Minimal Manipulation Research Articles

Modeling a Symmetrically-Notched Continuum Neurosurgical Robot With Non-Constant Curvature and Superelastic Property

A neurosurgical robot with 3-dimensional (3D) distal manipulation can increase instrument workspace for reaching peripheral regions of intracranial lesions to achieve complete lesion removal and minimal brain manipulation in a keyhole procedure. In this work, we designed a Nitinol-based symmetrically notched continuum robot based on the neurosurgical clinical constraints. A mechanics model is developed for the robot using a second order differential equation that exploits the shearing force formulation based upon the Euler <inline-formula xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink"><tex-math notation="LaTeX">$-$</tex-math></inline-formula> Bernoulli moment-curvature equation. It affords non-constant curvature analysis, and integrates the piecewise linear material model with three stages that closely approximates the nonlinear superelastic property of Nitinol. A solution was introduced to this complex mechanics model based on the fourth order Runge-Kutta method with variable transformation, and an iterative approach. Comparison with the experimental data using our proposed model shows its high modeling accuracy in terms of the bending angle and tip position for a single symmetric notch bending as well as 2D bending motion of the robot. The significantly improved accuracy over previous models justifies the added complexity of our modeling approach and could better guide the determination of the notch parameters during robot design.

Letter to the Editor: The Trend of “Neurosurgery Interested” Among Omani Medical Students and Interns Despite the Absence of a Neurosurgery Residency Program: Does This Indicate It's Time to Change?

The extreme lateral infrajugular transcondylar-transtubercular exposure (ELITE) is a surgical approach developed in the late 1980s by Prof. T. Fukushima and represents the dorsolateral inferior skull base procedure of choice to approach lesion located ventrolaterally at the level of the craniocervical junction (CCJ). This approach consist in a suboccipital craniotomy/craniectomy with partial condylectomy and jugular tubercule drilling that can be extended providing for subtotal condylectomy and vertebral artery transposition. The “limited” variation of the ELITE approach consist in a lateral suboccipital craniectomy opening the foramen magnum and removal of at least half of the posterior arch of the atlas without condyle drilling. This surgical technique was recently demonstrated to be particularly suitable for the surgical management of spinal tumor located ventrolaterally in the upper cervical spine. This operative video illustrates step-by-step the surgical technique adopted for the microsurgical resection of a C1-C2 intradural schwannoma located antero-laterally (Video 1). ELITE approach offers a wide and adequate exposure and access to the CCJ, allowing direct visualization and access to the tumor with minimal neural manipulations, early detection of the vertebral artery and, for tumor located at C1-C2 level, without drilling the occipital condyle. In our experience, ELITE procedure is the preferred surgical approach for resection of tumors located ventrally or ventrolaterally to the first 2 cervical levels.

Smart UV-spectrophotometric platforms for rapid green analysis of miconazole nitrate and nystatin in their combined suppositories and in vitro dissolution testing

Miconazole nitrate (MIC) and nystatin (NYS) combination has proven its effectiveness as a prodigious therapy to cure women's common infections; vaginal candidiasis and vaginal mycosis. Herein, six smart UV-spectrophotometric platforms depending on minimal mathematical manipulation steps were first introduced for the simultaneous green analysis of MIC and NYS in their pure forms and commercial vaginal suppositories without any preliminary separation steps. These platforms included dual-wavelength, ratio difference, mean centering of ratio spectra, first derivative ratio, ratio subtraction, and absorption correction methods. All of the aforementioned platforms could estimate MIC in a linear range of 90–900 µg/ml. While NYS was computed directly by zero-order spectrophotometry at its λ max (304 nm) in a linear range of 1–15 µg/ml without any interference by MIC even in low or high concentrations. Dual-wavelength and zero-order spectrophotometric platforms were successfully applied to study the dissolution profile of MIC and NYS in their combined formulation in compliance with FDA recommendations without excipients interference. According to ICH guidelines, all platforms were validated regarding the accuracy, precision, and selectivity producing satisfactory results within the accepted limits. Also, the suggested platforms’ results were statistically compared with each other and with those of the reported HPLC platform revealing no significant difference concerning accuracy and precision at p = .05. Accordingly, all proposed platforms are regarded as economic and eco-friendly alternatives to the expensive chromatographic platforms that utilize hazardous organic solvents during the analysis of cited drugs.

Cutting as an Innovative Approach to Surface and Textile Design

We live in an age where new technologies enable materials and techniques, hitherto unconventional for this field, to start being applied in the design of surfaces and textiles. One such technique is cutting. Used for the creation of works with high artistic value, the manual cutting of paper has been developed to the level of an autonomous art form: kirigami – the Japanese art of cutting paper. Inspired by the technique of kirigami, designers and artists today continue to create two- and three-dimensional surfaces and artworks through patterns of cuts in a wide variety of materials such as textiles, polymer foils, wood, metal and others. These cuts can be made by hand, or cut by machine, using technologies such as laser cutting. Novel technologies and materials open the way for an innovative expansion of the characteristics, functions and the aesthetic value of the textiles and surfaces created through these processes. The in-depth study and calculation of the geometry of such patterns of cuts also plays an important role in the scientific research of “smart” surfaces, as well as of surfaces which have the capability to morph from a two-dimensional structure into a three-dimensional one and vice versa. The current research has as its aim to survey how contemporary designers study and develop cutting techniques in unconventional ways, such as creating three-dimensional structures using minimal manipulation, engineering the properties of surfaces and finding alternative ways of constructing objects. The relation between structure, function and aesthetics and the technologies and materials used will be analysed to determine prevalent tendencies in the field.

Extraperitoneal Single-Port Robot-Assisted Radical Prostatectomy.

Robot-assisted radical prostatectomy (RARP) is currently the standard minimally invasive procedure for the surgical management of localized prostate cancer. It has been shown that the minimally invasive robotic approach offers comparable oncologic and functional outcomes with potential advantages, including decreased blood loss, shorter hospital stay, and recovery period when compared with open surgery. Generally, the transperitoneal RARP approach is the most commonly performed among robotic surgeons, owing to its wider space and early adoption. However, similar oncologic outcomes have been reported with the extraperitoneal approach. Owing to its perceived technical difficulty, extraperitoneal RARP is less adopted nowadays. This approach, however, has its merits particularly in cases where intraperitoneal access can be problematic with extensive adhesions from previous surgeries. Also, extraperitoneal approach allows for minimal bowel manipulation, less steep Trendelenburg positioning, and less pneumoperitoneum, which reflect on early recovery of bowel function after RARP. Both transperitoneal and extraperitoneal approaches can be performed using either the conventional multiport robotic system or the more recent single-port (SP) robotic system. With respect to extraperitoneal RARP, there has been an increased adoption of the SP system, with purported advantages such as better cosmesis, less postoperative analgesic and opioid requirements, and shorter duration of hospital stay. Herein, we describe the technical steps relevant to extraperitoneal single-port robot-assisted radical prostatectomy, and elaborate on the clinical outcomes reported in the literature.

Saphenous Vein Graft Failure: From Pathophysiology to Prevention and Treatment Strategies.

Saphenous vein grafts (SVGs) remain the most frequently used conduits in coronary artery bypass graft surgery (CABG). Despite advances in surgical techniques and pharmacotherapy, SVG failure rates remain high, often leading to repeat coronary revascularization. The no-touch SVG harvesting technique (minimal graft manipulation with preservation of vasa vasorum and nerves) reduces the risk of SVG failure, whereas the effect of the off-pump technique on SVG patency remains unclear. Use of buffered storage solutions, intraoperative graft flow measurement, careful selection of the target vessels, and physiological assessment of the native coronary circulation before CABG may also reduce the incidence of SVG failure. Perioperative aspirin and high-intensity statin administration are the cornerstones of secondary prevention after CABG. Dual antiplatelet therapy is recommended for off-pump CABG and in patients with a recent acute coronary syndrome. Intermediate (30%-60%) SVG stenoses often progress rapidly. Stenting of intermediate SVG stenoses failed to improve outcomes; hence, treatment focuses on strict control of coronary artery disease risk factors. Redo CABG is associated with higher perioperative mortality compared with percutaneous coronary intervention (PCI); hence, the latter is preferred for most patients requiring repeat revascularization after CABG. SVG PCI is limited by high rates of no-reflow and a high incidence of restenosis during follow-up. Drug-eluting and bare metal stents provide similar long-term outcomes in SVG PCI. Embolic protection devices reduce no-reflow and should be used when feasible. PCI of the corresponding native coronary artery is associated with better short- and long-term outcomes and is preferred over SVG PCI, if technically feasible.

Abstract LB141: Assessment of natural killer (NK) cell activity for immunotherapy using a novel flow cytometry-based killing assay

Abstract Natural killer (NK) lymphocytes exhibit potent responses against transformed and pathogen-infected cells. NK cells can act rapidly as they monitor the bloodstream and tissues for tumorigenic and infected cells that lack “self” markers of MHC class I. Upon recognition of a foreign invader or tumor cell, NK cells release cytotoxic proteins such as interferon-gamma and granzyme B. Because of their ability to recognize stressed cells lacking “self” markers, human NK cells have shown promise as therapeutics in clinical trials to reduce disease burden in patients with therapy-resistant or advanced-stage blood cancers. With more than one hundred NK cell- and induced NK cell-based clinical trials ongoing for blood cancers and refractory solid tumors, there is an ever-increasing need for NK cell therapies to treat cancer and immune diseases. We sought to develop novel, clinically relevant, and robust methods for human NK cell expansion. In addition, to simplify the processing of cells for characterization, we developed a flow cytometry based killing assay to monitor NK activity. Therefore, within the same experiment, we can analyze NK cell phenotype profiles with specific antibody panels while also assessing NK cell killing activity. Using optimized serum- and xeno-free conditions with minimal cell manipulations, we have expanded highly purified NK cells up to 500-fold in 14 days from human peripheral blood mononuclear cells (PBMCs) using optimized cytokines and Cloudz CD2/NKp46 microspheres. To characterize the resulting NK cell population, we used a unique antibody panel to phenotype the NK cells by flow cytometry. Within the same experiment, NK killing assays against K562 cells can be performed using a flow cytometry-based killing assay, which has the advantage of using one instrument for all analyses, shortened processing times, and reproducibility. Using this workflow, we can identify different culture conditions that adversely affect NK activity. Together, this data presents a comprehensive and clinically relevant workflow for the expansion of highly purified NK cells and assessing their killing potential. Furthermore, this workflow can be used for screening the activity of chimeric antigen receptor (CAR) expressing immune cells against specific cancer antigens. Citation Format: Jody Bonnevier, Christine Goetz, Li Peng, Jamie Van Etten, Bora Faulkner, Christopher Hammerbeck, Ariel Miller, Gabriella Perell, Christopher Johnson, Joseph Lomakin, David Hermanson, Kevin Flynn. Assessment of natural killer (NK) cell activity for immunotherapy using a novel flow cytometry-based killing assay [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr LB141.

Doppler changes in umbilical artery, middle cerebral artery, cerebroplacental ratio and ductus venosus during open fetal microneurosurgery for intrauterine open spina bifida repair.

To describe changes in fetal Doppler parameters during a novel technique for open fetal microneurosurgery for open spina bifida (OSB) repair. This was a prospective study of 44 fetuses undergoing open fetal surgery for OSB repair using a novel microneurosurgery approach that is characterized by a mini-hysterotomy (diameter of 15 mm), minimal fetal manipulation and maintenance of a constant normal amniotic fluid volume throughout the procedure. Doppler velocimetry of the umbilical artery (UA), fetal middle cerebral artery (MCA) and ductus venosus (DV) was performed before the start of surgery and at prespecified timepoints during fetal surgery. UA pulsatility index (PI) > 95th percentile, DV-PI > 95th percentile, MCA-PI < 5th percentile and cerebroplacental ratio (CPR) < 5th percentile were considered abnormal. Median gestational age at fetal surgery was 25.2 weeks (range, 22.9-27.9 weeks). Doppler recordings were successfully obtained in all cases during all timepoints throughout the surgery. As compared with Doppler values before surgery, there was a significant increase in the proportion of fetuses with MCA-PI < 5th percentile (63.6% vs 13.6%; P < 0.001), CPR < 5th percentile (65.9% vs 15.9%; P < 0.001) and DV-PI > 95th percentile (22.7% vs 0%; P = 0.01) and a non-significant increase in the proportion of fetuses with UA-PI > 95th percentile (11.4% vs 0%; P = 0.12) during fetal surgery. None of the fetuses showed absent or reversed end-diastolic velocity in the UA or absent or reversed DV a-wave at any stage during OSB repair. All abnormal Doppler parameters returned to normal after surgery. During open fetal surgery for OSB repair, a small hysterotomy, reduced fetal manipulation and maintenance of a normal amniotic fluid volume seem to prevent severe fetal Doppler abnormalities. The mild Doppler changes observed during fetal surgery could be a manifestation of fetal adaptation to the stress of fetal surgery. © 2020 International Society of Ultrasound in Obstetrics and Gynecology.

Comparative study of novel green UV-spectrophotometric platforms for simultaneous rapid analysis of flumethasone pivalate and clioquinol in their combined formulation

Flumethasone pivalate (FP) and clioquinol (CL) formulation was developed as a prodigious remedy to cure the external ear inflammatory disorders. So, the current research introduces five smart and novel UV-spectrophotometric platforms relying on minimal mathematical manipulation steps for simultaneous green analysis of FP and CL with no preliminary separation in their formulation that suffered from the high difference of their ratio and severe spectral overlapping. These platforms involved dual-wavelength, first derivative ratio, Fourier self-deconvolution, area under the curve, and bivariate methods. The suggested platform’ linearity was observed over the concentration range of 3–42 µg/ml for FP and 1.5–8 µg/ml for CL. All suggested platforms were validated according to ICH recommendations regarding accuracy, precision, repeatability, and selectivity producing satisfactory results within the accepted limits. These platforms were represented as rapid, green, and cheap alternatives to the reported chromatographic method due to lower solvent consumption and waste generation. Furthermore, they improved the determination sensitivity of the studied drugs and enhanced the recorded data signals or its spectral resolution by the newly introduced Fourier self-deconvoluted method. The statistical comparison between the results of the suggested platforms with each other and with those of the reported method showed no significant differences between them.

Dearomative Synthetic Entry into the Altemicidin Alkaloids.

Altemicidin and related Streptomyces-derived monoterpene alkaloids possess dense, highly polar azaindane cores as well as potent cytotoxic and tRNA synthetase inhibitory properties. The congested α-amino acid motif decorating their presumed iridoid-like core structure has proven to be both a synthetic challenge and a biosynthetic mystery to date. Herein, we report a distinct, abiotic strategy to these alkaloids resulting in a concise synthesis of altemicidin from simple chemical feedstocks. Key chemical findings include the exploitation of a dearomative pyridinium addition and dipolar cycloaddition sequence to stereospecifically install the quaternary amine moiety, and a chemoselective molybdenum-mediated double reduction to establish the fully functionalized azaindane nucleus with minimal redox manipulations.

Culture and Assay of Large-Scale Mixed-Stage Caenorhabditis elegans Populations.

Caenorhabditis elegans (C. elegans) has been and remains a valuable model organism to study developmental biology, aging, neurobiology, and genetics. The large body of work on C. elegans makes it an ideal candidate to integrate into large-population, whole-animal studies to dissect the complex biological components and their relationships with another organism. In order to use C. elegans in collaborative -omics research, a method is needed to generate large populations of animals where a single sample can be split and assayed across diverse platforms for comparative analyses. Here, a method to culture and collect an abundant mixed-stage C. elegans population on a large-scale culture plate (LSCP) and subsequent phenotypic data is presented. This pipeline yields sufficient numbers of animals to collect phenotypic and population data, along with any data needed for -omics experiments (i.e., genomics, transcriptomics, proteomics, and metabolomics). In addition, the LSCP method requires minimal manipulation to the animals themselves, less user preparation time, provides tight environmental control, and ensures that handling of each sample is consistent throughout the study for overall reproducibility. Lastly, methods to document population size and population distribution of C. elegans life stages in a given LSCP are presented.

A superior dead cell removal platform using Akadeum’s BACS microbubbles

Abstract Single cell sequencing (SCS) is one of the most commonly used analytical techniques for cellular characterization and has become a mainstay in immune profiling. As SCS has gained in popularity and improved in sensitivity, it has become apparent that ambient nucleic acids can have a major impact on the quality and reproducibility of obtained SCS results. Since the bulk of ambient nucleic acids in a sample come from dead or dying cells that have lost membrane integrity, one way to dramatically reduce ambient nucleic acids and decrease background noise in SCS is to remove dead cells from the sample prior to sequencing. To address the challenge presented by contaminating dead cells, Akadeum has developed a Buoyancy Activated Cell Sorting (BACS™) microbubble approach for depleting dead cells from biological samples. Leveraging the power of gravity to drive self-isolation, Akadeum’s BACS microbubbles represent some of the gentlest isolations available; therefore, they are ideally suited for applications where cell viability is integral to success of the experiment. Additionally, BACS microbubbles from Akadeum are quick and easy to use since they require only minimal manipulation and do not rely on any extra equipment or consumables. Depletion of dead cells is achieved through the selective capture of cells with exposed phosphatidylserine with Annexin V conjugated BACS microbubbles. Once mixed with the sample, the Annexin V BACS microbubbles capture dead cells and float them to the sample surface for removal leaving behind healthy and untouched cells. Samples exposed to the Annexin V BACS microbubbles demonstrated significantly reduced dead cell populations and ultimately yielded more reliable results.

Optimization and validation of Eco-friendly RP-HPLC and univariate spectrophotometric methods for the simultaneous determination of Fluorometholone and Tetrahydrozoline hydrochloride

AbstractA sensitive RP-HPLC method is presented for the simultaneous quantification of Fluorometholone (FLM) and Tetrahydrozoline hydrochloride (THZ). The method has the advantages of being rapid, accurate, reproducible, ecologically acceptable and sensitive. The separation utilized C8 Xbridge® column and mobile phase mixture of Acetonitrile/phosphate buffer pH 3 ± 0.1 (70:30, v/v) with UV detection at 230 nm. Stepwise optimization and factors affecting separation are properly discussed. Different factors were optimized such as stationary phase, selection of organic solvent and its content, buffer pH and concentration, flow rate, elution type and detection wavelength. The studied drugs were efficiently separated in 3.4 min with high resolution. Also, two univariate spectrophotometric methods have been optimized for the quantification of the studied drugs. Method 1: dual wavelength for THZ and iso-absorptive point for FLM, Method 2: ratio difference (RD) for THZ and first derivative FLM utilizing methanol as a solvent. These methods are accurate, precise with minimal data manipulation. Greenness of the methods was estimated using eco-scale tool where the presented methods were found to be excellent green with eco-score of 83 for HPLC and 80 for spectrophotometry. The methods are validated in conformance with ICH guidelines, with acceptable accuracy, precision, and selectivity. The suggested methods can be employed for the economic analysis of THZ and FLM in their pure form and binary ophthalmic formulation, that can be employed by quality control laboratories.

Optimal demand response strategy of commercial building‐based virtual power plant using reinforcement learning

In this paper, the optimal demand response strategy of a commercial building-based virtual power plant with real-world implementation in heavily urbanised area is studied. Instead of modelling the decision-making process as an optimisation problem, a reinforcement learning method is used to seek the optimal strategy, which could update its performance with minimal manpower manipulation. Specifically, the data collection from several commercial buildings, including hotel, shopping mall and office, in Huangpu district, Shanghai city is analysed to deploy the demand response program. Compared with the conventional demand response strategy based on optimisation, the learnt strategy does not rely on the forecasting information as input and could adapt to the changing demand response incentive automatically. It may not produce the best result every time, but can guarantee the benefit in a non-deterministic way in long-term operation. The real-world deployment of the Huangpu virtual power plant involving hardware and software platform is also introduced, as well as its future development projection.

POS-440 Minimal invasive implant using autologous 3D printed-omentum patch for chronic kidney disease

Chronic kidney disease (CKD), caused by various causes, leads to the end-stage of renal diseases (ESRD). Dialysis and kidney transplant are the only treatments existed in the market for ESRD. Many studies and clinical trials are being conducted to develop new treatments for kidney disease. However, there is no newly developed renal replacement therapies yet. In this study, we developed a new treatment that can delay the progression of ESRD, using autologous omentum tissue. Omentum is one layer of the peritoneum, and it recognizes injuries and infection. Moreover, omentum consists of various cell types such as mesothelial cells, milky spot (immune cells), and extracellular matrix, and these are necessary components in organ regeneration process. A 3D printed omentum patch, developed with a minimal manipulation protocol, is implantable. We micronized omentum tissues to evenly spread certain effective cells and printed them as a thin membrane. The types of CKD models that we use are unilateral ureteral obstruction (UUO) model and 5/6 nephrectomy models. We classified CKD treated models to experimental group and control group, and we transplanted the omentum patches in a subcapsular layer to the experimental group. As a result, we histologically analyzed UUO models, and found symptoms of tubular necrosis, tubule dilation, interstitium fibrosis, and immune cell infiltration. However, the omentum patch implanted group shows these symptoms are significantly inhibited. Also, renal functions were assessed in 5/6 nephrectomy, the experimental group shows that the range of BUN and creatinine maintained in the normal range, compared to the controls. In conclusion, we found that the omentum patch provides regenerative niche to cortex, and it is effective for anti-inflammatory, tissue repair and regeneration without immune rejection. In addition, the patch delays the progression of the kidney to ESRD. Therefore, the autologous omentum patch provides protective effects to the kidney diseases, and it has potentials as future therapeutics for the kidney repairs and its regeneration.

Asymmetric Photocatalytic C(sp3)-H Bond Addition to α-Substituted Acrylates.

Asymmetric functionalization of inert C(sp3)-H bonds is a straightforward approach to realize versatile bond-forming events, allowing the precise assembly of molecular complexity with minimal functional manipulations. Here, we describe an asymmetric photocatalytic C(sp3)-H bond addition to α-substituted acrylates by using tetrabutylammonium decatungstate (TBADT) as a hydrogen atom transfer (HAT) photocatalyst and chiral phosphoric acid as a chiral proton-transfer shuttle. This protocol is supposed to occur via a radical/ionic relay process, including a TBADT-mediated HAT to cleave the inert C(sp3)-H bond, a 1,4-radical addition, a back hydrogen abstraction, and an enantioselective protonation. A variety of inert C-H bond patterns and α-substituted acrylates are well tolerated to enable the rapid synthesis of enantioenriched α-stereogenic esters from simple raw materials.

A novel approach for the isolation and long-term expansion of pure satellite cells based on ice-cold treatment

Satellite cells (SCs) are muscle stem cells capable of regenerating injured muscle. The study of their functional potential depends on the availability of methods for the isolation and expansion of pure SCs with preserved myogenic properties after serial passages in vitro. Here, we describe the ice-cold treatment (ICT) method, which is a simple, economical, and efficient method for the isolation and in vitro expansion of highly pure mouse and human SCs. It involves a brief (15–30 min) incubation on ice (0 °C) of a dish containing a heterogeneous mix of adherent muscle mononuclear cells, which leads to the detachment of only the SCs, and gives rise to cultures of superior purity compared to other commonly used isolation methods. The ICT method doubles up as a gentle passaging technique, allowing SC expansion over extended periods of time without compromising their proliferation and differentiation potential. Moreover, SCs isolated and expanded using the ICT method are capable of regenerating injured muscle in vivo. The ICT method involves minimal cell manipulation, does not require any expertise or expensive reagents, it is fast, and highly reproducible, and greatly reduces the number of animals or human biopsies required in order to obtain sufficient number of SCs. The cost-effectiveness, accessibility, and technical simplicity of this method, as well as its remarkable efficiency, will no doubt accelerate SC basic and translational research bringing their therapeutic use closer to the clinic.

Rocuronium vs Succinylcholine: Emergency Airway Management of the COVID-19 Patient

Tracheal Intubation is routinely performed in many settings. Anesthesia providers are experts in this procedure. Determination for the best possible approach for tracheal intubation include patient and provider specific considerations. Severe acute respiratory syndrome-coronavirus-2 (SARS CoV-2) infection has led to the COVID-19 pandemic. SARS CoV-2 is a highly contagious RNA virus that has caused widespread infections, severe respiratory disease, and deaths. The purpose of this article is to describe the airway management currently recommended in Germany as well as the United States, the multi-systems pathophysiologic complications of these patients, and review the need for minimum airway manipulation prior to intubation of the trachea. Further, this article discusses the pharmacologic options that are available for muscle relaxation during rapid sequence induction. A review of the literature was performed. Further, some authors of this article have actively participated in airway management of COVID-19 patients. Available literature and guidelines suggest that rapid sequence induction with minimal airway manipulation is superior to standard induction. The article suggests that appropriate doses of rocuronium with an option of sugammadex reversal is a safer and superior choice to succinylcholine.

Dural Fenestrations versus Duraplasty in Traumatic Acute SubduralHematoma

AbstractBackground: Patients with Acute Subdural Hematomas (ASDHs) have higher mortality and lower functional recoveryrates compared with those of other head-injured patients. Theoptimal surgical management of traumatic (ASDHs) is con-troversial.Aim of Study: Is to compare results of (ASDHs) managedwith: Group (A) dural fenestrations (multiple fenestrationsof the dura in a meshlike fashion and removing clots throughthe small dural openings that are left open, short operativetime, minimal manipulations of the brain. Group (B) duraplasty (by pericranium or fascia lata graft and close dura afterevacation of hematoma long operative time, more manipula-tions of the brain.Patients and Methods: A retrospective review of 81patients with traumatic ASDH were operated at the Depart-ments of Neurosurgery at Cairo and Fayoum Universitesduring the period from 2012-2015. These patients are dividedinto two groups: Group (A) 55 patients operated with duralfenestrations, (50 males and 5 females) median age 41 yearsold. On admission there were 32 patients with Glasgow ComaScale (GCS) scores of 3 to 5, 21 patients with GCS scores of 6 to 8, and 2 patients with GCS scores of 9 to 12. Operative time average 120 minutes. Group (B) 26 patients operated with duraplasty, (22 males and 4 females) median age 44 years old. On admission there were 19 patients with Glasgow Coma Scale (GCS) scores of 3 to 5, 6 patients with GCS scores of 6 to 8, and one patient with GCS scores of 9 to 12. Operative time average 180 minutes. Early surgical evacuation, decompression craniotomy, intensive care management to monitor intracranial pressure and follow-up Computed Tomography (CT) of the brain are done for all patients.Results: Group (A): 20 patient died in the hospital, 16survived with unfavorable outcome, and 19 survived withfavorable outcome. Group (B): 15 patient died in the hospital, 6 survived with unfavorable outcome, and 5 survived with favorable outcome.Conclusions: The present analysis of the data reveals thatdural fenestrations show good prognosis in decompressivecraniectomy regarding short operative time, minimal brainmanipulations compared to duraplasty, which appear in a significant low morbidity, good survival with unfavorableoutcome and good survival with favorable outcome.

P0011 / #688: THE APPLICATION OF THE NURSING CARE PLAN OF THE MINIMAL MANIPULATION IN THE NEONATAL INTENSIVE CARE UNIT

Aims & Objectives: To verify the impact of the application of the Protocol of minimal manipulation in the control of Intraventricular Hemorrhage in the Neonatal Intensive Care Unit. Methods: Inclusion criteria: newborns with gestational age ≤ 29 6/7 weeks and/or ≤ 1,500g. Strict minimum manipulation was maintained in the first 72 hours of life and could be extended up to the 7th day of life 3-5. The release of the change of decubitus is allowed from the 7th day of life. First Ultrasound of Cranial Fontanelles between the 3rd and 7th day of life of the newborn, to verify hemorrhage6,7. There was an explanation of the content for the multidisciplinary team and family of the newborn, fixed support material in the unit and fixed identifier in the incubator for visualization of the newborn participants of the protocol. Results: There was a positive impact on the application of the Protocol demonstrating a significant decrease in cases of Intraventricular Cerebral hemorrhage. There was a decrease between grade I and III. The incidence of intraventricular cerebral hemorrhages decreased from 39,5% in 2018 to 29,2% in 2019. Grade III and IV Hemorrhages showed a decrease of 50,9% from 2018 to 2019. Conclusions: Considering the non-measurable results on the implementation of the Protocol, we can observe the involvement of the nursing team that conducted the protocol orientation and there was great adherence to the multidisciplinary team and the newborn’s family. The support material that was essential support for conducting the implementation, also reinforced the orientation of Protocol.