Three-Dimensionally Printed Hydrogel Cardiac Patch for Infarct Regeneration Based on Natural Polysaccharides.

Myocardial infarction is one of the more common cardiovascular diseases, and remains the leading cause of death, globally. Hydrogels (namely, those using natural polymers) provide a reliable tool for regenerative medicine and have become a promising option for cardiac tissue regeneration due to their hydrophilic character and their structural similarity to the extracellular matrix. Herein, a functional ink based on the natural polysaccharides Gellan gum and Konjac glucomannan has, for the first time, been applied in the production of a 3D printed hydrogel with therapeutic potential, with the goal of being locally implanted in the infarcted area of the heart. Overall, results revealed the excellent printability of the bioink for the development of a stable, porous, biocompatible, and bioactive 3D hydrogel, combining the specific advantages of Gellan gum and Konjac glucomannan with proper mechanical properties, which supports the simplification of the implantation process. In addition, the structure have positive effects on endothelial cells' proliferation and migration that can promote the repair of injured cardiac tissue. The results presented will pave the way for simple, low-cost, and efficient cardiac tissue regeneration using a 3D printed hydrogel cardiac patch with potential for clinical application for myocardial infarction treatment in the near future.

Aplicación de la mecánica de fluidos y la simulación: tracto urinario y catéteres ureterales / Application of fluid mechanics and simulation: urinary tract and ureteral catheters

El comportamiento de la orina durante su transporte, desde la pelvis renal hasta la vejiga, tiene un gran interés para los urólogos. El conocimiento de las diferentes variables físicas y su interrelación, en movimientos fisiológicos y patologías, ayudará a un mejor diagnóstico y tratamiento. El objetivo de este capítulo es exponer y acercar al mundo clínico los conceptos físicos y sus relaciones básicas más relevantes en el transporte de orina. Para ello, se explica el movimiento de la orina durante una peristalsis, una obstrucción ureteral y un uréter tutorizado con un catéter ureteral. Esta explicación se basa en dos herramientas muy utilizadas en bioingeniería: el análisis teórico a través de la Teoría de los Medios Continuos y la Mecánica de Fluidos y la simulación computacional que ofrece una solución práctica de cada uno de los escenarios. Además, se repasan otras aportaciones de la bioingeniería al campo de la Urología, como la simulación física o las técnicas de fabricación aditiva y sustractiva. Finalmente, se enumeran las limitaciones actuales de estas herramientas y las líneas de desarrollo tecnológico con más proyección. CONCLUSIÓN: Se pretende que este capítulo ayude a los urólogos a comprender algunos conceptos importantes de bioingeniería, fomentando la colaboración multidisciplinar para ofrecer herramientas complementarias que les ayuden en el diagnóstico y el tratamiento de enfermedades

The mechanics of urine during its transport from the renal pelvis to the bladder is of great interest for urologists. The knowledge of the different physical variables and their interrelationship, both in physiologic movements and pathologies, will help a better diagnosis and treatment. The objective of this chapter is to show the physics principles and their most relevant basic relations in urine transport, and to bring them over the clinical world. For that, we explain the movement of urine during peristalsis, ureteral obstruction and in a ureter with a stent. This explanation is based in two tools used in bioengineering: the theoretical analysis through the Theory of concontinuous media and Ffluid mechanics and computational simulation that offers a practical solution for each scenario. Moreover, we review other contributions of bioengineering to the field of Urology, such as physical simulation or additive and subtractive manufacturing techniques. Finally, we list the current limitations for these tools and the technological development lines with more future projection. CONCLUSIONS: In this chapter we aim to help urologists to understand some important concepts of bioengineering, promoting multidisciplinary cooperation to offer complementary tools that help in diagnosis and treatment of diseases

Approaches towards training in human risk management of surgical technology.

A safe application of modern surgical technology and computer-assisted surgery devices is based on an operation by adequately trained surgeons who are familiar with the benefits and limitations of the devices. We analyzed the in-depth interviews with seven Spanish and 10 German surgeons. Together with other studies, this analysis highlights the need for specific training in technological competence for surgeons. One way to train technological competence is to help surgeons understanding the basic principles of medical devices as well as explaining the basic concepts of risk analysis and risk management. Based on this premise, a stage model for risk assessment was developed and adapted for the training of surgeons. This was developed further into a train the trainer (TTT) concept, which was then evaluated for two example cases. During TTT-training, the trainers (expert surgeons) performed a risk analysis for several medical devices. Afterwards, the trainers organized a surgical workshop for surgical trainees (resident surgeons), in which high-fidelity simulators and the original medical devices were used. The results showed that the surgeons performed the risk analysis correctly with the stage model and afterwards were able to successfully apply the results in the workshop context.

[New technologies in minimally invasive surgery training: what do surgeons demand?]. / Nuevas tecnologías en formación de cirugía de mínima invasión: ¿qué demandan los cirujanos?

BACKGROUND: Minimally invasive surgery might greatly benefit from the Information and Communications Technologies. The objective of this work is to determine the better approach to include those technologies, in particular an e-Learning platform, into an in-person training course. METHODS: An online survey was sent to all participants in any of the laparoscopic training courses at Jesús Usón Minimally Invasive Surgery Centre. This survey included questions regarding new technologies used for training. Once all data were gathered, a descriptive analysis was performed. RESULTS: 382 questionnaires were sent of which 102 were correctly received back. This means a response rate equal to 30%. Current theoretical training means are watching surgical videos (85-83.3%) and assisting to in-person training courses (77-75.5%). Participants rated as useful the use of new technologies for training (4.1 ± 0.9) and they would mainly use it both before and after assisting to an in-person training course (80-78.4%). CONCLUSIONS: It is proposed a methodology that provides participants with didactic resources based on surgical videos, both before and after assisting to an in-person training course. Through the application of this methodology, an improvement and reduction of the time that surgeons expend in training is aimed.

Antecedentes: las tecnologías de la información y comunicación pueden aportar beneficios a la formación en cirugía de mínima invasión. Objetivo: determinar la manera más adecuada de incluir las tecnologías de la información y comunicación, en particular una plataforma de e-Learning, en un programa de formación presencial. Material y métodos: se realizó una encuesta en línea entre los asistentes al Centro de Cirugía de Mínima Invasión Jesús Usón, con preguntas relativas a las nuevas tecnologías aplicadas a la formación. Con los datos recopilados se efectuó un estudio descriptivo. Resultados: se enviaron 382 cuestionarios y se recibieron 102 (30%) correctamente respondidos. Los medios para formación teórica más empleados en la actualidad en la población estudiada son: visualización de videos quirúrgicos (85-83.3%) y la asistencia a cursos (77-75.5%). Los usuarios consideran útiles las nuevas tecnologías en formación (4.1 ± 0.9) y sobre todo usarían una plataforma de e-Learning personalizada antes y después de asistir a un curso de formación presencial (80-78.4%). Conclusiones: se propone una metodología de recursos didácticos basados en videos quirúrgicos antes y después que los alumnos asistan a un curso de formación presencial, para que mediante la aplicación de esta metodología se mejore y optimice el tiempo que los cirujanos dedican a su formación.

Construct and face validity of SINERGIA laparoscopic virtual reality simulator.

PURPOSE: Laparoscopic techniques have nowadays become a gold standard in many surgical procedures, but they imply a more difficult learning skills process. Simulators have a fundamental role in the formative stage of new surgeons. This paper presents the construct and face validity of SINERGIA laparoscopic virtual reality simulator in order to decide whether it can be considered as an assessment tool. METHODS: Twenty people participated in this study, 14 were novices and 6 were experts. Five tasks of SINERGIA were included in the study: coordination, navigation, navigation and touch, precise grasping and coordinate traction. For each one of these tasks, a certain number of metrics are automatically recorded. All subjects accomplished each task only once and filled in two questionnaires. A statistical analysis was made and results from both groups were compared with the Mann-Whitney U-test, considering significant differences when P < or = 0.05. Internal consistency of the system has been analyzed with the Cronbach's alpha test. RESULTS: Novices and experts positively rated SINERGIA characteristics. At least one of the evaluated metrics of each exercise presented significant differences between both groups. Nevertheless, all metrics under study gave a better punctuation to the executions accomplished by experts (lower time, higher efficiency, fewer errors. . .) than to those made by novices. CONCLUSION: SINERGIA laparoscopic virtual reality simulator is able to discriminate subjects according to their level of experience in laparoscopic surgery; therefore, it can be used within a training program as an assessment tool.