The wave function as a true ensemble.

In quantum mechanics, the wave function predicts probabilities of possible measurement outcomes, but not which individual outcome is realized in each run of an experiment. This suggests that it describes an ensemble of states with different values of a hidden variable. Here, we analyse this idea with reference to currently known theorems and experiments.

The Use of Short-Term Acupressure to Prevent Long-Term PONV: Was This a Case of Too Little, Too Late?

Purpose: Postoperative nausea and vomiting (PONV) is a common surgical complication that contributes to poor patient outcomes. The purpose of this study was to determine if acupressure to the P6 pressure point during the immediate postoperative period decreased PONV for the first 24 postoperative hours.

Design: This was a double-blind, randomized study.

Endobronchial Valves in the Treatment of Persistent Air Leaks.

Background: Endobronchial valves (EBVs) are a useful adjunct in the management algorithm of patients with persistent pulmonary air leaks. They are increasingly used in the management of postsurgical parenchymal air leaks and carry a humanitarian use device exemption for this purpose. We report our experience with EBVs in the management of patients with bronchopleural fistula secondary to postsurgical intervention and spontaneous pneumothorax from medical comorbidities.

A new technique of extreme lateral positioning for laparoscopic splenic flexure mobilization.

Aim: This aim of this study was to describe a novel positioning technique that assists in the expeditious mobilization of the splenic flexure without the need for redraping or compromise of port placement.

Method: A prospective case series was studied to evaluate the technique and its ability to facilitate splenic flexure mobilization.

Results: The technique was used in 12 patients.

17β-Hydroxyestra-4,9,11-trien-3-one (trenbolone) exhibits tissue selective anabolic activity: effects on muscle, bone, adiposity, hemoglobin, and prostate.

Selective androgen receptor modulators (SARMs) now under development can protect against muscle and bone loss without causing prostate growth or polycythemia. 17β-Hydroxyestra-4,9,11-trien-3-one (trenbolone), a potent testosterone analog, may have SARM-like actions because, unlike testosterone, trenbolone does not undergo tissue-specific 5α-reduction to form more potent androgens. We tested the hypothesis that trenbolone-enanthate (TREN) might prevent orchiectomy-induced losses in muscle and bone and visceral fat accumulation without increasing prostate mass or resulting in adverse hemoglobin elevations.

Abdominal injury due to a hand held flare: an ongoing insult.

Although traumatic abdominal missile injuries have been previously widely reported, there are no reports on penetrating hand held flare injuries. We report a case of a penetrating abdominal flare injury and the subsequent complications that occurred as a result of this unique injury.

Skills training in telerobotic surgery.

Surgical robots have the potential to expand the repertoire of minimally invasive surgery resulting in more patients benefiting from lower operative morbidity and shorter hospital stays. However, in a similar manner to all new surgical interventions it necessary to explore the learning curves of practitioners as they adopt this new technology to enable optimisation of future training programs. Only when the standard of practice is firmly established, should the proliferation of robotic practitioners be encouraged thus ensuring patient safety is not compromised.

Robotics and surgery: a long-term relationship?

This article introduces robotic surgical systems by explaining the shortcomings of traditional laparoscopic surgery, and how these new systems have been developed to address them. This is followed by a descriptive section of robotic systems past and present and their use in different surgical specialities. Finally, we discuss advances that are planned for the development of current systems and the future role of robotics in surgery.

Skills acquisition for laparoscopic gastric bypass in the training laboratory: an innovative approach.

Background: Laparoscopic Roux-en-Y gastric bypass (LRYGBP) is a technically demanding procedure, with a long learning curve. The aim of this study was three-fold: to develop a task-based approach to training in LRYGBP, define a tool for objective technical skills assessments, and objectively determine the efficacy of this approach.

Methods: Videos of expert and novice surgeons performing LRYGBP on patients and anesthetised porcine models were analyzed to define an appropriate task for skills assessment.

Evaluating surgical dexterity during corneal suturing.

Objective: To evaluate motion tracking as an aid to a more objective assessment of ophthalmic microsurgical skill.

Methods: In a cohort study, 3 groups of differing levels of surgical experience were assessed. The groups included novice surgeons (n = 10) with fewer than 5 previously performed corneal sutures, trainee surgeons (n = 10) with 5 to 100 previously performed corneal sutures, and expert surgeons (n = 10) with more than 100 previously performed corneal sutures.

Technical skills examination for general surgical trainees.

Background: The technical skills of surgical trainees are difficult to assess and compare objectively. This study involved a structured, multistation, technical skills examination that enables the stratification of surgical trainees.

Methods: Twenty-two surgeons (five basic surgical trainees, eight junior specialist trainees, four senior specialist trainees and five consultants) participated in the study.

Training junior operative residents in laparoscopic suturing skills is feasible and efficacious.

Background: Laparoscopic suturing has been regarded as an advanced operative task, and courses to develop this skill are aimed at senior trainees and consultants. This study evaluates the role of laparoscopic suturing courses in the modern operative training curriculum.

Methods: The performance of 9 senior operative trainees (course A) was compared to that of 14 junior operative trainees (course B) at identical, 2-day laparoscopic suturing courses.

A competency-based virtual reality training curriculum for the acquisition of laparoscopic psychomotor skill.

Background: Studies have demonstrated the beneficial effect of training novice laparoscopic surgeons using virtual reality (VR) simulators, although there is still no consensus regarding an optimal VR training curriculum. This study aims to establish and validate a structured VR curriculum to provide an evidence-based approach for laparoscopic training programmes.

Methods: The minimally invasive VR simulator (MIST-VR) has 12 abstract laparoscopic tasks, each at 3 graduated levels of difficulty (easy, medium, and hard).

Virtual reality simulation training can improve inexperienced surgeons' endovascular skills.

Purpose: The aim of this study was to evaluate virtual reality (VR) simulation for endovascular training of surgeons inexperienced in this technique.

Methods: Twenty consultant vascular surgeons were divided into those who had performed >50 endovascular procedures (e.g.

Assessment of psychomotor skills acquisition during laparoscopic cholecystectomy courses.

Background: Standardized short courses in laparoscopic cholecystectomy aim to teach laparoscopic skills to surgical trainees, although end-of-course assessments of performance remain subjective. The current study aims to objectively assess psychomotor skills acquisition of trainees attending laparoscopic cholecystectomy courses.

Methods: Thirty-seven junior surgical trainees had their laparoscopic skills assessed before and after attending 1 of 3 separate 2-day courses (A, B, and C), all with identical format.

Objective assessment of technical skills in cardiac surgery.

Objective: Reduced training time combined with no rigorous assessment for technical skills makes it difficult for trainees to monitor their competence. We have developed an objective bench-top assessment of technical skills at a level commensurate with a junior registrar in cardiac surgery.

Methods: Forty cardiothoracic surgeons were recruited for the study, consisting of 12 junior trainees (year 1-3), 15 senior trainees (year 4-6) and 13 consultants.

Robotics in colorectal surgery.

Minimally invasive surgery has been shown to offer many advantages to general surgical patients but has not been widely adopted for colorectal disease. Initial fears surrounding the oncological safety of laparoscopic colectomies have largely subsided but the technical challenges still remain. Surgical robots or telemanipulators present the laparoscopic surgeon with unrivaled dexterity and vision, which may allow colonic resections to be completed with greater ease.

Robot-assisted laparoscopic Heller cardiomyotomy: preliminary UK results.

Background/aim: Laparoscopic Heller cardiomyotomy is an established modality in the surgical treatment of patients having achalasia cardia. We present our initial experience in robot-assisted laparoscopic Heller cardiomyotomy without addition of an antireflux procedure and discuss the relative merits and disadvantages of the procedure.

Patients And Methods: Five patients underwent robot-assisted laparoscopic Heller cardiomyotomy between August 2001 and October 2002.

Evaluation of the benefit of VR simulation in a multi-media web-based educational tool.

WebSET is an Internet based educational tool that can be used on any standard personal computer. It has been developed by a European collaboration and integrates high quality multimedia learning materials with VR simulation. The aim of this study was to evaluate the benefit of the VR simulation on the learning of procedure based psychomotor skills.

Uterine secretion of ISP1 & 2 tryptases is regulated by progesterone and estrogen during pregnancy and the endometrial cycle.

We have described two novel implantation serine proteinase (ISP) genes that are expressed during the implantation period. The ISP1 gene may encode the embryo-derived enzyme strypsin, which is necessary for blastocyst hatching in vitro and the initiation of invasion. The ISP2 gene, which encodes a related tryptase, is expressed in endometrial glands and is regulated by progesterone during the peri-implantation period.