No abstract

By identifying the limitations imposed by aging, critical care problems in elderly patients can be anticipated and addressed, and surgical outcomes can be improved.

This research effort compared and contrasted two conceptually different methods for the exploration of human anatomy in the first-year dissection laboratory by accomplished students: "physical" dissection using an embalmed cadaver and "digital" dissection using three-dimensional volume modeling of whole-body CT and MRI image sets acquired using the same cadaver. The goal was to understand the relative contributions each method makes toward student acquisition of intuitive sense of practical anatomical knowledge gained during "hands-on" structural exploration tasks. The main instruments for measuring anatomical knowledge under this conceptual model were questions generated using a classification system designed to assess both visual presentation manner and the corresponding response information required. Students were randomly divided into groups based on exploration method (physical or digital dissection) and then anatomical region. The physical dissectors proceeded with their direct methods, whereas the digital dissectors generated and manipulated indirect 3D digital models. After 6 weeks, corresponding student anatomical assignment teams compared their results using photography and animated digital visualizations. Finally, to see whether each method provided unique advantages, a visual test protocol of new visualizations based on the classification schema was administered. Results indicated that all students, regardless of gender, dissection method, and anatomical region dissected performed significantly better on questions presented as rotating models requiring spatial ordering or viewpoint determination responses in contrast to requests for specific lexical feature identifications. Additional results provided evidence of trends showing significant differences in gender and dissection method scores. These trends will be explored with further trials with larger populations.

No abstract

On the basis of this large case series, the laparoscopic nonslit mesh technique for the repair of parastomal hernias seems to be a promising approach for the reduction of hernia recurrence in experienced hands.

Introduction Laparoscopic Roux-en-Y Gastric Bypass (LRYGB) has become the gold standard for surgical weight loss. The success of LRYGB may be measured by excess body-mass index loss (%EBMIL) over 25 kg/m2, which is partially determined by multiple patient factors. In this study, artificial neural network (ANN) modeling was used to derive a reasonable estimate of expected postoperative weight loss using only known preoperative patient variables. Additionally, ANN modeling allowed for the discriminant prediction of achievement of benchmark 50% EBMIL at one year postoperatively. Methods Six-hundred and forty-seven LRYGB included patients were retrospectively reviewed for preoperative factors independently associated with EBMIL at 180 and 365 days postoperatively (EBMIL180 and EBMIL365, respectively). Previously validated factors were selectively analyzed, including age; race; gender; preoperative BMI (BMI0); hemoglobin; and diagnoses of hypertension (HTN), diabetes mellitus (DM), and depression or anxiety disorder. Variables significant upon multivariate analysis (P<.05) were modeled by “traditional” multiple linear regression and an ANN, to predict %EBMIL180 and %EBMIL365. Results The mean EBMIL180 and EBMIL365 were 56.4%±16.5% and 73.5%±21.5%, corresponding to total body weight losses of 25.7%±5.9% and 33.6%±8.0%, respectively. Upon multivariate analysis, independent factors associated with EBMIL180 included black race (B=−6.3%, P<.001), BMI0 (B=−1.1%/unit BMI, P<.001) and DM (B=−3.2%, P<.004). For EBMIL365, independently associated factors were female gender (B=6.4%, P<.001), black race (B=−6.7%, P<.001), BMI0 (B=−1.2%/unit BMI, P<.001), HTN (B=−3.7%, P=.03) and DM (B=−6.0%, P<.001). Pearson r2 values for the multiple linear regression and ANN models were .38 (EBMIL180) and .35 (EBMIL365), and .42 (EBMIL180) and .38 (EBMIL365), respectively. ANN-prediction of benchmark 50% EBMIL at 365 days generated an area under the curve of 0.78±0.03 in the training set (n=518), and 0.83±0.04 (n=129) in the validation set. Conclusions Available at https://redcap.vanderbilt.edu/surveys/?s=3HCR43AKXR, this, or other ANN models may be used to provide an optimized estimate of postoperative EBMIL following LRYGB.

The authors proposed and developed live AR, a new surgical visualization approach that merges rich surface detail from a laparoscope with instantaneous 3D anatomy from continuous CT scanning of the surgical field. Through innovative use of deformable image registration, they also demonstrated the feasibility of continuous visualization of the vasculature and considerable X-ray dose reduction. This study provides motivation for further investigation and development of live AR.

The outcomes of medical treatment of stricturing or penetrating CD are poor, as 64% ultimately require surgery. Important factors that seem to be associated with either failed therapy include ileocolonic or colonic disease location. We report a high rate of IASC, especially in patients with penetrating disease and those treated with biologic therapy. This should be considered prior to attempted medical therapy.