The Podiatric Medical Profession: A Gender Comparison.

The number of women in podiatric medicine and surgery has increased steadily over the past 4 decades; however, there appears to be a large and continued gender gap with respect to representation in academic medicine and other positions of power. National and state level organizational data were obtained from multiple podiatry professional societies to evaluate the rate at which women achieved leadership roles within the podiatric profession over time. A secondary questionnaire was also developed and electronically mailed to 8684 doctors of podiatric medicine to help capture additional leadership information and to provide further insight into the trends observed. The response rate was 26% (2276/8684). Female representation in academia, research/publications, most leadership positions, and board certifications has increased over time, but at a slower rate than the number of women entering the profession. We observed a decreasing trend of females completing fellowships, speaking at national meetings, becoming residency directors, and receiving American College of Foot and Ankle Surgeons- and American Podiatric Medical Association-sponsored grants/awards. Based on the survey results, female podiatric physicians were more likely to be single, have fewer children, spend more time in a clinical setting, be less satisfied with work, and experience higher work stress levels than their male colleagues. Of the female respondents, 73% described experiencing gender discrimination at some point in their career, and 42% reported experiencing sexual harassment, compared with only 6% and 5% of men, respectively. There continues to be a gender gap in leadership roles, which may be explained partially by work/life balance issues, gender discrimination, and other issues.

Opioid Crisis and Acute Pain Management After Foot and Ankle Surgery.

Opioid abuse has plagued the United States, with a resurgence since the early 2000s. Governmental agencies, pharmaceutical companies, patients, and physicians have all contributed to this crisis. Severe pain has been reported following foot and ankle surgery. There are current national guidelines for chronic opioid prescribing, but guidelines for acute pain have not been established. Prescribing fewer opioids, education on opioid risks, proper disposal of unused medication, and participating in prescription monitoring programs help reduce opioid abuse. Multimodal analgesia is paramount in managing pain while reducing opioid consumption after postoperative foot and ankle surgery.

Women in Podiatry and Medicine.

The role of female physicians has advanced among western medicine. Women now constitute a majority within medical schools, and the number of women in podiatric medicine and surgery has increased over the last 5 decades. Conversely, female physicians continue to face barriers to closing the gender gap. They have lower academic standings and fewer publications, receive less awards/grants, are underrepresented in leadership positions, have a lower incidence pursuing surgical specialties, and receive lower compensation. Women experience an increased rate of burnout, gender discrimination, and sexual harassment. Increasing awareness of the gender gap is vital to the enhancement of the medical community.

Lipocalin-7 is a matricellular regulator of angiogenesis.

BACKGROUND: Matricellular proteins are extracellular regulators of cellular adhesion, signaling and performing a variety of physiological behaviors such as proliferation, migration and differentiation. Within vascular microenvironments, matricellular proteins exert both positive and negative regulatory cues to vascular endothelium. The relative balance of these matricellular cues is believed to be critical for vascular homeostasis, angiogenesis activation or angiogenesis resolution. However, our knowledge of matricellular proteins within vascular microenvironments and the mechanisms by which these proteins impact vascular function remain largely undefined. The matricellular protein lipocalin-7 (LCN7) is found throughout vascular microenvironments, and circumstantial evidence suggests that LCN7 may be an important regulator of angiogenesis. Therefore, we hypothesized that LCN7 may be an important regulator of vascular function. METHODOLOGY AND PRINCIPAL FINDINGS: To test this hypothesis, we examined the effect of LCN7 overexpression, recombinant protein and gene knockdown in a series of in vitro and in vivo models of angiogenesis. We found that overexpression of LCN7 in MB114 and SVEC murine endothelial cell lines or administration of highly purified recombinant LCN7 protein increased endothelial cell invasion. Similarly, LCN7 increased angiogenic sprouting from quiescent endothelial cell monolayers and ex vivo aortic rings. Moreover, LCN7 increased endothelial cell sensitivity to TGF-ß but did not affect sensitivity to other pro-angiogenic growth factors including bFGF and VEGF. Finally, morpholino based knockdown of LCN7 in zebrafish embryos specifically inhibited angiogenic sprouting but did not affect vasculogenesis within injected embryos. CONCLUSIONS AND SIGNIFICANCE: No functional analysis has previously been performed to elucidate the function of LCN7 in vascular or other cellular processes. Collectively, our results show for the first time that LCN7 is an important pro-angiogenic matricellular protein of vascular microenvironments.