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Journal and News Scan
Loghin and Loghin detail the intricacies of imaging modalities available for the assessment of patients in the era of novel mitral technologies. They include a description of functional mitral valve anatomy and discuss the multimodel approach to evaluation of patients undergoing implantation of transcatheter devices.
Diwan and colleagues retrospectively compared daytime to nighttime extubation for patients after cardiac surgery, considering outcomes for patients who were extubated early and patients who had longer intubation times. While there was no time-dependent difference in mortality for patients undergoing extubation within the first 24 hours after arrival in the intensive care unit, patients who were intubated for longer times showed a greater mortality risk with nighttime extubation than with daytime extubation (odds ratio 2.46, 95% confidence interval 1.45 - 4.16, p = 0.001).
Cao and colleagues compared outcomes with stereotactic body radiation therapy (SBRT) to surgery for patients with non–small cell lung cancer using a meta-analysis of 23 studies. Although periprocedural risk was lower for SBRT, surgery provided improved overall survival at later times in both unmatched (16 studies) and matched cohorts (14 studies), with odds ratios of 2.49 and 1.71, respectively. Subgroup analysis demonstrated superior overall survival for lobectomy and sublobar resection when compared with SBRT. The authors also evaluated cancer-specific survival, disease-free survival, and freedom from recurrence for the subsets of studies that reported them.
Patients who were nonadherent to participating in cancer screening tests experienced increased mortality from noncancer causes. It is hypothesized that such patients are also noncompliant with general medical care recommendations, and that such noncompliance represents a behavioral phenotype.
Within a year after a diagnosis of lung cancer the suicide rate for such patients is 6 times higher than in the general population. This is among the greatest increases in the risk of suicide among all cancer diagnoses.
Malignant pleural effusions (MPE) affect up to 15% of all patients with cancer, and in the last few years several well-designed randomized clinical trials have been published. In this position paper, members from both the European Respiratory Society and the European Association for Cardio-Thoracic Surgery summarize the available evidence, focusing on six topics: (1) symptomatic MPE, (2) MPE with trapped lung, (3) loculated MPE, (4) factors predicting prognosis, (5) timing of oncological therapy and definitive fluid management, and (6) histological diagnosis versus cytology.
Edwards Lifesciences announced that the SAPIEN 3 Ultra system has received US Food and Drug Administration approval for transcatheter aortic valve replacement in severe, symptomatic aortic stenosis patients who are determined to be at intermediate or greater risk of open-heart surgery.
On December 20, 2018, the US Food and Drug Administration (FDA) issued a new warning against the use of fluoroquinolones in patients with connective tissue disorders and those predisposed to aortic disease.
The FDA indicates that fluoroquinolones, a commonly prescribed class of antibiotics (including Avelox, Cipro, Factive, Levaquin, and Ofloxacin), should not be used in certain patients with aortic aneurysm/dissection and those who are at higher risks for developing aortic aneurysms and dissections, such as patients with connective tissue disorders, hypertension, peripheral atherosclerotic vascular diseases, and the elderly. A review of several recent studies shows that people who have taken a fluoroquinolone are twice as likely to develop an aortic aneurysm or dissection than those who have not taken one of these drugs. FDA has also required a new warning about this risk to be added to the labeling of these medications.
The world breaks everyone and afterward many are strong at the broken places. But those that will not break it kills. It kills the very good and the very gentle and the very brave impartially. If you are none of these you can be sure it will kill you too but there will be no special hurry.
Kiener and colleagues evaluated survival for patients receiving either an arterial or atrial switch operation for d-transposition of the great arteries. The authors evaluated operation data from the Pediatric Cardiac Care Consortium between 1982 and 1991, finding better 20-year overall transplant-free survival for arterial switch operations than for atrial switch (82.1% versus 76.3%) despite the fact that in-hospital mortality was higher for arterial switch (21.6% versus 12.9%).