ENT ORL Health
6 views | +0 today
Follow
Your new post is loading...
Your new post is loading...
Scooped by ALEXANDROSSFAKIANAKIS
Scoop.it!

Table of Contents & Bacode

Table of Contents & Bacode | ENT ORL Health | Scoop.it

Publication date: November 2018

Source: Journal of Surgical Education, Volume 75, Issue 6

Author(s):



from Medicine by Alexandros G. Sfakianakis via a.sfakia on Inoreader https://ift.tt/2rlNMGe
more...
No comment yet.
Scooped by ALEXANDROSSFAKIANAKIS
Scoop.it!

Use of Learning Teams to Improve the Educational Environment of General Surgery Residency

Use of Learning Teams to Improve the Educational Environment of General Surgery Residency | ENT ORL Health | Scoop.it

Publication date: November 2018

Source: Journal of Surgical Education, Volume 75, Issue 6

Author(s): Tovy Haber Kamine, Ashraf A. Sabe, Bharath Nath, Kelly Barnes, Tara S. Kent

OBJECTIVE

Recent surgical education literature has focused on means of improving structured educational experience in residency, particularly in the context of limited working hours. In addition, prior studies have illustrated a void in training regarding leadership. Learning teams have been adopted in several medical schools with an aim to improve the educational experience. We instituted resident learning teams with a goal of improving resident education.

DESIGN

In the 2015 to 2016 academic year, we implemented a team-based learning (TBL) system of 5 teams each led by 1 to 2 chief residents and containing an approximately equal number of residents from postgraduate year (PGY)1-4. The learning teams competed for points based on weekly quizzes, preparation of materials for resident teaching, and American Board of Surgery In-Training Exam (ABSITE) scores. After a full year of TBL, residents were surveyed on their view of the learning teams with respect to the educational experience in the residency with a series of Likert-type questions. Median ABSITE scores of categorical interns were compared between the 3 years after the implementation of the learning teams and the 4 years prior with a Mann–Whitney U test.

SETTING

Beth Israel Deaconess Medical Center, Boston, MA; Tertiary Care Center.

PARTICIPANTS

All residents from 2011 to 2018.

RESULTS

After TBL implementation, median ABSITE percentile scores of PGY2-5 residents increased (35-44, p = 0.04). PGY1 scores were not significantly changed. After TBL implementation, a majority of residents agreed or strongly agreed that they studied more consistently, felt more prepared for the ABSITE, were more prepared for resident school, learned more in resident school, and that the learning teams improved the educational experience of the residency.

CONCLUSIONS

Learning teams subjectively improved the educational experience in our residency and engaged residents in studying and participating. In addition, PGY2-5 ABSITE scores were significantly improved. Learning teams are a program that can be easily adopted by surgical residencies elsewhere.



from Medicine by Alexandros G. Sfakianakis via a.sfakia on Inoreader https://ift.tt/2FVHkzy
more...
No comment yet.
Scooped by ALEXANDROSSFAKIANAKIS
Scoop.it!

Documenting or Operating: Where Is Time Spent in General Surgery Residency?

Documenting or Operating: Where Is Time Spent in General Surgery Residency? | ENT ORL Health | Scoop.it

Publication date: November 2018

Source: Journal of Surgical Education, Volume 75, Issue 6

Author(s): Morgan L. Cox, Alfredo E. Farjat, TJ Risoli, Sarah Peskoe, Benjamin A. Goldstein, David A. Turner, John Migaly

Objective

The utilization of electronic health records (EHR) has become essential in the daily activities of physicians for documentation and as an information source. However, the amount of time spent by residents utilizing the EHR has not been thoroughly evaluated, particularly within surgical specialties. This study aims to analyze EHR usage by general surgery residents and to assess the association between this use and case volume at a single academic institution.

Design

For general surgery residents in clinical years (CY) 1-5, de-identified login and logout time data between September 2016 and June 2017 were retrospectively extracted from the Epic EHR (Verona, WI). A binary time series was created for each resident to indicate and track over time whether he or she was utilizing the EHR system. Comparisons between categorical variables were performed with Fisher's exact test. Continuous variables were compared using Wilcoxon rank sum test. Longitudinal linear mixed-effects models were used to assess the EHR usage among the surgery residents. The association between EHR time and the number of operative cases logged was evaluated with Pearson's correlation coefficient.

Setting

This study was performed by the Department of Surgery in conjunction with the Office of Graduate Medical Education at Duke University Health System.

Participants

All active general surgery residents during the 2016-2017 academic year.

Results

Thirty-six general surgery residents (28 males, 8 females) spent a median of 2.4 hours per day and 23.7 hours per week using the EHR. CY2 had the highest median usage per week (28.9 hours), while CY3 had the lowest (16.7 hours) but no significant difference based on EHR usage was found among the analyzed CYs (p = 0.164). Residents spent significantly more time logged into the EHR during the week compared to weekends and during the day compared to nights (all p < 0.001). For the residency program as a whole, a median of 151.5 total work hours per day was dedicated to documentation. On average, interns on dedicated night rotations spent 7% of their login time outside regularly scheduled duty hours while interns on dedicated day rotations spent 27%. There was no overall correlation between monthly case logs and EHR usage (r = 0.06, p = 0.30); however, CY2 had a significant negative correlation (r = −0.2, p = 0.038).

Conclusions

In the era of a maximum 80-hour work week, general surgery residents spend a substantial portion, at least 30%, of their time utilizing the EHR. One third of EHR usage by interns occurred outside the scheduled 12-hour shift, demonstrating the difficulties of completing paperwork as part of the scheduled work day. Additionally, the lack of correlation to case logs is likely due to an underestimation of the documentation burden associated with operating, which includes preparatory effort and operative notes. Ultimately, these quantitative EHR usage results will be correlated to burnout prior to implementing programs to improve efficiency and decrease the burden of charting.



from Medicine by Alexandros G. Sfakianakis via a.sfakia on Inoreader https://ift.tt/2G7ugrg
more...
No comment yet.
Scooped by ALEXANDROSSFAKIANAKIS
Scoop.it!

Cancer incidence and mortality patterns in women with breast symptoms in the mammography screening programme: a matched cohort analysis

Cancer incidence and mortality patterns in women with breast symptoms in the mammography screening programme: a matched cohort analysis | ENT ORL Health | Scoop.it

Efforts to reduce mortality through early detection and diagnosis has intensified in the recent decade. An important risk factor, ‘breast symptoms’ reported by women during screening visit, is still overlooked. In this population based matched cohort study using Finnish National Breast Cancer Screening Program (FNBCSP), we assessed the association between breast symptoms reported at screening visit and the risk of cancer incidence and breast cancer mortality and all‐cause mortality followed‐up over a period of 24 years. For each visit with symptoms, non‐symptomatic controls were matched (1:1 for lump and retraction; 1:2 for nipple discharge) based on age at screening visit, year of invitation, number of invited visits, and municipality of invitation. Women who reported lump or retraction had about 2‐fold risk of breast cancer incidence, 3‐fold risk of breast cancer mortality and all‐cause mortality respectively as compared to women without respective symptoms (p‐value<0.05). We found a substantial difference (p‐value<0.05) in mortality rates throughout the follow‐up period between symptomatic and asymptomatic group. In absolute terms, after the follow‐up period for women who reported lump, 180 died from breast cancer as compared to 70 deaths in those without lump, per 10000 person‐years of follow‐up, and 315 versus 160 all‐cause deaths per 10000 person‐years in women with and without lump respectively. This study provides comprehensive evidence that women with breast symptoms remain in a higher risk of dying over a very long period. The findings indicate needs to develop improvements in the guidelines for screening and clinical services for women presenting with symptoms.

This article is protected by copyright. All rights reserved.



from Medicine by Alexandros G. Sfakianakis via a.sfakia on Inoreader https://ift.tt/2QdkoRk
more...
No comment yet.
Scooped by ALEXANDROSSFAKIANAKIS
Scoop.it!

miR‐4324‐RACGAP1‐STAT3‐ESR1 feedback loop inhibits proliferation and metastasis of bladder cancer

miR‐4324‐RACGAP1‐STAT3‐ESR1 feedback loop inhibits proliferation and metastasis of bladder cancer | ENT ORL Health | Scoop.it

Considering the importance of microRNAs (miRNAs) in regulating cellular processes, we performed microarray analysis and revealed miR‐4324 as one of the most differentially expressed miRNAs in bladder cancer (BCa). Then, we discovered that miR‐4324 was a negative regulator of Rac GTPase activating protein 1 (RACGAP1) and that RACGAP1 functioned as an oncogenic protein in BCa. Our studies indicated that ectopic overexpression of miR‐4324 in BCa cells significantly suppressed cell proliferation and metastasis and enhanced chemotherapy sensitivity to doxorubicin by repressing RACGAP1 expression. Further studies showed that estrogen receptor 1 (ESR1) increased the expression of miR‐4324 by binding to its promoter, while the downregulation of ESR1 in BCa was caused by hypermethylation of its promoter. p‐STAT3 induced the enrichment of DNMT3B by binding to and inducing methylation of the ESR1 promoter. In turn, RACGAP1 induced STAT3 phosphorylation, increasing p‐STAT3 expression and promoting its translocation to the nucleus. Therefore, the miR‐4324‐RACGAP1‐STAT3‐ESR1 feedback loop could be a critical regulator of BCa progression.



from Medicine by Alexandros G. Sfakianakis via a.sfakia on Inoreader https://ift.tt/2RDy1WI
more...
No comment yet.
Scooped by ALEXANDROSSFAKIANAKIS
Scoop.it!

An Investigation of Reliability of the Sunderland Tracheosophageal Voice Perceptual Scale

An Investigation of Reliability of the Sunderland Tracheosophageal Voice Perceptual Scale | ENT ORL Health | Scoop.it

Background: The Sunderland Tracheosophageal Voice Perceptual scale (SToPS) is the only perceptual rating scale designed specifically for tracheosophageal voice [Hurren et al.: Clin Otolaryngol. 2009 Dec; 34(6): 533–8]. Objective: To investigate the inter rater reliability of the SToPS when analyzing alaryngeal voice. Methods: Prospective evaluation of inter rater reliability of the SToPS based on audio recordings of 230 voice samples from 41 laryngectomy patients rated by 3 experts. Interval data were analyzed using intraclass correlation coefficients (ICC) while categorical data were analyzed using Kappa. Results: ICC of above 0.6 was observed between raters for each prosthesis on a majority of parameters demonstrating a good level of reliability. Reliability was fair (ICC of between 0.40 and 0.59) on Q11 (Articulatory precision) and Q12 (Paralinguistics). Reliability was also fair (0.21–0.40) or slight (0.00–0.20) for Q2 (Tonicity), which was analyzed using Kappa. Kappa above 0.61 signified a good level of reliability. Conclusions: This study demonstrates good rater reliability for the majority of parameters on the SToPS scale, supporting the use of this tool within the clinical realm. However, further research is required to ascertain if any methods of increasing inter rater reliability on those parameters which did not reach good reliability can be identified.
Folia Phoniatr Logop 2019;71:16–23

from Medicine by Alexandros G. Sfakianakis via a.sfakia on Inoreader https://ift.tt/2KQ82sh
more...
No comment yet.
Scooped by ALEXANDROSSFAKIANAKIS
Scoop.it!

An Investigation of Reliability of the Sunderland Tracheosophageal Voice Perceptual Scale

An Investigation of Reliability of the Sunderland Tracheosophageal Voice Perceptual Scale | ENT ORL Health | Scoop.it

Background: The Sunderland Tracheosophageal Voice Perceptual scale (SToPS) is the only perceptual rating scale designed specifically for tracheosophageal voice [Hurren et al.: Clin Otolaryngol. 2009 Dec; 34(6): 533–8]. Objective: To investigate the inter rater reliability of the SToPS when analyzing alaryngeal voice. Methods: Prospective evaluation of inter rater reliability of the SToPS based on audio recordings of 230 voice samples from 41 laryngectomy patients rated by 3 experts. Interval data were analyzed using intraclass correlation coefficients (ICC) while categorical data were analyzed using Kappa. Results: ICC of above 0.6 was observed between raters for each prosthesis on a majority of parameters demonstrating a good level of reliability. Reliability was fair (ICC of between 0.40 and 0.59) on Q11 (Articulatory precision) and Q12 (Paralinguistics). Reliability was also fair (0.21–0.40) or slight (0.00–0.20) for Q2 (Tonicity), which was analyzed using Kappa. Kappa above 0.61 signified a good level of reliability. Conclusions: This study demonstrates good rater reliability for the majority of parameters on the SToPS scale, supporting the use of this tool within the clinical realm. However, further research is required to ascertain if any methods of increasing inter rater reliability on those parameters which did not reach good reliability can be identified.
Folia Phoniatr Logop 2019;71:16–23

from Medicine by Alexandros G. Sfakianakis,Anapafseos 5 via xloma.fota.13 on Inoreader https://ift.tt/2KQ82sh
more...
No comment yet.
Scooped by ALEXANDROSSFAKIANAKIS
Scoop.it!

Serum sickness disease in a patient with alopecia areata and Meniere' disease after PRP procedure

Serum sickness disease in a patient with alopecia areata and Meniere' disease after PRP procedure | ENT ORL Health | Scoop.it
Background

Platelet Rich Plasma procedure (PRP) is considered to be one of the safest aesthetic procedures. Adverse reactions after PRP administration are extreme rare.

Purpose

We present the patient with serum sickness disease (SSD) after PRP procedure.

Objective & Methods

41 years old female suffers from alopecia areata for 5 years with frequent relapses and she has been suffering from Menier's disease recurrent symptoms for 6 years. The patient developed SSD after third PRP rejuvenating procedure and she has also noticed new alopecia areata lessions, but without Menier's disease symptoms.

Results

After SSD, 4 months later, she developed severe symptoms of Menier's disease with an episode of sudden sensorineural hearing loss. It alleviated only after intravenous administration of methylprednisolone.

Conclusion

In our opinion, significant contraindication of PRP procedure is an autoimmune disease in the active phase.

This article is protected by copyright. All rights reserved.



from Medicine by Alexandros G. Sfakianakis via a.sfakia on Inoreader https://ift.tt/2DYDcMJ
more...
No comment yet.
Scooped by ALEXANDROSSFAKIANAKIS
Scoop.it!

Baccharis trimera (Carqueja) Improves Metabolic and Redox Status in an Experimental Model of Type 1 Diabetes

Baccharis trimera (Carqueja) Improves Metabolic and Redox Status in an Experimental Model of Type 1 Diabetes | ENT ORL Health | Scoop.it
Diabetes mellitus is a metabolic disorder that causes severe complications due to the increased oxidative stress induced by disease. Many plants are popularly used in the treatment of diabetes, e.g., Baccharis trimera (carqueja). The aim of this study was to explore the potential application of the B. trimera hydroethanolic extract in preventing redox stress induced by diabetes and its hypoglycemic properties. Experiments were conducted with 48 female rats, divided into 6 groups, named C (control), C600 (control + extract 600 mg/kg), C1200 (control + extract 1200 mg/kg), D (diabetic), D600 (diabetic + 600 mg/kg), and D1200 (diabetic + 1200 mg/kg). Type 1 diabetes was induced with alloxan, and the animals presented hyperglycemia and reduction in insulin and body weight. After seven days of experimentation, the nontreated diabetic group showed changes in biochemical parameters (urea, triacylglycerol, alanine aminotransferase, and aspartate aminotransferase) and increased carbonyl protein levels. Regarding the antioxidant enzymes, an increase in superoxide dismutase activity was observed but in comparison a decrease in catalase and glutathione peroxidase activity was noted which suggests that diabetic rats suffered redox stress. In addition, the mRNA of superoxide dismutase, catalase, and glutathione peroxidase enzymes were altered. Treatment of diabetic rats with B. trimera extract resulted in an improved glycemic profile and liver function, decreased oxidative damage, and altered the expression of mRNA of the antioxidants enzymes. These results together suggest that B. trimera hydroethanolic extract has a protective effect against diabetes.

from Medicine by Alexandros G. Sfakianakis,Anapafseos 5 via xloma.fota.13 on Inoreader https://ift.tt/2zJCgc7
more...
No comment yet.
Scooped by ALEXANDROSSFAKIANAKIS
Scoop.it!

Application of neuro-endoscopic target aspiration of the necrotic core for cerebral contusion with delayed progression: technical note

Application of neuro-endoscopic target aspiration of the necrotic core for cerebral contusion with delayed progression: technical note | ENT ORL Health | Scoop.it
Abstract Background

The optimal management strategy for cerebral contusion remains controversial, especially when standard craniotomy could not be used. We performed neuro-endoscopic target lesionectomy for the delayed progression of cerebral contusion in order to aspirate the necrotic core, which is the primal source of contusional edema.

Methods

The present study included 10 consecutive patients (2 women and 8 men, with a mean age of 67 years old) with traumatic brain injury presenting with delayed deterioration of cerebral contusion where standard craniotomy could not be used. Neuro-endoscopic aspiration of the necrotic core was prospectively performed for all patients. We assessed the computed tomography findings after surgery to evaluate the efficacy of this procedure.

Results

Endoscopic surgery was performed promptly after neurological deterioration, with a mean interval between trauma and surgery of 7 days, ranging from 2 to 16 days. During the operation, the centers of contusions comprised serous liquid components in all 10 patients and were easily aspirated by endoscopy. Contusional edemas were markedly decreased in all within 3 days after surgery.

Conclusions

Progression of contusional edema can be caused by the accumulation of water into the necrotic core due to the rapid increase in osmolality. In light of the highly liquefied demarcated characteristics of the necrotic core, neuro-endoscopic aspiration could be an optional treatment strategy for cerebral contusion with delayed progression in a minimally invasive manner.



from Medicine by Alexandros G. Sfakianakis,Anapafseos 5 via xloma.fota.13 on Inoreader https://ift.tt/2UbZekN
more...
No comment yet.
Scooped by ALEXANDROSSFAKIANAKIS
Scoop.it!

Selectable marker recycling in the nonconventional yeast Xanthophyllomyces dendrorhous by transient expression of Cre on a genetically unstable vector

Selectable marker recycling in the nonconventional yeast Xanthophyllomyces dendrorhous by transient expression of Cre on a genetically unstable vector | ENT ORL Health | Scoop.it
Abstract

Selectable marker recycling is a basic technique in bioengineering. However, this technique is usually unavailable in non-model microorganisms. In this study, we proposed a simple and efficient method for selectable marker recycling in the astaxanthin-synthesizing yeast Xanthophyllomyces dendrorhous. This method was based on a Cre-loxP system, in which the transient expression of the Cre recombinase was controlled by a genetically unstable vector independent of episomal plasmids and inducible promoters. The selectable markers in single-gene locus and multigene loci were removed along with the loss of the Cre vector with a ratio of 100% and 29%, respectively. The significance of the method was highlighted by the finding that stable autotrophic mutants were not readily obtained in X. dendrorhous. Comparative studies in X. dendrorhous and the non-homologous end joining dominant yeast Yarrowia lipolytica suggested that the method could be universally used in homologous recombination dominant yeasts.



from Medicine by Alexandros G. Sfakianakis,Anapafseos 5 via xloma.fota.13 on Inoreader https://ift.tt/2zJyqQf
more...
No comment yet.
Scooped by ALEXANDROSSFAKIANAKIS
Scoop.it!

Genomic architecture and introgression shape a butterfly radiation [NEW RESULTS]

Genomic architecture and introgression shape a butterfly radiation [NEW RESULTS] | ENT ORL Health | Scoop.it
We here pioneer a low-cost assembly strategy for 20 Heliconiini genomes to characterize the evolutionary history of the rapidly radiating genus Heliconius. A bifurcating tree provides a poor fit to the data, and we therefore explore a reticulate phylogeny for Heliconius. We probe the genomic architecture of gene flow, and develop a new method to distinguish incomplete lineage sorting from introgression. We find that most loci with non-canonical histories arose through introgression, and are strongly underrepresented in regions of low recombination and high gene density. This is expected if introgressed alleles are more likely to be purged in such regions due to tighter linkage with incompatibility loci. Finally, we identify a hitherto unrecognized inversion, and show it is a convergent structural rearrangement that captures a known color pattern switch locus within the genus. Our multi-genome assembly approach enables an improved understanding of adaptive radiation.

from Medicine by Alexandros G. Sfakianakis via a.sfakia on Inoreader https://ift.tt/2KR222s
more...
No comment yet.
Scooped by ALEXANDROSSFAKIANAKIS
Scoop.it!

The profile of organic acids and polyphenols in apple wines fermented with different yeast strains

The profile of organic acids and polyphenols in apple wines fermented with different yeast strains | ENT ORL Health | Scoop.it
Influence of two apple cultivars (cvs. Cripps Pink and Idared) and two commercial strains of Saccharomyces bayanus(Lalvin EC1118, Fermol Blanc) on the chemical composition an
more...
No comment yet.
Scooped by ALEXANDROSSFAKIANAKIS
Scoop.it!

Masthead

Masthead | ENT ORL Health | Scoop.it

Publication date: November 2018

Source: Journal of Surgical Education, Volume 75, Issue 6

Author(s):



from Medicine by Alexandros G. Sfakianakis via a.sfakia on Inoreader https://ift.tt/2FVy7r6
more...
No comment yet.
Scooped by ALEXANDROSSFAKIANAKIS
Scoop.it!

Use of 3D Printed Models in Resident Education for the Classification of Acetabulum Fractures

Use of 3D Printed Models in Resident Education for the Classification of Acetabulum Fractures | ENT ORL Health | Scoop.it

Publication date: November 2018

Source: Journal of Surgical Education, Volume 75, Issue 6

Author(s): Philip K. Lim, Graham S. Stephenson, Thomas W. Keown, Connor Byrne, Charles C. Lin, Geoffrey S. Marecek, John A. Scolaro

OBJECTIVE

To determine if three-dimensional (3D) printed models can be used to improve acetabular fracture pattern recognition and be a valuable adjunct in orthopedic resident education.

DESIGN

Fifteen randomized testing stations with each containing plain radiographs (XRs), two-dimensional computed tomography (CT) scans, or 3D model of an acetabular fracture.

SETTING

Two orthopedic residency programs based at Level 1 trauma centers.

PARTICIPANTS

Forty-one orthopedic residents, PGY 1-5.

RESULTS

Senior residents were superior to junior residents at correctly identifying the provided acetabular fracture pattern. Overall, use of CT scans or the 3D model improved fracture classification as compared to standard XRs, but there was no significant difference between use of the CT scans and 3D models. Subjective survey results indicated agreement among residents that 3D models were accurate representations of acetabular fractures and that models would be a desired educational modality.

CONCLUSIONS

3D models improved the accuracy of acetabular fracture identification compared to XR. In addition, trainees were able to use 3D models to obtain similar accuracy compared to CT scans despite not having previous exposure to the models. Interobserver agreement improved when comparing CT to 3D, but did not provide greater than a fair agreement indicating that fracture patterns were difficult to accurately classify even with the use of 3D models. Residents’ subjective responses indicated a positive experience with the use of 3D models. We conclude that the incorporation of 3D models could be an important adjunct to orthopedic residency education for the evaluation complex fracture patterns, but is not significantly superior to identification with CT scans.



from Medicine by Alexandros G. Sfakianakis via a.sfakia on Inoreader https://ift.tt/2riF3o2
more...
No comment yet.
Scooped by ALEXANDROSSFAKIANAKIS
Scoop.it!

Validation of the Omni: A Novel, Multimodality, and Longitudinal Surgical Skills Assessment

Validation of the Omni: A Novel, Multimodality, and Longitudinal Surgical Skills Assessment | ENT ORL Health | Scoop.it

Publication date: November 2018

Source: Journal of Surgical Education, Volume 75, Issue 6

Author(s): Morgan L. Cox, Donald A. Risucci, Brian F. Gilmore, Uttara P. Nag, Megan C. Turner, Shanna R. Sprinkle, John Migaly, Ranjan Sudan

Objective

The breadth of technical skills included in general surgery training continues to expand. The current competency-based training model requires assessment tools to measure acquisition, learning, and mastery of technical skill longitudinally in a reliable and valid manner. This study describes a novel skills assessment tool, the Omni, which evaluates performance in a broad range of skills over time.

Design

The 5 Omni tasks, consisting of open bowel anastomosis, knot tying, laparoscopic clover pattern cut, robotic needle drive, and endoscopic bubble pop, were developed by general surgery faculty. Component performance metrics assessed speed, accuracy, and quality, which were scaled into an overall score ranging from 0 to 10 for each task. For each task, ANOVAs with Scheffé's post hoc comparisons and Pearson's chi-squared tests compared performance between 6 resident cohorts (clinical years (CY1-5) and research fellows (RF)). Paired samples t-tests evaluated changes in performance across academic years. Cronbach's alpha coefficient determined the internal consistency of the Omni as an overall assessment.

Setting

The Omni was developed by the Department of Surgery at Duke University. Annual assessment and this research study took place in the Surgical Education and Activities Lab.

Participants

All active general surgery residents in 2 consecutive academic years spanning 2015 to 2017.

Results

A total of 62 general surgery residents completed the Omni and 39 (67.2%) of those residents completed the assessment in 2 consecutive years. Based on data from all residents' first assessment, statistically significant differences (p < 0.05) were observed among CY cohorts for bowel anastomosis, robotic, and laparoscopic task metrics. By pair-wise comparisons, mean bowel anastomosis scores distinguished CY1 from CY3-5 and CY2 from CY5. Mean robotic scores distinguished CY1 from RF, and mean laparoscopic scores distinguished CY1 from RF, CY3, and CY5 in addition to CY2 from CY3. Mean scores in performance on the knot tying and endoscopic tasks were not significantly different. Statistically significant improvement in mean scores was observed for all tasks from year 1 to year 2 (all p < 0.02). The internal consistency analysis revealed an alpha coefficient of 0.656.

Conclusions

The Omni is a novel composite assessment tool for surgical technical skill that utilizes objective measures and scoring algorithms to evaluate performance. In this pilot study, 3 tasks demonstrated discriminative ability of performance by CY, and all 5 tasks demonstrated construct validity by showing longitudinal improvement in performance. Additionally, the Omni has adequate internal consistency for a formative assessment. These results suggest the Omni holds promise for the evaluation of resident technical skill and early identification of outliers requiring intervention.



from Medicine by Alexandros G. Sfakianakis via a.sfakia on Inoreader https://ift.tt/2rs8WTb
more...
No comment yet.
Scooped by ALEXANDROSSFAKIANAKIS
Scoop.it!

Cancers, Vol. 10, Pages 484: The Role of Glucocorticoid Receptor Signaling in Bladder Cancer Progression

Cancers, Vol. 10, Pages 484: The Role of Glucocorticoid Receptor Signaling in Bladder Cancer Progression | ENT ORL Health | Scoop.it

Cancers, Vol. 10, Pages 484: The Role of Glucocorticoid Receptor Signaling in Bladder Cancer Progression

Cancers doi: 10.3390/cancers10120484

Authors: Hiroki Ide Satoshi Inoue Hiroshi Miyamoto

Previous preclinical studies have indicated that the activation of glucocorticoid receptor signaling results in inhibition of the growth of various types of tumors. Indeed, several glucocorticoids, such as dexamethasone and prednisone, have been prescribed for the treatment of, for example, hematological malignancies and castration-resistant prostate cancer. By contrast, the role of glucocorticoid-mediated glucocorticoid receptor signaling in the progression of bladder cancer remains far from being fully understood. Nonetheless, emerging evidence implies its unique functions in urothelial cancer cells. Moreover, the levels of glucocorticoid receptor expression have been documented to significantly associate with the prognosis of patients with bladder cancer. This review summarizes the available data suggesting the involvement of glucocorticoid-mediated glucocorticoid receptor signaling in urothelial tumor outgrowth and highlights the potential underlying molecular mechanisms. The molecules/pathways that contribute to modulating glucocorticoid receptor activity and function in bladder cancer cells are also discussed.



from Medicine by Alexandros G. Sfakianakis via a.sfakia on Inoreader https://ift.tt/2zGRpLn
more...
No comment yet.
Scooped by ALEXANDROSSFAKIANAKIS
Scoop.it!

Russell-Silver syndrome with cleft palate: a case report

Russell-Silver syndrome with cleft palate: a case report | ENT ORL Health | Scoop.it
Abstract Background

Russell-Silver syndrome (RSS) is characterized by intrauterine growth retardation, short stature without postnatal catch-up growth, and an inverted triangular face with relative macrocephaly. There have been few case reports of RSS with cleft palate, in which perioperative problems such as difficult intubation due to trismus and impossibility to wear a mouth gag due to growth failure of the mandible were described. The case of a female RSS patient with cleft palate who underwent palatoplasty is reported.

Case presentation

Although her weight was particularly low (5920 g), palatoplasty was performed under general anesthesia at 3 years and 6 months of age. Despite limited mouth opening, intubation was relatively easy. Although her mandibular alveolar width was narrow, a Dingman mouth gag could be tightly fastened around her mouth. Postoperatively, the patient was transferred to the intensive care unit without extubation due to pharyngeal edema. On the following day, since the pharyngeal edema had improved, the endotracheal tube was extubated, and her respiratory status was subsequently stable.

Conclusions

In RSS patients with cleft palate, there have been a few reports of pharyngeal edema. Thus, the risk of pharyngeal edema must be considered in such patients.



from Medicine by Alexandros G. Sfakianakis via a.sfakia on Inoreader https://ift.tt/2FXesXL
more...
No comment yet.
Scooped by ALEXANDROSSFAKIANAKIS
Scoop.it!

Cancers, Vol. 10, Pages 484: The Role of Glucocorticoid Receptor Signaling in Bladder Cancer Progression

Cancers, Vol. 10, Pages 484: The Role of Glucocorticoid Receptor Signaling in Bladder Cancer Progression | ENT ORL Health | Scoop.it

Cancers, Vol. 10, Pages 484: The Role of Glucocorticoid Receptor Signaling in Bladder Cancer Progression

Cancers doi: 10.3390/cancers10120484

Authors: Hiroki Ide Satoshi Inoue Hiroshi Miyamoto

Previous preclinical studies have indicated that the activation of glucocorticoid receptor signaling results in inhibition of the growth of various types of tumors. Indeed, several glucocorticoids, such as dexamethasone and prednisone, have been prescribed for the treatment of, for example, hematological malignancies and castration-resistant prostate cancer. By contrast, the role of glucocorticoid-mediated glucocorticoid receptor signaling in the progression of bladder cancer remains far from being fully understood. Nonetheless, emerging evidence implies its unique functions in urothelial cancer cells. Moreover, the levels of glucocorticoid receptor expression have been documented to significantly associate with the prognosis of patients with bladder cancer. This review summarizes the available data suggesting the involvement of glucocorticoid-mediated glucocorticoid receptor signaling in urothelial tumor outgrowth and highlights the potential underlying molecular mechanisms. The molecules/pathways that contribute to modulating glucocorticoid receptor activity and function in bladder cancer cells are also discussed.



from Medicine by Alexandros G. Sfakianakis,Anapafseos 5 via xloma.fota.13 on Inoreader https://ift.tt/2zGRpLn
more...
No comment yet.
Scooped by ALEXANDROSSFAKIANAKIS
Scoop.it!

Minimizing the electrosorption of water from humid ionic liquids on electrodes

Minimizing the electrosorption of water from humid ionic liquids on electrodes | ENT ORL Health | Scoop.it



from Medicine by Alexandros G. Sfakianakis via a.sfakia on Inoreader https://ift.tt/2QC1BhO
more...
No comment yet.
Scooped by ALEXANDROSSFAKIANAKIS
Scoop.it!

Pectoralis Major Myocutaneous Flap for the Reconstruction of the Palatal Defect

Pectoralis Major Myocutaneous Flap for the Reconstruction of the Palatal Defect | ENT ORL Health | Scoop.it
Abstract

It is always a challenge for the soft tissue reconstruction of the palatal defects in advanced malignancies of the oral cavity because of the higher chance flap failure. PMMC flap can be successfully used in patients with advanced malignancies to repair the palatal defect without any significant postoperative complication. In the present case, we have presented a case of malignant melanoma of gingivobuccal complex, involving the hard palate where the palatal defect was successfully reconstructed by the PMMC flap.



from Medicine by Alexandros G. Sfakianakis via a.sfakia on Inoreader https://ift.tt/2Ed62tz
more...
No comment yet.
Scooped by ALEXANDROSSFAKIANAKIS
Scoop.it!

Zirconium-Porphyrin PCN-222: pH-responsive Controlled Anticancer Drug Oridonin

Zirconium-Porphyrin PCN-222: pH-responsive Controlled Anticancer Drug Oridonin | ENT ORL Health | Scoop.it
Drug delivery carriers with a high drug loading capacity and biocompatibility, especially for controlled drug release, are urgently needed due to the side effects and frequent dose in the traditional therapeutic method. Guided by nanomaterials, we have successfully synthesized zirconium-based metal−organic frameworks, Zr-TCPP (TCPP: tetrakis (4-carboxyphenyl) porphyrin), namely, PCN-222, which is synthesized by solvothermal method. And it has been designed as a drug delivery system (DDS) with a high drug loading of 38.77 wt%. In our work, PCN-222 has achieved pH-sensitive drug release and showed comprehensive SEM, TEM, PXRD, DSC, FTIR, and N2 adsorption-desorption. The low cytotoxicity and good biocompatibility of PCN-222 were certificated by the in vitro results from an MTT assay, DAPI staining, and Annexin V/PI double-staining even cultivated L02 cells and HepG2 cells for 48h. Furthermore, Oridonin, a commonly used cancer chemotherapy drug, is adsorbed into PCN-222 via the solvent diffusion technique. Based on an analysis of the Oridonin release profile, results suggest that it can last for more than 7 days in vitro. And cumulative release rate of Ori at the 7 d was about 86.29% and 63.23% in PBS (pH 5.5 and pH 7.2, respectively) at 37°C. HepG2 cells were chosen to research the cytotoxicity of PCN-222@Ori and free Oridonin. The results demonstrated that the PCN-222@Ori nanocarrier shows higher cytotoxicity in HepG2 cells compared to Oridonin.

from Medicine by Alexandros G. Sfakianakis,Anapafseos 5 via xloma.fota.13 on Inoreader https://ift.tt/2Pivkro
more...
No comment yet.
Scooped by ALEXANDROSSFAKIANAKIS
Scoop.it!

Is surgical parent artery occlusion effective for intracranial aneurysms measuring over 10 mm in size? Result from long-term follow-up of size changes and outcomes

Is surgical parent artery occlusion effective for intracranial aneurysms measuring over 10 mm in size? Result from long-term follow-up of size changes and outcomes | ENT ORL Health | Scoop.it
Abstract Background

There have been no long-term follow-up reports pertaining to chronological size changes in large or giant unruptured intracranial aneurysms treated with surgical parent artery occlusion (PAO). The object of this study is to investigate the utility and safety of surgical PAO by conducting a long-term follow-up of chronological aneurysm size changes and outcomes.

Methods

A retrospective study of 21 unruptured intracranial aneurysms measuring over 10 mm (20 patients) treated with surgical PAO in the period 2012–2017 was conducted. For aneurysms presenting with anterior circulation, high/low flow bypass was chosen and carried out concomitantly on the basis of preoperative balloon occlusion test results. Aneurysm size before and after surgery was evaluated chronologically using maximum diameter measurements taken from the same slice of MRI T2-weighted images. Moreover, post-surgery outcomes were evaluated according to a modified Rankin scale (mRS) at discharge.

Results

PAO aiming for blind-alley formation was performed in 20 of 21 aneurysms (95.2%). Aneurysm size reduction was confirmed in 20 aneurysms (95.2%) after proper PAO, with an average reduction rate of 63.1% (range, 28–95%), during an average follow-up period of 27 months (range, 4–54 months). Eighteen (90.4%) of the 20 patients with 21 aneurysms returned to previous life with mRS score 0–2. With regard to preoperative symptoms, diplopia and visual impairment had improved in three patients (50%) and one patient (100%), respectively. Ischemic complications had occurred in five patients, two (9.6%) of whom were symptomatic and three (14.3%) were asymptomatic. The mortality rate in this study was 0%.

Conclusions

Surgical PAO for unruptured intracranial aneurysms measuring over 10 mm has been shown to be an effective method of treatment, eliciting a reduction in aneurysm size.



from Medicine by Alexandros G. Sfakianakis,Anapafseos 5 via xloma.fota.13 on Inoreader https://ift.tt/2AOen2O
more...
No comment yet.
Scooped by ALEXANDROSSFAKIANAKIS
Scoop.it!

Brewing with malted barley or raw barley: what makes the difference in the processes?

Brewing with malted barley or raw barley: what makes the difference in the processes? | ENT ORL Health | Scoop.it
Abstract

Malted barley is the main source for fermentable sugars used by yeasts in the traditional brewing of beers but its use has been increasingly substituted by unmalted barley and other raw grain adjuncts in recent years. The incorporation of raw grains is mainly economically driven, with the added advantage of improved sustainability, by reducing reliance on the malting process and its associated cost. The use of raw grains however, especially in high proportion, requires modifications to the brewing process to accommodate the lack of malt enzymes and the differences in structural and chemical composition between malted and raw grains. This review describes the traditional malting and brewing processes for the production of full malt beer, compares the modifications to these processes, namely milling and mashing, when raw barley or other grains are used in the production of wort—a solution of fermentable extracts metabolized by yeast and converted into beer, and discusses the activity of endogenous malt enzymes and the use of commercial brewing enzyme cocktails which enable high adjunct brewing.



from Medicine by Alexandros G. Sfakianakis,Anapafseos 5 via xloma.fota.13 on Inoreader https://ift.tt/2PkEDHz
more...
No comment yet.
Scooped by ALEXANDROSSFAKIANAKIS
Scoop.it!

Sudden death of baby elephant leaves Oregon Zoo staff heartbroken

Sudden death of baby elephant leaves Oregon Zoo staff heartbroken | ENT ORL Health | Scoop.it
A 6-year-old Asian elephant, the youngest member of the Oregon Zoo's elephant family who was the "darling of the zoo," unexpectedly died Thursday night from a deadly virus, according to zoo staff.
more...
No comment yet.