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Journal and News Scan
A clear message (although no causation is proven) regarding an important patient-centered research question, going bravely against the tide.
Schneider and colleagues have narrated a video demonstrating their technique for valve-sparing root replacement in a patient with Marfan syndrome. In the accompanying article, the authors report the outcomes of 61 patients with Marfan syndrome who underwent either aortic valve reimplantation or root remodeling at their institution.
A large follow-up study comparing repair and replacement results and trends. Of particular interest to the UK and European readership is the page 113 discussion on the center of mitral excellence principle.
A well executed study on an important problem in cardiac surgery that merits careful reading, as no one-sentence conclusion can be adequately gleaned.
Miller and colleagues retrospectively compared anastomotic integrity with pleural amylase levels (PAL), measured daily from postoperative day 3-10 after an Ivor Lewis esophagectomy. Three of 45 patients had an anastomotic leak, each of which coincided with a large increase in their PAL. The authors conclude that measuring PALs is an accurate, safe, and inexpensive way to detect esophageal anastomotic leaks.
A model analysis of a phase I surgical device trial. The readable editorial discusses the adoption of surgical innovation on the occasion of a harmonic sealing device for pulmonary resections, highlighting the problem of ligating small branches of the pulmonary artery in confined spaces.
An interesting article from a popular UK newspaper, reflecting perhaps the views of members of government and public in confining UK medical graduates to largely low-paid work for five years after graduation, on the socialist principle that the public has paid for their education (they pay quite a lot themselves as well, and end up in debt).
We experienced similar expansion of compulsory government low-paid work (extension of preregistration internship) in the Republic of South Africa after 1994.
The figure of 230 000 pounds as an average cost is probably demagogic, as no calculation source is being offered. It would be interesting to attempt a robust calculation of the cost of thoracic (cardiothoracic) specialist training.
The concept may come to a surprise to our North American colleagues, as the European socialist health concepts may have not penetrated the New World outside the British Commonwealth.
The United Kingdom has been facing a multilevel exodus of doctors since the beginning of the century, when a progressive deterioration in job satisfaction in the NHS started. It remains baffling how, in the face of loss of a highly qualified workforce, various governments have not attempted any improvement in work terms and conditions of doctors. The NHS salaries have particularly dropped for clinical staff since.
China and Cambodia will work together on a program to provide free heart surgery to 100 Cambodian children with congenital heart disease.
Quadruple bypass surgery was the inspiration a Singapore man needed to turn his lifestyle heart-healthy. Now he has run the Singapore Marathon.
A balloon sampling device that can be swallowed and then retrieved might provide an easier test for Barrett’s esophagus.
Drugs and Devices
The US Food and Drug Administration has expanded approval of the lung cancer drug afatinib to patients whose tumors show any of five EGFR mutations.
Brazil marked its first implantations of the transcatheter pulmonary valve called the Venus P-Valve, which is made by Chinese company Venus Medtech, Inc. The valve is under clinical trial investigation in Europe and the US.
Research, Trials, and Funding
Researchers in Japan have 3D-printed artificial tracheas without scaffolds using spheroids composed of multiple cell types, which they have transplanted into rats.
Merck announced that its anti-PD-L1 therapy, pembrolizumab met its primary endpoints of longer overall and progression-free survival when given in combination with pemetrexed and chemotherapy for non-small cell lung cancer.
The authors describe a clinical unit developed at their institution designed to implement "nudges" to help improve health care delivery, primarily through the EMR. "Nudges" have been used to shape other behaviors, such as offering opt-out (rather than opt-in) for organ donor status to encourage increased organ donation. The concept was described by Nobel prize winner Richard Thaler.
The authors summarize the rationale and utility of point of care ultrasonography for identifying factors associated with hypotension or hypoxia in a deteriorating surgical patient, including hypovolemia, LV dysfunction, PE, pleural fluid, ascites, etc. Their claim is that a variety of other diagnostic measures are less accurate, and that a single ultrasonographic exam of the abdomen, lung, pleura, and heart in a single study is efficient, useful, and can be performed in any location.