Spinal cord stimulation (SCS) is a safe, reversible surgical treatment for complex regional pain syndrome and failed back surgery syndrome refractory to conventional medical management. Paddle ...electrodes are routinely used for the permanent implant because of the reduced risk of migration, lower energy requirements, and expanded coverage options. The risks associated with paddle lead removal are not well defined in the literature.
We retrospectively reviewed the outcomes of all patients at the Cleveland Clinic who underwent removal of SCS paddle electrodes between 2009 and 2016.
We identified 68 patients during this interval who had a paddle electrode removed. The most common reason for removal was loss of coverage or effect (75%), followed by infection (13.24%), and the need for magnetic resonance imaging for diagnostic purposes (8.82%). Postoperative complications occurred in eight patients (11.75%), two of which were classified as major (2.94%). One of these patients developed a postoperative cerebrospinal fluid leak, and another suffered a large suprafascial hematoma. Both patients underwent reoperation. Minor complications were reported in six patients (8.82%) and included wound dehiscence, infection, and prolonged ileus in one case. On average, patients who developed complications lost 20 mL more blood during surgery than those who did not develop complications (p = 0.006).
One of the benefits of SCS therapy is the reversibility of the procedure. However, removal is not without some risk though the overall risk of minor or major complication is low. Patients who are considering removal should be counseled appropriately. Prophylactic removal is not recommended. However, when removal is needed, surgeons and pain specialists must be familiar with these complications and their management.
Aims. We present a spectroscopic analysis of MWC 314, a luminous blue variable (LBV) candidate with an extended bipolar nebula. The detailed spectroscopic variability is investigated to determine if ...MWC 314 is a massive binary system with a supersonically accelerating wind or a low-mass Be star. We compare the spectrum and spectral energy distribution to other LBVs (such as P Cyg) and find very similar physical wind properties, indicating strong kinship. Methods. We combined long-term high-resolution optical spectroscopic monitoring and V-band photometric observations to determine the orbital elements and stellar parameters and to investigate the spectral variability with the orbital phases. We developed an advanced model of the large-scale wind-velocity and wind-density structure with 3-D radiative transfer calculations that fit the orbitally modulated P Cyg profile of He i λ5876, showing outflow velocities above 1000 km s-1. Results. We find that MWC 314 is a massive semi-detached binary system of ≃1.22 AU, observed at an inclination angle of i = 72.8° with an orbital period of 60.8 d and e = 0.23. The primary star is a low-vsini LBV candidate of m1 = 39.6 M⊙ and R1 = 86.8 R⊙. The detailed radiative transfer fits show that the geometry of wind density is asymmetric around the primary star with increased wind density by a factor of 3.3, which leads the orbit of the primary. The variable orientation causes the orbital modulation that is observed in absorption portions of P Cyg wind lines. Wind accretion in the system produces a circumbinary disc. Conclusions. MWC 314 is in a crucial evolutionary phase of close binary systems, when the massive primary star has its H envelope being stripped and is losing mass to a circumbinary disc. MWC 314 is a key system for studying the evolutionary consequences of these effects.
Spinal cord stimulation (SCS) is both relatively safe and reversible. Although SCS is generally regarded as a last resort, some of these patients will undergo additional spinal surgery after the ...device has been implanted or after its removal. We present a descriptive study of subsequent spinal surgery after SCS implantation.
A retrospective review of patients who had undergone percutaneous or paddle SCS lead placement at our institution from 2009 to 2016 was performed. Patients who had only undergone trials or who had not undergone spine surgery after SCS implantation were excluded.
We identified 22 patients (5.7%) who had undergone spine surgery during the course of SCS treatment or after SCS removal, or both, of a total 383 patients who had undergone paddle and/or percutaneous SCS implantation. The most common additional spine interventions included lumbosacral decompression and fusion (n = 15; 42%). Of 36 surgeries, the most frequent indications for subsequent intervention were stenosis or restenosis (n = 16; 73%) and spine deformity (n = 6; 27%). The median EuroQol-5D index was 0.397 preoperatively and 0.678 postoperatively.
To the best of our knowledge, the present study is the first to describe spine surgery in the setting of SCS implantation. Our results have indicated that spine surgery subsequent to, or concurrent with, SCS implantation appears to occur in few patients. Our study results suggest a modest improvement in quality of life outcomes. Therefore, clinicians should remember that patients might require further spine surgery despite the use of SCS implantation and, thus, might require reevaluation by the spine team.
BRASS is an international networking project of the Federal Government of Belgium for the development of a new public database providing accurate fundamental atomic data of vital importance for ...stellar spectroscopic research. The BRASS database will offer atomic line data that is thoroughly tested by comparing theoretical and observed stellar spectra. We are in the course of performing extensive quality assessments of selected atomic input data with advanced radiative transfer spectrum synthesis calculations that we compare in detail to high-resolution Mercator-HERMES and ESO-VLT-UVES spectra of very high signal-to-noise ratios for about 30 hot and cool bright stars of B, A, F, G, and K spectral types. The new database will provide the tested and validated values of absorption lines we retrieve from various existing atomic repositories, such as NIST and VAMDC. The validated atomic datasets, combined with the observed and theoretical spectra, will be interactively offered online at brass.sdf.org. The combination of these datasets is a novel approach for its development, which will provide a universal reference for advanced stellar spectroscopic research. We present the atmospheric parameter results of a subset of five benchmark stars observed with signal-to-noise ratios of 800–1200. The observed and theoretical spectra of the Sun and 51 Peg between 4000 and 6800 Å are offered online in the BRASS Data Interface. It also incorporates a new list of ∼900 metal lines for which we compute blending below 5% of the equivalent width useful for detailed line profile modeling and synthetic spectrum fit quality assessments of atomic line data.
BACKGROUND:Virtual reality (VR) simulation-based technologies play an important role in neurosurgical resident training. The Congress of Neurological Surgeons (CNS) Simulation Committee developed a ...simulation-based curriculum incorporating VR simulators to train residents in the management of common neurosurgical disorders.
OBJECTIVE:To enhance neurosurgical resident training for ventriculostomy placement using simulation-based training.
METHODS:A course-based neurosurgical simulation curriculum was introduced at the Neurosurgical Simulation Symposium at the 2011 and 2012 CNS annual meetings. A trauma module was developed to teach ventriculostomy placement as one of the neurosurgical procedures commonly performed in the management of traumatic brain injury. The course offered both didactic and simulator-based instruction, incorporating written and practical pretests and posttests and questionnaires to assess improvement in skill level and to validate the simulators as teaching tools.
RESULTS:Fourteen trainees participated in the didactic component of the trauma module. Written scores improved significantly from pretest (75%) to posttest (87.5%; P < .05). Seven participants completed the ventriculostomy simulation. Significant improvements were observed in anatomy (P < .04), burr hole placement (P < .03), final location of the catheter (P = .05), and procedure completion time (P < .004). Senior residents planned a significantly better trajectory (P < .01); junior participants improved most in terms of identifying the relevant anatomy (P < .03) and the time required to complete the procedure (P < .04).
CONCLUSION:VR ventriculostomy placement as part of the CNS simulation trauma module complements standard training techniques for residents in the management of neurosurgical trauma. Improvement in didactic and hands-on knowledge by course participants demonstrates the usefulness of the VR simulator as a training tool.
ABBREVIATIONS:CA, Cochran-ArmitageCNS, Congress of Neurological SurgeonsPGY, postgraduate yearVR, virtual reality
BACKGROUND:The science of medicine has undergone rapid advancement and expansion as a result of significant technological innovations, and this has affected the training of neurosurgical residents.
...OBJECTIVE:To develop a simulation-based neurosurgical educational curriculum to improve resident education.
METHODS:The Congress of Neurological Surgeons established a Simulation Committee to explore the use of this technology in maximizing neurosurgical education. Simulators were incorporated into an educational curriculum with both a didactic and a technical component. The simulators and didactic portions were validated with objective pretests and posttests.
RESULTS:The Simulator Committee has continued to expand the use of simulators in neurosurgical education and has organized several practical courses. The simulator use continues to expand into vasculature, spinal, and cranial modules. Each module has independently shown improved training scores in both didactic and technical skills.
CONCLUSION:The Congress of Neurological Surgeons has successfully incorporated simulation into an educational curriculum with both didactic and technical components. This appears to be a powerful educational tool, and its uses are being further expanded.
ABBREVIATIONS:ACGME, Accreditation Council for Graduate Medical EducationCNS, Congress of Neurological SurgeonsVR, virtual reality
The young open cluster NGC3293 is included in the observing program of the Gaia-ESO survey (GES). The radial velocity values provided have been used to assign cluster membership probabilities by ...means of a single-variable parametric analysis. These membership probabilities are compared to the results of the photometric membership assignment of NGC3293, based on UBVRI photometry. The agreement of the photometric and kinematic member samples amounts to 65 per cent, and could increase to 70 per cent as suggested by the analysis of the differences between both samples. A number of photometric PMS candidate members of spectral type F are found, which are confirmed by the results from VPHAS photometry and SED fitting for the stars in common with VPHAS and GES data sets. Excesses at mid- and near-infrared wavelengths, and signs of Hα emission, are investigated for them. Marginal presence of Hα emission or infilling is detected for the candidate members. Several of them exhibit moderate signs of U excess and weak excesses at mid-IR wavelengths. We suggest that these features originate from accretion discs in their last stages of evolution.
BACKGROUND:There is a growing attention to determine the factors that predict quality of life (QoL) improvement after deep brain stimulation (DBS) for Parkinsonʼs disease. Prior literature has ...largely focused on examining predictors one at a time, sometimes controlling for covariates.
OBJECTIVE:To develop a model that could be used as a nomogram to predict improvement in QoL following DBS surgery in patients with Parkinsonʼs disease.
METHODS:All patients with complete pre- and postoperative movement disorder and neuropsychological testing who underwent DBS at a single institution between 2007–2012 were analyzed. The Parkinsonʼs Disease Questionnaire-39 (PDQ-39) was used to measure QoL. Potential predictive factors, including patient demographics, clinical presentation characteristics, radiographic imaging, and motor and psychological testing were analyzed for impact on QoL.
RESULTS:Sixty-seven patients were identified, 36 (53.73%) of whom had meaningfully improved QoL following surgery. Five baseline variables showed significant relationships with the outcomeyears since symptom onset, percent change in on/off motor evaluation, levodopa equivalent daily dose, bilateral vs unilateral DBS implantation, and PDQ-39 score. The final model includes PDQ-39, percent change in UPRS-III, and years since symptom onset and is able to predict improvement in QoL with 81% accuracy.
CONCLUSION:Our model accurately predicted whether QoL would improve in patients undergoing subthalamic nucleus DBS 81% of the time. Our data may serve as the foundation to further refine a clinically relevant prognostic tool that would assist the decision-making process for clinicians and DBS multidisciplinary teams assessing patient candidacy for surgery.
The Belgian Repository of fundamental Atomic data and Stellar Spectra (BRASS) aims to provide one of the largest systematic and homogeneous quality assessment to date of literature atomic data ...required for stellar spectroscopy. By comparing state-of-the-art synthetic spectrum calculations with extremely high-quality observed benchmark spectra, we have critically evaluated fundamental atomic data, such as line wavelengths and oscillator strengths, for thousands of astrophysically-relevant transitions found in the literature and across several major atomic data repositories. These proceedings provide a short overview of the BRASS project to date, highlighting our recent efforts to investigate and quality-assess the atomic literature data pertaining to over a thousand atomic transitions present in FGK-type stellar spectra. BRASS provides all quality assessed data, theoretical spectra, and observed spectra in a new interactive database under development at brass.sdf.org.
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