Communication sur l’aide publique au Dѐveloppement Etude de cas: La RDC

Nene DIOMBANA(네네 디옴바나) 서울행정학회 2013 서울행정학회 학술대회 발표논문집 Vol.2013 No.10

Cervical Kyphosis

Akshay Gadia,Kunal Shah,Abhay Nene 대한척추외과학회 2019 Asian Spine Journal Vol.13 No.1

Cervical kyphosis is a rare condition that can cause significant functional disability and myelopathy. Deciding the appropriate treatment for such deformities is challenging for the surgeon. Patients often present with axial neck pain, and it is not uncommon to find coexisting radiculopathy or myelopathy. The optimal approach for addressing this complex issue remains controversial. A comprehensive surgical plan based on knowledge of the pathology and biomechanics is important for kyphosis correction. Here we reviewed diagnoses of the cervical spine along with the literature pertaining to various approaches and management of cervical spine.

Short to Mid-Term Term Surgical Outcome Study with Posterior Only Approach on Tuberculous Spondylodiscitis in an Elderly Population

Manish Kothari,Kunal Shah,Agnivesh Tikoo,Abhay Nene 대한척추외과학회 2016 Asian Spine Journal Vol.10 No.2

Study Design: Retrospective study. Purpose: To study short to mid-term outcome of surgically managed elderly patients of tuberculous spondylodiscitis with posterior only approach in terms of decision making and challenges in treatment, choice of implants and outcomes. Overview of Literature: Tuberculous spondylodiscitis in the elderly is increasing due to longer survival rates. It presents with varied clinical manifestations needing surgical management. Management in tuberculous spondylodiscitis has been scarcely reported in the elderly, with a paucity of data on the choice of implants and approach. Methods: Sixteen patients (five males, 11 females) older than 70-years-of-age culture and/or histopathology proven tuberculous spondylodiscitis were included in the study. All patients were operated using a single posterior approach. Pedicle screw with rods (PS/ rods) or spinal loop with sublaminar wires (SL/SLW) were used for fixation. Clinical and surgical details were recorded. Sagittal correction achieved postoperatively and loss of correction at follow-up were noted. Results: The mean age was 73.6 years (range, 70 to 80 years). The mean follow up was 44.5 months (range, 24 to 84 months). The mean immediate postoperative correction of sagittal deformity was 11.3 degrees; this correction was lost by a mean of 3.1 degrees at last follow-up. All 10 patients with deficit showed neurological recovery and all but one of the seven non-walkers were capable of independent ambulation at follow-up. Patients with SL/SLW and PS/rods had similar radiological outcome at final follow up. Conclusions: Operative management gives satisfactory results in elderly patients with tuberculous spondylodiscitis. The posterior approach provides adequate exposure for decompression and rigid fixation, providing satisfactory clinical and radiological outcomes. SSL/SLW and pedicle screw rod construct both give similar radiological results if used appropriately in patients.

Outcomes of Various Treatment Modalities for Lumbar Spinal Ailments in Elite Athletes: A Literature Review

Akshay Gadia,Kunal Shah,Abhay Nene 대한척추외과학회 2018 Asian Spine Journal Vol.12 No.4

Lumbar spinal injuries are common in elite athletes, who can present with a spectrum of ailments ranging from lumbar strain to prolapsed intervertebral discs. Sequelae can include neurological impairment and lumbar instability among other possible outcomes. This group of patients is unique in terms of their clinicoradiological presentation and treatment modalities. The primary goals of treatment are a rapid return to play and prevention of recurrence, thus prolonging the athlete’s professional career. Treatment modalities can range from activity restriction to nerve root blocks and surgery. A successful treatment outcome is based on timely diagnosis, treatment suiting the demands of the particular sport, and early rehabilitation. A multidisciplinary team approach involving the coach, rehabilitation specialist, pain management specialist, and spine surgeon helps in planning appropriate treatment. In this article, we review special considerations in the elite athletic population with lumbar spinal ailments as well as the outcomes of various treatment modalities.

日韩医患纠纷非诉讼化解机制及其对中国的启示

李志行(Lee, Ji-Haeng),毛??(Mao NeNe) 동북아시아문화학회 2020 동북아 문화연구 Vol.1 No.62

The social and cultural backgrounds of China, Japan and Korea are similarities. Therefore, there are many and references in social governance. The Japanese Medical Doctors Association has established a system of professional liability insurance, and the association would participate in the mediation if the medical disputes have generated. On the other hand South Korea has established a Medical Dispute Mediation and Arbitration Agency. What’s more, both countries have achieved good dispute resolution effects in the practice of ADR systems and formed a standardized for the medical dispute handling mechanism, so the doctor-patient conflict performance is not very intense. This paper analyzes the successful experience of Japan and South Korea in dealing with medical disputes. Especially the non-litigation method to resolve medical disputes and analyzes the main problems existing in the current medical dispute resolution mechanism and methods in China. This essay found that influenced by the traditional methods, the ADR mechanism in China, Japan and Korea has distinctive differences on its demand, way of formation and mechanism, etc, through the analysis of the formation and development of ADR mechanism in medical disputes. Specifically, ADR mechanism has been massively influenced by its traditional mediation system, which leads to a further transformation from traditional mediation to modern legislation. In Korea, ADR mechanism ‘s development indicates that the pressure of litigation is greatly promoting the special legislation, while in China, the process of adopting ADR mechanism shows that conflicts is pushing the system construction. Therefore, comparing these three countries’ ADR mechanism, China is supposed to improve its ADR mechanism from these four aspects: First, build up and improve the legislation about ADR mechanism and clear the specifications of ADR resolving procedures. Second, set up ADR special institutions to settle extralegal issues authoritatively, professionally and appropriately. Third, improve the supporting mechanism resolving medical disputes outside the litigation so as to establish a smooth channel for resolving medical disputes outside the litigation. Fourth, complete complementary amount regulations to institutionalize the settlement of medical disputes outside the lawsuit. Medical disputes in China, Japan and Korea shows different characteristics. Meanwhile, the promotion, leading agency, resolving procedures and resolving effect of their resolving mechanism outside the litigation also have distinctive differences. It’s necessary to summarize, develop and complete ADR mechanism by clarifying and analyzing why these differences exist based on the comparison and learning from the different features of medical disputes in China, Japan and Korea, which greatly inspires other countries on how to settle medical disputes and further promotes the relationships between doctors and patients.

Assessment of Outcomes of Spine Surgery in Indian Athletes Involved in High-End Contact Sports

Shah Kunal,Bharuka Anuj,Gadiya Akshay,Nene Abhay 대한척추외과학회 2021 Asian Spine Journal Vol.15 No.2

Study Design: This study was a retrospective analysis.Purpose: This study aimed to analyze the functional outcome following spinal surgery in elite athletes using return-to-play criteria.Overview of Literature: Spinal ailments are relatively common in athletes and are bound to increase due to the ever-growing popularity of contact sports. An elite athlete is highly motivated to make a rapid recovery and return to full participation in sports. Although the criteria for diagnosis and surgical treatment of various spinal disorders in athletes have been well defined in the literature, there is no clear definition about the factors determining the return to play in athletes.Methods: This study was a retrospective analysis of the data of 10 elite athletes who underwent spinal surgery for symptomatic degenerative disorder of the spine. Eight patients underwent lumbar spine surgery (two patients of microdiscectomy and six patients of fusion), and the remaining two patients underwent cervical spine surgery (one each anterior cervical discectomy and fusion and anterior cervical disc replacement). Outcome measures were investigated using return-to-training and return-to-sports criteria, as indicated by the length of time between surgery and return to competitive sports as parameters.Results: Of the 10 patients, eight were males and two were females. The average age of the patients at the time of surgery was 32.4 years (range, 25–41 years). All patients returned to active participation of their sports. The average time for return to training was 7.3 weeks (range, 3–12 weeks). The average time for return to sports was 45.6 weeks (range, 36–72 weeks), and the average follow-up period was 59 months (range, 27–120 months).Conclusions: Spine surgery in an elite athlete involved in contact sports is safe and effective. Currently, there is a lack of standardized guidelines for return to sports after spine injuries. An athlete needs to be symptom-free, with full range of motion and full strength before returning to sports.

Emergence of Three-Dimensional Printing Technology and Its Utility in Spine Surgery

Akshay Gadia,Kunal Shah,Abhay Nene 대한척추외과학회 2018 Asian Spine Journal Vol.12 No.2

In the last decade, spine surgery has advanced tremendously. Tissue engineering and three-dimensional (3D) printing/additive manufacturing have provided promising new research avenues in the fields of medicine and orthopedics in recent literature, and their emergent role in spine surgery is encouraging. We reviewed recent articles that highlighted the role of 3D printing in medicine, orthopedics, and spine surgery and summarized the utility of 3D printing. 3D printing has shown promising results in various aspects of spine surgery and can be a useful tool for spine surgeons. The growing research on tissue bioengineering and its application in conjunction with additive manufacturing has revealed great potential for tissue bioengineering in the treatment of spinal ailments.

The relationship between cloud condensation nuclei (CCN) concentration and light extinction of dried particles: indications of underlying aerosol processes and implications for satellite-based CCN estimates

Shinozuka, Y.,Clarke, A. D.,Nenes, A.,Jefferson, A.,Wood, R.,McNaughton, C. S.,Strö,m, J.,Tunved, P.,Redemann, J.,Thornhill, K. L.,Moore, R. H.,Lathem, T. L.,Lin, J. J.,Yoon, Y. J. Copernicus GmbH 2015 Atmospheric chemistry and physics Vol.15 No.13

<P>Abstract. We examine the relationship between the number concentration of boundary-layer cloud condensation nuclei (CCN) and light extinction to investigate underlying aerosol processes and satellite-based CCN estimates. For a variety of airborne and ground-based observations not dominated by dust, regression identifies the CCN (cm−3) at 0.4 ± 0.1% supersaturation with 100.3α +1.3σ0.75 where σ (Mm−1) is the 500 nm extinction coefficient by dried particles and α is the Angstrom exponent. The deviation of 1 km horizontal average data from this approximation is typically within a factor of 2.0. ∂logCCN / ∂logσ is less than unity because, among other explanations, growth processes generally make aerosols scatter more light without increasing their number. This, barring special meteorology-aerosol connections, associates a doubling of aerosol optical depth with less than a doubling of CCN, contrary to previous studies based on heavily averaged measurements or a satellite algorithm. </P>

Surgical Management in Elderly Patients with Tuberculous Spondylodiscitis: Ten Year Mortality Audit Study

Manish Kundanmal Kothari,Kunal Chandrakant Shah,Agnivesh Tikoo,Abhay Madhusudan Nene 대한척추외과학회 2016 Asian Spine Journal Vol.10 No.5

Study Design: Retrospective study. Purpose: To evaluate the factors affecting immediate postoperative mortality in elderly patients with tuberculous spondylodiscitis. Overview of Literature: Treatment of spinal tuberculosis in the elderly involves consideration of age and co-morbidities, and often leads to an extended conservative management. Surgical intervention in these patients becomes a complex decision. There are no studies on risk factors of mortality in surgically treated elderly with tuberculous spondylodiscitis. Methods: Two hundred and seventy-six patients with spondylodiscitis were operated between 2005 and 2015. 20 consecutive patients over 70 years of age with and proven tuberculosis who met the inclusion/exclusion criteria were included. Demographic, clinical and radiological profile data with operative details of instrumentation, blood loss, surgical duration, and mortality were noted. There were 20 patients (6 males, 14 females) with a mean age of 73.5 years. The patients were divided into those with mortality (M) and those who survived (non-mortality, NM). Various variables were statistically tested for immediate postoperative medical complications and mortality. Results: There were four mortalities (20%). Age, sex, number of medical co-morbidities, American Society of Anaesthesiologists grade, Frankel grade C or worse, number of vertebrae involved, number of levels fused, blood loss and operative time did not have statistically significant impact on immediate postoperative mortality. Only preoperative immobility duration was statistically higher in the M group (p =0.016) than in the NM group. Conclusions: Preoperative immobility is associated with immediate postoperative mortality in elderly patients with spinal tuberculosis undergoing surgery. The findings identify preoperative immobility as a risk factor for mortality, which could contribute to a more detailed prognostic discussion between surgeon and patient before surgery.

Does Three-Dimensional Printed Patient-Specific Templates Add Benefit in Revision Surgeries for Complex Pediatric Kyphoscoliosis Deformity with Sublaminar Wires in Situ? A Clinical Study

Shah Kunal,Gadiya Akshay,Shah Munjal,Vyas Devarsh,Patel Priyank,Bhojraj Shekhar,Nene Abhay 대한척추외과학회 2021 Asian Spine Journal Vol.15 No.1

Study Design: Case-control study.Purpose: To evaluate the accuracy of three-dimensional (3D) printed patient-specific templates (PSTs) for placement of pedicle screws (PAs) in patients undergoing revision surgeries for complex kyphoscoliosis deformity with sublaminar wires in situ.Overview of Literature: Revision kyphoscoliosis correction surgery in pediatric patients is a challenging task for the treating surgeon. In patients with sublaminar wires in situ, the native anatomical landmarks are obscured, thus making the freehand screw placement technique a highly specialized task. Hence, the concept of using PSTs for insertion of PAs in such surgeries is always intriguing and attractive.Methods: Five consecutive patients undergoing revision deformity correction with sublaminar wires in situ were included in this study. Patients were divided in two groups based on the technique of PA insertion. A total of 91 PAs were inserted using either a freehand technique (group A) or 3D printed templates (group B) (34 vs. 57). The placement of PAs was classified according to a postoperative computed tomography scan using Neo’s classification. Perforation beyond class 2 (>2 mm) was termed as a misplaced screw. The average time required for the insertion of screws was also noted.Results: Mean age, surgical time, and blood loss were recorded. The change in mean Cobb’s angle in both groups was also recorded. The difference in rates of misplaced screws was noted in group A and group B (36.21% vs. 2.56%); however, the mean number of misplaced PAs per patient in group A and group B was statistically insignificant (6.5±3.54 vs. 4.67±1.53, p =0.4641). The mean time required to insert a single PA was also statistically insignificant (120±28.28 vs. 90±30 seconds, p =0.3456).Conclusions: Although 3D printed PSTs help to avoid the misplacement of PAs in revision deformity correction surgeries with sublaminar wires in situ, the mean number of misplaced screws per patient using this technique was found to be statistically insignificant when compared with the freehand technique in this study.