Hello! My name is Vanessa Lee. I graduated from Boston Latin School in 2012 and I am a rising junior at the University of Massachusetts Amherst as a Psychology-Neuroscience major. At UMass, I am a member of the Commonwealth Honors College, I research neuron signaling in the songbird brain with the Healey Lab, I am Vice President of UMass Timmy Global Health, and I am pursuing a minor in Sociology and following pre-medical studies with plans to attend medical school when I graduate.

This is my third year with Project Success and I am excited to meet everyone new and start in a new lab! The past two years I have worked in the Makino Lab at the Massachusetts Eye and Ear Infirmary studying visual transduction. It's been a blast not only joining the lab in the summer, but also making posters and presenting at conferences with the lab year round.

Fun facts about me:
I am ethnically Malaysian and Vietnamese.
Bring me your problems, because I am a nationally certified EMT.
Along with Project Success, I am also working at Urban Outfitters in Harvard Square.
A crafter at heart, I love DIY projects.
This year I am joining the Schermerhorn Lab at the Beth Israel Deaconess Medical Center. Dr. Marc Schermerhorn is a surgeon in the CardioVascular Institute at BIDMC. In addition to guiding us in research, he sees patients and performs various vascular surgery procedures daily.

The Schermerhorn Lab is a part of the Surgical Outcomes Analysis and Research office and often collaborates with other labs in the CardioVascular Institute and beyond. Among many things, the lab studies surgical techniques and procedures, different patient outcomes, and predictors in the patient population. Currently, we are working to put together a database of all BIDMC patients who have undergone a tibial artery angioplasty in the last ten years, collecting medical histories and any records prior to and after their operation.
For my project, I am working in collaboration with Dr. Raul Guzman, also of the CardioVascular Institute, to study comorbidities that may predict higher rates of certain outcomes after angioplasty in the patient population.

The aim of my project is to determine if a correlation exists between arterial stiffness and long term outcomes of infrapopliteal angioplasty patients at Beth Israel Deaconess Medical Center.

During an infrapopliteal percutaneous transluminal angioplasty procedure, a thin catheter is threaded through the popliteal artery in the patient's lower extremity to reach areas of reduced or obstructed blood flow caused by atherosclerosis. A balloon at the tip of the catheter is inflated to compress the buildup of plaque against the artery walls and restore perfusion. Arterial stiffness may play a role in the success of this procedure due to the lowered elasticity and flexibility of arteries to sustain a catheter.

Assignment: Share a few slides from presentation

Assignment: Question for Dr. Martin
In your experience at the Huntington's Disease Center and with the diagnosis of Huntington's Disease, have you encountered any ethical dilemmas regarding genetic testing and hereditary diseases? What is your view on the expanding use of genetic testing and its effects on families? -Pg. 152

Assignment: Powerpoint Slide and Question for Dr. Martin
Powerpoint Slide

You mentioned you had felt uncomfortable arriving in Edmonton to begin your studies at the University of Alberta. What inspired you to leave Duchess to explore such a different environment? -Pg. 65

Assignment: Introduction structure and data figure
- Increased pulse pressure (PP) is associated with many adverse cardiovascular events in the general population, all related to arterial stiffness, reduced blood flow to the lower extremities, and peripheral artery disease (PAD).
- Many studies have addressed relationships between perioperative variables and major adverse cardiac events (MACEs).
- Few studies have been conducted in regards to major adverse limb events (MALEs).
- The objective of our study is to test the hypothesis that increased perioperative PP predicts MALEs in patients undergoing infrapopliteal percutaneous transluminal angioplasty (PTA) for PAD.
Data Figure
Figure 1. Distribution of preoperative pulse pressure (PP) in millimeters of mercury verses number of subjects. Curve shows a Normal distribution.

Assignment: 1 method and 3 references
Subjects and Setting. The Beth Israel Deaconess Medical Center institutional review board approved this study protocol. Using prospectively collected data at our institution, we identified 685 patients who had undergone an attempt at infrapopliteal angioplasty from February 2004 to May 2014. Patients were identified with Current Procedural Terminology (CPT) codes for infrapopliteal revascularization, attempt and abortion of intervention, and diagnostic lower extremity angiogram as defined in our previous article. Indications for intervention included tissue loss, acute limb ischemia (ALI), rest pain, or stenosis within the outflow vessel of a tibial bypass, as determined by decreased graft flow velocities on duplex ultrasound (DUS). In patients with multiple indications for intervention, indication was assigned by the listed hierarchy above. All cases were performed using 5F or 6F sheaths through retrograde contralateral and occasionally antegrade ipsilateral access; no upper extremity access was used. Ultrasound guidance in gaining percutaneous access for catheter-based interventions was used on XXX patients (XX%). Stents, varied with availability and surgeon preference, were placed only for flow-limiting dissections or residual stenosis >30%. Unless a contraindication was present or a bypass was planned, patients were discharged on aspirin and clopidogrel.
Tibial artery calcification as a marker of amputation risk in patients with peripheral arterial disease - Vascular calcification occurs in the layers of the arterial wall and contributes to increased arterial stiffness due to the destruction of elastic fibers. This study evaluates the relationship between tibial artery calcification, limb ischemia, and risk of amputation. It concludes that calcification scores are higher in patients with peripheral arterial disease (PAD) than in asymptomatic control subjects and that increasing scores are associated with increasing severity of PAD. Tibial artery calcification (TAC) scores were also found to be predictors of short-term risk of amputation. This article gives me insight into major adverse limb events (MALEs) specifically as a result of arterial stiffness. In my research, I am also interested in MALEs, but will address arterial stiffness as a long-term risk predictor after intervention with angioplasty.
Preoperative pulse pressure and major perioperative adverse cardiovascular outcomes after lower extremity vascular bypass surgery - This study looks at increased pulse pressure (PP) as a predictor of major adverse cardiovascular events (MACEs) after open lower extremity revascularization surgery. It concluded that age is a significant predictor of MACE risk, as high PP is a manifestation of age, however PP alone is not a significant predictor of perioperative MACEs. It is possible that the results reported in this study present a type II error as it is unknown if limb PP can truly characterize central aortic stiffness. For my project, since I am interested in MALE risk, limb PP may prove to be a significant predictor. This study also addresses open bypass procedures, whereas my research is regarding closed angioplasties for revascularization. In addition, I found guidelines for data collection and analysis from this article.
Outcomes following infrapopliteal angioplasty for critical limb ischemia - Percutaneous transluminal angioplasty (PTA) is a routine treatment for critical limb ischemia (CLI) even with limited data on its long-term outcomes. Using TransAtlantic Inter-Society Consensus (TASC) I classification of infrapopliteal lesions, this study reviewed patients undergoing infrapopliteal PTA and their outcome risks including mortality, restenosis, artery patency, reintervention by repeat PTA or bypass, amputation, wound healing, and any procedural complications. It concludes that infrapopliteal PTA is an effective therapy for TASC A, B, and C lesions, and surgical bypass should be offered to patients with TASC D lesions. For my project, I am using the same patient database that is analysed in this paper and studying the risk of similar outcomes, but instead classifying patients based on preoperative PP rather than TASC.

Assignment: Hypothesis and brief methods
My hypothesis is that higher arterial stiffness is a predictor for higher rates of major amputation and mortality in patients who have undergone an infrapopliteal angioplasty. To test this hypothesis, I will:
1. Collect patient data from hospital Online Medical Records (OMR), Perioperative Information Management Systems (PIMS), and paper records.
2. Compile these data into a database.
3. Conduct statistical analyses using pulse pressure as an indicator for arterial stiffness.

Assignment: Reading summary//
Changes in Abdominal Aortic Aneurysm Rupture and Short-Term Mortality, 1995–2008 - Between 1995 and 2008, increased rates of detection and elective repair of abdominal aortic aneurysms (AAA) in addition to the introduction of minimally invasive endovascular aneurysm repair (EVAR) have lead to changes in risks and benefits in the Medicare population. Coincident with the introduction and increase in use of EVAR, this paper shows large declines in short-term AAA-related mortality in elderly Medicare beneficiaries, due to both decreased perioperative mortality and decreased deaths due to aneurysm ruptures during this time period.
Endovascular vs. Open Repair of Abdominal Aortic Aneurysms in the Medicare Population - A large national study of patients who underwent either open or endovascular repair for AAA, this paper shows that endovascular repair was associated with lower perioperative mortality, fewer major complications, a shorter hospital stay, and a greater likelihood of being discharged to home. These benefits from endovascular repair, versus open repair, increase with increasing age groups.

Note from Melissa: Welcome to your Project Success homepage! We've matched you with Dr. Marc Schermerhorn, at the Beth Israel Deaconess Medical Center. He has recommended some great readings for you; please be sure to read them before you get here.
Changes in Abdominal Aortic Aneurysm Rupture and Short-Term Mortality, 1995–2008
Endovascular vs. Open Repair of Abdominal Aortic Aneurysms in the Medicare Population

We've also matched you up with another mentor outside of the lab to help support you through the summer and give you further exposure to science careers. Your mentor is Gloria Faboyede.