Pre-Operative Physical Function Predicts Post-Operative Skeletal Muscle Gene Expression in Old Mice

In older adults, pre-operative physical function predicts post-operative outcomes. The biological mechanisms underlying vulnerability to physical decline remain poorly understood. Using a mouse model of laparotomy, we sought to identify biological correlates of post-operative function. 24-month-old male C57BL/6N mice were categorized as high functioning (HF) or low functioning (LF) based on pre-operative performance on the accelerating rotarod. On post-operative days (POD) 2 and 4, LF mice had lower rotarod latency to fall times than HF mice did. Forelimb grip strength was reduced after laparotomy in both HF and LF groups on POD 1 and 3 and did not differ significantly between these groups. Whole transcriptome sequencing analysis (RNAseq) of soleus muscles collected on POD 5 showed 224 and 228 differentially expressed genes (DEGs) for HF and LF, respectively, compared to their respective controls. Only 21 DEGs were observed in both groups, including Pparα, Fst and Pla2g15. Such changes may be hallmarks of the post-surgical response in aging. Pathway analysis of DEGs using Ingenuity Pathway Analysis software (Qiagen) revealed one pathway common to HF and LF (osteoarthritis) whereas activation of GP6 signaling and apoptosis signaling was observed in HF and inhibition of PPARα/RXR activation and PPARα signaling was noted in LF. We conclude that pre-operative performance on the accelerating rotarod correlates with differences in skeletal muscle gene expression, which may contribute to the differences in functional outcomes post-operatively in HF and LF mice. Further studies are needed to delineate the roles of these signaling pathways in physical resilience to surgery.

Autonomy in the Operating Room: A Multicenter Study of Gender Disparities During Surgical Training

ABSTRACT Background Gender disparities are prevalent in medicine, but their impact on surgical training is not well studied. Objective To quantify gender disparities in trainee intraoperative experiences and explore the variables associated with ratings of surgical autonomy and performance. Methods From September 2015 to May 2019, attending surgeons and trainees from 71 programs assessed trainee autonomy on a 4-level Zwisch scale and performance on a 5-level modified Dreyfus scale after surgical procedures. Multivariable regression models were used to examine the association of trainee gender with autonomy and performance evaluations. Results A total of 3255 trainees and attending surgeons completed 94 619 evaluations. Attendings gave lower ratings of operative autonomy to female trainees than male trainees when controlling for training level, attending, and surgical procedure (effect size B = −0.0199, P = .008). There was no difference in ratings of autonomy at the beginning of training (P = .32); the gap emerged as trainees advanced in years (B = −0.0163, P = .020). The gender difference in autonomy was largest for the most complex cases (B = −0.0502, P = .002). However, there was no difference in attending ratings of surgical performance for female trainees compared to male trainees (B = −0.0124, P = .066). Female trainees rated themselves as having less autonomy and worse performance than males when controlling for training level, attending, procedure, case complexity, and attending ratings (autonomy B = −0.0669, P < .001; performance B = −0.0704, P < .001). Conclusions While there was no significant difference in ratings of operative performance, a small difference between ratings of operative autonomy for female and male surgical trainees was identified.

Changes of Operative Performance of Pulse Pressure Variation As A Predictor of Fluid Responsiveness in a Swine Model of Endotoxin Shock

Background Several limitations regarding pulse pressure variation (PPV) use have been reported. Our aim was to describe changes in the PPV operative performance as a predictor of fluid responsiveness during the development of a swine endotoxin shock model and to assess hemodynamic variables associated with PPV changes. Methods A swine porcine endotoxin shock model was established (E. Coli 055:B5 endotoxin) in 7 pigs, and 3 pigs were included in the control group. The endotoxin was infused until the mean arterial pressure (MAP) dropped below 50 mmHg (TH0); then, the model animal was reanimated with fluids and vasopressors. We performed fluid challenges every hour for 6 hours. ROC curve analysis was conducted. Additionally, a linear mixed model was performed. Results The area under the curve (AUC) of PPV decreased from 0.95 (0.81–1.00) to 0.60 (0.17–1.00) at TH0. Its cutoff increased from 10.5–22.00% at TH0. PPV showed an inverse relationship with stroke volume, mean systemic filling pressure (MSFP), MAP, and systemic vascular resistance (SVR) (p < 0,001, AIC = 111.85). Conclusions The PPV operative performance as a predictor of fluid responsiveness decreased with the progression of endotoxic shock. This result could be due to the inverse association with MAP and SVR.

The Link Between Marketing Capabilities and Co-Operative Performance in Malaysia

Co-operative is a business entity established with voluntary participation to enhance the economic status of members, communities, and the country. As the third significant contributor to the nation's economic, due attention is essential in addressing some issues related to co-operative performance. Among these issues was the inability to meet the goals of the National Co-operative Policy II (2011-2020) as well as the low level of contribution to the country's GDP, despite various support provided by the government. Based on the literature, marketing capabilities are predicted to enhance co-operative performance, but less research has been conducted on this relationship, particularly in the Malaysia.Thus, 500 questionnaires were distributed to randomly selected co-operatives in Malaysia. In all, 133 sets of questionnaires were successfully collected, which showed a 27 percent response rate. This study utilises SPSS software to perform the required statistical analysis of the data survey. This study uses a simple random sampling method to select a sample based on a list of registered co-operatives from the Malaysian Co-operative Commission. Thus, this study found the marketing capabilities has positive and significant relationship with co-operative performance. The evidence from this study suggests that the co-operative needs to develop the marketing capabilities in order to enhance performance.The findings of this study will help the government to streamline the co-operative sector in Malaysia with the strategic planning and policies so that the co-operative sector would be stronger, competitive, and able to improve performance and contribution to economic as well as GDP of the country.