Capsular genotype and lipooligosaccharide locus class distribution in Campylobacter jejuni from young children with diarrhea and asymptomatic carriers in Bangladesh.

Campylobacter jejuni-related diarrheal diseases is one of the major health issues among young children (0-59 months old) in low-income countries. Monitoring of the capsular (capsule polysaccharide, CPS) types of virulent C. jejuni strains in regions where the disease is endemic is of great importance for the development of a customized capsule-based multivalent vaccine. Therefore, we aimed to determine the prevalence of CPS genotypes among C. jejuni strains isolated from young children with enteritis (n = 152) and asymptomatic carriers matched by age, sex, and residence defined as the control group (n = 215) in Bangladesh. CPS genotyping was performed using a newly established multiplex polymerase chain reaction (PCR) method and lipooligosaccharide (LOS) locus classes (A-E) were characterized using PCR as well. We identified 24 different CPS genotypes among the 367 isolates. Four prevalent capsular types, HS5/31 complex (n = 27, 18%), HS3 (n = 26, 17%), HS4A (n = 10, 7%), and HS8/17 (n = 10, 7%) covered almost 50% of the strains from enteritis patients and 43% of the isolates from controls. In combination, the CPS genotype and LOS class was not discriminative between cases and controls. Dominant capsular types previously identified in C. jejuni strains isolated from patients with Guillain-Barré syndrome in Bangladesh were rarely detected in strains isolated from the young children. A similar distribution was evident among enteritis- and control-related strains when comparison was done between CPS types and LOS classes. This is the first systematic study presenting the distribution of CPS genotypes of C. jejuni strains isolated in Bangladesh from children with diarrhea and controls, with capsular genotypes HS5/31 complex, HS3, HS4A, and HS8/17 being prevalent in both. In conclusion, systematic studies are required to develop a multivalent capsule-based vaccine for children in low-income countries.

Comparative population structure analysis of Campylobacter jejuni from human and poultry origin in Bangladesh.

Campylobacter jejuni is the most important cause of antecedent infections leading to Guillain-Barré syndrome (GBS) and Miller Fisher syndrome (MFS). The objective of the present study was to define the genetic diversity, population structure, and potential role of poultry in the transmission of Campylobacter to humans in Bangladesh. We determined the population structure of C. jejuni isolated from poultry (n = 66) and patients with enteritis (n = 39) or GBS (n = 10). Lipooligosaccharide (LOS) typing showed that 50/66 (76 %) C. jejuni strains isolated from poultry could be assigned to one of five LOS locus classes (A-E). The distribution of neuropathy-associated LOS locus classes A, B, and C were 30/50 (60 %) among the typable strains isolated from poultry. The LOS locus classes A, B, and C were significantly associated with GBS and enteritis-related C. jejuni strains more than for the poultry strains [(31/38 (82 %) vs. 30/50 (60 %), p < 0.05]. Multilocus sequence typing (MLST) defined 15 sequence types (STs) and six clonal complexes (CCs) among poultry isolates, including one ST-3740 not previously documented. The most commonly identified type, ST-5 (13/66), in chicken was seen only once among human isolates (1/49) (p < 0.001). Amplified fragment length polymorphism (AFLP) revealed three major clusters (A, B, and C) among C. jejuni isolated from humans and poultry. There seems to be a lack of overlap between the major human and chicken clones, which suggests that there may be additional sources for campylobacteriosis other than poultry in Bangladesh.

Single space transforaminal lumbar interbody fusion in spondylolisthesis: initial experience of 30 cases.

Spondylolisthesis in adults is characterized by the loss of disc height across the affected segment with sagital translation. The goal of stabilizing the spine is accomplished by fusion. Transforaminal approach for lumbar interbody fusion is a very good approach and reduces the complications associated with traditional posterior approach. It has been reported to be safe and effective in the treatment of spondylolisthesis. It has done to assess the functional outcome of Transforaminal Lumbar Interbody Fusion (TLIF) in spondylolisthesis. This prospective interventional study was performed from July 2008 to June 2011 included 30 patients (male 07, female 23), within a age range of 30-59 years. Nineteen cases were lytic, 08 cases were degenerative, 02 were post-traumatic and 01 dysplastic variety of spondylolisthesis. Follow up ranged from 12 to 24 months and outcome assessed by VAS and ODI regarding pain and disability. Achievement of fusion and complications were documented accordingly. Statistical analysis was done by unpaired t-test and chi-squared test in appropriate instances. We included twenty One (70.00%) patient had Grade-II Spondylolisthesis and L4 over L5 had been the commonest level (53.33%) involved. Pain and disability improved significantly and 22 (73.33%) patients returned to their previous level of activity. One (03.33%) patient developed superficial wound infection and 01 (03.33%) had persistent low back pain. All patients had neurological improvement. We concluded that Transforaminal Lumbar Interbody Fusion is an effective alternative surgical procedure for the treatment of spondylolisthesis. Overall outcome is satisfactory in 93.33% cases.

Towards next generation digital twin in robotics: Trends, scopes, challenges, and future.

With the advent of Industry 4.0, several cutting-edge technologies such as cyber-physical systems, digital twins, IoT, robots, big data, cloud computation have emerged. However, how these technologies are interconnected or fused for collaborative and increased functionality is what elevates 4.0 to a grand scale. Among these fusions, the digital twin (DT) in robotics is relatively new but has unrivaled possibilities. In order to move forward with DT-integrated robotics research, a complete evaluation of the literature and the creation of a framework are now required. Given the importance of this research, the paper seeks to explore the trends of DT incorporated robotics in both high and low research saturated robotic domains in order to discover the gap, rising and dying trends, potential scopes, challenges, and viable solutions. Finally, considering the findings, the study proposes a framework based on a hypothesis for the future paradigm of DT incorporated robotics.

Evaluation of the results of posterior decompression, posterolateral fusion and stabilization by pedicle screw and rod in traumatic thoracolumbar fractures.

This study is to evaluate the clinical and radiological success of posterior decompression, posterolateral fusion and stabilization by pedicle screw and rod in the management of traumatic thoracolumbar fractures. It is a prospective interventional study which is carried out in Bangabandhu Sheikh Mujib Medical University and different private hospitals in Dhaka city from January 2008 to December 2010. Total 16 patients were selected according to the inclusion and exclusion criteria. There were 10 male patients and 06 female within a age range of 21-40 years. Mean age was 33.32 years. Total 08 cases involved L1, 03 cases involved at D12, 02 cases involved at D1, and at L2 each whereas 01 case at L3. Total 10 cases were of compression fracture and remainder 06 burst fractures. Ten (10) patients presented with paraparesis, 05 patients with incomplete paraplegia and 01 patient with complete paraplegia. All the patients were followed up for minimum 1 year. Patients with paraparesis fully recovered neurologically and could walk without support. All the 05 patients with incomplete paraplegia also recovered fully except 01 which gained partial improvement and walks with aids. One patient with complete paraplegia remained unchanged. Our results show that posterior decompression posterolateral fusion and stabilization by pedicle screw and rod provides a safe and effective surgical option for management of traumatic thoracolumbar fractures.

Self-appraisal hierarchical task analysis of laparoscopic surgery performed by expert surgeons.

BACKGROUND: Evaluation of technical skill is notoriously difficult because of the subjectivity and time-consuming expert analysis. No ongoing evaluation scheme exists to assess the continuing competency of surgeons. This study examined whether surgeons' self-assessment accurately reflects their actual surgical technique. METHODS: Hierarchical task analysis (HTA) of laparoscopic cholecystectomy was constructed. Ten expert surgeons were asked to modify the HTA for their own technique. The HTAs of these surgeons then were compared with their actual operations, which had been recorded and assessed by two observers. RESULTS: A total of 40 operations were assessed. All the gallbladders subjected to surgery were classified as grades 1 to 3. The mean interrater reliability for the two observers had a k value of 0.84 (p < 0.05), and the mean intrarater reliability between surgeons and observers had a k value of 0.79 (p < 0.05). CONCLUSIONS: Surgeons' self-evaluation is accurate for technical skills aspects of their operations. This study demonstrates that self-appraisal using HTA is feasible, accurate, and practical. The authors aim to increase the numbers in their study and also to recruit residents.

Technical skills errors in laparoscopic cholecystectomy by expert surgeons.

BACKGROUND: Performing laparoscopic surgery involves a complex cascade of cognitive skills, which may inherently have a constant technical error rate. We assess generic and specific minor and major error rates in laparoscopic cholecystectomies (LCs) performed by consultant surgeons. METHODS: Checklists of generic (11) and specific technical minor (six) and major events (eight) were devised for LCs. Two experienced surgeons assessed each full-length operation blindly and independently. RESULTS: A total of 37 LCs were performed by eight consultants. There were no major intraoperative or postoperative complications. Mean inter-rater reliability was kappa = 0.91 (range 0.80-0.98) for each of the error categories. Error rates were generic (27/407) 6.6%, minor (59/222) 26.6%, and major (8/296) 2.7%, respectively. There was a significant statistical difference between the minor error group and the other groups, p

Surgical technique: submuscular placement of breast implant ports with delayed expansion following ultrasound localization.

Immediate or delayed reconstruction is offered to most women after mastectomy as standard care in the UK. Many women choose breast reconstruction with an implant alone or in conjunction with a myocutaneous flap. The most recent generation of biodimensional anatomical permanent expanders has permanent ports for delayed saline inflation. In slim women, the subcutaneous placement of the port and tubing may be unsightly and cause symptoms of pain and chaffing. We describe a technique of inserting the permanent port deep to a muscular layer on the chest wall to avoid these problems. This technique has been used in five satisfied patients, with a mean body mass index of 24.0 (range 21.7-25.5) kg/m(2). The mean follow-up was 9.4 (range 5-14) months with no complications or problems. The port placement technique we describe is effective and facilitates permanent implantation for long-term access.

Mean nuclear area and chromosomal DNA content of squamous cell carcinomas of the oral cavity using computerized image analysis.

Morphometric measurements of nuclei may be of prognostic value in some cancers. In this present study we have evaluated the mean nuclear area (MNA) of 50 squamous cell carcinomas of the oral cavity (SCCOC) using computerized image analysis. Since chromosomal DNA content is a reflection of the DNA content in the nucleus, we have evaluated the relationship between MNA and chromosomal DNA. Thirteen tumours had a MNA greater than 49.9 microns2 and 37 had a MNA less than this. Six tumours were classified as hypodiploid, 29 as diploid and 15 as aneuploid. There were 44 node-negative patients and six node-positive. When comparing MNA in these groups, 50 per cent of node-positive patients had a larger MNA whilst only 20 per cent of the node-negative group had a large MNA. The correlation coefficient between MNA and DNA indices was r = 0.75. The greater nuclear size is possibly a reflection of a more aggressive tumour biology in the node-positive patients. We conclude that a large MNA may be a marker of aggressive tumour biology in this group. In the future, we aim to evaluate the prognostic significance of MNA in patients with SCCOC.

Nuclear DNA content using computerized image cytometry of squamous cell carcinomas of the head and neck.

Ploidy status using flow cytometry of head and neck cancers may be of prognostic value. We describe the use of image cytometry in ploidy measurement of squamous cell carcinomas of the head and neck (SCCHN). This technique allows only tumour cells to be measured, thereby rejecting debris, artefact and benign cells. Tissue sections were cut from tumours and then Feulgen stained. A total of 60 patients were included in this study, 23 females and 37 males. The data reveals a relationship between ploidy status and the histological differentiation. However, the ploidy status and histological differentiation do not appear to correlate to the clinical stage of the disease. This method of measuring ploidy may be more accurate than flow cytometry and may have a prognostic role in head and neck cancer patients. A study comparing both methods may demonstrate this and we aim to evaluate this in the future.

DNA indices of primary and recurrent squamous cell carcinomas of the tongue and tonsil using image cytometry.

Ploidy status of squamous cell carcinomas of the head and neck (SCCHN) from primary and recurrent tonsillar and tongue lesions has not been compared using image cytometry. We have measured and compared the DNA indices in 41 cases. There were 29 tongue SCCHN, 20/29 were primary and 9/29 were recurrent. Mean DNA index (DI) was 1.19 (range 0.70-1.81) and 1.28 (range 0.79-1.94) respectively. There were 12 tonsillar cases, 10/12 primary and two out of 12 recurrent. Mean DI was 0.84 (range 0.57-1.09) and 1.00 (range 0.98-1.02) respectively. Mean DNA indices of both primary carcinomas were lower than the mean DNA indices of the recurrent carcinomas. This difference between the two groups may be a reflection of their tumour biology. However, since our study is small no definite conclusions can be made at this stage. We aim in the future to evaluate the prognostic role of DNA indices of patients with paired primary and recurrent SCCHN. This may be of clinical value and improve the treatment modalities available to this group.

A comparison of stapled vs handsewn anastomosis in anterior resection for carcinoma rectum.

The merits of stapled versus hand sewn anastomosis were evaluated in a prospective randomized study of 60 patients undergoing resection for rectal cancer. The analysed factors included the time required for construction of anastomosis, post operative complications, local recurrence, disease free state and survival. Hand sewn anastomosis was performed in two layers with 3/0 silk in 30 cases and the stapled anastomosis with EEA staplers in 30 cases. The anastomosis time averaged 24 minutes in the suture group and 16 minutes in the stapling group. Five post-operative complications occurred in each group. Six patients of the hand sewn group developed local recurrence as a first sign of treatment failure compared to four patients in the stapled group. The average time of study was 41 months. No significant difference was found in the overall survival pattern of the two groups.

Acute pancreatitis secondary to a perivaterian duodenal diverticular abscess.

A 46-year-old previously fit lady was admitted with acute pancreatitis. She had no history of gallstones. She was not on any medications and consumed minimal amounts of alcohol. On subsequent investigations as to the causative factor, she was found at ultrasound to have an air-fluid filled cystic structure posterior to the head of pancreas which was compressing the common bile duct. Further magnetic resonance imaging and computer tomography scans showed that this cystic lesion was located around the ampulla of Vater. A diagnosis of a perivaterian abscess was made. At endoscopy, a large contained abscess was seen which was successfully drained. She made a full and uneventful recovery.

Simulation and surgical training.

The aim of this review was to outline current forms of surgical simulation and methods of assessing technical skills using these forms of simulation. To review this subject, a literature search was done using key words 'assessment', 'simulation', 'surgery', 'technical skills' and 'virtual reality'. Simulation in surgery has several forms, inorganic (synthetic & computer) and organic (animal or cadaver). Surgical simulation is a mode of training which is promising and may be effective. Technical errors in the simulated environment do not have clinical consequences and does not have a morbidity or mortality. We must ensure that the competent skills learnt in the simulation environment are translated to the real environment. This can be achieved if the same assessment tools are used in both environments. Surgical training is entering a new era, with increased scrutiny and an evolving work and training environment. We as surgical teachers must ensure that the surgeons of the future are as competent as or better than their predecessors using these new modes of training which we have access to.

Mean nuclear area of squamous cell carcinomas of the head and neck using image cytometry.

OBJECTIVE: To determine if mean nuclear area (MNA) in squamous cell carcinomas of the head and neck (SCCHN) correlate with the TNM system and histologic grade. STUDY DESIGN: We measured MNA by image cytometry on 74 primary SCCHN. Fify-five had primary surgery, 16 had radiotherapy, and 3 and both as their primary treatment. RESULTS: The mean MNA was 47.85 microm2 (range, 20.5-84.8). Tumor size, nodal status and histologic grade were, respectively: T1 = 13, T2 = 29, T3 = 18, T4 = 14; N0 = 53, N1 = 15, N2 = 5, N3 = 1; 17 = well, 38 = moderate, 19 = poorly differentiated. Spearman rank and Kruskal-Wallis tests for MNA/histologic grade, MNA/tumor size, MNA/nodal status and MNA/site were calculated; only MNA/node was statistically significant (P<.05). CONCLUSION: MNA increases in primary SCCHN as nodal involvement increases. This may reflect that high MNA may be a biologic marker of primary SCCHN with a poorer prognosis.