Search Results (23,428)

Stroke causes approximately 12.2 million new cases and 6.5 million deaths annually, with survivors requiring coordinated care across pre-hospital, acute, rehabilitative, and preventive phases. Mobile health (mHealth) technologies, including smartphone applications, wearable sensors, and tablet-based platforms, have shown clinical potential across these contexts, yet a structured mapping of their distribution across the full stroke care continuum is lacking. We searched PubMed, Scopus, and Web of Science for publications from January 2019 to March 2025. Studies evaluated mHealth interventions in which the mobile platform directly performed diagnostic, therapeutic, or rehabilitative functions in stroke populations. Of 4524 records identified, 17 met the inclusion criteria. Studies originated from eight countries and used heterogeneous designs: five randomized controlled trials, five non-randomized studies, four cohort studies, and three diagnostic accuracy studies. Median sample size was 37 participants (range 10–2249). Evidence concentrated at two poles: six studies addressed acute diagnosis and ten addressed rehabilitation, predominantly in the chronic phase. One study addressed secondary prevention; two targeted early rehabilitation, the period of maximum neuroplasticity after discharge. All seventeen studies covered a single care phase. Smartphone platforms dominated acute contexts; wearable and mixed-modality systems were confined to rehabilitation. The mHealth stroke landscape is fragmented and phase-specific, exhibiting a silo effect in which interventions operate as isolated tools rather than components of an integrated care system. An important gap is the near-absence of research in early rehabilitation. Future priorities include cross-continuum design, expansion into cognitive and secondary prevention domains, and progression toward adequately powered trials. Full article

Background: Hashimoto’s thyroiditis (HT) is a chronic autoimmune disorder characterized not only by thyroid dysfunction but also by metabolic disturbances, micronutrient inadequacies, and low-grade inflammation. Composite indices derived from routine laboratory parameters may therefore help capture the broader systemic profile of the disease. This study explored within-cohort associations of immunonutritional indices including the Prognostic Nutritional Index (PNI), Nutritional Risk Index (NRI), and Controlling Nutritional Status (CONUT), and hemogram-derived inflammatory markers including the Neutrophil-to-Lymphocyte Ratio (NLR), Monocyte-to-Lymphocyte Ratio (MLR), Platelet-to-Lymphocyte Ratio (PLR), and Systemic Immune-Inflammation Index (SII), with thyroid function, thyroid autoimmunity, metabolic characteristics, disease duration, and vitamin D status in adults with Hashimoto’s thyroiditis. Methods: This cross-sectional study included 229 adults diagnosed with HT. PNI, NRI, CONUT, and complete blood count-derived inflammatory markers were evaluated in relation to thyroid function, thyroid autoimmunity, disease duration, metabolic characteristics, and vitamin D status. Because most variables were not normally distributed, the main analyses were conducted using non-parametric tests. Correlations were evaluated using Spearman’s rank correlation coefficients. Exploratory regression models were estimated using HC3 heteroscedasticity-consistent robust standard errors, and CRP-based sensitivity analyses were performed by excluding participants with CRP > 10 mg/L. Results: Vitamin D deficiency was highly prevalent and affected 70.3% of the participants. Among the immunonutritional indices, NRI differed significantly according to BMI category and HOMA-defined insulin resistance (both p < 0.001), indicating a closer relationship with metabolic burden. PNI was associated with disease duration (p = 0.009), whereas the inflammatory indices were largely similar across the clinical groupings examined. In exploratory robust regression models, the explanatory power remained modest (R² = 0.066–0.171). PLR showed the most consistent index-related association with TSH, whereas the CONUT–FT3 association observed in the full-sample robust model was not retained after CRP-based sensitivity analysis. Conclusions: Adults with HT in this study showed frequent vitamin D deficiency together with a substantial burden of excess weight and insulin resistance. Routine immunonutritional and inflammatory indices may provide supportive information on within-cohort biochemical and metabolic heterogeneity, but they should not be interpreted as stand-alone diagnostic or prognostic markers. In particular, NRI appeared to reflect metabolic and adiposity-related burden more than nutritional risk alone, while PLR showed the most internally consistent index-related association with TSH. Full article

The high prevalence of catheter-associated urinary tract infections (CAUTIs) has become a significant concern in the healthcare system, prompting the development of antibacterial urinary catheters to effectively prevent these infections in clinical settings. In this work, metallic phase and semiconducting phase molybdenum disulfide (MoS₂) embedded polydimethylsiloxane (PDMS) were developed as antibacterial urinary catheters with photothermal sterilization. The metallic phase MoS₂ (1T-MoS₂) was synthesized using a facile hydrothermal method, and an annealing process transformed it into the semiconducting phase (2H-MoS₂). The optical and structural characterizations confirmed the successful preparations of 1T-MoS₂ nanosheets (1T-MoS₂ NSs) and 2H-MoS₂ NSs. The increase in the contents of 1T-MoS₂ NSs and 2H-MoS₂ NSs in PDMS resulted in enhanced photothermal conversion, a slight decrease in the water contact angle, and no significant changes in the mechanical properties of the samples. The bacterial growth curves demonstrated the remarkable ability of phase-dependent 1T- and 2H-MoS₂ NSs-embedded PDMS urinary catheters to inhibit the growth of E. coli and S. aureus with near-infrared (NIR) laser irradiation. In the agar plate test, exposing PDMS with 0.3% 1T-MoS₂ or 2H-MoS₂ to NIR for 10 min demonstrated excellent antibacterial effects, completely eradicating E. coli and eliminating over 99.9% of S. aureus. The SEM image results highlighted the significant photothermal antibacterial effect of 1T-MoS₂ PDMS and 2H-MoS₂ PDMS urinary catheters, effectively damaging and eradicating both E. coli and S. aureus. The 1T-MoS₂ PDMS and 2H-MoS₂ PDMS urinary catheters, with excellent photothermal effects, good hydrophobicity, and superior mechanical properties, demonstrated their potential as photothermal antibacterial catheters for clinical applications. Full article

Background/Objectives: i-Factor™ Bone Graft is a composite bone substitute containing P-15 synthetic collagen fragment that has demonstrated noninferiority to local autograft in single-level anterior cervical discectomy and fusion (ACDF); however, direct head-to-head comparisons with demineralized bone matrix (DBM) using contemporary 3D-printed titanium cages are lacking. The aim of this retrospective study was to compare radiographic fusion rates, segmental stability, and clinical outcomes between i-Factor™ and DBM in single-level ACDF, with a particular focus on the early time course of fusion. Methods: A retrospective propensity score-matched cohort study was conducted in patients with single-level cervical degenerative disc disease (cervical disc herniation, cervical spondylotic radiculopathy, or cervical spondylotic myelopathy) operated between December 2021 and January 2024 at a single tertiary care hospital. Seventy-six consecutive patients undergoing single-level ACDF with 3D-printed titanium cages were matched 1:1 (i-Factor™ vs. DBM) on age, sex, and operative level. Fusion status was assessed by serial dynamic radiographs at 1, 3, 6, and 12 months and by 3D-CT at 12 months in all patients (with additional CT at earlier timepoints when plain films were equivocal), by two independent spine surgeons blinded to graft type; inter-rater agreement (Cohen’s κ) was computed. Results: Mean follow-up was 18.1 months. Fusion rates for i-Factor™ at 3, 6, and 12 months were 94.7%, 100%, and 100%, respectively, compared to 71.1%, 84.2%, and 94.7% for DBM. The differences were statistically significant at 3 months (p = 0.047) and 6 months (p = 0.012), but not at 12 months (p = 0.493). Inter-rater agreement was almost perfect (κ = 0.86–1.00). No adverse reactions or device-related complications were observed. Conclusions: In this matched cohort, i-Factor™ was associated with significantly faster fusion than DBM in single-level ACDF, with similar 12-month fusion rates. No adverse reactions were observed, although the sample size is insufficient to exclude rare complications. Full article

Despite growing recognition that nurses must be equipped with sustainability competencies to address climate-related health challenges, the psychological mechanisms through which nursing education fosters sustainability attitudes are not yet fully understood. This study examined the mediating role of clinical performance self-efficacy in the relationship between simulation-based learning quality and sustainability attitudes among undergraduate nursing students. A cross-sectional correlational design was employed with a main sample of 679 nursing students from four Egyptian universities. Data were collected using the CHEST, SECP Scale, and SANS_2. Mediation analysis used Hayes’ PROCESS macro with 5000 bootstrap resamples. Simulation-based learning quality significantly predicted both self-efficacy (β* = 0.772) and sustainability attitudes (β* = 0.613). Self-efficacy partially mediated this relationship, accounting for 68.34% of the total effect (indirect β* = 0.419, Boot 95% CI [0.343, 0.494]). Nursing educators should design simulation curricula that deliberately cultivate self-efficacy while embedding sustainability content, producing clinically competent and environmentally responsible graduates. Full article

Background/Objectives: Anshen Bunao Oral Liquid (ABOL) is a traditional medicinal formula comprising Cornu Cervi Pantotrichum, Radix Polygoni Multiflori Preparata and other ingredients. It replenishes essence, nourishes qi and blood, and soothes the spirit. It is used in clinical practice to treat neurasthenia and insomnia (emotion-related symptoms), and its key component, glycyrrhizin, exhibits anxiolytic properties. This aligns with the holistic approach of traditional Chinese medicine (TCM) to regulating neuropsychiatric disorders. The aim of this study is to evaluate the anxiolytic efficacy of ABOL in rats with anxiety induced by chronic restraint stress (CRS), and to clarify its mechanism by focusing on modulation of the gut–brain axis (microbiota and metabolism). Methods: Sprague-Dawley rats underwent three hours of restraint per day for 28 days to induce anxiety. ABOL was administered intragastrically in three doses. Anxiety-like behaviours were assessed using OFT, EPM and SPT. Serum, tissue and faecal samples were analysed using ELISA, histopathology, immunohistochemistry, non-targeted metabolomics, 16S rRNA sequencing and RT-qPCR. Results: CRS induced anxiety-like behaviours, impaired weight gain and perturbed the balance of neurotransmitters (decreasing 5-HT, GABA, NE and DA, while increasing CORT), inducing inflammation/oxidative stress, hippocampal neuronal injury, intestinal barrier dysfunction and gut microbiota/metabolic dysregulation. ABOL effectively reversed these abnormalities by restoring the balance of neurotransmitters and the HPA axis, suppressing inflammation and oxidation, protecting neurons and the intestinal barrier, remodelling the gut microbiota (enriching Akkermansia and balancing Firmicutes/Bacteroidota) and regulating sphingolipid and glycerophospholipid pathways. The interaction between the gut microbiota and metabolites may contribute to this pharmacological effect. Conclusions: ABOL exerts anxiolytic effects by modulating the gut–brain axis at multiple targets, involving microbiota remodelling, regulation of lipid metabolism and improvement of pathology. This validates its ethnopharmacological value, linking traditional Chinese medicine to the development of modern anxiolytics. Full article

Background/Objectives: Gut microbiota dysregulation has been increasingly implicated in the pathophysiology of autism spectrum disorder (ASD), yet clinical responses to standardized probiotic interventions remain inconsistent, likely reflecting substantial inter-individual variability in baseline microbiome composition, host–microbe interactions, immune tone, and metabolic function. Here, we present a pilot implementation of a metagenomics-guided, personalized synbiotic intervention in children with ASD using the Systematic Microbiome Assessment and Reconstruction Therapy (SMART) framework. Methods: Seven children (aged 5–12 years) underwent longitudinal fecal shotgun metagenomic profiling, and dietary habits, food sensitivities, and regional dietary background were recorded as contextual factors potentially influencing microbiome composition and response to intervention. Individualized synbiotic formulations were constructed based on microbial taxonomic composition and inferred functional capacity and iteratively refined over time. Gastrointestinal outcomes were assessed through caregiver-reported clinical observations, whereas behavioral changes were evaluated using standardized instruments. Results: Several participants demonstrated improvements in gastrointestinal symptoms and selected behavioral domains. Notably, in a subset of participants, improvements in gastrointestinal function preceded measurable behavioral changes. Conclusions: Although limited by a small sample size and lack of a control group, these findings provide preliminary evidence supporting the feasibility of implementing a metagenomics-guided personalized synbiotic framework in ASD and generate hypotheses for future investigation. This work presents a preliminary conceptual framework for integrating microbial composition and inferred functional profiling into individualized intervention design and highlights the potential value of microbiome-informed stratification in future studies of treatment response. Larger controlled studies with objective outcome measures are warranted to further evaluate feasibility, reproducibility, and potential clinical utility. Full article

Highly virulent African swine fever virus (ASFV) genotype II strains have been responsible for the global epidemic in domestic pigs and are typically characterized by a hemadsorption (HAD)-positive phenotype mediated by the CD2v protein encoded by the EP402R gene. Here, we report the detection and genetic characterization of three non-HAD genotype II ASFV isolates (VNUA/ASFV/VP2023-isolate1, VNUA/ASFV/TB2024-isolate2, and VNUA/ASFV/HY2024-isolate3) recovered from whole-blood samples collected from pigs exhibiting prolonged clinical signs in northern Vietnam. Whole-genome analysis revealed nonsense mutations in the EP402R gene (G57A in isolates VNUA/ASFV/TB2024-isolate2 and VNUA/ASFV/HY2024-isolate3, and G132A in VNUA/ASFV/VP2023-isolate1), resulting in premature stop codons and a HAD-negative phenotype. Furthermore, additional genetic alterations, including deletions and frameshift mutations, were identified within multigene families (MGF110, MGF360, and MGF505), which are known to play critical roles in virulence, host range, and immune evasion. Notably, VNUA/ASFV/VP2023-isolate1 harbored a partial deletion of the I177L gene along with the insertion of an mCherry marker gene, suggesting possible evolution of the modified live ASFV-G-ΔI177L vaccine strain under field conditions. Collectively, these findings underscore the ongoing evolution and genomic plasticity of ASFV strains circulating in Vietnam. Full article

Background: Patients with limited English proficiency (LEP) in the United States face significant barriers to safe and equitable healthcare despite federal protections guaranteeing access to qualified interpreter services at no cost. Many patients with LEP remain unaware of these rights, relying instead on informal learning through clinical encounters and community networks which are unreliable pathways that may perpetuate language access disparities. Point-of-care educational interventions grounded in just-in-time and situated learning theory represent a promising but understudied approach to bridging this gap. Objective: The aim was to examine Spanish-speaking emergency department patients’ interpreter access patterns, baseline knowledge of federal language rights, and immediate responses to a brief multilingual point-of-care educational video intervention. Methods: A pre–post survey design was used with a convenience sample of 40 Spanish-speaking adult patients presenting to a large, level 1 trauma center ED in the Southeastern United States between February and April 2025. Participants completed a 22-item iPad-administered Spanish-language survey that included baseline knowledge questions, an embedded 2 min educational video about federal language access rights, and post-video response questions. Descriptive statistics were calculated for quantitative data and thematic analysis was conducted for open-ended responses, with two independent coders achieving substantial inter-rater agreement (κ = 0.75, p < 0.001). Fisher’s exact tests examined associations between interpreter access mode and patient demographic characteristics. Results: Most participants (70%) accessed interpreters passively rather than by self-request, a pattern that did not vary significantly by patient status, age, or length of time in the United States. At baseline, 57.5% knew that federal laws prohibit language discrimination in healthcare and 77.5% knew they were entitled to a free qualified interpreter. Most participants (80%) reported learning something new from the video, with responses centering on rights awareness and anti-discrimination protections. Most participants (70%) reported that knowing their federal rights was helpful, describing increased confidence and reduced anxiety. All participants (100%) reported difficulty communicating without an interpreter and nearly all (97.5%) felt more confident asking questions when one was present. Conclusions: Significant knowledge gaps persist even among patients with some baseline rights awareness; a brief culturally appropriate point-of-care video may meaningfully increase awareness and confidence. The consistently passive pattern of interpreter access across all demographic subgroups underscores the need for proactive institutional practices and patient-facing education that empowers LEP patients to advocate for themselves in healthcare settings. Full article

Systemic sclerosis-associated interstitial lung disease (SSc-ILD) remains an important cause of morbidity and mortality in systemic sclerosis. Mycophenolate mofetil (MMF) is widely used as first-line immunosuppressive therapy; however, real-world descriptions of pulmonary functional and radiologic evolution during MMF therapy remain limited, particularly according to high-resolution computed tomography (HRCT) pattern. Objectives: To descriptively evaluate pulmonary function evolution, radiologic findings, and safety outcomes in patients with SSc-ILD treated with MMF in routine clinical practice, with exploratory analyses according to HRCT pattern and subsequent antifibrotic use. Materials and Methods: We conducted a retrospective single-center study including 20 patients with SSc-ILD treated with MMF. Clinical, functional (forced vital capacity [FVC]; diffusing capacity for carbon monoxide [DLCO]), and radiologic (HRCT Warrick score) parameters were assessed at baseline, 6 months, and 12 months. Patients were stratified according to nonspecific interstitial pneumonia (NSIP) and usual interstitial pneumonia (UIP) patterns. Statistical analyses were exploratory and descriptive. Results: Pulmonary function remained overall stable during follow-up under MMF therapy, while DLCO improvement was observed at 6 months and remained stable at 12 months. Radiologic progression appeared more limited in patients with NSIP pattern, whereas patients with UIP pattern generally exhibited more frequent radiologic progression during follow-up. Patients who subsequently received nintedanib generally presented with UIP-pattern disease, lower baseline DLCO values, and more advanced pulmonary involvement. MMF was generally well tolerated, with treatment discontinuation due to adverse events observed in a single patient. Conclusions: This small retrospective real-world case series describes pulmonary functional and radiologic evolution in patients with SSc-ILD treated with MMF in routine clinical practice. Overall functional stabilization was observed during follow-up, while radiologic progression was more frequently observed in patients with UIP-pattern disease and more advanced baseline pulmonary involvement. Because of the exploratory descriptive design and limited sample size, these observations should be interpreted cautiously and considered hypothesis-generating only. Further prospective studies with standardized radiologic assessment are required. Full article

Although Dupuytren’s disease (DD) and relapsed Clubfoot (RC) are clinically distinct conditions, both exhibit fibrotic tissue remodeling and contracture. This exploratory study investigated whether DD and RC share molecular features associated with fibroproliferative contracture. Pathological tissues from DD nodules and contracted tissues from RC together with their respective control tissues (n = 6/group), were analyzed using label-free quantitative proteomics. The analysis identified 12 significantly upregulated proteins shared between both pathological conditions relative to their controls (|log₂FC| ≥ 1, p ≤ 0.05). These proteins included structural, signaling and tensile stress ECM proteins. Functional enrichment and network analyses revealed partially overlapping dysregulation of pathways associated with ECM organization and degradation, ECM–receptor interaction, matricellular signaling and mechanobiological processes. In DD samples (n = 10), immunohistochemistry confirmed increased expression of fibrosis-associated proteins (α-SMA, TGF-β1, TGFBI, COL III, COL VI, and COL XII) (at least p < 0.01). Despite these similarities, differences in individual protein abundance and collagen crosslinking were observed between tissues. The findings suggest that DD and RC may share aspects of fibrotic ECM-remodeling despite differences in age, localization, and disease origin. These findings provide initial insights into shared ECM-remodeling processes, although their interpretation should consider the relatively small sample size and biological heterogeneity of the analyzed tissues. Full article

Over the past decade, serious games and virtual reality have gained increasing relevance in upper-limb rehabilitation, yet desktop virtual reality solutions often suffer from reduced spatial correspondence and limited sensory feedback. This work presents the design and preliminary evaluation of a desktop virtual reality-based serious game that combines Leap Motion Controller hand tracking with a custom wireless vibrotactile wearable device to support upper-limb rehabilitation training. Three training scenarios were implemented to target pronation/supination, pinch grip, ulnar/radial deviation, and wrist, elbow, and finger flexion/extension. Usability (System Usability Scale, SUS), user experience (short AttrakDiff), and perceived workload (Raw NASA-TLX), together with functionality and perception questionnaires, were collected from healthy participants randomly assigned to two groups (Group 1: $n=13$, LMC only; Group 2: $n=9$, LMC plus wearable). Across all instruments, the configuration including the wearable device tended to obtain higher usability ratings, more desirable pragmatic and hedonic quality scores, and lower overall workload means than the LMC-only configuration, with moderate effect sizes but limited statistical power due to the small samples. Participants in the wearable condition also reported clearer feedback, a perceived improvement in movement precision, and a stronger perceived alignment between real and virtual actions. These findings suggest that the proposed system may serve as a promising user-centered prototype for desktop VR-based upper-limb rehabilitation and provide preliminary design evidence to support future clinical and kinematic validation studies with larger cohorts. Full article

Chronic ulcers are characterized by impaired tissue repair and frequently harbor antimicrobial-resistant microorganisms, worsening clinical outcomes. The objective of this study is to identify microbial agents in chronic ulcers treated at the Lauro de Souza Lima Institute Wound Care Outpatient Clinic and to evaluate their antimicrobial susceptibility profiles and β-lactamase production. Samples (swab and biopsy) from patients treated at the Lauro de Souza Lima Institute were analyzed. Susceptibility was assessed by disk diffusion. ESBL and AmpC production were confirmed by PCR targeting blaTEM, blaSHV, blaCTX-M1, and blaCMY-2. In Staphylococcus spp., oxacillin and clindamycin resistance were evaluated and confirmed by mecA and ermAC. From 33 patients (mean age 63.4 years), 116 isolates were obtained, mainly Pseudomonas aeruginosa (27%), Proteus mirabilis (18%), and Staphylococcus aureus (13%). P. aeruginosa showed high resistance, with 48% MDR and 29% PDR. Among Enterobacterales, 19% were ESBL producers and 17% AmpC, with 56% carrying blaCMY-2. In Staphylococcus, 33% were oxacillin-resistant and 50% expressed MLSb phenotype. P. aeruginosa was identified as the most prevalent pathogen, with frequent MDR/PDR phenotypes. Resistance genes exhibited a discrepancy between genotypic and phenotypic profiles, suggesting the presence of unexpressed resistance that may be inducible during treatment. Full article

In this paper, recent advances (2016–2026) in bacterial separation and enrichment from blood for diagnosis of bloodstream infection (BSIs) through pathogen identification and antimicrobial susceptibility testing (AST) are reviewed. The review centers on sample processing as an indispensable front-end of biosensor and lab-on-chip platforms, since most sensors cannot operate directly in whole blood. Efficient separation and enrichment concentrate extremely low bacterial burdens, remove blood components that interfere with detection, and deliver bacteria in a sensor-compatible format; consequently, diagnostic sensitivity, specificity, turnaround time, and robustness are strongly determined by this step. We first summarize the clinical impact of BSIs and the value of rapid AST for guiding timely, targeted therapy, emphasizing that efficient bacterial isolation from blood is a prerequisite for accurate testing. We then discuss key challenges and recent progress in bacterial separation and enrichment from blood with major approaches, including filtration, centrifugation, functionalized magnetic beads, and microfluidic technologies. These strategies serve as core building blocks that interface with downstream identification and AST methods, supporting integrated biosensors and point-of-care devices. Finally, we outline future directions of bacterial separation and enrichment approaches to improve recovery, purity, integration, standardization, and overall diagnostic performance for BSI workflows. Full article

Objective: Electrocorticography can serve as an intraoperative research tool during deep brain stimulation procedure, when patients are awake to participate in behavioral tasks or to allow recordings while awake but at rest. This report aims to describe the electrocorticography methods used in awake patients undergoing deep brain stimulation surgery at a single center and to describe the feasibility, safety, and usefulness of high-density electrocorticography for capturing high-resolution neurophysiological data during deep brain stimulation surgery. We hypothesize that the use of high-density electrocorticography and multi-subject integration of cortical data enables improved spatial resolution and data analysis compared to prior studies employing lower-density electrodes and primarily single-subject analyses. Methods: Data were obtained from patients undergoing awake deep brain stimulation surgery for the treatment of Parkinson’s disease or essential tremor at Johns Hopkins Hospital between March 2022 and September 2024. Electrophysiological and anatomical data were analyzed, with localization in the anterior commissure and posterior commissure and Montreal Neurological Institute coordinate systems. Surgical complications were monitored for at least six months postoperatively. Results: Thirty-six patients (26 with Parkinson’s disease, 10 with essential tremor) were enrolled in the study. In one case, anatomical placement was inadequate for neurophysiological analysis. Postoperative complications included three infections (8.3%) and one chronic subdural hematoma (2.8%), with no permanent neurological deficits. Observed complication rates were within the range reported in the literature for standard deep brain stimulation surgeries without electrocorticography. Anatomical and neurophysiological analysis demonstrated high-resolution cortical mapping. Multiple-subject level analysis using high-density electrocorticography yielded over 1300 electrode positions. Conclusions: Electrocorticography during deep brain stimulation is a valuable research method for movement disorders and, based on a moderate sized consecutive clinic sample, appears safe with risks no greater than those associated with DBS surgery itself. Full article