Category: Nevin Manimala

Nat Commun. 2024 Oct 23;15(1):9153. doi: 10.1038/s41467-024-53326-x.

ABSTRACT

Representational drift-the gradual continuous change of neuronal representations-has been observed across many brain areas. It is unclear whether drift is caused by synaptic plasticity elicited by sensory experience, or by the intrinsic volatility of synapses. Here, using chronic two-photon calcium imaging in primary visual cortex of female mice, we find that the preferred stimulus orientation of individual neurons slowly drifts over the course of weeks. By using cylinder lens goggles to limit visual experience to a narrow range of orientations, we show that the direction of drift, but not its magnitude, is biased by the statistics of visual input. A network model suggests that drift of preferred orientation largely results from synaptic volatility, which under normal visual conditions is counteracted by experience-driven Hebbian mechanisms, stabilizing preferred orientation. Under deprivation conditions these Hebbian mechanisms enable adaptation. Thus, Hebbian synaptic plasticity steers drift to match the statistics of the environment.

PMID:39443498 | DOI:10.1038/s41467-024-53326-x

Sci Rep. 2024 Oct 23;14(1):25041. doi: 10.1038/s41598-024-74782-x.

ABSTRACT

NO previous studies have examined the simultaneous effects of obstructive sleep apnea (OSA), hypertension, and the SNP rs68430822 on stroke. We aimed to explore whether these elements together, play a role as risk factors for stroke. Data was obtained from the Taiwan Biobank and the National Health Insurance database. We used logistic regression analysis to investigate the effect of OSA and hypertension as a risk factor for stroke in different genotypes. We found that OSA and hypertension was associated with stroke in those with the rs6843082 genotype. People with OSA and hypertension together with the rs6843082 genotype (GA + AA) showed a statistically significant difference as a risk for stroke (OR,2.57; 95% CI,1.53 to 4.33). However, there was no statistically significant difference in those people with OSA but without hypertension (OR, 0.53; 95% CI,0.13 to 2.25). After further stratification by combination of OSA and hypertension, those with genotype rs6843082 (GG) had higher risk odds than those with OSA and those with hypertension alone (OR,5.46, 95% CI,3.46 to 8.60). Individuals with genotype rs6843082(GA + AA), OSA and hypertension together had the highest risk for stroke (OR,6.25, 95% CI,3.63 to 10.76) and those with OSA and no hypertension (OR,0.57, 95% CI,0.14 to 2.36) had no significant risk. Our findings showed that people with genotype rs6843082 (GG), with or without hypertension had OSA as a risk factor for stroke. For individuals with the genotype rs6843082 (GA + AA), those with hypertension, OSA is a risk factor for stroke, and for those without hypertension, OSA is not associated with stroke.

PMID:39443494 | DOI:10.1038/s41598-024-74782-x

Nat Commun. 2024 Oct 23;15(1):9157. doi: 10.1038/s41467-024-53224-2.

ABSTRACT

The observation of the gate-controlled supercurrent (GCS) effect in superconducting nanostructures increased the hopes for realizing a superconducting equivalent of semiconductor field-effect transistors. However, recent works attribute this effect to various leakage-based scenarios, giving rise to a debate on its origin. A proper understanding of the microscopic process underlying the GCS effect and the relevant time scales would be beneficial to evaluate the possible applications. In this work, we observed gate-induced two-level fluctuations between the superconducting state and normal state in Al/InAs nanowires (NWs). Noise correlation measurements show a strong correlation with leakage current fluctuations. The time-domain measurements show that these fluctuations have Poissonian statistics. Our detailed analysis of the leakage current measurements reveals that it is consistent with the stress-induced leakage current (SILC), in which inelastic tunneling with phonon generation is the predominant transport mechanism. Our findings shed light on the microscopic origin of the GCS effect and give deeper insight into the switching dynamics of the superconducting NW under the influence of the strong gate voltage.

PMID:39443447 | DOI:10.1038/s41467-024-53224-2

Int Urol Nephrol. 2024 Oct 23. doi: 10.1007/s11255-024-04249-5. Online ahead of print.

ABSTRACT

PURPOSE: This study aims to evaluate the necessity of spinal cord magnetic resonance imaging (MRI) in children with persistent enuresis, specifically those presenting with urodynamically reduced bladder capacity (RBC) and detrusor overactivity (DO), in comparison to children with normal urodynamic findings.

METHODS: We evaluated 586 children admitted for bedwetting, all of whom received urotherapy and/or pharmacotherapy. Persistent enuresis, lasting for over one year, was identified in 134 patients who were subsequently re-evaluated for occult neurological conditions and recommended for urodynamic studies (UDS). In total, 92 patients provided informed consent and underwent UDS. Of these, 40 patients were divided into two cohorts based on UDS findings. All patients were over 6 years of age and had normal physical examinations. The first cohort consisted of 23 children RBC and DO, while the second cohort included 17 children with normal UDS findings. All participants underwent spinal cord MRI with a 3 Tesla scanner. Urodynamic and MRI results were compared using Fisher’s chi-square test.

RESULTS: The median age of the cohort was 11 years, with 26 (65%) of the patients being female. Spinal disorders were identified in 10 patients (25%), with 8 cases of spina bifida without neurological compression and 2 cases of tethered cord. In the RBC + DO cohort, 7 out of 23 patients (30.4%) were found to have spinal disorders, compared to 3 out of 17 patients (17.6%) in the normal UDS cohort, with no statistically significant difference between the groups (p > 0.05).

CONCLUSION: When evaluating persistent enuresis nocturna, a combination of RBC and DO in children with nocturnal enuresis and daytime symptoms may warrant spinal cord MRI, though with limited cost-effectiveness.

PMID:39443432 | DOI:10.1007/s11255-024-04249-5

J Robot Surg. 2024 Oct 24;18(1):379. doi: 10.1007/s11701-024-02146-8.

ABSTRACT

A comparison was conducted between robot-assisted radical prostatectomy (RARP) performed using the Hugo RAS System and the Da Vinci System. We conducted an extensive search of online databases through September 2024. The data from eligible studies were pooled and analyzed with Review Manager 5.4, employing a random effects model. Weighted mean difference (WMD) and odds ratios (OR) with 95% confidence intervals (CI) were used to analyze continuous and categorical variables. A total of eight original studies, involving 1155 patients (HUGO-RARP: 468 vs. da Vinci-RARP: 687), were included. Compared with da Vinci-RARP, HUGO-RARP had a longer docking time (WMD: 6.2 min; 95% CI 4.25-8.14; p < 0.0001), while no significant differences were observed in total operative time, console time, bladder neck dissection time, seminal vesicle dissection time, vesicourethral anastomosis time, or pelvic lymph node dissection time between two systems. There were no significant differences in hospital stay, estimated blood loss, catheter duration, or complication rates. Likewise, oncological and functional outcomes were similar between the two systems. While these results suggest that the Hugo RAS system performs as well as the Da Vinci system in RARP, more randomized controlled studies are needed to further evaluate prognostic outcomes.

PMID:39443428 | DOI:10.1007/s11701-024-02146-8

Eur Arch Otorhinolaryngol. 2024 Oct 23. doi: 10.1007/s00405-024-09048-3. Online ahead of print.

ABSTRACT

PURPOSE: This study aims to develop a practical algorithm for utilizing smartphone-based thermal imaging (SBTI) in the perioperative setting and to establish a standardized evaluation method for objectively assessing SBTI images for cutaneous perfusion of pedicled flaps in the face, head, and neck.

METHODS: This prospective conducted study, integrated SBTI into the assessment of 16 patients undergoing reconstructive surgery for face and neck defects. Thermal images were captured at four timepoints: after marking (T1), after flap elevation (T2), upon completion of surgery (T3), and 24 h postoperatively (T4). The flap areas were divided into three flap zones and graded based on temperature differences (ΔT), with a grading system where grade 1 indicated perfect perfusion and grades 2 to 5 indicated increasing perfusion impairment.

RESULTS: 6 male and 10 female patients aged 64-93 years (mean 78.5 years) undergoing reconstructive pedicled skin flap surgery for facial and neck defects (1 × 1 cm to 11 × 8 cm) due to diagnoses of malignant cutaneous lesions were investigated. Intraoperative assessments indicated good perfusion across flaps. One postoperative dehiscence occurred in an 83-year-old male with a cervical advancement flap, correlated with a significant temperature difference (ΔT > 4 °C) intraoperatively. Statistical analysis revealed a strong positive correlation (p = 0.0003) between clinical assessment grades and ΔT values between specific flap zones at T3.

CONCLUSION: SBTI is an easy-to-apply, low-cost, real-time and reproducible technique for indirect perfusion assessment in pedicled skin flaps of the head and neck region. Further studies are needed implementing this methodology in large and free flaps.

PMID:39443388 | DOI:10.1007/s00405-024-09048-3

J Robot Surg. 2024 Oct 24;18(1):375. doi: 10.1007/s11701-024-02136-w.

ABSTRACT

Robotic-assisted surgery has revolutionised minimally invasive approaches, particularly in colorectal surgery. While many single-center studies on colorectal surgeries exist in present literature, including experiences with Senhance® Robotic Systems, comprehensive multi-center studies are lacking. This study, conducted through the TransEnterix European Patient Registry (“TRUST”), aims to assess the safety and feasibility in this context. The present study explored procedural times, complications, robotic malfunction and limitations, adverse events and pain management outcomes for colorectal procedures, including sigmoid resection, right hemicolectomy and rectal surgery collected in two European centers. Data from 355 colorectal surgeries showed that the median duration of surgery was 147.2 min (IQR: 124.3-183.0), the docking time was reported with a median of 3.4 min (IQR: 2.0-5.4) and the console time was found at a mean of 84.4 min (SD: 33.6). Despite minimal blood loss, pain scores, and robotic malfunction, 2.9% of the cases (10 instances) required conversions to either an open or laparoscopic approach. Further, most robotic limitations were attributed to limited motion (18.9%, 67 cases) and collisions (11.5%, 41 cases). Adverse events (24 cases, 6.8%) were effectively managed, with 23 instances judged completely unrelated to the robotic system. This study underscores the positive outcomes and safety profile of Senhance® Robotic Systems in colorectal surgery, contributing valuable insights for future research and clinical practice.

PMID:39443387 | DOI:10.1007/s11701-024-02136-w

Surg Endosc. 2024 Oct 23. doi: 10.1007/s00464-024-11343-3. Online ahead of print.

ABSTRACT

BACKGROUND: Esophageal cancer remains a significant global health challenge. Several treatment modalities were explored in randomized controlled trials (RCTs) in recent decades. This study evaluates the robustness of RCTs focusing on esophageal cancer treatment using the fragility index (FI) and reverse fragility index (RFI).

METHODS: A systematic review of RCTs studying different treatment modalities for esophageal cancer from 2000 to 2023 was conducted. The FI and RFI were utilized to gauge the robustness of statistically significant and non-significant outcomes, respectively. The FI represents the minimal number of patient outcomes that would need to alter to overturn a trial’s statistical significance, while RFI indicates the minimal changes required to achieve significance in non-significant results.

RESULTS: Out of 4028 studies retrieved, 21 RCTs were included for final analysis. The studies spanned 2001 to 2023 with a mean followup of 66 months (range, 29-108 months) and median number of patients of 194 (range, 45-802). The most common treatment modalities examined in these studies were neoadjuvant chemoradiotherapy (n = 7, 33.3%), neoadjuvant chemotherapy (n = 4, 19.0%), and neoadjuvant immunotherapy (n = 2, 9.5%). Only 5 studies (23.8%) had a statistically significant primary outcome result with a median FI of 6 (IQR, 2.5-8.5). Non-significant primary outcomes were seen in 16 studies (76.2%) with a median RFI of 4 (IQR 1-11) and lost to followup of 0 (IQR 0-4). In the study with the highest FI (10), the FI was lower than the number of patients lost to followup (13).

CONCLUSION: Our findings demonstrate that most RCTs on esophageal cancer treatments did not report significant primary outcomes. The few studies that reported significant results had a low fragility index, suggesting a vulnerability in their findings.

PMID:39443379 | DOI:10.1007/s00464-024-11343-3

Surg Endosc. 2024 Oct 23. doi: 10.1007/s00464-024-11337-1. Online ahead of print.

ABSTRACT

BACKGROUND: The COVID-19 pandemic has profoundly impacted the field of surgery, mostly through infectious risks, staff shortages, reduced hospital capacities, and changed patient pathways. Prompted by an increase in wound complications, we performed an in-depth analysis of an example surgical procedure.

METHODS: A consecutive cohort of 195 patients undergoing laparoscopic cholecystectomy was studied retrospectively. Data of patients receiving cholecystectomy before, during, and after the peak of the pandemic were compared. The potential influence of patient characteristics, pandemic phase, and staffing level (surgeons and nurse assistants) was analyzed statistically. In the primary analyses, the composite measure of a ‘textbook outcome’ was examined, which was defined as no relevant complication, hospital stay < 5 days, and no readmission.

RESULTS: During the COVID-19 phase, acute biliary disease was more common than in the pre-COVID-19 phase (62% vs. 30%). In 35% of cases, no qualified operating room nurse was available. Intraoperative features and postoperative complication rates were increased (bile spillage in 46%, wound complications in 24%). A 59-year-old male admitted with acute cholecystitis during COVID-19 died of wound-related septic shock. Multivariate analysis confirmed the acuity of gallbladder inflammation (odds ratio 5.3) and old age (2.6) as risk factors for a non-textbook outcome. The absence of qualified nursing staff was clearly associated with a non-textbook outcome (odds ratio 3.3).

CONCLUSIONS: The fact that laparoscopic cholecystectomy outcomes were worse during COVID-19 can be partly attributed to a change in patient case-mix, but the shortage of qualified nursing staff in the operating room also had a strong negative influence.

PMID:39443378 | DOI:10.1007/s00464-024-11337-1

Surg Endosc. 2024 Oct 23. doi: 10.1007/s00464-024-11350-4. Online ahead of print.

ABSTRACT

OBJECTIVE: To explore the application of small-sized magnetically controlled capsule gastroscopy (MCCG) in upper gastrointestinal diseases screening in asymptomatic individuals.

METHODS: A retrospective analysis of the clinical data of 2163 asymptomatic individuals who underwent small-sized MCCG at our center from September 2022 to December 2023. The detection of submucosal tumors, polyps and ulcers in the upper gastrointestinal tract, the tolerance and safety of the subjects were statistically analyzed.

RESULTS: Suspected submucosal tumors in the upper gastrointestinal tract were detected in 34 (1.57%) of 2136 subjects, with a higher incidence in females and no observed age difference. Polyps were detected in 328 subjects (15.16%), with a higher incidence in females and an increased detection rate with increasing age. Ulcers were detected in 27 subjects (1.25%), with a higher incidence in males and no observed age difference. There was no significant discomfort in all subjects, and no adverse event or capsule retention occurred.

CONCLUSION: Small-sized MCCG can be used for focal lesion screening in the upper gastrointestinal tract and is comfortable and safe, making it a safe and efficient method for examining upper gastrointestinal diseases in the physical examination population.

PMID:39443377 | DOI:10.1007/s00464-024-11350-4