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摘要： The article describes the development of a digitised, contact-free iteration of the mock oral board examination for neurological surgery trainees and the assessment of its ability to deliver comparable utility to the programme from an education and training perspective. Topics include components of the American Board of Neurological Surgery (ABNS) licensing, educational goal of the digital examination, and benefits of such examination.

关键词： Full-endoscopic discectomy   Lumbar disc herniation   Minimally invasive surgery   Transforaminal  

摘要： OBJECTIVE: To report the technical notes and clinical outcome of percutaneous isthmus foraminoplasty and full-endoscopic lumbar discectomy (PIF-FELD) for the treatment of very highly upmigrated lumbar disc herniation (VHUM-LDH). PATIENTS AND METHODS: From January 2014 to December 2017, 16 patients with VHUM-LDH underwent PIF-FELD surgery. A 10-mm-diameter semi-open foraminoplasty was performed on the dorsal side of the upper intervertebral foramen with lateral isthmus resection by a safe trephine system, in which the facet joint was not injured. Full-endoscopic transforaminal fragmentectomy in the spinal canal and discectomy in the intervertebral space were performed simultaneously. Magnetic resonance imaging of the lumbar spine was reexamined on the second day and 3 months after the operation to evaluate the completeness of the disc fragmentectomy and nerve decompression. The patients were followed up on the visual analog scale (VAS) of lumbar pain and leg pain and Oswestry Disability Index on the second day, 3 months, 6 months, 1 year, and 2 years after operation. The MacNab score and nerve root function recovery were evaluated at 2 years postoperative follow-up. RESULTS: All operations were successfully completed without any change in the surgical method. During the operation, 5 patients were found to have a single sequestered fragment, and the remaining 11 patients had multiple sequestered fragments. There were no complications (e.g., dural tear and nerve injury) during the operation, and no complications (e.g., infection, cerebrospinal fluid leakage, exacerbation of nerve root function injury, and recurrence of intervertebral disc herniation) occurred. Postoperative reexamination of lumbar magnetic resonance imaging in all patients showed complete disc fragmentectomy and adequate nerve decompression. The postoperative low back pain VAS and leg pain VAS scores and Oswestry Disability Index on the second day, 3 months, 6 months, 1 year, and 2 years after operatio

关键词： urine ammonium   acidosis   acidogenic diet   hypocalcemia  

摘要： Urine ammonium concentration (left perpendicularNH(4)(+)right perpendicular) provides a clinically useful indicator of the magnitude of nutritionally induced systemic acidification in dairy cattle when urine pH < 6.1. The objective of this study was to evaluate the analytical performance of a low-cost point-of-care colorimetric test in measuring urine left perpendicularNH(4)(+)right perpendicular in dairy cattle consuming an acidogenic ration. A method comparison study was performed using 154 urine samples from 43 periparturient Holstein-Friesian cows. We compared urine left perpendicularNH(4)(+)right perpendicular measured by an indophenol blue colorimetric test (MColortest, Merck KGaA, Billerica, MA;test method) with levels measured by formaldehyde titration (reference method). Diagnostic performance was evaluated using Pearson correlation coefficient (r), Passing-Bablok regression, Bland-Altman plot, and binary logistic regression. Urine left perpendicularNH(4)(+)right perpendicular measured by the colorimetric test was strongly correlated (r = 0.98) with urine left perpendicularNH(4)(+)right perpendicular measured by formaldehyde titration. Method comparison studies indicated that the colorimetric test provided acceptable test performance when urine left perpendicularNH(4)(+)right perpendicular < 80 mmol/L. Logistic regression analysis indicated that the area under the receiver operating characteristic curve for the colorimetric ammonium test was high at 0.985 when used to identify formaldehyde titration left perpendicularNH(4)(+)right perpendicular > 10 mmol/L, equivalent to urine pH <6.1. At the optimal cut point (left perpendicularNH(4)(+)right perpendicular > 11 mmol/L) for the colorimetric test, sensitivity = 0.94, specificity = 0.97, positive likelihood ratio = 27.6, and kappa = 0.89, indicating excellent test performance. We conclude that the indophenol blue colorimetric test provided an accurate, low-cost, and practical on-farm test for measuring urine l

关键词： GammaPod   lattice radiotherapy   stereotactic radiotherapy  

摘要： Purpose Studies on Lattice radiotherapy (LRT) for breast cancer have been largely lacking. This study investigates the dosimetric feasibility of using Gamma Pod, a stereotactic radiotherapy apparatus originally designed for breast SBRT, to deliver LRT to large, bulky breast tumor as a noninvasive treatment option. Methods The GammaPod-based LRT was simulated using Geant4 Gate Monte Carlo software. The simulated GammaPod was equipped with 5 mm diameter non-coplanar circular beams that span 28 degrees latitudinally from 18 degrees to 43 degrees off the horizontal plane. Two degrees longitudinal intervals were used to simulate rotating sources. To simulate the treatments to different breast sizes, three water-equivalent hemisphere volumes with diameters of 10, 15, and 20 cm were analyzed. The lattice was planned by spacing focal points 2 cm apart in the transverse and sagittal planes and 2.5 cm in the coronal plane. This resulted in 22-172 shots for full breast treatment. The maximum dose for each individual shot was 20 Gy. The peak-to-valley dose differences and skin dose were analyzed. To verify the feasibility of delivering LRT, a test plan was created and delivered to a commercial diode array dose verification device using a clinical GammaPod system with 15 mm collimators. Results The dose profiles showed the average peak-to-valley dose percent differences of 94.10% in the 10 cm hemispherical volume, 88.95% in the 15 cm hemispherical volume, and 83.60% in the 20 cm hemispherical volume. Average skin dose was 1.27, 1.72, and 2.13 Gy for the 10, 15, and 20 cm irradiation volumes, respectively. The LRT plan delivered using a clinical GammaPod system with larger collimators verified the feasibility of LRT plan delivery. Conclusion GammaPod-based lattice radiotherapy is a viable treatment option and its application can be extended to treating large bulky breast tumors.

关键词： Neurofibromatosis   Sphenoid dysplasia   Exophthalmos   Skull base  

摘要： Introduction Sphenoid dysplasia is a distinctive marker of neurofibromatosis 1. It is a malformation of the sphenoid bone characterized by an enlargement of the superior orbital fissure, through which the intracranial content herniates, leading to a facial disfigurement and exophthalmos and to a potential visual deterioration. Surgical treatment has the aim of separating the intracranial from the intraorbital space. Methods and results We present a new technique for the repair of sphenoid dysplasia, based on the preoperative planning on a 3D print of the skull base. Conclusions The use of a 3D skull base model allows an effective surgical planning and a precise modelling of the titanium mesh, which is implanted to separate the intracranial from the intraorbital space.

关键词： Pelvic fracture   Sacroiliac joint   Anterior approach   Exposure   Stoppa   Pararectus  

摘要： Displaced pelvic fractures, combining an anterior lesion and sacroiliac disruption, most often require multiple surgical approaches. The technique we describe here allows these lesions to be treated by a single approach. It combines a Stoppa approach to address the anterior lesion and a pararectus approach to the sacroiliac joint through the same incision under the rectus abdominis muscle. This pararectus approach is done by passing laterally to the external and common iliac vessels. The entire anterior surface of the sacroiliac joint is exposed by the same passage through the abdominal wall. No neurological or vascular complications occurred in a 7-patient case series. Reduction was achieved in all cases. This approach is an interesting alternative to traditional approaches and enriches the surgeon's therapeutic arsenal for managing these complex fractures. (C) 2020 Elsevier Masson SAS. All rights reserved.

摘要： Purpose: In the present report, we have introduced a novel technique for concomitant Le Fort I surgery and dorsal preservation rhinoplasty and reviewed the reported data. Patients and Methods: Concurrent surgery could be considered a suitable option for patients requiring both upper jaw orthognathic surgery and rhinoplasty or those who are willing to undergo single-stage concomitant rhinoplasty and orthognathic surgery. In the present technical note, we have introduced a dorsal preservation rhinoplasty technique combined with Le Fort I surgery through an intraoral approach. The advantages of this technique include its conservative design, avoidance of a second surgery and anesthetic, the ability to correct possible nasal defects caused by the Le Fort I osteotomy, keeping the keystone area intact, and, most importantly, the possibility of concomitant surgery. However, recurrence of the hump and nasal pyramid lateralization are among the problems that could be associated with this technique. These disadvantages might necessitate revision surgery. Results: A total of 48 patients (23 females and 15 males) had undergone concomitant rhinoplasty and Le Fort I surgery using a modified dorsal preservation technique. No patient reported dissatisfaction with the results of surgery regarding the nasal and facial esthetics. No evidence of severe complications, such as saddle nose, severe deviation, airway compromise, or severe asymmetry, was observed postoperatively. Conclusions: Based on our experience with patients and after at least 1 year of follow-up, the results of the present study suggest that this technique is straightforward and produces excellent results. (C) 2020 American Association of Oral and Maxillofacial Surgeons

关键词： comparison of dose distributions   comparison of independent delineations   similarity index  

摘要： Purpose To describe a new similarity index and consider its biomedical applications. Methods Similarity index for a pair of objects is defined by the number of shared features and total number of features in these objects. Similarity measure for more than two objects is commonly defined by using pairwise similarity indices. In the current study we suggest a novel similarity index which depends on the number of features shared between multiple objects and does not have the limitations of the recently described similarity measures. In order to introduce the new index, we consider a concept of "commonality." For a collection of setsA1,A2 horizontal ellipsis ,AN, commonality of a given element equals the number of sets this element belongs to. The similarity index for the compared sets is then defined by a weighted sum of normalized commonalities. Results The considered biomedical applications of the proposed index include comparison of independent delineations of critical cranial structures in MR images and comparison of isodose distributions from different radiotherapy plans. Conclusions This study describes a novel similarity index which can be used to assess the similarity of multiple independent delineations of the anatomical structure or similarity of multiple dose distributions. Unlike the commonly used pairwise similarity indices, the new index is defined by the number of elements shared between multiple sets. Potential applications of the suggested similarity index for radiotherapy and medical imaging have been described.

关键词： Rhizotomy   Pudendal mapping   S1 root   Dorsal action potential   Intraoperative neurophysiology  

摘要： Background The standard level for lesioning in a functional posterior rhizotomy (FPR) ranges from L2 to S1/S2. Lesioning of the S1 and S2 rootlets strongly correlates with a reduction in ankle spasticity. In the Japanese population, the S2 root often shows the highest dorsal root action potentials (DAPs) in the afferent fibers of the pudendal nerve and is not lesioned to preserve postoperative urinary function. Thus, cutting of the S1 root plays a key role in reducing ankle spasticity in FPR. However, on rare occasions, even an S1 root may show high DAP in the afferent fibers of the pudendal nerve. Purpose The present, brief, technical note aimed to describe how an S1 root with a relatively high DAP in the afferent fibers of the pudendal nerve may be handed. Methods In the procedure, the S1 root is divided into several rootlets, and each rootlet is tested for the pudendal mapping. A train of electrical stimuli is delivered to each rootlet in the standard FPR. If electromyography (EMG) findings after electrical stimulation are highly abnormal while the pudendal mapping demonstrates no or a relatively low DAPs, the rootlet is cut. In contrast, even if the rootlet shows highly abnormal EMG findings, it is preserved if mapping demonstrates a relatively high DAP. Conclusion The S1 pudendal mapping is combined with EMG findings to achieve satisfactory reduction in ankle spasticity while preserving urological function.

关键词： Hemopatch (R)   CSF leak   Retrosigmoid approach   Spine surgery   Dural sealant  

摘要： A major complication in cranial and spinal surgery is the post-operative occurrence of a cerebrospinal fluid (CSF) leak. Here we reported a technical note firstly describing the use of Hemopatch (R) with fibrin glue as a dural sealant in cranial and spinal neurosurgical procedures. Moreover we carried out a review of the literature. Further to the best of our knowledge this was the first series including patients submitted to different spinal surgeries in whom Hemopatch (R) was used as dural sealant. We prospectively collected the data of 22 patients. In all procedures, fibrin glue was applied after Hemopatch (R) . The mean age was 59.68 +/- 10.79 years and the mean follow-up (FU) was 3.63 +/- 1.46 months, respectively. Overall, Hemopatch (R) with fibrin glue was used in 8 cranial procedures (36.36%;all were retrosigmoid craniotomies) and 14 spinal procedures (63.64%). 9/14 spinal cases (64.28%) were incidental durotomies during a spinal decompression procedure. No CSF leak, no postoperative infection, no adverse reaction were observed during the FU in all cases. The literature search revealed only two retrospective series, reporting only patients submitted to cranial surgery for a total of 56 patients and a CSF leak occurring in 3 patients (5.35%). In conclusion, we firstly reported the feasibility and the safety of using Hemopatch (R) with fibrin glue as dural sealant in cranial surgery and different spinal procedures. Further larger comparative studies are needed to confirm our initial encouraging results. (C) 2020 Elsevier Ltd. All rights reserved.