BackgroundFLuorescence-based Enhanced Reality (FLER) is a software providing quantitative fluorescence angiography (FA), by computing the fluorescence intensity time-to-peak (TTP), after intravenous injection of indocyanine green (ICG). HSI is a contrast-free optical imaging modality, which measures tissue oxygenation (StO 2 ). MethodsIn 8 pigs, an ischemic bowel segment was created by dividing the arcade branches and imaged using HSI and FLER. StO 2 values were acquired through a hyperspectral imaging (HSI) system. Subsequently, FA was performed using a nearinfrared laparoscopic camera, after intravenous injection of 0.2mg/kg of ICG. The TTP fluorescence signal was analyzed through a proprietary software to realize a perfusion map. This was overlaid onto real-time images to obtain FLER. Simultaneously, nine adjacent regions of interest (ROIs) were selected and superimposed onto the real-time video obtaining HYperspectral-based Enhanced Reality (HYPER). FLER and HYPER were superimposed allowing a comparison of both imaging modalities. Local capillary lactates (LCL) were sampled at the ROIs. Two LCL prediction models were extrapolated based on both imaging. ResultsFor all ROIs mean LCL measured 4.67 ± 4.34 mmol/L, mean StO 2 45.92 ± 18.59%, and mean TTP 10.33 ± 9.36 sec. Pearson's test between FLER-TTP and HSI-StO2 at the corresponding ROIs gave an R=-0.66 (p<0.0001). The HSI lactate prediction model proved significantly more accurate than the FLER-based one (p<0.0001). Powered by Editorial Manager® and ProduXion Manager® from Aries Systems Corporation ConclusionBowel perfusion was clearly quantified using HSI and FA. HSI yielded more accurate results than FA. HYPER might become a useful intraoperative tool to quantify bowel ischemia in a contrast-free fashion.

Background Anastomotic leakage (AL) is one of the dreaded complications following surgery in the digestive tract. Nearinfrared fluorescence (NIRF) imaging is a means to intraoperatively visualize anastomotic perfusion, facilitating fluorescence image-guided surgery (FIGS) with the purpose to reduce the incidence of AL. The aim of this study was to analyze the current practices and results of NIRF imaging of the anastomosis in digestive tract surgery through the EURO-FIGS registry. Methods Analysis of data prospectively collected by the registry members provided patient and procedural data along with the ICG dose, timing, and consequences of NIRF imaging. Among the included upper-GI, colorectal, and bariatric surgeries, subgroup analysis was performed to identify risk factors associated with complications. Results A total of 1240 patients were included in the study. The included patients, 74.8% of whom were operated on for cancer, originated from 8 European countries and 30 hospitals. A total of 54 surgeons performed the procedures. In 83.8% of cases, a pre-anastomotic ICG dose was administered, and in 60.1% of cases, a post-anastomotic ICG dose was administered. A significant difference (p < 0.001) was found in the ICG dose given in the four pathology groups registered (range: 0.013-0.89 mg/kg) and a significant (p < 0.001) negative correlation was found between the ICG dose and BMI. In 27.3% of the procedures, the choice of the anastomotic level was guided by means of NIRF imaging which means that in these cases NIRF imaging changed the level of anastomosis which was first decided based on visual findings in conventional white light imaging. In 98.7% of the procedures, the use of ICG partly or strongly provided a sense of confidence about the anastomosis. A total of 133 complications occurred, without any statistical significance in the incidence of complications in the anastomoses, whether they were ICG-guided or not. ConclusionThe EURO-FIGS registry provides an insight into the current clinical practice across Europe with respect to NIRF imaging of anastomotic perfusion during digestive tract surgery.

dementia, which result from chronic and progressive loss of neuronal function. In view of an ageing population, disorders of the brain are likely to establish the principal economic challenge in the future of healthcare. [1] The total cost of dementia to society in the UK alone is £26.3 billion, and this is expected to double over the next 30 years given that prevalence is projected to rise by 40% in the coming decade alone. [2] Among NDs, significant attention has been paid to Alzheimer's disease (AD) and Parkinson's disease (PD) given their severe complications and economic burdens. AD, which accounts for the vast majority of age-related dementia, is a progressive disorder that is characterized by gradual neuronal loss and accumulation of proteins, namely extracellular amyloid-β plaques and intracellular tau tangles. [3] PD is a progressive ND resulting from the loss of specific dopaminergic (DA) neurons in the substantia nigra pars compacta and reduced DA levels in the nigrostriatal DA pathway in the brain. [4,5] Despite significant progress in the management of NDs over the recent years, the early diagnostic and treatment options remain limited. Patients currently suffering from NDs have no available disease-modifying treatments. Instead, patients are offered a therapeutic plan focused on the management of their ND symptoms, whilst concurrently attempting to reduce the adverse effects associated with the medications used. The systemic delivery of drugs to the central nervous system (CNS) is complex due to their poor delivery to the brain, extensive firstpass metabolism which reduces their half-life, and the sideeffects resulting from the drug acting on non-target peripheral tissues. [6] The mainstay of current treatments for NDs is typically through oral administration. For PD medications include L-dopa, carbidopa (peripheral inhibitor of L-dopa into DOPA), dopaminergic agonists, Entacapone (Catechol-O-methyl transferase inhibitor), monoamine oxidase-B inhibitors, amongst others. Other routes of drug administration exist such as subcutaneous injection of dopaminergic agonists. Interestingly, deep brain stimulation has also been offered to those patients resistant to medical therapy but again associated with significant adverse effects. L-Dopa, which is considered the most effective treatment in the short-term for PD, [7] is related to longterm wearing-off phenomena, dyskinesias, and neuropsychiatric disorders. [8] Redox regulation has recently been proposed as a critical intracellular mechanism affecting cell survival, proliferation, and differentiation. Redox homeostasis has also been implicated in a variety of degenerative neurological disorders such as Parkinson's and Alzheimer's disease. In fact, it is hypothesized that markers of oxidative stress precede pathologic lesions in Alzheimer's disease and other neurodegenerative diseases. Several therapeutic approaches have been suggested so far to improve the endogenous defense against oxidative stress and its harmful effects. Among such approaches, the use o...

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