Frostbite in the Pediatric Population: A Comprehensive Review and a Prospective Canadian Survey.

INTRODUCTION: Frostbite in the pediatric population, where skeletal maturity has not been achieved, can have important repercussions on subsequent growth. Yet, the optimal management of frostbite injuries in children remains vague. This review aims to summarize the current evidence for frostbite management in children and understand Canadian practice trends on this topic. METHODS: A review using Medline, Scopus, Web of Science, and gray literature was performed to identify relevant literature on the clinical manifestations, diagnostic methods, and treatment options in pediatric frostbite. An online survey was sent to plastic surgeons through the Canadian Society of Plastic Surgeons (CSPS) mailing list to further identify national practices and trends for pediatric frostbite management. RESULTS: A total of 109 articles were reviewed. No article provided a specific algorithm for pediatric frostbite, with existing recommendations suggesting the use of adult guidelines for treating children. Our survey yielded 9 responses and highlighted the rarity of pediatric frostbite cases, with no responder treating more than 10 cases per year. Most (55.6%) do not use a pediatric-specific treatment algorithm, whereas 30% apply adult guidelines. A conservative approach focusing on rewarming (55.6%), limb elevation (50%), and tetanus status verification (66.7%) was predominant. Imaging and surgical interventions seem to be reserved for severe cases. CONCLUSIONS: The current literature for pediatric frostbite management lacks specificity. Canadian practices vary, with a trend toward a conservative approach. The limited evidence and rarity of experience highlight the need for further research, ideally in a collaborative multicentric manner, to create a consensus for pediatric frostbite care.

Financial Barriers to Surgical Conferences: A Cross-Sectional Analysis of Registration Fees.

BACKGROUND: Scientific meetings provide much educational value to participants of all career stages. There is a paucity of literature surrounding the costs of attending scientific meetings and how this may affect participation, especially among trainees. The objective of this study is to assess the accessibility of surgical conferences for attendees by analyzing costs related to surgical society membership and conference registration. METHODS: Societal membership and conference registration fee data were collected according to career stage (i.e., student, resident, fellow, and staff) for the fourteen surgical specialties recognized by the American College of Surgeons (ACS). Fees for participants from low- and middle-income countries (LMICs) and for virtual-only attendance options were also collected when available. RESULTS: Overall, we included data from 46 surgical societies (32 North American, 14 European or global). The median conference fees for students in the member and non-member categories were 191.55 USD (IQR 42.22-320.99) and 452.40 USD (IQR 294.06-555.00), respectively, representing a 136.2% price increase if not a member. Median conference fees for residents, fellows, and staff in the member category were 65.5%, 66.9%, and 230.9% greater than that for students, respectively. Median prices for residents, fellows, and staff in the non-member category were 49.9%, 54.9%, and 49.9% greater than that for member trainees of the same category, respectively. CONCLUSIONS: Our results highlight the substantial costs associated with attending surgical conferences, especially for trainees, representing a significant barrier to already financially burdened trainees, especially those from LMICs, smaller institutions, or less well-off backgrounds.

Incorporating surgical and anesthesia care into universal health care: a national plan for the development of surgery in Madagascar.

Efforts have been made to strengthen national health systems for safe, affordable, and timely surgical, obstetric, trauma, and anesthesia (SOTA) care since 2015 when the Lancet Commission on Global Surgery (LCoGS) identified critical needs in improving access to essential surgical care for five billion people worldwide. Several governments have developed National Surgical, Obstetric, and Anesthesia Plans (NSOAPs) as a commitment to ensuring safe and accessible surgical care for all of their population. The Ministry of Public Health (MoPH) of Madagascar launched its NSOAP in May 2019, named Le Plan National de Développement de la Chirurgie a Madagascar (PNDCHM). This policy established Madagascar as the first African francophone country to define concrete objectives for the Malagasy health system to meet the targets set by the LCoGS by 2030. The PNDCHM outlined the following priorities and specific action points to be implemented from 2019 to 2023: improving technical capacity, training human resources, developing a health information system, ensuring adequate governance and leadership, offering quality care, creating specific surgical services, and financing and mobilizing resources for implementation. Challenges encountered in the process included complex coordination between different stakeholders, allocating a sufficient budget for its implementation, frequent turnover within the MoPH, and the COVID-19 pandemic. The PNDCHM is a first of its kind in francophone Africa and the many lessons learned can serve as guidance for countries aspiring to build NSOAPs of their own.

RéSUMé: Des efforts ont été déployés pour renforcer les systèmes de santé nationaux pour des soins chirurgicaux, obstétricaux, traumatologiques et anesthésiques sécuritaires, abordables et lorsque nécessaires depuis 2015, lorsque la Commission Lancet sur la chirurgie mondiale (LCoGS) a identifié des besoins critiques pour améliorer l'accès aux soins chirurgicaux essentiels pour cinq milliards de personnes dans le monde. Plusieurs gouvernements ont élaboré des Plans nationaux pour des soins en chirurgie, d'obstétrique et anesthésie (PNCOA) dans le but d'assurer des soins chirurgicaux sécuritaires et accessibles à l'ensemble de leur population. En mai 2019, le ministère de la Santé publique de Madagascar a lancé son propre PNCOA, baptisé Le Plan National de Développement de la Chirurgie à Madagascar (PNDChM). Cette politique a fait de Madagascar le premier pays africain francophone à définir des objectifs concrets pour que le système de santé malgache atteigne les cibles fixées par la Commission Lancet d'ici 2030. Le PNDChM a défini les priorités et points d'action spécifiques suivants à mettre en œuvre de 2019 à 2023 : amélioration des plateaux techniques, formation des ressources humaines, développement d'un système d'information sanitaire, bonne gouvernance et leadership, offre de soins de qualité, création de services chirurgicaux spécialisés, et financement et mobilisation des ressources pour la mise en œuvre. Les défis rencontrés dans le processus comprenaient une coordination complexe entre les différentes parties prenantes, l'allocation d'un budget suffisant pour sa mise en œuvre, un roulement fréquent au sein du ministère de la Santé publique et la pandémie de COVID-19. Le PNDChM est une première en son genre en Afrique francophone et les nombreuses leçons apprises pourront être utiles aux pays qui aspirent à élaborer leurs propres PNCOA.

Transcutaneous and Direct Electrical Stimulation of Mouse Sciatic Nerve Accelerates Functional Recovery After Nerve Transection and Immediate Repair.

BACKGROUND: Electrical stimulation can accelerate peripheral nerve regeneration after injury and repair. Clinically, direct electrical stimulation (DES) may involve longer operating times, increasing risks of perioperative complications. Transcutaneous electrical stimulation (TCES) is a noninvasive alternative. In this study, we investigate how transcutaneous and DES compare for accelerating functional nerve recovery in a mouse sciatic nerve model. METHODS: Twenty-eight mice were divided into sham (n = 4), axotomy (n = 8), DES (n = 8), and TCES (n = 8) groups. After sciatic nerve transection and repair, the proximal nerve was subjected to DES or TCES at 20 Hz for 1 hour. Sciatic functional index was measured before the injury, and at weeks 1, 2, 4, 6, 8, 10, and 12 by walking-track analysis. Electrophysiological measures were taken at week 12. RESULTS: Kinematic studies showed significant improvement from the 8th week to the 12th week for both electrical stimulation groups compared with the axotomy group (P < 0.05), with no difference between the electrical stimulation groups. At the 12th week, both DES and TCES groups had significantly faster average conduction velocity than the axotomy group. CONCLUSIONS: Functional recovery was significantly better from 8 weeks onward in mice receiving either DES or TCES stimulation when compared with axotomy and repair alone. Transcutaneous electrical stimulation is a minimally invasive alternative treatment for accelerating functional recovery after peripheral nerve injury.

Peer mentorship to build research capacity among members of the International Student Surgical Network (InciSioN): a proof of concept study.

BACKGROUND: International Student Surgical Network (InciSioN) is the largest student and trainee global surgery interest group worldwide and its members have contributed significantly to global surgery research. The InciSioN Research Capacity-Building (IReCaB) program aimed to enhance the research skills and confidence of participants via a peer mentorship model. METHODS: After an open call to members of InciSioN to enroll, participants' knowledge of research methods and the process was evaluated through a test to assign mentor and mentee roles, with mentors being those who scored ≥ 20/25. Mentors then delivered a series of four webinars to help disseminate research methodology to mentees. Finally, mentees were tested on their knowledge of research and their satisfaction with the program was also evaluated. RESULTS: Fifty-two participants, mostly from LMICs (n = 23/52, 44.2%) were enrolled, and 36 completed the program. There was a significant improvement in the proportion of questions answered correctly on the post-program test (R = 0.755, p < 0.001). Post-IReCaB test scores were greater than pre-IReCaB scores (p < 0.001). The difference in confidence after the course was also significant (p < 0.001). IReCaB participants successfully designed, implemented, and published an international cross-sectional study. CONCLUSION: This study showed improvements in participants' understanding of theoretical components of scientific research. We offer a model for research capacity building that can be implemented, modeled, and further refined by similar organizations with academic research goals.

Growing academic global surgery: opportunities for Canadian trainees.

SummaryGlobal surgery has seen exponential growth over the past few years, and Canadian trainees' interest in the field has followed. Global surgery is defined by a commitment to health equity and community partnership. Engagement with its core principles is relevant for all Canadian surgical trainees and offers a perspective into inequities in surgical access and outcomes for patients and communities, both locally and globally. Several opportunities in academic global surgery for trainees have emerged in Canada, but appear to be underutilized. This article highlights existing Canadian global surgery initiatives, including formal postgraduate curricula, research and policy collaborations, trainee networks, advocacy projects, dedicated fellowships, and conferences. We identify areas in which institutions and departments of surgery can better support trainees in exploring each of these categories during training. Canadian trainees' exposure to global surgery can nurture their roles as future health advocates, communicators, and leaders locally and beyond.

COVID-19 pandemic: a time for collaboration and a unified global health front.

Coronavirus disease 2019 has, in the span of weeks, immobilized entire countries and mobilized leading institutions worldwide in a race towards treatments and preventions. Although several solutions such as telemedicine and online education platforms have been implemented to reduce human contact and further transmission, countries need to favour collectivism both within and beyond their borders. Inspired by experiences of previous outbreaks such as SARS in 2003 and Ebola in 2014-2015, global solidarity is a must in order to prevent further morbidity and mortality. Examples in leadership and collaborations ranging from research funds from the Bill and Melinda Gates Foundation to mask donations by the Jack Ma Foundation should be celebrated as examples to follow. Open communication and transparency will be crucial in monitoring the evolution of the disease in the global effort of flattening the curve. This crisis will challenge the integrity and fuel innovation of health systems worldwide, whilst posing a new quality chasm that warrants increased recognition.

Structurally Defined Ru(II) Metallointercalators for Real-Time Monitoring of DNA Amplification Reactions.

The low cost and convenience of fluorescent DNA binding dyes make them widely used for real-time DNA analysis. Even though several dyes for real-time polymerase chain reaction (PCR) and loop-mediated isothermal amplification (LAMP) assays are commercially available, most of them rely on organic parent molecules with an indefinite chemical structure, making it difficult to predict their behavior in nucleic acid amplification and to get the best performance. Herein, we demonstrate for the first time the use of the structurally defined dipyridophenazine complexes of ruthenium(II) for real-time monitoring of PCR and LAMP. These inorganic metallointercalators exhibit less inhibition on DNA amplification. They can quantify a range of initial template concentrations and provide the product melting curve to differentiate the unspecific amplification and even perform multiplex assays. These ruthenium(II) complexes have the advantages of the defined structure, nontoxicity, good stability, and facile synthesis, and they may act as excellent alternative DNA binding dyes with wide applications in the field of nucleic acid research.

Construction of a high cell density human corneal endothelial equivalent and its transplantation in primate models.

BACKGROUND: Recently, many patients with corneal blindness caused by endothelial dysfunction have no opportunity to receive keratoplasty therapy because of the extremely limited number of donor corneas. Corneal tissue engineering opens a new path for in vitro reconstruction of tissue-engineered HCE which will cure the corneal endotheliopathy by clinical corneal transplantation. In this study, we construct a human corneal endothelium (HCE) equivalent with non-transfected monoclonal HCE (mcHCE) cells and modified denuded amniotic membrane (mdAM), and evaluate its functions in monkey models. METHODS: Tissue-engineered HCE (TE-HCE) was constructed by culturing DiI-labeled mcHCE cells on mdAMs in 20% fetal bovine serum-containing DMEM/Ham's Nutrient Mixture F12 (1:1) medium and 5% CO2 at 37°C on a 24-well culture plate. The constructed TE-HCE was transplanted into monkey corneas via penetrating keratoplasty with Descemet's membrane and endothelium stripped. The corneal transparency, thickness, and intraocular pressure were monitored in vivo, and the corneal morphology and histological structure were examined ex vivo 181 days after surgery. RESULTS: The constructed TE-HCE, with an average density of 3602.22 ± 45.22 cells/mm2 , mimicked its natural counterpart both in morphology and histological structure. In vivo, corneal transparency was maintained, and the corneal thickness gradually decreased to 567.33 ± 72.77 µm at day 181 after TE-HCE transplanted into monkey eyes, while intense corneal edema and turbid were found in mdAM-transplanted eyes with their corneal thicknesses maintained over 1000 µm during the monitoring period. Ex vivo, a monolayer of corneal endothelium, consisting of mcHCE cells at a density of 2795.65 ± 156.83 cells/mm2 , was reconstructed in transplanted monkey eyes. The cells in the transplanted area had the hexagonal or polygonal morphology and normal ultrastructure, and established plenty of cell-cell and cell-stromal matrix junctions. Besides, huge membrane-bounded flat stacks with electric dense inclusions were found in mcHCE cells beneath the plasma membrane at the stromal side. CONCLUSIONS: The constructed TE-HCE has normal histological property and functions well in monkey models. The TE-HCE could be used as a promising HCE equivalent in therapy of corneal endothelium dysfunction and corneal regenerative medicine.

Newsletter Spring 2019: Clinician Investigator Trainee Association of Canada (CITAC).

Message from the President: Demystifying and promoting the MD-PhD/MD+ world Since its inception in 2006, the Clinician-Investigator Trainee Association of Canada (CITAC) has investigated, supported and promoted the needs of Canadian trainees on track to building a career in research and medicine. Membership in CITAC signals interest in such a career as a physician/clinician/surgeon-scientist. MD+ trainees (e.g., those in Clinician Investigator Programs (CIP), MD-PhD and MD-MSc programs) are involved in discussions surrounding this dual career often enough to have a sense of what it entails. Trainees assume and trust that the training they receive, and the opportunities they seize, can lead them to the dual career. Yet, when considering practical questions about this career outcome, such as what is the success rate in landing a faculty position with that job description, we realize that much is unknown.

Newsletter 2018: Clinician Investigator Trainee Association of Canada (CITAC).

Message from the President: Optimism for the Future The Clinician-Investigator Trainee Association of Canada (CITAC) was established in 2006 to address issues relevant to Canadian trainees seeking dual training in medicine and research. As clinician-investigator (CI) trainees, we comprise but a fraction (less than 5%) of all medical trainees. Our 'bilingual' careers render our individual paths less straightforward and more challenging. As a community, we have had to confront several disappointments, perhaps most notably the cessation of funding support for MD/PhD programs in 2015, previously offered by the Canadian Institutes of Health Research (CIHR). Despite these individual and collective challenges, I remain optimistic and incredibly excited about our future. In my own work, I am reminded constantly that being trusted with the dual responsibility of patient care and innovation in medicine is a privilege to be cherished, rather than a burden to be feared. That which makes our path doubly challenging also makes it doubly rewarding. The progress that CITAC has made over the years only adds to my optimism, and I wish to take this opportunity to remind you of how far we have come and how much further we hope to go.

Scientific overview on CSCI-CITAC Annual General Meeting and 2017 Young Investigators' Forum.

The 2017 Annual General Meeting of the Canadian Society of Clinician Investigators (CSCI) and Clinician Investigator Trainee Association of Canada/Association des Cliniciens-Chercheurs en Formation du Canada (CITAC/ACCFC) was a national Annual General Meeting (AGM) held in Toronto, Ontario November 20-22, 2017, in conjunction with the University of Toronto Clinician Investigator Program Research Day. The theme for this year's meeting was "Roll up your sleeves-How to manage your physician scientist career", emphasizing lectures and workshops that were designed to provide tools for being proactive and successful in career planning. The keynote speakers were Dr. Rod McInnes (McGill University and Canadian Institutes of Health Research Acting President), who was the Distinguished Scientist Award recipient, Dr. David Goltzman (McGill University), who was the 2017 Henry Friesen Award recipient, Dr. Gillian Hawker (University of Toronto), Dr. Mike Sapieha (Université de Montréal), who was the 2017 Joe Doupe Award recipient, and Dr. Alex MacKenzie (Children's Hospital of Eastern Ontario Research Institute, University of Ottawa). The workshops, focusing on career development for clinician scientists, were hosted by Dr. Lisa Robinson, Dr. Nicola Jones, Kevin Vuong, Fran Brunelle, Dr. Jason Berman and Dr. Alan Underhill. Further to this, the Young Investigators' Forum encompasses presentations from scientist-clinician trainees from across the country. All scientific abstracts are summarized in this review. There were over 100 abstracts showcased at this year's meeting during the highlighted poster sessions, with six outstanding abstracts selected for oral presentations during the President's Forum.