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  • 1
    Online Resource
    Online Resource
    Assessing Technical Skill in Surgery and Endoscopy: A Set of Metrics and an Algorithm (C-PASS) to Assess Skills in Surgical and Endoscopic Procedures
    SAGE Publications ; 2007
    In:  Surgical Innovation Vol. 14, No. 2 ( 2007-06), p. 113-121
    Details
    In: Surgical Innovation, SAGE Publications, Vol. 14, No. 2 ( 2007-06), p. 113-121
    Abstract: Historically, the performance of surgeons has been assessed subjectively by senior surgical staff in both training and operating environments. In this work, the position and motion of surgical instruments are analyzed through an objective process, denoted C-PASS, to measure surgeon performance of laparoscopic, endoscopic, and image-guided procedures. To develop C-PASS, clinically relevant performance characteristics were identified. Then measurement techniques for parameters that represented each characteristic were derived, and analytic techniques were implemented to transform these parameters into explicit, robust metrics. The metrics comprise the C-PASS performance assessment method, which has been validated over the last 3 years in studies of laparoscopy and endoscopy. These studies show that C-PASS is straightforward, reproducible, and accurate. It is sufficiently powerful to assess the efficiency of these complex processes. It is likely that C-PASS and similar approaches will improve skills acquisition and learning and also enable the objective comparison of systems and techniques.
    Type of Medium: Online Resource
    ISSN: 1553-3506 , 1553-3514
    URL: Article
    DOI: 10.1177/1553350607302330
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2007
    detail.hit.zdb_id: 2233576-6
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  • 2
    Online Resource
    Online Resource
    Endoscopic ultrasound-guided sampling and profiling of portal circulation in human patients for metabolic research studies and biomarker assessment
    American Physiological Society ; 2020
    In:  American Journal of Physiology-Gastrointestinal and Liver Physiology Vol. 319, No. 5 ( 2020-11-01), p. G584-G588
    Details
    In: American Journal of Physiology-Gastrointestinal and Liver Physiology, American Physiological Society, Vol. 319, No. 5 ( 2020-11-01), p. G584-G588
    Abstract: Portal and hepatic circulation can now be safely accessed using endoscopic ultrasound (EUS). EUS-guided needle access of the portal vein is performed clinically at select tertiary centers for measurement of portal pressure gradients in patients with chronic liver disease and sampling of portal venous thrombus to diagnose malignancy. We propose that this novel clinical technique can be applied in research studies to allow blood collection from and profiling of portal and hepatic circulation. In this technical report, we present and highlight the technical aspects, feasibility, and safety of EUS: guided portal venous blood collection. As a proof of the concept and the utility of this technique in metabolic research and biomarker assessment and discovery, we present a pilot metabolite profiling study of portal venous blood in a small cohort of patients with cirrhosis and a comparison with a group without cirrhosis. Despite the very small diameter of the endoscopic needle used for the blood collection, the portal samples have the same quality as those collected from systemic circulation, and they can be used for the same downstream applications. Finally, we propose an analytical workflow to screen for promising metabolites that could qualify for further studies to determine their utility as sensitive, early candidate biomarkers of hepatic fibrosis, portal shunt, and hypertension. We hope that this report could stimulate and facilitate the widespread use of EUS-guided techniques for the profiling of portal circulation, which could potentially open a new field of scientific inquiry. NEW & NOTEWORTHY The technical aspects, feasibility, and safety of endoscopic ultrasound (EUS)-guided needle access for portal venous blood collection are presented in this technical report. Despite the very small diameter of the endoscopic needle, portal blood samples have the same quality as those collected from systemic circulation. As a proof of the concept and the utility of this technique in metabolic research and biomarker assessment and discovery, we present a pilot metabolite profiling study of portal venous blood in a small cohort of patients with cirrhosis and a comparison with a group without cirrhosis.
    Type of Medium: Online Resource
    ISSN: 0193-1857 , 1522-1547
    URL: Article
    DOI: 10.1152/ajpgi.00135.2020
    Language: English
    Publisher: American Physiological Society
    Publication Date: 2020
    detail.hit.zdb_id: 1477329-6
    SSG: 12
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  • 3
    Online Resource
    Online Resource
    Critical role for arginase 2 in obesity-associated pancreatic cancer
    Springer Science and Business Media LLC ; 2017
    In:  Nature Communications Vol. 8, No. 1 ( 2017-08-14)
    Details
    In: Nature Communications, Springer Science and Business Media LLC, Vol. 8, No. 1 ( 2017-08-14)
    Abstract: Obesity is an established risk factor for pancreatic ductal adenocarcinoma (PDA). Despite recent identification of metabolic alterations in this lethal malignancy, the metabolic dependencies of obesity-associated PDA remain unknown. Here we show that obesity-driven PDA exhibits accelerated growth and a striking transcriptional enrichment for pathways regulating nitrogen metabolism. We find that the mitochondrial form of arginase (ARG2), which hydrolyzes arginine into ornithine and urea, is induced upon obesity, and silencing or loss of ARG2 markedly suppresses PDA. In vivo infusion of 15 N-glutamine in obese mouse models of PDA demonstrates enhanced nitrogen flux into the urea cycle and infusion of 15 N-arginine shows that Arg2 loss causes significant ammonia accumulation that results from the shunting of arginine catabolism into alternative nitrogen repositories. Furthermore, analysis of PDA patient tumors indicates that ARG2 levels correlate with body mass index (BMI). The specific dependency of PDA on ARG2 rather than the principal hepatic enzyme ARG1 opens a therapeutic window for obesity-associated pancreatic cancer.
    Type of Medium: Online Resource
    ISSN: 2041-1723
    URL: Article
    DOI: 10.1038/s41467-017-00331-y
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2017
    detail.hit.zdb_id: 2553671-0
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  • 4
    Online Resource
    Online Resource
    Robotics and ergonomics
    Elsevier BV ; 2003
    In:  Surgical Clinics of North America Vol. 83, No. 6 ( 2003-12), p. 1321-1337
    Details
    In: Surgical Clinics of North America, Elsevier BV, Vol. 83, No. 6 ( 2003-12), p. 1321-1337
    Type of Medium: Online Resource
    ISSN: 0039-6109
    URL: Article
    DOI: 10.1016/S0039-6109(03)00161-0
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2003
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  • 5
    Online Resource
    Online Resource
    Publisher Correction: Inactivating hepatic follistatin alleviates hyperglycemia
    Springer Science and Business Media LLC ; 2018
    In:  Nature Medicine Vol. 24, No. 10 ( 2018-10), p. 1628-1628
    Details
    In: Nature Medicine, Springer Science and Business Media LLC, Vol. 24, No. 10 ( 2018-10), p. 1628-1628
    Type of Medium: Online Resource
    ISSN: 1078-8956 , 1546-170X
    URL: Article
    DOI: 10.1038/s41591-018-0129-0
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2018
    detail.hit.zdb_id: 1484517-9
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  • 6
    Online Resource
    Online Resource
    591 The Gluttonous Roux: Evidence of Increased Glucose and Lipid Metabolism in the Roux Limb After Gastric Bypass Surgery in Human Patients
    Elsevier BV ; 2014
    In:  Gastroenterology Vol. 146, No. 5 ( 2014-05), p. S-111-
    Details
    In: Gastroenterology, Elsevier BV, Vol. 146, No. 5 ( 2014-05), p. S-111-
    Type of Medium: Online Resource
    ISSN: 0016-5085
    URL: Article
    DOI: 10.1016/S0016-5085(14)60399-1
    RVK:
    XA 44500
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2014
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  • 7
    Online Resource
    Online Resource
    Resting Energy Expenditure and Energetic Cost of Feeding Are Augmented after Roux-en-Y Gastric Bypass in Obese Mice
    The Endocrine Society ; 2012
    In:  Endocrinology Vol. 153, No. 5 ( 2012-05-01), p. 2234-2244
    Details
    In: Endocrinology, The Endocrine Society, Vol. 153, No. 5 ( 2012-05-01), p. 2234-2244
    Abstract: Although the prevalence of obesity has increased dramatically throughout the world during the last 25 yr, its long-term control remains poor. Currently, only gastrointestinal weight loss surgery, especially Roux-en-Y gastric bypass (RYGB), is associated with substantial and sustained weight loss and resolution or significant improvement of diabetes mellitus and other metabolic obesity-induced complications. Clinical observations and recent studies have suggested that RYGB induces its effects by changing the physiology of weight regulation. Understanding the underlying mechanisms of these profound and sustainable effects could facilitate the development of novel and less invasive treatments against obesity and its complications. To study the physiological mechanisms of RYGB, we have developed a mouse RYGB model that replicates the human operation. The aims of this study were to develop a roadmap for assessing energy expenditure (EE) in animal models of weight loss surgery and to examine the effects of RYGB on EE. We first measured EE by indirect calorimetry in groups of animals that underwent RYGB or a sham operation. Calorimetry data were analyzed using three different methods: normalization by total body mass, allometric scaling, and analysis of covariance modeling. RYGB in mice induced a significant increase in EE that was independent of the method used. An energy balance analysis was then performed, which also confirmed that RYGB-treated animals have higher energy maintenance needs. Finally, we determined the EE components that account for the observed increase in EE, and we found that resting EE and postprandial thermogenesis are the major contributors to this increase.
    Type of Medium: Online Resource
    ISSN: 0013-7227 , 1945-7170
    URL: Article
    DOI: 10.1210/en.2011-2041
    Language: English
    Publisher: The Endocrine Society
    Publication Date: 2012
    detail.hit.zdb_id: 2011695-0
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  • 8
    Online Resource
    Online Resource
    Intestine-Specific Overexpression of LDLR Enhances Cholesterol Excretion and Induces Metabolic Changes in Male Mice
    The Endocrine Society ; 2019
    In:  Endocrinology Vol. 160, No. 4 ( 2019-04-01), p. 744-758
    Details
    In: Endocrinology, The Endocrine Society, Vol. 160, No. 4 ( 2019-04-01), p. 744-758
    Abstract: Roux-en-Y gastric bypass (RYGB) surgery is one of the most effective treatment options for severe obesity and related comorbidities, including hyperlipidemia, a well-established risk factor of cardiovascular diseases. Elucidating the molecular mechanisms underlying the beneficial effects of RYGB may facilitate development of equally effective, but less invasive, treatments. Recent studies have revealed that RYGB increases low-density lipoprotein receptor (LDLR) expression in the intestine of rodents. Therefore, in this study we first examined the effects of RYGB on intestinal cholesterol metabolism in human patients, and we show that they also exhibit profound changes and increased LDLR expression. We then hypothesized that the upregulation of intestinal LDLR may be sufficient to decrease circulating cholesterol levels. To this end, we generated and studied mice that overexpress human LDLR specifically in the intestine. This perturbation significantly affected intestinal metabolism, augmented fecal cholesterol excretion, and induced a reciprocal suppression of the machinery related to luminal cholesterol absorption and bile acid synthesis. Circulating cholesterol levels were significantly decreased and, remarkably, several other metabolic effects were similar to those observed in RYGB-treated rodents and patients, including improved glucose metabolism. These data highlight the importance of intestinal cholesterol metabolism for the beneficial metabolic effects of RYGB and for the treatment of hyperlipidemia.
    Type of Medium: Online Resource
    ISSN: 1945-7170
    URL: Article
    DOI: 10.1210/en.2018-00098
    Language: English
    Publisher: The Endocrine Society
    Publication Date: 2019
    detail.hit.zdb_id: 2011695-0
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  • 9
    Online Resource
    Online Resource
    The Benefit of Force Feedback in Surgery: Examination of Blunt Dissection
    MIT Press ; 2007
    In:  Presence: Teleoperators and Virtual Environments Vol. 16, No. 3 ( 2007-06-01), p. 252-262
    Details
    In: Presence: Teleoperators and Virtual Environments, MIT Press, Vol. 16, No. 3 ( 2007-06-01), p. 252-262
    Abstract: Force feedback is widely assumed to enhance performance in robotic surgery, but its benefits have not yet been systematically assessed. In this study we examine the effects of force feedback on a blunt dissection task. Twenty subjects used a telerobotic system to expose an artery in a synthetic model while viewing the operative site with a video laparoscope. Subjects were drawn from a range of surgical backgrounds, from inexperienced to attending surgeons. Performance was compared between three force feedback gains: 0% (no force feedback), 37%, and 75%. The absence of force feedback increased the average force magnitude applied to the tissue by at least 50%, and increased the peak force magnitude by at least 100%. The number of errors that damage tissue increased by over a factor of 3. The rate and precision of dissection were not significantly enhanced with force feedback. These results hold across all levels of previous surgical experience. We hypothesize that force feedback is helpful in this blunt dissection task because the artery is stiffer than the surrounding tissue. This mechanical contrast serves to constrain the subject's hand from commanding inappropriate motions that generate large forces.
    Type of Medium: Online Resource
    ISSN: 1054-7460
    URL: Article
    DOI: 10.1162/pres.16.3.252
    Language: English
    Publisher: MIT Press
    Publication Date: 2007
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  • 10
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    Online Resource
    Gut adaptation after gastric bypass in humans reveals metabolically significant shift in fuel metabolism
    Wiley ; 2023
    In:  Obesity Vol. 31, No. 1 ( 2023-01), p. 49-61
    Details
    In: Obesity, Wiley, Vol. 31, No. 1 ( 2023-01), p. 49-61
    Abstract: Roux‐en‐Y gastric bypass surgery (RYGB) is among the most effective therapies for obesity and type 2 diabetes, and intestinal adaptation is a proposed mechanism for these effects. It was hypothesized that intestinal adaptation precedes and relates to metabolic improvement in humans after RYGB. Methods This was a prospective, longitudinal, first‐in‐human study of gene expression (GE) in the “Roux limb” (RL) collected surgically/endoscopically from 19 patients with and without diabetes. GE was determined by microarray across six postoperative months, including at an early postoperative (1 month ± 15 days) time point. Results RL GE demonstrated tissue remodeling and metabolic reprogramming, including increased glucose and amino acid use. RL GE signatures were established early, before maximal clinical response, and persisted. Distinct GE fingerprints predicted concurrent and future improvements in HbA1c and in weight. Human RL exhibited GE changes characterized by anabolic growth and shift in metabolic substrate use. Paradoxically, anabolic growth in RL appeared to contribute to the catabolic state elicited by RYGB. Conclusions These data support a role for a direct effect of intestinal energy metabolism to contribute to the beneficial clinical effects of RYGB, suggesting that related pathways might be potential targets of therapeutic interest for patients with obesity with or without type 2 diabetes.
    Type of Medium: Online Resource
    ISSN: 1930-7381 , 1930-739X
    URL: Issue
    URL: Article
    DOI: 10.1002/oby.v31.1
    DOI: 10.1002/oby.23585
    Language: English
    Publisher: Wiley
    Publication Date: 2023
    detail.hit.zdb_id: 2027211-X
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