Introductory Video as a Supplemental Application for General Surgery Residency Candidates: Concept, Implementation, Preliminary Outcomes, and Future Directions.

OBJECTIVE: The residency selection process has changed dramatically over the past several years, primarily due to the COVID-19 pandemic causing a transition to virtual interviews and limiting sub-internship opportunities. Another new major change is the transition of the USMLE Step 1 examination from a numerical score to pass/fail as of January 2022. In anticipation of this major change, our program asked applicants to submit a short video clip expressing their interest. PARTICIPANTS: Review of each of the videos was completed by three members of the admission committee and each reviewer was required to complete formal implicit bias training prior to reviewing the videos. RESULTS: Over 1200 general surgery residency applications were received via the Electronic Residency Application Service (ERAS) for the 2022-2023 application cycle. 286 applicants were selected for a formal interview invitation and asked to submit a 2-minute introductory video. In response, 222 (77.62%) of the 286 cohort submitted introductory videos. 210 of these videos (94.59%) were submitted within the first week. The average length of the videos submitted was 105.10 seconds. CONCLUSION: Using optional introductory videos as a supplemental application has helped to narrow the applicant pool and identify individuals to offer interviews.

HAA by the first {Mn(iii)OH} complex with all O-donor ligands.

There is considerable interest in MnOHx moieties, particularly in the stepwise changes in those O-H bonds in tandem with Mn oxidation state changes. The reactivity of aquo-derived ligands, {MOHx}, is also heavily influenced by the electronic character of the other ligands. Despite the prevalence of oxygen coordination in biological systems, preparation of mononuclear Mn complexes of this type with all O-donors is rare. Herein, we report several Mn complexes with perfluoropinacolate (pinF)2- including the first example of a crystallographically characterized mononuclear {Mn(iii)OH} with all O-donors, K2[Mn(OH)(pinF)2], 3. Complex 3 is prepared via deprotonation of K[Mn(OH2)(pinF)2], 1, the pKa of which is estimated to be 18.3 ± 0.3. Cyclic voltammetry reveals quasi-reversible redox behavior for both 1 and 3 with an unusually large ΔEp, assigned to the Mn(iii/ii) couple. Using the Bordwell method, the bond dissociation free energy (BDFE) of the O-H bond in {Mn(ii)-OH2} is estimated to be 67-70 kcal mol-1. Complex 3 abstracts H-atoms from 1,2-diphenylhydrazine, 2,4,6-TTBP, and TEMPOH, the latter of which supports a PCET mechanism. Under basic conditions in air, the synthesis of 1 results in K2[Mn(OAc)(pinF)2], 2, proposed to result from the oxidation of Et2O to EtOAc by a reactive Mn species, followed by ester hydrolysis. Complex 3 alone does not react with Et2O, but addition of O2 at low temperature effects the formation of a new chromophore proposed to be a Mn(iv) species. The related complexes K(18C6)[Mn(iii)(pinF)2], 4, and (Me4N)2[Mn(ii)(pinF)2], 5, have also been prepared and their properties discussed in relation to complexes 1-3.

Treatment of Severe Hypertriglyceridemia With Insulin Infusions in Severe COVID-19: A Case Series.

PURPOSE: Rapid onset of severe hypertriglyceridemia was quickly recognized in critical COVID-19 patients. Associated causes have been due to secondary hemophagocytic lymphohystiocytosis (HLH) syndrome, medication-induced, or acute liver failure. Statins, omega-3 polyunsaturated acids, niacin, and fibrates are common oral lipid lowering therapy options in patients at risk for hypertriglyceridemia. The severity of hypertriglyceridemia in COVID-19 patients with triglyceride values reaching greater than 1,000 mg/dL put them at a heightened risk of pancreatitis and therefore an essential need to acutely lower their levels. We present a case series of 5 patients who achieved rapid triglyceride lowering through continuous insulin infusion therapy. METHODS: A retrospective chart review of 48 critical COVID-19 patients who were admitted from March 22 to April 15, 2020 was conducted. Inclusion criteria consisted of mechanical ventilation and continuous insulin infusion to treat severe hypertriglyceridemia resulting with 5 eligible patients in this case report. RESULTS AND CONCLUSION: In addition to standard oral lipid lowering therapies, continuous insulin infusion successfully treated severe hypertriglyceridemia in critically ill COVID-19 patients. None of the patients experienced pancreatitis or hypoglycemia necessitating cessation of insulin. Further studies are needed to show the optimum dose and duration of insulin infusion as monotherapy and in combination with oral therapies.

Impact of systemic inflammatory response syndrome on acute ischemic stroke patients treated with mechanical thrombectomy.

AIM: Systemic inflammatory response syndrome (SIRS) has been associated with poor outcomes after acute ischemic stroke (AIS). The primary goal of this study was to determine whether SIRS status on admission correlated with functional outcomes in AIS treated with mechanical thrombectomy (MT). METHODS: Consecutive patients from September 2015 to April 2019 were retrospectively reviewed for SIRS on admission. SIRS was defined as the presence of ≥2 of the following: temperature < 36 °C or > 38 °C, heart rate > 90, respiratory rate > 20, and white blood cell count <4000/mm or > 12,000 mm. RESULTS: Of 202 patients, 188 met inclusion criteria. 49 patients (26%) had evidence of SIRS. Neither basic patient demographics nor standard stroke risk factors predicted the development of SIRS. However, presentation with SIRS was correlated with higher rates of death (odds ratio [OR], 2.6; 95% confidence interval [CI], 1.2-5.5) as well as lower rates of favorable functional outcomes at discharge (OR, 0.09; 95% CI, 0.02-0.40) and 3-month follow up (OR 0.12; 95% CI 0.03-0.43). These results remained significant even after adjustment for age, sex, baseline NIHSS, recanalization status, and prior co-morbidities. CONCLUSION: In our sample population, SIRS was associated with worse outcomes and higher rates of mortality in AIS patients treated with MT. Recognition of key risk factors can provide better prognostication and possible future therapeutic targets.

Comparison of First-Pass Efficacy Among Four Mechanical Thrombectomy Techniques: A Single-Center Experience.

BACKGROUND: First-pass efficacy (FPE) is an established marker of technical and clinical efficacy among mechanical thrombectomy (MT) techniques. It is unclear what the optimal approach is in achieving FPE. We present a single-center experience comparing rates of FPE among 2 MT techniques and evaluate the potential predictors of FPE among other outcomes. METHODS: A single-center retrospective analysis was carried out of patients with consecutive large-vessel occlusion strokes (LVOS) of anterior circulation from September 2015 to April 2019 who underwent MT and for whom data were available on the status of FPE. Four MT techniques were identified: ADAPT (a direct first-pass aspiration), SrADAPT (stent retriever with aspiration), SRBG (stent retriever with balloon guide catheter), and STRAP (stent retriever-aspiration and proximal flow arrest). The primary outcome was FPE and secondary outcomes included the rate of successful reperfusion. RESULTS: Among 226 patients with LVOS of the anterior circulation who underwent MT, data were available for 164 on FPE for the 4 MT techniques. SRBG was the most prevalent technique. No significant difference was found in rates of FPE among the 4 MT techniques (P = 0.332). No independent predictors of FPE were identified on multivariable analysis. STRAP had the highest rate of successful reperfusion compared with the other techniques (P = 0.049) and was the only independent predictor of that outcome (P = 0.027). CONCLUSIONS: Among patients with LVOS of the anterior circulation, the rate of FPE did not differ among the 4 MT techniques. There were no predictors of FPE among the studied variables. STRAP was the only predictor of successful reperfusion.

Inter-molecular inter-actions in a phenol-substituted benzimidazole.

Hydrogen bonding plays an important role in the design of solid-state structures and gels with desirable properties. 1-(4-Hydroxybenzyl)-2-(4-hydroxyphenyl)-5,6-dimethyl-1H-benzimidazole was isolated as the acetone disolvate, C22H20N2O2·2C3H6O. O-H⋯N hydrogen bonding between benz-imidazole mol-ecules results in chains parallel to [010]. One of the acetone solvate mol-ecules participates in O-H⋯O hydrogen bonding with the benzimidazole derivative. C-H⋯π inter-actions are observed in the extended structure. Hirshfeld surface analysis was used to explore the inter-molecular inter-actions and density functional theory was used to estimate the strength of the hydrogen bonds.

The Importance of Improving Youths' Attitudes Toward Science (ATS): A Validation of a Short Form Assessment of Attitudes in Science Constructs for Fourth Grade (AASC-4).

If children have opportunities to develop positive attitudes toward learning science, the pipeline to science careers can be maintained and enhanced. This article describes the development and validation of a short form, 24-item, ssessment of Attitudes in Science Constructs for Fourth Grade (AASC-4) for utilization in future research aimed at improving youths' Attitudes Toward Science (ATS). A researcher developed long form, 50-item AASC-4 was administered in an intervention and comparison, pre- and post-implementation science education study (n=1,117). Exploratory factor analysis was conducted to reduce the original 50-item AASC-4 to the current 24-item form. The current AASC-4 included 24 questions, and eight constructs. Reliability measures of the short-form AASC-4 improved reliability for Fear of Failure on Course from 0.200 to 0.694, Value of Science from 0.478 to 0.779, Attitudes of Family (Parents) toward Science from 0.706 to 0.754, and Perception of the Science Teacher from 0.700 to 0.791. Utilization of the validated constructs within the short-form AASC-4 may help researchers and educators identify science education intervention features that have positive impact on youths' ATS.

Structural characterization, gelation ability, and energy-framework analysis of two bis(long-chain ester)-substituted 4,4'-biphenyl compounds.

There are few examples of single-crystal structure determinations of gelators, as gel formation requires that the dissolved gelator self-assemble into a three-dimensional network structure incorporating solvent via noncovalent interactions rather than self-assembly followed by crystallization. In the solid-state structures of the isostructural compounds 4,4'-bis[5-(methoxycarbonyl)pentyloxy]biphenyl (BBO6-Me), C26H34O6, and 4,4'-bis[5-(ethoxycarbonyl)pentyloxy]biphenyl (BBO6-Et), C28H38O6, the molecules sit on a crystallographically imposed center of symmetry, resulting in strictly coplanar phenyl rings. BBO6-Me behaves as an organogelator in various alcohol solvents, whereas BBO6-Et does not. The extended structure reveals bundles of molecules that form a columnar superstructure. Framework-energy calculations reveal much stronger interaction energies within the columns (-52 to -78 kJ mol-1) than between columns (-2 to -16 kJ mol-1). The intracolumnar interactions are dominated by a dispersion component, whereas the intercolumnar interactions have a substantial electrostatic component.

Proposed clinical internal carotid artery classification system.

INTRODUCTION: Numerical classification systems for the internal carotid artery (ICA) are available, but modifications have added confusion to the numerical systems. Furthermore, previous classifications may not be applicable uniformly to microsurgical and endoscopic procedures. The purpose of this study was to develop a clinically useful classification system. MATERIALS AND METHODS: We performed cadaver dissections of the ICA in 5 heads (10 sides) and evaluated 648 internal carotid arteries with computed tomography angiography. We identified specific anatomic landmarks to define the beginning and end of each ICA segment. RESULTS: The ICA was classified into eight segments based on the cadaver and imaging findings: (1) Cervical segment; (2) cochlear segment (ascending segment of the ICA in the temporal bone) (relation of the start of this segment to the base of the styloid process: Above, 425 sides [80%]; below, 2 sides [0.4%]; at same level, 107 sides [20%]; P < 0.0001) (relation of cochlea to ICA: Posterior, 501 sides [85%]; posteromedial, 84 sides [14%]; P < 0.0001); (3) petrous segment (horizontal segment of ICA in the temporal bone) starting at the crossing of the eustachian tube superolateral to the ICA turn in all 10 samples; (4) Gasserian-Clival segment (ascending segment of ICA in the cavernous sinus) starting at the petrolingual ligament (PLL) (relation to vidian canal on imaging: At same level, 360 sides [63%]; below, 154 sides [27%]; above, 53 sides [9%]; P < 0.0001); in this segment, the ICA projected medially toward the clivus in 275 sides (52%) or parallel to the clivus with no deviation in 256 sides (48%; P < 0.0001); (5) sellar segment (medial loop of ICA in the cavernous sinus) starting at the takeoff of the meningeal hypophyseal trunk (ICA was medial into the sella in 271 cases [46%], lateral without touching the sella in 127 cases [23%], and abutting the sella in 182 cases [31%]; P < 0.0001); (6) sphenoid segment (lateral loop of ICA within the cavernous sinus) starting at the crossing of the fourth cranial nerve on the lateral aspect of the cavernous ICA and located directly lateral to the sphenoid sinus; (7) ring segment (ICA between the 2 dural rings) starting at the crossing of the third cranial nerve on the lateral aspect of the ICA; (8) cisternal segment starting at the distal dural ring. CONCLUSIONS: The classification may be applied uniformly to all skull base surgical approaches including lateral microsurgical and ventral endoscopic approaches, obviating the need for 2 separate classification systems. The classification allows extrapolation of relevant clinical information because each named segment may indicate potential surgical risk to specific structures.