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Objective: The precision of neuronavigation systems relies on the correct registration of the patient's position in space and aligning it with radiological 3D imaging data. Registration is usually performed by the acquisition of anatomical landmarks or surface matching based on facial features. Another possibility is automatic image registration using intraoperative imaging. This could provide better accuracy, especially in rotated or prone positions where the other methods may be difficult to perform. The aim of this study was to validate automatic image registration (AIR) using intraoperative cone-beam computed tomography (CBCT) for cranial neurosurgical procedures and compare the registration accuracy to the traditional surface matching (SM) registration method based on preoperative MRI. The preservation of navigation accuracy throughout the surgery was also investigated. Methods: Adult patients undergoing intracranial tumor surgery were enrolled after consent. A standard SM registration was performed, and reference points were acquired. An AIR was then performed, and the same reference points were acquired again. Accuracy was calculated based on the referenced and acquired coordinates of the points for each registration method. The reference points were acquired before and after draping and at the end of the procedure to assess the persistency of accuracy. Results: In total, 22 patients were included. The mean accuracy was 6.6 ± 3.1 mm for SM registration and 1.0 ± 0.3 mm for AIR. The AIR was superior to the SM registration (p < 0.0001), with a mean improvement in accuracy of 5.58 mm (3.71–7.44 mm 99% CI). The mean accuracy for the AIR registration pre-drape was 1.0 ± 0.3 mm. The corresponding accuracies post-drape and post-resection were 2.9 ± 4.6 mm and 4.1 ± 4.9 mm, respectively. Although a loss of accuracy was identified between the preoperative and end-of-procedure measurements, there was no statistically significant decline during surgery. Conclusions: AIR for cranial neuronavigation consistently delivered greater accuracy than SM and should be considered the new gold standard for patient registration in cranial neuronavigation. If intraoperative imaging is a limited resource, AIR should be prioritized in rotated or prone position procedures, where the benefits are the greatest. [ABSTRACT FROM AUTHOR]

Simple Summary: Metastases to the brain result in serious morbidity and mortality. Surgical resection is a treatment option; however, many patients die within a short time after surgery. It is therefore important to understand which patients may benefit from surgical resection. We have investigated prognostic factors for survival after surgery for brain metastases. We identified eight factors that significantly predicted survival in these patients and created a preoperative prognostic index to estimate survival and to guide clinical decision-making in evaluating surgery as a treatment for brain metastases. We tested our findings on patients who underwent the same treatment at two other large hospitals in Norway and Sweden, and our findings were valid. This is to our knowledge the first such index to support decision-making in this setting. Background: Brain metastases (BM) are common in cancer patients and are associated with high morbidity and mortality. Surgery is an option, but the optimal selection of patients for surgery is challenging and controversial. Current prognostication tools are not ideal for preoperative prognostication. By using a reference population (derivation data set) and two external populations (validation data set) of patients who underwent surgery for BM, we aimed to create and validate a preoperative prognostic index. Methods: The derivation data set consists of 590 patients who underwent surgery for BM (2011–2018) at Oslo University Hospital. We identified variables associated with survival and created a preoperative prognostic index with four prognostic groups, which was validated on patients who underwent surgery for BM at Karolinska University Hospital and St. Olavs University Hospital during the same time period. To reduce over-fitting, we adjusted the index in accordance with our findings. Results: 438 patients were included in the validation data set. The preoperative prognostic index correctly divided patients into four true prognostic groups. The two prognostic groups with the poorest survival outcomes overlapped, and these were merged to create the adjusted preoperative prognostic index. Conclusion: We created a prognostic index for patients with BM that predicts overall survival preoperatively. This index might be valuable in supporting informed choice when considering surgery for BM. [ABSTRACT FROM AUTHOR]

Healthcare-associated infections are a global concern and can be dependent on the infection prevention behaviours of nursing staff, which in turn can be influenced by working conditions. Qualitative studies are scarce, and a greater understanding of the relationship between working conditions and nursing staff behaviour is needed.The aim was to describe nursing staff’s experiences and reflections on working conditions and infection prevention behaviours.A qualitative study with semi-structured focus group interviews at four surgical units and two orthopaedic hospital units. Twenty-seven nursing staff (12 registered nurses and 15 assistant nurses) participated. Data was analysed using qualitative content analysis.We generated one theme: Navigating in a complex and shifting context. The result indicates that working conditions are sometimes inadequate, which can hinder the nursing staff’s infection prevention behaviours. Even when working conditions seemed to be sufficient, hygiene routines could fail, since situations constantly arise in a hospital unit that are difficult to predict and regulate.This study highlights the complexities faced by nursing staff in maintaining infection prevention behaviours within the dynamic hospital work environment. While nursing staff are professionally obliged to comply with hygiene routines, organisational support is essential for fostering sustainable working conditions. A multi-tiered approach is needed, from first-line managers to decision-makers, to promote a supportive environment that sustains safe practices. [ABSTRACT FROM AUTHOR]

Background: In a previous article (10.1007/s00701-019-03888-3), preliminary results of a survey, aiming to shed light on the number of surgical procedures performed and assisted during neurosurgery residency in Europe were reported. We here present the final results and extend the analyses. Methods: Board-certified neurosurgeons of European Association of Neurosurgical Societies (EANS) member countries were asked to review their residency case logs and participate in a 31-question electronic survey (SurveyMonkey Inc., San Mateo, CA). The responses received between April 25, 2018, and April 25, 2020, were considered. We excluded responses that were incomplete, from non-EANS member countries, or from respondents that have not yet completed their residency. Results: Of 430 responses, 168 were considered for analysis after checking in- and exclusion criteria. Survey responders had a mean age of 42.7 ± 8.8 years, and 88.8% were male. Responses mainly came from surgeons employed at university/teaching hospitals (85.1%) in Germany (22.0%), France (12.5%), the United Kingdom (UK; 8.3%), Switzerland (7.7%), and Greece (7.1%). Most responders graduated in the years between 2011 and 2019 (57.7%). Thirty-eight responders (22.6%) graduated before and 130 responders (77.4%) after the European WTD 2003/88/EC came into effect. The mean number of surgical procedures performed independently, supervised or assisted throughout residency was 540 (95% CI 424–657), 482 (95% CI 398–568), and 579 (95% CI 441–717), respectively. Detailed numbers for cranial, spinal, adult, and pediatric subgroups are presented in the article. There was an annual decrease of about 33 cases in total caseload between 1976 and 2019 (coeff. − 33, 95% CI − 62 to − 4, p = 0.025). Variables associated with lesser total caseload during residency were training abroad (1210 vs. 1747, p = 0.083) and female sex by trend (947 vs. 1671, p = 0.111), whereas case numbers were comparable across the EANS countries (p = 0.443). Conclusion: The final results of this survey largely confirm the previously reported numbers. They provide an opportunity for current trainees to compare their own case logs with. Again, we confirm a significant decline in surgical exposure during training between 1976 and 2019. In addition, the current analysis reveals that female sex and training abroad may be variables associated with lesser case numbers during residency. [ABSTRACT FROM AUTHOR]

In birds, parental escorting of dependent young to feeding areas outside the breeding territory is a commonly observed, yet poorly documented phenomenon. Using radio-tracking, we provide a detailed description of the post-fledging movements of 12 blue tit Cyanistes caeruleus families and compare these observations with a much larger dataset of the closely related great tit Parus major collected over several years in the same study area. The proportion of families making excursions outside woodlots was similar in both species (± 50%), but the spatial extent of these movements tended to be larger in blue tits (mean ± SE: 1100 m ± 265, range: 643-2374, n = 6) as compared to great tits (mean ± SE: 666 m ± 42, range: 245-1898, n = 64). Blue tit families foraged significantly more in oak habitat within woodlots, independently of excursion behaviour, whereas great tits undertaking excursions shifted their range use towards more variable habitat outside woodlots. The observed excursions of blue tits appeared multiple-day or permanent shifts of the family range, and not daily excursions as most frequently observed in great tits. Although family movements in both species may be largely driven by common underlying factors, our results also points toward species-specific difference in spatial behaviour which may be linked with foraging specializations and post-fledging territory fidelity. [ABSTRACT FROM AUTHOR]

Neural progenitor cells (NPCs) have regenerative capabilities that are activated during inflammation. We aimed at elucidating how NPCs, with special focus on the spinal cord-derived NPCs (SC-NPCs), are affected by chronic inflammation modeled by experimental autoimmune encephalomyelitis (EAE). NPCs derived from the subventricular zone (SVZ-NPCs) were also included in the study as a reference from a distant inflammatory site. We also investigated the transcriptional and functional difference between the SC-NPCs and SVZ-NPCs during homeostatic conditions. NPCs were isolated and propagated from the SVZ and cervical, thoracic, and caudal regions of the SC from naive rats and rats subjected to EAE. Using Affymetrix microarray analyses, the global transcriptome was measured in the different NPC populations. These analyses were paralleled by NPC differentiation studies. Assessment of basal transcriptional and functional differences between NPC populations in naive rat revealed a higher neurogenic potential in SVZ-NPCs compared with SC-NPCs. Conversely, during EAE, the neurogenicity of the SC-NPCs was increased while their gliogenicity was decreased. We detected an overall increase of inflammation and neurodegeneration-related genes while the developmentally related profile was decreased. Among the decreased functions, we isolated a gliogenic signature that was confirmed by differentiation assays where the SC-NPCs from EAE generated fewer oligodendrocytes and astrocytes but more neurons than control cultures. In summary, NPCs displayed differences in fate-regulating genes and differentiation potential depending on their rostrocaudal origin. Inflammatory conditions downregulated gliogenicity in SC-NPCs, promoting neurogenicity. These findings give important insight into neuroinflammatory diseases and the mechanisms influencing NPC plasticity during these conditions. [ABSTRACT FROM AUTHOR]

Objective: Hydrocephalus is a common neurosurgical condition treated primarily through ventriculoperitoneal (VP) shunt placement. This study aims to investigate the relationship between the timing of VP shunt surgery (on-call vs. regular hours) and shunt failure rates., Methods: In this single-center, population-based observational cohort study, all adult patients who underwent VP shunt surgery were included. The main outcome was reoperation due to shunt failure within 12 months of the index surgery, comparing rates between procedures performed during regular hours and on-call periods. Adjustments for confounders were made using multivariable logistic regression., Results: Out of 810 cases included, 25% underwent surgery during on-call hours. Shunt failure occurred in 10% of cases, most often due to infection. Patients operated on during on-call hours had a significantly higher rate of shunt failure compared to those operated on during regular hours (17% vs. 7.9%, P < 0.001). However, after adjusting for confounders in a multivariable logistic regression, this relationship was no longer statistically significant (OR: 1.60, P = 0.073)., Conclusions: The rate of shunt failure was significantly greater in surgeries conducted during on-call hours as opposed to regular hours, but this was not statistically significant after adjusting for confounders. Therefore, the timing of VP shunt surgery may not be an independent risk factor for shunt failure. High-risk scenarios still deserve added caution, and further research is needed to identify factors influencing shunt outcomes and develop strategies to minimize failure rates., (Copyright © 2025 The Authors. Published by Elsevier Inc. All rights reserved.)

Objective: The aim of this study was to evaluate the effect of standardized care guidelines featuring next-day discharge on hospital length of stay (LOS), outcomes, patient experience, and healthcare consumption in patients receiving ventriculoperitoneal shunts (VPSs) for idiopathic normal pressure hydrocephalus (iNPH)., Methods: This single-center population-based observational cohort study included 271 adult iNPH patients who underwent VPS surgery at Karolinska University Hospital. Groups were compared before and after the implementation of new standardized discharge guidelines. The primary outcome was the hospital LOS. Secondary outcomes included postoperative complications, patient experience, and frequency of unscheduled outpatient follow-up appointments., Results: A total of 121 patients were treated with variable hospitalization periods. One hundred fifty patients were managed under the new guidelines stipulating next-day discharge. There was no significant difference in positive surgical outcome (66% vs 71%, p = 0.372) or rates of complication (p ≥ 0.066) between groups. The standardized guidelines group had a significantly shorter period of inpatient hospitalization (1 vs 2 days, p < 0.001) and demonstrated lower levels of unscheduled outpatient healthcare consumption (p < 0.001) while maintaining levels of positive patient experience (p = 0.828)., Conclusions: Standardized discharge guidelines featuring next-day discharge are safe for iNPH patients undergoing VPS surgery, maintain the quality of the patient experience, and are an effective method for mitigating healthcare consumption in an expanding patient group.

Background: Nurses' working conditions are important for their well-being at work and for their ability to provide patients with safe care. Self-efficacy can influence employees' behaviour at work. Therefore, it is valuable to study self-efficacy levels to medical asepsis in relation to working conditions., Objective: To investigate the relationship between nurses' assessed self-efficacy levels to medical asepsis in care situations and structural empowerment, work engagement and work-related stress., Methods: A cross-sectional study with a correlational design was conducted. A total of 417 registered nurses and licensed practical nurses at surgical and orthopaedic units responded to a questionnaire containing: the Infection Prevention Appraisal Scale, the Conditions of Work Effectiveness Questionnaire-II, the Utrecht Work Engagement Scale-9 and the Health & Safety Executive Management Standards Indicator Tool. Correlational analyses and group comparisons were performed., Results: The nurses rated high levels of self-efficacy to medical asepsis in care situations. The correlational analyses revealed that correlation coefficients between structural empowerment, work engagement, work-related stress and self-efficacy to medical asepsis were 0.254-0.268. Significant differences in self-efficacy were found in the grouped working conditions., Conclusions: This study revealed that nurses rated high self-efficacy levels to medical asepsis and, to some extent, this seemed related to structural empowerment, work engagement and work-related stress. This valuable knowledge could enable improvements at the managerial and organisational levels, benefiting both nurses and patients in the long run.

Adult neural stem cells (NSCs) are believed to facilitate CNS repair and tissue regeneration. However, it is not yet clear how these cells are influenced when the cellular environment is modified during neurotrauma or neuroinflammatory conditions. In this study, we determine how different proinflammatory cytokines modulate the expression of TLR2 and TLR4 in NSCs and how these cells respond to TLR2 and TLR4 agonists. Primary cultures of neural stem/progenitor cells isolated from the subventricular zone of brains from adult Dark Agouti rats were exposed to 1) supernatants from activated macrophages; 2) proinflammatory cytokines IFN-gamma, TNF-alpha, or both; and 3) agonists for TLR2 and TLR4. Both TLR2 and TLR4 were expressed during basal conditions and their mRNA levels were further increased following cytokine exposure. TLR4 was up-regulated by IFN-gamma and this effect was reversed by TNF-alpha. TLR2 expression was increased by supernatants from activated macrophages and by TNF-alpha, which synergized with IFN-gamma. TLR agonists induced the expression of TNF-alpha mRNA. Importantly, TNF-alpha could be translated into protein and released into the supernatants where it was quantified by cytokine ELISA. In conclusion, we demonstrate that NSCs constitutively express TLR2 and TLR4 and that their expression is increased as a consequence of exposure to proinflammatory mediators. Additionally, activation of these receptors can induce production of proinflammatory cytokines. These findings suggest that NSCs may be primed to participate in cytokine production during neuroinflammatory or traumatic conditions.