Purpose This study was conducted to compare 18 F-FDG PET/CT and electromyography (EMG) mapping in patients with primary cervical dystonia (PCD) to find dystonic superficial cervical muscles. Methods Ten consecutive patients with PCD (M:F=5:5, age 44±13 years) whose dystonic posture was not relieved with conventional muscle relaxant therapy were included. Target cervical muscles for the comparison between 18 F-FDG PET/CT and EMG mapping were four representative superficial bilateral cervical muscles: splenius capitis muscle, sternocleidomstoid muscle, upper trapezius muscle, and leavator scapulae muscle. The diagnostic efficacy was compared between 18 F-FDG PET/CT and EMG mapping using physical exam and measurement of rotation angle as the gold standard. Results Among 80 muscles evaluated, there were 21 (26%) dystonic superficial cervical muscles assessed with physical exam and motion analysis. The sensitivity, specificity, and accuracy for localizing dystonic muscles were 76, 92, and 88% for 18 F-FDG PET/CT, and 95, 66, and 74% for EMG mapping, respectively. The sensitivity of EMG mapping was significantly higher than that of 18 F-FDG PET/CT. In contrast, 18 F-FDG PET/CT was significantly superior to EMG mapping for specificity and accuracy. Conclusions 18 F-FDG PET/CT is more specific and accurate than EMG mapping for finding superficial dystonic cervical muscles. The high sensitivity of EMG mapping suggests that 18 F-FDG PET/CT and EMG mapping are complementary for finding dystonic superficial cervical muscles.

Objective: The study investigated our institutional learning curve for the ROSA ONE spine system (ROSA) based on ROSA usage time.Methods: ROSA was designed to provide high accuracy for spinal pedicle screw placement through a built-in tracking technique. This study was conducted from November 2018 to January 2021. The time taken to complete each step of the robotic workflow was recorded. Patient demographics, comorbidities, surgical indications, and number of screw placements were examined in subgroup analysis. The Curve Fitting-General package (a part of NCSS 2021 software) was used to fit a mathematical model to the learning curve. Patient demographics, imaging data, and surgical time were reviewed retrospectively.Results: A total of 167 patients who had undergone surgery were included. The mean total ROSA usage time was 107.1 ± 27.3 minutes. The estimated learning rate was 90.4%, and the largest slope change occurred close to the time of the 20th surgery. The observed overall learning trend in the 4-screw group could be attributed to screw planning. The presence of scoliosis (p = 0.73) or spondylolisthesis (p = 0.70) did not significantly influence the mean total time (TT) for all patients; however, the mean TT differed significantly (p < 0.01) among subgroups stratified by body mass index, screw number placement, and thoracic spine involvement.Conclusion: To the best of our knowledge, this is the first study to examine the learning curve for the various crucial steps of ROSA-guided pedicle screw placement. The indicative learning curve involved 20 patients who had undergone surgery.

Objective : High-molecular-weight hydroxyethyl starch (HES) compromises blood coagulation more than does low-molecular-weight HES. We compared the effects of low-and high-molecular-weight HES for the treatment of vasospasm and investigated the dose relationship with each other. Methods : Retrospectively, in a series of consecutive 102 patients with subarachnoid hemorrhage (SAH), 35 patients developed clinical symptoms of vasospasm of these fourteen patients were treated with low-molecularweight HES for volume expansion while the other 21 received high-molecular-weight HES as continuous intravenous infusion. Prothrombin time (PT), partial thromboplastin time (PTT), fibrinogen level, and platelet count were all measured prior to initiation, during treatment and after termination of therapy for symptomatic vasospasm. The total dose of HES ranged from 5 L to 14 L and median infusion duration was 10 days. Results : A more pronounced PTT prolongation was observed in high-molecular-weight HES group compared with low-molecular-weight HES group. No other coagulation parameters were altered. Dosage (=duration) shows a positive correlation with PTT. Clinically, significant bleeding episodes were noted in four patients who received high-molecular-weight HES. Conclusion : Coagulopathy was developed in direct proportion to molecular weight of starch and dosages. We propose the extreme caution in the administration of HES solution for the vasospasm treatment.