Retired Surgeons as Mentors for Surgical Training Graduates Entering Practice: An Underutilized Resource.

OBJECTIVE: Our study evaluated the willingness of retired surgeons to mentor newly trained surgeons. SUMMARY BACKGROUND DATA: Although mentoring is very important during the transition in practice, many novice surgeons are faced with inadequacy or lack of mentoring. METHODS: A survey regarding mentorship of new surgeons was sent in April 2018 to retired general, colorectal, vascular, and cardiothoracic surgeons that are members of the American College of Surgeons. The analysis of the data was performed in September 2018 and October 2018. RESULTS: A total of 2295 of 5282 surveys were completed (43.4% response rate). Mean age was 79.0 ±â€Š0.8 years, mean retirement age was 63.9 ±â€Š0.1 years, and mean interval since retirement was 15.2 ±â€Š0.9 years. Most retired surgeons were in private practice (66.4%), with other practice environments, including academic teaching hospital (12%), academic/private combination (11.3%), employment by community hospital or health system (6.4%), veteran affairs institution (2.7%), military hospital (1%), and Indian Health Service (0.09%). Approximately a third (31.1%) of respondents were not mentored when they first entered practice. The vast majority (98.3%) of participants considered mentoring beneficial during transition in practice. More than half (51.2%) of retired surgeons are interested in mentoring recently trained surgeons, with most of them (81.8%) willing to mentor even for free. CONCLUSION: Our findings suggest that a significant number of retired surgeons are enthusiastic about mentoring young surgeons during their transition in practice. Specific programs are necessary to meet the needs of newly hired surgeons and better utilize the expertise of retired surgeons.

Scattering-Based Light-Sheet Microscopy for Rapid Cellular Imaging of Fresh Tissue.

BACKGROUND AND OBJECTIVES: Light-sheet microscopy (LSM) is a novel imaging technology that has been used for imaging fluorescence contrast in basic life science research. In this paper, we have developed a scattering-based LSM (sLSM) for rapidly imaging the cellular morphology of fresh tissues without any exogenous fluorescent dyes. STUDY DESIGN/MATERIALS AND METHODS: In the sLSM device, a thin light sheet with the central wavelength of 834 nm was incident on the tissue obliquely, 45° relative to the tissue surface. The detection optics was configured to map the light sheet-illuminated area onto a two-dimensional imaging sensor. The illumination numerical aperture (NA) was set as 0.0625, and the detection NA 0.3. RESULTS: The sLSM device achieved a light sheet thickness of less than 6.7 µm over 284 µm along the illumination optical axis. The detection optics of the sLSM device had a resolution of 1.8 µm. The sLSM images of the swine kidney ex vivo visualized tubules with similar sizes and shapes to those observed in histopathologic images. The swine duodenum sLSM images revealed cell nuclei and villi architecture in superficial lesions and glands in deeper regions. CONCLUSIONS: The preliminary results suggest that sLSM may have the potential for rapidly examining the freshly-excised tissue ex vivo or intact tissue in vivo at microscopic resolution. Further optimization and performance evaluation of the sLSM technology will be needed in the future. Lasers Surg. Med. © 2020 Wiley Periodicals LLC.

Playing the Surgical Technologist Role by Surgery Residents Improves Their Technical and Nontechnical Skills.

BACKGROUND: The present study was designed to implement and evaluate an interprofessional surgical technologist-to-surgical resident training program for junior general surgery residents aimed at enhancing their operating room skills. This program would be incorporated into the general surgery educational curriculum. MATERIAL AND METHODS: Under the guidance and supervision of a surgical technologist, first-year and second-year general surgery residents performed the perioperative and intraoperative tasks that are the responsibilities of the surgical technologist for 16 inguinal/umbilical hernia and 15 laparoscopic appendectomy/cholecystectomy operations performed by attending surgeons assisted by other surgical residents from June 01, 2017 until December 31, 2017. A pretraining and post-training survey comprised 25 ranked questions (using a four-point Likert scale), and four Yes/No questions were administered to volunteer general surgery residents. RESULTS: Paired t-test analysis showed that playing the role of the surgical technologist by the junior surgery residents significantly improved (P < 0.0001) their assessment of operating room technical skills (knowledge and skills to prepare for the case and maintain a sterile field, understanding of the operative steps, knowledge of surgical instruments and their handling) as well as their nontechnical skills (situational awareness, understanding the importance of collaboration, teamwork, and communication). The answers to the binary Yes/No questions showed that all participating residents expect to use the experience gained from this training, would recommend this training session to a colleague, and support including this training session in their educational curriculum. CONCLUSIONS: The findings of this study suggest a significant educational benefit of incorporating interprofessional, surgical technologist-to-surgical resident training into the educational curriculum of the junior general surgery residents.

mTORC1-S6K1 inhibition or mTORC2 activation improves hippocampal synaptic plasticity and learning in Angelman syndrome mice.

Emerging evidence is implicating abnormal activation of the mechanistic target of rapamycin (mTOR) pathway in several monogenetic neuropsychiatric disorders, including Angelman syndrome (AS), which is caused by deficiency in maternally inherited UBE3A. Using an AS mouse model, we show that semi-chronic rapamycin treatment improves long-term potentiation (LTP) and actin polymerization in hippocampal slices, spine morphology, and fear-conditioning learning. Activity of mTORC1 and of its downstream substrate, S6K1, was increased in hippocampus of AS mice. However, mTORC2 activity, as reflected by PKCα levels, was decreased. Both increased mTORC1 and decreased mTORC2 activities were reversed by semi-chronic rapamycin treatment. Acute treatment of hippocampal slices from AS mice with rapamycin or an S6K1 inhibitor, PF4708671, improved LTP, restored actin polymerization, and normalized mTORC1 and mTORC2 activity. These treatments also reduced Arc levels in AS mice. Treatment with Torin 1, an inhibitor of both mTORC1 and mTORC2, partially rescued LTP and actin polymerization in hippocampal slices from AS mice, while partially impairing them in wild-type (WT) mice. Torin 1 decreased mTORC1 and increased mTORC2 activity in slices from AS mice but inhibited both mTORC1 and mTORC2 in WT mice. Finally, an mTORC2 activator, A-443654, increased hippocampal LTP in AS mice and actin polymerization in both WT and AS mice. Collectively, these results indicate that events set in motion by increased mTORC1 and decreased mTORC2 activities, including increased Arc translation and impaired actin remodeling, are crucial in AS pathogenesis. Therefore, selectively targeting these two master kinase complexes may provide new therapeutic approaches for AS treatment.

Variability in rod to bone distance needed in pelvic subcutaneous internal fixation to avoid nerve compression: A tridimensional population-based study.

INTRODUCTION: Pelvic internal fixation has become a popular method for treatment of unstable pelvic ring injuries. Although successful, one complication is femoral nerve palsy from compression of the connecting rod. In light of this complication, this study was designed to evaluate sagittal inclinations of the rod and the feasibility of using a rod with a constant curvature. HYPOTHESIS: It is hypothesized that that there is a connection between the sagittal inclination of the rod and the rod to bone distance, as well as single rod can be contoured with a constant curvature to be used in the majority of all patients. METHODS: Three dimensional models of pelvis CTs from a single level 1 trauma center were created and imported into a program where software superimposed a pre-contoured rod in the sagittal planes upon the pelvic slices. The sagittal inclination was deemed acceptable is no interference occurred between the area of compression risk and the rod. For each pelvis and considered sagittal rod inclination, the rod radius of curvature (ROC), minimal rod to bone distance (RTB) and transverse inclinations (φL and φR) were measured at which the pedicle screws should be inserted to follow the direction of the smallest RTB. RESULTS: The sagittal inclinations feasible for all subjects were between 15° to 30°. In this sagittal range, the average RTB varied in values ranging from 4.0±0.9mm to 25.4±11.4mm (p<0.01). Only 46% of subjects allowed a rod with constant curvature. DISCUSSION AND CONCLUSION: Our study found that a rod to bone distance of 15mm was not safe for all models. As well, many subject models did not allow placement of pre-contoured rod. Patient specific templating of pelvic subcutaneous internal fixation is strictly needed to limit complications. LEVEL OF EVIDENCE: VII; Basic Science.

Mentoring experience of new surgeons during their transition to independent practice: A nationwide survey.

BACKGROUND: New surgeons are faced with inadequate mentoring when first entering practice. Our study examined challenges faced by young surgeons during their transition in practice and their mentoring experience when entering practice. METHODS: An article-based survey was mailed in August 2019 to general, colorectal, vascular, and cardiothoracic surgeons that became members of the American College of Surgeons within the past 5 years. RESULTS: A total of 853 of 2,915 surveys were completed (29.3% response rate). Both female (38%) and male (62%) surgeons participated. The 3 most common challenges during the transition to practice were confidence building (26.0%), adjusting to a new institutional culture (16.9%), and business and administrative aspects of practice (16.3%). First job attrition rate 44.2%, with the mean duration of the first job being 3.28 ± 0.17 years. Nearly one-third (28.3%) of respondents were not mentored when they first entered practice. The proportion of nonmentored young surgeons leaving their first job (64.3%) was almost twice as that of surgeons who received mentoring (36.3%). Furthermore, the mean duration of the first job was significantly shorter in nonmentored versus mentored surgeons (3.16 ± 0.26 vs 3.76 ± 0.25 years; P < .05). A significant number (43.3%) of respondents reported a desire to be mentored by retired surgeons. CONCLUSION: Our survey highlights the importance of mentoring for young surgeons during their transition into practice. With many young surgeons being enthusiastic about mentoring by retired surgeons, specific programs are necessary to better use their expertise.

Sepsis and glucocorticoids downregulate the expression of the nuclear cofactor PGC-1beta in skeletal muscle.

Muscle wasting during sepsis is at least in part regulated by glucocorticoids and is associated with increased transcription of genes encoding the ubiquitin ligases atrogin-1 and muscle-specific RING-finger protein-1 (MuRF1). Recent studies suggest that muscle atrophy caused by denervation is associated with reduced expression of the nuclear cofactor peroxisome proliferator-activated receptor-γ coactivator (PGC)-1ß and that PGC-1ß may be a repressor of the atrogin-1 and MuRF1 genes. The influence of other muscle-wasting conditions on the expression of PGC-1ß is not known. We tested the influence of sepsis and glucocorticoids on PGC-1ß and examined the potential link between downregulated PGC-1ß expression and upregulated atrogin-1 and MuRF1 expression in skeletal muscle. Sepsis in rats and mice and treatment with dexamethasone resulted in downregulated expression of PGC-1ß and increased expression of atrogin-1 and MuRF1 in the fast-twitch extensor digitorum longus muscle, with less pronounced changes in the slow-twitch soleus muscle. In additional experiments, adenoviral gene transfer of PGC-1ß into cultured C2C12 myotubes resulted in a dose-dependent decrease in atrogin-1 and MuRF1 mRNA levels. Treatment of cultured C2C12 myotubes with dexamethasone or PGC-1ß small interfering RNA (siRNA) resulted in downregulated PGC-1ß expression and increased protein degradation. Taken together, our results suggest that sepsis- and glucocorticoid-induced muscle wasting may, at least in part, be regulated by decreased expression of the nuclear cofactor PGC-1ß.

Mentorship of Surgical Interns: Are We Failing to Meet Their Needs?

OBJECTIVE: This study aimed to determine the challenges faced by surgical trainees during their internship and to explore their experience with mentoring. DESIGN: An internet-based survey comprised of 30 questions was distributed to 59 surgical interns to evaluate their internship experience at the conclusion of the academic year 2018 to 2019. SETTING: Four academic medical centers in Boston, Massachusetts. PARTICIPANTS: Both preliminary as well as categorical general surgery interns were included in the study. Twenty-five responses were received (response rate of 42.4%). RESULTS: The majority of surgical interns (80%) reported having a mentor during their intern year. Gender as well as mentor career status/prestige were both the highest rated factors in selection of a mentor, (4.67/5 and 4.33/5 respectively). Mentoring topics varied by the career status of the mentor, with most surgical interns (80%) selecting senior faculty members for mentoring on career planning, clinical training, and research. Surgical interns relied only on junior faculty members to discuss work-life integration. Very few surveyed interns (only 1 in 10) discussed work-life integration with their mentors despite this being reported as the most significant challenge of their internship year. Only 15% of the interns reported that the effectiveness of the mentor-mentee relationship was reviewed by program administration. About one third (30%) of interns reported that they would not feel comfortable reporting a failed mentorship to their program director. Furthermore, 40% of the surgical interns were not given an option to choose a new mentor in case of failed mentoring. CONCLUSIONS: Surgical interns report high work demands and challenges with worklife integration in their first year of surgical training, however only a small minority of interns discuss this with their mentors. Surgical residency programs should better supervise and adjust mentoring of surgical interns in order to maximize their performance and wellness.

Smartphone epifluorescence microscopy for cellular imaging of fresh tissue in low-resource settings.

Disease diagnosis in low-resource settings can be challenging due to the lack of equipment and trained personnel required for histologic analysis. In this paper, we have developed a smartphone-based epifluorescence microscope (SeFM) for imaging fresh tissues at sub-cellular resolution. SeFM provides similar resolution and field of view (FOV) as those used during histologic analysis. The SeFM device achieved the lateral resolution of 0.57 µm and provided microscopy images over a sample area larger than 500 µm. The material cost was low, approximately $3,000. Preliminary images of human pancreatic tumor specimens clearly visualized cellular details. Quantitative analysis showed that using an excess dose of a chemotherapy drug significantly reduced the tumor-specific fluorescence signal, confirming the specificity of the drug and the detection potential of SeFM.

Experimental hyperthyroidism in rats increases the expression of the ubiquitin ligases atrogin-1 and MuRF1 and stimulates multiple proteolytic pathways in skeletal muscle.

Muscle wasting is commonly seen in patients with hyperthyroidism and is mainly caused by stimulated muscle proteolysis. Loss of muscle mass in several catabolic conditions is associated with increased expression of the muscle-specific ubiquitin ligases atrogin-1 and MuRF1 but it is not known if atrogin-1 and MuRF1 are upregulated in hyperthyroidism. In addition, it is not known if thyroid hormone increases the activity of proteolytic mechanisms other than the ubiquitin-proteasome pathway. We tested the hypotheses that experimental hyperthyroidism in rats, induced by daily intraperitoneal injections of 100 microg/100 g body weight of triiodothyronine (T3), upregulates the expression of atrogin-1 and MuRF1 in skeletal muscle and stimulates lysosomal, including cathepsin L, calpain-, and caspase-3-dependent protein breakdown in addition to proteasome-dependent protein breakdown. Treatment of rats with T3 for 3 days resulted in an approximately twofold increase in atrogin-1 and MuRF1 mRNA levels. The same treatment increased proteasome-, cathepsin L-, and calpain-dependent proteolytic rates by approximately 40% but did not influence caspase-3-dependent proteolysis. The expression of atrogin-1 and MuRF1 remained elevated during a more prolonged period (7 days) of T3 treatment. The results provide support for a role of the ubiquitin-proteasome pathway in muscle wasting during hyperthyroidism and suggest that other proteolytic pathways as well may be activated in the hyperthyroid state.

Curcumin and muscle wasting: a new role for an old drug?

Sepsis, severe injury, and cancer are associated with loss of muscle mass. Muscle wasting in these conditions is mainly caused by increased proteolysis, at least in part regulated by nuclear factor-kappaB. Despite recent progress in the understanding of mediators and mechanisms involved in muscle wasting, effective and universally accepted treatments by which muscle atrophy can be prevented or reversed are still lacking. We review recent evidence suggesting that curcumin (diferuloylmethane), a component of the spice turmeric, may prevent loss of muscle mass during sepsis and endotoxemia and may stimulate muscle regeneration after traumatic injury. Curcumin has been part of the traditional Asian medicine for centuries, mainly because of its anti-inflammatory properties. Studies suggest that inhibition of nuclear factor-kappaB is one of the mechanisms by which curcumin exerts its ant-inflammatory effects. Curcumin is easily accessible, inexpensive, and non-toxic even at high doses, and may therefore offer an important treatment modality in muscle wasting and injury. It should be noted, however, that the muscle-sparing effects of curcumin are not universally accepted, and more studies are therefore needed to further test the role of curcumin in the prevention and treatment of muscle wasting.

When initial postexcision PTH level does not fall appropriately during parathyroidectomy: what to do next?

BACKGROUND: Inadequate fall in the intraoperative parathyroid hormone (PTH) level after removing enlarged parathyroid gland(s) typically signifies additional hyperfunctioning gland(s), prompting further neck dissection, but it may also be a false negative result. We analyzed intraoperative management of patients with an inadequate fall on PTH after excision of enlarged parathyroid gland(s). METHODS: Analysis involved a prospective database of 189 patients undergoing 193 procedures for primary hyperparathyroidism. The PTH level was determined before neck incision and 10-15 min after excision of enlarged parathyroid gland(s). A PTH decrease > 50% and into normal range was used as the criterion of successful parathyroidectomy. RESULTS: In 48 of 193 operations, initial postexcision PTH level did not fall appropriately. That inadequate fall in PTH level was a false negative result in 16 patients (33%) and cure was achieved without additional neck exploration in all but one patient, who had additional (negative) neck exploration after excision of a parathyroid adenoma. In all patients with false negative postexcision PTH assay, operative findings concurred with preoperative imaging tests. CONCLUSIONS: Inadequate fall in intraoperative PTH may be false negative, particularly after removal of an adenoma found in the location determined by preoperative imaging. Repeat PTH may confirm the initial assay as false negative, obviating the need for additional neck dissection. Importantly, if repeat PTH does not fall appropriately, additional neck exploration needs to be performed.

Implementation of an Intraoperative Instructional Timeout Just Prior to Stapler Use Improves Proficiency of Surgical Stapler Usage by Surgery Residents.

INTRODUCTION: With the fragmented rotational structure of training, exposure to surgical staplers is not uniform across surgical residents. Traditionally, educational sessions dedicated to instruction in surgical staplers have taken place outside the operating room. This study implemented and evaluated an intraoperative timeout immediately prior to stapler use in cases with surgical residents. METHODS: During general surgery cases from June 1, 2017 until December 31, 2017, surgical teams, including the surgical attending, surgical resident, and scrub nurse participated in an intraoperative instructional timeout, during which proper use of linear or circular staplers was reviewed. At the conclusion of the timeout, residents were required to demonstrate proper stapler assembly and verbalize all technical steps involved in stapler use. Duration of each timeout was recorded. Immediately following the case, a pre-post survey was administered to each participating junior (R1-R2) or senior (R4-R5) surgical resident. The primary outcome was change in stapler use knowledge by surgical residents. Survey questions with Likert scale responses were analyzed using paired ttests, and responses from junior residents were compared to those from senior residents with independent t tests. RESULTS: Forty-three general surgery cases involved stapler use during the study period and implemented an intraoperative instructional timeout. The educational intervention increased stapler use knowledge significantly in all surgical residents. Prior to the timeout, junior residents reported significantly higher anxiety related to stapler usage compared to their senior counterparts; anxiety scores in junior residents decreased significantly for use of both linear and circular staplers. The mean timeout duration was 2.9 minutes (standard deviation 0.9 minutes, range 1.2-4.6 minutes). All participating surgical residents recommended routine implementation of an instructional timeout prior to intraoperative stapler use. CONCLUSIONS: An intraoperative timeout dedicated to stapler teaching is effective in increasing proficiency and easing anxiety in all levels of surgical residents. Further research is warranted to determine whether this educational intervention would translate into fewer stapler use errors and decreased intraoperative complications.

The NF-kappaB inhibitor curcumin blocks sepsis-induced muscle proteolysis.

We tested the hypothesis that treatment of rats with curcumin prevents sepsis-induced muscle protein degradation. In addition, we determined the influence of curcumin on different proteolytic pathways that are activated in septic muscle (i.e., ubiquitin-proteasome-, calpain-, and cathepsin L-dependent proteolysis) and examined the role of NF-kappaB and p38/MAP kinase inactivation in curcumin-induced inhibition of muscle protein breakdown. Rats were made septic by cecal ligation and puncture or were sham-operated. Groups of rats were treated with three intraperitoneal doses (600 mg/kg) of curcumin or corresponding volumes of solvent. Protein breakdown rates were measured as release of tyrosine from incubated extensor digitorum longus muscles. Treatment with curcumin prevented sepsis-induced increase in muscle protein breakdown. Surprisingly, the upregulated expression of the ubiquitin ligases atrogin-1 and MuRF1 was not influenced by curcumin. When muscles from septic rats were treated with curcumin in vitro, proteasome-, calpain-, and cathepsin L-dependent protein breakdown rates were reduced, and nuclear NF-kappaB/p65 expression and activity as well as levels of phosphorylated (activated) p38 were decreased. Results suggest that sepsis-induced muscle proteolysis can be blocked by curcumin and that this effect may, at least in part, be caused by inhibited NF-kappaB and p38 activities. The results also suggest that there is not an absolute correlation between changes in muscle protein breakdown rates and changes in atrogin-1 and MuRF1 expression during treatment of muscle wasting.

The Infectious Disease Network (IDN): Development and Use for Evaluation of Potential Ebola Cases in Georgia.

In response to the 2014 Ebola virus disease (EVD) outbreak in West Africa, the Georgia Department of Public Health developed the Infectious Disease Network (IDN) based on an EVD preparedness needs assessment of hospitals and Emergency Medical Services (EMS) providers. The network consists of 12 hospitals and 16 EMS providers with staff specially trained to provide a coordinated response and utilize appropriate personal protective equipment (PPE) for the transport or treatment of a suspected or confirmed serious communicable disease patient. To become a part of the network, each hospital and EMS provider had to demonstrate EVD capabilities in areas such as infection control, PPE, waste management, staffing and ongoing training, and patient transport and placement. To establish the network, the Georgia Department of Public Health provided training and equipment for EMS personnel, evaluated hospitals for EVD capabilities, structured communication flow, and defined responsibilities among partners. Since March 2015, the IDN has been used to transport, treat, and/or evaluate suspected or confirmed serious communicable disease cases while ensuring health care worker safety. Integrated infectious disease response systems among hospitals and EMS providers are critical to ensuring health care worker safety, and preventing or mitigating a serious communicable disease outbreak. (Disaster Med Public Health Preparedness. 2018;12:765-771).

Laser-induced thermal response and characterization of nanoparticles for cancer treatment using magnetic resonance thermal imaging.

Spherical nanoparticles with a gold outer shell and silica core can be tuned to absorb near-infrared light of a specific wavelength. These nanoparticles have the potential to enhance the treatment efficacy of laser-induced thermal therapy (LITT). In order to enhance both the potential efficacy and safety of such procedures, accurate methods of treatment planning are needed to predict the temperature distribution associated with treatment application. In this work, the standard diffusion approximation was used to model the laser fluence in phantoms containing different concentrations of nanoparticles, and the temperature distribution within the phantom was simulated in three-dimensions using the finite element technique. Magnetic resonance temperature imaging was used to visualize the spatiotemporal distribution of the temperature in the phantoms. In most cases, excellent correlation is demonstrated between the simulations and the experiment (<3.0% mean error observed). This has significant implications for the treatment planning of LITT treatments using gold-silica nanoshells.

Bioterrorism with zoonotic disease: public health preparedness lessons from a multiagency exercise.

Responding to agricultural bioterrorism with pathogenic agents that are communicable from animals to humans (zoonotic diseases) requires effective coordination of many organizations, both inside and outside of government. Action must be simultaneously taken to address public health concerns, respond to the agricultural dimensions of the event, and carry out the necessary law enforcement investigation. As part of a project focused on examining public health preparedness in Georgia, an exercise was carried out in July 2005 examining the intentional introduction of avian influenza (H5N1) in commercial poultry operations. The attack scenario, which was written to occur during an already severe human influenza season, enabled exploration of a range of issues associated with public health preparedness for major disease outbreaks including pandemic influenza, coordination of a multiagency response operation at multiple levels of government, and effective management of interdisciplinary response activities. The exercise is described and broader policy lessons regarding preparedness planning are discussed.

Antimicrobial Formulation and Delivery in the Prevention of Surgical Site Infection.

BACKGROUND: A number of adjunct antimicrobial measures have been studied in an attempt to reduce surgical site infection (SSI) rates. In addition to parenteral antibiotic prophylaxis, these measures include oral antibiotics in bowel preparation for colorectal surgery, antiseptic/antimicrobial irrigation, antimicrobial sutures, local antibiotics, skin incision antibacterial sealants, and antimicrobial dressings. It is the purpose of this review to study the evidence behind each of these measures and to evaluate relevant data for recommendations in each area. METHODS: A systematic review of the literature through PubMed was performed. RESULTS: Need for adequate dosing and re-dosing of intravenous peri-operative antibiotics, duration of antibiotic usage past wound closure, and the use of antibiotic bowel preparation in colorectal surgery are well defined in the published literature. However, data on local antimicrobial measures remain controversial. CONCLUSIONS: Proper dosing and re-dosing of prophylactic intravenous antibiotics should become standard practice. Continuation of intravenous antibiotic prophylaxis beyond wound closure is unnecessary in clean cases and remains controversial in clean-contaminated and complex cases. Oral antibiotic bowel preparation is an important adjunct to intravenous antibiotic prophylaxis in colorectal surgery. The use of topical antimicrobial and antiseptic agents such as antibacterial irrigations, local antimicrobial application, antimicrobial-coated sutures, antibacterial wound sealants, and antimicrobial impregnated dressings in the prevention of SSI is questionable.

Feasibility study using surface-enhanced Raman spectroscopy for the quantitative detection of excitatory amino acids.

The release of excitatory amino acids (EAAs) from injured neurons has been associated with secondary injury following head trauma. The development of a rapid and sensitive method for the quantification of EAAs may provide a means for clinical management of patients affected by head trauma. We explore the potential application of surface-enhanced Raman spectroscopy (SERS) for rapid quantification of the concentration of EAAs in aqueous silver colloids. The EAAs glutamate (Glu) and aspartate (Asp) are released following head injury and have been observed to exhibit SERS spectra that should enable them to be distinguished in a complex aqueous media. Of the two EAAs, the concentration of Glu has been shown to be more indicative of injury to the central nervous system. Using 30-s scans and a 50-mW argon laser, aqueous Glu is quantifiable from 0.4 to 5 micromol/L and is spectrally distinguishable from Asp. In addition, initial in vivo microdialysis experiments suggest that this SERS system is capable of measuring chemical changes following head trauma in the rat brain. Compared with current high-performance liquid chromatography (HPLC) techniques for amino acid detection, the short scanning and processing time associated with the SERS approach enables measurement on a near-real-time basis, providing clinical information in anticipation of pharmaceutical intervention.