Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland最新文献

This study investigates the potential of 2-methoxyestradiol (2-ME) to overcome tamoxifen (TAM) resistance in MCF-7 breast cancer cells by downregulating hypoxia-inducible factor 1 alpha (HIF-1α). Through a series of in vitro experiments, the authors demonstrate that combining 2-ME with TAM enhances the cytotoxic effects on resistant cells, increases apoptosis markers, and reduces cholesterol and triglyceride levels. While the findings highlight a promising therapeutic approach, the lack of in vivo or clinical data limits direct clinical application. Future research should focus on validating these results in animal models and exploring long-term efficacy and molecular mechanisms.

Background: The use of body-warming systems is recommended by international anaesthesia societies for patients undergoing surgery. Limited research is however available on the influence of positioning of forced-air warming blankets for patients undergoing spinal surgery. This study aimed to investigate how patients' intra-operative body temperature was affected by the position of forced-air warming blankets while undergoing spinal surgery on a spinal table.

Design: A randomized comparative experimental study was conducted with 60 adult patients undergoing posterior spinal surgery.

Methods: Patients were randomized into full underbody (n = 30) or surgical access (n = 30) forced-air warming blanket groups. Intra-operative body temperature was recorded at regular time intervals. The student's T-test, Chi-square, and MANOVA tests were performed to determine the differences between the two groups.

Results: Intraoperative hypothermia was significantly lower in the full underbody group than in the surgical access group (p = 0.020). The change in body temperature differed significantly between the two groups from 15 min until 240 min, with a mean difference of 0.5 °C.

Conclusion: The full underbody position of the forced-air warming blanket was effective for maintaining normal range core body temperature. The use of full underbody forced-air warming blanket for spinal surgery when patients are positioned on a spinal table in a prone position is recommended.

Background: Tourniquets are commonly used in extremity surgery to help provide a bloodless operative field to improve visibility and reduce length of procedures. With the development of WALANT (wide awake, local anaesthetic, no tourniquet) techniques, many surgeons undertake surgery without tourniquet inflation. The correct technique of pneumatic tourniquet application is poorly understood by healthcare staff. The application of a tight tourniquet when applied for optional use or use for only a portion of a procedure, rather than for inflation throughout can cause venous engorgement of an extremity leading to increased blood loss and reduced operative field visualisation thereby discouraging surgeons from persevering with WALANT strategies.

Aim: To determine the effect of tourniquet application tension on limb volume prior to skin incision.

Methods: 30 volunteers had the volume of their non-dominant forearm measured post-inflation of a surgical tourniquet using two different application techniques. Tight application was defined as the tourniquet fastened using a dynamometer to a tension of 100 N. Loose application was defined as the tourniquet fastened using a dynamometer to a tension of 50 N. The tourniquet was then inflated to 200 mmHg after both application techniques. Exsanguination was performed by elevation of the arm for 1 min prior to tourniquet inflation. At 5 min the forearm volume was measured using a volume displacement technique.

Results: 93 % of participants (28/30) had a higher volume of water displaced when the tourniquet was applied tightly. The mean difference between the loose and tight applications was 30.06 mls.

Conclusion: The increase in volume in tightly applied tourniquets is believed to result from increased intravascular volume. This increase in blood volume can lead to increased intra-operative blood loss and poor intra-operative visualisation when operating without tourniquet inflation. Loose application of the tourniquet pre-inflation appears to prevent sequestration of venous blood in the limb, therefore decreasing operative blood loss and improving view for operating.

Level of evidence: Level 1; Symptom Prevalence Study.

Background and aims: Activation of the systemic inflammatory response (SIR) is associated with inferior outcomes across a spectrum of disease. Routinely available measures of the SIR (neutrophil:lymphocyte ratio (NLR), platelet:lymphocyte ratio (PLR), systemic immune-inflammatory index (SII), systemic inflammatory grade (SIG)) have been shown to provide prognostic value in patients undergoing surgical intervention. The present study aimed to review the literature describing the prognostic association of NLR, PLR, SII and SIG in patients undergoing intervention for abdominal aortic aneurysm (AAA).

Methods: This PRISMA guidelines were followed. The MEDLINE database was interrogated for relevant studies investigating the effect of peri-operative systemic inflammation-based prognostic systems on all-cause mortality in patients undergoing OSR and EVAR for AAA. Inter-study heterogeneity precluded meaningful meta-analysis; qualitative analysis was instead performed.

Results: There were 9 studies included in the final review reporting outcomes on a total of 4571 patients; 1256 (27 %) patients underwent OSR, and 3315 (73 %) patients underwent EVAR. 4356 (95 %) patients underwent a procedure for unruptured AAA, 215 (5 %) patients underwent an emergency procedure for ruptured AAA0.5 studies reported early (inpatient or 30-day) mortality; 2 of these found that elevated NLR predicted inferior survival, however PLR did not provide prognostic value. 6 studies reported long-term mortality; elevated NLR (5 studies), PLR (1 study), and SIG (1 study) predicted inferior survival.

Conclusions: It appears that activation of the SIR is associated with inferior prognosis in patients undergoing intervention for AAA, however the evidence is limited by heterogenous methodology and lack of consensus regarding optimal cutoff.

Prospero database registration number: CRD42022363765.

Background: The MRCS is a key gatekeeping assessment in the UK, completion of which is a prerequisite for progression into higher specialist surgical training (HST) programmes. As a result, examination success or failure can have a significant and lasting impact on career progression. Yet despite such high stakes, little was known about factors that may influence examination performance.

Methods: To address this important gap in the literature, a series of large longitudinal cohort studies were undertaken. The work used data crossmatched from several national medical education databases to create the most extensive investigation of training outcomes for UK surgical trainees to date. MRCS data were matched to sociodemographic factors, training history and measures of prior academic attainment, and multivariate analyses identified independent predictors of MRCS success.

Results: Three key quantifiable factors were identified that predict success at MRCS: institutional differences in teaching and training, academic ability and individual differences in personal and social circumstances. This invited report for the Syme Medal discusses the key findings from this body of research and the implications for policy and practice.

Conclusions: The research studies discussed in this report are driving evidence-based changes at the national level. The findings contribute to the optimisation of surgical training and the recognition of candidates at increased risk of failure. This results in the appropriate reallocation of resources and support, enabling greater fairness, equity, diversity and inclusivity in surgical career progression.

Introduction: Recent technological advances have facilitated the development of new educational methods, such as simulation-based learning, in specialized bootcamps to enhance the learning of surgical residents. This study aimed to design, implement, and evaluate a basic surgical skills bootcamp for residents in general surgery, orthopedics, neurosurgery, and gynecology based on the learning gap in the current educational program.

Methods: This intervention study focused on the design, implementation, and evaluation of a basic surgical skills bootcamp in a simulated operating room for first-year surgical residents in general surgery, orthopedics, neurosurgery, and gynecology.

Results: The study resulted in the creation of a comprehensive course plan and the execution of a 6-day training program. Evaluation of educational outcomes confirmed high learner satisfaction, improvement in Multiple Choice Questions (MCQ) exam scores, and acceptable scores in the Objective Structured Clinical Examination (OSCE).

Conclusion: The findings of this study suggest that surgical bootcamps, when designed based on needs assessment and in line with scientific bootcamp design principles, play a crucial role in enhancing the satisfaction, knowledge, and skills of surgical residents.