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While the reasons for ethnic differences in AMI-related hospital delay are likely to be multifactorial and complex, there is an urgent need to promote change in both the South Asian patient (delays in arrival) and their treatment (delays in intervention).

Introduction of technology has revolutionised the postgraduate medical education in the twenty-first century. 1 Technology is proving useful in attaining desired professional growth through easy access to learning resources, and effective utilisation of this information for the development of knowledge and skills. 2,3 Electronic databases such as electronic portfolios (e-portfolio) or electronic logbooks, are now rapidly replacing the traditional paper-based logbooks. 4 College of Physicians and Surgeons Pakistan (CPSP) is the prime postgraduate medical institute of Pakistan. Traditionally, CPSP has used paper based logbooks which, although quite useful for training monitoring, had certain limitations. 5,6 To counter these deficiencies, CPSP introduced the electronic version of logbook, the e-logbook, in 2011. 7 The e-logbook of CPSP is in its 9 th year of induction. Earlier studies have shown e-logbook to be a valuable tool for training monitoring. 6,8 The success of an electronic logbook system depends on its ability to focus on students' satisfaction, flexible nature, ease of access to the learning material, costeffectiveness and strengthening of supervisorsupervisee relationship. 9,10 The question is, after nine years of induction, does the e-log system of CPSP fulfill these fundamental requirements? E-log system has undergone various modifications from time to time to make it a more useful tool. The impact of these changes still remains to be ascertained. This study was, therefore, designed with the aim to determine the feedback of supervisors regarding role of e-logbook in monitoring of training, strengthening supervisor-supervisee relationship, and improving

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Sex differences in gene expression are important contributors to normal physiology and mechanisms of disease. This is increasingly apparent in understanding and potentially treating chronic pain where molecular mechanisms driving sex differences in neuronal plasticity are giving new insight into why certain chronic pain disorders preferentially affect women vs. men. Large transcriptomic resources are now available and can be used to mine for sex differences to gather insight from molecular profiles using donor cohorts. We performed in-depth analysis of 248 human tibial nerve (hTN) transcriptomes from the GTEx Consortium project to gain insight into sex-dependent gene expression in the peripheral nervous system (PNS). We discover 149 genes with sex differential gene expression. Many of the more abundant genes in men are associated with inflammation and appear to be primarily expressed by glia or immune cells, with some genes downstream of Notch signaling. In women, we find the differentially expressed transcription factor SP4 that is known to drive a regulatory program, and may impact sex differences in PNS physiology. Many of these 149 differentially expressed (DE) genes have some previous association with chronic pain but few of them have been explored thoroughly. Additionally, using clinical data in the GTEx database, we identify a subset of DE, sexually dimorphic genes in diseases associated with chronic pain: arthritis and Type II diabetes. Our work creates a unique resource that identifies sexually dimorphic gene expression in the human PNS with implications for discovery of sex-specific pain mechanisms.

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Background. This study is aimed at investigating the feasibility and safety of the laparoscopic radical resection for treating type III and IV hilar cholangiocarcinoma (III/IV Hilar C). Methods. Six patients with III/IV Hilar C were enrolled in our hospital. All patients underwent total laparoscopic surgery, including basic surgery (laparoscopic gallbladder, hilar bile duct, and common bile duct resection and hepatoduodenal ligament lymph node dissection) combined with left hepatic and caudate lobe resection/portal resection. The tumor size, operation time, intraoperative blood loss, and postoperative complications were observed. The follow-up of the patients after discharge was recorded. Results. Surgery was successfully completed in 6 patients. We found that the tumor size of 6 patients ranged from 1.5 to 3.6 cm, with 4 lymph nodes. The operation time was 540-660 minutes, and the blood loss was 300-500 ml. One patient developed bile leakage after surgery, healed within 2 weeks after drainage. The postoperative hospital stay was 16 (13-24) days. There were 4 cases of negative bile duct margin tumor, 1 case was positive, and 1 case was not reported. All 6 patients were discharged smoothly without perioperative death. Regular examinations were conducted every 3 months after discharge, and the median duration was 7 months. Only 1 patient had a marginal dysplasia, and 5 patients had no obvious signs of recurrence. Conclusions. Application of laparoscopic radical resection for III/IV Hilar C is safe and feasible and has good short-term efficacy with adequate preoperative evaluation, appropriate case selection, and precise operative strategy.

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