Objective Surgery remains an inherently male-dominated profession. The aim of this study was to survey women working within the discipline, to understand their current perceptions, providing insight into their practical day-to-day lives, supporting an action-oriented change. Design and setting The link to a confidential, online survey was distributed through the Association of Surgeons of Great Britain and Ireland (ASGBI) social media platforms on Facebook and Twitter over a 2-week period in October 2017. Participants Women working in surgical specialties and actively responding to the link shared through the ASGBI social media platforms. No patients were involved in the study. Primary and secondary outcome measures Data were analysed through a mixed-methods approach. The quantitative data were analysed through descriptive statistics and qualitative analysis was undertaken using a constant comparative analysis of the participants’ comments, to identify salient patterns (themes). Results A total of 81 female participants replied (42% response rate based on the Facebook group members), with 88% (n=71) perceiving surgery as a male-dominated field. Over half had experienced discrimination (59%, n=47), while 22% (n=18) perceived a ‘glass ceiling’ in surgical training. Orthopaedics was reported as the most sexist surgical specialty by 53% (n=43). Accounts of gendered language in the workplace were reported by 59% (n=47), with 32% (n=25) of surveys participants having used it. Overall, a lack of formal mentorship, inflexibility towards part-time careers, gender stereotypes and poor work–life balance were the main perceived barriers for women in surgical careers. Conclusion These findings highlight the implicit nature of the perceived discrimination that women report in their surgical careers. The ASGBI acknowledges these perceptual issues and relative implications as the first of many steps to create an action-oriented change by allowing all staff, regardless of gender, to reflect on their own behaviour, perceptions and the culture in which they work.

In donation after circulatory death (DCD), (thoraco)abdominal regional perfusion (RP) restores circulation to a region of the body following death declaration. We systematically reviewed outcomes of solid organ transplantation after RP by searching PubMed, Embase, and Cochrane libraries. Eighty-eight articles reporting on outcomes of liver, kidney, pancreas, heart, and lung transplants or donor/organ utilisation were identified. Meta-analyses were conducted when possible. Methodological quality was assessed using National Institutes of Health (NIH)-scoring tools. Case reports (13/88), case series (44/88), retrospective cohort studies (35/88), retrospective matched cohort studies (5/88), and case-control studies (2/88) were identified, with overall fair quality. As blood viscosity and rheology change below 20°C, studies were grouped as hypothermic (HRP, ≤20°C) or normothermic (NRP, >20°C) regional perfusion. Data demonstrate that RP is a safe alternative to in situ cold preservation (ISP) in uncontrolled and controlled DCDs. The scarce HRP data are from before 2005. NRP appears to reduce post-transplant complications, especially biliary complications in controlled DCD livers, compared to ISP. Comparisons for kidney and pancreas with ISP are needed but there is no evidence NRP is detrimental. Additional data on NRP in thoracic organs are needed. Whether RP increases donor or organ utilisation needs further research.

Normothermic regional perfusion (NRP) in donation after circulatory death (DCD) is a safe alternative to in situ cooling and rapid procurement. An increasing number of countries and centres are performing NRP, a technically and logistically challenging procedure. This consensus document provides evidence-based recommendations on the use of NRP in uncontrolled and controlled DCDs. It also offers minimal ethical, logistical and technical requirements that form the foundation of a safe and effective NRP programme. The present article is based on evidence and opinions formulated by a panel of European experts of Workstream 04 of the Transplantation Learning Journey project, which is part of the European Society for Organ Transplantation.

Machine learning (ML) is an interdisciplinary sector in the subset of artificial intelligence (AI) that creates systems to set up logical connections using algorithms, and thus offers predictions for complex data analysis. In the present review, an up-to-date summary of the current state of the art regarding ML and AI implementation for thyroid nodule ultrasound characterization and cancer is provided, highlighting controversies over AI application as well as possible benefits of ML, such as, for example, training purposes. There is evidence that AI increases diagnostic accuracy and significantly limits inter-observer variability by using standardized mathematical algorithms. It could also be of aid in practice settings with limited sub-specialty expertise, offering a second opinion by means of radiomics and computer-assisted diagnosis. The introduction of AI represents a revolutionary event in thyroid nodule evaluation, but key issues for further implementation include integration with radiologist expertise, impact on workflow and efficiency, and performance monitoring.

Ultrasound (US) is the first imaging modality for thyroid parenchyma evaluation. In the last decades, the role of ultrasound has been improved with the introduction of new US software, such as contrast-enhanced ultrasound (CEUS) and US-elastography (USE). USE is nowadays recognized as an essential part of the multiparametric ultrasound (MPUS) examination, in particular for the indeterminate thyroid nodule with possible fine-needle aspiration cytology (FNAC) number reduction; even if further and larger studies are needed to validate it. More controversial is the role of CEUS in thyroid evaluation, due to its high variability in sensitivity and specificity. Semi-automatic US systems based on the computer-aided diagnosis (CAD) system are producing interesting results, especially as an aid to less experienced operators. New knowledge on the molecular mechanisms involved in thyroid cancer is allowing practitioners to identify new genomic thyroid markers that could reduce the number of “diagnostic” thyroidectomies. We have therefore drawn up an updated representation of the current evidence in the literature for thyroid nodule multiparametric ultrasound (MPUS) evaluation with particular regard to USE, the US CAD system and CEUS.