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Quinn KM, Runge LT, Griffiths C, Harris H, Pieper H, Meara M, Poulose B, Narula V, Renton D, Collins C, Harzman A, Husain S. Laparoscopic vs robotic inguinal hernia repair: a comparison of learning curves and skill transference in general surgery residents. Surg Endosc 2024:10.1007/s00464-024-10860-5. [PMID: 38693306 DOI: 10.1007/s00464-024-10860-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Accepted: 04/10/2024] [Indexed: 05/03/2024]
Abstract
BACKGROUND There is no consensus on whether laparoscopic experience should be a prerequisite for robotic training. Further, there is limited information on skill transference between laparoscopic and robotic techniques. This study focused on the general surgery residents' learning curve and skill transference within the two minimally invasive platforms. METHODS General surgery residents were observed during the performance of laparoscopic and robotic inguinal hernia repairs. The recorded data included objective measures (operative time, resident participation indicated by percent active time on console or laparoscopy relative to total case time, number of handoffs between the resident and attending), and subjective evaluations (preceptor and trainee assessments of operative performance) while controlling for case complexity, patient comorbidities, and residents' prior operative experience. Wilcoxon two-sample tests and Pearson Correlation coefficients were used for analysis. RESULTS Twenty laparoscopic and forty-four robotic cases were observed. Mean operative times were 90 min for robotic and 95 min for laparoscopic cases (P = 0.4590). Residents' active participation time was 66% on the robotic platform and 37% for laparoscopic (P = < 0.0001). On average, hand-offs occurred 9.7 times during robotic cases and 6.3 times during laparoscopic cases (P = 0.0131). The mean number of cases per resident was 5.86 robotic and 1.67 laparoscopic (P = 0.0312). For robotic cases, there was a strong correlation between percent active resident participation and their prior robotic experience (r = 0.78) while there was a weaker correlation with prior laparoscopic experience (r = 0.47). On the other hand, prior robotic experience had minimal correlation with the percent active resident participation in laparoscopic cases (r = 0.12) and a weak correlation with prior laparoscopic experience (r = 0.37). CONCLUSION The robotic platform may be a more effective teaching tool with a higher degree of entrustability indicated by the higher mean resident participation. We observed a greater degree of skill transference from laparoscopy to the robot, indicated by a higher degree of correlation between the resident's prior laparoscopic experience and the percent console time in robotic cases. There was minimal correlation between residents' prior robotic experience and their participation in laparoscopic cases. Our findings suggest that the learning curve for the robot may be shorter as prior robotic experience had a much stronger association with future robotic performance compared to the association observed in laparoscopy.
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Affiliation(s)
- Kristen M Quinn
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
- Department of Surgery, Medical University of South Carolina, 96 Jonathan Lucas St., Charleston, SC, 29425, USA.
| | - Louis T Runge
- Department of Surgery, Medical University of South Carolina, 96 Jonathan Lucas St., Charleston, SC, 29425, USA
| | - Claire Griffiths
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Hannah Harris
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Heidi Pieper
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Michael Meara
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Ben Poulose
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Vimal Narula
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - David Renton
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Courtney Collins
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Alan Harzman
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Syed Husain
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
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Meara M, Pieper H, Shields M, Woelfel I, Wang T, Renton D, Chen X. What influences general surgery residents' prospective entrustment and operative time in robotic inguinal hernia repairs. Surg Endosc 2023; 37:7908-7913. [PMID: 37430122 DOI: 10.1007/s00464-023-10242-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Accepted: 06/23/2023] [Indexed: 07/12/2023]
Abstract
INTRODUCTION Teaching residents robotic-assisted inguinal hernia repair (RIHR) is an increasingly common extension of contemporary surgical training. This study sought to investigate what variables would influence operative time (OT) and resident prospective entrustment in RIHR cases. METHODS We prospectively collected 68 resident RIHR operative performance evaluations with a validated instrument. Outpatient RIHR cases performed by 11 general surgery residents during 2020-2022 were included. The overall OT of matched cases was extracted from hospital billing; matched procedural step-specific OT was obtained from Intuitive Data Recorder (IDR). Statistical analysis was performed using Pearson correlation and one-way ANOVA. RESULTS The evaluation instrument reliably assessed residents' RIHR performance (Cronbach's α = 0.93); residents' prospective entrustment strongly correlated with overall guidance provided by attending surgeon (r = 0.86, p < 0.0001) and operative plan and judgment (r = 0.85, p < 0.0001). The overall OT was significantly associated with resident's team management (r = - 0.35, p = 0.011). Procedural step-specific OT was significantly associated with residents' step-specific skill (r = - 0.32, p = 0.014). On average, RIHR cases with the highest level of prospective entrustment (Resident can teach junior) showed the shortest step-specific OT. Entrustment level 3 (Reactive guidance needed) was the turning point of all four RIHR procedural step-specific OT. CONCLUSIONS Our findings suggest that in RIHR, attending guidance, resident operative plan and judgment, and resident technical skill contribute to resident prospective entrustment; resident team management, technical skill, and attending guidance influence operative time, which in turn impacts attendings' determination of resident prospective entrustment. Future studies with a larger sample size are needed to further validate the findings.
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Affiliation(s)
- Michael Meara
- Department of Surgery, The Ohio State University, 395 W 12th Ave, Columbus, OH, 43210, USA
| | - Heidi Pieper
- Department of Surgery, The Ohio State University, 395 W 12th Ave, Columbus, OH, 43210, USA
| | - Mallory Shields
- Research Division, Intuitive Surgical Inc, Norcross, GA, 30092, USA
| | - Ingrid Woelfel
- Department of Surgery, The Ohio State University, 395 W 12th Ave, Columbus, OH, 43210, USA
| | - Theresa Wang
- Department of Surgery, The Ohio State University, 395 W 12th Ave, Columbus, OH, 43210, USA
| | - David Renton
- Department of Surgery, The Ohio State University, 395 W 12th Ave, Columbus, OH, 43210, USA
| | - Xiaodong Chen
- Department of Surgery, The Ohio State University, 395 W 12th Ave, Columbus, OH, 43210, USA.
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Quinn KM, Chen X, Runge LT, Pieper H, Renton D, Meara M, Collins C, Griffiths C, Husain S. The robot doesn't lie: real-life validation of robotic performance metrics. Surg Endosc 2022:10.1007/s00464-022-09707-8. [PMID: 36266482 DOI: 10.1007/s00464-022-09707-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 10/11/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Degree of resident participation in a case is often used as a surrogate marker for operative autonomy, an essential element of surgical resident training. Previous studies have demonstrated a considerable disagreement between the perceptions of attending surgeons and trainees when it comes to estimating operative participation. The Da Vinci Surgical System dual console interface allows machine generated measurements of trainee's active participation, which has the potential to obviate the need for labor intensive direct observation of surgical procedures. However, the robotic metrics require validation. We present a comparison of operative participation as perceived by the resident, faculty, trained research staff observer (gold standard), and robotic machine generated data. METHODS A total of 28 consecutive robotic inguinal hernia repair procedures were observed by research staff. Operative time, percent active time for the resident, and number of handoffs between the resident and attending were recorded by trained research staff in the operating room and the Da Vinci Surgical System. Attending and resident evaluations of operative performance and perceptions of percent active time for the resident were collected using standardized forms and compared with the research staff observed values and the robot-generated console data. Wilcoxon two-sample tests and Pearson Correlation coefficients statistical analysis were performed. RESULTS Robotic inguinal hernia repair cases had a mean operative time of 91.3 (30) minutes and an attending-rated mean difficulty of 3.1 (1.26) out of 5. Residents were recorded to be the active surgeon 71.8% (17.7) of the total case time by research staff. There was a strong correlation (r = 0.77) in number of handoffs between faculty and trainee as recorded by the research staff and robot (4.28 (2.01) vs. 5.8 (3.04) respectively). The robotic machine generated data demonstrated the highest degree of association when compared to the gold standard (research staff observed data), with r = 0.98, p < 0.0001. Lower levels of association were seen with resident reported (r = 0.66) perceptions and faculty-reported (r = 0.55) perceptions of resident active operative time. CONCLUSIONS Our findings suggest that robot-generated performance metrics are an extremely accurate and reliable measure of intraoperative resident participation indicated by a very strong correlation with the data recorded by research staff's direct observation of the case. Residents demonstrated a more accurate awareness of their degree of participation compared with faculty surgeons. With high accuracy and ease of use, robotic surgical system performance metrics have the potential to be a valuable tool in surgical training and skill assessment.
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Affiliation(s)
- Kristen M Quinn
- Department of Surgery, Medical University of South Carolina, 96 Jonathan Lucas St. Room CSB 417, Charleston, SC, 29425, USA.
| | - Xiaodong Chen
- Division of Gastrointestinal Surgery, The Ohio State University Wexner Medical Center, Columbus, USA
| | - Louis T Runge
- Department of Surgery, Medical University of South Carolina, 96 Jonathan Lucas St. Room CSB 417, Charleston, SC, 29425, USA
| | - Heidi Pieper
- Center for Minimally Invasive Surgery, The Ohio State University Wexner Medical Center, Columbus, USA
| | - David Renton
- Division of Gastrointestinal Surgery, The Ohio State University Wexner Medical Center, Columbus, USA
| | - Michael Meara
- Division of Gastrointestinal Surgery, The Ohio State University Wexner Medical Center, Columbus, USA
| | - Courtney Collins
- Division of Gastrointestinal Surgery, The Ohio State University Wexner Medical Center, Columbus, USA
| | - Claire Griffiths
- Center for Minimally Invasive Surgery, The Ohio State University Wexner Medical Center, Columbus, USA
| | - Syed Husain
- Division of Colorectal Surgery, The Ohio State University Wexner Medical Center, Columbus, USA
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Lu EL, Harris MK, Gao TZ, Good L, Harris DP, Renton D. Near-Peer Teaching in Conjunction with Flipped Classroom to Teach First-Year Medical Students Basic Surgical Skills. Med Sci Educ 2022; 32:1015-1022. [PMID: 35936650 PMCID: PMC9340706 DOI: 10.1007/s40670-022-01602-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 07/15/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND There is increasing evidence that students are completing medical school with insufficient surgical education. Near-peer tutoring and flipped classroom formatting may be used to enhance learning while simultaneously relieving faculty burden of teaching. Here, we qualitatively evaluate a 3-month course that integrates the use of near-peer teaching and flipped classroom formatting, with the goal of increasing first-year medical students' self-perceived confidence in performing basic sutures and knot-ties as well as interest in surgery. METHODS Twenty-one first-year medical students participated in a suturing and knot-tying course led by senior medical students. The course consisted of 2-h sessions held every 2 weeks for a total of five sessions. Students were sent publicly available videos prior to each session by which to learn the upcoming techniques and received live feedback from instructors during sessions. Questionnaires were completed pre-course and post-course. RESULTS Compared to pre-course ratings, post-course ratings of self-perceived confidence to perform various knot-ties and sutures all increased significantly (p < 0.05). All students stated that the course strengthened their desire to pursue a career in surgery. Student feedback of the course was overall positive. CONCLUSIONS Near-peer teaching can be used in conjunction with flipped classroom to increase first-year medical students' self-perceived confidence in surgical suturing and knot-tying as well as interest in surgery. This curriculum may serve as an outline for student-led courses at other institutions.
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Affiliation(s)
- Emily L. Lu
- The Ohio State University College of Medicine, Columbus, OH USA
| | - Micah K. Harris
- The Ohio State University College of Medicine, Columbus, OH USA
| | - Thomas Z. Gao
- The Ohio State University College of Medicine, Columbus, OH USA
| | - Logan Good
- The Ohio State University College of Medicine, Columbus, OH USA
| | - Daniel P. Harris
- Case Western Reserve University School of Medicine, Cleveland, OH USA
| | - David Renton
- Department of General Surgery, The Ohio State University Wexner Medical Center, Columbus, OH USA
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Bradley D, Smith AJ, Blaszczak A, Shantaram D, Bergin SM, Jalilvand A, Wright V, Wyne KL, Dewal RS, Baer LA, Wright KR, Stanford KI, Needleman B, Brethauer S, Noria S, Renton D, Joseph JJ, Lovett-Racke A, Liu J, Hsueh WA. Interferon gamma mediates the reduction of adipose tissue regulatory T cells in human obesity. Nat Commun 2022; 13:5606. [PMID: 36153324 PMCID: PMC9509397 DOI: 10.1038/s41467-022-33067-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 08/31/2022] [Indexed: 11/09/2022] Open
Abstract
Decreased adipose tissue regulatory T cells contribute to insulin resistance in obese mice, however, little is known about the mechanisms regulating adipose tissue regulatory T cells numbers in humans. Here we obtain adipose tissue from obese and lean volunteers. Regulatory T cell abundance is lower in obese vs. lean visceral and subcutaneous adipose tissue and associates with reduced insulin sensitivity and altered adipocyte metabolic gene expression. Regulatory T cells numbers decline following high-fat diet induction in lean volunteers. We see alteration in major histocompatibility complex II pathway in adipocytes from obese patients and after high fat ingestion, which increases T helper 1 cell numbers and decreases regulatory T cell differentiation. We also observe increased expression of inhibitory co-receptors including programmed cell death protein 1 and OX40 in visceral adipose tissue regulatory T cells from patients with obesity. In human obesity, these global effects of interferon gamma to reduce regulatory T cells and diminish their function appear to instigate adipose inflammation and suppress adipocyte metabolism, leading to insulin resistance.
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Affiliation(s)
- David Bradley
- Diabetes and Metabolism Research Center, Division of Endocrinology, Diabetes & Metabolism, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, 43210, USA.
- Division of Endocrinology, Diabetes & Metabolism, Department of Internal Medicine, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, 17033, USA.
| | - Alan J Smith
- Diabetes and Metabolism Research Center, Division of Endocrinology, Diabetes & Metabolism, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, 43210, USA
| | - Alecia Blaszczak
- Diabetes and Metabolism Research Center, Division of Endocrinology, Diabetes & Metabolism, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, 43210, USA
| | - Dharti Shantaram
- Diabetes and Metabolism Research Center, Division of Endocrinology, Diabetes & Metabolism, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, 43210, USA
| | - Stephen M Bergin
- Diabetes and Metabolism Research Center, Division of Endocrinology, Diabetes & Metabolism, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, 43210, USA
| | - Anahita Jalilvand
- Diabetes and Metabolism Research Center, Division of Endocrinology, Diabetes & Metabolism, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, 43210, USA
| | - Valerie Wright
- Diabetes and Metabolism Research Center, Division of Endocrinology, Diabetes & Metabolism, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, 43210, USA
| | - Kathleen L Wyne
- Diabetes and Metabolism Research Center, Division of Endocrinology, Diabetes & Metabolism, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, 43210, USA
| | - Revati S Dewal
- Diabetes and Metabolism Research Center, Division of Physiology and Cell Biology, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, 43210, USA
| | - Lisa A Baer
- Diabetes and Metabolism Research Center, Division of Physiology and Cell Biology, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, 43210, USA
| | - Katherine R Wright
- Diabetes and Metabolism Research Center, Division of Physiology and Cell Biology, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, 43210, USA
| | - Kristin I Stanford
- Diabetes and Metabolism Research Center, Division of Physiology and Cell Biology, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, 43210, USA
| | - Bradley Needleman
- Center for Minimally Invasive Surgery, Department of General Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, 43210, USA
| | - Stacy Brethauer
- Center for Minimally Invasive Surgery, Department of General Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, 43210, USA
| | - Sabrena Noria
- Center for Minimally Invasive Surgery, Department of General Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, 43210, USA
| | - David Renton
- Center for Minimally Invasive Surgery, Department of General Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, 43210, USA
| | - Joshua J Joseph
- Diabetes and Metabolism Research Center, Division of Endocrinology, Diabetes & Metabolism, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, 43210, USA
| | - Amy Lovett-Racke
- Department of Microbial Immunity and Infection, The Ohio State University Wexner Medical Center, Columbus, OH, 43210, USA
| | - Joey Liu
- Diabetes and Metabolism Research Center, Division of Endocrinology, Diabetes & Metabolism, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, 43210, USA
| | - Willa A Hsueh
- Diabetes and Metabolism Research Center, Division of Endocrinology, Diabetes & Metabolism, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, 43210, USA.
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Bradley D, Blaszczak A, Yin Z, Liu J, Joseph JJ, Wright V, Anandani K, Needleman B, Noria S, Renton D, Yearsley M, Wong STC, Hsueh WA. Clusterin Impairs Hepatic Insulin Sensitivity and Adipocyte Clusterin Associates With Cardiometabolic Risk. Diabetes Care 2019; 42:466-475. [PMID: 30659075 PMCID: PMC6385696 DOI: 10.2337/dc18-0870] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Accepted: 12/19/2018] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Components of the adipose tissue (AT) extracellular matrix (ECM) are recently discovered contributors to obesity-related cardiometabolic disease. We identified increased adipocyte expression of ECM-related clusterin (apolipoprotein J) in obese versus lean women by microarray. Our objective was to determine 1) whether subcutaneous AT adipocyte (SAd) clusterin and serum clusterin are associated with insulin resistance (IR) and known markers of cardiometabolic risk and 2) how clusterin may contribute to increased risk. RESEARCH DESIGN AND METHODS We validated increased clusterin expression in adipocytes from a separate group of 18 lean and 54 obese individuals. The relationship of clusterin gene expression and plasma clusterin with IR, cardiovascular biomarkers, and risk of cardiovascular disease (CVD) was then determined. Further investigations in human cultured cells and in aged LDLR-/- mice prone to development of obesity-associated complications were performed. RESULTS SAd clusterin correlated with IR, multiple CVD biomarkers, and CVD risk, independent of traditional risk factors. Circulating human clusterin exhibited similar associations. In human adipocytes, palmitate enhanced clusterin secretion, and in human hepatocytes, clusterin attenuated insulin signaling and APOA1 expression and stimulated hepatic gluconeogenesis. LRP2 (megalin), a clusterin receptor, highly expressed in liver, mediated these effects, which were inhibited by LRP2 siRNA. In response to Western diet feeding, an increase in adipocyte clusterin expression was associated with a progressive increase in liver fat, steatohepatitis, and fibrosis in aged LDLR-/- mice. CONCLUSIONS Adipocyte-derived clusterin is a novel ECM-related protein linking cardiometabolic disease and obesity through its actions in the liver.
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Affiliation(s)
- David Bradley
- Diabetes and Metabolism Research Center, Division of Endocrinology, Diabetes and Metabolism, Department of Internal Medicine, Wexner Medical Center, The Ohio State University, Columbus, OH
| | - Alecia Blaszczak
- Diabetes and Metabolism Research Center, Division of Endocrinology, Diabetes and Metabolism, Department of Internal Medicine, Wexner Medical Center, The Ohio State University, Columbus, OH
| | - Zheng Yin
- Department of Systems Medicine and Bioengineering, Institute for Academic Medicine, Houston Methodist Hospital, Weill Cornell Medicine, Houston, TX
| | - Joey Liu
- Diabetes and Metabolism Research Center, Division of Endocrinology, Diabetes and Metabolism, Department of Internal Medicine, Wexner Medical Center, The Ohio State University, Columbus, OH
| | - Joshua J Joseph
- Diabetes and Metabolism Research Center, Division of Endocrinology, Diabetes and Metabolism, Department of Internal Medicine, Wexner Medical Center, The Ohio State University, Columbus, OH
| | - Valerie Wright
- Diabetes and Metabolism Research Center, Division of Endocrinology, Diabetes and Metabolism, Department of Internal Medicine, Wexner Medical Center, The Ohio State University, Columbus, OH
| | - Kajol Anandani
- Diabetes and Metabolism Research Center, Division of Endocrinology, Diabetes and Metabolism, Department of Internal Medicine, Wexner Medical Center, The Ohio State University, Columbus, OH
| | - Bradley Needleman
- Center for Minimally Invasive Surgery, Department of Surgery, Wexner Medical Center, The Ohio State University, Columbus, OH
| | - Sabrena Noria
- Center for Minimally Invasive Surgery, Department of Surgery, Wexner Medical Center, The Ohio State University, Columbus, OH
| | - David Renton
- Center for Minimally Invasive Surgery, Department of Surgery, Wexner Medical Center, The Ohio State University, Columbus, OH
| | - Martha Yearsley
- Department of Pathology, Wexner Medical Center, The Ohio State University, Columbus, OH
| | - Stephen T C Wong
- Department of Systems Medicine and Bioengineering, Institute for Academic Medicine, Houston Methodist Hospital, Weill Cornell Medicine, Houston, TX
| | - Willa A Hsueh
- Diabetes and Metabolism Research Center, Division of Endocrinology, Diabetes and Metabolism, Department of Internal Medicine, Wexner Medical Center, The Ohio State University, Columbus, OH
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Bradley D, Liu J, Blaszczak A, Wright V, Jalilvand A, Needleman B, Noria S, Renton D, Hsueh W. Adipocyte DIO2 Expression Increases in Human Obesity but Is Not Related to Systemic Insulin Sensitivity. J Diabetes Res 2018; 2018:2464652. [PMID: 30116736 PMCID: PMC6079440 DOI: 10.1155/2018/2464652] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 06/25/2018] [Indexed: 11/17/2022] Open
Abstract
Deiodinase type II (D2), encoded by DIO2, catalyzes the conversion of T4 to bioactive T3. T3 not only stimulates adaptive thermogenesis but also affects adipose tissue (AT) lipid accumulation, mitochondrial function, inflammation, and potentially systemic metabolism. Although better defined in brown AT, the precise role of DIO2 expression in white AT remains largely unknown, with data derived only from whole fat. Therefore, the purpose of this study was to determine whether subcutaneous (SAT) and visceral (VAT) adipocyte-specific gene expression of DIO2 differs between obese and lean patients and whether these differences relate to alterations in mitochondrial function, fatty acid flux, inflammatory cytokines/adipokines, and ultimately insulin sensitivity. Accordingly, adipocytes of 73 obese and 21 lean subjects were isolated and subjected to gene expression analyses. Our results demonstrate that obese compared to lean human individuals have increased adipocyte-specific DIO2 expression in both SAT and VAT. Although higher DIO2 was strongly related to reduced fatty acid synthesis/oxidation and mitochondrial function, we found no relationship to proinflammatory cytokines or insulin resistance and no difference based on diabetic status. Our results suggest that adipocyte-derived DIO2 may play a role in weight maintenance but is likely not a major contributor to obesity-related insulin resistance.
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Affiliation(s)
- David Bradley
- Diabetes and Metabolism Research Center, Division of Endocrinology, Diabetes & Metabolism, Department of Internal Medicine, Wexner Medical Center, Ohio State University, Columbus, OH, USA
| | - Joey Liu
- Diabetes and Metabolism Research Center, Division of Endocrinology, Diabetes & Metabolism, Department of Internal Medicine, Wexner Medical Center, Ohio State University, Columbus, OH, USA
| | - Alecia Blaszczak
- Diabetes and Metabolism Research Center, Division of Endocrinology, Diabetes & Metabolism, Department of Internal Medicine, Wexner Medical Center, Ohio State University, Columbus, OH, USA
| | - Valerie Wright
- Diabetes and Metabolism Research Center, Division of Endocrinology, Diabetes & Metabolism, Department of Internal Medicine, Wexner Medical Center, Ohio State University, Columbus, OH, USA
| | - Anahita Jalilvand
- Diabetes and Metabolism Research Center, Division of Endocrinology, Diabetes & Metabolism, Department of Internal Medicine, Wexner Medical Center, Ohio State University, Columbus, OH, USA
| | - Bradley Needleman
- Center for Minimally Invasive Surgery, Department of General Surgery, Wexner Medical Center, Ohio State University, Columbus, OH 43210, USA
| | - Sabrena Noria
- Center for Minimally Invasive Surgery, Department of General Surgery, Wexner Medical Center, Ohio State University, Columbus, OH 43210, USA
| | - David Renton
- Center for Minimally Invasive Surgery, Department of General Surgery, Wexner Medical Center, Ohio State University, Columbus, OH 43210, USA
| | - Willa Hsueh
- Diabetes and Metabolism Research Center, Division of Endocrinology, Diabetes & Metabolism, Department of Internal Medicine, Wexner Medical Center, Ohio State University, Columbus, OH, USA
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Beck C, Eakin J, Dettorre R, Renton D. Analysis of perioperative factors and cost comparison of single-incision and traditional multi-incision laparoscopic cholecystectomy. Surg Endosc 2012; 27:104-8. [PMID: 22806511 DOI: 10.1007/s00464-012-2428-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2012] [Accepted: 05/20/2012] [Indexed: 11/28/2022]
Abstract
BACKGROUND Recent technological advances in single-incision platforms have allowed many general surgeons to add single-incision laparoscopic cholecystectomy (SILC) to their armamentarium. However, adopting new surgical technologies comes at a cost to the patient and the surgeon. This study compared retrospective case-matched SILC and traditional multi-incision laparoscopic cholecystectomy (MILC) to evaluate the effects of SILC on perioperative outcomes and patient cost. METHODS The study compared 50 patients who underwent SILC with a case-matched population of individuals who underwent traditional MILC. The SILC technique was performed using one of three commercially available single-incision platforms currently used for single-incision laparoscopic surgery (SILS) cholecystectomies. All the SILS platforms were placed in a 2-cm supraumbilical incision. All statistical analyses were performed using Microsoft Excel 2008 for Macintosh, with statistical significance determined by a p value of 0.05 or less. RESULTS The average operative time was 42 min for the SILC group and 45 min for the MILC group. The difference was not statistically significant. Similarly, the average estimated blood loss was 14 ml for the SILC group and 11 ml for the MILC group. Again, the difference was not statistically significant. Moreover, the body mass index (BMI) did not differ statistically between the SILC group (28.4 kg/m(2)) and the MILC group (32.2 kg/m(2)). The average patient cost was $18,447 for SILC and $17,701 for MILC, yielding a cost difference of $746. This difference was not statistically significant. CONCLUSIONS At the authors' institution, SILS cholecystectomy was performed with blood loss, operating room time, and cost equal to that for MILC. Further research is necessary to assess the economic feasibility of SILC and the trade-off of cost with the improved cosmesis, decreased pain, greater patient satisfaction, reduced postoperative analgesic requirement, and faster return to work to determine the overall value and superiority of SILC compared with MILC.
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Affiliation(s)
- Catherine Beck
- Department of Surgery, Center for Minimally Invasive Surgery, The Ohio State University, Columbus, OH 43210, USA.
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Abstract
Ventral hernias, whether naturally occurring or the result of previous surgery, comprise one of the most common problems confronting general surgeons. As many as 25% of laparotomy incisions develop a hernia over long-term follow-up, which is a difficult problem with many treatment algorithms. Laparoscopic ventral hernia repair has improved over the last decade and has proven to be an effective treatment option. With fewer wound complications and low recurrence rates, it is a useful tool in the surgeon's armamentarium. Care should be taken regarding patient selection, operative technique, and mesh size to ensure adequate repair of the hernia, thereby preventing recurrence at a later date. The first attempt at a hernia repair has the highest chance of long-term success, so it is important that the surgeon take all the factors into mind before proceeding with operative repair.
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Affiliation(s)
- W Scott Melvin
- Department of Surgery, The Ohio State University, 395 West 12th Avenue, Columbus, OH 43210-1267, USA
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10
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Finan KR, Renton D, Vick CC, Hawn MT. Prevention of post-operative leak following laparoscopic Heller myotomy. J Gastrointest Surg 2009; 13:200-5. [PMID: 18781365 DOI: 10.1007/s11605-008-0687-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2008] [Accepted: 08/20/2008] [Indexed: 01/31/2023]
Abstract
PURPOSE Laparoscopic Heller myotomy is the preferred treatment for achalasia. Post-operative leaks cause significant morbidity and impair functional outcome. This study assesses the efficacy of intra-operative leak testing on post-operative leak rate. METHODS A retrospective analysis of 106 consecutive patients undergoing laparoscopic Heller myotomy by a single surgeon between November 2001 and August 2006 was undertaken. Intra-operative leak testing was performed in all patients. Variables associated with intra-operative mucosotomy were assessed by univariate analysis and logistic regression modeling. RESULTS Intra-operative mucosotomy occurred in 25% of patients. All mucosotomies were repaired primarily and tested with methylene-blue-stained saline. Dor fundoplication was performed in 74% of the patients. There were no post-operative leaks and patients were started on diet day of surgery. Mean LOS was 1.4(+/-0.7) days. Logistic regression modeling demonstrated that prior myotomy was associated with a statistically significant increase in the rate of mucosotomy (p = 0.033), while previous botox injection (p = 0.193), pneumatic dilation (p = 0.599) or concomitant hiatal hernia (p = 0.874) were not significantly associated with mucosotomy. CONCLUSION Laparoscopic Heller myotomy for the treatment of achalasia is a safe procedure. Intra-operative leak testing minimizes the risk of post-operative leaks and expedites post-operative management. Prior endoscopic treatment does not impair operative results.
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Affiliation(s)
- Kelly R Finan
- Section of Gastrointestinal Surgery, Department of Surgery, University of Alabama at Birmingham, KB 417 1530 3rd Ave S, Birmingham, AL 35294, USA
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11
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Renton D. Sidney Pollard: The refugee historian. Immigrants & Minorities 2002. [DOI: 10.1080/02619288.2002.9975037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- David Renton
- a Senior Research Fellow at Sunderland University ,
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12
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Guillebaud J, Renton D, Greenwood JJ, Jackson LN, Jain S. Population policy. Lancet 1971; 1:917-8. [PMID: 4102065 DOI: 10.1016/s0140-6736(71)92486-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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13
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Renton D. The outlook for the mentally retarded. (a). Parents' choice. R Soc Health J 1970; 90:302-5. [PMID: 5492745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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