Virtual reality simulation based training for endoscopy and laparoscopic surgery

Catedra Chirurgie nr.1 „N.Anestiadi”, Centrul Universitar de Simulare în Instruirea Medicală, USMF „Nicolae Testemiţanu”, Chişinău, Republica Moldova, Al XII-lea Congres al Asociației Chirurgilor „Nicolae Anestiadi” din Republica Moldova cu participare internațională 23-25 septembrie 2015Introducere: Centrul Universitar de Simulare în Instruirea Medicală (CUSIM) a fost creat cu scop de a spori siguranţa pacienţilor prin utilizarea instruirii prin simulare, a dezvolta noi modalităţi de instruire, a identifica cele mai bune practici şi a încuraja cercetarea şi colaborarea interdepartamentală şi interdisciplinară. Material şi metode: CUSIM este dotat cu 2 simulatoare cu realitate virtuală pentru chirurgia laparoscopică şi un simulator pentru bronhoscopie, endoscopie superioară şi inferioară. Curricula de instruire prin simulare este concepută să satisfacă necesităţile rezidenţilor şi specialiştilor indiferent de nivelul de competenţe şi facilitează obţinerea abilităţilor endoscopice şi de chirurgie laparoscopică pe parcursul rezidenţiatului şi a educaţiei medicale continue. Rezultate: Modulele incluse începînd cu abilităţile de bază şi esenţiale, continuînd apoi cu mediu anatomic complet pentru diverse intervenţii laparoscopice oferă obţinerea într-un mediu sigur a abilităţilor tehnice care pot fi transferate în sala de operaţii. Modulele de endoscopie includ atît procedee diagnostice, cît şi terapeutice pentru o gamă vastă de patologii. Rezultatele instruirii pot fi evaluate prin diferite categorii: economia mişcărilor; timpul de efectuare; ratele de erori şi scorul global al progresului. Concluzii: Instruirea prin simulare poate conduce la îmbunătăţire demonstrabilă a abilităţilor chirurgicale în condiţii clinice şi sala de operaţie. Feedback-ul obţinut sugerează că instruirea prin simulare reprezintă o modalitate sigură de învăţare a competenţelor practice endoscopice şi chirurgicale, de transfer al abilităţilor chirurgicale laparoscopice în sala de operaţ ie şi în final sporirea siguranţei pacienţilor; totuşi, sunt necesare studii ulterioare extinse pentru a determina dacă şi în ce mod simularea poate deveni o parte a curriculei chirurgicale.Introduction: University Center for Simulation in Medical Training was created to promote patient safety through the use of simulation, develop new education technologies, identify best practices, and encourage research and interdepartmental and interdisciplinary collaboration. Material and methods: University Center for Simulation in Medical Training is equipped with 2 virtual reality simulators for laparoscopic surgery and a simulator for bronchoscopy, upper and lower endoscopy. The simulation-based training curricula are designed to fit the needs of residents and specialists of any level of competence and facilitate the acquisition of endoscopic and laparoscopic surgery skills during residency and continuing medical education programs. Results: The included modules starting from basic and essential skills and going through complete anatomical settings of different laparoscopic interventions offer the acquisition of technical skills in a safe setting which could be translatable to the operating room (OR). The endoscopy modules include both diagnostic and therapeutic options for a variety of pathologies. The learning outcomes can be measured in different behavioral categories: economy of movement; performance time; error rates, and global progress rating. Conclusions: Simulation-based training can lead to demonstrable benefits of surgical skills in the OR environment and clinical settings. The received feedback suggests that simulation-based training is an effective way to teach endoscopy and laparoscopic surgery skills, increase translation of laparoscopic surgery skills to the OR, and increase patient safety; however, more research should be conducted to determine if and how simulation can become a part of surgical curriculum

Toward main chain metallo-terpyridyl supramolecular polymers: "The metal does the trick"

Metallo-supramolecular chemistry offers possibilities for the construction of stimuli-responsive polymeric materials where the environment can have a large impact on the reversibility and strength of interactions between the individual components. The potential of manipulating the strength of the intermolecular non-covalent bonds can result in impressive modifications of the metallo-supramolecular structure and, subsequently, produces changes in the properties of the designed material. The present feature article provides an overview on recent developments in the field of metallo-polymerization of chelating terpyridyl and analogues ligands. Synthetic strategies are described followed by a discussion regarding the characterization and the application of the reviewed metallo-supramolecular structures, mainly based on terpyridines

USE OF STAINLESS STEEL SLIP-RESISTANT CONNECTIONS in the renewal of the ventilated walls of the New Research Center at the Polytechnic Citadel

Different approaches, construction systems and use for two case studies that share the same ambition and nature of being prestigious projects, asked to become key elements in the urban texture, in which the facades play a key role to ensure reaching aesthetic and performance objectives. Manhattan Center is a refurbishment project which takes us through the various phases of a façade project, from the concept of façade systems and identification of performance requirements to the most advanced steps related to the detailed design, the realization and then mock-up and testing, construction and installation. Brighton University offers an example of façades made using dry construction technology with a strong prefabrication requirement applied to a complex of tall buildings characterized by a complex geometry. Architectural requirements, such as chromatic variations along the vertical elevation of the building and the need to use traditional materials such as clay and terracotta, determine specific construction solutions that are also dictated by the ability of the market to respond to these personalized requests

DESIGN ASSISTED BY LABORATORY TESTS OF STAINLESS STEEL STRUCTURES

The purpose of this work is to analyse how the concept of “design assisted by testing” has been applied to the re-functionalize plan of the façade’s stone cladding of the GMPT-E building, belong-ing to the Cittadella Politecnica, situated in Corso Castelfidardo n.36 in Turin. The construction of a new supporting substructure in stainless steel has been planned for the stone cladding in Balmoral red granite slabs. The proposal of this new structure is linked to the need to find a solution for the problem related to the imperfect flatness of the fixing surface. This type of coating, in fact, provides a very low tolerance, as the desired final effect is that of a perfectly flat granite surface. For this purpose, for the construction of the steel structure, slip-resistant connec-tions with slotted holes have been adopted and subjected to laboratory tests, in order to validate the assumptions made during the design phase. The aim of this work is to analyse this type of junctions, highlighting their ability to contain the slid-ing of the connected parts, aspect confirmed by the laboratory tests carried out

Thermosensitive and switchable terpyridine-functionalized metallo-supramolecular poly(N-isopropylacrylamide)

Metallo-supramol. polymers offer attractive possibilities to combine the properties of polymers with the characteristics offered by the metal-ligand coordination. Here we present for the first time the combination of metal-bis(terpyridine) complexes and lower crit. soln. temp. (LCST) polymers that can be switched by addressing either the thermosensitive polymer or the metal complex. We describe a new strategy for the synthesis of poly(N-isopropylacrylamide) (PNIPAM) end functionalized with a terpyridine moiety, which is further used for the prepn. of FeII and ZnII-bis(terpyridine PNIPAM). The comparison of the LCST behavior of the uncomplexed ligands and their metal complexes that bear different counter ions is included. Furthermore, the switchability of the synthesized FeII system is demonstrated by a decomplexation reaction followed by the characterization of the uncomplexed ligand. [on SciFinder (R)

Reversible supramolecular functionalization of surfaces: terpyridine ligands as versatile building blocks for noncovalent architectures

The authors report on the reversible and selective functionalization of surfaces by using supramol. building blocks. The reversible formation of bis-terpyridine complexes, based on a terpyridine ligand-functionalized monolayer, was used as a versatile supramol. binding motif. Thereby, click chem. was applied to covalently bind an acetylene functionalized Fe(II) bis-terpyridine complex onto azide-terminated self-assembled monolayers. By decomplexation of the formed supramol. complex, the ligand modified monolayer could be obtained. These monolayers were subsequently used for addnl. complexation reactions, resulting in the reversible functionalization of the substrates. The proper choice of the coordinating transition metal ions allows the tuning of the binding strength, as well as the physicochem. properties of the formed complexes and thus an engineering of the surface properties. [on SciFinder (R)

Zinc(II) bisterpyridine complexes: The influence of the cation on the π-conjugation between terpyridine and the lateral phenyl substituent

The synthesis and photophys. properties of an ethynylphenyl-substituted terpyridine ligand L and its corresponding zinc(II) complex [Zn(L)2](PF6)2, serving as model compds. for self-assembling Zn(II)-based metallopolymers suited for photoluminscent and electroluminescent devices, are presented. The UV-vis spectra are characterized, and the photoluminescence quantum yields are detd. The ground-state structures are calcd. by means of DFT, and the structural key features are approved by exptl. as well as by DFT-calcd. Raman spectra. Special attention is paid to the pi-electron delocalization between phenylene (ph) and pyridine (py) and, in particular, to changes in the ph-py bond due to complexation. The DFT-calcd. ph-py bond shortening in [Zn(L)2](PF6)2 compared to L correlates well with the higher wavenumber of the v(ph-py(trig)) vibration, which involves strong ph-py bond stretching. The higher ellipticity in the ph-py bond due to complexation, calcd. according to Bader's QTAIM indicating the pi-character of a bond, is confirmed by the higher Raman intensity of the v(ph-py(trig)) vibration. The electron d. distributions in the ph-py bond between [Zn(L)2](PF6)2 and L are compared in an inter-Delta r plot, which highlights the changes in the bonding situation of the ph-py bond induced by complex forming. [on SciFinder (R)