Current state and future perspectives of spinal navigation and robotics - an AO Spine survey [Abstract]

Objective: The use of robotics in spine surgery has gained popularity in recent years. This study aims to assess the current state of navigation and robotics in spine surgery and raise awareness of their educational implications across the AO Spine regions. Methods: An online questionnaire comprising 27 questions was distributed to AO spine members between October 25th and November 13th, 2023, using the SurveyMonkey platform (https://www.surveymonkey.com; SurveyMonkey Inc., San Mateo, CA, USA). Statistical analyses (descriptive statistics, Pearson Chi-Square tests) and generation of all graphs were performed using SPSS Version 29.0.1.0 (IBM SPSS Statistic). Results: We received 424 responses from AO Spine members (response rate = 9.9 %). The participants were mostly board-certified orthopedic surgeons (46 %, n=195) and neurosurgeons (32%, n=136) with an equal distribution from academic/non-academic institutions (50 %, n=212). While 49% (n=208) of the participants reported occasional or frequent use of navigation assistance, only 18 % (n=70) indicated the use of robotic assistance for spinal instrumentation. A significant difference based on the country’s median income status (p<0.001) and the respondent’s number of annual instrumentation procedures (p<0.001) has been observed. While 11 % (n=47) of all surgeons use a spinal robot frequently, 36 % (n=153) of the participants stated they don’t need a robot from a current perspective. Most participants (77%, n=301) concluded that high acquisition costs are the primary barrier for the implementation of robotics. Conclusion: Although the hype for robotics in spine surgery increased recently, robotic systems remain non-standard equipment due to cost constraints and limited usability. Spinal navigation appears to have a broader international utilization

Prasugrel results in higher decrease in high-sensitivity C-reactive protein level in patients undergoing percutaneous coronary intervention comparing to clopidogrel

Objectives: A growing body of clinical and laboratory evidence indicates that inflammation plays a crucial role in atherosclerosis. In the present study, we compared the effects of clopidogrel and prasugrel on high-sensitivity C-reactive protein (hs-CRP) in patients undergoing percutaneous coronary intervention (PCI). Methods: The present randomized, double-blind clinical trial included 120 patients who underwent PCI. Eligible patients were randomly assigned 2:1 to one of the two groups: 80 patients in the first group received clopidogrel (Plavix®; loading dose and maintenance dose of 300 and 75 mg daily, respec-tively) and 40 patients in the second group received prasugrel (Effient®; loading dose and maintenance dose of 60 and 10 mg, respectively) for 12 weeks. The hs-CRP levels between baseline and 12th week were compared.Results: Of the 120 patients, 69 patients (57.5) were male. Pretreatment hs-CRP level was statistically comparable in clopidogrel (median, 15.10 mg/dL; interquartile range IQR, 9.62-23.75 mg/dL) and prasugrel groups (median, 18 mg/dL; IQR, 14.25-22 mg/dL; P = 0.06). Patients taking clopidogrel showed a significant reduction in hs-CRP level compared with the baseline values (P < 0.001). Prasugrel administration also resulted in a significant reduc-tion in hs-CRP level (P < 0.001). A significant 73% overall reduction in the hs-CRP level was seen with prasugrel compared with 39% overall reduction in hs-CRP level with clopidogrel (P = 0.002). Conclusion: Prasugrel seems to be superior to clopidogrel in the reduction of hs-CRP in patients undergoing PCI. © the authors, publisher and licensee Libertas Academica Limited

Effective high compression of ECG signals at low level distortion

An effective method for compression of ECG signals, which falls within the transform lossy compression category, is proposed. The transformation is realized by a fast wavelet transform. The effectiveness of the approach, in relation to the simplicity and speed of its implementation, is a consequence of the efficient storage of the outputs of the algorithm which is realized in compressed Hierarchical Data Format. The compression performance is tested on the MIT-BIH Arrhythmia database producing compression results which largely improve upon recently reported benchmarks on the same database. For a distortion corresponding to a percentage root-mean-square difference (PRD) of 0.53, in mean value, the achieved average compression ratio is 23.17 with quality score of 43.93. For a mean value of PRD up to 1.71 the compression ratio increases up to 62.5. The compression of a 30 min record is realized in an average time of 0.14 s. The insignificant delay for the compression process, together with the high compression ratio achieved at low level distortion and the negligible time for the signal recovery, uphold the suitability of the technique for supporting distant clinical health care

Facial nerve motor evoked potentials during skull base surgery to monitor facial nerve function using the threshold-level method

Object During surgeries that put the facial nerve at risk for injury, its function can be continuously monitored by transcranial facial nerve motor evoked potentials (FNMEPs) in facial nerve target muscles. Despite their advantages, FNMEPs are not yet widely used. While most authors use a 50% reduction in FNMEP response amplitudes as a warning criterion, in this paper the authors' approach was to keep the response amplitude constant by increasing the stimulation intensity and to establish a warning criterion based on the "threshold-level" method. Methods The authors included 34 consecutive procedures involving 33 adult patients (median age 47 years) in whom FNMEPs were monitored. A threshold increase greater than 20 mA for eliciting FNMEPs in the most reliable facial nerve target muscle was considered a prediction of reduced postoperative facial nerve function, and subsequently a warning was issued to the surgeon. Preoperative and early postoperative function was documented using the House-Brackmann grading system. Results Monitoring of FNMEPs was feasible in all 34 surgeries in at least one facial nerve target muscle. The mentalis muscle yielded the best results. The House-Brackmann grade deteriorated in 17 (50%) of 34 cases. The warning criterion was reached in 18 (53%) of 34 cases, which predicted an 83% risk of House-Brackmann grade deterioration. Sensitivity amounted to 88% (CI 64%-99%) and specificity to 82% (CI 57%-96%). Deterioration of FNMEPs and a worse House-Brackmann grade showed a high degree of association (p < 0.001). The impact of FNMEP monitoring on surgical strategy is exemplified in an illustrative case. Conclusions In surgeries that put the facial nerve at risk, the intraoperative increase in FNMEP stimulation threshold was closely correlated to postoperative facial nerve dysfunction. Monitoring of FNMEPs is a valid indicator of facial nerve function in skull base surgery. It should be used as an adjunct to direct electrical facial nerve stimulation and continuous electromyographic monitoring of facial nerve target muscles

Investigation of frequency of hypogonadism in thalassemia major patients of hazrat-e rasool akram hospital during 2013-2017

Determining the frequency of hypogonadism in thalassemia major patients and clarifying factors affecting it can be helpful in reducing related complications and improving the prognosis. The objective of the present study was to establish the frequency of hypogonadism in thalassemia major patients of Hazrat-e Rasool Akram Hospital during 2013-2017. A descriptive and analytic cross-sectional observation was carried out for this study and 285 thalassemia major patients were selected via convenience sampling. The frequency of hypogonadism among samples was assessed and the relationship between hypogonadism and different factors was analyzed. One hundred forty-six patients (51/2) had hypogonadism. A statistically significant relationship was found between tallness and hypogonadism; taller patients suffered from hypogonadism more than shorter ones (P=0.025); but weight, Initial serum ferritin level, LH, FSH, testosterone, splenectomy and the type of Injectable product had no significant relationship with of hypogonadism occurrence in the studied patients (P > 0.05). Based on the results, it is inferred that hypogonadism can be found in half of thalassemia major patients and therefore proper measures must be taken in order to decrease its prevalence. © 2020, Japan International Cultural Exchange Foundation. All rights reserved

Conscious Experience and Psychological Consequences of Awake Craniotomy

Background Experiencing cranial surgery under awake conditions may expose patients to considerable psychological strain. Methods This study aimed to investigate the occurrence and course of psychological sequelae following awake craniotomy (AC) for brain tumors in a series of 20 patients using a broad, validated psychological assessment pre-, intra-, postoperatively and a standardized follow-up of 3 months. In addition, the association of the preoperative psychological condition (including, but not limited to, anxiety and fear) with perioperative pain perception and interference was assessed. Results AC did not induce any shift in the median levels of anxiety, depression, and stress symptoms already present prior to the procedure. Furthermore, anxiety and depression were all moderately to strongly associated over time (all p<0.05). Stress symptoms also correlated positively over all times of measurement. Stress three days after surgery was strongly associated with stress three months after surgery (p<0.001), while the correlation between pre- and immediate postoperative stress showed a statistical trend (p=0.07). Preoperative fear was not related to intraoperative pain, but to pain and its interference with daily activity on the third postoperative day (p<0.001 and p<0.01, respectively). Conclusion Postoperative psychological symptoms clearly correlated with their corresponding preoperative symptoms. Thus, mental health was not negatively affected by the awake craniotomy experience in our series. Intraoperative fear and pain were not related to the preoperative psychological condition. However, preoperative fear and anxiety were positively related with pain and its interference with daily activity in the immediate postoperative perio

Role of exosome in autoimmunity, with a particular emphasis on rheumatoid arthritis

Cell-derived exosomes are identified as carriers of lipids, proteins, and genetic materials that participate in cell-cell signal communication, biological process, and cell signaling. Also, their involvement has been reported in a vast array of disorders and inflammatory conditions such as autoimmune diseases. Rheumatoid arthritis (RA), a common cause of joint disorder, is an inflammation-based disease in which the precise understanding of its pathogenesis needs to be further investigated. Also, there is only a palliative care approach for the alleviation of RA symptoms. This paper discusses the recent advances in the biology of exosomes in autoimmune disorders especially in RA, and also provides a new line of research for arthritis therapy using exosomes. © 2020 Asia Pacific League of Associations for Rheumatology and John Wiley & Sons Australia, Lt

Intradural cystic schwannomas of the spine: A case-based systematic review of an unusual tumor

Introduction: Cystic schwannomas have only been reported in a few case reports/series. As a result, they may be misdiagnosed and a standardized management approach remains challenging to establish. Research question: The aim of this study was to compile all reported cases of cystic schwannomas and analyze the perioperative course based on a systematic review of the literature with an additional two cases from the authors’ experience. Material and methods: We conducted a search of MEDLINE and CENTRAL databases for spinal intradural extramedullary cystic schwannomas, in accordance to the PRISMA statement. All title/abstracts were screened, and a full-text review of the remaining articles was conducted. The results were compiled in tables and summarized using means and standard deviation (SD), median and interquartile range, and percentage and 95% confidence intervals. Results: We identified 263 articles, of which 35, which reported 54 cases, were included. Including our case-reports (n = 56), patients had a mean age of 47.7 years (SD ± 13.0 years) at presentation, 57% were males, and most lesions were lumbar (43%). The most common symptoms were pain (82%) and muscle weakness (68%) with 84% of patients showing neurological findings. 70% of patients showed a complete relief of symptoms after surgery and 96% reported improvement. Only four complications were reported. Discussion and conclusion: Schwannomas should be considered in the differential diagnosis of intradural extramedullary cystic lesions. Patients typically present with subacute to chronic pain and/or neurologic changes. Surgical resection is the primary therapeutic modality and usually has a good to excellent outcome