Uncharted Waters of Machine and Deep Learning for Surgical Phase Recognition in Neurosurgery.

Recent years have witnessed artificial intelligence (AI) make meteoric leaps in both medicine and surgery, bridging the gap between the capabilities of humans and machines. Digitization of operating rooms and the creation of massive quantities of data have paved the way for machine learning and computer vision applications in surgery. Surgical phase recognition (SPR) is a newly emerging technology that uses data derived from operative videos to train machine and deep learning algorithms to identify the phases of surgery. Advancement of this technology will be key in establishing context-aware surgical systems in the future. By automatically recognizing and evaluating the current surgical scenario, these intelligent systems are able to provide intraoperative decision support, improve operating room efficiency, assess surgical skills, and aid in surgical training and education. Still in its infancy, SPR has been mainly studied in laparoscopic surgeries, with a contrasting stark lack of research within neurosurgery. Given the high-tech and rapidly advancing nature of neurosurgery, we believe SPR has a tremendous untapped potential in this field. Herein, we present an overview of the SPR technology, its potential applications in neurosurgery, and the challenges that lie ahead.

Combination therapy of Tocilizumab and steroid for management of COVID-19 associated cytokine release syndrome: A single center experience from Pune, Western India.

ABSTRACT: Cytokine release syndrome (CRS) or cytokine storm is thought to be the cause of inflammatory lung damage, worsening pneumonia and death in patients with COVID-19. Steroids (Methylprednislone or Dexamethasone) and Tocilizumab (TCZ), an interleukin-6 receptor antagonist, are approved for treatment of CRS in India. The aim of this study was to evaluate the efficacy and safety of combination therapy of TCZ and steroid in COVID-19 associated CRS.This retrospective cohort study was conducted at Noble hospital and Research Centre (NHRC), Pune, India between April 2 and November 2, 2020. All patients administered TCZ and steroids during this period were included. The primary endpoint was incidence of all cause mortality. Secondary outcomes studied were need for mechanical ventilation and incidence of systemic and infectious complications. Baseline and time dependent risk factors significantly associated with death were identified by Relative risk estimation.Out of 2831 admitted patients, 515 (24.3% females) were administered TCZ and steroids. There were 135 deaths (26.2%), while 380 patients (73.8%) had clinical improvement. Mechanical ventilation was required in 242 (47%) patients. Of these, 44.2% (107/242) recovered and were weaned off the ventilator. Thirty seven percent patients were managed in wards and did not need intensive care unit (ICU) admission. Infectious complications like hospital acquired pneumonia, blood stream bacterial and fungal infections were observed in 2.13%, 2.13% and 0.06% patients respectively. Age ≥ 60 years (P = .014), presence of co-morbidities like hypertension (P = .011), IL-6 ≥ 100 pg/ml (P = .002), D-dimer ≥ 1000 ng/ml (P < .0001), CT severity index ≥ 18 (P < .0001) and systemic complications like lung fibrosis (P = .019), cardiac arrhythmia (P < .0001), hypotension (P < .0001) and encephalopathy (P < .0001) were associated with increased risk of death.Combination therapy of TCZ and steroids is likely to be safe and effective in management of COVID-19 associated cytokine release syndrome. Efficacy of this anti-inflammatory combination therapy needs to be validated in randomized controlled trials.