Update to the structured MRI report for primary staging of rectal cancer : Perspective from the SAR Disease Focused Panel on Rectal and Anal Cancer.

OBJECTIVE: To review existing structured MRI reports for primary staging of rectal cancer and create a new, freely available structured report based on multidisciplinary expert opinion and literature review. METHODS: Twenty abdominal imaging experts from the Society of Abdominal Radiology (SAR)'s Disease Focused Panel (DFP) on Rectal and Anal Cancer completed a questionnaire and participated in a subsequent consensus meeting based on the RAND-UCLA Appropriateness Method. Twenty-two items were classified via a group survey as "appropriate" or "inappropriate" (defined by ≥ 70% consensus), or "needs group discussion" (defined by < 70% consensus). Certain items were also discussed with multidisciplinary team members from colorectal surgery, oncology and pathology. RESULTS: After completion of the questionnaire, 16 (72%) items required further discussion (< 70% consensus). Following group discussion, consensus was achieved for 21 (95%) of the items. Based on the consensus meeting, a revised structured report was developed. The most significant modifications included (1) Exclusion of the T2/early T3 category; (2) Replacement of the term "circumferential resection margin (CRM)" with "mesorectal fascia (MRF)"; (3) A revised definition of "mucinous content"; (4) Creation of two distinct categories for suspicious lymph nodes (LNs) and tumor deposits; and (5) Classification of suspicious extra-mesorectal LNs by anatomic location. CONCLUSION: The SAR DFP on Rectal and Anal Cancer recommends using this newly updated reporting template for primary MRI staging of rectal cancer.

Gender Differences in Faculty Rank and Leadership Positions Among Physician Biochemistry Faculty in North America: A Retrospective, Cross-Sectional Study.

Purpose This study sought to assess gender differences among physician faculty in medical biochemistry and genetics programs in North America. It compared the distribution of academic and leadership ranks, years of active research, number of citations and publications, and Hirsch-index (h-index) by gender. Variable associations with the h-index were assessed. Method This was a cross-sectional retrospective study for which data was collected from June 2019 to October 2019 on academic and administrative physician faculty members for medical biochemistry and genetics programs. The website of Fellowship and Residency Electronic Interactive Database, Canadian Resident Matching Service website, and the medical biochemistry profile from the Canadian Medical Association to identify relevant programs and SCOPUS was used to gather faculty data. Results The analyses included 147 faculty members. More male faculty held higher academic rank positions and first-in-command leadership positions than female faculty. Men had more median years of active research, citation numbers, publication numbers, and h-index than women across all academic ranks. Upon performing multivariable linear regression, female faculty showed 0.39 times the odds of having a higher h-index than male faculty, keeping all other variables constant (p<0.01).  Conclusions In our study, it was shown that male physician faculty surveyed had higher performance than female faculty in academic rank and research productivity. Certain barriers may be contributing factors, including lack of mentorship or flexible institutional policies, women choosing clinical educator tracks, or gender bias. Considering the low retention rates of women in academic research, there is a need to address barriers in order to achieve gender parity.

The rule of thirds: Determining the ideal areolar proportions.

BACKGROUND: Breast surgery often requires changing the diameter of the areola. Recommended areolar size is commonly based on population averages, or surgical judgement. An ideal areola size has not been previously been described. We hypothesized that the ideal areolar diameter would be proportional to two breast measurements not commonly altered during breast surgery: the nipple diameter and breast base width. METHODS: 'The Sun' newspaper (London, UK) publishes photographs of topless models which are selected based on the aesthetic appeal of their non-operated breasts. The publication's archive, from March 2014 to January 2017, was independently reviewed by three authors to identify photographs that presented a clear anterior view of the breast. The base width, nipple diameter and areolar diameter were measured independently by each reviewer. Measurements were pooled, and the mean was included for analysis. Ratios of the areolar diameter to the base width and the nipple diameter were calculated. RESULTS: The photographs of 58 models were eligible for inclusion. The average areolar diameter to base width was 0.29 (SD = 0.05). The average nipple to areolar diameter was 0.29 (SD = 0.06). CONCLUSIONS: In aesthetically pleasing breasts, the areolar diameter is proportional to both the breast base width and nipple diameter. Breast base width is commonly measured preoperatively in aesthetic breast procedures, and is not typically modified. Breast base width can therefore be used to determine the ideal areolar size using the ratio of areola:base width ratio of 0.29 identified in this study.

Validation of a Weight Threshold-Based Vancomycin Dosing Protocol for Patients Undergoing Intermittent Hemodialysis.

BACKGROUND: Patients receiving intermittent hemodialysis (IHD) are at high risk of acquiring gram-positive infections, which are often treated with IV vancomycin. Despite frequent use of vancomycin in the IHD setting, there is variability in dosing and monitoring practices among clinicians at the study institution. There is also a paucity of evidence regarding optimal vancomycin dosing to achieve target pre-IHD serum concentration. OBJECTIVES: The primary objective was to compare the percentage of treatment courses with a serum vancomycin concentration between 15 and 20 mg/L, measured before the third IHD session, before and after implementation of a weight threshold-based dosing protocol. The secondary objectives were to compare the percentage of treatment courses with a pre-third IHD vancomycin concentration between 10 and 22 mg/L and the number of vancomycin measurements per treatment day, before and after protocol implementation. METHODS: This quasi-experimental, single-centre study included inpatients and outpatients who underwent IHD and received at least 2 IV doses of vancomycin, with vancomycin being measured in an appropriately drawn sample before the third IHD session. Before protocol implementation, vancomycin dosing was at the clinician's discretion (usual care). After protocol implementation, each patient received a loading dose of 1000, 1500, or 2000 mg and a maintenance dose of 500, 750, or 1000 mg, depending on body weight. RESULTS: The percentage of treatment courses with a pre-third IHD vancomycin concentration between 15 and 20 mg/L was greater after implementation of the protocol than with usual care, but the difference was nonsignificant (44% [8/18] versus 20% [3/15], p = 0.27). However, the percentage of treatment courses with a pre-third IHD vancomycin concentration between 10 and 22 mg/L was significantly higher after protocol implementation (94% [17/18] versus 53% [8/15], p = 0.012). There was no difference in the median number of vancomycin measurements per treatment day before and after protocol implementation (0.133 versus 0.125, p = 0.99). CONCLUSIONS: At the study institution, the likelihood of achieving recommended vancomycin concentration increased (relative to previous practice) after implementation of a simplified vancomycin dosing protocol for patients undergoing IHD.

CONTEXTE: Les patients recevant une hémodialyse intermittente (HDI) présentent un risque élevé de contracter des infections à Gram positif, souvent traitées à l'aide de vancomycine par intraveineuse (IV). Malgré l'utilisation fréquente de la vancomycine dans les environnements d'HDI, les pratiques portant sur le dosage et le suivi varient entre les cliniciens de l'institution où l'étude s'est déroulée. Il existe également peu de données probantes sur la dose optimale de vancomycine permettant d'atteindre la concentration sérique cible avant l'HDI. OBJECTIFS: L'objectif principal visait à comparer le pourcentage de traitements à la vancomycine, dont la concentration sérique se situait entre 15 et 20 mg/L, lors de la mesure prise avant la troisième séance de HDI, avant et après la mise en place d'un protocole de dosage basé sur le poids. Les objectifs secondaires visaient à comparer le pourcentage de traitements, dont la concentration de vancomycine mesurée avant la troisième séance d'HDI était comprise entre 10 et 22 mg/L, et le nombre de mesures de vancomycine par jour de traitement, avant et après la mise en place du protocole. MÉTHODES: Cette étude quasi expérimentale, menée dans un seul centre, comprenait des patients hospitalisés et ambulatoires ayant subi une HDI et reçu au moins deux doses de vancomycine par IV et dont un échantillon prélevé de manière appropriée avant la troisième séance d'HDI a permis de mesurer la vancomycine. Avant la mise en place du protocole, le dosage de vancomycine était laissé à la discrétion du clinicien (soins habituels). Après sa mise en place, chaque patient recevait une dose de charge de 1000, 1500 ou 2000 mg et une dose de maintenance de 500, 750 ou 1000 mg selon sa masse corporelle. RÉSULTATS: Le pourcentage de traitements dont la concentration de vancomycine mesurée avant la troisième séance d'HDI était comprise entre 15 et 20 mg/L était plus élevé après la mise en place du protocole qu'après les soins habituels, mais la différence n'était pas significative (44 % [8/18] contre 20 % [3/15], p = 0,27). Cependant, le pourcentage de traitements dont la concentration de vancomycine mesurée avant la troisième séance d'HDI était comprise entre 10 et 22 mg/L était significativement plus élevé après la mise en place du protocole (94 % [17/18] contre 53 % [8/15], p = 0,012). Le nombre moyen de mesures de vancomycine par traitement n'avait pas varié entre le jour précédant et le jour suivant la mise en place du protocole (0,133 contre 0,125, p = 0,99). CONCLUSIONS: Dans l'institution où l'étude s'est déroulée, la probabilité d'atteindre la concentration de vancomycine recommandée avait augmenté après la mise en place d'un protocole simplifié de dosage de vancomycine pour les patients recevant une HDI comparativement à une pratique antérieure.

Analysis of H-index in Assessing Gender Differences in Academic Rank and Leadership in Physical Medicine and Rehabilitation in the United States and Canada.

OBJECTIVES: The aims of the study were (1) to establish potential gender differences in academic physical medicine and rehabilitation faculty across the United States and Canada and (2) to evaluate associations between physician gender, leadership position, and research productivity. DESIGN: Physical medicine and rehabilitation programs enlisted in Fellowship and Residency Electronic Interactive Database (n = 72) and Canadian Resident Matching Service (n = 9) were searched for academic faculty with Doctor of Medicine degrees to generate a database of gender and academic profiles. Bibliometric data were collected using Elsevier's Scopus and analyzed by Strata v14.2. RESULTS: Of 1045 faculty meeting the inclusion criteria, 653 were men and 392 were women. Men were found in greater numbers across all academic ranks, with professors as most conspicuous (79.14%), and held most (85.54%) leadership positions. The study's prediction model assessed for gender differences in academic rank and leadership roles and found that odds of men having higher h-index as 0.78 (95% confidence interval = 0.24-0.87), indicating that women were not significantly inferior in academic performance. CONCLUSIONS: A significantly greater number of men make up physical medicine and rehabilitation faculty in all academic ranks and leadership positions. H-index based on gender and adjusted for covariates is comparable between men and women, suggesting that more complex, multifactorial issues are likely influencing the gender differences.

Anomalous Extratemporal Facial Nerve in Oculoauriculovertebral Spectrum.

Facial nerve dysfunction is common in oculoauriculovertebral spectrum (OAVS). However, the course of the nerve has rarely been described. A 23-year-old woman with OAVS underwent excision of microtic ear remnants in preparation for an osseointegrated prosthesis and suffered iatrogenic transection of the facial nerve-the pes anserinus was within the subcutaneous tissue 15 mm posterior and 15 mm cephalad to the external acoustic meatus. The patient underwent primary nerve repair and regained nearly complete preoperative function. When considering reconstruction for OAVS patients, clinicians should have a high index of suspicion for anomalous facial nerve anatomy.