Mechanisms and efficacy of vismodegib in the treatment of basal cell carcinoma.

Historically patients with advanced basal cell carcinoma have been subjected to large surgical resections for the treatment of their disease. However, with the development of vismodegib, a first in class molecule that acts to inhibit the hedgehog pathway, patients with advanced and metastatic basal cell carcinoma may have renewed hope in limiting the morbidity involved with surgery. Preliminary data shows a relatively good safety profile and promising results, although further research remains to be conducted. Current progress on utilization of vismodegib for the treatment of advanced basal cell carcinoma is reviewed in this article. Only literature with objective clinical evidence was included in this review.

Future of acute care surgery: a perspective from the next generation.

BACKGROUND: Access to emergent surgical care has been identified as a crisis in the United States. To address this challenge, the American Association for Surgery of Trauma has developed a fellowship in acute care surgery (ACS) to reestablish broad-based surgical capabilities. But the viability of this new discipline will rest on the interests of the next generation of surgeons. The objective of this study was to determine key factors influencing the choice of surgical specialties among medical students with a focus on their interest in trauma/ACS (T/ACS). METHODS: An online questionnaire was distributed to students at four medical schools affiliated with Level I trauma centers, one of which also has an ACS fellowship. The survey was sent to medical students at all levels (first to fourth year). Students with an interest in surgery as a career were asked to complete the survey and rank factors and experiences influencing career selection on a scale of 1 (no influence) to 10 (critical). Students were also asked to select their top five surgical specialties. RESULTS: Three hundred thirty-seven students interested in surgery responded. Mean age was 26 years ± 0.2 years (range, 20-37 years), 58% were men, and 86% were single. Respondents were distributed evenly over medical schools and medical school years. The three most popular career choices were orthopedics (16%), T/ACS (12%), and pediatric surgery (8%). As students progressed through medical school, lifestyle factors such as predictable hours and family time became more important in influencing their career choice. Overall, 115 students (34%) selected emergent surgery (T/ACS) as one of their top three career choices. Factors that were ranked significantly higher by students interested in T/ACS were related to professional satisfaction. These students also placed less emphasis on lifestyle factors when choosing a surgical career. CONCLUSIONS: Our results indicate that there is a reassuring interest to address the growing demand for emergency surgery among current medical students exposed to a broad range of T/ACS patients in Level I trauma centers. The T/ACS model is in accordance with the drives of these students looking for a diverse and challenging profession. Academic societies should make further efforts to encourage medical students to pursue T/ACS.