No abstract

Primary cilia are hairlike extensions of the plasma membrane of most mammalian cells that serve specialized signaling functions. To traffic properly to cilia, multiple cilia proteins rely on palmitoylation, the post-translational attachment of a saturated 16-carbon lipid. However, details regarding the mechanism of how palmitoylation affects cilia protein localization and function are unknown. Herein, we investigated the protein ADP-ribosylation factor-like GTPase 13b (ARL13b) as a model palmitoylated ciliary protein. Using biochemical, cellular, and studies, we found that ARL13b palmitoylation occurs in mouse kidneys and that it is required for trafficking to and function within cilia. Myristoylation, a 14-carbon lipid, is shown to largely substitute for palmitoylation with regard to cilia localization of ARL13b, but not with regard to its function within cilia. The functional importance of palmitoylation results in part from a dramatic increase in ARL13b stability, which is not observed with myristoylation. Additional results show that blockade of depalmitoylation slows the degradation of ARL13b that occurs during cilia resorption, raising the possibility that the sensitivity of ARL13b stability to palmitoylation may be exploited by the cell to accelerate degradation of ARL13b by depalmitoylating it. Together, the results show that palmitoylation plays a unique and critical role in controlling the localization, stability, abundance, and thus function of ARL13b. Pharmacological manipulation of protein palmitoylation may be a strategy to alter cilia function.

Background: The present study assesses training characteristics, scholastic achievements, and traditional career accomplishments of ethnically underrepresented in medicine (UIM) plastic and reconstructive surgery (PRS) faculty relative to non-UIM PRS faculty. Method: A cross-sectional analysis of core PRS faculty appointed to accredited United States residency training programs (n = 99) was performed. Results: Of the 949 US PRS faculty, a total of 51 (5.4%) were identified as UIM. Compared with non-UIM faculty, there were few differences when evaluating medical education, residency training, pursuit of advanced degrees, and attainment of subspecialty fellowship training. UIM faculty were more likely than non-UIM faculty to have graduated from a medical school outside the United States (25% versus 13%, P = 0.014). In addition, UIM faculty did not differ from non-UIM counterparts in traditional career accomplishments, including promotion to full professor, obtaining NIH funding, serving as program director, receiving an endowed professorship, appointment to a peer-reviewed editorial board, scholarly contributions (H-index and number of publications), and appointment to chief/ chair of their division/department. Conclusions: The historical lack of ethnic diversity that comprise US academic PRS faculty persists. This study reveals that those UIM faculty who are able to obtain faculty appointments are equally successful in achieving scholastic success and traditional career accomplishments as their non-UIM counterparts. As we strive toward increasing representation of UIM physicians in academic plastic surgery, the field will benefit from efforts that promote a pipeline for underrepresented groups who traditionally face barriers to entry.

Central centrifugal cicatricial alopecia (CCCA) is a scarring alopecia that primarily affects women of African descent. Although histopathological features of CCCA have been described, the pathophysiology of this disease remains unclear. To better understand the components of CCCA pathophysiology, we evaluated the composition of the inflammatory infiltrate, the distribution of Langerhans cells (LCs), and the relationship between fibrosis and perifollicular vessel distribution. Our data indicate that CCCA is associated with a CD4-predominant T-cell infiltrate with increased LCs extending into the lower hair follicle. Fibroplasia associated with follicular scarring displaces blood vessels away from the outer root sheath epithelium. These data indicate that CCCA is an inflammatory scarring alopecia with unique pathophysiologic features that differentiate it from other lymphocytic scarring processes.

Background: Successful strategies to improve the representation of female and ethnically underrepresented in medicine (UIM) physicians among US plastic and reconstructive surgery (PRS) faculty have not been adequately explored. Accordingly, we aimed to identify programs that have had success, and in parallel gather PRS program directors’ and chiefs/chairs’ perspectives on diversity recruitment intentionality and strategies. Methods: We conducted a cross-sectional analysis of the demographic composition of female and UIM faculty of PRS residency training programs. Separate lists of programs in the top quartile for female and UIM faculty representation were collated. Additionally, a 14-question survey was administered to program directors and chiefs/chairs of all 99 Accreditation Council for Graduate Medical Education-accredited PRS residency programs. The questions comprised three domains: (1) demographic information; (2) perceptions about diversity; and (3) recruitment strategies utilized to diversify faculty. Results: Female and UIM faculty representation ranged from 0% to 63% and 0% to 50%, respectively. Survey responses were received from program directors and chiefs/chairs of 55 institutions (55% response rate). Twenty-five (43%) respondents felt their program was diverse. Fifty-one (80%) respondents felt diversity was important to the composition of PRS faculty. Active recruitment of diverse faculty and the implementation of a diversity, equity, and inclusion committee were among the most frequently cited strategies to establish a culturally sensitive and inclusive environment. Conclusions: These findings reveal that female and UIM representation among US PRS faculty remains insufficient; however, some programs have had success through deliberate and intentional implementation of diversity, equity, and inclusion strategies.

Objective Dedicated research time is a component of certain plastic surgery programs, and yet, there is limited research examining its impact on academic productivity and career outcomes. This study aimed to assess the effect of dedicated research time on the academic productivity of residents and the likelihood of pursuing an academic career. Methods We conducted a cross-sectional study that examined bibliometric indices of integrated plastic surgery residency graduates from 2010 to 2020. Academic productivity was determined by the number of peer-reviewed publications and h-index 1 year after residency graduation. Results were analyzed using descriptive statistics, χ2 test, t test, and logistic regression. Results Data on plastic surgery residency graduates were analyzed (N = 490 from 46 programs). The mean numbers of publications and h-index per research track graduate were 26.1 and 8.23, respectively. The mean numbers of publications and h-index per nonresearch track graduate were 15.9 and 5.97, respectively. After controlling for the University of Alabama research ranking through multilinear regression analysis, we found that pursuing dedicated research time was an independent predictor of increased h-index and publication output, although it did not predict an increased likelihood of pursuing an academic career. Conclusions Participating in dedicated research during residency increases academic productivity, irrespective of the residency program’s research rank. Given this finding, offering research years can help support the mission of fostering academic opportunities within plastic surgery.

No abstract

I n the 2020 match cycle, 358 applicants applied for 180 integrated plastic surgery residency positions, a 33% increase compared with 262 applications in 2016. 1,2 While factors such as alpha omega alpha status and US Medical Licensing Examination scores remain important, 3 the increasingly competitive landscape requires applicants to further differentiate themselves in hopes of matching. A series of recent publications demonstrates that applicants have improved their odds of matching and of matriculating at higher-ranked institutions by participating in a research arms race. [4][5][6] At our home institution, we have observed applicants accomplishing this feat by pursuing nontraditional paths, to include master's degrees and clinical research fellowships.Herein, the authors review the frequency of nontraditional paths in recently matched interns. We used Mellia and colleagues' 5 data set that detailed 2019 and 2020 integrated interns' research productivity at the time of residency application submission. Through public curriculum vitae listings, such as LinkedIn and residency biographies, we collected years spent in medical school, categorizing interns as either traditional (4 years) or nontraditional (>4 years). Residents without a public curriculum vitae were excluded. Research productivity and the ability to match at a top 20 Doximity-ranked institution were compared between the groups. A Student t test was utilized. Significance was defined as P < 0.05.One hundred forty-nine residents, of 301, had accessible public profiles for inclusion in our analysis. Fifty-three interns (35%) pursued the nontraditional path, including 4 (3%) with MD/PhD and 6 (4%) international medical graduates. The mean number of publications among nontraditional interns was significantly higher than the mean for their traditional counterparts (Table 1).The increasing competitiveness to match into an integrated program is unlikely to abate-for the 2021 match cycle, ERAS reported 408 applicants, an increase of 17% from 2020 and 56% from 2016, an especially daunting number when compared with an 18% increase in intern positions from 2016 to 2020 (152 to 180) (Fig. 1). 1,2 As nontraditional paths boost applicant competitiveness, programs can expect a growing demand from medical school students for year-out research opportunities-through (1) full-time research positions and (2) research in tandem with master's degree programs. To facilitate this, our home institution has found great success in our Clinical Research Fellowship model. 7 Currently, we have 5 fully funded positions and have observed rapidly increasing fellowship application numbers.