Smoked drug use in patients with TB is associated with higher bacterial burden.

BACKGROUND: Smoking of illicit drugs may lead to more rapid TB disease progression or late treatment presentation, yet research on this topic is scant. We examined the association between smoked drug use and bacterial burden among patients newly initiated on drug-susceptible TB (DS-TB) therapy.METHODS: Data from 303 participants initiating DS-TB treatment in the Western Cape Province, South Africa, were analyzed. Smoked drug use was defined as self-reported or biologically verified methamphetamine, methaqualone and/or cannabis use. Proportional hazard and logistic regression models (adjusted for age, sex, HIV status and tobacco use) examined associations between smoked drug use and mycobacterial time to culture positivity (TTP), acid-fast bacilli sputum smear positivity and lung cavitation.RESULTS: People who smoked drugs (PWSD) comprised 54.8% (n = 166) of the cohort. TTP was faster for PWSD (hazard ratio 1.48, 95% CI 1.10-1.97; P = 0.008). Smear positivity was higher among PWSD (OR 2.28, 95% CI 1.22-4.34; P = 0.011). Smoked drug use (OR 1.08, 95% CI 0.62-1.87; P = 0.799) was not associated with increased cavitation.CONCLUSIONS: PWSD had a higher bacterial burden at diagnosis than those who do not smoke drugs. Screening for TB among PWSD in the community may facilitate earlier linkage to TB treatment and reduce community transmission.

A rare case of Immunoglobulin A dominant post-infectious glomerulonephritis (IgA PIGN) in a young patient.

BACKGROUND: Immunoglobulin A dominant postinfectious glomerulonephritis (IgA PIGN) is a unique medical entity that is rare in the paediatric population. It usually presents with severe renal failure, heavy proteinuria, hypertension, and hypocomplementemia and frequently has an unfavourable prognosis. IgA PIGN generally occurs in association with staphylococcal infections and diabetes mellitus in adult patients. Other pathogens include Escherichia coli and Streptococcus sp. Immunofluorescence studies of kidney biopsy samples show IgA as dominant or codominant antibody. CASE PRESENTATION: We encountered a 3-year-old girl with IgA PIGN presenting with acute renal failure, oedema, hypertension, and heavy proteinuria of 7955 mg/g creatinine. Renal biopsy specimens showed diffuse glomerular endocapillary hypercellularity with prominent neutrophil and monocyte infiltration on light microscopy. Strong deposits of IgA and C3 were observed along the glomerular basement membranes and the mesangium by immunofluorescence microscopy, and electron microscopy revealed the presence of subepithelial humps. The patient was managed with steroid (and probatory antibiotic) therapy and is now undergoing follow-up, with a significant improvement 6 months after the initial presentation (glomerular filtration rate (GFR) and cystatin C clearance rate of 165 ml/min/1.73m2 and 106 ml/min/1.73m2, respectively). No signs of bacterial infection were detectable. CONCLUSION: This variant of IgA PIGN must be distinguished from other clinical entities, especially IgA nephropathy (mesangial IgA deposits) and postinfectious glomerulonephritis (C3, IgG and occasional IgM capillary loop deposits with or without mesangial distribution), since patients with IgA PIGN may require steroid treatment in addition to antibiotic therapy. Differential diagnosis should also include C3 glomerulopathy. IgA PIGN is a recently identified disease entity that generally manifests in adult patients with both IgA and C3 mesangial and glomerular capillary wall deposits. We present a biopsy-proven case of IgA PIGN that manifested in a patient at an exceptionally young age and that has had a good clinical outcome. To the best of our knowledge, this is the youngest IgA PIGN patient reported thus far.

Transesophageal Echocardiography - Dysphagia Risk in Acute Stroke (TEDRAS): a prospective, blind, randomized and controlled clinical trial.

BACKGROUND AND PURPOSE: Dysphagia is common in acute stroke and leads to worse overall outcome. Transesophageal echocardiography (TEE) is used in the diagnostic evaluation of stroke with regard to its etiology and is a known cause of postoperative dysphagia in cardiac surgery. The prevalence of dysphagia in acute stroke patients undergoing TEE remains unknown. The aim of the Transesophageal Echocardiography - Dysphagia Risk in Acute Stroke (TEDRAS) study was to assess the influence of TEE on swallowing among patients who have experienced acute stroke. METHODS: The TEDRAS study was a prospective, blind, randomized, controlled trial that included two groups of patients with acute stroke. Simple unrestricted randomization was performed, and examiners were blinded to each other's results. Swallowing was tested using flexible endoscopic evaluation of swallowing (FEES) at three different time points in the intervention group (24 h before, immediately after and 24 h after TEE) and in the control group (FEES on three consecutive days and TEE earliest after the third FEES). Validated scales were used to assess dysphagia severity for all time points as primary outcome measures. RESULTS: A total of 34 patients were randomized: 19 to the intervention group and 15 to the control group. The key findings of the repeated-measures between-group comparisons were significant increases in the intervention group for the following dysphagia measures: (1) secretion severity score (immediately after TEE: P < 0.001; 24 h after TEE: P < 0.001) and (2) Penetration-Aspiration Scale score for saliva (immediately after TEE: P < 0.001; 24 h after TEE: P = 0.007), for small (immediately after TEE: P = 0.009) and large liquid boli (immediately after TEE: P = 0.009; 24 h after TEE: P = 0.025). CONCLUSION: The results indicate a negative influence of TEE on swallowing in acute stroke patients for at least 24 hours.

Genetic variant c.711A>T in the hepatobiliary phospholipid transporter ABCB4 is associated with significant liver fibrosis.

Liver fibrosis is the common consequence of chronic liver diseases (CLD). Recently liver stiffness measurements (LSM) ≥ 9.1 kPa, as determined by transient elastography (TE), were demonstrated to predict significant fibrosis (stages ≥ F2) in a population-based setting. The PNPLA3 (adiponutrin) p.I148M polymorphism enhances the risk of liver injury. The aim of our study was to investigate the association between the procholestatic ABCB4 polymorphism c.711A>T and LSM ≥ 9.1 kPa in humans as well as the interaction between ABCB4 and PNPLA3 in a mouse model of chronic cholestasis. Prospectively, we recruited 712 patients with CLD (278 women, age 50 ± 13 years) with available TE results; liver biopsy results were available in 165 individuals. The ABCB4 c.711 genotype was determined by PCR-based assays. PNPLA3 expression and liver injury were studied in Abcb4-/- mice and wild-type controls. Overall, median LSM in our cohort was 6.7 kPa, and 226 individuals had LSM ≥ 9.1 kPa. Carriers of the ABCB4 variant c.711A presented more frequently with LSM ≥ 9.1 kPa (OR = 1.33, P = 0.020) and FIB-4 score ≥ 2.67 (OR = 1.38, P = 0.040). The presence of the risk allele was associated (P = 0.002) with FIB-4. In a multivariate model, the ABCB4 variant (OR = 1.43, P = 0.047) as well as BMI (P = 0.043, OR = 1.04) and age (OR = 1.02, P < 0.010) were independent risk factors for fibrosis stage ≥ F2. Abcb4 deficiency in mice led to enhanced liver injury, coupled with a decrease (P = 0.020) of hepatic PNPLA3 expression. To conclude, the procholestatic variant ABCB4 c.711A>T might represent a new genetic risk factor for clinically significant liver fibrosis. Lower expression of PNPLA3 in fibrotic Abcb4-/- livers points to the interaction between phospholipid metabolism and PNPLA3 in progressive liver injury.

Reduced Neural Satiety Responses in Women Affected by Obesity.

Overweight and obesity are major risk factors for a number of chronic diseases, including diabetes, cardiovascular diseases, and cancer. Obesity rates are on the rise worldwide with women more frequently affected than men. Hedonic responses to food seem to play a key role in obesity, but the exact mechanisms and relationships are still poorly understood. In this study, we investigate the perceived pleasantness of food rewards in relation to satiety and calories consumed during an ad libitum meal in women. Using functional magnetic resonance imaging (fMRI) and a milkshake consumption task, we studied how experienced food values are encoded in women with healthy weight, overweight or obesity. Participants rated the pleasantness and intensity of high and low caloric milkshakes in the fMRI scanner during both the fasted and fed states. We found differences in the neural responses and experienced pleasantness of high and low caloric milkshakes depending on satiety and Body Mass Index (BMI). Women with both high ad libitum consumption levels and high BMI reported greater experienced pleasantness for milkshakes. In contrast, among women with low ad libitum consumption levels, greater BMI was associated with less experienced pleasantness. At the neural level, satiety affected women with obesity to a lesser degree than women with healthy weight. Thus, having obesity was associated with altered relationships between food consumption and the hedonic responses to food rewards as well as reduced satiety effects in women.

Laser-based synchrotron X-ray radiation experimental scaling.

We review the results obtained in several experimental campaigns with the INRS high-power laser system and determine the X-ray emission scaling from synchrotron radiation produced during laser wakefield acceleration (LWFA) of electrons. The physical processes affecting the generation of intense and stable X-ray beams during the propagation phase of the high-intensity ultrashort pulse in the gas jet target are discussed. We successfully produced stable propagation in the gas jet target of a relativistic laser pulse through self-guiding on length larger than the dephasing and depletion lengths, generating very intense beams of hard X-rays with up to 200 TW on target. The experimental scaling law obtained for the photon yield in the 10-40 keV range is presented and the level of X-ray emission at the 1 PW laser peak power level, now available at several laser facilities, is estimated.

Oregano essential oil in the diet of laying hens in winter reduces lipid peroxidation in yolks and increases shelf life in eggs.

We evaluated the effects of oregano essential oil (OEO) added to the feed of semi-heavy laying hens during winter. We measured performance as well as physical and chemical quality of fresh and 21-day stored eggs. A total of 240 semi-heavy laying hens were distributed into six treatments and five replicates (n = 8 each). Treatments consisted of five groups of hens fed diets supplemented with 0, 50, 100, 150 and 200 mg OEO/kg. We measured the average of three productive cycles (1st: week 1-4, 2nd: week 5-8 and 3rd: week 9-12), and found that feed consumption increased in hens in the control group and those in the group treated with 200 mg OEO/kg; other zootechnical variables did not differ between treatments. When we analyzed each individual production cycle individually, we did not observe differences between treatments for the performance variables in the first or second cycles. However, in the third cycle, when the animals were exposed to a greater number of days to cold stress, we recorded improved conversion rate/dozen eggs, conversion rate/daily feed consumed and egg production at T50 (50 mg OEO/kg). Stored eggs from hens supplemented with 50 mg OEO/kg showed lower eggshell percentages and higher yolk pHs. The intensity of the yellow was higher in yolks of the control group and in those from hens supplemented with 200 mg OEO/kg. Lipid peroxidation was lower in fresh egg yolks from hens that received 200 mg OEO/kg and stored eggs of T150. The reduction of lipid peroxidation in egg yolk is beneficial to consumer health by reducing levels of free radicals consumed. Reduction of lipid peroxidation associated with 150 mg OEO/kg in laying hens in winter might be useful for maintaining egg quality and for prolonging shelf life; productive efficiency was improving even at 39.8 mg OEO/kg if we consider feed conversion (kg/kg).

Oregano essential oil (Origanum vulgare) to feed laying hens and its effects on animal health.

This study evaluated the effect of oregano essential oil added to the feed of commercial laying hens. This research was focused on the analysis of biochemical changes linked to hepatic function, and protein and lipid metabolism. It was used 240 laying hens (59 weeks-old) distributed in a completely randomized design of six treatments (five repetitions with eight birds each). The experiments were constituted by a control treatment (CT) with the inclusion of zinc bacitracin and five treatments of oregano essential oil (OEO: 0, 50, 100, 150, and 200 mg.kg-1), respectively. After 28 days of feeding, an increase on serum levels of total proteins and globulins was observed on groups T150 and T200, as well as an increase on albumin levels on group CT. After 84 days of feeding, a significant reduction on total proteins and albumin was observed on group T200, as well as an increase in serum triglycerides. OEO at 200 mg.kg-1 increased globulin levels on day 28, which may be considered an effect in the inflammatory response, which increases serum immunoglobulins and proteins.

The accuracy of image-based safety analysis for robotic cochlear implantation.

PURPOSE: To evaluate the accuracy and reliability of image-based safety analysis for robotic cochlear implantation (RCI) in an ex vivo assessment. METHODS: The accuracy was evaluated in a study on 23 human temporal bones. For image analysis, a computer-assisted safety analysis based on intraoperative cone beam computed tomography was implemented. The method automatically segments the drill tunnel and predicts the distance between the tunnel and the facial nerve. In addition, the drilling error at the target is predicted. The predicted distances were compared with the actually drilled distances measured in postoperative high-resolution micro-computed tomography scans. The automatic method was compared to accuracies associated with a manual analysis of the image data. RESULTS: The presented computerized image-based analysis enabled the proximity of the facial nerve to the drill trajectory to be predicted with an accuracy of 0.22 ± 0.15 mm and drilling error at the target to be predicted with an accuracy of 0.11 mm ± 0.08 during N = 19 RCI procedures. The manual assessment of facial nerve proximity was performed with an accuracy of 0.34 ± 0.20 mm by a trained clinical expert. CONCLUSION: The assessment of intraoperative CT-based imaging presents multiple benefits over alternative safety mechanisms including early detection and applicability even in cases of malformation of the mastoid. This work presents a computer-assisted approach to image analysis that enables procedure safety measurements to be reliably performed with superior accuracy to other proposed safety methodologies, at a safe distance from the facial nerve. Its application must, however, be considered in relation to associated costs (time, cost, irradiation) and the dependence of the measure on a reliable preoperative segmentation.

[Navigated liver surgery : Current state and importance in the future]. / Navigierte Leberchirurgie : Aktueller Stand und Bedeutung in der Zukunft.

The preoperative computer-assisted resection planning is the basis for every navigation. Thanks to modern algorithms, the prerequisites have been created to carry out a virtual resection planning and a risk analysis. Thus, individual segment resections can be precisely planned in any conceivable combination. The transfer of planning information and resection suggestions to the operating theater is still problematic. The so-called stereotactic liver navigation supports the exact intraoperative implementation of the planned resection strategy and provides the surgeon with real-time three-dimensional information on resection margins and critical structures during the resection. This is made possible by a surgical navigation system that measures the position of surgical instruments and then presents them together with the preoperative surgical planning data. Although surgical navigation systems have been indispensable in neurosurgery and spinal surgery for many years, these procedures have not yet become established as standard in liver surgery. This is mainly due to the technical challenge of navigating a moving organ. As the liver is constantly moving and deforming during surgery due to respiration and surgical manipulation, the surgical navigation system must be able to measure these alterations in order to adapt the preoperative navigation data to the current situation. Despite these advances, further developments are required until navigated liver resection enters clinical routine; however, it is already clear that laparoscopic liver surgery and robotic surgery will benefit most from navigation technology.

Accuracy assessment of a potential clinical use of navigation-guided intra-operative liver metastasis brachytherapy-a planning study.

For patients with inoperable liver metastases, intra-operative liver high dose-rate brachytherapy (HDR-BT) is a promising technology enabling delivery of a high radiation dose to the tumor, while sparing healthy tissue. Liver brachytherapy has been described in the literature as safe and effective for the treatment of primary or secondary hepatic malignancies. It is preferred over other ablative techniques for lesions that are either larger than 4 cm or located in close proximity to large vessels or the common bile duct. In contrast to external beam radiation techniques, organ movements do not affect the size of the irradiated volume in intra-operative HDR-BT and new technical solutions exist to support image guidance for intra-operative HDR-BT. We have retrospectively analyzed anonymized CT datasets of 5 patients who underwent open liver surgery (resection and/or ablation) in order to test whether the accuracy of a new image-guidance method specifically adapted for intra-operative HDR-BT is high enough to use it in similar situations and whether patients could potentially benefit from navigation-guided intra-operative needle placement for liver HDR-BT.

Large Bacterial Floc Causing an Independent Extraradicular Infection and Posttreatment Apical Periodontitis: A Case Report.

This article describes a case of large persistent posttreatment apical periodontitis associated with 2 maxillary incisors, which was successfully managed by periradicular surgery. Histobacteriologic analysis revealed that the lesion was a granuloma that contained in its body a very large actinomycoticlike colony surrounded by accumulations of polymorphonuclear leukocytes and showing no direct communication with the root canal systems from both teeth. One incisor had no evidence of persistent intraradicular infection, whereas the other exhibited some residual dentinal tubule infection in the apical canal, which may have not significantly contributed to persistent inflammation given the organization and agglomeration of inflammatory cells around the large extraradicular bacterial colony. Findings showed that the main cause of persistent disease was the extraradicular infection in the form of a large bacterial floc, apparently independent of an intraradicular infection and as such only solved by surgery.

Identification of 'Point A' as the prevalent source of error in cephalometric analysis of lateral radiographs.

Deviations in measuring dentofacial components in a lateral X-ray represent a major hurdle in the subsequent treatment of dysgnathic patients. In a retrospective study, we investigated the most prevalent source of error in the following commonly used cephalometric measurements: the angles Sella-Nasion-Point A (SNA), Sella-Nasion-Point B (SNB) and Point A-Nasion-Point B (ANB); the Wits appraisal; the anteroposterior dysplasia indicator (APDI); and the overbite depth indicator (ODI). Preoperative lateral radiographic images of patients with dentofacial deformities were collected and the landmarks digitally traced by three independent raters. Cephalometric analysis was automatically performed based on 1116 tracings. Error analysis identified the x-coordinate of Point A as the prevalent source of error in all investigated measurements, except SNB, in which it is not incorporated. In SNB, the y-coordinate of Nasion predominated error variance. SNB showed lowest inter-rater variation. In addition, our observations confirmed previous studies showing that landmark identification variance follows characteristic error envelopes in the highest number of tracings analysed up to now. Variance orthogonal to defining planes was of relevance, while variance parallel to planes was not. Taking these findings into account, orthognathic surgeons as well as orthodontists would be able to perform cephalometry more accurately and accomplish better therapeutic results.

Genetic background influences susceptibility to chemotherapy-induced hematotoxicity.

Hematotoxicity is a life-threatening side effect of many chemotherapy regimens. Although clinical factors influence patient responses, genetic factors may also play an important role. We sought to identify genomic loci that influence chemotherapy-induced hematotoxicity by dosing Diversity Outbred mice with one of three chemotherapy drugs; doxorubicin, cyclophosphamide or docetaxel. We observed that each drug had a distinct effect on both the changes in blood cell subpopulations and the underlying genetic architecture of hematotoxicity. For doxorubicin, we mapped the change in cell counts before and after dosing and found that alleles of ATP-binding cassette B1B (Abcb1b) on chromosome 5 influence all cell populations. For cyclophosphamide and docetaxel, we found that each cell population was influenced by distinct loci, none of which overlapped between drugs. These results suggest that susceptibility to chemotherapy-induced hematotoxicity is influenced by different genes for different chemotherapy drugs.

Ethnic disparities in progression to advanced liver disease and overall survival in patients with chronic hepatitis C: impact of a sustained virological response.

BACKGROUND: Chronic hepatitis C (CHC) can lead to cirrhosis and hepatocellular carcinoma (HCC). A sustained virological response (SVR) is associated with improved outcomes, however, its impact on different ethnic groups is unknown. AIM: To evaluate ethnic differences in the natural history of CHC and the impact of SVR. METHODS: We conducted a cohort study of 8039 consecutive adult CHC patients seen at two medical centres in California between January 1997 and June 2016. Individual chart review confirmed CHC diagnosis. RESULTS: Asian and Hispanic but not African American patients had significantly higher cirrhosis and HCC incidence than Caucasians. On multivariate analysis, Hispanic ethnicity was independently associated with increased cirrhosis (adjusted HR 1.37, CI, confidence interval 1.10-1.71, P=.006) and HCC risk (adjusted HR 1.47, CI 1.13-1.92, P=.004) compared to Caucasian. Asian ethnicity had a significant association with cirrhosis (adjusted HR 1.28, CI 1.02-1.61, P=.034) and HCC risk (adjusted HR 1.29, CI 0.94-1.77, P=.025). In patients who achieved SVR, Hispanic ethnicity was no longer independently associated with cirrhosis (adjusted HR 1.76, CI 0.66-4.71, P=.26) or HCC (adjusted HR 1.05, CI 0.27-4.08, P=.94); nor was Asian ethnicity (adjusted HR 0.62, CI 0.21-1.82, P=.38 for cirrhosis; 2.01, CI 0.63-6.36, P=.24 for HCC). Similar findings were observed with overall survival among the ethnicities by SVR status. CONCLUSION: Hispanic and Asian ethnicity was independently associated with increased cirrhosis and HCC risk. Achieving an SVR eliminates the ethnic disparity in liver disease progression and overall survival between Hispanic and Asian vs Caucasian CHC patients.

Cure with ledipasvir/sofosbuvir for chronic hepatitis C virus in an individual with gastric bypass.

WHAT IS KNOWN AND OBJECTIVE: The impact of gastric bypass surgery on the pharmacokinetics of various medications has been reported. Presently, no data exist for the treatment of chronic hepatitis C virus with ledipasvir/sofosbuvir (LDV/SOF) in an individual with a history of gastric bypass. CASE DESCRIPTION: We report the successful cure of an individual who was treated with LDV/SOF who had a history of gastric bypass. The patient tolerated LDV/SOF well while only experiencing a minor headache. WHAT IS NEW AND CONCLUSION: Ledipasvir/sofosbuvir treatment may still be effective in those with a history of gastric bypass surgery.

[Epidural anesthesia for fetoscopy : Retrospective analysis of a one-year cohort]. / Peridurale Anästhesie zur Fetoskopie : Retrospektive Analyse einer Einjahreskohorte.

BACKGROUND: The introduction of routine prenatal screening using ultrasound has led to a substantial increase in diagnoses of fetal disorders that are amenable to intrauterine treatment. While an ultrasound guided insertion of small bore cannulas can be performed under local anesthesia, insertion of a fetoscope usually requires anesthetic management for the mother and the fetus. Additionally, the fetus' intrauterine position may have to be manipulated in order to enable access. Such manoeuvres depend on relaxation of the mother's abdominal wall. General anesthesia has been the preferred method, but it involves substantial risks both to the mother and possibly the fetus, especially when combined with aggressive uterine relaxation. Epidural anesthesia (EA) may provide an alternative. Only little systematic data on the efficacy, requirements or untoward effects of epidural anesthesia for fetoscopy exists in the literature, yet a high rate of arterial hypotension following EA has been reported. We therefore aimed to assess the hemodynamic reaction to EA in a mixed population of pregnant women undergoing fetoscopy for a variety of fetal conditions and performed a retrospective analysis of a one-year cohort in a single university hospital. METHODS: The local ethics committee approved this retrospective analysis and waived patient consent (local study identifier 304/14). We extracted anesthesiologic and hemodynamic data from the anesthesia charts of 23 consecutive cases of elective fetoscopic procedures requiring anesthesia between May 2011 and 2012 at a German university medical centre. RESULTS: Twenty-three cases of fetoscopy were included in this study. Indications for fetoscopy were congenital diaphragmatic hernia (n = 9), aortic valve stenosis (n = 8), and feto-fetal transfusion syndrome (n = 6). Median gestational age was 26 (8, interquartile range) weeks. Lumbar epidural catheters were injected with a median dose of 0.09 (0.02, interquartile range) ml ropivacaine 0.75% per cm maternal height. In 11 patients, EA was titrated to a sufficient height whereas 12 patients received a single dose with a median volume of 0.08 (0.02) ml/cm maternal height. After injection, systolic arterial pressure did not change significantly, mean arterial pressure dropped from 93 (14) mm Hg to 88 (15) mm Hg (p = 0.03). Heart rate fell from 96 (29) to 89 (20) beats per minute (p = 0.02). At incision, neither blood pressure nor heart rate changed significantly. For hemodynamic support during the procedure, cafedrine/theodrenaline (Akrinor™) was injected in five patients (median dose in these patients 0.5 (1.5) ml). One patient carrying a fetus with a poor prognosis and who underwent two separate procedures demanded additional sedation, for which we chose remifentanil. Another patient was hypotensive after intravenous administration of the tocolytic drug atosiban. A stable hemodynamic condition was quickly restored in this patient with administration of cafedrine/theodrenaline and i. v. fluids. All procedures were performed without conversion to general anaesthesia. CONCLUSION: This retrospective study demonstrates that fetoscopic procedures under EA in the range of indications treated in our institution can be performed safely. EA was associated with stable hemodynamic conditions in this mixed cohort of pregnant women. EA appears thus to be a suitable technique for fetoscopy, avoiding the risks inherent to general anesthesia in pregnant women.

Instrument flight to the inner ear.

Surgical robot systems can work beyond the limits of human perception, dexterity and scale making them inherently suitable for use in microsurgical procedures. However, despite extensive research, image-guided robotics applications for microsurgery have seen limited introduction into clinical care to date. Among others, challenges are geometric scale and haptic resolution at which the surgeon cannot sufficiently control a device outside the range of human faculties. Mechanisms are required to ascertain redundant control on process variables that ensure safety of the device, much like instrument-flight in avionics. Cochlear implantation surgery is a microsurgical procedure, in which specific tasks are at sub-millimetric scale and exceed reliable visuo-tactile feedback. Cochlear implantation is subject to intra- and inter-operative variations, leading to potentially inconsistent clinical and audiological outcomes for patients. The concept of robotic cochlear implantation aims to increase consistency of surgical outcomes such as preservation of residual hearing and reduce invasiveness of the procedure. We report successful image-guided, robotic CI in human. The robotic treatment model encompasses: computer-assisted surgery planning, precision stereotactic image-guidance, in-situ assessment of tissue properties and multipolar neuromonitoring (NM), all based on in vitro, in vivo and pilot data. The model is expandable to integrate additional robotic functionalities such as cochlear access and electrode insertion. Our results demonstrate the feasibility and possibilities of using robotic technology for microsurgery on the lateral skull base. It has the potential for benefit in other microsurgical domains for which there is no task-oriented, robotic technology available at present.