‘Glycaemic memory’ after acute and critical illnesses

Project code:  MHS007

Department

  • Surgery

Location

Auckland

Supervisor

Dr Max Petrov

'Glycaemic memory' is durable effect of prior hyperglycaemia on the development and progression of diabetes mellitus. In the past few decades, development of new onset diabetes despite reversal of in-hospital hyperglycaemia has been consistently observed in acute and critically ill patients. However, to date, the overall incidence of newly developed diabetes after an episode of acute hyperglycaemia is unknown. The aim of this project is to summarize available literature on the topic, conduct a meta-analysis of clinical studies to determine the incidence of this condition as well as its risk factors. The project is part of a larger research theme of the COSMOS (Clinical and epidemiOlogical inveStigations in Metabolism, nutritiOn, and pancreatitic diseaseS) group. The group offers a vibrant research environment, comprehensive research training, and clinical research experience, including involvement in a prospective cohort study of ‘glycaemic memory’ after acute pancreatitis.

Additional information:
Kennedy JI, Askelund KJ, Premkumar R, Phillips AR, Murphy R, Windsor JA, Petrov MS. Leptin is associated with persistence of hyperglycemia in acute pancreatitis: A prospective clinical study. Medicine 2016; 95:e2382.
Das SL, Singh PP, Phillips AR, Murphy R, Windsor JA, Petrov MS. Newly diagnosed diabetes mellitus after acute pancreatitis: A systematic review and meta-analysis. Gut 2014;63:818-831.

Skills

  • Working in a clinical research team environment
  • Management of a prospective clinical study
  • Systematic literature review
  • Statistical analysis of data (meta-analysis)
  • Preparation and submission of a peer-reviewed manuscript for publication

Pancreas volume and metabolic outcomes

Project code:  MHS008

Department

  • Surgery

Location

Auckland

Supervisor

Dr Max Petrov

The prevalence of obesity is increasing each decade. The current prevalence of obesity world-wide is 25% and it is associated with several serious diseases - metabolic syndrome, cardiovascular disease, and cancer - which makes obesity a major public health issue. Moreover, obesity is associated with altered volume of parenchymatous organs, such as  pancreas. The aim of this project is to summarize, for the first time, available literature on the topic by conducting a systematic review of animal and clinical studies. The project is part of a larger research theme of the COSMOS (Clinical and epidemiOlogical inveStigations in Metabolism, nutritiOn, and pancreatitic diseaseS) group. The group offers a vibrant research environment, comprehensive research training, and clinical research experience, including involvement in a case-control study of MRI after diseases of the exocrine pancreas.

Skills

  • Working in a clinical research team environment
  • Management of a case-control clinical study
  • Systematic literature review
  • Preparation of a manuscript for publication in international peer-reviewed journal

Outcome of Unicompartmental Knee Arthroplasty - Does Surgeon Volume Matter?

Project code:  MHS156

Department

  • Surgery

Location

Auckland

Supervisor

Simon W Young

This study aims to investigate the outcome of unicompartmental joint replacement using New Zealand national joint registry data. The student will be involved in:

1) Literature review

2) Data analysis

3) Presentation of results at national and/or international meeting

4) Manuscript preparation and publication

The key goal of the studentship is co-authorship on one or more publications. Previous students have all been successful in this regard. As the data for this project is already gathered, a desire and or ability to analyse and undertake scientific writing is essential. 

 

Study outline:

Introduction

The reported revision rates for unicompartmental knee arthroplasties (UKA) have varied widely. The effect of implant, patient, and surgeon factors on revision risk is unclear.  In particular, higher volume surgeons are postulated to have improved outcomes, but this has not been well studied. The aim of this study is to determine the impact of these variables on the risk for aseptic revision arthroplasty in unicompartmental knee replacement.

Methods

We will analyse 8,311 primary UKA procedures performed between 2000-2014 from the New Zealand National Joint Registry performed for a diagnosis of osteoarthritis. Functional outcomes are recorded using oxford knee score questionnaires sent at 6 months and 5 years post operatively. Surgical volume will be defined in three ways: 1)Number of cases performed per year (<12 or>12), 2) Surgeon ratio of UKA to total knee replacement (5%, 10%, 20%, >40%) 3) Surgeon experience (first 20 cases versus subsequent cases). The effect of surgical volume on functional outcome and revision rates will be analysed using a multivariate model adjusted for implant factors (fixed versus mobile bearing, cemented versus uncemented), patient factors (age, sex, comorbidities, previous surgery, ) and hospital factors (public versus private, theatre ventilation). Findings will be compared to data on TKA performed for the same diagnosis.

Skills

  • Literature review
  • Critical appraisal
  • Statistical analysis
  • Medical writing/preparation of publication

Development of Alignment in Adolescence – Constituational Varus and the Implications for Total Knee Replacement

Project code:  MHS161

Department

  • Surgery

Location

Auckland

Supervisor

Simon W Young

Introduction

Restoration of neutral mechanical alignment is considered a cornerstone for successful and durable knee arthroplasty. The reason for this general belief is that neutral mechanical alignment is considered by most surgeons as the normal healthy situation, which leads to symmetric mediolateral joint loading, and that therefore neutral mechanical restoration should be attempted to provide a durable and successful arthroplasty.

Whether this is correct has recently been questioned, however. A percentage of the normal population does not have neutral alignment at the end of skeletal growth but rather some degree of varus. Limited data suggests such varus alignment may be associated with sports participation as an adolescent, with the hypothesis being that physical activity causes more compression on the inside of the knee; and while growth plates are open this causes asymmetric growth and development of varus limb alignment. This varus has also been associated with a higher risk of later development of osteoarthritis, which may require total knee replacement (TKA).

TKA normally aims to position components in a neutral mechanical axis. However restoring the alignment to neutral at a later stage in the life of such varus patients may in fact be abnormal and unnatural for them, as it would implicate an overcorrection toward their natural situation in which they had spent their life since skeletal maturity. This may be a factor in the 20% patient dissatisfaction rate following TKA.

In this study we seek to answer the following questions:

  1. Does constitutional varus really exist in the normal population and, if so, in what percentage of healthy individuals does it occur?
  2. How does this alignment develop through adolescence?
  3. Is varus alignment associated with sports participation in adolescence?

Methods

This study will be a collaboration with the Growing Up in New Zealand study. From age 10, a total of 400 subjects will be examined at 3 yearly intervals until age 19. At each examination, questionnaires regarding general health and physical activity will be completed, and basic parameters including height and weight measured. Patients will then undergo full body low-dose radiographs using an EOS machine

These images allow full assessment of lower limb alignment, and how this develops though each subjects growth will be monitored, and any association with parameters such as BMI or sports participation identified. Multiple analyses will be possible for other clinical conditions including scoliosis and hip morphology and impingment.

Summer Students Role

In collaboration with the Growing up in NZ Study team, the summer student will be involved in a literature review, protocol development, ethical approval and funding grants.

A key goal of the studentship is co-authorship on one or more publications. Previous summer students have all been successful in this regard. As this is a long term project, publication of results is unlikely to occur during the studentship period. Therefore collaboration on other projects during the studentship is expected, to ensure this goal is achieved. 

Skills

  • Literature review
  • Critical appraisal
  • Protocol Development
  • Funding Applications
  • Statistical analysis
  • Medical writing/preparation of publication

Physical Simulations for Training in Robotic Surgery

Project code:  MHS031

Department

  • Surgery

Location

Auckland

The University of Auckland Bioengineering Institute has been gifted a Da Vinci Surgical Robot after it was decomissioned from a local private hospital. This gift could provide an opportunity for surgical students and trainees to gain basic experience and skills in robotic surgery, including use of controls, tissue handling, and suturing, before beginning to use robotic surgery in patients. In order to make use of this opportunity, validated physical simulations are required for use in effective training exercises.

The aim of this studentship will be to:
1. Conduct a review of physical (i.e. real and not ‘virtual’ or software-based) simulation systems and ‘games’ currently in use for training in minimally-invasive and robotic surgery.
2. Develop low-cost physical simulations for training in robotic surgery, e.g. for learning handling, grasping, stacking, suturing skills.
3. Validate the educational utility of the developed simulations with the help of medical student and surgical trainee volunteers.
 

Skills

This is a surgical / clinical education project, teaching simulation development, skills training and educational validation.  The use of surgical simulators is a rapidly developing field, and the studentship offers the chance to experience this area of research.  The project would suit students with a strong practical aptitude, and an interest in surgery, education, and bioengineering.