Extended reality in cranial and spinal neurosurgery - a bibliometric analysis.

PURPOSE: This bibliometric analysis of the top 100 cited articles on extended reality (XR) in neurosurgery aimed to reveal trends in this research field. Gender differences in authorship and global distribution of the most-cited articles were also addressed. METHODS: A Web of Science electronic database search was conducted. The top 100 most-cited articles related to the scope of this review were retrieved and analyzed for trends in publications, journal characteristics, authorship, global distribution, study design, and focus areas. After a brief description of the top 100 publications, a comparative analysis between spinal and cranial publications was performed. RESULTS: From 2005, there was a significant increase in spinal neurosurgery publications with a focus on pedicle screw placement. Most articles were original research studies, with an emphasis on augmented reality (AR). In cranial neurosurgery, there was no notable increase in publications. There was an increase in studies assessing both AR and virtual reality (VR) research, with a notable emphasis on VR compared to AR. Education, surgical skills assessment, and surgical planning were more common themes in cranial studies compared to spinal studies. Female authorship was notably low in both groups, with no significant increase over time. The USA and Canada contributed most of the publications in the research field. CONCLUSIONS: Research regarding the use of XR in neurosurgery increased significantly from 2005. Cranial research focused on VR and resident education while spinal research focused on AR and neuronavigation. Female authorship was underrepresented. North America provides most of the high-impact research in this area.

Extended Reality in Neurosurgical Education: A Systematic Review.

Surgical simulation practices have witnessed a rapid expansion as an invaluable approach to resident training in recent years. One emerging way of implementing simulation is the adoption of extended reality (XR) technologies, which enable trainees to hone their skills by allowing interaction with virtual 3D objects placed in either real-world imagery or virtual environments. The goal of the present systematic review is to survey and broach the topic of XR in neurosurgery, with a focus on education. Five databases were investigated, leading to the inclusion of 31 studies after a thorough reviewing process. Focusing on user performance (UP) and user experience (UX), the body of evidence provided by these 31 studies showed that this technology has, in fact, the potential of enhancing neurosurgical education through the use of a wide array of both objective and subjective metrics. Recent research on the topic has so far produced solid results, particularly showing improvements in young residents, compared to other groups and over time. In conclusion, this review not only aids to a better understanding of the use of XR in neurosurgical education, but also highlights the areas where further research is entailed while also providing valuable insight into future applications.

Validity and Reliability of a Light-Based Electronic Target for Testing Response Time in Fencers.

ABSTRACT: De Giorgio, A, Iuliano, E, Turner, A, Millevolte, C, Cular, D, Ardigò, LP, and Padulo, J. Validity and reliability of a light-based electronic target for testing response time in fencers. J Strength Cond Res 35(9): 2636-2644, 2021-Response time (RT) is a fencing fundamental sensorimotor skill. Therefore, the aim of the current study was to examine the efficacy of a light-based electronic target in fencers, designed to measure and train this entity. Ninety-five fencers (M = 53; F = 42) were tested in regard to their RT, using a light-based electronic target, for 3 different attack types: simple attack, the lunge, and an attack after a 1.5-m thrust. All subjects were divided into elite vs. novice fencers. Elite fencers had national and international rankings, and were again divided with regard to used weapon: épéeists (n = 32; M = 19; F = 13) and foilists (n = 30; M = 13; F = 17). Measurement was evaluated for validity/reliability, sensitivity/specificity, and correlation. Reliability was high for all attack types (intraclass correlation coefficient 0.94-0.96). Lower RTs were found in males for 2 attack types with good sensitivity (81-93%)/specificity (50-91%) for all attack types. Elite fencers responded faster than novice fencers for all attack types (p < 0.001), whereas elite males were faster than females for 2 attack types (p < 0.01). Lower RTs in females correlated with level for one attack type (r = 0.797, p < 0.05). In conclusion, the light-based electronic target system was found to be highly reliable and therefore could be used by fencing athletes as a further measure of performance.

Effects of Acute Alcohol Exposure on Layer 5 Pyramidal Neurons of Juvenile Mice.

Early-onset drinking during childhood or preadolescence is a serious social problem. Yet, most of the basic neurobiological research on the acute effects of ethanol has been carried out on adult or early postnatal animals. We studied the effect of alcohol exposure on the basic electrophysiological properties and cell viability of layer 5 pyramidal neurons from the somatosensory cortex of juvenile (P21-P23) C57BL/6N mice. After bath application of 50 mM ethanol to acute slices of the somatosensory cortex, no adverse effects were detected on cells survival, whereas the input resistance and firing rate of layer 5 neurons were significantly reduced. While the effect on the input resistance was reversible, the depressing effect on cell firing remained stable after 6 min of alcohol exposure. Ethanol application did not result in any significant change of mIPSC frequency, amplitude, and rise time. A slight increase of mIPSC decay time was observed after 6 min of ethanol exposure. The molecular mechanisms leading to these alterations and their significance for the physiology of the cerebral cortex are briefly discussed.

A new integrative approach to increase quality of life by reducing pain and fear of movement in patients undergoing total hip arthroplasty: the IARA model.

Total hip arthroplasty (THA) improve the patients' quality of life, and one of the most important problems after surgery is to optimize postoperative pain management. It has been shown that pain is intimately linked to the fear of movement, the so-called kinesiophobia, which can affect the entire perioperative period and quality of life in people undergoing THA. In this study, we aimed to present a new integrative approach called IARA model specifically focused on educational interventions such as knowledge and awareness of illness, guided imagery, and drawings to help the patient achieve full autonomy and confidence about the perioperative period and surgery. The Hip Injury and Osteoarthritis Outcome Score (HOOS), Tampa Scale Kinesiophobia (TSK) questionnaire, and Numeric Rating Scale 0-10 have been used to test the efficacy of IARA. The main finding in the present study was the effectiveness of IARA model in improving indexes of pain (p < 0.01) and QoL (p < 0.01) and to keep kinesiophobia levels low in patients undergoing THA.

The roles of motor activity and environmental enrichment in intellectual disability.

In people with intellectual disabilities, an enriched environment can stimulate the acquisition of motor skills and could partially repair neuronal impairment thanks to exploration and motor activity. A deficit in environmental and motor stimulation leads to low scores in intelligence tests and can cause serious motor skill problems. Although studies in humans do not give much evidence for explaining basic mechanisms of intellectual disability and for highlighting improvements due to enriched environmental stimulation, animal models have been valuable in the investigation of these conditions. Here, we discuss the role of environmental enrichment in four intellectual disabilities: Foetal Alcohol Spectrum Disorder (FASD), Down, Rett, and Fragile X syndromes.

Mindfulness and pharmacological prophylaxis after withdrawal from medication overuse in patients with Chronic Migraine: an effectiveness trial with a one-year follow-up.

BACKGROUND: Chronic Migraine (CM) is a disabling condition, worsened when associated with Medication Overuse (MO). Mindfulness is an emerging technique, effective in different pain conditions, but it has yet to be explored for CM-MO. We report the results of a study assessing a one-year course of patients' status, with the hypothesis that the effectiveness of a mindfulness-based approach would be similar to that of conventional prophylactic treatments. METHODS: Patients with CM-MO (code 1.3 and 8.2 of the International Classification of Headache Disorders-3Beta) completed a withdrawal program in a day hospital setting. After withdrawal, patients were either treated with Prophylactic Medications (Med-Group), or participated in a Mindfulness-based Training (MT-Group). MT consisted of 6 weekly sessions of guided mindfulness, with patients invited to practice 7-10 min per day. Headache diaries, the headache impact test (HIT-6), the migraine disability assessment (MIDAS), state and trait anxiety (STAI Y1-Y2), and the Beck Depression Inventory (BDI) were administered before withdrawal and at each follow-up (3, 6, 12 after withdrawal) to patients from both groups. Outcome variables were analyzed in separate two-way mixed ANOVAs (Group: Mindfulness vs. Pharmacology x Time: Baseline, 3-, 6-, vs. 12-month follow-up). RESULTS: A total of 44 patients participated in the study, with the average age being 44.5, average headache frequency/month was 20.5, and average monthly medication intake was 18.4 pills. Data revealed a similar improvement over time in both groups for Headache Frequency (approximately 6-8 days reduction), use of Medication (approximately 7 intakes reduction), MIDAS, HIT-6 (but only for the MED-Group), and BDI; no changes on state and trait anxiety were found. Both groups revealed significant and equivalent improvement with respect to what has become a classical endpoint in this area of research, i.e. 50% or more reduction of headaches compared to baseline, and the majority of patients in each condition no longer satisfied current criteria for CM. CONCLUSIONS: Taken as a whole, our results suggest that the longitudinal course of patients in the MT-Group, that were not prescribed medical prophylaxis, was substantially similar to that of patients who were administered medical prophylaxis.

Early exposure to alcohol leads to permanent impairment of dendritic excitability in neocortical pyramidal neurons.

Exposure to alcohol in utero is a well known cause of mental retardation in humans. Using experimental models of fetal alcohol spectrum disorder, it has been demonstrated that cortical pyramidal neurons and their projections are profoundly and permanently impaired. Yet, how the functional features of these cells are modified and how such modifications impact cognitive processes is still unknown. To address this, we studied the intrinsic electrophysiological properties of pyramidal neurons in young adult rats (P30-P60) exposed to ethanol inhalation during the first week of postnatal life (P2-P6). Dual whole-cell recordings from the soma and distal apical dendrites were performed and, following the injection of depolarizing current into the dendrites, layer 5 neurons from ethanol-treated (Et) animals displayed a lower number and a shorter duration of dendritic spikes, attributable to a downregulation of calcium electrogenesis. As a consequence, the mean number of action potentials recorded at the soma after dendritic current injection was also lower in Et animals. No significant differences between Et and controls were observed in the firing pattern elicited in layer 5 neurons by steps of depolarizing somatic current, even though the firing rate was significantly lower in Et animals. The firing pattern and the firing rate of layer 2/3 neurons were not affected by alcohol exposure.

The decision-making in dribbling: a video analysis study of U10 soccer players' skills and coaches' quality evaluation.

Introduction: Dribbling is an important soccer skill that, when effective, allows players to overcome opponents. It can provide a strong tactical advantage; for this reason, all of its components (sprint, speed, and ball control) are fundamental to the development of young players. Dribbling can also be considered a decision-making process, and due to its characteristics, it is not always easy to study ecologically. Using a video analysis study, this research aimed to determine whether dribbling skills, specifically dribbling choice (i.e., decision-making), were related to U10 soccer players' quality. Methods: Several outcomes measures, divided into three categories, were taken during video analyses: (i) measures related to the efficacy of dribbling skill; (ii) measures related to the ability of players without the ball to support the player in possession; and (iii) measures related to ball circulation. These data were retrospectively assessed to whether the coaches had formed the teams in training through an implicit knowledge of the players' dribbling skills. Results: The percentage of accurate dribbling (that is, the ability to perform correct passes after a successful dribble) was found to be the variable that coaches may have implicitly used in creating the three groups differentiated by technical skills (p < 0.05). In fact, this percentage was 12.9%, 24.0%, and 48.1% for the groups with lower, average, and higher technical skills, respectively. Conclusion: Overall, the results demonstrate that dribbling accuracy has an important weight in the coach's evaluation of the technical skills level of young soccer players.

Hatha yoga is more effective in improving kinesiophobia and subjective well-being when combined with self-compassion meditation in people with CLBP: a randomized control trial.

Objective: The present study aims to examine whether combining hatha yoga practice with self-compassion meditation could influence kinesiophobia, emotions, perceived stress, and perceived disability among individuals with chronic low back pain when compared with hatha yoga alone. Methods: The randomized controlled study included 70 participants with chronic low back pain (CLBP) who were randomly assigned to a Hatha yoga group (HY; n = 35) or a Hatha yoga group plus self-compassion meditation (HYSCM; n = 35). Participants followed a protocol for 8 weeks, and the assessments were carried out before and after the intervention, with a follow-up evaluation conducted after one month. The participants completed the PANAS, PSS, TSK, and RMQ questionnaires. A Generalized Estimating Equation was used to explore the effect of interventions. Results: Both HY and HYSCM groups improved kinesiophobia, perceived disability, and stress at the follow-up. However, the HYSCM group shown a more significant reduction in kinesiophobia compared to the HY group. Moreover, significant improvement in positive affect and a reduction in negative affect over time in the HYSCM group were observed. Conclusion: Hatha yoga practice when combined with self-compassion meditation led to extra benefits by exhibiting a prolonged effect, especially on kinesiophobia positive and negative effects.

Limitations in Evaluating Machine Learning Models for Imbalanced Binary Outcome Classification in Spine Surgery: A Systematic Review.

Clinical prediction models for spine surgery applications are on the rise, with an increasing reliance on machine learning (ML) and deep learning (DL). Many of the predicted outcomes are uncommon; therefore, to ensure the models' effectiveness in clinical practice it is crucial to properly evaluate them. This systematic review aims to identify and evaluate current research-based ML and DL models applied for spine surgery, specifically those predicting binary outcomes with a focus on their evaluation metrics. Overall, 60 papers were included, and the findings were reported according to the PRISMA guidelines. A total of 13 papers focused on lengths of stay (LOS), 12 on readmissions, 12 on non-home discharge, 6 on mortality, and 5 on reoperations. The target outcomes exhibited data imbalances ranging from 0.44% to 42.4%. A total of 59 papers reported the model's area under the receiver operating characteristic (AUROC), 28 mentioned accuracies, 33 provided sensitivity, 29 discussed specificity, 28 addressed positive predictive value (PPV), 24 included the negative predictive value (NPV), 25 indicated the Brier score with 10 providing a null model Brier, and 8 detailed the F1 score. Additionally, data visualization varied among the included papers. This review discusses the use of appropriate evaluation schemes in ML and identifies several common errors and potential bias sources in the literature. Embracing these recommendations as the field advances may facilitate the integration of reliable and effective ML models in clinical settings.

Smart Devices for Health and Wellness Applied to Tele-Exercise: An Overview of New Trends and Technologies Such as IoT and AI.

This descriptive article explores the use of smart devices for health and wellness in the context of telehealth, highlighting rapidly evolving technologies such as the Internet of Things (IoT) and Artificial Intelligence (AI). Key innovations, benefits, challenges, and opportunities related to the adoption of these technologies are outlined. The article provides a descriptive and accessible approach to understanding the evolution and impact of smart devices in the tele-exercise reality. Nowadays, technological advances provide solutions that were unthinkable just a few years ago. The habits of the general population have also changed over the past few years. Hence, there is a need to investigate this issue and draw the attention of the scientific community to this topic by describing the benefits and challenges associated with each topic. If individuals no longer go to exercise, the exercise must go to their homes instead.

Monitoring Internal Training Intensity Correlated with Neuromuscular and Well-Being Status in Croatian Professional Soccer Players during Five Weeks of the Pre-Season Training Phase.

This study aimed to investigate the changes in internal training intensity, well-being, and countermovement jump (CMJ) performance and to determine their relationship across five weeks of the pre-season training phase in professional soccer players. A total of 22 professional male soccer players (age = 21.7 ± 4 years, body height = 185.9 ± 6.3 cm, body weight = 79 ± 6.3 kg, BMI = 22.8 ± 1.4 kg·m−2; VO2max = 52.9 ± 3.2) from the Croatian Second League voluntary participated in this study. The players spent 2230 ± 117 min in 32 technical/tactical and strength/conditioning training sessions, mostly at the low intensity zone (61%), and played 8 friendly matches at a high intensity (>90%). A one-way repeated measure of analysis ANOVA revealed a significant difference between weeks in CMJ performance (F(1,22) = 11.8, p < 0.001), with CMJ height in weeks 4 and 5 being likely to very likely higher than that noted in week 1. Moreover, significant differences between weeks were found in all internal training intensity measures (average [F(1,22) = 74.8, p < 0.001] and accumulated weekly internal training intensity [F(1,22) = 55.4, p < 0.001], training monotony [F(1,22) = 23.9, p < 0.001], and training strain [F(1,22) = 34.5, p < 0.001]). Likewise, differences were observed for wellness status categories (fatigue [F(1,22) = 4.3, p = 0.003], sleep [F(1,22) = 7.1, p < 0.001], DOMS [F(1,22) = 5.7, p < 0.001], stress [F(1,22) = 15.6, p < 0.001]), mood [F(1,22) = 12.7, p < 0.001], and overall well-being status score (F(1,22) = 13.2, p < 0.001). Correlation analysis showed large negative correlations between average weekly internal training intensity and fatigue (r = −0.63, p = 0.002), DOMS (r = −0.61, p = 0.003), and WBI (r = −0.53, p = 0.011). Additionally, fatigue was significantly associated (large negative correlation) with accumulated weekly internal training intensity (r = −0.51, p = 0.014) and training strain (r = −0.61, p = 0.003). Small, but non-significant, correlations were found between CMJ performance and wellness status measures. These findings highlight the utility and simplicity of monitoring tools to improve athletes' performance.

Willingness to Receive COVID-19 Booster Vaccine: Associations between Green-Pass, Social Media Information, Anti-Vax Beliefs, and Emotional Balance.

The aims of the present investigation were (i) to determine psychological relapses of COVID-19 booster vaccine; (ii) to identify the determining factors affecting willingness to receive COVID-19 vaccine; and (iii) to study the relationship among emotional characteristics (anxiety, stress, depression, optimism), social media information, and the mandatory political choices (i.e., green-pass) in Croatian people. A cross-sectional online survey was conducted for 1003 participants (median age: 40 years) from Croatia during December 2021. Results showed a significant association between vaccinated and unvaccinated participants in all sociodemographic variables, except for gender (p = 0.905). For psychological variables, significant differences were found only for levels of optimism (p < 0.001). People with a postgraduate degree (OR: 2.25, [1.14−4.46], p = 0.020) and PhD (OR: 1.97, [95% CI: 1.01−3.52], p = 0.021) had higher odds of being vaccinated than participants with high school diplomas. Additionally, participants seeking information on TV and radio (OR: 2.35, [1.71−3.23], p < 0.001) or from general practitioner (OR: 2.53, [1.78−3.61], p < 0.001) had higher odds of being vaccinated. Conversely, participants seeking information on social networks (OR: 0.36, [0.27−0.49], p < 0.001), general internet/blogs forums (OR: 0.34, [0.22−0.52], p < 0.001), and from friends or acquaintances (OR: 0.66, [0.48−0.91], p = 0.011) had lower odds of being vaccinated. Additionally, results showed that information policies have failed to fully convince the population to vaccinate and that depression (p = 0.491), anxiety (p = 0.220), and stress (p = 0.521) were not determining factors leading to the decision to receive COVID-19 vaccine. Most of the vaccinated participants perceived the green-pass as potentially useful. In contrast, most unvaccinated participants believed that the green-pass is a form of discrimination and not useful (88%). Further and broader research into possible reasons for continuing or undertaking vaccination is needed. It is recommended to introduce a measure of conformism that represents a change of attitude, belief, or behavior in a narrower sense.

Trust in Science as a Possible Mediator between Different Antecedents and COVID-19 Booster Vaccination Intention: An Integration of Health Belief Model (HBM) and Theory of Planned Behavior (TPB).

As the literature highlights, many health behavior theories try to explain both social and psychological variables influencing an individual's health behavior. This study integrates insights relative to the antecedents of getting vaccinated from health behavior theories, particularly including the health belief model (HBM), the theory of planned behavior (TPB), and the different socio-demographic factors. Furthermore, we considered the possible mechanism of impact of distrust in science on individuals' hesitance and resistance to taking up SARS-CoV-2 vaccination in subjects living in Italy. A correlational study of 1095 subjects enrolled when the national vaccination campaign for the third dose was launched. A questionnaire was used to measure: Italian Risk Perception; subjective norm; trust in science, trust in the vaccine; fear of COVID-19; fear of the vaccine; perceived knowledge about SARS-CoV-2; booster vaccination intention. Principal results show that: (i) the positive relationship provided by HBM theory between perceptions of SARS-CoV-2 risk (vulnerability and severity) and intention to have the vaccine, through fear of COVID-19; (ii) the positive relationship between subjective norms and both trust in science and vaccination intention; (iii) that trust in science plays a crucial role in predicting vaccination intention. Finally, the results provided indications about a positive relationship between subjective norms and fear of COVID-19, and a full mediation role of trust in science in the relationships between determinants of both TPA and HBM, fear of COVID-19, and vaccination intention. In conclusion, an individual's intention (not) to get vaccinated requires the consideration of a plethora of socio-psychological factors. However, overall, trust in science appears to be a key determinant of vaccination intention. Additional strategies promoting healthy behavior are needed.

The Role of the Person Focused IARA Model in Reducing Anxiety and Improving Body Awareness and Illness Management in Diabetics with Acquired Lipodystrophy: A Mixed-Method Study.

Background: Lipodystrophy is one of the most frequent complications in people with diabetes following subcutaneous insulin therapy, and poor management can lead to several problems, such as impaired glycemic control and adherence to therapy, anxiety, and depression. Poor injection technique represents the main risk factor for lipodystrophies. In order to enhance the patient's insulin injection technique to heal lipodystrophy, improve psychological indices, and promote involvement in their health and care, the efficacy of emerging person-centered care called the IARA model was tested. Methods: A total of 49 patients were randomly allocated to the IARA group (Experimental; n = 25) or standard education (Control; n = 24). The following questionnaires were used in a mixed-method design: (i) State Anxiety Scale; (ii) Beck Depression Inventory; (iii) Italian Summary of Diabetes Self-Care Activities. An ad hoc open-ended questionnaire was structured for the qualitative analysis. Finally, photos were taken in order to verify if injection sites were changed until the follow-up at 12 months. The number of patients who participated until the completion of the study was 17 in the IARA and 11 in the Control group. Results: State anxiety was significantly reduced in people who followed IARA to follow-up at 3 and 6 months (p < 0.05). The IARA group also demonstrated better compliance in blood glucose monitoring and foot-care compared to Control at follow-up at 12 months. The management of insulin injections dramatically improved in participants who received IARA intervention. Conclusions: IARA could be considered an effective strategy to improve well-being and compliance in people affected with diabetes mellitus and lipodystrophy complications.

Plastic changes in striatal fast-spiking interneurons following hemicerebellectomy and environmental enrichment.

Recent findings suggest marked interconnections between the cerebellum and striatum, thus challenging the classical view of their segregated operation in motor control. Therefore, this study was aimed at further investigating this issue by analyzing the effects of hemicerebellectomy (HCb) on density and dendritic length of striatal fast-spiking interneurons (FSi). First, we analyzed the plastic rearrangements of striatal FSi morphology in hemicerebellectomized animals reared in standard conditions. Then, since environmental enrichment (EE) induces structural changes in experimental models of brain disease, we evaluated FSi morphology in lesioned animals exposed to an enriched environment after HCb. Although HCb did not affect FSi density, it progressively shrank dendritic branching of striatal FSi of both sides. These plastic changes, already evident 15 days after the cerebellar ablation, became very marked 30 days after the lesion. Such a relevant effect was completely abolished by postoperative enrichment. EE not only counteracted shrinkage of FSi dendritic arborization but also provoked a progressive increase in dendritic length which surpassed that of the controls as the enrichment period lengthened. These data confirm that the cerebellum and striatum are more interconnected than previously retained. Furthermore, cerebellar damage likely evokes a striatal response through cortical mediation. The EE probably modifies HCb-induced plastic changes in the striatum by increasing the efficiency of the cortical circuitry. This is the first study describing the morphological rearrangement of striatal FSi following a cerebellar lesion; it provides the basis for further studies aimed at investigating the mechanisms underlying cerebello-striatal "talking."

Selective underexpression of Kv3.2 and Kv3.4 channels in the cortex of rats exposed to ethanol during early postnatal life.

The expression of voltage-gated potassium channels belonging to the Kv3 family has been studied in the sensori-motor cortex of rats exposed to alcohol inhalation during the first postnatal week (P2-P6). The study was carried out using comparative RT-PCR. At P9, a significant reduction of the expression of Kv3.2 and Kv3.4 subunits occurred in alcohol-treated animals, as compared with controls. The expression of the Kv3.4a splicing variant, which is thought to be critically involved in the high-frequency firing of some cortical interneurons, was also correspondingly reduced. The downregulation of Kv3.2 and Kv3.4a subunits represented a long-lasting effect of alcohol exposure, since it was also observed in P24 animals. The expression of both Kv3.1 and Kv3.3 channels appeared to be not significantly affected by alcohol exposure. An increased susceptibility to apoptotic neuronal death after early postnatal exposure to ethanol was confirmed by the lower bcl-2/bax ratio observed in alcohol-treated animals. Although Kv3.4 subunits are thought to trigger apoptosis, the lack of upregulation in our model argues against their involvement in the mechanism leading to alcohol-induced apoptosis. The possible consequences of the selective downregulation of Kv3 subunits on the cortical function, as well as their relevance for the genesis of fetal alcohol effects, are discussed.