Background: Lack of female and ethnically underrepresented in medicine (UIM) surgeons remains concerning in academic plastic surgery. One barrier to inclusion may be unequal opportunity to publish research. This study evaluates the extent of this challenge for plastic surgery trainees and identifies potential solutions. Methods: Data were collected on academic plastic surgeons' research productivity during training. Bivariate analysis compared publication measures between genders and race/ethnicities at different training stages (pre-residency/residency/ clinical fellowship). Multivariate analysis determined training experiences independently associated with increased research productivity. Results: Overall, women had fewer total publications than men during training (8.89 versus 12.46, P = 0.0394). Total publications were similar between genders before and during residency (P > 0.05 for both) but lower for women during fellowship (1.32 versus 2.48, P = 0.0042). Women had a similar number of first-author publications during training (3.97 versus 5.24, P = 0.1030) but fewer middle-author publications (4.70 versus 6.81, P = 0.0405). UIM and non-UIM individuals had similar productivity at all training stages and authorship positions (P > 0.05 for all). Research fellowship completion was associated with increased total, first-, and middle-author training publications (P < 0.001 for all). Conclusions: Less research productivity for female plastic surgery trainees may reflect a disparity in opportunity to publish. Fewer middle-author publications could indicate challenges with network-building in a predominately male field. Despite comparable research productivity during training relative to non-UIM individuals, UIM individuals remain underrepresented in academic plastic surgery. Creating research fellowships for targeting underrepresented groups could help overcome these challenges.

Toxoplasma gondii is an obligate intracellular protozoan parasite that causes the disease toxoplasmosis. Chronic infection is established through the formation of tissue cysts predominantly in cardiac and neurologic tissues. A defining characteristic of T. gondii is its ability to evade the host’s immune defenses; specifically, T. gondii can invade and persist within host phagocytes, using them to disseminate to the brain and central nervous system where cysts are then formed. This protocol is used to evaluate the ability of Toxoplasma gondii to survive and replicate within naive and activated murine bone marrow-derived macrophages at the level of single infected cells. In the following protocol macrophages are naive or activated with IFN-γ and LPS but different activation stimuli can be utilized as well as different host cell populations and diverse inhibitors. Parasite replication is determined by evaluating the number of parasites per vacuole over time using immunofluorescence staining for parasties and microscopic analysis. Kinetic determination of parasite number per vacuole accurately reflects parasite replication over time as vacuoles-containing parasites do not fuse with one another. Isolation of murine bone marrow-derived macrophages, preparation of conditioned L929 cells for collection of macrophage colony-stimulating factor, and staining for fluorescence microscopy included in the protocol has broad applicability. This protocol works well for pathogens like Toxoplasma gondii that reside in vacuoles that do not fuse with one another and that can be visualized by microscopy.

Background: Ductal carcinoma in situ (DCIS) incidence has risen with increasing use of screening mammography. It is unclear who benefits from both the amount and type of adjuvant treatment (radiation therapy, (RT), endocrine therapy (ET)) versus what constitutes over-treatment. Our goal was to identify the effects of adjuvant RT, or ET+/- RT versus breast conservation surgery (BCS) alone in a large multi-center DCIS registry of retrospective patients with long follow up. Methods: Data was extracted on women with a primary diagnosis of DCIS (N=2979) between 1985 - 2017 treated in 2 University of California (UC) medical centers. ET treatment and duration was confirmed by chart review for 1916 patients for this analysis. Receipt of ET (N=404) was stratified to &gt; 2 years or &lt; 2 years. Association between treatment type and second events was assessed using Cox regression. Competing risks models were used to assess effect of treatment type on different type of second events (ipsilateral DCIS or invasive, or contralateral combined). Time-varying coefficients were used as appropriate. Results: Median follow up time was 8.2 years for the 1916 patients analyzed. The cumulative second event (any type) rate was 25% at 15 years. In univariate and multivariate analysis adjusting for clinical variables, all treatments reduced the risk of second events compared to BCS only. Further stratifying ET receipt by duration demonstrated significant risk reduction (HR=0.12, P=0.04) only in women taking &gt;2 years of ET, but not in women in the &lt;2year ET group (HR=1.3, P=0.55). In the competing risk model, RT significantly reduces the risk of both ipsilateral DCIS and invasive cancer, and ET &gt; 2 years significantly reduces the risk of ipsilateral invasive cancer. Conclusions: In our registry we show that women with DCIS who took less than 2 years of adjuvant endocrine therapy have a similar second event rate as BCS. In contrast, women who took more than 2 years of ET show a significantly reduced second event rate, similar to those who received either RT or combined ET+RT, which was independent of age, tumor size, grade, or period of diagnosis. This highlights the importance of ET duration for risk reduction of second events following surgery for newly diagnosed DCIS. Citation Format: Thomas O'Keefe, Christina Yau, Emma Iaconetti, Eliza Jeong, Case Brabham, Paul Kim, Joseph McGuire, Ann Griffin, Laura Esserman, Olivier Harismendy, Gillian Hirst. Duration of endocrine treatment for DCIS impacts second events: Insights from a large registry of cases at two academic medical centers [abstract]. In: Proceedings of the AACR Special Conference on Rethinking DCIS: An Opportunity for Prevention?; 2022 Sep 8-11; Philadelphia, PA. Philadelphia (PA): AACR; Can Prev Res 2022;15(12 Suppl_1): Abstract nr PR008.

Purpose: Vascularized lymph node transfer (VLNT) helps to restore physiological lymphatic function. Although effective, postoperative impairment of donor-site lymphatic function and iatrogenic lymphedema following lymph node transfer from the groin remains a pressing concern.Methods: Prospective analysis of VLNT patients that had undergone radioisotope-free dual fluorescent tracer assisted harvest was performed at our institution from September 2013 to August 2020. Reverse lymphatic mapping of the lower extremity was performed with indocyanine green (ICG). Blue dye was utilized in both white light and near infrared spectra for visualization and localization of donor site lymphatic structures. Demographics, intraoperative details, and surgical outcomes were recorded.