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Journal and News Scan
This trial of 2218 pts with STEMI being transported for PCI randomized pts to bivalirudin or standard therapy (LMW heparin with optional glycoprotein IIb/IIIa inhibitors). The primary outcome was death or major bleeding. Bivalirudin was associated with a significant reduction (40%) in the primary outcome incidence but had a 6-fold increase in the incidence of acute stent thrombosis. Death and reinfarction rates were similar.
This randomized trial included 148 pts with potentially resectable NSLCL. Mediastinal staging was randomized to EBUS-centered (EBUS possibly followed by EUS) or EUS-centered (EUS possibly followed by EBUS). Diagnostic accuracy and sensitivity were similar for both groups. Adding EBUS after initial EUS improved accuracy and sensitivity significantly, whereas adding EUS after initial EBUS did not significantly improve outcomes. The authors suggest that EBUS is the best first procedure in endoscopic mediastinal staging for potentially resectable lung cancer.
Of nearly 360,000 pts in England diagnosed with a first primary lung cancer, outcomes were assessed for 465 patients who underwent resection for small cell cancer. 5-year survival was 45% for resected NSCLC, 31% for resected SCLC, and was 3% for patients who didn't have resection. Survival was better for patients who had a resection for known SCLC compared to those whose histologic diagnosis wasn't made until after surgery. The authors conclude that resection should be offered to selected patients with SCLC.
Gastroesophageal reflux disease is a risk factor for esophageal adenocarcinoma and Barrett’s esophagus. Adenocarcinoma also may develop from Barrett’s esophagus. This multi-institutional study compares genome-wide association data to investigate the genetic architecture of esophageal adenocarcinoma, Barrett’s esophagus and gastroesophageal reflux. A high genetic correlation was found between esophageal adenocarcinoma and Barrett’s esophagus with significant polygenic overlap, which suggest that shared genes underlie the development of both lesions. On the contrary, no statistically significant results were obtained for gastroesophageal reflux.
In this manuscript the authors propose a strategy for the treatment of obstructive thrombosis of prosthetic heart valves based on a review of 30 studies published over a 17-year period. They suggest indications for thrombolysis and surgery in right and left sided prosthetic heart valve thrombosis.
This randomized controlled trial evaluated routine mural thrombus aspiration followed by PCI to PCI alone in 7,244 pts with STEMI undergoing PCI. Thrombus aspiration did not significantly decrease mortality, recurrent MI, or stent thrombosis. Stroke and neurologic complication rates were similar between the groups.
This study evaluated the effects of COPD on outcomes after TAVI in 319 pts, 30% of whom had COPD. COPD pts had a lower survival rate at 1 yr (71% vs 85%) and experienced less improvement in functional status. Cumulative mortality was predicted by the 6 min walk test, and periprocedural pulmonary complications were predicted by FEV1. TAVI was deemed futile in 40% of COPD pts.
In this randomized trial involving 100 pts requiring PCI for STEMI and occluded LAD, half received lower extremity preconditioning for 3 cycles of 5min/5min ischemia/reperfusion. Preconditioning reduced enzymatic infarct size, reduced myocardial edema, and provided greater improvement in ST segment resolution.
This single institution restrospective review examined outcomes of treatment for loco-regional recurrence after definitive trimodality therapy (chemotherapy, radiation therapy, resection) for esophageal adenocarcinoma. Isolated local recurrence developed in 27 patients (5%), most within 3 years. Median overall survival of those with loco-regional recurrence was 17 mos, with a poor response to additional therapy. These data suggest that intense post-treatment surveillance programs aimed at early detection of loco-regional recurrence may not provide much benefit.
This study found that tricyclic antidepressants like Imipramine, used to treat major depression and Promethazine used as an antiemetic and antihistaminic, induce apoptosis in both chemonaïve and chemoresistant SCLC cells in culture,v and in mouse and human SCLC tumors transplanted into immunocompromised mice. The relevance of this work is based on the power of bioinformatics to find new drugs to treat SCLC. The authors used gene expression microarrays to know how expression levels change in SCLC compared to normal lung cells. They found a gene expression signature for SCLC by using publically available gene expression data from FDA-approved drugs. Tricyclic antidepressants had a similar signature to previous chemotherapy agents, which suggested their ability to antagonize SCLC growth.