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evolution of surgical skills training

World Journal of Gastroenterology 2006年第20期12卷 3219-3224页

作者： Kurt e Roberts Robert L Bell Andrew J Duffy Department of Surgery Yale University School of Medicine 40 Temple StreetSuite 3ANew HavenCT 06510United Staets

Surgical training is changing： one hundred years of tradition is being challenged by legal and ethical concerns for patient safety, work hours restrictions, the cost of operating room time, and complications. Surgical simulation and skills training offers an opportunity to teach and practice advanced skills outside of the operating room environment before attempting them on living patients. Simulation training can be as straight forward as using real instruments and video equipment to manipulate simulated ＂tissue＂ in a box trainer. More advanced, virtual reality simulators are now available and ready for widespread use. early systems have demonstrated their effectiveness and discriminative ability. Newer systems enable the development of comprehensive curricula and full procedural simulations. The Accreditation Council of Graduate Medical education＇s （ACGMe） has mandated the development of novel methods of training and evaluation. Surgical organizations are calling for methods to ensure the maintenance of skills, advance surgical training, and to credential surgeons as technically competent. Simulators in their current form have been demonstrated to improve the operating room performance of surgical residents. Development of standardized training curricula remains an urgent and important agenda, particularly for minimal invasive surgery. An innovative and progressive approach, borrowing experiences from the field of aviation, can provide the foundation for the next century of surgical training, ensuring the quality of the product. As the technology develops, the way we practice will continue to evolve, to the benefit of physicians and patients.

关键词： Surgery Training Certification Skills Simulation Curriculum

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Aminobromination of ethyl α-Cyanocinnamate Derivatives with 1,3-Dibromo-5,5-dimethylhydantoin（DBDMH） as Nitrogen and Halogen Sources

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Chemical Research in Chinese Universities 2015年第1期31卷 65-70页

作者： CHeN Zhanguo LIU Yali HU Junli LIU De'e Key Laboratory for Macromolecular Science of Shaanxi Province School of Chemistry and Chemical Engineering Shaanxi Normal University Xi'an 710119 P R. China

1,3-Dibromo-5,5-dimethylhydantoin（DBDMH） was found to be a new and efficient nitrogen/halogen source for the aminobromination of ethyl a-cyanocinnamate derivatives catalyzed by K3PO4. The reaction afforded the aminobrominated products in high yields at room temperature, and the full regiospecificity of all the products were achieved. A possible pathway involving a Michael addition for this aminobromination was suggested.

关键词： Aminobromination ethyl a-cyanocinnamate derivative 1,3-Dibromo-5,5-dimethylhydantoin(DBDMH)

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No Sustainability without Technical, fiscal and Social Innovation

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Chinese Journal of Population,Resources and environment 2007年第3期5卷 9-15页

作者： Schmidt-Bleek f Cheng Yiheng factor 10 Institute La Rabassiere Carrere des Bravengues F-83660 Carnoules Provence France Quanta K＆M Consulting Co. Kunshan Yangzhou Jiangsu 215341 China

Officially, the environmental protection from industrial insults began with Rachel Carson＇s book ＂The Silent Spring＂ in 1963. Protection priorities have since changed. They can be grouped into three successive phases.

关键词：中国技术创新社会变革财政收入环境保护生物圈疾病臭氧层破坏

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Investigation of the phase space in lead‐free(K_(x)Na_(1-x))_(1-y)Li_(y)(Nb_(1-z)Ta_(z))O_(3) ferroelectric ceramics

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Journal of Advanced Ceramics 2015年第4期4卷 282-291页

作者： Henry e.MGBeMeRe Rolf JANSSeN Gerold A.SCHNeIDeR Department of Metallurgical&Materials engineering University of LagosAkokaLagosNigeria Institute of Advanced Ceramics Hamburg University of TechnologyDenickestrasse 1521073 HamburgGermany

A library of ceramic compounds based on the lead-free(K_(x)Na_(1-x))1-yLiy(Nb1-zTaz)O_(3)solid solution has been synthesized and characterized using high-throughput experimentation(HTe)*** phase space previously reported by Saito and Takao has been expanded to{{x,0.1,1.0},{y,0,0.1},{z,0,0.2}},and new phase boundaries are *** relative density values show that with the appropriate sintering temperature,~92%of the theoretical density can be *** relative permittivity values show that with increasing amount of K+and Ta5+,the dielectric constant values *** effect of density on the dielectric constant values is however *** values ranging from 109 to 1013Ω·cm are obtained for the *** piezoelectric charge coefficient values for selected compositions show that higher values are obtained close to the phase boundaries rather than away from *** properties for the ceramic library using the HTe method are generally 15%-20%less than from the conventional *** method is therefore more suited for screening of sample compositions than for producing samples with high piezoelectric properties.

关键词： ferroelectrics high-throughput synthesis (K_(x)Na_(1-x))NbO_(3)(KNN) lead-free ceramics

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Role of genetics in the diagnosis and prognosis of Crohn's disease

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World Journal of Gastroenterology 2012年第2期18卷 105-118页

作者： epameinondas V Tsianos Konstantinos H Katsanos Vasileios e Tsianos 1st Division of Internal Medicine and Hepato-Gastroenterology Unit Department of MedicineMedical SchoolUniversity of IoanninaLeoforos Stavrou NiarxouPO Box 118645110 IoanninaGreece

Considering epidemiological,genetic and immunological data,we can conclude that the inflammatory bowel diseases are heterogeneous disorders of multifactorial etiology in which hereditability and environment interact to produce the *** is probable that patients have a genetic predisposition for the development of the disease coupled with disturbances in *** genes have been so far related to the diagnosis of Crohn's *** genes are related to innate pattern recognition receptors,to epithelial barrier homeostasis and maintenance of epithelial barrier integrity,to autophagy and to lymphocyte *** far,the most strong and replicated associations with Crohn's disease have been done with NOD2,IL23R and ATG16L1 *** genes have so far been implicated in prognosis of Crohn's disease and many attempts have been made to classify genetic profiles in Crohn's ***15 seems not only a susceptibility gene,but also a disease-modifier gene for Crohn's *** our understanding on Crohn's disease genetics is important but when combining genetic data with functional data the outcome could be of major importance to clinicians.

关键词： Crohn's Genetics Polymorphism Diagnosis Prognosis Genome wide scan Genetic consortium

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Controversies in the treatment of gastroesophageal reflux and achalasia

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World Journal of Gastroenterology 2006年第20期12卷 3155-3161页

作者： Kurt e Roberts Andrew J Duffy Robert L Bell Department of Surgery Yale University School of Medicine 40 Temple St. Suite 3 ANew HavenCT 06510United States

The immense success of laparoscopic surgery as an effective treatment of gastroesophageal reflux disease （GeRD） and achalasia has established minimal invasive surgery as the gold standard for these two conditions with lower morbidity and mortality, shorter hospital stay, faster convalescence, and less postoperative pain. One controversy in the treatment of GeRD evolves around laparoscopic antireflux surgery （LAP, S） as the preferred treatmerit for Barrett＇s esophagus and the procedure＇s potential to reduce the risk of adenocarcinoma of the esophagus. GeRD has also been associated with respiratory symptoms, asthma and laryngeal injury, and a second controversy prompts discussions about whether total or partial fundoplication is the more appropriate treatment for GeRD. A new and promising alternative in the treatment of GeRD is endoluminal therapy. Three types of this new treatment option will be discussed： radiofrequency energy delivered to the lower esophageal sphincter, the creation of a mechanical barrier at the gastroesophageal junction, and the direct endoscopic tightening of the lower esophageal sphincter. Laparoscopic surgery is discussed not only as a very effective treatment for GeRD but also as permanent cure for achalasia. This review analyzes the three most important treatment options for achalasia： medications, pneumatic dilatation, and surgical therapy. Medications as the only true non-invasive option in the treatment of achalasia are not as effective as LAPS because of their short half-life and variable absorption due to the poor esophageal emptying. The second treatment option, pneumatic dilatation, involves the stretching of the lower esophagus and is still considered the most effective nonsurgical treatment for achalasia. finally, surgical therapy for achalasia and the two major controversies concerning this laparoscopic treatment are discussed. The first involves the extent to which the myotomy is extended onto the stomach, and the second concer

关键词： Gastroesophageal reflux disease Nissen Toupet fundoplication Achalasia Heller myotomy

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Behavioral study with erythrina velutina fractions

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Asian Pacific Journal of Tropical Medicine 2009年第5期2卷 30-33页

作者： Silvania Maria Mendes Vasconcelos Natalia Martins lima Lucas Siqueira de Lucena Alexandre Cesar Praxedes Rodrigues edilberto Rocha Silveira Carlos Clayton Torres Aguiar Paula Matias Soares francisca Clea florenco de Sousa Glauce Socorro de Barros Viana Department of Physiology and Pharmacology Federal University of CearaRua Cel.Nunes de Melo 112760431-270FortalezaCearaBrazil Department of Organic Chemistry Federal University of CearaAv.Mister Hull60455-760FortalezaCearaBrazil

Objective:To study the behavioral effects of semi purified fraction prepared from the stem bark of erythrina velutina on ***:Three chloroformic fractions(CA) at 50 or 100 mg/kg(CA1,CA2 and CA3) were tested in two behavioral tests;plus maze and open ***:In the plus maze test,it was observed a decrease in the number of entries in the closed arms(NeCA) CA2 at both doses as compared to the control *** the open field test,CA2 and CA3 fractions decreased the number of squares crossed and the time of permanence on the bar,increased the number of falls at both doses in the rota rod *** CA2 fraction decreased the NeCA,but this data did not characterize an anxiolytic *** was the consequence from decrease of locomotor activity(LA) observed in the open field test,that the decrease of LA and rearing,the number of falls and the decrease in time of permanence on the bar in rota rod test were observed after treatment with CA2 and CA3 at both doses,suggesting sedative ***:The present work demonstrated that CA2 and CA3 fractions have impairing effect on LA and motor coordination.

关键词： erythrina relutina fraction Locomotor activity Motor coordination

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Ontogenetic shift in response to prey-derived chemical cues in prairie rattlesnakes Crotalus viridis viridis

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Current Zoology 2012年第4期58卷 549-555页

作者： Anthony J. SAVIOLA David CHISZAR Stephen e MACKeSSY School of Biological Sciences University of Northern Colorado 501 20th Street CB 92 Greeley CO 80639 USA Department of Psychology CB 345 University of Colorado Boulder Colorado 80309 USA

Snakes often have specialized diets that undergo a shift from one prey type to another depending on the life stage of the snake. Crotalus viridis viridis （prairie rattlesnake） takes different prey at different life stages, and neonates typically prey on ectotherms, while adults feed almost entirely on small endotherms. We hypothesized that elevated rates of tongue flicking to chemical stimuli should correlate with particular prey consumed, and that this response shifts from one prey type to another as in- dividuals age. To examine if an ontogenetic shift in response to chemical cues occurred, we recorded the rate of tongue flicking for 25 neonate, 20 subadult, and 20 adult （average SVL = 280.9, 552, 789.5 mm, respectively） wild-caught C. v. viridis to chemi- cal stimuli presented on a cotton-tipped applicator; water-soluble cues from two ectotherms （prairie lizard, Sceloporus undulatus, and house gecko, Hemidactylusfrenatus）, two endotherms （deer mouse, Peromyscus maniculatus and lab mouse, Mus musculus）, and water controls were used. Neonates tongue flicked significantly more to chemical cues of their common prey, S. undulatus, than to all other chemical cues; however, the response to this lizard＇s chemical cues decreased in adult rattlesnakes. Subadults tongue flicked with a higher rate of tongue flicking to both S. undulatus and P. maniculatus than to all other treatments, and adults tongue flicked significantly more to P. maniculatus than to all other chemical cues. In addition, all three sub-classes demonstrated a greater response for natural prey chemical cues over chemical stimuli of prey not encountered in the wild （M. musculus and H. frenatus）. This shift in chemosensory response correlated with the previously described ontogenetic shifts in C. v. viridis diet. Be-cause many vipers show a similar ontogenetic shift in diet and venom composition, we suggest that this shift in prey cue dis- crimination is likely a general phenomenon among viperid snakes.

关键词： Gape-limited predator Prey choice Trophic adaptation Vomeronasal chemoreception

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A case for systemic environmental analysis of cultured meat

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Journal of Integrative Agriculture 2015年第2期14卷 249-254页

作者： Carolyn S Mattick Amy e Landis Braden R Allenby University of Texas School of Public Health 1200 Hermann Pressler DriveHouston TX 77030 USA School of Sustainable engineering and the Built environment Arizona State UniversityTempe AZ PO Box 875306 USA

The environmental implications of cultured meat are profound. An anticipatory life cycle assessment of cultured meat published in 2011 suggested it could have a smaller impact than agricultural meat in all categories except energy consumption. As with most technologies, cultured meat will almost certainly be accompanied by unintended consequences as well as unforeseen costs and benefits that accrue disproportionately to different stakeholders. Uncertainty associated with new engineered products cannot be completely eliminated prior to introduction, but ongoing environmental assessments of the technologies as they advance can serve to reduce unforeseen risks. Given the pace at which tissue engineering is advancing, systemic assessments of the technology will be pivotal in mitigating unintended environmental consequences.

关键词： cultured meat in vitro meat factory-grown food anticipatory life cycle assessment systemic environmental implications of emerging technologies

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Congenital penile curvature: long-term results of operative treatment using the plication procedure

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Asian Journal of Andrology 2004年第3期6卷 273-276页

作者： S.-S.Lee e.Meng f.-P.Chuang C.-Y.Yen S.-Y.Chang D.-S.Yu G.-H.Sun Division of Urology Department of SurgeryTri-Service General HospitalNational Defense Medical CenterNationalDefense UniversityTaipeiChina

Aim: To determine the long-term outcome, effectiveness and patient satisfaction of congenital penile curvature correction by plication of tunica albuginea. Methods: from January 1992 to January 2002, 106 young patients underwent surgical correction of congenital penile curvature by corporeal plication. Indications for operation were difficult or impossible vaginal penetration and cosmetic problems. The technique of corporeal plication consists of placing longitudinal plication sutures of 2-zero braided polyester on the convex side of the curvature until the curvature is corrected when erection is artificially induced. Results of this procedure were obtained by retrospective chart reviews and questionnaires via mail. Long-term follow-up ranged from 11 to 132 (mean 69.3) months and data were available for 68 patients. Results: Penile straightening was excellent in 62 patients (91 %) and good with less than 15 degree of residual curvature in 6 patients (9 %). Sixty-seven patients reported no change in erectile rigidity or maintenance postoperatively, while 1 described early detumescence. Shortening of the penis without functional problems was noted by 26 patients (38 %). Thirty-five patients (51 %) reported feeling palpable indurations (suture knots) on the penis. Temporary numbness of glans penis was described in 3 patients. Overall, 60 patients were very satisfied, 6 satisfied, 2 unsatisfied. Conclusion: Corporeal plication is an effective and durable procedure with a high rate of patient satisfaction.

关键词： penile curvature treatment plication procedure

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