Dynamic ultrasound for evaluating the adequacy of median nerve decompression following minimally invasive carpal tunnel release: technical innovation and case study.

Background: Minimally invasive carpal tunnel release has recently emerged as the primary surgical approach for recalcitrant carpal tunnel syndrome. A major concern related to surgical failure with this technique is the incomplete release of the flexor retinaculum. Case presentation: We developed a technique using dynamic ultrasound for evaluating the adequacy of median nerve decompression following minimally invasive carpal tunnel release. This novel imaging method was applied to two patients who showed significant symptom relief after the intervention. This case study also provides details of the dynamic ultrasound protocol and highlights the advantages of this technique. Conclusion: Dynamic ultrasound imaging can be used to confirm the completeness of carpal tunnel decompression. A large-scale prospective trial should be conducted to validate whether additional dynamic ultrasound examination can improve the outcome of minimally invasive carpal tunnel release.

Two new dihydro-ß-agarofuran sesquiterpenes from the roots of Celastrus angulatus.

Two new dihydro-ß-agarofuran sesquiterpenes chiapen T (1) and chiapen U (2), along with chiapen A (3), 1ß-hydroxy-2ß,6α,12-triacetoxy-8ß-(ß-nicotinoyloxy)-9ß-(benzoyloxy)-ß-dihydroagarofuran (4), wilforlide B (5), 3-hydroxy-2-oxo-3-friedelen-29-oic acid (6), epikatonic acid (7), 22-epi-maytenfolic acid (8), maytenoic acid (9), wilforic acid F (10), wilforic acid B (11), were reported for the first time from the Celastrus angulatus. The structures of all the compounds were elucidated by HR-ESI-MS, 1 D and 2 D NMR spectra, as well as single-crystal X-ray diffraction analyses. Compounds 1 and 2 were examined for anti-inflammatory activity, respectively. None of them showed potent activity.

Ultrasound Guidance for Full Endoscopic Spinal Surgery: A Technical Note.

BACKGROUND: The use of intraoperative ultrasound (IOU) has proven to be useful in spinal surgery. In this study, we present the techniques of applying IOU in cervical, thoracic, and lumbar full-endoscopic spine surgery (FESS). METHODS: For applying IOU in cervical FESS, first, we localize the surgical level by identifying the unique shape of C6 and C7 under ultrasound and then identify the cervical level subsequently. For the anterior approach, the endoscope passes through the cervical fascia between the carotid sheath and trachea/esophagus, which can be identified under ultrasound, and for the posterior approach, the endoscope docks on the facet joint under ultrasound. For applying IOU in thoracic FESS, we localize the surgical level by counting the ribs. The endoscope is advanced to the neural foramen under ultrasound without entering the pleural cavity. For applying IOU in lumbar FESS, we identify the surgical level by counting the interlaminar window from the sacrum. The endoscopic sheath is advanced to the neural foramen under ultrasound without entering the peritoneal cavity. RESULTS: The use of IOU in FESS has the potential to reduce radiation exposure, reach a higher successful puncture rate, and decrease the operation time. Furthermore, IOU prevents radiolucent organs from damage during FESS. CONCLUSIONS: We present the techniques of applying IOU in cervical, thoracic, and lumbar endoscopic spine surgery and hope that this will be helpful for physicians to master the IOU techniques.

Damage spreading in the mixed spin Ising model.

We apply the damage spreading technique to study a mixed spin Ising model consisting of spin 1/2 and spin 1 with a crystal field interaction on the square lattice within a kind of Metropolis dynamics. The completely different behavior, depending on the value of the crystal field interaction, strongly suggests there may exist a dynamical tricritical point where the phase transition may change from the second order to the first order for this model.