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Journal and News Scan

Source: The New England Journal of Medicine
Author(s): Alain Combes, David Hajage, Gilles Capellier, Alexandre Demoule, Sylvain Lavoué, Christophe Guervilly, Daniel Da Silva, Lara Zafrani, Patrice Tirot, Benoit Veber, Eric Maury, Bruno Levy, Yves Cohen, Christian Richard, Pierre Kalfon, Lila Bouadma, Hossein Mehdaoui, Gaëtan Beduneau, Guillaume Lebreton, Laurent Brochard, Niall D. Ferguson, Eddy Fan, Arthur S. Slutsky, Daniel Brodie, Alain Mercat, for the EOLIA Trial Group, REVA, and ECMONet

A severe blow to the concept of venovenous extracorporeal membrane oxygenation for acute respiratory distress syndrome in the form of a well-executed randomized controlled trial.

Source: The New England Journal of Medicine
Author(s): Panagiotis Xaplanteris, Stephane Fournier, Nico H.J. Pijls, William F. Fearon, Emanuele Barbato, Pim A.L. Tonino, Thomas Engstrøm, Stefan Kääb, Jan-Henk Dambrink, Gilles Rioufol, Gabor G. Toth, Zsolt Piroth, Nils Witt, Ole Fröbert, Petr Kala, Axel Linke, Nicola Jagic, Martin Mates, Kreton Mavromatis, Habib Samady, Anand Irimpen, Keith Oldroyd, Gianluca Campo, Martina Rothenbühler, Peter Jüni, Bernard De Bruyne, for the FAME 2 Investigators

Over 1200 patients with stable coronary artery disease and at least one angiographically-significant stenosis were randomized to percutaneous coronary intervention (PCI) plus medical therapy or medical therapy alone for lesions with fractional flow reserve (FFR) <0.8.  FFR-guided PCI was associated with a significantly reduced composite outcome (death, myocardial infarction, or urgent revascularization).  Patients without hemodynamically significant lesions had good outcomes on medical therapy alone.

Source: The New England Journal of Medicine
Author(s): Ahmedin Jemal, Kimberly D. Miller, Jiemin Ma, Rebecca L. Siegel, Stacey A. Fedewa, Farhad Islami, Susan S. Devesa, Michael J. Thun

The age-specific incidence of non-small cell lung cancer has reversed in individuals born since the 1960s, with women now having a higher incidence than men.  This trend is not explained by differences in smoking habits.

Source: The New England Journal of Medicine
Author(s): Patrick M. Forde, Jamie E. Chaft, Kellie N. Smith, Valsamo Anagnostou, Tricia R. Cottrell,Matthew D. Hellmann, Marianna Zahurak, Stephen C. Yang, David R. Jones, Stephen Broderick, Richard J. Battafarano, Moises J. Velez, Natasha Rekhtman, Zachary Olah, Jarushka Naidoo, Kristen A. Marrone, Franco Verde, Haidan Guo, Jiajia Zhang, Justina X. Caushi, Hok Yee Chan, John-William Sidhom, Robert B. Scharpf, James White, Edward Gabrielson, Hao Wang,Gary L. Rosner, Valerie Rusch, Jedd D. Wolchok, Taha Merghoub, Janis M. Taube, Victor E. Velculescu, Suzanne L. Topalian, Julie R. Brahmer, Drew M. Pardoll

This is among the first and largest summaries of the use of neoadjuvant PD-1 inhibitor (nivolumab) in patients with resectable lung cancer.  The safety profile was adequate, 20 of 21 patients underwent complete resection, and the pathologic major response rate was 45%.   The response was similar regardless of PD-L1 status, and response was related to tumor mutational burden.  

Source: The Annals of Thoracic Surgery
Author(s): Satoshi Kawatsu, Konosuke Sasaki, Ko Sakatsume, Shingo Takahara, Katsuhiro Hosoyama, Naoki Masaki, Yusuke Suzuki, Yukihiro Hayatsu, Ichiro Yoshioka, Kei Sakuma, Osamu Adachi, Masatoshi Akiyama, Kiichiro Kumagai, Naotaka Motoyoshi, Shunsuke Kawamoto, Yoshikatsu Saiki

Kawatsu and colleagues performed a retrospective analysis of preoperative characteristics and laboratory data for patients who did and did not exhibit heparin resistance (n = 25 and n = 464, respectively) prior to establishment of cardiopulmonary bypass for a cardiovascular operation. They identified chronic thoracic aortic dissection, smoking, chronic obstructive pulmonary disease, and elevated fibrinogen as independent predictors for heparin resistance. The authors conclude that patients with these predictive factors could potentially be given antithrombin-III if an initial dose of heparin does not achieve the desired activated clotting time, rather than being given an additional heparin dose that may be ineffective.

Source: MedPage Today
Author(s): Kristin Jenkins

Using eight computed tomography radiographic features in an automated algorithm, differentiating between benign and malignant status of indeterminate pulmonary nodules had an area under the curve of 0.939. 

Source: JAMA
Author(s): Xiaoxi Yao, Bernard J. Gersh, David R. Holmes Jr, Rowlens M. Melduni, Daniel O. Johnsrud, Lindsey R. Sangaralingham, Nilay D. Shah, Peter A. Noseworthy

This review of over 75,000 patients from a large administrative database found that occlusion of the left atrial appendage during cardiac surgery was associated with a reduced risk of subsequent stroke and all-cause mortality.

Source: Nature Biomedical Engineering
Author(s): M. Saad Bhamla, Brandon Benson, Chew Chai, Georgios Katsikis, Aanchal Johri, Manu Prakash

A centrifuge made of paper and string and powered by hand can separate plasma from whole blood in 90 seconds and permit the diagnosis of malaria in 15 minuntes at the point of care. The centrifuge generates speeds of 125,000 rpm, with a theoretical maximum of 1,000,000 rpm. Such devices may become the centerpiece of diagnostic assays in the developing world in the future.

Source: Nature Reviews Cardiology
Author(s): David A. Brown, Justin B. Perry, Mitchell E. Allen, Hani N. Sabbah, Brian L. Stauffer, Saame Raza Shaikh, John G. F. Cleland, Wilson S. Colucci, Javed Butler, Adriaan A. Voors, Stefan D. Anker, Bertram Pitt, Burkert Pieske, Gerasimos Filippatos, Stephen J. Greene, Mihai Gheorghiade

An interesting, informative, and timely consensus statement on mitochondrial dysfunction in heart failure and how to potentially target these abnormalities therapeutically.

Source: European Journal of Cardio-Thoracic Surgery
Author(s): Yves d’Udekem, James S Tweddell, Tom R Karl

d’Udekem and colleagues discuss aortic valve surgery in infants and neonates. The authors highlight issues such as considerations and strategies, the role of associated intracardiac and extracardiac lesions, how to deal with iatrogenic lesions following interventional catheter or surgical procedures, and techniques and limitations of aortic valve repair.