Is It Justified to Sacrifice the Pituitary Stalk During Craniopharyngioma Surgery? A Systematic Review and Meta-Analysis.

BACKGROUND AND OBJECTIVES: Pituitary stalk sacrifice is a surgical dilemma in craniopharyngioma surgery that needs a wise decision. To the authors' knowledge, this is the first study to conduct a meta-analysis of the current literature to assess if it is worth preserving the stalk during craniopharyngioma surgery or it is justified to sacrifice it. METHODS: PubMed, Web of Science, and Embase databases were searched for craniopharyngioma studies till December 2021 that directly compared the endocrine sequelae of stalk sacrifice vs preservation in their patients. Odds ratio (OR) with 95% CI was used through fixed- and random-effects models. RESULTS: Fourteen studies with a total of 2074 patients met our inclusion criteria. The stalk was preserved in 925 patients (44.6%), was sacrificed in 1053 patients (50.8%), and was not identified intraoperatively or partially preserved, or the authors did not mention enough data for 96 patients (4.6%). Our study found that sacrifice of the pituitary stalk was associated with a significantly increased risk of endocrine dysfunction at the last follow-up (OR = 6.69, 95% CI = 3.36-13.35, P < .0001); however, it was not associated with a significant decrease in the risk of recurrence/progression of the disease (OR = 0.80, 95% CI = 0.60-1.06, P = .13). CONCLUSION: Pituitary stalk sacrifice significantly increased the risk of postoperative endocrine dysfunction without reducing the risk of progression or recurrence of craniopharyngioma. The ability to preserve the pituitary stalk intraoperatively is multifactorial, and stalk preservation is recommended whenever possible. Future prospective studies are recommended to assess the effect of confounding factors on the outcomes of stalk sacrifice/preservation.

Discrimination of Genetic Biomarkers of Disease through Machine-Learning-Based Hypothesis Testing of Direct SERS Spectra of DNA and RNA.

Cancer is globally a leading cause of death that would benefit from diagnostic approaches detecting it in its early stages. However, despite much research and investment, cancer early diagnosis is still underdeveloped. Owing to its high sensitivity, surface-enhanced Raman spectroscopy (SERS)-based detection of biomarkers has attracted growing interest in this area. Oligonucleotides are an important type of genetic biomarkers as their alterations can be linked to the disease prior to symptom onset. We propose a machine-learning (ML)-enabled framework to analyze complex direct SERS spectra of short, single-stranded DNA and RNA targets to identify relevant mutations occurring in genetic biomarkers, which are key disease indicators. First, by employing ad hoc-synthesized colloidal silver nanoparticles as SERS substrates, we analyze single-base mutations in ssDNA and RNA sequences using a direct SERS-sensing approach. Then, an ML-based hypothesis test is proposed to identify these changes and differentiate the mutated sequences from the corresponding native ones. Rooted in "functional data analysis," this ML approach fully leverages the rich information and dependencies within SERS spectral data for improved modeling and detection capability. Tested on a large set of DNA and RNA SERS data, including from miR-21 (a known cancer miRNA biomarker), our approach is shown to accurately differentiate SERS spectra obtained from different oligonucleotides, outperforming various data-driven methods across several performance metrics, including accuracy, sensitivity, specificity, and F1-scores. Hence, this work represents a step forward in the development of the combined use of SERS and ML as effective methods for disease diagnosis with real applicability in the clinic.

Efficacy of chitosan nanoparticles and wax coatings on maintaining post-harvest quality of "Murcott" mandarins.

Because of its high degree of biodegradability, chitosan is widely used as a component in food packaging. However, its poor physical properties, such as permeability, limit its applicability. Consequently, applying nano chitosan is regarded as the most effective solution to this issue. In the current study, we studied the effect of using different materials in the coating process on the quality of "Murcott" mandarin during cold storage. We used different concentrations of nano chitosan (50 and 100 ppm) without wax and 100 ppm nano chitosan with wax. We investigated the impact of these compounds on the chemical composition and quality of fruits. The most successful treatment for preventing weight loss from discarded fresh fruit was a combination of wax and 100 ppm nano chitosan. This combination also prevented the deterioration of vitamin C, maintained the fruit pulp, and preserved the fruit's superior taste during cold storage and shelf life. It also maintains a better total soluble solids and total acidity level than other treatments. In addition, the activity of antioxidant enzymes and the total number of antioxidants indicates no degradation of plant tissues compared to those not coated with nano chitosan. It also reduces the microbial load on the coated fruits. Consequently, this coating combination could suggest prolonging post-harvest life and increasing the marketing period of mandarin fruits.

Understanding the facilitators and barriers to barcode medication administration by nursing staff using behavioural science frameworks. A mixed methods study.

INTRODUCTION: Barcode medication administration (BCMA) technology helps ensure correct medications are administered by nursing staff through scanning of patient and medication barcodes. In many hospitals scanning rates are low, limiting the potential safety benefits. We aimed to explore the barriers and facilitators to BCMA use in a London hospital. METHODS: In this mixed methods study we used local quantitative data on BCMA scanning rates to identify clinically similar wards (in terms of patient acuity and workload) with different scanning rates for qualitative exploration. Interviews designed to elicit barriers to using BCMA technology were conducted with nursing staff, supported by observations of medication administration. Qualitative data were analysed inductively and a thematic framework constructed housing key themes, subsequently categorised into barriers and facilitators. To explore patient perspectives of BCMA scanning, a purposive sample of patients were also interviewed. These patient data were analysed deductively according to the thematic framework. Themes were mapped to behavioural science frameworks to further understand the behaviours involved. RESULTS: BCMA was operational on 15 wards, with only six having medication scan rates of more than 10% of scannable doses. Of three wards selected for qualitative investigation, the lowest scan rate was 6.7%. Twenty-seven nurses and 15 patients were interviewed. Eleven key themes were identified, encompassing both barriers and facilitators to BCMA use. Barriers included poor trolley ergonomics and perceived time inefficiency. Facilitators included a streamlined process and thorough training. All nurses described BCMA as positive for patient safety. Patients described BCMA as making them "feel safer". Behavioural science frameworks highlighted the importance of professional role and an individual's belief in their capability. CONCLUSION: We present a novel exploration of facilitators and barriers to BCMA use from the viewpoint of both patients and nursing staff, highlighting a strong perception that BCMA enhances safety. Barriers were reported on both high and low usage wards, demonstrating the importance of behaviours and motivations. These findings provide a detailed understanding from which to design interventions to support behaviour change and increase BCMA use.

The neuroprotective effect of quercetin nanoparticles in the therapy of neuronal damage stimulated by acrolein.

A gradual loss of neuronal function or structure causes neurodegenerative disorders such as Parkinson's and Alzheimer's. Neurological damage might cause cell death. Acrolein is a high-risk air and water contaminant that causes neurodegenerative disorders. Quercetin has several strategies for treating neurodegenerative disorders but has limited bioavailability inside the body. One of the hypotheses offered to improve quercetin's bioavailability is to convert it into quercetin nanoparticles. This study aims to comprehend the immunohistochemical devastation that might arise in the cerebellum because of acrolein treatment. Furthermore, the protective and ameliorative roles of quercetin nanoparticles against oxidative stress and neurotoxicity induced in mice by acrolein were assessed. Ninety male albino rats weighing 120 to 200 g were used in the present investigation. The animals were split up into the following six groups: the control group, the acrolein-treated group: animals were given acrolein (3 mg/kg) for 30 days, quercetin nanoparticles treated group: animals were given quercetin nanoparticles (30 mg/kg) for 30 days. The administration of acrolein was found to be connected to immunohistochemical abnormalities in the cerebellum. Marked differences were observed in Bax, Bcl-2, TNF-α, and GFAP expressions in the cerebellum. Treatment of rats with quercetin nanoparticles either before or after treatment with acrolein has been found to preserve the cerebellum tissues from the toxic impacts and oxidative stress induced by acrolein. This may open the door to more nanomedicine studies and a new avenue for employing nanoparticles as a therapeutic intervention in neurodegenerative illnesses.

A look at the global impact of COVID-19 pandemic on neurosurgical services and residency training.

Background: The COVID-19 pandemic has left an indelible effect on healthcare delivery and education system, including residency training. Particularly, neurosurgical departments worldwide had to adapt their operating model to the constantly changing pandemic landscape. This review aimed to quantify the reduction in neurosurgical operative volume and describe the impact of these trends on neurosurgical residency training. Methods: We performed a comprehensive search of PubMed and EMBASE between December 2019 and October 2022 to identify studies comparing pre-pandemic and pandemic neurosurgical caseloads as well as articles detailing the impact of COVID-19 on neurosurgery residency training. Statistical analysis of quantitative data was presented as pooled odds ratio (OR) and 95% confidence intervals (CI). Results: A total of 49 studies met the inclusion criteria, of which 12 (24.5%) were survey-based. The case volume of elective surgeries and non-elective procedures decreased by 70.4% (OR=0.296, 95%CI 0.210-0.418) and 68.2% (OR=0.318, 95%CI 0.193-0.525), respectively. A significant decrease was also observed in functional (OR=0.542, 95%CI 0.394-0.746), spine (OR=0.545, 95%CI 0.409-0.725), and skull base surgery (OR=0.545, 95%CI 0.409-0.725), whereas the caseloads for tumor (OR=1.029, 95%CI 0.838-1.263), trauma (OR=1.021, 95%CI 0.846-1.232), vascular (OR=1.001, 95%CI 0.870-1.152), and pediatric neurosurgery (OR=0.589, 95%CI 0.344-1.010) remained relatively the same between pre-pandemic and pandemic periods. The reduction in caseloads had caused concerns among residents and program directors in regard to the diminished clinical exposure, financial constraints, and mental well-being. Some positives highlighted were rapid adaptation to virtual educational platforms and increasing time for self-learning and research activities. Conclusion: While COVID-19 has brought about significant disruptions in neurosurgical practice and training, this unprecedented challenge has opened the door for technological advances and collaboration that broaden the accessibility of resources and reduce the worldwide gap in neurosurgical education.

Rod migration through foramen magnum into posterior fossa after cervical spine lateral mass fixation: A case report and literature review.

Background: Posterior cervical fusion is one of the most common surgical procedures performed for the treatment of many cervical spine pathologies. Hardware failure, due to rod displacement either cranially or caudally, may occur. Case Description: Two years following a subaxial laminectomy/lateral mass fusion (from C3 to C6) for stenosis, a 67-year-old female, with a history of trauma 2 months ago, presented with headaches, right-sided facial palsy, and right complete ophthalmoplegia. When the computed tomography scan showed migration of the left-sided rod extending into the posterior fossa through the foramen magnum plus malpositioning of the right rod, she underwent bilateral rod removal resulting in marked headache improvement without improvement of ophthalmoplegia and facial palsy. Conclusion: Cephalad rod migration/displacement extending through the foramen magnum into the posterior fossa is a rare complication of cervical laminectomy/rod lateral mass screw instrumented fusion.

ٍSome biologically active microorganisms have the potential to suppress mosquito larvae (Culex pipiens, Diptera: Culicidae).

Malaria is a disease caused by protozoan species of the genus Plasmodium. It is widespread and becoming a challenge in several African countries in the tropical and subtropical regions. In 2010, a report was published showing that over 1.2 million death cases were occurred globally due to malaria in just one year. The transmission of the disease from one person to another occurs via the bite of the Anopheles female. It is known that Plasmodium ovale, P. vivax, P. malariae, P. falciparum, and P. knowlesi are the highly infective malaria species. The problem of this disease is the absence of any effective medical treatment or vaccine, making the mosquito control is the only feasible way for disease prevention. Pesticides are currently the most widely used method for mosquito control, despite its well-known negative effects, including health hazards on human, the increasing insecticidal resistance, and the negative impact on the environment and beneficial organisms. Biological control (also called: biocontrol) of insects has been a promising method to overcome the negative effects of using chemical insecticides, as it depends on just using the natural enemies of pests to either minimize their populations or eradicate them. This article provides an overview of the recent and effective biological means to control malaria, such as bacteria, fungi, viruses, larvivorous fish, toxorhynchites larva and nematodes. In addition, the importance, advantages, and disadvantages of the biocontrol methods will be discussed in comparison with the traditionally used chemical methods of malaria control with special reference to nanotechnology as a novel method for insects' control.

Biological control: An effective approach against nematodes using black pepper plants (Piper nigrum L.).

Black pepper (Piper nigrum L.) is one of the oldest spices in the world, additionally, it is highly demanded. Several biotic and abiotic variables pose black pepper production worldwide. Plant-parasitic nematodes play a key role among biotic factors, causing considerable economic losses and affecting the production. Different synthetic nematicides were used for controlling plant nematodes, however the majority of pesticides have been pulled from the market due to substantial non-target effects and environmental risks. As a result, the search for alternative eco-friendly agents for controlling plant-parasitic nematodes populations. Microbial agents are a precious option. In this review the bacterial and fungal agents used as an alternative nematicides, they were studied and confirmed as essential anti-microbial agents against plant nematodes which infected Piper nigrum L. This work examines the most common plant nematodes infected Piper nigrum L., with a focus on root knot and burrowing nematodes, in addition, how to control plant parasitic nematodes using microorganisms.

An eye on the future for defeating hydrocephalus, ciliary dyskinesia-related hydrocephalus: review article.

Congenital hydrocephalus affects approximately one in 1000 newborn children and is fatal in approximately 50% of untreated cases. The currently known management protocols usually necessitate multiple interventions and long-term use of healthcare resources due to a relatively high incidence of complications, and many of them mostly provide a treatment of the effect rather than the cause of cerebrospinal fluid flow reduction or outflow obstruction. Future studies discussing etiology specific hydrocephalus alternative treatments are needed. We systematically reviewed the available literature on the effect of ciliary abnormality on congenital hydrocephalus pathogenesis, to open a discussion on the feasibility of factoring ciliary abnormality in future research on hydrocephalus treatment modalities. Although there are different forms of ciliopathies, we focused in this review on primary ciliary dyskinesia. There is growing evidence of association of other ciliary syndromes and hydrocephalus, such as the reduced generation of multiple motile cilia, which is distinct from primary ciliary dyskinesia. Data for this review were identified by searching PubMed using the search terms 'hydrocephalus,' 'Kartagener syndrome,' 'primary ciliary dyskinesia,' and 'immotile cilia syndrome.' Only articles published in English and reporting human patients were included. Seven studies met our inclusion criteria, reporting 12 cases of hydrocephalus associated with primary ciliary dyskinesia. The patients had variable clinical presentations, genetic backgrounds, and ciliary defects. The ependymal water propelling cilia differ in structure and function from the mucus propelling cilia, and there is a possibility of isolated non-syndromic ependymal ciliopathy causing only hydrocephalus with growing evidence in the literature for the association ependymal ciliary abnormality and hydrocephalus. Abdominal and thoracic situs in children with hydrocephalus can be evaluated, and secondary damage of ependymal cilia causing hydrocephalus in cases with generalized ciliary abnormality can be considered.

In silico approaches to develop herbal acaricides against R. (Boophilus) Microplus and In vitro Anti-Tick activities of selected medicinal plants.

In tropical and sub-tropical areas of the world the most damaging pest of the livestock sector are cattle tick, Rhipicephalus microplus. The current study was aimed to generate phytochemical derived acaricides to control Rhipicephalus microplus populations, to maintain livestock herd production, minimize economic losses and to reduce uses of man-made chemicals acaricides. To achieve this goal, Adult immersion and larval package test were used to determine the feasibility of Berberium lyceum and Tamarixa aphylla against Rhipicephalus microplus ticks. Further, an In silico technique was employed to discover biologically active substances from both plants using docking method. Berberium lyceum and Tamarixa aphylla exhibited a reasonably high fatal effect at 40.0 mg/L on egg laying (index of egg laying = 0.19 and 0.19) respectively, thus inhibiting the oviposition (49.5 and 45.1, respectively) and the larval mortality (97% and 93%, respectively). Further, we also used Chem-Draw ultra-software (v. 12.0.2.1076. 2010) to illustrate different structures of38 known bioactive phytochemicals which are discovered in the PubChem database and verify the hypothesis that tick inhibition was linked to acetylcholinesterase (AChE). Barbamunine and rutin from Berberium lyceum showed remarkable interaction with RmAChE1 active site residues with docking scores of -9.11 to -8.71 while phytol and dehydrodigallic acid from Tamarix aphylla showed comparable docking scores of -7.17 and -7.14 respectively against Rhipicephalus microplus acetylcholinesterase protein. Based on obtained result, we believe that Berberium lyceum and Tamarixa aphylla bioactive components could be potential candidates in the control and management of Rhipicephalus microplus and should be studied further as a supplement or replacement for synthetic acaricides.

Nipple aspirate fluid and its use for the early detection of breast cancer.

Nipple aspirate fluid is the physiological biofluid lining ductal epithelial cells. Historically, cytology of nipple fluid has been the gold standard diagnostic method for assessment of ductal fluid in patients with symptomatic nipple discharge. The role of biomarker discovery in nipple aspirate fluid for assessment of asymptomatic and high-risk patients is highly attractive but evaluation to date is limited by poor diagnostic accuracy. However, the emergence of new technologies capable of identifying metabolites that have been previously thought unidentifiable within such small volumes of fluid, has enabled testing of nipple biofluid to be re-examined. This review evaluates the use of new technologies to evaluate the components of nipple fluid and their potential to serve as biomarkers in screening.

Synthesis, characterization, thermal properties, antimicrobial evaluation, ADMET study, and molecular docking simulation of new mono Cu (II) and Zn (II) complexes with 2-oxoindole derivatives.

One of the interesting research fields is developing and assessing novel metal-containing medications. A new isatin-3-thiosemicarbazone derivative 4 was synthesized by two different methods based on hydrazone derivatives 2 and 3. Additionally, the chelation of thiosemicarbazone with copper (II) and zinc (II) forms a monobasic tridentate (ONS) complex with two five-member rings and a tetrahedral geometry structure. The structure of synthesized complexes was characterized using elemental analysis, FT-IR, mass spectra, and 1H/13C NMR. Thermogravimetric analysis revealed the upgrading of the thermal stability of metal complexes compared to their thiosemicarbazone ligand. The stoichiometric ratio of the coordination confirmed the formation of 1:1 (M: L) stoichiometry. In vitro antimicrobial activity was screened against two gram-positive, two gram-negative, and one fungal strain. Both ligand 4 and Zn complex 6 displayed high antimicrobial activity compared with copper complex 5 based on the zone of inhibition. Further, MIC and MBC were determined for both zinc and ligand. The zinc complex 6 displayed excellent antimicrobial activity with (MIC = 3.9-27.77 µg/mL) against bacterial strains and (MIC = 7.81 µg/mL) against C. albicans, as well as exhibited MBC values ranging between (MBC = 6.51-45.58 µg/mL) and (MFC = 13.58 µg/mL), respectively, and demonstrated bactericidal and fungicidal behavior. The in-silico ADMET study for ligand and two complexes were determined and showed non-AMES toxicity, non-carcinogenic, and obey the rule of five. A comparative docking study provided more insight into the binding mechanisms and suggested that antimicrobial activity may be due to inhibition of different targets.

Emergence, evolution, and vaccine production approaches of SARS-CoV-2 virus: Benefits of getting vaccinated and common questions.

The emergence of coronavirus disease 2019 (COVID-19) pandemic in Wuhan city, China at the end of 2019 made it urgent to identify the origin of the causal pathogen and its molecular evolution, to appropriately design an effective vaccine. This study analyzes the evolutionary background of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2 or SARS-2) in accordance with its close relative SARS-CoV (SARS-1), which was emerged in 2002. A comparative genomic and proteomic study was conducted on SARS-2, SARS-1, and Middle East respiratory syndrome coronavirus (MERS), which was emerged in 2012. In silico analysis inferred the genetic variability among the tested viruses. The SARS-1 genome harbored 11 genes encoding 12 proteins, while SARS-2 genome contained only 10 genes encoding for 10 proteins. MERS genome contained 11 genes encoding 11 proteins. The analysis also revealed a slight variation in the whole genome size of SARS-2 comparing to its siblings resulting from sequential insertions and deletions (indels) throughout the viral genome particularly ORF1AB, spike, ORF10 and ORF8. The effective indels were observed in the gene encoding the spike protein that is responsible for viral attachment to the angiotensin-converting enzyme 2 (ACE2) cell receptor and initiating infection. These indels are responsible for the newly emerging COVID-19 variants αCoV, ßCoV, γCoV and δCoV. Nowadays, few effective COVID-19 vaccines developed based on spike (S) glycoprotein were approved and become available worldwide. Currently available vaccines can relatively prevent the spread of COVID-19 and suppress the disease. The traditional (killed or attenuated virus vaccine and antibody-based vaccine) and innovated vaccine production technologies (RNA- and DNA-based vaccines and viral vectors) are summarized in this review. We finally highlight the most common questions related to COVID-19 disease and the benefits of getting vaccinated.

Planning for disposal of COVID-19 pandemic wastes in developing countries: a review of current challenges.

The health sector is critical to the well-being of any country, but developing countries have several obstacles that prevent them from providing adequate health care. This became an even larger concern after the COVID-19 outbreak left millions of people dead worldwide and generated huge amounts of infected or potentially infected wastes. The management and disposal of medical wastes during and post-COVID-19 represent a major challenge in all countries, but this challenge is particularly great for developing countries that do not have robust waste disposal infrastructure. The main problems in developing countries include inefficient treatment procedures, limited capacity of healthcare facilities, and improper waste disposal procedures. The management of medical wastes in most developing countries was primitive prior to the pandemic. The improper treatment and disposal of these wastes in our current situation may further speed COVID-19 spread, creating a serious risk for workers in the medical and sanitation fields, patients, and all of society. Therefore, there is a critical need to discuss emerging challenges in handling, treating, and disposing of medical wastes in developing countries during and after the COVID-19 outbreak. There is a need to determine best disposal techniques given the conditions and limitations under which developing countries operate. Several open questions need to be investigated concerning this global issue, such as to what extent developing countries can control the expected environmental impacts of COVID-19, particularly those related to medical wastes? What are the projected management scenarios for medical wastes under the COVID-19 outbreak? And what are the major environmental risks posed by contaminated wastes related to COVID-19 treatment? Studies directed at the questions above, careful planning, the use of large capacity mobile recycling facilities, and following established guidelines for disposal of medical wastes should reduce risk of COVID-19 spread in developing countries.

New Insights of Potassium Sources Impacts as Foliar Application on 'Canino' Apricot Fruit Yield, Fruit Anatomy, Quality and Storability.

This is the first report to study the impacts of potassium sources on apricot fruit yield, quality and storability as a preharvest foliar application. Five sources of potassium (K-humate, K-sulphate, K-nitrate, K-silicate and K-citrate), plus water as a control treatment, were applied individually at 0.2% three times on 'Canino' apricot over the 2019 and 2020 seasons. The results showed that all potassium salts, applied foliarly, have potential to improve yield, fruit color, and some fruit physical attributes, such as: weight, size and firmness, as well as a reduced lipid peroxidation, accompanied by a low fruit malondialdehyde content reflected in a high tolerance during storage. The K-nitrate treatment was more effective in the improvement of fruit yield, preharvest quality parameters and keeping fruit postharvest quality characteristics from sharp decline during cold storage. Concerning fruit anatomy, K-nitrate and K-citrate showed thicker cuticle and epidermal parenchyma cell diameters, while the K-silicate induced the highest cell wall thickness. K-nitrate was the most economical, and could be recommended for apricot growers in the Nubaria region of Egypt.

The global mental health burden of COVID-19 on critical care staff.

BACKGROUND: Although the mental health burden in healthcare workers caused by COVID-19 has gained increasing attention both within the profession and through public opinion, there has been a lack of data describing their experience; specifically, the mental wellbeing of healthcare workers in the intensive care unit (ICU), including those redeployed. AIMS: The authors aimed to compare the mental health status of ICU healthcare workers (physicians, nurses and allied health professionals) affected by various factors during the COVID-19 pandemic; and highlight to policymakers areas of staff vulnerabilities in order to improve wellbeing strategies within healthcare systems. METHODS: An online survey using three validated scales was conducted in France, the UK, Italy, Mainland China, Taiwan, Egypt and Belgium. FINDINGS: The proportion of respondents who screened positive on the three scales across the countries was 16-49% for depression, 60-86% for insomnia and 17-35% for post-traumatic stress disorder. The authors also identified an increase in the scores with longer time spent in personal protective equipment, female gender, advancing age and redeployed status. CONCLUSION: The high prevalence of mental disorders among ICU staff during the COVID-19 crisis should inform local and national wellbeing policies.

An eye-tracking based robotic scrub nurse: proof of concept.

BACKGROUND: Within surgery, assistive robotic devices (ARD) have reported improved patient outcomes. ARD can offer the surgical team a "third hand" to perform wider tasks and more degrees of motion in comparison with conventional laparoscopy. We test an eye-tracking based robotic scrub nurse (RSN) in a simulated operating room based on a novel real-time framework for theatre-wide 3D gaze localization in a mobile fashion. METHODS: Surgeons performed segmental resection of pig colon and handsewn end-to-end anastomosis while wearing eye-tracking glasses (ETG) assisted by distributed RGB-D motion sensors. To select instruments, surgeons (ST) fixed their gaze on a screen, initiating the RSN to pick up and transfer the item. Comparison was made between the task with the assistance of a human scrub nurse (HSNt) versus the task with the assistance of robotic and human scrub nurse (R&HSNt). Task load (NASA-TLX), technology acceptance (Van der Laan's), metric data on performance and team communication were measured. RESULTS: Overall, 10 ST participated. NASA-TLX feedback for ST on HSNt vs R&HSNt usage revealed no significant difference in mental, physical or temporal demands and no change in task performance. ST reported significantly higher frustration score with R&HSNt. Van der Laan's scores showed positive usefulness and satisfaction scores in using the RSN. No significant difference in operating time was observed. CONCLUSIONS: We report initial findings of our eye-tracking based RSN. This enables mobile, unrestricted hands-free human-robot interaction intra-operatively. Importantly, this platform is deemed non-inferior to HSNt and accepted by ST and HSN test users.