Citations

INTRODUCTION: The number of applicants to Obstetrics and Gynecology subspecialty fellowships is projected to increase; however, it is known that the interview process is taxing for both applicants and the programs they attend. Concerns include excessive time away from work, cost, lack of coordination for regional travel, and overlapping interview dates. Little is known about applicant preferences for interviewing. METHODS: An e-mail link to a survey designed using web-based tool SurveyMonkey was sent to all residency directors for distribution to fourth year residents at ACGME-accredited Obstetrics and Gynecology programs in the United States. RESULTS: A total of 190 residents responded, 138 of whom applied to fellowship in 2016. Applicants were predominantly female (73.6%), Caucasian (78.3%), married (76.7%), and without children (74.4%). Most (81.3%) were from an academic program. Applicants attended a mean of 10.9 interviews; the most common reason to cancel was conflict with another interview (72.3%). Saturday was the most preferred interview day (46.7%). The majority of applicants preferred half-day interviews (93.2%), and 61.0% preferred an 0800 start to earlier or later times. A pre-interview dinner was favored (64.4%) with work restraints being the largest barrier to attendance. Personal days granted for interviews varied by program from zero (16.1%) to greater than 11 (25.0%). Vacation and unpaid leave were utilized by 56.5% and 9.0% respectively. CONCLUSION: Interviewing for fellowship is a burdensome process, but it could be improved by implementing regional coordination, shorter interview days and weekend interview dates. Gathering information from applicants and fellowship directors can help further streamline the process.

Study Design: A multicentered retrospective case series. Objective: To determine the incidence and circumstances surrounding the development of a symptomatic postoperative epidural hematoma in the cervical spine. Methods: Patients who underwent cervical spine surgery between January 1, 2005, and December 31, 2011, at 23 institutions were reviewed, and all patients who developed an epidural hematoma were identified. Results: A total of 16 582 cervical spine surgeries were identified, and 15 patients developed a postoperative epidural hematoma, for a total incidence of 0.090%. Substantial variation between institutions was noted, with 11 sites reporting no epidural hematomas, and 1 site reporting an incidence of 0.76%. All patients initially presented with a neurologic deficit. Nine patients had complete resolution of the neurologic deficit after hematoma evacuation; however 2 of the 3 patients (66%) who had a delay in the diagnosis of the epidural hematoma had residual neurologic deficits compared to only 4 of the 12 patients (33%) who had no delay in the diagnosis or treatment ( P = .53). Additionally, the patients who experienced a postoperative epidural hematoma did not experience any significant improvement in health-related quality-of-life metrics as a result of the index procedure at final follow-up evaluation. Conclusion: This is the largest series to date to analyze the incidence of an epidural hematoma following cervical spine surgery, and this study suggest that an epidural hematoma occurs in approximately 1 out of 1000 cervical spine surgeries. Prompt diagnosis and treatment may improve the chance of making a complete neurologic recovery, but patients who develop this complication do not show improvements in the health-related quality-of-life measurements.

Abstract Human neural progenitor cell (NPC) migration within the subventricular zone (SVZ) of the lateral ganglionic eminence is an active process throughout early brain development. The migration of human NPCs from the SVZ to the olfactory bulb during fetal stages resembles what occurs in adult rodents. As the human brain develops during infancy, this migratory stream is drastically reduced in cell number and becomes barely evident in adults. The mechanisms regulating human NPC migration are unknown. The Slit–Robo signaling pathway has been defined as a chemorepulsive cue involved in axon guidance and neuroblast migration in rodents. Slit and Robo proteins expressed in the rodent brain help guide neuroblast migration from the SVZ through the rostral migratory stream to the olfactory bulb. Here, we present the first study on the role that Slit and Robo proteins play in human-derived fetal neural progenitor cell migration (hfNPC). We describe that Robo1 and Robo2 isoforms are expressed in the human fetal SVZ. Furthermore, we demonstrate that Slit2 is able to induce a chemorepellent effect on the migration of hfNPCs derived from the human fetal SVZ. In addition, when Robo1 expression is inhibited, hfNPCs are unable to migrate to the olfactory bulb of mice when injected in the anterior SVZ. Our findings indicate that the migration of human NPCs from the SVZ is partially regulated by the Slit–Robo axis. This pathway could be regulated to direct the migration of NPCs in human endogenous neural cell therapy.