To investigate the effects of ultrasound-guided erector spinae plane block (ESPB) on acute and chronic post-surgical pain in patients underwent video-assisted thoracoscopic lobectomy.
A total of 94 patients, who underwent elective unilateral video-assisted thoracoscopic lobotomy from August 2021 to December 2021 were randomly divided into general anesthesia group (group A, n = 46) and ESPB combined with general anesthesia group (group B, n = 48) by computer. Patient controlled intravenous analgesia(PCIA) was performed in both groups after operation. The numerical rating scale(NRS) of rest and cough pain at post anesthesia care unit(PACU), 2 h, 6 h, 12 h, 24 and 48 h after operation, frequency of PCIA in 24 h after operation, frequency of rescue analgesia, patient satisfaction, adverse reactions and complications were recorded in the two groups. Incidence of chronic pain at 3 months and 6 months after operation, the effect of daily life and rating of chronic pain management measures were recorded in the two groups.
Compared with group A, rest and cough NRS score at 2 h, 6 h, 12 h, 24 and 48 h after surgery, frequency of PCIA use at 24 h after surgery, frequency of rescue analgesia were significantly decreased in group B (P < 0.05). There was no significant difference in NRS scores of rest and cough at PACU after operation between 2 groups after surgery at post anesthesia care unit (P > 0.05). There were no significant differences in the incidence of postoperative chronic pain between the 2 groups(P > 0.05);The effect of postoperative chronic pain on daily life and pain management measures in group B were significantly lower than those in group A(P < 0.05). Compared with group A, patients in group B had higher satisfaction degree, lower incidence of postoperative nausea and vomiting(PONV), and lower incidence of agitation during anesthesia recovery (P < 0.05). There were no pneumothorax, hematoma and toxicity of local anesthetic in the 2 groups.
Ultrasound-guided erector spinae plane block can significantly reduce acute post-surgical pain, can not reduce the incidence of chronic post-surgical pain, but can significantly reduce the severity of chronic pain in patients underwent video-assisted thoracoscopic lobectomy.
ChiCTR2100050313,date of registration:26/08/2021.

History has conflated the legacies of José Manuel Rodríguez Delgado and Walter Freeman, midcentury proponents of somatic therapies for neuropsychiatric conditions. Both gained notoriety: Delgado after he appeared on the front page of the New York Times having used his stimoceiver to stop a charging bull in Spain; Freeman as the proponent of lobotomy. Both were the object of critique by the antipsychiatry movement and those who felt that their methods and objectives posed a threat to personal liberty. Using archival sources, we demonstrate that this conflation is a misrepresentation of the historical record and that their methods, objectives, ethics, and philosophical commitments differed widely. Accurate knowledge about historical antecedents is a predicate for ethical analysis and becomes especially relevant information as neuroscience develops circuit-based treatments for conditions such as Parkinson disease, depression, and brain injury. Part of that corrective is to counter the conflation of Delgado\'s and Freeman\'s life and work. Appreciating their distinctive legacies can help guide neuropsychiatric research done today that might yet haunt future generations.

Despite national guidelines supporting surgical referral in drug-resistant epilepsy, it is hypothesized that surgery is underutilized. We investigated the volumes of lobectomy/amygdalohippocampectomy surgeries over time and examined differences in outcomes between (1) high-volume (HV), middle-volume (MV), and low-volume (LV) hospitals and (2) Level 4 Centers versus non-Level 4 Centers.
The 2003-2014 National Inpatient Sample (the largest all-payer hospitalization database, representative of the US population) was utilized. Epilepsy was identified using a previously validated International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) case definition and surgeries using ICD-9-CM procedure codes. A hospital was considered a Level 4 Center if it performed intracranial electroencephalographic (EEG) monitoring. Tumor surgeries were excluded. Linear regression was used to perform trend tests. Weighted multivariate logistic regression was used to summarize association of surgery with outcomes.
A total of 4,487 lobectomy/amygdalohippocampectomy surgeries were performed in children and adults with epilepsy. Lobectomy/amygdalohippocampectomy surgeries significantly decreased over time (slope: -0.24, P < .001). This declining surgical trend was greater for all resective/disconnective surgery (slope: -0.45, P < .001), and greatest when compared to all types of epilepsy surgery, for example, resection/disconnection/radiosurgery/laser interstitial thermal therapy/vagus nerve stimulation/deep brain stimulation/responsive neurostimulation/intracranial EEG (slope: -0.95, P < .001). LV compared to HV hospitals had higher odds of transfer to other facilities (13.60% vs 4.24%, odds ratio [OR] = 2.76, 95% confidence interval [CI] = 1.11-6.82). LV hospitals had higher odds of surgical complications versus MV (12.69% vs 6.80%, OR = 2.20, 95% CI = 1.01-5.09). HV hospitals incurred the least total charges. There were no differences in discharge status, adverse events, length of stay, or cost between Level 4 Centers versus non-Level 4 Centers.
Lobectomies/amygdalohippocampectomies are decreasing over time, suggesting ongoing underutilization. LV centers are associated with greater complication and transfer rates. Future studies are required to understand the reason for worse outcomes in LV centers and to determine whether a minimum number of surgeries must be performed to meet necessary standards.

BACKGROUND: The main objective of this study was to assess the safety and efficacy of deep brain stimulation (DBS) in patients with severe anorexia nervosa (AN).
METHODS: Eight participants received active DBS to the subcallosal cingulate (SCC) or nucleus accumbens (NAcc) depending on comorbidities (affective or anxiety disorders, respectively) and type of AN. The primary outcome measure was body mass index (BMI).
RESULTS: Overall, we found no significant difference (p = 0.84) between mean preoperative and postoperative (month 6) BMI. A BMI reference value (BMI-RV) was calculated. In patients that received preoperative inpatient care to raise the BMI, the BMI-RV was defined as the mean BMI value in the 12 months prior to surgery. In patients that did not require inpatient care, the BMI-RV was defined as the mean BMI in the 3-month period before surgery. This value was compared to the postoperative BMI (month 6), revealing a significant increase (p = 0.02). After 6 months of DBS, five participants showed an increase of ≥10% in the BMI-RV. Quality of life was improved (p = 0.03). Three cases presented cutaneous complications.
CONCLUSIONS: DBS may be effective for some patients with severe AN. Cutaneous complications were observed. Longer term data are needed.

With a recent trend towards supra-maximal resection for gliomas and minimally invasive techniques, keyhole temporal lobectomies may serve an important role in neurosurgical oncology. Due to their location and proximity to eloquent brain, temporal lobe gliomas offer unique challenges that may limit the extent of resection. Here we describe a modified technique using mini-craniotomies through a keyhole approach for temporal lobectomies in glioma patients. We retrospectively reviewed data from consecutive patients who underwent temporal lobectomies for resection of gliomas from 2012 to 2018. Demographic data, extent of tumor resection, pre and post-op KPS, short term and long term complications, as well as other relevant data were collected. We identified 57 patients who underwent keyhole-mini craniotomy for temporal lobectomies for glioma. Surgical procedures were performed in 12 patients for low-grade glioma (LGG) and 45 patients for high-grade glioma (HGG). Awake craniotomies were performed in 15 of the cases, and 13 cases were for tumor recurrence. Supra-maximal resection (SMR) was achieved in 15 patients, while gross total resection (GTR) and near total resection (NTR) achieved in 32 patients and 10 patients, respectively. Average pre- and post-op KPS were equivalent, and post-operative complications requiring surgical intervention were experienced in 4 patients. Here we show that our modified keyhole craniotomy is both safe and effective in achieving SMR or GTR in glioma patients, with minimal morbidity. This minimally-invasive temporal lobectomy may be an instrumental tool for neurosurgical oncologists transitioning to less invasive techniques.

Anterior capsulotomy (AC) is sometimes used as a life-saving treatment for patients with treatment-refractory obsessive-compulsive disorder (Tr-OCD). Most of the previous studies have assessed only total symptoms and have concluded that AC is a safe and effective procedure. Few of these studies have focused on meticulously investigating the variety of results obtained from patients with different subtypes of OCD. This study reviewed the long-term effects of AC on patients with OCD and analyzed the dissimilarity between particular subtypes of the disease in order to determine which groups are more suited to surgical treatment.
For this retrospective evaluation, we selected 54 consecutive patients from a total of 63 people with Tr-OCD between 2005 and 2014 who had undergone AC by thermocoagulation at our department. Preoperative and follow-up assessments were conducted at multiple time points (before surgery and 1, 3, 6, 12, and 36 months after surgery). The Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), Hamilton Depression Scale (HAMD), and Hamilton Anxiety Scale (HAMA) were used to quantify the symptoms of OCD. According to different elements (clinical manifestation, comorbidity, and whether a patient was more compulsive or more obsessive), we classified patients into various subtypes and analyzed the variation in symptom improvement and adverse effects.
The mean Y-BOCS, HAMD, and HAMA scores were, respectively, 27.03, 23.30, and 21.46 preoperatively and 8.50, 7.07, and 7.42, respectively, at 36 months after surgery. Most patients (n = 43, 79.6%) were shown to have been at least partially responsive to surgical treatment at their long-term follow-up. Six patients demonstrated no obvious improvement (Y-BOCS score decreased by <35%), and 5 patients developed recurrences of their conditions. The following subtypes demonstrated better results: contamination/cleaning; obsessions/checking; compulsive behavior dominant; pure OCD; and OCD with Tourette\'s -syndrome. The subtypes of aggressive/sexual, obsessive thought dominant, compulsive behavior with obsessive thoughts, OCD comorbidity with bipolar disorder, OCD comorbid with severe depression, and OCD comorbid with psychiatric symptoms showed good outcomes. However, surgery was ineffective for patients with the subtypes of symmetry/ordering, hoarding, pure obsessive thoughts, and OCD with obsessive slowness.
AC is effective in reducing symptoms of OCD. By comparing differently classified follow-up results, we found that patients with most subtypes/dimensions of OCD showed good outcomes. How-ever, patients categorized into the OCD subtypes of pure -obsessive thoughts, symmetry/ordering, hoarding, OCD with obsessive slowness, and OCD comorbid with psychiatric symptoms should take into account these results before undergoing AC.

To test the hypothesis that transcranial magnetic resonance-guided focused ultrasound (tcMRgFUS) thalamotomy is effective, durable, and safe for patients with medication-refractory essential tremor (ET), we assessed clinical outcomes at 3-year follow-up of a controlled multicenter prospective trial.
Outcomes were based on the Clinical Rating Scale for Tremor, including hand combined tremor-motor (scale of 0-32), functional disability (scale of 0-32), and postural tremor (scale of 0-4) scores, and total scores from the Quality of Life in Essential Tremor Questionnaire (scale of 0-100). Scores at 36 months were compared with baseline and at 6 months after treatment to assess for efficacy and durability. Adverse events were also reported.
Measured scores remained improved from baseline to 36 months (all p < 0.0001). Range of improvement from baseline was 38%-50% in hand tremor, 43%-56% in disability, 50%-75% in postural tremor, and 27%-42% in quality of life. When compared to scores at 6 months, median scores increased for hand tremor (95% confidence interval [CI] 0-2, p = 0.0098) and disability (95% CI 1-4, p = 0.0001). During the third follow-up year, all previously noted adverse events remained mild or moderate, none worsened, 2 resolved, and no new adverse events occurred.
Results at 3 years after unilateral tcMRgFUS thalamotomy for ET show continued benefit, and no progressive or delayed complications. Patients may experience mild degradation in some treatment metrics by 3 years, though improvement from baseline remains significant.
NCT01827904.
This study provides Class IV evidence that for patients with severe ET, unilateral tcMRgFUS thalamotomy provides durable benefit after 3 years.

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OBJECTIVE: There is no evidence concerning the appropriate drainage volume for indicating chest tube removal after pulmonary lobectomy. A prospective multi-institutional cohort study was designed to elucidate the safety of early chest tube removal after thoracoscopic lobectomy.
METHODS: Between April 2009 and November 2011, 310 patients with suspected or histologically documented lung cancer were screened. Patients without air leakage or bloody, chylous, or purulent pleural effusion underwent chest tube removal on the day after thoracoscopic lobectomy, independent of the drainage volume. The subjects were classified into three groups as tertiles according to the drainage volume that was observed for approximately 24 h after surgery. The associations between the drainage volume and the development of complications were investigated, with several clinical factors taken into account.
RESULTS: The 162 patients who were enrolled underwent early chest tube removal via this protocol and were classified into three groups according to their drainage volume (0-219 mL, n = 52; 220-349 mL, n = 56; and ≥ 350 mL, n = 54). A 7F backup tube placed within the dead space to prevent troubles was removed by postoperative day 4 in all patients because nothing happened. Univariate and multivariate analyses showed that the drainage volume was not associated with the risk of complications.
CONCLUSIONS: Early removal of the chest tube on the day after thoracoscopic lobectomy appears to be a safe treatment protocol in patients without air leakage or bloody, chylous, or purulent pleural effusion; however, careful surveillance is needed for patients who have a drainage volume of ≥ 350 mL/day.
UNASSIGNED: University Hospital Medical Information Network Clinical Trials Registry, 000028971 (Japan).