Transplant Surgery Pipeline: A Report from the American Society of Transplant Surgeons Pipeline Taskforce

BACKGROUND: Transplant surgery fellowship has evolved over the years and today there are 66 accredited training programs in the US and Canada. There is growing concern, however, about the number of US-trained general surgery residents pursuing transplant surgery. In this study, we examined the transplant surgery pipeline, comparing it with other surgical subspecialty fellowships, and characterized the resident transplantation experience. METHODS: Datasets were compiled and analyzed from surgical fellowship match data obtained from the National Resident Matching Program and ACGME reports and relative fellowship competitiveness was assessed. The surgical resident training experience in transplantation was evaluated. RESULTS: From 2006 to 2018, a total of 1,094 applicants have applied for 946 transplant surgery fellowship positions; 299 (27.3%) were US graduates. During this period, there was a 0.8% decrease per year in US-trained surgical residents matching into transplant surgery (p = 0.042). In addition, transplant surgery was one of the least competitive fellowships compared with other National Resident Matching Program surgical subspeciality fellowships, as measured by the number of US applicants per available fellowship position, average number of fellowship programs listed on each applicant\u27s rank list, and proportion of unfilled fellowship positions (each, p \u3c 0.05). Finally, from 2015 to 2017, there were 57 general surgery residency programs that produced 77 transplant surgery fellows, but nearly one-half of the fellows (n = 36 [46.8%]) came from 16 (28.1%) programs. CONCLUSIONS: Transplant surgery is one of the least competitive and sought after surgical fellowships for US-trained residents. These findings highlight the need for dedicated efforts to increase exposure, mentorship, and interest in transplantation to recruit strong US graduates

Cost effectiveness after a pancreaticoduodenectomy: bolstering the volume argument

AbstractBackgroundThe cost implication of variability in pancreatic surgery is not well described. It was hypothesized that for a pancreaticoduodenectomy (PD), lower volume centres demonstrate worse peri-operative outcomes at higher costs.MethodsFrom 2009–2011, 9883 patients undergoing a PD were identified from the University HealthSystems Consortium (UHC) database and stratified into quintiles by annual hospital case volume. A decision analytic model was constructed to assess cost effectiveness. Total direct cost data were based on Medicare cost/charge ratios and included readmission costs when applicable.ResultsThe lowest volume centres demonstrated a higher peri-operative mortality rate (3.5% versus 1.3%, P < 0.001) compared with the highest volume centres. When both index and readmission costs were considered, the per-patient total direct cost at the lowest volume centres was $23 005, or 10.9$2263 per case) more than at the highest volume centres. One-way sensitivity analyses adjusting for peri-operative mortality (1.3% at all centres) did not materially change the cost effectiveness analysis. Differences in cost were largely recognized in the index admission; readmission costs were similar across quintiles.ConclusionsFor PD, low volume centres have higher peri-operative mortality rates and 10.9% higher cost per patient. Performance of PD at higher volume centres can lead to both better outcomes and substantial cost savings

MRI characterization of 124 CT-indeterminate focal hepatic lesions: evaluation of clinical utility

Objective. To evaluate the diagnostic yield of MRI performed for characterization of focal hepatic lesions that are interpreted as indeterminate on CT. Patients and methods. In a retrospective investigation, 124 indeterminate focal hepatic lesions in 96 patients were identified on CT examinations over 5 years from 1997 to 2001. All patients had MRI performed for the liver within 6 weeks of their CT examination. CT and MR images were reviewed independently by two separate groups of two radiologists. The value of MRI in characterizing these lesions was assessed. Diagnoses were confirmed based on histology, characteristic imaging features, and clinical follow-up . Results. MRI definitely characterized 73 lesions (58%) that were indeterminate on CT. MRI was accurate in 72/73 of these lesions. MRI could not definitely characterize 51 lesions (42%). Ten lesions were not visualized on MRI, and follow-up imaging confirmed that no lesion was present in eight of these cases (pseudolesions). Conclusion. MRI is valuable for the characterization of indeterminate focal hepatic lesions detected on CT.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/75168/1/13651820701216950.pd

Solution-Based Structural Analysis of the Decaheme Cytochrome, MtrA, by Small-Angle X-ray Scattering and Analytical Ultracentrifugation

The potential exploitation of metal-reducing bacteria as a means for environmental cleanup or alternative fuel is an exciting prospect; however, the cellular processes that would allow for these applications need to be better understood. MtrA is a periplasmic decaheme c-type cytochrome from Shewanella oneidensis involved in the reduction of extracellular iron oxides and therefore is a critical element in Shewanella ability to engage in extracellular charge transfer. As a relatively small 333-residue protein, the heme content is surprisingly high. MtrA is believed to obtain electrons from the inner membrane-bound quinol oxidoreductase, CymA, and shuttle them across the outer membrane to MtrC, another decaheme cytochrome that directly interacts with insoluble metal oxides. How MtrA is able to perform this task is a question of interest. Here through the use of two solution-based techniques, small-angle X-ray scattering (SAXS) and analytical ultracentrifugation (AUC), we present the first structural analysis of MtrA. Our results establish that between 0.5 and 4 mg/mL, MtrA exists as a monomeric protein that is shaped like an extended molecular “wire” with a maximum protein dimension (D[subscript max]) of 104 Å and a rod-like aspect ratio of 2.2 to 2.5. This study contributes to a greater understanding of how MtrA fulfills its role in the redox processes that must occur before electrons reach the outside of the cell.National Science Foundation (U.S.). (0546323)National Institutes of Health (U.S.) (Grant Number F32GM904862)Howard Hughes Medical Institute. InvestigatorNational Science Foundation (U.S.) (Award DMR- 0936384

Disparities in the Operative Experience Between Female and Male General Surgery Residents: A Multi-institutional Study From the US ROPE Consortium

OBJECTIVE: To examine differences in resident operative experience between male and female general surgery residents. BACKGROUND: Despite increasing female representation in surgery, sex and gender disparities in residency experience continue to exist. The operative volume of male and female general surgery residents has not been compared on a multi-institutional level. METHODS: Demographic characteristics and case logs were obtained for categorical general surgery graduates between 2010 and 2020 from the US Resident OPerative Experience Consortium database. Univariable, multivariable, and linear regression analyses were performed to compare differences in operative experience between male and female residents. RESULTS: There were 1343 graduates from 20 Accreditation Council for Graduate Medical Education-accredited programs, and 476 (35%) were females. There were no differences in age, race/ethnicity, or proportion pursuing fellowship between groups. Female graduates were less likely to be high-volume residents (27% vs 36%, P \u3c 0.01). On univariable analysis, female graduates performed fewer total cases than male graduates (1140 vs 1177, P \u3c 0.01), largely due to a diminished surgeon junior experience (829 vs 863, P \u3c 0.01). On adjusted multivariable analysis, female sex was negatively associated with being a high-volume resident (OR = 0.74, 95% CI: 0.56 to 0.98, P = 0.03). Over the 11-year study period, the annual total number of cases increased significantly for both groups, but female graduates (+16 cases/year) outpaced male graduates (+13 cases/year, P = 0.02). CONCLUSIONS: Female general surgery graduates performed significantly fewer cases than male graduates. Reassuringly, this gap in operative experience may be narrowing. Further interventions are warranted to promote equitable training opportunities that support and engage female residents

Evidence for the adaptation of protein pH-dependence to subcellular pH

<p>Abstract</p> <p>Background</p> <p>The availability of genome sequences, and inferred protein coding genes, has led to several proteome-wide studies of isoelectric points. Generally, isoelectric points are distributed following variations on a biomodal theme that originates from the predominant acid and base amino acid sidechain pKas. The relative populations of the peaks in such distributions may correlate with environment, either for a whole organism or for subcellular compartments. There is also a tendency for isoelectric points averaged over a subcellular location to not coincide with the local pH, which could be related to solubility. We now calculate the correlation of other pH-dependent properties, calculated from 3D structure, with subcellular pH.</p> <p>Results</p> <p>For proteins with known structure and subcellular annotation, the predicted pH at which a protein is most stable, averaged over a location, gives a significantly better correlation with subcellular pH than does isoelectric point. This observation relates to the cumulative properties of proteins, since maximal stability for individual proteins follows the bimodal isoelectric point distribution. Histidine residue location underlies the correlation, a conclusion that is tested against a background of proteins randomised with respect to this feature, and for which the observed correlation drops substantially.</p> <p>Conclusion</p> <p>There exists a constraint on protein pH-dependence, in relation to the local pH, that is manifested in the pKa distribution of histidine sub-proteomes. This is discussed in terms of protein stability, pH homeostasis, and fluctuations in proton concentration.</p

Acceptance tests of Hamamatsu R7081 photomultiplier tubes

Photomultiplier tubes (PMTs) are traditionally an integral part of large underground experiments as they measure the light emission from particle interactions within the enclosed detection media. The BUTTON experiment will utilise around 100 PMTs to measure the response of different media suitable for rare event searches. A subset of low-radioactivity 10-inch Hamamatsu R7081 PMTs were tested, characterised, and compared to manufacture certification. This manuscript describes the laboratory tests and analysis of gain, peak-to-valley ratio and dark rate of the PMTs to give an understanding of the charge response, signal-to-noise ratio and dark noise background as an acceptance test of the suitability of these PMTs for water-based detectors. Following the evaluation of these tests, the PMT performance agreed with the manufacturer specifications. These results are imperative for modeling the PMT response in detector simulations and providing confidence in the performance of the devices once installed in the detector underground

Acceptance tests of Hamamatsu R7081 photomultiplier tubes

Photomultiplier tubes (PMTs) are traditionally an integral part of large underground experiments as they measure the light emission from particle interactions within the enclosed detection media. The BUTTON experiment will utilise around 100 PMTs to measure the response of different media suitable for rare event searches. A subset of low-radioactivity 10-inch Hamamatsu R7081 PMTs were tested, characterised, and compared to manufacture certification. This manuscript describes the laboratory tests and analysis of gain, peak-to-valley ratio and dark rate of the PMTs to give an understanding of the charge response, signal-to-noise ratio and dark noise background as an acceptance test of the suitability of these PMTs for water-based detectors. Following the evaluation of these tests, the PMT performance agreed with the manufacturer specifications. These results are imperative for modeling the PMT response in detector simulations and providing confidence in the performance of the devices once installed in the detector underground