Evolving robotic surgery training and improving patient safety, with the integration of novel technologies

INTRODUCTION: Robot-assisted surgery is becoming increasingly adopted by multiple surgical specialties. There is evidence of inherent risks of utilising new technologies that are unfamiliar early in the learning curve. The development of standardised and validated training programmes is crucial to deliver safe introduction. In this review, we aim to evaluate the current evidence and opportunities to integrate novel technologies into modern digitalised robotic training curricula. METHODS: A systematic literature review of the current evidence for novel technologies in surgical training was conducted online and relevant publications and information were identified. Evaluation was made on how these technologies could further enable digitalisation of training. RESULTS: Overall, the quality of available studies was found to be low with current available evidence consisting largely of expert opinion, consensus statements and small qualitative studies. The review identified that there are several novel technologies already being utilised in robotic surgery training. There is also a trend towards standardised validated robotic training curricula. Currently, the majority of the validated curricula do not incorporate novel technologies and training is delivered with more traditional methods that includes centralisation of training services with wet laboratories that have access to cadavers and dedicated training robots. CONCLUSIONS: Improvements to training standards and understanding performance data have good potential to significantly lower complications in patients. Digitalisation automates data collection and brings data together for analysis. Machine learning has potential to develop automated performance feedback for trainees. Digitalised training aims to build on the current gold standards and to further improve the 'continuum of training' by integrating PBP training, 3D-printed models, telementoring, telemetry and machine learning

Effect of Hydrated Lime on the Properties of Roller Compacted Concrete

Roller compacted concrete (RCC) is a concrete of no slump, no reinforcement, no finishing, and compacted using vibratory roller. When compared with conventional concrete, it contains less water content when compared to traditional concrete. The RCC technique achieves significant time and cost savings during the construction of concrete. This study demonstrates the preparation of RCC slab of (38 ×38× 10) cm samples by using roller compactor which is manufactured in local markets. The Hydrated lime additive is used to study the mechanical and physical properties of that RCC slab samples. This investigation is divided into two main stages: The First stage consists of hammer compaction method with two gradation of aggregate, dense and gap graded aggregate, using five percentages of cement content (10, 12, 14, 16, and 18) as a percentage of the total aggregate content. This stage is carried out for selecting the maximum dry density, optimum moisture content, and optimum cement content which is utilized in RCC slab samples construction, a total of 49 cylinder samples sized (10 cm diameter and 11.6 cm high) are prepared. The Second stage is classified into two sub stages; the first one consists of constructing RCC slab samples using roller compaction, 12% cement as a percentage of total aggregate weight has been used according to the data obtained from first stage, this group presents reference mixes without additives. While the second sub stage presents RCC mix with hydrated lime additive and with the same gradation of mixes compact by hammer compaction method, hydrated lime was implemented as (5, 10, 12, and 15) percentage as a partial replacement of cement content. Both of physical and mechanical properties of RCC are studied using cores, sawed cubes, and sawed beams obtained from RCC slab samples. The properties studied were porosity, absorption, and compressive strength, splitting tensile strength and flexural strength by using third point loading method. The results show that hydrated lime improved the overall properties of RCC as compared to reference mix. Mixes with 5% lime give the optimum values for most of strength properties. Dense graded mixes with hydrated lime show superior properties as compared to gap graded mixes

Effects of primary stored energy on relaxation behavior of high entropy bulk metallic glasses under compressive elastostatic loading

This paper aims to show the effects of primary stored energy in high entropy bulk metallic glasses (HE-BMGs) on their relaxation behavior after elastostatic loading process. For this purpose, three HE-BMGs with different chemical compositions and primary stored energy were fabricate

RoboCup 2D Soccer Simulation League: Evaluation Challenges

We summarise the results of RoboCup 2D Soccer Simulation League in 2016 (Leipzig), including the main competition and the evaluation round. The evaluation round held in Leipzig confirmed the strength of RoboCup-2015 champion (WrightEagle, i.e. WE2015) in the League, with only eventual finalists of 2016 competition capable of defeating WE2015. An extended, post-Leipzig, round-robin tournament which included the top 8 teams of 2016, as well as WE2015, with over 1000 games played for each pair, placed WE2015 third behind the champion team (Gliders2016) and the runner-up (HELIOS2016). This establishes WE2015 as a stable benchmark for the 2D Simulation League. We then contrast two ranking methods and suggest two options for future evaluation challenges. The first one, "The Champions Simulation League", is proposed to include 6 previous champions, directly competing against each other in a round-robin tournament, with the view to systematically trace the advancements in the League. The second proposal, "The Global Challenge", is aimed to increase the realism of the environmental conditions during the simulated games, by simulating specific features of different participating countries.Comment: 12 pages, RoboCup-2017, Nagoya, Japan, July 201

Whose values count? A review of the nature valuation studies with a focus on justice

The Values Assessment of the Intergovernmental Science-Policy Platform on Biodiversity and Ecosystem Services shows that multiple valuation methods and approaches exist to assess diverse value types. The evidence is based on the largest review of academic valuation studies on nature to date, developed for the Values Assessment of the Intergovernmental Science-Policy Platform on Biodiversity and Ecosystem Services (IPBES). We evaluate studies according to environmental justice criteria. The results suggest that although diverse value types and indicators are assessed across studies, few individual studies are plural, and studies fail to provide evidence on distributive justice and score low on procedural justice indicators. We provide a set of recommendations for incorporating issues of justice in the design of valuation studies

Deciphering the therapeutic potential of trimetazidine in rheumatoid arthritis via targeting mi-RNA128a, TLR4 signaling pathway, and adenosine-induced FADD-microvesicular shedding: In vivo and in silico study

Rheumatoid arthritis (RA) is a debilitating autoimmune condition characterized by chronic synovitis, joint damage, and inflammation, leading to impaired joint functionality. Existing RA treatments, although effective to some extent, are not without side effects, prompting a search for more potent therapies. Recent research has revealed the critical role of FAS-associated death domain protein (FADD) microvesicular shedding in RA pathogenesis, expanding its scope beyond apoptosis to include inflammatory and immune pathways. This study aimed to investigate the intricate relationship between mi-RNA 128a, autoimmune and inflammatory pathways, and adenosine levels in modulating FADD expression and microvesicular shedding in a Freund’s complete adjuvant (FCA) induced RA rat model and further explore the antirheumatoid potency of trimetazidine (TMZ). The FCA treated model exhibited significantly elevated levels of serum fibrogenic, inflammatory, immunological and rheumatological diagnostic markers, confirming successful RA induction. Our results revealed that the FCA-induced RA model showed a significant reduction in the expression of FADD in paw tissue and increased microvesicular FADD shedding in synovial fluid, which was attributed to the significant increase in the expression of the epigenetic miRNA 128a gene in addition to the downregulation of adenosine levels. These findings were further supported by the significant activation of the TLR4/MYD88 pathway and its downstream inflammatory IkB/NFB markers. Interestingly, TMZ administration significantly improved, with a potency similar to methotrexate (MTX), the deterioration effect of FCA treatment, as evidenced by a significant attenuation of fibrogenic, inflammatory, immunological, and rheumatological markers. Our investigations indicated that TMZ uniquely acted by targeting epigenetic miRNA128a expression and elevating adenosine levels in paw tissue, leading to increased expression of FADD of paw tissue and mitigated FADD microvesicular shedding in synovial fluid. Furthermore, the group treated with TMZ showed significant downregulation of TLR4/MYD88 and their downstream TRAF6, IRAK and NF-kB. Together, our study unveils the significant potential of TMZ as an antirheumatoid candidate, offering anti-inflammatory effects through various mechanisms, including modulation of the FADD-epigenetic regulator mi-RNA 128a, adenosine levels, and the TLR4 signaling pathway in joint tissue, but also attenuation of FADD microvesicular shedding in synovial fluid. These findings further highlight the synergistic administration of TMZ and MTX as a potential approach to reduce adverse effects of MTX while improving therapeutic efficacy.Peer Reviewe

The effects of progesterone administration in mice during pregnancy on ovarian development and anogenital distance of the offspring

Background: Progesterone is highly used in pregnant women as therapeutic agent to maintain and support pregnancy. Objective: To explore the effects of progesterone usage allover gestation till 7days postnatally on mice offspring ovaries development and anogenital distance. Material and methods: Ten pregnant mice were equally divide into control group that was injected with sesame oil which is used as a solvent for progesterone and treated group that is daily intraperitoneally injected with progesterone (dissolved in sesame oil 1:10) at dose 10.2mg/kg (the equivalent human dose) all through gestation till7day postnatal then sacrificed and measuring the anogenital distance (the distance between anus and genital papilla). Histological slides were prepared and Diameters of the ovary, primary oocyte and primordial follicles were measured and histopathological changes analysis was done. Result: Progesterone administration cause significant increment (p>0-05) in anogenital distance, significant decrement in primary oocyte diameter and primordial follicle diameter, with no significant difference in the ovary diameter. Histopathological changes were seen as hemorrhage, detachment of follicular cells from basement membrane with irregular arrangement and thickening or death of follicular cells, pyknosis of primary oocytes and vacculation. Stromal cells degeneration. Conclusion: The current study revealed that progesterone injection of mice with equivalent human dose during pregnancy is embryotoxic and teratogenic, may alter the female reproductive performance with virilizing the female genitalia. The benefit of progesterone as a therapies need to be proven before recommended as supportive treatment during pregnancy

Primary antibody deficiency in a tertiary referral hospital: A 30-year experiment

Background: Primary antibody deficiency (PAD) is the most common group of primary immunodeficiency disorders (PID), with a broad spectrum of clinical features ranging from severe and recurrent infections to asymptomatic disease. Objectives: The current study was performed to evaluate and compare demographic and clinical data in the most common types of PAD. Materials and Methods: We performed a retrospective review of the medical records of all PAD patients with a confirmed diagnosis of common variable immunodeficiency (CVID), hyper IgM syndrome (HIgM), selective IgA deficiency (SIgAD), and X-linked agammaglobulinemia (XLA) who were diagnosed during the last 30 years at the Children�s Medical Center, Tehran, Iran. Results: A total number of 280 cases of PAD (125 CVID, 32 HIgM, 63 SIgAD, and 60 XLA) were enrolled in the study. The median (range) age at the onset of disease in CVID, HIgM, SIgAD, and XLA was 2 (0-46), 0.91 (0-9), 1 (0-26), and 1 (0-10) years, respectively. Gastrointestinal infections were more prevalent in CVID patients, as were central nervous system infections in XLA patients. Autoimmune complications were more prevalent in HIgM patients, malignancies in CVID patients, and allergies in SIgAD patients. The mortality rate for CVID, HIgM, and XLA was 27.2, 28.1, and 25, respectively. No deaths were reported in SIgAD patients. Conclusions: SIgAD patients had the best prognosis. While all PAD patients should be monitored for infectious complications, special attention should be paid to the finding of malignancy and autoimmune disorders in CVID and HIgM patients, respectively. © 2015 Esmon Publicidad