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

In vitro transdifferentiation of umbilical cord stem cells into cardiac myocytes: Role of growth factors

Recently, stem cell based cell therapy has become a realistic option to replace damaged cardiomyocytes. Most studies on stem cell transplantation therapy have focused on the use of undifferentiated stem cells. There is a strong possibility that some cardiogenic differentiation of the stem cell in vitro prior to transplantation would result in higher engraftment efficiency, as well as enhanced myocardial regeneration and recovery of heart function. In this study we aimed to define the conditions for ex-vivo differentiation of cord blood stem cells to cardiomyocytes and endothelial cells. These conditions include the combination of vascular endothelial growth factor (VEGF); basic fibroblast growth factor (FGF-2) and platelet derived growth factor AB (PDGF-AB). Forty cord blood samples were included in this work. In this work, the percentage of CD34+ cells, CD31+ cells and CD34/31+ cells in mononuclear cells (MNC) suspension was counted prior to culture (day zero), and day 10 in the different growth factor cocktails used as well as the control tube, from which the fold increase of CD34+ cells, CD31+ cells and CD34/31+ cells was calculated. Detection of cardiac troponin I in the cultured cells to confirm cardiac differentiation was done at day 10 using Mouse anti-troponin I monoclonal antibody. From the present study, it was concluded that the growth factor cocktail in protocol 2 (FGF2+VEGF+PDGF-AB) gives better in vitro trans-differentiation of stem/progenitor cells in umbilical cord blood into cardiomyocytes and endothelial cells than the cytokines cocktail in protocol 1 (FGF2+VEGF) alone