Ιατρικά Άρθρα

Παρασκευή 7 Απριλίου 2017

What is Known About the Attributes of a Successful Surgical Trainer? A Systematic Review

Publication date: Available online 6 April 2017
Source:Journal of Surgical Education
Author(s): Ben Dean, Luke Jones, Patrick Garfjeld Roberts, Jonathan Rees
BackgroundSurgical training has been subject to significant upheaval in recent years with an increasingly rigorous assessment regimen for trainees. The assessment of surgical trainers is less well evolved by comparison. Recent proposals from the Royal College of Surgeons of England recommend "professionalising the trainers." However, they do not suggest any accepted or validated methods of trainer assessment, nor do they indicate how these might be implemented and monitored in a real-world training program to determine their effect on trainee outcomes.AimTo determine what is known about the attributes of successful surgical trainers.MethodsWe conducted a systematic review of the scientific literature using the preferred reporting items for systematic reviews and meta-analyses and Cochrane guidelines of the Medline database using specific search criteria. The qualitative analysis involved grouping trainer attributes together into "themes" within 4 "super-themes." Each theme needed to be mentioned by a minimum of 5 studies.ResultsAfter review of the full study texts a total of 14 studies met the inclusion criteria. Thirteen studies involved the views of trainees, whereas only 1 study solely assessed the views of trainers. There was a wide variety of study designs and types of participants.The attribute themes are listed in brackets after each super-theme: "character" (approachability, patience, enthusiasm, encouraging/supportiveness), "procedural" (willingness to let trainee operate, balance between supervision and independence), "teamwork and communication" (sets educational aims and objectives, ability to use appropriate feedback, communication skills, and time availability to train) and "clinical" (capable, good relationships with patients, and the health care team).ConclusionsThis detailed review describes several perceived important themes for the positive attributes of surgical trainers. The identification of these key attributes is only of value if their presence is confirmed by effective and feasible evaluation, and if the possession of such attributes in trainers is proven to have a positive effect on training. In times of reduced training opportunities, exploring the topics raised by this review through future education research is warranted.

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Vincristine-induced peripheral neuropathy in children with cancer: A systematic review

Publication date: Available online 6 April 2017
Source:Critical Reviews in Oncology/Hematology
Author(s): Mirjam E. van de Velde, Gertjan L. Kaspers, Floor C.H. Abbink, Abraham J. Wilhelm, Johannes C.F. Ket, Marleen H. van den Berg
Vincristine-induced peripheral neuropathy (VIPN) is a dose-limiting side effect of vincristine (VCR) treatment in children, leading to diminished quality of life. Much remains unknown about the underlying mechanisms of VIPN. This review systematically summarizes the available literature concerning contributing factors of VIPN development in children. Studied factors include patient characteristics, VCR dose, administration method, pharmacokinetics, and genetic factors. Furthermore, this review reports on currently available tools to assess VIPN in children. In total, twenty-eight publications were included. Results indicate that Caucasian race, higher VCR dose, older age and low clearance negatively influence VIPN, although results regarding the latter two factors were rather conflicting. Moreover, genetic pathways influencing VIPN were identified. Furthermore, the studied tools to assess VIPN seriously impairs comparability across study results. Studying the factors and their interactions that seem to influence VIPN in children, should aid in personalized VCR treatment, thereby increasing VCR effectiveness while minimizing toxicity.

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Insights into dovetailing GTD and Cancers

Publication date: Available online 7 April 2017
Source:Critical Reviews in Oncology/Hematology
Author(s): Revathy Nadhan, Jayashree V. Vaman, Nirmala C, Satheesh Kumar Sengodan, Sreelatha Krishnakumar Hemalatha, Arathi Rajan, Geetu Rose Varghese, Neetha RL, Amritha Krishna BV, Ratheeshkumar Thankappan, Priya Srinivas
Gestational trophoblastic diseases (GTD) encompass a group of placental tumors which mostly arise due to certain fertilization defects, resulting in the over-proliferation of trophoblasts. The major characteristic of this diseased state is that β-hCG rises up manifold than that is observed during pregnancy. The incidence of GTD when analyzed on a global scale, figures out that there is a greater risk in South-East Asia, the reason of which remains unclear. An insight into any possible correlation of GTD incidence with cancers, other than choriocarcinoma, is being attempted here. Also, we review the recent developments in research on the molecular etiopathology of GTD. This review would render a wider eye towards a new paradigm of thoughts to connect GTD and breast cancer, which has not been into the picture till date.

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HPV vaccine awareness and the association of trust in cancer information from physicians among males

Publication date: Available online 7 April 2017
Source:Vaccine
Author(s): Dexter L. Cooper, Natalie D. Hernandez, Latrice Rollins, Tabia Henry Akintobi, Calvin McAllister
IntroductionBlack and Hispanic men are diagnosed with more HPV-related cancers and at later stages compared to other racial/ethnic groups. Physician communication with men about HPV vaccination may be beneficial to increasing HPV vaccinations and decreasing HPV transmission. The purpose of this study was to examine HPV and HPV vaccine awareness among men by race, and the association between trust in cancer information from physicians and ever hearing about HPV and the HPV vaccine.MethodsU.S. adult males (age 18+) were identified from the 2014 Health Information National Trends Survey (HINTS) (n=1203). Binomial logistic regression models assessed the influences of race/ethnicity and trust of cancer information from physicians on men having heard of HPV and the HPV vaccination.ResultsApproximately 50% of the sample had never heard of HPV and 53% had never heard of the vaccine. Black men were less likely to know that HPV is sexually transmitted compared to White and Hispanic men (p<0.001). Hispanic and Black men were less likely to have heard about the HPV vaccine when compared to White men (p<0.001). Additionally, Hispanic men were less likely to trust a doctor about cancer information compared to White and Black men (p<0.001).ConclusionFindings highlight the lack of awareness about HPV among men. Furthermore, statistically significant racial/ethnic differences were found in HPV vaccine knowledge and trust in receiving cancer information from physicians. Future interventions should include community-based approaches and improved physicians' HPV-related communication to increase knowledge and uptake of the HPV vaccine.

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Efficacy of a high potency O1 Manisa foot-and-mouth disease vaccine in cattle against heterologous challenge with a field virus from the O/ME-SA/Ind-2001 lineage collected in North Africa

Publication date: Available online 7 April 2017
Source:Vaccine
Author(s): Emma Fishbourne, Anna B. Ludi, Ginette Wilsden, Pip Hamblin, Bob Statham, Abdelghani Bin-Tarif, Emiliana Brocchi, Santina Grazioli, Aldo Dekker, Phaedra Eblé, Donald P. King
Outbreaks of foot-and-mouth disease (FMD) in North Africa (2013) and the Gulf States (2013) of the Middle East have been caused by a FMD viral lineage (O/ME-SA/Ind-2001) that was before 2013 restricted to the Indian Sub-continent. This study was undertaken to assess the in vivo efficacy of a FMD virus emergency vaccine type O1 Manisa against heterologous challenge with a representative field virus (O/ALG/3/2014) from this emerging lineage. This widely available vaccine was selected since in vitro vaccine-matching results gave inconclusive results as to whether or not it would be protective. Three groups of five cattle were vaccinated with O1 Manisa (homologous potency ≥6PD50/dose) using study guidelines outlined in the European Pharmacopeia, and challenged at 21days post-vaccination by tongue inoculation. All animals that were vaccinated with the lowest dose (1/16) of vaccine developed generalised FMD, defined as vesicular lesions at the feet. One animal vaccinated with a 1/4 dose of the vaccine also developed generalised disease, as did two animals vaccinated with the full dose of vaccine. These results indicate that the heterologous potency of this high potency O1 Manisa vaccine was approximately 3.5 PD50/dose. These data support the use of the O1 Manisa vaccine for FMD control in areas where FMDV is endemic e.g. North Africa, and motivate further studies to evaluate other vaccine candidates (or multivalent combinations) that might be potentially used for emergency purposes in FMD-free settings.

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The rotavirus vaccine development pipeline

Publication date: Available online 7 April 2017
Source:Vaccine
Author(s): Carl D. Kirkwood, Lyou-Fu Ma, Megan E. Carey, A. Duncan Steele
Rotavirus disease is a leading global cause of mortality and morbidity in children under 5years of age. The effectiveness of the two globally used oral rotavirus vaccines quickly became apparent when introduced into both developed and developing countries, with significant reductions in rotavirus-associated mortality and hospitalizations. However, the effectiveness and impact of the vaccines is reduced in developing country settings, where the burden and mortality is highest.New rotavirus vaccines, including live oral rotavirus candidates and non-replicating approaches continue to be developed, with the major aim to improve the global supply of rotavirus vaccines and for local implementation, and to improve vaccine effectiveness in developing settings. This review provides an overview of the new rotavirus vaccines in development by developing country manufacturers and provides a rationale why newer candidates continue to be explored. It describes the new live oral rotavirus vaccine candidates as well as the non-replicating rotavirus vaccines that are furthest along in development.

Graphical abstract

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Novel Anticoagulant Agents in the Perioperative Setting

Publication date: Available online 7 April 2017
Source:Anesthesiology Clinics
Author(s): Allyson Lemay, Alan D. Kaye, Richard D. Urman

Teaser

An increasing number of oral anticoagulants have become available over the past decade. Each of these agents has differing implications on both regional and neuraxial anesthetic techniques. This article describes the pharmacology, pharmacokinetics, and pharmacodynamics of the most commonly used novel oral anticoagulants (NOACs). It also outlines recent guidelines for the use of NOACs in the perioperative setting, especially with regard to neuraxial anesthesia.

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Definition: Spatial neglect

Publication date: Available online 7 April 2017
Source:Cortex
Author(s): Roberto Cubelli

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Nakagami–m Parametric Imaging for Atherosclerotic Plaque Characterization Using the Coarse-to-Fine Method

Publication date: Available online 6 April 2017
Source:Ultrasound in Medicine & Biology
Author(s): Meng Han, Jinjin Wan, Yongfeng Zhao, Xiaodong Zhou, Mingxi Wan
The Nakagami model was used to analyze the statistical differences in ultrasound backscattered signals between different plaque types. To improve image resolution, Nakagami-m parametric imaging using the coarse-to-fine method based on the maximum likelihood estimation (CTF-BOW) was proposed for atherosclerotic plaque characterization. Simulation results confirmed that the CTF-BOW method significantly outperforms the sliding window method in precision, smoothness and resolution. Preliminary in vivo results (n = 45) indicated that the ranges of the m parameters for calcified, mixed and echolucent plaques are, respectively, 0.2852–0.5225, 0.6532–0.8784 and 0.8908–1.4011, with no overlap. Results revealed that the CTF-BOW method significantly improves image resolution without sacrificing accuracy and can distinguish between calcified, mixed and echolucent plaques. Moreover, it was found that the parameter m is related to the composition of the plaque, indicating that Nakagami-m parametric imaging has the potential to characterize plaques.

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SWAVE Imaging of Placental Elasticity and Viscosity: Proof of Concept

Publication date: Available online 6 April 2017
Source:Ultrasound in Medicine & Biology
Author(s): Jeffrey M. Abeysekera, Manyou Ma, Mehran Pesteie, Jefferson Terry, Denise Pugash, Jennifer A. Hutcheon, Chantal Mayer, Lutz Lampe, Septimiu Salcudean, Robert Rohling
The placenta is the interface between the fetus and the mother and is vital for fetal development. Ultrasound elastography provides a non-invasive way to examine in vivo the stiffness of the placenta; increased stiffness has previously been linked to fetal growth restriction. This study used a previously developed dynamic elastography method, called shear wave absolute vibro-elastography, to study 61 post-delivery clinically normal placentas. The shear wave speeds in the placenta were recorded under five different low-frequency mechanical excitations. The elasticity and viscosity were estimated through rheological modeling. The shear wave speeds at excitation frequencies of 60, 80, 90, 100 and 120 Hz were measured to be 1.23 ± 0.44, 1.67 ± 0.76, 1.74 ± 0.72, 1.80 ± 0.78 and 2.25 ± 0.80 m/s. The shear wave speed values we obtained are consistent with previous studies. In addition, our multi-frequency acquisition approach enables us to provide viscosity estimates that have not been previously reported.

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Computed determination of the in vitro optimal chemocombinations of sphaeropsidin A with chemotherapeutic agents to combat melanomas

Abstract

Purpose

Evasion to new treatments of advanced melanoma is still associated with a poor prognosis. Choosing the best combination of agents that can bypass resistance mechanisms remains a challenge. Sphaeropsidin A (Sph A) is a fungal bioactive secondary metabolite previously shown to force melanoma cells to undergo apoptosis via cell volume dysregulation. This work studied its in vitro combination with cytotoxic chemotherapeutics in a rational manner.

Methods

Four melanoma cell lines harboring different sensitivity levels to pro-apoptotic stimuli were used to build a predictive response surface model allowing the determination of the optimal in vitro combinations of Sph A with two drugs, i.e., cisplatin or temozolomide, owing to a limited set of experimentations.

Results

Testing 12 experimental combinations allowed us to build an accurate predictive model that considers the complexity of the drug interaction and determines the optimal combinations according to the endpoint chosen, i.e., the maximal cytotoxic effects. Therefore, combining 4 µM Sph A with 75 µM cisplatin concomitantly for 72 h improved its cytotoxic effects on melanoma cells in a synergistic manner. An optimal in vitro treatment schedule was also obtained for temozolomide.

Conclusions

The use of a response surface model offers the possibility of reducing the experiments while determining accurately the optimal combinations. We herein highlighted that combining the Na⁺/K⁺/2Cl⁻ cotransporter and/or anion exchanger inhibitor Sph A with chemotherapeutic agents could improve the therapeutic benefits of conventional chemotherapies against advanced melanomas, particularly because Sph A exerts cytotoxic effects regardless of the genetic BRAF and NRAS status.

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SBRT planning for liver metastases: A focus on immobilization, motion management and planning imaging techniques

Publication date: Available online 6 April 2017
Source:Reports of Practical Oncology & Radiotherapy
Author(s): Olivier Riou, Carmen Llacer Moscardo, Pascal Fenoglietto, Emmanuel Deshayes, Raphaël Tetreau, Jessica Molinier, Alexis Lenglet, Eric Assenat, Marc Ychou, Boris Guiu, Norbert Aillères, Ludovic Bedos, David Azria
AimTo evaluate the different techniques used for liver metastases Stereotactic Body Radiation Therapy (SBRT) planning. We especially focused on immobilization devices, motion management and imaging used for contouring.BackgroundAlthough some guidelines exist, there is no consensus regarding the minimal requirements for liver SBRT treatments.Materials and methodsWe reviewed the main liver metastases SBRT publications and guidelines; and compared the techniques used for immobilization, motion management, margins and imaging.ResultsThere is a wide variety of techniques used for immobilization, motion management and planning imaging.ConclusionsWe provide a subjective critical analysis of minimal requirements and ideal technique for liver SBRT planning.

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Anticancer potential of Trigonella foenum graecum: Cellular and molecular targets

Publication date: June 2017
Source:Biomedicine & Pharmacotherapy, Volume 90
Author(s): Khalid El Bairi, Mounir Ouzir, Najda Agnieszka, Loubna Khalki
A growing body of evidence supported by numerous studies on tumorigenesis confirms that it is possible to target various hallmarks of cancer. Recent studies have shown that plant-derived molecules may be used in targeting different signaling pathways for cancer drug discovery. The present paper gives an insight into the anticancer potential of fenugreek and lists the existing studies that have been carried out to demonstrate the advantages of the use of fenugreek in cancer treatment and prevention. It also aims at opening up new perspectives in the development of new drugs of natural origins in the future clinical trials. This review article will discuss; (1) the chemical constituents and bioactive compounds of fenugreek; (2) effects on oxidative stress and inflammation; (3) effects on proliferation, apoptosis, and invasion; (4) toxicity of fenugreek; and 5) future directions in cancer drug development. All of the experimental studies discussed in this paper suggest that multiple signaling pathways (hallmarks) are involved in the anticancer activities of fenugreek, but their efficacy is still unclear, which requires further investigation.