scholarly journals A Novel Approach to Maintaining Normothermia in Major Spinal Deformity Surgery with an Esophageal Warming Device

2020 ◽  
pp. 1-3
Author(s):  
David L. McDonagh ◽  
Alexander T. Mazal ◽  
Carlos A. Bagley ◽  
David L. McDonagh ◽  
Matthew T. Davies ◽  
...  
Keyword(s):  
Spinal Deformity ◽  
Standard Care ◽  
Large Body ◽  
The Novel ◽  
Ambient Temperatures ◽  
Novel Approach ◽  
Spinal Deformity Surgery ◽  
Prospective Trials ◽  
Warming Devices ◽  
Warming Device

Maintenance of normothermia is a priority during major spinal deformity surgery. However, this is difficult due to the large body surface area exposed to ambient temperatures. We report the novel use of an esophageal warming device, added to standard care, to maintain normothermia in three patients. We conclude that esophageal warming is feasible in major spine surgery with no apparent complications. Safety and efficacy, as compared to standard warming devices, will need to be determined in future prospective trials.

Group-based Trajectory Modeling: A Novel Approach to Classifying Discriminative Functional Status Following Adult Spinal Deformity Surgery

Spine ◽  
2020 ◽  
Vol 45 (13) ◽  
pp. 903-910
Author(s):  
Jingyan Yang ◽  
Renaud Lafage ◽  
Jeffrey L. Gum ◽  
Christopher I. Shaffrey ◽  
Douglas Burton ◽  
...  
Keyword(s):  
Functional Status ◽  
Spinal Deformity ◽  
Adult Spinal Deformity ◽  
Trajectory Modeling ◽  
Novel Approach ◽  
Spinal Deformity Surgery

Exploring normative perceptions and misperceptions of private, environmentally impactful behaviours

2020 ◽  
Author(s):  
Elaine Gallagher ◽  
Bas Verplanken ◽  
Ian Walker
Keyword(s):  
Social Norms ◽  
Behaviour Change ◽  
Social Contexts ◽  
The Novel ◽  
Normative Influence ◽  
Change Mechanism ◽  
Novel Approach ◽  
Classical Studies ◽  
Referent Group

Social norms have been shown to be an effective behaviour change mechanism across diverse behaviours, demonstrated from classical studies to more recent behaviour change research. Much of this research has focused on environmentally impactful actions. Social norms are typically utilised for behaviour change in social contexts, which facilitates the important element of the behaviour being visible to the referent group. This ensures that behaviours can be learned through observation and that deviations from the acceptable behaviour can be easily sanctioned or approved by the referent group. There has been little focus on how effective social norms are in private or non-social contexts, despite a multitude of environmentally impactful behaviours occurring in the home, for example. The current study took the novel approach to explore if private behaviours are important in the context of normative influence, and if the lack of a referent groups results in inaccurate normative perceptions and misguided behaviours. Findings demonstrated variance in normative perceptions of private behaviours, and that these misperceptions may influence behaviour. These behaviours are deemed to be more environmentally harmful, and respondents are less comfortable with these behaviours being visible to others, than non-private behaviours. The research reveals the importance of focusing on private behaviours, which have been largely overlooked in the normative influence literature.

Characteristics of false-positive alerts on transcranial motor evoked potential monitoring during pediatric scoliosis and adult spinal deformity surgery: an “anesthetic fade” phenomenon

2020 ◽  
Vol 32 (3) ◽  
pp. 423-431 ◽  
Author(s):  
Hiroki Ushirozako ◽  
Go Yoshida ◽  
Tomohiko Hasegawa ◽  
Yu Yamato ◽  
Tatsuya Yasuda ◽  
...  
Keyword(s):  
Spinal Deformity ◽  
False Positive ◽  
Adult Spinal Deformity ◽  
False Positive Rate ◽  
Multivariate Logistic Regression Analysis ◽  
Motor Evoked Potential ◽  
Scoliosis Surgery ◽  
True Negative ◽  
Duration Of Surgery ◽  
Spinal Deformity Surgery

OBJECTIVETranscranial motor evoked potential (TcMEP) monitoring may be valuable for predicting postoperative neurological complications with a high sensitivity and specificity, but one of the most frequent problems is the high false-positive rate. The purpose of this study was to clarify the differences in the risk factors for false-positive TcMEP alerts seen when performing surgery in patients with pediatric scoliosis and adult spinal deformity and to identify a method to reduce the false-positive rate.METHODSThe authors retrospectively analyzed 393 patients (282 adult and 111 pediatric patients) who underwent TcMEP monitoring while under total intravenous anesthesia during spinal deformity surgery. They defined their cutoff (alert) point as a final TcMEP amplitude of ≤ 30% of the baseline amplitude. Patients with false-positive alerts were classified into one of two groups: a group with pediatric scoliosis and a group with adult spinal deformity.RESULTSThere were 14 cases of false-positive alerts (13%) during pediatric scoliosis surgery and 62 cases of false-positive alerts (22%) during adult spinal deformity surgery. Compared to the true-negative cases during adult spinal deformity surgery, the false-positive cases had a significantly longer duration of surgery and greater estimated blood loss (both p < 0.001). Compared to the true-negative cases during pediatric scoliosis surgery, the false-positive cases had received a significantly higher total fentanyl dose and a higher mean propofol dose (0.75 ± 0.32 mg vs 0.51 ± 0.18 mg [p = 0.014] and 5.6 ± 0.8 mg/kg/hr vs 5.0 ± 0.7 mg/kg/hr [p = 0.009], respectively). A multivariate logistic regression analysis revealed that the duration of surgery (1-hour difference: OR 1.701; 95% CI 1.364–2.120; p < 0.001) was independently associated with false-positive alerts during adult spinal deformity surgery. A multivariate logistic regression analysis revealed that the mean propofol dose (1-mg/kg/hr difference: OR 3.117; 95% CI 1.196–8.123; p = 0.020), the total fentanyl dose (0.05-mg difference; OR 1.270; 95% CI 1.078–1.497; p = 0.004), and the duration of surgery (1-hour difference: OR 2.685; 95% CI 1.131–6.377; p = 0.025) were independently associated with false-positive alerts during pediatric scoliosis surgery.CONCLUSIONSLonger duration of surgery and greater blood loss are more likely to result in false-positive alerts during adult spinal deformity surgery. In particular, anesthetic doses were associated with false-positive TcMEP alerts during pediatric scoliosis surgery. The authors believe that false-positive alerts during pediatric scoliosis surgery, in particular, are caused by “anesthetic fade.”

Seromas Following Pediatric Spinal Deformity Surgery

2020 ◽  
Vol 40 (4) ◽  
pp. e277-e282
Author(s):  
James Yu ◽  
Anne M. Dumaine ◽  
Connie Poe-Kochert ◽  
George H. Thompson ◽  
R. Justin Mistovich
Keyword(s):  
Spinal Deformity ◽  
Spinal Deformity Surgery

scholarly journals Parallel veno-venous and veno-arterial extracorporeal membrane circuits for coexisting refractory hypoxemia and cardiovascular failure: a case report

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jose R. Navas-Blanco ◽  
Sofia A. Lifgren ◽  
Roman Dudaryk ◽  
Jeffrey Scott ◽  
Matthias Loebe ◽  
...  
Keyword(s):  
Cardiogenic Shock ◽  
Body Surface ◽  
Large Body ◽  
Morbidly Obese ◽  
Cardiovascular Collapse ◽  
Cardiovascular Failure ◽  
Fluid Removal ◽  
Novel Approach ◽  
Refractory Hypoxemia ◽  
Oxygenation Status

Abstract Background The complexity of extracorporeal membrane oxygenation (ECMO) techniques continues to evolve. Different cannulation methods and configurations have been proposed as a response to a challenging cardiovascular and pulmonary physiology of the patients. The use of parallel ECMO circuits represents a unique and novel approach for patients with refractory respiratory failure and cardiovascular collapse with very large body surface areas. Case presentation We present the case of a 25-year-old morbidly obese male patient admitted for severe acute respiratory distress syndrome (ARDS) and refractory hypoxemia, requiring institution of double cannulation for veno-venous ECMO. Since his hypoxemia persisted, likely due to insufficient flows given his large body surface area, an additional drainage venous cannula was implemented to provide higher flows, temporarily addressing his oxygenation status. Unfortunately, the patient developed concomitant cardiogenic shock refractory to inotropic support and extracorporeal fluid removal, further worsening his oxygenation status, thus the decision was to institute four-cannulation/parallel-circuits veno-venous and veno-arterial ECMO, successfully controlling both refractory hypoxemia and cardiogenic shock. Conclusions Our case illustrates a novel and complex approach for combined severe ARDS and cardiovascular collapse through the use of parallel veno-venous and veno-arterial ECMO circuits, and exemplifies the expansion of ECMO techniques and its life-saving capabilities when conservative approaches are futile.

scholarly journals Incidence, Management and Outcome of Delayed Deep Surgical Site Infection Following Spinal Deformity Surgery: 20-Year Experience at a Single Institution

2020 ◽  
pp. 219256822097822
Author(s):  
Muyi Wang ◽  
Liang Xu ◽  
Bo Yang ◽  
Changzhi Du ◽  
Zezhang Zhu ◽  
...  
Keyword(s):  
Surgical Site Infection ◽  
Spinal Deformity ◽  
Recurrent Infection ◽  
Implant Removal ◽  
Site Infection ◽  
Initial Surgery ◽  
Spinal Deformity Surgery ◽  
Solid Fusion ◽  
Deep Surgical Site Infection

Study Design: A retrospective study. Objectives: To investigate the incidence, management and outcome of delayed deep surgical site infection (SSI) after the spinal deformity surgery. Methods: This study reviewed 5044 consecutive patients who underwent spinal deformity corrective surgery and had been followed over 2 years. Delayed deep SSI were defined as infection involving fascia and muscle and occurring >3 months after the initial procedure. An attempt to retain the implant were initially made for all patients. If the infection failed to be eradicated, the implant removal should be put off until solid fusion was confirmed, usually more than 2 years after the initial surgery. Radiographic data at latest follow-up were compared versus that before implant removal. Results: With an average follow-up of 5.3 years, 56 (1.1%) patients were diagnosed as delayed deep SSI. Seven (12.5%) patients successfully retained instrumentation and there were no signs of recurrence during follow-up (average 3.4 years). The remaining patients, because of persistent or recurrent infection, underwent implant removal 2 years or beyond after the primary surgery, and solid fusion was detected in any case. However, at a minimum 1-year follow-up (average 3.9 years), an average loss of 9° in the thoracic curve and 8° in the thoracolumbar/lumbar curves was still observed. Conclusions: Delayed deep SSI was rare after spinal deformity surgery. To eradicate infection, complete removal of implant may be required in the majority of delayed SSI. Surgeons must be aware of high likelihood of deformity progression after implant removal, despite radiographic solid fusion.

scholarly journals A Novel Approach to EEG Speech Activity Detection with Visual Stimuli and Mobile BCI

2021 ◽  
Vol 11 (2) ◽  
pp. 674
Author(s):  
Marianna Koctúrová ◽  
Jozef Juhár
Keyword(s):  
Visual Stimuli ◽  
Computer Interface ◽  
Single Subject ◽  
Detection Accuracy ◽  
The Novel ◽  
Activity Detection ◽  
Speech Activity ◽  
Novel Approach ◽  
Eeg Data ◽  
Speech Activity Detection

With the ever-progressing development in the field of computational and analytical science the last decade has seen a big improvement in the accuracy of electroencephalography (EEG) technology. Studies try to examine possibilities to use high dimensional EEG data as a source for Brain to Computer Interface. Applications of EEG Brain to computer interface vary from emotion recognition, simple computer/device control, speech recognition up to Intelligent Prosthesis. Our research presented in this paper was focused on the study of the problematic speech activity detection using EEG data. The novel approach used in this research involved the use visual stimuli, such as reading and colour naming, and signals of speech activity detectable by EEG technology. Our proposed solution is based on a shallow Feed-Forward Artificial Neural Network with only 100 hidden neurons. Standard features such as signal energy, standard deviation, RMS, skewness, kurtosis were calculated from the original signal from 16 EEG electrodes. The novel approach in the field of Brain to computer interface applications was utilised to calculated additional set of features from the minimum phase signal. Our experimental results demonstrated F1 score of 86.80% and 83.69% speech detection accuracy based on the analysis of EEG signal from single subject and cross-subject models respectively. The importance of these results lies in the novel utilisation of the mobile device to record the nerve signals which can serve as the stepping stone for the transfer of Brain to computer interface technology from technology from a controlled environment to the real-life conditions.

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