Objective and Automated Quantification of Instrument Handling for Open Surgical Suturing Skill Assessment: A Simulation-Based Study.

Goal: Vascular surgical procedures are challenging and require proficient suturing skills. To develop these skills, medical training simulators with objective feedback for formative assessment are gaining popularity. As hardware advancements offer more complex, unique sensors, determining effective task performance measures becomes imperative for efficient suturing training. Methods: 97 subjects of varying clinical expertise completed four trials on a suturing skills measurement and feedback platform (SutureCoach). Instrument handling metrics were calculated from electromagnetic motion trackers affixed to the needle driver. Results: The results of the study showed that all metrics significantly differentiated between novices (no medical experience) from both experts (attending surgeons/fellows) and intermediates (residents). Rotational motion metrics were more consistent in differentiating experts and intermediates over traditionally used tooltip motion metrics. Conclusions: Our work emphasizes the importance of tool motion metrics for open suturing skills assessment and establishes groundwork to explore rotational motion for quantifying a critical facet of surgical performance.

Targeting Signaling Pathways in Chronic Lymphocytic Leukemia.

Various signal transduction pathways have been implicated in the pathogenesis of chronic lymphocytic leukemia (CLL), which is characterized by the progressive accumulation of monoclonal CD5+ B cells in the blood. B cell receptor (BCR) signaling appears to have a crucial role in disease onset and is thought to be induced by self or non-self-antigen recognition leading to chronic stimulation. Several of the kinases functioning downstream of the BCR are aberrantly expressed or constitutively activated in CLL. Yet, these kinases have additional roles, particularly in chemokine receptor signaling, which is essential for homing and survival of CLL cells in lymphoid organs, or in toll-like receptor signaling. Recently, small molecule inhibitors of kinases in the BCR signaling pathway have shown impressive anti-tumor activity in clinical trials. Remarkably, the observed durable responses in CLL patients were accompanied by transient increases in blood lymphocyte numbers, indicating the importance of these kinases in chemokine receptor signaling. In this review, we therefore highlight the role of BCR signaling and the important other associated signal transduction cascades for CLL cells and give an overview of novel agents that target these specific pathways and were shown to be successful for CLL treatment in clinical trials.