Factors Associated with Matching into Surgical Specialties.

BACKGROUND: The United States medical education system has a vested interest in understanding medical student specialty choice. The purpose of this study is to identify the demographic, educational, lifestyle preference, and other factors associated with matching into surgical specialties. METHODS: An annual survey was given to students at the University of Iowa Carver College of Medicine from 2013-2019. 456 medical students were eligible to participate and 374 completed at least one survey. Surveys were distributed 5 times; M1, M2, M3, and M4 years and after the residency match process. Logistic regression was used to estimate the association between various factors and the likelihood of matching into a surgical specialty. RESULTS: Exposure to surgical fields, through a family member practicing surgery (aOR = 3.21), mentorship (aOR = 2.78), or research (aOR = 2.96) increase the likelihood of matching into a surgical specialty. Married students are less likely to pursue surgical specialties (aOR = 0.246). White students interested in surgery in their first two years of medical school were more likely (aOR = 6.472) to match into surgery than non-White students also interested in surgery (aOR = 0.155). CONCLUSIONS: Factors associated with an increased likelihood of matching into surgical specialties include having surgical mentors, performing surgical research, and having family members in surgical specialties. Of the students interested in surgery early in medical school, being of Caucasian ethnicity is associated with higher rates of matching into surgery. Students who are married without children are less likely to enter a surgical field.

Amplification of Oncolytic Vaccinia Virus Widespread Tumor Cell Killing by Sunitinib through Multiple Mechanisms.

Oncolytic viruses pose many questions in their use in cancer therapy. In this study, we assessed the potential of mpJX-594 (mouse-prototype JX-594), a replication-competent vaccinia virus administered by intravenous injection, to target the tumor vasculature, produce immune activation and tumor cell killing more widespread than the infection, and suppress invasion and metastasis. These actions were examined in RIP-Tag2 transgenic mice with pancreatic neuroendocrine tumors that developed spontaneously and progressed as in humans. mpJX-594 initially infected tumor vascular endothelial cells, leading to vascular pruning and prolonged leakage in tumors but not in normal organs; parallel effects were observed in U87 gliomas. Viral infection spread to tumor cells, where tumor cell killing was much more widespread than the infection. Widespread tumor cell killing at 5 days was prevented by depletion of CD8+ T lymphocytes and did not require GM-CSF, as mpJX-594 variants that expressed human, mouse, or no GM-CSF produced equivalent amounts of killing. The antivascular, antitumor, and antimetastatic effects of mpJX-594 were amplified by concurrent or sequential administration of sunitinib, a multitargeted receptor tyrosine kinase inhibitor. These effects were not mimicked by selective inhibition of VEGFR2 despite equivalent vascular pruning, but were accompanied by suppression of regulatory T cells and greater influx of activated CD8+ T cells. Together, our results showed that mpJX-594 targets tumor blood vessels, spreads secondarily to tumor cells, and produces widespread CD8+ T-cell-dependent tumor cell killing in primary tumors and metastases, and that these effects can be amplified by coadministration of sunitinib.Significance: These findings reveal multiple unrecognized features of the antitumor properties of oncolytic vaccinia viruses, all of which can be amplified by the multitargeted kinase inhibitor sunitinib. Cancer Res; 78(4); 922-37. ©2017 AACR.