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Kambakamba P, Naiem A, Betz E, Hotz AS, Richetti K, Stein M, Abry L, Meier A, Seeger N, Grochola F, Grieder F, Breitenstein S. Applying augmented reality in teaching of surgical residents-telementoring, a "stress-free" way to surgical autonomy? Langenbecks Arch Surg 2024; 409:100. [PMID: 38504065 DOI: 10.1007/s00423-024-03287-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Accepted: 03/11/2024] [Indexed: 03/21/2024]
Abstract
BACKGROUND Achieving surgical autonomy can be considered the ultimate goal of surgical training. Innovative head-mounted augmented reality (AR) devices enable visualization of the operating field and teaching from remote. Therefore, utilization of AR glasses may be a novel approach to achieve autonomy. The aim of this pilot study is to analyze the feasibility of AR application in surgical training and to assess its impact on intraoperative stress. METHODS A head-mounted RealWear Navigator® 500 glasses and the TeamViewer software were used. Initial "dry lab" testing of AR glasses was performed in combination with the Symbionix LAP Mentor™. Subsequently, residents performed various stage-adapted surgical procedures semi-autonomously (SA) (on-demand consultation of senior surgeon, who is in theatre but not scrubbed) versus permanent remote supervision (senior surgeon not present) via augmented reality (AR) glasses, worn by the resident in theatre. Stress was measured by intraoperative heart rate (Polar® pulse belt) and State-Trait Anxiety Inventory (STAI) questionnaire. RESULTS After "dry lab" testing, N = 5 senior residents performed equally N = 25 procedures SA and with AR glasses. For both, open and laparoscopic procedure AR remote assistance showed satisfactory applicability. Utilization of AR significantly reduced intraoperative peak pulse rate from 131 to 119 bpm (p = 0.004), as compared with the semi-autonomous group. Likewise, subjectively perceived stress according to STAI was significantly lower in the AR group (p = 0.011). CONCLUSION AR can be applied in surgical training and may help to reduce stress in theatre. In the future, AR has a huge potential to become a stepping stone to surgical autonomy.
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Affiliation(s)
- Patryk Kambakamba
- Department of Surgery, Cantonal Hospital Winterthur, Winterthur, Switzerland.
| | - Amir Naiem
- Department of Surgery, Cantonal Hospital Winterthur, Winterthur, Switzerland
| | - Elise Betz
- Department of Surgery, Cantonal Hospital Winterthur, Winterthur, Switzerland
| | - Anne-Sophie Hotz
- Department of Surgery, Cantonal Hospital Winterthur, Winterthur, Switzerland
| | - Katharina Richetti
- Department of Surgery, Cantonal Hospital Winterthur, Winterthur, Switzerland
| | - Moritz Stein
- Department of Surgery, Cantonal Hospital Winterthur, Winterthur, Switzerland
| | - Lisa Abry
- Department of Surgery, Cantonal Hospital Winterthur, Winterthur, Switzerland
| | - Aline Meier
- Department of Surgery, Cantonal Hospital Winterthur, Winterthur, Switzerland
| | - Nico Seeger
- Department of Surgery, Cantonal Hospital Winterthur, Winterthur, Switzerland
| | - Filip Grochola
- Department of Surgery, Cantonal Hospital Winterthur, Winterthur, Switzerland
| | - Felix Grieder
- Department of Surgery, Cantonal Hospital Winterthur, Winterthur, Switzerland
| | - Stefan Breitenstein
- Department of Surgery, Cantonal Hospital Winterthur, Winterthur, Switzerland
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Boyanov N, Andonov V. Non-invasive stress estimation in simulative endoscopy setting: literature review. Folia Med (Plovdiv) 2024; 66:7-11. [PMID: 38426459 DOI: 10.3897/folmed.66.e115645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Accepted: 12/29/2023] [Indexed: 03/02/2024] Open
Abstract
One of the most common stressors is so-called "occupational stress." It is defined as the sum of physical, mental and physiological responses to work in situations where the workload or stress associated with it intensifies for an extended period of time. It is a gradual process in which individual cognitive assessments of occupational stressors generate adverse health events and may lead to burnout. Since it has become a major problem in the medical field, studying, measuring and limiting it have been set as goals for the future.
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Lee A, Torkamani-Azar M, Zheng B, Bednarik R. Unpacking the Broad Landscape of Intraoperative Stressors for Clinical Personnel: A Mixed-Methods Systematic Review. J Multidiscip Healthc 2023; 16:1953-1977. [PMID: 37484819 PMCID: PMC10361288 DOI: 10.2147/jmdh.s401325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Accepted: 06/09/2023] [Indexed: 07/25/2023] Open
Abstract
Purpose The main goals of this mixed-methods systematic review are to identify what types of intraoperative stressors for operating room personnel have been reported in collected studies and examine the characteristics of each intraoperative stressor. Methods With a systematic literature search, we retrieved empirical studies examining intraoperative stress published between 2010 and 2020. To synthesize findings, we applied two approaches. First, a textual narrative synthesis was employed to summarize key study information of the selected studies by focusing on surgical platforms and study participants. Second, a thematic synthesis was employed to identify and characterize intraoperative stressors and their subtypes. Results Ninety-four studies were included in the review. Regarding the surgical platforms, the selected studies mainly focused on minimally invasive surgery and few studies examined issues around robotic surgery. Most studies examined intra-operative stress from surgeons' perspectives but rarely considered other clinical personnel such as nurses and anesthetists. Among seven identified stressors, technical factors were the most frequently examined followed by individual, operating room environmental, interpersonal, temporal, patient, and organizational factors. Conclusion By presenting stressors as multifaceted elements affecting collaboration and interaction between multidisciplinary team members in the operating room, we discuss the potential interactions between stressors which should be further investigated to build a safe and efficient environment for operating room personnel.
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Affiliation(s)
- Ahreum Lee
- Samsung Electronics Co. Ltd., Suwon, Gyeonggi-do, Republic of Korea
| | | | - Bin Zheng
- Department of Surgery, University of Alberta, Edmonton, Canada
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Torkamani-Azar M, Lee A, Bednarik R. Methods and Measures for Mental Stress Assessment in Surgery: A Systematic Review of 20 Years of Literature. IEEE J Biomed Health Inform 2022; 26:4436-4449. [PMID: 35696473 DOI: 10.1109/jbhi.2022.3182869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Real-time mental stress monitoring from surgeons and surgical staff in operating rooms may reduce surgical injuries, improve performance and quality of medical care, and accelerate implementation of stress-management strategies. Motivated by the increase in usage of objective and subjective metrics for cognitive monitoring and by the gap in reviews of experimental design setups and data analytics, a systematic review of 71 studies on mental stress and workload measurement in surgical settings, published in 2001-2020, is presented. Almost 61% of selected papers used both objective and subjective measures, followed by 25% that only administered subjective tools - mostly consisting of validated instruments and customized surveys. An overall increase in the total number of publications on intraoperative stress assessment was observed from mid-2010 s along with a momentum in the use of both subjective and real-time objective measures. Cardiac activity, including heart-rate variability metrics, stress hormones, and eye-tracking metrics were the most frequently and electroencephalography (EEG) was the least frequently used objective measures. Around 40% of selected papers collected at least two objective measures, 41% used wearable devices, 23% performed synchronization and annotation, and 76% conducted baseline or multi-point data acquisition. Furthermore, 93% used a variety of statistical techniques, 14% applied regression models, and only one study released a public, anonymized dataset. This review of data modalities, experimental setups, and analysis techniques for intraoperative stress monitoring highlights the initiatives of surgical data science and motivates research on computational techniques for mental and surgical skills assessment and cognition-guided surgery.
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Guzmán-García C, Sánchez-González P, Margallo JAS, Snoriguzzi N, Rabazo JC, Margallo FMS, Gómez EJ, Oropesa I. Correlating Personal Resourcefulness and Psychomotor Skills: An Analysis of Stress, Visual Attention and Technical Metrics. SENSORS 2022; 22:s22030837. [PMID: 35161582 PMCID: PMC8838092 DOI: 10.3390/s22030837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 01/12/2022] [Accepted: 01/21/2022] [Indexed: 12/10/2022]
Abstract
Modern surgical education is focused on making use of the available technologies in order to train and assess surgical skill acquisition. Innovative technologies for the automatic, objective assessment of nontechnical skills are currently under research. The main aim of this study is to determine whether personal resourcefulness can be assessed by monitoring parameters that are related to stress and visual attention and whether there is a relation between these and psychomotor skills in surgical education. For this purpose, we implemented an application in order to monitor the electrocardiogram (ECG), galvanic skin response (GSR), gaze and performance of surgeons-in-training while performing a laparoscopic box-trainer task so as to obtain technical and personal resourcefulness' metrics. Eight surgeons (6 nonexperts and 2 experts) completed the experiment. A total of 22 metrics were calculated (7 technical and 15 related to personal resourcefulness) per subject. The average values of these metrics in the presence of stressors were compared with those in their absence and depending on the participants' expertise. The results show that both the mean normalized GSR signal and average surgical instrument's acceleration change significantly when stressors are present. Additionally, the GSR and acceleration were found to be correlated, which indicates that there is a relation between psychomotor skills and personal resourcefulness.
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Affiliation(s)
- Carmen Guzmán-García
- Biomedical Engineering and Telemedicine Centre, ETSI Telecomunicación, Centre for Biomedical Technology, Universidad Politécnica de Madrid, 28040 Madrid, Spain; (C.G.-G.); (P.S.-G.); (N.S.); (E.J.G.)
| | - Patricia Sánchez-González
- Biomedical Engineering and Telemedicine Centre, ETSI Telecomunicación, Centre for Biomedical Technology, Universidad Politécnica de Madrid, 28040 Madrid, Spain; (C.G.-G.); (P.S.-G.); (N.S.); (E.J.G.)
- Centro de Investigación Biomédica en Red en Bioingeniería, Biomateriales y Nanomedicina, 28029 Madrid, Spain
| | - Juan A. Sánchez Margallo
- Centro de Cirugía de Mínima Invasión Jesús Usón, 10071 Cáceres, Spain; (J.A.S.M.); (J.C.R.); (F.M.S.M.)
| | - Nicola Snoriguzzi
- Biomedical Engineering and Telemedicine Centre, ETSI Telecomunicación, Centre for Biomedical Technology, Universidad Politécnica de Madrid, 28040 Madrid, Spain; (C.G.-G.); (P.S.-G.); (N.S.); (E.J.G.)
| | - José Castillo Rabazo
- Centro de Cirugía de Mínima Invasión Jesús Usón, 10071 Cáceres, Spain; (J.A.S.M.); (J.C.R.); (F.M.S.M.)
| | | | - Enrique J. Gómez
- Biomedical Engineering and Telemedicine Centre, ETSI Telecomunicación, Centre for Biomedical Technology, Universidad Politécnica de Madrid, 28040 Madrid, Spain; (C.G.-G.); (P.S.-G.); (N.S.); (E.J.G.)
- Centro de Investigación Biomédica en Red en Bioingeniería, Biomateriales y Nanomedicina, 28029 Madrid, Spain
| | - Ignacio Oropesa
- Biomedical Engineering and Telemedicine Centre, ETSI Telecomunicación, Centre for Biomedical Technology, Universidad Politécnica de Madrid, 28040 Madrid, Spain; (C.G.-G.); (P.S.-G.); (N.S.); (E.J.G.)
- Correspondence: ; Tel.: +34-910-672-458
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6
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Boyanov N, Georgiou K, Thanasas D, Deneva T, Oussi N, Marinov B, Enochsson L. Use of saliva stress biomarkers to estimate novice male endoscopist's stress during training in a high-end simulator. Scand J Gastroenterol 2021; 56:1380-1385. [PMID: 34424793 DOI: 10.1080/00365521.2021.1965208] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Simulated endoscopic training can be challenging and stressful for the novice trainee. The absence of a reliable stress detection method during simulated endoscopic training makes estimating trainees' mental stress difficult to quantify. This study concomitantly measures the responses of four saliva stress biomarkers and compares them to the video score (VS) achieved by novice endoscopists in a reproducibly stressful simulation environment. METHODS Thirty-six male endoscopy naïve surgery residents were enrolled. After an orientation phase, a saliva specimen was collected for cortisol (sC), alpha-amylase (sAA), Chromogranin A (sCgA), and immunoglobulin A (sIgA) measurements (baseline phase, BL). Thereafter, the simulation exercise phase (E) started, practicing in the Fundamentals of Endoscopic Surgery Skills module (GI-Bronch Mentor). Immediately after, a second saliva sample for measuring the above-cited biomarkers was collected. The whole experiment was videotaped, and the VS was calculated. The percentage (E-BL)diff of each of the four saliva biomarkers was calculated and examined for correlation to VS. RESULTS sCgAdiff showed the best correlation with VS, followed by sAAdiff. CONCLUSIONS sCgA and sAA, are saliva stress biomarkers that are easy to collect non-invasively and showed the best correlation with novice endoscopist's performance in our simulation setting, and therefore, they could be used for monitoring stress.
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Affiliation(s)
- Nikola Boyanov
- Medical Simulation Training Center at Research Institute of Medical University of Plovdiv, Plovdiv, Bulgaria
| | - Konstantinos Georgiou
- 1st Department of Propaedeutic Surgery, Hippokration General Hospital of Athens, Athens Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios Thanasas
- Medical Physics Laboratory Simulation Center, Athens Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Tanya Deneva
- Central Clinical Laboratory, University Hospital St. George, Plovdiv, Bulgaria.,Department of Clinical Laboratory, Medical University of Plovdiv, Plovdiv, Bulgaria
| | - Ninos Oussi
- Division of Surgery, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden.,Centre for Clinical Research Sörmland, Uppsala University, Uppsala, Sweden
| | - Blagoi Marinov
- Medical Simulation Training Center at Research Institute of Medical University of Plovdiv, Plovdiv, Bulgaria
| | - Lars Enochsson
- Department of Surgical and Perioperative Sciences, Surgery, Umeå University, Umeå, Sweden
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Kaushik J, Pannu A, Chaitanya YVK, Kumar A, Parihar JKS, Jain VK, Chaturvedi P, Manumala LK, Singh A, Kochhar D. Effect of complicated ocular surgery in stress-related parameters: A novel outlook into surgeon's health. Indian J Ophthalmol 2021; 69:2282-2286. [PMID: 34427199 PMCID: PMC8544032 DOI: 10.4103/ijo.ijo_3517_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Purpose: To assess the stress-related physiological parameters of ophthalmic surgeons during complicated cataract surgery and compare them with uncomplicated routine cataract surgery. Methods: In this cross-sectional observational study, 110 patients of various types of cataract were divided into two groups: Group 1 included 55 patients with simple cataract (Grade ≤3) with no ocular or systemic comorbidities, whereas Group 2 included 55 patients with complicated cataracts (Grade >3) and ocular/systemic comorbidities. All patients underwent phacoemulsification with intraocular lens implantation in the right eye only. The outcome measures were systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), heart rate (HR), and saturation of peripheral oxygen (SpO2). Results: The average SBP, DBP, MAP, and HR were significantly higher in the surgeon operating Group 2 (complicated cataract) compared with Group 1 (uncomplicated cataract; P < 0.05). The average SBP of the surgeon while operating Group 1 patients preoperatively and postoperatively was 125.42 ± 2.49 mmHg and 122.45 ± 2.10 mmHg, respectively, whereas in Group 2, the average SBP of the surgeon taken preoperatively and postoperatively was 145.98 ± 3.80 mmHg and 137.44 ± 3.45 mmHg, respectively (P < 0.05). The surgeon’s SpO2 showed no significant difference between the two groups. Conclusion: There is a significant level of increase in stress-related parameters of operating surgeons while doing complicated cataract surgery.
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Affiliation(s)
- Jaya Kaushik
- Department of Ophthalmology, Armed Forces Medical College, Pune, Maharashtra, India
| | - Anju Pannu
- Department of Ophthalmology, Armed Forces Medical College, Pune, Maharashtra, India
| | - Y V K Chaitanya
- Department of Ophthalmology, Armed Forces Medical College, Pune, Maharashtra, India
| | - Ashok Kumar
- Department of Ophthalmology, Armed Forces Medical College, Pune, Maharashtra, India
| | | | - Vaibhav K Jain
- Department of Ophthalmology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | | | - Lalita K Manumala
- Department of Ophthalmology, Armed Forces Medical College, Pune, Maharashtra, India
| | - Ankita Singh
- Department of Ophthalmology, Armed Forces Medical College, Pune, Maharashtra, India
| | - Divya Kochhar
- Department of Ophthalmology, Armed Forces Medical College, Pune, Maharashtra, India
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8
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Uppada UK, Sinha R, James K, Bhogaraju S, Pravallika B. Extent of Ambidexterity Among Oral and Maxillofacial Surgeons in Southern region of India: An Evaluative Study. J Maxillofac Oral Surg 2021. [DOI: 10.1007/s12663-021-01619-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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9
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The perceived benefit of intraoperative stress modifiers for surgeons: an experimental simulation study in volunteers. Patient Saf Surg 2021; 15:23. [PMID: 34051829 PMCID: PMC8164765 DOI: 10.1186/s13037-021-00294-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 04/22/2021] [Indexed: 11/29/2022] Open
Abstract
Background During surgery, surgeons often work under stressful conditions, which could affect patient safety. Reducing intraoperative stress for surgeons could benefit surgeons and subsequently patients. It is difficult to study stress and stress relief in real life situations due to the multitude of confounding factors. The aim of this study was to evaluate simulated intraoperative stressors on surgeons’ stress levels and the effect of an intervention (pause including a sugar-containing drink) during standardized experiments (simulated operations). Methods An experimental interventional study was conducted using a simulator. The healthy surgeon volunteers were randomized to intervention and control in a cross-over design. Primary endpoint was salivary cortisol difference between a pause including a sugar containing drink (intervention) and controls. Secondary endpoints were change in heart rate, change in self-perceived stress measured by the State Trait Anxiety Inventory (STAI), and experience of the intraoperative pause. Endpoints were calculated with a mixed effect analysis of covariance (ANCOVA) model. Results Seventeen surgeons performed 32 experiments. There was no statistically significant difference in salivary cortisol between simulations with and without a pause including a sugar-containing drink; percent reduction, 8% (0.92 (95%CI:0.72;1.18)), p-value = 0.469. The surgeons’ self-estimation of intervention was positive, but there was no statistically significant difference in heart rate or STAI. Conclusions The surgeons’ experience of a pause including a drink was positive but there were no differences in physiological outcomes of the intervention. Lessons learned from this study could contribute to optimizing design of future studies. Trial registration Clinicaltrials.gov NCT04626648, Registered November 6, 2020, retrospectively registered.
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10
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Polmann H, Réus JC, Massignan C, Serra-Negra JM, Dick BD, Flores-Mir C, Lavigne GJ, De Luca Canto G. Association between sleep bruxism and stress symptoms in adults: A systematic review and meta-analysis. J Oral Rehabil 2021; 48:621-631. [PMID: 33377534 DOI: 10.1111/joor.13142] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 11/30/2020] [Accepted: 12/21/2020] [Indexed: 12/15/2022]
Abstract
To synthesise and critically review the association between sleep bruxism (SB) and stress symptoms in adults. A systematic review was performed. The search was completed using seven primary electronic databases in addition to a grey literature search. Two reviewers blindly selected studies based on pre-defined eligibility criteria. Risk of bias of the included articles was performed using the Joanna Briggs Institute Critical Appraisal Checklist for Analytical Cross-Sectional Studies. RevMan 5.4 was used to perform the meta-analysis. The quality of evidence was evaluated according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE). Ten studies were included for qualitative analysis, of which three were included for quantitative analysis. Three studies were evaluated to have low risk of bias, and seven were assessed with moderate risk of bias. Quality of evidence was classified as very low for all outcomes. Individuals with SB were found to have higher levels of some self-reported stress symptoms as assessed through questionnaires with a mean difference of 4.59 (95% CI 0.26-8.92). Biomarkers like epinephrine, norepinephrine, cortisol, adrenaline, dopamine, noradrenaline and prolidase enzyme levels also showed a positive association with SB. Although some associations were identified between probable SB and self-reported stress symptoms and biomarkers of stress in adults, given that the quality of evidence was found to be very low, caution should be exercised in interpreting these results. These findings suggest that additional and better designed studies are warranted in order to clarify the link between SB and stress.
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Affiliation(s)
- Helena Polmann
- Brazilian Centre for Evidence-Based Research, Federal University of Santa Catarina (UFSC), Florianópolis, Brazil
| | - Jéssica Conti Réus
- Brazilian Centre for Evidence-Based Research, Federal University of Santa Catarina (UFSC), Florianópolis, Brazil
| | - Carla Massignan
- Health Sciences Faculty, University of Brasília (UnB), Brasília, Brazil
| | - Junia Maria Serra-Negra
- Belo Horizonte (UFMG), Federal University of Minas Gerais, Pediatric Dentistry and Orthodontics, Minas Gerais, Brazil
| | - Bruce D Dick
- Faculty of Medicine and Dentistry, Department of Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Carlos Flores-Mir
- Faculty of Medicine and Dentistry, Department of Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Gilles J Lavigne
- Faculty of Dentistry, Surgery Department, Pain, Sleep and Trauma Unit, Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Montréal, QC, Canada
| | - Graziela De Luca Canto
- Brazilian Centre for Evidence-Based Research, Federal University of Santa Catarina (UFSC), Florianópolis, Brazil.,Faculty of Medicine and Dentistry, Department of Dentistry, University of Alberta, Edmonton, AB, Canada
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Yiasemidou M, Mushtaq F, Basheer M, Galli R, Panagiotou D, Stock S, Preston N, Mon-Williams M, Jayne DG, Miskovic D. Patient-specific mental rehearsal with three-dimensional models before low anterior resection: randomized clinical trial. BJS Open 2020. [PMCID: PMC7944490 DOI: 10.1093/bjsopen/zraa004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Background It was hypothesized that preparing for a surgical procedure, taking into account individual patient characteristics, may facilitate the procedure and improve surgical quality. The aim of this study was to compare different case-specific, preoperative mental rehearsal methods before minimally invasive rectal cancer surgery. Methods In this RCT, patients were allocated in a 1 : 1 : 1 : 1 ratio to four groups: systematic mental rehearsal (SMR) using MRI scans; SMR and three-dimensional (3D) virtual models; SMR and synthetic 3D printed models; and routine practice (control group). Surgeons operating on all but the control group underwent mental rehearsal with the visual aids, including axial MRI scans of the pelvis, interactive 3D virtual models reconstructed from axial MRIs, and synthetic models, manufactured by 3D printing. Operations were video-recorded and assessed by two experts blinded to allocation using two validated scores, the Competency Assessment Tool (CAT) and Objective Clinical Human Reliability Analysis (OCHRA). The primary outcome of the study was surgical performance, measured by the CAT. Results Forty-nine patients were randomized and allocated to the four groups. There were 12 participants in each of the control, MRI and SMR, and virtual and SMR groups, whereas the SMR using physical models and simulation group included 13. No difference was observed between groups in median CAT scores (control 30.50, MRI 34.25, virtual 31.75, physical 34.00; P = 0.748, partial η2 <0.001, where pη2 is indicative of effect size) or OCHRA scores (anterior, posterior, right and left lateral planes, transection P>0.200, pη2 =0.052–0.088). Time spent not performing dissection was significantly shorter for the SMR with MRI group than for the control (57.5 versus 42 respectively; P < 0.001, pη2 =0.212). Conclusion Mental rehearsal did not affect CAT and OCHRA scores of consultant surgeons. Reference number: ISRCTN 75603704 (https://www.isrctn.com).
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Affiliation(s)
- M Yiasemidou
- Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, St James’s University Hospital, Leeds, UK
- Academic Surgery, University of Hull, Hull, UK
| | - F Mushtaq
- School of Psychology, University of Leeds, Leeds, UK
| | - M Basheer
- Department of Colorectal Surgery, Pinderfields Hospital, Mid Yorkshire Hospitals NHS Trust, Wakefield, UK
| | - R Galli
- Department of Colorectal Surgery, St James’s University Hospital, Leeds Teaching Hospitals, Leeds, UK
| | - D Panagiotou
- General Surgery, York Teaching Hospital, York, UK
| | - S Stock
- General and Trauma Surgery, World Mate Emergency Hospital, Battambang, Cambodia
| | - N Preston
- School of Psychology, University of Leeds, Leeds, UK
| | | | - D G Jayne
- Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, St James’s University Hospital, Leeds, UK
- Department of Colorectal Surgery, St James’s University Hospital, Leeds Teaching Hospitals, Leeds, UK
| | - D Miskovic
- Department of Colorectal Surgery, St Mark’s Hospital, Harrow, London, UK
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12
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Alkindi M, Alghamdi O, Alnofaie H, AlHammad Z, Badwelan M, Albarakati S. Assessment of Occupational Stress Among Oral and Maxillofacial Surgeons and Residents in Saudi Arabia: A Cross-Sectional Study. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2020; 11:741-753. [PMID: 33117045 PMCID: PMC7567558 DOI: 10.2147/amep.s268430] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 09/14/2020] [Indexed: 06/11/2023]
Abstract
PURPOSE Considering the important role of oral and maxillofacial surgeons in healthcare services and the stressful nature of their job, this study aimed to assess the occupational stress among oral and maxillofacial surgeons and residents in Saudi Arabia. MATERIALS AND METHODS Cross-sectional questionnaires were developed, and they included the perceived stress scale and questions about potential sources of stress. A sample size of 180 was determined using a 0.05 level of significance and a precision of ±8%. The survey was distributed using a consecutive non-random sampling method to all oral and maxillofacial surgeons and residents in all regions in Saudi Arabia from May to December 2019. RESULTS One hundred and seventy-two responses were received. Males were the predominant gender. The perceived stress scale revealed a moderate stress level among surgeons and residents. However, residents had a significantly higher score (P = 0.005). Increased working days were significantly associated with higher stress levels (P = 0.006). Long on-call periods were significantly and positively correlated with increased stress levels among residents since their work schedule was not flexible (P = 0.000). The majority of surgeons and residents believe that they have unconducive and stressful work environments and that working as a maxillofacial surgeon is stressful. CONCLUSION The study results suggest that there is increased occupational stress among oral and maxillofacial surgeons and residents in Saudi Arabia. This study highlights the need for stress management programs to minimize stress factors at the workplace and to ensure a healthy working environment for the practitioners.
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Affiliation(s)
- Mohammed Alkindi
- Oral and Maxillofacial Surgery Department, College of Dentistry, King Saud University, Riyadh, Saudi Arabia
| | - Osama Alghamdi
- Oral and Maxillofacial Surgery Department, College of Dentistry, King Saud University, Riyadh, Saudi Arabia
| | - Hourya Alnofaie
- Oral and Maxillofacial Surgery Division, Basic Dental Sciences Department, College of Dentistry, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
- Saudi Board of Oral and Maxillofacial Surgery, Saudi Commission for Health Specialties, Riyadh, Saudi Arabia
| | - Ziyad AlHammad
- Oral and Maxillofacial Surgery, Ministry of Health, Riyadh, Saudi Arabia
| | - Mohammed Badwelan
- Oral and Maxillofacial Surgery Department, College of Dentistry, King Saud University, Riyadh, Saudi Arabia
| | - Sahar Albarakati
- Department of Pediatric Dentistry and Orthodontics, College of Dentistry, King Saud University, Riyadh, Saudi Arabia
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13
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Villafañe JH, Pedersini P, Bertozzi L, Drago L, Fernandez-Carnero J, Bishop MD, Berjano P. Exploring the relationship between chronic pain and cortisol levels in subjects with osteoarthritis: results from a systematic review of the literature. Osteoarthritis Cartilage 2020; 28:572-580. [PMID: 32156623 DOI: 10.1016/j.joca.2020.02.836] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 02/04/2020] [Accepted: 02/10/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Several reports in the literature have identified an association between cortisol levels and the presence of chronic pain in conditions such as rheumatoid arthritis, low back pain or whiplash. In contrast, few have examined the association of cortisol and pain in people with osteoarthritis (OA). The purpose of this systematic review was to verify the association between cortisol and pain in the OA population. DESIGN The databases MEDLINE, CINAHL, EMBASE were searched systematically for human studies written in English up to December 2018. Two researchers screened titles and abstracts against predefined inclusion criteria; a third resolved discrepancies. Articles were included if they measured the cortisol levels in adults with pain in the OA population. Methodological quality was assessed using Methodological Index for non-randomized Studies (MINORS) score. RESULTS Seven studies reporting on 415 patients were included in this review. The MINORS scale yielded mean scores of 8.6 of 16 and 17.5 of 24, for the cohort and case-control studies respectively. In general, the studies were of poor quality. A discrepancy of noteworthy associations between cortisol level comparison and pain was found. CONCLUSIONS This study shows that there is a discrepancy in the relationship between cortisol and pain dependent on how and when cortisol is measured. Evidence from three low-quality studies suggest increased cortisol levels in patients with pain but the conclusions have a high risk of bias. It was not possible to make a quantitative analysis comparing the relationship between cortisol and pain in the OA population.
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Affiliation(s)
| | - P Pedersini
- IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy.
| | - L Bertozzi
- Alma Mater Studiorum Università di Bologna, Bologna, Italy.
| | - L Drago
- Clinical Microbiology Department of Biomedical Sciences for Health, University of Milan, Italy.
| | | | - M D Bishop
- Department of Physical Therapy, University of Florida, USA.
| | - P Berjano
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy.
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14
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Stuepp RT, Barros Delben P, Modolo F, Trentin AG, Garcez RC, Biz MT. Human Dental Pulp Stem Cells in Rat Mandibular Bone Defects. Cells Tissues Organs 2019; 207:138-148. [PMID: 31734662 DOI: 10.1159/000502513] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 08/06/2019] [Indexed: 11/19/2022] Open
Abstract
This study aimed to evaluate the use of human dental pulp stem cells (hDPSCs) in non-critical-sized mandibular bone defects in rats. hDPSCs from permanent teeth were isolated and engrafted in mandibular bone defects in rats for 7, 14, and 28 days; bone defects without cells formed the control group. Samples were evaluated by scanning electron microscopy (SEM), light microscopy (hematoxylin and eosin staining), and the regeneration area was measured by the Image J program. Before surgery procedures, the human dental pulp cells were characterized as dental pulp stem cells: fusiform morphology, plastic-adherent; expression of CD105, CD73, and CD90; lack of expression of CD45 and CD34, and differentiated into osteoblasts, adipocytes, and chondroblasts. The results indicated that within 7 days the control group presented a pronounced bone formation when compared with the treated group (p < 0.05). After 14 days, the treated group showed an increase in bone formation, but with no statistical difference among the groups (p > 0.05). In the final evaluated period there was no difference between the control group and the treated group (p > 0.05). There was a significant difference between 7 and 14 days (p < 0.05) and between 7 and 28 days (p < 0.05) in the treated group. In conclusion, there is no evidence that the use of hDPSCs in the conditions of this study could improve bone formation in non-critical-sized mandibular bone defects.
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Affiliation(s)
- Rubia Teodoro Stuepp
- Programa de Graduação em Odontologia, Universidade Federal de Santa Catarina, Florianópolis, Brazil
| | - Priscilla Barros Delben
- Programa de Pós-Graduação em Biologia Celular e do Desenvolvimento, Universidade Federal de Santa Catarina, Florianópolis, Brazil
| | - Filipe Modolo
- Departamento de Patologia, Universidade Federal de Santa Catarina, Florianópolis, Brazil
| | - Andrea Gonçalves Trentin
- Departamento de Biologia Celular, Embriologia e Genética, Universidade Federal de Santa Catarina, Florianópolis, Brazil
| | - Ricardo Castilho Garcez
- Departamento de Biologia Celular, Embriologia e Genética, Universidade Federal de Santa Catarina, Florianópolis, Brazil
| | - Michelle Tillmann Biz
- Departamento de Ciências Morfológicas, Universidade Federal de Santa Catarina, Florianópolis, Brazil,
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15
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Ballini A, Santacroce L, Cantore S, Bottalico L, Dipalma G, Topi S, Saini R, De Vito D, Inchingolo F. Probiotics Efficacy on Oxidative Stress Values in Inflammatory Bowel Disease: A Randomized Double-Blinded Placebo-Controlled Pilot Study. Endocr Metab Immune Disord Drug Targets 2019; 19:373-381. [PMID: 30574857 DOI: 10.2174/1871530319666181221150352] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 11/18/2018] [Accepted: 11/28/2018] [Indexed: 01/14/2023]
Abstract
BACKGROUND Inflammatory bowel diseases (IBD), which include Crohn's disease (CD) and ulcerative colitis (UC), are described as a chronic inflammation of the small intestine and colon, caused by a dysregulated immune response to host intestinal microbiota in genetically susceptible subjects. OBJECTIVE The aim of this study was to compare probiotic therapy versus placebo in Oxidative Stress Values and clinical features in patients affected by IBD. METHOD Forty (40) patients previously diagnosed for IBD were recruited and randomized to receive probiotics (test group, n=20) or placebo (control group, n=20) administered for 90 days. Subjects in both the groups were assessed for overall oxidant ability (d-ROMs test) and for the antioxidant response (BAP test): data were reported at baseline, after 1 and 3 months. Additional data from anamnesis and haematological investigation were also reported during the study. RESULTS d-ROM assay clearly showed that the values observed in the test group were significantly improved, leading to oxidative stress values which are not pathological. The test group showed increasing BAP values, thus confirming the overall improvements of patients 'health following administration of probiotics. CONCLUSION Oral administration of the specific probiotics demonstrated its efficacy and safety on patients affected by IBD.
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Affiliation(s)
- Andrea Ballini
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari "Aldo Moro", Bari, Italy.,Interdisciplinary Department of Medicine, University of Bari "Aldo Moro", Bari, Italy
| | - Luigi Santacroce
- Ionian Department, University of Bari "Aldo Moro", Bari, Italy.,Polypheno - Academic Spin Off, University of Bari "Aldo Moro", Bari, Italy.,School of Technical Medical Sciences, "A. Xhuvani" University, Elbasan, Albania
| | - Stefania Cantore
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari "Aldo Moro", Bari, Italy.,Interdisciplinary Department of Medicine, University of Bari "Aldo Moro", Bari, Italy
| | - Lucrezia Bottalico
- Polypheno - Academic Spin Off, University of Bari "Aldo Moro", Bari, Italy
| | - Gianna Dipalma
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari "Aldo Moro", Bari, Italy.,Interdisciplinary Department of Medicine, University of Bari "Aldo Moro", Bari, Italy
| | - Skender Topi
- Ionian Department, University of Bari "Aldo Moro", Bari, Italy.,Polypheno - Academic Spin Off, University of Bari "Aldo Moro", Bari, Italy.,School of Technical Medical Sciences, "A. Xhuvani" University, Elbasan, Albania
| | - Rajiv Saini
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari "Aldo Moro", Bari, Italy
| | - Danila De Vito
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari "Aldo Moro", Bari, Italy
| | - Francesco Inchingolo
- Interdisciplinary Department of Medicine, University of Bari "Aldo Moro", Bari, Italy
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16
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Pavone C, Scardueli CR, de Oliveira GJPL, Cerri PS, Marcantonio Junior E, Marcantonio RAC. Effects of an Er,Cr:YSGG Laser on Bone Regeneration in Critical-Sized Calvarial Defects of Rats Exposed to Inhalation of Cigarette Smoke. Photobiomodul Photomed Laser Surg 2019; 37:500-507. [PMID: 31268410 DOI: 10.1089/photob.2018.4546] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Objective: To evaluate the effect of the Er,Cr:YSGG laser on healing of critical-sized calvarial defects (CSDs) in rats submitted to inhalation of cigarette smoke. Background: Smoking has been implicated with the delay in the bone healing after osteotomy procedures, then the use of the Er,Cr:YSGG laser for osteotomy in smokers could be an alternative to the conventional drills. Methods: One hundred animals were randomly allocated into four groups: trephine-the CSDs were made with a trephine drill in healthy rats; Er,Cr:YSGG-the CSDs were made with the Er,Cr:YSGG laser in healthy rats; Trephine-S-the CSDs were made with a trephine drill in rats exposed to cigarette smoke; and Er,Cr:YSGG-S-the CSDs were made with the Er,Cr:YSGG laser in rats exposed to cigarette smoke. The inhalation of cigarette smoke started 7 days before the surgical procedure until euthanasia (immediately, 7, 15, 30, or 60 days after the surgical procedure). A histometric analysis and a histological description were performed to evaluate (1) the residual linear lengths and bone formation in the CSDs; (2) the quality of bone healing. Results: The use of Er,Cr:YSGG laser induces more bone formation compared with the trephine in smokers; however, the closure of the CSD was only superior in the Er,Cr:YSGG-S group compared to the Trephine-S group at the 60-day period. Conclusions: The use of the Er,Cr:YSGG laser stimulated the bone repair process after osteotomy procedures in animals submitted to exposure of inhalation of cigarette smoke.
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Affiliation(s)
- Chaine Pavone
- 1School of Dentistry, Unicastelo, Descalvado, Brazil
| | - Cássio Rocha Scardueli
- 2Department of Diagnosis and Surgery, School of Dentistry at Araraquara, Sa∼o Paulo State University-Unesp, Araraquara, Brazil
| | | | - Paulo Sérgio Cerri
- 4Department of Pathology and Physiology, School of Dentistry at Araraquara, Sa∼o Paulo State University-Unesp, Araraquara, Brazil
| | - Elcio Marcantonio Junior
- 2Department of Diagnosis and Surgery, School of Dentistry at Araraquara, Sa∼o Paulo State University-Unesp, Araraquara, Brazil
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17
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Abstract
Only about 8% of head and neck tumors affect the midface. This anatomical area is characterized by an enormous number of functionally important structures, and it is frequently only possible to achieve small resection margin distances. To avoid complications and unfavorable results, a dedicated preparation of both patient and surgeon is warranted. This review aims to provide encouragement for the postgraduate training of interested ENT specialists. Following the clinical course and based on recent literature, strategies to avoid complications of tumor surgery to the midface are given.
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Affiliation(s)
- Achim G Beule
- Klinik für Hals‑, Nasen- und Ohrenheilkunde, Universitätsklinikum Münster, Kardinal-von-Galen-Ring 10, 48149, Münster, Deutschland.
- Klinik und Poliklinik für Hals-Nasen-Ohrenkrankheiten, Universitätsmedizin Greifswald, Greifswald, Deutschland.
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18
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Martínez-Rodrigo A, García-Martínez B, Zunino L, Alcaraz R, Fernández-Caballero A. Multi-Lag Analysis of Symbolic Entropies on EEG Recordings for Distress Recognition. Front Neuroinform 2019; 13:40. [PMID: 31214006 PMCID: PMC6558149 DOI: 10.3389/fninf.2019.00040] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2018] [Accepted: 05/16/2019] [Indexed: 11/13/2022] Open
Abstract
Distress is a critical problem in developed societies given its long-term negative effects on physical and mental health. The interest in studying this emotion has notably increased during last years, being electroencephalography (EEG) signals preferred over other physiological variables in this research field. In addition, the non-stationary nature of brain dynamics has impulsed the use of non-linear metrics, such as symbolic entropies in brain signal analysis. Thus, the influence of time-lag on brain patterns assessment has not been tested. Hence, in the present study two permutation entropies denominated Delayed Permutation Entropy and Permutation Min-Entropy have been computed for the first time at different time-lags to discern between emotional states of calmness and distress from EEG signals. Moreover, a number of curve-related features were also calculated to assess brain dynamics across different temporal intervals. Complementary information among these variables was studied through sequential forward selection and 10-fold cross-validation approaches. According to the results obtained, the multi-lag entropy analysis has been able to reveal new significant insights so far undiscovered, thus notably improving the process of distress recognition from EEG recordings.
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Affiliation(s)
- Arturo Martínez-Rodrigo
- Departamento de Sistemas Informáticos, Escuela Politécnica de Cuenca, Universidad de Castilla-La Mancha, Cuenca, Spain
- Instituto de Tecnologías Audiovisuales de Castilla-La Mancha, Universidad de Castilla-La Mancha, Cuenca, Spain
| | - Beatriz García-Martínez
- Departamento de Sistemas Informáticos, Escuela Técnica Superior de Ingenieros Industriales, Universidad de Castilla-La Mancha, Albacete, Spain
- Instituto de Investigación en Informática de Albacete, Universidad de Castilla-La Mancha, Albacete, Spain
| | - Luciano Zunino
- Centro de Investigaciones Ópticas (CONICET La Plata–CIC), C.C. 3, Gonnet, Argentina
- Departamento de Ciencias Básicas, Facultad de Ingeniería, Universidad Nacional de La Plata, La Plata, Argentina
| | - Raúl Alcaraz
- Research Group in Electronic, Biomedical and Telecommunication Engineering, Escuela Politécnica de Cuenca, Universidad de Castilla-La Mancha, Cuenca, Spain
| | - Antonio Fernández-Caballero
- Departamento de Sistemas Informáticos, Escuela Politécnica de Cuenca, Universidad de Castilla-La Mancha, Cuenca, Spain
- Instituto de Investigación en Informática de Albacete, Universidad de Castilla-La Mancha, Albacete, Spain
- CIBERSAM (Biomedical Research Networking Centre in Mental Health), Madrid, Spain
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19
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Crewther BT, Cook CJ. Medical students preferring a surgical or non-surgical elective differ in their emotional and hormonal responses to a psychological stressor. Am J Surg 2019; 219:604-607. [PMID: 31005239 DOI: 10.1016/j.amjsurg.2019.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 03/13/2019] [Accepted: 04/01/2019] [Indexed: 10/27/2022]
Abstract
This study examined a possible link between the elective preferences of medical students (surgical vs. non-surgical) and their emotional and hormonal responses to a psychological stressor. Forty medical students completed a laboratory stressor comprising of 10 puzzles in a time-limited format. Emotional state was assessed before (competitiveness, anxiety) and after (stress, enjoyment) testing, along with changes in salivary testosterone (ΔT) and cortisol (ΔC). Comparisons were made according to individual preferences for a surgical (n = 16) or non-surgical (n = 24) elective. Those seeking surgery had a lower 2D:4D (d = -2.0) with higher competitiveness scores (d = 2.7), but less anxiety (d = -0.9) and stress (d = -0.8). They also had a larger ΔT (17% vs. 6%) and smaller ΔC (7% vs. 12%) from the non-surgical cohort. Significant interrelationships were observed between 2D:4D, competitiveness, anxiety, stress and hormones. In summary, in students at a career stage of considering options in medicine, differences in stress responsivity were seen in those considering surgery, as compared to those considering other specialities.
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Affiliation(s)
- Blair T Crewther
- Institute of Sport - National Research Institute, Warsaw, Poland; Hamlyn Centre, Imperial College, UK.
| | - Christian J Cook
- Hamlyn Centre, Imperial College, UK; Research Institute for Sport and Exercise, University of Canberra, Canberra, Australia; School of Science and Technology, University of New England, Armidale, Australia
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20
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Tatullo M, Codispoti B, Paduano F, Nuzzolese M, Makeeva I. Strategic Tools in Regenerative and Translational Dentistry. Int J Mol Sci 2019; 20:ijms20081879. [PMID: 30995738 PMCID: PMC6514784 DOI: 10.3390/ijms20081879] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 04/10/2019] [Accepted: 04/14/2019] [Indexed: 02/06/2023] Open
Abstract
Human oral-derived stem cells can be easily obtained from several oral tissues, such as dental pulp, periodontal ligament, from gingiva, or periapical cysts. Due to their differentiation potential, oral-derived mesenchymal stem cells are promising for tissue engineering and regenerative medicine. The regenerative ability showed by some oral tissues strongly depends on their sleeping adult stem cell populations that are able to repair small defects and to manage local inflammation. To date, researchers are working on effective and efficient methods to ensure safe and predictable protocols to translate stem cell research into human models. In the last decades, the challenge has been to finally use oral-derived stem cells together with biomaterials or scaffold-free techniques, to obtain strategic tools for regenerative and translational dentistry. This paper aims to give a clear point of view on state of the art developments, with some exciting insights into future strategies.
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Affiliation(s)
- Marco Tatullo
- Department of Regenerative Medicine, Tecnologica Research Institute, 88900 Crotone, Italy.
- Department of Experimental Medicine, Marrelli Hospital, 88900 Crotone, Italy.
- Department of Therapeutic Dentistry, I.M. Sechenov First Moscow State Medical University, 119435 Moscow, Russia.
| | - Bruna Codispoti
- Department of Regenerative Medicine, Tecnologica Research Institute, 88900 Crotone, Italy.
- Department of Experimental Medicine, Marrelli Hospital, 88900 Crotone, Italy.
| | - Francesco Paduano
- Department of Regenerative Medicine, Tecnologica Research Institute, 88900 Crotone, Italy.
- Department of Experimental Medicine, Marrelli Hospital, 88900 Crotone, Italy.
| | - Manuel Nuzzolese
- Department of NHS Foundation Trust, University Hospitals Birmingham ⁻ NHS Foundation Trust, Birmingham B152GW, UK.
| | - Irina Makeeva
- Department of Therapeutic Dentistry, I.M. Sechenov First Moscow State Medical University, 119435 Moscow, Russia.
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21
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Surgeons’ preferences and anxiety levels in paediatric adenotonsillectomy: European perspective. The Journal of Laryngology & Otology 2019; 133:333-338. [DOI: 10.1017/s0022215119000434] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
AbstractObjectiveThis study assessed the preferences of surgeons regarding surgical modalities used for adenotonsillectomy, and determined anxiety levels related to the adenotonsillectomy procedure.MethodsA 10-question survey created by the authors was administered to 413 ENT specialists attending the 4th Congress of Otorhinolaryngology Head and Neck Surgery, held in October 2017 in Barcelona, Spain.ResultsCold knife dissection was the preferred surgical modality for both adenoidectomy and tonsillectomy. Most participants reported encountering one to five patients with post-tonsillectomy bleeding throughout their entire career. The mean anxiety levels during surgery and the 10-day post-operative period were 3.39 ± 2.14 and 4.18 ± 2.63, respectively (p < 0.05). There was a significant negative correlation between anxiety level and surgeon's experience (p < 0.05).ConclusionCold dissection is still the preferred surgical modality for adenotonsillectomy, while both suture ligation and electrocautery are used for haemostasis. Paediatric adenotonsillectomy is likely to generate anxiety in ENT surgeons, and the possibility of secondary post-tonsillectomy bleeding increases the anxiety levels of surgeons in the post-operative period.
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22
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Anitua E, Zalduendo M, Troya M. Autologous plasma rich in growth factors technology for isolation and ex vivo expansion of human dental pulp stem cells for clinical translation. Regen Med 2019; 14:97-111. [PMID: 30767653 DOI: 10.2217/rme-2018-0066] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM This study investigated the use of the autologous technology of plasma rich in growth factors (PRGF) as a human-based substitute to fetal bovine serum (FBS) in the culture of human dental pulp stem cells. MATERIALS & METHODS Stem cell characterization was performed. Analysis of isolation, proliferation, migration, trilineage differentiation, senescence and cryopreservation were compared between FBS and PRGF. RESULTS Human dental pulp stem cell cultures isolated and maintained with PRGF showed a significantly higher number of cells per explant than FBS cultures. Cell proliferation, migration, osteogenic mineralization and adipogenic differentiation were found to be significantly higher in PRGF than FBS. CONCLUSION The autologous PRGF technology could be a suitable and safer substitute for FBS as a culture medium supplement for clinical translation of cell therapy.
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Affiliation(s)
- Eduardo Anitua
- BTI - Biotechnology Institute, Regenerative Medicine Department, Vitoria 01007, Spain.,University Institute for Regenerative Medicine & Oral Implantology UIRMI, UPV/EHU - Fundación Eduardo Anitua, Vitoria 01007, Spain
| | - Mar Zalduendo
- BTI - Biotechnology Institute, Regenerative Medicine Department, Vitoria 01007, Spain
| | - María Troya
- BTI - Biotechnology Institute, Regenerative Medicine Department, Vitoria 01007, Spain
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23
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Biological and Mechanical Properties of Platelet-Rich Fibrin Membranes after Thermal Manipulation and Preparation in a Single-Syringe Closed System. Int J Mol Sci 2018; 19:ijms19113433. [PMID: 30388866 PMCID: PMC6274993 DOI: 10.3390/ijms19113433] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 10/24/2018] [Accepted: 10/29/2018] [Indexed: 12/12/2022] Open
Abstract
Platelet-rich fibrin (PRF) membrane is a three-dimensional biodegradable biopolymer, which consists of platelet derived growth factors enhancing cell adhesion and proliferation. It is widely used in soft and hard tissue regeneration, however, there are unresolved problems with its clinical application. Its preparation needs open handling of the membranes, it degrades easily, and it has a low tensile strength which does not hold a suture blocking wider clinical applications of PRF. Our aim was to produce a sterile, suturable, reproducible PRF membrane suitable for surgical intervention. We compared the biological and mechanical properties of PRF membranes created by the classical glass-tube and those that were created in a single-syringe closed system (hypACT Inject), which allowed aseptic preparation. HypACT Inject device produces a PRF membrane with better handling characteristics without compromising biological properties. Freeze-thawing resulted in significantly higher tensile strength and higher cell adhesion at a lower degradation rate of the membranes. Mesenchymal stem cells seeded onto PRF membranes readily proliferated on the surface of fresh, but even better on freeze/thawed or freeze-dried membranes. These data show that PRF membranes can be made sterile, more uniform and significantly stronger which makes it possible to use them as suturable surgical membranes.
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24
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Mesenchymal Stem Cells as Promoters, Enhancers, and Playmakers of the Translational Regenerative Medicine 2018. Stem Cells Int 2018; 2018:6927401. [PMID: 30510586 PMCID: PMC6232791 DOI: 10.1155/2018/6927401] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 09/18/2018] [Indexed: 01/22/2023] Open
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25
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Sethi AK, Samal R, Lahiri B, Das A, Kumar G, Behera S. Awareness, Attitude and Practice Regarding Disinfection and Handling of Extracted Teeth among the Students in a Dental College in India. J Int Soc Prev Community Dent 2018; 8:488-494. [PMID: 30596038 PMCID: PMC6280574 DOI: 10.4103/jispcd.jispcd_314_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2018] [Accepted: 10/12/2018] [Indexed: 11/23/2022] Open
Abstract
Objective: The main objective of this study is to assess about the awareness, attitude, and practice regarding disinfection and handling of extracted teeth among the students of a dental college in Odisha, India. Materials and Methods: The survey was done with a self-designed questionnaire distributed among the students of a dental college in Odisha, India. Data analysis was done using the Statistical Package for the Social Sciences Software (SPSS for Windows, Version 16.0., Released 2007, Chicago, SPSS Inc.) and the results obtained. Results: Of the many methods available, the safest and practical methods to sterilize and disinfect the extracted human teeth could be autoclaving, submersion in 10% formalin and 5.25% sodium hypochlorite solutions. In addition, it was found that there is a significant need to educate the potential handlers of such extracted teeth about the latest statuary protocol and guidelines. Conclusion: Most of the participants in the study were aware of the established safety protocols regarding how to handle the pathogenic specimens and were putting in practice those standardized guidelines. But still another good number of handlers need to change their casual attitude while following the safety guidelines so as to protect themselves, others and the environment from the pathogenic clinical specimens.
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Affiliation(s)
- Alok Kumar Sethi
- Department of Oral and Maxillofacial Surgery, Kalinga Institute of Dental Sciences, KIIT University, Bhubaneswar, Odisha, India
| | - Rajashree Samal
- Department of Oral and Maxillofacial Surgery, Hi-Tech Dental College and Hospital, Bhubaneswar, Odisha, India
| | - Banibrata Lahiri
- Department of Oral and Maxillofacial Surgery, Kalinga Institute of Dental Sciences, KIIT University, Bhubaneswar, Odisha, India
| | - Asutosh Das
- Department of Oral and Maxillofacial Surgery, Kalinga Institute of Dental Sciences, KIIT University, Bhubaneswar, Odisha, India
| | - Gunjan Kumar
- Department of Public Health Dentistry, Kalinga Institute of Dental Sciences, KIIT University, Bhubaneswar, Odisha, India
| | - Shibabrata Behera
- Department of Oral and Maxillofacial Surgery, Kalinga Institute of Dental Sciences, KIIT University, Bhubaneswar, Odisha, India
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26
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Concentric Ring Probe for Bioimpedance Spectroscopic Measurements: Design and Ex Vivo Feasibility Testing on Pork Oral Tissues. SENSORS 2018; 18:s18103378. [PMID: 30308986 PMCID: PMC6210762 DOI: 10.3390/s18103378] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 09/19/2018] [Accepted: 10/03/2018] [Indexed: 11/17/2022]
Abstract
Many oral diseases, such as oral leukoplakia and erythroplakia, which have a high potential for malignant transformations, cause abnormal structural changes in the oral mucosa. These changes are clinically assessed by visual inspection and palpation despite their poor accuracy and subjective nature. We hypothesized that non-invasive bioimpedance spectroscopy (BIS) might be a viable option to improve the diagnostics of potentially malignant lesions. In this study, we aimed to design and optimize the measurement setup and to conduct feasibility testing on pork oral tissues. The contact pressure between a custom-made concentric ring probe and tissue was experimentally optimized. The effects of loading time and inter-electrode spacing on BIS spectra were also clarified. Tissue differentiation testing was performed for ex vivo pork oral tissues including palatinum, buccal mucosa, fat, and muscle tissue samples. We observed that the most reproducible results were obtained by using a loading weight of 200 g and a fixed time period under press, which was necessary to allow meaningful quantitative comparison. All studied tissues showed their own unique spectra, accompanied by significant differences in both impedance magnitude and phase (p ≤ 0.014, Kruskal-Wallis test). BIS shows promise, and further studies are warranted to clarify its potential to detect specific pathological tissue alterations.
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Fournier I, Fakhry N, Kennel T, Tessier N, Bahgat A, Lechien JR, Ayad T. Challenges faced by young otolaryngologists-head & neck surgeons around the world. Eur Ann Otorhinolaryngol Head Neck Dis 2018; 135:S67-S73. [PMID: 30170973 DOI: 10.1016/j.anorl.2018.06.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 06/16/2018] [Accepted: 06/22/2018] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To document work-related stressors and to identify coping strategies employed by young board-certified otolaryngologists-head & neck surgeons (OTL-HNS) around the world. The second objective is to evaluate demographic and professional characteristics associated with a higher level of work-related stress. METHODS A survey was sent to all OTL-HNS under 45 years old from the 2017 IFOS meeting. This survey was conducted by the YO-IFOS group (Young Otolaryngologists of the International Federation of Otolaryngological Societies). Data were collected for a period of 1 month. Demographic characteristics and information concerning challenges encountered by OTL-HNS during the early years of their career were collected. RESULTS Among the 2787 attendees, 928 responded to the survey (response rate=33.3%). The three most frequent challenges faced by OTL-HNS in the early years of their career were related to administrative workload (45%), high patient quota (42%) and desire to achieve adequate work-life balance (42%). Practices used by OTL-HNS to cope with stress were physical activity (37%), recreational activities (35%) and self-organization (32%). Higher levels of stress were frequently found in participants who possessed five to ten years of experience (P=0.007) and who were employed by an academic institution (P=0.020). On the other hand, lower levels of stress were often encountered in participants who had 5 years or less of experience (P=0.002). CONCLUSION This study provides insight on characteristics that are associated with various levels of stress. Moreover, it demonstrates the work-related stressors and the resilience techniques employed by OTL-HNS in early years of their career. Stress will always be present during the surgeon's career. Therefore, knowing how to recognize it and how to deal with it is key. More resources should be made available for OTL-HNS needing aid. Because surgeons must be in control of their stress if they want to provide high quality health care.
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Affiliation(s)
- I Fournier
- School of medicine, université de Montréal, Montreal, Canada
| | - N Fakhry
- Hôpital de la Conception, 13005 Marseille, France
| | - T Kennel
- Hôpital universitaire Gui-de-Chauliac, université de Montpellier, CHRU de Montpellier, 34295 Montpellier, France
| | - N Tessier
- Hôpital Robert-Debré, 75019 Paris, France
| | - A Bahgat
- Lecturer of otorhinolaryngology and consultant of sleep surgery, Alexandria university, Alexandria, Egypt
| | - J R Lechien
- School of medicine, université de Mons, Mons, Belgium
| | - T Ayad
- Centre hospitalier de l'université de Montréal, Montreal, Canada.
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Regulation of PKCβ levels and autophagy by PML is essential for high-glucose-dependent mesenchymal stem cell adipogenesis. Int J Obes (Lond) 2018; 43:963-973. [PMID: 30082750 DOI: 10.1038/s41366-018-0167-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 05/15/2018] [Accepted: 06/15/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND/OBJECTIVES Obesity is a complex disease characterized by the accumulation of excess body fat, which is caused by an increase in adipose cell size and number. The major source of adipocytes comes from mesenchymal stem cells (MSCs), although their roles in obesity remain unclear. An understanding of the mechanisms, regulation, and outcomes of adipogenesis is crucial for the development of new treatments for obesity-related diseases. Recently an unexpected role for the tumor suppressor promyelocytic leukemia protein (PML) in hematopoietic stem cell biology and metabolism regulation has come to light, but its role in MSC biology remains unknown. Here, we investigated the molecular pathway underlying the role of PML in the control of adipogenic MSC differentiation. SUBJECTS/METHODS Muscle-derived stem cells (MDSCs) and adipose-derived stem cells (ADSCs) obtained from mice and voluntary patients (as a source of MSCs) were cultured in the presence of high glucose (HG) concentration, a nutrient stress condition known to promote MSCs differentiation into mature adipocytes and the adipogenic potential of PML was assessed. RESULTS PML is essential for a correct HG-dependent adipogenic differentiation, and the enhancement of PML levels is fundamental during adipogenesis. Increased PML expression enables the upregulation of protein kinase Cβ (PKCβ), which, in turn, by controlling autophagy levels permits an increase in peroxisome proliferator-activated receptor γ (PPARγ) that leads the adipogenic differentiation. Therefore, genetic and pharmacological depletion of PML prevents PKCβ expression, and by increasing autophagy levels, impairs the MSCs adipogenic differentiation. Human ADSCs isolated from overweight patients displayed increased PML and PKCβ levels compared to those found in normal weight individuals, indicating that the PML-PKCβ pathway is directly involved in the enhancement of adipogenesis and human metabolism. CONCLUSIONS The new link found among PML, PKCβ, and autophagy opens new therapeutic avenues for diseases characterized by an imbalance in the MSCs differentiation process, such as metabolic syndromes and cancer.
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Weenk M, Alken AP, Engelen LJ, Bredie SJ, van de Belt TH, van Goor H. Stress measurement in surgeons and residents using a smart patch. Am J Surg 2018; 216:361-368. [DOI: 10.1016/j.amjsurg.2017.05.015] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Revised: 03/18/2017] [Accepted: 05/06/2017] [Indexed: 10/19/2022]
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García-Martínez B, Martínez-Rodrigo A, Fernández-Caballero A, Moncho-Bogani J, Alcaraz R. Nonlinear predictability analysis of brain dynamics for automatic recognition of negative stress. Neural Comput Appl 2018. [DOI: 10.1007/s00521-018-3620-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Antibacterial Activity of Leukocyte- and Platelet-Rich Plasma: An In Vitro Study. BIOMED RESEARCH INTERNATIONAL 2018; 2018:9471723. [PMID: 30050949 PMCID: PMC6040244 DOI: 10.1155/2018/9471723] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/06/2018] [Accepted: 05/26/2018] [Indexed: 02/06/2023]
Abstract
The aim of the study was to investigate the leukocyte- and platelet-rich plasma (L-PRP) antimicrobial activity. The studied sample comprised 20 healthy males. The L-PRP gel, liquid L-PRP, and thrombin samples were tested in vitro for their antibacterial properties against selected bacterial strains using the Kirby-Bauer disc diffusion method. Two types of thrombin were used (autologous and bovine). Zones of inhibition produced by L-PRP ranged between 6 and 18 mm in diameter. L-PRP inhibited the growth of Staphylococcus aureus (MRSA and MSSA strains) and was also active against Enterococcus faecalis and Pseudomonas aeruginosa. There was no activity against Escherichia coli and Klebsiella pneumoniae. The statistically significant increase of L-PRP antimicrobial effect was noted with the use of major volume of thrombin as an activator. Additionally, in groups where a bovine thrombin mixture was added to L-PRP the zones of inhibition concerning MRSA, Enterococcus faecalis, and Pseudomonas aeruginosa were larger than in the groups with autologous thrombin. Based on the conducted studies, it can be determined that L-PRP can evoke in vitro antimicrobial effects and might be used to treat selected infections in the clinical field. The major volume of thrombin as an activator increases the strength of the L-PRP antimicrobial effect.
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Coskun ME, Coskun KA, Tutar Y. Determination of Optimum Operation Parameters for Low-Intensity Pulsed Ultrasound and Low-Level Laser Based Treatment to Induce Proliferation of Osteoblast and Fibroblast Cells. Photomed Laser Surg 2018; 36:246-252. [PMID: 29466082 DOI: 10.1089/pho.2017.4354] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Mehmet Emre Coskun
- Department of Prosthodontics, Faculty of Dentistry, Cumhuriyet University, Sivas, Turkey
| | - Kubra Acikalin Coskun
- Department of Biochemistry, Faculty of Pharmacy, Cumhuriyet University, Sivas, Turkey
| | - Yusuf Tutar
- Department of Nutrition and Dietetics, Health Sciences Faculty, University of Health Sciences, Istanbul, Turkey
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Jiménez R, Vera J. Effect of examination stress on intraocular pressure in university students. APPLIED ERGONOMICS 2018; 67:252-258. [PMID: 29122197 DOI: 10.1016/j.apergo.2017.10.010] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 08/22/2017] [Accepted: 10/16/2017] [Indexed: 06/07/2023]
Abstract
Intraocular pressure (IOP) has been investigated as a possible objective index of mental stressors. Here, we assessed the effect of examination stress on IOP in 33 university students. A repeated-measures design was used with two experimental conditions (examination and control) and two points of measurements (pre- and post-sessions). Also, the cardiovascular response, subjective perceived stress, as well as calculated ocular perfusion pressure and blood-pulse pressure were determined. A Bayesian statistical analysis showed higher IOP values in the examination in comparison to the control condition (BF01 < 0.001). A similar pattern was found for the cardiovascular indices (diastolic and systolic blood pressure, and heart rate), and these findings were corroborated by subjective reports (BF01 < 0.001 in all cases). Our data incorporates evidence in relation to the utility of IOP as an objective marker of examination stress, and it may help in the assessment and management of stress in applied scenarios.
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Affiliation(s)
| | - Jesús Vera
- Department of Optics, University of Granada, Spain.
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Pacifici A, Laino L, Gargari M, Guzzo F, Velandia Luz A, Polimeni A, Pacifici L. Decellularized Hydrogels in Bone Tissue Engineering: A Topical Review. Int J Med Sci 2018; 15:492-497. [PMID: 29559838 PMCID: PMC5859772 DOI: 10.7150/ijms.22789] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 02/02/2018] [Indexed: 12/23/2022] Open
Abstract
Nowadays, autograft and allograft techniques represent the main solution to improve bone repair. Unfortunately, autograft technique is expensive, invasive and subject to infections and hematoma, frequently affecting both donor sites and surgical sites. A recent advance in tissue engineering is the fabrication of cell-laden hydrogels with custom-made geometry, depending on the clinical case. The use of ECM (Extra-Cellular Matrix)-derived Hydrogels from bone tissue is the new opportunity to obtain good results in bone regeneration. Several micro-engineering techniques and approaches are available to fabricate different cell gradients and zonal structures in hydrogels design, in combination with the advancement in biomaterials selection. In this review, we analyse the stereolithografy, the Bio-patterning, the 3D bioprinting and 3D assembly, the Laser-Induced Forward Transfer Bioprinting (LIFT), the Micro-extrusion bioprinting, the promising Electrospinning technology, the Microfluidics and the Micromolding. Several mechanical properties are taken into account for bone regeneration scaffolds. However, each typology of scaffold presents some advantages and some concerns. The research on biomaterials is the most promising for bone tissue engineering: the new biomimetic materials will allow us to obtain optimal results in the next clinical application of basic research.
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Affiliation(s)
- Andrea Pacifici
- Department of Oral and Maxillofacial Sciences La Sapienza University of Rome, Italy
| | - Luigi Laino
- Multidisciplinary department of surgical and dental specialties. University of Campania Luigi Vanvitelli
| | - Marco Gargari
- Department of Clinical Sciences and Translational Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - Federico Guzzo
- Department of Dentistry "Fra G.B. Orsenigo", Ospedale San Pietro FBF, Rome, Italy
| | - Andrea Velandia Luz
- AgEstimation Project, Institute of Legal Medicine, University of Macerata, Macerata, Italy
| | - Antonella Polimeni
- Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Italy
| | - Luciano Pacifici
- Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Italy
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Tatullo M. About stem cell research in dentistry: many doubts and too many pitfalls still affect the regenerative dentistry. Int J Med Sci 2018; 15:1616-1618. [PMID: 30588184 PMCID: PMC6299415 DOI: 10.7150/ijms.27908] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Accepted: 09/14/2018] [Indexed: 12/15/2022] Open
Abstract
Stem cells (SCs) research is one of the most promising approaches to regenerative medicine. Our understanding of SCs biology and their potential role in tissue repairing has notably increased during the last few years. Mesenchymal stem cells (MSCs) are present in almost all human tissues, including oral and dental tissues (dental-derived stem cells or DDSCs). Despite many doubts and too many pitfalls still affect regenerative dentistry; however, it represents an exciting challenge for the next generations of young dentists. Educating and training in regenerative medicine the new generation of researchers is of utmost importance, albeit often underestimated: regenerative dentistry represents a big opportunity for the next generations of researchers and clinicians, and this review report underlines that dental schools should pay more attention to teachings of strategic subjects, such as cell biology, molecular biology and tissue engineering.
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Affiliation(s)
- Marco Tatullo
- Scientific Director, Tecnologica Research Institute, 88900 Crotone, Italy.,IM Sechenov First Moscow State Medical University, Moscow, Russia
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Sanavia C, Tatullo M, Bassignani J, Cotellessa S, Fantozzi G, Acito G, Iommiello A, Chiavistelli L, Iommiello A, Sabatini S, Nardi GM. Remineralization Strategies in Oral Hygiene: A Position Paper of Italian Society of Oral Hygiene Sciences-S.I.S.I.O. Working Group. Open Dent J 2017; 11:527-538. [PMID: 29238413 PMCID: PMC5712655 DOI: 10.2174/1874210601711010527] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2017] [Revised: 08/25/2017] [Accepted: 09/19/2017] [Indexed: 11/22/2022] Open
Abstract
Background/Objective: The clinical conditions that lead to an alteration of the enamel structure are numerous. The diet high in sugars and acidifying substances, psychological stress that triggers parafunctional behaviors, the reduced intake of fiber-rich foods or alkalizing substances, together with other factors, contribute to demineralization of the tooth enamel. Dental mineralizing products on the current market are distinguished according to the dosage form, the active ingredient, the release technology, clinical indications and patient choice. Currently, it is necessary to propose to oral health professionals a guide to orient themselves in this chaotic choice, in order to prefer the most effective product for their own clinical target. Methods: Italian Society of Oral Hygiene Sciences-S.I.S.I.O. is one of the leading scientific Italian societies representing those dental hygienists working with high-quality standards and in agreement with scientific evidence: in the last year, the SISIO working group has carried out a study focused on remineralizing agents in dentistry, in order to give an authoritative point of view to indicate a guideline in the decision process of the choice of a remineralizing agent. We will report the results pointed out from the last consensus meeting in 2017. Results: We have reported the good the bad and the ugly have been discussed in a critical discussion of such topic. Conclusion: The SISIO experience has been reported in this position paper with the aim to serve as a useful aid in the daily choice of the clinical steps to perform, when dental professionals need to treat demineralized teeth.
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Affiliation(s)
- Consuelo Sanavia
- Italian Society of Oral Hygiene Sciences-S.I.S.I.O. working group, Pisa, Italy
| | | | - Jessica Bassignani
- Italian Society of Oral Hygiene Sciences-S.I.S.I.O. working group, Pisa, Italy
| | - Silvia Cotellessa
- Italian Society of Oral Hygiene Sciences-S.I.S.I.O. working group, Pisa, Italy
| | - Giulia Fantozzi
- Italian Society of Oral Hygiene Sciences-S.I.S.I.O. working group, Pisa, Italy
| | - Giovanna Acito
- Italian Society of Oral Hygiene Sciences-S.I.S.I.O. working group, Pisa, Italy
| | - Alessia Iommiello
- Italian Society of Oral Hygiene Sciences-S.I.S.I.O. working group, Pisa, Italy
| | | | - Alessia Iommiello
- Italian Society of Oral Hygiene Sciences-S.I.S.I.O. working group, Pisa, Italy
| | - Silvia Sabatini
- Italian Society of Oral Hygiene Sciences-S.I.S.I.O. working group, Pisa, Italy
| | - Gianna Maria Nardi
- Italian Society of Oral Hygiene Sciences-S.I.S.I.O. working group, Pisa, Italy.,Department of Oral and Maxillofacial Science, University of Rome "Sapienza", Rome, Italy
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Sangamesh NC, Vidya KC, Pathi J, Singh A. Awareness, Attitude, and Knowledge of Basic Life Support among Medical, Dental, and Nursing Faculties and Students in the University Hospital. J Int Soc Prev Community Dent 2017; 7:161-167. [PMID: 28852630 PMCID: PMC5558248 DOI: 10.4103/jispcd.jispcd_240_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 07/20/2017] [Indexed: 11/23/2022] Open
Abstract
Objective: To assess the awareness, attitude, and knowledge about basic life support (BLS) among medical, dental, and nursing students and faculties and the proposal of BLS skills in the academic curriculum of undergraduate (UG) course. Recognition, prevention, and effective management of life-threatening emergencies are the responsibility of health-care professionals. These situations can be successfully managed by proper knowledge and training of the BLS skills. These life-saving maneuvers can be given through the structured resuscitation programs, which are lacking in the academic curriculum. Materials and Methods: A questionnaire study consisting of 20 questions was conducted among 659 participants in the Kalinga Institute of Dental Sciences, Kalinga Institute of Medical Sciences, KIIT University. Medical junior residents, BDS faculties, interns, nursing faculties, and 3rd-year and final-year UG students from both medical and dental colleges were chosen. The statistical analysis was carried out using SPSS software version 20.0 (Armonk, NY:IBM Corp). Results: After collecting the data, the values were statistically analyzed and tabulated. Statistical analysis was performed using Mann–Whitney U-test. The results with P < 0.05 were considered statistically significant. Our participants were aware of BLS, showed positive attitude toward it, whereas the knowledge about BLS was lacking, with the statistically significant P value. Conclusion: By introducing BLS regularly in the academic curriculum and by routine hands on workshops, all the health-care providers should be well versed with the BLS skills for effectively managing the life-threatening emergencies.
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Affiliation(s)
- N C Sangamesh
- Department of Oral Medicine and Radiology, Kalinga Institute of Dental Sciences, KIIT University, Bhubaneswar, Odisha, India
| | - K C Vidya
- Department of Oral and Maxillofacial Surgery, Kalinga Institute of Dental Sciences, KIIT University, Bhubaneswar, Odisha, India
| | - Jugajyoti Pathi
- Department of Oral and Maxillofacial Surgery, Kalinga Institute of Dental Sciences, KIIT University, Bhubaneswar, Odisha, India
| | - Arpita Singh
- Department of Preventive and Community Dentistry, Kalinga Institute of Dental Sciences, KIIT University, Bhubaneswar, Odisha, India
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Georgiou K, Larentzakis A, Papavassiliou AG. Surgeons' and surgical trainees' acute stress in real operations or simulation: A systematic review. Surgeon 2017; 15:355-365. [PMID: 28716368 DOI: 10.1016/j.surge.2017.06.003] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Revised: 05/29/2017] [Accepted: 06/19/2017] [Indexed: 12/16/2022]
Abstract
BACKGROUND AND PURPOSE Acute stress in surgery is ubiquitous and has an immediate impact on surgical performance and patient safety. Surgeons react with several coping strategies; however, they recognise the necessity of formal stress management training. Thus, stress assessment is a direct need. Surgical simulation is a validated standardised training milieu designed to replicate real-life situations. It replicates stress, prevents biases, and provides objective metrics. The complexity of stress mechanisms makes stress measurement difficult to quantify and interpret. This systematic review aims to identify studies that have used acute stress estimation measurements in surgeons or surgical trainees during real operations or surgical simulation, and to collectively present the rationale of these tools, with special emphasis in salivary markers. METHODS A search strategy was implemented to retrieve relevant articles from MEDLINE and SCOPUS databases. The 738 articles retrieved were reviewed for further evaluation according to the predetermined inclusion/exclusion criteria. RESULTS Thirty-three studies were included in this systematic review. The methods for acute stress assessment varied greatly among studies with the non-invasive techniques being the most commonly used. Subjective and objective tests for surgeons' acute stress assessment are being presented. CONCLUSION There is a broad spectrum of acute mental stress assessment tools in the surgical field and simulation and salivary biomarkers have recently gained popularity. There is a need to maintain a consistent methodology in future research, towards a deeper understanding of acute stress in the surgical field.
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Affiliation(s)
- Konstantinos Georgiou
- Department of Biological Chemistry, Medical School, National and Kapodistrian University of Athens, 75 Mikras Asias Street, Athens 11527, Greece.
| | - Andreas Larentzakis
- 1st Propaedeutic Surgical Clinic, Medical School, National and Kapodistrian University of Athens, 114 Vasilissis Sofias Avenue, Athens 11527, Greece.
| | - Athanasios G Papavassiliou
- Department of Biological Chemistry, Medical School, National and Kapodistrian University of Athens, 75 Mikras Asias Street, Athens 11527, Greece.
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Marvin RK, Saepoo MB, Ye S, White DB, Liu R, Hensley K, Rega P, Kazan V, Giovannucci DR, Isailovic D. Salivary protein changes in response to acute stress in medical residents performing advanced clinical simulations: a pilot proteomics study. Biomarkers 2017; 22:372-382. [PMID: 28055279 DOI: 10.1080/1354750x.2017.1279215] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
CONTEXT Quantitative changes of salivary proteins due to acute stress were detected. OBJECTIVE To explore protein markers of stress in saliva of eight medical residents who performed emergency medicine simulations. MATERIALS AND METHODS Saliva was collected before the simulations, after the simulations, and following morning upon waking. Proteins were separated by sodium dodecyl sulphate-polyacrylamide gel electrophoresis (SDS-PAGE), identified by mass spectrometry (MS), and relatively quantified by densitometry. RESULTS Salivary alpha-amylase and S-type cystatins significantly increased, while the ∼26 kDa and low-molecular weight (MW) (<10 kDa) SDS-PAGE bands exhibited changes after stress. DISCUSSION AND CONCLUSION Alpha-amylase and cystatins are potential salivary markers of acute stress, but further validation should be performed using larger sample populations.
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Affiliation(s)
- Rachel K Marvin
- a Department of Chemistry and Biochemistry , University of Toledo , Toledo , OH , USA
| | | | - Simiao Ye
- c Department of Mathematics and Statistics , University of Toledo , Toledo , OH , USA
| | - Donald B White
- c Department of Mathematics and Statistics , University of Toledo , Toledo , OH , USA
| | - Rong Liu
- c Department of Mathematics and Statistics , University of Toledo , Toledo , OH , USA
| | - Kenneth Hensley
- d Department of Pathology , University of Toledo, Toledo , OH, USA
| | - Paul Rega
- e Department of Emergency Medicine , University of Toledo , Toledo , OH , USA
| | - Viviane Kazan
- e Department of Emergency Medicine , University of Toledo , Toledo , OH , USA
| | | | - Dragan Isailovic
- a Department of Chemistry and Biochemistry , University of Toledo , Toledo , OH , USA
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Application of Entropy-Based Metrics to Identify Emotional Distress from Electroencephalographic Recordings. ENTROPY 2016. [DOI: 10.3390/e18060221] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Hemodynamic response during aneurysm clipping surgery among experienced neurosurgeons. Acta Neurochir (Wien) 2016; 158:221-7. [PMID: 26711287 DOI: 10.1007/s00701-015-2682-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Accepted: 12/14/2015] [Indexed: 01/08/2023]
Abstract
BACKGROUND Neurosurgery is a challenging field associated with high levels of mental stress. The goal of this study was to investigate the hemodynamic response of experienced neurosurgeons during aneurysm clipping surgery and to evaluate whether neurosurgeons' hemodynamic responses are associated with patients' clinical statuses. METHODS Four vascular neurosurgeons (all male; mean age 51 ± 10 years; post-residency experience ≥7 years) were studied during 42 aneurysm clipping procedures. Blood pressure (BP) and heart rate (HR) were assessed at rest and during seven phases of surgery: before the skin incision, after craniotomy, after dural opening, after aneurysm neck dissection, after aneurysm clipping, after dural closure and after skin closure. RESULTS HR and BP were significantly greater during surgery relative to the rest situation (p ≤ 0.03). There was a statistically significant increase in neurosurgeons' HR (F [6, 41] = 10.88, p < 0.001), systolic BP (F [6, 41] = 2.97, p = 0.01), diastolic BP (F [6, 41] = 2.49, p = 0.02) and mean BP (F [6, 41] = 3.36, p = 0.003) during surgery. The greatest mean HR was after aneurysm clipping, and the greatest BP was after aneurysm neck dissection. Systolic, diastolic and mean BPs were significantly greater during surgical clipping for unruptured aneurysms compared to ruptured aneurysms across all stages of surgery (p ≤ 0.002); however, after adjusting for neurosurgeon experience, the difference in BP as a function of aneurysm rupture was not significant (p > 0.08). Aneurysm location, intraoperative aneurysm rupture, admission WFNS score, admission Glasgow Coma Scale scores and Fisher grade were not associated with neurosurgeons' intraoperative HR and BP (all p > 0.07). CONCLUSIONS Aneurysm clipping surgery is associated with significant hemodynamic system activation among experienced neurosurgeons. The greatest HR and BP were after aneurysm neck dissection and clipping. Aneurysm location and patient clinical status were not associated with intraoperative changes of neurosurgeons' HR and BP.
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Watanabe K, Shirakawa T. Characteristics of Perceived Stress and Salivary Levels of Secretory Immunoglobulin A and Cortisol in Japanese Women With Premenstrual Syndrome. Nurs Midwifery Stud 2015; 4:e24795. [PMID: 26339665 PMCID: PMC4557405 DOI: 10.17795/nmsjournal24795] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Revised: 01/23/2015] [Accepted: 02/05/2015] [Indexed: 12/27/2022] Open
Abstract
Background: Several studies have demonstrated the associations between Premenstrual Syndrome and perceived stress, and no studies quantifying stress based on biochemical parameters have been conducted. Objectives: The objective of this study was to examine the changes in biochemical parameters of stress and measured perceived stress during the menstrual cycle of women with premenstrual syndrome. Patients and Methods: A longitudinal observational study was conducted in 2010 in the Kansai region of Japan. Thirteen women with premenstrual syndrome and 11 controls, all with regular menstrual cycles, participated in this study. Salivary secretory immunoglobulin A (S-IgA) and cortisol levels were measured as biochemical parameters, and scores on the Stress Check List KM (SCL-KM) (Cronbach’s α in this study ranged from 0.76 to 0.84) were used to indicate perceived stress through two complete menstrual cycles. Before stress measurements were taken, premenstrual, menstrual and postmenstrual phases were confirmed based on records of basal body temperature across two menstrual cycles. Data analysis was performed using the Student’s t-test, analysis of variance with repeated measures, and Pearson’s correlation coefficient, as appropriate. Results: Both the postmenstrual S-IgA concentration and secretion rate were significantly lower in the group with premenstrual syndrome than in controls (P < 0.05). Premenstrual S-IgA concentrations were significantly higher than postmenstrual levels in the group with premenstrual syndrome (P < 0.05). No significant differences in cortisol levels were seen in either group during any phase. Premenstrual and postmenstrual phase SCL-KM scores were significantly higher in the group with premenstrual syndrome than in controls (P < 0.05). No significant changes in the SCL-KM scores were observed among menstrual cycle phases in either group. Postmenstrual S-IgA levels were negatively correlated with the SCL-KM score (P < 0.05). Conclusions: The stress due to psychosomatic changes in the menstrual cycle is associated with premenstrual syndrome. Measures of S-IgA, rather than cortisol or subjective responses to stress, may be most closely associated with PMS.
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Affiliation(s)
- Kaori Watanabe
- School of Human Nursing, University of Shiga Prefecture, Hikone, Shiga, Japan
| | - Taku Shirakawa
- Graduate School of Health Sciences, University of Kobe, Kobe, Hyogo, Japan
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