China's first surgeon: Hua Tuo (c. 108-208 AD)

Outside Europe

This chapter illustrates that cranial surgery was not limited to Europe. There was however no contribution to improving knowledge outside Europe until medical science departed for the Arab world.

Mycobacterium leprae: A historical study on the origins of leprosy and its social stigma

This article aims to investigate about the social stigma and the prejudice of society towards the patients with leprosy, but also to understand how this infectious disease has largely influenced human lifestyle and evolution analyzing the evolution of its treatments from past empirical treatments to actual multidrug therapy (MDT). References on leprosy were extensively searched in literature using PubMed, Web of Science, Medline, Springer link and Elsevier's (EMBASE.com) databases, but also in medical, religious and archaeological books. Leprosy's spread all around the world following human paths of migration from the African Continent to the Asian one and to Europe, instead its appearance in the New Continent is more recent. Wars, unhygienic conditions, social and health inequality created conditions for its spread since prehistorical times, and existing health disparities contributed to unequal morbidity and mortality, before its gradual decline after the Middle Ages due to the raise of other worse pandemics. Starting from Renaissance, a deeper knowledge on its pathophysiological mechanisms brought an increasingly advanced combined surgical and pharmacological treatment, but still in modern times many efforts have been made to erase its social stigma, changing its name in "Hansen's disease" included.

Legacies of Neurosurgery and its Implications on Global Neurosurgery Today

Trephination, the practice of boring a hole in ones skull, is one of the oldest surgical procedures performed by and on man. Fossil records show evidence of trephined skulls on separate continents throughout ancient history. Even more remarkably, fossils show that ancient humans actually survived the procedure, some more than once. Ancient mythologies and texts provide context to the fossil record, indicating that trephination was performed some of the time for medical indications, including traumatic head injury and intractable neurological conditions. In modern day, traumatic brain injury accounts for a significant percentage of the overall global burden of disease and its incidence is disproportionately increasing in low-and-middle-income countries. In critical situations neurosurgical intervention may be indicated. The burr hole procedure, or trephination, was identified as an essential surgical procedures that all first-level hospitals should be able to perform; however, there exists a dramatic lack of access to neurosurgical specialists and care globally, especially among low-and-middle-income countries. Task-shifting/sharing is one paradigm that may be used effectively to broaden access to this life-saving procedure but it is at the moment a contested practice.

Shear stress-related mechanosignaling with lung ischemia: lessons from basic research can inform lung transplantation

Cessation of blood flow represents a physical event that is sensed by the pulmonary endothelium leading to a signaling cascade that has been termed "mechanotransduction." This paradigm has clinical relevance for conditions such as pulmonary embolism, lung bypass surgery, and organ procurement and storage during lung transplantation. On the basis of our findings with stop of flow, we postulate that normal blood flow is "sensed" by the endothelium by virtue of its location at the interface of the blood and vessel wall and that this signal is necessary to maintain the endothelial cell membrane potential. Stop of flow is sensed by a "mechanosome" consisting of PECAM-VEGF receptor-VE cadherin that is located in the endothelial cell caveolae. Activation of the mechanosome results in endothelial cell membrane depolarization that in turn leads to activation of NADPH oxidase (NOX2) to generate reactive oxygen species (ROS). Endothelial depolarization additionally results in opening of T-type voltage-gated Ca(2+) channels, increased intracellular Ca(2+), and activation of nitric oxide (NO) synthase with resultant generation of NO. Increased NO causes vasodilatation whereas ROS provide a signal for neovascularization; however, with lung transplantation overproduction of ROS and NO can cause oxidative injury and/or activation of proteins that drive inflammation and cell death. Understanding the key events in the mechanosignaling cascade has important lessons for the design of strategies or interventions that may reduce injury during storage of donor lungs with the goal to increase the availability of lungs suitable for donation and thus improving access to lung transplantation.