Representation of online LGBTQ+ support in general surgery residency programs.

BACKGROUND: Lesbian, Gay, Bisexual, Transgender, Queer, and more(LGBTQ+) trainees are underrepresented in medicine, and their experiences in surgery have not been well studied. We sought to examine the practices of general surgery residency programs by region regarding representation of LGBTQ+ â€‹support online. METHODS: Retrospective, two-person review of 100 general surgery residency programs stratified by Electronic Residency Application Service(ERAS) region comparing data on Diversity, Equity, and Inclusion(DEI) and LGBTQ+ â€‹-specific webpages. RESULTS: The Middle Atlantic and South Atlantic regions had 20% of programs each, with fewer programs found in other regions. Of the 100 institutions, 92% had DEI webpages, and 43% had LGBTQ+ â€‹-specific webpages. There was a significant difference in the likelihood of a program being an Human Rights Campaign(HRC) LGBTQ+ â€‹leader when compared by region(p â€‹< â€‹0.01). CONCLUSIONS: Few general surgery residency programs share LGBTQ+-specific DEI content online with no regional difference observed. Recommendations such as updating websites to highlight LGBTQ+ â€‹inclusion should aid recruitment of a diverse, surgical residency as well as create a welcoming environment for prospective residents.

Factors affecting timing of surgery following neoadjuvant chemoradiation for esophageal cancer.

Background: Neoadjuvant chemoradiation with esophagectomy is standard management for locally advanced esophageal cancer. Studies have shown that surgical timing following chemoradiation is important for minimizing postoperative complications, however in practice timing is often variable and delayed. Although postoperative impact of surgical timing has been studied, less is known about factors associated with delays. Materials and methods: A retrospective review was performed for 96 patients with esophageal cancer who underwent chemoradiation then esophagectomy between 2018 and 2020 at a single institution. Univariable and stepwise multivariable analyses were used to assess association between social (demographics, insurance) and clinical variables (pre-operative weight, comorbidities, prior cardiothoracic surgery, smoking history, disease staging) with time to surgery (≤8 weeks "on-time" vs. >8 weeks "delayed"). Results: Fifty-one patients underwent esophagectomy within 8 weeks of chemoradiation; 45 had a delayed operation. Univariate analysis showed the following characteristics were significantly different between on-time and delayed groups: weight loss within 3 months of surgery (3.9 ± 5.1 kg vs. 1.5 ± 3.6 kg; P = 0.009), prior cardiovascular disease (29% vs. 49%; P = 0.05), prior cardiothoracic surgery (4% vs. 22%; P = 0.01), history of ever smoked (69% vs. 87%; P = 0.04), absent nodal metastasis on pathology (57% vs. 82%; P = 0.008). Multivariate analysis demonstrated that prior cardiothoracic surgery (OR 8.924, 95%CI 1.67-47.60; P = 0.01) and absent nodal metastasis (OR 4.186, 95%CI 1.50-11.72; P = 0.006) were associated with delayed surgery. Conclusions: Delayed esophagectomy following chemoradiotherapy is associated with prior cardiothoracic surgery and absent nodal metastasis. Further investigations should focus on understanding how these factors contribute to delays to guide treatment planning and mitigate sources of outcome disparities.

The Selective Monobromination of a Highly Sterically Encumbered Corrole: Structural and Spectroscopic Properties of Fe(Cl)(2-Bromo-5,10,15-tris(triphenyl)phenyl corrole).

The corrole ligand serves as a versatile tri-anionic, macrocyclic platform on which to model biological catalytic systems, as well as to effect mechanistically challenging chemical transformations. Here in we describe the synthesis, structure, and characterization of an isomerically pure corrole ligand, selectively mono-brominated at the ß-carbon position adjacent to the corrole C-C bond (2-C) and produced in relatively high yields, as well as its iron chloride complex. Analysis of the iron metalated complex by cyclic voltammetry shows that the bromine being present on the ligand resulted in anodic shifts of +93 and +63 mV for first oxidation and first reduction of the complex respectively. The Mossbauer spectrum of the iron metalated complex shows negligible change relative to the non-brominated analog, indicating the presence of the halide substituent predominantly effects the orbitals of the ligand rather than the metal.

Novel Direct Annuloplasty Fastener System for Minimally Invasive Mitral Valve Repair.

The development of less invasive approaches for mitral valve repair remains an important objective, particularly in patients with multiple comorbidities. We describe a novel method to affix a mitral valve annuloplasty ring in a minimally invasive manner. A delivery apparatus for an annuloplasty fastener system was designed. Two channels were created, one for advancing the annuloplasty ring, and another to accommodate the fastener applicator. Custom designed fasteners, either with a helical-shaped screw or a strap-shaped tack structure, were tested. Fasteners were primed within an application device and automatic alignment of fasteners was achieved to allow accurate firing of the fixators securing the ring. The delivery apparatus was constructed to be deployed within a 10 mm trocar through a left atrial approach. Using a cadaveric swine heart model, access to the mitral valve from the left atrium was obtained with insertion of a trocar. The delivery apparatus was accurately directed to the mitral annulus under echocardiographic guidance. Fasteners were placed along the annular plane to secure the annuloplasty ring. Both fastener designs achieved considerable fixation force; the helical-shaped screw was found to have significantly greater fixation force compared to the strap-shaped tack design. The annuloplasty ring remained intact and did not experience any structural deformity during the fixation process. The use of a novel fastener system was successful in deploying and securing a mitral valve annuloplasty ring. These promising results may have further application for minimally invasive mitral valve repairs. Additional evaluation of this procedure with pre-clinical in vivo animal studies is necessary.

Routine Use of Topical Bacitracin to Prevent Sternal Wound Infections After Cardiac Surgery.

BACKGROUND: The development of sternal wound infections remains a serious complication after cardiac surgery. A number of studies have assessed the use of topical antibiotics placed on the sternal edges. We evaluated the routine use of bacitracin ointment applied over the sternotomy skin incision as a prophylactic measure against sternal wound infections. METHODS: A retrospective review of all coronary artery bypass graft and valve surgery cases performed at a single institution between 2006 and 2015 was performed (n = 1,495). Appropriate preoperative intravenous antibiotics were administered for all patients. Bacitracin topical antibiotic ointment was routinely applied to the sternal surgical incision after skin closure for all patients during this period. The incidence of sternal wound infection was assessed. RESULTS: During this 9-year experience, no episodes of deep sternal wound infections were observed, compared with a predicted rate of 0.29% (interquartile range: 0.19% to 0.46%) based on The Society of Thoracic Surgeons National Database risk calculator. Four episodes of superficial sternal wound infections were noted; gram-positive organisms were cultured in the majority of these cases. Bacitracin ointment was well tolerated by patients, with no serious adverse effects reported. CONCLUSIONS: This study suggests that the routine application of topical bacitracin over the surgical skin incision is safe after cardiac surgery. Deep sternal wound infections were notably absent during this period. As a readily available and inexpensive therapy, this simple intervention may be a useful adjunct strategy in preventing sternal wound infections.