Filling the gap between the OR and virtual simulation : a European study on a basic neurosurgical procedure

Aki Laakso tutkimusryhmän jäsenenä.Currently available simulators are supposed to allow young neurosurgeons to hone their technical skills in a safe environment, without causing any unnecessary harm to their patients caused by their inexperience. For this training method to be largely accepted in neurosurgery, it is necessary to prove simulation efficacy by means of large-scale clinical validation studies. We correlated and analysed the performance at a simulator and the actual operative skills of different neurosurgeons (construct validity). We conducted a study involving 92 residents and attending neurosurgeons from different European Centres; each participant had to perform a virtual task, namely the placement of an external ventricular drain (EVD) at a neurosurgical simulator (ImmersiveTouch). The number of attempts needed to reach the ventricles and the accuracy in positioning the catheter were assessed. Data suggests a positive correlation between subjects who placed more EVDs in the previous year and those who get better scores at the simulator (p = .008) (fewer attempts and better surgical accuracy). The number of attempts to reach the ventricle was also analysed; senior residents needed fewer attempts (mean = 2.26; SD = 1.11) than junior residents (mean = 3.12; SD = 1.05) (p = .007) and staff neurosurgeons (mean = 2.89, SD = 1.23). Scoring results were compared by using the Fisher's test, for the analysis of the variances, and the Student's T test. Surprisingly, having a wider surgical experience overall does not correlate with the best performance at the simulator. The performance of an EVD placement on a simulator correlates with the density of the neurosurgical experience for that specific task performed in the OR, suggesting that simulators are able to differentiate neurosurgeons according to their surgical ability. Namely this suggests that the simulation performance reflects the surgeons' consistency in placing EVDs in the last year.Peer reviewe

Source apportionment of PM10 in the Western Mediterranean based on observations from a cruise ship

Two intensive PM10 sampling campaigns were performed in the summers of 2009 and 2010 on the ship Costa Pacifica during cruises in the Western Mediterranean. Samples, mainly collected on a hourly basis, were analysed with different techniques (Particle Induced X-Ray Emission, PIXE; Energy Dispersive – X Ray Fluorescence, ED-XRF; Ion Chromatography, IC; Thermo-optical analysis) to retrieve the PM10 composition and its time pattern. The data were used for obtaining information about the sources of aerosol, with a focus on ship emissions, through apportionment using chemical marker compounds, correlation analysis and Positive Matrix Factorization (PMF) receptor modeling. For the campaign in 2010, 66% of the aerosol sulphate was found to be anthropogenic, only minor contributions of dust and sea salt sulphate were observed while the biogenic contribution, estimated based on the measurements of MSA, was found to be more important (26%), but influenced by large uncertainties. V and Ni were found to be suitable tracers of ship emissions during the campaigns. Four sources of aerosol were resolved by the PMF analysis; the source having the largest impact on PM10, BC and sulphate was identified as a mixed source, comprising emissions from ships. Ship emissions were observed to have a dominating impact on sulphate in aerosol for the leg Palma-Tunis, crossing a main ship route, and strong impacts also in some other parts of the route. However, looking at the entire dataset these impacts were much less pronounced and showed large spatial and temporal variations.JRC.H.2-Air and Climat

PM10 source apportionment applying PMF and chemical tracer analysis to ship-borne measurements in the Western Mediterranean

A PM10 sampling campaign was carried out on board the cruise ship Costa Concordia during three weeks in summer 2011. The ship route was Civitavecchia-Savona-Barcelona-Palma de Mallorca-Malta (Valletta)-Palermo-Civitavecchia. The PM10 composition was measured and utilized to identify and characterize the main PM10 sources along the ship route through receptor modelling, making use of the Positive Matrix Factorization (PMF) algorithm. A particular attention was given to the emissions related to heavy fuel oil combustion by ships, which is known to be also an important source of secondary sulphate aerosol. Five aerosol sources were resolved by the PMF analysis. The primary contribution of ship emissions to PM10 turned out to be (12 ± 4)%, while secondary ammonium sulphate contributed by (35 ± 5)%. Approximately, 60% of the total sulphate was identified as secondary aerosol while about 20% was attributed to heavy oil combustion in ship engines. The measured concentrations of methane sulphonic acid (MSA) indicated a relevant contribution to the observed sulphate loading by biogenic sulphate, formed by the atmospheric oxidation of dimethyl sulphide (DMS) emitted by marine phytoplankton.JRC.H.2-Air and Climat

Snake-Eye Myelopathy and Surgical Prognosis: Case Series and Systematic Literature Review

The prognostic value of "snake-eyes" sign in spinal cord magnetic resonance imaging (MRI) is unclear and the correlation with different pathological conditions has not been completely elucidated. In addition, its influence on surgical outcome has not been investigated in depth. A literature review according to PRISMA (Preferred reporting items for systematic review and meta-analysis protocols) guidelines on the prognostic significance of "snake-eyes" sign in operated patients was performed. Clinical, neuroradiological, and surgical data of three institutional patients, were also retrospectively collected. The three patients, with radiological evidence of "snake-eyes" myelopathy, underwent appropriate surgical treatment for their condition, with no new post-operative neurological deficits and good outcome at follow-up. The literature review, however, reported conflicting results: the presence of "snake-eyes" sign seems a poor prognostic factor in degenerative cervical myelopathy, even if some cases can improve after surgery. "Snake-eyes" myelopathy represents a rare form of myelopathy; pathophysiology is still unclear. The frequency of this myelopathy may be greater than previously thought and according to our literature review it is mostly a negative prognostic factor. However, from our experience, prognosis might not be so dire, especially when tailored surgical intervention is performed; therefore, surgery should always be considered and based on the complete clinical, neurophysiological, and radiological data