An analysis of the ergonomic risk of surgical trainees and experienced surgeons during laparoscopic procedures

BackgroundWork-related musculoskeletal injuries have been increasingly recognized to affect surgeons. It is unknown whether such injuries also affect surgical trainees. The purpose of this study was to assess the ergonomic risk of surgical trainees as compared with that of experienced surgeons.MethodsErgonomic data were recorded from 9 surgeons and 11 trainees. Biomechanical loads during surgery were assessed using motion tracking sensors and electromyography sensors. Demanding and static positions of the trunk, neck, right/left shoulder, as well as activity from the deltoid and trapezius muscles bilaterally were recorded. In addition, participants reported their perceived discomfort on validated questionnaires.ResultsA total of 87 laparoscopic general surgery cases (48 attendings and 39 trainees) were observed. Both trainees and attendings spent a similarly high percentage of each case in static (>60%) and demanding positions (>5%). Even though residents reported overall more discomfort, all participants shared similar ergonomic risk with the exception of trainees’ trunk being more static (odds ratio: –11.42, P = .006).ConclusionSurgeons are prone to ergonomic risk. Trainees are exposed to similar postural ergonomic risk as surgeons but report more discomfort and, given that musculoskeletal injuries are cumulative over time, the focus should be on interventions to reduce ergonomic risk in the operating room.     

Evaluating mechanism and severity of injuries among trauma patients admitted to Sina Hospital, the National Trauma Registry of Iran

Purpose: Injuries are one of the leading causes of death and lead to a high social and financial burden. Injury patterns can vary significantly among different age groups and body regions. This study aimed to evaluate the relationship between mechanism of injury, patient comorbidities and severity of injuries. Methods: The study included trauma patients from July 2016 to June 2018, who were admitted to Sina Hospital, Tehran, Iran. The inclusion criteria were all injured patients who had at least one of the following: hospital length of stay more than 24 h, death in hospital, and transfer from the intensive care unit of another hospital. Data collection was performed using the National Trauma Registry of Iran minimum dataset. Results: The most common injury mechanism was road traffic injuries (49.0%), followed by falls (25.5%). The mean age of those who fell was significantly higher in comparison with other mechanisms (p < 0.001). Severe extremity injuries occurred more often in the fall group than in the vehicle collision group (69.0% vs. 43.5%, p < 0.001). Moreover, cases of severe multiple trauma were higher amongst vehicle collisions than injuries caused by falls (27.8% vs. 12.9%, p = 0.003). Conclusion: Comparing falls with motor vehicle collisions, patients who fell were older and sustained more extremity injuries. Patients injured by motor vehicle collision were more likely to have sustained multiple trauma than those presenting with falls. Recognition of the relationship between mechanisms and consequences of injuries may lead to more effective interventions.     

The Effect of Foot Reflexology on the Quality of Sexual Life in Hemodialysis Patients: A Randomized Controlled Clinical Trial

Sexuality and Disability - Sexual problems of hemodialysis patients are one of the most significant factors affecting their quality of life and families. On the other hand, an essential part of the...     

SB‐334867, an orexin receptor 1 antagonist,decreased seizure and anxiety in pentylenetetrazol‐kindled rats

Convulsive seizures are due to abnormal synchronous and repetitive neuronal discharges in the central nervous system (CNS). Finding new therapeutics to overcome the side effects of the current drug therapies and to increase their effectiveness is ongoing. Orexin‐A and orexin‐B are brain neuropeptides originating from postero‐lateral hypothalamic neurons. Studies show that orexins, through activation of OX1 and OX2 receptors, have excitatory effects in the CNS. Accordingly, this study was designed to evaluate the effect of OX1 receptor antagonist (SB‐334867) on seizure‐ and anxiety‐related behaviors of pentylenetetrazol (PTZ)‐kindled rats. Kindling was induced by repeated intraperitoneal (IP) injections of PTZ (32 mg/kg) with two‐day intervals for 24 days in male Wistar rats. Three groups received intracerebroventricular (ICV) injections of SB‐334867 (2.5, 5, and 10 μg/rat) before PTZ injections. Two control groups received vehicle (2 μL/rat, ICV) and valproate (26 μg/rat, ICV) before PTZ injections. An extra group of control animals received saline both ICV and IP. Seizure‐related behaviors were monitored for 30 min following PTZ administration. The anxiety‐like behaviors were also assessed using elevated plus‐maze in the first and last days of the study. The results revealed that ICV injection of SB‐334867, mainly at the dose of 10 μg/rat, decreased the median of seizure stages, prolonged the latency and reduced the duration of different seizure stages, and reversed the PTZ‐induced anxiety‐like behaviors. Based on the presented results, it is suggested that pharmacological blockade of the OX1 receptor is a potential target in the treatment of seizure and concomitant anxiety disorders.     

Automated sleep staging of OSAs based on ICA preprocessing and consolidation of temporal correlations

An automated sleep staging based on analyzing long-range time correlations in EEG is proposed. These correlations, indicating time-scale invariant property or self-similarity at different time scales, are known to be salient dynamical characteristics of stage succession for a sleeping brain even when the subject suffers a destructive disorder such as Obstructive Sleep Apnea (OSA). The goal is to extract a set of complementary features from cerebral sources mapped onto the scalp electrodes or from a number of denoised EEG channels. For this purpose, source localization/extraction and noise reduction approaches based on Independent Component Analysis were used prior to correlation analysis. Feature extracted segments were then classified in one of the five classes including WAKE, STAGE1, STAGE2, SWS and REM via an ensemble neuro-fuzzy classifier. Some techniques were employed to improve the classifier’s performance including Scaled Conjugate Gradient Method to speed up learning the ANFIS classifiers, a pruning algorithm to eliminate irrelevant fuzzy rules and the 10-fold cross-validation technique to train and test the system more efficiently. The performance of classification for two strategies including (1) feature extraction from effective cerebral sources and (2) feature extraction from selected channels of denoised EEG signals was compared and contrasted in terms of training errors and test accuracies. The first and second strategies achieved 92.23 and 88.74% agreement with human expert respectively which indicates the effectiveness of the staging system based on cerebral sources of activity. Our results further indicate that the misclassification rates were almost below 10%. The proposed automated sleep staging system is reliable due to the fact that it is based on the underlying dynamics of sleep staging which is less likely to be affected by sleep fragmentations occurred repeatedly in OSA.     

Applicability of Universal Thermal Climate Index (UTCI) in occupational heat stress assessment: a case study in brick industries

The present study aimed to investigate the applicability of Universal Thermal Climate Index (UTCI) as an innovative and science-based index in public health researches, in occupational heat stress assessment. All indoor and outdoor workers (200 people) of Brick industries of Shahroud, Iran participated in the research. First, the environmental variables such as air temperature, wet-bulb temperature, globe temperature, air velocity and relative humidity were measured; then UTCI and WBGT (wet-bulb globe temperature) indices were calculated. Simultaneously, physiological parameters including systolic and diastolic blood pressure, oral temperature, skin temperature, tympanic temperature and heart rate of workers were measured. UTCI and WBGT indices were 34.2 ± 2°C, 21.8 ± 1.8°C in the outdoor environments and 38.1 ± 4.4°C, 24.7 ± 3.3°C at the indoor environments, respectively. There were the weak inverse relationships between UTCI and WBGT indices at the outdoor environments and physiological responses such as systolic blood pressure, and diastolic blood pressure. However, there were no similar results for indoor environments. The significant relationships were found between UTCI and WBGT at both indoor and outdoor environments. Both UTCI and WBGT indices are suitable for assessing the occupational heat stress. Although, UTCI index seems more appropriate for heat stress assessment in the environments with low humidity and air velocity.