Current Surgical Techniques Research Articles

Signal protein-functionalized gold nanoparticles for nuclear targeting into osteosarcoma cells for use in radiosensitization experiments.

The standard therapy for malignant primary bone tumors such as osteosarcoma involves major surgeries. For tumors located in difficult regions such as the pelvis, surgical intervention could lead to serious side effects for example loss of a limb and/or function, loss of bowel, bladder and sexual function as well as problems with wound healing and surgical complications. Therefore, exploring other approaches that can improve or complement current surgical techniques is important. Hence, sensitizing primary bone tumors to radiation could offer an additional strategy that could complement surgery and significantly improve survival and quality of life. Gold nanoparticles (AuNPs) have been shown to enhance radiosensitivity by increasing the local dose of radiation inside tumors. Therefore, the referred procedure of preparation and functionalization of gold nanoparticles may be used for investigation whether DNA repair inhibition in the presence of AuNPs leads to an effective radiosensitizing strategy for primary bone tumor cells and explore the mechanism of how this may be happening. In our work, we prepared gold nanoparticles and verified the relation between the size of the AuNPs and their uptake in tumor 143B cells and also investigated whether the optimal size of the AuNPs should not be smaller than the size of nuclear envelope pores (20-50 nm). Hence, two different AuNPs systems were prepared: the first one with AuNPs core size of about 5 nm (BS) and the second one with AuNPs core size of about 50 nm (ZA). For cellular AuNPs uptake enhancement, we functionalized the AuNPs with signaling peptides. For this purpose we prepared PEG-coated AuNPs functionalized with signal peptides for targeted transport into the cytoplasm (CPP) and into the cell nucleus (CPP + NLS). The toxicity of the AuNPs systems was assessed by MTS assay. We prepared stable functionalized AuNPs systems of both sizes. With the functionalizing of the AuNPs using signal peptides (CPP, NLS), the AuNPs penetrated into the cell nucleus. The referred procedure of preparation and functionalization of gold nanoparticles may be used for investigating inhibition of DNA repair in the presence of AuNPs and it could lead to new understanding in overcoming radioresistance in primary bone tumor cells.

Técnicas quirúrgicas actuales en el cáncer de recto

espanolEl cancer de recto es actualmente una de las enfermedades que implican una mayor morbimortalidad en la sociedad, tanto para la persona que lo sufre como para la esfera que lo rodea. La evolucion en este tipo de tumores permiten abandonar el concepto clasico de grandes incisiones y extensas resecciones, para acercarnos al abordaje minimamente invasivo, y a realizar la reseccion que sea unicamente necesaria, buscando preservar la integridad esfinterica en el paciente, y tratando de evitar en la medida de lo posible la confeccion de ostomias.La mayoria de las investigaciones que se realizan sobre el cancer de recto, van encaminadas a la mejora en los tratamientos complementarios a la cirugia, como los tratamientos quimioterapicos neoadyuvantes, y los farmacos posteriores a la cirugia, es decir, la quimioterapia adyuvante. Unicamente un tercio de los estudios que se llevan a cabo son para mejorar la tecnica quirurgica. En este apartado, la aparicion de la cirugia laparoscopica, el uso de dispositivos a traves de orificios naturales para realizar cirugia local, la aparicion de la cirugia combinada TaTME, y el auge de la cirugia robotica, parecen ser la antesala de lo que se desarrollara en un futuro respecto a las mejoras quirurgicas. En esta revision, queremos poner de manifiesto un resumen del tratamiento quirurgico del cancer de recto, haciendo especial hincapie en las nuevas tecnicas y avances, con una breve resena historica y anatomica, sin olvidar la importancia y seguridad para el paciente, tanto en la misma cirugia, como en los resultados oncologicos posteriores. EnglishRectal cancer is currently one of the diseases that imply greater morbidity and mortality in society, both for people suffering and for the people around. The evolution in this type of tumors allows us to leave the classic concept of large incisions and extensive resections towards the minimally invasive approach, and to perform the resection that is only necessary, seeking to preserve the sphincteric integrity in the patient, and trying to avoid as much as possible ostomies.Most of rectal cancer research is aimed to improving complementary treatments to surgery, such as neoadjuvant chemotherapeutic treatments, and post-surgery drugs. Only one third of the studies carried out are focused on improvig the surgical technique. In this section, the appearance of laparoscopic surgery, the use of devices through natural holes to perform local surgery, the appearance of TaTME combined surgery, and the rise of robotic surgery, seem to be the prelude to what will be developed. in the future regarding surgical improvements.In this review, we want to highlight a summary of the surgical treatment of rectal cancer, with special emphasis on new techniques and advances and also a brief historical and anatomical review, also including the importance and safety for the patient both in the surgery and subsequent cancer follow-up.

Complex Hernia Repair

Complex Hernia Repair Abstract. Treatment of complex hernia is underestimated and remains a challenge. Often tailored surgical techniques are required. The anatomy of the abdominal wall is reconstructed and reinforced by the placement of a mesh. In this article current surgical techniques of abdominal wall reconstruction are discussed.

Antimicrobial Prophylaxis for the Prevention of Surgical Site Infections in Orthopaedic Oncology - A Narrative Review of Current Concepts.

The incidence of surgical site infections (SSIs) after elective tumour orthopaedic surgery in adults is higher than non-oncologic orthopaedic surgery. Their causative microorganisms and antibiotic susceptibilities are also different from the non-oncologic cases; with no apparent predictable microbiological patterns. Clinicians continue to struggle to tailor the optimal prophylactic regimen for the very heterogeneous group of tumour patients. Many clinicians thus prolong the first-and second-generation cephalosporin agents, while a minority chooses to broaden the antimicrobial spectrum by combination prophylaxis. The variability in current practices and surgical techniques is enormous, even within the same setting. The scientific literature lacks adequate retrospective case-studies and there is currently only one prospective randomized trial. In this narrative review, we discuss various perioperative antibiotic concepts in oncologic orthopaedic surgery, including a summary of the state-to-the-art, opinions and difficulties related to the different prophylactic strategies.

Multicentric Registry Study on Epidemiological and Biological Disease Profile as Well as Clinical Outcome in Patients with Low-Grade Gliomas: The LoG-Glio Project.

World Health Organization (WHO) grade II low-grade gliomas (LGGs) in adults are rare, and patients' mean overall survival (OS) is relatively long. Epidemiological data on factors influencing tumor genesis and progression are scarce, and prospective data on surgical management are still lacking. Because of the molecular heterogeneity of LGG, a comprehensive molecular characterization is required for any clinical and epidemiological research. Further, a detailed radiologic assessment is needed as the only established objective criterion for progressive disease. Both radiologic and molecular assessments have to be standardized to produce comparable data. The aim of the registry is to improve the evidence for surgical management of LGG patients by establishing a multicenter registry with a strong surgical and clinical focus including mandatory biobanking. The LoG-Glio project is a prospective national observational multicenter registry that began on November 1, 2015. Inclusion criteria encompass all patients > 18 years of age with a radiologic suspicion of LGG. Patients with severe neurologic or psychiatric disorders that may interfere with their informed consent or if there is no possibility for further follow-up are excluded. Diagnosis of glioblastoma WHO grade IV isocitrate dehydrogenase (IDH) wild type leads to a secondary exclusion of patients. In addition to demographic data, results of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire, add-on for patients with brain tumors, and National Health Institute Stroke Scale before and after surgery and during regular follow-ups are collected. At each time point a detailed recording of surgical and adjuvant treatment is performed. Radiologic assessment involves three-dimensional (3D) acquisition of T1, fluid-attenuated inversion recovery, and T2 sequences. For the final evaluation, a central detailed neuropathologic and molecular assessment of tumor samples and a radiologic evaluation of imaging sets are part of the study protocol. We report the first 100 consecutively registered patients for LoG-Glio. Three patients dropped out due to loss of follow-up. Of the remaining recruited patients, 8 were classified as wait and scan; 89 had surgery. Using the inclusion criteria described previously, 70 patients had an IDH-mutated glioma, 10 had miscellaneous rare LGGs, and 8 patients had an IDH wild-type WHO grade II or III glioma. The LoG-Glio registry has been successfully implemented. Applied selection criteria result in an appropriately balanced patient cohort. Short-term outcome data on epidemiology as well as the influence of current surgical techniques and adjuvant treatment on patient outcomes are expected. In the long run, the aim of the registry is to validate the new molecular-based WHO classification and the influence of the extent of resection on progression-free survival and OS. The registry provides an open platform for future research projects benefiting patients with LGG. NCT02686229 Clinical trials.

The use of L‐PRF and A‐PRF for three‐dimensional gain in implantation sites – The open wound technique

Background Since the discovery of osseointegration in the 1960s, the greatest challenge for the placement of functional implants is the presence of an implantation site - a muco-osseous envelope that guarantees these proper three-dimensional positioning. Several strategies to overcome this quest have been proposed in the last decades, most notably techniques of Tissue Engineering (Langer and Vacanti, 1993). In recent years dentists have seen a primordial shift in regenerative and reconstructive techniques such as the inductive and conductive function of potential of blood concentrates. Through the fundamental use of Tissue Engineering in clinical procedures, technical and conceptual modifications have contributed to the adoption of more scientifically efficient, less-invasive and less-morbid solutions. These have substantially improved the outcomes of surgical procedures with the use of three-dimensional blood transitory matrix. Nonetheless, achieving clinical results would require a revolution in current surgical techniques. Obtaining of maximum efficiency when using blood concentrate matrices can be conquered through principals of biomodulation with biofunctional sutures and biotensegrity. In this scenario, the aim of this work is to present and describe of procedures that we call Biologically Intelligent Tissue Engineering (BITE), through a series of clinical cases using a new procedure called the Open Wound Technique. Aim/Hypothesis The aim of this work is to evaluate the gain of keratinized mucosa+ phenotype modification+ bone profile in twenty implantation sites. This will be performed with the use of BITE (Biologically Intelligent Tissue Engineering) methodology, using the technique of the Open Wound. Material and Methods Twenty edentulous sites of immediate and late placement of implants were evaluated by calibrate examination in a probe measuring the thickness of peri-implant mucosa. After the implant's placement, the surgical site was filled with L-PRF or A-PRF plugs and covered by six to eight PRF membranes inserted in bone-mucoperiosteal flap interface. These were left exposed to the oral environment. The flaps were stabilized by layered sutures. The evolution of the wound repair was registered periodically (3 days, 7 days, 15 days, 30 days and 1-year follow-up), as well as the thickness of keratinized mucosa and tomographic profile were measured within 30 and 60 days and after 1 year. Results In all cases the PRF plugs and membranes were replaced by healthy keratinized tissue with 1.5–4 mm thickness (average of 3 mm) and modified with peri-implant phenotype. The bone profile average gain was identified by tomographic evaluation and ranged in thickness from 0.5 to 1.5 mm. The value remained the same after 1 year of follow-up. Conclusion and Clinical Implications The Biologically Intelligent Tissue Engineering (BITE), can and will improve the peri-implant tissues with three-dimensional gain through a series of a new procedure called the Open Wound Technique. The outcome will be a less morbid and invasive strategy for development and correction of small defects in implantation sites

Type II Medial Meniscus Root Repair With Peripheral Release for Addressing Meniscal Extrusion

Medial meniscal root tears are often disabling injuries that can occur in isolation during low-velocity, deep knee flexion maneuvers in middle-aged patients. The most common meniscal root tear pattern is a radial tear near the root attachment (type II). Root tears are often associated with meniscal extrusion, identified on magnetic resonance imaging. Relocation of the meniscal root to its anatomic center is a reported current difficulty faced by surgeons during surgical repair. However, this can be achieved via sufficient peripheral release of the posteromedial capsular attachment of the medial meniscus. The purpose of this Technical Note is to describe the authors' current surgical technique for medial meniscus root repair with a peripheral release for addressing meniscal extrusion. Classifications: level I (knee); level II (meniscus).

Comparison of outpatient versus inpatient total hip and knee arthroplasty: A systematic review and meta-analysis of complications

IntroductionPatients undergoing TKA or THA have traditionally been managed post-operatively as inpatients. However, with current surgical techniques and pain management, there is evidence that outpatient joint arthroplasty can be safely performed in selected patient. This systematic review and meta-analysis aimed to compare the post-operative complication rates of outpatient and inpatient TJA with subgroup analysis of TKA and THA. MethodsElectronic searches were performed using five databases from their date of inception to October 2018. Relevant studies were identified, with data extracted and meta-analyzed from the studies. ResultsFrom seven included studies, 176,179 patients were inpatient TJA and 1613 were outpatient TJA. The outpatient and inpatient TJA cohorts had similar mean age and BMI, with a greater proportion of females in the inpatient group. For TJA we found no significant difference in total complications (P = 0.06), major complications (P = 0.59), readmissions (P = 0.60), DVT (P = 0.94), UTI (P = 0.50), pneumonia (P = 0.42) and wound complications (P = 0.50) between the outpatient and inpatient groups. However, there were fewer transfusions (P = 0.05) but increased reoperations (P = 0.02) in the outpatient TJA group. Subgroup analysis of TKA (P = 0.25) and THA (P = 0.39) also found no significant differences in total complications between the outpatient and inpatient groups. ConclusionOutpatient TJA had comparable total complication rates to inpatient TJA. Along with that outpatient TJA can significantly reduce costs to healthcare systems but careful pre-operative patient selection is required to optimize outcomes. More quality randomized controlled trials with longer follow-up periods are needed to add to this body of evidence.

Сучасні методи хірургічної реабілітації пацієнтів з тотальними симблефаронами обох повік

Сучасні методи хірургічної реабілітації пацієнтів з тотальними симблефаронами обох повік

Revision Ulnar Collateral Ligament Reconstruction in Professional Baseball: Current Trends, Surgical Techniques, and Outcomes.

Background:Ulnar collateral ligament (UCL) reconstruction of the elbow is commonly performed on professional baseball pitchers. Recent reports have suggested that revision rates are on the rise and may be higher than previously thought.Purpose:To provide a comprehensive report on current trends, surgical techniques, and outcomes of revision UCL reconstructions performed on professional baseball pitchers between 2010 and 2016.Study Design:Case series; Level of evidence, 4.Methods:The Major League Baseball Health and Injury Tracking System (HITS) was used to compile records of all revision UCL reconstructions performed on professional baseball pitchers between 2010 and 2016. Player data and outcomes were obtained from HITS, and surgical details were obtained from operative reports. Descriptive statistical analysis was performed on epidemiologic data. Outcomes (return to play [RTP] rates, RTP times, subsequent injuries, and subsequent surgeries) were compared across the most common surgical techniques (docking vs modified Jobe) and graft sources (palmaris longus autograft vs hamstring autograft).Results:A total of 69 professional baseball pitchers underwent revision UCL reconstruction from 2010 to 2016 at an average of 1424 days (47 months) after their primary surgery. A trend was seen toward increasing numbers of revision surgeries over time (R2 = 0.441; P = .104). The most commonly used tunnel configuration was the modified Jobe technique (n = 41; 59.4%), and the most commonly used graft was hamstring autograft (n = 34; 49.3%). A majority (76.6%) of pitchers achieved RTP, and 55.3% were able to return to the same level of play. Mean time to RTP was 436 days (14.5 months) for players with a palmaris longus autograft versus 540 days (18 months) for those with a hamstring autograft (P = .108). Further, the mean time to RTP was 423 days (14 months) for the docking technique versus 519 days (17 months) for the modified Jobe technique (P = .296). Similar rates of subsequent injuries and surgeries were noted between the 2 revision techniques and 2 most commonly used graft constructs.Conclusion:Revision UCL reconstruction showed relatively high RTP rates (77%), but only 55% of players returned to their same level of play. Mean time to RTP was shorter than that found in other, smaller investigations. Although general trends were seen toward decreased time to RTP for the docking technique and palmaris longus autograft, these differences did not reach statistical significance.

A feasibility study to investigate post-operative oxygen consumption (POpOC) after colorectal surgery requiring bowel resection

BackgroundOxygen consumption after surgery is increased in response to the tissue trauma sustained intra-operatively and the subsequent systemic inflammatory response that ensues. The cardio-respiratory system must match the tissue oxygen and metabolic requirements; otherwise, peri-operative complications may occur. Existing data is several decades old. The primary objective of this feasibility study was to determine the ease of recruiting participants and collecting relevant data to assess the extent and duration of increased oxygen consumption and post-operative complications after major abdominal surgery in contemporaneous times.MethodsOne hundred patients scheduled for elective colorectal surgery requiring a bowel resection were screened to test specific feasibility criteria relating to ease of recruitment, duration of post-operative stay, ease of data collection, and drop-out rates. A calibrated metabolic cart was used to obtain unblinded pre-operative resting oxygen consumption recordings. The metabolic cart was then used to obtain post-operative oxygen consumption readings on days 1 to 5 as long as the participant remained as an inpatient. At the time of the oxygen consumption reading, a Post-Operative Morbidity Survey score (POMS) was calculated. Feasibility outcomes chosen a priori were that at least one participant would be recruited every 2 weeks from the pre-admission colorectal clinic, at least 10% of potential subjects screened would be enrolled, at least 80% of recruited participants would have a minimum post-operative stay of 2 nights, a minimum of 3 consecutive days of oxygen consumption data would be collected for each subject, at least 8 of 9 POMS score domains would be completed per participant per day and the drop-out rate would be no greater than 10%. We deemed that screening 100 patients would be sufficient to test our feasibility outcomes.ResultsTwelve participants completed the protocol. All pre-specified feasibility criteria were met. No increase in post-operative oxygen consumption was observed in this feasibility cohort.ConclusionsThe protocol and experiences gained from this feasibility study could be used to plan a larger study to better define changes in post-operative oxygen consumption after major abdominal surgery utilizing current surgical techniques.

Revision Ulnar Collateral Ligament Reconstruction in Professional Baseball: Current Trends, Surgical Techniques, and Outcomes

Objectives: Ulnar collateral ligament (UCL) reconstruction of the elbow is a commonly performed surgery on professional baseball pitchers. Recent reports have suggested that revision rates are on the rise and may be higher than previously thought. The purpose of this study is to provide a comprehensive report on current trends, surgical techniques, and outcomes of revision UCL reconstructions performed on professional baseball pitchers between 2010 and 2016. Methods: The Major League Baseball (MLB) Health and Injury Tracking System (HITS) was used to compile records of all revision UCL reconstructions performed on professional baseball pitchers between 2010 and 2016. Player data and outcomes were obtained from HITS while surgical details were obtained from operative reports. Descriptive statistical analysis was performed on epidemiologic data. Outcomes (return to play rates, return to play times, subsequent injuries, and subsequent surgeries) were compared across the most common surgical techniques (Docking vs. Modified Jobe) and graft sources (palmaris longus autograft vs. hamstring autograft). Results: A total of 69 professional baseball pitchers underwent revision UCL reconstruction from 2010 to 2016 at an average of 1,424 days (47 months) after their primary surgery. There was a trend toward increasing numbers of revision surgeries over time (R2=0.441; p=0.104). The most commonly used tunnel configuration was the Modified Jobe technique (n=41, 59.4%) and the most common graft utilized was hamstring autograft (n=34, 49.3%). 76.6% of pitchers were able to return to play (RTP) and 55.3% were able to return to the same level of play. Mean time to RTP in players with a palmaris longus autograft was 436 days versus 540 days for hamstring autograft (p=0.108) and the mean time to RTP in players was 423 days for the Docking technique versus 519 days for the Modified Jobe technique (p=0.296). Similar rates of subsequent injuries and surgeries were noted between the two revision techniques and two most commonly used graft constructs. Conclusion: This report detailing revision UCL reconstruction amongst professional baseball pitchers showed a trend towards increasing numbers of revisions being performed, a finding consistent with other recent studies. The overall return to play percentage was higher than previously reported (76.6%); however, significantly fewer (55.3%) players returned to the same level of play. This work also demonstrated decreased return to play times (n=484 days, SD: 117.3) compared to other investigations. The Modified Jobe was the most commonly used surgical technique and the two most commonly used graft constructs were hamstring autograft and palmaris longus autograft. Although this analysis did not reveal any statistically significant comparative differences between surgical techniques or graft constructs, future studies involving head-to-head comparisons of these surgical variables, specific to revision UCL reconstruction, may be helpful in improving player outcomes and career performance.

Revision Stapes Surgery in a Tertiary Referral Center: Surgical and Audiometric Outcomes.

Objectives:To evaluate pure-tone audiometric results in otosclerosis patients undergoing revision stapes surgery following previous middle ear interventions.Methods:A retrospective cohort study was performed in a tertiary referral center. Consecutive otosclerosis patients who underwent revision stapes surgeries, following previous middle ear interventions, for persistent conductive hearing loss, recurrent conductive hearing loss, or vertigo and had available postoperative pure-tone audiometry were included. Mean pre- and postoperative air conduction, bone conduction, and air-bone gap averaged over 0.5, 1, 2, and 3 kHz were obtained. Audiometric outcomes were obtained at 7 weeks postoperatively.Results:In total, 63 consecutive otosclerosis patients who underwent 66 revision stapes surgeries were included. Air-bone gap improved significantly with a mean gain of 19 dB (95% CI, 15-22). Air conduction improved significantly with a mean gain of 18 dB (95% CI, 14-23). Bone conduction did not change significantly, with a mean deterioration of 0 dB (95% CI, –2 to 1). Air-bone gap closure to 10 dB or less was achieved in 38% of cases and to 20 dB or less in 80% of cases. Indication for surgery, previous type of procedure, primary cause of failure, and current surgical technique were not significantly associated with air-bone gap closure to 10 dB or less. Indication for surgery and primary cause of failure were associated with one another.Conclusions:Compared to the available literature, a slightly larger gain in air conduction and air-bone gap was achieved in our study. Air-bone gap closure to 10 dB or less was achieved less often in our study.

Product Development of a Bio-Composite Medical Device

The paper presents a development methodology for a new bio-composite medical device used in extensive anatomical reconstructions. Current surgical techniques and devices include auto transplant, surgical meshes or even acellular devices. Due to the high degree of reconstruction and large amount of exposed tissue, the surgeries tend to have high re-intervention rates, leading to severe complications and even death. A functional approach is proposed to develop an improved medical device for the treatment of these severe traumatic lesions. A six step methodology is presented, validating the first three with the development of several concepts. The general need is accurately identified using the APTE instrument and a FAST diagram is constructed for one product existence stage. Nine concepts are generated using the proposed methodology and three were preliminarily kept for development. Further research will be undertaken for manufacturing and testing of the final selected concept.

Surgical outcomes of chronic isolated scapholunate interosseous ligament injuries: a systematic review of 805 wrists

Management of chronic isolated scapholunate interosseous ligament (SLIL) injuries has generated a substantial volume of low-quality literature with descriptions of multiple new surgical techniques, and the impact of instability pattern and the optimal surgical technique remain unclear. The primary goal of this review was to compare clinical, radiographic and patient-rated outcomes between current surgical techniques. We performed a systematic literature search using multiple databases. We analyzed clinical, radiographic and patient-reported outcomes. We used a fixed-effects model weighted by sample size with combined outcomes estimated via least squares means with 95% confidence intervals. We also performed a subgroup analysis of static versus dynamic instability. We assessed 805 procedures from 37 study groups, with 429 procedures used in subgroup analysis. There were no statistically significant differences in outcomes between surgical techniques or in subgroup analysis. Overall, postoperative wrist flexion and pain scores decreased, and grip strength and patient-rated outcomes improved. Compared to overall preoperative values, modest improvements in pain score, grip strength and functional outcome scores were obtained from a range of reconstructive procedures performed for chronic isolated SLIL injuries. No significant differences could be ascertained between surgical techniques, potentially owing to the low quality of evidence and procedure heterogeneity. This study provides accurate preoperative reference values for future studies, highlights the controversial clinical impact of instability classification, and the need for higher-quality multicentre or collaborative trials to improve our understanding and management of this common injury.

Современные подходы в хирургическом лечении макулярных разрывов

Современные подходы в хирургическом лечении макулярных разрывов

Calibration of fluorescence imaging for tumor surgical margin delineation: multistep registration of fluorescence and histological images.

Although a greater extent of tumor resection is important for patients' survival, complete tumor removal, especially tumor margins, remains challenging due to the lack of sensitivity and specificity of current surgical guidance techniques at the margins. Intraoperative fluorescence imaging with targeted fluorophores is promising for tumor margin delineation. To verify the tumor margins detected by the fluorescence images, it is necessary to register fluorescence with histological images, which provide the ground truth for tumor regions. However, current registration methods compare fluorescence images to a single-layer histological slide, which is selected subjectively and represents a single plane of the three-dimensional tumor. A multistep pipeline is established to correlate fluorescence images to stacked histological images, including fluorescence calibration and multistep registration. Multiple histological slices are integrated as a two-dimensional (2-D) tumor map using optical attenuation model and average intensity projection. A BLZ-100-labeled medulloblastoma mouse model is used to test the whole framework. On average, the synthesized 2-D tumor map outperforms the selected best slide as ground truth [Dice similarity coefficient (DSC): 0.582 versus 0.398, with significant differences; mean area under the curve (AUC) of the receiver operating characteristic curve: 88% versus 85.5%] and the randomly selected slide as ground truth (DSC: 0.582 versus 0.396 with significant differences; mean AUC: 88% versus 84.1% with significant differences), which indicates our pipeline is reliable and can be applied to investigate targeted fluorescence probes in tumor margin detection. Following this proposed pipeline, BLZ-100 shows enhancement in both tumor cores and tumor margins (mean target-to-background ratio: and , respectively).

Primary Repair of the Anterior Cruciate Ligament: A Review of Recent Literature (2016-2017).

Anterior cruciate ligament (ACL) reconstruction using tendon or ligament autograft is the current gold standard surgical technique for acute ACL ruptures. However, ACL repair surgical procedures are reappearing as an optimistic treatment alternative for acute proximal ruptures. The purpose of this annotation is to review the current role of primary repair of the ACL. A Cochrane Library and PubMed (MEDLINE) search related to the role of ACL repair in acute ACL rupture was analyzed. Arthroscopic ACL repair can accomplish good short-run outcomes with knee stability and resumption of sport activity in children, with proximal ACL avulsion tear. Reported results of open primary repair in adult patients with proximal tears are excellent, which ratifies there may be a possible role for primary repair as management for proximal ACL tears. Recent reports suggest that refixation of the ACL is a possible treatment alternative in selected patients. Only time will tell whether the long-run results are similar to those obtained following ACL reconstruction. III.

The kneeling test is a valid method of assessing kneeling tolerance.

No quantitative test exists to reliably assess kneeling tolerance before and after surgery. The aim of this study was to validate a kneeling test, designed to quantify kneeling tolerance. A total of 179 participants (324 knees) were enrolled into the study, including 124 asymptomatic knees, 98 with osteoarthritis (OA), 85 following total knee arthroplasty (TKA) and 17 following anterior cruciate ligament reconstruction (ACLR). Patients were asked to kneel on a custom-built platform on a soft, firm and hard surface, at both 90° and 110° of knee flexion. A kneeling score of 0-100 was established for 90° and 110° with 100 being a complete absence of pain or discomfort. A linear mixed model with random intercept was used to estimate differences between conditions (healthy, OA, ACLR and TKA). Pearson's correlation coefficient was used to test the strength of the association between the kneeling test and the forgotten joint score (FJS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score. Test-retest reliability was estimated by the intraclass correlation coefficient (ICC). The kneeling test demonstrated good discriminative validity with differences at 110° between asymptomatic knees and knees with OA (difference = -42, p < 0.001), following ACLR (-12, p = 0.013) and TKA (-26, p < 0.001). Similar differences were observed at 90°. The kneeling test demonstrated construct validity, with a moderately strong correlation observed between the kneeling test and the FJS and the WOMAC at 90° (FJS 0.474 [95%CI: 0.357, 0.577], WOMAC -0.503 [-0.389, - 0.602]) and 110° (FJS 0.579 [95% CI: 0.479, 0.665], WOMAC -0.648 [-0.560, -0.722]). The ICC for the kneeling test at 90° and 110° was 0.843 (95% CI: 0.745, 0.905) and 0.926 (95% CI: 0.877, 0.956), respectively. The kneeling test is a valid technique to quantitatively determine kneeling tolerance. It can aid in the assessment and modification of current surgical techniques to improve patient outcomes. III.

Hybrid ablation for atrial fibrillation: the importance of achieving transmurality and lesion validation.

Therapeutic ablation for atrial fibrillation (AF) has evolved significantly with progressive advancements in technology and surgical instruments. With the goal of minimizing surgical morbidity while maintaining the benefits of the traditional Cox-Maze procedure, surgical ablation for AF has undergone significant modifications. Most recently, an increased understanding of substrate complexity, predominantly in patients with persistent or long-standing persistent AF, has led to the development of a synergistic hybrid approach. The hybrid approach attempts to combine the benefits of epicardial ablation and catheter-based endocardial ablation in order to overcome the shortcomings associated with each technique alone. Importantly, the aid of electrophysiological intervention has provided new opportunities for evaluating lesion transmurality both acutely and in a staged approach. Therefore, the hybrid procedure may provide the optimal approach for the surgical treatment of AF, with the potential to tailor procedural treatment according to the patient's specific needs. In this review, we aim to provide an overview of current surgical techniques, including the implications of this novel hybrid approach in the management of AF and improving procedural outcomes. Recent findings from published studies are highlighted with a primary focus on the importance of lesion transmurality and validation in a hybrid setting.