Minimally Invasive
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PLoS ONE ◽  
2021 ◽  
Vol 16 (12) ◽  
pp. e0260984
Maria Paola Tramonti Fantozzi ◽  
Ugo Faraguna ◽  
Adrien Ugon ◽  
Gastone Ciuti ◽  
Andrea Pinna

The Cyclic Alternating Pattern (CAP) is composed of cycles of two different electroencephalographic features: an activation A-phase followed by a B-phase representing the background activity. CAP is considered a physiological marker of sleep instability. Despite its informative nature, the clinical applications remain limited as CAP analysis is a time-consuming activity. In order to overcome this limit, several automatic detection methods were recently developed. In this paper, two new dimensions were investigated in the attempt to optimize novel, efficient and automatic detection algorithms: 1) many electroencephalographic leads were compared to identify the best local performance, and 2) the global contribution of the concurrent detection across several derivations to CAP identification. The developed algorithms were tested on 41 polysomnographic recordings from normal (n = 8) and pathological (n = 33) subjects. In comparison with the visual CAP analysis as the gold standard, the performance of each algorithm was evaluated. Locally, the detection on the F4-C4 derivation showed the best performance in comparison with all other leads, providing practical suggestions of electrode montage when a lean and minimally invasive approach is preferable. A further improvement in the detection was achieved by a multi-trace method, the Global Analysis—Common Events, to be applied when several recording derivations are available. Moreover, CAP time and CAP rate obtained with these algorithms positively correlated with the ones identified by the scorer. These preliminary findings support efficient automated ways for the evaluation of the sleep instability, generalizable to both normal and pathological subjects affected by different sleep disorders.

2021 ◽  
Vol 2021 ◽  
pp. 1-5
Pingxia Zheng ◽  
Jia Wang ◽  
Yan Ma ◽  
Jingjing Xu ◽  
Qianping Zhu

Hypertensive intracerebral hemorrhage is a common condition in clinic. Due to the improvement of minimally invasive technology, its therapeutic effect is good, but there are still postoperative complications. The corresponding routine nursing intervention is not effective in the rehabilitation of postoperative patients with hypertensive intracerebral hemorrhage. In this paper, cluster nursing was applied to the treatment of postoperative patients with hypertensive intracerebral hemorrhage. For this purpose, a retrospective study or experiment was conducted on 150 patients with hypertensive intracerebral hemorrhage in the hospital specifically from January 2019 to December 2020. According to the nursing strategy, patients were divided into experimental (n = 75) and control groups (n = 75), respectively. The control group adopted routine nursing mode, whereas the experimental group adopted cluster nursing mode. The treatment compliance of patients in the experimental group was 86.67%, while that in the control group was 73.33% ( P  < 0.05). The total incidence of postoperative complications in the experimental group was 3.2%, which was lower than 25% in the control group ( P  < 0.05). The motor function score of the experimental group was better than that of the control group ( P  < 0.05). The application of cluster nursing in postoperative patients with hypertensive intracerebral hemorrhage is feasible, and its nursing effect is significant, which can not only reduce the incidence of postoperative complications but also improve patients’ compliance and quality of life. It has good application value.

2021 ◽  
Jianyu Lai ◽  
Jennifer Rebecca German ◽  
Filbert H. Hong ◽  
S.-H. Sheldon Tai ◽  
Kathleen M. McPhaul ◽  

Background: Saliva is an attractive sample for detecting SARS-CoV-2 because it is easy to collect and minimally invasive. However, contradictory reports exist concerning the sensitivity of saliva versus nasal swabs. Methods: We recruited and followed close contacts of COVID-19 cases for up to 14 days from their last exposure and collected self-reported symptoms, mid-turbinate swabs (MTS) and saliva every two or three days. Ct values and frequency of viral detection by MTS and saliva were compared. Logistic regression was used to estimate the probability of detection by days since symptom onset for the two sample types. Results: We enrolled 58 contacts who provided a total of 200 saliva and MTS sample pairs; 14 contacts (13 with symptoms) had one or more positive samples. Overall, saliva and MTS had similar rates of viral detection (p=0.78). Although Ct values for saliva were significantly greater than for MTS (p=0.014), Cohen′s Kappa demonstrated substantial agreement (κ=0.83). However, sensitivity varied significantly with time relative to symptom onset. Early in the course of infection (days -3 to 2), saliva had 12 times (95%CI: 1.2, 130) greater likelihood of detecting viral RNA compared to MTS. After day 2, there was a non-significant trend to greater sensitivity using MTS samples. Conclusion: Saliva and MTS specimens demonstrated high agreement, making saliva a suitable alternative to MTS nasal swabs for COVID-19 detection. Furthermore, saliva was more sensitive than MTS early in the course of infection, suggesting that it may be a superior and cost-effective screening tool for COVID-19.

2021 ◽  
Vol 8 ◽  
Wenshuai Fan ◽  
Tianyao Zhou ◽  
Jinghuan Li ◽  
Yunfan Sun ◽  
Yutong Gu

Objective: To compare freehand minimally invasive pedicle screw fixation (freehand MIPS) combined with percutaneous vertebroplasty (PVP), minimally invasive decompression, and partial tumor resection with open surgery for treatment of thoracic or lumbar vertebral metastasis of hepatocellular carcinoma (HCC) with symptoms of neurologic compression, and evaluate its feasibility, efficacy, and safety.Methods: Forty-seven patients with 1-level HCC metastatic thoracolumbar tumor and neurologic symptoms were included between February 2015 and April 2017. Among them, 21 patients underwent freehand MIPS combined with PVP, minimally invasive decompression, and partial tumor resection (group 1), while 26 patients were treated with open surgery (group 2). Duration of operation, blood loss, times of fluoroscopy, incision length, and stay in hospital were compared between the two groups. Pre- and postoperative visual analog scale (VAS) pain score, Oswestry Disability Index (ODI), American Spinal Injury Association (ASIA) grade, ambulatory status, and urinary continence were also recorded. The Cobb angle and central and anterior vertebral body height were measured on lateral radiographs before surgery and during follow-ups.Results: Patients in group 1 showed significantly less blood loss (195.5 ± 169.1 ml vs. 873.1 ± 317.9 ml, P = 0.000), shorter incision length (3.4 ± 0.3 vs. 13.6 ± 1.8 cm, P = 0.000), shorter median stay in hospital (4–8/6 vs. 8–17/12 days, P = 0.000), more median times of fluoroscopy (5–11/6 vs. 4–7/5 times, P = 0.000), and longer duration of operation (204.8 ± 12.1 vs. 171.0 ± 12.0 min, P = 0.000) than group 2. Though VAS significantly decreased after surgery in both groups, VAS of group 1 was significantly lower than that of group 2 immediately after surgery and during follow-ups (P &lt; 0.05). Similar results were found in ODI. No differences in the neurological improvement and spinal stability were observed between the two groups.Conclusion: Freehand MIPS combined with PVP, minimally invasive decompression, and partial tumor resection is a safe, effective, and minimally invasive method for treating thoracolumbar metastatic tumors of HCC, with less blood loss, better pain relief, and shorter length of midline incision and stay in hospital.

2021 ◽  
Vol 51 (6) ◽  
pp. E3
Gaetano De Biase ◽  
Shaun E. Gruenbaum ◽  
James L. West ◽  
Selby Chen ◽  
Elird Bojaxhi ◽  

OBJECTIVE There has been increasing interest in the use of spinal anesthesia (SA) for spine surgery, especially within Enhanced Recovery After Surgery (ERAS) protocols. Despite the wide adoption of SA by the orthopedic practices, it has not gained wide acceptance in lumbar spine surgery. Studies investigating SA versus general anesthesia (GA) in lumbar laminectomy and discectomy have found that SA reduces perioperative costs and leads to a reduction in analgesic use, as well as to shorter anesthesia and surgery time. The aim of this retrospective, case-control study was to compare the perioperative outcomes of patients who underwent minimally invasive surgery (MIS)–transforaminal lumbar interbody fusion (TLIF) after administration of SA with those who underwent MIS-TLIF under GA. METHODS Overall, 40 consecutive patients who underwent MIS-TLIF by a single surgeon were analyzed; 20 patients received SA and 20 patients received GA. Procedure time, intraoperative adverse events, postoperative adverse events, postoperative length of stay, 3-hour postanesthesia care unit (PACU) numeric rating scale (NRS) pain score, opioid medication, and time to first ambulation were collected for each patient. RESULTS The two groups were homogeneous for clinical characteristics. A decrease in total operating room (OR) time was found for patients who underwent MIS-TLIF after administration of SA, with a mean OR time of 156.5 ± 18.9 minutes versus 213.6 ± 47.4 minutes for patients who underwent MIS-TLIF under GA (p < 0.0001), a reduction of 27%. A decrease in total procedure time was also observed for SA versus GA (122 ± 16.7 minutes vs 175.2 ± 10 minutes; p < 0.0001). No significant differences were found in intraoperative and postoperative adverse events. There was a difference in the mean maximum NRS pain score during the first 3 hours in the PACU as patients who received SA reported a lower pain score compared with those who received GA (4.8 ± 3.5 vs 7.3 ± 2.7; p = 0.018). No significant difference was observed in morphine equivalents received by the two groups. A difference was also observed in the mean overall NRS pain score, with 2.4 ± 2.1 for the SA group versus 4.9 ± 2.3 for the GA group (p = 0.001). Patients who received SA had a shorter time to first ambulation compared with those who received GA (385.8 ± 353.8 minutes vs 855.9 ± 337.4 minutes; p < 0.0001). CONCLUSIONS The results of this study have pointed to some important observations in this patient population. SA offers unique advantages in comparison with GA for performing MIS-TLIF, including reduced OR time and postoperative pain, and faster postoperative mobilization.

Merlin Behling ◽  
Felix Wezel ◽  
Peter P Pott

Detection of metastasis spread at an early stage of disease in lymph nodes can be achieved by imaging techniques, such as PET and fluoride-marked tumor cells. Intraoperative detection of small metastasis can be problematic especially in minimally invasive surgical settings. A γ-radiation sensor can be inserted in the situs to facilitate intraoperative localization of the lymph nodes. In the minimally invasive setting, the sensor must fit through the trocar and for robot-aided interventions, a small, capsule-like device is favorable. Size reduction could be achieved by using only a few simple electronic parts packed in a single-use sensor-head also leading to a low-cost device. This paper first describes the selection of an appropriate low-cost diode, which is placed in a sensor head (Ø 12 mm) and characterized in a validation experiment. Finally, the sensor and its performance during a detection experiment with nine subjects is evaluated. The subjects had to locate a 137Cs source (138 kBq activity, 612 keV) below a wooden plate seven times. Time to accomplish this task and error rate were recorded and evaluated. The time needed by the subjects to complete each run was 95 ± 68.1 s for the first trial down to 40 ± 23.9 s for the last. All subjects managed to locate the 137Cs source precisely. Further reduction in size and a sterilizable housing are prerequisites for in vitro tests on explanted human lymph nodes and finally in vivo testing.

Robotics ◽  
2021 ◽  
Vol 10 (4) ◽  
pp. 129
Lamar O. Mair ◽  
Sagar Chowdhury ◽  
Xiaolong Liu ◽  
Onder Erin ◽  
Oleg Udalov ◽  

The application of force in surgical settings is typically accomplished via physical tethers to the surgical tool. While physical tethers are common and critical, some internal surgical procedures may benefit from a tetherless operation of needles, possibly reducing the number of ports in the patient or the amount of tissue damage caused by tools used to manipulate needles. Magnetic field gradients can dynamically apply kinetic forces to magnetizable objects free of such tethers, possibly enabling ultra-minimally invasive robotic surgical procedures. We demonstrate the untethered manipulation of a suture needle in vitro, exemplified by steering through narrow holes, as well as needle penetration through excised rat and human tissues. We present proof of principle manipulations for the fully untethered control of a minimally modified, standard stainless steel surgical suture needle.

2021 ◽  
Tsuyoshi Saito ◽  
Motoki Matsuura ◽  
Masato Tamate ◽  
Masahiro Iwasaki ◽  
Tasuku Mariya

AbstractRecently, radical vaginal hysterectomy (RVH) has developed into laparoscopically assisted radical vaginal hysterectomy (LARVH), which is associated with the laparoscopical procedure, and it is applied as radical vaginal trachelectomy and semi-radical vaginal hysterectomy. LARVH is indicated for patients with stage IB1 and IIA1 cervical carcinoma, especially those with a tumor size of less than 2 cm, because the cardinal ligaments cannot be resected widely. Although RVH that is associated with laparoscopic pelvic lymphadenectomy is the most used surgical procedure, radical trachelectomy may be performed either abdominally or vaginally (laparoscopic or robotic). One report found that the pregnancy rate was higher in patients who underwent minimally invasive or radical vaginal trachelectomy than in those who underwent radical abdominal trachelectomy.

Surgery Today ◽  
2021 ◽  
Jun Kanamori ◽  
Masayuki Watanabe ◽  
Suguru Maruyama ◽  
Yasukazu Kanie ◽  
Daisuke Fujiwara ◽  

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