Notes

Physical exercise Addiction and Muscle tissue Dysmorphia: The part regarding Psychological Addiction and Accessory.
Cytology of bile duct brushings (BDBs) is a specific, but insensitive, test for malignancy. Next-generation sequencing (NGS) of BDBs has recently been shown to improve sensitivity. We analyzed the cytologic features of NGS-positive (NGS
) and NGS-negative (NGS
) BDBs and correlated the morphology with the presence of mutations.

A total of 96 BDBs were analyzed for 29 cytologic features by 2 pathologists who were unaware of the original diagnosis and NGS results. Clinicopathologic follow-up was used to determine the patient outcomes (ie, benign, low-grade neoplasm, malignant [carcinoma/high-grade dysplasia]).

We analyzed 74 NGS
BDBs from 66 patients and 22 NGS
BDBs from 22 patients. During follow-up, 58 of 66 NGS
patients (88%) had malignancy compared with 0% of NGS
patients (P < 0.001). Fewer than 50% of the malignant cases had been interpreted as malignant on cytology; however, 100% had demonstrated mutations using NGS. Within the NGS
cases, 53% showed late mutations (TP53, SMAD4, and CDhalf of cancer cases had been interpreted as "nonmalignant" on cytology. NGS showing late mutations was 100% specific for malignancy. Adding genetic testing to BDB cytology would be a valuable ancillary test for the detection of malignancy, and reflex testing should be considered.
We found significant overlap in the cytomorphologic features between neoplastic and non-neoplastic BDBs, and more than one half of cancer cases had been interpreted as "nonmalignant" on cytology. NGS showing late mutations was 100% specific for malignancy. Adding genetic testing to BDB cytology would be a valuable ancillary test for the detection of malignancy, and reflex testing should be considered.
SMARCB1 encodes for a component of the SWI/SNF complex and is widely implicated in carcinogenesis. In the head and neck, SMARCB1-deficient carcinomas typically arise in the sinonasal tract but can be found at other sites. EZH2 inhibitors have emerged as potential targeted therapy against SWI/SNF-deficient tumors. We sought to characterize the cytomorphology of head and neck carcinomas with SMARCB1 deficiencies to identify potential candidates for targeted therapy.

Head and neck carcinomas with SMARCB1 mutations were retrospectively identified and confirmed to be SMARCB1-deficient by both molecular (fluorescent in-situ hybridization or next generation sequencing) and immunohistochemical means. Cases with positive cytology were reviewed and their cytologic features cataloged.

A total of 19 specimens from 13 patients were reviewed, including 8 specimens from 7 sinonasal carcinomas, 4 specimens from 3 thyroid carcinomas, 3 specimens from 2 skin carcinomas, and 4 specimens from 1 carcinoma of unknown primaryo tumors with rhabdoid morphology.
Nontechnical skills (NTS) encompass interpersonal, cognitive, and personal resource skills that can mitigate surgical errors and improve patient outcomes. However, inconsistencies in medical student awareness around NTS suggest limited exposure to these skills. This study aimed to determine the prevalence and content of NTS in medical school surgery and anesthesiology education.

Learning objectives from clerkship core surgery and anesthesiology rotations were collected from Canadian anglophone medical schools. Two raters independently classified each objective under one of the Non-Technical Skills for Surgeons (NOTSS) or Anaesthetists' Non-Technical Skills (ANTS) "Categories" and "Elements" of NTS, or as a non-NTS objective. Rater disagreements were resolved by group consensus. Group discussion was also held to identify examples of objectives that could help develop future curricula. Descriptive statistics were used to determine the number of NTS objectives from each school and within each NOTSS and ANTS omponents of their surgery and anesthesiology education.
A paucity of objectives in the clerkship perioperative curricula involve NTS. These findings suggest that NTS are unlikely being adequately introduced as critical skillsets of surgeons and anesthesiologists in undergraduate perioperative education. Future curriculum development should involve greater medical student exposure to NTS as key components of their surgery and anesthesiology education.
To provide a framework for effective mentorship of residents underrepresented in medicine (UIM) situated in the context of their experiences in healthcare teams.

A perspective summarizing the important elements for the effective mentorship of UIM residents.

Mentorship of trainees is of profound importance in medical education as it provides tangible benefits for professional and personal development. However, given their unique experiences and position in our teams as well as the larger healthcare construct, the mentorship of UIM residents requires special consideration and focus. Implementing programs that foster diversity, cross-cultural mentorship, and sponsorship are imperative.
Mentorship of trainees is of profound importance in medical education as it provides tangible benefits for professional and personal development. However, given their unique experiences and position in our teams as well as the larger healthcare construct, the mentorship of UIM residents requires special consideration and focus. Implementing programs that foster diversity, cross-cultural mentorship, and sponsorship are imperative.
Coaching has been proposed as a potential form of continuing professional development (CPD) for surgeons. Saracatinib mouse Our study aimed to elicit qualified surgeons' perceptions of peer coaching as a form of CPD and to determine the effect of demographic factors on surgeons' views.

A cross-sectional paper survey was conducted across 2 South Australian metropolitan hospitals from November 2018 to January 2019. This comprised 5 demographic questions and 6 Likert items eliciting views on peer-based coaching and was distributed at departmental unit meetings to surgical consultants and fellows. Participation was voluntary and a definition of "peer-based coaching" was provided.

Hundred and eighteen surgeons of a possible 125 (94.4% response rate) from 8 surgical specialties completed the survey with 45.4% (n = 54) having received coaching since obtaining their fellowship. The majority of participants (72.9%, n = 86) reported consultant surgeons would benefit from peer coaching and that one-on-one coaching in an individual setting would be a useful CPD activity (73.
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