Seatbelt Use in Females of Childbearing Age at an Urban Safety-Net Level 1 Trauma Center.

BACKGROUND: Safety restraint system (SRS) use is known to improve maternal and fetal outcomes in pregnant women. Factors associated with seatbelt use in females of childbearing age are largely unstudied despite global public health endeavors to increase use. We sought to define its use and uncover risk factors for not using a restraint system in this vulnerable patient cohort. MATERIALS AND METHODS: A retrospective chart review of all female patients aged 15-35 y presenting from 2007 to 2017 was performed using our institutional level 1 trauma database. Age, pregnancy, insurance status (commercial or private, Medicaid plan, and uninsured), race, and Injury Severity Score (ISS) were examined in unmatched data. A matched cohort was created to evaluate the impact of pregnancy on SRS use based on ISS, age, race, and insurance status with blinding to belt use during matching (two nonpregnant to one pregnant). Differences in restraint use were then examined using Mann-Whitney U and Chi-square tests. RESULTS: A total of 779 patients met inclusion criteria, of which 140 were pregnant. In unmatched data, there was no difference in belt use with regard to age, race, or insurance type. Overall belt use was 59%. Twenty-five percent of patients were uninsured, and 39% used a Medicaid plan. Pregnant patients were statistically more likely to wear belts (71% versus 57%, P = 0.003). In ISS-matched data, this difference was not upheld (63% pregnant belt use versus 58%, P = 0.615). CONCLUSIONS: Pregnancy did not induce improved safety behavior in our population. More study is needed to confirm our findings. Overall SRS use in our urban population is very poor, lags behind the national average, and requires additional public health attention.

Rates of caesarian section and trials and success of vaginal birth after caesarean sections in secondary care hospital.

We planned to investigate the rates of Caesarean Section (CS), potential Vaginal Births After previous Caesarean Section (VBAC), and successful VBAC in a secondary care hospital. We conducted an analytical retrospective study at Aga Khan Hospital for Women, Karimabad, Karachi, from October 2011 to September 2012. Data related to total deliveries, Lower Segment CS (LSCS), attempted VBAC and successful VBAC was retrieved from medical records. Total number of deliveries were 3266. Of these, 1021(31.26%) deliveries were conducted by CS. A total of 365(11.1%) had a previous history of one CS and VBAC trial was given to 33(9%) of these pregnancies. The success rate of VBAC was 21 (63.6%). Our results highlight that despite having limited resources, our rates of CS, VBAC trials and successful VBACs were within reasonable limits when compared with international rates.

Effect of conditions being present at time of surgery (PATOS) on outcomes in liver surgery.

INTRODUCTION: Information about condition(s) being present at time of surgery (PATOS) in the American College of Surgeons (ASC) National Surgical Quality Improvement Program (NSQIP) database can influence the postoperative complication rates after liver surgeries. Here, we compare the postoperative complication rates with and without taking condition(s) being PATOS into account. METHODS: We retrospectively reviewed the ACS NSQIP Participant User Files (PUFs) from 2015 through 2019. We analyzed rates of eight different postoperative complications: superficial surgical site infection (SSI), deep SSI, organ space SSI, pneumonia, urinary tract infection, ventilator, sepsis, and septic shock. In addition, we calculated the percent change in event rates after taking into account whether a condition is PATOS. RESULTS: Of the 22,463 patients in the ACS NSQIP PUFs for liver surgery, 334 (1.49%) had one or more conditions PATOS. The percentages of patients with PATOS events ranged from 2.03% for superficial SSI to 14.74% for sepsis. For all complications, event rates declined when taking condition(s) PATOS into account. From 2015 through 2019, the observed-to-expected ratios for most complications remained unchanged. CONCLUSION: Whether a condition is PATOS is important in reporting postoperative complication rates for patients undergoing liver surgery. When taking whether a condition is PATOS into account, we demonstrated an overall decrease in event rates across all eight postoperative complications.

Effect of Present at Time of Surgery (PATOS) on Outcomes in Pancreatic Surgery.

INTRODUCTION: While there is some data available on the importance of accounting for the effect of present at time of surgery (PATOS) when estimating unadjusted postoperative complication rates, little is known about the impact of PATOS on outcomes in patients undergoing pancreatic surgery specifically. By taking PATOS into account, we hypothesized that unadjusted, observed postoperative complication rates might be reduced, with these reductions being different across outcomes; however, we expected fewer differences in risk-adjusted results, i.e., observed to expected ratios (O/E ratios). METHODS: We retrospectively analyzed the ACS NSQIP Participant Use Files (PUFs) from 2015 to 2019. PATOS data were analyzed for the 8 postoperative complications of superficial, deep, and organ space surgical site infection; pneumonia; urinary tract infection; ventilator dependence; sepsis; and septic shock. Postoperative complication rates were compared by ignoring PATOS vs. taking PATOS into account. RESULTS: Of the 31,919 patients in the ACS NSQIP PUFs who underwent pancreatic surgery, 1120 (3.51%) patients had one or more PATOS conditions. The event rates after taking PATOS into account declined for all outcomes-superficial surgical site infection (SSI) rates reduced by 2.56%, deep SSI rates reduced by 4.28%, organ space SSI rates reduced by 9.31%, pneumonia rates reduced by 2.91%, urinary tract infection rates declined by 4.69%, and septic shock rates declined by 9.27%. CONCLUSION: Our paper highlights that accounting for PATOS is important for estimating unadjusted postoperative complication rates in patients undergoing pancreatic surgery. Risk adjustment is essential to any attempt at quality assessment and benchmarking. Failure to account for PATOS may penalize surgeons who care for the sickest and most complicated patients and subsequently encourage cherry-picking of less risky patients and procedures.

Role of laparoscopic surgery in the management of gallbladder cancer: Systematic review & meta-analysis.

BACKGROUND: This meta-analysis evaluates the safety and short-term oncological outcomes of laparoscopic vs. open surgery for gallbladder carcinoma(GBC). METHODS: Meta-analysis was performed on laparoscopic(LG) and open group(OG) studies. Data for survival outcomes were extracted from Kaplan-Meier curves and combined with Tierney's method to estimate hazard ratios(HRs) and 95% CIs. RESULTS: There was no significant difference in overall survival(HR: 1.01), disease-free survival(HR: 0.84), 30-day mortality(RR:1.10), overall recurrence(RR:0.93), intraoperative gallbladder violation(RR:1.17), operative time(WMD:8.32), number of patients receiving adjuvant chemotherapy(RR:1.06) and blood transfusion(RR: 0.81). A significant difference was seen in survival of T3 subgroup(HR:0.77) and number of lymph node dissections (LND)(WMD: 0.63) favoring OG, along with a decrease in postoperative complications(RR:0.65), greater incidence of R0 resections(RR:1.04), lower volume of intraoperative blood loss(WMD: 128.62), lower time in removing drainage tube(WMD: 1.35), shorter diet recovery time(WMD: 1.88), shorter hospital stay(WMD: 3.51), lower incidence of 90-day mortality(RR:0.49) favoring LG. A higher incidence of port-site recurrence(RR:1.99) was reported in LG. CONCLUSION: Laparoscopic surgery is non-inferior to the open approach in terms of oncological outcomes and has an improved rate of postoperative complications.

Current Status of National Institutes of Health Research Funding for Women Surgeon-Scientists.

Importance: Women have made substantial advancements in academic surgery, but research funding disparities continue to hamper their progress, and current literature on the status of National Institutes of Health (NIH) funding awarded to women surgeon-scientists appears to be conflicting. Objective: To examine gender-based differences in NIH funding awarded to surgeon-scientists by comparing total grant amounts awarded and the distribution of grants by gender and research type. Design, Setting, and Participants: This cross-sectional study was performed using a previously created database of NIH-funded surgeons from 2010 to 2020. Active physician data from the Association of American Medical Colleges were used to calculate total surgeon populations. This study was performed at the NIH using the NIH internal data platform, iSearch Grants. A total of 715 men and women surgeon-scientists funded by the NIH in 2010 and 1031 funded in 2020 were included in the analysis. Main Outcomes and Measures: The main outcome was the number of women among the total number of surgeons who received NIH grants and the total grant amounts awarded to them. Bivariate χ2 analyses were performed using population totals and substantiated by z tests of population proportions. Results: This study included 715 physicians (n = 579 men [81.0%]) in 2010 and 1031 physicians (n = 769 men [74.6%]) in 2020. In 2020, women comprised 27.4% of the surgical workforce and 25.4% of surgeons with research funding in the US, but they received only 21.7% of total NIH research funding awarded to all surgeons. The number of funded women surgeon-scientists, however, significantly increased from 2010 to 2020 (262 [25.4%] in 2020 vs 136 [19.0%] in 2010; P < .001) as did their funding ($189.7 million [21.7%] in 2020 vs $75.9 million [12.3%] in 2010; P < .001). Furthermore, the proportion of US women surgeons overall with NIH funding significantly increased in 2020 vs 2010 (0.7% vs 0.5%; P < .001). Basic science, clinical outcomes, and clinical trial R01 grants also increased among women surgeon-scientists. Women and men K grant holders had a similar mean (SD) number of R01 application attempts before success (2.7 [3.01] vs 2.3 [3.15]; P = .60) and similar K-to-R award conversion rates (23.5% vs 26.7%; P = .55). Conclusions and Relevance: This cross-sectional study found an increasing number of women surgeon-scientists receiving NIH funding in 2020 vs 2010 as well as increases in the median grant amounts awarded. Although these results are promising, a discrepancy remains in the proportion of women in the surgical workforce compared with those funded by the NIH and the total grant amounts awarded to them.

NIH Funding Across Surgical Specialties; How Do Women Fare?

BACKGROUND: Much has been written about the under-representation of women in academic medicine. However, no study has comprehensively described the gender-based trends of National Institutes of Health funding across surgical specialties; this study provides such an overview. METHODS: We queried a previously created database to identify both male and female National Institutes of Health-funded surgeons. Surgical specialties and subspecialties were determined based upon formal training. Total grant costs and average costs per R01 and K grant were calculated and compared. Bivariate χ2 analyses were performed using population totals. RESULTS: In 2020, the specialties with the highest proportion of National Institutes of Health-funded female surgeon-scientists were obstetrics and gynecology (57%) and vascular surgery (40%). The general surgery subspecialties with the highest proportion of women were breast (85%), endocrine (58%), and colorectal surgery (40%). An analysis of total grant costs in 2020 revealed that in most specialties, the proportion of funding held by women was substantially less than the proportion of women investigators. In obstetrics and gynecology, women comprised 57% of surgeons, but held only 46% of the funding. Similarly, in breast surgery, women comprised 85% of surgeons, but held only 45% of the funding. Women and men had similar changes in the average total cost per R01 and K grant awarded from 2010 to 2020. In 2020, women were awarded less than men per R01 grant in general, otolaryngology, plastic and reconstructive, urology, and vascular surgery. CONCLUSION: Although female surgeon-scientists have made significant advances in some surgical specialties, they continue to lag in others. An in-depth analysis of the factors contributing to these trends is necessary to achieve gender parity across all academic surgical specialties.

Multiregional single-cell dissection of tumor and immune cells reveals stable lock-and-key features in liver cancer.

Intratumor heterogeneity may result from the evolution of tumor cells and their continuous interactions with the tumor microenvironment which collectively drives tumorigenesis. However, an appearance of cellular and molecular heterogeneity creates a challenge to define molecular features linked to tumor malignancy. Here we perform multiregional single-cell RNA sequencing (scRNA-seq) analysis of seven liver cancer patients (four hepatocellular carcinoma, HCC and three intrahepatic cholangiocarcinoma, iCCA). We identify cellular dynamics of malignant cells and their communication networks with tumor-associated immune cells, which are validated using additional scRNA-seq data of 25 HCC and 12 iCCA patients as a stable fingerprint embedded in a malignant ecosystem representing features of tumor aggressiveness. We further validate the top ligand-receptor interaction pairs (i.e., LGALS9-SLC1A5 and SPP1-PTGER4 between tumor cells and macrophages) associated with unique transcriptome in additional 542 HCC patients. Our study unveils stable molecular networks of malignant ecosystems, which may open a path for therapeutic exploration.

Idelalisib for the treatment of chronic lymphocytic leukemia.

Chronic lymphocytic leukemia is the most common leukemia in the United States. It is a slowly progressive disease, with an 82% five-year survival rate. The treatment strategies are highly individualized with patients in the early and stable stages typically not requiring treatment. However, those with progressive or clinically advanced disease will require treatment. Cytotoxic drugs, such as the alkylating agents, purine nucleoside antagonists, and immunotherapeutic agents, have been the mainstay of chemotherapeutic treatment in CLL. However, given the lack of therapeutic specificity, these medications (especially older ones) have limited tolerability due to side effects. In this paper, we will discuss the data on the use of phosphatidylinositol 3 kinase inhibitor Idelalisib in the management of patients with chronic lymphocytic leukemia. The preclinical and clinical data thus far demonstrate that Idelalisib produces a dramatic and durable response in patients with chronic lymphocytic leukemia and without causing significant toxicity. Moving forward, the ongoing clinical trials will help address the various questions currently being raised regarding the long-term application and safety of Idelalisib. With greater clinical experience following more widespread use of Idelalisib, we will be able to determine the optimal combination therapies in treatment-naïve and relapsed/refractory patients, resulting in more individualized therapeutic strategies for patients with chronic lymphocytic leukemia.