Defining New Research Questions and Protocols in the Field of Traumatic Brain Injury through Public Engagement: Preliminary Results and Review of the Literature

Traumatic brain injury (TBI) is the most common cause of death and disability in the age group below 40 years. The financial cost of loss of earnings and medical care presents a massive burden to family, society, social care, and healthcare, the cost of which is estimated at £1 billion per annum (about brain injury (online)). At present, we still lack a full understanding on the pathophysiology of TBI, and biomarkers represent the next frontier of breakthrough discoveries. Unfortunately, many tenets limit their widespread adoption. Brain tissue sampling is the mainstay of diagnosis in neuro-oncology; following on this path, we hypothesise that information gleaned from neural tissue samples obtained in TBI patients upon hospital admission may correlate with outcome data in TBI patients, enabling an early, accurate, and more comprehensive pathological classification, with the intent of guiding treatment and future research. We proposed various methods of tissue sampling at opportunistic times: two methods rely on a dedicated sample being taken; the remainder relies on tissue that would otherwise be discarded. To gauge acceptance of this, and as per the guidelines set out by the National Research Ethics Service, we conducted a survey of TBI and non-TBI patients admitted to our Trauma ward and their families. 100 responses were collected between December 2017 and July 2018, incorporating two redesigns in response to patient feedback. 75.0% of respondents said that they would consent to a brain biopsy performed at the time of insertion of an intracranial pressure (ICP) bolt. 7.0% replied negatively and 18.0% did not know. 70.0% would consent to insertion of a jugular bulb catheter to obtain paired intracranial venous samples and peripheral samples for analysis of biomarkers. Over 94.0% would consent to neural tissue from ICP probes, external ventricular drains (EVD), and lumbar drains (LD) to be salvaged, and 95.0% would consent to intraoperative samples for further analysis

In Reply: neurosurgery and coronavirus (COVID-19) epidemic: doing our part

To the Editor: We appreciated the Letter, “Letter: Neurosurgery and Coronavirus (COVID-19) Epidemic: Doing Our Part” by Pesce et al, published in April 2020 in Neurosurgery. We are grateful to the authors of the Letter for their clear analysis of some neurosurgical procedures in the COVID-19 era. Everyone in the neurosurgical community and in the whole medical community is doing their own part to face this terrible pandemic. Specifically, we would like to present our experience with patients needing a lumbar function or a neuroimaging. We already described our strategy for all emergency patients in an article published in Neurosurgery in April 2020 entitled “In Reply: Rongeurs, Neurosurgeons, and COVID-19: How Do We Protect Health Care Personnel During Neurosurgical Operations in the Midst of Aerosol-Generation From High-Speed Drills?

Autologous fibrin sealant (Vivostat®) in the neurosurgical practice: Part I: Intracranial surgical procedure

Background: Hemorrhages, cerebrospinal fluid (CSF) fistula and infections are the most challenging postoperative complications in Neurosurgery. In this study, we report our preliminary results using a fully autologous fibrin sealant agent, the Vivostat® system, in achieving hemostasis and CSF leakage repair during cranio-cerebral procedures. Methods: From January 2012 to March 2014, 77 patients were studied prospectively and data were collected and analyzed. Autologous fibrin sealant, taken from patient's blood, was prepared with the Vivostat® system and applied on the resection bed or above the dura mater to achieve hemostasis and dural sealing. The surgical technique, time to bleeding control and associated complications were recorded. Results: A total of 79 neurosurgical procedures have been performed on 77 patients. In the majority of cases (98%) the same autologous fbrin glue provided rapid hemostasis and dural sealing. No patient developed allergic reactions or systemic complications in association with its application. There were no cases of cerebral hematoma, swelling, infection, or epileptic seizures after surgery whether in the immediate or in late period follow-up. Conclusions: In this preliminary study, the easy and direct application of autologous fibrin sealant agent helped in controlling cerebral bleeding and in providing prompt and efficient dural sealing with resolution of CSF leaks. Although the use of autologous fibrin glue seems to be safe, easy, and effective, further investigations are strongly recommended to quantify real advantages and potential limitations

Ventricular-vascular coupling in hypertension: methodological considerations and clinical implications

The present review is addressed to analyse the complex interplay between left ventricle and arterial tree in hypertension. The different methodological approaches to the analysis of ventricular vascular coupling in the time and frequency domain are discussed. Moreover, the role of hypertension-related changes of arterial structure and function (stiffness and wave reflection) on arterial load and how ventricular-vascular coupling modulates the process of left ventricular adaptation to hypertension are analysed.The different interplay between vascular bed and left ventricle emerges as the pathophysiological basis for the development of the multiple patterns of ventricular structural adaptation in hypertension and provides a pathway for the interpretation of systolic and diastolic functional abnormalities observed in hypertensive patients. Targeting the therapeutic approach to improve ventricular-vascular coupling may have relevant impact on reversing left ventricular hypertrophy and improving systolic and diastolic dysfunctio

GRANIT project: a trap for gravitational quantum states of UCN

Previous studies of gravitationally bound states of ultracold neutrons showed the quantization of energy levels, and confirmed quantum mechanical predictions for the average size of the two lowest energy states wave functions. Improvements in position-like measurements can increase the accuracy by an order of magnitude only. We therefore develop another approach, consisting in accurate measurements of the energy levels. The GRANIT experiment is devoted to the study of resonant transitions between quantum states induced by an oscillating perturbation. According to Heisenberg's uncertainty relations, the accuracy of measurement of the energy levels is limited by the time available to perform the transitions. Thus, trapping quantum states will be necessary, and each source of losses has to be controlled in order to maximize the lifetime of the states. We discuss the general principles of transitions between quantum states, and consider the main systematical losses of neutrons in a trap.Comment: presented in ISINN 15 seminar, Dubn

Titania-doped tantala/silica coatings for gravitational-wave detection

Reducing thermal noise from optical coatings is crucial to reaching the required sensitivity in next generation interferometric gravitational-wave detectors. Here we show that adding TiO2 to Ta2O5 in Ta2O5/SiO2 coatings reduces the internal friction and in addition present data confirming it reduces thermal noise. We also show that TiO2-doped Ta2O5/SiO2 coatings are close to satisfying the optical absorption requirements of second generation gravitational-wave detectors

Emergency endovascular treatment of petrous carotid artery false aneurysm

Introduction: The management of ruptured intracranial false aneurysms (IFAs) might be tricky as any kind of treatment modality, surgical or endovascular, is burdened with significant challenges. A case report of the endovascular treatment of IFA in emergency setting is presented to provide more understanding of its pathophysiology as well as of the best operative work-up for petrous carotid artery reconstruction. Methods: Technical notes from a left sided skull base abscess, involving and eroding the carotid canal and petrous carotid artery (PCA) resulting in an IFA are shown and analyzed. Results: Balloon-assisted low viscosity Onyx embolization seems an effective method for the emergency treatment of IFA. Indications, technical nuances, and peri- and post-procedural complications are thoroughly discussed. A flow chart for the management of IFA is also proposed. Conclusions: The combination of parent artery balloon protection and low viscosity Onyx embolization can provide an effective occlusion of the IFA while maintaining parent artery patency. Normal distal filling of the parent artery, and optimal obliteration of the IFA are easily achievable