The surgical personality: comparisons between urologists, non-urologists and non-surgeons

Background:

Our objective was to compare personality traits between urologists and other surgeons, as well as between surgeons and non-surgeons.

Methods:

Eighty-six surgeons (57 faculty, 29 residents) completed the Revised NEO Personality Inventory (NEO PI-R), a validated measure of normal personality traits. Subjects agree or disagree with 240 statements to generate a score in each of the 5 major character traits: extraversion (E), openness (O), conscientiousness (C), agreeableness (A) and neuroticism (N). Each factor is subdivided into 6 component facets. Scores for urology faculty and residents were compared to the other surgical groups and 21 pediatricians.

Results:

The 3 groups differed significantly on extraversion (p < 0.001). Post-hoc analyses indicated that urologists obtained significantly higher extraversion scores than other surgeons (p < 0.05) and non-surgeons (p < 0.001) Other surgeons also scored significantly higher than non-surgeons on the extraversion factor (p < 0.05). No significant differences emerged on openness, conscientiousness, agreeableness or neuroticism. Of the 6 extraversion facets, urologists obtained significantly higher scores on gregariousness and excitement-seeking (p < 0.05) than non-urologist surgeons, and significantly higher scores on gregariousness (p < 0.05), activity (p < 0.01), excitement seeking (p < 0.001), and positive emotions (p < 0.05) than non-surgeons. Non-urologist surgeons obtained significantly higher scores than non-surgeons on Activity and Excitement-seeking (p < 0.01).There were no significant differences in the facets of warmth or assertiveness.

Interpretation:

Urologists appear to be more extraverted compared to other surgeons. Both groups of surgeons were more extraverted than non-surgeons. If these findings can be confirmed on a wider basis, the data may be helpful in resident selection, mentoring, evaluation and career counselling.     

Analysis of the human E2 ubiquitin conjugating enzyme protein interaction network

In eukaryotic cells the stability and function of many proteins are regulated by the addition of ubiquitin or ubiquitin-like peptides. This process is dependent upon the sequential action of an E1-activating enzyme, an E2-conjugating enzyme, and an E3 ligase. Different combinations of these proteins confer substrate specificity and the form of protein modification. However, combinatorial preferences within ubiquitination networks remain unclear. In this study, yeast two-hybrid (Y2H) screens were combined with true homology modeling methods to generate a high-density map of human E2/E3-RING interactions. These data include 535 experimentally defined novel E2/E3-RING interactions and >1300 E2/E3-RING pairs with more favorable predicted free-energy values than the canonical UBE2L3–CBL complex. The significance of Y2H predictions was assessed by both mutagenesis and functional assays. Significantly, 74/80 (>92%) of Y2H predicted complexes were disrupted by point mutations that inhibit verified E2/E3-RING interactions, and a ∼93% correlation was observed between Y2H data and the functional activity of E2/E3-RING complexes in vitro. Analysis of the high-density human E2/E3-RING network reveals complex combinatorial interactions and a strong potential for functional redundancy, especially within E2 families that have undergone evolutionary expansion. Finally, a one-step extended human E2/E3-RING network, containing 2644 proteins and 5087 edges, was assembled to provide a resource for future functional investigations.Protein ubiquitination is mediated by the sequential action of an E1 activating enzyme, an E2 conjugating enzyme, and a range of E3 proteins, which are thought to confer substrate specificity (Hershko and Ciechanover 1998). Two main forms of E3 proteins have been characterized: HECT domain ligases, which act as enzymatic intermediates in protein ubiquitination and E3-RING proteins, which appear to be nonenzymatic recognition factors, although their exact role in catalysis remains to be established (Ozkan et al. 2005; Petroski et al. 2006). Although the sequence of events that facilitate the addition of ubiquitin (Ub) or ubiquitin-like (Ubl) proteins is conserved in all eukaryotic cells, the extent and form of Ub and Ubl modification can be diverse, ranging from the addition of single Ub or Ubl residues at one or more sites within a target protein (mono- and multi-ubiquitination), to the assembly of a range of structurally distinct polyubiquitin chains (Peng et al. 2003), which may confer different functional properties (Welchman et al. 2005; Ikeda and Dikic 2008).Although E2 and E3 proteins are thought to work in a combinatorial manner to generate different forms of substrate modification (Weissman 2001; Christensen et al. 2007), very little is known about the specificity or combinatorial nature of human E2/E3-RING interactions. As such, the potential for redundancy or antagonism within the human ubiquitome remains unclear, as does the degree of connectivity between different network components. As Ub and Ubl proteins are known to play a key role in the regulation of both physiological and pathological processes, there is a growing need to develop a better understanding of the complex ways in which E2 and E3 proteins work together in human cells.While isolated biochemical studies and unbiased global interactome projects continue to provide invaluable and exciting data, coverage of the human ubiquitome, and, in particular, E2/E3 interactions, remains limited. To provide new insights into partner preferences and the degree of redundancy within this combinatorial process, the density of network coverage must be significantly increased using techniques that define or predict binary interactions. Analysis of data contained within the MINT, IntAct, BioGRID, and HPRD databases revealed 60 human E2/E3-RING interactions (Fig. 1A; Supplemental Files 3 and 4), including data from both binary and co-complex isolation studies. This lack of experimental data is compounded by the expansion in E2- and E3-RING protein numbers, which has occurred during eukaryotic evolution. Searches performed using data from the Inparanoid and Homologene databases show that 34 of the 39 human E2-related proteins have clearly identifiable orthologs in yeast, fly, or worm. However, 48% (146 out of 304) of E3-RING proteins do not (Supplemental File 1). Consequently, methods developed to predict interactions between orthologous proteins in different species (Interolog interactions) (Matthews et al. 2001; Lehner and Fraser 2004) cannot be used to assign combinatorial preferences for all human E2/E3-RING complexes.Open in a separate windowFigure 1.Binary human E2/E3-RING protein interaction networks. (A) Previously known interactions derived from the MINT, IntAct, BioGRID, and HPRD databases at the time of this study. (B) Predicted human E2/E3-RING interactions including Interologs (purple edges) or non-Interolog predicted interactions from Hi-map and IntNet databases (orange edges). (C) Increased coverage within the human E2/E3-RING interaction space as a result of this study. Novel interactions are shown as red edges. Bold edges represent interactions confirmed by our data. Blue nodes represent E2 ubiquitin conjugating enzymes, while yellow nodes represent E3-RING proteins. To aid network analysis and node identification, all networks are provided as ready-to-view Cytoscape files (Supplemental File 3).To address these problems we have assembled a high-density binary protein interaction map containing >1810 human E2- or E3-RING interactions. Initially, two stringent Y2H methods were used to investigate the spectrum of human E2 protein interactions and the combinatorial nature of human E2/E3-RING complexes. In addition, a structure-based true homology modeling method was also used to provide an independent prediction of interactions between 3180 human E2/E3-RING pairs. Finally, experimental data from this study were combined with known human E2- or E3-RING interactions and available Interolog data to generate a one-step extended map, which provides an initial insight into the gross topology and modular organization within the highly combinatorial human E2/E3-RING network.     

Cryptorchidism: the veracity of online information accessible to the public

Purpose

The objective of this study is to assess the quality of information regarding cryptorchidism using common Internet resources.

Methods

Five common search engines were queried with the string “cryptorchidism OR undescended testicle OR undescended testes OR retractile testes OR retractile testicle.” The first 30 sites retrieved via each engine were reviewed, and the content veracity of the following components was assessed independently by 2 pediatric urologists: natural history, diagnosis, treatment, complications, and long-term outcome. Components were scored 0 to 2 based on whether topics were addressed and in accordance with accepted practice patterns.

Results

Of the 124 of 150 links accessible, 84% were oriented toward laypeople. Only 43 (35%) had endorsement by a nonprofit accreditation organization, but 76 (61%) had affiliation with a medical institution/professional. Authors were mostly pediatric urologists/surgeons (36%) or unspecified (48%). Median total scores were only 16 of 44 primarily because of incomplete information rather than misinformation. High scoring components included natural history, surgical options, long-term outcomes for fertility, and malignancy. Components scoring poorly included future sexuality, imaging, hormonal use, and treatment complications. Multivariate analysis demonstrated that only accreditation status was associated with high quality (P = .05).

Conclusions

Online information, when available to the public, is generally of good quality. However, many Web sites fail to adequately address all aspects of the condition.     

Prognostic factors of survival time after hematopoietic stem cell transplant in acute lymphoblastic leukemia patients: Cox proportional hazard versus accelerated failure time models

Background

The aim of this study is to evaluate the prognostic factors of overall survival (OS) after haematopoietic stem cell transplant (HSCT) in acute lymphoblastic leukaemia (ALL) patients using accelerated failure time (AFT), Cox proportional hazard (PH), and Cox time-varying coefficient models.

Methods

206 patients were enrolled after HSCH in Shariati Hospital between 1993 and 2007. There was evidence of marked departures from the proportional hazards assumption with two prognostic factors, relapse and chronic graft-versus-host disease (cGVHD) (P < .001). Performance among AFT and Cox''s models was assessed using explained variation and goodness of fit methods. Discrimination among the exponential, Weibull, generalized gamma (GG), log-logistic, and lognormal distributions was done using maximum likelihood and Akaike information criteria.

Results

The 5-year OS was 52% (95%CI: 47.3–56.7). Peak mortality hazard occurred at months 6–7 after HSCT followed by a decreasing trend. In univariate analysis, the data was better fitted by GG distribution than by other distributions. Univariate analysis using GG distribution showed a positive association between OS with acute graft-versus-host disease (aGVHD) (P = .021), no relapse (P < .001), cGVHD (P < .001), neutrophil recovery (P < .001) and platelet recovery (P < .001). Based on Cox PH models; however cGVHD and relapse were the predictive factors of OS (P < .001). Multivariate analysis indicated that, OS is related to relapse (P < .001) and platelet recovery (P = .037), where predictive power of Weibull AFT models was superior to Cox PH model and Cox with time-varying coefficient (R² = 0.46 for AFT, R² = .21 for Cox PH and R² = .34 for Cox time-varying coefficient). Cox-Snell residual shows Weibull AFT fitted to data better than other distributions in multivariate analysis.

Conclusion

We concluded that AFT distributions can be a useful tool for recognizing prognostic factors of OS in acute lymphoblastic leukemia patients.     

Effects of neurofeedback on the short-term memory and continuous attention ofpatients with moderate traumatic brain injury: A preliminary randomized controlled clinical trial

Purpose: There are some studies which showed neurofeedback therapy (NFT) can be effective in clients with traumatic brain injury (TBI) history. However, randomized controlled clinical trials are still needed for evaluation of this treatment as a standard option. This preliminary study was aimed to evaluate the effect of NFT on continuous attention (CA) and short-term memory (STM) of clients with moderate TBI using a randomized controlled clinical trial (RCT). Methods: In this preliminary RCT, seventeen eligible patients with moderate TBI were randomly allocated in two intervention and control groups. All the patients were evaluated for CA and STM using the visual continuous attention test and Wechsler memory scale-4th edition (WMS-IV) test, respectively, both at the time of inclusion to the project and four weeks later. The intervention group participated in 20 sessions of NFT through the first four weeks. Conversely, the control group participated in the same NF sessions from the fifth week to eighth week of the project. Results: Eight subjects in the intervention group and five subjects in the control group completed the study. The mean and standard deviation of participants'' age were (26.75 ± 15.16) years and (27.60 ± 8.17) years in experiment and control groups, respectively. All of the subjects were male. No significant improvement was observed in any variables of the visual continuous attention test and WMS-IV test between two groups (p≥0.05). Conclusion: Based on our literature review, it seems that our study is the only study performed on the effect of NFT on TBI patients with control group. NFT has no effect on CA and STM in patients with moderate TBI. More RCTs with large sample sizes, more sessions of treatment, longer time of follow-up and different protocols are recommended.     

The relationship between preoperative nutritional state and adverse outcome following abdominal and thoracic surgery in children: Results from the NSQIP database

Introduction

Anthropometric measurements can be used to define pediatric malnutrition. Our study aims to: (1) characterize the preoperative nutritional status of children undergoing abdominal or thoracic surgery, and (2) describe the associations between WHO-defined acute (stunting) and chronic (wasting) undernutrition (Z-scores <?2) and obesity (BMI Z-scores > + 2) with 30-day postoperative outcomes.

APPLICATION OF PROGNOSTIC SCORING SYSTEMS IN DIFFERENTIATED THYROID CARCINOMA

Background : Total thyroidectomy is widely practised in Australasia for papillary and follicular thyroid carcinoma. Data from large overseas series have demonstrated that patients with these cancers may be separated into risk groups based on clinicopathological prognostic factors. Furthermore, evidence suggests that low-risk patients may be safely treated with less than total thyroidectomy. The aim of the present paper was to determine what proportion of our patients with papillary and follicular thyroid cancer were in the low-risk group in order to select candidates for less aggressive treatment. Methods : A prospectively documented series of 175 previously untreated patients with papillary and follicular thyroid carcinoma, treated principally by total thyroidectomy over a 10-year period, was divided into risk groups using the Mayo Clinic, Lahey Clinic and Memorial Hospital prognostic scoring systems. Complication rates for 103 patients treated by total thyroidectomy were also studied and reported. Results : Women outnumbered men by 2.3:1. There were 128 papillary carcinomas (73%) and 47 follicular cancers (27%). These tumours were < 4 cm in diameter in 81% of patients, and 41% of patients were 40 years of age or younger. Low-risk patients accounted for 75, 81 and 45% of the study group, respectively, when the three prognostic scoring systems were applied to our patient population. The rates for recurrent laryngeal nerve palsy and permanent hypoparathyroidism for patients having total thyroidectomy were 1 and 1.9%, respectively. In the low-risk group there were no permanent complications. Conclusion : Most patients treated at Royal Prince Alfred Hospital during the past 10 years were low-risk patients who may have been eligible for less aggressive surgical treatment.     

The discard of deceased donor kidneys in the UK

It is essential to minimize the unnecessary discard of procured deceased donor kidneys, but information on discard rates and the extent to which discard can be avoided are limited. Analysis of the UK Transplant Registry revealed that the discard rate of procured deceased donor kidneys has increased from 5% in 2002‐3 to 12% in 2011‐12. A national offering system for hard‐to‐place kidneys was introduced in the UK in 2006 (the Declined Kidney Scheme), but just 13% of kidneys that were subsequently discarded until 2012 were offered through the scheme. In order to examine the appropriateness of discard, 20 consecutive discarded kidneys from 13 deceased donors were assessed to determine if surgeons agreed with the decision that they were not implantable. Donors had a median (range) age of 67 (31–80) yr. Kidneys had been offered to a median of 3 (1–12) centers before discard. Four (20%) of the discarded kidneys were thought to be usable, and nine (45%) were possibly usable. As a result of these findings, major changes to the UK deceased donor kidney offering system have been implemented, including simultaneous offering and broader entry criteria for hard‐to‐place kidneys. Organizational changes are necessary to improve utilization of deceased donor kidneys.