The role of simulator Promis2 in learning laparoscopic skill

INTRODUCTION

Laparoscopic surgery is unique and complex in nature, so the training is necessary before proceeding to operation room. Many computer aided simulators have been developed for the purpose. Our objective is to assess the improvement of basic laparoscopic skills after training in simulator.

METHODS

The fifth year medical students underwent training of three laparoscopic skills using Promis2 simulator twice weekly for 4-6 weeks. The skills are laparoscopic orientation, target pointing and objects transferring. Time, path length of instruments and economy of movements were recorded. The comparisons were made for these parameters between session first and the last using a Mann-Whitney U test.

RESULTS

Ten volunteers completed the exercises in less time (186.3 +/- 55.4 seconds) than the first exercise (215.7 +/- 57.4 seconds) (P=0.0027). Both the right and left hand instrument path lengths were also improved from 4425.8 +/- 1284.3 mm in the first exercise to 3925.3 +/- 1313.6 mm in the last exercise in the left side (P=0.0219) and likewise from 4273.8 +/- 1859.4 mm to 3831.3 +/- 1717.4 mm in the right side (P=0.0027). Economy of the movement in the left handed instrument improved from 1114.4 +/- 453.5 mm in the first exercise to 966.8 +/- 411.1 mm in the last (P=0.0443) and in the right handed instrument from 845 +/- 398.8 mm to 771.4 +/- 370.5 mm according to the software of Promis2 simulator (P >0.005).

CONCLUSIONS

Training in Promis2 simulator improves the basic laparoscopic skills. The candidates become consistently faster with shorter path lengths and had smoother instruments movements. They also became significantly more consistent in their performance.

Search for a light pseudoscalar particle in the decay K_{L};{0}-->pi;{0}pi;{0}X

We performed a search for a light pseudoscalar particle X in the decay K_{L};{0}-->pi;{0}pi;{0}X, X-->gammagamma with the E391a detector at KEK. Such a particle with a mass of 214.3 MeV/c;{2} was suggested by the HyperCP experiment. We found no evidence for X and set an upper limit on the product branching ratio for K_{L};{0}-->pi;{0}pi;{0}X, X-->gammagamma of 2.4x10;{-7} at the 90% confidence level. Upper limits on the branching ratios in the mass region of X from 194.3 to 219.3 MeV/c;{2} are also presented.

New measurement of the K+-->pi+ nunu branching ratio

Three events for the decay K+-->pi+ nunu have been observed in the pion momentum region below the K+-->pi+pi0 peak, 140 < Ppi < 199 MeV/c, with an estimated background of 0.93+/-0.17(stat.) -0.24+0.32(syst.) events. Combining this observation with previously reported results yields a branching ratio of B(K+-->pi+ nunu) = (1.73(-1.05)+1.15) x 10(-10) consistent with the standard model prediction.

Factors related to the advantageous effects of wearing a wetsuit during swimming at different submaximal velocity in triathletes

This study was designed to compare the effects of wetsuit (WS) to swimsuit (SS) at identical relative velocities in a swimming flume. Thirteen triathletes performed a continuous progressive swimming test and submaximal steady state swimming tests with a WS and with a SS. Maximal oxygen uptake (VO2max) and the associated velocity at which the VO2max was achieved (VVO2max) were determined during the continuous progressive tests. Two 5 min swims (at 60% VVO2max (V(60%)) and 80% VVO2max (V(80%))) were then conducted to measure VO2max, blood lactate concentration (LA), rating of perceived exertion (RPE), the energy cost of swimming (Cs), stroke rate (SR) and stroke length (SL). No difference was found in VO2max, but VVO2max with a WS was 5.4% higher than with a SS. VO2 with a WS was lower than with a SS alone at V(60%), but not at V(80%). Cs with a WS was lower by 14.4% at V(60%) and 7.5% at V(80%) than with a SS. No differences were found in LA and RPE between suit conditions during both submaximal swims. Wearing a WS did not affect SL, but SR tended to be higher in a WS for both submaximal velocities. These results suggest that the benefits of wearing a WS are not only improvement in swimming performance and propulsion efficiency, but reduction in gross energy consumption in the swimming portion of triathlon races. Furthermore, when wearing a WS, incremental changes in SR rather than SL are associated with improved swimming performance.

Search for the Decay K L0-->pi0nu nu[over]

We performed a search for the K L0-->pi0nu nu[over] decay at the KEK 12-GeV proton synchrotron. No candidate events were observed. An upper limit on the branching ratio for the decay was set to be 6.7 x 10(-8) at the 90% confidence level.

Assessment of hallucinations in Parkinson's disease using a novel scale

OBJECTIVE

To assess hallucinations in Parkinson's disease (PD), we developed a novel practical rating scale that evaluates five items including variety, frequency, and severity of hallucinations, caregiver burden levels, and psychiatric status at nighttime.

METHODS

Forty-one PD patients and their caregivers were examined regarding the status of the hallucinations associated with PD.

RESULTS

As a measure of internal consistency, the Tottori University Hallucination Rating Scale (TUHARS) has a Cronbach's alpha of 0.88. Mini-Mental State Examination (MMSE) and Hoehn-Yahr stage were associated with the TUHARS scores in a multivariate regression analysis. Visual hallucinations are the most common. However, half of the patients who reported visual hallucinations also had other hallucinations. The scale scores in the PD patients with dementia (PDD) group were significantly greater than in the PD patients without dementia (PDnD) group.

CONCLUSIONS

TUHARS appears to be a suitable and easily administered instrument for assessment of hallucinations in PD. PD patients experienced various kinds of hallucinations. Hallucinations may have a close relationship with cognitive decline in PD patients.

Evaluation of genetic diversity in Japanese Brown cattle population by pedigree analysis

The Japanese Brown is the second most common domestic beef breed in Japan. However, nowadays this breed is facing reduction in numbers because of pressure from a profitable domestic breed. This breed is uniformly characterized by its brown coat colour, but is comprised of two isolated sub-breeds, Kumamoto and Kouchi, each possessing a different gene pool. Pedigree analyses were carried out for the two sub-breeds using the pedigree records of animals born from 1970 to 2000. The effective population size has been found to be consistently reducing during the last three decades in both sub-breeds. The current effective sizes were estimated to be 25.5 and 6.0 for the Kumamoto and Kouchi sub-breeds, respectively. The estimate of the effective number of founders (N(ef)) in the Kumamoto sub-breed decreased from 152.1 to 74.4; that of non-founders (N(enf)), from 41.7 to 5.3; and that of founder genome equivalents (N(ge)), from 32.7 to 4.9. The corresponding changes in the Kouchi sub-breed were from 108.2 to 79.4, 16.2 to 4.1, and 14.1 to 3.9. Increasing differences between the two genetic diversity indices in the sub-breeds indicate that the greater part of the reduction of genetic diversity can be attributed to genetic drift that accumulated in the non-founder generations. A comparison with published estimates for several cattle breeds suggests the extremely limited genetic diversity of Japanese Brown. In addition to the avoidance of further reduction of genetic diversity, it will be important to counteract the process of breed decline by establishing a production system to efficiently utilize the unique characteristics of this breed and by developing links between the breed and products with market value.

Epidermolysis bullosa acquisita associated with psoriasis vulgaris

We report a case of epidermolysis bullosa acquisita (EBA) associated with psoriasis vulgaris. A 71-year-old woman with psoriasis vulgaris developed subepidermal blisters on the extremities. Direct immunofluorescence demonstrated linear deposit of IgG at the basement membrane zone, which bound to the dermal side of normal human skin split with 1 mol/L NaCl. Immunoblot analysis using recombinant full-length type VII collagen detected a 290-kDa band, confirming the diagnosis of EBA. A literature search for previous reports found a few cases of EBA associated with psoriasis, and all cases, including our own, presented with widespread inflammatory vesicles and bullae, and responded to conventional therapy with corticosteroids and immunosuppressive agents. This study suggests that western blotting using recombinant full-length type VII collagen could be useful for diagnosis of EBA, and that EBA associated with psoriasis may have a tendency to be the inflammatory type.

Creation of a novel cell penetrating peptide, using a random 18mer peptides library

Cell penetrating peptides (CPPs) have drawn attention as carriers for intracellular drug delivery. It is commonly believed that TAT peptide is the best carrier among the existing CPPs due to its high translocational activity. Despite considerable research, the cellular uptake mechanism of TAT peptide remains unclear. Additionally, the transduction efficiency of TAT peptide is insufficient for use in intracellular therapy. In this study, we attempted to identify novel CPPs from a random 18mer peptide library using a phage display system. To isolate novel CPPs more effectively, PSIF (protein synthesis inhibition factor) was used with the screening system. Consequently, we isolated 7 novel CPPs from the library and determined by flow cytometry and confocal laser microscopy that these CPPs were taken up into cells. Once the cellular uptake pathway of these CPPs has been determined, it may be possible to use them for intracellular therapy.

[Aortic arch aneurysm with aortopulmonary fistula; report of a case]

A 77-year-old female was admitted to our hospital due to congestive heart failure. Computed tomography and angiography showed a saccular aneurysm with aortopulmonary fistula in the aortic arch. The patient underwent total arch replacement and patch closure of the pulmonary artery in an urgent operation. She was discharged after uneventful postoperative course, although staged sternal closure and 5 days of respiratory management were needed. A few cases of aortic arch aneurysm with perforation to the pulmonary artery are operated with success, which depends on severity of congestive heart failure and urgency. Therefore, it should be diagnosed exactly and rapidly. In the operation, special care should be taken to avoid right heart failure and postoperative respiratory distress.

Serum p53 antibody as a predictor of early recurrence in patients with postoperative esophageal squamous cell carcinoma

It is reported that surveillance of serum p53 antibody (Ab) is a useful marker in detecting esophageal squamous cell carcinoma (ESCC). But there is little reported about prognostic significance of serum p53-Ab in postoperative patients with ESCC. The aim of this study is to evaluate the significance of preoperative serum p53-Ab as a marker of early recurrence after curative resection for ESCC. Enzyme-linked immunosorvent assay (ELISA) was used to analyze serum p53-Ab before treatment in 44 patients with ESCC. Carcinoembryonic antigen (CEA) and squamous cell carcinoma antigen (SCC-Ag) were examined by immunoradiometric assay. The patients who were strongly positive and positive in serum p53-Ab were more likely to have early recurrence after curative resection than seronegative patients. There were no significant correlations between CEA, SCC-Ag positivity and early recurrence. We found that serum p53-Ab was useful to predict a risk of early recurrence after curative surgical resection for ESCC.

Dwarfism and cytochrome P450-mediated C-6 oxidation of plant steroid hormones

BRs (brassinosteroids) are plant steroid hormones that are essential for normal plant development. The dramatic dwarfism exhibited by mutants in the CYP (cytochrome P450) enzymes involved in BR biosynthesis indicates a role for these hormones in plant growth and development. Since the mid-1990s, collaborative research has been geared towards developing a better understanding of the CYP85 class of CYPs involved in BR biosynthesis in both Arabidopsis and tomato. Some of the most recent observations include the fact that certain CYP85 CYPs catalyse the synthesis of the most bioactive BR, BL (brassinolide). Current evidence suggests that evolution of this function may have occurred independently in different dicotyledonous species. Interestingly, BL accumulates in tomato fruits, highlighting a key role for this hormone in fruit development. At the same time as developing a better understanding of the enzymatic function of these CYPs, we have also carried out experiments towards characterizing where and when these genes are expressed and mechanisms of their regulation. As expected for a hormone involved in growth and development, biosynthetic gene promoter activity is associated with young rapidly growing cells and with fruit development.

Optimization of anti-tumor necrosis factor-alpha single chain Fv displayed on phages for creation of functional antibodies

In this study, we converted the immunoglobulin-type anti-human tumor necrosis factor-alpha (TNF-alpha) monoclonal antibody (Mab) to a scFv-type antibody in order to assess its basic properties. The immunoglobulin VH and VL genes were isolated from the hybridoma that produced an anti-TNF-alpha neutralizing Mab, and they were then linked together to create scFvs of the VL-VH or VH-VL-form. The binding affinity to TNF-a was retained in both scFvs. Interestingly, the VL-VH-type scFv effectively inhibited the TNF-alpha-mediated cytotoxicity, while this neutralization activity was dramatically decreased in the VH-VL-type scFv. These results suggest that the VL-VH-type scFv is a suitable template to create improved versions of the anti-TNF-alpha antibody using a phage display system, and they also show that the structural format must be taken into account in manufacturing scFvs.

Listeriolysin O derived from Listeria monocytogenes inhibits the effector phase of an experimental allergic rhinitis induced by ovalbumin in mice

Listeriolysin O (LLO) derived from Listeria monocytogenes is highly capable of inducing interleukin (IL)-12, IL-18 and interferon (IFN)-gamma, and facilitates the generation of Th1 cells. We have recently shown that recombinant LLO (rLLO) inhibits generation of ovalbumin (OVA)-specific Th2 immune response by skewing maturation of antigen-specific T cells into Th1 cells. In the present study, we investigated the effect of rLLO on the effector phase of Th2-dependent allergic rhinitis in BALB/c mice sensitized with OVA. In mice sensitized intraperitoneally and challenged intranasally with OVA, nasal allergic symptoms such as sneezing and nose-scratching were observed at a high frequency. A high titre of anti-OVA IgE antibody was detected in sera and a large number of eosinophils migrated into the nasal tissue. However, rLLO treatment during the intranasal challenge inhibited the allergic symptoms, production of anti-OVA IgE antibody and eosinophil infiltration. Though rLLO did not affect antigen-specific cytokine production from splenic CD4(+) T cells, rLLO significantly suppressed OVA-specific IL-4 and IL-5 production from nasal mononuclear cells. We further found that rLLO inhibited the recruitment of CD4(+) T cells in nasal mucosa, and diminished the transcription and cell surface expression of CCR4 on splenic CD4(+) T cells. Moreover, rLLO was able to inhibit the passive cutaneous anaphylaxis reaction mediated by anaphylactic antibodies (IgE and IgG(1)) and mast cells. Taken together, these data showed that rLLO suppresses the effector phase of allergic rhinitis by inhibition of Th2 cell recruitment to nasal mucosa and type I allergic reaction.

Naturally arising Foxp3-expressing CD25+CD4+ regulatory T cells in self-tolerance and autoimmune disease

Naturally arising CD25+CD4+ regulatory T cells, which express the transcription factor Foxp3, play key roles in the maintenance of immunologic self-tolerance and negative control of a variety of physiological and pathological immune responses. The majority of them are produced by the normal thymus as a functionally mature T cell subpopulation specialized for suppressive function. Their generation is in part genetically and developmentally controlled. Genetically determined or environmentally induced abnormality in CD25+CD4+ regulatory T cell development, maintenance, and function can be a cause of autoimmune disease in humans.

[Off-pump atrial septectomy in a small neonate]

We report a surgical technique for off-pump atrial septectomy using a Rongeur forceps in the case of a newborn infant weighing less than 2,000 grams. The 6-day-old patient suffered from hypoplastic left heart syndrome with a restrictive interatrial communication. A purse-string suture was placed on the right atrium. A hand-made dull-tipped cannula was inserted into the right atrium through the suture to probe the interatrial communication. Monitoring the pressure at the tip of cannula, we could clearly determine when the cannula tip entered the left atrium. Then, a Rongeur forceps was inserted instead of the cannula, and used to bite into the interatrial septum. It was removed slowly together with the resected atrial specimen. In this manner, an atrial septectomy can be performed without cardiopulmonary bypass; this is far safer and easier than other procedures, such as the Blalock-Hanlon technique. This method can be performed in a small neonate as well as an older infant in whom balloon atrial septostomy is difficult.

Listeriolysin O, a cytolysin derived from Listeria monocytogenes, inhibits generation of ovalbumin-specific Th2 immune response by skewing maturation of antigen-specific T cells into Th1 cells

Listeriolysin O (LLO), a cholesterol-dependent cytolysin derived from Listeria monocytogenes, is a potent inducer of interleukin (IL)-12, IL-18 and interferon (IFN)-gamma. We have shown that LLO facilitates development of T cells mediating protective immunity against L. monocytogenes through the induction of IFN-gamma production at an early stage. Based on this finding, it is postulated that LLO inhibits differentiation of Th2 cells and the Th2 immune response. By using a murine model of ovalbumin (OVA)-induced allergic rhinitis, we investigated whether LLO has an ability to modulate the Th2-type immune disorder. In mice sensitized intraperitoneally with ovalbumin (OVA)/alum and challenged intranasally with OVA, a large number of eosinophils migrated into the nasal tissue, and high titres of anti-OVA IgE and IgG(1) antibodies were detected in sera. However, LLO treatment during sensitization markedly inhibited the eosinophil infiltration and production of these anti-OVA antibodies. A large number of T cells from mice sensitized and challenged with OVA produced high level of IL-4 and IL-5 but not IFN-gamma after stimulation with OVA. In contrast, OVA-specific IFN-gamma-producing T cells were preferentially induced in mice treated with LLO at the time of sensitization. In the absence of LLO administration, the expression level of GATA-3 and SOCS-3 in CD4(+) T cells was enhanced after sensitization with OVA. LLO treatment resulted in a reduction of GATA-3 and SOCS-3 expressions but induced the transcription of T-bet instead. Taken together, these data show clearly that LLO is capable of inhibiting Th2 immune response by skewing differentiation of antigen-specific T cells into Th1 cells.