Search

The diagnostic uncertainty for children with abdominal pain has increased during the COVID-19 pandemic with the additional consideration of both COVID-19 and paediatric inflammatory multisystem syndrome—temporally associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (PIMS-TS) alongside appendicitis, mesenteric adenitis and other less common causes of abdominal pain. We describe the cases of two children who presented with severe abdominal pain, non-bilious vomiting and high temperatures during the UK's first peak of the COVID-19 pandemic. Laboratory and abdominal ultrasound features were similar for both children but symptom progression in combination with cross-sectional abdominal imaging enabled differentiation between PIMS-TS and appendicitis with concurrent COVID-19. These cases highlight the importance of regular clinical review, multidisciplinary working and the utility of early cross-sectional imaging to determine the underlying condition. [ABSTRACT FROM AUTHOR]

Introduction: Objective performance feedback has potential to maximize the training benefit of laparoscopic simulators. Instrument movement metrics are, however, currently the preserve of complex and expensive systems. We aimed to develop and validate affordable, user-ready software that provides objective feedback by tracking instrument movement in a "take-home" laparoscopic simulator. Materials and Methods: Computer-vision processing tracks the movement of colored bands placed around the distal instrument shafts. The position of each instrument is logged from the simulator camera feed and movement metrics calculated in real time. Ten novices (junior doctors) and 13 general surgery trainees (StR) (training years 3-7) performed a standardized task (threading string through hoops) on the eoSim (eoSurgical™ Ltd., Edinburgh, Scotland, United Kingdom) take-home laparoscopic simulator. Statistical analysis was performed using unpaired t tests with Welch's correction. Results: The software was able to track the instrument tips reliably and effectively. Significant differences between the two groups were observed in time to complete task (StR versus novice, 2 minutes 33 seconds versus 9 minutes 53 seconds; P=.01), total distance traveled by instruments (3.29 m versus 11.38 m, respectively; P=.01), average instrument motion smoothness (0.15 mm/second(3) versus 0.06 mm/second(3), respectively; P<.01), and handedness (mean difference between dominant and nondominant hand) (0.55 m versus 2.43 m, respectively; P=.03). There was no significant difference seen in the distance between instrument tips, acceleration, speed of instruments, or time off-screen. Conclusions: We have developed software that brings objective performance feedback to the portable laparoscopic box simulator. Construct validity has been demonstrated. Removing the need for additional motion-tracking hardware makes it affordable and accessible. It is user-ready and has the potential to enhance the training benefit of portable simulators both in the workplace and at home. [ABSTRACT FROM AUTHOR]

Introduction: Objective performance feedback has potential to maximize the training benefit of laparoscopic simulators. Instrument movement metrics are, however, currently the preserve of complex and expensive systems. We aimed to develop and validate affordable, user-ready software that provides objective feedback by tracking instrument movement in a 'take-home' laparoscopic simulator. Materials and Methods: Computer-vision processing tracks the movement of colored bands placed around the distal instrument shafts. The position of each instrument is logged from the simulator camera feed and movement metrics calculated in real time. Ten novices (junior doctors) and 13 general surgery trainees (StR) (training years 3-7) performed a standardized task (threading string through hoops) on the eoSim (eoSurgical™ Ltd., Edinburgh, Scotland, United Kingdom) take-home laparoscopic simulator. Statistical analysis was performed using unpaired t tests with Welch's correction. Results: The software was able to track the instrument tips reliably and effectively. Significant differences between the two groups were observed in time to complete task (StR versus novice, 2 minutes 33 seconds versus 9 minutes 53 seconds; P=.01), total distance traveled by instruments (3.29 m versus 11.38 m, respectively; P=.01), average instrument motion smoothness (0.15 mm/second3 versus 0.06 mm/second3, respectively; P<.01), and handedness (mean difference between dominant and nondominant hand) (0.55 m versus 2.43 m, respectively; P=.03). There was no significant difference seen in the distance between instrument tips, acceleration, speed of instruments, or time off-screen. Conclusions: We have developed software that brings objective performance feedback to the portable laparoscopic box simulator. Construct validity has been demonstrated. Removing the need for additional motion-tracking hardware makes it affordable and accessible. It is user-ready and has the potential to enhance the training benefit of portable simulators both in the workplace and at home. [ABSTRACT FROM AUTHOR]

Aim: To quantitatively determine whether a three-dimensional (3D) image improves laparoscopic performance compared with a two-dimensional (2D) image.Method: This is a prospective study with two groups of participants: novices (5) and experts (5). Individuals within each group undertook a validated laparoscopic task on a box simulator, alternating between 2D and a 3D laparoscopic image until they had repeated the task five times with each imaging modality. A dedicated motion capture camera was used to determine the time taken to complete the task (seconds) and instrument distance traveled (meters).Results: Among the experts, the mean time taken to perform the task on the 3D image was significantly quicker than on the 2D image, 40.2 seconds versus 51.2 seconds, P < .0001. Among the novices, the mean task time again was significantly quicker on the 3D image, 56.4 seconds versus 82.7 seconds, P < .0001. There was no significant difference in the mean time it took a novice to perform the task using a 3D camera compared with an expert on a 2D camera, 56.4 seconds versus 51.3 seconds, P = .3341.Conclusion: The use of a 3D image confers a significant performance advantage over a 2D camera in quantitatively measured laparoscopic skills for both experts and novices. The use of a 3D image appears to improve a novice's performance to the extent that it is not statistically different from an expert using a 2D image. [ABSTRACT FROM AUTHOR]

The development of the microscope in 1590 by Zacharias Janssenby and Hans Lippershey gave the world a new way of visualizing details of morphogenesis and development. More recent improvements in this technology including confocal microscopy, scanning electron microscopy (SEM) and Optical Projection Tomography (OPT) have enhanced the quality of the resultant image. These technologies also allow a representation to be made of a developing tissue's three-dimensional (3-D) form. With all these techniques however, the image is delivered on a flat two-dimensional (2-D) screen. 3-D printing represents an exciting potential to reproduce the image not simply on a flat screen, but in a physical, palpable three-dimensional structure. Here we explore the scope that this holds for exploring and interacting with the structure of a developing organ in an entirely novel way. As well as being useful for visualization, 3-D printers are capable of rapidly and Do not d cost-effectively producing custom-made structures for use within the laboratory. We here describe the advantages of producing hardware for a tissue culture system using an inexpensive in-lab printer. [ABSTRACT FROM AUTHOR]

Background: Surgical training emphasizes technical competence. Growing evidence indicates that nontechnical skills are also significant in determining performance. Critically, surgeons should be aware how performance is affected by pressure or distraction. We assessed the impact of novel auditory and visual stressors on performance during a simulated laparoscopic task. We hypothesized that the stressors would worsen performance, and that stress-induced diminution in performance would be inversely related to surgical experience. Methods: Twenty participants (10 surgeons and 10 medical students) completed a peg-threading task using a laparoscopic simulator: three times under control conditions, next with a visual distraction overlay (progressive red saturation of the surgical field, timing personalized to the user's index performance), and then with an auditory distraction overlay (operating theater environment noise). Task completion time and instrument tracking metrics (instrument tip distance traveled and instrument smoothness) were measured. Results: Under control conditions, surgeons completed the task significantly faster, with greater economy of movement, and improved instrument smoothness-compared with students. When exposed to distracting stimuli, the groups behaved differently. Surgeons completed the task more slowly, instrument movements became less smooth (significantly so under audio distraction conditions), but total distance traveled by instruments was unchanged. By contrast, student performance was not impaired and, in some ways, improved. Conclusion: The impact of visual and auditory distraction on surgical performance can be modeled in a laparoscopic simulation environment. The effect of distraction varies according to expertise. This environment may be an effective setting within which to learn to mitigate stress-induced diminution in performance. [ABSTRACT FROM AUTHOR]

Background: Both tissue hypoxia in vitro, and whole-body hypoxia in vivo, have been found to promote the release of reactive oxygen species (ROS) that are potentially damaging to the cardiovascular system. Antioxidant systems protect against oxidative damage by ROS and may exhibit some degree of responsiveness to oxidative stimuli. Production of urate, a potent soluble antioxidant, is increased in hypoxic conditions. We aimed to determine whether urate is an important antioxidant defense in healthy subjects exposed to hypoxia. Methods: We conducted a cohort study of 25 healthy lowland volunteers during acute exposure to high altitude (4 days at 3,600 m, followed by 10 days at 5,200 m) on the Apex high-altitude research expedition to Bolivia. We measured markers of oxidative stress (8-isoprostane F2), serum urate concentration, and total plasma antioxidant activity by two techniques: 2,2'-amino-di-[3-ethylbenzthiazole sulfonate] spectrophotometry (total antioxidant status [TAS]) and enhanced chemiluminescence (ECL). Results: On ascent, F2-isoprostane levels were significantly elevated compared with those at sea level (p < 0.01). After 1 week at high altitude, plasma antioxidant capacity (AOC) by both TAS and ECL, and serum urate concentration were significantly elevated (each p < 0.01 vs sea level), and F2-isoprostane levels were reduced to values at sea level. There was a highly significant correlation between plasma urate and AOC at this stage (ECL, r(2) = 0.59, p = 0.0001; TAS, r(2) = 0.30, p = 0.0062). Conclusions: Our results support the hypothesis that urate may act as a responsive endogenous antioxidant in high-altitude hypoxia. [ABSTRACT FROM AUTHOR]