High molecular weight fibroblast growth factor-2 as a promising prognostic biomarker to predict the occurrence of heart failure in atrial fibrillation patients

Abstract

Heart failure (HF) has a significant effect on the prognosis of the patients with atrial fibrillation (AF), and also it is an important risk factor for overall mortality. High molecular weight fibroblast growth factor-2 (Hi-FGF-2) is emerging as a prognostic marker with HF and AF. The aim of this study was to prove that Hi-FGF-2 would predict occurrence of HF in the patients with AF. Subjects diagnosed with paroxysmal AF (Group paAF), persistent AF (Group peAF) and sinus rhythm (Group SR) were enrolled in the study. Serum Hi-FGF-2 concentration was measured by ELISA at baseline. Multivariable logistic models and receiver operating characteristic (ROC) curve analysis were established to predict the prognosis of AF subjects. 260 patients were enrolled in the study: 104 (40.0%) admitted for sinus rhythm (Group SR) and 156 (60.0%) with AF (Group paAF and Group peAF). The Hi-FGF-2 levels were much lower in the Group SR (58.2 ± 27.1 ng/L) than in the Group AF. Furthermore, the Group peAF (84.3 ± 34.1 ng/L) had higher Hi-FGF-2 levels than the Group paAF (72.9 ± 35.8 ng/L). Serum Hi-FGF-2 levels were classified into trisection in the multivariable logistic model (T1 < 57.3 ng/L, 57.3 < T2 < 86.5 ng/L, and T3 > 86.5 ng/L). Hi-FGF-2 showed good predictive ability for new-onset HF in the patients with AF. The occurrence of HF was associated significantly with increased tertile of serum Hi-FGF-2 levels (T2: OR 5.922, 95% CI 1.109–31.626, P = 0.037 and T3: OR 8.262, 95% CI 1.735–39.343, P = 0.008). ROC curve analysis showed that the area under curves for Hi-FGF-2 were 0.720 (P < 0.0001). Hi-FGF-2 has a significant meaning in AF subjects. Further to this, higher circulating Hi-FGF-2 was highly related to persistent AF, and Hi-FGF-2 may be an independent risk factor of occurrence HF in AF subjects.

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Erratum to: The Validity of a New Structured Assessment of Gastrointestinal Symptoms Scale (SAGIS) for Evaluating Symptoms in the Clinical Setting

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Erratum to: The Validity of a New Structured Assessment of Gastrointestinal Symptoms Scale (SAGIS) for Evaluating Symptoms in the Clinical Setting

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Identification of patients with cancer with a high risk to develop delirium

Abstract

Delirium deteriorates the quality of life in patients with cancer, but is frequently underdiagnosed and not adequately treated. In this study, we evaluated the occurrence of delirium and its risk factors in patients admitted to the hospital for treatment or palliative care in order to develop a prediction model to identify patients at high risk for delirium. In a period of 1.5 years, we evaluated the risk of developing delirium in 574 consecutively admitted patients with cancer to our academic oncology department with the Delirium Observation Screening Scale. Risk factors for delirium were extracted from the patient's chart. A delirium prediction algorithm was constructed using tree analysis, and validated with fivefold cross-validation. A total of 574 patients with cancer were acutely (42%) or electively (58%) admitted 1733 times. The incidence rate of delirium was 3.5 per 100 admittances. Tree analysis revealed that the predisposing factors of an unscheduled admittance and a metabolic imbalance accurately predicted the development of delirium. In this group the incidence rate of delirium was 33 per 100 patients (1:3). The AUC of the model was 0.81, and 0.65 after fivefold cross-validation. We identified that especially patients undergoing an unscheduled admittance with a metabolic imbalance do have a clinically relevant high risk to develop a delirium. Based on these factors, we propose to evaluate preventive treatment of these patients when admitted to the hospital in order to improve their quality of life.

The predisposing factors of an unscheduled admittance and a metabolic imbalance accurately predict the development of delirium in patients with cancer (delirium risk 1:3). This prediction algorithm for delirium that can be easily implemented in daily clinical practice should be evaluated for the potential benefit of preventive treatment of patients with cancer who are prone to develop delirium.

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MicroRNAs in Parkinson’s disease

Abstract

Parkinson’s disease is the second most common neurodegenerative disease commonly affecting the older population. Loss of dopaminergic neurons in the substantia nigra of brain leads to impairment of motor activities as well as cognitive defects. There are many underlying causes to this disease, both genetic and epigenetic, which are yet to be fully explored. Non-coding RNAs are significant part of our genome and are involved in various cellular processes. MicroRNAs, which are small non-coding RNAs having 20–22 nucleotides, are involved in many underlying mechanisms of pathogenesis of several neurodegenerative diseases including Parkinson’s. This review focuses on the role played by microRNAs in regulating various genes responsible for the onset and pathogenesis of Parkinson’s disease and various literature evidences pointing at the usefulness of targeting specific microRNAs as a potential alternate therapeutic strategy for successful impairment of the disease progression. This review also discusses about various biofluid-based microRNA markers which may be potentially utilized for diagnostic purposes.

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Oncology Physicians' Perspectives on Practices and Barriers to Fertility Preservation and the Feasibility of a Prospective Study of Pregnancy After Breast Cancer

Journal of Adolescent and Young Adult Oncology , Vol. 0, No. 0.


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Thymic Hyperplasia Associated with Graves' Disease: Pathophysiology and Proposed Management Algorithm

Thyroid , Vol. 0, No. 0.


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Role of dual red imaging to guide intravariceal sclerotherapy injection of esophageal varices (with videos)

Dual red imaging (DRI) is a novel image-enhanced endoscopy technique that can increase the visibility and predict the depth of esophageal varices (EVs). The recurrence rate of EVs after endoscopic injection sclerotherapy (EIS) reportedly decreases by intravariceal injection of a sclerosant. We evaluated prospectively whether the EIS success rate was increased by DRI compared with the white light (WLI) mode.

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Impact of the pretreatment Glasgow prognostic score on treatment tolerance, toxicities, and survival in patients with advanced head and neck cancer undergoing concurrent chemoradiotherapy

Abstract

Background

The purpose of this study was to evaluate the impact of the pretreatment Glasgow prognostic score on treatment-related toxicities, tolerance, and survival in patients with advanced head and neck cancers undergoing concurrent chemoradiotherapy (CRT).

Methods

We retrospectively analyzed and compared the clinical characteristics, toxicities, and survival of 143 patients with stages III, IVA, and IVB head and neck cancer treated with concurrent CRT according to their Glasgow prognostic score between 2007 and 2010.

Results

The Glasgow prognostic score was correlated with advanced tumor stage and T/N classification. Patients with a higher Glasgow prognostic score were less likely to tolerate concurrent CRT, experienced more weight loss, required tube feeding support more frequently, and had higher percentage of grade ≥3 hematological toxicities, sepsis, and toxic death. Patients with a Glasgow prognostic score of 0 had better overall and recurrence-free survival than those with a Glasgow prognostic score of 1 or 2.

Conclusion

Pretreatment Glasgow prognostic score predicts treatment tolerance, toxicity, and survival in patients with advanced head and neck cancer undergoing concurrent CRT.

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Three-dimensional analysis of linear vestibulo-ocular reflex in humans during eccentric rotation while facing downwards

Abstract

When participants undergo eccentric rotation (ER), i.e., they are rotated while displaced from the axis of rotation, they undergo both rotational stimulation and linear acceleration, which induces both the angular vestibulo-ocular reflex (aVOR) and linear VOR (lVOR). During ER, the lVOR induced by tangential linear acceleration enhances the eye movement induced by aVOR. In this study, we attempted to measure aVOR and lVOR separately, while participants underwent ER while facing the ground in a dark room. We analyzed three-dimensional eye movements using a video-oculography system. The participants sat on the ER chair either directly above the center of rotation, or with their head out, head in, right ear out, or left ear out against the center of rotation. Under these conditions, the rotational axis of the eye was perpendicular to the ground for rotational stimulation (aVOR), and the axis was parallel to the ground for linear stimulation (lVOR). Thus, measured eye movements could be separated into these two components. At 0.1 and 0.3 Hz rotation, we observed aVOR but not lVOR. However, when the stimulation frequency was above 0.5 Hz, we observed both aVOR and lVOR. These data indicate that lVOR is activated when the stimulation frequency is above 0.5 Hz. We conclude that it is possible to separately analyze aVOR and lVOR, and to simultaneously assess the function of aVOR and lVOR by analyzing eye movements induced when participants undergo ER above 0.5 Hz while facing the ground.

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On the contribution of overt tactile expectations to visuo-tactile interactions within the peripersonal space

Abstract

Since the discovery of neural regions in the monkey brain that respond preferentially to multisensory stimuli presented in proximal space, researchers have been studying this specialised spatial representation in humans. It has been demonstrated that approaching auditory or visual stimuli modulate tactile processing, while they are within the peripersonal space (PPS). The aim of the current study is to investigate the additional effects of tactile expectation on the PPS-related multisensory interactions. Based on the output of a computational simulation, we expected that as tactile expectation increases rapidly during the course of the motion of the visual stimulus, the outcome RT curves would mask the multisensory contribution of PPS. When the tactile expectation remains constant during the motion, the PPS-related spatially selective multisensory processes become apparent. The behavioural results on human experiments followed the pattern predicted by the simulation. That is, rapidly changing levels of tactile expectation, caused by dynamic visual stimuli, masks the outcome of the multisensory processes within peripersonal space. This indicates that both PPS-related multisensory interactions and tactile expectations play an important role in anticipating and responding to interactions with the body.

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Tactile feedback is an effective instrument for the training of grasping with a prosthesis at low- and medium-force levels

Abstract

Grasping is a complex task routinely performed in an anticipatory (feedforward) manner, where sensory feedback is responsible for learning and updating the internal model of grasp dynamics. This study aims at evaluating whether providing a proportional tactile force feedback during the myoelectric control of a prosthesis facilitates learning a stable internal model of the prosthesis force control. Ten able-bodied subjects controlled a sensorized myoelectric prosthesis performing four blocks of consecutive grasps at three levels of target force (30, 50, and 70%), repeatedly closing the fully opened hand. In the first and third block, the subjects received tactile and visual feedback, respectively, while during the second and fourth block, the feedback was removed. The subjects also performed an additional block with no feedback 1 day after the training (Retest). The median and interquartile range of the generated forces was computed to assess the accuracy and precision of force control. The results demonstrated that the feedback was indeed an effective instrument for the training of prosthesis control. After the training, the subjects were still able to accurately generate the desired force for the low and medium target (30 and 50% of maximum force available in a prosthesis), despite the feedback being removed within the session and during the retest (low target force). However, the training was substantially less successful for high forces (70% of prosthesis maximum force), where subjects exhibited a substantial loss of accuracy as soon as the feedback was removed. The precision of control decreased with higher forces and it was consistent across conditions, determined by an intrinsic variability of repeated myoelectric grasping. This study demonstrated that the subject could rely on the tactile feedback to adjust the motor command to the prosthesis across trials. The subjects adjusted the mean level of muscle activation (accuracy), whereas the precision could not be modulated as it depends on the intrinsic myoelectric variability. They were also able to maintain the feedforward command even after the feedback was removed, demonstrating thereby a stable learning, but the retention depended on the level of the target force. This is an important insight into the role of feedback as an instrument for learning of anticipatory prosthesis force control.

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Clinical benefit of sunitinib in gastrointestinal stromal tumors with different exon 11 mutation genotypes

Future Oncology, Ahead of Print.


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Effect of cancer-associated fibroblasts on radiosensitivity of cancer cells

Future Oncology, Ahead of Print.


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Osteopontin polymorphism increases gastric precancerous intestinal metaplasia susceptibility in Helicobacter pylori infected male

Future Oncology, Ahead of Print.


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Investigation of correlation between mutational status in key EGFR signaling genes and prognosis of stage II colorectal cancer

Future Oncology, Ahead of Print.


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Second primary malignancy in acute promyelocytic leukemia: a Surveillance, Epidemiology and End Results database study

Future Oncology, Ahead of Print.


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Characterization of Carbapenem-Resistant Escherichia coli Isolates Through the Whole-Genome Sequencing Analysis

Microbial Drug Resistance , Vol. 0, No. 0.


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Circumvent hesitancy between CDK4/6 and mTOR inhibitors in second-line treatment of HR+, erb2- metastatic breast cancer

Future Oncology, Ahead of Print.


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State of the ablation nation: a review of ablative therapies for cure in the treatment of hepatocellular carcinoma

Future Oncology, Ahead of Print.


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What's new in small cell lung cancer – extensive disease? An overview on advances of systemic treatment in 2016

Future Oncology, Ahead of Print.


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Prognostic potential of neutrophil-to-lymphocyte ratio and lymphocyte nadir in stage III non-small-cell lung cancer

Future Oncology, Ahead of Print.


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Using Simulation to Improve Systems

Attempts to understand and improve health care delivery often focus on the characteristics of the patient and the characteristics of the health care providers, but larger systems surround and integrate with patients and providers. Components of health care delivery systems can support or interfere with efforts to provide optimal health care. Simulation in situ, involving real teams participating in simulations in real care settings, can be used to identify latent safety threats and improve the work environment while simultaneously supporting participant learning. Thoughtful planning and skilled debriefing are essential.

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Change in lip closing force in Classes II and III malocclusion before and after sagittal split ramus osteotomy with Le Fort I osteotomy

Many studies have shown that cranio-maxillofacial deformity patients have lower functioning than persons with normal skeleton and occlusion (Throckmorton et al., 2000). Improvement of that functioning is one of the purposes of orthognathic surgery.

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Prospective comparison of 18F-NaF PET/CT versus 18F-FDG PET/CT imaging in mandibular extension of head and neck squamous cell carcinoma with dedicated analysis software and validation with surgical specimen. A preliminary study

: The aim of this study is to propose a new method to quantify radioactivity with PET/CT imaging in mandibular extension in head and neck squamous cell carcinoma (HNSCC), using innovative software, and to compare results with microscopic surgical specimens.

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Circumvent hesitancy between CDK4/6 and mTOR inhibitors in second-line treatment of HR+, erb2- metastatic breast cancer

Future Oncology, Ahead of Print.


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Clinical accuracy of waferless maxillary positioning using customized surgical guides and patient specific osteosynthesis in bimaxillary orthognathic surgery

Computer-assisted planning and surgery for the treatment of orthognathic deformities have been extensively documented over the last decade. Computerized and customized wafers have lacked to improve the accuracy of maxillary positioning, resulting in a draw back of computer-assisted orthognathic surgery. The aim of this study was to determine the accuracy of a new technique of waferless maxillary positioning using customized surgical guides and patient specific osteosynthesis implants in bimaxillary orthognathic surgery.

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Clinical accuracy of waferless maxillary positioning using customized surgical guides and patient specific osteosynthesis in bimaxillary orthognathic surgery

Computer-assisted planning and surgery for the treatment of orthognathic deformities have been extensively documented over the last decade. Computerized and customized wafers have lacked to improve the accuracy of maxillary positioning, resulting in a draw back of computer-assisted orthognathic surgery. The aim of this study was to determine the accuracy of a new technique of waferless maxillary positioning using customized surgical guides and patient specific osteosynthesis implants in bimaxillary orthognathic surgery.

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Clinical benefit of sunitinib in gastrointestinal stromal tumors with different exon 11 mutation genotypes

Future Oncology, Ahead of Print.


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Associations between subclinical hypocalcemia and postparturient diseases in dairy cows

Publication date: Available online 6 July 2017
Source:Journal of Dairy Science
Author(s): E.M. Rodríguez, A. Arís, A. Bach
Dairy cows suffer blood Ca losses as lactation begins and might be affected by hypocalcemia in its clinical (total serum Ca concentration <1.50 mM) or subclinical form (total serum Ca concentration ≤2.14 mM). Several studies have suggested that hypocalcemia is associated with different health problems of the cow but results from different studies are not consistent. The objective of this study was to assess potential associations between subclinical hypocalcemia (SCHC) and displaced abomasum, intramammary infections, metritis, retained placenta, and ketosis. Also, the associations between SCHC and milk yield and reproductive function were evaluated. After discarding cows (32) with clinical hypocalcemia, a total of 764 cows from 6 different commercial farms were enrolled in this study. Blood samples were collected at 24 to 48 h postcalving and analyzed for total Ca concentration. Odds ratios of the different afflictions potentially associated with SCHC were calculated. Seventy-eight percent of the analyzed cows incurred SCHC. The occurrence of displaced abomasum, ketosis, retained placenta, and metritis was 3.7, 5.5, 3.4, and 4.3 times more likely, respectively, in cows that had SCHC than in cows with normocalcemia. Furthermore, the risk of incurring retained placenta or metritis increased in multiparous cows as serum Ca concentrations decreased compared with that in primiparous cows. Normocalcemic cows, independent of parity, were more likely to show their first estrus sooner after calving than SCHC cows, but no correlation was found between SCHC and other reproductive parameters. Different serum Ca concentration cutoffs were identified for several postpartum afflictions (≤1.93, ≤2.05, ≤2.05, and ≤2.10 mM for ketosis, retained placenta, metritis, and displaced abomasum, respectively). In conclusion, SCHC, defined as serum Ca ≤2.14 mM, is a frequent illness affecting the majority of the dairy cows with important repercussions on health. However, if SCHC were to be used to predict postpartum disease, different serum Ca cutoff points are likely to be needed because best predictive cutoff values varied among postpartum ketosis, displaced abomasum, retained placenta, and metritis.



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Effect of cancer-associated fibroblasts on radiosensitivity of cancer cells

Future Oncology, Ahead of Print.


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Osteopontin polymorphism increases gastric precancerous intestinal metaplasia susceptibility in Helicobacter pylori infected male

Future Oncology, Ahead of Print.


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Investigation of correlation between mutational status in key EGFR signaling genes and prognosis of stage II colorectal cancer

Future Oncology, Ahead of Print.


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Second primary malignancy in acute promyelocytic leukemia: a Surveillance, Epidemiology and End Results database study

Future Oncology, Ahead of Print.


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Stereo-electroencephalography identifies N2 sleep and spindles in human hippocampus

Physiological activity and related functions of the hippocampus are clearly modulated by sleep. For example, the sequences of hippocampal neuronal discharges in rats occurring during a space exploration are reactivated during both non-rapid eye movement (NREM) and rapid eye movement (REM) sleep (Wilson et al., 1994; O'Neill et al., 2008). In humans, this so-called hippocampal replay was also highlighted in positron emission tomography (PET) in healthy volunteers during slow-wave sleep (SWS) the night following a mnesic episodic learning task (Peigneux et al., 2004).

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Unsupervised Detection and Removal of Muscle Artifacts from Scalp EEG Recordings using Canonical Correlation Analysis, Wavelets and Random Forests

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Synaptic damage underlies EEG abnormalities in postanoxic encephalopathy: a computational study

Of all comatose survivors of cardiac arrest, 46-48% are alive and independent in activities of daily living after 6 months (Hofmeijer et al., 2015; Nielsen et al., 2013). Continuous electroencephalography (cEEG) in the first 24 hours after resuscitation allows reliable identification of 50% of patients with either a good or poor outcome (Hofmeijer et al., 2015). Not only the EEG abnormalities as such, but also their timing and evolution are crucial indicators of the severity of the ischemic injury and prognosis (Tjepkema-Cloostermans et al., 2015).

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Failed Removal of Indwelling Urinary Catheters in Acute Stroke Patients: Incidence and Risk Factors

Reducing the incidence of indwelling urinary catheter (IUC) use and early removal of the devices that are inserted are appropriate priorities for quality patient care. Just like symptomatic bacteriuria, failed catheter removal as a complication of IUC use is associated with considerable morbidity. In the ideal setting, patients that need IUCs have them, and patients that do not need them will have them safely removed, with the goal of reducing medical complications and facilitating the rehabilitation phase of care.

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Nordic Walking for the management of people with Parkinson’s disease: a systematic review

It is well known that physical exercise is the main therapeutic element of rehabilitation programs for people with Parkinson's disease (PD). As traditional forms of exercise can guarantee significant health benefits, the emergence of non-conventional physical activities, such as Nordic walking (NW), may add positive effects.

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The magnitude of angular and translational displacement of dens fractures is dependent on the sagittal alignment of the cervical spine rather than the force of injury

Although it is generally believed that the magnitude of dens fracture displacement is proportional to the amount of force applied to the cervical spine during injury, the factors responsible for displacement have not been studied.

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An analysis of radiographic parameters comparison between lumbar spine latericumbent and full-length lateral standing radiographs

The lumbar spine latericumbent and full-length lateral standing radiographs are most commonly used to assess lumbar disorder. However, there are few literatures regarding the difference and correlation of the sagittal parameters between the two shooting positions.

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Cancer-Associated Fibroblasts Share Characteristics and Pro-tumorigenic Activity with Mesenchymal Stromal Cells

Cancer-associated fibroblasts (CAF) have been suggested to originate from mesenchymal stromal cells (MSC), but their relationship to MSC is not clear. Here we have isolated from primary human neuroblastoma (NB) tumors a population of αFAP- and FSP-1-expressing CAF that share phenotypic and functional characteristics with bone marrow-derived MSC (BM-MSC). Analysis of human NB tumors also confirmed the presence of αFAP- and FSP-1-positive cells in the tumor stroma, and their presence correlated with that of M2 tumor-associated macrophages. These cells (designated CAF-MSC) enhanced in vitro NB cell proliferation, survival, and resistance to chemotherapy and stimulated NB tumor engraftment and growth in immunodeficient mice, indicating an effect independent of the immune system. The pro-tumorigenic activity of MSC in vitro and in xenografted mice was dependent on the co-activation of JAK2/STAT3 and MEK/ERK1/2 in NB cells. In a mouse model of orthotopically implanted NB cells, inhibition of JAK2/STAT3 and MEK/ERK/1/2 by ruxolitinib and trametinib potentiated tumor response to etoposide and increased overall survival. These data point to a new type pro-tumorigenic CAF in the tumor microenvironment (TME) of NB and to STAT3 and ERK1/2 as mediators of their activity.

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Kindlin-2 regulates the growth of breast cancer tumors by activating CSF-1-mediated macrophage infiltration

Interplay between tumor cells and host cells in the tumor microenvironment dictates the development of all cancers. In breast cancer, malignant cells educate host macrophages to adopt a pro-tumorigenic phenotype. In this study, we show how the integrin regulatory protein kindlin-2 (FERMT2) promotes metastatic progression of breast cancer through the recruitment and subversion of host macrophages. Kindlin-2 expression was elevated in BC biopsy tissues where its levels correlated with reduced patient survival. Based on these observations, we used CRISPR/Cas9 technology to ablate Kindlin-2 expression in human MDA-MB-231 and murine 4T1 breast cancer cells. Kindlin-2 deficiency inhibited invasive and migratory properties in vitro without affecting proliferation rates. However, in vivo tumor outgrowth was inhibited by >80% in a manner associated with reduced macrophage infiltration and secretion of the macrophage attractant and growth factor CSF-1. The observed loss of CSF-1 appeared to be caused by a more proximal deficiency in TGF-β-dependent signaling in Kindlin-2 deficient cells. Collectively, our results illuminate a Kindlin-2/TGF-β/CSF-1 signaling axis employed by breast cancer cells to capture host macrophage functions that drive tumor progression.

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Resistance to the antibody-drug conjugate T-DM1 is based in a reduction in lysosomal proteolytic activity

Trastuzumab-emtansine (T-DM1) is an antibody-drug conjugate (ADC) that was approved recently to treat HER2+ breast cancers. Despite its impressive clinical efficacy in many patients, intrinsic and acquired resistance to T-DM1 has emerged as a challenge. To identify mechanisms of T-DM1 resistance, we isolated several resistant HER2+ clones exhibiting stable drug refractoriness in vitro and in vivo. Genomic comparisons showed substantial differences among three of the isolated clones, indicating several potential mechanisms of resistance to T-DM1. However, we observed no differences in HER2 levels and signaling among the resistant models and parental HER2+ cells. Bioinformatics studies suggested that intracellular trafficking of T-DM1 could underlie resistance to T-DM1, and systematic analysis of the path followed by T-DM1 showed that the early steps in the internalization of the drug were unaltered. However, in some of the resistant clones T-DM1 accumulated in lysosomes. In these clones, lysosomal pH was increased and the proteolytic activity of these organelles was deranged. These results were confirmed in T-DM1-resistant cells from patient-derived HER2+ samples. We postulate that resistance to T-DM1 occurs through multiple mechanisms, one of which is impaired lysosomal proteolytic activity. Since other ADC may use the same internalization-degradation pathway to deliver active payloads, strategies aimed at restoring lysosomal functionality might overcome resistance to ADC-based therapies and improve their effectiveness.

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Huwe1 sustains normal ovarian epithelial cell transformation and tumor growth through the histone H1.3-H19 cascade

Ubiquitination-directed protein degradation is important in many cancers for tumor initiation and maintenance, and E3 ligases containing HECT domains are emerging as new therapeutic targets. In contrast to many other E3 ligases, the role of HUWE1 in ovarian cancer where HUWE1 is dysregulated has been unclear. Here we report that genetic deletion of Huwe1 in the mouse inhibits transformation of ovary surface epithelium cells without significantly affecting cell survival and apoptosis, and that Huwe1 deletion after tumors have been initiated inhibits tumor growth. In Huwe1-deficient cells, expression of histone H1.3 increased, inhibiting the expression of noncoding RNA H19. H19 silencing phenocopied the effects of Huwe1 deficiency, whereas H1.3 silencing partially rescued the expression of H19 and the Huwe1 null phenotype. Inducible silencing of HUWE1 in human ovarian cancer cells produced a similar phenotype. Mechanistically, HUWE1 bound and ubiquitinated H1.3, which was consequently marked for destruction by proteasomes. Our results establish that HUWE1 plays an essential role in promoting ovarian cancer.

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Proinflammatory CXCL12-CXCR4/CXCR7 signaling axis drives Myc-induced prostate cancer in obese mice

Obesity is a prognostic risk factor in the progression of prostate cancer (PCa), however, the molecular mechanisms involved are unclear. In this study, we provide preclinical proof of concept for the role of a pro-inflammatory CXCL12-CXCR4/CXCR7 signaling axis in an obesity-driven mouse model of HiMyc prostate cancer. Analysis of the stromal vascular fraction (SVF) from periprostatic white adipose tissue (ppWAT) from obese HiMyc mice at 6 months of age revealed a dramatic increase in mRNAs encoding various chemokines, cytokines, growth factors and angiogenesis mediators, with CXCL12 among the most significantly upregulated genes. Immunofluorescence staining of ventral prostate tissue from obese HiMyc mice revealed high levels of CXCL12 in the stromal compartment as well as high staining for CXCR4 and CXCR7 in the epithelial compartment of tumors. PCa cell lines derived from HiMyc tumors (HMVP2 and derivative cell lines) displayed increased protein expression of both CXCR4 and CXCR7 compared to protein lysates from a non-tumorigenic prostate epithelial cell line (NMVP cells). CXCL12 treatment stimulated migration and invasion of HMVP2 cells but not NMVP cells. These effects of CXCL12 on HMVP2 cells were inhibited by the CXCR4 antagonist AMD3100 as well as knockdown of either CXCR4 or CXCR7. CXCL12 treatment also produced rapid activation of STAT3, NFkB, and MAPK signaling in HMVP2 cells which was again attenuated by either AMD3100 or knockdown of CXCR4 or CXCR7. Collectively, these data suggest that CXCL12 secreted by stromal cells activates invasiveness of PCa cells and may play a role in driving tumor progression in obesity. Targeting the CXCL12-CXCR4/CXCR7 axis could lead to novel approaches for offsetting the effects of obesity on PCa progression.

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SOX5/6/21 prevent oncogene-driven transformation of brain stem cells

Molecular mechanisms preventing self-renewing brain stem cells from oncogenic transformation are poorly defined. We show that the expression levels of SOX5, SOX6 and SOX21 (SOX5/6/21) transcription factors increase in stem cells of the subventricular zone (SVZ) upon oncogenic stress, whereas their expression in human glioma decreases during malignant progression. Elevated levels of SOX5/6/21 promoted SVZ cells to exit the cell cycle, while genetic ablation of SOX5/6/21 dramatically increased the capacity of these cells to form glioma-like tumors in an oncogene-driven mouse brain tumor model. Loss-of-function experiments revealed that SOX5/6/21 prevent detrimental hyper proliferation of oncogene expressing SVZ cells by facilitating an anti-proliferative expression profile. Consistently, restoring high levels of SOX5/6/21 in human primary glioblastoma cells enabled expression of CDK inhibitors and decreased p53 protein turnover, which blocked their tumorgenic capacity through cellular senescence and apoptosis. Altogether, these results provide evidence that SOX5/6/21 play a central role in driving a tumor suppressor response in brain stem cells upon oncogenic insult.

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Post-transcriptional regulation of PARG mRNA by HuR facilitates DNA repair and resistance to PARP inhibitors

The majority of pancreatic ductal adenocarcinomas (PDA) rely on the mRNA stability factor HuR (ELAV-L1) to drive cancer growth and progression. Here we show that CRISPR-Cas9-mediated silencing of the HuR locus increases the relative sensitivity of PDA cells to PARP inhibitors (PARPi). PDA cells treated with PARPi stimulated translocation of HuR from the nucleus to the cytoplasm, specifically promoting stabilization of a new target, polyADP-ribose glycohydrolase (PARG) mRNA, by binding a unique sequence embedded in its 3′ untranslated region (UTR). HuR-dependent upregulation of PARG expression facilitated DNA repair via hydrolysis of polyADP-ribose on related repair proteins. Accordingly, strategies to inhibit HuR directly promoted DNA damage accumulation, inefficient PAR removal, and persistent PARP-1 residency on chromatin (PARP-1 trapping). Immunoprecipitation assays demonstrated that the PARP1 protein binds and post-translationally modifies HuR in PARPi-treated PDA cells. In a mouse xenograft model of human PDA, PARPi monotherapy combined with targeted silencing of HuR significantly reduced tumor growth compared to PARPi therapy alone. Our results highlight the HuR-PARG axis as an opportunity to enhance PARPi-based therapies.

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SOX5/6/21 prevent oncogene-driven transformation of brain stem cells

Molecular mechanisms preventing self-renewing brain stem cells from oncogenic transformation are poorly defined. We show that the expression levels of SOX5, SOX6 and SOX21 (SOX5/6/21) transcription factors increase in stem cells of the subventricular zone (SVZ) upon oncogenic stress, whereas their expression in human glioma decreases during malignant progression. Elevated levels of SOX5/6/21 promoted SVZ cells to exit the cell cycle, while genetic ablation of SOX5/6/21 dramatically increased the capacity of these cells to form glioma-like tumors in an oncogene-driven mouse brain tumor model. Loss-of-function experiments revealed that SOX5/6/21 prevent detrimental hyper proliferation of oncogene expressing SVZ cells by facilitating an anti-proliferative expression profile. Consistently, restoring high levels of SOX5/6/21 in human primary glioblastoma cells enabled expression of CDK inhibitors and decreased p53 protein turnover, which blocked their tumorgenic capacity through cellular senescence and apoptosis. Altogether, these results provide evidence that SOX5/6/21 play a central role in driving a tumor suppressor response in brain stem cells upon oncogenic insult.

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Failed Removal of Indwelling Urinary Catheters in Acute Stroke Patients: Incidence and Risk Factors

Reducing the incidence of indwelling urinary catheter (IUC) use and early removal of the devices that are inserted are appropriate priorities for quality patient care. Just like symptomatic bacteriuria, failed catheter removal as a complication of IUC use is associated with considerable morbidity. In the ideal setting, patients that need IUCs have them, and patients that do not need them will have them safely removed, with the goal of reducing medical complications and facilitating the rehabilitation phase of care.

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Nordic Walking for the management of people with Parkinson’s disease: a systematic review

It is well known that physical exercise is the main therapeutic element of rehabilitation programs for people with Parkinson's disease (PD). As traditional forms of exercise can guarantee significant health benefits, the emergence of non-conventional physical activities, such as Nordic walking (NW), may add positive effects.

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Erratum to: Do epinephrine auto-injectors have an unsuitable needle length in children and adolescents at risk for anaphylaxis from food allergy?

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Intraoperative endoscopic nasobiliary drainage over primary closure of the common bile duct for choledocholithiasis combined with cholecystolithiasis: a cohort study of 211 cases

Abstract

Background

Endoscopic nasobiliary drainage (ENBD) was often used for preoperative biliary drainage in cases like cholangiocarcinoma or acute obstructive suppurative cholangitis, reports on endoscopic nasobiliary drainage (ENBD) over primary closure of the common bile duct (CBD) are limited. This study compares outcomes of laparoscopic cholecystectomy (LC) + laparoscopic CBD exploration (LCBDE) + intraoperative ENBD + primary closure of CBD with equivalent patients who underwent preoperative endoscopic retrograde cholangiopancreatography (ERCP) and subsequent LC.

Methods

From January 2013 to December 2015, 829 consecutive patients with choledocholithiasis combined with cholecystolithiasis underwent surgery in our department. 211 patients underwent LC + LCBDE + intraoperative ENBD + primary closure of CBD (group A) and 117 preoperative ERCP + subsequent LC (group B). A total of 501 patients (355 who underwent T-tube drainage and 146 who underwent transcystic exploration) were excluded from the analysis. Clinical records, operative findings, and postoperative follow-up were analyzed.

Results

Age and sex distribution, comorbidity, presentations, CBD diameter, and size and number of stones were similar in the two groups, and there was no postoperative mortality. Duration of surgery in group A was shorter (83 vs. 104 min, P < 0.01), as was postoperative hospital stay (6 vs. 9 days, P < 0.01). Average operative expenditure in group A was less than that of group B ($ 3816 vs. $ 4015, P < 0.01). The success rate in group A was higher (100 vs. 91%, P < 0.01). Ten patients in group B converted to LCBDE. The postoperative complication rate was higher in group B but without significant difference (1.9 vs. 4.2%, P = 0.29). Median follow-up time was 24 (3–28) months (n = 302 patients). Two patients in group B reported residual stones.

Conclusion

LC + LCBDE + intraoperative ENBD + primary closure of CBD should have priority over preoperative ERCP + subsequent LC for choledocholithiasis combined with cholecystolithiasis.

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Erratum to: Do epinephrine auto-injectors have an unsuitable needle length in children and adolescents at risk for anaphylaxis from food allergy?

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Intraoperative endoscopic nasobiliary drainage over primary closure of the common bile duct for choledocholithiasis combined with cholecystolithiasis: a cohort study of 211 cases

Abstract

Background

Endoscopic nasobiliary drainage (ENBD) was often used for preoperative biliary drainage in cases like cholangiocarcinoma or acute obstructive suppurative cholangitis, reports on endoscopic nasobiliary drainage (ENBD) over primary closure of the common bile duct (CBD) are limited. This study compares outcomes of laparoscopic cholecystectomy (LC) + laparoscopic CBD exploration (LCBDE) + intraoperative ENBD + primary closure of CBD with equivalent patients who underwent preoperative endoscopic retrograde cholangiopancreatography (ERCP) and subsequent LC.

Methods

From January 2013 to December 2015, 829 consecutive patients with choledocholithiasis combined with cholecystolithiasis underwent surgery in our department. 211 patients underwent LC + LCBDE + intraoperative ENBD + primary closure of CBD (group A) and 117 preoperative ERCP + subsequent LC (group B). A total of 501 patients (355 who underwent T-tube drainage and 146 who underwent transcystic exploration) were excluded from the analysis. Clinical records, operative findings, and postoperative follow-up were analyzed.

Results

Age and sex distribution, comorbidity, presentations, CBD diameter, and size and number of stones were similar in the two groups, and there was no postoperative mortality. Duration of surgery in group A was shorter (83 vs. 104 min, P < 0.01), as was postoperative hospital stay (6 vs. 9 days, P < 0.01). Average operative expenditure in group A was less than that of group B ($ 3816 vs. $ 4015, P < 0.01). The success rate in group A was higher (100 vs. 91%, P < 0.01). Ten patients in group B converted to LCBDE. The postoperative complication rate was higher in group B but without significant difference (1.9 vs. 4.2%, P = 0.29). Median follow-up time was 24 (3–28) months (n = 302 patients). Two patients in group B reported residual stones.

Conclusion

LC + LCBDE + intraoperative ENBD + primary closure of CBD should have priority over preoperative ERCP + subsequent LC for choledocholithiasis combined with cholecystolithiasis.

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Pre-treatment Eckardt score is a simple factor for predicting one-year peroral endoscopic myotomy failure in patients with achalasia

Abstract

Background

Peroral endoscopic myotomy (POEM) is a novel treatment for achalasia with excellent outcomes. But the predictor for treatment failure is not well defined. This study was aimed to prospectively investigate the factors for predicting failed POEM.

Methods

From June 2011 to May 2015, a total of 115 achalasia patients treated by POEM were included for the retrospective cohort study from Nanfang Hospital and the First People’s Hospital of Yunnan Province. Patients were followed up with Eckardt score, high-resolution manometry and endoscope. POEM failure was defined as primary failure (Eckardt score failed to decrease to 3 or below) and recurrences (decrease of Eckardt score to 3 or below, then rise to more than 3) during one-year follow-up. Univariate and multivariate Cox regression analyses were performed to assess the predictive factor. For the associated factor, receiver operating characteristic curve (ROC) was utilized to determine the cutoff value of the predicting factor.

Results

The failure rate of POEM after 1 year was 7.0% (8/115), including 5 primary failure cases and 3 recurrences. Multivariate analysis showed higher pre-treatment Eckardt score was the single independent factor associated with POEM failure [9.5 (6–12) vs. 7 (2–12), odds ratio (OR) 2.24, 95 confidence interval (95% CI) 1.39–3.93, p = 0.001]. The cutoff value (Eckardt score ≥9) had 87.5 sensitivity (95% CI 47.3–99.7%) and 73.8% specificity (95% CI 64.4–81.9%) for predicting failed POEM.

Conclusions

Pre-treatment Eckardt score could be a predictive factor for failed POEM. Eckardt score ≥9 was associated with high sensitivity and specificity for predicting POEM failure.

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Reoperation for recurrent hepatolithiasis: laparotomy versus laparoscopy

Abstract

Background

Laparoscopy has been proposed for the management of recurrent hepatolithiasis, but no comparative study of its relative efficacy versus laparotomy has been performed, and the patient selection criteria for laparoscopy are not clear. This study aimed to investigate the therapeutic effect of laparoscopy versus laparotomy for repeated hepatolithiasis and to highlight how to select patients best suited for laparoscopy.

Methods

We performed a cohort study of 94 patients who underwent laparotomy or laparoscopy for recurrent hepatolithiasis between January 2010 and May 2014. The clinical data of 53 patients who underwent open biliary exploration (laparotomy group) and 41 patients who underwent laparoscopic biliary exploration (laparoscopy group) for recurrent hepatolithiasis were retrospectively analyzed and compared.

Results

Intestinal adhesions to the porta hepatis occurred in 62 (66%) patients. There was no difference in operating time between the two groups. In comparing the laparoscopic group versus the laparotomy group, the intraoperative blood loss was less (P = .001), the incidence of postoperative ascites (9.8 vs. 30.2%, P = .016) and/or pleural effusion (7.3 vs. 28.3%, P = .010) was lower, and the stone clearance rates were comparable. Wound morbidity appeared peculiarly in 15 (28.3%) patients among the laparotomy group. The postoperative hospital stay in the laparoscopy group was shorter than that in the laparotomy group (P = .000).

Conclusion

Laparoscopy is a safe and effective treatment for recurrent hepatolithiasis patients who are scheduled for bile duct exploration.

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Laparoendoscopic single-site retroperitoneoscopic adrenalectomy: bilateral step-by-step technique

Abstract

Background

Laparoscopic adrenalectomy is the gold standard surgical approach for small benign adrenal tumors [1]. Several surgical approaches were developed in order to overcome the difficulty to access the adrenal glands, located in the upper retroperitoneum space [2–4]. Laparoendoscopic single-site posterior retroperitoneoscopic adrenalectomy (LESS-PRA) is an emerging technique that reduced the multiple trocar-related trauma and improved cosmetic outcomes while minimizing postoperative morbidity [5–8]. The aim of this study was to describe our step-by-step technique for LESS-PRA and to compare our perioperative outcomes with the conventional 3-port lateral retroperitoneoscopic adrenalectomy (LRA).

Methods

A retrospective review was carried out from February 2008 to January 2016 that included 100 patients with adrenal tumors smaller than 4 cm. Study exclusion criteria were defined as tumor size greater than 4 cm, patients older than 80 years, and body mass index (BMI) greater than 40. A total of 20 patients underwent LESS-PRA and 80 patients underwent 3-port lateral retroperitoneoscopic laparoscopic adrenalectomy. Patient’s demographic data and perioperative outcomes were compared and statistically analyzed. The cosmetic satisfaction was evaluated with a visual analog scale.

Results

Estimated blood loss was higher in LRA (100 vs. 50 ml; p = 0.35). Operative time was longer in LESS-PRA than LRA (100.0 vs. 60 min; p < 0.001). Analgesic time necessary for LRA was longer than LESS-PRA (40 vs. 24 h; p < 0.001). Cosmetic satisfaction score was higher in LESS-PRA (9.5 vs. 8.6; p = 0.03). There were no significant differences in perioperative complications and length of hospital stay. No conversion to conventional laparoscopic or open surgery was necessary.

Conclusion

LESS-PRA presented comparable functional and perioperative outcomes to LRA for small adrenal tumors. Although LESS-PRA was associated with longer operative time, it provided inferior estimated blood loss, analgesic time, and improved cosmetic satisfaction.

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Indocyanine green fluorescence-navigated robotic segmentectomy

Abstract

Background

Pulmonary segmentectomy with radical lymphadenopathy has been considered effective to manage small primary lung cancers [1, 2]. This procedure provides the advantages of minimal invasive surgery and is reported sufficient for safe margin. However, segmentectomy is more difficult to be performed than lobectomy because intersegmental plane cannot be detected easily. Several methods have been reported for identifying the actual intersegmental plane [3–7], but the sensitivity of these methods is limited to the lung conditions like patients with emphysematous lung and needed skilled surgeon to perform. We demonstrated the technique of visualizing the intersegmental plane via fluorescence navigated with indocyanine green (ICG) injection intravenously during robotic S6 segmentectomy.

Methods

This video presents a case that 70-year-old male who has past history of rectal cancer status post-LAR in 1991, HCC status post-RFA, and hepatitis C was found a lung nodule over superior segment of left lower lobe during regular examination. The nodule was considered metastatic tumor preoperatively. The segmental pulmonary artery and pulmonary bronchus to superior segment of left lower lobe were ligated firstly, and the intersegmental plane was seen clearly after ICG injection intravenously under fluorescence navigated. Intersegmental plane was marked by electrocautery, and then, the target segment was resected by endostapler.

Results

Patient tolerated the procedure well. Chest tube was removed by postoperative day 3, and he was discharged smoothly by postoperative day 5. There were no complications. Postoperative chest X-ray revealed good lung expansion. Not as preoperative expectation, the final pathology was consistent with caseating granulomatous inflammation.

Conclusion

It is difficult to identify intersegmental plane during segmentectomy. ICG fluorescence-navigated segmentectomy provides immediate visualization of the intersegmental plane and makes the procedure easy and fast.

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Intraoperative endoscopic nasobiliary drainage over primary closure of the common bile duct for choledocholithiasis combined with cholecystolithiasis: a cohort study of 211 cases

Abstract

Background

Endoscopic nasobiliary drainage (ENBD) was often used for preoperative biliary drainage in cases like cholangiocarcinoma or acute obstructive suppurative cholangitis, reports on endoscopic nasobiliary drainage (ENBD) over primary closure of the common bile duct (CBD) are limited. This study compares outcomes of laparoscopic cholecystectomy (LC) + laparoscopic CBD exploration (LCBDE) + intraoperative ENBD + primary closure of CBD with equivalent patients who underwent preoperative endoscopic retrograde cholangiopancreatography (ERCP) and subsequent LC.

Methods

From January 2013 to December 2015, 829 consecutive patients with choledocholithiasis combined with cholecystolithiasis underwent surgery in our department. 211 patients underwent LC + LCBDE + intraoperative ENBD + primary closure of CBD (group A) and 117 preoperative ERCP + subsequent LC (group B). A total of 501 patients (355 who underwent T-tube drainage and 146 who underwent transcystic exploration) were excluded from the analysis. Clinical records, operative findings, and postoperative follow-up were analyzed.

Results

Age and sex distribution, comorbidity, presentations, CBD diameter, and size and number of stones were similar in the two groups, and there was no postoperative mortality. Duration of surgery in group A was shorter (83 vs. 104 min, P < 0.01), as was postoperative hospital stay (6 vs. 9 days, P < 0.01). Average operative expenditure in group A was less than that of group B ($ 3816 vs. $ 4015, P < 0.01). The success rate in group A was higher (100 vs. 91%, P < 0.01). Ten patients in group B converted to LCBDE. The postoperative complication rate was higher in group B but without significant difference (1.9 vs. 4.2%, P = 0.29). Median follow-up time was 24 (3–28) months (n = 302 patients). Two patients in group B reported residual stones.

Conclusion

LC + LCBDE + intraoperative ENBD + primary closure of CBD should have priority over preoperative ERCP + subsequent LC for choledocholithiasis combined with cholecystolithiasis.

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Reoperation for recurrent hepatolithiasis: laparotomy versus laparoscopy

Abstract

Background

Laparoscopy has been proposed for the management of recurrent hepatolithiasis, but no comparative study of its relative efficacy versus laparotomy has been performed, and the patient selection criteria for laparoscopy are not clear. This study aimed to investigate the therapeutic effect of laparoscopy versus laparotomy for repeated hepatolithiasis and to highlight how to select patients best suited for laparoscopy.

Methods

We performed a cohort study of 94 patients who underwent laparotomy or laparoscopy for recurrent hepatolithiasis between January 2010 and May 2014. The clinical data of 53 patients who underwent open biliary exploration (laparotomy group) and 41 patients who underwent laparoscopic biliary exploration (laparoscopy group) for recurrent hepatolithiasis were retrospectively analyzed and compared.

Results

Intestinal adhesions to the porta hepatis occurred in 62 (66%) patients. There was no difference in operating time between the two groups. In comparing the laparoscopic group versus the laparotomy group, the intraoperative blood loss was less (P = .001), the incidence of postoperative ascites (9.8 vs. 30.2%, P = .016) and/or pleural effusion (7.3 vs. 28.3%, P = .010) was lower, and the stone clearance rates were comparable. Wound morbidity appeared peculiarly in 15 (28.3%) patients among the laparotomy group. The postoperative hospital stay in the laparoscopy group was shorter than that in the laparotomy group (P = .000).

Conclusion

Laparoscopy is a safe and effective treatment for recurrent hepatolithiasis patients who are scheduled for bile duct exploration.

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Laparoendoscopic single-site retroperitoneoscopic adrenalectomy: bilateral step-by-step technique

Abstract

Background

Laparoscopic adrenalectomy is the gold standard surgical approach for small benign adrenal tumors [1]. Several surgical approaches were developed in order to overcome the difficulty to access the adrenal glands, located in the upper retroperitoneum space [2–4]. Laparoendoscopic single-site posterior retroperitoneoscopic adrenalectomy (LESS-PRA) is an emerging technique that reduced the multiple trocar-related trauma and improved cosmetic outcomes while minimizing postoperative morbidity [5–8]. The aim of this study was to describe our step-by-step technique for LESS-PRA and to compare our perioperative outcomes with the conventional 3-port lateral retroperitoneoscopic adrenalectomy (LRA).

Methods

A retrospective review was carried out from February 2008 to January 2016 that included 100 patients with adrenal tumors smaller than 4 cm. Study exclusion criteria were defined as tumor size greater than 4 cm, patients older than 80 years, and body mass index (BMI) greater than 40. A total of 20 patients underwent LESS-PRA and 80 patients underwent 3-port lateral retroperitoneoscopic laparoscopic adrenalectomy. Patient's demographic data and perioperative outcomes were compared and statistically analyzed. The cosmetic satisfaction was evaluated with a visual analog scale.

Results

Estimated blood loss was higher in LRA (100 vs. 50 ml; p = 0.35). Operative time was longer in LESS-PRA than LRA (100.0 vs. 60 min; p < 0.001). Analgesic time necessary for LRA was longer than LESS-PRA (40 vs. 24 h; p < 0.001). Cosmetic satisfaction score was higher in LESS-PRA (9.5 vs. 8.6; p = 0.03). There were no significant differences in perioperative complications and length of hospital stay. No conversion to conventional laparoscopic or open surgery was necessary.

Conclusion

LESS-PRA presented comparable functional and perioperative outcomes to LRA for small adrenal tumors. Although LESS-PRA was associated with longer operative time, it provided inferior estimated blood loss, analgesic time, and improved cosmetic satisfaction.

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Robotic cholecystectomy using Revo-i Model MSR-5000, the newly developed Korean robotic surgical system: a preclinical study

Abstract

Background

Laparoscopic surgery has become the standard option for gastrointestinal surgeries. However, laparoscopic procedures require extended training times and are difficult for inexperienced surgeons. Robot-assisted laparoscopic surgery facilitates easy adaptation of laparoscopic procedures, but robotic surgical systems are expensive. In addition, their cost has remained high because there is currently only one manufacturer of commercially available systems. Recently, a new Korean robotic surgical system, Revo-i, has been developed. The aim of this study was to evaluate the feasibility and safety of Revo-i by performing robotic cholecystectomy in a porcine model.

Methods

After approval by the Institutional Animal Care and Use Committee of Yonsei University Health System, cholecystectomy was performed in four pigs using the Revo-i robotic surgical system. Operative time and perioperative complications were recorded, and all animals were observed for postoperative complications for 2 weeks after surgery

Results

Robotic cholecystectomy was completed successfully and without gallbladder perforation in all cases. The mean operative time was 78 ± 12 min, the mean docking time was 4.5 ± 2.52 min, and the mean console time was 49.8 ± 14.17 min. There were no perioperative complications, and none of the animal used for the in vivo models exhibited abnormal behavior during the postoperative observation period.

Conclusions

These preliminary results verify the safety and efficacy of robotic cholecystectomy using the Revo-i robotic surgical system. Human trials are slated to begin accordingly.

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SAGES quality initiative: an introduction

Abstract

The Medicare program has transitioned to paying healthcare providers based on the quality of care delivered, not on the quantity. In May 2015, SAGES held its first ever Quality Summit. The goal of this meeting was to provide us with the information necessary to put together a strategic plan for our Society over the next 3–5 years, and to participate actively on a national level to help develop valid measures of quality of surgery. The transition to value-based medicine requires that providers are now measured and reimbursed based on the quality of services they provide rather than the quantity of patients in their care. As of 2014, quality measures must cover 3 of the 6 available National Quality domains. Physician quality reporting system measures are created via a vigorous process which is initiated by the proposal of the quality measure and subsequent validation. Commercial, non-profit, and governmental agencies have now been engaged in the measurement of hospital performance through structural measures, process measures, and increasingly with outcomes measures. This more recent focus on outcomes measures have been linked to hospital payments through the Value-Based Purchasing program. Outcomes measures of quality drive CMS' new program, MACRA, using two formats: Merit-based incentive programs and alternative payment models. But, the quality of information now available is highly variable and difficult for the average consumer to use. Quality metrics serve to guide efforts to improve performance and for consumer education. Professional organizations such as SAGES play a central role in defining the agenda for improving quality, outcomes, and safety. The mission of SAGES is to improve the quality of patient care through education, research, innovation, and leadership, principally in gastrointestinal and endoscopic surgery.

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A cable-driven soft robot surgical system for cardiothoracic endoscopic surgery: preclinical tests in animals

Abstract

Background

Minimally invasive surgery attracts more and more attention because of the advantages of minimal trauma, less bleeding and pain and low complication rate. However, minimally invasive surgery for beating hearts is still a challenge. Our goal is to develop a soft robot surgical system for single-port minimally invasive surgery on a beating heart.

Materials and methods

The soft robot described in this paper is inspired by the octopus arm. Although the octopus arm is soft and has more degrees of freedom (DOFs), it can be controlled flexibly. The soft robot is driven by cables that are embedded into the soft robot manipulator and can control the direction of the end and middle of the soft robot manipulator. The forward, backward and rotation movement of the soft robot is driven by a propulsion plant. The soft robot can move freely by properly controlling the cables and the propulsion plant. The soft surgical robot system can perform different thoracic operations by changing surgical instruments. To evaluate the flexibility, controllability and reachability of the designed soft robot surgical system, some testing experiments have been conducted in vivo on a swine.

Results

Through the subxiphoid, the soft robot manipulator could enter into the thoracic cavity and pericardial cavity smoothly and perform some operations such as biopsy, ligation and ablation. The operations were performed successfully and did not cause any damage to the surrounding soft tissues. From the experiments, the flexibility, controllability and reachability of the soft robot surgical system have been verified. Also, it has been shown that this system can be used in the thoracic and pericardial cavity for different operations.

Conclusions

Compared with other endoscopy robots, the soft robot surgical system is safer, has more DOFs and is more flexible for control. When performing operations in a beating heart, this system maybe more suitable than traditional endoscopy robots.

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Laparoscopic antireflux surgery increases health-related quality of life in children with GERD

Abstract

Introduction

Improving health-related quality of life (HRQoL) is increasingly recognized as an essential part of patient care outcome. Little is known about the effect of laparoscopic antireflux surgery (LARS) on the HRQoL in the pediatric patients. The aims of this study were to evaluate the effect of LARS on HRQoL in children with gastroesophageal reflux disease (GERD) and to identify predictors that influence HRQoL outcome after LARS.

Methods

Between 2011 and 2013, 25 patients with therapy-resistant GERD [median age 6 (2–18) years] were included prospectively. Caregivers and children with normal neurodevelopment (>4 years) were asked to fill out the validated PedsQL 4.0 Generic Core Scales before and 3–4 months after LARS.

Results

The PedsQL was completed by all caregivers (n = 25) and 12 children. HRQoL total score improved significantly after LARS, both from a parental (p = 0.009) and child's perspective (p = 0.018). The psychosocial health summary and physical health summary scores also improved significantly after LARS. HRQoL before and after LARS was significantly lower in children with impaired neurodevelopment (p < 0.001). However, neurodevelopment did not influence the effect of LARS on HRQoL. The only significant predictor for improvement in HRQoL after LARS was age at the time of operation (p = 0.001).

Conclusions

HRQoL significantly improves after LARS. Although children with impaired neurodevelopment had lower overall HRQoL, neurodevelopment by itself does not predict inferior improvement in HRQoL after LARS. Older children have a more favorable HRQoL outcome after LARS compared to younger children. This may suggest caution when considering LARS in younger GERD patients.

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Single-incision laparoscopic surgery increases the risk of unintentional thermal injury from the monopolar “Bovie” instrument in comparison with traditional laparoscopy

Abstract

Background

Single-incision laparoscopic surgery (SILS) places multiple instruments in close, parallel proximity, an orientation that may have implications in the production of stray current from the monopolar "Bovie" instrument. The purpose of this study was to compare the energy transferred during SILS compared to traditional four-port laparoscopic surgery (TRD).

Method

In a laparoscopic simulator, instruments were inserted via SILS or TRD setup. The monopolar generator delivered energy to a laparoscopic L-hook instrument for 5-s activations on 30-Watts coag mode. The primary outcome (stray current) was quantified by measuring the heat of liver tissue held adjacent to the non-electrically active 10-mm telescope tip and Maryland grasper in both the SILS and TRD setups. To control for the potential confounder of stray energy coupling via wires outside the surgical field, the camera cord and active electrode wires were oriented parallel or completely separated.

Results

SILS and TRD setups create similar amounts of stray current as measured by increased tissue temperature at the non-electrically active telescope tip (41 ± 12 vs. 39 ± 10 °C; p = 0.71). Stray current was greater in SILS compared to TRD at the tip of the non-electrically active Maryland forceps (38 ± 9 vs. 20 ± 10 °C; p < 0.01). Separation of the active electrode and camera cords did not change the amount of stray energy in the SILS orientation for either telescope (39 ± 10 °C bundled vs. 36 ± 10 °C separated; p = 0.40) or grasper (38 ± 9 °C bundled vs. 34 ± 11 °C separated; p = 0.19) but did in the TRD orientation (41 ± 12 bundled vs. 24 ± 10 separated; p < 0.01). When SILS was compared to TRD with the cords separated, SILS increased stray energy at both the telescope tip and grasper tip (36 ± 10 vs. 24 ± 10 °C; p < 0.01 and 34 ± 11 vs. 17 ± 8 °C; p < 0.01).

Conclusion

SILS increases stray energy transfer nearly twice as much as TRD with the use of the monopolar instrument. Strategies to mitigate the amount of stray energy in the TRD setup such as separation of the active electrode and camera cords are not effective in the SILS setup. These practical findings should enhance surgeons using the SILS approach of increased stray energy that could result in injury.

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Tritium forms discrimination in ryegrass under constant tritium exposure: From seed germination to seedling autotrophy

Publication date: October 2017
Source:Journal of Environmental Radioactivity, Volume 177
Author(s): H. Renard, D. Maro, S. Le Dizès, A. Escobar-Gutiérrez, C. Voiseux, L. Solier, D. Hébert, M. Rozet, C. Cossonnet, R. Barillot
Uncertainties remain regarding the fate of atmospheric tritium after it has been assimilated in grasslands (ryegrass) in the form of TFWT (Tissue Free Water Tritium) or OBT (Organically Bound Tritium). One such uncertainty relates to the tritium forms discrimination during transfer from TFWT to OBT resulting from photosynthesis (OBTphoto), corresponding to the OBTphoto/TFWT ratio. In this study, the OBT/TFWT ratio is determined by experiments in the laboratory using a ryegrass model and hydroponic cultures, with constant activity of tritium in the form of tritiated water (denoted as HTO) in the "water" compartment (liquid HTO) and "air" compartment (HTO vapour in the air). The OBTphoto/TFWT ratio and the exchangeable OBT fraction are measured for three parts of the plant: the leaf, seed and root. Plant growth is modelled using dehydrated biomass measurements taken over time in the laboratory and integrating physiological functions of the plant during the first ten days after germination. The results suggest that there is no measurable discrimination of tritium in the plant organic matter produced by photosynthesis.



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Intraoperative near-infrared autofluorescence imaging of parathyroid glands

Abstract

Objective

To identify parathyroid glands intraoperatively by exposing their autofluorescence using near-infrared light.

Methods

Fluorescence imaging was carried out during minimally invasive and open parathyroid and thyroid surgery. After identification, the parathyroid glands as well as the surrounding tissue were exposed to near-infrared (NIR) light with a wavelength of 690–770 nm using a modified Karl Storz near-infrared/indocyanine green (NIR/ICG) endoscopic system. Parathyroid tissue was expected to show near-infrared autofluorescence, captured in the blue channel of the camera. Whenever possible the visual identification of parathyroid tissue was confirmed histologically.

Results

In preliminary investigations, using the original NIR/ICG endoscopic system we noticed considerable interference of light in the blue channel overlying the autofluorescence. Therefore, we modified the light source by interposing additional filters. In a second series, we investigated 35 parathyroid glands from 25 patients. Twenty-seven glands were identified correctly based on NIR autofluorescence. Regarding the extent of autofluorescence, there were no noticeable differences between parathyroid adenomas, hyperplasia and normal parathyroid glands. In contrast, thyroid tissue, lymph nodes and adipose tissue revealed no substantial autofluorescence.

Conclusion

Parathyroid tissue is characterized by showing autofluorescence in the near-infrared spectrum. This effect can be used to distinguish parathyroid glands from other cervical tissue entities.

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A cable-driven soft robot surgical system for cardiothoracic endoscopic surgery: preclinical tests in animals

Abstract

Background

Minimally invasive surgery attracts more and more attention because of the advantages of minimal trauma, less bleeding and pain and low complication rate. However, minimally invasive surgery for beating hearts is still a challenge. Our goal is to develop a soft robot surgical system for single-port minimally invasive surgery on a beating heart.

Materials and methods

The soft robot described in this paper is inspired by the octopus arm. Although the octopus arm is soft and has more degrees of freedom (DOFs), it can be controlled flexibly. The soft robot is driven by cables that are embedded into the soft robot manipulator and can control the direction of the end and middle of the soft robot manipulator. The forward, backward and rotation movement of the soft robot is driven by a propulsion plant. The soft robot can move freely by properly controlling the cables and the propulsion plant. The soft surgical robot system can perform different thoracic operations by changing surgical instruments. To evaluate the flexibility, controllability and reachability of the designed soft robot surgical system, some testing experiments have been conducted in vivo on a swine.

Results

Through the subxiphoid, the soft robot manipulator could enter into the thoracic cavity and pericardial cavity smoothly and perform some operations such as biopsy, ligation and ablation. The operations were performed successfully and did not cause any damage to the surrounding soft tissues. From the experiments, the flexibility, controllability and reachability of the soft robot surgical system have been verified. Also, it has been shown that this system can be used in the thoracic and pericardial cavity for different operations.

Conclusions

Compared with other endoscopy robots, the soft robot surgical system is safer, has more DOFs and is more flexible for control. When performing operations in a beating heart, this system maybe more suitable than traditional endoscopy robots.

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Endoscope-assisted extracapsular dissection of benign parotid tumors through a single cephaloauricular furrow incision versus a conventional approach

Abstract

Background

A few modified approaches have been reported for performing endoscope-assisted dissections of benign parotid tumors, but none that use incisions totally hidden in a natural furrow. This study evaluated the feasibility of performing endoscope-assisted extracapsular dissections of benign parotid tumors using a single cephaloauricular furrow incision.

Methods

Forty-six patients with benign parotid superficial lobe tumors were randomly divided into two groups: an endoscope-assisted (21 patients) group or a conventional (25 patients) surgery group. Perioperative and postoperative outcomes of the patients were evaluated, including the maximum diameter of the tumors, length of the incision, operating time, estimated blood loss during the operation, amount and duration of drainage, satisfaction scores based on the cosmetic results, perioperative complications, and follow-up information.

Results

The diameters of the tumors were comparable between the groups, and all operations were successfully performed as planned. The mean length of the incision in the endoscope-assisted group (3.6 ± 0.5 cm) was significantly shorter than that in the conventional group (9.1 ± 1.9). Meanwhile, the intraoperative blood loss, amount of drainage, perioperative complications, and cosmetic outcomes were all improved in the endoscope-assisted group. No tumor recurrence was found during 11–40 months of follow-up.

Conclusions

Cephaloauricular furrow incisions were totally and naturally hidden in this procedure. Endoscope-assisted extracapsular dissections of benign parotid tumors via a small cephaloauricular furrow incision were found to be feasible and reliable, providing a minimally invasive approach and a satisfactory appearance.

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Hands-on 2.0: improving transfer of training via the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) Acquisition of Data for Outcomes and Procedure Transfer (ADOPT) program

Abstract

Background

Practicing surgeons commonly learn new procedures and techniques by attending a “hands-on” course, though trainings are often ineffective at promoting subsequent procedure adoption in practice. We describe implementation of a new program with the SAGES All Things Hernia Hands-On Course, Acquisition of Data for Outcomes and Procedure Transfer (ADOPT), which employs standardized, proven teaching techniques, and 1-year mentorship. Attendee confidence and procedure adoption are compared between standard and ADOPT programs.

Methods

For the pilot ADOPT course implementation, a hands-on course focusing on abdominal wall hernia repair was chosen. ADOPT participants were recruited among enrollees for the standard Hands-On Hernia Course. Enrollment in ADOPT was capped at 10 participants and limited to a 2:1 student-to-faculty ratio, compared to the standard course 22 participants with a 4:1 student-to-faculty ratio. ADOPT mentors interacted with participants through webinars, phone conferences, and continuous email availability throughout the year. All participants were asked to provide pre- and post-course surveys inquiring about the number of targeted hernia procedures performed and related confidence level.

Results

Four of 10 ADOPT participants (40%) and six of 22 standard training participants (27%) returned questionnaires. Over the 3 months following the course, ADOPT participants performed more ventral hernia mesh insertion procedures than standard training participants (median 13 vs. 0.5, p = 0.010) and considerably more total combined procedures (median 26 vs. 7, p = 0.054). Compared to standard training, learners who participated in ADOPT reported greater confidence improvements in employing a components separation via an open approach (p = 0.051), and performing an open transversus abdominis release, though the difference did not achieve statistical significance (p = 0.14).

Discussion

These results suggest that the ADOPT program, with standardized and structured teaching, telementoring, and a longitudinal educational approach, is effective and leads to better transfer of learned skills and procedures to clinical practice.

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Robotic cholecystectomy using Revo-i Model MSR-5000, the newly developed Korean robotic surgical system: a preclinical study

Abstract

Background

Laparoscopic surgery has become the standard option for gastrointestinal surgeries. However, laparoscopic procedures require extended training times and are difficult for inexperienced surgeons. Robot-assisted laparoscopic surgery facilitates easy adaptation of laparoscopic procedures, but robotic surgical systems are expensive. In addition, their cost has remained high because there is currently only one manufacturer of commercially available systems. Recently, a new Korean robotic surgical system, Revo-i, has been developed. The aim of this study was to evaluate the feasibility and safety of Revo-i by performing robotic cholecystectomy in a porcine model.

Methods

After approval by the Institutional Animal Care and Use Committee of Yonsei University Health System, cholecystectomy was performed in four pigs using the Revo-i robotic surgical system. Operative time and perioperative complications were recorded, and all animals were observed for postoperative complications for 2 weeks after surgery

Results

Robotic cholecystectomy was completed successfully and without gallbladder perforation in all cases. The mean operative time was 78 ± 12 min, the mean docking time was 4.5 ± 2.52 min, and the mean console time was 49.8 ± 14.17 min. There were no perioperative complications, and none of the animal used for the in vivo models exhibited abnormal behavior during the postoperative observation period.

Conclusions

These preliminary results verify the safety and efficacy of robotic cholecystectomy using the Revo-i robotic surgical system. Human trials are slated to begin accordingly.

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SAGES quality initiative: an introduction

Abstract

The Medicare program has transitioned to paying healthcare providers based on the quality of care delivered, not on the quantity. In May 2015, SAGES held its first ever Quality Summit. The goal of this meeting was to provide us with the information necessary to put together a strategic plan for our Society over the next 3–5 years, and to participate actively on a national level to help develop valid measures of quality of surgery. The transition to value-based medicine requires that providers are now measured and reimbursed based on the quality of services they provide rather than the quantity of patients in their care. As of 2014, quality measures must cover 3 of the 6 available National Quality domains. Physician quality reporting system measures are created via a vigorous process which is initiated by the proposal of the quality measure and subsequent validation. Commercial, non-profit, and governmental agencies have now been engaged in the measurement of hospital performance through structural measures, process measures, and increasingly with outcomes measures. This more recent focus on outcomes measures have been linked to hospital payments through the Value-Based Purchasing program. Outcomes measures of quality drive CMS’ new program, MACRA, using two formats: Merit-based incentive programs and alternative payment models. But, the quality of information now available is highly variable and difficult for the average consumer to use. Quality metrics serve to guide efforts to improve performance and for consumer education. Professional organizations such as SAGES play a central role in defining the agenda for improving quality, outcomes, and safety. The mission of SAGES is to improve the quality of patient care through education, research, innovation, and leadership, principally in gastrointestinal and endoscopic surgery.

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A cable-driven soft robot surgical system for cardiothoracic endoscopic surgery: preclinical tests in animals

Abstract

Background

Minimally invasive surgery attracts more and more attention because of the advantages of minimal trauma, less bleeding and pain and low complication rate. However, minimally invasive surgery for beating hearts is still a challenge. Our goal is to develop a soft robot surgical system for single-port minimally invasive surgery on a beating heart.

Materials and methods

The soft robot described in this paper is inspired by the octopus arm. Although the octopus arm is soft and has more degrees of freedom (DOFs), it can be controlled flexibly. The soft robot is driven by cables that are embedded into the soft robot manipulator and can control the direction of the end and middle of the soft robot manipulator. The forward, backward and rotation movement of the soft robot is driven by a propulsion plant. The soft robot can move freely by properly controlling the cables and the propulsion plant. The soft surgical robot system can perform different thoracic operations by changing surgical instruments. To evaluate the flexibility, controllability and reachability of the designed soft robot surgical system, some testing experiments have been conducted in vivo on a swine.

Results

Through the subxiphoid, the soft robot manipulator could enter into the thoracic cavity and pericardial cavity smoothly and perform some operations such as biopsy, ligation and ablation. The operations were performed successfully and did not cause any damage to the surrounding soft tissues. From the experiments, the flexibility, controllability and reachability of the soft robot surgical system have been verified. Also, it has been shown that this system can be used in the thoracic and pericardial cavity for different operations.

Conclusions

Compared with other endoscopy robots, the soft robot surgical system is safer, has more DOFs and is more flexible for control. When performing operations in a beating heart, this system maybe more suitable than traditional endoscopy robots.

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Laparoscopic antireflux surgery increases health-related quality of life in children with GERD

Abstract

Introduction

Improving health-related quality of life (HRQoL) is increasingly recognized as an essential part of patient care outcome. Little is known about the effect of laparoscopic antireflux surgery (LARS) on the HRQoL in the pediatric patients. The aims of this study were to evaluate the effect of LARS on HRQoL in children with gastroesophageal reflux disease (GERD) and to identify predictors that influence HRQoL outcome after LARS.

Methods

Between 2011 and 2013, 25 patients with therapy-resistant GERD [median age 6 (2–18) years] were included prospectively. Caregivers and children with normal neurodevelopment (>4 years) were asked to fill out the validated PedsQL 4.0 Generic Core Scales before and 3–4 months after LARS.

Results

The PedsQL was completed by all caregivers (n = 25) and 12 children. HRQoL total score improved significantly after LARS, both from a parental (p = 0.009) and child’s perspective (p = 0.018). The psychosocial health summary and physical health summary scores also improved significantly after LARS. HRQoL before and after LARS was significantly lower in children with impaired neurodevelopment (p < 0.001). However, neurodevelopment did not influence the effect of LARS on HRQoL. The only significant predictor for improvement in HRQoL after LARS was age at the time of operation (p = 0.001).

Conclusions

HRQoL significantly improves after LARS. Although children with impaired neurodevelopment had lower overall HRQoL, neurodevelopment by itself does not predict inferior improvement in HRQoL after LARS. Older children have a more favorable HRQoL outcome after LARS compared to younger children. This may suggest caution when considering LARS in younger GERD patients.

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Endoscope-assisted extracapsular dissection of benign parotid tumors through a single cephaloauricular furrow incision versus a conventional approach

Abstract

Background

A few modified approaches have been reported for performing endoscope-assisted dissections of benign parotid tumors, but none that use incisions totally hidden in a natural furrow. This study evaluated the feasibility of performing endoscope-assisted extracapsular dissections of benign parotid tumors using a single cephaloauricular furrow incision.

Methods

Forty-six patients with benign parotid superficial lobe tumors were randomly divided into two groups: an endoscope-assisted (21 patients) group or a conventional (25 patients) surgery group. Perioperative and postoperative outcomes of the patients were evaluated, including the maximum diameter of the tumors, length of the incision, operating time, estimated blood loss during the operation, amount and duration of drainage, satisfaction scores based on the cosmetic results, perioperative complications, and follow-up information.

Results

The diameters of the tumors were comparable between the groups, and all operations were successfully performed as planned. The mean length of the incision in the endoscope-assisted group (3.6 ± 0.5 cm) was significantly shorter than that in the conventional group (9.1 ± 1.9). Meanwhile, the intraoperative blood loss, amount of drainage, perioperative complications, and cosmetic outcomes were all improved in the endoscope-assisted group. No tumor recurrence was found during 11–40 months of follow-up.

Conclusions

Cephaloauricular furrow incisions were totally and naturally hidden in this procedure. Endoscope-assisted extracapsular dissections of benign parotid tumors via a small cephaloauricular furrow incision were found to be feasible and reliable, providing a minimally invasive approach and a satisfactory appearance.

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Laparoscopic antireflux surgery increases health-related quality of life in children with GERD

Abstract

Introduction

Improving health-related quality of life (HRQoL) is increasingly recognized as an essential part of patient care outcome. Little is known about the effect of laparoscopic antireflux surgery (LARS) on the HRQoL in the pediatric patients. The aims of this study were to evaluate the effect of LARS on HRQoL in children with gastroesophageal reflux disease (GERD) and to identify predictors that influence HRQoL outcome after LARS.

Methods

Between 2011 and 2013, 25 patients with therapy-resistant GERD [median age 6 (2–18) years] were included prospectively. Caregivers and children with normal neurodevelopment (>4 years) were asked to fill out the validated PedsQL 4.0 Generic Core Scales before and 3–4 months after LARS.

Results

The PedsQL was completed by all caregivers (n = 25) and 12 children. HRQoL total score improved significantly after LARS, both from a parental (p = 0.009) and child’s perspective (p = 0.018). The psychosocial health summary and physical health summary scores also improved significantly after LARS. HRQoL before and after LARS was significantly lower in children with impaired neurodevelopment (p < 0.001). However, neurodevelopment did not influence the effect of LARS on HRQoL. The only significant predictor for improvement in HRQoL after LARS was age at the time of operation (p = 0.001).

Conclusions

HRQoL significantly improves after LARS. Although children with impaired neurodevelopment had lower overall HRQoL, neurodevelopment by itself does not predict inferior improvement in HRQoL after LARS. Older children have a more favorable HRQoL outcome after LARS compared to younger children. This may suggest caution when considering LARS in younger GERD patients.

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Robot-assisted laparoscopic colpectomy in female-to-male transgender patients; technique and outcomes of a prospective cohort study

Abstract

Background

Gender-affirming surgeries in female-to-male (FtM) transgender patients include mostly hysterectomy, bilateral salpingo-oophorectomy and mastectomy. Sometimes further surgery is performed, such as phalloplasty. Colpectomy may be performed to overcome gender dysphoria and disturbing vaginal discharge; furthermore, it may be important in reducing the risk of fistulas due to the phalloplasty procedure with urethral elongation. Colpectomy prior to the reconstruction of the neourethra seems to reduce fistula rates on the very first anastomosis. Therefore, at our center, colpectomy has become a standard procedure prior to phalloplasty and metoidioplasty with urethral elongation. Colpectomy is known as a procedure with potentially serious complications, e.g., extensive bloodloss, vesicovaginal fistula or rectovaginal fistula. Colpectomy performed via the vaginal route can be a challenging procedure due to lack of exposure of the surgical field, as many patients are virginal. Therefore, we investigated whether robot-assisted laparoscopic hysterectomy with bilateral salpingo-oophorectomy (TLH–BSO) followed by robot-assisted laparoscopic colpectomy (RaLC) is an alternative for the vaginal approach.

Methods

Robot TLH/BSO and RaLC as a single-step procedure was performed in 36 FtM patients in a prospective cohort study.

Results

Median length of the procedure was 230 min (197–278), which reduced in the second half of the patients, median blood loss was 75 mL (30–200), and median discharge was 3 days (2–3) postoperatively. One patient with a major complication (postoperative bleeding with readmission and transfusion) was reported.

Conclusion

To our knowledge, this is the first report of RaLC. Our results show that RaLC combined with robot TLH–BSO is feasible as a single-step surgical procedure in FtM transgender surgery. Future studies are needed to compare this technique to the two-step surgical approach and on its outcome and complication rates of subsequent phalloplasty.

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Single-incision laparoscopic surgery increases the risk of unintentional thermal injury from the monopolar “Bovie” instrument in comparison with traditional laparoscopy

Abstract

Background

Single-incision laparoscopic surgery (SILS) places multiple instruments in close, parallel proximity, an orientation that may have implications in the production of stray current from the monopolar “Bovie” instrument. The purpose of this study was to compare the energy transferred during SILS compared to traditional four-port laparoscopic surgery (TRD).

Method

In a laparoscopic simulator, instruments were inserted via SILS or TRD setup. The monopolar generator delivered energy to a laparoscopic L-hook instrument for 5-s activations on 30-Watts coag mode. The primary outcome (stray current) was quantified by measuring the heat of liver tissue held adjacent to the non-electrically active 10-mm telescope tip and Maryland grasper in both the SILS and TRD setups. To control for the potential confounder of stray energy coupling via wires outside the surgical field, the camera cord and active electrode wires were oriented parallel or completely separated.

Results

SILS and TRD setups create similar amounts of stray current as measured by increased tissue temperature at the non-electrically active telescope tip (41 ± 12 vs. 39 ± 10 °C; p = 0.71). Stray current was greater in SILS compared to TRD at the tip of the non-electrically active Maryland forceps (38 ± 9 vs. 20 ± 10 °C; p < 0.01). Separation of the active electrode and camera cords did not change the amount of stray energy in the SILS orientation for either telescope (39 ± 10 °C bundled vs. 36 ± 10 °C separated; p = 0.40) or grasper (38 ± 9 °C bundled vs. 34 ± 11 °C separated; p = 0.19) but did in the TRD orientation (41 ± 12 bundled vs. 24 ± 10 separated; p < 0.01). When SILS was compared to TRD with the cords separated, SILS increased stray energy at both the telescope tip and grasper tip (36 ± 10 vs. 24 ± 10 °C; p < 0.01 and 34 ± 11 vs. 17 ± 8 °C; p < 0.01).

Conclusion

SILS increases stray energy transfer nearly twice as much as TRD with the use of the monopolar instrument. Strategies to mitigate the amount of stray energy in the TRD setup such as separation of the active electrode and camera cords are not effective in the SILS setup. These practical findings should enhance surgeons using the SILS approach of increased stray energy that could result in injury.

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ES301 Endoscope

FOR VETERINARY USE ONLY

Features

• 2.7mm Diameter
• 107mm Length
• 0 Degree Angle
• Stainless Steel
• Ideal for use with:
  • DE1250 Wireless Endoscope Camera
  • ES201 Portable LED Light Source

For more information contact sales@fireflyglobal.com

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ES302 Endoscope

FOR VETERINARY USE ONLY

Features

• 4mm Diameter
• 175mm Length
• 0 Degree Angle
• Stainless Steel
• Ideal for use with:
  • KT2130 Wireless Veterinary Endoscopy Set
  • DE1250 Wireless Endoscope Camera
  • ES201 Portable LED Light Source

For more information contact sales@fireflyglobal.com

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Firefly will be at FIME 2017

Firefly will be in Booth #B.J31 at FIME 2017! Make sure to buy your tickets to Orlando – The show is NOT in Miami this year!

• There will be live demonstrations of:

DE1250 Wireless Endoscope Camera R3800 Redfin Full HD Camera System ES201 Compact LED Light Source DE550 Wireless Video Otoscope

Come by the booth to see a demo!

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Physeal Abnormalities - Everything You Need To Know - Dr. Nabil Ebraheim

Dr. Ebraheim's animated educational video describing physeal abnormalities.


Follow me on twitter:
https://twitter.com/#!/DrEbraheim_UTMC

Donate to the University of Toledo Foundation Department of Orthopaedic Surgery Endowed Chair Fund:
http://ift.tt/1HCFAla

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