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<1>
Accession Number
2014250697
Authors
Cooper Jr. L.T. Keren A. Sliwa K. Matsumori A. Mensah G.A.
Institution
(Cooper Jr.) Division of Cardiovascular Diseases, Mayo Clinic, Rochester,
MN, United States
(Keren) Center for Heart Failure and Heart Muscle Diseases, Hadassah -
Hebrew University Hospital, Jerusalem, Israel
(Sliwa) Hatter Institute for Cardiovascular Research University of Cape
Town, Cape Town, South Africa
(Matsumori) Non-Profit Organization Asian Pacific Society of Cardiology,
Kyoto, Japan
(Mensah) Center for Translation Research and Implementation Science
(CTRIS), National Heart, Lung, and Blood Institute, National Institutes of
Health, Bethesda, MD, United States
Title
The global burden of myocarditis: Part 1: A systematic literature review
for the global burden of diseases, injuries, and risk factors 2010 study.
Source
Global Heart. 9 (1) (pp 121-129), 2014. Date of Publication: March 2014.
Publisher
Elsevier
Abstract
Myocarditis contributes to the global burden of cardiovascular disease
primarily through sudden death and dilated cardiomyopathy. A systematic
approach to identify the cardiovascular mortality and major morbidity
attributable to myocarditis has not been performed. A writing group
convened by the GBD 2010 (Global Burden of Diseases, Injuries and Risk
Factors) Study systematically reviewed the world's literature by a manual
review of all titles since 1966 on myocarditis identified using Ovid
Medline, development of a disease model, and provision of estimates when
possible of the incidence, prevalence, risk of death, and major morbidity
for the world regions. Accurate population-based estimates of myocarditis
incidence and prevalence are not directly available in any world region.
However, a model that quantitates the risk of acute death and chronic
heart failure following myocarditis was derived from the published data.
Using hospital dismissal data, the burden of myocarditis as a percentage
of prevalent heart failure varied by age and region from approximately
0.5% to 4.0%. The novel combination of multiple data sources may provide
an estimate of the years of life lost and years of life disabled from
myocarditis. Pending the integration of these data sources, the burden of
dilated cardiomyopathy and myocarditis were reported together in the 2010
GBD report. The 2013 GBD project may refine these estimates with the
inclusion of more comprehensive payor databases and more precise case
definitions. 2014 World Heart Federation (Geneva). Published by Elsevier
Ltd. All rights reserved.

<2>
Accession Number
2014250694
Authors
Bin Abdulhak A.A. Baddour L.M. Erwin P.J. Hoen B. Chu V.H. Mensah G.A.
Tleyjeh I.M.
Institution
(Bin Abdulhak) Department of Medicine, School of Medicine, University of
Missouri - Kansas City, Kansas City, MO, United States
(Baddour, Tleyjeh) Division of Infectious Diseases, Mayo Clinic,
Rochester, MN, United States
(Erwin) Mayo Medical Library, Mayo Clinic, Rochester, MN, United States
(Hoen) Department of Infectious Diseases, Dermatology and Internal
Medicine, University Medical Center of Guadeloupe, cedex, France
(Chu) Division of Infectious Diseases, Department of Medicine, Duke
University Medical Center, Durham, NC, United States
(Mensah) Center for Translation Research and Implementation Science
(CTRIS), National Heart, Lung, and Blood Institute, National Institutes of
Health, Bethesda, MD, United States
(Tleyjeh) Division of Epidemiology, Mayo Clinic, Rochester, MN, United
States
(Tleyjeh) Department of Medicine, Infectious Diseases Section, King-Fahad
Medical City, Riyadh, Saudi Arabia
(Tleyjeh) College of Medicine, Al Faisal University, Riyadh, Saudi Arabia
Title
Global and regional burden of infective endocarditis, 1990-2010: A
systematic review of the literature.
Source
Global Heart. 9 (1) (pp 131-143), 2014. Date of Publication: March 2014.
Publisher
Elsevier
Abstract
Infective endocarditis (IE) is a life-threatening disease associated with
serious complications. The GBD 2010 (Global Burden of Disease, Injuries,
and Risk Factors) study IE expert group conducted a systematic review of
IE epidemiology literature to inform estimates of the burden on IE in 21
world regions in 1990 and 2010. The disease model of IE for the GBD 2010
study included IE death and 2 sequelae: stroke and valve surgery. Several
medical and science databases were searched for IE epidemiology studies in
GBD high-, low-, and middle-income regions published between 1980 and
2008. The epidemiologic parameters of interest were IE incidence,
proportions of IE patients who developed stroke or underwent valve
surgery, and case fatality. Literature searches yielded 1,975 unique
papers, of which 115 published in 10 languages were included in the
systematic review. Eligible studies were population-based (17%),
multicenter hospital-based (11%), and single-center hospital-based studies
(71%). Population-based studies were reported from only 6 world regions.
Data were missing or sparse in many low- and middle-income regions. The
crude incidence of IE ranged between 1.5 and 11.6 cases per 100,000 people
and was reported from 10 countries. The overall mean proportion of IE
patients that developed stroke was 0.158 + 0.091, and the mean proportion
of patients that underwent valve surgery was 0.324 + 0.188. The mean case
fatality risk was 0.211 + 0.104. A systematic review for the GBD 2010
study provided IE epidemiology estimates for many world regions, but
highlighted the lack of information about IE in low- and middle-income
regions. More complete knowledge of the global burden of IE will require
improved IE surveillance in all world regions. 2014 World Heart
Federation (Geneva). Published by Elsevier Ltd. All rights reserved.

<3>
Accession Number
2011419774
Authors
Jacobson T.A.
Institution
(Jacobson) Office of Health Promotion and Disease Prevention, Department
of Medicine, Emory University School of Medicine, Atlanta, GA, United
States
Title
Opening a new lipid "Apo-thecary": Incorporating apolipoproteins as
potential risk factors and treatment targets to reduce cardiovascular
risk.
Source
Mayo Clinic Proceedings. 86 (8) (pp 762-780), 2011. Date of Publication:
August 2011.
Publisher
Mayo Medical Ventures
Abstract
Statins (3-hydroxy-3-methylglutaryl-coenzyme A reductase inhibitors)
represent the cornerstone of drug therapy to reduce lowdensity lipoprotein
(LDL) cholesterol and cardiovascular risk. However, even optimal statin
management of LDL cholesterol leaves many patients with residual
cardiovascular risk, in part because statins are more effective in
reducing LDL cholesterol than apolipoprotein B (Apo B). Apo B may be a
better marker of atherogenic risk than LDL cholesterol because Apo B
measures the total number of all atherogenic particles (total
atherosclerotic burden), including LDL, very low-density lipoprotein,
intermediate-density lipoprotein, remnant lipoproteins, and
lipoprotein(a). To determine whether Apo B is a better indicator of
baseline cardiovascular risk and residual risk after lipid therapy
compared with LDL cholesterol, a MEDLINE search of the literature
published in English from January 1, 1975, through December 1, 2010, was
conducted. On the basis of data from most population studies, elevated Apo
B was more strongly associated with incident coronary heart disease than
similarly elevated LDL cholesterol. Apo B was also a superior benchmark
(vs LDL cholesterol) of statins' cardioprotective efficacy in both
primary-prevention and secondary-prevention trials. To minimize
cardiovascular risk among persons with hypercholesterolemia or
dyslipidemia, the best available evidence suggests that intensive therapy
with statins should be initiated to achieve the lowest possible Apo B
level (with adequate drug toleration) and then other therapies (eg,
niacin, bile acid resins, ezetimibe) added to potentiate these Apo B -
lowering effects. In future consensus lipid-lowering treatment guidelines,
Apo B should be considered as an index of residual risk, a potential
parameter of treatment efficacy, and a treatment target to minimize risk
of coronary heart disease. 2011 Mayo Foundation for Medical Education and
Research.

<4>
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Accession Number
2014311410
Authors
Qi J. Du B. Gurnaney H. Lu P. Zuo Y.
Institution
(Qi, Du, Lu, Zuo) Department of Anesthesiology, West China Hospital,
Sichuan University, Chengdu, Sichuan, China
(Gurnaney) Department of Anesthesiology and Critical Care Medicine,
Children's Hospital of Philadelphia, University of Pennsylvania,
Philadelphia, PA., United States
Title
A prospective randomized observer-blinded study to assess postoperative
analgesia provided by an ultrasound-guided bilateral thoracic
paravertebral block for children undergoing the nuss procedure.
Source
Regional Anesthesia and Pain Medicine. 39 (3) (pp 208-213), 2014. Date of
Publication: May-June 2014.
Publisher
Lippincott Williams and Wilkins
Abstract
BACKGROUND AND OBJECTIVES: This prospective, randomized, single-blinded
study evaluates the effectiveness of the ultrasound-guided bilateral
thoracic paravertebral (BTPV) block for providing postoperative pain
control in children undergoing the Nuss procedure. METHODS: Thirty
American Society of Anesthesiologists I-II children with pectus excavatum,
scheduled for the Nuss procedure, were enrolled at West China Hospital of
Sichuan University. The patients were randomly allocated into the BTPV
block group or the control group. In the BTPV group, 0.25% ropivacaine 0.5
mL/kg with 1:200,000 epinephrine was injected under ultrasound guidance on
each side at the level of the fifth thoracic vertebra. Postoperative pain
was evaluated in both groups for the first 48 hours. Total opioid
administered and cumulative attempts on the patient/parent-controlled
intravenous analgesia (PCA) pump were recorded. Postoperative negative
behavioral changes in the children were evaluated on postoperative days 1,
7, and 30, respectively, using the posthospital behavior questionnaire.
RESULTS: The pain scores were significantly reduced in the postanesthesia
care unit and for the first 48 hours postoperatively in the BTPV group
compared to the control group (P < 0.01). The sufentanil use in the
postanesthesia care unit was significantly greater in the control group
[mean (SD), 0.2 (0) mcg/kg] compared to the BTPV group [mean (SD), 0.05
(0.06) mcg/kg] (P < 0.01). The postoperative sufentanil use was
significantly higher in the control group during the first 24 hours (P <
0.01). Numbers of attempts on the PCA pump were significantly greater in
the control group (P < 0.01). The posthospital behavior questionnaire
score was lower in the BTPV group on day 1, day 7, and 1 month,
respectively (P < 0.01). CONCLUSIONS: Ultrasound-guided BTPV block
provides improved postoperative analgesia for children undergoing the Nuss
procedure as compared with intravenous PCA and decreases the incidence of
postoperative behavioral disturbance. 2014 American Society of Reginal
Anesthesia and Pain Medicine.

<5>
Accession Number
2014307026
Authors
Neragi-Miandoab S. Salemi A.
Institution
(Neragi-Miandoab) Department of Cardiovascular and Thoracic Surgery,
Montefiore Medical Center, Albert Einstein College of Medicine, 3400
Bainbridge Ave, MAP 5, New York, NY 10467, United States
(Salemi) Department of Cardiothoracic Surgery, Cornell University Medical
Center, New York, NY, United States
Title
The most relevant complications of transcatheter aortic valve implantation
according to VARC criteria.
Source
Minerva Cardioangiologica. 62 (2) (pp 205-220), 2014. Date of Publication:
April 2014.
Publisher
Edizioni Minerva Medica S.p.A.
Abstract
Transcatheter aortic valve implantation (TAVI) has been shown to be a
viable alternative for high-risk patients who may not tolerate a surgical
aortic valve replacement. The Edwards Sapien valve and the Core Valve are
the most widely implanted valves worldwide. The indication may be expanded
to intermediate and eventually low-risk patients in future; however, this
will require a better understanding of potential complications and
selecting the right valve for each individual patient. Although TAVI has
expanded physicians' ability to intervene in many high-risk patients,
there are still circumstances under which this procedure should not be
considered, and some drawbacks have been identified, including important
differences in periprocedural risks, aortic regurgitation, stroke, kidney
injury, access associated complications, and significant conduction
disturbances. One major concern is the higher rate of paravalvular leakage
compared to SAVR. The Valve Academic Research Consortium established an
independent collaboration between Academic Research organizations and
specialty societies (cardiology and cardiac surgery) in the US and Europe.
Consensus criteria were developed for the following endpoints: mortality,
myocardial infarction, stroke, bleeding, acute kidney injury, vascular
complications, and prosthetic valve performance. VARC definitions have
already been incorporated into research and clinical practice. However, as
clinical experience with this technology has matured and expanded, certain
definitions have become unsuitable or ambiguous. The VARC 2
recommendations try to define the following clinical endpoints: mortality,
stroke, myocardial infarction, bleeding complications, acute kidney
injury, vascular complications, conduction disturbances, and arrhythmias,
as well as a miscellaneous category including relevant complications not
otherwise categorized. This manuscript reviews the most relevant
complications of TAVI-transapical and transfemoral.

<6>
Accession Number
2014306864
Authors
Ali M.S. Sayed S.A.A.R. Mohamoud M.S. Abd-Elshafy S.K. Almaz M.G.
Institution
(Ali) Departments of Anesthesia, Assiut University Hospital, PO Box 71111,
Assiut, Egypt
(Sayed) Department of Cardiothoracic Surgery Department, Assiut University
Hospital, Assiut, Egypt
(Mohamoud) Department of Clinical Pathology Department, Assiut University
Hospital, Assiut, Egypt
(Abd-Elshafy, Almaz) Departments of Anesthesia, Assiut University
Hospital, Assiut, Egypt
Title
Effect of slow versus rapid rewarming on jugular bulb oxygen saturation in
adult patients undergoing open heart surgery.
Source
Saudi Journal of Anaesthesia. 8 (2) (pp 178-182), 2014. Date of
Publication: April-June 2014.
Publisher
Medknow Publications (A-109, Kanara Business Centre, off Link Road,
Ghatkopar (E), Mumbai 400 075, India)
Abstract
Background: A debate has appeared in the recent literature about the
optimum rewarming strategy (slow vs. rapid) for the best brain function.
This study was designed to compare the effect of slow versus rapid
rewarming on jugular bulb oxygen saturation (SjO ₂) in adult
patients undergoing open heart surgery. Materials and Methods: A total of
80 patients undergoing valve and adult congenital heart surgery were
randomly allocated equally to rapid rewarming group 0.5 (0.136)degreeC/min
and slow rewarming group 0.219 (0.055)degreeC/min in jugular bulb sampling
was taken before, during and after surgery. Surgery was done at
cardiopulmonary bypass (CPB) temperature of 28-30degreeC and rewarming was
performed at the end of the surgical procedure. Results: CPB time,
rewarming period were significantly longer in the slow rewarming group.
Significant difference was observed in the number of the desaturated
patients (SjO ₂ < 50%) between the two groups; 14 (35%) in
rapid rewarming versus 6 (15%) in the slow rewarming group; P = 0.035 by
Fisher's exact test. Conclusions: Slow rewarming could reduce the
incidence of SjO ₂ desaturation during rewarming in adult
patients undergoing open heart surgery.

<7>
Accession Number
2014292854
Authors
Kormi I. Alfakry H. Tervahartiala T. Pussinen P.J. Sinisalo J. Sorsa T.
Institution
(Kormi) Oral and Maxillofacial Department, Oulu University Hospital, Oulu,
Finland
(Kormi, Alfakry, Tervahartiala, Pussinen, Sorsa) Institute of Dentistry,
University of Helsinki, P.O. Box 63, 00014 Helsinki, Finland
(Sorsa) Department of Oral and Maxillofacial Diseases, Helsinki University
Central Hospital, Helsinki, Finland
(Sinisalo) Division of Cardiology, Department of Medicine, Helsinki
University Central Hospital, Helsinki, Finland
Title
The effect of prolonged systemic doxycycline therapy on serum tissue
degrading proteinases in coronary bypass patients: A randomized,
double-masked, placebo-controlled clinical trial.
Source
Inflammation Research. 63 (5) (pp 329-334), 2014. Date of Publication: May
2014.
Publisher
Birkhauser Verlag AG
Abstract
Objective: Serum matrix metalloproteinases (MMP-8, MMP-7) and their
regulators may be associated with the risk of incident cardiovascular
disease events. Doxycycline can be used as matrix metalloproteinase (MMP)
inhibitor independent of its antimicrobial activity. We aimed to
investigate serum inflammatory biomarkers during 4 months of doxycycline
therapy in coronary bypass patients. Materials and methods: Thirty-one
non-smoking men who had previous coronary bypass surgery were randomly
assigned to receive placebo or 100 mg doxycycline daily for 4 months.
Serum samples were collected at baseline before the treatment, and at 2,
4, and 10 months. Serum levels of MMP-7, tissue inhibitor of matrix
metalloproteinase (TIMP)-1, myeloperoxidase, and neutrophil elastase were
analyzed with enzyme-linked immunosorbent assay, MMP-8 by
immunofluorometric assay, and C-reactive protein by rate nephelometry.
Results: At baseline, no significant differences existed between the two
groups. Serum levels of MMP-8, MMP-7, and MMP-8/TIMP-1 were and remained
lower (p = 0.034, p = 0.041, and NS) in the doxycycline group relative to
the placebo group at 4 months of follow-up. Conclusions: Doxycycline
decreases the systemic inflammatory burden in patients with myocardial
infarction and especially down-regulates MMP-7, MMP-8, and MMP-8/TIMP-1.
Doxycycline might prevent or reduce the risk of secondary myocardial
infarctions by providing a systemic anti-proteolytic and -inflammatory
shield. 2013 Springer.

<8>
Accession Number
2014314330
Authors
Adams D.H. Popma J.J. Reardon M.J. Yakubov S.J. Coselli J.S. Deeb G.M.
Gleason T.G. Buchbinder M. Hermiller Jr. J. Kleiman N.S. Chetcuti S.
Heiser J. Merhi W. Zorn G. Tadros P. Robinson N. Petrossian G. Hughes G.C.
Harrison J.K. Conte J. Maini B. Mumtaz M. Chenoweth S. Oh J.K.
Institution
(Adams) Mount Sinai Medical Center, New York, NY, United States
(Robinson, Petrossian) St. Francis Hospital, Roslyn, NY, United States
(Popma) Interventional Cardiology Service, Beth Israel Deaconess Medical
Center, 185 Pilgrim Rd., Boston, MA 02460, United States
(Reardon, Kleiman) Houston Methodist DeBakey Heart and Vascular Center,
Houston, TX, United States
(Coselli) Texas Heart Institute at St. Luke's Medical Center, Houston, TX,
United States
(Yakubov) Riverside Methodist Hospital, Columbus, OH, United States
(Deeb, Chetcuti) University of Michigan Medical Center, Ann Arbor, MI,
United States
(Hermiller Jr., Merhi) Spectrum Health Hospitals, Grand Rapids, MI, United
States
(Gleason) University of Pittsburgh Medical Center, Pittsburgh, PA, United
States
(Buchbinder) Palo Alto Veterans Affairs Medical Center, Palo Alto, CA,
United States
(Heiser) St. Vincent Medical Center, Indianapolis, IN, United States
(Zorn, Tadros) University of Kansas Hospital, Kansas City, KS, United
States
(Hughes, Harrison) Duke University Medical Center, Durham, NC, United
States
(Conte) Johns Hopkins Hospital, Baltimore, United States
(Maini, Mumtaz) Pinnacle Health, Harrisburg, PA, United States
(Chenoweth) Medtronic, Minneapolis, MN, United States
(Oh) Mayo Clinical Foundation, Rochester, MN, United States
Title
Transcatheter aortic-valve replacement with a self-expanding prosthesis.
Source
New England Journal of Medicine. 370 (19) (pp 1790-1798), 2014. Date of
Publication: 2014.
Publisher
Massachussetts Medical Society
Abstract
BACKGROUND: We compared transcatheter aortic-valve replacement (TAVR),
using a self-expanding transcatheter aortic-valve bioprosthesis, with
surgical aortic-valve replacement in patients with severe aortic stenosis
and an increased risk of death during surgery. METHODS: We recruited
patients with severe aortic stenosis who were at increased surgical risk
as determined by the heart team at each study center. Risk assessment
included the Society of Thoracic Surgeons Predictor Risk of Mortality
estimate and consideration of other key risk factors. Eligible patients
were randomly assigned in a 1:1 ratio to TAVR with the self-expanding
transcatheter valve (TAVR group) or to surgical aortic-valve replacement
(surgical group). The primary end point was the rate of death from any
cause at 1 year, evaluated with the use of both noninferiority and
superiority testing. RESULTS: A total of 795 patients underwent
randomization at 45 centers in the United States. In the as-treated
analysis, the rate of death from any cause at 1 year was significantly
lower in the TAVR group than in the surgical group (14.2% vs. 19.1%), with
an absolute reduction in risk of 4.9 percentage points (upper boundary of
the 95% confidence interval, -0.4; P<0.001 for noninferiority; P = 0.04
for superiority). The results were similar in the intention-to-treat
analysis. In a hierarchical testing procedure, TAVR was noninferior with
respect to echocardiographic indexes of valve stenosis, functional status,
and quality of life. Exploratory analyses suggested a reduction in the
rate of major adverse cardiovascular and cerebrovascular events and no
increase in the risk of stroke. CONCLUSIONS: In patients with severe
aortic stenosis who are at increased surgical risk, TAVR with a
self-expanding transcatheter aortic-valve bioprosthesis was associated
with a significantly higher rate of survival at 1 year than surgical
aortic-valve replacement. Copyright 2014 Massachusetts Medical Society.

<9>
Accession Number
2014316624
Authors
Cheng J. Zhang W. Zhang X. Han F. Li X. He X. Li Q. Chen J.
Institution
(Cheng, Zhang, Han, Li, He, Li, Chen) Kidney Disease Center, First
Affiliated Hospital, Medical School of Zhejiang University, 79 Qingchun
Rd, Hangzhou, Zhejiang Province, 310003, China
(Zhang) Department of Nephrology, Hangzhou Red Cross Hospital, Hangzhou,
China
Title
Effect of angiotensin-converting enzyme inhibitors and angiotensin II
receptor blockers on all-cause mortality, cardiovascular deaths, and
cardiovascular events in patients with diabetes mellitus: A meta-analysis.
Source
JAMA Internal Medicine. 174 (5) (pp 773-785), 2014. Date of Publication:
May 2014.
Publisher
American Medical Association
Abstract
IMPORTANCE Angiotensin-converting enzyme inhibitors (ACEIs) and
angiotensin II receptor blockers (ARBs) may have different effects on
cardiovascular (CV) events in patients with diabetes mellitus (DM).
OBJECTIVE To conduct ameta-analysis to separately evaluate the effects of
ACEIs and ARBs on all-cause mortality, CV deaths, and major CV events in
patients with DM. DATA SOURCES Data sources included MEDLINE (1966-2012),
EMBASE (1988-2012), the Cochrane Central Register of Controlled Trials,
conference proceedings, and article reference lists. STUDY SELECTION We
included randomized clinical trials reporting the effects of ACEI and ARB
regimens for DMon all-cause mortality, CV deaths, and major CV events with
an observation period of at least 12 months. Studies were excluded if they
were crossover trials. DATA EXTRACTION AND SYNTHESIS Dichotomous outcome
data from individual trials were analyzed using the risk ratio (RR)
measure and its 95%CI with random-effects models.We estimated the
difference between the estimates of the subgroups according to tests for
interaction.We performed meta-regression analyses to identify sources of
heterogeneity. MAIN OUTCOMES AND MEASURES Primary end points were
all-cause mortality and death from CV causes. Secondary end points were
the effects of ACEIs and ARBs on major CV events. RESULTS Twenty-three of
35 identified trials compared ACEIs with placebo or active drugs (32 827
patients) and 13 compared ARBs with no therapy (controls) (23 867
patients). When compared with controls (placebo/active treatment), ACEIs
significantly reduced the risk of all-cause mortality by 13%(RR, 0.87;
95%CI, 0.78-0.98), CV deaths by 17%(0.83; 0.70-0.99), and major CV events
by 14%(0.86; 0.77-0.95), includingmyocardial infarction by 21% (0.79;
0.65-0.95) and heart failure by 19% (0.81; 0.71-0.93). Treatment with ARBs
did not significantly affect all-cause mortality (RR, 0.94; 95%CI,
0.82-1.08), CV death rate (1.21; 0.81-1.80), and major CV events (0.94;
0.85-1.01) with the exception of heart failure (0.70; 0.59-0.82). Both
ACEIs and ARBs were not associated with a decrease in the risk for stroke
in patients with DM. Meta-regression analysis showed that the ACEI
treatment effect on all-cause mortality and CV death did not vary
significantly with the starting baseline blood pressure and proteinuria of
the trial participants and the type of ACEI and DM. CONCLUSIONS AND
RELEVANCE Angiotensin-converting enzyme inhibitors reduced all-cause
mortality, CV mortality, and major CV events in patients with DM, whereas
ARBs had no benefits on these outcomes. Thus, ACEIs should be considered
as first-line therapy to limit excess mortality and morbidity in this
population. 2014 American Medical Association. All rights reserved.

<10>
Accession Number
2014316623
Authors
Bonds D.E. Harrington M. Worrall B.B. Bertoni A.G. Eaton C.B. Hsia J.
Robinson J. Clemons T.E. Fine L.J. Chew E.Y.
Institution
(Bonds, Fine) Division of Cardiovascular Sciences, National Heart, Lung,
and Blood Institute, National Institutes of Health, 6701 Rockledge Dr,
Bethesda, MD 20892-7936, United States
(Harrington, Clemons) EMMES Corporation, Rockville, MD, United States
(Worrall) Department of Neurology, School of Medicine, University of
Virginia, Charlottesville, United States
(Bertoni) Department of Epidemiology and Prevention, Division of Public
Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, United
States
(Eaton) Department of Family Medicine and Epidemiology, Division of
Biology and Medicine, School of Public Health of Brown University,
Providence, RI, United States
(Hsia) AstraZeneca LLP, Washington, DC, United States
(Robinson) Department of Epidemiology, University of Iowa, Iowa City,
United States
(Robinson) Department of Medicine, University of Iowa, Iowa City, United
States
(Chew) Division of Epidemiology and Clinical Applications, National Eye
Institute, National Institutes of Health, Bethesda, MD, United States
Title
Effect of long-chain -3 fatty acids and lutein+zeaxanthin supplements on
cardiovascular outcomes: Results of the age-related eye disease study 2
(AREDS2) randomized clinical trial.
Source
JAMA Internal Medicine. 174 (5) (pp 763-771), 2014. Date of Publication:
May 2014.
Publisher
American Medical Association
Abstract
IMPORTANCE Dietary supplements have been proposed as a mechanism to
improve health and prevent disease. OBJECTIVE To determine if
supplementing diet with long-chain -3 polyunsaturated fatty acids or with
macular xanthophylls results in a reduced rate of cardiovascular disease
(CVD). DESIGN, SETTING, AND PARTICIPANTS The Cardiovascular Outcome Study
(COS)was an ancillary study of the Age-Related Eye Disease Study 2
(AREDS2), a factorial-designed randomized clinical trial of 4203
participants recruited from 82 US academic and community ophthalmology
clinics, who were followed up for a median of 4.8 years. Individuals were
eligible to participate if they were between the ages of 50 and 85 years,
had intermediate or advanced age-related macular degeneration in 1 eye,
and were willing to be randomized. Participants with stable, existing CVD
(>12 months since initial event) were eligible to participate.
Participants, staff, and outcome assessors were masked to intervention.
INTERVENTIONS Daily supplementation with long-chain -3 polyunsaturated
fatty acids (350-mg docosahexaenoic acid [DHA] + 650-mg eicosapentaenoic
acid [EPA]), macular xanthophylls (10-mg lutein + 2-mg zeaxanthin),
combination of the two, or matching placebos. These treatments were added
to background therapy of the AREDS vitamin and mineral formulation for
macular degeneration. MAIN OUTCOMES AND MEASURES A composite outcome of
myocardial infarction, stroke, and cardiovascular death with 4
prespecified secondary combinations of the primary outcome with
hospitalized heart failure, revascularization, or unstable angina. RESULTS
Study participants were primarily white, married, and highly educated,
with a median age at baseline of 74 years. A total of 602 cardiovascular
events were adjudicated, and 459 were found to meet 1 of the study
definitions for a CVD outcome. In intention-to-treat analysis, no
reduction in the risk of CVD or secondary CVD outcomes was seen for the
DHA + EPA (primary outcome: hazard ratio [HR], 0.95; 95%CI, 0.78-1.17) or
lutein + zeaxanthin (primary outcome: HR, 0.94; 95%CI, 0.77-1.15) groups.
No differences in adverse events or serious adverse event were seen by
treatment group. The sample size was sufficient to detect a 25%reduction
in CVD events with 80% power. CONCLUSIONS AND RELEVANCE Dietary
supplementation of long-chain -3 polyunsaturated fatty acids or macular
xanthophylls in addition to daily intake of minerals and vitamins did not
reduce the risk of CVD in elderly participants with age-related macular
degeneration. 2014 American Medical Association. All rights reserved.

<11>
Accession Number
2014316622
Authors
Klompas M. Speck K. Howell M.D. Greene L.R. Berenholtz S.M.
Institution
(Klompas) Department of Population Medicine, Harvard Medical School,
Harvard Pilgrim Health Care Institute, 133 Brookline Ave, Boston, MA
02215, United States
(Klompas) Department of Medicine, Brigham and Women's Hospital, Boston,
MA, United States
(Speck, Berenholtz) Department of Anesthesiology and Critical Care
Medicine, Johns Hopkins University School of Medicine, Baltimore, MD,
United States
(Howell) Department of Medicine, University of Chicago, Chicago, IL,
United States
(Greene) Highland Hospital, University of Rochester Medical Center
Affiliate, Rochester, NY, United States
(Berenholtz) Department of Surgery, Johns Hopkins University School of
Medicine, Baltimore, MD, United States
(Berenholtz) Department of Health Policy and Management, Bloomberg School
of Public Health, Johns Hopkins University, Baltimore, MD, United States
Title
Reappraisal of routine oral care with chlorhexidine gluconate for patients
receiving mechanical ventilation: Systematic review and meta-analysis.
Source
JAMA Internal Medicine. 174 (5) (pp 751-761), 2014. Date of Publication:
May 2014.
Publisher
American Medical Association
Abstract
IMPORTANCE Regular oral care with chlorhexidine gluconate is standard of
care for patients receiving mechanical ventilation in most hospitals. This
policy is predicated on meta-analyses suggesting decreased risk of
ventilator-associated pneumonia, but these meta-analysesmay be misleading
because of lack of distinction between cardiac surgery and non-cardiac
surgery studies, conflation of open-label vs double-blind investigations,
and insufficient emphasis on patient-centered outcomes such as duration of
mechanical ventilation, length of stay, and mortality. OBJECTIVE To
evaluate the impact of routine oral care with chlorhexidine on
patient-centered outcomes in patients receiving mechanical ventilation.
DATA SOURCES PubMed, Embase, CINAHL, andWeb of Science from inception
until July 2013 without limits on date or language. STUDY SELECTION
Randomized clinical trials comparing chlorhexidine vs placebo in adults
receiving mechanical ventilation. Of 171 unique citations, 16 studies
including 3630 patients met inclusion criteria. DATA EXTRACTION AND
SYNTHESIS Eligible trials were independently identified, evaluated for
risk of bias, and extracted by 2 investigators. Differences were resolved
by consensus.We stratified studies into cardiac surgery vs non-cardiac
surgery and open-label vs double-blind investigations. Eligible studies
were pooled using random-effects meta-analysis. MAIN OUTCOMES AND MEASURES
Ventilator-associated pneumonia, mortality, duration of mechanical
ventilation, intensive care unit and hospital length of stay, antibiotic
prescribing. RESULTS There were fewer lower respiratory tract infections
in cardiac surgery patients randomized to chlorhexidine (relative risk
[RR], 0.56 [95%CI, 0.41-0.77]) but no significant difference in
ventilator-associated pneumonia risk in double-blind studies of
non-cardiac surgery patients (RR, 0.88 [95%CI, 0.66-1.16]). There was no
significant mortality difference between chlorhexidine and placebo in
cardiac surgery studies (RR, 0.88 [95%CI, 0.25-2.14]) and nonsignificantly
increased mortality in non-cardiac surgery studies (RR, 1.13 [95%CI,
0.99-1.29]). There were no significant differences in mean duration of
mechanical ventilation or intensive care length of stay. Data on hospital
length of stay and antibiotic prescribing were limited. CONCLUSIONS AND
RELEVANCE Routine oral care with chlorhexidine prevents nosocomial
pneumonia in cardiac surgery patients but may not decrease
ventilator-associated pneumonia risk in non-cardiac surgery patients.
Chlorhexidine use does not affect patient-centered outcomes in either
population. Policies encouraging routine oral care with chlorhexidine for
non-cardiac surgery patients merit reevaluation. 2014 American Medical
Association. All rights reserved.

<12>
Accession Number
2014298849
Authors
Drakos S.G.
Institution
(Drakos) Division of Cardiovascular Medicine and Cardiac Mechanical
Support Program, University of Utah, Utah Transplantation Affiliated
Hospitals (UTAH), 30 North 1900 East, Salt Lake City, UT 84132, United
States
Title
The odyssey of chronic cardiac mechanical support.
Source
Journal of the American College of Cardiology. 63 (17) (pp 1758-1760),
2014. Date of Publication: 06 May 2014.
Publisher
Elsevier USA

<13>
Accession Number
2014298808
Authors
Waljee J. McGlinn E.P. Sears E.D. Chung K.C.
Institution
(Waljee, McGlinn, Sears, Chung) Section of Plastic Surgery, Department of
Surgery, University of Michigan Health System, 1500 E. Medical Center
Drive, Ann Arbor, MI 48109-5340, United States
Title
Patient expectations and patient-reported outcomes in surgery: A
systematic review.
Source
Surgery (United States). 155 (5) (pp 799-808), 2014. Date of Publication:
May 2014.
Publisher
Mosby Inc.
Abstract
Background Recent events in health care reform have brought national
attention to integrating patient experiences and expectations into quality
metrics. Few studies have comprehensively evaluated the effect of patient
expectations on patient-reported outcomes (PROs) after surgery. The
purpose of this study is to systematically review the available literature
describing the relationship between patient expectations and postoperative
PROs. Methods We performed a search of the literature published before
November 1, 2012. Articles were included in the review if (1) primary data
were presented, (2) patient expectations regarding a surgical procedure
were measured, (3) PROs were measured, and (4) the relationship between
patient expectations and PROs was specifically examined. PROs were
categorized into 5 subgroups: Satisfaction, quality of life (QOL),
disability, mood disorder, and pain. We examined each study to determine
the relationship between patient expectations and PROs as well as study
quality. Results From the initial literature search yielding 1,708
studies, 60 articles were included. Fulfillment of expectations was
associated with improved PROs among 24 studies. Positive expectations were
correlated with improved PROs for 28 studies (47%), and poorer PROs for 9
studies (15%). Eighteen studies reported that fulfillment of expectations
was correlated with improved patient satisfaction, and 10 studies
identified that positive expectations were correlated with improved
postoperative. Finally, patients with positive preoperative expectations
reported less pain (8 studies) and disability (15 studies) compared with
patients with negative preoperative expectations. Conclusion Patient
expectations are inconsistently correlated with PROs after surgery, and
there is no accepted method to capture perioperative expectations. Future
efforts to rigorously measure expectations and explore their influence on
postoperative outcomes can inform clinicians and policymakers seeking to
integrate PROs into measures of surgical quality. 2014 Published by
Mosby, Inc.

<14>
Accession Number
2014298158
Authors
Kaur N. Pandey A. Negi H. Shafiq N. Reddy S. Kaur H. Chadha N. Malhotra S.
Institution
(Kaur, Pandey, Negi, Shafiq, Malhotra) Department of Pharmacology,
Institute of Medical Education and Research, Chandigarh, India
(Reddy) Department of Cardiology, Institute of Medical Education and
Research, Chandigarh, India
(Kaur) ICMR- Advanced Centre for Evidence Based Child Health, Advance
Paediatric Centre, Institute of Medical Education and Research,
Chandigarh, India
(Chadha) Dr. Tulsi das Library, Institute of Medical Education and
Research, Chandigarh, India
Title
Effect of HDL-raising drugs on cardiovascular outcomes: A systematic
review and meta-regression.
Source
PLoS ONE. 9 (4) , 2014. Article Number: e94585. Date of Publication: 11
Apr 2014.
Publisher
Public Library of Science
Abstract
Background: Substantial residual cardiovascular risk remains after optimal
LDL lowering in patients of established coronary artery disease. A number
of therapeutic agents that raise HDL-C have been tested in clinical trials
to cover this risk. However, the results of clinical trials are
conflicting. Objectives: To determine whether raising HDL-C with
pharmacologic therapies translates into beneficial cardiovascular outcomes
and to find out if this change was proportional to the percentage change
in HDL levels. Methods: Electronic and printed sources were searched up to
August, 2013 for randomised controlled trials (RCTs) using at least one of
the HDL raising therapies for secondary prevention of adverse
cardiovascular events over optimal LDL levels. Data from eligible studies
were pooled for the following outcomes: all cause mortality,
cardiovascular disease mortality, hospitalization for unstable angina,
non-fatal myocardial infarction, coronary revascularization and ischemic
stroke. Mantel Haensnzel fixed effect model was used preferentially.
Meta-regression was done to see the correlation of change in HDL levels
and cardiovascular outcomes. Pooled odds ratios with 95% confidence
interval (CI) were calculated. Results: A total of 12 RCTs including
26,858 patients with follow up period ranging from 1 year to 6.2 years
were included in the analysis. Pooled analysis showed no significant
difference in all-cause mortality between the treatment and control group
(Pooled OR 1.07; 95% CI 0.98-1.16, p = 0.15). No significant difference
was found between the groups for any of the secondary outcomes. Similarly
no correlation was seen between percentage change in HDL and adverse
cardiovascular outcomes on meta-regression analysis. Conclusion:
Increasing HDL levels via pharmacological manipulation beyond optimal
lipid lowering therapy for secondary prevention is not beneficial. 2014
Kaur et al.

<15>
Accession Number
2014295948
Authors
Schwingshackl L. Hoffmann G.
Institution
(Schwingshackl, Hoffmann) Faculty of Life Sciences, Department of
Nutritional Sciences, University of Vienna, Vienna, Austria
Title
Dietary fatty acids in the secondary prevention of coronary heart disease:
A systematic review, meta-analysis and meta-regression.
Source
BMJ Open. 4 (4) , 2014. Article Number: e004487. Date of Publication:
2014.
Publisher
BMJ Publishing Group
Abstract
Objective: Previous systematic reviews were not restricted to either
primary or secondary prevention trials, this study aimed to investigate
the effects of reduced and/or modified fat diets and dietary fatty acids
on all-cause mortality, cardiovascular mortality and cardiovascular events
in participants with established coronary heart disease. Design:
Systematic review, meta-analysis and univariate/multivariate
meta-regression. Eligibility and criteria for selecting studies:
Electronic searches for randomised controlled trials comparing
reduced/modified fat diets versus control diets were performed in MEDLINE,
EMBASE and the Cochrane Library. Data extraction: Pooled effects were
calculated using an inverse-variance random effect meta-analysis. Random
effects univariate and multivariate metaregressions were performed
including changes in all types of dietary fatty acids. Results: Overall,
12 studies enrolling 7150 participants were included in the present
systematic review. No significant risk reduction could be observed
considering all-cause mortality (relative risk (RR) 0.92, p=0.60;
I²=59%) and cardiovascular mortality (RR 0.96, p=0.84;
I²=69%), combined cardiovascular events (RR 0.85, p=0.30;
I²=75%) and myocardial infarction (RR 0.76, p=0.13;
I²=55%) comparing modified fat diets versus control diets. This
results could be confirmed for the reduced fat versus control diets (RR
0.79, p=0.47; I²=0%), (RR 0.93, p=0.66; I²=0%), (RR
0.93, p=0.71; I²=57%) and (RR 1.18, p=0.26; I²=18%).
The multivariate and univariate model showed no significant associations
between the independent variables and the changes from saturated fat,
monounsaturated fat, polyunsaturated fat and linoleic acid. Sensitivity
analyses did not reveal a significant risk reduction for any outcome
parameter when polyunsaturated fat was increased in exchange for saturated
fat. Conclusions: The present systematic review provides no evidence
(moderate quality evidence) for the beneficial effects of reduced/modified
fat diets in the secondary prevention of coronary heart disease.
Recommending higher intakes of polyunsaturated fatty acids in replacement
of saturated fatty acids was not associated with risk reduction.

<16>
Accession Number
2014318337
Authors
Liu X.-H. Xu C.-Y. Fan G.-H.
Institution
(Liu, Fan) Department of Cardiology, Wuhan General Hospital of Guangzhou
Military Command, 627 Wuluo Road, Wuhan, China
(Xu) Department of Endocrinology, Wuhan General Hospital of Guangzhou
Military Command, 627 Wuluo Road, Wuhan, China
(Liu) Hubei University of Chinese Medicine, 1 Tanhualin Road, Wuhan, China
Title
Efficacy of N-acetylcysteine in preventing atrial fibrillation after
cardiac surgery: A meta-analysis of published randomized controlled
trials.
Source
BMC Cardiovascular Disorders. 14 , 2014. Article Number: 52. Date of
Publication: 16 Apr 2014.
Publisher
BioMed Central Ltd. (34 - 42 Cleveland Street, London W1T 4LB, United
Kingdom)
Abstract
Background: Atrial fibrillation is a common complication after cardiac
surgery. The aim of this study is to evaluate whether N-acetylcysteine
(NAC) could prevent postoperative atrial fibrillation (POAF).Methods:
PubMed, Embase and Cochrane Center Register of Controlled Trials were
searched from the date of their inception to 1 July 2013 for relevant
randomized controlled trials (RCTs), in which NAC was compared with
controls for adult patients undergoing cardiac surgery. Outcome measures
comprised the incidence of POAF, all-cause mortality, length of intensive
care unit (ICU) stay, hospital length of stay, and the incidence of
cerebrovascular events. The meta-analysis was performed with the
fixed-effect model or random-effect model according to the
heterogeneity.Results: We retrieved ten studies enrolling a total of 1026
patients. Prophylactic NAC reduced the incidence of POAF (OR 0.56; 95% CI
0.40 to 0.77; P < 0.001) and all-cause mortality (OR 0.40; 95% CI 0.17 to
0.93; P = 0.03) compared with controls, but failed to reduce the stay in
ICU and overall stay in hospital. No difference in the incidence of
cerebrovascular events was observed.Conclusions: Prophylactic use of NAC
could reduce the incidence of POAF and all-cause mortality in adult
patients undergoing cardiac surgery. However, larger RCTs evaluating these
and other postoperative complication endpoints are needed. 2014 Liu et
al.; licensee BioMed Central Ltd.

<17>
Accession Number
2014306915
Authors
Merry A.F. Avery E.G. Nussmeier N.A. Playford H.R. Warman G.R. Wang Y.
Sladen R.N.
Institution
(Merry, Warman) Faculty of Medical and Health Sciences, School of
Medicine, University of Auckland, Private Bag 92019, Auckland 1003, New
Zealand
(Merry) Green Lane Hospital, Mercy Ascot Integrated Hospital, Auckland,
New Zealand
(Merry) Auckland City Hospital, Auckland, New Zealand
(Avery, Nussmeier) Massachusetts General Hospital, Boston, MA, United
States
(Avery) University Hospitals Case Medical Center, Cleveland, OH, United
States
(Nussmeier) Texas Heart Institute, Houston, TX, United States
(Playford, Sladen) College of Physicians and Surgeons, Columbia
University, New York, NY, United States
(Playford) Westmead Hospital, Sydney, NSW, Australia
(Wang) Medicines Company, Parsippany, NJ, United States
Title
Clevidipine compared with nitroglycerin for blood pressure control in
coronary artery bypass grafting: A randomized double-blind study.
Source
Canadian Journal of Anesthesia. 61 (5) (pp 398-406), 2014. Date of
Publication: May 2014.
Publisher
Springer New York LLC
Abstract
Purpose: We tested the hypothesis that clevidipine, a rapidly acting
dihydropyridine calcium channel blocker, is not inferior to nitroglycerin
(NTG) in controlling blood pressure before cardiopulmonary bypass (CPB)
during coronary artery bypass grafting (CABG). Methods: In this
double-blind study from October 4, 2003 to April 26, 2004, 100 patients
undergoing CABG with CPB were randomized at four centres to receive
intravenous infusions of clevidipine (0.2-8
mugkg^-1min^-1) or NTG (0.4
mugkg^-1min^-1 to a clinician-determined maximum dose
rate) from induction of anesthesia through 12 hr postoperatively. The
study drug was titrated in the pre-CPB period with the aim of maintaining
mean arterial pressure (MAP) within + 5 mmHg of a clinician-predetermined
target. The primary endpoint was the area under the curve (AUC) for the
total time each patient's MAP was outside the target range from drug
initiation to the start of CPB, normalized per hour (AUC_MAP-D).
The predefined non-inferiority criterion for the primary endpoint was a
95% confidence interval (CI) upper limit no greater than 1.50 for the
geometric means ratio between clevidipine and NTG. Results: Total mean
[standard deviation (SD)] dose pre-bypass was 4.5 (4.7) mg for clevidipine
and 6.9 (5.4) mg for NTG (P < 0.05). The geometric mean
AUC_MAP-D for clevidipine was 283 mmHgminhr^-1 (n =
45) and for NTG was 292 mmHgminhr^-1 (n = 48); the geometric
means ratio was 0.97 (95% CI 0.74 to 1.27). The geometric mean
AUC_MAP-D during aortic cannulation was 357.7
mmHgminhr^-1 for clevidipine compared with 190.5
mmHgminhr^-1 for NTG. Mean (SD) heart rate with clevidipine was
76.0 (13.8) beatsmin^-1 compared with 81.5 (14.4)
beatsmin^-1 for NTG. There were no clinically important
differences between groups in adverse events. Conclusion: During CABG,
clevidipine was not inferior to NTG for blood pressure control pre-bypass.
2014 Canadian Anesthesiologists' Society.

<18>
Accession Number
2014306918
Authors
Schloglhofer T. Gilly H. Schima H.
Institution
(Schloglhofer, Gilly, Schima) Center for Medical Physics and Biomedical
Engineering, Medical University of Vienna, AKH-4L, Waehringer Guertel
18-20, 1090 Vienna, Austria
(Schloglhofer, Schima) Department of Cardiac Surgery, Medical University
of Vienna, Vienna, Austria
(Schloglhofer, Schima) Ludwig-Boltzmann-Cluster for Cardiovascular
Research, Medical University of Vienna, Vienna, Austria
Title
Semi-invasive measurement of cardiac output based on pulse contour: A
review and analysis.
Source
Canadian Journal of Anesthesia. 61 (5) (pp 452-479), 2014. Date of
Publication: May 2014.
Publisher
Springer New York LLC
Abstract
Purpose: The aim of this review was to provide a meta-analysis of all five
of the most popular systems for arterial pulse contour analysis compared
with pulmonary artery thermodilution, the established reference method for
measuring cardiac output (CO). The five investigated systems are
FloTrac/Vigileo, PiCCO, LiDCO/PulseCO, PRAM/MostCare, and Modelflow.
Source: In a comprehensive literature search through MEDLINE, Web of
Knowledge (v.5.11), and Google Scholar, we identified prospective studies
and reviews that compared the pulse contour approach with the reference
method (n = 316). Data extracted from the 93 selected studies included
range and mean cardiac output, bias, percentage error, software versions,
and study population. We performed a pooled weighted analysis of their
precision in determining CO in various patient groups and clinical
settings. Principal findings: Results of the majority of studies indicate
that the five investigated systems show acceptable accuracy during
hemodynamically stable conditions. Forty-three studies provided adequate
data for a pooled weighted analysis and resulted in a mean (SD) total
pooled bias of -0.28 (1.25) Lmin^-1, percentage error of 40%,
and a correlation coefficient of r = 0.71. In hemodynamically unstable
patients (n = 8), we found a higher percentage error (45%) and bias of
-0.54 (1.64) Lmin^-1. Conclusion: During hemodynamic
instability, CO measurement based on continuous arterial pulse contour
analysis shows only limited agreement with intermittent bolus
thermodilution. The calibrated systems seem to deliver more accurate
measurements than the auto-calibrated or the non-calibrated systems. For
reliable use of these semi-invasive systems, especially for critical
therapeutic decisions during hemodynamic disorders, both a strategy for
hemodynamic optimization and further technological improvements are
necessary. 2014 Canadian Anesthesiologists' Society.

<19>
Accession Number
2014307457
Authors
Gasparovic H. Petricevic M. Kopjar T. Djuric Z. Svetina L. Biocina B.
Institution
(Gasparovic, Petricevic, Kopjar, Djuric, Svetina, Biocina) Department of
Cardiac Surgery, University Hospital Center Zagreb, University of Zagreb,
Zagreb, Croatia
Title
Impact of dual antiplatelet therapy on outcomes among aspirin-resistant
patients following coronary artery bypass grafting.
Source
American Journal of Cardiology. 113 (10) (pp 1660-1667), 2014. Date of
Publication: 15 May 2014.
Publisher
Elsevier Inc.
Abstract
Coronary artery bypass grafting is pivotal in the contemporary management
of complex coronary artery disease. Interpatient variability to
antiplatelet agents, however, harbors the potential to compromise the
revascularization benefit by increasing the incidence of adverse events.
This study was designed to define the impact of dual antiplatelet therapy
(dAPT) on clinical outcomes among aspirin-resistant patients who underwent
coronary artery surgery. We randomly assigned 219 aspirin-resistant
patients according to multiple electrode aggregometry to receive
clopidogrel (75 mg) plus aspirin (300 mg) or aspirin-monotherapy (300 mg).
The primary end point was a composite outcome of all-cause death, nonfatal
myocardial infarction, stroke, or cardiovascular hospitalization assessed
at 6 months postoperatively. The primary end point occurred in 6% of
patients assigned to dAPT and 10% of patients randomized to
aspirin-monotherapy (relative risk 0.61, 95% confidence interval 0.25 to
1.51, p = 0.33). No significant treatment effect was noted in the
occurrence of the safety end point. The total incidence of bleeding events
was 25% and 19% in the dAPT and aspirin-monotherapy groups, respectively
(relative risk 1.34, 95% confidence interval 0.80 to 2.23, p = 0.33). In
the subgroup analysis, dAPT led to lower rates of adverse events in
patients with a body mass index >30 kg/m² (0% vs 18%, p <0.01)
and those <65 years (0% vs 10%, p = 0.02). In conclusion, the addition of
clopidogrel in patients found to be aspirin resistant after coronary
artery bypass grafting did not reduce the incidence of adverse events, nor
did it increase the number of recorded bleeding events. dAPT did, however,
lower the incidence of the primary end point in obese patients and those
<65 years. 2014 Elsevier Inc. All rights reserved.

<20>
Accession Number
2014299949
Authors
Moris D. Mantonakis E. Makris M. Michalinos A. Vernadakis S.
Institution
(Moris, Mantonakis, Michalinos) First Department of Surgery, 'Laiko'
General Hospital, National and Kapodistrian University of Athens, Athens,
Greece
(Makris) Department of Surgery and Cancer, St Mary's Hospital, Imperial
College of London, London, United Kingdom
(Vernadakis) Department of General, Visceral and Transplantation Surgery,
University Hospital Essen, Essen, Germany
Title
Hoarseness after thyroidectomy: Blame the endocrine surgeon alone?.
Source
Hormones. 13 (1) (pp 5-15), 2014. Date of Publication: January - March
2014.
Publisher
Hellenic Endocrine Society (14 Alexandras Avenue, Athens 10682, Greece)
Abstract
Objective: Hoarseness is a postoperative complication of thyroidectomy,
mostly due to damage to the recurrent laryngeal nerve (RLN). Hoarseness
may also be brought about via vocal cord dysfunction (VCD) due to injury
of the vocal cords from manipulations during anesthesia, as well as from
psychogenic disorders and respiratory and upper-GI related infections. We
reviewed the literature aiming to explore these potential surgical and
non-surgical causes of hoarseness beyond thyroidectomy and the role of the
endocrine surgeon. Is he/she alone to blame? Methods/Material: The
MEDLINE/PubMed database was searched for publications with the medical
subject heading "hoarseness" and keywords "thyroidectomy", "RLN", "VCD" or
"intubation". We restricted our search till up to May 2013. Results: In
our final review we included 80 articles and abstracts that were
accessible and available in English. We demonstrated the incidence of
hoarseness stemming from surgical and non-surgical causes and also
highlighted the role of intubation as a potential cause of injury-related
VCD. Conclusions: Hoarseness is a relatively common complication of
thyroidectomy, which can be attributed to many factors including surgeon's
error or injuries during intubation as well as to other non-surgical
causes. However, compared to procedures such as cervical spine surgery,
mediastinal surgery, esophagectomy and endarterectomy, thyroidectomy would
seem to be a procedure with a relatively low rate of recurrent laryngeal
nerve palsies (RLNPs). It is often difficult to determine whether the
degree of hoarseness after thyroidectomy should be attributed only the
surgical procedure itself or to other causes, for example intubation and
extubation maneuvers. The differential diagnosis of postoperative
hoarseness requires the use of specific tools, such as stroboscopy and
intra- and extralaryngeal electromyography, while methods like acoustic
voice analysis, with estimation of maximum phonation time and phonation
frequency range, can distinguish between objective and subjective
deterioration in the voice. The importance of medical history should be
also emphasized.

<21>
Accession Number
2014296255
Authors
Malhotra A. Garg P. Bishnoi A.K. Pendro V. Sharma P. Upadhyay M. Gandhi S.
Institution
(Malhotra, Garg, Bishnoi, Sharma, Upadhyay, Gandhi) Department of
Cardiothoracic and Vascular Surgery, U. N. Mehta Institute of Cardiology
and Research Center, Ahmedabad, Gujarat, India
(Pendro) Department of General Surgery, Gandhi Medical College, Bhopal,
Madhya Pradesh, India
Title
Is steel wire closure of sternotomy better than polyester suture closure?.
Source
Asian Cardiovascular and Thoracic Annals. 22 (4) (pp 409-415), 2014. Date
of Publication: May 2014.
Publisher
SAGE Publications Inc.
Abstract
Introduction: Median sternotomy is the preferred approach for open heart
surgeries. The sternotomy incision is predominantly closed with either
steel wire or polyester suture. The type of material used is primarily
based on the surgeon's choice, and both materials achieve a good result.
No prospective clinical study has been undertaken to evaluate differences
in the incidence of wound infection and the degree of pain associated with
both techniques. Patients and methods: Our randomized controlled
double-blind study included 200 adults undergoing single-valve
replacement. The technique of surgery, apart from the material used for
sternal closure, was the same in both groups. Postoperatively, patients
were analyzed for wound infection and wound pain based on the ASEPSIS
score and Numeric Pain Rating Score, respectively. Results: The polyester
suture group had a significantly higher mean ASEPSIS score, indicating a
higher incidence of wound infection, and more late wound complications.
The polyester suture group also had a significantly higher mean pain
score. The steel wire group had significantly higher mediastinal drain
output in the first 48 h after surgery. Conclusion: The use of polyester
suture for sternal closure in adult patients results in increased wound
infection, wound pain, and late wound complications, but lower mediastinal
drain output. The Author(s) 2013 Reprints and permissions:
sagepub.co.uk/journalsPermissions.nav.

<22>
Accession Number
2014281904
Authors
Rivosecchi R.M. Rice M.J. Smithburger P.L. Buckley M.S. Coons J.C.
Kane-Gill S.L.
Institution
(Rivosecchi) University of Pittsburgh Medical Center, Presbyterian Campus,
Pittsburgh, PA, United States
(Rice) University of Florida, College of Medicine, Gainesville, FL, United
States
(Smithburger, Coons, Kane-Gill) University of Pittsburgh, School of
Pharmacy, Pittsburgh, PA, United States
(Buckley) Banner Health Good Samaritan Medical Center, Pheonix, AZ, United
States
Title
An evidence based systematic review of remifentanil associated
opioid-induced hyperalgesia.
Source
Expert Opinion on Drug Safety. 13 (5) (pp 587-603), 2014. Date of
Publication: May 2014.
Publisher
Informa Healthcare
Abstract
Introduction: Therapeutic opioid use continues to grow, with greater than
a fivefold increase in usage of fentanyl-based products over a 10-year
period. Opioids are known for their side-effect profile, including
bradycardia and respiratory depression; questions remain, however,
regarding lesser known side effects such as opioid-induced hyperalgesia
(OIH). Areas covered: A systematic review of published literature
addressing remifentanil OIH in the surgical setting was completed. A
search was conducted of PubMed, Embase and Ovid from 1946 until June 2013.
Inclusion criteria consisted of age > 18 years, humans, full-text articles
and English language. A total of 35 unique articles were included. Sixteen
articles reported outcomes that supported remifentanil OIH and 6 that
refuted and 22 were focused on prevention. Expert opinion: There is
conflicting evidence regarding the existence of remifentanil OIH. Outcomes
evaluating measures of hyperalgesia frequently conclude that remifentanil
OIH exists, while those evaluating opioid consumption do not. Therefore,
remifentanil does induce a degree of hyperalgesia, but we do not believe
that it reaches a level of clinical significance that requires prevention.
If a significant concern for the development of remifentanil OIH is
suspected, we suggest using the least possible effective dose of
remifentanil as the primary prevention strategy. 2014 Informa UK, Ltd.

<23>
Accession Number
2014284793
Authors
Liu C. Wang J. Yiu D. Liu K.
Institution
(Liu, Yiu, Liu) Hebei Medical University, Hebei Medical University,
Shijiazhuang, China
(Liu) Department of Pharmacology, Hebei Medical University, Shijiazhuang,
China
(Wang) Hebei Northern Institute, Hebei Northern Institute, Zhangjiakou,
China
Title
The efficacy of glucocorticoids for the prevention of atrial fibrillation,
or length of intensive care unite or hospital stay after cardiac surgery:
A meta-analysis.
Source
Cardiovascular Therapeutics. 32 (3) (pp 89-96), 2014. Date of Publication:
June 2014.
Publisher
Blackwell Publishing Ltd
Abstract
Summary: Aims: cardiopulmonary bypass and cardiac surgery are associated
with a significant systemic inflammatory response that has been suggested
playing a causative role in the development of perioperative atrial
fibrillation (POAF). The goal of this meta-analysis was to determine the
efficacy of glucocorticoid prophylaxis in preventing POAF, or length of
intensive care unite (ICU) or hospital stay. Methods: A systematic
electronic database literature search of Cochrane controlled trials
register (2013, issue 4) and MEDLINE (1966 to April, 2013) was conducted
using specific search terms for all relevant articles. Including criteria
were: randomized controlled clinical trials, participants were adults (>18
years of age) undergoing cardiac surgery, evaluated glucocorticoid
prophylaxis in cardiac surgery with adequately reported data on incidence
of POAF, or length of ICU or hospital stay. Results: Forty-two randomized
controlled trials involving 7621 participants were included in the
meta-analysis. Overall, glucocorticoids prophylaxis significantly lowered
participants' risk of developing POAF (Relative Risk [RR] 0.77; 95%
confidence interval [CI] 0.66-0.90), P < 0.01), reduced length of ICU stay
by 0.25 day (95% CI -0.40 to -0.10, P < 0.01). Glucocorticoid prophylaxis
in cardiac surgery was not associated with increased all-cause of
infection (RR 0.68; 95% CI 0.58-0.78, P < 0.01) and mortality (RR 0.75;
95% CI 0.52-1.08, P = 0.12). Conclusions: Pooled evidence suggests that
glucocorticoid prophylaxis may reduce the incidence of POAF. The
beneficial effect on POAF is associated with reduced length of ICU and
hospital stay, and infection rate. 2014 John Wiley & Sons Ltd.