Academic anaesthesiology: a global perspective on training, support, and future development of early career researchers

As anaesthesiologists face increasing clinical demands and a limited and competitive funding environment for academic work, the sustainability of academic anaesthesiologists has never been more tenuous. Yet, the speciality needs academic anaesthesiologists in many roles, extending beyond routine clinical duties. Anaesthesiologist educators, researchers, and administrators are required not only to train future generations but also to lead innovation and expansion of anaesthesiology and related specialities, all to improve patient care. This group of early career researchers with geographically distinct training and practice backgrounds aim to highlight the diversity in clinical and academic training and career development pathways for anaesthesiologists globally. Although multiple routes to success exist, one common thread is the need for consistent support of strong mentors and sponsors. Moreover, to address inequitable opportunities, we emphasise the need for diversity and inclusivity through global collaboration and exchange that aims to improve access to research training and participation. We are optimistic that by focusing on these fundamental principles, we can help build a more resilient and sustainable future for academic anaesthesiologists around the world

Blood Transfusions in Total Hip and Knee Arthroplasty: An Analysis of Outcomes

Background. Various studies have raised concern of worse outcomes in patients receiving blood transfusions perioperatively compared to those who do not. In this study we attempted to determine the proportion of perioperative complications in the orthopedic population attributable to the use of a blood transfusion. Methods. Data from 400 hospitals in the United States were used to identify patients undergoing total hip or knee arthroplasty (THA and TKA) from 2006 to 2010. Patient and health care demographics, as well as comorbidities and perioperative outcomes were compared. Multivariable logistic regression models were fitted to determine associations between transfusion, age, and comorbidities and various perioperative outcomes. Population attributable fraction (PAF) was determined to measure the proportion of outcome attributable to transfusion and other risk factors. Results. Of 530,089 patients, 18.93% received a blood transfusion during their hospitalization. Patients requiring blood transfusion were significantly older and showed a higher comorbidity burden. In addition, these patients had significantly higher rates of major complications and a longer length of hospitalization. The logistic regression models showed that transfused patients were more likely to have adverse health outcomes than nontransfused patients. However, patients who were older or had preexisting diseases carried a higher risk than use of a transfusion for these outcomes. The need for a blood transfusion explained 9.51% (95% CI 9.12–9.90) of all major complications. Conclusions. Advanced age and high comorbidity may be responsible for a higher proportion of adverse outcomes in THA and TKA patients than blood transfusions

Global patient outcomes after elective surgery: prospective cohort study in 27 low-, middle- and high-income countries.

BACKGROUND: As global initiatives increase patient access to surgical treatments, there remains a need to understand the adverse effects of surgery and define appropriate levels of perioperative care. METHODS: We designed a prospective international 7-day cohort study of outcomes following elective adult inpatient surgery in 27 countries. The primary outcome was in-hospital complications. Secondary outcomes were death following a complication (failure to rescue) and death in hospital. Process measures were admission to critical care immediately after surgery or to treat a complication and duration of hospital stay. A single definition of critical care was used for all countries. RESULTS: A total of 474 hospitals in 19 high-, 7 middle- and 1 low-income country were included in the primary analysis. Data included 44 814 patients with a median hospital stay of 4 (range 2-7) days. A total of 7508 patients (16.8%) developed one or more postoperative complication and 207 died (0.5%). The overall mortality among patients who developed complications was 2.8%. Mortality following complications ranged from 2.4% for pulmonary embolism to 43.9% for cardiac arrest. A total of 4360 (9.7%) patients were admitted to a critical care unit as routine immediately after surgery, of whom 2198 (50.4%) developed a complication, with 105 (2.4%) deaths. A total of 1233 patients (16.4%) were admitted to a critical care unit to treat complications, with 119 (9.7%) deaths. Despite lower baseline risk, outcomes were similar in low- and middle-income compared with high-income countries. CONCLUSIONS: Poor patient outcomes are common after inpatient surgery. Global initiatives to increase access to surgical treatments should also address the need for safe perioperative care. STUDY REGISTRATION: ISRCTN5181700

Knochenstruktur bei Adipositas : Auswirkung von körperlicher Aktivität auf Lendenwirbelkörper und Schulterblatt

Hintergrund Aktuellen Studien zufolge besteht eine Verbindung zwischen dem Knochenstoffwechsel und Fettgewebe. Hormone des Fettgewebes wirken sowohl direkt über Rezeptoren an Osteoblas-ten und Osteoklasten, als auch indirekt über die Aktivität des Enzyms „Aromatase“ im Fett-gewebe. Ebenso zeigte sich bei diversen Sportarten unterschiedliche Auswirkungen auf die Knochenstruktur. Folglich stellt sich nun die Frage, welche Auswirkung körperliche Aktivi-tät bei adipösen Sprague-Dawley-Ratten auf die Knochenstruktur hat. Methodik Untersucht wurden 32 männliche Sprague-Dawley-Ratten. Zunächst wurden die Ratten, bis zum Erreichen eines adipösen Körpergewichts hyperkalorisch ernährt. Anschließend wurden die Ratten in eine körperlich ruhende Gruppe (n=16) eingeteilt und in den Folgewochen hy-pokalorisch und danach normokalorisch ernährt. Die zweite Gruppe (n=16) bekam ebenfalls zunächst eine hypokalorische und danach eine normokalorische Diät und musste sich zusätz-lich, in Form eines Laufbandtrainings körperlich betätigen. Mittels CT (ScanCo CT35) wurden Aufnahmen zur Beurteilung der Knochenstruktur erstellt. Dabei wurden jeweils der vierte Corpus vertebrae für den trabekulären und die Scapulae für den kortikalen Knochen untersucht. Als primärer Parameter für den trabekulären Knochen ist der Knochenvolumsan-teil (BV/TV) und für den kortikalen Knochen die mittlere Dichte des Knochenvolumens (Mean Dens. BV) definiert. Resultate Die Untersuchungen zeigten beim trabekulären Knochen für das BV/TV zwischen den Grup-pen keine signifikanten Unterschiede. Ebenso zeigten sich keine signifikanten Unterschiede bei dem Mean Dens. BV der Gruppen beim kortikalen Knochen. Auch die sekundären Para-meter weisen keine signifikanten Unterschiede auf. Conclusio Die Ergebnisse zeigen keine signifikanten Auswirkungen der Gewichtsreduktion auf die Knochenstruktur. Im Gegensatz zu Studien über Anorexia Nervosa oder bariatrische Eingriff kommt es bei der Gewichtsabnahme durch Bewegung zu keiner wesentlichen Veränderung der Knochenstruktur.Background According to the literature there is a link between bone metabolism and adipose tissue. Hormones of the adipose tissue act both directly via receptors on osteoblasts and osteoclasts, as well as indirectly via the activity of the aromatase in adipose tissue. Various types of sports have shown different effects on bone structure. However, the effect of physical activi-ty on bone structure of adipose Sprague-Dawley rats is unclear. Methods 32 male Sprague-Dawley rats were studied. At first the rats were fed a hypercaloric diet un-til they reached obesity. Then the rats were subdivided in one group without exercise (n=16) fed a hypocaloric and later a normocaloric diet. The second group (n=16), which was also fed a hypocaloric and then a normocaloric diet, in addition exercised in form of treadmill training. With the use of a microCT (ScanCo CT35) images of the bone structure are made and evaluated. The focus was on changes in the cortical and trabecular bone area. Region of interests were the fourth corpus vertebrae and the scapula. As the primary parameter of tra-becular bone the bone volume fraction (BV/TV) was defined; the mean density of the bone volume (Mean Dens. BV) was the primary parameter for the cortical bone. Results The analyses of two groups showed no significant differences for the bone volume fraction of the trabecular bone. There were also no significant differences between the groups with regard to the mean density of the bone volume in the cortical bone. Moreover, no significant differences of the secondary parameters were seen. Conclusion The results show no significant effect of weight reduction on bone structure. In comparison with anorexia nervosa or bariatric interventions, weight loss through exercise does not alter bone structure.eingereicht von Maximilian StundnerMedizinische Universität Wien, Diplomarb., 201

Females prefer the scent of outbred males: good-genes-as-heterozygosity?

<p>Abstract</p> <p>Background</p> <p>There is increasing interest to determine the relative importance of non-additive genetic benefits as opposed to additive ones for the evolution of mating preferences and maintenance of genetic variation in sexual ornaments. The 'good-genes-as-heterozygosity' hypothesis predicts that females should prefer to mate with more heterozygous males to gain more heterozygous (and less inbred) offspring. Heterozygosity increases males' sexual ornamentation, mating success and reproduction success, yet few experiments have tested whether females are preferentially attracted to heterozygous males, and none have tested whether females' own heterozygosity influences their preferences. Outbred females might have the luxury of being more choosey, but on the other hand, inbred females might have more to gain by mating with heterozygous males. We manipulated heterozygosity in wild-derived house mice (<it>Mus musculus musculus</it>) through inbreeding and tested whether the females are more attracted to the scent of outbred versus inbred males, and whether females' own inbreeding status affects their preferences. We also tested whether infecting <it>both </it>inbred and outbred males with <it>Salmonella </it>would magnify females' preferences for outbred males.</p> <p>Results</p> <p>Females showed a significant preference for outbred males, and this preference was more pronounced among inbred females. We found no evidence that <it>Salmonella </it>infection increased the relative attractiveness of outbred versus inbred males; however, we found no evidence that inbreeding affected males' disease resistance in this study.</p> <p>Conclusion</p> <p>Our findings support the idea that females are more attracted to outbred males, and they suggest that such preferences may be stronger among inbred than outbred females, which is consistent with the 'good-genes-as-heterozygosity' hypothesis. It is unclear whether this odour preference reflects females' actual mating preferences, though it suggests that future studies should consider females' as well as males' heterozygosity. Our study has implications for efforts to understand how mate choice can provide genetic benefits without eroding genetic diversity (lek paradox), and also conservation efforts to determine the fitness consequences of inbreeding and the maintenance of genetic diversity in small, inbred populations.</p