Minimal Tissue Damage Research Articles

Surgical Deescalation Within Gynecologic Oncology

The goal of surgical deescalation is to minimize tissue damage, enhance patient outcomes, and reduce the adverse effects often associated with extensive or traditional surgical procedures. This shift toward less invasive techniques has the potential to revolutionize surgical practices, profoundly impacting the methods and training of future surgeons. To evaluate adoption of surgical deescalation within the field of gynecologic oncology using The National Cancer Database. This cohort study used prospectively collected data from the National Cancer Database from January 2004 to December 2020. Eligible participants included women in the US who received a diagnosis of clinical stage I to IV endometrial, ovarian, cervical, or vulvar cancer within this time frame. Data were analyzed between January and June 2024. Diagnosis of stage I to IV endometrial, ovarian, cervical, or vulvar cancer. The primary outcome was surgical deescalation, which included evaluation of receipt of surgical intervention, the surgical approach, the type of lymph node assessment, and salvage interventions for disease-affected organs. A Poisson model was applied to estimate the average annual percentage change (AAPC) in the receipt of surgical treatment. A total of 1 218 490 patients (mean [SD] age at diagnosis, 61.2 [13.7] years) were included. Over the study period, the percentage of patients undergoing surgery decreased from 47.4% to 39.9% for those with cervical cancer (AAPC, -1.3%; 95% CI, -1.6% to -1.1%), from 72.0% to 67.9% for those with ovarian cancer (AAPC, -0.5%; 95% CI, -0.6% to -0.4%), from 83.7% to 79.1% for those with endometrial cancer (AAPC, -0.5%; 95% CI, -0.7% to 11 -0.4%), and from 81.1% to 72.6% for those with vulvar cancer (AAPC, -1.3%; 95% CI, -1.6% to -0.9%). The use of minimally invasive surgery increased from 45.8% to 82.2% for those with endometrial cancer (AAPC, 4.6%; 95% CI, 4.5% to 4.8%) and from 13.3% to 37.0% for those with ovarian cancer (AAPC, 9.4%; 95% CI, 9.0% to 9.7%). Sentinel lymph node dissection increased from 0.7% to 39.6% for patients with endometrial cancer (AAPC, 51.8%; 95% CI, 50.5% to 53.2%), from 0.2% to 10.6% for patients with cervical cancer (AAPC, 44.0%; 95% CI, 39.3% to 48.9%), and from 12.3% to 36.9% for patients with vulvar cancer (AAPC, 10.7%; 95% CI, 8.0% to 13.5%) cancers, whereas the rate of complete lymphadenectomies decreased in all 3 groups. The rate of fertility-sparing surgery for patients with cervical cancer younger than 40 years rose from 17.8% to 28.1% (AAPC, 3.1%; 95% CI, 2.3%-3.9%). These findings suggest that over the past 15 years, the field of gynecologic oncology has moved toward surgical deescalation through an overall reduction in the number of patients who undergo surgery, increased use of minimally invasive surgical techniques, and increased use of sentinel lymph node techniques. Future research should focus not only on understanding the impact of surgical escalation on patients (including disease outcomes, quality of life, and equitable access to these services), but also on surgical training.

Formation of aggregated neutrophil extracellular traps in tissues is determining the efficacy of particulate nanoadjuvants

Neutrophils are essential for innate immunity, using mechanisms like Neutrophil Extracellular Trap (NET) formation to fight pathogens. Aggregated NETs (aggNETs) help resolve inflammation by cleaving pro-inflammatory cytokines, while scattered NETs can exacerbate inflammation, leading to tissue damage. Co-injection of 10 nm nanodiamonds (ND10) with peptide antigens boosts immune responses, including anti-SARS-CoV-2 immunity, due to transient immune responses induced by aggNETs around ND10 particles. Diamond nanoparticles in adjuvant mixtures enhance vaccines, though the optimal dose is uncertain. Our study aimed to find the minimal ND10 amount needed for effective aggNETs formation and a robust immune response with minimal long-term tissue damage. In vivo experiments revealed 1 mg of ND10 per injection significantly enhances immune responses, forming granulomas rich in neutrophil elastase. Lower doses left scattered nanoparticles, insufficient for aggNETs formation. The effective ND10 dose for mice, 1 mg per injection, can be extrapolated to other organisms.

Efficacy of lipid nanoparticles-based vaccine to protect against vulvovaginal candidiasis (VVC): Implications for women's reproductive health.

Vulvovaginal candidiasis (VVC) is a common women's health issue, with rising antifungal resistance. This study was aimed to prepare and evaluate the efficacy of a lipid nanoparticle-based vaccine in a murine model of VVC. Dried and reconstituted vesicles containing C. albicans antigens (DRNPs-Ca-Ags) vaccine, formulated with phosphatidylcholine and cholesterol-based lipid nanoparticles via film hydration and freeze-drying. The safety evaluation of DRNPs-CaAgs was conducted by determining hepatic (AST, ALT) or renal (BUN, creatinine) biomarkers. Female mice were immunized with DRNPs-CaAgs or Alum-CaAgs, and immune responses were evaluated via antibody titers, IgG isotypes, and splenocyte proliferation. Protective efficacy of vaccine formulations was assessed through fungal burden, biofilm formation, cytokine levels, and histopathological analysis of vaginal tissues. Mice vaccinated with DRNPs-CaAgs showed significantly enhanced immune responses, with higher antibody titers and IgG2a levels as compared to the Alum-CaAgs group. Vaginal fungal burden was dramatically reduced (665±78 CFUs in DRNPs-CaAgs immunized group vs. 12,944±3540 CFUs in Alum-CaAgs group, p<0.01). Biofilm formation decreased by 45% (p<0.05), and inflammatory cytokines were significantly lowered. Histopathological analysis revealed minimal tissue damage in DRNPs-CaAgs vaccinated mice. The findings suggest DRNPs-CaAgs as a promising vaccine for VVC, eliciting strong immunity, reducing fungal load, and minimizing inflammation. While the reliance on a murine model is a limitation, future clinical trials are essential to evaluate its efficacy and safety in humans, offering a potential strategy to combat drug-resistant infections and improve women's reproductive health.

An MRI-guided stereotactic neurosurgical robotic system for semi-enclosed head coils.

Magnetic resonance imaging (MRI) offers high-quality soft tissue imaging without radiation exposure, which allows stereotactic techniques to significantly improve outcomes in cranial surgeries, particularly in deep brain stimulation (DBS) procedures. However, conventional stereotactic neurosurgeries often rely on mechanical stereotactic head frames and preoperative imaging, leading to suboptimal results due to the invisibility and the contact with patient's head, which may cause additional harm. This paper presents a frameless, MRI-guided stereotactic neurosurgical robotic system. The robot features a seven-degree-of-freedom (7-DOF) remote center of motion, with five DOFs for preoperative trajectory alignment to the target lesion and two DOFs for defining the depth and twisting motion of the needle during insertion, thus to minimize tissue damage. The system employs interactive MRI guidance for real-time visualization of the puncture process, showing great potential in reducing surgery time, enhancing targeting accuracy, and improving safety. Experiments were conducted on the proposed system to evaluate signal-to-noise ratio (SNR) and geometric distortion. During the simultaneous operation and imaging, the system demonstrated less than 10.02% SNR attenuation and less than 0.1% geometric distortion, ensuring image usability. The free-space positioning accuracy of the system was evaluated using a laser tracker, revealing a tip position repeatability error within 0.3 ± 0.1mm.

Treatment of post-traumatic instability of the shoulder joint in athletes: literature review

According to the World Health Organization, the incidence of shoulder injuries is 17.2 cases per 100,000 population. Sports injuries account for approximately 7% of all shoulder injuries, which frequently results in sports career termination if medical attention is not received on time. Over the last decade, arthroscopic surgery has evolved from a diagnostic procedure to an effective therapy method for post-traumatic shoulder instability. Compared to open surgery, arthroscopic surgery is associated with a lower incidence of postoperative complications, shorter surgery duration, lower pain intensity, and early initiation of rehabilitation therapy. The use of both metal and biodegradable anchors reduced the incidence of relapses to 7%, which is a positive outcome. Advances in surgical treatment, particularly the use of arthroscopic techniques, allow for the minimally invasive restoration of shoulder joint function in athletes in a short period of time. Moreover, the postoperative period is characterized by a low incidence of complications and relapses. With each passing year, arthroscopic surgery allows for a broader spectrum of procedures with minimal tissue damage.

Ligasure Hemorrhoidectomy Versus Milligan Morgan Hemorrhoidectomy Prospective Randomized Study

Background: Hemorrhoidectomy is a frequently performed surgical procedure associated with postoperative pain. The use of Ligasure could result in a decreased incidence of pain and bleeding, as coagulation with high-frequency currency has minimal thermal spread and limited tissue damage. Objective: The research compares Ligasure pile excision with surgical diathermy excision for the treatment of III-IV-grade piles. Patients and Methods: Eighty patients with pile III or IV degrees were randomized into two groups: Group one (LS) and group two (diathermy). The study evaluates the mean postoperative pain, intraoperative bleeding, and intraoperative time requirement, early and late complications. All patients were followed up for of 10-12 months. Results: The operating time is considerably shortened in Ligasure group (LS); postoperative pain disappears earlier in LS than in diathermy. Additionally, there was less intraoperative bleeding in LS, and short duration hospital stay as compared to diathermy group. Conclusion: LS is an efficient procedure in degree III or IV pile excision. Therefore, the procedure enhances the use of LS as one of the acceptable modality surgical options for grade III–IV pile. Keywords: Hemorrhoidectomy, ligasure™ vessel sealing system, milligan morgan technique.

Immune Checkpoint Inhibitors in Breast Cancer

The incidence of breast cancer has risen dramatically over the past few decades and has become the most common malignancy in women. By 2040, it is expected that there will be more than 3 million new cases of breast cancer and more than 1 million deaths per year. The incidence of breast cancer has risen dramatically over the past few decades and has become the most common malignancy in women. By 2040, it is expected that there will be more than 3 million new cases of breast cancer and more than 1 million deaths per year. Immune checkpoint therapeutics was significant technological breakthrough on cancer treatment programs. It uses the body’s immune system targets and eliminates cancer cells. This therapy maintains self-tolerance and modulates the immune response to minimize tissue damage during infection. This therapy inhibits immune checkpoints such as PD-1, PD-L1, and CTLA-4, which tumors exploit to evade immune detection. By blocking these pathways, immune checkpoint inhibitors can reactivate T cells, enabling them to recognize and attack breast cancer cells. This essay will explain how does checking for inhibitors help T cells recognize the breast tumor cells, and some drugs specialize in PD-1 and CTLA-4.

An Augmented Reality Visor for Intraoperative Visualization, Guidance, and Temperature Monitoring Using Fluorescence

ABSTRACTFluorescence‐guided surgeries, including tumor resection and tissue soldering, are advancing the frontiers of surgical precision by offering enhanced control that minimizes tissue damage, improving recovery and outcomes. However, integrating fluorescence visualization with real‐time temperature monitoring remains a challenge, limiting broader clinical use. We address this issue with an augmented reality (AR) visor that combines nanomaterial excitation, fluorescence detection, and temperature monitoring. Using advanced fluorescent nanoparticles like indocyanine green‐doped particles and carbon nanotubes, the visor provides a comprehensive view of both the surgical field and sub‐surface conditions invisible to the naked eye. This integration improves the safety and efficacy of fluorescence‐guided surgeries, including laser tissue soldering, by ensuring optimal temperatures and laser guidance in real time. The presented technology enhances existing surgical techniques and supports the development of new strategies and sensing technologies in areas where traditional methods fall short, marking significant progress in precision surgery and potentially improving patient care.

Design and characterization of hollow microneedles for localized intrascleral drug delivery of ocular formulations.

Effective drug delivery to the posterior segment of the eye remains a challenge owing to the limitations of conventional methods such as intravitreal injections, which are associated with significant side effects. This study explored the use of hollow microneedles (HMNs) for localized intrascleral drug delivery as a minimally invasive alternative. Stainless steel HMNs with bevel angles of 30°, 45°, 60°, and 75° were fabricated using wire electron discharge machining. The penetration force of these HMNs in ex vivo porcine sclera was assessed using a texture analyser, revealing that the 60° bevel angle required the lowest force (<2N), making it optimal for scleral penetration. To ensure precision in drug delivery, 3D-printed adapters were developed to control the injection angles and volumes. The distribution of a model dye, rhodamine B, was studied via digital imaging, multiphoton microscopy, and confocal microscopy. The results showed that HMNs with a 60° bevel angle could penetrate the sclera to a depth of approximately 450µm at a 45° injection angle, providing enhanced distribution within the scleral layers. This study confirmed that the use of HMNs enables effective and controlled intrascleral drug delivery, resulting in the formation of localized depots with minimal tissue damage. This research demonstrates the potential of HMNs as a promising alternative to traditional ocular drug delivery methods, offering improved bioavailability and the potential to reduce patient discomfort.

Optimizing total hip arthroplasty: the gripper table mounted system for enhanced soft tissue preservation and postoperative outcomes.

In total hip arthroplasty (THA), soft tissue retraction is crucial, but traditional methods may cause damage. This study addresses the issue by introducing the Gripper Table Mounted System, a pulley-based retraction system. The research compares THA outcomes with and without the Gripper system, whether reducing soft tissue damage and postoperative pain. The Gripper, with its unique design, aims to minimize tissue damage during surgery. The study conducted a retrospective analysis of 180 patients (180 hips) who underwent THA via an antero-lateral approach with the Gripper System or conventional retraction methods. Primary outcomes included gluteus medius cross-sectional area and hip abductor muscle strength. Secondary outcomes were pain VAS, intraoperative bleeding, operative time, laboratory data, and WOMAC score. The study compared outcomes between those using the Gripper System (Gripper + group, n = 58) and those without (Gripper - group, n = 122). Both groups exhibited no significant differences in demographics or operative parameters. Gripper + group showed enhanced recovery in gluteus medius cross-sectional area and hip abductor muscle strength, with significant analgesia at various postoperative time points. No complications were noted in either group. The Gripper system proved effective in early analgesia, swift recovery of hip strength, and preserving muscle area. Its single-use, sterile, and compact design offers advantages over traditional retractor holders or human assistance, potentially reducing soft tissue damage and postoperative pain. This study concluded the Gripper system's value in reducing pain and restoring strength in THA. Therapeutic Level III. The University Hospital Medical Information Network (UMIN) registration number UMIN000052948.

Endotyping in Chronic Rhinosinusitis-An EAACI Task Force Report.

Chronic rhinosinusitis (CRS) is a clinical syndrome defined by typical sinonasal symptoms persisting for at least 12 weeks. CRS is divided into two distinct phenotypes, CRS with nasal polyps (CRSwNP) and without (CRSsNP). The aim of the review is to provide an update on the current knowledge in CRS endotypes. The prevailing hypothesis regarding the pathogenesis of CRS suggests that dysfunctional interactions between the host and environmental stressors at the mucosal surface drive the diverse inflammatory mechanisms. Genetic and epigenetic variations in the mucosal immune system are believed to play a significant role in the pathomechanisms of CRS. Various environmental agents (such as microbes and irritants) have been implicated in CRS. In a healthy state, the sinonasal mucosa acts as a barrier, modulating environmental stimulation and mounting appropriate immune responses against pathogens with minimal tissue damage. Different endotypes may exist based on the specific mechanistic pathways driving the chronic tissue inflammation of CRS. There is a need to understand endotypes in order to better predict, diagnose, and treat CRS. This literature review provides an update on the role of the endotypes in CRS and the limitations of endotyping CRS in clinical practice. Understanding of the pathogenesis and optimal management of CRS has progressed significantly in the last decades; however, there still are several unmet needs in endotype research.

A Case of Severe Post-Biopsy Bleeding and Perforation in Gastric Amyloidosis.

We herein describe a case of severe post-biopsy bleeding and perforation in gastric amyloidosis. A 70-year-old man who had been on dialysis underwent esophagogastroduodenoscopy and biopsy was performed. Post-biopsy bleeding occurred, and three times of coagulation hemostasis and once clip hemostasis were performed. After the hemostasis, he eventually had a gastric perforation and omental patch surgery was performed, however, he passed away after the surgery. From the pathological finding of biopsy specimen, he was diagnosed with gastric amyloidosis caused by dialysis-related amyloidosis. In patients of amyloidosis, the risk of bleeding and perforation is elevated due to vascular and tissue fragility. Therefore, when performing hemostasis in patients with gastrointestinal amyloidosis, clip hemostasis which minimizes tissue damage is considered preferable to coagulation hemostasis.

Maintenance and functional regulation of immune memory to COVID-19 vaccines in tissues.

Memory T and B cells in tissues are essential for protective immunity. Here, we performed a comprehensive analysis of the tissue distribution, phenotype, durability, and transcriptional profile of COVID-19 mRNA vaccine-induced immune memory across blood, lymphoid organs, and lungs obtained from 63 vaccinated organ donors aged 23-86, some of whom experienced SARS-CoV-2 infection. Spike (S)-reactive memory Tcells were detected in lymphoid organs and lungs and variably expressed tissue-resident markers based on infection history, and S-reactive B cells comprised class-switched memory cells resident in lymphoid organs. Compared with blood, S-reactive tissue memory Tcells persisted for longer times post-vaccination and were more prevalent with age. S-reactive Tcells displayed site-specific subset compositions and functions: regulatory cell profiles were enriched in tissues, while effector and cytolytic profiles were more abundant in circulation. Our findings reveal functional compartmentalization of vaccine-induced Tcell memory where surveilling effectors and in situ regulatory responses confer protection with minimal tissue damage.

B-Guide System: Improving the Predictability of Complete-Arch Implant and Prosthetic Placement Using Fixed Prosthesis Guides.

Computer-aided implant placement (CAIP) offers improved accuracy and reduced invasiveness. However, traditional static CAIP (sCAIP) protocols for complete-arch restorations often involve multiple guides and clinical steps, increasing the risk of soft tissue trauma and procedural complexity. This article introduces the B-guide technique, which integrates implant placement and interim prosthesis delivery into a single device to simplify the procedure and minimize tissue damage. The B-guide combines the implant osteotomy and placement guide with an abutment placement and prosthesis pick-up mechanism. The guide remains in place post-implantation, allowing immediate prosthesis conversion. A 55-year-old female patient underwent complete-arch rehabilitation using the B-guide, enabling immediate implant placement and loading. The B-guide minimized soft tissue trauma and eliminated the need for multiple guides, significantly reducing treatment complexity and time. The B-guide simplifies procedures and improves predictability compared with traditional systems by integrating prosthetic adaptation and implant placement, reducing cumulative errors. However, its success is heavily reliant on the operator's expertise, especially in preoperative planning and design. By integrating implant and prosthesis placement into a single guide, the B-guide reduces surgical complexity, minimizes trauma, and enhances prosthetic outcomes, improving clinical efficiency.

Modulation of the Gut-Lung Axis by Water Kefir and Kefiran and Their Impact on Toll-like Receptor 3-Mediated Respiratory Immunity.

The beneficial effect of milk kefir on respiratory heath has been previously demonstrated; however, water kefir and kefiran in the context of respiratory viral infections have not been investigated. Water kefir and kefiran could be alternatives to milk kefir for their application in persons with lactose intolerance or milk allergy and could be incorporated into vegan diets. Using mice models, this work demonstrated that the oral administration of water kefir or kefiran can modulate the respiratory Toll-like receptor (TLR3)-mediated innate antiviral immunity and improve the resistance to respiratory syncytial virus (RSV) infection. The treatment of mice with water kefir or kefiran for 6 days improved the production of interferons (IFN-β and IFN-γ) and antiviral factors (Mx2, OAS1, RNAseL, and IFITM3) in the respiratory tract after the activation of the TLR3 signaling pathway, differentially modulated the balance of pro- and anti-inflammatory cytokines, reduced RSV replication, and diminished lung tissue damage. Maintaining a proper balance between anti-inflammatory and pro-inflammatory mediators is vital for ensuring an effective and safe antiviral immune response, and the results of this work show that water kefir and kefiran would help to maintain that balance promoting a controlled inflammatory response that defends against infection while minimizing tissue damage.

Pharmacology and Articular Cartilage Regeneration: A New Strategy for Osteoarthritis

ABSTRACT Background: Osteoarthrosis is a slowly progressive, multifactorial, and non-inflammatory degenerative disease affecting synovial joints and is typically associated with aging or previous joint damage. Method: Fifty male Sprague Dawley rats were utilized in the study and divided into five groups, with ten rats in each group. The experiment was divided into two phases: in Phase 1, ten animals received 50 μL of saline in the left tibiotarsal joint and served as the control group (SAL), while the other four groups (n = 40) received a single dose of 50 μL complete Freund’s adjuvant (CFA) to induce monoarthritis. In Phase II, after the induction of monoarthritis, from the fourth week onward, the rats in the four CFA-induced monoarthritis groups were treated with 20 μl of gamma-amino butyric acid (GABA), serotonin (SERO), or a neurotransmitter cocktail (NTC) which were given intra-articularly once for three consecutive weeks, while one group was kept as an experimental control. The animals were monitored throughout the experiment, for ankle diameter, gait, and radiological assessment, and were then euthanized and subjected to histopathological evaluation at the conclusion of the study. Results: The study found that there were statistically significant differences in the degree of inflammation between the CFA group and the groups treated with GABA, SERO, and NTC. The CFA group exhibited the most severe and persistent inflammation, whereas the NTC group showed a milder and shorter inflammatory response than the control group (SAL). In terms of gait score, the NTC treatment resulted in a significant reduction in score compared to the treatments with GABA and SERO administered separately. The radiological scores revealed that NTC was the most effective treatment in mitigating radiographic evidence of joint damage, with a significant decrease in bone destruction. The histopathological examination showed that the NTC group had minimal tissue damage or inflammation and had a regenerative effect compared to the other treatment groups. Conclusions: In conclusion, the local administration of neurotransmitters was found to be effective in reversing inflammation, improving gait score, and mitigating radiological changes in CFA-induced arthritis in the murine model.

Expanding Applications and Future of Robotic Microsurgery.

Robotic-assisted microsurgery has emerged as a transformative technology, offering enhanced precision for complex procedures across various fields, including lymphatic surgery, breast reconstruction, trauma, and neurosurgery. This paper reviews current advancements, applications, and potential future directions for robotic-assisted microsurgery. In lymphatic surgery, robotic systems such as Symani have improved precision in thoracic duct reconstruction and lymphatic vessel anastomoses, reducing morbidity despite longer surgery times. In breast reconstruction, robotic systems are being used to refine techniques like the miraDIEP approach, minimizing tissue damage and enhancing precision in individualized treatments. Trauma reconstruction, particularly for extremities, has also benefited from robotic assistance, enabling successful sutures in small vessels and nerves. Emerging applications in meningeal lymphatics show potential for treating neurodegenerative diseases through improved drainage. In neurosurgery, robots enhance precision in deep and narrow anatomic spaces, although advancements in specialized instruments are needed for full implementation. Future development of robotic microsurgery systems will focus on improved maneuverability, miniaturization, and integration of tools like augmented reality and haptic feedback. The goal is to combine robotic precision, data storage, and processing with human skills such as judgment and flexibility. Although robots are unlikely to replace surgeons, they are poised to play an increasingly significant role in enhancing surgical outcomes. As the technology evolves, further research and clinical trials are needed to refine robotic systems and validate their expanding applications in clinical practice.

Letter to the Editor Regarding "The Efficacy and Safety of Topical Saline Irrigation with Tranexamic Acid on Perioperative Blood Loss in Patients Treated with Percutaneous Endoscopic Interlaminar Diskectomy: A Retrospective Study".

Letter: We have read the recent article published by Zhang et al titled "The Efficacy and Safety of Topical Saline Irrigation with Tranexamic Acid on Perioperative Blood Loss in Patients Treated with Percutaneous Endoscopic Interlaminar Diskectomy: A Retrospective Study". In this retrospective study, authors performed interlaminar endoscopic lumbar discectomy (IELD) for L5-S1 disc herniations, categorizing patients into two groups. One group underwent IELD with saline irrigation fluid containing 0.33 gm of tranexamic acid (TXA) per 1L of saline, while the other group received only saline irrigation fluid. We appreciate the authors' efforts in shedding light on the use of TXA in irrigation fluid, which currently has limited literature available. However, we wish to highlight several points of concern that, in our view, warrant further discussion. Upon reviewing the manuscript, our initial concern centers on the reported amount of blood loss, a crucial outcome in this study. The blood loss figures presented in this study appear significantly higher compared to the existing literature. In both study groups, the authors indicate total blood loss (TBL) exceeding 300 ml and intraoperative blood loss (IBL) surpassing 40 ml. In contrast, a systematic review and meta-analysis by Jitpakdee et al. (1) reported a range of blood loss from 10.9 ml to 23.35 ml for interlaminar endoscopic discectomy without any systemic or local use of tranexamic acid. Accurately assessing blood loss in endoscopic spine surgery poses a challenge, and the accuracy of indirect calculation methods is questionable, particularly when bleeding is minimal. Endoscopic discectomy has been proven benefits by minimal tissue damage and negligible blood loss. Another significant concern we would like to address is related to the safety and efficacy of topical tranexamic acid (TXA) use in endoscopic spine surgery. The existing literature generally accepts the safety profile and efficacy of use of intravenous TXA in open spine surgery where the blood loss incurred is substantial (2, 3). However, when it comes to the safety of topical TXA, it is important to note that TXA is known to have neurotoxic and epileptogenic properties when applied to central nervous system (CNS) tissue (5, 6). This is due to its interference with central GABAA receptors and glycine receptors (7). In endoscopic spine surgeries, small dural tears can sometimes go unnoticed due to continuous irrigation fluid pressure. In such cases, the potential CNS side effects associated with topical TXA could pose a real danger. Furthermore, even when dural tears are identified during surgery, it can be challenging to completely washout all the irrigation fluid containing TXA from the surgical field. The accumulation of excessive epidural or intrathecal TXA, especially after a dural tear, can lead to life-threatening conditions such as seizures or arrhythmias, significantly increasing morbidity and mortality in what is often intended as a day-care procedure. Moreover, the authors have not mentioned any exclusion criteria for patients with conditions that are suspected to elevate risk of developing TXA-related side effects, such as a history of thromboembolic events and/or coagulopathy, convulsive disorders and dural disruption. Lastly, in terms of the efficacy of TXA, there are limited studies demonstrating the use of local TXA in spine surgeries to reduce blood loss. For example, Krohn et al(4) used topical TXA irrigation in open instrumented spinal fusion surgery before wound closure. Their study showed a reduction in postoperative blood loss, with drain output decreasing from 525 ml in the non-TXA group to 252 ml in the TXA group. However, it had no significant effect on intraoperative blood loss. We would like to raise a pertinent question regarding endoscopic discectomy procedures, which are characterized by minimal blood loss and are often conducted as day-care surgeries. It becomes a matter of concern whether the potential advantages of using topical TXA in reducing blood loss outweigh the associated risks of neurological damage to the central nervous system (CNS) and other potentially life-threatening complications.

Intravascular delivery of an ultraflexible neural electrode array for recordings of cortical spiking activity

Although intracranial neural electrodes have significantly contributed to both fundamental research and clinical treatment of neurological diseases, their implantation requires invasive surgery to open craniotomies, which can introduce brain damage and disrupt normal brain functions. Recent emergence of endovascular neural devices offers minimally invasive approaches for neural recording and stimulation. However, existing endovascular neural devices are unable to resolve single-unit activity in large animal models or human patients, impeding a broader application as neural interfaces in clinical practice. Here, we present the ultraflexible implantable neural electrode as an intravascular device (uFINE-I) for recording brain activity at single-unit resolution. We successfully implanted uFINE-Is into the sheep occipital lobe by penetrating through the confluence of sinuses and recorded both local field potentials (LFPs) and multi-channel single-unit spiking activity under spontaneous and visually evoked conditions. Imaging and histological analysis revealed minimal tissue damage and immune response. The uFINE-I provides a practical solution for achieving high-resolution neural recording with minimal invasiveness and can be readily transferred to clinical settings for future neural interface applications such as brain-machine interfaces (BMIs) and the treatment of neurological diseases.

Quantitative evaluation of microenvironmental changes and efficacy of cupping therapy under different pressures based on photoacoustic imaging

Cupping therapy, a traditional Chinese medicinal practice, has been subjected to scientific scrutiny to validate its effects on local tissue microenvironments. This study provides a quantitative assessment of cupping therapy at different negative pressures using photoacoustic imaging. Low-pressure cupping (-20 kPa) significantly improved local blood circulation, evidenced by increased hemoglobin oxygen saturation and vessel dilation that normalized within two hours. In contrast, high-pressure cupping (-30 kPa) led to capillary rupture, bleeding, and tissue edema, similar to the clinical presentation of cupping bruises. Additionally, our research unveiled that −20 kPa cupping expedited the clearance of indocyanine green dye, suggesting enhanced lymphatic drainage, which was further supported by fluorescence imaging. This indicates a potential mechanism for cupping's pain relief effects. Moreover, cupping showed promising results in improving sepsis outcomes in mice, potentially due to its anti-inflammatory properties. This study establishes a foundation for the objective evaluation of cupping therapy, demonstrating that low-pressure cupping is effective in promoting blood and lymphatic flow while minimizing tissue damage, thereby offering a safer therapeutic approach.