ALERT!

This site is not optimized for Internet Explorer 8 (or older).

Please upgrade to a newer version of Internet Explorer or use an alternate browser such as Chrome or Firefox.

Journal and News Scan

Source: New England Journal of Medicine
Author(s): Kirsi-Maija Kaukonen, Michael Bailey, David Pilcher, D. Jamie Cooper, and Rinaldo Bellomo

The authors sought to validate the definition of the systemic inflammatory response syndrome (SIRS), which requires the presence of 2 or more clinical criteria, and determined whether meeting the definition was associated with an increased risk of death.  Over 109,000 ICU patients in Australia and New Zealand who had infection and organ failure were studied.  88% had SIRS positive sepsis, the others did not meet the SIRS criteria (SIRS negative sepsis).   Mortality in the two groups decreased similarly over the 14 year study.  There was a linear increase in mortality associated with each additional SIRS criterion, indicating that the threshold of 2 criteria did not represent a transition in risk level.

Source: New England Journal of Medicine
Author(s): A. Marc Gillinov, Annetine C. Gelijns, Michael K. Parides, Joseph J. DeRose, Jr., Alan J. Moskowitz, Pierre Voisine, Gorav Ailawadi, Denis Bouchard, Peter K. Smith, Michael J. Mack, Michael A. Acker, John C. Mullen, Eric A. Rose, Helena L. Chang, John D. Puskas, Jean-Philippe Couderc, Timothy J. Gardner, Robin Varghese, Keith A. Horvath, Steven F. Bolling, Robert E. Michler, Nancy L. Geller, Deborah D. Ascheim, Marissa A. Miller, Emilia Bagiella, Ellen G. Moquete, Paula Williams, Wendy C. Taddei-Peters, Patrick T. O'Gara, Eugene H. Blackstone, and Michael Argenziano for the CTSN Investigators

The study investigated management of atrial fibrillation existing at the time of mitral valve surgery, randomizing 260 pts to ablation or observation.  The end point was freedom from afib at both 6 and 12 mos.  Ablation yielded success in 63% compared to 29% of controls, but was associated with a higher risk of pacemaker implant (21% vs 8%).   

Source: Annals of Oncology
Author(s): M.L.G. Janssen-Heijnen, F.N. van Erning, D.K. De Ruysscher, J.W.W. Coebergh and H.J.M. Groen

This Netherlands population-based study followed causes of death in patients with NSCLC diagnosed 1989-2008, including more than 72,000 patients.  For those with localized disease, lung cancer was the cause of death in 80-85% for years 0-3, 60-75% for years 4-6, and remained the cause of death for more than 30% thereafter.  After 6 years CAD and COPD became the primary causes of death.

Source: Thorax
Author(s): Hes A P Brokx, Marinus A Paul, Pieter E Postmus, Thomas G Sutedja

The authors describe results of initial bronchoscopy therapy (IBT) for endobronchial carcinoids aimed at relieving obstruction, accurate subtyping, and potentially complete eradication.  After a minimum follow-up of 5 years, 42% of patients were spared surgical therapy, having had no evidence of local or distant recurrence (42/83 with typical histology, 5/29 with atypical histology). 

Source: Circulation
Author(s): Iqbal J, Zhang Y-J, Holmes DR, Morice M-C, Mack MJ, Kappetein AP, Feldman T, Escaned J, Stahle E, Banning AP, Gunn JP, Colombo A, Steyerberg EW, Mohr FW, Serruys PW

In this manuscript the authors present a post-hoc study of the SYNTAX trial. They compare outcomes between those patients on optimal medical therapy (OMT) and non-optimal medical therapy following revascularization for complex coronary artery disease (CAD). OMT was defined as combination of at least one antiplatelet drug, statin, beta-blocker and angiotensin converting enzyme inhibitor/angiotensin receptor blocker (ACE-I/ARB). Only one third of the patients were found to be on OMT at 5-year follow up. Lack of OMT was associated with a higher mortality and combined endpoint of death, MI and stroke. These findings reinforce the the importance of OMT use for patients with complex CAD undergoing revascularization.

Source: JAMA
Author(s): David R. Holmes Jr; J. Matthew Brennan; John S. Rumsfeld; David Dai; Sean M. O’Brien; Sreekanth Vemulapalli; Fred H. Edwards; John Carroll; David Shahian; Fred Grover; E. Murat Tuzcu; Eric D. Peterson; Ralph G. Brindis; Michael J. Mack; for the STS/ACC TVT Registry

Using STS/ACC registry data, the authors updated 30-day outcomes and present 1 year outcomes for TAVR pts.  Over 12,000 pts were in the registry; median age was 84, and STS predicted operative mortality risk was 7.1%.   30-day mortality was 7.0%, 1-year mortality was 23.7%.  1-year mortality was associated with advanced age, male sex, end-stage renal disease, COPD, non-transfemoral access, high predicted risk, and preoperative afib.   

Source: Thorax
Author(s): Felix JF Herth, Ralf Eberhardt, Daniel Sterman, Gerard A Silvestri, Hans Hoffmann, Pallav L Shah

With the increase in solitary pulmonary nodule identification anticipated with increased CT screening, the authors devised a novel method of bronchoscopically biopsying nodules not adjacent to airways.  Using endoscopic instruments, a transparenchymal tunnel was created between a bronchial entry point to the nodule, and biopsies were obtained.  The procedure was successful in 10/12 pts and the histologic results were well correlated with surgical findings.  No complications occurred.

Source: New England Journal of Medicine
Author(s): Gavin J. Murphy, Katie Pike, Chris A. Rogers, Sarah Wordsworth, Elizabeth A. Stokes, Gianni D. Angelini, and Barnaby C. Reeves, for the TITRe2 Investigators

This is a very provocative British study that examined whether a more liberal (Hgb < 9 g/dL) versus a more restrictive (Hgb < 7.5 g/dL) transfusion threshold after cardiac surgery is associated with higher morbidity and costs.  The authors conducted a multicenter, prospective randomized trail by randomizing patients who had a Hgb < 9 g/dL after heart surgery to one of the two groups.  Over 2,000 patients were enrolled in the study.  Interestingly, the group with the more liberal transfusion protocol had no worse outcomes and no higher costs than the restrictive group.  Moreover - even more provocatively - the secondary outcome of 90-day all-cause mortality was 64% more likely to occur in the restrictive transfusion threshold group.

Source: Journal of the National Cancer Institute
Author(s): Kurt A. Schalper, Jason Brown, Daniel Carvajal-Hausdorf, Joseph McLaughlin, Vamsidhar Velcheti, Konstantinos N. Syrigos, Roy S. Herbst and David L. Rimm

Samples from tissue microarrays of 552 NSCLC patients were analyzed to measure the levels of 3 different tumor-infiltrating lymphocytes (TILs): CD3, CD8, and CD20. An elevated level of CD3 or CD8 was associated with longer survival. This finding might be useful to evaluate response or assess the local immune effect of anticancer immune inhibitors.

Source: Journal of Clinical Oncology
Author(s): Cliff G. Robinson, Aalok P. Patel, Jeffrey D. Bradley, Todd DeWees, Saiama N. Waqar, Danieal Morgensztern, Maria Q. Baggstrom, Ramaswamy Govindan, Jennifer M. Bell, Tracay J. Guthrie, Graham A. Colditz, Traves D. Crabtree, Daniel Kreisel, Alexander S. Krupnick, G. Alexander Patterson, Bryan F. Meyers, and Varun Puri

A review of the National Cancer Data Base was undertaken to determine the impact of postoperative radiation therapy on survival for patients with pathologic stage IIIA NSCLC in the setting of adjuvant chemotherapy. The authors point out that some prior analyses demonstrated a decrease in survival with postoperative radiation therapy likely due to the inclusion of patients with N0 or N1 disease and toxicity associated with outdated radiation treatment regimens. The main results of this study were that in patients with completely resected stage IIIA NSCLC, there was an improvement in median overall survival and 5-year overall survival with postoperative radiation therapy (45.2 months and 39.3%) over adjuvant chemotherapy alone (40.7 months and 34.8%). Furthermore, when other factors associated with overall survival were controlled for, the survival benefit of postoperative radiation therapy, although modest, continued to be significant.

Pages