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<1>
Accession Number
2012697281
Authors
De Seigneux S. Ponte B. Weiss L. Pugin J. Romand J.A. Martin P.-Y. Saudan
P.
Institution
(De Seigneux, Ponte, Martin, Saudan) Service of Nephrology, Department of
Medical Specialties, Geneva University Hospitals, Rue Gabrielle-Perret
Gentil 4, 1211, Geneva, Switzerland
(Weiss) Department of Internal Medicine, Geneva University Hospitals,
Geneva, Switzerland
(Pugin, Romand) Service of General Intensive Care, Department of
Anesthesiology, Geneva University Hospitals, Geneva, Switzerland
Title
Epoetin administrated after cardiac surgery: Effects on renal function and
inflammation in a randomized controlled study.
Source
BMC Nephrology. 13 (1) , 2012. Article Number: 132. Date of Publication:
2012.
Publisher
BioMed Central Ltd. (Floor 6, 236 Gray's Inn Road, London WC1X 8HB, United
Kingdom)
Abstract
Background: Experimentally, erythropoietin (EPO) has nephroprotective as
well as immunomodulatory properties when administered after ischemic renal
injury. We tested the hypothesis that different doses of recombinant human
EPO administered to patients after cardiac surgery would minimize kidney
lesions and the systemic inflammatory response, thereby decreasing acute
kidney injury (AKI) incidence. Methods. In this double-blinded randomized
control study, 80 patients admitted to the ICU post-cardiac surgery were
randomized by computer to receive intravenously isotonic saline (n=40)
versus -Epoetin (n=40): either 40000 IU (n=20) or 20000 IU (n=20). The
study lasted one year. The primary outcome was the change in urinary NGAL
concentration from baseline and 48 h after EPO injection. Creatinine,
cystatine C and urinary NGAL levels were measured on the day of
randomization and 2-4 days after EPO injection. To assess acute
inflammatory response, serum cytokines (IL6 and IL8) were measured at
randomization and four days after r-HuEPO injection. Patients and
care-takers were blinded for the assignment. Results: No patient was
excluded after randomization. Patient groups did not differ in terms of
age, gender, comorbidities and renal function at randomization. The rate
of AKI assessed by AKIN criteria was 22.5% in our population. EPO
treatment did not significantly modify the difference in uNGAl between 48
hours and randomization compared to placebo [2.5 ng/ml (17.3; 22.5) vs 0.7
ng/ml (31.77; 25.15), p=0.77] and the incidence of AKI was similar.
Inflammatory cytokines levels were not influenced by EPO treatment.
Mortality and hospital stays were similar between the groups and no
adverse event was recorded. Conclusion: In this randomized-controlled
trial, -Epoetin administrated after cardiac surgery, although safe,
demonstrated neither nephroprotective nor anti-inflammatory properties.
Trial registration number. NCT00676234. 2012 de Seigneux et al.; licensee
BioMed Central Ltd.

<2>
Accession Number
2012701724
Authors
Jiang W.-B. Zhao W. Huang H. Li C.-L. Zhang J.-H. Wang Y. Fu G.-S.
Institution
(Jiang, Zhao, Zhang, Wang) Department of Cardiology, Wenzhou Third
People's Hospital, Wenzhou, Zhejiang, China
(Huang, Li, Fu) Department of Cardiology, Sir Run Run Shaw Hospital,
Zhejiang University, Hangzhou, Zhejiang, China
Title
Meta-analysis of effectiveness of first-generation drug-eluting stents
versus coronary artery bypass grafting for unprotected left main coronary
disease.
Source
American Journal of Cardiology. 110 (12) (pp 1764-1772), 2012. Date of
Publication: 15 Dec 2012.
Publisher
Elsevier Inc. (360 Park Avenue South, New York NY 10010, United States)
Abstract
It is controversial whether drug-eluting stents (DESs) are safe and
effective when generalized to "real-world" patients with unprotected left
main coronary artery disease. This meta-analysis compared the safety and
efficacy of DESs to coronary artery bypass grafting (CABG) in real-world
patients with unprotected left main coronary artery. We identified
comparative, observational, DES versus CABG studies published from January
2000 through May 2012. All studies included <100 patients and reported end
points with follow-ups <6 months. We included adjusted risk estimates and,
when no adjusted estimate was available, crude estimates. Data were
grouped according to follow-up times of <=2, <=3, and >3 years. We
included data from 25 observational studies representing 7,230 patients.
No differences were detected between CABG and DES in overall mortality
(<=2 years, adjusted risk ratio [RR], 0.83, 95% confidence interval [CI]
0.53 to 1.28; <=3 years, adjusted RR 0.60, 95% CI 0.20 to 1.66; >3 years,
adjusted RR 0.58, 95% CI 0.29 to 1.17) or in major adverse cardiac and
cerebrovascular events (<=2 years, adjusted RR 1.22, 95% CI 0.86 to 1.73;
<=3 years, adjusted RR 1.70, 95% CI 1.35 to 2.15; >3 years, adjusted RR
1.23, 95% CI 0.87 to 1.73). Compared to DESs, CABG showed a significant
decrease in target vessel revascularization (<=2 years, adjusted RR 3.72,
95% CI 2.50 to 5.52; <=3 years, adjusted RR 3.92, 95% CI 2.54 to 6.04; >3
years, adjusted RR 3.45, 95% CI 2.14 to 5.57). In conclusion, DESs and
CABG were not significantly different in short- and long-term rates of
death or major cardiovascular/cerebrovascular events, but DESs showed a
higher risk of target vessel revascularization compared to CABG. 2012
Elsevier Inc.

<3>
Accession Number
2012700658
Authors
El-Morsy G.Z. El-Deeb A. El-Desouky T. Elsharkawy A.A. Elgamal M.A.F.
Institution
(El-Morsy, El-Deeb, El-Desouky) Department of Anesthesia, Faculty of
Medicine, Mansoura University, Egypt
(Elsharkawy) Department of Pediatrics, Faculty of Medicine, Mansoura
University, Egypt
(Elgamal) Department of Cardiothoracic, Faculty of Medicine, Mansoura
University, Egypt
Title
Can thoracic paravertebral block replace thoracic epidural block in
pediatric cardiac surgery A randomized blinded study.
Source
Annals of Cardiac Anaesthesia. 15 (4) (pp 259-263), 2012. Date of
Publication: October-December 2012.
Publisher
Medknow Publications and Media Pvt. Ltd (B9, Kanara Business Centre, off
Link Road, Ghatkopar (E), Mumbai 400 075, India)
Abstract
To compare the outcomes of thoracic epidural block with thoracic
paravertebral block for thoracotomy in pediatric patients. A prospective
double-blind study. 60 pediatric patients aged 1-24 months, ASA II, III
scheduled for thoracotomy were randomly allocated into two groups. After
induction of general anesthesia, thoracic epidural catheter was inserted
in group E (epidural) patients and thoracic paravertebral catheter was
inserted in group P (paravertebral) patients. Post operative pain score
was recorded hourly for 24 hours. Plasma cortisol level was recorded at
three time points. Tidal breathing analysis was done preoperatively and 6
hours postoperatively. Analgesia, serum cortisol level, and pulmonary
function parameters were comparable in the two groups. However, failure
rate (incorrect placement of catheter) was significantly higher in
epidural group than in paravertebral group (7% versus 0%, respectively).
The complications were also significantly higher in epidural group
(vomiting 14.8%, urine retention 11.1% and hypotension 14.8%) than
paravertebral group (0%, 0%, and 3.6%, respectively). We conclude that
both thoracic paravertebral block and thoracic epidural block results in
comparable pain score and pulmonary function after thoracotomy in
pediatric patients; the paravertebral block is associated with
significantly less failure rate and side effects.

<4>
Accession Number
2012696872
Authors
Hirschhorn A.D. Richards D.A.B. Mungovan S.F. Morris N.R. Adams L.
Institution
(Hirschhorn, Mungovan) Westmead Private Physiotherapy Services, Clinical
Research Institute, 16-18 Mons Road, Westmead, NSW 2145, Australia
(Hirschhorn, Mungovan) Clinical Research Institute, NSW, Australia
(Hirschhorn, Morris, Adams) School of Rehabilitation Sciences and Griffith
Health Institute, Griffith University, QLD, Australia
(Richards) Westmead Private Hospital, NSW, Australia
Title
Does the mode of exercise influence recovery of functional capacity in the
early postoperative period after coronary artery bypass graft surgery? A
randomized controlled trial.
Source
Interactive Cardiovascular and Thoracic Surgery. 15 (6) (pp 995-1003),
2012. Date of Publication: December 2012.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
Objectives: The purpose of this study was to compare the effectiveness of
moderate-intensity stationary cycling and walking exercise programmes in
the early postoperative period after first-time coronary artery bypass
graft surgery. Method: In this prospective trial, 64 patients (57 men, 7
women, mean age = 66 +/- 9 years) performed twice daily,
moderate-intensity exercise sessions, of 10-min duration, from
postoperative day 3 until discharge from hospital. Patients were randomly
assigned to stationary cycling or walking exercise intervention groups.
Preoperative and discharge functional exercise capacity and health-related
quality of life were assessed using 6-min walk and cycle assessments and
the SF-36 version 2.0 questionnaire. Compliance with exercise was
calculated as the proportion of scheduled exercise sessions completed.
Results: There were no significant differences between intervention groups
at hospital discharge for 6-min walk distance (cyclists: 402 +/- 93 m vs
walkers: 417 +/- 86 m, P = 0.803), 6-min cycle work (cyclists: 15.0 +/-
6.4 kJ vs walkers: 14.0 +/- 6.3 kJ, P = 0.798) or health-related quality
of life. There was no significant difference between intervention groups
for postoperative length of hospital stay (P = 0.335). Compliance rates
for intervention groups were cyclists: 185/246 (75%) scheduled exercise
sessions completed vs walkers: 199/242 (82%) scheduled exercise sessions
completed (P = 0.162). Conclusion: Stationary cycling provides a
well-tolerated and clinically effective alternative to walking in the
early postoperative period after coronary artery bypass graft surgery. The
optimal frequency, intensity and duration of exercise in the early
postoperative period require further investigation. (Clinical trials
register: Australian New Zealand Clinical Trials Registry; identification
number: ACTRN12608000359336; http://www.anzctr.org.au/
trial-view.aspx?ID=82978). 2012 The Author. Published by Oxford
University Press on behalf of the European Association for Cardio-Thoracic
Surgery. All rights reserved.

<5>
Accession Number
2012696866
Authors
Shaikhrezai K. Khorsandi M. Patronis M. Prasad S.
Institution
(Shaikhrezai, Khorsandi, Patronis, Prasad) Department of Cardiothoracic
Surgery, Royal Infirmary of Edinburgh, Little France Crescent, Dalkeith
Road, Edinburgh EH16 4SA, United Kingdom
Title
Is it safe to cut pacing wires flush with the skin instead of removing
them?.
Source
Interactive Cardiovascular and Thoracic Surgery. 15 (6) (pp 1047-1051),
2012. Date of Publication: December 2012.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
A best evidence topic in cardiac surgery was written according to a
structured protocol. The question addressed was whether it is safe to cut
the temporary epicardial pacing wires (TEPWs) flush with the patient's
skin surface prior to discharge. Altogether 105 relevant papers were
identified of which 13 case reports represented the best evidence to
answer the question. The author, journal, date, country of publication,
complications, the culprit TEPW and relevant outcomes are tabulated. All
case reports demonstrated a wide spectrum of complications. Complications
from a retained TEPW mainly arise after a long dormant period. A recent
case report has demonstrated the herniation of intra-abdominal contents
through a diaphragmatic defect created by the abandoned epicardial pacing
wires after a few decades. In multiple case reports, the migration of TEPW
was the culprit of serious complications. In two case reports, the TEPWs
attached to the right chambers of the heart had migrated to the pulmonary
artery via the right atrium and then the right ventricle. In one case
report, a similar migration of the right ventricular TEPW to the right
ventricular outflow track was observed. The TEPW migration was not limited
to the right side of the heart, as in one case report the right atrial
TEPW had migrated to the right carotid artery via the ascending aorta. A
distant extravascular migration of TEPWs to the skin surface and
intraperitoneal and pelvic cavities has also been reported. Retained TEPWs
have also been reported to inflict complications locally. One case report
has shown a large right-sided para-cardiac mass caused by a right atrial
TEPW. In two other case reports, the bronchocutaneous fistula, lobar
consolidation and bronchiectasis were the manifestations of a retained
TEPW. We conclude that the retention of TEPW after cardiac surgery is not
necessarily safe and may cause severe complications. We recommend that
TEPWs should be completely removed when possible. If TEPWs are retained,
this should be appropriately documented and the surgeon should be mindful
of this when the patient presents with complications postoperatively.
2012 The Author. Published by Oxford University Press on behalf of the
European Association for Cardio-Thoracic Surgery. All rights reserved.

<6>
Accession Number
2012696864
Authors
Acharya M.N. Ashrafian H. Athanasiou T. Casula R.
Institution
(Acharya, Athanasiou, Casula) Department of Cardiothoracic Surgery,
Imperial College London, Hammersmith Hospital Campus, London, United
Kingdom
(Ashrafian, Athanasiou) Department of Surgery and Cancer, Imperial College
London, St. Mary's Hospital Campus, Praed Street, London W2 1NY, United
Kingdom
Title
Is totally endoscopic coronary artery bypass safe, feasible and
effective?.
Source
Interactive Cardiovascular and Thoracic Surgery. 15 (6) (pp 1040-1046),
2012. Date of Publication: December 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 totally endoscopic coronary artery bypass
(TECAB) is safe, effective and feasible. A total of 171 papers were found,
of which eight represented the best evidence. The authors, date, journal,
study type, population, main outcome measures and results are tabulated.
The da Vinci robotic system was utilized in seven retrospective studies
and one multicentre prospective trial, comprising 724 patients undergoing
TECAB. Patient-related outcomes, including the incidence of major adverse
cardiac events, graft patency and survival, were investigated. From the
studies evaluated, TECAB appears to be safe operation with low
complication rates and excellent early- and mid-term graft patencies. The
incidence of internal thoracic artery injury was documented in four
studies and ranged from 0 to10%. Re-exploration for bleeding was necessary
in 1-15% of patients. Conversion to open techniques was performed in 0-24%
of cases. There was no in-hospital mortality in the majority of studies,
but this reached 2.1% in a large series of 228 patients. Target-vessel
reintervention rates varied between 0 and 12.1% according to the
institutional experience. Pre- and post-discharge graft patencies were
excellent at 93-100 and 92-100%, respectively. Intraoperative variables,
such as time taken for internal thoracic artery harvest, anastomosis,
cross-clamp, cardiopulmonary bypass (CPB) and the overall operation were
as follows: internal thoracic artery harvest time (range 5-187 min),
anastomosis time (range 6-82 min), cross-clamp time (range 30-223 min),
CPB time (range 41-268 min) and operative time (range 84-600 min). TECAB
is a technically demanding and time-consuming procedure associated with a
significant learning curve. Proctoring and structured training programmes
are currently supported by European and international societies to
encourage wider uptake of the procedure. In conclusion, TECAB represents a
feasible alternative to conventional coronary artery bypass in selected
patients. It is associated with low morbidity and excellent mid-term graft
patency. Larger, prospective and multicentre trials are required to assess
the long-term and patient-reported outcomes of TECAB. 2012 The Author.
Published by Oxford University Press on behalf of the European Association
for Cardio-Thoracic Surgery. All rights reserved.

<7>
Accession Number
2012696860
Authors
De Oliveira Sa M.P.B. Ferraz P.E. Escobar R.R. Martins W.S. De Araujo E Sa
F.B.C. Lustosa P.C. Vasconcelos F.P. Lima R.C.
Institution
(De Oliveira Sa, Ferraz, Escobar, Martins, De Araujo E Sa, Lustosa,
Vasconcelos, Lima) Division of Cardiovascular Surgery of Pronto Socorro
Cardiologico de Pernambuco (PROCAPE), Av. Eng. Domingos Ferreira no. 4172,
Recife, Pernambuco 51021-040, Brazil
(De Oliveira Sa, Ferraz, Escobar, Martins, De Araujo E Sa, Lustosa,
Vasconcelos, Lima) University of Pernambuco (UPE), Recife, Brazil
(De Oliveira Sa, Ferraz, Vasconcelos, Lima) Nucleus of Postgrad. and Res.
in Hlth. Sci. of Fac. of Med. Sci. and Biological Sciences Institute,
Recife, Brazil
Title
Preservation versus non-preservation of mitral valve apparatus during
mitral valve replacement: A meta-analysis of 3835 patients.
Source
Interactive Cardiovascular and Thoracic Surgery. 15 (6) (pp 1033-1039),
2012. Date of Publication: December 2012.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
Resection of the chordopapillary apparatus during mitral valve replacement
has been associated with a negative impact on survival. Mitral valve
replacement with the preservation of the mitral valve apparatus has been
associated with better outcomes, but surgeons remain refractory to its
use. To determine if there is any real difference in preservation vs
non-preservation of mitral valve apparatus during mitral valve replacement
in terms of outcomes, we performed a systematic review and meta-analysis
using MEDLINE, EMBASE, CENTRAL/CCTR, SciELO, LILACS, Google Scholar and
reference lists of relevant articles to search for clinical studies that
compared outcomes (30-day mortality, postoperative low cardiac output
syndrome or 5-year mortality) between preservation vs non-preservation
during mitral valve replacement from 1966 to 2011. The principal summary
measures were odds ratios (ORs) with 95% confidence interval and P-values
(that will be considered statistically significant when <0.05). The ORs
were combined across studies using a weighted DerSimonian-Laird
random-effects model. The meta-analysis was completed using the software
Comprehensive Meta-Analysis version 2 (Biostat Inc., Englewood, NJ, USA).
Twenty studies (3 randomized and 17 non-randomized) were identified and
included a total of 3835 patients (1918 for mitral valve replacement
preservation and 1917 for mitral valve replacement non-preservation).
There was significant difference between mitral valve replacement
preservation and mitral valve replacement non-preservation groups in the
risk of 30-day mortality (OR 0.418, P <0.001), postoperative low cardiac
output syndrome (OR 0.299, P <0.001) or 5-year mortality (OR 0.380, P
<0.001). No publication bias or important heterogeneity of effects on any
outcome was observed. In conclusion, we found evidence that argues in
favour of the preservation of mitral valve apparatus during mitral valve
replacement. 2012 The Author. Published by Oxford University Press on
behalf of the European Association for Cardio-Thoracic Surgery. All rights
reserved.

<8>
Accession Number
2012696859
Authors
Attaran S. Chukwuemeka A. Punjabi P.P. Anderson J.
Institution
(Attaran, Chukwuemeka, Punjabi, Anderson) Department of Cardiothoracic
Surgery, Hammersmith Hospital, Imperial College, 46 Queen of Denmark
Court, Finland Street, London SE16 7TB, United Kingdom
Title
Do all patients with prosthetic valve endocarditis need surgery?.
Source
Interactive Cardiovascular and Thoracic Surgery. 15 (6) (pp 1057-1062),
2012. Date of Publication: December 2012.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
A best evidence topic in cardiothoracic surgery was written according to a
structured protocol. The question addressed was do all patients with
prosthetic valve endocarditis need surgery? Seventeen papers were found
using the reported search that 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. These studies compared the outcome and survival
between surgically and non-surgically treated patients with prosthetic
valve endocarditis. Of these studies, two were prospective observational
studies and the rest were retrospective studies. The results of most of
these papers were in accordance with the guidelines of the American
College of Cardiology and American Heart association. These studies showed
that unless a patient is not a surgical candidate, an operation is the
treatment of choice in prosthetic valve endocarditis. Surgery should be
performed as soon as possible, particularly in haemodynamically unstable
patients and those who develop complications such as heart failure,
valvular dysfunction, regurgitation/obstruction, dehiscence and annular
abscess. In addition to the above indications and cardiac/valvularrelated
complications of prosthetic valve endocarditis, infection with
Staphylococcus aureus plays an important role in the outcome, and the
presence of this micro-organism should be considered an urgent surgical
indication in the treatment of prosthetic valve endocarditis. Surgery
should be performed before the development of any cerebral or other
complications. In contrast, in stable patients with other micro-organisms,
particularly those with organisms sensitive to antibiotic treatment who
have no structural valvular damage or cardiac complications, surgery can
be postponed. The option of surgical intervention can also be revisited if
there is a change in response to the treatment. This option is reserved
for selected patients only and we conclude that as soon as the diagnosis
of prosthetic valve endocarditis is made, cardiac surgeons should be
involved.

<9>
Accession Number
2012696858
Authors
Barua A. Vaughan P. Wotton R. Naidu B.
Institution
(Barua) Department of Cardiac Surgery, Leeds General Infirmary, Leeds,
United Kingdom
(Vaughan, Wotton, Naidu) Department of Thoracic Surgery, Birmingham
Heartland Hospital, Birmingham B9 5SS, United Kingdom
(Naidu) University of Warwick, Coventry, United Kingdom
Title
Do endobronchial valves improve outcomes in patients with emphysema?.
Source
Interactive Cardiovascular and Thoracic Surgery. 15 (6) (pp 1072-1076),
2012. Date of Publication: December 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 addressed was whether endobronchial
valves improve outcomes in patients with severe emphysema. Eighty-seven
papers were found using the reported search, of which seven 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. Endobronchial
Valve for Emphysema Palliation Trial demonstrated that endobronchial valve
increased forced expiratory volume in one second by 4.3% (95% confidence
interval 1.4-7.2) and decreased by 2.5% in the control group (95%
confidence interval -5.4 to 0.4) at a 6-month interval. This benefit is
more marked in patients who do not have collateral ventilation into the
area of lung being isolated as mapped by bronchoscopic physiological
mapping (Chartis) or by computed tomography imaging documenting intact
fissures. This evidence is reflected in the Endobronchial Valve for
Emphysema Palliation Trial. Patients treated with endobronchial valve with
high heterogeneity and complete fissures had greater improvement in forced
expiratory volume in one second at 6- and 12-month intervals. We conclude
that endobronchial valve placement improves lung function, exercise
capacity and quality of life in selected patients with emphysematous
diseases. 2012 The Author. Published by Oxford University Press on behalf
of the European Association for Cardio-Thoracic Surgery. All rights
reserved.

<10>
Accession Number
2012696857
Authors
Okonta K.E. Adamu Y.B.
Institution
(Okonta) Division of Cardiothoracic Surgery, Department of Surgery,
University College Hospital, PMB 5116, Ibadan, Nigeria
(Adamu) Cardiothoracic Unit, Department of Surgery, National Hospital,
Abuja, Nigeria
Title
What size of vegetation is an indication for surgery in endocarditis?.
Source
Interactive Cardiovascular and Thoracic Surgery. 15 (6) (pp 1052-1056),
2012. Date of Publication: December 2012.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
A best evidence topic in cardiac surgery was written according to a
structured protocol. The question addressed was whether the of vegetations
in endocarditis is an indication for surgery. Altogether, 102 papers were
found using the reported search; 16 papers were identified that provided
the best evidence to answer the question. The authors, journal, date,
country of publication, patient group, study type, relevant outcomes and
results were tabulated. The vegetation size was classified into small (<5
mm), medium (5-9 mm), or large (>=10 mm) using echocardiography and a
vegetation size of >=10 mm was a predictor of embolic events and increased
mortality in most of the studies with left-sided infective endocarditis.
For large vegetations - that commonly resulted from the failure of
antibiotics to decrease the vegetation size during 4-8 weeks' therapy -
and complications such as perivalvular abscess formation, valvular
destruction and persistent pyrexia necessitated surgical intervention. In
a multicentre prospective cohort study of 384 consecutive patients with
infective endocarditis, it was observed that a vegetation size of >10 mm
and severe vegetation mobility were predictors of new embolic events.
Equally, a meta-analysis showed that the echocardiographic detection of a
vegetation size of >=10 mm in patients with left-sided infective
endocarditis posed significantly increased risk of embolic events. In
another prospective cohort study of 211 patients, it was observed that
there was an increased risk of embolization with vegetations of >=10 mm.
In similarly another study of 178 consecutive patients with infective
endodarditis assessed by echocardiographic study, it was found out that
there was a significantly higher incidence of embolism with a vegetation
size >10 mm (60%, P<0.001). When using the area of the vegetation, a
vegetation size of >1.8 cm² predicted the development of a
complication. Assuming that the vegetation was a sphere, the calculated
diameter will be 8 mm when using 4r² for the area. However, for
right-sided infection endocarditis, a vegetation size of >20 mm was
associated with a higher mortality when compared with a vegetation size of
<=20 mm. There is strong evidence to suggest that a vegetation size of
>=10 mm especially for left-sided infective endocarditis is an indication
for surgery. 2012 The Author. Published by Oxford University Press on
behalf of the European Association for Cardio-thoracic Surgery. All rights
reserved.

<11>
Accession Number
2012696853
Authors
Garrido-Martin P. Nassar-Mansur M.I. De La Llana-Ducros R. Virgos-Aller
T.M. Fortunez P.M.R. Avalos-Pinto R. Jimenez-Sosa A. Martinez-Sanz R.
Institution
(Garrido-Martin, Nassar-Mansur, De La Llana-Ducros, Avalos-Pinto,
Martinez-Sanz) Department of Cardiovascular Surgery, Hospital
Universitario de Canarias, University of la Laguna, Ofra s/n. La Cuesta,
La Laguna 38320, Santa Cruz de Tenerife, Spain
(Virgos-Aller) Department of Pharmacy, Hospital Universitario de Canarias,
University of la Laguna, La Laguna, Santa Cruz de Tenerife, Spain
(Fortunez, Jimenez-Sosa) Mixed Research Unit HUC-ULL, Hospital
Universitario de Canarias, University of la Laguna, La Laguna, Santa Cruz
de Tenerife, Spain
(Martinez-Sanz) Department of Surgery of la Laguna University, Hospital
Universitario de Canarias, University of la Laguna, La Laguna, Santa Cruz
de Tenerife, Spain
Title
The effect of intravenous and oral iron administration on perioperative
anaemia and transfusion requirements in patients undergoing elective
cardiac surgery: A randomized clinical trial.
Source
Interactive Cardiovascular and Thoracic Surgery. 15 (6) (pp 1013-1018),
2012. Date of Publication: December 2012.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
Objectives: Anaemia is a frequent complication after cardiopulmonary
bypass surgery. Iron therapy has been variably employed by medical centres
over the years. In our study we test o test the clinical effectiveness of
intravenous and oral iron supplementation in correcting anaemia, and its
impact on blood transfusion requirements, in patients undergoing
cardiopulmonary bypass surgery. Method: A double-blind, randomized,
placebo-controlled clinical trial with three parallel groups of patients.
Group I (n = 54): intravenous iron(III)-hydroxide sucrose complex, three
doses of 100 mg/24 h during pre- and postoperative hospitalization and 1
pill/24 h of oral placebo in the same period and during 1 month after
discharge. Group II (n = 53): oral ferrous fumarate iron 1 pill/24 h pre-
and postoperatively and during 1 month after discharge, and intravenous
placebo while hospitalized. Group III (n = 52): oral and intravenous
placebo pre- and postoperatively, following the same protocol. Data were
collected preoperatively, at theatre, at intensive care unit admission,
before hospital discharge and 1 month later. Results: (1) Baseline
clinical and demographic characteristics and surgical procedures were
similar in the three groups; (2) no inter-group differences were found in
haemoglobin and haematocrit during the postoperative period; (3) the
intravenous iron group showed higher serum ferritin levels at hospital
discharge (1321 +/- 495 ng/ml; P < 0.001) and 1 month later (610 +/- 387;
P < 0.001) compared with the other groups and (4) we did not observe
statistical differences in blood transfusion requirements between the
three groups. Conclusion: The use of intravenous or oral iron
supplementation proved ineffective in correcting anaemia after
cardiopulmonary bypass and did not reduce blood transfusion requirements.
[Current Controlled Trials number: NCT01078818 (oral and intravenous iron
in patients postoperative cardiovascular surgery under EC)]. 2012 The
Author. Published by Oxford University Press on behalf of the European
Association for Cardio-Thoracic Surgery. All rights reserved.

<12>
Accession Number
2012696851
Authors
Sepehripour A.H. Lo T.T. Shipolini A.R. McCormack D.J.
Institution
(Sepehripour) Department of Cardiothoracic Surgery, Wythenshawe Hospital,
Manchester, United Kingdom
(Lo) Department of Obstetrics and Gynaecology, William Harvey Hospital,
Ashford-Kent, United Kingdom
(Shipolini, McCormack) Department of Cardiothoracic Surgery, London Chest
Hospital, Bonner Road, London E2 9JX, United Kingdom
Title
Can pregnant women be safely placed on cardiopulmonary bypass?.
Source
Interactive Cardiovascular and Thoracic Surgery. 15 (6) (pp 1063-1071),
2012. Date of Publication: December 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 cardiopulmonary bypass can be used safely
with satisfactory maternal and foetal outcomes in pregnant patients
undergoing cardiac surgery. A total of 679 papers were found using the
reported searches of which 14 represented the best evidence to answer the
clinical question. The authors, date, journal, study type, population,
main outcome measures and results are tabulated. Reported measures were
maternal and foetal mortality and complications, mode of delivery,
cardiopulmonary bypass and aortic cross-clamp times, perfusate flow rate
and temperature and maternal NYHA functional class. The most recent of the
best evidence studies, a retrospective observational study of 21 pregnant
patients reported early and late maternal mortalities of 4.8 and 14.3%,
respectively, and a foetal mortality of 14.3%. Median cardiopulmonary
bypass and aortic cross-clamp times were 53 and 35 min, respectively, and
the median bypass temperature was 37degreeC. Three larger retrospective
reviews of the literature reported maternal mortality rates of 2.9-5.1%
and foetal mortality rates of 19-29%. Mean cardiopulmonary bypass times
ranged from 50.5 to 77.8 min. Another retrospective observational study
reported maternal mortality of 13.3% and foetal mortality of 38.5%. Mean
cardiopulmonary bypass and aortic cross-clamp times were 89.1 and 62.8
min, respectively, with a mean bypass temperature of 31.8degreeC. A
retrospective case series reported no maternal mortality and one case of
foetal mortality. Median cardiopulmonary bypass and aortic cross-clamp
times were 101 and 88 min, respectively. Eight case reports described 10
patients undergoing cardiopulmonary bypass. There were no reports of
maternal mortality and one report of foetal mortality. Mean
cardiopulmonary bypass and aortic cross-clamp times were 105 and 50 min,
respectively. We conclude that while the use of cardiopulmonary bypass
during pregnancy poses a high risk for both the mother and the foetus, the
use of high-flow, high-pressure, pulsatile, normothermic bypass and
continuous foetal and uterine monitoring can allow cardiac surgery with
the use of cardiopulmonary bypass to be performed with the greatest
control of risk in the pregnant patient. 2012 The Author. Published by
Oxford University Press on behalf of the European Association for
Cardio-Thoracic Surgery. All rights reserved.

<13>
Accession Number
2012693022
Authors
Longo U.G. Loppini M. Romeo G. Maffulli N. Denaro V.
Institution
(Longo, Loppini, Romeo, Denaro) Centre for Sport and Exercise Medicine,
London, United Kingdom
(Longo, Loppini, Romeo, Denaro) Surgeon Campus Bio-medico University,
Department of Orthopaedic and Trauma Surgery, Via Alvaro del Portillo 200,
00128 Trigoria, Rome, Italy
(Maffulli) Centre for Sport and Exercise Medicine, Mile End Hospital,
Queen Mary University of London, 275 Bancroft Road, London E1 4DG, United
Kingdom
Title
Errors of level in spinal surgery: An evidence-based systematic review.
Source
Journal of Bone and Joint Surgery - Series B. 94 B (11) (pp 1546-1550),
2012. Date of Publication: November 2012.
Publisher
British Editorial Society of Bone and Joint Surgery (22 Buckingham Street,
London WC2N 6ET, United Kingdom)
Abstract
Wrong-level surgery is a unique pitfall in spinal surgery and is part of
the wider field of wrong-site surgery. Wrong-site surgery affects both
patients and surgeons and has received much media attention. We performed
this systematic review to determine the incidence and prevalence of
wrong-level procedures in spinal surgery and to identify effective
prevention strategies. We retrieved 12 studies reporting the incidence or
prevalence of wrong-site surgery and that provided information about
prevention strategies. Of these, ten studies were performed on patients
undergoing lumbar spine surgery and two on patients undergoing lumbar,
thoracic or cervical spine procedures. A higher frequency of wrong-level
surgery in lumbar procedures than in cervical procedures was found. Only
one study assessed preventative strategies for wrong-site surgery,
demonstrating that current site-verification protocols did not prevent
about one-third of the cases. The current literature does not provide a
definitive estimate of the occurrence of wrong-site spinal surgery, and
there is no published evidence to support the effectiveness of
site-verification protocols. Further prevention strategies need to be
developed to reduce the risk of wrong-site surgery. 2012 British Editorial
Society of Bone and Joint Surgery.

<14>
Accession Number
2012697311
Authors
Rosendahl J. Tigges-Limmer K. Gummert J. Dziewas R. Albes J.M. Strauss B.
Institution
(Rosendahl, Strauss) Institute of Psychosocial Medicine and Psychotherapy,
Jena University Hospital, Friedrich Schiller University, Stoystrasse 3,
DE-07740 Jena, Germany
(Tigges-Limmer, Gummert) Clinic for Thoracic and Cardiovascular Surgery,
Heart and Diabetes Center North Rhine-Westphalia, Bad Oeynhausen, Germany
(Dziewas, Albes) Department of Cardiovascular Surgery, Heart Center
Brandenburg, Bernau, Germany
(Dziewas) Theological Seminary Elstal, Wurstermark, Germany
Title
Bypass surgery with psychological and spiritual support (the BY.PASS
Study): Results of a pragmatic trial based on patients' preference.
Source
Psychotherapy and Psychosomatics. 82 (1) (pp 35-44), 2013. Date of
Publication: November 2012.
Publisher
S. Karger AG (Allschwilerstrasse 10, P.O. Box, Basel CH-4009, Switzerland)
Abstract
Background: Some general hospitals within the German health system provide
supportive interventions, psychological as well as spiritual, to their
patients. It remains to be proven if these interventions are effective
when used in routine clinical practice. Aim: To evaluate the effectiveness
of psychological and spiritual interventions on improving recovery
following bypass surgery. Methods: The BY.PASS study is a pragmatic,
patient preference trial (ISRCTN 07297983). Adult patients scheduled for
elective coronary bypass surgery were enrolled. Patients were assigned to
study conditions according to their personal preference: preference for
psychological interventions, for spiritual interventions or for no
intervention. Patients who were open for any kind of intervention were
randomly assigned either to psychological or spiritual interventions.
During a control period, patients were asked about their preference, but
did not receive any interventions. Primary outcomes of the study were
in-hospital morbidity and early mortality. Psychological measures served
as secondary outcomes. Results: A total of 847 patients were enrolled.
Patients of the control (n = 260) and the intervention group (n = 269) who
explicitly wanted to have interventions were compared. No significant
treatment effects either for morbidity (d = 0.08, 95% CI-0.09 to 0.25), or
for mortality (OR = 1.81; 95% CI 0.50-6.57) could be found. A reduction of
negative mood resulted from both interventions. Conclusions: Although the
effects observed were small, the study can serve as a basis to discuss
methodological as well as theoretical aspects of a pragmatic trial, based
upon patients' preferences. 2012 S. Karger AG, Basel.

<15>
[Use Link to view the full text]
Accession Number
2012695888
Authors
Touzot M. Soulillou J.P. Dantal J.
Institution
(Touzot, Soulillou, Dantal) Institut de Transplantation Urologie,
Nephrologie and Institut National de la Sante et de la Recherche Me Dicale
UMR1064, Nantes University Hospital, 30 Bd Jean Monnet, 44093 Nantes,
France
Title
Mechanistic target of rapamycin inhibitors in solid organ transplantation:
From benchside to clinical use.
Source
Current Opinion in Organ Transplantation. 17 (6) (pp 626-633), 2012. Date
of Publication: December 2012.
Publisher
Lippincott Williams and Wilkins (530 Walnut Street,P O Box 327,
Philadelphia PA 19106-3621, United States)
Abstract
PURPOSE OF REVIEW: Here, we review recent advances and new insights in
mechanistic target of rapamycin (mTOR) biology (signalling pathway, kidney
biology and immune system), and recent clinical data on mTOR inhibitors
related to solid organ transplantation. RECENT FINDINGS: The mTOR pathway
is a major integrator of signals governing protein and lipid biosynthesis
and growth factor-driven cell cycle progression. Recent findings have
emphasized a critical role of mTOR in cellular homeostasis with a crucial
role in podocyte function. Beyond CD8 and regulatory T-cell control, mTOR
protein is involved in critical biological functions of T helper cells or
dendritic cells. New specific inhibitors of mTORC1/C2 are available and
shed new light on mTOR functions. Finally, clinical trials have better
defined the use of mTOR inhibitors and emphasized their role in cancer
prevention. SUMMARY: The mTOR pathway is considered as a key integrator of
multiple inputs that drives numerous biological processes in cell biology.
mTOR inhibitors are potent immunosuppressive drugs for solid organ
transplantation. Newly designed specific inhibitors of mTOR complex 1 and
2 offer promising therapeutic effects and a better understanding of the
pathway. Many conditions may benefit from mTOR inhibition for a short
period, but tolerance of treatment in a chronic setting remains a major
concern. Copyright 2012 Lippincott Williams & Wilkins.

<16>
Accession Number
2012689248
Authors
Grundeken M.J. Smits M. Harskamp R.E. Damman P. Woudstra P. Hoorweg A.J.
Baan Jr. J. Arkenbout E.K. Piek J.J. Vis M.M. Henriques J.P.S. Koch K.T.
Tijssen J.G. de Winter R.J. Wykrzykowska J.J.
Institution
(Grundeken, Smits, Harskamp, Damman, Woudstra, Hoorweg, Baan Jr.,
Arkenbout, Piek, Vis, Henriques, Koch, Tijssen, de Winter, Wykrzykowska)
Department of Cardiology, Academic Medical Center, University of
Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, Netherlands
Title
Six-month clinical outcomes of the Tryton Side Branch Stent for the
treatment of bifurcation lesions.
Source
Netherlands Heart Journal. 20 (11) (pp 439-446), 2012. Date of
Publication: November 2012.
Publisher
Bohn Stafleu van Loghum (P.O. Box 75971, Amsterdam 1070 A2, Netherlands)
Abstract
Aims Percutaneous coronary intervention (PCI) of a bifurcation lesion (BL)
is still associated with poorer clinical outcomes when compared with PCI
of a non-BL. Therefore, several dedicated coronary bifurcation stents,
such as the Tryton Side Branch Stent (Tryton Medical, Durham, NC, USA),
were developed to improve clinical outcomes. We investigated 6-month
clinical outcomes after placement of a Tryton stent in 91 patients treated
for 93 BLs in our centre. Methods and results All consecutive patients who
have undergone PCI of a BL treated with the Tryton stent in our centre
were included. Outcomes were defined as any death, cardiac death,
myocardial infarction (MI), any revascularisation, ischaemia-driven target
vessel revascularisation (TVR), ischaemia-driven target lesion
revascularisation (TLR), stent thrombosis, and target vessel failure (TVF;
composite of cardiac death, MI, and ischaemia-driven TVR). Event rates
were estimated using the Kaplan-Meier method. Thirty-eight (42 %) patients
with acute coronary syndrome (ACS) were included (16 % ST-segment
elevation MI (STEMI)). The 6-month event rates were 5.4 % (death), 4.3 %
(cardiac death), 2.2 % (MI), 4.5 % (any revascularisation), 4.5 % (TVR),
4.5 % (TLR) and 9.7 % (TVF). Conclusion In a real-world all-comers
single-centre registry, the use of the Tryton Side Branch Stent was
associated with acceptable procedural and promising clinical outcomes at 6
months, including ACS and STEMI patients. Springer Media / Bohn Stafleu
van Loghum 2012.

<17>
Accession Number
2012688636
Authors
Romeo S. Jacobson P. Maglio C. Svensson P.-A. Burza M.A. Peltonen M.
Pirazzi C. Sjostrom L. Sjoholm K. Carlsson L.M.S.
Institution
(Romeo, Jacobson, Maglio, Svensson, Burza, Pirazzi, Sjostrom, Sjoholm,
Carlsson) Department of Molecular and Clinical Medicine, Sahlgrenska
Academy, University of Gothenburg, Gothenburg, Sweden
(Peltonen) Chronic Disease Epidemiology and Prevention Unit, Department of
Chronic Disease Prevention, National Institute for Health and Welfare,
Helsinki, Finland
Title
Cardiovascular events after bariatric surgery in obese subjects with type
2 diabetes.
Source
Diabetes Care. 35 (12) (pp 2613-2617), 2012. Date of Publication: December
2012.
Publisher
American Diabetes Association Inc. (1701 North Beauregard St., Alexandria
VA 22311, United States)
Abstract
OBJECTIVE - Obese individuals with type 2 diabetes have an increased risk
of cardiovascular disease. The effect of bariatric surgery on
cardiovascular events in obese individuals with type 2 diabetes remains to
be determined. The Swedish Obese Subjects (SOS) study is a prospective,
controlled intervention study that examines the effects of bariatric
surgery on hard end points. The aim of the present study was to examine
the effect of bariatric surgery on cardiovascular events in the SOS study
participants with type 2 diabetes. RESEARCH DESIGN AND METHODS - All SOS
study participants with type 2 diabetes at baseline were included in the
analyses (n = 345 in the surgery group and n = 262 in the control group).
Mean follow-up was 13.3 years (interquartile range 10.2-16.4) for all
cardiovascular events. RESULTS - Bariatric surgery was associated with a
reduced myocardial infarction incidence (38 events among the 345 subjects
in the surgery group vs. 43 events among the 262 subjects in the control
group; log-rank P = 0.017; adjusted hazard ratio [HR] 0.56 [95% CI
0.34-0.93]; P = 0.025). No effect of bariatric surgery was observed on
stroke incidence (34 events among the 345 subjects in the surgery group
vs. 24 events among the 262 subjects in the control group; log-rank P =
0.852; adjusted HR 0.73 [0.41-1.30]; P = 0.29). The effect of surgery in
reducing myocardial infarction incidence was stronger in individuals with
higher serum total cholesterol and triglycerides at baseline (interaction
P value = 0.02 for both traits). BMI (interaction P value = 0.12) was not
related to the surgery outcome. CONCLUSIONS - Bariatric surgery reduces
the incidence of myocardial infarction in obese individuals with type 2
diabetes. Preoperative BMI should be integrated with metabolic parameters
to maximize the benefits of bariatric surgery. 2012 by the American
Diabetes Association.

<18>
Accession Number
2012686319
Authors
Thadani U.
Institution
(Thadani) University of Oklahoma Health Sciences Center, Staff
Cardiologist, OU Medical Center, and VA Medical Center, Oklahoma City, OK
73104, United States
Title
Should ranolazine be used for all patients with ischemic heart disease or
only for symptomatic patients with stable angina or for those with
refractory angina pectoris? A critical appraisal.
Source
Expert Opinion on Pharmacotherapy. 13 (17) (pp 2555-2563), 2012. Date of
Publication: December 2012.
Publisher
Informa Healthcare (69-77 Paul Street, London EC2A 4LQ, United Kingdom)
Abstract
Introduction: Ranolazine is a novel antianginal and anti-ischemic agent,
that, unlike other available antianginal drugs in the United States
(beta-blockers, organic nitrates, and calcium channel blockers), has no
significant effect on either heart rate or blood pressure. Its exact
mechanism of action is unknown. Ranolazine does increase
electrocardiographic QTc interval in a dose-related manner, but at
therapeutic doses it has no proarrhythmic effects. Ranolazine (ER) at
doses of 500 and 1,000 mg twice daily is currently approved for the
treatment of angina pectoris either as monotherapy or added to
beta-blockers, nitrates, and calcium channel blockers. Ranolazine (ER) is
currently not approved for the treatment of unstable angina, silent
ischemia, or cardiac arrhythmias. The most common adverse effects reported
in clinical trials during ranolazine (ER) treatment are dizziness,
headaches, constipation, and nausea. Areas covered: Recent changes in
ranolazine (ER) labeling have led to its increased use for treating
patients with ischemic heart disease. This review addresses its
appropriate use. All publications were reviewed and those relevant were
included. Expert opinion: Ranolazine (ER) is an effective antianginal and
anti-ischemic agent, but I restrict its use to treat patients with stable
angina pectoris. Informa UK, Ltd.

<19>
[Use Link to view the full text]
Accession Number
2012695411
Authors
Jacobi J. Bircher N. Krinsley J. Agus M. Braithwaite S.S. Deutschman C.
Freire A.X. Geehan D. Kohl B. Nasraway S.A. Rigby M. Sands K. Schallom L.
Taylor B. Umpierrez G. Mazuski J. Schunemann H.
Institution
(Jacobi) Indiana University Health Methodist Hospital, Indianapolis, IN,
United States
(Bircher) University of Pittsburgh Medical Center, Pittsburgh, PA, United
States
(Krinsley) Stamford Hospital, Stamford, CT, United States
(Agus) Intermediate Care Unit, Children's Hospital Boston, Boston, MA,
United States
(Braithwaite) Endocrine Consults and Care, Evanston, IL, United States
(Deutschman) Critical Care and Surgery, Perelman School of Medicine,
University of Pennsylvania, Philadelphia, PA, United States
(Freire) PCC and Sleep Medicine, University of Tennessee, Health Science
Center, Memphis, TN, United States
(Geehan) University of Missouri Kansas City, Kansas City, MO, United
States
(Kohl) University of Pennsylvania, Philadelphia, PA, United States
(Nasraway) SICU, Tufts/New England Medical Center, Boston, MA, United
States
(Rigby) Pediatric Critical Care, Riley Hospital for Children,
Indianapolis, IN, United States
(Sands) Novant Health, Winston Salem, NC, United States
(Schallom) Barnes-Jewish Hosptial, St. Louis, MO, United States
(Taylor) Barnes Jewish Hospital, St. Louis, MO, United States
(Umpierrez) Emory University School of Medicine, Atlanta, GA, United
States
(Mazuski) Washington University St. Louis, St. Louis, MO, United States
(Schunemann) McMaster University, Hamilton, ON, Canada
Title
Guidelines for the use of an insulin infusion for the management of
hyperglycemia in critically ill patients.
Source
Critical Care Medicine. 40 (12) (pp 3251-3276), 2012. Date of Publication:
December 2012.
Publisher
Lippincott Williams and Wilkins (530 Walnut Street,P O Box 327,
Philadelphia PA 19106-3621, United States)
Abstract
Objective:: To evaluate the literature and identify important aspects of
insulin therapy that facilitate safe and effective infusion therapy for a
defined glycemic end point. Methods:: Where available, the literature was
evaluated using Grades of Recommendation, Assessment, Development, and
Evaluation (GRADE) methodology to assess the impact of insulin infusions
on outcome for general intensive care unit patients and those in specific
subsets of neurologic injury, traumatic injury, and cardiovascular
surgery. Elements that contribute to safe and effective insulin infusion
therapy were determined through literature review and expert opinion. The
majority of the literature supporting the use of insulin infusion therapy
for critically ill patients lacks adequate strength to support more than
weak recommendations, termed suggestions, such that the difference between
desirable and undesirable effect of a given intervention is not always
clear. RECOMMENDATIONS:: The article is focused on a suggested glycemic
control end point such that a blood glucose 150 mg/dL triggers
interventions to maintain blood glucose below that level and absolutely
<180 mg/dL. There is a slight reduction in mortality with this treatment
end point for general intensive care unit patients and reductions in
morbidity for perioperative patients, postoperative cardiac surgery
patients, post-traumatic injury patients, and neurologic injury patients.
We suggest that the insulin regimen and monitoring system be designed to
avoid and detect hypoglycemia (blood glucose <=70 mg/dL) and to minimize
glycemic variability.Important processes of care for insulin therapy
include use of a reliable insulin infusion protocol, frequent blood
glucose monitoring, and avoidance of finger-stick glucose testing through
the use of arterial or venous glucose samples. The essential components of
an insulin infusion system include use of a validated insulin titration
program, availability of appropriate staffing resources, accurate
monitoring technology, and standardized approaches to infusion
preparation, provision of consistent carbohydrate calories and nutritional
support, and dextrose replacement for hypoglycemia prevention and
treatment. Quality improvement of glycemic management programs should
include analysis of hypoglycemia rates, run charts of glucose values <150
and 180 mg/dL. The literature is inadequate to support recommendations
regarding glycemic control in pediatric patients. Conclusions:: While the
benefits of tight glycemic control have not been definitive, there are
patients who will receive insulin infusion therapy, and the suggestions in
this article provide the structure for safe and effective use of this
therapy. 2012 by the Society of Critical Care Medicine and Lippincott
Williams and Wilkins.

<20>
Accession Number
2012692667
Authors
O'Neil M.P. Fleming J.C. Badhwar A. Guo L.R.
Institution
(O'Neil, Badhwar, Guo) Departments of Surgery and Clinical Perfusion
Services, Division of Cardiac Surgery, London Health Sciences Centre,
London, ON, Canada
(O'Neil, Badhwar) Department of Medical Biophysics, Schulich School of
Medicine and Dentistry, University of Western Ontario, London, ON, Canada
(Fleming, Badhwar) Centre for Critical Illness Research, Lawson Health
Research Institute, Victoria Research Laboratories, London, ON, Canada
Title
Pulsatile versus nonpulsatile flow during cardiopulmonary bypass:
Microcirculatory and systemic effects.
Source
Annals of Thoracic Surgery. 94 (6) (pp 2046-2053), 2012. Date of
Publication: December 2012.
Publisher
Elsevier USA (6277 Sea Harbor Drive, Orlando FL 32862 8239, United States)
Abstract
Background: Controversy exists regarding the optimal perfusion modality
during cardiopulmonary bypass (CPB). Here we compare the effects of
pulsatile versus nonpulsatile perfusion on microvascular blood flow during
and after CPB. Methods: High-risk cardiac surgical patients were randomly
assigned to have pulsatile (n = 10) or nonpulsatile (n = 10) flow during
CPB. The sublingual microcirculation was assessed using orthogonal
polarization spectral imaging. Hemodynamic and microvascular variables
were obtained after anesthesia (baseline), during CPB, and post-CPB.
Results: Compared with baseline, a normal microcirculatory blood flow
pattern was accomplished at all time points under pulsatile flow
conditions. Peaking 24 hours postoperatively, a higher proportion of
normally perfused microvessels occurred under pulsatile versus
nonpulsatile flow (56.0% +/- 3.9% vs 33.3% +/- 4.1%; p < 0.05).
Concurrently, pulsatility resulted in a reduction in the prevalence of
pathologic hyper-dynamically perfused vessels (6.0% +/- 3.4% vs 19.6% +/-
8.8%; p < 0.05). Leukocyte adherence decreased relative to the
nonpulsatile group both during and after CPB. Furthermore, peak lactate
levels were reduced under pulsatile flow conditions postoperatively.
Conclusions: Pulsatile perfusion is superior to nonpulsatile perfusion at
preserving the microcirculation, which may reflect attenuation of the
systemic inflammatory response during CPB. We suggest the implementation
of pulsatile flow can better optimize microvascular perfusion, and may
lead to improved patient outcomes in high-risk cardiac surgical procedures
requiring prolonged CPB time. 2012 The Society of Thoracic Surgeons.

<21>
Accession Number
2012690995
Authors
Mennander A.A. Shalaby A. Oksala N. Leppanen T. Hamalainen M. Huovinen S.
Zhao F. Moilanen E. Tarkka M.
Institution
(Mennander, Shalaby, Tarkka) Heart Center, Cardiac Research, Tampere
University Hospital, Teiskontie 35, PL 2000 Tampere, 33521, Finland
(Oksala) Department of Vascular Surgery, Tampere University Hospital,
Tampere, Finland
(Leppanen, Hamalainen) Immunopharmacology Research Group, University of
Tampere School of Medicine, Tampere University Hospital, Tampere, Finland
(Huovinen) Department of Pathology, Tampere University Hospital, Tampere
University, Tampere, Finland
(Zhao, Moilanen) Advanced Microscopy Unit, Haartman Institute, Helsinki
University, Helsinki, Finland
Title
Diazoxide may protect endothelial glycocalyx integrity during coronary
artery bypass grafting.
Source
Scandinavian Cardiovascular Journal. 46 (6) (pp 339-344), 2012. Date of
Publication: December 2012.
Publisher
Informa Healthcare (69-77 Paul Street, London EC2A 4LQ, United Kingdom)
Abstract
Objectives. Plasma hyaluronan and syndecan-1 levels represent shedding of
the endothelium glycocalyx during ischemia and edema. Diazoxide, a K
_ATP-channel opener, has been shown to decrease myocardial edema
during coronary artery bypass grafting (CABG). We evaluated whether
Diazoxide exerts an impact on plasma hyaluronan and syndecan-1 levels
during CABG. Design. Representative blood samples for hyaluronan and
syndecan-1, before, during and after surgery, were obtained in 13 out of
16 patients that had a history of stable coronary artery disease
undergoing CABG with or without Diazoxide. Electron microscopy from
biopsies procured from the right atrium in 9 patients was performed to
confirm ultrastructural differences among patients before and during CABG.
Results. Ultrastructural differences were apparent between individual
patients already before operation at base line reflecting differences in
the severity of myocardial ischemia and edema. A significant decrease of
hyaluronan and syndecan-1 values was observed in patients with Diazoxide
after surgery (p < 0.04). Significant correlation of Plasma hyaluronan and
syndecan-1 levels was observed in patients with Diazoxide but not in
controls (p < 0.005, Spearman rank rho). Conclusion. Diazoxide may have an
impact on levels of peripheral plasma hyaluronan and syndecan-1 after
CABG, suggesting decreased shedding of the endothelial glycocalyx layer.
2012 Informa Healthcare.

<22>
Accession Number
70935525
Authors
Layton J.B. Kshirsagar A.V. Simpson R. Pate V. Jonson-Funk M. Sturmer T.
Brookhart M.A.
Institution
(Layton, Pate, Jonson-Funk, Sturmer, Brookhart) Epidemiology, University
of North Carolina at Chapel Hill, Chapel Hill, NC, United States
(Layton, Kshirsagar) Medicine, Division of Nephrology, University of North
Carolina at Chapel Hill, Chapel Hill, NC, United States
(Simpson) Medicine, Division of Cardiology, University of North Carolina
at Chapel Hill, Chapel Hill, NC, United States
Title
The effect of statin use on acute kidney injury risk following coronary
artery bypass graft surgery.
Source
Pharmacoepidemiology and Drug Safety. Conference: 28th International
Conference on Pharmacoepidemiology and Therapeutic Risk Management, ICPE
2012 Barcelona Spain. Conference Start: 20120823 Conference End: 20120826.
Conference Publication: (var.pagings). 21 (pp 161), 2012. Date of
Publication: August 2012.
Publisher
John Wiley and Sons Ltd
Abstract
Background: Acutekidney injury (AKI)is a serious complication of
cardiovascular surgery.Non-experimental studies suggest that pre-surgical
statin use may reduce post-surgical AKI, but others have not found an
association. Methodologic differences in study designs leave uncertainty
regarding the magnitude or presence of the protective effect. Objectives:
We estimated the effect of pre-operative statin initiation on
post-coronary artery bypass graft (CABG) AKI using a new epidemiologic
approach more closely simulating a randomized controlled trial in a large
CABG patient population. Methods: We employed healthcare claims data from
large, employer-based andMedicare insurance data. Tominimize the healthy
user bias we restricted our analysis to patients without a history of
statin use. We identified 24,693 patients undergoing non-emergency CABG
surgery who either newly initiated a statin within the 20 days prior to
surgery or were unexposed for at least 200 days prior to CABG. AKI was
identified in the 15 days following CABG from inpatient ICD-9-CM diagnosis
codes. Multivariable Poisson regression was used to calculate adjusted
risk ratios (RR) and 95% confidence intervals (CI). Analyses were repeated
using propensity score methods adjusted for clinical and healthcare
utilization variables. Results: Post-CABGAKI developed in 3.7%of statin
initiators and 6.2% of non-initiators. After adjustment for clinical
characteristics and markers of disease management and healthcare
utilization, we observed a protective effect of statin initiation on AKI
(RR = 0.80, 95% CI 0.67, 0.96). This effect differed by age: >=65 years,
RR = 0.90 (95% CI: 0.71, 1.14); <65 years, RR = 0.69 (95% CI: 0.52, 0.91),
although AKI was much more common in the older age group (8.1 vs. 3.9%).
Conclusions: Statin initiation immediately prior to CABG may modestly
reduce the risk of post-operative AKI.

<23>
Accession Number
70932178
Authors
Fischer B.M.
Institution
(Fischer) Deparment of Nuclear Medicine and Pet, Rigshospitalet,
Copenhagen, Denmark
Title
PET-CT imaging.
Source
Journal of Thoracic Oncology. Conference: 3rd European Lung Cancer
Conference, ELCC 2012 Geneva Switzerland. Conference Start: 20120418
Conference End: 20120421. Conference Publication: (var.pagings). 7 (6
SUPPL. 1) (pp S11), 2012. Date of Publication: June 2012.
Publisher
International Association for the Study of Lung Cancer
Abstract
Positron Emission Tomography with computer tomography (PET-CTCT) and the
clinical use of this imaging technology has developed rapidly during the
last decade, especially in the field of lung cancer. The first PET-CT
scanner was introduced in 2000 in the United States, combining the
functional information from the PET scanner with anatomical structures
obtained by CTCT. During the last decade app. 2000 PET/CTCT scanners have
been installed in the United States (6.5 scanner per million people), 70
in Germany (1.2 scanner per million people) and 350 PET/CT scanners in
Europe as a whole (0.4 scanner per million people). The role and potential
impact of PET/CTCT in diagnosing and staging patients with non-small lung
cancer is well established and incorporated in several clinical guidelines
and recommendations. The European Society of Thoracic Surgery (ESTS ) as
well as the American College of Chest Physicians (ACC P) has published
guidelines for proper preoperative mediastinal staging, both including a
PET/CT examination. PET/CT is potentially hampered by a relatively high
frequency of false positive findings; however, both specificity and
sensitivity can be increased by detailed knowledge of patient history and
side-by-side reading by an experienced radiologist and nuclear medicine
physician. This presentation includes a brief introduction to the
technology; including limitations and pitfalls. Through a presentation of
recent meta-analyses as well as clinical studies, the role of PET/CTCT in
staging patients with non-small cell lung cancer will be described and
discussed. Current issues of controversies, e.g. the value of SUV and the
use of low dose versus diagnostic CT will be addressed, as well as
considerations on cost-effectiveness and future perspectives.