Training programme in gasless laparoscopy for rural surgeons of India (TARGET study) - Observational feasibility study.

BACKGROUND: Benefits of laparoscopic surgery are well recognised but uptake in rural settings of low- and middle-income countries is limited due to implementation barriers. Gasless laparoscopy has been proposed as an alternative but requires a trained rural surgical workforce to upscale. This study evaluates a feasibility of implementing a structured laparoscopic training programme for rural surgeons of North-East India. METHODS: A 3-day training programme was held at Kolkata Medical College in March 2019. Laparoscopic knowledge and Fundamentals of Laparoscopic Skills (FLS) were assessed pre and post simulation training using multiple choice questions and the McGill Inanimate System for Training and Evaluation of Laparoscopic Skills (MISTELS), respectively. Competency with an abdominal lift device was assessed using the Objective Structured Assessment of Technical Skills (OSATS) and live operating performance via the Global Operative Assessment of Laparoscopic Skills (GOALS) scores during live surgery. Costs of the training programme and qualitative feedback were evaluated. RESULTS: Seven rural surgeons participated. There was an improvement in knowledge acquisition (mean difference in MCQ score 5.57 (SD = 4.47)). The overall normalised mean MISTELS score for the FLS tasks improved from 386.02 (SD 110.52) pre-to 524.40 (SD 94.98) post-training (p = 0.09). Mean OSATS score was 22.4 out of 35 (SD 3.31) indicating competency with the abdominal lift device whilst a mean GOALS score of 16.42 out of 25 (SD 2.07) indicates proficiency in performing diagnostic laparoscopy using the gasless technique during live operating. Costs of the course were estimated at 354 USD for trainees and 461 USD for trainers. CONCLUSION: Structured training programme in gasless laparoscopy improves overall knowledge and skills acquisition in laparoscopic surgery for rural surgeons of North-East India. It is feasible to deliver a training programme in gasless laparoscopy for rural surgeons. Larger studies are needed to assess the benefits for wider adoption in a similar context.

Transition-transversion encoding and genetic relationship metric in ReliefF feature selection improves pathway enrichment in GWAS.

BACKGROUND: ReliefF is a nearest-neighbor based feature selection algorithm that efficiently detects variants that are important due to statistical interactions or epistasis. For categorical predictors, like genotypes, the standard metric used in ReliefF has been a simple (binary) mismatch difference. In this study, we develop new metrics of varying complexity that incorporate allele sharing, adjustment for allele frequency heterogeneity via the genetic relationship matrix (GRM), and physicochemical differences of variants via a new transition/transversion encoding. METHODS: We introduce a new two-dimensional transition/transversion genotype encoding for ReliefF, and we implement three ReliefF attribute metrics: 1.) genotype mismatch (GM), which is the ReliefF standard, 2.) allele mismatch (AM), which accounts for heterozygous differences and has not been used previously in ReliefF, and 3.) the new transition/transversion metric. We incorporate these attribute metrics into the ReliefF nearest neighbor calculation with a Manhattan metric, and we introduce GRM as a new ReliefF nearest-neighbor metric to adjust for allele frequency heterogeneity. RESULTS: We apply ReliefF with each metric to a GWAS of major depressive disorder and compare the detection of genes in pathways implicated in depression, including Axon Guidance, Neuronal System, and G Protein-Coupled Receptor Signaling. We also compare with detection by Random Forest and Lasso as well as random/null selection to assess pathway size bias. CONCLUSIONS: Our results suggest that using more genetically motivated encodings, such as transition/transversion, and metrics that adjust for allele frequency heterogeneity, such as GRM, lead to ReliefF attribute scores with improved pathway enrichment.

Monitoring anti-HPA-1a platelet antibody levels during pregnancy using the MAIPA test.

Anti-HPA-1a platelet antibody levels in pregnant women with a history of fetomaternal alloimmune thrombocytopenia (FMAIT) were monitored longitudinally using the monoclonal antibody immobilisation of platelet antigens (MAIPA) assay, in order to examine any variation in optical density (OD) readings obtained over the course of pregnancy and after delivery. Seven women were selected; 4 were studied retrospectively and 3 prospectively (the latter being treated with intravenous gammaglobulin; IVGG). Levels of anti-HPA-1a were measured at various intervals after delivery of the first affected infant, to post delivery of the following affected infant. A decrease in MAIPA OD was demonstrated in all patients during the course of these pregnancies. This assay is a useful tool for monitoring anti-HPA-1a in women with a history of infants affected with FMAIT. A maternal antibody 'resting' level prior to, or early in the first trimester, must be established for comparison.

Plasma concentrations of vitellogenin and sex steroids in female tuatara (Sphenodon punctatus punctatus) from northern New Zealand.

Vitellogenesis in tuatara (Sphenodon punctatus) on Stephens Island, New Zealand, at the southern (coolest) end of the geographical range of this species involves a prolonged period of about 3 years of the average 4-year reproductive cycle. These studies used a semiquantitative electrophoretic assay for vitellogenin (Vg). In the present study an ELISA was used to measure plasma levels of Vg in 138 female northern tuatara (S.p. punctatus) on 11 islands at the warmest end of the tuatara's range. Blood samples were collected in late summer-early autumn, just prior to the expected time of ovulation in those females that would nest the following spring. Plasma Vg levels ranged from nondetectable to 2.9 mg/ml but were not significantly correlated with plasma estradiol, testosterone, or progesterone levels. There was also no significant correlation among the three sex steroids. Plasma Vg and hormone levels were further examined as to whether females were ovulating. Incipient ovulation was inferred using endocrinological criteria derived from studies of tuatara on Stephens Island (i.e., elevated plasma testosterone). Plasma levels of Vg differed significantly between inferred ovulators and nonovulators when data for all islands were combined, although similar ranges were observed in the two groups of females (inferred ovulators: nondetectable to 2382 micrograms/ml, mean = 505 +/- 75; inferred nonovulators: nondetectable to 2864 micrograms/ml, mean = 460 +/- 63). Plasma levels of estradiol, but not progesterone, differed significantly between inferred ovulators and nonovulators when data for all islands were combined. Mean levels in inferred ovulators were: estradiol, 157 +/- 16 pg/ml (vs. 34 +/- 5 pg/ml in inferred nonovulators); progesterone, 1.1 +/- 0.2 ng/ml (vs. 0.7 +/- 0.1 ng/ml in inferred nonovulators); and testosterone, 5.6 +/- 0.5 ng/ml (vs. 0.2 +/- 0 ng/ml in inferred nonovulators). Only 37% of the females sampled met the minimum hormonal criteria indicative of ovulation. This suggests that, as in S. punctatus on Stephens Island, female S.p. punctatus on northern islands do not ovulate each year.

Genital herpes simplex infections.

Herpes simplex virus infection is a sexually transmitted disease that is becoming increasingly more common. Symptomatic primary infections tend to be severe and prolonged, whereas recurrences are milder and shorter in duration. The most sensitive and specific laboratory test currently available for detecting and typing HSV is tissue culture. The most appropriate management strategy for pregnant women at risk for transmitting the virus at delivery is currently being studied and debated, but evidence indicates that routine surveillance cultures in pregnant women with a history of HSV infection are of no clinical usefulness and that, if there are no visible lesions, culture is not necessary and vaginal delivery is acceptable. Although acyclovir can effectively control symptomatology and speed the healing of lesions, it does not, with current dosage regimens, decrease the frequency of subsequent recurrences. Asymptomatic viral shedding is now considered to cause a large proportion of HSV transmissions; the role of acyclovir in suppression of viral shedding is an area requiring further study.

Clinical significance of antibodies to ribonucleoprotein.

Antibodies to ribonucleoprotein (RNP) were detected by an immunofluorescence technique based on the sensitivity of speckled antinuclear antibodies to ribonuclease. These antibodies were found to identify a group of patients with a consistent set of clinical features, especially arthritis, swollen hands, Raynaud's phenomenon, and myositis. The presence of anti-RNP antibodies in sera from patients with polymyositis, systemic lupus erythematosus, and systemic sclerosis was also associated with these clinical features. Other studies of the clinical significance of these antibodies support the concept that they appear to identify a group of patients with a distinct clinical condition.

Polypeptide sequencing by liquid chromatography mass spectrometry.

Key steps in a proposed automated system for polypeptide sequencing utilizing a liquid chromatograph mass spectrometer computer system have been tested with mixtures containing up to six model oligopeptides. At the low nanomole level it was possible to obtain complete sequence information for all components in many, but not all, of the mixtures tried. Interpretation of the results is complicated by the presence of numerous side-products formed in the derivatization process. Minimization of such impurities will be necessary to reduce the ambiguity of the sequence information resulting from more complex mixtures, such as those expected from the degradation of larger polypeptides, and to reduce sample requirements to the subnanomole level. However, the present system appears to have unique advantages over other proposed automated methods.