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Journal and News Scan
The USPST updated its review on lung cancer screening utilizing RTCs and cohort studies. One trial reported that screening resulted in important reductions in cancer and all-cause mortality. Three trials reported no benefit but were underpowered. They conclude that screening offers benefit but is associated with potential harm that must be taken into consideration.
Cancer Research UK announced a large investment into TRACERx, a project aimed at identifying genetic abnormalities in lung cancers and following their evolution over the lifetime of the patient. Similar efforts are underway in France and the US.
In this manuscript the authors investigate the effect of the intracoronary injection of autologus cardiac stem cells (CSCs) in chronic ischemic cardiomyopathy in pigs. CSCs were obtained from the pigs’ right atrium. Three groups were created. Groups II and III underwent a 90 minute occlusion of the left anterior descending artery in order to cause an anterior myocardial infarction (MI). Group I served as control. At 3 to 4 months after MI, pigs received intracoronary infusion of vehicle (group II), or autologous CSCs into the infarct-related artery by the use of a balloon catheter (group III). Echocardiographic and hemodynamic assessment of cardiac function was performed before treatment and at the time of euthanasia at 31 days after vehicle/CSC therapy. Morphometric and histological studies were also carried out. CSC-treated pigs exhibited significantly greater LV ejection fraction, systolic thickening fraction in the infarcted left ventricular wall, and maximum LV dP/dt, as well as lower LV end-diastolic pressure. Microscopic findings were consistent with cardiac regeneration. These findings were in keeping with those recently published on humans in the SCIPIO trial.
Nine patients from a single institution underwent ECMO support as a bridge to transplantation with 100% post-transplant one year survival. Five patients underwent a rehabilitation program and had minimal sedation. Four patients underwent standard sedation and were immobilized in bed during the ECMO bridge. Rehabilitation could be conducted only in those patients who were cannulated with a two stage single cannula either in the internal jugular or subclavian vein as those with femoral vein cannula could not be mobilized. Rehabilitation started with active and passive exercises in bed, progressed to sitting, then standing and finally ambulation. This required a multi-person team including one strictly responsible for the ECMO cannula and lines. Those who underwent rehabilitation had shorter: post-transplant mechanical ventilation (4 d vs. 34 d), ICU stay (11 d vs. 45 d) and hospital stay (26 d vs. 80 d). This paper underscores two points: ECMO can be successfully used as a bridge to lung transplantation and pre-transplant deconditioning has a negative impact on the post-transplant outcome.
The newest set of guidelines for managing early and regionally advanced NSCLC from the ESMO focuses on screening, staging algorithms, risk assessment, and treatment options.
A retrospective analysis of SBRT in 13 institutions over a 10 year interval was conducted on outcomes in 582 pts with Stage I NSCLC. At 3 years, freedom from local recurrence was 80% and overall survival was 47%. The biological dose was the most important determinant of outcomes. With higher effective dosing, freedom from local recurrence was 92% and overall survival was 62%.
The authors review their shot- and mid-term experience with a new precurved fenestrated aortic endograft in the treatment of aortic arch aneurysms. This multicenter study included 393 patients (2010-2011). 94% of patients had landing zone <20 mm and in 62% the landing zone was less than 15 mm. The authors report technical success of 99.2%. The procedures were complicated by endoleak in 17 patients, stroke in 7, and six deaths. Type I endoleak was related to the maximum length of the aneurysm and in cases with proximal lending zone <15 mm.
The authors reviewed their 16 year experience with Marfan syndrome patients (94) requiring surgical intervention, presenting with acute aortic dissection in 35% of patients (76% Type A and 24% Type B) and aneurysmal disease in 65%. Total arch replacement was performed initially in 8% of patients for acute aortic dissection. Reoperative total arch replacement had to be performed in 33% of patients with initial presentation of acute aortic dissection and in 3% of patients without aortic dissection. Operative and 30-day mortality for secondary total arch replacement was 0. The authors recommend limiting surgery to the aortic root, ascending aorta and proximal aortic arch in Marfan syndrome patients presenting with acute aortic dissection.
This prospective observational study compared outcomes in children undergoing cardiac surgery and requiring continuous renal replacement therapy (CRRT) to other critically ill children also requiring CRRT. Of 1650 patients undergoing cardiac surgery, 5% required CRRT and 80% of those patients had multiorgan failure. 43% of those requiring CRRT after cardiac surgery died compared to 29% of other children requiring CRRT. In multivariable analysis, the only factor related to an increased risk of mortality on CRRT was hypotension at the time of instituting CRRT.
Both overall outcomes and propensity score matched outcomes were compared in patients undergoing either lobectomy or segmentectomy for clinical stage IA adenocarcinoma of the lung. In the overall cohort, 3-year recurrence-free and overall survival were similar between the groups. Among the matched patients, RFS (92.9% vs 90.9%) and OS (93.2% vs 95.7%) were also similar between the lobectomy and segementectomy groups at 3 years.