Practice Longer and Stronger: Maximizing the Physical Well-Being of Surgical Residents with Targeted Ergonomics Training.

OBJECTIVE: Pain and disability among surgeons can lead to practice restrictions, early retirement, and physician burnout. This project sought to address the physical well-being of surgical residents by teaching ergonomic principles, a "microbreaks" model, and stretching exercises aimed at targeting the four anatomical areas identified as most problematic for surgeons. DESIGN: Three modules, led by physical therapists, were presented to surgical residents over the course of the 2018-2019 academic year. These modules targeted specific problem areas for surgeons according to current literature. A perioperative micro-break model was also presented. Pre- and post-lecture surveys were administered to document pain, applicability of lecture content and effectiveness for use in the operating room (OR), and were reviewed retrospectively. SETTING: Jackson Memorial Hospital, DeWitt Daughtry Family Department of Surgery, Division of General Surgery, Miami, Florida RESULTS: A large number of participants reported pain in one or more body part (87%) prior to beginning this ergonomic training and 39% indicated that this pain was performance-limiting. The majority of residents (93%) who attended Module #3 reported that learning the targeted exercises and microbreaks model would help them physically perform better in the OR and, in fact, after practicing these exercises during this Module, 85% of residents reported decreased pain, especially in the areas of the cervical and lumbar spine. CONCLUSIONS: Preliminary data indicate that this novel curriculum was perceived as valuable by surgical residents and that practicing these targeted exercises reduced pain, particularly in the neck and lower back. Further research is needed to determine the longitudinal effects of this ergonomics curriculum on surgical resident well-being and whether these exercises will be effective in reducing pain and enhancing performance in the OR setting.

Phylogenetic Diversity of Sponge-Associated Fungi from the Caribbean and the Pacific of Panama and Their In Vitro Effect on Angiotensin and Endothelin Receptors.

Fungi occupy an important ecological niche in the marine environment, and marine fungi possess an immense biotechnological potential. This study documents the fungal diversity associated with 39 species of sponges and determines their potential to produce secondary metabolites capable of interacting with mammalian G-protein-coupled receptors involved in blood pressure regulation. Total genomic DNA was extracted from 563 representative fungal strains obtained from marine sponges collected by SCUBA from the Caribbean and the Pacific regions of Panama. A total of 194 operational taxonomic units were found with 58% represented by singletons based on the internal transcribed spacer (ITS) and partial large subunit (LSU) rDNA regions. Marine sponges were highly dominated by Ascomycota fungi (95.6%) and represented by two major classes, Sordariomycetes and Dothideomycetes. Rarefaction curves showed no saturation, indicating that further efforts are needed to reveal the entire diversity at this site. Several unique clades were found during phylogenetic analysis with the highest diversity of unique clades in the order Pleosporales. From the 65 cultures tested to determine their in vitro effect on angiotensin and endothelin receptors, the extracts of Fusarium sp. and Phoma sp. blocked the activation of these receptors by more than 50% of the control and seven others inhibited between 30 and 45%. Our results indicate that marine sponges from Panama are a "hot spot" of fungal diversity as well as a rich resource for capturing, cataloguing, and assessing the pharmacological potential of substances present in previously undiscovered fungi associated with marine sponges.

Fluorescence correlation spectroscopy in drug discovery: study of Alexa532-endothelin 1 binding to the endothelin ETA receptor to describe the pharmacological profile of natural products.

Fluorescence correlation spectroscopy and the newly synthesized Alexa532-ET1 were used to study the dynamics of the endothelin ET(A) receptor-ligand complex alone and under the influence of a semisynthetic selective antagonist and a fungal extract on living A10 cells. Dose-dependent increase of inositol phosphate production was seen for Alexa532-ET1, and its binding was reduced to 8% by the selective endothelin ET(A) antagonist BQ-123, confirming the specific binding of Alexa532-ET1 to the endothelin ET(A) receptor. Two different lateral mobilities of the receptor-ligand complexes within the cell membrane were found allowing the discrimination of different states for this complex. BQ-123 showed a strong binding affinity to the "inactive" receptor state characterized by the slow diffusion time constant. A similar effect was observed for the fungal extract, which completely displaced Alexa532-ET1 from its binding to the "inactive" receptor state. These findings suggest that both BQ-123 and the fungal extract act as inverse agonists.