Research Spotlight

Liechty, J. M., R. J. Weddle, W. P. Shutze and B. L. Smith (2016). “Occurrence of a type 2 proatlantal intersegmental artery during carotid endarterectomy for symptomatic stenosis.” J Vasc Surg 64(3): 807-808.

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A 63-year-old female patient presented with transient right hand weakness and left amaurosis fugax. A computed tomography angiogram demonstrated a 75% to 90% internal carotid artery (ICA) stenosis and a persistent proatlantal intersegmental artery (PAIA) originating from the external carotid artery (ECA), passing lateral to the internal jugular vein (A), and joining the ipsilateral vertebral artery. The PAIA was the major contributor to the basilar artery. Also noted were an absent left cervical vertebral artery and a hypoplastic right vertebral artery terminating as the posterior inferior cerebellar artery.

Arsalan, M., G. Filardo, W. K. Kim, J. J. Squiers, B. Pollock, C. Liebetrau, J. Blumenstein, J. Kempfert, A. Van Linden, A. Arsalan-Werner, C. Hamm, M. J. Mack, H. Moellmann and T. Walther (2016). “Prognostic value of body mass index and body surface area on clinical outcomes after transcatheter aortic valve implantation.” Clin Res Cardiol: 2016 Aug [Epub ahead of print].

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BACKGROUND: Inverse associations between Body Mass Index (BMI) and Body Surface Area (BSA) with mortality in patients after Transcatheter Aortic Valve Implantation (TAVI) have been reported. This “obesity paradox” is controversial, and it remains unclear which parameter, BMI or BSA, is of greater prognostic value. The aim of this study was to investigate the association of BMI and BSA on short- and mid-term outcomes after TAVI. METHODS AND RESULTS: This prospective, observational study consisted of 917 consecutive patients undergoing TAVI at our center from 2011 to 2014. The association between BMI/BSA and mortality (at 30 days and 1 year) was assessed using restricted cubic spline functions in propensity-adjusted (by Society of Thoracic Surgeons (STS) risk factors) logistic and Cox proportional models, respectively. The median age of the patients was 82.6 years, with a mean STS Predicted Risk of Mortality (STS-PROM) of 6.6 +/- 4.3 %. Throughout the study period (mean follow-up time was 297 days), 150 (16.4 %) patients died; 72 (7.9 %) patients died within 30 days of TAVI. After risk adjustment, the association between body constitution and 30-day mortality was not significant for either measure (BMI p = 0.25; BSA p = 0.32). However, BMI (p = 0.01), but not BSA (p = 0.13), was significantly associated with 1-year survival. There was no association between stroke, vascular complications, or length of stay with BMI or BSA. CONCLUSIONS: BMI was associated with survival at 1-year after TAVI. Despite the trend towards implementing BSA in risk score calculation, BMI may be more suitable for the assessment of TAVI patients.

Fallahzadeh, M. K. and P. A. McCullough (2015). “Cardiac electromechanical abnormalities in hemodialysis patients: Indicators of cardiomyopathy and future risk.” Am J Nephrol 42(3): 237-238.

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Cardiovascular diseases (CVDs) are more common in chronic kidney disease and end-stage renal disease (ESRD) patients as compared with general population and are a major of cause of morbidity and mortality in this population [1,2]. CVD accounts for approximately 50% of mortality in ESRD patients. In addition to the increased chance of coronary artery disease, the chance of developing arrhythmic events and sudden cardiac death is also higher in ESRD patients [3,4]. The underlying pathophysiology behind this increased chance of arrhythmic event in hemodialysis patients is not clearly understood. Previous studies have shown that hemodialysis patients have lower left ventricular ejection fraction and higher atrial diameters as compared with general population [5,6,7]. Using the timing of electrocardiogram and tissue Doppler on echocardiography, the time from electrical activation to muscular contraction can be assessed. Atrial electromechanical delay (AEMD) times have been reported to be longer in ESRD patients and have been shown to improve after each hemodialysis session [6,7,8]. Additionally, prolonged atrial conduction times are considered as predisposing factors for atrial fibrillation [9]. In this issue of Journal, Turkmen et al. [10] from Turkey have compared the cardiac electromechanical characteristics and biochemical profile of 60 hemodialysis patients versus 44 healthy controls. They also followed the hemodialysis patients for 2 years and compared the characteristics of 19 patients who died within this 2-year period versus 41 living hemodialysis patients.

Cass, I., L. R. Duska, S. V. Blank, G. Cheng, N. C. duPont, P. J. Frederick, E. K. Hill, C. M. Matthews, T. L. Pua, K. S. Rath, R. Ruskin, P. H. Thaker, A. Berchuck, B. S. Gostout, D. M. Kushner and J. M. Fowler (2016). “Stress and burnout among gynecologic oncologists: A society of gynecologic oncology evidence-based review and recommendations.” Gynecol Oncol: 2016 Aug [Epub ahead of print].

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Burnout has been studied among medical oncologists and surgeons; however, there is less data specific to gynecologic oncolxogists [14] and [15]. Job satisfaction and work related stress among gynecologic oncologists have been assessed [2], but until recently, burnout was not assessed. Two large, seminal studies, a 2014 survey of 369 members of the Society of Gynecologic Oncologists (SGO) and a 2008 survey of 7900 members of the American College of Surgeons (ACS), established the high prevalence of physician burnout in gynecologic oncologists and surgeons respectively, affecting 32%–40% of responders [16] and [17]. Both works are cited throughout this paper and were driving forces motivating the Society of Gynecologic Oncology (SGO) to assemble a Wellness Task Force to address this issue. This paper represents an effort by the Task Force to acknowledge the high rate of burnout in gynecologic oncology as a specialty by bringing the subject forward for discussion, and exploring potential solutions.

McComb, S., C. Jones, A. Smith, W. Collins and B. Pope (2016). “Designing incentives to change behaviors: Examining college student intent toward healthy diets.” West J Nurs Res 38(9): 1094-1113.

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College is a time when young adults establish lifestyle habits. This research examines how personalization and limited resources might be balanced most effectively when designing incentives to shift college students’ intentions toward positive dietary changes. A randomized 2 x 2 experiment (Coaching/Coupons x Fruits and Vegetables/Low Fat) was conducted, where respondents were exposed to virtual interventions and asked pre- and post-intervention about their intent to eat healthy. Results suggest that interventions may incentivize students, but are dependent on student characteristics. On-campus students and students with more knowledge about healthy diets were more likely to increase their intent when offered coaching; students living off campus and those with less knowledge resonated with coupons. On- and off-campus students differed in their positive responses to eating fruits and vegetables versus low fat foods, respectively. Younger students may be more susceptible to interventions. Findings may be useful in designing meaningful incentives for college students.