OBJECTIVE:Despite advances in the treatment of psychiatric diseases, currently available therapies do not provide sufficient and durable relief for as many as 30-40% of patients. Neuromodulation, including deep brain stimulation (DBS), has emerged as a potential therapy for persistent disabling disease, however it has not yet gained widespread adoption. In 2016, the American Society for Stereotactic and Functional Neurosurgery (ASSFN) convened a meeting with leaders in the field to discuss a roadmap for the path forward. A follow-up meeting in 2022 aimed to review the current state of the field and to identify critical barriers and milestones for progress.DESIGN:The ASSFN convened a meeting on June 3, 2022 in Atlanta, Georgia and included leaders from the fields of neurology, neurosurgery, and psychiatry along with colleagues from industry, government, ethics, and law. The goal was to review the current state of the field, assess for advances or setbacks in the interim six years, and suggest a future path forward. The participants focused on five areas of interest: interdisciplinary engagement, regulatory pathways and trial design, disease biomarkers, ethics of psychiatric surgery, and resource allocation/prioritization. The proceedings are summarized here.CONCLUSION:The field of surgical psychiatry has made significant progress since our last expert meeting. Although weakness and threats to the development of novel surgical therapies exist, the identified strengths and opportunities promise to move the field through methodically rigorous and biologically-based approaches. The experts agree that ethics, law, patient engagement, and multidisciplinary teams will be critical to any potential growth in this area.

Gingiva-Derived Mesenchymal Stromal Cells (GMSCs) have been shown to play an important role in periodontitis. However, how P. gingivalis, one of the key etiological agents of the disease, affects healthy (H)- and periodontitis (P)-GMSCs is unknown. To address this problem, we established 10 H-GMSC and 12 P-GMSC lines. No significant differences in morphology, differentiation into chondroblasts and adipocytes, expression of characteristic MSCS markers, including pericyte antigens NG2 and PDGFR, were observed between H- and P-GMSC lines. However, proliferation, cell size and osteogenic potential were higher in P-GMSCs, in contrast to their lower ability to suppress mononuclear cell proliferation. P. gingivalis up-regulated the mRNA expression of IL-6, IL-8, MCP-1, GRO-α, RANTES, TLR-2, HIF-1α, OPG, MMP-3, SDF-1, HGF and IP-10 in P-GMSCs, whereas only IL-6, MCP-1 and GRO-α were up-regulated in H-GMSCs. The expression of MCP-1, RANTES, IP-10 and HGF was significantly higher in P-GMSCs compared to H-GMSCs, but IDO1 was lower. No significant changes in the expression of TLR-3, TLR-4, TGF-β, LAP, IGFBP4 and TIMP-1 were observed in both types of GMSCs. In conclusion, our results suggest that P-GMSCs retain their pro-inflammatory properties in culture, exhibit lower immunosuppressive potential than their healthy counterparts, and impaired regeneration-associated gene induction in culture. All these functions are potentiated significantly by P. gingivalis treatment.

Hybrid feedforward control architecture is alternative to feedback control architecture and in many cases offers significant advantages over the later for synthesizing control of PWM converters. Stability of hybrid feedforward control architecture can be of concern and is analyzed here. To illustrate stability analysis, dynamic model is developed for two hybrid feedforward controllers implemented on DCM boost and four switch buck-boost converter-based PFC rectifiers. The dynamic model developed is shown to match with accurate time domain simulations for the cases presented. Experimental results verifying stable operation of the loop are also presented.

This paper presents a burst-mode controlled inductive wireless power transfer system (WPT). Power is transmitted in bursts between transmitter (TX) and receiver (RX). Duty cycle of the burst is controlled through load modulation to control power flow between TX and RX. The proposed WPT circuit can regulate output voltage against distance and load variations. No extra communication channel is present to establish feedback between transmitter and receiver, making the circuit suitable for many applications. A 100-milliwatt prototype circuit for use in medical implant is designed, built and tested.

Advanced renal cell carcinoma accompanied by tumor thrombus in the venous system is present in up to 10% of cases. Extension of tumor thrombus above the diaphragm or into the right atrium represents level IV disease. Level IV tumors are typically treated with sterno-laparotomy approach with or without deep hypothermic circulatory arrest and veno-venous bypass. In this case report, the surgical technique for the resection of advanced RCC were described, with the concomitant use of transesophageal echocardiography for thrombus extraction without the veno-venous or cardiopulmonary bypass.

Closed-loop neuromodulation with simultaneous stimulation and sensing is desired to advance deep brain stimulation (DBS) therapies. However, stimulation generates large artifacts (~100mV) at the recording sites that saturate traditional front-ends. We present a 15.2b-ENOB CT ΔΣM with 187dB FOM, which along with an 8x-gain capacitively coupled chopper instrumentation amplifier (CCIA), realizes a front-end that can digitize neural signals (<;2mV pp ) from 1Hz to 5kHz in the presence of 200mV pp artifacts. Neural recording front-ends need to function within a power budget of 10μW/ch, input-referred noise of 4-8μV rms in 1Hz-5kHz,DC input impedance Z in, DC >1GΩ and high-pass (HP) cutoff <;1Hz[1]. Prior work has addressed power and noise [1]-[2], but has limited dynamic-range and bandwidth (BW), making them incapable of performing true closed-loop operation.

In this work we propose an energy-efficient, implantable, real-time, blind Adaptive Stimulation Artifact Rejection (ASAR) engine. This enables concurrent neural stimulation and recording for state-of-the-art closed-loop neuromodulation systems. Two engines, implemented in 40nm CMOS, achieve convergence of <;42μs for Spike ASAR and <;167μs for LFP ASAR, and can attenuate artifacts up to 100mV p-p by 49.2dB, without any prior knowledge of the stimulation pulse. The LFP and Spike ASAR designs occupy an area of 0.197mm 2 and 0.209mm 2 , and consume 1.73μW and 3.02μW, respectively at 0.644V.

Closed-loop neuromodulation is essential for the advance of neuroscience and for administering therapy in patients suffering from drug-resistant neurological conditions. Neural stimulation generates large differential and common-mode (CM) artifacts at the recording sites, which easily saturate traditional recording front ends. This paper presents a neural recording chopper amplifier capable of handling in-band 80-mV(pp) differential artifacts and 650-mV(pp) CM artifacts while preserving the accompanying small neural signals. New techniques have been proposed that introduce immunity to CM interference, increase the input impedance of the chopper amplifier to 1.6 G Omega, and increase the maximum realizable resistance of duty-cycled resistors (DCR) to 90 G Omega. These techniques enable our recording front-end to achieve a dynamic range of 74 dB (200 Hz5 kHz) and 81 dB (1-200 Hz). Implemented in a 40-nm CMOS process, the prototype occupies an area of 0.069 mm(2)/channel, and consumes 2.8 mu W from a 1.2-V supply. The input-referred noise is 5.3 mu V-rms (200 Hz-5 kHz) and 1.8 mu V-rms (1-200Hz). The total harmonic distortion for a 40-mVp input at 1 kHz is -76 dB. This work improves the input impedance by 5.3x for chopped front-ends, linear-input range by 2x, maximum resistance of DCR by 32x, and tolerance to CM interferers by 6.5x, while maintaining comparable power and noise performance.

In this paper, we present a case of kidney injury as a complication of renal artery angioplasty in a 54-year-old female patient that suffered from resistant renovascular hypertension. This case emphasises the unpredictable nature of endovascular procedures, the need for careful post-procedure evaluation and the role of 'old fashioned' surgical techniques in resolving complications of endovascular procedures.

INTRODUCTION:In-hospital mortality of acute aortic type III dissection ranged about 12%. Complicated dissections represent about 18% of all cases, and require open surgery or TEVAR. More morphological predictors of in hospital mortality are needed to differentiate patients who should be selected for immediate, surgical or endovascular intervention.METHODS:From January 2009 to December 2014, 74 patients with acute aortic type III dissection were enrolled at Clinic of Vascular and Endovascular Surgery in Belgrade Serbia and retrospectively analyzed. Every MSCT was observed in regard to morphologic characteristics of dissection.RESULTS:By analyzing morphologic parameters in patients between survival and non-survival group only localization of intimal tear showed statistical significance (p=0,020). The size of the intimal tear didn't reach statistical significance with the tendency of doing so in a larger sample of patients (p=0,063) with the cut-off value of 9.55mm. The shape of the true lumen was on the border of statistical significance (p=0,053).CONCLUSION:Inner curvature intimal tear localization, huge intimal tear as well as elliptic shape of the true lumen together should raise awareness to a subgroup at risk for in hospital mortality. More liberal endovascular treatment in this subgroup of patients is advocated.

Stress evokes an integrated neuroendocrine response perturbing the homeostasis of different physiological systems. In contrast to well established physiologica linteractions between neuroendocrine and immune systems during chronic stress, there has been relatively little information on the effects of psychological stress on erythroid cells. Since stress-induced erythropoiesis occurs predominantly in the spleen, in the current study, we investigated the influence of chronic psychological stress on splenic erythroid progenitors and examined a role of glucocorticoid receptor (GR) in observed effect using a mouse model of restraint. The adult male mice were subjected to 2 hours daily restraint stress for 7 or 14 consecutive days and the role of GR in erythropoietic response to stress was assessed by pretreatment of mice with GR antagonist mifepristone 60 min prior to restraint. The results showed that chronic restraint stress induced an increase in spleen weight as well as in the cellularity of red pulp, as compared to controls. Furthermore, 7 and 14 days of restraint stress resulted in markedly increased number of both splenic early (BFU-E) and late (CFU-E) erythroid progenitors. Blockade of GR with mifepristone did not affect the number of BFU-E in stressed mice, but it completely abolished the effect of repeated psychological stress on CFU-E cells. Additionally, plasma corticosterone concentration was enhanced whereas the GR expression was significantly decreased within splenic red pulp after one and two weeks of stress exposure. Obtained findings suggest for the first time an indispensable role for GR in the expansion of CFU-E progenitors in the spleen under conditions of chronic psychological stress.