Randomized controlled trial of virtual reality and hybrid simulation for robotic surgical training

Study Type – Therapy (outcomes research) Level of Evidence 2c

OBJECTIVE

• ? To evaluate if two commonly used laparoscopic simulators could be adapted and used successfully for the robotics platform in a laparoscopic and roboticnaïve medical student population.

MATERIALS AND METHODS

• ? We identified two widely validated laparoscopic simulation programs, LapSim® (Surgical Science Sweden AB), and ProMIS® (Haptica, Ireland)for inclusion in the study. The McGill Inanimate System for Training and Evaluation of Laparoscopic Skills® task set was used for ProMIS, and adapted for the DaVinci® console (Intuitive Surgical, Inc., Sunnyvale, CA, USA) robotic platform.
• ? We then randomized 20 naïve medical students to receive training on either LapSimor ProMIS, both or neither, and evaluated them beforeand aftertraining.

RESULTS

• ? When the groups were compared at baseline, there were no statistical differences in mean scores amongst the groups in univariate analysis (α= 0.05).
• ? Whencomparing mean scores within groups before and after training sessions, statistically significant performance enhancement in all four robotic tasks were identified in the groups receiving dual training.

CONCLUSION

• ? We have shownthat the use of ProMIS hybrid and LapSimvirtual reality (VR) simulators in conjunction with each other can considerable improve robotic console performance in novice medical students compared with hybrid and VR simulation alone.

     

Trabecular metal used for major bone loss in acetabular hip revision

The purpose of this study was to evaluate the outcome of trabecular metal (TM) acetabular components used in revision hip arthroplasty with major bone deficiency. We retrospectively reviewed the records of 46 patients undergoing revision hip arthroplasty with severe acetabular bone loss. Clinical outcomes were assessed using Harris Hip Score, Western Ontario and McMaster Universities, and Short-Form 12. Mean follow-up was 50 months. All patients had Paprosky type IIc or III acetabular bone deficiency. Major complications included 1 infection, 2 dislocations, and 1 arterial bleeding. Average Harris Hip Score was 78.2. Short-Form 12 scores were within population-based age-matched averages. Western Ontario and McMaster Universities scores were mainly in the 2 lowest disability categories. Porous tantalum shows promising results in revision arthroplasty with severe acetabular bone loss.     

The effect of etoricoxib on the pharmacodynamics and pharmacokinetics of warfarin

The effects of etoricoxib on pharmacodynamic and pharmacokinetic parameters of warfarin were determined in healthy men and women. Subjects titrated with warfarin to an international normalized ratio for prothrombin time of 1.4 to 1.7 during a 28-day prestudy period were randomly assigned in crossover fashion to be coadministered etoricoxib (120 mg) or matching placebo over two 21-day continuous periods. On day 21, a 24-hour pharmacokinetic profile of both S(-) and R(+) warfarin, as well as international normalized ratio values, were determined. Etoricoxib increased the international normalized ratio by 13% (90% confidence interval: 8%, 19%; P 相似文献   

Prioritizing care during the acute phase: the prominent role of basic psychosocial life support

The issue of basic psychosocial life support during and after disasters is important. People who are affected by disasters can experience severe distress and may need psychosocial support. However, there still are many questions about service design and effectiveness of psychosocial support. During the process of the Targeted Agenda Program, "Prioritizing Care during the Acute Phase: The Prominent Role of Basic Psychosocial Life Support", a team of experts reached consensus on some important issues concerning psychosocial first aid, civil participation, and risk communication. The experts come from many different backgrounds, which supports the notion that psychosocial care deserves special attention within disaster relief programs involving all disciplines and all responsibilities.     

SHH Pathway and Cerebellar Development

The morphogenetic factor Sonic hedgehog (SHH) has been discovered as one of the masterplayers in cerebellar patterning and was subjected to intensive investigation during the last decade. During early postnatal development, this continuously secreted cholesterol-modified protein drives the expansion of the largest neuronal population of the brain, the granular cells. Moreover, it acts on Bergmann glia differentiation and would potentially affect Purkinje cells homeostasis at adult age. The cerebellar cortex constituted an ideal developmental model to dissect out the upstream mechanisms and downstream targets of this complex pathway. Its deep understanding discloses some of the mechanistic disorders underlying pediatric tumorigenesis, congenital ataxia, and mental retardation. Therapeutical use of its regulators has been consolidated on murine transgenic models and is now considered as a realistic human clinical application. Here, we will review the most recent advances made in the comprehensive understanding of SHH involvement in cerebellar development and pathology.     

Complete remission of experimental arthritis by joint targeting of glucocorticoids with long‐circulating liposomes

Objective

To increase the therapeutic activity of glucocorticoids in experimental arthritis by encapsulation in long‐circulating polyethylene glycol liposomes, which have shown the ability to preferentially accumulate in inflamed joints after intravenous administration.

Methods

Rats with adjuvant‐induced arthritis (AIA) were treated intravenously with liposomal and free prednisolone phosphate (PLP) a few days after the first signs of disease. The effect on paw inflammation scores during the weeks after treatment was evaluated. Liposome biodistribution and joint localization were investigated by labeling the preparation with radioactive ¹¹¹In‐oxine. By studying PLP encapsulated in other types of liposomes, which show a distinctive tissue distribution pattern and reduced accumulation in inflamed joints, the importance of targeted delivery to inflamed joints for achieving an increased therapeutic effect was illustrated.

Results

Liposomal PLP proved to be highly effective in the rat AIA model. A single injection of 10 mg/kg resulted in complete remission of the inflammatory response for almost a week. In contrast, the same dose of unencapsulated PLP did not reduce inflammation, and only a slight effect was observed after repeated daily injections. Evidence was found that preferential glucocorticoid delivery to the inflamed joint was the key factor explaining the observed strong therapeutic benefit obtained with the liposomal preparation, while other possible mechanisms, such as splenic accumulation or prolonged release of prednisolone in the circulation, were excluded.

Conclusion

Targeted delivery using long‐circulating liposomes is a promising, novel means to successfully intervene in arthritis with glucocorticoid therapy.