Factors during training which predict future use of minimally invasive thoracic surgery.

BACKGROUND: While minimally invasive thoracic surgery (MIS) has increased nationwide over the years, most patients undergoing lung and esophageal resections still undergo an open approach. We performed a national survey to analyze factors associated with a propensity to perform MIS after completing a cardiothoracic training program. MATERIALS AND METHODS: Cardiothoracic surgery trainees in 2 or 3-year programs from 2010 to 2016 were sent an online survey regarding the numbers and types of cases performed during training and current practice patterns as attending surgeons. Comfort level with MIS was also assessed. Responses were recorded and analyzed using SPSS. RESULTS: One hundred thirty-six trainees responded, with a mean of 121 lobectomies (30-250) and 40 esophagectomies (8-110) performed during training. Mean minimally invasive lobectomy and esophagectomy rates during training were 53% and 30% respectively. A greater ratio of MIS procedures performed during training correlated with a higher rate performed as an attending (lobectomies, p = 0.04; esophagectomies, p = 0.01) and a greater comfort level with performing these procedures (lobectomies, p = 0.01 and esophagectomies, p < 0.01). CONCLUSIONS: Based on these results, performing a greater ratio of minimally invasive lobectomies and esophagectomies during fellowship training increases the likelihood of performing them as an attending.

Use of an operant paradigm for the study of antidepressant-induced sexual dysfunction.

These studies were designed to develop a paradigm for the detection of antidepressant-induced sexual dysfunction in female rats. Ovariectomized, Fischer rats were conditioned to nose poke to open a guillotine door to gain access to a sexually active male. To develop the procedure, we examined the acquisition and stability of the response with a 15-s fixed interval, compared rats treated with 10 µg estradiol benzoate and 500 µg progesterone with those that received only estradiol benzoate, and carried out a preliminary analysis of the effects of 5, 10, and 15 mg/kg fluoxetine. We then more fully evaluated the effects of 5 mg/kg fluoxetine. Fluoxetine reduced sexual motivation, as assessed by the number of nose pokes, the number of nose poke episodes, and the latency to approach the male. In addition, changes in the females' sexual motivation were examined before and after ejaculation during the final conditioning trials. The number of nose pokes was reduced and the latency to initiate a new nose poke episode was increased following ejaculation. The robustness of the antidepressant-induced decline in sexual motivation is in marked contrast to the findings with several other animal models for sexual dysfunction and illustrates the usefulness of the operant procedure.