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Journal and News Scan
The entire issue is dedicated to thrombosis and makes a compulsory read for cardiovascular and thoracic hospitalists. Of patricular relevance to the thoracic surgeon are the translational articles on system analysis (page 1348) and the table on oral anticoagulants on page 1410.
A collaborative multi-funded RCT by Chinese surgeons and European epidemiologists, this article is guaranteed to elicit thunderous responses from biomedical publishing and the pharmaceutical industry. Although various arguments can be presented on methodology and collection of data, it is most likely in any case that this paper will be widely discussed!
This is a very well done video of: "A Day in the Life of a Perfusionist." The video captures many intersting aspects and diversities of a perfusionists responsibilities. My compliments to the creators and editors.
The authors report on the differences in outcome after semicontinuous versus interrupted suture techniques for aortic valve implantation. In a propensity matched analysis with 411 patient pairs they found similar mortality and the risk of redo surgery regardless of the implantation technique. The advantage of semicontinuous sutures were shorter operation times and larger valve sizes.
The effectivity of Sildenafil for preoperative preconditioning in pediatric heart surgery was tested in a randomized trial. Thirteen children each with low-dose (0.06 mg/kg), high-dose (0.6 mg/kg) or no preconditioning underwent VSD closure. Sildenafil application did not alter myocardial injury, cardiac function, inotropic needs or postoperative course.
The goal of this multicenter survey was to determine the psychological and social impact of incidental pulmonary nodule detection. The primary outcome was nodule specific distress and secondary outcomes included perceived lung cancer risk (with misperception defined as 15% discrepency), quality of communication with clinicians, and psychosocial factors that affect distress. Approximately half of the patients had distress, 24% of which was considered clinically significant. Only 25% of patients accurately estimated their risk of lung cancer, with the majority overestimating the likelihood of cancer. Many (41%) believed that if untreated their nodule would turn into cancer, and a majority (71%) did not know that pulmonary nodules can be benign or indolent tumors. While most physicians discussed nodule size with patients, only a small fraction reviewed the CT scan with the patient and discussed lung cancer risk. Greater than one third of patients stopped smoking when they found out they had a pulmonary nodule.
The FDA is assuming regulatory control over e-cigarettes. Sales of e-cigarettes will be banned to those <18 years old. In addition, warning labels will be required on all packages and all products are now subject to government approval.
This is an outstanding and provocative editorial comment concerning treatment costs of lung cancer based on an article published in the last issue of the European Respiratory Journal. It reveals discrepancies in access to new therapies based on therapeutic targets due to molecular testing and treatment costs.
In this multicenter study, baseline QOL was assessed in over 200 patients with stage II or III esophageal cancer who underwent induction therapy and surgery or definitive chemoradiotherapy. Baseline QOL was related to survival independent of age, stage, histologic type, and treatment. It is suggested that assessment of baseline QOL is a prognostic tool that can be used in shared decision making.
The authors measured serum amino-terminal procollagen III (PIII) as a marker of myocardial fibrogenesis in patients undergoing the Fontan procedure for single ventricle circulation and in controls. Patients with single venticle circulation had elevated PIII levels compared to controls. Staged Fontan elements successively reduced PIII levels. The levels of volume load and cyanosis were related to PIII levels. Persisently elevated PIII levels were related to venticular stiffening. PIII may be a useful marker of disease state and could indicate a therpeutic target.