Case report: Use of markerless augmented reality system for ventriculoperitoneal shunt placement.

Background: Ventriculoperitoneal (VP) shunt placement is one of the most commonly performed neurosurgical procedures, yet failure rates remain very high. Surface landmarks are typically used to guide VP shunt placement, but they are not reliable in identifying the target anatomy. Augmented reality (AR) is a promising new technology that has the potential to improve the accuracy and effectiveness of neurosurgical procedures. We describe the use of AR for the surgical planning of a VP shunt. Case Description: A 62-year-old male with a history of subarachnoid hemorrhage presented with delayed hydrocephalus. A computed tomography scan was obtained that confirmed dilated ventricles, requiring a right VP shunt. The patient was brought to the operating room, where the AR system was used for visualization and planning. Conclusion: In this study, we describe the use of AR for VP shunt placement. The AR system consists of a Microsoft HoloLens 2 head-mounted display and a novel markerless registration system, which was used to register patient-specific 3D models onto the patient's head for visualizing target anatomy and planning an operative approach. The AR system was used to plan the VP shunt placement in the operating room. This system is easy to use and provides a visualization of the patient's anatomy, which can be used to plan an optimal trajectory. We believe that this has the potential to improve the accuracy and outcomes of VP shunt placements, and further studies are needed to characterize the system's accuracy and benefits.

Evaluation of trauma and critical care training courses on the knowledge and confidence of participants in Kenya and Zambia.

BACKGROUND: Trained health-care personnel are essential for improved outcomes for injured and critically ill patients. The highest injury-related mortality is seen in sub-Saharan Africa, where there is a paucity of skilled personnel. Therefore, the College of Surgeons of East, Central, and Southern Africa (COSECSA) along with Emory University provided an acute trauma care (ATC) and fundamental critical care support course (FCCS). This study evaluates the impact of American-derived courses on the knowledge and confidence of participants from resource-limited countries. METHODS: Courses were held in Lusaka, Zambia, and Nakuru, Kenya. Participants were COSECSA trainees and personnel from local institutions. The evaluation used a pre-/postcourse multiple-choice exam for knowledge acquisition and a pre-/postcourse questionnaire for confidence assessment. Confidence was measured using a 5-point Likert score, with 5 being the highest level of confidence. Confidence or self-reported efficacy is correlated with increased performance of new skills. RESULTS: There were 75 participants (median age = 31 years, 67% male). Three-quarters of the participants reported no prior specific training in either trauma or critical care. Knowledge increased from an average of 51 to 63.3% (p = 0.002) overall, with a 21.7% gain for those who scored in the lowest quartile. Confidence increased from pre- to postcourse on all measures tested: 22 clinical situations (10 trauma, 9 critical care, 3 either) and 15 procedures (p < 0.001 for all measures both individually and aggregated, Wilcoxon rank sum test). The strongest absolute increase in confidence, as well as the largest number of participants who reported any increase, were all in the procedures of cricothyroidotomy [median: pre = 3 (IQR: 2-3) to post = 5 (IQR: 4-5)], DPL [median: pre = 3 (IQR: 2-4) to post = 5 (IQR: 4-5)], and needle decompression [median: pre = 3 (IQR: 3-4) to post = 5 (IQR: 5-5)]. CONCLUSIONS: Participants from resource-limited countries benefit from ATC/FCCS courses as demonstrated by increased knowledge and confidence across all topics presented. However, the strongest increase in confidence was in performing life-saving procedures. Therefore, future courses should emphasize essential procedures, reduce didactics, and link knowledge acquisition to skill-based teaching.

Biochemical modifications and neuronal damage in brain of young and adult rats after long-term exposure to mobile phone radiations.

This study investigated the effect of exposure to mobile phone radiations on oxidative stress and apoptosis in brain of rats. Rats were allocated into six groups (three young and three adult). Groups 1 and 4 were not subjected to the radiation source and served as control groups. In groups 2 and 5, the mobile phones were only connected to the global system for mobile communication, while in groups 3 and 6, the option of calling was in use. Microwaves were generated by a mobile test phone (SAR = 1.13 W/kg) during 60 days (2 h/day). Significant increments in conjugated dienes, protein carbonyls, total oxidant status, and oxidative stress index along with a significant reduction of total antioxidant capacity levels were evident after exposure. Bax/Bcl-2 ratio, caspase-3 activity, and tumor necrosis factor-alpha level were enhanced, whereas no DNA fragmentation was detected. The relative brain weight of young rats was greatly affected, and histopathological examination reinforced the neuronal damage. The study highlights the detrimental effects of mobile phone radiations on brain during young and adult ages. The interaction of these radiations with brain is via dissipating its antioxidant status and/or triggering apoptotic cell death.