Safe Corridor Research Articles

Infra-Occipital Supra-Tentorial Approach for Resection of Low-Grade Tumor of the Left Lingual Gyrus: 2-Dimensional Operative Video.

Surgical treatment of lesions involving the postero-medial occipito-temporal region is challenging because of high risk of morbidity due to damage or excessive retraction of critical neuro-vascular structures, especially within the dominant hemisphere.1-3 Here, we describe the case of a 17-yr-old patient who underwent resection of an epileptogenic low-grade tumor located within the left-dominant lingual gyrus. Seizures were characterized, as a first symptom, by right-sided simple visual hallucination that pointed to the left pericalcarine region, corresponding to the lesion location. No signs of primary involvement of anterior temporo-mesial structures (hippocampus/amygdala) were found. As the anatomo-electroclinical correlation was concordant, direct tumor removal was indicated through an infra-occipital supratentorial approach. This route allowed direct access to the target through a safe extra-axial corridor, which limits intraparenchymal dissection until the tumor margin is identified and avoids critical vascular structures, such as the vein of Labbé.4,5 An external cerebrospinal fluid (CSF) drainage was used to facilitate brain relaxation, minimizing brain and venous retraction and, consequently, reducing the risk of postoperative neurological complications, especially for vision. Postoperative magnetic resonance imaging (MRI) demonstrated no surgical complications. Pathological examination revealed a ganglioglioma. At 9-mo follow-up, the neurological examination was normal, antiepileptic therapy was stopped, and the patient was seizure-free. The video describes the main surgical steps, using both intraoperative videos and advanced 3-dimensional modeling of neuroimaging pictures. Informed consent was obtained for surgery and video recording.

Surgical approaches and applied anatomy of the wrist

A familiarity with common approaches to the wrist and their associated anatomy is essential for any surgeon operating in this area. Such knowledge reduces the likelihood of iatrogenic injury to adjacent structures; enabling the surgeon to progress purposefully and with confidence through an operation, to reveal underlying pathology. Furthermore, it is a favourite topic for the fellowship examiner. This article provides a description of the common dorsal, volar, radial and ulnar approaches to the carpus and distal radius. Safe corridors for external fixation are also considered. Additionally, clinical pearls are included for each approach, to enable the surgeon to avoid common pitfalls.

Epineurotomy for leprous, high ulnar neuropathy: defining a safe corridor based on the epineural vascular anatomy.

Leprous neuropathy is treatable but still a source of disability worldwide. Multidrug therapy (MDT) and oral steroids are the main stay of treatment. Ulnar nerve, at the elbow, is commonly involved. Nerve decompression may be required in selected cases by an epineurotomy (internal neurolysis). The preferred surface of ulnar nerve for performing this procedure to minimize iatrogenic vascular compromise is a matter of debate. We describe the epineural vessel arrangement on the medial and lateral surface of ulnar nerve around the medial epicondyle while performing epineurotomy for leprous neuropathy. We enrolled patients of symptomatic leprous ulnar neuropathy of less than oneyear duration on MDT that did not respond to steroids, for surgical decompression. Ten patients underwent epineurotomy of ulnar nerves (N = 11) around medial epicondyle. The epineural vessels were classified as per Sunderland's classification of arteriae nervorum. The number of epineural vessels was assessed on the medial and lateral surface of the ulnar nerve adjoining the medial epicondyle. The epineurotomy incision was placed over the surface of ulnar nerve having relatively less vessels. The mean number of epineural vessels on the medial surface was 9.72 (range; 7-14) and on the lateral surface were 4.72 (range; 3-6). The average number of vessels per cm2 of the medial and lateral surface of the nerve was 0.94 and 0.48, respectively. The most common type of epineural vessel was type 3 on both medial and lateral surface of the nerve. Lateral epineurotomy was performed in all 11 cases. All the patients had relief from neuropathic pain. The mean VAS score improved from 3.20 ± 0.89 to 0.50 ± 0.34 at 2years follow-up (p = 0.02). The mean motor score improved from 9.31 ± 4.12 to 15.42 ± 3.10 and sensory score improved from 40.0 ± 30.70 to 85 ± 9.90 at two years follow-up (p < 0.01). Lateral surface (facing the medial epicondyle) of ulnar nerve has a lesser density of epineural vessels in comparison to its medial (subcutaneous) surface. This anatomical understanding may be helpful in minimizing the iatrogenic vascular compromise of ulnar nerve while performing its epineurotomy around the medial epicondyle for leprous neuropathy. The findings may be extrapolated to other clinical indications of epineurotomy of ulnar nerve, for example, in cubital tunnel syndrome, traumatic ulnar neuroma in continuity, and benign ulnar nerve tumors.

TÜRKİYE VE AZERBAYCAN ARASINDAKİ İLİŞKİLERİN MALİ VE İKTİSADİ ANALİZİ

İktisadın ve Kamu maliyesinin önemli konularından biri olan enerji, geçmişten bugüne insan hayatı için elzem bir ihtiyaçtır. İnsan hayatının hemen hemen çoğu alanında kullanım alanı bulan enerji, mevcut rolünü ve alan çeşitliliğini, her geçen gün arttırarak sürdürmektedir. Söz konusu kaynağa sahip olan ülkeler, hammadde zenginliği sebebiyle önemli avantajlar elde etmektedir. Uluslararası politika çerçevesinde, enerji kaynağına sahip olan ülkeler, uluslararası düzeyde önemli kazanımlar elde etmektedir. Türkiye ise henüz enerji alanında istenilen rezervlere ulaşamamış olmasına rağmen rezerv kaynakların arz güvenliği temelinde ekonomik yollarla taşınmasına aracılık ederek rezerv dezavantajını bu yolla avantaja çevirme gayretindedir. Ülke toprakları içerisinde yoğun enerji tüketiminin karşısında ihtiyaç duyulan arz miktarını düşük maliyetle ve sürdürülebilir yollarla temin edebilmek için komşu coğrafyalarla çeşitli projeler geliştirmiştir. Ve bu projeler boru hatları vasıtasıyla meyvesini vermiştir. Türkiye sahip olduğu topraklar ile jeopolitik açıdan avantaj sahibidir. Bu avantajını değerlendirmek adına yürüttüğü stratejiler neticesinde enerji alanında koridor pozisyonu üstlenmektedir. Türkiye bölgesindeki istikrarın sürekliliği adına komşularına nispeten uluslararası sahada daha fazla güven veren bir ülke konumunda olduğu için enerji arz güvenliği hususunda ihracatçı ve ithalatçı ülkeler arasında güvenli koridor olma rolüne uygundur. Son yıllarda TANAP ve Trans Adriyatik hattının faaliyete geçirilmesiyle bu alanda önemli bir ivme yakalanmıştır. Türkiye ve Azerbaycan arasındaki iki devlet tek millet düsturunun ortak menfaatler çerçevesinde gerçekleştirilmesi ile Türkiye’nin enerji alanında Rusya’ya olan bağımlılığı da önemli oranda azalmıştır. Özellikle son iki yılda Doğu Akdeniz’de gerçekleştirilen arama ve tarama faaliyetleri netice vermeye başlamış ve doğalgaz rezervleri anlamında umut verici gelişmeler sağlanmıştır. Bu çalışmanın amacı Türkiye ve Azerbaycan ülkeleri arasındaki enerji ilişkilerini hem iktisadi hem de mali açıdan irdelemektir.

An Analysis of Youth Deradicalization Programs in Northeast Nigeria: A Study on Boko Haram

Using qualitative secondary analysis, the research examine the effects of Operation Safe Corridor (OSC), a home-grown prison-based deradicalization program targeted at low-risk Boko Haram combatants, and Yellow Ribbon Initiative, an education-based recivilization program designed for young adult women associated with Boko Haram. Together with pioneer countries like Saudi Arabia and Indonesia, the structural design and implementation of OSC remain shrouded in utmost secrecy. Even though it claims to have rehabilitated over 2,000 ex-Boko Haram combatants, there is no medium to independently ascertain these claims. Relatedly, the Yellow Ribbon Initiative also claimed to have successfully reintegrated thousands of women, with little to no means to validate their claims independently. Premised on the need to implement context-specific, inclusive and robust counterinsurgency programs, the research takes issues with both programs. Furthermore, the lack of accountability and transparency in the operations of both programs put to question their credibility and objectiveness. Alternatively, the research suggests the need for a paradigm shift from deradicalization to counter-radicalization, as this will put the government on the offensive side against radicalization. If targeted at volatile communities, counter-radicalization could be designed to address underlying causalities such as unequal education opportunities and poor social infrastructure, which will in turn foster a sense of belongingness in deprived and impoverished youths in the Northeast.

Defining a Safe Corridor of Cervical Branch Preservation in Lateral Platysmaplasty Surgery During Facial Rejuvenation Surgery.

During rhytidectomies, the cervical branch of the facial nerve (CBFN) can easily be encountered, and potentially injured, when releasing the cervical retaining ligaments in the lateral neck. This nerve has been shown to occasionally co-innervate the depressor anguli oris muscle, and damage to it can thus potentially compromise outcomes with a postoperative palsy. The authors sought to examine the lateral cervical anatomy specific to the CBFN to ascertain if the position of the nerve can be predicted, thereby enhancing safety of the platysmal flap separation and dissection from this lateral zone of adhesion. Eleven cadaveric hemifaces were dissected, and the distance between the medial border of sternocleidomastoid muscle (SCM) and the CBFN was measured at 3 key points: (1) superior: the distance between the SCM and the nerve at the level of the angle of the mandible in neutral; (2) narrowest: the narrowest distance measurable between the superior and inferior points as the CBFN descends into the neck medial to the SCM; and (3) inferior: the distance at the most distal part of the cervical nerve identified before its final intramuscular course. The average distances (in mms) were as follows: superior = 12.1 (range, 10.1-15.4), narrowest = 8.8 (range, 5.6-12.2), and inferior = 10.9 (range, 7.9-16.7). There is a narrow range between the nerve and the anterior border of SCM. We thus propose a safe corridor where lateral deep-plane dissection can be performed to offer cervical retaining ligament release, with reduced risk of endangering the CBFN.

International Mechanisms for Prosecuting Isil Members for Their Crime of Genocide against Yazidis People in Sinjar, Iraq - 2014 Internati̇onal Cri̇mi̇nal Court (icc) As A Case Study

On August 3, 2014, the terrorist organization Islamic State in Iraq and the Levant (ISIL), also known as Da’esh or most recently shortened to Islamic State (IS) attacked Sinjar in Northern Iraq within the Nineveh province. The region was home to about 400,000 Yazidis as well as other religious minorities. More than two million people have caused serious human rights violations in Nineveh province.ISIL captured Sinjar and the surrounding villages within a few hours on that fateful morning. The Yazidis were specifically targeted by ISIL members and were subjected to some of its worst atrocities including but not limited to executions, sexual slavery, abduction, forced conversion, imprisonment and torture.At the request of the Iraqi government, the United States began conducting air strikes and air-dropping humanitarian aid on August 8, 2014. Between August 9 and 13, Kurdish forces opened a safe corridor, allowing most of the surviving Yazidis to flee through Syria into the Kurdistan region of Iraq.The Rome Statute of the International Criminal Court (ICC) expressly incorporates the court has jurisdiction in accordance with this Statute with respect to the crimes of (a) Genocide; (b) Crimes against humanity; (c)War crimes; (d) The crime of aggression. These are elaborated on in Articles 5 and genocide specifically in Article 6.This study aims to find out whether such heinous international crimes committed by IS against the Yazidi people in Sinjar, Iraq during 2014-2017 can be placed under the jurisdiction of the ICC in accordance with its governing document, the Rome Statute.The study is illustrative and uses a content analysis approach to answer research questions. The researcher analyzed the existing literature as well as the ICC legal documents to interpret and determine the jurisdiction of the ICC regarding the Yazidi genocide in Iraq to ultimately recommend and demand reform at the end of the study.

International Mechanisms for Prosecuting Isil Members for Their Crime of Genocide against Yazidis People in Sinjar, Iraq - 2014 Internati̇onal Cri̇mi̇nal Court (icc) As A Case Study

On August 3, 2014, the terrorist organization Islamic State in Iraq and the Levant (ISIL), also known as Da’esh or most recently shortened to Islamic State (IS) attacked Sinjar in Northern Iraq within the Nineveh province. The region was home to about 400,000 Yazidis as well as other religious minorities. More than two million people have caused serious human rights violations in Nineveh province.ISIL captured Sinjar and the surrounding villages within a few hours on that fateful morning. The Yazidis were specifically targeted by ISIL members and were subjected to some of its worst atrocities including but not limited to executions, sexual slavery, abduction, forced conversion, imprisonment and torture.At the request of the Iraqi government, the United States began conducting air strikes and air-dropping humanitarian aid on August 8, 2014. Between August 9 and 13, Kurdish forces opened a safe corridor, allowing most of the surviving Yazidis to flee through Syria into the Kurdistan region of Iraq.The Rome Statute of the International Criminal Court (ICC) expressly incorporates the court has jurisdiction in accordance with this Statute with respect to the crimes of (a) Genocide; (b) Crimes against humanity; (c)War crimes; (d) The crime of aggression. These are elaborated on in Articles 5 and genocide specifically in Article 6.This study aims to find out whether such heinous international crimes committed by IS against the Yazidi people in Sinjar, Iraq during 2014-2017 can be placed under the jurisdiction of the ICC in accordance with its governing document, the Rome Statute.The study is illustrative and uses a content analysis approach to answer research questions. The researcher analyzed the existing literature as well as the ICC legal documents to interpret and determine the jurisdiction of the ICC regarding the Yazidi genocide in Iraq to ultimately recommend and demand reform at the end of the study.

International Mechanisms for Prosecuting Isil Members for Their Crime of Genocide against Yazidis People in Sinjar, Iraq - 2014 Internati̇onal Cri̇mi̇nal Court (icc) As A Case Study

On August 3, 2014, the terrorist organization Islamic State in Iraq and the Levant (ISIL), also known as Da’esh or most recently shortened to Islamic State (IS) attacked Sinjar in Northern Iraq within the Nineveh province. The region was home to about 400,000 Yazidis as well as other religious minorities. More than two million people have caused serious human rights violations in Nineveh province.ISIL captured Sinjar and the surrounding villages within a few hours on that fateful morning. The Yazidis were specifically targeted by ISIL members and were subjected to some of its worst atrocities including but not limited to executions, sexual slavery, abduction, forced conversion, imprisonment and torture.At the request of the Iraqi government, the United States began conducting air strikes and air-dropping humanitarian aid on August 8, 2014. Between August 9 and 13, Kurdish forces opened a safe corridor, allowing most of the surviving Yazidis to flee through Syria into the Kurdistan region of Iraq.The Rome Statute of the International Criminal Court (ICC) expressly incorporates the court has jurisdiction in accordance with this Statute with respect to the crimes of (a) Genocide; (b) Crimes against humanity; (c)War crimes; (d) The crime of aggression. These are elaborated on in Articles 5 and genocide specifically in Article 6.This study aims to find out whether such heinous international crimes committed by IS against the Yazidi people in Sinjar, Iraq during 2014-2017 can be placed under the jurisdiction of the ICC in accordance with its governing document, the Rome Statute.The study is illustrative and uses a content analysis approach to answer research questions. The researcher analyzed the existing literature as well as the ICC legal documents to interpret and determine the jurisdiction of the ICC regarding the Yazidi genocide in Iraq to ultimately recommend and demand reform at the end of the study.

Beyond the Battlefields, Non-Militarized Approach and Management of Armed Conflict in Nigeria: Takeaways from Operation Safe Corridor

Beyond the Battlefields, Non-Militarized Approach and Management of Armed Conflict in Nigeria: Takeaways from Operation Safe Corridor

Surgical Outcome of Sellar Suprasellar Brain Tumors through Retracterless Subfrontal Approach

Objectives: The aim of this study is to see the surgical outcome of Sellar and Suprasellar brain tumors with retractorless modified subfrontal approach.&#x0D; Material and Methods: We did cohort study of 15 patients who were operated in Neurosurgery Unit 2, PINS. Our study duration is 1 year and follow up duration is of 3 months. Clinical features were related to cranial nerves 2nd, 3rd ,4th, and pituitary gland, dural irritation and temporal lobe compression i.e., diplopia, decrease vision, CSF rhinorrhea, abnormal olfaction, headache, GTCS etc.&#x0D; Results: In our study, age range was 8 – 62 years with mean age was 35 years. Our 5 patients were male and 10 patients were female. Surgery was performed in all patients through subfrontal approach with retractorless method. In Histopathological report of 2 patients’ findings was Craniopharyngioma, 12 were of pituitary adenoma and 1 was of sellar meningioma. Seven 46.67 percent patients operated successfully with no new neurological deficit. Three 20 percent patients operated but no post op improvement in clinical symptoms, no patients were re-explored postoperatively due to CSF Rhinorrhea. Diabetes Insipidus occurred in 5 (33.3%) patients post-operatively which was managed later on.&#x0D; Conclusion: Surgery subfrontal approach with retractorless method is the safe corridor for treatment of sellar and Suprasellar brain tumors.

Defining a safe corridor for trans-iliac pin placement in cats.

To identify whether a theoretical predictable safe corridor is available in cats for placement of trans-iliac pins without the use of fluoroscopy. Twenty-one cats with straight orthogonal normal pelvic radiographs were included. Two start points were evaluated: a midpoint and a dorsal point. The midpoint was defined as midway between the dorsal lamina of the sacral vertebral canal and the cranial dorsal iliac spine. The dorsal start point was 2 mm ventral to the cranial dorsal iliac spine. The pin was assumed to be driven at 90 degrees to the lateral face of the ilium, and considered surgeon accuracy was ±4 degrees from the perpendicular. The angular range and the distance between the iliac wings from the ventrodorsal radiograph were used to calculate the possible cross-sectional area and pin exit location if driven from one iliac wing to the other. The corridor was then evaluated for repeatability in six randomly selected cats. Vertebral foramina penetration risk was identified in some cats when using a 1.6 and 2 mm-diameter pin using the mid-iliac wing start point. The dorsal start point decreased the available pin placement area but reduced the risk of entering the hazardous zone for all pin sizes up to 2 mm. A theoretical defined safe corridor is available for trans-iliac pin placement in cats between 2.0 and 5.5 kg. A 1.2-mm pin is the safest if using the mid-iliac wing start point. A more dorsal start point can accommodate up to a 2.0-mm pin if correctly aligned to the sacrum.

Novel Technique for Sacral-Alar-Iliac Screw Placement Using Three-Dimensional Patient-Specific Template Guide.

Introduction The sacral-alar-iliac (SAI) screw technique is becoming popular for sacropelvic fixation. However, appropriately placing SAI screws is technically demanding because of a narrow safe corridor and the risk of neurovascular/visceral injuries. Recently, a three-dimensional patient-specific template guiding technique for pedicle screw placement has been considered a promising method to improve accuracy and safety. The objective of the present study was to investigate the accuracy of SAI screw placement with a patient-specific template guide using cadaveric and prospective clinical pilot studies. Methods Three-dimensional planning of SAI screw placement, including entry point, screw trajectory, length, and diameter, was performed using a computer simulation software. Then, three-dimensional printed patient-specific template guides were created based on the plan. Firstly, a total of 12 SAI screws were placed for 6 cadaveric specimens using the guides. Next, in a prospective clinical trial, a total of 20 SAI screws were placed for 10 consecutively enrolled patients. The safety and accuracy of screw placement were analyzed using postoperative computed tomography by the evaluation of any cortical breach and measurement of screw deviations between the planned and actual screw positions. Results All the screws showed no perforation. In the cadaveric study, the mean horizontal and vertical deviations from the planned screw position at the entry point were 1.40±1.21 mm and 1.34±1.09 mm, respectively. The mean angular deviations in the sagittal and transverse planes were 1.68°±1.24° and 1.53°±1.06°, respectively. The results of the clinical study showed comparable accuracy with those of the cadaveric study, except for the vertical deviation at the entry point (p=0.048). Conclusions This is the first study to evaluate the feasibility and accuracy of using a patient-specific template guide for SAI screw placement. This technique could become an effective solution to achieve accurate screw placement.

Planning of labor resources in construction organizations

Based on the reporting and technical documentation and for the objects under consideration, the authors were able to form resource schedules that reflect the planned and actual values of the labor force for certain time periods. After analyzing the available statistics in terms of the activities of the leading production stream, a number of graphs were compiled showing the movement of these teams at the facilities. Based on these data, the authors determined the average deviation of the actual number of workers in the leading stream from the planned one. Also, the availability of operational information from these objects made it possible to determine the consequences of deviations and a set of measures taken. As a result, the authors analyzed the dynamics of construction of typical facilities of different general contracting organizations, taking into account the scale factor (capacity of the construction organization) , indicating the difference in the values of the planned (predicted) and actual labor resources at the facilities. Possible solutions of this problem with the mathematical modeling of stable labor force distribution system at sites followed by a possible optimization of the objective function on limitations have been determined. Safe corridors of fluctuations in the values of the labor force, as well as the fundamental foundations of the optimization method, have been also determined.

Transtubular Anterior Cervical Foraminotomy for the Treatment of Compressive Cervical Radiculopathy: Surgical Results and Complications in a Consecutive Series of Cases.

Study DesignThis was a retrospective review of patients with compressive cervical radiculopathy treated with a minimally invasive anterior cervical foraminotomy (ACF).PurposeThis study aimed to evaluate the results and complication rates of ACF in a consecutive series of patients and to report our clinical results of ACF as a minimally invasive technique in a series of 45 consecutive patients treated for compressive cervical radiculopathy.Overview of LiteratureACF is a motion-sparing procedure and an alternative to anterior cervical discectomy and fusion (ACDF) and posterior cervical foraminotomy for direct nerve root decompression in patients with compressive cervical radiculopathy.MethodsThe chart review recorded clinical and radiological features preoperatively and postoperatively and at follow-up (FU). The effect of prognostic factors was analyzed in relation to the clinical outcome.ResultsBetween January 2004 and October 2019, 45 patients (15 females and 30 males) with a mean age of 55.9 years (range, 28–78 years) underwent ACF for unilateral cervical radiculopathy. The global clinical outcome according to the MacNab scale was evaluated as excellent in 64.5% of patients (n=29), good in 28.9% (n=13), fair in 4.4% (n=2), and poor in 2.2% (n=1). The radiological FU was available for 73.3% (n=33). The statistical analysis revealed no influence of age, sex, operated level, and side on the clinical outcome. Only one patient (2.2%) exhibited spontaneous bone fusion at the operated level on FU after a right-sided C6–7 ACF with no clinical consequences. No patient presented with signs of delayed segmental instability. The overall reoperation rate of this series was 4.4%.ConclusionsACF is a feasible and low-cost alternative to ACDF in selected patients with cervical radiculopathy. The use of tubular retractors in ACF may confer an added advantage that creates a safe corridor for direct cervical root decompression yet minimizing surrounding soft tissue retraction and avoiding unnecessary bone removal.

Optimal Frontier-Based Autonomous Exploration in Unconstructed Environment Using RGB-D Sensor.

Aerial robots are widely used in search and rescue applications because of their small size and high maneuvering. However, designing an autonomous exploration algorithm is still a challenging and open task, because of the limited payload and computing resources on board UAVs. This paper presents an autonomous exploration algorithm for the aerial robots that shows several improvements for being used in the search and rescue tasks. First of all, an RGB-D sensor is used to receive information from the environment and the OctoMap divides the environment into obstacles, free and unknown spaces. Then, a clustering algorithm is used to filter the frontiers extracted from the OctoMap, and an information gain based cost function is applied to choose the optimal frontier. At last, the feasible path is given by A* path planner and a safe corridor generation algorithm. The proposed algorithm has been tested and compared with baseline algorithms in three different environments with the map resolutions of m, and m. The experimental results show that the proposed algorithm has a shorter exploration path and can save more exploration time when compared with the state of the art. The algorithm has also been validated in the real flight experiments.

Safe Route Mapping of Roadways Using Multiple Sourced Data

The use of systematic techniques with historical crash data and qualitative measures has long been a common practice to identify the problematic road features and develop countermeasures to mitigate the crash risk in crash-prone locations. This paper proposes a novel approach, <italic xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">Safe Route Mapping</i> ( <italic xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">SRM</i> ) model that integrates crash-based estimates with conflict risks computed from driver-based data to score the safety of roadways. An advanced Safety Performance Function (SPF) estimates the number of crashes, and a driver-based model computes dynamic conflict risk measures from driver and traffic data. In real-life implementations of the proposed methodology, the driver-based data and traffic data can be collected from vehicles or infrastructure-based data sources, including smartphones. We demonstrate the methodology using real historical crash data and simulated driver-based data obtained from VISSIM and SSAM. We show safety risk heat maps for the example roadway and illustrate how these maps change with driver types and traffic volumes. The proposed methodology fills the existing gaps in the use of near real-time dynamic data to designate safe corridors, dispatch law enforcement, and plan safety projects. Drivers can also use the road heat maps for situational awareness and trip planning.

TENS for surgical stabilisation of acetabular fracture in the skeletally immature: A novel technique

BackgroundAcetabular fractures in childhood are rare and the literature is scarce to describe a standard protocol in surgical management of these injuries. As the patient is still growing, it warrants a detailed assessment with a sound surgical plan if operative intervention is deemed necessary to prevent late complications. Throughout literature, most fixation rely on using pins, screws, plates or combination of the three which require large surgical exposure and risk of secondary physeal injury, hence we come up with a method of using the Titanium Elastic Nail System (TENS) to overcome this issue. We describe a novel technique in managing acetabular fractures in this group of patients using the TENS. MethodAn 8 year old girl with a diagnosis of right anterior column posterior hemitransverse acetabular fracture was fixed with 3 TENS for supra-acetabular, anterior column and posterior column fragments. Surgery was performed in a minimally invasive manner. No drilling was performed during the surgery and implant insertion is done manually. ResultsAdvantages of this procedure include minimally invasive surgery with smaller wounds, minimal intraoperative bleeding and theoretically reduces the risk of premature fusion of the triradiate cartilage. Patient is allowed early rehabilitation with this method. ConclusionThis novel method provides an alternative to traditional usage of wires, pins, plates and screws as is described in most literature. However, it requires the surgeon to appreciate that the safe corridors for the implant are much narrower than adults. We recommend this technique for fractures that are deemed suitable for intramedullary fixation and further research in the future will be needed.

Absolute lymphocyte count as marker of cytomegalovirus and allograft rejection: Is there a "Safe Corridor" after kidney transplantation?

The contrasting outcomes of lymphocyte manipulation after solid organ transplantation are allograft rejection and infections, commonly with cytomegalovirus (CMV). Peripheral blood absolute lymphocyte count (ALC) may serve as a predictive marker for these outcomes. Using a retrospective review of clinical and laboratory dataset, we aimed to determine whether a range of ALC (termed "safe ALC corridor") exists where CMV infection and rejection outcomes are minimal in a cohort of 381 kidney transplant recipients. In an extended Cox model using a time-dependent covariate for peripheral blood ALC, a value below the cut-off of 610 cells/uL was associated with the development of CMV infection both in the overall cohort (Hazard Ratio [HR] 2.25 (95% confidence internal [CI] 1.02-4.96; P=.043) and the subgroup of high-risk CMV D+/R- mismatch patients (HR 2.91 [95% CI 1.09-7.77]; P=.033). In contrast, a time-dependent Cox analysis did not show any significant association between ALC and rejection (per IQR decrease, HR 1.2 [95% CI: 0.76-1.9]; P=.434). Accordingly, a "safe ALC corridor" could not be defined. In conclusion, a low peripheral blood ALC (ie, threshold of 610cells/uL) can be used to stratify the risk of CMV disease after kidney transplantation.

Using the Lateral Pontine Safe Entry Zone for Resection of Deep-Seated Cavernous Malformations in the Lateral Pons: 2-Dimensional Operative Video.

The retrosigmoid approach is one of the main approaches used in the surgical management of pontine cavernous malformations. It definitely provides a lateral route to large central lesions but also makes possible resection of some ventral lesions as an alternative to the petrosal approaches. However, when these vascular malformations do not emerge on surface, one of the safe corridors delimited by the origin of the trigeminal nerve and the seventh-eight cranial nerve complex can be used.1-5 Baghai et al2 described the lateral pontine safe entry zone in 1982, as an alternative to approaches through the floor of the fourth ventricle when performing tumor biopsies. They advocated a small neurotomy performed right between the emergence of the trigeminal nerve and the facial-vestibulocochlear cranial nerves complex. Accurate image guidance, intraoperative cranial nerve monitoring, and comprehensive anatomical knowledge are critical for this approach.4,5 Knowing the natural history of a brainstem cavernous malformation after bleeding,6 we sought to demonstrate in this video: (1) the use of the retrosigmoid craniotomy in lateral decubitus for resection of deep-seated pontine cavernous malformations; (2) the wide opening of arachnoid membranes and dissection of the superior petrosal vein complex to improve surgical freedom and prevent use of fixed cerebellar retraction; and (3) the opening of the petrosal fissure and exposure of the lateral pontine zone for gross total resection of a cavernous malformation in a 19-yr-old female with a classical crossed brainstem syndrome. She had full neurological recovery after 3 mo of follow-up. The patient consented in full to the surgical procedure and publication of the video and manuscript.