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Disease Markers 2022To investigate the prognosis and influencing factors of early microsurgery for severe hypertensive brainstem hemorrhage.
OBJECTIVE
To investigate the prognosis and influencing factors of early microsurgery for severe hypertensive brainstem hemorrhage.
METHODS
The clinical data of 19 patients with severe hypertensive brainstem hemorrhage treated in the Department of Neurosurgery of the Second Affiliated Hospital of Shandong First Medical University between January 2018 and December 2021 were retrospectively analyzed. The clinical efficacy and risk factors affecting the prognosis were analyzed by chi-square test and multivariate logistic regression.
RESULTS
A total of 19 patients with severe hypertensive brainstem hemorrhage were treated by early microsurgery, including 14 cases by subtemporal approach and 5 cases by retrosigmoid approach. After 3 months of follow-up, 6 patients died and 13 patients survived. The 30-day and 90-day mortality rates were 21.1% and 31.6%, respectively, and the good prognosis rate was 15.4%. Univariate analysis showed that hematoma volume and hematoma clearance rate might be the factors affecting the prognosis of patients with severe hypertensive brainstem hemorrhage; the observed difference was statistically significant ( < 0.05). Multivariate logistic regression analysis further confirmed that hematoma volume was an independent factor affecting the death of patients with brainstem hemorrhage ( < 0.05), while hematoma volume (: 2.909, OR: 18.332, 95% CI: 1.020-329.458, : 0.048) was a risk factor.
CONCLUSION
Hematoma volume resulted as an independent factor affecting the death of patients with severe hypertensive brainstem hemorrhage. Early microsurgical clearance of brainstem hematoma contributed to reducing the 30-day and 90-day mortality and improving the prognosis of patients.
Topics: Brain Stem; Cerebral Hemorrhage; Hematoma; Humans; Hypertension; Microsurgery; Prognosis; Retrospective Studies
PubMed: 36193500
DOI: 10.1155/2022/5062591 -
Journal of Dentistry Jun 2023The study aimed to develop and validate machine learning models for case difficulty prediction in endodontic microsurgery, assisting clinicians in preoperative analysis.
OBJECTIVES
The study aimed to develop and validate machine learning models for case difficulty prediction in endodontic microsurgery, assisting clinicians in preoperative analysis.
METHODS
The cone-beam computed tomographic images were collected from 261 patients with 341 teeth and used for radiographic examination and measurement. Through linear regression (LR), support vector regression (SVR), and extreme gradient boosting (XGBoost) algorithms, four models were established according to different loss functions, including the L1-loss LR model, L2-loss LR model, SVR model and XGBoost model. Five-fold cross-validation was applied in model training and validation. Explained variance score (EVS), coefficient of determination (R), mean absolute error (MAE), mean squared error (MSE) and median absolute error (MedAE) were calculated to evaluate the prediction performance.
RESULTS
The MAE, MSE and MedAE values of the XGBoost model were the lowest, which were 0.1010, 0.0391 and 0.0235, respectively. The EVS and R values of the XGBoost model were the highest, which were 0.7885 and 0.7967, respectively. The factors used to predict the case difficulty in endodontic microsurgery were ordered according to their relative importance, including lesion size, the distance between apex and adjacent important anatomical structures, root filling density, root apex diameter, root resorption, tooth type, tooth length, root filling length, root canal curvature and the number of root canals.
CONCLUSIONS
The XGBoost model outperformed the LR and SVR models on all evaluation metrics, which can assist clinicians in preoperative analysis. The relative feature importance provides a reference to develop the scoring system for case difficulty assessment in endodontic microsurgery.
CLINICAL SIGNIFICANCE
Preoperative case assessment is a crucial step to identify potential risks and make referral decisions. Machine learning models for case difficulty prediction in endodontic microsurgery can assist clinicians in preoperative analysis efficiently and accurately.
Topics: Humans; Microsurgery; Root Canal Therapy; Cone-Beam Computed Tomography; Algorithms
PubMed: 37080531
DOI: 10.1016/j.jdent.2023.104522 -
World Neurosurgery Oct 2020
Topics: Betacoronavirus; COVID-19; Coronavirus Infections; Eye Protective Devices; Humans; Microsurgery; Neuroendoscopes; Neurosurgical Procedures; Pandemics; Personal Protective Equipment; Pneumonia, Viral; SARS-CoV-2; Surveys and Questionnaires
PubMed: 32413563
DOI: 10.1016/j.wneu.2020.04.251 -
World Journal of Gastroenterology Jul 2020Liver transplantation (LT) is currently the only effective treatment option for end-stage liver disease. The importance of animal models in transplantation is widely... (Review)
Review
Liver transplantation (LT) is currently the only effective treatment option for end-stage liver disease. The importance of animal models in transplantation is widely recognized among researchers. Because of the well-characterized mouse genome and the greater diversity and availability of both genetically modified animals and research reagents, mouse orthotopic LT (MOLT) has become an ideal model for the investigation of liver biology, tissue injury, regulation of alloimmunity and tolerance induction, and the pathogenesis of specific liver diseases. However, due to its complicated and technically demanding procedure, the model has merely been used by only a few research groups in the world for years. For a new learner, training lasting at least a couple of months or even years is required. Most of the investigators have emphasized the importance of elaborate techniques and dedicated instruments in establishing a MOLT model, but some details are often neglected. The nontechnical details are also significant, especially for researchers who have little experience in mouse microsurgery. Here, we review and summarize the crucial technical and nontechnical details in establishing the model of MOLT based on scientific articles and our experience in six aspects: animal selection, anesthesia, perioperative management, organ procurement, back-table preparation, and implantation surgery. We aim to enable research groups to shorten the learning curve and implement the mouse LT procedure with high technical success.
Topics: Animals; Disease Models, Animal; Humans; Liver Diseases; Liver Transplantation; Mice; Microsurgery
PubMed: 32774064
DOI: 10.3748/wjg.v26.i27.3889 -
Journal of Clinical Neuroscience :... Sep 2022In the surgical approach to treat deep-seated intracranial lesions, endoscopes can be used to assist microsurgical operations and improve outcomes. This technique is... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
In the surgical approach to treat deep-seated intracranial lesions, endoscopes can be used to assist microsurgical operations and improve outcomes. This technique is often called endoscope-assisted microneurosurgery (EAM). This systematic review and meta-analysis aimed to evaluate the feasibility, safety, and effectiveness of EAM.
METHODS
We performed a meta-analysis of relevant articles identified using PubMed, Embase, and the Cochrane Central Register to assess the efficacy of EAM according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria. Primary outcomes were repositioning of the definitive clip, better surgical field, the overall and endoscope-related complication rates, mortality, and the rate of follow up.
RESULTS
A total of 10 studies of 1,432 patients with 1,717 aneurysms treated with EAM were included. EAM led to repositioning of the definitive clip in 13% (95% CI, 9%-17%; I = 72.61%; p < 0.001); 77% of aneurysms treated with endoscopically assisted vision and information had a better outcome than that with standard surgery (95% CI, 52%-95%; I = 97.63%; p < 0.001). There was an overall complication rate of 6% (95% CI, 1%-13%; I = 91.39%; p < 0.001). The incidence of endoscope-related complications was 0% (95% CI, 0%-1%; I = 64%; p < 0.001). The mortality was 0% (95% CI, 0-1%; I = 0.0%); and 94% of patients had an excellent to good recovery and good outcome (95% CI, 88%-98%; I = 88.42%; p < 0.001).
CONCLUSIONS
Our comprehensive study showed that EAM for intracranial aneurysms is feasible, the safety of the surgery is good, and the patients have a good prognosis, Therefore, we think EAM can be more widely adopted in the future.
Topics: Endoscopes; Humans; Intracranial Aneurysm; Microsurgery; Surgical Instruments; Treatment Outcome
PubMed: 35816766
DOI: 10.1016/j.jocn.2022.06.029 -
British Dental Journal Jul 2020
Topics: Dental Care; Humans; Microsurgery
PubMed: 32651489
DOI: 10.1038/s41415-020-1904-0 -
Neurology India 2022Spinal dural arteriovenous fistula (SDAVF) is a rare but curable condition. Microsurgery is a highly effective and readily affordable treatment modality.
BACKGROUND AND INTRODUCTION
Spinal dural arteriovenous fistula (SDAVF) is a rare but curable condition. Microsurgery is a highly effective and readily affordable treatment modality.
OBJECTIVE
We present a surgical video of SDAVF to demonstrate the operative nuances involved.
SURGICAL TECHNIQUE
A 53-year-old wheelchair-bound man with spastic paraparesis for 1.5 years was found to have a SDAVF at L1/2 level with a single fistula point. During surgery, a L1-L2 laminectomy and durotomy revealed a dilated vein accompanying the nerve root exiting L1/2 foramen that showed early filling on indocyanine green (ICG) video angiography. This vein was occluded, and a segment of this vein was removed during surgery, which led to resumption of normal spinal cord perfusion.
RESULTS
The patient showed gradual recovery of lower limb motor power and improved to assisted ambulation after 3 months.
CONCLUSIONS
Surgery is a simple, effective, and cost-effective treatment option in SDAVF.
Topics: Angiography; Central Nervous System Vascular Malformations; Humans; Laminectomy; Male; Microsurgery; Middle Aged; Neurosurgical Procedures; Spinal Cord; Spine
PubMed: 35263853
DOI: 10.4103/0028-3886.338640 -
Fertility and Sterility Oct 2019
Topics: Azoospermia; DNA Damage; Fertilization in Vitro; Humans; Hypogonadism; Male; Microsurgery; Varicocele
PubMed: 31561866
DOI: 10.1016/j.fertnstert.2019.08.057 -
Computers in Biology and Medicine Feb 2022In microsurgical procedures, surgeons use micro-instruments under high magnifications to handle delicate tissues. These procedures require highly skilled attentional and...
In microsurgical procedures, surgeons use micro-instruments under high magnifications to handle delicate tissues. These procedures require highly skilled attentional and motor control for planning and implementing eye-hand coordination strategies. Eye-hand coordination in surgery has mostly been studied in open, laparoscopic, and robot-assisted surgeries, as there are no available tools to perform automatic tool detection in microsurgery. We introduce and investigate a method for simultaneous detection and processing of micro-instruments and gaze during microsurgery. We train and evaluate a convolutional neural network for detecting 17 microsurgical tools with a dataset of 7500 frames from 20 videos of simulated and real surgical procedures. Model evaluations result in mean average precision at the 0.5 threshold of 89.5-91.4% for validation and 69.7-73.2% for testing over partially unseen surgical settings, and the average inference time of 39.90 ± 1.2 frames/second. While prior research has mostly evaluated surgical tool detection on homogeneous datasets with limited number of tools, we demonstrate the feasibility of transfer learning, and conclude that detectors that generalize reliably to new settings require data from several different surgical procedures. In a case study, we apply the detector with a microscope eye tracker to investigate tool use and eye-hand coordination during an intracranial vessel dissection task. The results show that tool kinematics differentiate microsurgical actions. The gaze-to-microscissors distances are also smaller during dissection than other actions when the surgeon has more space to maneuver. The presented detection pipeline provides the clinical and research communities with a valuable resource for automatic content extraction and objective skill assessment in various microsurgical environments.
Topics: Biomechanical Phenomena; Deep Learning; Microsurgery; Neural Networks, Computer; Robotic Surgical Procedures
PubMed: 34968859
DOI: 10.1016/j.compbiomed.2021.105121 -
Andrologia Aug 2022The objective of this study was to identify factors that predict for sperm granuloma formation and the impact of sperm granuloma presence and quantity on vasectomy...
The objective of this study was to identify factors that predict for sperm granuloma formation and the impact of sperm granuloma presence and quantity on vasectomy reversal (VR) outcomes. A cross sectional retrospective review of prospectively collected data, on the impact of granuloma on VR outcomes from a single academic center was performed. The impact of age, obstructive interval, intraoperative vasal fluid findings, anastomosis type, body mass index, tobacco use and total motile count (TMC) was determined. A total of 1550 men underwent VR between January 2000 and August 2019. Granulomas were present unilaterally in 23.3% (n = 361) and bilaterally in 14.2% (n = 220). On univariate analysis, increasing patient age negatively correlated with a larger number of granulomas (p = .011). Granuloma presence was associated with finding intact and motile sperm from the vasal stump intraoperatively (p = .001), and vasoepididymostomy anastomosis (p < .001). However, granuloma presence (and quantity) did not correlate with obstructive interval or maximum TMC. Tobacco use and body mass index (BMI) were not associated with granuloma presence. On multivariate analysis, granuloma quantity was not associated with TMC. Obstructive interval and vasovasostomy anastomosis were associated with higher TMC, while BMI was negatively associated with TMC. In conclusion, increasing age was negatively correlated with granuloma formation. Granuloma presence was associated with more favourable intraoperative fluid findings and anastomosis type, but not post-VR TMC, suggesting men with and without granulomas undergoing skilled microsurgery will have similar patency rates. Heavier men should be encouraged for weight loss prior to vasectomy reversal as increasing BMI was associated with lower TMC.
Topics: Cross-Sectional Studies; Granuloma; Humans; Male; Microsurgery; Semen; Spermatozoa; Vasectomy; Vasovasostomy
PubMed: 35524153
DOI: 10.1111/and.14439