Utility of total cell-free DNA levels for surgical damage evaluation in patients with urological surgeries

The evaluation of surgical damage is challenging because of the lack of specific biomarkers. Total cell-free DNA (cfDNA) levels have been reported to increase with external trauma and may be a biomarker for tissue damage. To investigate the utility of perioperative total cfDNA levels in evaluating surgical damage in urological surgeries. This multicenter, prospective, observational study included 196 patients scheduled for urological surgeries between September 2020 and July 2021. The primary outcome was the change in total cfDNA levels before and after urological surgery. The secondary outcome was the effect of surgical type on total cfDNA ratio before and after urological surgery. The postoperative median total cfDNA level of the 196 patients was significantly increased 2.5-fold compared to the preoperative level (185.2 ng/mL vs. 406.7 ng/mL, P < 0.001). The median total cfDNA before/after ratio was greater than four-fold for kidney transplantation, open cystectomy, and open adrenalectomy. The ratio was less than two-fold for laparoscopic adrenalectomy and robot-assisted radical prostatectomy. Major surgery showed a significant postoperative increase in total cfDNA levels, while minor surgery did not. Total cfDNA levels increased 2.5-fold after urological surgery and it can be used as an acute-phase biomarker for surgical damage.

Robotic Milling of Electrode Lead Channels During Cochlear Implantation in an ex-vivo Model

Objective: Robotic cochlear implantation is an emerging surgical technique for patients with sensorineural hearing loss. Access to the middle and inner ear is provided through a small-diameter hole created by a robotic drilling process without a mastoidectomy. Using the same image-guided robotic system, we propose an electrode lead management technique using robotic milling that replaces the standard process of stowing excess electrode lead in the mastoidectomy cavity. Before accessing the middle ear, an electrode channel is milled robotically based on intraoperative planning. The goal is to further standardize cochlear implantation, minimize the risk of iatrogenic intracochlear damage, and to create optimal conditions for a long implant life through protection from external trauma and immobilization in a slight press fit to prevent mechanical fatigue and electrode migrations.Methods: The proposed workflow was executed on 12 ex-vivo temporal bones and evaluated for safety and efficacy. For safety, the difference between planned and resulting channels were measured postoperatively in micro-computed tomography, and the length outside the planned safety margin of 1.0 mm was determined. For efficacy, the channel width and depth were measured to assess the press fit immobilization and the protection from external trauma, respectively.Results: All 12 cases were completed with successful electrode fixations after cochlear insertions. The milled channels stayed within the planned safety margins and the probability of their violation was lower than one in 10,000 patients. Maximal deviations in lateral and depth directions of 0.35 and 0.29 mm were measured, respectively. The channels could be milled with a width that immobilized the electrode leads. The average channel depth was 2.20 mm, while the planned channel depth was 2.30 mm. The shallowest channel depth was 1.82 mm, still deep enough to contain the full 1.30 mm diameter of the electrode used for the experiments.Conclusion: This study proposes a robotic electrode lead management and fixation technique and verified its safety and efficacy in an ex-vivo study. The method of image-guided robotic bone removal presented here with average errors of 0.2 mm and maximal errors below 0.5 mm could be used for a variety of other otologic surgical procedures.

Utility of total cell-free DNA levels for surgical damage evaluation in patients with urological surgeries

The evaluation of surgical damage is challenging because of the lack of specific biomarkers. Total cell-free DNA (cfDNA) levels have been reported to increase with external trauma and may be a biomarker for tissue damage. To investigate the utility of perioperative total cfDNA levels in evaluating surgical damage in urological surgeries. This multicenter, prospective, observational study included 196 patients scheduled for urological surgeries between September 2020 and July 2021. The primary outcome was the change in total cfDNA levels before and after urological surgery. The secondary outcome was the effect of surgical type on total cfDNA ratio before and after urological surgery. The postoperative median total cfDNA level of the 196 patients was significantly increased 2.5-fold compared to the preoperative level (185.2 ng/mL vs. 406.7 ng/mL, P < 0.001). The median total cfDNA before/after ratio was greater than four-fold for kidney transplantation, open cystectomy, and open adrenalectomy. The ratio was less than two-fold for laparoscopic adrenalectomy and robot-assisted radical prostatectomy. Major surgery showed a significant postoperative increase in total cfDNA levels, while minor surgery did not. Total cfDNA levels increased 2.5-fold after urological surgery and it can be used as an acute-phase biomarker for surgical damage.

Two Cases of Idiopathic Progressive Sensorineural Hearing Loss with Positional Nystagmus in Postpartum Period: Possible Spontaneous Perilymph Fistula?

Perilymph fistula (PLF) is defined as an abnormal communication between the middle ear cavity and perilymphatic space of the inner ear. Most cases of PLF are responsible for pressure change caused by internal trauma or external trauma. However, spontaneous PLF might occur without an obvious history of barotrauma. We report two cases of possible spontaneous PLF in the postpartum period: both cases involved progressive sensorineural hearing loss with positional dizziness. Although the leakage of perilymph was not found during exploration, both hearing loss and dizziness improved immediately after PLF repair. It is necessary to consider the possibility of PLF in patients who have sudden or progressive sensorineural hearing loss with positional nystagmus. Early surgical exploration is recommended even if the history of barotrauma is not clear.

Euthanasia Through Cervical Dislocation or CO2 Might Affect Keel Bone Fracture Prevalence in 30-Week-Old Laying Hens

Laying hens are susceptible to keel bone fractures due to continuous endogenous calcium resorption for eggshell formation. Although it is assumed that external trauma to the keel bone, e.g., due to collisions, is the main cause for fractures, accumulated forces or asymmetric load on a weakened bone might contribute to the high keel bone fracture prevalence found in commercial laying hens. The objective of this study was to investigate whether forces applied to the keel due to involuntary convulsions and uncontrolled wing flapping during euthanasia have the potential to cause keel bone fractures. Two hundred and seventy Dekalb White laying hens were euthanized at 30 weeks of age using cervical dislocation (n = 60) or CO2 (n = 210). All hens were radiographed immediately before and after euthanasia. Radiographs were compared side by side to detect new fractures. Four out of the 270 hens (1.5%) obtained a fracture during euthanasia. Specifically, 0.95% of hens euthanized with CO2 (2 out of 210) and 3.3% of hens euthanized through cervical dislocation (2 out of 60) obtained a euthanasia-induced fracture. All four hens with a euthanasia-induced fracture had signs of damage to the keel before euthanasia, indicating that pre-existing fractures could affect fracture susceptibility. Based on our results, we cannot rule out that convulsions during euthanasia can cause keel bone fractures in laying hens. In studies investigating keel bone integrity in birds euthanized with CO2 or cervical dislocation, fracture prevalence might be overestimated. Future research is needed to assess whether euthanasia might be more likely to cause keel bone fractures in older birds and to quantify the frequency and strength of convulsions as a potential cause of fractures.

Epidemiological comparison of adults with TBI before and after the mandatory use of frontal airbags in Salvador

Introduction: Traumatic Brain Injury (TBI) is an external trauma, which results in brain alterations. Law 11.910, which requires the presence of frontal Airbags, was developed as a mechanism to minimize the consequences of automobile accidents, like TBI. Objectives: To epidemiologically compare adults with TBI before and after the mandatory use of Airbags in Salvador. Design and settings: An ecological study in Brazil. Methods: Data was published by the Ministry of Health through DATASUS. The selected timeframe was five years before and after the mandatory use of frontal Airbags (2014). The data collected were hospitalizations, deaths, mortality rate, age, and total value. Results: The average mortality rate due to TBI (2009-2013) was 11.6, while decreasing from 2014- 2018 to 8.9 (reduction of 23,3%). The average amount spent in the period preceding the law was 1.250.675 reais, while afterwards it was 1.535.268 (increase of 22,76%). The age group with the most hospitalizations before the law was 20-29 years old, while after it was 30-39. Conclusions: There was a reduction in the mortality rate after 2014, which may be associated with the mandatory use of Airbags. Prior to the law, the total amount spent was lower, possibly associated with a greater severity of injuries and, consequently, a higher number of deaths.

Life-design counselling for survivors of family violence in resource-constrained areas

The purpose of this study was to explore and assess the feasibility of counselling based on life-design principles in enhancing the career resilience of children who are exposed to family violence. The research project involved a QUALITATIVE–quantitative mode of inquiry with 6 participants chosen based on certain characteristics. Life-design-related intervention strategies, together with various (postmodern) qualitative and quantitative techniques, were used to gather data, while data analysis was done using thematic content analysis. Quantitative data were collected from parents as well as the participants before and after the intervention. Certain themes, sub-themes and sub-sub-themes that all contributed to participants’ career resilience were identified. Following the intervention, findings obtained from a qualitative perspective indicated that the outcomes of the life-design-related counselling intervention were substantial. The findings showed that various narrative techniques could be used to enhance the career resilience of children exposed to family violence. Future research could assess the value of life-design counselling in enhancing the career resilience of survivors of family violence in diverse group contexts. A greater focus could be placed on the (unforeseen) external trauma that had an impact on participants’ ability to (re-)construct their career-life narratives to enhance their future selves and careers.

Medial Bone Plating for Management of Type V Central Tarsal Bone Fractures in Six Dogs

Objective The aim of this study was to report the surgical technique and outcomes of dogs with type V central tarsal bone (CTB) fractures stabilized with a bone plate applied to the medial aspect of the tarsus and metatarsus. Study Design This study was a retrospective review of dogs with type V CTB fractures diagnosed with computed tomography and stabilized using a medial bone plate. Follow-up included clinical examination and radiography 8 to 10 weeks postoperatively and/or a long-term owner questionnaire. Results Six dogs were identified. All fractures occurred during exercise without external trauma and all dogs had additional tarsal fractures. Five dogs returned for clinical follow-up; all had no or mild lameness and evidence of fracture healing on radiography. A suspected surgical site infection occurred in one dog and resolved with medical management. Suspected contact between the plate and medial malleolus in one dog, and loosening of a talar screw in another, were identified, though not treated. Five owners completed the questionnaire, a median of 88 months postoperatively. No further complications were reported, limb function was reportedly acceptable, and all owners were very satisfied with the surgery. Conclusion Medial bone plate stabilization of highly comminuted CTB fractures resulted in evidence of fracture healing, and a low incidence of complications in six non-racing dogs.

Hemostatic efficacy evaluation of radiation-crosslinked carboxymethyl cellulose granules and kappa-carrageenan/polyethylene oxide/polyethylene glycol dressing in rat bleeding models

Carboxymethyl cellulose granules (CMC-G) and kappa-carrageenan/polyethylene oxide/polyethylene glycol dressing (KPP-D) hemostatic agents, developed through radiation-induced crosslinking and sterilization, were tested in Sprague-Dawley rats using three bleeding models: (a) deep wound with the puncture of femoral artery; (b) aortic puncture; and (c) partial nephrectomy. Dressing and granules were applied in the animals without sustained compression and monitored for a period of 7 or 14 days. Comparisons were made against the commercial chitosan-based agent, Celox (CLX). Primary outcomes observed were bleeding time, the incidence of re-bleeding, animal survival, as well as gross and microscopic changes. The KPP-D group showed the shortest bleeding time for all bleeding models (a. 2.75 ± 0.64, b. 1.63 ± 0.54, c. 2.05 ± 0.62), significantly faster than all the other treatment groups. KPP-D also registered the highest survival rate of 100% with no display of gross abnormalities. CMC-G showed comparable bleeding time with CLX products but had a better survival rate at 98% compared to 96%. The incidence of re-bleeding was greater in CLX treated groups as well as more occurrence of granular adhesions that impacted mortality outcomes. Findings indicate the efficacy of KPP-D in the treatment of severe hemorrhage due to traumatic injury and intraoperative cases, while CMC-G was more suited for external trauma. Complications arising from inflammation, granules deposition, and adhesions emphasize stringent handling and removal of granular hemostat as a critical consideration in hemostat development and testing.