EMBASE Cardiac Update AutoAlert: EPICORE Cardiac Surgery Blogger2

Total documents retrieved: 53

Results Generated From:
Embase <1980 to 2018 Week 39>
Embase (updates since 2018-09-14)

<1>
Accession Number
623656274
Title
De novo NAD⁺ biosynthetic impairment in acute kidney injury in
humans.
Source
Nature Medicine. 24 (9) (pp 1351-1359), 2018. Date of Publication: 01 Sep
2018.
Author
Poyan Mehr A.; Tran M.T.; Ralto K.M.; Leaf D.E.; Washco V.; Messmer J.;
Lerner A.; Kher A.; Kim S.H.; Khoury C.C.; Herzig S.J.; Trovato M.E.;
Simon-Tillaux N.; Lynch M.R.; Thadhani R.I.; Clish C.B.; Khabbaz K.R.;
Rhee E.P.; Waikar S.S.; Berg A.H.; Parikh S.M.
Institution
(Poyan Mehr, Tran, Ralto, Washco, Messmer, Kher, Kim, Simon-Tillaux,
Lynch, Parikh) Division of Nephrology and Department of Medicine, Beth
Israel Deaconess Medical Center and Harvard Medical School, Boston, MA,
United States
(Ralto) Division of Pulmonary and Critical Care and Department of
Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School,
Boston, MA, United States
(Ralto) Division of Pulmonary and Critical Care, Massachusetts General
Hospital and Harvard Medical School, Boston, MA, United States
(Leaf, Waikar) Division of Renal Medicine and Department of Medicine,
Brigham and Women's Hospital and Harvard Medical School, Boston, MA,
United States
(Lerner) Department of Anesthesia and Critical Care, Beth Israel Deaconess
Medical Center and Harvard Medical School, Boston, MA, United States
(Khoury, Thadhani, Rhee) Division of Nephrology and Department of
Medicine, Massachusetts General Hospital and Harvard Medical School,
Boston, MA, United States
(Herzig) Division of General Medicine and Primary Care Medicine and
Department of Medicine, Beth Israel Deaconess Medical Center and Harvard
Medical School, Boston, MA, United States
(Trovato, Khabbaz) Cardiovascular Institute and Department of Surgery,
Beth Israel Deaconess Medical Center and Harvard Medical School, Boston,
MA, United States
(Clish, Rhee) Broad Institute of Harvard and MIT, Cambridge, MA, United
States
(Rhee) Endocrine Unit and Department of Medicine, Massachusetts General
Hospital and Harvard Medical School, Boston, MA, United States
(Berg) Division of Clinical Chemistry and Department of Pathology, Beth
Israel Deaconess Medical Center and Harvard Medical School, Boston, MA,
United States
Publisher
Nature Publishing Group (Houndmills, Basingstoke, Hampshire RG21 6XS,
United Kingdom)
Abstract
Nicotinamide adenine dinucleotide (NAD⁺) extends longevity in
experimental organisms, raising interest in its impact on human health. De
novo NAD⁺ biosynthesis from tryptophan is evolutionarily
conserved yet considered supplanted among higher species by biosynthesis
from nicotinamide (NAM). Here we show that a bottleneck enzyme in de novo
biosynthesis, quinolinate phosphoribosyltransferase (QPRT), defends renal
NAD⁺ and mediates resistance to acute kidney injury (AKI).
Following murine AKI, renal NAD⁺ fell, quinolinate rose, and
QPRT declined. QPRT^+/- mice exhibited higher quinolinate, lower
NAD⁺, and higher AKI susceptibility. Metabolomics suggested an
elevated urinary quinolinate/tryptophan ratio (uQ/T) as an indicator of
reduced QPRT. Elevated uQ/T predicted AKI and other adverse outcomes in
critically ill patients. A phase 1 placebo-controlled study of oral NAM
demonstrated a dose-related increase in circulating NAD⁺
metabolites. NAM was well tolerated and was associated with less AKI.
Therefore, impaired NAD⁺ biosynthesis may be a feature of
high-risk hospitalizations for which NAD⁺ augmentation could be
beneficial.<br/>Copyright &#xa9; 2018, The Author(s).

<2>
Accession Number
623793983
Title
Impact of renin-angiotensin system inhibitors on clinical outcomes and
ventricular remodelling after transcatheter aortic valve implantation:
Rationale and design of the RASTAVI randomised multicentre study.
Source
BMJ Open. 8 (2) (no pagination), 2018. Article Number: e020255. Date of
Publication: 01 Feb 2018.
Author
Amat-Santos I.J.; Catala P.; Diez Del Hoyo F.; Fernandez-Diaz J.A.;
Alonso-Briales J.H.; Del Trigo M.; Regueiro A.; Juan-Salvadores P.; Serra
V.; Gutierrez-Ibanes E.; Munoz-Garcia A.J.; Nombela-Franco L.; Sabate M.;
Jimenez-Diaz V.A.; Garcia Del Blanco B.; Lopez J.; Varela-Falcon L.H.;
Sevilla T.; Arnold R.; Revilla A.; San Roman J.A.
Institution
(Amat-Santos, Lopez, Varela-Falcon, Sevilla, Arnold, Revilla, San Roman)
Cardiology Department, CIBERCV, Hospital Clinico Universitario,
Valladolid, Spain
(Catala) Cardiology Department, Hospital Clinico Universitario,
Valladolid, Spain
(Diez Del Hoyo, Gutierrez-Ibanes) Cardiology Department, CIBERCV, Hospital
General Universitario Gregorio Maranon, Madrid, Spain
(Fernandez-Diaz) Cardiology Department, CIBERCV, Hospital Puerta de
Hierro, Madrid, Spain
(Alonso-Briales, Munoz-Garcia) Cardiology Department, CIBERCV, Hospital
Virgen de la Victoria, Malaga, Spain
(Del Trigo, Nombela-Franco) Cardiology Department, CIBERCV, Hospital
Clinico San Carlos, Madrid, Spain
(Regueiro, Sabate) Cardiology Department, CIBERCV, Hospital Clinic de
Barcelona, Barcelona, Spain
(Juan-Salvadores, Jimenez-Diaz) Cardiology Department, CIBERCV, Hospital
Universitario Alvaro Cunqueiro, EOXI de Vigo, Vigo, Spain
(Serra, Garcia Del Blanco) Cardiology Department, CIBERCV, Hospital Val
d'Hebron, Barcelona, Spain
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Introduction Transcatheter aortic valve implantation (TAVI) as a treatment
in severe aortic stenosis (AS) is an excellent alternative to conventional
surgical replacement. However, long-term outcomes are not benign.
Renin-angiotensin system (RAS) blockade has shown benefit in terms of
adverse remodelling in severe AS and after surgical replacement. Methods
and analysis The RAS blockade after TAVI (RASTAVI) trial aims to detect if
there is a benefit in clinical outcomes and ventricular remodelling with
this therapeutic strategy following the TAVI procedure. The study has been
designed as a randomised 1:1 open-label study that will be undertaken in 8
centres including 336 TAVI recipients. All patients will receive the
standard treatment. The active treatment group will receive ramipril as
well. Randomisation will be done before discharge, after signing informed
consent. All patients will be followed up for 3 years. A cardiac magnetic
resonance will be performed initially and at 1 year to assess ventricular
remodelling, defined as ventricular dimensions, ejection fraction,
ventricular mass and fibrosis. Recorded events will include cardiac death,
admission due to heart failure and stroke. The RASTAVI Study will improve
the management of patients after TAVI and may help to increase their
quality of life, reduce readmissions and improve long-term survival in
this scenario. Ethics and dissemination All authors and local ethics
committees have approved the study design. All patients will provide
informed consent. Results will be published irrespective of whether the
findings are positive or negative. Trial registration number
NCT03201185.<br/>Copyright &#xa9; Article author(s) (or their employer(s)
unless otherwise stated in the text of the article) 2018. All rights
reserved. No commercial use is permitted unless otherwise expressly
granted.

<3>
Accession Number
623793237
Title
Comparison of new-generation drug-eluting stents versus drug-coated
balloon for in-stent restenosis: A meta-analysis of randomised controlled
trials.
Source
BMJ Open. 8 (2) (no pagination), 2018. Article Number: e017231. Date of
Publication: 01 Feb 2018.
Author
Cai J.-Z.; Zhu Y.-X.; Wang X.-Y.; Bourantas C.V.; Iqbal J.; Zhu H.;
Cummins P.; Dong S.-J.; Mathur A.; Zhang Y.-J.
Institution
(Cai, Zhu, Zhu) Department of Cardiology, Nanjing Medical University,
Nanjing, China
(Wang, Zhang) Department of Cardiology, Xuzhou Third People's Hospital,
Xuzhou Cancer Hospital, Xuzhou Hospital Affiliated to Jiangsu University,
Xuzhou, China
(Bourantas) Sheffield Teaching Hospitals and the University of Sheffield,
Sheffield, United Kingdom
(Bourantas, Mathur) Department of Cardiovascular Sciences, University
College London, London, United Kingdom
(Iqbal) Department of Cardiology, Barts Heart Centre, London, United
Kingdom
(Cummins) Department of Cardiology, Erasmus MC, Rotterdam, Netherlands
(Dong) Department of the Joint and Bone Surgery, Yantaishan Hospital,
Yantai, China
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
The study sought to compare angiographic and clinical outcomes of
new-generation drug-eluting stents (DES) versus drug-coated balloon (DCB)
in patients with coronary in-stent restenosis (ISR). Design Meta-analysis
using data from randomised trial found by searches on PubMed, the Cochrane
Library, ClinicalTrials.gov and websites of major cardiovascular
congresses. Setting Only randomised trials comparing DES with DCB were
included. Participants Patients with ISR in the included trials.
Interventions New-generation DES versus DCB. Outcomes The angiographic and
clinical outcomes including cardiac death, all-cause death, myocardial
infarction, target lesion revascularisation (TLR), target vessel
revascularisation (TVR), major adverse cardiac events (MACE) and stent
thrombosis were investigated. Results Five trials including 913 patients
were eligible and included. Pooled analysis in angiographic results
identified that new-generation DES were associated with higher acute
luminal gain ( 0.31 mm, 95% CI 0.42 to 0.20, P<0.001) and lower per cent
diameter stenosis (risk ratio (RR): 0.28, 95% CI 0.02 to 0.55, P=0.04).
DES significantly reduced the risk of TLR (RR: 1.96, 95% CI 1.17 to 3.28,
P=0.01) compared with DCB; however, there was no statistical differences
for MACE (RR: 1.21, 95% CI 0.67 to 2.17, P=0.53), myocardial infarction
(RR: 1.16, 95% CI 0.55 to 2.48, P=0.69) and cardiac death (RR: 1.80, 95%
CI 0.60 to 5.39, P=0.29). Conclusions Interventions with new-generation
DES appear to be associated with significant reduction in per cent
diameter stenosis and TLR at short-term follow-up, but had similar MACE,
myocardial infarction and cardiac death for patients with coronary ISR
compared with DCB. Appropriately powered studies with longer term
follow-up are warranted to confirm these findings.<br/>Copyright &#xa9;
Article author(s) 2018.

<4>
Accession Number
623793755
Title
Study protocol of the randomised placebo-controlled GLOBE trial: GL P-1 f
o r b ridging of hyperglyca e mia during cardiac surgery.
Source
BMJ Open. 8 (6) (no pagination), 2018. Article Number: e022189. Date of
Publication: 01 Jun 2018.
Author
Hulst A.H.; Visscher M.J.; Godfried M.B.; Thiel B.; Gerritse B.M.; Scohy
T.V.; Bouwman R.A.; Willemsen M.G.A.; Hollmann M.W.; Devries J.H.; Preckel
B.; Hermanides J.
Institution
(Hulst, Visscher, Hollmann, Preckel, Hermanides) Department of
Anaesthesiology, Academic Medical Center, University of Amsterdam,
Amsterdam, Netherlands
(Godfried, Thiel) Department of Anaesthesiology, Onze Lieve Vrouwe
Gasthuis, Amsterdam, Netherlands
(Gerritse, Scohy) Department of Anaesthesiology, Amphia Ziekenhuis, Breda,
Netherlands
(Bouwman, Willemsen) Department of Anaesthesiology, Catharina
Ziekenhuisen, Eindhoven, Netherlands
(Devries) Department of Endocrinology, Academic Medical Center, University
of Amsterdam, Amsterdam, Netherlands
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Introduction Perioperative hyperglycaemia is common during cardiac surgery
and associated with postoperative complications. Although intensive
insulin therapy for glycaemic control can reduce complications, it carries
the risk of hypoglycaemia. GLP-1 therapy has the potential to lower
glucose without causing hypoglycaemia. We hypothesise that preoperative
liraglutide (a synthetic GLP-1 analogue) will reduce the number of
patients requiring insulin to achieve glucose values<8 mmol l -1 in the
intraoperative period. Methods and analysis We designed a multi-centre
randomised parallel placebo-controlled trial and aim to include 274
patients undergoing cardiac surgery, aged 18-80 years, with or without
diabetes mellitus. Patients will receive 0.6 mg liraglutide or placebo on
the evening before, and 1.2 mg liraglutide or placebo just prior to
surgery. Blood glucose is measured hourly and controlled with an insulin
bolus algorithm, with a glycaemic target between 4-8 mmol l a -1. The
primary outcome is the percentage of patients requiring insulin
intraoperatively. Ethics and dissemination This study protocol has been
approved by the medical ethics committee of the Academic Medical Centre
(AMC) in Amsterdam and by the Dutch competent authority. The study is
investigator-initiated and the AMC, as sponsor, will remain owner of all
data and have all publication rights. Results will be submitted for
publication in a peer-reviewed international medical journal. Trial
registration number NTR6323; Pre-results.<br/>Copyright &#xa9; Article
author(s) (or their employer(s) unless otherwise stated in the text of the
article) 2018.

<5>
Accession Number
623793382
Title
Efficacy and safety of the Shexiang Baoxin Pill for the treatment of
coronary artery disease not amenable to revascularisation: Study protocol
for a randomised, placebo-controlled, double-blinded trial.
Source
BMJ Open. 8 (2) (no pagination), 2018. Article Number: e018052. Date of
Publication: 01 Feb 2018.
Author
Tian P.-P.; Li J.; Gao J.; Li Y.
Institution
(Tian, Li, Gao, Li) Guang'Anmen Hospital, China Academy of Chinese Medical
Sciences, Beijing, China
(Tian, Gao, Li) Graduate School Department, Beijing University of Chinese
Medicine, Beijing, China
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Coronary artery disease (CAD) not amenable to revascularisation indicates
that the coronary arteries have severe diffuse lesions or calcifications,
or that CAD is complicated with severe multiple-organ disease. Currently,
Western medicines available for the treatment of CAD not amenable to
revascularisation are limited. Shexiang Baoxin Pill (SBP), a type of
Chinese patent medicine, has been widely used to treat CAD in China for
many years. Previous studies have shown that long-term administration of
SBP (1-2 pills three times daily, for at least 6 months) for treatment of
CAD is effective and safe, with a significant, long-term effect. This
study aims to evaluate the efficacy and safety of SBP in patients with CAD
not amenable to revascularisation. Methods and analysis This is a
multicentre, randomised, double-blinded, placebo-controlled clinical
trial. A total of 440 participants will be randomly allocated to two
groups: the intervention group and the placebo group. Based on
conventional treatment with Western medicine, the intervention group will
be treated with SBP and the placebo group will be treated with SBP
placebo. The primary outcomes include major adverse cardiovascular events
(including angina, acute myocardial infarction, pulmonary embolism and
aortic dissection). The secondary outcomes include C reactive protein,
B-type natriuretic peptide, ECG, echocardiographic parameters (ejection
fraction percentage and the E/A ratio) and hospital readmission rates due
to CAD. Assessments will be performed at baseline (before randomisation)
and at 24 weeks after randomisation. Ethics and dissemination The protocol
has been approved by the Research Ethics Committee of Guang'anmen
Hospital, China Academy of Chinese Medical Sciences in Beijing, China
(reference: 2016-129-KY-01). The results of this study will be published
in a peer-reviewed journal and will be used as a basis for a multisite
trial. Trial registration number NCT03072121; Pre-results.<br/>Copyright
&#xa9; Article author(s) 2018.

<6>
Accession Number
623793373
Title
Outcomes comparison of different surgical strategies for the management of
severe aortic valve stenosis: Study protocol of a prospective multicentre
European registry (E-AVR registry).
Source
BMJ Open. 8 (2) (no pagination), 2018. Article Number: e018036. Date of
Publication: 01 Feb 2018.
Author
Onorati F.; Gherli R.; Mariscalco G.; Girdauskas E.; Quintana E.; Santini
F.; De Feo M.; Sponga S.; Tozzi P.; Bashir M.; Perrotti A.; Pappalardo A.;
Ruggieri V.G.; Santarpino G.; Rinaldi M.; Ronaldo S.; Nicolini F.
Institution
(Onorati) Division of Cardiac Surgery, University of Verona Medical
School, Verona, Italy
(Gherli) Division of Cardiac Surgery, Department of Cardiosciences,
Hospital S. Camillo-Forlanini, Rome, Italy
(Mariscalco) Department of Cardiovascular Surgery and Anesthesia and
Critical Care of Glenfield Hospital, University Hospitals of Leicester NHS
Trust, Leicester, United Kingdom
(Girdauskas) Department of Cardiovascular Surgery, University Heart Center
Hamburg, Hamburg, Germany
(Quintana) Cardiovascular Surgery, Univeristy Hospital Clinic, Barcelona,
Cataluna, Spain
(Santini) Cardiac Surgery Unit, University of Genova, Genoa, Italy
(De Feo) Division of Cardiac Surgery, Department of Cardiothoracic
Sciences, Second University of Naples, Naples, Italy
(Sponga) Cardiothoracic Department, University Hospital of Udine, Udine,
Italy
(Tozzi) Cardiac Surgery Unit, Centre Hopitalier Universitaire Vaudois,
Lausanne, Switzerland
(Bashir) Division of Cardiac Surgery, St. Barth Hospital NHS, London,
United Kingdom
(Perrotti) Department of Thoracic and Cardio-Vascular Surgery, University
Hospital Jean Minjoz, Besancon, France
(Pappalardo) Division of Cardiac Surgery, Ospedali Riuniti, Trieste, Italy
(Ruggieri) Chirurgie Thoracique et Cardio-Vasculaire, Pole TCVN, Hopital
Robert Debre, Reims, France
(Santarpino) Cardiovascular Center, Klinikum Nurnberg, Paracelsus Medical
University, Nuremberg, Germany
(Rinaldi) Department of Cardiac Surgery, Torino University Hospitals,
Turin, Italy
(Ronaldo) Unit for Clinical Research and Biostatistics, Verona University
Hospital, Verona, Italy
(Nicolini) Divison of Cardiac Surgery, University of Parma, Parma, Italy
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Traditional and transcatheter surgical treatments of severe aortic valve
stenosis (SAVS) are increasing in parallel with the improved life
expectancy. Recent randomised controlled trials (RCTs) reported comparable
or non-inferior mortality with transcatheter treatments compared with
traditional surgery. However, RCTs have the limitation of being a mirror
of the predefined inclusion/exclusion criteria, without reflecting the
real clinical world'. Technological improvements have recently allowed the
development of minimally invasive surgical accesses and the use of
sutureless valves, but their impact on the clinical scenario is difficult
to assess because of the monocentric design of published studies and
limited sample size. A prospective multicentre registry including all
patients referred for a surgical treatment of SAVS (traditional, through
full sternotomy; minimally invasive; or transcatheter; with both sutured'
and sutureless' valves) will provide a real-world' picture of available
results of current surgical options and will help to clarify the grey
zones' of current guidelines. Methods and analysis European Aortic Valve
Registry is a prospective observational open registry designed to collect
all data from patients admitted for SAVS, with or without coronary artery
disease, in 16 cardiac surgery centres located in six countries (France,
Germany, Italy, Spain, Switzerland and UK). Patients will be enrolled over
a 2-year period and followed up for a minimum of 5 years to a maximum of
10 years after enrolment. Outcome definitions are concordant with Valve
Academic Research Consortium-2 criteria and established guidelines.
Primary outcome is 5-year all-cause mortality. Secondary outcomes aim at
establishing early' 30-day all-cause and cardiovascular mortality, as well
as major morbidity, and late' cardiovascular mortality, major morbidity,
structural and non-structural valve complications, quality of life and
echocardiographic results. Ethics and dissemination The study protocol is
approved by local ethics committees. Any formal presentation or
publication of data will be considered as a joint publication by the
participating physician(s) and will follow the recommendations of the
International Committee of Medical Journal Editors for authorship. Trial
registration number NCT03143361; Pre-results.<br/>Copyright &#xa9; Article
author(s) 2018.

<7>
Accession Number
623793281
Title
Resuming anticoagulants after anticoagulation-associated intracranial
haemorrhage: Systematic review and meta-analysis.
Source
BMJ Open. 8 (5) (no pagination), 2018. Article Number: e019672. Date of
Publication: 01 May 2018.
Author
Zhou Z.; Yu J.; Carcel C.; Delcourt C.; Shan J.; Lindley R.I.; Neal B.;
Anderson C.S.; Hackett M.L.
Institution
(Zhou) Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University,
Shanghai, China
(Zhou, Yu, Carcel, Delcourt, Lindley, Neal, Anderson, Hackett) George
Institute for Global Health, Faculty of Medicine, University of New South
Wales, Sydney, NSW, Australia
(Yu) Department of Cardiology, Peking University Third Hospital, Beijing,
China
(Carcel, Delcourt, Anderson) Department of Neurology, Royal Prince Alfred
Hospital, Sydney Health Partners, Sydney, NSW, Australia
(Carcel, Delcourt, Lindley, Hackett) Sydney Medical School, University of
Sydney, Sydney, NSW, Australia
(Shan) Department of Geriatrics, Ren Ji Hospital, Shanghai Jiao Tong
University, Shanghai, China
(Neal) Charles Perkins Centre, University of Sydney, Sydney, NSW,
Australia
(Neal) Department of Epidemiology and Biostatistics, Imperial College
London, London, United Kingdom
(Anderson) George Institute China, Peking University Health Science
Center, Beijing, China
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Objective To determine the adverse outcomes following resumption of
anticoagulation in patients with anticoagulation-associated intracranial
haemorrhage (ICH). Design We performed a systematic review and
meta-analysis in this clinical population. The Preferred Reporting Items
for Systemic Reviews and Meta-Analyses statement was followed, and two
authors independently assessed eligibility of all retrieved studies and
extracted data. Data sources Medline, Embase and the Cochrane Central
Register of Controlled Trials, from inception to February 2017.
Eligibility criteria and outcomes Randomised controlled trials or cohort
studies that recruited adults who received oral anticoagulants at the time
of ICH occurrence and survived after the acute phase or hospitalisation
were searched. Primary outcomes, including long-term mortality, recurrent
ICH and thromboembolic events. Secondary outcomes were the frequency of
resuming anticoagulant therapy and related factors. Results We included 12
cohort studies (no clinical trials) involving 3431 ICH participants. The
pooled frequency of resuming anticoagulant therapy was 38% (95% CI 32% to
44%), but this was higher in participants with prosthetic heart valves,
subarachnoid haemorrhage or dyslipidaemia. There was no evidence that
resuming anticoagulant therapy was associated with higher long-term
mortality (pooled relative risk (RR) 0.60, 95% CI 0.30 to 1.19; p=0.14) or
ICH recurrence (pooled RR 1.14, 95% CI 0.72 to 1.80; p=0.57). Resumption
of anticoagulation was associated with significantly fewer thromboembolic
events (pooled RR 0.31, 95% CI 0.23 to 0.42; p<0.001). In a subgroup of
patients with atrial fibrillation, resuming anticoagulant therapy was
associated with fewer long-term mortality (pooled RR 0.27, 95% CI 0.20 to
0.37, p<0.001). Conclusions Based on these observational studies, resuming
anticoagulant therapy after anticoagulation-associated ICH has beneficial
effects on long-term complications. Clinical trials are needed to
substantiate these findings. PROSPERO registration number
CRD42017063827.<br/>Copyright &#xa9; Article author(s) (or their
employer(s) unless otherwise stated in the text of the article) 2018.

<8>
Accession Number
615136925
Title
Coronary Artery Bypass Surgery in Diffuse Advanced Coronary Artery
Disease: 1-Year Clinical and Angiographic Results.
Source
Thoracic and Cardiovascular Surgeon. 66 (6) (pp 477-482), 2018. Date of
Publication: 18 Feb 2018.
Author
Dourado L.O.C.; Bittencourt M.S.; Pereira A.C.; Poppi N.T.; Dallan L.A.O.;
Krieger J.E.; Cesar L.A.M.; Gowdak L.H.W.
Institution
(Dourado, Pereira, Poppi, Dallan, Krieger, Cesar, Gowdak) Cardiopneumology
Department, Heart Institute (InCor), University of Sao Paulo Medical
School, Sao Paulo, Brazil
(Bittencourt) Division of Internal Medicine, Center for Clinical and
Epidemiological Research, University Hospital, University of Sao Paulo,
Sao Paulo, Brazil
Publisher
Georg Thieme Verlag (E-mail: iaorl@iaorl.org)
Abstract
Background Proper treatment of patients with diffuse, severe coronary
artery disease (CAD) is a challenge due to its complexity. Thus, data on
the outcomes after coronary artery bypass graft (CABG) in this population
is scarce. In this study, we aimed to determine the impact of CABG on the
clinical and functional status, as well as graft patency in those
individuals. Methods Patients with severe and diffuse CAD who underwent
incomplete CABG due to complex anatomy or extensive distal coronary
involvement were evaluated preoperatively and 1 year after surgery.
Postoperative coronary angiography was performed to evaluate graft
patency. Graft occlusion was defined as the complete absence of
opacification of the target vessel. Stratified analysis of graft occlusion
was performed by graft type and territories, defined as left anterior
descending artery (LAD), the left circumflex branch, and the right
coronary artery territories; the latter two, grouped, were further
classified as non-LAD territory. Results A total of 57 patients were
included, in whom 131 grafts were placed. There was a significant
improvement in Canadian Cardiovascular Society angina symptom severity (Z
= -6.1; p < 0.001) and maximum oxygen uptake (p < 0.001), with a
corresponding decrease in the use of long-acting nitrates (p < 0.001). The
overall graft occlusion rate was 19.1%, with no significant difference
between LAD and non-LAD territories (p = 0.08). However, a significantly
lower occlusion rate was noted for the internal mammary artery (IMA)
grafts when compared with saphenous vein grafts (p = 0.01), though this
difference was only significant in the LAD territory (p = 0.04). Overall,
the use of venous graft was the only predictor occlusion at 1 year (odds
ratio: 4.03; p = 0.016). Conclusion In patients with diffuse CAD,
incomplete CABG surgery resulted in a significant clinical improvement,
with acceptable graft occlusion rates at 1 year, particularly for IMA
grafts to the LAD territory.<br/>Copyright &#xa9; 2018 Georg Thieme Verlag
KG Stuttgart. New York.

<9>
Accession Number
619499363
Title
Effect of Sustained Use of Aspirin until the Time of Surgery on Outcomes
following Coronary Artery Bypass Grafting: A Randomized Clinical Trial.
Source
Thoracic and Cardiovascular Surgeon. 66 (6) (pp 442-451), 2018. Date of
Publication: 24 Nov 2018.
Author
Sharifi M.; Kamali A.; Ghandi Y.
Institution
(Sharifi) Department of Cardiovascular Surgery, Amir-Almomenin Training
and Research Hospital, Arak University of Medical Sciences, Arak
3848176941, Iran, Islamic Republic of
(Kamali) Department of Anesthesiology, Faculty of Medicine, Arak
University of Medical Sciences, Arak, Iran, Islamic Republic of
(Ghandi) Department of Pediatric Cardiology, Faculty of Medicine, Arak
University of Medical Sciences, Arak, Iran, Islamic Republic of
Publisher
Georg Thieme Verlag (E-mail: iaorl@iaorl.org)
Abstract
Background The topic of aspirin (acetylsalicylic acid, ASA) use in
coronary artery disease patients planned for coronary artery bypass
grafting during perioperative period is among the most disputed issues in
cardiac surgery. We designed a study to weigh the risks and benefits of
continued ASA ingestion until the time of surgery. Methods In this
randomized double-blind clinical trial, 206 consecutive patients scheduled
for isolated coronary artery bypass surgery (CABG) were randomly
stratified into two groups. In group 1 (104 cases), patients were given 80
mg ASA per day until the day of surgery. In group 2 (102 patients), ASA
(80 mg per day) was stopped 4 days before the operation. Patients in these
two groups were similar in terms of preoperative patient and procedural
characteristics. ASA was resumed 24 hours after the surgery in all
patients. Results The rates of bleeding and reexploration within 24 hours
of surgery were significantly higher in group 1 (824.3 vs. 492.1 mL, p <
0.001 and 5.7% vs. 0, p = 0.0138, respectively). The amount of intra- and
postoperative packed red blood cell (PRBC) transfusion was considerably
greater in group 1 (mean: 1.83 vs. 0.71 units, p < 0.001). The rate of
hospital mortality was similar (1.9% in both the groups, p = 0.98).
Patients in group 1 had significantly longer mean hospital stay than
patients in group 2 (8 vs. 5.1 days, p < 0.001). Again the time interval
between weaning from heart-lung machine and closing the sternum was
strikingly longer in group 1 (mean: 32.1 vs. 14.5 minutes, p < 0.001). The
incidence of adverse postoperative outcomes such as myocardial infarction,
stroke, and renal failure was not statistically different between the two
groups. Conclusion Sustained ASA use until the day of surgery in patients
planned for elective isolated CABG can result in excessive bleeding,
increased rate of reexploration, and need for more PRBC transfusion
without any proven beneficial effect on reducing unfavorable postoperative
outcomes. Hence, we recommend discontinuing ASA between 3 and 5 days
before non-urgent CABG while keeping it on in nonelective
circumstances.<br/>Copyright &#xa9; 2018 Georg Thieme Verlag KG Stuttgart.
New York.

<10>
Accession Number
623831954
Title
Risk stratification and role for additional diagnostic testing in patients
with acute chest pain and normal high-sensitivity cardiac troponin levels.
Source
PLoS ONE. 13 (9) (no pagination), 2018. Article Number: e0203506. Date of
Publication: September 2018.
Author
Smulders M.W.; Bekkers S.C.A.M.; van Cauteren Y.J.M.; Liefhebber A.;
Vermeer J.R.; Vervuurt J.; Van Dieijen-Visser M.P.; Mingels A.M.A.; Rocca
H.-P.B.-L.; Dagnelie P.C.; Wildberger J.E.; Crijns H.J.G.M.; Kietselaer
B.L.J.H.
Institution
(Smulders, Bekkers, van Cauteren, Liefhebber, Vermeer, Vervuurt, Rocca,
Crijns, Kietselaer) Department of Cardiology, Maastricht University
Medical Center, Maastricht, Netherlands
(Smulders, Bekkers, van Cauteren, Van Dieijen-Visser, Mingels, Rocca,
Dagnelie, Wildberger, Crijns, Kietselaer) Cardiovascular Research
Institute Maastricht (CARIM), Maastricht University, Maastricht,
Netherlands
(Bekkers, van Cauteren, Wildberger, Kietselaer) Department of Radiology,
Maastricht University Medical Center, Maastricht, Netherlands
(Van Dieijen-Visser, Mingels) Department of Clinical Chemistry, Maastricht
University Medical Center, Maastricht, Netherlands
(Dagnelie) Department of Epidemiology, Maastricht University, Maastricht,
Netherlands
(Dagnelie) School for Public Health and Primary Care (CAPHRI), Maastricht
University, Maastricht, Netherlands
(Kietselaer) Department of Cardiology, Zuyderland Medical Center7,
Heerlen, Netherlands
Publisher
Public Library of Science (E-mail: plos@plos.org)
Abstract
Background Normal high sensitivity cardiac troponin (hs-cTn) assays rule
out acute myocardial infarction (AMI) with great accuracy, but additional
non-invasive testing is frequently ordered. This observational study
evaluates whether clinical characteristics can contribute to risk
stratification and could guide referral for additional testing. Methods
918 serial patients with acute chest pain and normal hs-cTnT levels were
prospectively included. Major adverse cardiac events (MACE) and
non-invasive test results were assessed during one-year follow-up.
Patients were classified as low and high risk based on clinical
characteristics. Results MACE occurred in 6.1% of patients and mainly
comprised revascularizations (86%). A recent abnormal stress test,
suspicious history, a positive family history and higher baseline hs-cTnT
levels were independent predictors of MACE with odds ratios of 16.00 (95%
CI:6.25-40.96), 16.43 (6.36-42.45), 2.33 (1.22-4.42) and 1.10 (1.01-1.21),
respectively. Absence of both recent abnormal stress test and suspicious
history identified 86% of patients. These patients were at very low risk
for MACE (0.4% in 30-days and 2.3% in one-year). Despite this, the
majority (287/345 = 83%) of additional tests were performed in low risk
patients, with <10% abnormal test findings. The diagnostic yield was
significantly higher in the remaining higher risk patients, 40% abnormal
test findings and a positive predictive value of 70% for MACE. Similar
results were observed in patients without known coronary artery disease.
Conclusions Clinical characteristics can be used to identify low risk
patients with acute chest pain and normal hs-cTnT levels. Current
strategies in the emergency department result in numerous additional
tests, which are mostly ordered in patients at very low risk and have a
low diagnostic yield.<br/>Copyright &#xa9; 2018 Smulders et al. This is an
open access article distributed under the terms of the Creative Commons
Attribution License, which permits unrestricted use, distribution, and
reproduction in any medium, provided the original author and source are
credited.

<11>
Accession Number
623795076
Title
Self-management of cardiac pain in women: An evidence map.
Source
BMJ Open. 7 (11) (no pagination), 2017. Article Number: 018549. Date of
Publication: 01 Nov 2017.
Author
Parry M.; Bjornnes A.K.; Clarke H.; Cooper L.; Gordon A.; Harvey P.;
Lalloo C.; Leegaard M.; Lefort S.; McFetridge-Durdle J.; McGillion M.;
O'Keefe-Mccarthy S.; Price J.; Stinson J.; Victor J.C.; Watt-Watson J.
Institution
(Parry, Bjornnes, Stinson, Watt-Watson) Lawrence S Bloomberg Faculty of
Nursing, University of Toronto, Toronto, ON, Canada
(Bjornnes, Leegaard) Institute of Nursing and Health Promotion, Oslo and
Akershus University College of Applied Sciences, Oslo, Norway
(Clarke) Pain Research Unit, University Health Network, Toronto, ON,
Canada
(Cooper) Canadian Pain Coalition, Toronto, ON, Canada
(Gordon) Wasser Pain Management Centre, Mount Sinai Hospital, Toronto, ON,
Canada
(Harvey) Department of Medicine, Women's College Hospital, Toronto, ON,
Canada
(Harvey, Price) Women's College Hospital, Women's College Research
Institute, Toronto, ON, Canada
(Lalloo, Stinson) Hosp Sick Children, Peter Gilgan Centre for Research and
Learning, Toronto, ON, Canada
(Lefort) School of Nursing, Memorial University of Newfoundland, St.
John's, NSW, Canada
(McFetridge-Durdle) College of Nursing, Florida State University,
Tallahassee, FL, United States
(McGillion) School of Nursing, McMaster University, Hamilton, ON, Canada
(O'Keefe-Mccarthy) Department of Nursing, Faculty of Applied Sciences,
Brock University, Toronto, ON, Canada
(Victor) Institute of Health Policy Management and Evaluation, University
of Toronto, Toronto, ON, Canada
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Objective To describe the current evidence related to the self-management
of cardiac pain in women using the process and methodology of evidence
mapping. Design and setting Literature search for studies that describe
the self-management of cardiac pain in women greater than 18 years of age,
managed in community, primary care or outpatient settings, published in
English or a Scandinavian language between 1 January 1990 and 24 June 2016
using AMED, CINAHL, ERIC, EMBASE, MEDLINE, Proquest, PsychInfo, the
Cochrane Library, Scopus, Swemed+, Web of Science, the Clinical Trials
Registry, International Register of Controlled Trials, MetaRegister of
Controlled Trials, theses and dissertations, published conference
abstracts and relevant websites using GreyNet International, ISI
proceedings, BIOSIS and Conference papers index. Two independent reviewers
screened using predefined eligibility criteria. Included articles were
classified according to study design, pain category, publication year,
sample size, per cent women and mean age. Interventions Self-management
interventions for cardiac pain or non-intervention studies that described
views and perspectives of women who self-managed cardiac pain. Primary and
secondary outcomes measures Outcomes included those related to knowledge,
self-efficacy, function and health-related quality of life. Results The
literature search identified 5940 unique articles, of which 220 were
included in the evidence map. Only 22% (n=49) were intervention studies.
Sixty-nine per cent (n=151) of the studies described cardiac pain related
to obstructive coronary artery disease (CAD), 2% (n=5) non-obstructive CAD
and 15% (n=34) postpercutaneous coronary intervention/cardiac surgery.
Most were published after 2000, the median sample size was 90 with
25%-100% women and the mean age was 63 years. Conclusions Our evidence map
suggests that while much is known about the differing presentations of
obstructive cardiac pain in middle-aged women, little research focused on
young and old women, non-obstructive cardiac pain or self-management
interventions to assist women to manage cardiac pain. PROSPERO
registration number CRD42016042806.<br/>Copyright &#xa9; 2017 Article
author(s) (or their employer(s) unless otherwise stated in the text of the
article). All rights reserved. No commercial use is permitted unless
otherwise expressly granted.

<12>
Accession Number
623906721
Title
Evaluation of pain and patient satisfaction by music therapy in patients
with endoscopy/colonoscopy.
Source
Turkish Journal of Gastroenterology. 29 (5) (pp 574-579), 2018. Date of
Publication: September 2018.
Author
Bashiri M.; Akcali D.; Coskun D.; Cindoruk M.; Dikmen A.; Cifdaloz B.U.
Institution
(Bashiri, Akcali, Coskun) Department of Anesthesiology and Reanimation,
Gazi University School of Medicine, Ankara, Turkey
(Cindoruk) Department of Gastroenterology, Gazi University School of
Medicine, Ankara, Turkey
(Dikmen) Department of Public Health, Gazi University School of Medicine,
Ankara, Turkey
(Cifdaloz) Department of Musicology, Gazi University Turkish Music
National Conservatory, Ankara, Turkey
Publisher
AVES Ibrahim KARA (105/9 Buyukdere Cad, Mecidiyekoy,Sisli, Istanbul 34394,
Turkey)
Abstract
Background/Aims: Endoscopy and colonoscopy are frequently performed
procedures to evaluate the gastrointestinal system. These procedures are
sometimes disturbing and painful for the patient. In gastrointestinal
suits, endoscopy and colonoscopy may be performed on awake or sedated
patients. Music therapy is a common and non-pharmacological treatment for
various medical conditions, pain, and anxiety. The aim of the present
study was to add music therapy to sedation administered during endoscopy
and colonoscopy. The effect of music treatment on drug consumption,
anxiety, and pain was investigated. Materials and Methods: American
Anesthesiologist Association I-III adult patients scheduled for
endo/colonoscopy were randomized to music treatment and no music treatment
groups. Patients with endoscopic ultrasound and endoscopic retrograde
colangiopancreaticography were excluded from the study. Anxiety score and
pain severity were evaluated before and after the procedure. Heart rate,
mean arterial pressure, and oxygen saturation were recorded before,
during, and after the procedure. Total drug consumption was recorded.
Patient satisfaction and desire for the same protocol for recurrent
procedures were investigated. Results: Music therapy added to deep
sedation administered by anesthesiologists provided decreased anxiety
score and propofol consumption. Patient satisfaction was increased, and
patients reported a desire for the same protocol for recurrent procedures.
Conclusion: The present study may serve as the beginning of using music
therapy for pain treatment in gastroenterology procedures in our hospital
with/without sedation. Music and other non-pharmacological treatment
methods must be remembered to increase patient comfort during
enco/colonoscopies and other painful procedures.<br/>&#xa9; Copyright 2018
by The Turkish Society of Gastroenterology * Available online at
www.turkjgastroenterol.org

<13>
Accession Number
623897589
Title
Impact of Concomitant Mitral Valve Surgery With LVAD Placement: Systematic
Review and Meta-Analysis.
Source
Artificial Organs. (no pagination), 2018. Date of Publication: 2018.
Author
Choi J.H.; Luc J.G.Y.; Moncho Escriva E.; Phan K.; Rizvi S.S.A.; Patel S.;
Entwistle J.W.; Morris R.J.; Massey H.T.; Tchantchaleishvili V.
Institution
(Choi, Rizvi, Patel, Entwistle, Morris, Massey, Tchantchaleishvili)
Division of Cardiac Surgery, Thomas Jefferson University, Philadelphia,
PA, United States
(Luc) Division of Cardiovascular Surgery, Department of Surgery,
University of British Columbia, Vancouver, BC, Canada
(Moncho Escriva) Department of Statistics, University of Granada, Granada,
Spain
(Phan) Faculty of Medicine, University of New South Wales, Sydney, NSW,
Australia
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
The aim of this systematic review and meta-analysis was to evaluate the
outcomes of concomitant mitral valve surgery for significant preexisting
mitral regurgitation (MR) in patients undergoing continuous-flow left
ventricular assist device (CF-LVAD) implantation. Electronic search was
performed to identify all studies in the English literature examining
concurrent mitral valve surgery in patients with CF-LVAD implantation.
Identified articles were systematically assessed for inclusion and
exclusion criteria. Of 2319 studies identified, 8 studies were included.
Among 445 patients with moderate to severe or severe MR, 113 (25.4%)
patients received concurrent mitral valvular intervention during CF-LVAD
implantation. There were no significant differences in cardiopulmonary
bypass time (MR Surgery 154 min vs. no MR Surgery 119 min, P = 0.64) or
hospital length of stay (MR Surgery 21 days vs. no MR Surgery 18 days, P =
0.93). On follow-up, there were no significant differences in freedom from
greater than moderate MR (MR Surgery 100% vs. no MR Surgery 74%, P = 0.12)
or left ventricular end-diastolic diameter (MR Surgery: 60 mm vs. no MR
Surgery 65 mm, P = 0.51). Survival was comparable at 6-months (MR Surgery
77% vs. no MR Surgery 81%, P = 0.75), 1-year (MR Surgery 72% vs. no MR
Surgery 80%, P = 0.36), and 2-years of follow-up (MR Surgery 65% vs. no MR
Surgery 70%, P = 0.56). The results of our systematic review and
meta-analysis of 8 studies consisting of 445 patients demonstrates that
the addition of mitral valve intervention to CF-LVAD implantation appears
to be safe with comparable survival to those undergoing CF-LVAD
implantation alone. Large prospective randomized clinical trials are
needed to elucidate whether concomitant mitral valve intervention during
CF-LVAD implantation in patients with severe MR is
necessary.<br/>Copyright &#xa9; 2018 International Center for Artificial
Organs and Transplantation and Wiley Periodicals, Inc.

<14>
Accession Number
2001001361
Title
What are the clinical, quality-of-life, and cost consequences of 30years
of excellent vs. poor glycemic control in type 1 diabetes?.
Source
Journal of Diabetes and its Complications. 32 (10) (pp 911-915), 2018.
Date of Publication: October 2018.
Author
Herman W.H.; Braffett B.H.; Kuo S.; Lee J.M.; Brandle M.; Jacobson A.M.;
Prosser L.A.; Lachin J.M.
Institution
(Herman) Departments of Internal Medicine and Epidemiology, University of
Michigan, Ann Arbor, MI, United States
(Braffett, Lachin) The Biostatistics Center, George Washington University,
Washington, DC, United States
(Kuo) Department of Internal Medicine, University of Michigan, Ann Arbor,
MI, United States
(Lee) Pediatric Endocrinology, Child Health Evaluation and Research Unit,
University of Michigan, Ann Arbor, MI, United States
(Brandle) Division of Endocrinology and Diabetes, Kantonsspital St.
Gallen, Sankt Gallen, SG, Switzerland
(Jacobson) Winthrop-University Hospital, Mineola, NY, United States
(Prosser) Department of Pediatrics, University of Michigan, Ann Arbor, MI,
United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objective: The Diabetes Control and Complications Trial (DCCT)
demonstrated that intensive therapy for type 1 diabetes delayed the
development of microvascular and neuropathic complications compared to
conventional therapy. At the end of DCCT, all participants were trained in
intensive therapy, care was transferred to community providers, and the
difference in HbA1c between treatment groups narrowed and disappeared. Our
objective was to describe the outcomes and the quality-of-life and costs
associated with those outcomes in participants who maintained excellent
vs. poor glycemic control over 30 years. Research design and methods: We
assessed the incidence of retinopathy, nephropathy, neuropathy,
cardiovascular disease, acute metabolic complications, death,
quality-of-life, and costs in the tertile of DCCT intensive therapy
participants who achieved a mean updated HbA1c of <7.2% (55 mmol/mol) and
the tertile of DCCT conventional therapy participants (n = 240) who
achieved a mean updated HbA1c of >8.8% (73 mmol/mol) over 30 years.
Results: Thirty years of excellent vs. poor glycemic control substantially
reduced the incidence of retinopathy requiring laser therapy (5% vs. 45%),
end-stage renal disease (0% vs. 5%), clinical neuropathy (15% vs. 50%),
myocardial infarction (3% vs. 5%), stroke (0.4% vs. 2%), and death (6% vs.
20%). It also resulted in a gain of ~1.62 quality-adjusted life-years and
averted ~$90,900 in costs of complications per participant. Conclusions:
Thirty years of excellent vs. poor glycemic control for T1DM can
substantially reduce the incidence of complications, comorbidities, and
death, improve quality-of-life, and reduce costs. These estimates
represent the benefits that may be achieved with excellent glycemic
control.<br/>Copyright &#xa9; 2018 Elsevier Inc.

<15>
Accession Number
623794411
Title
Point-of-care washing of allogeneic red blood cells for the prevention of
transfusion-related respiratory complications (WAR-PRC): A protocol for a
multicenter randomised clinical trial in patients undergoing cardiac
surgery.
Source
BMJ Open. 7 (8) (no pagination), 2017. Article Number: e016398. Date of
Publication: 01 Aug 2017.
Author
Warner M.A.; Welsby I.J.; Norris P.J.; Silliman C.C.; Armour S.; Wittwer
E.D.; Santrach P.J.; Meade L.A.; Liedl L.M.; Nieuwenkamp C.M.; Douthit B.;
Van Buskirk C.M.; Schulte P.J.; Carter R.E.; Kor D.J.
Institution
(Warner) Division of Critical Care, Department of Anesthesiology and
Perioperative Medicine, Mayo Clinic Minnesota, Rochester, MN, United
States
(Welsby, Douthit) Department of Anesthesiology, Duke University Medical
Center, Raleigh, NC, United States
(Norris) Blood Systems Research Institute, University of California, San
Francisco, CA, United States
(Silliman) Bonfils Blood Center, University of Colorado Denver, Denver,
CO, United States
(Armour, Wittwer, Meade, Liedl, Kor) Department of Anesthesiology and
Perioperative Medicine, Mayo Clinic, Rochester, MN, United States
(Santrach, Nieuwenkamp) Department of Laboratory Medicine and Pathology,
Mayo Clinic, Rochester, MN, United States
(Liedl, Schulte, Carter) Department of Biomedical Statistics and
Informatics, Mayo Clinic, Rochester, MN, United States
(Van Buskirk) Laboratory Medicine and Pathology, Mayo Clinic, Rochester,
MN, United States
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Introduction: The transfusion-related respiratory complications,
transfusion-related acute lung injury (TRALI) and transfusion-associated
circulatory overload (TACO), are leading causes of transfusion-related
morbidity and mortality. At present, there are no effective preventive
strategies with red blood cell (RBC) transfusion. Although mechanisms
remain incompletely defined, soluble biological response modifiers (BRMs)
within the RBC storage solution may play an important role. Point-of-care
(POC) washing of allogeneic RBCs may remove these BRMs, thereby mitigating
their impact on post-transfusion respiratory complications. Methods and
analysis: This is a multicenter randomised clinical trial of standard
allogeneic versus washed allogeneic RBC transfusion for adult patients
undergoing cardiac surgery testing the hypothesis that POC RBC washing is
feasible, safe, and efficacious and will reduce recipient immune and
physiologic responses associated with transfusion-related respiratory
complications. Relevant clinical outcomes will also be assessed. This
investigation will enrol 170 patients at two hospitals in the USA. Simon's
two-stage design will be used to assess the feasibility of POC RBC
washing. The primary safety outcomes will be assessed using Wilcoxon
Rank-Sum tests for continuous variables and Pearson chi-square test for
categorical variables. Standard mixed modelling practices will be employed
to test for changes in biomarkers of lung injury following transfusion.
Linear regression will assess relationships between randomised group and
post-transfusion physiologic measures. Ethics and dissemination: Safety
oversight will be conducted under the direction of an independent Data and
Safety Monitoring Board (DSMB). Approval of the protocol was obtained by
the DSMB as well as the institutional review boards at each institution
prior to enrolling the first study participant. This study aims to provide
important information regarding the feasibility of POC washing of
allogeneic RBCs and its potential impact on ameliorating post-transfusion
respiratory complications. Additionally, it will inform the feasibility
and scientific merit of pursuing a more definitive phase II/III clinical
trial.<br/>Copyright &#xa9; 2017 Article author(s). All rights reserved.

<16>
Accession Number
622992072
Title
Evaluation of Cardiovascular Disease Risk in HIV-1-Infected Patients
Treated with Darunavir.
Source
Drugs in R and D. 18 (3) (pp 199-210), 2018. Date of Publication: 01 Sep
2018.
Author
Opsomer M.; Dimitrova D.; Verspeelt J.; Purrington A.; Mehbob A.; Chavers
S.; Pai H.; Vanveggel S.; Luo D.; Brown K.; Moecklinghoff C.; Nettles
R.E.; Boven K.
Institution
(Opsomer, Verspeelt, Vanveggel) Janssen Research and Development, Beerse,
Belgium
(Dimitrova, Chavers, Luo, Boven) Janssen Research and Development, LLC,
Titusville, NJ, United States
(Purrington) Janssen Research and Development, LLC, Horsham, PA, United
States
(Mehbob) Janssen-Cilag Ltd, High Wycombe, United Kingdom
(Pai) Janssen Research and Development, LLC, Raritan, NJ, United States
(Brown, Nettles) Janssen Scientific Affairs, LLC, Titusville, NJ, United
States
(Moecklinghoff) Janssen EMEA, Neuss, Germany
Publisher
Springer International Publishing
Abstract
Introduction: We evaluated cardiovascular disease (CVD) risk associated
with darunavir treatment and examined the demographic/clinical
characteristics of darunavir users based on data from Janssen-sponsored
clinical trials, post-marketing pharmacovigilance databases, and
administrative claims databases. Methods: First, selected CVD events
[myocardial infarction, stroke, sudden death, invasive cardiovascular
procedures (coronary artery angioplasty or bypass, or carotid
endarterectomy)] were analyzed in 19 Janssen-sponsored phase 2-4 studies
(incidence rates estimated from pooled data; 95% confidence intervals
derived from Poisson distribution). Second, analyses were conducted to
identify spontaneously reported CVD events in post-marketing
pharmacovigilance databases and evaluate disproportional reporting of CVD
events for darunavir (using Empirical Bayesian Geometric Mean scores).
Third, baseline demographic/clinical characteristics of human
immunodeficiency virus-1 (HIV-1)-infected patients in general and new
users of darunavir and atazanavir were explored using three US
administrative claims databases. Results: Among 19 Janssen-sponsored
clinical trials (treatment durations <= 6 years), the CVD event rate (95%
CI) per 1000 person-years (pooled population; n = 5713) was 6.15
(2.91-11.89), and was lower for patients who used once-daily
darunavir/ritonavir 800/100 mg [0.71 (0.16-3.05); n = 1326] versus
twice-daily darunavir/ritonavir 600/100 mg [9.21 (4.94-16.04); n = 3058].
Trend analysis of post-marketing pharmacovigilance data showed that
cumulative CVD event reporting rates for darunavir users (any dose)
generally declined over time. Spontaneously reported CVD events were not
disproportionately reported with darunavir versus other protease
inhibitors. Compared with the general HIV-1-infected population and
atazanavir users, higher proportions of darunavir users were male, older,
and had comorbidities associated with CVD risk based on results from US
administrative claims databases. Conclusions: This comprehensive review of
Janssen-sponsored clinical trial, post-marketing, and epidemiological data
does not suggest that CVD should be considered an important risk for users
of darunavir.<br/>Copyright &#xa9; 2018, The Author(s).

<17>
Accession Number
623884535
Title
Management of simultaneous traumatic brain injury and aortic injury.
Source
Journal of Neurotrauma. Conference: 3rd Joint Symposium of the
International and National Neurotrauma Societies and AANS/CNS Section on
Neurotrauma and Critical Care. Canada. 35 (16) (pp A57), 2018. Date of
Publication: 2018.
Author
Rasschaert R.; Lavrysen E.
Institution
(Rasschaert, Lavrysen) Neurosurgery, ZNA Middelheim, Antwerp, Belgium
Publisher
Mary Ann Liebert Inc.
Abstract
Trauma cases with Traumatic Brain Injury (TBI) together with an aortic
injury (AI) are rare and have a high mortality rate. 24-50% of patients
with aortic injury also have TBI. These cases require a multidisciplinary
approach: neurosurgery, cardiac surgery and thoracic and vascular surgeons
have to intervene as soon as possible and are often faced with opposing
treatments, such as target blood pressure and the use of anticoagulants.
Due to the rareness of this combination of traumatic injuries and even
then in most cases fatal, literature is lacking treatment protocols. A
case report and a short review of literature will be presented.

<18>
Accession Number
623819120
Title
Coronary CT angiography and 5-year risk of myocardial infarction.
Source
New England Journal of Medicine. 379 (10) (pp 924-933), 2018. Date of
Publication: 06 Sep 2018.
Author
Newby D.E.; Adamson P.D.; Berry C.; Boon N.A.; Dweck M.R.; Flather M.;
Forbes J.; Hunter A.; Lewis S.; MacLean S.; Mills N.L.; Norrie J.; Roditi
G.; Shah A.S.V.; Timmis A.D.; Van Beek E.J.R.; Williams M.C.
Institution
(Newby, Adamson, Boon, Dweck, Hunter, Lewis, Mills, Norrie, Shah, Van
Beek, Williams) University of Edinburgh, Edinburgh, United Kingdom
(Berry, Roditi) University of Glasgow, Glasgow, United Kingdom
(Flather) University of East Anglia, Norwich, United Kingdom
(MacLean) NHS Fife, Kirkcaldy, United Kingdom
(Timmis) Queen Mary University, London, United Kingdom
(Forbes) University of Limerick, Limerick, Ireland
Publisher
Massachussetts Medical Society
Abstract
BACKGROUND Although coronary computed tomographic angiography (CTA)
improves diagnostic certainty in the assessment of patients with stable
chest pain, its effect on 5-year clinical outcomes is unknown. METHODS In
an open-label, multicenter, parallel-group trial, we randomly assigned
4146 patients with stable chest pain who had been referred to a cardiology
clinic for evaluation to standard care plus CTA (2073 patients) or to
standard care alone (2073 patients). Investigations, treatments, and
clinical outcomes were assessed over 3 to 7 years of follow-up. The
primary end point was death from coronary heart disease or nonfatal
myocardial infarction at 5 years. RESULTS The median duration of follow-up
was 4.8 years, which yielded 20,254 patientyears of follow-up. The 5-year
rate of the primary end point was lower in the CTA group than in the
standard-care group (2.3% [48 patients] vs. 3.9% [81 patients]; hazard
ratio, 0.59; 95% confidence interval [CI], 0.41 to 0.84; P = 0.004).
Although the rates of invasive coronary angiography and coronary
revascularization were higher in the CTA group than in the standard-care
group in the first few months of follow-up, overall rates were similar at
5 years: invasive coronary angiography was performed in 491 patients in
the CTA group and in 502 patients in the standard- care group (hazard
ratio, 1.00; 95% CI, 0.88 to 1.13), and coronary revascularization was
performed in 279 patients in the CTA group and in 267 in the standard-care
group (hazard ratio, 1.07; 95% CI, 0.91 to 1.27). However, more preventive
therapies were initiated in patients in the CTA group (odds ratio, 1.40;
95% CI, 1.19 to 1.65), as were more antianginal therapies (odds ratio,
1.27; 95% CI, 1.05 to 1.54). There were no significant between-group
differences in the rates of cardiovascular or noncardiovascular deaths or
deaths from any cause. CONCLUSIONS In this trial, the use of CTA in
addition to standard care in patients with stable chest pain resulted in a
significantly lower rate of death from coronary heart disease or nonfatal
myocardial infarction at 5 years than standard care alone, without
resulting in a significantly higher rate of coronary angiography or
coronary revascularization. (Funded by the Scottish Government Chief
Scientist Office and others; SCOT-HEART ClinicalTrials.gov number,
NCT01149590.).<br/>Copyright &#xa9; 2018 Massachusetts Medical Society.

<19>
Accession Number
623882850
Title
Outcome measures for pediatric laryngotracheal reconstruction:
International consensus statement.
Source
Laryngoscope. (no pagination), 2018. Date of Publication: 2018.
Author
Balakrishnan K.; Sidell D.R.; Bauman N.M.; Bellia-Munzon G.F.; Boesch
R.P.; Bromwich M.; Cofer S.A.; Daines C.; de Alarcon A.; Garabedian N.;
Hart C.K.; Ida J.B.; Leboulanger N.; Manning P.B.; Mehta D.K.; Monnier P.;
Myer C.M.; Prager J.D.; Preciado D.; Propst E.J.; Rahbar R.; Russell J.;
Rutter M.J.; Thierry B.; Thompson D.M.; Torre M.; Varela P.; Vijayasekaran
S.; White D.R.; Wineland A.M.; Wood R.E.; Wootten C.T.; Zur K.; Cotton
R.T.
Institution
(Balakrishnan, Cofer) Department of Otorhinolaryngology and Mayo Clinic
Children's Center, Rochester, MN, United States
(Boesch) Department of Pediatric and Adolescent Medicine and Mayo Clinic
Children's Center, Mayo Clinic, Rochester, MN, United States
(Sidell) Department of Otolaryngology-Head and Neck Surgery, Stanford
University, Palo Alto, CA, United States
(Bauman, Preciado) Division of Otolaryngology, Children's National Health
System, Washington, DC, United States
(Daines) Department of Pediatrics, University of Arizona Health Sciences,
Tucson, AZ, United States
(de Alarcon, Hart, Myer, Rutter, Cotton) Division of Pediatric
Otolaryngology and Aerodigestive and Esophageal Center, Cincinnati
Children's Hospital Medical Center and University of Cincinnati College of
Medicine, Cincinnati, OH, United States
(Wood) Division of Pulmonary Medicine, Cincinnati Children's Hospital,
Cincinnati, OH, United States
(Ida, Thompson) Department of Otolaryngology, Head and Neck Surgery,
Northwestern University Feinberg School of Medicine, Chicago, IL, United
States
(Manning) Section of Pediatric Cardiothoracic Surgery, St. Louis
Children's Hospital and Washington University School of Medicine, St.
Louis, MO, United States
(Mehta) Department of Pediatric Otolaryngology, Texas Children's Hospital,
Houston, TX, United States
(Prager) Department of Otolaryngology, University of Colorado, Aurora, CO,
United States
(Rahbar) Department of Otolaryngology, Boston Children's Hospital, Harvard
Medical School, Boston, MA, United States
(White) Department of Otolaryngology-Head and Neck Surgery, Medical
University of South Carolina, Charleston, SC, United States
(Wineland) University of Arkansas School for Medical Sciences, Department
of Otolaryngology-Head & Neck Surgery, Arkansas Children's Hospital,
Little Rock, AR, United States
(Wootten) Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville,
TN, United States
(Zur) Center for Pediatric Airway Disorders, Children's Hospital of
Philadelphia, Perelman School of Medicine, University of Pennsylvania,
Philadelphia, PA, United States
(Bellia-Munzon) Department of Pediatric Surgery, General Hospital of
Children Pedro de Elizalde, Buenos Aires, Argentina
(Bromwich) Department of Otorhinolaryngology, University of Ottawa,
Ottawa, Canada
(Propst) Department of Otolaryngology-Head & Neck Surgery, Hospital for
Sick Children, University of Toronto, Toronto, ON, Canada
(Garabedian, Leboulanger, Thierry) Department of Otorhinolaryngology,
Hopital Universitaire Necker-Enfants Malades, Paris, France
(Monnier) Department of Otolaryngology, Head and Neck Surgery, University
Hospital of Lausanne (CHUV), Lausanne, Switzerland
(Russell) Department of Paediatric Otolaryngology, Our Lady's Hospital for
Sick Children, Dublin, Ireland
(Torre) Airway Team and Surgical Department, Instituto Giannina Gaslini,
Genoa, Italy
(Varela) Pediatric Surgery Department, University of Chile, Clinical Las
Condes Medical Center, Santiago, Chile
(Vijayasekaran) Department of Otolaryngology, Head and Neck Surgery,
Princess Margaret Hospital for Children, Perth, Australia
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Objectives: Develop multidisciplinary and international consensus on
patient, disease, procedural, and perioperative factors, as well as key
outcome measures and complications, to be reported for pediatric airway
reconstruction studies. Methods: Standard Delphi methods were applied.
Participants proposed items in three categories: 1) patient/disease
characteristics, 2) procedural/intraoperative/perioperative factors, and
3) outcome measures and complications. Both general and anatomic
site-specific measures were elicited. Participants also suggested specific
operations to be encompassed by this project. We then used iterative
ranking and review to develop consensus lists via a priori Delphi
consensus criteria. Results: Thirty-three pediatric airway experts from
eight countries in North and South America, Europe, and Australia
participated, representing otolaryngology (including International
Pediatric Otolaryngology Group members), pulmonology, general surgery, and
cardiothoracic surgery. Consensus led to inclusion of 19 operations
comprising open expansion, resection, and slide procedures of the larynx,
trachea, and bronchi as well as three endoscopic procedures. Consensus was
achieved on multiple patient/comorbidity (10), disease/stenosis (7),
perioperative-/intraoperative-/procedure-related (16) factors. Consensus
was reached on multiple outcome and complication measures, both general
and site-specific (8 general, 13 supraglottic, 15 glottic, 17 subglottic,
8 cervical tracheal, 12 thoracic tracheal). The group was able to clarify
how each outcome should be measured, with specific instruments defined
where applicable. Conclusion: This consensus statement provides a
framework to communicate results consistently and reproducibly,
facilitating meta-analyses, quality improvement, transfer of information,
and surgeon self-assessment. It also clarifies expert opinion on which
patient, disease, procedural, and outcome measures may be important to
consider in any pediatric airway reconstruction patient. Level of
Evidence: 5. Laryngoscope, 2018.<br/>Copyright &#xa9; 2018 The American
Laryngological, Rhinological and Otological Society, Inc.

<20>
Accession Number
623882844
Title
Total cardiovascular events analysis of the EXAMINE trial in patients with
type 2 diabetes and recent acute coronary syndrome.
Source
Clinical Cardiology. (no pagination), 2018. Date of Publication: 2018.
Author
Cavender M.A.; White W.B.; Liu Y.; Massaro J.M.; Bergenstal R.M.; Mehta
C.R.; Zannad F.; Heller S.; Cushman W.C.; Cannon C.P.
Institution
(Cavender) Department of Medicine, University of North Carolina, Chapel
Hill, NC, United States
(Cavender, Liu, Cannon) Baim Institute for Clinical Research, Boston, MA,
United States
(White) Calhoun Cardiology Center, University of Connecticut School of
Medicine, Farmington, CT, United States
(Massaro) Department of Biostatistics, Boston University School of Public
Health, Boston, MA, United States
(Bergenstal) Department of Endocrinology, Park Nicollet Clinic,
Minneapolis, MN, United States
(Mehta) Department of Biostatistics, Harvard School of Public Health,
Boston, MA, United States
(Zannad) Department of Medicine, INSERM 1143, Universite de Lorraine,
Nancy, France
(Heller) Department of Medicine, University of Sheffield and Sheffield
Teaching Hospitals National Health Service Foundation Trust, Sheffield,
United Kingdom
(Cushman) Department of Medicine, Memphis Veterans Affairs Medical Center
and University of Tennessee Health Science Center, Memphis, TN, United
States
(Cannon) Department of Medicine, Brigham and Women's Hospital, Boston, MA,
United States
Publisher
John Wiley and Sons Inc. (E-mail: cs-journals@wiley.com)
Abstract
Alogliptin, a dipeptidyl peptidase-4 inhibitor, is approved for the
treatment of patients with type 2 diabetes (T2DM). EXAMINE was a
randomized controlled clinical trial designed to demonstrate the
cardiovascular (CV) safety of alogliptin. In the trial, 5380 patients with
established T2DM who had a recent acute coronary syndrome event (between
15 and 90 days) were randomized to treatment with either alogliptin or
placebo. To better understand and describe the CV safety of alogliptin, we
analyzed data from the EXAMINE trial to determine whether treatment with
alogliptin affected recurrent and total CV events. Poisson regression
analysis compared the total number of occurrences of CV death, MI, stroke,
unstable angina, and coronary revascularization between all patients
randomized to alogliptin vs placebo groups. Patients with recurrent CV
events were older and more likely to have renal disease and history of
heart failure. There were 1100 first CV events and an additional 666
recurrent events over a median of 18 months of follow-up. There were no
significant differences with regard to total number of events in patients
treated with alogliptin (n = 873) or placebo (n = 893; P = 0.52).
Furthermore, there were no differences in the types of events seen in
patients treated with alogliptin or placebo. Alogliptin did not increase
the risk of either first or recurrent CV events when compared with placebo
in patients with T2DM and recent acute coronary syndrome. These data
support the CV safety of alogliptin in patients who are at increased risk
of future CV events.<br/>Copyright &#xa9; 2018 Wiley Periodicals, Inc.

<21>
Accession Number
618266150
Title
Effects on the incidence of cardiovascular events of the addition of
pioglitazone versus sulfonylureas in patients with type 2 diabetes
inadequately controlled with metformin (TOSCA.IT): a randomised,
multicentre trial.
Source
The Lancet Diabetes and Endocrinology. 5 (11) (pp 887-897), 2017. Date of
Publication: November 2017.
Author
Vaccaro O.; Masulli M.; Nicolucci A.; Bonora E.; Del Prato S.; Maggioni
A.P.; Rivellese A.A.; Squatrito S.; Giorda C.B.; Sesti G.; Mocarelli P.;
Lucisano G.; Sacco M.; Signorini S.; Cappellini F.; Perriello G.; Lapolla
A.; Giordano C.; Buzzetti R.; Clemente G.; Di Cianni G.; Iannarelli R.;
Cordera R.; La Macchia O.; Zamboni C.; Scaranna C.; Boemi M.; Iovine C.;
Lauro D.; Leotta S.; Dall'Aglio E.; Cannarsa E.; Tonutti L.; Pugliese G.;
Bossi A.C.; Anichini R.; Dotta F.; Di Benedetto A.; Citro G.; Antenucci
D.; Ricci L.; Giorgino F.; Santini C.; Gnasso A.; De Cosmo S.; Zavaroni
D.; Vedovato M.; Consoli A.; Calabrese M.; di Bartolo P.; Fornengo P.;
Riccardi G.; D'Angelo F.; Giansanti R.; Tanase L.; Lanari L.; Testa I.;
Pancani F.; Ranchelli A.; Vagheggi P.; Scatona A.; Fontana L.; Laviola L.;
Tarantino L.; Ippolito C.; Gigantelli V.; Manicone M.; Conte E.; Trevisan
R.; Rota R.; Dodesini A.R.; Reggiani G.M.; Montesi L.; Mazzella N.;
Forlani G.; Caselli C.; Di Luzio R.; Mazzotti A.; Aiello A.; Barrea A.;
Musto A.; D'Amico F.; Sinagra T.; Longhitano S.; Trowpea V.; Sparti M.;
Italia S.; Lisi E.; Grasso G.; Pezzino V.; Insalaco F.; Carallo C.;
Scicchitano C.; De Franceschi M.S.; Calbucci G.; Ripani R.; Corsi L.;
Cuneo G.; Corsi S.; Romeo F.; Lesina A.; Comoglio M.; Bonetto C.; Robusto
A.; Nada E.; Asprino V.; Cetraro R.; Impieri M.; Lucchese G.; Donnarumma
G.; Tizio B.; Lenza L.; Paraggio P.; Tomasi F.; Dozio N.; Scalambra E.;
Mannucci E.; Lamanna C.; Cignarelli M.; Macchia O.L.; Fariello S.;
Sorrentino M.R.; Franzetti I.; Radin R.; Annunziata F.; Bonabello L.A.;
Durante A.; Dolcino M.; Gallo F.; Mazzucchelli C.; Aleo A.; Melga P.;
Briatore L.; Maggi D.; Storace D.; Cecoli F.; D'Ugo E.; Pupillo M.;
Baldassarre M.P.A.; Salvati F.; Minnucci A.; De Luca A.; Zugaro A.;
Santarelli L.; Bosco A.; Petrella V.; La Verghetta G.G.; D'Andrea S.;
Giuliani A.E.; Polidoro W.L.; Sperandio A.; Sciarretta F.; Pezzella A.;
Carlone A.; Venditti C.; Foffi C.; Carbone S.; Cipolloni L.; Moretti C.;
Leto G.; Serra R.; Petrachi F.; Romano I.; Lacaria E.; Russo L.; Goretti
C.; Sannino C.; Gregori G.; Dolci M.; Bruselli L.; Mori M.L.; Baccetti F.;
Del Freo M.; Cucinotta D.; Giunta L.; Ruffo M.C.; Cannizzaro D.; Pintaudi
B.; Perrone G.; Pata P.; Ragonese F.; Lettina G.; Mancuso T.; Coppolino
A.; Piatti P.M.; Monti L.; Stuccillo M.; Lucotti P.; Setola M.; Crippa
G.V.; Loi C.; Oldani M.; Bottalico M.L.; Pellegata B.; Bonomo M.;
Menicatti L.S.M.; Resi V.; Bertuzzi F.; Disoteo E.O.; Pizzi G.; Annuzzi
G.; Capaldo B.; Nappo R.; Auciello S.M.; Turco A.A.; Costagliola L.; Corte
G.D.; Vallefuoco P.; Nappi F.; Vitale M.; Cocozza S.; Ciano O.; Massimino
E.; Garofalo N.; Avogaro A.; Guarneri G.; Fedele D.; Sartore G.; Chilelli
N.C.; Burlina S.; Bonsembiante B.; Galluzzo A.; Torregrossa V.;
Mancastroppa G.; Arsenio L.; Cioni F.; Caronna S.; Papi M.; Santeusanio
F.; Calagreti G.; Timi A.; Tantucci A.; Marino C.; Ginestra F.; Di Biagio
R.; Taraborelli M.; Miccoli R.; Bianchi C.; Garofolo M.; Politi K.S.;
Penno G.; Livraga S.; Calzoni F.; Mancastroppa G.L.F.; Corsini E.;
Tedeschi A.; Gagliano M.S.; Ippolito G.; Salutini E.; Cervellino F.;
Natale M.; Salvatore V.; Zampino A.; Sinisi R.; Arcangeli A.; Zogheri A.;
Guizzotti S.; Longo R.; Pellicano F.; Scolozzi P.; Termine S.; Luberto A.;
Ballardini G.; Babini A.C.; Trojani C.; Mazzuca P.; Bruglia M.; Ciamei M.;
Genghini S.; Zannoni C.; Rangel G.; Salvi L.; Zappaterreno A.; Cordone S.;
Simonelli P.; Meggiorini M.; Frasheri A.; Di Pippo C.; Maglio C.;
Mazzitelli G.; Rinaldi M.E.; Galli A.; Romano M.; D'Angelo P.; Suraci C.;
Bacci S.; Palena A.P.; Genovese S.; Mancino M.; Rondinelli M.; Capone F.;
Calabretto E.; Bulgheroni M.; Bucciarelli L.; Ceccarelli E.; Fondelli C.;
Santacroce C.; Guarino E.; Nigi L.; Lalli C.; Di Vizia G.; Scarponi M.;
Montani V.; Di Bernardino P.; Romagni P.; Dolcetti K.; Forte E.;
Potenziani S.; Tamburo L.; Perin P.C.; Prinzis T.; Gruden G.; Bruno G.;
Zucco C.; Perotta M.; Marena S.; Monsignore S.; Panero F.; Ponzi F.;
Carpinteri R.; Casagrande M.L.; Coletti M.F.; Balini A.; Filopanti M.;
Madaschi S.; Pulcina A.; Grimaldi F.; Venturini G.; Agus S.; Pagnutti S.;
Guidotti F.; Cavarape A.; Cigolini M.; Pichiri I.; Brangani C.; Fainelli
G.; Tomasetto E.; Zoppini G.; Galletti A.; Perrone D.; Capra C.; Bianchini
F.; Ceseri M.; Di Nardo B.; Sasso E.; Bartolomei B.; Suliman I.; Fabbri
G.; Romano G.; Maturo N.; Nunziata G.; Capobianco G.; De Simone G.; Villa
V.; Rota G.; Pentangelo C.; Carbonara O.; Caiazzo G.; Cutolo M.;
Sorrentino T.; Mastrilli V.; Amelia U.; Masi S.; Corigliano G.; Gaeta I.;
Armentano V.; Calatola P.; Capuano G.; Angiulli B.; Auletta P.; Petraroli
E.; Iodice C.E.; Agrusta M.
Institution
(Vaccaro, Masulli, Rivellese, Riccardi) Department of Clinical Medicine
and Surgery, University of Naples Federico II, Naples, Italy
(Iovine) Diabetes Unit, University of Naples Federico II, Naples, Italy
(Nicolucci, Lucisano, Sacco) Center for Outcomes Research and Clinical
Epidemiology (CORESEARCH), Pescara, Italy
(Bonora) Division of Endocrinology, Diabetes and Metabolism, University
and Hospital Trust of Verona, Verona, Italy
(Del Prato) Department of Clinical & Experimental Medicine, University of
Pisa, Pisa, Italy
(Maggioni) National Association of Hospital Cardiologists (ANMCO) Research
Center, Florence, Italy
(Squatrito) Diabetes Unit, University Hospital Garibaldi-Nesima of
Catania, Catania, Italy
(Giorda) Diabetes Unit, Azienda Sanitaria Locale (ASL) Torino 5, Torino,
Italy
(Sesti) Department of Medical and Surgical Sciences, Magna Graecia
University of Catanzaro, Italy
(Gnasso) Department of Clinical and Experimental Medicine, Magna Graecia
University of Catanzaro, Italy
(Mocarelli, Signorini, Cappellini) University Department Laboratory
Medicine, Hospital of Desio, Monza, Italy
(Perriello) Endocrinology and Metabolism, University of Perugia, Perugia,
Italy
(Babini) Medical Division, Rimini Hospital, Rimini, Italy
(Lapolla) Dipartimento di Medicina, Universita di Padova, Padova, Italy
(Gregori) Diabetes Unit, Massa Carrara, Azienda Unita Sanitarie Locali
(USL) Toscana Nord Ovest, Carrara, Italy
(Giordano) Section of Endocrinology, Diabetology and Metabolic Diseases,
University of Palermo, Palermo, Italy
(Corsi) Diabetes Unit, ASL 4 Chiavarese, Chiavari, Italy
(Buzzetti) Department of Experimental Medicine, Sapienza University, Rome,
Italy
(Pugliese) Department of Clinical and Molecular Medicine, Sapienza
University, Rome, Italy
(Clemente) Institute for Research on Population and Social
Policies-National Research Council, Penta di Fisciano, Italy
(Di Cianni) Diabetes and Metabolism, Livorno Hospital, Livorno, Italy
(Iannarelli) Diabetes Unit, Department of Medicine, San Salvatore
Hospital, L'Aquila, Italy
(Cordera) Diabetes Unit, School of Medicine, University of Genova,
Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) San Martino
Hospital, Genova, Italy
(La Macchia) Endocrinology, Azienda Ospedaliero Universitaria Ospedali
Riuniti, Foggia, Italy
(Zamboni) Diabetes Unit, University of Ferrara, Ferrara, Italy
(Scaranna) Endocrinology and Diabetology, Azienda Socio Sanitaria
Territoriale (ASST) Papa Giovanni XXIII, Bergamo, Italy
(Boemi) Diabetes and Metabolism Unit, IRCCS Istituto Nazionale Riposo e
Cura Anziani, Ancona, Italy
(Lauro) Department of Systems Medicine, University of Rome Tor Vergata,
Rome, Italy
(Leotta) UOC Diabetologia Ospedale Sandro Pertini, Rome, Italy
(Dall'Aglio) Clinical and Experimental Medicine, University of Parma,
Parma, Italy
(Cannarsa) Diabetes Unit, San Liberatore Hospital, Atri Teramo, Italy
(Tonutti) Endocrinology, Diabetes, Metabolism and Clinical Nutrition Unit,
Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italy
(Bossi) ASST Bergamo Ovest, Treviglio, Italy
(Anichini) Diabetes Unit, USL 3, Pistoia, Italy
(Dotta) Diabetes Unit, Department of Medicine, Surgery and Neurosciences,
University of Siena, Siena, Italy
(Di Benedetto) Department of Clinical and Experimental Medicine,
University of Messina, Messina, Italy
(Citro) Endocrinology and Diabetes Unit, Azienda Sanitaria Locale di
Potenza, Potenza, Italy
(Antenucci) Diabetes Unit, Renzetti Hospital, ASL 2 Abruzzo, Lanciano,
Italy
(Ricci) Diabetes Unit, USL Sud Est, Toscana, Italy
(Giorgino) Department of Emergency and Organ Transplantation,
Endocrinology and Metabolic Diseases, University of Bari Aldo Moro, Bari,
Apulia, Italy
(Santini) Department Endocrinology and Diabetology, Cesena Hospital,
Cesena, Italy
(De Cosmo) Unit of Internal Medicine, IRCCS Casa Sollievo della
Sofferenza, San Giovanni Rotondo, Italy
(Zavaroni) Diabetes Unit, Guglielmo da Saliceto Hospital, Piacenza, Italy
(Vedovato) Metabolism Unit, Azienda Ospedaliera di Padova, Padova, Italy
(Consoli) Department of Medicine and Aging Sciences, Aging and
Translational Medicine Research Center (CeSI-Met), D'Annunzio University,
Chieti-Pescara, Italy
(Calabrese) Diabetes Unit, USL Toscana Centro, Prato, Italy
(di Bartolo) Diabetes Unit, Ravenna Internal Medicine Department, Romagna
Local Health Unit, Ravenna, Italy
(Fornengo) Department of Medical Sciences, University of Turin, Turin,
Italy
Publisher
Lancet Publishing Group (E-mail: cususerv@lancet.com)
Abstract
Background The best treatment option for patients with type 2 diabetes in
whom treatment with metformin alone fails to achieve adequate glycaemic
control is debated. We aimed to compare the long-term effects of
pioglitazone versus sulfonylureas, given in addition to metformin, on
cardiovascular events in patients with type 2 diabetes. Methods TOSCA.IT
was a multicentre, randomised, pragmatic clinical trial, in which patients
aged 50-75 years with type 2 diabetes inadequately controlled with
metformin monotherapy (2-3 g per day) were recruited from 57 diabetes
clinics in Italy. Patients were randomly assigned (1:1), by permuted
blocks randomisation (block size 10), stratified by site and previous
cardiovascular events, to add-on pioglitazone (15-45 mg) or a sulfonylurea
(5-15 mg glibenclamide, 2-6 mg glimepiride, or 30-120 mg gliclazide, in
accordance with local practice). The trial was unblinded, but event
adjudicators were unaware of treatment assignment. The primary outcome,
assessed with a Cox proportional-hazards model, was a composite of first
occurrence of all-cause death, non-fatal myocardial infarction, non-fatal
stroke, or urgent coronary revascularisation, assessed in the modified
intention-to-treat population (all randomly assigned participants with
baseline data available and without any protocol violations in relation to
inclusion or exclusion criteria). This study is registered with
ClinicalTrials.gov, number NCT00700856. Findings Between Sept 18, 2008,
and Jan 15, 2014, 3028 patients were randomly assigned and included in the
analyses. 1535 were assigned to pioglitazone and 1493 to sulfonylureas
(glibenclamide 24 [2%], glimepiride 723 [48%], gliclazide 745 [50%]). At
baseline, 335 (11%) participants had a previous cardiovascular event. The
study was stopped early on the basis of a futility analysis after a median
follow-up of 57.3 months. The primary outcome occurred in 105 patients
(1.5 per 100 person-years) who were given pioglitazone and 108 (1.5 per
100 person-years) who were given sulfonylureas (hazard ratio 0.96, 95% CI
0.74-1.26, p=0.79). Fewer patients had hypoglycaemias in the pioglitazone
group than in the sulfonylureas group (148 [10%] vs 508 [34%], p<0.0001).
Moderate weight gain (less than 2 kg, on average) occurred in both groups.
Rates of heart failure, bladder cancer, and fractures were not
significantly different between treatment groups. Interpretation In this
long-term, pragmatic trial, incidence of cardiovascular events was similar
with sulfonylureas (mostly glimepiride and gliclazide) and pioglitazone as
add-on treatments to metformin. Both of these widely available and
affordable treatments are suitable options with respect to efficacy and
adverse events, although pioglitazone was associated with fewer
hypoglycaemia events. Funding Italian Medicines Agency, Diabete Ricerca,
and Italian Diabetes Society.<br/>Copyright &#xa9; 2017 Elsevier Ltd

<22>
Accession Number
623324391
Title
Early initiation of post-sternotomy cardiac rehabilitation exercise
training (SCAR): Study protocol for a randomised controlled trial and
economic evaluation.
Source
BMJ Open. 8 (3) (no pagination), 2018. Date of Publication: 2018.
Author
Ennis S.; Lobley G.; Worrall S.; Powell R.; Kimani P.K.; Khan A.J.;
Banerjee P.; Barker T.; McGregor G.
Institution
(Ennis, Lobley, Worrall, Powell, McGregor) Department of Cardiac
Rehabilitation, Centre for Exercise and Health, University Hospital,
Coventry, United Kingdom
(Ennis) Cardiff Centre for Exercise and Health, Cardiff Metropolitan
University, Cardiff, United Kingdom
(Kimani) Statistics and Epidemiology, Division of Health Sciences, Warwick
Medical School, University of Warwick, Coventry, United Kingdom
(Khan, Banerjee, McGregor) Health and Life Sciences Research Centre,
Coventry University, Coventry, United Kingdom
(Banerjee) Department of Cardiology, University Hospitals, Coventry,
United Kingdom
(Barker) Department of Cardiothoracic Surgery, University Hospital,
Coventry, United Kingdom
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Introduction Current guidelines recommend abstinence from supervised
cardiac rehabilitation (CR) exercise training for 6 weeks post-sternotomy.
This practice is not based on empirical evidence, thus imposing
potentially unnecessary activity restrictions. Delayed participation in CR
exercise training promotes muscle atrophy, reduces cardiovascular fitness
and prolongs recovery. Limited data suggest no detrimental effect of
beginning CR exercise training as early as 2 weeks post-surgery, but
randomised controlled trials are yet to confirm this. The purpose of this
trial is to compare CR exercise training commenced early (2 weeks
post-surgery) with current usual care (6 weeks post-surgery) with a view
to informing future CR guidelines for patients recovering from sternotomy.
Methods and analysis In this assessor-blind randomised controlled trial,
140 cardiac surgery patients, recovering from sternotomy, will be assigned
to 8 weeks of twiceweekly supervised CR exercise training commencing at
either 2 weeks (early CR) or 6 weeks (usual care CR) post-surgery. Usual
care exercise training will adhere to current UK recommendations.
Participants in the early CR group will undertake a highly individualised
2-3 week programme of functional mobility, strength and cardiovascular
exercise before progressing to a usual care CR programme. Outcomes will be
assessed at baseline (inpatient), pre-CR (2 or 6 weeks post-surgery),
post-CR (10 or 14 weeks post-surgery) and 12 months. The primary outcome
will be change in 6 min walk distance. Secondary outcomes will include
measures of functional fitness, quality of life and cost-effectiveness.
Ethics and dissemination Recruitment commenced on July 2017 and will
complete by December 2019. Results will be disseminated via national
governing bodies, scientific meetings and peer-reviewed
journals.<br/>Copyright &#xa9; 2018 BMJ Publishing Group. All rights
reserved.

<23>
Accession Number
2000904542
Title
Meta-Analysis Comparing Dual Versus Single Antiplatelet Therapy in
Combination With Antithrombotic Therapy in Patients With Atrial
Fibrillation Who Underwent Percutaneous Coronary Intervention With Stent
Implantation.
Source
American Journal of Cardiology. 122 (4) (pp 604-611), 2018. Date of
Publication: 15 August 2018.
Author
Lou B.; Liang X.; Wu Y.; Deng Y.; Zhou B.; Yuan Z.; She J.
Institution
(Lou, Liang, Wu, Deng, Yuan, She) Cardiovascular Department, First
Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710048, China
(Lou, Liang, Wu, Deng, Yuan, She) Key Laboratory of Environment and Genes
Related to Diseases, Ministry of Education, Xi'an 710048, China
(Lou, Liang, Wu, Deng, Yuan, She) Key Laboratory of Molecular Cardiology,
Shaanxi Province, China
(Zhou) Respiratory Department, First Affiliated Hospital of Xi'an Jiaotong
University, Xi'an 710048, China
(Lou) European Center for Angioscience (ECAS), Department of Vascular
Biology&Tumor Angiogenesis, Medical Faculty Mannheim, Heidelberg
University, Mannheim 68169, Germany
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
The coexistence of atrial fibrillation and coronary artery disease is
commonly found in clinical practice. The aim of this meta-analysis is to
compare the clinical efficacy and safety of dual versus single
antiplatelet therapy in combination with antithrombotic therapy in
patients with atrial fibrillation undergoing percutaneous coronary
intervention. PubMed, EMBASE and Web of Science databases were
systematically evaluated for articles published up to October 31, 2017.
The risk ratios (RR) were extracted from each study. Pooled estimates with
corresponding 95% confidence intervals (CI) were estimated by a fixed or
random-effects model. Eight studies involving a total of 10,861 patients
with atrial fibrillation were included in this meta-analysis. Five
thousand sixty-six participants received dual antiplatelet therapy
together with warfarin or new oral anticoagulation (triple antithrombotic
therapy, TT) and 5,795 participants received single antiplatelet therapy
together with warfarin or new oral anticoagulation (dual antithrombotic
therapy). TT was associated with a significantly higher incidence of all
(RR 1.45, p <0.001) and major (RR 1.77, p <0.001) bleeding events, but no
difference with regard to stroke, in-stent thrombosis, major adverse
cardiovascular events, and all-cause mortality rate. In conclusion, as
compared to TT, dual antithrombotic therapy is equally effective in
reducing stroke, in-stent thrombosis, major adverse cardiovascular events,
and all-cause mortality rate, but shows beneficial effect in reducing
overall bleeding incidence in atrial fibrillation patients who underwent
percutaneous coronary intervention.<br/>Copyright &#xa9; 2018 The
Author(s)

<24>
Accession Number
2000900534
Title
Meta-Analysis Comparing Primary Percutaneous Coronary Intervention Versus
Pharmacoinvasive Therapy in Transfer Patients with ST-Elevation Myocardial
Infarction.
Source
American Journal of Cardiology. 122 (4) (pp 542-547), 2018. Date of
Publication: 15 August 2018.
Author
Siddiqi T.J.; Usman M.S.; Khan M.S.; Sreenivasan J.; Kassas I.; Riaz H.;
Raza S.; Deo S.V.; Sharif H.; Kalra A.; Yadav N.
Institution
(Siddiqi, Usman) Internal Medicine, Dow University of Health Sciences,
Karachi, Pakistan
(Khan, Sreenivasan) Internal Medicine, John H Stroger Jr. Hospital of Cook
County, Chicago, Illinois, United States
(Kassas) Division of Cardiology, New York University School of Medicine,
New York, New York, United States
(Riaz) Division of Cardiology, Cleveland Clinic, Cleveland, Ohio, United
States
(Raza, Kalra) Department of Cardiology, University Hospitals Cleveland
Medical Center, Cleveland, Ohio, United States
(Deo) Department of Cardiac Surgery, University Hospitals Cleveland
Medical Center, Cleveland, Ohio, Pakistan
(Sharif) Department of Cardiac Surgery, Aga Khan University Hospital,
Karachi, Pakistan
(Yadav) Division of Cardiology, John H Stroger Jr. Hospital of Cook
County, Chicago, Illinois, United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
ST-elevation myocardial infarction patients presenting at non-percutaneous
coronary intervention (PCI)-capable hospitals often need to be transferred
for primary percutaneous coronary intervention (PPCI). This increases time
to revascularization, leading to increased risk of in-hospital mortality.
With recent focus on total ischemic time rather than door-to-balloon time
as the principal determinant of outcomes in ST-elevation myocardial
infarction patients, pharmacoinvasive therapy (PIT) has gained attention
as a possible improvement over PPCI in patients requiring transfer. Our
objective was to observe how PIT stands against PPCI in terms of safety
and efficacy. Electronic databases were searched for randomized controlled
trials and observational studies comparing PPCI to PIT. PIT was defined as
administration of thrombolytic drugs followed by immediate PCI only in
case of failed thrombolysis. Results from studies were pooled using a
random-effects model. We identified 17 relevant studies (6 randomized
controlled trials, 11 observational studies) including 13,037 patients.
Overall, there was no significant difference in short-term mortality (odds
ratio [OR] = 1.20 [0.97 to 1.49]; I² = 14.2%; p = 0.099);
however, PIT significantly decreased short-term mortality (OR = 1.46 [1.08
to 1.96]; I² = 0%; p = 0.01) in those studies with a
symptom-onset-to-device time >=200 minutes. There was a significantly
lower risk reinfarction (OR = 0.69 [0.49 to 0.97]; I² = 0%; p =
0.033) in the PPCI group, while the risk of cardiogenic shock was
significantly higher (OR = 1.48 [1.13 to 1.94]; I² = 0%; p =
0.005). In conclusion, PIT versus PPCI decisions should preferably be
customized in patients presenting to non-PCI capable hospitals. Factors
that need to be considered include symptom-onset to first medical contact
time, expected time of transfer to a PCI-capable hospital, and patients
risk factors.<br/>Copyright &#xa9; 2018 Elsevier Inc.

<25>
Accession Number
623771658
Title
Maintaining intraoperative normothermia reduces blood loss in patients
undergoing major operations: A pilot randomized controlled clinical trial.
Source
BMC Anesthesiology. 18 (1) (no pagination), 2018. Article Number: 126.
Date of Publication: 08 Sep 2018.
Author
Yi J.; Liang H.; Song R.; Xia H.; Huang Y.
Institution
(Yi, Liang, Song, Xia, Huang) Chinese Academy of Medical Science,
Department of Anesthesia, Peking Union Medical College Hospital, 1
Shuaifuyuan, Dongcheng District, Beijing 100730, China
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Inadvertent intraoperative hypothermia (core
temperature<36degreeC) is a common but preventable adverse event. This
study aimed to determine whether active intraoperative warming reduced
bleeding in patients undergoing major operations: open thoracic surgery
and hip replacement surgery. Methods/Design: The study was a pilot,
prospective, parallel two-arm randomized controlled trial. Eligible
patients were randomly allocated to two groups: passive warming (PW), with
application of a cotton blanket (thermal insulation), or active warming
(AW), with a forced-air warming system. The primary endpoint was
intraoperative blood loss, and secondary endpoints were surgical-site
infection, cardiovascular events, and length of stay in the
post-anesthesia care unit, intensive care unit, and hospital. Results:
Sixty-two patients were enrolled. Forced-air active warming maintained
intraoperative normothermia in all AW subjects, whereas intraoperative
hypothermia occurred in 21/32 (71.8%) of PW patients (p=0.000). The volume
of blood loss was more in the PW group (682+/-426ml) than in the AW group
(464+/-324ml) (p<0.021), and the perioperative hemoglobin value declined
more in the PW group (28.6+/-17.5g/L) than in the AW group (21.0+/-9.9g/L)
(p=0.045). However, there were no difference in other clinical outcomes
between two groups. Conclusion: Intraoperative active warming is
associated with less blood loss than passive warming in open thoracic and
hip replacement operations in this pilot study.<br/>Copyright &#xa9; 2018
The Author(s).

<26>
Accession Number
2000919966
Title
Outcomes of anticoagulated patients with atrial fibrillation treated with
or without antiplatelet therapy - A pooled analysis from the PREFER in AF
and PREFER in AF PROLONGATON registries.
Source
International Journal of Cardiology. 270 (pp 160-166), 2018. Date of
Publication: 1 November 2018.
Author
Patti G.; Pecen L.; Lucerna M.; Huber K.; Rohla M.; Renda G.;
Siller-Matula J.; Schnabel R.B.; Cemin R.; Kirchhof P.; De Caterina R.
Institution
(Patti) Department of Cardiovascular Sciences, Campus Bio-Medico
University of Rome, Italy
(Pecen) Medical Faculty Pilsen of Charles University, Czech Republic
(Lucerna) Daiichi Sankyo Europe, Munich, Germany
(Huber, Rohla) 3rd Department of Medicine, Cardiology and Intensive Care
Medicine, Wilhelminenhospital, Vienna, Austria
(Huber, Rohla) Sigmund Freud University, Medical School, Vienna, Austria
(Renda, De Caterina) G. d'Annunzio University, Chieti, Italy
(Siller-Matula) Department of Cardiology, Medical University of Vienna,
Austria
(Siller-Matula) 1st Department of Cardiology, Poznan University of Medical
Sciences, Poland
(Schnabel) University Heart Center Hamburg, Clinic for General and
Interventional Cardiology, Hamburg, Germany
(Schnabel) DZHK (German Center for Cardiovascular Research), partner site
Hamburg/Kiel/Luebeck, Germany
(Cemin) Department of Cardiology, San Maurizio Regional Hospital of
Bolzano, Italy
(Kirchhof) Institute of Cardiovascular Sciences, University of Birmingham
and SWBH and UHB NHS Trust, Birmingham, United Kingdom
(De Caterina) Fondazione G. Monasterio, Pisa, Italy
(De Caterina) University Cardiology Division, "G. d'Annunzio" University -
Chieti, Ospedale SS. Annunziata, Via dei Vestini, Chieti 66013, Italy
Publisher
Elsevier Ireland Ltd
Abstract
Background: Evidence on whether antiPLT added to OACs is of advantage in
atrial fibrillation (AF) patients with concomitant stable coronary artery
disease (CAD) is limited. We evaluated clinical outcomes with oral
anticoagulant (OAC) monotherapy vs antiplatelet therapy (antiPLT) plus OAC
in patients with AF and stable CAD. Methods: Data on 1058 AF patients on
OACs and history (>1 year) of myocardial infarction or coronary stenting
were pooled from the PREFER-in-AF and PREFER-in-AF PROLONGATION
registries. We primarily compared the 1-year incidence of a net composite
endpoint (primary endpoint), including acute coronary syndrome and major
bleeding, with or without antiPLT. Results: The incidence of the primary
net composite endpoint was significantly higher in patients receiving OACs
+ antiPLT (N = 348) vs OACs alone (N = 710): 7.9 vs 4.2 per 100
patients/year; adjusted OR [95% CI] 1.84 [1.01-3.37]; p = 0.048. Among the
components of the primary endpoint, the greatest relative difference was
found for major bleeding (OR [95% CI] 2.28 [95% CI 1.00-5.19]), and
especially life-threatening or non-gastrointestinal bleeding. The net
clinical outcome with OACs + antiPLT was poorer irrespective of the type
of CAD (previous infarction or coronary stenting), the type of stent (bare
metal or drug-eluting) or the type of OAC (vitamin K antagonist or
non-vitamin K antagonist OAC). Conclusions: Among patients with AF and
stable CAD >1-year after the index event, the addition of antiPLT to OAC
does not apparently provide added protection against coronary events, but
increases major bleeding. OAC monotherapy should thus be considered the
antithrombotic therapy of choice for such patients.<br/>Copyright &#xa9;
2018 Elsevier B.V.

<27>
Accession Number
623866962
Title
Clinical events after discontinuation of beta-blockers in patients without
heart failure optimally treated after acute myocardial infarction: A
cohort study on the French health care databases.
Source
Pharmacoepidemiology and Drug Safety. Conference: 34th International
Conference on Pharmacoepidemiology and Therapeutic Risk Management. Czech
Republic. 27 (Supplement 2) (pp 397-398), 2018. Date of Publication:
August 2018.
Author
Neumann A.; Maura G.; Weill A.; Alla F.; Danchin N.
Institution
(Neumann, Maura, Weill, Alla) Assurance Maladie/Cnam (French National
Health Insurance), Paris, France
(Danchin) Hopital Europeen Georges Pompidou, Assistance Publique -
Hopitaux de Paris, Universite Paris Descartes, Paris, France
Publisher
John Wiley and Sons Ltd
Abstract
Background: beta-blockers have been among the first medications shown to
improve outcomes after acute myocardial infarction (AMI). With the advent
of reperfusion therapy and other secondary prevention medications,
large-scale experience after AMI in the contemporary era is lacking.
Objectives: To evaluate the impact of beta-blocker discontinuation beyond
the acute stage in a cohort of patients without heart failure,
revascularized and optimally-treated after AMI. Methods: Using the French
Healthcare databases, 73 450 patients (<80 years of age), admitted for AMI
in 2007-2012, without acute coronary syndrome (ACS) in the previous 2
years and no evidence of heart failure, having received optimal treatment
with myocardial revascularization and all recommended medications in the 4
months following index admission and not having discontinued beta-blockers
before 1 year, were followed for 3.8 years on average. beta-blocker
discontinuation was defined as 4 consecutive months without exposure. If
beta-blocker treatment was resumed later on, follow-up was stopped. Both
the risk of the composite outcome of death or admission for ACS and the
risk of all-cause mortality were assessed in relation with beta-blocker
discontinuation over follow-up. Adjusted hazard ratios (aHR) were
estimated using marginal structural models accounting for time-varying
confounders affected by previous exposure. A similar analysis was
performed with statins. Results: Of 204 592 patient-years, 12 002 (5.9%)
discontinued beta-blocker treatment. For beta-blocker discontinuation, the
aHR for death or ACS was 1.17 (95% confidence interval 1.01-1.35); for
all-cause death, the aHR was 1.13 (0.94-1.36). In contrast, for statin
discontinuation, the aHR for death or ACS and for all-cause death were
2.31 (2.01-2.65) and 2.57 (2.19-3.02), respectively. The estimated effect
of beta-blockers discontinuation was modified by the type of AMI and the
presence of asthma/chronic obstructive pulmonary disease at baseline.
Conclusions: In routine care of patients without heart failure,
revascularized and optimally-treated after AMI, discontinuation of
beta-blockers beyond 1 year after AMI was associated with an increased
risk of death or readmission for ACS, while statistically significance was
not reached for the association with all-cause mortality. A contemporary
randomized clinical trial is needed to precise the role of beta-blockers
in the long-term treatment after AMI.

<28>
Accession Number
623865367
Title
Unicentric randomized trial on the effect of remote ischemic
preconditioning in patients with myocardial injury after off-pump coronary
artery bypass graft.
Source
Basic and Clinical Pharmacology and Toxicology. Conference: 1st Meeting in
Translational Pharmacology, 38th Spanish Society of Pharmacology Meeting
and 9th Spanish Society of Pharmacogenetics and Pharmacogenomics Meeting.
Spain. 123 (Supplement 2) (pp 29), 2018. Date of Publication: August 2018.
Author
Bouza M.G.; Medina U.; Carnero M.; Acedo M.V.; Tejerina T.
Institution
(Bouza, Carnero, Acedo) Dpto. Farmacologia, Facultad de Medicina,
Universidad Complutense de Madrid, Madrid, Spain
(Medina) Clinical Epidemiology, Faculty of Medicine, Universidad Autonoma
de San Luis Potosi, San Luis Potosi, Mexico
(Tejerina) Servicio de Cirugia Cardiaca, Hospital Clinico San Carlos,
Madrid, Spain
Publisher
Blackwell Publishing Ltd
Abstract
Objective: Remote ischemic preconditioning (RIP) on cardiac surgery has
given variable results in different studies. We designed a clinical trial
to evaluate the effect of RIP on myocardial injury after off-pump coronary
artery bypass grafting (CABG). We also studied clinical effects and the
signaling molecules involved: Troponin 12 hours after surgery between two
groups (RIP CABG vs Control) and to compare clinical events and protein
quantification involved between the two groups. Methods: Patients (67)*
with indication to surgical myocardial revascularization off-pump were
selected. Randomization (1:1) (Table presented) The RIP was performed with
3 cycles of 5 min ischemia and 5 min reperfusion in an upper using a blood
pressure cuff inflated to 200 mmHg. We evaluated the troponin levels 6,
12, 24 hours after surgery and at discharge. The proteins quantification
were obtained at basal and 6, 24 hours after surgery with by WB, renal
failure and atrial fibrillation were evaluated. Conclusion: PIR-GABG in
the upper and the lower limbs simultaneously hasn't demonstrated reduce
the myocardial injury and neither to (Figure presented) have repercussion
in the new onset of atrial fibrillation or in acute renal failure.
Cardioprotective proteins tend to be expressed more in patients receiving
remote ischemic preconditioning with a peak at 6 hours after surgery.

<29>
Accession Number
623864938
Title
Endoscopic vein harvest: First irish experience of a minimally invasive
conduit harvesting.
Source
Irish Journal of Medical Science. Conference: 43rd Sir Peter Freyer
Memorial Lecture and Surgical Symposium. Ireland. 187 (Supplement 4) (pp
S162), 2018. Date of Publication: April 2018.
Author
Siddiqui S.; Kelly R.; Veerasingam D.; DaCosta M.; Soo A.
Institution
(Siddiqui, Kelly, Veerasingam, DaCosta, Soo) Department of Cardiothoracic
Surgery, University Hospital Galway, Saolta University Health Care Group,
Ireland
Publisher
Springer London
Abstract
Introduction: Despite multiple randomized trials, coronary artery bypass
grafting (CABG) remains the gold standard coronary revascularisation
technique. The long saphenous vein (LSV) is the most common conduit
harvested using an open technique. However, the open technique is
associated with severe wound complications and poor cosmesis. Endoscopic
vein harvesting (EVH) is a new minimally invasive vein harvesting
technique that significantly reduces wound complications. EVH commenced in
UHG on 14th February 2017. Here we report our first year experience of
introducing this technique. Aim: To assess the impact of EVH during the
first year of its use. Method: Data was collected retrospectively from a
prospectively maintained electronic database of all CABG patients from
February 2017 to February 2018. Results: 117 patients underwent CABG
procedure. Out of these, 57 patients (49%) had EVH. For the first 10
cases, the average harvesting time per vein graft length was 35 minutes.
For the last 10 cases, the average harvesting time per vein graft length
was 16 minutes. There was negligible blood loss in all cases. There were 4
conversions (7%) to open LSV harvesting. There was no conversion in last
26 cases. Post operatively, average pain score was 1/10. 2 patients (3.5%)
developed haematoma at the LSV harvest site, which did not require
intervention. At 6 weeks check there were no wound complications. In
contrast, during the same period, 5 patients who had open LSV harvest,
developed surgical site infection. All 5 required antibiotics and
dressings. 2 required VAC dressing and prolonged hospital stay.
Conclusion: EVH, although challenging, could be introduced safely with
appropriate mentoring. The adoption of EVH has significantly improved
wound infection rate in patients undergoing CABG in UHG.

<30>
Accession Number
623864869
Title
Benefit risk assessment for fibrinogen concentrate in the setting of
complex cardiac surgery: Lessons learned using the CIRSBRAT framework.
Source
Pharmacoepidemiology and Drug Safety. Conference: 34th International
Conference on Pharmacoepidemiology and Therapeutic Risk Management. Czech
Republic. 27 (Supplement 2) (pp 516-517), 2018. Date of Publication:
August 2018.
Author
Forssen U.M.; Brainsky A.; Ye J.; Chung T.; Watson D.J.
Institution
(Forssen, Brainsky, Ye, Chung, Watson) CSL Behring, King of Prussia, PA,
United States
Publisher
John Wiley and Sons Ltd
Abstract
Background: Fibrinogen concentrate (FCH) has been successfully used in the
setting of perioperative bleeding in complex cardiac surgery (CCS), as
reported in several single center trials. CSL Behring conducted a
multi-center, multi-national, placebo-controlled study (REPLACE) to
demonstrate efficacy in this clinical setting to support a label
expansion. Contrary to the single center studies, REPLACE did not show
efficacy superiority over placebo, while the safety endpoints were
favourable to FCH. Although the label expansion was not pursued, the
company decided to conduct a thorough benefit-risk assessment (BRA) of
FCH. Objectives: To assess the benefit-risk profile of FCH in the clinical
setting of CCS taking into account all available published evidence and
completed clinical trials. Methods: A CSL Behring cross-functional team
was formed to conduct the BRA. The team followed the CIRS-BRAT framework
to establish the decision frame, identify key benefits and risks, gather
and interpret the data, and produce visualizations to display the results.
A systematic literature review was conducted to identify relevant studies
in addition to the data from REPLACE. Forest plots were generated to show
the benefits and risks of FCH compared to placebo or standard of care by
each key outcome as well as by each study and by crude pooled analyses of
identified placebo-controlled clinical trials. Results: Eight studies were
identified based on criteria established in the decision frame. Based on
predefined criteria, 2 studies were excluded because information on key
benefits and risks were not presented as binary data, and 1 observational
study was described separately. The BRA of the 5 remaining studies showed
that the evaluated benefits favored FCH in most studies and the evaluated
risks were similar between FCH and the comparator. The benefit risk
profile of FCH in the setting of complex cardiac surgery was determined to
be favorable by the company; regulatory authorities agreed with the
conclusion. Conclusions: The use of a transparent structured approach
(CIRSBRAT framework) facilitated assessment and interpretation of a large
volume of information in a complex situation and the positive benefit-risk
profile for FCH in the setting of complex cardiac surgery was successfully
communicated.

<31>
Accession Number
2000888541
Title
Meta-Analysis Comparing Outcomes and Need for Renal Replacement Therapy of
Transcatheter Aortic Valve Implantation Versus Surgical Aortic Valve
Replacement.
Source
American Journal of Cardiology. 122 (3) (pp 468-476), 2018. Date of
Publication: 1 August 2018.
Author
Siddiqui W.J.; Alvarez C.; Aslam M.; Bakar A.; Khan M.H.; Aslam A.; Hanif
M.O.; Hasni S.F.; Ranganna K.; Eisen H.; Aggarwal S.
Institution
(Siddiqui, Hanif, Hasni, Ranganna, Eisen, Aggarwal) Drexel University
College of Medicine, Philadelphia, Pennsylvania, United States
(Siddiqui, Hanif, Hasni, Ranganna, Eisen, Aggarwal) Hahnemann University
Hospital, Philadelphia, Pennsylvania, United States
(Alvarez) Seton Hall University, St. Francis Medical Center, Trenton, New
Jersey, United States
(Aslam, Bakar) Department of Medicine, Dow University of Health Sciences,
Karachi, Pakistan
(Khan) Aga Khan University Medical College, Karachi, Pakistan
(Aslam) Department of Medicine, Beth Israel Deaconess Medical Center,
Harvard University, Boston, Massachusetts, United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Acute kidney injury (AKI) is commonly associated with aortic valve
replacement. Surgical aortic valve replacement (SAVR) is a known risk
factor for AKI but little is known about the short- and long-term effects
of transcatheter aortic valve implantation (TAVI). The purpose of our
analysis is to identify the short- and long-term effect of TAVI on renal
outcomes. We searched Medline and PUBMED from January 1, 2000 to November
6, 2017 for randomized control trials (RCTs) comparing TAVI to SAVR in
patients with severe aortic stenosis. Three hundred sixty-nine trials were
identified, 6 RCTs were included in our analysis. RevMan version 5.3 was
used for statistical analysis. Heterogeneity is calculated using
I² statistics. Primary outcomes were AKI within 30 days and 1
year of TAVI, and requirement for renal replacement therapy. We included
5,536 patients (2,796 in TAVI and 2,740 in SAVR arm) from 6 RCTs. Baseline
characteristics were similar. There was reduced incidence of AKI at 30
days of TAVI compared with SAVR, 57 versus 133 (odds ratio [OR] 0.40,
confidence interval [CI] 0.28 to 0.56, p <0.00001, I² = 7%)
with no difference at 1 year (OR 0.65, CI 0.32 to 1.32, p = 0.23,
I² = 76%) and need for renal replacement therapy OR 0.95, CI
0.50 to 1.80, p = 0.87, I² = 0%). Permanent pacemaker was more
frequent in the TAVI arm compared with SAVR arm, 379 versus 110, (OR 3.75,
CI 1.67 to 8.42, p = 0.001, I² = 89%). In conclusion, TAVI is
associated with a reduction in AKIs at 30 days despite the exposure to
contrast and higher incidence of new permanent pacemaker
placement.<br/>Copyright &#xa9; 2018 Elsevier Inc.

<32>
Accession Number
618786080
Title
Electrical support during outdoor cycling in patients with coronary artery
disease: impact on exercise intensity, volume and perception of effort.
Source
Acta Cardiologica. 73 (4) (pp 343-350), 2018. Date of Publication: 04 Jul
2018.
Author
Hansen D.; Soors A.; Deluyker V.; Frederix I.; Dendale P.
Institution
(Hansen, Soors, Deluyker, Frederix, Dendale) Faculty of Medicine and Life
Sciences, Hasselt University, Agoralaan gebouw D, Diepenbeek, Belgium
(Hansen, Frederix, Dendale) Department of Cardiology/Heart Centre Hasselt,
Jessa Hospital, Hasselt, Belgium
(Frederix) Faculty of Medicine and Health Sciences, Antwerp University,
Antwerp, Belgium
Publisher
Taylor and Francis Ltd. (E-mail: michael.wagreich@univie.ac.at)
Abstract
Background: Electrical assisted bicycles (EAB's) could be used to overcome
barriers and difficulties to outdoor cycling and thus assist in achieving
a sufficient physical activity level in coronary artery disease (CAD)
patients, but it is unknown whether sufficient exercise intensities and
volumes could be elicited during cycling on EAB's. In this study we
examined, for the first time, the acute physiological impact of electrical
support during outdoor cycling in CAD patients (ISRCTN32238279). Methods:
Fifteen CAD patients (13 males), aged 64 +/- 7 years executed a maximal
cardiopulmonary exercise test and afterwards cycled a predefined outdoor
route of 10 km, in three different conditions: classical cycling (no
support), EAB with low support (EAB<inf>low</inf>) and high support
(EAB<inf>high</inf>). Oxygen uptake (VO<inf>2</inf>) and carbon dioxide
output (VCO<inf>2</inf>) was measured continuously by a portable
gas-analysing system. Cycling time was recorded and ratings of perceived
exertion (RPE) was assessed at 3 and 7 km. Results: Mean VO<inf>2</inf>
during EAB<inf>high</inf> (1721 +/- 537 ml*min^-1) was
significantly lower compared to EAB<inf>low</inf> (1890 +/- 619
ml*min^-1, p <.05), but no differences were found between
EAB<inf>low</inf> and classical cycling (1846 +/- 523
ml*min^-1). EAB<inf>low</inf> and EAB<inf>high</inf> elicited a
sufficient volume and intensity (6.6 +/- 2.0 MET's (74 +/- 6%
VO<inf>2peak</inf>) and 6.0 +/- 1.8 MET's (68 +/- 7% VO<inf>2peak</inf>),
respectively) to adhere to the guidelines for secondary prevention in CAD.
RPE was significantly lower p <.05) during EAB<inf>high</inf> (9 +/- 2),
than during EAB<inf>low</inf> (11 +/- 2) or classical cycling (11 +/- 2).
Conclusions: Outdoor cycling with electrical support leads to a
sufficiently high exercise intensity and volume in CAD patients, and may
be considered as an alternative exercise modality.<br/>Copyright &#xa9;
2017, &#xa9; 2017 Belgian Society of Cardiology.

<33>
Accession Number
623714866
Title
Reduction of vascular inflammation, LDL-C, or both for the protection from
cardiovascular events?.
Source
Open Respiratory Medicine Journal. 12 (1) (pp 29-40), 2018. Date of
Publication: 2018.
Author
Reklou A.; Doumas M.; Imprialos K.; Stavropoulos K.; Patoulias D.; Athyros
V.G.
Institution
(Reklou, Doumas, Imprialos, Stavropoulos, Patoulias, Athyros) Second
Propedeutic Department of Internal Medicine, Medical School, Aristotle
University of Thessaloniki, Hippocration Hospital, Thessaloniki, Greece
(Doumas) George Washington University, Washington, DC, United States
Publisher
Bentham Science Publishers B.V. (P.O. Box 294, Bussum 1400 AG,
Netherlands)
Abstract
Background: Low density lipoprotein cholesterol (LDL-C) and low grade
arterial inflammation are key pathogenic factors for atherosclerosis and
its manifestation, cardiovascular disease (CVD). Objective: In this
narrative review we assessed if decreasing LDL-C levels or inflammation or
both is more effective in reducing CVD events. Results: In the
Scandinavian Simvastatin Survival Study (4S), all statin trials of the
90s' and the Further Cardiovascular Outcomes Research with PCSK9
Inhibition in Subjects with Elevated Risk (FOURIER) the benefit came from
the LDL-C reduction. In the GREak and Atorvastatin Coronary heart disease
Evaluation (GREACE), the Treating to New Targets (TNT), and the
Justification for the Use of Statins in Prevention: an Intervention Trial
Evaluating Rosuvastatin (JUPITER) trials both mechanisms in combination
produced significant benefits. In the Atorvastatin for Reduction of
MYocardial Damage during Angioplasty (ARMYDA) trials and the Canakinumab
Antiinflammatory Thrombosis Outcome Study (CANTOS) with a human antibody
targeting IL-1beta with no lipid lowering effect, the reduction in
arterial inflammation played the only beneficial role because there was no
change in lipids levels. Conclusion: Both LDL-C and inflammation reduction
are beneficial to the reduction of CVD risk. However, canakinumab is a
very expensive drug that only induced a 15% reduction in CVD events, thus
drastically reducing the possibility for it to be used in clinical
practice. Besides, canakinumab is associated with increased infections,
some fatal. A potent statin with anti-inflammatory effects is probably the
best choice for the majority of those needing hypolipidaemic drug
therapy.<br/>Copyright &#xa9; 2018 Reklou et al.

<34>
Accession Number
623829514
Title
Whole lung irradiation in patients with osteosarcoma and ewing sarcoma.
Source
Anticancer Research. 38 (9) (pp 4977-4985), 2018. Date of Publication:
September 2018.
Author
Ronchi L.; Buwenge M.; Cortesi A.; Ammendolia I.; Frakulli R.; Abate M.E.;
Arcelli A.; Donati C.M.; Macchia G.; Morganti A.G.; Cammelli S.
Institution
(Ronchi, Buwenge, Ammendolia, Frakulli, Arcelli, Donati, Morganti,
Cammelli) Radiation Oncology Center, Department of Experimental,
Diagnostic and Speciality Medicine -DIMES, S. Orsola-Malpighi Hospital,
University of Bologna, via Giuseppe Massarenti 9, Bologna 40138, Italy
(Cortesi) Istituto Scientifico Romagnolo per lo Studio e la Cura dei
Tumori (I.R.S.T.) S.r.l., Sede Legale, Meldola, Italy
(Abate) Chemotherapy Section, Istituto Ortopedico Rizzoli, Bologna, Italy
(Macchia) Radiotherapy Unit, Department of Oncology, Giovanni Paolo II
Foundation, Catholic University of Sacred Heart, Campobasso, Italy
Publisher
International Institute of Anticancer Research (1st km Kapandritiou -
Kalamou Rd., P.O. Box 22, Kapandriti, Attica GR-19014, Greece. E-mail:
subscriptions@iiar-anticancer.org)
Abstract
Background/Aim: Whole lung irradiation (WLI) represents standard therapy
for patients with pulmonary metastases from Ewing sarcoma although the
impact on clinical outcomes and toxicity is still unclear. The aim of this
study was to evaluate toxicity after WLI in patients with Ewing sarcoma
and osteosarcoma as well as overall survival (OS) and event-free survival
(EFS). Materials and Methods: A systematic review of studies on bilateral
pulmonary irradiation treatments for prophylactic or curative therapy was
performed based on PRISMA methodology. Data base searches on PubMed and
Cochrane Library from the earliest time possible through 31st March 2018
were carried out. Combination with other treatments, such as chemotherapy
and surgery were allowed. Only articles published in English were
considered. Results: Toxicity was evaluated in 13 of the 14 analyzed
studies (640 patients). Reported lung acute toxicity grade >=3 ranged
between 0.0 and 12.2%. Three studies reported 12 cases (1.8%) of severe
pneumonitis. Grade >=2 late toxicity was mainly recorded in patients who
received boost irradiation, previous thoracic surgery, chemotherapy or who
were smokers. Lack of a significant impact of WLI on OS was reported in
comparative studies although patients treated with WLI showed higher
survival in most individual studies. Conclusion: Although the rate of
severe toxicity was very low, the real impact of WLI on patients' outcomes
remains unproven, probably due to the narrow dose limits that can be
delivered to the whole lung parenchyma. New strategies to prevent or treat
lung metastases in these patients should be tested. Ultra-fractionated
radiotherapy concurrent with modern chemotherapy protocols could be tested
in this setting due to the chemo-sensitizing effect and negligible
radio-induced toxicity of fraction doses <0.5 Gy.<br/>Copyright &#xa9;
2018 International Institute of Anticancer Research. All rights reserved.

<35>
Accession Number
623851505
Title
Pain-diminishing effects of Kinesio taping after median sternotomy.
Source
Physiotherapy theory and practice. 34 (6) (pp 433-441), 2018. Date of
Publication: 01 Jun 2018.
Author
Brockmann R.; Klein H.-M.
Institution
(Brockmann, Klein) Department of Cardiovascular Surgery,
Heinrich-Heine-University, Duesseldorf, Germany
Abstract
METHODS: Thirty-nine patients (mean age 66 +/- 9 years, CI: 63.28; 68.98)
who underwent median sternotomy between 09/2014 and 11/2014 participated
in this prospective randomized controlled trial. Patients were assigned
into a treatment on a non-treatment group. Patients in the treatment group
were taped after leaving the intensive care unit. We assessed, pain,
consumption of pain medication, the subjective estimation of patients'
ability to breathe, radiologic and microbial abnormalities as well as
adverse effects resulting from the tape use daily until discharge. To
determine the patients' satisfaction a discharge questionnaire was offered
after completion of data.
RESULTS: Patients who were treated with tape report significantly less
pain (2.14 +/- 0.5, CI: 1.1; 3.13) than patients from the control group
(4.16 +/- 0.6, CI: 2.92; 5.41, p = 0.01). The need for opioid pain
medication, as assessed by total analgesic consumption per patient, was
significantly less in the treatment group (1.2 ml +/- 0.4 ml, CI: 0.40 ml;
2.01 ml) versus (3.1 ml +/- 0.5 ml, CI: 2.0 ml; 4.2 ml, p = 0.01). The
subjective estimation of patients' ability to breathe was significantly
better (p < 0.001) and the satisfaction was higher in the Kinesio tape
group compared to the control group. Taped patients had a mean
hospitalization of 10 +/- 1 day (CI: 8.74 days; 11.78 days) untapped
patients stayed for 11 +/- 1 days (CI: 9.17 days; 11.83 days). Adverse
effects from the tape treatment were not observed.
CONCLUSIONS: Kinesio taping after median sternotomy is a low-risk,
non-pharmacologic, cost effective, and promising method for improving
patients' breathing conditions, reducing postoperative pain, pain
medication consumption, and thus, potential adverse effects of analgesics.
BACKGROUND: Postoperative pain and severe side effects of opioid
analgesics present a clinical challenge after cardio-thoracic surgery. In
this study, the impact of Kinesio taping on postoperative morbidity after
median sternotomy was observed.

<36>
Accession Number
2001092620
Title
The Role of Colchicine in Treating Postoperative and Post-Catheter
Ablation Atrial Fibrillation.
Source
Clinical Therapeutics. (no pagination), 2018. Date of Publication: 2018.
Author
Deftereos S.G.; Vrachatis D.A.; Angelidis C.; Vrettou A.-R.; Sarri E.K.;
Giotaki S.G.; Varytimiadi E.; Kossyvakis C.; Kotsia E.; Deftereos G.S.;
Doudoumis K.; Giannopoulos G.
Institution
(Deftereos, Angelidis, Vrettou, Varytimiadi) 2nd Department of Cardiology,
Medical School, Attikon Hospital, National and Kapodistrian University of
Athens, Athens, Greece
(Vrachatis, Sarri, Giotaki, Kossyvakis, Kotsia, Deftereos, Doudoumis,
Giannopoulos) Department of Cardiology, "G. Gennimatas" General Hospital
of Athens, Athens, Greece
Publisher
Excerpta Medica Inc.
Abstract
Purpose: The goal of this review was to summarize, analyze, and compare
trials studying the efficacy of colchicine in the prevention of atrial
fibrillation (AF) post-operatively (POAF) and post-catheter ablation.
Ongoing studies and current guidelines are also presented and reviewed.
Methods: Published studies on the field were identified through a
literature search of the PubMed and clinicaltrials.gov databases.
Findings: Four original studies regarding POAF, two original studies
regarding post-catheter ablation AF, and six meta-analyses were
identified. In addition, the 3 most recent guidelines/expert consensus
documents were scrutinized. Implications: AF occurs frequently after
cardiac surgery (POAF) and catheter pulmonary vein isolation (postablation
AF) and is associated with increased cardiovascular morbidity. A number of
trials over the last few years have investigated the role of colchicine in
the prevention of POAF and postablation AF targeting the local and
systemic inflammatory process that leads to initiation and maintenance of
AF. Available data imply that colchicine may have a preventive role in
POAF and/or postablation AF. However, certain limitations of these studies
underline the need for further investigation.<br/>Copyright &#xa9; 2018
Elsevier Inc.

<37>
Accession Number
623845505
Title
Post-operative cardiovascular complications and time to recurrence in
meningioma patients treated with versus without pre-operative
embolization: a retrospective cohort study of 741 patients.
Source
Journal of Neuro-Oncology. (no pagination), 2018. Date of Publication:
2018.
Author
Wirsching H.-G.; Richter J.K.; Sahm F.; Morel C.; Krayenbuehl N.; Rushing
E.J.; von Deimling A.; Valavanis A.; Weller M.
Institution
(Wirsching, Morel, Weller) Department of Neurology, University Hospital
and University of Zurich, Frauenklinikstrasse 26, Zurich 8091, Switzerland
(Richter, Valavanis) Department of Neuroradiology, University Hospital and
University of Zurich, Zurich, Switzerland
(Krayenbuehl) Department of Neurosurgery, University Hospital and
University of Zurich, Zurich, Switzerland
(Rushing) Department of Neuropathology, University Hospital and University
of Zurich, Zurich, Switzerland
(Sahm, von Deimling) Department of Neuropathology, University Hospital
Heidelberg, Heidelberg, Germany
(Sahm, von Deimling) Clinical Cooperation Unit Neuropathology, German
Consortium for Translational Cancer Research (DKTK), German Cancer
Research Center (DKFZ), Heidelberg, Germany
(Richter) Department of Diagnostic, Interventional and Pediatric
Radiology, Inselspital and University of Bern, Bern, Switzerland
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
Purpose: Preoperative embolization of radiographically suspected
meningiomas is often performed to facilitate tumor resection. Its effects
on the subsequent disease course of meningioma patients have not been
studied in detail and randomized trials are lacking. The purpose of this
study was to explore associations of preoperative meningioma embolization
with postoperative outcome. Patients and methods: Patients undergoing
resection of an intracranial meningioma at the University Hospital Zurich
2000-2013 (N = 741) were reviewed for the inclusion of pre-operative
embolization in the management strategy. Annotations included
demographics, radiographic, surgical, histological and hematological
parameters, cardiovascular risk factors, pre- and postoperative
neurological function and gene methylation-based classification. Binary
regression and Cox proportional hazards models were applied to determine
factors associated with outcome. Results: Pre-operative embolization was
performed in 337 patients (42%). Cardiovascular events after surgery
comprised mostly deep vein thrombosis (N = 39) and pulmonary embolisms (N
= 64). On multivariate analyses of post-operative cardiovascular adverse
events controlling for established risk factors, there were associations
with embolization (OR 2.38, 95% CI 1.37-4.00), and with female gender (OR
2.18, 95% CI 1.17-4.08). Recurrence-free survival (RFS) of embolized
patients was less favorable among patients with WHO grade II or grade III
meningiomas (median RFS: 4.3 vs. 7.0 years, P = 0.029) or in patients with
intermediate or malignant gene methylation subtype meningiomas (median
RFS: 2.0 vs. 8.2 years, P = 0.005). Conclusion: Pre-operative meningioma
embolization may cause adverse outcomes. Randomized trials to determine
benefit-risk ratios are warranted to clarify the role of pre-operative
embolization for the treatment of meningioma patients.<br/>Copyright
&#xa9; 2018, Springer Science+Business Media, LLC, part of Springer
Nature.

<38>
Accession Number
621568344
Title
Effect of loading dose of atorvastatin prior to planned percutaneous
coronary intervention on major adverse cardiovascular events in acute
coronary syndrome the SECURE-PCI randomized clinical trial.
Source
JAMA - Journal of the American Medical Association. 319 (13) (pp
1331-1340), 2018. Date of Publication: 03 Apr 2018.
Author
Berwanger O.; Santucci E.V.; Jesuino I.D.A.; Damiani L.P.; Barbosa L.M.;
Nakagawa Santos R.H.; Laranjeira L.N.; Egydio F.D.M.; Borges De Oliveira
J.A.; Dall Orto F.T.C.; De Andrade P.B.; De Castro Bienert I.R.; Bosso
C.E.; Mangione J.A.; Polanczyk C.A.; De Moraes Rego Sousa A.G.; Kalil
R.A.K.; Santos L.D.M.; Sposito A.C.; Rech R.L.; Sousa A.C.S.; Baldissera
F.; Nascimento B.R.; Giraldez R.R.C.V.; Cavalcanti A.B.; Pereira S.B.;
Mattos L.A.; Armaganijan L.V.; Guimaraes H.P.; Rego Sousa J.E.M.;
Alexander J.H.; Granger C.B.; Lopes R.D.; De Barros E Silva P.G.M.; De
Macedo T.A.; Peixoto De Miranda E.J.F.; Godoy L.C.; Dos Santos M.H.H.;
Katz M.; Truffa A.A.M.; Carvalho L.; Oliveira R.; Valois M.V.; Pacheco
B.G.; Kodama A.; Sampaio B.
Institution
(Berwanger, Santucci, De Barros E Silva, Jesuino, Damiani, Nakagawa
Santos, Laranjeira, Borges De Oliveira, Cavalcanti, Pereira, Guimaraes,
Rego Sousa, Pacheco, Kodama, Sampaio) Research Institute, Heart Hospital,
Abilio Soares St 250, Twelfth Floor, Sao Paulo, SP 04005-000, Brazil
(De Barros E Silva, Barbosa, Egydio, Armaganijan, Lopes) Brazilian
Clinical Research Institute, Sao Paulo, Brazil
(Dall Orto) Hospital Do Coracao de Pocos de Caldas, Pocos de Caldas,
Brazil
(De Andrade) Santa Casa de Marilia, Marilia, Brazil
(De Castro Bienert) Hospital das Clinicas da Faculdade de Medicina de
Marilia, Marilia, Brazil
(Bosso) Santa Casa de Presidente Prudente/ Instituto Do Coracao de
Presidente Prudente, Presidente Prudente, Brazil
(Mangione) Hospital Sao Francisco de Assis, Braganca Paulista, Brazil
(Polanczyk) Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil
(De Moraes Rego Sousa) Instituto Dante Pazzanese de Cardiologia, Sao
Paulo, Brazil
(Kalil) Instituto de Cardiologia Do Rio Grande Do sul, Porto Alegre,
Brazil
(Santos) Instituto de Cardiologia Do Distrito Federal, Brasilia, Brazil
(Sposito) Faculdade de Ciencias Medicas, Universidade Estadual de
Campinas, Campinas, Brazil
(Rech) Hospital Universitario de Canoas, Canoas, Brazil
(Sousa) Hospital Sao Lucas, Aracaju, Brazil
(Baldissera) Instituto de Pesquisa e Estudos Medicos de Itajai, Itajai,
Brazil
(Nascimento) Hospital Universitario Ciencias Medicas, Belo Horizonte,
Brazil
(Giraldez) Instituto Do Coracao, Sao Paulo, Brazil
(Mattos) Rede D'Or Sao Luiz, Sao Paulo, Brazil
(Alexander, Granger, Lopes) Duke University Medical Center, Duke Clinical
Research Institute, Durham, NC, United States
Publisher
American Medical Association (E-mail: smcleod@itsa.ucsf.edu)
Abstract
IMPORTANCE The effects of loading doses of statins on clinical outcomes in
patients with acute coronary syndrome (ACS) and planned invasive
management remain uncertain. OBJECTIVE To determine if periprocedural
loading doses of atorvastatin decrease 30-day major adverse cardiovascular
events (MACE) in patients with ACS and planned invasive management.
DESIGN, SETTING, AND PARTICIPANTS Multicenter, double-blind,
placebo-controlled, randomized clinical trial conducted at 53 sites in
Brazil among 4191 patients with ACS evaluated with coronary angiography to
proceed with a percutaneous coronary intervention (PCI) if anatomically
feasible. Enrollment occurred between April 18, 2012, and October 6, 2017.
Final follow-up for 30-day outcomes was on November 6, 2017. INTERVENTIONS
Patients were randomized to receive 2 loading doses of 80mg of
atorvastatin (n = 2087) or matching placebo (n = 2104) before and 24 hours
after a planned PCI. All patients received 40mg of atorvastatin for 30
days starting 24 hours after the second dose of study medication. MAIN
OUTCOMES AND MEASURES The primary outcome was MACE, defined as a composite
of all-cause mortality, myocardial infarction, stroke, and unplanned
coronary revascularization through 30 days. RESULTS Among the 4191
patients (mean age, 61.8 [SD, 11.5] years; 1085women [25.9%]) enrolled,
4163 (99.3%) completed 30-day follow-up. A total of 2710 (64.7%) underwent
PCI, 333 (8%) underwent coronary artery bypass graft surgery, and 1144
(27.3%) had exclusively medical management. At 30 days, 130 patients in
the atorvastatin group (6.2%) and 149 in the placebo group (7.1%) had
aMACE (absolute difference, 0.85%[95%CI, -0.70%to 2.41%]; hazard ratio,
0.88; 95%CI, 0.69-1.11; P = .27). No cases of hepatic failurewere
reported; 3 cases of rhabdomyolysis were reported in the placebo group
(0.1%) and 0 in the atorvastatin group. CONCLUSIONS AND RELEVANCE Among
patients with ACS and planned invasive management with PCI, periprocedural
loading doses of atorvastatin did not reduce the rate of MACE at 30 days.
These findings do not support the routine use of loading doses of
atorvastatin among unselected patients with ACS and intended invasive
management.<br/>Copyright &#xa9; 2018 American Medical Association. All
rights reserved.

<39>
Accession Number
621295616
Title
Treatment effects of systematic two-stent and provisional stenting
techniques in patients with complex coronary bifurcation lesions:
Rationale and design of a prospective, randomised and multicentre
DEFINITION II trial.
Source
BMJ Open. 8 (3) (no pagination), 2018. Article Number: e020019. Date of
Publication: 01 Mar 2018.
Author
Zhang J.-J.; Gao X.-F.; Han Y.-L.; Kan J.; Tao L.; Ge Z.; Tresukosol D.;
Lu S.; Ma L.-K.; Li F.; Yang S.; Zhang J.; Munawar M.; Li L.; Zhang R.-Y.;
Zeng H.-S.; Santoso T.; Xie P.; Jin Z.-N.; Han L.; Yin W.-H.; Qian X.-S.;
Li Q.-H.; Hong L.; Paiboon C.; Wang Y.; Liu L.-J.; Zhou L.; Wu X.-M.; Wen
S.-Y.; Lu Q.-H.; Yuan J.-Q.; Chen L.-L.; Lavarra F.; Rodriguez A.E.; Zhou
L.-M.; Ding S.-Q.; Vichairuangthum K.; Zhu Y.-S.; Yu M.-Y.; Chen C.;
Sheiban I.; Xia Y.; Tian Y.-L.; Shang Z.-L.; Jiang Q.; Zhen Y.-H.; Wang
X.; Ye F.; Tian N.-L.; Lin S.; Liu Z.-Z.; Chen S.-L.
Institution
(Zhang, Gao, Ge, Ye, Tian, Lin, Liu, Chen) Department of Cardiology,
Nanjing First Hospital, Nanjing Medical University, Nangjing, Jiangsu,
China
(Han) Department of Cardiology, General Hospital of Shenyang Military,
Shenyang, China
(Kan, Chen) Department of Cardiology, Nanjing Heart Center, Nanjing, China
(Tao) Department of Cardiology, Xijing Hospital, 4th Military Medical
University, Xi'an, China
(Tresukosol) Department of Cardiology, Medicine Siriraj Hospital, Mahidol
University, Bangkok, Thailand
(Lu) Department of Cardiology, Taicang People's Hospital, Taicang, China
(Ma) Department of Cardiology, Anhui Provincial Hospital, Hefei, Anhui,
China
(Li) Department of Cardiology, Huainan Eastern Hospital, Huainan, China
(Yang) Department of Cardiology, Yixin People's Hospital, Yixing, China
(Zhang) Department of Cardiology, Cangzhou Central Hospital, Cangzhou,
China
(Munawar) Department of Cardiology, Binawaluya Cardiac Center, Jakarta,
Indonesia
(Li) Department of Cardiology, Guangzhou Red Cross Hospital, Guangzhou,
Guangdong, China
(Zhang) Department of Cardiology, Shanghai Ruijin Hospital, Shanghai,
China
(Zeng) Department of Cardiology, Tongji Hospital, Tongji Medical College,
Huazhong University of Science and Technology, Wuhan, China
(Santoso) Department of Cardiology, Medistra Hospital, University of
Indonesia, Jakarta, Indonesia
(Xie) Department of Cardiology, Gansu Provincial Hospital, Lanzhou, China
(Jin) Department of Cardiology, Beijing Anzhen Hospital, Capital Medical
University, Beijing, China
(Han) Department of Cardiology, Changshu First People's Hospital,
Changshu, China
(Yin) Department of Cardiology, Cheng-Hsin General Hospital, Taipei,
Taiwan (Republic of China)
(Qian) Department of Cardiology, Zhangjiagang First People's Hospital,
Zhangjiagang, China
(Li) Department of Cardiology, Changzhou Hospital of Traditional Chinese
Medicine, Changzhou, China
(Hong) Department of Cardiology, Jiangxi Provincial People's Hospital,
Nanchang, Jiangxi, China
(Paiboon) Department of Cardiology, Bangkok General Hospital, Bangkok,
Thailand
(Wang) Department of Cardiology, Xia'Men Zhongshan Hospital, Xia'men,
China
(Liu) Department of Cardiology, Huainan First People's Hospital, Huainan,
China
(Zhou) Department of Cardiology, Jintan People's Hospital, Jintan, China
(Wu) Department of Cardiology, Wuxi Third People's Hospital, Wuxi, China
(Wen) Department of Cardiology, Daqing Oil General Hospital, Daqing, China
(Lu) Department of Cardiology, Second Hospital of Shandong University,
Ji'nan, China
(Yuan) Department of Cardiology, Xinyang Central Hospital, Xinyang, Henan,
China
(Chen) Department of Cardiology, Fujian Union Hospital, Fuzhou, China
(Lavarra) Department of Cardiology, Jilin Heart Hospital, Changchun, China
(Rodriguez) Department of Cardiology, Otamendi Hospital, Buenos Aires,
Argentina
(Zhou) Department of Cardiology, Chuzhou First People's Hospital, Chuzhou,
China
(Ding) Department of Cardiology, Huainan Xinhua Hospital, Huainan, China
(Vichairuangthum) Department of Cardiology, Bangplee Hospital, Bangkok,
Thailand
(Zhu) Department of Cardiology, Huai'an Second People's Hospital, Huai'an,
China
(Yu) Department of Cardiology, Qingdao Fuwai Hospital, Qingdao, China
(Chen) Department of Cardiology, Affiliated Hospital of Guangdong Medical
University, Guangzhou, China
(Sheiban) Department of Cardiology, University of Turin, Turin, Italy
(Xia) Department of Cardiology, Affiliated Hospital of Xuzhou Medical
University, Xuzhou, China
(Tian) Department of Cardiology, Xuyi People's Hospital, Xuyi, China
(Shang) Department of Cardiology, Wuxi Huishan District People's Hospital,
Wuxi, China
(Jiang) Department of Cardiology, Anqing First People's Hospital, Anqing,
China
(Zhen) Department of Cardiology, Liyang Hospital of Traditional Chinese
Medicine, Liyang, China
(Wang) Department of Cardiology, Lianyungang Hospital of Traditional
Chinese Medicine, Lianyungang, China
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Introduction Provisional stenting (PS) for simple coronary bifurcation
lesions is the mainstay of treatment. A systematic two-stent approach is
widely used for complex bifurcation lesions (CBLs). However, a randomised
comparison of PS and two-stent techniques for CBLs has never been studied.
Accordingly, the present study is designed to elucidate the benefits of
two-stent treatment over PS in patients with CBLs. Methods and analysis
This DEFINITION II study is a prospective, multinational, randomised,
endpoint-driven trial to compare the benefits of the two-stent technique
with PS for CBLs. A total of 660 patients with CBLs will be randomised in
a 1:1 fashion to receive either PS or the two-stent technique. The primary
endpoint is the rate of 12-month target lesion failure defined as the
composite of cardiac death, target vessel myocardial infarction (MI) and
clinically driven target lesion revascularisation. The major secondary
endpoints include all causes of death, MI, target vessel
revascularisation, in-stent restenosis, stroke and each individual
component of the primary endpoints. The safety endpoint is the occurrence
of definite or probable stent thrombosis. Ethics and dissemination The
study protocol and informed consent have been approved by the
Institutional Review Board of Nanjing First Hospital, and accepted by each
participating centre. Written informed consent was obtained from all
enrolled patients. Findings of the study will be published in a
peer-reviewed journal and disseminated at conferences.<br/>Copyright
&#xa9; 2018 Article author(s) (or their employer(s) unless otherwise
stated in the text of the article). All rights reserved.

<40>
Accession Number
620922554
Title
An investigation into the use of recorded music as a surgical
intervention: A systematic, critical review of methodologies used in
recent adult controlled trials.
Source
Complementary Therapies in Medicine. 37 (pp 110-126), 2018. Date of
Publication: April 2018.
Author
Williams C.; Hine T.
Institution
(Williams) Queensland Conservatorium Research Centre, Griffith University,
South Brisbane, QLD, Australia
(Hine) Menzies Health Institute Queensland, Australia
(Hine) School of Applied Psychology, Griffith University, Mt Gravatt, QLD,
Australia
Publisher
Churchill Livingstone
Abstract
Context: While music is being increasingly used as a surgical
intervention, the types of music used and the reasons underlying their
selection remain inconsistent. Empirical research into the efficacy of
such musical interventions is therefore problematic. Objective: To provide
clear guidelines for musical selection and employment in surgical
interventions, created through a synthesis of the literature. The aim is
to examine how music is implemented in surgical situations, and to provide
guidance for the selection and composition of music for future
interventions. Methods: English language quantitative surgical
intervention studies from Science Direct, ProQuest, and Sage Journals
Online, all published within the last 10 years and featuring recorded
music, were systematically reviewed. Variables investigated included: the
time the intervention was performed, the intervention length, the outcomes
targeted, music description (general and specific), theoretical frameworks
underlying the selection of the music, whether or not a musical expert was
involved, participant music history, and the participants' feedback on the
chosen music. Results: Several aspects contribute to the lack of
scientific rigour regarding music selection in this field, including the
lack of a theoretical framework or frameworks, no involvement of musical
experts, failure to list the music tracks used, and the use of vague and
subjective terms in general music descriptions. Patients are frequently
allowed to select music (risking both choosing music that has an adverse
effect and making study replication difficult), and patient music history
and listening habits are rarely considered. Crucially, five primary
theoretical frameworks underlying the effectiveness of music arose in the
literature (distraction, relaxation, emotional shift, entrainment, and
endogenous analgesia), however music was rarely selected to enhance any of
these mechanisms. Conclusions: Further research needs to be conducted to
ensure that music is selected according to a theoretical framework and
more rigorous and replicable methodology. Music interventions can be made
more effective at improving psychological states and reducing
physiological arousal by selecting music conducive to specific mechanisms,
and also by considering at what point during the surgical experience the
music would be most effective. Greater involvement of music experts in
interventions would help to ensure that the most appropriate music was
chosen, and that it is clearly and precisely described.<br/>Copyright
&#xa9; 2018

<41>
Accession Number
616112943
Title
Screening for coronary artery disease in patients with type 2 diabetes: A
meta-Analysis and trial sequential analysis.
Source
BMJ Open. 7 (5) (no pagination), 2017. Article Number: e015089. Date of
Publication: 01 May 2017.
Author
Rados D.V.; Pinto L.C.; Leitao C.B.; Gross J.L.
Institution
(Rados, Pinto, Leitao, Gross) Division of Endocrinology, Hospital de
Clinicas de Porto Alegre, Porto Alegre, Brazil
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Objective To evaluate the efficacy of coronary artery disease screening in
asymptomatic patients with type 2 diabetes and assess the statistical
reliability of the findings. Methods Electronic databases (MEDLINE,
EMBASE, Cochrane Library and clinicaltrials.org) were reviewed up to July
2016. Randomised controlled trials evaluating coronary artery disease
screening in asymptomatic patients with type 2 diabetes and reporting
cardiovascular events and/or mortality were included. Data were summarised
with Mantel-Haenszel relative risk. Trial sequential analysis (TSA) was
used to evaluate the optimal sample size to detect a 40% reduction in
outcomes. Main outcomes were all-cause mortality and cardiac events
(non-fatal myocardial infarction and cardiovascular death); secondary
outcomes were non-fatal myocardial infarction, myocardial
revascularisations and heart failure. Results One hundred thirty-five
references were identified and 5 studies fulfilled the inclusion criteria
and totalised 3315 patients, 117 all-cause deaths and 100 cardiac events.
Screening for coronary artery disease was not associated with decrease in
risk for all-cause deaths (RR 0.95(95% CI 0.66 to 1.35)) or cardiac events
(RR 0.72(95% CI 0.49 to 1.06)). TSA shows that futility boundaries were
reached for all-cause mortality and a relative risk reduction of 40%
between treatments could be discarded. However, there is not enough
information for firm conclusions for cardiac events. For secondary
outcomes no benefit or harm was identified; optimal sample sizes were not
reached. Conclusion Current available data do not support screening for
coronary artery disease in patients with type 2 diabetes for preventing
fatal events. Further studies are needed to assess the effects on cardiac
events. PROSPERO CRD42015026627.<br/>Copyright &#xa9; Article author(s)
(or their employer(s) unless otherwise stated in the text of the article)
2017. All rights reserved. No commercial use is permitted unless otherwise
expressly granted.

<42>
Accession Number
621562750
Title
Remote ischemic preconditioning does not affect the release of humoral
factors in propofol-anesthetized cardiac surgery patients: A secondary
analysis of the RIPHeart study.
Source
International Journal of Molecular Sciences. 19 (4) (no pagination), 2018.
Article Number: 1094. Date of Publication: 05 Apr 2018.
Author
Ney J.; Hoffmann K.; Meybohm P.; Goetzenich A.; Kraemer S.; Benstom C.;
Weber N.C.; Bickenbach J.; Rossaint R.; Marx G.; Zacharowski K.; Bernhagen
J.; Stoppe C.
Institution
(Ney, Rossaint) Department of Anesthesiology, Medical Faculty, RWTH Aachen
University, Aachen 52074, Germany
(Ney, Hoffmann, Benstom, Bickenbach, Marx, Stoppe) Department of Intensive
Care Medicine, Medical Faculty, RWTH Aachen University, Aachen 52074,
Germany
(Meybohm, Zacharowski) Departments of Anesthesiology, Intensive Care
Medicine and Pain Therapy, University Hospital Frankfurt, Frankfurt 60590,
Germany
(Goetzenich, Kraemer) Department of Thoracic, Cardiac and Vascular
Surgery, Medical Faculty, RWTH Aachen University, Aachen 52074, Germany
(Weber) Department of Anesthesiology, Laboratory of Experimental Intensive
Care and Anesthesiology, L.E.I.C.A, Amsterdam 1105 AZ, Netherlands
(Bernhagen) Vascular Biology, Institute for Stroke and Dementia Research,
Ludwig-Maximilians-University of Munich Hospital, Munich 80539, Germany
Publisher
MDPI AG (Postfach, Basel CH-4005, Switzerland)
Abstract
In contrast to several smaller studies, which demonstrate that remote
ischemic preconditioning (RIPC) reduces myocardial injury in patients that
undergo cardiovascular surgery, the RIPHeart study failed to demonstrate
beneficial effects of troponin release and clinical outcome in
propofol-anesthetized cardiac surgery patients. Therefore, we addressed
the potential biochemical mechanisms triggered by RIPC. This is a
predefined prospective sub-analysis of the randomized and controlled
RIPHeart study in cardiac surgery patients (n = 40) that was recently
published. Blood samples were drawn from patients prior to surgery, after
RIPC of four cycles of 5 min arm ischemia/5 min reperfusion (n = 19) and
the sham (n = 21) procedure, after connection to cardiopulmonary bypass
(CPB), at the end of surgery, 24 h postoperatively, and 48 h
postoperatively for the measurement of troponin T, macrophage migration
inhibitory factor (MIF), stromal cell-derived factor 1 (CXCL12), IL-6,
CXCL8, and IL-10. After RIPC, right atrial tissue samples were taken for
the measurement of extracellular-signal regulated kinase (ERK1/2), protein
kinase B (AKT), Glycogen synthase kinase 3 (GSK-3beta), protein kinase C
(PKC"), and MIF content. RIPC did not significantly reduce the troponin
release when compared with the sham procedure. MIF serum levels
intraoperatively increased, peaking at intensive care unit (ICU) admission
(with an increase of 48.04%, p = 0.164 in RIPC; and 69.64%, p = 0.023 over
the baseline in the sham procedure), and decreased back to the baseline 24
h after surgery, with no differences between the groups. In the right
atrial tissue, MIF content decreased after RIPC (1.040 +/- 1.032 Arbitrary
units [au] in RIPC vs. 2.028 +/- 1.631 [au] in the sham procedure, p <
0.05). CXCL12 serum levels increased significantly over the baseline at
the end of surgery, with no differences between the groups. ERK1/2, AKT,
GSK-3beta, and PKC<inf>epsilon</inf> phosphorylation in the right atrial
samples were no different between the groups. No difference was found in
IL-6, CXCL8, and IL10 serum levels between the groups. In this cohort of
cardiac surgerypatients that received propofol anesthesia, we could not
show a release of potential mediators of signaling, nor an effect on the
inflammatory response, nor an activation of well-established protein
kinases after RIPC. Based on these data, we cannot exclude that
confounding factors, such as propofol, may have interfered with
RIPC.<br/>Copyright &#xa9; 2018 by the authors. Licensee MDPI, Basel,
Switzerland.

<43>
Accession Number
622796865
Title
Long-term impact of chronic total occlusion recanalisation in patients
with ST-elevation myocardial infarction.
Source
Heart. 104 (17) (pp 1432-1438), 2018. Date of Publication: 01 Sep 2018.
Author
Elias J.; Van Dongen I.M.; Ramunddal T.; Laanmets P.; Eriksen E.;
Meuwissen M.; Michels H.R.; Bax M.; Ioanes D.; Suttorp M.J.; Strauss B.H.;
Barbato E.; Marques K.M.; Claessen B.E.P.M.; Hirsch A.; Van Der Schaaf
R.J.; Tijssen J.G.P.; Henriques J.P.S.; Hoebers L.P.
Institution
(Elias, Van Dongen, Claessen, Tijssen, Henriques, Hoebers) Department of
Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam
1105 AZ, Netherlands
(Ramunddal, Ioanes) Sahlgrenska University Hospital, Gothenburg, Sweden
(Laanmets) North-Estonia Medical Centre, Talinn, Estonia
(Eriksen) Haukeland University Hospital, Bergen, Norway
(Meuwissen) Department of Cardiology, Amphia Hospital, Breda, Netherlands
(Michels) Catharina Hospital, Eindhoven, Netherlands
(Bax) Department of Cardiology, Haga Teaching Hospital, The Hague,
Netherlands
(Suttorp) Department of Cardiology, Sint Antonius Ziekenhuis, Nieuwegein,
Netherlands
(Strauss) Sunnybrook Health Sciences Centre, Toronto, Canada
(Barbato) Cardiovascular Center, Onze Lieve Vrouwe Ziekenhuis, Aalst,
Belgium
(Marques) VU University Medical Center, Amsterdam, Netherlands
(Hirsch) Erasmus Medical Center, Rotterdam, Netherlands
(Van Der Schaaf) Department of Cardiology, Onze Lieve Vrouwe Gasthuis,
Amsterdam, Netherlands
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Background During primary percutaneous coronary intervention (PCI), a
concurrent chronic total occlusion (CTO) is found in 10% of patients with
ST-elevation myocardial infarction (STEMI). Long-term benefits of CTO-PCI
have been suggested; however, randomised data are lacking. Our aim was to
determine mid-term and long-term clinical outcome of CTO-PCI versus CTO-No
PCI in patients with STEMI with a concurrent CTO. Methods The Evaluating
Xience and left ventricular function in PCI on occlusiOns afteR STEMI
(EXPLORE) was a multicentre randomised trial that included 302 patients
with STEMI after successful primary PCI with a concurrent CTO. Patients
were randomised to either CTO-PCI or CTO-No PCI. The primary end point of
the current study was occurrence of major adverse cardiac events (MACE):
cardiac death, coronary artery bypass grafting and MI. Other end points
were 1-year left ventricular function (LVF); LV-ejection fraction and LV
end-diastolic volume and angina status. Results The median long-term
follow-up was 3.9 (2.1-5.0) years. MACE was not significantly different
between both arms (13.5% vs 12.3%, HR 1.03, 95% CI 0.54 to 1.98; P=0.93).
Cardiac death was more frequent in the CTO-PCI arm (6.0% vs 1.0%, P=0.02)
with no difference in all-cause mortality (12.9% vs 6.2%, HR 2.07, 95% CI
0.84 to 5.14; P=0.11). One-year LVF did not differ between both arms.
However, there were more patients with freedom of angina in the CTO-PCI
arm at 1 year (94% vs 87%, P=0.03). Conclusions In this randomised trial
involving patients with STEMI with a concurrent CTO, CTO-PCI was not
associated with a reduction in long-term MACE compared to CTO-No PCI.
One-year LVF was comparable between both treatment arms. The finding that
there were more patients with freedom of angina after CTO-PCI at 1-year
follow-up needs further investigation. Clinical trial registration EXPLORE
trial number NTR1108 www.trialregister.nl.<br/>Copyright &#xa9; Article
author(s) (or their employer(s) unless otherwise stated in the text of the
article) 2018. All rights reserved. No commercial use is permitted unless
otherwise expressly granted.

<44>
Accession Number
623805068
Title
Cardiac rehabilitation and its effects on cognition in patients with
coronary artery disease and heart failure.
Source
Expert Review of Cardiovascular Therapy. 16 (9) (pp 645-652), 2018. Date
of Publication: 02 Sep 2018.
Author
Alagiakrishnan K.; Mah D.; Gyenes G.
Institution
(Alagiakrishnan, Mah, Gyenes) Faculty of Medicine and Dentistry,
University of Alberta, Edmonton, Canada
Publisher
Taylor and Francis Ltd (E-mail: info@expert-reviews.com)
Abstract
Introduction: Cardiac rehabilitation program is an evidence-based
intervention and established model of exercise delivery following
myocardial infarction and heart failure. Although it forms an important
part of recovery and helps to prevent future events and complications,
there has been little focus on its potential cognitive benefits. Areas
covered: Coronary artery disease and heart failure are common heart
problems associated with significant morbidity and mortality, and
cognitive decline is commonly seen in affected individuals. Cognitive
impairment may influence patient self-management by reducing medication
adherence, rendering patients unable to make lifestyle modifications and
causing missed healthcare visits. Cognitive assessment in cardiac
rehabilitation as an outcome measure has the potential to improve
clinical, functional and behavioral domains as well as help to reduce gaps
in the quality of care in these patients. Expert commentary: Limited
evidence at present has shown that cardiac rehabilitation and exercise has
potential in preventing cognitive decline. Cardiac prehabilitation, a
rehabilitation-like program delivered before cardiac surgery, may also
play a role in preventing postoperative cognitive dysfunction, but needs
future research studies to support it.<br/>Copyright &#xa9; 2018, &#xa9;
2018 Informa UK Limited, trading as Taylor & Francis Group.

<45>
Accession Number
623266621
Title
Transcatheter mitral valve implantation for degenerated mitral
bioprostheses or failed surgical annuloplasty rings: A systematic review
and meta-analysis.
Source
Journal of Cardiac Surgery. 33 (9) (pp 508-519), 2018. Date of
Publication: September 2018.
Author
Hu J.; Chen Y.; Cheng S.; Zhang S.; Wu K.; Wang W.; Zhou Y.
Institution
(Hu, Chen, Cheng, Zhang, Wu, Wang, Zhou) Department of
Thoracic-Cardiovascular Surgery, Tongji Hospital, Tongji University School
of Medicine, Shanghai, China
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Background: Transcatheter mitral valve-in-valve (TMVIV) and valve-in-ring
(TMVIR) implantation for degenerated mitral bioprostheses and failed
annuloplasty rings have recently emerged as treatment options for patients
deemed unsuitable for repeat surgery. Methods: A systematic literature
review was conducted to summarize the data regarding the baseline
characteristics and clinical outcomes of patients undergoing TMVIV and
TMVIR procedures. Results: A total of 245 patients (172 patients who
underwent TMVIV surgery and 73 patients who underwent TMVIR surgery) were
included in the study; 93.5% of patients experienced successful TMVIV or
TMVIR implantation. The mortality rates at discharge, 30 days, and 6
months were 5.7%, 8.1%, and 23.4%, respectively. The transapical (TA)
access route was used in most procedures (55.2%). The TA and transseptal
(TS) access routes resulted in similar outcomes. No significant
differences were observed in the short-term outcomes between the patients
who developed mitral stenosis versus mitral regurgitation as the mode of
failure. Conclusions: TMVIV and TMVIR implantation for degenerated mitral
bioprostheses and failed annuloplasty rings are safe and effective. Both
procedures, via TA or TS access, can result in excellent short-term
clinical outcomes in patients with mitral stenosis or regurgitation, but
long-term follow-up data are currently lacking to determine the durability
of these procedures.<br/>Copyright &#xa9; 2018 The Authors. Journal of
Cardiac Surgery Published by Wiley Periodicals, Inc.

<46>
Accession Number
623755779
Title
Comparing the effect of oral clonidine and tranexamic acid on bleeding and
surgical field quality during functional endoscopic sinus surgery.
Source
Iranian Journal of Otorhinolaryngology. 30 (5) (pp 255-260), 2018. Date of
Publication: 2018.
Author
Ghorbani J.; Arastou S.; Naeini A.S.; Raad N.; Galougahi M.K.;
Jahangirifard A.; Dilmaghani N.A.
Institution
(Ghorbani) Chronic Respiratory Disease Research Center, National Research
Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of
Medical Sciences, Tehran, Iran, Islamic Republic of
(Arastou) Department of Rhinology, Shahid Beheshti University of Medical
Sciences, Tehran, Iran, Islamic Republic of
(Naeini, Raad, Galougahi) Tracheal Research Center, National Research
Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of
Medical Sciences, Tehran, Iran, Islamic Republic of
(Jahangirifard) Lung Transplantation Research Center, National Research
Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of
Medical Sciences, Tehran, Iran, Islamic Republic of
(Dilmaghani) Hearing Disorders Research Center, Shahid Beheshti University
of Medical Sciences, Tehran, Iran, Islamic Republic of
Publisher
Mashhad University of Medical Sciences (E-mail: IJO@mums.ac.ir)
Abstract
Introduction: Bleeding during functional endoscopic sinus surgery (FESS)
is an important issue for both anesthesiologists and surgeons as it can
affect the safety and efficiency of the procedure. We compared the
efficacy of tranexamic acid (TXA) and clonidine in reducing blood loss and
improving surgical field visualization during FESS. Materials and Methods:
In a double-blind, randomized, clinical trial, 52 patients, American
Society of Anesthesiologists (ASA) physical status 1-2, aged 13-75 years,
suffering from rhinosinusitis with or without polyposis, and who were
candidates for FESS, were enrolled. The first group received intravenous
TXA 15 mg/kg diluted in 100 ml normal saline, administered during 10-min
infusion after induction. In the second group, 0.2 mg oral clonidine was
given 1 to 1.5 hours before surgery. Duration of surgery, hemoglobin
level, heart rate, blood pressure, and quality of surgical field based on
Boezzart's scale and surgeon satisfaction based on Likert's scale were
recorded in both groups. Results: In total, 52 patients, 27 (51.9%) males
and 25 (48.07%) females were studied. Twenty-two (42.3%) and 30 (57.7%)
were in the TXA and clonidine groups, respectively. The mean pre- and
post-surgical hemoglobin level showed no meaningful difference between the
two groups. The same result was obtained for blood pressure and heart rate
at different time points (P > 0.05). Mean anesthesia time (P=0.859), mean
surgical time (P=0.880), surgeon's satisfaction of the surgical field
(P=0.757) and surgical field quality at different time points revealed no
significant difference between the two groups. Conclusion: Premedication
with oral clonidine and intravenous TXA has the same effect on bleeding
during FESS, surgical field visualization, and surgeon
satisfaction.<br/>Copyright &#xa9; 2018, Mashhad University of Medical
Sciences.

<47>
Accession Number
623751668
Title
Preoperative rehabilitation in lung cancer patients: Yoga approach.
Source
Advances in Experimental Medicine and Biology. 1096 (pp 19-29), 2018. Date
of Publication: 2018.
Author
Barassi G.; Bellomo R.G.; Di Iulio A.; Lococo A.; Porreca A.; Di Felice
P.A.; Saggini R.
Institution
(Barassi, Porreca, Di Felice, Saggini) Department of Medical Oral and
Biotechnological Science, "Gabriele d'Annunzio" University,
Chieti-Pescara, Italy
(Bellomo) Department of Biomolecular Sciences, 'Carlo Bo' University,
Urbino, Italy
(Di Iulio, Lococo) Division of Thoracic Surgery, Santo Spirito Hospital of
Pescara, Pescara, Italy
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
Lung cancer is one of the leading causes of cancer death worldwide.
Surgical removal remains the best option for most tumors of this type.
Reduction of cigarette consumption in patients with lung cancer candidates
for the surgery could limit the impact of tobacco on postsurgical
outcomes. Breathing exercises appear to help combat cigarette cravings.
Yoga exercise benefits have been studied in lung cancer survivors, rather
than in the preoperative setting. In this study, we have recruited 32
active smokers affected by lung cancer and being candidates for pulmonary
surgery. The patients were randomly assigned to two groups: one treated by
standard breathing and the other treated by yoga breathing (YB). The
groups were evaluated at times T0 (baseline) and T1 (after 7 days of
treatment) to compare the effects of the two breathing treatments on
pulmonary performance in a presurgery setting. Pulmonary and
cardiocirculatory functions have been tested using a self-calibrating
computerized spirometer and a portable pulse oximetry device. The findings
demonstrate appreciable short-term improvement in lung function assessed
by spirometry. We conclude that yoga breathing can be a beneficial
preoperative support for thoracic surgery.<br/>Copyright &#xa9; 2018,
Springer International Publishing AG, part of Springer Nature.

<48>
Accession Number
623779007
Title
Inotropic and lusitropic effects of levosimendan and milrinone assessed by
strain echocardiography-A randomised trial.
Source
Acta Anaesthesiologica Scandinavica. 62 (9) (pp 1246-1254), 2018. Date of
Publication: October 2018.
Author
Fredholm M.; Jorgensen K.; Houltz E.; Ricksten S.-E.
Institution
(Fredholm, Jorgensen, Houltz, Ricksten) Department of Anesthesiology and
Intensive Care Medicine at the Sahlgrenska Academy, University of
Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
Publisher
Blackwell Munksgaard (E-mail: info@mks.blackwellpublising.com)
Abstract
Background: We compared the direct inotropic and lusitropic effects of two
inodilators, milrinone and levosimendan in patients after aortic valve
replacement for aortic stenosis. Methods: In this randomised, blinded
study, 31 patients with normal LV function, were randomised to either
levosimendan (0.1 and 0.2 mug/kg/min, n = 15) or milrinone (0.4 and 0.8
mug/kg/min, n = 16) after aortic valve replacement. The effects on LV
performance, LV strain, systolic (SR-S) and early diastolic (SR-E) strain
rate were assessed by a pulmonary artery catheter and transoesophageal
two-dimensional speckle tracking echocardiography of the LV inferior wall.
To circumvent the inodilator-induced hemodynamic changes on LV systolic
and diastolic deformation, central venous pressure (CVP), systolic artery
pressure (SAP), and heart rate were maintained constant by colloid
infusion, phenylephrine-induced vasoconstriction and atrial pacing,
respectively, during drug infusion. Results: Both inotropic agents induced
a dose-dependent increase in cardiac index and stroke volume index by
approximately 20% at the highest infusion rates with no differences
between groups (P =.139 and.249, respectively). CVP, pulmonary capillary
wedge pressure, SAP and heart rate were maintained constant in both
groups. LV strain and SR-S increased with both agents, dose-dependently,
by 17%-18% and 25%-30%, respectively, at the highest infusion rates, with
no difference between groups (P =.434 and.284, respectively). Both agents
improved early LV relaxation with no differences between groups (P =.637).
At the higher doses, both agents increased SR-E by 30%. Conclusions: At
clinically relevant infusion rates and a certain increase in LV
performance the direct inotropic and lusitropic of milrinone and
levosimendan were comparable.<br/>Copyright &#xa9; 2018 The Acta
Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons
Ltd

<49>
Accession Number
623779001
Title
Intraoperative ketamine administration to prevent delirium or
postoperative cognitive dysfunction: A systematic review and
meta-analysis.
Source
Acta Anaesthesiologica Scandinavica. 62 (9) (pp 1182-1193), 2018. Date of
Publication: October 2018.
Author
Hovaguimian F.; Tschopp C.; Beck-Schimmer B.; Puhan M.
Institution
(Hovaguimian, Tschopp, Beck-Schimmer) Institute of Anaesthesiology,
University of Zurich and University Hospital of Zurich, Zurich,
Switzerland
(Puhan) Epidemiology, Biostatistics and Prevention Institute, University
of Zurich, Zurich, Switzerland
Publisher
Blackwell Munksgaard (E-mail: info@mks.blackwellpublising.com)
Abstract
Background: Postoperative cognitive complications are associated with
substantial morbidity and mortality. Ketamine has been suggested to have
neuroprotective effects in various settings. This systematic review
evaluates the effects of intraoperative ketamine administration on
postoperative delirium and postoperative cognitive dysfunction (POCD).
Methods: Medline, Embase and Central were searched to 4 March 2018 without
date or language restrictions. We considered randomised controlled trials
(RCTs) comparing intraoperative ketamine administration versus no
intervention in adults undergoing surgery under general anaesthesia.
Primary outcomes were postoperative delirium and POCD. Non-cognitive
adverse events, mortality and length of stay were considered as secondary
outcomes. Data were independently extracted. The quality of the evidence
(GRADE approach) was assessed following recommendations from the Cochrane
collaboration. Risk ratios were calculated for binary outcomes, mean
differences for continuous outcomes. We planned to explore the effects of
age, specific anaesthesia regimen, depth of anaesthesia and intraoperative
haemodynamic events through subgroup analyses. Results: Six RCTs were
included. The incidence of postoperative delirium did not differ between
groups (4 trials, 557 patients, RR 0.83, 95% CI [0.25, 2.80]), but
patients receiving ketamine seemed at lower risk of POCD (3 trials, 163
patients, RR 0.34, 95% CI [0.15, 0.73]). However, both analyses presented
limitations. Therefore, the quality of the evidence (GRADE) was deemed low
(postoperative delirium) and very low (POCD). Conclusion: The effect of
ketamine on postoperative delirium remains unclear but its administration
may offer some protection towards POCD. Large, well-designed randomised
trials are urgently needed to further clarify the efficacy of ketamine on
neurocognitive outcomes.<br/>Copyright &#xa9; 2018 The Acta
Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons
Ltd

<50>
Accession Number
623837171
Title
Effectiveness of Low-Intensity Laser Therapy on Tissue Repair Following
Saphenectomy in Patients Who Underwent Coronary Artery Bypass Graft: A
Randomized, Double-Blind Study.
Source
Photomedicine and laser surgery. 36 (1) (pp 18-23), 2018. Date of
Publication: 01 Jan 2018.
Author
Gonzaga I.C.A.; Araujo R.B.; Lima A.C.G.; Fernandes G.A.; Cortellazi P.S.;
Oliveira R.A.; Nicolau R.A.
Institution
(Gonzaga, Lima, Fernandes, Nicolau) Lasertherapy and Photobiology Center,
Research and Development Institute, IP&D, Universidade do Vale do Paraiba,
UNIVAP, Sao Paulo, Brazil
(Gonzaga, Fernandes, Oliveira) Uninovafapi College, Department of Physical
Therapy, Teresina, Piaui, Brazil
(Araujo) Department of Cardiac Surgery, Santa Maria Hospital, Teresina,
Brazil
(Lima) University of Piaui State (UESPI), Center of Health Sciences,
Teresina, Piaui, Brazil
(Cortellazi) Department of Cardiac Surgery, Sao Paul Hospital, Teresina,
Brazil
(Oliveira) Department of Health Sciences, University of Piaui State
(UESPI), Teresina, Piaui, Brazil
Abstract
OBJECTIVE: To verify the effectiveness of low-intensity laser therapy
(LLLT) on tissue repair following saphenectomy during postoperative period
in patients having undergone coronary artery bypass graft (CABG).
MATERIALS AND METHODS: A randomized clinical trial, controlled and
double-blind study was conducted with 40 volunteers, divided into 2
groups: a placebo group (PG, n=20) and a laser group (LG, n=20). The
patients in the LG group were irradiated with laser during saphenectomy
(InGaAlP, lambda 660nm, energy density 6J/cm2) daily from the first to the
fourth postoperative day. The surgical incision was clinically evaluated
and imaged at the beginning and at the end of the treatment. The areas of
hematoma and hyperemia were evaluated using the software ImageJ 1.4&#xa9;,
and border closure was evaluated by three researchers, who were blinded
concerning the allocation of the participants.
RESULTS: The LG group presented a reduction of the areas of hematoma and
hyperemia (p=0.0003) and better border closure (p=0.009), when compared
with the PG group.
CONCLUSIONS: The proposed LLLT protocol improved the tissue repair
following saphenectomy in CABG patients.

<51>
Accession Number
623836833
Title
Comparing Hemodynamic Responses to Diazepam, Propofol and Etomidate During
Anesthesia Induction in Patients with Left Ventricular Dysfunction
Undergoing Coronary Artery Bypass Graft Surgery: a Double-blind,
Randomized Clinical Trial.
Source
Medical archives (Sarajevo, Bosnia and Herzegovina). 71 (3) (pp 198-203),
2017. Date of Publication: 01 Jun 2017.
Author
Soleimani A.; Heidari N.; Habibi M.R.; Kiabi F.H.; Khademloo M.; Emami
Zeydi A.; Sohrabi F.B.
Institution
(Soleimani, Habibi, Kiabi) Department of Anesthesiology, Faculty of
Medicine, Mazandaran University of Medical Sciences, Sari, Iran, Islamic
Republic of
(Heidari) Student Research Committee, Faculty of Para-medicine, Mazandaran
University of Medical Sciences, Sari, Iran, Islamic Republic of
(Heidari) School of Pharmacy and Bimolecular Sciences, University of
Brighton, Brighton, East Sussex, United Kingdom
(Khademloo) Department of Community Medicine, Faculty of Medicine,
Mazandaran University of Medical Sciences, Sari, Iran, Islamic Republic of
(Emami Zeydi) Student research committee, PhD candidate, School of Nursing
and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran,
Islamic Republic of
(Sohrabi) Mazandaran Heart Center, Mazandaran University of Medical
Sciences, Sari, Iran, Islamic Republic of
Abstract
BACKGROUND: Anesthesia induction is often accompanied by a period of
hemodynamic instability, which could be deleterious in patients with
coronary artery disease (CAD) and left ventricular dysfunction undergoing
coronary artery bypass graft (CABG) surgery. The aim of this study was to
compare the hemodynamic responses to propofol, etomidate, and diazepam
following anesthesia induction, laryngoscopy and intubation in CABG
surgery patients with low ejection fraction (EF).
METHODS: A double-blind randomized, clinical study was performed on 150
patients with CAD and left ventricular dysfunction (EF<=35%) scheduled for
elective CABG surgery with Cardiopulmonary bypass (CPB). Patients were
randomly allocated to three groups A, B, and C. These patients received
propofol, etomidate or diazepam at induction of anesthesia, respectively.
Hemodynamic variables (systolic and diastolic blood pressure [SBP, DBP],
mean arterial pressure [MAP] and heart rate [HR]) were measured and
recorded at baseline, immediately before laryngoscopy and tracheal
intubation and one and three minutes after intubation.
RESULT: One minute after induction and before laryngoscopy, there was a
statistically significant decrease from the baseline in SBP, DBP and MAP
in all three groups, but these variables in each hemodynamic parameters in
diazepam group were less than other two groups (p<0.001). Moreover, the
mean HR decreased in patients receiving propofol and etomidate one minute
after induction and before laryngoscopy, but did not decreased in the
diazepam group (p=0.005).
CONCLUSION: The present study showed that in patients undergoing CABG
surgery with low EF, diazepam is more favorable in terms of hemodynamic
stability compared to propofol and etomidate and this drug can be used
safely for induction of anesthesia in patients with impaired ventricular
function.

<52>
Accession Number
2001085516
Title
Calculation Algorithm Reduces Protamine Doses Without Increasing Blood
Loss or the Transfusion Rate in Cardiac Surgery: Results of a Randomized
Controlled Trial.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2018.
Date of Publication: 2018.
Author
Kjellberg G.; Holm M.; Fux T.; Lindvall G.; van der Linden J.
Institution
(Kjellberg) Department of Thoracic Surgery and Anesthesia, Academic
Hospital, Uppsala, Sweden
(Kjellberg, Holm, Fux, Lindvall, van der Linden) Department of Molecular
Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
(Holm) Division of Perioperative Medicine and Intensive Care, Karolinska
University Hospital, Huddinge, Sweden
(Fux, Lindvall, van der Linden) Division of Perioperative Medicine and
Intensive Care, Section Cardiothoracic Surgery and Anesthesiology,
Karolinska University Hospital, Stockholm, Sweden
Publisher
W.B. Saunders
Abstract
Objectives: The aim of the study was to investigate whether the HeProCalc
algorithm affects heparin and protamine dosage, postoperative blood loss,
and transfusion rate. Design: Randomized controlled trial. Setting:
University hospital. Participants: The study comprised 210 cardiac surgery
patients undergoing cardiac surgery with cardiopulmonary bypass. Twenty
patients were excluded because of re-exploration for localized surgical
bleeding (n = 9), violation of protocol (n = 2), aprotinin use (n = 3 and
nadir body temperature <32degreeC (n = 6). Interventions: Study
participants were randomly assigned to either traditional heparin and
protamine dosage based on body weight only (control group) or dosage based
on the HeProCalc algorithm (intervention group). Measurements and Main
Results: The initial median heparin dose was 32,500 IU (interquartile
range [IQR] 30,000-35,000) in the intervention group compared with 35,000
IU (IQR 30,000-37,500) (p = 0.025) in the control group. The total heparin
dose in the intervention group was 40,000 IU (IQR 32,500-47,500) compared
with 42,500 IU (IQR 35,000-50,000) in the control group (p = 0.685). The
total protamine dose was 210 mg (IQR 190-240) in the intervention group
compared with 350 mg (IQR 300-380) (p < 0.001) in the control group. The
ratio of total protamine to initial dose of heparin in the intervention
group was 0.62 compared with 1.0 (p < 0.001). The amount of chest tube
bleeding after 12 postoperative hours was 320 mL (IQR 250-460) in the
intervention group compared with 350 mL (IQR 250-450) (p = 0.754) in the
control group. Neither the transfusion rate nor postoperative blood loss
differed significantly between the 2 groups. Conclusion: Use of the
HeProCalc algorithm reduced protamine dosage and the protamine/heparin
ratio after cardiopulmonary bypass compared with conventional dosage based
on weight without significant effect on postoperative blood loss or the
transfusion rate.<br/>Copyright &#xa9; 2018 Elsevier Inc.

<53>
Accession Number
623825596
Title
Health-related quality of life in adult heart-transplant recipients-a
systematic review.
Source
Herz. (no pagination), 2018. Date of Publication: 2018.
Author
Tackmann E.; Dettmer S.
Institution
(Tackmann, Dettmer) Institute of Medical Sociology and Rehabilitation
Science, Charite - Universitatsmedizin Berlin, Chariteplatz 1, Berlin
10117, Germany
Publisher
Urban und Vogel GmbH (E-mail: verlag@urban-vogel.de)
Abstract
Background: Health-related quality of life is a multidimensional concept
to assess the impact of medical interventions from an individual
perspective. This concept is important to evaluate benefits of heart
transplantation. This systematic review was conducted to determine (1)
posttransplant health-related quality of life in heart transplantation
patients and (2) influencing factors of health-related quality of life.
Methods: A systematic review of cross-sectional, prospective and mixed
methods studies published from November 2007 to November 2017 was
conducted on PsycINFO, PSYNDEX and PubMed using a combination of the
keywords heart transplantation, heart transplantation patient, quality of
life, and health-related quality of life. Results: A total of 14 studies
with a cross-sectional design, 6 studies with a prospective design and 2
mixed-methods studies were identified. The stability of health-related
quality of life up to 10 years after transplantation has been reported.
Most often generic scales, such as SF-36 (8) and WHOQoL-BREF (7) were used
for data collection. Demoralization, depression, pain, gastrointestinal
symptoms, sexual dysfunction, and poor oral health influence
health-related quality of life negatively, whereas social and family
support have a positive impact. Conclusion: Although health-related
quality of life is positively influenced by transplantation, further
research regarding gender differences is needed. Disease-specific scales
were rarely used.<br/>Copyright &#xa9; 2018, Springer Medizin Verlag GmbH,
ein Teil von Springer Nature.