Learning Curve Research Articles

Review: Food-induced mucosal alterations visualized using endomicroscopy.

Confocal laser endomicroscopy (CLE) is a novel technique allowing real time invivo microscopy during standard endoscopy. Recently, acute mucosal alterations after food administration visualized by CLE have been linked to symptoms in irritable bowel syndrome (IBS). Interestingly, the observed reactions occurred in subjects without demonstrable allergic sensitization to food-this is in line with mechanistic research showing local but not systemic allergic sensitization to foods in an animal model for IBS. Here, European experts conducting CLE with food administration provide a narrative review of the available literature and propose practical guidance on the use of this technique. CLE allows physicians to observe acute mucosal reactions after the application of food to the duodenal mucosa in patients with functional gastrointestinal disorders. Some open-label interventions show a symptomatic benefit when patients exclude the nutrient that triggered an acute mucosal reaction. However, many technical, mechanistic, and clinical questions remain unanswered to date. Technically, the interobserver variability and learning curve requires systematic evaluation and criteria or cutoffs for alterations require validation. Mechanistic studies are needed to enhance our understanding of the mechanisms underlying observed alterations. Finally, rigorous blinded controlled studies are needed to assess a link of these observed alterations with symptom generation. CLE offers a platform allowing scientific insights related to food induced acute mucosal alterations. However, many questions remain unanswered, and more research is warranted to understand the role of acute mucosal alterations visualized upon food administration in IBS pathophysiology and treatment.

A Bedside Electronic Whiteboard System for Patient Care in Isolation Rooms: A Scenario-Based Preliminary Study.

To assess a commercially available electronic whiteboard's usability and acceptability in isolation rooms, focusing on improving nurse-patient communication and supporting data input. A cross-sectional study with quantitative and qualitative mixed methods. We evaluated the usability and acceptability of electronic whiteboards among nurses using scenarios in a virtual isolation room environment. Nurses recognised the electronic whiteboard as a valuable tool for communication and error reductions in record-keeping but noted a learning curve for less tech-savvy users. Positive correlations were found between perceived usefulness, ease of use and adoption intent. Despite challenges, electronic whiteboards show promise for enhancing patient care, requiring comprehensive training and management systems. Time allocation in patient wards and nurse-patient interactions are crucial considerations. Electronic whiteboards have usability and acceptability as a tool to improve nurse-patient communication. However, considering technical issues and staff resistance, a management system and user training are necessary. Nurses perceive electronic whiteboards as user-friendly and as facilitating data input. TREND (Nonrandomised evaluations of behavioural and public health interventions). No patient or public contribution.

Cadaveric Feasibility of Robotic-Assisted Radial Artery-Internal Carotid Artery-Middle Cerebral Artery Anastomosis for Neurovascular Surgery.

To the best of our knowledge, this is the first reported cadaveric feasibility study of leader-follower type robotic-assisted middle cerebral artery (MCA)-radial artery-internal carotid artery anastomosis in the neurovascular surgery field using the da Vinci Xi system (da Vinci Surgical System; Intuitive Surgical, Inc.). Vascular suturing is a necessary skill in neurosurgery; however, the learning curve for deep and high-flow bypasses is severely low. Thus, robot-assisted surgery has been introduced. Here, we describe the surgical workflow adaptations of vascular anastomosis using the da Vinci system to assess the feasibility of robot-assisted anastomoses of the radial and middle cerebral arteries. Two fresh cadaver heads were studied using the da Vinci Xi Surgical System with 0° and 30° stereoscopic endoscopes to visualize the neuroanatomy. The da Vinci Xi Surgical System was used throughout the anastomosis of the MCA and intracarotid artery. The optic nerve, optic chiasm, carotid artery, and oculomotor nerve were visualized using standard microdissection techniques. The Sylvian fissure was exposed from the proximal Sylvian membrane to the distal MCA. Using black diamond microforceps and Potts scissors, suturing was achieved on the radial artery-middle cerebral artery using 8-0 Prolene and on the radial artery-internal carotid artery using 7-0 Prolene. A bypass of the MCA-radial artery-internal carotid artery can be achieved using the da Vinci Xi Surgical System in cadaver models. This system provides experts and less experienced neurosurgeons with stable bypass techniques for both superficial and deep-seated arteries. However, further studies are needed to evaluate the safety and benefits of the da Vinci Xi Surgical System for bypass procedures.

Monte Carlo Workflow Unification for Nuclear Reactor Analysis with Metamodel-Driven Modeling

Monte Carlo (MC) transport codes are a cornerstone of nuclear reactor analysis frameworks, providing reference solutions and multigroup cross sections, and even as core components in multiphysics couplings. These applications can be seen in toolkits from the Nuclear Energy Advanced Modeling and Simulation program and the U.S. Nuclear Regulatory Commission’s BlueCRAB (Comprehensive Reactor Analysis Bundle). Contrary to their ubiquitousness in reactor physics modeling and simulation, popular MC codes, such as MCNP, Serpent, and KENO, are still reliant on antiquated textual input formats. These input languages use a plethora of keywords with terse syntax to specify all facets of a model, including its geometry, materials, physics settings, and tally options. This poses a steep learning curve and a poor user experience. Being tied to unique text-based input formats also significantly complicates programmatic input generation or modification that may be desired and/or required within a multiphysics framework. This work demonstrates how the development of programmatic interfaces for MC codes can support model unification and translation activities. Building on the Python application program interface (API) development of MCNPy, similar capabilities are being implemented for Serpent that are able to support model translation. In future work, the Serpent API capabilities will be made more robust and the work will be further expanded to include translations with KENO.

Robotic-assisted microsurgery using the MUSA-robot: evaluation of the learning curve in three clinical pilot trials

Aim: Current microsurgical procedures are limited by the physiological tremor and dexterity of the surgeon. The MicroSurgical Assistant (MUSA, Microsure), the world’s first robotic platform for (super)microsurgery can aid in resolving issues encountered during microsurgery. This study presents an overview of the operating times and Structured Assessment of Microsurgery Skills (SAMS) scores to assess the duration and quality of microsurgical anastomoses for three microsurgical procedures currently performed using the MUSA. Methods: This study integrates data from one ongoing randomized controlled trial focusing on robotic-assisted lymphaticovenous anastomosis, along with findings from two separate prospective pilot studies concerning digital nerve repair and free tissue transplantation. SAMS scores and time needed per anastomosis were used to evaluate the quality and learning curve of the MUSA-assisted procedures. Results: Thirty-five robotic-assisted procedures were analyzed, including 18 lymphaticovenous anastomoses, 9 digital nerve repairs, and 8 free tissue transplantations. All procedures showed a trend of a decrease in the time needed to perform the procedure. Moreover, the mean overall SAMS scores for all three procedures were rated above ‘satisfactory’, with all procedures demonstrating a consistent trend of increasing SAMS scores over time. Conclusion: The evaluation of anastomosis’ quality in the initial cohorts of patients undergoing robotic-assisted microsurgery using MUSA indicates satisfying outcomes across all three types of procedures. The reduction in anastomosis time and the improvement in SAMS scores imply an ongoing learning process among the operating surgeons. Subsequent reports are expected to provide information on reaching a plateau phase in procedural efficiency.

A Comparative Study on the Application of Robotic Hair Restoration Technology Versus Traditional Follicular Unit Excision in Male Androgenetic Alopecia

ABSTRACTBackgroundThe robotic hair transplant technology, ARTAS, has a series of fine mechanical structure and an intelligent recognition system that allows it to independently select hair follicular units (FUs) and effectively harvest hair. After entering China in 2016, ARTAS has attracted the attention of hair transplant surgeons and hair loss patients given its advantages in a short learning curve and simple operation.ObjectiveTo compare the efficacy and safety between the ARTAS system and follicular unit excision (FUE) in the treatment of male androgenetic alopecia (AGA) and to further promote the improvement and upgrading of ARTAS technology concerning hair transplantation.MethodsThirteen Chinese male patients with Norwood–Hamilton II–IV AGA aged 25–35 years were enrolled in this study. The donor site of each patient was randomly divided into left and right regions, receiving ARTAS on one side and FUE on the other. Yield, transection, and discard rates of hair FUs from both sides were compared. Safety of the procedures in whole, as well as follow‐up results were investigated and evaluated.ResultsThe total yield rate on the ARTAS side was lower than on the FUE side (82.05% vs. 90.03%, p > 0.05); the total discard rate on the ARTAS side was higher than on the FUE side (10.71% vs. 5.46%, p < 0.05); the total transection rate on the ARTAS side was lower than on the FUE side (13.17% vs. 13.96%, p > 0.05). No significant difference was found in patient satisfaction (efficacy), and no side effects or complications were detected during or after all surgeries.ConclusionThe current iteration of Robotic hair transplant technology is effective and safe, and can be recommended for AGA hair transplantation surgery.

Evaluating the Status and Promising Potential of Robotic Spinal Surgery Systems.

The increasing frequency of cervical and lumbar spine disorders, driven by aging and evolving lifestyles, has led to a rise in spinal surgeries using pedicle screws. Robotic spinal surgery systems have emerged as a promising innovation, offering enhanced accuracy in screw placement and improved surgical outcomes. We focused on literature of this field from the past 5 years, and a comprehensive literature search was performed using PubMed and Google Scholar. Robotic spinal surgery systems have significantly impacted spinal procedures by improving pedicle screw placement accuracy and supporting various techniques. These systems facilitate personalized, minimally invasive, and low-radiation interventions, leading to greater precision, reduced patient risk, and decreased radiation exposure. Despite advantages, challenges such as high costs and a steep learning curve remain. Ongoing advancements are expected to further enhance these systems' role in spinal surgery.

Comparative study of robotic-assisted single-incision-plus-one port and single-incision laparoscopic choledochal cyst excision.

To compare the efficacy of robotic-assisted single-incision-plus-one-port laparoscopic choledochal cyst excision (R-SILC + 1) and single-incision laparoscopic choledochal cyst (SILC) in treating pediatric choledochal cyst (CDC). We retrospectively analyzed the clinical data of patients diagnosed with CDC in our hospital from June 2021 to October 2023. Among them, patients underwent either R-SILC + 1 or SILC procedures. Demographic parameters, operative details, and postoperative outcomes were studied. A total of forty-nine patients were included, with 23 children undergoing R-SILC + 1 and 26 children undergoing SILC. There were no statistically significant differences in demographic data, postoperative pain scores, and postoperative complication rates between the two groups (all p > 0.05). Compared with the SILC group, the R-SILC + 1 group demonstrated less intraoperative bleeding volume (10.4 ± 3.6 vs. 15.0 ± 3.6 ml, p < 0.05), a shorter indwelling time of the abdominal drainage tube [5(5,6) vs. 7(5.8,8.3) d, p < 0.05], a shorter postoperative fasting time [4(3,4) vs. 6(5,7) d, p < 0.05], and a shorter postoperative discharge time [6(6,7) vs. 8(6,11) d, p < 0.05]. However, the R-SILC + 1 group had a longer operation time [388(295,415) vs. 341(255.8,375.2) min, p < 0.05] and higher hospitalization cost (7.9 ± 0.4 vs. 3.2 ± 0.3 ten thousand, p < 0.05). Compared with the SILC group, the R-SILC + 1 group demonstrated clear advantages in treating pediatric CDC, but it is associated with a prolonged learning curve and operation time, and high costs. With improvements in physician experience and technological advancements, its potential will be further unleashed.

The role of Water Operator Partnership in accelerating adoption of new working process for non-revenue water reduction: a case study – Waterworx WOP between Perumda Air Minum Tirta Moedal and VEI

ABSTRACT This paper presents the approach, results, and contributing factors to success of a Non-Revenue Water (NRW) reduction intervention in a Water Operator Partnership (WOP) between Perumda Air Minum Tirta Moedal Kota Semarang (PDAM Semarang) and VEI Dutch Water Operators (VEI). This paper makes a case for the prioritisation of small but smart operational investment to improve the water use efficiency (SDG 6.4) in infrastructure development programmes which typically focus on expanding network coverage (SDG 6.1) alone. The successful intervention is hinged on VEI's international track record, and PDAM's commitment to performance improvement. VEI training and coaching focused on strengthening the NRW management organisation, working processes, and skills to conduct top-down assessments by quantifying NRW components with historical data, localize leaks with live flow/pressure data, and pinpoint/repair leaks through active leak detection. PDAM staff demonstrated a steep learning curve by spearheading the establishment of a dedicated NRW department and sharpening its leak detection procedures to reduce NRW levels from 39 to 26% in 5 months in pilot area. The evaluated business case revealed that the relatively small investment (USD 60.000) was recovered within 1.2 years.

A bench-top evaluation of the Ily® robotics assisted tele console system in ureteroscopy by medical students, residents and urologists: does prior videogaming experience help shape the learning curve?

Previous studies have demonstrated an association between video-gaming experience (VGE) and improved robotics skills. We aimed to evaluate the initial learning curve for the Ily® robotics system (Sterlab, Sophia Antipolis, France) when applied to flexible ureteroscopy (FU) among both medical students and urology surgeons. There were two groups, surgeons and students. An initial questionnaire was completed detailing basic demographics and experience. In part one, both groups performed two simple timed tasks using an Ily® mounted single-use RAU. In part two, group 1 repeated both tasks using a hand-held FU. A subjective assessment of comfort, intuitiveness and a NASA Task Load Index were then completed. There was a total of 28 participants. Among medical students with VGE (n = 9, 64%)., average calyceal inspection time was 185 ± 80s; 133 ± 42s; 121 ± 71s. For non-gamers (n = 5, 36%), average times were longer at 221 ± 97s; 134 ± 35s; 143 ± 68s respectively. Average calyceal inspection time for videogaming surgeons (n = 8, 57%) was 126 ± 95s; 98 ± 40s; 107 ± 71s, respectively. For non-gamers average inspection times were longer at 150 ± 73s; 114 ± 82s; 111 ± 47s, respectively. None of these differences achieved statistical significance. Surgeons trial speeds were, however, significantly faster by hand-held compared to RAU: by 103, 81 and 82s respectively (p < 0.05). These results show that ex- or current- video gamers do not have a significant advantage in time to perform FU. Any early advantage conferred to ex- or current- gamers may be rapidly overcome.

The Role of ICG-Guided Fluorescent Mode in Boosting the Learning Curve of Laparoscopic Cholecystectomy.

Background: The most common therapy for gallstones is laparoscopic cholecystectomy (LC). How to help young residents avoid bile duct injuries (BDI) during surgery and grasp LC seems to be a paradox. Methods: We retrospectively reviewed 145 cases of LC operated by two residents under indocyanine green (ICG)-guided mode or normal LC procedures to illustrate the role of ICG mode in boosting the LC learning curve. The clinic data were analyzed by logistic regression, receiver operator curve tests, Cumulative Sum (CUSUM), and Risk-Adjusted Cumulative Sum (RA-CUSUM) analysis. Results: The operation failure rate is similar. However, operation time under ICG mode is shorter than that under normal mode. The peak at the 49th case represented the normal resident's complete mastery of the surgery, while the peak point of ICG mode appeared at the 36th case in the fitting curve. The most significant cumulative risk (peak point) of operation failure of LC was at the 35th case in ICG LC mode, while it appeared in the 49th in normal LC mode. Conclusions: Owing to the advantage of real-time imaging and the stable success rate of cholangiography, ICG-guided LC helps residents shorten the operation time, boost the learning curve, and manage to control the operation failure rate.

Application of the Self-Assembling Peptide Hydrogel RADA16 for Hemostasis during Tonsillectomy: A Feasibility Study.

Tonsillectomy is a common surgical procedure but carries a high risk of readmission for secondary bleeding and pain. This study evaluated the feasibility and effectiveness of using the hemostatic self-assembling peptide hydrogel RADA16 (PuraBond, 3-D Matrix SAS; Caluire et Cuire, France) to control bleeding from the tonsillectomy wound bed. Readmission/re-operation rates were compared between a prospective case series of 21 primarily adult tonsillectomy patients treated with topical RADA16 and an untreated historical Control group of 164 patients who underwent tonsillectomy by 10 surgeons at a single tertiary hospital in the UK between March 2019 and June 2022. Cumulative readmission rates for any reason were 2-fold elevated in Control subjects (18.9%; n = 31/164 subjects) compared to patients treated intra-operatively with RADA16 hemostatic hydrogel (9.5%; n = 2/21) (p = 0.378). Readmission rates for postoperative bleeding were 3-fold higher in Controls (14.6%; n = 24/164 subjects) than in the RADA16-treated group (4.8%; n = 1/21) (p = 0.317). A similar rate of retreatment for pain was recorded in the Control (4.3%; n = 7/164) and RADA16 (4.8%; n = 1/21) groups (p = 0.999). Two Control subjects (1.2%) required re-operation for recalcitrant bleeding; no RADA16 subject (0.0%) required re-operation for any reason. No device-related adverse events occurred in the RADA16 group. Surgeons were pleased with the easy learning curve and technical feasibility associated with intra-operatively administering RADA16 hemostatic hydrogel. Intra-operative hemostasis using RADA16 peptide hydrogel was straightforward and was associated with a trend of 3-fold lower rates of readmission for postoperative bleeding events than untreated Control subjects.

Hand Tool Intervention for Rubber Tappers Using Modified Michie Golledge Knife

ABSTRACT Background and Objectives Rubber tapping is a physically demanding and skilled agricultural operation that can cause musculoskeletal disorders (MSDs). This research investigated the impact of using an ergonomically modified rubber tapping knife on the hand posture of rubber tappers. Methods Initially, a postural assessment was conducted using CATIA V6 modelling software followed by a non-randomized longitudinal study with 32 rubber tappers. In the second phase, the study used a custom-modified Standard Nordic Questionnaire, video recordings, and direct observations. The study compared the results of the ergonomically modified rubber tapping knife with the traditional tapping knife, evaluating hand grip strength, endurance time chip thickness, time required to complete 300 trees, and posture using the Rapid Upper Limb Assessment (RULA) tool. Results Compared to pre-tapping values, the mean reduction in grip strength after tapping was significantly less with the modified rubber tapping knife than with the traditional tapping knife (2.96 kg, SD 0.85 kg vs 7.31 kg SD 2.13 kg). Similarly, the reduction in hand endurance time was less with the modified knife than with the traditional knife (1.78 seconds, SD 0.47 seconds vs 3.34 seconds, SD 0.87 seconds). The study also indicated that the modified knife did not significantly affect chip thickness. Additionally, a slight increasing in tapping time was observed with the ergonomically modified knife, which may be attributed to a learning curve phenomenon. This suggests that as rubber tappers become more accustomed to the new tool, their efficiency may improve over time. Conclusion The hand grip strength and endurance time was significantly lower with the ergonomically modified tapping knife. The study concluded that using an ergonomically modified tapping knife led to a significant improvement in hand posture among rubber tappers.

Detailed analysis of learning phases and outcomes in robotic and endoscopic thyroidectomy

BackgroundThyroid surgery has undergone significant transformation with the introduction of minimally invasive techniques, particularly robotic and endoscopic thyroidectomy. These advancements offer improved precision and faster recovery but also present unique challenges. This study aims to compare the learning curves, operational efficiencies, and patient outcomes of robotic versus endoscopic thyroidectomy.MethodsA retrospective cohort study was conducted, analyzing 258 robotic (da Vinci) and 214 endoscopic thyroidectomy cases. Key metrics such as operation duration, drainage volume, lymph node dissection outcomes, and hypoparathyroidism incidence were assessed to understand surgical learning curves and efficiency.ResultsRobotic thyroidectomy showed a longer learning curve with initially longer operation times and higher drainage volumes but superior lymph node dissection outcomes. Both techniques were safe, with no permanent hypoparathyroidism or recurrent laryngeal nerve damage reported. The study delineated four distinct stages in the robotic and endoscopic surgery learning curve, each marked by specific improvements in proficiency. Endoscopic thyroidectomy displayed a shorter learning curve, leading to quicker operational efficiency gains.ConclusionRobotic and endoscopic thyroidectomies are viable minimally invasive approaches, each with its learning curves and efficiency metrics. Despite initial challenges and a longer learning period for robotic surgery, its benefits in complex dissections may justify specialized training. Structured training programs tailored to each technique are crucial for improving outcomes and efficiency. Future research should focus on optimizing training protocols and increasing accessibility to these technologies, enhancing patient care in thyroid surgery.

Assessing functional and radiological outcomes: open reduction and internal fixation vs. minimally invasive plate osteosynthesis for humerus shaft fractures-a prospective comparative study.

To analyse and compare the functional and radiological outcome of different methods of surgical management of humerus shaft fractures in 30 patients treated by conventional open reduction and internal fixation (ORIF) or minimally invasive plate osteosynthesis (MIPO). This prospective interventional study was conducted among 30 patients by dividing into two equal groups over oneyear and sixmonths. All patients were followed up for a minimum of at least sixmonths. Radiological outcome was assessed using fracture union in serial radiographs and functional outcome was measured using DASH scoring. The majority of patients (26.7%) were between 18 to 30years, overall mean age was 44.4years, most of the patients (50%) had 12A3 AO type fractures, and 73.3% of patients had injuries following two-wheeler road traffic accidents. On comparing multiple factors, we found a statistically significant reduction of intra-operative blood loss in MIPO compared to ORIF. Though time taken for fracture union, functional outcome and complication rate were better in MIPO when compared to ORIF, these differences were not statistically significant. two patients in the MIPO group and one patient in the ORIF group had a peri-implant fracture following slip and fall again within the study period and underwent Revision plating. Excluding cases of peri-implant fractures, out of 13 patients in the MIPO group, only one patient developed fracture non-union. Of 14 patients in the ORIF group, three developed fracture non-union. MIPO is a safe, reproducible, efficient and good if not a better alternative to ORIF as it offers good radiological and functional outcomes with advantages of minimal soft tissue damage, minimal blood loss, better cosmesis, no incidence of radial nerve palsy and with few concerns such as the need for fluoroscopy, and a learning curve.

Application of Echocardiography in Anaesthesia: From Preoperative Risk Assessment to Postoperative Care.

Echocardiography has carved out a fundamental niche in anaesthesiology, revolutionizing the monitoring and management of cardiac function during surgery. Clinical practice has changed from simple 2D and 3D echocardiography to more sophisticated applications such as incorporating artificial intelligence. Echocardiography provides detailed real-time information about cardiac anatomy and function, helping anaesthesiologists make better decisions regarding tailoring anesthetic interventions and optimizing patient outcomes. From optimizing hemodynamic management in patients with severe aortic stenosis to fine-tuning fluid and vasopressor therapy in patients with right heart dysfunction, echocardiography has improved the care provided in the perioperative period. These applications permit the demonstration of not only technical advantages that could accrue from echocardiography but are also a part of individualized care to improve the outcomes of patients. The challenges in integrating echocardiography with anaesthesia include operator dependency, a steep learning curve in acquiring echocardiographic skills, and limitations due to patient factors and technological limitations, which lead to poor echocardiographic performance. Additionally, transoesophageal echocardiography (TEE) is an invasive procedure with several potential risks that must be considered cautiously. Continuing education, certification recommendations, and skill development are prerequisites for this echocardiography tool to remain robust and reliable in anaesthesiology. Technological innovation, especially in improving 3D imaging and integration with artificial intelligence, is where a very bright future lies ahead for echocardiography. It would further accelerate the process of echocardiographic evaluation and improve diagnostic accuracy. All these would turn out to be more person-centered for each patient. Anaesthesiologists must, therefore, pace themselves with such developments so these can be appropriately applied in the clinics. In summary, echocardiography became so integrally ingrained into anaesthesia that it propelled the specialty with essential tools anaesthesiologists use to manage patients for optimum outcomes. Its application has difficulties and limitations, but continued professional development and development of echocardiographic technology will make sure that its benefits are maximized. Quickly, echocardiography is becoming central to anaesthesiology's role in optimizing patient care and surgical success as we move into the application of evermore sophisticated echocardiographic techniques.

Identifying Component Processes in Perceptual Learning with Non-parametric Bayesian Modeling of the Learning Curve in a Yes-No task with Method of Constant Stimuli

Identifying Component Processes in Perceptual Learning with Non-parametric Bayesian Modeling of the Learning Curve in a Yes-No task with Method of Constant Stimuli

Endoscopic Endonasal Skull Base Surgery: Analysis of the Results in the Author’s Initial 200 Cases

Background Endoscopic endonasal approaches represent currently an important tool for approaching the skull base. The evolution of new techniques is based in the continuous acquisition of skills and abilities and it is paramount to determine the safety and effectiveness of new approaches. Based on that, the aim of this study is to analyze our results after the first 200 cases. Material and methods We performed a retrospective review of all cases operated on through an endoscopic endonasal approach in our Skull Base Unit, between January 2007 and May 2018. We analyze the results and all the per-operative complications associated. Results In this study we included 200 cases, comprising 105 female (52,2 %) and 95 male (47,5 %), with a mean age of 45,6 (range 21-85 years-old). The most commonly reported pathology was the pituitary adenoma, comprising 121 cases (60,5 %), followed by 13 meningocele (6,5 %), 9 chordoma (4,5 %), 6 skull base meningioma (3 %) and 7 cranyopharingioma (3,5 %). 161 cases (81 %) represented first surgery. The most frequently reported complication was diabetes insipidous in 17 % of all cases, followed by CSF leak, represented by 15 cases (7,5 %). 12 CSF leak cases were successfully treated by external lumbar draining and 3 patients required second surgery to skull base repair. In the last 50 cases, only one CSF leak has been reported, representing an incidence of 2 %, successfully treated by endoscopic repair. This decrease in CSF leak represents the impact of the learning curve in skull base reconstruction. 5 % of patients suffered meningitis and 5 % presented permanent anosmia. In our serie we reported 1,6 % of transient neurologic deficit represented by oculomotor palsy and 1,6 % of permanent neurologic deficit due to infarction. 3 patients in this serie has died, two due to malignant ICA occlusion and 1 due to infection (overall mortality 1,5 %). The most commonly used approach was the transsphenoidal transsellar approach (58 %), followed by transplanum-transtubercullum approach (8 %). Gross total resection was achieved in 76 % of tumoral pathology, 71 % in cases of pituitary adenomas. Conclusion From this review we can conclude that, in our serie, endoscopic endonasal surgeries represent safe approaches to the skull base to a huge variety of pathologies. Progressive acquisition of skills and experience is paramount to improve the results, avoiding and reducing complications. Appropriate patient and pathology selection is also mandatory.

Comparison of complications and degree of correction between the extensile lateral and sinus tarsi approaches in the treatment of calcaneus fractures: a cross-sectional observational retrospective study

Introduction: Calcaneus fractures are a challenge for traumatologists. Their complex anatomy, relative scarcity of surrounding soft tissue, and long learning curve for surgical treatment partly explain the difficulties encountered by surgeons, in addition to contributing to the high rate of complications. Objective: This study aimed to identify the differences in complication rates and degree of correction between extensile lateral access (ELA) and sinus tarsi (STA) approaches by reviewing medical records between 2018 and 2023 of patients who underwent open reduction and internal fixation of calcaneus fractures at a hospital in the interior of São Paulo. Methods: The present study followed a retrospective observational and cross-sectional model (STROBE). The Kolmogorov Smirnov test, Student-t test, Wilcoxon Rank test, Mann-Whitney test, Pearson Chi-Square test, and binary and predictive logistic regression analysis were used, adopting a confidence risk of 0.05. Results and Conclusion: A total of 77 patients were included (52 ELA and 25 STA). It was concluded that no statistical differences were observed after intergroup comparisons (ELA vs. STA). There was also no statistically significant influence of the predictor “age” on the predictors of the responses “Böhler and Gissane angles in degrees” in the final post-procedure phase. In general, STA presented a lower probability of complications with the use of the sinus tarsi route, reaching the same level of joint reduction and control of progression to osteoarthritis. All these results of the present study almost completely confirm the literary findings that appear under discussion.

Evaluation of the feasibility of equine in-vivo ultrasound technique for the medial branch of the dorsal ramus of the cervical spinal nerves

Ultrasound-guided local anaesthesia is commonly used in veterinary orthopaedics for horses. This study aimed to assess an in vivo ultrasound technique for the medial branch of the dorsal branch of the cervical spinal nerves (MB-DBCSNs) in horses and compare the performance of clinicians with different experience levels. Ten healthy, skeletally mature horses were examined using radiographic and ultrasound (US) techniques in the cervical area (C3–C7). Four operators with varying experience conducted US examinations using a 10 MHz linear and 6 MHz curvilinear transducer over ten training sessions. The number of cervical nerves visualized was recorded. A chi-square test was used to analyse the impact of training, anatomical location, and operator experience on the identification of facet joints. Operator agreement was evaluated with Cohen’s K test. The operators assessed 80 MB-DBCSNs, with radiographs and identified 70 healthy and 10 pathological facet joints. Training significantly improved visualization success, reaching 90% in later sessions. Cranial facet joints (C3–C5) were more frequently visualized (81%) than caudal ones (C5–C7) were (59%). US performance was influenced by the operator’s skill, and agreement among operators ranged from slight to fair. Overall, practice improved cervical nerve visualization in vivo, particularly for cranial nerves, but the technique requires a long learning curve because of low levels of operator agreement.