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Journal and News Scan

Source: JAMA
Author(s): Camila Caram-Deelder, Aukje L. Kreuger, Dorothea Evers, Karen M. K. de Vooght, Daan van de Kerkhof, Otto Visser,Nathalie C. V. Péquériaux, Francisca Hudig, Jaap Jan Zwaginga, Johanna G. van der Bom, Rutger A. Middelburg

The authors report the non-intuitive finding that blood from female donors who had ever been pregnant was associated with increased mortality among male recipients (HR 1.13).   If validated by other studies, might this substantially complicate matching donated blood with appropriate recipients?  Clearly the underlying mechanism will be interesting to sort out.

Source: MedPage Today
Author(s): Suneel Dhand

The author decries what he sees as the corporatization of airline pilots, with their accompanying loss of autonomy and prestige.  He speculates on whether a similar future is ahead for physicians, but does not provide specific suggestions on how to avoid this from occurring. 

Source: JAMA
Author(s): Ashish K. Jha

In this JAMA Forum article, Harvard's Ashish Jha discusses the pros and cons of public reporting of individual surgeon's outcomes. He uses the New York state cardiac surgery registry as an example and argues why, despite its problems, it is still the way forward. What are your thoughts!?

Source: The Annals of Thoracic Surgery
Author(s): Ben Hobbes, Yves d’Udekem, Diana Zannino, Igor E. Konstantinov, Christian Brizard, Johann Brink

Hobbes and colleagues retrospectively evaluated systemic-to-pulmonary shunt procedures for 173 patients over a 10-year period at a single institution. Despite their importance for many patients with single ventricle or complex biventricular lesions, shunt procedures carry a high risk of morbidity and mortality. The authors found the main predictors of morbid events in their cohort were patient characteristics such as extracardiac or genetic anomalies and needing preoperative ventilation, but not age, weight, or shunt size to weight ratio. Additionally, oxygen saturation on ICU admission and amount of platelets transfused each predicted early shunt thrombosis.

Source: Journal of the American College of Surgeons
Author(s): Mark R. Katlic

Very nice paper that, once again, demonstrates established experience with awake thoracic surgery. Is this the future? Does a minimally invasive surgeon need a minimally invasive anesthesiologist beside? 

Source: News from around the web.
Author(s): Claire Vernon

Patient Care

A teenager suffered a “boy band-induced pneumothorax” at a One Direction concert, and the case was recently reported in the Journal of Emergency Medicine.

At the 48th Union World Conference on Lung Health in Guadalajara, México, the United Nations and its partners launched an initiative to combat zoonotic tuberculosis.

Read a summary of presentations on percutaneous mitral valve techniques from the 2017 PCR London Valves meeting in the UK.

 

Drugs and Devices

In an interview with Nature, the executive director of the European Medicines Agency talks about the effect that the agency’s impending move from London could have on its operations.

The US Food and Drug Administration (FDA) will temporarily allow imports of intravenous saline to avoid shortages as Puerto Rico, which manufactures about 10% of medical products consumed in the US, continues recovering from the devastation caused by Hurricane Maria.

The US FDA approved a magnet-tipped catheter device for correcting pediatric esophageal atresia without open surgery.

 

Research, Trials, and Funding

Researchers from Uganda, the US, and France find that prophylactic penicillin might be helpful for children with mild latent rheumatic heart disease.

Two studies published in JAMA Cardiology and the European Heart Journal suggest that low mitochondrial DNA copy number might indicate increased risk of cardiac events.

A new protocol from a multidisciplinary team at Johns Hopkins University in Baltimore, US, aims to reduce the incidence of acute kidney injury after cardiac surgery.

Researchers at Harvard University in Boston, US, used “lung-on-a-chip” tissue models to study NSCLC adenocarcinoma cells. Mechanical forces, applied to these model lungs to mimic breathing, reduced cancer cell growth and invasion and influenced anti-cancer drug efficacy.

Source: JAMA Surgery
Author(s): James M. Healy, Kimberly A. Davis, Kevin Y. Pei

This study examined risk estimates for complex major surgery by trainees in internal medicine and in general surgery using seven clinical scenarios.  Surgery residents expressed more confidence in their estimates, but were less likely to use published risk models.  Most trainees in both specialties significantly overestimated every type of risk, averaging a quarter to a third higher than risk model predictions.

Source: Nature Biomedical Engineering
Author(s): Eric N. Feins, Yuhan Lee, Eoin D. O’Cearbhaill, Nikolay V. Vasilyev, Shogo Shimada, Ingeborg Friehs, Douglas Perrin, Peter E. Hammer, Haruo Yamauchi, Gerald Marx, Andrew Gosline, Veaceslav Arabagi, Jeffrey M. Karp, Pedro J. del Nido

The authors report on the design and use of a growth-accommodating device that may have a variety of pediatric applications, including valve annuloplasty. The device consists of a biodegradable core and a tubular braided sleeve (woven much like a 'finger trap' toy). After implantation, the core—which constrains the length of the device—degrades so as to allow the annuloplasty to enlarge gradually over time. Thus, the device 'grows' with the child. The authors further present validation of the device in a swine model.

The free full text is available.

Source: The British Medical Journal
Author(s): Christopher JD Wallis, Bheeshma Ravi, Natalie Coburn, Robert K Nam, Allan S Detsky, Raj Satkunasivam

What is already known on this topic:

Female and male physicians differ in their practice of medicine in ways that might substantially affect patient outcomes. Outcomes after surgery depend on the technical and cognitive skills of treating physicians, so findings from medical specialties might not apply to surgical specialties.

What this study adds:

This large, population-based, matched cohort analysis found small differences in surgical outcomes between patients treated by female and male surgeons, with the former having a small but statistically significant decreased risk of short-term postoperative death.

 

Source: JAMA Cardiology
Author(s): Aihua Pu, Lillian Ding, Jungwon Shin, Joel Price, Peter Skarsgard, Daniel R. Wong, John Bozinovski, Guy Fradet, James G. Abel

In this retrospective study, the long-term survival benefits of multiple arterial coronary grafting were evaluated among over 20,000 patients in British Columbia by comparing outcomes to those of L IMA + SVG.    Multiple arterial grafting was associated with decreased mortality (HR 0.79) and decreased revascularization rates (HR 0.74).  The incidences of MI and heart failure were also reduced (HR 0.63 and 0.79, respectively).

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