Revistas
Revista:
ACTAS UROLÓGICAS ESPAÑOLAS (ENGLISH ED.)
ISSN:
2173-5786
Año:
2023
Vol.:
47
N°:
4
Págs.:
236 - 243
Introduction: Simulation in medicine has developed a lot in the last few decades. There is a broad range of simulators available, above all for training in surgical procedures. Endourology can benefit much from simulation because the minimally-invasive procedures of endourology frequently have long learning curves, which can be reduced by training with simulators.
Materials and methods: A low-fidelity simulator was designed for practicing endourology techniques that use cystoscopy. The process of validation involved 5 experts and 19 non-experts. Experts comprised medical professionals working in a department of urology who had performed at least 100 flexible cystoscopy procedures. Non-experts were residents in internal medicine without experience in any type of endoscopy. Information about face and content validity was collected by means of Likert scales from 1 to 5. To evaluate construct validity, we measured the time to complete two tasks, for which the procedure was evaluated by means of the OSATS global evaluation scale.
Results: New simulator was successfully built according to its design. For all evaluated aspects of construct validity, there was a significant difference (p < 0.05) between the group of experts and the group of non-experts. Content validity was scored 4.66 (standard deviation ±0.56) by the experts and 4.41 (±0.71) by the non-experts. In the face validity questionnaire, the average score was 4.14 (±0.94), the question receiving the highest score: 4.6 (±0.84) concerned immersion in the procedure.
Conclusion: The simulator presented is valid both for training up new urologists in endourology technique and for experts seeking to perfect their skills.
Revista:
ACTA BIOMATERIALIA
ISSN:
1742-7061
Año:
2022
Vol.:
141
Págs.:
264 - 279
Biomechanical properties of adipose tissue (AT) are closely involved in the development of obesity associated comorbidities. Bariatric surgery (BS) constitutes the most effective option for a sustained weight loss in addition to improving obesity-associated metabolic diseases including type 2 diabetes (T2D). We aimed to determine the impact of weight loss achieved by BS and caloric restriction (CR) on the biomechanical properties of AT. BS but not CR changed the biomechanical properties of epididymal white AT (EWAT) from a diet-induced obesity rat model, which were associated with metabolic improvements. We found decreased gene expression levels of collagens and Lox together with increased elastin and Mmps mRNA levels in EWAT after BS, which were also associated with the biomechanical properties. Moreover, an increased blood vessel density was observed in EWAT after surgery, confirmed by an up regulation of Acta2 and Antxr1 gene expression levels, which was also correlated with the biomechanical properties. Visceral AT from patients with obesity showed increased stiffness after tensile tests compared to the EWAT from the animal model. This study uncovers new insights into EWAT adaptation after BS with decreased collagen crosslink and synthesis as well as an increased degradation together with enhanced blood vessel density providing, simultaneously, higher stiffness and more ductility.
Statement of Significance
Biomechanical properties of the adipose tissue (AT) are closely involved in the development of obesity associated comorbidities. In this study, we show for the first time that biomechanical properties of AT determined by E , UTS and strain at UTS are decreased in obesity, being increased after bariatric surgery by the promotion of ECM remodelling and neovascularization. Moreover, these changes in biomechanical properties are associated with improvements in metabolic homeostasis. Consistently, a better characterization of the plasticity and biomechanical properties of the AT after bariatric surgery opens up a new field for the development of innovative strategies for the reduction of fibrosis and inflammation in AT as well as to better understand obesity and its associated comorbidities.
Revista:
SIMULATION IN HEALTHCARE
ISSN:
1559-2332
Año:
2021
Vol.:
16
N°:
5
Págs.:
367 - 371
Introduction: The AirSim Multi (TruCorp) airway simulator is used to practice exploration of the upper respiratory tract with a flexible endoscope to assess the nasal cavities, their structures and spaces (inferior, middle, and superior turbinates and meati), and the nasopharynx. The passage of the flexible endoscope through the nose is usually the most annoying and painful maneuver to continue the exploration of the airway to the pharynx and larynx. For this reason, it is important to develop self-assessment training systems in safe environments that allow trainees to develop the necessary skills to carry out this type of assessment with the least inconvenience and the greatest security. Despite this simulator's accurate anatomical reproduction of the tract, its suitability as a tool for endoscope exploration learning is limited without a feedback system. Effective endoscopic exploration should not cause pain or lesions, not only for comfort and safety reasons, but also because only when discomfort is minimized is a complete and detailed exploration of the anatomical structures possible. The objective of the project was to provide a feedback system from the simulator to the trainee that would facilitate improvements in self-trained skills needed to perform an endoscopic exploration of the airways. Methods: A device based on the Hall-effect sensor was designed and placed outside the airway in the upper nasal turbinate. This device detects changes in the magnetic flux, indicating a displacement on the nasal turbinate due to endoscopic maneuvers that deform the inside of the simulator and would be expected to be harmful or painful in real life. Results: The improved AirSim provides audible and visual feedback during exploration to indicate a change on the nasal turbinate due to endoscopic contact with the turbinate surface that would be expected to be harmful or painful in real life. We expect this feature to facilitate self-learning with minimal professional supervision and reduce the overall training time required to successfully perform a complete exploration of the airway. Conclusions: The inclusion of sensors on a passive simulator is a cost-effective measure that may allow for better training experiences using AirSim Multi simulator from the TruCorp company. Our improved simulator turns endoscopic exploration into a self-assessed exercise suitable for all disciplines and level of learners.
Revista:
OTOLARYNGOLOGY-HEAD AND NECK SURGERY
ISSN:
0194-5998
Año:
2021
Vol.:
164
N°:
2
Págs.:
339 - 345
Objective To validate a simulator for upper airway examination, fitted with sensors, for use as an academic tool for learning how to conduct examination of the upper airway and for evaluation of that learning. Study Design Validation study. Setting Undergraduate medical education. Subjects and Methods A group of 18 fifth-year medical students and another of 6 otorhinolaryngology specialists conducted 6 examinations each with the simulator. To investigate concurrent validity, we calculated the correlation between damage scores provided by the simulator and damage assessment by a specialist. To evaluate construct validity, we compared both groups with regard to damage scores, technical procedure, and time spent. To examine content and face validity, we used questionnaires based on a 5-point Likert scale. Results For concurrent validity, the correlation between the simulator's damage scores and the specialist's damage assessment was high: Spearman's rho was 0.828 (P< .001). For construct validity, the group of students differed from the group of specialists in damage scores (P= .027) and in technical procedures (P< .001) but not in time spent. For content validity, all questionnaire statements were scored highly, and both groups had similar average scores. For face validity, the group of specialists considered the simulator to be realistic, and all statements on the questionnaire were rated with at least 4/5. Conclusion Concurrent, construct, content, and face validity have been demonstrated for a sensor-fitted simulator for upper airway examination, which is therefore accurate enough to be used as an academic tool for learning and evaluation of learning.
Revista:
BMC OPHTHALMOLOGY
ISSN:
1471-2415
Año:
2020
Vol.:
20
N°:
1
Págs.:
12
BackgroundTear film stability is the key event in ocular surface diseases. The purpose of this study is to evaluate spatial and temporal progression of the tear film breakup using an automatic non-invasive device.MethodsNon-invasive tear breakup time (NITBUT) parameters, such as First NITBUT (F-NITBUT) and Average NITBUT (A-NITBUT), were evaluated in 132 glaucoma and 87 control eyes with the Keratograph 5M device. Further analysis of this data was used to determine size, location and progression of tear film breakup with automatically identified breakup areas (BUA). The progression from First BUA (F-BUA) to total BUA (T-BUA) was expressed as Dry Area Growth Rate (DAGR). Differences between both groups were analysed using Student t-test for parametric data and Mann-Whitney U test for non-parametric data. Pearson's correlation coefficient was used to assess the relationship between parametric variables and Spearman in the case of non-parametric variables.ResultsF-NITBUT was 11.437.83s in the control group and 8.17 +/- 5.73 in the glaucoma group (P=0.010). A-NITBUT was 14.04 +/- 7.21 and 11.82 +/- 6.09s in control and glaucoma groups, respectively (P=0.028). F-BUA was higher in the glaucoma group than in the control group (2.73 and 2.28; P=0.022) and was more frequently located at the centre of the cornea in the glaucoma group (P=0.039). T-BUA was also higher in the glaucoma group than in the control group (13.24 and 9.76%; P=0.012) and the DAGR was steeper in the glaucoma group than in the control group (34.38 degrees and 27.15 degrees; P=0.009).Conclusions Shorter NITBUT values and bigger, more central tear film breakup locations were observed in the glaucoma group than in the control group. The DAGR indicates that tear film rupture is bigger and increases faster in glaucomatous eyes than in normal eyes.
Revista:
INTERNATIONAL JOURNAL OF OBESITY
ISSN:
0307-0565
Año:
2018
Vol.:
42
N°:
8
Págs.:
1458 - 1470
Background/Objectives: Obesity is related to a dynamic extracellular matrix (ECM) remodeling, which involves the synthesis and degradation of different proteins, such as tenascin C (TNC) in the adipose tissue (AT). Given the functional relationship between leptin and inducible nitric oxide synthase (iNOS), our aim was to analyze the impact of the absence of the iNOS gene in AT inflammation and ECM remodeling in ob/ob mice. Subjects/Methods: The expression of genes involved in inflammation and ECM remodeling was evaluated in 10-week-old male double knockout (DBKO) mice simultaneously lacking the ob and iNOS genes as well as in ob/ob mice classified into three groups [control, leptin-treated (1 mg kg(-1) day(-1)) and pair-fed]. Results: Leptin deficiency increased inflammation and fibrosis in AT. As expected, leptin treatment improved the obesity phenotype. iNOS deficiency in ob/ob mice improved insulin sensitivity, AT inflammation, and ECM remodeling, as evidenced by lower AT macrophage infiltration and collagen deposition, a downregulation of proinflammatory and profibrogenic genes Tnf, Emr1, Hif1a, Col6a1, Col6a3, and Tnc, as well as lower circulating TNC levels. Interestingly, leptin upregulated TNC expression and release in 3T3-L1 adipocytes, and iNOS knockdown in 3T3-L1 fat cells produced a significant decrease in basal and leptin-induced Tnc expression. Conclusions: Ablation of iNOS in leptin-deficient mice improved AT inflammation and ECM remodeling-related genes, attenuating fibrosis, and metabolic dysfunction. The activation of iNOS by leptin is necessary for the synthesis and secretion of TNC in adipocytes, suggesting an important role of this alarmin in the development of AT inflammation and fibrosis.
Revista:
NEUROCIRUGIA
ISSN:
1130-1473
Año:
2017
Vol.:
28
N°:
6
Págs.:
260 - 265
Introduction: Craniosynostosis is a rare condition and requires a personalised surgical approach, which is why we consider the use of 3D printed models beneficial in the surgical planning of this procedure.
Material and methods: Acrylonitrile butadiene styrene plastic skull models were designed and printed from CT images of patients between 3 and 6 months of age with craniosynostosis of different sutures. The models were used to simulate surgical procedures.
Results: Four models of four patients with craniosynostosis were produced: two with closure of the metopic suture and two with sagittal suture closure. The mean age of the patients was 5 months (3-6 m) and the mean duration of the surgery was 286 min (127-380 min).
The acrylonitrile butadiene styrene plastic models printed for the project proved to be optimal for the simulation of craniosynostosis surgeries, both anatomically and in terms of mechanical properties and reaction to surgical instruments.
Conclusions: 3D printers have a wide range of medical applications and they offer an easy and affordable way to produce skull models. The acrylonitrile butadiene styrene material is suitable for the production of operable bone models as it faithfully reproduces the mechanical characteristics of bone tissue. (C) 2017 Sociedad Espariola de Neurocirugia.
Nacionales y Regionales
Título:
Cambios en la plasticidad del tejido adiposo tras cirugía bariátrica y su papel en la mejoría de comorbilidades asociadas.
Código de expediente:
PI16/01217
Investigador principal:
Gema Frühbeck Martínez
Financiador:
INSTITUTO DE SALUD CARLOS III
Convocatoria:
2016 AES PROYECTOS DE INVESTIGACIÓN
Fecha de inicio:
01/01/2017
Fecha fin:
31/12/2019
Importe concedido:
260.452,50€
Otros fondos:
Fondos FEDER
