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Journal and News Scan
This behavioral modification study covered 6 months at a single institution during which 144 pts underwent 510 transfusion events. Cardiac surgeons agreed on a Hgb cutoff value of 8 as an indication for transfusion (massive transfusions were excluded). Surgeons received weekly feedback as to their practice patterns. Compared to baseline, feedback resulted in a 63% reduction in transfusions and an increase in single transfusions from 77% to 90%.
Researchers at Tsinghua University in Beijing have taken a potentially wildly complicated problem and come up with a (relatively) simple solution by injecting the heart with gallium, a chemically stable metal that melts at about 85 degrees Fahrenheit. In other words, it has no problems flowing through the labyrinthine vessels of the heart.
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.