Dominguezpearson3684

ience may have a competitive edge in attracting applicants to their programs.BACKGROUND Neoadjuvant chemoradiation for locally advanced rectal cancer combining 5FU to radiation increases tumor regression compared to radiation alone. However, it occurs at the cost of significant treatment-related toxicity. Patients with rectal cancer using metformin have been associated with improved response to radiotherapy. OBJECTIVE To evaluate the radiosensitizing effects of metformin in vitro and in vivo and compare it to standard combination of radiation/5FU. DESIGN Colorectal cancer cell lines SW480, HT29, and HCT116 were used as models. Cell viability was compared under treatments with radiation, radiation/5FU, metformin, radiation/metformin, and radiation/5FU/metformin. Nude mice were injected subcutaneously with SW480 cells and treated for one week with radiation/5FU, metformin, radiation/metformin or radiation/5FU/metformin. Tumor volume was evaluated for 4 weeks after treatment completion. Etoposide The phosphorylation status of key proteins of the PI3K/Akt/mTOR pathway was determined by immunoblots. SETTINGS Experimental study in vitro and in vivo. PATIENTS Animal model/cell lines. MAIN OUTCOME MEASURES The end point was to investigate how metformin compares to 5FU as a radiosensitizer. RESULTS All cell lines significantly decreased cell viability after treatment with radiation/metformin when compared to radiation alone. Radiation/metformin was superior to radiation/5FU in SW480 (37% vs 74%; p0.05). Metformin exerted strong PI3K/Akt/mTOR pathway inactivation effects after 24-hour exposure (increasing pAMPK p less then 0.01, decreasing pAkt, p less then 0.01; and pS6, p less then 0.05). LIMITATIONS In vitro and in vivo CRT regimens cannot be directly translated to human delivery methods. CONCLUSIONS Metformin enhances tumor response to radiation in vitro and in vivo. Metformin is an attractive alternative radiosensitizing agent to be considered in future studies/trials. See Video Abstract at http//links.lww.com/DCR/B219.BACKGROUND Operative approaches for Hinchey III diverticulitis include the Hartmann's procedure, primary resection and anastomosis, and laparoscopic lavage. Several randomized controlled trials and meta-analyses have compared these approaches; however, results are conflicting and previous studies have not captured the complexity of balancing surgical risks and quality-of-life. OBJECTIVE To determine the optimal operative strategy for patients with Hinchey III sigmoid diverticulitis. DESIGN We developed a Markov cohort model, incorporating perioperative morbidity/mortality, emergency and elective reoperations, and quality-of-life weights. We derived model parameters from systematic reviews and meta-analyses, where possible. We performed a second-order Monte Carlo probabilistic sensitivity analysis to account for joint uncertainty in model parameters. SETTING Lifetime horizon. PATIENTS The base-case was a simulated cohort 65-year-old patients with Hinchey III diverticulitis. A scenario simulating a cohort of hiho underwent laparoscopic lavage as little long-term data for this group have been published. CONCLUSIONS Although the Hartmann's procedure is widely used for Hinchey III diverticulitis, when considering both surgical risks and quality of life, both laparoscopic lavage and primary resection and anastomosis provide greater quality-adjusted life years for patients with Hinchey III diverticulitis and primary resection and anastomosis appears to be the optimal approach. See Video Abstract at http//links.lww.com/DCR/B223.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 Evaluate gender bias in colon and rectal surgery training program operative experience. DESIGN 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 two academic years (2016-17, 2017-18). MAIN OUTCOME MEASURE Percentage of trainee console participation and completion of total mesorectal excision. Resident and attending physician gender were recorded retrospectively. The cohort was separated into four groups based on resident and attending gender combination. Case volume, average console participation per case, and completion of total mesorectal excisions were compared for each grd 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.BACKGROUND Inducible left ventricular outflow tract obstruction (LVOTO) is often encountered in liver transplant (LT) candidates during cardiac workup. While the impact of LVOTO on adverse cardiovascular hemodynamics is well reported, it is unclear whether it predisposes to perioperative cardiovascular complications. METHODS Consecutive patients with end-stage liver disease undergoing dobutamine stress echocardiography (DSE) were evaluated at a LT center between 2010-2017. Perioperative major adverse cardiovascular events (MACE) at 30 days and all-cause death were recorded from a prospectively maintained LT database. RESULTS We evaluated 560 patients who underwent DSE during LT workup, with LVOTO identified in 24.3% (n=136). Of these, 309 patients progressed to transplant. Patients with LVOTO demonstrated a lower peak systolic blood pressure (SBP) and an overall reduction in SBP on DSE. A total of 85 MACE were recorded in 72 patients (23.3%) including 3 deaths, 19 cases of heart failure, 11 cardiac arrests, 8 acute coronary syndromes and 44 arrhythmias. MACE occurred in 15/64 patients (23.4%) with LVOTO and 57/245 (23.3%) without (p=0.92). There was an increased risk of perioperative cardiac arrest in patients with LVOTO (7.4% vs. 2.4%, p=0.04). Intraoperatively, patients with LVOTO required higher doses of vasopressors (p=0.01) and received greater volumes of fluid (10.5 ± 8.1L vs. 8.4 ± 6.4L, p=0.03). CONCLUSIONS Patients with end-stage liver disease and LVOTO demonstrate a reduction in SBP during physiological stress that may translate to hemodynamic instability during LT. LVOTO was not associated with an increased rate of perioperative MACE or death.