Identifying Predictors of Initial Surgical Failure during Minimally Invasive Endoscopic Intracerebral Hemorrhage Evacuation.

Background and Purpose: Intracerebral hemorrhage (ICH) is a common and severe disease with high rates of morbidity and mortality; however, minimally invasive surgical (MIS) hematoma evacuation represents a promising avenue for treatment. In February of 2019, the MISTIE III study found that stereotactic thrombolysis with catheter drainage did not benefit patients with supratentorial spontaneous ICH but that a clinical benefit may be present when no more than 15 mL of hematoma remains at the end of treatment. Intraoperative CT (iCT) imaging has the ability to assess whether or not this surgical goal has been met in real time, allowing for operations to add additional CT-informed 'evacuation periods' (EPs) to achieve the surgical goal. Here, we report on the frequency and predictors of initial surgical failure on at least one iCT requiring additional EPs in a large cohort of patients undergoing endoscopic minimally invasive ICH evacuation with the SCUBA technique. Methods: All patients who underwent minimally invasive endoscopic evacuation of supratentorial spontaneous ICH in a major health system between December 2015 and October 2018 were included in this study. Patient demographics, clinical and radiographic features, procedural details, and outcomes were analyzed retrospectively from a prospectively collected database. Procedures were characterized as initially successful when the first iCT demonstrated that surgical success had been achieved and initially unsuccessful when the surgical goal was not achieved, and additional EPs were performed. The surgical goal was prospectively identified in December of 2015 as leaving no more than 20% of the preoperative hematoma volume at the end of the procedure. Descriptive statistics and regression analyses were performed to identify predictors of initial failure and secondary rescue. Results: Patients (100) underwent minimally invasive endoscopic ICH evacuation in the angiography suite during the study time period. In 14 cases, the surgical goal was not met on the first iCT and multiple Eps were performed; in 10 cases the surgical goal was not met, and no additional EPs were performed. In 14 cases, the surgical goal was never achieved. When additional EPs were performed, a rescue rate of 71.4% (10/14) was seen, bringing the total percentage of cases meeting the surgical goal to 86% across the entire cohort. Cases in which the surgical goal was not achieved were significantly associated with older patients (68 years vs. 60 years; p = 0.0197) and higher rates of intraventricular hemorrhage (34.2% vs. 70.8%; p = 0.0021). Cases in which the surgical goal was rescued from initial failure had similar levels of IVH, suggesting that these additional complexities can be overcome with the use of additional iCT-informed EPs. Conclusions: Initial and ultimate surgical failure occurs in a small percentage of patients undergoing minimally invasive endoscopic ICH evacuation. The use of intraoperative imaging provides an opportunity to evaluate whether or not the surgical goal has been achieved, and to continue the procedure if the surgeon feels that more evacuation is achievable. Now that level-one evidence exists to target a surgical evacuation goal during minimally invasive ICH evacuation, intraoperative imaging, such as iCT, plays an important role in aiding the surgical team to achieve the surgical goal.

Potential Development of N-Doped Carbon Dots and Metal-Oxide Carbon Dot Composites for Chemical and Biosensing.

Among carbon-based nanomaterials, carbon dots (CDs) have received a surge of interest in recent years due to their attractive features such as tunable photoluminescence, cost effectiveness, nontoxic renewable resources, quick and direct reactions, chemical and superior water solubility, good cell-membrane permeability, and simple operation. CDs and their composites have a large potential for sensing contaminants present in physical systems such as water resources as well as biological systems. Tuning the properties of CDs is a very important subject. This review discusses in detail heteroatom doping (N-doped CDs, N-CDs) and the formation of metal-based CD nanocomposites using a combination of matrices, such as metals and metal oxides. The properties of N-CDs and metal-based CDs nanocomposites, their syntheses, and applications in both chemical sensing and biosensing are reviewed.

Potentialities of graphene and its allied derivatives to combat against SARS-CoV-2 infection.

Graphene is a two-dimensional material with sp2 hybridization that has found its broad-spectrum potentialities in various domains like electronics, robotics, aeronautics, etc.; it has recently gained its utilities in the biomedical domain. The unique properties of graphene and its derivatives of graphene have helped them find their utilities in the biomedical domain. Additionally, the sudden outbreak of SARS-CoV-2 has immensely expanded the research field, which has also benefitted graphene and its derivatives. Currently, the world is facing a global pandemic due to the sudden outbreak of Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2), also known as COVID-19, from its major onset in Wuhan city, China, in December 2019. Presently, many new variants and mutants appear, which is more harmful than previous strains. However, researchers and scientists are focused on understanding the target structure of coronavirus, mechanism, causes and transmission mode, treatment, and alternatives to cure these diseases in this critical pandemic situation; many findings are achieved, but much more is unknown and pending to be explored. This review paper is dedicated to exploring the utilities of graphene and its derivatives in combating the SARS-CoV-2 by highlighting their mechanism and applications in the fabrication of biosensors, personal protection equipment (PPE) kits, 3-D printing, and antiviral coatings. Further, the paper also covers the cytotoxicity caused by graphene and its derivatives and highlights the graphene-based derivatives market aspects in biomedical domains. Thus, graphene and graphene-derived materials are our new hope in this pandemic time, and this review helps acquire broad knowledge about them.

Microenvironment changes in arteriovenous malformations after stereotactic radiation.

Cerebral arteriovenous malformations are dysplastic vascular tangles with aberrant vascular dynamics and can result significant morbidity and mortality. A myriad of challenges are encountered when treating these lesions and are largely based on nidal size, location, and prior hemorrhage. Currently, stereotactic radiosurgery is an accepted form of treatment for small to medium sized lesions and is especially useful in the treatment of lesions in non-surgically assessable eloquent areas of the brain. Despite overall high rates of nidal obliteration, there is relatively limited understand on the mechanisms that drive the inflammatory and obliterative pathways observed after treatment with stereotactic radiosurgery. This review provides an overview of arteriovenous malformations with respect to stereotactic radiosurgery and the current understanding of the mechanisms that lead to nidal obliteration.

Chloramine-T/N-Bromosuccinimide/FeCl3/KIO3 Decorated Graphene Oxide Nanosheets and Their Antibacterial Activity.

In this work, we report the synthesis of graphene oxide nanosheets (GO NS) using four different oxidants, namely, chloramine-T (CAT), FeCl3, N-bromosuccinimide (NBS), and KIO3. Fourier transform infrared spectroscopy (FTIR) was used to characterize the functional groups present in the synthesized GO. The microstructure analysis was performed using X-ray diffraction (XRD) and scanning electron microscopy (SEM) to investigate the morphology of GO. High-resolution transmission electron microscopy (HRTEM) studies demonstrated the nanostructure and crystalline phases of GO. The antibacterial activity of the prepared GO NS was investigated against pure cultures of Pseudomonas pneumonia and Staphylococcus aureus. The synthesized GO NS with CAT-GO (C-GO) exhibited very good antibacterial activity towards pathogens.