Operative Session Research Articles

Docteur Junior en chirurgie plastique, un nouveau statut. Évaluation des pratiques après un semestre d’application de la réforme

The reform of the third cycle of medical studies in 2017led to the creation of the status of "Junior Doctor", corresponding to the consolidation phase and allowing increasing autonomy and supervision from the intern. In plastic surgery, this status appeared for the first time in November 2021in French hospitals; it lasts two years and succeeds the first four years of internship. We sent a self-questionnaire by email in May 2022to the 21French Junior Doctors. This was interested in their training ground, formation program, consultation activity, operating program, integration into the on-call list, the existence of half-days of availability, and their general opinion on this reform and its implementation. We collected 20questionnaires with a sex ratio of twelve men for eight women. The majority of respondents worked in a university hospital (85%). 45% had their consultations, 60% had their own operating sessions under general anesthesia, and 35% under local anesthesia. Only 25% of them considered this reform to be a step forward in terms of training. The introduction of the status of Junior Doctor is contrasted within the various hospitals. Despite the progressive and supervised autonomy provided by this reform, it is generally perceived neutrally or negatively by Junior Doctors. The establishment of own consultations and operating sessions stands out as a key positive element allowing better application of the reform.

Introducing the “Twilight” operating room concept: a feasibility study to improve operating room utilization

BackgroundThe efficient use of operating room is important to ensure optimum cost–benefit for the hospital and to reduce elective surgery waiting times. We introduced a concept of non-commissioned “Twilight” operating room to reduce patient waiting list and mitigate consequences of non-availability of elective operative time due to closure of an affiliated hospital operating suite.MethodsA retrospective audit was performed during a 10-month period where “Twilight” operating room was implemented in our institution. Additionally, we included patients that were operated on 13 non-commissioned whole day operative sessions on Saturdays during the same period.ResultsA total of 223 surgical procedures were performed during the study time window. Most patients have American Society of Anaesthesiologists (ASA) Class 2. Participating subspecialties were General Surgery, Orthopaedic surgery, Gynaecology, Urology, Plastic surgery and Dental surgery. A wide range of operations was performed in the “Twilight” operating room. No major complications were observed.ConclusionOur study demonstrated the feasibility of conducting elective surgeries after hours with the advantage of reducing the hospital’s elective surgery waiting time. Importantly, no major post-operative complications were reported. This model is a feasible and safe strategy to restore surgical activity impacted by the COVID-19 pandemic.

Comparative study of bilateral total hip arthroplasty in one or two stages

IntroductionBilateral total hip arthroplasty (Bi THA) for disabling bilateral hip osteoarthritis can be performed in one or two operative sessions. The objective of this study was to compare the complication rates of a group of patients who had bilateral THA in one operating session (Bi-1S THA) to a matched group of patients who had bilateral THA in two separate operating sessions (Bi-2S THA). Materials and methodsThis retrospective case-control study compared 84 Bi-1S THA matched to 84 Bi-2S THA by age, gender, diagnosis, ASA score (1–2) and surgical approach. The minimum follow-up was 12 months. Complication rates, total blood loss, number of blood transfusion units, and functional outcomes were assessed. ResultsTwelve patients (14.3%) in the Bi-1S THA group had minor or major complications, compared to twenty-one (25%) in the Bi-2S THA group (p=0.08): there were fewer minor complications in the Bi-1S THA group and a similar rate of major complications amongst the two groups. Total blood loss estimated using the OSTHEO formula was significantly lower in patients operated on by Bi-1S THA (1853±753mL versus 2804±1012mL, p <0.0001). The number of blood transfusion units was similar between the groups (0.5±0.8 versus 0.3±1.4 respectively, p=0.55). No significant difference was found regarding the functional results. ConclusionUnder the conditions of this study, bilateral total hip arthroplasty in one operative session leads to fewer minor complications, and a similar rate of major complications, when compared to bilateral total hip arthroplasty in two separate sessions. This strategy can therefore be recommended for ASA 1 and 2 patients, under the age of 80 with disabling bilateral osteoarthritis. Level of evidenceIII, retrospective comparative study.

Preclinical 3D-printed laboratory simulation of deep caries and the exposed pulp reduced student anxiety and stress, while increasing confidence and knowledge in vital pulp treatment.

AimTo evaluate the impact of a preclinical laboratory session using 3D printed teeth on dental student stress, anxiety, confidence and knowledge when treating deep caries and pulp exposure.MethodologyThis was a two‐centre controlled study, with randomized distribution of students into two groups: a vital pulp treatment (VPT) lecture‐only (control) group and a VPT‐lecture combined with a VPT‐laboratory (experimental) group. In both universities, preclinical students with endodontic or operative dentistry laboratory sessions could participate. All students were invited to the lecture. Two weeks later (timepoint‐T1), both groups completed validated and bespoke questionnaires and scales to evaluate their stress (Stress‐VAS), anxiety (STAI Trait [T] and State [S]), self‐confidence and knowledge. Thereafter, only the experimental group attended the hands‐on laboratory session demonstrating the techniques of selective caries removal and partial pulpotomy on a commercial 3D‐printed tooth. Two weeks later (timepoint‐T2), the participants from both groups repopulated the same questionnaires and VAS. The control group had the laboratory session after the completion of the study. The statistical analysis was performed with Statistica® (significance p = .05). The homogeneity between the two samples was checked by Khi2 and Student tests. Stress‐VAS, STAI‐S, confidence and knowledge scores were compared within each group, and between the two groups, at T1 and T2, with a repeated measures anova test (+/−Tukey post‐hoc test).ResultsThe groups comprised 54 students each, with no statistical difference between the groups regarding demographic, academic data and STAI‐T score. The two groups had no significant difference of Stress‐VAS, STAI‐S, confidence and knowledge scores at T1 while they presented a significant difference in stress, anxiety and confidence scores at T2, but with no significant difference in knowledge score. However, knowledge score, as other parameters, improved significantly between T1 and T2 in the experimental group.ConclusionsThe addition of a laboratory session using 3D‐printed teeth that simulated deep caries and pulp exposure management, significantly reduced the stress and anxiety of students and increased their confidence. Within the limitations of this study, the benefit of introducing new technology in increasing student confidence and reducing stress offers opportunity for educational improvement in the VPT and cariology areas.

Supplementing Intraoperative Mastoidectomy Teaching With Video-Based Coaching.

Video-based coaching might complement general surgery education, but little is known of its applicability for otologic microsurgical teaching. Our purpose was thus to evaluate the content and resident-perceived benefit of video-based coaching for mastoidectomy education. In this mixed-methods pilot design, mastoidectomies were recorded from operative microscopes and reviewed during 30-minute video-based coaching sessions at 2 tertiary care centers. Eight residents and 3 attendings participated. Ten-point Likert-type questionnaires on the extent to which attendings taught 12 topics through 8 techniques were completed by residents after surgical and coaching sessions. Coaching sessions and structured interviews with residents were audio-recorded, transcribed and iteratively coded. Seven audio-recordings were available for coaching sessions, during which a mean of 2.22 ± 0.5 topics per minute were discussed. Of the 12 teaching topics, technique was discussed most frequently (32%, 0.71 ± 0.2 topics/min), followed by anatomy (16%, 0.31 ± 0.16 topics/min). Of all 8 ratings between coaching and operative sessions, residents indicated a greater extent of discussion of anatomy (median difference, [95% confidence interval (CI)] of 3 [1-4]), progress (2.25 [95% CI, 0.5-4]), technique (3.5 [95% CI, 1.5-5.5]), pitfalls (2.5 [95% CI, 1-3.5]), and summarizing (3 [95% CI, 1-5]). In structured interviews, residents reported improved self-confidence and global perspective. Video-based coaching is educationally dense and characterized by perceived richer teaching and promotion of a deeper surgical understanding. It requires no additional resources, can be completed in a short period of time and can be implemented programmatically for any otolaryngologic subspecialty utilizing video-recording capable equipment.

자유학기제에 활용 가능한 학교상담자용 학급단위 집단상담 모형 개발

The purpose of this study was to develop and validate a class unit group counseling model for school counselors to use the free-semester program. In order to accomplish the purpose, first of all this study reviewed the previous research studies, and conducted a survey, a focus group interview, and an expert meeting to develop a proposed model, which consists of the content area, the organizational frame area, and the required resource area. The proposed tentative model was confirmed as the final model by securing content validity through the first and second Delphi surveys of panels of professional counselors who are 40 school counseling field experts. The research results of this study are as follows. The class unit group counseling model for school counselors that can be used in the final proposed free semester system consisted of a total of three areas (content area, organizational frame area, and required resource area). The content area includes three sub-areas(understanding and accepting oneself, making a decision, understanding others and getting along well). The organizational framework includes four sub-areas(available time, number of operational sessions, a most suitable model among the free-semester models, and program operation). The required resource area includes five sub-areas (program operator, required capacity, capacity development method, financial support, and administrative support). This study is significant in that it provides a model for looking for a solution to establish the role of school counselors and to enhance their competency to manage class unit group counseling with middle school students.

Combined Neuroendoscopic Techniques in the Management of Pediatric Brain and Skull Base Tumors: A Single-Institutional Case Series

Central nervous system tumors encompass the leading cause of cancer-related death in the pediatric population. Neuroendoscopic techniques have been optimized over the years, becoming an important tool for the management of brain tumors. Our study aims to review the indications for neuroendoscopic procedures and the feasibility of combined interventions. This is a single-center, self-adjudicated, retrospective experience. Inclusion criteria consisted of pediatric patients (≤18years old) who underwent management of brain tumor or related diseases with the employment of neuroendoscopy. A total of 47 patients undergoing 51 procedures met inclusion criteria. The mean age was 9.8±4.6 years, and the majority were female (55.3%). Common indications for endoscopic intervention were hydrocephalus management (n= 24; 16 endoscopic third ventriculostomies and 9 septostomies), tumor biopsy (n= 19), cyst fenestration (n= 16), and tumor resection (n= 9). In one third of the cases, combined interventions occurred during a single operative session. Hydrocephalus was successfully managed in 74.4% of cases; tumor biopsy confirmed the diagnosis in 95.8% of cases, and gross total resection was achieved in 88.9% of cases. Cyst fenestration required reintervention in 3 cases: one case associated with initial cyst enlargement and 2 cases with the development of new tumor cysts separated from the originally fenestrated cyst. The overall complication rate was 6.3%, with only one major safety event, which was successfully managed. Neuroendoscopy is an important minimally invasive tool for diagnosing and treating pediatric patients with brain tumors, permitting to address multiple problems in a single surgery.

96P Transbronchial microwave ablation: Important role in the battle of lung preservation for multifocal lung primaries or metastases

Multifocal small, deep and subsolid lung nodules are increasingly discovered incidentally, often harboring early malignancies. In these cases, lung-preservation rather than major lung resection is the optimal strategy of choice. We retrospectively reviewed all lung nodules treated by electromagnetic navigation bronchoscopy (ENB) transbronchial microwave ablation between March 2019 and January 2022. Among these, we extract the case series of patients with multifocal lung cancers or oligometastases which have been managed by ENB ablation with or without other forms of local treatment. Among 80 patients treated with ENB microwave ablation in the hybrid operating room, 17 had multiple lung nodules which were suspicious of or confirmed malignancies. Reason for lung preserving strategy includes multi-lobar location of nodules (70.6%), inadequate lung function (23.5%), previous major lung resection (17.6%) and patient preference (11.7%). All nodules were relatively deep (mean of 14mm from pleural surface) and small (mean of 11mm in diameter). Eight patients were histologically proven primary lung cancers or metastases, while the rest were highly suspicious of malignancies. Seven patients had ENB ablation for two or more nodules in the same session, while 7 had ENB ablation on separate occasions. Four patients had concurrent wedge resection of other lung nodules in the same operative session. Technically success rate was 100%, and the average length of hospital stay was 1.3 days after same session ENB ablation, and 2 days after concurrent wedge resection. No complications were encountered except mild pain (17.6%) or low grade fever (5.9%). Over a median follow up of 13 months, there was 1 local recurrence which was subsequently treated with stereotactic radiotherapy and 1 local plus distant metastases which was managed by systemic chemotherapy. ENB ablation can be combined with other multimodality treatments including surgical wedge resection, radiotherapy, or percutaneous local ablation, providing personalized therapeutic options. It is an important armamentarium in tackling multifocal lung cancers or oligometastases, as part of lung-preserving strategy.

Setting up a Neurosurgical Skills Laboratory and Designing Simulation Courses to Augment Resident Training Program.

The surgical skill practice in neurosurgery is being compromised in the recent past owing to the duty time constraint, patient safety concerns, and medico-legal issues. Surgical practice outside the operating room is essential to enhance a resident's operative skills and to gain confidence. To discuss the experience of establishing an 'in-house neurosurgery skills laboratory' and various training sessions conducted with cadaveric and non-cadaveric simulation modules. A skills laboratory was set up in the existing resident teaching hall with nine workstations. Each station has been equipped with an operating table, surgeon's chair, basic microscope, endoscope, high-speed drill system, and a suction machine. Vascular anastomosis, high-speed drilling, and basic neuroendoscopy were planned on low-cost non-cadaveric modules. Craniotomy and various surgical approaches were designed on cadaveric modules obtained from the anatomy department. A total of 18 residents in divided groups during their initial three semesters had participated in the non-cadaveric simulation courses. Twenty-six residents had participated and 12 sessions were conducted on the cadaveric modules. Three workshops were conducted and 20 residents and faculty members from five other institutions had participated in the cadaveric hands-on training session. A well-equipped skills laboratory provides an opportunity for the residents to acquire operative expertise in a similar atmosphere to that of the operating theater. A structured program comprising various operative practice sessions should be incorporated into the resident training program.

Effectiveness of implementing a preventive urinary catheter care bundle in hip fracture patients.

BackgroundUrinary catheter (UC)–associated infections are one of the most common preventable healthcare-associated infections (HAIs) and they frequently occur in older, frail populations.AimThe study aim was to describe the incidence of UC-associated infection in elderly patients undergoing hip fracture surgery after implementing a preventive care bundle.MethodsA longitudinal prospective study using a before-and-after design. The bundle was theory driven and involved the co-creation of a standard operational procedure, education and practical training sessions. Prospectively collected registry data were analysed. Univariable statistics and multivariable logistic regressions were used for analyses.Results2,408 patients with an acute hip fracture were included into the study. There was an overall reduction in UC catheter associated-associated urinary tract infections, from 18.5% (n = 75/406) over time to 4.2% (n = 27/647). When adjusting for all identified confounders, patients in phase 4 were 74% less likely to contract an UC-associated infection (OR, 0.26; 95% CI, 0.15–0.45, p < 0.0001).DiscussionBundled interventions can reduce UC-associated infections substantially, even in elderly frail patients. Partnership and co-creation as implementation strategies appear to be promising in the fight against HAI.

Accidental Bladder Injury during Elective Repair of a Strangulated Inguinal Hernia: A Preventable Complication with High Morbidity

Urinary bladder injury is usually rare and asymptomatic, and can occur during herniorrhaphy for misdiagnosed sliding hernia. It’s necessary to recognize a iatrogenic injury intra operatively, and institute treatment in the same operative session, Preoperative diagnosis can prevent possible to the bladder and ureter surgery and lead to quick recovery. The radiological examination is needed before any surgery, especially when the patient has concomitant urinary symptoms. If bladder hernia is suspected, we should imperatively perform preoperative radiology including ultrasound cystography, CT scan or MRI. Keeping a bladder catheter in situ can alert the surgeon in the event of bladder surgery.

The enduring behavioral and neurobiological effects of a flavor cue paired with alcohol drinking during adolescence on the incentive properties of the flavor cue in adulthood in female alcohol-preferring (P) rats

BackgroundAlcohol use disorders (AUDs) affect 15 million people nationwide, 4% of which are adolescents (ages 12–17) and adolescents who binge drink significantly increase their likelihood of suffering from an AUD in adulthood. Research shows that cues (i.e. flavors) paired with alcohol (EtOH) produce significant cue-induced alcohol craving and contribute to relapse in adolescent and adult populations. However, there is a lack of research focused on how cues that accompany EtOH drinking during adolescence, affect EtOH craving later in life. The current study sought to examine the sex- and developmental-dependent effects of adolescent exposure to flavor cues associated with EtOH on operant-lick behavior and cue-induced dopamine (DA) levels within the nucleus accumbens shell (AcbSh; reward structure) in adulthood. MethodsAdolescent alcohol-preferring (P) rats were randomly assigned to one of 4 groups and received 24 hr. access to three bottles on their home cage: Paired: 0.1% blueberry flavor extract (BB) + 15% v/v EtOH and 2 water bottles; Unpaired: 0.1% BB, 15% v/v EtOH, and water; 15% EtOH alone, and 2 water bottles; BB alone and 2 water bottles. Home cage fluid consumption was measured for 2-weeks. On the third week bottles were removed and all animals underwent 9 days of operant training using an operant sipper paradigm. This consisted of two sipper spouts connected to the computer by a lickometer, which registered tongue contacts with the sipper tube (Paired: BB+EtOH or water; Unpaired BB or EtOH; EtOH alone: EtOH or water; BB alone: BB or water). When the fixed ratio (FR) requirement for number of licks/tongue contacts was met, a liquid delivery solenoid dispensed 0.05 ml of fluid into the sipper tube. Following the final operant session all rats remained in their home-cage for approximately 40 days until adulthood at which point they were returned to the operant chambers and tested for appetitive and consummatory behavior in response to the flavor cue (all rats: BB or water; NO EtOH). Two weeks after the final operant session all rats underwent microdialysis testing to examine cue-induced DA levels in the AcbSh. Results: Data indicated that animals in the paired group exhibited a significantly greater level of licking at the BB sipper and a significantly greater level of DA release in response to the flavor cue compared to the other groups. ConclusionsOverall, the data suggest that cues paired with EtOH during adolescence may produce persistent changes to the behavioral and neurobiological mechanisms that contribute to an increased risk of developing an AUD later in life.

Evaluation of pre-operative and post-operative endothelial cell counts in single-site versus twin-site phacoemulsification trabeculectomy: A Prospective, randomized study

Introduction: Phacotrabeculectomy is a combined procedure in which both cataract extraction and glaucoma filtering surgery are performed in the same operative session. The one-site approach consists of both cataract extraction and trabeculectomy occurring through a single scleral incision. The two-site approach begins with cataract surgery, typically through a clear cornea incision, followed by a completely separate trabeculectomy performed superiorly upon completing the cataract procedure. This study looks at IOP changes, vision, loss of endothelial cells and BCVA between single-site and twin-site phacoemulsification -trabeculectomy surgeries, Methods: This prospective, randomized study was conducted between September 2014 to August 2015 with sample size of 80 subjects at National institute of Ophthalmology, Pune. Results: The endothelial cell loss was significantly more in single site surgery when compared to twin site surgery, in both at 1 month and 3 months follow-up time points (P-value

Post-traumatic tension pneumocephalus and cystic angiomatosis of the skull: case report

BackgroundTension pneumocephalus is an increasing air trapped intracranially. Either spontaneous, post-traumatic or iatrogenic in origin. Cystic angiomatosis is a benign vascular hamartoma of the skeleton, when acquired it is either due to trauma or infection. This is the second report in English literature of post-traumatic delayed tension pneumocephalus with the development of cystic angiomatosis of the skull bone.Case presentationA 55-year-old gentlemen, presented with scalp swelling of 6-month duration with history of head trauma 2 years back. The swelling was increasing and associated with progressive walking difficulties and left hearing loss. CT scan and MRI revealed extradural pneumocephalus, parietal and occipital pneumatocele, and multiple lytic bony lesions, left mastoid hyperpneumatization with inner table defect communicating with the extradural space. Diagnosis of delayed extradural tension pneumocephalus was made. Surgical exploration revealed multiple bony defects of parietal, temporal and squamous part of left temporal bones, confirmed extradural pneumocephalus with intact dura. Repair of mastoid defect of (0.5 × 0.5 cm), excision of pneumatocele and removal of lytic bones were performed. Defective bone “cribriform-like” was identified at occipital and parietal regions centrally with a defect of nearly 7 × 7 cm. Future cranioplasty was considered after 6 months. Histology of bony chips and surrounding soft tissues is recognized as cystic angiomatosis.ConclusionsThe present case developed two very rare complications, following trivial head trauma; the first complication was delayed extradural tension pneumocephalus with pneumatocele which presented 2 years after trauma, the origin of air was from a defect of the inner table of the mastoid, the second complication was cystic angiomatosis of the skull bones. Both complications were managed surgically in one operative session as a combined neurosurgery and otolaryngology teams approach.

Promoting mentalizing in organisations through learning operative groups

Current and pressing scientific and technological changes are producing drastic transformations within organisations, creating anxiety and uncertainty and inhibiting the reflective function of the workers who experience conditions of senselessness and estrangement from their work. This article presents a case study from learning operative group training sessions aimed to promote the identity work through the (re)activation of the reflective function towards the definition of new shared meanings. As part of a broader organisational development process, group training sessions based on learning operative groups were arranged in order to offer participants a group reflective space in which each of them could share her or his thoughts and feelings. Organisational changes require workers to face the challenge of constantly developing new professional skills, thereby threatening personal identity and separating it from the professional function and leading to a situation of “identity ambiguity” which becomes difficult to maintain. The learning operative group setting allowed a critical reflection within the organisational development process and promoted mutual trust, empathy, and perspective taking, that, in turn, fed reflective practices in support of individual identities.

Comparison of 2 Fasciotomes for Treatment of Patients With Chronic Exertional Compartment Syndrome of the Anterior Leg.

Background:Chronic exertional compartment syndrome (CECS) of the anterior leg compartment (ant-CECS) is frequently treated with a minimally invasive fasciotomy. Several operative techniques and operative devices exist, but none have been compared in a systematic and randomized manner.Purpose:To compare efficacy, safety, and postoperative pain of a novel operative device (FascioMax fasciotome) with a widely accepted device created by Due and Nordstrand (Due fasciotome) during a minimally invasive fasciotomy for ant-CECS.Study Design:Randomized controlled trial; Level of evidence, 2.Methods:Patients with bilateral isolated ant-CECS between October 2013 and April 2018 underwent a minimally invasive fasciotomy using the FascioMax fasciotome in 1 leg and the Due fasciotome in the contralateral leg in a single operative session. Symptom reduction at 3 to 6 months and >1 year, postoperative pain within the first 2 weeks, peri- and postoperative complications, and ability to regain sports were assessed using diaries, physical examination, and timed questionnaires.Results:Included in the study were 50 patients (66% female; median age, 22 years [range, 18-65 years]). No differences between the devices were found in terms of perioperative complications (both had none), minor postoperative complications including hematoma and superficial wound infection (overall complication rate: FascioMax, 8% vs Due, 6%), or reduction of CECS-associated symptoms at rest and during exercise. At long-term follow-up (>1 year), 82% of the patients were able to regain their desired type of sport, and 67% (33/49) were able to exercise at a level that was comparable with or higher than before their CECS-associated symptoms started.Conclusion:Both the FascioMax and the Due performed similarly in terms of efficacy, safety, and levels of pain within the first 2 weeks postoperatively.Registration:NL4274; Netherlands Trial Register.

The effectiveness of the information-motivation model and domestic brushing with a hypochlorite-based formula on peri-implant mucositis: A randomized clinical study.

ObjectiveManagement of mucositis is essential for the long‐term maintenance of dental implants. This study determined the efficacy, in terms of clinical parameters, of an adjunctive domiciliary agent paired with non‐surgical periodontal therapy (NSPT) for patients with peri‐implant mucositis.Materials and methodsPatients involved in a periodontal maintenance program were randomly distributed to the domestic use of a chlorhexidine toothpaste and mouthwash (control) or a hypochlorite‐based formula brushing solution (test) after diagnosis of peri‐implant mucositis. A modified approach towards NSPTwas performed after 10 days of domestic use of the assigned maintenance product in both groups. Clinical and patient‐related outcomes were recorded during a 90‐day follow‐up period.ResultsForty patients completed the three‐month study (20 patients per group). Both groups showed relevant clinical and patient outcome improvements after the NSPT (T2) and between T1 and T2 (p < 0 0.01), except for PPD. For the test group, the clinical improvement was significantly greater than that for the control group at the seventh‐day evaluation (T1) in the gingival index (0–3) and FMBS (%). Favorable outcomes were maintained during the entire follow‐up period.ConclusionThe present study showed that the modified NSPT paired with the domestic use of nitradine‐based formula helps resolve peri‐implant mucositis and that nitradine might represent an alternative to chlorhexidine in these cases.Clinical relevanceThe gold standard for nonsurgical maintenance is full‐mouth disinfection. A previous decontamination of the oral cavity with chlorhexidine or nitradine domiciliary for 10 days could reduce plaque and inflammation, resulting in a painless operative session. This protocol may help reduce airborne contamination and the risk of cross‐infection, and during the pandemic, the protocol is safer for clinicians. In the same clinical cases, nitradine may be more efficient than chlorhexidine, and the former has no side effects such as discolouration.

Comparative Study between One or Two Stage Bilateral Open Reduction and Bony Procedures for Neglected Developmental Dysplasia of the Hips

Objectives: This study aimed at evaluating the surgical management of bilateral developmental dysplasia of the hip (DDH), reducing both sides of the hips in one or two different stages. Patients and Methods: A retrospective sequential comparative study on children with bilateral DDH was carried out in the Azadi Teaching hospital of Kirkuk, in between October 2009 and June 2013. There were two groups of patients. The first group consisted of 10 children (20 hips), with a mean age of 26 months (12-36 months), treated by open reduction of the DDH performing the procedure on each hip at two different occasions. The second group of 13 children with bilateral DDH had a mean age of 26 months (12-48) months, were treated in a single-stage; openely reducing both hips in the same operative session. In the first group in addition to the open reduction of the hips, 8 patients required Salter osteotomy, and 3 patients required femoral shortening in order to achieve concentric stable reduction. In the second group, shortening of four femori, Salter osteotomy of 12 acetabulae was performed for the same purposes. At a mean follow-up of 28 months, clinical and radiological assessment was carried out. Modified McKee and Severin criteria was used, the assessment also included analysis of the operative time, the amount of blood loss and transfusion, duration of analgesia, and record of the complications. Results: There were no significant differences between those who underwent open reduction of the hips with respect to mean age, gender, pre- and postoperative acetabular indices. Mean duration of anaesthesia, analgesia, and the amount of blood transfusion was more in patients of group two compared to group one. Rehabilitation and physiotherapy was needed more in group one. Mean improvement of the acetabular index was 10 degrees in both groups. Conclusion: Single-stage bilateral open reduction of DDH with or without bony surgery in patients with bilateral DDH is safe.

Release of endogenous dynorphin opioids in the prefrontal cortex disrupts cognition.

Following repeated opioid use, some dependent individuals experience persistent cognitive deficits that contribute to relapse of drug-taking behaviors, and one component of this response may be mediated by the endogenous dynorphin/kappa opioid system in neocortex. In C57BL/6 male mice, we find that acute morphine withdrawal evokes dynorphin release in the medial prefrontal cortex (PFC) and disrupts cognitive function by activation of local kappa opioid receptors (KORs). Immunohistochemical analyses using a phospho-KOR antibody confirmed that both withdrawal-induced and optically evoked dynorphin release activated KOR in PFC. Using a genetically encoded sensor based on inert KOR (kLight1.2a), we revealed the in vivo dynamics of endogenous dynorphin release in the PFC. Local activation of KOR in PFC produced multi-phasic disruptions of memory processing in an operant-delayed alternation behavioral task, which manifest as reductions in response number and accuracy during early and late phases of an operant session. Local pretreatment in PFC with the selective KOR antagonist norbinaltorphimine (norBNI) blocked the disruptive effect of systemic KOR activation during both early and late phases of the session. The early, but not late phase disruption was blocked by viral excision of PFC KORs, suggesting an anatomically dissociable contribution of pre- and postsynaptic KORs. Naloxone-precipitated withdrawal in morphine-dependent mice or optical stimulation of pdynCre neurons using Channelrhodopsin-2 disrupted delayed alternation performance, and the dynorphin-induced effect was blocked by local norBNI. Our findings describe a mechanism for control of cortical function during opioid dependence and suggest that KOR antagonism could promote abstinence.

Riding the waves: the ongoing impact of COVID-19 on a national surgical training cohort

BackgroundThe World Health Organisation declared a global pandemic on the 11 March 2020 resulting in implementation of methods to contain viral spread, including curtailment of all elective and non-emergent interventions. Many institutions have experienced changes in rostering practices and redeployment of trainees to non-surgical services. Examinations, study days, courses, and conferences have been cancelled. These changes have the potential to significantly impact the education and training of surgical trainees.AimTo investigate the impact of the COVID-19 pandemic on training, educational, and operative experiences of Irish surgical trainees.MethodsSurgical trainees were surveyed anonymously regarding changes in working and educational practices since the declaration of the COVID-19 pandemic on 11 March 2020. The survey was circulated in May 2020 to both core and higher RCSI surgical trainees, when restrictions were at level five. Questions included previous and current access to operative sessions as well as operative cases, previous and current educational activities, access to senior-led training, and access to simulation-/practical-based training methods. A repeat survey was carried out in October 2020 when restrictions were at level two.ResultsOverall, primary and secondary survey response rates were 29% (n = 98/340) and 19.1% (n = 65/340), respectively. At the time of circulation of the second survey, the number of operative sessions attended and cases performed had significantly improved to numbers experienced pre-pandemic (p < 0.0001). Exposure to formal teaching and education sessions returned to pre-COVID levels (p < 0.0001). Initially, 23% of trainees had an examination cancelled; 53% of these trainees have subsequently sat these examinations. Of note 27.7% had courses cancelled, and 97% of these had not been rescheduled.ConclusionSurgical training and education have been significantly impacted in light of COVID-19. This is likely to continue to fluctuate in line with subsequent waves. Significant efforts have to be made to enable trainees to meet educational and operative targets.