Towards safety in minimally invasive surgery : patient safety, tissue handling and training aspects

In recent years a flow of media reports about unsafe situations in operating rooms have reached the general public. Awareness of the importance of patient safety also reached politicians. The report by the Dutch inspectorate of health care __Risico__s minimaal invasieve chirurgie onderschat__ (Risks minimally invasive surgery underestimated) stressed that patient safety is especially at risk in Minimally Invasive Surgery. Therefore patient safety became a focus of research and quality improvement, also in minimally invasive surgery. The current thesis aimes to give insight into patient safety risk factors in minimally invasive surgery. Of all examined risk factors minimally invasive surgical skills appeared to be directly related to patient safety. Therefore special focus for training of these skills is necessary. Previous research has shown that during simulation training objective assessment of economy of movements and time is possible. However, until recently there was no way to objectively assess one of the most important surgical skills: tissue handling. The development of a force sensor has made it possible to measure interaction forces with artificial tissue. In this thesis the clinical implications of a force sensor and the need of this new technology within training of minimally invasive surgical skills is examined.Financial support for the publication of this thesis was kindly provided by: Nederlandse Vereniging voor Endoscopische Chirurgie, Medical Dynamics, Olympus Nederland BV, ERBE Nederland BV, Skills Meducation, ChipSoft, Memidis Pharma b.v., Goodlife Healthcare bv, Covidien, Stöpler Instrumenten en Apparaten B.V.UBL - phd migration 201

Interleukin-21 expanded NKDC in vitro reduces the B16F10 tumor growth in vivo

AbstractInnate immunity to tumors is mediated mainly by natural killer cells (NKs) and dendritic cells (DCs). The function of these cells is coordinated by cytokines produced during the inflammatory process. NK cells are highly active against tumors, being an important source of IFN-γ. Natural killer dendritic cells (NKDCs) were recently identified as a group of hybrid cells; some studies claim that they have lytic activity, produce IFN-γ and can also stimulate antigen-specific T cells. Interleukin 21 (IL-21) regulates the proliferation capacity and cytotoxicity of NK and T cells. The main objective of this study was to investigate if IL-21 influences the frequency of NKDCs in vitro as well as IFN-γ production and also to verify if these cells could enhance the antitumor activity against B16F10 tumor model in vivo. Splenocytes from C57BL/6 mice were isolated and the DC were enriched by immunomagnetic beads and cultured for four days with recombinant IL-21 (10, 20, 40 or 100ng/ml). NKDC population was characterized as CD11clow/medB220+NK1.1+. Expanded cells were used to treat B16F10 tumor bearing mice and tumor growth was compared between the doses of IL-21 10ng/ml and 20ng/ml. The results indicate that IL-21 increases the expansion of splenic NKDCs in vitro in doses of 10ng/ml and 20ng/ml and these cells produce IFN-γ. In vivo, cells expanded with IL-21 and injected directly into the growing tumor efficiently reduced the tumor size. Together, these results showed for the first time that IL-21 influences the biology and the effector activity of NKDCs

Identification of risk factors in minimally invasive surgery: a prospective multicenter study

Development and application of statistical models for medical scientific researc

Global distribution of material inflows to in-use stocks in 2011 and its implications for a circularity transition

Around 40% of global raw materials that are extracted every year accumulate as in-use stocks in the form of buildings, infrastructure, transport equipment, and other durable goods. Material inflows to in-use stocks are a key component in the circularity transition, since the reintegration of those materials back into the economy, at the end of the stock's life cycle, means that less extraction of raw materials is required. Thus, understanding the geographical, material, and sectoral distribution of material inflows to in-use stocks globally is crucial for circular economy policies. Here we quantify the geographical, material, and sectoral distributions of material inflows to in-use stocks of 43 countries and 5 rest-of-the-world regions in 2011, using the global, multiregional hybrid units input-output database EXIOBASE v3.3. Among all regions considered, China shows the largest amount of material added to in-use stocks in 2011 (around 46% of global material inflows to in-use stocks), with a per capita value that is comparable to high income regions such as Europe and North America. In these latter regions, more than 90% of in-use stock additions are comprised of non-metallic minerals (e.g., concrete, brick/stone, asphalt, and aggregates) and steel. We discuss the importance of understanding the distribution and composition of materials accumulated in society for a circularity transition. We also argue that future research should integrate the geographical and material resolution of our results into dynamic stock-flow models to determine when these materials will be available for recovery and recycling. This article met the requirements for a Gold-Gold JIE data openness badge described in http://jie.click/badgesIndustrial Ecolog

Can we predict who will benefit from the deep inspiration breath hold (DIBH) technique for breast cancer irradiation?

Background: The objective was to explore the clinical use of an “in-house” prototype developed to monitor respiratory motion to implement the deep inspiration breath hold technique (DIBH), compare dosimetric differences, and assess whether simple anatomic metrics measured on free breathing (FB) computed tomography scan (CT) can help in selecting patients that would benefit the most from the technique. Materials and methods: A prospective study was conducted on patients with left breast cancer with an indication of adjuvant radiotherapy for breast only. Treatment simulation consisted of four series of CTs: the first during FB and three in DIBH to assess the reproducibility and stability of apnea. Contouring was based on the RTOG atlas, and planning was done in both FB and DIBH. Dosimetric and geometric parameters were assessed and compared between FB and DIBH. Results: From June 2020 to December 2021, 30 patients with left breast cancer were recruited. Overall, the DIBH technique presented a mean dose reduction of 24% in the heart and 30% in the left anterior descendent coronary artery (LAD) (p < 0.05). The only geometric parameter correlated to a 30% dose reduction in the mean heart dose and LAD doses was the anterolateral distance from the heart to the chest wall of at least 1.5 cm measured on FB (p < 0.0001). Conclusion: The prototype enabled the use of the DIBH technique with dose reductions in the heart and LAD. The benefit of the DIBH technique can be predicted on FB CT by measuring the distance between the heart and chest wall at the treatment isocenter

Electric charge quantization and the muon anomalous magnetic moment

We investigate some proposals to solve the electric charge quantization puzzle, which simultaneously explain the recent measured deviation on the muon anomalous magnetic moment. For this we assess extensions of the Electro-Weak Standard Model spanning modifications on the scalar sector only. It is interesting to verify that one can have modest extensions which easily account for the solution for both problems.Comment: 20 pages, 1 figures, needs macro axodraw.st

Clinical presentation, histological findings, and prognosis in female dogs with mixed mammary neoplasms

ABSTRACT The aim of this study was to describe the clinical and morphological characteristics of mixed mammary neoplasms and verify what characteristics affect the prognosis of female dogs with carcinomas in mixed tumors and carcinosarcomas. This was a retrospective study of 67 female dogs that underwent mastectomies and were diagnosed with benign mixed tumors (n=13), carcinomas in mixed tumors (n=44) and carcinosarcomas (n=10). Data regarding the clinical and histological aspects of the neoplasms were collected and the relation with specific survival times, and hazard ratios (HR) in 24 months was calculated. In univariate analysis, the diagnosis of carcinosarcoma (HR 8.26, p=0.006), carcinomatous areas with micropapillary or solid patterns (HR 17.49; p=0. 001) and lymph node metastasis (HR 7.07;p=0.020) were associated with specific survival. In multivariable analysis, only micropapillary or solid pattern (HR=16.34; p=0.007) remained independent factor associated with lower specific survival. Micropapillary or solid carcinomatous patterns were associated with shorter specific survival time (p=0.002) among animals with carcinomas in mixed tumors. Among the carcinosarcomas, lymph node metastasis (p=0.010) was associated with a shorter specific survival time. In conclusion, carcinomas in mixed tumors and carcinosarcomas vary in prognosis depending on the carcinomatous proliferation patterns and spread of the disease