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Journal and News Scan
As many will recall, world chess champion Garry Kasparov was defeated by IBM's Deep Blue computer in 1997. Now machine-learning algorithms have bested trained pathologists in differentiating between benign and malignant changes in sentinel lymph nodes in breast cancer patients. We can expect to see increasing involvement of AI in pathology as well as other fields in medicine in the future.
Liquid biopsies have long held promise for diagnosis, treatment selection, and surveillance of lung cancer patients. This articles summarizes results of two studies involving highly precise measurement of tumor mutational burden. A burden of 16-fold or greater was associated with improved overall survival with immunotherapy (atezolizumab) compared to standard chemotherapy (docetaxel) in two prospective studies. Additional trials are ongoing.
US states that implemented policies for screening newborns for critical congenital heart disease have seen reductions in infant cardiac deaths compared to states that didn’t implement screening.
Jimmy Kimmel’s infant son, whose medical care has been in the spotlight as part of the US healthcare debate, is recovering from his second heart surgery.
The man who received the first locally-developed mechanical heart valve in India, the TTK-Chitra valve, celebrates 27 years with his mechanical valve.
Surgeons in New York City remove a tennis ball-sized tumor from a man’s heart.
Drugs and Devices
The US Food and Drug Administration announced new guidance on 3D-printed medical devices.
A transcatheter device for mitral regurgitation that is anchored entirely in the left atrium was awarded Best Technology Parade Presentation at the International Conference for Innovations in Cardiovascular Interventions in Tel Aviv, Israel.
Edwards Lifesciences has purchased Harpoon Medical, including its mitral valve repair device that is expected to receive CE mark approval soon.
Research, Trials, and Funding
Adding atezolizumab, an anti-PD-L1 immunotherapy, to an antiangiogenic biologic drug and chemotherapy delayed progression of non-small cell lung cancer regardless of PD-L1 expression, in an early report from the phase III IMpower150 trial.
Former US National Football League athletes were found to have a higher incidence of an ascending aorta over 4 cm wide than similarly aged men who were not professional athletes.
Apple and Stanford University have launched the Apple Heart Study, which uses an app linked to the Apple Watch to monitor participants for irregular heart rhythms.
Iribarne and colleagues analyzed US Medicare claims from 2009 to 2014 to characterize bilateral internal mammary artery (BIMA) usage in coronary artery bypass surgery. They found that regional usage of BIMA differed significantly, and that BIMA usage was related to the intensity of cardiovascular care but only somewhat to surgical volume.
This study encompasses 2,363 pediatric patients who underwent cardiac surgery before and after the implementation of an acuity adaptable care model. Under the conventional model, patients moved among units and care teams based on age, operative status, and acuity. Under the acuity adaptable care model, patients remained in the Cardiac Care Unit and received care from one clinical team throughout their hospitalization. The acuity adaptable care model was associated with a lower failure-to-rescue rate and favorable trends for operative mortality and length of stay.
LoMauro and colleagues measured tidal volume and ribcage expansion during rest and exercise to evaluate functional recovery after minimally invasive thoracic surgery. Video-assisted thoracoscopic surgery (VATS) preserved these kinematic measures better than posterolateral thoracotomy, and the advantage was observed over two postoperative months. Patients compensated for restriction by shifting the expansion to the contralateral thorax after VATS and to the abdomen after thoracotomy.
Bhagat and colleagues analyzed the rate of unplanned hospital readmission from 2012 to 2015 using the American College of Surgeons National Surgical Quality Improvement Program Participant Use File. Thoracoscopic surgery was associated with a higher rate of postdischarge complications, a finding related to the shorter length of stay for these patients. Open surgery was associated with a higher rate of related unplanned readmissions, but after risk adjustment, open and thoracoscopic surgery readmissions were not different.
An inspiring presidential address from the new EACTS president.
The president of Brazil had stents placed for coronary artery obstructions over the weekend.
The first transcatheter implantation of a retrievable aortic valve in China occurred at the Second Affiliated Hospital of Zhejiang University.
Drugs and Devices
A UK-based company is developing a more mobile, more affordable surgical robot.
Boston Scientific announced that it will indefinitely delay seeking US Food and Drug Administration approval for its Lotus Edge transcatheter valve.
Puerto Rico’s ongoing recovery from Hurricane Maria could affect surgical device supplies.
The European Medicines Agency will move from London to Amsterdam.
Research, Trials, and Funding
Researchers from the University of California, San Diego, in the US, find that lobectomy for early stage lung cancer provides better survival than stereotactic body radiation therapy.
A review of randomized controlled trials in pediatric heart surgery suggests that many studies do not provide sufficiently robust evidence.
A new imaging technology could provide higher resolution views of important tissues in minimally invasive surgery.
Biomedical engineers from Duke University in North Carolina, US, have implanted patches of induced cardiomyocytes onto rodent hearts; the implants showed near mature electrical and mechanical function.
Sato and colleagues applied elliptic Fourier analysis to morphological aortic measurements from 80 patients with uncomplicated type B aortic dissection. The patients were divided in two groups according to aortic enlargement during follow-up. The shape of the aortic diameter at initial operation was a significant predictor of further morphologic development.