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Objective:. Our objective was to review the use of videoconferencing as a practical tool for remote surgical education and to propose a model to overcome the impact of a pandemic on resident training. Summary Background Data:. In response to the coronavirus disease 2019 pandemic, most institutions and residency programs have been restructured to minimize the number of residents in the hospital as well as their interactions with patients and to promote physical distancing measures. This has resulted in decreased resident operative exposure, responsibility, and autonomy, hindering their educational goals and ability to achieve surgical expertise necessary for independent practice. Methods:. We conducted a narrative review to explore the use of videoconferencing for remote broadcasting of surgical procedures, telecoaching using surgical videos, telesimulation for surgical skills training, and establishing a didactic lecture series. Results and Conclusions:. We present a multimodal approach for using practical videoconferencing tools that provide the means for audiovisual communication to help augment residents’ operative experience and limit the impact of self-isolation, redeployment, and limited operative exposure on surgical training.

Background Service models for gastrointestinal endoscopy sedation must be safe, as endoscopy is the most common procedure performed under sedation in many countries. The aim of this prospective cohort study was to determine the patient risk profile, and incidence of and risk factors for significant unplanned events, in adult patients presenting for gastrointestinal endoscopy in a group of university-affiliated hospitals where most sedation is managed by anaesthetists. Methods Patients aged ≥18 yr presenting for elective and emergency gastrointestinal endoscopy under anaesthetist-managed sedation at nine hospitals affiliated with the University of Melbourne, Australia, were included. Outcomes included significant airway obstruction, hypoxia, hypotension and bradycardia; unplanned tracheal intubation; abandoned procedure; advanced life support; prolonged post-procedure stay; unplanned over-night admission and 30-day mortality. Results 2,132 patients were included. Fifty percent of patients were aged >60 yr, 50% had a BMI >27 kg m −2, 42% were ASA physical status III-V and 17% were emergency patients. The incidence of significant unplanned events was 23.0% (including significant hypotension 11.8%). Significant unplanned intraoperative events were associated with increasing age, BMI Conclusions Patients presenting for gastrointestinal endoscopy at a group of public university-affiliated hospitals where most sedation is managed by anaesthetists, had a high risk profile and a substantial incidence of significant unplanned intraoperative events and 30-day mortality.

e18322 Background: Though patients (pts) with gynecological cancer are at higher risk of MBO, clinical management is not well defined. We implemented a coordinated team approach to evaluate MBO at Princess Margaret Cancer Centre. The Princess Margaret Cancer Centre inter-professional MBO management program includes nurse led ambulatory symptom management, inpatient treatment algorithm, patient directed bowel management education & MCCs. This study evaluates the utility of MBO MCC on clinical decision making in gynecologic oncology. Methods: Monthly MBO MCCs are conducted to discuss complex clinical management issues. A clinical summary is presented prior to the discussion with each case incorporating radiology review followed by interdisciplinary discussion. In this study, the initial management plan was compared to post-MCC consensus. A change in plan was defined as a consensus plan different from the pre-MCC plan or no definite plan prior to MCC. Barriers to implementation of the consensus were analyzed. Results: From December 2016 to November 2018, 90 pts were discussed in 22 MCCs. Of these, 60 had high grade serous ovarian carcinoma (67%) & 64 had small bowel obstruction (71%). Discussion in MCCs lead to a change in management plan in 49 cases(54%). These changes included recommendations for palliative surgery (25%) or radiation (10%), interventional radiology (23%), pharmacologic management alone (14%), imaging studies (4%) & total parenteral nutrition (TPN) (4%). Chemotherapy continuation, break or regimen changes were recommended in 20%. MCC consensus plan could not be implemented in 11 cases (23%). The barriers were refusal of surgery (8%), interventional radiology procedures (2%), TPN (4%) by patients, functional decline (6%) & inability to create a colostomy due to dense adhesions (2%). During MCC referrals to the dietitian & palliative care team were planned for 16 (18%) & 22 (24%) pts respectively. Conclusions: Interdisciplinary MBO MCCs have a significant impact on decision making in complex MBO cases. Radiology review & group discussion facilitates greater clarity in formulation of a management plan.

Musca domestica L. is a non-biting nuisance fly that is capable of transmitting a large variety of pathogens to humans and non-human animals. Natural compounds and their derivatives, which are often less toxic than entirely synthetic compounds, may be used as repellents against M. domestica as part of comprehensive pest control and disease mitigation programs. This work investigates the repellent properties of the natural compound α-pinene against M. domestica. Adult house flies of both sexes avoided the volatile plant-derived terpenes (1S)-(-)-α-pinene 1 and (1R)-(+)-α-pinene 2 in constant air flow laboratory conditions, with 1 exhibiting a stronger repellent effect. House flies also avoided tarsal contact with filter paper saturated with 1. Furthermore, both 1 and 2 are electrophysiologically active on in situ female house fly antennal preparations. These findings demonstrate that α-pinene exhibits natural baseline repellency against the house fly, elicits a specific physiological response in this fly, and that functional or structural modification of 1 in particular may yield novel fly repellents with desirable properties.

158 Background: Malignant bowel obstruction (MBO) is a common and challenging clinical predicament in women with advanced gynecological cancers. However, there is a lack of evidence-based guidelines or innovative approaches to improve patient care and quality of life. We implemented an inter-professional MBO management program incorporating a nurse-led ambulatory symptom management algorithm and multidisciplinary care conferences (MCC) as hallmarks of this program. Methods: Princess Margaret Cancer Centre has piloted an inter-professional MBO management program that supports women with advanced gynecological cancers who are at risk of/have developed MBO. The MBO team includes oncologists (medical, surgical, gynecologic and radiation), palliative care physicians, diagnostic and interventional radiologists, home parenteral nutrition physicians, specialized oncology nurses, dietitians, pharmacists and social workers. Complex MBO cases are discussed at regular MCC to derive treatment consensus. A symptom-driven MBO management algorithm has been devised and all patients are educated with a personalized bowel symptom management and dietary plan. For outpatient care, patients with MBO are proactively monitored by our specialized oncology nurses via phone or an eHealth bowel application to facilitate communication of symptoms and early intervention. Access to community services and home palliative care services are utilized to support care at home. All patients are enrolled into a prospective database to assess care impact and quality. Results: A total of 145 patients have been followed through the MBO management program over 12 months. At time of data cutoff, 14 had MBO (3 inpatients and 11 outpatients) and 22 were deemed at risk of MBO. Majority patients are managed as an outpatient and avoided unnecessary emergency department episodes. Detailed methodology and data analyses will be presented. Conclusions: A successful novel MBO program incorporating inter-professional care model and nurse-led ambulatory symptom management algorithm optimizes patient care in this vulnerable population and foster collaboration in implementing best practice clinical processes.

Diabetes mellitus (DM) affects 150 million people worldwide including 50 million in India. The incidence rate of the disease is expected to double by 2025. Diabetes emerges due to several factors such as inhibition of glucose absorption, increase in glucose uptake and upregulation of glucose transporters, activation of the nuclear receptor PPARγ, increase in adiponectin release, glycogen metabolism, absent or decreased insulin production and/or impaired function, insulin mimetic and insulinotropic effect, elevation of D-Chloroinositol, incretin mimetics and incretin enhancers, and the role of endogenous opioids on glucose homeostasis and antioxidants. Based on the pancreatic effect, DM is classified as type 1 (insulin dependent diabetes mellitus (IDDM)) and type 2 (noninsulin dependent diabetes mellitus (NIDDM)). DM induced hyperglycemia leads to many clinical complications either at the macrovascular level causing coronary artery and cerebrovascular diseases or at the microvascular level causing renal failure, blindness, limb amputation, neurological complications, and premature death [1, 2]. The symptoms of DM include severe hypoglycemia, lactic acidosis, idiosyncratic liver cell injury, permanent neurological deficit, digestive discomfort, headache, and dizziness. Existing therapeutics against DM mainly include synthetic hypoglycemic drugs and insulin. These anti-DM drugs usually target a single metabolic pathway to regulate hyperglycemia and are laced with numerous side effects and their efficacies are questionable. Therefore, it is imperative to develop new therapeutic paradigms that can act on more than one key metabolic pathway concerning carbohydrate, fat, or protein metabolism. Herbal preparations from over 200 traditional plants and their bioactive constituents are known to possess antidiabetic property as demonstrated by various screening methods. The extracts or constituents of some plants may act at different levels such as inhibiting glucose absorption from intestines, increasing insulin secretion from the pancreas, enhancing glucose uptake by adipose and muscle tissues, or inhibiting glucose production from hepatocytes [2]. Accordingly, there are ample possibilities to exploit phytochemicals as effective alternative medicines with limited or no side effects. Given that limited information is available regarding the evidence-based therapeutic usage of many antidiabetic plants, this special issue was proposed. It attracted many submissions; following a peer review, only seven submissions were recommended for publication. These articles include review articles and technical papers that provide comprehensive reports on antidiabetic plants and the mode of action of their active ingredients. The review article “Botanical, pharmacological, phytochemical, and toxicological aspects of the antidiabetic plant Bidens pilosa L.” written by W.-C. Yang provides up-to-date information on the pharmacology, phytochemistry, and toxicology of Bidens pilosa in regard to type 1 and type 2 diabetes. The author has highlighted medicinal properties of ingredients isolated from the plant, B. pilosa L., which is easy-to-grow, widespread, and a palatable perennial. The author has presented the structure and biosynthesis of B. pilosa and its polyynes in relation to their antidiabetic action and mechanism. In the article “Antidiabetic effect of oral borapetol B compound, isolated from the plant Tinospora crispa, by stimulating insulin release,” F. E. Lokman et al. have presented an evaluation of the antidiabetic property of a biologically active small compound borapetol B (C1) isolated from T. crispa in normoglycemic control using Wistar (W) and spontaneously type 2 diabetic Goto-Kakizaki (GK) rats. They found that an acute oral administration of the compound significantly improves blood glucose levels in the treated group in comparison to the placebo group. They observed that plasma insulin levels were significantly enhanced by 2-fold in treated W and GK rats compared to the placebo group at 30 minutes. Their study provides evidence that borapetol B (C1)'s antidiabetic property is mainly due to stimulation of insulin release. N. H. M.-Radzman et al. in the paper “Stevioside from Stevia rebaudiana Bertoni increases insulin sensitivity in 3T3-L1 adipocytes” have reported that stevioside from Stevia rebaudiana may exert an antihyperglycemic effect on both rat and human subjects. Using methods such as the radioactive glucose uptake assay, they have shown the improvements in insulin sensitivity in 3T3-L1 cells by elevation of glucose uptake as a result of stevioside treatments. They found that stevioside managed to increase uptake activities to a maximum of 2.08 times (P < 0.001) under normal conditions and up to 4.40 times (P < 0.001) in insulin-resistant states. It was noncytotoxic to the 3T3-L1 cells. The authors have shown that stevioside can have a direct effect on 3T3-L1's insulin sensitivity, by means of the glucose uptake elevation and the increase in expression of proteins in the insulin-signaling pathway. The article “Potential roles of Stevia rebaudiana Bertoni in abrogating insulin resistance and diabetes: A review” by N. H. M.-Radzman et al. highlights the mechanisms involving free fatty acids, adipocytokines such as TNFα and PPARγ and serine kinases like JNK and IKKβ, asserted to be responsible for the development of insulin resistance. The review article “Use of laser-induced breakdown spectroscopy for the detection of glycemic elements in Indian medicinal plants” by P. K. Rai et al. describes how a unique combination of physics, chemistry, and biological techniques can be exploited to evaluate antidiabetic Indian medicinal plants. They show laser-induced breakdown spectroscopy (LIBS) as a sensitive optical technique being widely used for the detection of glycemic elements from medicinal plants. G. Sartore et al. in the article “Mediterranean diet and red yeast rice supplementation for the management of hyperlipidemia in statin-intolerant patients with or without type 2 diabetes” found that the lipid profile can be modified by consuming Mediterranean diet (MD) and red yeast rice (RYR). They indicate that MD counseling alone is effective in reducing low density lipoprotein (LDL) cholesterol levels in moderately hypercholesterolemic statin-intolerant patients with a presumably low cardiovascular risk, and combining MD with the administration of RYR improves patients with LDL cholesterol levels considerably more than when the patient is on MD only. In a quest to cure many serious diseases using more cost-effective and safer drugs, there has been a paradigm shift in drug discovery that involves using plant-based molecules. More effort, however, is required to explore newer and more promising herbal ingredients that qualify absorption, distribution, metabolism, and excretion (ADME) criteria with a relatively larger therapeutic index. Geeta Watal Preeti Dhar Sharad Kr. Srivastava Bechan Sharma