Colon and Rectal Surgery Robotic Training Programs: An Evaluation of Gender Disparities.

BACKGROUND: Female surgeons are subjected to implicit bias throughout their careers. The evaluation of gender bias in training is warranted with increasing numbers of female trainees in colon and rectal surgery. OBJECTIVE: This study aimed to evaluate gender bias in colon and rectal surgery training program operative experience. DESIGN: This is a retrospective cohort study. SETTING: The Association of Program Directors for Colon and Rectal Surgery robotic case log database contains operative details (procedure, attending surgeon, case percentage, and operative segments) completed by trainees as console surgeon for 2 academic years (2016-2017, 2017-2018). MAIN OUTCOME MEASURE: The primary outcomes measured are the percentage of trainee console participation and the completion of total mesorectal excision. Resident and attending surgeon gender was recorded retrospectively. The cohort was separated into 4 groups based on resident and attending surgeon gender combination. Case volume, average console participation per case, and completion of total mesorectal excisions were compared for each group by using interaction regression analysis. RESULTS: Fifty-two training programs participated, including 120 trainees and 190 attending surgeons. Forty-five (37.5%) trainees and 36 (18.9%) attending surgeons were women. The average number of cases per trainee was 23.27 per year for women and 28.15 per year for men (p = 0.19). Average console participation was 53.5% for women and 61.7% for men (p < 0.001). Male attending surgeons provided female trainees less console participation than male counterparts (52.1% vs 59.7%, p < 0.001). Female attending surgeons provided the same amount of console participation to female and male trainees (63.3% vs 61.8%, p = 0.62). Male trainees performed significantly more complete total mesorectal excision console cases than female trainees (57.16% vs 42.38%, p < 0.0001). LIMITATIONS: The data are subject to self-reporting bias. CONCLUSIONS: There is gender disparity in robotic operative experience in colon and rectal surgery training programs with less opportunity for console participation and less opportunity to complete total mesorectal excisions for female trainees. This trend should be highlighted and further evaluated to resolve this disparity. See Video Abstract at http://links.lww.com/DCR/B224. PROGRAMAS DE CAPACITACIÓN ROBÓTICA SOBRE CIRUGÍA DE COLON Y RECTO: UNA EVALUACIÓN DE LAS DISPARIDADES DE GÉNERO: Cirujanos mujeres están sujetas a sesgos implícitos a lo largo de sus carreras. La evaluación del sesgo de género en el entrenamiento se amerita por un número cada vez mayor de aprendices femeniles en cirugía de colon y recto.Evaluar el sesgo de género en la experiencia operativa en programas de entrenamiento de cirugía de colon y recto.Estudio de cohorte retrospectivo.La base de datos de registro de casos robóticos de la Asociación de Directores de Programas para Cirugía de Colon y Rectal contiene detalles operativos (procedimiento, cirujano asistente, porcentaje de casos y segmentos operativos) completados por los alumnos como cirujanos de consola durante dos años académicos (2016-17, 2017-18).Porcentaje de participación de la consola de entrenamiento y finalización de la escisión mesorrectal total. Se registraron retrospectivamente el sexo de los médicos residentes y asistentes. La cohorte se separó en cuatro grupos según la combinación de género residente y asistente. El volumen de casos, la participación promedio de la consola por caso y la finalización de las extirpaciones mesorrectales totales se compararon para cada grupo mediante el análisis de regresión de interacción.Participaron 52 programas de capacitación, incluidos 120 aprendices y 190 cirujanos asistentes. Cuarenta y cinco (37.5%) aprendices y 36 (18.9%) cirujanos asistentes eran mujeres. El número promedio de casos por aprendiz fue de 23.27 / año para mujeres y 28.15 / año para hombres (p = 0.19). La participación promedio de la consola fue del 53.5% para las mujeres y del 61.7% para los hombres (p <0.001). Los cirujanos asistentes masculinos proporcionaron a las mujeres aprendices menos participación en la consola en comparación con sus compañeros masculinos (52.1% vs 59.7%, p <0.001). Los cirujanos asistentes femeninos proporcionaron la misma cantidad de participación en la consola a los aprendices femeninos y masculinos (63.3% vs 61.8%, p = 0.62). Los aprendices masculinos realizaron casos de consola TME significativamente más completos que las aprendices femeninas (57.16% vs 42.38%, p <0.0001).Los datos están sujetos a sesgos de autoinforme.Existe una disparidad de género en la experiencia quirúrgica robótica en los programas de entrenamiento de cirugía de colon y recto con menos oportunidades para la participación de la consola y menos oportunidades para completar las extirpaciones mesorrectales totales para las mujeres en formación. Esta tendencia debe destacarse y evaluarse para resolver esta disparidad. Consulte Video Resumen en http://links.lww.com/DCR/B224. (Traducción-Dr. Adrián Ortega).

Sugarcane scum as a novel substrate for rapid biogas production from the non-centrifugal cane sugar agribusiness sector in developing countries.

Sugarcane scum (SCS) is a waste from the non-centrifugal cane sugar making process. Due to its physicochemical characteristics, it has a high-energy potential to produce biomethane via anaerobic digestion (AD). However, (i) the total solids concentration in the SCS exceeds the limit for wet digestion and (ii) the SCS has a low pH. The aim of this research was to evaluate the utilization capacity of the SCS for methane production through a biochemical methane potential test and extent of disintegration, using dilution pretreatment. The highest methane yield, 0.227 N m3 CH4 kg-1 VS, was achieved at a 12.5% SCS dilution, with an organic matter removal greater than 70% and an extent of disintegration of 34.5%. This is evidence that the AD process is a feasible alternative for SCS treatment.

First 100 liver transplants at the medico-surgical research center (CIMEQ).

In July 1999 we began a liver transplant program that to October 2005 has included 100 liver transplants in 92 patients, eight retransplants, and two combined liver and kidney grafts. Twelve transplants were in pediatric patients, who showed a 92% survival rate in the first year. Fifty-four percent of the patients were male and 46% female. The most frequent etiologies of cirrhosis were 27% hepatitis virus C, 18% alcoholic, 13% cryptogenic, and 11% autoimmune. In 95% of the patients, we preserved the retrohepatic vena cava. The bile duct was reconstructed with a Kehr tube in 46% of patients with 31% using end-to-end suture with a tutor and 15% an end-to-end suture without a tutor. A hepaticojejunostomy was performed in 8%. The immunosuppression included cyclosporine (Neoral) or Prograf combined with mycophenolate mofetil or mycophenolate sodium and steroids. The most frequent biliary complications were local anastomosis leaks (6%) and stenosis (10%). The overall 1-year survival rate was 72%.

A common NKCC2 mutation in Costa Rican Bartter's syndrome patients: evidence for a founder effect.

Bartter's syndrome involves an overlapping set of closely related renal tubular disorders that can be subdivided into at least three clinical phenotypes: (1) the hypercalciuric antenatal Bartter variant; (2) the classic Bartter variant; and (3) the hypocalciuric-hypomagnesemic Gitelman variant. Recent data demonstrate that in several phenotypically indistinguishable cohorts, antenatal Bartter's syndrome is genetically heterogeneous. In these patients, mutations in the genes encoding either the bumetanide-sensitive Na-K-2Cl cotransporter (NKCC2) or the ATP-regulated potassium channel ROMK (KCNJI) have been identified. A cohort of 20 Costa Rican patients with a congenital syndrome that bears strong similarities to antenatal Bartter's syndrome but also has several distinct features has recently been described. In this cohort, we have identified a predominant mutation that introduces a premature stop in codon W625 of the NKCC2 gene (SCL12A1). This mutant allele is contained on a single common haplotype, suggesting that the majority of antenatal Bartter's syndrome patients in Costa Rica share a single common ancestor.

Bartter syndrome in Costa Rica: a description of 20 cases.

Bartter syndrome involves an overlapping set of closely related renal tubular disorders which can be subdivided into at least three clinical phenotypes: (1) classic Bartter syndrome (2) Gitelman syndrome, and (3) a neonatal variant of Bartter syndrome. In contrast to classic Bartter syndrome and Gitelman syndrome, the neonatal variant of Bartter syndrome has both the features of renal tubular hypokalemic alkalosis as well as profound systemic manifestations. Specifically, neonatal Bartter syndrome is characterized by intrauterine polyhydramnios, premature delivery, and life-threatening episodes of fever and dehydration. Most of these infants also have severe hypercalciuria with associated nephrocalcinosis and osteopenia. Over a 22-year period, 20 Costa Rican patients with a congenital syndrome that resembles neonatal Bartter syndrome have been identified and characterized. While these patients exhibit some of the clinical characteristics previously described for neonatal Bartter syndrome, this cohort also has a set of distinct features. They are predominantly female, have a later age of diagnosis, manifest a relatively unique set of physical traits, and appear to have milder clinical disease. Given these differences, it will be important to apply the emerging molecular tools to determine whether the phenotypic variability indicates genetic heterogeneity in neonatal-onset Bartter syndrome.

Single dose antibiotic therapy is not as effective as conventional regimens for management of acute urinary tract infections in children.

One hundred thirty-two children with acute urinary tract infection were randomly assigned to receive trimethoprim-sulfamethoxazole in one dose, two doses daily for 3 days or two doses daily for 7 days. The patient characteristics, etiologic agents and frequency of roentgenologic abnormalities were similar for the three treatment groups. There was no significant difference in bacteriologic cure rates for the single dose regimen (93%) and multidose regimens (96%). The difference in rates of recurrent urinary tract infection between the single dose (20.5%) and 3-day (5.6%) and 7-day (8%) regimens was statistically significant (P = 0.033). A single dose of trimethoprim-sulfamethoxazole is inadequate treatment for infants and children with acute urinary tract infection.

Lisis tumoral aguda. Un problema en oncologia pediatrica. / Acute tumoral lysis: a problem in pediatric oncology

Se reportan cuatro pacientes con linfoma no Hodgkin en estadios III y IV, tres de los cuales presentaron muerte subita en los primeros dias de la induccion de la remision con alteraciones metabolicas y hallazgos de autopsia de lisis tumoral aguda y lesion renal por hiperuricemia. El cuarto paciente presento lesion renal, hiperfosfatemia, hipocalcemia, hiperuricemia y manifestaciones de insuficiencia renal aguda que cedieron con dialisis peritoneal Se discuten algunos aspectos del sindrome de lisis tumoral aguda como complicacion del tratamiento de neoplasias del sistema reticuloendotelial en las primeras fases de la induccion de la remision