Surgical epidemiology of Antarctic stations from 1904 to 2022: A scoping review.

In Antarctica, it is extremely difficult to organise medical evacuations in winter. Antarctic physicians are often alone and must be prepared to perform surgery and dentistry, even if they are not specialists. This scoping review summarises epidemiological data on the types of surgical procedures performed in Antarctica and identifies gaps in the literature in this area. We searched PubMed and Google Scholar, without language restriction, for papers published between 1 January 1904, and 1 February 2022. Of the 35 papers on 12 Antarctic programs, very few were retrospective observational epidemiological studies; the majority were medical reports. The search identified 41 surgical procedures or reasons for surgical consultation, 19 different reasons for medical evacuations, and 12 causes of death that may have required surgical management. The diagnostic classifications used and the prevalence of each reported surgical speciality were heterogeneous. The most cited specialities were orthopaedics, dentistry, and digestive surgery. Telemedicine was integrated into on-site care or medical evacuation decisions. The current literature is poor, and most studies do not apply to surgical issues. The heterogeneous data collection methodologies limit their interpretation. A standardised diagnostic classification and detailed and systematic epidemiological registers will help define the contours of surgical management in Antarctica.

Surgical training strategies for physicians practicing in an isolated environment: an example from Antarctica. International survey of 13 countries with active winter stations.

For 60 years, human presence in Antarctica has required particularly demanding medical skills. Nevertheless, the preparation of physicians working in this extreme environment remains unknown and deserves clarification. This study aimed to summarise data on the surgical training given to physicians by different countries. In April 2020, we conducted a questionnaire-based study of 14 countries wintering in Antarctica. Responses were descriptively analysed. Regarding the profiles of physicians recruited by the wintering countries, 30% to 55% were non-surgeon doctors compared with 45% to 70% for surgeons depending on the year. Of the 13 countries answering the questionnaire, nine organised practical surgical training and six used theoretical material. All countries reported practical training for dental surgery, while only five countries provided training in four other surgical specialities (orthopaedic, digestive, thoracic, and ear, throat, and nose). All 13 countries reported using a telemedicine system. These results revealed heterogeneous training strategies among the recruited physicians, reflecting the difficulties of practice on this extreme continent. Future work may assess the effectiveness of each strategy. A better understanding of surgical epidemiology and a detailed referencing of the equipment available at the bases would help better define the contours of surgical care in Antarctica.

Role of the chemokine receptors CCR2 and CX3CR1 in an experimental model of thrombotic stroke.

Stroke is the second cause of mortality worldwide and occurs following the interruption of cerebral blood circulation by cerebral vessel burst or subsequent to a local thrombus formation. Ischemic lesion triggers an important inflammatory response, characterized by massive infiltration of leukocytes, activation of glial cells and neurovascular reorganization. Chemokines and their receptors, such as CCR2 and CX3CR1, play an important role in leukocyte recruitment in the damaged area. Mice genetically depleted for the two receptors CCR2 and CX3CR1 underwent focal cerebral ischemia, based on the topical application of ferric chloride to truncate the distal middle cerebral artery. The infarct, limited only to the cortical area, remained stable in WT mice, while it is reduced overtime in the transgenic mice. Moreover, we did not observe any significant changes in the level of the inflammatory response in the infarcted areas while immune cell infiltration and neurovascularization are modulated according to genotype. Our results show that the genetic deletion of both CCR2 and CX3CR1 receptors has neuroprotective effects in response to a cerebral permanent ischemia. This study underlines a key role of CCR2- and CX3CR1-expressing immune cells in the neuropathology associated with ischemic injuries.