Large Animal Studies to Reduce the Foreign Body Reaction in Brain-Computer Interfaces: A Systematic Review.

Brain-computer interfaces (BCI) are reliant on the interface between electrodes and neurons to function. The foreign body reaction (FBR) that occurs in response to electrodes in the brain alters this interface and may pollute detected signals, ultimately impeding BCI function. The size of the FBR is influenced by several key factors explored in this review; namely, (a) the size of the animal tested, (b) anatomical location of the BCI, (c) the electrode morphology and coating, (d) the mechanics of electrode insertion, and (e) pharmacological modification (e.g., drug eluting electrodes). Trialing methods to reduce FBR in vivo, particularly in large models, is important to enable further translation in humans, and we systematically reviewed the literature to this effect. The OVID, MEDLINE, EMBASE, SCOPUS and Scholar databases were searched. Compiled results were analysed qualitatively. Out of 8388 yielded articles, 13 were included for analysis, with most excluded studies experimenting on murine models. Cats, rabbits, and a variety of breeds of minipig/marmoset were trialed. On average, over 30% reduction in inflammatory cells of FBR on post mortem histology was noted across intervention groups. Similar strategies to those used in rodent models, including tip modification and flexible and sinusoidal electrode configurations, all produced good effects in histology; however, a notable absence of trials examining the effect on BCI end-function was noted. Future studies should assess whether the reduction in FBR correlates to an improvement in the functional effect of the intended BCI

In and around the optic chiasm: a pictorial review of neuroimaging

The optic chiasm is a key anatomical structure along the visual pathway, situated at the crossroads between optic nerves and tracts. A wide range of diseases can affect the optic chiasm and its surrounding strategic region at the base of the brain. Management strategies for optic chiasm abnormalities vary substantially, depending on the abnormalities revealed on neuroimaging. Scant attention has been paid to date to comprehensive classification of neuroimaging manifestations of optic chiasm abnormalities. We comprehensively review and present the imaging findings in a wide spectrum of pathologies originating from or involving the optic chiasm. This review will aid in differentiating the many neuroimaging appearances of lesions in this region

Methodological shortcomings in the literature evaluating the role and applications of 3D training for surgical trainees.

AIM: There has been an increased interest in the use of three-dimensional (3D) technology in surgical training. We wish to appraise the methodological rigor applied to evaluating the role and applications of 3D technology in surgical training, in particular, on the validity of these models and assessment methods in simulated surgical training. METHODS: Literature search was performed using MEDLINE with the following terms: "3D"; "surgery"; and "training". Only studies evaluating the role of 3D technology in surgical training were eligible for inclusion and assessed for the level of evidence, validity of the simulation model, and assessment method used. RESULTS: A total of 93 studies were analyzed, and majority of reviewed articles focused on 3D displays (36) and 3D printing (35). Most of these studies were case series, the most common assessment was subjective (69), with objective assessment used by 57 studies. Very few studies provided evidence for validity of the model or the assessment methods used. CONCLUSIONS: 3D technology has a great potential in simulated surgical training. However, the validity of this technology and strong evidence for its beneficial effects in surgical training is lacking. Further work on validation of 3D technology and assessment tools is needed

Ileus nakon spontanog intramuralnog hematoma jejunuma: prikaz slučaja i pregled literature

Anticoagulant therapy may cause the onset of a spontaneous intramural hematoma of the small bowel, in the jejunum, ileum or duodenum. A 53-year-old woman on therapy with heparin for previous pulmonary embolism was admitted for abdominal pain and vomit. Computed tomography scan visualized an intramural hematoma of the jejunum causing subtotal obstruction of the intestinal lumen. The patient underwent resection of a part of the jejunum, securing intestinal continuity by a mechanical side-to-side anastomosis. The postoperative course was regular, but the initial anticoagulant therapy was reduced to prevent recurrence. In conclusion, spontaneous hematoma of small bowel can occur as a complication of anticoagulant therapy. The clinical picture and rapid diagnosis indicate medical or surgical therapy.Antikoagulantna terapija može uzrokovati spontanu pojavu intraparijetalnog hematoma tankog crijeva na razini jejunuma, ileuma ili duodenuma. Prikazuje se klinički slučaj 53-godišnje žene na terapiji heparinom zbog ranije plućne embolije, koja je zadržana na bolničkom liječenju zbog bolova u trbuhu i mučnine. Tomografija abdomena potvrdila je prisutnost intraparijetalnog hematoma jejunuma koji je uzrokovao gotovo potpuno zakrčenje crijevnog lumena. Izvedena je resekcija zahvaćenog dijela jejunuma i rekonstrukcija crijevnog nastavka posredstvom “mehaničke latero-lateralne anastomoze”. Poslijeoperacijski tijek je bio uredan, ali je smanjena početna antikoagulantna terapija kako bi se izbjegao recidiv bolesti. U zaključku, spontani intraparijetalni hematom tankog crijeva može biti rezultat komplikacija antikoagulantne terapije. Klinička slika i brzo postavljanje dijagnoze upućuju na medicinsku ili kiruršku terapiju

Neutrophil percentage-to-albumin ratio predicts mortality in bladder cancer patients treated with neoadjuvant chemotherapy followed by radical cystectomy

To investigate the prognostic role of neutrophil percentage-to-albumin ratio (NPAR) in muscle-invasive bladder cancer (MIBC) patients treated with neoadjuvant chemotherapy (NAC) and radical cystectomy (RC)

How future surgery will benefit from SARS-COV-2-related measures: a SPIGC survey conveying the perspective of Italian surgeons

COVID-19 negatively affected surgical activity, but the potential benefits resulting from adopted measures remain unclear. The aim of this study was to evaluate the change in surgical activity and potential benefit from COVID-19 measures in perspective of Italian surgeons on behalf of SPIGC. A nationwide online survey on surgical practice before, during, and after COVID-19 pandemic was conducted in March-April 2022 (NCT:05323851). Effects of COVID-19 hospital-related measures on surgical patients' management and personal professional development across surgical specialties were explored. Data on demographics, pre-operative/peri-operative/post-operative management, and professional development were collected. Outcomes were matched with the corresponding volume. Four hundred and seventy-three respondents were included in final analysis across 14 surgical specialties. Since SARS-CoV-2 pandemic, application of telematic consultations (4.1% vs. 21.6%; p < 0.0001) and diagnostic evaluations (16.4% vs. 42.2%; p < 0.0001) increased. Elective surgical activities significantly reduced and surgeons opted more frequently for conservative management with a possible indication for elective (26.3% vs. 35.7%; p < 0.0001) or urgent (20.4% vs. 38.5%; p < 0.0001) surgery. All new COVID-related measures are perceived to be maintained in the future. Surgeons' personal education online increased from 12.6% (pre-COVID) to 86.6% (post-COVID; p < 0.0001). Online educational activities are considered a beneficial effect from COVID pandemic (56.4%). COVID-19 had a great impact on surgical specialties, with significant reduction of operation volume. However, some forced changes turned out to be benefits. Isolation measures pushed the use of telemedicine and telemetric devices for outpatient practice and favored communication for educational purposes and surgeon-patient/family communication. From the Italian surgeons' perspective, COVID-related measures will continue to influence future surgical clinical practice

Correction to: Two years later: Is the SARS-CoV-2 pandemic still having an impact on emergency surgery? An international cross-sectional survey among WSES members

Background: The SARS-CoV-2 pandemic is still ongoing and a major challenge for health care services worldwide. In the first WSES COVID-19 emergency surgery survey, a strong negative impact on emergency surgery (ES) had been described already early in the pandemic situation. However, the knowledge is limited about current effects of the pandemic on patient flow through emergency rooms, daily routine and decision making in ES as well as their changes over time during the last two pandemic years. This second WSES COVID-19 emergency surgery survey investigates the impact of the SARS-CoV-2 pandemic on ES during the course of the pandemic. Methods: A web survey had been distributed to medical specialists in ES during a four-week period from January 2022, investigating the impact of the pandemic on patients and septic diseases both requiring ES, structural problems due to the pandemic and time-to-intervention in ES routine. Results: 367 collaborators from 59 countries responded to the survey. The majority indicated that the pandemic still significantly impacts on treatment and outcome of surgical emergency patients (83.1% and 78.5%, respectively). As reasons, the collaborators reported decreased case load in ES (44.7%), but patients presenting with more prolonged and severe diseases, especially concerning perforated appendicitis (62.1%) and diverticulitis (57.5%). Otherwise, approximately 50% of the participants still observe a delay in time-to-intervention in ES compared with the situation before the pandemic. Relevant causes leading to enlarged time-to-intervention in ES during the pandemic are persistent problems with in-hospital logistics, lacks in medical staff as well as operating room and intensive care capacities during the pandemic. This leads not only to the need for triage or transferring of ES patients to other hospitals, reported by 64.0% and 48.8% of the collaborators, respectively, but also to paradigm shifts in treatment modalities to non-operative approaches reported by 67.3% of the participants, especially in uncomplicated appendicitis, cholecystitis and multiple-recurrent diverticulitis. Conclusions: The SARS-CoV-2 pandemic still significantly impacts on care and outcome of patients in ES. Well-known problems with in-hospital logistics are not sufficiently resolved by now; however, medical staff shortages and reduced capacities have been dramatically aggravated over last two pandemic years

Global disparities in surgeons’ workloads, academic engagement and rest periods: the on-calL shIft fOr geNEral SurgeonS (LIONESS) study

: The workload of general surgeons is multifaceted, encompassing not only surgical procedures but also a myriad of other responsibilities. From April to May 2023, we conducted a CHERRIES-compliant internet-based survey analyzing clinical practice, academic engagement, and post-on-call rest. The questionnaire featured six sections with 35 questions. Statistical analysis used Chi-square tests, ANOVA, and logistic regression (SPSS® v. 28). The survey received a total of 1.046 responses (65.4%). Over 78.0% of responders came from Europe, 65.1% came from a general surgery unit; 92.8% of European and 87.5% of North American respondents were involved in research, compared to 71.7% in Africa. Europe led in publishing research studies (6.6 ± 8.6 yearly). Teaching involvement was high in North America (100%) and Africa (91.7%). Surgeons reported an average of 6.7 ± 4.9 on-call shifts per month, with European and North American surgeons experiencing 6.5 ± 4.9 and 7.8 ± 4.1 on-calls monthly, respectively. African surgeons had the highest on-call frequency (8.7 ± 6.1). Post-on-call, only 35.1% of respondents received a day off. Europeans were most likely (40%) to have a day off, while African surgeons were least likely (6.7%). On the adjusted multivariable analysis HDI (Human Development Index) (aOR 1.993) hospital capacity > 400 beds (aOR 2.423), working in a specialty surgery unit (aOR 2.087), and making the on-call in-house (aOR 5.446), significantly predicted the likelihood of having a day off after an on-call shift. Our study revealed critical insights into the disparities in workload, access to research, and professional opportunities for surgeons across different continents, underscored by the HDI

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Inflammasome mediated response to biomaterials implanted in the peripheral nervous system

Neurological disabilities carry an enormous burden on patients and communities, with almost no treatment strategies available in clinical practice. Implantable neural interfaces represent a promising tool, able to potentially restore loss of neurological function in brain, spinal cord or peripheral nerve injury patients. However, neural interfaces require selectivity and long-term stability, which are compromised by the physiological host-implant response (foreign body reaction - FBR), which surrounds the implant with fibrotic connective tissue. Little is known about the cellular and molecular mechanisms of FBR in peripheral nerves and all the treatments to date have shown to be not specific and unsuitable to be translated in clinical practice. The aim of this project is to elucidate the molecular mechanism involved in the early stages of FBR and peripheral nerve injury and identify a potential target able to reduce FBR, without affecting neuronal regeneration. Using RNA sequencing, I have determined the differential expression of genes (between day 1 and day 28 post intervention) between a normal mouse sciatic nerve (control), a crushed one (peripheral nerve injury PNI model) and one with a device implanted (FBR model). From this dataset, I have characterised the differences in the immune response between PNI and FBR and demonstrated the potential role of IL1b and the inflammasome in the treatment of FBR. Using in vivo knock-out models of the inflammasome, I have shown: reduction in the expression of molecules involved in inflammation and fibrosis (using RT-qPCR); reduction in scar thickness and increase in axonal regeneration (using histology). I have developed a protocol to manufacture implants (conduits – model of regenerative neural interface) impregnated with either dexamethasone (used as positive control) and NLRP3 inflammasome inhibitor (proposed intervention). I have demonstrated that localised delivery of a NLRP3 inhibitor reduces FBR scar thickness (at 3 months), without reduction in axonal count. This also corresponded with a possible reduction in IL1b production in the NLRP3 inhibitor group. Using RNA sequencing, I further characterised the differential expression of genes of the proposed treatment strategies (at 28 days post intervention) to investigate the molecular pathways and cell types involved in the interventions. These findings show that inhibition of NLRP3 inflammasome reduces inflammation and FBR in peripheral nerve implants, without compromising neuronal regeneration