BackgroundBody mass index (BMI) is sometimes used to determine surgical eligibility for gender-affirming mastectomy (GAM) but there is insufficient data informing these criteria. Given the limitations of single-institution studies, which lack the ability to generalize the potential impact of BMI on GAM complications across various surgical practices, a systematic review is needed.MethodsA systematic review and meta-analysis was performed for all studies that evaluated the relationship between BMI and surgical outcomes after GAM. Our institution's GAM cohort (n = 457) was also included. Obesity was defined as BMI >= 30 kg/m2. The random-effects DerSimonian-Laird method was used to synthesize results across studies.ResultsOf 605 studies screened, 10 met the inclusion criteria. There were a total of 1195 patients, of whom 441 (37%) were obese and 754 (63%) were nonobese. There were significantly higher odds of nipple-areola complex [odds ratio (OR) = 4.13, P = 0.04] and wound complications (OR = 4.27, P = 0.03) in patients with obesity compared to those without obesity. There were no significant differences in hematoma (OR = 1.16, P = 0.62), seroma (OR = 2.49, P = 0.14), or infection (OR = 1.63, P = 0.24).ConclusionsWhile some GAM complications were more common in patients with obesity, serious complications like hematoma and infection were as likely to occur among obese and nonobese patients. Patients with higher BMIs should be counseled about their increased risk for these complications. However, BMI cutoffs alone should not determine surgical eligibility, as these findings provide more generalizable evidence confirming the low morbidity associated with GAM.

BACKGROUND:Body mass index (BMI) is sometimes used to determine surgical eligibility for gender-affirming mastectomy (GAM) but there is insufficient data informing these criteria. Given the limitations of single-institution studies, which lack the ability to generalize the potential impact of BMI on GAM complications across various surgical practices, a systematic review is needed. METHODS:A systematic review and meta-analysis was performed for all studies that evaluated the relationship between BMI and surgical outcomes after GAM. Our institution's GAM cohort (n = 457) was also included. Obesity was defined as BMI ≥ 30 kg/m 2 . The random-effects DerSimonian-Laird method was used to synthesize results across studies. RESULTS:Of 605 studies screened, 10 met the inclusion criteria. There were a total of 1195 patients, of whom 441 (37%) were obese and 754 (63%) were nonobese. There were significantly higher odds of nipple-areola complex [odds ratio (OR) = 4.13, P = 0.04] and wound complications (OR = 4.27, P = 0.03) in patients with obesity compared to those without obesity. There were no significant differences in hematoma (OR = 1.16, P = 0.62), seroma (OR = 2.49, P = 0.14), or infection (OR = 1.63, P = 0.24). CONCLUSIONS:While some GAM complications were more common in patients with obesity, serious complications like hematoma and infection were as likely to occur among obese and nonobese patients. Patients with higher BMIs should be counseled about their increased risk for these complications. However, BMI cutoffs alone should not determine surgical eligibility, as these findings provide more generalizable evidence confirming the low morbidity associated with GAM.

INTRODUCTION:Women continue to be underrepresented in academic anesthesiology. This study assessed guidelines in anesthesia journals over the past 5 years, evaluating differences in woman-led versus man-led guidelines in terms of author gender, quality, and changes over time. We hypothesized that anesthesia guidelines would be predominately man-led, and that there would be differences in quality between woman-led versus man-led guidelines. METHODS:All clinical practice guidelines published in the top 10 anesthesia journals were identified as per Clarivate Analytics Impact Factor between 2016 and 2020. Fifty-one guidelines were included for author, gender, and quality analysis using the Appraisal of Guidelines for Research & Evaluation (AGREE) II instrument. Each guideline was assessed across 6 domains and 23 items and given an overall score, overall quality score, and overall rating/recommendation. Stratified and trend analyses were performed for woman-led versus man-led guidelines. RESULTS:Fifty out of 51 guidelines were included: 1 was excluded due to unidentifiable first-author gender. In total, 255 of 1052 (24%) authors were women, and woman-led guidelines (woman-first author) represented 12 of 50 (24%) overall guidelines. Eighteen percent (9 of 50) of guidelines had all-male authors, and a majority (26 of 50, 52%) had less than one-third of female authors. The overall number and percentage of woman-led guidelines did not change over time. There was a significantly higher percentage of female authors in woman-led versus man-led guidelines, median 39% vs 20% ( P = .012), as well as a significantly higher number of female coauthors in guidelines that were woman-led median 3.5 vs 1.0, P = .049. For quality, there was no significant difference in the overall rating or objective quality of woman- versus man-led guidelines. However, there was a significant increase in the overall rating of all the guidelines over time ( P = .010), driven by the increase in overall rating among man-led guidelines, P = .002. The overall score of guidelines did not increase over time; however, they increased in man-led but not woman-led guidelines. There was no significant correlation between the percentage of female authors per guideline and either overall score or overall rating. CONCLUSIONS:There is a substantial disparity in the number of women leading and contributing to guidelines which has not improved over time. Woman-led guidelines included more women and a higher percentage of women. There was no difference in quality of guidelines by first-author gender or percentage of female authors. Further systematic and quota-driven sponsorship is needed to promote gender equity, diversity, and inclusion in anesthesia guidelines.

Background Detailed understanding of the association between intraoperative left atrial and left ventricular diastolic function and postoperative atrial fibrillation is lacking. In this post hoc analysis of the Posterior Left Pericardiotomy for the Prevention of Atrial Fibrillation after Cardiac Surgery (PALACS) trial, we aimed to evaluate the association of intraoperative left atrial and left ventricular diastolic function as assessed by transesophageal echocardiography (TEE) with postoperative atrial fibrillation. Methods PALACS patients with available intraoperative TEE data (n = 402 of 420; 95.7%) were included in this cohort study. We tested the hypotheses that preoperative left atrial size and function, left ventricular diastolic function, and their intraoperative changes were associated with postoperative atrial fibrillation. Normal left ventricular diastolic function was graded as 0 and with lateral e’ velocity 10 cm/s or greater. Diastolic dysfunction was defined as lateral e’ less than 10 cm/s using E/e’ cutoffs of grade 1, E/e’ 8 or less; grade, 2 E/e’ 9 to 12; and grade 3, E/e’ 13 or greater, along with two criteria based on mitral inflow and pulmonary wave flow velocities. Results A total of 230 of 402 patients (57.2%) had intraoperative diastolic dysfunction. Posterior pericardiotomy intervention was not significantly different between the two groups. A total of 99 of 402 patients (24.6%) developed postoperative atrial fibrillation. Patients who developed postoperative atrial fibrillation more frequently had abnormal left ventricular diastolic function compared to patients who did not develop postoperative atrial fibrillation (75.0% [n = 161 of 303] vs. 57.5% [n = 69 of 99]; P = 0.004). Of the left atrial size and function parameters, only delta left atrial area, defined as presternotomy minus post–chest closure measurement, was significantly different in the no postoperative atrial fibrillation versus postoperative atrial fibrillation groups on univariate analysis (–2.1 cm2 [interquartile range, –5.1 to 1.0] vs. 0.1 [interquartile range, –4.0 to 4.8]; P = 0.028). At multivariable analysis, baseline abnormal left ventricular diastolic function (odds ratio, 2.02; 95% CI, 1.15 to 3.63; P = 0.016) and pericardiotomy intervention (odds ratio, 0.46; 95% CI, 0.27 to 0.78, P = 0.004) were the only covariates independently associated with postoperative atrial fibrillation. Conclusions Baseline preoperative left ventricular diastolic dysfunction on TEE, not left atrial size or function, is independently associated with postoperative atrial fibrillation. Further studies are needed to test if interventions aimed at optimizing intraoperative left ventricular diastolic function during cardiac surgery may reduce the risk of postoperative atrial fibrillation. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

BACKGROUND:In the Posterior left pericardiotomy for the prevention of atrial fibrillation after cardiac surgery (PALACS) trial, posterior pericardiotomy was associated with a significant reduction in postoperative atrial fibrillation (POAF) after cardiac surgery. We aimed to investigate the mechanisms underlying this effect. METHODS:We included PALACS patients with available echocardiographic data (n = 387/420, 92%). We tested the hypotheses that the reduction in POAF with the intervention was associated with 1) a reduction in postoperative pericardial effusion and/or 2) an effect on left atrial size and function. Spline and multivariable logistic regression analyses were used. RESULTS:Most patients (n = 307, 79%) had postoperative pericardial effusions (anterior 68%, postero-lateral 51.9%). The incidence of postero-lateral effusion was significantly lower in patients undergoing pericardiotomy (37% vs 67%; P < .001). The median size of anterior effusion was comparable between patients with and without POAF (5.0 [IQR 3.0-7.0] vs 5.0 [IQR 3.0-7.5] mm; P = .42), but there was a nonsignificant trend towards larger postero-lateral effusion in the POAF group (5.0 [IQR 3.0-9.0] vs 4.0 [IQR 3.0-6.4] mm; P = .06). There was a non-linear association between postero-lateral effusion and POAF at a cut-off at 10 mm (OR 2.70; 95% CI 1.13, 6.47; P = .03) that was confirmed in multivariable analysis (OR 3.5, 95% CI 1.17, 10.58; P = 0.02). Left atrial dimension and function did not change significantly after posterior pericardiotomy. CONCLUSIONS:Reduction in postero-lateral pericardial effusion is a plausible mechanism for the effect of posterior pericardiotomy in reducing POAF. Measures to reduce postoperative pericardial effusion are a promising approach to prevent POAF.

OBJECTIVES:Three-dimensional transesophageal echocardiography (TEE) is widely used to guide decision-making for mitral repair. The relative impact of surgical mitral valve repair (MVr) and MitraClip on annular remodeling is unknown. The aim was to determine the impact of both mitral repair strategies on annular geometry, including the primary outcome of annular circumference and area. DESIGN:This was a retrospective observational study of patients who underwent mitral intervention between 2016 and 2020. SETTING:Weill Cornell Medicine, a single, large, academic medical center. PARTICIPANTS:The population comprised 50 patients with degenerative mitral regurgitation (MR) undergoing MVr. INTERVENTIONS:Elective MVr and TEE. MEASUREMENTS AND MAIN RESULTS:Patients undergoing MitraClip or surgical MVr were matched (1:1) for sex and coronary artery disease. Mitral annular geometry indices were quantified on intraprocedural three-dimensional TEE. Mild or less MR on follow-up transthoracic echocardiography defined optimal response. Patients undergoing MitraClip were older (80 ± eight v 66 ± six years; p < 0.001) but were otherwise similar to surgical patients. Patients undergoing MitraClip had larger baseline left atrial and ventricular sizes, increased tenting height, and volume (p < 0.01), with a trend toward increased annular area (p = 0.23). MitraClip and surgery both induced immediate mitral annular remodeling, including decreased area, circumference, and tenting height (p < 0.001), with greater remodeling with surgical repair. At follow-up (4.1 ± 9.0 months) optimal response (≤ mild MR) was ∼twofold more common with surgery than MitraClip (81% v 46%; p = 0.02). The relative reduction in annular circumference (odds ratio [OR] 1.05 [1.00-1.09] per cm; p = 0.04) and area (OR 1.03 [1.00-1.05] per cm2; p = 0.049) were both associated with optimal response. CONCLUSIONS:Surgical MVr and MitraClip both reduce annular size, but repair-induced remodeling is greater with surgery and associated with an increased likelihood of optimal response.

article: Characterizing factors associated with high authorship in contemporary anesthesia literature: a cross-sectional study - Minerva Cardiology and Angiology 2022 February;70(1):123-4 - Minerva Medica - Journals

We sought to determine the correlation between Altmetric Attention Score and traditional bibliometrics in the gynecologic oncology literature. We identified the 10 most-cited gynecologic oncology articles from 5 major gynecology journals and 10 major "oncology" journals that publish on gynecologic oncology during 2014, 2016, and 2018. Article citation count and Altmetric Attention Score (AAS), as well as journal impact factor (IF) and date of Twitter account development were recorded. Pearson's correlation coefficient was used to describe the relationship between AAS, tweets, IF, and citation count. While the median citation counts significantly decreased for the top-cited gynecologic oncology articles from 2014 to 2018 (p < 0.001), the corresponding median AAS continuously increased during this period (p = 0.008). For articles published in 2014 and 2018, there was a strong positive relationship between the median citation count and the median AAS (2014: r = 0.92; 2018: r = 0.97), as well as between the IF (r = 0.78 and r = 0.89, respectively); these correlations were moderate to weak in 2016 (r = 0.5 and r = 0.41, respectively). There was a continuously increasing strong positive correlation from 2014 to 2018 between journal IF and median AAS (2014: r = 0.75; 2016: r = 0.82; 2018: r = 0.92). Gynecologic oncology articles published in higher impact journals are associated with increased social media visibility and attention. Our data support the idea that early online attention scores, like the AAS, might be useful for predicting future citation counts for oncology publications in general and gynecologic oncology specifically.

Editor—Recent studies have shown an increase in the number of authors of scientific publications in the medical field.1Dotson B. McManus K.P. Zhao J.J. Whittaker P. Authorship and characteristics of articles in pharmacy journals: changes over a 20-year interval.Ann Pharmacother. 2011; 45: 357-363Crossref PubMed Scopus (25) Google Scholar, 2Levsky M.E. Rosin A. Coon T.P. Enslow W.L. Miller M.A. A descriptive analysis of authorship within medical journals, 1995–2005.South Med J. 2007; 100: 371-375Crossref PubMed Scopus (74) Google Scholar, 3Khan K.S. Nwosu C.R. Khan S.F. Dwarakanath L.S. Chien P.F. A controlled analysis of authorship trends over two decades.Am J Obstet Gynecol. 1999; 181: 503-507Abstract Full Text Full Text PDF PubMed Scopus (33) Google Scholar, 4Weeks W.B. Wallace A.E. Kimberly B.C. Changes in authorship patterns in prestigious US medical journals.Soc Sci Med. 2004; 59: 1949-1954Crossref PubMed Scopus (123) Google Scholar Several reasons have been proposed, including greater complexity of the scientific question requiring interdisciplinary collaboration, pressure to publish in academia for promotion purposes, and honorary or gift authorship. Gift authorship is defined as naming a person as an author who does not meet authorship criteria. The last reason is a cause for potential concern. To date, no study evaluating the number of authors in the anaesthesiology literature has been published. We analysed articles published from 2008 to 2018 in the five anaesthesia journals with the highest 2018 impact factors (based on Thomson Reuters-Clarivate Analytics) as an extension of a previous study on gender authorship presented at the American Society of Anesthesiology annual meeting. Our objective was to determine the trend of number of authors and the factors associated with high author numbers over time in the anaesthesiology literature. This study was prospectively registered with the International Prospective Register of Systematic Reviews (Registration number 151092).5Chang J. Desai N. Gosain A. Correlation between altmetric score and citations in pediatric surgery core journals.J Surg Res. 2019; 243: 52-58Abstract Full Text Full Text PDF PubMed Scopus (46) Google Scholar The journals Anesthesiology, British Journal of Anaesthesia (BJA), Anaesthesia, European Journal of Anaesthesiology (EJA), and Anesthesia and Analgesia (A&A) were included (Fig. 1a). Original research articles, systematic reviews, and meta-analyses published in 2008, 2010, 2012, 2014, 2016, and 2018 were selected. The number and gender of authors, year of publication, country of origin, departmental affiliations, type of study, and source of funding were extracted for each article. Continuous variables, normally distributed based on visual inspection and the Shapiro–Wilk normality test, were reported as mean and standard deviation (sd) and compared using the Mann–Whitney U-test. Categorical variables were reported as counts and percentages and compared using the χ2 test. Two-sided significance testing was used and P-values <0.05 were considered significant. A total of 4720 articles were included over the study period. Although the number of articles overall slightly decreased over time (1642–1506 to 1572), the number of co-authors per article increased significantly from a mean (sd) of 5.80 (sd 2.23) in 2012–2014 to 6.35 (sd 2.72) in 2014–2016 to 7.10 (sd 3.46) in 2016–2018, all P<0.001. In all five journals, there was a statistically significant increase in the number of authors per article over time (P<0.001). Anesthesiology had the highest mean number of authors at 7.28 (sd 3.23) and Anaesthesia had the lowest at 5.56 (sd 2.71) (Fig. 1a, Supplementary Table S1). The number of authors increased significantly over time in all considered subgroups, including basic research articles, clinical articles, retrospective and prospective studies, single and multiple institutions studies, different funding sources, and for all continents of origin (Fig. 1b–d). We examined the number of authors over 10 years in the five anaesthesia journals with the highest impact factors and found a significant increase from a mean of 5.80 authors per manuscript in 2008–2010 to 7.10 in 2016–2018. This trend held true for each journal. The percentage of articles with more than eight authors, defined as the highest quartile of author number per article, more than doubled from 9.8% in 2008 to 25.9% in 2018. Anesthesiology had the highest mean number of authors and percentage of articles with more than eight authors (28.0%), while Anaesthesia had the lowest mean number and percentage of articles with more than eight authors (9.3%). Our results are similar to results from previous studies on authorship patterns in general medicine. Studies found that the number of authors of manuscripts published in high impact medical journals increased by 53% from 1980 to 2000,4Weeks W.B. Wallace A.E. Kimberly B.C. Changes in authorship patterns in prestigious US medical journals.Soc Sci Med. 2004; 59: 1949-1954Crossref PubMed Scopus (123) Google Scholar and by 23% from 1995 to 2005.2Levsky M.E. Rosin A. Coon T.P. Enslow W.L. Miller M.A. A descriptive analysis of authorship within medical journals, 1995–2005.South Med J. 2007; 100: 371-375Crossref PubMed Scopus (74) Google Scholar A significant increasing trend in shared first-authorship was found from 2011 vs 2002 in top anaesthesia journals from 6.4% vs 0.4% overall: Anesthesiology, 8.8% vs 0.9%; BJA, 8.8% vs 0%; A&A, 3.4% vs 0.3%.6Li Z. Sun Y.M. Wu F.X. Yang L.Q. Lu Z.J. Yu W.F. Equal contributions and credit: an emerging trend in the characterization of authorship in major anaesthesia journals during a 10-yr period.PLoS One. 2013; 8e71430Crossref PubMed Scopus (28) Google Scholar Although legitimate reasons may exist for this increase in authorship, including increased collaboration among investigators because of more complex research questions, it is possible that the increase may reflect an increase in gift authorship. Evidence suggests that a not negligible proportion of authors do not meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship. In a 2011 survey of corresponding authors of 896 articles in six general medicine journals with high impact factors including the New England Journal of Medicine and Lancet, the rate of honorary authorship was highest in original manuscripts, compared with review articles and editorials at 25.0%,7Wislar J.S. Flanagin A. Fontanarosa P.B. Deangelis C.D. Honorary and ghost authorship in high impact biomedical journals: a cross sectional survey.BMJ. 2011; 343: d6128Crossref PubMed Scopus (278) Google Scholar and was significantly higher than found in 1996 at 16.3%.8Flanagin A. Carey L.A. Fontanarosa P.B. et al.Prevalence of articles with honorary authors and ghost authors in peer-reviewed medical journals.JAMA. 1998; 280: 222-224Crossref PubMed Scopus (415) Google Scholar This may also be an optimistic number because of the possibility of response biases in the survey. Each journal included in this analysis requests that authors meet all ICMJE criteria. When authorship criteria are not met, contributors should be listed as a collaborator (A&A) or in the acknowledgements section (BJA, Anesthesiology). To further encourage ethical authorship, Anesthesiology requests all authors to confirm authorship and approval of the manuscript and EJA reserves the right to reject the manuscript if there is evidence of inappropriate authorship. However, there is a lack of further requirements; notably, no anaesthesia journals designate a maximum recommended number of authors. This is in contrast to other journals that recommend a maximum of 10 authors for an original manuscript and require justification for additional authors. Several limitations exist to our study. We only included the anaesthesia journals with the highest impact factor; we did not include anaesthesia articles published in general medical journals. We could not assess whether all authors fulfilled authorship criteria and did not identify the reasons for the described increase in author number. In conclusion, we found that from 2008 to 2018 the number of authors in top anaesthesia journals increased significantly as did the percentage of articles with more than eight authors. Further studies should seek to determine the causes of this trend and determine whether more stringent authorship guidelines should be used. LQR is a British Journal of Anaesthesia Editorial Fellow. LQR is significantly funded by Foundation for Anesthesia Education and Research (FAER) (MRTG-CT-08-15-2018-Rong).

OBJECTIVE Whereas left atrial (LA) strain has been well-validated using transthoracic echocardiography (TTE), its detection using transesophageal echocardiography (TEE) has not been studied. Conventional transesophageal views are known to be limited due to the posterior location of the LA. Here, the feasibility and accuracy of the deep transgastric long-axis LA focused view for peak atrial longitudinal strain (PALS) quantification was tested. DESIGN This was a retrospective study of patients who underwent elective cardiac surgery between 2018 and 2020. TEE deep transgastric long-axis view was compared to TTE 4-chamber atrial focused view as the reference standard. LA area, volume, and PALS were quantified independently. SETTING At Weill Cornell Medicine, a single, large academic medical center. PARTICIPANTS The population comprised 42 patients undergoing cardiac surgery who had a TTE and TEE within 14.9 ± 20.8 days. INTERVENTIONS TTE, TEE, and cardiac surgery. MEASUREMENTS AND MAIN RESULTS TEE-derived PALS strongly correlated with TTE- derived PALS (r = 0.92, p < 0.001), though absolute PALS were lower (20.7 ± 6.0% v 25.7 ± 6.8%; p < 0.001). Mean TEE-derived atrial length was similar to TTE-derived length (5.18 ± 0.61 cm v 5.24 ± 0.61 cm; p = 0.38), but mean LA area was significantly smaller (16.7 ± 3.5 cm2v 18.9 ± 3.7 cm2; p < 0.001), with significant correlations between the 2 modalities for both (r = 0.74, 0.74, respectively; all p < 0.001). CONCLUSION This exploratory study supported the feasibility of TEE for assessing LA longitudinal strain. There was an excellent correlation between atrial strain derived via TEE versus TTE, although values tended to be smaller on TEE, and bias between values was highly variable, suggesting that the values were not interchangeable.

Editor—Traditional measures of impact of scientific research focus on article citation numbers and journal impact factor (IF).1Barbic D. Tubman M. Lam H. Barbic S. An analysis of altmetrics in emergency medicine.Acad Emerg Med. 2016; 23: 251-268Crossref PubMed Scopus (76) Google Scholar With the increase of digital technology and use of social media platforms to discuss research, impact for these channels can also be assessed. Alternative-level metrics (altmetrics) are a new measure of the attention, dissemination, overall influence, and impact of scientific publications.2Nocera A.P. Boyd C.J. Boudreau H. Hakim O. Rais-Bahrami S. Examining the correlation between altmetric score and citations in the urology literature.Urology. 2019; 134: 45-50Abstract Full Text Full Text PDF PubMed Scopus (25) Google Scholar There are various altmetrics platforms being used, but the first and most popular of these, Altmetric, compiles the number of mentions of an article across the most commonly used social media platforms such as Twitter, Facebook, and blogs and research websites to generate a weighted score.3Bookmarklet - altmetric. 2020https://www.altmetric.com/products/free-tools/bookmarkletDate accessed: December 20, 2019Google Scholar We explored the relationship between traditionally-used bibliometrics (citation counts) and altmetrics among highly cited articles in top anaesthesiology journals. We identified the top 10 most-cited articles in the five anaesthesiology journals with the highest Clarivate Analytics IF (Anesthesiology, British Journal of Anaesthesia [BJA], European Journal of Anaesthesiology, Anaesthesia, and Anesthesia & Analgesia) in 2016 and 2018.4Journal citation reports, clarivate Analytics.https://incites-clarivate-com.ezproxy.med.cornell.eduDate accessed: December 20, 2019Google Scholar Guidelines were excluded because of their disproportionally higher likelihood of being cited. For each journal, the following were recorded: the IF in 2016/2018, total number of tweets, and the 10 articles with the highest number of citations on Scopus in March, 2020.5Web of Science - Scopus http://www.scopus.comDate accessed: December 20, 2019Google Scholar For each article, the citation count and Altmetric score were recorded.3Bookmarklet - altmetric. 2020https://www.altmetric.com/products/free-tools/bookmarkletDate accessed: December 20, 2019Google Scholar After testing for normality, continuous variables such as citation count and Altmetric score were expressed as median and interquartile range (IQR). Descriptive statistics were performed and Pearson's correlation tests were used. A total of 100 articles were evaluated. For articles published in 2016, overall Altmetric scores were weakly correlated with citation count (r=0.40) but not journal IF (r=0.25). There was strong correlation between journal IF and overall citation count (r=0.71), and journal IF and median citation count for that journal (r=0.89). There was strong correlation between the number of journal tweets and the median journal Altmetric score (r=0.95) (Fig 1). The largest Altmetric score for any article was 351 (median 13.0; IQR [7.5, 33.0]) and the largest citation count was 136 (median 55.5; IQR [41.5, 75.0]). Anaesthesia had the largest median article Altmetric score (41) and largest number of journal tweets (14 600), while the BJA had the largest IF (5.62), and Anesthesiology had the largest median number of citations (85.5). For articles published in 2018, Altmetric scores were not correlated with citation count (r=0.13) or journal IF (r=0.15). There was a moderate correlation between journal IF and median citation count (r=0.68) but no correlation between journal IF and overall citation count for that journal (r=0.20). There was a strong correlation between the number of journal tweets and the median journal Altmetric score (r=0.97). The highest Altmetric score for any article was 589 (median 23.5; IQR [7, 95]) and the highest citation count was 139 (median 28.5; IQR [18, 38]). Anesthesiology had the highest IF (6.5) and the highest median number of citations (37). Anaesthesia had the highest number of journal tweets (14,600) and largest median Altmetric score (136). To our knowledge, this is the first study evaluating the relationship between altmetrics and traditionally used bibliometrics for the top-cited anaesthesiology articles. We found that for articles published in 2016, the Altmetric score was weakly correlated with citation count and its median score was strongly correlated with the overall number of journal tweets. In 2018, the median citation counts (29 vs 53) were less, and Altmetric scores (24 vs 13) were greater than in 2016. The overall highest individual citation count and Altmetric score was found in 2018. While there was no correlation between citation count (139) and Altmetric score (589), there was a moderate correlation between journal IF and median citation count, a weak correlation between journal tweets and IF, and a strong correlation between journal tweets and Altmetric score. Our results demonstrate that journal social media activity may influence Altmetric scores but that there is a limited correlation between citation and Altmetric scores. Top anaesthesiology journals routinely report altmetrics online. For example, Anesthesiology articles link to Altmetrics while the BJA articles link to Plum Analytics.6PlumX metrics.https://plumanalytics.com/learn/about-metrics/Date accessed: December 20, 2019Google Scholar Researchers in urology, emergency medicine, and paediatric surgery have studied the effect of social media on academic influence and have shown a weak correlation between Altmetric score and citation counts.1Barbic D. Tubman M. Lam H. Barbic S. An analysis of altmetrics in emergency medicine.Acad Emerg Med. 2016; 23: 251-268Crossref PubMed Scopus (76) Google Scholar,2Nocera A.P. Boyd C.J. Boudreau H. Hakim O. Rais-Bahrami S. Examining the correlation between altmetric score and citations in the urology literature.Urology. 2019; 134: 45-50Abstract Full Text Full Text PDF PubMed Scopus (25) Google Scholar,7Chang J. Desai N. Gosain A. Correlation between altmetric score and citations in pediatric surgery core journals.J Surg Res. 2019; 243: 52-58Abstract Full Text Full Text PDF PubMed Scopus (40) Google Scholar Other studies have found that journals with social media accounts had significantly higher Altmetric scores than those without accounts8Wang J. Alotaibi N.M. Ibrahim G.M. Kulkarni A.V. Lozano A.M. The spectrum of altmetrics in neurosurgery: the top 100 "trending" articles in neurosurgical journals.World Neurosurg. 2017; 103 (883–95.e1)Crossref Scopus (45) Google Scholar and that tweets can predict highly cited articles within the first 3 days of article publication.9Eysenbach G. Can tweets predict citations? Metrics of social impact based on Twitter and correlation with traditional metrics of scientific impact.J Med Internet Res. 2011; 13: e123Crossref PubMed Scopus (628) Google Scholar Another recent study demonstrated a weak correlation between Altmetric score and citations for a percentage of articles published in top medicine journals.10Barakat A.F. Nimri N. Shokr M. et al.Correlation of altmetric attention score and citations for high-impact general medicine journals: a cross-sectional study.J Gen Intern Med. 2019; 34: 825-827Crossref PubMed Scopus (18) Google Scholar Altmetrics and traditional bibliometrics such as citation count both provide insight into the impact and influence of research. However, while an article needs time to accumulate citations and influence, altmetrics provide rapid feedback on the ripple effect of research which may not be sustained.2Nocera A.P. Boyd C.J. Boudreau H. Hakim O. Rais-Bahrami S. Examining the correlation between altmetric score and citations in the urology literature.Urology. 2019; 134: 45-50Abstract Full Text Full Text PDF PubMed Scopus (25) Google Scholar It has been shown that there is an initial 3 month spike in social media interest that often abates.2Nocera A.P. Boyd C.J. Boudreau H. Hakim O. Rais-Bahrami S. Examining the correlation between altmetric score and citations in the urology literature.Urology. 2019; 134: 45-50Abstract Full Text Full Text PDF PubMed Scopus (25) Google Scholar This short-lived impact may reflect a different measure of influence compared with citations which take time to accrue. Our study has important limitations. We only analysed the top five anaesthesiology journals, selected by IF in 2016 and 2018. It is unknown whether journals of lower IF would have shown similar results. We also analysed only the top 10 most cited articles of each journal, and our findings may not be consistent with respect to less cited articles. For 2018 data, there may not have been enough time for citations to accrue. It is also possible that our results may not reflect the impact of social media use in 2020. Finally, we only used each journal's Twitter activity as a measure of the journal's social media presence. As the use of social media for research dissemination grows, further research is needed to understand the relationship between traditional bibliometrics and altmetrics over time, qualitative aspects of articles with high citations, almetrics, or both, and the impact of social media exposure on articles and journals, both short-term and long-term. Study concept and design: LQR, IH, MFLG, MEC Data extraction: LQR Data analysis: LQR, AL Interpretation of data: all authors Preparation of first draft of manuscript, revision of manuscript: LQR, AL Preparation of manuscript: all authors The authors declare that they have no conflicts of interest. LQR is supported in part by the Foundation for Anesthesia Research and Education Training Grant (FAER MTRG-CT-08-15-2018-Rong). LQR is a fellow with the British Journal of Anaesthesia Peer Review Fellowship Programme.

OBJECTIVE:Revascularization via coronary artery bypass grafting (CABG) remains a common therapy for coronary artery disease. CABG-based revascularization is most commonly performed via either single arterial graft (SAG) or multiple arterial grafting (MAG) strategies. Echo-derived global and regional longitudinal strain was used to test where SAG or MAG results in immediate differences in left ventricular (LV) function after CABG.MATERIALS AND METHODS:Pre- and postprocedural intraoperative transesophageal echos were prospectively collected. Two-dimensional LV images were analyzed for global and regional longitudinal strain (GLS), LV ejection fraction, end-diastolic volume, end-systolic volume, and stroke volume (SV).RESULTS:Twenty patients underwent open, on-pump CABG (63.9 ± 10 years old, 85% male; 10 with SAG and 10 with MAG. Preprocedural GLS significantly differed between patients with SAG and MAG, with patients with MAG having greater GLS (mean [standard deviation, SD], 20.41 [5.54]) than patients with SAG (16.28 [3.48]). After CABG, in patients with MAG, LV strain decreased both globally (-1.13 [3.15]) and regionally in the anterior-lateral (-1.22 [3.84]) and inferior-lateral regions (-1.32 [5.69]), along with LVEF. In patients with SAG, LV strain increased after CABG globally (1.34 [2.73]) and regionally in the anterior-lateral (1.20 [6.49]) and inferior-lateral regions (0.39 [7.26]), as did LVEF and SV. Postprocedure, more patients with MAG were given vasopressor (100% vs 60%) and inotrope infusions (70% vs 40%) than patients with SAG.CONCLUSIONS:After CABG, LV function quantified through GLS changes both globally and regionally increased after SAG and decreased after MAG. This finding may have important clinical implications in terms of optimizing intraoperative management for patients with CABG and have the potential to guide the improvement of clinical outcomes.

BACKGROUND:Whereas cardiac magnetic resonance (CMR) imaging provides high temporal resolution imaging of aortic distensibility (strain), transesophageal echocardiography (TEE) is widely used for intra-operative aortic imaging and provides a clinical alternative for aortic assessment. We tested intra-operative global circumferential aortic strain (GCS) measured on TEE in relation to the reference of CMR-derived strain among patients undergoing surgical graft repair of ascending aortic aneurysms.METHODS:CMR (3T) was prospectively performed in patients scheduled for aortic repair. TEE was performed intra-operatively; images were co-localized with MRI. GCS on CMR and TEE was quantified independently, blinded to results of the other modality.RESULTS:25 patients (54 ± 10 year-old, 88% male) were studied, inclusive of 13 genetically mediated and 12 degenerative aneurysms: CMR and TEE were performed within 12 ± 9 days. Pulse pressure (PP)-adjusted descending aortic TEE-derived GCS strongly correlated with cine-CMR-derived GCS (r = .75, P = .002) though absolute GCS and PP-adjusted values were slightly lower (5.40 ± 1.11 vs 6.49 ± 1.43% and 11.55 ± 3.04 vs 13.99 ± 4.53%, respectively). Similarly, TEE yielded slightly lower end-diastolic area (EDA [5.1 ± 1.7 cm2 vs 5.8 ± 1.3 cm2 , P = .004]) and end-systolic area (ESA [6.1 ± 1.9 cm2 vs 6.5 ± 1.7 cm2 , P = .10]), with significant correlations between the two modalities (r = .73, .76, P < .05 for all).CONCLUSIONS:This exploratory study supports feasibility of TEE for assessing aortic GCS in a surgical at-risk population, as well as magnitude of agreement between intra-operative TEE and preoperative CMR. We found that there is a significant correlation between GCS and EDA and ESA aortic areas, but that TEE-derived parameters underestimated CMR values by a small but significant amount.