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Photon-counting detectors are a promising new technology for computed tomography (CT) systems. They provide energy-resolved CT data at very high spatial resolution without electronic noise and with improved tissue contrasts. This review article gives an overview of the principles of photon-counting detector CT, of potential clinical benefits and limitations, and of the experience gained so far in pre-clinical installations.

Treatment of lumbosacral tuberculosis is still controversial. In our study, we assessed the efficacy and feasibility of single-stage posterior debridement, interbody fusion using a structural autograft combined with a titanium mesh cage, and posterior instrumentation for the treatment of lumbosacral tuberculosis with significant vertebral body loss.

From May 2011 to June 2018, 15 patients with lumbosacral tuberculosis with significant vertebral body loss had undergone single-stage posterior debridement, interbody fusion using a structural autograft combined with a titanium mesh cage, and posterior instrumentation. The pre- and postoperative lumbosacral angle, visual analog scale score, erythrocyte sedimentation rate, C-reactive protein, and neurological status were assessed.

Surgery was successful for all patients, and no patient experienced tuberculosis recurrence during an average follow-up period of 27.3 months (range, 12-60 months). After surgery, the erythrocyte sedimentation rate and C-reactive protein for all patients had returned to normal within 3 months. At the final follow-up examination, the neurological status had improved in all patients who had had neurological deficits preoperatively. The mean preoperative lumbosacral angle was 12.6° (range, 6.7°-17.9°), and had increased to 27.7° (range, 24.3°-34.6°) after surgery. The average lumbosacral angle was 26.4° (range, 22.1°-32.3°), with an average loss of 1.4° (range, 0.6°-2.3°) at the final follow-up visit.

The combination of single-stage posterior debridement, interbody fusion using structural autografts with a titanium mesh cage, and posterior instrumentation is an effective and safe option for the treatment of lumbosacral tuberculosis with significant vertebral body loss.

The combination of single-stage posterior debridement, interbody fusion using structural autografts with a titanium mesh cage, and posterior instrumentation is an effective and safe option for the treatment of lumbosacral tuberculosis with significant vertebral body loss.This paper explores the clinical effect of midazolam as an adjuvant analgesic and tranquilizer after brachial plexus block anaesthesia with the aid of medical imaging. The paper selected 106 patients who underwent elective unilateral upper extremity surgery from January 2017 to December 2019, and randomly divided them into group A and group B, with 53 cases in each group, all underwent brachial plexus block anaesthesia, and group A was given imidazole Lon assisted sedation, group B was given fentanyl + midazolam assisted sedation. Under ultrasound-guided intermuscular sulcus brachial plexus block, observe and record the ultrasound anatomical images before injection, the distance from the lower edge of the upper, middle and lower trunk of the forearm brachial plexus to the skin; observe and record the operation time and the effect of anaesthesia block And the incidence of adverse reactions. The distance from the lower edge of each nerve trunk to the skin (average value) upper stem 1.002 cm, middle stem 1.598 cm, and lower stem 2.26 cm. selleck screening library The average operation time is 3min+56s; 92% of the operation time is within 3-5min. The anaesthesia effect was 81% excellent, 11% good, 6% poor, 2% ineffective, and 92% effective. Ultrasound guided inferior intermuscular sulcus approach brachial plexus block is suitable for unilateral upper extremity hand radial surgery. For surgery involving the upper extremity hand ulnar side, a larger dose (concentration) of local anaesthetics should be used within a safe range and (or) additional ulnar nerve block is necessary. Midazolam adjuvant medication can play a good sedative and amnestic effect in brachial plexus block anaesthesia, help reduce pain and inhibit the increase in stress levels.

Chiari malformation type I (CM-I) is a craniocervical junction disorder associated with descent of the cerebellar tonsils >5 mm. The prevalence of CM-I is common, including 0.5%-3.5% in the general population, 0.56%-0.77% on magnetic resonance imaging, and 0.62% in anatomic dissection studies. We sought to measure our surgical outcomes related to resolution/improvement of headaches, neurologic outcomes, and syringomyelia compared with reported adult CM-I studies from 2000-2019.

From December 2003 to June 2018, the first author (K.I.A.) performed 270° circumferential decompression on adult (>18 years) patients with CM-I. At admission and follow-up, all parameters were numerically evaluated; headaches were self-reported on the visual analog scale, neurologic condition was evaluated using Karnofsky Performance Status and European Myelopathy Score, and syrinx width (if present) was measured on magnetic resonance imaging by grades I-IV. All parameters were analyzed, compared, and statistically tested. We syrinx, neurologic symptoms, and headaches. We also confirm the association of body mass index with CM-I. Further studies are needed to confirm our results.

Stereoelectroencephalography (SEEG) consists of the implantation of microelectrodes for the electrophysiological characterization of epileptogenic networks. To reduce a possible risk of intracranial bleeding by vessel rupture during the electrode implantation, the stereotactic trajectories must follow avascular corridors. The use of digital subtraction angiography (DSA) for vascular visualization during planning is controversial due to the additional risk related to this procedure. Here we evaluate the utility of this technique for planning when the neurosurgeon has it available together with gadolinium-enhanced T1-weighted magnetic resonance sequence (T1-Gd) and computed tomography angiography (CTA).

Twenty-two implantation plans for SEEG were initially done using T1-Gd imaging (251 trajectories). DSA was only used later during the revision process. In 6 patients CTA was available at this point as well. We quantified the position of the closest vessel to the trajectory in each of the imaging modalities.

Two thirds of the trajectories that appeared vessel free in the T1-Gd or CTA presented vessels in their proximity, as shown by DSA.