RESUMEN
INTRODUCTION: Surgeons are often exposed to different types of operative room (OR) noise, for instance machine alarms, phone calls, and interacting objects. The aim of this study was to evaluate the effect of OR noise on the surgeons' laparoscopic performance. METHODS: A total of 30 laparoscopic novices participated in this single-center, prospective, randomized cross-over trial after completing a standardized laparoscopic training until reaching proficiency. Afterward, all participants performed four different laparoscopic tasks (peg transfer, circle cutting, balloon resection, suture, and knot) twice, once under noise exposure (intervention group), and once without any noise (control group). Primary endpoints were the force exertion and motion analyses. To assess the psychological workload the NASA task load index score was used. RESULTS: The error rates varied and were significantly different between the noise and the control group. More complex tasks like the circle cutting and suture and knot task revealed higher error rates concerning precision (circle cutting: P < 0.01; suture and knot: P < 0.01). In line with increased error rates in the circle cutting task, increased NASA task load index scores were observed in this task (P = 0.03). However, no significant differences were found in force parameters, such as the maximal force exertion (peg transfer: P = 0.43; circle cutting: P = 0.54; balloon resection: P = 0.64; suture and knot: P = 0.63) and the mean force exertion (peg transfer: P = 0.43; circle cutting: P = 0.54; balloon resection: P = 0.64; suture and knot: P = 0.63) between the groups. CONCLUSIONS: Exposure to normal OR noise led to higher error rates in two of four tasks. This effect could be linked to an increased psychological workload that was present under normal OR noise exposure. However, normal OR noise does not appear to impact surgical novices' laparoscopic task performance regarding applied forces and instrument motion.
RESUMEN
Compromised blood-brain barrier (BBB) by dysregulation of cellular junctions is a hallmark of many cerebrovascular disorders due to the pro-inflammatory cytokines action. Interleukin 6 (IL6) is implicated in inflammatory processes and in secondary brain injury after subarachnoid hemorrhage (SAH) but its role in the maintenance of cerebral endothelium still requires a precise elucidation. Although IL6 has been shown to exert pro-inflammatory action on brain microvascular endothelial cells (ECs), the expression of one of the IL6 receptors, the IL6R is controversially discussed. In attempt to reach more clarity in this issue, we present here an evident baseline expression of the IL6R in BBB endothelium in vivo and in an in vitro model of the BBB, the cEND cell line. A significantly increased expression of IL6R and its ligand was observed in BBB capillaries 2 days after experimental SAH in mice. In vitro, we saw IL6 administration resulting in an intracellular and extracellular elevation of IL6 protein, which was accompanied by a reduced expression of tight and adherens junctions, claudin-5, occludin, and vascular-endothelial (VE-) cadherin. By functional assays, we could demonstrate IL6-incubated brain ECs to lose their endothelial integrity that can be attenuated by inhibiting the IL6R. Blockade of the IL6R by a neutralizing antibody has reconstituted the intercellular junction expression to the control level and caused a restoration of the transendothelial electrical resistance of the cEND cell monolayer. Our findings add depth to the current understanding of the involvement of the endothelial IL6R in the loss of EC integrity implicating potential therapy options.