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Journal and News Scan
A reexamination of data from the National Lung Screening Trial (NLST) with nodules above the 4mm, has been shown that increasing the nodule size threshold for a positive screen, substantially reduces the false-positive CT screenings rate and increase slightly the lung cancer missed or delayed but without affecting the survival.
Randomized multicenter trial comparing losartan versus atenolol in young patients with Marfan's syndrome with no significant difference in aortic root dilation between groups.
141,905 isolated primary surgical aortic valve replacements (SAVR) were stratified by STS risk of mortality. SAVR outcomes were superior to those by the predicted risk models.
Shanker Vedantam interviews Jason Hockenberry, an economist at Emory University, regarding recent research into patient behavior following PCI or CABG. CABG patients were more likely to quit smoking after intervention for CAD. This may be a result of the magnitude of the intervention, and has implications for improving smoking cessation programs.
Abrams and colleagues provide a comprehensive review of the topic of recirculation during VV ECMO. Specifically, the authors discuss the factors contributing to recirculation, how to calculate the extent of recirculation, and what interventions can be applied to correct the issue. Recirculation can be a significant challenge during VV ECMO, particularly in patients that have worse underlying pulmonary function. For ECMO programs, this article is a "must-have" to distribute to fellows, residents, and other health care providers managing these patients.
Goldberg and colleagues provide an excellent review on a complex topic: intramural hematomas. The article has several take-home messages: one must be very careful in how one defines IMH; its pathogenesis remains unclear; IMH tends to involve a more outer location of the aortic media than aortic dissections (AD) do; IMH is more likely to rupture externally than AD; risk factors for progression from IMH to AD include aortic diameter and aortic wall thickness; the liberal use of stent grafting for type B IMH is probably unwarranted. It remains to be proven whether IMH should be treated any differently from AD. Until then, except under unusual circumstances, the same treatment approach is likely warranted.
Simply fabulous !!
Well done Shanda Blackmon. We are all proud to be Cardiothoracic surgeon too !
In a retrospective review of 45 cases where patients were placed on VV ECMO, investigators from Seoul performed a multivariate analysis of pre-ECMO risk factors that might be predictive of an unsuccessful ECMO wean. Notably, successful weaning from ECMO was only 46%, and overall survival was only 18%. Importantly, higher platelet counts at ICU admission and the day prior to initiating ECMO were predictive of successful weaning. Specifically, patients with a platelet count > 70K had an 11X greater likelihood of a successful wean. Why? Is the low platelet count a surrogate for the severity of illness?
Data from the Barrett's and Esophageal Adenocarcinoma Genetic Susceptibility Study were used to determine the relationship of a genetic risk score associated with obesity to cancer risk. The risk score was not associated with GERD or smoking. Cancer and Barrett's were strongly associated with increasing BMI. The authors conlude that those with a genetic makeup associated with obesity have increased risk of cancer and Barrett's.
Data from the National Lung Screening Trial (NLST) were examined by exploring different size thresholds for classifying CT screening scans as positive. In the NLST, nearly two-thirds of nodules were 7mm in diameter or less. Using a threshold of 5mm, the percentage of missed/delayed diagnosis and the likelihood of avoiding false positive findings were 1% and 16%. Using a threshold of 8mm increased those rates to 11% and 66%. Increasing size thresholds reduced follow-up CTs and invasive procedures. Interestingly, differences in thresholds did not affect survival or mortality.