ABSTRACT
To evaluate the validity and reliability of an innovative training model for endocrine surgical procedures. A simulator training model for endocrine procedures (SimLife) was developed at an academic center. The model consisted of a realistic operating environment with a coherent simulated patient dynamized by pulsatile vascularization with simulated blood warmed to 37 °C, and ventilation. Training sessions were designed for adrenal and thyroid surgery, as well as neck dissection. The primary outcome of interest was to evaluate learners' performance and satisfaction. Learners' performance was evaluated based on a scoring scale that followed the Downing method for the assessment of competency. While learners' satisfaction was evaluated using a Likert scale of 1 to 10 on four items (ease of learning, anatomic correspondence of landmarks, realism, and overall satisfaction). Participants were engaged in 32 training sessions. These included 24 adrenalectomies (conventional and laparoscopic both transabdominal and posterior), and 4 thyroid lobectomies with concomitant functional lateral compartment neck dissection. competency scores were procedure-specific addressing specific core components of a given procedure. Learners' performance scored above average in all procedures evaluated. Satisfaction scores for the specified four items ranged between 8.43 (SD 0.87) and 8.89 (SD 0.96). No major events were reported for the adrenalectomies, while only one jugular vein injury occurred during neck dissection. SimLife is a hyper-realistic training model that allows for satisfactory acquisition of skills and the evaluation of performance progression. It has the potential to become a cornerstone in specialized surgical training.
Subject(s)
Clinical Competence/statistics & numerical data , Computer Simulation , Curriculum , Education, Medical/methods , Endocrine Surgical Procedures/education , Models, Educational , Teaching , Adrenal Glands/surgery , Adrenalectomy/education , Humans , Neck Dissection/education , Reproducibility of Results , Thyroid Gland/surgery , Thyroidectomy/educationABSTRACT
Increased intestinal permeability due to barrier dysfunction is supposed to cause several gastrointestinal diseases. We have previously demonstrated that a single ß-carotene (BC) dose protects against increase in anaphylactic response in ß-lactoglobulin (BLG)-sensitized mice with no effect on the epithelial permeability and weak recovery of villi length. Utilizing the same murine ex vivo intestinal model, the aim of this study was to investigate the effect of different BC doses on BLG-mediated intestinal epithelial barrier disturbances. Jejunum was harvested from BLG-sensitized mice pretreated with either one of three different doses of BC (5, 10 and 20 mg/ kg body weight) and mounted on Ussing Chambers. Transepithelial electrical resistance (TER) and short-circuit current (Isc) were recorded as indicators of intestinal epithelial barrier function. Histopathological analysis of the intestine was carried out for the control and experimental mice. TNF-α and IL-6 levels were determined in serum using ELISA, and the analysis of antioxidant activity was performed for reduced glutathione (GSH) and thiobarbituric acid reactive substances (TBARS). BC was capable of enhancing the intestinal barrier function, as indicated by the increased TER and the decreased Isc. Intestinal damage characterized by the shortening of villi and infiltration of intestinal lymphocytes was significantly reversed by BC pretreatment. Such effects of BC were accompanied by a reduction in the levels of IL-6 and TBARS and an increase of GSH. TNF-α levels were reduced only at the lowest BC dose. These findings may encourage the use of BC-based therapies for controlling the breakdown of the intestinal barrier in vivo.
Subject(s)
Antioxidants/physiology , Cytokines/physiology , Intestinal Mucosa/physiopathology , beta Carotene/therapeutic use , Animals , Glutathione , Lactoglobulins , Mice , Permeability , Thiobarbituric Acid Reactive SubstancesABSTRACT
Little information exists about caregivers of persons with multiple sclerosis (MS). Our aims were to describe the characteristics of a sample of caregivers of persons with MS, assess their perceived burden, health-related quality of life, and investigate factors influencing this burden. We studied 278 caregivers of persons with MS, recruited from a Spanish cross-sectional survey, measuring health-related quality of life by the 36-Item Short-Form Health Survey (SF-36) and burden by the Zarit Caregiver Burden Interview. Of the caregivers, 56.8% were female and their mean age was 50.1 +/- 12.6 years. Their main relationship with the person with MS was spouse/partner (52.9%) and son or daughter (25.9%). Caregiver General Health, Mental Health, Bodily Pain, and Role-emotional Functioning were the most affected dimensions on the SF-36. Multiple regression analysis showed that independent and significant predictors of burden were Role-emotional Functioning and Vitality dimensions SF-36 scores of caregivers, and the Expanded Disability Status Scale scores. The total adjusted variance explained by these variables (adjusted R(2)) was 0.512. Emotional factors and the disability of the person with MS were major predictors of burden. Psychological and social support should be considered to reduce caregiver burden.
Subject(s)
Caregivers/psychology , Cost of Illness , Multiple Sclerosis/psychology , Quality of Life , Adolescent , Adult , Aged , Data Interpretation, Statistical , Disability Evaluation , Female , Humans , Linear Models , Male , Middle Aged , Motor Activity , Multiple Sclerosis/epidemiology , Pain/etiology , Regression Analysis , Socioeconomic Factors , Spain , Surveys and Questionnaires , Young AdultSubject(s)
Brain/virology , Creutzfeldt-Jakob Syndrome , 14-3-3 Proteins , Aged , Autopsy , Brain/pathology , Creutzfeldt-Jakob Syndrome/complications , Creutzfeldt-Jakob Syndrome/diagnosis , Creutzfeldt-Jakob Syndrome/immunology , Creutzfeldt-Jakob Syndrome/therapy , Electroencephalography , Enzyme Inhibitors/cerebrospinal fluid , Fatal Outcome , Humans , Male , Tyrosine 3-Monooxygenase/cerebrospinal fluidABSTRACT
No disponible
No disponible
Subject(s)
Aged , Male , Humans , Creutzfeldt-Jakob Syndrome , Tyrosine 3-Monooxygenase , Fatal Outcome , Autopsy , Electroencephalography , Enzyme Inhibitors , Tyrosine 3-Monooxygenase , TelencephalonABSTRACT
Desde que hace más de 100 años Carswell, Cruveilhier y especialmente Charcot que en 1868 ofrece la primera descripción detallada de lo que él llamó "esclerosis en placas", hasta la actualidad, la esclerosis múltiple sigue siendo un desafío para los investigadores y médicos que se dedican a tratarla. Sin embargo, la aparición de nuevos medios diagnósticos, como la resonancia magnética nuclear (RMN), y de nuevos tratamientos como el interferón beta 1 a y 1 b han supuesto un importante cambio en el pronóstico y la calidad de vida de estos pacientes. El médico de familia debe sospechar esta patología en pacientes con alteraciones piramidales, déficits sensoriales o sensitivos recientes, con el fin de remitirlos tempranamente a centros en los que se pueda completar el diagnóstico e iniciar un tratamiento, así como de atender las complicaciones y posibles secuelas de esta patología (AU)
Subject(s)
Humans , Multiple Sclerosis/diagnosis , Multiple Sclerosis/therapy , Multiple Sclerosis/epidemiology , Multiple Sclerosis/physiopathology , Diagnosis, Differential , Disability EvaluationABSTRACT
We report a case of acute abdomen due to appendicular lumen occlusion by anisakis larvae. This is the first case of human anisakiasis known in Spain, and the first case of acute appendicitis, in the medical World literature, produced by this nemathode. The association of myalgias and arthralgias stands out, being in this aspect the second case found the in medical litterature.
