Adjuvant radiotherapy and health-related quality of life of patients at intermediate risk of recurrence following primary surgery for oral squamous cell carcinoma.

Controversy surrounds who should receive adjuvant radiotherapy in patients with intermediate risk of recurrence of oral squamous cell carcinoma following primary surgery. The aim of this study was to compare health-related quality of life (HRQOL) outcomes of those who received adjuvant radiotherapy to those who did not in patients at intermediate-risk of recurrence. A total of 765 oral cancer patients were treated at the Regional Maxillofacial Unit, Liverpool from 1995 to 2007. After excluding 124 patients (87 primary radiotherapy, 23 died within 90 days, 14 had insufficient information for determining risk group status), 169 were low-risk, 271 intermediate-risk and 201 were high-risk. In the intermediate-risk group, 33% had adjuvant radiotherapy. Allowing for attrition, more than 70% had University of Washington quality of life data (UW-QOL). Cumulative survival was similar in those with and without adjuvant radiotherapy in a subset of patients at intermediate risk. There was little difference in overall HRQOL scores and in the socio-emotional subscale scores of the UW-QOL. However, there was a significant difference in physical subscale scores and the issue most affected was saliva. These findings support better stratification of risk in the intermediate group, and the plausibility of withholding radiotherapy without compromising survival. This can have dramatic positive benefits on patient physical outcomes, in particular saliva. Where adjuvant radiotherapy is necessary, it is appropriate to minimise adverse effects through measures such as intensity-modulated radiation therapy.

The advantage in being magnocellular: a few more remarks on attention and the magnocellular system.

We have recently proposed a model of visual processing in which object recognition through the ventral stream into inferotemporal cortex is facilitated by an initial rapid feedforward sweep through the dorsal stream activating parietal and frontal regions prior to subsequent feedback to primary visual cortex (V1). Modulation of inferotemporal cortex also requires feedback from frontal regions, and horizontal connections from the dorsal stream. Aspects of this model, however, have been called into question-in particular the timing advantage of magnocellular over parvocellular arrivals in V1 (the 'magnocellular advantage'), the link between attention and the magnocellular system, and also the role of MT in smooth pursuit and saccadic eye movements. These criticisms are each rebutted in detail here, and the basis for a model derived from the magnocellular advantage is reaffirmed.

A role for the 'magnocellular advantage' in visual impairments in neurodevelopmental and psychiatric disorders.

Evidence exists implicating abnormal visual information processing and visually driven attention in a number of neurodevelopmental and psychiatric disorders, suggesting that research into such disorders may benefit from a better understanding of more recent advances in visual system processing. A new integrated model of visual processing based on primate single cell and human electrophysiology may provide a framework, to understand how the visual system is involved, by implicating the magnocellular pathway's role in driving attentional mechanisms in higher-order cortical regions, what we term the 'magnocellular advantage'. Evidence is also presented demonstrating visual processing occurs considerably faster than previously assumed, and emphasising the importance of top-down feedback signals into primary visual cortex, as well as considering the possibility of lateral connections from dorsal to ventral visual areas. Such organisation is argued to be important for future research highlighting visual aspects of impairment in disorders as diverse as schizophrenia and autism.

Outcome of consecutive pregnancies in a patient with Bombay (Oh) blood group.

A young lady with a rare Bombay (Oh) blood group had two successive uneventful pregnancies. Her serum contained a potent high-titre anti-H and serological as well as chemiluminescence tests, suggesting that the antibody was haemolytic. Her husband was of the normal H status. Theoretically, both babies should have been positive for the H antigen and should have suffered from haemolytic disease of the newborn. This apparent conundrum could be owing to the weak expression of the H antigens on the infant red cells.

Comparison of video trainer and virtual reality training systems on acquisition of laparoscopic skills.

Training on a video trainer or computer-based minimally invasive surgery trainer leads to improved benchtop laparoscopic skill. Recently, improved operative performance from practice on a video trainer was reported. The purpose of this study was three fold: (a) to compare psychomotor skill improvement after training on a virtual reality (VR) system with that after training on a video-trainer, (VT) (b) to evaluate whether skills learned on the one training system are transferable to the other, and (c) to evaluate whether VR or VT training improves operative performance. For the study, 50 junior surgery residents completed baseline skill testing on both the VR and VT systems. These subjects then were randomized to either a VR or VT structured training group. After practice, the subjects were tested again on their VR and VT skills. To assess the effect of practice on operative performance, all second-year residents (n = 19) were evaluated on their operative performance during a laparoscopic cholecystectomy before and after skill training. Data are expressed as percentage of improvement in mean score/time. Analysis was performed by Student's paired t-test. The VR training group showed improvement of 54% on the VR posttest, as compared with 55% improvement by the VT group. The VR training group improved more on the VT posttest tasks (36%) than the VT training group improved on the VR posttest tasks (17%) (p <0.05). Operative performance improved only in the VR training group (p <0.05). Psychomotor skills improve after training on both VR and VT, and skills may be transferable. Furthermore, training on a minimally invasive surgery trainer, virtual reality system may improve operative performance during laparoscopic cholecystectomy.

Evaluating surgical competency with the American Board of Surgery In-Training Examination, skill testing, and intraoperative assessment.

BACKGROUND: Evaluation of surgical competency should include assessment of knowledge, technical skill, and judgment. The purpose of this study was to determine the relationship between the American Board of Surgery In-Training Examination (ABSITE), skill testing, and intraoperative assessment. METHODS: Postgraduate year 2 (PGY-2) and postgraduate year 3 (PGY-3) surgery residents (n = 33) were tested by means of (1) the ABSITE, (2) skill testing on a laparoscopic video-trainer, and (3) intra-operative global assessments during laparoscopic cholecystectomy. The Pearson correlation was used to determine the correlation between the ABSITE, skill testing, and intraoperative assessments. For the comparison of PGY-2 and PGY-3 resident performance, Wilcoxon rank sum tests were used. RESULTS: The ABSITE scores did not correlate with skill testing or intraoperative assessments (not significant). Skill testing correlated with the intraoperative composite score and with 4 of 8 operative performance criteria (P<.05). The ABSITE scores and skill testing were not different for PGY-2 and PGY-3 residents (not significant). Intraoperative assessments were better in 5 of 8 criteria and the composite score for PGY-3 versus PGY-2 residents (P<.05), which demonstrated construct validity. CONCLUSIONS: The ABSITE measures knowledge but does not correlate with technical skill or operative performance. Residency programs should use multiple assessment instruments to evaluate competency. There may be a role for both skill testing and intraoperative assessment in the evaluation of surgical competency.

Laparoscopic training on bench models: better and more cost effective than operating room experience?

BACKGROUND: Developing technical skill is essential to surgical training, but using the operating room for basic skill acquisition may be inefficient and expensive, especially for laparoscopic operations. This study determines if laparoscopic skills training using simulated tasks on a video-trainer improves the operative performance of surgery residents. STUDY DESIGN: Second- and third-year residents (n= 27) were prospectively randomized to receive formal laparoscopic skills training or to a control group. At baseline, residents had a validated global assessment of their ability to perform a laparoscopic cholecystectomy based on direct observation by three evaluators who were blinded to the residents' randomization status. Residents were also tested on five standardized video-trainer tasks. The training group practiced the video-trainer tasks as a group for 30 minutes daily for 10 days. The control group received no formal training. All residents repeated the video-trainer test and underwent a second global assessment by the same three blinded evaluators at the end of the 1-month rotation. Within-person improvement was determined; improvement was adjusted for differences in baseline performance. RESULTS: Five residents were unable to participate because of scheduling problems; 9 residents in the training group and 13 residents in the control group completed the study. Baseline laparoscopic experience, video-trainer scores, and global assessments were not significantly different between the two groups. The training group on average practiced the video-trainer tasks 138 times (range 94 to 171 times); the control group did not practice any task. The trained group achieved significantly greater adjusted improvement in video-trainer scores (five of five tasks) and global assessments (four of eight criteria) over the course of the four-week curriculum, compared with controls. CONCLUSIONS: Intense training improves video-eye-hand skills and translates into improved operative performance for junior surgery residents. Surgical curricula should contain laparoscopic skills training.

Measuring operative performance after laparoscopic skills training: edited videotape versus direct observation.

BACKGROUND AND PURPOSE: Global assessment by direct observation has been validated for evaluating operative performance of surgery residents after formal skills training but is time-consuming. The purpose of this study was to compare global assessment performed from edited videotape with scores from direct observation. MATERIALS AND METHODS: Junior surgery residents (N = 22) were randomized to 2 weeks of formal videotrainer skills training or a control group. Laparoscopic cholecystectomy was performed at the beginning and end of the rotation, and global assessment scores were compared for the training and control groups. Laparoscopic videotapes were edited: initial (2 minutes), cystic duct/artery (6 minutes), and fossa dissection (2 minutes). Two independent raters performed both direct observation and videotape assessments, and scores were compared for each rater and for interrater reliability using a Spearman correlation. RESULTS: Correlation coefficients for videotape versus direct observation for five global assessment criteria were <0.33 for both raters (NS for all values). The correlation coefficient for interrater reliability for the overall score was 0.57 (P = 0.01) for direct observation v 0.28 (NS) for videotape. The trained group had significantly better overall performance than the control group according to the assessment by direct observation (P = 0.02) but not by videotape assessment (NS). CONCLUSIONS: Direct observation demonstrated improved overall performance of junior residents after formal skills training on a videotrainer. Global assessment from an edited 10-minute videotape did not correlate with direct observation and had poor interrater reliability. Efficient and valid methods of evaluating operative performance await development.

A comparison of freezing and thawing methods for the cryopreservation of human semen.

The purpose of this study was twofold. In the first part are compared cryosurvival rates for human semen following two different freezing and three different thawing techniques. In the second part a larger number of samples processed by the best of the six methods described were examined to ensure reproducibility. Eighteen human semen samples with initial motility greater than 60% and density greater than 20 X 10(6)/ml were mixed with a cryopreservative medium at 35 degree C and vacuumed into 0.5 ml straws. Six aliquots were prepared from as many specimens as possible. Three straws were frozen by a programmed method (P) and three by a rapid freezing technique (V). All six straws were stored in liquid nitrogen vapor (-196 degree C) for 1 week. The straws were thawed by 1 of 3 methods: (1) room temperature for 10 minutes and 37 degree C hot plate for 10 minutes, (2) ice water for 10 minutes and 37 degree C hot plate for 10 minutes, (3) 35 degree C water for 12 seconds and 37 degree C hot plate for 10 minutes. Postthaw motility was assessed for each aliquot. The freeze/thaw method P/1 was judged optimal. In the second part of the study a larger number of samples were processed by P/1. The mean +/- standard deviation postthaw motility o 57 semen specimens processed by this method was 61.4 +/- 12.1.

Pseudomonads and achromobacters in the spoilage of irradiated haddock of different preirradiation quality.

The effect of initial quality of fish on postirradiation (100 krad) changes in the bacterial flora of haddock fillets during aerobic storage at 3 C has been investigated, with emphasis on the Pseudomonas and Achromobacter groups. The quality was related to the length of time the eviscerated fish had been stored in ice prior to filleting. Increased numbers of organisms, in particular Pseudomonas putrefaciens, were found initially on fillets cut from older fish. Pseudomonads were reduced by 2 to 3 log orders by irradiation, and achromobacters and gram-positive isolates predominated in the immediate postirradiation flora. Little difference could be detected in either types or relative proportions of organisms occurring during storage of unirradiated fish of different quality. Pseudomonads outgrew achromobacters and dominated the spoilage flora in all cases. After spoilage, however, the growth rate of pseudomonads declined markedly. In irradiated fish, achromobacters predominated throughout storage. In fish of better initial quality, bacterial numbers were 1 to 2 log orders higher at spoilage than in their unirradiated counterparts and in the poorer quality of irradiated samples. The increased number of organisms was accompanied by a radical change in the character of the predominant achromobacters. Pseudomonads were found to increase in numbers during storage of irradiated fish, in particular in poorer quality fish on which they were initially present in higher numbers. Detection of pseudomonads, even when present in high numbers, was found to be limited by the identification techniques normally used.