Timing of surgical intervention in peripheral nerve injuries from gunshot wounds: Management and review of the literature.

Background: Gunshot wounds (GSWs) can result in various peripheral nerve injuries (PNIs), ranging from direct nerve transection to neuropraxia caused by the ballistic shockwave mechanism. PNIs from GSWs can be treated with either early or delayed intervention, with the literature supporting both approaches and sparking a debate between early and delayed intervention for PNIs from GSWs. Here, we present a case that underwent delayed exploration of the right common peroneal nerve after GSW and a literature review comparing early versus delayed intervention for PNIs from GSWs. Case Description: A 29-year-old male underwent right common peroneal nerve exploration 2 months after he sustained a GSW to the right lower extremity at the level of the fibular head tracking to the lateral malleolus. Initially, after the injury, he was offered supportive care. On evaluation, 1 month later, he reported a right-sided foot drop and paresthesias in the right lower extremity. A partial-thickness injury of the right peroneal nerve was seen on ultrasound, and a bullet fragment in the distal right lower extremity was revealed on computed tomography. The surgical intervention consisted of the right common peroneal nerve decompression proximally to distally and removal of the bullet fragment. Postoperatively, the patient did well with improvements in his right ankle dorsiflexion and plantar flexion seen at his 1.5-month follow-up visit. Conclusion: Many factors must be considered when treating PNIs from GSWs. For each case, clinical judgment, injury mechanism, and risk-benefit analysis must be evaluated to determine each patient's optimal treatment strategy.

A comparative study on the protective effects of cuminaldehyde, thymoquinone, and gallic acid against carbon tetrachloride-induced pulmonary and renal toxicity in rats by affecting ROS and NF-κB signaling.

CCl4 toxicity is a fatal condition that can cause numerous organ dysfunctions. We evaluated and compared the protective effects of cuminaldehyde (CuA), thymoquinone (TQ), and gallic acid (GA) on CCl4-induced pulmonary and renal toxicity in rats. The impacts of these compounds on CCl4-induced oxidative stress, inflammation, and morphological alterations were examined. The results showed that the compounds under investigation prevented CCl4 from significantly increasing pulmonary and renal lipid peroxidation and NO levels, as well as massively depleting GSH levels and GPX and SOD activities. Moreover, they suppressed the CCl4-induced increase in mucus secretion in the lung and upregulated the gene expression of pulmonary and renal NF-Ò¡B, iNOS, TNF-α, and COX-2. The heatmap cluster plots showed that GA and TQ had better protective potencies than CuA. The external organ morphology, histopathological results, and chest X-ray analysis confirmed the toxicity of CCl4 and the protective influences of the tested compounds in both the lungs and kidneys of rats. These compounds displayed predicted competitive inhibitory effects on iNOS activity and may block the IL-13α2 receptor, as revealed by molecular docking analysis. Thus, CuA, TQ, and GA, particularly the latter two, are prospective protective compounds against the pulmonary and renal toxicity caused by CCl4.

Deep-Learning Based Automated Segmentation and Quantitative Volumetric Analysis of Orbital Muscle and Fat for Diagnosis of Thyroid Eye Disease.

Purpose: Thyroid eye disease (TED) is characterized by proliferation of orbital tissues and complicated by compressive optic neuropathy (CON). This study aims to utilize a deep-learning (DL)-based automated segmentation model to segment orbital muscle and fat volumes on computed tomography (CT) images and provide quantitative volumetric data and a machine learning (ML)-based classifier to distinguish between TED and TED with CON. Methods: Subjects with TED who underwent clinical evaluation and orbital CT imaging were included. Patients with clinical features of CON were classified as having severe TED, and those without were classified as having mild TED. Normal subjects were used for controls. A U-Net DL-model was used for automatic segmentation of orbital muscle and fat volumes from orbital CTs, and ensemble of Random Forest Classifiers were used for volumetric analysis of muscle and fat. Results: Two hundred eighty-one subjects were included in this study. Automatic segmentation of orbital tissues was performed. Dice coefficient was recorded to be 0.902 and 0.921 for muscle and fat volumes, respectively. Muscle volumes among normal, mild, and severe TED were found to be statistically different. A classification model utilizing volume data and limited patient data had an accuracy of 0.838 and an area under the curve (AUC) of 0.929 in predicting normal, mild TED, and severe TED. Conclusions: DL-based automated segmentation of orbital images for patients with TED was found to be accurate and efficient. An ML-based classification model using volumetrics and metadata led to high diagnostic accuracy in distinguishing TED and TED with CON. By enabling rapid and precise volumetric assessment, this may be a useful tool in future clinical studies.

Exploring the feasibility of pupillometry training and perceptions of potential use for intracranial pressure monitoring in Uganda: A mixed methods study.

INTRODUCTION: Traumatic brain injury (TBI) accounts for the majority of Uganda's neurosurgical disease burden; however, invasive intracranial pressure (ICP) monitoring is infrequently used. Noninvasive monitoring could change the care of patients in such a setting through quick detection of elevated ICP. PURPOSE: Given the novelty of pupillometry in Uganda, this mixed methods study assessed the feasibility of pupillometry for noninvasive ICP monitoring for patients with TBI. METHODS: Twenty-two healthcare workers in Kampala, Uganda received education on pupillometry, practiced using the device on healthy volunteers, and completed interviews discussing pupillometry and its implementation. Interviews were assessed with qualitative analysis, while quantitative analysis evaluated learning time, measurement time, and accuracy of measurements by participants compared to a trainer's measurements. RESULTS: Most participants (79%) reported a positive perception of pupillometry. Participants described the value of pupillometry in the care of patients during examination, monitoring, and intervention delivery. Commonly discussed concerns included pupillometry's cost, understanding, and maintenance needs. Perceived implementation challenges included device availability and contraindications for use. Participants suggested offering continued education and engaging hospital leadership as implementation strategies. During training, the average learning time was 13.5 minutes (IQR 3.5), and the measurement time was 50.6 seconds (IQR 11.8). Paired t-tests to evaluate accuracy showed no statistically significant difference in comparison measurements. CONCLUSION: Pupillometry was considered acceptable for noninvasive ICP monitoring of patients with TBI, and pupillometer use was shown to be feasible during training. However, key concerns would need to be addressed during implementation to aid device utilization.

Evaluating the diagnostic accuracy of 3D contrast-enhanced magnetic resonance angiography versus digital subtraction angiography in spinal dural arteriovenous fistulas.

OBJECTIVE: Spinal dural arteriovenous fistulas (SDAVFs) often go undiagnosed, leading to irreversible spinal cord dysfunction. Although digital subtraction angiography (DSA) is the gold standard for diagnosing SDAVF, DSA is invasive and operator dependent, with associated risks. MR angiography (MRA) is a promising alternative. This study aimed to evaluate the performance of MRA as an equal alternative to DSA in investigating, diagnosing, and localizing SDAVF. METHODS: Prospectively collected data from a single neurosurgeon at a large tertiary academic center were searched for SDAVFs. Eligibility criteria included any patient with a surgically proven SDAVF in whom preoperative DSA, MRA, or both had been obtained. The eligible patients formed a consecutive series, in which they were divided into DSA and MRA groups. DSA and MRA were the index tests that were compared to the surgical SDAVF outcome, which was the reference standard. Accurate diagnosis was considered to have occurred when the imaging report matched the operative diagnosis to the correct spinal level. Comparisons used a two-sample t-test for continuous variables and Fisher-Freeman-Halton's exact test for categorical variables, with p < 0.05 specifying significance. Univariate, bivariate, and multivariate analyses were conducted to investigate group associations with DSA and MRA accuracy. Positive predictive value, sensitivity, and accuracy were calculated. RESULTS: A total of 27 patients with a mean age of 63 years underwent surgery for SDAVF. There were 19 male (70.4%) and 8 female (29.6%) patients, and the mean duration of symptoms at the time of surgery was 14 months (range 2-48 months). Seventeen patients (63%) presented with bowel or bladder incontinence. Bivariate analysis of the DSA and MRA groups further revealed no significant relationships between the characteristics and accuracy of SDAVF diagnosis. MRA was found to be more sensitive and accurate (100% and 73.3%) than DSA (85.7% and 69.2%), with a subanalysis of the patients with both preoperative MRA and DSA showing that MRA had a greater positive predictive value (78.6 vs 72.7), sensitivity (100 vs 72.7), and accuracy (78.6 vs 57.1) than DSA. CONCLUSIONS: In surgically proven cases of SDAVFs, the authors determined that MRA was more accurate than DSA for SDAVF diagnosis and localization to the corresponding vertebral level. Incomplete catheterization at each vertebral level may result in the failure of DSA to detect SDAVF.

Lysozyme Peptides as a Novel Nutra-Preservative to Control Some Food Poisoning and Food Spoilage Microorganisms.

Foodborne illnesses and microbial food contamination are crucial concerns and still issues of great worldwide concern. Additionally, the serious health hazards associated with the use of chemical preservatives in food technology. Lysozyme (Lz) is an active protein against Gram-positive bacterial cell wall through its muramidase lytic activity; however, several authors could identify some antimicrobial peptides derived from Lz that have an exaggerated and broad-spectrum antibacterial activity. Therefore, a lysozyme peptides preparation (LzP) is developed to broaden the Lz spectrum. In this work, we investigated the potential efficacy of LzP as a novel Nutra-preservative (food origin) agent against some pathogenic and spoilage bacteria. Our results showed that LzP demonstrated only 11% of the lysozyme lytic activity. However, LzP exhibited strong antibacterial activity against Escherichia coli, Salmonella enteritidis, and Pseudomonas species, while Salmonella typhi and Aeromonas hydrophila exhibited slight resistance. Despite the lowest LzP concentration (0.1%) employed, it performs stronger antibacterial activity than weak organic acids (0.3%). Interestingly, the synergistic multi-component formulation (LzP, glycine, and citric acid) could inhibit 6 log10 cfu/ml of E. coli survival growth. The effect of heat treatment on LzP showed a decrease in its antibacterial activity at 5 and 67% by boiling at 100 °C/30 min, and autoclaving at 121 °C/15 min; respectively. On the other hand, LzP acquired stable antibacterial activity at different pH values (4-7). In conclusion, LzP would be an innovative, natural, and food origin preservative to control the growth of food poisoning and spoilage bacteria in food instead chemical one.

Recycled gold-reduced graphene oxide nanocomposite for efficient adsorption and photocatalytic degradation of crystal violet.

In this study, gold-reduced graphene oxide (Au@rGO) nanocomposite has been synthesized by repurposing electronic waste and dry batteries. This innovative approach involved utilizing the graphite rod from dry batteries to produce reduced graphene oxide (rGO), which was subsequently modified through the incorporation of gold nanoparticles obtained from recycled electronic waste. This methodology marks a significant breakthrough in electronic waste recycling, presenting a cost-effective and sustainable means of creating novel nanocomposites for applications in photocatalysis and adsorption, particularly in the removal of crystal violet (CV) from aqueous media. The synthesized Au@rGO nanocomposite was characterized using X-ray diffraction, scanning electron microscopy, energy dispersed X-ray, and N2 adsorption/desorption. Parameters that affect the adsorption and photocatalytic degradation of CV dye have been studied in detail. The optimal conditions for CV adsorption and photocatalytic degradation were pH of 10, equilibrium time of 30 min, CV concentration of 10 mg/L and adsorbent dosage of 40 mg. Furthermore, the isotherm and kinetics of CV removal were also studied. The removal of CV dye using adsorption and photocatalytic degradation techniques reached 95% and 99%, respectively. Consequently, the results showed that photocatalytic degradation of CV dye onto the mesoporous Au@rGO nanocomposite is more proper way than the adsorption technique for removing the CV dye from aqueous media. The designed photocatalyst has high efficiency and it can be reused and activated several times so it can be used in real water treatment applications.

The neurosurgery research & education foundation-young neurosurgeons committee webinar series: Providing education and inspiration during the COVID-19 pandemic.

OBJECTIVE: During the COVID-19 pandemic, the American Association of Neurological Surgeons (AANS) Young Neurosurgeons Committee (YNC) and Neurosurgery Research & Education Foundation (NREF) launched the YNC-NREF Webinar Series to provide young and aspiring neurosurgeons with timely information, education, and inspiration in the absence of in-person programming. DESIGN: Five 90-minute Zoom webinars were evaluated, each including 1-2 keynote speakers, a panel discussion, and an audience question-and-answer section. Topics included overviews of neurosurgery, the match, subspecialties, and inspirational career stories. Optional pre- and post-webinar surveys with 11-point Likert-type scores were distributed to attendees. We compared groups using chi-squared and Kruskal-Willis tests, and perceptions pre- and post-webinar using Mann-Whitney tests. SETTING: The webinars were live using Zoom, and the recordings were published on NREF's YouTube channel. PARTICIPANTS: The webinar series targeted young neurosurgeons. The first five episodes had a particular focus on medical students and undergraduates. RESULTS: A total of 673 unique participants attended the webinar series; 257 (38%) and 78 (11%) attendees completed the pre- and post-webinar survey, respectively. Respondents had high baseline interest in neurosurgery and were motivated to learn about the match and training in the US, understand neurosurgeons' day-to-day lives, and ask questions. There were significant differences in perceptions between USMSs, IMSs, and undergraduate students. The webinar improved attendees' knowledge about neurosurgical specialties, the match, and US neurosurgery training. CONCLUSIONS: The YNC and NREF effectively engaged a large, diverse audience through an online webinar series, building a foundation for future virtual programming by organized neurosurgery. ACGME competencies.

A Mixed-Methods Assessment of the Feasibility of Conducting Neurosurgical Clinical Research in Uganda.

BACKGROUND: Clinical research is necessary to evaluate neurosurgical interventions, yet clinical trials are conducted less frequently in low- and middle-income countries. Because specific barriers, facilitating factors, and strategies for neurosurgical clinical research in Uganda have not been previously identified, this study evaluated neurosurgical providers' perspectives on clinical research and documentation patterns of neurosurgical variables at Mulago National Referral Hospital. METHODS: Retrospective review of 166 neurosurgical patient charts assessed the frequency of documentation of key variables. Twenty-two providers working in neurosurgery participated in 6 focus group discussions with qualitative analysis utilizing the framework method. RESULTS: Chart review showed that primary diagnosis (99.4%), pupil light response (97.6%), and computed tomography scan results (93.3%) were documented for most patients. Cranial nerve exam (61.5%), pupil size (69.9%), and time to neurosurgical intervention (45%) were documented less frequently. On average, Glasgow Coma Scale was documented for 86.6% of days hospitalized, while vital signs were documented for 12.3%. In most focus group discussions, participants identified follow-up, financing, recruitment, time, approval, and sociocultural factors as research barriers. Participants described how the current health workforce facilitates successful research. To improve research capacity, suggested strategies focused on research networks, data collection, leadership, participant recruitment, infrastructure, and implementation. CONCLUSIONS: At Mulago National Referral Hospital, there was variability in the frequency of documentation of neurosurgical variables, which may impact data collection for future studies. While multiple barriers were identified, sociocultural, financing, and time barriers greatly impacted neurosurgical clinical research. Despite that, identified facilitating factors and strategies could be utilized to support neurosurgical research capacity growth.

Clinical course of ventriculoperitoneal shunting for hydrocephalus following glioblastoma surgery: a systematic review and meta-analysis.

BACKGROUND: Surgical resection of glioblastoma (GBM) remains a cornerstone in the current treatment paradigm. The postoperative evolution of hydrocephalus necessitating ventriculoperitoneal shunting (VPS) continues to be defined. Correspondingly the objective of this study was to aggregate pertinent metadata to better define the clinical course of VPS for hydrocephalus following glioblastoma surgery in light of contemporary management. METHODS: Searches of multiple electronic databases from inception to November 2023 were conducted following PRISMA guidelines. Articles were screened against pre-specified criteria. Outcomes were pooled by random-effects meta-analyses where possible. RESULTS: A total of 12 cohort studies satisfied all selection criteria, describing a total of 6,098 glioblastoma patients after surgery with a total of 261 (4%) of patients requiring postoperative VPS for hydrocephalus. Meta-analysis demonstrated the estimated pooled rate of symptomatic improvement following VPS was 78% (95% CI 66-88), and the estimated pooled rate of VPS revision was 24% (95% CI 16-33). Pooled time from index glioblastoma surgery to VPS surgery was 4.1 months (95% CI 2.8-5.3), and pooled survival time for index VPS surgery was 7.3 months (95% CI 5.4-9.4). Certainty of these outcomes were limited by the heterogenous and palliative nature of postoperative glioblastoma management. CONCLUSIONS: Of the limited proportion of glioblastoma patients requiring VPS surgery for hydrocephalus after index surgery, 78% patients are expected to show symptom improvement, and 24% can expect to undergo revision surgery. An individualized approach to each patient is required to optimize both index glioblastoma and VPS surgeries to account for anatomy and goals of care given the poor prognosis of this tumor overall.

Outcomes of the Treatment of Humeral Shaft Fractures by Closed Reduction and Internal Fixation With Multiple Intramedullary Kirschner Wires (K-wires).

Background Humeral shaft fractures are common orthopedic injuries, and their treatment options vary based on fracture characteristics. One surgical method involves closed reduction and internal fixation (CRIF) with multiple intramedullary (IM) Kirschner wires (K-wires), which remains less explored, especially in adults. This study aims to investigate the outcomes of the treatment of humeral shaft fractures by closed reduction and internal fixation with multiple flexible intramedullary K-wires. Materials and methods We conducted a retrospective study at King Abdulaziz Medical City, Riyadh, Saudi Arabia, focusing on patients with traumatic humeral shaft fractures who underwent flexible intramedullary K-wire fixation. We analyzed nine patient records for demographic information, fracture location, type, mechanism of injury, intra-operative and post-operative factors, and complications. Results Fractures mostly affected the middle third of the humerus (55.6%) and were primarily transverse or oblique (77.8%). Motor vehicle accidents were the leading cause of injury (66.7%). Intra-operative time was 125 minutes on average, with minimal blood loss (78 mL). No participants required intra-operative blood transfusion. Complications following IM K-wire fixation were absent in all cases. Three patients had not yet undergone instrumental removal, and most reported mild or no pain during the final follow-up. All participants achieved a full range of motion for their elbows. All participants achieved complete radiological and clinical union (healing) of their fractures. Conclusion The use of multiple intramedullary K-wires for the treatment of humeral shaft fractures in this study demonstrated positive outcomes with low complication rates. This approach provides an effective option for managing these fractures, particularly in cases where surgical indications favor it.

Evaluation of Cangrelor Use After Percutaneous Coronary Intervention in Patients With Mechanical Circulatory Support.

OBJECTIVES: To describe cangrelor use in patients on concurrent mechanical circulatory support who underwent postpercutaneous coronary intervention. DESIGN: A single-center, retrospective, cohort study. SETTING: At a quaternary teaching hospital. PARTICIPANTS: Included patients were ≥18 years old, admitted to the intensive care unit, underwent percutaneous coronary intervention with stent placement, initiated on mechanical circulatory support, and received cangrelor in the postpercutaneous coronary intervention period. INTERVENTIONS: Retrospectively analyzed cangrelor use in patients on mechanical circulatory support. MEASUREMENTS AND MAIN RESULTS: The primary outcome was the incidence of thrombosis and bleeding events during cangrelor administration. Additional outcomes included initial cangrelor dose, number of cangrelor dose adjustments per patient, survival from mechanical circulatory support, and mortality within 30 days. Overall, 19 patients were included in this study. In total, 14 patients (74%) experienced a bleeding event; however, 93% were classified as a minor bleed. There was 1 major bleeding event. There were no thrombotic events observed during cangrelor administration. The median initial cangrelor dose was 0.5 µg/kg/min. There were 10 patients who underwent dose adjustment, with the majority being dose reductions based on antiplatelet monitoring (VerifyNow assay). Survival from mechanical circulatory support occurred in 17 patients (89%), and 30-day mortality occurred in 8 patients (42%). CONCLUSIONS: For patients receiving cangrelor as a bridge to oral P2Y12 inhibitor therapy on mechanical circulatory support, the authors observed a low rate of major bleeding and no episodes of thrombosis. Lower starting doses appear feasible with no observed increased risk of thrombotic complications. Future studies are needed to confirm these observations.

Emerging trends and applications of metabolomics in food science and nutrition.

The study of all chemical processes involving metabolites is known as metabolomics. It has been developed into an essential tool in several disciplines, such as the study of plant physiology, drug development, human diseases, and nutrition. The field of food science, diagnostic biomarker research, etiological analysis in the field of medical therapy, and raw material quality, processing, and safety have all benefited from the use of metabolomics recently. Food metabolomics includes the use of metabolomics in food production, processing, and human diets. As a result of changing consumer habits and the rising of food industries all over the world, there is a remarkable increase in interest in food quality and safety. It requires the employment of various technologies for the food supply chain, processing of food, and even plant breeding. This can be achieved by understanding the metabolome of food, including its biochemistry and composition. Additionally, Food metabolomics can be used to determine the similarities and differences across crop kinds, as an indicator for tracking the process of ripening to increase crops' shelf life and attractiveness, and identifying metabolites linked to pathways responsible for postharvest disorders. Moreover, nutritional metabolomics is used to investigate the connection between diet and human health through detection of certain biomarkers. This review assessed and compiled literature on food metabolomics research with an emphasis on metabolite extraction, detection, and data processing as well as its applications to the study of food nutrition, food-based illness, and phytochemical analysis. Several studies have been published on the applications of metabolomics in food but further research concerning the use of standard reproducible procedures must be done. The results published showed promising uses in the food industry in many areas such as food production, processing, and human diets. Finally, metabolome-wide association studies (MWASs) could also be a useful predictor to detect the connection between certain diseases and low molecular weight biomarkers.

Biosynthesis approach of zinc oxide nanoparticles for aqueous phosphorous removal: physicochemical properties and antibacterial activities.

In this study, phosphorus (PO43--P) is removed from water samples using zinc oxide nanoparticles (ZnO NPs). These nanoparticles are produced easily, quickly, and sustainably using Onion extracts (Allium cepa) at an average crystallite size of 8.13 nm using the Debye-Scherrer equation in the hexagonal wurtzite phase. The characterization and investigation of bio-synthesis ZnO NPs were carried out. With an initial concentration of 250 mg/L of P, the effects of the adsorbent dose, pH, contact time, and temperature were examined. At pH = 3 and T = 300 K, ZnO NPs achieved the optimum sorption capacity of 84 mg/g, which was superior to many other adsorbents. The isothermal study was found to fit the Langmuir model at a monolayer capacity of 89.8 mg/g, and the kinetic study was found to follow the pseudo-second-order model. The adsorption process was verified to be endothermic and spontaneous by thermodynamic characteristics. As a result of their low cost as an adsorbent and their high metal absorption, ZnO NPs were found to be the most promising sorbent in this investigation and have the potential to be used as effective sorbents for the removal of P from aqueous solutions. The antimicrobial activity results showed that ZnO NPs concentration had greater antibacterial activity than conventional Cefotaxime, which was utilized as a positive control in the inhibitory zone. However, no inhibitory zone was visible in the controlled wells that had been supplemented with onion extract and DMSO.

Developing a Simple, Effective, and Quick Process to Make Silver Nanowires with a High Aspect Ratio.

A growing number of people are interested in using silver nanowires (AgNWs) as potential transparent and conductive materials. The production of high-performance and high-throughput AgNWs was successfully optimized in this work using a one-step, straightforward, and reproducible modified polyol approach. The factors influencing the morphology of the silver nanowires have undergone extensive research in order to determine the best-optimized approach for producing AgNWs. The best AgNW morphology, with a length of more than 50 m and a diameter of less than 35 nm (aspect ratio is higher than 1700), was discovered to be produced by a mixture of 44 mM AgNO3, 134 mM polyvinylpyrrolidone (PVP) (Mo.Wt 40,000), and 2.4 mM KCl at 160 °C with a stirring rate of 100 rpm. With our improved approach, the overall reaction time was cut from almost an hour with the conventional polyol method to a few minutes. Scanning electron microscopy (SEM), X-ray diffraction (XRD), and ultraviolet (UV) spectroscopy were used to characterize AgNWs. The resultant AgNWs' dispersion was cleaned using a centrifuge multiple times before being deposited on glass and PET substrates at room temperature. In comparison to commercial, delicate, and pricey indium-doped tin oxide (ITO) substrates, the coated samples displayed exceptionally good sheet resistance of 17.05/sq and optical haze lower than 2.5%. Conclusions: Using a simple one-step modified polyol approach, we were able to produce reproducible thin sheets of AgNWs that made excellent, flexible transparent electrodes.

An asynchronous web-based intervention for neurosurgery residents to improve education on cost-effective care.

OBJECTIVE: To gauge resident knowledge in the socioeconomic aspects of neurosurgery and assess the efficacy of an asynchronous, longitudinal, web-based, socioeconomics educational program tailored for neurosurgery residents. METHODS: Trainees completed a 20-question pre- and post-intervention knowledge examination including four educational categories: billing/coding, procedure-specific concepts, material costs, and operating room protocols. Structured data from 12 index cranial neurosurgical operations were organized into 5 online, case-based modules sent to residents within a single training program via weekly e-mail. Content from each educational category was integrated into the weekly modules for resident review. RESULTS: Twenty-seven neurosurgical residents completed the survey. Overall, there was no statistically significant difference between pre- vs post-intervention resident knowledge of billing/coding (79.2 % vs 88.2 %, p = 0.33), procedure-specific concepts (34.3 % vs 39.2 %, p = 0.11), material costs (31.7 % vs 21.6 %, p = 0.75), or operating room protocols (51.7 % vs 35.3 %, p = 0.61). However, respondents' accuracy increased significantly by 40.8 % on questions containing content presented more than 3 times during the 5-week study period, compared to an increased accuracy of only 2.2 % on questions containing content presented less often during the same time period (p = 0.05). CONCLUSIONS: Baseline resident knowledge in socioeconomic aspects of neurosurgery is relatively lacking outside of billing/coding. Our socioeconomic educational intervention demonstrates some promise in improving socioeconomic knowledge among neurosurgery trainees, particularly when content is presented frequently. This decentralized, web-based approach to resident education may serve as a future model for self-driven learning initiatives among neurosurgical residents with minimal disruption to existing workflows.

Patient reported outcomes and treatment satisfaction in patients with cushing syndrome.

PURPOSE: Cushing Syndrome (CS) is a rare endocrine disorder associated with physical and mental symptoms that can drastically affect quality of life (QoL). This study characterizes QoL in patients with CS, describes their treatment experiences, and identifies patient subsets associated with decreased QoL or shared impressions of treatment. METHODS: A 136-question survey addressing QoL factors and treatment experiences was completed by adult patients with CS from the Cushing Support and Research Foundation. Patient demographics, tumor characteristics, and treatment information were collected. Bivariate analyses were conducted to determine if patients' symptoms or treatment experiences were significantly associated with demographics or other variables. RESULTS: A total of 178 patients, predominantly female (94%) with mean age 53 years, completed the survey. Anxiety and/or depression (n = 163, 94%), loss of physical strength (n = 164, 93%), loneliness (n = 156, 90%), fatigue from treatment (n = 142, 89%), memory loss (n = 153, 88%), insomnia (n = 144, 83%), and pain (n = 141, 83%) were symptoms most commonly experienced by respondents. Patients experiencing delay of diagnosis >10 years were more likely to have suicidal thoughts (p = 0.002). Younger patients were more likely to express concerns about hair loss (p = 0.007), loneliness (p = 0.025), pain (p = 0.004), or the impact of CS on their marriage (p = 0.039) or children (p = 0.024). CONCLUSION: This survey demonstrates CS impacts patients across many dimensions, emphasizing the need for holistic support. We identified patient subsets in which QoL may be improved with additional patient resources or provider attention.

Thoracic Segmental Spinal Anesthesia for Emergency Cholecystectomy: A Case Report.

Anesthesia is a rapidly evolving medical specialty, centered around the patient's safety, and enhancement of surgical outcomes. In their daily practice, anesthesiologists encounter complex challenges, and always search for, and practice the best evidence-based medicine, which allows them to overcome the challenges, and to obtain the maximum benefits of the intervention, with minimal side effects. Regional anesthesia is considered a favorable modality with significant potential in selected patients and is becoming more popular day by day. In this regard, we present a case report of a 65-year-old man, with multiple co-morbidities, who needed urgent surgery to remove a gangrenous gall bladder. After discussion with the surgical colleagues, thoracic segmental spinal anesthesia (SA) was performed, and the patient underwent an open cholecystectomy awake with spontaneous respiration. The procedure went well, and the patient recovered quickly. This case presentation highlights the potential benefits of segmental SA in managing some selected cases.

Regulation of the NF-κB signaling pathway and IL-13 in asthmatic rats by aerosol inhalation of the combined active constituents of Punica granatum juice and peel.

Bronchial asthma is a chronic inflammatory airway illness. For the first time, we evaluated the proposed anti-asthmatic protective and therapeutic potency of inhaling Punica granatum juice (PJE) and peel (PPE) extract mixture (PM). Rats were challenged with ovalbumin (OVA) for 23 days and aerosolized with PM before each OVA challenge (protected group) or following the final OVA challenge for 3 days (therapeutic group). Considerable concentrations of phenolics were detected in PJE and PPE. Therefore, PM demonstrated synergistic scavenging abilities of NO and DPPH radicals. It also showed synergistic anti-inflammatory activities against lipopolysaccharide (LPS)-induced inflammation in the white blood cells by lowering the gene expression of CXCR1, CXCR2, IL-6, and IL-8. In addition, PM increased IL-10 gene expression while decreasing NO and TNF-α levels in LPS-exposed cells. Regarding the rats that were protected with PM, they exerted pulmonary pro-oxidant effects but prevented the OVA-induced upregulation of NF-κB, IKK, TNF-α, COX-2, iNOS, IL-13, and COL1A1, as well as MUC5AC and mucin over-secretion. While PM in the therapeutic group improved reactive oxygen species levels and normalized most of the investigated inflammatory and fibrotic mediators and mucin formation, but slightly improved the antioxidant indices. In addition, OVA-induced morphological alterations were massively improved after PM inhalation for short or long periods. Thus, PM inhalation prevented and treated OVA-induced pulmonary inflammation and fibrosis, while the inhalation period between 3 and 23 days needs to be optimized to acquire a better impact on the antioxidant indices.

Assessing the Success and Sustainability of Global Neurosurgery Collaborations: Systematic Review and Adaptation of the Framework for Assessment of InteRNational Surgical Success Criteria.

BACKGROUND: The high unmet neurosurgical burden in low- and middle-income countries has necessitated multiple global neurosurgical collaborations. We identified these collaborations and their peer-reviewed journal publications and evaluated them using a modified version of the Framework for Assessment of InteRNational Surgical Success (FAIRNeSS). METHODS: A systematic literature review yielded 265 articles describing neurosurgery-focused collaborations. A subset of 101 papers from 17 collaborations were evaluated with the modified FAIRNeSS criteria. Analysis of trends was performed for both individual articles and collaborations. RESULTS: Most of the articles were general reviews (64), and most focused on clinical research (115). The leading collaboration focus was workforce and infrastructure development (45%). Composite FAIRNeSS scores ranged from 7/34 to 30/34. Average FAIRNeSS scores for individual articles ranged from 0.25 to 26.75, while collaboration-wide FAIRNeSS score averages ranged from 5.25 to 20.04. There was significant variability within each subset of FAIRNeSS indicators (P value <0.001). Short-term goals had higher scores than medium- and long-term goals (P value <0.001). Collaboration composite scores correlated with the number of papers published (R2 = 0.400, P = 0.007) but not with the number of years active (R2 = 0.072, P = 0.3). Finally, the overall agreement between reviewers was 53.5%, and the overall correlation was 38.5%. CONCLUSIONS: Global neurosurgery has no established metrics for evaluating collaborations; therefore, we adapted the FAIRNeSS criteria to do so. The criteria may not be well suited for measuring the success and sustainability of global neurosurgery collaborations, creating a need to develop a more applicable alternate set of metrics.