RESUMO
Abuse, bullying, harassment, and discrimination are prominent workplace occurrences within cardiothoracic (CT) surgery that cause burnout and threaten the well-being of surgeons. Under-represented and marginalized groups experience higher incidences of these negative events, and CT surgery is one of the least diverse specialties. The CT surgery workforce and institutional leadership must prioritize mentorship, sponsorship, and allyship to promote a diverse and healthy specialty for surgeon recruitment, growth, and job satisfaction.
Assuntos
Bullying , Cirurgia Torácica , Humanos , Bullying/psicologia , Bullying/estatística & dados numéricos , Cirurgiões/psicologia , Cirurgiões/estatística & dados numéricos , Esgotamento Profissional/epidemiologia , Esgotamento Profissional/psicologia , Satisfação no EmpregoRESUMO
Morgagni hernias may range from asymptomatic incidental findings to surgical emergencies. An abdominal approach is ideal in the majority of cases, although surgeons should understand alternatives for repair.
Assuntos
Hérnias Diafragmáticas Congênitas , Humanos , Hérnias Diafragmáticas Congênitas/cirurgia , Hérnias Diafragmáticas Congênitas/complicações , Adulto , Herniorrafia/métodos , Tomografia Computadorizada por Raios XRESUMO
Robotic transanal minimally invasive surgery (R-TAMIS) is a novel and evolving technique with limited reported outcomes in the literature. Compared to the laparoscopic approach, R-TAMIS provides enhanced optics, increased degrees of motion, superior ergonomics, and easier maneuverability in the confines of the rectum. We report a single institution experience at a large quaternary referral academic medical center with R-TAMIS using the da Vinci Xi® platform. This is a retrospective review of electronic medical records at the Mayo Clinic from September 2017 to April 2020. It includes all available clinical documentations for patients undergoing R-TAMIS at our institution. Patient demographics, intraoperative data (procedure time, tumor size and distance), complications, and pathology reports were reviewed. A total of 28 patients underwent R-TAMIS. Median follow-up was 23.65 months. Sixteen patients underwent R-TAMIS for endoscopically unresectable rectal polyps, eight for rectal adenocarcinoma, two for rectal gastrointestinal stromal tumor, and two for rectal carcinoid tumor. The mean size of the lesions was 4.1 cm (range 0.2-13.8 cm). The mean location of lesions was 7.8 cm (range 0-16 cm) from the anal verge. The mean operative time was 132.5 ± 46.8 min. There was one 30-day complication, and no deaths. Twenty-three (82%) patients were discharged the day of surgery. R-TAMIS is a safe, feasible, and effective technique for the surgical treatment of a variety of rectal pathology. A hybrid technique can be used for the resecting tumors extending into the anal canal.
Assuntos
Neoplasias Retais , Procedimentos Cirúrgicos Robóticos , Cirurgia Endoscópica Transanal , Canal Anal/cirurgia , Humanos , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Neoplasias Retais/patologia , Neoplasias Retais/cirurgia , Reto/cirurgia , Procedimentos Cirúrgicos Robóticos/métodos , Cirurgia Endoscópica Transanal/métodosRESUMO
Fructo-oligosaccharides (FOS) are one of the most well-studied and commercialized prebiotics. FOS can be obtained either by controlled hydrolysis of inulin or by sucrose transfructosylation. FOS produced from sucrose are typically classified as short-chain FOS (scFOS), of which the best known are 1-kestotriose (GF2), 1,1-kestotetraose (GF3), and 1,1,1-kestopentaose (GF4), produced by fructosyltransferases (FTases) or ß-fructofuranosidases. In previous work, FOS production was studied using the Aspergillus oryzae N74 strain, its ftase gene was heterologously expressed in Komagataella phaffii (Pichia pastoris), and the enzyme's tertiary structure modeled. More recently, residues that may be involved in protein-substrate interactions were predicted. In this study, the aim was to experimentally validate previous in silico results by independently producing recombinant wild-type A. oryzae N74 FTase and three single-point mutations in Komagataella phaffii (Pichia pastoris). The R163A mutation virtually abolished the transfructosylating activity, indicating a requirement for the positively charged arginine residue in the catalytic domain D. In contrast, transfructosylating activity was improved by introducing the mutations V242E or F254H, with V242E resulting in higher production of GF2 without affecting that of GF3. Interestingly, initial sucrose concentration, reaction temperature and the presence of metal cofactors did not affect the enhanced activity of mutant V242E. Overall, these results shed light on the mechanism of transfructosylation of the FTase from A. oryzae and expand considerations regarding the design of biotechnological processes for specific FOS production.
Assuntos
Aspergillus oryzae , Aspergillus oryzae/genética , Hexosiltransferases , Oligossacarídeos , Pichia/genética , Saccharomycetales , SacaroseRESUMO
OBJECTIVE: To describe the incidence of post-operative seroma and interventions attempted to reduce this complication in patients undergoing minimally invasive inguinal lymph node dissection (MILND). BACKGROUND: MILND has resulted in fewer wound complications, hospital readmissions, and shorter length of stay; unfortunately, seroma formation remains a major source of morbidity. METHODS: A retrospective study of MILNDs performed from 2010 to 2017 was conducted. Different interventions were trialed attempting to combat this problem. We report the analysis with respect to seroma formation. RESULTS: Forty-one patients underwent 44 MILND. Twenty-two (50%) patients developed symptomatic seroma requiring aspiration and/or drain placement. Risk factors associated with seroma on univariate analysis were increased number of metastatic nodes (pâ¯=â¯0.028), increasing BMI (pâ¯=â¯0.046), increasing age (pâ¯=â¯0.056), and larger suction drain bulbs (pâ¯=â¯0.013). There was an association with postoperative seroma formation and post-operative lymphedema (pâ¯=â¯0.001). Multiple interventions trialed to reduce seroma formation were unsuccessful in reducing the seroma rate. CONCLUSION: Seromas formation continues to be a common morbidity following MILND. Further research is needed to determine how seroma incidence can be reduced in patients undergoing MILND.
Assuntos
Laparoscopia/efeitos adversos , Excisão de Linfonodo/efeitos adversos , Excisão de Linfonodo/métodos , Seroma/etiologia , Fatores Etários , Índice de Massa Corporal , Drenagem/instrumentação , Feminino , Virilha , Humanos , Laparoscopia/estatística & dados numéricos , Linfedema/etiologia , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Estudos Retrospectivos , Fatores de Risco , Seroma/terapia , SucçãoAssuntos
Neoplasias Pulmonares , Realidade Virtual , Humanos , Pneumonectomia , Pulmão , Neoplasias Pulmonares/cirurgiaAssuntos
Carcinoma Pulmonar de Células não Pequenas , Neoplasias Pulmonares , Mesotelioma Maligno , Mesotelioma , Neoplasias Pleurais , Humanos , Carcinoma Pulmonar de Células não Pequenas/terapia , Neoplasias Pulmonares/terapia , Neoplasias Pulmonares/patologia , Neoplasias Pleurais/terapia , Neoplasias Pleurais/patologia , Mesotelioma/terapia , Mesotelioma/patologia , ImunoterapiaRESUMO
Deficiency of the eye-stabilizing vestibulo-ocular reflex (VOR) is a defining feature in multiple diseases of the vestibular labyrinth, which comprises the inner ear's sensors of head rotation, translation and orientation. Diagnosis of these disorders is facilitated by observation and measurement of eye movements during and after head motion. The video head impulse test has recently garnered interest as a clinical diagnostic assessment of vestibular dysfunction. In typical practice, it involves use of video-oculography goggles to measure eye movements while a clinician examiner grasps the subject's head and manually rotates it left or right at sufficient acceleration to cover ~20 deg over ~150 mS, reaching a peak velocity of >120 deg/S midway through the movement. Manual delivery of head impulses incurs significant trial-by-trial, inter-session and inter-operator variability, which lessens the test's reliability, efficiency, safety and standardization across testing facilities. We describe application of a novel, compact and portable automated head impulse test (aHIT™) device that delivers highly repeatable head motion stimuli about axes parallel to those of the vestibular labyrinth's six semicircular canals, with programmable Gaussian and sinusoidal motion profiles at amplitudes, velocities and accelerations sufficient to test VOR function over the spectral range for which the VOR dominates other vision-stabilizing reflexes. We tested the aHIT™ on human subjects and demonstrated its high reproducibility compared to manually delivered head impulses. This device has the potential to be a valuable clinical and research tool for diagnostic evaluation and investigation of the vestibular system.