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Journal and News Scan

Source: MedPage Today
Author(s): C Phend
On March 20, 2014, a panel of the FDA gave unanimous approval for use of an ex-vivo perfusion system for improving the quality of explanted lungs prior to transplantation. If this recommendation is followed by the FDA, such devices could be used clinically under IRB protocols.
Source: Annals of Internal Medicine
Author(s): Rajiv Chowdhury, MD, PhD; Samantha Warnakula, MPhil*; Setor Kunutsor, MD, MSt*; Francesca Crowe, PhD; Heather A. Ward, PhD; Laura Johnson, PhD; Oscar H. Franco, MD, PhD; Adam S. Butterworth, PhD; Nita G. Forouhi, MRCP, PhD; Simon G. Thompson, FMedSci; Kay-Tee Khaw, FMedSci; Dariush Mozaffarian, MD, DrPH; John Danesh, FRCP*; and Emanuele Di Angelantonio, MD, PhD*

The effects of different kinds of fats and food oils on health may have been exaggerated, researchers warned last night.

The latest analysis casts doubt on advice to avoid the saturated fats found in dairy foods.

And it casts further doubt on the benefits of oils extracted from plants, finding some limited evidence for the benefits of fish oils.

Researchers at Cambridge University, UK, set out to compare saturated fats with the polyunsaturated fats, such as omega 3 and omega 6, found in plant oils and fish.

Their analysis of more than 72 pieces of research involving studying the diets of more than 600,000 people concluded there was no link between total levels of saturated fat in the diet and risk of heart disease.

There was even evidence that one dairy fat, margaric acid, was linked to a reduced risk of heart disease.

Reporting in the Annals of Internal Medicine, the researchers say there is "weak" evidence linking animal fats to increased risk of heart disease.

There was also "some" evidence that the two omega-3 oils found in fish, eicosapentaenoic and docosahexaenoic acids, are linked to reduce heart disease risk.

Researcher Dr Rajiv Chowdhury said: "In 2008, more than 17 million people died from a cardiovascular cause globally. With so many affected by this illness, it is critical to have appropriate prevention guidelines which are informed by the best available scientific evidence."

Professor Jeremy Pearson, associate medical director of the British Heart Foundation, called for "large-scale" clinical studies to come to give conclusive answers to the link between fat in the diet and heart disease.

He said: "This analysis of existing data suggests there isn't enough evidence to say that a diet rich in polyunsaturated fats but low in saturated fats reduces the risk of cardiovascular disease.

"Alongside taking any necessary medication, the best way to stay heart healthy is to stop smoking, stay active, and ensure our whole diet is healthy – and this means considering not only the fats in our diet but also our intake of salt, sugar and fruit and vegetables."

Association of Dietary, Circulating, and Supplement Fatty Acids With Coronary Risk. Annals of Internal Medicine 18 March 2014

Source: New England Journal of Medicine
Author(s): P Caironi and others for the ALBIOS Study Investigators

This study randomized severely septic patients to either 20% albumin or crystalloid for resuscitation, with a primary outcome of mortality at 28 days.  During the first week the albumin pts had a higher MAP and lower net fluid balance.  Total administered fluids did not differ between the groups.  Morality was similar at 28 and 90 days, and the rate of organ dysfunction did not differ between the groups.

Source: New England Journal of Medicine
Author(s): P Asfar and others for the SEPSISPAM Investigators

This randomized trial assigned septic pts to resuscitation with a MAP goal of 80-85 mm Hg or 65-70 mm Hg.  There was no difference in mortality at 30 or 90 days.  Afib was more common in the high goal pts, and high goal pts with chronic hypertension required less renal replacement therapy.

Source: Journal of Thoracic and Cardiovascular Surgery
Author(s): Hisato Takagi, Shin-nosuke Goto, Taku Watanabe, Yusuke Mizuno, Norikazu Kawai, Takuya Umemoto

Takagi H, et al. – A 12–year–ago landmark meta–analysis of bilateral versus single internal thoracic artery (bilateral ITA [BITA] versus single ITA [SITA]) coronary artery bypass grafting for long–term survival included 7 observational studies (only 3 of which reported adjusted hazard ratios [HRs]) enrolling approximately 16,000 patients. Updating the previous meta–analysis to determine whether BITA grafting reduces long–term mortality over SITA grafting, the authors exclusively abstracted (then combined in a meta–analysis) adjusted (not unadjusted) HRs from observational studies. Based on an updated meta–analysis of exclusive adjusted HRs from 20 observational studies enrolling >70,000 patients, BITA grafting appears to significantly reduce long–term mortality. As the proportion of men increases, BITA grafting is more beneficial in reducing the mortality.

Methods

  • MEDLINE and EMBASE were searched through September 2013.
  • Eligible studies were observational studies of BITA versus SITA grafting and reporting adjusted HRs for long-term (≥4-year) mortality as an outcome.
  • Meta-regression analyses were performed to determine whether the effects of BITA grafting were modulated by the pre-specified factors.

 

Results

  • Twenty observational studies enrolling 70,897 patients were identified and included.
  • A pooled analysis suggested a significant reduction in long-term mortality with BITA relative to SITA grafting (HR, 0.80; 95% confidence interval, 0.77 to 0.84).
  • When data from 6 pedicled and 6 skeletonized ITA studies were separately pooled, BITA grafting was associates with a statistically significant 26% and 16% reduction in mortality relative to SITA grafting, respectively (P for subgroup differences = .04).
  • A meta-regression coefficient was significantly negative for proportion of men (–0.00960; -0.01806 to -0.00114).

 

Source: Lancet
Author(s): CT Ruff, RP Giugliano, E Braunwald, EB Hoffman, N Deenadayalu, MD Ezekowitz, AJ Camm, JI Weitz, BS Lewis, A Parkhomenko, T Yamashita, EM Antman

This meta-analysis evaluated the 4 new oral anticoagulants and compared their efficacy and side-effects to those of warfarin using results from randomized trials of treatment of afib.  Outcomes in nearly 72,000 recipients were evaluated, including stroke, embolic events, mortality, MI, and bleeding.  The newer anticoagulants reduced stroke risk by 19% compared to warfarin, and were associated with reduced mortality and intracranial hemorrhage.  The oral anticoagulants were associated with an increased risk of GI bleeding.

Source: Journal of Clinical Oncology
Author(s): J-S Ryu, HJ Ryu, S-N Lee, A Memon, S-K Lee, H-S Nam, H-J Kim, K-H Lee, J-H Cho, S-S Hwang

The authors evaluated the impact of small (<10mm) pleural effusion on outcomes in patients with NSCLC.  Of over 2000 pts, minimal PE was present in 13%.  It was more common in patients with more advanced stages.  Minimal PE was associated with decreased median survival (7.7 vs 17.7 mos) after adjustment for other prognostic variables.  The impact on outcomes was greater for earlier stages of disease.

Source: Journal of the American College of Cardiology
Author(s): Makkar RR, Jilaihawi H, Mack M, Chakravarty T, Cohen DJ, Cheng W, Fontana GP, Bavaria JE, Thourani VH, Herrmann HC, Pichard A, Kapadia S, Babaliaros V, Whisenant BK, Kodali SK, Williams M, Trento A, Smith CR, Teirstein PS, Cohen MG, Xu K, Tuzcu EM, Webb JG, Leon MB.
In this manuscript the authors analyse data from the cohort B (inoperable patients) of the PARTNER trial in order to compare outcomes in two groups of patients, those inoperable for technical reasons and those inoperable for clinical reasons. Patients deemed inoperable for technical reasons had a lower risk profile. Two-year mortality and quality of life was significantly better in this group.
Source: American Journal of Cardiology
Author(s): Costopoulos C, Latib A, Maisano F, Testa L, Bedogni F, Buchanan L, Naganuma T, Sticchi A, Sato K, Miyazaki T, Figini F, Giannini F, Taramasso M, Naim C, Carlino M, Chieffo A, Montorfano M, Alfieri O, Colombo A.
There have been some concerns about outcomes of TAVI in patients with bicuspid aortic valves (BAV). In this retrospective study, outcomes after TAVI in 21 patients with BAVs were compared with those in 447 patients with tricuspid aortic valves (TAV). Device success was lower and 30-day mortality was higher in BAV patients. There was no significant difference between groups in terms of 30-day composite safety end point, postprocedural aortic regurgitation or in 12-month cardiovascular mortality.
Source: Journal of Nuclear Medicine
Author(s): ZB Zeliadt, ET Loggers, CG Slatore, DH Au, PL Herbert, GJ Klein, LG Kessler, LM Backhus

During the period 1997-2009, nearly 3,000 military veterans with NSCLC were evaluated regarding the utility of PET in staging their cancers.  PET use increased in frequency during the study period from 9% to 91%.  PET reduced the chance of unnecessary surgery by nearly 50%. 

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