University of Alabama at Birmingham Hospital

Abstract Introduction Minimally invasive techniques have transformed early rectal cancer treatment; yet the optimal approach is unclear. ESD, EMR, and TAMIS are increasingly being used, however, most studies only compare two of these techniques. This meta-analysis directly compares all three in efficacy, safety, and oncological performance. Methods PubMed, Scopus, and Medline were searched to identify relevant studies as of September 2024. Criteria included studies in adults with early rectal cancer treated by ESD, EMR, or TAMIS, reporting at least one outcome and specifying treatment type and cancer stage. Comprehensive Meta-Analysis v4 was used for analysis with heterogeneity assessed via I². Results A total of 127 studies encompassing 8915 patients were included (EMR = 3979, ESD = 4470, and TAMIS = 466). Mean procedural times were: overall 8.3 min (7.7–8.8), I² = 99%; EMR 7.5 (6.9–8.1), I² = 98%; ESD 32.6 (29.3–36), I² = 99%; TAMIS 101.6 (83.9–119.9), I² = 95%. En bloc resection: overall 87.1% (85.6–88.5), I² = 81%; EMR 86.5% (84.4–88.4), I² = 82%; ESD 87.2% (84.4–89.5), I² = 80%; TAMIS 94.1% (88.9–97), I² = 0%. R0 resection: overall 79.7% (78.6–80.8), I² = 80%—EMR 79.9% (78.3–81.5), I² = 85%; ESD 78.7% (77.1–80.3), I² = 76%; TAMIS 87.1% (82.8–90.4), I² = 42%. Conclusions Although EMR appears efficient, it demonstrated less favourable outcomes regarding en bloc resection. ESD showed favourable oncological outcomes while maintaining moderate procedural time. TAMIS is most time-intensive but yields the highest resection quality.

We have previously shown that 16 weeks of combined aerobic–resistance training in older women decreases non-exercise activity thermogenesis (NEAT) when performed 3 times/week, but not when performed once or twice weekly. To examine changes from weeks 16 to 32 in anthropometrics, body composition, fitness, cytokines, mood, and energy expenditure (EE) components among training frequencies in older women. Sedentary women (60–74 y) previously randomized to 1 + 1, 2 + 2, or 3 + 3 sessions/wk of supervised combined aerobic–resistance training continued the program from weeks 16 to 32. Total EE (TEE) (doubly labeled water), resting EE (REE) (indirect calorimetry), training-related EE (TREE) (validated estimates), NEAT = activity EE (AEE) − TREE (AEE = 0.9×TEE − REE), fat mass (FM), and fat-free mass (FFM) (DXA), V̇O₂max (treadmill), mood/fatigue, and serum cytokines were measured at weeks 16 and 32. Two-way repeated-measures ANOVA was used with Tukey posthocs. Fifty-seven women contributed anthropometry/fitness/cytokines; 44 contributed EE components. Weight decreased, whereas FM (kg and %), FFM, V̇O₂max, IL-6, CRP, TNF-α, fatigue, vigor and REE were unchanged. Bench- and leg-press strength increased across groups. Depression varied by group (lower in 3 + 3 vs. 2 + 2; P = 0.044). TEE differed between groups (P = 0.017; 2 + 2 > 1 + 1 and 3 + 3). TREE increased over time (P = 0.002) and differed by group (P < 0.001). NEAT showed a time-by-group interaction (P = 0.049), increasing only in 3 + 3 (P = 0.044). High-frequency (3 + 3) combined aerobic-resistance training was associated with increased NEAT between weeks 16–32, but not lower frequencies. However, the 2 + 2 group continued to have the highest NEAT overall.

Acute myocardial ischemia/reperfusion (MI/R) increases risk for cognitive decline, yet the underlying mechanisms mediating heart-brain communication remain poorly understood. Small extracellular vesicles (sEVs) have emerged as novel long-range signaling mediators and may play a critical role. MI/R was induced by transient ligation of the left anterior descending artery. Cognitive performance was assessed using multiple behavioral tests. sEVs derived from cardiomyocytes were labeled to track their distribution and cellular uptake in the brain. Heart and brain tissues were analyzed for microRNAs (miRNAs) expression using bioinformatics, qPCR, and RNAScope. The role of specific miRNAs was investigated through genetic inhibition of cardiomyocyte-derived sEVs release using Rab27af/fMyh6-Cre+ mice, pharmacological blockade of exosome, and AAV-mediated overexpression or knockdown. MI/R mice exhibited significant cognition deficits along with hypothalamic paraventricular nucleus (PVN) synaptic ultrastructural injury and dysfunction. sEVs released from injured cardiomyocytes were significantly elevated and preferentially accumulated in oxytocin neurons from the PVN. Inhibiting cardiomyocyte-derived sEVs ameliorated cognitive impairments and synaptic pathology. Conversely, injection of cardiomyocyte-derived sEVs into the PVN recapitulated MI/R-induced cognitive deficits. Among candidate miRNAs, miR-574-5p was identified as a key mediator. Its inhibition via miRNA sponge restored cognitive function. Bioinformatic analyses revealed that miR-574-5p targets genes involved in synaptic structure and GABAB receptor signaling. Cardiomyocyte-derived sEVs contribute to MI/R-induced cognitive impairment through miR-574-5p. Upon delivery to the PVN and uptake by oxytocin neurons, miR-574-5p suppresses synaptic and GABAB receptor-related proteins, leading to synaptic disruption and cognitive decline. Targeting this pathway may represent a promising therapeutic approach for cognitive dysfunction associated with heart disease.

Introduction: Augmented reality (AR) offers an immersive experience by overlaying digital content onto the real world, creating a more realistic and three-dimensional environment for users. We hypothesized that AR technology would improve live procedural performance of trainees. This study aimed to demonstrate the utility of AR in assisting resident and fellow ultrasound-guided central line simulation training. Methods: This was a prospective observational study. Physician trainees participating in residency and fellowship programs at the University of Alabama at Birmingham were recruited for this study. Participants received brief training on ultrasound-guided vascular access and use of AR. All participants performed vascular access with and without AR assistance. A Microsoft HoloLens 2 AR headset equipped with the HoloUS application was used to display real-time ultrasound imaging to the user. Our primary outcomes include: the number of needle sticks, head redirections and total time required for successful vascular access. We also surveyed the participants about their experience using AR and their preferences for the use of this technology in the future. Results: Fifty-one physician trainees participated in the study. All participants were successfully able to obtain vascular access on each attempt. There was no significant difference between groups in the time (30.06 seconds versus 29.96 seconds; p 0.0803) or number of needle sticks (1.18 versus 1.25; p 0.5391). However, there was a significant reduction in the average number of head redirections (2.96 versus 5.26, mean difference -2.31; 95% CI: -4.42 to -2.02; p 0.033) required with the use of AR. Results from survey data showed a preference toward the use of AR in performing vascular access, with 51% of participants favoring AR assistance, and 25% reporting no difference. Also, 76% of participants indicated they would opt to use AR technology to assist with vascular access if it were available to them. Conclusions: AR is a feasible tool in vascular access training. It is non-inferior to ultrasound guidance alone in total time spent and number of needle sticks and superior with fewer head turns in obtaining vascular access.

Background: Plastic surgery training in the United Kingdom (UK) is a highly competitive and evolving field. Recent reforms have aimed to standardise operative exposure, academic opportunities, and mentorship, yet the perspectives of current trainees remain underexplored.Objective: This study assessed UK plastic surgery trainees’ perceptions of their training quality, satisfaction, and preparedness for independent practice.Methods: A cross-sectional, anonymised online survey was distributed to UK plastic surgery trainees. The questionnaire included demographic items, views on training duration and fellowship structure, and satisfaction ratings across key domains of training using a five-point Likert scale. Free-text comments were thematically analysed to identify recurrent qualitative themes.Results: Fourteen trainees from multiple UK deaneries responded. Half reported three to four years of training (n = 7, 50%), and four (29%) had less than one year of training. Most respondents (n = 9, 64%) believed six years of training was sufficient to achieve key competencies, while two (14%) disagreed and three (21%) were uncertain. Opinions on fellowship structure were divided: seven (50%) supported integration within the six-year programme (5+1), six (43%) preferred a separate post-CCT (certificate of completion of training) fellowship (6+1), and one (7%) was unsure. Mean overall satisfaction was 3.2/5 (median = 3). Highest domain scores were supervisor involvement (mean = 3.5/5, n = 14) and case variety/hands-on opportunities (mean = 3.5/5, n = 14); lowest were research opportunities (mean = 2.9/5, n = 14) and work-life balance (mean = 3.0/5, n = 14). Qualitative responses highlighted five themes: limited operative exposure, inconsistent mentorship, regional variation, restricted research time, and the lasting impact of COVID-19.Conclusions: UK plastic surgery trainees report moderate satisfaction overall, with particular concern regarding research access and work-life balance. Qualitative feedback revealed recurring issues around mentorship and operative opportunities, consistent with national trainee trends.