Clinical strategies to aim an adequate safety profile for patients and effective training for surgical residents: The laparoscopic cholecystectomy model

Background Training programs for resident surgeons represent a challenge for the mentoring activity. The aim of the present study is to investigate the impact of our training program for laparoscopic cholecystectomy on patient's safety and on the modulation of the residents' exposure to clinical scenario with different grades of complexity. Material and methods This is a retrospective study based on a clinical series of laparoscopic cholecystectomy performed in a teaching hospital. Study population was grouped according to the expertise of the attending primary operator among resident surgeons. Four groups were identified: consultant (C), senior resident (SR); intermediate level resident (IR); junior resident (JR). The intraoperative and postoperative outcomes were confronted to evaluate the patient's safety profile. Results 447 patients were submitted to LC: 96 cases were operated by a C, 200 by SR, 112 by IR and 39 by JR. The mean operative time was the longest for the JR group. A statistically higher rate of conversion to open approach was registered in C and IR groups in comparison to JR and SR groups. However, in C and IR groups, patients had worse ASA score, higher BMI and more frequent past history of previous abdominal surgery, cholecystitis or pancreatitis. Overall, it was not registered any statistically significant difference among the groups in terms of length of hospital stay and prevalence of major postoperative complications. Conclusion Applying an educational model based on both graduated levels of responsibility and modulated grade of clinical complexity can guarantee an high safety profile

Automatic 3D facial model and texture reconstruction from range scans

This paper presents a fully automatic approach to fitting a generic facial model to detailed range scans of human faces to reconstruct 3D facial models and textures with no manual intervention (such as specifying landmarks). A Scaling Iterative Closest Points (SICP) algorithm is introduced to compute the optimal rigid registrations between the generic model and the range scans with different sizes. And then a new template-fitting method, formulated in an optmization framework of minimizing the physically based elastic energy derived from thin shells, faithfully reconstructs the surfaces and the textures from the range scans and yields dense point correspondences across the reconstructed facial models. Finally, we demonstrate a facial expression transfer method to clone facial expressions from the generic model onto the reconstructed facial models by using the deformation transfer technique

The relationship between fixation stability and retinal structural parameters in children with anisometropic, strabismic and mixed amblyopia

Background: Amblyopia is an ocular condition leading to structural and functional changes. The relationship between these changes is complex and remains poorly understood. (2) Methods: Participants included 31 children aged 5 to 9 years with strabismic (n = 9), anisometropic (n = 16) and mixed (n = 6) unilateral amblyopia, and 14 age-matched non-amblyopic children. The 95% and 63% Bivariate Contour Ellipse Area (BCEA), axial length, Foveal Avascular Zone (FAZ) area, center macular thickness and volume were assessed. The relationship between these parameters was explored. (3) Results: Statistically significant differences were found among the four groups in best corrected distance visual acuity (BCVA) (p < 0.001), BCEA 95% (p = 0.002) and BCEA 63% (p = 0.002), but not in the FAZ area, central macular thickness, central macular volume and axial length. Eyes with amblyopia had poorer BCVA and larger fixation instability than controls. Inter-ocular differences were more significant in patients with strabismic amblyopia, particularly in BCVA (p = 0.003), central macular thickness (p < 0.001) and central macular volume (p = 0.002). In amblyopic eyes, BCEA 95% and 63% were correlated with BCVA, but not with the FAZ area. (4) Conclusion: Amblyopia is associated with a reduction in fixation stability and BCVA, although there is a general lack of correlation with structural changes, suggesting a complex interaction between anatomy and function in amblyopia.Peer ReviewedPostprint (published version

Hypoxia and risk preferences: Mild hypoxia impacts choices for low-probability high-payoff bets

Mild degrees of hypoxia are known to exert a detrimental effect on cognitive functions. In a lab study, we assessed the effect of mild hypoxia on risk-taking behavior. Participants (N = 25) were presented with pairs of bets of equal expected monetary value, one having a higher probability of winning/losing a lower payoff (safer bet) and one having a lower probability of winning/losing a higher payoff (riskier bet). We systematically varied the ratio of the probabilities (and corresponding payoffs) of the two bets and examined how this affected participants’ choice between them. Following a familiarization session, participants performed the task twice: once in a normoxic environment (20.9% oxygen concentration) and once in a mildly hypoxic environment (14.1% oxygen concentration). Participants were not told and could not guess which environment they were in. We found a higher preference for the riskier bet in the mild hypoxic than normoxic environment but only in the loss domain. Furthermore, as the probability ratio increased, mild hypoxia increased the preference for the riskier bet in the domain of losses but decreased it for gains. The present findings support that mild hypoxia promotes riskier choices in the loss domain and provide new insights into the impact of mild hypoxia in moderating the effect of probability ratio on risky choices

From reading numbers to seeing ratios: a benefit of icons for risk comprehension

Promoting a better understanding of statistical data is becoming increasingly important for improving risk comprehension and decision-making. In this regard, previous studies on Bayesian problem solving have shown that iconic representations help infer frequencies in sets and subsets. Nevertheless, the mechanisms by which icons enhance performance remain unclear. Here, we tested the hypothesis that the benefit offered by icon arrays lies in a better alignment between presented and requested relationships, which should facilitate the comprehension of the requested ratio beyond the represented quantities. To this end, we analyzed individual risk estimates based on data presented either in standard verbal presentations (percentages and natural frequency formats) or as icon arrays. Compared to the other formats, icons led to estimates that were more accurate, and importantly, promoted the use of equivalent expressions for the requested probability. Furthermore, whereas the accuracy of the estimates based on verbal formats depended on their alignment with the text, all the estimates based on icons were equally accurate. Therefore, these results support the proposal that icons enhance the comprehension of the ratio and its mapping onto the requested probability and point to relational misalignment as potential interference for text-based Bayesian reasoning. The present findings also argue against an intrinsic difficulty with understanding single-event probabilities

Structural mapping in statistical word problems: A relational reasoning approach to Bayesian inference

Presenting natural frequencies facilitates Bayesian inferences relative to using percentages. Nevertheless, many people, including highly educated and skilled reasoners, still fail to provide Bayesian responses to these computationally simple problems. We show that the complexity of relational reasoning (e.g., the structural mapping between the presented and requested relations) can help explain the remaining difficulties. With a non-Bayesian inference that required identical arithmetic but afforded a more direct structural mapping, performance was universally high. Furthermore, reducing the relational demands of the task through questions that directed reasoners to use the presented statistics, as compared with questions that prompted the representation of a second, similar sample, also significantly improved reasoning. Distinct error patterns were also observed between these presented- and similar-sample scenarios, which suggested differences in relational-reasoning strategies. On the other hand, while higher numeracy was associated with better Bayesian reasoning, higher-numerate reasoners were not immune to the relational complexity of the task. Together, these findings validate the relational-reasoning view of Bayesian problem solving and highlight the importance of considering not only the presented task structure, but also the complexity of the structural alignment between the presented and requested relations

Regulators of floral fragrance production and their target genes in petunia are not exclusively active in the epidermal cells of petals

In which cells of the flower volatile biosynthesis takes place is unclear. In rose and snapdragon, some enzymes of the volatile phenylpropanoid/benzenoid pathway have been shown to be present in the epidermal cells of petals. It is therefore generally believed that the production of these compounds occurs in these cells. However, whether the entire pathway is active in these cells and whether it is exclusively active in these cells remains to be proven. Cell-specific transcription factors activating these genes will determine in which cells they are expressed. In petunia, the transcription factor EMISSION OF BENZENOIDS II (EOBII) activates the ODORANT1 (ODO1) promoter and the promoter of the biosynthetic gene isoeugenol synthase (IGS). The regulator ODO1 in turn activates the promoter of the shikimate gene 5-enolpyruvylshikimate-3-phosphate synthase (EPSPS). Here the identification of a new target gene of ODO1, encoding an ABC transporter localized on the plasma membrane, PhABCG1, which is co-expressed with ODO1, is described. PhABCG1 expression is up-regulated in petals overexpressing ODO1 through activation of the PhABCG1 promoter. Interestingly, the ODO1, PhABCG1, and IGS promoters were active in petunia protoplasts originating from both epidermal and mesophyll cell layers of the petal, suggesting that the volatile phenylpropanoid/benzenoid pathway in petunia is active in these different cell types. Since volatile release occurs from epidermal cells, trafficking of (volatile) compounds between cell layers must be involved, but the exact function of PhABCG1 remains to be resolved

Berry Flesh and Skin Ripening Features in Vitis vinifera as Assessed by Transcriptional Profiling

Background Ripening of fleshy fruit is a complex developmental process involving the differentiation of tissues with separate functions. During grapevine berry ripening important processes contributing to table and wine grape quality take place, some of them flesh- or skin-specific. In this study, transcriptional profiles throughout flesh and skin ripening were followed during two different seasons in a table grape cultivar ‘Muscat Hamburg’ to determine tissue-specific as well as common developmental programs. Methodology/Principal Findings Using an updated GrapeGen Affymetrix GeneChip® annotation based on grapevine 12×v1 gene predictions, 2188 differentially accumulated transcripts between flesh and skin and 2839 transcripts differentially accumulated throughout ripening in the same manner in both tissues were identified. Transcriptional profiles were dominated by changes at the beginning of veraison which affect both pericarp tissues, although frequently delayed or with lower intensity in the skin than in the flesh. Functional enrichment analysis identified the decay on biosynthetic processes, photosynthesis and transport as a major part of the program delayed in the skin. In addition, a higher number of functional categories, including several related to macromolecule transport and phenylpropanoid and lipid biosynthesis, were over-represented in transcripts accumulated to higher levels in the skin. Functional enrichment also indicated auxin, gibberellins and bHLH transcription factors to take part in the regulation of pre-veraison processes in the pericarp, whereas WRKY and C2H2 family transcription factors seems to more specifically participate in the regulation of skin and flesh ripening, respectively. Conclusions/Significance A transcriptomic analysis indicates that a large part of the ripening program is shared by both pericarp tissues despite some components are delayed in the skin. In addition, important tissue differences are present from early stages prior to the ripening onset including tissue-specific regulators. Altogether, these findings provide key elements to understand berry ripening and its differential regulation in flesh and skin.This study was financially supported by GrapeGen Project funded by Genoma España within a collaborative agreement with Genome Canada. The authors also thank The Ministerio de Ciencia e Innovacion for project BIO2008-03892 and a bilateral collaborative grant with Argentina (AR2009-0021). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.Peer reviewe