A spine robot has expanded the capabilities of surgeons at the University of Alabama at Birmingham’s hospital.
UAB Medicine, a pioneer in minimally invasive robotic surgeries, achieved a significant milestone by surpassing 20,000 robotic surgical procedures in early 2023.
Now, it is incorporating a cutting-edge spine robot, demonstrating a commitment to precision and innovation.
Precision is paramount in spinal surgery, where targets often measure a mere half centimetre, leaving no room for error.
Dr Jake Godzik, a skilled neurosurgeon and assistant professor in the UAB Department of Neurosurgery, emphasised that while robotic techniques do not revolutionise the field, they empower adept surgical teams to achieve heightened precision, consistency and proficiency – even in the realm of intricate surgeries.
The latest addition – the ExcelsiusGPS spine robot – was developed by Globus Medical, and the Department of Neurosurgery utilises its minimally invasive techniques for precise instrument placement and the treatment of degenerative spinal conditions.
Beyond elevating surgical precision, the robot boasts minimal invasiveness, contributing to swifter patient recovery times.
Dr Godzik also emphasised the robot’s utility in trauma scenarios, where patients might not be sufficiently stable for extensive procedures but necessitate surgical intervention.
Although robotic surgical procedures have been established for some time, their integration into neurosurgery is recent.
Speaking in a recent podcast, Dr Godzik said: ‘Using robotic techniques doesn't revolutionise what we do, but what it allows us to do, especially an experienced surgeon or experienced team, is make surgery just much more consistent. It can help do more complex surgeries with minor potential errors or complications. So, it's a powerful tool in practice, whether in a community hospital or an academic teaching institution.
‘It's beneficial for patients a bit more heavyset because it allows us to be accurate and make smaller incisions, decreasing the infection rate. But it's useful for all spine pathologies, which is great for degenerative conditions.’
He added: ‘Of course, surgeon skill and experience are very important. This doesn't eliminate that or doesn't eliminate the need for quality decision-making and good judgement. Still, I think it takes us and elevates us to another level of performance, and that's something that’s here to stay. Robotics will only get more powerful as we move forward.’
Dr Godzik anticipates a future where this technology is incorporated into various specialities and procedures across UAB, fostering the continual enhancement of patient care.
Photo caption - Neurosurgeon Jake Godzik trains on the ExcelsiusGPS spine robot by Globus Medical. Photography: Lexi Coo
A prototype technology designed to reduce the risks of spinal fusion surgery could be commercially available as early as next year.
The cutting-edge prototype device and software also offer remote postoperative monitoring, raising the bar for patient care.
Associate Professor Debbie Munro of the University of Canterbury in Christchurch, New Zealand, unveiled her solution to the inherent challenges of the procedure earlier this month.
A high failure rate often plagues spinal fusion surgery and can occur within five years.
Associate Professor Munro has been on a relentless quest to enhance the outcome of spinal fusion surgery for two decades.
Her prototype device attaches to the rod inserted during the operation, similar to a strain gauge.
To complement this hardware, she has also invented a wireless sensor and sophisticated software to interpret the gauge's outputs, thereby determining the success of the fusion.
The current challenge surgeons face in spinal fusion surgery lies in the uncertainty of its success until months after the operation, typically around the four-month mark when it becomes visible on an X-ray.
In New Zealand, the situation is even more precarious, as patients are not routinely subjected to postoperative X-rays unless they experience severe pain after 12 weeks.
Associate Professor Munro’s device aims to turn the tables on this dilemma.
She explained: ‘When the sensor is first implanted, it should display the maximum strain. If my software shows no strain, the surgeon knows it hasn't worked and can address the issue before closing up the patient.’
This early detection could prevent a second, highly invasive surgery, sparing patients the ordeal of bone grafts and further complications.
Additionally, once deemed successful, the device will continue to play a pivotal role in the patient's recovery journey, offering a tangible way for them to track their progress.
This is particularly crucial, as spinal fusion surgery necessitates weeks of bedrest – a challenging regimen for many patients, especially those in physically demanding jobs.
What makes this technology even more promising is its potential for remote monitoring. Associate Professor Munro envisions a future where patients can scan the surgical site themselves, with the data transmitted directly to the surgeon.
Face-to-face appointments would only be necessary in the event of an issue, making healthcare more accessible and convenient.
The device and its accompanying software boast long-term advantages, as they require no batteries, eliminating the risk of leakage.
Furthermore, in case of accidents, individuals with the implant can quickly assess whether the fusion has been impacted, offering a sense of security and peace of mind.
Associate Professor Munro also believes this technology could find applications beyond spinal fusion, potentially extending to monitoring hip and knee replacements for signs of degradation.
Further testing is planned, with the device possibly ready for commercial interest as early as 2024.
Spine surgery fusion rates continue to increase worldwide due to new developments in spine fusion procedures and surgical techniques, improved implants and interbody devices, and advancements in complication prevention strategies. Lumbar degenerative disc disease is the most common diagnosis for spine fusion surgery.
According to a literature review in 2020, how this increasing upward trend will affect healthcare systems worldwide is ‘one of the important future questions’.
Photo caption - UC lecturer and researcher Associate Professor Debbie Munro has developed a prototype device and software to reduce the risk in spinal fusion surgery.
Scientists have shared promising findings from a phase I clinical trial centred on an advanced stem cell therapy for repairing cornea damage.
The innovative therapy, known as cultivated autologous limbal epithelial cell transplantation (CALEC), demonstrates both safety and short-term efficacy in patients suffering from severe cornea damage caused by chemical burns.
Published in the journal Science Advances, the team’s study showcases the potential of CALEC in transforming the lives of patients previously deemed untreatable due to their extensive cornea injuries.
The trial tracked four patients over 12 months and revealed remarkable outcomes.
Two individuals could undergo successful corneal transplants, while the remaining two reported significant enhancements in vision without requiring supplementary interventions.
Though the primary aim of the phase I trial was to assess the therapy's initial safety and feasibility, the researchers are optimistic about its implications.
Principal investigator Dr Ula Jurkunas, who is also the associate director of the Cornea Service at Mass Eye and Ear and an associate professor of ophthalmology at Harvard Medical School, emphasised the potential of CALEC to address the critical treatment gap for patients enduring vision loss and pain due to major cornea injuries.
The CALEC procedure involves harvesting stem cells from a patient’s healthy eye through a minimally invasive biopsy.
These cells are then expanded and cultured on a graft using an innovative manufacturing process at the Connell and O’Reilly Families Cell Manipulation Core Facility at Dana-Farber Cancer Institute.
After two to three weeks, the cultivated graft is transplanted back into the damaged eye at Mass Eye and Ear.
This ground-breaking collaboration is the brainchild of Dr Jurkunas and her peers at the Cornea Service at Mass Eye and Ear, alongside researchers from Dana-Farber Cancer Institute, Boston Children’s Hospital, and the JAEB Centre for Health Research.
The clinical trial, noteworthy for being the first human study of a stem cell therapy funded by the National Eye Institute (NEI), signifies a pivotal step in advancing treatment options for patients suffering from chemical burns and related eye injuries.
Chemical burns and similar ocular traumas can result in limbal stem cell deficiency, a condition marked by the irreversible loss of cells around the cornea.
This often leads to chronic vision impairment, pain, and discomfort in the affected eye. The CALEC procedure looks to revolutionise treatment by utilising a patient's stem cells, which are then cultured and expanded to create a cell sheet that facilitates tissue growth.
Dr Jerome Ritz, executive director of the Connell and O'Reilly Families Cell Manipulation Core Facility at Dana-Farber and professor of medicine at Harvard Medical School, highlighted the challenges in creating a manufacturing process that meets stringent FDA regulations for tissue engineering.
The successful implementation of this process and the promising clinical outcomes witnessed in the trial’s initial cohort of patients mark a significant achievement.
As studies like these continue to underscore the potential of cell therapies in tackling previously incurable conditions, the Gene and Cell Therapy Institute at Mass General Brigham plays a pivotal role in translating scientific breakthroughs into tangible clinical trials.
This multidisciplinary approach positions the institute at the forefront of pioneering treatments, pushing the boundaries of technology and clinical application.
The phase I trial enrolled five patients with chemical burns to one eye, with four receiving the CALEC treatment. Detailed quality control assessments determined that the fifth patient's cells were unsuitable for expansion.
Over a 12-month follow-up period, the CALEC recipients demonstrated remarkable progress. One patient regained vision sufficiently for an artificial cornea transplant, while another experienced a substantial improvement from 20/40 to 20/30 vision.
The team is preparing for the next phase of clinical trials involving 15 CALEC patients, with an 18-month observation period to evaluate the therapy's overall efficacy.
There are high hopes that CALEC could eventually fill a crucial void in eye injury treatments, offering a lifeline to patients who have endured long-term deficits due to the lack of viable options.
Picture caption - Ula Jurkunas (left) at a monitor with researchers in her laboratory
Beth Frates wears multiple hats. She is a pioneer in lifestyle medicine and education and practises lifestyle medicine via her health and wellness coaching company, Wellness Synergy, LLC. She is an award-winning teacher at Harvard Medical School and an acclaimed author. One of Beth’s earliest literary successes came with her book, The Lifestyle Medicine Handbook: An Introduction to the Power of Healthy Habits. Highly recommended by a wide variety of professionals, it is regarded as a practical guide for anyone looking to embrace a better work-life balance. But it has also served to shine a spotlight on the hugely significant role health care workers can and should have in their interactions with their patients by helping them make appropriate choices to support a healthier lifestyle.
Beth ‘walks the walk’ and never misses an opportunity to talk and educate about the six pillars of lifestyle medicine. They include the management of nutrition, exercise, sleep, stress, substance use and personal connections. She is passionate about her capacity to connect on social media. A prolific contributor to Twitter and Instagram, she harnesses the platforms to share affirmations, discuss evidence-based studies and offer health and self-care tips to an audience far beyond the usual reach of the medical profession. Her Twitter account – @BethFratesMD – has ramped up an impressive 132K followers. Her Instagram posts are an eclectic mix of personal experiences interwoven with a wealth of lifestyle medicine knowledge. Her bio lists interests in yoga and running, her beloved dog, and her career accolades. Above all else she maintains that social interactions are everything – especially after the pandemic.
Beth was recently elected president of the American College of Lifestyle Medicine (ACLM), which comes at a time of growing recognition among health leaders and policymakers that lifestyle medicine can deliver high-value care.
It was the faltering health of Beth’s Father that set her on a quest to learn about the profound influence sustainable lifestyle choices can have on health and quality of life. Lived experiences are often a catalyst for new understanding and change. So, when her Dad suffered a heart attack, largely due to poor diet, lack of exercise and extreme stress, Beth (then aged 18) immersed herself in a journey of learning. Lifestyle medicine, she discovered, helps people change the trajectory of their lives. And physicians, she felt, could benefit from adapting their own habits to prevent burnout, which in turn would help their patients make smarter choices.
She recalls: ‘My Father was financial advising and accounting in New York City in a very competitive market. It’s not easy – you have to constantly be upping your game – and, although he was a healthy, athletic person, by 52 he had fallen off his routine exercise, was not eating healthily and was working from 6.00am until 11.00pm. He would go to church with us on a Sunday but leave us to return to work. Then one day, running for the last train home, he had a heart attack – and it changed everything in our world.’
Thanks to an insightful physician, who gathered the family together to work towards improving her father’s work-life balance, he made a recovery – and her family made massive lifestyle changes. Some of his New York friends were ‘quite savvy’, Beth remembers, and recommended the Pritikin Center, which was one of the earliest programs in lifestyle medicine where they helped him establish a safe and successful rehabilitation by embracing healthy habits.
‘I'm not sure what they called it then, but we would now call it an intensive lifestyle medicine programme. He learned how to exercise safely. My Mom learnt about cooking healthy food, and we had our eyes opened to resiliency and stress management.’
Primed to follow her Dad into the family business, she was studying economics when her lightbulb moment came. It was 1988 and having come across an article by Dr Alan Rozansky about mental stress and cardiac patients and how mental stress could affect heart health as much as physical stress, she grew hungry to learn more. Armed with the paper, she presented herself at Westchester Medical Center in Valhalla, New York, and declared, ‘I'm a college student. My Dad had a heart attack and stroke and I would like to work in this area for the summer.’ Luckily for her she met cardiologist Michael Kay who subsequently became her mentor. He appreciated her bold approach and passion for what was to become a deep love affair with lifestyle medicine. She hasn’t looked back.
It feels a tad distasteful to suggest any upside to the recent pandemic. After all, Beth is a member of the 'physician family' – a community heavily impacted by the global catastrophe. But as a lifestyle medicine pioneer, Beth seemingly used the pandemic as a springboard for change when it shone a much-needed spotlight on physician overload and burnout.
With the media focused on the relentless frontline challenges, there came a heightened awareness of the stressful ‘day-to-day ‘– a subject long overdue for discussion.
Quite simply, the effects of Covid-19 led to discussions not previously had about the mental health risks within the medical profession. It’s an uncomfortable truth Beth seems willing to accept.
Those with a passing concern for the welfare of medics might have foreseen a future less rosy. With the pandemic, physicians had their work cut out; circumstances forced them to adapt quickly. They faced hardships and had to make difficult choices. Tasked with safely and effectively navigating care whilst meeting the demands of changing guidelines and standards, many of these unprecedented challenges led to terrible decision-making scenarios. It took its toll. And, for many, the fallout remains.
Beth is unequivocal about the importance of physician wellness in all this melee. For her, the steps to mitigate against the inevitable dangers to health should begin at a student level. Embracing healthy habits sooner rather than later might even stop those burnout statistics in their tracks – or at least prevent them from rising exponentially. And she believes that if physicians embrace wellness, they are more likely to guide their patients in a similar direction.
She goes as far as to suggest that the successful rehabilitation of patients is influenced by the lifestyle behaviours and attitudes toward wellbeing of their treating health professional. What she often finds with lifestyle medicine is that the physicians who are working to improve their own lifestyles and maintain healthy practices are more likely to feel comfortable counselling patients about these topics. Interestingly, when physicians themselves are feeling over-exhausted and signs of burnout, they often explore healthy living and find lifestyle medicine. Many lifestyle medicine clinicians have shared the fact that this new specialty helped them find new meaning and purpose in their work, helping them work through or escape burnout.
This fact places Beth in a hugely influential position.
She graduated magna cum laude from Harvard College, majoring in psychology and biology. She then attended Stanford Medical School, interned at Massachusetts General Hospital, and completed her residency in the department of physical medicine and rehabilitation at Harvard Medical School, where she served as chief resident.
After residency, Beth focused on stroke and stroke prevention.
And it was in this role that she had something of an epiphany, seeing the possibilities of casting her net wider to guide people to better health with her lifestyle medicine insights.
Joining the dots, she used this background as a starting point to empower a larger spectrum of people, adding behaviour change, coaching and motivational courses to her panoply of skills.
By 2008, Beth had developed the concept of a lifestyle medicine interest group (LMIG).
She has won multiple teaching awards for her work in pre-clinical core courses, including nutrition, musculoskeletal system, central nervous system, endocrine system, and introduction to the professions.
More recently, Beth created a college curriculum on lifestyle medicine for a Harvard Extension School undergraduate and graduate-level course, which many physicians and pre-meds have taken each year.
As director of lifestyle medicine and wellness for the Department of Surgery at Massachusetts General Hospital, she also helped craft an innovative wellness initiative. It is a unique role. With an interest in surgical burnout – notorious for forcing surgeons to rethink their career choice and quit the profession early – her job is to reduce the chances of this happening.
Compassion is Beth’s watchword. She evidently places a high value on self-care and is the embodiment of her health messaging. She exercises regularly – ‘I run a lot – I've always enjoyed that runner's high – and I paddle board, but I like to try new things. I like to be challenged’. She also enjoys yoga, eats healthily and has a dog, Athena, who needs twice daily walking. When we talk over Zoom, her beloved German Shepherd is sat beside her, the perfect close companion and confidante. Her husband and two sons also keep her busy and her desire for a more balanced work-family life set her career pathway.
She considered becoming a surgeon, but she felt that the lifestyle required to practice surgery was not compatible with the family life she envisioned for herself. Even before having her children, she held family time in the highest regard.
‘I enjoy working closely with surgeons and my time with them. I know how demanding their lives can be.’
She loves teaching, coaching and lecturing and has developed a close relationship with the physician community over 30 years. Her focus may be on helping them maintain a healthier perspective, but a strong sense of fun lies at the heart of what she does.
‘Surgeons are driven, competitive people and I can identify with that. But they need to relax, too. It was a surgeon who taught me how to windsurf when I was a medical student at Stanford, so I know they like fun, and I know they like a challenge. I brought my hula hoops to one lecture, and I did some hula hooping and said, “You guys could do this, too. I mean, come on, it's so simple.” One gave it an impressive try, and another did it better than I did! So I added another hoop and double hooped. We had fun, but they also understood that I was serious about lifestyle medicine and that I was there for a reason.’
Her home life inspires her professionally and vice versa. Having overcome a fear of dogs by adopting Reesee, her Goldendoodle who recently passed away, and more latterly Athena the German Shepherd– Beth served as medical editor for the Harvard Special Health Report titled, Get Healthy, Get a Dog [2] that explored the many direct physical and mental health benefits of owning a four-legged friend.
In 2016, she co-wrote The Laughter Prescription [3], a paper that referenced evidence to indicate that laughter is a part of our basic armamentarium that helps prevent diseases and ensure a healthier population. Laugher, she concluded, allows a rush of mood-boosting, pain-alleviating endorphins.
What may have once felt a little left field, these studies serve a serious purpose. Preventative practices reduce the financial burden on the healthcare sectors, makes for healthier physicians who share these best practices with their patients.
Beth has been talking about the transformative effects of healthy habits for more than a decade and is now widely considered an authority on lifestyle medicine.
Her connection with cardiologists goes back a long way from when her father had a heart attack and recently came full circle when she was surprised to receive an email from her original inspiration, the pioneering Dr Alan Rozansky, an advocate of mind and body connections and behavioural cardiology for many years. He wrote to her to tell her he had heard her talk at the Institute of Lifestyle Medicine, had become Board Certified in Lifestyle Medicine, and recently edited an entire journal edition on lifestyle medicine that he was eager to share with the American College of Lifestyle Medicine community. He reached out to Beth as she serves as President of that organization. He had no idea of the fact that his work had had a profound influence on her career. Noting her focus on evidence-based posts, sharing research and even adding a sense of ‘spirituality’ to her feeds, he informed her that he had followed her on Twitter and said, ‘ I love the information you share.’ Beth was delighted – the comments providing a strong sense of validation to her life’s work.
We discuss the power of digital communications, and it is evident that social connections are something she holds dear. Quite possibly, it is the most important in the six lifestyle medicine pillars.
So, just how sustainable are those six pillars in a world beset by constant challenges that includes conflict and crises? There will be times when we lapse, Beth admits, but a sense of purpose, social connections and natural sources of energy help to bolster our resilience. It is not necessarily a quick fix; moreover a long-term commitment.
The relationship between wellness and medicine is not complicated, and Beth is at the forefront of changing attitudes to blend these two areas in everyday lives. That includes those working within the profession who are prone to allowing their focus on self-care to slip. Looking after others can be detrimental to health, which is why Beth argues it is just as important to talk and share stories with colleagues who understand as it is with patients.
When the going gets tough, the co-dependency of physical, economic and social wellbeing is crucial. And if we can implement these habits for such a profound change that it can prevent poor health – without the need for surgical intervention – then what’s not to love, embrace and share forward?
References
- https://www.health.harvard.edu/staying-healthy/get-healthy-get-a-dog
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6125057/
The ‘Qatar flap’ innovative technology has been explicitly created for reconstructive microsurgery in hand procedures.
Surgical teams at the Hamad Medical Corporation (HMC), Qatar’s principal public healthcare provider, have undertaken over 100 procedures using this innovative surgical technique.
The innovative ‘Qatar Flap’ facilitates the functional and cosmetic restoration of various fingertip injuries, restoring the natural function of the finger without any disability or disfigurement.
It makes it easier for patients to resume their everyday lives after surgery.
Dr Saleem Al-Lahham, a Specialist in the Department of Plastic Surgery at HMC, is the innovator of the Qatar flap.
He explained that the innovation is based on functionally and cosmetically repairing fingertip injuries through a single surgical procedure that involves one of the minor secondary arterial branches, which contributes to restoring the fingers to their natural shape without any disability or deformity.
He said: ‘The Department of Plastic Surgery at HMC receives many hand injuries requiring precise surgical intervention to restore the finger’s functional and anatomical state.
‘Given the different types of finger injuries, the surgical procedures available may vary, but these procedures often leave painful scars on the fingers, and some require the sacrifice of major blood vessels in the fingers, making them undesirable options for patients.’
The ‘Qatar flap’ features in a paper published in PRS Global Open, a peer-reviewed journal covering reconstructive and cosmetic hand microsurgery.
In it, the authors note that ‘treatment of such defects to maintain the finger length and cover the bone when exposed has gained more attention in recent years, especially after the advancements made in the field of micro and super microsurgery (although some surgeons still prefer to manage such defects by secondary intention healing, claiming simplicity, low cost, and reproducibility of the method). However, it has the disadvantages of hyperalgesia, shortening of the finger, and persistent phalanx exposure’.
They add: ‘Our main indication to use the Qatari flap was bone exposure, but another potential indication is a painful adherent fingertip scar after secondary intention healing,
the scar can be excised, and the area can be covered with the described flap to provide padding over the bone.
‘The retrograde island digital artery perforator flap is a reliable choice, done in one stage and does not require loss of the digital artery.’
Dr Al-Lahham hopes his innovation will be adopted globally for fingertip restoration surgery.
Photo caption - Dr Saleem Al-Lahham and his team have performed over 100 surgical procedures using the innovation.
A neurosurgeon investigating a woman’s mystery symptoms in an Australian hospital has plucked a three-inch live worm from the patient’s brain.
In a remarkable medical case, the diligent efforts of neurosurgeon Hari Priya Bandi eventually solved this unsettling mystery.
The patient had been experiencing baffling symptoms that defied conventional diagnosis.
Dr Bandi, a clinical lecturer and examiner for the ANU Medical School and examiner for the Royal Australasian College of Surgeons clinical exam, performed a biopsy.
Extracting a wriggling, three-inch worm from the brain, the seasoned neurosurgeon later admitted to feeling a sense of discomfort upon this shocking revelation.
The larva of an Australian native roundworm was a species previously unrecognised as a human parasite and designated as Ophidascaris robertsi.
These parasites are typically associated with carpet pythons, their natural hosts. As a result of the astonishing finding, Dr Bandi and her colleagues authored a compelling article recounting the extraordinary case.
The 64-year-old woman from south-eastern New South Wales, Australia, was admitted to a local hospital in late January 2021 after three weeks of abdominal pain and diarrhoea, followed by a dry cough and night sweats.
Her medical history included diabetes mellitus, hypothyroidism, and depression. She was treated for community-acquired pneumonia with doxycycline and had not recovered fully.
The team recall that during three months in 2022, the patient experienced forgetfulness and worsening depression.
They write: ‘In June 2022, she underwent an open biopsy. We noted a string-like structure within the lesion, which we removed; it was a live and motile helminth (80 mm long, 1mm diameter).
‘In this case, the patient resided near a lake area inhabited by carpet pythons. Despite no direct snake contact, she often collected native vegetation, warrigal greens, from around the lake to use in cooking. We hypothesised that she inadvertently consumed O. robertsi eggs either directly from the vegetation or indirectly by contamination of her hands or kitchen equipment.
‘The patient’s clinical and radiologic progression suggests a dynamic process of larval migration to multiple organs, accompanied by eosinophilia in blood and tissues, indicative of visceral larva migrans syndrome. We suspect the splenic lesions are a separate pathology because they remained stable and were not PET avid, unlike the pulmonary and hepatic lesions.’
They suggest this case highlights the difficulty in obtaining a suitable specimen for parasitic diagnosis and the challenging management decisions regarding immunosuppression in the presence of potentially life-threatening HES.
Although visceral involvement is common in animal hosts, the invasion of the brain by Ophidascaris larvae had not been reported previously.
‘The patient’s immunosuppression may have enabled the larvae to migrate into the central nervous system (CNS). The growth of the third-stage larva in the human host is notable, given that previous experimental studies have not demonstrated larval development in domesticated animals, such as sheep, dogs, and cats, and have shown more restricted larval growth in birds and non-native mammals than in native mammals,’ they say.
‘After we removed the larva from her brain, the patient received anthelmintics and dexamethasone to address potential larvae in other organs. Ophidascaris larvae survive for long periods in animal hosts; for example, laboratory rats have remained infected with third-stage larvae for more than four years. The rationale for ivermectin and albendazole was based on data from the treatment of nematode infections in snakes and humans. Albendazole has better penetration into the CNS than ivermectin. Dexamethasone has been used in other human nematode and tapeworm infections to avoid deleterious inflammatory CNS responses following treatment.’
They conclude: ‘This case emphasises the ongoing risk for zoonotic diseases as humans and animals interact closely. Although O. robertsi nematodes are endemic to Australia, other Ophidascaris species infect snakes elsewhere, indicating that additional human cases may emerge globally.’
Their comprehensive account is published in the latest edition of Emerging Infectious Disease.
Figure 2. Ophidascaris robertsi nematode infection was detected in a 64-year-old woman from southeastern New South Wales, Australia. A) MRI of the patient’s brain by fluid-attenuated inversion recovery demonstrating an enhancing right frontal lobe lesion, 13 × 10mm. A live third-stage larval form of Ophidascaris robertsi (80mm long, 1mm diameter) was removed from the patient’s right frontal lobe. C) Live third-stage larval form of O. robertsi (80mm long, 1mm diameter) under a stereomicroscope (original magnification ×10).
Next-generation sutures are being developed to close wounds, detect inflammation, and deliver therapeutic drugs, further raising the bar in surgical recovery.
Engineers at the Massachusetts Institute of Technology (MIT) have created bioderived sutures to reduce patient discomfort and complications after surgery.
These smart sutures could help patients heal after bowel resection or other types of surgery.
The MIT researchers used pig tissue to create sutures that can carry sensors, drugs or cells and could also be adapted to heal wounds or surgical incisions elsewhere in the body.
Their work draws inspiration from catgut sutures that utilise collagen from cows, sheep and goats to form strong, naturally dissolving knots within around 90 days.
Former MIT postdocs Jung Seung Lee and Hyunjoon Kim are the lead authors of the paper published in Matter.
Giovanni Traverso is an associate professor of mechanical engineering at MIT, a gastroenterologist at Brigham and Women’s Hospital and the study's senior author.
Building on the concept of catgut, Traverso and his collaborators aimed to develop a tissue-derived suture material with enhanced properties such as toughness, absorbability and the advanced functionalities of sensing and drug delivery.
Such sutures could prove especially valuable for patients with Crohn’s disease, necessitating intestinal section removal due to scarring or inflammation-induced blockages.
The resealing of the remaining intestine ends following a procedure like this demands a secure seal to prevent hazardous leaks.
To mitigate this risk, the MIT team conceived the suture design that anchors the tissue and detects inflammation – a critical sign that the healed intestines are not recovering as expected.
The researchers crafted their innovative sutures from pig tissue, employing a ‘decellularisation’ process involving detergents to reduce the likelihood of triggering inflammation in the host tissue.
This process leaves a cell-free material called De-gut, encompassing structural proteins such as collagen and other biomolecules in the extracellular matrix around cells.
The team assessed its tensile strength after dehydrating and twisting the tissue into strands.
The results indicated comparable strength to commercially available catgut sutures, with the benefit of inducing significantly lower immune responses in surrounding tissue than traditional catgut.
Lee said: ‘Decellularised tissues have found extensive use in regenerative medicine due to their remarkable biofunctionality. We now propose an innovative platform for sensing and delivery using decellularised tissue that will unlock new applications for tissue-derived materials.’
The researchers progressed to enhance the suture material further by coating it with a hydrogel layer. Various cargo types could be embedded within this hydrogel, including microscopic particles capable of sensing inflammation, diverse drug compounds and even living cells.
The team designed microparticles coated with peptides released by inflammation-associated enzymes called MMPs for sensing.
These peptides can be detected through a simple urine test. Additionally, the researchers demonstrated the potential to carry drugs like dexamethasone and adalimumab—used for treating inflammatory bowel disease – via microparticles crafted from FDA-approved polymers like PLGA and PLA.
This method controls the drug release rate and can be adapted for other drug types like antibiotics or chemotherapy.
The versatility of these intelligent sutures extends to delivering therapeutic cells such as stem cells.
In exploring this application, the researchers incorporated stem cells engineered to express a fluorescent marker into the sutures, observing their viability for at least seven days after implantation in mice.
These cells could also produce vascular endothelial growth factor (VEGF), stimulating blood cell growth.
The team is now focused on comprehensively testing each potential application and scaling up suture manufacturing. They are also eager to investigate the feasibility of utilising these sutures in body regions beyond the gastrointestinal tract.
MIT engineers have designed tissue-derived smart sutures, pictured here, that can not only hold the tissue in place but also detect inflammation and release drugs. The sutures are coated with hydrogels that can be embedded with sensors, drugs, or cells that release therapeutic molecules. Image courtesy of the researchers
Researchers have demonstrated the power of artificial intelligence (AI) in breast cancer detection.
In a ground-breaking study published in The Lancet Oncology, a Swedish team found that AI-supported mammograms detected 20% more breast cancers compared to the routine double readings conducted by two radiologists.
One of the most promising aspects of this research is that the AI system didn’t cause an increase in false positives.
Traditional mammography screenings have long relied on the expertise of radiologists to identify potential cancers, and it can take more than 10 years to train a radiologist capable of interpreting mammograms.
This process almost halves the screen-reading workload – a key consideration in the current climate. There is a shortage of breast radiologists in many countries, including a shortfall of around 41 (8%) in the UK and about 50 in Sweden.
However, this study, which represents a significant advancement, introduces AI as a supportive tool to enhance accuracy and patient safety of screenings.
Despite the numerous retrospective studies showing the potential of AI in mammography, this is the first randomised trial to validate these results.
The study involved women aged 40 to 80 years eligible for mammography screening at four sites across Sweden.
Participants were randomly assigned to receive AI-supported screenings or standard double readings by radiologists without AI assistance.
The AI system, known as Transparent version 1.7.0, provided a malignancy risk score for each examination.
Based on this score, the system then guided radiologists to decide whether further screening was necessary.
Throughout the study, 80,033 women participated, with roughly half assigned to each group.
The AI-supported screening group detected 244 cancers out of 39,996 participants, while the standard screening group identified 203 cancers out of 40,024 participants. Although the ratio was insignificant, the AI-supported group had a slightly higher cancer detection rate.
Crucially, introducing AI substantially reduced the screen-reading workload by an impressive 44.3%.
This finding suggests that AI can significantly streamline the review of mammography images, allowing radiologists to focus more on complex cases.
The authors emphasised that AI-enhanced mammography screening is a safe and viable approach. Notably, the trial continues to assess the primary endpoint, the interval cancer rate, over a two-year follow-up period.
Lead author Dr Kristina Lång from Lund University, Sweden, said: ‘We still need to understand the implications on patients’ outcomes, especially whether combining radiologists’ expertise with AI can help detect interval cancers that traditional screening often misses, as well as the cost-effectiveness of the technology.’
The final trial results – and whether AI’s use in mammography screening is justified – are not expected for several years.
The Swedish Cancer Society, the Confederation of Regional Cancer Centres and the Swedish governmental funding for clinical research (ALF) financially supported the research.
Meanwhile, a recent study published in the Annals of Internal Medicine questioned the value of breast cancer screening in older women. It found overdiagnosis of up to 31% of breast cancer cases among women aged 70 to 74 who underwent mammograms.
In an editorial accompanying the study, oncologists Otis Brawley and Rohan Ramalingam observe that physicians need new tools to identify the stage and severity of cancer objectively.
A team is developing a ‘bionic eye’ using highly advanced imaging technology to distinguish between healthy and diseased brain tissue.
Researchers hope this innovative solution will offer higher levels of precision to neurosurgeons in removing tumour tissue and, at the same time, protect healthy brain tissue.
AI technology currently being developed by the Brain Tumour Research Centre of Excellence at Imperial College London in collaboration with the team at the Hamlyn Centre, one of the Institute of Global Health Innovation’s research centres at Imperial College London, could transform neurosurgery.
The surgeons face a significant challenge in removing glioma because these tumours are diffuse – the cancer infiltrates healthy brain tissue and has no visible boundary.
The new technology will rely on a comprehensive database of images, and work to build this is already underway. The next step will be to train an algorithm to distinguish between tumours and healthy brain tissue and identify highly functional brain areas.
These will go on to guide the development of a ‘bionic eye’ device to be installed in the surgical microscope for use during surgery to enable neurosurgeons to differentiate diseased tissue and healthy tissue.
The final stage of this research is to develop a revolutionary piece of equipment that fits inside a microscope to enable tumour-brain differentiation to happen in real-time during surgery, providing neurosurgeons with a much clearer picture of what is safe to remove whilst ensuring maximal resection.
This new technology could become a neurosurgical standard of practice as a tool to refine the extent of resection of brain tumours, identify highly functional brain areas, and consequently reduce the possibility of post-operative disability and stroke.
The research team at Imperial have worked with 47 brain tumour patients in a clinical research study capturing the images required for the deep learning algorithm.
The data analysis will take a few additional months. This process will guide the hardware and software development for the next phase.
This phase will be a much larger study with hundreds of patients to validate the technology further, use it with different surgeons and tumours, and test the possibility of scaling it to a broader level.
Dr Giulio Anichini, a Brain Tumour Research funded clinical research fellow, said: ‘This is an exciting development for glioma and GBM patients, and potentially to be used in other areas of neurosurgery.
‘It allows us to be much more precise in removing diseased tissue versus healthy tissue. It also means we can determine areas of the brain which are crucial to vital functions, such as speech and mobility, and those where we’d be more proactive in removing tissue around the tumour without causing lasting damage.’
Dr Karen Noble, Director of Research, Policy and Innovation at Brain Tumour Research, said: ‘This exciting project is at the cutting edge of surgical research, and we congratulate the team at Imperial on their progress so far.
‘Not only will this innovative technology allow surgeons to be more precise in removing diseased tissue versus healthy tissue, but it also means they can identify and avoid areas of the brain which are crucial to vital functions such as speech and mobility, and be more proactive in removing tissue around the tumour without causing permanent damage.
‘We look forward to being able to share further updates with our community as the work progresses.’
Photo Caption - Brain Tumour Research Centre of Excellence at Imperial College, London
Dr Pedro Basilio a colorectal surgeon in Rio de Janeiro, Brazil, has a passion for exploring new opportunities. He travels the world to learn from other experts in his specialty, and brings back the knowledge he gains to his home country, to support his patients and the public he serves.
Outside his surgical work he finds opportunities to forge strong relationships with clinical colleagues through a mutual love of sport.
These deep connections, along with a series of happy coincidences, have helped to shape his career so far. The first fitting coincidence was that he was born in the same hospital that he would later work in as a clinician in his first job - San Joseph Hospital.
The hospital’s director was also a friend of his grandfather, who was an obstetrician, and the inspiration for Dr Basilio’s choice of career.
Originally, Dr Basilio was set to go to study medicine in Brazil at a public university. But his love of horses, and of show jumping in particular, led to a valuable connection that was to change the course of his medical training.
“I’ve always loved horses and have been riding since I was two years old. I used to practice show jumping. And I would be very excited about taking part in show jumping tournaments and championships,” he says.
His sporting achievements led him to a chance encounter with the then president of the Brazilian Equestrian Confederation, who also owned a group of universities.
“He told me: ‘You will do medicine at my university on a scholarship, and maybe represent the university at show jumping tournaments’. And so that’s where I went - to Gama Filho University.”
During his third year of studying medicine, his professors suggested he miss some classes in order to attend tournaments, which forced him to choose between show jumping and medicine.
“I decided to quit show jumping and to become a doctor. I told the owner of the university I was quitting the scholarship, that I would pay for university, but would dedicate myself to my medical career,” he recalls.
“However, the owner replied: ‘I gave you a scholarship to go to medical school - and you can have that scholarship until the end of your studies’. I was so grateful.”
Dr Basilio went on to do his residency in general surgery. Mid way through his residency in surgical oncology at the National Cancer Institute, he was working night shifts at a private hospital.
“One night I was in on call, and an emergency doctor called me to say that they needed a vascular access. I rushed into emergency to do the procedure. When I spoke to the patient, he said: ‘I know you’. He was the owner of the university.
“I carried out the dissection of the brachial vein. As we chatted, he became emotional and started crying - which moved me a lot. He said: ‘The scholarship was nothing to me at that time. I have a lot of them to distribute. But look at what I get back. My own health’. And so the message is: if you do good things, life will manage to pay you back later.”
Since the start of his career in medicine, Dr Basilio has invested time, effort and resources in progressing as a clinician.
“That has always been my intention”, he says. “While my friends were buying cars and apartments, I invested in my studies.”
Then, during his residency, his supervisor recommended that he should spend time learning from the distinguished Italian breast surgeon Professor Umberto Veronesi at the National Cancer Institute of Milan. “My boss - who was very well connected - sent a fax to Professor Veronesi who straight away asked me to come to Milan.
“Three months later, I was at the institute meeting the professor, who was not only the director of the hospital, but also a medical celebrity in Italy, as important as the minister of health. It was amazing to meet him, and I spent a great three months there,” he says.
Early on in his career - right after he concluded his residency in surgical oncology at the National Cancer Institute in Brazil - he saved up to go to Florida where he worked for a year doing a research residency at the Cleveland Clinic.Dr Basilio has continued to learn new skills through taking time to travel to hospitals in different countries to meet the people who are changing the face of surgery.
“In my life I always try to ‘merge’ the things I like. I love to travel, and I also love to know new things - new ways to think, to treat, to operate.
“So whenever I read an interesting article, I travel to wherever the author is based, to learn from them, and to extract more information from real life than what is written in a paper. And I think about how I can develop that learning and use it in my practice life.”
As surgeons develop their careers, with that seniority comes leadership, and it is important to learn the necessary skills to carry out leadership roles effectively. For Dr Basilio, that learning began during his surgical oncology when he was made chief resident. “This was my first position as a leader. I learned from former surgical oncology department heads, the different ways to lead, and to try and get the best from people,” he says.
His leadership skills also developed while working as a military surgeon.“Before you start work at the hospital, you have to do military training. And with military training, you're training to be a leader. But you have to pass all these steps - and this was quite an experience,” he says.
Once, he recalls, he was assigned on a mission to lead a medical team support a military intervention when there was a prison rebellion. “The mission was to assist the police officers who might be injured during the invasion of the prison facility. I was leading a small team of two doctors, three nurses and four emergency physician assistants. On arrival at the prison, we parked the ambulances outside the prison walls.
“Suddenly, an order came to send our unit inside, where there was a lot of gunshot noise. Two guys were injured, and about a dozen had eye burns from pepper gas spray. It was quite an experience. I was wearing an armoured vest and carrying a 9mm pistol. I called my mother before I went in,” he says.
Another memorable experience during his time as a military surgeon was during the summer of 2011, when there was a natural disaster. “Heavy showers had destroyed some mountain cities around Rio De Janeiro. There were several casualties. I helped to find people, and to get medicines, water, and other supplies to them,” he says.
Currently, Dr Basilio’s leadership positions include president of the Brazilian Board of Colorectal Surgeons, and president of the committee for the Brazilian Congress of Coloproctology 2022.
“I’ve tried to learn how to manage people in a way that makes everybody happy. That is my aim with leadership. You join forces with people, and try to extract from them the best things they have to offer. And this is not easy. With leadership, you have to train, and you have to learn - and I’m starting to learn,” he says.
Dr Basilio and his fellow clinicians have been learning from the lessons that came out of the COVID-19 pandemic.
“We had a lot of problems during the pandemic in Brazil,” says Dr Basilio. “We have a vast territory, and a huge population. So in order to manage that, the government had several difficulties, such as having to buy healthcare equipment and vaccines from abroad, and choosing where to find the best healthcare facilities.
New facilities were also built to deliver healthcare services during the pandemic only. Within a reasonable amount of time we got on track,” he says.
Post COVID, the Brazilian healthcare sector as a whole - and more specifically surgery - continues to face challenges, he says.
“We have a lot of difficulties, specifically in the prevention of colorectal cancer. There have also been delays in colonoscopies, and to treatments, including chemotherapy, which have had a significant health impact.
“Now, we have to fix all those problems. So we're trying to increase the availability of examinations and surgery for all these patients,” he says.
He explains that while there is a shortage of qualified surgeons and doctors in Brazil, a bigger problem is where they are distributed.
“Our doctors are concentrated in the main cities, but Brazil is a vast territory. So we need to spread these doctors around the country. We have some government programmes that do this, but distribution is still a real challenge for us.”
For Dr Basilio, a love of sport helps him to deal with the pressures of work. He remains a keen sportsman and has recently discovered a new passion - one that he is showcasing to the whole of Brazil.
“I discovered beach tennis through Facebook. I tried it once, then I fell in love with the sport. It’s like beach volleyball, but with a lower net. “It’s a very inclusive sport - you’re at the beach, so you have the sun, the sea, the relaxing atmosphere. Children and old people can play beach tennis. You can play at a high level if you want to train - and I train every day,” he says.
“We have a cafe, a rooftop bar, and four courts. We even have our own Flamengo beach tennis club rackets and hats,” he says.
Just like his trips to visit the sources of the latest clinical research, Dr Basilio wanted to travel to where beach tennis originated - a journey that took him to Romagna near Venice, “where I booked lessons with some of the best trainers in the world”.
And once again, his love of sport has led to a happy coincidence and a strong clinical connection.
“In Romagna, I was introduced to one of the professional players’ fathers who was a doctor. We had lunch together, and found out we both worked in colorectal surgery. So we developed a partnership - he came to Brazil and attended operations with me to discuss some of my cases. And now we’ll be collaborating for years to come.”
Interview by Kathy Oxtoby