Auditory Cortex Basal Activity Modulates Cochlear Responses in Chinchillas

Background: The auditory efferent system has unique neuroanatomical pathways that connect the cerebral cortex with sensory receptor cells. Pyramidal neurons located in layers V and VI of the primary auditory cortex constitute descending projections to the thalamus, inferior colliculus, and even directly to the superior olivary complex and to the cochlear nucleus. Efferent pathways are connected to the cochlear receptor by the olivocochlear system, which innervates outer hair cells and auditory nerve fibers. The functional role of the cortico-olivocochlear efferent system remains debated. We hypothesized that auditory cortex basal activity modulates cochlear and auditory-nerve afferent responses through the efferent system. Methodology/Principal Findings: Cochlear microphonics (CM), auditory-nerve compound action potentials (CAP) and auditory cortex evoked potentials (ACEP) were recorded in twenty anesthetized chinchillas, before, during and after auditory cortex deactivation by two methods: lidocaine microinjections or cortical cooling with cryoloops. Auditory cortex deactivation induced a transient reduction in ACEP amplitudes in fifteen animals (deactivation experiments) and a permanent reduction in five chinchillas (lesion experiments). We found significant changes in the amplitude of CM in both types of experiments, being the most common effect a CM decrease found in fifteen animals. Concomitantly to CM amplitude changes, we found CAP increases in seven chinchillas and CAP reductions in thirteen animals. Although ACE

Two-vessel branched stent graft for severely angulated aortic arch aneurysm in a Jehovah's Witness

Aneurysmal disease involving the origins of supra aortic vessels often requires complex open and/or endovascular repair that is not only associated with significant risk of mortality and morbidity but also often with perioperative blood loss requiring transfusion. We report a successful repair of a large thoracic aortic aneurysm (TAA) involving the aortic arch with a custom-made Bolton Relay 2-vessel branched thoracic aortic endograft in a 42-year-old Jehovah’s Witness who would otherwise be very unlikely to survive an open repair. Branched thoracic aortic endografting offers a potentially safe, minimally invasive, and effective alternative for TAA disease involving the supra-aortic arteries, especially in patients who are at high risk of open surgery

Surgical technology and operating-room safety failures: a systematic review of quantitative studies.

BACKGROUND: Surgical technology has led to significant improvements in patient outcomes. However, failures in equipment and technology are implicated in surgical errors and adverse events. We aim to determine the proportion and characteristics of equipment-related error in the operating room (OR) to further improve quality of care. METHODS: A systematic review of the published literature yielded 19 362 search results relating to errors and adverse events occurring in the OR, from which 124 quantitative error studies were selected for full-text review and 28 were finally selected. RESULTS: Median total errors per procedure in independently-observed prospective studies were 15.5, interquartile range (IQR) 2.0-17.8. Failures of equipment/technology accounted for a median 23.5% (IQR 15.0%-34.1%) of total error. The median number of equipment problems per procedure was 0.9 (IQR 0.3-3.6). From eight studies, subdivision of equipment failures was possible into: equipment availability (37.3%), configuration and settings (43.4%) and direct malfunctioning (33.5%). Observed error rates varied widely with study design and with type of operation: those with a greater burden of technology/equipment tended to show higher equipment-related error rates. Checklists (or similar interventions) reduced equipment error by mean 48.6% (and 60.7% in three studies using specific equipment checklists). CONCLUSIONS: Equipment-related failures form a substantial proportion of all error occurring in the OR. Those procedures that rely more heavily on technology may bear a higher proportion of equipment-related error. There is clear benefit in the use of preoperative checklist-based systems. We propose the adoption of an equipment check, which may be incorporated into the current WHO checklist

Surgical technology and operating-room safety failures: a systematic review of quantitative studies.

BACKGROUND: Surgical technology has led to significant improvements in patient outcomes. However, failures in equipment and technology are implicated in surgical errors and adverse events. We aim to determine the proportion and characteristics of equipment-related error in the operating room (OR) to further improve quality of care. METHODS: A systematic review of the published literature yielded 19 362 search results relating to errors and adverse events occurring in the OR, from which 124 quantitative error studies were selected for full-text review and 28 were finally selected. RESULTS: Median total errors per procedure in independently-observed prospective studies were 15.5, interquartile range (IQR) 2.0-17.8. Failures of equipment/technology accounted for a median 23.5% (IQR 15.0%-34.1%) of total error. The median number of equipment problems per procedure was 0.9 (IQR 0.3-3.6). From eight studies, subdivision of equipment failures was possible into: equipment availability (37.3%), configuration and settings (43.4%) and direct malfunctioning (33.5%). Observed error rates varied widely with study design and with type of operation: those with a greater burden of technology/equipment tended to show higher equipment-related error rates. Checklists (or similar interventions) reduced equipment error by mean 48.6% (and 60.7% in three studies using specific equipment checklists). CONCLUSIONS: Equipment-related failures form a substantial proportion of all error occurring in the OR. Those procedures that rely more heavily on technology may bear a higher proportion of equipment-related error. There is clear benefit in the use of preoperative checklist-based systems. We propose the adoption of an equipment check, which may be incorporated into the current WHO checklist

The use of video motion analysis to determine the impact of anatomic complexity on endovascular performance in carotid artery stenting

OBJECTIVE: Video motion analysis (VMA) uses fluoroscopic sequences to derive information on catheter and guidewire movement and is able to calculate two-dimensional catheter tip path length (PL) on the basis of frame-by-frame pixel coordinates. The objective of this study was to evaluate the effect of anatomic complexity on the efficiency of completion of defined stages of simulated carotid artery stenting as measured by VMA. METHODS: Twenty interventionists each performed a standardized easy, medium, and difficult carotid artery stenting case in random order on an ANGIO Mentor (Simbionix, Airport City, Israel) simulator. Videos of all procedures were analyzed using VMA software, and performance was expressed in terms of two-dimensional guidewire tip trajectory distance (PL). Comparisons of PL were used to identify differences in cannulation performance of the participants between the three cases of varying difficulty. The procedure was subdivided into four procedural phases: arch navigation, common carotid artery (CCA) cannulation, external carotid manipulation, and carotid lesion crossing. Comparisons of PL were used to identify differences in performance between the three cases of varying difficulty for each of the procedural phases. RESULTS: There were significant differences in PL in relation to anatomic complexity, with a stepwise increase in PL from easy to difficult cases: easy, median of 5000 pixels (interquartile range, 4075-5403 pixels); intermediate, 9059 (5974-14,553) pixels; difficult, 17,373 (11,495-26,594) pixels (P < .001). Similarly, during CCA cannulation, there was a stepwise increase in PL from easy to difficult cases: easy, 749 (603-1403) pixels; intermediate, 3274 (1544-8142) pixels; difficult, 8845 (5954-15,768) pixels (P < .001). There were no observed differences across the groups of anatomic difficulty for the phases of arch navigation, external carotid manipulation, and carotid lesion crossing. CONCLUSIONS: Increasing anatomic complexity leads to significant increases in PL of endovascular tools, in particular during CCA cannulation. This increase in tool movement may have a bearing on clinical outcome

Reducing error and improving efficiency during vascular interventional radiology: implementation of a preprocedural team rehearsal.

PURPOSE: To determine the type and frequency of errors during vascular interventional radiology (VIR) and design and implement an intervention to reduce error and improve efficiency in this setting. MATERIALS AND METHODS: Ethical guidance was sought from the Research Services Department at Imperial College London. Informed consent was not obtained. Field notes were recorded during 55 VIR procedures by a single observer. Two blinded assessors identified failures from field notes and categorized them into one or more errors by using a 22-part classification system. The potential to cause harm, disruption to procedural flow, and preventability of each failure was determined. A preprocedural team rehearsal (PPTR) was then designed and implemented to target frequent preventable potential failures. Thirty-three procedures were observed subsequently to determine the efficacy of the PPTR. Nonparametric statistical analysis was used to determine the effect of intervention on potential failure rates, potential to cause harm and procedural flow disruption scores (Mann-Whitney U test), and number of preventable failures (Fisher exact test). RESULTS: Before intervention, 1197 potential failures were recorded, of which 54.6% were preventable. A total of 2040 errors were deemed to have occurred to produce these failures. Planning error (19.7%), staff absence (16.2%), equipment unavailability (12.2%), communication error (11.2%), and lack of safety consciousness (6.1%) were the most frequent errors, accounting for 65.4% of the total. After intervention, 352 potential failures were recorded. Classification resulted in 477 errors. Preventable failures decreased from 54.6% to 27.3% (P < .001) with implementation of PPTR. Potential failure rates per hour decreased from 18.8 to 9.2 (P < .001), with no increase in potential to cause harm or procedural flow disruption per failure. CONCLUSION: Failures during VIR procedures are largely because of ineffective planning, communication error, and equipment difficulties, rather than a result of technical or patient-related issues. Many of these potential failures are preventable. A PPTR is an effective means of targeting frequent preventable failures, reducing procedural delays and improving patient safety

Reducing error and improving efficiency during vascular interventional radiology: implementation of a preprocedural team rehearsal.

PURPOSE: To determine the type and frequency of errors during vascular interventional radiology (VIR) and design and implement an intervention to reduce error and improve efficiency in this setting. MATERIALS AND METHODS: Ethical guidance was sought from the Research Services Department at Imperial College London. Informed consent was not obtained. Field notes were recorded during 55 VIR procedures by a single observer. Two blinded assessors identified failures from field notes and categorized them into one or more errors by using a 22-part classification system. The potential to cause harm, disruption to procedural flow, and preventability of each failure was determined. A preprocedural team rehearsal (PPTR) was then designed and implemented to target frequent preventable potential failures. Thirty-three procedures were observed subsequently to determine the efficacy of the PPTR. Nonparametric statistical analysis was used to determine the effect of intervention on potential failure rates, potential to cause harm and procedural flow disruption scores (Mann-Whitney U test), and number of preventable failures (Fisher exact test). RESULTS: Before intervention, 1197 potential failures were recorded, of which 54.6% were preventable. A total of 2040 errors were deemed to have occurred to produce these failures. Planning error (19.7%), staff absence (16.2%), equipment unavailability (12.2%), communication error (11.2%), and lack of safety consciousness (6.1%) were the most frequent errors, accounting for 65.4% of the total. After intervention, 352 potential failures were recorded. Classification resulted in 477 errors. Preventable failures decreased from 54.6% to 27.3% (P &lt; .001) with implementation of PPTR. Potential failure rates per hour decreased from 18.8 to 9.2 (P &lt; .001), with no increase in potential to cause harm or procedural flow disruption per failure. CONCLUSION: Failures during VIR procedures are largely because of ineffective planning, communication error, and equipment difficulties, rather than a result of technical or patient-related issues. Many of these potential failures are preventable. A PPTR is an effective means of targeting frequent preventable failures, reducing procedural delays and improving patient safety

Aurora

MsTítol obtingut de f. 1rCol·lació: Pergamí, f. 222 (f. 124v, 212r i 213r en blanc) + i (paper)Composició: Escrit a línia tirada a 40 línies (f. 2r)Escriptura: Gòtica textual cal·ligràfica. Copiat per varies mans. Anotacions marginals contemporànies i posteriorsDecoració: Caplletres decorades alternant amb tinta blava i vermellaEnquadernació: Pergamí, en els plànols de l'enquadernació forats per a les brides de cuir. Al llom, teixell de paper amb la següent anotació: "Petrus Remensis Aurora MS"Origen: Copiat per diverses mans, probablement a França, als anys centrals del s. XIII. El text afegit a partir del f. 213v s'escriví a la segona meitat del s. XIV en una zona fronterera entre França, Itàlia i la Corona d'AragóSignatura anterior: Universitat de València. Biblioteca Històrica, 90-04-24Signatura actual: València, Universitat de València. Biblioteca Històrica, BH Ms. 311A començaments del s. XV hom inclogué a la fi del manuscrit (f. 222v) diverses receptes mèdiques escrites en catalàCatalogat des del manuscrit original. Lectura i identificació de textos pel Prof. Francisco M. Gimeno BlayEl manuscrit transcriu la Bíblia versificada per Petrus de Riga. A la fi, possiblement a la segona meitat del segle XIV, hom ha incorporat l'obra "Summarium Bibliorum metricum" d'Alexander, de Villa Dei, que el manuscrit atribueix a sant Joan Crisòstom (f. 213v-222r)1. f. 1r: [Prologus] "[rúbr.] Incip[it] bibliotecha met[ri]ce [com]posita a magistro Petro reinense Riga qua[m] i[n]titulav[it] Aurora. [text] Freq[ue]ns sodaliu[m] m[e]o[rum] peticio cu[m] q[ui]b[us] co[n]v[er]sando flore[m] exegi i[n]fantie ... q[uia] fig[ur]as [et] u[m]bras explicui [et] v[er]itatis fulgor pate[n]t[er] illuxit"2. f. 1r-22v: [Genesis] f. 1r+v: [Prologus] "[rúbr.] De operib[us] sex dieru[m]. [text] Primo facta die duo celu[m] t[er]ra legu[n]t[ur] ... sub sexta fit h[om]o septima [com]plet opus" ; f. 1v-22v: [Genesis] "[rúbr.] De op[er]e p[r]ime diei. [text] Principio t[er]ra[m] celu[m]q[ue] creasse refertur ... supplicat huic frat[er] ille remittit eis. [rúbr.] Explic[it] Genesis"3. f. 22v-40v: [Exodus] "[rúbr.] Incip[it] Exod[us]. [text] Hec duodena patru[m] su[n]t no[m]i[n]a q[u]i q[uas]i plebis ... crimina n[ost]ra lavet nos sup[er] astra levet. [rúbr.] Explicit Exod[us]"4. f. 40v-51r: [Leviticus] f. 40v: [Prologus] "[rúbr.] Incipit p[ro]logus s[upe]r Leviticum. [text] Vox aut[em] D[omi]ni Moyse[n] vocat imperat illi ... sacrum pneuma roga[n]s ut m[e]a vela regat" ; f. 40v-51r: [Leviticus] "[rúbr.] Incipit Leviticus. [text] Vox aut[em] d[omi]ni Moysen vocat imperat illi ... qui tumet ascribens candida f[a]c[t]a sibi. [rúbr.] Explicit Levitic[us]"5. f. 51r-59v: [Numeri] "[rúbr.] Incipit liber Numeri. [text] Alloq[ui]t[ur] Moyse[n] D[eu]s [et] iub[et] ut num[er]et[ur] ... reddit[ur] [et] n[o]b[is] nectare t[er]ra flue[n]s. [rúbr.] Explicit lib[er] Numeri"6. f. 59v-63v: [Deuteronomium] f. 59v-60r: [Prologus] "[rúbr.] Incipit p[ro]logos [sic] sup[er] Deut[er]onomium. [text] Hec su[n]t v[er]ba q[ui]b[us] Moyses i[n]strux[it] hebreos ... namq[ue] sub eloquii melle [sic] venena late[n]t. [rúbr.] Explicit p[ro]logus" ; f. 60r-63v: [Deuteronomium] "[rúbr.] Dilige d[o]m[i]n[um] D[eum] t[uum] ex toto c[orde] tuo et ex to[ta] a[nima] tu[a] [et] p[roximum] s[icut] t[e] [ipsum]. [text] Ex toto corde d[omi]n[u]m tu dilige tota ... est credend[us] cui[us] ille figura fuit. [rúbr.] Explic[it] V libri Moysi"7. f. 63v-67v: [Iosue] "[rúbr] Incip[it] Iosue. [text] Post Moysen Yosue p[o]p[u]lo d[o]minatur hebreo ... transiit ad patres dign[us] honore suos. [rúbr.] Explicit lib[er] Yosue"8. f. 67v-72r: [Iudices] "[rúbr] Incipit Iudicu[m]. [text] Post Yosue de iudicib[us] narrac[i]o fiat ... extinxit Sathana[n] cu[m] legione sua. [rúbr.] Explicit lib[er] Iudicu[m]"9. f. 72r+v: [Ruth] "[rúbr] Incipit lib[er] Ruth. [text] Ad Ruth festinat Pet[ri] stil[us] ei[us] ut act[us] ... efficit[ur] Iesse fit pat[er] iste D[avi]d. [rúbr.] Explicit Ruth"10. f. 72v-94r: [Regum] f. 72v-73r: [Liber I Regum. Prologus] "[rúbr.] Incipit p[ro]log[us] sup[er] libru[m] Regu[m]. [text] Post librum de iudicib[us] sacra lectio tracta[n]s ... ; [f. 73r] et regnu[m] venturu[m] rex novus iste tulit. [rúbr.] Explicit p[ro]log[us]. ; [f. [73r-80r] [Liber I Regum] “I[n]cipit Regu[m]. [text] Monte manens Effraym qui[s] civis de Ramata Sophym ... et fructu[m] p[er]dunt corda sup[er]ba bonu[m]. [rúbr.] Explic[it] p[r]im[us] lib[er] Regu[m]” ; [f. 80r-85v] [Liber II Regum] "[rúbr.] “Incepit [sic] s[e]c[un]d[u]s. [text] Por Ionathe morte[m] p[at]risq[ue] fui D[avi]d u[n]ct[us] … Iusticie placas co[n]siliasq[ue] Deum. [Explic[it] lib[er] IIus Regu[m] i[n]cipit IIIus” ; [f. 85v-91r] [Liber III Regum] "[text] Rexq[ue] D[avi]d senuit frigesc[er]e cepit amictu … et mox dimisso patre ministrat ei” ; f. [91r-94r] [Liber IV Regum] "[text] Dunc [sic] rex Ozias qui regnabat s[upe]r omne[m] … septem nos revocat ad sua templa Deus" ; f. 94r+v: "[text] In tera [sic] Salomon sapie[n]ti p[er]itior om[n]i ... ultim[us] ut placuit hic recitand[us] erit"11. f. 94v-114r: [Canticum Canticorum] f. 94v-95r: [Prologus] "[rúbr.] Incipit p[ro]logus sup[er] Cantica Cantico[rum]. [text] Doct[us] origenes cum doctos vicerit omnes ... q[uo]d multu[m] debe[n]t acq[ui]rere magna favore[m]. [rúbr.] Explic[it] p[ro]lugus" ; f. 95r-114r: [Canticum Canticorum] "[rúbr.] Incipiu[n]t Cantica Cantico[rum] q[uod] q[ue] hic elicit[ur] p[re]munt[ur] de p[ri]ma omelia Origenis. [text] Omni plena bono Salomonis cantica regis ... descendens ventu[m] [sic] patru[m] de germine nat[us]. [rúbr.] Expliciu[n]t Cantica Cantico[rum]"12. f. 114r-124r: [Job] f. 114r+v: [Prologus] "[rúbr.] S[ed] Petru[m] Riga[m] incipit incipid [sic] p[ro]log[us] i[n] libro Iob. [text] Libru[m] Iob Moysi q[ui]da[m] at[ri]bue [sic] mag[ist]ri ... Illut op[us] seq[ui]m[ur] d[e] m[u]ltis pauca tene[n]tes" ; f. 114v-124r: [Liber Job] "[rúbr.] Incip[it] lib[er] Iob vir erat in t[er]ra Hus nomine Iob. [text] Domine [sic] Iob vir erat si[m]plex [et] iuris amator ... quos D[omi]ni s[er]vus [com]plevit fine decenti. [rúbr.] Hic lib[er] script[us] qui scrip[sit] sit benedict[us]"13. f. 125r-162r: [Evangelium Secundum Lucam] [vid. f. 210v-211r] "[text] Archa colu[m]ba Noe fuit Moysi rub[us] Aaro[n] ... dat fide[m] Petr[us] finit [et] r[ati]o[n]e suu[m]. [rúbr.] Expliciu[n]t Euv[angelia]"14. f. 162r-168r: [Recapitulationes] "[rúbr.] I[n]cipiu[n]t recap[itu]lat[i]o[n]es Vet[er]is Testam[en]ti. [text] Principio rerum post q[ui]nq[ue] dies h[om]o p[ri]mus ... Barnabas [et] Tit[us] hii docuere fide[m]"15. f. 168r-181r: [Actus Apostolorum] "[rúbr.] Incipiunt Act[us] Aposto[lorum]. [text] Tiberii nonodecimo regna[n]tis i[n] anno ... ense sac[ra]t Paulu[m] pax lux urbs dux cruce Petrum. [rúbr.] Explic[it] lib[er] Regu[m]" [i.e. “Actus Apostolorum”16. f. 181r-187v: [Tobias] "[rúbr.] Incip[it] lib[er] Thobie. [text] Qui legis istoria[m] Tobye discute se[n]sum ... Anna pare[n]s stelle maris A[n]na p[ro]ph[et]a fidel[is]. [rúbr.] Explicit lib[er] Thobie"17. f. 187v-198r: [Daniel] "[rúbr.] Incip[it] lib[er] Daniel[is]. [text] Postq[uam] subiectos sibi rex Babilonis Heb[re]os ... cessavitq[ue] malu[m] cu[m] p[er]iere mali. [rúbr.] Explic[it] Daniel"18. f. 198r-200v: [Iudith] "[rúbr.] Inc[i]pit historia de Iudith. [text] Eustochio Pauleq[ue] fave[n]s Ieronim[us] act[us] ... plangitur habra Iudith lib[er]a f[a]c[t]a fuit. [rúbr.] Explic[it] Iudith"19. f. 200v-204r: [Esther] "[rúbr.] Incip[it] Hester. [text] Donec ad Ethiopum t[er]ras veniat[ur] ab Indis ... nullam senser[un]t regia iussa mora[m]"20. f. 204r-209v: [Machabeorum] [Prologus] "[text] Magn[us] Alexa[n]der q[uo] p[ri]mu[m] Grecia rege ... cui[us] vivit adhuc nescia fama mori. [rúbr.] Explic[it] p[ro]logus. [Machabeorum] “[text] [P]ost ei[us] morte[m] iuvenes q[ui]b[us] ille reliq[ui]t ... de patre facturi Cesar in aure tua"21. f. 209v-211r: f. 209v-210v: [Novum Testamentum. Prologus] "[text] Post lege[m] vetere[m] respira Petre refulget ... currat ut ystorie litt[er]a more suo. [rúbr.] Explicit p[ro]logus"22. f. 210v-211r: [Evangelium secundum Lucam] "[rúbr.] S[e]c[un]d[u]m Luca[m] fuit in dieb[us] H[er]odis regis sac[er]dos no[m]i[n]e Çacarias [et] c[etera]. [text] Claruit Herode ius regis agente sac[er]dos … archa colu[m]ba Noe fuit h[ec] Moysi rub[us] Aaron" [vid. f. 125r-162r23. f. 213v-222r: [Summarium Bibliorum metricum / Alexander, de Villa Dei] "[rúbr.] Incipit tabula Biblie Novi [et] Veteris Test[ament]i versifice a maxi[m]o theologie mag[ist]ro[rum] mag[ist]ro Joha[n]ne Crisostomo co[m]pilata et p[ri]mo liber Genesis ... [text] "Fflebu[n]t 18 ad cenam 19 surgu[n]t 20 spo[n]samq[ue] 21 nemo iam 22"Llat