Burnout among surgeons before and during the SARS-CoV-2 pandemic: an international survey

Background: SARS-CoV-2 pandemic has had many significant impacts within the surgical realm, and surgeons have been obligated to reconsider almost every aspect of daily clinical practice. Methods: This is a cross-sectional study reported in compliance with the CHERRIES guidelines and conducted through an online platform from June 14th to July 15th, 2020. The primary outcome was the burden of burnout during the pandemic indicated by the validated Shirom-Melamed Burnout Measure. Results: Nine hundred fifty-four surgeons completed the survey. The median length of practice was 10 years; 78.2% included were male with a median age of 37 years old, 39.5% were consultants, 68.9% were general surgeons, and 55.7% were affiliated with an academic institution. Overall, there was a significant increase in the mean burnout score during the pandemic; longer years of practice and older age were significantly associated with less burnout. There were significant reductions in the median number of outpatient visits, operated cases, on-call hours, emergency visits, and research work, so, 48.2% of respondents felt that the training resources were insufficient. The majority (81.3%) of respondents reported that their hospitals were included in the management of COVID-19, 66.5% felt their roles had been minimized; 41% were asked to assist in non-surgical medical practices, and 37.6% of respondents were included in COVID-19 management. Conclusions: There was a significant burnout among trainees. Almost all aspects of clinical and research activities were affected with a significant reduction in the volume of research, outpatient clinic visits, surgical procedures, on-call hours, and emergency cases hindering the training. Trial registration: The study was registered on clicaltrials.gov "NCT04433286" on 16/06/2020

A Fresh Look at AGB Stars in Galactic Open Clusters with Gaia: Impact on Stellar Models and the Initial-Final Mass Relation

Benefiting from the Gala second and early third releases of photometric and astrometric data, we examine the population of asymptotic giant branch (AGB) stars that appear in the fields of intermediate-age and young open star clusters. We identify 49 AGB star candidates, brighter than the tip of the red giant branch, with a good to high cluster membership probability. Among them, we find 19 TP-AGB stars with known spectral type: 4 M stars, 3 MS/S stars, and 12 C stars. By combining observations, stellar models, and radiative transfer calculations that include the effect of circumstellar dust, we characterize each star in terms of initial mass, luminosity, mass-loss rate, core mass, period, and mode of pulsation. The information collected helps us shed light on the TP-AGB evolution at solar-like metallicity, placing constraints on the third dredge-up process, the initial masses of carbon stars, stellar winds, and the initial-final mass relation (IFMR). In particular, we find that two bright carbon stars, MSB 75 and BM IV 90, members of the clusters NGC 7789 and NGC 2660 (with similar ages of similar or equal to 1.2-1.6 Gyr and initial masses 2.1 greater than or similar to M-i/M-circle dot greater than or similar to 1.9), have unusually high core masses, M-c approximate to 0.67-0.7 M-circle dot. These results support the findings of a recent work (Mango et al. 2020) that identified a kink in the IFMR, which interrupts its monotonic trend just at the same initial masses. Finally, we investigate two competing scenarios to explain the M-c data: the role of stellar winds in single-star evolution, and binary interactions through the blue straggler channel

Unrelated donor stem cell transplantation in adult patients with thalassemia

Allogeneic SCT remains the only potential cure for patients with thalassemia. However, most BMT candidates lack a suitable family donor and require an unrelated donor (UD). We evaluated whether BMT using UDs in high-risk adult thalassemia patients can offer a probability of cure comparable to that reported employing an HLA-compatible sibling as donor. A total of 27 adult thalassemia patients (15 males and 12 females, median age 22 years) underwent BMT from a UD selected by high-resolution HLA molecular typing. The conditioning regimen consisted of Busulphan (BU, 14 mg/kg) plus Cyclophosphamide (CY, 120 or 160 mg/kg) in 12 cases and BU (14 mg/kg), Thiotepa (10 mg/kg) and CY (120-160 mg/ kg) in the remaining 15 cases. Cyclosporine-A and short-term Methotrexate were used for graft-versus-host disease (GVHD) prophylaxis. In all, 19 patients (70%) are alive and transfusion-independent after a median follow-up of 43 months (range 16-137). A total of 10 patients (37%) developed grade II-IV acute GVHD and six (27%) chronic GVHD. Eight patients (30%) died from transplant-related causes. UD-BMT can cure more than two-thirds of adult thalassemia patients, and is a particularly attractive option for patients who are not compliant with conventional treatment