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Oikonomou P, Nikolaou C, Papachristou F, Sovatzidis A, Lambropoulou M, Giouleka C, Kontaxis V, Linardoutsos D, Papalois A, Pitiakoudis M, Tsaroucha A. Eugenol Reduced ΜPO, CD45 and HMGB1 Expression and Attenuated the Expression of Leukocyte Infiltration Markers in the Intestinal Tissue in Biliopancreatic Duct Ligation-Induced Pancreatitis in Rats. Medicina (Kaunas) 2023; 60:74. [PMID: 38256335 PMCID: PMC10820626 DOI: 10.3390/medicina60010074] [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] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 11/30/2023] [Accepted: 12/26/2023] [Indexed: 01/24/2024]
Abstract
Background and Objectives: Inflammation and dysregulation in the intestinal barrier function in acute pancreatitis (AP) trigger pancreatic lesions, systemic inflammatory response, and multiple organ dysfunction. Eugenol, as the main component of clove (Syzygium aromaticum), is known for its antioxidant and anti-inflammatory properties. We studied the potentially beneficial effect of eugenol in a rodent model of biliopancreatic duct ligation-induced AP. Materials and Methods: Rats were randomly divided into three groups: Sham, AP, and AP + eugenol (15 mg/kg/day). Serum TNFα, IL-6, IL-18, and resistin levels, as well as IL-6, TNFα, MPO, HMGB1, and CD45 tissue expression, were determined at various timepoints after the induction of AP. Results: Eugenol attenuated hyperemia and inflammatory cell infiltration in the intestinal mucosal, submucosal, and muscular layers. IL-6 and resistin serum levels were significantly reduced in the AP + eugenol group, while serum TNFα and IL-18 levels remained unaffected overall. TNFα pancreatic and intestinal expression was attenuated by eugenol at 72 h, while IL-6 expression was affected only in the pancreas. MPO, CD45, and HMGB1 intestinal expression was significantly reduced in eugenol-treated rats. Conclusions: Eugenol managed to attenuate the inflammatory response in the intestine in duct ligation-induced AP in rats.
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Affiliation(s)
- Panagoula Oikonomou
- Postgraduate Program in Hepatobiliary and Pancreatic Surgery, 2nd Department of Surgery, Faculty of Medicine, Democritus University of Thrace, 68100 Alexandroupolis, Greece; (A.S.); (C.G.); (V.K.); (D.L.); (M.P.); (A.T.)
- Laboratory of Experimental Surgery and Surgical Research, Faculty of Medicine, Democritus University of Thrace, 68100 Alexandroupolis, Greece; (C.N.); (F.P.)
| | - Christina Nikolaou
- Laboratory of Experimental Surgery and Surgical Research, Faculty of Medicine, Democritus University of Thrace, 68100 Alexandroupolis, Greece; (C.N.); (F.P.)
| | - Fotini Papachristou
- Laboratory of Experimental Surgery and Surgical Research, Faculty of Medicine, Democritus University of Thrace, 68100 Alexandroupolis, Greece; (C.N.); (F.P.)
| | - Apostolos Sovatzidis
- Postgraduate Program in Hepatobiliary and Pancreatic Surgery, 2nd Department of Surgery, Faculty of Medicine, Democritus University of Thrace, 68100 Alexandroupolis, Greece; (A.S.); (C.G.); (V.K.); (D.L.); (M.P.); (A.T.)
| | - Maria Lambropoulou
- Laboratory of Histology-Embryology, Faculty of Medicine, Democritus University of Thrace, 68100 Alexandroupolis, Greece;
| | - Charikleia Giouleka
- Postgraduate Program in Hepatobiliary and Pancreatic Surgery, 2nd Department of Surgery, Faculty of Medicine, Democritus University of Thrace, 68100 Alexandroupolis, Greece; (A.S.); (C.G.); (V.K.); (D.L.); (M.P.); (A.T.)
| | - Vasileios Kontaxis
- Postgraduate Program in Hepatobiliary and Pancreatic Surgery, 2nd Department of Surgery, Faculty of Medicine, Democritus University of Thrace, 68100 Alexandroupolis, Greece; (A.S.); (C.G.); (V.K.); (D.L.); (M.P.); (A.T.)
| | - Dimitrios Linardoutsos
- Postgraduate Program in Hepatobiliary and Pancreatic Surgery, 2nd Department of Surgery, Faculty of Medicine, Democritus University of Thrace, 68100 Alexandroupolis, Greece; (A.S.); (C.G.); (V.K.); (D.L.); (M.P.); (A.T.)
| | - Apostolos Papalois
- Experimental Research Center, ELPEN Pharmaceuticals, Pikermi, 19009 Athens, Greece;
| | - Michael Pitiakoudis
- Postgraduate Program in Hepatobiliary and Pancreatic Surgery, 2nd Department of Surgery, Faculty of Medicine, Democritus University of Thrace, 68100 Alexandroupolis, Greece; (A.S.); (C.G.); (V.K.); (D.L.); (M.P.); (A.T.)
| | - Alexandra Tsaroucha
- Postgraduate Program in Hepatobiliary and Pancreatic Surgery, 2nd Department of Surgery, Faculty of Medicine, Democritus University of Thrace, 68100 Alexandroupolis, Greece; (A.S.); (C.G.); (V.K.); (D.L.); (M.P.); (A.T.)
- Laboratory of Experimental Surgery and Surgical Research, Faculty of Medicine, Democritus University of Thrace, 68100 Alexandroupolis, Greece; (C.N.); (F.P.)
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Kitridis D, Savvidis P, Cheva A, Papalois A, Givissis P, Chalidis B. Are Absorbable Plates More Resistant to Infection Than Titanium Implants? An Experimental Pre-Clinical Trial in Rabbits. J Funct Biomater 2023; 14:498. [PMID: 37888163 PMCID: PMC10607271 DOI: 10.3390/jfb14100498] [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: 08/18/2023] [Revised: 09/17/2023] [Accepted: 10/07/2023] [Indexed: 10/28/2023] Open
Abstract
Background: Infection of orthopaedic implants after internal fixation of bone fractures remains a major complication with occasionally devastating consequences. Recent studies have reported that the use of absorbable materials, instead of metallic ones, may lead to a lower incidence of postoperative infection. In this experimental pre-clinical animal study, we compared the infection rate between absorbable implants consisting of copolymers composed from trimethylene carbonate, L-polylactic acid, and D, L-polylactic acid monomers, and titanium implants after the inoculation of a pathogenic microorganism. Material and Methods: We used an experimental implant-related infection model in rabbits. Sixty animals were randomly and equally divided into two groups. In all animals, the right femur was exposed via a lateral approach and a 2.5 mm two-hole titanium plate with screws (Group A), or a two-hole absorbable plate and screws (Group B), were applied in the femoral shaft. Afterwards, the implant surface was inoculated with Pseudomonas Aeruginosa at a concentration of 2 × 108 CFU/mL. The primary outcome was the comparison of the incidence of developed infection between the two groups. The wound condition was monitored on a daily basis and radiographies were obtained at 12 weeks postoperatively. Infection-related laboratory markers (white blood cell count, erythrocyte sedimentation rate, and C-reactive protein values) were assessed at 3, 6, and 16 weeks postoperatively. Histologic analysis and cultures of tissue samples were also performed to evaluate the presence of infection. Results: Clinical and laboratory signs of infection were evident in 11 rabbits in Group A (36.7%), and 4 in Group B (13.3%). The difference between the groups was statistically significant (p = 0.04). Five animals in Group B (16.7%) had clinical and histologic signs of a foreign-body reaction with significantly elevated CRP and ESR values but no simultaneous presence of infection was identified (p = 0.04). Bone remodelling with thickening of the periosteum and surrounding sclerosis was demonstrated radiologically in animals developing infection or foreign-body reactions. Conclusions: Absorbable plates and screws show lower susceptibility to infection compared to titanium ones. However, their application is associated with foreign-body reaction and the potential need for a second surgical intervention.
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Affiliation(s)
- Dimitrios Kitridis
- 1st Orthopaedic Department, School of Medicine, Faculty of Health Science, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece; (D.K.); (P.S.); (P.G.)
| | - Panagiotis Savvidis
- 1st Orthopaedic Department, School of Medicine, Faculty of Health Science, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece; (D.K.); (P.S.); (P.G.)
| | - Angeliki Cheva
- Department of Pathology, School of Medicine, Faculty of Health Science, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece;
| | | | - Panagiotis Givissis
- 1st Orthopaedic Department, School of Medicine, Faculty of Health Science, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece; (D.K.); (P.S.); (P.G.)
| | - Byron Chalidis
- 1st Orthopaedic Department, School of Medicine, Faculty of Health Science, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece; (D.K.); (P.S.); (P.G.)
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Mantelou AG, Barbouti A, Goussia A, Zacharioudaki A, Papoudou-Bai A, Vlachou C, Kokkoris S, Papalois A, Galaris D, Glantzounis GK. Combined administration of membrane-permeable and impermeable iron-chelating drugs attenuates ischemia/reperfusion-induced hepatic injury. Free Radic Biol Med 2022; 193:227-237. [PMID: 36243210 DOI: 10.1016/j.freeradbiomed.2022.10.266] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 10/07/2022] [Accepted: 10/07/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND The underlying pathophysiological mechanisms of hepatic ischemia-reperfusion (I/R) injury have not been completely elucidated. However, it is well known that oxidative stress, caused by a burst of reactive oxygen species (ROS) production during the reperfusion phase, plays a crucial role. A growing body of evidence indicates that the intracellular availability of free iron represents a requirement for ROS-induced adverse effects, as iron catalyzes the generation of highly reactive free radicals. The aim of this study was to examine whether a combination of iron chelators with varying lipophilicity could offer enhanced protection against I/R by diminishing the conversion of weak oxidants, like H2O2, to extremely reactive ones such as hydroxyl radicals (HO.). METHODS HepG2 cells (hepatocellular carcinoma cell line) were exposed to oxidative stress conditions after pre-treatment with the iron chelators desferrioxamine (DFO) and deferiprone (DFP) alone or in combination. Labile iron pool was estimated using the calcein-acetoxymethyl ester (calcein-AM) method and DNA damage with the comet assay. We subsequently used a rabbit model (male New Zealand white rabbits) of hepatic I/R-induced injury to investigate, by measuring biochemical (ALT, ALT, ALP, γGT) and histological parameters, whether this may be true for in vivo conditions. RESULTS The combination of a membrane-permeable iron chelator (DFP) with a strong membrane-impermeable one (DFO) raises the level of protection in both hepatic cell lines exposed to oxidative stress conditions and hepatic I/R rabbit model. CONCLUSIONS Our results show that combinations of iron chelators with selected lipophilicity and iron-binding properties may represent a valuable strategy to protect against tissue damage during reperfusion after a period of ischemia.
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Affiliation(s)
- Athina G Mantelou
- HPB Unit, Department of Surgery, University Hospital of Ioannina and Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, 45110, Greece
| | - Alexandra Barbouti
- Department of Anatomy-Histology-Embryology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, 45110, Greece
| | - Anna Goussia
- Department of Pathology, University Hospital of Ioannina and Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, 45110, Greece
| | | | - Alexandra Papoudou-Bai
- Department of Pathology, University Hospital of Ioannina and Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, 45110, Greece
| | - Chara Vlachou
- Laboratory of Biological Chemistry, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, 45110, Greece
| | - Stelios Kokkoris
- First Department of Critical Care, School of Medicine, National and Kapodistrian University of Athens, Athens, 10676, Greece
| | - Apostolos Papalois
- Experimental, Educational and Research Center ELPEN, Athens, 19009, Greece; European University of Cyprus, School of Medicine, Nicosia, 2404, Cyprus
| | - Dimitrios Galaris
- Laboratory of Biological Chemistry, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, 45110, Greece
| | - Georgios K Glantzounis
- HPB Unit, Department of Surgery, University Hospital of Ioannina and Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, 45110, Greece.
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Rallis KS, Wozniak A, Hui S, Stammer A, Cinar C, Sun M, Fulton-Ward T, Clarke AA, Papagrigoriadis S, Papalois A, Sideris MC. Mentoring Medical Students Towards Oncology: Results from a Pilot Multi-institutional Mentorship Programme. J Cancer Educ 2022; 37:1053-1065. [PMID: 33242159 PMCID: PMC7688447 DOI: 10.1007/s13187-020-01919-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/01/2020] [Indexed: 06/02/2023]
Abstract
The mounting global cancer burden has generated an increasing demand for oncologists to join the workforce. Yet, students report limited oncology exposure in undergraduate medical curricula, while undergraduate oncology mentorships remain underutilised. We established an undergraduate oncology society-led mentorship programme aimed at medical students across several UK universities to increase medical student oncology exposure. We electronically recruited and paired oncologist mentors and medical student mentees and distributed a dedicated questionnaire (pre- and post-mentorship) to compare mentees' self-reported cancer specialty knowledge and oncology career motivation after undertaking a 6-week mentorship. We also determined students' interest across specialties and subspecialties and measured mentor availability via percentage programme uptake. Statistical analysis included univariate inferential tests on SPSS software. Twentynine (23.4%) of 124 oncology specialists agreed to become mentors. The mentorship was completed by 30 students across three medical schools: 16 (53.3%) Barts, 10 (33.3%) Birmingham, and 4 (13.3%) King's; 11 (36.7%) mentored by medical oncologists, 10 (33.3%) by clinical/radiation oncologists, and 9 (30%) by surgical oncologists. The mentorship generated a statically significant increase in students' knowledge of the multidisciplinary team and all oncology-related specialties including academia/research but not interest towards a career in oncology. Undergraduate oncology mentoring is an effective educational, networking and motivational tool for medical students. Student societies are a valuable asset in cultivating medical student oncology interest by connecting students to faculty and increasing mentor accessibility. Further research should focus on developing an optimal mentorship structure and evaluating long-term outcomes of such educational initiatives.
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Affiliation(s)
- Kathrine S Rallis
- Barts Cancer Institute, Queen Mary University of London, London, UK.
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
| | - Anna Wozniak
- Barts Cancer Institute, Queen Mary University of London, London, UK
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Sara Hui
- Barts Cancer Institute, Queen Mary University of London, London, UK
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Adam Stammer
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Cigdem Cinar
- Birmingham Medical School, University of Birmingham, Birmingham, UK
| | - Min Sun
- Birmingham Medical School, University of Birmingham, Birmingham, UK
| | | | - Alison A Clarke
- Guy's, King's and St Thomas' School of Medicine, King's College London, London, UK
| | | | | | - Michail Ch Sideris
- Women's Health Research Unit, Queen Mary University of London, London, UK
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Emin EI, Emin E, Bimpis A, Pierides M, Dedeilia A, Javed Z, Rallis KS, Saeed F, Theophilou G, Karkanevatos A, Kitapcioglu D, Aksoy ME, Papalois A, Sideris M. Teaching and Assessment of Medical Students During Complex Multifactorial Team-Based Tasks: The "Virtual on Call" Case Study. Adv Med Educ Pract 2022; 13:457-465. [PMID: 35547870 PMCID: PMC9084906 DOI: 10.2147/amep.s357514] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 03/31/2022] [Indexed: 06/15/2023]
Abstract
Abstract Although considerable efforts have been made to incorporate simulation-based learning (SBL) in undergraduate medical education, to date, most of the medical school curricula still focus on pure knowledge or individual assessment of objective structured clinical examination skills (OSCE). To this end, we designed a case study named "iG4 (integrated generation 4) virtual on-call (iVOC)". We aimed to simulate an on-call shift in a high-fidelity virtual hospital setting in order to assess delegates' team-based performance on tasks related to patient handovers (prioritisation, team allocation). Methods A total of 41 clinical year medical students were split into 3 cohorts, each of which included 3 groups of 4 or 5 people. The groups consisted of a structured mix of educational and cultural backgrounds of students to achieve homogeneity. Each performing group received the handover for 5 patients in the virtual hospital and had to identify and deal with the acutely unwell ones within 15 minutes. We used TEAMTM tool to assess team-based performances. Results The mean handover performance was 5.44/10 ± 2.24 which was the lowest across any performance marker. The overall global performance across any team was 6.64/10 ± 2.11. The first rotating team's global performance for each cycle was 6.44/10 ± 2.01, for the second 7.89/10 ± 2.09 and for the third 6.78/10 ± 1.64 (p = 0.099 between groups). Conclusion This is one of the first reported, high-fidelity, globally reproducible SBL settings to assess the capacity of students to work as part of a multinational team, highlighting several aspects that need to be addressed during undergraduate studies. Medical schools should consider similar efforts with the aim to incorporate assessment frameworks for individual performances of students as part of a team, which can be a stepping-stone for enhancing safety in clinical practice.
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Affiliation(s)
- Elif Iliria Emin
- Department of Acute Medicine, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Ece Emin
- EGA Institute for Women’s Health, University College London, London, UK
| | - Alexios Bimpis
- Department of Neurosurgery, Tzaneio General Hospital, Piraeus, Greece
| | - Michael Pierides
- Department of Acute Medicine, Kettering General Hospital NHS Trust, Northamptonshire, UK
| | - Aikaterini Dedeilia
- School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Zibad Javed
- Faculty of Medicine and Dentistry, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Kathrine-Sofia Rallis
- Faculty of Medicine and Dentistry, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Ferha Saeed
- Faculty of Medicine and Dentistry, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Georgios Theophilou
- Department of Gynaecological Oncology, St James Institute of Oncology, Leeds, UK
| | | | - Dilek Kitapcioglu
- Center of Advanced Simulation and Education, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | - Mehmet Emin Aksoy
- Center of Advanced Simulation and Education, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | - Apostolos Papalois
- Special Unit for Biomedical Research and Education, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Michail Sideris
- Faculty of Medicine and Dentistry, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
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Kapoulas S, Papalois A, Papadakis G, Tsoulfas G, Christoforidis E, Papaziogas B, Schizas D, Chatzimavroudis G. Safety and efficacy of absorbable and non-absorbable fixation systems for intraperitoneal mesh fixation: an experimental study in swine. Hernia 2022; 26:567-579. [PMID: 33400026 DOI: 10.1007/s10029-020-02352-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 09/13/2020] [Accepted: 12/02/2020] [Indexed: 02/05/2023]
Abstract
PURPOSE Choice of the best possible fixation system in terms of safety and effectiveness for intraperitoneal mesh placement in hernia surgery remains controversial. The aim of the present study was to compare the performance of four fixation systems in a swine model of intraperitoneal mesh fixation. METHODS Fourteen Landrace swine were utilized in the study. The experiment included two stages. Initially, four pieces of mesh (Ventralight ™ ST) sizing 10 × 5 cm were placed and fixed intraperitoneally to reinforce 4 small full thickness abdominal wall defects created with diathermy. These defects were repaired primarily with absorbable suture before mesh implantation. Each mesh was anchored with a different tack device between Absorbatack™, Protack™, Capsure™, or Optifix™. The second stage took place after 60 days and included euthanasia, laparoscopy, and laparotomy via U-shaped incision to obtain the measurements for the outcome parameters. The primary endpoint of the study was to compare the peel strength of the compound tack/mesh from the abdominal wall. Secondary parameters were the extent and quality of visceral adhesions to the mesh, the degree of mesh shrinkage and the histological response around the tacks. RESULTS Thirteen out of 14 animals survived the experiment and 10 were included in the final analysis. Capsure™ tacks had higher peel strength when compared to Absorbatack™ (p = 0.028); Protack™ (p = 0.043); and Optifix™ (p = 0.009). No significant differences were noted regarding the extent of visceral adhesions (Friedman's test p value 0.854), the adhesion quality (Friedman's test p value 0.506), or the mesh shrinkage (Friedman's test p value = 0.827). Four out of the ten animals developed no adhesions at all 2 months after implantation. CONCLUSION Capsure™ fixation system provided higher peel strength that the other tested devices in our swine model of intraperitoneal mesh fixation. Our findings generate the hypothesis that this type of fixation may be superior in a clinical setting. Clinical trials with long-term follow-up are required to assess the safety and efficacy of mesh fixation systems in hernia surgery.
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Affiliation(s)
- S Kapoulas
- 2nd Department of Surgery, Aristotle University of Thessaloniki, G. Gennimatas General Hospital, Thessaloniki, Greece.
- Department of Upper Gastrointestinal and Bariatric Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
- , Flat 318, Centenary Plaza, 18 Holliday Street, Birmingham, B11TW, UK.
| | - A Papalois
- ELPEN Pharmaceuticals Research and Experimental Centre, Pikermi, Greece
| | - G Papadakis
- Department of Renal Transplant and Access Surgery, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - G Tsoulfas
- 1st Department of Surgery, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki, Greece
| | - E Christoforidis
- 2nd Department of Surgery, Aristotle University of Thessaloniki, G. Gennimatas General Hospital, Thessaloniki, Greece
| | - B Papaziogas
- 2nd Department of Surgery, Aristotle University of Thessaloniki, G. Gennimatas General Hospital, Thessaloniki, Greece
| | - D Schizas
- 1st Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - G Chatzimavroudis
- 2nd Department of Surgery, Aristotle University of Thessaloniki, G. Gennimatas General Hospital, Thessaloniki, Greece
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Sakarellos P, Papalois A, Gakiopoulou H, Zacharioudaki I, Katsimpoulas M, Belia M, Moris D, Aggelou K, Vagios I, Davakis S, Vailas M, Liakakos T, Diamantis T, Felekouras E, Kontos M. Growth of Intestinal Neomucosa on Pedicled Gastric Wall Flap, a Novel Technique in an Animal Model. J INVEST SURG 2022; 35:1329-1339. [PMID: 35196939 DOI: 10.1080/08941939.2022.2034196] [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] [Indexed: 10/19/2022]
Abstract
Background: Short bowel syndrome (SBS) remains an unsolved issue in modern medicine. Numerous experimental surgical techniques have been proposed in the attempt to increase the intestinal absorptive capacity.Materials and Methods: Ten female Landrace pigs, divided in two groups of 5 (A and B), were explored through a midline incision. A spindle-shaped vascularized full-thickness gastric wall flap (GWF) consisting of part of the major curvature with the gastroepiploic arch preserved was de-epithelialized and then placed as a "patch" to cover an antimesenteric border defect of either a nonfunctional blind intestinal loop (group A) or a functional intestinal loop of the gastrointestinal tract (group B). A spindle-shaped curved, rigid, low density polyethylene (LDPE) splint was sutured on the external surface of the patch in order to prevent shrinkage of GWF and collapse of the intestinal wall in group A.Results: There was a decrease of both dimensions of the patch. Microscopically a thin layer of columnar epithelial cells covered the center of the patch, evolving in shorter, blunt, poorly developed villi with increasing maturation laterally. The patch surface was covered by nearly 90%. In the three animals that died prematurely the coverage of GWF was negligent or suboptimal directly dependent on the length of survival.Conclusions: The hereby-described patching technique demonstrated the growth of intestinal neomucosa on the GWF. The capability of the stomach to provide large flaps and the advantages of the use of native tissues render this animal model valuable for the future research in the field.
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Affiliation(s)
- Panagiotis Sakarellos
- First Department of Surgery, Laiko General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Harikleia Gakiopoulou
- First Department of Pathology, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Iro Zacharioudaki
- Experimental, Educational and Research Centre, ELPEN, Athens, Greece
| | - Michalis Katsimpoulas
- Experimental Surgery Unit, Center of Clinical, Experimental Surgery and Translational Research, Βιοmedical Research Foundation of the Academy of Athens, Athens, Greece
| | - Marina Belia
- Department of Haematology and Bone Marrow Transplantation, Laiko General Hospital, National and Kapodistrian University of Athens, Athens Greece
| | - Dimitrios Moris
- First Department of Surgery, Laiko General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Kyveli Aggelou
- Department of Obstetrics and Gynecology, Alexandra Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Ilias Vagios
- First Department of Surgery, Laiko General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Spiridon Davakis
- First Department of Surgery, Laiko General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Michail Vailas
- First Department of Surgery, Laiko General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Theodoros Liakakos
- First Department of Surgery, Laiko General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Theodoros Diamantis
- First Department of Surgery, Laiko General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Evangelos Felekouras
- First Department of Surgery, Laiko General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Michael Kontos
- First Department of Surgery, Laiko General Hospital, National and Kapodistrian University of Athens, Athens, Greece
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Gerogiannis I, Papalois A, Psalla D, Kambaroudis A. Beneficiary Effect of Fibrin Glue on Healing of Ileoileal Anastomoses in Rats. In Vivo 2022; 36:221-226. [PMID: 34972718 DOI: 10.21873/invivo.12694] [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: 11/13/2021] [Revised: 11/29/2021] [Accepted: 11/30/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM Intestinal anastomosis' integrity is crucial in surgery. This study aimed to investigate whether fibrin glue (FG) (a fibrin sealant containing human factor XII and fibrinogen) has a positive effect on the healing and the integrity of the ileoileal anastomosis in rats. MATERIALS AND METHODS Twenty Wistar rats underwent enterotomy, ileoileal anastomosis and divided into four groups (A: complete anastomosis-no FG, B: complete anastomosis-FG, C: incomplete anastomosis-no FG, D: incomplete anastomosis-FG). Data included leak, adhesions, bursting pressure of the anastomosis, neoangiogenesis, and hydroxyproline levels. RESULTS Angiogenesis was significantly higher in group B compared to group A (p=0.019). There were no significant differences between groups A and B regarding adhesions, hydroxyproline, and bursting pressure (p=0.500, p=0.158 and p=0.829, respectively). Hydroxyproline levels were higher in group D compared to C, but did not reach significance (p=0.098). CONCLUSION Fibrin glue has a positive effect on ileoileal anastomoses. It is not entirely clear whether this effect is due to mechanical support or to the facilitation of the healing process or both. Further research is needed before FG can be applied to humans.
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Affiliation(s)
- Ioannis Gerogiannis
- Department of Surgery, Kingston Hospital NHS Foundation Trust, London, U.K.;
| | | | - Dimitra Psalla
- Laboratory of Pathology, School of Veterinary Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
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9
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Mantelou AG, Zacharioudaki A, Pappas-Gogos G, Papalois A, Papoudou-Bai A, Goussia A, Glantzounis GK. Description of a Recovery Model in Rabbits for the Study of the Late Phase of Liver Ischemia-Reperfusion Injury. In Vivo 2022; 36:153-160. [PMID: 34972710 DOI: 10.21873/invivo.12686] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 08/23/2021] [Revised: 09/23/2021] [Accepted: 09/29/2021] [Indexed: 11/10/2022]
Abstract
AIM Description of an anesthetic recovery model with endotracheal intubation in rabbits which provides metabolic stability for the study of the late phase of liver ischemia/reperfusion (I/R) injury. MATERIALS AND METHODS Two groups of New Zealand rabbits, n=7 in each, were used: Ischemia/reperfusion (I/R) group (45 min of partial liver ischemia/reperfusion) and no intervention (sham) group. Blood alanine aminotransferase, lactate, pH values, mean arterial pressure and pCO2 were calculated at baseline, and at 2 and 24 h post reperfusion. Tissue samples from left (ischemic) and right (non-ischemic) liver lobes were examined at 2 and 24 h after reperfusion. RESULTS The I/R group presented significantly higher levels of alanine aminotransferase (p=0.001) at 2 and 24 h, and of lactate (p=0.016) at 2 h post reperfusion. No differences were documented for pH, mean arterial pressure and pCO2 Histological exanimation revealed significant injury at 24 h post reperfusion for the I/R group. CONCLUSION This anesthetic recovery model permitted avoidance of hypoxia and respiratory acidosis, allowing the study of the late phase of I/R injury.
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Affiliation(s)
- Athina G Mantelou
- Department of Surgery, University Hospital of Ioannina and School of Medicine, University of Ioannina, Ioannina, Greece
| | | | - George Pappas-Gogos
- Department of Surgery, University Hospital of Ioannina and School of Medicine, University of Ioannina, Ioannina, Greece
| | - Apostolos Papalois
- Experimental, Educational and Research Center ELPEN, Athens, Greece.,European University Cyprus, School of Medicine, Nicosia, Cyprus
| | - Alexandra Papoudou-Bai
- Department of Pathology, Ioannina University Hospital and School of Medicine, University of Ioannina, Ioannina, Greece
| | - Anna Goussia
- Department of Pathology, Ioannina University Hospital and School of Medicine, University of Ioannina, Ioannina, Greece
| | - Georgios K Glantzounis
- Department of Surgery, University Hospital of Ioannina and School of Medicine, University of Ioannina, Ioannina, Greece;
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10
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Lymperopoulos NS, Sideris M, Sofos S, Zografos C, Nanidis T, Manjumder S, Shokrollahi K, Zografos G, Papalois A. A novel plastic surgery simulation model for medical students. J Plast Reconstr Aesthet Surg 2021; 75:1261-1282. [PMID: 35034790 DOI: 10.1016/j.bjps.2021.11.072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 04/24/2021] [Accepted: 11/12/2021] [Indexed: 10/19/2022]
Affiliation(s)
| | - Michail Sideris
- Women's Health Research Unit, Queen Mary University of London, London, UK
| | - Stratos Sofos
- St Andrew's Centre for Plastic Surgery, Mid Essex Hospitals NHS Trust, Chelmsford, UK
| | | | - Theodore Nanidis
- Department of Plastic Surgery, The Royal Marsden Hospital NHS Trust, London, UK
| | - Sanjib Manjumder
- Department of Plastic Surgery, Pinderfields Hospital, Yorkshire, UK
| | - Kayvan Shokrollahi
- Mersey Regional Centre for Burns and Plastic Surgery, Whiston Hospital, Liverpool, UK; University of Liverpool, Merseyside, UK; Edge Hill University, Ormskirk, UK
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11
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Kapoulas S, Papalois A, Papadakis G, Tsoulfas G, Christoforidis E, Papaziogas B, Schizas D, Chatzimavroudis G. P049 SAFETY AND EFFICACY OF ABSORBABLE AND NON-ABSORBABLE FIXATION SYSTEMS FOR INTRAPERITONEAL MESH FIXATION: AN EXPERIMENTAL STUDY IN SWINE. Br J Surg 2021. [DOI: 10.1093/bjs/znab395.045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Aim
Choice of the best fixation system in terms of safety and effectiveness for intraperitoneal mesh placement in hernia surgery remains controversial. The aim of this study was to compare the performance of four fixation systems in a swine model of intraperitoneal mesh fixation.
Material and Methods
Fourteen Landrace swine were utilized and the experiment included two stages. Initially, four pieces of polypropylene mesh with hydrogel barrier coating1 were fixed intraperitoneally to reinforce 4 small full thickness abdominal wall defects created with diathermy. Each mesh was anchored with a different tack device between titanium2, steel3 or absorbable (4,5) fasteners. The second stage took place after 60 days and included euthanasia, laparoscopy, and laparotomy. The primary endpoint was to compare the peel strength of the compound tack/mesh from the abdominal wall. Secondary parameters were the extent and quality of visceral adhesions to the mesh, the degree of mesh shrinkage and the histological response around the tacks.
Results
Thirteen out of 14 animals survived the experiment and 10 were included in the final analysis. Steel tacks had higher peel strength when compared to titanium and absorbable fasteners. No significant differences were noted regarding the secondary endpoints.
Conclusions
Steel fasteners provided higher peel strength that the other devices in this swine model of intraperitoneal mesh fixation. Our findings generate the hypothesis that this type of fixation may be superior in a clinical setting. Clinical trials with long-term follow-up are required to assess the safety and efficacy of mesh fixation systems in hernia surgery.
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Affiliation(s)
- Spyridon Kapoulas
- University Hospitals Birmingham, General and Upper Gi Surgery, Birmingham, United Kingdom
| | | | - Georgios Papadakis
- Guy's and St. Thomas' NHS Foundation Trust, Renal Transplant and Access Surgery, London, United Kingdom
| | - Georgios Tsoulfas
- Aristotle University of Thessaloniki, 1st Department of Surgery - Papageorgiou General Hospital, Thessaloniki, Greece
| | - Emmanouil Christoforidis
- Aristotle University of Thessaloniki, 2nd Department of Surgery - G. Gennimatas General Hospital, Thessaloniki, Greece
| | - Basileios Papaziogas
- Aristotle University of Thessaloniki, 2nd Department of Surgery - G. Gennimatas General Hospital, Thessaloniki, Greece
| | - Dimitrios Schizas
- National and Kapodistrian University of Athens, 1st Department of Surgery - Laikon General Hospital, Athens, Greece
| | - Grigorios Chatzimavroudis
- Aristotle University of Thessaloniki, 2nd Department of Surgery - G. Gennimatas General Hospital, Thessaloniki, Greece
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12
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Sideris M, Hanrahan JG, Nicolaides M, Jagiello J, Rallis KS, Emin E, Theodorou E, Mallick R, Odejinmi F, Lymperopoulos N, Papalois A, Tsoulfas G. In vivo Simulation-Based Learning for Undergraduate Medical Students: Teaching and Assessment [Response to Letter]. Adv Med Educ Pract 2021; 12:1221-1222. [PMID: 34703352 PMCID: PMC8526365 DOI: 10.2147/amep.s342865] [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] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 10/05/2021] [Indexed: 02/05/2023]
Affiliation(s)
- Michail Sideris
- Women's Health Research Unit, Queen Mary University of London, London, UK
| | | | - Marios Nicolaides
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | | | - Kathrine S Rallis
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Elif Emin
- Women's Health Research Unit, Queen Mary University of London, London, UK
| | - Efthymia Theodorou
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Rebecca Mallick
- Princess Royal Hospital, Brighton and Sussex University Hospitals NHS Trust, Haywards Heath, UK
| | - Funlayo Odejinmi
- Whipps Cross University Hospital, Barts Health NHS Trust, London, UK
| | | | - Apostolos Papalois
- Special Unit for Biomedical Research and Education, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - George Tsoulfas
- Department of Surgery, Aristotle University of Thessaloniki, Thessaloniki, Greece
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13
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Douvanas A, Kalafati M, Tamvaki E, Nieri A, Papalois A, Koulouglioti C, Aggelina A, Papathanassoglou E. Ventilation With or Without Endotracheal Tube Leak in Prolonged Neonatal Asphyxia. Cureus 2021; 13:e17798. [PMID: 34660008 PMCID: PMC8496741 DOI: 10.7759/cureus.17798] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2021] [Indexed: 11/05/2022] Open
Abstract
Background Severe and prolonged asphyxia can result in either intrauterine fetal death and stillbirth or multiorgan failure in surviving neonates. Establishing effective ventilation is the primary aim of resuscitation in newborns with asphyxia. The objective of this study was to compare the outcome of resuscitation by applying an endotracheal tube (ETT) with less, an ETT with moderate, and an ETT with high leakage during mechanical ventilation in swine neonates after prolonged perinatal asphyxia. Materials and methods A prospective, randomized controlled laboratory study was performed. Thirty Landrace/large white pigs, aged one to four days and weighted 1.754±218 gr, were randomly allocated into three groups depending on the ETT size: Group C (less leak: ETT no 4.0, n=10); Group A (high leak: ETT no 3.0, n=10); and Group B (moderate leak: ETT no 3.5, n=10). Mechanical asphyxia was performed until their heart rate was less than 60 bpm or their mean arterial pressure was below 15 mmHg. All animals with return of spontaneous circulation (ROSC) were monitored for four hours for their hemodynamic parameters, arterial oxygen saturation, and lactate acid levels. Results We demonstrate that 70% of the surviving animals were ventilated with an ETT with a leak (no. 3.5 and 3). A statistically significant difference was noted in PO2 (p=0.032) between Group B (126.4±53.4 mmHg) compared to Group A (72.28±29.18 mmHg) and Group C (94.28±20.46 mmHg) as well as in the right atrial pressure (p<0.001) between Group C (4.5 mmHg) vs Groups A (2 mmHg) and B (2 mmHg) during ROSC time. Lactate levels were statistically significantly lower (p=0.035) in Group C (mean=0.92 ± 0.07mmol/L) as compared to Group A (mean=1.13 ± 0.1 mmol/L) and Group B (mean= 1.08 ± 0.07 mmol /L; p = 0.034) at 4h post-ROSC. Conclusion We provide preliminary evidence that ventilation with ETT with moderate leakage improves survival after 2h of ROSC, along with oxygenation and hemodynamic parameters, in a porcine model of neonatal asphyxia and resuscitation, compared to less leakage ETT.
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Affiliation(s)
- Alexandros Douvanas
- Pediatrics, Medical School, National and Kapodistrian University of Athens, Athens, GRC
| | - Maria Kalafati
- Faculty of Nursing, National and Kapodistrian University of Athens, Athens, GRC
| | - Eleni Tamvaki
- Children's Intensive Treatment Unit (ITU), Great Ormond Street Hospital, London, GBR
| | - Alexandra Nieri
- Faculty of Nursing, National and Kapodistrian University of Athens, Athens, GRC
| | - Apostolos Papalois
- Translational Research and Training, Experimental, Educational and Research Centre, Elpen Pharmaceutical Co. Inc., Athens, GRC
| | | | - Afrodite Aggelina
- Emergency Medicine, School of Medicine, National and Kapodistrian University of Athens, Athens, GRC
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14
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Kratiras Z, Stylianaki A, Chalasti M, Iordanou C, Bouboulis G, Trigka E, Zografos G, Papalois A, Chrisofos M. Study of the effect of Sildenafil on the kidney graft quality; an experimental animal model for kidney grafts preservation before transplantation. EUR UROL SUPPL 2021. [DOI: 10.1016/s2666-1683(21)01209-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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15
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Kratiras Z, Stylianaki A, Iordanou C, Chalasti M, Bouboulis G, Trigka E, Zografos G, Papalois A, Chrisofos M. Study of the effect of Erythropoietin on the kidney graft quality; an experimental animal model for kidney grafts preservation before transplantation. EUR UROL SUPPL 2021. [DOI: 10.1016/s2666-1683(21)01210-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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16
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Sideris M, Nicolaides M, Jagiello J, Rallis KS, Emin E, Theodorou E, Hanrahan JG, Mallick R, Odejinmi F, Lymperopoulos N, Papalois A, Tsoulfas G. In vivo Simulation-Based Learning for Undergraduate Medical Students: Teaching and Assessment. Adv Med Educ Pract 2021; 12:995-1002. [PMID: 34512069 PMCID: PMC8416184 DOI: 10.2147/amep.s272185] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 07/20/2021] [Indexed: 02/05/2023]
Abstract
An increasing emphasis on simulation has become evident in the last three decades following fundamental shifts in the medical profession. Simulation-based learning (SBL) is a wide term that encompasses several means for imitating a skill, attitude, or procedure to train personnel in a safe and adaptive environment. A classic example has been the use of live animal tissue, named in vivo SBL. We aimed to review all published evidence on in vivo SBL for undergraduate medical students; this includes both teaching concepts as well as focused assessment of students on those concepts. We performed a systematic review of published evidence on MEDLINE. We also incorporated evidence from a series of systematic reviews (eviCORE) focused on undergraduate education which have been outputs from our dedicated research network (eMERG). In vivo SBL has been shown to be valuable at undergraduate level and should be considered as a potential educational tool. Strict adherence to 3R (Reduce, Refine, Replace) principles in order to reduce animal tissue usage, should always be the basis of any curriculum. In vivo SBL could potentially grant an extra mile towards medical students' inspiration and aspiration to become safe surgeons; however, it should be optimised and supported by a well-designed curriculum which enhances learning via multi-level fidelity SBL.
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Affiliation(s)
- Michail Sideris
- Women’s Health Research Unit, Queen Mary University of London, London, UK
| | - Marios Nicolaides
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | | | - Kathrine S Rallis
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Elif Emin
- Women’s Health Research Unit, Queen Mary University of London, London, UK
| | - Efthymia Theodorou
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | | | - Rebecca Mallick
- Princess Royal Hospital, Brighton and Sussex University Hospitals NHS Trust, Haywards Heath, UK
| | - Funlayo Odejinmi
- Whipps Cross University Hospital, Barts Health NHS Trust, London, UK
| | | | - Apostolos Papalois
- Special Unit for Biomedical Research and Education, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - George Tsoulfas
- Department of Surgery, Aristotle University of Thessaloniki, Thessaloniki, Greece
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17
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Aggelina A, Pantazopoulos I, Giokas G, Chalkias A, Mavrovounis G, Papalois A, Douvanas A, Xanthos T, Iacovidou N. Continuous chest compressions with asynchronous ventilation improve survival in a neonatal swine model of asphyxial cardiac arrest. Am J Emerg Med 2021; 48:60-66. [PMID: 33839633 DOI: 10.1016/j.ajem.2021.04.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 12/07/2020] [Revised: 03/27/2021] [Accepted: 04/03/2021] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND Guidelines for neonatal resuscitation recommend a 3:1 compression to ventilation ratio. However, this recommendation is based on expert opinion and consensus rather than strong scientific evidence. Our primary aim was to assess whether continuous chest compressions with asynchronous ventilations would increase return of spontaneous circulation (ROSC) rate and survival compared to the 3:1 chest compression to ventilation ratio. METHODS This was a prospective, randomized, laboratory study. Twenty male Landrace-Large White pigs, aged 1-4 days with an average weight 1.650 ± 228.3 g were asphyxiated and left untreated until heart rate was less than 60 bpm or mean arterial pressure was below 15 mmHg. Animals were then randomly assigned to receive either continuous chest compressions with asynchronous ventilations (n = 10), or standard (3:1) chest compression to ventilation ratio (n = 10). Heart rate and arterial pressure were assessed every 30 s during cardiopulmonary resuscitation (CPR) until ROSC or asystole. All animals with ROSC were monitored for 4 h. RESULTS Coronary perfusion pressure (CPP) at 30 s of CPR was significantly higher in the experimental group (45.7 ± 16.9 vs. 21.8 ± 6 mmHg, p < 0.001) and remained significantly elevated throughout the experiment. End-tidal carbon dioxide (ETCO2) was also significantly higher in the experimental group throughout the experiment (23.4 ± 5.6 vs. 14.7 ± 5.9 mmHg, p < 0.001). ROSC was observed in six (60%) animals treated with 3:1 compression to ventilation ratio and nine (90%) animals treated with continuous chest compressions and asynchronous ventilation (p = 0.30). Time to ROSC was significantly lower in the experimental group (30 (30-30) vs. 60 (60-60) sec, p = 0.021). Of note, 7 (77.8%) animals in the experimental group and 1 (16.7%) animal in the control group achieved ROSC after 30 s (0.02). At 4 h, 2 (20%) animals survived in the control group compared to 7 (70%) animals in the experimental group (p = 0.022). CONCLUSION Continuous chest compressions with asynchronous ventilations significantly improved CPP, ETCO2, time to ROSC, ROSC at 30 s and survival in a porcine model of neonatal resuscitation.
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Affiliation(s)
- Afrodite Aggelina
- National & Kapodistrian University of Athens, School of Medicine, 11527, Greece
| | - Ioannis Pantazopoulos
- University of Thessaly, School of Health Sciences, Faculty of Medicine, Department of Emergency Medicine, 41110 Larissa, Greece
| | - George Giokas
- National & Kapodistrian University of Athens, School of Medicine, 11527, Greece
| | - Athanasios Chalkias
- University of Thessaly, School of Health Sciences, Faculty of Medicine, Department of Anesthesiology, 41110 Larissa, Greece
| | - Georgios Mavrovounis
- University of Thessaly, School of Health Sciences, Faculty of Medicine, Department of Emergency Medicine, 41110 Larissa, Greece.
| | - Apostolos Papalois
- Experimental, Educational and Research Center ELPEN, Greece; European University Cyprus, School of Medicine, 1516, Cyprus.
| | - Alexandros Douvanas
- National & Kapodistrian University of Athens, School of Medicine, 11527, Greece
| | | | - Nicoletta Iacovidou
- National and Kapodistrian University of Athens, Medical School, 11527, Greece; Department of Neonatology, Aretaieio Hospital, 11528, Greece
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18
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Sideris M, Nicolaides M, Theodoulou I, Emin EI, Hanrahan JG, Dedeilia A, Theodorou E, Paparoidamis G, Abdullah Z, Papoutsos C, Pittaras T, Odejinmi F, Papalois A. Student Views on a Novel Holistic Surgical Education Curriculum (iG4): A Multi-national Survey in a Changing Landscape. In Vivo 2021; 34:1063-1069. [PMID: 32354893 DOI: 10.21873/invivo.11876] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 01/03/2020] [Revised: 01/20/2020] [Accepted: 01/21/2020] [Indexed: 11/10/2022]
Abstract
AIM Essential Skills in the Management of Surgical Cases (ESMSC Marathon Course™) Integrated Generation 4 (iG4) is the first reported multifaceted undergraduate surgical course aiming to provide holistic surgical teaching. In this prospective observational study, we explored students' views on the iG4 curriculum, and identified how it can potentially address modern challenges in surgical training. MATERIAL AND METHODS Medical students were invited to apply to the course online and were screened against pre-defined criteria. A multi-national structured questionnaire incorporating five domains related to the course curriculum and our dedicated research network, was designed and distributed to participants after successful completion of the course. RESULTS Forty-one students from European and Asian medical schools completed the course and filled in the survey. The median overall evaluation score of the course was 4.73 out of 5 (interquartile range=4.21-4.72) and all students found that iG4 served the vision of holistic surgical education. ESMSC had a positive motivational effect towards following a career in surgery (p=0.012) and 92.7% of students declared that it should be an essential part of a future medical school curriculum. There was no statistically significant difference (p>0.05) in results between participants of different countries of study, year of studies or age group. CONCLUSION The ESMSC Marathon Course™ is perceived as a unique course model, with an established educational value and a positive motivational effect towards surgery. It might potentially be implemented in future medical school curricula as an essential element of undergraduate surgical education. The iG4 curriculum has opened a new exciting horizon of opportunities for advancing undergraduate holistic surgical education.
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Affiliation(s)
- Michail Sideris
- Women's Health Research Unit, Queen Mary University of London, London, U.K.
| | - Marios Nicolaides
- Barts Cancer Institute, Queen Mary University of London, London, U.K
| | - Iakovos Theodoulou
- Faculty of Life Sciences and Medicine, King's College London, London, U.K
| | - Elif Iliria Emin
- Faculty of Life Sciences and Medicine, King's College London, London, U.K
| | | | - Aikaterini Dedeilia
- Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Efthymia Theodorou
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, U.K
| | | | - Ziena Abdullah
- Barking, Havering and Redbridge Hospitals NHS Trust, London, U.K
| | - Constantinos Papoutsos
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, U.K
| | - Theodoros Pittaras
- Hematology Laboratory-Blood Bank, Aretaieion Hospital, University of Athens School of Medicine, Athens, Greece
| | | | - Apostolos Papalois
- Experimental, Educational and Research Centre ELPEN, Athens, Greece.,School of Medicine, European University of Cyprus, Nicosia, Cyprus
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19
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Tsaroucha A, Kaldis V, Vailas M, Schizas D, Lambropoulou M, Papalois A, Tsigalou C, Gaitanidis A, Pitiakoudis M, Simopoulos C. The positive effect of eugenol on acute pancreatic tissue injury: a rat experimental model. Pan Afr Med J 2021; 38:132. [PMID: 33912302 PMCID: PMC8052617 DOI: 10.11604/pamj.2021.38.132.20202] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 01/20/2021] [Indexed: 11/18/2022] Open
Abstract
Introduction we present a rat experimental model used to evaluate the possible reduction in the extent of pancreatic tissue injury in acute pancreatitis cases, after administration of eugenol. Methods one hundred and twenty Wistar rats were used, which were randomly assigned in 3 groups: sham (n=20), control (n=50) and eugenol (n=50). Acute pancreatitis was induced by biliopancreatic ligation in the control and eugenol groups, but not in the Sham group. In the eugenol group, eugenol was administered per-os. Five histopathological parameters, such as edema, inflammatory infiltration, duct dilatation, hemorrhage and acinar necrosis were evaluated. Results at 72 h from acute pancreatitis induction, the total histological score was diminished in the eugenol group (p<0.0005) and duct dilatation and inflammatory infiltration were reduced compared to the control group (p<0.05). In addition, at 72 h, eugenol reduced pancreatic myeloperoxidase activity (p<0.0005). Conclusion eugenol, a highly free radical scavenger agent, may have a preventive role in acute pancreatic injury, as it was evident in our rat experimental model.
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Affiliation(s)
- Alexandra Tsaroucha
- Postgraduate Program in Hepatobiliary/Pancreatic Surgery, Faculty of Medicine, Democritus University of Thrace, Alexandroupolis, Greece.,2nd Department of Surgery and Laboratory of Experimental Surgery, Faculty of Medicine, Democritus University of Thrace, Alexandroupolis, Greece
| | - Vasileios Kaldis
- Postgraduate Program in Hepatobiliary/Pancreatic Surgery, Faculty of Medicine, Democritus University of Thrace, Alexandroupolis, Greece
| | - Michail Vailas
- Postgraduate Program in Hepatobiliary/Pancreatic Surgery, Faculty of Medicine, Democritus University of Thrace, Alexandroupolis, Greece.,First Department of Surgery, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios Schizas
- Postgraduate Program in Hepatobiliary/Pancreatic Surgery, Faculty of Medicine, Democritus University of Thrace, Alexandroupolis, Greece.,First Department of Surgery, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria Lambropoulou
- Postgraduate Program in Hepatobiliary/Pancreatic Surgery, Faculty of Medicine, Democritus University of Thrace, Alexandroupolis, Greece.,Laboratory of Histology-Embryology, Faculty of Medicine, Democritus University of Thrace, Alexandroupolis, Greece
| | - Apostolos Papalois
- Experimental-Research Department, ELPEN Pharmaceuticals, Pikermi, Attica, Greece
| | - Christina Tsigalou
- Postgraduate Program in Hepatobiliary/Pancreatic Surgery, Faculty of Medicine, Democritus University of Thrace, Alexandroupolis, Greece.,Laboratory of Microbiology, Faculty of Medicine, Democritus University of Thrace, Alexandroupolis, Greece
| | - Apostolos Gaitanidis
- 2nd Department of Surgery and Laboratory of Experimental Surgery, Faculty of Medicine, Democritus University of Thrace, Alexandroupolis, Greece
| | - Michael Pitiakoudis
- Postgraduate Program in Hepatobiliary/Pancreatic Surgery, Faculty of Medicine, Democritus University of Thrace, Alexandroupolis, Greece.,2nd Department of Surgery and Laboratory of Experimental Surgery, Faculty of Medicine, Democritus University of Thrace, Alexandroupolis, Greece
| | - Constantinos Simopoulos
- Postgraduate Program in Hepatobiliary/Pancreatic Surgery, Faculty of Medicine, Democritus University of Thrace, Alexandroupolis, Greece.,2nd Department of Surgery and Laboratory of Experimental Surgery, Faculty of Medicine, Democritus University of Thrace, Alexandroupolis, Greece
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Rallis KS, Wozniak AM, Hui S, Nicolaides M, Shah N, Subba B, Papalois A, Sideris M. Inspiring the future generation of oncologists: a UK-wide study of medical students' views towards oncology. BMC Med Educ 2021; 21:82. [PMID: 33530974 PMCID: PMC7852146 DOI: 10.1186/s12909-021-02506-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 01/20/2021] [Indexed: 05/18/2023]
Abstract
BACKGROUND One in 2 people born in the UK after 1960 are expected to require oncology input in their lifetime. However, only 36% of UK medical schools provide dedicated oncology placements and teaching indicating a discordance between public health impact and training. We designed a UK-wide survey to capture medical students' views on current oncology teaching and the potential role of a national undergraduate oncology symposium as an educational, networking and motivational tool. METHODS We undertook a national cross-sectional survey of UK medical students' views in oncology and satisfaction with teaching using pre-designed questionnaires. We also distributed a dedicated survey (pre and post-conference) to compare medical students' motivation towards a career in oncology after attending the national symposium. This study was prospectively approved by QMUL Ethics Committee (Reference number QMREC2348). Statistical analysis included univariate inferential tests on SPSS and GraphPad software. RESULTS The national survey was completed by 166 students representing 22 UK medical schools. Students reported limited interest, knowledge and exposure to oncology, lack of confidence in skills, and teaching dissatisfaction. Oncology was perceived as a challenging specialty (mean 4.5/5 ± 0.7), yet most students estimate receiving only 1-2 weeks of dedicated oncology teaching. The national symposium generated a statically significant increase in students' interest, knowledge, and confidence in skills surrounding oncology, improving students' perceived ability to cope with the emotional challenges in this field. CONCLUSION Students' views towards oncology alongside their teaching dissatisfaction underpin the need to revisit and strive to improve current undergraduate oncology curricula. Increasing medical student oncology exposure by proposing outcome-based guidelines and adopting a standardised undergraduate oncology curriculum should be the foremost priority in inspiring future oncologists to ensure excellent cancer patient care.
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Affiliation(s)
- Kathrine S Rallis
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Anna Maria Wozniak
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Sara Hui
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Marios Nicolaides
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Neha Shah
- Newham University Hospital, Barts Health NHS Trust, London, UK
| | - Beena Subba
- North Middlesex University Hospital NHS Trust, London, UK
| | | | - Michail Sideris
- Women's Health Research Unit, Queen Mary University of London, Yvonne Carter Building, 58 Turner Street, London, E1 2AB, UK.
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21
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Hanrahan JG, Sideris M, Pasha T, Dedeilia A, Papalois A, Papalois V. Postgraduate Assessment Approaches Across Surgical Specialties: A Systematic Review of the Published Evidence. Acad Med 2021; 96:285-295. [PMID: 32889945 DOI: 10.1097/acm.0000000000003712] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
PURPOSE Ensuring competence for surgical trainees requires holistic assessment of the qualities and competencies necessary to practice safely and effectively. To determine the next steps toward achieving this aim, the authors conducted a systematic review to summarize and appraise the available evidence related to any assessment approach to postgraduate surgical training and to identify the dominant themes for assessment approaches across different specialties or countries. METHOD Medline and Embase were searched on January 10, 2019, without language or time restrictions. Any peer-reviewed study that described an assessment framework (in practice or novel) throughout postgraduate surgical training globally was included. An iterative review and thematic analysis were performed on full-text articles to determine assessment themes. Studies were then grouped by assessment themes. A tailored quality assessment of the studies included in the final analysis was conducted. Assessment themes and validity were compared across surgical specialties and countries. RESULTS From an initial 7,059 articles, 91 studies (evaluating 6,563 surgical trainees) were included in the final analysis. Ten defined assessment themes were extracted. Ten studies (11.0%) were deemed low risk of bias based on the quality assessment tool used and thus were determined to be high quality. Minor differences in assessment themes were observed between specialties and countries. Assessment themes neglected by individual surgical specialties and assessment themes that need validated assessment tools were identified. CONCLUSIONS This review highlights the low quality of evidence and fragmented efforts to develop and optimize surgical assessments. The minor differences observed demonstrate a common approach, globally and across specialties, related to surgical assessments. A paradigm shift in assessment approaches, which will require national and international collaboration, is required to optimize design and validation so that a comprehensive assessment of surgical competence can be implemented.
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Affiliation(s)
- John Gerrard Hanrahan
- J.G. Hanrahan is academic foundation doctor, Department of General Surgery, Lister Hospital, Stevenage, United Kingdom
| | - Michail Sideris
- M. Sideris is a specialty trainee in obstetrics and gynaecology, Women's Health Research Unit, Queen Mary University of London, London, United Kingdom
| | - Terouz Pasha
- T. Pasha is a final-year medical student, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
| | - Aikaterini Dedeilia
- A. Dedeilia is a final-year medical student, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Apostolos Papalois
- A. Papalois is director, ELPEN Research & Experimental Centre, Athens, Greece
| | - Vassilios Papalois
- V. Papalois is professor of transplant surgery, Department of Surgery and Cancer, Renal Transplant Directorate, Imperial College Healthcare NHS Trust, London, United Kingdom
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Samiotis I, Papakonstantinou NA, Dedeilias P, Vasileiadis I, Papalois A, Deftereos S, Kotanidou A. Dantrolene Induces Mitigation of Myocardial Ischemia-Reperfusion Injury by Ryanodine Receptor Inhibition. Semin Thorac Cardiovasc Surg 2021; 34:123-132. [PMID: 33460764 DOI: 10.1053/j.semtcvs.2021.01.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 12/31/2020] [Accepted: 01/05/2021] [Indexed: 11/11/2022]
Abstract
The impairment of intracellular calcium homeostasis plays an essential role during ischemia-reperfusion injury. Calcium release from sarcoplasmic reticulum which is triggered by myocardial ischemia is mainly mediated by ryanodine receptors. Dantrolene sodium is a ryanodine receptor antagonist. The objective of the present study was to evaluate the in-vivo impact of dantrolene sodium on myocardial ischemia-reperfusion injury in swine models. An in vivo, experimental trial comparing 10 experimental animals which received dantrolene sodium with 9 control swine models was conducted. Their left anterior descending coronary artery was temporarily occluded for 75 minutes via a vessel tourniquet, which was then released. Myocardial reperfusion was allowed for 24 hours. Dantrolene was administered at the onset of the reperfusion period and levels of troponin, creatine phosphokinase and creatine kinase myocardial band between the two groups were compared. Additionally, various other hemodynamic parameters and left ventricular morphology and function were examined. There were significantly lower values of troponin, creatine phosphokinase and creatine kinase myocardial band in the dantrolene group indicating less ischemia-reperfusion injury. Moreover, the postischemic cardiac index was also greater in the dantrolene group, whereas viable myocardium was also better preserved. In conclusion, the in vivo cardioprotective role of dantrolene sodium against ischemia-reperfusion injury in swine models was indicated in this study. Therefore, dantrolene sodium administration could be a promising treatment against ischemia-reperfusion injury in humans. However, large randomized clinical studies should be firstly carried out to prove this hypothesis.
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Affiliation(s)
- Ilias Samiotis
- Cardiovascular and Thoracic Surgery Department, General Hospital of Athens "Evangelismos'', Greece
| | | | - Panagiotis Dedeilias
- Cardiovascular and Thoracic Surgery Department, General Hospital of Athens "Evangelismos'', Greece
| | - Ioannis Vasileiadis
- 1st Respiratory Medicine Department, Hospital for Diseases of the Chest "Sotiria", National and Kapodistrian University of Athens, Greece
| | - Apostolos Papalois
- Experimental, Educational and Research Center, ELPEN Pharmaceuticals, Athens, Greece; School of Medicine European University of Cyprus, Nicosia, Cyprus
| | - Spyridon Deftereos
- 2nd Department of Cardiology, "Attikon" Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece
| | - Anastasia Kotanidou
- 1st Department of Critical Care Medicine, General Hospital of Athens "Evangelismos'', School of Medicine, National and Kapodistrian University of Athens, Greece
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Sousonis V, Sfakianaki T, Ntalianis A, Nanas I, Kontogiannis C, Aravantinos D, Kapelios C, Katsaros L, Nana M, Sampaziotis D, Sanoudou D, Papalois A, Malliaras K. Intracoronary Administration of Allogeneic Cardiosphere-Derived Cells Immediately Prior to Reperfusion in Pigs With Acute Myocardial Infarction Reduces Infarct Size and Attenuates Adverse Cardiac Remodeling. J Cardiovasc Pharmacol Ther 2021; 26:88-99. [PMID: 32677460 DOI: 10.1177/1074248420941672] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Allogeneic cardiosphere-derived cells (CDCs) exert cardioprotective effects when administered intracoronarily after reperfusion in animal models of acute myocardial infarction (AMI). The "no-reflow" phenomenon develops rapidly post-reperfusion and may undermine the efficacy of cell therapy, due to poor cell delivery in areas of microvascular obstruction (MVO). We hypothesized that CDC-induced cardioprotection would be enhanced by cell administration prior to reperfusion, when microvasculature is still relatively intact, to facilitate widespread cell delivery within the ischemic area. METHODS AND RESULTS We studied 81 farm pigs; 55 completed the specified protocols. A dose-optimization study in infarcted pigs demonstrated that the doses of 5 million and 10 million CDCs are the maximum safe doses that can be administered intracoronarily at 5 minutes prior to and at 5 minutes post-reperfusion, respectively, without aggravating MVO. Quantification of acute cell retention by polymerase chain reaction demonstrated that cell delivery prior to reperfusion resulted in higher cardiac cell retention compared to delivery post-reperfusion. We then performed a randomized, placebo-controlled study to assess the long-term efficacy of intracoronary infusion of 5 million allogeneic CDCs, delivered at 5 minutes prior to reperfusion, in a porcine model of AMI. The CDC therapy resulted in decreased scar size, improved regional systolic function, and attenuation of adverse cardiac remodeling (manifested as preserved global systolic function, preserved end-systolic volume, and decreased interstitial fibrosis) compared to placebo at 30 days post-MI. CONCLUSIONS Dose-optimized intracoronary infusion of allogeneic CDCs prior to reperfusion in a porcine model of AMI is feasible, safe and confers long-term benefits.
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Affiliation(s)
- Vasileios Sousonis
- Third Department of Cardiology, University of Athens School of Medicine, Athens, Greece
- Center for New Biotechnologies and Precision Medicine, University of Athens School of Medicine, Athens, Greece
| | - Titika Sfakianaki
- Third Department of Cardiology, University of Athens School of Medicine, Athens, Greece
| | - Argirios Ntalianis
- Third Department of Cardiology, University of Athens School of Medicine, Athens, Greece
| | - Ioannis Nanas
- Third Department of Cardiology, University of Athens School of Medicine, Athens, Greece
| | - Christos Kontogiannis
- Third Department of Cardiology, University of Athens School of Medicine, Athens, Greece
| | - Dionysios Aravantinos
- Third Department of Cardiology, University of Athens School of Medicine, Athens, Greece
| | - Chris Kapelios
- Third Department of Cardiology, University of Athens School of Medicine, Athens, Greece
| | - Lampros Katsaros
- Third Department of Cardiology, University of Athens School of Medicine, Athens, Greece
| | - Maria Nana
- Third Department of Cardiology, University of Athens School of Medicine, Athens, Greece
| | | | - Despina Sanoudou
- Center for New Biotechnologies and Precision Medicine, University of Athens School of Medicine, Athens, Greece
- Fouth Department of Internal Medicine, Clinical Genomics and Pharmacogenomics Unit, Attikon Hospital, University of Athens School of Medicine, Athens, Greece
| | - Apostolos Papalois
- Experimental Educational and Research Center, ELPEN Pharmaceuticals, Athens, Greece
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Sideris M, Papalois V, Athanasiou T, Papagrigoriadis S, Pierides M, Velmahos G, Papalois A. A Novel Multi-faceted Course Blueprint to Support Outcome-based Holistic Surgical Education: The Integrated Generation 4 Model (iG4). In Vivo 2020; 34:503-509. [PMID: 32111747 DOI: 10.21873/invivo.11801] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 11/29/2019] [Revised: 12/04/2019] [Accepted: 12/06/2019] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM We present a novel multi-faceted, internationally adaptable course curriculum blueprint, which provides holistic surgical education at the undergraduate level. MATERIALS AND METHODS The Integrated Generation 4 (iG4) course (Essential Skills in the Management of Surgical Cases - ESMSC Marathon course) curriculum consists of four essential learning components: core skills-based learning, case-based discussions, basic science workshops and soft-skills. These are all clustered in a specialty-led network architecture. Every cluster consists of modules from the four learning cores, while network nodes are modules that are mutually shared by more than one clusters. RESULTS We produced a standardized blueprint of 50 modules based on the 4 learning cores, covering 9 surgical specialties. This resulted in a curriculum map where every module is described using 3 parameters: χ axis (skills component), y axis (knowledge component), z axis (specialty component). CONCLUSION iG4 proof of concept sets the ground for a novel, reproducible and standardised effort to produce a portfolio of undergraduate surgical skills serving the vision of holistic surgical education.
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Affiliation(s)
- Michail Sideris
- Women's Health Research Unit, Queen Mary University of London, London, U.K.
| | - Vassilios Papalois
- Department of Surgery and Cancer, Renal Transplant Directorate, Imperial College Healthcare NHS Trust, London, U.K
| | - Thanos Athanasiou
- Department of Surgery and Cancer, Cardiothoracic Directorate, Imperial College Healthcare NHS Trust, London, U.K
| | | | | | - George Velmahos
- Department of Surgery, Division of Trauma, Emergency Surgery, and Surgical Critical Care, Harvard Medical School, Boston, MD, U.S.A
| | - Apostolos Papalois
- Experimental Educational and Research Centre ELPEN, Athens, Greece.,School of Medicine European University Cyprus, Nicosia, Cyprus
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Kormpakis I, Papalois A, Kinnas P, Zoubos AB, Sioutis I, Dimitriadi A, Soucacos PN, Johnson EO. Silicone tubes with thyroid hormone (Τ3) and BDNF as an alternative to autografts for bridging neural defects. Injury 2020; 51:2879-2886. [PMID: 32284185 DOI: 10.1016/j.injury.2020.03.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Revised: 02/24/2020] [Accepted: 03/07/2020] [Indexed: 02/02/2023]
Abstract
The way thyroid hormone works in peripheral nerve regeneration has not been fully elucidated, although studies have shown that it has a strong positive effect on nerve regeneration. It is argued that its action is probably stronger than the neurotrophic factors that have been used for some time. It is hypothesized that the use of thyroid hormone in the nerve tubes has a beneficial effect on nerve regeneration to the extent that the results of its use are comparable to those of the autograft technique in bridging small nerve deficits. In this experimental study, we examined the effect of thyroid hormone and BDNF (Brain Derived Neurotrophic Factor) on the repair of 10 mm nerve defects when administered within silicone nerve tubes and compared the results with the autograft method. Thyroid hormone promotes nerve regeneration mainly by increasing its speed and its effect on the maturation of nerve fibers compared to the other groups where the nerve deficit was bridged by entubulation. Also, better organization and the absence of intraneural fibrosis, compared to the other groups, may argue for the action of thyroid hormone in regulating the inflammatory response. Functionally, the AG group showed better results compared to the other groups by the end of the study (16 weeks).
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Affiliation(s)
- Ioannis Kormpakis
- Orthopaedic Research & Education Center, Department of Orthopaedic Surg, Greece; Laboratory of Education & Research in Neuroscience (LERNs), Department of Anatomy, National & Kapodistrian University of Athens, Greece.
| | | | | | - Aristides B Zoubos
- Orthopaedic Research & Education Center, Department of Orthopaedic Surg, Greece
| | | | | | | | - Elizabeth O Johnson
- Laboratory of Education & Research in Neuroscience (LERNs), Department of Anatomy, National & Kapodistrian University of Athens, Greece; School of Medicine, European University Cyprus, Cyprus
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Spyropoulos V, Chalkias A, Georgiou G, Papalois A, Kouskouni E, Baka S, Xanthos T. Initial Immune Response in Escherichia coli, Staphylococcus aureus, and Candida albicans Bacteremia. Inflammation 2020; 43:179-190. [PMID: 31758425 DOI: 10.1007/s10753-019-01108-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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] [Indexed: 12/29/2022]
Abstract
Sepsis remains a leading cause of mortality worldwide and is characterized by sustained inflammatory responses, reflected as changes in the expression profile of cytokines with time. The aim of the present study was to investigate the dynamic changes in complete blood count, serum chemistry, procalcitonin (PCT), tumor necrosis factor-alpha (TNF-α), and interleukin-6 (IL-6) in Escherichia coli, Staphylococcus aureus, and Candida albicans bacteremia. Study subjects were 32 healthy male Landrace-Large White pigs, aged 10-15 weeks and of average weight 19 ± 2 kg. Bacteremia was induced by continuous intravenous infusion of microbial suspensions during a period of 8 h. E. coli and S. aureus bacteremia were associated with a significant gradual decrease in white blood cells and platelets, respectively (p = 0.002 and p = 0.004), while candidemia was characterized by a significant gradual decrease in lymphocytes (p = 0.009). Serum PCT levels were either undetectable or very low, with no significant changes with time in all groups. E. coli bacteremia elicited a strong pro-inflammatory response, characterized by a significant increase in TNF-α expression from the onset of bacteremia (p = 0.042). C. albicans exhibited a different profile with an early, moderate increase in TNF-α followed by a subsequent marked increase in IL-6 levels (p = 0.03). The differential regulation of inflammatory and hematological responses depending on the pathogenic agent can reveal differences in the underlying inflammatory mechanisms, which may assist in the ongoing quest for the identification of a panel of circulating biomarkers during bacteremia.
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Affiliation(s)
| | - Athanasios Chalkias
- Department of Anesthesiology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larisa, Greece.
- Hellenic Society of Cardiopulmonary Resuscitation, Athens, Greece.
- Department of Anesthesiology, University Hospital of Larisa, C' Wing, 2nd Floor, PC 41110, Mezourlo, Larisa, Greece.
| | - Georgia Georgiou
- Department of Surgery, 1st Propaedeutic Surgical Clinic, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Evangelia Kouskouni
- Department of Biopathology - Microbiology and Biochemistry, Aretaieion University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Stavroula Baka
- Department of Biopathology - Microbiology and Biochemistry, Aretaieion University Hospital, National and Kapodistrian University of Athens, Athens, Greece
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27
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Karmaniolou I, Lamprou K, Staikou C, Giamarellos-Bourboulis E, Theodoraki K, Papalois A, Mylonas A, Orfanos N, Smyrniotis V, Arkadopoulos N. Effect of Triiodothyronine Administration on the Kidney During Haemorrhagic Shock and Resuscitation. Turk J Anaesthesiol Reanim 2020; 48:406-413. [PMID: 33103146 PMCID: PMC7556640 DOI: 10.5152/tjar.2019.81542] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Accepted: 09/02/2019] [Indexed: 11/22/2022] Open
Abstract
Objective Apoptosis, measured via caspase activity, can be used to assess renal tissue damage in haemorrhagic shock. We investigated whether Triiodothyronine could attenuate apoptosis and protect against haemorrhagic shock-induced renal injury. Methods Haemorrhagic shock was induced in swine until the mean arterial pressure (MAP) was 35–40 mmHg for 40 minutes. Animals were randomly assigned to a control group (n=5), Group-F (Fluid resuscitation, n=6), and Group-T3 (Fluid plus Triiodothyronine, n=6). The swine were resuscitated for 1 hour aiming to MAP restoration (±10% from baseline) and were followed up for another 360 minutes. Haemodynamic parameters, fluids, acid-base status, plasma urea nitrogen, creatinine levels and caspase activity in the kidney were measured. Results Haemodynamic parameters did not differ significantly amongst the three groups. Group-T3 required less normal saline (Group-T3: 1083±204 mL versus F: 2500±547 mL, p=0.001) and hydroxyethyl starch (Group-T3: 558±102 mL versus F: 916±204 mL, p=0.004) during resuscitation. Additionally, Group-T3 swine experienced less acidosis following haemorrhage/resuscitation with a pH of 7.39 versus a pH of 7.26 in Group-F (p=0.004) at 360 minutes. Urea remained within normal limits in all groups, but creatinine levels were elevated at 6 hours in Group-F as compared to Group-T3 (p=0.019). Apoptosis, assessed by renal caspase-3 activity, was increased in Group-T3 (132±174 pmol minute−1 g−1) and reduced in Group-F (32±18 pmol minute−1 g−1) as compared to the control group, but without statistical significance (p=0.245 between Group-T3 and Group-F). Conclusion Administration of Triiodothyronine in a swine model of haemorrhagic shock seems to interfere with renal cell apoptosis. The exact mechanism needs to be further investigated in future research.
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Affiliation(s)
- Iosifina Karmaniolou
- Department of Anaesthesia, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Konstantinos Lamprou
- Department of Obstetrics and Gynaecology, Bradford Royal Infirmary, Bradford, UK
| | - Chryssoula Staikou
- 1 Department of Anaesthesia, Aretaieion Hospital, University of Athens Medical School, Athens, Greece
| | | | - Kassiani Theodoraki
- 1 Department of Anaesthesia, Aretaieion Hospital, University of Athens Medical School, Athens, Greece
| | | | - Anastasios Mylonas
- 4 Department of Surgery, Attikon Hospital, Medical School, University of Athens, Chaidari, Greece
| | - Nikolaos Orfanos
- 4 Department of Surgery, Attikon Hospital, Medical School, University of Athens, Chaidari, Greece
| | - Vassilios Smyrniotis
- 4 Department of Surgery, Attikon Hospital, Medical School, University of Athens, Chaidari, Greece
| | - Nikolaos Arkadopoulos
- 4 Department of Surgery, Attikon Hospital, Medical School, University of Athens, Chaidari, Greece
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Nicolaides M, Theodorou E, Iliria Emin E, Theodoulou I, Odejinmi F, Papalois A, Sideris M. Team Performance Training for Medical Students: Low vs High Fidelity Simulation. J Am Coll Surg 2020. [DOI: 10.1016/j.jamcollsurg.2020.08.535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Chalidis B, Kitridis D, Savvidis P, Papalois A, Givissis P. Does the Inion OTPS TM absorbable plating system induce higher foreign-body reaction than titanium implants? An experimental randomized comparative study in rabbits. ACTA ACUST UNITED AC 2020; 15:065011. [PMID: 32629429 DOI: 10.1088/1748-605x/aba326] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Hardware removal after complete fracture healing is a laborious and traumatic procedure that bears the risks of refracture, infection, and soft tissue damage. Absorbable materials for fracture fixation have the advantage of eliminating the need for removal; however, they may stimulate a considerable inflammatory response. For that reason, we compared in a prospective randomized experimental animal model study the incidence of foreign-body reactions between Inion OTPSTM absorbable plate implants, consisting of carbon trimethylene, L-polylactic acid, and D, L-polylactic acid, and conventional titanium plates. Seventy rabbits were equally divided into two groups. Titanium (Group A) or absorbable (Group B) plates and screws were implanted in the femoral shaft of the rabbits. Wound reaction and laboratory tests including white blood cell count (WBC), erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) values were measured and compared at different time points. Radiographs and histological analysis of tissue samples from all animals were also used to identify potential foreign-body reactions. WBC showed normal values in both groups. In Group A, ESR levels were higher at all time points but CRP values were normalized at 3 weeks postoperatively. In Group B, ESR and CRP levels reached a peak at 3 weeks and were above normal values throughout the whole experiment (p < 0.001). Radiologic examination revealed periosteal thickening and surrounding sclerosis in 23 out of 35 animals of Group B (66%). All Group A animals had normal radiographic findings. Histopathology showed a typical non-specific foreign-body reaction in all animals in Group B (100%) but none in Group A. However, only four of them (11.8%) developed non-infected wound complications and showed significantly elevated CRP and ESR values (p = 0.054). Although Inion OTPSTM Biodegradable Plating System stimulates a foreign-body reaction, only a small but not negligible percentage of almost 12% may lead to wound problems. However, this difference compared to titanium plates was of borderline not statistically significant. Future studies should focus on the development of absorbable implants with improved biocompatibility aiming to further decrease the potential of foreign-body reaction and eliminate the need for additional reoperative procedures.
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Affiliation(s)
- Byron Chalidis
- Orthopaedic Department of Aristotle University of Thessaloniki, George Papanikolaou Hospital Thessaloniki, Thessaloniki, Greece
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Tassopoulos A, Chalkias A, Papalois A, Karlovasiti P, Zanda JSA, Chatzidakis S, Gazouli M, Iacovidou N, Fanni D, Xanthos T. Assessment of Post-Resuscitation Intestinal Injury and Timing of Bacterial Translocation in Swine Anaesthetized With Propofol-Based Total Intravenous Anaesthesia. Cureus 2020; 12:e10362. [PMID: 33062485 PMCID: PMC7549874 DOI: 10.7759/cureus.10362] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Introduction and objectives Bacterial translocation (BT) is the passage of viable bacteria or endotoxins from the gastrointestinal lumen to extra-luminal tissues and is usually observed after intestinal ischaemia-reperfusion injury. The aim of this study was to investigate post-resuscitation BT after cardiac arrest and resuscitation in a swine anaesthetized with propofol-based total intravenous anaesthesia. Materials and methods Eighteen female Landrace/Large White piglets were randomly divided into control (CON), cardiac arrest (CA) and cardiac arrest-cardiopulmonary resuscitation (CA-CPR) groups. In the CON group, the animals were only monitored for two hours. In the CA group, the animals were not resuscitated and underwent necropsy immediately after cardiac arrest. In the CA-CPR group, the animals were resuscitated until the return of spontaneous circulation (ROSC) and were monitored for two hours. The animals of the CON and CA-CPR groups underwent necropsy 24 hours later. Bacterial translocation was assessed by blood and tissue cultures and endotoxin measurement in the portal and systemic circulation. Malondialdehyde content calculation and histological analysis of the intestine were performed in order to estimate ischemia and reperfusion (I/R) tissue damage. Results Malondialdehyde content, an indicator of oxidative stress, was significantly higher in the CA-CPR group compared to the CA in homogenized ileum (p=0.016). Malondialdehyde content in homogenized colon revealed significantly higher levels in the CA-CPR group compared to the CON (p=0.004) and the CA group (p=0.016). We found significantly higher levels of portal endotoxin in the CA-CPR group compared to the CON (p=0.026) and the CA group (p=0.026). The number of positive mesenteric lymph nodes cultures for E. coli was greater in the CA-CPR group, followed by the CA and CON groups, although the difference was not significant (67%, 33%, and 33%, respectively; p=0.407). Conclusions Malondialdehyde content and portal endotoxin levels do not increase during the cardiac arrest interval, but only after CPR and ROSC. Although the number of positive MLNs cultures was greater in the CA-CPR animals, no statistically significant differences were observed between the three groups due to the short monitoring period.
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Affiliation(s)
| | - Athanasios Chalkias
- Department of Anesthesiology, University of Thessaly, School of Health Sciences, Faculty of Medicine, Larisa, GRC
| | - Apostolos Papalois
- Translational Research and Training, ELPEN Research & Experimental Center, Athens, GRC
| | - Paraskevi Karlovasiti
- Department of Biopathology - Microbiology and Biochemistry, Medical School, National and Kapodistrian University of Athens, Athens, GRC
| | | | - Stefanos Chatzidakis
- Department of Medicine, European University Cyprus, School of Medicine, Nicosia, CYP
| | - Maria Gazouli
- Laboratory of Biology, Medical School, National and Kapodistrian University of Athens, Athens, GRC
| | - Nicoletta Iacovidou
- Department of Neonatology, Medical School, National and Kapodistrian University of Athens, Athens, GRC
| | - Daniela Fanni
- Division of Pathology, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, ITA
| | - Theodoros Xanthos
- Department of Physiology and Pathophysiology, European University Cyprus, School of Medicine, Nicosia, CYP
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Sideris M, Emin EI, Hanrahan JG, Odejinmi F, Mallick R, Nicolaides M, Velmahos G, Athanasiou T, Papalois V, Papalois A. ABC of Surgical Teaching: Time to Consider a Global Blueprint for Holistic Education. J INVEST SURG 2020; 34:1355-1365. [PMID: 32806964 DOI: 10.1080/08941939.2020.1800870] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Educating and equipping students and trainees into clinicians capable of meeting healthcare demands and service provision needs is essential. Unprecedented events like COVID-19 pandemic, highlight urgent need for reformation of training to ensure high quality education is maintained. To this end, we describe an innovative and globally adaptable blueprint for establishing a surgical curriculum, aiming to optimize preparation of future surgeons. METHODS We used a structured protocol to synthesize evidence from previous systematic reviews focused on surgical education alongside a series of focused original educational studies. This approach allowed incorporation of prospectively applied novel ideas into the existing landscape of published evidence. All material used for this proof of concept derives from the outputs of a dedicated research network for surgical education (eMERG). RESULTS We propose the foundation blueprint framework called "Omnigon iG4" as a globally applicable model. It allows adaptation to individual local educational environments for designing, appraising and/or refining surgical curricula. We also describe the "Omnigon iG4 Hexagon Pragmatic Model," a novel perspective model which assesses the performance of our blueprint in a multi-layer fashion. This "Hexagon" model is the first to introduce pragmatic outcomes in curricula performance assessment. CONCLUSIONS This proof of concept, "Omnigon iG4," proposes an adaptable version of a curriculum blueprint. The framework allows educators to establish a surgical curriculum with the ability to map out competencies, permitting full control over their intended learning outcomes. This can form the basis for developing globally adaptable multifaceted Simulation-Based learning (SBL) courses or even surgical curricula for undergraduates.
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Affiliation(s)
- Michail Sideris
- Women's Health Research Unit, Queen Mary University of London, London, UK
| | - Elif Iliria Emin
- Faculty of Life Sciences and Medicine, King's College London, London, UK
| | | | - Funlayo Odejinmi
- Whipps Cross University Hospital, Barts Health NHS Trust, London, UK
| | - Rebecca Mallick
- Princess Royal Hospital, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - Marios Nicolaides
- Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - George Velmahos
- Department of Surgery, Division of Trauma, Emergency Surgery, and Surgical Critical Care, Harvard Medical School, Boston, Maryland, USA
| | | | | | - Apostolos Papalois
- Experimental Educational and Research Centre ELPEN, Athens, Greece.,School of Medicine, European University Cyprus, Nicosia, Cyprus
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Nicolaides M, Rallis K, Eyskens PJ, Andreou A, Odejinmi F, Papalois A, Sideris M. A student initiative to improve exposure in research - Dual benefit? Ann Med Surg (Lond) 2020; 56:211-216. [PMID: 32685141 PMCID: PMC7355375 DOI: 10.1016/j.amsu.2020.06.033] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 06/21/2020] [Accepted: 06/22/2020] [Indexed: 11/29/2022] Open
Abstract
Purpose Despite the recent implementation of research-focused activities into undergraduate education, there is still a universal lack of offered exposure experienced by medical students. We organised an undergraduate research conference to explore students' views on research and evaluate the impact of the conference on participants' and organisers’ research skills and non-technical skills respectively. Methods The conference was a student-led initiative which took place at a London medical school. Feedback from delegates was collected before and after the conference and aimed to evaluate previous experience and views in research, subjective assessment of relevant skills and the overall quality of the conference. Subjective change in organisers’ non-technical skill performance was also evaluated using an online questionnaire following the conference. Results Forty-four students attended the conference, out of which only 3 (7.7%) have published in an international peer-reviewed journal. Finding a project supervisor was reported by most delegates as the biggest barrier in becoming involved in research. Delegates' study design (p = 0.041) and oral/poster presentation skills (p = 0.041) showed a statistically significant subjective improvement. A clear benefit in organisers’ subjective improvement in non-technical skill performance has been demonstrated. The conference was evaluated highly. Conclusion There is need to address the barriers that medical and dental students face in the path to get involved in research. Our conference framework has demonstrated benefit to both delegates and organisers in improving their research skills and non-technical skills respectively. The conference, being highly appraised, lays the ground for such initiatives to be integrated in undergraduate medical and dental curricula. Less than 10% of students have published in peer-reviewed journals. Finding a project supervisor was reported as the biggest barrier in becoming involved in research. A student-led research conference can improve organisers' non-technical skills. A student-led research conference can improve delegates research and presentation skills.
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Affiliation(s)
- Marios Nicolaides
- Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Kathrine Rallis
- Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Pieter Jan Eyskens
- Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Andreas Andreou
- Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Funlayo Odejinmi
- Whipps Cross University Hospital, Barts Health NHS Trust, London, UK
| | - Apostolos Papalois
- Experimental Educational and Research Centre ELPEN, Athens, Greece.,European University Cyprus, Nicosia, Cyprus
| | - Michail Sideris
- Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK.,Women's Health Research Unit, Queen Mary University of London, London, UK
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Afaloniati H, Angelopoulou K, Giakoustidis A, Hardas A, Pseftogas A, Makedou K, Gargavanis A, Goulopoulos T, Iliadis S, Papadopoulos V, Papalois A, Mosialos G, Poutahidis T, Giakoustidis D. HDAC1/2 Inhibitor Romidepsin Suppresses DEN-Induced Hepatocellular Carcinogenesis in Mice. Onco Targets Ther 2020; 13:5575-5588. [PMID: 32606772 PMCID: PMC7304783 DOI: 10.2147/ott.s250233] [Citation(s) in RCA: 12] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 05/27/2020] [Indexed: 12/24/2022] Open
Abstract
Background Hepatocellular carcinoma (HCC) is a frequently diagnosed cancer and a leading cause of cancer-related death worldwide. Its rapid progression, combined with the limited treatment options at late stages, imposes the need for early detection and aggressive intervention. Based on the knowledge that hepatocarcinogenesis is significantly influenced by histone acetylation, we directed our search for novel HCC therapeutics among histone deacetylation inhibitors (HDACi). The aim of the present study was to investigate the effect of HDAC1/2 inhibitor Romidepsin in the well-established mouse model of diethylnitrosamine (DEN)-induced HCC. Materials and Methods C56BL/6 mice were treated with Romidepsin at the critical point of 10 months after DEN challenge and their livers were examined 2 months later using histopathology and morphometry. Protein levels were assessed in serum using ELISA and in liver tissues using Western blot and immunohistochemistry (in-situ detection). Gene expression was quantified using real-time PCR. Results Romidepsin suppressed cancer progression. This effect was associated with decreased proliferation and increased apoptosis of cancer cells. The cell cycle regulator CK2a, the anti-inflammatory molecule PPAR-γ, and the tumor suppressors PTEN and CYLD were upregulated in treated HCC. By contrast, the expression of PI3K, NF-κB p65 and c-Jun was reduced. In line with this result, the levels of two major apoptosis regulators, ie, BAD and the multifunctional protein c-Met, were lower in the blood serum of treated mice compared to the untreated mice with HCC. Conclusion These findings suggest that Romidepsin, a drug currently used in the treatment of lymphoma, could also be considered in the management of early-stage HCC.
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Affiliation(s)
- Hara Afaloniati
- Laboratory of Biochemistry and Toxicology, School of Veterinary Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Katerina Angelopoulou
- Laboratory of Biochemistry and Toxicology, School of Veterinary Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Alexander Giakoustidis
- First Department of Surgery, Medical School, Aristotle University of Thessaloniki, General Hospital Papageorgiou, Thessaloniki, Greece
| | - Alexandros Hardas
- Laboratory of Pathology, School of Veterinary Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Athanasios Pseftogas
- School of Biology, Faculty of Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Kali Makedou
- Department of Biological Chemistry, Medical School, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Athanasios Gargavanis
- First Department of Surgery, Medical School, Aristotle University of Thessaloniki, General Hospital Papageorgiou, Thessaloniki, Greece
| | - Thomas Goulopoulos
- First Department of Surgery, Medical School, Aristotle University of Thessaloniki, General Hospital Papageorgiou, Thessaloniki, Greece
| | - Stavros Iliadis
- Department of Biological Chemistry, Medical School, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Vasileios Papadopoulos
- First Department of Surgery, Medical School, Aristotle University of Thessaloniki, General Hospital Papageorgiou, Thessaloniki, Greece
| | - Apostolos Papalois
- Experimental, Educational and Research Center, ELPEN, Pikermi, Attica, Greece
| | - George Mosialos
- School of Biology, Faculty of Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Theofilos Poutahidis
- Laboratory of Pathology, School of Veterinary Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Dimitrios Giakoustidis
- First Department of Surgery, Medical School, Aristotle University of Thessaloniki, General Hospital Papageorgiou, Thessaloniki, Greece
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Feretis T, Katselis C, Papanikolaou IG, Apostolou K, Tsikalakis S, Toutouzas KG, Theodoropoulos G, Trigka EA, Saetta AA, Alexakis N, Konstandoulakis M, Tsarea K, Karamperi M, Kletsas D, Patsouris E, Manouras A, Zografos GC, Papalois A. ATSC transplantation contributes to liver regeneration following paracetamol-induced acute liver injury through differentiation into hepatic-like cells. Am J Stem Cells 2020; 9:36-56. [PMID: 32699656 PMCID: PMC7364386] [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] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 05/12/2020] [Indexed: 06/11/2023]
Abstract
INTRODUCTION Drug-induced liver injury (DILI) is a leading cause of acute liver injury (ALI). Acetaminophen (also termed paracetamol), can often be found in drugs that may be abused (i.e., prescription for pain relief). Animal experiments have shown that mesenchymal stem cell transplantation can ameliorate or even reverse hepatic injury. MATERIAL AND METHODS ALI was induced in Wistar rats using paracetamol. ATSCs were transplanted via the intravenous, portal vein, or intrahepatic route directly onto the liver parenchyma. Histological evaluation was conducted to assess drug-induced injury following transplantation. Fluorescence in situ hybridization (FISH) was used to verify the location of stem cells on the liver parenchyma. The effect of those cells on liver regeneration was tested by immunohistochemistry for hepatic growth factor (HGF). In addition, reverse transcription-quantitative PCR (qRT-PCR) was used to assess hepatic growth factor (HGF), hepatic nuclear factor 4α (HNF4α), cytochrome P450 1A2 (CYP1A2) and α-fetoprotein (AFP) mRNA expression. RESULTS Immunohistochemical staining for HGF was stronger in the transplanted groups than that in the control group (P<0.001). HNF4α and HGF mRNA levels were increased on day 7 following transplantation (P<0.001 and P=0.009, respectively). CYP1A2 mRNA levels were also increased (P=0.013) in the intravenous groups, while AFP levels were higher in the intrahepatic groups (P=0.006). ATSC transplantation attenuates ALI injury and promotes liver regeneration. Furthermore, expression of specific hepatic enzymes points to ATSC hepatic differentiation. CONCLUSION The study showed the positive effects of transplanted adipose tissue stem cells (ATSCs) on liver regeneration (LG) through hepatotrophic factors. Furthermore, increased expression of hepatic specific proteins was recorded in ATSC transplanted groups that indicate stem cells differentiation into hepatic cells.
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Affiliation(s)
- Themistoklis Feretis
- 1 Department of Propaedeutic Surgery, Medical School, National Kapodistrian University of Athens, Hippocratio HospitalAthens 11527, Greece
- Experimental, Educational Research Center, ELPEN Pharmaceuticals190 09 Pikermi, Greece
| | - Charalampos Katselis
- 1 Department of Propaedeutic Surgery, Medical School, National Kapodistrian University of Athens, Hippocratio HospitalAthens 11527, Greece
- Experimental, Educational Research Center, ELPEN Pharmaceuticals190 09 Pikermi, Greece
| | - Ioannis G Papanikolaou
- 1 Department of Propaedeutic Surgery, Medical School, National Kapodistrian University of Athens, Hippocratio HospitalAthens 11527, Greece
- Experimental, Educational Research Center, ELPEN Pharmaceuticals190 09 Pikermi, Greece
| | - Konstantinos Apostolou
- 1 Department of Propaedeutic Surgery, Medical School, National Kapodistrian University of Athens, Hippocratio HospitalAthens 11527, Greece
- Experimental, Educational Research Center, ELPEN Pharmaceuticals190 09 Pikermi, Greece
| | - Spyridon Tsikalakis
- Department of Pathology, Medical School, National Kapodistrian University of Athens, Hippocratio HospitalAthens 11527, Greece
| | - Konstantinos G Toutouzas
- 1 Department of Propaedeutic Surgery, Medical School, National Kapodistrian University of Athens, Hippocratio HospitalAthens 11527, Greece
| | - George Theodoropoulos
- 1 Department of Propaedeutic Surgery, Medical School, National Kapodistrian University of Athens, Hippocratio HospitalAthens 11527, Greece
| | - Eleni Andrianna Trigka
- Department of Pathology, Medical School, National Kapodistrian University of Athens, Hippocratio HospitalAthens 11527, Greece
| | - Angelica A Saetta
- Department of Pathology, Medical School, National Kapodistrian University of Athens, Hippocratio HospitalAthens 11527, Greece
| | - Nicholas Alexakis
- 1 Department of Propaedeutic Surgery, Medical School, National Kapodistrian University of Athens, Hippocratio HospitalAthens 11527, Greece
| | - Manousos Konstandoulakis
- 1 Department of Propaedeutic Surgery, Medical School, National Kapodistrian University of Athens, Hippocratio HospitalAthens 11527, Greece
| | - Kalliopi Tsarea
- Experimental, Educational Research Center, ELPEN Pharmaceuticals190 09 Pikermi, Greece
| | - Maria Karamperi
- Experimental, Educational Research Center, ELPEN Pharmaceuticals190 09 Pikermi, Greece
| | - Dimitrios Kletsas
- Laboratory of Cell Proliferation & Ageing, Institute of Biology NCSR ‘Demokritos’Athens 15310, Greece
| | - Efstratios Patsouris
- Department of Pathology, Medical School, National Kapodistrian University of Athens, Hippocratio HospitalAthens 11527, Greece
| | - Andreas Manouras
- 1 Department of Propaedeutic Surgery, Medical School, National Kapodistrian University of Athens, Hippocratio HospitalAthens 11527, Greece
| | - Georgios C Zografos
- 1 Department of Propaedeutic Surgery, Medical School, National Kapodistrian University of Athens, Hippocratio HospitalAthens 11527, Greece
| | - Apostolos Papalois
- 1 Department of Propaedeutic Surgery, Medical School, National Kapodistrian University of Athens, Hippocratio HospitalAthens 11527, Greece
- Experimental, Educational Research Center, ELPEN Pharmaceuticals190 09 Pikermi, Greece
- European University Cyprus, Medical SchoolNicosia 2404, Cyprus
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Nicolaides M, Theodorou E, Emin EI, Theodoulou I, Andersen N, Lymperopoulos N, Odejinmi F, Kitapcioglu D, Aksoy ME, Papalois A, Sideris M. Team performance training for medical students: Low vs high fidelity simulation. Ann Med Surg (Lond) 2020; 55:308-315. [PMID: 32551104 PMCID: PMC7292889 DOI: 10.1016/j.amsu.2020.05.042] [Citation(s) in RCA: 12] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 05/19/2020] [Accepted: 05/19/2020] [Indexed: 11/24/2022] Open
Abstract
Objectives The aim of this study is to evaluate a simulation-based team performance course for medical students and compare its low- and high-fidelity components. Study design This is a prospective crossover observational study. Groups participated in one low- and one high-fidelity session twice. Low-fidelity scenarios included management of an emergency case on a simulated-patient, whereas high-fidelity scenarios constituted of multiple-trauma cases where simulated-patients wore a hyper-realistic suit. Team performance was assessed objectively, using the TEAM™ tool, and subjectively using questionnaires. Questionnaires were also used to assess presence levels, stress levels and evaluate the course. Results Participants’ team performance was higher in the low-fidelity intervention as assessed by the TEAM™ tool. An overall mean increase in self-assessed confidence towards non-technical skills attitudes was noted after the course, however there was no difference in self-assessed performance between the two interventions. Both reported mean stress and presence levels were higher for the high-fidelity module. Evaluation scores for all individual items of the questionnaire were ≥4.60 in both NTS modules. Students have assessed the high-fidelity module higher (4.88 out of 5, SD = 0.29) compared to low-fidelity module (4.74 out of 5, SD = 0.67). Conclusions Both the low- and high-fidelity interventions demonstrated an improvement in team performance of the attending medical students. The high-fidelity intervention was more realistic, yet more stressful. Furthermore, it proved to be superior in harvesting leadership, teamwork and task management skills. Both modules were evaluated highly by the students, however, future research should address retention of the taught skills and adaptability of such interventions. The high-fidelity intervention was superior in harvesting leadership, teamwork and task management skills, yet more stressful. We set the group to develop a novel group of team-based OSCE performance. The next step is to adapt such taught skills to different specialties and implement initiatives in the medical school curricula.
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Affiliation(s)
- Marios Nicolaides
- Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Efthymia Theodorou
- Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Elif Iliria Emin
- Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
| | - Iakovos Theodoulou
- Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
| | | | | | - Funlayo Odejinmi
- Department of Obstetrics and Gynaecology, Whipps Cross University Hospital, London, United Kingdom
| | - Dilek Kitapcioglu
- Center of Advanced Simulation and Education, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | - Mehmet Emin Aksoy
- Center of Advanced Simulation and Education, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | - Apostolos Papalois
- European University Cyprus, Nicosia, Cyprus.,Experimental, Educational and Research Centre Elpen, Athens, Greece
| | - Michail Sideris
- Blizard Institute of Cell and Molecular Science, Queen Mary University of London, London, United Kingdom
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Chalkias A, Koutsovasilis A, Laou E, Papalois A, Xanthos T. Measurement of mean systemic filling pressure after severe hemorrhagic shock in swine anesthetized with propofol-based total intravenous anesthesia: implications for vasopressor-free resuscitation. Acute Crit Care 2020; 35:93-101. [PMID: 32506874 PMCID: PMC7280792 DOI: 10.4266/acc.2019.00773] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Accepted: 02/12/2020] [Indexed: 01/27/2023] Open
Abstract
Background Mean systemic filling pressure (Pmsf) is a quantitative measurement of a patient’s volume status and represents the tone of the venous reservoir. The aim of this study was to estimate Pmsf after severe hemorrhagic shock and cardiac arrest in swine anesthetized with propofol-based total intravenous anesthesia, as well as to evaluate Pmsf’s association with vasopressor-free resuscitation. Methods Ten healthy Landrace/Large-White piglets aged 10–12 weeks with average weight 20±1 kg were used in this study. The protocol was divided into four distinct phases: stabilization, hemorrhagic, cardiac arrest, and resuscitation phases. We measured Pmsf at 5–7.5 seconds after the onset of cardiac arrest and then every 10 seconds until 1 minute postcardiac arrest. During resuscitation, lactated Ringers was infused at a rate that aimed for a mean right atrial pressure of ≤4 mm Hg. No vasopressors were used. Results The mean volume of blood removed was 860±20 ml (blood loss, ~61%) and the bleeding time was 43.2±2 minutes while all animals developed pulseless electrical activity. Mean Pmsf was 4.09±1.22 mm Hg, and no significant differences in Pmsf were found until 1 minute postcardiac arrest (4.20±0.22 mm Hg at 5–7.5 seconds and 3.72±0.23 mm Hg at 55– 57.5 seconds; P=0.102). All animals achieved return of spontaneous circulation (ROSC), with mean time to ROSC being 6.1±1.7 minutes and mean administered volume being 394±20 ml. Conclusions For the first time, Pmsf was estimated after severe hemorrhagic shock. In this study, Pmsf remained stable during the first minute post-arrest. All animals achieved ROSC with goal-directed fluid resuscitation and no vasopressors.
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Affiliation(s)
- Athanasios Chalkias
- Department of Anesthesiology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece.,Hellenic Society of Cardiopulmonary Resuscitation, Athens, Greece
| | | | - Eleni Laou
- Department of Anesthesiology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
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Theodoulou I, Louca C, Sideris M, Nicolaides M, Agrawal D, Halapas A, Diamantopoulos A, Papalois A. A prospective study integrating a curriculum of interventional radiology in undergraduate education: a tetra-core simulation model. CVIR Endovasc 2020; 3:12. [PMID: 32147761 PMCID: PMC7061096 DOI: 10.1186/s42155-020-0104-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Accepted: 01/20/2020] [Indexed: 12/01/2022] Open
Abstract
Background Interventional radiology (IR) is underrepresented in undergraduate medical curricula across Europe. By continuing to challenge the boundaries of IR, a rise in the demand for radiologists has been inevitable – a trend not met by a corresponding rise in the supply of radiologists. On tracing the roots of this shortage, lack of awareness of the specialty within medical trainees coupled with a global lack of IR teaching in undergraduate education seem to constitute major exacerbating factors. The purpose of this study was to identify gaps in the field of IR education and address these by implementing an international IR simulation-based course for undergraduates. Results Implementation of a multi-modality simulation-based course consisted of seven modules incorporating technical and non-technical skills, basic science and applied clinical science modules. Of all participants, 90.7% (N = 68) never had previous IR teaching experience and only 28% (N = 21) had a previous placement in an IR department. Following the course, confidence improvement was statistically significant both in IR skills (1/5, p < 0.01) and knowledge (1/5, p < 0.01)]. The majority (90.7%) said they would benefit with more exposure to IR. In terms of the students’ motivation for a career in IR, 32% (N = 24) reported that they would more likely consider a career in IR after completing the course. Conclusion Delivery of a tetra-core simulation course with the aim to address the gaps in undergraduate IR education has had a positive impact on students’ skills, confidence levels as well as motivation. We propose reviewing the curricula across medical schools in Europe to identify gaps and address any inadequacies; for this, we consider our simulation course an excellent starting point.
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Affiliation(s)
- Iakovos Theodoulou
- Faculty of Life Sciences and Medicine, King's College London, Great Maze Pond, London, SE1 9RT, UK. .,Department of Interventional Radiology, Guy's and St Thomas' Hospitals, NHS Foundation Trust, London, UK.
| | - Christina Louca
- Faculty of Life Sciences and Medicine, King's College London, Great Maze Pond, London, SE1 9RT, UK
| | - Michail Sideris
- Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Marios Nicolaides
- Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Deepsha Agrawal
- County Durham and Darlington NHS Foundation Trust, Darlington, UK
| | - Antonios Halapas
- Department of Transcatheter Heart Valves, Hygeia Hospital, Athens, Greece
| | - Athanasios Diamantopoulos
- Faculty of Life Sciences and Medicine, King's College London, Great Maze Pond, London, SE1 9RT, UK.,Department of Interventional Radiology, Guy's and St Thomas' Hospitals, NHS Foundation Trust, London, UK
| | - Apostolos Papalois
- Experimental Educational and Research Centre ELPEN, Athens, Greece.,School of Medicine, European University Cyprus, Nicosia, Cyprus
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Theodoulou I, Sideris M, Lawal K, Nicolaides M, Dedeilia A, Emin EI, Tsoulfas G, Papalois V, Velmahos G, Papalois A. Retrospective qualitative study evaluating the application of IG4 curriculum: an adaptable concept for holistic surgical education. BMJ Open 2020; 10:e033181. [PMID: 32041855 PMCID: PMC7044980 DOI: 10.1136/bmjopen-2019-033181] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVES Faced with a costly and demanding learning curve of surgical skills acquisition, the growing necessity for improved surgical curricula has now become irrefutable. We took this opportunity to formulate a teaching framework with the capacity to provide holistic surgical education at the undergraduate level. SETTING Data collection was conducted in all the relevant healthcare centres the participants worked in. Where this was not possible, interviews were held in quiet public places. PARTICIPANTS We performed an in-depth retrospective evaluation of a proposed curriculum, through semi-structured interviews with 10 participants. A targeted sampling technique was employed in order to identify senior academics with specialist knowledge in surgical education. Recruitment was ceased on reaching data saturation after which thematic data analysis was performed using NVivo 11. RESULTS Thematic analysis yielded a total of 4 main themes and 29 daughter nodes. Majority of study participants agreed that the current landscape of basic surgical education is deficient at multiple levels. While simulation cannot replace surgical skills acquisition taking place in operating rooms, it can be catalytic in the transition of students to postgraduate training. Our study concluded that a standardised format of surgical teaching is essential, and that the Integrated Generation 4 (IG4) framework provides an excellent starting point. CONCLUSIONS Through expert opinion, IG4 has been validated for its capacity to effectively accommodate learning in a safer and more efficacious environment. Moreover, we support that through dissemination of IG4, we can instil a sense of motivation to students as well as develop robust data sets, which will be amenable to data analysis through the application of more sophisticated methodologies.
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Affiliation(s)
| | - Michail Sideris
- Women's Health Research Unit, Queen Mary University of London, London, UK
| | - Kola Lawal
- King's College London - Strand Campus, London, UK
| | | | | | | | | | - Vassilios Papalois
- Renal Transplant Directorate, Imperial College Healthcare NHS Trust, London, UK
- Department of Surgery and Cancer, Imperial College London, London, UK
| | | | - Apostolos Papalois
- European University Cyprus, Nicosia, Nicosia, Cyprus
- Experimental Educational and Research Centre ELPEN, Athens, Greece
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Emin EI, Emin E, Papalois A, Willmott F, Clarke S, Sideris M. Artificial Intelligence in Obstetrics and Gynaecology: Is This the Way Forward? In Vivo 2020; 33:1547-1551. [PMID: 31471403 DOI: 10.21873/invivo.11635] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [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: 05/29/2019] [Revised: 07/03/2019] [Accepted: 07/08/2019] [Indexed: 12/20/2022]
Abstract
An increasing trend in funding towards artificial intelligence (AI) research in medicine has re-animated huge expectations for future applications. Obstetrics and gynaecology remain highly litigious specialities, accounting for a large proportion of indemnity payments due to poor outcomes. Several challenges have to be faced in order to improve current clinical practice in both obstetrics and gynaecology. For instance, a complete understanding of fetal physiology and establishing accurately predictive antepartum and intrapartum monitoring are yet to be achieved. In gynaecology, the complexity of molecular biology results in a lack of understanding of gynaecological cancer, which also contributes to poor outcomes. In this review, we aim to describe some important applications of AI in obstetrics and gynaecology. We also discuss whether AI can lead to a deeper understanding of pathophysiological concepts in obstetrics and gynaecology, allowing delineation of some grey zones, leading to improved healthcare provision. We conclude that AI can be used as a promising tool in obstetrics and gynaecology, as an approach to resolve several longstanding challenges; AI may also be a means to augment knowledge and assist clinicians in decision-making in a variety of areas in obstetrics and gynaecology.
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Affiliation(s)
- Elif Iliria Emin
- Faculty of Life Sciences and Medicine, King's College London, London, U.K
| | - Ece Emin
- School of Biosciences, Kingston University London, London, U.K
| | | | - Fredric Willmott
- Whipps Cross University Hospital Barts Health NHS Trust, London, U.K
| | - Sonji Clarke
- Guys and St Thomas' Hospital, King's College London, London, U.K
| | - Michail Sideris
- Women's Health Research Unit, Queen Mary University of London, London, U.K.
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Panteris V, Vasilakis N, Demonakou M, Kornarou E, Ktenas E, Rapti E, Spithakis G, Katopodi K, Horti M, Vgenopoulou S, Triantafyllidis J, Papalois A, Karantanos P. Alarming endoscopic data in young and older asymptomatic people: Results of an open access, unlimited age colonoscopic screening for colorectal cancer. Mol Clin Oncol 2020; 12:179-185. [PMID: 31929891 DOI: 10.3892/mco.2019.1967] [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: 07/29/2019] [Accepted: 11/04/2019] [Indexed: 11/06/2022] Open
Abstract
There is a lack of a national organized screening program for colorectal cancer in Greece, and asymptomatic detection is usually the result of individual decisions. The collection of epidemiologic endoscopic data from a population of interest would therefore provide valuable information for future treatment guidance, especially during periods of economic austerity. The current cross-sectional study included 380 asymptomatic, average risk individuals undergoing screening colonoscopy for the first time, during the period of one year in a tertiary public hospital in Athens. Descriptive and analytic epidemiologic data were analyzed. The prevalence of adenomas and advanced lesions were compared between the younger and older cohort, and a regression model was applied for risk evaluation. The mean age of participants was 63 years, and 53% were male. A significant proportion of patients presented with polyps (51.5%) and 25% of them had lesions in the proximal colon. The prevalence of adenomas and advanced adenomas was 29.5 and 11.8%, respectively. Similar high prevalence rates of lesions were identified in the cohort of individuals <50 years of age and the older cohort (>50 years of age). Regression models identified age, number and size of polyps as the major risk factors for the detection of adenomas. The increase of advanced lesions in the older and younger cohort requires confirmation by larger studies. Overall, the results of the present study indicate the requirement for a well-organized screening colonoscopy program starting from as early as 40 years of age. This program may confer an additional endoscopic burden with socioeconomic consequences in a country with limited health resources.
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Affiliation(s)
- Vasileios Panteris
- Department of Gastroenterology, Sismanogleio-Amalia Flemig General Hospital, 15126 Athens, Greece
| | - Nikolaos Vasilakis
- Department of Gastroenterology, Sismanogleio-Amalia Flemig General Hospital, 15126 Athens, Greece
| | - Maria Demonakou
- Department of Histopathology, Sismanogleio-Amalia Flemig General Hospital, 15126 Athens, Greece
| | - Eleni Kornarou
- Department of Epidemiology and Biostatistics, National School of Public Health, 11521 Athens, Greece
| | - Eftyxios Ktenas
- Department of Epidemiology and Biostatistics, National School of Public Health, 11521 Athens, Greece
| | - Emanuella Rapti
- Department of Gastroenterology, Sismanogleio-Amalia Flemig General Hospital, 15126 Athens, Greece
| | - George Spithakis
- Department of Gastroenterology, Sismanogleio-Amalia Flemig General Hospital, 15126 Athens, Greece
| | - Konstantina Katopodi
- Department of Gastroenterology, Sismanogleio-Amalia Flemig General Hospital, 15126 Athens, Greece
| | - Maria Horti
- Department of Histopathology, Sismanogleio-Amalia Flemig General Hospital, 15126 Athens, Greece
| | - Stefani Vgenopoulou
- Department of Histopathology, Sismanogleio-Amalia Flemig General Hospital, 15126 Athens, Greece
| | - John Triantafyllidis
- Department of Gastroenterology, Metropolitan General, Hellenic Society of Gastrointestinal Oncology, 15562 Athens, Greece
| | - Apostolos Papalois
- Experimental, Educational and Research Center, ELPEN Laboratories, Hellenic Society of Gastrointestinal Oncology, 19009 Athens, Greece
| | - Panagiotis Karantanos
- Department of Gastroenterology, Sismanogleio-Amalia Flemig General Hospital, 15126 Athens, Greece
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Spyropoulos V, Chalkias A, Georgiou G, Papalois A, Kouskouni E, Baka S, Xanthos T. Correction to: Initial Immune Response in Escherichia coli, Staphylococcus aureus, and Candida albicans Bacteremia. Inflammation 2019; 43:191-192. [PMID: 31858316 DOI: 10.1007/s10753-019-01156-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The original version of this article contained mistakes, and the authors would like to correct them.
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Affiliation(s)
| | - Athanasios Chalkias
- Department of Anesthesiology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larisa, Greece. .,Hellenic Society of Cardiopulmonary Resuscitation, Athens, Greece. .,Department of Anesthesiology, University Hospital of Larisa, C' Wing, 2nd Floor, PC 41110 Mezourlo, Larisa, Greece.
| | - Georgia Georgiou
- Department of Surgery, 1st Propaedeutic Surgical Clinic, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Evangelia Kouskouni
- Department of Biopathology - Microbiology and Biochemistry, Aretaieion University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Stavroula Baka
- Department of Biopathology - Microbiology and Biochemistry, Aretaieion University Hospital, National and Kapodistrian University of Athens, Athens, Greece
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Charalabopoulos A, Davakis S, Lambropoulou M, Papalois A, Simopoulos C, Tsaroucha A. Apigenin Exerts Anti-inflammatory Effects in an Experimental Model of Acute Pancreatitis by Down-regulating TNF-α. In Vivo 2019; 33:1133-1141. [PMID: 31280202 DOI: 10.21873/invivo.11583] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [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: 04/20/2019] [Revised: 06/06/2019] [Accepted: 06/10/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND/AIM This study investigated the anti-inflammatory effect of apigenin in an experimental model of acute pancreatitis. Inflammatory response was reflected by tissue expression of the cytokine TNF-α coupled with histological examination. MATERIALS AND METHODS Wistar rats were divided into three groups: Sham-group animals underwent laparotomy only, without any other interventions. Control-group animals underwent laparotomy and bilio-pancreatic duct ligation to induce pancreatitis without apigenin administration. Apigenin group animals were further treated with apigenin. Euthanasia was performed at 6, 12, 24, 48 and 72 h post-operatively. RESULTS Over-expression of TNF-α in relation to postoperative time was observed in the control group (p<0.001). In the apigenin group, under-expression of TNF-α in relation to postoperative time was observed (p<0.013). At 72 h, apigenin reduced pancreatic TNF-α expression and prevented pancreatic necrosis. CONCLUSION Apigenin slows progression and reduces severity of acute pancreatitis. Apigenin may serve as an adjunct to a more successful therapeutic strategy in acute pancreatitis.
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Affiliation(s)
- Alexandros Charalabopoulos
- Department of Upper Gastrointestinal and General Surgery, Broomfield Hospital, Mid Essex Hospital Services NHS Trust, Essex, U.K.,Experimental-Research Center, ELPEN Pharmaceuticals, Athens, Greece
| | - Spyridon Davakis
- Department of Upper Gastrointestinal and General Surgery, Broomfield Hospital, Mid Essex Hospital Services NHS Trust, Essex, U.K. .,First Department of Surgery, Laiko General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria Lambropoulou
- Department of Histopathology, Faculty of Medicine, Democritus University of Thrace, Alexandroupoli, Greece
| | | | - Constantinos Simopoulos
- Laboratory of Experimental Surgery and Surgical Research, Faculty of Medicine, Democritus University of Thrace, Alexandroupoli, Greece
| | - Alexandra Tsaroucha
- Laboratory of Experimental Surgery and Surgical Research, Faculty of Medicine, Democritus University of Thrace, Alexandroupoli, Greece
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Alexopoulos G, Pavlidis L, Tsagarakis M, Delimpaltas A, Tsimponis A, Papalois A, Batistatou A, Papoudou-Bai A, Barritault D, Demiri E, Spyropoulou GA. Can ReGeneraTing Agents Improve Functional Recovery of Transected Peripheral Nerve through a Nerve Gap Bridged with an Artery Graft? J Reconstr Microsurg Open 2019. [DOI: 10.1055/s-0039-1692453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
Background The purpose of this study was to use artery grafts filled with CACIPLIQ20 and see if they promote nerve regeneration.
Methods Sixty male Wistar rats were used. The rats were randomly divided into four experimental groups (n = 15): transected control group (negative control group [NCG]), sham-operated group (positive control group [SO]) artery graft group filled with saline (AG/NS), and CACIPLIQ20-treated group (AG/CACIPLIQ20). Fifteen rats were used as artery graft donors. In the SO group, the sciatic nerve was dissected from the surrounding tissues and left intact. In the NCG, AG/NS and AG/CACIPLIQ20) groups, a 10-mm gap was created in the left sciatic nerve. In the NCG group, the gap was not bridged with a graft. In the AG/NS group, the gap was bridged with a graft filled with saline. In the AG/CACIPLIQ20 group, the graft was filled with CACIPLIQ20. Walking track analysis was performed at 4, 8, 12, and 16 weeks after surgery. At 16 weeks postoperatively, the rats were sacrificed, nerve sections were harvested for histopathology analysis, and the weight ratio of the gastrocnemius muscle was measured.
Results There was no significant difference in myelin sheath thickness between the AG/NS and AG/CACIPLIQ20 groups. Muscle weight in the AG/CACIPLIQ20 group was higher but not statistically significant (p = 0.168) compared with the AG/NS group. Also, AG/CACIPLIQ20 mean was better than AG/NS mean, although there was no statistically significant difference (p = 0.605).
Conclusion There could be an indication that CACIPLIQ20 improves functional recovery of a transected peripheral nerve through a nerve gap bridged with an artery graft.
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Affiliation(s)
| | - Leonidas Pavlidis
- Clinic of Plastic Surgery, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Myron Tsagarakis
- Department of Plastic and Reconstructive Surgery, ENI Medical Group, Kavos Lefkimi, Corfu, Greece
| | - Alexandros Delimpaltas
- Clinic of Plastic Surgery, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Antonios Tsimponis
- Clinic of Plastic Surgery, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Apostolos Papalois
- Department of Research and Development, "ELPEN" Pharmaceuticals, Athens, Greece
| | - Anna Batistatou
- Department of Pathology, Panepistimio Ioanninon, Ioannina, Greece
| | | | | | - Efterpi Demiri
- Clinic of Plastic Surgery, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Giannakopoulou CE, Sotiriou A, Dettoraki M, Yang M, Perlikos F, Toumpanakis D, Prezerakos G, Koutsourelakis I, Kastis GA, Vassilakopoulou V, Mizi E, Papalois A, Greer JJ, Vassilakopoulos T. Regulation of breathing pattern by IL-10. Am J Physiol Regul Integr Comp Physiol 2019; 317:R190-R202. [PMID: 31091151 DOI: 10.1152/ajpregu.00065.2019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Proinflammatory cytokines like interleukin-1β (IL-1β) affect the control of breathing. Our aim is to determine the effect of the anti-inflammatory cytokine IL-10 οn the control of breathing. IL-10 knockout mice (IL-10-/-, n = 10) and wild-type mice (IL-10+/+, n = 10) were exposed to the following test gases: hyperoxic hypercapnia 7% CO2-93% O2, normoxic hypercapnia 7% CO2-21% O2, hypoxic hypercapnia 7% CO2-10% O2, and hypoxic normocapnia 3% CO2-10% O2. The ventilatory function was assessed using whole body plethysmography. Recombinant mouse IL-10 (rIL-10; 10 μg/kg) was administered intraperitoneally to wild-type mice (n = 10) 30 min before the onset of gas challenge. IL-10 was administered in neonatal medullary slices (10-30 ng/ml, n = 8). We found that IL-10-/- mice exhibited consistently increased frequency and reduced tidal volume compared with IL-10+/+ mice during room air breathing and in all test gases (by 23.62 to 33.2%, P < 0.05 and -36.23 to -41.69%, P < 0.05, respectively). In all inspired gases, the minute ventilation of IL-10-/- mice was lower than IL-10+/+ (by -15.67 to -22.74%, P < 0.05). The rapid shallow breathing index was higher in IL-10-/- mice compared with IL-10+/+ mice in all inspired gases (by 50.25 to 57.5%, P < 0.05). The intraperitoneal injection of rIL-10 caused reduction of the respiratory rate and augmentation of the tidal volume in room air and also in all inspired gases (by -12.22 to -29.53 and 32.18 to 45.11%, P < 0.05, respectively). IL-10 administration in neonatal rat (n = 8) in vitro rhythmically active medullary slice preparations did not affect either rhythmicity or peak amplitude of hypoglossal nerve discharge. In conclusion, IL-10 may induce a slower and deeper pattern of breathing.
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Affiliation(s)
- Charoula Eleni Giannakopoulou
- Department of Critical Care and Pulmonary Services and Marianthi Simou Applied Biomedical Research and Training Center, University of Athens Medical School , Athens , Greece
| | - Adamantia Sotiriou
- Department of Critical Care and Pulmonary Services and Marianthi Simou Applied Biomedical Research and Training Center, University of Athens Medical School , Athens , Greece
| | - Maria Dettoraki
- Department of Critical Care and Pulmonary Services and Marianthi Simou Applied Biomedical Research and Training Center, University of Athens Medical School , Athens , Greece
| | - Michael Yang
- Experimental Research Center, ELPEN Pharmaceuticals, Attica, Greece
| | - Fotis Perlikos
- Department of Critical Care and Pulmonary Services and Marianthi Simou Applied Biomedical Research and Training Center, University of Athens Medical School , Athens , Greece
| | - Dimitrios Toumpanakis
- Department of Critical Care and Pulmonary Services and Marianthi Simou Applied Biomedical Research and Training Center, University of Athens Medical School , Athens , Greece
| | - Georgios Prezerakos
- Department of Critical Care and Pulmonary Services and Marianthi Simou Applied Biomedical Research and Training Center, University of Athens Medical School , Athens , Greece
| | - Ioannis Koutsourelakis
- Department of Critical Care and Pulmonary Services and Marianthi Simou Applied Biomedical Research and Training Center, University of Athens Medical School , Athens , Greece
| | - Georgios A Kastis
- Department of Critical Care and Pulmonary Services and Marianthi Simou Applied Biomedical Research and Training Center, University of Athens Medical School , Athens , Greece
| | - Vyronia Vassilakopoulou
- Department of Critical Care and Pulmonary Services and Marianthi Simou Applied Biomedical Research and Training Center, University of Athens Medical School , Athens , Greece
| | - Eleftheria Mizi
- Department of Critical Care and Pulmonary Services and Marianthi Simou Applied Biomedical Research and Training Center, University of Athens Medical School , Athens , Greece
| | | | - John J Greer
- Department of Physiology, Neuroscience and Mental Health Institute, Women and Children's Health Research Institute, Faculty of Medicine and Dentistry, University of Alberta , Edmonton, Alberta , Canada
| | - Theodoros Vassilakopoulos
- Department of Critical Care and Pulmonary Services and Marianthi Simou Applied Biomedical Research and Training Center, University of Athens Medical School , Athens , Greece
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Korontzi MI, Theodoropoulos G, Agrogiannis G, Flessas I, Chrysikos D, Gioxari A, Sergentanis TN, Patsouris E, Zografos GC, Papalois A. Lazaroid U-74389G in liver ischemia-reperfusion injury: A swine model. Exp Ther Med 2019; 18:230-236. [PMID: 31258658 DOI: 10.3892/etm.2019.7561] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 07/11/2018] [Accepted: 03/15/2019] [Indexed: 12/13/2022] Open
Abstract
Reactive oxygen species have a key role in liver ischemia-reperfusion (I/R) injury. In the present study, the effect of the anti-oxidant compound lazaroid U-74389G in preventing liver I/R injury was investigated in a swine model. Ischemia was produced by portal vein occlusion. Two sets of experiments were performed, each with two groups (n=7 per group). In the first group, the potential protective effect of an intracaval injection of U-74389G after a 30-min ischemia, followed by a 60-min reperfusion period was assessed (biopsies at 0, 15, 30 and 90 min experimental time). In the second set, the effect of intracaval U-74389G injection after 30 min of ischemia, followed by a longer reperfusion period of 120 min was determined (biopsies at 0, 15, 30 and 150 min experimental time). Liver malondialdehyde, hepatocyte vacuolation-degeneration, venous congestion, inflammatory cell infiltration, sinus congestion-dilation and Chiu score of intestinal damage were determined at up to 150 min of reperfusion. In the second set of experiments, the Chiu score of intestinal damage was improved by the administration of U-74389G (3.17±0.40 vs. 4.33±0.21; P=0.030). However, in the two sets of experiments, the liver inflammatory reaction was more pronounced in the U-74389G groups (P=0.017 for the first set, P=0.021 for the second set). No significant effect of U-74389G on any other parameters was detected. In conclusion, intestinal damage due to portal venous congestion and reflow appears to be mitigated by the lazaroid U-74389G; however, intracaval administration of U-74389G does not appear to exert any protective effects against liver I/R-induced inflammation.
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Affiliation(s)
- Maria I Korontzi
- First Department of Propaedeutic Surgery, Hippocration Hospital, School of Medicine, University of Athens, 11527 Athens, Greece
| | - George Theodoropoulos
- First Department of Propaedeutic Surgery, Hippocration Hospital, School of Medicine, University of Athens, 11527 Athens, Greece
| | - George Agrogiannis
- Department of Pathology, School of Medicine, University of Athens, 11527 Athens, Greece
| | - Ioannis Flessas
- First Department of Propaedeutic Surgery, Hippocration Hospital, School of Medicine, University of Athens, 11527 Athens, Greece
| | - Dimosthenis Chrysikos
- First Department of Propaedeutic Surgery, Hippocration Hospital, School of Medicine, University of Athens, 11527 Athens, Greece
| | - Aristea Gioxari
- Department of Nutrition and Dietetics, Harokopio University, 17676 Athens, Greece
| | - Theodoros N Sergentanis
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, University of Athens, 11527 Athens, Greece
| | - Efstratios Patsouris
- Department of Pathology, School of Medicine, University of Athens, 11527 Athens, Greece
| | - George C Zografos
- First Department of Propaedeutic Surgery, Hippocration Hospital, School of Medicine, University of Athens, 11527 Athens, Greece
| | - Apostolos Papalois
- Experimental, Educational and Research Center, ELPEN Pharmaceuticals, 19009 Athens, Greece.,School of Medicine European University of Cyprus, 2404 Nicosia, Cyprus
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Nicolaides M, Theodorou E, Hanrahan JG, Theodoulou I, Emin EI, Papalois A, Sideris M. Advancing Medical Students' Non-technical Skills in a Group-Based Setting. J INVEST SURG 2019; 34:39-43. [PMID: 31035823 DOI: 10.1080/08941939.2019.1602691] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Aim of the study: Introduction of non-technical skill (NTS) modules in undergraduate medical curricula is essential to prevent errors that occur due to inadequate communication and malfunctioning teams. We primarily aimed to observe medical students' NTS performance improvement in a group-based setting and compare it across participants of different countries of study. Secondarily, we aimed to assess students' views on such initiatives. Material and Methods: We designed a pilot module for assessing and improving a group's NTS performance. This was based on three main pillars: simulation-based learning, constructive feedback and objective assessment. Senior medical students from EU universities were invited to apply online. Delegates were divided according to their country of study and participated in two surgical scenarios. Groups had two attempts at each scenario and feedback was given in between. Performance was assessed using a modified version of the Individual Teamwork Observation and Feedback Tool (iTOFT). Participant feedback was collected at the end of the module. Results: Eighty delegates were recruited and finished the study. A mean increase performance of 0.81 out of 3 was noted between attempts in trauma-case scenarios and 0.88 out of 3 in ward round scenarios. Overall performance improvement was similar across all groups (p > 0.05). Feedback of delegates was encouragingly positive. Conclusions: The reported improvement and positive feedback received highlight that such an intervention can be implemented in medical school curricula of all countries. Our module design, along with the use of iTOFT, should act as the basis for future development of group-based learning and assessment in undergraduate medical education.
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Affiliation(s)
- Marios Nicolaides
- Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Efthymia Theodorou
- Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | | | - Iakovos Theodoulou
- Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Elif Iliria Emin
- Faculty of Life Sciences and Medicine, King's College London, London, UK
| | | | - Michail Sideris
- Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK.,Experimental Educational and Research Centre ELPEN, Athens, Greece
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Emin EI, Ruhomauly Z, Theodoulou I, Hanrahan JG, Staikoglou N, Nicolaides M, Thulasidasan N, Papalois A, Sideris M. Are interventional radiology and allied specialities neglected in undergraduate medical education? A systematic review. Ann Med Surg (Lond) 2019; 40:22-30. [PMID: 30962927 PMCID: PMC6429536 DOI: 10.1016/j.amsu.2019.03.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Revised: 02/17/2019] [Accepted: 03/11/2019] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES Minimally invasive interventional approaches are gaining wider acceptance with several specialities incorporating such principles. Awareness and understanding of interventional principles require efficacious education and training methodologies. We performed a systematic review to identify all available interventional speciality learning modules or training opportunities available for undergraduate medical students. We also propose a standardised framework for relevant modules. METHODS We searched PubMed and all Ovid databases with no language restriction for studies that report and evaluate interventional speciality educational modules or similar training initiatives. We followed a prospective protocol (PROSPERO registration: CRD42018110006). Internal and external validity of the included studies was assessed. Qualitative synthesis of data was performed to define performance improvement and/or motivation towards a career in an interventional speciality. RESULTS Out of 6081 records, 17 studies met the inclusion criteria, 15 of which were focused on interventional radiology. More than half of studies (9/17) were surveys where student knowledge and interest were reported as poor. 5 out of 6 studies which assessed the effect of educational interventions concluded to improved knowledge or performance. Most surveys concluded that early exposure can increase interest towards such specialities, improve knowledge and relevant motivation. CONCLUSIONS Few studies report teaching initiatives in interventional radiology and other interventional specialities, reflecting the poor relevant motivation and knowledge amongst medical students. Simple interventions e.g. introductory lectures and simulation sessions spark interest in students and also improve knowledge as proven in the case of interventional radiology. Standardisation of such efforts via a suggested framework, Strategy Development Framework for Interventional Radiology, can further optimise such outcomes.
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Affiliation(s)
- Elif Iliria Emin
- Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Zeinab Ruhomauly
- Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Iakovos Theodoulou
- Faculty of Life Sciences and Medicine, King's College London, London, UK
| | | | - Nikolaos Staikoglou
- Medical School of Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Marios Nicolaides
- Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | | | | | - Michail Sideris
- Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
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Nicolaides M, Cardillo L, Theodoulou I, Hanrahan J, Tsoulfas G, Athanasiou T, Papalois A, Sideris M. Developing a novel framework for non-technical skills learning strategies for undergraduates: A systematic review. Ann Med Surg (Lond) 2018; 36:29-40. [PMID: 30370054 PMCID: PMC6199815 DOI: 10.1016/j.amsu.2018.10.005] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 09/18/2018] [Accepted: 10/02/2018] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVES There is substantial lack of guidance when it comes to the implementation of non-technical skills (NTS) in undergraduate medical education. This review aimed to identify and critically evaluate published literature on learning strategies for NTS in undergraduate medical education and to derive a training framework targeted towards standardizing future training interventions. METHODS A systematic review of the MEDLINE database was performed using a prospective protocol following PRISMA guidelines. Studies evaluating undergraduate medical students exposed to NTS interventions, which measured subjective or objective outcomes in selected attributes, were included. RESULTS Initial systematic search yielded a total of 5079 articles, out of which 68 fulfilled the inclusion criteria. A total of 24 NTS were identified, with communication skills being the most commonly reported skill evaluated (n = 37). A variety of educational tools were used (n = 32), noteworthy being the use of simulated patients. Great heterogeneity was also observed in measured outcomes and methods of assessment. A 'triad of outcomes' in NTS training was devised (knowledge, skill performance and attitude towards skills) and used for classification of all reported outcomes. Extracted data were used to design a non-technical skill training framework. CONCLUSIONS The existing literature describes a plethora of NTS interventions in undergraduate medical education, with varied outcomes and assessments. We hereby propose the 'NTS Training Framework', in an attempt to coordinate future research and catalyze the identification of an ideal NTS course structure to form tomorrow's physicians.
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Affiliation(s)
- Marios Nicolaides
- Barts and the London School of Medicine and Dentistry, Queen Mary University of London, 4 Newark St, Whitechapel, London, E1 2AT, United Kingdom
| | - Luca Cardillo
- Faculty of Life Sciences and Medicine, King's College London, Great Maze Pond, London, SE1 9RT, United Kingdom
| | - Iakovos Theodoulou
- Faculty of Life Sciences and Medicine, King's College London, Great Maze Pond, London, SE1 9RT, United Kingdom
| | - John Hanrahan
- Faculty of Life Sciences and Medicine, King's College London, Great Maze Pond, London, SE1 9RT, United Kingdom
| | - Georgios Tsoulfas
- Department of Surgery, Aristotle University of Thessaloniki, Thessaloniki, 54124, Greece
| | - Thanos Athanasiou
- Imperial College London, Faculty of Medicine, Department of Surgery and Cancer, South Kensington Campus, London, SW7 2AZ, UK
| | - Apostolos Papalois
- Experimental Research Centre ELPEN, 95 Marathonos Avenue, 19009, Pikermi, Greece
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Kostakis ID, Sikalias N, Alexiou K, Mountzalia L, Papalois A, Karatzas T. How Much Ischemia Can the Severely Steatotic Rat Liver Tolerate? In Vivo 2018; 32:1381-1386. [PMID: 30348692 DOI: 10.21873/invivo.11390] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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: 07/18/2018] [Revised: 09/22/2018] [Accepted: 09/25/2018] [Indexed: 12/14/2022]
Abstract
AIM Steatotic liver is more susceptible to ischemia-reperfusion injury than is lean liver. Our aim was to investigate the ability of the severely steatotic rat liver to sustain ischemia. MATERIALS AND METHODS One hundred male Wistar rats aged 12-14 weeks were included. Fifty rats were given regular diet, while the rest were given a choline-free diet for 12-14 weeks to develop severe liver steatosis. Each group was divided into the following five subgroups: Sham-operated, and 5, 10, 15 and 20 minutes of continuous vascular inflow occlusion. Serum glutamic-oxaloacetic transaminase and serum glutamic-pyruvic transaminase levels were measured at 24 hours postoperatively and the animals were surveilled for 30 days. RESULTS Serum transaminase levels increased as the duration of ischemia increased in lean livers (p<0.0001), without a significant impact on animal survival. Similarly, serum transaminase levels increased as the duration of ischemia increased in severely steatotic livers (p<0.0001), reaching a plateau after 15 minutes of liver ischemia. Survival was significantly affected after the same cut-off point in rats with steatotic liver (p<0.0001). Serum transaminase levels were greater in severely rats with steatotic liver than in rats with lean liver, when they were adjusted for the duration of liver ischemia. Moreover, survival was reduced when serum transaminase levels surpassed the threshold of 2,000 IU/l (p<0.0001). CONCLUSION Severely steatotic rat liver can safely tolerate up to 10 minutes of continuous ischemia, with survival being affected after 15 minutes or more. On the other hand, lean rat liver can safely tolerate even 20 minutes of continuous ischemia.
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Affiliation(s)
- Ioannis D Kostakis
- Second Department of Propaedeutic Surgery, Laiko General Hospital, National and Kapodistrian University of Athens, Medical School, Athens, Greece .,N.S. Christeas Laboratory of Experimental Surgery and Surgical Research, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Nikolaos Sikalias
- Department of Surgery, Sismanogleion General Hospital, Athens, Greece
| | | | | | | | - Theodore Karatzas
- Second Department of Propaedeutic Surgery, Laiko General Hospital, National and Kapodistrian University of Athens, Medical School, Athens, Greece.,N.S. Christeas Laboratory of Experimental Surgery and Surgical Research, National and Kapodistrian University of Athens, Medical School, Athens, Greece
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Hanrahan J, Theodoulou I, Staikoglou N, Tsagkaraki IM, Pasha T, Plastiras A, Tsoulfas G, Velmahos GC, Sideris M, Papalois A. Evidence-Based Approach to Harmonize Core Performance Outcomes in Undergraduate Simulation-Based Education: The Integrated Generation 4 Model. J Am Coll Surg 2018. [DOI: 10.1016/j.jamcollsurg.2018.08.553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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