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Journal and News Scan
The authors of this article aimed to describe survival and clinical outcomes beyond 30 years of follow-up after surgical repair of Tetralogy of Fallot. They found a survival of 72% after 40 years. Health status was comparable to the Dutch population. Factors that were associated with late mortality included: a prior shunt operation, low temperature during surgery and early postoperative arrhythmias. They conclude that although many patients needed reoperation or developed arrhythmias, long-term survival was good, as was health status.
This study was conducted in 94 lung adenocarcinoma patients matching pairs from current, former and never smokers' lung adenocarcinoma and non-malignant lung parenchymal tissue. Investigators discovered different smoking-specific microRNA differences. These findings may explain distinct tumorigenic processes influenced by different smoking and non-smoking expositions.
CMS determined that the evidence of benefit for CT screening for lung cancer is sufficient to permit this as an annual benefit for Medicare and Medicaid recipients in the US. The availability of such coverage will be limited, however, by the need to have the screening as part of a comprehensive counseling (smoking cessation, etc) visit with qualified physicians or non-physician practitioners. Radiologists and imaging centers must meet specific criteria, and activity must be submitted to a registry.
This study explored financial conflicts of interest (FCOI) among authors of published guidelines and consensus statements and their relationship to endorsement of specific drugs. 93% of recent articles reported FCOI status. Of articles publishing funding sources, 65% reported partial or full industry funding. Endorsement of chemotherapeutic agents was strongly associated with FCOIs (p=0.001).
Differentiating a primary lung cancer from an intrapulmonary metastasis can be challenging. The authors developed a lineage test using whole genome amplification and next-generation sequencing to identify breakpoints in known primary tumors and known metastases. Independent primary tumors did not share any genomic rearrangements, whereas primary tumors and their known metastases all had shared rearrangements. This type of analysis may enable pathologists to distinguish primary lung tumors from intrapulmonary mets.
The authors explored a sample of Medicare patients who survived sepsis during hospitalization to assess the impact of afib developing during sepsis on long-term outcomes. Of nearly 139,000 sepsis survivors, 7% had new onset afib during sepsis. Of those pts, 55% were found to have afib after hospitlization. New onset afib during sepsis was associated with increased risks of subsequent heart failure, stroke, and death.
The effects of exercise, increasing pump speed, or both on invasive hemodynamics in centrifugal flow LVAD patients were analyzed in this small study. Findings included:
- Increasing pump speed at rest increased pump flow and decreased PCWP.
- Exercise increased pump flow but yielded increased right and left-sided filling pressures.
- Exercise combined with increased pump speed increased pump flow further (synergistic effect) without lowering right- and left-sided filling pressures.
- What should be done to improve unloading in LVAD patients during exercise?
- Should algorithms be included in the LVAD that automatically uptitrate RPMs during exercise?
- Would increasing pump speeds further, beyond manufacturer's recommendations, safely improve unloading during exercise?
The correlation between "field independence"--i.e., the ability to ignore distracting visual stimuli--and surgical skills was examined in this simulator model. Resident participants, after undergoing field dependence testing, were asked to place curved needles in a mitral valve model at 10 premarked sites. The residents were assessed on their ability to load the needle on the driver at the appropriate angle. The accuracy of needle loading correlated significantly with the relative field independence of the residents.
1. If this methodology is validated in a larger study, would it prove useful in resident training?
2. How about as a factor in resident selection?
The Cardiothoracic Surgical Trials Network recently reported that a third of patients after mitral valve repair for ischemic MR developed at least moderate recurrent MR at 1 year following surgery. This begs the question as to which patients with ischemic MR would benefit from repair vs. replacement. The present publication explored the development of a model to discriminate those patients that were more likely to develop recurrent MR following repair. The model included the following preoperative variables: age, BMI, sex, race, EROA, basal aneurysm/dyskinesis, NYHA, history of CABG, PCI, or ventricular arrhythmias. The model demonstrated good discrimination with an area under the ROC curve of 0.82.
A multicenter, randomized, controlled trail including 900 patients divided patients into those undergoing on-pump versus off-pump CABG. Identical heparinization and heparin reversal protocols were followed. At angiography at 6 months following CABG, graft patency was inferior after off-pump as compared to on-pump revascularization. In the off-pump group, 21% of the grafts were either stenotic or occluded; in the on-pump group, 14% were either stenotic or occluded.