Advanced training in laparoscopic gastrointestinal surgical procedures using Genelyn®-embalmed human cadavers: A novel model.

BACKGROUND: Human cadaver is ideal for learning and acquiring new surgical skills. While cadavers preserved using Thiel's embalming method are commonly used for training in laparoscopic surgery, it is a cumbersome technique. We report our experience of using Genelyn®-embalmed cadavers for training in advanced laparoscopic gastrointestinal procedures. MATERIALS AND METHODS: A cross-sectional satisfaction survey corresponding to level 1 of the Kirkpatrick model for training evaluation was performed among 19 participants of advanced laparoscopy surgical skills training workshop, in December 2019, using Genelyn®-embalmed cadavers. Visual, haptic and tactile characteristics of the organs and tissues were assessed along with overall satisfaction of the workshop using Likert scale. RESULTS: Five Genelyn®-embalmed cadavers were used for the workshop. All the 19 participants perceived that the cadavers were odourless and allowed adequate insufflation for laparoscopic procedures. Most of the participants(n=16, 84%) agreed that the appearance and tactile fidelity of the solid organs, luminal structures and tissues in Genelyn®-embalmed cadavers were similar to that of a live patient. There was a strong agreement among participants that the workshop will help improve the laparoscopic skills(median Likert score-4). CONCLUSION: The participants of the surgical skill training workshop felt that the Genelyn®-embalmed cadavers were ideal for use in practicing advanced laparoscopic procedures.

Does management reasoning constitute the backbone of the clinical learning environment?: Conceptual analysis of the existing notions.

Management reasoning is a paradigm whereby learning occurs in a context bound fashion on analysing the biophysical factors existing in the clinical learning environment. In the contemporary medical education forums, much importance is being laid on clinical reasoning and this warrants the appropriate usage of the biomedical knowledge in arriving at the diagnosis. We perceive that clinical reasoning, in pure sense, often doesn't solve the purpose of rendering the best management plan to the patient. This holds stronger when the case is non-linear and highly complex in nature. Management reasoning fills the gap between hypotheses generation, i.e. accomplishing diagnosis and devising management plan. Indeed, it is a complex activity relying on several factors including the physician's perceptual abilities and situated cognition derived from formal and informal learning experiences. In contrast to clinical reasoning, which can be taught using structured scenarios, management reasoning necessitates analysing multitude of factors revolving around a patient and prioritizing those in order to titrate the best possible management plan. This commentary spotlights different dimensions of management reasoning, emphasizes the need of teaching it in the current scenarios, enlists the ways it can be taught, and opens the platform for discussing further on this underemphasized topic.

Philadelphia-Like Acute Lymphoblastic Leukemia: A Systematic Review.

Philadelphia-like (Ph-like) acute lymphoblastic leukemia (ALL) is a subgroup of B-cell precursor ALL (BCP-ALL) with a gene expression profile analogous to Philadelphia-positive ALL and recurrent IKAROS Family Zinc Finger 1 (IKZF1) gene deletion despite lacking BCR-ABL1 (Breakpoint cluster region-ABL protooncogene) translocation. Although recognized to occur at all ages, the proportion of cases among BCP-ALL varies (< 10% in children and up to 30% in adolescents). In all age groups, males are more commonly affected. Generally, Ph-like ALL is associated with adverse clinical features and an increased risk of treatment failure with conventional approaches. Genetic alterations such as aberrant expression, point mutations, or fusion translocations lead to activation of cytokine receptors and signaling kinases, which affect the ABL1 (ABL class fusion) or Janus Kinase (JAK) signaling pathways. Several clinical trials are being conducted to understand whether specific tyrosine kinase inhibitor therapy can improve cure rates. This review summarizes the current literature available about this entity.

Post-transcriptional gene silencing: Basic concepts and applications.

Post-transcriptional gene silencing (PTGS)-mediated gene silencing exploits the cellular mechanism wherein transcripts having sequence similarity to the double-stranded RNA (dsRNA) molecules present in the cell will be subjected to degradation. PTGS is closely related to natural processes such as RNA-mediated virus resistance and cross-protection in plants. Gene silencing and the cellular machinery for affecting this phenomenon might have evolved as a natural protective measure against viral infection in plants. In PTGS, small interfering RNA (siRNA) molecules of 21-23 nucleotides length act as homology guides for triggering the systemic degradation of transcripts homologous to the siRNA molecules. PTGS phenomenon, first discovered in transgenic petunia plants harbouring chalcone synthase gene and termed co-suppression, has been subsequently exploited to target specific gene transcripts for degradation leading to manifestation of desirable traits in crop plants. Targeted gene silencing has been achieved either through the introduction of DNA constructs encoding dsRNA or antisense RNA or by deploying cosuppression constructs producing siRNAs against the transcript of interest. Understanding the mechanism of gene silencing has led to the development of several alternative strategies for inducing gene silencing in a precise and controlled way. This has paved the way for using PTGS as one ofthe chief functional genomicstools in plants and has helped in unraveling the mechanism of many cellular processes and identifying the focal points in pathways, besides, opening new vistas in genetic engineering of plants for human benefits. PTGS has shown great potential in silencing the deleterious genes efficiently so that value-added plant products could be obtained. Thus, PTGS has ushered in a new era in the genetic manipulation of plants for both applied and basic studies. In this review, we have outlined the basics of RNAi-mediated gene silencing and summarized the work carried out at our institute using this approach, as case studies. In particular, adopting RNAi-mediated gene silencing (a) as a method to restore fertility in transgenic male sterile lines developed based on orfH522 gene from sunflower PET1-CMS source, (b) as a tool to suppress the production of toxic proteins, ricin and RCA, in castor, and (c) as an approach to induce bud necrosis virus resistance in sunflower has been discussed. Examples from other plant systems also have been mentioned to exemplify the concept and utility of gene silencing in crop plants.

Professionalism in practice: Exploring the ethical perplexity of involving students in Medical Education Research.

With the worldwide increase in the number of medical education researches, few ethical quagmires have emerged regarding the recruitment and inclusion of students in research projects. The ethicists often tend to raise questions regarding the possibilities of students getting coerced to participate, such as whether they receive extra course credits in exchange for their participation, or whether their privacy is getting violated in the course of data collection. It is the need of the hour to address the perplexity behind these ethical dilemmas. Some answers to the ethical questions might call for implication of change in the organization of research, thereby affecting the output. This commentary tries to address these issues in a genuine manner and affords a way forward in the context of ethics related to educational research. By treading the delicate path between framing the research question which never encompass any ethical breaches and compromising the rigour of the study design to suffice certain baseless hindrances, we could appreciate the importance of practical ethics in educational researches.

Truly Existing or Hyped up? Unravelling the Current Knowledge Regarding the Anatomy, Radiology, Histology and Biomechanics of the Enigmatic Anterolateral Ligament of the Knee Joint.

Ever since its description, anterolateral ligament (ALL) of the knee joint remains as the hotspot of controversies. Though it has been described under various descriptions, the structure gained its limelight when it was christened as anterolateral ligament by Claes in 2013. The main reason for the controversies around it is the lack of concrete evidences regarding its attachments, morphology, biomechanical aspects and radiological appearance. Similarly the role of ALL in pivot shift phenomenon also remains as a point of debate. The advocates of ALL suggest that because of its ability to modulate internal rotation and attachment to the lateral meniscus, ALL contributes to the pivot shift phenomenon. Similarly, the orientation of ALL stands as the reason for varied documentation with respect to imaging techniques. With the growing body of evidence, it is imperative to fix our stand regarding the structure because, if found to be morphologically persistent, it can be used for concomitant anterolateral stabilization along with anterior cruciate ligament reinforcement surgeries. The present review tries to systematically review the anatomy, variations in classifications, descriptions, histology, radiology and biomechanical features of ALL. At the end of the review, we would like to find the answer for the question: Is ALL a distinct ligamentous structure located at the anterolateral aspect of the knee? What is the contribution of it to the tibial internal rotation stability?

Evaluating the effectiveness of integrating radiological and cross-sectional anatomy in first-year medical students - A randomized, crossover study.

CONTEXT: Radiological anatomy (RA) knowledge is essential for the current-day clinical practice due to the rapid development in imaging technologies. As there is a long interval between learning RA in the 1st year and applying it in their clinical disciplines impedes their functional understanding, this study has been planned to provide the students with a right mix of anatomy and radiology in order to promulgate deeper medical comprehension. AIM: This study aimed to evaluate the effectiveness of integrated RA in honing the radiological reasoning abilities in 1st year medical students and to develop critical thinking skills through small-group, case-based learning experience. METHODOLOGY: All the students of 2017-2018 batch were randomized equally into study group and control group. The study group was exposed to the interactive RA module followed by posttest. The control group was exposed to traditional teaching and then given posttest. The groups were flipped for successive regions of anatomy. Feedbacks were obtained by both quantitative and qualitative methods. STATISTICAL ANALYSIS: Posttest scores were compared using Student's t-test. Feedbacks were analyzed using descriptive statistics. RESULTS: The posttest scores were significantly higher in the study group when compared to the control group. Nearly 92% of the students felt that the integrated module made them learn better and 44% of the students felt that it helped them to apply the knowledge in clinical context. CONCLUSION: For the present millennial-generation students, integrated RA lectures help develop their critical thinking and help in the subsequent clinical years.

Superficial palmar branch of the radial artery in a fibromuscular tunnel: a case report.

The radial artery usually passes on the radial side of the wrist lateral to the wrist to enter the anatomical snuff box and dorsum of the hand. If the radial artery passes anterior to the wrist, it usually enters the carpal tunnel, and in such cases, it may lead to the compression of the median nerve within the carpal tunnel. During the routine dissection, we found a case of the unusual radial arterial branch that passed anterior to the wrist yet outside the carpal tunnel. The artery passed within a tunnel formed by the fibromuscular fibers of thenar muscles arising from the anterior aspect of the transverse carpal ligament. Knowledge of the course and distribution of the variant superficial palmar branch of radial artery are of importance to the surgeons operating around the wrist, radiologist interpreting angiograms, and orthopedists managing trauma to the wrist.

Intangibility of the invisible hand - Analysing the micro-dynamics of novice mentoring program based upon one institutional experience.

Although mentoring has been regarded as an essential component in the developmental phase of medical students, it is the nature of hierarchical relationship and the quality of emotional exchange which determine its sustainability. With great enthusiasm, we had launched our mentoring program for the new entrants of our medical school. After an initial faculty development workshop on mentoring, we framed our guidelines for implementing the program. To measure the relationship satisfaction on both sides and self-efficacy, we used relationship satisfaction scales. As the winds offered us the beginner's fortune, our program went on well for the first six months. Slowly, the colour of the mentorship program began to fade. Students began to find excuses for not meeting their mentors and the sessions truncated into a "hay- how do you do - bye" meetings. Through this commentary, we would like to introspect the factors which would have dampened the interest. Would it be the asynchronous agency support or lack of motivation / self-efficacy or roadblocks in Communication Bridge or lack of adequate matching or lack of need? The outcomes of our introspection would be of help for others who run the mentorship programs or who wish to install in their own institutes.

Multiple Faces of Narcissistic Leadership in Medical Education.

Narcissism, being the critical part of the toxic leadership paradigm, has its own impact in the education sphere. Contrastingly, leader's narcissism cannot be simply underweighted because such leaders often tend to be creative strategists who can take risky challenges to suffice the self-ego and leave behind a legacy as well. This commentary intends to portray the complex mosaic of the positive and negative consequences inbred in a narcissistic leader. The debate over whether these people provide a net gain or loss remains everlasting because it varies based on the organizational climate and also other contextual factors.

Good, Bad and Ugly: Exploring the Machiavellian power dynamics of Leadership in medical education.

INTRODUCTION: Medical education requires participation of various stakeholders and this contributes to power dynamics operating at multiple levels. Personality traits of an individual can affect the smooth execution of the educational programmes and eventually the professionalism of the environment. With the increased focus on leadership traits in medical education and collaboration in health care settings, I, through this commentary, would like to explore the Machiavellian power dynamics involved and how it can influence the harmony prevailing in an organization. METHODS: The author has tried to review the several aspects of Machiavellianism in health care settings and describe day-to-day experiences at four levels; micro (individual), meso (departmental), macro (institutional) and mega (discipline). Introspecting on the unaddressed issues in a different light would help to gain a deeper understanding regarding work place ethics and professionalism. RESULTS: The reflection of day-to-day experiences in a different perspective would provide an insight regarding various issues to health professionals and help in developing ethical leadership abilities in them, which eventually promulgates professionalism. CONCLUSION: To my best knowledge, this is the first commentary to deal with the implications of Machiavellianism in different issues related to health care settings. With the increased emphasis on the leadership traits related to medical education, analysing organizational issues in various dimensions is of paramount importance.

Comparing Curricular Reform in Medical Schools and the Ship of Theseus: Insights Regarding Philosophical and Ideological Characteristics.

Most of the curricular reforms are either imprecise, lacking appropriate contextualization or keen in "lifting" the solution from one context and fixing it in some other context. The greatest obstacle for curricular reform is something intrinsic [philosophical and ideological] and related to the general disposition of educators to resist the change and love status quo. We would like to put forth that viewing reforms under these lenses is the ultimate requirement and when winds of reform begin to blow in curriculum, definitely it would become unstoppable and one reform would give birth to the necessity for other reform. This commentary intends to discuss the under emphasized intricacies related to curricular reform by comparing it with analogy of "The Ship of Theseus."