Rudolph the red-nosed reindeer

Rudolph - probably the best known reindeer in the world - but do you know the other reindeers' names (see below for answer).

Rudolph first appeared in a 1939 booklet written by RL May.

His spouse's name is 'Clarice', and BBC has made a show on his son "Robbie the Reindeer". His brother "Rusty the Reindeer" appeared in a 2006 TV show in the US.

In 2012 Rudolph appeared as the frontcover of the British Journal of Surgery, albeit in a more anatomical figure than usually seen:

From the BJS front cover, December issue 2012 (photo A Montgomery)

One big question has never been answered over the years though: 

Why is Rudolph's nose red?

The scientific explanation to why Rudolph has a red nose is now clear. A recent research paper in the BMJ has investigated this and found that Rudolph’s nose is red because it is richly supplied with red blood cells, comprises a highly dense microcirculation, and is anatomically and physiologically adapted for reindeer to carry out their flying duties for Santa Claus.

Fig 3 Infrared image of a reindeer’s head after a treadmill test shows the presence of a red nose (arrow, panel A).23 Colours represent different temperatures: blue 15°C, white 19°C, and red 24°C. The dark band is the harness. Real time intravital video microscopy images of reindeer nasal microcirculatory network with hairpin-like (panel B) and related ring-like vasculature (panel C), similar to human nasal microcirculation. Reproduced with permission of the Department of Arctic and Marine Biology, University of Tromsø -reproduced from BMJ 2012.

from http://www.bmj.com/content/345/bmj.e8311

The names of the other 8 reindeers are:

Dasher, Dancer, Prancer Vixen, Comet, Cupid, Donder and Blitzen.

Medical info - collecting and curation in the internet era

Never has there been a larger stream of info available for humankind. Getting access to info is not the problem anymore, rather the selection, digestion and prioritizing of info is the key skills needed in modern information overload.

Notably, PubMed alone has now grown to include over 22 million references!

On this week's cover, the Science Translational Medicine new "Collections icons" are shown as if they were apps on a smart phone, linking users to the information they seek. Editor-selected highlights from the journal are grouped by subject to form more than 50 collections on topics such as cancer, biomarkers, vaccines, partnerships, and bioengineering, pluss many more; go see the web @  SciTM Collections.

[CREDIT: C. BICKEL/SCIENCE TRANSLATIONAL MEDICINE]

Open access to BJS trauma issue 2012 - still!

Free access to the BJS trauma issue 2012 is still available:

The special issue on trauma highlights:

• established and emerging areas in injury care 
• epidemiology to epigenetics
• areas of current and ongoing interest, 
• explores translational aspects of pathophysiology in trauma care, 
• discusses changes in concepts and paradigms, and 
• gives ‘best evidence’ even where this is still guided largely by expert opinion and limited data

The trauma chain of survival. First displayed at the TraumaCare2002 conference in Stavanger, Norway, and reproduced with permission from Laerdal Medical, Stavanger, Norway. BLS, basic life support; ALS, advanced life support. (From K Søreide "Strengthening the Trauma Chain of Survival" Br J Surg, 2012).

Link to the BJS website and the themed issue on "Trauma", published in January 2012:

http://www.bjs.co.uk/details/issue/1431707/Volume-99-Issue-S1-January-2012.html

International Surgical Week 2013 - reminder!

Don't forget about the ISW-2013 in Finland and the abstract deadline!

The Deadline for the submission of Abstracts ISW 2013 is approaching quickly and you are kindly invited to submit your abstract for presentation at: http://www.isw2013.com/aabstracts.html 

The deadline for abstract submissions is January 7, 2013. The abstract system allows you to prepare your submission already now and modify or up-date it until deadline when you need to finally submit it. Accepted Abstracts will be published in the congress abstract volume.
Detailed information regarding the Helsinki Congress ISW 2013 including the scientific program is available at: http://www.isw2013.org

Archives of Surgery will become JAMA Surgery

Beginning in January 2013, Archives of Surgery will become JAMA Surgery, a member of The JAMA Network, a group of 10 leading medical journals.

Advantages to publishing in JAMA Surgery include

• A single portal that links articles across all 10 journals via semantic tagging
• 27 million annual online visits
• Online First: 90% of major articles will be published Online First in April 2013
• Fast Decisions: Time to first decision for authors is as low as 1 day
• Impact Factor of 4.24, ranked 7 of 198 journals
• JAMA referral preference: Papers not accepted by JAMA can automatically be referred to JAMA Surgery
• CME opportunities for authors and reviewers
• A robust resource base to better serve authors
• Free submission and publication: No submission fees, page charges, or publication fees
• Free access: All major research articles made freely available 12 months after publication
• Multimedia enhancements: Author audio podcasts and other online features to highlight articles
• Wide news media coverage: News releases of major articles distributed each week to more than 5000 journalists worldwide

se editorials:

http://archsurg.jamanetwork.com/article.aspx?articleid=1206540

Acute pancreatitis reclassified - twice!

Acute pancreatitis is a fairly common disease mot often caused by either gallstone disease or alcohol, with a number of other causes involved as well. The natural history may be unpredictable - mild disease usually resolves without any or just little medical support, while severe disease may involve into several complications, need for organ support and intensive care, and have a mortality as high as 30%.
Predicting which patient will develop severe disease is difficult, with a number of scoring systems proposed over the years; the Ranson score, Imrie (or Glasgow) score, the Harmless Acute Pancreatitis Score (HAPS), the APACAHE II score, JSS, BISAP, SIRS, Panc, POP, and so on...
However, noen of these work perfectly - the clinical prediction riles have reached their limitation (see Mounzer, Gastroenterology, 2012).

Disease severeity and classification of acute pancreatitis have been based on the Atlanta consensus from 1992. Several components of this classification have been controversial and critized over the years, and several research groups have argued for better definitions in order to compare results between studies and generate commonly agreed definitions for conducting trials.

This work has over the past several years come to fruition through two released international consensus reports:

One from the "Acute Pancreatitis Classification Working Group"

Banks PA, Bollen TL, Dervenis C, Gooszen HG, Johnson CD, Sarr MG, Tsiotos GG, Vege SS; Acute Pancreatitis Classification Working Group. Classification of acute pancreatitis--2012: revision of the Atlanta classification and definitions by international consensus. Gut. 2012 Oct 25. [Epub ahead of print]


and the other one from the PANCREA group

Dellinger EP, Forsmark CE, Layer P, Lévy P, Maraví-Poma E, Petrov MS,Shimosegawa T, Siriwardena AK, Uomo G, Whitcomb DC, Windsor JA; Pancreatitis Across Nations Clinical Research and Education Alliance (PANCREA). Determinant-Based Classification of Acute Pancreatitis Severity: An International Multidisciplinary Consultation. Ann Surg. 2012 Dec;256(6):875-880.

The consensus reports will hopefully allow for commonly agreed terms and definitions for future research. A problem is obviously that the two reports divert somewhat in their agreement in the number of categories neede for classifying acute pancreatitis. In the Gut paper the authors have defined a 3-tier system og mild, moderate and severe pancreatitis. The Annals paper have added a fourth group, named crititcal acute pancreatitis, when organ failure persists WITH the addition of infected (peri)pancreatic necrosis.

The Gut paper has emphasized several agreed terms and definitions for radiological classification of early (<4 weeks) and late (>4 weeks) fluid collections (such as "acute peripancreatic fluid collection; APFC" and "walled off necrosis; WON") to be distinguished from other terms such as "pseudocysts" and the now abandonded term "pancreatic abcess".

Which of the two suggestions will prevail over the other remains to be seen.

Cartoon commercials

I have to admit I do not remember the name of the artist to be credited for this, so if anyone coul dhelp me post his/her name for credits it would be great. However, the artistic work focuses on health problems related to the consumerism seen with certain products - I think the pictures really do speak for themselves.

BJS GI Cancer issue now online

The BJS 2013 special issue on Gastrointestinal cancer is now free accessible online:

http://onlinelibrary.wiley.com/doi/10.1002/bjs.v100.1/issuetoc

Table of contents:

Leading articles

Improving outcomes in gastrointestinal cancer (pages 1–2) D. Alderson and D. C. Winter Article first published online: 20 NOV 2012 | DOI: 10.1002/bjs.9004 Plenty of challenges for the GI surgeon Robotic cancer surgery (pages 3–4) M. H. Sodergren and A. Darzi Article first published online: 6 NOV 2012 | DOI: 10.1002/bjs.8972 Surgery of the future

Reviews

Impact of targeted neoadjuvant therapies in the treatment of solid organ tumours (pages 5–14) T. Waddell and D. Cunningham Article first published online: 20 NOV 2012 | DOI: 10.1002/bjs.8987 Treatments based on molecular profiles will become increasingly common Patient optimization for gastrointestinal cancer surgery (pages 15–27) K. C. Fearon, J. T. Jenkins, F. Carli and K. Lassen Article first published online: 20 NOV 2012 | DOI: 10.1002/bjs.8988 Every bit as important as the operation itself Integration of clinical and patient-reported outcomes in surgical oncology (pages 28–37) R. C. Macefield, K. N. L. Avery and J. M. Blazeby Article first published online: 20 NOV 2012 | DOI: 10.1002/bjs.8989 Patient-reported outcomes are still under-utilised by surgeons Contemporary perioperative care strategies (pages 38–54) M. Adamina, O. Gié, N. Demartines and F. Ris Article first published online: 20 NOV 2012 | DOI: 10.1002/bjs.8990 Defines optimal management Principles, effectiveness and caveats in screening for cancer (pages 55–65) M. Bretthauer and M. Kalager Article first published online: 5 DEC 2012 | DOI: 10.1002/bjs.8995 Potential for benefits but also harms

Randomized Clinical Trials

Randomized clinical trial of goal-directed fluid therapy within an enhanced recovery protocol for elective colectomy (pages 66–74) S. Srinivasa, M. H. G. Taylor, P. P. Singh, T.-C. Yu, M. Soop and A. G. Hill Article first published online: 6 NOV 2012 | DOI: 10.1002/bjs.8940 No value within a restrictive protocol

Original Articles

Long-term follow-up of the Medical Research Council CLASICC trial of conventional versuslaparoscopically assisted resection in colorectal cancer (pages 75–82) B. L. Green, H. C. Marshall, F. Collinson, P. Quirke, P. Guillou, D. G. Jayne and J. M. Brown Article first published online: 6 NOV 2012 | DOI: 10.1002/bjs.8945 Continued evidence supporting laparoscopic approach Differences in outcomes of oesophageal and gastric cancer surgery across Europe (pages 83–94) J. L. Dikken, J. W. van Sandick, W. H. Allum, J. Johansson, L. S. Jensen, H. Putter, V. H. Coupland, M. W. J. M. Wouters, V. E. P. Lemmens and C. J. H. van de Velde Article first published online: 23 NOV 2012 | DOI: 10.1002/bjs.8966 Call for standardization across Europe Impact of postoperative morbidity on long-term survival after oesophagectomy (pages 95–104) M. W. Hii, B. M. Smithers, D. C. Gotley, J. M. Thomas, I. Thomson, I. Martin and A. P. Barbour Article first published online: 12 NOV 2012 | DOI: 10.1002/bjs.8973 No effect on long-term survival Impact of a multidisciplinary standardized clinical pathway on perioperative outcomes in patients with oesophageal cancer (pages 105–112) S. R. Preston, S. R. Markar, C. R. Baker, Y. Soon, S. Singh and D. E. Low Article first published online: 12 NOV 2012 | DOI: 10.1002/bjs.8974 Standardized care improves short-term outcomes Surgical treatment of hepatocellular carcinoma associated with the metabolic syndrome (pages 113–121) F. Cauchy, S. Zalinski, S. Dokmak, D. Fuks, O. Farges, L. Castera, V. Paradis and J. Belghiti Article first published online: 12 NOV 2012 | DOI: 10.1002/bjs.8963 Risky even if liver grossly normal Risk factors for major morbidity after liver resection for hepatocellular carcinoma (pages 122–129) H. Sadamori, T. Yagi, S. Shinoura, Y. Umeda, R. Yoshida, D. Satoh, D. Nobuoka, M. Utsumi and T. Fujiwara Article first published online: 22 NOV 2012 | DOI: 10.1002/bjs.8957 Repeat and prolonged surgery are risk factors Liver resection for hepatocellular carcinoma in patients without cirrhosis (pages 130–137) A. Thelen, C. Benckert, H.-M. Tautenhahn, H.-M. Hau, M. Bartels, J. Linnemann, J. Bertolini, M. Moche, C. Wittekind and S. Jonas Article first published online: 6 NOV 2012 | DOI: 10.1002/bjs.8962 Radicality is crucial Evaluation of a fast-track programme for patients undergoing liver resection (pages 138–143) N. A. Schultz, P. N. Larsen, B. Klarskov, L. M. Plum, H. J. Frederiksen, B. M. Christensen, H. Kehlet and J. G. Hillingsø Article first published online: 20 NOV 2012 | DOI: 10.1002/bjs.8996 Fast-track recovery after liver surgery is safe Exhaled volatile organic compounds identify patients with colorectal cancer (pages 144–150) D. F. Altomare, M. Di Lena, F. Porcelli, L. Trizio, E. Travaglio, M. Tutino, S. Dragonieri, V. Memeo and G. de Gennaro Article first published online: 5 DEC 2012 | DOI: 10.1002/bjs.8942 VOC a potential screening test

Commentaries

Exhaled volatile organic compounds identify patients with colorectal cancer (Br J Surg 2013; 100: 144–150) (page 151) AP Zbar Article first published online: 5 DEC 2012 | DOI: 10.1002/bjs.8970

Original Articles

Minimal-access colorectal surgery is associated with fewer adhesion-related admissions than open surgery (pages 152–159) E. M. Burns, A. Currie, A. Bottle, P. Aylin, A. Darzi and O. Faiz Article first published online: 12 NOV 2012 | DOI: 10.1002/bjs.8964 Less risk of obstruction Multicentre study of circumferential margin positivity and outcomes following abdominoperineal excision for rectal cancer (pages 160–166) R. P. Kennelly, A. C. Rogers and D. C. Winter, on behalf of the Abdominoperineal Excision Study Group Article first published online: 12 NOV 2012 | DOI: 10.1002/bjs.9001 Tumour stage determines circumferential resection margin positivity

“If I Had Only Known” — On Choice and Uncertainty in the ICU — NEJM

“If I Had Only Known” — On Choice and Uncertainty in the ICU — NEJM

Sutureless mesh for hernia repair - RCT in BJS

Hernia repair is one of the most commonly performed surgical procedures worldwide. The number of surgical techniques and available equipment is considerable and several alternatives have been introduced and suggested over the years. Common to them all is that none is "perfect", and complication rates - most commonly discomfort and pain (up tp 15-20% of patients ) and hernia recurrence (up to 10-15%) continues to be a problem.

Resorbable polylactic acid (PLA) microgrips, from Covidien

A recent sutureless mesh was introduced by Covidien (Parietene ProGrip TM) with the idea that this would 
Now the DANGRIP Study Group have performed a randomized multicentre clinical trial comparing a self-gripping mesh (Parietene Progrip^®) and sutured mesh for open primary repair of uncomplicated inguinal hernia by the Lichtenstein technique. Patients were assessed before surgery, on the day of operation, and at 1 and 12 months after surgery. The primary endpoint was moderate or severe symptoms after 12 months, including a combination of chronic pain, numbness and discomfort.

The intention-to-treat population comprised 163 patients with self-gripping mesh and 171 with sutured mesh. The 12-month prevalence of moderate or severe symptoms was 17·4 and 20·2 per cent respectively (P = 0·573). There were no significant differences between the groups in postoperative complications (33·7 versus 40·4 per cent; P = 0·215), rate of recurrent hernia within 1 year (1·2 per cent in both groups) or quality of life.

The authors conclude that, the avoidance of suture fixation using a self-gripping mesh was not accompanied by a reduction in chronic symptoms after inguinal hernia repair.

For the full study details, please see:

Jorgensen, L. N., Sommer, T., Assaadzadeh, S., Strand, L., Dorfelt, A., Hensler, M., Rosenberg, J. and for the Danish Multicentre DANGRIP Study Group (2012), Randomized clinical trial of self-gripping mesh versus sutured mesh for Lichtenstein hernia repair. Br J Surg. doi: 10.1002/bjs.9006

Crowded house

Anyone recognize space limitation sin their lab? have a good w/e  ;-)

Revisions and more revisions...

This Friday's joke is probably something that every PhD student, or all scientific writers for that sake, can painfully relate to: Just when you thought you had it all down and finished your Magnus Opum Academica, ready for submission and done that job... it is returned from your coauthors and supervisor with request for a complete makeover and redo... well, it just exemplifies that writing is something most find difficult and it requires training and adherence to sound advise... hope to be able to share some writing advises on later occasions on this blog. Have a good w/e... and don't despair - you'll get your masterpiece published in the end!!  ;-)

Punctuations...

Communication is everything, yet we communicate in so many ways - physically as verbally.
Todays "lesson" goes with out any further explanations in the era of tweets , blogs and sms communication between supervisor and student... ***smirk***

Improbable research and the Ig Nobel Prize

If you've never heard about the improbable research you should go visit the homepage www.improbable.com. Improbable Research

They award prizes for researcg that first make people laugh, then think. Among the several categories are research iin medicla fields, such as 'anatomy' and 'medicine'.
The 2012 winners in these two categories are:

ANATOMY PRIZE: Frans de Waal [The Netherlands and USA] and Jennifer Pokorny [USA] for discovering that chimpanzees can identify other chimpanzees individually from seeing photographs of their rear ends.

REFERENCE: "Faces and Behinds: Chimpanzee Sex Perception" Frans B.M. de Waal and Jennifer J. Pokorny, Advanced Science Letters, vol. 1, 99–103, 2008.

MEDICINE PRIZE: Emmanuel Ben-Soussan and Michel Antonietti [FRANCE] for advising doctors who perform colonoscopies how to minimize the chance that their patients will explode.

REFERENCE: "Colonic Gas Explosion During Therapeutic Colonoscopy with Electrocautery," Spiros D Ladas, George Karamanolis, Emmanuel Ben-Soussan, World Journal of Gastroenterology, vol. 13, no. 40, October 2007, pp. 5295–8.
REFERENCE: "Argon Plasma Coagulation in the Treatment of Hemorrhagic Radiation Proctitis is Efficient But Requires a Perfect Colonic Cleansing to Be Safe," E. Ben-Soussan, M. Antonietti, G. Savoye, S. Herve, P. Ducrotté, and E. Lerebours, European Journal of Gastroenterology and Hepatology, vol. 16, no. 12, December 2004, pp 1315-8.

BJS celebrates 100 years anniversary

As one of the editors of the BJS (although still a 'freshman') I am proud to be part of along tradition in surgical publishing. Indeed, the BJS celebrates its 100-year anniversary in 2013, a remarkable feat in surgical publishing history! 

This gives opportunities for looking back to the beginning of the BJS and to the several remarkable progresses made over the last century. 

Please click here for free access to the first issue ever published.


This issue also includes an obituary of Lord Joseph Lister (click here to read it). It gives a good opportunity for going back to the early days before asepsis and antisepsis was 'discovered' and applied as we know it in modern surgery.

Modern surgery as we know it today was not able to develop until three great hurdles had been overcome:  

• the control of bleeding, 
• the control of pain, and 
• the control of infection.

The latter is often referred to as "asepsis" or "antisepsis", which are integrated into modern day surgical principles.

While still a student, Lister had decided not just to practise medicine, but also to conduct research to improve medical knowledge. His early investigations explored the action of muscles in the skin and the eye, the mechanism involved in the coagulation of blood, and the role played by blood vessels in the early stages of infection. Lister's research required frequent use of a microscope—a tool very familiar to him because of his father's involvement with it.

In the Edinburgh Hospital where Lister worked, almost half of the surgery patients died from infection. In some hospitals in Europe, as many as 80 per cent died. While surgeons regretted this high death rate, they trained themselves to accept this unpleasant aspect of their work. After all, they thought, nothing could be done about these infections, because they arose spontaneously inside the wound. Lister however, was not convinced of the inevitability of infection (which was also known as sepsis). He began to search for a way of preventing infection—that is, an antisepsis method.

Lister’s first clue as to the cause of infection came from comparing patients who had simple fractures with those who had compound fractures. Simple fractures do not involve an external wound. These patients had their bones set and placed in a cast, and they recovered. Compound fractures are those where the broken bone pierces the skin and is exposed to the air. More than half of these patients died. Lister reasoned that somehow the infection must enter the wound from the outside. But how exactly did this occur? And what could be done to prevent it?

Lister began washing his hands before operating, and wearing clean clothes. As the son of a wine merchant, Lister was all too familiar with the problem of wine going bad because of faulty fermentation. Pasteur had shown that the problem was caused by germs which entered from the air, and that organisms did not come to life spontaneously from non-living matter within the wine. Lister immediately recognized the truth and usefulness of Pasteur’s work. If infection arose spontaneously within a wound, it would be virtually impossible to eliminate it. However, if germs entering from the air outside the wound caused infection (in the same way that the wine became contaminated), then those germs could be killed and infection prevented.Pasteur had used heat and filters to eliminate the germs in the wine, but these techniques were not suitable for use with human flesh. Instead, Lister needed to find a suitable chemical to kill the germs. He learned that carbolic acid was being used as an effective disinfectant in sewers and could safely be used on human flesh. Beginning in 1865, Lister used carbolic acid to wash his hands, his instruments, and the bandages used in the operation. Lister also sprayed the air with carbolic acid to kill airborne germs. 

Application of carbolic acid during an operation

After more than a year of using and refining these techniques, Lister had sufficient data to show that his methods were a success. He published his findings in the medical journal, The Lancet, in 1867.Lister was always eager to acknowledge Louis Pasteur’s invaluable contribution. 

In a letter to Pasteur in February 1874, Lister gave him ‘thanks for having, by your brilliant researches, proved to me the truth of the germ theory. You furnished me with the principle upon which alone the antiseptic system can be carried out.’

Listers also gave name to a family of gram-positive bacteria "Listeria monocytogenes" known to cause 'Listeriosis' in cattle and sheep (and one of the reasons why we pasteurize milk products, to get rid of the bacteria - so there is a contribution to both Lister and Pasteur!)

Listeria monocytogenes

Several modern products still carry names with referral to Lister and his techniques for killing germs - among the better known products are probably mouth washes, as displayed from different time periods below.

Antiseptic alcohol

Modern "original Listerine"