SAMHD1 controls innate immunity by regulating condensation of immunogenic self RNA

Recognition of pathogen-derived foreign nucleic acids is central to innate immune defense. This requires discrimination between structurally highly similar self and nonself nucleic acids to avoid aberrant inflammatory responses as in the autoinflammatory disorder Aicardi-Goutières syndrome (AGS). How vast amounts of self RNA are shielded from immune recognition to prevent autoinflammation is not fully understood. Here, we show that human SAM-domain- and HD-domain-containing protein 1 (SAMHD1), one of the AGS-causing genes, functions as a single-stranded RNA (ssRNA) 3'exonuclease, the lack of which causes cellular RNA accumulation. Increased ssRNA in cells leads to dissolution of RNA-protein condensates, which sequester immunogenic double-stranded RNA (dsRNA). Release of sequestered dsRNA from condensates triggers activation of antiviral type I interferon via retinoic-acid-inducible gene I-like receptors. Our results establish SAMHD1 as a key regulator of cellular RNA homeostasis and demonstrate that buffering of immunogenic self RNA by condensates regulates innate immune responses.

364 Systematic Review of Simulation-Based Training Tools in Plastic Surgery

Aim

The recent shift from traditional surgical teaching to the incorporation of simulation training in plastic surgery has resulted in the development of a variety of simulation models and tools. We aim to identify all currently available simulators and tools for plastic surgery, assess their validity and establish their effectiveness.

Method

MEDLINE and Embase were searched for articles which validate simulation models in plastic surgery. Each study was screened in accordance with the Messick validity framework, and a rating was given for each section. In order to determine the effectiveness of each study, the McGaghie model of translational outcomes was used.

Results

On screening 2104 articles, 71 were identified to discuss validity and effectiveness. Only one study was found to achieve a high score in all validity parameters and no studies achieved an effectiveness level >2.

Conclusions

With the increasing amount of simulation training tools, there must be more validity studies conducted using updated validity frameworks. In addition, there should be an increased emphasis of the relationship between these simulators and patient outcomes/surgical technique in the operating theatre in order to determine translational outcomes. More training tools evaluating both technical and nontechnical surgical skills are recommended.

A rare case of duodenal inversum- A laparoscopically manageable entity

Duodenal inversum is a rare disease not frequently encountered in clinical practice. The diagnosis is usually made late due to its rarity. Many other causes of abdominal pain like ulcer disease, pancreatitis, malrotation are mostly thought of initially and the diagnosis is usually missed. Only a few cases of duodenal inversum present with outlet obstruction. Duodenojejunostomy is perhaps the ideal management for duodenal inversum if the patient presents with outlet obstruction. Our intention is to create awareness of such a rare disease with an available definitive treatment option in the form of minimally invasive surgery. One such case of a 31-year-old man is described that was successfully managed by laparoscopic duodenojejunostomy.

O53: SO YOU WANT TO BE A ROBOTIC SURGEON? THE EFFECT OF BASELINE PSYCHOMOTOR ABILITY AND VIDEO-GAME EXPERIENCE ON ROBOTIC SURGICAL SKILL: A RANDOMISED CONTROL TRIAL

Introduction

We assessed whether expert mentoring improved the rate of uptake of robotic surgical skill and whether general advanced psychomotor ability (PMA), and specific video-game experience (VGE) had any impact on robotic surgical skill.

Method

Twenty robotically naive medical students were blinded and randomised to two cohorts; control (CC) and intervention (IC). Each student's initial performance on a variety of da Vinci Skills Simulator (dVSSim) exercises was measured and then reassessed following an independent practice (CC) or mentor guided practice session (IC). Outcome metrics were overall score, time to completion, economy of motion and master workspace range. Quantitative, questionnaire data was collected to evaluate the relationship between robotic surgical skill, PMA and VGE. Statistical analysis was performed with SPSS software utilising the independent t-test.

Result

On average, overall score for CC improved by 16.8% compared to 43.3% for the IC (p=0.04). Time to completion improved by 26.2% (CC) vs. 40% (IC), economy of motion by 16.5% vs. 25% and master workspace range by 8% vs. 11%. PMA correlated with better initial performances for all metrics, especially for overall score (p=0.003) and economy of motion (p=0.03). Students with more VGE had overall scores that were on average 20% better than those with little or no experience and this relationship was also seen for economy of motion and master workspace range.

Conclusion

Expert mentoring leads to a greater improvement in performance than independent practice alone. Advanced PMA correlates with greater innate robotic skill, as does VGE, but to a lesser extent.

Take-home message

1) Expert mentoring leads to a greater improvement in performance than independent practice alone. 2) Advanced PMA correlates with greater innate robotic skill, as does VGE, but to a lesser extent.

Effects of water deficit stress on agronomic and physiological responses of rice and greenhouse gas emission from rice soil under elevated atmospheric CO2

Rice is the foremost staple food in the world, safeguarding the global food and nutritional security. Rise in atmospheric carbon dioxide (CO₂) and water deficits are threatening global rice productivity and sustainability. Under real field conditions these climatic factors often interact with each other resulting in impacts that are remarkably different compared to individual factor exposure. Rice soils exposed to drought and elevated CO₂ (eCO₂) alters the biomass, diversity and activity of soil microorganisms affecting greenhouse gas (GHG) emission dynamics. In this review we have discussed the impacts of eCO₂ and water deficit on agronomic, biochemical and physiological responses of rice and GHGs emissions from rice soils. Drought usually results in oxidative stress due to stomatal closure, dry weight reduction, formation of reactive oxygen species, decrease in relative water content and increase in electrolyte leakage at almost all growth and developmental phases of rice. Elevated atmospheric CO₂ concentration reduces the negative effects of drought by improving plant water relations, reducing stomatal opening, decreasing transpiration, increasing canopy photosynthesis, shortening crop growth period and increasing the antioxidant metabolite activities in rice. Increased scientific understanding of the effects of drought and eCO₂ on rice agronomy, physiology and GHG emission dynamics of rice soil is essential for devising adaptation options. Integration of novel agronomic practices viz., crop establishment methods and alternate cropping systems with improved water and nutrient management are important steps to help rice farmers cope with drought and eCO₂. The review summarizes future research needs for ensuring sustained global food security under future warmer, drier and high CO₂ conditions.

Effectiveness of pectoralis major myocutaneous flap in the surgical management of oral cancer: A retrospective study

INTRODUCTION

Over 80,000 oral cancer cases get diagnosed each year in India, majority undergoing extensive resections owing to their late presentation. Pectoralis major myocutaneous (PMMC) flap is a pedicled axial pattern flap which is based on thoracoacromical artery. It is readily available as a viable alternative to free flap reconstruction, especially for the economically poor and malnourished patients. Its proximity to head and neck structures gives added advantage to reconstruct complex and large volume oral and maxillofacial defects. It provides a relatively good possibility of functional and aesthetic restoration providing both mucosal lining and skin cover.

MATERIALS AND METHODS

This was a prospective observational study of 29 PMMC flap reconstructions, conducted between 2013-2016. The reconstruction outcomes assessed in this study were divided into two categories namely "success" and "failure" based on certain functional parameters observed during follow-up of 1 year. The complications were broadly classified as major/minor and flap related/non-flap related. We assessed the feasibility of using a PMMC flap for reconstructing various subsites of oral cavity cancer. Further, the association of patient variables with complication rates and outcome of reconstruction were analysed.

RESULTS

Out of 29 patients overall complications were noted in 15 (51.7%) cases with a female preponderance. Flap-related complications were noted in 9 whereas non-flap-related complications were seen in 6 patients. Major and minor complications were noted in 2 (both flap related) and 13 cases respectively. Complete full thickness flap necrosis was not encountered in any patient. Patients with flap skin paddle size ≤ 36 cm² (n = 12) had significantly increased overall complication rates. Despite complications a high success rate (93.1%, n = 27) was achieved with this mode of reconstruction.

CONCLUSION

The PMMC flap reconstruction is a versatile, reliable and an affordable single staged procedure with a high success rate in terms of achieving treatment goals. Although it has moderately high complication rates, but PMMC flap proved to be a workhorse in locally advanced cases of head and neck cancer at the end of 1 year follow-up.

Development and validation of a training and assessment tool for laparoscopic radical nephrectomy

INTRODUCTION

Laparoscopic radical nephrectomy(LRN) is a cornerstone in managing renal cancer and small renal masses. Twenty-first century surgical training faces challenges, thus must be efficient and safe so surgeons attain relevant skills, protecting patients and operative outcomes. This study aimed to systematically develop a tool for training and assessment in LRN and validate the developed tool for use by trainee urologists.

METHODS

This prospective, longitudinal, multi-institutional study was undertaken from September 2014 - June 2015. Healthcare Failure Mode and Effect Analysis was utilised for development and followed by validation where the assessment tool was distributed to five specialists to increase content validity. Four experts were observed as a multi-institutional approach. Hand-assisted, transperitoneal and retroperitoneal approaches were considered.

RESULTS

The LRN Assessment Tool comprised four phases, 17 processes, 41 sub-processes. Four surgeons and operating teams were observed across four hospitals for 19.5hours (5.75h hand-assisted, 8.75h trans-peritoneal, 5h retro-peritoneal). After hazard analysis, three checklists were constructed. Those for hand-assisted LRN and transperitoneal LRN contained four phases, 20 processes, 33 sub-processes and that for retroperitoneal LRN contained four phases, 20 processes, 30 sub-processes. These were merged to form one assessment tool. The final result was a four phase LRN Assessment Tool with 17 processes, 41 sub-processes. All participants agreed the final LRN Assessment Tool included pertinent steps.

CONCLUSIONS

The LRN Assessment Tool was developed using Healthcare Failure Mode and Effect Analysis risk analysis to ensure hazardous procedural sub-steps were included. Validation ascertained important processes were not overlooked. Full application through a pilot study must be undertaken.

Sella Turcica Bridging As A Predictor Of Class II Malocclusion-An Investigative Study

BACKGROUND

Sella turcica, the bony depression located in sphenoid bone houses and protects the pituitary gland. Formation and development of the sella turcica and teeth share, in common, the involvement of neural crest cells. The anterior part of the sella turcica is believed to develop mainly from neural crest cells, and dental epithelial progenitor cells differentiate through sequential and reciprocal interaction with neural crest-derived mesenchyme. Thus, any structural deviations in the sella, like bridging or roofing, are believed to be related to specific deviations in the facial skeleton and dental anomalies. Until now, there have been no studies concerning the prevalence of sella turcica bridging in skeletal Class II subjects.

OBJECTIVE

The aim of this study was to analyse the prevalence of sella turcica bridging in subjects with class I and class II skeletal types and to check whether sella can be considered as diagnostic marker for skeletal class II malocclusion.

MATERIALS AND METHODS

Lateral cephalometric images of 205 subjects in the age range of 13 to 25 years were retrospectively analysed and classified for the type of skeletal malocclusion and the radiographs were evaluated for the prevalence of bridging of the sella in these subjects.

RESULTS

The results show significance in the prevalence of sella turcica bridging (partial/complete) among subjects with skeletal class II malocclusion.

The role of cognitive training in endourology: a randomised controlled trial

INTRODUCTION

Cognitive training is an important training modality which allows the user to rehearse a procedure without physically carrying it out. This has led to recent interests to incorporate cognitive training within surgical education but research is currently limited. The use of cognitive training in surgery is not clear-cut and so this study aimed to determine whether, relative to a control condition, the use of cognitive training improves technical surgical skills on a ureteroscopy simulator, and if so whether one cognitive training method is superior.

METHODS

This prospective, comparative study recruited 59 medical students and randomised them to one of three groups: control- simulation training only (n=20), flashcards cognitive training group (n=20) or mental imagery cognitive training group (n=19). All participants completed three tasks at baseline on the URO Mentor simulator followed by the cognitive intervention if randomised to receive it. Participants then returned to perform an assessment task on the simulator. Outcome measures from the URO Mentor performance report was used for analysis and a quantitative survey was given to all participants to assess usefulness of training received.

RESULTS

This study showed cognitive training to have minimal effects on technical skills of participants. The mental imagery group had fewer laser misfires in the assessment task when compared to both control and flashcards group (P=.017, P=.036, respectively). The flashcards group rated their preparation to be most useful when compared to control (P=.0125). Other parameters analysed between the groups did not reach statistical significance. Cognitive training was found to be feasible and cost effective when carried out in addition to simulation training.

CONCLUSION

This study has shown that the role of cognitive training within acquisition of surgical skills is minimal and that no form of cognitive training was superior to another. Further research needs to be done to evaluate other ways of performing cognitive training.

King's Health Partners' Prostate Cancer Biobank (KHP PCaBB)

The KHP PCaBB was established in 2013 and recruits donors from the Urology or Oncology Departments at Guy's Hospital in London (UK). Prostate cancer patients may be approached to give their consent for biobanking at any point in their treatment pathway, which allows residual material from their earlier diagnosis to be transferred and used by the Biobank. Currently, patients are specifically asked to donate samples of blood and surplus prostate tissue as well as permitting access to their clinical and pathological data that continues to be added throughout the course of their disease. Between 2013 and 2015, 549 prostate cancer patients gave their consent to the biobank and, the tissue repository collected 489 blood samples, 120 frozen prostate tissue samples and 1064 formalin fixed paraffin embedded diagnostic blocks.Prostate cancer has become a chronic disease in a large proportion of men, with many men receiving multiple subsequent treatments, and their treatment trajectory often spanning over decades. Therefore, this resource aims to provide an ideal research platform to explore potential variations in treatment response as well as disease markers in the different risk categories for prostate cancer.A recent audit of the KHP PCaBB revealed that between 2013 and 2015, 1796 patients were diagnosed with prostate cancer at King's Health Partners (KHP), out of which 549 (30.6%) gave their consent to KHP PCaBB. Comparisons between demographic and clinical characteristics of patients who had consented compared to the total patient population revealed that the KHP PCaBB is demographically representative of the total prostate cancer patient population seen in Guy's and St Thomas' NHS Foundation Trust (GSTT). We observed no differences in distribution of ethnicity (p = 0.507) and socioeconomic status (p = 0.097). Some differences were observed in clinical characteristics, specifically with treatment type - which differed significantly between the patients who had given consent and total patient population.The KHP PCaBB has thereby amassed a rich data and tissue repository that is largely reflective of both the demographic and clinical diversity within the total prostate cancer patient population seen at KHP, making it an ideal platform for prostate cancer research.

Morphological variations of median maxillary labial frenum: A clinical study

BACKGROUND

Median maxillary labial frenum (MMLF) appears as a fold of mucous membrane extending from the lining of the mucous membrane of the lips towards the crest of the alveolar ridge on the labial surface. MMLF can demonstrate certain variations in their shape, size and position, both among individuals and within the same individual at different ages. Many clinicians, not being aware of the normal variations of median maxillary labial frenum misinterpret them as pathological entities.

OBJECTIVES

The objectives of the study were to determine the prevalence of morphologic variations of MMLF, to classify the morphological variations of MMLF on the basis of their location on the frenum and to compare the morphological variations of MMLF among different age groups and genders.

MATERIALS AND METHODS

The study was conducted on 700 males and 700 females of age 5 to 74 yrs, chosen randomly. They were equally divided on the basis of age into 7 groups, each group having equal gender distribution. The morphological variations of MMLF were classified according to Sewerin's classification and the attachments on the freni were further sub-classified.

RESULTS

The commonest type of frenum was found to be the simple type, whereas bifid frenum was not found at all. Statistically significant difference was found in proportion of types of frenum among the different age groups and also in proportion of types of frenum among the different sites of presence of frenal attachments. No statistically significant difference was found in proportion of types of frenum in male and female subjects.

CONCLUSION

This study shows that MMLF presents with an array of morphological variations. These morphological variations may sometimes pose a complicating factor in maintaining oral hygiene, speech, mastication, esthetics, denture construction, etc. Hence, appropriate recognition of frenal variations and subsequent modification of treatment procedures are essential for a successful outcome of therapy.

Precision surgery and genitourinary cancers

The landscape of the surgical management of urologic malignancies has dramatically changed over the past 20 years. On one side, better diagnostic and prognostic tools allowed better patient selection and more reliable surgical planning. On the other hand, the implementation of minimally invasive techniques and technologies, such as robot-assisted laparoscopy surgery and image-guided surgery, allowed minimizing surgical morbidity. Ultimately, these advances have translated into a more tailored approach to the management of urologic cancer patients. Following the paradigm of "precision medicine", contemporary urologic surgery has entered a technology-driven era of "precision surgery", which entails a range of surgical procedures tailored to combine maximal treatment efficacy with minimal impact on patient function and health related quality of life. Aim of this non-systematic review is to provide a critical analysis of the most recent advances in the field of surgical uro-oncology, and to define the current and future role of "precision surgery" in the management of genitourinary cancers.

Comfort and learnability assessment of a new soft robotic manipulator for minimally invasive surgery

Laparoscopic surgeons perform precise and time consuming procedures while holding awkward poses in their upper body and arms. There is an ongoing effort to produce robotic tools for laparoscopic surgery that will simplify these tasks and reduce risk of errors to help both the surgeon and the patient. STIFF-FLOP is an ongoing EU FP7 project focusing on this by creating a stiffness controllable soft robotic manipulator. This paper reports on a study to test the soft manipulator's learnability and the effort associated with its use. The tests involved a limited prototype of the manipulator with a custom built test rig and EMG acquisition system. Task times and video recordings along with EMG waveforms from the forearm muscles of participants (n=25) were measured for objective assessment. A questionnaire was also provided to the participants for subjective assessment. The data shows that in average EMG levels were 25.9% less in RMS when using the STIFF-FLOP arm than when conventional laparoscopic tools were used. In terms of learnability, from the first to the second attempt on the STIFF-FLOP manipulator, elapsed time was reduced by an average of 32.1%. Further details and analysis of the EMG signals as well as time and questionnaire results is presented in the paper.

Systematic review of the relationship between artificial sweetener consumption and cancer in humans: analysis of 599,741 participants

BACKGROUND

The effect of artificial sweetener consumption on cancer risk has been debated in animal models for over four decades. To further investigate this relationship, this study aims to synthesise results from several of the most recent studies in humans.

METHODS

An online literature search was performed in MEDLINE from 2003 to 2014 using Ovid, PubMed, Web of Science, and Scopus using keywords 'artificial', 'sweetener' and 'cancer'. Ninety-two results were then manually assessed for eligibility. Studies were included if the relationship between artificial sweeteners and cancer was their central hypothesis, and if they adjusted for age, gender, smoking status and body mass index. Extracted data included study design, patient characteristics, outcome measure and results.

RESULTS

In the five publications that satisfied the inclusion criteria, significant direct associations with artificial consumption were found for laryngeal (odds ratio, OR 2.34, 95% CI: 1.20-4.55), urinary tract tumours (OR 2.12, 95% CI: 1.22-3.89), non-Hodgkin lymphoma in men (RR 1.31, 95% CI: 1.01-1.72), multiple myeloma in men (RR 2.02, 95% CI: 1.20-3.40) and leukaemia (RR 1.42, 95% CI: 1.00-2.02). Inverse relationships were found in breast (OR 0.70, 95% CI: 0.54-0.91, p trend = 0.015) and ovarian (OR 0.56, 95% CI: 0.38-0.81, p trend < 0.001) cancers.

CONCLUSION

The statistical value of this review is limited by the heterogeneity and observational designs of the included studies. Although there is limited evidence to suggest that heavy consumption may increase the risk of certain cancers, overall the data presented are inconclusive as to any relationship between artificial sweeteners and cancer.

Primary Peritoneal Papillary Serous Cystadenocarcinoma - A Rare Malignancy

Primary peritoneal papillary serous carcinoma is a rare primary malignancy diffusively involving the peritoneum of abdomen and pelvis. Epithelial ovarian cancers and primary peritoneal cancers arise from the common germinal epithelium which develops from the coelomic epithelium. Due to a common embryonic origin of the ovary and the peritoneum, carcinoma of the ovary and primary peritoneal carcinoma have much histological similarity. However the incidence of Primary peritoneal serous carcinoma is considerably lower than that of epithelial ovarian cancer and is mostly seen in elderly women. Early stages of this disease may be asymptomatic; symptoms of the advance stages of the disease include abdominal distention, abdominal lump, non-specific abdominal pain, vomiting and dyspnoea all as a result of massive ascites. Patients diagnosed with primary peritoneal papillary serous carcinoma are treated using the same staging, surgical and chemotherapeutic approach as epithelial ovarian cancer because of the similarities in biological behavior.

Active surveillance in prostate cancer: a critical review

The aim of this paper was to examine the eligibility criteria, surveillance protocols and oncological outcomes of published active surveillance (AS) series. We also assessed the evidence for utility of novel tools for optimal risk stratification and surveillance of men suitable for AS. A non-systematic literature search of the Medline, Embase, and Scopus databases was performed in April 2015 using medical subject headings and free-text protocol. The search was conducted by applying free-text protocol with the following search terms: "active surveillance", "prostate cancer", "prostatic neoplasm", "watchful waiting", "low risk prostate cancer" and "very low risk prostate cancer". The definition of insignificant disease remains debatable as criteria for patient selection vary among studies. Tools for better selection of candidates and monitoring of the disease process have evolved since the conception of AS, including new biomarkers like phi, mpMRI and alternate biopsy strategies. AS is a sound strategy for reducing overtreatment of men with low-risk, and potentially selected men with intermediate-risk prostate cancer and shorter life expectancy, without compromising overall and cancer specific survival. More data are needed on the optimal integration of the new tools on AS paradigms and on the long-term health impact of AS in different populations.

Robotic surgery in trauma and orthopaedics: a systematic review

The use of robots in orthopaedic surgery is an emerging field that is gaining momentum. It has the potential for significant improvements in surgical planning, accuracy of component implantation and patient safety. Advocates of robot-assisted systems describe better patient outcomes through improved pre-operative planning and enhanced execution of surgery. However, costs, limited availability, a lack of evidence regarding the efficiency and safety of such systems and an absence of long-term high-impact studies have restricted the widespread implementation of these systems. We have reviewed the literature on the efficacy, safety and current understanding of the use of robotics in orthopaedics.

Endoscopic add-on stiffness probe for real-time soft surface characterisation in MIS

This paper explores a novel stiffness sensor which is mounted on the tip of a laparoscopic camera. The proposed device is able to compute stiffness when interacting with soft surfaces. The sensor can be used in Minimally Invasive Surgery, for instance, to localise tumor tissue which commonly has a higher stiffness when compared to healthy tissue. The purely mechanical sensor structure utilizes the functionality of an endoscopic camera to the maximum by visually analyzing the behavior of trackers within the field of view. Two pairs of spheres (used as easily identifiable features in the camera images) are connected to two springs with known but different spring constants. Four individual indenters attached to the spheres are used to palpate the surface. During palpation, the spheres move linearly towards the objective lens (i.e. the distance between lens and spheres is changing) resulting in variations of their diameters in the camera images. Relating the measured diameters to the different spring constants, a developed mathematical model is able to determine the surface stiffness in real-time. Tests were performed using a surgical endoscope to palpate silicon phantoms presenting different stiffness. Results show that the accuracy of the sensing system developed increases with the softness of the examined tissue.

Systematic review of prostate cancer risk and association with consumption of fish and fish-oils: analysis of 495,321 participants

INTRODUCTION

Fish-oils have a potential role in inflammation, carcinogenesis inhibition and favourable cancer outcomes. There has been increasing interest in the relationship of diet with cancer incidence and mortality, especially for eicosapantaenoic acid (EPA) and docosahexaenoic acid (DHA). This systematic-analysis of the literature aims to review evidence for the roles of dietary-fish and fish-oil intake in prostate-cancer (PC) risk, aggressiveness and mortality.

METHODS

A systematic-review, following PRISMA guidelines was conducted. PubMed, MEDLINE and Embase were searched to explore PC-risk, aggressiveness and mortality associated with dietary-fish and fish-oil intake. 37 studies were selected.

RESULTS

A total of 495,321 (37-studies) participants were investigated. These revealed various relationships regarding PC-risk (n = 31), aggressiveness (n = 8) and mortality (n = 3). Overall, 10 studies considering PC-risk found significant inverse trends with fish and fish-oil intake. One found a dose-response relationship whereas greater intake of long-chain-polyunsaturated fatty acids increased risk of PC when considering crude odds-ratios [OR: 1.36 (95% CI: 0.99-1.86); p = 0.014]. Three studies addressing aggressiveness identified significant positive relationships with reduced risk of aggressive cancer when considering the greatest intake of total fish [OR 0.56 (95% CI 0.37-0.86)], dark fish and shellfish-meat (p < 0.0001), EPA (p = 0.03) and DHA (p = 0.04). Three studies investigating fish consumption and PC-mortality identified a significantly reduced risk. Multivariate-OR (95% CI) were 0.9 (0.6-1.7), 0.12 (0.05-0.32) and 0.52 (0.30-0.91) at highest fish intakes.

CONCLUSIONS

Fish and fish-oil do not show consistent roles in reducing PC incidence, aggressiveness and mortality. Results suggest that the specific fish type and the fish-oil ratio must be considered. Findings suggest the need for large intervention randomised placebo-controlled trials.

Stable room temperature magnetic ordering and excellent catalytic activity of mechanically activated high surface area nanosized Ni0.45Zn0.55Fe2O4

Mechanosynthesized nanometric Ni_0.45Zn_0.55Fe₂O₄ exhibit stable magnetic ordering at room temperature, excellent catalytic property and memory effect in dc magnetization profile.

Systematic review of live surgical demonstrations and their effectiveness on training

BACKGROUND

Live surgical demonstrations are commonly performed for surgical conferences. These live procedures have recently come under scrutiny, in particular with issues pertaining to patient safety. This systematic review aimed to explore the evidence for live surgery as a training tool, and to investigate the safety of live surgical broadcasts.

METHODS

PubMed, Embase, MEDLINE and Cochrane Library databases were searched using a predefined search strategy from January 1980 to October 2013. Specialty Societies and primary Colleges of Surgeons were searched for guidelines or position statements on live surgical teaching.

RESULTS

Educational value criteria demonstrated for live surgery included feasibility, acceptability, construct and concurrent validity. Complication rates during live procedures were not compromised in the majority of studies. Patient safety, however, may be affected during live procedures as success rates have been found to be lower in some studies. Only Cardiothoracic, Urology and Vascular Surgical Societies currently offer guidelines on conducting live surgical demonstrations.

CONCLUSION

Little evidence exists on the safety and educational value of live surgery, with few studies of high quality conducted. Guidance on live procedures is scarce, with only three major surgical specialties offering any advice. More needs to be done to establish and promote evidence for the value of live surgery demonstrations.

Technical aspects of botulinum toxin type A injection in the bladder to treat urinary incontinence: reviewing the procedure

AIMS

Standardise the injection technique with botulinum toxin type A (BoNT A) in the bladder of patients with overactive bladder (OAB) [idiopathic overactive bladder (iOAB) or neurogenic overactive bladder (nOAB) with urinary incontinence], using a literature review and a survey of an International expert panel.

METHODS

PubMed literature searches of BoNT A in adults with iOAB/nOAB together with a survey of 13 experts from 10 countries.

RESULTS

Data from 21 articles and completed questionnaires were collated. The procedure can be carried out in an out-/inpatient setting. Dose used in clinical studies vs. clinical practice was 300 and 200 U for nOAB and 200 and 100 U for iOAB. Recent studies have also demonstrated that there are no clinically relevant benefits between 100 and 150 U in iOAB or between 300 and 200 U in nOAB, though adverse effects are increased with higher doses. Usually, 30 sites for nOAB (range: 6.7-10 U/ml) and 20-30 sites for iOAB (range: 5-10 U/ml) are injected in clinical studies vs. 20-30 sites of 1 ml/injection for 200 U in nOAB and 10-20 sites of 0.5-1 ml/injection for 100 U in iOAB in clinical practice. BoNT A is usually injected directly into the detrusor, sparing the trigone. Flexible or rigid cystoscopes are used. The needle should be typically 22-27 gauge and 4 mm in length and should have a stopper to avoid any leakage or perforation of the bladder wall while ensuring a targeted injection.

CONCLUSION

Based on the literature and survey analysis, recommendations are proposed for the standardisation of the injection procedure.

Learning Curve of Basic Surgical Skill Acquisition on the Sep Robot

The benefits of minimally invasive surgery have led to adoption of laparoscopic assisted robotic surgery across several surgical specialties. Surgeons have acquired considerable expertise in conventional laparoscopic surgery but robotic assistance has allowed performance of similar tasks with greater ease. However, the embracing of minimal invasive surgical techniques demands the rapid acquisition of new skills by surgical trainees and practising surgeons.