Work-related musculoskeletal pain and discomfort in laparoscopic surgeons: an international multispecialty survey.

INTRODUCTION: As laparoscopic surgery is used more widely across the globe and within multiple surgical specialties the potential impact on surgeons is yet to be fully quantified. Maintenance of uncomfortable body positions may lead to work-related musculoskeletal disorders (WMSD) in surgeons, with potential knock-on effects. METHODS: An international open online survey of multispecialty laparoscopic surgeons was carried out, designed and reported in accordance with the CHERRIES checklist for internet e-survey research. There was no paid advertising and no incentives offered. RESULTS: A total of 259 surgeons from 9 specialties and 32 countries answered the survey, with 90% reporting pain attributable to performing laparoscopic surgery. All training grades were represented. Longer average operative duration and a greater number of years in practice were both associated with a significantly higher prevalence of pain. Surgeons with a pre-existing injury were significantly more likely to report pain than those without. Twenty per cent of surgeons would consider early retirement owing to pain. CONCLUSIONS: The impact on surgeons of performing laparoscopic surgery is significant, even given the limitations of an open survey. Innovations such as robotic surgery and improved ergonomic education may reduce the incidence of WMSD in surgeons, to mitigate both the personal effects on surgeons and the wider effect on the future surgical workforce.

Learning in the COVID-19 pandemic and beyond: development and rapid uptake of an online learning platform for vascular surgery.

INTRODUCTION: With the onset of the COVID-19 pandemic, alternative methods of delivering medical education were rapidly required. An online learning platform was developed with the aim of providing high-quality, accessible learning to vascular specialty trainees. We describe the design, delivery and analysis of the first 15 months of the platform. Although originally a regional initiative, we discuss how popularity and feedback led to a rapid expansion of the training programme internationally. METHODS: A fully online educational platform for vascular surgery specialist trainees was developed. The primary aims and ethos of the programme were that it should be easily accessible from any location, convenient, flexible, cooperative and collaborative, social and free financially to access. All learning resources were researched carefully and based on the UK vascular surgery curriculum and 20 seminal papers targeted in the Vascular Specialist Fellow of the Royal College of Surgeons (FRCSVasc) examination. RESULTS: The project demonstrated that it is feasible to design, build and deliver a postgraduate clinical teaching platform with minimal time requirement, resources and cost while creating and maintaining high-quality content. Rapid national and international uptake has proven there is demand - in addition to overwhelmingly positive feedback from educators and learners, this demonstrates that previously perceived barriers to online education can be overcome. At present, 53 educational sessions have been delivered and are available in the online library, and in the past year (8 December 2020 to 8 December 2021) the website has been accessed 3,877 times. CONCLUSIONS: Although the programme has grown and evolved, a strong focus is being kept on its original ethos and aims - easily accessible, collaborative, free learning resources for all vascular professionals, based on the UK vascular surgery curriculum. Making learning convenient is key. The COVID-19 pandemic may be a watershed moment for a new era of learning. It is an opportunity for people from different backgrounds to share experiences and to develop cohesion within a hospital and network, nationally and worldwide.

Major colorectal resection is feasible using a new robotic surgical platform: the first report of a case series.

BACKGROUND: The number of abdominal procedures performed via a robotic-assisted approach is increasing as potential advantages of the modality are recognised. We report the first in human case series of major colorectal resection performed using a new system, Versius®, and assess the feasibility of its use. METHODS: The initial cases performed using Versius® at a single centre in the UK were included in the study. Anonymised data were prospectively collected including patient demographics, operative details and postoperative outcomes. RESULTS: Twenty-three operations were performed, including left (n = 14) and right (n = 9)-sided colonic resections. Rectal mobilisation was performed in 13. Fifty-seven percent of the patients were male, with a malignant indication for surgery in 70% of cases. Overall mean age was 59.1 ± 15.3 (range 23-89) years. Overall mean body mass index was 28.9 ± 5.2 with a mean of 31.3 ± 4.5 for left-sided resections. The median console operating time was 166 min (range 75-320 min). All malignant cases had negative resection margins and the mean lymph node yield was 18 (SD 9.4). Only one operation (4%) was converted from robotic to open approach. Postoperative length of stay was a median of 5 days (range 3-34 days) and there were no readmissions within 30 days. CONCLUSIONS: These results compare favourably with the literature on existing robotic systems and also conventional laparoscopic surgery; hence, we believe that this series indicates the Versius® system is feasible for use in major colorectal resection. These early results from a robot-naïve centre show exciting promise for an expanding robotic market and highlight the need for further evaluation.

Susceptibility of Snails to Infection with Schistosomes is influenced by Temperature and Expression of Heat Shock Proteins.

The freshwater snail, Biomphalaria glabrata is the obligate intermediate host for the transmission of the parasitic trematode, Schistosoma mansoni the causative agent of the chronic debilitating neglected tropical disease, schistosomiasis. We showed previously that in juvenile snails, early and significant induction of stress manifested by the expression of stress proteins, Hsp 70, Hsp 90 and reverse transcriptase (RT) of the non- LTR retrotransposon, nimbus, is a characteristic feature of juvenile susceptible NMRI but not resistant BS-90 snails. These latter, however, could be rendered susceptible after mild heat shock at 32°C, revealing that resistance in the BS-90 resistant snail to schistosomes is a temperature dependent trait. Here we tested the hypothesis that maintenance of BS-90 resistant snails at the permissive temperature for several generations affects the resistance phenotype displayed at the non-permissive temperature of 25°C. The progeny of BS-90 snails bred and maintained through several generations (F1 to F4) at 32°C were susceptible to the schistosome infection when returned to room temperature, shedding cercariae at four weeks post-infection. Moreover, the study of expression levels of the heat shock protein (Hsp) 70 protein by ELISA and western blot analysis, showed that this protein is also differentially expressed between susceptible and resistant snails, with susceptible snails expressing more protein than their resistant counterparts after early exposure to wild-type but not to radiation-attenuated miracidia. These data suggested that in the face of global warming, the ability to sustain a reduction in schistosomiasis by using refractory snails as a strategy to block transmission of the disease might prove challenging since non-lethal elevation in temperature, affects snail susceptibility to S. mansoni.

An investigation into exposure of pigs to lead from contaminated zinc oxide in 2007-2008.

BACKGROUND: High levels of lead, up to 3.3 mg/kg fresh weight, were detected in pig liver in Western Australia at the beginning of 2008. This followed the detection of lead at above the maximum level (ML) in a pig liver through the National Residue Survey (NRS). The contamination source was traced back to a zinc oxide feed additive used early post-weaning that contained in excess of 8% lead. METHODS AND RESULTS: Confirmation of the source of lead contamination was obtained by comparing lead isotope ratios for the zinc oxide and the pig livers. The investigation demonstrated the importance of verifying the safety of feed and feed ingredients prior to incorporation in feed. Retrospective analysis of NRS data indicated that the level of lead needed to trigger an investigation for intensively housed pigs should be considerably lower than the ML. As a result, investigations in Australia will now be conducted when levels of lead in pig liver exceed 0.1 mg/kg fresh weight. CONCLUSIONS: Despite the potential for small amounts of non-compliant kidney and liver to enter the human food chain, there was no significant increase in the risk to consumers.

Characterization of the response to moisture of talc and perlite in the environmental scanning electron microscope.

This article focuses on the application of ESEM to study the dynamic interaction of hydrophobic and hydrophilic filler materials of interest for the cosmetic and pharmaceutical industries. The ability of ESEM to attain different thermodynamic stages was used to record real-time information of hydration and dehydration processes of those materials in the presence of water and sweat (used as a model physiological fluid). This information is of great importance to understand the behavior of a product containing those fillers as well as to identify potential processing issues related to the interaction of the filler with moisture.

Outbreak of bovine tuberculosis featuring anergy to the skin test, udder lesions and milkborne disease in young calves.

A severe outbreak of bovine tuberculosis in a 1300-head, multisite dairy herd in Great Britain had several unusual features, including anergy to the tuberculin skin test, milkborne disease in calves and a farm cat, and a risk of human infection. The outbreak was controlled by culling 221 cattle over 15 months, by using the gamma-interferon (gamma-IFN) test and by the examination of milk samples. The gamma-IFN test detected infected animals that were not detected by the skin test.

Age and sex differences in the cerebellum and the ventral pons: a prospective MR study of healthy adults.

BACKGROUND AND PURPOSE: The human brain exhibits a complex pattern of differential aging. The purpose of this study was to examine whether age differences in the volume of cerebellar regions and the ventral pons are differential or generalized, whether the age-related shrinkage is linear or exponential, and whether there are sex differences in the size of the cerebellum and pons. METHODS: The volumes of the cerebellar hemispheres (excluding the vermis and the peduncles), the vermis, and the ventral pons were estimated from the prospectively acquired MR scans of 190 healthy volunteers (aged 18-81 years). The relation between regional volumes, age, and sex was assessed while taking into account differences in body size (height). RESULTS: We found a moderate age-related reduction in the volume of the cerebellar hemispheres and the cerebellar vermis. In contrast to previous findings that suggested differential vulnerability of the posterior vermis, the age-related shrinkage of the vermian lobules was uniform-about 2% per decade. In accord with all reports in the literature, the size of the ventral pons was unrelated to age. The volume of the cerebellar hemispheres, the vermis, and the ventral pons were larger in men, even after adjustment for height. The magnitude of the sex difference was the largest in the hemispheres and the anterior vermis, and the smallest in the lobules VI-VII (declive-folium-tuber). CONCLUSION: Moderate age-related shrinkage of the cerebellum and lack of age-related differences in the ventral pons are robust phenomena. However, in all likelihood, the effects of age on the cerebellum are not differential but uniform. The cerebellum and the pons are larger in men than in women and the difference is especially pronounced in the cerebellar hemispheres and the anterior vermis.

Neuroanatomical and cognitive correlates of adult age differences in acquisition of a perceptual-motor skill.

The objective of this study was to examine age differences in procedural learning and performance in conjunction with differential aging of central nervous system (CNS) structures. Sixty-eight healthy volunteers (age 22-80) performed a pursuit rotor task (four blocks of 20 15-second trials each). Volumes of the cerebellar hemispheres, neostriatum, prefrontal cortex, and hippocampus were measured from Magnetic Resonance (MR) images. Improvement in pursuit rotor performance was indexed by increase in time on target (TOT). A general improvement trend was evident across the blocks of trials. Overall, younger participants showed significantly longer TOT. The rate of improvement was age-invariant during the initial stages of skill acquisition but became greater in middle-aged participants as the practice progressed. When the influences of regional brain volumes were taken into account, the direct age effect on mean TOT measured during the first day of practice disappeared. Instead, reduced volumes of the cerebellar hemispheres and the putamen and poorer performance on nonverbal working memory tasks predicted shorter TOT. In contrast, neither the volume of the caudate and the hippocampus, nor verbal working memory showed association with motor performance. Pursuit rotor performance at the later stages of practice was unrelated to the reduction in putamen volume and was affected directly by age, cerebellar volume, and nonverbal working memory proficiency. We conclude that in a healthy population showing no clinical signs of extrapyramidal disease, age-related declines in procedural learning are associated with reduced volume of the cerebellar hemispheres and lower nonverbal working memory scores. During initial stages of skill acquisition, reduced volume of the putamen is also predictive of poorer performance.

The cognitive correlates of white matter abnormalities in normal aging: a quantitative review.

Cerebral white matter of asymptomatic people frequently exhibits circumscribed areas of hyperintensity on magnetic resonance (MR) images and hypodensity on computed tomography scans. However, behavioral implications of this phenomenon remain unclear. In this meta-analysis, the authors examine cumulative evidence regarding the cognitive sequelae of white matter abnormalities in adults without dementia. The influence of potential moderator variables, such as neuroimaging technique, location of the lesions, rating scale, and demographic characteristics of the sample on the association between the burden of white matter hyperintensities and cognitive performance was also examined. Results indicate that white matter abnormalities observed on MR images are associated with attenuated performance on tasks of processing speed, immediate and delayed memory, executive functions, and indices of global cognitive functioning. There was no significant link between the white matter hyperintensities and psychometric indices of intelligence or fine motor performance.

Identification and cloning of GCA1, a gene that encodes a cell surface glucoamylase from Candida albicans.

Adherence of yeast cells of Candida albicans to human oesophageal cells is greater when cells are grown in 500 mM D-galactose in comparison to D-glucose at the same concentration. Moreover, a 190 kDa mannoprotein (MP190) from a yeast cell wall preparation is highly expressed when cells are grown in the presence of galactose but less so in glucose. We now report on the identification of the MP190 and the isolation of its encoding gene. MP190 was purified, and three internal peptides were isolated and sequenced. Each of the three peptides showed significant homology (65-85%) with a glucoamylase (GAM1) from the yeast, Schwanniomyces occidentalis. In order to isolate the C. albicans homologue of GAM1 (GCA1), we probed a genomic library with a 0.9-kb internal fragment of the S. occidentalis GAM1 and isolated a 2.3-kb clone that corresponded to the 5' region of the gene. Polymerase chain reaction (PCR) amplification was used to isolate the remainder of the open reading frame. GCA1 encodes a 946 amino acid protein containing three putative hydrophobic, membrane-spanning domains and 15 potential N-glycosylation sites. Both Gca1p and GAM1 are novel to the family of glycosyl hydrolases. Northern analysis indicated that GCA1 is transcribed to a greater extent in galactose than in sucrose or glucose. Also, using reverse transcriptase (RT)-PCR, we observed expression of GCA1 in a rat model of oral candidiasis, indicating that Gca1p is expressed during disease development.

Differential aging of the human striatum: a prospective MR imaging study.

BACKGROUND AND PURPOSE: Advancing age is associated with declines in motor function; understanding age-related changes in the basal ganglia, therefore, is imperative for comprehension of such functional changes. The purpose of this study was to examine the age, sex, and hemispheric differences in volume of the caudate nucleus, the putamen, and the globus pallidus. METHODS: In a sample of 148 healthy right-handed adults (18-77 years old) with no evidence of age-related motor disorders, we estimated the volume of the head of the caudate nucleus, the putamen, and the globus pallidus from MR images. RESULTS: The analyses revealed bilateral age-related shrinkage of the head of the caudate nucleus and the putamen in both sexes. In men, the age-related shrinkage of the caudate was stronger on the left, whereas, in women, the opposite trend was evident. In both sexes, age-related shrinkage of the right putamen was greater than of its left counterpart. The mild bilateral age-related shrinkage of the globus pallidus was observed only in men. In both sexes, we observed significant rightward asymmetry in the putamen, significant leftward asymmetry in the caudate, and no asymmetry in the globus pallidus. CONCLUSIONS: Bilateral age-related shrinkage of the neostriatum is found in healthy adults. The shrinkage of the globus pallidus is less pronounced and may be restricted to men only.

Metabolism of carvedilol in dogs, rats, and mice.

The excretion and biotransformation of carvedilol [1-[carbazolyl-(4)-oxy]-3-[(2-methoxyphenoxyethyl)amino]-2-p ropanol], a new, multiple-action, neurohormonal antagonist that exhibits the combined pharmacological activities of beta-adrenoreceptor antagonism, vasodilation, and antioxidation, were investigated in dogs, rats, and mice. Carvedilol was absorbed well, and biliary secretion was predominant in each species. Carvedilol was metabolized extensively in each species, and elimination of unchanged compound was minor in bile duct-catheterized rats and dogs. In dogs, glucuronidation of the parent compound and hydroxylation of the carbazolyl ring, with subsequent glucuronidation, were the major metabolic pathways. Rats showed the simplest metabolite profile; the primary metabolites were formed by hydroxylation of the carbazolyl ring, with subsequent glucuronidation. Mice displayed the most complicated metabolite profile; glucuronidation of the parent compound and hydroxylation of either the carbazolyl or phenyl ring, with subsequent glucuronidation, were the major metabolic routes. O-Dealkylation was a minor pathway in all species examined.

Neuroanatomical correlates of cognitive aging: evidence from structural magnetic resonance imaging.

To examine putative brain substrates of cognitive functions differentially affected by age the authors measured the volume of cortical regions and performance on tests of executive functions, working memory, explicit memory, and priming in healthy adults (18-77 years old). The results indicate that shrinkage of the prefrontal cortex mediates age-related increases in perseveration. The volume of visual processing areas predicted performance on nonverbal working memory tasks. Contrary to the hypotheses, in the examined age range, the volume of limbic structures was unrelated to any of the cognitive functions; verbal working memory, verbal explicit memory, and verbal priming were independent of cortical volumes. Nevertheless, among the participants aged above 60, reduction in the volume of limbic structures predicted declines in explicit memory. Chronological age adversely influenced all cognitive indices, although its effects on priming were only indirect, mediated by declines in verbal working memory.

In vivo immunosuppression by targeting a novel protease receptor.

Membrane receptors for blood proteases govern the clotting and fibrinolytic cascades, regulate signal transduction and control the growth of mesenchymal cells. Despite their importance in the development of vascular injury, it is unclear whether these mechanisms participate in the generation of an immune response. Here we report that targeting a factor Xa receptor, designated effector cell protease receptor-1 (EPR-1), with antisense oligonucleotide or with a monoclonal antibody (mAB 2E1) inhibited CD3/T-cell receptor-dependent lymphocyte proliferation. Immunosuppression was mediated by abolishing cytokine production and down-modulating membrane expression of the interleukin (IL)-2 receptor. In vivo administration of mAb 2E1 to severe-combined-immunodeficient mice injected with human peripheral blood leukocytes suppressed production of human immunoglobulin, abolished graft-versus-host disease, and protected these xenochimaeric mice from Epstein-Barr-virus-induced human lymphoproliferative disease. These observations indicate a new role for protease receptors in the regulation of the immune response, and identify a potential target for therapeutic immunosuppression in humans.

Effect of high-performance liquid chromatography mobile phase components on sensitivity in negative atmospheric pressure chemical ionization liquid chromatography-mass spectrometry.

We have investigated the effect of several common buffers (10-mM formic acid, 10-mM ammonium acetate, and 100-mM ammonium acetate) on the ionization of a series of model compounds that are amenable to negative atmospheric pressure chemical ionization to determine the extent of ionization quenching that can occur. In addition, we have compared the sensitivity of these standard mobile phases to a mobile phase that does not contain an acidic buffer component, but rather a base (N-methylmorpholine). The results showed that, as expected, the sensitivity for the test analytes was greatest in the mobile phase that lacked acidic components. In general, ionization of analytes that contained a single, more weakly acidic functional group was inhibited to a greater degree by more strongly acidic buffer components. In some cases, ionization was quenched completely by acidic buffer components, Ionization of compounds that were more strongly acidic was quite good in all mobile phases tested. Differences in the ionization efficiencies of the analytes in each mobile phase were correlated with the gas-phase reagent ions present. As a point of reference, each of the analytes also was analyzed in the positive ion mode and the signal intensities were compared to those obtained in the negative ion mode. In addition, the utility of mobile phases that contained N-methylmorpholine for chromatographic separations was demonstrated.

The influence of increased health care costs on general practitioner consultations and prescription collection.

AIM: Increased health service charges have led to concern that some patients may be unable to meet these costs, which could compromise their care. Increased costs may affect general practitioner attendance, and/or the collection of a prescription. This study examines both of these factors. METHODS: Between 18 August and 14 September 1992, questionnaires were sent to the consenting patients of 19 general practitioners from the Hutt Valley requesting information regarding the general practice (GP) visit and the prescription. The information included the reason for the GP visit, whether there was any delay and its duration, the reason for any delay, the cost of the visit and whether a prescription was received. Data regarding the prescription included the cost and whether all, some, or none of the items were uplifted, and whether the patient had a community service card. RESULTS: 489 (86%) returned completed questionnaires and 426 received a prescription. Of these, 164 were group 1 community service card holders; one was a group 2 community service card holder; 186 were group 3; 59 did not specify their group; 18 had a chronic-user card. Forty percent (194 patients), delayed going to their doctor, 118 by more than 3 days. The most common reasons for delay were hope that their condition may improve spontaneously and the cost of the consultation or prescription. Possession of a community service card was a significant factor in delay with group 3 (high wage earners) more likely to delay than group 1 (p < 0.0005). Only two patients did not present their prescription. Ninety-three percent of those receiving a prescription presented for dispensing within 24 hours. Ninety-two percent of patients paid for all their prescription items. CONCLUSIONS: Delay in obtaining treatment is common and occurs primarily at the general practitioner consultation. It primarily affects those individuals who were classified as group 3, the group that has taken the burden of recent health service charges increases.