scholarly journals A Reusable Perfused Human Cadaver Model for Surgical Training: An Initial Proof of Concept Study

2019 ◽  
Vol 184 (Supplement_1) ◽  
pp. 43-47 ◽  
Author(s):  
Jenny M Held ◽  
Robert B McLendon ◽  
Christian S McEvoy ◽  
Travis M Polk
Keyword(s):  
Surgical Training ◽  
Tap Water ◽  
Regional Perfusion ◽  
Whole Body ◽  
Suture Repair ◽  
Second Phase ◽  
Proof Of Concept ◽  
Handling Characteristics ◽  
Surgical Trainees ◽  
Over Time

Abstract Objectives Today’s surgical trainees have less exposure to open vascular and trauma procedures. Lightly embalmed cadavers may allow a reusable model that maximizes resources and allows for repeat surgical training over time. Methods This was a three-phased study that was conducted over several months. Segments of soft-embalmed cadaver vessels were harvested and perfused with tap water. To test durability, vessels were clamped, then an incision was made and repaired with 5-0 polypropylene. Tolerance to suturing and clamping was graded. In a second phase, both an arterial-synthetic graft and an arterial-venous anastomosis were performed and tested at 90 mmHg perfusion. In the final phase, lower extremity regional perfusion was performed and vascular control of a simulated injury was achieved. Results Seven arteries and six veins from four cadavers were explanted. All vessels accommodated suture repair over 6 weeks. There was minor leaking at all previous clamp sites. In the anastomotic phase, vessels tolerated grafting, clamping, and perfusion without tearing or leaking. Regional perfusion provided a life-like training scenario. Conclusions Explanted vessels of soft-embalmed cadavers show adequate durability over time with realistic vascular surgery handling characteristics. This shows promise as initial proof of concept for a reusable perfused cadaver model. Further study with serial regional and whole-body perfusion is warranted.

A Melanocortin-4 Receptor Agonist Induces Skin and Hair Pigmentation in Patients with Monogenic Mutations in the Leptin-Melanocortin Pathway

2021 ◽  
pp. 1-10
Author(s):  
Varvara Kanti ◽  
Lia Puder ◽  
Irina Jahnke ◽  
Philipp Maximilian Krabusch ◽  
Jan Kottner ◽  
...  
Keyword(s):  
Leptin Receptor ◽  
Skin Pigmentation ◽  
Gene Mutations ◽  
Continuous Treatment ◽  
Whole Body ◽  
Hair Color ◽  
Phase 2 ◽  
Loss Of Function ◽  
The Impact ◽  
Over Time

<b><i>Background and Objectives:</i></b> Gene mutations within the leptin-melanocortin signaling pathway lead to severe early-onset obesity. Recently, a phase 2 trial evaluated new pharmacological treatment options with the MC4R agonist <i>setmelanotide</i> in patients with mutations in the genes encoding proopiomelanocortin (POMC) and leptin receptor (LEPR). During treatment with <i>setmelanotide,</i> changes in skin pigmentation were observed, probably due to off-target effects on the closely related melanocortin 1 receptor (MC1R). Here, we describe in detail the findings of dermatological examinations and measurements of skin pigmentation during this treatment over time and discuss the impact of these changes on patient safety. <b><i>Methods:</i></b> In an investigator-initiated, phase 2, open-label pilot study, 2 patients with loss-of-function POMC gene mutations and 3 patients with loss-of-function variants in LEPR were treated with the MC4R agonist <i>setmelanotide</i>. Dermatological examination, dermoscopy, whole body photographic documentation, and spectrophotometric measurements were performed at screening visit and approximately every 3 months during the course of the study. <b><i>Results:</i></b> We report the results of a maximum treatment duration of 46 months. Skin pigmentation increased in all treated patients, as confirmed by spectrophotometry. During continuous treatment, the current results indicate that elevated tanning intensity levels may stabilize over time. Lips and nevi also darkened. In red-haired study participants, hair color changed to brown after initiation of <i>setmelanotide</i> treatment. <b><i>Discussion:</i></b> <i>Setmelanotide</i> treatment leads to skin tanning and occasionally hair color darkening in both POMC- and LEPR-deficient patients. No malignant skin changes were observed in the patients of this study. However, the results highlight the importance of regular skin examinations before and during MC4R agonist treatment.

scholarly journals Kinetic analysis and optimisation of 18F-rhPSMA-7.3 PET imaging of prostate cancer

2021 ◽  
Author(s):  
Simona Malaspina ◽  
Vesa Oikonen ◽  
Anna Kuisma ◽  
Otto Ettala ◽  
Kalle Mattila ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Metastatic Disease ◽  
Uptake Kinetics ◽  
Whole Body ◽  
Target Area ◽  
Post Injection ◽  
The Mean ◽  
Pet Radiopharmaceutical ◽  
Time Frames ◽  
Over Time

Abstract Purpose This phase 1 open-label study evaluated the uptake kinetics of a novel theranostic PET radiopharmaceutical, 18F-rhPSMA-7.3, to optimise its use for imaging of prostate cancer. Methods Nine men, three with high-risk localised prostate cancer, three with treatment-naïve hormone-sensitive metastatic disease and three with castration-resistant metastatic disease, underwent dynamic 45-min PET scanning of a target area immediately post-injection of 300 MBq 18F-rhPSMA-7.3, followed by two whole-body PET/CT scans acquired from 60 and 90 min post-injection. Volumes of interest (VoIs) corresponding to prostate cancer lesions and reference tissues were recorded. Standardised uptake values (SUV) and lesion-to-reference ratios were calculated for 3 time frames: 35–45, 60–88 and 90–118 min. Net influx rates (Ki) were calculated using Patlak plots. Results Altogether, 44 lesions from the target area were identified. Optimal visual lesion detection started 60 min post-injection. The 18F-rhPSMA-7.3 signal from prostate cancer lesions increased over time, while reference tissue signals remained stable or decreased. The mean (SD) SUV (g/mL) at the 3 time frames were 8.4 (5.6), 10.1 (7) and 10.6 (7.5), respectively, for prostate lesions, 11.2 (4.3), 13 (4.8) and 14 (5.2) for lymph node metastases, and 4.6 (2.6), 5.7 (3.1) and 6.4 (3.5) for bone metastases. The mean (SD) lesion-to-reference ratio increases from the earliest to the 2 later time frames were 40% (10) and 59% (9), respectively, for the prostate, 65% (27) and 125% (47) for metastatic lymph nodes and 25% (19) and 32% (30) for bone lesions. Patlak plots from lesion VoIs signified almost irreversible uptake kinetics. Ki, SUV and lesion-to-reference ratio estimates showed good agreement. Conclusion 18F-rhPSMA-7.3 uptake in prostate cancer lesions was high. Lesion-to-background ratios increased over time, with optimal visual detection starting from 60 min post-injection. Thus, 18F-rhPSMA-7.3 emerges as a very promising PET radiopharmaceutical for diagnostic imaging of prostate cancer. Trial Registration NCT03995888 (24 June 2019).

scholarly journals An analysis of the cost of postgraduate training in surgery in Ireland compared to other specialties

2021 ◽  
Author(s):  
Earley H. ◽  
Mealy K.
Keyword(s):  
Surgical Training ◽  
Financial Support ◽  
Postgraduate Training ◽  
Medical Training ◽  
Medical Council ◽  
List Type ◽  
Training Costs ◽  
Considerable Cost ◽  
Surgical Trainees ◽  
The Cost

Abstract Introduction Postgraduate specialty training in Ireland is associated with considerable cost. Some of these are mandatory costs such as medical council fees, while others are necessary to ensure career progression, such as attendance at courses and conferences. In particular, surgical specialities are believed to be associated with high training costs. It is unknown how these costs compare to those borne by counterparts in other specialities. Aims The aims of this study were to Quantify the amount that trainees in Ireland spend on postgraduate training Determine whether a difference exists between surgery and other non-skill-based specialties in terms of expenditure on training Methods A standardised non-mandatory questionnaire was circulated to trainees across two training centres in Ireland. Trainees at all levels were invited to participate. Results Sixty responses were obtained. Fifty-seven questionnaires were fully completed and included for analysis. The median expenditure on training was higher for surgical than non-surgical specialities. Subgroup analysis revealed surgical training was associated with higher expenditure on higher degrees and courses compared to medical training (p = 0.035). > 95% of trainees surveyed felt that greater financial support should be available for trainees during the course of their training. Conclusions This study demonstrated that a career in surgery is associated with higher ongoing costs for higher degrees and courses than counterparts in non-surgical training. All surgical trainees surveyed felt that better financial support should be available. Increasing financial support for may be a tangible way to mitigate against attrition during training.

scholarly journals Riding the waves: the ongoing impact of COVID-19 on a national surgical training cohort

2021 ◽  
Author(s):  
Orla Hennessy ◽  
Amy Lee Fowler ◽  
Conor Hennessy ◽  
David Brinkman ◽  
Aisling Hogan ◽  
...  
Keyword(s):  
Surgical Training ◽  
World Health Organisation ◽  
World Health ◽  
Training Methods ◽  
Viral Spread ◽  
Surgical Services ◽  
Global Pandemic ◽  
Surgical Trainees ◽  
Secondary Survey ◽  
The Impact

Abstract Background The World Health Organisation declared a global pandemic on the 11 March 2020 resulting in implementation of methods to contain viral spread, including curtailment of all elective and non-emergent interventions. Many institutions have experienced changes in rostering practices and redeployment of trainees to non-surgical services. Examinations, study days, courses, and conferences have been cancelled. These changes have the potential to significantly impact the education and training of surgical trainees. Aim To investigate the impact of the COVID-19 pandemic on training, educational, and operative experiences of Irish surgical trainees. Methods Surgical trainees were surveyed anonymously regarding changes in working and educational practices since the declaration of the COVID-19 pandemic on 11 March 2020. The survey was circulated in May 2020 to both core and higher RCSI surgical trainees, when restrictions were at level five. Questions included previous and current access to operative sessions as well as operative cases, previous and current educational activities, access to senior-led training, and access to simulation-/practical-based training methods. A repeat survey was carried out in October 2020 when restrictions were at level two. Results Overall, primary and secondary survey response rates were 29% (n = 98/340) and 19.1% (n = 65/340), respectively. At the time of circulation of the second survey, the number of operative sessions attended and cases performed had significantly improved to numbers experienced pre-pandemic (p < 0.0001). Exposure to formal teaching and education sessions returned to pre-COVID levels (p < 0.0001). Initially, 23% of trainees had an examination cancelled; 53% of these trainees have subsequently sat these examinations. Of note 27.7% had courses cancelled, and 97% of these had not been rescheduled. Conclusion Surgical training and education have been significantly impacted in light of COVID-19. This is likely to continue to fluctuate in line with subsequent waves. Significant efforts have to be made to enable trainees to meet educational and operative targets.

scholarly journals P38 COVID-19 impact on Surgical Training And Recovery Planning (COVID-STAR) Survey

BJS Open ◽  
2021 ◽  
Vol 5 (Supplement_1) ◽  
Author(s):  
◽  
Joshua Clements
Keyword(s):  
Surgical Training ◽  
Negative Impact ◽  
Healthcare Delivery ◽  
Cross Sectional Study ◽  
Surgical Trainee ◽  
Surgical Specialty ◽  
Cross Sectional ◽  
Training Time ◽  
Surgical Trainees ◽  
And Training

Abstract Background The COVID-19 pandemic has resulted in dynamic changes to healthcare delivery. Surgery as a specialty has been significantly affected and with that the delivery of surgical training. Method This national, collaborative, cross sectional study comprising 13 surgical trainee associations distributed a pan surgical specialty survey on the COVID-19 impact on surgical training over a 4-week period (11th May - 8th June 2020). The survey was voluntary and open to medical students and surgical trainees of all specialties and training grades. All aspects of training were qualitatively assessed. This study was reported according to STROBE guidelines. Results 810 completed responses were analysed. (M401: F 390) with representation from all deaneries and training grades. 41% of respondents (n = 301) were redeployed with 74% (n = 223) redeployed &gt; 4 weeks. Complete loss of training was reported in elective operating (69.5% n = 474), outpatient activity (67.3%, n = 457), Elective endoscopy (69.5% n = 246) with &gt; 50% reduction in training time reported in emergency operating (48%, n = 326) and completion of work-based assessments (WBA) (46%, n = 309). 81% (n = 551) reported course cancellations and departmental and regional teaching programmes were cancelled without rescheduling in 58% and 60% of cases respectively. A perceived lack of Elective operative exposure and completions of WBA’s were the primary reported factor affecting potential training progression. Overall, &gt; 50% of trainees (n = 377) felt they would not meet the competencies required for that training period. Conclusion This study has demonstrated a perceived negative impact on numerous aspects of surgical training affecting all training specialties and grades.

scholarly journals 354 Differential Attainment in Surgical Training

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
Z Vinnicombe ◽  
M Little ◽  
J Super
Keyword(s):  
Academic Performance ◽  
Surgical Training ◽  
General Medical Council ◽  
Career Progression ◽  
Medical Council ◽  
Multiple Deprivation ◽  
Surgical Trainees ◽  
Economic Background ◽  
The Relationship ◽  
Index Of Multiple Deprivation

Abstract Introduction Differential attainment (DA), according to the General Medical Council (GMC), is the gap between attainment levels in different groups. Attainment measures should cover aspects that include academic performance and career progression. Two such areas in surgical training are the MRCS examinations and ARCPs, both of which are required for progression in a career in surgery. Our aim was to investigation whether socio-economic background was a significant factor for progression in surgical training. Method Data from the GMC for Core Surgical Trainees (CSTs) taking the MRCS examination between 2016 and 2019 and CST ARCP outcomes between 2017 and 2019 were obtained. Socio-economic background was assessed using the Index of Multiple Deprivation (IMD). ARCP and MRCS outcomes were assessed against IMD. Results Trainees from IMD Q1&2 (most deprived) had a significantly higher (p &lt; 0.01) mean number of attempts (1.86) to pass MRCS examinations than trainees from IMD Q4&5 (least deprived) (1.54). IMD Q1&2 were significantly more likely to obtain unsatisfactory outcomes (24.4%) than trainees from IMD Q4&5 (14.2%) (p &lt; 0.05). Conclusions There is clear evidence that differential attainment exists within Core Surgical Training. The reasons for this are likely to be complex and more work is needed to further investigate the relationship.

scholarly journals Comparison of different techniques for estimating rates of protein synthesis in vivo in healthy and bacteraemic rats

1985 ◽  
Vol 226 (1) ◽  
pp. 37-42 ◽  
Author(s):  
J J Pomposelli ◽  
J D Palombo ◽  
K J Hamawy ◽  
B R Bistrian ◽  
G L Blackburn ◽  
...  
Keyword(s):  
Protein Synthesis ◽  
Rectus Muscle ◽  
Stochastic Modelling ◽  
Whole Body ◽  
Constant Infusion ◽  
Second Phase ◽  
Sprague Dawley ◽  
Body Protein ◽  
To Receive

Previous studies have reported that use of a flooding dose of radiolabelled amino acid is a more precise technique than the constant infusion of tracer quantities for determining rates of protein synthesis in rapidly turning-over tissues in the rat. However, there has been little direct investigation comparing different methods under comparable conditions. Initially, 12 healthy male Sprague-Dawley rats, weighing approx. 100 g, were randomized to receive either a bolus intravenous injection of 100 mumol of L-leucine (containing 30 microCi of [1-14C]leucine)/100 g body wt., or a continuous 2 h tracer infusion of [14C]leucine. In the second phase of the experiment, 12 additional rats were intravenously injected with 1 × 10(8) colony-forming units of Pseudomonas aeruginosa and 16 h later randomized to receive one of two infusions described above. Total protein synthesis as well as fractional synthesis rates were determined in liver, rectus muscle and whole body. Synthesis rates measured in liver, muscle and whole body were significantly higher in bacteraemic rats than in healthy rats. The flooding-dose methodology gave significantly higher estimates of protein synthesis in the liver, skeletal muscle and whole body than did the continuous-infusion method using direct measurement of the acid-soluble fraction from the respective tissue. Indirect estimates of whole-body protein synthesis based on plasma enrichments and stochastic modelling gave the lowest values.

Outcomes following a dedicated period of research during surgical training

2011 ◽  
Vol 56 (4) ◽  
pp. 206-209 ◽  
Author(s):  
B M Stutchfield ◽  
E M Harrison ◽  
S J Wigmore ◽  
R W Parks ◽  
O J Garden
Keyword(s):  
Surgical Training ◽  
Academic Outcomes ◽  
Online Survey ◽  
Career Progression ◽  
Working Time ◽  
Research Interest ◽  
Surgical Trainees ◽  
Surgical Career ◽  
Training Structure ◽  
Research Period

With recent ‘working-time'-related changes to surgical training structure, the value of dedicated research during surgical training has been questioned. Online survey examining career and academic outcomes following a period of surgically related dedicated research at a Scottish University between 1972 and 2007. Of 58 individuals identified, contact details were available for 49 and 43 (88%) responded. Ninety-five percent ( n = 41) of respondents continue to pursue a career in surgery and 41% ( n = 17) are currently in academic positions. Ninety-one percent ( n = 39) had published one or more first-author peer-reviewed articles directly related to their research, with 53% ( n = 23) publishing three or more. Respondents with a clinical component to their research published significantly more papers than those with purely laboratory-based research ( P = 0.04). Eighty-one percent ( n = 35) thought that research was necessary for career progression, but only 42% ( n = 18) felt research should be integral to training. In conclusion, the majority of surgical trainees completing a dedicated research period, published papers and continued to pursue a surgical career with a research interest. A period of dedicated research was thought necessary for career progression, but few thought dedicated research should be integral to surgical training.

Increasing Treatment Lifetime through Sustained Release of Scale Inhibitor from Scale Inhibitor Nanoparticles

SPE Journal ◽  
2021 ◽  
pp. 1-7
Author(s):  
Huili Guan ◽  
Austin Lim ◽  
Joshua Hernandez ◽  
Jenn-Tai Liang
Keyword(s):  
Sustained Release ◽  
Functional Group ◽  
Proof Of Concept ◽  
Linear Scale ◽  
Scale Inhibitor ◽  
Concept Study ◽  
Inhibition Concentration ◽  
Calcium And Magnesium ◽  
Inhibitor Treatment ◽  
Over Time

Summary Scale can cause flow assurance issues because of damage to the near-wellbore region and in production facilities. Scale inhibitors are often used to help mitigate these problems. The main focus of this proof-of-concept study is to examine the ability of a newly developed crosslinked nanosized scale inhibitor (NSI) particle to inhibit scale formation through sustained release of scale inhibitor into a model brine and increase scale inhibitor treatment lifetime. Results from minimum inhibition concentration (MIC) measurements showed that, at 95°C, the MIC decreased gradually from 10 ppm at day 0 to 5 ppm after 9 days and eventually reached a very low MIC of 2 ppm after 49 days. These findings are consistent with our hypothesis that the sustained release of linear scale inhibitor from the NSI would result in a decrease in MIC over time caused by an increased amount of linear scale inhibitor being released into the model brine. Also, attaching 2-acrylamido-2-methyl-1-propanesulfonic functional group (AMPS) to NSI successfully inhibits the pseudoscale formation when the scale inhibitor comes into contact with the calcium and magnesium in the model brine. Results from sandpack floods showed that NSI increased the treatment lifetime from 3 pore volumes (PV) postflush throughput, for the traditional scale inhibitor, to 35 to 105 PV postflush throughput. These results support our hypothesis that sustained release of the trapped NSI nanoparticles can improve the treatment lifetime.

scholarly journals Establishing a surgical skills laboratory and dissection curriculum for neurosurgical residency training

2015 ◽  
Vol 123 (5) ◽  
pp. 1331-1338 ◽  
Author(s):  
James K. C. Liu ◽  
Varun R. Kshettry ◽  
Pablo F. Recinos ◽  
Kambiz Kamian ◽  
Richard P. Schlenk ◽  
...  
Keyword(s):  
Surgical Training ◽  
Training Programs ◽  
Core Competencies ◽  
Technical Skills ◽  
Surgical Skills ◽  
Training Experience ◽  
Surgical Trainees ◽  
Modern Health Care ◽  
External Pressures ◽  
Skills Laboratory

Surgical education has been forced to evolve from the principles of its initial inception, in part due to external pressures brought about through changes in modern health care. Despite these pressures that can limit the surgical training experience, training programs are being held to higher standards of education to demonstrate and document trainee competency through core competencies and milestones. One of the methods used to augment the surgical training experience and to demonstrate trainee proficiency in technical skills is through a surgical skills laboratory. The authors have established a surgical skills laboratory by acquiring equipment and funding from nondepartmental resources, through institutional and private educational grants, along with product donations from industry. A separate educational curriculum for junior- and senior-level residents was devised and incorporated into the neurosurgical residency curriculum. The initial dissection curriculum focused on cranial approaches, with spine and peripheral nerve approaches added in subsequent years. The dissections were scheduled to maximize the use of cadaveric specimens, experimenting with techniques to best preserve the tissue for repeated uses. A survey of residents who participated in at least 1 year of the curriculum indicated that participation in the surgical skills laboratory translated into improved understanding of anatomical relationships and the development of technical skills that can be applied in the operating room. In addition to supplementing the technical training of surgical residents, a surgical skills laboratory with a dissection curriculum may be able to help provide uniformity of education across different neurosurgical training programs, as well as provide a tool to assess the progression of skills in surgical trainees.

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