- Email: [email protected]
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ASSOCIATION FOR ACADEMIC SURGERY AND SOCIETY OF UNIVERSITY SURGEONS—ABSTRACTS
telesurgery systems that can robustly operate in extreme environments could serve as surgical force multipliers and help to save the lives and limbs of our warfighters. Objective: To develop, deploy, and validate mobile telesurgical systems in extreme environments. We will discuss recent robotic telesurgery experiments in the context of battlefield trauma. Methods: The University of Cincinnati and United States Army Telemedicine and Advanced Technology Research Center (TATRC) have collaborated with academic and industrial partners to further advance robotic telesurgery. Recent research includes: Internet-based use of the Intuitive Surgical da Vinci robot, wireless microwave use of the SRI International M7 robot in the Aquarius undersea habitat during NASA Extreme Environment Mission Operations (NEEMO), and unmanned airborne-vehicle based use of the University of Washington robot in the high desert of Simi Valley, CA. Ongoing research includes robotic telesurgery in parabolic flight and far forward semi-autonomous telerobotic combat casualty care within the Defense Advanced Research Projects Agency (DARPA) Trauma Pod program. Results: We have and continue to combine wireless telecommunication and mobile robots to successfully perform robotic telesurgery in extreme environments. Conclusions: Ongoing research indicates that telesurgery could deliver life-saving surgical care on the battlefield and during evacuation. Further investigation is necessary to develop and integrate wireless communication, trauma specific robots, and emerging technologies such as image guidance and therapeutic directed energy. Mobile robotic telesurgery will save the lives and limbs of our soldiers.
P40. SURGICAL CONTROL ROOM - A CONCEPT WHICH CAN CHANGE THE EXISTING WAY THE DATA IN SURGICAL SERVICES IS MANAGED. M. Asad; Bronx Lebanon Hospital Center, Bronx, NY In this article concept of surgical control room is discussed. This idea has been taken from the concept of a war-room setup by an army at the time of war. This war room is a facility where information from different sources comes and it is integrated to form the basis of useful decisions. Now applying the same idea to general surgery practice, we see that depending upon the volume of a surgical service a considerable amount of data is to be managed on daily basis. Now most of the hospitals are getting computerized. How ever in most of the situations the software programs are not uniform. It requires considerable time for data retrieval. Most of the programs do not allow list sharing or to run quarries according to physician needs.We discuss the need of establishment of a room in which there will be big screens on the walls allowing to see the data from different patients at the same time in a real time fashion. One resident assigned to the room can keep an eye on the whole of surgical service patients including critical care units. He will have quick access to radiology, medication lists and labs for each patient. The same room will provide him access to information about status of outpatient clinic load, emergency / floor waiting consults, operating room status, resident assignments and their locations, pending work for each resident. With all above information the control room resident will be able to make decisions in a real time manner. We also recommend establishment of a very efficient communication system for the person running the control room. The data in this room will be integrated and brought in to shape before morning rounds start. For the incoming teams in the morning, all they have to do is to get a print of sheets (or electronic copy) by one click, containing basic data, relevant lab results, vital signs, radiology reports including consults written on a sheet separately for each patient and start the rounds. We feel such a system can tremendously shorten the time for pre-rounds and increase the time residents can spend with the patients and involve in educational activities. We believe it can also improve patient care.
P41. CAN A UNIFORM SOFTWARE BE USEFUL FOR DATA MANAGEMENT FOR ALL HOSPITALS IN THE COUNTRY? M. Asad; Bronx Lebanon Hospital Center, Bronx, NY We propose the need of a uniform software for all hospitals in the country. It will be helpful for the new staff joining a hospital as they will be familier with the system already. It will avoid the training costs and save time. It is also likely to improve patient care as for a new commers it takes several days to weeks to understand the software used in that particular hosptial. The data from different hospitals will be in a uniform format. In this paper we discuss the pros and cons of such a system. P42. HIGH-DEFINITION STEREOSCOPIC MICRO-SURGERY FOR TEACHING AND CLINICAL PRACTICE. J. Ilgner1, M. A. Weissman2, J. Park1, D. Labbe1; 1Aachen University Hospital, Aachen, Germany, 2Micro Vision Systems, Inc., Santa Barbara, CA Introduction: While there is an increasing demand for minimally invasive operative techniques in Ear, Nose and Throat surgery, these operations are difficult to learn for junior doctors and demanding to supervise for experienced surgeons, largely due to the limited access to the surgical site provided by the eyepieces of a surgical microscope. In addition, performing long operations via the microscope can be stressful and tiring. The motivation for this study was to integrate high-definition (HD) stereoscopic video monitoring in microscopic surgery in order to 1) facilitate teaching interaction between senior and junior surgeon and 2) investigate its utility as a surgical tool. Material and methods: We attached a 1280⫻1024 HD stereo camera (TrueVision, Micro Vision Systems, Inc., Santa Barbara, CA) to an operating microscope (Zeiss ProMagis, Zeiss Co., Oberkochen, Germany), whose images were processed online by a PC workstation. The live image was displayed by two LCD projectors 1280⫻768 pixels on a 1.25m rearprojection screen by polarized filters. While the junior surgeon performed the surgical procedure based on the displayed stereoscopic image, all other participants (senior surgeon, nurse and medical students) shared the same stereoscopic image from the screen. Results: With the basic setup being performed only once on the day before surgery, fine adjustments required about 10 minutes extra during the operation schedule, which fitted into the time interval between patients and thus did not prolong operation times. As all relevant features of the operative field were demonstrated on one large screen, four major effects were obtained: A) Stereoscopy facilitated orientation for the junior surgeon as well as for medical students. B) The stereoscopic image served as an unequivocal guide for the senior surgeon to demonstrate the next surgical steps to the junior colleague. C) The theatre nurse shared the same image, anticipating the next instruments which were needed. D) Medical students instantly shared the information given by all staff and the image, thus avoiding the need for an extra teaching session. Conclusion: High-definition stereoscopy bears the potential to compress the learning curve for undergraduate as well as postgraduate medical professionals in minimally invasive surgery. Further studies will focus on the long term effect for operative training as well as on post-processing of HD stereoscopy video content for off-line interactive medical education.
GASTROINTESTINAL IV: SMALL BOWEL P43. MITOCHONDRIAL DYSFUNCTION LEADS TO APOPTOTIC CELL DEATH IN THE ENTERIC NERVOUS SYSTEM. E. A. Newman, W. Zhang, J. Ammori, M. W. Mulholland; The University of Michigan, Ann Arbor, MI Background: Recent work has revealed the importance of mitochondria in a number of neuronal metabolic cellular processes,
ASSOCIATION FOR ACADEMIC SURGERY AND SOCIETY OF UNIVERSITY SURGEONS—ABSTRACTS including cell death. There is little information about the capacity of gastrointestinal neurons to undergo apoptosis and the role of mitochondria in neurotoxicity and cell death. We examined the hypotheses that neurons of the gastrointestinal track are capable of undergoing apoptosis and that mitochondrial dysfunction could induce apoptotic cell death in guinea pig enteric neurons. Methods: Primary cultures of enteric neurons from guinea pig taenia coli were exposed to glutamate (3mM) for 60 minutes, and examined for signs of apoptosis at 24 hours. Mitochondria were then localized in the enteric nervous system utilizing the fluorescent dye, Mito-Tracker green (Molecular Probes). To determine if mitochondrial dysfunction could induce apoptosis in enteric neurons, cells were treated with the mitochondrial inhibitor, FCCP (10 uM) for 24 hours. In all experiments, apoptosis was assessed by the presence of nuclear changes and the activation of the apoptotic enzymes caspase 3 and 7. Nuclear fragmentation was identified by the fluorescent indicator Hoechst 33258 and caspase activation was detected by fluorochrome labeled caspase 3 and 7 inhibitors. Control experiments were performed, examining untreated cells, as well as cells treated with both glutamate and FCCP vehicle solutions. Cells were confirmed as neurons by double staining with the neuronal tracer DiI (Molecular Probes). Data were analyzed using ANOVA. Significance was accepted as P ⬍0.05. Results: Excessive exposure to glutamate caused apoptosis in greater than 90% of enteric neurons studied within 24 hours (Figure 1, *⫽ p⬍0.05 versus control and vehicle). Mitochondrial staining revealed a dense network of mitochondria, particularly surrounding the nucleus (Figure 2). Prolonged neuronal exposure to FCCP induced mitochondrial dysfunction and led to cell apoptosis rates of up to 85%, as demonstrated by nuclear changes and caspase 3 and 7 activation (Figure 3, *⫽ p⬍0.05 versus control and vehicle). Conclusions: The mechanism of apoptosis in the enteric nervous system is unknown. The current data has begun to describe apoptotic cell death in enteric neurons, and has also shown for the first time that mitochondrial dysfunction leads to apoptosis in the enteric nervous system. Understanding the capacity and mechanism of apoptotic cell death in enteric neurons may have pharmacological importance for future development of therapeutic targets.
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Figure 2: Enteric neurons with Mito-Tracker Green
Figure 3: FCCP Induced Apoptosis P44. DIURNAL VARIATION AND TEMPORAL COORDINATION OF HEXOSE TRANSPORTER EXPRESSION IN MOUSE SMALL INTESTINE. J. Fatima, S. G. Houghton, J. A. Duenes, C. W. Iqbal, M. S. Kasparek, M. G. Sarr; Mayo Clinic College of Medicine, Rochester, MN
Figure 1: Glutamate Induced Apoptosis
Background: In rat small intestine, mRNA and protein expression levels of hexose transporters follow a diurnal variation. Whether a diurnal rhythm exists in mice is unknown. Aim: To investigate diurnal variation in expression levels of SGLT1, GLUT2 and GLUT5 mRNA and protein in mouse duodenum, jejunum, and ileum. Hypothesis: Hexose transporter expression exhibits diurnal rhythm in mouse small intestine. Methods: c57bl6 mice (n⫽24) maintained in a 12 hour light/dark room (light from 6AM to 6PM) had free access to mouse chow and water. At each of 4 designated time points (3AM, 9AM, 3PM, and 9PM), mucosa was harvested from all 3 segments of intestine from 6 mice. mRNA levels were quantified by reverse transcription real-time PCR and protein by Western blot analysis.
ASSOCIATION FOR ACADEMIC SURGERY AND SOCIETY OF UNIVERSITY SURGEONS—ABSTRACTS
telesurgery systems that can robustly operate in extreme environments could serve as surgical force multipliers and help to save the lives and limbs of our warfighters. Objective: To develop, deploy, and validate mobile telesurgical systems in extreme environments. We will discuss recent robotic telesurgery experiments in the context of battlefield trauma. Methods: The University of Cincinnati and United States Army Telemedicine and Advanced Technology Research Center (TATRC) have collaborated with academic and industrial partners to further advance robotic telesurgery. Recent research includes: Internet-based use of the Intuitive Surgical da Vinci robot, wireless microwave use of the SRI International M7 robot in the Aquarius undersea habitat during NASA Extreme Environment Mission Operations (NEEMO), and unmanned airborne-vehicle based use of the University of Washington robot in the high desert of Simi Valley, CA. Ongoing research includes robotic telesurgery in parabolic flight and far forward semi-autonomous telerobotic combat casualty care within the Defense Advanced Research Projects Agency (DARPA) Trauma Pod program. Results: We have and continue to combine wireless telecommunication and mobile robots to successfully perform robotic telesurgery in extreme environments. Conclusions: Ongoing research indicates that telesurgery could deliver life-saving surgical care on the battlefield and during evacuation. Further investigation is necessary to develop and integrate wireless communication, trauma specific robots, and emerging technologies such as image guidance and therapeutic directed energy. Mobile robotic telesurgery will save the lives and limbs of our soldiers.
P40. SURGICAL CONTROL ROOM - A CONCEPT WHICH CAN CHANGE THE EXISTING WAY THE DATA IN SURGICAL SERVICES IS MANAGED. M. Asad; Bronx Lebanon Hospital Center, Bronx, NY In this article concept of surgical control room is discussed. This idea has been taken from the concept of a war-room setup by an army at the time of war. This war room is a facility where information from different sources comes and it is integrated to form the basis of useful decisions. Now applying the same idea to general surgery practice, we see that depending upon the volume of a surgical service a considerable amount of data is to be managed on daily basis. Now most of the hospitals are getting computerized. How ever in most of the situations the software programs are not uniform. It requires considerable time for data retrieval. Most of the programs do not allow list sharing or to run quarries according to physician needs.We discuss the need of establishment of a room in which there will be big screens on the walls allowing to see the data from different patients at the same time in a real time fashion. One resident assigned to the room can keep an eye on the whole of surgical service patients including critical care units. He will have quick access to radiology, medication lists and labs for each patient. The same room will provide him access to information about status of outpatient clinic load, emergency / floor waiting consults, operating room status, resident assignments and their locations, pending work for each resident. With all above information the control room resident will be able to make decisions in a real time manner. We also recommend establishment of a very efficient communication system for the person running the control room. The data in this room will be integrated and brought in to shape before morning rounds start. For the incoming teams in the morning, all they have to do is to get a print of sheets (or electronic copy) by one click, containing basic data, relevant lab results, vital signs, radiology reports including consults written on a sheet separately for each patient and start the rounds. We feel such a system can tremendously shorten the time for pre-rounds and increase the time residents can spend with the patients and involve in educational activities. We believe it can also improve patient care.
P41. CAN A UNIFORM SOFTWARE BE USEFUL FOR DATA MANAGEMENT FOR ALL HOSPITALS IN THE COUNTRY? M. Asad; Bronx Lebanon Hospital Center, Bronx, NY We propose the need of a uniform software for all hospitals in the country. It will be helpful for the new staff joining a hospital as they will be familier with the system already. It will avoid the training costs and save time. It is also likely to improve patient care as for a new commers it takes several days to weeks to understand the software used in that particular hosptial. The data from different hospitals will be in a uniform format. In this paper we discuss the pros and cons of such a system. P42. HIGH-DEFINITION STEREOSCOPIC MICRO-SURGERY FOR TEACHING AND CLINICAL PRACTICE. J. Ilgner1, M. A. Weissman2, J. Park1, D. Labbe1; 1Aachen University Hospital, Aachen, Germany, 2Micro Vision Systems, Inc., Santa Barbara, CA Introduction: While there is an increasing demand for minimally invasive operative techniques in Ear, Nose and Throat surgery, these operations are difficult to learn for junior doctors and demanding to supervise for experienced surgeons, largely due to the limited access to the surgical site provided by the eyepieces of a surgical microscope. In addition, performing long operations via the microscope can be stressful and tiring. The motivation for this study was to integrate high-definition (HD) stereoscopic video monitoring in microscopic surgery in order to 1) facilitate teaching interaction between senior and junior surgeon and 2) investigate its utility as a surgical tool. Material and methods: We attached a 1280⫻1024 HD stereo camera (TrueVision, Micro Vision Systems, Inc., Santa Barbara, CA) to an operating microscope (Zeiss ProMagis, Zeiss Co., Oberkochen, Germany), whose images were processed online by a PC workstation. The live image was displayed by two LCD projectors 1280⫻768 pixels on a 1.25m rearprojection screen by polarized filters. While the junior surgeon performed the surgical procedure based on the displayed stereoscopic image, all other participants (senior surgeon, nurse and medical students) shared the same stereoscopic image from the screen. Results: With the basic setup being performed only once on the day before surgery, fine adjustments required about 10 minutes extra during the operation schedule, which fitted into the time interval between patients and thus did not prolong operation times. As all relevant features of the operative field were demonstrated on one large screen, four major effects were obtained: A) Stereoscopy facilitated orientation for the junior surgeon as well as for medical students. B) The stereoscopic image served as an unequivocal guide for the senior surgeon to demonstrate the next surgical steps to the junior colleague. C) The theatre nurse shared the same image, anticipating the next instruments which were needed. D) Medical students instantly shared the information given by all staff and the image, thus avoiding the need for an extra teaching session. Conclusion: High-definition stereoscopy bears the potential to compress the learning curve for undergraduate as well as postgraduate medical professionals in minimally invasive surgery. Further studies will focus on the long term effect for operative training as well as on post-processing of HD stereoscopy video content for off-line interactive medical education.
GASTROINTESTINAL IV: SMALL BOWEL P43. MITOCHONDRIAL DYSFUNCTION LEADS TO APOPTOTIC CELL DEATH IN THE ENTERIC NERVOUS SYSTEM. E. A. Newman, W. Zhang, J. Ammori, M. W. Mulholland; The University of Michigan, Ann Arbor, MI Background: Recent work has revealed the importance of mitochondria in a number of neuronal metabolic cellular processes,
ASSOCIATION FOR ACADEMIC SURGERY AND SOCIETY OF UNIVERSITY SURGEONS—ABSTRACTS including cell death. There is little information about the capacity of gastrointestinal neurons to undergo apoptosis and the role of mitochondria in neurotoxicity and cell death. We examined the hypotheses that neurons of the gastrointestinal track are capable of undergoing apoptosis and that mitochondrial dysfunction could induce apoptotic cell death in guinea pig enteric neurons. Methods: Primary cultures of enteric neurons from guinea pig taenia coli were exposed to glutamate (3mM) for 60 minutes, and examined for signs of apoptosis at 24 hours. Mitochondria were then localized in the enteric nervous system utilizing the fluorescent dye, Mito-Tracker green (Molecular Probes). To determine if mitochondrial dysfunction could induce apoptosis in enteric neurons, cells were treated with the mitochondrial inhibitor, FCCP (10 uM) for 24 hours. In all experiments, apoptosis was assessed by the presence of nuclear changes and the activation of the apoptotic enzymes caspase 3 and 7. Nuclear fragmentation was identified by the fluorescent indicator Hoechst 33258 and caspase activation was detected by fluorochrome labeled caspase 3 and 7 inhibitors. Control experiments were performed, examining untreated cells, as well as cells treated with both glutamate and FCCP vehicle solutions. Cells were confirmed as neurons by double staining with the neuronal tracer DiI (Molecular Probes). Data were analyzed using ANOVA. Significance was accepted as P ⬍0.05. Results: Excessive exposure to glutamate caused apoptosis in greater than 90% of enteric neurons studied within 24 hours (Figure 1, *⫽ p⬍0.05 versus control and vehicle). Mitochondrial staining revealed a dense network of mitochondria, particularly surrounding the nucleus (Figure 2). Prolonged neuronal exposure to FCCP induced mitochondrial dysfunction and led to cell apoptosis rates of up to 85%, as demonstrated by nuclear changes and caspase 3 and 7 activation (Figure 3, *⫽ p⬍0.05 versus control and vehicle). Conclusions: The mechanism of apoptosis in the enteric nervous system is unknown. The current data has begun to describe apoptotic cell death in enteric neurons, and has also shown for the first time that mitochondrial dysfunction leads to apoptosis in the enteric nervous system. Understanding the capacity and mechanism of apoptotic cell death in enteric neurons may have pharmacological importance for future development of therapeutic targets.
255
Figure 2: Enteric neurons with Mito-Tracker Green
Figure 3: FCCP Induced Apoptosis P44. DIURNAL VARIATION AND TEMPORAL COORDINATION OF HEXOSE TRANSPORTER EXPRESSION IN MOUSE SMALL INTESTINE. J. Fatima, S. G. Houghton, J. A. Duenes, C. W. Iqbal, M. S. Kasparek, M. G. Sarr; Mayo Clinic College of Medicine, Rochester, MN
Figure 1: Glutamate Induced Apoptosis
Background: In rat small intestine, mRNA and protein expression levels of hexose transporters follow a diurnal variation. Whether a diurnal rhythm exists in mice is unknown. Aim: To investigate diurnal variation in expression levels of SGLT1, GLUT2 and GLUT5 mRNA and protein in mouse duodenum, jejunum, and ileum. Hypothesis: Hexose transporter expression exhibits diurnal rhythm in mouse small intestine. Methods: c57bl6 mice (n⫽24) maintained in a 12 hour light/dark room (light from 6AM to 6PM) had free access to mouse chow and water. At each of 4 designated time points (3AM, 9AM, 3PM, and 9PM), mucosa was harvested from all 3 segments of intestine from 6 mice. mRNA levels were quantified by reverse transcription real-time PCR and protein by Western blot analysis.