Neuroenhancement of surgeons during robotic suturing

Background The initial phases of robotic surgical skills acquisition are associated with poor technical performance, such as low knot-tensile strength (KTS). Transcranial direct-current stimulation (tDCS) can improve force and accuracy in motor tasks but research in surgery is limited to open and laparoscopic tasks in students. More recently, robotic surgery has gained traction and is now the most common approach for certain procedures (e.g. prostatectomy). Early-phase robotic suturing performance is dependent on prefrontal cortex (PFC) activation, and this study aimed to determine whether performance can be improved with prefrontal tDCS. Methods Fifteen surgical residents were randomized to either active then sham tDCS or sham then active tDCS, in two counterbalanced sessions in a double-blind crossover study. Within each session, participants performed a robotic suturing task repeated in three blocks: pre-, intra- and post-tDCS. During the intra-tDCS block, participants were randomized to either active tDCS (2 mA for 15 min) to the PFC or sham tDCS. Primary outcome measures of technical quality included KTS and error scores. Results Significantly faster completion times were observed longitudinally, regardless of active (p < 0.001) or sham stimulation (p < 0.001). KTS was greater following active compared to sham stimulation (median: active = 44.35 N vs. sham = 27.12 N, p < 0.001). A significant reduction in error scores from “pre-” to “post-” (p = 0.029) were only observed in the active group. Conclusion tDCS could reduce error and enhance KTS during robotic suturing and warrants further exploration as an adjunct to robotic surgical training.

Bromazepam changes performance during target shooting but does not affect the interhemispheric coupling in the theta rhythm of the electroencephalography

Bromazepam emulates the inhibitory effect of the neurotransmitter gamma-aminobutyric acid (GABA) and can lead to impaired visuomotor performance. However, few studies have evaluated its effects on cortical coupling in target shooting activities. The present study aimed to analyze the acute effects of bromazepam administration in a target shooting task and the EEG theta rhythm coherence between frontal, temporal, and motor cortical areas in four shooting preparation periods. Thus, a double blind, crossover study was conducted with 30 subjects under two conditions: bromazepam (6mg) and placebo, with electroencephalographic analysis to simultaneously study the theta rhythm coherence in frontal, temporal, and motor cortex in a target shooting task; and the possible interferences of bromazepam administration. Subjects in the bromazepam group showed lower performance on the task compared to placebo (p=0.001). In addition, our analysis showed decreased coherence between regions in the same hemisphere, increased theta rhythm coherence in interhemispheric regions in frontal, temporal and motor cortex at different intervals in the preparation preceding the shooting (p=0.001). The use of bromazepam may influence task execution, possibly due to neurochemical modulation, during decision making, developing shooting preparation strategies, as well as interfering with the flow of information at the level of attention during task execution.

In a Randomized, Placebo-Controlled Cross-Over Study, Administration of 6 and 12 G Fortetropin® Does Not Reduce Serum Myostatin in Healthy Adult Dogs Over 72-Hours

Objective: To evaluate the effect of a single administration of 6 and 12 g of Fortetropin compared to placebo on serum myostatin in healthy, adult dogs over a 72-h period.Methods: Prospective, placebo-controlled, randomized, double-blind, crossover study. Ten hospital-employee-owned healthy adult dogs aged 2 to 8 years old were enrolled in the study. Blood samples were collected prior to and then 12-, 24-, 36-, 48-, and 72-h following administration of the test agent (6 and 12 g) or placebo. Serum samples were processed according to manufacturer's guidelines for canine serum using GDF-8/Myostatin Quantikine ELISA kit (R&amp;D Systems). Analysis-of-variance (ANOVA) analyses were carried out where P &lt; 0.05 was deemed significant.Results: Mean serum myostatin was not significantly lower in treatment groups of either low or high dose compared to placebo at any time point. Baseline mean serum myostatin in low and high dose treatment groups was 29,481 (SD = 5,224) and 32,214 pg/mL (SD = 7,353), respectively. Placebo group low and high dose baseline mean serum myostatin was 30,247 (SD = 5,875) and 28,512 (SD = 5,028).Conclusion: The results of this study indicate that administration of single 6 or 12 g dose of Fortetropin does not reduce serum myostatin in healthy adult dogs over a 72-h period.Clinical Importance: Oral supplements, like Fortetropin, require further studies to determine the efficacy and bioavailability in order to guide clinical use in dogs.

Suppressive effect of a single dose of monoglucosyl rutin on postprandial blood glucose elevation: A randomized, placebo-controlled, double-blind crossover study

Objective: This study aimed to investigate the suppressive effect of a single dose of water-soluble α- glycosylated rutin (monoglucosyl rutin; MR) on postprandial blood glucose elevation in healthy subjects with relatively high fasting blood glucose levels.Methods: This randomized, placebo-controlled, double-blind crossover study enrolled 34 healthy Japanese adult subjects with relatively high fasting blood glucose levels. The study period ran from November 13, 2019, to March 19, 2020. All subjects were randomly allocated to either sequence A or sequence B (n = 17 per group) using a computerized random number generator. The washout period was at least one week between periods I and II. In period I, the subjects took either MR or placebo tablets. In period II, subjects took different tablets from the ones they had taken in period I. We evaluated their blood glucose and insulin levels after glucose loading (150 g of cooked rice). The incremental area under the curve (IAUC) of the postprandial blood glucose level was determined as the primary outcome. The blood glucose and insulin levels at maximum (maximum blood concentration; Cmax), each measurement point, and IAUC of the blood insulin level after glucose loading were the secondary outcomes.Results: Out of 33 subjects, 16 in sequence A (11 men and 5 women, 54.5 ± 9.8 years) and 17 in sequence B (9 men and 8 women, 58.8 ± 9.4 years) were analyzed as a per-protocol dataset. The glucose IAUC after MR consumption was significantly lower than that of the placebo (P = 0.034). Results of the other outcomes were not observed with significant treatment effects. There were no adverse events attributable to the test foods.Conclusions: We suggest that MR has a suppressive effect on the elevation of postprandial blood glucose in healthy adults with relatively high fasting blood glucose levels.Trial registration: UMIN-CTR: UMIN000038515. Foundation: Toyo Sugar Refining Co., Ltd.Keywords: monoglucosyl rutin, blood glucose level, incremental area under the curve, α-amylase, α-glucosidase, crossover study

Caffeine Doses of 3 mg/kg Increase Unilateral and Bilateral Vertical Jump Outcomes in Elite Traditional Jiu-Jitsu Athletes

Caffeine increases vertical jump, although its effects on kinetics and kinematics during different phases of bilateral and unilateral jumps remain unclear. The aim of this study was to identify the effects of 3 mg/kg on kinetic, kinematic and temporal variables in the concentric and eccentric phases of bilateral and unilateral countermovement jumps. A total of 16 Spanish national team traditional Jiu-Jitsu athletes took part in two experimental trials (3 mg/kg caffeine or placebo) in a randomized, double-blind crossover study. Sixty minutes after ingestion, bilateral and unilateral jumps were performed on a force platform. Compared to the placebo, caffeine increased bilateral jump height (p = 0.008; Δ% = 4.40), flight time (p = 0.008; Δ% = 2.20), flight time:contraction time (p = 0.029; Δ% = 8.90), concentric impulse (p = 0.018; Δ% = 1.80), peak power (p = 0.049; Δ% = 2.50), RSI-modified (p = 0.011; Δ% = 11.50) and eccentric mean braking force (p = 0.045; Δ% = 4.00). Additionally, caffeine increased unilateral RSI-mod in both legs (Left: p = 0.034; Δ% = 7.65; Right: p = 0.004; Δ% = 11.83), left leg flight time (p = 0.044; Δ% = 1.91), left leg jump height (p = 0.039; Δ% = 3.75) and right leg FT:CT (p = 0.040; Δ% = 9.72). Caffeine in a dose of 3 mg/kg BM in elite Jiu-Jitsu athletes is a recommended ergogenic aid as it increased performance of bilateral and unilateral vertical jumps. These increases were also accompanied by modified jump execution during the different phases of the countermovement prior to take-off.