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Background Rural access to surgical care has reached crisis level. Practicing in rural America offers unique challenges with limited resources and specialists. Most training programs do not provide enough exposure to the endoscopic or the surgical subspecialty skills to prepare a resident for an isolated rural environment. As awareness has increased, many programs have modified curriculum to address this need. The Advisory Council on Rural Surgery (ACRS) of the American College of Surgeons set out to delineate important components of rural training programs and measure to what degree the existing heterogeneous programs contain these components. Study Design The ACRS identified 4 essential components of rural surgical training based on literature and expert opinion. These components included rotations in a rural setting, broad exposure to surgical specialties, endoscopy experience, and lack of competing specialty learners. A list of Accreditation Council for Graduate Medical Education programs from a prior publication was updated with the 2019 Fellowship and Residency Electronic Interactive Database self-identified “rural track” programs, reviewed, and categorized. Results We identified 39 programs that self-identified as having a rural emphasis. Depending on the extent of which 4 essential components were included, programs were categorized as either “Broad” (12 programs), “Basic” (20 programs), or “Indeterminate” (7 programs). Conclusion The ACRS described the optimal components of a rural surgical training program and identified which components are present in those surgical residencies which self-identified as having a rural focus. This information is valuable to students planning a future in rural surgery and benefits programs hoping to enhance their curriculum to meet this critical need.

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Background Head and neck surgical pathology has been shown to be prone to histopathologic diagnostic error that can adversely impact patient care due to inappropriate management. Sinonasal tumors, in particular, present a diagnostic challenge given the relative rarity and diversity in histology and thus may have higher rates of discordant histology. Objective The purpose of this study is to determine the rate of discrepancy between preoperative and postoperative diagnoses of sinonasal tumors. Methods Retrospective chart review was performed on 52 patients treated for sinonasal tumors between January 2013 and December 2016. Initial diagnosis on preoperative biopsy was compared to postoperative diagnosis rendered at a single tertiary care referral center. A discrepant diagnosis was regarded as any change in diagnosis that resulted in further refinement of therapy or prognosis. Results Eleven (21.2%) patients had discrepancy between the preliminary pathology and postsurgical diagnosis. Of these diagnoses, four involved a change from a benign to a more aggressive benign or malignant process, three involved reclassification of a malignant tumor to a more aggressive histology, and four involved change from an aggressive process to benign histology. In all 11 cases, alteration in management strategy was rendered. The majority of discordant diagnoses were of fibro-osseous lesions and small round blue cell tumors. Conclusion Sinonasal tumors exhibit a high degree of discordance from preoperative to postoperative diagnosis. Critical decision-making should be reserved until careful review of operative specimens is performed to minimize patient morbidity and unnecessary interventions.

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Cancer chemotherapy failures often involve the over‐expression of ABC‐transporters like the MDR1 P‐glycoprotein (Pgp). These membrane transporters use ATP hydrolysis to move a wide variety of compounds including cytotoxins across the plasma membrane, a normally protective function for the cell. In chemotherapies, however, selection for cells over‐expressing transporters like Pgp results in cell populations that are resistant to the therapeutic agents. This results in cancer recurrence that is multidrug resistant and refractory to treatment. In recent work using targeted molecular dynamics methods, we uncovered some of the molecular details of the conformational changes Pgp undergoes during its catalytic transport mechanism (Biochemistry 2012 51:5125–41). The conformational changes elucidated in this study have been used in massively parallel in silico ligand docking studies employing a very large database of commercially‐available compounds (zinc.docking.org). Using novel screening procedures, we have been able to identify several compounds that differentially bind to ATP hydrolyzing power transducing structures and not to drug transporting structures within Pgp. These compounds are predicted to be effective inhibitors of Pgp. In vitro analysis of several of the identified leads demonstrated that a number of these compounds do inhibit Pgp. Supported by NIH 1R15GM094771–01A1 to PDV and JGW.

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