简介：目的将由解剖学习和临床的申请探索paraspinal途径的优点和指示。解剖数据和27个盒子的临床的实践被分析探索在paraspinal肌肉和周围的纸巾的结构之间的精确途径的方法，以及paraspinal的临床的申请的结果来临。操作时间，血损失，切口长度，X光线照相术的结果(Cobb角度，vertebrae的前面的边的高度)与在传统的途径对待的24种情况中的那些相比。结果完成方面的暴露能被识别在multifidus和longissimus肌肉之间的自然劈开飞机容易执行。自然肌肉发达的劈开是(1.47

简介：AbstractThe surgical approach to lesions of the ventral craniovertebral junction (CVJ) has evolved significantly in the last several years with the advent of endoscopic skull base surgery. Differing pathologies of the CVJ can result in irreducible compression of the cervicomedullary region. The endoscopic endonasal approach lends itself well to this region due to the ventral location, and while there is a steep learning curve, is a safe and effective way to perform decompression of the cervicomedullary region. Herein, we discuss the anatomy of the CVJ, preoperative evaluation and surgical considerations, our surgical approach, complications, and outcomes.

简介：Anovelapproachhasbeendevelopedtodeterminetheamountofresidualwaterinhumanerythrocyteatroomtemperaturebyelectronicparticlecounter.Naclsolutionsof13osmolalitieswerepreparedandtheequilibriumcellvolumesinwhichweremeasuredonebyone.Theisotonicvolume,Vo,wasobtainedundertheisotoniccondition.ThemeanRBCvolumesof5donorsateachosmolalitywerefittedaccordingtoBoylevan'tHoffrelationship,andtheosmoticallyinactivevolume,Vb,oferythrocytewasthendetermined.TheresultsshowthatVb＝50%Vo.Moreimportantly,thefinalcellvolumewithregardtothesolutionofthehighestconcentrationfoundtobekeptatabout0.5V0.Thedifferencebetweenthesetwovolumesisunconspicuous.Accordingtothepublisheddatathatnon-watervolumeofhumanerythrocyteisabout28.3%ofitsisotonicvolume,residualwaterofhumanerythrocytecanbegainedbysubtractingVdryfromVf,thatisVrw----21.7%VoThenitwasconcludedthattheresidualwaterofhumanlaysin2states,oneisboundwater,andtheotherisfreewater.

简介：Duodenalpolypsorlesionsareuncommonlyfoundonupperendoscopy.Duodenallesionscanbecategorizedassubepithelialormucosally-based,andthetypeoflesionoftendictatesthework-upandpossibletherapeuticoptions.Subepitheliallesionsthatcanariseintheduodenumincludelipomas,gastrointestinalstromaltumors,andcarcinoids.Endoscopicultrasonographywithfineneedleaspirationisusefulinthecharacterizationanddiagnosisofsubepitheliallesions.Duodenalgastrointestinalstromaltumorsandlargeormultifocalcarcinoidsarebestmanagedbysurgicalresection.Brunner＇sglandtumors,solitaryPeutz-Jegherspolyps,andnon-ampullaryandampullaryadenomasaremucosally-basedduodenallesions,whichcanrequireremovalandaretypicallyamenabletoendoscopicresection.Severalanatomiccharacteristicsoftheduodenummakeendoscopicresectionofduodenallesionschallenging.However,advancedendoscopictechniquesexistthatenabletheresectionoflargemucosally-basedduodenallesions.Endoscopicpapillectomyisnotwithoutrisk,butthisprocedurecaneffectivelyresectampullaryadenomasandallowspatientstoavoidsurgery,whichtypicallyinvolvespancreaticoduodenectomy.Endoscopicmucosalresectionanditsvariations（suchascap-assisted,cap-band-assisted,andunderwatertechniques）enablethesafeandeffectiveresectionofmostduodenaladenomas.Endoscopicsubmucosaldissectionispossiblebutverydifficulttosafelyperformintheduodenum.

简介：AbstractPurpose:The purpose of this study was to review the microsurgical anatomy and clipping of ruptured anterior communicating artery (AComA) aneurysms and to plan and avoid complications before operation.Methods:A total of 523 cases of cerebral aneurysms admitted to the neurosurgery department of the Third Affiliated Hospital of Sun Yat-Sen University from September 2010 to October 2018 were analyzed retrospectively. Among them, 85 patients had ruptured AComA aneurysms. This study was limited to 85 of these cases, whose satisfactory preoperative angiographic diagnostic films can be retrieved from the hospital database system because of the need for detailed review.Results:We performed supraorbital eyebrow keyhole approach (SOEK) craniotomy in 85 patients to clip 85 AComA aneurysms, in the setting of subarachnoid hemorrhage (SAH). Patients’ mean age was (52.69 ± 9.94) years (range, 28-78 years). The proportions of small, medium and large aneurysms were 83.5%, 15.3%, and 1.2%, respectively. The average size of the aneurysms was (5.07 ± 2.36) mm. There were 77.8% of patients with inferior aneurysms and 81.3% of patients with superior aneurysms achieved good results. There was a significant correlation between A1 dominance and operation method (p < 0.001). There was no significant relationship between surgical approach and aneurysm projection or A2 plane (p = 0.157 & p = 0.318).Conclusion:Regardless of whether the A2 plane is open or closed, the A1 dominant side is still a better choice for accessing AComA aneurysms to avoid dangerous premature bleeding.

简介：Earlydefibrillationiscriticaltosurvivalinanypatientwithacardiacarrest.ElectrophysiologistswhoimplantICDs(implantablecardioverterdefi-brillators)testthembyfibrillatingthepatientfollowedbyimmediatedefibrillation.Thisemphasizesthepointthatearlydefibrillationresultsinsurvivalofthesepatients;CPRisdoneonlyifthereisadelayinobtainingthedefibrillatororiftheICDisnotworking.

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简介：ObjectivesConventionalapproachesforremovaloflateralskullbasetumors,includingtransmandibular,infratemporalfossa,preauriculartranszygmaticsubtemporalapproaches,aremajorinvasiveproceduresthatoftensacrificehearingandcauseabnormalocclusionandcosmeticdefects.Reportsofthetranscervicalapproachforresectionofskullbasetumorsarerare,althoughitwasdescribedforresectionofclivalchordomasinasearlyas1966.Thepurposeofthisstudyistoreviewourexperiencesinmanagementoflateralskullbasetumorsusingthetranscervicalapproach.StudyDesignRetrospectivechartreview.MethodsSixlateralskullbasetumorcasestreatedwithtranscervicalapproachprocedureswerereviewed,includingthemedicalrecords.ResultsTherewere4malesand2females.Agerangedfrom12through52years.Histopathologicaldiagnosesincludedmalignantschwannoma(n=1),malignantcarotidbodytumor(n=1),heamangioma(n=1),schwannoma(n=2)andpleomorphicadenoma(n=1).Transcervicaltechniqueswereusedinallcaseswiththeuseofmicroscopeinthelateralskullbasearea.Completetumorremovalwasachievedinallcases.Postoperativeradiotherapywasimplementedin1caseofmalignantschwannomaand1caseofmalignantcarotidbodytumor.Jugularforamensyndromeoccurredasasurgicalcomplicationin1caseofmalignantSchwannomaofthevagusnerve.Therewasnotumorrecurrenceduringthe10-42monthfollow-upperiod.ConclusionComparedwithconventionalapproaches,thetranscervicalapproachprovidesaeasy,safe,minimalinvasiveandeffectiveprocedureforremovalofselectedlateralskullbasetumors.

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简介：从名古屋，东京和哈密尔顿的研究人员的一个队为学习neuroimmune相互作用，共焦的激光荧光显微镜学几年以前扫描开发了一种唯一的技术。它依靠由创造粘合剂环境用指导免疫者和神经房间相互作用一在里面vitrococulture盘子。与他们的技术，他们能学习神经房间怎么与有免疫力的房间(桅杆房间和T淋巴细胞)并且反过来也如此交流的机制的细节。他们证明那神经桅杆房间通讯能当一个中间人transducing房间不在时发生，经由NK-1受体操作并且neuropeptide物质P，是这通讯的一个可溶的因素。最近，另外，他们证明被免除激活的桅杆细胞的ATP调停了神经细胞的激活。进一步与他们的技术，名古屋的组能学习神经桅杆的分子的机制的细节房间相互作用。N-cadherin和CADM1(房间粘附分子1)看起来调停附件并且主要支持了在桅杆房间和神经之间的通讯。它将基于象神经原的发炎，肠的肠疾病，气喘，和自体免疫的混乱那样的neuroimmune相互作用为疾病导致新治疗学的形式。

简介：Cardiaccatheterizationandpercutaneouscoronaryinterventionplayanimportantroleinthemanagementofcoronaryarterydisease.Althoughthetransfemoralapproachhasbeenthetraditionallydominantmethod,therehasbeenanincreasedutilizationofthetransradialapproach.Multipleobservationalstudiesandrandomizedclinicaltrialshaveshownfewerbleedingcomplications,reducedmorbidityandmortality,improvedqualityoflife,andbettereconomicoutcomeswhenthetransradialapproachisutilizedwhencomparedtothetransfemoralapproach.Despiteitsmanybenefits,utilizationofthisapproachincertaincountriesincludingtheUnitedStateshasbeenlessthanoptimalduetoaloweradoptionratesmostlydrivenbylackoftrainingopportunitiesanddecreasedawarenessofclinicalbenefitsofthetransradialapproach.Inthisreview,thehistory,observationaltrends,efficacy,andtechnicalaspectsoftransradialcardiaccatheterizationandpercutaneouscoronaryinterventionarediscussed.

简介：Pulmonaryvesselsextractionisachallengingtaskinclinicalmedicine.Manypulmonarydiseasesareaccompaniedbythechangesofvesseldiameters.Thevesselsandtheirbranches,whichexhibitmuchvariability,aremostimportantinperformingdiagnosisandplanningthefollow-uptherapies.Inthispaper,weproposeanefficientapproachtopulmonaryvesselsextractionbasedonthecurveevolution.Thisapproachmodelsthevesselsasmonotonicallymarchingfrontunderthespeedfieldintegratingboththeregionandtheedgeinformationwhereanewregionspeedfunctionisdesignedandintegratedwiththeedgebasedspeedfunction.Duetotheregionbasedspeedterm,thefrontcouldevenpropagateinsmallnarrowvesselbranches.Tofurtherimprovethesegmentationresults,amulti-initialfastmarchingalgorithmisdevelopedtofastimplementthenumericalsolution,whichmayavoidthemonotonicallymarchingfrontleakingoutoftheweakboundarytooearlierandalsoreducethecomputationalcost.ThevalidityofourapproachisdemonstratedbyCTpulmonaryvesselsextraction.Experimentsshowthatthesegmentationresultsbyourapproach,especiallyonthenarrowthinvesselbranchesextraction,aremoreprecisethanthatoftheexistingmethod.

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简介：在这份报纸，我们使用了SVM方法检测P300信号。在为SVM训练一个分类参数前，几预处理操作包括过滤被用于数据，downsampling，单个试用抽取，windsorizing，电极选择等。与SVM算法，分类精确性能直到上面80%。在一些情况中，精确性能到达100%。在基于P300的大脑计算机接口(BCI)为P300EEG识别使用SVM是合适的系统。我们的进一步的工作将包括改进用更少试用产出更高的分类精确性。

简介：介绍进散开张肌图象(DTI)的Rician噪音能在追踪的张肌计算和纤维以后带严肃的影响。减少Rician噪音的效果，我们建议认为基于小浪的散开方法降噪多信道的打的散开加权(DW)图象。当保存质地和边时，介绍变光滑的策略，在小浪领域利用各向异性的非线性的散开，成功地移开噪音。为了评估份量上，在为介绍进DW图象，peak-to-peaksignal-to-noise比率(PSNR)和signal-to-mean的Rician噪音的财务的介绍方法的效率摆平错误比率(SMSE)度量标准被采用。基于合成、真实的数据，我们计算了明显的散开系数(模数转换器)并且追踪了纤维。我们做了在介绍模型，波浪收缩和调整非线性的散开变光滑方法之间的比较。所有实验结果证明份量上并且视觉上介绍过滤器的更好的表演。

简介：AbstractAdvances in imaging for preoperative localization have propelled the widespread adoption of minimally invasive/focused parathyroidectomy in primary hyperparathyroidism. Though it is performed through a relatively small incision, studies have shown that the presence of a neck scar increases attentional bias towards the neck resulting in compromised quality of life. Transoral endoscopic parathyroidectomy vestibular approach (TOEPVA) eliminates a neck scar. While indications for TOEPVA are the same as that of minimally invasive open parathyroidectomy, confident preoperative localization of the parathyroid with a surgeon performed ultrasound along with concordant localization with SPECT CT is an essential prerequisite before offering patients this approach for parathyroidectomy. Early data has demonstrated the feasibility and safety of this approach.

简介：AbstractCerebral small vessel disease (SVD) is a common global brain disease that causes cognitive impairment, ischemic or hemorrhagic stroke, problems with mobility, and neuropsychiatric symptoms. The brain damage, seen as focal white and deep grey matter lesions on brain magnetic resonance imaging (MRI) or computed tomography (CT), typically accumulates "covertly" and may reach an advanced state before being detected incidentally on brain scanning or causing symptoms. Patients have typically presented to different clinical services or been recruited into research focused on one clinical manifestation, perhaps explaining a lack of awareness, until recently, of the full range and complexity of SVD.In this review, we discuss the varied clinical presentations, established and emerging risk factors, relationship to SVD features on MRI or CT, and the current state of knowledge on the effectiveness of a wide range of pharmacological and lifestyle interventions. The core message is that effective assessment and clinical management of patients with SVD, as well as future advances in diagnosis, care, and treatment, will require a more "joined-up" ’ approach. This approach should integrate clinical expertise in stroke neurology, cognitive, and physical dysfunctions. It requires more clinical trials in order to improve pharmacological interventions, lifestyle and dietary modifications. A deeper understanding of the pathophysiology of SVD is required to steer the identification of novel interventions. An essential prerequisite to accelerating clinical trials is to improve the consistency, and standardization of clinical, cognitive and neuroimaging endpoints.

简介：摘要After severe COVID-19 disease, many patients will experience a variety of problems with normal functioning and will require rehabilitation services to overcome these problems. The principles of and evidence on rehabilitation will allow an effective response. These include a simple screening process; use of a multidisciplinary expert team; four evidence-based classes of intervention (exercise, practice, psychosocial support, and education particularly about self-management); and a range of tailored interventions for other problems. The large number of COVID-19 patients needing rehabilitation coupled with the backlog remaining from the crisis will challenge existing services. The principles underpinning vital service reconfigurations needed are discussed.

简介：AIMTounderstandtheinfluenceoffrailtyonpostoperativeoutcomesforlaparoscopicandopencolectomy.METHODSDatawereobtainedfromtheNationalSurgicalQualityImprovementProgram(2005-2012)forpatientsundergoingcolonresection[opencolectomy(OC)andlaparoscopiccolectomy(LC)].Patientswereclassifiedasnon-frail(0points),lowfrailty(1point),moderatefrailty(2points),andseverefrailty(≥3)usingtheModifiedFrailtyIndex.30-dmortalityandcomplicationswereusedastheprimaryendpointandanalyzedfortheoverallpopulation.Complicationsweregroupedintomajorandminor.Subsetanalysiswasperformedforpatientsundergoingcolectomy(totalcolectomy,partialcolectomyandsigmoidcolectomy)andseparatelyforpatientsundergoingrectalsurgery(abdominoperinealresection,lowanteriorresection,andproctocolectomy).WeanalyzedthedatausingSASPlatformJMPProversion10.0.0(SASInstituteInc.,Cary,NC,UnitedStates).RESULTSAtotalof94811patientswereidentified;themajorityunderwentOC(58.7%),werewhite(76.9%),andnon-frail(44.8%).Themedianagewas61.3years.Prolongedlengthofstay(LOS)occurredin4.7%,and30-dmortalitywas2.28%.PatientsundergoingOCwereolder(61.89±15.31vs60.55±14.93)andhadahigherASAscore(48.3%ASA3vs57.7%ASA2intheLCgroup)(P<0.0001).Mostpatientswerenon-frail(42.5%OCvs48%LC,P<0.0001).Complications,prolongedLOS,andmortalityweresignificantlymorecommoninpatientsundergoingOC(P<0.0001).OChadahigherriskofdeathandcomplicationscomparedtoLCforallfrailtyscores(non-frail:OR=4.7,andOR=4.67;mildlyfrail:OR=2.51,andOR=2.47;moderatelyfrail:OR=2.94,andOR=2.02,severelyfrail:OR=2.37,andOR=2.34,P<0.05)andanincreaseinabsolutemortalitywithincreasingfrailty(non-frail0.68%OC,mildlyfrail1.39%,moderatelyfrail3.44%,andseverelyfrail5.83%,P<0.0001).CONCLUSIONLCisassociatedwithimprovedoutcomes.Althoughtheoddsofmortalityarehigherin

简介：AbstractBackground:Piriformis syndrome accounts for approximately 6% of patients who present with sciatic pain. There are many treatment options ranging from physical therapy, to trigger point injections, to surgical intervention. We discuss a surgical method that represents a minimally invasive technique for the treatment of piriformis syndrome.Methods:We describe a novel operative approach and technique for release of the piriformis muscle in the treatment of piriformis syndrome. Described are the preoperative planning, incision and approach, and technique for identifying and releasing the piriformis muscle.Results:Three patients were treated for piriformis syndrome using the described technique. Each patient displayed successful relief of their symptoms immediately following the surgical procedure and at delayed follow-up.Conclusion:Early experience with our method of piriformis release suggests that it is well suited for the treatment of piriformis syndrome. The novel integration of pre-operative trigger point localization coupled with intraoperative neuromonitoring allows effective pain relief with minimal morbidity.