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Journal and News Scan

Source: JAMA Surgery
Author(s): Joseph G. Crompton, Peter D. Crompton, Polly Matzinger

The authors point out that randomized trials of incentive spirometry have failed to mitigate early postoperative fevers, traditionally attributed to atelectasis. They propose that an immune response triggered by injured cells is responsible for noninfectious postoperative fevers, and that this is a natural, self-limited process that requires no intervention.

Source: MedPage Today
Author(s): Clifford Robinson, Ian Ingram

Investigators reported, in abstract form, promising results of a single dose of radiotherapy, delivered with electorphysiologic guidance, for managing ventricular tachycardia. Seventy-eight percent of patients had a clinically important reduction in ventricular tachycardia episodes. 

Source: Annals of Oncology
Author(s): R de Vries, M Muller, V van der Noort, W S M E Theelen, R D Schouten, K Hummelink, S H Muller, M Wolf-Lansdorf, J W F Dagelet, K Monkhorst, A H Maitland-van der Zee, P Baas, P J Sterk, M M van den Heuvel

Immune checkpoint inhibitors have revolutionized treatment of non-small cell lung cancer. In this study, breath prophiles were collected from 143 patients and a single biomarker profile was created that detected responses to anti-PD-1 treatment with 89% accuracy.

Source: JAMA Surgery
Author(s): William O. Cooper, David A. Spain, Oscar Guillamondegui, Rachel R. Kelz, Henry J. Domenico, Joseph Hopkins, Patricia Sullivan, Ilene N. Moore, James W. Pichert, Thomas F. Catron, Lynn E. Webb, Roger R. Dmochowski, Gerald B. Hickson

Using coworker reports of unprofessional behavior as a metric, surgeons' complication rates were assessed.  Compared to surgeons with no reports, the complication rate for surgeons with 1-3 reports was increased 14.3%, and that for surgeons with 4 or more reports was increased 11.9%.

Source: JAMA Surgery
Author(s): Charles H. Brown IV, Karin J. Neufeld, Jing Tian, Julia Probert, Andrew LaFlam, Laura Max, Daijiro Hori, Yohei Nomura, Kaushik Mandal, Ken Brady, Charles W. Hogue, and the Cerebral Autoregulation Study Group

In this randomized trial, the authors studied the use of cerebral autoregulation monitoring to target mean arterial pressure during CPB. The outcome of interest was postopertive delirium. The incidence of delirium was 53% in the usual care group compared to 38% in the intervention group, with a reduction in the odds of delirium of 45% (p=0.04). 

Source: Journal of Cardiothoracic Surgery
Author(s): Jef Van den Eynde, Astrid Heeren, Delphine Szecel, Bart Meuris, Steven Jacobs, Peter Verbrugghe, Wouter Oosterlinck

This is a retrospective study in OPCAB patients comparing patients who received skeletonized versus nonskeletonized SIMA and BIMA grafts. They reported patients with any sternal wound complication including redness or minor drainage that healed naturally. There was a lower incidence of complications in the skeletonized group as well as overall lower grade of complications. These effects were more pronounced in subgroup analysis of the BIMA group, including diabetics.

Source: JACC: Heart Failure
Author(s): Jonathan G. Howlett, Amanda Stebbins, Mark C. Petrie, Pardeep S. Jhund, Serenella Castelvecchio, Alexander Cherniavsky, Carla A. Sueta, Ambuj Roy, Ileana L. Piña, Raphael Wurm, Mark H. Drazner, Bert Andersson, Carmen Batlle, Michele Senni, Lukasz Chrzanowski, Bela Merkely, Peter Carson, Patrice M. Desvigne-Nickens, Kerry L. Lee, Eric J. Velazquez, Hussein R. Al-Khalidi on behalf of the STICH Trial Investigators

This study reports ten year outcomes of the STICH trial. Comparing CABG to medical therapy groups, the authors note that CABG reduced all cause, cardiovascular, and heart failure hospitalizations. This included time-to-first and recurrent events. This was due to fewer total cardiovascular hospitalizations, the majority due to heart failure.

Source: The Annals of Thoracic Surgery
Author(s): Nadine Straka, Kimberlee Gauvreau, Catherine Allan, Marshall L. Jacobs, Sara K. Pasquali, Jeffrey P. Jacobs, John E. Mayer, Luis Quinonez, Jane W. Newburger, Ravi Thiagarajan, Meena Nathan Source The Annals of Thoracic Surgery

Using the STS Congenital Heart Surgery Database, investigators identified factors associated with adverse outcomes after repair of anomalous coronary arteries arising from the pulmonary artery. Operative mortality was increased related to preoperative shock and the use of extracorporeal membrane oxygenation.

Source: European Journal of Cardio-Thoracic Surgery
Author(s): Josephina Haunschild, Sven Scharnowski, Meinhard Mende, Konstantin von Aspern, Martin Misfeld, Friedrich-Wilhelm Mohr, Michael A Borger, Christian D Etz

Concomitant aortic root enlargement at the time of surgical aortic valve replacement is an option to avoid patient-prosthesis mismatch. In this single-center study, 4,210 patients underwent aortic valve replacement, of which 171 had concomitant aortic root enlargement. In analysis of matched patient outcomes, there were similar numbers of postoperative bleeding and pericardial effusion events, and no difference in early deaths. The authors conclude that aortic root enlargement can be performed safely with no increase in early postoperative surgical complications. 

Source: MedPage and TEDMED
Author(s): Pamela Wible

Posting of a still-relevant TED video regarding the high number of suicides among physicians, a world-wide problem that relates  in part to training and working conditions.