Virtual Reality Warm-up Before Robot-assisted Surgery: A Randomized Controlled Trial.

TRIAL DESIGN: This was a randomized controlled trial. BACKGROUND: Intraoperative errors correlate with surgeon skill and skill declines with intervals of inactivity. The goals of this research were to identify the optimal virtual reality (VR) warm-up curriculum to prime a surgeon's technical skill and validate benefit in the operating room. MATERIALS AND METHODS: Surgeons were randomized to receive six trial sessions of a designated set of VR modules on the da Vinci Skills Simulator to identify optimal VR warm-up curricula to prime technical skill. After performing their curricula, warm-up effect was assessed based on performance on a criterion task. The optimal warm-up curriculum was chosen from the group with the best task time and video review-based technical skill. Robot-assisted surgery-experienced surgeons were then recruited to either receive or not receive warm-up before surgery. Skill in the first 15 min of surgery was assessed by blinded surgeon and crowdworker review as well as tool motion metrics. The intervention was performing VR warm-up before human robot-assisted surgery. Warm-up effect was measured using objective performance metrics and video review using the Global Evaluative Assessment of Robotic Skills tool. Linear mixed effects models with a random intercept for each surgeon and nonparametric modified Friedman tests were used for analysis. RESULTS: The group performing only a Running Suture task on the simulator was on average 31.3 s faster than groups performing other simulation tasks and had the highest Global Evaluative Assessment of Robotic Skills scores from 41 surgeons who participated. This was chosen as the optimal curriculum. Thereafter, 34 surgeons completed 347 surgeries with corresponding video and tool motion data. No statistically significant differences in skill were observed with the warm-up intervention. CONCLUSIONS: We conclude that a robotic VR warm-up before performing the early stages of surgery does not impact the technical skill of the surgeon.

Maternal erythrocyte omega-3 and omega-6 fatty acids, and plasma lipid concentrations, are associated with habitual dietary fish consumption in early pregnancy.

OBJECTIVES: We investigated the relationship between selected maternal erythrocyte omega-3 and omega-6 polyunsaturated fatty acids (PUFA) and plasma lipids in early pregnancy and reported habitual fish consumption during the periconceptional period. DESIGN AND METHODS: This cohort study included 923 pregnant women who reported periconceptional dietary habits and provided a blood sample before 20 weeks of gestation. PUFA was determined by gas chromatography and plasma lipids by standard enzymatic methods. Differences in erythrocyte PUFA and plasma lipid concentrations were estimated using linear regression. RESULTS: Mean erythrocyte eicosapentanoic acid and other PUFA content (%/total) were positively associated with frequency of self-reported fish consumption. Arachidonic acid was inversely related with frequent fish consumption (p trend <0.001). Women who consumed fish >twice/week had lower plasma triglyceride (-11.5 mg/dl) and higher HDL-cholesterol (+2.8 mg/dl) concentrations than women consuming fish

Maternal plasma concentrations of IGF-1, IGFBP-1, and C-peptide in early pregnancy and subsequent risk of gestational diabetes mellitus.

OBJECTIVE: Insulin-like growth factor-1 (IGF-1) and IGF binding protein-1 (IGFBP-1) may be important determinants of glucose homeostasis. We examined the association between circulating concentrations of IGF-1, IGFBP-1 in early pregnancy and development of gestational diabetes mellitus (GDM). STUDY DESIGN: Maternal plasma (collected at 13 weeks) IGF-1, IGFBP-1, and C-peptide were measured using immunoassay. Relative risks (RR) and 95% CIs were calculated. RESULTS: The percentage of the cohort that developed GDM was 5.8% (n = 804). Free IGF-1 and IGFBP-1 were inversely associated with GDM risk, while C-peptide was positively associated with GDM risk (P for trend test < .05). Women with free IGF-1 > or = 1.08 ng/mL experienced a 69% reduced risk of GDM (CI 0.12-0.75) compared with women having concentrations < 0.80 ng/mL. There was a 57% reduced risk of GDM among women with IGFBP-1 > or = 68.64 ng/mL (RR = 0.43, CI 0.18-1.05). Women with C-peptide > or = 3.00 ng/mL experienced a 2.28-fold increased risk of GDM (CI 1.00-5.19) compared with women who had concentrations < 1.45 ng/mL. CONCLUSION: These associations may help to further elucidate the pathologic process of GDM.