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关键词： Skull base surgery   Suction spatula   Supine position   Vestibular schwannoma  

摘要： Background Resection of vestibular schwannomas with good functional outcome remains a neurosurgical challenge. In this study, we report on our initial experience with a suction spatula, which allows free bimanual dissection of small tumors in a clear, bloodless surgical field in supine *** Forty-one patients underwent vestibular schwannoma surgery in supine position, using a suction spatula. To analyze its feasibility, 11 aspects of the device were compared with the regular *** The suction spatula was successfully applied in all surgeries. Compared with a common spatula, the suction spatula showed superior performance during meatotomy, microsurgical and endoscopic tumor dissection, and management of bleedings. We noted no difference in ergonomics, compatibility, instrumental conflict, costs, reusability, and sterilization issues. Minor performance was related to its thickness/size. There were no significant disadvantages according to our data. There were no surgical complications related to this *** The main advantage of the suction spatula is in the treatment of small, mainly intrameatal vestibular schwannomas in supine patient position. It gives the surgeon a “third hand” while enabling a continuous bimanual dissection with 2 microinstruments without the use of a regular suction tip.

关键词： En-bloc   Fusion   Osteoblastoma   Resection   Spine   Technique   Tumor  

摘要： Background Osteoblastomas are a type of primary osseous neoplasm that exhibit a proclivity for the spine, primarily the posterior elements. While generally considered benign, some variants of osteoblastoma exhibit aggressive growth with lytic osseous destruction and soft tissue invasion, with some recurring after initial treatment. Given their proximity to vital structures and potential for rapid growth, these tumors are often managed with aggressive surgery, with en-bloc resection *** Here we describe our osteotomy technique for resecting en bloc a posterolateral thoracic osteoblastoma causing rapidly progressive myelopathy in a 17-year-old *** Successful treatment of osteoblastoma in a 17-year-old male demonstrates the efficacy of our laminopedicular osteotomy technique in treating 1 instance of a rapidly presenting spinal *** This case bolsters the growing body of literature that favors the outcomes of a more conservative approach to en-bloc resection of spinal tumors.

关键词： Broken intramedually nail   Removal of nail   AO broken implant set  

摘要： Objective: We describe a novel technique for removing broken intra-medullary femoral nails Methods: This technique involves the initial removal of the blade, screw at proximal femur, and proximal part of the broken nail. A hole is then drilled in the remnant nail and a cerclage wire passed into the hole. The distal interlocking screw is then removed, before removing the nail. Results: In these case studies, the nail was removed from the patients using the technique of drilling a hole into the remnant nail and passing a cerclage wire through for removal, without any complications. Conclusion: The method described is easy, replicable, and requires only a steel drill, cerclage wires, nail extraction hook and slotted hammer. (C) 2020 Elsevier Ltd. All rights reserved.

ISBN: (纸本)9787568921381

关键词： endoscopic spine surgery   minimally invasive surgery   spine  

摘要： Background Minimally invasive surgery is heavily dependent on indirect visualization and image guidance, often resulting in non-ergonomic postures. Minimally invasive surgeons are more likely to experience neck pain, shoulder pain, and fatigue compared to open surgeons. Spinal endoscopy is rapidly increasing in popularity among minimally invasive spine surgeons. A primary ergonomic issue is the position of the endoscope display, which is often not in line with the operative field or the surgeon's natural line of sight. Methods Smart glasses providing a head-up display are used in a case of percutaneous endoscopic lumbar discectomy to bring the surgeon's line of sight into parallel with the operative field. Results Bringing the surgeon's visual and motor axes into parallel resulted in a more comfortable and ergonomic operating position. Conclusions Head-up displays may provide an elegant and relatively simple solution to the issue of inadequate ergonomics in minimally invasive surgery.

关键词： 文化交流   英语   高等职业教育   教材  

ISBN: (纸本)9787566321459

摘要： 本书通过对英语国家较为典型的主流文化现象进行描述、阐释和讨论，培养学生对目的语文化的兴趣和理解力，进而使学生主动观察、分析、对比、评价文化及文化差异现象，较为客观、系统、全面地认识英语国家的文化，以有效拓宽学生的国际视野，提高学生的跨文化交际意识，培养学生的跨文化交际能力。本次修订更加注重以强调教学与实际应用相结合，突出实用与培养技能为原则。本书共分为八章，涵盖了跨文化交际各个方面的主要内容，并对其中一些重要问题有相对深入的介绍与讨论。

关键词： Complication   Extreme lateral interbody fusion   Lumbar plexus   Technical note  

摘要： Background This study modified the traditional extreme lateral lumbar interbody fusion (XLIF) surgery and was intended to reduce the approach related to lumbar plexus *** The patients receiving a new modified XLIF for treatment of lumbar degenerative diseases since September 2017 in our hospital were retrospectively collected. Postoperative additional symptoms of leg numbness, pain, or weakness were recorded as lumbar plexus nerve injury. Intraoperative electromyographic monitoring was recorded during surgery to evaluate the safety of the modified entry point. The visual analog scale and Oswestry Disability Index were adopted to evaluate the postoperative clinical efficacy. Modified MacNab criteria were introduced to evaluate the patients’ satisfaction 12 months after surgery. The preoperative and postoperative intervertebral height, foraminal height, and lumbar lordotic angle were measured. Repeated measurement variance analysis was used for comparison of clinical and imaging indexes in various periods. P < 0.05 indicated statistical *** Fifty-nine patients were finally included in the retrospective study. The intraoperative average blood loss and operation time were 70 mL (40-130 mL) and 77.90 ± 13.65 minutes. The average follow-up time was 18 months. Postoperative visual analog scale and Oswestry Disability Index were significantly decreased compared with those before the operation. The intervertebral height and foraminal height were dramatically higher than those before surgery. No lumbar plexus injury *** The initial result was optimistic in reducing lumbar plexus injury and obtaining good clinical efficacy. We need to further expand the sample size and carry out a comparative study to observe the advantages and disadvantages of modified XLIF.

关键词： milk yield   milking parlor   flow meter   calibration  

摘要： Milk yield is a fundamental observation in most dairy experiments and is commonly determined using integrated milk meters that measure milk weight as the cow is being milked. These meters are heavily used in a harsh environment and often are not regularly calibrated, so calibration errors and mechanical problems may create artificial variation in milk weight data. Additionally, direct calibration by collection of milk in a bucket is difficult and imperfect because the use of the bucket may affect yield recorded by the milk meter. The objective of this work was to define a method to easily check parlor meter precision and adjust milk weight values for variation between individual stalls in a parlor. Because most cows are milked in a different stall at each milking, it has been proposed that stall deviations that represent the fixed effect of stall on milk weight could be statistically determined. Individual milk weights from 14 milkings across 7 d from approximately 200 cows were collected from the Penn State dairy farm, which is equipped with a double-10 herringbone parlor with an Afimilk 2000 milking system (S.A.E. Afikim, Afikim, Israel). Milk yield was measured automatically by in-line flow through milk meters (Afi 200;S.A.E. Afikim). The effect of stall on milk weight was modeled using a mixed model that included the fixed effect of stall and the random effects of day, milking time, and cow. First, stall deviations were calculated as the stall least squares means (LSM) minus the average LSM to identify malfunctioning meters requiring service (e.g., deviation exceeding 1 kg). A correction factor for each stall was then generated by dividing the LSM of each stall by the average LSM. Milk yields were then corrected by multiplying the meter weight value by the correction factor. To determine the effect of the correction, raw and corrected meter values were compared with weight of milk collected in a bucket (n = 3/stall). The corrected values had a 5% greater coeffic

关键词： Percutaneous pedicle screws   Jamshidi needles   15 mm tube   Radiation exposure   Entrance site of facet joints  

摘要： Background: Percutaneous pedicle screws(PPS) have been used for decades. The difficult part of PPS placement is locating the proper entry sites on the facet joints for the Jamshidi needles. The correct positioning is usually ensured by fluoroscopy, which exposes surgeons and patients to extensive radiation exposure. Objective: To describe a novel retractor tube technique used in the placement of PPS, which enables visualization of the anatomy of the facet joints and enables accurate placement of the Jamshidi needles. Methods: A newly designed 15-mm-diameter retractor tube was applied during the placement of Jamshidi needles in 21 operations using PPS to treat thoracolumbar fracture. The anatomy of the entry site could be clearly visualized, and a Kirschner wire was inserted 2 mm into each of the ideal entry sites. When all the Kirschner wires were placed, the annular tubes of the Jamshidi needles were placed along the Kirschner wires into the pedicles. Fluoroscopy was used to confirm the positions of the Jamshidi needles. The rest of the procedure was conducted in the traditional PPS placement technique. Results: The entrance sites were successfully accessed through the retractor tube, with only one adjustment needed at most. Only one or two fluoroscopy images were taken during the placement of the Kirschner wires, and another image was taken after all the Jamshidi needles were placed. Fluoroscopy confirmed that the positioning of the PPS was good. Conclusion: A retractor tube accurately exposes the entry points on the facet joints in PPS placement, and is technically easy to use. (C) 2020 Elsevier Ltd. All rights reserved.

关键词： blood gas analyzer   electrolyte stability   glucose   lactate  

摘要： The objectives of this study were to describe the stability of bovine whole-blood electrolytes, glucose, and lactate in samples collected in lithium heparin tubes and stored in thermoconductive modules immersed in ice water. A total of 99 Jersey cows (40 first-parity, 18 second-parity, and 41 third-parity or greater cows) from a commercial dairy farm in West Texas were enrolled between June and July 2018. Blood was collected from the jugular vein using a 60-mL polypropylene syringe and equally distributed into 5 spray-dried evacuated lithium heparin tubes. Baseline samples were analyzed within 90 s of collection using a benchtop blood gas analyzer. The remaining 4 tubes were stored in a thermoconductive, passive-temperature-regulating module inside a cooler with ice water. At 30 min and 2, 4, and 8 h post-collection, samples were removed from the temperature-regulating module, gently inverted for 10 s, and analyzed. Repeated-measures models were built to evaluate the effect of time on the stability of ionized Ca (iCa), ionized Mg (iMg), Na, K, Cl, glucose, and lactate. Most of the analytes investigated remained stable up to 8 h under ice water storage conditions before analysis, including iCa, iMg, Cl, glucose, and lactate. However, Na and K were significantly affected by delayed analysis: Na remained stable up to 4 h post-collection, but K was not stable starting at 2 h post-collection. The results of this study are useful in helping future researchers and consultants to recognize acceptable time delays between whole blood collection and processing or analysis for electrolytes, glucose, and lactate.