Results Generated From:
Embase <1980 to 2012 Week 30>
Embase (updates since 2012-07-20)
<1>
Accession Number
22613298
Authors
Creanor S. Barton A. Marchbank A.
Institution
(Creanor) Centre for Health and Environmental Statistics, Plymouth
University, UK.
Title
Effectiveness of a gentamicin impregnated collagen sponge on reducing
sternal wound infections following cardiac surgery: a meta-analysis of
randomised controlled trials.
Source
Annals of the Royal College of Surgeons of England. 94 (4) (pp 227-231),
2012. Date of Publication: May 2012.
Abstract
Gentamicin impregnated collagen sponges are licensed for use after cardiac
surgery in over 50 countries but their effectiveness at preventing sternal
wound infections (SWIs) remains uncertain. The aim of this meta-analysis
was to assess the current evidence for effectiveness of such sponges at
preventing SWIs in patients after cardiac surgery. A systematic search of
the literature was undertaken and meta-analyses were performed on the
results of the identified, eligible studies. Using random effects models,
odds ratios (OR) and corresponding 95% confidence intervals (CI) were
calculated for all SWIs and deep SWIs for: a) all participants, and b)
participants deemed as high risk. Three unique randomised controlled
trials (published between 2005 and 2010) involving 3,994 participants met
the inclusion criteria. There was insufficient evidence of a significant
difference between intervention and control groups for all SWIs (all
participants: OR: 0.66, 95% CI: 0.39-1.14; high risk participants: OR:
0.60, 95% CI: 0.24-1.52). There was insufficient evidence of a significant
benefit of the sponge in deep SWIs across all participants (OR: 0.72, 95%
CI: 0.47-1.10) but some evidence of benefit in terms of reducing the
incidence of deep SWIs in high risk participants (OR: 0.62, 95% CI:
0.39-0.98). There is insufficient evidence of the effectiveness (or
otherwise) of gentamicin impregnated sponges in preventing SWIs following
cardiac surgery. However, some evidence does exist that such sponges can
reduce the incidence of deep infections in high risk patients.
<2>
Accession Number
22513959
Authors
Liakopoulos O.J. Kuhn E.W. Slottosch I. Wassmer G. Wahlers T.
Institution
(Liakopoulos) Department of Cardiothoracic Surgery, Heart Center,
University of Cologne, Cologne, Germany.
Title
Preoperative statin therapy for patients undergoing cardiac surgery.
Source
Cochrane database of systematic reviews (Online). 4 (pp CD008493), 2012.
Date of Publication: 2012.
Abstract
Patients referred to cardiac surgery for cardiovascular disease are at
significant risk for the development of post-operative major adverse
events despite significant advances in surgical techniques and
perioperative care. Statins (HMG-CoA reductase inhibitors) have gained a
pivotal role in the primary and secondary prevention of coronary artery
disease, and are thought to improve perioperative outcomes in patients
undergoing cardiac surgery. To determine the effectiveness of a
preoperative statin therapy in patients undergoing cardiac surgery. We
searched CENTRAL (Issue 2 of 4, 2010 on The Cochrane Library), MEDLINE
(1950 to May, Week 1 2010), EMBASE (1980 to 2010 Week 19), and the
metaRegister of Controlled Trials. Additionally, ongoing trials were
searched through the National Research Register, the ClinicalTrials.gov
registry and grey literature. Conference indices from relevant scientific
meetings (2006-2009) were screened online for eligible trials. No language
restrictions were applied. All randomized controlled trials comparing any
statin treatment before cardiac surgery, for any given duration and dose,
to no preoperative statin therapy (standard of care) or placebo. Two
authors evaluated trial quality and extracted data from titles and
abstracts identified from the electronic database searches according to
pre-defined criteria. Accordingly, full text articles of potentially
relevant studies that met the inclusion criteria were retrieved to assess
definite eligibility for inclusion. Effect measures are reported as odds
ratios (OR) or weighted mean difference (WMD) with 95% confidence
intervals (95%-CI). Eleven randomized controlled studies including a total
of 984 participants undergoing on- or off-pump cardiac surgical procedures
were identified. Pooled analysis showed that statin pre-treatment before
surgery reduced the incidence of post-operative atrial fibrillation (AF)
(OR 0.40; 95%-CI: 0.29 to 0.55; p<0.01), but failed to influence
short-term mortality (OR 0.98, 95%-CI: 0.14 to 7.10; p=0.98) or
post-operative stroke (OR 0.70, 95%-CI: 0.14 to 3.63; p=0.67). In
addition, statin therapy was associated with a shorter length of stay of
patients on the intensive care unit (ICU) (WMD: -3.39 hours; 95%-CI: -5.77
to -1.01) and in-hospital (WMD: -0.48 days; 95%-CI: -0.85 to -0.11) where
significant heterogeneity was observed. There was no reduction in
myocardial infarction (OR 0.52; 95%-CI: 0.2. to 1.30) or renal failure (OR
0.41; 95%-CI: 0.15 to 1.12). These results were unaffected after subgroup
analysis. No major or minor perioperative statin side-effects were
reported from trials investigating this safety endpoint. Preoperative
statin therapy reduces the odds of post-operative AF and shortens the stay
on the ICU and in the hospital. Statin pretreatment had no influence on
perioperative mortality, stroke, myocardial infarction or renal failure.
Since analysed studies included mainly patients undergoing myocardial
revascularizations the results cannot be extrapolated to patients
undergoing other cardiac procedures such as heart valve or aortic surgery.
<3>
Accession Number
2012406649
Authors
Jouybar R. Kabgani H. Kamalipour H. Shahbazi S. Allahyary E. Rasouli M.
Akhlagh S.H. Shafa M. Ghazinoor M. Moeinvaziri M.T. Khademi S.
Institution
(Jouybar, Kabgani, Shahbazi, Allahyary, Akhlagh, Shafa, Ghazinoor,
Moeinvaziri, Khademi) Shiraz Anesthesiology and Critical Care Research
Center, Shiraz University of Medical Sciences, Shiraz, Iran, Islamic
Republic of
(Kamalipour) Laparoscopy Research Center, Shiraz University of Medical
Sciences, Shiraz, Iran, Islamic Republic of
(Rasouli) Immunology and Clinical Microbiology Research center, Shiraz
University of Medical Sciences, Shiraz, Iran, Islamic Republic of
Title
The perioperative effect of ascorbic acid on inflammatory response in
coronary artery bypass graft surgery; A randomized controlled trial
coronary artery bypass graft surgery.
Source
Iranian Cardiovascular Research Journal. 6 (1) (pp 13-17), 2012. Date of
Publication: -.
Publisher
Iranian Cardiovascular Research Journal (Zand Ave., Shiraz, Iran, Islamic
Republic of)
Abstract
Background: Different pharmacological agents may decrease the inflammatory
response during cardiac surgery. The aim of this study was to evaluate the
effect of ascorbic acid as an antioxidant on inflammatory markers
(interleukins 6 and interleukin 8) released during cardiopulmonary bypass.
Method: Forty patients scheduled for elective coronary artery bypass
grafting surgery, were randomly assigned to two groups. The patients in
the case group were given 3 grams ascorbic acid 12-18 hours before
operation and 3 grams during CPB initiation. The patients in the control
group were given the same amounts of normal saline at similar times. Blood
samples were collected 6 hours preoperatively and postoperative serum
interleukin 6 and 8 were measured using enzyme-linked immunosorbent assay
(ELISA). Result: In both groups CPB caused an increase in IL6 and IL8
plasma concentrations compared with baseline levels, but the pattern of
changes at such levels were similar in both groups after receiving
ascorbic acid or placebo. Ascorbic acid did not reduce the inflammatory
cytokines during CPB. Compared to the placebo, ascorbic acid had no
significant effect on hemodynamic parameters such as systolic and
diastolic blood pressure, heart rate, arterial blood gases, BUN,
Creatinine and WBC and platelet counts. Conclusion: Ascorbic acid has no
effect on the reduction of IL6 and IL8 during CPB. Also, it causes no
improvement in hemodynamics, blood gas variables, and the outcomes of
patients undergoing CABG.
<4>
Accession Number
2012376912
Authors
Sun J.H. Wu X.Y. Wang W.J. Jin L.L.
Institution
(Sun, Wang, Jin) Department of Anaesthesia, The First Affiliated Hospital,
Wenzhou Medical College, 2 Fu-Xue Street, Lucheng District, Wenzhou, China
(Wu) Department of Anaesthesia, Shengjing Hospital, China Medical
University, Shenyang, China
Title
Cognitive dysfunction after off-pump versus on-pump coronary artery bypass
surgery: A meta-analysis.
Source
Journal of International Medical Research. 40 (3) (pp 852-858), 2012. Date
of Publication: 2012.
Publisher
Field House Publishing (6 Sompting Ave, Worthing BN14 8HN, United Kingdom)
Abstract
Objective: A meta-analysis to compare the incidence of postoperative
cognitive dysfunction (POCD) following off-pump coronary artery bypass
grafting (OPCAB) versus after conventional coronary artery bypass grafting
(CABG). METHODS: A systematic search of the Medline, EMBASE and Cochrane
Library databases was performed to identify randomized controlled trials
published until the end of November 2011. Data were analysed using RevMan
version 5.0 software. RESULTS: The literature search identified 13
randomized controlled trials which included a total of 2326 cases.
Meta-analysis found that the incidence of POCD was significantly higher
following CABG than after OPCAB during the perioperative period (1 - 2
weeks) and at 3 months postsurgery. There were no significant
between-group differences at 6 or 12 months postsurgery. CONCLUSIONS:
Compared with CABG, OPCAB was found to be associated with a reduced
incidence of early-stage POCD. Caution must be taken when interpreting
these findings because of limitations in the available data. 2012 Field
House Publishing LLP.
<5>
Accession Number
2012404432
Authors
Venugopal V. Laing C.M. Ludman A. Yellon D.M. Hausenloy D.
Institution
(Venugopal, Ludman, Yellon, Hausenloy) Hatter Cardiovascular Institute,
University College London Hospital, 67 Chenies Mews, London, WC1E 6HX,
United Kingdom
(Laing) Centre for Nephrology, University College London, Royal Free
Campus, London, United Kingdom
Title
Pathogenesis and treatment of kidney disease: Effect of remote ischemic
preconditioning on acute kidney injury in nondiabetic patients undergoing
coronary artery bypass graft surgery: A Secondary analysis of 2 small
randomized trials.
Source
American Journal of Kidney Diseases. 56 (6) (pp 1043-1049), 2010. Date of
Publication: December 2010.
Publisher
W.B. Saunders (Independence Square West, Philadelphia PA 19106-3399,
United States)
Abstract
Background: Novel treatment strategies are required to reduce the
development of acute kidney injury (AKI) in patients undergoing cardiac
surgery. In this respect, remote ischemic preconditioning (RIPC), a
phenomenon in which transient nonlethal ischemia applied to an organ or
tissue protects another organ or tissue from subsequent lethal ischemic
injury, is a potential renoprotective strategy. Study Design: Secondary
analysis of 2 randomized trials. Setting & Participants: 78 consenting
selected nondiabetic patients in a university teaching hospital undergoing
elective coronary artery bypass graft (CABG) surgery recruited to 2
previously reported randomized studies. Intervention: RIPC consisted of
three 5-minute cycles of right forearm ischemia, induced by inflating a
blood pressure cuff on the upper arm to 200 mm Hg, with an intervening 5
minutes of reperfusion, during which time the cuff was deflated. The
control consisted of placing an uninflated cuff on the arm for 30 minutes.
Outcomes: AKI measured using Acute Kidney Injury Network (AKIN) criteria,
duration of hospital stay, in-hospital and 30-day mortality. Results:
Numbers of participants with AKI stages 1, 2, and 3 were 1 (3%), 3 (8%),
and 0 in the intervention group compared with 10 (25%), 0, and 0 in the
control group, respectively (P = 0.005). The decrease in AKI was
independent of the effect of concomitant aortic valve replacement and
cross-clamp times, which were distributed unevenly between the 2 groups.
Limitations: Retrospective analysis of data. More patients in the RIPC
group underwent concomitant aortic valve replacement with CABG; although
we have corrected statistically for this imbalance, it remains an
important confounding variable. Conclusions: RIPC induced using transient
forearm ischemia decreased the incidence of AKI in nondiabetic patients
undergoing elective CABG surgery in this retrospective analysis. A large
prospective clinical trial is required to study this effect and clinical
outcomes in patients undergoing cardiac surgery. 2010 by the National
Kidney Foundation, Inc.
<6>
Accession Number
2012395204
Authors
Takagi H. Yamamoto H. Iwata K. Goto S.-N. Umemoto T.
Institution
(Takagi, Yamamoto, Iwata, Goto, Umemoto) Department of Cardiovascular
Surgery, Shizuoka Medical Center, 762-1 Nagasawa, Shimizu-cho, Sunto-gun,
Shizuoka 411-8611, Japan
Title
Ask not which can impair early morbidity - Ask which can improve late
survival: A meta-analysis of randomized trials of off-pump versus on-pump
coronary artery bypass.
Source
International Journal of Cardiology. 158 (3) (pp 435-438), 2012. Date of
Publication: 26 Jul 2012.
Publisher
Elsevier Ireland Ltd (P.O. Box 85, Limerick, Ireland)
<7>
Accession Number
2012399809
Authors
Newman M.F. Ferguson T.B. White J.A. Ambrosio G. Koglin J. Nussmeier N.A.
Pearl R.G. Pitt B. Wechsler A.S. Weisel R.D. Reece T.L. Lira A. Harrington
R.A.
Institution
(Newman, White, Reece, Harrington) Duke Clinical Research Institute, Duke
University Medical Center, Durham, NC, United States
(Ferguson) Department of Cardiovascular Sciences, East Carolina Heart
Institute, Greenville, NC, United States
(Ambrosio) University of Perugia School of Medicine, Perugia, Italy
(Koglin, Lira) Merck Sharp and Dohme Corp., Whitehouse Station, NJ, United
States
(Nussmeier) SUNY Upstate Medical University, Syracuse, NY, United States
(Pearl) Stanford University School of Medicine, Palo Alto, CA, United
States
(Pitt) University of Michigan School of Medicine, Ann Arbor, MI, United
States
(Wechsler) Drexel University College of Medicine, Philadelphia, PA, United
States
(Weisel) University Health Network, Toronto, ON, Canada
Title
Effect of adenosine-regulating agent acadesine on morbidity and mortality
associated with coronary artery bypass grafting: The RED-CABG randomized
controlled trial.
Source
JAMA - Journal of the American Medical Association. 308 (2) (pp 157-164),
2012. Date of Publication: 11 Jul 2012.
Publisher
American Medical Association (515 North State Street, Chicago IL 60654,
United States)
Abstract
Context: Ischemia/reperfusion injury remains an important cause of
morbidity and mortality after coronary artery by pass graft (CABG)
surgery. In a meta-analysis of randomized controlled trials, perioperative
and postoperative infusion of acadesine,afirst-in-class adenosine
regulating agent, was associated with a reduction in early cardiac death,
myocardial infarction, and combined adverse cardiac outcomes in
participants undergoing on-pump CABG surgery. Objective: To assess the
efficacy and safety of acadesine administered in the perioperative period
in reducing all-cause mortality, nonfatal stroke, and severe left
ventricular dysfunction (SLVD) through 28 days. Design, Setting, and
Participants: The Reduction in Cardiovascular Events by Acadesine in
Patients Undergoing CABG (RED-CABG) trial, a randomized, double-blind,
placebo-controlled, parallel-group evaluation of intermediate- to
high-risk patients (median age, 66 years) undergoing nonemergency, on-pump
CABG surgery at 300 sites in 7 countries. Enrollment occurred from May 6,
2009, to July 30, 2010. Interventions: Eligible participants were
randomized 1:1 to receive acadesine (0.1 mg/kg per minute for 7 hours) or
placebo (both also added to cardioplegic solutions) beginning just before
anesthesia induction. Main Outcome Measure: Composite of all-cause
mortality, nonfatal stroke, or need for mechanical support for SLVD during
and following CABG surgery through postoperative day 28. Results: Because
results of a prespecified futility analysis indicated a very low
likelihood of a statistically significant efficacious outcome, the trial
was stopped after 3080 of the originally projected 7500 study participants
were randomized. The primary outcome occurred in 75 of 1493 participants
(5.0%) in the placebo group and 76 of 1493 (5.1%) in the acadesine group
(odds ratio, 1.01 [95% CI, 0.73-1.41]). There were no differences in key
secondary end points measured. Conclusion: In this population of
intermediate- to high-risk patients undergoing CABG surgery, acadesine did
not reduce the composite of all-cause mortality, nonfatal stroke, or SLVD.
Trial Registration: clinicaltrials.gov Identifier: NCT00872001. 2012
American Medical Association. All rights reserved.
<8>
Accession Number
2012387181
Authors
Zaman M. Bilal H. Mahmood S. Tang A.
Institution
(Zaman, Mahmood) School of Medicine, University of Liverpool, Liverpool,
United Kingdom
(Bilal, Tang) Department of Cardiothoracic Surgery, Blackpool Victoria
Hospital, Blackpool, United Kingdom
Title
Does getting smokers to stop smoking before lung resections reduce their
risk?.
Source
Interactive Cardiovascular and Thoracic Surgery. 14 (3) (pp 320-323),
2012. Date of Publication: March 2012.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
A best-evidence topic in thoracic surgery was written according to a
structured protocol. The question of whether the incidence of major
pulmonary morbidity after lung resection was associated with the timing of
smoking cessation was addressed. Overall 49 papers were found using the
reported search outlined below, of which 7 represented the best evidence
to answer the clinical question. The authors, journal, date and country of
publication, patient group studied, study type, relevant outcomes and
results of these papers are tabulated. In most studies, smoking abstinence
was shown to reduce the incidence of post-operative pulmonary
complications (PPCs) such as pneumonia, respiratory distress, atelectasis,
air leakage, bronchopleural fistula and re-intubation. The timing of
cessation is not clearly identified, although there is some evidence
showing reduction in risk of PPCs with increasing interval since
cessation. Two studies suggested that smoking abstinence for at least 4
weeks prior to surgery was necessary in order to reduce the incidence of
major pulmonary events. Furthermore, it was also shown that a
pre-operative smoke-free period of >10 weeks produced complication rates
similar to those of patients who had never smoked. We conclude that
smoking cessation reduces the risk of PPCs. All patients should be advised
and counseled to stop smoking before any form of lung resection. The
Author 2012.
<9>
Accession Number
2012387179
Authors
Girsowicz E. Falcoz P.-E. Santelmo N. Massard G.
Institution
(Girsowicz, Falcoz, Santelmo, Massard) Department of Thoracic Surgery,
University Hospital, 1 Place de l'Hopital, 67091 Strasbourg Cedex, France
Title
Does surgical stabilization improve outcomes in patients with isolated
multiple distracted and painful non-flail rib fractures?.
Source
Interactive Cardiovascular and Thoracic Surgery. 14 (3) (pp 312-315),
2012. Date of Publication: March 2012.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
A best evidence topic was constructed according to a structured protocol.
The question addressed was whether surgical stabilization is effective in
improving the outcomes of patients with isolated multiple distracted and
painful non-flail rib fractures. Of the 356 papers found using a report
search, nine presented the best evidence to answer the clinical question.
The authors, journal, date and country of publication, study type, group
studied, relevant outcomes and results of these papers are given. We
conclude that, on the whole, the nine retrieved studies clearly support
the use of surgical stabilization in the management of isolated multiple
non-flail and painful rib fractures for improving patient outcomes. The
interest and benefit was shown not only in terms of pain (McGill pain
questionnaire) and respiratory function (forced vital capacity, forced
expiratory volume in 1 s and carbon monoxide diffusing capacity), but also
in improved quality of life (RAND 36-Item Health Survey) and reduced
socio-professional disability. Indeed, most of the authors justified
surgical management based on the fact that the results of surgical
stabilization showed improvement in short- and long-term patient outcomes,
with fast reduction in pain and disability, as well as lower average wait
before recommencing normal activities. Hence, the current evidence shows
surgical stabilization to be safe and effective in alleviating
post-operative pain and in improving patient recovery, thus enhancing the
outcome after isolated multiple rib fractures. However, given the little
published evidence, prospective trials are necessary to confirm these
encouraging results. The Author 2012.
<10>
Accession Number
2012387178
Authors
Sepehripour A.H. Nasir A. Shah R.
Institution
(Sepehripour, Nasir, Shah) Department of Cardiothoracic Surgery,
Wythenshawe Hospital, Southmoor Road, Manchester M23 9LT, United Kingdom
Title
Does mechanical pleurodesis result in better outcomes than chemical
pleurodesis for recurrent primary spontaneous pneumothorax?.
Source
Interactive Cardiovascular and Thoracic Surgery. 14 (3) (pp 307-311),
2012. Date of Publication: March 2012.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
A best-evidence topic was written according to a structured protocol. The
question addressed was whether mechanical pleurodesis results in better
outcomes in comparison with chemical pleurodesis in patients undergoing
surgery for recurrent primary spontaneous pneumothorax. A total of 542
papers were found using the reported searches, of which 6 represented the
best evidence to answer the clinical question. The authors, date, journal,
study type, population, main outcome measures and results are tabulated.
The studies found compared the outcomes of mechanical and chemical
pleurodesis and also focused on the outcomes of the different methods of
mechanical pleurodesis: pleural abrasion and pleurectomy. Reported
measures were operative mortality, mean operation time, post-operative
bleeding, persistent air leaks, chest drain duration, pain levels,
pneumonia, respiratory failure, wound infection, pulmonary function,
re-exploration for bleeding and air leak, hospital stay, recurrence and
re-operation for recurrence. One large cohort study compared the outcomes
of mechanical and chemical talc pleurodesis and reported a significant
reduction in recurrence with talc pleurodesis in comparison with
pleurectomy (1.79 vs. 9.15%, P = 0.00018). Another large cohort study,
analysing pleural abrasion, pleurectomy and talc pleurodesis, both in
isolation and in combination with apical bullectomy, reported the highest
rate of recurrence in bullectomy plus abrasion patients (1.4%) followed by
bullectomy plus talc pleurodesis patients (0.4%). No recurrence was seen
with other techniques. The reported freedom from surgery at 10-year
follow-up was 98.9% with talc pleurodesis, 97.5% with pleurectomy and
96.4% with pleural abrasion, however, with no statistical significance. A
prospective randomized study, a retrospective case series review and two
smaller cohort studies compared the outcomes of pleural abrasion and
pleurectomy as different techniques of mechanical pleurodesis and reported
statistically significant shorter operation times, lower rates of
post-operative bleeding, re-exploration and pain observed with pleural
abrasion and lower rates of recurrence with pleurectomy. Three studies
reported the outcomes of apical bullectomy or wedge resection with
recurrence rates ranging from 0.4 to 6.2%. We conclude that there is a
very similar outcome profile in the comparison of mechanical and chemical
pleurodesis, with modest evidence suggesting lower rates of recurrence
with chemical talc pleurodesis. The Author 2012.
<11>
Accession Number
2012394165
Authors
Ruddox V. Mathisen M. Otterstad J.E.
Institution
(Ruddox, Otterstad) Department of Cardiology, Vestfold Hospital Trust,
Tonsberg, Norway
(Mathisen) Medical Libraries, Vestfold Hospital Trust, Tonsberg, Norway
Title
Prevalence and prognosis of non-specific chest pain among patients
hospitalized for suspected acute coronary syndrome - a systematic
literature search.
Source
BMC Medicine. 10 , 2012. Article Number: 58. Date of Publication: 12 Jun
2012.
Publisher
BioMed Central Ltd. (Floor 6, 236 Gray's Inn Road, London WC1X 8HB, United
Kingdom)
Abstract
Background: The term non-specific chest pain (NSCP) is applied to
hospitalized patients in order to designate that they neither have an
acute coronary syndrome (ACS) nor display evidence of a coronary ischemia.
The number of NSCP patients is increasing and comprehensive guidelines
specifying their optimal management have not yet been introduced. The
objective of this review was to explore the prevalence and prognosis of
NSCP versus ACS among patients recruited in consecutive series
hospitalized for chest pain suspected to be ACS.Methods: This is a
systematic literature search where three databases were searched from 1990
to 14 November 2011. In addition, one database was searched for Epub ahead
of print per 24 March 2012. Three inclusion criteria were applied: 1.
documentation of an unselected consecutive series of patients admitted for
chest pain, where this review is based upon two groups of patients defined
as follows: a) 'ACS/high-risk' and b) NSCP; 2. at least 100 cases with
NSCP; and 3. follow-up of hospital readmissions and mortality for at least
six months.Results: A total of 2,204 citations were screened after removal
of duplicates. Out of 80 full text articles assessed for eligibility 12
studies were included, comprising 24,829 patients (inter-study range 250
to 13,762), with 11,008 (44%) categorized as NSCP and 13,821 (56%) as
'ACS/high-risk'. The mean one-year total mortality rate among patients
with NSCP in nine studies was 3.2% (inter-study range 1.4% to 8.1%), with
the highest mortality among patients with pre-existing coronary heart
disease (CHD). The mean one-year mortality rate among 'ACS/high-risk'
patients was 18.0% (inter-study range 14.0% to 19.9%) in four studies with
available data. In six studies the mean one-year readmission rate for
patients with NSCP was 17.5% (inter-study range 2.5% to 40%).Conclusions:
Patients with NSCP represent a large, heterogeneous and important group.
Due to co-existing CHD in nearly 40% of these patients, their prognosis is
not necessarily benign. Although their average one-year mortality rate was
almost six times lower than those with 'ACS/high-risk', the subset with
concomitant CHD had a relatively poor prognosis when compared with NSCP
patients without evidence of CHD. 2012 Ruddox et al; licensee BioMed
Central Ltd.
<12>
Accession Number
22219462
Authors
Goudie E. Bah I. Khereba M. Ferraro P. Duranceau A. Martin J. Thiffault V.
Liberman M.
Institution
(Goudie) Department of Surgery, Division of Thoracic Surgery, University
of Montreal, Montreal, Quebec, Canada.
Title
Prospective trial evaluating sonography after thoracic surgery in
postoperative care and decision making.
Source
European journal of cardio-thoracic surgery : official journal of the
European Association for Cardio-thoracic Surgery. 41 (5) (pp 1025-1030),
2012. Date of Publication: May 2012.
Abstract
Following thoracic surgery, daily chest X-rays (CXRs) are performed to
assess patient evolution and to make decisions regarding chest tube
removal and patient discharge. Sonography after thoracic surgery (SATS)
has the potential to be an effective, convenient, inexpensive and easy to
learn tool in the post-operative management of thoracic surgery patients.
We hypothesized that SATS could alleviate the need for repetitive CXRs,
thus reducing the related risks, costs and inconvenience. This study
consisted of a prospective cohort trial. All patients scheduled to undergo
thoracic surgery at a single academic medical centre were eligible.
Post-operative bedside pleural ultrasound was performed whenever a CXR was
ordered by the treating team. Investigators specifically assessed patients
with the goals of identifying pleural effusions and pneumothoraces. Study
investigators were blinded to CXR results. SATS findings were compared
with CXRs, which were considered the gold standard in routine
post-operative pleural space evaluation. One hundred and twenty patients
were prospectively enrolled over a 5.5-month period. Three hundred and
fifty-two ultrasound examinations were performed (mean = 3.0 +/- 2.4 exams
per patient). The time interval between the ultrasound and the comparative
CXR was 166 +/- 149 min. The mean time required to perform SATS was 11 +/-
6 min per exam. In the detection of pleural effusion, SATS yielded a
sensitivity of 83.1% and a specificity of 59.3%. In the detection of
pneumothoraces, a sensitivity of 21.2% and a specificity of 94.7% were
obtained. Post-operative ultrasound may alleviate the need to perform
routine CXR in patients with a previously ruled out pneumothorax. SATS
used selectively may be able to reduce the number of routine CXRs
performed; however, it does not have high enough accuracy to replace CXRs.
<13>
Accession Number
2012391685
Authors
Gijsen V.M.G.J. Madadi P. Dube M.-P. Hesselink D.A. Koren G. de Wildt S.N.
Institution
(Gijsen, Madadi, Koren) Division of Clinical Pharmacology and Toxicology,
Hospital for Sick Children, Toronto, ON, Canada
(Gijsen, de Wildt) Department of Pediatric Surgery and Intensive Care,
Erasmus MC Sophia Children's Hospital, Rotterdam, Netherlands
(Dube) Montreal Heart Institute Research Centre, Montreal, QC, Canada
(Dube) Department of Medicine, Universite de Montreal, Montreal, QC,
Canada
(Hesselink) Department of Internal Medicine, Division of Nephrology and
Renal Transplantation, Erasmus MC, Rotterdam, Netherlands
Title
Tacrolimus-induced nephrotoxicity and genetic variability: A review.
Source
Annals of Transplantation. 17 (2) (pp 111-121), 2012. Date of Publication:
2012.
Publisher
Medical Science International (ul. Ustrzycka 11, Warsaw 02-141, Poland)
Abstract
Background: Calcineurin inhibition (CNI) is the mainstay of
immunosuppressant therapy for most solid organ transplant patients. High
tacrolimus levels are related with acute nephrotoxicity, but the
relationship with chronic toxicity is less clear. Variation in disposition
of tacrolimus is associated with genetic variation in CYP3A5. Hence, could
genetic variation in CYP3A5 or other genes involved in tacrolimus
disposition and effect be associated with a risk for tacrolimus-induced
nephrotoxicity? To perform a review of the literature and to identify if
genetic variation in CYP3A5 or other genes involved in tacrolimus
disposition or effect may be associated with tacrolimus-induced
nephrotoxicity and/or renal dysfunction in solid organ transplant
recipients. Material/Methods: Pubmed/Medline, Embase and Google were
searched from their inception till November 8<sup>th</sup> 2010 with the
search terms 'tacrolimus', 'genetics', and 'nephrotoxicity' or 'renal
dysfunction'. References of relevant articles were screened as well.
Results: We identified 13 relevant papers. In kidney recipients,
associations between donor ABCB1, recipient CCR5 genotype and
tacrolimus-induced nephrotoxicity were found. CYP3A5 genotype studies in
kidney recipients yielded contradictory results. In liver recipients, a
possible association between recipient ACE, CYP3A5, ABCB1 and CYP2C8
genetic polymorphisms and tacrolimus-induced nephrotoxicity was suggested.
In heart recipients, TGF-beta genetic polymorphisms were associated with
tacrolimus-induced nephrotoxicity. The quality of the studies varied
considerably. Conclusions: Limited evidence suggests that variation in
genes involved in pharmacokinetics (ABCB1 and CYP3A5) and pharmacodynamics
(TGF-beta, CYP2C8, ACE, CCR5) of tacrolimus may impact a transplant
recipients' risk to develop tacrolimus-induced nephrotoxicity across
different transplant organ groups. Ann Transplant, 2012.
<14>
Accession Number
2012385835
Authors
O'Donoghue M.L. Vaidya A. Afsal R. Alfredsson J. Boden W.E. Braunwald E.
Cannon C.P. Clayton T.C. De Winter R.J. Fox K.A.A. Lagerqvist B.
McCullough P.A. Murphy S.A. Spacek R. Swahn E. Windhausen F. Sabatine M.S.
Institution
(O'Donoghue, Braunwald, Cannon, Murphy, Sabatine) TIMI Study Group,
Cardiovascular Division, Brigham and Women's Hospital, 350 Longwood
Avenue, Boston, MA 02115, United States
(Vaidya) Cardiovascular Division, University of California, San Francisco,
San Francisco, CA, United States
(Afsal) Department of Medicine, Hamilton Health Sciences, McMaster
University, Hamilton, ON, Canada
(Alfredsson, Swahn) Department of Cardiology, Linkoping University,
University Hospital, Linkoping, Sweden
(Boden) Department of Medicine, Albany Stratton VA Medical Center, Albany,
NY, United States
(Clayton) London School of Hygiene and Tropical Medicine, London, United
Kingdom
(De Winter, Windhausen) Academic Medical Center, Amsterdam, Netherlands
(Fox) University and Royal Infirmary of Edinburgh, Edinburgh, United
Kingdom
(Lagerqvist) Uppsala University Hospital, Uppsala, Sweden
(McCullough) St. John Providence Health System Providence Park Heart
Institute, Novi, MI, United States
(Spacek) Third Medical Faculty Prague, Prague, Czech Republic
Title
An invasive or conservative strategy in patients with diabetes mellitus
and non-ST-segment elevation acute coronary syndromes: A collaborative
meta-analysis of randomized trials.
Source
Journal of the American College of Cardiology. 60 (2) (pp 106-111), 2012.
Date of Publication: 10 Jul 2012.
Publisher
Elsevier USA (6277 Sea Harbor Drive, Orlando FL 32862 8239, United States)
Abstract
Objectives: The purpose of this study was to conduct a meta-analysis to
examine an invasive or conservative strategy in diabetic versus
nondiabetic patients. Background: Diabetic patients are at increased risk
of cardiovascular events after an acute coronary syndrome, yet it remains
unknown whether they derive enhanced benefit from an invasive strategy.
Methods: Randomized trials comparing an invasive versus conservative
treatment strategy were identified. The prevalence of cardiovascular
events through 12 months was reported for each trial, stratified by
diabetes mellitus status and randomized treatment strategy. Relative risk
(RR) ratios and absolute risk reductions were combined using
random-effects models. Results: Data were combined across 9 trials
comprising 9,904 subjects of whom 1,789 (18.1%) had diabetes mellitus. The
RRs for death, nonfatal myocardial infarction (MI), or rehospitalization
with an acute coronary syndrome for an invasive versus conservative
strategy were similar between diabetic patients (RR: 0.87; 95% confidence
interval [CI]: 0.73 to 1.03) and nondiabetic patients (RR: 0.86; 95% CI:
0.70 to 1.06; p interaction = 0.83). An invasive strategy reduced nonfatal
MI in diabetic patients (RR: 0.71; 95% CI: 0.55 to 0.92), but not in
nondiabetic patients (RR: 0.98; 95% CI: 0.74 to 1.29; p interaction =
0.09). The absolute risk reduction in MI with an invasive strategy was
greater in diabetic than nondiabetic patients (absolute risk reduction:
3.7% vs. 0.1%; p interaction = 0.02). There were no differences in death
or stroke between groups (p interactions 0.68 and 0.20, respectively).
Conclusions: An early invasive strategy yielded similar RR reductions in
overall cardiovascular events in diabetic and nondiabetic patients.
However, an invasive strategy appeared to reduce recurrent nonfatal MI to
a greater extent in diabetic patients. These data support the updated
guidelines that recommend an invasive strategy for patients with diabetes
mellitus and non-ST-segment elevation acute coronary syndromes. 2012
American College of Cardiology Foundation.
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