Real-time magnetic resonance-guided endovascular repair of experimental abdominal aortic aneurysm in swine

OBJECTIVES: This study tested the hypotheses that endografts can be visualized and navigated in vivo solely under real-time magnetic resonance imaging (rtMRI) guidance to repair experimental abdominal aortic aneurysms (AAA) in swine, and that MRI can provide immediate assessment of endograft apposition and aneurysm exclusion. BACKGROUND: Endovascular repair for AAA is limited by endoleak caused by inflow or outflow malapposition. The ability of rtMRI to image soft tissue and flow may improve on X-ray guidance of this procedure. METHODS: Infrarenal AAA was created in swine by balloon overstretch. We used one passive commercial endograft, imaged based on metal-induced MRI artifacts, and several types of homemade active endografts, incorporating MRI receiver coils (antennae). Custom interactive rtMRI features included color coding the catheter-antenna signals individually, simultaneous multislice imaging, and real-time three-dimensional rendering. RESULTS: Eleven repairs were performed solely using rtMRI, simultaneously depicting the device and soft-tissue pathology during endograft deployment. Active devices proved most useful. Intraprocedural MRI provided anatomic confirmation of stent strut apposition and functional corroboration of aneurysm exclusion and restoration of laminar flow in successful cases. In two cases, there was clear evidence of contrast accumulation in the aneurysm sac, denoting endoleak. CONCLUSIONS: Endovascular AAA repair is feasible under rtMRI guidance. Active endografts facilitate device visualization and complement the soft tissue contrast afforded by MRI for precise positioning and deployment. Magnetic resonance imaging also permits immediate post-procedural anatomic and functional evaluation of successful aneurysm exclusion.     

A randomized trial of low-frequency right-prefrontal-cortex transcranial magnetic stimulation as augmentation in treatment-resistant major depression

Low-frequency right prefrontal repetitive transcranial magnetic stimulation (rTMS) appears to have antidepressant properties although the effectiveness of this treatment in clinical practice has not been assessed nor have the optimal stimulation parameters been adequately defined. A total of 130 patients with treatment-resistant depression were randomized to either 1- or 2-Hz rTMS over the right prefrontal cortex (PFC) for 2 wk with a possible further 2 wk extension. Non-responders were randomized to either 5- or 10-Hz left PFC rTMS. Overall, 66 patients (51%) achieved response and 35 (27%) remission criteria. For right-sided treatment, depression significantly improved but there was no between-group difference. Twenty-eight (42%) patients in the 1-Hz group and 33 (53%) patients in the 2-Hz group achieved response criteria (chi2=1.40, p>0.05). Depression symptom scores also improved for patients who crossed over to left-sided treatment but there was no significant difference in response between 5- and 10-Hz rTMS. Despite a heterogeneous sample, a significant proportion of patients met clinical response criteria following treatment but response to 1 and 2 Hz did not differ. 2-Hz right PFC rTMS has antidepressant properties but offers no advantage over 1 Hz despite doubling pulse number.     

Physical inactivity among physiotherapy undergraduates: exploring the knowledge-practice gap

Background

Physical inactivity is a common risk factor for several non-communicable diseases (NCDs). Increasing physical activity could reduce the burden of disease due to major NCDs and increase life expectancy. Undergraduate physiotherapy students represent a group of young-adults expected to have a good knowledge of physical activity. We evaluated physical activity levels of undergraduate physiotherapy students of University of Colombo, Sri Lanka and determined their motives and barriers for participation in physical activity.

Methods

All physiotherapy undergraduates studying at the University of Colombo, Sri Lanka in 2013 were invited for the study. Phase one was a quantitative study to evaluate the physical activity levels and phase two was a qualitative study to identify motives and barriers for physical activity and sports in the same cohort. Physical activity levels (phase 1) were assessed using the interviewer administered International Physical Activity Questionnaire (long-version). The qualitative study (phase 2) was conducted in the same population using Focus Group Discussions (n?=?3) and individual In-depth Interviews (n?=?5).

Results

Sample size in phase 1 and phase 2 were 113 (response rate?=?98%; [N-115]) and 87 (response rat?=?97%; [N-90]) respectively. Mean age (±SD) of participants was 23.4?±?1 years. The mean weekly total MET minutes (±SD) of the study population was 1791.25?±?3097. According to the IPAQ categorical score a higher percentage of participants were ‘inactive’ (48.7%), while only 15.9% were in the ‘Highly active’ group. Lack of support and encouragement received during childhood to engage in sports activity seem to have played an important role in continuing their exercise behavior through to the adult life. Academic activities were given priority by both parents and teachers. The environment and support from teachers, family and friends were important to initiate and adhere to sports and physical activity.

Conclusions

A higher percentage of participants were ‘inactive’, in spite of belonging to a group which is presumed to be knowledgeable regarding the benefits of physical activity. A significant negative attitude towards physical activity was observed in this cohort of young-adults. This seems to stem from earlier in life, due to lack of support and motivation for physical exercise and sports, received during primary and secondary schooling. This negative attitude has become a significant ‘internal’ barrier, which has not been changed in spite of their education.

     

Simulation for Teaching Orthopaedic Residents in a Competency-based Curriculum: Do the Benefits Justify the Increased Costs?

Background

Although simulation-based training is becoming widespread in surgical education and research supports its use, one major limitation is cost. Until now, little has been published on the costs of simulation in residency training. At the University of Toronto, a novel competency-based curriculum in orthopaedic surgery has been implemented for training selected residents, which makes extensive use of simulation. Despite the benefits of this intensive approach to simulation, there is a need to consider its financial implications and demands on faculty time.

Questions/purposes

This study presents a cost and faculty work-hours analysis of implementing simulation as a teaching and evaluation tool in the University of Toronto’s novel competency-based curriculum program compared with the historic costs of using simulation in the residency training program.

Methods

All invoices for simulation training were reviewed to determine the financial costs before and after implementation of the competency-based curriculum. Invoice items included costs for cadavers, artificial models, skills laboratory labor, associated materials, and standardized patients. Costs related to the surgical skills laboratory rental fees and orthopaedic implants were waived as a result of special arrangements with the skills laboratory and implant vendors. Although faculty time was not reimbursed, faculty hours dedicated to simulation were also evaluated. The academic year of 2008 to 2009 was chosen to represent an academic year that preceded the introduction of the competency-based curriculum. During this year, 12 residents used simulation for teaching. The academic year of 2010 to 2011 was chosen to represent an academic year when the competency-based curriculum training program was functioning parallel but separate from the regular stream of training. In this year, six residents used simulation for teaching and assessment. The academic year of 2012 to 2013 was chosen to represent an academic year when simulation was used equally among the competency-based curriculum and regular stream residents for teaching (60 residents) and among 14 competency-based curriculum residents and 21 regular stream residents for assessment.

Results

The total costs of using simulation to teach and assess all residents in the competency-based curriculum and regular stream programs (academic year 2012–2013) (CDN 155,750, USD 158,050) were approximately 15 times higher than the cost of using simulation to teach residents before the implementation of the competency-based curriculum (academic year 2008–2009) (CDN 10,090, USD 11,140). The number of hours spent teaching and assessing trainees increased from 96 to 317 hours during this period, representing a threefold increase.

Conclusions

Although the financial costs and time demands on faculty in running the simulation program in the new competency-based curriculum at the University of Toronto have been substantial, augmented learner and trainer satisfaction has been accompanied by direct evidence of improved and more efficient learning outcomes.

Clinical Relevance

The higher costs and demands on faculty time associated with implementing simulation for teaching and assessment must be considered when it is used to enhance surgical training.     

Hydroxyapatite/L-Lysine Composite Coating as Glassy Carbon Electrode Modifier for the Analysis and Detection of Nile Blue A

An amperometric sensor was developed by depositing a film coating of hydroxyapatite (HA)/L-lysine (Lys) composite material on a glassy carbon electrode (GCE). It was applied for the detection of Nile blue A (NBA). Hydroxyapatite was obtained from snail shells and its structural properties before and after its combination with Lys were characterized using X-ray diffraction (XRD), Fourier-transform infrared (FTIR) spectroscopy, scanning electron microscopy (SEM), and Brunauer–Emmett–Teller (BET) surface area analyses. The coupling of Lys to HA was attributed to favorable interaction between negatively charged -COO⁻ groups of Lys and divalent ions Ca²⁺ of HA. Electrochemical investigations pointed out the improvement in sensitivity of the GCE/Lys/HA sensor towards the detection of NBA in solution. The dependence of the peak current and potential on the pH, scan rate, and NBA concentration was also investigated. Under optimal conditions, the GCE/Lys/HA sensor showed a good reproducibility, selectivity, and a NBA low detection limit of 5.07 × 10⁻⁸ mol L⁻¹. The developed HA/Lys-modified electrode was successfully applied for the detection of NBA in various water samples.     

Health effects of coconut oil: Summary of evidence from systematic reviews and meta-analysis of interventional studies

Background and aimsSystemic review (SR) and meta-analysis (MA) of interventional studies are considered as the highest level of evidence for clinical decision making. Therefore, we systematically summarized all high-quality evidence on the usage of coconut oil for health-related benefits from SRs and MA.MethodsPubMed®, Web of science®, SciVerse Scopus®, and EMBASE® databases were systematically searched to select SRs and SRs with MA of interventional studies reporting health-related clinical outcomes of coconut oil. Similar studies were grouped based on their respective clinical areas. A methodological quality appraisal was conducted for all included SRs and SRs with MA using the Critical Appraisal Checklist for Systematic Reviews.ResultsA total of seven papers were selected for inclusion in this review, consisting of three MA and one SR on cardio-metabolic health, one SR on oral health, and one SR and one MA each on skin health. Coconut oil significantly increases serum total cholesterol, low-density- and high-density- lipoprotein cholesterol levels compared to poly- and mono-unsaturated oils. Limited studies showed that topical use of coconut oil helps in the prevention and treatment of atopic dermatitis and oil pulling for the prevention of dental caries. All four studies on cardiometabolic health and the SR on oral health had a high score in the quality assessment, SR with MA on skin health fulfilled high-quality scoring whereas the SR on the same topic had a low-quality scoring.ConclusionsIn summary, consistent and strong evidence shows that coconut oil has an adverse effect on the lipids parameters associated with cardio-metabolic health, with limited studies to conclude the effects of atopic dermatitis and oil pulling.     

The benefits of yoga practice compared to physical exercise in the management of type 2 Diabetes Mellitus: A systematic review and meta-analysis

Yoga is increasingly used as an adjunctive therapy in the management of Type-2 Diabetes Mellitus (T2DM). The present study aims to systematically evaluate the literature and perform a meta-analysis on the effects of yoga practice compared to physical exercise in the management of T2DM. Data were obtained using a stepwise search process using keywords in the following online medical databases; PubMed, Web of Science and Scopus. All controlled clinical trials involving patients with T2DM, comparing yoga as an intervention with physical exercise and evaluating glycaemic control and other outcomes between the intervention and control groups were included in the analysis.Eight studies were eligible to be included in the systematic review. In total, 842 participants were assigned to a Yoga intervention or a control group with an Exercise intervention and the age range of participants was 30–78 years. A significant reduction in FBG (15.16?mg/dl), PPBG (28.66?mg/dl), HbA1c (0.39%) and BMI (0.71?kg/m2) was noted in the intervention group (‘Yoga’) compared to the control group (‘Physical Exercise’) in the pooled analysis. We did not observe any significant difference between the two groups for lipid parameters, other body composition measures (WC and WHR) and Blood Pressure. In conclusion, our results show that Yoga has beneficial effects on glycaemic control in comparison to physical exercise in T2DM However, individual studies showed considerable heterogeneity. Hence, further well-controlled randomized trials are required prior to drawing conclusions about the benefits of yoga in comparison to physical exercise.