Immune-monitoring of myelodysplastic neoplasms: Recommendations from the i4MDS consortium.

Advancements in comprehending myelodysplastic neoplasms (MDS) have unfolded significantly in recent years, elucidating a myriad of cellular and molecular underpinnings integral to disease progression. While molecular inclusions into prognostic models have substantively advanced risk stratification, recent revelations have emphasized the pivotal role of immune dysregulation within the bone marrow milieu during MDS evolution. Nonetheless, immunotherapy for MDS has not experienced breakthroughs seen in other malignancies, partly attributable to the absence of an immune classification that could stratify patients toward optimally targeted immunotherapeutic approaches. A pivotal obstacle to establishing "immune classes" among MDS patients is the absence of validated accepted immune panels suitable for routine application in clinical laboratories. In response, we formed International Integrative Innovative Immunology for MDS (i4MDS), a consortium of multidisciplinary experts, and created the following recommendations for standardized methodologies to monitor immune responses in MDS. A central goal of i4MDS is the development of an immune score that could be incorporated into current clinical risk stratification models. This position paper first consolidates current knowledge on MDS immunology. Subsequently, in collaboration with clinical and laboratory specialists, we introduce flow cytometry panels and cytokine assays, meticulously devised for clinical laboratories, aiming to monitor the immune status of MDS patients, evaluating both immune fitness and identifying potential immune "risk factors." By amalgamating this immunological characterization data and molecular data, we aim to enhance patient stratification, identify predictive markers for treatment responsiveness, and accelerate the development of systems immunology tools and innovative immunotherapies.

Simulation and virtual reality in intracranial aneurysms neurosurgical training: a systematic review.

INTRODUCTION: The recent emphasis on simulation-based training in neurosurgery has led to the development of many simulation models and training courses. We aimed to identify the currently available simulators and training courses for neurovascular surgery and endovascular interventions to assess their validity and determine their effectiveness to suggest widespread applicability in educational curricula. EVIDENCE ACQUISITION: Literature research was performed on academic databases for English language articles that validate simulation or virtual reality intracranial aneurysm models. Studies for neurosurgery and interventional neuroradiology published between January 2011 and January 2021 were included. Each study was assessed according to the Medical Education Research Quality Instrument. EVIDENCE SYNTHESIS: Between January 2011 and January 2021, 44 articles were screened and 12 were identified to be included in our research. The study involved 177 trainers. Participant trainers' characteristics reveal sensible homogeneity between studies. All studies reported a significant improvement in technical outcomes after simulator or virtual reality training. The Medical Education Research Quality Instrument average rate from 12 studies was M=11.7 (range: 8.5-14.5). CONCLUSIONS: Nowadays, the training of a medical doctor in the neurovascular field benefits from modern methods like simulators and virtual reality. With the advent of increasing neurosurgery simulators and training instruments, there is a need for more validity studies. More training tools incorporating full-immersion simulation are recommended to develop a standardized learning curve in neurovascular procedures.

A study investigating the knowledge and responses of Italian medical students to the COVID-19 pandemic.

Italy was initially one of the worse affected countries by the novel coronavirus (COVID-19). Medical students frequenting hospitals are more susceptible to be infected by the virus but also able to see the effects of the pandemic from the frontline. The aim of this study was to assess the COVID-19 related knowledge, behavioral changes, and perceptions of Italian medical students within the first 90 days after the onset of the outbreak in Italy. A national cross-sectional study was conducted from 23rd April to 31st April 2020. Participants were Italian medical students whose knowledge, behavioral changes, and perceptions of the COVID-19 pandemic were assessed. The survey consisted of: demographics, COVID-19 related general knowledge, behavioral changes, and perceptions of the pandemic. A total of 520 students answered the survey. The majority of the students' ages ranged from 21 to 25 years old (345, 66.3%). Only 48.6% stated that they had received a formal education about COVID-19 from their medical institutions. However, all the students declared that they tried to inform themselves, mostly through WHO, CDC, UpToDate (56%), but also (21.6%) through national guidelines, social networks (Facebook, Instagram, and YouTube) (11.5%), and other sources (10.9%). Italian medical students demonstrated a high level of COVID-19-related general knowledge as well as self-reported preventative behavioral changes but only had a moderate risk perception regarding the pandemic. They improved their health habits but questioned the reliability of information and handling of the pandemic by health authorities.

Burnout Among Neurosurgeons and Residents in Neurosurgery: A Systematic Review and Meta-Analysis of the Literature.

BACKGROUND: Burnout syndrome (BS) is a common condition among medical professionals. It is composed of 3 different subdimensions: emotional exhaustion (EE), depersonalization (DP), and reduced personal accomplishment (PA). In the last years, interest in BS in the neurosurgical community has increased. Here we investigated burnout among neurosurgeons and residents in neurosurgery. METHODS: A systematic review with meta-analysis was performed following PRISMA guidelines. A search of bibliographic databases was conducted from study inception to February 2020. A total of 16,377 studies were found. Six articles were included in our final analysis. Their references were checked for additional studies, but none were found. RESULTS: From the initial 16,377 studies identified, only 6 met our inclusion criteria. These studies included a total of 3310 physicians. The general prevalence of BS was 48%. The prevalence in neurosurgeons was 51.1%, higher than that recorded in neurosurgical residents (45.4%). Regarding subdimensions, personal accomplishment seemed to be the most influential factor for burnout development among neurosurgeons (42.57%) and residents (51.56%) alike. CONCLUSIONS: Neurosurgery is a rewarding career choice, but numerous challenges and stressors can lead to lower levels of satisfaction and dangerously increased levels of burnout. We hope that our results will generate discussion, raise awareness, stimulate further studies, and lead to programs designed to mitigate excessive stress and burnout in neurosurgeons.

Italian Neurosurgical Residents' Experience with Research Activities: A National Survey.

BACKGROUND: In parallel with the progress in neurosurgery, improvements in residents' training strategies have been reported. Increasing focus has been placed on residents' participation in research. Previous studies analyzed neurosurgery residents' contributions to research activities, time dedicated to research, and outcomes. However, few studies investigating these aspects outside the United States are present in the literature. METHODS: A 3-section survey was sent to neurosurgery residents in Italy to determine the current opinion, perceptions, and experiences in the research field. A review of the pertinent literature was carried out. RESULTS: Ninety-seven responding residents (response rate of 41.5%) self-reported an average time spent on research of 9.7 ± 11.4 hours/week. In decreasing frequency, residents were working on retrospective cohort studies (27.5%), case reports (21.7%), case series (15.5%), prospective cohort studies (13.4%), and others (16.4%). The most commonly reported factors promoting interest in research were interaction with peers (76.3%), mentorship (70.1%), and conference exposure (52.6%). Reported strategies of program support were heterogeneous with a prevalence for established collaborative agreements (59.8%) and the presence of a study coordinator (37.1%). The most frequently cited limiting factors were regulatory paperwork (70.1%), call schedule (60.8%), and lack of participating students/residents (57.7%). CONCLUSIONS: By describing the current status of Italian residents' participation in research, we provide additional insight into factors supporting research involvement and existing barriers. Strategies for improvement at national and departmental levels are suggested. We encourage further investigations in other countries, to provide useful information in a worldwide framework.