George A. Perdrizet

Development and evaluation of the advanced trauma operative management course.

BACKGROUND The Advanced Trauma Operative Management (ATOM) course was developed as a model for teaching operative trauma techniques to surgical residents, fellows, and attending surgeons as the number of these cases decreases. METHODS The ATOM course consists of lectures and a porcine operative experience. Comprehensive evaluation of ATOM was designed to assess participant learning in the cognitive, affective, and psychomotor domains. Data on the first 50 participants were prospectively collected and analyzed. RESULTS Participants included 20 expert traumatologists, 9 general surgeons, 9 trauma fellows, 8 general surgery fifth-year residents, and 4 general surgery fourth-year residents. All groups showed improvement in knowledge, with results in the expert and fellow groups reaching statistical significance. Self-efficacy (self-confidence) also improved, with all groups reaching statistical significance. CONCLUSION This course creates life-like situations in a standardized fashion that, along with didactic instruction, improves knowledge and operative confidence for practicing surgeons and surgeons-in-training.

In vivo characterization of the molecular-genetic changes in gastric mucosa during the development of acute gastritis and stress ulceration.

BACKGROUND Trauma patients are at risk for the development of stress ulceration. Stress ulceration should be associated with increased heat-shock gene (iHSP70) and an inhibition of the trefoil peptide, spasmolytic polypeptide (SP), and mucin (MUC5AC) gene expressions. METHODS Male Sprague-Dawley rats (10 weeks old) were restrained for 0-, 4-, 8-, 12-, and 24-hour periods of time. Gastric ulcers were graded using a one- to three-point scoring system. The level of mucosal gene expression was determined at each time point for three genes: iHSP70, SP, and MUC5AC. RESULTS Gastric ulceration developed in direct proportion to the duration of restraint. Gastric ulceration was preceded by increased iHSP70 and decreased SP and MUC5AC gene expressions. CONCLUSION Restraint-induced gastric ulceration was preceded by an up-regulation of iHSP70 and a down-regulation of SP and MUC5AC gene expressions.

Biology of the Heat Shock Response and Stress Conditioning

The heat shock or stress response has been studied mainly as a cellular response. Most of the data come from bacterial cells, eukaryotic microorganisms (yeast primarily), and cultured animal cells. Often these cultured cells are tumor cell lines, i.e., cells that are functionally eukaryotic microorganisms as a consequence of genetic changes that change their social behavior and proliferative control. These systems have provided useful information about stress protein function and their roles in the defensive cellular state of cytoprotection. However, a full understanding of stress response biology in complex multicellular organisms requires different thinking and different models. This conclusion stems from the paradigm that the basic unit of function in animals and plants is not the individual cell but the tissue. Therefore stress response biology in these complex biological systems is primarily about tissue-level protection. Ultimately we would like to know how these responses are deployed in humans and how these inducible defenses may be used to prevent tissue damage from disease and from surgical intervention.