ABSTRACT
Mesenchymal stem cells have proven to be a promising alternative to conventional steroids to treat canine inflammatory bowel disease (IBD). However, their administration requires a washout period of immunosuppressive drugs that can lead to an exacerbation of the symptoms. Therefore, the feasibility and effects of the combined application of stem cells and prednisone in IBD-dogs without adequate response to corticosteroids was evaluated for the first time in this study over a long- term follow up. Two groups of dogs with IBD, one without treatment and another with prednisone treatment, received a single infusion of stem cells. The clinical indices, albumin and cobalamin were determined prior to the infusion and after one, three, six and 12 months. In both groups, all parameters significantly improved at each time point. In parallel, the steroid dosage was gradually reduced until it was suppressed in all patients a year after the cell therapy. Therefore, cell therapy can significantly and safely improve the disease condition in dogs with IBD receiving or not receiving prednisone. Furthermore, the steroid dosage can be significantly reduced or cancelled after the stem cell infusion. Their beneficial effects are stable over time and are long lasting.
ABSTRACT
BACKGROUND: Minimally invasive surgery implementation requires a regulated and orderly learning process. METHODS: Jesús Usón Minimally Invasive Surgery Centre promotes a pyramid training model structured into four levels: training of basic and advanced skills in physical simulator (level 1), training of anatomical protocols and advanced skills with animal models (level 2) training advanced procedural skills with tele-surgical applications (level 3), and training in the operating room (level 4). Training provided at levels 1 and 2 is described and evaluated. RESULTS: 4284 participants have been trained in laparoscopy at our institution. 95.5% surgeons: 49% gastroenterologists, 30% urologists, and 14% gynecologist (14%). 77% of celebrated courses consisted of 20 hours training (8 at level 1 and 12 at level 2). 94.37% of participants considered pyramid model as highly suitable, scoring 9.5 on a scale 1-10 for the model and for the simulation quality. 82.7% perceived the improvement in their laparoscopic skills and 99.56% recommend this training program to other surgeons. DISCUSSION: There are no unified criteria between different training programs but most of them measure laparoscopic skills based on time of execution, quality or mistakes of the exercise, and the student satisfaction test. CONCLUSION: The pyramid training model lead to the acquisition of necessary laparoscopic skills to perform safely advanced minimally invasive techniques.
Antecedentes: la práctica de la cirugía de mínima invasión necesita que el aprendizaje sea estructurado y progresivo. Material y métodos: estudio prospectivo efectuado en el Centro de Cirugía de Mínima Invasión Jesús Usón que propone un modelo de formación piramidal con cuatro niveles: adquisición de habilidades básicas en simulador (nivel 1), desarrollo de técnicas quirúrgicas específicas en modelos animales (nivel 2), telemedicina y telementorización (nivel 3), y aplicación al paciente con supervisión experimentada (nivel 4). Objetivo: describir los niveles 1 y 2 que se practican en el Centro y evaluar la formación impartida. Resultados: 4,284 alumnos han recibido formación en cirugía laparoscópica: 95.5% médicos: cirujanos del aparato digestivo (49%), urólogos (30%) y ginecólogos (14%). En 77% de los cursos celebrados disponen de 20 horas de adiestramiento, 8 en el nivel 1, y 12 en el nivel 2. El 94.37% considera altamente apropiado el modelo de formación piramidal, calificándolo con 9.58 sobre 10 y con 9.5 a la calidad de la simulación. El 82.75% percibe que ha avanzado notablemente en sus destrezas y 99.56% recomendaría a otros cirujanos la realización de actividades en el Centro. Conclusión: el modelo de formación propuesto permite alcanzar las habilidades necesarias para efectuar correctamente procedimientos avanzados en cirugía de mínima invasión.
