Design Principle and Proofing of a New Smart Textile Material That Acts as a Sensor for Immobility in Severe Bed-Confined Patients.

The immobility of patients confined to continuous bed rest continues to raise a couple of very serious challenges for modern medicine. In particular, the overlooking of sudden onset immobility (as in acute stroke) and the delay in addressing the underlying conditions are of utmost importance for the patient and, in the long term, for the medical and social systems. This paper describes the design principles and concrete implementation of a new smart textile material that can form the substrate of intensive care bedding, that acts as a mobility/immobility sensor in itself. The textile sheet acts as a multi-point pressure-sensitive surface that sends continuous capacitance readings through a connector box to a computer running a dedicated software. The design of the capacitance circuit ensures enough individual points to provide an accurate description of the overlying shape and weight. We describe the textile composition and circuit design as well as the preliminary data collected during testing to demonstrate the validity of the complete solution. These results suggest that the smart textile sheet is a very sensitive pressure sensor and can provide continuous discriminatory information to allow for the very sensitive, real-time detection of immobility.

Current and Emerging Approaches for Spine Tumor Treatment.

Spine tumors represent a significant social and medical problem, affecting the quality of life of thousands of patients and imposing a burden on healthcare systems worldwide. Encompassing a wide range of diseases, spine tumors require prompt multidisciplinary treatment strategies, being mainly approached through chemotherapy, radiotherapy, and surgical interventions, either alone or in various combinations. However, these conventional tactics exhibit a series of drawbacks (e.g., multidrug resistance, tumor recurrence, systemic adverse effects, invasiveness, formation of large bone defects) which limit their application and efficacy. Therefore, recent research focused on finding better treatment alternatives by utilizing modern technologies to overcome the challenges associated with conventional treatments. In this context, the present paper aims to describe the types of spine tumors and the most common current treatment alternatives, further detailing the recent developments in anticancer nanoformulations, personalized implants, and enhanced surgical techniques.

Recent Advances in Managing Spinal Intervertebral Discs Degeneration.

Low back pain (LBP) represents a frequent and debilitating condition affecting a large part of the global population and posing a worldwide health and economic burden. The major cause of LBP is intervertebral disc degeneration (IDD), a complex disease that can further aggravate and give rise to severe spine problems. As most of the current treatments for IDD either only alleviate the associated symptoms or expose patients to the risk of intraoperative and postoperative complications, there is a pressing need to develop better therapeutic strategies. In this respect, the present paper first describes the pathogenesis and etiology of IDD to set the framework for what has to be combated to restore the normal state of intervertebral discs (IVDs), then further elaborates on the recent advances in managing IDD. Specifically, there are reviewed bioactive compounds and growth factors that have shown promising potential against underlying factors of IDD, cell-based therapies for IVD regeneration, biomimetic artificial IVDs, and several other emerging IDD therapeutic options (e.g., exosomes, RNA approaches, and artificial intelligence).

European survey on neurosurgical management of primary central nervous system lymphomas and preoperative corticosteroid therapy.

Introduction: Preoperative corticosteroid therapy (CST) is common in primary central nervous system lymphoma (PCNSL) and may complicate histopathological diagnosis. There is an ongoing debate on the best management after preoperative CST. Research question: We aimed to survey how different European neurosurgical units treat PCNSL patients after preoperative CST. Methods: An English-language survey consisting of 21 questions addressing the management of patients with suspected PCNSL and preoperative CST was sent to European hospitals. The survey also included three clinical cases to assess the decision-making process in a clinical setting. Results: The survey was completed by 74 European hospitals. There was no clear consensus on how to treat a patient with PCNSL after CST. Accordingly, 24.3% responded that they would generally defer surgery regardless of a possible radiological response, 47.3% would defer surgery only if there is regression in preoperative MRI and the remaining 28.4% would defer surgery only if the tumor had completely vanished. Furthermore, there were distinct discrepancies in responses of neurosurgical units regarding their general management approach and their case-based decision in the three example cases. The results of our survey also showed regional differences and differences in treatment decisions between high-, intermediate- and low-volume centers. Discussion and conclusion: There was no clear consensus on how to treat patients with suspected PCNSL and preoperative CST. Furthermore, most centers also showed inconsistencies in their responses regarding their general approach as well as individual patient treatment. More high-quality evidence-based recommendations are needed to improve consensus and thus patient care.

Adaptive changes in neuronal synchronization in macaque V4.

A fundamental property of cortical neurons is the capacity to exhibit adaptive changes or plasticity. Whether adaptive changes in cortical responses are accompanied by changes in synchrony between individual neurons and local population activity in sensory cortex is unclear. This issue is important as synchronized neural activity is hypothesized to play an important role in propagating information in neuronal circuits. Here, we show that rapid adaptation (300 ms) to a stimulus of fixed orientation modulates the strength of oscillatory neuronal synchronization in macaque visual cortex (area V4) and influences the ability of neurons to distinguish small changes in stimulus orientation. Specifically, rapid adaptation increases the synchronization of individual neuronal responses with local population activity in the gamma frequency band (30-80 Hz). In contrast to previous reports that gamma synchronization is associated with an increase in firing rates in V4, we found that the postadaptation increase in gamma synchronization is associated with a decrease in neuronal responses. The increase in gamma-band synchronization after adaptation is functionally significant as it is correlated with an improvement in neuronal orientation discrimination performance. Thus, adaptive synchronization between the spiking activity of individual neurons and their local population can enhance temporally insensitive, rate-based-coding schemes for sensory discrimination.

Correction: Iliescu, B.F. Learning by Exposure in the Visual System. Brain Sci. 2022, 12, 508.

Bryan Hansen and Valentin Dragoi were previously included as authors in the publication [...].

Analysis of the Classification Systems for Thoracolumbar Fractures in Adults and Their Evolution and Impact on Clinical Management.

Although they represent a significant chapter of traumatic pathology with a deep medical and social impact, thoracolumbar fractures have proven to be elusive in terms of a definitive classification. The ever-changing concept of the stability of a thoracolumbar injury (from Holdsworth's two-column concept to Denis' three-column theory), the meaningful integration of neurological deficit, and a reliable clinical usability have made reaching a universally accepted and reproductible classification almost impossible. The advent of sophisticated imaging techniques and an improved understanding of spine biomechanics led to the development of several classification systems. Each successive system has contributed significantly to the understanding of physiopathological mechanisms and better treatment management. Magerl et al. developed a comprehensive classification system based on progressive morphological damage determined by the following three fundamental forces: compression, distraction, and axial torque. Vaccaro et al. devised the thoracolumbar injury severity score based on the following three independent variables: the morphology of the injury, posterior ligamentous complex (PLC) integrity, and neurological status at the time of injury. However, there are limitations to the classification system, especially when magnetic resonance imaging yields an uncertain status of PLC. The authors review the various classification systems insisting on their practical relevance and caveats and illustrate the advantages and disadvantages of the most widely used systems with relevant cases from their practice.

Learning by Exposure in the Visual System.

It is increasingly being understood that perceptual learning involves different types of plasticity. Thus, whereas the practice-based improvement in the ability to perform specific tasks is believed to rely on top-down plasticity, the capacity of sensory systems to passively adapt to the stimuli they are exposed to is believed to rely on bottom-up plasticity. However, top-down and bottom-up plasticity have never been investigated concurrently, and hence their relationship is not well understood. To examine whether passive exposure influences perceptual performance, we asked subjects to test their orientation discrimination performance around and orthogonal to the exposed orientation axes, at an exposed and an unexposed location while oriented sine-wave gratings were presented in a fixed position. Here we report that repetitive passive exposure to oriented sequences that are not linked to a specific task induces a persistent, bottom-up form of learning that is stronger than top-down practice learning and generalizes across complex stimulus dimensions. Importantly, orientation-specific exposure learning led to a robust improvement in the discrimination of complex stimuli (shapes and natural scenes). Our results indicate that long-term sensory adaptation by passive exposure should be viewed as a form of perceptual learning that is complementary to practice learning in that it reduces constraints on speed and generalization.

Traumatic subaxial cervical spine injury - Improving initial evaluation through correlation of diffusion tensor imaging and subaxial cervical spine injury classification SLIC score.

BACKGROUND: Traumatic injury to spine and spinal cord represents a devastating condition, with a huge risk for permanent severe disabilities. Predicting the long-term outcome in this type of trauma is a very difficult task being under the influence of a wide spectrum of biomechanical and pathophysiological factors. The advent of magnetic resonance imaging (MRI) structural evaluation of the spinal cord brought critical supplementary data in the initial evaluation of these cases. Although edema and hemorrhage proved to be valuable in predicting the outcome, there is a well-documented discrepancy between MRI findings and clinical status. METHODS: We performed diffusion tensor imaging (DTI) MR in 22 symptomatic patients with traumatic cervical spine injuries (mean age 49.6 ± 16, range from 17 to 74 years, 20 males and 2 females). DTI parameters were computed in 15 patients. Regional apparent diffusion coefficient, fractional anisotropy (FA), and fiber length (FL) were calculated in the region of interest defined as the region of maximum structural MR alterations and in the normal cord (above or below the level of the injury). The values for normal and pathological cord were compared. The clinical deficit was assessed with ASIA and subaxial cervical spine injury classification (SLIC) scores. We looked at the correlation between the DTI measures and clinical scores. RESULTS: There is a highly significant difference between normal and pathological spinal cord for all DTI properties measured. There is also a strong correlation between DTI measures and SLIC clinical score, especially for FA. Significant results were obtained for CDA and FL as well although with lesser statistical power. CONCLUSION: Our results suggest that DTI measures, especially FA, represent a strong indicator of the severity of the traumatic cervical cord injury. It correlates very well with SLCI score and can be used as an additional confirmation of the real degree of level lesioning and as a prognostic factor for the neurological outcome regardless of the choice of treatment.

One-step endovascular treatment of bilateral traumatic carotid-cavernous fistulae with atypical clinical course.

Traumatic carotid-cavernous fistula (TCCF) is a rare neurovascular pathologic entity. The bilateral form occurs even rarer and given the potential risk for both optic tracts presents an urgent indication for quick and effective treatment. We present a patient with a bilateral Barrow type A TCCF with a fulminant development of symptoms, who was successfully treated with bilateral detachable balloons in a single session endovascular procedure. The patient experienced complete relief of symptoms, however the complete neurological deficit in the left optic nerve was persistent.

Advanced techniques for removal of retrievable inferior vena cava filters.

Inferior vena cava (IVC) filters have proven valuable for the prevention of primary or recurrent pulmonary embolism in selected patients with or at high risk for venous thromboembolic disease. Their use has become commonplace, and the numbers implanted increase annually. During the last 3 years, in the United States, the percentage of annually placed optional filters, i.e., filters than can remain as permanent filters or potentially be retrieved, has consistently exceeded that of permanent filters. In parallel, the complications of long- or short-term filtration have become increasingly evident to physicians, regulatory agencies, and the public. Most filter removals are uneventful, with a high degree of success. When routine filter-retrieval techniques prove unsuccessful, progressively more advanced tools and skill sets must be used to enhance filter-retrieval success. These techniques should be used with caution to avoid damage to the filter or cava during IVC retrieval. This review describes the complex techniques for filter retrieval, including use of additional snares, guidewires, angioplasty balloons, and mechanical and thermal approaches as well as illustrates their specific application.

Utility of aortic cuffs in converting initially ineligible patients due to unfavorable neck anatomy into successful candidates for endovascular aortic aneurysm repair: A Case Series.

Endovascular repair of the abdominal aortic aneurysm has been established as a successful alternative to open surgical repair, provided that the criteria necessary for such an approach are fulfilled. Anatomic criteria include suitable diameter, length, and angle of the aneurysm proximal neck. We present three cases in which patients were initially ineligible for endovascular repair because of unfavorable neck anatomy but in whom the use of aortic cuffs allowed for successful endograft placement and aneurysm exclusion.

Attention alters visual plasticity during exposure-based learning.

It is generally believed that attention enhances the processing of sensory information during perception and learning. Here we report that, contrary to common belief, attention limits the degree of plasticity induced by repeated exposure to image features. Specifically, daily exposure to oriented stimuli that are not linked to a specific task causes an orientation-specific improvement in perceptual performance along the "exposed" axes. This effect is modulated by attention: human subjects showed a larger improvement in orientation discrimination when attention is directed toward the location where stimuli are presented. However, the capacity to perform discriminations away from the exposed orientation is enhanced when the exposure stimuli are unattended. Importantly, the improvement in orientation discrimination at the unattended location leads to a robust enhancement in the discrimination of complex stimuli, such as natural texture images, with orientation components along the exposed axes, whereas the improvement in orientation discrimination at the attended location exhibits only weak transfer to complex stimuli. These results indicate that sensory adaptation by passive stimulus exposure should be viewed as a form of perceptual learning that is complementary to practice-based learning in that it reduces constraints on generalization.