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<1>
Accession Number
2012453140
Authors
Benyamin R.M. Wang V. Vallejo R. Singh V. Helm S.
Institution
(Benyamin, Vallejo) Millennium Pain Center, Bloomington, IL, United States
(Benyamin, Vallejo) University of Illinois, Urbana-Champaign, IL, United
States
(Wang) University of Illinois School of Medicine, Urbana, IL, United
States
(Vallejo) Illinois State University, United States
(Singh) Illinois State University, Normal, IL, United States
(Helm) The Helm Center for Pain Management, Laguna Hills, CA, United
States
Title
A systematic evaluation of thoracic interlaminar epidural injections.
Source
Pain Physician. 15 (4) (pp E497-E514), 2012. Date of Publication:
July/August 2012.
Publisher
American Society of Interventional Pain Physicians (Pain Physicians, 81
Lakeview Drive, Paducah KY 42001, United States)
Abstract
Background: There is a paucity of literature on the use of epidural
injections for the treatment of chronic mid and upper back pain due to
disc herniation and radiculitis, axial or discogenic pain, spinal
stenosis, post surgery syndrome, and post thoracotomy pain syndrome. Study
Design: A systematic review of therapeutic thoracic epidural injection
therapy for chronic mid and upper back pain. Objective: The objective of
this systematic review is to determine the effects of thoracic
interlaminar epidural injections with or without steroids, with or without
fluoroscopy, and for various conditions including disc herniation and
radiculitis, axial or discogenic pain, spinal stenosis, post thoracic
surgery syndrome, and post thoracotomy pain syndrome. Methods: The
available literature on thoracic interlaminar epidural injections with or
without steroids in managing various types of chronic mid and upper back
pain was reviewed. The quality assessment and clinical relevance criteria
utilized were the Cochrane Musculoskeletal Review Group criteria as
utilized for interventional techniques for randomized trials and the
criteria developed by the Newcastle-Ottawa Scale criteria for
observational studies. The level of evidence was classified as good, fair,
or limited (or poor) based on the quality of evidence developed by the
U.S. Preventive Services Task Force (USPSTF). Data sources included
relevant literature identified through searches of PubMed and EMBASE from
1966 to March 2012, and manual searches of the bibliographies of known
primary and review articles. Outcome Measures: The primary outcome measure
was pain relief (short-term relief = up to 6 months and long-term > 6
months). Secondary outcome measures were improvement in functional status,
psychological status, return to work, and reduction in opioid intake.
Results: For this review, 17 studies were identified, including studies
examining adverse reactions. Only 2 studies were included: one randomized
trial and one non-randomized or observational study. The results of this
systematic review evaluating the effectiveness of thoracic epidural
injections with or without steroids in managing chronic thoracic pain
shows fair evidence with one randomized trial in patients with various
causes; whereas the evidence is limited based on one non-randomized study
evaluating chronic pain in post thoracotomy syndrome. Limitations: The
limitations of this study include paucity of evidence. Conclusion: The
evidence based on this systematic review for thoracic epidural injection
in treating chronic thoracic pain is considered fair and limited for post
thoracotomy pain.

<2>
Accession Number
22563215
Authors
Oh S.W. Chin H.J. Chae D.W. Na K.Y.
Institution
(Oh, Chin, Chae, Na) Division of Nephrology, Seoul National University
Bundang Hospital, Seongnam, South Korea
(Chin, Chae, Na) Department of Internal Medicine, Seoul National
University College of Medicine, Seoul, South Korea
Title
Erythropoietin improves long-term outcomes in patients with acute kidney
injury after coronary artery bypass grafting.
Source
Journal of Korean Medical Science. 27 (5) (pp 506-511), 2012. Date of
Publication: May 2012.
Publisher
Korean Academy of Medical Science (302-75 Dong bu Ichon-dong, Yongsan-ku,
Seoul 140-031, South Korea)
Abstract
Previous studies reported the beneficial effect of erythropoietin (EPO) in
acute injuries. We followed patients with and without acute kidney injury
(AKI) after coronary artery bypass grafting (CABG) and evaluated the
effect of EPO on long-term outcome. We also assessed the efficacy of
urinary neutrophil gelatinase-associated lipocalin (uNGAL) as a predictive
marker of AKI. Seventy-one patients scheduled for elective CABG were
randomly given either 300 U/kg of EPO or saline before CABG. The primary
outcome was AKI, and the secondary outcome was the all-cause-mortality and
composite of all-cause-mortality and end stage renal disease (ESRD).
Twenty-one patients had AKI, 14 (66.7%) in the placebo group and 7 (33.3%)
in the EPO group (P = 0.05). Also, uNGAL was higher in the patients with
AKI than in those without AKI at baseline, 2, 4, 24, and 72 hr after CABG
(P = 0.011). Among patients with AKI, 2-week creatinine (Cr) was not
different from baseline Cr in the EPO group, but 2-week Cr was
significantly higher than baseline Cr in the placebo group (P = 0.009).
All-cause-mortality (P = 0.022) and the composite of all-cause-mortality
and ESRD (P = 0.003) were reduced by EPO. EPO reduces all-cause-mortality
and ESRD in patients with AKI, largely due to the beneficial effect of EPO
on recovery after AKI. 2012 The Korean Academy of Medical Sciences.

<3>
Accession Number
2012499251
Authors
Geng D.-F. Liu M. Jin D.-M. Wu W. Deng J. Wang J.-F.
Institution
(Geng, Deng, Wang) Departments of Cardiology, Sun Yat-sen Memorial
Hospital, Sun Yat-sen University, No.107 West Yanjiang Road, Guangzhou
510120, China
(Liu) Departments of Stomatology, Sun Yat-sen Memorial Hospital, Sun
Yat-sen University, Guangzhou, China
(Jin) Departments of Rehabilitation Medicine, Sun Yat-sen Memorial
Hospital, Sun Yat-sen University, Guangzhou, China
(Wu) Department of Cardiology, Fifth Affiliated Hospital, Sun Yat-sen
University, Zhuhai, China
Title
Cilostazol-based triple antiplatelet therapy compared to dual antiplatelet
therapy in patients with coronary stent implantation: A meta-analysis of
5,821 patients.
Source
Cardiology (Switzerland). 122 (3) (pp 148-157), 2012. Date of Publication:
August 2012.
Publisher
S. Karger AG (Allschwilerstrasse 10, P.O. Box, Basel CH-4009, Switzerland)
Abstract
Background: Uncertainties still remain in terms of what kinds of patients
benefit most from cilostazol-based triple antiplatelet therapy (TAT) after
coronary stenting. Methods: We performed a meta-analysis of all relevant
randomized controlled trials (RCTs) to investigate the effect of TAT
versus dual antiplatelet therapy (DAT) in terms of major adverse
cardiovascular events (MACEs) in patients undergoing coronary stenting.
Results: Fourteen RCTs with 5,821 patients were included in this study.
TAT was associated with a significant reduction in the risk of MACEs
compared to DAT [9.2 vs. 13.4%; odds ratio 0.59 (0.46, 0.76)] with
consistent benefits among patients with diabetes, long lesions and small
vessels. There were no significant between-group differences in the risk
of cardiac death, myocardial infarction, stent thrombosis and bleeding
events; however, the risk of target lesion revascularization was
significantly lower in the TAT group. TAT resulted in borderline
significant reduction in the risk of cardiovascular thrombotic events in
unselected patients and significant decrease in patients with acute
coronary syndrome [odds ratio 0.51 (0.27, 0.94)]. Conclusion: Under the
treatment of standard DAT, the addition of cilostazol is an effective and
relatively safe strategy in preventing MACEs after coronary stenting,
especially for patients at high risk of restenosis or clinical events.
2012 S. Karger AG, Basel.

<4>
Accession Number
2012492806
Authors
Klug G. Mayr A. Schenk S. Esterhammer R. Schocke M. Nocker M. Jaschke W.
Pachinger O. Metzler B.
Institution
(Klug, Schenk, Nocker, Pachinger, Metzler) Cardiology, University Clinic
of Internal Medicine III, Medical University Innsbruck, Innsbruck, Austria
(Mayr, Esterhammer, Schocke, Jaschke) Department of Radiology i, Medical
University Innsbruck, Innsbruck, Austria
Title
Prognostic value at 5 years of microvascular obstruction after acute
myocardial infarction assessed by cardiovascular magnetic resonance.
Source
Journal of Cardiovascular Magnetic Resonance. 14 (1) , 2012. Article
Number: 46. Date of Publication: 2012.
Publisher
BioMed Central Ltd. (Floor 6, 236 Gray's Inn Road, London WC1X 8HB, United
Kingdom)
Abstract
Background: Early and late microvascular obstruction (MVO) assessed by
cardiovascular magnetic resonance (CMR) are prognostic markers for
short-term clinical endpoints after acute ST-elevation myocardial
infarction (STEMI). However, there is a lack of studies with long-term
follow-up periods (>24months). Methods. STEMI patients reperfused by
primary angioplasty (n=129) underwent MRI at a median of 2days after the
index event. Early MVO was determined on dynamic Gd first-pass images
directly after the administration of 0.1mmol/kg bodyweight Gd-based
contrast agent. Furthermore, ejection fraction (EF, %), left ventricular
myocardial mass (LVMM) and total infarct size (% of LVMM) were determined
with CMR. Clinical follow-up was conducted after a median of 52months. The
primary endpoint was defined as a composite of death, myocardial
re-infarction, stroke, repeat revascularization, recurrence of ischemic
symptoms, atrial fibrillation, congestive heart failure and
hospitalization. Results: Follow-up was completed by 107 patients. 63
pre-defined events occurred during follow-up. Initially, 74 patients
showed early MVO. Patients with early MVO had larger infarcts (mean: 24.9g
vs. 15.5g, p=0.002) and a lower EF (mean: 39% vs. 46%, p=0.006). The
primary endpoint occurred in 66.2% of patients with MVO and in 42.4% of
patients without MVO (p<0.05). The presence of early MVO was associated
with a reduced event-free survival (log-rank p<0.05). Early MVO was
identified as the strongest independent predictor for the occurrence of
the primary endpoint in the multivariable Cox regression analysis
adjusting for age, ejection fraction and infarct size (hazard ratio: 2.79,
95%-CI 1.25-6.25, p=0.012). Conclusion: Early MVO, as assessed by
first-pass CMR, is an independent long-term prognosticator for morbidity
after AMI. 2012 Klug et al.; licensee BioMed Central Ltd.

<5>
Accession Number
2012495214
Authors
Sharif F. Shoul A. Janati M. Kojuri J. Zare N.
Institution
(Sharif) Mental Health Nursing Department, Community Based Nursing and
Midwifery Research Center, Faculty of Nursing and Midwifery, Shiraz
University of Medical Sciences, Shiraz, Iran, Islamic Republic of
(Shoul) Faghihi Hospital, Cardiac Surgery Unit, Shiraz University of
Medical Sciences, Shiraz, Iran, Islamic Republic of
(Janati) Department of Surgery, Shiraz University of Medical Sciences,
Shiraz, Iran, Islamic Republic of
(Kojuri) Department of Internal Medicine, Shiraz University of Medical
Sciences, Shiraz, Iran, Islamic Republic of
(Zare) Department of Biostatistics, Shiraz University of Medical Sciences,
Shiraz, Iran, Islamic Republic of
(Sharif) Department of Psychiatric and Mental Health Nursing, Shiraz
University of Medical Sciences, Shiraz, Iran, Islamic Republic of
Title
The effect of cardiac rehabilitation on anxiety and depression in patients
undergoing cardiac bypass graft surgery in Iran.
Source
BMC Cardiovascular Disorders. 12 , 2012. Article Number: 40. Date of
Publication: 08 Jun 2012.
Publisher
BioMed Central Ltd. (Floor 6, 236 Gray's Inn Road, London WC1X 8HB, United
Kingdom)
Abstract
Background: Many patients experience anxiety and depression after cardiac
bypass surgery.The aim of this study was to examine the effect of cardiac
rehabilitation on anxiety and depression in patients undergoing coronary
artery bypass grafting in hospitals affiliated to Shiraz University of
Medical Sciences in southern Iran.Methods: For this randomized controlled
trial, 80 patients who met the inclusion criteria were recruited and
randomly assigned to case and control groups. Anxiety was measured with
the Spielberger Anxiety Scale and depression was measured using Beck's
Depression Inventory at three points in time: on discharge from the
hospital, immediately after the intervention, and 2 months after cardiac
rehabilitation. After measuring anxiety and depression in both groups upon
discharge, the experimental group participated in 8 cardiac rehabilitation
sessions over a 4-week period. The control group received only the routine
follow-up care.Results: There was a statistically significant difference
in depression scores between groups at all three time-points (Mean score
from 19.6 to 10 in the intervention group and from 19.5 to 14 in the
control group, P = 0.0014). However, no significant difference was seen in
anxiety scores between the groups (Mean score from 37 to 28 in the
intervention group and from 38 to 32 in the control group, P =
0.079).Conclusions: Cardiac rehabilitation was effective in reducing
depression 2 months after surgery in patients undergoing coronary artery
bypass grafting.Trial registration: IRCTN201203262812N8. 2012 Sharif et
al.; licensee BioMed Central Ltd.

<6>
Accession Number
2012499093
Authors
Mookadam F. Thota V.R. Garcia-Lopez A.M. Emani U.R. Alharthi M.S. Zamorano
J. Khandheria B.K.
Institution
(Mookadam, Thota, Garcia-Lopez, Emani, Alharthi, Zamorano, Khandheria)
Cardiovascular Disease and Internal Medicine, Mayo Clinic Arizona, 13400 E
Shea Blvd., Scottsdale, AZ 85259-5499, United States
Title
Unicuspid aortic valve in adults: A systematic review.
Source
Journal of Heart Valve Disease. 19 (1) (pp 79-85), 2010. Date of
Publication: January 2010.
Publisher
ICR Publishers Ltd (12/A South Approach, Moor Park, Northwood HA6 2ET,
United Kingdom)
Abstract
Background and aim of the study: The natural history of the unicuspid
aortic valve (UAV) is poorly described in the literature. In order to
study the association between UAV with any other cardiac or extra cardiac
abnormalities, an evidence-based systematic review was carried out.
Methods: A computerized search was carried out of the medical literature
published between 1st January 1966 and 1st September 2008 of the following
databases: MEDLINE; EMBASE; Web of Science; and the Cochrane Database.
Results: A total of 231 cases of adult UAV was identified in 38 articles.
The mean patient age was 42 years, and the most common presenting symptoms
reported (in 52 cases) included dyspnea (44%; n = 23), angina (21%; n =
11), and dizziness or syncope (8%; n = 4). The most common lesion in UAV
was isolated aortic stenosis (AS) (41%; n = 95) and AS with or without
aortic regurgitation (28%; n = 64). The preoperative diagnosis of UAV is
rare, and 139 cases (60%) of UAV were reported at autopsy or by
examination of surgically excised valves. Aortic valve replacement was
performed in 166 cases (82%). Concomitant aortic surgery was performed in
47 of the UAV cases (23%), either for a dilated or aneurysmal aorta.
Conclusion: UAV shares many of the features of bicuspid aortic valve,
including valvular dysfunction, aortic dilatation, aortic dissection, and
dystrophic calcification, although these conditions develop at an earlier
age and progress at a faster pace in UAV. Further investigations are
warranted regarding the possibility of a familial incidence, associated
histopathological changes in the aorta, preoperative diagnostic tools,
ideal follow up and surgical intervention. Copyright by ICR Publishers
2010.

<7>
Accession Number
2012491861
Authors
Siebenhofer A. Hemkens L.G. Rakovac I. Spat S. Didjurgeit U.
Institution
(Siebenhofer) Institute for General Practice, Goethe University,
Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
(Hemkens) Stanford Prevention Research Center, Department of Medicine,
Stanford University School of Medicine, Stanford, CA 94305, United States
(Rakovac, Spat) HEALTH - Institute for Biomedicine and Health Sciences,
JOANNEUM RESEARCH Forschungsgesellschaft MbH, Graz, Austria
(Didjurgeit) DIeM, Institute for Evidence-based Medicine GmbH, Cologne,
Germany
Title
Self-management of oral anticoagulation in elderly patients - Effects on
treatment-related Quality of Life.
Source
Thrombosis Research. 130 (3) (pp e60-e66), 2012. Date of Publication:
September 2012.
Publisher
Elsevier Ltd (Langford Lane, Kidlington, Oxford OX5 1GB, United Kingdom)
Abstract
Background - rationale for study: In elderly patients, long-term
self-management of oral anticoagulation has been shown to reduce the
number of major thromboembolic and bleeding complications and improve the
quality of oral anticoagulation (OAC) control compared to routine care for
a mean follow-up period of three years. This article presents the results
of the predefined secondary endpoint treatment-related quality of life
(QoL). Methods and Results: The effect of self-management on five aspects
of QoL was evaluated in comparison with routine care. A validated
questionnaire specifically designed for patients receiving OAC was used.
The evaluation was possible for 141 patients, comprising 90% of surviving
patients on OAC. At baseline, all patients had high scores for the
following QoL-aspects: general treatment satisfaction, self-efficacy,
daily hassles and strained social network. A high proportion of patients
in both groups explicitly reported high distress, indicating that general
psychological distress seems to be of particular concern in this
population. After about 3 years of follow-up, patients performing
self-management showed a significantly greater improvement in general
treatment satisfaction than controls (median score increase [25th
percentile, 75th percentile]: 0.9 [0.0, 1.6] vs. 0.0 [- 0.2, 0.6], p =
0.002; scale 1-6). Changes in general psychological distress,
self-efficacy, daily hassles and strained social network were not
significant. Conclusion: Treatment related quality of life in elderly
patients performing self-management of OAC was similar as for patients in
routine care setting, with a tendency of higher general treatment
satisfaction, after three years of follow up. 2012 Elsevier Ltd.

<8>
Accession Number
2012494299
Authors
Ahmed M.I. Aban I. Lloyd S.G. Gupta H. Howard G. Inusah S. Peri K.
Robinson J. Smith P. McGiffin D.C. Schiros C.G. Denney Jr. T. Dell'Italia
L.J.
Institution
(Ahmed, Lloyd, Gupta, Robinson, Smith, Dell'Italia) Division of
Cardiology, Department of Medicine and Cardiovascular Disease, University
of Alabama at Birmingham, 901 19th Street South, 434 BMR2, Birmingham, AL
35294-2180, United States
(Aban, Howard, Inusah, Peri) Department of Biostatistics, University of
Alabama at Birmingham, Birmingham, AL, United States
(Lloyd, Gupta, Dell'Italia) Birmingham Veteran Affairs Medical Center,
Birmingham, AL, United States
(McGiffin) Department of Cardiovascular Surgery, University of Alabama at
Birmingham, Birmingham, AL, United States
(Schiros, Denney Jr.) Samuel Ginn College of Engineering, Auburn
University, Auburn, AL, United States
Title
A randomized controlled phase IIb trial of Beta1-receptor blockade for
chronic degenerative mitral regurgitation.
Source
Journal of the American College of Cardiology. 60 (9) (pp 833-838), 2012.
Date of Publication: 28 Aug 2012.
Publisher
Elsevier USA (6277 Sea Harbor Drive, Orlando FL 32862 8239, United States)
Abstract
The purpose of the study was to evaluate the effect of long-term
beta₁-aderergic receptor (AR) blockade on left ventricular (LV)
remodeling and function in patients with chronic, isolated, degenerative
mitral regurgitation (MR). Isolated MR currently has no proven therapy
that attenuates LV remodeling or preserves systolic function. Thirty-eight
asymptomatic subjects with moderate to severe, isolated MR were randomized
either to placebo or beta₁-AR blockade (Toprol-XL, AstraZeneca,
London, United Kingdom) for 2 years. Magnetic resonance imaging with
tissue tagging and 3-dimensional analysis was performed at baseline and at
6-month intervals for 2 years. Rate of progression analysis was performed
for endpoint variables for primary outcomes: LV end-diastolic volume/body
surface area, LV ejection fraction, LV end-diastolic (ED) mass/ED volume
ratio, LV ED 3-dimensional radius/wall thickness; LV end-systolic
volume/body surface area, LV longitudinal strain rate, and LV early
diastolic filling rate. Baseline LV magnetic resonance imaging or
demographic variables did not differ between the 2 groups. Significant
treatment effects were found on LV ejection fraction (p = 0.006) and LV
early diastolic filling rate (p = 0.001), which decreased over time in
untreated patients on an intention-to-treat analysis and remained
significant after sensitivity analysis. There were no significant
treatment effects found on LV ED or LV end-systolic volumes, LV ED mass/LV
ED volume or LV ED 3-dimensional radius/wall thickness, or LV longitudinal
strain rate. Over 2 years, 6 patients treated in the placebo group and 2
patients in the beta₁-AR blockade group required mitral valve
surgery (p = 0.23). beta₁-AR blockade improves LV function over
a 2-year follow-up in isolated MR and provides the impetus for a
large-scale clinical trial with clinical outcomes. (Molecular Mechanisms
of Volume Overload-Aim 1 [SCCOR in Cardiac Dysfunction and Disease];
NCT01052428) 2012 American College of Cardiology Foundation.

<9>
Accession Number
2012494302
Authors
Palmerini T. Biondi-Zoccai G. Reggiani L.B. Sangiorgi D. Alessi L. De
Servi S. Branzi A. Stone G.W.
Institution
(Palmerini, Reggiani, Sangiorgi, Alessi, Branzi) Istituto di Cardiologia,
Policlinico S. Orsola, Bologna, Italy
(Biondi-Zoccai) Department of Medico-Surgical Sciences and
Biotechnologies, Sapienza University of Rome, Latina, Italy, Italy
(De Servi) Dipartimento di Malattie Cardiovascolari, Ospedale Civile,
Legnano, Italy
(Stone) Cardiovascular Research Foundation, Columbia University Medical
Center, New York-Presbyterian Hospital, 111 East 59th Street, New York, NY
10022, United States
Title
Risk of stroke with coronary artery bypass graft surgery compared with
percutaneous coronary intervention.
Source
Journal of the American College of Cardiology. 60 (9) (pp 798-805), 2012.
Date of Publication: 28 Aug 2012.
Publisher
Elsevier USA (6277 Sea Harbor Drive, Orlando FL 32862 8239, United States)
Abstract
This study sought to determine whether coronary artery bypass graft (CABG)
surgery is associated with an increased risk of stroke compared with
percutaneous coronary intervention (PCI). Some, but not all, randomized
trials have reported increased rates of stroke with CABG compared with
PCI. However, all these studies were powered insufficiently to examine
differences in the risk of stroke reliably. We performed a meta-analysis
of 19 trials in which 10,944 patients were randomized to CABG versus PCI.
The primary end point was the 30-day rate of stroke. We also determined
the rate of stroke at the midterm follow-up and investigated whether there
was an interaction between revascularization type and the extent of
coronary artery disease on the relative risk of stroke. The 30-day rate of
stroke was 1.20% after CABG compared with 0.34% after PCI (odds ratio:
2.94, 95% confidence interval: 1.69 to 5.09, p < 0.0001). Similar results
were observed after a median follow-up of 12.1 months (1.83% vs. 0.99%,
odds ratio: 1.67, 95% confidence interval: 1.09 to 2.56, p = 0.02). The
extent of coronary artery disease (single vessel vs. multivessel vs. left
main) did not affect the relative increase in the risk of stroke observed
with CABG compared with PCI at either 30 days (p = 0.57 for interaction)
or midterm follow-up (p = 0.08 for interaction). Similar results were
observed when the outcomes in 33,980 patients from 27 observational
studies were analyzed. Coronary revascularization by CABG compared with
PCI is associated with an increased risk of stroke at 30 days and at the
mid-term follow-up. 2012 American College of Cardiology Foundation.

<10>
Accession Number
2012491419
Authors
Sufit A. Weitzel L.B. Hamiel C. Queensland K. Dauber I. Rooyackers O.
Wischmeyer P.E.
Institution
(Sufit, Weitzel, Hamiel, Queensland, Wischmeyer) University of Colorado
School of Medicine, Box 8602, Department of Anesthesiology, 12700 E. 19th
Ave, Aurora, CO 80045, United States
(Dauber) South Denver Cardiology Associates, Littleton, Denver, CO, United
States
(Rooyackers) Karolinska University Hospital, Karolinska, Sweden
Title
Pharmacologically dosed oral glutamine reduces myocardial injury in
patients undergoing cardiac surgery: A randomized pilot feasibility trial.
Source
Journal of Parenteral and Enteral Nutrition. 36 (5) (pp 556-561), 2012.
Date of Publication: September 2012.
Publisher
SAGE Publications Inc. (2455 Teller Road, Thousand Oaks CA 91320, United
States)
Abstract
Background and Objective: Glutamine (GLN) has been shown to protect
against in vitro and in vivo myocardial injury. In humans, perioperative
ischemia/reperfusion (I/R) injury during cardiac surgery is associated
with higher morbidity and mortality. The objective of this safety and
feasibility pilot trial was to determine if pharmacologically dosed,
preoperative oral GLN attenuates myocardial injury in cardiac surgery
patients. Methods: Patients undergoing elective cardiac surgery, requiring
cardiopulmonary bypass, were enrolled in a randomized, double-blind pilot
trial to receive 25 g twice of oral alanyl-glutamine (GLN; n = 7) or
maltodextrin (CONT; n = 7) daily for 3 days preoperatively. Serum troponin
(TROP I), creatine kinase (CK-MB), and myoglobin (MG) were measured at
multiple perioperative time points. Clinical outcomes were also recorded
and assessed. Results: GLN therapy significantly decreased TROP I levels
at 24, 48, and 72 hours postoperatively (all P < .05) vs CONT. GLN also
reduced CK-MB at 24 and 48 hours (P < .05, P < .001) vs CONT. MG was
reduced at 24 hours vs control (P = .0397). GLN also significantly reduced
pooled clinical complications vs CONT (P = .03). Conclusion: This pilot
study showed that pharmacologically dosed oral GLN therapy prior to
cardiac surgery was safe, well tolerated, and feasible. GLN therapy
reduced myocardial injury and clinical complications in this small
randomized, blinded feasibility trial. These data indicate that a larger
trial of preoperative GLN therapy in patients undergoing cardiac surgery
is needed to confirm clinical benefit. (JPEN J Parenter Enteral Nutr.
2012;36:556-561). 2012 American Society for Parenteral and Enteral
Nutrition.

<11>
Accession Number
2012482917
Authors
Santos V.C.J. Sanches-Giraud C. Lanchote V.L. Santos L.M. Carmona M.J.C.
Santos S.R.C.J.
Institution
(Santos, Sanches-Giraud, Lanchote, Santos, Carmona, Santos) School of
Pharmaceutical Sciences, Instituto do Coracao, Medical School, University
of Sao Paulo/SP, Brazil
Title
PK/PD of morphine for postoperative analgesia after coronary artery bypass
grafting. intrathecal morphine significantly reduces drug consumption.
Source
Latin American Journal of Pharmacy. 31 (5) (pp 686-692), 2012. Date of
Publication: 2012.
Publisher
Colegio de Farmaceuticos de la Provincia de Buenos Aires (Calle 5 No. 966,
La Plata 1900, Argentina)
Abstract
The aim of the present study was to evaluate intrathecal morphine outcome
on postoperative pain and apply pharmacokinetic/pharmacodynamic model to
justify morphine consumption, plasma concentration and pain intensity
during coronary artery bypass grafting surgery. Thirty six patients were
prospectively randomized for general anesthesia and allocated in the
control or morphine (400 mug intrathecal) group. At postoperative period,
all patients received a loading dose of morphine (1 mg bolus), and then
patient-controlled analgesia device was installed and delivered until 36
h. Blood samples was collected from venous catheter, morphine plasma
concentrations were determined by liquid chromatography and pain intensity
evaluated by visual analogue scale. Drug dose requirements and pain
intensity at rest were different between groups. No kinetic parameters
difference was obtained. Maximum effect model and hysteresis curve were
proposed to correlate drug plasma concentration versus time, drug
consumption and pain intensity. Intrathecal morphine reduces at rest
morphine consumption and pain intensity postoperatively; the best fit
pharmacokinetic/pharmacodynamic models were maximum effect and hysteresis
curve.

<12>
Accession Number
2012481757
Authors
van Rijen M.M.L. Bode L.G.M. Baak D.A. Kluytmans J.A.J.W. Vos M.C.
Institution
(van Rijen, Kluytmans) Laboratory for Microbiology and Infection Control,
Amphia Hospital, Breda, Netherlands
(Bode, Vos) Department of Medical Microbiology and Infectious Diseases,
Erasmus University Medical Centre, Rotterdam, Netherlands
(Baak) Business Information Centre, Amphia Hospital, Breda, Netherlands
(Kluytmans) Department of Medical Microbiology and Infection Control, VU
University Medical Centre, Amsterdam, Netherlands
Title
Reduced costs for staphylococcus aureus carriers treated prophylactically
with mupirocin and chlorhexidine in cardiothoracic and orthopaedic
surgery.
Source
PLoS ONE. 7 (8) , 2012. Article Number: e43065. Date of Publication: 14
Aug 2012.
Publisher
Public Library of Science (185 Berry Street, Suite 1300, San Francisco CA
94107, United States)
Abstract
Background: A multi centre double-blind randomised-controlled trial
(M-RCT), carried out in the Netherlands in 2005-2007, showed that
hospitalised patients with S. aureus nasal carriage who were treated
prophylactically with mupirocin nasal ointment and chlorhexidine gluconate
medicated soap (MUP-CHX), had a significantly lower risk of health-care
associated S. aureus infections than patients receiving placebo (3.4% vs.
7.7%, RR 0.42, 95% CI 0.23-0.75). The objective of the present study was
to determine whether treatment of patients undergoing elective
cardiothoracic or orthopaedic surgery with MUP-CHX (screen-and-treat
strategy) affected the costs of patient care. Methods: We compared
hospital costs of patients undergoing cardiothoracic or orthopaedic
surgery (n = 415) in one of the participating centres of the M-RCT. Data
from the 'Planning and Control' department were used to calculate total
hospital costs of the patients. Total costs were calculated including
nursing days, costs of surgery, costs for laboratory and radiological
tests, functional assessments and other costs. Costs for personnel,
materials and overhead were also included. Mean costs in the two treatment
arms were compared using the t-test for equality of means (two-tailed).
Subgroup analysis was performed for cardiothoracic and orthopaedic
patients. Results: An investigator-blinded analysis revealed that costs of
care in the treatment arm (MUP-CHX, n = 210) were on average 1911 lower
per patient than costs of care in the placebo arm (n = 205) (8602 vs.
10513, p = 0.01). Subgroup analysis showed that MUP-CHX treated
cardiothoracic patients cost 2841 less (n = 280, 9628 vs 12469, p = 0.006)
and orthopaedic patients 955 less than non-treated patients (n = 135, 6097
vs 7052, p = 0.05). Conclusions: In conclusion, in patients undergoing
cardiothoracic or orthopaedic surgery, screening for S. aureus nasal
carriage and treating carriers with MUP-CHX results in a substantial
reduction of hospital costs. 2012 van Rijen et al.

<13>
Accession Number
22448716
Authors
Schattke S. Baldenhofer G. Prauka I. Zhang K. Laule M. Stangl V. Sanad W.
Spethmann S. Borges A.C. Baumann G. Stangl K. Knebel F.
Institution
(Schattke) Charite - Universitatsmedizin Berlin, Medizinische Klinik m.S.
Kardiologie und Angiologie, Charite Campus Mitte, Germany.
Title
Acute regional improvement of myocardial function after interventional
transfemoral aortic valve replacement in aortic stenosis: a speckle
tracking echocardiography study.
Source
Cardiovascular ultrasound. 10 (pp 15), 2012. Date of Publication: 2012.
Abstract
Transcatheter aortic valve implantation (TAVI) is a promising therapy for
patients with severe aortic stenosis (AS) and high perioperative risk. New
echocardiographic methods, including 2D Strain analysis, allow the more
accurate measurement of left ventricular (LV) systolic function. The goal
of this study was to describe the course of LV reverse remodelling
immediately after TAVI in a broad spectrum of patients with symptomatic
severe aortic valve stenosis. Thirty consecutive patients with symptomatic
aortic valve stenosis and preserved LVEF underwent transfemoral aortic
valve implantation. We performed echocardiography at baseline and one week
after TAVI. Echocardiography included standard 2D and Doppler analysis of
global systolic and diastolic function as well as 2D Strain measurements
of longitudinal, radial and circumferential LV motion and Tissue Doppler
echocardiography. The baseline biplane LVEF was 57 +/- 8.2%, the mean
pressure gradient was 46.8 +/- 17.2 mmHg and the mean valve area was 0.73
+/- 0.27 cm(2). The average global longitudinal 2D strain of the left
ventricle improved significantly from -15.1 (+/- 3.0) to -17.5 (+/- 2.4) %
(p < .001). This was reflected mainly in improvement in the basal and
medial segments while strain in the apex did not change significantly
[-11.6 (+/- 5.2) % to -15.1 (+/- 5.5) % (p < .001), -13.9 (+/- 5.1) % to
-16.8 (+/- 5.6) % (p < .001) and -19.2 (+/- 7.0) % to -20.0 (+/- 7.2) % (p
= .481) respectively]. While circumferential strain [-18.1 (+/- 5.1) % vs.
-18.9 (+/- 4.2) %, p = .607], radial strain [36.5 (+/- 13.7) % vs. 39.7
(+/- 17.2) %, p = .458] and the LVEF remained unchanged after one week
[57.0 (+/- 8.2) % vs. 59.1 (+/- 8.1) %, p = .116]. There is an acute
improvement of myocardial longitudinal systolic function of the basal and
medial segments measured by 2D Strain analysis immediately after TAVI. The
radial, circumferential strain and LVEF does not change significantly in
all patients acutely after TAVI. These data suggest that sensitive new
echo methods can reliably detect early regional changes of myocardial
function after TAVI before benefits in LVEF are detectable.

<14>
Accession Number
22405079
Authors
Derossi R. Pagliosa R. Modolo T.C. Maciel F.B. Macedo G.G.
Institution
(Derossi) Department of Veterinary Medicine Surgery and Anesthesiology,
Faculty of Veterinary Medicine and Animal Science, Federal University of
Mato Grosso do Sul, Campo Grande, Brazil
(Pagliosa, Modolo, Maciel) Department of Veterinary Medicine, Federal
University of Mato Grosso do Sul, Campo Grande, MS, Brazil
(Macedo) School of Veterinary Medicine, Federal University of Vicosa,
Vicosa, MG, Brazil
Title
Thoracic epidural analgesia via the lumbosacral approach using multiport
catheters with a low concentration of bupivacaine and morphine in sheep.
Source
Veterinary Anaesthesia and Analgesia. 39 (3) (pp 306-314), 2012. Date of
Publication: March 2012.
Publisher
Blackwell Publishing Ltd (9600 Garsington Road, Oxford OX4 2XG, United
Kingdom)
Abstract
Objective To determine the analgesic and systemic effects of thoracic
epidural administration of bupivacaine (BP) and morphine (MP) in conscious
sheep. Study design Randomized, crossover, experimental study. Animals Six
healthy castrated sheep weighing between 40 and 50kg. Methods Each sheep
received, via the lumbosacral approach, BP (0.5mgkg^-1), MP
(0.1mgkg^-1), and BP plus MP (BPMP; 0.25mgkg^-1+
0.05mgkg^-1) in a randomized order. Heart rate, blood pressure,
respiratory rate, blood gas analysis, skin temperature, rectal
temperature, analgesia, sedation, and motor blockade were determined
before treatment and at predetermined intervals until analgesia had
disappeared. Results The main areas of complete analgesia for the BP and
BPMP treatments were the thorax and forelimb bilaterally. The median
duration of analgesia was shorter with MP treatment (45minutes; score 2)
than with BP treatment (70minutes) and BPMP treatment (140minutes;
p<0.05). The BP and BPMP treatments caused motor block, and MP and BPMP
treatments showed mild sedation. Significant decreases in systolic and
diastolic arterial blood pressures were observed only with the BP
treatment (p<0.05). Epidural MP combined with the BP local anesthetic
depressed ventilation but within acceptable limits in these clinically
healthy sheep. Conclusions Thoracic epidural administration of BPMP to
sheep resulted in longer duration of analgesia of the thorax and forelimbs
bilaterally in conscious sheep than the administration of MP or BP alone.
The incidence of complications was low, but side-effects such as depressed
ventilation and muscle paralysis occurred and require appropriate
management. Clinical relevance This technique should be considered as
another method for the relief of postoperative pain after thoracic surgery
in sheep. 2012 The Authors. Veterinary Anaesthesia and Analgesia. 2012
Association of Veterinary Anaesthetists and the American College of
Veterinary Anesthesiologists.

<15>
Accession Number
70850655
Title
Annual Scientific Meeting of the Association of Paediatric Anaesthetists
of Great Britain and Ireland, APAGBI 2011.
Source
Paediatric Anaesthesia. Conference: Annual Scientific Meeting of the
Association of Paediatric Anaesthetists of Great Britain and Ireland,
APAGBI 2011 Torquay, Devon United Kingdom. Conference Start: 20110518
Conference End: 20110520. Conference Publication: (var.pagings). 22 (9) ,
2012. Date of Publication: September 2012.
Publisher
Blackwell Publishing Ltd
Abstract
The proceedings contain 9 papers. The topics discussed include: randomized
controlled trial of the Airtraq optical laryngoscope and conventional
laryngoscopy in children; best position and depth of anesthesia for
laryngeal mask airway removal in children - a randomized controlled trial;
crossover study: intubation by novices with Airtraq optical laryngoscope
vs standard equipment in a simulated difficult airway using SimBaby
manikin; remote measurement of the leak around the uncuffed endotracheal
tube: objective measurement and physical characteristics; anesthetic
complications during insertion of tunneled central lines in interventional
radiology in babies <2 kg; does neonatal transverse abdominal plane block
remove the need for postoperative opioid infusion? a case series of
neonatal laparotomies; and ultrasound-guided bilateral paravertebral
blocks for children undergoing cardiac surgery - a case series.

<16>
Accession Number
70850635
Title
European Society of Paediatric Anaesthesiology Annual Congress 2011.
Source
Paediatric Anaesthesia. Conference: European Society of Paediatric
Anaesthesiology Annual Congress 2011 Palma de Mallorca Spain. Conference
Start: 20110922 Conference End: 20110924. Conference Publication:
(var.pagings). 22 (9) , 2012. Date of Publication: September 2012.
Publisher
Blackwell Publishing Ltd
Abstract
The proceedings contain 9 papers. The topics discussed include: best
position and depth of anaesthesia for LMA removal in children - a
randomised controlled trial; use of a low dose opiate/multi modal
analgesic regime to reduce respiratory complications in children with
obstructive sleep apnoea following adenotonsilectomy; earlier detection of
coagulopathy during paediatric cardiac surgery; comparing the effect of
combined spinal - epidural anaesthesia vs general anaesthesia on the
recovery time of gastrointestinal function in infants undergoing
gastrointestinal surgery: a randomised, controlled trial; the child
behaviour checklist as an assessment tool in predicting perioperative
maladaptive behaviour; the influence of anaesthetic chemical structure on
reducing tourniquet induced ischemia-reperfusion injuries during extremity
surgery at children's age; and randomized, double-blind, controlled trial
pregabalin vs placebo on morphine consumption and pain control after
pectus excavatum surgery in children.

<17>
Accession Number
70848946
Authors
Bin Abdulhak A.A. AlAsmari F.A. Riaz M. Khan A.R. Kashour T.S. AlTannir
M.A. Tleyjeh I.M. Ibrahim T.
Institution
(Bin Abdulhak, AlAsmari, Riaz, Khan, Kashour, AlTannir, Tleyjeh) King Fahd
Medical City, Riyadh, Saudi Arabia
(Ibrahim) Paediatric orthopaedic surgery, Toronto, Canada
Title
The association between statins use and the risk of post cardiac surgeries
infectious complications: A systematic review and metaanalysis.
Source
American Journal of Respiratory and Critical Care Medicine. Conference:
American Thoracic Society International Conference, ATS 2011 Denver, CO
United States. Conference Start: 20110513 Conference End: 20110518.
Conference Publication: (var.pagings). 183 (1 MeetingAbstracts) , 2011.
Date of Publication: 01 May 2011.
Publisher
American Thoracic Society
Abstract
Background: Post cardiac surgery infectious complications are a major
problem with significant morbidity and mortality. Statins have a
pleiotropic effect that might help in prevention of infections. We sought
to systematically examine the association between statins use and the risk
of post-operative infectious complications in patients who undergo cardiac
surgeries. Methods: We searched OVID MEDLINE from 1950 - 2010; EMBASE from
1988 - 2010 for any comparative studies examining the association between
statins use and risk of post-operative infections in patients who undergo
cardiac surgeries. Two reviewers independently extracted data. We
contacted studies authors for missing information. We conducted a
random-effects meta-analysis of individual studies odds ratios (adjusted
for potential confounders). I-squared and Egger test were used to examine
for heterogeneity and publication bias, respectively. Results: Six cohort
studies from Canada, USA, and Germany with 17244 patients were included in
the analysis. Use of statins in preoperative period was associated with a
trend for reduced incidence of post-operative infections in patients who
underwent cardiac surgeries [OR 0.90; 95% CI (0.77-1.04)], I2= 61% and
Egger test revealed no publication bias. Sensitivity analysis was
conducted after removing the study by Daneman et al which included only
elderly patients; [OR 0.84 CI (0.70-1.01)], p=0.08, I2=53%. Conclusion:
Our metaanalysis suggests that statins use may be associated with a lower
risk of post operative infectious complications after cardiac surgeries.
Given the safety of statins and the major sequalea of post-operative
infections, our results merit further validation in randomized controlled
trials.

<18>
Accession Number
70847501
Authors
Kaw R. Pasupuleti V. Thota P. Aboussouan L.
Institution
(Kaw, Pasupuleti, Thota, Aboussouan) Cleveland Clinic, Cleveland, OH,
United States
Title
Obesity hypoventilation syndrome: An emerging and unrecognized risk factor
among surgical patients.
Source
American Journal of Respiratory and Critical Care Medicine. Conference:
American Thoracic Society International Conference, ATS 2011 Denver, CO
United States. Conference Start: 20110513 Conference End: 20110518.
Conference Publication: (var.pagings). 183 (1 MeetingAbstracts) , 2011.
Date of Publication: 01 May 2011.
Publisher
American Thoracic Society
Abstract
RATIONALE: The incidence of Obesity Hypoventilation Syndrome (OHS) is
increasing. Although largely unknown, a recent meta-analysis reported a
19% prevalence of OHS among a cohort of 4250 patients with OSA, and a
prevalence of 3 per 1000 in the overall population. Untreated patients
with OHS have been reported to have a higher mortality compared to
well-matched (23% vs 9%) after hospital discharge. We looked at
postoperative respiratory failure (RF) among patients with OHS, who
underwent non-cardiac surgery (NCS) at our hospital. METHODS: The Internal
Medicine preoperative assessment and Polysomnography (PSG) databases were
crossmatched to identify patients who underwent both NCS and PSG at a
major tertiary care center. OSA defined as apnea-hypopnea index (AHI)>5
was presumed to be present at the time of surgery, even if established by
PSG upto 3 years after NCS. Information about arterial blood gases (ABG)
and pulmonary function testing closest to the time of NCS were obtained.
Impact of OSA on postoperative outcomes was analyzed with a multivariate
logistic model adjusted for age, gender, race, type of anesthesia, BMI,
ASA class and medical comorbidities by way of propensity matching. Out of
this group we looked next at patients with OHS as characterized by
PaCO2>45 mmHg, BMI>30 and absence of obstructive/ severe restrictive
disease. RESULTS: Out of a total of 1784 patients who underwent both PSG
and NCS, 471 were eligible for the study of which 269 (57%) had OSA.
Majority of patients (>80%) in each group underwent intermediate risk
surgery and had surgery under general anesthesia. Presence of OSA was
associated with higher incidence of significant hypoxia (p=0.02),
reintubation (p=0.048), unplanned ICU transfer (p=0.03; OR =7.6); overall
complications (p=0.0006; OR=9.9) and longer length of hospital stay
(p=0.04; OR= 1.9). Among the OSA group, 36 (13%) patients had data
regarding ABG prior to their NCS, most of which were done inpatient. Nine
patients (3%) in the OSA group had OHS and they were predominantly male,
had higher BMI (45 vs 38) and higher AHI (52 vs 35). Fourteen patients
(5%) developed postoperative RF, of which 4 had OHS, 3 had possible OHS
(no preoperative ABG); 3 had overlap syndrome and the rest had OSA.
Patients with OHS had a 44% rate of postoperative RF compared to a
corresponding rate of 3% among all other patients with OSA without any
preoperative ABG data. CONCLUSION: Among patients with OSA, unrecognized
OHS accounts for a majority of postoperative RF.