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The profitability of medical treatment has gained increasing importance in health politics and likewise has become a considerable part of a microsurgeon's daily practice. The resulting cost pressure leads to microsurgeons having to justify their often complex and expensive treatments against hospital providers and health insurances. In this position paper of the German Speaking Group for Microsurgery of Peripheral Nerves and Vessels, we analyze the current status of profitability of microsurgical extremity and breast reconstruction, and its impact on choice of therapy and residency training. We specifically highlight the available literature, that shows often reduced long-term treatment costs after microsurgical reconstruction in comparison to cheaper initial treatments. The statements are based on a consensus workshop on the 40th meeting of the DAM in Lugano, Switzerland.
AssuntosMicrocirurgia , Procedimentos Cirúrgicos Reconstrutivos , Cirurgia Plástica , Internato e Residência , Mamoplastia/economia , Microcirurgia/economia , Microcirurgia/métodos , Nervos Periféricos/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/economia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Suíça
PURPOSE OF REVIEW: Peripheral nerve blocks are effective and safe modalities for perioperative analgesia. But it remains unclear what blocks are adequate for ambulatory surgeries, as well as the proper patient management before and after discharge. RECENT FINDINGS: Emerging nerve blocks have sparked interests due to ease to perform under ultrasound guidance and lower risks of adverse events. Some of these novel blocks are particularly suitable for ambulatory procedures, including but not limited to motor-sparing lower extremity nerve blocks and phrenic-sparing nerve blocks for shoulder surgeries. The adoption of peripheral nerve block into outpatient surgery is a multidisciplinary effort that encompasses appropriate patient choice, careful selection of nerve blocks that minimize potential adverse events after discharge, and proper patient follow-up until block effects resolve.
AssuntosProcedimentos Cirúrgicos Ambulatórios , Anestesia por Condução , Bloqueio Nervoso , Pacientes Ambulatoriais , Nervos Periféricos/cirurgia , Anestesia por Condução/métodos , Humanos , Bloqueio Nervoso/métodos , Ultrassonografia de Intervenção/métodos
Plastic and reconstructive surgery is characterized by a high degree of interdisciplinarity. Although Plastic surgery offers a wide range of reliable surgical treatment options independent departments for plastic and reconstructive surgery are not present in every university clinic or leading hospital in Germany. However, the ongoing improvements especially in the field of reconstructive microsurgery enabled and enhanced the treatment of complex defects in order to restore function as well as cosmetic outcome. Knowing the fact that patients are usually referred from other medical disciplines that are familiar with the development and treatment of the primary disease, creation of an interdisciplinary reconstructive treatment plan is crucial to guarantee best patient care. Thus, one of the future major challenges in plastic surgery will be the establishment of multidisciplinary boards in order to strengthen the role of plastic surgery within the medical system with the overall aim to solve complex reconstructive cases. During the 39th annual meeting of the German Speaking Society for Microsurgery of Peripheral Nerves and Vessels a workshop titled "The interdisciplinary microsurgeon" addressed this topic. In the present article we will highlight the consented results of the workshop and provide pitfalls and pearls concerning the implementation process of different multidisciplinary boards based on representative examples.
AssuntosMicrocirurgia , Nervos Periféricos , Procedimentos Cirúrgicos Reconstrutivos , Cirurgia Plástica , Consenso , Alemanha , Humanos , Comunicação Interdisciplinar , Nervos Periféricos/cirurgia
BACKGROUND: Peripheral nerve assessment has traditionally been studied through histological and immunological staining techniques in a limited cross-sectional modality, making detailed analysis difficult. A new application of serial section electron microscopy is presented to overcome these limitations. METHODS: Direct nerve repairs were performed on the posterior auricular nerve of transgenic YFP-H mice. Six weeks postoperatively the nerves were imaged using confocal fluorescent microscopy then excised and embedded in resin. Resin blocks were sequentially sectioned at 100 nm, and sections were serially imaged with an electron microscope. Images were aligned and autosegmented to allow for 3D reconstruction. RESULTS: Basic morphometry and axonal counts were fully automated. Using full 3D reconstructions, the relationships between the axons, the Nodes of Ranvier, and Schwann cells could be fully appreciated. Interactions of individual axons with their surrounding environment could be visualized and explored in a virtual three-dimensional space. CONCLUSIONS: Serial section electron microscopy allows the detailed pathway of the regenerating axon to be visualized in a 3D virtual space in comparison to isolated individual traditional histological techniques. Fully automated histo-morphometry can now give accurate axonal counts, provide information regarding the quality of nerve regeneration, and reveal the cell-to-cell interaction at a super-resolution scale. It is possible to fully visualize and "fly-through" the nerve to help understand the behavior of a regenerating axon within its environment. This technique provides future opportunities to evaluate the effect different treatment modalities have on the neuroregenerative potential and help us understand the impact different surgical techniques have when treating nerve injuries.
AssuntosAxônios/fisiologia , Imagem Tridimensional/métodos , Microscopia Intravital/métodos , Regeneração Nervosa , Nervos Periféricos/diagnóstico por imagem , Animais , Axônios/ultraestrutura , Proteínas de Bactérias/genética , Comunicação Celular/fisiologia , Modelos Animais de Doenças , Feminino , Corantes Fluorescentes , Humanos , Proteínas Luminescentes/genética , Camundongos , Camundongos Transgênicos , Microscopia Confocal , Microscopia Eletrônica , Procedimentos Neurocirúrgicos/métodos , Traumatismos dos Nervos Periféricos/diagnóstico por imagem , Traumatismos dos Nervos Periféricos/cirurgia , Nervos Periféricos/fisiologia , Nervos Periféricos/cirurgia , Nós Neurofibrosos/fisiologia , Nós Neurofibrosos/ultraestrutura
BACKGROUND: Schwannomas are well-encapsulated, benign neoplasms, and enucleation is a standard operation procedure. The incidence of neurological complications after surgical treatment for schwannomas of the extremities varies, and there is no consensus concerning predictive factors for complications. The aim of this study was to elucidate predictive factors for complications after surgical treatment of schwannomas that develop in the major nerves of the extremities. METHODS: A total of 139 patients with 141 schwannomas arising in major nerves were retrospectively analyzed. Data regarding preoperative clinical features, the postoperative neurological complications, and clinical course of complications, with a median follow-up period of 2 months (range, 0.5-96), were obtained. Predictive factors for complications were statistically analyzed. RESULTS: Postoperative complications occurred in 49 lesions (34.8%), including 42 with sensory disturbance and 8 with motor weakness. In univariate analysis, older age, tumors originating from the upper extremity, and major motor nerve involvement were associated with a higher complication rate (p = 0.03, p = 0.003, and p = 0.001, respectively). In multivariate analysis, major motor nerve involvement was an independent predictive factor for postoperative complications (p = 0.03). Almost all complications gradually improved, but 6 out of 8 patients with motor weakness did not show full recovery at the final follow-up. CONCLUSIONS: Schwannomas originating from major motor nerves can lead to a higher risk for postoperative complications.
AssuntosDoenças do Sistema Nervoso/diagnóstico , Neurilemoma/cirurgia , Procedimentos Neurocirúrgicos/efeitos adversos , Complicações Pós-Operatórias/diagnóstico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Extremidades/inervação , Extremidades/cirurgia , Feminino , Seguimentos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Doenças do Sistema Nervoso/epidemiologia , Doenças do Sistema Nervoso/etiologia , Neurilemoma/patologia , Nervos Periféricos/patologia , Nervos Periféricos/cirurgia , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Prognóstico , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
BACKGROUND: Complex digital injuries involving soft-tissue loss and digital nerve defect continues to pose a reconstructive challenge. This study reports the repair of such neurocutaneous defect with the bipedicled nerve flap or the Littler flap and compares the results of the two techniques. METHODS: A retrospective study was conducted in 59 patients who had a neurocutaneous defect in the single digit treated with the bipedicled nerve flap or the Littler flap from Jul 2008 to May 2016. The patients were divided into two groups based on which flap was chosen. At the final follow-up, the two groups were compared for static two-point discrimination and Semmes-Weinstein monofilament scores on both flap and pulp, and pain, cold intolerance and patient satisfaction of the reconstructed digit. RESULTS: Significant differences were found in static two-point discrimination, pain, cold intolerance, and patient satisfaction (p < 0.05). In comparison with the bipedicled flap group, the Littler flap group presented better discriminatory sensation in the flap and pulp, but exhibited higher incidence of pain and cold intolerance in the reconstructed digit. In the donor digits, the bipedicled flap group achieved lower pain incidence. Finally, the bipedicled flap group attained a larger degree of satisfaction than the Littler flap group. CONCLUSIONS: When reconstructing a complex neurocutaneous defect in the digit, choosing the bipedicled nerve flap rather than the Littler flap attains lower incidence of pain and cold intolerance, and higher patient satisfaction. Our results suggest that repair of the transected digital nerves can reduce neuroma incidence.
AssuntosTraumatismos dos Dedos/fisiopatologia , Dedos/inervação , Nervos Periféricos/cirurgia , Lesões dos Tecidos Moles/fisiopatologia , Retalhos Cirúrgicos , Adulto , Feminino , Traumatismos dos Dedos/cirurgia , Dedos/cirurgia , Seguimentos , Humanos , Masculino , Satisfação do Paciente/estatística & dados numéricos , Nervos Periféricos/fisiopatologia , Procedimentos Cirúrgicos Reconstrutivos , Recuperação de Função Fisiológica , Estudos Retrospectivos , Lesões dos Tecidos Moles/cirurgia , Retalhos Cirúrgicos/irrigação sanguínea , Resultado do Tratamento
BACKGROUND: Entrapment neuropathies include a wide field of locations. In most cases, the microsurgical decompression is still the therapy of choice. However, the role of venous stasis and ischemia is still discussed controversially. Here the authors evaluated the visualization of microvessels and the microperfusion at peripheral nerves with a contact endoscope during the surgical decompression for the first time. METHODS: Eight patients were subjected to endoscopic or endoscopically assisted peripheral nerve decompression. In 3 patients with nerve tumors, the tumor carrying nerve was inspected endoscopically proximal and distal to the tumor site before and after resection. Microcirculation was assessed by a contact endoscope, allowing a 150-fold magnification, at superficial areas proximal and distal to the compression site. The electronically stored records were analyzed retrospectively using image processing software. Vessel diameter, red blood cell velocity, and blood flow, before and after decompression, were extracted. RESULTS: The contact endoscope was easy to handle intraoperatively without problems. All minimally invasive procedures were performed without complications. In the offline computer-assisted analysis, single arterioles and veins were visualized showing decreased red blood cell velocity prior to decompression. After surgical treatment, a statistically significant increase of blood flow was observed. CONCLUSIONS: Basically, the application of a contact endoscope for visualization of peripheral nerves' microcirculation is feasible. The observed effect of increased blood flow after decompression should be compared with the clinical outcome in a further prospective randomized study.
AssuntosSíndromes de Compressão Nervosa/cirurgia , Neuroendoscopia/instrumentação , Neuroendoscopia/métodos , Nervos Periféricos/irrigação sanguínea , Adulto , Idoso , Descompressão Cirúrgica/instrumentação , Descompressão Cirúrgica/métodos , Endoscópios , Feminino , Hemodinâmica , Humanos , Masculino , Pessoa de Meia-Idade , Nervos Periféricos/cirurgia
INTRODUCTION: Enlargement of the ilioinguinal nerve distal to the inguinal ring is common in primary open inguinal herniorrhaphy and is histologically consistent with compression neuropathy. However, the origin of this neuropathy has not been thoroughly studied in primary inguinal hernia. METHODS: In this prospective study, 143 primary inguinal herniorrhaphies were performed. Prior to surgery, all patients completed a preoperative pain questionnaire from the Carolina Comfort Scale and Visual Analog Scale-evaluating pain with various activities. Pain scores were statistically compared with several different anatomical surgical observations. RESULTS: When each variable is individually compared with pain scores, a significant positive correlation exists between nerve enlargement and increased pain compared to those without enlargement for preoperative "most of the time pain" (Pâ¯<â¯0.0017). There is also a statistically significant positive correlation between nerve enlargement and external ring fibrosis (Pâ¯<â¯0.001). 81% of patients with enlargement have histological abnormalities. CONCLUSION: Preoperative pain in primary inguinal hernia is correlated with ilioinguinal nerve enlargement, which is also correlated with fibrosis of the external oblique fascia at the external ring.
AssuntosHérnia Inguinal/cirurgia , Síndromes de Compressão Nervosa/etiologia , Medição da Dor , Nervos Periféricos/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Fáscia/patologia , Fibrose , Virilha/patologia , Hérnia Inguinal/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Síndromes de Compressão Nervosa/cirurgia , Dor/etiologia , Nervos Periféricos/cirurgia , Período Pré-Operatório , Estudos Prospectivos , Adulto Jovem
BACKGROUND: This study was designed to assess the safety and efficacy of site-specific fat injection for the treatment of refractory migraine headaches following medical or surgical treatment. METHODS: A prospective cohort study was performed on consecutive patients who had migraine headaches with persistent symptoms after surgical decompression and were given therapeutic fat injections from September of 2012 to January of 2015 with 12 months' minimum follow-up. Clinical outcomes assessment included migraine frequency, intensity, duration, migraine headache index, and complications. A 50 percent or greater decrease in frequency, intensity, or duration was considered therapeutic success, whereas 10 percent or greater increase in migraine headache index was considered worsening of symptoms. Pairwise t tests were used to assess statistical significance (p < 0.05). RESULTS: Twenty-nine patients met inclusion criteria. All were female, with a mean age of 49.0 years (range, 21.5 to 72.5 years), and mean follow-up was 29.4 months (range, 12.3 to 49.5 months). Twenty patients (69.0 percent) experienced successful improvement; 12 (41.4 percent) experienced complete resolution. Five patients (17.2 percent) experienced subtherapeutic improvement, and four (13.8 percent) experienced worsening of symptoms. Mean improvement per patient at their last follow-up was 5.1 (39.3 percent) fewer attacks per month (p = 0.035); 3.1 (42.0 percent) lower intensity on a scale of 1 to 10 (p = 0.001); 31.8 (74.4 percent) fewer hours of duration (p = 0.219); and 52.8 percent lower migraine headache index (p = 0.012). There were no complications for any patient. CONCLUSIONS: Migraine headache symptoms were successfully reduced in the majority of cases with fat injection. A comprehensive surgical treatment algorithm including this novel procedure is presented. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
AssuntosGordura Abdominal/transplante , Descompressão Cirúrgica/métodos , Transtornos de Enxaqueca/cirurgia , Procedimentos Neurocirúrgicos/métodos , Adulto , Idoso , Cânula , Feminino , Seguimentos , Humanos , Injeções Subcutâneas/instrumentação , Injeções Subcutâneas/métodos , Pessoa de Meia-Idade , Transtornos de Enxaqueca/diagnóstico , Bainha de Mielina/patologia , Medição da Dor , Nervos Periféricos/patologia , Nervos Periféricos/cirurgia , Estudos Prospectivos , Transplante Autólogo/instrumentação , Transplante Autólogo/métodos , Resultado do Tratamento , Adulto Jovem
AIM: To seek the efficacy of selective spinal nerve blocks in the treatment of groin pain that are irresponsive to peripheral nerve blocks. MATERIAL AND METHODS: This retrospective study comprised 17 patients with ilioinguinal, iliohypogastric, and genitofemoral neuralgias treated between 2017 and 2018. RESULTS: All patients received diagnostic peripheral nerve blocks and/or TAP blocks with blind or ultrasound-guided techniques. Four patients had ineffectual peripheral nerve blocks, after which they underwent T12 and L1 selective spinal nerve blocks. All four patients had satisfactory results. CONCLUSION: If distal peripheral nerve blocks are ineffective, an upper level nerve lesion, a lesion in the lumbar plexus or an L1 radiculopathy should be considered in ilioinguinal, iliohypogastric, and genitofemoral neuralgias. Upper level nerve blocks should be performed before deciding on surgery.
AssuntosBloqueio Nervoso Autônomo/métodos , Neuropatia Femoral/diagnóstico por imagem , Neuralgia/diagnóstico por imagem , Nervos Espinhais/diagnóstico por imagem , Adulto , Raquianestesia/métodos , Feminino , Neuropatia Femoral/cirurgia , Humanos , Plexo Lombossacral/diagnóstico por imagem , Plexo Lombossacral/cirurgia , Masculino , Pessoa de Meia-Idade , Neuralgia/cirurgia , Nervos Periféricos/diagnóstico por imagem , Nervos Periféricos/cirurgia , Estudos Retrospectivos , Nervos Espinhais/cirurgia
Nerve transfer has become a common and often effective reconstructive strategy for proximal and complex peripheral nerve injuries of the upper limb. This case-based discussion explores the principles and potential benefits of nerve transfer surgery and offers in-depth discussion of several established and valuable techniques including: motor transfer for elbow flexion after musculocutaneous nerve injury, deltoid reanimation for axillary nerve palsy, intrinsic re-innervation following proximal ulnar nerve repair, and critical sensory recovery despite non-reconstructable median nerve lesions.
AssuntosTransferência de Nervo/métodos , Traumatismos dos Nervos Periféricos/cirurgia , Extremidade Superior/inervação , Adulto , Axila/inervação , Feminino , Humanos , Masculino , Nervo Mediano/lesões , Nervo Mediano/cirurgia , Pessoa de Meia-Idade , Nervo Musculocutâneo/anatomia & histologia , Nervo Musculocutâneo/lesões , Nervo Musculocutâneo/cirurgia , Traumatismos dos Nervos Periféricos/diagnóstico , Traumatismos dos Nervos Periféricos/etiologia , Nervos Periféricos/anatomia & histologia , Nervos Periféricos/cirurgia , Luxação do Ombro/etiologia , Nervo Ulnar/lesões , Nervo Ulnar/transplante , Extremidade Superior/lesões , Adulto Jovem
INTRODUCTION: A recent survey among plastic surgery residents and directors of microsurgical clinics demonstrates a great interest in high- quality microsurgery education. Unfortunately, due to economic pressures, limited operating resources as well as forensic considerations, it has become a challenge to provide sufficient on-the-job training, which needs to be shifted outside of the OR. To promote microsurgical teaching, the German-speaking Working Group for Microsurgery of Peripheral Nerves and Vessels (DAM) organises two-day microsurgery academies to provide interested colleagues with a broad spectrum of microsurgical procedures. In this publication, we present the workshop concept and an evaluation of the first three years. MATERIAL AND METHODS: Since 2015, a two-day workshop has been held at the BG Trauma Centre in Ludwigshafen on a yearly basis. Each day, at least three surgical procedures were performed simultaneously in the area of breast, nerve, bone/hand, extremity and lymph reconstruction, along with presentations regarding the various cases, diseases and specific operative challenges. To evaluate this course concept, we asked participants to identify their expectations and evaluate the academy and its program. RESULTS: The academy and its goals were demonstrated. In a second step, the evaluation, conducted by 79 % of participants, was presented. 67 % of participants were consultants or residents in their final year. 90 % worked at maximum care facilities or university hospitals. 57 % reported that less than 5 microsurgery cases are performed at their institution per week. All participants considered microsurgery to be part of their future work spectrum, with the greatest fields of interest being extremity reconstruction (90 %) or microsurgical reconstruction of the hand (80 %). All participants would recommend the course to their colleagues, but suggest improving the intraoperative video monitoring. DISCUSSION: This work demonstrates that hands-on academies for microsurgery are a highly relevant teaching format, which can counteract the limitations of surgical residency training. In particular, the close contact between senior and junior surgeons was considered highly relevant for building a network within German microsurgery. The overall goal of the academy is to improve teaching and increase the enthusiasm of future microsurgeons and provide a network for German microsurgeons during their training and beyond.
AssuntosInternato e Residência , Microcirurgia , Procedimentos Cirúrgicos Reconstrutivos , Cirurgia Plástica , Nervos Periféricos/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/educação , Cirurgia Plástica/educação
PURPOSE: This study aimed to evaluate the prognostic significance of lymphovascular (LVI), perineural invasion (PNI), and tumor budding positivity in patients with colorectal cancer. METHODS: From January 2008 to December 2011, 3707 consecutive patients who underwent curative surgery for stage I-III colorectal cancer were assessed. These patients were then categorized into four groups based on LVI, PNI, and tumor budding (risk grouping): all negative (n = 1495), 1 + only (n = 1063), 2 + only (n = 861), and all positive (n = 288). RESULTS: With a median follow-up period of 52 months, the 5-year disease-free survival rates of the risk groups were significantly different in terms of cancer staging (stage I, Stage II, and Stage III: P = 0.006, P < 0.001, and P < 0.001, respectively). In the multivariate analysis, risk grouping was an independent prognostic factor of disease-free survival. Preoperative carcinoembryonic antigen level, tumor size, T category, and N category were independent predictors of LVI, PNI, and tumor budding positivity. CONCLUSION: Risk grouping based on LVI, PNI, and tumor budding positivity is a strong predictor of disease-free survival in patients with colorectal cancer.
AssuntosNeoplasias Colorretais/patologia , Endotélio Vascular/patologia , Linfonodos/patologia , Nervos Periféricos/patologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias Colorretais/cirurgia , Endotélio Vascular/cirurgia , Feminino , Seguimentos , Humanos , Linfonodos/cirurgia , Masculino , Pessoa de Meia-Idade , Gradação de Tumores , Invasividade Neoplásica , Nervos Periféricos/cirurgia , Estudos Retrospectivos , Taxa de Sobrevida , Adulto Jovem
While systematic reviews are regarded as the strongest level of medical evidence, inconsistency in the quality and rigor of systematic reviews raises concerns about their use as a tool in guiding quality delivery in evidence-based clinical practice. The objective of this present study was to assess methodological soundness of systematic reviews with a particular focus on peripheral nerve repair and reconstruction. We performed a comprehensive search using PubMed and Scopus to identify all systematic reviews published on peripheral nerve reconstruction in 9 high-impact surgical journals. Two authors independently performed literature searches, screened abstracts, and extracted data. Discrepancies were resolved by discussion and consensus. The quality of systematic reviews was assessed using AMSTAR criteria. Initial search retrieved 184 articles. After screening duplicates, titles, abstracts, and conducting full text reviews, 26 studies met inclusion criteria. Of those, 18 (65%) were published by Plastic Surgery, 7 (27%) by Orthopedic Surgery, and 1 (4%) by Occupational Therapy. The total number of systematic reviews published on peripheral nerves each year has shown an increasing trend from 2004 through 2015. The overall median AMSTAR score was 5, reflecting a "fair" quality. There was no evidence of AMSTAR score improvement over time. Although the number of systematic reviews published on peripheral nerve repair has risen over the last decade, their quality has not exhibited the same increase. This highlights the necessity to increase familiarity with and conform to methodological quality criteria in order to improve the integrity of evidence-based medicine in peripheral nerve repair and reconstruction.
AssuntosTraumatismos dos Nervos Periféricos/cirurgia , Nervos Periféricos/cirurgia , Procedimentos Cirúrgicos Reconstrutivos , Literatura de Revisão como Assunto , Humanos , Procedimentos Cirúrgicos Reconstrutivos/métodos
Severe spinal cord injuries cause permanent neurological deficits and are still considered as inaccessible to efficient therapy. Injured spinal cord axons are unable to spontaneously regenerate. Re-establishing functional activity especially in the lower limbs by reinnervation of the caudal infra-lesional territories might represent an effective therapeutic strategy. Numerous surgical neurotizations have been developed to bridge the spinal cord lesion site and connect the intact supra-lesional portions of the spinal cord to peripheral nerves (spinal nerves, intercostal nerves) and muscles. The major disadvantage of these techniques is the increased hypersensitivity, spasticity and pathologic pain in the spinal cord injured patients, which occur due to the vigorous sprouting of injured afferent sensory fibers after reconstructive surgery. Using micro-surgical instruments and an operation microscope we performed detailed anatomical preparation of the vertebral canal and its content in five human cadavers. Our observations allow us to put forward the possibility to develop a more precise surgical approach, the so called "ventral root bypass" that avoids lesion of the dorsal roots and eliminates sensitivity complications. The proposed kind of neurotization has been neither used, nor put forward. The general opinion is that radix ventralis and radix dorsalis unite to form the spinal nerve inside the dural sac. This assumption is not accurate, because both radices leave the dural sac separately. This neglected anatomical feature allows a reliable intravertebral exposure of the dura-mater ensheathed ventral roots and their damage-preventing end-to-side neurorrhaphy by interpositional nerve grafts.
AssuntosParalisia/cirurgia , Traumatismos da Medula Espinal/cirurgia , Raízes Nervosas Espinhais/anatomia & histologia , Raízes Nervosas Espinhais/cirurgia , Cadáver , Dura-Máter/anatomia & histologia , Humanos , Microcirurgia/instrumentação , Músculo Esquelético/anatomia & histologia , Músculo Esquelético/cirurgia , Regeneração Nervosa , Procedimentos Neurocirúrgicos , Nervos Periféricos/anatomia & histologia , Nervos Periféricos/cirurgia , Canal Vertebral/anatomia & histologia , Medula Espinal/anatomia & histologia , Medula Espinal/cirurgia , Coluna Vertebral/anatomia & histologia
BACKGROUND: The extreme lateral approach is a direct lateral approach which allows a good control of the entire length of the vertebral artery (VA), the jugular foramen, the lowest cranial nerves, and the jugular-sigmoid complex. Herein we try to exploit the variants of the approach and we identify indications, advantages, and disadvantages. METHODS: All phases of the study were conducted at the Institute of Public Health Section of Legal Medicine and Insurance of the University. We performed the extreme lateral approach in four subjects, who died between 24 and 48 h before in non-traumatic circumstances (three men and one woman). RESULTS: The great auricular nerve, the spinal accessory, the branches of the first ventral spinal nerves, the jugular vein, and the vertebral artery were identified in all the cadavers. In all cases the right VA exited from the transverse foramen of C1. The site of SCM piercing the accessory nerve was at a distance from the tip of the mastoid between 3 and 4 cm (3.3 in one case, 3.4 in 2 cases, and 3.7 in one case). No vessels and nerves have been damaged after being identified and isolated. CONCLUSIONS: Extradural lesions at the ventro-lateral aspect of the CVJ may require an extreme lateral approach, a procedure more aggressive comparing with far lateral approach, which represents a reasonable option for large anterior and anterolateral lesions when greater exposure is required.
AssuntosVértebras Cervicais/anatomia & histologia , Veias Jugulares/anatomia & histologia , Procedimentos Neurocirúrgicos/métodos , Nervos Periféricos/anatomia & histologia , Artéria Vertebral/anatomia & histologia , Cadáver , Vértebras Cervicais/cirurgia , Feminino , Humanos , Veias Jugulares/cirurgia , Masculino , Nervos Periféricos/cirurgia , Crânio/cirurgia , Artéria Vertebral/cirurgia
Purpose: Motor nerve transfer surgery involves re-innervation of important distal muscles using either an expendable motor branch or a fascicle from an adjacent functioning nerve. This technique is established as part of the reconstructive algorithm for traumatic brachial plexus injuries. The reproducible outcomes of motor nerve transfer surgery have resulted in exploration of the application of this technique to other paralysing conditions. The objective of this study is to report feasibility and increase awareness about nerve transfer as a method of improving upper limb function in patients with cervical motor radiculopathy of different aetiology. Results: In this case series we report 3 cases with different modes of injury to the spinal nerve roots with significant and residual motor radiculopathy that have been successfully treated with nerve transfer surgery with good functional outcomes. The cases involved iatrogenic nerve root injury, tumour related root compression and degenerative root compression. Conclusion: Nerve transfer surgery may offer reliable reconstruction for paralysis when there has been no recovery following a period of conservative management. However the optimum timing of nerve transfer intervention is not yet identified for patients with motor radiculopathy.
AssuntosTransferência de Nervo/métodos , Radiculopatia/cirurgia , Acidentes de Trânsito , Idoso , Plexo Braquial/lesões , Plexo Braquial/cirurgia , Neuropatias do Plexo Braquial/cirurgia , Estudos de Viabilidade , Humanos , Masculino , Pessoa de Meia-Idade , Nervos Periféricos/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Terapia de Salvação/métodos , Raízes Nervosas Espinhais/cirurgia
Several patients' and pathological characteristics in rectal surgery can significantly complicate surgical loco regional tumor clearance. The main factors are obesity, short tumor distance from anal verge, bulky tumors, and narrow pelvis, which have been shown to be associated to poor surgical results in open and laparoscopic approaches. Minimally invasive surgery has the potential to reduce perioperative morbidity with equivalent short- and long-term oncological outcomes compared to conventional open approach. Achilles' heel of laparoscopic approaches is conversion to open surgery. High risk for conversion is evident for patients with bulky and low tumors as well as male gender and narrow pelvis. Hence, patient's characteristics represent challenges in rectal cancer surgery especially in minimally invasive approaches. The available surgical techniques increased remarkably with recently developed and implemented improvements of minimally invasive rectal cancer surgery. The controversial discussions about sense and purpose of these novel approaches are still ongoing in the literature. Herein, we evaluate, if latest technical advances like transanal approach or robotic assisted surgery have the potential to overcome known challenges and pitfalls in rectal cancer surgery in demanding surgical cases and highlight the role of current minimally invasive approaches in rectal cancer surgery.
AssuntosProcedimentos Cirúrgicos Minimamente Invasivos/métodos , Protectomia/métodos , Neoplasias Retais/cirurgia , Procedimentos Cirúrgicos Robóticos , Conversão para Cirurgia Aberta , Humanos , Procedimentos Cirúrgicos Minimamente Invasivos/efeitos adversos , Recidiva Local de Neoplasia , Duração da Cirurgia , Tratamentos com Preservação do Órgão , Nervos Periféricos/cirurgia , Protectomia/efeitos adversos , Neoplasias Retais/patologia , Taxa de Sobrevida
BACKGROUND: Due to limited number of studies, we tested feasibility of autologous epineural sheath conduit (ESC) in repair of 6-cm median nerve gaps in a sheep-the large animal model. MATERIALS AND METHODS: Eight ewes, 6-8 months old, 30-35 kg, were divided into three experimental groups: group 1-no defect repair (n = 4 nerves/group), group 2-autograft controls (n = 6 nerves/group), group 3-autologous ESC filled with saline (n = 6 nerves/group). ESC was constructed from a 6-cm long segment of sheep median nerve and tested for expression of laminin B, Glial fibrillary acidic protein (GFAP), S-100 and CD31 using immunofluorescent staining. At 6 months after nerve repair, nerve conduction velocity and somatosensory evoked potentials (SSEP) assessed neurosensory recovery, while histomorphometry tested nerve regeneration. RESULTS: Ex vivo characterization of ESC, before in vivo nerve gap repair, showed high laminin B expression, which supports axonal growth. At 6 months post-repair, structural integrity of ESC was preserved. ESC was well-vascularized and tissue adhesions were comparable to autograft controls. The maximal conduction velocities (29.80 ± 5.85 ms vs. 32.28 ± 6.75 ms; p = .44), action potential amplitudes (32.68 ± 17.44 mV vs. 44.14 ± 23.10 mV; p = .38) and SSEP amplitude values (6.18 ± 5.84 mV vs. 4.68 ± 2.53 mV; p = .28) were comparable between autograft and ESC groups. Presence of regenerating axons was confirmed in the distal segment of ESC at 6 months after repair. CONCLUSION: The feasibility of ESC in restoration of 6-cm long nerve defects in a sheep median nerve model was confirmed by nerve conduction assessments and correlated with axonal regeneration tested by histomorphometry. We confirmed ESC potential in support of regeneration of long nerve defects.


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SUPERTEC HAND FEED -MANUAL SURFACE GRINDER MODEL: STP-618M S/N: NEW: 2003 SPECIFICATIONS:TABLE SIZE: 6" X 18"GRINDING CAPACITY: 6" X 19"GRINDING WHEEL SIZE:8" DIAMETER X 1/2" WIDTH X 1-1/4 HOLESTANDARD CHUCK SIZE: 6" W X 18" LTABLE SURFACE TO SPINDLE CENTER DISTANCE: 19"LONGITUDINAL MOVEMENT TRAVERSE DISTANCE:20" CROSS MOVEMENT TRAVERSE DISTANCE:7"CROSS MOVEMENT HANDWHEEL PER REVOLUTION: 0.2"CROSS MOVEMENT HANDWHEEL PER GRADUATION: 0.001"VERTICAL DOWNFEED HANDWHEEL PER REVOLUTION: 0.05"VERTICAL DOWNFEED HANDWHEEL PER GRADUATION: 0.0001"WORK TABLE FLATNESS ACCURACY: 0.00012"LONGITUDINAL MOVEMENTPARALLELISM ACURACY: 0.0001/18" PER DISTANCECROSS MOVEMENT PARALLELISM ACCURACY: 0.000080/6" PER DISTANCESPINDLE PARALLEL TO WORK TABLE ACCURACY: 0.003/12" PER DISTANCETABLE ACCURACY : 0.0003/12" PER DISTANCEWHEEL TAPER RUN-OUT ACCURACY: 0.000060" GRINDING WHEEL SPINDLE SPEEDS: 3450 RPMSPINDLE MOTOR: 3 HP, 220/44O VOLTS, 3 PHASE, 60 HZ EQUIPPED WITH:"New" Fine-Division" Permanent Magnetic Chuck FLOOR SPACE DIMENSIONS: 76" X 43" 88" WEIGHT:. 1,520 LBS STANDARD FEATURES • Hand Feeds - Manual operation model • All castings are tempered and stress relieved twice to assure stability of the machine structure and resist deflection under load • Hardened and ground column ways with cast spindle slide is precision fit for no "hang-up" gravity downfeed • 3 HP V3 Grade spindle motor for powerful output to achieve precisionwork standards and better grinding capability • Cartridge spindle with four preloaded class 7 P4 bearings and run-outof taper nose better than 0.000060" T.I.R. provides quiet, vibration freeoperation for better workpieces accuracy • The table traverses on linear ball bearings with hardened and ground guide ways to ensure a smooth and easy movement of the table • Double V cross ways are hand scraped and Turcite coated for greater flatness and high wear resistance • Indexable table handwheel for ease of operation • Vertical handwheel at the waist level • The automatic lubrication system continuously floods saddle and column ways, bearings, and leadscrews for better machine performance and less maintenance • Wheelhead variable spindle speeds as options • 0.000050" Micro downfeed and micro crossfeed as options • Voltage requires 220V/440V/3 Phase/60 Hz., prewired 220V *** 2003 Machine in Superb Condition - Very Quiet Spindle, Smooth Table ***** Inspect Under Power in our Harrison, NJ Warehouse *** FOR MORE INFORMATION: Call Andy at 973-497-7600
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Flat stepping stones hang in the air. A small boy sits in the shadow of vast objects above him. The image looks impossible, out of scale, and out of gravity. And then the perspective shifts into place, and the image is a reflection — the stones sit at the edge […]Read article
Rarely Seen gathers wonders at the Berkshire Museum
Rarely Seen: Photographs of the Extraordinary, a National Geographic exhibition based on a book of 400 images from around the world, comes to the Berkshire Museum in 2018 and 2019.Read article
Hawaiian past and present converge at Williams College Museum of Art
A young man is singing in a low and carrying voice. He holds long phrases on a breath. He is chanting a Hawaiian oli, and the words are his. Nālamakū Ahsing is a Williams student, class of '21, and he wrote these verses calling to the people who came before […]Read article
Kinetic sculpture brings international artists with local ties to Chesterwood
George Rickey's metal forms caught the light and shifted in the wind. By that summer, he had shown them worldwide from Osaka to Berlin. In 1978, Maxwell Davidson met George Rickey for the first time at Rickey's studio in East Chatham, N.Y. Davidson had opened his New York gallery 10 years […]Read article
Women Artists launch careers in Paris 1850 to 1910 — Summer show at the Clark Art Institute
Rosa Bonheur had won international fame for her scenes of horse fairs and ploughing oxen. She went to abattoirs and open markets to study animals, and she dissected them to learn their anatomy, like Leonardo Da Vinci learning the chambers of the human heart. But she had to get a […]Read article
Fiddlers jam in a day of music at Hancock Shaker Village
Imagine holding hands and spinning until the room blurs. Imagine that movement in someone's arms, to the beat of music. Imagine the musicians sliding from one tune to the next, the melody racing over the chords. Across the country, across 200 years and more, folk dance music has stayed alive. Mill workers […]Read article
William Kentridge honors Africa in World War I
You have already taken all I have. Now you are taking my son. The words appear on a vast wall. At center stage a man faces a round microphone, as though he is speaking on the radio in 1918. He is reliving the history of Africa in World War I — a […]Read article
Ellsworth Kelly leaves — Berkshire Botanical Garden
A line curves into a ripe pear, or a petal, or a stem. Walk through earth banks planted with larch, hawthorn and sporobolus grass. Pass the stone lip of fountain with a flame at the center. Enter a doorway in a living wall of cyclamen, maidenhair fern and ivy. And here, […]Read article
A collage shows the first statewide Artweek festival in images
Get behind the scenes, get muddy, get up close to paper and paint and clay. ArtWeek crossed the state to the Berkshires in April and May 2018 with dozens of events, most of them free …Read article
Artweek festival crosses Massachusetts and the Berkshires
The Germans called them the Night Witches. In World War II they flew planes made mostly of wood and canvas at night, without parachutes or radios. They were a Russian regiment, a few hundred women as young as 17. In 1941, the Soviet air force became the first in the […]Read article


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addressSHANGHAI BRICKPRESS MINERALS CO., LTD
Concrete aggregate collected from demolition sites is put through a crushing machine. Crushing facilities accept only uncontaminated concrete, which must be free of trash, wood, paper and other such materials. Metals such as rebar are accepted, since they can be removed with magnets and other sorting devices and melted down for recycling elsewhere.GET PRICE
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Concrete crushing is a process in which we grind concrete into gravel that you can reuse and recycle. Before our Oregon demolition experts can crush concrete, they tear down the respective building using precision equipment, such as high-reach excavators with attachments. We then separate the concrete, place it in a discrete location at your ...GET PRICE
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The Georgian Prime Minister, Mamuka Bakhtadze, responds to a noisy statement by the former president of the NATO Parliamentary Assembly, where she spoke about the violations revealed during the presidential elections.
According to the Prime Minister, the Georgian government is conducting the elections in compliance with the highest standards.
"Elections, which are going to have, will be held in compliance with the highest standards ... I returned from Brussels a few days ago and this is the best message, I think about the success of Georgia"s democratic transformation. Georgia has been recognized as the most successful country in the Eastern Partnership, "- Mamuka Bakhtadze said.
The Prime Minister criticizes the opposition for critical statements and says their assessments affect the country"s image at international level.
"In my opinion, when we talk about national interests of Georgia and of course the national interests of Georgia are first of all our integration into the EU and our integration into NATO, those who put question marks in ths regard, and here I mean Georgian politicians, do the worst to their homeland by such irresponsible assessments, "- said the Prime Minister.
Former president of the NATO Parliamentary Assembly, in an interview with the Georgian Bureau of the Voice of America said that the ruling team was using the administrative resources very disproportionately in favor of a single candidate.
Rasa Juknevičienė believes that the promise of paying off debts for the population of Georgia is bribery of voters.


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Emirates has been flying to the UK since 1987 and currently offers 130 weekly flights between Dubai and eight UK gateways – Birmingham, Edinburgh, Gla...
REED EXHIBITIONS LIMITED is a private limited company, having its registered and principal office at Gateway House, 28 The Quadrant, Richmond, Surrey, TW9 1ON, registered in England and Wales with Company No. 678540. Business activity: Activities of exhibition and fair organisers. VAT No. GB 232 4004 20. Tax ID No: 13960 00581.
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Lakeside Private Cabin with Views from Deck near Wild Horse Island, MontanaRollins, Montana (United States)
Lakeside Private Cabin with Views from Deck near Wild Horse Island, Montana
Verified host
- ID authenticated
- Phone, email and address confirmed
- Hosted a verified guest
- Kid-friendly
- Private Barbecue
The living room has a charming mix of modern and retro elements with elongated windows overlooking the lake and the mountains. Guests can lean back on the cozy recliner and warm up next to the wood-burning stove or chill on the plush couch and watch a DVD on the TV.
The living room is just steps away from the fully equipped kitchen, which features an oven, a stove, a fridge, a microwave, and a coffeemaker. Guests can whip up a meal to share at the dining table with seating for six. The gas grill outside is perfect for a BBQ cookout that guests can enjoy al fresco at the tree-shaded picnic table at the water's edge. On a sunny day, guests can head to the property's boat slip for a canoe ride, and tell ghost stories around the outdoor fire pit once the sun has set.
- Queen-size bed
- Double bed
- Electricity
- Water
- Wi-Fi/Internet
- Air conditioning
- Linens and pillows
- Television
- Parking
- Fireplace
- Dining table
- Bathroom
- Shower
- Toilet
- Sink
- Towels
- Toiletries
- Kitchen
- Cooking basics
- Fridge
- Coffeemaker
- Microwave
- Oven
- Stove
- Dishwasher
- Toaster
- Icemaker
- Freezer
- Private Lounge/Living room
- Fire pit
- Private Barbecue
- Docking station
- BR/DVD player
Location + Surroundings
- Swimming
- Winter sports
- Water sports
- Kayaking/Canoeing
- Fishing
- Boating/Sailing
Outdoor enthusiasts might have a hard time deciding where to start between hiking at Glacier National Park and boating on Flathead Lake. A quick trip across the water to Wild Horse Islands offers even more hiking trails and wildlife viewing. Guests can jump in head-first with swimming, canoeing, and kayaking on the clear waters. Fishing and boating tours can be hired, and Mavericks Casino is just a short drive away in Lakeside. Whitefish Mountain Resort and Blacktail Mountain both offer glampers winter sports recreation, like skiing and snowboarding, making this property an ideal getaway no matter the season.
7 Reviews
Accommodation Rules
Check-in: Flexible
Check-out: Flexible
Infants allowed Under 2 years old
Children allowed 2-12 years old
No Pets allowed
No smoking
No parties
Cancellation policy
Additional Information
This property is not pet-friendly.


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"Excellent hotel for solo travelers. Close to the city center and public transportation."
Great Overall Ranking
Great city hotel
Excellent breakfast
"Comfortable beds. Close to public transport. Professional service. Clean rooms."
Great Overall Ranking
Great city hotel
Great location
Cafes and restaurants nearby. Close to the city. Close to tube station.
Hotel description
Built in 2008, the 8-storey establishment is located within the Olympic Garden and lies extremely close to the Moskovsky Prospect. It is a 5-minute walk from the Tekhnologicheskiy Institut Metro Station, 2 stops from the Nevsky Prospekt and 3 stations from the historical city centre and its restaurants, cafés and prime boutiques. Guests arriving through the Pulkovo Airport can use the shuttle service in order to make the 10km journey as pleasant as possible. Due to its location the venue can offer business travellers a modern business centre and 11 multi-functional conference rooms that can be used to stage all types of events. There is also an elegant restaurant that features an inviting fireplace, serves delicious French cuisine and is the perfect spot for a stylish dinner. The 2 relaxed bars are just ideal for cocktails or a chilled drink with friends at the end of the day.
Pets Allowed with Extra Charge.
Paying at the Hotel
The following payment methods are accepted by the hotel. Master Card, Visa Card, American Express Card, JCB Card, Maestro.
City important notice
The hotel does not accept children under 18 years of age staying alone.
Breakfast is provided
Breakfast Fee
please contact the hotel for the price
Breakfast Business Hours
07:00 - 10:30 from Monday to Sunday.
Children are welcome at this hotel.
Using Existing Beds
For each room 1 child 3 years old and under can use existing beds for free breakfast included.
Food & Drink
Health & Fitness
Room service


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I have a bit trouble getting that raw 'raunchy' unpolished sound out of the Axe. A watt tube amp is overkill for most gigs and can easily drown out a small venue. Remember that essentially every single feature of his guitar have changed over the years: different pickups, different necks even a rosewood fretboard at one pointdifferent bridges, etc. I saw Brit Floyd a couple of nights ago and they were getting amazing spot-on tones out of their Axe-FX's. This pedal gives you the classic Big Muff sound that David has used throughout his career in a smaller casing.
Hi, I am practising with Guitar Rig5 on a strat. Don't have any experience!
How To Sound Like David Gilmour Seymour Duncan
How can I get the sound of David Gilmour, or Andy Latimer of Camel? I The actual amp/effect settings are good enough though not perfect. › en-us › community › posts › I can hear my guitar when I play, through Guitar Rig 5. However, when I install new presets to sound like certain musicians e.g. David Gilmour.
It was a great show and the music and singing was about as close as it can get to the original.
7 Best Guitar Rig images Guitar rig, Guitar, Rigs
Just a dude jamming out to a backer track in his kitchen. Careful with that Axe fx! Viktoriia Titova - July 22, at am Good day everybody!
When a compressor is used with a fuzz distortion, it smooths it out and adds some warmth. Danny Danzi. This would be extremely useful, especially for creating drum tracks.
Guitar Pro 7 Signature Sounds Explained Guitar Pro Blog – Arobas Music
DAVID GILMOUR PINK FLOYD. 5 product names or trademarks of other manufacturers should not be construed. If there was ever a master of guitar tone, Pink Floyd guitarist David Gilmour's add effects on top of one another with no regard for the overall sound.
For the amp I used these settings: Master 9; Normal 8; Brill 9; Bass 5. 10 Greatest Guitar Riffs with Guitar Rig 5 + пресеты. Пост, обсуждение David Gilmour Sound on Sound Guitar Rig 5 preset.
Also try if possible a 45 degree mic and rear mic sounds. I forget what the cab micing options are like in GR5 but I seem to recall them being rather limited. David constantly experiments with different configurations so you can do the same thing.
In the late 70s he switched to using an Electric Mistress by Electro-Harmonix and you can hear it throughout his first solo album. I do have Platinum, as well as Native-Instruments Komplete 8 Ultimate, so between Sonar and Komplete I have a bunch of effects, and I have a bunch of other freeware bit effects from other folks.
signature presets Guitar Rig Presets Online
What can I do with those?
David gilmour sound guitar rig 5 no sound
|It is twice the price of the Phase 90 or the BOSS below so keep this in mind when comparing the options. Last Updated on February 14, Gear will get you so far, technique will take you the rest of the way.
You can use the approach starting from scratch in GR. Even a 20 or watt amp can easily be overkill for some gigs or rehearsals. In the late 70s he switched to using an Electric Mistress by Electro-Harmonix and you can hear it throughout his first solo album.
Look up Jamie Humphries.


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Auto Glass Repaired or Replaced In Your Driveway!
Local Installers In Ellisville, Mississippi Available
For both repair and replacement, trust Paul's Discount Glass for your auto glass needs. Friendly, professional auto glass service is available in MS You don't need to wait weeks for Paul's Discount Glass to come to Ellisville for your car. Leading Glass Technicians is a worthwhile consideration when your windshield is broken or cracked. It may be broken now, but our auto glass experts can usually fix it in one day.
Auto Glass Services Offered
- Windshield Repair
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Customers Love our Qualified Glass Professionals!
Toyota Camry Windshield Replacement
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Installation was done quickly and professionally. John was very personable!
Bryan B• Darien, IL • 2012 Toyota Camry
Toyota RAV4 Windshield Replacement
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Quick service and did a good job so far. Props to the shop that did it.
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Jeep Wrangler Windshield Replacement
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I'm very unhappy! You replaced my windshield last week and the first rain proved it to be a poor fit. The windshield wiper is catching the bottom of the windshield on every swing. Also, the adhesive was amateurish because it is visibly asymmetrical all around the window. I'll take some pictures and post them everywhere I can!
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Toyota Prius Windshield Replacement
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Published on 13/02/2020 1:15:02 PM | Source: Zigwheels
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Here's all you need to know about the 2020 Honda Dio
After the Honda Activa 125 and the recently launched Honda Activa 6G, the Japanese brand has now ridden in the new BS6 Honda Dio. Over the years, the Honda Dio has remained the sportier option to the Honda Activa and has been popular among youngsters. We list out the major changes on the new Honda Dio BS6.
Updated features:
Honda hasn't restricted the new Dio with a BS6-compliant engine as it has been loaded with new features as well. The Deluxe variant of the Honda Dio sports an all-digital instrument console (first for a Honda scooter in India). It also gets equipped with an external fuel filler cap and ACG starter motor. Also, the scooter features engine kill switch, a front pocket below the handlebar, pass light switch and side stand engine cut-off.
BS6 heart:
Just like the Activa 6G, the new Honda Dio's motor features fuel injection to meet the stringent BS6 emission norms. Powering the scooter is a 109.5cc, single-cylinder, air-cooled engine delivering 7.76PS, which is 0.16PS less than the older engine, and 9Nm.
Style updates:
One of the major reasons for the popularity of the Dio has been its sporty styling that made it stand apart from other 110cc scooters. The 2020 Honda Dio gets styling updates with an edgy LED headlight, restyled apron, new exhaust muffler and LED DRLs to give it a modern look. It also gets a better stance owing to the inclusion of larger wheels and a telescopic fork up front. While the overall styling is still reminiscent of the original Dio, the new styling elements make it more visually appealing.
It's offered in two variants: Standard & Deluxe. The Standard variant is available in four colour options: Mat Axis Grey Metallic, Candy Jazzy Blue, Sports Red & Vibrant Orange. The Deluxe variant is offered in the following three shades: Mat Sangria Red Metallic, Dazzle Yellow Metallic & Mat Axis Grey Metallic.
Better hardware:
Finally, Honda has equipped the Dio with a telescopic fork replacing the old trailing link suspension which offered a juddery ride. Another major change is the inclusion of a 12-inch front wheel, which might reduce the agility of the Dio slightly but will offer better stability. Also, the new Dio has grown in size as its wheelbase is 22mm longer than its predecessor. It is also 3kg heavier. Fuel tank capacity remains identical at 5.3 litres. Seat height as quoted on HMSI's website is 650mm, but we think it's a typo as the older Dio's seat height stood at 765mm. The monoshock suspension is now adjustable. However, it's really disappointing that Honda doesn't offer disc brake even as an option on the new Dio.
Price & warranty:
All these updates do come at a price. The base variant of the Honda Dio BS6 is priced at Rs 59,990 (Rs 5,749 more than Dio BS4) whereas the Honda Dio deluxe price is Rs 63,340 (Rs 7,099 more). Note: All prices mentioned are ex-showroom Delhi. Given the new list of features and the inclusion of fuel injection, the price hike is kind of justifiable. Honda is also offering a special 6-year warranty (3 years standard + 3 years optional extended warranty) on the BS6 Dio
Source Name : www.zigwheels.com
Views Quote On Market by Mr. S Hariharan
Daily Market Commentary 24 February 2020 by Mr. Siddhartha Khemka
Last Week Optimism gone for a toss, 11800 – 11750 to watch out for: Angel Broking
DIPAM extends time for clarifications on Air India divestment


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The Boo York, Boo York - Frightseers is a doll line and comprises of three characters dressed for crystal comet. They are Clawdeen Wolf, Draculaura (there are two dolls which is same Boo York, Boo York - Out-of-Tombers dolls but here they have their handbags) and Operetta.
Boo York, Boo York was trademarked on June 26, 2014. Frightseers was trademarked on October 08, 2014.
|This article or section is a stub. You can help the Monster High Wiki by expanding it.
Each doll comes with their bio is printed on the back of the box.
The 2015 TV special "Boo York, Boo York" prominently features the Boo York, Boo York line.
- The Boo York, Boo York look of Frankie that appears in "Boo York, Boo York" is a reworked Picture Day model from "13 Wishes" and therefore does not represent an unproduced doll.
|Clawdeen Wolf
Community content is available under CC-BY-SA unless otherwise noted.


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Hi everyone,
I used up the cold chicken in a Chicken Stir-fry - and had it with some Egg Noodles - and I made my own sauce (a Satay sauce) - and it was very tasty.
I am including a couple of photos I took whilst out on my walk yesterday - admiring the gorgeous flowers - a hedge of Dancing Ladies, and also some Purple Petunias. Gorgeous. (Now I'm doubting my knowledge of flowers - are they petunias?)


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