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3.
Front Surg ; 11: 1440042, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-39296348

RESUMO

Background: Craniosynostosis is a type of skull deformity caused by premature ossification of cranial sutures in children. Given its variability and anatomical complexity, three-dimensional visualization is crucial for effective teaching and understanding. We developed a VR database with 3D models to depict these deformities and evaluated its impact on teaching efficiency, motivation, and memorability. Methods: We included all craniosynostosis cases with preoperative CT imaging treated at our institution from 2012 to 2022. Preoperative CT scans were imported into SpectoVR using a transfer function to visualize bony structures. Measurements, sub-segmentation, and anatomical teaching were performed in a fully immersive 3D VR experience using a headset. Teaching sessions were conducted in group settings where students and medical personnel explored and discussed the 3D models together, guided by a host. Participants' experiences were evaluated with a questionnaire assessing understanding, memorization, and motivation on a scale from 1 (poor) to 5 (outstanding). Results: The questionnaire showed high satisfaction scores (mean 4.49 ± 0.25). Participants (n = 17) found the VR models comprehensible and navigable (mean 4.47 ± 0.62), with intuitive operation (mean 4.35 ± 0.79). Understanding pathology (mean 4.29 ± 0.77) and surgical procedures (mean 4.63 ± 0.5) was very satisfactory. The models improved anatomical visualization (mean 4.71 ± 0.47) and teaching effectiveness (mean 4.76 ± 0.56), with participants reporting enhanced comprehension and memorization, leading to an efficient learning process. Conclusion: Establishing a 3D VR database for teaching craniosynostosis shows advantages in understanding and memorization and increases motivation for the study process, thereby allowing for more efficient learning. Future applications in patient consent and teaching in other medical areas should be explored.

4.
Science ; 385(6710): 770-775, 2024 Aug 16.
Artigo em Inglês | MEDLINE | ID: mdl-39146405

RESUMO

The functions of proteins generally depend on their assembly into complexes. During evolution, some complexes have transitioned from homomers encoded by a single gene to heteromers encoded by duplicate genes. This transition could occur without adaptive evolution through intermolecular compensatory mutations. Here, we experimentally duplicated and evolved a homodimeric enzyme to determine whether and how this could happen. We identified hundreds of deleterious mutations that inactivate individual homodimers but produce functional enzymes when coexpressed as duplicated proteins that heterodimerize. The structure of one such heteromer reveals how both losses of function are buffered through the introduction of asymmetry in the complex that allows them to subfunctionalize. Constructive neutral evolution can thus occur by gene duplication followed by only one deleterious mutation per duplicate.


Assuntos
Duplicação Gênica , Deriva Genética , Mutação com Perda de Função , Multimerização Proteica , Multimerização Proteica/genética , Citosina Desaminase/química , Citosina Desaminase/genética
5.
Bioengineering (Basel) ; 11(8)2024 Aug 22.
Artigo em Inglês | MEDLINE | ID: mdl-39199815

RESUMO

The detection of contrast-enhancing lesions (CELs) is fundamental for the diagnosis and monitoring of patients with multiple sclerosis (MS). This task is time-consuming and suffers from high intra- and inter-rater variability in clinical practice. However, only a few studies proposed automatic approaches for CEL detection. This study aimed to develop a deep learning model that automatically detects and segments CELs in clinical Magnetic Resonance Imaging (MRI) scans. A 3D UNet-based network was trained with clinical MRI from the Swiss Multiple Sclerosis Cohort. The dataset comprised 372 scans from 280 MS patients: 162 showed at least one CEL, while 118 showed no CELs. The input dataset consisted of T1-weighted before and after gadolinium injection, and FLuid Attenuated Inversion Recovery images. The sampling strategy was based on a white matter lesion mask to confirm the existence of real contrast-enhancing lesions. To overcome the dataset imbalance, a weighted loss function was implemented. The Dice Score Coefficient and True Positive and False Positive Rates were 0.76, 0.93, and 0.02, respectively. Based on these results, the model developed in this study might well be considered for clinical decision support.

6.
Surg Obes Relat Dis ; 2024 Jul 08.
Artigo em Inglês | MEDLINE | ID: mdl-39117560

RESUMO

BACKGROUND: The pilot study addresses the challenge of predicting postoperative outcomes, particularly body mass index (BMI) trajectories, following bariatric surgery. The complexity of this task makes preoperative personalized obesity treatment challenging. OBJECTIVES: To develop and validate sophisticated machine learning (ML) algorithms capable of accurately forecasting BMI reductions up to 5 years following bariatric surgery aiming to enhance planning and postoperative care. The secondary goal involves the creation of an accessible web-based calculator for healthcare professionals. This is the first article that compares these methods in BMI prediction. SETTING: The study was carried out from January 2012 to December 2021 at GZOAdipositas Surgery Center, Switzerland. Preoperatively, data for 1004 patients were available. Six months postoperatively, data for 1098 patients were available. For the time points 12 months, 18 months, 2 years, 3 years, 4 years, and 5 years the following number of follow-ups were available: 971, 898, 829, 693, 589, and 453. METHODS: We conducted a comprehensive retrospective review of adult patients who underwent bariatric surgery (Roux-en-Y gastric bypass or sleeve gastrectomy), focusing on individuals with preoperative and postoperative data. Patients with certain preoperative conditions and those lacking complete data sets were excluded. Additional exclusion criteria were patients with incomplete data or follow-up, pregnancy during the follow-up period, or preoperative BMI ≤30 kg/m2. RESULTS: This study analyzed 1104 patients, with 883 used for model training and 221 for final evaluation, the study achieved reliable predictive capabilities, as measured by root mean square error (RMSE). The RMSE values for three tasks were 2.17 (predicting next BMI value), 1.71 (predicting BMI at any future time point), and 3.49 (predicting the 5-year postoperative BMI curve). These results were showcased through a web application, enhancing clinical accessibility and decision-making. CONCLUSION: This study highlights the potential of ML to significantly improve bariatric surgical outcomes and overall healthcare efficiency through precise BMI predictions and personalized intervention strategies.

7.
Nat Microbiol ; 9(9): 2434-2447, 2024 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-39103571

RESUMO

Loss of endothelial integrity and vascular leakage are central features of sepsis pathogenesis; however, no effective therapeutic mechanisms for preserving endothelial integrity are available. Here we show that, compared to dermal microvessels, brain microvessels resist infection by Neisseria meningitidis, a bacterial pathogen that causes sepsis and meningitis. By comparing the transcriptional responses to infection in dermal and brain endothelial cells, we identified angiopoietin-like 4 as a key factor produced by the brain endothelium that preserves blood-brain barrier integrity during bacterial sepsis. Conversely, angiopoietin-like 4 is produced at lower levels in the peripheral endothelium. Treatment with recombinant angiopoietin-like 4 reduced vascular leakage, organ failure and death in mouse models of lethal sepsis and N. meningitidis infection. Protection was conferred by a previously uncharacterized domain of angiopoietin-like 4, through binding to the heparan proteoglycan, syndecan-4. These findings reveal a potential strategy to prevent endothelial dysfunction and improve outcomes in patients with sepsis.


Assuntos
Modelos Animais de Doenças , Células Endoteliais , Sepse , Animais , Sepse/microbiologia , Camundongos , Humanos , Células Endoteliais/metabolismo , Células Endoteliais/microbiologia , Neisseria meningitidis/genética , Neisseria meningitidis/metabolismo , Proteína 4 Semelhante a Angiopoietina/metabolismo , Proteína 4 Semelhante a Angiopoietina/genética , Barreira Hematoencefálica/metabolismo , Infecções Meningocócicas/microbiologia , Encéfalo/metabolismo , Encéfalo/microbiologia , Encéfalo/patologia , Camundongos Endogâmicos C57BL , Endotélio Vascular/metabolismo , Endotélio Vascular/microbiologia
8.
Sci Data ; 11(1): 880, 2024 Aug 14.
Artigo em Inglês | MEDLINE | ID: mdl-39143109

RESUMO

Walking is a fundamental aspect of human movement, and understanding how irregular surfaces impact gait is crucial. Existing gait research often relies on laboratory settings with ideal surfaces, limiting the applicability of findings to real-world scenarios. While some irregular surface datasets exist, they are often small or lack biomechanical gait data. In this paper, we introduce a new irregular surface dataset with 134 participants walking on surfaces of varying irregularity, equipped with inertial measurement unit (IMU) sensors on the trunk and lower right limb (foot, shank, and thigh). Collected during the North American Congress on Biomechanics conference in 2022, the dataset aims to provide a valuable resource for studying biomechanical adaptations to irregular surfaces. We provide the detailed experimental protocol, as well as a technical validation in which we developed a machine learning model to predict the walking surface. The resulting model achieved an accuracy score of 95.8%, demonstrating the discriminating biomechanical characteristics of the dataset's irregular surface gait data.


Assuntos
Marcha , Caminhada , Humanos , Fenômenos Biomecânicos , Aprendizado de Máquina
9.
Int J Infect Dis ; 146: 107122, 2024 09.
Artigo em Inglês | MEDLINE | ID: mdl-38823623

RESUMO

OBJECTIVES: Nontuberculous mycobacteria (NTM) bone and joint infections (BJIs) are uncommon. We evaluated the characteristics of BJIs and identified differences according to immune status. METHODS: We performed a multicenter retrospective study in France involving patients with documented NTM BJI over a 9-year period. We collected the clinical and microbiological characteristics, management, and clinical outcomes of the patients. RESULTS: Overall, 95 patients were included, of whom 50.5% (48/95) were immunosuppressed. Tenosynovitis was more frequent in the immunocompetent group, and native arthritis more common in the immunosuppressed group. Mycobacerium marinum and M. abscessus complex were significantly more frequent in the immunocompetent group, and M. avium and M. xenopi were significantly more frequent in the immunosuppressed group. The combination of antibiotherapy with surgery tended to be more frequent in the immunocompetent than the immunosuppressed group (63.8% (30/47) vs 47.8% (22/46), respectively); of the latter, 45.7% (21/46) received antimicrobial therapy alone, a higher frequency than in the immunocompetent group (23.4%, 11/47). The median duration of antimicrobial treatment was similar in the two groups (11 months). Mortality was significantly higher in the immunosuppressed group. CONCLUSIONS: Although the clinical presentations and the NTM species involved in BJI differed according to immune status, most recovered completely after treatment.


Assuntos
Antibacterianos , Infecções por Mycobacterium não Tuberculosas , Micobactérias não Tuberculosas , Humanos , Infecções por Mycobacterium não Tuberculosas/tratamento farmacológico , Infecções por Mycobacterium não Tuberculosas/imunologia , Infecções por Mycobacterium não Tuberculosas/mortalidade , Infecções por Mycobacterium não Tuberculosas/microbiologia , Estudos Retrospectivos , Masculino , Feminino , Idoso , Pessoa de Meia-Idade , Micobactérias não Tuberculosas/imunologia , Resultado do Tratamento , Antibacterianos/uso terapêutico , França/epidemiologia , Hospedeiro Imunocomprometido , Idoso de 80 Anos ou mais , Adulto , Artrite Infecciosa/microbiologia , Artrite Infecciosa/tratamento farmacológico , Artrite Infecciosa/imunologia , Artrite Infecciosa/mortalidade
10.
Invest Ophthalmol Vis Sci ; 65(6): 9, 2024 Jun 03.
Artigo em Inglês | MEDLINE | ID: mdl-38837167

RESUMO

Purpose: Optical coherence tomography (OCT) representations in clinical practice are static and do not allow for a dynamic visualization and quantification of blood flow. This study aims to present a method to analyze retinal blood flow dynamics using time-resolved structural OCT. Methods: We developed novel imaging protocols to acquire video-rate time-resolved OCT B-scans (1024 × 496 pixels, 10 degrees field of view) at four different sensor integration times (integration time of 44.8 µs at a nominal A-scan rate of 20 kHz, 22.4 µs at 40 kHz, 11.2 µs at 85 kHz, and 7.24 µs at 125 kHz). The vessel centers were manually annotated for each B-scan and surrounding subvolumes were extracted. We used a velocity model based on signal-to-noise ratio (SNR) drops due to fringe washout to calculate blood flow velocity profiles in vessels within five optic disc diameters of the optic disc rim. Results: Time-resolved dynamic structural OCT revealed pulsatile SNR changes in the analyzed vessels and allowed the calculation of potential blood flow velocities at all integration times. Fringe washout was stronger in acquisitions with longer integration times; however, the ratio of the average SNR to the peak SNR inside the vessel was similar across all integration times. Conclusions: We demonstrated the feasibility of estimating blood flow profiles based on fringe washout analysis, showing pulsatile dynamics in vessels close to the optic nerve head using structural OCT. Time-resolved dynamic OCT has the potential to uncover valuable blood flow information in clinical settings.


Assuntos
Fluxo Sanguíneo Regional , Vasos Retinianos , Tomografia de Coerência Óptica , Tomografia de Coerência Óptica/métodos , Humanos , Vasos Retinianos/fisiologia , Vasos Retinianos/diagnóstico por imagem , Velocidade do Fluxo Sanguíneo/fisiologia , Fluxo Sanguíneo Regional/fisiologia , Disco Óptico/irrigação sanguínea , Disco Óptico/diagnóstico por imagem , Razão Sinal-Ruído , Masculino , Feminino , Adulto , Pessoa de Meia-Idade
11.
Surg Endosc ; 38(7): 3672-3683, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38777894

RESUMO

BACKGROUND: Anastomotic leakage (AL), a severe complication following colorectal surgery, arises from defects at the anastomosis site. This study evaluates the feasibility of predicting AL using machine learning (ML) algorithms based on preoperative data. METHODS: We retrospectively analyzed data including 21 predictors from patients undergoing colorectal surgery with bowel anastomosis at four Swiss hospitals. Several ML algorithms were applied for binary classification into AL or non-AL groups, utilizing a five-fold cross-validation strategy with a 90% training and 10% validation split. Additionally, a holdout test set from an external hospital was employed to assess the models' robustness in external validation. RESULTS: Among 1244 patients, 112 (9.0%) suffered from AL. The Random Forest model showed an AUC-ROC of 0.78 (SD: ± 0.01) on the internal test set, which significantly decreased to 0.60 (SD: ± 0.05) on the external holdout test set comprising 198 patients, including 7 (3.5%) with AL. Conversely, the Logistic Regression model demonstrated more consistent AUC-ROC values of 0.69 (SD: ± 0.01) on the internal set and 0.61 (SD: ± 0.05) on the external set. Accuracy measures for Random Forest were 0.82 (SD: ± 0.04) internally and 0.87 (SD: ± 0.08) externally, while Logistic Regression achieved accuracies of 0.81 (SD: ± 0.10) and 0.88 (SD: ± 0.15). F1 Scores for Random Forest moved from 0.58 (SD: ± 0.03) internally to 0.51 (SD: ± 0.03) externally, with Logistic Regression maintaining more stable scores of 0.53 (SD: ± 0.04) and 0.51 (SD: ± 0.02). CONCLUSION: In this pilot study, we evaluated ML-based prediction models for AL post-colorectal surgery and identified ten patient-related risk factors associated with AL. Highlighting the need for multicenter data, external validation, and larger sample sizes, our findings emphasize the potential of ML in enhancing surgical outcomes and inform future development of a web-based application for broader clinical use.


Assuntos
Fístula Anastomótica , Aprendizado de Máquina , Humanos , Fístula Anastomótica/etiologia , Fístula Anastomótica/epidemiologia , Projetos Piloto , Feminino , Masculino , Estudos Retrospectivos , Suíça/epidemiologia , Idoso , Pessoa de Meia-Idade , Anastomose Cirúrgica/efeitos adversos , Cuidados Pré-Operatórios/métodos , Estudos de Viabilidade
13.
PLoS Genet ; 20(4): e1011252, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38683847

RESUMO

Pneumocystis jirovecii is a fungal pathogen that causes pneumocystis pneumonia, a disease that mainly affects immunocompromised individuals. This fungus has historically been hard to study because of our inability to grow it in vitro. One of the main drug targets in P. jirovecii is its dihydrofolate reductase (PjDHFR). Here, by using functional complementation of the baker's yeast ortholog, we show that PjDHFR can be inhibited by the antifolate methotrexate in a dose-dependent manner. Using deep mutational scanning of PjDHFR, we identify mutations conferring resistance to methotrexate. Thirty-one sites spanning the protein have at least one mutation that leads to resistance, for a total of 355 high-confidence resistance mutations. Most resistance-inducing mutations are found inside the active site, and many are structurally equivalent to mutations known to lead to resistance to different antifolates in other organisms. Some sites show specific resistance mutations, where only a single substitution confers resistance, whereas others are more permissive, as several substitutions at these sites confer resistance. Surprisingly, one of the permissive sites (F199) is without direct contact to either ligand or cofactor, suggesting that it acts through an allosteric mechanism. Modeling changes in binding energy between F199 mutants and drug shows that most mutations destabilize interactions between the protein and the drug. This evidence points towards a more important role of this position in resistance than previously estimated and highlights potential unknown allosteric mechanisms of resistance to antifolate in DHFRs. Our results offer unprecedented resources for the interpretation of mutation effects in the main drug target of an uncultivable fungal pathogen.


Assuntos
Farmacorresistência Fúngica , Antagonistas do Ácido Fólico , Metotrexato , Mutação , Pneumocystis carinii , Tetra-Hidrofolato Desidrogenase , Tetra-Hidrofolato Desidrogenase/genética , Tetra-Hidrofolato Desidrogenase/metabolismo , Tetra-Hidrofolato Desidrogenase/química , Pneumocystis carinii/genética , Pneumocystis carinii/enzimologia , Pneumocystis carinii/efeitos dos fármacos , Antagonistas do Ácido Fólico/farmacologia , Farmacorresistência Fúngica/genética , Metotrexato/farmacologia , Regulação Alostérica , Saccharomyces cerevisiae/genética , Saccharomyces cerevisiae/efeitos dos fármacos , Humanos , Proteínas Fúngicas/genética , Proteínas Fúngicas/metabolismo , Proteínas Fúngicas/química , Domínio Catalítico/genética
14.
J Biomech ; 168: 112116, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38677026

RESUMO

Time-series data are common in biomechanical studies. These data often undergo pre-processing steps such as time normalization or filtering prior to use in further analyses, including deep-learning classification. In this context, it remains unclear how these preprocessing steps affect deep-learning model performance. Thus, the aim of this study is to assess the effect of time-normalization and filtering on the performance of deep-learning classification models. We also investigated the effect of amplitude scaling. Using a public dataset (Gutenburg Gait Database, a ground reaction force database of level overground walking at self-selected walking speed involving 350 healthy individuals), we trained convolutional neural network (CNN) and long short-term memory (LSTM) models to predict binary sex (male, female) using three-dimensional ground-reaction forces to which we applied different processing approaches: zero padding, interpolation to 100% of signal, filtering, and scaling (min-max, body mass). The results show that transformations resulted in differences in model performances. Highest performance was obtained using unfiltered data, zero-padding, and min-max amplitude scaling (F1-score of 91 and 87% for CNN and LSTM, respectively). Not filtering data and using min-max scaling generally improve performance for both model architectures. For interpolation, results are not consistent across model architectures. This study suggests that processing steps must be considered in applications where deep-learning classification performance is relevant.


Assuntos
Aprendizado Profundo , Humanos , Masculino , Fenômenos Biomecânicos/fisiologia , Feminino , Adulto , Marcha/fisiologia , Processamento de Sinais Assistido por Computador , Redes Neurais de Computação , Caminhada/fisiologia , Modelos Biológicos
15.
3D Print Med ; 10(1): 13, 2024 Apr 19.
Artigo em Inglês | MEDLINE | ID: mdl-38639834

RESUMO

BACKGROUND: Bioresorbable patient-specific additive-manufactured bone grafts, meshes, and plates are emerging as a promising alternative that can overcome the challenges associated with conventional off-the-shelf implants. The fabrication of patient-specific implants (PSIs) directly at the point-of-care (POC), such as hospitals, clinics, and surgical centers, allows for more flexible, faster, and more efficient processes, reducing the need for outsourcing to external manufacturers. We want to emphasize the potential advantages of producing bioresorbable polymer implants for cranio-maxillofacial surgery at the POC by highlighting its surgical applications, benefits, and limitations. METHODS: This study describes the workflow of designing and fabricating degradable polymeric PSIs using three-dimensional (3D) printing technology. The cortical bone was segmented from the patient's computed tomography data using Materialise Mimics software, and the PSIs were designed created using Geomagic Freeform and nTopology software. The implants were finally printed via Arburg Plastic Freeforming (APF) of medical-grade poly (L-lactide-co-D, L-lactide) with 30% ß-tricalcium phosphate and evaluated for fit. RESULTS: 3D printed implants using APF technology showed surfaces with highly uniform and well-connected droplets with minimal gap formation between the printed paths. For the plates and meshes, a wall thickness down to 0.8 mm could be achieved. In this study, we successfully printed plates for osteosynthesis, implants for orbital floor fractures, meshes for alveolar bone regeneration, and bone scaffolds with interconnected channels. CONCLUSIONS: This study shows the feasibility of using 3D printing to create degradable polymeric PSIs seamlessly integrated into virtual surgical planning workflows. Implementing POC 3D printing of biodegradable PSI can potentially improve therapeutic outcomes, but regulatory compliance must be addressed.

16.
J Am Chem Soc ; 146(13): 9347-9355, 2024 Apr 03.
Artigo em Inglês | MEDLINE | ID: mdl-38520392

RESUMO

Tuning the photophysical properties of iron-based transition-metal complexes is crucial for their employment as photosensitizers in solar energy conversion. For the optimization of these new complexes, a detailed understanding of the excited-state deactivation paths is necessary. Here, we report femtosecond transient mid-IR spectroscopy data on a recently developed octahedral ligand-field enhancing [Fe(dqp)2]2+ (C1) complex with dqp = 2,6-diquinolylpyridine and prototypical [Fe(bpy)3]2+ (C0). By combining mid-IR spectroscopy with quantum chemical DFT calculations, we propose a method for disentangling the 5Q1 and 3T1 multiplicities of the long-lived metal-centered (MC) states, applicable to a variety of metal-organic iron complexes. Our results for C0 align well with the established assignment toward the 5Q1, validating our approach. For C1, we find that deactivation of the initially excited metal-to-ligand charge-transfer state leads to a population of a long-lived MC 5Q1 state. Analysis of transient changes in the mid-IR shows an ultrafast sub 200 fs rearrangement of ligand geometry for both complexes, accompanying the MLCT → MC deactivation. This confirms that the flexibility in the ligand sphere supports the stabilization of high spin states and plays a crucial role in the MLCT lifetime of metal-organic iron complexes.

17.
J Exp Bot ; 75(13): 4093-4110, 2024 Jul 10.
Artigo em Inglês | MEDLINE | ID: mdl-38551810

RESUMO

Among plant pathogens, the necrotrophic fungus Botrytis cinerea is one of the most prevalent, leading to severe crop damage. Studies related to its colonization of different plant species have reported variable host metabolic responses to infection. In tomato, high N availability leads to decreased susceptibility. Metabolic flux analysis can be used as an integrated method to better understand which metabolic adaptations lead to effective host defence and resistance. Here, we investigated the metabolic response of tomato infected by B. cinerea in symptomless stem tissues proximal to the lesions for 7 d post-inoculation, using a reconstructed metabolic model constrained by a large and consistent metabolic dataset acquired under four different N supplies. An overall comparison of 48 flux solution vectors of Botrytis- and mock-inoculated plants showed that fluxes were higher in Botrytis-inoculated plants, and the difference increased with a reduction in available N, accompanying an unexpected increase in radial growth. Despite higher fluxes, such as those involved in cell wall synthesis and other pathways, fluxes related to glycolysis, the tricarboxylic acid cycle, and amino acid and protein synthesis were limited under very low N, which might explain the enhanced susceptibility. Limiting starch synthesis and enhancing fluxes towards redox and specialized metabolism also contributed to defence independent of N supply.


Assuntos
Botrytis , Nitrogênio , Doenças das Plantas , Caules de Planta , Solanum lycopersicum , Botrytis/fisiologia , Solanum lycopersicum/microbiologia , Solanum lycopersicum/metabolismo , Nitrogênio/metabolismo , Doenças das Plantas/microbiologia , Caules de Planta/metabolismo , Caules de Planta/microbiologia , Modelos Biológicos , Análise do Fluxo Metabólico
18.
Int J Med Robot ; 20(1): e2623, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-38375774

RESUMO

BACKGROUND: The integration of virtual reality (VR) in surgery has gained prominence as VR applications have increased in popularity. METHODS: A scoping review was undertaken, gathering the most relevant sources, utilising a detailed literature search of medical and academic databases including EMBASE, PubMed, Cochrane, IEEE, Google Scholar, and the Google search engine. RESULTS: Of the 18 articles included, 7 focused on VR in colon surgery, 5 addressed VR in pancreas surgery, and the remaining 6 concentrated on VR in liver surgery. All the articles concluded that VR has a promising future in abdominal surgery by facilitating precision, visualisation, and surgeon training. CONCLUSIONS: Adopting VR technology in abdominal surgery has the potential to improve preoperative planning, decrease perioperative anxiety among patients, and facilitate the training of surgeons, residents, and medical students. Additional supporting studies are necessary before VR can be widely implemented in surgical care delivery.


Assuntos
Cirurgiões , Realidade Virtual , Humanos
19.
Front Public Health ; 12: 1194844, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38351958

RESUMO

Background: The 2022 multicountry mpox outbreaks predominantly affected gay, bisexual and other men who have sex with men (GBMSM) in non-endemic countries, including in the Netherlands. We conducted a survey-based assessment of the alignment between the risk factors associated with mpox diagnosis among GBMSM in the Netherlands and the eligibility criteria used in 2022 for vaccinating this group, with the aim to refine these criteria. Methods: An online self-report survey was conducted among adult GBMSM in the Netherlands between 29 July and 30 August 2022, corresponding to the first month of the Dutch mpox vaccination campaign. GBMSM were recruited via advertisements on social media and gay dating apps. Participants reported on their sexual behaviour, mpox diagnosis, and/or (initial) mpox vaccination since the start of the outbreak. Covariables of mpox diagnosis and vaccination were assessed using logistic regression analyses. Results: Of the 2,460 participants, 73 (3.0%, 95% CI 2.3-3.6%) were diagnosed with mpox and 485 (19.7%, 95% CI 18.1-21.3%) had received (initial) mpox vaccination. Using sample weighting, we estimated that, of the GBMSM population aged 18-80 years in the Netherlands, 1.1% (95% CI 0.7-1.6%) had been diagnosed with mpox and 7.8% (95% CI 6.8-8.9%) had received (initial) vaccination. HIV-PrEP use, living with HIV, reporting ≥20 sex partners in the past 12 months, and sex in sex venues/parties in the past 2 months were independent risk factors for mpox diagnosis. Except for sex in sex venues/parties, these variables were also independently associated with mpox vaccination. Conclusion: This study provides novel evidence regarding the degree to which the 2022 eligibility criteria for mpox vaccination align with the risk factors for mpox among GBMSM in the Netherlands. The findings contribute to a refinement of the eligibility criteria for mpox vaccination, to which sex in sex venues/parties should be added.


Assuntos
Infecções por HIV , Mpox , Profilaxia Pré-Exposição , Minorias Sexuais e de Gênero , Vacina Antivariólica , Masculino , Adulto , Humanos , Homossexualidade Masculina , Países Baixos/epidemiologia , Infecções por HIV/epidemiologia , Comportamento Sexual
20.
J Leukoc Biol ; 115(6): 1183-1189, 2024 05 29.
Artigo em Inglês | MEDLINE | ID: mdl-38345417

RESUMO

Prostaglandin E2 (PGE2) is a recognized inhibitor of granulocyte functions. However, most of the data supporting this was obtained when available pharmacological tools mainly targeted the EP2 receptor. Herein, we revisited the inhibitory effect of PGE2 on reactive oxygen species production, leukotriene biosynthesis, and migration in human neutrophils. Our data confirm the inhibitory effect of PGE2 on these functions and unravel that the effect of PGE2 on human neutrophils is obtained by the combined action of EP2 and EP4 agonism. Accordingly, we also demonstrate that the inhibitory effect of PGE2 is fully prevented only by the combination of EP2 and EP4 receptor antagonists, underscoring the importance of targeting both receptors in the effect of PGE2. Conversely, we also show that the inhibition of ROS production by human eosinophils only involves the EP4 receptor, despite the fact that they also express the EP2 receptor.


Assuntos
Dinoprostona , Neutrófilos , Receptores de Prostaglandina E Subtipo EP2 , Receptores de Prostaglandina E Subtipo EP4 , Humanos , Receptores de Prostaglandina E Subtipo EP4/metabolismo , Receptores de Prostaglandina E Subtipo EP2/metabolismo , Neutrófilos/metabolismo , Neutrófilos/efeitos dos fármacos , Dinoprostona/metabolismo , Espécies Reativas de Oxigênio/metabolismo , Movimento Celular/efeitos dos fármacos
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