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Journal and News Scan
This manuscript reports on data from the UK registry from 2007 to 2012 including 3980 TAVI procedures and a 6 year follow up. The authors carry out a good analysis of trends, risk factors for mortality and results. They found little change in the characteristics of patients treated in the UK by TAVI from 2007 to 2012. Pre-procedural atrial fibrillation was strongly associated with later mortality. Patients who could be treated by the femoral route had a lower mortality than those for whom an alternative route was needed. Unadjusted survival for the direct aortic and the transapical approach were similar at 1 to 2 years. Surgical femoral approaches were used in about 11% in 2007 to 2009, but in later years it increased to about 20%. No difference in outcomes was identified according to need for pacing, or the presence of pre-procedural LBBB. The presence of post procedural aortic regurgitation (moderate or severe) was associated with lower long term survival on multivariate analysis at 1 and 2 years. There was a low incidence of procedural stroke, but it had the strongest independent association with early and late mortality.
A survey involving the general public identified opinions regarding lung cancer. Most felt it was related to smoking and lifestyle, was a serious cancer, and involved major treatments. The participants underestimated cure rates for early stage disease (52% survival) and overestimated overall survival (32% survival).
Indications for postoperative radiation therapy (PORT) for resected lung cancer are unclear. This study evaluated outcomes from the National Cancer Data Base 2004-2006, including 2115 patients resected with pathologic N2 NSCLC, of whom 918 (43%) received PORT. PORT was associated with better median survival (42 vs 38 mos, p=0.048) and was associated with improved survival on multivariable analysis.
SEER outcomes from 1973-2010 were evaluated, including a total of over 947,000 pts, of whom only 441 had atypical carcinoid tumors of the lung. 69% were women and 87% were white. 20% had stage IV disease at diagnosis. 78% of the patients underwent resection. 3-year survival was 85% for N0, 69% for N1-2, and 26% for stage IV.
The meta-analysis by Kowalewski et al found that implantable gentamicin collagen sponges significantly reduced the incidence of sternal wound infections by nearly 40%.
Beautiful video. The background music is also beautiful, but I think something with more of a beat would have been appropriate.
Usually patients with prior cancer are excluded in lung cancer trials, but the impact on survival in lung cancer is not known. In a cohort of 102929 patients older than 65 with stage IV lung cancer, a propensity score analysis were performed and found that patients with prior cancer had better survival (all-cause and lung cancer-specific). Therefore these patients with prior cancer should be considered candidates for clinical trials for advanced lung cancer.
This trial randomized 61 pts to a program of endurance and strength training or no training beginning 5-7 weeks after lung resection for cancer and lasting 20 weeks. Compared to controls, treatment group patients demonstrated significant improvements in peak O2 uptake, DLCO, leg and arm strength, muscle mass, and QOL.
The author presents credible (and enticing) evidence for eating dark chocolate for health reasons, including managing hypertension and cardiovascular disease.
The authors evaluated the change in risk profile of 65097 patients who underwent CABG between 1997 and 2011 in the Veterans Affairs Surgical Quality Improvement Program (VASQIP). They found that there was a marked increase in the prevalence of obesity, diabetes, left main coronary artery disease and NYHA class. Prevalences of previous myocardial infarction, low ejection fraction and advanced angina decreased. Importantly, operative mortality decreased over time. The trends confirm the general perception of ongoing improvement in outcomes, despite a sicker and older population.