Assessment and bioaccumulation of heavy metal contaminants in Golden Mahseer (Tor putitora Hamilton, 1822).

Unpolluted freshwater is a crucial component for maintaining the health of humans. This study aimed to investigate the bioaccumulation and potential health hazards of heavy metal contaminants (Fe, Cd, Cr, Cu, Pb) in water, sediments, and tissues of the golden mahseer fish (Tor putitora) from Zhob River to assess their suitability for human consumption. Samples (soil, water, and fish) were collected from the Zhob River, and Flame Atomic Absorption Spectrometry (FAAS) was employed to measure the concentration of these metals found in soil, water, and various fish body tissues (muscles, skin, gills, and liver). The overall results revealed that water quality parameters, i.e., temperature and pH were found within tolerable ranges, while electrical conductivity and turbidity exceeded the permissible limits of FAO/WHO for fish. Furthermore, this study also identified elevated concentrations of Pb in water and soil, as well as Fe and Cd in soil beyond the standards set by the World Health Organization (WHO) and the United States Environmental Protection Agency (USEPA). In contrast, the concentrations of other targeted metals examined in fish body tissues were found below the permissible limits set by the Food and Agriculture Organization (FAO) and the World Health Organization (WHO), indicating the suitability of this fish species for human consumption. The estimated daily intake (EDI) of these targeted metals in various fish body tissues was found to be within the recommended dietary allowance (RDA), suggesting no associated health risks for the local population. Furthermore, both the Target Hazard Quotient (THQ) and Total Target Hazard Quotient (TTHQ) values measured in this study were less than one, indicating the absence of potential non-carcinogenic health risks related to the consumption of this riverine mahseer fish, but combined metal intake may pose potential health risks. Carcinogenic risk assessment for some metals like Cd, Cr, and Pb revealed no cancer risk for consumers. Moreover, our present research observed comparatively high bioaccumulation (BAF) of each targeted metal in the fish liver from both Zhob River water and soil as compared to other body tissues. Multivariate analysis, including the correlation matrix, revealed strong and significant correlations (P < 0.05) among heavy metal pairs (Fe/Cr, Fe/Pb, Cr/Fe, Cr/Pb, Pb/Fe, Pb/Cr). Hierarchical cluster analysis and Principal Component Analysis (PCA) were utilized to trace the origins of these metals, attributing their presence to nearby rock weathering, mining, as well as municipal and agricultural activities. These factors were recognized as potential sources of heavy metal bioaccumulation in riverine fish. Thus, our current study concluded that the Zhob River was contaminated with these heavy metals and emphasized the need to prevent domestic and industrial sewage inflow. The monitoring of these metals in the food chain was also underscored as crucial for reducing all kinds of associated health risks. This study provides the first report on heavy metal distribution in highly abundant and edible mahseer fishes of the Zhob River.

Nitrogen-Doped Graphene-Supported Nickel Nanoparticles Reveal Low Dehydrogenation Temperature and Long Cyclic Life of Magnesium Hydrides.

Magnesium hydride (MgH2) is a promising hydrogen storage candidate due to its large capacity; however, high dehydrogenation temperature and slow kinetic rates are the main bottlenecks. Herein, we proposed a strategy for designing nitrogen-doped graphene-supported Ni nanoparticles (NPs) (Ni@NC) to tackle these problems. The results showed that the MgH2 + 15 wt % Ni@NC nanocomposite reduced the on-set dehydrogenation temperature to 195 °C, which was 175 °C lower than pristine MgH2. In addition, MgH2 + 15 wt % Ni@NC achieved 1.7 and 6.5 wt % desorption capacities at 225 and 300 °C, respectively, while absorbing 5.5 wt % hydrogen at 100 °C. The MgH2 + 15 wt % Ni@NC nanocomposite showed high cyclic stability, achieving 98.0% capacity retention after 100 cycles at 270 °C with negligible loss in capacity. This remarkable hydrogen storage performance can be attributed to the homogeneous distribution of Ni NPs on N-doped graphene layers, in situ formed Mg2NiH2 NPs, and multiphasic regions, promoting the nucleation and growth process during hydrogenation/dehydrogenation, which stabilized and improved the cyclic stability. This strategy paves the way to developing high-performance MgH2 for large-scale applications.

Exploring medical and nursing students' perceptions about a patient safety course: a qualitative study.

BACKGROUND: Educating health professionals on patient safety can potentially reduce healthcare-associated harm. Patient safety courses have been incorporated into medical and nursing curricula in many high-income countries and their impact has been demonstrated in the literature through objective assessments. This study aimed to explore student perceptions about a patient safety course to assess its influence on aspiring health professionals at a personal level as well as to explore differences in areas of focus between medical and nursing students. METHODS: A dedicated patient safety course was introduced for year III medical and year II and IV nursing students at the Aga Khan University (2021-2022). As part of a post-course assessment, 577 participating students (184 medical and 393 nursing) wrote reflections on the course, detailing its influence on them. These free-text responses were thematically analyzed using NVivo. RESULTS: The findings revealed five major themes: acquired skills (clinical, interpersonal), understanding of medical errors (increased awareness, prevention and reduction, responding to errors), personal experiences with patient safety issues, impact of course (changed perceptions, professional integrity, need for similar sessions, importance of the topic) and course feedback (format, preparation for clinical years, suggestions). Students reported a lack of baseline awareness regarding the frequency and consequences of medical errors. After the course, medical students reported a perceptional shift in favor of systems thinking regarding error causality, and nursing students focused on human factors and error prevention. The interactive course format involving scenario-based learning was deemed beneficial in terms of increasing awareness, imparting relevant clinical and interpersonal skills, and changing perspectives on patient safety. CONCLUSIONS: Student perspectives illustrate the benefits of an early introduction of dedicated courses in imparting patient safety education to aspiring health professionals. Students reported a lack of baseline awareness of essential patient safety concepts, highlighting gaps in the existing curricula. This study can help provide an impetus for incorporating patient safety as a core component in medical and nursing curricula nationally and across the region. Additionally, patient safety courses can be tailored to emphasize areas identified as gaps among each professional group, and interprofessional education can be employed for shared learning. The authors further recommend conducting longitudinal studies to assess the long-term impact of such courses.

Network-based drug repurposing identifies small molecule drugs as immune checkpoint inhibitors for endometrial cancer.

Endometrial cancer (EC) is the 6th most common cancer in women around the world. Alone in the United States (US), 66,200 new cases and 13,030 deaths are expected to occur in 2023 which needs the rapid development of potential therapies against EC. Here, a network-based drug-repurposing strategy is developed which led to the identification of 16 FDA-approved drugs potentially repurposable for EC as potential immune checkpoint inhibitors (ICIs). A network of EC-associated immune checkpoint proteins (ICPs)-induced protein interactions (P-ICP) was constructed. As a result of network analysis of P-ICP, top key target genes closely interacting with ICPs were shortlisted followed by network proximity analysis in drug-target interaction (DTI) network and pathway cross-examination which identified 115 distinct pathways of approved drugs as potential immune checkpoint inhibitors. The presented approach predicted 16 drugs to target EC-associated ICPs-induced pathways, three of which have already been used for EC and six of them possess immunomodulatory properties providing evidence of the validity of the strategy. Classification of the predicted pathways indicated that 15 drugs can be divided into two distinct pathway groups, containing 17 immune pathways and 98 metabolic pathways. In addition, drug-drug correlation analysis provided insight into finding useful drug combinations. This fair and verified analysis creates new opportunities for the quick repurposing of FDA-approved medications in clinical trials.

Highly scalable photoinduced synthesis of silanols via untraversed pathway for chlorine radical (Cl•) generation.

The emergence of visible light-mediated synthetic transformations has transpired as a promising approach to redefine traditional organic synthesis in a sustainable way. In this genre, transition metal-mediated photoredox catalysis has led the way and recreated a plethora of organic transformations. However, the use of photochemical energy solely to initiate the reaction is underexplored. With the direct utilization of photochemical energy herein, we have established a general and practical protocol for the synthesis of diversely functionalized organosilanols, silanediols, and polymeric siloxanol engaging a wide spectrum of hydrosilanes under ambient reaction conditions. Streamlined synthesis of bio-active silanols via late-stage functionalization underscores the importance of this sustainable protocol. Interestingly, this work also reveals photoinduced non-classical chlorine radical (Cl•) generation from a readily available chlorinated solvent under aerobic conditions. The intriguing factors of the proposed mechanism involving chlorine and silyl radicals as intermediates were supported by a series of mechanistic investigations.

Lanthanide complexes facilitate wound healing by promoting fibroblast viability, migration and M2 macrophage polarization.

A tridentate ligand LH3 ((2-hydroxy-3-methoxybenzylidene)-2-(hydroxyimino)propanehydrazide) comprising o-vanillin, hydrazone and oxime donor groups has been employed to prepare a series of tetranuclear Ln(III) complexes. The reaction of ligand LH3 with Ln(NO3)3 [Ln = Sm, Eu, Gd, Tb, Dy, Ho, Er] in MeOH yielded Ln4(LH)6(MeOH)2 (Ln = Sm(1), Eu(2), Gd(3), Tb(4), Ho (6) and Er (7))] whereas the corresponding reaction with Dy(NO3)3 afforded Dy4(LH)4(LH2)2(OH)2 (5). All complexes were characterized by various analytical techniques including single crystal X-ray diffraction, IR spectroscopy, UV-Vis spectroscopy, and elemental analysis. To investigate the potential of these lanthanide complexes for wound healing applications, their effects on fibroblast viability, migration, and M2 macrophage polarization were evaluated. The cytotoxicity assessment revealed that complexes 2(Eu), 4(Tb), 5(Dy), and 7(Er) significantly enhanced fibroblast viability compared to the negative control (NC). In vitro wound healing assay demonstrated that complexes 2(Eu) and 7(Eu) substantially promoted fibroblast migration compared to the NC. Moreover, complex 2(Eu) exhibited significant anti-inflammatory effects by reducing the phagocytic ability of lipopolysaccharide (LPS)-stimulated macrophage cells and attenuating nitric oxide (NO) production. In conclusion, among the series of complexes tested, complex 2(Eu) displayed the most potent anti-inflammatory effect on macrophage cells, while simultaneously promoting fibroblast viability and migration. This unique combination of properties renders complex 2 (Eu) highly promising for wound healing applications.

Heavy metal(loid)s contamination and potential risk assessment via groundwater consumption in the district of Hangu, Pakistan.

This study examined the concentration of heavy metal(loid)s (HM) in groundwater and associated health risks in the Hangu District, Pakistan. Seventy-one groundwater samples were selected from various sources to determine the concentration of twelve HM using the ICP-MS. The average concentrations of HM in groundwater were observed within acceptable guidelines proposed by the World Health Organization (WHO). Similarly, the groundwater of the study area based on the HM contamination index results was noted as an excellent group. Generally, the chronic daily intake (CDI) values for both adults and children were observed in the sequence of Fe > Zn > Ni > Mn > Cu > Sb > Cr > Mo > As > Pb > Co > Cd. The highest hazard quotient was computed for children through groundwater from the tube well. Moreover, both carcinogenic and non-carcinogenic hazards of groundwater were observed in the order of tube well > dug well > spring > bore well. The present study suggests that children were more susceptible to health risks than adults.

Diagnosis of Primary Hepatic Lymphoma in a 55-Year-Old Male Patient Presented With Pain in the Right Hypochondrium: A Very Rare Case.

Primary hepatic lymphoma (PHL) is a rare subtype of diffuse large B-cell lymphoma (DLBCL). A 55-year-old male patient presented to us with jaundice and right upper quadrant pain. Investigations showed elevated alkaline phosphatase, lactate dehydrogenase, total bilirubin, normal alanine transaminase, and negative viral profile. Sonographic and computed tomographic scans show hepatosplenomegaly with hypodense lesion in liver associated with lymph nodes enlargement in the region of porta hepatis celiac axis, mediastinal and axillary lymphadenopathy. On immunohistochemistry, cells were positive for cluster of differentiation (CD)-19, CD-20, CD-21, c-myelocytomatosis oncogene (c-MYC), B-cell lymphoma 2 (Bcl-2), multiple myeloma oncogene-1 (MUM-1), same as B cell markers so it is diagnosed as PHL. DLBCL especially PHL shall be considered among the differentials of space-occupying lesions of liver. Early diagnosis of primary hepatic lymphoma is not a difficult task if excisional lymph node biopsy is taken following detection on ultrasound or CT scan which will lead to improved treatment, improvement in survival, and cost-effectiveness with good prognostic outcomes.

Acceptability and feasibility of HIV self-testing among transgender people in Larkana, Pakistan: Results from a pilot project.

BACKGROUND: HIV self-testing (HIVST) is an innovative HIV testing approach that effectively reaches those who do not otherwise test, including key populations (KPs). Despite potential benefits, HIVST is not currently implemented in Pakistan. The high risk of HIV among transgender (TGs) persons is among the highest risk group for HIV in Pakistan, yet knowledge of HIV status remains low in this key population group. We conducted a pilot project to assess the acceptability and feasibility of distributing HIVST to TGs in Larkana. METHODS: Eligible participants were 18 years or above and self-identified as transgender ("hijra"). One oral fluid HIVST kit per person was distributed free of cost in the community by trained transgender peer outreach workers (ORW). Participants could request a demonstration of the HIVST procedure before performing self-testing which was provided by the trained ORW. Demographic characteristics of participants were collected. The ORW followed up with phone calls two days later to record if HIVST kits were used, the results, and whether assistance was required. RESULTS: Between November 2020 and February 2021, 150 HIVST kits were distributed to eligible TGs. The average age of participants was 25.5 years (standard deviation: 7.0). Over a third (52, 34.7%) had no formal education, while (16, 10.6%) had attended at least five years of schooling. Over one-third (58, 38.6%) of participants were first-time testers. One hundred and thirty-nine (92.7%) participants reported their results within two days. For the remaining 11 participants, ORWs had to contact them. All participants reported using HIVST kits within three days. A majority (141, 94%) used the kit in their homes, and the remaining nine (6%) used it at the community-based organization's office. Overall, a small proportion (11, 7.3%) of participants requested a demonstration of the test procedure before performing HIVST. Four (2.7%) participants who had performed unsupervised self-tests reported reactive HIVST results; all were linked to treatment within five working days once their HIV result was confirmed. The majority (136, 90.6%) of participants felt that self-testing was easy to perform independently, and 143 (95%) reported that they would recommend HIVST to their peers. CONCLUSION: HIVST is acceptable among TGs and identified by first-time testers as undiagnosed infections. Peer-led distribution appears to be a feasible approach for implementation in this setting. HIVST should be considered for routine implementation and scale up to reduce testing gaps among Pakistan's key population, particularly TGs.

Not Just "COVID Anxiety": A Case of Subacute Thyroiditis in a Patient Recovering From SARS-CoV-2 Infection.

Subacute thyroiditis (SAT) is an uncommon, granulomatous, inflammatory thyroid disorder. It usually presents with anterior neck and/or jaw pain, diffusely tender goiter, fever, fatigue, myalgia, and anorexia. Most patients with SAT initially develop symptoms and signs of hyperthyroidism which usually subsides within a few weeks with or without going through a transient phase of hypothyroidism. SAT is usually associated with a viral infection of the upper respiratory tract. We report a case of SAT in a 30-year-old male with a recent COVID-19 infection. The patient presented with a three days history of painful anterior neck mass and palpitations. He was diagnosed with COVID-19 16 days before presentation. His infection was mild and did not need any treatment apart from as-needed paracetamol. The patient was found to have a clinical, laboratory, and imaging findings consistent with SAT. The patient was prescribed ibuprofen, prednisone, and propranolol. The patient showed significant clinical and biochemical improvement on follow-up visits, achieving a euthyroid state within several weeks. Like many other respiratory viral illnesses, COVID-19 also seems to be associated with SAT. Other endocrinological sequelae have also been reported. While reviewing patients suffering from COVID-19 infection, these possibilities should be kept in mind.

Efficacy of Azadirachta indica (Neem) leaf extract and hypertonic saline solution as intratesticular chemical sterilizing agents in dogs / Eficácia do extrato de folha de Azadirachta indica (Neem) e solução salina hipertônica como agente químico esterilizante intratesticular em cães

Castration refers to induced sterility via physical, chemical, or hormonal methods. Chemical castration is an efficient and reliable technique in contrast to other sterilization procedures as it is less painful to physical methods and cost­effective to hormonal methods. Azadirachta indica (neem), is a charismatic plant as its leaves possess anti­inflammatory, anti­microbial, and anti­androgenic chattels. To abate the escalating human population in South Asia, neem oil and neem leaf extract have been effectively used as a contraceptive agent. The key determinant of the current study was to evaluate Neem as a chemical sterilizing agent, (either necrotic or apoptotic), in dogs injected intratesticular in comparison to a hypertonic saline solution. Pre­ and post­injection testicular width size and blood samples for serum testosterone levels were collected on alternative days. Results disclosed substantial changes in testicular width size, histopathological profile, and serum testosterone level. A non­significant (P > 0.05) pre­injection testicular width readings in contrast to a significant increase (P < 0.05) three days post­injection was noted in all the competitive groups. The mean values recorded for testicular width size at the end of the trial study via neem leaf extract, 30% HSS and, control groups were 27.7362 ± 2.3315mm, 30.9594 ± 4.6861mm, and 24.5023 ± 2.5387mm, respectively. A declining trend, regarding serum testosterone level being statistically significant (P < 0.05) was recorded in treated groups (A, B) in contrast to the control group (C) as the values were 1.5357 ± 0.7819ng, 1.2669 ± 0.9095ng, and 2.4517 ± 0.1827ng in groups A, B, and C, respectively. Histopathological findings advocated the presence of apoptotic bodies in the neem treated group whereas the presence of degenerated interstitial cells, necrosed seminiferous tubules, damaged germinal epithelium, and ceased spermatogenesis was also studied in both competitive groups. Thus, the apoptotic effect and anti­inflammatory property of neem leaf extract resulted in less painful castration and verified Azadirachta indica as a better substitute for chemical castration in contrast to hypertonic saline solution.(AU)

A castração consiste na indução da esterilidade por meio físico, químico ou hormonal. A castração química é uma técnica eficiente e confiável, em contraste com outros procedimentos de esterilização, pois é menos dolorosa para os métodos físicos e econômicos para os métodos hormonais. Azadirachta indica (neem), é uma planta carismática, pois possui folhas anti­inflamatórias, antimicrobianas e antiandrogênicas. Para diminuir a crescente população humana no sul da Ásia, o óleo de nim e o extrato de folhas de nim têm sido efetivamente usados como agente contraceptivo. O principal determinante deste estudo atual foi avaliar o Neem como um agente esterilizante químico (necrótico ou apoptótico) em cães injetados intratesticularmente em comparação com uma solução salina hipertônica. O tamanho da largura testicular pré e pós­injeção e as amostras de sangue para os níveis séricos de testosterona foram colhidas em dias alternados. Os resultados obtidos revelaram alterações substanciais no tamanho da largura testicular, perfil histopatológico e nível sérico de testosterona. Observou­se uma leitura não significativa (P> 0,05) da largura testicular da pré­injeção, em contraste com um aumento significativo (P <0,05) três dias após a injeção em todos os grupos competitivos.Os valores médios registrados para o tamanho da largura testicular no final do estudo via extrato de folhas de nim,HSS a 30% e grupos controle foram 27,7362 ± 2,3315 mm, 30,9594 ± 4,6861 mm e 24,5023 ± 2,5387 mm, respectivamente.Uma tendência decrescente, com relação ao nível sérico de testosterona sendo estatisticamente significante (P <0,05), foi registrada nos grupos tratados (A, B), em contraste com o grupo controle (C), pois os valores eram 1,5357 ± 0,7819ng, 1,2669 ± 0,9095ng e 2,4517 ± 0,1827ng nos grupos A, B e C, respectivamente. Os achados histopatológicos advogaram a presença de corpos apoptóticos no grupo tratado com nim, enquanto a presença de células intersticiais degeneradas, túbulos seminíferos necrosados, epitélio germinativo danificado e espermatogênese interrompida também foi estudada nos dois grupos competitivos. Assim, o efeito apoptótico e a propriedade anti­inflamatória do extrato de folhas de nim resultaram em uma castração menos dolorosa e confirmaram que a Azadirachta indica foi um melhor substituto para a castração química do que a solução salina hipertônica.(AU)

Fuzzy Gaussian Lasso clustering with application to cancer data.

Recently, Yang et al. (2019) proposed a fuzzy model-based Gaussian (F-MB-Gauss) clustering that combines a model-based Gaussian with fuzzy membership functions for clustering. In this paper, we further consider the F-MB-Gauss clustering with the least absolute shrinkage and selection operator (Lasso) for feature (variable) selection, termed a fuzzy Gaussian Lasso (FG-Lasso) clustering algorithm. We demonstrate that the proposed FG-Lasso is a good clustering algorithm with better choice for feature subset selection. Experimental results and comparisons actually present these good aspects of the proposed FG-Lasso clustering algorithm. Cancer is a disease with growth of abnormal cells in a body. WHO reported that it is the first or second main leading cause of death. It spreads and affects the other parts of body if there is not properly diagnosed. In the paper, we apply the proposed FG-Lasso to cancer data with good feature selection and clustering results.

A Mature Cystic Teratoma of the Urinary Bladder.

We report a case of a mature cystic teratoma of urinary bladder in a 17-year female, which is extremely rare. The patient presented with pain in suprapubic region for one year. On computerized tomography (CT) of abdomen and pelvis, a welldefined, enhancing heterogeneous soft tissue density lesion measuring 2.5x2.3x3 cm with mean density of 48 Hounsfield unit was found originating from the superior wall of the urinary bladder and projecting into the lumen. Cystoscopy showed a 2X2 cm growth containing concretions. Resection of the lesion was done with wide margin by transurethral resection of bladder tumor (TURBT). Histopathological examination showed fragments of skin, sebaceous glands, fat and muscle cells, confirming mature cystic teratoma.

Prominent role of histone lysine demethylases in cancer epigenetics and therapy.

Protein methylation has an important role in the regulation of chromatin, gene expression and regulation. The protein methyl transferases are genetically altered in various human cancers. The enzymes that remove histone methylation have led to increased awareness of protein interactions as potential drug targets. Specifically, Lysine Specific Demethylases (LSD) removes methylated histone H3 lysine 4 (H3K4) and H3 lysine 9 (H3K9) through formaldehyde-generating oxidation. It has been reported that LSD1 and its downstream targets are involved in tumor-cell growth and metastasis. Functional studies of LSD1 indicate that it regulates activation and inhibition of gene transcription in the nucleus. Here we made a discussion about the summary of histone lysine demethylase and their functions in various human cancers.

Post-PCNL Renal Artery Pseudoanurysm.

A renal artery pseudoaneurysm is a rare but important complication that can occur after renal trauma, renal biopsy, percutaneous nephrostomy, percutaneous nephrolithotomy (PCNL), and partial nephrectomy. The incidence of this potentially life-threatening complication is less than 1%, but is likely to increase with the increasing popularity of endoscopic renal procedures. We present a case of a 30-year female who underwent right PCNL for a right renal pelvic stone. Two weeks later, she presented with massive hematuria. Renal angiography revealed psuedoanurysm of interlobar artery which was successfully treated with coil embolization.

Abdominal Supernumerary Testis Complicated by Yolk Sac Tumor.

We describe a case of a 26-year man with complaints of suprapubic pain and burning micturition for two weeks and intermittent hematuria for two months. On physical examination, there was palpable mobile pelvic mass measuring 10x10 cm. Both testes were palpable in the scrotum. CT scan abdomen revealed well-defined, soft tissue mass, about 11x10 cm between rectum and urinary bladder. Mass showed internal necrotic changes and enhancement along the walls. No calcification was seen. Exploratory laparotomy was done. Tumour mass was nodular tissue weighing 194 gm. Diagnosis was confirmed histologically showing yolk sac tumor. Postoperatively, tumour markers were normal. MRI pelvis revealed no residual tumor.

Interacting partners of FEN1 and its role in the development of anticancer therapeutics.

Protein-protein interaction (PPI) plays a key role in cellular communication, Protein-protein interaction connected with each other with hubs and nods involved in signaling pathways. These interactions used to develop network based biomarkers for early diagnosis of cancer. FEN1(Flap endonuclease 1) is a central component in cellular metabolism, over expression and decrease of FEN1 levels may cause cancer, these regulation changes of Flap endonuclease 1reported in many cancer cells, to consider this data may needs to develop a network based biomarker. The current review focused on types of PPI, based on nature, detection methods and its role in cancer. Interacting partners of Flap endonuclease 1 role in DNA replication repair and development of anticancer therapeutics based on Protein-protein interaction data.

Use of the Resection Map system as guidance during hepatectomy.

BACKGROUND: The objective of this work is to evaluate a new concept of intraoperative three-dimensional (3D) visualization system to support hepatectomy. The Resection Map aims to provide accurate cartography for surgeons, who can therefore anticipate risks, increase their confidence and achieve safer liver resection. METHODS: In an experimental prospective cohort study, ten consecutive patients admitted for hepatectomy to three European hospitals were selected. Liver structures (portal veins, hepatic veins, tumours and parenchyma) were segmented from a recent computed tomography (CT) study of each patient. The surgeon planned the resection preoperatively and read the Resection Map as reference guidance during the procedure. Objective (amount of bleeding, tumour resection margin and operating time) and subjective parameters were retrieved after each case. RESULTS: Three different surgeons operated on seven patients with the navigation aid of the Resection Map. Veins displayed in the Resection Map were identified during the surgical procedure in 70.1% of cases, depending mainly on size. Surgeons were able to track resection progress and experienced improved orientation and increased confidence during the procedure. CONCLUSIONS: The Resection Map is a pragmatic solution to enhance the orientation and confidence of the surgeon. Further studies are needed to demonstrate improvement in patient safety.

Cognitive processes as integrative component for developing expert decision-making systems: a workflow centered framework.

The development of expert decision-making systems, which improve task performance and reduce errors within an intra-operative clinical workspace, is critically dependent on two main aspects: (a) Analyzing the clinical requirements and cognitive processes within the workflow and (b) providing an optimal context for accurate situation awareness through effective intra-operative information visualization. This paper presents a workflow centered framework and its theoretical underpinnings to design expert decision-making systems. The framework integrates knowledge of the clinical workflow based on the requirements within the clinical workspace. Furthermore, it builds upon and integrates the theory of situation awareness into system design to improve decision-making. As an application example, this framework has been used to design an intra-operative visualization system (IVS), which provides image guidance to the clinicians to perform minimally invasive procedure. An evaluative study, comparing the traditional ultrasound guided procedure with the new developed IVS, has been conducted with expert intervention radiologists and medical students. The results reveal significant evidence for improved decision-making when using the IVS. Therefore, it can be stated that this study demonstrates the benefits of integrating knowledge of cognitive processes into system development to support clinical decision-making and hence improvement of task performance and prevention of errors.