Madridge Journal of Internal and Emergency Medicine

ISSN: 2638-1621

2nd International Surgery, Translational and Regenerative Medicine Conference

April 15-16, 2019, Valencia, Spain
Accepted Abstracts
DOI: 10.18689/2638-1621.a2.013

Laparoscopic Cholecystectomy in Patients with Liver Cirrhosis: 8 Years Experience in a Tertiary Centre and the Rule of Harmonic Device

Emad Hamdy Gad*, Yasmin Kamel, Ayman Alsebaey, Anwar Mohamed, Ali Nada and Mohammed Alsayed Abdelsamee

Menoufia university, Egypt

Objectives: With improved laparoscopic techniques and experience, availability of newer tools and instruments like ultrasonic shears; laparoscopic cholecystectomy (LC) became feasible option in cirrhotic patients, the aim of this study was to analyze the outcome of LC in cirrhotic patients and the rule of harmonic device.

Patients and Methods: We retrospectively analyzed 213 cirrhotic patients underwent LC, in the period from 2011 to 2019, the overall male /female ratio was 114/99.

Results: The most frequent CTP score was A, the most frequent cause of cirrhosis was HCV, while biliary colic was the most frequent presentation. Harmonic device was used in around 40% of patients and on comparing patients with and without harmonic use, there were significant lower operative bleeding, less amount of blood and plasma transfusion, shorter operative time and hospital stay and lower conversion and morbidity rates in the former. The morbidity was around 22% while mortality was around 2% and morbidity significant predictors were CTP score B, C, non harmonic group, operative bleeding, increased MELD score, blood and plasma transfusion units, lower platelet count and longer operative time.

Conclusion: LC can be safely performed in cirrhotic patients with appropriate patient selection. However, operative bleeding increased blood and plasma transfusion units, CTP and MELD scores are predictors of poor outcome that can be improved by using harmonic scalpel shears.

Keywords: Laparoscopic cholecystectomy, liver cirrhosis and harmonic device

Dr. Emad Hamdy Gad is currently working as associate professor of surgery in the Department of Transplantation, Hepatobiliary & Pancreatic surgery. National Liver Institute, University of Minoufiya, Shibin El-Kom, Minoufiya, Egypt and Consultant, general surgery, hepatobiliary surgery in King Faisal hospital, Taif, KSA. He worked as specialist in general surgery in Alganzoury private hospital in Cairo, Egypt from 2008 to 2014 (part time), He worked as consultant hepatopancreatobiliary and laparoscopic surgery in King Khaled hospital (General surgery and trauma hospital) in Hail in KSA for 6 months (Locum) from 2/2015 to 8/2015, he worked as consultant general surgery in Alnile hospital, Gherghada, Egypt from 3/2016 until 8/2016.

Total Pancreatectomy is the Best Option for Early Pancreatic Cancer Epistemological Foundations

Luis Barneo Serra*, Lorena Solar García, Alberto Miyar de León, María Eugenia Lauret Braña and Paula Jiménez Fonseca

Hospital Universitario Central de Asturias, Spain

Introduction: At present there is a renewed interest in total pancreatectomy (TP) in some pancreatic neoplasms but its application in pancreatic ductal adenocarcinoma (PD) continues to be discussed and debated.

Epistemological foundations: The indications for TP in early PD, rests on four epistemological foundations:

-Empiric data: today survival is better with an acceptable quality of life (HPB 2016, 18:21; and others)

-Cancer is a systemic disease

-PD develops early liver micrometastases (Cell 2012, 148:349)

-Pancreas is an important source of growth factor for the liver


1. The poor long-term survival and the recurrence after parcial pancreatectomy are influenced by trophic factors released from the normal residual pancreas.

2. TP eliminates these trophic factors; the growth of the micrometastases is slowed, with low relapse rates and better survival.


1. Review of pancreatic trophic factors and literature review of TP

2. To propose a prospective multicentric study pilot about TP in early PD

Methods: Determination of pancreatic trophic factors in portal vein and arterial circulation during pancreatic surgery, before and after resection.

Results and Conclusions: Description and discussion of the preliminary results.

Dr. Luis Barneo Serra is a Professor of General Surgery at the University of Oviedo, Spain and Hospital Universitario Central de Asturias, Oviedo, Spain. He got his MD at University of Barcelona in 1972 and his PhD in Medicine at University of Oviedo in 1986. He has Masterʼs Degree in “Surgical Research Laboratories” by the University of Minnesota, in 1987, University Expert in Colorectal Surgery by Public University of Pamplona in 2001, Barneo developed his foreign training in the Department of Surgery, University of Minnesota, in experimental and clinical transplantation, in 1984 and 1987. Currently, Dr. Barneoʼs researches focus on pancreatic cancer, the stroma of cancer, animal models of human cancer and experimental islet transplantation.

Surgical (Open and Laparoscopic) Management of Large Difficult CBD Stones after Different Sessions of Endoscopic Failure

Emad Hamdy Gad*, Hazem Zakaria, Yasmin Kamel, Ayman Alsebaey, Talat Zakareya, Mohamed Abbasy, Anwar Mohamed, Ali Nada, Mohammed Alsayed Abdelsamee and Mohamed Housseni

Menoufia University, Egypt

Objectives: For complicated large difficult common bile duct (CBD) stones that cannot be extracted by ERCP, patients can be managed safely by open or laparoscopic CBD exploration. The aim of this study was to assess these surgical procedures of CBDE after endoscopic failure.

Methods: We retrospectively reviewed and analyzed 85 patients underwent surgical management of large difficult CBD stones after ERCP failure, in the period from the beginning of 2013 to the beginning of 2018. The overall male/female ratio was 27/58.

Results: Sixty-seven (78.8%) and 18 (21.2%) of our patients underwent single and multiple ERCP sessions respectively with a significant correlation between number of ERCP sessions and post-ERCP complications (P=0.009). An impacted large stone was the most frequent cause of ERCP failure (60%). Laparoscopic CBD exploration (LCBDE), open CBD exploration (OCBDE) and the converted cases were 24.7% (n=21), 70.6% (n=60) and 4.7% (n= 4) respectively. Stone clearance rate post LCBDE and OCBDE reached 95.2% and 95% respectively (P< 0.05), Eleven (12.9%) of our patients had postoperative complications (14.3% post LCBDE and 11.7% post OCBDE, P<0.05) without mortality. By comparing LCBDE and OCBDE groups; there was a significant association between the former and younger age, shorter referral time, more frequent choledochoscopy and longer operative time with independent correlation regarding operative time. On comparing, T-tube and 1ry CBD closure in LCBDE group, there was significant longer operative time and post-operative hospital stays in the former. However, on comparing them in OCBDE group, there was a significant correlation between 1ry CBD closure and a smaller diameter of CBD, single stone, choledochoscopy, shorter operative times and post-operative hospital stays. Further more, in OCBDE group, choledocoscopy had an independent direction to 1ry CBD repair and significant association with higher stone clearance rate, shorter operative time and post-operative hospital stay.

Conclusion: Large difficult CBD stones can be managed either by open surgery or laparoscopically with acceptable comparable outcomes with no need for multiple ERCP sessions due to their related morbidities; furthermore, Open choledocoscopy has a good impact on stone clearance rate with direction towards doing primary repair that is better than T-tube regarding operative time and post-operative hospital stay.

Dr. Emad Hamdy Gad is currently working as associate professor of surgery in the Department of Transplantation, Hepatobiliary & Pancreatic surgery, National Liver Institute, University of Minoufiya, Shibin El-Kom, Minoufiya, Egypt and Consultant, general surgery, hepatobiliary surgery in King Faisal hospital, Taif, KSA. He worked as specialist in general surgery in Alganzoury private hospital in Cairo, Egypt from 2008 to 2014 (part time), He worked as consultant hepatopancreatobiliary and laparoscopic surgery in King Khaled hospital (General surgery and trauma hospital) in Hail in KSA for 6 months (Locum) from 2/2015 to 8/2015, He worked as consultant general surgery in Alnile hospital, Gherghada, Egypt from 3/2016 until 8/2016.

Bullying at Workplace and Brain-Imaging Correlates

Alberto Negro*, Mario Cirillo, Giovanni Nolfe, Alessandro Iavarone, Elisabetta Garofalo, Annisa Cotena, Massimo Lazazzara, Gemma Zontini, Fabio Tortora, Renata Conforti and Sossio Cirillo

University of Campania Luigi Vanvitelli, Italy

The relationship between psychosocial stress at work and mental health outcome is well known. Brain-imaging studies hypothesize morphological brain modifications connected to work-related stress. To our knowledge this is the first study describing the link between work.

Characteristics and brain imaging in a sample of work-related psychiatric patients assessed according to standardized clinical and diagnostic criteria. The aims of the study are: (1) to evaluate hippocampal and whole brain volumes in work-related psychiatric disturbances; (2) to verify the relationship between brain changes and the anxious and/or depressive symptoms; (3) to observe the relationship between the brain changes and the degree of the bullying at workplace. The hippocampus and whole brain volumes of 23 patients with work-related adjustment-disorders were compared with 15 controls by means of MRI. MR images highlight a smaller hippocampal volume in patients compared with controls. Significant reduction in the patientsʼ gray matter was found in three brain areas: right inferior temporal gyrus, left cuneus, left inferior occipital gyrus. The reduction of the hippocampi volumes was related to work distress and, above all, to bullying at workplace. The results confirm that the morphological brain abnormalities could be involved in work-related psychiatric disturbances.

Proper Establishment of Epithelial Polarity as a New Mechanism for Lung Stem Cell Behavior

Ahmed El Hashash

University of Edinburgh-Zhejiang Institute, UK

The balance between cell gain (self-renewal) and cell loss (apoptosis/differentiation) governs the size of the progenitorsʼ compartment. Molecular programs regulating the balance between different fates of endogenous organ-specific stem/progenitor cells are likely critical both to development and to regenerating diseased and damaged tissues in different organs, including the lung. Recent studies demonstrated the importance of disruption of epithelial apical-basal polarity in epithelial cell apoptosis and proliferation. However, how epithelial polarity regulation is coupled to apoptosis and proliferation is not well understood. We find that Asp-based PTPs such as Eya1 and none-receptor PTPs are essential for balancing differentiation and proliferation and apoptosis versus self-renewal/differentiation, respectively by controlling the activity and localization of Par polarity complex in lung distal epithelial progenitors during pre- and postnatal development. The difference of the effect of these different PTPs possibly reflects the facts they regulate the activity and localization of Par polarity complex by targeting the activity of different upstream signaling events: Eya1 controls Par polarity complex by binding to and controlling aPKCζ activity, while none receptor PTPs controls Par complex by controlling the activity of GTPases. Thus, Eya1 phosphates regulate cell polarity and mitotic spindle orientation by controlling aPKCζ phosphorylation levels. Loss of apical-basal polarity in Eya1-/- distal lung progenitors results in loss of asymmetric cell division, leading to increased symmetric differentiation and hence lack of stem/progenitor cell self-renewal. Conditional deletion of none-receptor PTPs in lung epithelial progenitors results in disruption of Par polarity complex and consequently inhibition of PI3K pathway leading to increased apoptosis, but decreased cell proliferation/differentiation.

Dr. Ahmed Hashash has completed his PhD from Manchester University, UK. He is a fellow of the California Institute of Regenerative Medicine and New York University Medical School. Prof. Hashash worked at Mount Sinai School of Medicine of New York University and Childrenʼs Hospital Los Angeles. He was Assistant Professor and Principal Investigator of Stem Cell & Regenerative Medicine at School of Medicine, University of Southern California, USA. In 2016, Prof. Hashash has joined The University of Edinburgh, as Tenure-Track Associate Professor of Biomedicine, Stem Cell & Regenerative Medicine. Prof. Hashash has several breakthrough discoveries in genes/enzymes that control stem cell behavior and regenerative medicine. He acts as a discussion leader at the Gordon Research Seminar/Conference in USA and a Peer Reviewer at the MRC, UK. He is invited to speak at several international conferences in USA, Spain and Greece. He is the editor or author of three books on stem cell and regenerative medicine.

Dilated Virchow-Robin space and Parkinsonʼs Disease: A Case Report of Combined MRI and Diffusion Tensor Imaging

Alberto Negro*, Renata Conforti, Angela Sardaro, Giuseppina Caiazzo, Antonella Paccone, Rosita De Micco, Sossio Cirillo and Alessandro Tessitore

University of Campania Luigi Vanvitelli, Italy

Purpose: To identify a possible correlation between dilated Virchow Robin spaces (dPVS) and Parkinsonʼs disease (PD).

Materials and Methods: We report the case of a 69-year-old female patient that developed PD with rigidity and bradykinesia, predominantly affecting the right limbs. The family history affirmed that the mother suffered from PD. Non-motor symptoms were constipation, anxiety, insomnia and daytime sleepiness. The response to dopaminergic therapy was positive. The patient underwent a 3T high field Magnetic Resonance study through morphological and functional sequences for a Diffusion Tensor study. The MRI data were analyzed using the MIPAV software and a study of the diffusion data was developed through the FSL software for an adequate probabilistic processing of the graphic tract based on a multi-fiber model.

Results: Presence of dPVS on the left anterior perforated substance, with dimensions of approximately: 13.4718 mm (minor axis), 384.728 mm2 (area) and 461.674 mm3 (volume). The DTI data of our PD patient showed increased peak frequency of left FA (fractional anisotropy) and decreases in the distribution of MD (mean diffusivity) with changes in the fiber density compared to the normal contralateral tract.

Conclusion: Even if MRI morphologic brain study did not show evidence of compression signs due to enlarged VRS, we instead hypothesize that the DTI changes are due to dVRS. Because fMRI symmetrical data does not entirely explain patient PD symptomatology, therefore larger sample of patients compared with healthy controls of MRI and fMRI studies will be made showing the relation between dVRS and PD symptoms.

Co-Delivery of Albendazole and OTS964 by Lipid-Coated Calcium Phosphate (LCP) Nanoparticles to Treat Metastatic Cancers

Fatemeh Movahedi*, Wenyi Gu and Zhi Ping Xu

The University of Queensland, Australia

The leading reason of death for the majority of patients with cancer is metastasis. Currently, 90% of chemotherapeutic treatments fail during the metastasis stage of cancer due to drug resistance. A promising approach to combat the drug resistance is combination therapy by at least two therapeutic agents. OTS 964 is a novel anti-cancer drug targeting TOPK pathway which is highly expressed in the circulating tumour cells. On the other hand, albendazole is recently recognized as an anti-cancer drug inhibiting tubulin polymerization. The combination of OTS 964 and albendazole not only can be employed as an effective tool against drug resistance but also can act against metastasis by targeting the marker of metastatic cells.

In this work, we employed pH-responsive lipid-coated calcium phosphate (LCP) nanoparticles for co-delivery of albendazole and OTS 964 (OTS-ABZ-LCP). OTS-ABZ-LCPs were tested against B16F0 melanoma cells, B16F10 metastatic melanoma cells and HUVEC cells. Cell toxicity, apoptosis induction, ROS and VEGF level and cell migration ability were measured to investigate the mechanism of action.

OTS-ABZ-LCPs were highly effective against B16F0 and B16F10 melanoma cells while showing no significant toxicity against healthy cell line, HUVEC. The results revealed that albendazole and OTS kill cancer cells in a synergistic fashion through inducing synergistic apoptosis induction. The treatment not only reduced VEGF expression in cancer cells but also decreased their migration ability and metastatic properties.

Co-delivery of albendazole and OTS 964 in LCP form can be a promising tool to overcome drug resistance in cancer cells as well as targeting metastasis with minimum toxicity to healthy organs. Further in vivo studies are required to confirm the results and move toward clinical trials.

Dr. Fatemeh Movahedi did her bachelor in Sharif University of Technology (2007) the leading university in Iran. She did her master in IUST (2012). Later, she pursued her research in drug delivery in Nanyang Technological University (NTU) in Singapore and then moved to Australia and started her PhD in Australian Institute for Bioengineering and Nanotechnology, The University of Queensland under supervision of Professor Zhiping (Gordon) Xu. Fatemeh Movahedi`s research is to develop a new nanoplatform to efficiently deliver albendazole for cancer therapy. Her research is focused on optimizing LCP nanoparticles to carry albendazole and enhancing the delivery efficacy in vitro and in vivo for cancer therapy.

Surface Modification with ECM-Inspired SDF-1α/Laminin-Loaded Nanocoating for Vascular Wound Healing

Xia Li*, Tao Liu, Xin Wang, Xiaohan Tang and Tao Gong

The Affiliated Huaiʼan Hospital of Xuzhou Medical University, China

Surface biomimetic modification with extra-cellular matrix (ECM)-derived biomolecules is an emerging potential method of accelerating the healing of vascular stent lesions. However, insufficient capacity of the constructed biofunctional layer in maintaining its long-term efficiency and preventing thrombus and neointimal hyperplasia continue to be major limitations in clinical application. On the basis of the structure and function of ECM, in this study, we constructed a novel stromal cell-derived factor-1α (SDF-1α)/lamininloaded nanocoating on the 316L stainless steel (SS) surface to provide improved function in modulation of vascular remodeling. The modified surface was found to control delivery of biomolecules and exhibit promising potential to provide stage-adjusted treatment after injury. An in vitro biocompatibility study suggested that the constructed layer may effectively prevent thrombosis formation by inhibiting platelet adhesion and activation, while accelerating endothelium regeneration by inducing endothelial cell (EC) migration and endothelial progenitor cell (EPC) aggregation. An in vivo animal test further demonstrated that the nanocoating may prevent thrombus and neointimal hyperplasia after implantation for 3 months. Therefore, the ECM-inspired nanocoating described in this study is a promising novel approach for vascular stent surface modification.

Dr. Xia Li achieved his Medicine Bachelor Degree at Medical University of China Qinghai, China in 1982, his Internal Medicine Specialist title at Peopleʼs Hospital, Medical University of China Qinghai in 1983, his lecturer and chief resident of cardiology and geriatrics in 1988, his assistant professor and attending physician of cardiology and geriatrics in 1994, his Master of Medicine Medical University of China Lanzhou in 1988, his Doctor of Medicine Degree at Medical University of China Qinghai in 1992, his associate professor and associate chief physician of cardiology and geriatrics in 1997 and his professor and chief physician of cardiology and geriatrics in 2002. He was visiting research scholar in College of Health Sciences, University of Wyoming, U.S.A. Research project Molecular Pulmonology, visiting professor and postdoc in College of Health Sciences, University of Wyoming, U.S.A. Research Project Molecular Cardiology Aging and Myocardial Hypertrophy, Postdoc TX Medical Center U.S.A. Research Project Molecular Cardiology. He has been the associate chairman of Geriatric Association North China, Director of China Nanjing Huaian Geriatric Institute, Director of Department of Geriatric Huaian Hospital Xuzhou Medical University of China. 16 SCI papers were published in 2016-2017.

The Investigation of Behaviour of Soliton Transported Bio-Energy along the Protein Molecules

Pang Xiao-feng

University of Electronic Science and Technology of China, China

The propagated properties of soliton transported bio-energy excited in the α-helix protein molecules with three channels in the cases of short-time and the long-time motion and its features of collision at temperature T=0 and biological temperature T=300 K are studied numerically by the dynamic equations in the improved Davydov theory and fourth-order Runge-Kutta method, respectively. From these simulation experiments we see that the new solitons in the improved model can move without dispersion at a constant speed retaining its shape and energy in the cases of motion of both short-time and T=0 and long time or T=300 K and can go through each other without scattering in their collisions. In these cases its lifetime is, at least, 120 PS at 300 K, in which the soliton can travel over about 700 amino acid residues. These results obtained are consistent with analytic result obtained by quantum perturbed theory in this model. In the meanwhile, the influences of structure disorder of α-helix protein molecules, including the inhomogeneous distribution of amino acids with different masses and fluctuations of spring constant, dipole-dipole interaction, exciton-phonon coupling constant and diagonal disorder, on the solitons are also studied by the fourth-order Runge-Kutta method. Therefore, the soliton still is very robust against the structure disorders and thermal perturbation of proteins at biological temperature 300 K. From this investigations of the properties of soliton solutions of equations of motion in the cases of short-time and long-time motion and its features of collision in the α-helix protein molecules with three channels at the biological temperature 300 K in the improved model by the fourth-order Runge-Kutta method we finally obtain that this soliton in the improved model is very stable whether in the cases of long- and short-time motions and mutual collision at 300 K, it can move along the protein molecular chains without dispersion at a constant speed retaining its shape and energy in the cases of motion of both short-time and T=0 and long time and T=300 K and can go through each other without scattering in the collision. In this case its lifetime is at least, 120 PS at 300 K, in which the soliton can travel over about 700 amino acid residues.

This result is consistent with analytic result obtained by quantum perturbed theory in this model. In the meanwhile, the influences of structure disorder of protein molecules, including the inhomogeneous distribution of amino acids with different masses and fluctuations of spring constant, dipole-dipole interaction, exciton-phonon coupling constant and diagonal disorder, on the solitons are also studied. The results show that the soliton is easily undisturbed and very robust against the structure disorders and thermal perturbation. Therefore the new soliton in the improved model is a possible carrier of bio-energy transport and the model is possibly a candidate for the mechanism of this transport.

Direct Evidence of Viral Infection and Mitochondrial Alterations in the Brain of Foetuses at High Risk for Schizophrenia

Segundo Mesa Castillo

Psychiatric Hospital of Havana, Cuba

There is increasing evidences that favour the prenatal beginning of schizophrenia. These evidences point toward intra-uterine environmental factors that act specifically during the second pregnancy trimester producing a direct damage of the brain of the fetus [1]. The current available technology doesnʼt allow observing what is happening at cellular level since the human brain is not exposed to a direct analysis in that stage of the life in subjects at high risk of developing schizophrenia.

Methods: In 1977 we began a direct electron microscopic research of the brain of foetuses at high risk from schizophrenic mothers in order to finding differences at cellular level in relation to controls.

Results: In these studies we have observed within the nuclei of neurons the presence of complete and incomplete viral particles that reacted in positive form with antibodies to herpes simplex hominis type I [HSV-1] virus and mitochondria alterations [2].

Conclusion: The importance of these findings can have practical applications in the prevention of the illness keeping in mind its direct relation to the aetiology and physiopathology of schizophrenia. A study of the gametes or the amniotic fluid cells in women at risk of having a schizophrenic offspring is considered. Of being observed the same alterations that those observed previously in the cells of the brain of the studied foetuses, it would intend to these women in risk of having a schizophrenia descendant, previous information of the results, the voluntary medical interruption of the pregnancy or an early anti HSV-1 viral treatment as preventive measure of the later development of the illness.

Segundo Mesa Castillo is a Specialist in Neurology; he worked for 10 years in the Institute of Neurology of Havana, Cuba. He has worked in Electron Microscopic Studies on Schizophrenia for 32 years. He was awarded with the International Price of the Stanley Foundation Award Program and for the Professional Committee to work as a fellowship position in the Laboratory of the Central Nervous System Studies, National Institute of Neurological Diseases and Stroke under Dr. Joseph Gibbs for a period of 6 months, National Institute of Health, Bethesda, Maryland, Washington D.C. USA, June 5, 1990. At present he is member of the Scientific Board of the Psychiatric Hospital of Havana and give lectures to residents in psychiatry.

Identification and Annotation of Long Non-Coding RNA in Myogenesis

Soumyadeep Nandi

Gauhati University, India

Our understanding of genome regulation is ever evolving with the continuous discovery of the new mode of gene regulation. Transcriptomic studies of mammalian genomes have recently revealed the presence of an extremely large population of noncoding RNA molecules in the transcripts expressed in cells. One such non-coding RNA molecule is the long non-coding RNA (lncRNA). This new class of gene is recently identified in various tissues. The function of the lncRNAs in gene regulation is not well understood. ENCODE project has annotated thousands of lncRNA in various cells. Studies are yet to be carried for functional annotation of these lncRNAs. Many recent studies have, however, showed the evidence of lncRNAs playing important role in normal physiology and in many diseases, such as X-chromosomal dosage compensation, embryonic stem cell maintenance, differentiation and development, antiviral response, gene imprinting, cancer progression and vernalization in plants. In this present study, we have identified the lncRNAs and determined their role in the developmental process. The function of these lncRNAs was determined by correlating these lncRNAs with other epigenetic marks, such as histone modifications. We have selected the process of myogenesis as a study case, where we have identified lncRNAs in mouse and human and annotated them based on their association with the genes in their vicinity. With this study, we have identified few novel lncRNAs in myogenesis and annotated them. In this analysis we have discovered few lncRNAs in myogenesis which has a role in muscle development, chromatin modifications, etc. and were not reported earlier.

Dr. Soumyadeep Nandi pursued his M.Sc from Gauhati University in Zoology with specialization in Cell Biology. He did his Ph.D. from Jawaharlal Nehru University in Computational Biology. In his Ph.D. research, he was mainly involved in characterizing proteins function by developing and implementing different protein classification techniques. His first postdoc was at Ottawa Institute of Systems Biology, Faculty of Medicine and University of Ottawa, Ontario, Canada. His second postdoc was at Molecular Biology Department, Umeå University, Sweden. Currently, he is working as a Ramalingaswami Fellow at the IASST, Guwahati. Research in his group includes sequence analysis, correlation studies of epigenetic factors, developing computational tools.

Hospital Preparedness during Mass Casualty Events – A Systematic Review of Lessons Learned

Ary Phaily1*, OluwaseunAdeboyejo2, Adnan DʼCunha Kamath2, Aisha Hakim2 and Haoyu Wang2

1Imperial College London, UK
2Royal Berkshire Hospital, UK

Aims: The dawn of the 21st century ushered in an era of increasing terrorism and a wave of mass casualty events across cities in Europe and the United States. The scientific community must now consider how best to prepare for such events and analyse previous responses. Are lessons learned or the same mistakes repeated in reported mass casualty events?

Methods: A systematic literature review of the PubMed/MEDLINE, Scopus and Cochrane databases from December 2012 to December 2017 using Medical Subject Headings (MeSH) for ‘Mass casualty/casualtiesʼ and ‘analysisʼ or ‘reviewʼ. In-depth analysis of responses to 3 separate events in Boston (2013), Paris (2015) and London (2017) was carried out with a focus on the preparedness, accomplishments and challenges of each.

Results: From 612 potentially relevant citations, 72 underwent further analysis and 8 met the inclusion criteria. Lessons learned include greater collaboration between emergency services, improved crisis command and control structures and rapid augmentation of surge capacity. Although preparedness has improved, recurring failures in internal hospital systems, communication and resource allocation were noted.

Conclusions: Lack of a standardised and validated method of analysis of emergency responses remains a barrier to dissemination of lessons learned. The need for greater transnational academic collaboration in mass casualty response and preparedness is now undeniable.

Lastly, this review recommends increasing collaboration and training between emergency services, the formation of hospital networks to deal with multiple critical victims and drawing upon the experiences from military combat situations.

Dr. Ary Phaily is a surgeon undergoing higher surgical training in the Oxford Deanery in the United Kingdom with an interest in surgical innovation and research. He is currently finishing postgraduate studies in Surgical Innovation at Imperial College London.

Trauma Laparoscopy – Lessons Learnt and Future Applications

Ary Phaily1*, Aisha Hakim2, Oluwaseun Adeboyejo2, Adnan DʼCunha Kamath2 and Haoyu Wang2

1Imperial College London, UK
2Royal Berkshire Hospital, UK

Aims: Recent innovation in the fields of robotics, optics, miniaturisation and computing hold promise that minimally invasive surgery (MIS) will result in a paradigm shift in the future of surgical trauma care. This article assesses the current and future applications of laparoscopy in trauma management.

Methods: A literature search of the PubMed/MEDLINE, Cochrane Library, Web of Science and National Institute for Health and Care Excellence Evidence databases using entry sets of Medical Subject Headings (MeSH) for Abdomen (or Abdominal), Trauma and Laparoscopy (or Laparoscopic) as well as a comparative search of the grey literature was also carried out.

Results: 2,623 unique articles were screened. Following abstract review, 64 articles were selected for further analysis. Results show laparoscopy in abdominal trauma is associated with fewer complications, reduced length of stay, morbidity and negative laparotomy rates in haemodynamically stable patients. Current systematic reviews are based on low quality studies with great degrees of heterogeneity. Alternative MIS methods such as endoscopy and angioembolisation have been successfully used as adjuncts during non-operative management of abdominal trauma.

Conclusions: To increase preparedness for the inevitable rise in the worldwide trauma burden, a concerted effort must be made to focus research efforts on multi-centre, prospective studies to produce meaningful guidelines. Hybrid non-operative and minimally invasive techniques will have a greater role to play in future trauma management. Dedicated training in MIS and increased research efforts are still needed if we are to effectively combat the societal and global burden of trauma.

Dr. Ary Phaily is a surgeon undergoing higher surgical training in the Oxford Deanery in the United Kingdom with an interest in surgical innovation and research. He is currently finishing postgraduate studies in Surgical Innovation at Imperial College London.

Amniofix in Refractory Knee Pain

Ashish Anand

University of Mississsippi, USA

The amniotic membrane is a constituent of placental tissue that protects and supports the fetus in utero. It is composed of extracellular matrix components such as collagen, fibronectin and laminin and contains many different growth factors and cytokines. The healing properties of amniotic tissue were first identified in 1910 (1) where it was discovered that they help in healing refractory, stalled wounds. However this immunologically privileged structure was lost to scientific community for close to 90 years until technological advances led to its being “rediscovered” in 2000.

I am reporting my retrospective case series of 40 patients of variable age group who had failed all conservative treatment options including all other injections like steroids and visco supplementation and was reluctant for surgery. Patients were injected with Amnio-fix injection and were followed at 4 weeks and 8 weeks and 6 months and contacted at 1 year. Failure rate was defined as improvement of < 50 percent in VAS scale. 65 percent Patients reported improvement in there VAS pain levels of more than 60 percent and 25 percent reported improvement of 50 percent and 10 percent did not have any improvement. The majority group above reported improvement in their walking distance. Based on above failure rate was 10-25 percent which was defined as need of other treatments/surgery. This retrospective review of cases suggests that Amnio-fix can be used in treatment of refractory arthritic knee pain. To the best of our knowledge this is a second follow up series in English Literature elucidating the benefits of Amniofix in osteoarthritis. As technology advances and price become affordable the research world will hear more about this prod.

Dr. Ashish Anand is an Orthopedic Surgeon at VAMC Jackson, MS. He also serves as Assistant Clinical Prof (Adj) at Department of Orthopedics, University of Mississsippi Medical Center, Jackson, MS. In his current assignment he is involved in care direct patient care as well as is involved in teaching activities with residents, RN and PAs. He is also involved in research activities, which enables him to stay abreast with cutting edge technology. He has significant number of publications in national and international journals of repute. Dr. Anand has presented lectures as a faculty both at national and international levels. He is life member of Indian Orthopedic Association, Indian Arthroscopic Association, Indian Arthroplasty Association, Indian Society of Hip and Knee Surgeons and associate member of American Orthopedic Association. He was a lead author in a book chapter (Exposures in Knee Arthroplasty) in the book Surgical Techniques in Knee Arthroplasty published by Elseiver. He is the Editor for a book titled Management of arthritis-A Holistic view, published by Bentham publishers and had also authored a chapter in the book.

Preoperative Progressive Pneumoperitoneum in Reconstruction of Eventrations and Inguinoscrotal Hernias with Loss of Domain in Bogotá

Beltrán-García Tatiana Carolina1*, Quintero Marco Tulio2, Sánchez Gonzalo2 and Navarro Alean Jorge Alberto3

1Universidad del Rosario, Colombia
2Hospital Universitario Mayor, Colombia
3Universidad del Rosario, Colombia

Introduction: The preoperative pneumoperitoneum (PPP) is a safe technique for the management of complex incisional hernias and with associated loss of domain. In Colombia, there are no current data on peritoneal catheter placement techniques and PPP efficacy, surgical success rate, frequency of complications and recurrence.

Methods: Retrospective cohort with the objective of measuring the efficacy of PPP in patients taken to surgery for giant incisional hernias or inguinoscrotal hernias with loss of domain in Bogota.

Results: Cohort composed of 17 patients, 70% men (59 years average), predominating midline eventrations. The placement of the peritoneal catheter in 95% of the cases was by means of a percutaneous technique guided by tomography. Imaging showed a significant difference between the average volume of the initial abdominal cavity (7649.85cc) and after the PPP (10155.93cc) with a p 0,000, representing a gain of 2506cc (95% CI: 1657, 8cc - 3354, 2cc) and an increase of 32.7% with respect to the initial average volume. The rotation of anterior components with sandwich mesh was the most performed surgical technique (n:15) and there were postoperative complications in 58.8% of the patients. There is no clinical recurrence of the incisional hernia in the postoperative follow-up.

Conclusion: Currently, the PPP is an effective complementary technique for the surgical management of complex eventrations with clinical and radiological loss of domain, thus impacting the quality of life of the patient to achieve the final closure of the abdominal wall.

Dr. Beltrán-García Tatiana Carolina is an Epidemiologist and General Surgeon since 2019 at Rosario University in Colombia, responsible and disciplined, with the ability to apply medical knowledge in clinical practice to put them at the service of patients and the community showing a professional and ethical performance. Additionally he is proactive, perseverant and with a high interest in clinical research in the surgical area.

Optical Coherence Tomography Capabilities for Early Stent Thrombosis after Primary Percutaneous Coronary Intervention

Ermolaev Pavel* and Geynts Kristina

Omsk Regional Clinical Hospital, Russia

Early stent thrombosis is a life-threatening complication of primary percutaneous coronary intervention, which manifests itself in the clinical picture of recurrence of myocardial infarction. The frequency of early stent thrombosis after the primary PCI is significantly higher than in the intervention for stable coronary heart disease and in large registers reaches 3.5%, the lethality, according to various reports, is 20-40%. Angiography is limited in the ability to determine the causes of early stent thrombosis.

The aim was to identify the benefits of optical coherence tomography (OCT) in determining the causes of early stent thrombosis after the primary PCI.

Methods: PCI was performed by transradial access. 25 patients (15 men and 10 women) with early stent thrombosis were performed OCT in re-intervention after predilatation with a small coronary balloon catheter and restoration of antegrade blood flow.

Results: All patients received anti platelet and anticoagulant therapy in accordance with standards. At primary PCI in target lesion were implanted BMS and DES in the ratio 1:1. At repeated intervention in all cases, total thrombosis of the stented segment, peripheral blood flow TIMI 0 were observed. According to OCT, significant stent mal position was detected in 12 cases, which was eliminated by post-dilating with a larger diameter balloon catheter, in 7 cases an additional stent was implanted due to protrusion of thrombotic masses. In the group with stent malposition, the phenomenon of “slow flow” was developed in 5 cases, GP IIb/IIIa blockers were not used. Edge dissection was detected in 3 cases, it was eliminated by implantation of an additional stent. The coronary blood flow was restored TIMI 3. The under expantion of the stent after the primary PCI was revealed in 5 cases, it was eliminated by post-dilating with a larger balloon balloon catheter. Coronary blood flow was restored TIMI 3.

Conclusion: OCT allows to establish the reasons and choose a therapeutic tactic for early stent thrombosis after the primary PCI.

Comparison of Tension free Desarda Technique with Lichtenstein for Inguinal Hernia Repair

Janmejai Prasad Sharma*, Abhishek Gupta and Subash Chandra Sharma

Shri Guru Ram Rai Institute of Medical & Health Sciences, India

Background: Inguinal hernia is a very common surgical problem for which, mesh-based techniques, particularly the Lichtenstein repair is considered standard. However, problems like foreign body sensation, wound infection, cord fibrosis, chronic pain and recurrence are major concern. Desarda tissue repair (non-mesh technique), which was given by an Indian surgeon, is now being used in many countries because of low cost of procedure with very low recurrence rates.

The objective of this study was to evaluate the feasibility of Desarda tissue repair at a tertiary care centre of Central India as a treatment of primary inguinal hernia, by comparing it with Lichtenstein repair in terms of various post-operative parameters.

Methods: Patients between age of 18 and 70 years with primary inguinal hernia were included in this randomised controlled trial. Patients with strangulated, obstructed or recurrent hernia, surgically unfit patients and patients having unmanaged urinary obstruction, cough or constipation were excluded. Randomization was done by sealed envelope method into Lichtenstein and Desarda arm and respective surgeries were performed.

Results: 51 patients were included in the study and average duration of follow-up was 11 months. Operative time was significantly less in Desarda arm (28.24 min compared to 30.88min in Lichtenstein arm). Cost, incidence of seroma formation, post-operative pain, foreign body sensation and chronic pain were also significantly less in Desarda arm. No recurrence was observed in both arms.

Conclusions: Desarda repair is easy to perform and takes less time to perform and proves cost effective. Desarda repair is comparable to Lichtenstein repair in terms of many parameters and superior in terms of post-operative pain and foreign body sensation and can be preferred for young patients. In infected and strangulated cases, Desarda repair can be used effectively without fear of mesh infection.

Keywords: Chronic pain, Desarda tissue repair, Inguinal hernia, Lichtenstein repair, Recurrence

Dr. Janmejai Prasad Sharma has completed his graduation and postgraduation from LLRMMC, CCS University, Meerut, Uttar Pradesh, India. He has worked as a Senior Registrar in Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi, India. He is a currently Professor, Department of General Surgery, Shri Guru Ram Rai Institute of Medical and Health Sciences, Dehradun, Uttarakhand, India. A dedicated teacher, adored by his students and has dedicated his life towards his profession. He was Executive Council Member of The Association of Surgeon of India and currently President of Surgical Society of Dehradun and Dehradun Chapter of ASI. He also was Past President of Indian Medical Association, Dehradun, Uttarakhand, India.

Functional Neuroimaging for Prognostics and Diagnostics at Rest

Radu Mutihac

University of Bucharest, Romania

The human brain is a large-scale complex network whose function relies on the interaction between its various regions. Recent studies of the human brain connectivity using resting-state/sleep functional magnetic resonance imaging (rsfMRI), diffusion tensor imaging (DTI) and more recently, diffusion tensor spectroscopic imaging (DSI) data have provided deeper insight on the organization of structural and functional brain networks that continuously share information. Brainʼs energy is largely consumed at rest during spontaneous neuronal activity (~20%), while task-related increases in metabolism energy are minor (<5%). Spontaneous ultralow-frequency fluctuations in BOLD-based rsfMRI signals (<0.01Hz) at the level of large-scale neural systems are not noise, but orderly and organized in a series of functional networks that permanently maintain a high level of temporal coherence among brain areas that are structurally segregated and functionally linked in resting state networks (RSNs). There is evidence suggesting that such signals permit to extract information about the connectivity and functionality of specific networks. It is also documented that functional connectivity reflects the underlying structural connectivity, which at rest undergoes specific alterations in several neurological and psychiatric disorders. Human brain function imaged by rsfMRI allows accessing both sides of human mind-brain interface (subjective experience and objective observations). As such, functional neuroimaging moves onto new potential applications like reading the brain states, discriminate neurological dysfunctions (if any), artificial intelligence (AI), brain-computer interfaces (BCI), lie detection and alike. The presentation aims to review and evaluate the most current approaches for early detection and classification of various forms of dementia, particularly among syndromes with relatively similar behavioral effects, as well as stages in a given syndrome, based on modifications of the brain connectivity at rest explored by rsfMRI, DTI and DSI.

Professor Emeritus Radu Mutihac is Chair of Medical Physics, University of Bucharest and works in Neuroscience, Neural Networks, Signal Processing, Microelectronics and Artificial Intelligence. As postdoc/research associate/visiting professor/full professor he has conducted research at the University of Bucharest, International Centre for Theoretical Physics (Italy), Ecole Polytechnique (France), Institute Henri Poincaré (France), KU Leuven (Belgium). Data mining and exploratory analysis of neuroimaging time series were addressed during two Fulbright Grants in Neuroscience (Yale University, CT and University of New Mexico, NM, USA). His research in fused biomedical imaging modalities was carried out at the Johns Hopkins University, National Institutes of Health and Walter Reed Army Institute of Research, MD, USA. Since 2008, Professor Radu Mutihac has been nominated PhD student supervisor in the field of Biophysics and Medical Physics at the University of Bucharest, Romania.

Chest Trauma

Tarun Lall

Trauma Centre, S.M.S Hospital, India


• Majority of chest wounds result from blunt trauma, secondary to motor vehicle/ road traffic accident.

• Most of the deaths in these cases are due to asphyxia and haemorrhage and are avoidable.

• Blast lung injury (BLI) is a major cause of morbidity after terrorist bomb attacks (TBAs) and is seen with increasing frequency worldwide.

• Death can occur

- Immediately (within seconds to minutes), disruption of the heart or great vessel injury.

- Early (minutes to hours), airway obstruction, tension pneumothorax, pulmonary contusion or cardiac tamponade.

- Late (days to weeks) after injury. Pulmonary complications, sepsis and missed injuries.

Mechanism of Chest Injury:

1. Body acceleration and deceleration (organ inertia lags behind skeletal acceleration or deceleration) e.g. RTA

2. Body compression (force > the strength of skeleton) e.g. Crush injury and falls Penetrating wounds (open pneumothorax and organ injury) e.g. assaults.

Types of Chest Injury: 1. Blunt Chest injury (closed chest injury) E.g. RTA, fall, Crush injury – Associated with multiple injuries such as head, limb and abdomen

2. Penetrating Chest injury (open chest injury) mostly by assault–associated with chest wall damage, open pneumothorax and organ injury

3. Blast Injury- One of the emerging problems in developing country is terrorism.
Blast injury may involve many organs and commonly involves lung.

Damage to Lungs Due to Air Blast:

• Alveolar haemorrhage due to tearing of alveolar septa

• Lungs are bruised due to direct blow on the chest by bomb fragments and debris. • Chest X-ray showing typical bilateral patchy infiltrates commonly known as “Blast Lungs”

Assessment and Management

- Primary survey with resuscitation of vital functions

- Detailed secondary survey definitive care goal of early intervention is to prevent or correct hypoxia.

General Anaesthetic Management Considerations

1. Pre-operative assessment:

In conscious patients the following brief history should be taken. –

• History of present illness
• Past medical and surgical history
• Previous anesthesia difficulties
• Malignant hyperthermia
• Current medication
• Allergies
• NPO status
• Review of systems
• Monitoring

2. Induction:

• Unconscious moribund patient – intubated; surgery is performed without anesthesia.
• When vital signs and consciousness improve, anesthetics can be added, start with lower doses.
• Drug of choice - Ketamine
• Avoid thiopentone and like drugs including inhalational agents in patients in shock.
• They should be used only after correction of BP with adequate fluid replacement.
• Excessive crystalloids may lead to hypo proteinemia and further pharmacokinetic disturbances hence after adequate hydration colloids should be added as plasma expanders.
• Consider full stomach and delayed gastric emptying.

Criteria for Operating Room or Postanesthesia Care Unit Extubation of the Trachea in a Trauma Patient

Mental Status

Resolution of intoxication
Able to follow commands
Pain adequately controlled

Airway Anatomy and Reflexes

Appropriate cough and gag
Ability to protect airway from aspiration
No excessive airway edema or instability

Respiratory Mechanics

Adequate tidal volume and respiratory rate
Normal motor strength
Required FiO2 less than 0.50

Systemic Stability

Adequately resuscitated (see earlier)
Small likelihood of urgent return to the operating room
Normothermic, without signs of sepsis

Perioperative EVLT Images by Duplex Ultrasonography and 3-Dimensional CT

Won Gon Kim

Seoul National University Hospital, South Korea

Endovenous laser treatment (EVLT) has been recently well established as an effective modality of elimination for varicose veins. Obliteration and eventual disappearance of the treated vein has been usually confirmed with aid of duplex ultrasound imaging.

On the other hand, CT of the varicose veins and volume-rendered 3D reconstruction can provide operator-friendly images and excellent road map of perforators, despite disadvantages such as high cost and extra burden of radiation.

For the purpose of 3D evaluation of obliteration and eventual disappearance of the treated vein, we analyzed pre-and post-EVLT images of 3D CT in 17 patients taken with consent.

Among the 17 patients (14 women, 3 men; mean age, 56.2 years; range, 33-72 years), 9 patients had bilateral varicose veins and remaining 8 patients had varicose veins in only one limb. Total of 26 EVLT procedures for the greater saphenous vein were performed. The mean interval between EVLT and postoperative CT examination was 12.7 months with range of 5-27 months.

Among 26 limbs, 23 proved to be three-dimensionally obliterated. In the remaining 3 limbs, two were patent and one was reanalyzed.

Parietization of Colon following Tuberculous Acites

Shailesh Kumar*, Abu Masud Ansari and Devaa Dutta Poddar

PGIMER Dr RML Hospital, India

A 46 years old menopausal female presented to Surgical OPD with the complaints of recurrent pain abdomen with vomiting and fever off and on. Pt was a treated case of Kochʼs abdomen. There was no history of jaundice and other co- morbidities.

On examinations, she had tenderness in Right Hypochondrium (RHC) on deep palpation. Rest of the Parameters were normal.

On Investigation, ultrasonography of abdomen revealed multiple Gallstones with Normal CBD. Rest of the abdomen and pelvis were normal. Her blood and urinary examinations were within normal limits. X-ray chest revealed features suggestive of healed tuberculosis.

Pt was posted for Laparoscopic Cholecystectomy. After pneumo-peritoneum, 10mm Optical port was placed in periumbilical area. On diagnostic laparoscopy, whole of the colon was densely adhered to the pariety (Fig-1a). Liver, Gall blader and Spleen were nor not visible. As Falciform Ligament and liver was not visible, two working port were inserted in the mid clavicular line both side around 3 inches below the Costal Margin in an anticipation to de-Parietization of the transverse colon to assess the feasibility to proceed. We broke the adhesion between the transverse colon and pariety in the midline and proceeded to de-parietisation the whole transverse colon with the help of ultrasonic scissor (Fig-1b). After that we could visualised the Liver and Gall bladder (Fig-1c) and proceeded with the Laparoscopic Cholecystectomy.

Abdominal cavity is the sixth most common extra peritoneal site of tuberculosis1 . There are different studies that support the crucial role of diagnostic laparoscopy in the diagnosis of abdominal tuberculosis. The diagnostic laparoscopy revealed ascetic fluid, violin string adhesion of peritoneum and omental thickness2. Peritoneal involvement is a common features and more than half of the patients presents with ascites, Lymphadenopathy and stranding of the mesenteric fat3. Laparoscopy is normally accepted as accurate and prompt diagnostic tools in case of suspected abdominal tuberculosis.

Keywords: Kochʼs Abdomen, Parietization, Colon, Laparoscopy.


1. Sharma MP, Bhatia V, Abdominal Tuberculosis. Indian J Med Res 2004; 120:305-315 [PubMed]

2. D Mistikas, T Kapp and Montmollin de. Laparoscopic diagnosis of abdominal tuberculosis. HippoKratia. 2016 Ap-jan; 20(2):175.

3. Sinant T, Sheikh M, Ramadan S, Sahwney S, Behbehani A. CT- features in abdominal Tuberculosis: 20 years Experience. BMC Medical imaging. 2002; 2 [PMC free article][PubMed]