Dr. Xiaoyu Cai acknowledges the financial support from the China Scholarship Council. This work was funded by the Natural Science Foundation of Xinjiang Province, P. R. China (no. 2016B03047-3).

The study was approved by the ethical committee of the First Affiliated Hospital of Xinjiang Medical University, China17.
1. Informed Consent
<ol>
	<li>Obtain the patient&#39;s informed consent after explaining the details of the surgical procedure, postoperative prognosis, and possible complications (infection, epidural hematoma, spinal cord injury, failure of internal fixation, and cerebrospinal fluid leakage).</li>
	<li>Explain the other risks generally associated with using an implant (e.g., internal fixation system) such as allergic or immune system responses to the implanted materials.</li>
	<li>Rule out any contraindications of the patients.</li>
</ol>
2. Patient selection
<ol>
	<li>Diagnosis of BS
	<ol>
		<li>Base the initial diagnosis of BS on the clinical manifestations and radiographic assessments8.
		<ol>
			<li>Look for clinical manifestations and symptoms such as back pain, undulant fever, malaise, profuse night sweating, weight loss, polyarthralgia, and generalized myalgias8,18.</li>
			<li>In plain radiographs, look for osteophytes, sclerosis, osteoporosis of the vertebral body, and narrowing of the intervertebral disc space, with posterior elements being mostly preserved. 
			NOTE: Central necrosis is mostly not present, and the vertebral body is mostly morphologically intact (Figure 1)18.</li>
			<li>In computed tomography (CT), look for small bone destruction lesions at vertebral edges that occur in multiple areas, and for hyperplastic and sclerotic lesions that are more prominent and often admixed (Figure 1)18. 
			&#8203;NOTE: CT features are divided into those of vertebral osteolysis and vertebral hyperplastic sclerosis stages19.</li>
			<li>As magnetic resonance imaging (MRI) is the best imaging tool for BS diagnosis (Figure 1)20,21,22, look for characteristic MRI findings that can be classified into five subsets: discitis, spondylitis, paraspinal/psoas abscess, appendicitis, and compound (Table 1).</li>
		</ol>
		</li>
		<li>Confirm the diagnosis according to the presence of the following three criteria23:
		<ol>
			<li>Ensure that the clinical picture is compatible with that of BS.</li>
			<li>Confirm the absence of any etiology other than Brucellosis that can explain spinal involvement.</li>
			<li>Confirm that the results of the standard tube agglutination test reveal a titer of antibodies to Brucella of &#8805; 1/16024.</li>
		</ol>
		</li>
	</ol>
	</li>
	<li>Indications for surgery23
	<ol>
		<li>Look for persistent pain due to spinal instability, which is caused by severe disc or/and vertebral destruction.</li>
		<li>Confirm severe or progressive neurologic dysfunction that can be attributed to nerve root compression by inflammatory granuloma or epidural abscesses.</li>
		<li>Confirm that there is no response to oral antibiotic therapy (e.g., doxycycline, rifampicin, streptomycin).</li>
	</ol>
	</li>
</ol>
3. Preoperative procedure
<ol>
	<li>Administer a chemotherapy regimen (oral doxycycline 200 mg/day plus oral rifampicin 600-900 mg/day)25 to all patients.</li>
	<li>Offer surgical interventions to patients who have surgical indications after two weeks of antibiotic treatment.</li>
</ol>
4. Operative procedures for single-stage transforaminal decompression, debridement, interbody fusion, and internal fixation via posterior-only approach
<ol>
	<li>Place the patient on a four-poster frame in the prone position after administration of general anesthesia with endotracheal intubation.</li>
	<li>Disinfect the surgical area with 1% iodophor, and then cover with standard surgical towels (see Table of Materials).</li>
	<li>Make a midline longitudinal incision over the spinous process of the infected vertebra.</li>
	<li>Expose the posterior spinal structures including lamina, facet joints, and transverse processes.</li>
	<li>Place the pedicle screws (diameter: 5-7 mm, length: 20-65 mm) into both sides of the affected vertebra with the assistance of C-arm fluoroscopy26,27,28 (see Table of Materials). 
	NOTE: To achieve adequate debridement, place the pedicle screws closest to the superior or inferior endplate and away from the infection lesions. Fix the screws to a temporary rod (diameter: 5.5 mm) on the less involved side (see Table of Materials).</li>
	<li>Perform the facetectomy at the involved level on the side where neurologic and radiological manifestations are more severe29.</li>
	<li>Debride the epidural abscess, granulation tissues, infected disc with curettes, and scrape the vertebral endplates. Meanwhile, protect the nerve root with a nerve retractor (see Table of Materials). 
	NOTE: Perform a blunt dissention to adequately drain the psoas abscess from the posterolateral as thoroughly as possible. Analyze the tissues and abscess histopathologically30,31. Noncaseating granulomatous inflammation with predominant lymphocyte and monocytes infiltration is the typical histopathologic finding of BS32. If the result of decompression and debridement is not satisfactory after a unilateral facetectomy, perform the same procedure on the opposite side.</li>
	<li>After adequately removing the lesions and decompressing the neural elements, use 1000-2000 mL of 0.9% sodium chloride solution for surgical area irrigation to clear the residual Brucellar lesion (see Table of Materials).</li>
	<li>Saturate an absorbable gelatin sponge (60 mm x 20 mm x 5 mm) with 0.75-1.5 g of streptomycin, and use it for both hemostasis and local antibiotic treatment within the surgical area (see Table of Materials).</li>
	<li>Implant the locally harvested autogenous bone into the defected space for interbody fusion with a bone graft funnel and bone pusher (see Table of Materials).</li>
	<li>Fix pedicle screws (diameter: 5-7 mm, length: 20-65 mm) on both sides to the pre-contoured rods (diameter: 5.5 mm) under a slight compression33,34 (see Table of Materials).</li>
	<li>Drain and close the lesion35 (see Table of Materials).</li>
</ol>
5. Postoperative management
<ol>
	<li>Administer intravenous antibiotic (cefuroxime sodium, 1.5 g, q12h) for 1-3 days postoperatively.</li>
	<li>Remove the drainage tube when the drainage volume is less than 30 mL per day.</li>
	<li>Administer the aforementioned antibiotic therapies with doxycycline (200 mg/day) and rifampicin (600-900 mg/day) for at least 3 months (range 3-12 months) after surgery.</li>
	<li>Ensure the patient remains in bed for 3-5 days postoperatively, and allow for mobilization by providing effective support with a lumbosacral brace.</li>
	<li>Perform plain radiography before the patient&#39;s discharge to evaluate the location of the graft and instrumentation.</li>
	<li>Ensure at least 2-3 months of brace protection.</li>
</ol>
6. Follow-up evaluation
<ol>
	<li>Follow up with the patients at 1, 3, and 6 months postoperatively and then annually.</li>
	<li>Monitor the infection by measuring erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP).</li>
	<li>Evaluate interbody fusion by radiography at the last follow-up. 
	NOTE: Assess graft fusion with the radiologic criteria of Bridwell36. Perform CT scans if there is any uncertainty regarding plain radiographs.</li>
	<li>Utilize the visual analogue scale (VAS) to assess back pain.</li>
	<li>Evaluate pain-related dysfunction with the Oswestry Disability Index (ODI).</li>
	<li>Use the Japanese Orthopedic Association (JOA) scale to evaluate the functional outcomes.</li>
</ol>

The authors have nothing to disclose.

The present guideline of diagnosis and surgical treatment of human BS with a detailed protocol and satisfactory clinical evidence from representative cohorts shows clinical efficacy and is proposed for large-scale application to manage human BS, especially in endemic regions. The first critical step in the treatment of BS is to make the correct diagnosis. The diagnosis of BS needs to be differentiated from spinal tuberculosis compared to which BS is relatively less bone-destructive and usually responds effectively to ant...

With more than half a million new cases annually, human Brucellosis has become a public health concern and remains an enormous burden worldwide1,2,3,4. BS, as the most common and severe osteoarticular manifestation of human Brucellosis, involves multiple structures including vertebral bodies, intervertebral disc, and paraspinal structures5,6. It occurs frequently in the lumbosacral zone and needs to be differentiated from other infectious diseases because of its nonspecific clinical characteristics7,8. Despite the significant advances in research over the past decades, accurate and timely diagnosis of BS is still a challenge for clinicians due to its late-onset radiological findings, slow growth rate in blood cultures, and the complexity of its serodiagnosis9. Therefore, human BS remains clinically underdiagnosed and underreported. Although the past decades have seen increasingly rapid advances in the introduction and popularization of several therapeutic guidelines, there is still no consensus for an optimal management modality10. Frequent relapses, treatment failure, and sequelae are reported constantly11.
Of note, BS can be severely debilitating and disabling even if it is rarely fatal. If it is not treated appropriately, possible serious sequelae might be induced including persistent back pain, neurological deficiency, and even kyphotic deformity12,13. Antibiotic therapy is the core in the treatment of BS and yields generally promising outcomes9. However, certain patients may require surgical treatment if neurological dysfunction, spinal instability, abscess formation, intractable pain, or a previous unsatisfactory response to conservative treatments are observed. Surgical intervention remains controversial. Different surgical procedures for debridement and fusion have been described for infectious diseases of the lumbar spine including anterior-only, posterior-only, and combined approaches14,15,16. Here, diagnostic guidelines have been presented for human BS and for the single-stage surgical treatment with transforaminal decompression, debridement, interbody fusion, and internal fixation via a posterior-only approach. A detailed protocol of this method is given below.

<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td>Absorbable gelatin sponge</td>
			<td>Chuhe Medical Devices Co., Ltd.</td>
			<td>AWZ-035-XSMJHM-AD.</td>
			<td>60 mm x 20 mm x 5 mm</td>
		</tr>
		<tr>
			<td>Box curette&#160;</td>
			<td>Rudischhauser GmbH</td>
			<td>R16-BD2310-ST</td>
			<td>Width: 7.5 mm; height: 5.9 mm; shaft: 6.0 mm (diameter); working length: 223 mm</td>
		</tr>
		<tr>
			<td>Bone graft funnel&#160;</td>
			<td>Rudischhauser GmbH</td>
			<td>R19-K00000-FU</td>
			<td>Working length: 246.5 mm; End diameter: 42 mm; shaft: 6.4 mm (diameter)</td>
		</tr>
		<tr>
			<td>Bone pusher&#160;</td>
			<td>Rudischhauser GmbH</td>
			<td>R19-EK4110-00</td>
			<td>Working length: 220 mm; shaft: 6.0 mm (diameter)</td>
		</tr>
		<tr>
			<td>Bone rongeur</td>
			<td>Vet Direct &#38; VETisco</td>
			<td>EC-RG-BO-180</td>
			<td>Length: 180 mm</td>
		</tr>
		<tr>
			<td>Iodophor (1%)</td>
			<td>Beijing SanYao Science &#38; Technology Development Co.</td>
			<td>14975I</td>
			<td>Volume: 500 mL</td>
		</tr>
		<tr>
			<td>Nerve retractor</td>
			<td>Rudischhauser GmbH</td>
			<td>R16-HD1710-00</td>
			<td>Width: 10 mm; length: 145 mm; shaft: 5.0 mm (diameter)</td>
		</tr>
		<tr>
			<td>Osteotome 1</td>
			<td>Rudischhauser GmbH</td>
			<td>R16-CD2310-08</td>
			<td>Width: 8 mm; height: 3 mm; shaft: 6.0 mm (diameter); working length: 223 mm</td>
		</tr>
		<tr>
			<td>Osteotome 2</td>
			<td>Rudischhauser GmbH</td>
			<td>R16-CD2310-10</td>
			<td>Width: 10 mm; height: 3 mm; shaft: 6.0 mm (diameter); working length: 223 mm</td>
		</tr>
		<tr>
			<td>Pedicle screw</td>
			<td>DePuy Synthes Companies</td>
			<td>199723540</td>
			<td>Length: 40 mm; diameter: 5.0 mm</td>
		</tr>
		<tr>
			<td></td>
			<td>DePuy Synthes Companies</td>
			<td>199723545</td>
			<td>Length: 45 mm; diameter: 5.0 mm</td>
		</tr>
		<tr>
			<td></td>
			<td>DePuy Synthes Companies</td>
			<td>199723550</td>
			<td>Length: 50 mm; diameter: 5.0 mm</td>
		</tr>
		<tr>
			<td></td>
			<td>DePuy Synthes Companies</td>
			<td>199723640</td>
			<td>Length: 40 mm; diameter: 6.0 mm</td>
		</tr>
		<tr>
			<td></td>
			<td>DePuy Synthes Companies</td>
			<td>199723645</td>
			<td>Length: 45 mm; diameter: 6.0 mm</td>
		</tr>
		<tr>
			<td></td>
			<td>DePuy Synthes Companies</td>
			<td>199723650</td>
			<td>Length: 50 mm; diameter: 6.0 mm</td>
		</tr>
		<tr>
			<td></td>
			<td>DePuy Synthes Companies</td>
			<td>199723740</td>
			<td>Length: 40 mm; diameter: 7.0 mm</td>
		</tr>
		<tr>
			<td></td>
			<td>DePuy Synthes Companies</td>
			<td>199723745</td>
			<td>Length: 45 mm; diameter: 7.0 mm</td>
		</tr>
		<tr>
			<td></td>
			<td>DePuy Synthes Companies</td>
			<td>199723750</td>
			<td>Length: 50 mm; diameter: 7.0 mm</td>
		</tr>
		<tr>
			<td>Securo Drain</td>
			<td>Dispomedica GmbH</td>
			<td>1.33578</td>
			<td>Size: 7 mm; Length of perforation: 15 cm; Total length: 80 cm; Reservior size: 150 ml</td>
		</tr>
		<tr>
			<td>Sterile 0.9% Sodium Chloride Solution</td>
			<td>Beijing SanYao Science &#38; Technology Development Co.</td>
			<td>15935S</td>
			<td>Volume: 500 mL</td>
		</tr>
		<tr>
			<td>Straight rod</td>
			<td>DePuy Synthes Companies</td>
			<td>1797-62-480</td>
			<td>Length: 480 mm; diameter: 5.5 mm</td>
		</tr>
		<tr>
			<td>Streptomycin sulfate, Powder</td>
			<td>Beijing SanYao Science &#38; Technology Development Co.</td>
			<td>P06-11025P</td>
			<td>Size: 1 g</td>
		</tr>
	</tbody>
</table>

diagnosis and surgical treatment of human brucellar spondylodiscitis

Brucellar spondylodiscitis (BS) is the most prevalent and significant osteoarticular presentation of human Brucellosis, which is commonly manifested in pastoral communities. It is difficult to differentially diagnose and usually leads to irreversible neurologic deficits and spinal deformities. The initial diagnosis of BS is based on clinical findings and radiographic assessments, and the confirmed diagnosis should be established by the isolation of Brucella species from the blood and/or the standard tube agglutination test. Differential diagnosis of multifocal BS from either degenerative disc diseases or tuberculosis is especially highlighted. The surgical approach, either endoscopic or open, is demonstrated in detail, accompanied by radiographic evidence of structural compression or severe instability. Further, the crucial surgical steps, including single-stage transforaminal decompression, debridement, interbody fusion, and internal fixation, are explained. Moreover, perioperative care and postoperative rehabilitation are also addressed. Taken together, this clinical algorithm presents a practical guide that has yielded substantially satisfactory outcomes in the past decades, which can also be introduced for large-scale application to manage human BS, especially in endemic regions.

This paper describes a prospective, non-randomized, controlled study of 32 consecutive BS patients who were treated by a single-stage transforaminal decompression, debridement, interbody fusion, and internal fixation via a posterior-only approach in the Department of Spine Surgery, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China. Figure 1 shows a typical case in this study.
T...

Watch this Scientific Journal Video about Diagnosis and Surgical Treatment of Human Brucellar Spondylodiscitis at JoVE.com

Diagnosis and Surgical Treatment of Human Brucellar Spondylodiscitis

We describe a clinical algorithm, based on decades of front-line experience of diagnosis and surgical treatment of human Brucellar spondylodiscitis in the largest medical center of the China's Xinjiang Pastoral Area.

Brucellar spondylodiscitis (BS) is the most prevalent and significant osteoarticular presentation of human Brucellosis, which is commonly manifested in ...

diagnosis-and-surgical-treatment-of-human-brucellar-spondylodiscitis

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Medicine

4.7K Views.  First Affiliated Hospital of Xinjiang Medical University. We describe a clinical algorithm, based on decades of front-line experience of diagnosis and surgical treatment of human Brucellar spondylodiscitis in the largest medical center of the China's Xinjiang Pastoral Area.

Video: Diagnosis and Surgical Treatment of Human Brucellar Spondylodiscitis

Improved Protocol For Laser Microdissection Of Human Pancreatic Islets From Surgical Specimens

Laser microdissection (LMD) is a technique that allows the recovery of selected cells and tissues from minute amounts of parenchyma 1,2. The dissected cells can be used for a variety of investigations, such as transcriptomic or proteomic studies, DNA assessment or chromosomal analysis 2,3. An especially challenging application of LMD is transcriptome analysis, which, due to the lability of RNA 4, can be particularly prominent when cells are dissected from tissues that are rich of RNases, such as the pancreas. A microdissection protocol that enables fast identification and collection of target cells is essential in this setting in order to shorten the tissue handling time and, consequently, to ensure RNA preservation. 
Here we describe a protocol for acquiring human pancreatic beta cells from surgical specimens to be used for transcriptomic studies 5. Small pieces of pancreas of about 0.5-1 cm3 were cut from the healthy appearing margins of resected pancreas specimens, embedded in Tissue-Tek O.C.T. Compound, immediately frozen in chilled 2-Methylbutane, and stored at -80 &deg;C until sectioning. Forty serial sections of 10 &mu;m thickness were cut on a cryostat under a -20 &deg;C setting, transferred individually to glass slides, dried inside the cryostat for 1-2 min, and stored at -80 &deg;C. 
Immediately before the laser microdissection procedure, sections were fixed in ice cold, freshly prepared 70% ethanol for 30 sec, washed by 5-6 dips in ice cold DEPC-treated water, and dehydrated by two one-minute incubations in ice cold 100% ethanol followed by xylene (which is used for tissue dehydration) for 4 min; tissue sections were then air-dried afterwards for 3-5 min. Importantly, all steps, except the incubation in xylene, were performed using ice-cold reagents - a modification over a previously described protocol 6. utilization of ice cold reagents resulted in a pronounced increase of the intrinsic autofluorescence of beta cells, and facilitated their recognition. For microdissection, four sections were dehydrated each time: two were placed into a foil-wrapped 50 ml tube, to protect the tissue from moisture and bleaching; the remaining two were immediately microdissected. This procedure was performed using a PALM MicroBeam instrument (Zeiss) employing the Auto Laser Pressure Catapulting (AutoLPC) mode. The completion of beta cell/islet dissection from four cryosections required no longer than 40-60 min. Cells were collected into one AdhesiveCap and lysed with 10 &mu;l lysis buffer. Each single RNA specimen for transcriptomic analysis was obtained by combining 10 cell microdissected samples, followed by RNA extraction using the Pico Pure RNA Isolation Kit (Arcturus). This protocol improves the intrinsic autofluorescence of human beta cells, thus facilitating their rapid and accurate recognition and collection. Further improvement of this procedure could enable the dissection of phenotypically different beta cells, with possible implications for better understanding the changes associated with type 2 diabetes.

Laser microdissection is a technique that allows the recovery of selected cells from minute amounts of parenchyma. Here we describe a protocol for acquiring human pancreatic islets from surgical specimens to be used for transcriptomic studies. Our protocol improves the intrinsic autofluorescence of human beta cells, thus facilitating their collection.

Laser microdissection (LMD) is a technique that allows the recovery of selected cells and tissues from minute amounts of parenchyma 1,2. The dissected ...

Isolation and Functional Characterization of Human Ventricular Cardiomyocytes from Fresh Surgical Samples

Cardiomyocytes from diseased hearts are subjected to complex remodeling processes involving changes in cell structure, excitation contraction coupling and membrane ion currents. Those changes are likely&#160;to be responsible for the increased arrhythmogenic risk and the contractile alterations leading to systolic and diastolic dysfunction in cardiac patients. However, most information on the alterations of myocyte function in cardiac diseases has come from animal models.
Here we describe and validate a protocol to isolate viable myocytes from small surgical samples of ventricular myocardium from patients undergoing cardiac surgery operations. The protocol is described in detail. Electrophysiological and intracellular calcium measurements are reported to demonstrate the feasibility of a number of single cell measurements in human ventricular cardiomyocytes obtained with this method.
The protocol reported here can be useful for future investigations of the cellular and molecular basis of functional alterations of the human heart in the presence of different cardiac diseases. Further, this method can be used to identify novel therapeutic targets at cellular level and to test the effectiveness of new compounds on human cardiomyocytes, with direct translational value.

Current knowledge on the cellular basis of cardiac diseases mostly relies on studies on animal models. Here we describe and validate a novel method to obtain single viable cardiomyocytes from small surgical samples of human ventricular myocardium. Human ventricular myocytes can be used for electrophysiological studies and drug testing.

Cardiomyocytes from diseased hearts are subjected to complex remodeling processes involving changes in cell structure, excitation contraction coupling and ...

Integrated Compensatory Responses in a Human Model of Hemorrhage

Hemorrhage is the leading cause of trauma-related deaths, partly because early diagnosis of the severity of blood loss is difficult. Assessment of hemorrhaging patients is difficult because current clinical tools provide measures of vital signs that remain stable during the early stages of bleeding due to compensatory mechanisms. Consequently, there is a need to understand and measure the total integration of mechanisms that compensate for reduced circulating blood volume and how they change during ongoing progressive hemorrhage. The body&#39;s reserve to compensate for reduced circulating blood volume is called the &#39;compensatory reserve&#39;. The compensatory reserve can be accurately evaluated with real-time measurements of changes in the features of the arterial waveform measured with the use of a high-powered computer. Lower Body Negative Pressure (LBNP) has been shown to simulate many of the physiological responses in humans associated with hemorrhage, and is used to study the compensatory response to hemorrhage. The purpose of this study is to demonstrate how compensatory reserve is assessed during progressive reductions in central blood volume with LBNP as a simulation of hemorrhage.

The purpose of this protocol is to demonstrate the techniques for measuring compensatory responses to reduced central blood volume using lower body negative pressure as a noninvasive experimental model of human hemorrhage which can be used to quantify the total integration of compensatory mechanisms to blood volume deficit in humans.

Hemorrhage is the leading cause of trauma-related deaths, partly because early diagnosis of the severity of blood loss is difficult. Assessment of ...

Surgical Treatment for Benign Prostatic Hyperplasia: Holmium Laser Enucleation of the Prostate (HoLEP).

Benign prostatic hyperplasia (BPH) commonly occurs among elderly males. The condition causes symptoms in the lower urinary tract, thereby reducing the quality of life. BPH includes 2 major treatments: medication and surgery. Surgical treatment is often the most effective and final intervention. Holmium laser enucleation of the prostate (HoLEP), one of the most efficient surgical procedures for BPH, is conducted transurethrally. During surgery, the most important and most difficult part is to locate the surgical capsule of the prostate, which is consistent to the idea of anatomic surgery. Different skills may be needed in treating different parts of the prostate. HoLEP tends to be efficient and safe with good hemostatic properties, and able to treat bladder calculus, which may be the complications of BPH. The technique is particularly suitable for prostate of varying volumes and sizes. Indeed, HoLEP also presents certain disadvantages, such as a long learning curve and costly equipment. Regardless, this method may be the "new standard" and the excellent method for the surgical treatment of BPH.

Surgical Treatment for Benign Prostatic Hyperplasia: Holmium Laser Enucleation of the Prostate HoLEP.

Here we present a safe and efficient protocol, holmium laser enucleation of the prostate, to treat benign prostatic hyperplasia.

Benign prostatic hyperplasia (BPH) commonly occurs among elderly males. The condition causes symptoms in the lower urinary tract, thereby reducing the ...

Integrating Augmented Reality Tools in Breast Cancer Related Lymphedema Prognostication and Diagnosis

Breast cancer related lymphedema (BCRL) is a detrimental condition characterized by fluid accumulation in the upper limb in breast cancer patients subjected to axillary surgery and/or radiations. Its etiology is multifactorial and include also tumor-specific pathological features, such as lymphovascular invasion (LVI) and extranodal extension (ENE). To date, no widely employed guidelines for the early diagnosis of BCRL are available. Here, we illustrate a protocol for a digitally assisted BCRL assessment using a 3D laser scanner (3DLS) and a tablet computer. It has been specifically optimized in a discovery cohort of high-risk breast cancer patients. This study provides a proof-of-principle that augmented reality tools, such as 3DLS, can be incorporated into the clinical workup of BCRL to allow for a precise, reproducible, reliable, and cheap diagnosis.

Breast cancer related lymphedema is frequent in breast cancer survivors, but there are not widely employed guidelines for its diagnosis and quantification. Here, we introduce a reliable and cost-effective protocol to define, quantify, and compare upper limb volume in breast cancer patients.

Breast cancer related lymphedema (BCRL) is a detrimental condition characterized by fluid accumulation in the upper limb in breast cancer patients ...

OP-IVM: Combining In vitro Maturation after Oocyte Retrieval with Gynecological Surgery

The use of in vitro maturation (IVM) before gynecological operation (OP-IVM) is an extension of conventional IVM that combines IVM following oocyte retrieval with routine gynecological surgery. OP-IVM is suitable for patients undergoing benign gynecological surgery who have the need for fertility preservation (FP) or infertility treatments such as in vitro fertilization and embryo transfer (IVF-ET). In the operating room, patients undergoing benign gynecological surgery are first anesthetized and receive ultrasound-guided immature follicle aspiration (IMFA) treatment. As the subsequent gynecological surgery is performed, the cumulus-oocyte complexes (COCs) are examined, and the immature COCs are transferred into the IVM medium and cultured for 28-32 hours in the IVF laboratory. After assessment, mature oocytes in the MII stage will be selected and cryopreserved in liquid nitrogen for FP or fertilized by intracytoplasmic sperm injection (ICSI) for IVF-ET. By combining IVM with gynecological surgery, immature oocytes that would have been discarded can be saved and used for assisted reproductive technology (ART). The procedure, significance and critical aspects of OP-IVM are described in this article.

In vitro maturation (IVM) before gynecological operation (OP-IVM) combines IVM following oocyte retrieval with routine gynecological surgery and serves as an extension of conventional IVM applications for fertility preservation.

The use of in vitro maturation (IVM) before gynecological operation (OP-IVM) is an extension of conventional IVM that combines IVM following oocyte ...

Basophil Activation Test for Allergy Diagnosis

The basophil activation test (BAT) is a complementary in vitro diagnostic test that can be used in addition to clinical history, skin test (ST), and specific IgE (sIgE) determination in the evaluation of IgE-mediated allergic reactions to food, insect venom, drugs, as well as some forms of chronic urticaria. However, the role of this technique in the diagnostic algorithms is highly variable and not well determined.
BAT is based on the determination of basophil response to allergen/drug cross-linking IgE activation through the measurement of activation markers (such as CD63, CD203c) by flow cytometry. This test can be a useful and complementary tool to avoid controlled challenge tests&#160;to confirm allergy diagnosis, especially in subjects experiencing severe life-threatening reactions. In general, the performance of BAT should be considered if i) the allergen/drug produces false positive results in ST; ii) there is no allergen/drug source to use for ST or sIgE determination; iii) there is discordance between patient history and ST or sIgE determination; iv) symptoms suggest that ST may result in systemic response; v) before considering a CCT to confirm the culprit allergen/drug. The main limitations of the test are related to non-optimal sensitivity, especially in drug allergy, the need to perform the test no longer than 24 h after sample extraction, and the lack of standardization between laboratories in terms of procedures, concentrations, and cell markers.

The basophil activation test is a complementary in vitro diagnostic test for the evaluation of IgE-mediated allergic reactions based on the detection of basophil activation in the presence of a specific stimulus through the measure of activation markers by flow cytometry.

The basophil activation test (BAT) is a complementary in vitro diagnostic test that can be used in addition to clinical history, skin test (ST), and ...

Endolymphatic Duct Blockage as a Surgical Treatment Option for M&#233;ni&#232;re's Disease

Endolymphatic duct blockage is a relatively new treatment option for M&#233;ni&#232;re's disease, aiming to reduce vertigo attacks while sparing hearing and equilibrium. After a regular mastoidectomy, the posterior semicircular canal is identified, and Donaldson's line is determined. This is a line through the horizontal semicircular canal, crossing the posterior semicircular canal. The endolymphatic sac is usually found at this site under the posterior semicircular canal. The bone of the endolymphatic sac and the dura are thinned until the sac is skeletonized, after which the endolymphatic duct is identified. The duct is then blocked with a titanium clip. Using a computerized tomography (CT) scan, the position is confirmed. Follow-up visits take place 1 week, 6 weeks and 1 year after surgery. To this day, only one prospective trial assessing this method has been conducted, comparing this new method to endolymphatic sac decompression. Results of the duct blockage are promising, with 96.5% of the patients free of vertigo after 2 years. However, further research is required.

Endolymphatic duct blockage is a relatively new surgical method for patients suffering from M&#233;ni&#232;re's disease. Following a regular mastoidectomy, the endolymphatic duct is identified and ligated using a regular titanium hemoclip. The effectiveness of this procedure is currently being assessed in a randomized trial.

Endolymphatic duct blockage is a relatively new treatment option for M&#233;ni&#232;re's disease, aiming to reduce vertigo attacks while sparing hearing ...

3D Reconstruction for the Diagnosis and Treatment of Pulmonary Nodules

A 3D Digital Model for the Diagnosis and Treatment of Pulmonary Nodules

The three-dimensional (3D) reconstruction of pulmonary nodules using medical images has introduced new technical approaches for diagnosing and treating pulmonary nodules, and these approaches are progressively being acknowledged and adopted by physicians and patients. Nonetheless, constructing a relatively universal 3D digital model of pulmonary nodules for diagnosis and treatment is challenging due to device differences, shooting times, and nodule types. The objective of this study is to propose a new 3D digital model of pulmonary nodules that serves as a bridge between physicians and patients and is also a cutting-edge tool for pre-diagnosis and prognostic evaluation. Many AI-driven pulmonary nodule detection and recognition methods employ deep learning techniques to capture the radiological features of pulmonary nodules, and these methods can achieve a good area under-the-curve (AUC) performance. However, false positives and false negatives remain a challenge for radiologists and clinicians. The interpretation and expression of features from the perspective of pulmonary nodule classification and examination are still unsatisfactory. In this study, a method of continuous 3D reconstruction of the whole lung in horizontal and coronal positions is proposed by combining existing medical image processing technologies. Compared with other applicable methods, this method allows users to rapidly locate pulmonary nodules and identify their fundamental properties while also observing pulmonary nodules from multiple perspectives, thereby providing a more effective clinical tool for diagnosing and treating pulmonary nodules.

Author Spotlight: A 3D Digital Model for the Diagnosis and Treatment of Pulmonary Nodules  

The objective of this study is to develop a novel 3D digital model of pulmonary nodules that serves as a communication bridge between physicians and patients and is also a cutting-edge tool for pre-diagnosis and prognostic evaluation.

The three-dimensional (3D) reconstruction of pulmonary nodules using medical images has introduced new technical approaches for diagnosing and treating ...

Surgical Treatment of an Endolymphatic Sac Tumor

Endolymphatic sac tumors (ELST) are low-grade papillary adenocarcinoma originating from the endolymphatic sac. Usually slow-growing, with local aggressiveness and a low risk of distant metastases, ELST can be sporadic but also frequently associated with von Hippel Lindau disease. The current treatment of ELST is primarily surgical resection. A 55-year-old woman accessed our otologic tertiary level referral center for a sudden worsening of hearing loss in her left ear and vertigo. A magnetic resonance (MRI) and computer tomography scan study subsequently showed a mass in the petrous bone; hence, the presence of an ELST was hypothesized. After embolization of the mass, the patient underwent surgical removal of the lesion. The resection of the mass was done through a translabirinthine approach, with an uneventful procedure. No residual disease remained after surgery. After 24 months of radiologic follow up with MRI, there are no signs of recurrence disease. This paper reports the management of this sporadic ELST, as well as the follow up results, providing clinicians this protocol for the handling of such a challenging otologic skull base surgery and rare disease.

Here, we discuss clinical and radiological features of endolymphatic sac tumors and report the methodology and results of a surgical removal in a case in care at our otologic referral center.