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Journal and News Scan
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.
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.
- 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.
- 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).
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.
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.
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%.
In an effort to provide diagnostic information complementary to radiographic screening for lung cancer, the authors evaluated the diagnostic performance of plasma mRNA. The mRNA signature classifier demonstrated 87% sensitivity and 81% specificity, with a negative predictive value of 99%. In contrast, low dose CT had a sensitivity of 79% and a specificity of 81%. Combining the mRNA signature classifier and low dose CT resulted in a 5-fold decrease in false positive findings based on CT alone.
LVI is thought to be an adverse prognostic indicator of survival in patients with NSCLC. This review quantified the relationship of LVI and survival. The unadjusted effect of LVI for recurrence-free survival was HR=3.63 and for overall survival was HR=2.38. After adjustment for covarates, these HRs were 2.52 and 1.81, both highly significant.