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Background:Activation of the Wnt/β-catenin signaling pathway is implicated in thyroid tumorigenesis, and up to 90% of papillary thyroid cancer (PTC) demonstrate aberrant expression of β-catenin. Nonsteroidal antiinflammatory drugs reverse aberrant β-catenin expression and localization in colon cancer. In this study, we tested the hypothesis that the nonsteroidal antiinflammatory drug sulindac would reverse aberrant β-catenin activity in thyroid cancer cells.Methods:β-catenin protein levels were determined in thyroidectomy specimens from six consecutive patients and in three different thyroid cancer cells lines (8505-C, KTC-1, and TPC-1) by immunoblotting. Cells of 8505-C and KTC-1 harbor the BRAFV600Emutation, and TPC-1 has the RET/PTC rearrangement. All cell lines were treated with sulindac (100 μM for up to 72 hours). Protein levels of c-myc and cyclin D1 were detected by immunoblotting, and β-catenin localization was determined by immunocytochemistry in the PTC cell lines. PCCL3 rat thyroid cells that conditionally overexpress either BRAFV600Eor RET/PTC were also treated with sulindac.Results:All PTC specimens and cell lines expressed high levels of β-catenin protein and displayed aberrant nuclear and cytoplasmic localization of β-catenin. Exposure to sulindac for 48 hours reduced β-catenin expression in 8505-C and KTC-1 cells, but not in TPC-1 cells. Further, sulindac treatment reduced c-myc and cyclin D1 levels in 8505-C and KTC-1 cells, but had no effect in TPC-1 cells. Immunocytochemistry demonstrated that sulindac treatment redistributed β-catenin from the nucleus to the membrane in 8505-C and KTC-1 cells. However, sulindac did not affect β-catenin localization in TPC-1 cells. Finally, sulindac was effective in decreasing β-catenin expression and cellular proliferation in BRAFV600E-overexpressing cells, but not in RET/PTC3-overexpressing cells.Conclusions:Taken together, our findings demonstrate that sulindac treatment reverses β-catenin activity in 8505-C and KTC-1 cell lines with the BRAFV600E, but not in TPC-1 cells with the RET/PTC mutation. Future studies should investigate the potential for β-catenin-directed therapy for patients with advanced thyroid cancers. [ABSTRACT FROM AUTHOR]

Abstract Glucagon-like peptide 2 (GLP-2) is a 33-amino acid gut peptide that leads to villus hyperplasia and altered gene expression.We examined the effect of chronically administered GLP-2 on diurnal gene expression rhythms using the Na+/glucose cotransporter 1 (SGLT1) as the index. Animals were treated with [Gly2]GLP-2 (twice daily; 1µg/g body weight) or vehicle (control) for 10 days. Rats were killed at either 3 hr or 9 hr after light onset (ZT3 and ZT9, respectively), an interval during which SGLT1 expression exhibits a robust induction. SGLT1 mRNA expression was assessed by Northern blotting and in situ hybridization. SGLT1 protein was examined by immunofluorescence and Western blotting. Tissues from GLP-2-treated rats had increased villus height, crypt depth, and proliferation index (P < 0.05). GLP-2 administration did not alter the diurnal increase in mRNA levels of SGLT1, GLUT2, or GLUT5. However, in GLP-2-treated rats, the SGLT1 protein amount increased at both ZT3 and ZT9. Moreover, SGLT1 was preferentially localized to the apical membranes in this group. GLP-2 does not adversely affect the diurnal expression rhythm of SGLT1 and appears to increase membrane expression of the protein. These biological actions of GLP-2 may contribute to its therapeutic value in intestinal diseases. [ABSTRACT FROM AUTHOR]

OBJECTIVETo determine the impact of work hour limitations imposed by the 405 (Bell) Regulations as perceived by general surgery residents in New York State.SUMMARY BACKGROUND DATANew Accreditation Council for Graduate Medical Education (ACGME) requirements on resident duty hours are scheduled to undergo nationwide implementation in July 2003. State regulations stipulating similar resident work hour limitations have already been enacted in New York.METHODSA statewide survey of residents enrolled in general surgery residencies in New York was administered.RESULTSMost respondents reported general compliance with 405 Regulations in their residency programs, a finding corroborated by reported work hours and call schedules. Whereas a majority of residents reported improved quality of life as a result of the work hour limitations, a substantial portion reported negative impacts on surgical training and quality and continuity of patient care. Negative perceptions of the impact of duty hour restrictions were more prevalent among senior residents and residents at academic medical centers than among junior residents and residents at community hospitals.CONCLUSIONSImplementation of resident work hour limitations in general surgery residencies may have negative consequences for patient care and resident education. As surgical residency programs develop strategies for complying with ACGME requirements, these negative consequences must be addressed. [ABSTRACT FROM AUTHOR]

Objective: Concerns exist about clinical and operative skill decay in surgery residents when they dedicate time away from clinical training to pursue research. However, it remains undetermined how to best prevent these negative impacts. Our study evaluated the perspectives of surgical research residents on interventions to improve their reentry into clinical training., Design, Setting, and Participants: An anonymous web-based survey was distributed between 5/01/2023 and 6/01/2023 to 102 current and former (within the previous 3 years) general surgery research residents from 4 academic medical centers in Boston, MA., Results: Survey response rate was 35.3% (36/102 residents). About 22 of 36 residents (61.1%) felt that their clinical aptitude decreased during the research years, whereas 33 of 36 (91.7%) reported reduced surgical skills. When reflecting on their re-entry to residency, former research residents reported feeling anxious and less confident (3.84/5 on a 1-5 Likert scale) as well as being below the expected level of clinical performance (3.42/5). Most of them (12 of 17; 70.6%) reported that it took up to 6 months, whereas 5 of them (29.4%) up to 12 months to feel at the expected level. When compared to nonmoonlighting residents, those who moonlighted often and operated during moonlighting, denied a decrease in clinical and surgical skills, and reported less anxiety, higher confidence, and a quicker return to the expected level of performance. Interventions proposed for improving their clinical re-entry included individualized development plans for 3 months before returning to clinical training, established curriculum for clinical work throughout the research years, clinical preceptorships throughout the research years, and simulation curriculum throughout the research years., Conclusions: General surgery residents feel that their clinical and surgical skills decreased during the research years, leading to anxiety and lack of confidence when returning to residency. Therefore, comprehensive interventions are needed to improve the reentry of the research residents into clinical training., (Copyright © 2024 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.)

Introduction: There are increasing concerns regarding resident autonomy in the context of efficiency, legal ramifications, patient expectations and patient safety. However, autonomy is necessary to develop competent, independent surgeons. Therefore, educational paradigms that maximize opportunities for entrustability without sacrificing patient safety are necessary to ensure adequate training for surgeons., Methods: This is a prospective, qualitative study of intraoperative role reversal between surgeons and residents. Using Likert scales and binary questions, preintervention and postintervention surveys were collected, evaluating variables including intraoperative learning, decision making, communication, confidence, autonomy and opportunity for safe struggle. The Mann-Whitney U test was used to analyze results and compare responses between training years., Results: Thirty-six general surgery residents comprising post-graduate year 1, 2, 4, and 5 acted as primary surgeon in a total of 36 cases. Preoperative knowledge scores were significantly higher in more senior residents (P < 0.001), but all residents had significant improvement in knowledge scores postoperatively (P < 0.001). The knowledge improvement was quantitatively larger for junior versus senior residents. Intraoperative decision making significantly improved after the intervention for all training levels (P < 0.001). 25 intraoperative "rescues" were performed by faculty for failure to progress or unsafe conditions (23 for junior residents, 2 for senior residents). Residents indicated that this intraoperative role reversal improved preparation, confidence, autonomy, and intraoperative communication., Conclusions: Intraoperative role reversal between residents and surgeons provides a safe opportunity for maximizing learning and increasing entrustability under direct supervision., (Published by Elsevier Inc.)

Background: Our study evaluated general surgery resident indebtedness and perspectives on financial compensation., Methods: In May 2020, a survey was distributed nationwide by general surgery program directors in the Association of Program Directors in Surgery on a voluntary basis to their residents., Results: The survey was completed by 419 general surgery residents. Median salary was $60-65 K and median medical educational debt was $200-250 K. Approximately 61% of residents reported that their financial needs were not met by their income. Most residents (76%) believe that for a fair compensation, their salaries should be 30-50% higher. Proposed interventions for improvement in resident compensation included: overtime payment, redirection of GME funds to the residency programs, and compensating residents for billable services., Conclusions: Residents enter training with significant medical educational debt and feel unfairly compensated for their work. Therefore, comprehensive interventions with input from residents are needed to improve their financial well-being., (Published by Elsevier Inc.)

Background: Given the importance of operative documentation, we reviewed operative notes for surgeries that required splenic flexure mobilization (SFM) to determine their accuracy. Materials and Methods: We performed a retrospective review of 51 operative notes for complete SFMs performed at a single institution from January 2015 to June 2020. Results: None of the operative notes reported a rationale for performing SFM, use of preoperative imaging to guide technical approach, reasoning for the operative method and mobilization approach used, or specific steps taken to ensure that SFM was done safely. Most reports did not include technical details, with one-third of the notes merely reporting that "the splenic flexure was mobilized." Conclusions: Increased awareness about the lack of operative documentation of the critical aspects of the SFM could stimulate initiatives to standardize the SFM method and improve the quality of operative notes for SFM.

Background: Given the lack of empiric recommendations for vascular access for palliative chemotherapy, we aimed to analyze survival and complications after placement of central venous access ports for palliative chemotherapy., Methods: We performed a retrospective chart review of 135 patients undergoing port placement for palliative chemotherapy at a single institution from January 2015 - July 2020., Results: The median age was 68 (range 47-91). Median overall survival was 7.7 months (95% CI, 6.5-8.9 months). The rate of port-related complications was 11.1% (15 of 135). Patients who developed port-related complications required corrective surgery in 73.3% (11 of 15) of cases. Results were similar among all patients, regardless of their primary diagnoses or central venous access sites., Conclusions: Increased awareness about the limited survival of patients after port placement for palliative chemotherapy, and their significant complication risk could be used to help patients and their providers make value-aligned decisions about vascular access.

Background: New surgeons are faced with inadequate mentoring when first entering practice. Our study examined challenges faced by young surgeons during their transition in practice and their mentoring experience when entering practice., Methods: An article-based survey was mailed in August 2019 to general, colorectal, vascular, and cardiothoracic surgeons that became members of the American College of Surgeons within the past 5 years., Results: A total of 853 of 2,915 surveys were completed (29.3% response rate). Both female (38%) and male (62%) surgeons participated. The 3 most common challenges during the transition to practice were confidence building (26.0%), adjusting to a new institutional culture (16.9%), and business and administrative aspects of practice (16.3%). First job attrition rate 44.2%, with the mean duration of the first job being 3.28 ± 0.17 years. Nearly one-third (28.3%) of respondents were not mentored when they first entered practice. The proportion of nonmentored young surgeons leaving their first job (64.3%) was almost twice as that of surgeons who received mentoring (36.3%). Furthermore, the mean duration of the first job was significantly shorter in nonmentored versus mentored surgeons (3.16 ± 0.26 vs 3.76 ± 0.25 years; P < .05). A significant number (43.3%) of respondents reported a desire to be mentored by retired surgeons., Conclusion: Our survey highlights the importance of mentoring for young surgeons during their transition into practice. With many young surgeons being enthusiastic about mentoring by retired surgeons, specific programs are necessary to better use their expertise., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Background: The face mask has been used to protect against airborne diseases throughout history. We conducted a historical review of the literature on the origin of the face mask, the scientific evidence of its benefits, and its implications for domestic and international politics. Material and Methods: We performed a comprehensive search for peer- and nonpeer- reviewed literature published between 1905 and 2020. Results: Face mask wearing in hospital settings to prevent disease transmission from health care workers to their patients originates with the first use of the mask in surgery in 1897 by German surgeon Johann von Mikulicz. During the first half of the 20th century, various scientific investigators focused on determining the most effective type of medical mask. The role of the face mask in the general population as a preventive intervention during public health emergencies is supported by historical reports spanning from the European Bubonic Plague in 1619, to the Great Manchurian Plague of 1910-1911, the influenza pandemic of 1918, and the current coronavirus disease in 2019 (COVID-19) pandemic. Although the face mask has helped against airborne disease transmission, its benefits during pandemics have been filtered through the prism of political leanings and geopolitical interests. Conclusions: Our review suggests that while face mask alone cannot stop pandemics, in conjunction with other nonpharmacologic interventions it can be useful in mitigating them. When cooperation rather than division becomes the norm in the global response to pandemics, the face mask can then unite rather than divide us.

Objective: Our study evaluated the willingness of retired surgeons to mentor newly trained surgeons., Summary Background Data: Although mentoring is very important during the transition in practice, many novice surgeons are faced with inadequacy or lack of mentoring., Methods: A survey regarding mentorship of new surgeons was sent in April 2018 to retired general, colorectal, vascular, and cardiothoracic surgeons that are members of the American College of Surgeons. The analysis of the data was performed in September 2018 and October 2018., Results: A total of 2295 of 5282 surveys were completed (43.4% response rate). Mean age was 79.0 ± 0.8 years, mean retirement age was 63.9 ± 0.1 years, and mean interval since retirement was 15.2 ± 0.9 years. Most retired surgeons were in private practice (66.4%), with other practice environments, including academic teaching hospital (12%), academic/private combination (11.3%), employment by community hospital or health system (6.4%), veteran affairs institution (2.7%), military hospital (1%), and Indian Health Service (0.09%). Approximately a third (31.1%) of respondents were not mentored when they first entered practice. The vast majority (98.3%) of participants considered mentoring beneficial during transition in practice. More than half (51.2%) of retired surgeons are interested in mentoring recently trained surgeons, with most of them (81.8%) willing to mentor even for free., Conclusion: Our findings suggest that a significant number of retired surgeons are enthusiastic about mentoring young surgeons during their transition in practice. Specific programs are necessary to meet the needs of newly hired surgeons and better utilize the expertise of retired surgeons., Competing Interests: The authors report no conflicts of interest., (Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.)

Background: With increased attention on the federal budget deficit, graduate medical education (GME) funding has in particular been targeted as a potential source of cost reduction. Reduced GME funding can further deteriorate the compensation of physicians during their residency training., Methods: In order to understand the GME funding mechanisms and current challenges, as well as the value of the work accomplished by residents, we searched peer-reviewed, English language studies published between 2000 and 2019., Results: Direct and indirect GME funding is intended to support resident reimbursement and the higher costs associated with supporting a teaching program. However, policy efforts have aimed to reduce federal funding for GME. Furthermore, evidence suggests that residents are inadequately compensated because their salaries do not reflect the number of hours worked and are not comparable to those of other medical staff., Conclusions: Our review suggests that creative solutions are needed to diversify GME funding and improve resident compensation., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Objective: This study aimed to determine the challenges faced by surgical trainees during their internship and to explore their experience with mentoring., Design: An internet-based survey comprised of 30 questions was distributed to 59 surgical interns to evaluate their internship experience at the conclusion of the academic year 2018 to 2019., Setting: Four academic medical centers in Boston, Massachusetts., Participants: Both preliminary as well as categorical general surgery interns were included in the study. Twenty-five responses were received (response rate of 42.4%)., Results: The majority of surgical interns (80%) reported having a mentor during their intern year. Gender as well as mentor career status/prestige were both the highest rated factors in selection of a mentor, (4.67/5 and 4.33/5 respectively). Mentoring topics varied by the career status of the mentor, with most surgical interns (80%) selecting senior faculty members for mentoring on career planning, clinical training, and research. Surgical interns relied only on junior faculty members to discuss work-life integration. Very few surveyed interns (only 1 in 10) discussed work-life integration with their mentors despite this being reported as the most significant challenge of their internship year. Only 15% of the interns reported that the effectiveness of the mentor-mentee relationship was reviewed by program administration. About one third (30%) of interns reported that they would not feel comfortable reporting a failed mentorship to their program director. Furthermore, 40% of the surgical interns were not given an option to choose a new mentor in case of failed mentoring., Conclusions: Surgical interns report high work demands and challenges with worklife integration in their first year of surgical training, however only a small minority of interns discuss this with their mentors. Surgical residency programs should better supervise and adjust mentoring of surgical interns in order to maximize their performance and wellness., (Copyright © 2020 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.)

Background: The coronavirus disease 2019 pandemic has negatively affected the training of general surgery chief residents during the last trimester of their residency. Our goal was to evaluate the educational concerns of graduating general surgery chief residents during the coronavirus disease 2019 pandemic., Methods: An anonymous web-based survey was distributed between March 31 and April 7, 2020 to all current general surgery chief residents from 6 academic medical centers in Boston, Massachusetts. Interviews were also conducted with attending surgeons from participating institutions., Results: A total of 24 of 39 general surgery chief residents participated in our survey (61.5% response rate). General surgery chief residents were most concerned about the potential delay in the date of board examinations, followed by not feeling adequately prepared for the board examinations and a possible delay in the graduation date. Whereas not having enough cases to feel ready for fellowship or job and not achieving a sufficient number of cases to meet the requirements for graduation were only moderately concerning to chief residents, attending surgeons stressed a greater importance on the loss of the operative experience as nearly all (93.3%) of them suggested a personalized approach for additional general surgery training during fellowship or job onboarding., Conclusion: In addition to the dramatic impact on public health, the coronavirus disease 2019 outbreak has also caused unprecedented changes to surgical education. Therefore, creative interventions are needed to help general surgery chief residents successfully transition into the next phase of their surgical career., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Objective: The purpose of this study was to determine the concerns of General Surgery residents as they prepare to be in the frontlines of the response against coronavirus disease 2019 (COVID-19&#95;)., Design, Setting, and Participants: A qualitative study with voluntary dyadic and focus group interviews with a total of 30 General Surgery residents enrolled at 2 academic medical centers in Boston, Massachusetts was conducted between March 12 to 16, 2020., Results: The most commonly reported personal concern related to the COVID-19 outbreak was the health of their family (30 of 30 [100%]), followed by the risk of their transmitting COVID-19 infection to their family members (24 of 30 [80%]); risk of their transmitting COVID-19 infection their patients (19 of 30 [63%]); anticipated overwork for taking care of a high number of patients (15 of 30 [50%]); and risk of their acquiring COVID-19 infection from their patients (8 of 30 [27%]) . The responses were comparable when stratified by sex, resident training level, and residency program. All residents self-expressed their readiness to take care of COVID-19 patients despite the risk of personal or familial harm . To improve their preparedness, they recommend increasing testing capacity, ensuring personal protective equipment availability, and transitioning to a shift schedule in order to minimize exposure risk and prevent burnout., Conclusions: General Surgery residents are fully dedicated to taking care of patients with COVID-19 infection despite the risk of personal or familial harm. Surgery departments should protect the physical and psychosocial wellbeing of General Surgery residents in order to increase their ability to provide care in the frontlines of the COVID-19 pandemic., (Copyright © 2020 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.)

Introduction: With the fragmented rotational structure of training, exposure to surgical staplers is not uniform across surgical residents. Traditionally, educational sessions dedicated to instruction in surgical staplers have taken place outside the operating room. This study implemented and evaluated an intraoperative timeout immediately prior to stapler use in cases with surgical residents., Methods: During general surgery cases from June 1, 2017 until December 31, 2017, surgical teams, including the surgical attending, surgical resident, and scrub nurse participated in an intraoperative instructional timeout, during which proper use of linear or circular staplers was reviewed. At the conclusion of the timeout, residents were required to demonstrate proper stapler assembly and verbalize all technical steps involved in stapler use. Duration of each timeout was recorded. Immediately following the case, a pre-post survey was administered to each participating junior (R1-R2) or senior (R4-R5) surgical resident. The primary outcome was change in stapler use knowledge by surgical residents. Survey questions with Likert scale responses were analyzed using paired ttests, and responses from junior residents were compared to those from senior residents with independent t tests., Results: Forty-three general surgery cases involved stapler use during the study period and implemented an intraoperative instructional timeout. The educational intervention increased stapler use knowledge significantly in all surgical residents. Prior to the timeout, junior residents reported significantly higher anxiety related to stapler usage compared to their senior counterparts; anxiety scores in junior residents decreased significantly for use of both linear and circular staplers. The mean timeout duration was 2.9 minutes (standard deviation 0.9 minutes, range 1.2-4.6 minutes). All participating surgical residents recommended routine implementation of an instructional timeout prior to intraoperative stapler use., Conclusions: An intraoperative timeout dedicated to stapler teaching is effective in increasing proficiency and easing anxiety in all levels of surgical residents. Further research is warranted to determine whether this educational intervention would translate into fewer stapler use errors and decreased intraoperative complications., (Copyright © 2019 Association of Program Directors in Surgery. All rights reserved.)

Background: The present study was designed to implement and evaluate an interprofessional surgical technologist-to-surgical resident training program for junior general surgery residents aimed at enhancing their operating room skills. This program would be incorporated into the general surgery educational curriculum., Material and Methods: Under the guidance and supervision of a surgical technologist, first-year and second-year general surgery residents performed the perioperative and intraoperative tasks that are the responsibilities of the surgical technologist for 16 inguinal/umbilical hernia and 15 laparoscopic appendectomy/cholecystectomy operations performed by attending surgeons assisted by other surgical residents from June 01, 2017 until December 31, 2017. A pretraining and post-training survey comprised 25 ranked questions (using a four-point Likert scale), and four Yes/No questions were administered to volunteer general surgery residents., Results: Paired t-test analysis showed that playing the role of the surgical technologist by the junior surgery residents significantly improved (P < 0.0001) their assessment of operating room technical skills (knowledge and skills to prepare for the case and maintain a sterile field, understanding of the operative steps, knowledge of surgical instruments and their handling) as well as their nontechnical skills (situational awareness, understanding the importance of collaboration, teamwork, and communication). The answers to the binary Yes/No questions showed that all participating residents expect to use the experience gained from this training, would recommend this training session to a colleague, and support including this training session in their educational curriculum., Conclusions: The findings of this study suggest a significant educational benefit of incorporating interprofessional, surgical technologist-to-surgical resident training into the educational curriculum of the junior general surgery residents., (Copyright © 2019 Elsevier Inc. All rights reserved.)