Acosta, Michael A; Smith, Timothy R

2017-02-01

Observational cross-sectional survey. To compare defensive practices of U.S. spine and nonspine neurosurgeons in the context of state medical liability risk. Defensive medicine is a commonly reported and costly phenomenon in neurosurgery. Although state liability risk is thought to contribute greatly to defensive practice, variation within neurosurgical specialties has not been well explored. A validated, online survey was sent via email to 3344 members of the American Board of Neurological Surgeons. The instrument contained eight question domains: surgeon characteristics, patient characteristics, practice type, insurance type, surgeon liability profile, basic surgeon reimbursement, surgeon perceptions of medical legal environment, and the practice of defensive medicine. The overall response rate was 30.6% (n = 1026), including 499 neurosurgeons performing mainly spine procedures (48.6%). Spine neurosurgeons had a similar average practice duration as nonspine neurosurgeons (16.6 vs 16.9 years, P = 0.64) and comparable lifetime case volume (4767 vs 4,703, P = 0.71). The average annual malpractice premium for spine neurosurgeons was similar to nonspine neurosurgeons ($104,480.52 vs $101,721.76, P = 0.60). On average, spine neurosurgeons had a significantly higher rate of ordering labs, medications, referrals, procedures, and imaging solely for liability concerns compared with nonspine neurosurgeons (89.2% vs 84.6%, P = 0.031). Multivariate analysis revealed that spine neurosurgeons were roughly 3 times more likely to practice defensively compared with nonspine neurosurgeons (odds ratio, OR = 2.9, P = 0.001) when controlling for high-risk procedures (OR = 7.8, P < 0.001), annual malpractice premium (OR = 3.3, P = 0.01), percentage of patients publicly insured (OR = 1.1, P = 0.80), malpractice claims in the last 3 years (OR = 1.13, P = 0.71), and state medical-legal environment (OR = 1.3, P = 0

Preoperative imaging as the basis for image-guided neurosurgery

International Nuclear Information System (INIS)

Winkler, D.; Strauss, G.; Hesse, S.; Sabri, O.; Goldammer, A.; Meixensberger, J.; Hund-Georgiadis, M.; Richter, A.; Kahn, T.

2004-01-01

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.) [de

Rapidly photo-cross-linkable chitosan hydrogel for peripheral neurosurgeries.

Science.gov (United States)

Rickett, Todd A; Amoozgar, Zohreh; Tuchek, Chad A; Park, Joonyoung; Yeo, Yoon; Shi, Riyi

2011-01-10

Restoring continuity to severed peripheral nerves is crucial to regeneration and enables functional recovery. However, the two most common agents for coaptation, sutures and fibrin glues, have drawbacks such as inflammation, pathogenesis, and dehiscence. Chitosan-based adhesives are a promising alternative, reported to have good cytocompatibility and favorable immunogenicity. A photo-cross-linkable hydrogel based on chitosan is proposed as a new adhesive for peripheral nerve anastomosis. Two Az-chitosans were synthesized by conjugating 4-azidobenzoic acid with low (LMW, 15 kDa) and high (HMW, 50-190 kDa) molecular weight chitosans. These solutions formed a hydrogel in less than 1 min under UV light. The LMW Az-chitosan was more tightly cross-linked than the HMW variant, undergoing significantly less swelling and possessing a higher rheological storage modulus, and both Az-chitosan gels were stiffer than commercial fibrin glue. Severed nerves repaired by Az-chitosan adhesives tolerated longitudinal forces comparable or superior to fibrin glue. Adhesive exposure to intact nerves and neural cell culture showed both Az-chitosans to be nontoxic in the acute (minutes) and chronic (days) time frames. These results demonstrate that Az-chitosan hydrogels are cytocompatible and mechanically suitable for use as bioadhesives in peripheral neurosurgeries.

Efficacy of neurosurgery resident education in the new millennium: the 2008 Council of State Neurosurgical Societies post-residency survey results.

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Mazzola, Catherine A; Lobel, Darlene A; Krishnamurthy, Satish; Bloomgarden, Gary M; Benzil, Deborah L

2010-08-01

Neurosurgical residency training paradigms have changed in response to Accreditation Council for Graduate Medical Education mandates and demands for quality patient care. Little has been done to assess resident education from the perspective of readiness to practice. To assess the efficacy of resident training in preparing young neurosurgeons for practice. In response to Resolution V-2007F of the Council of State Neurosurgical Societies, a survey was developed for neurosurgeons who applied for oral examination, Part II of the American Board of Neurological Surgery boards, in 2002 through 2007 (N = 800). The survey was constructed in "survey monkey" format and sent to 775 of 800 (97%) neurosurgeons for whom e-mail addresses were available. The response rate was 30% (233/775). Most neurosurgeons were board certified (n = 226, 97%). General neurosurgical training was judged as adequate by a large majority (n = 188, 80%). Sixty-percent chose to pursue at least 1 additional year of fellowship training (n = 138, 60%). Surgical skills training was acceptable, but 6 skill-technique areas were reported to be inadequate (endovascular techniques, neurosurgical treatment of pain, stereotactic radiosurgery, epilepsy surgery, cranial base surgery, and stereotactic neurosurgery). Respondents also noted inadequate education in contract negotiation, practice evaluation, and management. The study suggests that neurosurgeons believed that they were well trained in their surgical skills except for some areas of subspecialization. However, there is a significant need for improvement of resident training in the areas of socioeconomic and medicolegal education. Continued evaluation of the efficacy of neurosurgical education is important.

Computational Modeling for Enhancing Soft Tissue Image Guided Surgery: An Application in Neurosurgery.

Science.gov (United States)

Miga, Michael I

2016-01-01

With the recent advances in computing, the opportunities to translate computational models to more integrated roles in patient treatment are expanding at an exciting rate. One area of considerable development has been directed towards correcting soft tissue deformation within image guided neurosurgery applications. This review captures the efforts that have been undertaken towards enhancing neuronavigation by the integration of soft tissue biomechanical models, imaging and sensing technologies, and algorithmic developments. In addition, the review speaks to the evolving role of modeling frameworks within surgery and concludes with some future directions beyond neurosurgical applications.

Factors associated with burnout among US neurosurgery residents: a nationwide survey.

Science.gov (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

2018-02-09

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

Kazan period of life-sustaining activity of professor V.I. Ra-zumovsky — a pioneer of Russian neurosurgery

Directory of Open Access Journals (Sweden)

Danilov V.I.

2012-06-01

Full Text Available There were presented historical data of life-sustaining activity of professor V. I. Razumovsky — a pioneer of Russian neurosurgery, who began to perform and then was performing systematically neurosurgical operations in the Kazan clinic under the guidance of outstanding neurologists V. M. Bekhterev and L. O. Darkshevich.

Sir Charles Bell (1774-1842) and his contributions to early neurosurgery.

Science.gov (United States)

Tubbs, R Shane; Riech, Sheryl; Verma, Ketan; Mortazavi, Martin M; Loukas, Marios; Benninger, Brion; Cohen-Gadol, Aaron A

2012-03-01

The renowned surgeon, neuroanatomist, and artist Sir Charles Bell not only impacted the lives of his peers through his creative endeavors and passion for art, but also sparked noteworthy breakthroughs in the field of neuroscience. His empathetic nature and zest for life enabled him to develop an early proclivity for patient care. As a result of his innovative findings regarding sensory and motor nerves and the anatomical makeup of the brain, he accepted some of the most prestigious awards and received an honorable reputation in society. Bell is recognized for his diligence, perseverance, and his remarkable contributions to surgery. The present review will explore his contributions to the discipline now known as neurosurgery.

Misclassification of Case-Control Studies in Neurosurgery and Proposed Solutions.

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Esene, Ignatius Ngene; Mbuagbaw, Lawrence; Dechambenoit, Gilbert; Reda, Wael; Kalangu, Kazadi K

2018-04-01

Case-control studies (CCS) and cohort studies (CS) are common research designs in neurosurgery. But the term case-control study is frequently misused in the neurosurgical literature, with many articles reported as CCS, even although their methodology does not respect the basic components of a CCS. We sought to estimate the extent of these discrepancies in neurosurgical literature, explore factors contributing to mislabeling, and shed some light on study design reporting. We identified 31 top-ranking pure neurosurgical journals and searched them for articles reported as CCS, either in the title or in the abstract. The articles were read to determine if they really were CCS according to STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) guidelines. Article assessment was conducted in duplicate (agreement [κ statistics] = 99.82%). Two hundred and twenty-four articles met our inclusion criteria, 133 of which (59.38%) correctly labeled the case-control design, whereas 91 (40.62%) misclassified this study design. Cohort studies (CS) were the most common design mislabeled as case-control studies in 76 articles (33.93%), 57 of which (25.45%) were retrospective CS. The mislabeling of CCS impairs the appropriate indexing, classification, and sorting of evidence. Mislabeling CS for CCS leads to a downgrading of evidence as CS represent the highest level of evidence for observational studies. Odds ratios instead of relative risk are reported for these studies, resulting in a distortion of the measurement of the effect size, compounded when these are summarized in systematic reviews and pooled in meta-analyses. Many studies reported as CCS are not true CCS. Reporting guidelines should include items that ensure that studies are labeled correctly. STROBE guidelines should be implemented in assessment of observational studies. Researchers in neurosurgery need better training in research methods and terminology. We also recommend accrued vigilance from

Counting the cost of negligence in neurosurgery: Lessons to be learned from 10 years of claims in the NHS.

Science.gov (United States)

Hamdan, Alhafidz; Strachan, Roger D; Nath, Fredrick; Coulter, Ian C

2015-04-01

Despite substantial progress in modernising neurosurgery, the specialty still tops the list of medico-legal claims. Understanding the factors associated with negligence claims is vital if we are to identify areas of underperformance and subsequently improve patient safety. Here we provide data on trends in neurosurgical negligence claims over a 10-year period in England. We used data provided by the National Health Service Litigation Authority to analyse negligence claims related to neurosurgery from the financial years 2002/2003 to 2011/2012. Using the abstracts provided, we extracted information pertaining to the underlying pathology, injury severity, nature of misadventure and claim value. Over the 10-year period, the annual number of claims increased significantly. In total, there were 794 negligence claims (range 50-117/year); of the 613 closed cases, 405 (66.1%) were successful. The total cost related to claims during the 10 years was £65.7 million, with a mean claim per successful case of £0.16 million (total damages, defence and claimant costs of £45.1, £6.36 and £14.3 million, respectively). Claims related to emergency cases were more costly compared to those of elective cases (£209,327 vs. £112,627; P=0.002). Spinal cases represented the most frequently litigated procedures (350; 44.1% of total), inadequate surgical performance the most common misadventure (231; 29.1%) and fatality the commonest injury implicated in claims (102; 12.8%). Negligence claims related to wrong-site surgery and cauda equina syndrome were frequently successful (26/26; 100% and 14/16; 87.5% of closed cases, respectively). In England, the number of neurosurgical negligence claims is increasing, the financial cost substantial, and the burden significant. Lessons to be learned from the study are of paramount importance to reduce future cases of negligence and improve patient care.

A new operational method of functional neurosurgery combining micro-recording and MRI stereotaxy for the treatment of Parkinson's disease

International Nuclear Information System (INIS)

Nishimura, Hiroyuki; Hirai, Tatsuo.

1993-01-01

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 and 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. (author)

A new operational method of functional neurosurgery combining micro-recording and MRI stereotaxy for the treatment of Parkinson's disease

Energy Technology Data Exchange (ETDEWEB)

Nishimura, Hiroyuki [Kochi Medical School, Nankoku (Japan); Hirai, Tatsuo

1993-02-01

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 and 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. (author).

INFORMATION SYSTEM FOR DEPARTMENT OF RECONSTRUCTIVE NEUROSURGERY

Directory of Open Access Journals (Sweden)

V. I. Tsymbaliuk

2015-05-01

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.

Analysis of linear measurements on 3D surface models using CBCT data segmentation obtained by automatic standard pre-set thresholds in two segmentation software programs: an in vitro study.

Science.gov (United States)

Poleti, Marcelo Lupion; Fernandes, Thais Maria Freire; Pagin, Otávio; Moretti, Marcela Rodrigues; Rubira-Bullen, Izabel Regina Fischer

2016-01-01

The aim of this in vitro study was to evaluate the reliability and accuracy of linear measurements on three-dimensional (3D) surface models obtained by standard pre-set thresholds in two segmentation software programs. Ten mandibles with 17 silica markers were scanned for 0.3-mm voxels in the i-CAT Classic (Imaging Sciences International, Hatfield, PA, USA). Twenty linear measurements were carried out by two observers two times on the 3D surface models: the Dolphin Imaging 11.5 (Dolphin Imaging & Management Solutions, Chatsworth, CA, USA), using two filters(Translucent and Solid-1), and in the InVesalius 3.0.0 (Centre for Information Technology Renato Archer, Campinas, SP, Brazil). The physical measurements were made by another observer two times using a digital caliper on the dry mandibles. Excellent intra- and inter-observer reliability for the markers, physical measurements, and 3D surface models were found (intra-class correlation coefficient (ICC) and Pearson's r ≥ 0.91). The linear measurements on 3D surface models by Dolphin and InVesalius software programs were accurate (Dolphin Solid-1 > InVesalius > Dolphin Translucent). The highest absolute and percentage errors were obtained for the variable R1-R1 (1.37 mm) and MF-AC (2.53 %) in the Dolphin Translucent and InVesalius software, respectively. Linear measurements on 3D surface models obtained by standard pre-set thresholds in the Dolphin and InVesalius software programs are reliable and accurate compared with physical measurements. Studies that evaluate the reliability and accuracy of the 3D models are necessary to ensure error predictability and to establish diagnosis, treatment plan, and prognosis in a more realistic way.

Localization and registration accuracy in image guided neurosurgery: a clinical study

International Nuclear Information System (INIS)

Shamir, Reuben R.; Joskowicz, Leo; Spektor, Sergey; Shoshan, Yigal

2009-01-01

To measure and compare the clinical localization and registration errors in image-guided neurosurgery, with the purpose of revising current assumptions. Twelve patients who underwent brain surgeries with a navigation system were randomly selected. A neurosurgeon localized and correlated the landmarks on preoperative MRI images and on the intraoperative physical anatomy with a tracked pointer. In the laboratory, we generated 612 scenarios in which one landmark pair was defined as the target and the remaining ones were used to compute the registration transformation. Four errors were measured: (1) fiducial localization error (FLE); (2) target registration error (TRE); (3) fiducial registration error (FRE); (4) Fitzpatrick's target registration error estimation (F-TRE). We compared the different errors and computed their correlation. The image and physical FLE ranges were 0.5-2.0 and 1.6-3.0 mm, respectively. The measured TRE, FRE and F-TRE were 4.1±1.6, 3.9±1.2, and 3.7±2.2 mm, respectively. Low correlations of 0.19 and 0.37 were observed between the FRE and TRE and between the F-TRE and the TRE, respectively. The differences of the FRE and F-TRE from the TRE were 1.3±1.0 mm (max=5.5 mm) and 1.3±1.2 mm (max=7.3 mm), respectively. Contrary to common belief, the FLE presents significant variations. Moreover, both the FRE and the F-TRE are poor indicators of the TRE in image-to-patient registration. (orig.)

Straight trajectory planning for keyhole neurosurgery in sheep with automatic brain structures segmentation

Science.gov (United States)

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

2017-03-01

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.

[Epidemiological profile of traumatic brain injury at the Dr. Rafael A. Calderón Guardia Hospital, Neurosurgery Department, during the period from 2007 to 2012].

Science.gov (United States)

Petgrave-Pérez, Alexander; Padilla, Juan I; Díaz, José; Chacón, Rosarito; Chaves, Carlos; Torres, Héctor; Fernández, Jorge

2016-01-01

To determine the epidemiological profile of the patients who suffered traumatic brain injury (TBI) and were treated at the Dr. Rafael A. Calderón Guardia Hospital (HCG) Neurosurgery department, during the period from 2007 to 2012. An observational, descriptive, retrospective and cross section study was performed on all the patients with TBI and who were admitted to the emergency room of the HCG during the period 2007 to 2012. There were a total of 721 cases, of which 566 records were obtained of patients who had the variables established in this study, excluding those with incomplete or inconsistent information. The present study established the epidemiological profile of the TBI in the population seen during the period 2007 to 2012 at the HCG. It was determined that the male sex made up the majority of the cases were male, with mean age of 46 years. The mortality rate was 12.69% (n=69). Car accidents were the most frequent cause of TBI (n=259 persons) in the age group of 25 to 44 years, followed by falls (n=174). It was observed that the majority were farmers, followed by students, and then construction workers. No chronic illnesses were recorded in 71.6% of the medical charts. No alcohol or other drugs were reported in 74.9% of the cases, while there was evidence of the presence of alcohol recorded in 22.8%. The clinical and laboratory parameters that had statistical significance (Paccidents being the main cause of these lesions (45.8%) in combination with alcohol consumption. Also, the consequences of such are aggravated when the victims present with chronic diseases such as, systemic arterial hypertension and mellitus diabetes. As regards the post-traumatic indicators directly related to a poor outcome, it was determined that a GCS score equal to or less than 8, a mean blood pressure less than 60, the prolongation of the coagulation times, the presence of mydriasis, and skull fractures, have a direct association with the negative or fatal outcome for the

Robotic System for MRI-Guided Stereotactic Neurosurgery

Science.gov (United States)

Li, Gang; Cole, Gregory A.; Shang, Weijian; Harrington, Kevin; Camilo, Alex; Pilitsis, Julie G.; Fischer, Gregory S.

2015-01-01

Stereotaxy is a neurosurgical technique that can take several hours to reach a specific target, typically utilizing a mechanical frame and guided by preoperative imaging. An error in any one of the numerous steps or deviations of the target anatomy from the preoperative plan such as brain shift (up to 20 mm), may affect the targeting accuracy and thus the treatment effectiveness. Moreover, because the procedure is typically performed through a small burr hole opening in the skull that prevents tissue visualization, the intervention is basically “blind” for the operator with limited means of intraoperative confirmation that may result in reduced accuracy and safety. The presented system is intended to address the clinical needs for enhanced efficiency, accuracy, and safety of image-guided stereotactic neurosurgery for Deep Brain Stimulation (DBS) lead placement. The work describes a magnetic resonance imaging (MRI)-guided, robotically actuated stereotactic neural intervention system for deep brain stimulation procedure, which offers the potential of reducing procedure duration while improving targeting accuracy and enhancing safety. This is achieved through simultaneous robotic manipulation of the instrument and interactively updated in situ MRI guidance that enables visualization of the anatomy and interventional instrument. During simultaneous actuation and imaging, the system has demonstrated less than 15% signal-to-noise ratio (SNR) variation and less than 0.20% geometric distortion artifact without affecting the imaging usability to visualize and guide the procedure. Optical tracking and MRI phantom experiments streamline the clinical workflow of the prototype system, corroborating targeting accuracy with 3-axis root mean square error 1.38 ± 0.45 mm in tip position and 2.03 ± 0.58° in insertion angle. PMID:25376035

Parental Evaluation of a Nurse Practitioner-Developed Pediatric Neurosurgery Website.

Science.gov (United States)

Vogel, Tina Kovacs; Kleib, Manal; Davidson, Sandra J; Scott, Shannon D

2016-04-12

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. 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. 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. 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 about the 2 summer camps, (2) explore the Media

Tissue Factor and Tissue Factor Pathway Inhibitor in the Wound-Healing Process After Neurosurgery.

Science.gov (United States)

Ślusarz, Robert; Głowacka, Mariola; Biercewicz, Monika; Barczykowska, Ewa; Haor, Beata; Rość, Danuta; Gadomska, Grażyna

2016-03-01

The aim of the study was to assess the concentrations of tissue factor (TF) and tissue factor pathway inhibitor (TFPI) in the blood of patients with a postoperative wound after neurosurgery. Participants included 20 adult patients who underwent neurosurgery because of degenerative spine changes. The concentration of TF and TFPI in the patients' blood serum was measured 3 times: before surgery, during the first 24 hr after surgery, and between the 5th and 7th days after surgery. The control group comprised 20 healthy volunteers similar to the patient group with respect to gender and age. A statistically significant difference was observed between TF concentration at all three measurement time points in the research group and TF concentration in the control group (p = .018, p = .010, p = .001). A statistically significant difference was found between TFPI concentration at the second time point in the research group and TFPI concentration in the control group (p = .041). No statistically significant within-subject difference was found between TF concentrations before and after surgery. A statistically significant within-subject difference was found between TFPI concentrations within 24 hr after surgery and 5-7 days after surgery (p = .004). High perioperative concentrations of TF indicate not only the presence of thrombophilia but also the importance of TF in the wound-healing process. Perioperative changes in TFPI concentrations are related to its compensatory influence on hemostasis in thrombophilic conditions. © The Author(s) 2015.

Various irrigation fluids affect postoperative brain edema and cellular damage during experimental neurosurgery in rats.

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Doi, Kazuhisa; Kawano, Takeshi; Morioka, Yujiro; Fujita, Yasutaka; Nishimura, Masuhiro

2006-12-01

This study was conducted to investigate how various irrigation fluids used during neurosurgical procedures affect the degree of postoperative brain edema and cellular damage during experimental neurosurgery in rats. The cerebral cortex was exposed and incised crosswise with a surgical knife under irrigation with an artificial CSF, lactated Ringer's solution, or normal saline. Four hours after injury, irrigation was stopped and brain tissue samples were obtained from injured and uninjured sites. Specific gravity, cerebrovascular permeability, and TTC staining of the samples were evaluated. Incision and irrigation of the brain were not performed on the control group. At the injured site, specific gravities of the samples in the normal saline group and the lactated Ringer's solution group were significantly lower than the specific gravity in the artificial CSF group. The EB concentration was significantly higher in the lactated Ringer's solution group and relatively high in the normal saline group as compared with the artificial CSF group. TTC staining did not differ significantly between the artificial CSF group and the control group. It was significantly lower in the lactated Ringer's solution group and the normal saline group than in the control group and the artificial CSF group. As compared with normal saline and lactated Ringer's solution, artificial CSF reduced postoperative brain edema, cerebrovascular permeability, and cellular damage in sites injured by experimental neurosurgery in rats.

Simulation training in neurosurgery: advances in education and practice

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Konakondla, Sanjay; Fong, Reginald; Schirmer, Clemens M

2017-01-01

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. PMID:28765716

On Positive Solutions for the Rational Difference Equation Systems x n+1 = A/x n y n (2), and y n+1 = By n /x n-1 y n-1.

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Ma, Hui-Li; Feng, Hui

2014-01-01

Our aim in this paper is to investigate the behavior of positive solutions for the following systems of rational difference equations: x n+1 = A/x n y n (2), and y n+1 = By n /x n-1 y n-1, n = 0,1,…, where x -1, x 0, y -1, and y 0 are positive real numbers and A and B are positive constants.

Morbidity associated with 30-day surgical site infection following nonshunt pediatric neurosurgery

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Sherrod, Brandon A.; Rocque, Brandon G.

2017-01-01

Objective Morbidity associated with surgical site infection (SSI) following nonshunt pediatric neurosurgical procedures is poorly understood. The purpose of this study was to analyze acute morbidity and mortality associated with SSI after nonshunt pediatric neurosurgery using a nationwide cohort. Methods The authors reviewed data from the American College of Surgeons National Surgical Quality Improvement Program Pediatric (NSQIP-P) 2012–2014 database, including all neurosurgical procedures performed on pediatric patients. Procedures were categorized by Current Procedural Terminology (CPT) codes. CSF shunts were excluded. Deep and superficial SSIs occurring within 30 days of an index procedure were identified. Deep SSIs included deep wound infections, intracranial abscesses, meningitis, osteomyelitis, and ventriculitis. The following outcomes occurring within 30 days of an index procedure were analyzed, along with postoperative time to complication development: sepsis, wound disruption, length of postoperative stay, readmission, reoperation, and death. Results A total of 251 procedures associated with a 30-day SSI were identified (2.7% of 9296 procedures). Superficial SSIs were more common than deep SSIs (57.4% versus 42.6%). Deep SSIs occurred more frequently after epilepsy or intracranial tumor procedures. Superficial SSIs occurred more frequently after skin lesion, spine, Chiari decompression, craniofacial, and myelomeningocele closure procedures. The mean (± SD) postoperative length of stay for patients with any SSI was 9.6 ± 14.8 days (median 4 days). Post-SSI outcomes significantly associated with previous SSI included wound disruption (12.4%), sepsis (15.5%), readmission (36.7%), and reoperation (43.4%) (p neurosurgery. Rates of SSI-associated complications are significantly lower in patients with superficial infection than in those with deep infection. There were no cases of SSI-related mortality within 30 days of the index procedure. PMID:28186474

Launching Effectiveness Research to Guide Practice in Neurosurgery: A National Institute Neurological Disorders and Stroke Workshop Report

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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

2017-01-01

Abstract 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.” PMID:28362926

Critical assessment of pediatric neurosurgery patient/parent educational information obtained via the Internet.

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Garcia, Michael; Daugherty, Christopher; Ben Khallouq, Bertha; Maugans, Todd

2018-05-01

OBJECTIVE The Internet is used frequently by patients and family members to acquire information about pediatric neurosurgical conditions. The sources, nature, accuracy, and usefulness of this information have not been examined recently. The authors analyzed the results from searches of 10 common pediatric neurosurgical terms using a novel scoring test to assess the value of the educational information obtained. METHODS Google and Bing searches were performed for 10 common pediatric neurosurgical topics (concussion, craniosynostosis, hydrocephalus, pediatric brain tumor, pediatric Chiari malformation, pediatric epilepsy surgery, pediatric neurosurgery, plagiocephaly, spina bifida, and tethered spinal cord). The first 10 "hits" obtained with each search engine were analyzed using the Currency, Relevance, Authority, Accuracy, and Purpose (CRAAP) test, which assigns a numerical score in each of 5 domains. Agreement between results was assessed for 1) concurrent searches with Google and Bing; 2) Google searches over time (6 months apart); 3) Google searches using mobile and PC platforms concurrently; and 4) searches using privacy settings. Readability was assessed with an online analytical tool. RESULTS Google and Bing searches yielded information with similar CRAAP scores (mean 72% and 75%, respectively), but with frequently differing results (58% concordance/matching results). There was a high level of agreement (72% concordance) over time for Google searches and also between searches using general and privacy settings (92% concordance). Government sources scored the best in both CRAAP score and readability. Hospitals and universities were the most prevalent sources, but these sources had the lowest CRAAP scores, due in part to an abundance of self-marketing. The CRAAP scores for mobile and desktop platforms did not differ significantly (p = 0.49). CONCLUSIONS Google and Bing searches yielded useful educational information, using either mobile or PC platforms. Most

Intraoperative magnetic resonance imaging for neurosurgery – An anaesthesiologist's challenge

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Rajashree U Gandhe

2018-01-01

Full Text Available Intraoperative magnetic resonance imaging (MRI-guided neurosurgery has gained popularity over the years globally. These surgeries require a dedicated operating room and MRI-compatible anaesthesia equipment. The anaesthesiologist providing care in this setup needs to be experienced and vigilant to ensure patient safety. Strict adherence to MRI safety checklists and regular personnel training would avoid potential accidents and life-threatening emergencies. Teamwork, good communication, preprocedure planning, and familiarity with the surroundings are very important for safe care and good outcomes. We performed a literature search in Google Scholar, PubMed and Cochrane databases for original and reviewed articles for the origins, development and applications of intraoperative MRI in neurosurgical procedures. Much of the research has emphasised on the surgical indications than the anaesthetic challenges faced during intraoperative MRI guided surgery. The purpose of this review is to discuss the anaesthetic concerns specific to this unique environment.

Simulation and augmented reality in endovascular neurosurgery: lessons from aviation.

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

2013-01-01

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.

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

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Mezue, Wilfred C; Ohaegbulam, Samuel C; Ndubuisi, Chika C; Chikani, Mark C; Achebe, David S

2012-09-01

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. 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. 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. The pattern of meningioma in our area may have geographical differences in location and histology. Childhood meningioma was rare.

The Role of Neurosurgery in Countries with Limited Facilities: Facts and Challenges.

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Servadei, Franco; Rossini, Zefferino; Nicolosi, Federico; Morselli, Carlotta; Park, Kee B

2018-04-01

The Lancet Commission on Global Surgery has recently focused its attention on the lack of surgical care worldwide. Like other surgical subspecialties, neurosurgical care needs to be better distributed around the world, with a major focus on low- to middle-income countries. Neurosurgical diseases like hydrocephalus, traumatic brain injury, and brain tumors have a high impact on families, individual quality of life, and cost for the society. Implementation of neurosurgical care in poor settings is not easy. More than other surgeries, neurosurgery requires great amounts of human resources, dedicated environments, and specialized postoperative care. It is responsibility of the neurosurgical community to identify major areas of current gaps and outline strategies for intervention. Copyright © 2018 Elsevier Inc. All rights reserved.

Multi-detector computed tomography radiation doses in the follow-up of paediatric neurosurgery patients in KwaZulu-Natal: A dosimetric audit

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Christopher T. Sikwila

2014-05-01

Full Text Available Background: Multi-detector computed tomography (MDCT is the preferred modality for follow-up of paediatric neurosurgery patients. Serial imaging, however, has the disadvantage of an ionising radiation burden, which may be mitigated using the ‘as low as reasonably achievable’ (ALARA principle. Objectives: The primary objectives were to determine the radiation dose exposure in paediatric patients subjected to MDCT imaging following neurosurgery and to compare these values with references in current literature. Our secondary objective was to assess the relationship between radiation dose and clinical scenario. Method: Retrospective descriptive data were collected from all paediatric postsurgical patients (n = 169 between the ages of 0 and 12 years who had their first followed-up scan in the year 2010 and were followed up for six months or less. Dose-length product (DLP and current-time product were collected from the picture archiving and communication system. Demographic data including radiology reports were collected from the hospital information system. The effective doses (ED were calculated from the corresponding DLP using age-adjusted conversion factors. For purposes of comparison with other studies, median dosimetric values were calculated and the children were grouped into three age ranges, namely younger than 3 years, 3–7 years and 8–12 years old. Results: The highest median radiation doses were noted in patients being followed-up for intracranial abscesses (1183 mGy cm in the 8–12 year age group, most of whom were female. The lowest radiation doses were for intracranial shunt follow-ups (447 mGy cm. Median values for DLP, ED and current-time product (mAs were comparable to reference doses in all three age groups. However, our study showed a much broader distribution of values with higher upper limits relative to reference values. Indications for follow-up included shunts (n = 110; 65%, intracranial abscess (n = 31; 18%, subdural

Multi-detector computed tomography radiation doses in the follow-up of paediatric neurosurgery patients in KwaZulu-Natal: A dosimetric audit

Directory of Open Access Journals (Sweden)

Christopher T. Sikwila

2014-04-01

Full Text Available Background: Multi-detector computed tomography (MDCT is the preferred modality for follow-up of paediatric neurosurgery patients. Serial imaging, however, has the disadvantage of an ionising radiation burden, which may be mitigated using the ‘as low as reasonably achievable’ (ALARA principle. Objectives: The primary objectives were to determine the radiation dose exposure in paediatric patients subjected to MDCT imaging following neurosurgery and to compare these values with references in current literature. Our secondary objective was to assess the relationship between radiation dose and clinical scenario.Method: Retrospective descriptive data were collected from all paediatric postsurgical patients (n = 169 between the ages of 0 and 12 years who had their first followed-up scan in the year 2010 and were followed up for six months or less. Dose-length product (DLP and current-time product were collected from the picture archiving and communication system. Demographic data including radiology reports were collected from the hospital information system. The effective doses (ED were calculated from the corresponding DLP using age-adjusted conversion factors. For purposes of comparison with other studies, median dosimetric values were calculated and the children were grouped into three age ranges, namely younger than 3 years, 3–7 years and 8–12 years old.Results: The highest median radiation doses were noted in patients being followed-up for intracranial abscesses (1183 mGy cm in the 8–12 year age group, most of whom were female. The lowest radiation doses were for intracranial shunt follow-ups (447 mGy cm. Median values for DLP, ED and current-time product (mAs were comparable to reference doses in all three age groups. However, our study showed a much broader distribution of values with higher upper limits relative to reference values. Indications for follow-up included shunts (n = 110; 65%, intracranial abscess (n = 31; 18%, subdural

Does peroperative external pneumatic leg muscle compression prevent post-operative venous thrombosis in neurosurgery?

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Bynke, O; Hillman, J; Lassvik, C

1987-01-01

Post-operative deep venous thrombosis (DVT) is a frequent and potentially life-threatening complication in neurosurgery. In this field of surgery, with its special demands for exact haemostasis, prophylaxis against deep venous thrombosis with anticoagulant drugs has been utilized only reluctantly. Postoperative pneumatic muscle compression (EPC) has been shown to be effective, although there are several practical considerations involved with this method which limit its clinical applicability. In the present study per-operative EPC was evaluated and was found to provide good protection against DVT in patients with increased risk from this complication. This method has the advantage of being effective, safe, inexpensive and readily practicable.

Acute extradural haematomas in children: A single neurosurgery unit's 12-year experience.

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Enicker, B; Louw, H; Madiba, T

2016-11-01

Acute extradural haematomas (AEDHs) occur infrequently in children. This study was undertaken to review our experience with management and outcomes of this condition in children treated in the Neurosurgery Unit at Inkosi Albert Luthuli Central Hospital. A retrospective review of medical records of all children (age less than or equal to (≤) 12 years) with a diagnosis of AEDH admitted from January 2003 to December 2014 was performed. Records were analyzed for demographics, mechanisms of injury, clinical presentation, neuroradiology findings, management and outcomes at discharge. A total of 150 children with AEDHs were admitted during this period. The mean age was 6.6 ± 3.8 years with a peak incidence in the 7-9 year age group. There were 84 (56%) males, (M: F= 1.3:1). Sixty AEDHs resulted from road traffic crashes (40%). On admission 104 (69.3%) children were Glasgow coma scale (GCS) 13-15, 26 (17.3%) GCS 9-12 and 20 (13.4%) GCS 3-8. Haemoglobin was less than (children and the mean hospital stay was 6.9 ± 6.1 days. Four children (2.7%) died during in-hospital stay period. One hundred and forty one (94%) children had a favourable Glasgow outcome scale (GOS) at discharge. AEDHs in children carry a good prognosis, but can be potentially fatal. A vigilant approach is required when assessing these children, as early diagnosis and treatment yields gratifying results.

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

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Wilfred C Mezue

2012-01-01

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.

Integrating multimodal information for intraoperative assistance in neurosurgery

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Eisenmann U.

2015-09-01

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.

Robot-assisted procedures in pediatric neurosurgery.

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De Benedictis, Alessandro; Trezza, Andrea; Carai, Andrea; Genovese, Elisabetta; Procaccini, Emidio; Messina, Raffaella; Randi, Franco; Cossu, Silvia; Esposito, Giacomo; Palma, Paolo; Amante, Paolina; Rizzi, Michele; Marras, Carlo Efisio

2017-05-01

OBJECTIVE During the last 3 decades, robotic technology has rapidly spread across several surgical fields due to the continuous evolution of its versatility, stability, dexterity, and haptic properties. Neurosurgery pioneered the development of robotics, with the aim of improving the quality of several procedures requiring a high degree of accuracy and safety. Moreover, robot-guided approaches are of special interest in pediatric patients, who often have altered anatomy and challenging relationships between the diseased and eloquent structures. Nevertheless, the use of robots has been rarely reported in children. In this work, the authors describe their experience using the ROSA device (Robotized Stereotactic Assistant) in the neurosurgical management of a pediatric population. METHODS Between 2011 and 2016, 116 children underwent ROSA-assisted procedures for a variety of diseases (epilepsy, brain tumors, intra- or extraventricular and tumor cysts, obstructive hydrocephalus, and movement and behavioral disorders). Each patient received accurate preoperative planning of optimal trajectories, intraoperative frameless registration, surgical treatment using specific instruments held by the robotic arm, and postoperative CT or MR imaging. RESULTS The authors performed 128 consecutive surgeries, including implantation of 386 electrodes for stereo-electroencephalography (36 procedures), neuroendoscopy (42 procedures), stereotactic biopsy (26 procedures), pallidotomy (12 procedures), shunt placement (6 procedures), deep brain stimulation procedures (3 procedures), and stereotactic cyst aspiration (3 procedures). For each procedure, the authors analyzed and discussed accuracy, timing, and complications. CONCLUSIONS To the best their knowledge, the authors present the largest reported series of pediatric neurosurgical cases assisted by robotic support. The ROSA system provided improved safety and feasibility of minimally invasive approaches, thus optimizing the surgical

Functional neurosurgery for movement disorders: a historical perspective.

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Benabid, Alim Louis; Chabardes, Stephan; Torres, Napoleon; Piallat, Brigitte; Krack, Paul; Fraix, Valerie; Pollak, Pierre

2009-01-01

Since the 1960s, deep brain stimulation and spinal cord stimulation at low frequency (30 Hz) have been used to treat intractable pain of various origins. For this purpose, specific hardware have been designed, including deep brain electrodes, extensions, and implantable programmable generators (IPGs). In the meantime, movement disorders, and particularly parkinsonian and essential tremors, were treated by electrolytic or mechanic lesions in various targets of the basal ganglia, particularly in the thalamus and in the internal pallidum. The advent in the 1960s of levodopa, as well as the side effects and complications of ablative surgery (e.g., thalamotomy and pallidotomy), has sent functional neurosurgery of movement disorders to oblivion. In 1987, the serendipitous discovery of the effect of high-frequency stimulation (HFS), mimicking lesions, allowed the revival of the surgery of movement disorders by stimulation of the thalamus, which treated tremors with limited morbidity, and adaptable and reversible results. The stability along time of these effects allowed extending it to new targets suggested by basic research in monkeys. The HFS of the subthalamic nucleus (STN) has profoundly challenged the practice of functional surgery as the effect on the triad of dopaminergic symptoms was very significant, allowing to decrease the drug dosage and therefore a decrease of their complications, the levodopa-induced dyskinesias. In the meantime, based on the results of previous basic research in various fields, HFS has been progressively extended to potentially treat epilepsy and, more recently, psychiatric disorders, such as obsessive-compulsive disorders, Gilles de la Tourette tics, and severe depression. Similarly, suggested by the observation of changes in PET scan, applications have been extended to cluster headaches by stimulation of the posterior hypothalamus and even more recently, to obesity and drug addiction. In the field of movement disorders, it has become

[Medico-economic analysis of a neurosurgery department at a university hospital].

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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

2015-02-01

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.

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

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Weitao Li

2017-01-01

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.

Protective efficacy of an inactivated Eurasian avian-like H1N1 swine influenza vaccine against homologous H1N1 and heterologous H1N1 and H1N2 viruses in mice.

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Sui, Jinyu; Yang, Dawei; Qiao, Chuanling; Xu, Huiyang; Xu, Bangfeng; Wu, Yunpu; Yang, Huanliang; Chen, Yan; Chen, Hualan

2016-07-19

Eurasian avian-like H1N1 (EA H1N1) swine influenza viruses are prevalent in pigs in Europe and Asia, but occasionally cause human infection, which raises concern about their pandemic potential. Here, we produced a whole-virus inactivated vaccine with an EA H1N1 strain (A/swine/Guangxi/18/2011, SW/GX/18/11) and evaluated its efficacy against homologous H1N1 and heterologous H1N1 and H1N2 influenza viruses in mice. A strong humoral immune response, which we measured by hemagglutination inhibition (HI) and virus neutralization (VN), was induced in the vaccine-inoculated mice upon challenge. The inactivated SW/GX/18/11 vaccine provided complete protection against challenge with homologous SW/GX/18/11 virus in mice and provided effective protection against challenge with heterologous H1N1 and H1N2 viruses with distinctive genomic combinations. Our findings suggest that this EA H1N1 vaccine can provide protection against both homologous H1N1 and heterologous H1N1 or H1N2 virus infection. As such, it is an excellent vaccine candidate to prevent H1N1 swine influenza. Copyright © 2016 Elsevier Ltd. All rights reserved.

1/N

International Nuclear Information System (INIS)

Coleman, S.

1980-03-01

There exist families of field theories with symmetry group SO(N) (or SU(N)) that become simpler as N becomes larger. More precisely, the solutions to these theories possess an expansion in powers of 1/N. This expansion is the subject of these lectures. The 1/N expansion can be used to analyze model field theories. The 1/N expansion is developed for phi 4 theory and applied to two two-dimensional models with similar combinatoric structures, the Gross-Neveu model and the CP/sup N-1/ model. These models display (in the leading 1/N approximation) such interesting phenomena as asymptotic freedom, dynamical symmetry breaking, dimensional transmutation, and non-perturbative confinement. It is possible that the 1/N expansion, with N the number of colors, might fruitfully be applied to quantum chromodynamics. Unfortunately, it is not possible to make a decisive test of the approximation, because no one knows how to compute even the first term in the expansion in closed form. However, it is possible to argue that this first term, whatever its detailed form, has many properties that are also shared by the real world, and which are otherwise underived from field theory. These include the saturation of scattering amplitudes by an infinite number of narrow resonances, the essential feature of dual-resonance models

Using Electronic Noses to Detect Tumors During Neurosurgery

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Homer, Margie L.; Ryan, Margaret A.; Lara, Liana M.; Kateb, Babak; Chen, Mike

2008-01-01

It has been proposed to develop special-purpose electronic noses and algorithms for processing the digitized outputs of the electronic noses for determining whether tissue exposed during neurosurgery is cancerous. At present, visual inspection by a surgeon is the only available intraoperative technique for detecting cancerous tissue. Implementation of the proposal would help to satisfy a desire, expressed by some neurosurgeons, for an intraoperative technique for determining whether all of a brain tumor has been removed. The electronic-nose technique could complement multimodal imaging techniques, which have also been proposed as means of detecting cancerous tissue. There are also other potential applications of the electronic-nose technique in general diagnosis of abnormal tissue. In preliminary experiments performed to assess the viability of the proposal, the problem of distinguishing between different types of cultured cells was substituted for the problem of distinguishing between normal and abnormal specimens of the same type of tissue. The figure presents data from one experiment, illustrating differences between patterns that could be used to distinguish between two types of cultured cancer cells. Further development can be expected to include studies directed toward answering questions concerning not only the possibility of distinguishing among various types of normal and abnormal tissue but also distinguishing between tissues of interest and other odorous substances that may be present in medical settings.

Integral Representation of the Pictorial Proof of Sum of [superscript n][subscript k=1]k[superscript 2] = 1/6n(n+1)(2n+1)

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Kobayashi, Yukio

2011-01-01

The pictorial proof of the sum of [superscript n][subscript k=1] k[superscript 2] = 1/6n(n+1)(2n+1) is represented in the form of an integral. The integral representations are also applicable to the sum of [superscript n][subscript k-1] k[superscript m] (m greater than or equal to 3). These representations reveal that the sum of [superscript…

Thermal expansion and magnetostriction in Pr(n+2)(n+1)Nin(n-1)+2Sin(n+1) compounds

International Nuclear Information System (INIS)

Jiles, D.C.; Song, S.H.; Snyder, J.E.; Pecharsky, V.K.; Lograsso, T.A.; Wu, D.; Pecharsky, A.O.; Mudryk, Ya.; Dennis, K.W.; McCallum, R.W.

2006-01-01

Thermal expansion and magnetostriction of members of a homologous series of compounds based on the alloy series Pr (n+2)(n+1) Ni n(n-1)+2 Si n(n+1) have been measured. The crystal structures of these compounds are closely interrelated because they form trigonal prismatic columns in which the number of trigonal prisms that form the base of the trigonal columns is determined by the value of n in the chemical formula. Two compositions were investigated, Pr 5 Ni 2 Si 3 and Pr 15 Ni 7 Si 10 , corresponding to n=3 and n=4, respectively. The results were analyzed and used to determine the location of magnetic phase transitions by calculating the magnetic contribution to thermal expansion using the Gruneisen-Debye theory. This allowed more precise determination of the magnetic transition temperatures than could be achieved using the total thermal expansion. The results show two phase transitions in each material, one corresponding to the Curie temperature and the other at a lower temperature exhibiting characteristics of a spin reorientation transition

1/N expansion in SUSY CPsup(N-1) model

International Nuclear Information System (INIS)

Krivoshchekov, V.K.; Medvedev, P.B.

1983-01-01

The 1/N expansion for supersymmetric two-dimensional CPsup(N-1) model has been constructed in the superfield formalism. The subtraction procedure and the way to choose manifestly supersymmetric gauge is formulated to define UV and IR regular Green functions for any given order in 1/N

Strategic design for pediatric neurosurgery missions across the Western Hemisphere.

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Hambrecht, Amanda; Duenas, Matthew J; Hahn, Edward J; Aryan, Henry E; Hughes, Samuel A; Waters, Dawn; Levy, Michael L; Jandial, Rahul

2013-01-01

With growing interest in global health, surgeons have created outreach missions to improve health care disparities in less developed countries. These efforts are mainly episodic with visiting surgeons performing the operations and minimal investment in local surgeon education. To create real and durable advancement in surgical services in disciplines that require urgent patient care, such as pediatric neurosurgery, improving the surgical armamentarium of the local surgeons must be the priority. We propose a strategic design for extending surgical education missions throughout the Western Hemisphere in order to transfer modern surgical skills to local neurosurgeons. A selection criteria and structure for targeted missions is a derivative of logistical and pedagogical lessons ascertained from previous missions by our teams in Peru and Ukraine. Outreach programs should be applied to hospitals in capital cities to serve as a central referral center for maximal impact with fiscal efficiency. The host country should fulfill several criteria, including demonstration of geopolitical stability in combination with lack of modern neurosurgical care and equipment. The mission strategy is outlined as three to four 1-week visits with an initial site evaluation to establish a relationship with the hospital administration and host surgeons. Each visit should be characterized by collaboration between visiting and host surgeons on increasingly complex cases, with progressive transfer of skills over time. A strategic approach for surgical outreach missions should be built on collaboration and camaraderie between visiting and local neurosurgeons, with the mutual objective of cost-effective targeted renovation of their surgical equipment and skill repertoire.

Manejo do paciente no período perioperatório em neurocirurgia pediátrica Perioperative patient management in pediatric neurosurgery

Directory of Open Access Journals (Sweden)

Eduardo Mekitarian Filho

2012-06-01

Full Text Available OBJETIVOS: Descrever as principais diferenças fisiopatológicas entre procedimentos neurocirúrgicos em crianças e adultos; as principais complicações e eventos adversos descritos em estudos publicados decorrentes de neurocirurgia pediátrica; as peculiaridades do manejo anestésico e intraoperatório das diversas doenças neurocirúrgicas; as complicações mais comuns específicas e seus manejos nos procedimentos mais frequentes em neurocirurgia pediátrica; e as causas e tratamento para as principais complicações gerais encontradas em crianças submetidas à neurocirurgia. MÉTODOS: Realizou-se revisão não sistemática da literatura nas bases de dados Pub-Med, EMBASE e SciELO utilizandose como palavras-chave pediatrics, children, neurosurgery, risk factors, intraoperative complications e postoperative period e seus correspondentes em português e espanhol de janeiro de 2001 a janeiro de 2011, além da utilização de referências bibliográficas importantes dos textos escolhidos em qualquer período de tempo. RESULTADOS: Os três procedimentos mais comuns realizados em crianças incluem correção de hidrocefalia, cranioestenoses e ressecção de tumores cerebrais. Complicações como febre, sangramentos, distúrbios metabólicos (hiponatremia e hiperglicemia, edema cerebral e déficits focais transitórios (como paresias e distúrbios de fala e deglutição são frequentes, porém costumam evoluir com rápida melhora. Até 50% das crianças podem evoluir sem nenhuma complicação no período pós-operatório. Atenção especial deve ser dada à prevenção de infecções e convulsões no período pós-operatório, com terapêutica medicamentosa adequada para cada caso. CONCLUSÃO: A complexidade dos procedimentos neurocirúrgicos em crianças é crescente, e a observação e conhecimento das complicações dentro da unidade de terapia intensiva pediátrica são fundamentais. Antecipar as complicações de modo ao tratamento precoce e

The Richard C. Schneider Lecture. New dimensions of neurosurgery in the realm of high technology: possibilities, practicalities, realities.

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Apuzzo, M L

1996-04-01

Fueled by a buoyant economy, popular attitudes and demands, and parallel progress in transferable technical and biological areas, neurosurgery has enjoyed a remarkable quarter of a century of progress. Developmental trends in the discipline have included the following: 1) a refinement of preoperative definition of the structural substrate, 2) miniaturization of operative corridors, 3) reduction of operative trauma, 4) increased effectiveness at the target site, and 5) incorporation of improved technical adjuvants and physical operative tools into treatment protocols. In particular, the computer has become a formidable ally in diagnostic and surgical events. Trends in technical development indicate that we are entering an exciting era of advanced surgery of the human cerebrum, which is heralded by the following: 1) current developments in areas of imaging, sensors, and visualization; 2) new devices for localization and navigation; 3) new capabilities for action at the target point; and 4) innovative concepts related to advanced operative venues. Imaging has provided structurally based surgical maps, which now are being given the new dimension of function in complex and integrated formats for preoperative planning and intraoperative tactical direction. Cerebral localization and navigation based on these advances promise to provide further refinement to the field of stereotactic neurosurgery, as linked systems are superseded by more flexible nonlinked methodologies in functionally defined volume-oriented navigational databases. Target point action now includes not only ablative capabilities through micro-operative methods and the use of stereotactically directed high-energy forms but also the emergence of restorative capabilities through applications of principles of genetic engineering in the areas of molecular and cellular neurosurgery. Complex, dedicated, and self-contained operative venues will be required to optimize the emergence and development of these

Standardizing the evaluation of scientific and academic performance in neurosurgery--critical review of the "h" index and its variants.

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Aoun, Salah G; Bendok, Bernard R; Rahme, Rudy J; Dacey, Ralph G; Batjer, H Hunt

2013-11-01

Assessing the academic impact and output of scientists and physicians is essential to the academic promotion process and has largely depended on peer review. The inherent subjectivity of peer review, however, has led to an interest to incorporate objective measures into more established methods of academic assessment and promotion. Journal impact factor has been used to add objectivity to the process but this index alone does not capture all aspects of academic impact and achievement. The "h" index and its variants have been designed to compensate for these shortcomings, and have been successfully used in the fields of physics, mathematics, and biology, and more recently in medicine. Leaders in academic neurosurgery should be aware of the advantages offered by each of these indices, as well as of their individual shortcomings, to be able to efficiently use them to refine the peer-review process. This review critically analyzes indices that are currently available to evaluate the academic impact of scientists and physicians. These indices include the total citation count, the total number of papers, the impact factor, as well as the "h" index with eight of its most common variants. The analysis focuses on their use in the field of academic neurosurgery, and discusses means to implement them in current review processes. Copyright © 2013 Elsevier Inc. All rights reserved.

Stereotactic imaging in functional neurosurgery

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Hirabayashi, Hidehiro

2012-07-01

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

Stereotactic imaging in functional neurosurgery

International Nuclear Information System (INIS)

Hirabayashi, Hidehiro

2012-01-01

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 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 MRI

Accurate multi-robot targeting for keyhole neurosurgery based on external sensor monitoring.

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Comparetti, Mirko Daniele; Vaccarella, Alberto; Dyagilev, Ilya; Shoham, Moshe; Ferrigno, Giancarlo; De Momi, Elena

2012-05-01

Robotics has recently been introduced in surgery to improve intervention accuracy, to reduce invasiveness and to allow new surgical procedures. In this framework, the ROBOCAST system is an optically surveyed multi-robot chain aimed at enhancing the accuracy of surgical probe insertion during keyhole neurosurgery procedures. The system encompasses three robots, connected as a multiple kinematic chain (serial and parallel), totalling 13 degrees of freedom, and it is used to automatically align the probe onto a desired planned trajectory. The probe is then inserted in the brain, towards the planned target, by means of a haptic interface. This paper presents a new iterative targeting approach to be used in surgical robotic navigation, where the multi-robot chain is used to align the surgical probe to the planned pose, and an external sensor is used to decrease the alignment errors. The iterative targeting was tested in an operating room environment using a skull phantom, and the targets were selected on magnetic resonance images. The proposed targeting procedure allows about 0.3 mm to be obtained as the residual median Euclidean distance between the planned and the desired targets, thus satisfying the surgical accuracy requirements (1 mm), due to the resolution of the diffused medical images. The performances proved to be independent of the robot optical sensor calibration accuracy.

Rivaling paradigms in psychiatric neurosurgery: adjustability versus quick fix versus minimal-invasiveness.

Science.gov (United States)

Müller, Sabine; Riedmüller, Rita; van Oosterhout, Ansel

2015-01-01

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 1970s 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.

Sensors management in robotic neurosurgery: the ROBOCAST project.

Science.gov (United States)

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

2011-01-01

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.

Microvascular Anastomosis Training in Neurosurgery: A Review

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Vadim A. Byvaltsev

2018-01-01

Full Text Available Cerebrovascular diseases are among the most widespread diseases in the world, which largely determine the structure of morbidity and mortality rates. Microvascular anastomosis techniques are important for revascularization surgeries on brachiocephalic and carotid arteries and complex cerebral aneurysms and even during resection of brain tumors that obstruct major cerebral arteries. Training in microvascular surgery became even more difficult with less case exposure and growth of the use of endovascular techniques. In this text we will briefly discuss the history of microvascular surgery, review current literature on simulation models with the emphasis on their merits and shortcomings, and describe the views and opinions on the future of the microvascular training in neurosurgery. In “dry” microsurgical training, various models created from artificial materials that simulate biological tissues are used. The next stage in training more experienced surgeons is to work with nonliving tissue models. Microvascular training using live models is considered to be the most relevant due to presence of the blood flow. Training on laboratory animals has high indicators of face and constructive validity. One of the future directions in the development of microsurgical techniques is the use of robotic systems. Robotic systems may play a role in teaching future generations of microsurgeons. Modern technologies allow access to highly accurate learning environments that are extremely similar to real environment. Additionally, assessment of microsurgical skills should become a fundamental part of the current evaluation of competence within a microneurosurgical training program. Such an assessment tool could be utilized to ensure a constant level of surgical competence within the recertification process. It is important that this evaluation be based on validated models.

Three-dimensional printing: technologies, applications, and limitations in neurosurgery.

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

2017-09-01

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.

Evolution of growth hormone neurosecretory disturbance after cranial irradiation for childhood brain tumours: a prospective study

International Nuclear Information System (INIS)

Spoudeas, H.A.; Hindmarsh, P.C.; Brook, C.G.D.; Matthews, D.R.

1996-01-01

To determine the aetiopathology of post-irradiation growth hormone (GH) deficiency, we performed a mixed longitudinal analysis of 56 24 h serum GH concentration profiles and 45 paired insulin-induced hypoglycaemia tests (ITT) in 35 prepubertal children, aged 1.5-11.8 years, with brain tumours in the posterior foss (n = 25) or cerebral hemispheres (n 10). Assessments were made before (n = 16), 1 year (n = 25) and 2 to 5 years (n = 15) after a cranial irradiation (DXR) dose of at least 30 Gy. Fourier transforms, occupancy percentage, first-order derivatives (FOD) and mean concentrations were determined from the GH profiles taken after neurosurgery but before radiotherapy (n = 16) and in three treatment groups: Group 1: neurosurgery only without DXR 9n 9); Group 2: ≥ 30 Gy DXR only (n = 22); Group 3: ≥ 30 Gy DXR with additional chemotherapy (n = 9). Results were compared with those from 26 short normally growing (SN) children. (author)

Patient protection in radiotherapy (Radio neurosurgery National Service of the Social Security Mexican Institute)

International Nuclear Information System (INIS)

Espiritu R, R.

2008-12-01

The perspective of patient protection at the Radio neurosurgery National Service of the Social Security Mexican Institute is divided into three parts: the testing program for equipment acceptance, an assurance quality program based on periodic tests, an also other assurance quality based on tests during the application. Among the technical aspects that influence in the equipment acceptance tests, it is the collimation type, the characteristics of the lineal accelerator, the platform for planning and the network type. In the case of the collimation system and the accelerator characteristics, we consider the manufacturer's specifications and requirements of Mexican Official Standard NOM-033-NUCL-1999, T echnical Specifications for the Teletherapy Units Operation, Linear Accelerators . Planning for the platform takes into account the manufacturer's specifications. In the case of computed tomography as well as review the calibration according to manufacturer's specifications should be considered the standard NOM-229-SSA1-2002. In the case of the linear accelerator must be the radiological characterization of radiation beam as part of this, the absolute dose determination. As for the periodic tests is verified the dose constancy, as well as the flattening and symmetry of X-rays beam. There are also tests battery with daily, monthly and yearly frequencies, which make up the assurance quality program. (Author)

Investigating the scope of resident patient care handoffs within neurosurgery.

Science.gov (United States)

Babu, Maya A; Nahed, Brian V; Heary, Robert F

2012-01-01

Handoffs are defined as verbal and written communications during patient care transitions. With the passage of recent ACMGE work hour rules further limiting the hours interns can spend in the hospital, many fear that more handoffs will occur, putting patient safety at risk. The issue of handoffs has not been studied in the neurosurgical literature. A validated, 20-question online-survey was sent to neurosurgical residents in all 98 accredited U.S. neurosurgery programs. Survey results were analyzed using tabulations. 449 surveys were completed yielding a 56% response rate. 63% of neurosurgical residents surveyed had not received formal instruction in what constitutes an effective handoff; 24% believe there is high to moderate variability among their co-residents in terms of the quality of the handoff provided; 55% experience three or more interruptions during handoffs on average. 90% of neurosurgical residents surveyed say that handoff most often occurs in a quiet, private area and 56% report a high level of comfort for knowing the potential acute, critical issues affecting a patient when receiving a handoff. There needs to be more focused education devoted to learning effective patient-care handoffs in neurosurgical training programs. Increasingly, handing off a patient adequately and safely is becoming a required skill of residency.

Investigating the scope of resident patient care handoffs within neurosurgery.

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Maya A Babu

Full Text Available INTRODUCTION: Handoffs are defined as verbal and written communications during patient care transitions. With the passage of recent ACMGE work hour rules further limiting the hours interns can spend in the hospital, many fear that more handoffs will occur, putting patient safety at risk. The issue of handoffs has not been studied in the neurosurgical literature. METHODS: A validated, 20-question online-survey was sent to neurosurgical residents in all 98 accredited U.S. neurosurgery programs. Survey results were analyzed using tabulations. RESULTS: 449 surveys were completed yielding a 56% response rate. 63% of neurosurgical residents surveyed had not received formal instruction in what constitutes an effective handoff; 24% believe there is high to moderate variability among their co-residents in terms of the quality of the handoff provided; 55% experience three or more interruptions during handoffs on average. 90% of neurosurgical residents surveyed say that handoff most often occurs in a quiet, private area and 56% report a high level of comfort for knowing the potential acute, critical issues affecting a patient when receiving a handoff. CONCLUSIONS: There needs to be more focused education devoted to learning effective patient-care handoffs in neurosurgical training programs. Increasingly, handing off a patient adequately and safely is becoming a required skill of residency.

First Experiences in Intensity Modulated Radiation Surgery at the National Institute of Neurology and Neurosurgery: A Dosimetric Point of View

Science.gov (United States)

Lárraga-Gutiérrez, José M.; Celis-López, Miguel A.

2003-09-01

The National Institute of Neurology and Neurosurgery in Mexico City has acquired a Novalis® shaped beam radiosurgery unit. The institute is pioneer in the use of new technologies for neuroscience. The Novalis® unit allows the use of conformal beam radiosurgery/therapy and the more advanced modality of conformal therapy: Intensity Modulated Radiation Therapy (IMRT). In the present work we present the first cases of treatments that use the IMRT technique and show its ability to protect organs at risk, such as brainstem and optical vias.

First Experiences in Intensity Modulated Radiation Surgery at the National Institute of Neurology and Neurosurgery: A Dosimetric Point of View

International Nuclear Information System (INIS)

Larraga-Gutierrez, Jose M.; Celis-Lopez, Miguel A.

2003-01-01

The National Institute of Neurology and Neurosurgery in Mexico City has acquired a Novalis registered shaped beam radiosurgery unit. The institute is pioneer in the use of new technologies for neuroscience. The Novalis registered unit allows the use of conformal beam radiosurgery/therapy and the more advanced modality of conformal therapy: Intensity Modulated Radiation Therapy (IMRT). In the present work we present the first cases of treatments that use the IMRT technique and show its ability to protect organs at risk, such as brainstem and optical vias

Global behavior of the difference equation $x_{n+1}=\\frac{Ax_{n-1}} {B-Cx_{n}x_{n-2}}$

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R. Abo-Zeid

2013-11-01

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.

Dislocaciones occipito-atloideas: Revisión de la literatura y presentación de 7 casos

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Esteban Roig Fabré

2002-04-01

Full Text Available Esta lesión poco común, se presenta con gran frecuencia como muerte súbita, por lo que su diagnóstico muchas veces se realiza posmortem. Gracias al desarrollo de las técnicas de resucitación y reanimación en los centros especializados en politrauma, han sobrevivido algunos pacientes con dislocación occipito-atloidea, tema de este trabajo. Se presentan 7 casos atendidos en el Servicio de Neurocirugía del Hospital Universitario «General Calixto García»This uncommon injury is frequently presented as sudden death. That’s why its diagnosis is many times made after death. Thanks to the development of resuscitation and reanimation techniques in the centers specialized in polytrauma, some patients with atlanto-occipital dislocation have survived, and this is the topic we deal with in this paper. 7 cases that received attention at the Neurosurgery Service of " General Calixto García" Teaching Hospital are presented here

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

Directory of Open Access Journals (Sweden)

Müller eSabine

2015-04-01

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.

Post Mortem Validation of MRI-Identified Veins on the Surface of the Cerebral Cortex as Potential Landmarks for Neurosurgery

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Günther Grabner

2017-06-01

Full Text Available Background and Objective: Image-guided neurosurgery uses information from a wide spectrum of methods to inform the neurosurgeon's judgement about which tissue to resect and which to spare. Imaging data are registered to the patient's skull so that they correspond to the intraoperative macro- and microscopic view. The correspondence between imaging and optical systems breaks down during surgery, however, as a result of cerebro-spinal fluid drain age, tissue resection, and gravity-based brain shift. In this work we investigate whether a map of surface veins, automatically segmented from MRI, could serve as additional reference system.Methods: Gradient-echo based T2*-weighted imaging was performed on two human cadavers heads using a 7 Tesla MRI scanner. Automatic vessel segmentation was performed using the Frangi vesselness filter, and surface renderings of vessels compared with photographs of the surface of the brain following craniotomy.Results: A high level of correspondence was established between vessel maps and the post autopsy photographs. Corresponding veins, including the prominent superior anastomotic veins, could be identified in all brain lobes.Conclusion: Automatic surface vessel segmentation is feasible and the high correspondence to post autopsy photographs indicates that they could be used as an additional reference system for image-guided neurosurgery in order to maintain the correspondence between imaging and optical systems.This has the advantage over a skull-based reference system that veins are clearly visible to the surgeon and move and deform with the underlying tissue, potentially making this surface net of landmarks robust to brain shift.

Robotic Stereotaxy in Cranial Neurosurgery: A Qualitative Systematic Review.

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Fomenko, Anton; Serletis, Demitre

2017-12-14

Modern-day stereotactic techniques have evolved to tackle the neurosurgical challenge of accurately and reproducibly accessing specific brain targets. Neurosurgical advances have been made in synergy with sophisticated technological developments and engineering innovations such as automated robotic platforms. Robotic systems offer a unique combination of dexterity, durability, indefatigability, and precision. To perform a systematic review of robotic integration for cranial stereotactic guidance in neurosurgery. Specifically, we comprehensively analyze the strengths and weaknesses of a spectrum of robotic technologies, past and present, including details pertaining to each system's kinematic specifications and targeting accuracy profiles. Eligible articles on human clinical applications of cranial robotic-guided stereotactic systems between 1985 and 2017 were extracted from several electronic databases, with a focus on stereotactic biopsy procedures, stereoelectroencephalography, and deep brain stimulation electrode insertion. Cranial robotic stereotactic systems feature serial or parallel architectures with 4 to 7 degrees of freedom, and frame-based or frameless registration. Indications for robotic assistance are diversifying, and include stereotactic biopsy, deep brain stimulation and stereoelectroencephalography electrode placement, ventriculostomy, and ablation procedures. Complication rates are low, and mainly consist of hemorrhage. Newer systems benefit from increasing targeting accuracy, intraoperative imaging ability, improved safety profiles, and reduced operating times. We highlight emerging future directions pertaining to the integration of robotic technologies into future neurosurgical procedures. Notably, a trend toward miniaturization, cost-effectiveness, frameless registration, and increasing safety and accuracy characterize successful stereotactic robotic technologies. Copyright © 2017 by the Congress of Neurological Surgeons

GaN epilayers on nanopatterned GaN/Si(1 1 1) templates: Structural and optical characterization

International Nuclear Information System (INIS)

Wang, L.S.; Tripathy, S.; Wang, B.Z.; Chua, S.J.

2006-01-01

Template-based nanoscale epitaxy has been explored to realize high-quality GaN on Si(1 1 1) substrates. We have employed polystyrene-based nanosphere lithography to form the nano-hole array patterns on GaN/Si(1 1 1) template and then, subsequent regrowth of GaN is carried out by metalorganic chemical vapor deposition (MOCVD). During the initial growth stage of GaN on such nanopatterned substrates, we have observed formation of nanoislands with hexagonal pyramid shape due to selective area epitaxy. With further epitaxial regrowth, these nanoislands coalesce and form continuous GaN film. The overgrown GaN on patterned and non-patterned regions is characterized by high-resolution X-ray diffraction (HRXRD) and high-spatial resolution optical spectroscopic methods. Micro-photoluminescence (PL), micro-Raman scattering and scanning electron microscopy (SEM) have been used to assess the microstructural and optical properties of GaN. Combined PL and Raman data analyses show improved optical quality when compared to GaN simultaneously grown on non-patterned bulk Si(1 1 1). Such thicker GaN templates would be useful to achieve III-nitride-based opto- and electronic devices integrated on Si substrates

Comparative pathology of pigs infected with Korean H1N1, H1N2, or H3N2 swine influenza A viruses.

Science.gov (United States)

Lyoo, Kwang-Soo; Kim, Jeong-Ki; Jung, Kwonil; Kang, Bo-Kyu; Song, Daesub

2014-09-24

The predominant subtypes of swine influenza A virus (SIV) in Korea swine population are H1N1, H1N2, and H3N2. The viruses are genetically close to the classical U.S. H1N1 and triple-reassortant H1N2 and H3N2 viruses, respectively. Comparative pathogenesis caused by Korean H1N1, H1N2, and H3N2 SIV was evaluated in this study. The H3N2 infected pigs had severe scores of gross and histopathological lesions at post-inoculation days (PID) 2, and this then progressively decreased. Both the H1N1 and H1N2 infected pigs lacked gross lesions at PID 2, but they showed moderate to severe pneumonia on PID 4, 7 and 14. The pigs infected with H1N1 had significant scores of gross and histopathological lesions when compared with the other pigs infected with H1N2, H3N2, and mock at PID 14. Mean SIV antigen-positive scores were rarely detected for pigs infected with H1N2 and H3N2 from PID 7, whereas a significantly increased amount of viral antigens were found in the bronchioles and alveolar epithelium of the H1N1infected pigs at PID 14. We demonstrated that Korean SIV subtypes had different pulmonary pathologic patterns. The Korean H3N2 rapidly induced acute lung lesions such as broncho-interstitial pneumonia, while the Korean H1N1 showed longer course of infection as compared to other strains.

Evaluation excitation functions for "2"8Si(n,p)"2"8Al, "3"1P(n,p)"3"1Si, and "1"1"3In(n,γ)"1"1"4"mIn reactions

International Nuclear Information System (INIS)

Zolotarev, K.I.

2014-10-01

Cross section data for "2"8Si(n,p)"2"8Al, "3"1P(n,p)"3"1Si and "1"1"3In(n,γ)"1"1"4"mIn reactions are needed for solving a wide spectrum of scientific and technical tasks. The excitation function of "2"8Si(n,p)"2"8Al reaction refers to the nuclear data involved in fusion reactor design calculations. The "2"8Si(n,p)"2"8Al reaction is interesting also as the monitor reaction for measurements at fusion facilities. Activation detectors on the basis of the 31P(n,p)31Si reaction are commonly used in the reactor dosimetry. The "1"1"3In(n,γ)"1"1"4"mIn reaction is promising regarding reactor dosimetry application for two reasons. First, due to the "1"1"4"mIn decay parameters which are rather suitable for activation measurements. Half-life of "1"1"4"mIn is equal to T_1/_2 = (49.51 ± 0.01) days and gamma spectrum accompanying decay has only one line with energy 190.27 keV and intensity (15.56 ± 0.15)%. Second, the "1"1"3In(n,γ)"1"1"4"mIn reaction rate may be measured by using one activation detector simultaneously with the "1"1"5In(n,γ)"1"1"6"mIn reaction. Preliminary analysis of existing evaluated excitation functions for "2"8Si(n,p)"2"8Al, "3"1P(n,p)"3"1Si and "1"1"3In(n,γ)"1"1"4"mIn reactions show that new evaluations are needed for all above mentioned reactions. This report is devoted to the preparation of the new evaluations of cross sections data and related covariance matrixes of uncertainties for the "2"8Si(n,p)"2"8Al, "3"1P(n,p)"3"1Si and "1"1"3In(n,γ)"1"1"4"mIn reactions.

Comparative pathology of pigs infected with Korean H1N1, H1N2, or H3N2 swine influenza A viruses

OpenAIRE

Lyoo, Kwang-Soo; Kim, Jeong-Ki; Jung, Kwonil; Kang, Bo-Kyu; Song, Daesub

2014-01-01

Background The predominant subtypes of swine influenza A virus (SIV) in Korea swine population are H1N1, H1N2, and H3N2. The viruses are genetically close to the classical U.S. H1N1 and triple-reassortant H1N2 and H3N2 viruses, respectively. Comparative pathogenesis caused by Korean H1N1, H1N2, and H3N2 SIV was evaluated in this study. Findings The H3N2 infected pigs had severe scores of gross and histopathological lesions at post-inoculation days (PID) 2, and this then progressively decrease...

H1N1 influenza (Swine flu)

Science.gov (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 ...

3D printing in orthopedics and neurosurgery: Presentation held at 3D Printing & Bio-Printing in Healthcare Conference, 12th & 13th October 2017, Düsseldorf, Germany

OpenAIRE

Grunert, Ronny; Rotsch, Christian; Müller, Marcel; Schmidt, Michael; Möbius, Robert; Töppel, Thomas; Prietzel, Torsten; Winkler, Dirk

2017-01-01

Concept of a lightweight tumor endoprosthesis in orthopedic surgery which is created with laser beam melting allows the realization of the original biomechanics • Biopsy target platform for neurosurgery enables the surgeon to remove unknown tissue out of the brain with a high precision for further diagnosis• 3D printing supports the surgeons in patient-individualized therapy

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

International Nuclear Information System (INIS)

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

2014-01-01

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

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

Science.gov (United States)

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

2014-11-01

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.

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

Energy Technology Data Exchange (ETDEWEB)

Alva-Sánchez, Héctor, E-mail: halva@ciencias.unam.mx [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)

2014-11-07

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.

Creation of a novel simulator for minimally invasive neurosurgery: fusion of 3D printing and special effects.

Science.gov (United States)

Weinstock, Peter; Rehder, Roberta; Prabhu, Sanjay P; Forbes, Peter W; Roussin, Christopher J; Cohen, Alan R

2017-07-01

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

A new robust markerless method for automatic image-to-patient registration in image-guided neurosurgery system.

Science.gov (United States)

Liu, Yinlong; Song, Zhijian; Wang, Manning

2017-12-01

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.

Prior infection of chickens with H1N1 or H1N2 avian influenza elicits partial heterologous protection against highly pathogenic H5N1.

Science.gov (United States)

Nfon, Charles; Berhane, Yohannes; Pasick, John; Embury-Hyatt, Carissa; Kobinger, Gary; Kobasa, Darwyn; Babiuk, Shawn

2012-01-01

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.

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.

Intravenous and oral levetiracetam in patients with a suspected primary brain tumor and symptomatic seizures undergoing neurosurgery: the HELLO trial.

Science.gov (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

2012-02-01

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.

Full-text automated detection of surgical site infections secondary to neurosurgery in Rennes, France.

Science.gov (United States)

Campillo-Gimenez, Boris; Garcelon, Nicolas; Jarno, Pascal; Chapplain, Jean Marc; Cuggia, Marc

2013-01-01

The surveillance of Surgical Site Infections (SSI) contributes to the management of risk in French hospitals. Manual identification of infections is costly, time-consuming and limits the promotion of preventive procedures by the dedicated teams. The introduction of alternative methods using automated detection strategies is promising to improve this surveillance. The present study describes an automated detection strategy for SSI in neurosurgery, based on textual analysis of medical reports stored in a clinical data warehouse. The method consists firstly, of enrichment and concept extraction from full-text reports using NOMINDEX, and secondly, text similarity measurement using a vector space model. The text detection was compared to the conventional strategy based on self-declaration and to the automated detection using the diagnosis-related group database. The text-mining approach showed the best detection accuracy, with recall and precision equal to 92% and 40% respectively, and confirmed the interest of reusing full-text medical reports to perform automated detection of SSI.

Consensus on guidelines for stereotactic neurosurgery for psychiatric disorders

Science.gov (United States)

Nuttin, Bart; Wu, Hemmings; Mayberg, Helen; Hariz, Marwan; Gabriëls, Loes; Galert, Thorsten; Merkel, Reinhard; Kubu, Cynthia; Vilela-Filho, Osvaldo; Matthews, Keith; Taira, Takaomi; Lozano, Andres M; Schechtmann, Gastón; Doshi, Paresh; Broggi, Giovanni; Régis, Jean; Alkhani, Ahmed; Sun, Bomin; Eljamel, Sam; Schulder, Michael; Kaplitt, Michael; Eskandar, Emad; Rezai, Ali; Krauss, Joachim K; Hilven, Paulien; Schuurman, Rick; Ruiz, Pedro; Chang, Jin Woo; Cosyns, Paul; Lipsman, Nir; Voges, Juergen; Cosgrove, Rees; Li, Yongjie; Schlaepfer, Thomas

2014-01-01

Background For patients with psychiatric illnesses remaining refractory to ‘standard’ therapies, neurosurgical procedures may be considered. Guidelines for safe and ethical conduct of such procedures have previously and independently been proposed by various local and regional expert groups. Methods To expand on these earlier documents, representative members of continental and international psychiatric and neurosurgical societies, joined efforts to further elaborate and adopt a pragmatic worldwide set of guidelines. These are intended to address a broad range of neuropsychiatric disorders, brain targets and neurosurgical techniques, taking into account cultural and social heterogeneities of healthcare environments. Findings The proposed consensus document highlights that, while stereotactic ablative procedures such as cingulotomy and capsulotomy for depression and obsessive-compulsive disorder are considered ‘established’ in some countries, they still lack level I evidence. Further, it is noted that deep brain stimulation in any brain target hitherto tried, and for any psychiatric or behavioural disorder, still remains at an investigational stage. Researchers are encouraged to design randomised controlled trials, based on scientific and data-driven rationales for disease and brain target selection. Experienced multidisciplinary teams are a mandatory requirement for the safe and ethical conduct of any psychiatric neurosurgery, ensuring documented refractoriness of patients, proper consent procedures that respect patient's capacity and autonomy, multifaceted preoperative as well as postoperative long-term follow-up evaluation, and reporting of effects and side effects for all patients. Interpretation This consensus document on ethical and scientific conduct of psychiatric surgery worldwide is designed to enhance patient safety. PMID:24444853

Air-guided photonic-crystal-fiber pulse-compression delivery of multimegawatt femtosecond laser output for nonlinear-optical imaging and neurosurgery

Science.gov (United States)

Lanin, Aleksandr A.; Fedotov, Il'ya V.; Sidorov-Biryukov, Dmitrii A.; Doronina-Amitonova, Lyubov V.; Ivashkina, Olga I.; Zots, Marina A.; Sun, Chi-Kuang; Ömer Ilday, F.; Fedotov, Andrei B.; Anokhin, Konstantin V.; Zheltikov, Aleksei M.

2012-03-01

Large-core hollow photonic-crystal fibers (PCFs) are shown to enable a fiber-format air-guided delivery of ultrashort infrared laser pulses for neurosurgery and nonlinear-optical imaging. With an appropriate dispersion precompensation, an anomalously dispersive 15-μm-core hollow PCF compresses 510-fs, 1070-nm light pulses to a pulse width of about 110 fs, providing a peak power in excess of 5 MW. The compressed PCF output is employed to induce a local photodisruption of corpus callosum tissues in mouse brain and is used to generate the third harmonic in brain tissues, which is captured by the PCF and delivered to a detector through the PCF cladding.

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

DEFF Research Database (Denmark)

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

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...

Antigenic variation of H1N1, H1N2 and H3N2 swine influenza viruses in Japan and Vietnam.

Science.gov (United States)

Takemae, Nobuhiro; Nguyen, Tung; Ngo, Long Thanh; Hiromoto, Yasuaki; Uchida, Yuko; Pham, Vu Phong; Kageyama, Tsutomu; Kasuo, Shizuko; Shimada, Shinichi; Yamashita, Yasutaka; Goto, Kaoru; Kubo, Hideyuki; Le, Vu Tri; Van Vo, Hung; Do, Hoa Thi; Nguyen, Dang Hoang; Hayashi, Tsuyoshi; Matsuu, Aya; Saito, Takehiko

2013-04-01

The antigenicity of the influenza A virus hemagglutinin is responsible for vaccine efficacy in protecting pigs against swine influenza virus (SIV) infection. However, the antigenicity of SIV strains currently circulating in Japan and Vietnam has not been well characterized. We examined the antigenicity of classical H1 SIVs, pandemic A(H1N1)2009 (A(H1N1)pdm09) viruses, and seasonal human-lineage SIVs isolated in Japan and Vietnam. A hemagglutination inhibition (HI) assay was used to determine antigenic differences that differentiate the recent Japanese H1N2 and H3N2 SIVs from the H1N1 and H3N2 domestic vaccine strains. Minor antigenic variation between pig A(H1N1)pdm09 viruses was evident by HI assay using 13 mAbs raised against homologous virus. A Vietnamese H1N2 SIV, whose H1 gene originated from a human strain in the mid-2000s, reacted poorly with post-infection ferret serum against human vaccine strains from 2000-2010. These results provide useful information for selection of optimal strains for SIV vaccine production.

A value-based, no-cost-to-patient health model in the developing world: Critical appraisal of a unique patient-centric neurosurgery unit.

Science.gov (United States)

Thakar, Sumit; Dadlani, Ravi; Sivaraju, Laxminadh; Aryan, Saritha; Mohan, Dilip; Sai Kiran, Narayanam Anantha; Rajarathnam, Ravikiran; Shyam, Maya; Sadanand, Venkatraman; Hegde, Alangar S

2015-01-01

It is well-accepted that the current healthcare scenario worldwide is due for a radical change, given that it is fraught with mounting costs and varying quality. Various modifications in health policies have been instituted toward this end. An alternative model, the low-cost, value-based health model, focuses on maximizing value for patients by moving away from a physician-centered, supply-driven system to a patient-centered system. The authors discuss the successful inception, functioning, sustainability, and replicability of a novel health model in neurosurgery built and sustained by inspired humanitarianism and that provides all treatment at no cost to the patients irrespective of their socioeconomic strata, color or creed. The Sri Sathya Sai Institute of Higher Medical Sciences (SSSIHMS) at Whitefield, Bengaluru, India, a private charitable hospital established in 2001, functions on the ideals of providing free state-of-the-art healthcare to all in a compassionate and holistic manner. With modern equipment and respectable outcome benchmarks, its neurosurgery unit has operated on around 18,000 patients since its inception, and as such, has contributed INR 5310 million (USD 88.5 million) to society from an economic standpoint. The inception and sustainability of the SSSIHMS model are based on self-perpetuating philanthropy, a cost-conscious culture and the dissemination of human values. Replicated worldwide, at least in the developing nations, this unique healthcare model may well change the face of healthcare economics.

Structure of N = 2 supergravity in N = 1 superfields

Energy Technology Data Exchange (ETDEWEB)

Awada, M.A.; Mokhtari, S. (Imperial Coll. of Science and Technology, London (UK). Blackett Lab.)

1985-01-01

A formulation of N = 2 supergravity in N = 1 superspace is presented. The authors solve up to all orders the N = 2 supergravity constraints in terms of unconstrained N = 1 superfields. The structure of the N = 2 action in N = 1 superspace is examined. The proposed action coincides in the quadratic limit of the spin (3/2,1) matter fields with the action given by previous workers.

Synthesis of [2-13C, 2-14C] 2-aminoethanol, [1-13C, 1-14C] 2-chloroethylamine, N,N'-bis([1-13C, 1-14C] 2-chloroethyl)-N-nitrosourea(BCNU) and N-([1-13C, 1-14C] 2-chloroethyl)-N-nitrosourea(CNU)

International Nuclear Information System (INIS)

Narayan, R.; Chang, C-j.

1982-01-01

[2- 13 C, 2- 14 C]2-Aminoethanol hydrochloride was prepared in good yield from Na*CN in a two step sequence by first converting the Na*CN to OHCH 2 *CN and then reducing the nitrile directly with a solution of borane-tetrahydrofuran complex. The reaction procedure was simple and the pure product could be obtained readily. Using this specifically labelled precursor, the synthesis of [1- 13 C, 1- 14 C]2-chloroethylamine hydrochloride, N-([1- 13 C, 1- 14 C]2-chloroethyl)-N-nitrosourea(CNU) and N,N'-bis([1- 13 C, 1- 14 C]2-chloroethyl)-N-nitrosourea(BCNU) in good yield without isotope scrambling was also reported. (author)

Reassortant H1N1 influenza virus vaccines protect pigs against pandemic H1N1 influenza virus and H1N2 swine influenza virus challenge.

Science.gov (United States)

Yang, Huanliang; Chen, Yan; Shi, Jianzhong; Guo, Jing; Xin, Xiaoguang; Zhang, Jian; Wang, Dayan; Shu, Yuelong; Qiao, Chuanling; Chen, Hualan

2011-09-28

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.

Perceived benefits and barriers to a career in pediatric neurosurgery: a survey of neurosurgical residents.

Science.gov (United States)

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

2013-11-01

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

Development of neurosurgery in Germany: comparison of data collected by polls for 1997, 2003, and 2008 among providers of neurosurgical care.

Science.gov (United States)

Steiger, Hans J; Krämer, Michael; Reulen, Hans J

2012-01-01

To deduce structural trends in neurosurgery in Germany by comparison of data derived from polls conducted by the Deutsche Gesellschaft für Neurochirurgie (DGNC) in 1997, 2003 and 2008. The questionnaires of the different polls probed a comparable set of issues. The data from the responding sample were extrapolated to the nationwide average or sum and compared between the different time periods. The number of identified neurosurgical departments increased from 146 to 201 during the years 1997-2008 largely as a result of the new foundation of numerous private groups. Nationwide total neurosurgical bed capacity and intensive care unit bed capacity increased modestly over the time period. The extrapolated total number of neurosurgical operations increased from 196,341 to 319,295. Although cranial and spinal neurosurgery remain the dominant subspecialties, the number of functional neurosurgical procedures and operations for pain increased more than proportionally. Outpatient procedures were established during the time period and corresponded in 2008 to a substantial proportion of the surgical volume. The total number of residents and board-certified neurosurgeons increased during the period 1997-2008 from 1513 to 1961. The proportion of residents decreased during 1997-2003 and then increased again. The number of neurosurgical operations increased in Germany proportionally to the economic growth of other service branches over the time period. Private organizations developed more than neurosurgical departments at university and other general hospitals. Work density measured as operations per physician increased during the period 1997-2008. Copyright © 2012 Elsevier Inc. All rights reserved.

2009 H1N1 Flu Vaccine Facts

Science.gov (United States)

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

Elemental Mind: Human Consciousness and the New Physics

Indian Academy of Sciences (India)

article/fulltext/reso/003/02/0086-0088. Author Affiliations. P N Tandon1. Neurosciences Centre, Department of Neurosurgery, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110 029, India.

A study of analysis PB1-F2 protein of Influenza Viruses A/H1N1pdm09, A/ H3N2, and A/H5N1

Directory of Open Access Journals (Sweden)

Hana Apsari Pawestri

2016-07-01

Full Text Available Abstrak Tujuan. Protein PB1-F2 (polymerase basic 1-frame 2 adalah protein terbaru yang ditemukan pada virus Influenza dan telah terbukti berperan dalam induksi kematian sel dan patogenitas. Tujuan dari tulisan ini adalah untuk menganalisis protein PB1-F2 pada virus Influenza A/H5N1 dan A/H1N1pdm09. Metode. Kami melakukan pencarian data yang relevan yaitu sekuens gen virus Influenza A/H5N1 dan A/H1N1pdm09 dari Gen Bank National Center for Biotechnology Information (NCBI selama tahun 1997-2015. Data yang digunakan adalah data sekuens nukleotida gen PB1 (polymerase basic1 virus influenza A/H5N1 dan A/H1N1pdm09. Kemudian dilakukan analisis alignment untuk mengetahui variasi protein dan mutasi yang berhubungan dengan patogenitas dan virulensi. Hasil. Kami melakukan penelitian terhadap sekuens PB1-F2 sebanyak 3262 influenza A/H5N1 dan 2472 Influenza A/H1N1pdm09. Hasil analisis menunjukkan bahwa semua sekuens A/H5N1 memiliki panjang yang penuh sebanyak 90 asam amino, kecuali influenza pandemi 2009 hanya memiliki panjang 87 asam amino. Kemudian, ditemukan mutasi yang berhubungan dengan virulensi yang ditunjukan dengan perubahan asam amino Asparagin (N menjadi Serin (S. Mutasi tersebut terjadi pada Influenza A/H5N1 sebanyak 8.5% dan Influenza A/H1N1pdm09 sebanyak 0.5%. Kesimpulan. Ditemukan beberapa variasi panjang asam amino dan mutasi penting pada sekuens PB1-F2 dari subtipe yang berbeda yaitu influenza A/H5N1 dan A/H1N1pdm09  yang mengindikasikan seleksi spesifik karena introduksi dan adaptasi terhadap inang yang berbeda. Diperlukan penelitian lanjutan untuk lebih memahami variasi dan kontribusi protein PB1-F2 tersebut terhadap virulensi dan patogenitas virus Influenza. Kata kunci : Patogenesis, Virus Influenza, Protein  PB1-F2 Abstract Aim. Influenza virus PB1-F2 (polymerase basic 1-frame 2 protein is a novel protein previously shown to be involved in cell death induction and pathogenesis. Here we analysis the PB1-F2 protein of Influenza virus A

A study of analysis PB1-F2 protein of Influenza Viruses A/H1N1pdm09, A/ H3N2, and A/H5N1

Directory of Open Access Journals (Sweden)

Hana Apsari Pawestri

2016-07-01

Full Text Available Abstrak Tujuan. Protein PB1-F2 (polymerase basic 1-frame 2 adalah protein terbaru yang ditemukan pada virus Influenza dan telah terbukti berperan dalam induksi kematian sel dan patogenitas. Tujuan dari tulisan ini adalah untuk menganalisis protein PB1-F2 pada virus Influenza A/H5N1 dan A/H1N1pdm09. Metode. Kami melakukan pencarian data yang relevan yaitu sekuens gen virus Influenza A/H5N1 dan A/H1N1pdm09 dari Gen Bank National Center for Biotechnology Information (NCBI selama tahun 1997-2015. Data yang digunakan adalah data sekuens nukleotida gen PB1 (polymerase basic1 virus influenza A/H5N1 dan A/H1N1pdm09. Kemudian dilakukan analisis alignment untuk mengetahui variasi protein dan mutasi yang berhubungan dengan patogenitas dan virulensi. Hasil. Kami melakukan penelitian terhadap sekuens PB1-F2 sebanyak 3262 influenza A/H5N1 dan 2472 Influenza A/H1N1pdm09. Hasil analisis menunjukkan bahwa semua sekuens A/H5N1 memiliki panjang yang penuh sebanyak 90 asam amino, kecuali influenza pandemi 2009 hanya memiliki panjang 87 asam amino. Kemudian, ditemukan mutasi yang berhubungan dengan virulensi yang ditunjukan dengan perubahan asam amino Asparagin (N menjadi Serin (S. Mutasi tersebut terjadi pada Influenza A/H5N1 sebanyak 8.5% dan Influenza A/H1N1pdm09 sebanyak 0.5%. Kesimpulan. Ditemukan beberapa variasi panjang asam amino dan mutasi penting pada sekuens PB1-F2 dari subtipe yang berbeda yaitu influenza A/H5N1 dan A/H1N1pdm09  yang mengindikasikan seleksi spesifik karena introduksi dan adaptasi terhadap inang yang berbeda. Diperlukan penelitian lanjutan untuk lebih memahami variasi dan kontribusi protein PB1-F2 tersebut terhadap virulensi dan patogenitas virus Influenza. Kata kunci : Patogenesis, Virus Influenza, Protein  PB1-F2 Abstract Aim. Influenza virus PB1-F2 (polymerase basic 1-frame 2 protein is a novel protein previously shown to be involved in cell death induction and pathogenesis. Here we analysis the PB1-F2 protein of Influenza virus A

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

Science.gov (United States)

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

2016-05-01

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.

Causes and Timing of Unplanned Early Readmission After Neurosurgery.

Science.gov (United States)

Taylor, Blake E S; Youngerman, Brett E; Goldstein, Hannah; Kabat, Daniel H; Appelboom, Geoffrey; Gold, William E; Connolly, Edward Sander

2016-09-01

Reducing the rate of 30-day hospital readmission has become a priority in healthcare quality improvement policy, with a focus on better characterizing the reasons for unplanned readmission. In neurosurgery, however, peer-reviewed analyses describing the patterns of readmission have been limited in their number and generalizability. To determine the incidence, timing, and causes of 30-day readmission after neurosurgical procedures. We conducted a retrospective longitudinal study from 2009 to 2012 using the Statewide Planning And Research Cooperative System, which collects patient-level details for all admissions and discharges within New York. We identified patients readmitted within 30 days of initial discharge. The rate of, reasons for, and time to readmission were determined overall and within 4 subgroups: craniotomies, cranial surgery without craniotomy, spine, and neuroendovascular procedures. There were 163 743 index admissions, of whom 14 791 (9.03%) were readmitted. The most common reasons for unplanned readmission were infection (29.52%) and medical complications (19.22%). Median time to readmission was 11 days, with hemorrhagic strokes and seizures occurring earlier, and medical complications and infections occurring later. Readmission rates were highest among patients undergoing cerebrospinal fluid shunt revision and malignant tumor resection (15.57%-22.60%). Spinal decompressions, however, accounted for the largest volume of readmissions (33.13%). Many readmissions may be preventable and occur at predictable time intervals. The causes and timing of readmission vary significantly across neurosurgical subgroups. Future studies should focus on detecting specific complications in select cohorts at predefined time points, which may allow for interventions to lower costs and reduce patient morbidity. CSF, cerebrospinal fluidIQR, interquartile rangeSPARCS, Statewide Planning And Research Cooperative System.

XANES study on Ruddlesdan-Popper phase, Lan+1NinO3n+1 (n = 1, 2 and ∞)

International Nuclear Information System (INIS)

Park, Jung-Chul; Kim, Dong-Kuk; Byeon, Song-Hu; Kim, Don

2001-01-01

Ruddlesden-Popper phase, La n+1 Ni n O 3n+ 1 (n = 1, 2, and ∞) compounds were prepared by citrate sol-gel method. We revealed the origin of the variation of the electrical conductivities in La n+1 Ni n O 3n+1 (n= 1, 2, and ∞) using resistivity measurements, Rietveld analysis, and X-ray absorption spectroscopy. According to the XANES spectra, it is found that the degree of 4pπ - 4pσ energy splitting between 8345 eV and 8350 eV is qualitatively proportional to the elongation of the out-of-plane Ni-O bond length. With the decrease of 4pπ-4pσ splitting, the strong hybridization of the σ-bonding between Ni-3d and O-2p orbitals creates narrow antibonding σ bands, which finally results in the lower electrical resistivity. (au)

Thermochemistry of 1,1'-di-n-butyluranocene

International Nuclear Information System (INIS)

Kuznetsov, N.T.; Mitin, V.A.; Kir'yanov, K.V.; Sevast'yanov, V.G.; Bogdanov, V.A.

1987-01-01

Combustion enthalpy, temperature dependence of saturated vapor of uranium 1,1'-di-n-butylcyclooctatetraene (1,1'-di-n-butyluranocene) are determined for the first time and its thermal behaviour is studied using DTA and high temperature spectrophotometry. Melting and thermal decomposition beginning temperatures; melting and vaporization enthalpies; standard formation enthalpies in a condensed and gaseous states; mean dissociation energy of uranium bond to n-butylcyclooctatetraene are calculated according to the data obtained

Genetic divergence of influenza A NS1 gene in pandemic 2009 H1N1 isolates with respect to H1N1 and H3N2 isolates from previous seasonal epidemics

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Campanini Giulia

2010-09-01

Full Text Available Abstract Background The Influenza A pandemic sustained by a new H1N1 variant (H1N1v started in Mexico and the USA at the end of April 2009 spreading worldwide in a few weeks. In this study we investigate the variability of the NS1 gene of the pandemic H1N1v strain with respect to previous seasonal strains circulating in humans and the potential selection of virus variants through isolation in cell culture. Methods During the period April 27th 2009-Jan 15th 2010, 1633 potential 2009 H1N1v cases have been screened at our center using the CDC detection and typing realtime RT-PCR assays. Virus isolation on MDCK cells was systematically performed in 1/10 positive cases. A subset of 51 H1N1v strains isolated in the period May-September 2009 was selected for NS1 gene sequencing. In addition, 15 H1N1 and 47 H3N2 virus isolates from three previous seasonal epidemics (2006-2009 were analyzed in parallel. Results A low variability in the NS1 amino acid (aa sequence among H1N1v isolates was shown (aa identity 99.5%. A slightly higher NS1 variability was observed among H1N1 and H3N2 strains from previous epidemics (aa identity 98.6% and 98.9%, respectively. The H1N1v strains were closely related (aa identity 92.1% to swine reference strain (A/swine/Oklahoma/042169/2008. In contrast, substantial divergence (aa identity 83.4% with respect to human reference strain A/Brevig Mission/1/1918 and previous epidemic strains H1N1 and H3N2 (aa identity 78.9% and 77.6%, respectively was shown. Specific sequence signatures of uncertain significance in the new virus variant were a C-terminus deletion and a T215P substitution. Conclusions The H1N1v NS1 gene was more conserved than that of previous epidemic strains. In addition, a closer genetic identity of H1N1v with the swine than the human reference strains was shown. Hot-spots were shown in the H1N1v NS1 aa sequence whose biologic relevance remains to be investigated.

Neurosurgery simulation using non-linear finite element modeling and haptic interaction

Science.gov (United States)

Lee, Huai-Ping; Audette, Michel; Joldes, Grand R.; Enquobahrie, Andinet

2012-02-01

Real-time surgical simulation is becoming an important component of surgical training. To meet the realtime requirement, however, the accuracy of the biomechancial modeling of soft tissue is often compromised due to computing resource constraints. Furthermore, haptic integration presents an additional challenge with its requirement for a high update rate. As a result, most real-time surgical simulation systems employ a linear elasticity model, simplified numerical methods such as the boundary element method or spring-particle systems, and coarse volumetric meshes. However, these systems are not clinically realistic. We present here an ongoing work aimed at developing an efficient and physically realistic neurosurgery simulator using a non-linear finite element method (FEM) with haptic interaction. Real-time finite element analysis is achieved by utilizing the total Lagrangian explicit dynamic (TLED) formulation and GPU acceleration of per-node and per-element operations. We employ a virtual coupling method for separating deformable body simulation and collision detection from haptic rendering, which needs to be updated at a much higher rate than the visual simulation. The system provides accurate biomechancial modeling of soft tissue while retaining a real-time performance with haptic interaction. However, our experiments showed that the stability of the simulator depends heavily on the material property of the tissue and the speed of colliding objects. Hence, additional efforts including dynamic relaxation are required to improve the stability of the system.

Industry Financial Relationships in Neurosurgery in 2015: Analysis of the Sunshine Act Open Payments Database.

Science.gov (United States)

de Lotbiniere-Bassett, Madeleine P; McDonald, Patrick J

2018-03-23

The 2013 Physician Payments Sunshine Act mandates that all U.S. drug and device manufacturers disclose payments to physicians. All payments are made available annually in the Open Payments Database (OPD). Our aim was to determine prevalence, magnitude, and nature of these payments to physicians performing neurologic surgery in 2015 and to discuss the role that financial conflicts of interest play in neurosurgery. All records of industry financial relationships with physicians identified by the neurological surgery taxonomy code in 2015 were accessed via the OPD. Data were analyzed in terms of type and amounts of payments, companies making payments, and comparison with previous studies. In 2015, 83,690 payments (totaling $99,048,607) were made to 7613 physicians by 330 companies. Of these, 0.01% were >$1 million, and 73.2% were <$100. The mean payment ($13,010) was substantially greater than the median ($114). Royalties and licensing accounted for the largest monetary value of payments (74.2%) but only 1.7% of the total number. Food and beverage payments were the most commonly reported transaction (75%) but accounted for only 2.5% of total reported monetary value. Neurologic surgery had the second highest average total payment per physician of any specialty. The neurological surgery specialty receives substantial annual payments from industry in the United States. The overall value is driven by a small number of payments of high monetary value. The OPD provides a unique opportunity for increased transparency in industry-physician relationships facilitating disclosure of financial conflicts of interest. Copyright © 2018 Elsevier Inc. All rights reserved.

Thermal model to investigate the temperature in bone grinding for skull base neurosurgery.

Science.gov (United States)

Zhang, Lihui; Tai, Bruce L; Wang, Guangjun; Zhang, Kuibang; Sullivan, Stephen; Shih, Albert J

2013-10-01

This study develops a thermal model utilizing the inverse heat transfer method (IHTM) to investigate the bone grinding temperature created by a spherical diamond tool used for skull base neurosurgery. Bone grinding is a critical procedure in the expanded endonasal approach to remove the cranial bone and access to the skull base tumor via nasal corridor. The heat is generated during grinding and could damage the nerve or coagulate the blood in the carotid artery adjacent to the bone. The finite element analysis is adopted to investigate the grinding-induced bone temperature rise. The heat source distribution is defined by the thermal model, and the temperature distribution is solved using the IHTM with experimental inputs. Grinding experiments were conducted on a bovine cortical bone with embedded thermocouples. Results show significant temperature rise in bone grinding. Using 50°C as the threshold, the thermal injury can propagate about 3mm in the traverse direction, and 3mm below the ground surface under the dry grinding condition. The presented methodology demonstrated the capability of being a thermal analysis tool for bone grinding study. Copyright © 2013 IPEM. Published by Elsevier Ltd. All rights reserved.

"Extremely minimally invasive": recent advances in nanotechnology research and future applications in neurosurgery.

Science.gov (United States)

Mattei, Tobias A; Rehman, Azeem A

2015-01-01

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.

Whole exome sequencing reveals a MLL de novo mutation ...

Indian Academy of Sciences (India)

article/fulltext/jgen/094/04/0755-0758 ... University of Messina, Messina, 98123, Italy; National Hospital for Neurology and Neurosurgery, London, WC1N 3BG, United Kingdom; The Portland Hospital for Women and Children, London, W1W 5AH, ...

Comparative analyses of pandemic H1N1 and seasonal H1N1, H3N2, and influenza B infections depict distinct clinical pictures in ferrets.

Directory of Open Access Journals (Sweden)

Stephen S H Huang

Full Text Available Influenza A and B infections are a worldwide health concern to both humans and animals. High genetic evolution rates of the influenza virus allow the constant emergence of new strains and cause illness variation. Since human influenza infections are often complicated by secondary factors such as age and underlying medical conditions, strain or subtype specific clinical features are difficult to assess. Here we infected ferrets with 13 currently circulating influenza strains (including strains of pandemic 2009 H1N1 [H1N1pdm] and seasonal A/H1N1, A/H3N2, and B viruses. The clinical parameters were measured daily for 14 days in stable environmental conditions to compare clinical characteristics. We found that H1N1pdm strains had a more severe physiological impact than all season strains where pandemic A/California/07/2009 was the most clinically pathogenic pandemic strain. The most serious illness among seasonal A/H1N1 and A/H3N2 groups was caused by A/Solomon Islands/03/2006 and A/Perth/16/2009, respectively. Among the 13 studied strains, B/Hubei-Wujiagang/158/2009 presented the mildest clinical symptoms. We have also discovered that disease severity (by clinical illness and histopathology correlated with influenza specific antibody response but not viral replication in the upper respiratory tract. H1N1pdm induced the highest and most rapid antibody response followed by seasonal A/H3N2, seasonal A/H1N1 and seasonal influenza B (with B/Hubei-Wujiagang/158/2009 inducing the weakest response. Our study is the first to compare the clinical features of multiple circulating influenza strains in ferrets. These findings will help to characterize the clinical pictures of specific influenza strains as well as give insights into the development and administration of appropriate influenza therapeutics.

Seroprevalence of H1N1, H3N2 and H1N2 influenza viruses in pigs in seven European countries in 2002-2003.

Science.gov (United States)

Van Reeth, Kristien; Brown, Ian H; Dürrwald, Ralf; Foni, Emanuela; Labarque, Geoffrey; Lenihan, Patrick; Maldonado, Jaime; Markowska-Daniel, Iwona; Pensaert, Maurice; Pospisil, Zdenek; Koch, Guus

2008-05-01

Avian-like H1N1 and human-like H3N2 swine influenza viruses (SIV) have been considered widespread among pigs in Western Europe since the 1980s, and a novel H1N2 reassortant with a human-like H1 emerged in the mid 1990s. This study, which was part of the EC-funded 'European Surveillance Network for Influenza in Pigs 1', aimed to determine the seroprevalence of the H1N2 virus in different European regions and to compare the relative prevalences of each SIV between regions. Laboratories from Belgium, the Czech Republic, Germany, Italy, Ireland, Poland and Spain participated in an international serosurvey. A total of 4190 sow sera from 651 farms were collected in 2002-2003 and examined in haemagglutination inhibition tests against H1N1, H3N2 and H1N2. In Belgium, Germany, Italy and Spain seroprevalence rates to each of the three SIV subtypes were high (> or =30% of the sows seropositive) to very high (> or =50%), except for a lower H1N2 seroprevalence rate in Italy (13.8%). Most sows in these countries with high pig populations had antibodies to two or three subtypes. In Ireland, the Czech Republic and Poland, where swine farming is less intensive, H1N1 was the dominant subtype (8.0-11.7% seropositives) and H1N2 and H3N2 antibodies were rare (0-4.2% seropositives). Thus, SIV of H1N1, H3N2 and H1N2 subtype are enzootic in swine producing regions of Western Europe. In Central Europe, SIV activity is low and the circulation of H3N2 and H1N2 remains to be confirmed. The evolution and epidemiology of SIV throughout Europe is being further monitored through a second 'European Surveillance Network for Influenza in Pigs'.

Augmented-reality integrated robotics in neurosurgery: are we there yet?

Science.gov (United States)

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

2017-05-01

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.

Neurosurgery clinical registry data collection utilizing Informatics for Integrating Biology and the Bedside and electronic health records at the University of Rochester.

Science.gov (United States)

Pittman, Christine A; Miranpuri, Amrendra S

2015-12-01

In a population health-driven health care system, data collection through the use of clinical registries is becoming imperative to continue to drive effective and efficient patient care. Clinical registries rely on a department's ability to collect high-quality and accurate data. Currently, however, data are collected manually with a high risk for error. The University of Rochester's Department of Neurosurgery in conjunction with the university's Clinical and Translational Science Institute has implemented the integrated use of the Informatics for Integrating Biology and the Bedside (i2b2) informatics framework with the Research Electronic Data Capture (REDCap) databases.

Predictors of H1N1 influenza in the emergency department: proposition for a modified H1N1 case definition.

Science.gov (United States)

Flick, H; Drescher, M; Prattes, J; Tovilo, K; Kessler, H H; Vander, K; Seeber, K; Palfner, M; Raggam, R B; Avian, A; Krause, R; Hoenigl, M

2014-02-01

Reliable and rapid diagnosis of influenza A H1N1 is essential to initiate appropriate antiviral therapy and preventive measures. We analysed the differences in clinical presentation and laboratory parameters between emergency department patients with PCR-confirmed H1N1 influenza infection (n = 199) and those with PCR-negative influenza-like illness (ILI; n = 252). Cough, wheezing, leucopenia, eosinopenia and a lower C-reactive protein remained significant predictors of H1N1 influenza. Proposed combinations of clinical symptoms with simple laboratory parameters (e.g. reported or measured fever and either cough or leucocytes definitions that use clinical criteria alone. © 2013 The Authors Clinical Microbiology and Infection © 2013 European Society of Clinical Microbiology and Infectious Diseases.

Thermochemical characteristics of La n+1Ni nO3n+1 oxides

International Nuclear Information System (INIS)

Bannikov, D.O.; Safronov, A.P.; Cherepanov, V.A.

2006-01-01

Lanthanum nickelates: La 2 NiO 4+δ , La 3 Ni 2 O 7-δ , La 4 Ni 3 O 10-δ and LaNiO 3-δ the members of Ruddlesden-Popper series La n+1 Ni n O 3n+1 were prepared using citrate route. Dissolution enthalpies of complex oxides as well as a number of subsidiary substances were measured by means of Calvet calorimeter in 1 M solution of hydrochloric acid at 25 deg. C. The dissolution scheme of complex oxides in hydrochloric acid was proposed and enthalpies of formation of the complex oxides from binary oxides were calculated considering oxygen nonstoichiometry of these substances. Enthalpies of step-by-step oxidation were evaluated. Partial enthalpy contribution of LaO layers was calculated endothermic equals to 30.9 J/mol while partial enthalpy contribution of perovskite LaNiO 3 layers was negative equals to -97.0 J/mol. Enthalpy of formation of any complex oxide of Ruddlesden-Popper series fits very well to the linear regression based on these values

New hierarchy in GUTs based on SU(n,1)/SU(n)U(1) SUGRA

International Nuclear Information System (INIS)

Hayashi, M.J.; Murayama, Akihiro

1985-01-01

Grand unified theories (GUTs) in the framework of SU(n, 1)/SU(n) x U(1) supergravity are discussed which naturally generate a new hierarchy, Msub(P) (Planck mass): Msub(X) (GUT scale):msub(3/2) (gravitino mass):m (explicit supersymmetry breaking scale)=1:epsilon:epsilon 3 :epsilon 5 α(Msub(X)) with Msub(P) as the only input mass scale. The SUSY breaking scale m is expected to be fixed radiatively as mproportionalMsub(W), i.e., epsilonproportional10 -3 . Our method would be applicable to any GUT based on SU(n, 1)/SU(n) x U(1) supergravity. (orig.)

Retractor-induced brain shift compensation in image-guided neurosurgery

Science.gov (United States)

Fan, Xiaoyao; Ji, Songbai; Hartov, Alex; Roberts, David; Paulsen, Keith

2013-03-01

In image-guided neurosurgery, intraoperative brain shift significantly degrades the accuracy of neuronavigation that is solely based on preoperative magnetic resonance images (pMR). To compensate for brain deformation and to maintain the accuracy in image guidance achieved at the start of surgery, biomechanical models have been developed to simulate brain deformation and to produce model-updated MR images (uMR) to compensate for brain shift. To-date, most studies have focused on shift compensation at early stages of surgery (i.e., updated images are only produced after craniotomy and durotomy). Simulating surgical events at later stages such as retraction and tissue resection are, perhaps, clinically more relevant because of the typically much larger magnitudes of brain deformation. However, these surgical events are substantially more complex in nature, thereby posing significant challenges in model-based brain shift compensation strategies. In this study, we present results from an initial investigation to simulate retractor-induced brain deformation through a biomechanical finite element (FE) model where whole-brain deformation assimilated from intraoperative data was used produce uMR for improved accuracy in image guidance. Specifically, intensity-encoded 3D surface profiles at the exposed cortical area were reconstructed from intraoperative stereovision (iSV) images before and after tissue retraction. Retractor-induced surface displacements were then derived by coregistering the surfaces and served as sparse displacement data to drive the FE model. With one patient case, we show that our technique is able to produce uMR that agrees well with the reconstructed iSV surface after retraction. The computational cost to simulate retractor-induced brain deformation was approximately 10 min. In addition, our approach introduces minimal interruption to the surgical workflow, suggesting the potential for its clinical application.

A comparison of two surgical approaches in functional neurosurgery: individualized versus conventional stereotactic frames.

Science.gov (United States)

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

2015-01-01

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 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 patients' discomfort during DBS

The structure of N = 2 supergravity in N = 1 superfields

International Nuclear Information System (INIS)

Awada, M.A.; Mokhtari, S.

1985-01-01

A formulation of N = 2 supergravity in N = 1 superspace is presented. The authors solve up to all orders the N = 2 supergravity constraints in terms of unconstrained N = 1 superfields. The structure of the N = 2 action in N = 1 superspace is examined. The proposed action coincides in the quadratic limit of the spin (3/2,1) matter fields with the action given by previous workers. (author)

Genetic Characterization of H1N1 and H1N2 Influenza A Viruses Circulating in Ontario Pigs in 2012.

Science.gov (United States)

Grgić, Helena; Costa, Marcio; Friendship, Robert M; Carman, Susy; Nagy, Éva; Poljak, Zvonimir

2015-01-01

The objective of this study was to characterize H1N1 and H1N2 influenza A virus isolates detected during outbreaks of respiratory disease in pig herds in Ontario (Canada) in 2012. Six influenza viruses were included in analysis using full genome sequencing based on the 454 platform. In five H1N1 isolates, all eight segments were genetically related to 2009 pandemic virus (A(H1N1)pdm09). One H1N2 isolate had hemagglutinin (HA), polymerase A (PA) and non-structural (NS) genes closely related to A(H1N1)pdm09, and neuraminidase (NA), matrix (M), polymerase B1 (PB1), polymerase B2 (PB2), and nucleoprotein (NP) genes originating from a triple-reassortant H3N2 virus (tr H3N2). The HA gene of five Ontario H1 isolates exhibited high identity of 99% with the human A(H1N1)pdm09 [A/Mexico/InDRE4487/09] from Mexico, while one Ontario H1N1 isolate had only 96.9% identity with this Mexican virus. Each of the five Ontario H1N1 viruses had between one and four amino acid (aa) changes within five antigenic sites, while one Ontario H1N2 virus had two aa changes within two antigenic sites. Such aa changes in antigenic sites could have an effect on antibody recognition and ultimately have implications for immunization practices. According to aa sequence analysis of the M2 protein, Ontario H1N1 and H1N2 viruses can be expected to offer resistance to adamantane derivatives, but not to neuraminidase inhibitors.

1H-1H correlations across N-H···N hydrogen bonds in nucleic acids

International Nuclear Information System (INIS)

Majumdar, Ananya; Gosser, Yuying; Patel, Dinshaw J.

2001-01-01

In 2H J NN -COSY experiments, which correlate protons with donor/acceptor nitrogens across N d ···HN a bonds, the receptor nitrogen needs to be assigned in order to unambiguously identify the hydrogen bond. For many situations this is a non-trivial task which is further complicated by poor dispersion of (N a ,N d ) resonances. To address these problems, we present pulse sequences to obtain direct, internucleotide correlations between protons in uniformly 13 C/ 15 N labeled nucleic acids containing N d ···HN a hydrogen bonds. Specifically, the pulse sequence H2(N1N3)H3 correlates H2(A,ω 1 ):H3(U,ω 2 ) protons across Watson-Crick A-U and mismatched G·A base pairs, the sequences H5(N3N1)H1/H6(N3N1)H1 correlate H5(C,ω 1 )/H6(C,ω 1 ):H1(G,ω 2 ) protons across Watson-Crick G-C base pairs, and the H 2 (N2N7)H8 sequence correlates NH 2 (G,A,C;ω 1 ):H8(G,A;ω 2 ) protons across G·G, A·A, sheared G·A and other mismatch pairs. These 1 H- 1 H connectivities circumvent the need for independent assignment of the donor/acceptor nitrogen and related degeneracy issues associated with poorly dispersed nitrogen resonances. The methodology is demonstrated on uniformly 13 C/ 15 N labeled samples of (a) an RNA regulatory element involving the HIV-1 TAR RNA fragment, (b) a multi-stranded DNA architecture involving a G·(C-A) triad-containing G-quadruplex and (c) a peptide-RNA complex involving an evolved peptide bound to the HIV-1 Rev response element (RRE) RNA fragment

Non(anti)commutative N = (1,1/2) supersymmetric U(1) gauge theory

International Nuclear Information System (INIS)

Araki, Takeo; Ito, Katsushi; Ohtsuka, Akihisa

2005-01-01

We study a reduction of deformation parameters in non(anti)commutative N = 2 harmonic superspace to those in non(anti)commutative N = 1 superspace. By this reduction we obtain the exact gauge and supersymmetry transformations in the Wess-Zumino gauge of non(anti)commutative N = 2 supersymmetric U(1) gauge theory defined in the deformed harmonic superspace. We also find that the action with the first order correction in the deformation parameter reduces to the one in the N = 1 superspace by some field redefinition. We construct deformed N = (1,1/2) supersymmetry in N = 2 supersymmetric U(1) gauge theory in non(anti)commutative N = 1 superspace

Genetic Characterization of H1N1 and H1N2 Influenza A Viruses Circulating in Ontario Pigs in 2012.

Directory of Open Access Journals (Sweden)

Helena Grgić

Full Text Available The objective of this study was to characterize H1N1 and H1N2 influenza A virus isolates detected during outbreaks of respiratory disease in pig herds in Ontario (Canada in 2012. Six influenza viruses were included in analysis using full genome sequencing based on the 454 platform. In five H1N1 isolates, all eight segments were genetically related to 2009 pandemic virus (A(H1N1pdm09. One H1N2 isolate had hemagglutinin (HA, polymerase A (PA and non-structural (NS genes closely related to A(H1N1pdm09, and neuraminidase (NA, matrix (M, polymerase B1 (PB1, polymerase B2 (PB2, and nucleoprotein (NP genes originating from a triple-reassortant H3N2 virus (tr H3N2. The HA gene of five Ontario H1 isolates exhibited high identity of 99% with the human A(H1N1pdm09 [A/Mexico/InDRE4487/09] from Mexico, while one Ontario H1N1 isolate had only 96.9% identity with this Mexican virus. Each of the five Ontario H1N1 viruses had between one and four amino acid (aa changes within five antigenic sites, while one Ontario H1N2 virus had two aa changes within two antigenic sites. Such aa changes in antigenic sites could have an effect on antibody recognition and ultimately have implications for immunization practices. According to aa sequence analysis of the M2 protein, Ontario H1N1 and H1N2 viruses can be expected to offer resistance to adamantane derivatives, but not to neuraminidase inhibitors.

[Psychiatric disorders in patients with Cushing's disease before and after neurosurgery].

Science.gov (United States)

Gnjidiae, Zivko; Karloviae, Dalibor; Buljan, Danijel; Malencia, Masa; Kovak-Mufiae, Ana; Kostanjsak, Lidija

2011-01-01

Cushing's disease which is a consequence of ACTH-secreting pituitary adenoma leads to hypercortisolism. Cushing's disease is associated with several psychiatric disturbances. The aim of the present study was to identify which psychiatric disorders were present in patients with Cushing's disease over a 2-year period and to monitor their general psychiatric condition. Additionally, the study aimed to examine the relationship between the duration of Cushing's disease, and the severity of psychiatric conditions based on psychiatric rating scales. The study included 39 patients with Cushing's disease that underwent neurosurgery for ACTH-secreting pituitary adenomas. The transsphenoidal approach (the standard microsurgery technique) was performed in all patients. ACTH-secreting pituitary adenomas were confirmed based on immunohistochemistry in all patients. Psychiatric conditions in the patients were identified using the Clinical Global Impression Scale (CGI) and ICD 10 diagnostic criteria at 3 time points: prior to surgery, and 6 and 48 months post surgery. The Cushing's disease patients exhibited statistically significant improvement in their psychiatric condition, according to the CGI, 6 and 48 months post surgery. There wasn't any significant correlation between the duration of Cushing's disease and psychiatric status, as measured by the CGI prior to surgery, 6 months post surgery, or 48 months post surgery. Patients with Cushing's disease had a significant level psychiatric disturbance that remitted after surgery. There wasn't a significant correlation between the duration of Cushing's disease and psychiatric status.

N,N,N′,N′,N′′,N′′-Hexamethylguanidinium 1,1,3,3-tetracyanoprop-2-en-1-ide

Directory of Open Access Journals (Sweden)

Ioannis Tiritiris

2016-03-01

Full Text Available The asymmetric unit of the title salt, C7H18N3+·C7HN4−, comprises one cation and one anion. The N,N,N′,N′,N′′,N′′-hexamethylguanidinium ion shows orientational disorder and two sets of N- and C-atom positions were found, with an occupancy ratio of 0.535 (3:0.465 (3. The C—N bond lengths in the guanidinium ion range from 1.339 (16 to 1.35 (2 Å, indicating partial double-bond character pointing towards charge delocalization within the NCN planes. The negative charge in the 1,1,3,3-tetracyanoprop-2-en-1-ide ion is delocalized within the CCC planes with the C—C bonds ranging in length from 1.379 (3 to 1.427 (3 Å, also indicating partial double-bond character.

Visual deterioration 1½ years after wrapping an un-clippable ...

African Journals Online (AJOL)

2005-09-02

Sep 2, 2005 ... C/O Division of Neurosurgery, Department of Neurosciences,. University of the Witwatersrand, 7 York Rd. Parktown 2193,. Johannesburg, South Africa email: jmno@mweb.co.za. Visual deterioration 1½ years after wrapping an un-clippable anterior communicating artery aneurysm: report of a case and.

Conformal potential in N dimensions (N>1)

Energy Technology Data Exchange (ETDEWEB)

Barucchi, G [Turin Univ. (Italy). Ist. di Fisica; Istituto di Fisica Matematica dell' Universita, Torino (Italy); Istituto Nazionale di Fisica Nucleare, Turin (Italy))

1977-07-21

The conformal invariant model of de Alfaro, Fubini and Furlan is studied in the case of potential V(Q) = g/2Q/sup 2/(Q/sup 2/ = ..sigma..sub(i=1)sup(N) Qsub(i)sup(2), N>1). By means of the invariance under projective transformations and the rotation symmetry of the system in configuration space, explicit solutions are obtained.

THE TOMSK SCIENTIFIC SCHOOL OF NEUROLOGISTS. TO THE 120TH ANNIVERSARY OF THE DEPARTMENT OF NEUROLOGY AND NEUROSURGERY OF SIBERIAN STATE MEDICAL UNIVERSITY

Directory of Open Access Journals (Sweden)

V. M. Alifirova

2013-01-01

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. 

Self-consistent simulation of carrier confinement characteristics in (AlyGa1−yN/AlN)SLs/GaN/(InxGa1−xN/GaN)MQW/GaN heterostructures

International Nuclear Information System (INIS)

Ding Jieqin; Wang Xiaoliang; Xiao Hongling; Wang Cuimei; Yin Haibo; Chen Hong; Feng Chun; Jiang Lijuan

2012-01-01

Highlights: ► We present calculations of carrier confinement characteristics. ► An optimization of In x Ga 1−x N/GaN multiquantum-well (MQW) was made. ► 2DEG sheet carrier density in designed heterostructure is greatly increased. ► Interface roughness and alloy disorder scattering reduced. ► Carrier mobility will be improved in designed heterostructure. - Abstract: We present calculations of carrier confinement characteristics in (Al y Ga 1−y N/AlN)SLs/GaN/(In x Ga 1−x N/GaN)MQW/GaN heterojunction structure in the presence of spontaneous and piezoelectrically induced polarization effects. The calculations were made using a self-consistent solution of the Schrödinger, Poisson, potential and charge balance equations. An optimization of In x Ga 1−x N/GaN multiquantum-well (MQW) was made firstly including thickness of GaN channel, InGaN, and indium composition of In x Ga 1−x N in order to increase carrier density and mobility, and the influence of pairs of AlGaN/AlN superlattices (SLs) and InGaN/GaN MQWs on structure was discussed. Theoretical calculations clearly indicate that the two-dimensional electron gas (2DEG) sheet carrier density in designed heterostructure is greatly increased due to the enhancing of carrier confinement compared to those in conventional AlGaN/GaN one at the similar Al composition. Furthermore, the calculated carrier distribution shows that carrier mobility will be improved by reducing interface roughness and alloy disorder scattering in designed heterostructure.

The genesis of neurosurgery and the evolution of the neurosurgical operative environment: part II--concepts for future development, 2003 and beyond.

Science.gov (United States)

Liu, Charles Y; Spicer, Mark; Apuzzo, Michael L J

2003-01-01

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

Fiber-based tissue identification for electrode placement in deep brain stimulation neurosurgery (Conference Presentation)

Science.gov (United States)

DePaoli, Damon T.; Lapointe, Nicolas; Goetz, Laurent; Parent, Martin; Prudhomme, Michel; Cantin, Léo.; Galstian, Tigran; Messaddeq, Younès.; Côté, Daniel C.

2016-03-01

Deep brain stimulation's effectiveness relies on the ability of the stimulating electrode to be properly placed within a specific target area of the brain. Optical guidance techniques that can increase the accuracy of the procedure, without causing any additional harm, are therefore of great interest. We have designed a cheap optical fiber-based device that is small enough to be placed within commercially available DBS stimulating electrodes' hollow cores and that is capable of sensing biological information from the surrounding tissue, using low power white light. With this probe we have shown the ability to distinguish white and grey matter as well as blood vessels, in vitro, in human brain samples and in vivo, in rats. We have also repeated the in vitro procedure with the probe inserted in a DBS stimulating electrode and found the results were in good agreement. We are currently validating a second fiber optic device, with micro-optical components, that will result in label free, molecular level sensing capabilities, using CARS spectroscopy. The final objective will be to use this data in real time, during deep brain stimulation neurosurgery, to increase the safety and accuracy of the procedure.

Influenza A (H1N1) organising pneumonia.

Science.gov (United States)

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

2010-04-27

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.

(H1N1) Influenza in Saurashtra, India

African Journals Online (AJOL)

Mexico in April, 2009,[1] and then in United States (US).[2,3]. This was originally ... duration of hospital stay of such patients was 2‑32 days. All admitted A (H1N1) .... Because of limited resources, only 2009 A (H1N1) influenza virus was tested ...

Evaluation of twenty rapid antigen tests for the detection of human influenza A H5N1, H3N2, H1N1, and B viruses.

Science.gov (United States)

Taylor, Janette; McPhie, Kenneth; Druce, Julian; Birch, Chris; Dwyer, Dominic E

2009-11-01

Twenty rapid antigen assays were compared for their ability to detect influenza using dilutions of virus culture supernatants from human isolates of influenza A H5N1 (clade 1 and 2 strains), H3N2 and H1N1 viruses, and influenza B. There was variation amongst the rapid antigen assays in their ability to detect different influenza viruses. Six of the 12 assays labeled as distinguishing between influenza A and B had comparable analytical sensitivities for detecting both influenza A H5N1 strains, although their ability to detect influenza A H3N2 and H1N1 strains varied. The two assays claiming H5 specificity did not detect either influenza A H5N1 strains, and the two avian influenza-specific assays detected influenza A H5N1, but missed some influenza A H3N2 virus supernatants. Clinical trials of rapid antigen tests for influenza A H5N1 are limited. For use in a pandemic where novel influenza strains are circulating (such as the current novel influenza A H1N1 09 virus), rapid antigen tests should ideally have comparable sensitivity and specificity for the new strains as for co-circulating seasonal influenza strains.

Evaluation of the impact of collaborative work by teams from the National Medical Residency Committee and the Brazilian Society of Neurosurgery. Retrospective and prospective study.

Science.gov (United States)

Santos, Renato Antunes Dos; Snell, Linda; Nunes, Maria do Patrocínio Tenório

2016-04-01

Training for specialist physicians in Brazil can take place in different ways. Closer liaison between institutions providing this training and assessment and health care services may improve qualifications. This article analyzes the impact of closer links and joint work by teams from the National Medical Residency Committee (Comissão Nacional de Residência Médica, CNRM) and the Brazilian Society of Neurosurgery (Sociedade Brasileira de Neurocirurgia, SBN) towards evaluating these programs. Retrospective and prospective study, conducted in a public university on a pilot project developed between CNRM and SBN for joint assessment of training programs across Brazil. The literature in the most relevant databases was reviewed. Documents and legislation produced by official government bodies were evaluated. Training locations were visited. Reports produced about residency programs were analyzed. Only 26% of the programs were immediately approved. The joint assessments found problems relating to teaching and to functioning of clinical service in 35% of the programs. The distribution of programs in this country has a strong relationship with the Human Development Index (HDI) of the regions and is very similar to the distribution of specialists. Closer collaboration between the SBN and CNRM had a positive impact on assessment of neurosurgery medical residency across the country. The low rates of direct approval have produced modifications and improvements to the quality of teaching and care (services). Closer links between the CNRM and other medical specialties have the capability to positively change the structure and function of specialty training in Brazil.

Identification of knowledge gaps in neurosurgery using a validated self-assessment examination: differences between general and spinal neurosurgeons.

Science.gov (United States)

Sheehan, Jason; Starke, Robert M; Pouratian, Nader; Litvack, Zachary

2013-11-01

The practice of neurosurgery requires fundamental knowledge base. Residency training programs and continuing medical education courses are designed to teach relevant neurosurgical principles. Nevertheless, knowledge gaps exist for neurosurgeons and may be different between cohorts of neurosurgeons. The Self-Assessment in Neurological Surgery (SANS) General Examination and Spine Examination are online educational tools for lifelong learning and maintenance of certification. This study examines the gaps in knowledge of spinal neurosurgeons and general neurosurgeons taking SANS. From 2008 to 2010, a total of 165 spinal neurosurgeons completed the 243 available questions of the SANS Spine Examination. Over that same time frame, 993 general neurosurgeons completed the SANS General Spine Examination. Mean scores were calculated and assessed according to 18 major neurosurgical knowledge disciplines. Statistical analysis was carried out to evaluate for significant knowledge gaps among all users and significant differences in performance between spinal neurosurgeons and their general neurosurgeon counterparts. The mean overall examination score was 87.4% ± 7.5% for spinal neurosurgeons and 71.5% ± 8.9% for general neurosurgeons (P neurosurgeons (n = 165) answered questions incorrectly 15% or greater of the time in five of the categories. The categories of lower performance for spinal neurosurgeons were cerebrovascular, anesthesia and critical care, general clinical, tumor, and trauma. For general neurosurgeons (n = 993), the five knowledge categories with lowest performance were cerebrovascular, epilepsy, peripheral nerve, trauma, and radiosurgery. Although spinal neurosurgeons and general neurosurgeons shared some areas of decreased performance including trauma and cerebrovascular, spine neurosurgeons relatively underperformed in general clinical, anesthesia and critical care, and tumor. The SANS Spine Examination demonstrated knowledge gaps in specific categories for

Matrix-isolation FTIR, theoretical structural analysis and reactivity of amino-saccharins: N-(1,1-dioxo-1,2-benzisothiazol-3-yl)- N-methyl amine and - N,N-dimethyl amine

Science.gov (United States)

Almeida, R.; Gómez-Zavaglia, A.; Kaczor, A.; Ismael, A.; Cristiano, M. L. S.; Fausto, R.

2009-12-01

In this work, two novel amino-substituted derivatives of saccharin, N-(1,1-dioxo-1,2-benzisothiazol-3-yl)- N-methyl amine (MBAD) and N-(1,1-dioxo-1,2-benzisothiazol-3-yl)- N, N-dimethyl amine (DMBAD), were synthesized and characterized, and their molecular structure and vibrational properties were investigated by matrix-isolation FTIR spectroscopy and theoretical calculations undertaken using different levels of approximation. The calculations predicted the existence of two conformers of MBAD. The lowest energy form was predicted to be considerably more stable than the second conformer (Δ E > ca. 20 kJ mol -1) and was the sole form contributing to the infrared spectrum of the compound isolated in solid xenon. Both conformers have planar amine moieties. In the case of DMBAD, only one doubly-degenerated-by-symmetry conformer exists, with the amine nitrogen atom considerably pyramidalized. The effect of the electron-withdrawing saccharyl ring on the C-N bond lengths is discussed. The different structural preferences around the amine nitrogen atom in the two molecules were explained in terms of repulsive interactions involving the additional methyl group of DMBAD. Observed structural features are correlated with the reactivity exhibited by the two compounds towards nucleophiles. The experimentally obtained spectra of the matrix-isolated monomers of MBAD and DMBAD were fully assigned by comparison with the corresponding calculated spectra.

Cn(1), Dn(1) and A2n-1(2) reflection K-matrices

International Nuclear Information System (INIS)

Lima-Santos, A.; Malara, R.

2003-01-01

We investigate the possible regular solutions of the boundary Yang-Baxter equation for the vertex models associated with the C n (1) , D n (1) and A 2n-1 (2) affine Lie algebras. We find three types of solutions with n, n-1 and 1 free parameters, respectively. Special cases and all diagonal solutions are presented separately

Protection against H5N1 Highly Pathogenic Avian and Pandemic (H1N1) 2009 Influenza Virus Infection in Cynomolgus Monkeys by an Inactivated H5N1 Whole Particle Vaccine

Science.gov (United States)

Nakayama, Misako; Shichinohe, Shintaro; Itoh, Yasushi; Ishigaki, Hirohito; Kitano, Mitsutaka; Arikata, Masahiko; Pham, Van Loi; Ishida, Hideaki; Kitagawa, Naoko; Okamatsu, Masatoshi; Sakoda, Yoshihiro; Ichikawa, Takaya; Tsuchiya, Hideaki; Nakamura, Shinichiro; Le, Quynh Mai; Ito, Mutsumi; Kawaoka, Yoshihiro; Kida, Hiroshi; Ogasawara, Kazumasa

2013-01-01

H5N1 highly pathogenic avian influenza virus (HPAIV) infection has been reported in poultry and humans with expanding clade designations. Therefore, a vaccine that induces immunity against a broad spectrum of H5N1 viruses is preferable for pandemic preparedness. We established a second H5N1 vaccine candidate, A/duck/Hokkaido/Vac-3/2007 (Vac-3), in our virus library and examined the efficacy of inactivated whole particles of this strain against two clades of H5N1 HPAIV strains that caused severe morbidity in cynomolgus macaques. Virus propagation in vaccinated macaques infected with either of the H5N1 HPAIV strains was prevented compared with that in unvaccinated macaques. This vaccine also prevented propagation of a pandemic (H1N1) 2009 virus in macaques. In the vaccinated macaques, neutralization activity, which was mainly shown by anti-hemagglutinin antibody, against H5N1 HPAIVs in plasma was detected, but that against H1N1 virus was not detected. However, neuraminidase inhibition activity in plasma and T-lymphocyte responses in lymph nodes against H1N1 virus were detected. Therefore, cross-clade and heterosubtypic protective immunity in macaques consisted of humoral and cellular immunity induced by vaccination with Vac-3. PMID:24376571

Protection against H5N1 highly pathogenic avian and pandemic (H1N1 2009 influenza virus infection in cynomolgus monkeys by an inactivated H5N1 whole particle vaccine.

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Misako Nakayama

Full Text Available H5N1 highly pathogenic avian influenza virus (HPAIV infection has been reported in poultry and humans with expanding clade designations. Therefore, a vaccine that induces immunity against a broad spectrum of H5N1 viruses is preferable for pandemic preparedness. We established a second H5N1 vaccine candidate, A/duck/Hokkaido/Vac-3/2007 (Vac-3, in our virus library and examined the efficacy of inactivated whole particles of this strain against two clades of H5N1 HPAIV strains that caused severe morbidity in cynomolgus macaques. Virus propagation in vaccinated macaques infected with either of the H5N1 HPAIV strains was prevented compared with that in unvaccinated macaques. This vaccine also prevented propagation of a pandemic (H1N1 2009 virus in macaques. In the vaccinated macaques, neutralization activity, which was mainly shown by anti-hemagglutinin antibody, against H5N1 HPAIVs in plasma was detected, but that against H1N1 virus was not detected. However, neuraminidase inhibition activity in plasma and T-lymphocyte responses in lymph nodes against H1N1 virus were detected. Therefore, cross-clade and heterosubtypic protective immunity in macaques consisted of humoral and cellular immunity induced by vaccination with Vac-3.

Risk factors for surgical site infection following nonshunt pediatric neurosurgery: a review of 9296 procedures from a national database and comparison with a single-center experience.

Science.gov (United States)

Sherrod, Brandon A; Arynchyna, Anastasia A; Johnston, James M; Rozzelle, Curtis J; Blount, Jeffrey P; Oakes, W Jerry; Rocque, Brandon G

2017-04-01

OBJECTIVE Surgical site infection (SSI) following CSF shunt operations has been well studied, yet risk factors for nonshunt pediatric neurosurgery are less well understood. The purpose of this study was to determine SSI rates and risk factors following nonshunt pediatric neurosurgery using a nationwide patient cohort and an institutional data set specifically for better understanding SSI. METHODS The authors reviewed the American College of Surgeons National Surgical Quality Improvement Program-Pediatric (ACS NSQIP-P) database for the years 2012-2014, including all neurosurgical procedures performed on pediatric patients except CSF shunts and hematoma evacuations. SSI included deep (intracranial abscesses, meningitis, osteomyelitis, and ventriculitis) and superficial wound infections. The authors performed univariate analyses of SSI association with procedure, demographic, comorbidity, operative, and hospital variables, with subsequent multivariate logistic regression analysis to determine independent risk factors for SSI within 30 days of the index procedure. A similar analysis was performed using a detailed institutional infection database from Children's of Alabama (COA). RESULTS A total of 9296 nonshunt procedures were identified in NSQIP-P with an overall 30-day SSI rate of 2.7%. The 30-day SSI rate in the COA institutional database was similar (3.3% of 1103 procedures, p = 0.325). Postoperative time to SSI in NSQIP-P and COA was 14.6 ± 6.8 days and 14.8 ± 7.3 days, respectively (mean ± SD). Myelomeningocele (4.3% in NSQIP-P, 6.3% in COA), spine (3.5%, 4.9%), and epilepsy (3.4%, 3.1%) procedure categories had the highest SSI rates by procedure category in both NSQIP-P and COA. Independent SSI risk factors in NSQIP-P included postoperative pneumonia (OR 4.761, 95% CI 1.269-17.857, p = 0.021), immune disease/immunosuppressant use (OR 3.671, 95% CI 1.371-9.827, p = 0.010), cerebral palsy (OR 2.835, 95% CI 1.463-5.494, p = 0.002), emergency operation (OR 1

Pediatric neurosurgery outreach: sustainability appraisal of a targeted teaching model in Kiev, Ukraine.

Science.gov (United States)

Levy, Michael L; Duenas, Vincent J; Hambrecht, Amanda C; Hahn, Edward J; Aryan, Henry E; Jandial, Rahul

2012-01-01

This study evaluates the efficacy of operative skill transfer in the context of targeted pediatric outreach missions completed in Kiev, Ukraine. In addition the ability to create sustainable surgical care improvement is investigated as an efficient method to improve global surgical care. Three 1-week targeted neurosurgical missions were performed (2005-2007) to teach neuroendoscopy, which included donation of the necessary surgical equipment, so the host team can deliver newly acquired surgical skills to their citizens after the visiting mission team departs. The neuroendoscopy data for the 4 years after the final mission in 2007 was obtained. After performing pediatric neurosurgery missions in 2005-2007, with a focus on teaching neuroendoscopy, the host team demonstrated the sustainability of our educational efforts in the subsequent 4 years by performing cases independently for their citizens. Since the last targeted mission of 2007, neuroendoscopic procedures have continued to be performed by the trained host surgeons. In 2008, 33 cases were performed. In 2009 and 2010, 29 and 22 cases were completed, respectively. In 2011, local neurosurgeons accomplished 27 cases. To date, a total of 111 operations have been performed over the past 4 years independent of any visiting team, illustrating the sustainability of educational efforts of the missions in 2005-2007. Effective operative skill transfer to host neurosurgeons can be accomplished with limited international team visits using a targeted approach that minimizes expenditures on personnel and capital. With the priority being teaching of an operative technique, as opposed to perennially performing operations by a visiting mission team, sustainable surgical care was achieved and perpetuated after missions officially concluded. Copyright © 2012 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

Epitaxial growth of mixed conducting layered Ruddlesden–Popper La{sub n+1}Ni{sub n}O{sub 3n+1} (n = 1, 2 and 3) phases by pulsed laser deposition

Energy Technology Data Exchange (ETDEWEB)

Wu, Kuan-Ting; Soh, Yeong-Ah; Skinner, Stephen J., E-mail: s.skinner@imperial.ac.uk

2013-10-15

Graphical abstract: - Highlights: • High quality epitaxial thin films of layered Ruddlesden–Popper nickelates were prepared. • For the first time this has been achieved by the PLD process. • n = 1, 2 and 3 films were successfully deposited on SrTiO{sub 3} and NdGaO{sub 3} substrates. • c-Axis oriented films were confirmed by XRD analysis. • In-plane and out-of-plane strain effects on lattice are discussed. - Abstract: Layered Ruddlesden–Popper phases of composition La{sub n+1}Ni{sub n}O{sub 3n+1} (n = 1, 2 and 3) have been epitaxially grown on SrTiO{sub 3} (0 0 1) or NdGaO{sub 3} (1 1 0) single crystal substrates using the pulsed laser deposition technique. X-ray diffraction analyses (θ/2θ, rocking curves, and φ-scans) and atomic force microscopy confirms the high-quality growth of the series of films with low surface roughness values (less than 1 nm). In particular, epitaxial growth of the higher order phases (n = 2 and 3) of lanthanum nickelate have been demonstrated for the first time.

Internal (m=1, n=1) and (m=2, n=1) resistive modes in the toroidal tokamak with circular cross-section

International Nuclear Information System (INIS)

Bussac, M.N.; Pellat, R.; Edery, D.; Soule, J.L.

1977-01-01

A linear analysis is presented of the toroidal coupling between the internal resistive modes (m=1, n=1) and (m=2, n=1) in the tokamak with circular cross-section. The resistive and diamagnetic effects are included in the singular layers where the safety factor q takes respectively the values one and two. By expanding the MHD equations in powers of epsilon, the local inverse of the aspect ratio, a system of two coupled equations is obtained for the harmonic amplitudes. When the shear is finite on q=1 the toroidal coupling is negligible. In the opposite limit, one can explain (a) the experimental behaviour of the (m=1, n=1) mode before the internal disruption, and (b) the simultaneous observation of the modes (m=1, n=1) and (m=2, n=1) before the main disruption. (author)

Order 1/N corrections to the time-dependent Hartree approximation for a system of N+1 oscillators

International Nuclear Information System (INIS)

Mihaila, B.; Dawson, J.F.; Cooper, F.

1997-01-01

We solve numerically to order 1/N the time evolution of a quantum dynamical system of N oscillators of mass m coupled quadratically to a massless dynamic variable. We use Schwingers closed time path formalism to derive the equations. We compare two methods which differ by terms of order 1/N 2 . The first method is a direct perturbation theory in 1/N using the path integral. The second solves exactly the theory defined by the effective action to order 1/N. We compare the results of both methods as a function of N. At N=1, where we expect the expansion to be quite innacurate, we compare our results to an exact numerical solution of the Schroedinger equation. In this case we find that when the two methods disagree they also diverge from the exact answer. We also find at N=1 that the 1/N corrected evolutions track the exact answer for the expectation values much longer than the mean field (N=∞) result. copyright 1997 The American Physical Society

Growth of epitaxial (Sr, Ba){sub n+1}Ru{sub n}O{sub 3n}P+{sub 1}films

Energy Technology Data Exchange (ETDEWEB)

Schlom, D.G.; Knapp, S.B.; Wozniak, S. [Department of Materials Science and Engineering, Penn State University, University Park, PA (United States); Zou, L.N.; Park, J.; Liu, Y. [Department of Physics, Penn State University, University Park, PA (United States); Hawley, M.E.; Brown, G.W. [Center for Materials Science, Los Alamos National Laboratory, Los Alamos, NM (United States); Dabkowski, A.; Dabkowska, H.A. [Institute of Materials Research, McMaster University, Hamilton, Ontario (Canada); Uecker, R.; Reiche, P. [Institute of Crystal Growth, Berlin (Germany)

1997-12-01

We have grown epitaxial (Sr,Ba){sub n+1}Ru{sub n}O{sub 3n+1} films, n = 1, 2 and {infinity}, by pulsed laser deposition (PLD) and controlled their orientation by choosing appropriate substrates. The growth conditions yielding phase-pure films have been mapped out. Resistivity versus temperature measurements show that both a-axis and c-axis films of Sr{sub 2}RuO{sub 4} are metallic, but not superconducting. The latter is probably due to the presence of low-level impurities that are difficult to avoid given the target preparation process involved in growing these films by PLD. (author)

Prophylactic and therapeutic efficacy of avian antibodies against influenza virus H5N1 and H1N1 in mice.

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Huan H Nguyen

Full Text Available BACKGROUND: Pandemic influenza poses a serious threat to global health and the world economy. While vaccines are currently under development, passive immunization could offer an alternative strategy to prevent and treat influenza virus infection. Attempts to develop monoclonal antibodies (mAbs have been made. However, passive immunization based on mAbs may require a cocktail of mAbs with broader specificity in order to provide full protection since mAbs are generally specific for single epitopes. Chicken immunoglobulins (IgY found in egg yolk have been used mainly for treatment of infectious diseases of the gastrointestinal tract. Because the recent epidemic of highly pathogenic avian influenza virus (HPAIV strain H5N1 has resulted in serious economic losses to the poultry industry, many countries including Vietnam have introduced mass vaccination of poultry with H5N1 virus vaccines. We reasoned that IgY from consumable eggs available in supermarkets in Vietnam could provide protection against infections with HPAIV H5N1. METHODS AND FINDINGS: We found that H5N1-specific IgY that are prepared from eggs available in supermarkets in Vietnam by a rapid and simple water dilution method cross-protect against infections with HPAIV H5N1 and related H5N2 strains in mice. When administered intranasally before or after lethal infection, the IgY prevent the infection or significantly reduce viral replication resulting in complete recovery from the disease, respectively. We further generated H1N1 virus-specific IgY by immunization of hens with inactivated H1N1 A/PR/8/34 as a model virus for the current pandemic H1N1/09 and found that such H1N1-specific IgY protect mice from lethal influenza virus infection. CONCLUSIONS: The findings suggest that readily available H5N1-specific IgY offer an enormous source of valuable biological material to combat a potential H5N1 pandemic. In addition, our study provides a proof-of-concept for the approach using virus

Multiplex RT-PCR assay for differentiating European swine influenza virus subtypes H1N1, H1N2 and H3N2.

Science.gov (United States)

Chiapponi, Chiara; Moreno, Ana; Barbieri, Ilaria; Merenda, Marianna; Foni, Emanuela

2012-09-01

In Europe, three major swine influenza viral (SIV) subtypes (H1N1, H1N2 and H3N2) have been isolated in pigs. Developing a test that is able to detect and identify the subtype of the circulating strain rapidly during an outbreak of respiratory disease in the pig population is of essential importance. This study describes two multiplex RT-PCRs which distinguish the haemagglutinin (HA) gene and the neuraminidase (NA) gene of the three major subtypes of SIV circulating in Europe. The HA PCR was able to identify the lineage (avian or human) of the HA of H1 subtypes. The analytical sensitivity of the test, considered to be unique, was assessed using three reference viruses. The detection limit corresponded to 1×10(-1) TCID(50)/200μl for avian-like H1N1, 1×10(0) TCID(50)/200μl for human-like H1N2 and 1×10(1) TCID(50)/200μl for H3N2 SIV. The multiplex RT-PCR was first carried out on a collection of 70 isolated viruses showing 100% specificity and then on clinical samples, from which viruses had previously been isolated, resulting in an 89% positive specificity of the viral subtype. Finally, the test was able to identify the viral subtype correctly in 56% of influenza A positive samples, from which SIV had not been isolated previously. It was also possible to identify mixed viral infections and the circulation of a reassortant strain before performing genomic studies. Copyright © 2012 Elsevier B.V. All rights reserved.

Initial experience with a robotically operated video optical telescopic-microscope in cranial neurosurgery: feasibility, safety, and clinical applications.

Science.gov (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

2017-05-01

. Overall, the authors encountered 3 (1.5%) major neurological morbidities and 6 (3%) 30-day mortalities. Four of the 6 deaths were in the ICH group, resulting in a 1% mortality rate for the remainder of the cohort when excluding these patients. None of the intraoperative complications were considered to be attributable to the visualization provided by the ROVOT-m. When comparing the early and late cohorts, the authors noticed an increase in the proportion of higher-complexity surgeries (Categories IV-VI), from 23% in the early cohort, to 37% in the late cohort (p = 0.030). In addition, a significant reduction in operating room setup time was demonstrated (p < 0.01). CONCLUSIONS The feasibility and safety of the ROVOT-m was demonstrated in a wide range of cranial microsurgical applications. The authors report a gradual increase in case complexity over time, representing an incremental acquisition of experience with this technology. A learning curve of both setup and execution phases should be anticipated by new adopters of the robot system. Further prospective studies are required to address the efficacy of ROVOT-m. This system may play a role in neurosurgery as an integrated platform that is applicable to a variety of cranial procedures.

Experimental infection with H1N1 European swine influenza virus protects pigs from an infection with the 2009 pandemic H1N1 human influenza virus.

Science.gov (United States)

Busquets, Núria; Segalés, Joaquim; Córdoba, Lorena; Mussá, Tufaria; Crisci, Elisa; Martín-Valls, Gerard E; Simon-Grifé, Meritxell; Pérez-Simó, Marta; Pérez-Maíllo, Monica; Núñez, Jose I; Abad, Francesc X; Fraile, Lorenzo; Pina, Sonia; Majó, Natalia; Bensaid, Albert; Domingo, Mariano; Montoya, María

2010-01-01

The recent pandemic caused by human influenza virus A(H1N1) 2009 contains ancestral gene segments from North American and Eurasian swine lineages as well as from avian and human influenza lineages. The emergence of this A(H1N1) 2009 poses a potential global threat for human health and the fact that it can infect other species, like pigs, favours a possible encounter with other influenza viruses circulating in swine herds. In Europe, H1N1, H1N2 and H3N2 subtypes of swine influenza virus currently have a high prevalence in commercial farms. To better assess the risk posed by the A(H1N1) 2009 in the actual situation of swine farms, we sought to analyze whether a previous infection with a circulating European avian-like swine A/Swine/Spain/53207/2004 (H1N1) influenza virus (hereafter referred to as SwH1N1) generated or not cross-protective immunity against a subsequent infection with the new human pandemic A/Catalonia/63/2009 (H1N1) influenza virus (hereafter referred to as pH1N1) 21 days apart. Pigs infected only with pH1N1 had mild to moderate pathological findings, consisting on broncho-interstitial pneumonia. However, pigs inoculated with SwH1N1 virus and subsequently infected with pH1N1 had very mild lung lesions, apparently attributed to the remaining lesions caused by SwH1N1 infection. These later pigs also exhibited boosted levels of specific antibodies. Finally, animals firstly infected with SwH1N1 virus and latter infected with pH1N1 exhibited undetectable viral RNA load in nasal swabs and lungs after challenge with pH1N1, indicating a cross-protective effect between both strains. © INRA, EDP Sciences, 2010.

Electronic structures of B1 MoN, fcc Mo2N, and hexagonal MoN

International Nuclear Information System (INIS)

Ihara, H.; Kimura, Y.; Senzaki, K.; Kezuka, H.; Hirabayashi, M.

1985-01-01

The electronic structures of B1 MoN, fcc Mo 2 N, and hexagonal MoN were observed by photoelectron spectroscopic measurement. The B1-MoN phase has been predicted to be a high-T/sub c/ superconductor because of a large density of states at Fermi level. The observed electronic structure of the stoichiometric B1-MoN phase is different from that of the real B1-MoN type. The nitrogen excess B1-MoN/sub x/ (x> or =1.3) phase, however, shows the B1-type electronic structure. This is explained by the occurrence of a nitrogen vacancy in the apparent stoichiometric B1 phase and the occupation of the nitrogen vacancy in the nitrogen-excess B1 phase. This property is related to the previously reported low T/sub c/ of the B1-MoN crystals

In vitro reassortment between endemic H1N2 and 2009 H1N1 pandemic swine influenza viruses generates attenuated viruses.

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Ben M Hause

Full Text Available The pandemic H1N1 (pH1N1 influenza virus was first reported in humans in the spring of 2009 and soon thereafter was identified in numerous species, including swine. Reassortant viruses, presumably arising from the co-infection of pH1N1 and endemic swine influenza virus (SIV, were subsequently identified from diagnostic samples collected from swine. In this study, co-infection of swine testicle (ST cells with swine-derived endemic H1N2 (MN745 and pH1N1 (MN432 yielded two reassortant H1N2 viruses (R1 and R2, both possessing a matrix gene derived from pH1N1. In ST cells, the reassortant viruses had growth kinetics similar to the parental H1N2 virus and reached titers approximately 2 log(10 TCID(50/mL higher than the pH1N1 virus, while in A549 cells these viruses had similar growth kinetics. Intranasal challenge of pigs with H1N2, pH1N1, R1 or R2 found that all viruses were capable of infecting and transmitting between direct contact pigs as measured by real time reverse transcription PCR of nasal swabs. Lung samples were also PCR-positive for all challenge groups and influenza-associated microscopic lesions were detected by histology. Interestingly, infectious virus was detected in lung samples for pigs challenged with the parental H1N2 and pH1N1 at levels significantly higher than either reassortant virus despite similar levels of viral RNA. Results of our experiment suggested that the reassortant viruses generated through in vitro cell culture system were attenuated without gaining any selective growth advantage in pigs over the parental lineages. Thus, reassortant influenza viruses described in this study may provide a good system to study genetic basis of the attenuation and its mechanism.

Infinitely many N=1 dualities from m+1−m=1

Energy Technology Data Exchange (ETDEWEB)

Agarwal, Prarit; Intriligator, Kenneth; Song, Jaewon [Department of Physics, University of California,San Diego, La Jolla, CA 92093 (United States)

2015-10-06

We discuss two infinite classes of 4d supersymmetric theories, T{sub N}{sup (m)} and U{sub N}{sup (m)}, labelled by an arbitrary non-negative integer, m. The T{sub N}{sup (m)} theory arises from the 6d, A{sub N−1} type N=(2,0) theory reduced on a 3-punctured sphere, with normal bundle given by line bundles of degree (m+1,−m); the m=0 case is the N=2 supersymmetric T{sub N} theory. The novelty is the negative-degree line bundle. The U{sub N}{sup (m)} theories likewise arise from the 6d N=(2,0) theory on a 4-punctured sphere, and can be regarded as gluing together two (partially Higgsed) T{sub N}{sup (m)} theories. The T{sub N}{sup (m)} and U{sub N}{sup (m)} theories can be represented, in various duality frames, as quiver gauge theories, built from T{sub N} components via gauging and nilpotent Higgsing. We analyze the RG flow of the U{sub N}{sup (m)} theories, and find that, for all integer m>0, they end up at the same IR SCFT as SU(N) SQCD with 2N flavors and quartic superpotential. The U{sub N}{sup (m)} theories can thus be regarded as an infinite set of UV completions, dual to SQCD with N{sub f}=2N{sub c}. The U{sub N}{sup (m)} duals have different duality frame quiver representations, with 2m+1 gauge nodes.

La influenza A (H1N1: estado actual del conocimiento Influenza A (H1N1 virus: current information

Directory of Open Access Journals (Sweden)

Laura Margarita González Valdés

2010-03-01

Full Text Available Se revisó la bibliografía actualizada sobre el tema a partir de los principales buscadores, y reuniones internacionales realizadas sobre la pandemia de la influenza A (H1N1. Se tratan los aspectos relacionados con la historia, la aparición de la pandemia, la biología de la enfermedad, la epidemiología, el cuadro clínico, el tratamiento y el pronóstico y la prevención. La gripe A (H1N1 es una pandemia causada por una variante nueva del virus de la Influenza A que ha sufrido cambios antigénicos en la hemaglutinina y la neuraminidasa. Esto hace que la población sea altamente vulnerable a la infección y produce una sobrecarga temporal enorme a los servicios de salud. El virus se trasmite como otros virus Influenza. Su letalidad es similar a la de la influenza estacional, pero puede incrementarse en personas con factores de riesgo y en adultos jóvenes sanos. El asma y el embarazo parecen ser condiciones de base importantes para incrementar la severidad de la infección. Puede existir cierta protección por inmunidad cruzada con cepas que circularon en el pasado. El espectro clínico va desde personas asintomáticas hasta las formas graves que requieren internación en cuidados intensivos, con rápido deterioro hasta llegar a la insuficiencia respiratoria en un plazo de 24 horas. La vacunación durante la pandemia no parece ser suficientemente efectiva. Son necesarios antivirales (oseltamivir y zanamivir, y las medidas preventivas higiénico-sanitarias son muy eficaces.An updated review using the main search motors and international meetings already celebrated related to Influenza A H1N1 pandemics. Items related to the history, the appearance of the pandemics, the biology of the disease, its epidemiology, clinics, treatment, prognosis and prevention. Grippe A H1N1 is a pandemic caused by a new variant of the Influenza A virus that has suffered antigenic changes in haemaglutinin and neuraminidase. This turns populations more susceptible to

Comprehension and compliance with the discharge advice and quality of life at home among the postoperative neurosurgery patients discharged from PGIMER, Chandigarh, India

Science.gov (United States)

Kumar, Vishal; Singh, Amarjeet; Tewari, Manoj K.; Kaur, Sukhpal

2016-01-01

Problem Statement: Neurosurgical patients require special care not only in the hospital but also after their discharge from the hospital. Comprehension and compliance to the instructions given by the doctors/nurses at the time of discharge is important in home care of these patients. Many such patients suffer from various co-morbidities. Variable periods of convalescence affect health-related quality of life in these patients. Purpose of the Study: To determine the degree of compliance of neurosurgery patients and their family caregivers with the discharge advice given by the consultantsTo evaluate the quality of life of these patientsTo know the problems faced by these patients at home. Materials and Methods: This cross-sectional interview-based descriptive study was conducted in 2010 in Chandigarh. These patients were visited at their home. A scale was evolved to evaluate comprehension and compliance to the advice given at the time of discharge, according to the criteria developed by Clark et al. Lawton Brody instrumental activity of daily life and Spitzer quality of life index were used to assess patients' quality of life after the operation. Verbatim responses were recorded for the purpose of qualitative research. Results: Overall, 58 patients and their caregivers were interviewed at home. Mean age of the patients was 38.9 years. Out of 37 patients, 35 showed good comprehension and 33 patients had a good compliance with the instructions given for medication. The condition of 74.1% patients improved after the operation. Depression was reported in 31% of the patients. Many (36.2%) patients had to quit their job due to the disease. Almost half (47.4%) of the patients were independent in daily activities of their life while being evaluated on Barthel activity of daily life index. Conclusion and Recommendations: It is in the long term that the true complexity and impact of operations become apparent. After operation, such patients are likely to have a range of

Different neuraminidase inhibitor susceptibilities of human H1N1, H1N2, and H3N2 influenza A viruses isolated in Germany from 2001 to 2005/2006.

Science.gov (United States)

Bauer, Katja; Richter, Martina; Wutzler, Peter; Schmidtke, Michaela

2009-04-01

In the flu season 2005/2006 amantadine-resistant human influenza A viruses (FLUAV) of subtype H3N2 circulated in Germany. This raises questions on the neuraminidase inhibitor (NAI) susceptibility of FLUAV. To get an answer, chemiluminescence-based neuraminidase inhibition assays were performed with 51 H1N1, H1N2, and H3N2 FLUAV isolated in Germany from 2001 to 2005/2006. According to the mean IC(50) values (0.38-0.91 nM for oseltamivir and 0.76-1.13 nM for zanamivir) most H1N1 and H3N2 FLUAV were NAI-susceptible. But, about four times higher zanamivir concentrations were necessary to inhibit neuraminidase activity of H1N2 viruses. Two H1N1 isolates were less susceptible to both drugs in NA inhibition as well as virus yield reduction assays. Results from sequence analysis of viral hemagglutinin and neuraminidase genes and evolutionary analysis of N2 gene revealed (i) different subclades for N2 in H1N2 and H3N2 FLUAV that could explain the differences in zanamivir susceptibility among these viruses and (ii) specific amino acid substitutions in the neuraminidase segment of the two less NAI-susceptible H1N1 isolates. One H3N2 was isolate proved to be a mixture of a NA deletion mutant and full-length NA viruses.

Seroprevalence of H1N1, H3N2 and H1N2 influenza viruses in pigs in seven European countries in 2002-2003

NARCIS (Netherlands)

Reeth, K.; Brown, I.H.; Durrwald, R.; Foni, E.; Labarque, G.; Lenihan, P.; Maldonado, J.; Markowska-Daniel, I.; Pensaert, M.; Pospisil, Z.; Koch, G.

2008-01-01

Objectives Avian-like H1N1 and human-like H3N2 swine influenza viruses (SIV) have been considered widespread among pigs in Western Europe since the 1980s, and a novel H1N2 reassortant with a human-like H1 emerged in the mid 1990s. This study, which was part of the EC-funded 'European Surveillance

Research-retreat-recovery: A potential model for organization and completion of research projects. Experience from a neurosurgery department in a developing country.

Science.gov (United States)

Godil, Saniya Siraj; Kazim, Syed Faraz; Shamim, Muhammad Shahzad

2010-10-30

In the current era of biomedical research, it is imperative that every research study at an institution is properly organized, and frequently audited to streamline efforts and maintain standards. Recently, a research retreat was organized by the Section of Neurosurgery at Aga Khan University Hospital, Karachi, Pakistan, and following that a recovery team was made with the aim of recovering "lost in translation" research projects. In the realm of our experience, the current model is being proposed as a means for organization of departmental research. The "research" component of the model comprised compilation of an abstract book of all research work done within the section during the last five years. The "retreat" component of the model was intended with objectives of analysis of past research and generation of fresh ideas. The "recovery" component of the model was accomplished by formation of a research recovery team with the aim of recovering unfinished, and/or unpublished research projects. The abstract book comprised 103 abstracts: 52.4% original research studies, 12.6% review articles, and 34.9% case report/series. Only 8.7% abstracts were of basic science research whereas the remaining 91.3% were clinical research papers. Only 34% had been published in an article form in a biomedical research journal (51.4% in international journals and 48.6% in national journals); remaining papers were either in submission/preparation process or had been abandoned. As part of research recovery, 29.4% projects were recovered within 12 weeks of the retreat component. We conclude that the model of "research-retreat-recovery" is highly successful in the context of neurosurgery departments in developing countries without a proper research unit, and can result in better organization of departmental research, recovery of unfinished projects, and initiation of new research studies.

Synthesis of ketene N,N-acetals by copper-catalyzed double-amidation of 1,1-dibromo-1-alkenes.

Science.gov (United States)

Coste, Alexis; Couty, François; Evano, Gwilherm

2009-10-01

An efficient procedure for the preparation of ketene N,N-acetals by copper-catalyzed double amidation of 1,1-dibromo-1-alkenes is reported. The reaction was found to be general, and ketene aminals could be obtained in good yields when potassium phosphate in toluene was used at 80 degrees C. The reaction was found to proceed through a regioselective monocoupling reaction followed by dehydrobromination and hydroamidation.

H1N1, H3N2 et B à Abidjan, Côte d'Ivoire

African Journals Online (AJOL)

English Title: Comparative analysis of the epidemiological and clinical profiles of influenza infection due to 2009 pH1N1, H1N1, H3N2 and B viruses in Abidjan, Cote d'Ivoire. English Abstract. Influenza can have various epidemiological and clinical characteristics. This study compares the epidemio-clinical profiles of ...

High sensitivity cavity ring down spectroscopy of N_2O near 1.22 µm: (II) "1"4N_2"1"6O line intensity modeling and global fit of "1"4N_2"1"8O line positions

International Nuclear Information System (INIS)

Tashkun, S.A.; Perevalov, V.I.; Karlovets, E.V.; Kassi, S.; Campargue, A.

2016-01-01

In a recent work (Karlovets et al., 2016 [1]), we reported the measurement and rovibrational assignments of more than 3300 transitions belonging to 64 bands of five nitrous oxide isotopologues ("1"4N_2"1"6O, "1"4N"1"5N"1"6O, "1"5N"1"4N"1"6O, "1"4N_2"1"8O and "1"4N_2"1"7O) in the high sensitivity CRDS spectrum recorded in the 7915–8334 cm"−"1 spectral range. The assignments were performed by comparison with predictions of the effective Hamiltonian models developed for each isotopologue. In the present paper, the large amount of measurements from our previous work mentioned above and literature are gathered to refine the modeling of the nitrous oxide spectrum in two ways: (i) improvement of the intensity modeling for the principal isotopologue, "1"4N_2"1"6O, near 8000 cm"−"1 from a new fit of the relevant effective dipole moment parameters, (ii) global modeling of "1"4N_2"1"8O line positions from a new fit of the parameters of the global effective Hamiltonian using an exhaustive input dataset collected in the literature in the 12–8231 cm"−"1 region. The fitted set of 81 parameters allowed reproducing near 5800 measured line positions with an RMS deviation of 0.0016 cm"−"1. The dimensionless weighted standard deviation of the fit is 1.22. As an illustration of the improvement of the predictive capabilities of the obtained effective Hamiltonian, two new "1"4N_2"1"8O bands could be assigned in the CRDS spectrum in the 7915–8334 cm"−"1 spectral range. A line list at 296 K has been generated in the 0–10,700 cm"−"1 range for "1"4N_2"1"8O in natural abundance with a 10"−"3"0 cm/molecule intensity cutoff. - Highlights: • Line parameters of two new "1"4N_2"1"8O bands centered at 7966 cm"−"1 and at 8214 cm"−"1. • Refined sets of the "1"4N_2"1"6O effective dipole moment parameters for ΔP=13,14 series. • Global modeling of "1"4N_2"1"8O line positions and intensities in the 12–8231 cm"−"1 range. • 5800 observed of "1"4N_2"1"8O line positions

Internal (m=1, n=1) and (m=2, n=1) resistive modes in the toroidal Tokomak with circular cross sections

International Nuclear Information System (INIS)

Bussac, M.N.; Pellat, R.; Edery, D.; Soule, J.L.

1976-01-01

A linear analysis is presented of the toroidal coupling between the internal resistive modes (m=1, n=1) and (m=2, n=1) in the Tokomak with circular cross sections. One includes the resistive and diamagnetic effects in the singular layers where the safety factor q takes respectively the values one and two. By expanding the MHD equations in powers of epsilon, the local inverse of the aspect ratio, one obtains a system of two coupled equations for the harmonic amplitudes. When the shear is finite on q=1, the toroidal coupling is negligible. In the opposite limit, one can explain: the experimental behaviour of the (m=1, n=1) mode before the internal disruption; the simultaneous observation of the modes (m=1, n=1) and [de

Predicting H1N1 vaccine uptake and H1N1-related health beliefs: the role of individual difference in consideration of future consequences.

Science.gov (United States)

Nan, Xiaoli; Kim, Jarim

2014-01-01

This research examines the influence of individual difference in consideration of future consequences on H1N1 vaccine uptake and H1N1-related health beliefs (i.e., perceived susceptibility to and severity of the H1N1 flu, perceived efficacy and safety of the H1N1 vaccine, and perceived self-efficacy in obtaining the H1N1 vaccine). A survey of 411 college students showed that consideration of future consequences had no direct effect on vaccine uptake, but higher consideration of future consequences was associated with greater perceived severity of the flu, higher perceived effectiveness of the vaccine, and greater perceived self-efficacy. Additional analysis suggested that consideration of future consequences had a significant indirect effect on vaccine uptake through perceived vaccine efficacy. Results of the study also revealed gender and racial differences in some of the H1N1-related health beliefs. Implications of the findings for vaccine risk communication are discussed.

Investigation of the transient receptor potential vanilloid 1 (TRPV1) ion channel

OpenAIRE

Winter Zoltán

2013-01-01

The aims of this research were to determine sensory modalities that may be lost after the RTX treatment of newborn or adult mice, to dissect potential side-effect(s) of molecular neurosurgery, to gather information about the structure and function of the channel by investigating the effects of M2+ on the TRPV1 and by collecting the literature data on the functionally important point mutations of the channel for prospective in silico modeling. The findings of the research work can be summa...

Recording stereoscopic 3D neurosurgery with a head-mounted 3D camera system.

Science.gov (United States)

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

2015-06-01

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.

Neurosurgery certification in member societies of the World Federation of Neurosurgical Societies: Asia.

Science.gov (United States)

Gasco, Jaime; Braun, Jonathan D; McCutcheon, Ian E; Black, Peter M

2011-01-01

To objectively compare the complexity and diversity of the certification process in neurological surgery in member societies of the World Federation of Neurosurgical Societies. This study centers in continental Asia. We provide here an analysis based on the responses provided to a 13-item survey. The data received were analyzed, and three Regional Complexity Scores (RCS) were designed. To compare national board experience, eligibility requirements for access to the certification process, and the obligatory nature of the examinations, an RCS-Organizational score was created (20 points maximum). To analyze the complexity of the examination, an RCS-Components score was designed (20 points maximum). The sum of both is presented in a Global RCS score. Only those countries that responded to the survey and presented nationwide homogeneity in the conduction of neurosurgery examinations could be included within the scoring system. In addition, a descriptive summary of the certification process per responding society is also provided. On the basis of the data provided by our RCS system, the highest global RCS was achieved by South Korea and Malaysia (21/40 points) followed by the joint examination of Singapore and Hong-Kong (FRCS-Ed) (20/40 points), Japan (17/40 points), the Philippines (15/40 points), and Taiwan (13 points). The experience from these leading countries should be of value to all countries within Asia. Copyright © 2011 Elsevier Inc. All rights reserved.

Effect of priming with H1N1 influenza viruses of variable antigenic distances on challenge with 2009 pandemic H1N1 virus.

Science.gov (United States)

O'Donnell, Christopher D; Wright, Amber; Vogel, Leatrice N; Wei, Chih-Jen; Nabel, Gary J; Subbarao, Kanta

2012-08-01

Compared to seasonal influenza viruses, the 2009 pandemic H1N1 (pH1N1) virus caused greater morbidity and mortality in children and young adults. People over 60 years of age showed a higher prevalence of cross-reactive pH1N1 antibodies, suggesting that they were previously exposed to an influenza virus or vaccine that was antigenically related to the pH1N1 virus. To define the basis for this cross-reactivity, ferrets were infected with H1N1 viruses of variable antigenic distance that circulated during different decades from the 1930s (Alaska/35), 1940s (Fort Monmouth/47), 1950s (Fort Warren/50), and 1990s (New Caledonia/99) and challenged with 2009 pH1N1 virus 6 weeks later. Ferrets primed with the homologous CA/09 or New Jersey/76 (NJ/76) virus served as a positive control, while the negative control was an influenza B virus that should not cross-protect against influenza A virus infection. Significant protection against challenge virus replication in the respiratory tract was observed in ferrets primed with AK/35, FM/47, and NJ/76; FW/50-primed ferrets showed reduced protection, and NC/99-primed ferrets were not protected. The hemagglutinins (HAs) of AK/35, FM/47, and FW/50 differ in the presence of glycosylation sites. We found that the loss of protective efficacy observed with FW/50 was associated with the presence of a specific glycosylation site. Our results suggest that changes in the HA occurred between 1947 and 1950, such that prior infection could no longer protect against 2009 pH1N1 infection. This provides a mechanistic understanding of the nature of serological cross-protection observed in people over 60 years of age during the 2009 H1N1 pandemic.

On the formation of m = 1, n = 1 density snakes

Energy Technology Data Exchange (ETDEWEB)

Sugiyama, Linda E. [Laboratory for Nuclear Science, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139-4307 (United States)

2013-03-15

The m/n = 1/1 helical ion density 'snake' located near the q = 1 magnetic surface in a toroidal, magnetically confined plasma arises naturally in resistive MHD, when the plasma density evolves separately from pressure. Nonlinear numerical simulations show that a helical density perturbation applied around q = 1 can form a quasi-steady state over q Greater-Than-Or-Equivalent-To 1 with T(tilde sign) of opposite average sign to n. Two principal outcomes depend on the magnitude of n/n and the underlying stability of the 1/1 internal kink mode. For a small q<1 central region, a moderate helical density drives a new, slowly growing type of nonlinear 1/1 internal kink inside q<1, with small n and {nabla}p(tilde sign) Asymptotically-Equal-To {nabla}(nT(tilde sign)). The hot kink core moves away from, or perpendicular to, the high density region near q Asymptotically-Equal-To 1, preserving the snake density during a sawtooth crash. The mode resembles the early stage of heavy-impurity-ion snakes in ohmic discharges, including recent observations in Alcator C-Mod. For a larger, more unstable q<1 region, the helical density perturbation drives a conventional 1/1 kink where n aligns with T(tilde sign), leading to a rapid sawtooth crash. The crash redistributes the density to a localized helical concentration inside q Less-Than-Or-Equivalent-To 1, similar to experimentally observed snakes that are initiated by a sawtooth crash.

Identification of swine H1N2/pandemic H1N1 reassortant influenza virus in pigs, United States.

Science.gov (United States)

Ali, Ahmed; Khatri, Mahesh; Wang, Leyi; Saif, Yehia M; Lee, Chang-Won

2012-07-06

In October and November 2010, novel H1N2 reassortant influenza viruses were identified from pigs showing mild respiratory signs that included cough and depression. Sequence and phylogenetic analysis showed that the novel H1N2 reassortants possesses HA and NA genes derived from recent H1N2 swine isolates similar to those isolated from Midwest. Compared to the majority of reported reassortants, both viruses preserved human-like host restrictive and putative antigenic sites in their HA and NA genes. The four internal genes, PB2, PB1, PA, and NS were similar to the contemporary swine triple reassortant viruses' internal genes (TRIG). Interestingly, NP and M genes of the novel reassortants were derived from the 2009 pandemic H1N1. The NP and M proteins of the two isolates demonstrated one (E16G) and four (G34A, D53E, I109T, and V313I) amino acid changes in the M2 and NP proteins, respectively. Similar amino acid changes were also noticed upon incorporation of the 2009 pandemic H1N1 NP in other reassortant viruses reported in the U.S. Thus the role of those amino acids in relation to host adaptation need to be further investigated. The reassortments of pandemic H1N1 with swine influenza viruses and the potential of interspecies transmission of these reassortants from swine to other species including human indicate the importance of systematic surveillance of swine population to determine the origin, the prevalence of similar reassortants in the U.S. and their impact on both swine production and public health. Copyright © 2012 Elsevier B.V. All rights reserved.

Impacto de la vacunación frente a la gripe (H1N1)2009 en Navarra: comparación de diferentes escenarios

OpenAIRE

Jesús Castilla; Marcela Guevara; Manuel García Cenoz; Fátima Irisarri; Maite Arriazu; Aurelio Barricarte; Red de Médicos Centinela; Red de Vigilancia Epidemiológica y Microbiológica de Gripe de Navarra

2011-01-01

Fundamento: En 2009 se realizó una campaña de vacunación específica frente a la gripe (H1N1) 2009. El objetivo de este trabajo es evaluar su impacto en Navarra. Métodos: En la cohorte de población no institucionalizada de enfermos crónicos cubiertos por el Servicio Navarro de Salud (N=131.333), asumiendo una efectividad del 100! desde el octavo día tras la administración de la vacuna pandémica, estimamos su impacto en la prevención de casos y de hospitalizaciones por gripe (H1N1) 2009 entre l...

The Co-III-C bond in (1-thia-4,7-diazacyclodecyl-kappa N-3(4),N-7,C-10)(1,4,7-triazacyclononane-kappa N-3(1),N-4,N-7)-cobalt(III) dithionate hydrate

DEFF Research Database (Denmark)

Harris, Pernille; Kofod, P.; Song, Y.S.

2003-01-01

In the title compound, [Co(C6H15N3)(C7H15N2S)]S2O6.H2O, the Co-C bond distance is 1.9930 (13) Angstrom, which is shorter than for related compounds with the linear 1,6-diamino-3-thiahexan-4-ide anion in place of the macrocyclic 1-thia-4,7-diazacyclodecan-8-ide anion. The coordinated carbanion pro...... produces an elongation of 0.102 (7) Angstrom of the Co-N bond to the 1,4,7-triazacyclononane N atom in the trans position. This relatively small trans influence is presumably a result of the triamine ligand forming strong bonds to the Co-III atom....

Treatment and Prevention of Pandemic H1N1 Influenza.

Science.gov (United States)

Rewar, Suresh; Mirdha, Dashrath; Rewar, Prahlad

2015-01-01

Swine influenza is a respiratory infection common to pigs worldwide caused by type A influenza viruses, principally subtypes H1N1, H1N2, H2N1, H3N1, H3N2, and H2N3. Swine influenza viruses also can cause moderate to severe illness in humans and affect persons of all age groups. People in close contact with swine are at especially high risk. Until recently, epidemiological study of influenza was limited to resource-rich countries. The World Health Organization declared an H1N1 pandemic on June 11, 2009, after more than 70 countries reported 30,000 cases of H1N1 infection. In 2015, incidence of swine influenza increased substantially to reach a 5-year high. In India in 2015, 10,000 cases of swine influenza were reported with 774 deaths. The Centers for Disease Control and Prevention recommend real-time polymerase chain reaction as the method of choice for diagnosing H1N1. Antiviral drugs are the mainstay of clinical treatment of swine influenza and can make the illness milder and enable the patient to feel better faster. Antiviral drugs are most effective when they are started within the first 48 hours after the clinical signs begin, although they also may be used in severe or high-risk cases first seen after this time. The Centers for Disease Control and Prevention recommends use of oseltamivir (Tamiflu, Genentech) or zanamivir (Relenza, GlaxoSmithKline). Prevention of swine influenza has 3 components: prevention in swine, prevention of transmission to humans, and prevention of its spread among humans. Because of limited treatment options, high risk for secondary infection, and frequent need for intensive care of individuals with H1N1 pneumonia, environmental control, including vaccination of high-risk populations and public education are critical to control of swine influenza out breaks. Copyright © 2015 The Authors. Published by Elsevier Inc. All rights reserved.

Risk factors for surgical site infection following nonshunt pediatric neurosurgery: a review of 9296 procedures from a national database and comparison with a single-center experience

Science.gov (United States)

Sherrod, Brandon A.; Arynchyna, Anastasia A.; Johnston, James M.; Rozzelle, Curtis J.; Blount, Jeffrey P.; Oakes, W. Jerry; Rocque, Brandon G.

2017-01-01

Objective Surgical site infection (SSI) following CSF shunt operations has been well studied, yet risk factors for nonshunt pediatric neurosurgery are less well understood. The purpose of this study was to determine SSI rates and risk factors following nonshunt pediatric neurosurgery using a nationwide patient cohort and an institutional dataset specifically for better understanding SSI. Methods The authors reviewed the American College of Surgeons National Surgical Quality Improvement Program Pediatric (ACS NSQIP-P) database for the years 2012–2014, including all neurosurgical procedures performed on pediatric patients except CSF shunts and hematoma evacuations. SSI included deep (intracranial abscesses, meningitis, osteomyelitis, and ventriculitis) and superficial wound infections. The authors performed univariate analyses of SSI association with procedure, demographic, comorbidity, operative, and hospital variables, with subsequent multivariate logistic regression analysis to determine independent risk factors for SSI within 30 days of the index procedure. A similar analysis was performed using a detailed institutional infection database from Children’s Hospital of Alabama (COA). Results A total of 9296 nonshunt procedures were identified in NSQIP-P with an overall 30-day SSI rate of 2.7%. The 30-day SSI rate in the COA institutional database was similar (3.3% of 1103 procedures, p = 0.325). Postoperative time to SSI in NSQIP-P and COA was 14.6 ± 6.8 days and 14.8 ± 7.3 days, respectively (mean ± SD). Myelomeningocele (4.3% in NSQIP-P, 6.3% in COA), spine (3.5%, 4.9%), and epilepsy (3.4%, 3.1%) procedure categoriess had the highest SSI rates by procedure category in both NSQIP-P and COA. Independent SSI risk factors in NSQIP-P included postoperative pneumonia (OR 4.761, 95% CI 1.269–17.857, p = 0.021), immune disease/immunosuppressant use (OR 3.671, 95% CI 1.371–9.827, p = 0.010), cerebral palsy (OR 2.835, 95% CI 1.463–5.494, p = 0.002), emergency

Influenza A (H1N1) neuraminidase inhibitors from Vitis amurensis

DEFF Research Database (Denmark)

Nguyen, Ngoc Anh; Dao, Trong Tuan; Tung, Bui Thanh

2011-01-01

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...... of Vitis amurensis. This manuscript reports the isolation, structural elucidation, and anti-viral activities of eight compounds on various neuraminidases from influenza A/PR/8/34 (H1N1), novel swine-origin influenza A (H1N1), and oseltamivir-resistant novel H1N1 (H274Y) expressed in 293T cells...

‘Presenting CXR phenotype of H1N1’ flu compared with contemporaneous non-H1N1, community acquired pneumonia, during pandemic and post-pandemic outbreaks’

International Nuclear Information System (INIS)

Minns, F.C.; Nimhuineachain, A; Beek, E.J.R. van; Ritchie, G.; Hill, A.; Murchison, J.T.

2015-01-01

Highlights: • Patients with H1N1 pneumonia demonstrated more opacified zones on chest x-ray than patients with non-H1N1 pneumonias. • A particular ‘phenotype’ of chest x-ray changes was identified in H1N1 patients. • This H1N1 ‘phenotype’ was the same for the two evaluated ‘flu seasons, during both pandemic and post pandemic stages. - Abstract: Aims: To review, phenotype and assess potential prognostic value of initial chest X-ray findings in patients with H1N1 influenza during seasonal outbreaks of 2009 and 2010, in comparison with non-H1N1, community acquired pneumonia (CAP). Methods: We retrospectively identified 72 patients admitted to hospital with pneumonia during the seasons of 2009 and 2010. H1N1 cases were confirmed by virology PCR. Presenting chest X-rays were jointly read by 2 radiologists, who were ‘blinded’ to further patient details and divided into 6 zones. Total number of opacified zones, the pattern and distribution of changes and length of hospital stay were recorded. Results: Patients with H1N1 demonstrated more opacified zones (mean of 2.9 compared with 2.0; p = 0.006), which were bilateral in two-thirds compared with a quarter of those with non-H1N1 CAP (p = 0.001). H1N1 radiographs were more likely to be ‘patchy’ versus ‘confluent’ changes of non-H1N1 CAP (p = 0.03) and more often demonstrated peripheral distribution (p = 0.01). H1N1 patients tended to stay in hospital longer (not significant; p = 0.08). A positive correlation existed between number of affected zones and length of inpatient stay, which was statistically significant for the cohorts combined (p = 0.02). The findings were the same for the two evaluated seasons. Conclusion: H1N1 patients demonstrated more extensive disease, which was more likely bilateral, ‘patchy’, and peripheral in distribution. With increasing global cases of H1N1, knowledge of the typical findings of the H1N1 presenting chest X-ray may assist with early triage of patients

‘Presenting CXR phenotype of H1N1’ flu compared with contemporaneous non-H1N1, community acquired pneumonia, during pandemic and post-pandemic outbreaks’

Energy Technology Data Exchange (ETDEWEB)

Minns, F.C., E-mail: Fiona.Minns@nhslothian.scot.nhs.uk [Department of Radiology, New Royal Infirmary Edinburgh, 51 Little France Crescent, Edinburgh, EH16 4SA (United Kingdom); Nimhuineachain, A, E-mail: draideen@gmail.com [Department of Radiology, New Royal Infirmary Edinburgh, 51 Little France Crescent, Edinburgh, EH16 4SA (United Kingdom); Beek, E.J.R. van, E-mail: Edwin-vanbeek@ed.ac.uk [Clinical Research Imaging Centre, University of Edinburgh, 47 Little France Crescent, Edinburgh, Midlothian EH16 4TJ (United Kingdom); Ritchie, G., E-mail: drgillritchie@hotmail.com [Department of Radiology, New Royal Infirmary Edinburgh, 51 Little France Crescent, Edinburgh, EH16 4SA (United Kingdom); Hill, A., E-mail: adam.hill318@nhs.net [Department of Respiratory Medicine, New Royal Infirmary, Edinburgh (United Kingdom); Murchison, J.T., E-mail: john.murchison@nhslothian.scot.nhs.uk [Department of Radiology, New Royal Infirmary Edinburgh, 51 Little France Crescent, Edinburgh, EH16 4SA (United Kingdom)

2015-09-15

Highlights: • Patients with H1N1 pneumonia demonstrated more opacified zones on chest x-ray than patients with non-H1N1 pneumonias. • A particular ‘phenotype’ of chest x-ray changes was identified in H1N1 patients. • This H1N1 ‘phenotype’ was the same for the two evaluated ‘flu seasons, during both pandemic and post pandemic stages. - Abstract: Aims: To review, phenotype and assess potential prognostic value of initial chest X-ray findings in patients with H1N1 influenza during seasonal outbreaks of 2009 and 2010, in comparison with non-H1N1, community acquired pneumonia (CAP). Methods: We retrospectively identified 72 patients admitted to hospital with pneumonia during the seasons of 2009 and 2010. H1N1 cases were confirmed by virology PCR. Presenting chest X-rays were jointly read by 2 radiologists, who were ‘blinded’ to further patient details and divided into 6 zones. Total number of opacified zones, the pattern and distribution of changes and length of hospital stay were recorded. Results: Patients with H1N1 demonstrated more opacified zones (mean of 2.9 compared with 2.0; p = 0.006), which were bilateral in two-thirds compared with a quarter of those with non-H1N1 CAP (p = 0.001). H1N1 radiographs were more likely to be ‘patchy’ versus ‘confluent’ changes of non-H1N1 CAP (p = 0.03) and more often demonstrated peripheral distribution (p = 0.01). H1N1 patients tended to stay in hospital longer (not significant; p = 0.08). A positive correlation existed between number of affected zones and length of inpatient stay, which was statistically significant for the cohorts combined (p = 0.02). The findings were the same for the two evaluated seasons. Conclusion: H1N1 patients demonstrated more extensive disease, which was more likely bilateral, ‘patchy’, and peripheral in distribution. With increasing global cases of H1N1, knowledge of the typical findings of the H1N1 presenting chest X-ray may assist with early triage of patients

Characteristics of atopic children with pandemic H1N1 influenza viral infection: pandemic H1N1 influenza reveals 'occult' asthma of childhood.

Science.gov (United States)

Hasegawa, Shunji; Hirano, Reiji; Hashimoto, Kunio; Haneda, Yasuhiro; Shirabe, Komei; Ichiyama, Takashi

2011-02-01

The number of human cases of pandemic H1N1 influenza viral infection has increased in Japan since April 2009, as it has worldwide. This virus is widespread in the Yamaguchi prefecture in western Japan, where most infected children exhibited respiratory symptoms. Bronchial asthma is thought to be one of the risk factors that exacerbate respiratory symptoms of pandemic H1N1-infected patients, but the pathogenesis remains unclear. We retrospectively investigated the records of 33 children with pandemic H1N1 influenza viral infection who were admitted to our hospital between October and December 2009 and analyzed their clinical features. The percentage of children with asthma attack, with or without abnormal findings on chest radiographs (pneumonia, atelectasis, etc.), caused by pandemic H1N1 influenza infection was significantly higher than that of children with asthma attack and 2008-2009 seasonal influenza infection. Of the 33 children in our study, 22 (66.7%) experienced an asthma attack. Among these children, 20 (90.9%) did not receive long-term management for bronchial asthma, whereas 7 (31.8%) were not diagnosed with bronchial asthma and had experienced their first asthma attack. However, the severity of the attack did not correlate with the severity of the pulmonary complications of pandemic H1N1 influenza viral infection. The pandemic H1N1 influenza virus greatly increases the risk of lower respiratory tract complications such as asthma attack, pneumonia, and atelectasis, when compared to the seasonal influenza virus. Furthermore, our results suggest that pandemic H1N1 influenza viral infection can easily induce a severe asthma attack, pneumonia, and atelectasis in atopic children without any history of either an asthma attack or asthma treatment. © 2011 John Wiley & Sons A/S.

Case series and descriptive cohort studies in neurosurgery: the confusion and solution.

Science.gov (United States)

Esene, Ignatius N; Ngu, Julius; El Zoghby, Mohamed; Solaroglu, Ihsan; Sikod, Anna M; Kotb, Ali; Dechambenoit, Gilbert; El Husseiny, Hossam

2014-08-01

Case series (CS) are well-known designs in contemporary use in neurosurgery but are sometimes used in contexts that are incompatible with their true meaning as defined by epidemiologists. This inconsistent, inappropriate and incorrect use, and mislabeling impairs the appropriate indexing and sorting of evidence. Using PubMed, we systematically identified published articles that had "case series" in the "title" in 15 top-ranked neurosurgical journals from January 2008 to December 2012. The abstracts and/or full articles were scanned to identify those with descriptions of the principal method as being "case series" and then classified as "true case series" or "non-case series" by two independent investigators with 100 % inter-rater agreement. Sixty-four articles had the label "case series" in their "titles." Based on the definition of "case series" and our appraisal of the articles using Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines, 18 articles (28.13 %) were true case series, while 46 (71.87 %) were mislabeled. Thirty-five articles (54.69 %) mistook retrospective (descriptive) cohorts for CS. CS are descriptive with an outcome-based sampling, while "descriptive cohorts" have an exposure-based sampling of patients, followed over time to assess outcome(s). A comparison group is not a defining feature of a cohort study and distinguishes descriptive from analytic cohorts. A distinction between a case report, case series, and descriptive cohorts is absolutely necessary to enable the appropriate indexing, sorting, and application of evidence. Researchers need better training in methods and terminology, and editors and reviewers should scrutinize more carefully manuscripts claiming to be "case series" studies.

E/Z-Photoisomerization of N,N'-Bis(4-dimethylaminobenzylidene1,2-diaminoethane and N,N'-Bis(4-dimethylaminobenzylidene1,3-diaminopropane in Chloroform

Directory of Open Access Journals (Sweden)

Asghar Samimi

2011-01-01

Full Text Available The E/Z-Photoisomerization of Schiff bases N,N'-bis(4-dimethylamino benzylidene1,2-diaminoethane (BDAE and N,N'-bis(4-dimethylaminobenzyli-dene1,3-diaminopropane (BDAP were studied by UV-Vis absorption spectroscopy and theoretical chemistry calculations. Photochemical investigations in solution depict the time resolved spectral changes, recorded before and after irradiation. The shift indicates the transformation from E to Z configuration of the C=N bond in solution for BDAE and BDAP. Spectra profiles and kinetic constants were evaluated using multivariate curve resolution and non-linear least squares curve fitting by toolbox of MATLAB program using the corresponding absorption spectra-time data. The experimental results show that BDAP can perform the photochromism easier than BDAE, may be due to the molecular topology difference.

Mielitis transversa relacionada con vacunación anti-influenza A(H1N1

Directory of Open Access Journals (Sweden)

María Florencia Arcondo

2011-04-01

Full Text Available La mielitis transversa es una enfermedad inflamatoria que se caracteriza por disfunción de la médula espinal. Las causas reconocidas de mielitis transversa son autoinmunes, enfermedades desmielinizantes, post infecciosas y post vacunales, aunque hasta el 50% de los casos son idiopáticas. Las vacunas contra la rubéola, paperas, rabia y gripe estacional han sido asociadas a diversos trastornos neurológicos, como el Síndrome de Guillain Barré, la encefalomielitis diseminada aguda (ADEM y la mielitis transversa. Como mecanismo preventivo luego de la pandemia de 2009, en febrero del año 2010 se inició en nuestro país la campaña de vacunación contra la Influenza A (H1N1. Se presenta el caso de una paciente con hipoestesias que aparecieron cuatro días después de haber recibido la vacuna monovalente anti-influenza A (H1N1 y progresaron con evidente nivel sensitivo. La paciente cumplía criterios diagnósticos de mielitis transversa, según el Transverse Myelitis Consortium Working Group. Tuvo remisión de las imágenes de la resonancia magnética y estabilidad clínica sin tratamiento con corticoides. Se discuten aspectos diagnósticos, pronósticos y terapéuticos de esta entidad clínica.

SU(N,1) inflation

International Nuclear Information System (INIS)

Ellis, J.; Enqvist, K.; Nanopoulos, D.V.; Olive, K.A.; Srednicki, M.

1985-01-01

We present a simple model for primordial inflation in the context of SU(N, 1) no-scale n=1 supergravity. Because the model at zero temperature very closely resembles global supersymmetry, minima with negative cosmological constants do not exist, and it is easy to have a long inflationary epoch while keeping density perturbations of the right magnitude and satisfying other cosmological constraints. We pay specific attention to satisfying the thermal constraint for inflation, i.e. the existence of a high temperature minimum at the origin. (orig.)

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.

Science.gov (United States)

Thapa, Amit; Kc, Bidur; Shakya, Bikram

2016-11-01

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.

Intraoperative CT with integrated navigation system in spinal neurosurgery

International Nuclear Information System (INIS)

Zausinger, S.; Heigl, T.; Scheder, B.; Schnell, O.; Tonn, J.C.; Uhl, E.; Morhard, D.

2007-01-01

For spinal surgery navigational system images are usually acquired before surgery with patients positioned supine. The aim of this study was to evaluate prospectively navigated procedures in spinal surgery with data acquisition by intraoperative computed tomography (iCT). CT data of 38 patients [thoracolumbar instability (n = 24), C1/2 instability (n = 6), cervicothoracic stabilization (n = 7), disk herniation (n = 1)] were acquired after positioning the patient in prone position. A sliding gantry 24 detector row CT was used for image acquisition. Data were imported to the frameless infrared-based neuronavigation station. A postprocedural CT was obtained to assess the extent of decompression and the accuracy of instrumentation. Intraoperative registration revealed computed accuracy 2 mm in 9/158 screws (5.6%), allowing immediate correction in five screws without any damage to vessels or nerves. There were three transient complications with clinical improvement in all patients. Intraoperative CT in combination with neuronavigation provides high accuracy of screw placement and thus safety for patients undergoing spinal stabilization. The procedure is rapid and easy to perform and - by replacing pre- and postoperative imaging-is not associated with additional exposure to radiation. (orig.)

Isolation and genetic characterization of avian-like H1N1 and novel ressortant H1N2 influenza viruses from pigs in China.

Science.gov (United States)

Yu, Hai; Zhang, Peng-Chao; Zhou, Yan-Jun; Li, Guo-Xin; Pan, Jie; Yan, Li-Ping; Shi, Xiao-Xiao; Liu, Hui-Li; Tong, Guang-Zhi

2009-08-21

As pigs are susceptible to both human and avian influenza viruses, they have been proposed to be intermediate hosts or mixing vessels for the generation of pandemic influenza viruses through reassortment or adaptation to the mammalian host. In this study, we reported avian-like H1N1 and novel ressortant H1N2 influenza viruses from pigs in China. Homology and phylogenetic analyses showed that the H1N1 virus (A/swine/Zhejiang/1/07) was closely to avian-like H1N1 viruses and seemed to be derived from the European swine H1N1 viruses, which was for the first time reported in China; and the two H1N2 viruses (A/swine/Shanghai/1/07 and A/swine/Guangxi/13/06) were novel ressortant H1N2 influenza viruses containing genes from the classical swine (HA, NP, M and NS), human (NA and PB1) and avian (PB2 and PA) lineages, which indicted that the reassortment among human, avian, and swine influenza viruses had taken place in pigs in China and resulted in the generation of new viruses. The isolation of avian-like H1N1 influenza virus originated from the European swine H1N1 viruses, especially the emergence of two novel ressortant H1N2 influenza viruses provides further evidence that pigs serve as intermediate hosts or "mixing vessels", and swine influenza virus surveillance in China should be given a high priority.

Comparison of temporal and spatial dynamics of seasonal H3N2, pandemic H1N1 and highly pathogenic avian influenza H5N1 virus infections in ferrets.

Directory of Open Access Journals (Sweden)

Judith M A van den Brand

Full Text Available Humans may be infected by different influenza A viruses--seasonal, pandemic, and zoonotic--which differ in presentation from mild upper respiratory tract disease to severe and sometimes fatal pneumonia with extra-respiratory spread. Differences in spatial and temporal dynamics of these infections are poorly understood. Therefore, we inoculated ferrets with seasonal H3N2, pandemic H1N1 (pH1N1, and highly pathogenic avian H5N1 influenza virus and performed detailed virological and pathological analyses at time points from 0.5 to 14 days post inoculation (dpi, as well as describing clinical signs and hematological parameters. H3N2 infection was restricted to the nose and peaked at 1 dpi. pH1N1 infection also peaked at 1 dpi, but occurred at similar levels throughout the respiratory tract. H5N1 infection occurred predominantly in the alveoli, where it peaked for a longer period, from 1 to 3 dpi. The associated lesions followed the same spatial distribution as virus infection, but their severity peaked between 1 and 6 days later. Neutrophil and monocyte counts in peripheral blood correlated with inflammatory cell influx in the alveoli. Of the different parameters used to measure lower respiratory tract disease, relative lung weight and affected lung tissue allowed the best quantitative distinction between the virus groups. There was extra-respiratory spread to more tissues--including the central nervous system--for H5N1 infection than for pH1N1 infection, and to none for H3N2 infection. This study shows that seasonal, pandemic, and zoonotic influenza viruses differ strongly in the spatial and temporal dynamics of infection in the respiratory tract and extra-respiratory tissues of ferrets.

Hydrogen bonded networks in formamide [HCONH2]n (n = 1 – 10 ...

Indian Academy of Sciences (India)

gns

Table S1: Comparison of interaction energy (I.E) in kcal/mol in four arrangements of formamide n=1-10 at B3LYP/D95** level of theory. n = #monomers. Table S2: O---H bond length (in Å) for formamide clusters n = (2-10). Table S3: N-H bond stretching frequency (in cm-1) for four arrangements of formamide clusters n.

The critical $A_{n-1}^{(1)}$ chain

OpenAIRE

Kojima, T.; Yamasita, S.

2000-01-01

We study the $A_{n-1}^{(1)}$ spin chain at the critical regime $|q|=1$. We give the free boson realizations of the type-I vertex operators and their duals. Using these free boson realizations, we give the integral representations for the correlation functions.

Towards the development of a spring-based continuum robot for neurosurgery

Science.gov (United States)

Kim, Yeongjin; Cheng, Shing Shin; Desai, Jaydev P.

2015-03-01

Brain tumor is usually life threatening due to the uncontrolled growth of abnormal cells native to the brain or the spread of tumor cells from outside the central nervous system to the brain. The risks involved in carrying out surgery within such a complex organ can cause severe anxiety in cancer patients. However, neurosurgery, which remains one of the more effective ways of treating brain tumors focused in a confined volume, can have a tremendously increased success rate if the appropriate imaging modality is used for complete tumor removal. Magnetic resonance imaging (MRI) provides excellent soft-tissue contrast and is the imaging modality of choice for brain tumor imaging. MRI combined with continuum soft robotics has immense potential to be the revolutionary treatment technique in the field of brain cancer. It eliminates the concern of hand tremor and guarantees a more precise procedure. One of the prototypes of Minimally Invasive Neurosurgical Intracranial Robot (MINIR-II), which can be classified as a continuum soft robot, consists of a snake-like body made of three segments of rapid prototyped plastic springs. It provides improved dexterity with higher degrees of freedom and independent joint control. It is MRI-compatible, allowing surgeons to track and determine the real-time location of the robot relative to the brain tumor target. The robot was manufactured in a single piece using rapid prototyping technology at a low cost, allowing it to disposable after each use. MINIR-II has two DOFs at each segment with both joints controlled by two pairs of MRI-compatible SMA spring actuators. Preliminary motion tests have been carried out using vision-tracking method and the robot was able to move to different positions based on user commands.

Ageing behaviour of [(n-1)/n] active redundancy systems

International Nuclear Information System (INIS)

Eid, M.Y.

1995-01-01

Ageing of systems becomes a real concern if intelligent maintenance is required. Determining the ageing behaviour of a system necessitate having a powerful calculating tool and knowing the ageing behaviour of the basic components of the systems. Consequently, time dependent failure rates are required for basic components and need to be determined for systems. As, this is the general problem in reliability analysis, only (n-1)/n active redundancy system will be examined in the paper. Systems with (n-1)/n active redundancy are commonly used in a wide range of engineering fields. This should permit a priori improving the system reliability. Still, a deeper analysis of the ageing behaviour of such systems may reveal some particular aspects. (authors). 2 refs., 5 figs

[μ-N,N′-Bis(2-aminoethylethane-1,2-diamine-κ4N1,N1′:N2,N2′]bis{[N,N′-bis(2-aminoethylethane-1,2-diamine-κ4N,N′,N′′,N′′′]cadmium} tetrakis(perchlorate

Directory of Open Access Journals (Sweden)

Hamid Goudarziafshar

2012-09-01

Full Text Available The centrosymmetric dinuclear cadmium title complex, [Cd2(C6H18N43](ClO44, was obtained by the reaction of N,N′-bis(2-aminoethylethane-1,2-diamine (trien with Cd(NO32·4H2O and sodium perchlorate in methanol. The CdII cation is coordinated by four N atoms of a non-bridging trien ligand and by two N atoms of a bridging trien ligand in a slightly distorted octahedral coordination geometry. The bridging ligand shares another two N atoms with a neighboring symmetry-equivalent CdII cation. The structure displays C—H...O and N—H...O hydrogen bonding. The perchlorate anion is disordered over two sets of sites in a 0.854 (7: 0.146 (7 ratio.

Gap bowing in Inx Ga1-x N and Inx Al1-x N under pressure

DEFF Research Database (Denmark)

Gorczyca, I.; Suski, T.; Christensen, Niels Egede

2009-01-01

The electronic band structures of InxGa1-xN and InxAl1-xN alloys are calculated by ab-initio methods in a supercell geometry, and the effects of varying the composition and applying external pressure examined. Indium segregation is also simulated, and it is shown that it strongly influences the b...... the band gap and its pressure derivative. Both the band gaps and their pressure coefficients are considerably lower when In atoms are clustered, than when they are uniformly distributed.......The electronic band structures of InxGa1-xN and InxAl1-xN alloys are calculated by ab-initio methods in a supercell geometry, and the effects of varying the composition and applying external pressure examined. Indium segregation is also simulated, and it is shown that it strongly influences...

Stochastic quantization and 1/N expansion

International Nuclear Information System (INIS)

Brunelli, J.C.; Mendes, R.S.

1992-10-01

We study the 1/N expansion of field theories in the stochastic quantization method of Parisi and Wu using the supersymmetric functional approach. This formulation provides a systematic procedure to implement the 1/N expansion which resembles the ones used in the equilibrium. The 1/N perturbation theory for the non linear sigma model in two dimensions is worked out as an example. (author). 19 refs., 5 figs

Raman study of HgBa 2Ca n-1 Cu nO 2 n+2+ δ ( n=1,2,3,4 and 5) superconductors

Science.gov (United States)

Zhou, Xingjiang; Cardona, M.; Chu, C. W.; Lin, Q. M.; Loureiro, S. M.; Marezio, M.

1996-02-01

Polarized micro-Raman scattering measurements have been performed on the five members of the HgBa 2Ca n-1 Cu nO 2 n+2+ δ ( n=1,2,3,4 and 5) high- Tc superconductor family using different laser frequencies. Local laser annealing measurements were carried out to investigate the variation of the Raman spectra with the excess oxygen content, δ. A systematic evolution of the spectra, which display mainly peaks near 590, 570, 540 and 470 cm -1, with increasing number of CuO 2 layers has been observed; its origin has been shown to lie in the variation of the interstitial oxygen content. In addition to confirming that the 590 cm -1 mode represents vibration of apical oxygens in the absence of neighboring excess oxygen, the 570 cm -1 mode, which may be composed of some finer structures, has been assigned to the vibration of the apical oxygen modified by the presence of the neighboring excess oxygens. The 540 and 470 cm -1 modes may represent the direct vibration of excess oxygens. The implication of possible different distribution sites of excess oxygens is discussed. All other observed lower-frequency modes are also assigned.

[Deep brain recording and length of surgery in stereotactic and functional neurosurgery for movement disorders].

Science.gov (United States)

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

2014-01-01

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.

Bis[N,N-bis(1-allyl-1H-benzimidazol-2-ylmethyl-κN3benzylamine-κN]cadmium dipicrate

Directory of Open Access Journals (Sweden)

Jing-Kun Yuan

2011-06-01

Full Text Available The crystal structure of the title compound, [Cd(C29H29N52](C6H2N3O72, consists of CdII complex cations and picrate anions. In the complex cation, the CdII ion is chelated by two bis(1-allylbenzimidazol-2-ylmethylbenzylamine (babb ligands in a distorted octahedral geometry. Extensive C—H...O hydrogen bonding occurs between cations and anions in the crystal structure.

Use of neurosurgical decision-making and damage-control neurosurgery courses in the Iraq and Afghanistan conflicts: a surgeon's experience.

Science.gov (United States)

Teff, Richard J

2010-05-01

A shortage of Coalition neurological surgeons in the Iraq conflict prompted a creative approach to standardized neurosurgical care in 2007. After formulation of theater-wide clinical pathway guidelines, a need for standardized triage and neurological resuscitation was identified. The object was to establish a simple, reproducible course for medics, forward surgical and emergency room personnel, and other critical care providers to quickly standardize the ability of all deployed health care personnel to provide state-of-the-art neurosurgical triage and damage-control interventions. The methods applied were Microsoft PowerPoint presentations and hands-on learning. The year-long project resulted in more than 100 individuals being trained in neurosurgical decision making and in more than 15 surgeons being trained in damage-control neurosurgery. At the year's conclusion, hundreds of individuals received exceptional neurosurgical care from nonneurosurgical providers and a legacy course was left for future deployed providers to receive ongoing education at their own pace.

African Health Sciences - Vol 1, No 1 (2001)