The Initial Stage of Neurosurgery in China: Contributions from Peking Union Medical College Hospital.

Modern neurosurgery has been developing worldwide for more than a century, whereas in China, as stated in previous literature, only 7 decades have passed since the development of neurosurgery during the early 1950s after World War II and China's War of Liberation. However, as increasing evidence before the wars from medical records, annual hospital reports, and journal archives emerge, the history of neurosurgery in China, especially the initial stage, needs to be reassessed. The establishment of the Peking Union Medical College Hospital (PUMCH) in 1921, funded by the Rockefeller Foundation, marked the start of Western medicine in China. Meanwhile, modern neurosurgery started to take root in the nation. Chinese neurosurgeons at PUMCH, Song-Tao Guan, M.D. and Yi-Cheng Zhao, M.D., both of whom graduated from PUMC and received further training abroad, made great contributions to the initial growth of Chinese neurosurgery. Although neurosurgery experienced slow and even stagnant development in China during the wars that took place from 1941-1949, the prewar period from 1921-1940 witnessed substantial improvement in operative skills, bedside education, resident training, and scientific research in neurosurgery at PUMCH, providing indispensable contributions that have allowed Chinese neurosurgery to flourish during the past 7 decades.

Seeking Parity for Women in Academic Medicine: A Historical Perspective.

In this Invited Commentary, the author applies a historical lens to explore a fundamental paradox in U.S. medical education: the fact that long after women gained parity with men in matriculation to medical school, women remain highly underrepresented in leadership positions in academic medicine. The reasons for this are many and complex, but at the core are the subtle but hurtful indignities ("microinequities") experienced by women physicians and an academic culture that expects single-minded dedication to work, regardless of the costs to faculty members' personal lives. Achieving parity for women in academic leadership will require changing the culture of medical schools and teaching hospitals to correct these 2 fundamental obstacles. In recent years, many medical schools and teaching hospitals have made efforts to improve opportunities and satisfaction for women trainees and physicians, enacting reforms to improve work-life balance for all faculty. It is plausible to imagine a future in which flexible time frames to achieve tenure and promotion are universally available to both women and men, with high scholarly standards firmly maintained. If this occurs, it will represent a profound legacy for women in academic medicine, for their generations of professional sacrifice and advocacy for a more equitable culture will have changed its culture.

Race, Kidney Transplants, Immunosuppression Research, and White Supremacy under Apartheid, 1960-80.

This paper uses the history of kidney transplantation in South Africa as a lens through which to write a racialized, micro history that illustrates the politics of medical discoveries and medical research at one of South Africa's most prestigious medical research universities, the University of the Witwatersrand (Wits) in Johannesburg. Between 1966 and the 1980s, the Wits team became the most advanced and prolific kidney transplant unit in the country. Yet the racist, oppressive Apartheid system fundamentally shaped these developments. Transplantation, as this paper shows, became an elite medical procedure, performed by a select group of white doctors on mostly white patients. For these doctors, transplantation showed their medical prowess and displayed the technical advancements they were able to make in research and clinical practice as they strove to position South Africa as a significant international player in medical research, despite academic boycotts and increasing sanctions. Transplantation became a symbol of white supremacy in a country where the black majority were excluded from anything but the most basic health care.

The History of Neurosurgery at Houston Methodist Hospital.

The history of neurosurgery in Texas is linked with the development over the past century of the Houston Methodist Hospital (HMH) from a 30-bed hospital in downtown Houston to an academic medical center with 900 beds in the Texas Medical Center. Neurosurgery at HMH has developed to meet the needs of the Houston Metropolitan Area, which has grown from 130,000 people in 1919 to 7 million people today. Neurosurgery at HMH has had steady growth and stable leadership with Dr. James Greenwood Jr. 1936-1980, Dr. Robert Grossman 1980-2013, and Dr. Gavin Britz 2013-present, as Chiefs of the Neurosurgical Service. HMH has been affiliated with 2 medical schools: Baylor College of Medicine 1950-2003 and Weill College of Medicine Cornell University 2004-present. Neurosurgical training began at HMH with the establishment of the Baylor College of Medicine Neurosurgery Residency Program with Dr. George Ehni as Program Director 1959-1979 and Dr. Robert Grossman as Program Director 1980-2006. Training has continued in the HMH residency program from 2006 to present with Dr. David Baskin as Program Director. As of 2019, 138 neurosurgical residents have been trained at HMH. The goals of delivering responsible patient care, advancing neurosurgical knowledge, and training the next generation of practitioners and teachers of neurosurgery have remained constant and have been met and remain the mission of the department.

The Rock of Gibraltar: The Value of Mentorship in the Early Years (Dr. Virginia Apgar and Dr. Ralph Waters).

Behind every successful physician there are mentors to light the path. Ralph Waters, founder of the anesthesiology residency at the University of Wisconsin-Madison, was an instrumental part of Virginia Apgar's success; his support of her education and promotion of her professional endeavors proved to shape the medical powerhouse that Apgar would become. In this article, we learn about the professional and personal relationship between Waters and Apgar through personal correspondence from the Ralph Waters Collection at University of Wisconsin Archives, scientific publications, and meeting records. Through his support of her career, she was able to achieve success despite the Great Depression, World War II, and the novelty of being a woman in medicine. In her career, Apgar became the first female full professor at Columbia University, designed and implemented the Apgar score, and led the Division of Congenital Malformations at the March of Dimes among many other accomplishments. Though they lived half of a country apart in Wisconsin and in New York, the mentor and mentee bridged the gap in geography through regular correspondence, American Society of Anesthetists (now American Society of Anesthesiologists) meetings (where Waters served as president and Apgar as treasurer), and exchange of trainees between the University of Wisconsin at Madison and Columbia University. Apgar revealed herself to be a persistent, hardworking, intelligent, and passionate academic physician - the perfect pupil for Waters. This article's aim is to underscore the importance of mentorship - with equal commitment to the relationship from mentor and mentee - then and now.

Past, present and future of university hospitals.

Objectives: Health care systems worldwide are changing and taking new forms. The old, more hierarchically oriented, model with individual institutional and bilateral interactions between primary, secondary, tertiary and quaternary care is being replaced by an integrated and dynamic network model. We aim to look at what role university hospitals will play in this future organization of health care.Method: In this paper, we look at the relevant literature on the history of academic medicine and university hospitals. Subsequently, we look at the challenges university hospitals are facing according to contemporary literature on the topic.Results: Our current model of academic medicine with its university hospitals finds its origin in the institutionalization of the academic mission in the late 18th century. Currently, the sustainability of the model is under immense pressure. University hospitals are facing economic challenges, teaching challenges and research challenges. However, there is reason to believe that they can continue to play a role of importance in tomorrow's medicine. The organization of health care is undergoing two important changes. The first is the evolution towards a more dynamic and integrated network model. University hospitals can become an important hub within this network. The second change is an evolution towards evidence based medicine and translational research.Conclusion: Due to their unique tripartite mission, we argue that university hospitals can continue to play an important and critical role in promoting evidence-based medicine and speedy translation of new evidence.

Cytogenetic profile of patients with clinical spectrum of ambiguous genitalia, amenorrhea, and Turner phenotype: A 21-year single-center experience.

The aim of the present study was to determine the frequency and nature of chromosomal abnormalities involved in patients with the clinical spectrum of ambiguous genitalia (AG), amenorrhea, and Turner phenotype, in order to compare them with those reported elsewhere. The study was conducted in the Cytogenetic Department of Pasteur Institute of Morocco, and it reports on the patients who were recruited between 1996 and 2016. Cytogenetic analysis was performed according to the standard method. Among 1,415 patients, chromosomal abnormalities were identified in 7.13% (48/673) of patients with AG, 17.39% (28/161) of patients with primary amenorrhea (PA), 4% (1/25) of patients with secondary amenorrhea, and 23.20% (129/556) of patients with Turner phenotype. However, Turner syndrome was diagnosed in 0.89% (6/673) of patients with AG, 10.56% (17/161) of patients with PA, and 19.78% (110/556) of patients with Turner phenotype. In addition, Klinefelter syndrome and mixed gonadal dysgenesis were confirmed in 2.97% and 1.93% of patients, respectively, with AG, while, chimerism, trisomy 8, and trisomy 13 were confirmed only in 0.15% each. Trisomy 21 was confirmed in patients with AG and Turner phenotype (0.15% and 0.36%, respectively). Moreover, 5.60% (9/161) of patients with PA have been diagnosed as having sex reversal. Thus, the frequency of chromosomal abnormalities observed in Moroccan patients with PA is comparable to that reported in Tunisia, Turkey, Iran, and Hong Kong. However, the frequency is significantly less than that identified in India, Malaysia, Italy, and Romania.

The First North American Clinical Gamma Knife Center.

A decision to develop a stereotactic radiosurgery center and install the first 201 cobalt-60 Gamma Knife in Pittsburgh was made in 1981 after gathering regional and leadership support. This was part of a 7-year quest that required overcoming barriers to a new technology unfamiliar to US regulatory authorities and insurance companies. The first patient was treated in August 1987. Since that time our center has installed each succeeding Gamma Knife device developed. During an initial 30-year experience we performed more than 14,750 patient procedures. In addition to patient care our Center's goal was to develop a major teaching and clinical research program that eventually led to the training of more than 2,500 physicians and medical physicists, the publication of more than 600 peer-reviewed clinical outcome research studies, and 4 books. This report summarizes the rationale for acquisition, the challenges and the early years, and then the evolution of our center which installed the first US 201 source Gamma Knife.

Commentary: The Tulane University-Ochsner Clinic Foundation Neurosurgery Program: 75 Years of History, Including the Program's Rebirth After Katrina.

Neurosurgery training in New Orleans began when Dr Dean Echols became the head of Neurosurgery for the Ochnser Clinic and Charity Hospital in 1944. The oldest in Louisiana, the Tulane-Ochsner program has trained 63 board-certified neurosurgeons since its founding, including 5 chairmen. The program has a colorful history linked to New Orleans. Its residents have enjoyed training at Charity Hospital, Tulane Hospital and Clinics, Veterans Affairs Medical Center, and the Ochsner Clinic Foundation.

History of liver transplantation in Poland.

Experimental research on liver transplantation was introduced in Poland by Waldemar Olszewski with his team. It was in 1972. Not until 15 years later, in 1987, did Stanislaw Zielinski in Szczecin and Marian Pardela in Katowice make an attempt of transplanting liver in humans. In 1989, the attempt was made by Jacek Pawlak and Marek Krawczyk in Warsaw. The first successful liver transplantation in Poland was performed by Piotr Kalicinski at the Children's Memorial Health Institute, Warsaw. Also, in early 1990s the attempts were made by Jerzy Polanski in Warsaw and Piotr Szyber in Wroclaw. In the next years, liver transplantations were connected with three centers in Szczecin and were associated with the following persons: Roman Kostryka, Maciej Wójcicki and Samir Zeaira. In Warsaw, 1994, Jacek Pawlak, Bogdan Michalowicz and Krzysztof Zieniewicz performed another successful liver transplantation. The program started to develop rapidly and is still up and running. In 2000, Wojciech Rowinski and Marek Pacholczyk created another liver transplant center in Warsaw, while in 2005 Lech Cierpka and Robert Król did the same in Katowice. In the following years, liver transplantation was initiated by Maciej Slupski in Bydgoszcz (2017) and Zbigniew Sledzinski in Gdansk (2018). In the developing liver transplant centers, an exceptional contribution was made by Pawel Nyckowski, Jacek Pawlak, Krzysztof Zieniewicz, Waldemar Patkowski, Tadeusz Wróblewski, Rafal Paluszkiewicz, Marek Pacholczyk, Andrzej Chmura, Maciej Kosieradzki and Marek Krawczyk - all employees of the Medical University of Warsaw. In Wroclaw, Dariusz Patrzalek and Pawel Chudoba were very active in the field of liver transplantations. In 1996, the Organizing-Coordinating Center for Transplantation POLTRANSPLANT was brought to life. It was directed by Janusz Walaszewski, then by Roman Danielewicz and Artur Kaminski. In 1999, Piotr Kalicinski and Marek Krawczyk started the program for liver fragment harvesting and transplantation from living donors. Until the end of 2016, 4186 liver transplantations including 314 liver transplants from living donors were performed in Poland. Currently, the active centers are three centers from Warsaw, namely Pediatric Surgery and Transplantation Surgery, Children's Memorial Health Institute; Department of General, Transplant and Liver Surgery, Medical University of Warsaw; Department of General and Transplant Surgery, Medical University of Warsaw. Other active centers include Department of General and Transplant Surgery, Provincial Hospital in Szczecin, Department of General, Vascular and Transplant Surgery, Medical University of Silesia, Katowice, Department of Vascular, General and Transplant Surgery in Wroclaw. Liver transplant programs have also been initiated at the Department of Liver and General Surgery, Bydgoszcz, and Department of General, Endocrine and Transplant Surgery, Medical University of Gdansk.