Blue Ribbon Committee II Faculty Development: Report of the Subcommittee on Faculty Development and Educational Support.

The American College of Surgeons, the American Board of Surgery, and the American Surgical Association have created a Blue Ribbon Committee II to evaluate the current status of surgical education in the United States. As part of this endeavor, a subcommittee was formed to address issues pertinent to the development of surgical faculty as teachers. This entailed multiple discussions among a group of experienced surgical educators, a review of the literature, and a Delphi analysis of possible suggested improvements for faculty educational support, resulting in a final set of recommendations for improvement for future surgical faculty development.

Immune-Mediated Necrotizing Myopathies: Current Landscape.

Purpose Of Review: Immune-mediated necrotizing myopathy (IMNM), characterized by acute or subacute onset, severe weakness, and elevated creatine kinase levels, poses diagnostic and therapeutic challenges. This article provides a succinct overview of IMNM, including clinical features, diagnostic strategies, and treatment approaches.

Recent Findings: Recent insights highlight the different clinical presentations and therapeutic options of IMNM stratified by autoantibody positivity and type.

A United States-based patient-reported adult polyglucosan body disease registry: initial results.

Background: Adult Polyglucosan Body Disease (APBD) is an ultra-rare, genetic neurodegenerative disorder caused by autosomal recessive mutations in the glycogen branching enzyme gene. Knowledge of the demographic and clinical characteristics of APBD patients and the natural history of the disease is lacking. We report here initial results from a patient-reported registry of APBD patients.

A targetable pathway to eliminate TRA-1-60+/TRA-1-81+ chemoresistant cancer cells.

Chemoresistance is a primary cause of treatment failure in pancreatic cancer. Identifying cell surface markers specifically expressed in chemoresistant cancer cells (CCCs) could facilitate targeted therapies to overcome chemoresistance. We performed an antibody-based screen and found that TRA-1-60 and TRA-1-81, two 'stemness' cell surface markers, are highly enriched in CCCs.

Levofloxacin-associated transient mixed sensorimotor lacunar syndrome.

Fluoroquinolones are commonly used antimicrobials with multiple known adverse effects, yet overdose events are rarely reported. Here, we report a case of a previously healthy middle-aged woman who unintentionally ingested 7 g of levofloxacin in one dose. Thereafter, she presented to the emergency department with hemiparesis concerning for ischaemic stroke and was administered tissue plasminogen activator.

Active antiracism through surgical education.

Introduction: Disparities in surgical outcomes are well documented. Racial/ethnic minorities are also disproportionately underrepresentated in surgery; however, most surgeons do not acknowledge the existence of disparities. Diversity, equity, and inclusion (DEI) education in surgery is needed, yet DEI education is often confined to designated diversity lectures, limiting depth of content.

Managing Stricturing Crohn's Disease: Resect? Strictureplasty? Dilate?

Crohn's disease (CD) is a pan-intestinal disease of the gastrointestinal tract characterized by inflammatory, penetrating, and fibrostenotic phenotypes. Fibrostenotic stricture formation, without inflammatory or penetrating disease, is a common complication in CD, primarily affecting the small intestine and leading to small bowel obstruction. Because there is no medical therapy that prevents or reverses stricturing disease, endoscopic and surgical treatments are the mainstays of treatment, indicated to palliate symptoms and treat the complications.

A unique C2 domain at the C terminus of Munc13 promotes synaptic vesicle priming.

Neurotransmitter release during synaptic transmission comprises a tightly orchestrated sequence of molecular events, and Munc13-1 is a cornerstone of the fusion machinery. A forward genetic screen for defects in neurotransmitter release in identified a mutation in the Munc13-1 ortholog UNC-13 that eliminated its unique and deeply conserved C-terminal module (referred to as HC2M) containing a Ca-insensitive C2 domain flanked by membrane-binding helices. The HC2M module could be functionally replaced in vivo by protein domains that localize to synaptic vesicles but not to the plasma membrane.

Segmental Colectomy for Ulcerative Colitis: Is There a Place in Selected Patients Without Active Colitis? An International Multicentric Retrospective Study in 72 Patients.

Background And Aims: The aim of this study was to report a multicentric experience of segmental colectomy [SC] in ulcerative colitis [UC] patients without active colitis, in order to assess if SC can or cannot represent an alternative to ileal pouch-anal anastomosis [IPAA].

Methods: All UC patients undergoing SC were included. Postoperative complications according to ClavienDindo's classification, long term results, and risk factors for postoperative colitis and reoperation for colitis on the remnant colon, were assessed.

Michelassi II Strictureplasty for Crohn's Disease: A New Side-to-Side Isoperistaltic Strictureplasty With Discontinuous Bowel Loops.

Objective: We report on a new side-to-side isoperistaltic strictureplasty (SSIS), the Michelassi II or end-to-side-to-side-to-end strictureplasty, performed with discontinuous bowel loops.

Summary Background Data: The SSIS Michelassi strictureplasty was described a quarter of a century ago to avoid massive bowel resections in patients with extensive fibrostenosing Crohn's jejuno-ileitis.

Methods: The end-to-side-to-side-to-end strictureplasty is performed in patients presenting with 3 severely fibrotic and deformed bowel loops separated by 2 diseased segments with sequential strictures.

Challenges in IBD Research: Novel Technologies.

Novel technologies is part of five focus areas of the Challenges in IBD research document, which also includes preclinical human IBD mechanisms, environmental triggers, precision medicine and pragmatic clinical research. The Challenges in IBD research document provides a comprehensive overview of current gaps in inflammatory bowel diseases (IBD) research and delivers actionable approaches to address them. It is the result of a multidisciplinary input from scientists, clinicians, patients, and funders, and represents a valuable resource for patient centric research prioritization.

Long-term Results of the Side-to-side Isoperistaltic Strictureplasty in Crohn Disease: 25-year Follow-up and Outcomes.

Objective: Review the long-term outcomes of the side-to-side isoperistaltic strictureplasty (SSIS) and its effects on bowel preservation in Crohn disease (CD).

Summary Background Data: The first SSIS was performed 25 years ago as an alternative to resection in the treatment of extensive fibrostenosing jejuno-ileal CD.

Methods: Prospective study (January 1992-December 2016) of all patients with a SSIS performed by the authors.

Impact of Medical School Experience on Attrition From General Surgery Residency.

Background: Medical school experience informs the decision to pursue graduate surgical education. However, it is possible that inadequate preparation in medical school is responsible for the high rate of attrition seen in general surgery residency.

Materials And Methods: We performed a national prospective cohort study of all categorical general surgery interns who entered training in the 2007-2008 academic year.

Operating Room Attire Policy and Healthcare Cost: Favoring Evidence over Action for Prevention of Surgical Site Infections.

Background: The Association of Perioperative Registered Nurses (AORN) released new guidelines for operating room attire in 2015 in an attempt to reduce surgical site infections (SSIs). These guidelines have been adopted by the Centers for Medicare and Medicaid Services. We aimed to assess the relationships among operating room attire, SSIs, and healthcare costs.

Changing trends in surgery for abdominal Crohn's disease.

Aim: The introduction of biological agents and laparoscopy are, arguably, the most important developments for the treatment of Crohn's disease (CD) in the last two decades. Due to the efficacy of biological agents in treating mild disease, it is likely that the percentage of surgery for complex cases may have increased. The objective of this study was to analyse the changing characteristics and results of the surgical treatment of patients with CD over the past 13 years.

Laparoscopy in Crohn Disease: Learning Curve and Current Practice.

Objective: To identify preoperative characteristics to help in selecting laparoscopy or laparotomy in Crohn disease (CD).

Summary Background: Laparoscopy in CD is associated with high rates of conversion.

Methods: All patients undergoing abdominal surgery for CD in 2004 to 2016 by the senior author.

Analysis of the Learning Curve and Patient Outcomes of Endovascular Repair of Thoracoabdominal Aortic Aneurysms Using Fenestrated and Branched Stent Grafts: Prospective, Nonrandomized, Single-center Physician-sponsored Investigational Device Exemption Clinical Study.

Objective: To evaluate the outcomes and learning curve of fenestrated and branched endovascular repair (F/BEVAR) of thoracoabdominal aneurysms.

Summary Of Background Data: Endovascular aneurysm repair has reduced morbidity and mortality compared with open surgical repair. However, application to thoracoabdominal aneurysm repair remains limited by procedural complexity and device availability.

Is it Time to Abandon the Milan Criteria?: Results of a Bicoastal US Collaboration to Redefine Hepatocellular Carcinoma Liver Transplantation Selection Policies.

Objectives: European liver transplant (LT) centers have moved away from using the Milan Criteria (MC) for hepatocellular carcinoma (HCC) patient selection, turning to models including tumor biological indices, namely alpha-fetoprotein (AFP). We present the first US model to incorporate an AFP response (AFP-R), with comparisons to MC and French-AFP models (F-AFP).

Methods: AFP-R was measured as differences between maximum and final pre-LT AFP in HCC patients undergoing LT at 3 US centers (2001 to 2013).

Ensuring Equity, Diversity, and Inclusion in Academic Surgery: An American Surgical Association White Paper.

Objective: The leadership of the American Surgical Association (ASA) appointed a Task Force to objectively address issues related to equity, diversity, and inclusion with the discipline of academic surgery.

Summary Of Background Data: Surgeons and the discipline of surgery, particularly academic surgery, have a tradition of leadership both in medicine and society. Currently, we are being challenged to harness our innate curiosity, hard work, and perseverance to address the historically significant deficiencies within our field in the areas of diversity, equity, and inclusion.

Delays in Initiating Post-operative Prophylactic Biologic Therapy Are Common Among Crohn's Disease Patients.

Background: Studies have shown that prophylactic biologic therapy can reduce post-surgical Crohn's disease recurrence.

Aims: We aimed to identify the frequency of delay and risk factors associated with a delay in the initiation of prophylactic post-surgical biologic therapy in high-risk patients.

Methods: We performed a cohort study of Crohn's disease patients who underwent a bowel resection.

Readmission After Abdominal Surgery for Crohn's Disease: Identification of High-Risk Patients.

Background: Although many predictive factors for postoperative morbidity are known, few data are available about readmission after abdominal surgery for Crohn's disease (CD). The objective of this study is to identify predictive factors and high-risk patients for readmission after abdominal CD surgery.

Methods: All patients who underwent abdominal surgery for CD in one tertiary referral center between January 2004 and December 2016 were included.