Smartwatch helps detects lung cancer: Using personal technology to advance healthcare.

The prevalence of smartwatches and other wearable medical technology has been increasing yearly. These watches offer a sensitive tool for capturing cardiac dysrhythmias and can lead to patients seeking earlier medical advice. This case report highlights the importance of clinicians seeking and using the information provided by wearable medical technology which in this case resulted in both the timely treatment of non-sustained ventricular tachycardia and lung adenocarcinoma.

A combined approach to correct posterior left ventricular aneurysm, aortic stenosis and coronary artery disease.

Ischaemic heart disease and aortic stenosis are potentially life-threatening conditions. A post-infarct left ventricular aneurysm, when combined with the above, is particularly hazardous. We present a case where all three conditions occurred simultaneously and describe the surgical approach undertaken to attempt correction. The patient underwent aneurysmectomy together with aortic valve replacement and two-vessel coronary artery bypass grafting. The aneurysm was excised with direct linear closure of the walls using a Teflon-buttressed interrupted mattress suture technique. Post-operatively, ventricular systolic function was good (LVEF 40%) together with a well-seated aortic valve showing no paravalvular leaks. This case highlights the importance of meticulous removal of thrombus from the aneurysm and everting the edges thereby eliminating a thrombogenic surface and the risk of embolic stroke. The restorative procedure itself serves to underline the importance of ventricular shape in the effective functioning of the myocardium for sustaining an adequate stroke volume with normalized physiology.

Epidural analgesia versus paravertebral block in video-assisted thoracoscopic surgery.

A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was: In patients undergoing video-assisted thoracoscopic surgery, is paravertebral block (PVB) superior to epidural analgesia (EP) in terms of pain control and its postoperative complication rates? Altogether, 153 papers were found using the reporting search, of which 4 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. At present, there are a limited number of studies directly comparing pain control and postoperative outcomes between PVB and EP, and no large-scale randomized trials have been reported. Three of the 4 papers are small prospective randomized trials, with a small cohort study featuring as the final piece of literature. There is no conclusive body of evidence to recommend either route as more efficacious from a pain control perspective; one study demonstrated significantly lower levels of pain with EP (P = 0.01), with a second study demonstrating significantly better pain control with PVB (P < 0.01) and a third failing to demonstrate any significant difference (P = 0.899). The frequency of requiring supplemental analgesia was similar between the PVB and EP cohorts (56% vs 48%, P = 0.26). PVB is associated with lower rates of postoperative complications compared to EP, specifically urinary retention (64% vs 34.6%, P = 0.0036) and hypotension (32% vs 7%, P = 0.0031; 21% vs 3%, P = 0.02). In summary, PVBs appear to offer an equivalent level of analgesic effect following video-assisted thoracoscopic surgery, with a more favourable side-effect profile, compared to EP. This does need to be contextualized in light of the scarcity of published material, with the available studies each containing a small number of participants.

Surgical ergonomics. Analysis of technical skills, simulation models and assessment methods.

INTRODUCTION: Over the past two centuries the surgical profession has undergone a profound evolution in terms of efficiency and outcomes. Societal concerns in relation to quality assurance, patient safety and cost reduction have highlighted the issue of training expert surgeons. The core elements of a training model build on the basic foundations of gross and fine motor skills. In this paper we provide an analysis of the ergonomic principles involved and propose relevant training techniques. We have endeavored to provide both the trainer and trainee perspectives. METHODS: This paper is structured into four sections: 1) Pre-operative preparation issues, 2) technical skills and instrument handling, 3) low fidelity simulation models and 4) discussion of current concepts in crew resource management, deliberate practice and assessment. DISCUSSION: Rehearsal, warm-up and motivation-enhancing techniques aid concentration and focus. Appropriate posture, comprehension of ergonomic principles in relation to surgical instruments and utilisation of the non-dominant hand are essential skills to master. Low fidelity models can be used to achieve significant progress through the early stages of the learning curve. Deliberate practice and innate ability are complementary to each other and may be considered useful adjuncts to surgical skills development. CONCLUSION: Safe medical care requires that complex patient interventions be performed by highly skilled operators supported by reliable teams. Surgical ergonomics lie at the heart of any training model that aims to produce professionals able to function as leaders of a patient safety oriented culture.

Cell cycle progression score and treatment decisions in prostate cancer: results from an ongoing registry.

OBJECTIVE: The cell cycle progression (CCP) test (Prolaris) is a novel prognostic assay that provides accurate risk of prostate cancer-specific disease progression and disease specific mortality when combined with standard clinicopathologic parameters. This prospective study evaluated the impact of the CCP report on physician treatment recommendations for prostate cancer. METHODS: Physicians ordering the CCP test in clinical practice completed surveys regarding treatment recommendations before and after they received and discussed the test results with patients. Clinicians also rated the influence of the test result on treatment decisions. Treatment selections were confirmed via third-party audit of patient charts following final survey responses. RESULTS: Overall, 65% of cases showed a change between intended treatment pre- and post-CCP test reporting. Pre-CCP testing, 164 of 305 cases received a recommendation for interventional treatment. Post-CCP test, interventional therapy was recommended for 103 of these cases, a reduction of 37.2%. Conversely, 141 of 305 cases were recommended pre-CCP testing for non-interventional treatment; 108 of these remained with non-interventional treatment while 33 shifted to interventional options, a 23.4% increase. There was a 49.5% reduction in surgical interventions and a 29.6% reduction in radiation treatment. A third-party audit identified 80.2% concordance between the post-CCP testing treatment recommendation and actual treatment. Re-assignment to intervention or non-intervention generally correlated with the result of the CCP report. Study limitations included physician selection of patients for testing, no evaluation of patient input in therapeutic choice, and other potential treatment decision factors not queried by the survey. CONCLUSION: Based on responses of ordering physicians, the CCP report adds meaningful new information to risk assessment for localized prostate cancer patients. Test results led to changes in treatment with reductions and increases in interventional treatment that were directionally aligned with prostate cancer risk specified by the test.

A Case of Squamous Cell Carcinoma of the Renal Pelvis in association with Schistosoma hematobium.

A 72-year-old man presented with painless frank haematuria. Investigations included intravenous urogram and abdominal/pelvic CT which revealed a marked focal thickening of the wall of the inferior aspect of the left renal pelvis extending into the lower pole calyx and into the pelviureteric junction resulting in left hydronephrosis. Urine cytology demonstrated clusters of malignant keratinised squamous cells and schistosome ova. He underwent left laparoscopic radical nephroureterectomy and histology revealed moderately differentiated keratinising squamous cell carcinoma in the renal pelvis.

Multiple protein phosphatases are required for mitosis in Drosophila.

BACKGROUND: Approximately one-third of the Drosophila kinome has been ascribed some cell-cycle function. However, little is known about which of its 117 protein phosphatases (PPs) or subunits have counteracting roles. RESULTS: We investigated mitotic roles of PPs through systematic RNAi. We found that G(2)-M progression requires Puckered, the JNK MAP-kinase inhibitory phosphatase and PP2C in addition to string (Cdc25). Strong mitotic arrest and chromosome congression failure occurred after Pp1-87B downregulation. Chromosome alignment and segregation defects also occurred after knockdown of PP1-Flapwing, not previously thought to have a mitotic role. Reduction of several nonreceptor tyrosine phosphatases produced spindle and chromosome behavior defects, and for corkscrew, premature chromatid separation. RNAi of the dual-specificity phosphatase, Myotubularin, or the related Sbf "antiphosphatase" resulted in aberrant mitotic chromosome behavior. Finally, for PP2A, knockdown of the catalytic or A subunits led to bipolar monoastral spindles, knockdown of the Twins B subunit led to bridged and lagging chromosomes, and knockdown of the B' Widerborst subunit led to scattering of all mitotic chromosomes. Widerborst was associated with MEI-S332 (Shugoshin) and required for its kinetochore localization. CONCLUSIONS: We identify cell-cycle roles for 22 of 117 Drosophila PPs. Involvement of several PPs in G(2) suggests multiple points for its regulation. Major mitotic roles are played by PP1 with tyrosine PPs and Myotubularin-related PPs having significant roles in regulating chromosome behavior. Finally, depending upon its regulatory subunits, PP2A regulates spindle bipolarity, kinetochore function, and progression into anaphase. Discovery of several novel cell-cycle PPs identifies a need for further studies of protein dephosphorylation.

Botryoid rhabdomyosarcoma of vagina--two case reports.

Botryoid rhabdomyosarcoma, previously considered a type of embryonal rhabdomyosarcoma, has clinicopathological features distinctive enough to warrant its classification as a separate entity. It almost always occurs in children under 5 years of age. Two cases of botryoid rhabdomyosarcoma are reported here because of their relative rarity.