Operative Session Research Articles

Chronic inflammatory pain reduces fentanyl intake during early acquisition of fentanyl self-administration, but does not change motivation to take fentanyl in male and female rats

The co-occurrence of chronic pain and opioid misuse has led to numerous preclinical investigations of pain-opioid interactions to examine how pain manipulations alter the reinforcing properties of opioids. However, preclinical investigations of chronic pain effects on opioid drug self-administration have produced inconsistent results. Our previous work demonstrated that established fentanyl self-administration is resistant to change by induction of chronic inflammatory pain (Complete Freund's Adjuvant; CFA) in male and female rats, while other laboratories have shown that CFA increased fentanyl self-administration in male but not female rats when pain induction precedes self-administration, which may be a critical factor in determining the effects of chronic pain on self-administration. The present study was designed similarly to Higginbotham et al. (2022) to test the effects of CFA on fentanyl self-administration in rats that underwent pain prior to acquisition of fentanyl self-administration. Male and female rats treated with hindpaw CFA or saline were trained to intravenously self-administer (IVSA) fentanyl for 3 weeks under limited access to fentanyl (2 h per day) conditions. After 3 weeks of fentanyl IVSA acquisition, we tested motivation to take fentanyl using progressive ratio testing and dose-response testing. CFA male and female rats self-administered less fentanyl than saline-treated controls during week 1 of acquisition, but not during weeks 2–3 of acquisition. Intra-session analysis of week 1 data demonstrated that chronic inflammatory pain suppressed fentanyl intake towards the end of week 1 and at the end of each operant session. We also report no effects of chronic inflammatory pain on motivation to take fentanyl. We discuss potential methodological explanations for differences between these results and prior reports. Our findings demonstrate that CFA temporarily suppresses fentanyl IVSA in animals without changing motivation to take fentanyl or promoting escalation of opioid use, suggesting that chronic inflammatory pain is unlikely to promote long-term risk of opioid misuse.

Sex differences in the social motivation of rats: Insights from social operant conditioning, behavioural economics, and video tracking

BackgroundSocial behaviour plays a key role in mental health and wellbeing, and developing greater understanding of mechanisms underlying social interaction—particularly social motivation—holds substantial transdiagnostic impact. Common rodent behavioural assays used to assess social behaviour are limited in their assessment of social motivation, whereas the social operant conditioning model can provide unique and valuable insights into social motivation. Further characterisation of common experimental parameters that may influence social motivation within the social operant model, as well as complementary methodological and analytical approaches, are warranted.MethodsThis study investigated the effects of biological sex, housing condition, and time-of-day, on social motivation using the social operant model. This involved training rats to lever press (FR1) for 60-s access to a social reward (same-sex conspecific stimulus). Subjects were male and female Wistar rats, housed under individual or paired conditions, and sessions were conducted either in the mid-late light phase (ZT6-10) or early-mid dark phase (ZT13-17). A behavioural economics approach was implemented to measure social demand and the influence of stimulus partner sex (same- vs. opposite-sex stimulus) on social operant responding. Additionally, video tracking analyses were conducted to assess the degree of convergence between social appetitive and consummatory behaviours.ResultsBiological sex, housing conditions, the interaction between sex and housing, and stimulus partner sex potently influenced social motivation, whereas time-of-day did not. Behavioural economics demonstrated that sex, housing, and their interaction influence both the hedonic set-point and elasticity of social demand. Video analysis of social interaction during social operant sessions revealed that social appetitive and consummatory behaviours are not necessarily convergent, and indicate potential social satiety. Lastly, oestrus phase of female experimental and stimulus rats did not impact social motivation within the model.ConclusionsSocial isolation-dependent sex differences exist in social motivation for rats, as assessed by social operant conditioning. The social operant model represents an optimal preclinical assay that comprehensively evaluates social motivation and offers a platform for future investigations of neurobiological mechanisms underlying sex differences in social motivation. These findings highlight the importance of continued consideration and inclusion of sex as a biological variable in future social operant conditioning studies.Plain English summaryHumans are social creatures—our everyday interactions with others and the support this provides play a key role in our wellbeing. For those experiencing mental health conditions, people’s motivation to engage with others can wane, which can lead them to withdraw from those who support them. Therefore, to develop better treatment strategies for these conditions, we need to gain a deeper understanding of social motivation. Studying social behaviour in animals can facilitate this investigation of social motivation as it allows for a causal understanding of underlying neurobiology that is not possible in human experiments. An optimal way to study social motivation in animals is using the social operant conditioning model, where rats learn to press a lever that opens a door and allows them to interact with another rat for a short time. This study characterised the social operant model by testing whether sex, housing conditions, time-of-day, and the sex of the stimulus partner influence rats’ motivation to seek interaction with another rat. We found that female rats were more socially motivated than males, and that rats living alone were more motivated than those living with another rat; interestingly, this effect of housing affected females more than males. Regardless of sex, rats were more motivated to interact with a rat of the opposite sex. These findings provide insights into sex differences in social motivation in rats and new insights into the social operant model which will help guide future research into social motivation and other mental health conditions.

Correcting for ERP latency jitter improves gaze-independent BCI decoding

Objective. Patients suffering from heavy paralysis or Locked-in-Syndrome can regain communication using a Brain–Computer Interface (BCI). Visual event-related potential (ERP) based BCI paradigms exploit visuospatial attention (VSA) to targets laid out on a screen. However, performance drops if the user does not direct their eye gaze at the intended target, harming the utility of this class of BCIs for patients suffering from eye motor deficits. We aim to create an ERP decoder that is less dependent on eye gaze. Approach. ERP component latency jitter plays a role in covert visuospatial attention (VSA) decoding. We introduce a novel decoder which compensates for these latency effects, termed Woody Classifier-based Latency Estimation (WCBLE). We carried out a BCI experiment recording ERP data in overt and covert visuospatial attention (VSA), and introduce a novel special case of covert VSA termed split VSA, simulating the experience of patients with severely impaired eye motor control. We evaluate WCBLE on this dataset and the BNCI2014-009 dataset, within and across VSA conditions to study the dependency on eye gaze and the variation thereof during the experiment. Main results. WCBLE outperforms state-of-the-art methods in the VSA conditions of interest in gaze-independent decoding, without reducing overt VSA performance. Results from across-condition evaluation show that WCBLE is more robust to varying VSA conditions throughout a BCI operation session. Significance. Together, these results point towards a pathway to achieving gaze independence through suited ERP decoding. Our proposed gaze-independent solution enhances decoding performance in those cases where performing overt VSA is not possible.

Does anesthesia duration or number of cases per patient predict safety events?

The need for dental rehabilitation under general anesthesia is increasing, with varying needs between patients. Mortality has been found to be a rare event in these patients; however other perioperative events can and do occur. Previous studies have established increased incidence of perioperative events with younger, sicker children, and longer anesthetics, however, no studies to date have evaluated if the incidence of perioperative events is more closely associated with one long anesthetic or multiple anesthetics per patient. To evaluate the association of perioperative events related to single anesthetic duration or number of anesthetics per patient for dental rehabilitation. After Children's Wisconsin Human Research Protection Program determined this quality activity did not meet the definition of human subjects research, we performed an epidemiologic observational evaluation by extracting all dental related cases (dental alone or with oral surgeon vs. dental with other specialties) with an associated general anesthesia encounter from Children's Wisconsin electronic data warehouse from June 1, 2015 to December 31, 2021. These cases occurred at a free-standing children's hospital or associated pediatric-only ambulatory surgery center. The risk of perioperative safety events was analyzed for previously identified risk groups such as American Society of Anesthesiologists Physical Status (ASA-PS), patient age, anesthesia case time with the addition of number of dental cases per patient. In this study, 8468 procedures were performed on 8082 patients. Of this cohort, 7765 patients underwent one procedure for dental care while 317 patients underwent a total of 703 dental-related procedures, ranging from two to five procedures per patient. Multivariable logistic regression identified increased risk of perioperative events in patients with ASA-PS 3 (n = 1459, rate 1.78%, p value .001, OR 5.7, CI 2.1-15.5) and ASA-PS 4 (n = 86, rate 5.8%, p < .001, OR 17.2, CI 4.4-67.3), anesthesia duration (p < .001, OR 1.46, CI 1.21-1.76), but no increased risk with number of anesthetics per patient (p value .54, OR 0.81, CI 0.4-1.61). Limiting dental care under general anesthesia to multiple short cases may decrease the risk of perioperative events when compared to completing all treatment in one long operative session.

Semirigid ureteroscopy and tamsulosin therapy as dilatation methods before flexible ureteroscopy: evaluation and benefits

ObjectiveTo evaluate the effect of semirigid ureteroscopy and tamsulosin therapy as dilatation methods before flexible ureteroscopy advancement to the renal collecting system.Patients and methodsThis prospective study included patients with renal stones less than 2 cm who underwent retrograde flexible ureteroscopy and laser lithotripsy. The patients were randomized into two groups: group A patients were given a placebo for 1 week before flexible ureteroscopy, and group B patients were administered 0.4 mg of tamsulosin once daily for 1 week before surgery and underwent active dilatation using semirigid ureteroscopy before flexible ureteroscopy. The ability of the flexible ureteroscope to reach the collecting system in both groups during the same operative session was assessed. Operative outcomes and complications were collected and analyzed in both groups.ResultsA total of 170 patients were included in our study, with each group comprising 85 patients. In group B, the flexible ureteroscope successfully accessed the kidney in 61 patients, while in group A, the flexible ureteroscope was successful only in 28 cases (71.4% versus 32.9%). In group A, 33 (38.8%) patients had lower urinary tract symptoms compared to 17 (20.2%) patients in group B (P = 0.013).ConclusionUsing tamsulosin therapy and semirigid ureteroscopy as dilatation methods before flexible ureteroscopy increased the success of primary flexible ureteroscopy advancement to renal collecting system.

Community-based COVID vaccination center ready for the switch towards a broad community-based prevention center: In Jan'21 the Flemish Region started the COVID vaccination in a public health mode, at 60 primary health care units.

Framework: Each local “unit of care” has an average population of 100.000 people and is managed by local caregivers. Within two months (Jan-Feb'21), 80 vaccination centers were set up and launched. A central strategic center and logistic/financial support were created. A local team of municipal representatives and caregivers was composed. It resulted in a management team which launched the operational vaccination sessions.&#x0D; All citizens were invited by email, letter or SMS. An individual appointment was booked in the vaccination center matching the zip code of the citizen’s residence. Specific software enabled vaccination agenda management and its registration in Flanders’ central vaccination database.&#x0D; The initial goal was to cover at least 70% of the target population, but in the primary care unit “Voorkempen”, a coverage of 95,45% was reached.&#x0D; Vaccination center “Voorkempen” ‘s results: The health unit “Voorkempen” is a defined area, situated in the province of Antwerp and is composed of 6 municipalities which give home to 111.102 inhabitants.&#x0D; The campaign consisted of four periods :&#x0D; - Feb-Sep'21 : basic vaccination (97.763 citizens)&#x0D; - Oct'21-Feb'22 : 1st booster campaign for all 12+ ( 93.316 citizens).&#x0D; - May-June'22: extra booster exclusively for 80+ (7.153 citizens)&#x0D; - Sept-Oct'22 : 2nd booster for all 18+, (90.473 citizens)&#x0D; Lessons learned: &#x0D; 1.Flexible management by a limited number of managers (4) with daily meetings and quick decision making is essential and covers :&#x0D; A.The infrastructure in time and space.&#x0D; B.The IT environment including call center, vaccination agenda and HR management.&#x0D; C.Vaccination sessions planning : stock control and ordering, session planning and unfolding of a mobile team.&#x0D; D.HR management : staff recruitment &amp; selection, training, coaching, contracting, team composition, insurance, payroll.&#x0D; E.Operational vaccination sessions: reception and flow inside the vaccination center, problem solving, administrative check-in, vaccination, registration, surveillance.&#x0D; F.Vaccination registration : group registration in Vaccinnet as a base for COVID certification&#x0D; 2.The support of the municipalities was crucial : accountancy, logistic support, mass communication.&#x0D; 3.The primary healthcare providers’ trust and cooperation was established by constant communication, information and feedback.&#x0D; 4.The mobilization of local volunteers was overwhelming - it became a flexible group coping with unforeseen circumstances and unexpected events.&#x0D; 5.Population management: the data collection concerns local infection rates, hospitalizations and vaccination rates. Its analysis allowed quick reactions.&#x0D; Future: The broad experiences of the central management, people management and population management in this vaccination center can be used to improve preventive actions and early detection programs in different domains:&#x0D; -Infectious diseases including influenza: testing and vaccinations in a similar center as the COVID vaccination center, - new vaccines will be on the market soon.&#x0D; -Chronic diseases: early risk detection and risk management: lifestyle, healthy diet, exercising,…&#x0D; -Improvement of oncological screening programs (breast cancer, cervix cancer and colorectal cancer).&#x0D; -Geriatric stratification and early support&#x0D; -Mental health&#x0D; For the permanent switch to a local “prevention center”, political decisions, a legal framework and structural support is absolutely necessary.&#x0D;

Patient Perspectives on Kidney Stone Surgery: A Content Analysis of Instagram Posts by Patients Versus Surgeons

BackgroundBoth clinicians and patients use social media to post about health care issues such as kidney stone disease, but their perspectives may differ. ObjectiveTo evaluate content and themes regarding kidney stone surgery shared by patients and urologists on Instagram. Design, setting, and participantsA search was performed on Instagram using the term “kidney stone surgery”. The first 100 posts from individuals who were clearly identified as a patient were assessed. We also assessed 100 posts from self-identified urologists. Outcome measurements and statistical analysisA previously published system was applied as a framework for categorizing the information collected. Outcomes of interested included pain, recovery, and costs. Results and limitationsSome 71% of the patients were female and most of their posts (52%) were shared postoperatively. The most common themes covered in patient posts were the need for multiple operative sessions (45%), pain (43%), and recovery (42%). Other themes included activities of daily life (18%), return to work (11%), nervousness (16%), stent issues (31%), stent on a string (5%), diet and prevention (9%), gratitude for health care services (10%), disease recurrence (18%), and costs (10%). Some 94% of the urologists were male and their posts covered the following domains: recovery (11%), stent issues (3%), pain (1%), stent on a string (1%), gratitude for health care services (1%), and recurrence 1%. Among the posts from urologists, 79% included self-promotion and 52% covered new technology. Overall, 10% contained false information. The majority of the posts with surgical images had no clear statement regarding patient consent (97%). ConclusionsKidney stone surgery can affect many areas of a patient’s quality of life. Most of the posts shared by patients were negative. Posts shared by urologists do not reflect the same themes. Moreover, there appears to be poor adherence to European Association of Urology recommendations regarding online professional conduct. Patient summaryMany patients use social media to share their experiences of kidney stone surgery. Posts are largely related to quality-of-life issues and are mostly negative. While urologists also use social media, the content they post on professional accounts is mostly focused on new technology and career promotion.

The SingHealth Perioperative and Anesthesia Subject Area Registry (PASAR), a large-scale perioperative data mart and registry.

To enhance perioperative outcomes, a perioperative registry that integrates high-quality real-world data throughout the perioperative period is essential. Singapore General Hospital established the Perioperative and Anesthesia Subject Area Registry (PASAR) to unify data from the preoperative, intraoperative, and postoperative stages. This study presents the methodology employed to create this database. Since 2016, data from surgical patients have been collected from the hospital electronic medical record systems, de-identified, and stored securely in compliance with privacy and data protection laws. As a representative sample, data from initiation in 2016 to December 2022 were collected. As of December 2022, PASAR data comprise 26 tables, encompassing 153,312 patient admissions and 168,977 operation sessions. For this period, the median age of the patients was 60.0 years, sex distribution was balanced, and the majority were Chinese. Hypertension and cardiovascular comorbidities were also prevalent. Information including operation type and time, intensive care unit (ICU) length of stay, and 30-day and 1-year mortality rates were collected. Emergency surgeries resulted in longer ICU stays, but shorter operation times than elective surgeries. The PASAR provides a comprehensive and automated approach to gathering high-quality perioperative patient data.

Single-Event Multi-Level Surgery in Cerebral Palsy: A Bibliometric Analysis.

Background and Objectives: Single-Event Multi-Level Surgery (SEMLS) is a complex surgical programme in which soft tissue contractures and bony torsional deformities at the ankle, knee and hip, in both lower limbs are surgically corrected during a single operative session, requiring one hospital admission and one period of rehabilitation. The aim of SEMLS is to improve gait and function in ambulant children with cerebral palsy. Utilisation of the SEMLS concept can reduce the number of surgical events, hospital inpatient stays and reduce rehabilitation requirements to a single intensive episode. Three-dimensional gait analysis is a pre-requisite to plan intervention at multiple anatomic levels to correct fixed deformities and to improve gait and function. Materials and Methods: This study was a bibliometric analysis of SEMLS in cerebral palsy using the Clarivate Web of Science Core Collection database from 1900 to 29 May 2023. Results: A total of 84 studies met the inclusion criteria. The most highly cited article was "Correction of severe crouch gait in patients with spastic diplegia with use of multilevel orthopaedic surgery" by Rodda et al. (2006) with 141 citations. The most productive institutions by number of articles were the Royal Children's Hospital Melbourne (Australia), Murdoch Children's Research Institute (Australia) and University of Melbourne (Australia). The most productive author by number of citations was HK Graham (Australia). Conclusions: The literature base for SEMLS consists largely of retrospective cohort studies. The aforementioned three institutes in Melbourne, Australia, which frequently collaborate together, have contributed the greatest number of studies in this field.

Impact of COVID-19 pandemic on sports and arthroscopic surgery in local hospitals

Introduction: Elective orthopaedic service has been reduced during the COVID-19 pandemic, and sports activities of the population have been minimised due to the social distancing strategies. This study aimed to quantify the change in sports medicine operations and its distributions during the COVID-19 pandemic, which could be useful for healthcare providers and policymakers plan in terms of resource planning in case of another severe infection outbreak in the future. Methods: Data, including age and gender of the patients and the types of operation, of all the surgeries performed by the Division of Sports and Arthroscopic Surgery in our institution from September 2017 to June 2022 was retrieved. The first 29 months of the 58 months period were classified as pre-COVID-19. Result: During the COVID-19 pandemic, there was a 20.9% reduction in the total number of sports and arthroscopic surgeries performed, from 10.1 to 8.0 per month ( p = 0.042). The number of shoulder operations was significantly reduced by 32% ( p = 0.029), with rotator cuff surgery reduced by 42% ( p = 0.022). The number of knee operations decreased by 15% ( p = 0.278), with anterior cruciate ligament (ACL) surgery reduced by 20% ( p = 0.093). Notably, the relative proportion of knee and shoulder operations, as well as the patient demographics, remained similar during the COVID-19 pandemic. Conclusion: The reduction in the number of ACL and rotator cuff surgeries could be related to the reduced sports activity and manual labour activity during the lockdown periods of the pandemic. This study provides information and insight into the demand for sports medicine-related operations during the pandemic. It may be practical to limit elective operation sessions for sports and arthroscopic surgery during the pandemic, especially when resources are scarce. However, it is essential to strike a good balance between providing necessary care for patients who require these surgeries, while also taking appropriate measures to combat the pandemic.

Multivisceral combined robot-assisted surgery: Single docking partial nephrectomy and cholecystectomy

We present a case of robot-assisted combined partial nephrectomy and robot-assisted cholecystectomy in a 71-year-old male patient diagnosed with a lower solid renal mass, identified during a regular oncological follow-up for non-Hodgkin’s lymphoma, and suffering of chronic cholecystitis due to a concomitant gall bladder stone. We performed both procedures during a single operative session, using a modified trocar configuration with Da Vinci-Xi Robotic Surgical System (Intuitive Surgical, Sunnyvale, California) Platform that allowed the performance of both surgeries with a total blood loss of 100 ml and 187 min of surgical time. A single docking approach of the Xi Da Vinci System resulted in feasible and allowed a reduction of hospitalization costs improving intraoperative surgical timing with all the benefits of the robotic approach for both surgeries.

THC exposure during adolescence increases impulsivity-like behavior in adulthood in a WIN 55,212-2 self-administration mouse model.

Cannabis addiction is a chronically relapsing disorder lacking effective treatment. Regular cannabis consumption typically begins during adolescence, and this early cannabinoid exposure may increase the risk for drug addiction in adulthood. This study investigates the development of cannabis addiction-like behavior in adult mice after adolescent exposure to the main psychoactive component of cannabis, Δ9-tetrahydrocannabinol (THC). Adolescent male mice were exposed to 5 mg/kg of THC from postnatal days 37 to 57. Operant self-administration sessions of WIN 55,212-2 (12.5 μg/kg/infusion) were conducted for 10 days. Mice were tested for three addiction-like criteria (persistence of response, motivation, and compulsivity), two parameters related to craving (resistance to extinction and drug-seeking behavior), and two phenotypic vulnerability traits related to substance use disorders (impulsivity and reward sensitivity). Additionally, qPCR assays were performed to detect differentially expressed genes in medial prefrontal cortex (mPFC), nucleus accumbens (NAc), dorsal striatum, and hippocampus (HPC) of "addicted" and "non-addicted" mice. Adolescent THC exposure did not modify WIN 55,212-2 reinforcement nor the development of cannabis addiction-like behavior. Inversely, THC pre-exposed mice displayed impulsive-like behavior in adulthood, which was more pronounced in mice that developed the addiction-like criteria. Moreover, downregulated drd2 and adora2a gene expression in NAc and HPC was revealed in THC pre-exposed mice, as well as a downregulation of drd2 expression in mPFC of vehicle pre-treated mice that developed addiction-like behaviors. These findings suggest that adolescent THC exposure may promote impulsivity-like behavior in adulthood, associated with downregulated drd2 and adora2a expression in NAc and HPC.

Strengthening Speed and Child Restraint Enforcement Capacity in the Philippines

Recent legislative developments in the Philippines provided opportunities to strengthen existing speed enforcement capacity and build competence in relation to enforcing child restraint use for the first time in this country. The Global Road Safety Partnership’s (GRSP) Road Policing Capacity Building programme team worked closely with government and non-government agencies in the Philippines to develop and deliver a series of classroom and roadside theoretical and operational training sessions. These training sessions resulted in the establishment of a core group of trainers from within local enforcement agencies in the country. This group received initial training as well as ongoing coaching and mentoring support from GRSP to establish a sustainable model of enforcement capability development. Various training methods and curriculum topics are described, noting the importance of supporting in-country partners to determine relevant, context-specific issues according to local needs in the country. This body of work provides a useful example of mechanisms to transfer specific knowledge from the field of traffic law enforcement to police officers in a systematic way, and to build training and enforcement capacity in a sustainable manner.

Risk of Complications in Combined Plastic Surgery Procedures Using the Tracking Operations and Outcomes for Plastic Surgeons Database.

Combining multiple surgical procedures into one operative session is widespread in the field of plastic surgery; however, the implications of this practice are not fully understood. This study compared 30-day complication rates associated with combined plastic surgery procedures compared to index procedures. This retrospective cohort analysis utilized the Tracking Operations and Outcomes for Plastic Surgeons database from 2016-2020 to identify the three most frequent combinations with augmentation mammaplasty, reduction mammaplasty, trunk liposuction, mastopexy, and abdominoplasty. The 30-day overall complication rate was 5.0% (1,400 of 26,771 patients), with a higher complication rate for combined procedures compared to index (7.6% vs 4.2%, aOR 1.91 (95% CI 1.61-2.27), p<0.001). There were no significant differences in complication rates for abdominoplasty or mastopexy combinations compared to index. Complication rates for reduction mammaplasty combinations compared to index were not statistically different after controlling for demographics (aOR 1.02 (95% CI 0.61, 1.64) p=0.93). Higher rates of minor and major complications were observed for combinations of trunk liposuction (aOR 4.84, (95% CI 3.31, 7.21), p<0.001) and augmentation mammaplasty (aOR 1.60, (95% CI 1.13, 2.22), p=0.007) compared to index. TOPS data suggests that combinations with trunk liposuction or augmentation mammaplasty present with increased risk of complications compared to index, controlling for demographics. Abdominoplasty and mastopexy may be combined with other plastic surgery procedures without increased risk to patients. The complication risk of reduction mammaplasty combinations is mediated by other variables, suggesting the need for shared surgical decision making when recommending these combinations to patients.

Proopiomelanocortin projections to the nucleus accumbens modulate acquisition and maintenance of operant palatable pellet administration in mice

Obesity is a crisis in the United States, producing many co-morbid diseases that can drastically decrease quality of life. While diet is a major focus for therapeutic intervention, the need to understand underlying appetitive neurocircuitry persists. Proopiomelanocortin (POMC) peptides are well-known for their anorexigenic activity, but also mediate reward and learning. The nucleus accumbens (NAcc) is best known for its role in reward-based learning, but the contribution of POMC projections to NAcc on feeding are controversial since the two major POMC-derived peptides (β-endorphin and α-MSH) have opposite effects on food intake. Our objective was to determine the effect of stimulating POMC projections in the NAcc on acquisition and maintenance of operant self-administration of a palatable food. Adult POMCCre mice were microinjected into the NAcc with a Cre-dependent retrograde adeno-associated viral vector expressing Gq Designer Receptors Exclusively Activated by Designer Drugs (DREADDs). Mice were trained to self-administer palatable 20-mg pellets in daily operant sessions. Acquisition of self-administration (fixed ratio 30) and baseline self-administration were measured in daily sessions, with mice receiving injections of either JHU37152 (DREADD agonist) or saline (i.p.) 15 min prior to the sessions. POMC neuron stimulation (JHU injection) before training sessions produced a significant increase in rate of acquisition and accuracy compared to the saline treated group, with no significant effect on rewards earned. Removal of POMC neuron stimulation before sessions initially reduced consumption with a gradual increase in responding for reinforcer over 3 days of saline injections. Reinstatement of POMC neuron stimulation (JHU) before the session resulted in a significant decrease in responding and rewards earned. These results suggest a complex role of POMC peptides within the NAcc that increase reward learning for a novel palatable food while decreasing consumption of the reinforcer following experience with it.

Pathological Background and Clinical Procedures in Oral Surgery Haemostasis Disorders: A Narrative Review

Haemostasis disorders are serious pathologies that could put dental and surgical procedures at risk as they are associated with postoperative bleeding, which in some circumstances could be prolonged and dangerous for the patient. In-depth knowledge of the problems associated with coagulation pathologies and the suitable specific procedures should be implemented in dental practice. A good awareness of the clinical protocols to be used in these circumstances may help reduce operator stress and increase patient compliance. Collaboration with the haematologist is always recommended to establish an adequate treatment plan, both regarding the administration of therapies that promote haemostasis and for assessing the operative risk. Hereby, we summarize the congenital and hereditary pathologies that lead to haemostasis disorders, which can be found in patients undergoing dental procedures. The purpose of this narrative review is to frame the diseases from a clinical, anamnestic, and etiopathological standpoint, as well as to evaluate an operative approach to the pathology under consideration, with particular attention to anaesthesia manoeuvres and post-surgical haemostasis, to avoid hematoma formation and uncontrolled bleeding which can lead procedure failure up and even death. Of note, it is likewise important to educate the patient about prevention, to keep the oral cavity healthy and avoid invasive procedures, limiting the number of operative sessions.

Dissecting operant alcohol self-administration using saccharin-fading procedure.

Although alcohol use disorder is a complex human pathology, the use of animal models represents an opportunity to study some aspects of this pathology. One of the most used paradigms to study the voluntary alcohol consumption in rodents is operant self-administration (OSA). In order to facilitate the performance of this paradigm, we aim to describe some critical steps of OSA under a saccharin-fading procedure. We used 40 male Wistar rats to study the process of acquiring the operant response through a saccharin-fading procedure under a fixed ratio (FR1) schedule of reinforcement. Next, we analyze the alcohol introduction and concentration increase, the effect of an alcohol deprivation, and the analogy between this paradigm with the Drinking in the Dark-Multiple Scheduled Access paradigm. During alcohol concentration increase, animals reduced their lever presses in accordance with the increase in alcohol concentration. On the contrary, the consumption measured in g·kg-1 BW showed a great stability. The lever presses pattern within operant session changes with the introduction of different alcohol concentrations: at higher alcohol concentrations, animals tended to accumulate most of their presses in the initial period of the session. We show the utility of fading with low concentrations of saccharin and the evolution of the operant response through the different concentrations of alcohol. Taken together, our results aimed to dissect the acquisition and maintenance of OSA behavior as well as other related variables, to facilitate the understanding and performance of this paradigm.

NEW ZEALAND PROVINCIAL ORTHOPAEDIC TRAUMA STUDY (NZPOTS): THE EFFECTS OF INCREASING TRAUMA ON ELECTIVE ORTHOPAEDIC SURGERY IN PROVINCIAL NEW ZEALAND

Trauma and elective orthopaedic demands in New Zealand are increasing. In this study, prospective and retrospective data has been collected at Nelson Hospital and across New Zealand to identify the percentage of elective theatre time lost due to cancellation for acute patient care. Data has been collected from theatre management systems, hospital data systems and logged against secretarial case bookings, to calculate a percentage of elective theatre time lost to acute operating or insufficient bed capacity.Data was collected over a five-month period at Nelson Hospital, with a total of 215 elective and 226 acute orthopaedic procedures completed. A total of 95 primary hip or knee arthroplasties were completed during this trial while 53 were cancelled. The total number of elective operative sessions (one session is the equivalent of a half day operating theatre time) lost to acute workload was 47.9. Thirty-three percent of allocated elective theatre time was cancelled - an equivalent of approximately one-full day elective operating per week.Over a five-week period data was collected across all provincial hospitals in New Zealand, with an average of 18% of elective operating time per week lost due to acute workload. Elective cancellations were due to acute operating 40% of the time and bed shortages 60% of the time. The worst effected centre was Palmerston North which had an average of 33% of elective operating cancelled per week to accommodate acute surgery or due to bed shortages.New Zealand's provincial orthopaedic surgeons are under immense pressure from acute operating that impedes provision of elective surgery. The New Zealand government definition of an ‘acute case’ does not reflect the nature of today's orthopaedic burden. Increasing and aging populations along with staff and infrastructure shortages have financial and societal impacts beyond medicine and require better definitions, further research, and funding from governance.

Management for Ureteral Injury during Laparoscopic or Robotic Hysterectomy: Minimally Invasive Strategies

<h3>Study Objective</h3> To demonstrate minimally invasive techniques to repair ureteral injury or ureteral stenosis related to minimally invasive hysterectomy. <h3>Design</h3> Retrospective cohort study. <h3>Setting</h3> Gynecology and Obstetrics department of a general hospital. <h3>Patients or Participants</h3> 23 patients who suffered from ureteral injury during surgery or ureteral stenosis or ureterovaginal fistula after hysterectomy. <h3>Interventions</h3> Between January 2010 and December 2021, 7,154 patients underwent laparoscopic or robotic simple hysterectomy for benign pathology. 16 patients experienced intraoperative ureteral injury found during the procedure. (Group 1) All were repaired in the same operative session using laparoscopic or robotic ureteroneocystostomy using bladder mobilization. In cases with large defects, psoas hitch or boari flap are used to compensate. 7 patients had ureteral injuries undetected intraoperatively and discovered as stenosis or fistula 3 to 12 days postoperatively. (Group 2) All were repaired via laparoscopic or robotic ureteroneocystostomy with or without psoas hitch. <h3>Measurements and Main Results</h3> No patient required reoperation and no patient required laparotomy. Although Group 1 the patients required 3 days placement of an indwelling bladder catheter, the hospital stay of patients was the same as patients who did not experience injury. Operative duration for repair is difficult to evaluate as it is combined with the difficult hysterectomy procedure time. Estimations show intraoperative repair took 40-104 minutes. Group 2 patients required surgical duration ranging from 70- 120 minutes. Blood loss was minimal to 150mL. No patient suffered from stenosis of the anastomotic site. 7 patients suffered from mild vesicoureteral regurgitation which did not require surgical intervention. 7 patients suffered from pyelonephritis, but only one or two episodes. (Follow up period: 3 months to 10 years.) <h3>Conclusion</h3> Avoiding open surgery in cases where injury occurs is important for maintaining the minimally invasive goals of the original surgery. Even if technically demanding, knowledge of laparoscopic and robotic urinary tract reconstruction techniques makes it possible to avoid open surgery for repair.

Assessment of Adverse Event Risk in Combined Plastic Surgery Procedures Utilizing the Tracking Operations and Outcomes for Plastic Surgeons (TOPS) Database

PURPOSE: Combining several surgical procedures into one operative session is widespread in the field of plastic surgery; however, the implications of this practice are not fully understood. There are several benefits that should be taken into consideration when deciding whether to combine plastic surgery procedures. First, combining procedures reduces the number of times a patient must undergo anesthesia. Additionally, the patient benefits from a lower cost burden and single postoperative recovery. However, these benefits must be weighed against any potential increased risk for the patient. This study aimed to evaluate the rates and characteristics of adverse events associated with combining plastic surgery procedures in a single session as compared with similar outcomes of index procedures alone. METHOD: A retrospective cohort analysis was performed utilizing data between January 2016 and December 2020 from the TOPS database. The three most frequent combinations for each of the five most commonly performed plastic surgery procedures (augmentation mammaplasty, reduction mammaplasty, trunk liposuction, mastopexy, and abdominoplasty) were selected for analysis. The rate of 30-day adverse events, as defined by the TOPS database, served as the primary outcome. Chi-square analyses were to compare adverse event percentages. Chi-square, Kruskal-Wallis and Fisher’s exact tests were used as appropriate to compare patient characteristics. RESULTS: Of the total 35,157 patients analyzed, 12,373 (35%) underwent multiple concurrent procedures. Double or triple procedure combinations were found to have higher rates of 30-day adverse events compared to index procedures (8.7% and 7.7% compared to 4.2%, p<0.001, respectively). Rates of adverse events for double and triple procedure combinations remained elevated compared to index procedures throughout the five-year analysis (p<0.05). The 30-day adverse event rates were significantly higher for the three most common combinations for augmentation mammaplasty compared to index (4.3% and 2.3%, respectively, p<0.001), trunk liposuction combinations compared to index (13% and 2%, respectively, p<0.001), and reduction mammaplasty combinations compared to index (14% and 7.1%, respectively, p<0.001). Adverse events were not significantly different for the three most common combinations for mastopexy compared to index (4.7% and 4.5%, respectively, p=0.8), and abdominoplasty combinations compared to index (11% and 8.7%, respectively, p=0.066). A sub-analysis comparing patients coded for abdominoplasty, panniculectomy, or both was performed. Patients coded for both procedures had a higher rate of adverse events (12%) compared to abdominoplasty or panniculectomy alone (8.7% and 9.1%, respectively p=0.012). However, patients coded for panniculectomy alone were found to have the highest rates of diabetes (10%), hypertension (16%), and ASA class 5 status (9.2%) compared to patients coded for abdominoplasty alone or both procedures. CONCLUSION: The findings from this study help elucidate the impact of combining procedures. These results serve to inform shared surgical decision making in multi-procedure planning and contribute to patient safety.