EuroSpine

Carbon-fiber-reinforced polyetheretherketone (CFR-PEEK) instrumentation has been reported in recent years for metastatic spine tumor surgery (MSTS). The benefits of CFR-PEEK include imaging artifact reduction, which enables more efficient follow-up and adjuvant radiotherapy (RT) planning compared with traditional titanium implants. Despite the increase in CFR-PEEK application in the literature, technical guides or considerations in terms of CFR-PEEK usage in MSTS are currently unavailable. This study aimed to highlight various important technical considerations and potential pitfalls for surgeons when applying CFR-PEEK instrumentation in MSTS. This narrative review was conducted using PubMed, Medical Literature Analysis and Retrieval System Online, The Cochrane Library, and Scopus databases through December 31, 2024. This review included all studies related to CFR-PEEK instrumentation in MSTS. The vast personal experiences of the senior authors with the CFR-PEEK instrumentation circumstantiated the concepts emphasized in this paper. This review included 36 articles and discussed various considerations when planning for CFR-PEEK instrumentation in patients undergoing MSTS. Factors include preoperative construct planning, intraoperative CFR-PEEK system handling, and postoperative considerations such as the requirement for RT planning. This review is the first to highlight various considerations for MSTS surgeons when applying CFR-PEEK instrumentation. This serves as an important guide for surgeons performing MSTS, with the continuous evolution of our treatment capacity in metastatic spinal disease (Level of evidence: IV).

This chapter describes the requirements, design, and construction of the European Spallation Source (ESS) elliptical-cavity cryomodules. Initial testing of the components and cryomodules is described. The production of these cryomodules is accomplished via the ESS Superconducting Radio Frequency (SRF) Collaboration. This collaboration involves ESS and numerous in-kind partners. The development and management of this collaboration is discussed in this chapter. Lessons learned, both technical and organizational, are also provided.

In this chapter the requirements and early design choices for the test and instruments cryoplant (TICP) are addressed, along with procurement, design, installation, and commissioning experiences. The name ‘test and instruments cryoplant' indicates the cryoplant's main tasks, which is first to provide cooling to the elliptical cryomodule test stand and second to provide liquid helium to the neutron instruments and their sample environments. Besides these core cryogenic requirements, the TICP work unit also comprises a local and later side-wide helium recovery system, purification and storage units, liquid helium and nitrogen filling, and other commonly used piping and other auxiliary systems.

The cryomodule qualification test stand (TS2) in Lund was fully commissioned in 2021 and is performing site acceptance testing of all the elliptical cryomodules (CMs) before installation in the linear accelerator (LINAC) tunnel. This chapter describes the infrastructure available at TS2 and the workflow leading to the acceptance of cavities and cryomodules received from the different partners. We will then focus on the cryogenic operation aspects of TS2 and the cryogenic acceptance testing of elliptical cryomodules. Finally, we will draw some lessons learned about the construction and operation of TS2.

INTRODUÇÃO: O tratamento das fraturas e deformidades secundárias à fragilidade óssea nas crianças com osteogênese imperfeita (OI) tem evoluído para cirurgias minimamente invasivas e estabilização com implantes que acompanham o crescimento longitudinal do osso longo. As hastes telescopáveis são consideradas padrão ouro para o tratamento, no entanto as altas taxas de complicações tem sido foco de estudos. O objetivo deste estudo foi investigar fatores associados à falha das hastes Fassier Duval (FD) no fêmur e tíbia. MATERIAL E MÉTODOS: Foram incluídos 32 pacientes com OI, idade média de 8,0±3,6 anos e seguimento mínimo de um ano, com 17 meninos (53%) e 15 meninas (47%). Cinco pacientes (16%) foram classificados como Sillence do Tipo I, quatorze (43%) do Tipo III, oito (25%) como do Tipo IV e 5 (16%) desconhecidos. Foram realizadas 84 correções cirúrgicas estabilizadas por hastes telescopáveis de FD, sendo 50 nos fêmures e 34 nas tíbias, e 40 (48%) das correções ocorreram devido a deformidades crônicas e 44 (52%) por fraturas agudas. Foram avaliadas as falhas em relação as variáveis clínicas (sexo, etnia, Tipo de Sillence e idade nos procedimentos), cirúrgicas (imobilização, uso de bisfosfonatos, alteração prévia a cirurgia, síntese prévia, tempo de seguimento e tempo de consolidação). As variáveis radiográficas foram aferidas no pré e pós-operatório imediato, seis meses, um ano e na última avaliação disponível. Foram avaliadas as angulações da diáfise, orientações articulares proximal e distal e posicionamento da haste nas epífises. Os critérios de falhas foram, angulação diafisária >20° em pelo menos um plano ou a necessidade de revisão por fratura, travamento, migração distal e protrusão cortical da haste. A sobrevida cirúrgica foi determinada por meio do método de Kaplan-Meier. RESULTADOS: As falhas ocorreram em 45 segmentos (53%), com migração distal em 26 casos (58%), oito fraturas (18%) e seguida por e sete protrusões corticais (16%). Na tíbia, as hastes falharam mais que no fêmur (73% vs 40%; p< 0,01). Para o fêmur, houve mais falhas nos meninos (p=0,042), e nas tíbias, em pacientes mais novos (p=0,007). Fatores radiográficos pós-operatórios associados à falha no fêmur e tíbia foram o aumento da angulação diáfisária nas radiografias e posicionamento excêntrico da haste na epífise distal (p≤0,01). O ângulo distal tibial anterior (ADTA) apresentou valores maiores no grupo com falha (p=0,01), no final do seguimento. A sobrevida cirúrgica de 4 anos foi de 66% no fêmur e 20% na tíbia. CONCLUSÕES: As taxas de complicações de 53% foram altas, principalmente nas cirurgias das tíbias, houve tendência de sobrevida maior para hastes femorais, e fatores clínicos como sexo masculino e idade mais jovem podem estar associados a maior chance de falha do fêmur e tíbia respectivamente. Contraintuitivamente, o uso de bisfosfonatos e a classificação de Sillence não tiveram influência nas falhas.

Each year, the Japan Neurosurgical Society (JNS) reports up-to-date statistics from the Japan Neurosurgical Database regarding case volume, patient demographics, and in-hospital outcomes of the overall cohort and neurosurgical subgroup according to the major classifications of main diagnosis. We hereby report patient demographics, in-hospital mortality, length of hospital stay, purpose of admission, number of medical management, direct surgery, endovascular treatment, and radiosurgery of the patients based on the major classifications and/or main diagnosis registered in 2018 and 2019 in the overall cohort (523283 and 571143 patients, respectively) and neurosurgical subgroup (177184 and 191595 patients, respectively). The patient demographics, disease severity, proportion of purpose of admission (e.g., operation, 33.9–33.5%) and emergent admission (68.4–67.8%), and in-hospital mortality (e.g., cerebrovascular diseases, 6.3–6.5%; brain tumor, 3.1–3%; and neurotrauma, 4.3%) in the overall cohort were comparable between 2018 and 2019. In total, 207783 and 225217 neurosurgical procedures were performed in the neurosurgical subgroup in 2018 and 2019, respectively, of which endovascular treatment comprised 19.1% and 20.3%, respectively. Neurosurgical management of chronic subdural hematoma (19.4–18.9%) and cerebral aneurysm (15.4–14.8%) was most common. Notably, the proportion of management of ischemic stroke/transient ischemic attack, including recombinant tissue plasminogen activator infusion and endovascular acute reperfusion therapy, increased from 7.5% in 2018 to 8.8% in 2019. The JNS statistical update represents a critical resource for the lay public, policy makers, media professionals, neurosurgeons, healthcare administrators, researchers, health advocates, and others seeking the best available data on neurosurgical practice.

Abstract This article analyzes the war memories and processes of meaning‐making of Dutch veterans who returned to places related to their deployment in former Yugoslavia in the 1990s. It argues that the incentive to return can be found in the difficulties that veterans have in assigning positive meaning to their deployment because existing collective and cultural memories about the war and the genocide in Srebrenica do not align with many of the veterans’ experiences during and after the war. In the analysis of interviews conducted with seventeen Dutch veterans, attention is paid to their wartime memories, motivation to return, and experiences during the return trips. Returning to former places of deployment provides a way to reconcile memories, especially traumatic ones. The building of these memories passes through several phases: introspection; opening up to family, friends, and relatives; and helping others.