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Journal and News Scan
This meta-analysis compared outcomes of PCI vs CABG in patients with multivessel disease, evaluating studies that were not individually powered to detect survival differences. 6 RTC including 6055 pts were analyzed. Significant benefits for CABG were associated with overall mortality, MI, and the need for revascularization.
The use of pharmaceutical strategies to prevent contrast-induced acute kidney injury continues to be an unresolved matter. In this manuscript the authors describe their findings of a systematic review with a meta-analysis on the prevention of this type of injury with ascorbic acid. They conclude that ascorbic acid appears to be nephro-protective against contrast-induced acute kidney injury.
This article describes outcomes of en bloc resection of superior sulcus tumors invading the spine in 48 pts from multiple centers operated on during a 22 year period. Most pts received induction chemotherapy and radiation therapy. Complete resection was achieved in 88%, and 5-year survival was 61%. Surgical mortality was 6%. The primary determinant of survival was complete response to induction therapy.
Bicuspid AV repair was performed in 146 pts over a period of 34 years; the primary indication was stenosis. Survival at 20 yrs was 88%. Freedom from reintervention at 18 yrs was 43%. 30 additional pts without reintervention had moderate to severe stenosis or moderate regurgitation at last follow-up.
The patency and clinical outcomes of the right internal thoracic artery (RITA) and right gastroepiploic artery (RGEA) as Y-grafts to the LIMA in situ were evaluated in 443 pts using propensity score matching. Graft patency, overall survival, and freedom from reintervention rates were similar for the two groups.
Osteopontin (OPN) influences metastatic behavior of tumors through binding to CD44v6 and integrin. The authors in this study assessed OPN and CD44v6 expression in 159 NSCLC pts and evaluated survival. The combination of markers stratified overall and disease-free survival, especially in stage I pts. Overall survival for [OPN- AND CD44v6-] pts was 64.4%, for [OPN+ OR CD44v6+] was 49.1%, and for [OPN+ AND CD44v6+] was 16.4%.
Guidelines for evaluation of patients with suspected lung cancer and evidence for mediastinal adenopathy in the absence of distant metastatic disease recommend mediastinal nodal sampling as the initial diagnostic/staging technique. In this study the authors evaluated compliance with that guideline in 137 pts. Guideline-compliant pts underwent 1.3 tests compared to 2.3 tests for guideline-noncompliant pts and experienced fewer complications (0% vs 17%). Most complications were related to unnecessary CT-FNA. Initial EBUS-TBNA was sufficient in 64%. Guideline compliance was only 22%.
The New York Times revisits the spiraling increase in health care costs in the United States.
The authors performed off-pump left ventricular reconstruction for ischemic cardiomyopathy in ovine model applying epicardial catheter-based ventricular reconstruction. Six weeks after ventricular reconstruction end-systolic volume was decreased by 38% and ejection fraction increased by 13%. Histopathology showed appreciable reduction of the chronic infarct in the left ventricle.
The authors analyzed cardiac CT scans of 70 patients for the smallest distance between each point on the annulus and each of the left circumflex and right coronary arteries. The global minimum for the left circumflex was <5 mm for about 30% of patients. Knowledge of the exact anatomic relationships could help to reduce iatrogenic complications of mitral annuloplasty.