Regional cerebral oxygen saturation monitoring during spinal surgery in order to identify patients at risk for cerebral desaturation

Publisher Copyright: © 2020 by the authors. Copyright: Copyright 2020 Elsevier B.V., All rights reserved.Background: Near infrared spectroscopy (NIRS) devices are non-invasive and monitor cerebral oxygen saturation (rScO2) continuously. NIRS interventional protocol is available in order to avoid hypoxic brain injury. Methods: We recruited patients scheduled for spinal surgery (n = 44). rScO2 was monitored throughout the surgery using INVOS 4100 cerebral oximeter. If the rScO2 values dropped more than 20% below baseline, or there was an absolute drop to below 50%, NIRS interventional protocol was followed. Results: In two patients rScO2 decreased by more than 20% from baseline values. In one patient rScO2 decreased to below 50%. NIRS protocol was initiated. As the first step, correct head position was verified-in one patient rScO2 increased above the threshold value. In the two remaining patients, mean arterial pressure was raised by injecting Ephedrin boluses as the next step. rScO2 raised above threshold. Patients with desaturation episodes had longer medium time of the operation (114 ± 35 versus 200 ± 98 min, p = 0.01). Pearson's correlation showed a negative correlation between rScO2 and duration of operation (r = 0.9, p = 0.2). Receiver operating characteristic curve analysis showed blood loss to be a strong predictor for possible cerebral desaturation (Area under the curve (AUC): 0.947, 95%CI: 0.836-1.000, p = 0.04). Conclusion: Patients with higher blood loss might experience cerebral desaturation more often than spinal surgery patients without significant blood loss.publishersversionPeer reviewe

Studi Efisiensi Sistem Prasedimentasi Dan Free Water Surface Wetland Dalam Menurunkan Kadar Nitrat, Fosfat, Kekeruhan, Zat Organik Dan Total Coli

Boezem Wonorejo saat ini telah dikembangkan menjadi tempat wisata yaitu Ekowisata Mangrove. Sampai saat ini pihak pengelola boezem masih kesulitan dalam penyediaan air bersihnya Sungai Jagir yang mengalir di sekitar wilayah Ekowisata tersebut merupakan sumber air permukaan yang berpotensi sebagai pemenuhan kebutuhan tersebut secara kuantitatif. Agar dapat terpenuhi secara kualitatif, maka Perlu dilakukan penelitian awal untuk mengetahui efisiensi penurunan kadar Nitrat, Fosfat, Zat Organik, Kekeruhan maupun Total Coli. Dalam penelitian ini akan digunakan rangkaian suatu sistem pengolahan Prasedimentasi dan Free Water Surface wetland skala laboratoium, Dengan variabel ukuran media pasir (16-32 mesh dan lolos 32 mesh) dan umur mangrove (3 bulan dan 6 bulan) yang akan di analisis di laboratorium Teknik Lingkungan ITS. Dari hasil analisis didapat removal maksimum untuk kekeruhan pada prasedimentasi 46,5%, sedangkan pada wetland yaitu pada media pasir mesh 16-32 dan mangrove 6 bulan yaitu 94,8%. Presentase maksimum removal nitrat pada prasedimentasi yaitu 17,8%, removal maksimum pada wetland dengan mangrove 6 bulan dan media pasir lolos 32 mesh yaitu 53,6%. Pada mangrove sendiri removal makismum terdapat pada umur 6 bulan dengan besar removal 36,5%. Removal maksimum fosfat terbesar pada prasedimentasi yaitu 64,3%, untuk Reaktor Wetland yaitu pada wetland dengan mangrove 6 bulan dan media pasir lolos mesh 32 sebesar 90,5%. Untuk . Mangrovenya sendiri mampu meremoval maksimum pada umur 6 bulan dengan besar 53,8%. Presentase removal maksimum zat organik pada prasedimentasi sebesar 35,7%, pada reaktor wetland sebesar 21,8% dengan ukuran media pasir mesh 16-32 dan umur mangrove 3 bulan

Non-linear Dynamical Analysis of Intraspinal Pressure Signal Predicts Outcome After Spinal Cord Injury.

The injured spinal cord is a complex system influenced by many local and systemic factors that interact over many timescales. To help guide clinical management, we developed a technique that monitors intraspinal pressure from the injury site in patients with acute, severe traumatic spinal cord injuries. Here, we hypothesize that spinal cord injury alters the complex dynamics of the intraspinal pressure signal quantified by computing hourly the detrended fluctuation exponent alpha, multiscale entropy, and maximal Lyapunov exponent lambda. 49 patients with severe traumatic spinal cord injuries were monitored within 72 h of injury for 5 days on average to produce 5,941 h of intraspinal pressure data. We computed the spinal cord perfusion pressure as mean arterial pressure minus intraspinal pressure and the vascular pressure reactivity index as the running correlation coefficient between intraspinal pressure and arterial blood pressure. Mean patient follow-up was 17 months. We show that alpha values are greater than 0.5, which indicates that the intraspinal pressure signal is fractal. As alpha increases, intraspinal pressure decreases and spinal cord perfusion pressure increases with negative correlation between the vascular pressure reactivity index vs. alpha. Thus, secondary insults to the injured cord disrupt intraspinal pressure fractality. Our analysis shows that high intraspinal pressure, low spinal cord perfusion pressure, and impaired pressure reactivity strongly correlate with reduced multi-scale entropy, supporting the notion that secondary insults to the injured cord cause de-complexification of the intraspinal pressure signal, which may render the cord less adaptable to external changes. Healthy physiological systems are characterized by edge of chaos dynamics. We found negative correlations between the percentage of hours with edge of chaos dynamics (-0.01 ≤ lambda ≤ 0.01) vs. high intraspinal pressure and vs. low spinal cord perfusion pressure; these findings suggest that secondary insults render the intraspinal pressure more regular or chaotic. In a multivariate logistic regression model, better neurological status on admission, higher intraspinal pressure multi-scale entropy and more frequent edge of chaos intraspinal pressure dynamics predict long-term functional improvement. We conclude that spinal cord injury is associated with marked changes in non-linear intraspinal pressure metrics that carry prognostic information

Visual shape and position sensing algorithm for a continuum robot

Continuum robots represent an actively developing and fast-growing technology in robotics. To successfully implement control and path planning of continuum robots it is important to develop an accurate three-dimensional shape and position sensing algorithm. In this paper, we propose an algorithm for the three-dimensional reconstruction of the continuum robot shape. The algorithm is performed during several steps. Initially, images from two cameras are processed by applying pre-processing and segmentation techniques. Then, the gradient descent method is applied to compare two-dimensional skeleton points of both masks. Having compared these points, it finds a skeleton of the robot in a threedimensional form. Additionally, the proposed algorithm is able to define key points using the distance from the robot base along the center line. The latter allows controlling the position of points of interest defined by a user. As a result, the developed algorithm achieved a relatively high level of accuracy and speed

Intraaortic Balloon Pump Counterpulsation and Cerebral Autoregulation: an observational study

The use of Intra-aortic counterpulsation is a well established supportive therapy for patients in cardiac failure or after cardiac surgery. Blood pressure variations induced by counterpulsation are transmitted to the cerebral arteries, challenging cerebral autoregulatory mechanisms in order to maintain a stable cerebral blood flow. This study aims to assess the effects on cerebral autoregulation and variability of cerebral blood flow due to intra-aortic balloon pump and inflation ratio weaning

Pyogenic spondylitis

Pyogenic spondylitis is a neurological and life threatening condition. It encompasses a broad range of clinical entities, including pyogenic spondylodiscitis, septic discitis, vertebral osteomyelitis, and epidural abscess. The incidence though low appears to be on the rise. The diagnosis is based on clinical, radiological, blood and tissue cultures and histopathological findings. Most of the cases can be treated non-operatively. Surgical treatment is required in 10–20% of patients. Anterior decompression, debridement and fusion are generally recommended and instrumentation is acceptable after good surgical debridement with postoperative antibiotic cover

Monitoring the Depth of Anaesthesia

One of the current challenges in medicine is monitoring the patients’ depth of general anaesthesia (DGA). Accurate assessment of the depth of anaesthesia contributes to tailoring drug administration to the individual patient, thus preventing awareness or excessive anaesthetic depth and improving patients’ outcomes. In the past decade, there has been a significant increase in the number of studies on the development, comparison and validation of commercial devices that estimate the DGA by analyzing electrical activity of the brain (i.e., evoked potentials or brain waves). In this paper we review the most frequently used sensors and mathematical methods for monitoring the DGA, their validation in clinical practice and discuss the central question of whether these approaches can, compared to other conventional methods, reduce the risk of patient awareness during surgical procedures

Spinal infection: state of the art and management algorithm

Spinal infection is a rare pathology although a concerning rising incidence has been observed in recent years. This increase might reflect a progressively more susceptible population but also the availability of increased diagnostic accuracy. Yet, even with improved diagnosis tools and procedures, the delay in diagnosis remains an important issue. This review aims to highlight the importance of a methodological attitude towards accurate and prompt diagnosis using an algorithm to aid on spinal infection management. METHODS: Appropriate literature on spinal infection was selected using databases from the US National Library of Medicine and the National Institutes of Health. RESULTS: Literature reveals that histopathological analysis of infected tissues is a paramount for diagnosis and must be performed routinely. Antibiotic therapy is transversal to both conservative and surgical approaches and must be initiated after etiological diagnosis. Indications for surgical treatment include neurological deficits or sepsis, spine instability and/or deformity, presence of epidural abscess and upon failure of conservative treatment. CONCLUSIONS: A methodological assessment could lead to diagnosis effectiveness of spinal infection. Towards this, we present a management algorithm based on literature findings