Safe total intrafascial laparoscopic (TAIL™) hysterectomy: a prospective cohort study

This study directly compares total intrafascial laparoscopic (TAIL™) hysterectomy with vaginal (VH) and abdominal (AH) hysterectomy with regard to safety, operating time and time of convalescence. The study is a prospective cohort study (Canadian Task Force classification II-2), including data from patients of a single university-affiliated teaching institution, admitted between 1997 and 2008 for hysterectomy due to benign uterus pathology. Patient data were collected pre-, intra- and postoperatively and complications documented using a standardised data sheet of a Swiss obstetric and gynaecological study group (Arbeitsgemeinschaft Schweizerische Frauenkliniken, Amlikon/Switzerland). Classification of complications (major complications and minor complications) for all three operation techniques, evaluation of surgeons and comparison of operation times and days of hospitalisation were analysed. 3066 patients were included in this study. 993 patients underwent AH, 642 VH and 1,431 total intrafascial hysterectomy. No statistically significant difference for the operation times comparing the three groups can be demonstrated. The mean hospital stay in the TAIL™ hysterectomy, VH and AH groups is 5.8 ± 2.4, 8.8 ± 4.0 and 10.4 ± 3.9 days, respectively. The postoperative minor complications including infection rates are low in the TAIL™ hysterectomy group (3.8%) when compared with either the AH group (15.3%) or the VH group (11.2%), respectively. The total of minor complications is statistically significant lower for TAIL™ hysterectomy as for AH (O.R. 4.52, CI 3.25–6.31) or VH (O.R. 3.16, CI 2.16–4.62). Major haemorrhage with consecutive reoperation is observed statistically significantly more frequent in the AH group when compared to the TAIL™ hysterectomy group, with an O.R. of 6.13 (CI 3.05–12.62). Overall, major intra- and postoperative complications occur significant more frequently in the AH group (8.6%) when compared to the VH group (3%) and the TAIL™ hysterectomy group (1.8%). The incidence of major complications applying the standardised TAIL™ hysterectomy technique is not related to the experience of the surgeons. We conclude that a standardised intrafascial technique of total laparoscopic (TAIL™) hysterectomy using an anatomically developed special uterine device is associated with a very low incidence of minor and major intra- and postoperative complications. The direct comparison of complication rates with either vaginal or abdominal hysterectomy favours the total laparoscopic technique, and therefore, this technique can be recommended as a relatively atraumatic procedure. The operation times are comparable for all three techniques without any statistically significant differences. This technique for laparoscopic hysterectomy is shown to be equally safe when applied by experienced gynaecologic surgeons or by residents in training

Sensual Technologies: Embodied experience and visualisation of scientific data

''Sometimes I think; and sometimes I am.'' Paul Valéry In this text I set out to discuss the relationship between a selection of four works which bring together the sciences, natural processes, the body and sensorial perception. These works are, Ned Kahn’s ‘Seismic Sea’, Luke Jerram’s ‘Tide’, Hugo Kükelhaus ‘Strudel, Wirbel, Spirale’ and Antenna Theater’s ‘Sands of Time’. These works blur boundaries as it is difficult to categories them. They could be seen in science centres visualising scientific principles, in art exhibitions for their aesthetic qualities or possibly function as types of scientific instruments in their own right. They have in common that they use natural processes or environments as a medium of visualisation or as an interface for action and reflection. Within each work the human body plays an essential role in stimulating the imagination through aesthetic experience. These particular examples have been selected for their usefulness to discuss the potentially transformative role of bodily experience in works that emerge from art and science collaborations. The text aims to show a genre of evocative works that not so much depend on technology than on investigations into phenomenology and contemporary research into neuro-plasticity. Their primary goal though is not to create new knowledge but to make curious and to delight. A critical reflection as a result of curiosity may follow later

Post-infarction cardiac remodeling-differential biomarkers for left atrial and left ventricular remodeling

(...

Optimizing RNA Extraction from Fungal-Algal Tissues for Transcriptomic Gene Expression Analysis

Extracting high-quality RNA is critical for downstream applications such a qRT-PCR and RNA-Seq based transcriptomics. Single-stranded RNA is readily susceptible to degradation by environmental RNases, necessitating rapid and sterile homogenization techniques; freezing at -80°C, lysis buffer addition, and short bursts of beadbeating have been shown to increase yields and quality of extracted RNA. Utilizing fungal-algal tissues from the model symbiosis between the filamentous fungi Aspergillus nidulans and the green alga Chlamydomonas reinhardtii, three different commercial homogenizers and six RNA extractions kits were assessed and an optimized extraction protocol for total RNA from fungal-algal tissues was determined. Using the protocol designed in this study, the relationship between Chlamydomonas reinhardtii and the budding yeast Saccharomyces cerevisiae when grown under circadian-based light conditions prior to co-culturing will be assessed using RNA-Seq to determine changes gene expression patterns in response to co-culturing under a new light condition to look for synchrony. A phenotypic study of this system was performed and while no significant differences in biomass were observed, it is believed that with the fungus Neurospora crassa, a model organism for studying circadian rhythms, a light regimen-dependent phenotypic resonse will be observed

Modelling of a triage scoring tool for SARS-COV-2 PCR testing in health-care workers: data from the first German COVID-19 Testing Unit in Munich

Background Numerous scoring tools have been developed for assessing the probability of SARS-COV-2 test positivity, though few being suitable or adapted for outpatient triage of health care workers. Methods We retrospectively analysed 3069 patient records of health care workers admitted to the COVID-19 Testing Unit of the Ludwig-Maximilians-Universität of Munich between January 27 and September 30, 2020, for real-time polymerase chain reaction analysis of naso- or oropharyngeal swabs. Variables for a multivariable logistic regression model were collected from self-completed case report forms and selected through stepwise backward selection. Internal validation was conducted by bootstrapping. We then created a weighted point-scoring system from logistic regression coefficients. Results 4076 (97.12%) negative and 121 (2.88%) positive test results were analysed. The majority were young (mean age: 38.0), female (69.8%) and asymptomatic (67.8%). Characteristics that correlated with PCR-positivity included close-contact professions (physicians, nurses, physiotherapists), flu-like symptoms (e.g., fever, rhinorrhoea, headache), abdominal symptoms (nausea/emesis, abdominal pain, diarrhoea), less days since symptom onset, and contact to a SARS-COV-2 positive index-case. Variables selected for the final model included symptoms (fever, cough, abdominal pain, anosmia/ageusia) and exposures (to SARS-COV-positive individuals and, specifically, to positive patients). Internal validation by bootstrapping yielded a corrected Area Under the Receiver Operating Characteristics Curve of 76.43%. We present sensitivity and specificity at different prediction cut-off points. In a subgroup with further workup, asthma seems to have a protective effect with regard to testing result positivity and measured temperature was found to be less predictive than anamnestic fever. Conclusions We consider low threshold testing for health care workers a valuable strategy for infection control and are able to provide an easily applicable triage score for the assessment of the probability of infection in health care workers in case of resource scarcity

Confidence and doubt in doctoral research: The temptation of certainty

Many aspects of doctoral supervision are well known from methods and methodology to research questions, philosophies and epistemologies. A core aspect that is touched upon less frequently yet is central to the lived experience of the researcher (and that is essential for rigour and trust occupying a significant amount of cognitive effort) is confidence and doubt. The use of confidence and doubt to drive research is a daily experience for the researcher yet the practice and challenges are infrequently addressed directly in doctoral environments. Confidence can be essential as a driver when researchers with strong convictions lack complete arguments to justify actions based on experiential, innate or purely intuitive motivations. Doubt can act as a valuable aid to personal critique and can mitigate the excesses of over-confidence. Overconfidence can blind a researcher to critical flaws whereas excessive doubt can destroy promising findings and innovations before they are proven. The authors explore how the initial worries and concerns from novice researchers about reliability and rigour transform into an exchange between confidence and doubt which become central generators balancing critique, risk, experimentation, and honesty. We review a wide range of diverse theories and concepts exploring different perspectives with a view to supporting those building research careers with positions from which to gather insight to strengthen their practices. Particular value can be gained from the decision-making routes that can follow from a better understanding of what underpins the drive for certainty

Exceptionally preserved early Cambrian bilaterian developmental stages from Mongolia

Fossilized invertebrate embryonic and later developmental stages are rare and restricted largely to the Ediacaran-Cambrian, providing direct insight into development during the emergence of animal bodyplans. Here we report a new assemblage of eggs, embryos and bilaterian post-embryonic developmental stages from the early Cambrian Salanygol Formation of Dzhabkan Microcontinent of Mongolia. The post-embryonic developmental stages of the bilaterian are preserved with cellular fidelity, possessing a series of bilaterally arranged ridges that compare to co-occurring camenellan sclerites in which the initial growth stages retain the cellular morphology of modified juveniles. In this work we identify these fossils as early post-embryonic developmental stages of camenellans, an early clade of stem-brachiopods, known previously only from isolated sclerites. This interpretation corroborates previous reconstructions of camenellan scleritomes with sclerites arranged in medial and peripheral concentric zones. It further supports the conjecture that molluscs and brachiopods are descended from an ancestral vermiform and slug-like bodyplan. The Cambrian is known as a period of rapid animal diversification, but the development of these animals is not well characterized. Here, Steiner et al. describe a new assemblage of Cambrian eggs, embryos and early postembryonic stages from Mongolia that provides insight into ancient bilaterian development and evolution

Successful remission of extensive liver metastases in a breast cancer patient with acute liver failure using a combined chemotherapy regimen with mitomycin, folinate, and 5-fluorouracil (Mi/Fo/FU)

Liver failure due to disseminated hepatic secondaries represents a therapeutic dilemma in patients with metastatic breast cancer (MBC). Reduced liver function and non-assessable toxicity are limiting factors in the selection of chemotherapeutic agents. Currently, there is no standard treatment after failure of anthracycline-and taxane-based first-line therapies, although there is a variety of well evaluated drugs such as capecitabine