Relevance of basic laboratory and clinical research activities as part of the vascular surgery fellowship: an assessment by program directors and postfellowship surgeons

INTRODUCTION: Decreased federal monies for graduate medical education, increased clinical training demands, and a decreased pool of general surgery trainees applying to vascular surgery fellowships have brought into question the relevance of the fellowship research experience. This study sought to describe the recent laboratory experience of the fellows, the value of this experience to program directors (PDs) and the trainees, and what factors related to this experience contributed to the trainee entering an academic career versus a private practice career. METHODS: A survey regarding the relevance of research experience during fellowship training was mailed in 2001 to all Accreditation Council for Graduate Medical Education-approved vascular surgery fellowship PDs and vascular surgery fellows (VSFs) from 1988 to 2000 applying for the American Board of Surgery Certificate of Added Qualification in General Vascular Surgery. RESULTS: Survey responses were received from 89% of the PDs (74/83) and 69% of the VSFs (259/378). Among the PDs, 70% had completed an approved fellowship, and current bench research was performed by 46%. The PDs afforded protected research time to 69% of the VSFs (with a mean duration of 12 months). This research was in the basic science laboratory 34% of the time. Only 42% of the PDs considered basic laboratory research to be an important part of the fellowship, whereas 99% believed that clinical research was important. Among the PDs, 42% believed that more practice-oriented fellowships with no basic research were needed, whereas 35% believed that basic research should remain an integral component of the fellowship. VSF basic science productivity was significantly greater from those programs that offered protected research time as compared with those that did not (mean basic science paper published, 1.7 +/- 0.1 versus 0.3 +/- 0.6 per VSF; P <.001). At the time of the survey, 99 VSFs had entered academic careers and 136 were in private practice. Basic science research had been undertaken by 56% of the VSFs during medical school and by 53% during general surgery residency. Research during the fellowship was performed by 65% of the VSFs. This experience was considered helpful in choosing an academic or private practice career by 44% of the VSFs. A greater proportion of academic surgeons had research experience as VSFs when compared with VSFs who became private practitioners (71% versus 57%; P <.05). VSFs who entered academic careers had a more productive publication record in fellowship than did those who chose private practice (mean paper, 2.4 versus 1.5; P <.05). Overall, 78% of the VSFs believed that their research experience was maturing beyond the technical skills learned. CONCLUSION: This report provides a benchmark of the vascular surgery fellowship research experience. Most VSFs considered the research experience as it now exists to be worthwhile, and less than half of the PDs believed that it should remain as it is. Research experience in fellowship seemed more influential than that in medical school or general surgical residency in promoting an academic career.     

Hepatobiliary nutrition: history and future

The liver is a master metabolic gland; consequently, liver disease commonly results in significant malnutrition. Complex metabolic derangements always accompany liver failure, often reflect the magnitude of hepatic insufficiency, and are characterized by accentuated catabolism. Nutritional assessment is problematic in these patients, because many of the usual indicators of nutritional status are altered directly by the hepatic pathophysiology rather than, or in addition to, preexisting or subsequent secondary malnutrition. The objective of nutritional support in patients with liver failure is to provide adequate nutrients to ensure the availability of specific substrates for energy and protein synthesis and for normal hepatocyte survival and function, without inducing or accentuating encephalopathy or otherwise compounding hepatic insufficiency. In the near future, guidelines must be developed for the specific nutritional support of patients with fulminant hepatic failure, cholestatic liver disease, steatosis, and cirrhosis. Currently, work is underway to develop an artificial liver for patients awaiting transplantation; to use genetic engineering technology to provide an alternative source of hepatic tissue; and to test the utility of various intermediary metabolites for hepatobiliary nutrition support. No ideal regimen for nutritional support of all forms of liver failure exists, and this also represents a significant challenge for future basic and clinical investigations. However, it is mandatory to attempt to maintain optimal nutrition in patients with severe liver failure if morbidity and mortality are to be reduced and survival is to be maximized. Received: February 19, 2002 / Accepted: March 8, 2002 Offprint requests to: S.J. Dudrick     

The use of postoperative topical mitomycin C in the treatment of recurrent conjunctival papilloma

PURPOSE: To describe the use of postoperative topical mitomycin C (MMC) in the treatment of recurrent conjunctival papilloma. METHODS: Case report. RESULTS: We report a 26-year-old man with recurrent conjunctival papilloma despite repeated surgical excision, cauterization, and cryotherapy. He was then treated with excision by cryotherapy, followed by a 2-week course of topical MMC eyedrops prescribed at postoperative day 7 (0.02 mg/mL, four times daily). No recurrence was observed 24 months postoperatively, and no complication was observed during the follow-up period. CONCLUSION: Postoperative topical MMC may be a useful adjunct in the management of recurrent conjunctival papilloma.     

Detection of West Nile virus in oral and cloacal swabs collected from bird carcasses

We evaluated if postmortem cloacal and oral swabs could replace brain tissue as a specimen for West Nile virus (WNV) detection. WNV was detected in all three specimen types from 20 dead crows and jays with an average of >10(5) WNV PFU in each. These findings suggest that testing cloacal or oral swabs might be a low-resource approach to detect WNV in dead birds.     

Differential coupling of 5-HT(1) receptors to G proteins of the G(i) family

1: Since all 5-HT(1) receptors couple to G(i)-type G proteins and inhibit adenylyl cyclase, the functional significance of five distinct subtypes of 5-HT(1) receptors has been unclear. 2: In previous studies we have used transfected cells to demonstrate that 5-HT(1B) receptors can couple more efficiently than 5-HT(1A) receptors to activation of extracellular signal-regulated kinase (ERK) and to inhibition of adenylyl cyclase. These findings suggested the possibility that individual 5-HT(1) receptors differentially couple to isoforms of G(ialpha). 3: In the present study we utilized a model system in which pertussis toxin resistant forms of human G(ialpha1), G(ialpha2), and G(ialpha3) were used to directly compare the coupling of human 5-HT(1A), 5-HT(1B), and 5-HT(1D) receptors to each G(ialpha) in transfected human HeLa cells. 4: 5-HT(1A) receptors displayed a preference for G(ialpha1) and G(ialpha2), relative to G(ialpha3). Pertussis toxin resistant forms of G(ialpha1), G(ialpha2), and G(ialpha3) rescued 73%, 76%, and 44%, respectively, of the ERK activation stimulated by 5-HT in the absence of pertussis toxin. 5: In contrast, pertussis toxin resistant forms of G(ialpha1), G(ialpha2), and G(ialpha3) rescued 32%, 118%, and 35% of 5-HT(1B) receptor-stimulated activity, respectively, indicating that 5-HT(1B) receptors coupled primarily through G(ialpha2). A similar preference for G(ialpha2) was found in studies of the 5-HT(1D) receptor, where toxin resistant G(ialpha1), G(ialpha2), and G(ialpha3) rescued 30%, 70%, and 40% of activity, respectively. 6: In conclusion, the observed differential coupling of 5-HT(1) receptors to isoforms of G(ialpha), provides additional evidence for our previous findings that the subtypes of 5-HT(1) receptors exhibit similar, but distinct, functions.     

Low molecular weight glycosaminoglycan blockade of beta-amyloid induced neuropathology

Previous studies have shown different roles for proteoglycans and glycosaminoglycans (GAGs) in Alzheimer's disease (AD) neuropathology. Using a rat model of beta-amyloid induced neuropathology, we tested whether low molecular weight glycosaminoglycans (Certoparin and C6) could be useful as preventative agents and/or as a potential therapeutic treatment for AD. Chronic subcutaneous low molecular weight glycosaminoglycan injections beginning either before or after an intra-amygdaloid beta-amyloid-(25-35) injection blocked abnormal intracellular tau changes and reactive astrocytosis but did not affect beta-amyloid's aggregation state. Also, low molecular weight glycosaminoglycan injections beginning 1 day prior to sacrifice did not block the effects of beta-amyloid nor did injections of a disaccharide, suggesting chronic low molecular weight glycosaminoglycan treatment is needed to block the effects of beta-amyloid. Furthermore, these data indicate that there is a molecular weight range of active low molecular weight glycosaminoglycans in this model; and supports the investigation of low molecular weight glycosaminoglycans as a preventative and/or therapeutic treatment of beta-amyloid induced neuropathology.