A minimum number of index procedures did not reflect competence in a significant proportion of trainees. A more reliable tool is required for certification.

Background: Practice on Virtual Reality simulators (VRS) have been shown to improve surgical performance. However, VRS are expensive and usually housed in surgical skills centres that may be inaccessible at times convenient for surgical trainees to practice. Conversely, box trainers are inexpensive and can be used anywhere at anytime. This study assesses "take-home" Box Trainers (BT) as an alternative to VRS.Methods: After baseline assessments (two simulated laparoscopic cholecystectomies, one on a VRS and one on a BT) 25 surgical trainees were randomised to two groups. Trainees were asked to practice 3 basic laparoscopic tasks for 6 weeks (BT group using a "take-home" box trainer; VR group using VRS in clinical skills centres). After the practice period all performed two LC, one on a VRS and one on a BT; (i.e. post-training assessment). VRS provided metrics (total time (TT), number of movements (NOM) instrument tip path length (PL)) and expert video assessment of cholecystectomy in a BT (GOALS score) were recorded. Performance during pre-and post-training assessment was compared.Results: The BT group showed a significant improvement for all VRS metrics (p=0.008) and the efficiency category of GOALS score (p=0.03). Only TT improved in the VRS group and none of the GOALS categories demonstrated a statistically significant improvement after training.

BackgroundSelaginella convoluta (Arn.) Spring (Selaginellaceae), commonly known as “jericó”, is a medicinal plant found in northeastern Brazil. S. convoluta is used in folk medicine as an antidepressant, aphrodisiac, diuretic, analgesic, anti-inflammatory and it is used to combat amenorrhea, coughing and bleeding. This study was performed to evaluate the antinociceptive effects of ethanolic extract from S. convoluta in mice exposed to chemical and thermal models of nociception.MethodsPreliminary phytochemical analysis of the ethanolic extract was performed. The ethanolic extract from Selaginella convoluta (Sc-EtOH) was examined for its intraperitoneal (i.p.) antinociceptive activity at the doses of 100, 200 and 400 mg/kg body weight. Acetic acid-induced writhing, formalin injection and hot plate tests were used to evaluate the antinociceptive activity of Sc-EtOH extract. The rota-rod test was used to evaluate motor coordination.ResultsA preliminary analysis of Sc-EtOH revealed that it contained phenols, steroids, terpenoids and flavonoids. In the acetic acid-induced writhing test, mice treated with Sc-EtOH (100, 200 and 400 mg/kg, i.p.) exhibited reduced writhing (58.46, 75.63 and 82.23%, respectively). Secondly, Sc-EtOH treatment (100, 200 and 400 mg/kg, i.p.) decreased the paw licking time in mice during the first phase of the formalin test (by 44.90, 33.33 and 34.16%, respectively), as well as during the second phase of the test (by 86.44, 56.20 and 94.95%, respectively). Additionally, Sc-EtOH treatment at doses of 200 and 400 mg/kg increased the latency time in the hot plate test after 60 and 90 minutes, respectively. In addition, Sc-EtOH did not impair motor coordination.ConclusionOverall, these results indicate that Sc-EtOH is effective as an analgesic agent in various pain models. The activity of Sc-EtOH is most likely mediated via the inhibition of peripheral mediators and central inhibitory mechanisms. This study supports previous claims of traditional uses for S. convoluta.

The management of the open abdomen can be achieved safely in a district general hospital setting with acceptable outcomes for the non-trauma patients commonly seen in UK practice but it is a resource intensive and expensive undertaking.

Lectin-like oxidized low-density lipoprotein receptor-1 (SR-E1, LOX-1, OLR1) was first discovered as a vascular receptor for modified lipoprotein particles nearly 20 years ago. Since then, in vitro and in vivo studies have demonstrated an association between LOX-1, a soluble form (sLOX-1) and a number of diseases including atherosclerosis, arthritis, hypertension and pre-eclampsia. However, converting such discoveries into tools and drugs for routine clinical use is dependent on translational preclinical and clinical studies but such studies have only begun to emerge in the past decade. In this review, we identify the key clinical applications and corresponding criteria that need to be addressed for the effective use of LOX-1-related probes and molecules for patient benefit in different disease states.