Editorial: New Frontiers for Artificial Intelligence in Surgical Decision Making and its Organizational Impacts

The purpose of the research topic call “New Frontiers for Artificial Intelligence in Surgical Decision Making and its Organizational Impacts “ was to collect the recent developments and undergoing studies in AI in surgery and surgical oncology. More in detail, the aim was to gather contributions on the advancement, deployment, use, and implementation of AI-based applications in surgical practice, understanding their potential contribution to clinical decision making. Moreover, the idea was to assess the potential impacts of such a technology on surgeons, other clinicians, patients, medical institutions, developers, and policy-makers, with an eye open to the organizational and educational consequences and opportunities

Prosthetic abdominal wall hernia repair in emergency surgery: from polypropylene to biological meshes

The use of nonabsorbable prosthetic materials such as polypropylene, polyester, and ePTFE, have expanded and are now widely used in reparative surgery for abdominal wall hernias

Hemothorax caused by rupture of a primitive thoracic leiomyosarcoma of the thoracic aorta: Description of a case and literature review

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Approximate logic synthesis: a survey

Approximate computing is an emerging paradigm that, by relaxing the requirement for full accuracy, offers benefits in terms of design area and power consumption. This paradigm is particularly attractive in applications where the underlying computation has inherent resilience to small errors. Such applications are abundant in many domains, including machine learning, computer vision, and signal processing. In circuit design, a major challenge is the capability to synthesize the approximate circuits automatically without manually relying on the expertise of designers. In this work, we review methods devised to synthesize approximate circuits, given their exact functionality and an approximability threshold. We summarize strategies for evaluating the error that circuit simplification can induce on the output, which guides synthesis techniques in choosing the circuit transformations that lead to the largest benefit for a given amount of induced error. We then review circuit simplification methods that operate at the gate or Boolean level, including those that leverage classical Boolean synthesis techniques to realize the approximations. We also summarize strategies that take high-level descriptions, such as C or behavioral Verilog, and synthesize approximate circuits from these descriptions

Why non-technical skills matter in surgery. New paradigms for surgical leaders

The surgical literature is paying more and more attention to the topic of soft or non-technical skills (NTS), defined as those cognitive and social skills that characterize high-performing individuals and teams. NTS are essential in supporting surgeons in dealing with unexpected situations. During the COVID-19 pandemic, NTS have been considered crucial in defining situation awareness, enhancing decision making, communicating among groups and teams, and fostering leadership. With a “looking back and planning forward” approach, the current perspective aims at deepening the contribution of NTS for surgeons to deal with the unexpected challenges posed by the COVID crisis, surgical emergencies, the introduction of new technologies in clinical practice, to understand how such skills may help shape the surgical leaders of the future

The Operative management in Bariatric Acute abdomen (OBA) Survey: long-term complications of bariatric surgery and the emergency surgeon\u27s point of view.

Background: The number of bariatric procedures is increasing worldwide. No consensus or guidelines about the emergency management of long-term complications following bariatric surgery are currently available. The aim of this study is to investigate by a web survey how an emergency surgeon approaches this unique group of patients in an emergency medical scenario and to report their personal experience. Method: An international web survey was sent to 197 emergency surgeons with the aim to collect data about emergency surgeons\u27 experience in the management of patients admitted in the emergency department for acute abdominal pain after bariatric surgery. The survey was conceived as a questionnaire composed by 26 (multiple choice and open) questions and approved by a steering committee. Results: One hundred seventeen international emergency surgeons decided to join the project and answered to the web survey with a response rate of 59.39%. Conclusions: The aim of this WSES web survey was to highlight the current management of patients previously submitted to bariatric surgical procedures by ES.Emergency surgeons must be mindful of postoperative bariatric surgery complications. CT scan with oral intestinal opacification may be useful in making a diagnosis if carefully interpreted by the radiologist and the surgeon.In case of inconclusive clinical and radiological findings, when symptoms fail to improve, surgical exploration for bariatric patients presenting acute abdominal pain, by laparoscopy if expertise is available, is mandatory in the first 12-24 h, to have good outcomes and decrease morbidity rate

Emergency surgery for recurrent intraabdominal cancer

Recurrent abdominal cancer can manifest in many ways but there are certain situations that are a great challenge to clinicians. Emergency presentation is one such situation. Surgeons are faced with a therapeutic dilemma that on the one hand most of these patients have a limited life expectancy, and on the other surgical procedures are unavoidable. We reviewed our experience of recurrent abdominal cancers presenting with acute abdominal symptoms requiring emergency

Analysis of LINE1 Retrotransposons in Huntington’s Disease

Transposable elements (TEs) are mobile genetic elements that made up about half the human genome. Among them, the autonomous non-LTR retrotransposon long interspersed nuclear element-1 (L1) is the only currently active TE in mammals and covers about 17% of the mammalian genome. L1s exert their function as structural elements in the genome, as transcribed RNAs to influence chromatin structure and as retrotransposed elements to shape genomic variation in somatic cells. L1s activity has been shown altered in several diseases of the nervous system. Huntington disease (HD) is a dominantly inherited neurodegenerative disorder caused by an expansion of a CAG repeat in the HTT gene which leads to a gradual loss of neurons most prominently in the striatum and, to a lesser extent, in cortical brain regions. The length of the expanded CAG tract is related to age at disease onset, with longer repeats leading to earlier onset. Here we carried out bioinformatic analysis of public RNA-seq data of a panel of HD mouse models showing that a decrease of L1 RNA expression recapitulates two hallmarks of the disease: it correlates to CAG repeat length and it occurs in the striatum, the site of neurodegeneration. Results were then experimentally validated in HttQ111 knock-in mice. The expression of L1-encoded proteins was independent from L1 RNA levels and differentially regulated in time and tissues. The pattern of expression L1 RNAs in human HD post-mortem brains showed similarity to mouse models of the disease. This work suggests the need for further study of L1s in HD and adds support to the current hypothesis that dysregulation of TEs may be involved in neurodegenerative diseases

Splenic Trauma: WSES Classification and Guidelines for Adult and Pediatric Patients

Spleen injuries are among the most frequent trauma-related injuries. At present, they are classified according to the anatomy of the injury. The optimal treatment strategy, however, should keep into consideration the hemodynamic status, the anatomic derangement, and the associated injuries. The management of splenic trauma patients aims to restore the homeostasis and the normal physiopathology especially considering the modern tools for bleeding management. Thus, the management of splenic trauma should be ultimately multidisciplinary and based on the physiology of the patient, the anatomy of the injury, and the associated lesions. Lastly, as the management of adults and children must be different, children should always be treated in dedicated pediatric trauma centers. In fact, the vast majority of pediatric patients with blunt splenic trauma can be managed non-operatively. This paper presents the World Society of Emergency Surgery (WSES) classification of splenic trauma and the management guidelines

Shared decision-making in trauma and emergency surgery settings. A literature review

Emergency teams are made up of professionals of different specialities, including emergency physicians, surgeons, anesthesiologists, and nurses. Such units are characterized by the need to face unexpected situations with little time to make clinical decisions. In trauma and emergency settings, clinicians must act in a coordinated way, ensuring, at the same time, proper knowledge transfer and sharing to reach the best possible result for the patient. While such dynamics must be explicit and clear within the team, involving the patient in the decision-making process may require additional tools and procedures. Indeed, the time to engage with the patient and the family to understand the patient’s wishes and treatment preferences may be limited or absent at all. While the so-called shared decision-making (SDM) stands as one of the pillars of the modern patient-centric healthcare scenario, knowledge translation and transfer dynamics may appear particularly challenging in emergency settings. Starting from an investigation of the recent literature on SDM, the paper presents a literature review of the barriers, facilitators, and knowledge translation dynamics of SDM in trauma and emergency surgery. Results assess the importance, tools, and dynamics of SDM processes