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The Society for Pediatric Anesthesia launched the Women's Empowerment and Leadership Initiative (WELI) in 2018 to empower highly productive women pediatric anesthesiologists to achieve equity, promotion, and leadership. WELI is focused on six career development domains: promotion and leadership, networking, conceptualization and completion of projects, mentoring, career satisfaction, and sense of well-being. We sought feedback about whether WELI supported members' career development by surveys emailed in November 2020 (baseline), May 2021 (6 months), and January 2022 (14 months). Program feedback was quantitatively evaluated by the Likert scale questions and qualitatively evaluated by extracting themes from free-text question responses. The response rates were 60.5% (92 of 152) for the baseline, 51% (82 of 161) for the 6-month, and 52% (96 of 185) for the 14-month surveys. Five main themes were identified from the free-text responses in the 6- and 14-month surveys. Members reported that WELI helped them create meaningful connections through networking, obtain new career opportunities, find tools and projects that supported their career advancement and promotion, build the confidence to try new things beyond their comfort zone, and achieve better work-life integration. Frustration with the inability to connect in-person during the coronavirus-19 pandemic was highlighted. Advisors further stated that WELI helped them improve their mentorship skills and gave them insight into early career faculty issues. Relative to the baseline survey, protégés reported greater contributions from WELI at 6 months in helping them clarify their priorities, increase their sense of achievement, and get promoted. These benefits persisted through 14 months. Advisors reported a steady increase in forming new meaningful relationships and finding new collaborators through WELI over time. All the members reported that their self-rated mentoring abilities improved at 6 months with sustained improvement at 14 months. Thus, programs such as WELI can assist women anesthesiologists and foster gender equity in career development, promotion, and leadership.

Promoting and retaining junior faculty are major challenges for many medical schools. High clinical workloads often limit time for scholarly projects and academic development, especially in anesthesiology. To address this, we created the East/West Visiting Scholars in Pediatric Anesthesia Program (ViSiPAP). The program's goal is to help "jumpstart" academic careers by providing opportunities for national exposure and recognition through invited lectures and collaborative opportunities. East/West ViSiPAP benefits the participating scholars, the home and hosting anesthesia departments, and pediatric anesthesia fellowship training programs. By fostering a sense of well-being and inclusion in the pediatric anesthesia community, East/West ViSiPAP has the potential to increase job satisfaction, help faculty attain promotion, and reduce attrition. Faculty and trainees are exposed to new expertise and role models. Moreover, ViSiPAP provides opportunities for women and underrepresented in medicine faculty. This program can help develop today's junior faculty into tomorrow's leaders in pediatric anesthesia. We advocate for expanding the concept of ViSiPAP to other institutions in academic medicine.

This review focuses on the literature published from January 2019 to February 2020 that is of interest to anesthesiologists taking care of children and adults with congenital heart disease. Five themes are addressed during this time period, and 59 peer-reviewed articles are discussed.

Research has shown that women have leadership ability equal to or better than that of their male counterparts, yet proportionally fewer women than men achieve leadership positions and promotion in medicine. The Women's Empowerment and Leadership Initiative (WELI) was founded within the Society for Pediatric Anesthesia (SPA) in 2018 as a multidimensional program to help address the significant career development, leadership, and promotion gender gap between men and women in anesthesiology. Herein, we describe WELI's development and implementation with an early assessment of effectiveness at 2 years. Members received an anonymous, voluntary survey by e-mail to assess whether they believed WELI was beneficial in several broad domains: career development, networking, project implementation and completion, goal setting, mentorship, well-being, and promotion and leadership. The response rate was 60.5% (92 of 152). The majority ranked several aspects of WELI to be very or extremely valuable, including the protege-advisor dyads, workshops, nomination to join WELI, and virtual facilitated networking. For most members, WELI helped to improve optimism about their professional future. Most also reported that WELI somewhat or absolutely contributed to project improvement or completion, finding new collaborators, and obtaining invitations to be visiting speakers. Among those who applied for promotion or leadership positions, 51% found WELI to be somewhat or absolutely valuable to their application process, and 42% found the same in applying for leadership positions. Qualitative analysis of free-text survey responses identified 5 main themes: (1) feelings of empowerment and confidence, (2) acquisition of new skills in mentoring, coaching, career development, and project implementation, (3) clarification and focus on goal setting, (4) creating meaningful connections through networking, and (5) challenges from coronavirus disease 2019 (COVID-19) and the inability to sustain the advisor-protege connection. We conclude that after 2 years, the WELI program has successfully supported career development for the majority of proteges and advisors. Continued assessment of whether WELI can meaningfully contribute to attainment of promotion and leadership positions will require study across a longer period. WELI could serve as a programmatic example to support women's career development in other subspecialties.

Electronic cigarettes (e-cigarettes) or vaping use in adolescents has emerged as a public health crisis that impacts the perioperative care of this vulnerable population. E-cigarettes have become the most commonly used tobacco products among youth in the United States. Fruit and mint flavors and additives such as marijuana have enticed children and adolescents. E-cigarette, or vaping, product use-associated lung injury (EVALI) is a newly identified lung disease linked to vaping. Clinical presentation of EVALI can be varied, but most commonly includes the respiratory system, gastrointestinal (GI) tract, and constitutional symptoms. Clinical management of EVALI has consisted of vaping cessation and supportive therapy, including supplemental oxygen, noninvasive ventilation, mechanical ventilation, glucocorticoids, and empiric antibiotics, until infectious causes are eliminated, and in the most severe cases, extracorporeal membrane oxygenation (ECMO). Currently, although there is an insufficient evidence to determine the safety and the efficacy of e-cigarettes for perioperative smoking cessation, EVALI clearly places these patients at an increased risk of perioperative morbidity. Given the relatively recent introduction of e-cigarettes, the long-term impact on adolescent health is unknown. As a result, the paucity of postoperative outcomes in this potentially vulnerable population does not support evidence-based recommendations for the management of these patients. Clinicians should identify "at-risk" individuals during preanesthetic evaluations and adjust the risk stratification accordingly. Our societies encourage continued education of the public and health care providers of the risks associated with vaping and nicotine use and encourage regular preoperative screening and postoperative outcome studies of patients with regard to smoking and vaping use.

There are more adults living with congenital heart disease than children. Many of these adults with congenital heart disease (ACHD) will require a surgery or intervention, which may or not be related to their congenital heart disease (CHD). The successful anesthetic management of adults with CHD requires a stepwise approach to consider all the relevant factors. The perioperative management of ACHD patients requires a multidisciplinary team collaboration, and those with complex lesions should be cared for in centers with experience in CHD.

Children with suspected pulmonary hypertension must undergo extensive and invasive evaluations to establish a definitive diagnosis. A previously healthy 4-year old girl, newly diagnosed with suprasystemic pulmonary hypertension required multiple lung biopsies. Each procedure was associated with significant bleeding. The challenging anesthetic management of lung biopsy in the presence of suprasystemic pulmonary hypertension is described.

Delayed presentation of coarctation of the aorta can be associated with severe complications. A challenging case of aortoenteric fistula secondary to an aneurysm from coartation of the aorta presented with massive gastrointestinal hemorrhage. The clinical management of this patient and a review of the literature are presented.

Dexmedetomidine is a selective α-2 receptor agonist with a sedative and cardiopulmonary profile that makes it an attractive anesthetic for pediatric patients with congenital heart disease (CHD). Although several smaller, single-center studies suggest that dexmedetomidine use is gaining traction in the perioperative setting in children with CHD, there are limited multicenter data, with little understanding of the variation in use across age ranges, procedural complexity, and centers. The aim of this study was to use the Congenital Cardiac Anesthesia Society-Society of Thoracic Surgeons (CCAS-STS) registry to describe patient- and center-level variability in the use of dexmedetomidine in the perioperative setting in children with heart disease.To describe the use of dexmedetomidine in patients for CHD surgery, we analyzed all index cardiopulmonary bypass operations entered in the CCAS-STS database from 2010 to 2013. Patient and operative characteristics were compared between those who received intraoperative dexmedetomidine and those who did not. Selective outcomes associated with dexmedetomidine use were also described.Of the 12,142 operations studied, 3600 (29.6%) received perioperative dexmedetomidine (DEX) and 8542 did not receive the drug (NoDEX). Patient characteristics were different between the 2 groups with the DEX group generally exhibiting both lower patient and procedural risk factors. Patients who received dexmedetomidine were more likely to have a lower level of Society of Thoracic Surgeons mortality complexity than patient who did not receive it. Consistent with their overall lower risk profile, children in the DEX group also demonstrated improved outcomes compared with patients who did not receive dexmedetomidine.We described the growing use of dexmedetomidine in children anesthetized for surgical repair of CHD. Dexmedetomidine appears to be preferentially given to older and larger children who are undergoing less complex CHD surgery. We believe that the data provided in this study are the largest investigating the use of an anesthetic drug in CHD patients. It is also the first analysis of the anesthesia data in the CCAS-STS Congenital Heart Disease database.

Dexmedetomidine is an α-2 agonist with a sedative and cardiopulmonary profile that makes it an attractive anesthetic in pediatric cardiac patients. Cardiac transplant patients may suffer from acute cellular rejection of the cardiac conduction system and, therefore, are at an increased risk of the electrophysiological effect of dexmedetomidine. We present such a patient who had a cardiac arrest while receiving dexmedetomidine during cardiac catheterization. Because acute cellular rejection of the cardiac conduction system is difficult to diagnose, dexmedetomidine should be used with caution in pediatric heart transplant patients.

Plastic bronchitis is potentially a life-threatening complication of long-standing surgically palliated single ventricle congenital heart disease. Patients can present with hypoxia requiring urgent bronchoscopy for removal of bronchial casts. Perioperative care for these patients is challenging and anesthesia is associated with significant cardiac risk. As more surgically corrected single ventricle patients survive to adulthood, these patients are expected to present more frequently. This report details the perioperative management of 2 Fontan patients with hypoxia and significant plastic bronchitis disease burden.

Iron-dextran complex in a concentration of 50 mg. of iron per milliliter was administered intramuscularly to pregnant patients suffering from iron-deficiency anemia as well as to normal nonpregnant women. The preparation was well tolerated and presented no serious side effects. When given to pregnant patients with iron-deficiency anemia, the material caused an average hemoglobin increase of 0.32 Gm. per cent per 100 mg. of iron, and replenished the depleted iron stores, as evidenced by the restoration of normal serum iron levels. Single intramuscular injections of 250 mg. of iron in the dextran complex in normal nonpregnant women gave peak serum iron levels in approximately 24 hours with a gradual fall to normal in approximately one week.

Four cases of ulcerative colitis associated with antibody-coated red cells are presented. The clinical, hematologic and immunologic findings are discussed. One of the patients had overt hemolytic anemia of the acquired autoimmune variety. It was not possible to assess the role played by hemolysis in the anemia presented by the other three patients. The occurrence of antibody-coated red cells in ulcerative colitis appears to be related to the underlying intestinal disorder, and particularly to the presence of diseased bowel, although it is not necessarily related to the clinical activity of the colitis. The possibility of an autoimmune hemolytic process should be considered in the pathogenesis of anemia in ulcerative colitis.

Forty-two patients with various diseases of leukocytic proliferation were treated with one or more courses of adrenocorticotropic hormone or cortisone. Of 13 patients with acute or subacute lymphocytic leukemia who received adequate courses of treatment, 9 (69 per cent) developed objective and hematologic evidence of well defined remissions. Remissions were, however, brief, lasting one to ten weeks. Retreatments produced further remissions but a state of refractoriness was eventually reached. Of 5 patients with acute granulocytic leukemia only 1 showed a slight clinical improvement with therapy. An actual acceleration of the process occurred in 2 cases. Two cases of monocytic leukemia showed no response and death seemed to be hastened. In 5 cases of chronic lymphocytic leukemia, distinct improvement occurred in 4, particularly in those showing terminal leukemia with anemia, exfoliative dermatitis, or symptomatic hemolytic anemia. All of 5 cases of lymphosarcoma showed some degree of improvement. Features benefited were organ enlargement, symptomatic hemolytic anemia and anemia. In 5 cases of Hodgkin’s disease, 3 were notably benefited particularly with respect to constitutional symptoms. There was, however, no fundamental alteration of the disease process. Only 1 case of 5 with multiple myeloma showed a favorable response. Hyperglobulinemia decreased to a variable extent in all cases, as did Bence-Jones proteinuria. The characteristics of remission including reticulocytosis, thrombocytosis, white cell response and marrow picture are detailed. The effect of ACTH on the level of serum globulins, the activity of abnormal hemagglutinins, and sedimentation rate are likewise discussed. The nonspecific effects of adrenocorticotropic therapy are indicated. Comment is made of the undesirable effects of ACTH therapy. These included psychoses, fluid retention, hypertension, convulsions, porcine, obesity, acne, hirsutes and diabetes mellitus. The therapeutic effectiveness of ACTH is compared with the existing available methods of therapy in the hematologic conditions under discussion.

ACQUIRED hemolytic anemia, in contrast with the hereditary types, is usually due to an "extrinsic" mechanism acting upon normal red blood cells, injuring them and leading to an increased rate of destruction. In many cases, a fundamental pathologic process such as lymphosarcoma or leukemia can be found (symptomatic1 2 3 or secondary types), but most of the cases have no well defined etiology — that is, they are "idiopathic." Whether the anemia is symptomatic or idiopathic, an abnormal antibody can usually be found free in the blood or adsorbed to the red-cell surface. We have postulated that this antibody, which is ordinarily . . .

1. Acid-inactivated yeast invertase could not be regenerated in the presence of the proteolytic enzymes trypsin, pepsin, and chymotrypsin. 2. Certain foreign proteins of non-enzymatic nature partially inhibited the reactivation of acid-inactivated invertase. 3. Certain proteins as gelatin, lacto-globulin, and carbohydrate-free horse crystalbumin did not prevent the reactivation of invertase at all. 4. Highly purified reactivated invertase was shown to exhibit an effect typical of original native invertase; that is, acceleration of its activity in presence of foreign protein at pH 3.0. 5. Native invertase was not digested by trypsin and chymotrypsin. 6. The addition of trypsin and chymotrypsin to reactivating invertase did not affect the invertase which had already reverted to the active form, but prevented further reactivation of inactive invertase.

In 1948, Hargraves, Richmond, and Morton (1) described a new cellular element in the bone marrow of patients with acute systemic lupus erythematosus. This element, referred to as the "L.E. cell," has been confirmed by a number of investigators, and has been suggested as a diagnostic aid (2). The L.E. cell may be formed during the incubation of normal homologous or heterologous leucocytes (3) with the sera of some patients suffering

SummaryAn agglutinin is described which exists in most normal sera and which is capable of agglutinating trypsin modified erythrocytes. By virtue of such action, it resembles the agglutinins active against erythrocytes altered by bacterial filtrates, viruses, and periodate ions. Undiluted serum or serum in weak dilution is able to reverse the activity of this agglutinin. Such a reversal effect is mediated through an altered reactivity of the trypsin treated erythrocytes with respect to the agglutinin described above. No modification of the reactivity of the cells with respect to other agglutinins has been noted. The effect of various physical and chemical agents on the activity of the agglutinin and the agglutination reversal effect is described and the patho-physiological role of the agglutinin is discussed.

Previous reports(1,2) concerning the disappearance of a tracer dose of radioactive iron from the plasma implied a single plasma iron pool with no significant return of radioiron to the plasma during the experimental period of one to 2 hours. Assuming instantaneous mixing following the injection of ferric 59-beta-1 globulinate, as well as a constant relative disappearance rate, the theoretical data could be represented by a single exponential function, i.e., a straight line on semi-log paper. Such a first approximation fitted the experimental data well because of the large errors involved in electroplating(123) and the relatively insensitive counting technics employed(123).Two considerations prompted reevaluation of the above concepts. Firstly, utilizing improved counting technics it was noted that the experimental data were no longer approximated by a straight line when plotted on semilog paper. Re-examination of some of the published data in earlier reports reveals similar findings(1,4). Secondly, the ap...