1327 Youtube As in Information Source for Microsurgical Training: A Systematic Review of Video Content

Aim

The COVID-19 pandemic has resulted in fewer physical microsurgical training opportunities, forcing trainees to seek virtual alternatives. As one of the largest video-sharing platforms globally, YouTube is increasingly being used to provide educational content. With additional emphasis placed on these videos, there will likely have an impact on training progression further down the line. This research aims to evaluate YouTube video content as a microsurgical training information source.

Method

We searched Youtube.com for videos demonstrating and teaching microsurgical techniques. Search terms included “microsurgical”, “teaching”, “anastomosis” and “flap”. All videos of neurosurgical nature were excluded. Thirty-one videos were evaluated using nine criteria and using a modified GQS score. To reduce duplication, included videos were limited to two from one source.

Results

Initial results show 79% of the videos were GQS Score 4/5 and therefore of good quality, despite only 38.7% featuring human procedures. 82.8% of the videos found were from medical websites, with most generated from three independent sources. The highly-scoring YouTube videos tended to have an audio voice-over or subtitles and clearly described the instruments and materials used.

Conclusions

The results demonstrated that high-quality videos are easily accessible on YouTube and deemed useful as educational tools. However, trainees should be aware that varied sources provide videos that range in quality; and the learning acquired may not directly correspond to learning objectives set out by governing bodies and is unlikely to be comparable to real-life observation in theatre. Overall, evidence for the current educational value of YouTube for microsurgical techniques is somewhat limited.

The application of triple aim framework in the context of primary healthcare: A systematic literature review

The Triple Aim framework is an increasingly popular tool for designing and assessing quality improvements in the health care sector. We systematically reviewed the empirical evidence on the application of the Triple Aim framework within primary healthcare settings since its inception almost a decade ago. Results show that primary healthcare providers varied in their interpretation of the Triple Aim framework and generally struggled with a lack of guidance and an absence of composite sets of measures for performance assessment. Greater clarity around application of the Triple Aim framework in primary healthcare is needed, especially around the selection and implementation of purposeful measures from locally available data. This review highlights areas for improvement and makes recommendations intended to guide future applications of the Triple Aim in the context of primary healthcare.

Anti-CD22 and anti-CD79B antibody drug conjugates are active in different molecular diffuse large B-cell lymphoma subtypes

Antibody drug conjugates (ADCs), in which cytotoxic drugs are linked to antibodies targeting antigens on tumor cells, represent promising novel agents for the treatment of malignant lymphomas. Pinatuzumab vedotin is an anti-CD22 ADC and polatuzumab vedotin an anti-CD79B ADC that are both linked to the microtubule-disrupting agent monomethyl auristatin E (MMAE). In the present study, we analyzed the activity of these agents in different molecular subtypes of diffuse large B-cell lymphoma (DLBCL) both in vitro and in early clinical trials. Both anti-CD22-MMAE and anti-CD79B-MMAE were highly active and induced cell death in the vast majority of activated B-cell-like (ABC) and germinal center B-cell-like (GCB) DLBCL cell lines. Similarly, both agents induced cytotoxicity in models with and without mutations in the signaling molecule CD79B. In line with these observations, relapsed and refractory DLBCL patients of both subtypes responded to these agents. Importantly, a strong correlation between CD22 and CD79B expression in vitro and in vivo was not detectable, indicating that patients should not be excluded from anti-CD22-MMAE or anti-CD79B-MMAE treatment because of low target expression. In summary, these studies suggest that pinatuzumab vedotin and polatuzumab vedotin are active agents for the treatment of patients with different subtypes of DLBCL.

Safety of biological therapies following rituximab treatment in rheumatoid arthritis patients

OBJECTIVE

To assess the safety of biological disease-modifying antirheumatic drugs (DMARD) in rheumatoid arthritis (RA) patients following rituximab.

METHODS

RA patients who participated in an international rituximab clinical trial programme were included. Patients who had received one or more rituximab courses and entered safety follow-up (SFU) were permitted additional biological DMARD. Serious infection events (SIE) were collected.

RESULTS

Of 185 of 2578 patients who entered SFU and received another biological DMARD, 88.6% had peripheral B-cell depletion at the time of initiation of another biological agent. Thirteen SIE (6.99 events/100 patient-years) occurred following rituximab but before another biological DMARD and 10 SIE (5.49 events/100 patient-years) occurred following another biological DMARD. SIE were of typical type and severity for RA patients. 153 had received one or more tumour necrosis factor inhibitor(s). No fatal or opportunistic infections occurred.

CONCLUSIONS

In this analysis, treatment with biological DMARD after rituximab was not associated with an increased serious infection rate. Sample size with limited follow-up restricts definitive conclusions.

Use of skin allograft and its donation rate in Singapore: an 11-year retrospective review for burns treatment

An 11-year retrospective review (1993 to 2003) of 102 severe burn patients (>40% total body surface area and undergone wound excision surgery) was performed to determine the efficacy of early wound debridement and coverage of large burns with skin allografts, a treatment introduced here in 1998 with the establishment of a skin banking facility. While there was no significant reduction in mortality, length of hospital stay decreased by 15.7 days (P < .05) during the post-skin-banking period. Skin allograft donation rates from multiorgan donors were consistently fewer compared with corneal donation, mainly due to strong cultural beliefs and public misconceptions regarding skin harvesting. The overall tissue donation rate in Singapore may improve if efforts focus on deceased cases sent to the state coroner where retrieval and counseling can be centralized.

Monte carlo method study of terahertz pulse propagation in biological tissue

The terahertz pulse (THz pulse) propagation in biological tissue is simulated by Monte Carlo method (MCM). The migratory route of THz pulse in the tissue is presented. The computation model is based on the assumption that the refraction indexes of tissue and air are mismatch and both surfaces of the tissue have the reflection effect for THz pulse.

Alpha-synuclein haplotypes implicated in risk of Parkinson's disease

The authors examined four- and six-loci haplotype constructs (from five single nucleotide polymorphisms and three microsatellite regions) of the alpha-synuclein gene in patients with Parkinson's disease (PD) and controls in an ethnic Chinese population. Logistic regression analysis demonstrated an association of NACP-Rep1 (p = 0.002) and L478 (p < 0.0001) with risk of PD after correction for the effects of age, sex, and the other polymorphic loci. Specific four-loci and six-loci haplotypes were significantly associated with an increased or decreased risk of PD.

Dose-dependent protective effect of coffee, tea, and smoking in Parkinson's disease: a study in ethnic Chinese

INTRODUCTION

Few studies have examined the relationship of coffee and tea in Parkinson's disease (PD). The potential protective effect of coffee intake and risk of PD has not been studied in a Chinese population. There is a high prevalence of caffeine takers among Chinese in our population.

OBJECTIVE

We undertook a case control study to examine the relationship between coffee and tea drinking, cigarette smoking, and other enviromental factors and risk of PD among ethnic Chinese in our population.

METHODS AND RESULTS

300 PD and 500 population controls were initially screened. Two hundred case control pairs matched for age, gender, and race were finally included in the analysis. Univariate analysis revealed significant association of PD with coffee drinking (p<0.0005), tea drinking (p=0.019), alcohol drinking (p=0.001), cigarette smoking (p<0.0005), and exposure to heavy metals (p=0.006). Conditional logistic regression analysis demonstrated that amount of coffee drunk (OR 0.787, 95%CI 0.664-0.932, p=0.006), amount of tea drunk (OR 0.724, 95%CI 0.559-0.937, p=0.014), number of cigarettes smoked (OR 0.384, 95%CI 0.204-0.722, p=0.003), history of heavy metal and toxin exposure (OR 11.837, 95%CI 1.075-130.366, p=0.044), and heart disease (OR 5.518, 95%CI 1.377-22.116, p=0.016) to be significant factors associated with PD. One unit of coffee and tea (3 cups/day for 10 years) would lead to a 22% and 28% risk reduction of PD. One unit of cigarette smoke (3 packs/day for 10 years) reduced the risk of PD by 62%.

CONCLUSIONS

We demonstrated a dose-dependent protective effect of PD in coffee and tea drinkers and smokers in an ethnic Chinese population. A history of exposure to heavy metals increased the risk of PD, supporting the multifactorial etiologies of the disease.

Monoamine oxidase B polymorphism, cigarette smoking and risk of Parkinson's disease: a study in an Asian population

Cigarette smoking is associated with reduced monoamine oxidase B (MAO B) activity. Polymorphisms of the MAO B gene may modify the relationship between smoking and Parkinson's Disease (PD). We examined the association of MAO B intron 13 G/A polymorphism and risk of PD, and the modulation of the polymorphism on smoking and PD in an Asian study population in Singapore. Two hundred and thirty PD patients (mean age 66.0 +/- 9.4 years, 63% men) and 241 age, gender, and race matched controls (mean age 64 +/- 9.2 years, 58.9% males) were studied. The frequency of G and A alleles in PD and controls was; 66/315 (21.0%) vs. 73/340 (21.5%) and 249/315 (79.0%) vs. 267/340 (78.5%). For women, the genotype frequency in PD and controls was; GG: 7/85 (8.2%) vs. 8/99 (8.1%); GA: 25/85 (29.4%) vs. 27/99 (27.3%); AA: 53/85 (62.4%) vs. 64/99 (64.6%). For men, allele frequency in PD and controls was; A: 118/145 (81.4%) vs. 112/142 (78.9%) and G: 27/145 (18.6%) vs. 30/142 (21.1%). The allele and genotype frequencies were not significantly different between young and late onset PD. The frequency of "ever" smokers in PD and controls was 31/230 (13.5%) vs. 52/241 (21.6%), P = 0.02. A stepwise logistic regression analysis did not reveal any interaction of smoking and the G allele and risk of PD. The MAO B G/A genotype frequency in our Asian population was quite different from Caucasians suggesting that ethnicity specific effects need to be considered in evaluating gene-environmental interaction.

Boundary detection of retinoblastoma tumors with neural networks

Consistent and accurate measurement of retinoblastoma tumors is of important clinical value for treatment management. This paper presents an algorithm for the determination of retinoblastoma (RB) tumor to assist in the determination of tumor volume changes throughout treatment periods. The result of the development of a neural network approach for the analysis of three-dimensional ultrasound images shows that it is possible to identify retinoblastoma tumors and accurately determine the front and back boundary of the tumor. The algorithm used was a soft competitive learning network with two inputs. The outputs of the network identify the eye, the tumor, and the back of the eye.

Pharmacokinetic modeling and absorbed dose estimation for chimeric anti-CEA antibody in humans

The objective of this article was to model pharmacokinetic data from clinical diagnostic studies involving the 111In-labeled monoclonal antibody (MAb) chimeric T84.66, against carcinoembryonic antigen. Model-derived results based on the 111In-MAb blood, urine and digital imaging data were used to predict 90Y-MAb absorbed radiation doses and to guide treatment planning for future therapy trials. Fifteen patients with at least one carcinoembryonic antigen-positive lesion were evaluated. We report the kinetic parameter estimates and absorbed 111In-MAb dose and projected 90Y-MAb doses for each patient as well as describe our approach and rationale for modeling an extensive set of pharmacokinetic data.

METHODS

The ADAPT II software package was used to create three- and five-compartment models of uptake against time in the patient population. The "best-fit" model was identified using ordinary least squares. Areas under the curve were calculated using the modeled curves and input into MIRDOSE3 to estimate absorbed radiation doses for each patient.

RESULTS

A five-compartment model best described the liver, whole body, blood and urine data for a subcohort of nine patients with digital imaging data. A three-compartment model best described the blood and urine data for all 15 clinical patients accrued in the clinical trial. For the subcohort, the largest projected 90Y-MAb doses were delivered to the liver (mean, 24.78 rad/mCi; range, 15.02-37.07 rad/mCi), with red marrow estimates on the order of 3.32 rad/mCi (range, 1.24-5.55) of 90Y. Corresponding estimates for the 111In-MAb were 3.18 (range, 2.09-4.43) and 0.55 (range, 0.34-0.74), respectively.

CONCLUSION

The three- and five-compartment models presented here were successfully used to represent the blood, urine and imaging data. This was evidenced by the small standard errors for the kinetic parameter estimates and R2 values close to 1. As planned future therapeutic trials will involve stem cell support to alleviate hematological toxicities, the development of an approach for estimating doses to other major organs is crucial.

Discovery and analysis of inflammatory disease-related genes using cDNA microarrays

cDNA microarray technology is used to profile complex diseases and discover novel disease-related genes. In inflammatory disease such as rheumatoid arthritis, expression patterns of diverse cell types contribute to the pathology. We have monitored gene expression in this disease state with a microarray of selected human genes of probable significance in inflammation as well as with genes expressed in peripheral human blood cells. Messenger RNA from cultured macrophages, chondrocyte cell lines, primary chondrocytes, and synoviocytes provided expression profiles for the selected cytokines, chemokines, DNA binding proteins, and matrix-degrading metalloproteinases. Comparisons between tissue samples of rheumatoid arthritis and inflammatory bowel disease verified the involvement of many genes and revealed novel participation of the cytokine interleukin 3, chemokine Gro alpha and the metalloproteinase matrix metallo-elastase in both diseases. From the peripheral blood library, tissue inhibitor of metalloproteinase 1, ferritin light chain, and manganese superoxide dismutase genes were identified as expressed differentially in rheumatoid arthritis compared with inflammatory bowel disease. These results successfully demonstrate the use of the cDNA microarray system as a general approach for dissecting human diseases.

Parallel human genome analysis: microarray-based expression monitoring of 1000 genes

Microarrays containing 1046 human cDNAs of unknown sequence were printed on glass with high-speed robotics. These 1.0-cm2 DNA "chips" were used to quantitatively monitor differential expression of the cognate human genes using a highly sensitive two-color hybridization assay. Array elements that displayed differential expression patterns under given experimental conditions were characterized by sequencing. The identification of known and novel heat shock and phorbol ester-regulated genes in human T cells demonstrates the sensitivity of the assay. Parallel gene analysis with microarrays provides a rapid and efficient method for large-scale human gene discovery.

In vivo purging with high-dose cytarabine followed by high-dose chemoradiotherapy and reinfusion of unpurged bone marrow for adult acute myelogenous leukemia in first complete remission

PURPOSE

To evaluate in a prospective study the efficacy of autologous bone marrow transplantation (BMT) in adult patients with acute myelogenous leukemia (AML) in first remission, using a single course of high-dose Cytarabine (HD Ara-C) consolidation therapy as in vivo purging.

PATIENTS AND METHODS

Sixty consecutive adult patients with AML in first complete remission (CR) were treated with HD Ara-C consolidation therapy as a method of in vivo purging before marrow collection. High-dose therapy consisted of fractionated total-body irradiation (FTBI) 12 Gy, intravenous etoposide 60 mg/kg, and cyclophosphamide 75 mg/kg, followed by reinfusion of cryopreserved marrow.

RESULTS

Sixty patients underwent consolidation treatment with HD Ara-C with the intent to treat with autologous BMT. Sixteen patients were unable to proceed to autologous BMT (10 patients relapsed, one died of sepsis, one developed cerebellar toxicity, two had inadequate blood counts, and two refused). Forty-four patients underwent autologous BMT and have a median follow-up time of 37 months (range, 14.7 to 68.7) for patients who are alive with no relapse. The cumulative probability of disease-free survival (DFS) at 24 months in the intent-to-treat group is 49% (95% confidence interval [CI], 37% to 62%) and in those who actually underwent autologous BMT is 61% (95% CI, 46% to 74%). The probability of relapse was 44% (95% CI, 31% to 58%) and 33% (95% CI, 20% to 49%) for the intent-to-treat and autologous BMT patients, respectively.

CONCLUSION

This approach offers a relatively high DFS rate to adult patients with AML in first CR. The results of this study are similar to those achieved with allogeneic BMT.

Histopathologic effects of tamoxifen on the uterine epithelium of breast cancer patients: analysis by menopausal status

We evaluated the histopathologic changes of the uterine epithelium in 73 breast cancer patients with tamoxifen stratified by menopausal status. Clinicopathologic data at the time of breast cancer diagnosis and endometrial sampling were analyzed and compared with 122 breast cancer patients not receiving the drug. The incidence of endocervical and/or endometrial polyps was increased in tamoxifen-treated postmenopausal patients compared with untreated patients, 43% (25 of 58) and 24% (16 of 68), respectively (odds ratio=2.46, P=0.02). In contrast, there was no increase in polyps in premenopausal tamoxifen-treated patients. This finding suggests that the effects of tamoxifen on the endometrium may vary with menopausal status.

On the correction for radioactive decay in pharmacokinetic modeling

The question of how to include radioactive decay during biological modeling with first-order differential equations was considered. Modeling may involve either experimental data y(t) or decay-corrected data z(t) [identical to exp(lambda t)y(t) where lambda is the decay constant] for each compartment. It is sometimes assumed that the latter are solutions to corresponding purely pharmacokinetic models (no decay). We primarily compared the two analyses in the case where the model did not require simultaneous consideration of both labeled and unlabeled material. A general theorem was found which limits the use of decay-corrected data to pharmacokinetic models containing linear, homogeneous differential equations. By way of verification, an example of this model type was analyzed for a chimeric monoclonal antibody biodistribution in man. Even in this case, statistically significant differences between the two solutions showed that one may find different model parameters depending upon which data set (y or z) was analyzed. For other mathematical forms, the analyst must include the physical decay in all relevant compartments. By analyzing an open, quadratic model, effects of not including decay were seen to be maximized if the biological rate constant was > or = lambda, the physical decay constant. Finally, using monoclonal antibody-antigen reactions, similar discrepancies between the z functions and the pharmacokinetic variables were demonstrated. This result was found to persist even if competitive molecules were included. We conclude that decay-corrected data may be shown, but should not be entered into the modeling equations unless the latter are of the linear, homogeneous form.

Effect of H-2 compatibility in autoimmune destruction of islet allografts from B10 congenic lines to nonobese diabetic mice

Autoimmune diabetes involves multiple antigens, and both cellular and humoral immune responses. Using CBA (H-2k) C57BL/6 (H-2b), and BALB/c (H-2d) newborn mouse pancreata, we previously demonstrated that acute and strong destruction of islet allografts by anti-islet autoimmunity in the nonobese diabetic (NOD) mouse H-2Kd, Db) is under the influence of major histocompatibility complex (MHC) antigens. In the current study, we have attempted to confirm these results in the absence of minor alloantigenic differences using B10 congenic strains as pancreatic donors. Pancreata from B10.BR (H-2k), C57BL/10SnJ (H-2b), and B10.D2 (H-2d) were transplanted under the kidney capsule of NOD mice within 1 month of diabetes onset. These recipients were immunosuppressed with cyclosporine (CsA) in a dosage that effectively prevents rejection of skin allograft, but not islet isograft destruction that is mediated by anti-islet autoimmunity. On day 10, the grafts were harvested and examined histologically to assess viability. Pancreatic allografts from B10.D2, sharing the H-2Kd with the NOD mouse, showed the strongest lymphocytic infiltration, and neither islets nor beta cells were found in all seven grafts. C57BL/10SnJ grafts, sharing the same H-2Db, also showed severe lymphocytic infiltration, and no intact islets, and only a few beta cells were found, as single cells, in three of eight grafts. In contrast, B10.BR grafts, completely incompatible at the H-2, showed the least infiltration, and normal islets containing many beta cells were found in 10 of 11 grafts. These results again suggested the hypothesis that islet allograft destruction by diabetic NOD mice is MHC restricted.(ABSTRACT TRUNCATED AT 250 WORDS)

Prevention of diabetes in nonobese diabetic mice by dendritic cell transfer

The purpose of this study was to determine the effect of dendritic cell (DC) transfers on the incidence of diabetes in female nonobese diabetic (NOD) mice. Groups of 4-wk-old NOD female mice were given a single foot pad of DCs (70-90% purity) isolated from the draining lymph nodes (LN) of the pancreas (PLN), the cervical LNs, or the axillary/inguinal LNs. In addition, other groups of NOD mice received purified spleen DCs, purified PLN T cells (the major contaminating population in DC preparations), or the injection vehicle PBS. All groups were monitored for diabetes for one year. Significant protection from diabetes was observed in NOD mice receiving greater than 1 x 10(4) PLN DCs in comparison to mice receiving other DCs populations, PLN T cells, or PBS (P less than 0.05). The pancreata of NOD mice that received PLN DCs demonstrated significantly lower levels of lymphocytic infiltration in the islets that age-sex matched nondiabetic female NOD control mice (P less than 0.05). LN cells from nondiabetic NOD mice that received PLN DC protected irradiated female recipients from the adoptive transfer of diabetes to a greater degree than LN cells from age and sex matched nondiabetic female NOD mice that did not receive PLN DC transfers at 36 d (P = 0.014) and at 1 yr (P = 0.0015) after transfer. These data suggest that the PLN DC transfers are able to modulate autoimmunity and limit diabetes expression in the NOD mouse. PLN DCs transfers may regulate autoimmunity by the induction of regulatory cells.

Expression of genetically determined diabetes and insulitis in the nonobese diabetic (NOD) mouse at the level of bone marrow-derived cells. Transfer of diabetes and insulitis to nondiabetic (NOD X B10) F1 mice with bone marrow cells from NOD mice

The development of autoimmune diabetes in the nonobese diabetic (NOD) mouse is controlled by at least three recessive loci, including one linked to the MHC. To determine whether any of these genetic loci exert their effects via the immune system, radiation bone marrow chimeras were constructed in which (NOD X B10)F1-irradiated recipients were reconstituted with NOD bone marrow cells. Unmanipulated (NOD X B10)F1 mice, or irradiated F1 mice reconstituted with F1 or B10 bone marrow, did not display insulitis or diabetes. In contrast, insulitis was observed in a majority of the NOD----F1 chimeras and diabetes developed in 21% of the mice. These data demonstrate that expression of the diabetic phenotype in the NOD mouse is dependent on NOD-derived hematopoietic stem cells. Diabetogenic genes in the NOD mouse do not appear to function at the level of the insulin-producing beta cells since NOD----F1 chimeras not only developed insulitis and diabetes but also rejected beta cells within pancreas transplants from newborn B10 mice. These data suggest that the beta cells of the NOD mouse do not express a unique antigenic determinant that is the target of the autoimmune response.