The Journal of surgical research
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Intestinal ischemia/reperfusion (I/R) is a complex phenomenon causing destruction of both local and remote tissues, as well as multiple-organ failure. We investigated the role of lipid peroxidation in damage to intestinal, liver, and lung tissues in this pathology. ⋯ This study demonstrated for the first time that oxidized LDL accumulated in the terminal ileum, liver, and lung tissues after intestinal ischemia/reperfusion. This occurrence (or the presence of oxidized LDL) may be an indicator of ongoing oxidative stress and enhanced lipid peroxidation. Augmentation of inducible nitric oxide synthase expression may play a role in progression of inflammation and LDL oxidation. These data support the hypothesis that cellular oxidative stress is a critical step in reperfusion-mediated injury in both the intestine and end organs, and that antioxidant strategies may provide organ protection in patients with reperfusion injury, at least through affecting interaction with free radicals, nitric oxide, and oxidized LDL.
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Chronic allograft nephropathy (CAN) is a major cause of late allograft loss. Recent evidences suggest that Rho and its downstream effector ROCK may be greatly involved in the progression of renal fibrosis. Inhibition of Rho/ROCK pathway might interact with the inflammatory process in the renal interstitium, and antagonize the process of epithelial-to-mesenchymal transition (EMT). We hypothesized that Y-27632 could inhibit the chronic inflammatory process and prevent the progression of CAN. ⋯ The Rho/ROCK pathway plays an important role in the progression of CAN, and specific inhibition of Rho activity by Y-27632 showed favorable effects on blocking renal interstitial inflammation and fibrosis, thus efficiently retarding the development of CAN, which might provide us with a novel strategy to improve long-term renal graft survival.
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Reduced heart rate (HR) complexity (e.g., a lack of randomness or unpatterned variability) is an established predictor of trauma patient mortality. However, this finding has not been validated across the diverse spectrum of traumatic injury, and underlying mechanisms of this relationship are poorly understood. ⋯ Early reduction of heart rate complexity is an important risk factor across diverse injury etiology. This suggests common underlying physiologic mechanisms linking the loss of biologic complexity to death.
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Technological advancements, along with economic and political issues, have resulted in major changes in surgical education. The development of high fidelity simulators and the widespread availability of the Internet have allowed learning to be shifted away from the operating room. Furthermore, the Internet provides an opportunity for surgical educators to standardize general surgery training and assessment and to develop collaborations nationally and globally. This paper highlights presentations about the challenges as well as the rewards of surgical education in the age of the Internet from the 2009 Academic Surgical Congress.
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Laparoscopic virtual reality simulators are becoming a ubiquitous tool in resident training and assessment. These devices provide the operator with various levels of realism, including haptic (or force) feedback. However, this feature adds significantly to the cost of the devices, and limited data exist assessing the value of haptics in skill acquisition and development. Utilizing the Laparoscopy VR (Immersion Medical, Gaithersburg, MD), we hypothesized that the incorporation of force feedback in the simulated operative environment would allow superior trainee performance compared with performance of the same basic skills tasks in a non-haptic model. ⋯ In the more advanced tasks, haptics allowed superior precision, resulting in faster completion of tasks and a trend toward fewer technical errors. In the more basic tasks, haptic-enhanced simulation did not demonstrate an appreciable performance improvement among our trainees. These data suggest that the additional expense of haptic-enhanced laparoscopic simulators may be justified for advanced skill development in surgical trainees as simulator technology continues to improve.