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Journal and News Scan

Source: Journal of Thoracic Oncology
Author(s): Michelle C. Salazar, Joshua E. Rosen, Brian N. Arnold, Daniel C. Thomas, Anthony W. Kim, Frank C. Detterbeck, Justin D. Blasberg, Daniel J. Boffa
This is a retrospective National Cancer Data Base cohort study of patients with pathologic stage T3 invasive NSCLC with separate tumor nodules in the same lobe. The goal was to determine with adjuvant chemotherapy increased survival. The study cohort was divided into 2 groups: 1) Pathologic stage T3 with an additional tumor nodule in the same lobe (adjuvant chemotherapy n=450, surgery only n=563). In this group, the 3-year overall survival for the adjuvant subset was 70% versus 59% in the surgery only subset and 2) Pathologic stage T3 with an additional tumor nodule in the same lobe, excluding pN>0, Tumor size >=4 cm, and tumor invasion (adjuvant chemotherapy n=192, surgery only n=336). In this group, the 3-year overall survival for the adjuvant subset was 86% versus 71% in the surgery only subset. 
Source: JAMA Internal Medicine
Author(s): Kooistra HA, Calf AH, Piersma-Wichers M, Kluin-Nelemans HC, Izaks GJ, Veeger NJ, Meijer K.
In this matched cohort study the authors evaluate the age-associated risk of bleeding and thrombosis in 3313 patients ≥70 years attending a single thrombosis service and treated with vitamin K antagonist (VKA). Patients were matched 1:1:1 by decade (70-79, 80-89, 90-99 years) and duration of treatment. The primary end point was a composite of clinically relevant non-major and major bleeding. The main finding of this study was that the frequency of bleeding events was not significantly increased in patients aged 80 to 89 years and only mildly increased in patients 90 years or older compared with patients in their 70s. The subgroup analyses showed that the risk of bleeding increased more with age in men than in women.
Source: Circulation: Cardiovascular Interventions
Author(s): Stefano Rosato, Francesco Santini, Marco Barbanti, Fausto Biancari, Paola D’Errigo, Francesco Onorati, Corrado Tamburino, Marco Ranucci, Remo Daniel Covello, Gennaro Santoro, Claudio Grossi, Martina Ventura, Danilo Fusco, Fulvia Seccareccia, on behalf of the OBSERVANT Research Group
This article explores the controversial topic of TAVR versus surgical AVR in low-risk patients.  The primary outcome was 3-year survival.  The authors report 3-year survival for TAVR and surgical AVR as 72% and 83.4%, respective (p=0.0015).  Although TAVR is an exciting technology, there should be caution in adopting it in lower risk patients.  
Source: J Anesth. 2016 Jun 22. [Epub ahead of print]
Author(s): Ying-Hsuan Tai, Kuang-Yi Chang, Shu-Wei Liao, Kwei-Chun Chung, Chun-Che Shih, Shung-Tai Ho, Chih-Cherng Lu, Mei-Yung Tsou
This retrospective study evaluated the effects of high-dose nitroglycerine (NTG) on glucose metabolism, tissue oxygenation and postoperative recovery in cardiac surgical patients. Two groups were classified: NTG group (iv loading of NTG starting at rewarming of cardiopulmonary bypass; n=101), NON-NTG group (n=151). Authors found that the the plasma glucose was significantly lower in the NTG group during and after CPB, the total consumption of regular insulin was significantly lower in the NTG group, there was a significantly lower incidence of hyperlactatemia in the NTG group during CPB, and the mixed venous oxygen saturation in the intensive care unit was higher in the NTG group.
Source: Annals of Thoracic Surgery
Author(s): Elisabeth Mahla, MD, Florian Prueller, MD, Sylvia Farzi, MD, Gudrun Pregartner, MSc, Reinhard B. Raggam, MD, Elisabeth Beran, MD, Wolfgang Toller, MD, Andrea Berghold, PhD, Udaya S. Tantry, PhD, Paul A. Gurbel, MD
The authors enrolled 149 patients on DAPT undergoing urgent cardiac surgery in a prospective study analyzing the association between platelet reactivity and postoperative bleeding.  They found that decreasing platelet reactivity correlated with an increase in calculated red blood cell loss after surgery.  Their findings support the use of objective measures of platelet function prior to proceeding with cardiac surgery.
Source: Critical Care
Author(s): Ayan Sen, Joel S. Larson, Kianoush B. Kashani, Stacy L. Libricz, Bhavesh M. Patel, Pramod K. Guru, Cory M. Alwardt, Octavio Pajaro and J. Christopher Farmer
With the rapid expansion of mechanical circulatory support (MCS) in various contexts (CVICU, in-hospital cardiac arrest (E-CPR) and the ED), the authors have provided a very nice overview of the general principles of MCS options and management to assist the broader healthcare team involved with these complex patients.
Source: Critical Care
Author(s): Jason B. O’Neal, Andrew D. Shaw and Frederic T. Billings IV
Acute kidney injury (AKI) complicates recovery from cardiac surgery in up to 30% of patients, injures and impairs the function of the brain, lungs, and gut, and places patients at a 5-fold increased risk of death during hospitalization. The authors have provided a nice general overview of the key determinants, outcomes and treatments for AKI in the cardiac surgery patient.
Source: Journal of Thoracic Diseases
Author(s): Ryutaro Kakinuma, Masayuki Noguchi, Kazuto Ashizawa, Keiko Kuriyama, Akiko Miyagi Maeshima, Naoya Koizumi, Tetsuro Kondo, Haruhisa Matsuguma, Norihisa Nitta, Hironobu Ohmatsu, Jiro Okami, Hiroshi Suehisa, Taiki Yamaji, Ken Kodama, Kiyoshi Mori, Kouzo Yamada, Yoshihiro Matsuno, Sadayuki Murayama, Kiyoshi Murata
The multi-institutional prospective study evaluated the behavior of pure GGOs (85%), heterogeneous GGOs (part solid only on CT lung windows; 7%), and part-solid GGOs on soft-tissue windows.   Among pure GGOs, 6.6% advanced to one of the other categories during a mean follow-up period of 4.3 years.  Of the 35 pure GGOs that were resected, none was an invasive cancer.  Invasive adenocarcinoma was identified in only 1% of all nodules, and only among the part solid nodules. 
Source: J Thorac Cardiovasc Surg
Author(s): Brandon M. Jones, E. Murat Tuzcu, Amar Krishnaswamy, Zoran Popovic, Stephanie Mick, Eric E. Roselli, Sajjad Gul, Jasneet Devgun, Sohi Mistry, Wael A. Jaber, Lars G. Svensson, Samir R. Kapadia
This article investigates the effects of varying degrees of aortic regurgitation (AR) on survival after transcatheter aortic valve replacement (TAVR).  They retrospectively evaluated a cohort of 237 patients undergoing TAVR from 2006 to 2012 with echocardiogram performed within 30 days of the procedure.  Using a Cox proportional multivariable regression model, they found each 1+ increase in AR (on a scale of none to 4+) was associated with a unit hazard ratio of 2.26.   After TAVR, patients with no paravalvular aortic regurgitation (15% of patients) had 0% mortality at 1 year, trivial to 1+ AR (29.5% of patiens) had 7.1% mortality at 1 year, and 1+ AR (32.5% of patients) had 16.9% mortality at 1 year.   The authors conclude that even a mild degree of AR is associated with significant prognostic value after TAVR and that more discriminating grading scales of AR will be important in evaluating TAVR as it is applied to intermediate and low risk patient populations.
Source: Eur J Cardiothorac Surg
Author(s): Sophie C. Hofferberth, Mark W. Grinstaff, and Yolonda L. Colson
The paper provides a comprehensive overview of current and developing applications of nanotechnologies for diagnostics, surveillance and therapy of thoracic cancer.