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<1>
Accession Number
2001110854
Title
Intraoperative hypotension is not associated with postoperative cognitive
dysfunction in elderly patients undergoing general anesthesia for surgery:
results of a randomized controlled pilot trial.
Source
Journal of Clinical Anesthesia. 52 (pp 111-118), 2019. Date of
Publication: February 2019.
Author
Langer T.; Santini A.; Zadek F.; Chiodi M.; Pugni P.; Cordolcini V.;
Bonanomi B.; Rosini F.; Marcucci M.; Valenza F.; Marenghi C.; Inglese S.;
Pesenti A.; Gattinoni L.
Institution
(Langer, Zadek, Chiodi, Pugni, Cordolcini, Valenza, Pesenti, Gattinoni)
Department of Pathophysiology and Transplantation, University of Milan,
Milan, Italy
(Langer, Santini, Valenza, Marenghi, Pesenti, Gattinoni) Department of
Anesthesia, Critical Care and Emergency, Fondazione IRCCS Ca' Granda
Ospedale Maggiore Policlinico, Milan, Italy
(Bonanomi, Rosini, Marcucci, Inglese) Geriatric Unit, Department of
Medical Sciences and Community Health, University of Milan, Italy
(Marcucci) Department of Health Research Methods, Evidence, and Impact,
McMaster University, Hamilton, ON, Canada
(Rosini, Marcucci, Inglese) Fondazione IRCCS Ca' Granda Ospedale Maggiore
Policlinico, Milan, Italy
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Study objective: To assess the effect of different intraoperative blood
pressure targets on the development of POCD and test the feasibility of a
larger trial. Design(s): Randomized controlled pilot trial.
 Setting(s): Perioperative care in a tertiary care teaching hospital
with outpatient follow-up. Patient(s): One hundred one patients aged
>=75 years with ASA physical status <4, undergoing elective, non-cardiac
surgery under general anesthesia and 33 age-matched healthy controls.
 Intervention(s): Randomization to a personalized intraoperative blood
pressure target, mean arterial pressure (MAP) >= 90% of preoperative
values (Target group), or to a more liberal intraoperative blood pressure
management (No-Target group). Strategies to reach intraoperative blood
pressure target were at discretion of anesthesiologists. Measurements: An
experienced neuropsychologist performed a validated battery of
neurocognitive tests preoperatively and 3 months after surgery. Incidence
of POCD at three months and postoperative delirium were assessed.
Intraoperative time spent with MAP >= 90% of preoperative values,
recruitment and drop-out rate at 3 months were feasibility outcomes.
 Main Result(s): The Target group spent a higher percentage of
intraoperative time with MAP >=90% of preoperative values (65 +/- 25% vs.
49 +/- 28%, p < 0.01). Incidence of POCD (11% vs. 7%, relative risk 1.52;
95% CI, 0.41 to 6.3; p = 0.56) and delirium (6% vs. 14%, relative risk,
0.44; 95% CI, 0.12 to 1.60; p = 0.21) did not differ between groups. No
correlation was found between intraoperative hypotension and postoperative
cognitive performance (p = 0.75) or delirium (p = 0.19). Recruitment rate
was of 6 patients/month (95% confidential interval (CI), 5 to 7) and
drop-out rate at 3 months was 24% (95% CI, 14 to 33%). Conclusion(s):
Intraoperative hypotension did not correlate with postoperative cognitive
dysfunction or delirium occurrence in elderly patients undergoing general
anesthesia for non-cardiac surgery. A multicenter randomized controlled
trial is needed in order to confirm the effect of intraoperative blood
pressure on the development of POCD. Trial registration number:
NCT02428062 www.clinicaltrials.gov. Copyright © 2018

<2>
Accession Number
2001302089
Title
A Randomized Controlled Trial of Liposomal Bupivacaine Parasternal
Intercostal Block for Sternotomy.
Source
Annals of Thoracic Surgery. 107 (1) (pp 128-134), 2019. Date of
Publication: January 2019.
Author
Lee C.Y.; Robinson D.A.; Johnson C.A.; Zhang Y.; Wong J.; Joshi D.J.; Wu
T.-T.; Knight P.A.
Institution
(Lee, Robinson, Johnson, Wong, Joshi, Knight) Division of Cardiac Surgery,
Department of Surgery, University of Rochester Medical Center, Rochester,
NY, United States
(Zhang, Wu) Department of Biostatistics and Computational Biology,
University of Rochester, Rochester, NY, United States
Publisher
Elsevier USA
Abstract
Background: Optimal pain control continues to be a concern in cardiac
surgery. Current strategies for postoperative pain management often yield
suboptimal results. The superiority of Exparel (Pacira Pharmaceuticals,
Inc, Parsippany, NJ) in providing postoperative pain control and opioid
sparing is equivocal. This prospective, randomized, double-blind study
examines the efficacy of Exparel as a novel single-dose application
parasternal nerve block in postoperative pain control and opioid sparing.
 Method(s): This single-surgeon study included 79 patients undergoing
median sternotomy for coronary revascularization. Study participants were
randomized to either the drug or a control arm. Each participant received
Exparel or normal saline placebo administered as a parasternal nerve
block. Postoperative pain was rated according to the nonverbal pain scale
or numeric rating scale. Total amount of narcotic pain medication used and
patients' pain scores within the first 72 hours postoperatively were
compared. Secondary outcomes compared the intensive care unit length of
stay, hospital length of stay, time to extubation, time to return of bowel
function, and time to return to work or daily activities. Result(s):
The primary endpoint of pain levels between the two groups demonstrated no
significant difference when analyzing the individual time points
postoperatively. However, overall pain levels were significantly lower in
the study drug group (p = 0.04). There was no significant difference in
the amount of analgesics required postoperatively or in secondary
endpoints between the groups. Conclusion(s): Exparel does not provide
an opioid-sparing benefit or any secondary outcome benefit compared with
placebo. Exparel may be associated with a marginal decrease in
postoperative pain levels. (Parasternal Nerve Bock in Cardiac Patients;
NCT01826851.) Copyright © 2019 The Society of Thoracic Surgeons

<3>
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Accession Number
2001072974
Title
Impact of Isolyte Versus 0.9% Saline on Postoperative Event of Acute
Kidney Injury Assayed by Urinary [TIMP-2]x[IGFBP7] in Patients Undergoing
Cardiac Surgery.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 33 (2) (pp 348-356),
2019. Date of Publication: February 2019.
Author
Lee N.M.; Deriy L.; Petersen T.R.; Shah V.O.; Hutchens M.P.; Gerstein N.S.
Institution
(Lee, Deriy, Petersen, Gerstein) Department of Anesthesiology and Critical
Care Medicine, University of New Mexico School of Medicine, Albuquerque,
N, United States
(Shah) Department of Internal Medicine, Division of Nephrology, University
of New Mexico School of Medicine, Albuquerque, NM, United States
(Hutchens) Department of Anesthesiology and Perioperative Medicine, Oregon
Health & Science University, Portland, OR, United States
Publisher
W.B. Saunders
Abstract
Objective: Administration of excess chloride in 0.9% normal saline (NS)
decreases renal perfusion and glomerular filtration rate, thereby
increasing the risk for acute kidney injury (AKI). In this study, the
effect of NS versus Isolyte use during cardiac surgery on urinary levels
of tissue inhibitor of metalloproteinase 2 and insulin-like growth
factor-binding protein 7 [TIMP-2] x [IGFBP7] and postoperative risk of AKI
were examined. Design(s): Prospective, randomized, and single-blinded
trial. Setting(s): Single university medical center.
 Participant(s): Thirty patients over 18 years without chronic renal
insufficiency or recent AKI undergoing elective cardiac surgery.
 Intervention(s): Subjects were randomized to receive either NS or
Isolyte during the intraoperative period. Measurements and Main
Results: The primary outcome was the change in urinary levels of [TIMP2] x
[IGFBP7] from before surgery to 24 hours postoperatively. Secondary
outcomes included serum creatinine pre- and postoperatively at 24 and 48
hours, serum chloride pre- and postoperatively at 24 and 48 hours, need
for dialysis prior to discharge, and arterial pH measured 24 hours
postoperatively. Sixteen patients received NS and 14 patients received
Isolyte. Three patients developed AKI within the first 3 postoperative
days, all in the NS group. The authors found increases in [TIMP-2] x
[IGFBP7] in both groups. However, the difference in this increase between
study arms was not significant (p = 0.92; -0.097 to 0.107).
 Conclusion(s): The authors observed no change in urinary [TIMP-] x
[IGFBP7] levels in patients receiving NS versus Isolyte during cardiac
surgery. Future larger studies in patients at higher risk for AKI are
recommended to evaluate the impact of high- versus lower-chloride
solutions on the risk of postoperative AKI after cardiac
surgery. Copyright © 2018 Elsevier Inc.

<4>
Accession Number
2001137503
Title
Shifts of Transfusion Demand in Cardiac Surgery After Implementation of
Rotational Thromboelastometry-Guided Transfusion Protocols: Analysis of
the HEROES-CS (HEmostasis Registry of patiEntS in Cardiac Surgery)
Observational, Prospective Open Cohort Database.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 33 (2) (pp 307-317),
2019. Date of Publication: February 2019.
Author
Kuiper G.J.A.J.M.; van Egmond L.T.; Henskens Y.M.C.; Roekaerts P.M.;
Maessen J.G.; ten Cate H.; Buhre W.F.; Lance M.D.
Institution
(Kuiper, Buhre, Lance) Department of Anaesthesiology and Pain Treatment,
Maastricht University Medical Center, Maastricht, Netherlands
(Kuiper, ten Cate) Laboratory for Clinical Thrombosis and Haemostasis,
Department of Internal Medicine, Cardiovascular Research Institute
Maastricht, Maastricht University Medical Center, Maastricht, Netherlands
(van Egmond, Henskens) Central Diagnostic Laboratory, Cluster for
Haemostasis and Transfusion, Maastricht University Medical Center,
Maastricht, Netherlands
(Roekaerts) Department of Intensive Care Medicine, Maastricht University
Medical Center, Maastricht, Netherlands
(Maessen) Department of Cardiothoracic Surgery, Maastricht University
Medical Center, Maastricht, Netherlands
(ten Cate) Department of Internal Medicine, Maastricht University Medical
Center, Maastricht, Netherlands
Publisher
W.B. Saunders
Abstract
Objectives: Rotational thromboelastometry (ROTEM)-guided transfusion
algorithms in cardiac surgery have been proven to be successful in
reducing blood loss in randomized controlled trials. Using an
institutional hemostasis registry of patients in cardiac surgery
(HEROES-CS), the authors hypothesized that the use of ROTEM-guided
transfusion algorithms would save blood products and overall costs in
cardiac surgery in every day practice. Design(s): Observational,
prospective open cohort database. Setting(s): Single-center academic
hospital. Participant(s): Cardiac surgery patients.
 Intervention(s): Implementation of ROTEM-guided bleeding management.
 Measurements and Main Results: A classical-guided algorithm and a
ROTEM-guided algorithm were used for patient blood management in 2
cohorts. Primary outcome was the use and amount of blood products and
hemostatic medication. Secondary outcomes were amount of rethoracotomies,
length of stay, and 30-day mortality. Finally, costs and savings were
calculated. The classical-guided cohort comprised 204 patients, and
ROTEM-guided cohort comprised 151 patients. Baseline characteristics
showed excellent similarities after propensity score matching of 202
patients. Blood loss was lower after ROTEM guidance (p < 0.001). Absolute
risk reduction was 17% for red blood cells (p = 0.024), 12% for fresh
frozen plasma (p = 0.019), and 4% for thrombocyte concentrates (p =
0.582). More tranexamic acid was given, but not more fibrinogen
concentrate, while desmopressin was given less often. Hospital length of
stay was reduced by an overall median of 2 and a mean of 4 days (p <
0.001). Mortality and rethoracotomy rates were not affected. Potential
savings were about 4,800 ($5,630) per patient. Conclusion(s):
Implementation of a ROTEM-guided transfusion algorithm in cardiac surgery
patients reduced the use of blood products and hemostatic medication,
hereby saving costs. Reductions in mortality and rethoracotomy rates could
not be found. Copyright © 2018 The Authors

<5>
Accession Number
2001411722
Title
Assessment of Platelet REACtivity After Transcatheter Aortic Valve
Replacement: The REAC-TAVI Trial.
Source
JACC: Cardiovascular Interventions. 12 (1) (pp 22-32), 2019. Date of
Publication: 14 January 2019.
Author
Jimenez Diaz V.A.; Tello-Montoliu A.; Moreno R.; Cruz Gonzalez I.; Baz
Alonso J.A.; Romaguera R.; Molina Navarro E.; Juan Salvadores P.; Paredes
Galan E.; De Miguel Castro A.; Bastos Fernandez G.; Ortiz Saez A.;
Fernandez Barbeira S.; Raposeiras Roubin S.; Ocampo Miguez J.; Serra
Penaranda A.; Valdes Chavarri M.; Cequier Fillat A.; Calvo Iglesias F.;
Iniguez Romo A.
Institution
(Jimenez Diaz, Baz Alonso, Paredes Galan, De Miguel Castro, Bastos
Fernandez, Ortiz Saez, Fernandez Barbeira, Raposeiras Roubin, Ocampo
Miguez, Calvo Iglesias, Iniguez Romo) Cardiology Department, Hospital
Alvaro Cunqueiro, University Hospital of Vigo, Vigo, Spain
(Jimenez Diaz, Juan Salvadores) Cardiovascular Research Unit, Cardiology
Department, Hospital Alvaro Cunqueiro, University Hospital of Vigo, Vigo,
Spain
(Tello-Montoliu, Valdes Chavarri) Cardiology Department, Hospital
Universitario Virgen de la Arrixaca, IMIB-Arrixaca, Murcia, Spain
(Tello-Montoliu, Cruz Gonzalez, Valdes Chavarri, Cequier Fillat, Iniguez
Romo) Centro de Investigacion en Red de Enfermedades Cardiovasculares
(Network Research Center for Cardiovascular Diseases), CIBER-CV, Madrid,
Spain
(Moreno) Cardiology Department, Hospital Universitario La Paz, Madrid,
Spain
(Cruz Gonzalez) Cardiology Department, Hospital Universitario de
Salamanca, Salamanca, Spain
(Romaguera, Cequier Fillat) Cardiology Department, Hospital Universitario
de Bellvitge, Barcelona, Spain
(Molina Navarro) Cardiology Department, Hospital Universitario Virgen de
las Nieves, Granada, Spain
(Juan Salvadores) Cardiovascular Research Group, Galicia Sur Health
Research Institute (IIS Galicia Sur), SERGAS-UVIGO, Vigo, Spain
(Serra Penaranda) Cardiology Department, Hospital Universitario San Pau,
Barcelona, Spain
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives: The REAC-TAVI (Assessment of platelet REACtivity after
Transcatheter Aortic Valve Implantation) trial enrolled patients with
aortic stenosis (AS) undergoing transcatheter aortic valve replacement
(TAVR) pre-treated with aspirin + clopidogrel, aimed to compare the
efficacy of clopidogrel and ticagrelor in suppressing high platelet
reactivity (HPR) after TAVI. Background(s): Current recommendations
support short-term use of aspirin + clopidogrel for patients with severe
AS undergoing TAVR despite the lack of compelling evidence.
 Method(s): This was a prospective, randomized, multicenter
investigation. Platelet reactivity was measured at 6 different time points
with the VerifyNow assay (Accriva Diagnostics, San Diego, California). HPR
was defined as (P2Y<inf>12</inf> reaction units (PRU) >=208. Patients with
HPR before TAVR were randomized to either aspirin + ticagrelor or aspirin
+ clopidogrel for 3 months. Patients without HPR continued with aspirin +
clopidogrel (registry cohort). The primary endpoint was non-HPR status
(PRU <208) in >=70% of patients treated with ticagrelor at 90 days
post-TAVR. Result(s): A total of 68 patients were included. Of these,
48 (71%) had HPR (PRU 273 +/- 09) and were randomized to aspirin +
ticagrelor (n = 24, PRU 277 +/- 08) or continued with aspirin +
clopidogrel (n = 24, PRU 269 +/- 49). The remaining 20 patients (29%)
without HPR (PRU 133 +/- 12) were included in the registry. Overall,
platelet reactivity across all the study time points after TAVR was lower
in patients randomized to ticagrelor compared with those treated with
clopidogrel, including those enrolled in the registry (p < 0.001). The
primary endpoint was achieved in 100% of patients with ticagrelor compared
with 21% with clopidogrel (p < 0.001). Interestingly, 33% of clopidogrel
responder patients at baseline developed HPR status during the first month
after TAVR. Conclusion(s): HPR to clopidogrel is present in a
considerable number of patients with AS undergoing TAVR. Ticagrelor
achieves a better and faster effect, providing sustained suppression of
HPR to these patients. (Platelet Reactivity After TAVI: A Multicenter
Pilot Study [REAC-TAVI]; NCT02224066) Copyright © 2019 The
Authors

<6>
Accession Number
620548208
Title
Preoperative factors associated with worsening in health-related quality
of life following coronary artery bypass grafting in the Randomized On/Off
Bypass (ROOBY) trial.
Source
American Heart Journal. 198 (pp 33-38), 2018. Date of Publication: April
2018.
Author
Bishawi M.; Hattler B.; Almassi G.H.; Spertus J.A.; Quin J.A.; Collins
J.F.; Grover F.L.; Shroyer A.L.
Institution
(Bishawi, Shroyer) Northport VA Medical Center, Northport, NY, United
States
(Bishawi) Duke University Medical Center, Durham, NC, United States
(Hattler, Grover, Shroyer) Eastern Colorado Health Care System, Denver VA
Medical Center, Denver, CO, United States
(Hattler, Grover) University of Colorado School of Medicine, Anschutz
Medical Campus, Aurora, CO, United States
(Almassi) Clement J. Zablocki Veterans Affairs (VA) Medical Center,
Milwaukee, WI, United States
(Almassi) Medical College of Wisconsin, Milwaukee, WI, United States
(Spertus) Saint Luke's Mid America Heart Institute and University of
Missouri, Kansas City, MO, United States
(Collins) Cooperative Studies Program Coordinating Center, Veterans
Affairs Medical Center, Point, Perry, MD, United States
(Quin) VA Boston Healthcare System, West Roxbury, MA and Harvard Medical
School, Boston, MA, United States
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
For advanced coronary disease, coronary artery bypass graft (CABG) surgery
generally improves patients' symptoms and long-term survival.
Unfortunately, some patients experience worse health-related quality of
life (HRQL) after CABG. The objective of this study is to report the
frequency and risk factors associated with 1-year post-CABG HRQL
deterioration. Method(s): From 2002 to 2007, 2203 "Randomized On/Off
Bypass" (ROOBY) trial patients randomly received either off-pump or
on-pump CABG at 18 VA medical centers. Subjects completed both baseline
and 1-year Seattle Angina Questionnaire (SAQ) and the Veterans Rand 36
(VR-36) questionnaires to assess HRQL. Using previously published
criteria, the rates of clinically significant changes were determined for
the SAQ [angina frequency (AF), physical limitation (PL), and quality of
life (QoL)] and VR36 [mental component score (MCS) and physical component
score (PCS)] subscales. Multivariate regression models were then used to
identify pre-CABG patient characteristics associated with worsened 1-year
HRQL status for each subscale. Result(s): Over 80% of patients had an
improvement or no change in SAQ and VR-36 subscale scores 1 year after
CABG. The HRQL scale-specific deterioration rates were 4.5% SAQ-AF, 16.8%
SAQ-PL, 4.9% SAQ-QoL, 19.4% VR36-MCS, and 13.5% VR36-PCS. Predictors of
1-year HRQL deterioration were diabetes and smoking for the SAQ-AF;
diabetes, chronic obstructive pulmonary disease (COPD), and peripheral
vascular disease (PVD) for SAQ-PL; COPD and depression for the SAQ-QoL;
diabetes for VR36-PCS, and history of stroke and depression for VR36-MCS.
The baseline score was an independent predictor for worsening in all the
subscales studied. Conclusion(s): Among VA patients, less than 20%
experienced worse HRQL 1 year after CABG. For patients with low symptom
burden at baseline, diabetes, smoking, depression, PVD, COPD, and a prior
stroke, clinicians should be more cautious in pre-CABG counseling as to
their anticipated HRQL improvements. Copyright © 2018

<7>
Accession Number
620059693
Title
Nonprimary PCI at hospitals without cardiac surgery on-site: Consistent
outcomes for all?.
Source
American Heart Journal. 197 (pp 18-26), 2018. Date of Publication: March
2018.
Author
Czarny M.J.; Miller J.M.; Naiman D.Q.; Hwang C.-W.; Hasan R.K.; Lemmon
C.C.; Aversano T.
Institution
(Czarny, Miller, Hwang, Hasan, Lemmon, Aversano) School of Medicine, Johns
Hopkins University, Baltimore, MD, United States
(Naiman) Department of Applied Mathematics and Statistics, Johns Hopkins
University, Baltimore, MD, United States
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Background The CPORT-E trial showed the noninferiority of nonprimary
percutaneous coronary intervention (PCI) at hospitals without cardiac
surgery on-site (SoS) compared with hospitals with SoS for 6-week
mortality and 9-month major adverse cardiac events (MACE). However, target
vessel revascularization (TVR) was increased at non-SoS hospitals.
Therefore, we aimed to determine the consistency of the CPORT-E trial
findings across the spectrum of enrolled patients. Methods Post hoc
subgroup analyses of 6-week mortality and 9-month MACE, defined as the
composite of death, Q-wave myocardial infarction, or TVR, were performed.
Patients with and without 9-month TVR and rates of related outcomes were
compared. Results There was no interaction between SoS status and
clinically relevant subgroups for 6-week mortality or 9-month MACE (P for
any interaction =.421 and.062, respectively). In addition to increased
9-month rates of TVR and diagnostic catheterization at hospitals without
SoS, non-TVR was also increased (2.7% vs 1.9%, P =.002); there was no
difference in myocardial infarction-driven TVR, non-TVR, or diagnostic
catheterization. Predictors of 9-month TVR included intra-aortic balloon
pump use, any index PCI complication, and 3-vessel PCI, whereas predictors
of freedom from TVR included SoS, discharge on a P2Y<inf>12</inf>
inhibitor, and stent implantation. Conclusions The noninferiority of
nonprimary PCI at non-SoS hospitals was consistent across clinically
relevant subgroups. Elective PCI at an SoS hospital conferred a TVR
benefit which may be related to a lower rate of referral for diagnostic
catheterization for reasons other than myocardial
infarction. Copyright © 2017 Elsevier Inc.

<8>
[Use Link to view the full text]
Accession Number
624836981
Title
Adding sufentanil to ropivacaine in continuous thoracic paravertebral
block fails to improve analgesia after video-assisted thoracic surgery: A
randomised controlled trial.
Source
European Journal of Anaesthesiology. 35 (10) (pp 766-773), 2018. Date of
Publication: 2018.
Author
Bauer C.; Pavlakovic I.; Mercier C.; Maury J.-M.; Koffel C.; Roy P.;
Fellahi J.-L.
Institution
(Bauer, Maury) Hospices Civils de Lyon, Hopital de la Croix Rousse,
Service d'Anesthesie-Reanimation, 103 Grande Rue de la Croix-Rousse, Lyon
69004, France
(Pavlakovic, Koffel, Fellahi) Hospices Civils de Lyon, Hopital
Cardiologique et Pneumologique Louis Pradel, Service
d'Anesthesie-Reanimation, Lyon, France
(Mercier, Roy) Hospices Civils de Lyon, Service de Biostatistique -
Bioinformatique, Lyon, France
(Koffel, Roy, Fellahi) Faculte de Medecine, Universite Claude Bernard Lyon
1, Lyon, France
(Koffel, Roy) CNRS UMR5558, Laboratoire de Biometrie et Biologie
Evolutive, Departement Biostatistiques et Modelisation pour la Sante et
l'Environnement, Equipe Biostatistique-Sante, Lyon, France
(Fellahi) Hospices Civils de Lyon, Hopital Cardiologique et Pneumologique
Louis Pradel, Service de Chirurgie Thoracique, Lyon, France
Publisher
Lippincott Williams and Wilkins (E-mail: agents@lww.com)
Abstract
BACKGROUND: The benefit of adding opioid to a local anaesthetic for
continuous thoracic paravertebral analgesia after video-assisted thoracic
surgery (VATS) is unclear. OBJECTIVE(S): To analyse the analgesic
efficacy of ropivacaine and sufentanil in combination compared with
ropivacaine alone after VATS. DESIGN: A randomised, double-blinded,
single-centre clinical trial. SETTING: A tertiary university hospital
between March 2010 and April 2014. PATIENTS: Ninety patients were
recruited, two were not included leaving 88 randomised into two groups.
Eighteen patients were excluded from analysis and 70 completed the study.
INTERVENTION: To receive thoracic paravertebral analgesia with either 2 mg
m-1 ropivacaine and 0.25 mug m-1 sufentanil
(ropivacaine R sufentanil group) or 2 mg m-1 ropivacaine alone
(ropivacaine group) for 48 h postoperatively. Infusion rate was set at
0.15 ml kg-1 h-1 in both groups. MAIN OUTCOME
MEASURES: The primary endpoint was the mean total amount of
self-administered morphine by the patients in each group at 48 h
postoperatively. RESULT(S): The mean +/- SD total amount of
self-administered morphine was not significantly different between groups
(53.1+/-27.2mg in the ropivacaine R sufentanil group vs. 58.8+/- 34.3 mg
in the ropivacaine group; P=0.72). No significant differences were found
between the two groups in either pain scores at rest or during movement,
in opioid-related adverse reactions, in patient satisfaction or length of
hospital stay. CONCLUSION(S): Adding 0.25 mugm-1
sufentanil to 2 mg m-1 ropivacaine in continuous thoracic
paravertebral analgesia for VATS did not reduce morphine consumption or
pain scores when compared with ropivacaine alone. We cannot recommend its
use for routine clinical practice. Further studies analysing different
concentrations and infusion rates of sufentanil are needed before a lack
of efficacy can be confirmed. Copyright © 2018 European Society
of Anaesthesiology. All rights reserved.

<9>
Accession Number
622947957
Title
Lower on-treatment platelet reactivity during everolimus-eluting stent
implantation contributes to the resolution of post-procedural intra-stent
thrombus: serial OCT observation in the PRASFIT-Elective study.
Source
Heart and Vessels. 33 (12) (pp 1423-1433), 2018. Date of Publication: 01
Dec 2018.
Author
Konishi A.; Iwasaki M.; Shinke T.; Otake H.; Nakagawa M.; Hariki H.; Osue
T.; Inoue T.; Taniguchi Y.; Nishio R.; Kinutani H.; Hiranuma N.; Kuroda
M.; Hirata K.-I.; Saito S.; Nakamura M.; Shite J.; Akasaka T.
Institution
(Konishi, Iwasaki, Shinke, Otake, Nakagawa, Hariki, Osue, Inoue,
Taniguchi, Nishio, Kinutani, Hiranuma, Kuroda, Hirata) Division of
Cardiovascular Medicine, Department of Internal Medicine, Kobe University
Graduate School of Medicine, Kobe, Japan
(Saito) Division of Cardiology, Shonan Kamamura General Hospital,
Kamakura, Japan
(Nakamura) Division of Cardiovascular Medicine, Ohashi Medical Center,
Toho University, Tokyo, Japan
(Shite) Division of Cardiology, Osaka Saiseikai Nakatsu Hospital, Osaka,
Japan
(Akasaka) Department of Cardiovascular Medicine, Wakayama Medical
University, Wakayama, Japan
(Shinke) Department of Cardiology, Kobe University Graduate School of
Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo 650-0017, Japan
Publisher
Springer Tokyo (E-mail: orders@springer.jp)
Abstract
Intra-stent thrombus (IS-Th) formed immediately after percutaneous
coronary intervention (PCI) is associated with subsequent adverse coronary
events. However, the impact of on-treatment platelet reactivity on IS-Th
is unknown. PRASFIT-Elective is a multicenter study of PCI patients
receiving prasugrel (20/3.75 mg, loading/maintenance dose) or clopidogrel
(300/75 mg), with aspirin (100 mg). Among the 742 study patients, 111 were
pre-specified for the OCT sub-study. Of these, 82 underwent OCT
immediately after PCI to assess IS-Th and at an 8-month follow-up to
evaluate the fate of the IS-Th. Lesions were considered resolved when
IS-Th were detected after PCI but not on the follow-up or persistent when
IS-Th were observed on both scans. The P2Y12 Reactive Unit (PRU) value was
determined at the initial PCI and 4 and 48 weeks post-PCI. In 76 patients
(86 lesions), we detected 230 IS-Th initially, and 196 IS-Th (85.2%) were
resolved at the 8-month OCT. At PCI, but not 4 or 48 weeks after, the
resolved IS-Th group had a lower PRU than the persistent IS-Th group (199
+/- 101 vs. 266 +/- 102, p = 0.008). Multivariate logistic regression
analyses revealed that lower PRU at PCI and less calcified lesions were
independent predictive factors for the resolution of IS-Th. Local
lesion-related factors and lower on-treatment platelet reactivity at the
time of PCI may contribute to the resolution of IS-Th after EES
implantation, potentially improving clinical outcome. Copyright ©
2018, Springer Japan KK, part of Springer Nature.

<10>
Accession Number
624732967
Title
A double-blind randomized controlled trial of the local application of
vancomycin versus ampicillin powder into the operative field for thoracic
and/or lumbar fusions.
Source
Journal of Neurosurgery: Spine. 29 (5) (pp 553-559), 2018. Date of
Publication: November 2018.
Author
Takeuchi M.; Wakao N.; Kamiya M.; Hirasawa A.; Murotani K.; Takayasu M.
Institution
(Takeuchi, Wakao, Kamiya, Hirasawa, Takayasu) Spine Center, Aichi Medical
University Hospital, Nagakute, Japan
(Takeuchi, Takayasu) Department of Neurological Surgery, Aichi Medical
University Hospital, Nagakute, Japan
(Wakao, Kamiya, Hirasawa) Department of Orthopedics Surgery, Aichi Medical
University Hospital, Nagakute, Japan
(Murotani) Division of Biostatistics, Clinical Research Center, Aichi
Medical University Hospital, Nagakute, Japan
(Takeuchi) Department of Spine Surgery, Aichi Spine Hospital, Inuyama,
Aichi, Japan
Publisher
American Association of Neurological Surgeons
Abstract
OBJECTIVE Retrospective studies have reported that the local application
of vancomycin (VCM) powder into the operative field decreases the
incidence of surgical site infection (SSI) in thoracic and/or lumbar
fusion. Authors of the present study prospectively evaluated the effects
of VCM in patients undergoing thoracic and/or lumbar fusion. METHODS In
this randomized double-blind trial, 230 patients undergoing thoracic
and/or lumbar fusion were randomly assigned to the local administration of
VCM (interventional group, 1 g) or ampicillin (AMP; control group, 1 g)
into the surgical field. The primary outcome was SSI results within 1 year
of surgery. RESULTS The trial was prematurely stopped according to
predetermined rules. The results showed one superficial infection (0.9%,
Staphylococcus aureus) and one deep infection (0.9%, S. aureus) in the VCM
group and two superficial infections (1.8%, Staphylococcus epidermidis and
culture negative) and one deep infection (0.9%, methicillin-resistant S.
aureus) in the AMP group. No significant differences in infection rates
were observed between the groups (p = 0.8). CONCLUSIONS This double-blind
randomized controlled trial demonstrated that the local application of VCM
or AMP powder into the operative field in short thoracic and/or lumbar
fusion procedures resulted in a similar incidence of SSI. CLASSIFICATION
OF EVIDENCE Type of question: therapeutic; study design: randomized
controlled trial; evidence: class III. Clinical trial registration no.:
UMIN000009377 (umin.ac.jp/ctr). Copyright © AANS 2018.

<11>
[Use Link to view the full text]
Accession Number
624093791
Title
Cyclosporine before Coronary Artery Bypass Grafting Does Not Prevent
Postoperative Decreases in Renal Function: A Randomized Clinical Trial.
Source
Anesthesiology. 128 (4) (pp 710-717), 2018. Date of Publication: 01 Apr
2018.
Author
Ederoth P.; Dardashti A.; Grins E.; Bronden B.; Metzsch C.; Erdling A.;
Nozohoor S.; Mokhtari A.; Hansson M.J.; Elmer E.; Algotsson L.; Jovinge
S.; Bjursten H.
Institution
(Ederoth, Dardashti, Grins, Bronden, Metzsch, Erdling, Algotsson)
Departments of Anesthesiology and Intensive Care, Sweden
(Nozohoor, Mokhtari, Bjursten) Departments of Cardiothoracic Surgery,
Clinical Sciences, Lund University, Skane University Hospital, Lund 221
85, Sweden
(Hansson, Elmer) Department of Mitochondrial Medicine Clinical Sciences,
Lund University, Lund, Sweden
(Jovinge) Frederik Meijer Heart and Vascular Institute, Spectrum Health,
Grand Rapids, MI, United States
(Jovinge) Van Andel Institute, Grand Rapids, MI, United States
(Jovinge) Cardiovascular Institute, Stanford University, Stanford, CA,
United States
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: Acute kidney injury is a common complication after cardiac
surgery, leading to increased morbidity and mortality. One suggested cause
for acute kidney injury is extracorporeal circulation-induced
ischemia-reperfusion injury. In animal studies, cyclosporine has been
shown to reduce ischemia-reperfusion injury in the kidneys. We
hypothesized that administering cyclosporine before extracorporeal
circulation could protect the kidneys in patients undergoing cardiac
surgery. Method(s): The Cyclosporine to Protect Renal Function in
Cardiac Surgery (CiPRICS) study was an investigator-initiated,
double-blind, randomized, placebo-controlled, single-center study. The
primary objective was to assess if cyclosporine could reduce acute kidney
injury in patients undergoing coronary artery bypass grafting surgery with
extracorporeal circulation. In the study, 154 patients with an estimated
glomerular filtration rate of 15 to 90 ml . min-1 . 1.73
m-2 were enrolled. Study patients were randomized to receive
2.5 mg/kg cyclosporine or placebo intravenously before surgery. The
primary endpoint was relative plasma cystatin C changes from the
preoperative day to postoperative day 3. Secondary endpoints included
biomarkers of kidney, heart, and brain injury. Result(s): All
enrolled patients were analyzed. The cyclosporine group (136.4 +/- 35.6%)
showed a more pronounced increase from baseline plasma cystatin C to day 3
compared to placebo (115.9 +/- 30.8%), difference, 20.6% (95% CI, 10.2 to
31.2%, P < 0.001). The same pattern was observed for the other renal
markers. The cyclosporine group had more patients in Risk Injury Failure
Loss End-stage (RIFLE) groups R (risk), I (injury), or F (failure; 31% vs.
8%, P < 0.001). There were no differences in safety parameter distribution
between groups. Conclusion(s): Administration of cyclosporine did not
protect coronary artery bypass grafting patients from acute kidney injury.
Instead, cyclosporine caused a decrease in renal function compared to
placebo that resolved after 1 month. Copyright © 2018, the
American Society of Anesthesiologists, Inc. Wolters Kluwer Health, Inc.
All Rights Reserved.

<12>
Accession Number
2001082783
Title
The value of Coronary Artery computed Tomography as the first-line
anatomical test for stable patients with indications for invasive
angiography due to suspected Coronary Artery Disease: CAT-CAD randomized
trial.
Source
Journal of Cardiovascular Computed Tomography. 12 (6) (pp 472-479), 2018.
Date of Publication: November - December 2018.
Author
Rudzinski P.N.; Kruk M.; Kepka C.; Schoepf U.J.; Duguay T.; Dzielinska Z.;
Pregowski J.; Witkowski A.; Ruzyllo W.; Demkow M.
Institution
(Rudzinski, Kruk, Kepka, Dzielinska, Pregowski, Witkowski, Ruzyllo,
Demkow) Institute of Cardiology in Warsaw, Poland
(Schoepf, Duguay) Division of Cardiovascular Imaging, Department of
Radiology and Radiological Science, Medical University of South Carolina,
Charleston, SC, United States
(Schoepf) Division of Cardiology, Department of Medicine, Medical
University of South Carolina, Charleston, SC, United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background: The aim of this prospective, randomized trial was to evaluate
whether the use of coronary computed tomography angiography (CCTA) as the
first-line anatomical test in patients with suspected significant coronary
artery disease (CAD) may reduce the number of coronary invasive
angiographies (ICA), and expand the use of CCTA in patients currently
diagnosed invasively. Method(s): 120 patients (age:60.6 +/- 7.9
years, 35% female) with indications to ICA were randomized 1:1 to undergo
CCTA versus direct ICA. Outcomes were evaluated during the diagnostic and
therapeutic periods. Result(s): The number of invasively examined
patients was reduced by 64.4% in the CCTA group as compared to the direct
ICA group (21vs59,p < 0.0001). The number of patients with ICAs not
followed by coronary intervention was reduced by 88.1% with the CCTA
strategy (5vs42,p < 0.0001). Over the diagnostic and therapeutic course
there were no significant differences regarding the median volume of
contrast (CCTA 80.3 ml[65.0-165.0] vs ICA 90.0 ml[55.0-100.0], p = 0.099),
while a non-significant trend towards higher radiation dose in the CCTA
group was observed (9.9 mSv[7.0-22.1] vs 9.4 mSv[5.2-14.0], p = 0.05).
There were no acute cardiovascular events. Conclusion(s): CCTA may
hypothetically act as an effective 'gatekeeper' to the catheterization
laboratory in the diagnosis of stable patients with current indications
for ICA. This strategy may result in non-invasive, outpatient-based triage
of two thirds of individuals without actionable CAD, obviating unnecessary
invasive examinations. However, the longer follow-up is indispensable.
ClinicalTrials.gov number: NCT02591992 The aim of our trial was to
evaluate the clinical value of coronary computed tomography angiography
(CCTA) as the first-line anatomical test in the diagnosis of stable
patients with indications for invasive coronary angiography (ICA) due to
suspected significant coronary artery disease (CAD). This is the first
study triaging this group of patients with CT and the results of this
randomized trial are promising in terms of safety and
efficacy. Copyright © 2018 Society of Cardiovascular Computed
Tomography

<13>
Accession Number
625756754
Title
Impact of Early versus Late Initiation of Renal Replacement Therapy in
Patients with Cardiac Surgery-Associated Acute Kidney Injury:
Meta-Analysis with Trial Sequential Analysis of Randomized Controlled
Trials.
Source
BioMed Research International. 2018 (no pagination), 2018. Article Number:
6942829. Date of Publication: 2018.
Author
Cui J.; Tang D.; Chen Z.; Liu G.
Institution
(Cui) Head and Neck Surgery, Affiliated Cancer Hospital, Institute of
Guangzhou Medical University, Guangdong Province 510095, China
(Tang) Department of General Surgery, Third Xiangya Hospital, Central
South University, Changsha, Hunan Province 410008, China
(Chen) Intensive Care Unit, Shunde Hospital, Southern Medical University,
Foshan, Guangdong Province 528300, China
(Liu) Department of Pathology, Affiliated Cancer Hospital, Institute of
Guangzhou Medical University, Guangzhou, Guangdong Province 510095, China
Publisher
Hindawi Limited (410 Park Avenue, 15th Floor, 287 pmb, New York NY 10022,
United States)
Abstract
Background. Previous studies have examined the effect of the initiation
time of renal replacement therapy (RRT) in patients with cardiac
surgery-associated acute kidney injury (CSA-AKI), but the findings remain
controversial. The aim of this meta-analysis was to systematically and
quantitatively compare the impact of early versus late initiation of RRT
on the outcome of patients with CSA-AKI. Methods. Four databases (PubMed,
the Cochrane Library, ISI Web of Knowledge, and Embase) were
systematically searched from inception to June 2018 for randomized
clinical trials (RCTs). Two investigators independently performed the
literature search, study selection, data extraction, and quality
evaluation. Meta-analysis and trial sequential analysis (TSA) were used to
examine the impact of RRT initiation time on all-cause mortality (primary
outcome). The Grading of Recommendations Assessment Development and
Evaluation (GRADE) was used to evaluate the level of evidence. Results. We
identified 4 RCTs with 355 patients that were eligible for inclusion.
Pooled analyses indicated no difference in mortality for patients
receiving early and late initiation of RRT (relative risk [RR] = 0.61, 95%
confidence interval [CI] = 0.33 to 1.12). However, the results were not
confirmed by TSA. Similarly, early RRT did not reduce the length of stay
(LOS) in the intensive care unit (ICU) (mean difference [MD] = -1.04; 95%
CI = -3.34 to 1.27) or the LOS in the hospital (MD = -1.57; 95% CI = -4.62
to 1.48). Analysis using GRADE indicated the certainty of the body of
evidence was very low for a benefit from early initiation of RRT.
Conclusion. Early initiation of RRT had no beneficial impacts on outcomes
in patients with CSA-AKI. Future larger and more adequately powered
prospective RCTs are needed to verify the benefit of reduced mortality
associated with early initiation of RRT. Trial Registration. This trial is
registered with PROSPERO registration number CRD42018084465, registered on
11 February 2018. Copyright © 2018 Jie Cui et al.

<14>
Accession Number
620590629
Title
Rationale and design of the Statins Evaluation in Coronary procedUres and
REvascularization: The SECURE-PCI Trial.
Source
American Heart Journal. 198 (pp 129-134), 2018. Date of Publication: April
2018.
Author
Berwanger O.; de Barros e Silva P.G.M.; Dall Orto F.T.C.; de Andrade P.B.;
de Castro Bienert I.R.; Bosso C.E.; Mangione J.; Polanczyk C.A.; Sousa A.;
Kalil R.; de Moura Santos L.; Sposito A.C.; Rech R.L.; Sousa A.C.S.;
Baldissera F.; Nascimento B.R.; de Andrade Jesuino I.; Santucci E.V.;
Damiani L.P.; Laranjeira L.N.; Borges de Oliveira J.A.; Giraldez R.R.;
Cavalcanti A.B.; Pereira S.B.; Mattos L.A.; Armaganijan L.V.; Guimaraes
H.P.; Sousa J.E.; Alexander J.H.; Granger C.B.; Lopes R.D.
Institution
(Berwanger, de Barros e Silva, Dall Orto, de Andrade, de Castro Bienert,
Bosso, Mangione, Polanczyk, Sousa, Kalil, de Moura Santos, Sposito, Rech,
Sousa, Baldissera, Nascimento, de Andrade Jesuino, Santucci, Damiani,
Laranjeira, Borges de Oliveira, Giraldez, Cavalcanti, Pereira, Mattos,
Armaganijan, Guimaraes, Sousa, Alexander, Granger, Lopes) Research
Institute-Heart Hospital (HCor), Rua Abilio Soares 250, 12th floor, Sao
Paulo, SP 04005-000, Brazil
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Background: Previous evidence suggests that acute treatment with statins
reduce atherosclerotic complications, including periprocedural myocardial
infarction, but currently, there are no large, adequately powered studies
to define the effects of early, high-dose statins in patients with acute
coronary syndrome (ACS) and planned invasive management.
 Objective(s): The main goal of Statins Evaluation in Coronary
procedUres and REvascularization (SECURE-PCI) Trial is to determine
whether the early use of a loading dose of 80 mg of atorvastatin before an
intended percutaneous coronary intervention followed by an additional dose
of 80 mg 24 hours after the procedure will be able to reduce the rates of
major cardiovascular events at 30 days in patients with an ACS.
 Design(s): The SECURE-PCI study is a pragmatic, multicenter,
double-blind, placebo-controlled randomized trial planned to enroll around
4,200 patients in 58 different sites in Brazil. The primary outcome is the
rate of major cardiovascular events at 30 days defined as a composite of
all-cause mortality, nonfatal acute myocardial infarction, nonfatal
stroke, and coronary revascularization. The SECURE PCI is a large
randomized trial testing a strategy of early, high-dose statin in patients
with ACS and will provide important information about the acute treatment
of this patient population. Copyright © 2018

<15>
Accession Number
625824043
Title
Effect of dexmedetomidine or propofol sedation on haemodynamic stability
of patients after thoracic surgery.
Source
Anaesthesiology Intensive Therapy. 50 (5) (pp 359-366), 2018. Date of
Publication: 31 Dec 2018.
Author
Bialka S.; Copik M.; Karpe J.; Przybyla M.; Sliwczynska M.; Czyzewski D.;
Misiolek H.
Institution
(Bialka, Copik, Karpe, Przybyla, Sliwczynska, Misiolek) Department of
Anaesthesiology and Intensive Care, School of Medicine, Division of
Dentistry in Zabrze, Medical University of Silesia, 3 Maja 13-15, Zabrze
41-800, Poland
(Czyzewski) Department of Thoracic Surgery, School of Medicine, Division
of Dentistry in Zabrze, Medical University of Silesia, Katowice, Poland
Publisher
Via Medica (Ul. Swietokrzyska 73, Gdansk 80-180, Poland. E-mail:
elzbieta.zabrocka@viamedica.pl)
Abstract
Background: Dexmedetomidine and propofol are commonly used sedative agents
in non-invasive ventilation as they allow for straightforward arousal and
are easily controllable to a relative degree. Moreover, dexmedetomidine is
associated with a low risk of respiratory depression. However, both agents
are associated with significant haemodynamic side effects. The primary aim
of this study is to compare the influence of both drugs on haemodynamic
effects in patients after thoracic surgical procedures receiving
dexmedetomidine or propofol for non-invasive postoperative ventilation.
 Method(s): A prospective, randomised, observational study conducted
in a university hospital. Intervention(s): Continuous sedation with
dexmedetomidine or propofol for six hours of postoperative non-invasive
ventilation after thoracic surgery, with concomitant use of continuous
epidural analgesia. Result(s): A total of 38 patients (20 on
dexmedetomidine and 18 on propofol) were included in the analysis. The
primary findings of this study were that although the heart rate, along
with the systolic and mean arterial blood pressure did not differ
significantly between the groups (P = 0.87; P = 0.42; P = 0.13,
respectively), diastolic arterial blood pressure was significantly higher
in the propofol group (P = 0.02). A comparative analysis of epinephrine
usage did not reveal significant differences between the groups. Although
cardiac output (P = 0.36) and cardiac index (P = 0.36) analyses did not
show significant differences between the groups, there is a clear tendency
toward lower values of CO/CI in the group receiving propofol. While we
also observed a similar tendency in the stroke volume index and stroke
volume variation values, these differences did not reach statistical
significance either (P = 0.16; P = 0.64, respectively). Despite systemic
vascular resistance index values being higher in the propofol group,
exceeding reference values, similarly, the difference between the groups
was not significant (P = 0.36). Conclusion(s): The main finding of
this study is that dexmedetomidine and propofol provide similar advantages
in haemodynamic stability during short-term sedation for non-invasive
ventilation after thoracic surgical procedures in patients receiving
continuous epidural analgesia. Copyright © 2018 Via Medica. All
rights reserved.

<16>
[Use Link to view the full text]
Accession Number
624892939
Title
A randomized, triple-blind trial of cardiac shock-wave therapy on exercise
tolerance and symptoms in patients with stable angina pectoris.
Source
Coronary Artery Disease. 29 (7) (pp 579-586), 2018. Date of Publication:
01 Nov 2018.
Author
Shkolnik E.; Burneikaite G.; Jakutis G.; Scherbak M.; Zuoziene G.;
Petrauskiene B.; Trush E.; Vasyuk Y.; Laucevicius A.; Celutkiene J.
Institution
(Shkolnik, Scherbak, Trush, Vasyuk) Moscow State University of Medicine
and Dentistry, Moscow, Russian Federation
(Shkolnik) Yale-New Haven Health Bridgeport Hospital, Bridgeport,
Connecticut, United States
(Burneikaite, Jakutis, Zuoziene, Petrauskiene, Celutkiene) Clinic of
Cardiac and Vascular Diseases, Institute of Clinical Medicine, Faculty of
Medicine, Vilnius University, Palangos Street 1/10-3, Vilnius 01117,
Lithuania
(Burneikaite, Zuoziene, Petrauskiene, Celutkiene) Vilnius University
Hospital, Santaros Klinikos, Centre of Cardiology and Angiology, Lithuania
(Laucevicius) Centre of Innovative Medicine, Vilnius, Lithuania
Publisher
Lippincott Williams and Wilkins (E-mail: agents@lww.com)
Abstract
Background Despite major advances in managing coronary artery disease and
continuous research on alternative techniques to enhance myocardial
perfusion and reduce symptoms, coronary artery disease is still one of the
leading causes of adult disability worldwide. Cardiac shockwave therapy
(CSWT) has shown promising results in the amelioration of myocardial
ischemia in experimental studies; however, clinical results are limited to
single-center, mostly uncontrolled and underpowered trials. The current
study aimed to evaluate whether CSWT can improve exercise tolerance and
relieve angina symptoms in addition to optimal medical treatment in
patients with stable angina. Participants and methods A prospective,
randomized, triple blind, sham-procedure-controlled study was carried out.
The primary endpoint was total exercise duration in the modified Bruce
treadmill test at the 6-month follow-up. The secondary endpoints were
changes in ST-segment depression during the treadmill test, angina
symptoms during the treadmill test, number of angina attacks per week,
number of sublingual nitroglycerin consumption per week, Canadian
Cardiovascular Society angina functional class, and the Seattle Angina
Questionnaire score at the 6-month follow-up. Patients were randomized at
a 1 : 1 ratio to optimal medical plus cardiac shock-wave therapy
(OMT+CSWT) and optimal medical therapy with sham procedure (OMT+placebo)
groups. Results The mean exercise time improved in both study arms - CSWT
and placebo treatment - at the 3- and 6-month follow-up, without a
significant difference between groups. The magnitude and frequency of peak
exercise ST-segment depression reduced significantly in the CSWT+OMT group
compared with the OMT+placebo group at the 6-month follow-up (51.4 vs.
90.6%, P=0.001). Percentage of angina-free patients increased
progressively in both groups throughout the study. The Seattle Angina
Questionnaire scores improved significantly in both arms for four of five
domains at the 3- and the 6-month follow-up. Numerically, although
insignificant, the decrease in the number of angina episodes was more
prominent in the OMT+CSWTgroup compared with the OMT+placebo group.
Conclusion The total exercise duration in the modified Bruce treadmill
test at the 6-month follow-up did not differ significantly in patients
treated with CSWT compared with optimal medical therapy alone. In
addition, CSWT exerted a neutral effect on the quality of life and level
of angina. Copyright © 2018 Wolters Kluwer Health, Inc. All
rights reserved.

<17>
Accession Number
621531340
Title
Does high body mass index have any impact on survival of patients
undergoing oesophagectomy for oesophageal cancer?.
Source
Interactive Cardiovascular and Thoracic Surgery. 26 (4) (pp 693-695),
2018. Date of Publication: 01 Apr 2018.
Author
Deng H.-Y.; Qin C.-L.; Qiu X.-M.; Zhou Q.
Institution
(Deng, Qin, Qiu, Zhou) Lung Cancer Center, West China Hospital, Sichuan
University, No. 37 Guoxue Alley, Chengdu, Sichuan 610041, China
(Deng) Department of Thoracic Surgery, West China Hospital, Sichuan
University, Chengdu, China
Publisher
Oxford University Press
Abstract
A best evidence topic in thoracic surgery was written according to a
structured protocol. The question addressed was 'Does high body mass index
(BMI) have any impact on survival of patients undergoing oesophagectomy
for oesophageal cancer?' A total of 232 papers were found using the
reported search, of which 8 papers represented the best evidence to answer
the clinical question, which included 1 meta-analysis and 7 cohort
studies. The authors, journal, date and country of publication, patient
group studied, study type, relevant outcomes and results of these papers
are tabulated. One meta-analysis and 4 cohort studies provided the
evidence that high BMI was significantly correlated with a better survival
of oesophageal cancer patients undergoing oesophagectomy, while the other
3 cohort studies found that high BMI had no impact on the survival of
those patients. We conclude that patients with high BMI may have a better
prognosis than those with normal BMI undergoing oesophagectomy for
oesophageal cancer. Copyright © The Author(s) 2018. Published by
Oxford University Press on behalf of the European Association for
Cardio-Thoracic Surgery. All rights reserved.

<18>
Accession Number
621531250
Title
Dual antiplatelet therapy after coronary artery bypass surgery: Is there
an increase in bleeding risk? A meta-analysis.
Source
Interactive Cardiovascular and Thoracic Surgery. 26 (4) (pp 573-582),
2018. Date of Publication: 01 Apr 2018.
Author
Zhao Y.; Peng H.; Li X.; Qin Y.; Cao F.; Peng D.; Liu J.
Institution
(Zhao, Peng, Cao, Peng) Department of Cardiology, Beijing Anzhen Hospital,
Capital Medical University, Beijing, China
(Li, Qin, Liu) Department of Cardiology, Beijing Anzhen Hospital, Capital
Medical University, Anzhen Road, Chaoyang District, Beijing 100029, China
Publisher
Oxford University Press
Abstract
OBJECTIVES: There is increasing evidence that dual antiplatelet therapy
(DAPT) when compared with single antiplatelet therapy may improve venous
graft patency after coronary artery bypass graft. However, it is not yet
known whether postoperative administration of DAPT may increase the
potential risk of bleeding, especially in the early postoperative period.
 METHOD(S): We searched studies on PubMed, Embase, Web of Science and
the Cochrane Central Register of Controlled Trials. Relative risk (RR) was
pooled with 95% confidence intervals (CIs) for dichotomous data. Prior
subgroup analyses were performed to look for potential heterogeneity.
 RESULT(S): Thirteen studies involving 23 591 participants were
included. Our meta-analysis showed that DAPT does not increase the risk of
major bleeding (randomized controlled trials group: RR = 1.28, 95% CI
0.951.71; cohort studies group: RR = 0.99, 95% CI 0.661.51) and minor
bleeding (randomized controlled trials group: RR = 1.15, 95% CI 0.731.81;
cohort studies group: RR = 0.84, 95% CI 0.371.93) when compared with
single antiplatelet therapy. Meanwhile, DAPT does not increase the
incidence of major bleeding events during hospitalization (randomized
controlled trials group: RR = 1.27, 95% CI 0.911.78; cohort studies group:
RR = 0.50, 95% CI 0.122.09). Sensitivity analyses showed that our results
are stable, and there was no evidence of publication bias.
 CONCLUSION(S): DAPT does not increase the risk of major bleeding and
minor bleeding when compared with single antiplatelet therapy.
Postoperative administration of DAPT is considered to be safe in patients
after coronary artery bypass graft, even in the early postoperative
period. Copyright © The Author(s) 2018. Published by Oxford
University Press on behalf of the European Association for Cardio-Thoracic
Surgery. All rights reserved.

<19>
Accession Number
621531233
Title
Outcome reporting for surgical treatment of degenerative mitral valve
disease: A systematic review and critical appraisal.
Source
Interactive Cardiovascular and Thoracic Surgery. 26 (4) (pp 566-572),
2018. Date of Publication: 01 Apr 2018.
Author
Tomsic A.; Arabkhani B.; Schoones J.W.; Van Brakel T.J.; Takkenberg
J.J.M.; Palmen M.; Klautz R.J.M.
Institution
(Tomsic, Arabkhani, Van Brakel, Palmen, Klautz) Department of
Cardiothoracic Surgery, Leiden University Medical Center, PO Box 9600,
Leiden 2300, Netherlands
(Schoones) Walaeus Library, Leiden University Medical Centre, Leiden,
Netherlands
(Takkenberg) Department of Cardiothoracic Surgery, Erasmus University
Medical Center, Rotterdam, Netherlands
Publisher
Oxford University Press
Abstract
OBJECTIVES: Standardized outcome reporting is of critical importance for
performance monitoring, improvement of existing techniques and
introduction of novel technologies. Whether outcome reporting for surgical
treatment of degenerative mitral valve disease complies with the
guidelines has not been assessed to date. METHOD(S): A systematic
review of PubMed, EMBASE, Web of Science and the Cochrane Library was
conducted for articles published between 1 January 2009 and 7 March 2016.
Inclusion criteria were adult patient population (n >- 200) and surgical
intervention for degenerative mitral valve disease. The quality of
reported outcome was compared with the standard recommended by the
guidelines on reporting morbidity and mortality after cardiac valve
interventions. RESULT(S): Forty-two non-randomized clinical studies
were included: 4 provided early and 38 provided early and late outcome
data. Early echocardiographic outcome was reported in 49% of studies.
Freedom from reintervention, the indication for reintervention and the
follow-up echocardiographic outcome were reported in 97%, 59% and 79% of
studies providing late outcome data, respectively. The KaplanMeier method
was used to assess the freedom from recurrent mitral regurgitation in 60%
(18/30) of studies, whereas 7% (2/30) of studies applied a longitudinal
data analysis. Recurrent mitral regurgitation was most commonly defined as
moderate (Grade 2+; 60%) or severe (Grade 4+; 37%) regurgitation.
 CONCLUSION(S): There is a significant discordance between the
guidelines-based recommendations and actual reporting of outcome for
surgical treatment of degenerative mitral valve disease. Better adherence
to the guidelines would raise the quality and generalizability of clinical
data reporting. Copyright © The Author(s) 2018. Published by
Oxford University Press on behalf of the European Association for
Cardio-Thoracic Surgery. All rights reserved.

<20>
Accession Number
625122037
Title
Preventing Postoperative Delirium After Major Noncardiac Thoracic
Surgery-A Randomized Clinical Trial.
Source
Journal of the American Geriatrics Society. 66 (12) (pp 2289-2297), 2018.
Date of Publication: December 2018.
Author
Khan B.A.; Perkins A.J.; Campbell N.L.; Gao S.; Khan S.H.; Wang S.;
Fuchita M.; Weber D.J.; Zarzaur B.L.; Boustani M.A.; Kesler K.
Institution
(Khan, Khan, Fuchita, Boustani) Department of Medicine, School of
Medicine, Indiana University, Indianapolis, IN, United States
(Khan, Campbell, Boustani) Department of Medicine, Center for Aging
Research, Indiana University, Indianapolis, IN, United States
(Khan, Campbell, Boustani) Department of Medicine, Regenstrief Institute,
Inc., Indianapolis, IN, United States
(Khan, Campbell, Boustani) Department of Medicine, Center for Health
Innovation and Implementation Science, Indiana Clinical and Translational
Sciences Institute, Indiana University, Indianapolis, IN, United States
(Perkins, Gao) Department of Statistics, School of Medicine, Indiana
University, Indianapolis, IN, United States
(Campbell) Eskenazi Health, Indianapolis, IN, United States
(Campbell) Department of Pharmacy Practice, College of Pharmacy, Purdue
University, West Lafayette, IN, United States
(Wang) Department of Psychiatry, School of Medicine, Indiana University,
Indianapolis, IN, United States
(Weber) Department of Surgery, University of California, San Francisco,
San Francisco, CA, United States
(Zarzaur, Kesler) Department of Surgery, School of Medicine, Indiana
University, Indianapolis, IN, United States
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Objectives: To assess the efficacy of haloperidol in reducing
postoperative delirium in individuals undergoing thoracic surgery.
 Design(s): Randomized double-blind placebo-controlled trial.
 Setting(s): Surgical intensive care unit (ICU) of tertiary care
center. Participant(s): Individuals undergoing thoracic surgery
(N=135). Intervention(s): Low-dose intravenous haloperidol (0.5 mg
three times daily for a total of 11 doses) administered postoperatively.
Measurements: The primary outcome was delirium incidence during
hospitalization. Secondary outcomes were time to delirium, delirium
duration, delirium severity, and ICU and hospital length of stay. Delirium
was assessed using the Confusion Assessment Method for the ICU and
delirium severity using the Delirium Rating Scale-Revised. Result(s):
Sixty-eight participants were randomized to receive haloperidol and 67
placebo. No significant differences were observed between those receiving
haloperidol and those receiving placebo in incident delirium (n=15 (22.1%)
vs n=19 (28.4%); p =.43), time to delirium (p =.43), delirium duration
(median 1 day, interquartile range (IQR) 1-2 days vs median 1 day, IQR 1-2
days; p =.71), delirium severity, ICU length of stay (median 2.2 days, IQR
1-3.3 days vs median 2.3 days, IQR 1-4 days; p =.29), or hospital length
of stay (median 10 days, IQR 8-11.5 days vs median 10 days, IQR 8-12 days;
p =.41). In the esophagectomy subgroup (n = 84), the haloperidol group was
less likely to experience incident delirium (n=10 (23.8%) vs n=17 (40.5%);
p =.16). There were no differences in time to delirium (p =.14), delirium
duration (median 1 day, IQR 1-2 days vs median 1 day, IQR 1-2 days; p
=.71), delirium severity, or hospital length of stay (median 11 days, IQR
10-12 days vs median days 11, IQR 10-15 days; p =.26). ICU length of stay
was significantly shorter in the haloperidol group (median 2.8 days, IQR
1.1-3.8 days vs median 3.1 days, IQR 2.1-5.1 days; p =.03). Safety events
were comparable between the groups. Conclusion(s): Low-dose
postoperative haloperidol did not reduce delirium in individuals
undergoing thoracic surgery but may be efficacious in those undergoing
esophagectomy. J Am Geriatr Soc 66:2289-2297, 2018. © 2018,
Copyright the Authors Journal compilation © 2018, The American
Geriatrics Society

<21>
Accession Number
625044093
Title
Impact of dexmedetomidine infusion during general anaesthesia on incidence
of postoperative delirium in elderly patients after major non-cardiac
surgery: Study protocol of a randomised, double-blinded and
placebo-controlled trial.
Source
BMJ Open. 8 (4) (no pagination), 2018. Article Number: e019549. Date of
Publication: 01 Apr 2018.
Author
Wang B.-J.; Li C.-J.; Hu J.; Li H.-J.; Guo C.; Wang Z.-H.; Zhang Q.-C.; Mu
D.-L.; Wang D.-X.
Institution
(Wang, Li, Hu, Li, Guo, Zhang, Mu, Wang) Department of Anesthesiology and
Critical Care Medicine, Peking University First Hospital, Beijing, China
(Wang) Department of Anesthesiology, Dongping People's Hospital, Dongping,
China
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Introduction: Delirium is a common complication in the elderly after
surgery and is associated with worse outcomes. Multiple risk factors are
related with postoperative delirium, such as exposure to general
anaesthetics, pain and postoperative inflammatory response. Preclinical
and clinical studies have shown that dexmedetomidine attenuated
neurotoxicity induced by general anaesthetics, improved postoperative
analgesia and inhibited inflammatory response after surgery. Several
studies found that intraoperative use of dexmedetomidine can prevent
postoperative delirium, but data were inconsistent. This study was
designed to investigate the impact of dexmedetomidine administered during
general anaesthesia in preventing delirium in the elderly after major
non-cardiac surgery. Methods and analysis: This is a randomised,
double-blinded and placebo-controlled trial. 620 elderly patients (age
>=60 years) who are scheduled to undertake elective major non-cardiac
surgery (with an expected duration >=2 hours) are randomly divided into
two groups. For patients in the dexmedetomidine group, a loading dose
dexmedetomidine (0.6 mug/kg) will be administered 10 min before
anaesthesia induction, followed by a continuous infusion at a rate of 0.5
mug/kg/hour until 1 hour before the end of surgery. For patients in the
control group, normal saline will be administered with an identical rate
as in the dexmedetomidine group. The primary endpoint is the incidence of
delirium during the first five postoperative days. The secondary endpoints
include pain intensity, cumulative opioid consumption and subjective sleep
quality during the first three postoperative days, as well as the
incidence of non-delirium complications and all-cause mortality within 30
days after surgery. Ethics and dissemination: The study protocol was
approved by the Clinical Research Ethics Committee of Peking University
First Hospital (2015-987) and registered at Chinese Clinical Trial
Registry (http://www.chictr.org.cn) with identifier ChiCTR-IPR-15007654.
The results of the study will be presented at academic conferences and
submitted to peer-reviewed journals. Copyright © 2018 Article
author(s).

<22>
Accession Number
2001108334
Title
Remote ischaemic conditioning for prevention of acute kidney injury after
valvular heart surgery: a randomised controlled trial.
Source
British Journal of Anaesthesia. 121 (5) (pp 1034-1040), 2018. Date of
Publication: November 2018.
Author
Song J.W.; Lee W.K.; Lee S.; Shim J.K.; Kim H.J.; Kwak Y.L.
Institution
(Song, Lee, Shim, Kim, Kwak) Department of Anaesthesiology and Pain
Medicine, Yonsei University College of Medicine, Seoul, South Korea
(Song, Shim, Kwak) Anaesthesia and Pain Research Institute, Yonsei
University College of Medicine, Seoul, South Korea
(Lee) Department of Cardiovascular Surgery, Yonsei University College of
Medicine, Seoul, South Korea
Publisher
Elsevier Ltd
Abstract
Background: Repeated remote ischaemic conditioning (RIC) during weaning
from cardiopulmonary bypass and in the early postoperative period may
confer protection against acute kidney injury (AKI). We evaluated the
effect of repeated RIC on the incidence of AKI in patients undergoing
valvular heart surgery. Method(s): Patients were randomised into
either the RIC (n=120) or control (n=124) group. A pneumatic tourniquet
was placed on each patient's thigh. Upon removal of the aortic
cross-clamp, three cycles of inflation for 5 min at 250 mm Hg (with 5 min
intervals) were applied in the RIC group. Additionally, three cycles of
RIC were repeated at postoperative 12 and 24 h. AKI was diagnosed based on
the Kidney Disease: Improving Global Outcomes guideline. The incidences of
renal replacement therapy, permanent stroke, sternal wound infection,
newly developed atrial fibrillation, mechanical ventilation >24 h, and
reoperation for bleeding during hospitalisation were recorded.
 Result(s): The incidences of AKI were not significantly different
between the control (19.4%) and RIC (15.8%) groups (a difference of 3.5
percentage points; 95% confidence interval: -6.8%-13.9%; P=0.470).
Perioperative serum creatinine concentrations were similar in the control
and RIC groups (P=0.494). Fluid balance, urine output, blood loss,
transfusion, and vasopressor/inotropic requirements were not significantly
different between the groups (all P>0.05). The occurrences of a composite
of morbidity and mortality endpoints were not significantly different
between the control (46.0%) and RIC (39.2%) groups (a difference of 6.8
percentage points; 95% confidence interval: -6.4%-20.0%; P=0.283).
 Conclusion(s): The results of our study do not support repeated RIC
to decrease the incidence of AKI after valvular heart surgery. Clinical
trial registration: NCT02720549. Copyright © 2018 British Journal
of Anaesthesia

<23>
Accession Number
622056132
Title
Is MRI equivalent to CT in the guidance of TAVR? A pilot study.
Source
European Radiology. 28 (11) (pp 4625-4634), 2018. Date of Publication: 01
Nov 2018.
Author
Mayr A.; Klug G.; Reinstadler S.J.; Feistritzer H.-J.; Reindl M.; Kremser
C.; Kranewitter C.; Bonaros N.; Friedrich G.; Feuchtner G.; Metzler B.
Institution
(Mayr, Kremser, Kranewitter, Feuchtner) University Clinic of Radiology,
Medical University of Innsbruck, Anichstrase 35, Innsbruck A-6020, Austria
(Klug, Reinstadler, Feistritzer, Reindl, Friedrich, Metzler) University
Clinic of Internal Medicine III, Cardiology and Angiology, Medical
University of Innsbruck, Anichstrase 35, Innsbruck A-6020, Austria
(Bonaros) University Clinic of Cardiac Surgery, Medical University of
Innsbruck, Anichstrase 35, Innsbruck A-6020, Austria
Publisher
Springer Verlag (E-mail: service@springer.de)
Abstract
Objectives: To compare a comprehensive cardiovascular magnetic resonance
imaging (MRI) protocol with contrast-enhanced computed tomography
angiography (CTA) for guidance in transcatheter aortic valve replacement
(TAVR) evaluation. Methods and Results: Non-contrast
three-dimensional (3D) 'whole heart' MRI imaging for aortic annulus sizing
and measurements of coronary ostia heights, contrast-enhanced MRI
angiography (MRA) for evaluation of transfemoral routes as well as
aortoiliofemoral-CTA were performed in 16 patients referred for evaluation
of TAVR. Aortic annulus measurements by MRI and CTA showed a very strong
correlation (r=0.956, p<0.0001; effective annulus area for MRI 430+/-74
vs. 428+/-78 mm2 for CTA, p=0.629). Regarding decision for
valve size there was complete consistency between MRI and CTA. Moreover,
vessel luminal diameters and angulations of aortoiliofemoral access as
measured by MRA and CTA showed overall very strong correlations (r= 0.819
to 0.996, all p<0.001), the agreement of minimal vessel diameter between
the two modalities revealed a bias of 0.02 mm (upper and lower limit of
agreement: 1.02 mm and -0.98 mm). Conclusion(s): In patients referred
for TAVR, MRI measurements of aortic annulus and minimal aortoiliofemoral
diameters showed good to excellent agreement. Decisions based on MRI
measurements regrading prosthesis sizing and transfemoral access would not
have modified TAVR-strategy as compared to a CTA-based choice. Key Points:
* 'Whole heart' MRI and CTA measurements of aortic annulus correlate very
strongly. * MRI- and CTA-based prostheses sizing are in excellent
agreement. * MRA and CTA equally guide TAVR access strategy. Copyright
© 2018, European Society of Radiology.

<24>
Accession Number
625958818
Title
In HF with secondary mitral regurgitation, transcatheter mitral valve
repair reduced HF hospitalizations at 2 years.
Source
Annals of Internal Medicine. 170 (2) (pp JC7-JC8), 2019. Date of
Publication: 15 Jan 2019.
Author
Donato A.; Elgin E.
Institution
(Donato, Elgin) Tower Health System, West Reading, PA, United States
Publisher
American College of Physicians (190 N. Indenpence Mall West, Philadelphia
PA 19106-1572, United States)

<25>
Accession Number
625958779
Title
A wearable cardioverter-defibrillator did not reduce arrhythmic death in
MI with reduced ejection fraction.
Source
Annals of Internal Medicine. 170 (2) (pp JC5), 2019. Date of Publication:
15 Jan 2019.
Author
Sullivan K.; Van Spall H.G.C.
Institution
(Sullivan, Van Spall) McMaster University, Hamilton, ON, Canada
Publisher
American College of Physicians (190 N. Indenpence Mall West, Philadelphia
PA 19106-1572, United States)

<26>
Accession Number
625955291
Title
Cell therapy and left ventricular restoration for ischemic cardiomyopathy:
Long-term results of a perspective, randomized study.
Source
Minerva Cardioangiologica. 67 (1) (pp 64-72), 2019. Date of Publication:
February 2019.
Author
Stefanelli G.; Pirro F.; Olaru A.; Giovanardi P.; Meli M.; Concari M.;
Weltert P.L.
Institution
(Stefanelli, Pirro, Olaru, Meli, Concari) Department of Cardiac Surgery,
Hesperia Hospital, via Arqua 80, Modena, Italy
(Giovanardi) Department of Cardiology, University Hospital, Modena, Italy
(Weltert) Department of Cardiac Surgery, European Hospital, Rome, Italy
Publisher
Edizioni Minerva Medica (E-mail: subscriptions.dept@minervamedica.it)
Abstract
BACKGROUND: Aim of this study is to verify the potential advantages and
benefits of bone-marrow derived autologous stem cells implantation
associated to surgical left ventricular restoration (SVR), to report a new
modality of cell delivery to myocardium, and to identify possible side
effects of this procedure. METHOD(S): Between March 2007 and March
2013, 30 patients affected by ischemic dilative cardiomyopathy who
received a SVR operation were enrolled in the study. The population was
divided in two groups:16 patients were randomly assigned to receive stem
cells therapy in addition to SVR (groupA), 14 patients received a placebo
(group B). The two groups were homogeneous in respect of age, gender,
preoperative NYHA class, mitral incompetence and left ventricular sizes
and volumes. The patients were evaluated by echo and pet-scan before
surgery and at 6 months follow-up, and by echo at subsequent follow-up.
 RESULT(S): Overall 30 days-in hospital mortality was 0 for the entire
cohort. At last follow-up ejection fraction increased from 25.3% before
surgery to 36.3% in group A, and from 31.8% to 45.6% in group B. Reduction
of LVEDD was 6% in group A, 9% in group B. ESLVV and EDLVD decreased more
significantly in patients receiving stem cells (55% vs. 35%). Late cardiac
mortality at 9 years follow-up was similar in the two groups of patients.
No early or late adverse reaction nor cases of infections were observed.
 CONCLUSION(S): Patients affected by ischemic cardiomyopathy have a
favourable outcome after SVR. Ahigher reduction of LVEDV and LVESV
assessed by CT-Scan evaluation in patients receiving cell therapy, when
compared to control group, encourages the evolution and refinement of
myocardial regenerative therapy added to SVR. Copyright © 2018
EDIZIONIMINERVAMEDICA.

<27>
Accession Number
625936803
Title
Different suturing techniques in thoracic incision: Protocol for a
feasibility randomised controlled trial.
Source
BMJ Open. 9 (1) (no pagination), 2019. Article Number: e021645. Date of
Publication: 01 Jan 2019.
Author
Liu Z.; Liu X.; He L.; Yu X.; Wang L.; Wang R.; He Y.; Hao X.; Tang Z.; Su
Y.; Shu M.
Institution
(Liu, Liu, He, Yu, Wang, Wang, He, Hao, Tang, Shu) Department of
Aesthetic, Plastic and Maxillofacial Surgery, First Affiliated Hospital of
Xi'an Jiaotong University, Xi'an, Shaanxi, China
(Liu, Su) Department of Plastic Surgery, Xijing Hospital, Fourth Military
Medical University, Xi'an, Shaanxi, China
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Introduction: Based on the principles of the ideal skin closure technique,
we previously described a suture technique (wedge-shaped excision and
modified buried vertical mattress suture (WE-MBVMS)) that could provide
excellent outcomes for the most demanding surfaces. However, adequate
clinical comparative evidence supporting improved outcomes is lacking.
Thus, the purpose of this protocol is to establish the feasibility of
conducting a fully randomised controlled trial (RCT) comparing the
clinical effectiveness of WE-MBVMS with a buried intradermal suture (BIS)
in closing thoracic incision. Methods and analysis: This study is a
feasibility RCT of WE-MBVMS and BIS in patients undergoing surgery for
costal cartilage harvesting. Seventy-eight participants are expected to
participate in the study and will be randomised in a ratio of 1:1 to
WE-MBVMS or BIS. Trial feasibility will be assessed by the number of
participants assessed for eligibility, recruitment rates, reasons for
ineligibility or non-participation, time for interventions, withdrawal and
retention at all follow-up points (3, 6 and 12 months), follow-up rates
and reasons for withdrawing from the trial. In addition, clinical data
regarding the cosmetic results of scars will be collected to inform the
sample size for a fully powered RCT. Ethics and dissemination: This study
has been approved by The First Affiliated Hospital of Xi'an Jiaotong
University Institutional Review Board (XJTU1AF2017LSK-120). The findings
will be published in peer-reviewed journals. Copyright © 2019
Author(s).

<28>
[Use Link to view the full text]
Accession Number
621798694
Title
Complete revascularization for patients with ST-segment elevation
myocardial infarction and multivessel coronary artery disease: A
meta-analysis of randomized trials.
Source
Coronary Artery Disease. 29 (3) (pp 204-215), 2018. Date of Publication:
2018.
Author
Bajraktari G.; Jashari H.; Ibrahimi P.; Alfonso F.; Jashari F.; Ndrepepa
G.; Elezic S.; Heneina M.Y.
Institution
(Bajraktari, Jashari, Ibrahimi, Jashari, Elezic, Heneina) Department of
Public Health and Clinical Medicine, Umea University, Umea, Sweden
(Bajraktari, Jashari, Ibrahimi) Clinic of Cardiology, University Clinical
Centre of Kosova, Serbia
(Bajraktari, Jashari) Department of Internal Medicine, Medical Faculty,
University of Prishtina, Prishtina, Kosovo, Serbia
(Alfonso) Cardiac Department, La Princesa University Hospital, Institute
of Health Research, IIS-IP, University Autonoma of Madrid, Madrid, Spain
(Ndrepepa) Department of Adult Cardiology, German Heart Centre Munich,
Technical University of Munich, Munich, Germany
(Heneina) St George University, London, United Kingdom
Publisher
Lippincott Williams and Wilkins (E-mail: agents@lww.com)
Abstract
Introduction Despite the recent findings in randomized clinical trials
(RCTs) with limited sample sizes and the updates in clinical guidelines,
the current available data for the complete revascularization (CR) in
hemodynamically stable patients with ST-segment elevation myocardial
infarction (STEMI) at the time of primary percutaneous coronary
intervention (PCI) are still contradictory. Aim The aim of this
meta-analysis of the existing RCTs was to assess the efficacy of the CR
versus revascularization of infarct-related artery (IRA) only during
primary PCI in patients with STEMI and multivessel disease (MVD). Patients
and methods We searched PubMed, MEDLINE, Embase, Scopus, Google Scholar,
Cochrane Central Register of Controlled Trials (CENTRAL), and
ClinicalTrials. gov databases aiming to find RCTs for patients with STEMI
and MVD which compared CR with IRA-only. Random effect risk ratios (RRs)
were calculated for efficacy and safety outcomes. Results Ten RCTs with
3291 patients were included. The median follow-up duration was 17.5
months. Major adverse cardiac events (RR=0.57; 0.43-0.76; P<0.0001),
cardiac mortality (RR=0.52; 0.31-0.87; P=0.014), and repeat
revascularization (RR=0.50; 0.30-0.84; P=0.009) were lower in CR compared
with IRA-only strategies. However, there was no significant difference in
the risk of all-cause mortality, recurrent nonfatal myocardial infarction,
stroke, major bleeding events, and contrast-induced nephropathy.
Conclusion For patients with STEMI and MVD undergoing primary PCI, the
current evidence suggests that the risk of major adverse cardiac events,
repeat revascularization, and cardiac death is reduced by CR. However, the
risk for all-cause mortality and PCI-related complications is not
different from the isolated culprit lesion-only treatment. Although these
findings support the cardiac mortality and safety benefit of CR in stable
STEMI, further large trials are required to provide better guidance for
optimum management of such patients. Copyright © 2018 Wolters
Kluwer Health, Inc.

<29>
[Use Link to view the full text]
Accession Number
621798692
Title
A comparison of intracoronary treatment strategies for thrombus burden
removal during primary percutaneous coronary intervention: A COCTAIL II
substudy.
Source
Coronary Artery Disease. 29 (3) (pp 186-193), 2018. Date of Publication:
2018.
Author
Gatto L.; Di Landro A.; Romagnoli E.; Marco V.; Russo C.; Pawlowski T.;
Versaci F.; Limbruno U.; Castriota F.; Di Vito L.; Trivisonno A.; Prati F.
Institution
(Gatto, Romagnoli, Prati) Interventional Cardiology, San Giovanni
Addolorata Hospital, Via dell'Amba Aradam, 8, Rome 00184, Italy
(Gatto, Di Landro, Romagnoli, Marco, Russo, Di Vito, Prati) Centro per la
Lotta Contro L'Infarto, CLI Foundation, Rome, Italy
(Versaci) S. Maria Goretti Hospital, Latina, Italy
(Limbruno) Misericordia Hospital, Grosseto, Italy
(Castriota) Maria Cecilia Hospital, GVM Care and Research, Ettore
Sansavini Health Science Foundation, Cotignola, Italy
(Trivisonno) Ospedale A. Cardarelli, Campobasso, Italy
(Pawlowski) Central Clinical Hospital, Ministry of Interior, Warsaw,
Poland
Publisher
Lippincott Williams and Wilkins (E-mail: agents@lww.com)
Abstract
Background Manual thrombus aspiration and local drug delivery of abciximab
have been proposed as a strategy to reduce thrombus burden during
percutaneous coronary intervention in patients with ST elevation
myocardial infarction; however, the effectiveness of these approaches, is
uncertain. In this COCTAIL II substudy, we compared the effect of these
strategies on prestenting and poststenting thrombus burden assessed by
optical coherence tomography. Patients and methods COCTAIL II trial
enrolled patients with ST elevation myocardial infarction randomized to
intralesion (IL, by the ClearWay catheter) versus intracoronary (IC, by
the guide catheter) abciximab bolus with or without aspiration
thrombectomy (AT). The following parameters were used to quantify
atherothrombotic burden: thrombus volume (TVol), maximum thrombus area
(TA), and thrombus burden (TB). Primary endpoint was the comparison of
prestenting TVol after the use of local drug delivery (group IL+IL
abciximab plus AT) versus nonlocal drug delivery (group IC abciximab plus
AT+IC). Results The final population consisted of 59 patients undergoing
both prestenting and poststenting optical coherence tomography assessment.
The amount of thrombus was not significantly different in the groups with
local drug delivery of abciximab versus nonlocal drug delivery in both
prestenting (TVol: 18.87+/- 26.70 vs. 19.02 +/-18.45; TB: 26.73 +/-12.8
vs. 25.18 +/-13.25; and maximum TA: 59.25 +/- 18.84 vs. 53.34 +/- 19.30)
and poststenting (TVol: 8.46+/- 9.15 vs. 8.05 +/- 6.81; TB: 6.68 +/-3.54
vs. 6.24+/- 3.66; and maximum TA: 15.47 +/-7.61 vs. 16.52 +/-11.55)
evaluations. A good correlation between thrombus measurements after
thrombus removal techniques and intrastent thrombus was observed.
Conclusion Either local drug delivery of abciximab or manual thrombus
aspiration showed comparable results in terms of prestenting and
poststenting thrombus burden removal. Copyright © 2018 Wolters
Kluwer Health, Inc.

<30>
Accession Number
623653093
Title
Adverse side effects of dexamethasone in surgical patients.
Source
Cochrane Database of Systematic Reviews. 2018 (8) (no pagination), 2018.
Article Number: CD011940. Date of Publication: 28 Aug 2018.
Author
Polderman J.A.W.; Farhang-Razi V.; Van Dieren S.; Kranke P.; Devries J.H.;
Hollmann M.W.; Preckel B.; Hermanides J.
Institution
(Polderman, Farhang-Razi, Van Dieren, Hollmann, Preckel, Hermanides)
Academic Medical Center (AMC) University of Amsterdam, Department of
Anaesthesiology, Meibergdreef 9, Amsterdam 1105 AZ, Netherlands
(Kranke) University of Wurzburg, Department of Anaesthesia and Critical
Care, Oberdurrbacher Str. 6, Wurzburg 97080, Germany
(Devries) Academic Medical Centre, Department of Internal Medicine, PO Box
22700, Amsterdam 1100 DE, Netherlands
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom. E-mail: vgorayska@wiley.com)
Abstract
Background: In the perioperative period, dexamethasone is widely and
effectively used for prophylaxis of postoperative nausea and vomiting
(PONV), for pain management, and to facilitate early discharge after
ambulatory surgery. Long-term treatment with steroids has many side
effects, such as adrenal insufficiency, increased infection risk,
hyperglycaemia, high blood pressure, osteoporosis, and development of
diabetes mellitus. However, whether a single steroid load during surgery
has negative effects during the postoperative period has not yet been
studied. Objective(s): To assess the effects of a steroid load of
dexamethasone on postoperative systemic or wound infection, delayed wound
healing, and blood glucose change in adult surgical patients (with planned
subgroup analysis of patients with and without diabetes). Search
Method(s): We searched MEDLINE, Embase, the Cochrane Central Register of
Controlled Trials (CENTRAL), in the Cochrane Library, and the Web of
Science for relevant articles on 29 January 2018. We searched without
language or date restriction two clinical trial registries to identify
ongoing studies, and we handsearched the reference lists of relevant
publications to identify all eligible trials. Selection Criteria: We
searched for randomized controlled trials comparing an incidental steroid
load of dexamethasone versus a control intervention for adult patients
undergoing surgery. We required that studies include a follow-up of 30
days for proper assessment of the number of postoperative infections,
delayed wound healing, and the glycaemic response. Data Collection
and Analysis: Two review authors independently screened studies for
eligibility, extracted data from relevant studies, and assessed all
included studies for bias. We resolved differences by discussion and
pooled included studies in a meta-analysis. We calculated Peto odds ratios
(ORs) for dichotomous outcomes and mean differences (MDs) for continuous
outcomes. Our primary outcomes were postoperative systemic or wound
infection, delayed wound healing, and glycaemic response within 24 hours.
We created a funnel plot for the primary outcome postoperative (wound or
systemic) infection. We used GRADE to assess the quality of evidence for
each outcome. Main Result(s): We included in the meta-analysis 38
studies that included adults undergoing a large variety of surgical
procedures (i.e. abdominal surgery, cardiac surgery, neurosurgery, and
orthopaedic surgery). Age range of participants was 18 to 80 years. There
is probably little or no difference in the risk of postoperative (wound or
systemic) infection with dexamethasone compared with no treatment,
placebo, or active control (ramosetron, ondansetron, or tropisetron) (Peto
OR 1.01, 95% confidence interval (CI) 0.80 to 1.27; 4931 participants, 27
studies; I2 = 27%; moderate-quality evidence). The effects of
dexamethasone on delayed wound healing are unclear because the wide
confidence interval includes both meaningful benefit and harm (Peto OR
0.99, 95% CI 0.28 to 3.43; 1072 participants, eight studies; I2 = 0%;
low-quality evidence). Dexamethasone may produce a mild increase in
glucose levels among participants without diabetes during the first 12
hours after surgery (MD 13 mg/dL, 95% CI 6 to 21; 10 studies; 595
participants; I2 = 50%; low-quality evidence). We identified two studies
reporting on glycaemic response after dexamethasone in participants with
diabetes within 24 hours after surgery (MD 32 mg/dL, 95% CI 15 to 49; 74
participants; I2 = 0%; very low-quality evidence). Authors' conclusions: A
single dose of dexamethasone probably does not increase the risk for
postoperative infection. It is uncertain whether dexamethasone has an
effect on delayed wound healing in the general surgical population owing
to imprecision in trial results. Participants with increased risk for
delayed wound healing (e.g. participants with diabetes, those taking
immunosuppressive drugs) were not included in the randomized studies
reporting on delayed wound healing included in this meta-analysis;
therefore our findings should be extrapolated to the clinical setting with
caution. Furthermore, one has to keep in mind that dexamethasone induces a
mild increase in glucose. For patients with diabetes, very limited
evidence suggests a more pronounced increase in glucose. Whether this
influences wound healing in a clinically relevant way remains to be
established. Once assessed, the three studies awaiting classification and
two that are ongoing may alter the conclusions of this
review. Copyright © 2018 The Cochrane Collaboration.

<31>
Accession Number
625728440
Title
Vasopressin therapy in cardiac surgery.
Source
Journal of Cardiac Surgery. 34 (1) (pp 20-27), 2019. Date of Publication:
January 2019.
Author
Kunkes J.H.; Baker W.L.; Hammond J.A.; Gluck J.
Institution
(Kunkes, Hammond, Gluck) Hartford Hospital, Hartford, CT, United States
(Kunkes, Hammond, Gluck) University of Connecticut School of Medicine,
Farmington, CT, United States
(Baker) University of Connecticut School of Pharmacy, Storrs, CT, United
States
(Hammond, Gluck) Heart and Vascular Institute, Hartford Healthcare,
Hartford, CT, United States
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Background: Arginine vasopressin (AVP) is a naturally occurring peptide
with diverse effects mediated through selective V1 and V2 receptors. About
10% of patients undergoing cardiopulmonary bypass develop postoperative
vasodilatory shock requiring high-dose catecholamines. We sought to
examine the role of AVP therapy in cardiac surgery. Method(s): A
search of Medline was conducted through September 2018 using key words and
medical subject headings (MeSH) relating to AVP, copeptin, and cardiac
surgery. A systematic review was performed on articles as they pertained
to AVP for use as a vasopressor after cardiovascular surgery complicated
by vasodilatory shock. Result(s): A relative or absolute deficiency
of Arginine vasopressin is associated with vasodilatory shock after
cardiopulmonary bypass. Physiologic replacement with exogenous Arginine
vasopressin results in significant increases in systemic vascular
resistance and mean arterial pressure with decreased requirements of
catecholamines. At doses of <0.1 U/min Arginine vasopressin is safe with
very few adverse effects. Conclusion(s): Post-cardiopulmonary bypass
vasodilatory shock is largely due to a relative deficiency of Arginine
vasopressin. Exogenous administration of low-dose Arginine vasopressin
alone or in combination with traditional catecholamines is a safe and
effective way to manage this type of vasodilatory shock. Copyright
© 2018 Wiley Periodicals, Inc.

<32>
Accession Number
2000856302
Title
Comprehensive Echocardiographic Assessment of Normal Transcatheter Valve
Function.
Source
JACC: Cardiovascular Imaging. 12 (1) (pp 25-34), 2019. Date of
Publication: January 2019.
Author
Hahn R.T.; Leipsic J.; Douglas P.S.; Jaber W.A.; Weissman N.J.; Pibarot
P.; Blanke P.; Oh J.K.
Institution
(Hahn) Columbia University Medical Center/New York-Presbyterian Hospital,
New York, NY, United States
(Leipsic, Blanke) University of British Columbia and St. Paul's Hospital,
Vancouver, Canada
(Douglas) Division of Cardiovascular Medicine, Duke University Medical
Center, Duke Clinical Research Institute, Durham, NC, United States
(Jaber) Cleveland Clinic Foundation, Cleveland, OH, United States
(Weissman) Medstar Health Research Institute, Washington, DC, United
States
(Pibarot) Institut Universitaire de Cardiologie et de Pneumologie de
Quebec/Quebec Heart & Lung Institute, Department of Medicine, Laval
University, Quebec, Canada
(Oh) Mayo Clinic, Rochester, MN, United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives: This study aims to establish parameters for identifying normal
function for each of the 3 iterations of balloon-expandable valves and 2
iterations of self-expanding valves. Background(s): Expected
transthoracic echocardiographic Doppler-derived hemodynamic data for
transcatheter aortic valves inform pre-implant decision-making and
post-implanted monitoring of longitudinal valve function. Method(s):
We collected the echocardiography core Lab measured mean gradients and
effective orifice area (EOA) from discharge or 30-day echocardiograms from
randomized trials; the PARTNER (Placement of Aortic Transcatheter Valves)
trials for the balloon-expandable valves and the Medtronic CoreValve US
Pivotal trial and Medtronic CoreValve Evolut R United States IDE Clinical
Study for the self-expanding valves. Result(s): For all SAPIEN
(Edwards Lifesciences, Irvine, California) valve sizes, mean EOA is 1.70
+/- 0.49 cm2 with a mean gradient of 9.36 +/- 4.13 mm Hg. For
all SAPIEN XT valve sizes, mean EOA is 1.67 +/- 0.46 cm2 with a
mean gradient of 9.52 +/- 3.64 mm Hg. For all SAPIEN 3 valve sizes, the
mean EOA is 1.66 +/- 0.38 cm2 with a mean gradient of 11.18 +/-
4.35 mm Hg. For all CoreValve valve sizes, the mean EOA is 1.88 +/- 0.56
cm2 with a mean gradient of 8.85 +/- 4.14 mm Hg. For all Evolut
R valve sizes, the mean EOA is 2.01 +/- 0.65 cm2 with a mean
gradient of 7.52 +/- 3.19 mm Hg. The SAPIEN 3 post-implant EOA was
progressively larger for each quintile of baseline annular area by
computed tomography (p < 0.001). Similarly, for the Evolut R valve,
post-implantation EOA was significantly larger for each quintile of
baseline annular perimeter (p < 0.001). Conclusion(s): Tables of
expected mean transcatheter aortic valve hemodynamics by valve type and
size are essential in evaluating the function of these transcatheter
prosthetic valves. Tables of expected EOA by the native annular anatomy
may be useful for pre-implantation decision making. Criteria for defining
structural valve dysfunction are proposed. Copyright © 2019
American College of Cardiology Foundation

<33>
Accession Number
624424788
Title
A prospective study of patients' pain intensity after cardiac surgery and
a qualitative review: Effects of examiners' gender on patient reporting.
Source
Scandinavian Journal of Pain. 19 (1) (pp 39-51), 2019. Date of
Publication: 01 Jan 2019.
Author
Meyer-Friessem C.H.; Szalaty P.; Zahn P.K.; Pogatzki-Zahn E.M.
Institution
(Meyer-Friesem, Szalaty, Zahn) Department of Anaesthesiology, Intensive
Care Medicine Palliative Care and Pain Medicine, Medical Faculty of
Ruhr-University, Burkle-de-la-Camp-Platz 1, Bochum 44789, Germany
(Meyer-Friesem) Agaplesion Bethesda Krankenhaus Wuppertal GGmbH,
Department of Anaesthesiology and Intensive Care Medicine, Hainstr. 35,
Wuppertal, Germany
(Pogatzki-Zahn) Department of Anaesthesiology, Intensive Care and Pain
Medicine, University Hospital of Muenster, Munster, Germany
Publisher
De Gruyter (E-mail: peter.golla@degruyter.com)
Abstract
As indicated by experimental studies, reports of pain intensity may depend
on the examiner's gender. Until now, it is unclear whether this is
relevant in clinical routine. This study investigated prospectively
whether the gender of assessor plays a role in patients' pain reports and
whether this role differs in male and female patients. 165 patients (66.4
years+/-0.63; 118 males) scheduled for heart surgery were allocated
consecutively to one examiner out of four students of both genders: two
females and two males (aged 24.3 years+/-1.7). Therefore, the following
study groups were defined: Group 1: female assessors-female patients, 2:
female-male; 3: male-female, 4: male-male. Using a standardized analgesic
scheme, patients were asked to rank their pain intensity on a numeric
rating scale (NRS: 0-10), postoperatively. Statistics: Kruskal-Wallis,
Mann-Whitney; p<0.05. Additionally, a qualitative literature review of the
databases Medline and CENTRAL was performed focusing on experimental and
clinical studies on experimenter gender bias. Due to the review, this
prospective clinical study was designed to investigate whether patients
after surgery report lower pain intensities when assessed by a female
compared to a male assessor. Summarizing all patients, pain intensity on
POD_1 was rated 4.0+/-2.4 on NRS and decreased on POD_2 to 3.0+/-2.1
[H(3)=37.941, p=0.000]. On average, pain intensity did not differ between
males and females (NRS: 3.5 vs. 3.6). Only on the second postoperative
day, more intense pain was reported in front of female assessors and less
intense pain in front of male assessors (NRS: 3.4 vs. 2.4; p=0.000). A
main effect for the four groups was seen (p=0.003): male patients reported
higher pain scores to female assessors (NRS: 3.5 vs. 2.3; p=0.000).
Together, contrary to the expectations, patients after cardiac surgery
reported a higher pain intensity in front of a female and a lower pain
intensity in front of a male assessor. In particular, female caregivers
may heighten the reported pain intensity up to 1.2 NRS-points; this bias
seems to be more relevant for male patients. Therefore, despite some
methodological weakness, our data suggest that attention should be paid to
a rather small, but somehow significant and consistent examiner gender
bias after cardiac surgery especially in male patients. Further clinical
studies are needed to show the true extent of clinical relevance and exact
mechanisms underlying these gender reporting bias. Copyright ©
2019 2018 Scandinavian Association for the Study of Pain. Published by
Walter de Gruyter GmbH, Berlin/Boston. All rights reserved.

<34>
Accession Number
626025160
Title
Effectiveness of Saphenous Vein Y-Grafts in Patients Undergoing Off-Pump
Complete Myocardial Revascularization.
Source
Medical science monitor : international medical journal of experimental
and clinical research. 25 (pp 598-604), 2019. Date of Publication: 21 Jan
2019.
Author
Yu S.; Zhang W.; Wang L.; Li Z.; Li Q.; Lv M.; Liu B.; Zhang Y.
Institution
(Yu, Wang, Zhang) Key Laboratory of Arrhythmias of the Ministry of
Education of China, East Hospital, Tongji University School of Medicine,
Shanghai, China
(Yu) Heart Health Center, East Hospital, Tongji University School of
Medicine, Shanghai, China
(Zhang) Department of Cardiothoracic Surgery, BenQ Hospital, Affiliated
Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
(Wang, Lv) Nanjing Medical University, Shanghai East Hospital of Clinical
Medical College, Nanjing, Jiangsu, China
(Li, Li) Department of Cardiothoracic Surgery, First Affiliated Hospital
with Nanjing Medical University, Nanjing Medical University, Nanjing,
Jiangsu, China
(Lv, Zhang) Department of Cardiovascular Surgery, East Hospital, Tongji
University School of Medicine, Shanghai, China
(Liu) Department of Cardiology, Shanghai Tenth People's Hospital, Tongji
University School of Medicine, Shanghai, China
Publisher
NLM (Medline)
Abstract
BACKGROUND To evaluate perioperative and mid-term outcomes of saphenous
vein Y-grafts in patients with multi-vessel coronary artery disease.
MATERIAL AND METHODS Sixty patients who underwent off-pump coronary
surgery with Y-graft between 2005 and 2016 were enrolled, including 38
patients with natural Y-graft. Sixty patients with multi-vessel lesions in
the same period were randomly selected as a control group. RESULTS A total
of 484 conduits were employed. The intraoperative variables were
insignificantly different between groups, but Y-graft group compared with
control group had more grafts (4.2+/-0.84 vs. 3.87+/-0.85) and anastomoses
(6.30+/-1.39 vs. 5.62+/-1.15). No patient died during coronary artery
bypass grafting and no episode of perioperative myocardial infarction was
found. Follow-up duration lasted from 1 to 137 (40.0+/-27.7) months. No
significant difference between Y-graft group and control group was found
in Kaplan-Meier 3-year survival rate (93.4% vs. 88.0%) or 5-year survival
rate (81.4% vs. 88.0%). CONCLUSIONS Saphenous vein Y-graft is a feasible
and safe revascularization strategy for multi-vessel coronary artery
disease patients and brings about satisfactory outcomes.

<35>
Accession Number
626013008
Title
Effects of Selenium Supplementation on Metabolic Status in Patients
Undergoing for Coronary Artery Bypass Grafting (CABG) Surgery: a
Randomized, Double-Blind, Placebo-Controlled Trial.
Source
Biological Trace Element Research. (no pagination), 2019. Date of
Publication: 2019.
Author
Kamali A.; Amirani E.; Asemi Z.
Institution
(Kamali) Department of Anesthesiology, Faculty of Medicine, Arak
University of Medical Sciences, Arak, Iran, Islamic Republic of
(Amirani, Asemi) Research Center for Biochemistry and Nutrition in
Metabolic Diseases, Kashan University of Medical Sciences, Kashan, Iran,
Islamic Republic of
Publisher
Humana Press Inc. (E-mail: humana@humanapr.com)
Abstract
This study was carried out to evaluate the effects of selenium
supplementation on glycemic control, lipid profiles, and biomarkers of
inflammation and oxidative stress in patients undergoing for coronary
artery bypass grafting (CABG) surgery. This randomized, double-blind,
placebo-controlled trial was performed among 33 patients undergoing for
CABG surgery, aged 40-85 years old. Subjects were randomly allocated into
two groups to intake either 200 mug/day selenium supplements as selenium
yeast (n = 17) or placebo (n = 16) for 4 weeks. Glycemic control, lipid
profiles, and biomarkers of inflammation and oxidative stress were
assessed at baseline and at the end of trial. After the 4-week
intervention, selenium supplementation significantly decreased fasting
plasma glucose (FPG) (beta, 6.76 mg/dL; 95% CI, - 13.13, - 0.40; P =
0.03), insulin (beta, - 1.14 muIU/mL; 95% CI, - 2.01, - 0.28; P = 0.01);
homeostasis model of assessment-estimated insulin resistance (HOMA-IR)
(beta - 0.35; 95% CI, - 0.62, - 0.08; P = 0.01); and
total-/HDL-cholesterol ratio (beta - 0.31; 95% CI, - 0.51, - 0.09; P =
0.008); and significantly increased HDL-cholesterol levels (beta, 2.72
mg/dL; 95% CI, 0.89, 4.55; P = 0.005) compared with the placebo. Moreover,
selenium supplementation led to a significant reduction in
high-sensitivity C-reactive protein (hs-CRP) (beta, - 0.68 mg/L; 95% CI, -
1.18, - 0.17; P = 0.01) and malondialdehyde (MDA) (beta, - 0.27 mumol/L;
95% CI, - 0.47, - 0.07; P = 0.009), and a significant elevation in total
glutathione (GSH) levels (beta, 77.33 mumol/L; 95% CI, 56.11, 98.55; P <
0.001) compared with the placebo. Selenium supplementation did not affect
other metabolic profiles. Overall, our study demonstrated that selenium
supplementation for 4 weeks to patients undergoing for CABG surgery had
beneficial effects on FPG, insulin, HOMA-IR, total-/HDL-cholesterol ratio,
HDL-cholesterol, hs-CRP, GSH, and MDA levels, but did not affect other
metabolic profiles. Clinical trial registration number:
http://www.irct.ir: IRCT2017090533941N22. Copyright © 2019,
Springer Science+Business Media, LLC, part of Springer Nature.

<36>
Accession Number
626012636
Title
Comparison between blood and non-blood cardioplegia in tetralogy of
Fallot.
Source
Asian Cardiovascular and Thoracic Annals. (no pagination), 2018. Date of
Publication: 2018.
Author
Romolo H.; Hernisa L.; Fakhri D.; Rachmat J.; Dwi Mulia D.; Rahmat B.
Institution
(Romolo, Hernisa, Fakhri, Rachmat, Rahmat) Department of Pediatric Cardiac
Surgery, Rumah Sakit Jantung dan Pembuluh Darah Nasional Harapan Kita,
Jakarta, Indonesia
(Dwi Mulia) Department of Surgery, Rumah Sakit Cipto Mangunkusumo, Faculty
of Medicine, Universitas Indonesia, Jakarta, Indonesia
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Background: Cardioplegia is an integral part of myocardial protection. The
superiority of blood cardioplegia in adult patients has been reported.
However, this is yet to be studied in cyanotic pediatric patients.
 Method(s): A randomized open-label trial was conducted in 70 patients
with tetralogy of Fallot. They were divided into two groups: 35 patients
had crystalloid cardioplegia (controls), and 35 had blood cardioplegia.
Lactate and coronary oxygen extraction in arterial blood and the coronary
sinus were measured immediately after cessation of cardiopulmonary bypass,
15 and 30 min later. Postoperative mortality, major adverse cardiac
events, mechanical ventilation time, inotrope administration, arrhythmias,
right ventricular function, intensive care unit and hospital length of
stay were observed. Result(s): There were no significant differences
in clinical outcomes or lactate levels. There was a significant difference
in coronary oxygen extraction immediately and 15 min after cessation of
cardiopulmonary bypass (p = 0.038, p = 0.015). Conclusion(s): Blood
cardioplegia gave a better postoperative oxygen extraction value but there
were no differences in myocardial damage or clinical outcome between the
two groups. Copyright © The Author(s) 2018.

<37>
Accession Number
626026884
Title
Previous coronary artery bypass graft is not associated with higher
mortality in transcatheter aortic valve replacement: systemic review and
meta-analysis.
Source
Acta Cardiologica. (no pagination), 2018. Date of Publication: 2018.
Author
Prasitlumkum N.; Kewcharoen J.; Kanitsoraphan C.; Rattanawong P.;
Mekritthikrai R.; Gillaspie E.A.; Mao M.A.; Cheungpasitporn W.
Institution
(Prasitlumkum, Kewcharoen, Kanitsoraphan, Rattanawong, Mekritthikrai)
Internal Medicine Residency Program, University of Hawaii, Honolulu, HI,
United States
(Rattanawong) Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
(Gillaspie) Department of Thoracic Surgery, Vanderbilt University Medical
Center, Nashville, TN, United States
(Mao) Division of Internal Medicine, Mayo Clinic, Rochester, MN, United
States
(Cheungpasitporn) Department of Medicine, University of Mississippi
Medical Center, Jackson, MS, United States
Publisher
Taylor and Francis Ltd. (E-mail: michael.wagreich@univie.ac.at)
Abstract
Introduction: Patients with previous coronary artery bypass graft (CABG)
are usually considered as high-risk groups perioperatively. Recent studies
suggest that previous CABG is not associated with mortality in patients
with severe aortic stenosis (AS) who underwent transcatheter aortic valve
replacement (TAVR). However, systematic review and meta-analysis of the
literature has not been done. Thus, we conducted this systematic review
and meta-analysis to assess the association between previous CABG and
mortality in patients undergoing TAVR. Method(s): We comprehensively
searched the databases of MEDLINE and EMBASE from inception to July 2018.
Included studies were published prospective or retrospective cohort
studies that evaluated the effects of previous CABG status on mortality
risk among patients undergoing TAVR. Data from each study were combined
using the random-effects, generic inverse variance method of DerSimonian
and Laird to calculate risk ratios and 95% confidence intervals.
 Result(s): Eleven cohort studies from March 2010 to April 2018 were
included in this meta-analysis involving 7299 subjects with severe AS
undergoing TAVR (1890 with and 5409 without previous CABG). Previous CABG
was not associated with all-cause mortality (pooled risk ratio = 0.96, 95%
confidence interval: 0.80-1.16, p=.66, I2=21%) and
cardiovascular (CV) mortality (pooled risk ratio = 1.23, 95% confidence
interval: 0.64-2.39, p=.72, I2=35%). Conclusion(s):
Previous CABG is not associated with either all-cause mortality or CV
mortality in patients with severe AS undergoing TAVR. TAVR should be
considered as an alternative or first-line treatment option among severe
AS patient, regardless of previous CABG status. Copyright © 2019,
© 2019 Belgian Society of Cardiology.

<38>
Accession Number
2001240292
Title
Colchicine in Stable Coronary Artery Disease.
Source
Clinical Therapeutics. 41 (1) (pp 30-40), 2019. Date of Publication:
January 2019.
Author
Fiolet A.T.L.; Nidorf S.M.; Mosterd A.; Cornel J.H.
Institution
(Fiolet) Department of Cardiology, University Medical Centre Utrecht,
Utrecht, Netherlands
(Fiolet, Mosterd) Dutch Network for Cardiovascular Research (WCN),
Utrecht, Netherlands
(Nidorf) Heart Care Western Australia, Perth, Western Australia, Australia
(Mosterd) Department of Cardiology, Meander Medisch Centrum, Amersfoort,
Netherlands
(Cornel) Department of Cardiology, Northwest Clinics, Alkmaar, Netherlands
Publisher
Excerpta Medica Inc.
Abstract
Purpose: Disease management of stable coronary artery disease consists of
controlling hemostasis and lipid regulation. No treatment strategies
preventing plaque erosion or rupture are yet available. Cholesterol
crystal-induced inflammation leading to plaque destabilization is believed
to be an important factor contributing to plaque instability and might
well be amenable to treatment with anti-inflammatory drugs. Colchicine has
anti-inflammatory properties with the potential to address both the direct
and indirect inflammatory mechanisms in the plaque. Method(s): A
literature search was performed in MEDLINE (PubMed), EMBASE, and the
Cochrane Central Register of Controlled Trials, as well as in the clinical
trial registries, to identify finished and ongoing clinical studies on
colchicine in stable coronary artery disease. Finding(s): Preclinical
findings of colchicine in stable coronary artery disease have shown
protective effects on surrogate outcomes, such as myocardial infarction
size and postangioplasty restenosis. Retrospective cohort studies in
patients with gout report a lower incidence of combined cardiovascular
outcomes in those treated with colchicine. Thus far, one prospective,
randomized clinical trial has provided evidence on a possible protective
effect of colchicine in stable coronary artery disease. Meta-analysis of
trials of colchicine in multiple cardiovascular diseases revealed a
decrease in myocardial infarction with varying levels of evidence.
Currently, 5 major clinical trials involving >10,000 patients are
recruiting patients, all focusing on major cardiovascular outcomes.
Implications: The body and quality of evidence regarding the efficacy of
colchicine for secondary prevention of stable and acute phases of coronary
artery disease will be greatly expanded in the upcoming years, providing
less biased and more accurate effect estimates. If colchicine's
anti-inflammatory characteristics translate to improved event-free
cardiovascular survival, this relatively safe, low-cost, and well-known
drug may become the third pillar (next to lipid regulation and platelet
inhibition) in the medical management of stable coronary artery
disease. Copyright © 2018

<39>
Accession Number
2001363600
Title
Effects of Perioperative Dexmedetomidine on Postoperative Mortality and
Morbidity: A Systematic Review and Meta-analysis.
Source
Clinical Therapeutics. 41 (1) (pp 138-154.e4), 2019. Date of Publication:
January 2019.
Author
Peng K.; Ji F.-H.; Liu H.-Y.; Zhang J.; Chen Q.-C.; Jiang Y.-H.
Institution
(Peng, Ji, Liu, Zhang, Chen, Jiang) Departments of Anesthesiology,
Intensive Care Medicine, and Pain Medicine, First Affiliated Hospital of
Soochow University, Suzhou, China
Publisher
Excerpta Medica Inc.
Abstract
Purpose: Major postoperative complications translate into increased health
care resource utilization, prolonged hospital stays, and increased
mortality. We aimed to assess the effects of perioperative dexmedetomidine
use on postoperative mortality and the prevalence of major complications
after cardiac and noncardiac surgery. Method(s): We searched the
PubMed, EMBASE, and Cochrane databases to analyze all published evidence
from randomized controlled trials (RCTs) and cohort studies comparing
perioperative dexmedetomidine use versus no dexmedetomidine use in adult
patients undergoing cardiac and noncardiac surgery. The primary outcome
was postoperative mortality. Secondary outcomes were the durations of
mechanical ventilation, intensive care unit (ICU) stay, and hospital stay,
and the prevalence of major complications. Finding(s): Twenty-three
studies in cardiac surgery (n = 7635) and 8 studies in noncardiac surgery
(n = 1805) were included. In cardiac surgery, dexmedetomidine use reduced
postoperative 30-day mortality (risk ratio [RR], 0.35 [95% CI, 0.24 to
0.51]); durations of mechanical ventilation (mean difference [MD], -1.56 h
[-2.52 to -0.60]), ICU stay (MD, -0.22 day [-0.35 to -0.08]), and hospital
stay (MD, -0.65 day [-1.12 to -0.18]); and the prevalences of delirium
(RR, 0.50 [0.36 to 0.69]), atrial fibrillation (RR, 0.74 [0.57 to 0.97]),
and cardiac arrest (RR, 0.34 [0.13 to 0.87]). In noncardiac surgery,
dexmedetomidine use was associated with decreases in the durations of
mechanical ventilation and hospital stay, with a trend toward a lower
prevalence of delirium (RR, 0.57 [0.32 to 1.01]). The prevalence of
bradycardia was increased in dexmedetomidine-treated patients undergoing
cardiac surgery (RR, 1.70 [1.19 to 2.44]) and noncardiac surgery (RR, 1.64
[1.05 to 2.58]). Implications: Dexmedetomidine use may help to reduce
postoperative 30-day mortality, durations of mechanical ventilation, ICU
stay, and hospital stay, and the prevalences of delirium, atrial
fibrillation, and cardiac arrest in patients who undergo cardiac surgery.
The majority of the benefits of dexmedetomidine were not significant in
patients undergoing noncardiac surgery. An increased risk for bradycardia
should be taken into consideration when prescribing dexmedetomidine.
International Prospective Register of Systematic Reviews identifier:
CRD42017070791. Copyright © 2018 Elsevier Inc.

<40>
Accession Number
2001092620
Title
The Role of Colchicine in Treating Postoperative and Post-catheter
Ablation Atrial Fibrillation.
Source
Clinical Therapeutics. 41 (1) (pp 21-29), 2019. Date of Publication:
January 2019.
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.
 Method(s): Published studies on the field were identified through a
literature search of the PubMed and clinicaltrials.gov databases.
 Finding(s): 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. Copyright © 2018
Elsevier Inc.

<41>
Accession Number
2000956154
Title
Ablation strategies for the management of symptomatic Brugada syndrome: A
systematic review.
Source
Heart Rhythm. 15 (8) (pp 1140-1147), 2018. Date of Publication: August
2018.
Author
Fernandes G.C.; Fernandes A.; Cardoso R.; Nasi G.; Rivera M.; Mitrani
R.D.; Goldberger J.J.
Institution
(Fernandes, Nasi, Rivera) Department of Internal Medicine, University of
Miami Miller School of Medicine, Miami, Florida, United States
(Fernandes) Centro de Ciencias Medicas, Universidade Federal da Paraiba,
Joao Pessoa, Brazil
(Cardoso) Division of Cardiology, Johns Hopkins University, Baltimore,
Maryland, United States
(Mitrani, Goldberger) Division of Cardiology, University of Miami Miller
School of Medicine, Miami, Florida, United States
Publisher
Elsevier B.V.
Abstract
Background: Ablation approaches have been described for the management of
symptomatic ventricular arrhythmias in patients with Brugada syndrome, but
this treatment is still considered experimental. Objective(s): We
aimed to perform a systematic review of the current evidence on the use of
catheter ablation in Brugada syndrome. Method(s): MEDLINE, Embase,
and Scopus were searched for articles describing the use of catheter
ablation for ventricular arrhythmia management in Brugada syndrome.
 Result(s): We included 11 case series and 11 case reports including a
total of 233 patients. Ablation strategies included epicardial mapping
with substrate modification (n = 180; 77.3%), endocardial-only mapping
with substrate modification (n = 17; 7.3%), ventricular fibrillation
(VF)-triggering premature ventricular complex ablation (n = 5; 2.1%), and
mixed approaches (n = 31; 13.3%). During a 2.5- to 78-month follow-up
period, the success rates in preventing ventricular tachycardia or VF
(VT/VF) were 96.7%, 70.6%, and 80% with epicardial, endocardial, and
triggering premature ventricular complex ablation approaches,
respectively. Among patients who underwent both epicardial and endocardial
mapping, there was no identifiable endocardial substrate in 92.9% of
cases. Elimination of type 1 Brugada-pattern electrocardiogram was
attained in 98.3% and 34.8% of the epicardial and endocardial ablation
groups, respectively. VT/VF occurred in 7 of 9 patients (77.8%) who had
persistent or recurrent J-ST elevation and in none of the 24 patients with
complete resolution during follow-up. Pharmacologic provocation augmented
the abnormal area. Conclusion(s): Epicardial substrate modification
appears to be more effective than endocardial-only approach in preventing
VT/VF. Persistent or recurrent J-ST elevation appears to represent a
marker of failure of ablation. Ablation seems to be an acceptable strategy
for patients with Brugada syndrome and VT/VF. Copyright © 2018
Heart Rhythm Society

<42>
Accession Number
623585944
Title
Association of body mass index with short-term outcomes after cardiac
surgery: Retrospective study and meta-analysis.
Source
Medicina (Argentina). 78 (3) (pp 171-179), 2018. Date of Publication: June
2018.
Author
Borracci R.A.; Ingino C.A.; Miranda J.M.
Institution
(Borracci) Departamento de Cirugia Cardiaca, Hospital de Clinicas,
Facultad de Medicina, Universidad de Buenos Aires, Argentina
(Borracci, Ingino, Miranda) Departamento de Cardiologia y Cirugia
Cardiaca, ENERI-Sagrada Familia, Buenos Aires, Argentina
Publisher
Instituto de Investigaciones Medicas (E-mail: revmed@intramed.net.ar)
Abstract
The relationship between higher body mass index (BMI), decreased morbidity
and mortality is known as the "obesity paradox", and has been described in
cohorts of patients with hypertension, diabetes, heart failure, coronary
and peripheral artery diseases, non-cardiac surgery, and end-stage renal
disease. Here we investigated the relationship between BMI and short-term
outcomes after adult cardiac surgery to explore the existence of an
obesity paradoxical effect. A secondary objective was to perform an
updated systematic review to further analyze the association between BMI
and 30-day in-hospital mortality after cardiac surgery. A retrospective
analysis was performed from a consecutive series of 1823 adult patients
who underwent cardiac surgery, that were assigned to five BMI groups:
normal weight (18.5-24.9 kg/m2), overweight (25-29.9 kg/m2), class I obese
(30-34.9 kg/m2), class II obese (35-39.9 kg/m2), and class III obese or
morbidly obese (40-49.9 kg/m2). A systematic review search was performed
including controlled trials and observational studies identified in
MEDLINE, Embase, SCOPUS, and the Cochrane library (to the end of June
2017). In the present series, overweight and obese patients had similar or
slightly lower in-hospital mortality rates after cardiac surgery compared
with normal-weight individuals. Conversely, postoperative complication
rates increased with higher BMI levels. Most studies included in the
review showed that overweight and obese patients had at least the same
mortality rate as normal-weight patients, or even a lower death risk.
Pooled-data of the meta-analysis provided evidence on the association
between higher BMI levels and a lower all-cause in-hospital mortality rate
after cardiac surgery. Copyright © 2018, Instituto de
Investigaciones Medicas. All rights reserved.

<43>
Accession Number
620560845
Title
Differences between Slovak and Dutch patients scheduled for coronary
artery bypass graft surgery regarding clinical and psychosocial predictors
of physical and mental health-related quality of life.
Source
European Journal of Cardiovascular Nursing. 17 (4) (pp 324-335), 2018.
Date of Publication: 01 Apr 2018.
Author
El-Baz N.; Ondusova D.; Studencan M.; Rosenberger J.; Reijneveld S.A.; van
Dijk J.P.; Middel B.
Institution
(El-Baz) University of Groningen, University Medical Center Groningen,
Department of Epidemiology, Groningen, Netherlands
(El-Baz) Alexandria University, Faculty of Nursing, Department of
Emergency and Critical Care Nursing, Alexandria, Egypt
(El-Baz, Reijneveld, van Dijk, Middel) University of Groningen, University
Medical Center Groningen, Department of Community & Occupational Medicine,
Netherlands
(Ondusova) East Slovakian Institute for Cardiac and Vascular Diseases,
Kosice, Slovakia
(Studencan) Cardiocentre of Teaching Hospital of J.A. Reiman, Presov,
Slovakia
(Rosenberger, van Dijk) Pavol Jozef Safarik University, Faculty of
Medicine, Graduate School Kosice Institute for Society and Health, Kosice,
Slovakia
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Background: Differences in health-related quality of life in coronary
artery disease patients and associated factors between patients of central
and western European descent are rarely investigated. We aim to test
differences between Dutch and Slovak health-related quality of life,
whether nationality predicted health-related quality of life and if
standardised beta weights of health-related quality of life determinants
differ across countries. Design(s): An observational multicentre
study at university cardiac centres in the Netherlands and Slovakia.
 Method(s): In 226 coronary artery disease patients, health-related
quality of life was measured by the Short Form Health Survey 36, anxiety
and depression were measured using the Hospital Anxiety and Depression
Scale, and type D personality was assessed with the 14-item Type D Scale.
Multivariate analysis was used to explore the effect of patient
characteristics on the physical and mental component summaries. Estimates
of each predictor's beta value of the physical and mental component
summaries in the Slovak and Dutch patient sample were separately
calculated using the Cummings criterion for comparison of two independent
betas. Result(s): Stronger predictors of physical health-related
quality of life in Slovak patients were educational level, current
smoking, poor functional status, history of diabetes and amount of social
support. In Dutch patients, only more symptoms of depression was a
stronger predictor (P<0.05). Regarding Slovak mental health-related
quality of life, stronger predictors were educational level, current
smoking and amount of social support. Female gender, history of myocardial
infarction and more symptoms of depression were stronger predictors in
Dutch patients (P<0.05). Conclusion(s): Descent and differences
between both populations in determinants of health-related quality of life
should be considered while planning care, follow-up, health education and
rehabilitation. Copyright © 2017, © The European Society of
Cardiology 2017.

<44>
Accession Number
622931550
Title
Impact of mean arterial pressure on sublingual microcirculation during
cardiopulmonary bypass-Secondary outcome from a randomized clinical trial.
Source
Microcirculation. 25 (5) (no pagination), 2018. Article Number: e12459.
Date of Publication: July 2018.
Author
Holmgaard F.; Vedel A.G.; Ravn H.B.; Nilsson J.C.; Rasmussen L.S.
Institution
(Holmgaard, Vedel, Ravn, Nilsson) Department of Cardiothoracic Anesthesia,
Heart Centre, Rigshospitalet, University of Copenhagen, Copenhagen,
Denmark
(Rasmussen) Department of Anesthesia, Centre of Head and Orthopedics,
Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
Publisher
Wiley Blackwell (E-mail: info@wiley.com)
Abstract
Objective: In this substudy of a randomized, clinical trial, we explored
the sublingual microcirculation during cardiac surgery at 2 different
levels of blood pressure. We hypothesized that a higher map during CPB
would cause higher MFI. Method(s): Thirty-six cardiac surgery
patients undergoing CABG were included and randomized to either low (40-50
mm Hg) or high (70-80 mm Hg) MAP during CPB. SDF video images were
recorded from the sublingual mucosa. Recordings were analyzed in a blinded
fashion to quantify microcirculatory variables. Result(s): MAP during
CPB in the low target group was 45.0 mm Hg (SD: 5.3) vs 67.2 mm Hg (SD:
8.9) in the high target group. We found no significant difference between
the 2 groups in MFI during CPB evaluated for AV: 2.91 vs 2.90 (P =.82).
For sm AV (<20 mum), the corresponding values were 2.87 and 2.85 in the
low and high target groups, respectively (P =.82). Conclusion(s): We
found no significant difference in sublingual microcirculatory flow
expressed as MFI according to 2 different levels of MAP during
CPB. Copyright © 2018 John Wiley & Sons Ltd

<45>
[Use Link to view the full text]
Accession Number
617616595
Title
Letter by Shi et al Regarding Article, "Body Mass Index and Mortality
Among Adults Undergoing Cardiac Surgery: A Nationwide Study With a
Systematic Review and Meta-Analysis".
Source
Circulation. 136 (5) (pp 505-506), 2017. Date of Publication: 01 Aug 2017.
Author
Shi Y.; Yu H.; Yang X.-Y.
Institution
(Shi, Yu) Department of Anesthesiology, West China Hospital, Sichuan
University, Chengdu, China
(Yang) Department of Obstetrics and Gynecology, West China Second
Hospital, Sichuan University, Chengdu, China
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)

<46>
Accession Number
610196600
Title
Cardiovascular and other outcomes postintervention with insulin glargine
and omega-3 fatty acids (ORIGINALE).
Source
Diabetes Care. 39 (5) (pp 709-716), 2016. Date of Publication: May 2016.
Author
Gerstein H.C.; Bosch J.; Dagenais G.R.; Jung H.; Maggioni A.P.; Pogue J.;
Probstfield J.; Ramachandran A.; Riddle M.C.; Ryden L.E.; Yusuf S.; Diaz
R.; Johnston P.; Vige R.; Birkeland K.; Budaj A.; Cardona E.; Chazova I.;
Commerford P.; Danilova L.; Davies M.; Fernando R.; Fodor G.; Gilbert R.;
Gomis R.; Hanefeld M.; Hildebrandt P.; Kacerovsky-Bielesz G.; Keltai M.;
Kim J.H.; Krum H.; Lanas F.; Lewis B.S.; Lonn E.; Marin-Neto J.; Marre M.;
McKelvie R.; McQueen M.; Mendoza I.; Morillo C.; Pan C.; Profozic V.;
Ratner R.; Richardson L.; Rosenstock J.; Spinas G.A.; Sreenan S.; Stoel
I.; Syvanne M.; Yale J.F.; Avezum A.; Bahit M.C.; Bogaty P.; Bordeleau L.;
Chacomicronn C.; Corson M.; Harper W.L.; Halon D.; Magloire P.; Mann J.;
Pavlova V.; Punthakee Z.; Silva J.; Tsang B.; Yakubovich N.; Abdallah A.;
Ahmad S.; Chandra J.; Chandra R.; Cukierman-Yaffee T.; Dyal L.; Joldersma
L.; MacRae L.; MacRae S.; Malik S.; Mead A.; Pasha F.; Pazmino-Canizares
J.; Pohl K.; Sakalas A.; Tyrwhitt J.; Ahuad Guerrero R.; Alebuena A.;
Alvarez N.; Alzogaray M.; Amuchastegui M.; Andres M.; Angos M.; Baglivo
H.; Barbieri M.; Bassi F.; Bello F.; Bono J.; Bustamante Labarta M.;
Bustos B.; Caccavo A.; Calveira M.; Camino A.; Cantero M.; Capozzi M.;
Cardone M.; Cartasegna L.; Cassetari A.; Castellanos R.; Chavez Caballero
R.; Cipullo M.; Contreras A.; Coria J.; Corinaldesi F.; Costa G.; Crespo
C.; Cruz M.; Cuello J.; Cuneo C.; Del Corro I.; Diez R.; Dituro C.;
Dominguez A.; Facta A.; Faingold C.; Farah M.; Fares Taie A.; Fernandez
A.; Ferrari A.; Ferrari N.; Garcia Monteverde C.; Garrido M.; Giachello
C.; Gonzalez M.; Gutierrez N.; Guzman L.; Guzman P.; Hasbani E.; Henquin
R.; Hershon A.; Hirschon Alvarez Prado A.; Hominal M.; Hrabar A.; Imposti
H.; La Grutta M.; Lanchiotti P.; Lobo Marquez L.; Lopez Santi R.;
Lowenstein J.; Lugo M.; Luqueci M.; Mainini S.; Majul C.; Manzano R.;
Manzur S.; Marcucci G.; Marino M.; Massari F.; Mendez N.; Molina M.;
Montana O.; Mulazzi M.; Nardone L.; Odetto I.; Orlandini A.; Oviedo A.;
Paez O.; Parnas A.; Patron F.R.; Pedernera C.; Pelagagge M.; Plastino M.;
Polari P.; Pomposiello J.; Porta A.; Prado A.; Quiroz M.; Ramirez A.;
Rodriguez M.; Ronderos R.; Sago L.; Sanchez A.; Sanchez R.; Sandrin A.;
Schygiel P.; Sernia V.; Sinay I.; Smith Casabella T.; Sosa Liprandi A.;
Sosa Liprandi M.; Soso L.; Sposetti G.; Stisman D.; Streitenberger P.;
Suarez G.; Tonin H.; Ulla M.; Valdez J.; Vico M.; Villamil A.; Villarino
A.; Viscaya Castro A.; Visco V.; Vogel D.; Waisman F.; Zaidman C.; Amerena
J.; Applebe A.; Aylward P.; Binnekamp M.; Bruce I.; Burdeniuk C.; Burnet
R.; Colman P.; Colquhoun D.; Davis S.; De Looze F.; De Pasquale C.;
D'Emden M.; Eaton H.; Farshid A.; Foulanos S.; Galanos J.; Gordon G.; Guhu
M.; Ho J.; Jeffery I.; Jerums G.; Kwan M.; Lefkovits J.; Luu S.; MacIsaac
R.; Marjason J.; Mohabbati V.; Nankervis A.; O'Neal D.; Perera N.; Poynten
A.; Rahman A.; Razak S.; Roberts T.; Sebastian M.; Simpson R.; Soldatos
G.; Sullivan D.; Teede H.; Tiong F.; Topliss D.; Torpy D.; Waddell-Smith
K.; Waites J.; Wenman J.; Whelan A.; Williams L.; Yeap B.; Yeow W.; Yong
G.; Aczel S.; Azimy N.; Bertha P.; Blocher J.; Bohnel C.; Brath H.; Breuss
J.; De Campo A.; Drexel H.; Ettmuller Y.; Feder A.; Feinboeck C.; Gulz E.;
Hofmann M.; Hoppichler F.; Jahnel H.; Jankovic V.; Kann T.; Kathrein T.;
Kotter T.; Kratz E.; Kreuzwieser E.; Loreck C.; Ludvik B.; Marte T.;
Mellitzer K.; Nistler S.; Placher-Sorko G.; Prager R.; Rein P.; Riedl M.;
Saly C.; Schernthaner G.; Schichka E.; Seidlhofer C.; Sonnenfeld M.;
Stefan H.; Steiner K.; Thomas B.; Toplak H.; Urstoger K.; Vetter B.;
Vonbank A.; Waldschutz W.; Wallner F.; Winkler F.; Goncharik D.; Lazareva
I.; Lichorad N.; Mrochek A.; Murashko N.; Radyuk D.; Ramanovski A.;
Sudzhaeva S.; Sujayeva V.; Yarashevich N.; Campbell G.; Marshall S.; West
A.; Abreu F.; Alves M.; Ayoub-Aidar J.; Barros M.; Barros-Silveira J.;
Blacher M.; Costa E.; Costa F.; Daltro C.; Delana J.; Eliaschewitz F.;
Facanha C.; Feitosa G.; Figueiredo J.; Forti A.; Franco D.; Franken M.;
Freire F.; Garcia V.; Gouvea-Neto A.; Grofallo S.; Kanedlai N.;
Kerr-Saraiva J.; Ladeira R.; Leaes P.; Lemos M.; Lima F.; Lima Filho M.;
Macedo L.; Manenti E.; Monte O.; Mossman A.; Mothe F.; Mouco O.; Moyses
Golbert M.; Nasser Hissa L.; Nasser-Hissa M.; Nicolau J.; Nigro Maia L.;
Ninno T.; Nunes C.; Oliveira C.; Oliveira O.; Passos da silva R.;
Pericles-Esteves J.; Rabelo L.; Rabelo-Alves Junior A.; Rassi S.; Rech R.;
Roldan F.; Salles J.; Sampaio C.; Seabra A.; Sealissi N.; Seixas A.; Sena
R.; Shehadeh I.; Teixeira M.; Turin H.; Vicente Serrano C.; Vidigal M.;
Vilela M.; Wajchenberg B.; Abbott C.; Abu-Bakare A.; Ardilouze J.;
Auersperg E.; Bailey A.; Bailey G.; Baillargeon J.; Beaurivage C.; Belair
J.; Belanger A.; Bellabarba D.; Berlingieri J.; Bernier F.; Bhargava R.;
Bhesania T.; Booth W.; Bose S.; Boulianne M.; Bourgeois S.; Breton D.;
Brossoit R.; Buithieu J.; Campeau J.; Carlson B.; Carpentier A.;
Cavalcanti R.; Cha J.; Chagnon P.; Chan Y.; Chessex C.; Chiasson J.;
Chouinard S.; Clayton D.; Conway J.; Crepeau J.; Cudmore D.; D'Ignazio G.;
Doig G.; Dominguez M.; Dube F.; Dumas R.; Dupuis R.; Dyrda I.; Eddy D.;
Eiley D.; Fox H.; Fratesi S.; Gallant S.; Garceau C.; Garfield N.; Germain
C.; Glazer S.; Gosselin G.; Gould D.; Grills G.; Halle J.; Hardin P.;
Harper W.; Heath J.; Heath V.; Hivert M.; Ho K.; Houde G.; Hramiak I.;
Hutchinson A.; Huynh T.; Ilie-Haynes R.; Imran S.; Islam A.; Iwanochko M.;
Jones C.; Joyce C.; Kirouac I.; Kumar R.; Lamothe M.; Langlois M.; Lauzon
C.; Lavoie M.; Leader R.; Lecours S.; Lepage S.; Lochnan H.; Ma P.; McLean
A.; Mecci S.; Mehta P.; Mercier M.; Miller D.; Morisset A.; Nawaz S.;
Nisker W.; Nyomba G.; O'Keefe D.; Palardy J.; Parekh P.; Paul T.; Perron
P.; Pesant M.; Phillips R.; Pruneau G.; Quintin I.; Raby K.; Richard C.;
Rosenfeld G.; Saulnier D.; Shaban J.; Shah A.; Shu D.; Sigal R.; Silverman
M.; Singh J.; Sivucha W.; Skamene A.; Sliwowicz D.; Smith R.; St Hilaire
R.; Steinson D.; Sussex B.; Tan K.; Tannous R.; Telner A.; Theroux P.;
Tsoukas C.; Tsoukas G.; van Buuren J.; VanRossum N.; Vexler R.; Vizel S.;
Warnica W.; Weingert M.; Wilson R.; Wong W.; Woo V.; Yale J.; Acevedo M.;
Alwyn C.; Baier E.; Baier S.; Galloso R.; Lahsen R.; Lorenas G.;
Montecinos A.; Montecinos M.; Pineda P.; Pollak F.; Sapunar J.; Serrano
V.; Stockins B.; Varleta P.; Yovanovich J.; Zambra F.; Ba J.; Bao Y.; Bi
Y.; Bu S.; Chen B.; Chen H.; Chen J.; Chen L.; Chen M.; Chen Y.; Cui J.;
Dong M.; Feng P.; Feng Z.; Gao C.; Gao F.; Gao X.; Gao Z.; Gong Y.; Guang
L.; Guo X.; Han F.; Han X.; Hou X.; Hu R.; Ji L.; Jia J.; Jia W.; Jiao X.;
Jin X.; Kuang J.; Li M.; Li Q.; Li X.; Li Y.; Ling Y.; Liu F.; Liu Z.; Lu
B.; Lu J.; Lu Z.; Lv X.; Ning G.; Peng Y.; Ren Y.; Shao Y.; Shi Y.; Shu
X.; Sun H.; Sun L.; Sun X.; Tang K.; Tian H.; Wang C.; Wang F.; Wang L.;
Wang Q.; Wang W.; Wang X.; Wang Y.; Wen J.; Wu C.; Wu H.; Wu J.; Wu M.;
Xing X.; Xue Y.; Yan L.; Yan S.; Yang H.; Yang N.; Yang W.; Yang Z.; Yao
J.; Yao L.; Yu D.; Yu H.; Yu M.; Yu X.; Yuan L.; Yuan M.; Yuan S.; Yuan
W.; Yuan Y.; Yuan Z.; Zeng T.; Zhang J.; Zhang R.; Zhang X.; Zhao L.;
Zheng B.; Zheng J.; Zhou W.; Zhu N.; Zhu Y.; Zou D.; Zou J.;
Lopez-Jaramillo P.; Accini J.L.; Bohorquez R.; Botero R.; Cure C.;
Figueredo M.; Hernandez E.; Kattah W.; Llamas A.; Orozco L.; Pava L.;
Perez M.; Pineda M.; Quintero A.; Quiros R.; Urina M.; Velez S.; Altabas
V.; Baotic I.; Berkovic M.; Goldoni V.; Kerum T.; Mirosevic G.; Tarle D.;
Vidovic I.; Zjacic-Rotkvic V.; Abbas R.; Andersen H.; Auscher S.; Baumbach
L.; Brockstedt H.; Christensen P.; Christiansen M.; Clemmensen K.; Egstrup
K.; Gislason G.; Haar D.; Hansen K.; Heden Andersen P.; Helleberg K.;
Hermansen K.; Holmer J.; Jeppesen J.; Klausen I.; Koustrup-Sonder T.;
Krarup T.; Lerche S.; Lervang H.; Linde B.; Lund P.; Lund S.; Madsbed S.;
Molvig J.; Orskov C.; Ostergaaard O.; Perrild H.; Pietraszek A.; Ralfkjaer
N.; Roenne H.; Rokkedal Nielsen J.; Seibaek M.; Soendergaard H.; Sorensen
L.; Sundahl Mortensen L.; Torp-Pedersen C.; Tuxen C.; Urhammer S.;
Vadstrup E.; Pirags V.; Ambos A.; Janson A.; Rudenko P.; Viitas L.; Aranko
S.; Badeau M.; Eriksson J.; Haapamaki H.; Kajander O.; Kuusisto A.;
Luukkonen S.; Makela J.; Nieminen S.; Niskanen L.; Ripatti J.;
Ruotsalainen S.; Saltevo J.; Savela K.; Strand J.; Valle T.; Virkamaki A.;
Aboud E.; Alavoine L.; Bekherraz A.; Bohme P.; Bourezane H.; Catargi B.;
Charpentier G.; Clergeot A.; Courreges J.; Delmas T.; Duengler F.; Feknous
C.; Gendre D.; Guerci B.; Hadjadj S.; Kerlan V.; Laguerre N.; Le Potier
J.; Lombardo F.; Malville E.; Marechaud R.; Mattei C.; Moreira J.;
Penfornis A.; Petit C.; Pinel J.; Piquel X.; Raccah D.; Reznik Y.; Rod A.;
Roudaut N.; Rousseau E.; Schillo F.; Schmitt B.; Sonnet E.; Torremocha F.;
Travert F.; Vanhoute C.; Vimeux M.; Abdollahnia R.; Adamidou A.; Arslan
S.; Bach-Kliegel B.; Bartusch B.; Bauer N.; Bieler T.; Blankenfeld H.;
Boeckmann U.; Busch K.; Butzer R.; Chenchanna-Merzhaeuser M.; Denger R.;
Deutsch C.; Diessel S.; Donati-Hirsch I.; Dornisch M.; Enghofer K.; Fleig
T.; Forst T.; Frommherz M.; Goeller K.; Habbig J.; Hadziselimovic S.;
Hamann A.; Hampel T.; Heger S.; Helmes C.; Hoffman C.; Hohberg C.; Humpert
P.; Kamke A.; Kamke W.; Kindermann P.; Klein C.; Klein D.; Koehler A.;
Kuehn A.; Langer K.; Limmer S.; Loew A.; Maimer A.; Marck C.; Meier G.;
Methner-Friederich M.; Metzler W.; Meyer K.; Miftari N.; Milde J.; Minnich
J.; Molkewehrum M.; Morcos M.; Mueller-Hoff C.; Nguyen M.; Nishwitz M.;
Oldenburg J.; Ott P.; Pauli K.; Pauly B.; Pfeiffer A.; Pfuetzner A.;
Pischa U.; Radke R.; Reismann P.; Riemer M.; Rochlitz H.; Rudofsky G.;
Ruhla S.; Sammler A.; Schaper F.; Schiemenz K.; Scholz G.; Schumm-Draeger
P.; Segiet T.; Segner A.; Seissler J.; Spahn S.; Stier U.; Tonon G.; von
Amelunxen S.; von Schacky C.; Wilhelm B.; Wilhelm K.; Witt K.;
Wuechner-Hofmann S.; Baranyai M.; Birkus Z.; Foldesi I.; Gaal Z.; Harcsa
E.; Hati K.; Hohmann Z.; Istenes I.; Jozsef I.; Juhasz E.; Kempler P.;
Keresztes B.; Keresztes K.; Kis-Gombos P.; Kovacs I.; Kozma T.; Laszlo Z.;
Noori E.; Nyirati G.; Papp Z.; Patkay J.; Poor F.; Pusztai P.; Putz Z.;
Rigo E.; Sereg M.; Simon K.; Somogyi A.; Sumegi J.; Szabo A.; Szabo J.;
Szigeti S.; Szilveszter D.; Tarko M.; Varga C.; Varga Szabo L.; Voros P.;
Arathi; Aravind S.; Badgandi M.; Balaji M.; Balaji V.; Chamukuttan S.;
Devi Manduva P.; Fatima S.; Ganapathy B.; George O.; George P.; Jaffar M.;
Jain P.; Kamath P.; Karthik V.; Koshy G.; Krishnan L.; Kumar H.; Lal P.;
Mithal A.; Modi S.; Mohan V.; Moses V.; Oomen R.; Pais P.; Pati P.;
Pendsey S.; Rai P.; Rajagopal R.; Ramu M.; Ranjit U.; Rao P.; Senthil V.;
Seshaiah V.; Sethi B.; Shah P.; Sharma R.; Shetty S.; Shobha A.; Siddharth
R.; Sridhar G.; Sudeep K.; Sunil C.; Sunitha S.; Suresh S.; Thomas N.;
Vageesh A.; Anwer Z.; Barton J.; Behan L.; Bell M.; Cullen M.; Dineen S.;
Draman Yusof M.; Dunne F.; Gibney J.; Hussain T.; Khan M.; Kinsley B.;
Kyithar P.; Lavin F.; McGowan A.; McGurk C.; Mirza A.; Mohammadi B.;
O'Brien T.; O'Connell J.; O'Halloran D.; O'Shea D.; Roberts G.; Tomkin G.;
Wan Mahmood W.; Abramod-Ness R.; Adawi F.; Aharon B.; Backer M.;
Beniashvili A.; Berliner A.; Bloch L.; Bugelman D.; Butnaru A.; Cohen O.;
Cohen Y.; Frenkel M.; Glant M.; Gustava B.; Guttman H.; Halabi S.;
Harman-Boehm I.; Ilany J.; Karkabi B.; Khader N.; Khaskia A.; Khudyak Y.;
Klainman E.; Kogan N.; Lender D.; Levin I.; Mardi T.; Marmor A.; Mosseri
M.; Nabriski D.; Omary M.; Orlovsky S.; Peres D.; Quasim M.; Raz I.;
Remesnik M.; Rogowski O.; Rozenfeld I.; Scharr D.; Shnifer I.; Shuster T.;
Solomon R.; Steiner H.; Tzivoni D.; Wolfson N.; Yossef Z.; Zahger D.;
Zeltser D.; Zimlichman R.; Aina F.; Ariatti C.; Bonetti R.; Cacciatore F.;
Calcinaro F.; Corona G.; De Maria P.; Del Prato S.; Derosa G.; Di Pasquale
G.; Falorni A.; Fanelli R.; Fedele D.; Filorizzo G.; Fogari R.; Furgi G.;
Ghio A.; Giorda C.; Gregori G.; Iannuzzi G.; Lapolla A.; Luciano B.;
Lucotti P.; Maggi A.; Marafetti L.; Marchese T.; Martino G.; Marzotti S.;
Miccoli R.; Monti L.D.; Moretti L.; Palvarini M.; Petacchi R.; Piarulli
F.; Piatti P.M.; Rudi S.; Santeusanio F.; Sesti G.; Setola E.; Sforza A.;
Shehaj E.; Veniani M.; Viviani G.; Zigoura E.; Chae S.; Cho D.; Cho E.;
Cho Y.; Choi Y.; Chung M.; Hong E.; Hong Y.; Jeong M.; Kim B.; Kim D.; Kim
H.; Kim I.; Kim J.; Kim P.; Kim S.; Koo B.; Kwok S.; Kwon H.; Lee J.; Lim
J.; Oh S.; Ohn J.; Park C.; Park H.; Park K.; Seung K.; Son H.; Woo J.;
Yoon K.; Ansmite B.; Balcere I.; Bumbure A.; Ducena K.; Lejnieks A.; Rasa
I.; Ritenberga R.; Romanova M.; Salmina I.; Steina S.; Badariene J.;
Gailiuniene S.; Grigonis S.; Juskiene R.; Petrulioniene Z.; Sakalyte G.;
Stasiunas T.; Sulskiene M.; Urbonaite B.; Zarankiene R.; Ziukaite R.;
Arechavaleta R.; Beltran-Jaramillo T.; Calvo-Vargas C.; Campillo-Cardenas
C.; Cardona D.; Carmona-Huerta J.; Cedano-Limon M.; Comellas-De M.;
Dominguez C.; Gomez-Cruz J.; Gonzalez-Perez R.; Illescas J.; Jimenez-Ramos
S.; Lopez-Alvarado A.; Marquez-Rodriguez E.; Martinez G.; Pascoe S.;
Plascencia Vazquez O.; Rodriguez H.; Ruiz-Cornejo M.; Velasco-Sanchez G.;
Vidrio-Velazquez M.; Villeda-Espinosa E.; Badings E.; Bartels G.;
Bruggink-Andre de la Porte P.; Bruijns E.; Cornel J.; De Milliano P.; De
Mulder M.; De Swart J.; Derks A.; Dirkali A.; Droste J.; Galjee M.;
Hautvast R.; Hermans W.; Holwerda N.; Ilmer B.; Kofflard M.;
Kooistra-Huizer J.; Kurvers M.; Langerveld J.; Leenders C.; Liem A.; Lok
D.; Neumann D.; Nierop P.; Plomp K.; Posma J.; Reichert C.; Roeters Van
Lennep H.; Ronner E.; Said S.; Takens L.; Umans V.; Van der Sluis A.A.;
Van der Zwaan C.; Van Dobbenburgh J.; Van Es A.; Van Hessen M.; Van
Mechelen R.; Van Miltenburg-Van Zijl A.; Van Zeijl L.; Veerhoek M.;
Viergever E.; Weijers E.E.; Willems F.; Blix I.; Cooper J.; Debowska A.;
Erichsen K.; Fossum J.; Gjertsen E.; Grill V.; Gudnason S.; Hoye K.; Istad
H.; Winther J.; Joakimsen R.; Jorde R.; Larsen I.; Mella B.; Otterstad J.;
Risberg K.; Skare K.; Skeie S.; Sommervoll L.; Tandberg A.; Whitfield R.;
Wium C.; Cunanan E.; Fernando-Catindig E.; Gomez M.; Jaring C.;
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Cif A.; Ciomos D.; Cosma D.; Creteanu G.; Crisan I.; Danciulescu R.;
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A.; Carrique P.; Casquero M.; Castro M.; Cendali G.; Chatelain M.;
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L.; Flenche M.; Fracaro V.; Funosas C.; Garrido I.; Gomez Garrido A.;
Guzman A.; Izzicupo M.; Luca S.; Luciani C.; Majul S.; Moreno Cepeda I.;
Moschin Y.; Niemann G.; Novas V.; Olmi M.; Palma F.; Peralta A.; Puig A.;
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Vignau S.; Yanez K.; Zarate M.; Appeldorf R.; Batrouney B.; Bonner A.;
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Phillips J.; Price-Smith S.; Ryan S.; Stockle P.; Tapp E.; Taverner P.;
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Hofurthner A.; Kivioja P.; Kretschmer S.; Lener P.; Maiweg J.; Tscherner
D.; Weichelt H.; Winkler J.; Jones D.; Alves L.; Batista R.; Bernardes A.;
Demore de Souza A.; Ferraz R.; Ferreira A.; Freitas E.; Guanaes D.;
Kuschel K.; Muniz R.; Nasser-Hissa V.; Nhan P.; Osorio R.; Queirantes C.;
Reboucas R.; Souza C.; Tonani M.; Vicente C.; Zilli A.; Andersen K.; Aro
L.; Barber C.; Barnable B.; Berard L.; Bernier A.; Boudreault C.;
Bourbonnais A.; Bourgeois L.; Boutin D.; Boyer D.; Branco N.; Briol L.;
Brousseau M.; Burke M.; Chambers C.; Champoux A.; Chan S.; Colborne C.;
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V.; Kitagawa H.; Kooistra L.; Landry F.; Lapointe F.; Larrivee L.; Leonard
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D.; Schellenberg S.; Schellevis K.; Schmidt N.; Scott L.; Skarpinsky B.;
Smith B.; Smith E.; Stafford C.; Stata C.; Sternberg B.; St-Jean N.;
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Wall C.; Zaniol D.; Arau M.; Fuentes J.; Hidalgo J.; Landaeta O.; Padilla
I.; Sanzana S.; Tellos G.; Toro F.; Vergara R.; Che T.; Du Y.; He Y.;
Huang C.; Li H.; Liu S.; Luo X.; Ma Y.; Pan S.; Wan Q.; Wang H.; Wang S.;
Xie Y.; Xu X.; Xu Y.; Zhao F.; Zhou M.; Accini M.; Bello O.; Caceres A.;
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Martinez M.; Medina Ramos M.; Mejia C.; Montoya L.; Ramos C.; Restrepo P.;
Rodriguez D.; Santamaria A.; Valencia T.; Spanic V.; Borre Hansen A.;
Bulow M.; Ehlers G.; Frederiksen A.; Gottschalck H.; Hejlskov B.; Holm
Fruesnsgaard Pedersen L.; Hornum H.; Jansen S.; Johansen A.; Jorgensen A.;
Kjaeulff Svaneborg T.; Kruse A.; Lund K.; Lundgaard M.; Madsen J.; Meier
A.; Muurholm A.; Nedergaard A.; Nielsen S.; Norgaard D.; Olsen A.; Raae
D.; Reiter P.; Sigsgaard U.; Vestergaar I.; Witt A.; Mitt T.; Timmusk P.;
Heikkila E.; Heiskanen R.; Huotari E.; Keskitalo A.; Kylmala L.; Laitinen
M.; Laukkanen M.; Leskinen S.; Liesivuori J.; Lukkari-Kuronen L.; Merisalo
P.; Muurinen E.; Nikkanen P.; Niskanen T.; Pasanen P.; Pekkonen L.; Retsu
A.; Soppela A.; Andreu N.; Ankotche A.; Bairras C.; Boch C.; Camachon L.;
Cherchouly A.; Coudret S.; Demer C.; Gilg R.; Lemonade L.; Madec O.;
Pinotti D.; Poirier I.; Tenne N.; Vogler C.; Amman M.; Andratschke-Gentsch
B.; Beckmann H.; Bischoff S.; Bleich B.; Bueschges G.; Busch E.;
Deigentasch S.; Dietze S.; Dollinger M.; El-Bahay C.; Flehmig G.; Frenzel
I.; Geissler K.; Guerro J.; Heike B.; Holler D.; Inhoffen C.; Klein K.;
Kraehe I.; Kress P.; Krueger H.; Lenz R.; Linnebach B.; Lueck A.; Markhof
P.; Matthies K.; Meier C.; Metzler E.; Moor E.; Noll I.; Paulsen S.;
Pfeffer B.; Promnitz N.; Saljew B.; Schad S.; Schoner C.; Sellmann R.;
Tanis M.; Vogelbusch J.; Wagner E.; Winkler S.; Zenker K.; Zvork S.;
Balogh E.; Buncsikne Molnar S.; Gulyasne Gaspar E.; Herold M.; Kovacs E.;
Kozmane Paszternak A.; Maarne Nagy S.; Nagyne Zoltan A.; Nemeth Z.; Roth
T.; Rozsa I.; Szalai M.; Anuradha M.; Bawa T.; Bhaskar B.; Chalkhore S.;
Choudhary D.; Dhanalaxmi T.; Dhingra V.; Gayatri R.; Gnanasundram R.;
Gopal U.; Govindaraj S.; Indira P.; James S.; Karkuzhli K.; Koppikar V.;
Malhotra N.; Manmohan B.; Mazher A.; Menon R.; Nalini S.; Panda M.; Patel
K.; Poongothai S.; Ramanathan S.; Ramu I.; Sangeetha K.; Sankar K.;
Savitha; Seeli Abraham C.; Shrinivas K.; Sudha S.; Tripathi S.; Vaseem A.;
Yamuna A.; Banques R.; Chong J.; Courcy M.; Donnelly E.; Fauzi A.; Gately
M.; Hanlon G.; Kelly-Conroy M.; McAteer S.; McGovern G.; Meaney E.; Storey
S.; Todd M.; Aharonof-Segal M.; Aliazarov N.; Arbeli S.; Butbul E.; Chagai
E.; Confino K.; Domb L.; Dvir R.; Erez N.; Foiening O.; Frishberg A.;
Genin I.; Gertman R.; Golan L.; Grosberd A.; Hadad D.; Israeli S.;
Kaplunski Y.; Karpf D.; Katzir A.; Kivity Z.; Li L.; Livshitz L.; Nachmias
A.; Orr I.; Peer E.; Platner N.; Pritulo L.; Rojansky A.; Rosenblat T.;
Saranga H.; Schterchman G.; Shenhar S.; Shkliar T.; Stam T.; Stinmann S.;
Suliman A.; Tsirulnikov E.; Uziel K.; Weinshtock S.; Yedid-Am S.; Yuval
R.; Zuker S.; Brunella L.; Durante A.; Nada E.; Pugolotti M.; Robusto A.;
Testa M.; Toniato R.; Ha I.; Jung S.; Kim C.; Mi Ran K.; Song B.; Wi Y.;
Yang K.; You J.; Gaisute R.; Ozolina L.; Dzagajeva N.; Kasperaviciene V.;
Krikstaponiene Z.; Montviliene R.; Morkunaite K.; Piepoliene L.; Stoniene
E.; Stonkus S.; Ulpaityte I.; Arenas-Vanhorn M.; Espitia-Serrato L.;
Garcia-Munoz E.; Nunez V.; Sainz T.; Bakker H.; Danse I.; De Greef S.; De
Jong C.; De Wit M.; Didden E.; Dommerholt R.; Goddrie M.; Haazer C.;
Havenaar J.; Hendriks-Van Woerden M.; Jongenotter M.; Kort I.; Koster L.;
Kramer H.; Maarssen E.; Posthuma-Visscher M.; Reijnierse-Buitenwerf H.;
Rood P.; Swets E.; Tousain W.A.; Van Buchem-Damming G.; Van
Buijsen-Nutters A.; Van de Loo R.; Van den Hondel M.; Van den Berg A.; Van
der Knaap-van Keulen M.; Van der Zeijst M.; Van Setten-Van der Meer L.;
Von Bannisseht E.E.; Wouda Z.; Aarsland T.; Amlie L.; Andresen B.;
Bakketun A.; Bognaes A.; Botten C.; Coucheron S.; Halsne A.; Hansen H.;
Holthe T.; Husby E.; Iversen E.; Kvalvik A.; Landbakk T.; Lovseth E.; Moen
S.; Orvik E.; Ovrehus G.; Salater S.; Sorgard B.; Sorstrom A.; Tandberg
L.; Veiding B.; Vinje G.; Winge A.; Abquina G.; Patena B.; Reyes R.;
Tamondong A.; Vega A.; Vitug L.; Makuch M.; Torun A.; Adam A.; Basaraba
M.; Chira C.; Darida C.; Haica C.; Nedelcu A.; Patru D.; Patrut L.; Rau
I.; Rotaru N.; Szabo L.; Vrinceanu G.; Sovenko T.; Zatsevskaya O.;
Horynova Z.; Vankova L.; Barkhuizen M.; Barnard L.; Bekker D.; Botha D.;
Commerford A.; de Klerk A.; De Waal A.; Devchand S.; Drummond F.; Du Toit
A.; Du Toit S.; Ellis T.; Engelbrecht M.; Eramus T.; Fonda K.; Goosen A.;
Gopel E.; Govender P.; Hodge E.; Ismael F.; Jonker E.; Jonker L.; Joubert
A.; Kilian M.; Koegenlenberg N.; Lehner L.; Lingham R.; Llyod T.; Mangoeng
P.; Mapele S.; Meiring J.; Methusi P.; Mmethi M.; Mohamed K.; Moore A.;
Ndiweni H.; Parker F.; Schoneman J.; Smit M.; Steyn A.; Van Dongren J.;
Van Schalkwyk S.; Van Staden L.; van Wyngaard G.; Wolf A.; Ashbaugh R.;
Bande C.; Barquero R.; Gaspar R.; Martin E.; Megia B.; Rodriguez C.;
Seoane A.; Viaplana J.; Akesson Jacobsson I.; Andersson C.; Asperen M.;
Backlund M.; Berglund M.; Bjorck L.; Borjesson M.; Brolin G.; Danielsson
Frojd M.; Duckert A.; Eriksson K.; Fehling K.; Glaas A.; Hage C.; Hoglund
K.; Jernhed H.; Johansson K.; Johansson S.; Lidin M.; Lundell L.; Lundgren
C.; Magnusson K.; Matsson E.; Norman J.; Nystrom K.; Ojutkangas M.;
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M.; Soderlund M.; Stensgaard Nake E.; Torebo E.; Uggeldahl I.; Walldin C.;
Welin-Berger B.; Dwyer A.; Meyer-Lazzarini V.; Morello R.; Schefer M.;
Oney S.; Seker T.; Tavlayan S.; Appleby M.; Astin J.; Baker M.; Brann H.;
Brennan C.; Bryan L.; Campbell D.; Carey J.; Cox K.; Davis C.; Dyson B.;
Everdell R.; Gammon B.; Godden J.; Gray T.; Griffiths E.; Grimes Y.; Hall
D.; Hall K.; Holme A.; Howe J.; Lambley-Burke R.; Nation M.; Norcott K.;
Mitchell K.; Poxon S.; Quick C.; Shute C.; Thomas J.; Vinnell T.; Bawa S.;
Bogan C.; Fallye O.; Ginsberg J.; Gregory B.; House B.; Isonaga M.;
Keanne-Richmond P.; Kelly C.; Kimpel J.; Leiby A.; Lyons L.; McCoy B.;
Monk A.; Pelayo E.; Perron M.; Posey D.; Rehan M.; Suarez R.; Tilton L.;
Waite K.; White G.; Chacon R.; Meza Y.; Misticchio F.; Torres M.; Urbaneja
H.
Publisher
American Diabetes Association Inc. (E-mail: membership@diabetes.org)
Abstract
OBJECTIVE: The Outcome Reduction With Initial Glargine Intervention
(ORIGIN) trial reported neutral effects of insulin glargine on
cardiovascular outcomes and cancers and reduced incident diabetes in
high-cardiovascular risk adults with dysglycemia after 6.2 years of active
treatment. Omega-3 fatty acids had neutral effects on cardiovascular
outcomes. The ORIGIN and Legacy Effects (ORIGINALE) study measured
posttrial effects of these interventions during an additional 2.7 years.
RESEARCH DESIGN AND METHODS: Surviving ORIGIN participants attended up to
two additional visits. The hazard of clinical outcomes during the entire
follow-up period from randomization was calculated. RESULT(S): Of
12,537 participants randomized, posttrial data were analyzed for 4,718
originally allocated to insulin glargine (2,351) versus standard care
(2,367), and 4,771 originally allocatedto omega-3 fatty acid supplements
(2,368) versus placebo (2,403). Posttrial, small differences in median
HbA1c persisted (glargine 6.6% [49 mmol/mol], standard care 6.7% [50
mmol/mol], P = 0.025). From randomization to the end of posttrial
follow-up, no differences were found between the glargine and standard
care groups in myocardial infarction, stroke, or cardiovascular death
(1,185 vs. 1,165 events; hazard ratio 1.01 [95%CI 0.94-1.10]; P = 0.72);
myocardial infarction, stroke, cardiovascular death, revascularization, or
hospitalization for heart failure (1,958 vs. 1,910 events; 1.03
[0.97-1.10]; P = 0.38); or any cancer (524 vs. 529 events; 0.99
[0.88-1.12]; P = 0.91) or between omega-3 and placebo groups in
cardiovascular death (688 vs. 700; 0.98 [0.88-1.09]; P = 0.68) or other
outcomes. CONCLUSION(S): During >6 years of treatment followed by
>2.5 years of observation, insulin glargine had neutral effects on health
outcomes and salutary effects on metabolic control, whereas omega-3 fatty
acid supplementation had no effect. Copyright © 2016 by the
American Diabetes Association.

<47>
Accession Number
365300092
Title
Basal insulin and cardiovascular and other outcomes in dysglycemia.
Source
New England Journal of Medicine. 367 (4) (pp 319-328), 2012. Date of
Publication: 26 Jul 2012.
Author
Gerstein H.C.; Bosch J.; Dagenais G.R.; Jung H.; Maggioni A.P.; Pogue J.;
Probstfield J.; Ramachandran A.; Riddle M.C.; Ryden L.E.; Yusuf S.; Diaz
R.; Johnston P.; Vige R.; Birkeland K.; Budaj A.; Cardona E.; Chazova I.;
Commerford P.; Danilova L.; Davies M.; Fernando R.; Fodor G.; Gilbert R.;
Gomis R.; Hanefeld M.; Hildebrandt P.; Kacerovsky-Bielesz G.; Keltai M.;
Kim J.H.; Krum H.; Lanas F.; Lewis B.S.; Lonn E.; Marin-Neto J.; Marre M.;
McKelvie R.; McQueen M.; Mendoza I.; Morillo C.; Pan C.; Profozic V.;
Ratner R.; Richardson L.; Rosenstock J.; Spinas G.A.; Sreenan S.; Stoel
I.; Syvanne M.; Yale J.F.; Avezum A.; Bahit M.C.; Bogaty P.; Bordeleau L.;
Chacomicronn C.; Corson M.; Harper W.L.; Halon D.; Magloire P.; Mann J.;
Pavlova V.; Punthakee Z.; Silva J.; Tsang B.; Yakubovich N.; Abdallah A.;
Ahmad S.; Chandra J.; Chandra R.; Cukierman-Yaffee T.; Dyal L.; Joldersma
L.; MacRae L.; MacRae S.; Malik S.; Mead A.; Pasha F.; Pazmino-Canizares
J.; Pohl K.; Sakalas A.; Tyrwhitt J.; Ahuad Guerrero R.; Alebuena A.;
Alvarez N.; Alzogaray M.; Amuchastegui M.; Andres M.; Angos M.; Baglivo
H.; Barbieri M.; Bassi F.; Bello F.; Bono J.; Bustamante Labarta M.;
Bustos B.; Caccavo A.; Calveira M.; Camino A.; Cantero M.; Capozzi M.;
Cardone M.; Cartasegna L.; Cassetari A.; Castellanos R.; Chavez Caballero
R.; Cipullo M.; Contreras A.; Coria J.; Corinaldesi F.; Costa G.; Crespo
C.; Cruz M.; Cuello J.; Cuneo C.; Del Corro I.; Diez R.; Dituro C.;
Dominguez A.; Facta A.; Faingold C.; Farah M.; Fares Taie A.; Fernandez
A.; Ferrari A.; Ferrari N.; Garcia Monteverde C.; Garrido M.; Giachello
C.; Gonzalez M.; Gutierrez N.; Guzman L.; Guzman P.; Hasbani E.; Henquin
R.; Hershon A.; Hirschon Alvarez Prado A.; Hominal M.; Hrabar A.; Imposti
H.; La Grutta M.; Lanchiotti P.; Lobo Marquez L.; Lopez Santi R.;
Lowenstein J.; Lugo M.; Luqueci M.; Mainini S.; Majul C.; Manzano R.;
Manzur S.; Marcucci G.; Marino M.; Massari F.; Mendez N.; Molina M.;
Montana O.; Mulazzi M.; Nardone L.; Odetto I.; Orlandini A.; Oviedo A.;
Paez O.; Parnas A.; Patron F.R.; Pedernera C.; Pelagagge M.; Plastino M.;
Polari P.; Pomposiello J.; Porta A.; Prado A.; Quiroz M.; Ramirez A.;
Rodriguez M.; Ronderos R.; Sago L.; Sanchez A.; Sanchez R.; Sandrin A.;
Schygiel P.; Sernia V.; Sinay I.; Smith Casabella T.; Sosa Liprandi A.;
Sosa Liprandi M.; Soso L.; Sposetti G.; Stisman D.; Streitenberger P.;
Suarez G.; Tonin H.; Ulla M.; Valdez J.; Vico M.; Villamil A.; Villarino
A.; Viscaya Castro A.; Visco V.; Vogel D.; Waisman F.; Zaidman C.; Amerena
J.; Applebe A.; Aylward P.; Binnekamp M.; Bruce I.; Burdeniuk C.; Burnet
R.; Colman P.; Colquhoun D.; Davis S.; De Looze F.; De Pasquale C.;
D'Emden M.; Eaton H.; Farshid A.; Foulanos S.; Galanos J.; Gordon G.; Guhu
M.; Ho J.; Jeffery I.; Jerums G.; Kwan M.; Lefkovits J.; Luu S.; MacIsaac
R.; Marjason J.; Mohabbati V.; Nankervis A.; O'Neal D.; Perera N.; Poynten
A.; Rahman A.; Razak S.; Roberts T.; Sebastian M.; Simpson R.; Soldatos
G.; Sullivan D.; Teede H.; Tiong F.; Topliss D.; Torpy D.; Waddell-Smith
K.; Waites J.; Wenman J.; Whelan A.; Williams L.; Yeap B.; Yeow W.; Yong
G.; Aczel S.; Azimy N.; Bertha P.; Blocher J.; Bohnel C.; Brath H.; Breuss
J.; De Campo A.; Drexel H.; Ettmuller Y.; Feder A.; Feinboeck C.; Gulz E.;
Hofmann M.; Hoppichler F.; Jahnel H.; Jankovic V.; Kann T.; Kathrein T.;
Kotter T.; Kratz E.; Kreuzwieser E.; Loreck C.; Ludvik B.; Marte T.;
Mellitzer K.; Nistler S.; Placher-Sorko G.; Prager R.; Rein P.; Riedl M.;
Saly C.; Schernthaner G.; Schichka E.; Seidlhofer C.; Sonnenfeld M.;
Stefan H.; Steiner K.; Thomas B.; Toplak H.; Urstoger K.; Vetter B.;
Vonbank A.; Waldschutz W.; Wallner F.; Winkler F.; Goncharik D.; Lazareva
I.; Lichorad N.; Mrochek A.; Murashko N.; Radyuk D.; Ramanovski A.;
Sudzhaeva S.; Sujayeva V.; Yarashevich N.; Campbell G.; Marshall S.; West
A.; Abreu F.; Alves M.; Ayoub-Aidar J.; Barros M.; Barros-Silveira J.;
Blacher M.; Costa E.; Costa F.; Daltro C.; Delana J.; Eliaschewitz F.;
Facanha C.; Feitosa G.; Figueiredo J.; Forti A.; Franco D.; Franken M.;
Freire F.; Garcia V.; Gouvea-Neto A.; Grofallo S.; Kanedlai N.;
Kerr-Saraiva J.; Ladeira R.; Leaes P.; Lemos M.; Lima F.; Lima Filho M.;
Macedo L.; Manenti E.; Monte O.; Mossman A.; Mothe F.; Mouco O.; Moyses
Golbert M.; Nasser Hissa L.; Nasser-Hissa M.; Nicolau J.; Nigro Maia L.;
Ninno T.; Nunes C.; Oliveira C.; Oliveira O.; Passos da silva R.;
Pericles-Esteves J.; Rabelo L.; Rabelo-Alves Junior A.; Rassi S.; Rech R.;
Roldan F.; Salles J.; Sampaio C.; Seabra A.; Sealissi N.; Seixas A.; Sena
R.; Shehadeh I.; Teixeira M.; Turin H.; Vicente Serrano C.; Vidigal M.;
Vilela M.; Wajchenberg B.; Abbott C.; Abu-Bakare A.; Ardilouze J.;
Auersperg E.; Bailey A.; Bailey G.; Baillargeon J.; Beaurivage C.; Belair
J.; Belanger A.; Bellabarba D.; Berlingieri J.; Bernier F.; Bhargava R.;
Bhesania T.; Booth W.; Bose S.; Boulianne M.; Bourgeois S.; Breton D.;
Brossoit R.; Buithieu J.; Campeau J.; Carlson B.; Carpentier A.;
Cavalcanti R.; Cha J.; Chagnon P.; Chan Y.; Chessex C.; Chiasson J.;
Chouinard S.; Clayton D.; Conway J.; Crepeau J.; Cudmore D.; D'Ignazio G.;
Doig G.; Dominguez M.; Dube F.; Dumas R.; Dupuis R.; Dyrda I.; Eddy D.;
Eiley D.; Fox H.; Fratesi S.; Gallant S.; Garceau C.; Garfield N.; Germain
C.; Glazer S.; Gosselin G.; Gould D.; Grills G.; Halle J.; Hardin P.;
Harper W.; Heath J.; Heath V.; Hivert M.; Ho K.; Houde G.; Hramiak I.;
Hutchinson A.; Huynh T.; Ilie-Haynes R.; Imran S.; Islam A.; Iwanochko M.;
Jones C.; Joyce C.; Kirouac I.; Kumar R.; Lamothe M.; Langlois M.; Lauzon
C.; Lavoie M.; Leader R.; Lecours S.; Lepage S.; Lochnan H.; Ma P.; McLean
A.; Mecci S.; Mehta P.; Mercier M.; Miller D.; Morisset A.; Nawaz S.;
Nisker W.; Nyomba G.; O'Keefe D.; Palardy J.; Parekh P.; Paul T.; Perron
P.; Pesant M.; Phillips R.; Pruneau G.; Quintin I.; Raby K.; Richard C.;
Rosenfeld G.; Saulnier D.; Shaban J.; Shah A.; Shu D.; Sigal R.; Silverman
M.; Singh J.; Sivucha W.; Skamene A.; Sliwowicz D.; Smith R.; St Hilaire
R.; Steinson D.; Sussex B.; Tan K.; Tannous R.; Telner A.; Theroux P.;
Tsoukas C.; Tsoukas G.; van Buuren J.; VanRossum N.; Vexler R.; Vizel S.;
Warnica W.; Weingert M.; Wilson R.; Wong W.; Woo V.; Yale J.; Acevedo M.;
Alwyn C.; Baier E.; Baier S.; Galloso R.; Lahsen R.; Lorenas G.;
Montecinos A.; Montecinos M.; Pineda P.; Pollak F.; Sapunar J.; Serrano
V.; Stockins B.; Varleta P.; Yovanovich J.; Zambra F.; Ba J.; Bao Y.; Bi
Y.; Bu S.; Chen B.; Chen H.; Chen J.; Chen L.; Chen M.; Chen Y.; Cui J.;
Dong M.; Feng P.; Feng Z.; Gao C.; Gao F.; Gao X.; Gao Z.; Gong Y.; Guang
L.; Guo X.; Han F.; Han X.; Hou X.; Hu R.; Ji L.; Jia J.; Jia W.; Jiao X.;
Jin X.; Kuang J.; Li M.; Li Q.; Li X.; Li Y.; Ling Y.; Liu F.; Liu Z.; Lu
B.; Lu J.; Lu Z.; Lv X.; Ning G.; Peng Y.; Ren Y.; Shao Y.; Shi Y.; Shu
X.; Sun H.; Sun L.; Sun X.; Tang K.; Tian H.; Wang C.; Wang F.; Wang L.;
Wang Q.; Wang W.; Wang X.; Wang Y.; Wen J.; Wu C.; Wu H.; Wu J.; Wu M.;
Xing X.; Xue Y.; Yan L.; Yan S.; Yang H.; Yang N.; Yang W.; Yang Z.; Yao
J.; Yao L.; Yu D.; Yu H.; Yu M.; Yu X.; Yuan L.; Yuan M.; Yuan S.; Yuan
W.; Yuan Y.; Yuan Z.; Zeng T.; Zhang J.; Zhang R.; Zhang X.; Zhao L.;
Zheng B.; Zheng J.; Zhou W.; Zhu N.; Zhu Y.; Zou D.; Zou J.;
Lopez-Jaramillo P.; Accini J.L.; Bohorquez R.; Botero R.; Cure C.;
Figueredo M.; Hernandez E.; Kattah W.; Llamas A.; Orozco L.; Pava L.;
Perez M.; Pineda M.; Quintero A.; Quiros R.; Urina M.; Velez S.; Altabas
V.; Baotic I.; Berkovic M.; Goldoni V.; Kerum T.; Mirosevic G.; Tarle D.;
Vidovic I.; Zjacic-Rotkvic V.; Abbas R.; Andersen H.; Auscher S.; Baumbach
L.; Brockstedt H.; Christensen P.; Christiansen M.; Clemmensen K.; Egstrup
K.; Gislason G.; Haar D.; Hansen K.; Heden Andersen P.; Helleberg K.;
Hermansen K.; Holmer J.; Jeppesen J.; Klausen I.; Koustrup-Sonder T.;
Krarup T.; Lerche S.; Lervang H.; Linde B.; Lund P.; Lund S.; Madsbed S.;
Molvig J.; Orskov C.; Ostergaaard O.; Perrild H.; Pietraszek A.; Ralfkjaer
N.; Roenne H.; Rokkedal Nielsen J.; Seibaek M.; Soendergaard H.; Sorensen
L.; Sundahl Mortensen L.; Torp-Pedersen C.; Tuxen C.; Urhammer S.;
Vadstrup E.; Pirags V.; Ambos A.; Janson A.; Rudenko P.; Viitas L.; Aranko
S.; Badeau M.; Eriksson J.; Haapamaki H.; Kajander O.; Kuusisto A.;
Luukkonen S.; Makela J.; Nieminen S.; Niskanen L.; Ripatti J.;
Ruotsalainen S.; Saltevo J.; Savela K.; Strand J.; Valle T.; Virkamaki A.;
Aboud E.; Alavoine L.; Bekherraz A.; Bohme P.; Bourezane H.; Catargi B.;
Charpentier G.; Clergeot A.; Courreges J.; Delmas T.; Duengler F.; Feknous
C.; Gendre D.; Guerci B.; Hadjadj S.; Kerlan V.; Laguerre N.; Le Potier
J.; Lombardo F.; Malville E.; Marechaud R.; Mattei C.; Moreira J.;
Penfornis A.; Petit C.; Pinel J.; Piquel X.; Raccah D.; Reznik Y.; Rod A.;
Roudaut N.; Rousseau E.; Schillo F.; Schmitt B.; Sonnet E.; Torremocha F.;
Travert F.; Vanhoute C.; Vimeux M.; Abdollahnia R.; Adamidou A.; Arslan
S.; Bach-Kliegel B.; Bartusch B.; Bauer N.; Bieler T.; Blankenfeld H.;
Boeckmann U.; Busch K.; Butzer R.; Chenchanna-Merzhaeuser M.; Denger R.;
Deutsch C.; Diessel S.; Donati-Hirsch I.; Dornisch M.; Enghofer K.; Fleig
T.; Forst T.; Frommherz M.; Goeller K.; Habbig J.; Hadziselimovic S.;
Hamann A.; Hampel T.; Heger S.; Helmes C.; Hoffman C.; Hohberg C.; Humpert
P.; Kamke A.; Kamke W.; Kindermann P.; Klein C.; Klein D.; Koehler A.;
Kuehn A.; Langer K.; Limmer S.; Loew A.; Maimer A.; Marck C.; Meier G.;
Methner-Friederich M.; Metzler W.; Meyer K.; Miftari N.; Milde J.; Minnich
J.; Molkewehrum M.; Morcos M.; Mueller-Hoff C.; Nguyen M.; Nishwitz M.;
Oldenburg J.; Ott P.; Pauli K.; Pauly B.; Pfeiffer A.; Pfuetzner A.;
Pischa U.; Radke R.; Reismann P.; Riemer M.; Rochlitz H.; Rudofsky G.;
Ruhla S.; Sammler A.; Schaper F.; Schiemenz K.; Scholz G.; Schumm-Draeger
P.; Segiet T.; Segner A.; Seissler J.; Spahn S.; Stier U.; Tonon G.; von
Amelunxen S.; von Schacky C.; Wilhelm B.; Wilhelm K.; Witt K.;
Wuechner-Hofmann S.; Baranyai M.; Birkus Z.; Foldesi I.; Gaal Z.; Harcsa
E.; Hati K.; Hohmann Z.; Istenes I.; Jozsef I.; Juhasz E.; Kempler P.;
Keresztes B.; Keresztes K.; Kis-Gombos P.; Kovacs I.; Kozma T.; Laszlo Z.;
Noori E.; Nyirati G.; Papp Z.; Patkay J.; Poor F.; Pusztai P.; Putz Z.;
Rigo E.; Sereg M.; Simon K.; Somogyi A.; Sumegi J.; Szabo A.; Szabo J.;
Szigeti S.; Szilveszter D.; Tarko M.; Varga C.; Varga Szabo L.; Voros P.;
Arathi; Aravind S.; Badgandi M.; Balaji M.; Balaji V.; Chamukuttan S.;
Devi Manduva P.; Fatima S.; Ganapathy B.; George O.; George P.; Jaffar M.;
Jain P.; Kamath P.; Karthik V.; Koshy G.; Krishnan L.; Kumar H.; Lal P.;
Mithal A.; Modi S.; Mohan V.; Moses V.; Oomen R.; Pais P.; Pati P.;
Pendsey S.; Rai P.; Rajagopal R.; Ramu M.; Ranjit U.; Rao P.; Senthil V.;
Seshaiah V.; Sethi B.; Shah P.; Sharma R.; Shetty S.; Shobha A.; Siddharth
R.; Sridhar G.; Sudeep K.; Sunil C.; Sunitha S.; Suresh S.; Thomas N.;
Vageesh A.; Anwer Z.; Barton J.; Behan L.; Bell M.; Cullen M.; Dineen S.;
Draman Yusof M.; Dunne F.; Gibney J.; Hussain T.; Khan M.; Kinsley B.;
Kyithar P.; Lavin F.; McGowan A.; McGurk C.; Mirza A.; Mohammadi B.;
O'Brien T.; O'Connell J.; O'Halloran D.; O'Shea D.; Roberts G.; Tomkin G.;
Wan Mahmood W.; Abramod-Ness R.; Adawi F.; Aharon B.; Backer M.;
Beniashvili A.; Berliner A.; Bloch L.; Bugelman D.; Butnaru A.; Cohen O.;
Cohen Y.; Frenkel M.; Glant M.; Gustava B.; Guttman H.; Halabi S.;
Harman-Boehm I.; Ilany J.; Karkabi B.; Khader N.; Khaskia A.; Khudyak Y.;
Klainman E.; Kogan N.; Lender D.; Levin I.; Mardi T.; Marmor A.; Mosseri
M.; Nabriski D.; Omary M.; Orlovsky S.; Peres D.; Quasim M.; Raz I.;
Remesnik M.; Rogowski O.; Rozenfeld I.; Scharr D.; Shnifer I.; Shuster T.;
Solomon R.; Steiner H.; Tzivoni D.; Wolfson N.; Yossef Z.; Zahger D.;
Zeltser D.; Zimlichman R.; Aina F.; Ariatti C.; Bonetti R.; Cacciatore F.;
Calcinaro F.; Corona G.; De Maria P.; Del Prato S.; Derosa G.; Di Pasquale
G.; Falorni A.; Fanelli R.; Fedele D.; Filorizzo G.; Fogari R.; Furgi G.;
Ghio A.; Giorda C.; Gregori G.; Iannuzzi G.; Lapolla A.; Luciano B.;
Lucotti P.; Maggi A.; Marafetti L.; Marchese T.; Martino G.; Marzotti S.;
Miccoli R.; Monti L.D.; Moretti L.; Palvarini M.; Petacchi R.; Piarulli
F.; Piatti P.M.; Rudi S.; Santeusanio F.; Sesti G.; Setola E.; Sforza A.;
Shehaj E.; Veniani M.; Viviani G.; Zigoura E.; Chae S.; Cho D.; Cho E.;
Cho Y.; Choi Y.; Chung M.; Hong E.; Hong Y.; Jeong M.; Kim B.; Kim D.; Kim
H.; Kim I.; Kim J.; Kim P.; Kim S.; Koo B.; Kwok S.; Kwon H.; Lee J.; Lim
J.; Oh S.; Ohn J.; Park C.; Park H.; Park K.; Seung K.; Son H.; Woo J.;
Yoon K.; Ansmite B.; Balcere I.; Bumbure A.; Ducena K.; Lejnieks A.; Rasa
I.; Ritenberga R.; Romanova M.; Salmina I.; Steina S.; Badariene J.;
Gailiuniene S.; Grigonis S.; Juskiene R.; Petrulioniene Z.; Sakalyte G.;
Stasiunas T.; Sulskiene M.; Urbonaite B.; Zarankiene R.; Ziukaite R.;
Arechavaleta R.; Beltran-Jaramillo T.; Calvo-Vargas C.; Campillo-Cardenas
C.; Cardona D.; Carmona-Huerta J.; Cedano-Limon M.; Comellas-De M.;
Dominguez C.; Gomez-Cruz J.; Gonzalez-Perez R.; Illescas J.; Jimenez-Ramos
S.; Lopez-Alvarado A.; Marquez-Rodriguez E.; Martinez G.; Pascoe S.;
Plascencia Vazquez O.; Rodriguez H.; Ruiz-Cornejo M.; Velasco-Sanchez G.;
Vidrio-Velazquez M.; Villeda-Espinosa E.; Badings E.; Bartels G.;
Bruggink-Andre de la Porte P.; Bruijns E.; Cornel J.; De Milliano P.; De
Mulder M.; De Swart J.; Derks A.; Dirkali A.; Droste J.; Galjee M.;
Hautvast R.; Hermans W.; Holwerda N.; Ilmer B.; Kofflard M.;
Kooistra-Huizer J.; Kurvers M.; Langerveld J.; Leenders C.; Liem A.; Lok
D.; Neumann D.; Nierop P.; Plomp K.; Posma J.; Reichert C.; Roeters Van
Lennep H.; Ronner E.; Said S.; Takens L.; Umans V.; Van der Sluis A.A.;
Van der Zwaan C.; Van Dobbenburgh J.; Van Es A.; Van Hessen M.; Van
Mechelen R.; Van Miltenburg-Van Zijl A.; Van Zeijl L.; Veerhoek M.;
Viergever E.; Weijers E.E.; Willems F.; Blix I.; Cooper J.; Debowska A.;
Erichsen K.; Fossum J.; Gjertsen E.; Grill V.; Gudnason S.; Hoye K.; Istad
H.; Winther J.; Joakimsen R.; Jorde R.; Larsen I.; Mella B.; Otterstad J.;
Risberg K.; Skare K.; Skeie S.; Sommervoll L.; Tandberg A.; Whitfield R.;
Wium C.; Cunanan E.; Fernando-Catindig E.; Gomez M.; Jaring C.;
Lantion-Ang F.; Licaros M.; Lim-Abrahan M.; Madronio E.; Panelo A.; Raboca
J.; Ramos G.; Tugna S.; Aksamit-Bialoszewska E.; Bandurska-Stankiewicz E.;
Baranska M.; Bronisz A.; Bronisz M.; Chrustowski W.; Cieslak B.;
Czupryniak L.; Drazkowicz-Gozdzik B.; Galuszka-Bilinska A.; Gmytrasiewicz
M.; Janik K.; Jedynasty K.; Kania G.; Kawka-Urbanek T.; Kinalska I.;
Kincel K.; Kleszczewska U.; Kruszewski J.; Loba J.; Malicka J.;
Mielecka-Kincel M.; Milczarczyk A.; Milosz D.; Mrowczynska A.; Mytnik M.;
Nowakowski A.; Nowakowski P.; Oleskowska L.; Omelanczuk-Wiech E.;
Pawlowski M.; Poplawska A.; Rucinska M.; Rucinski M.; Rutkowska J.;
Saryusz-Wolska M.; Siewko K.; Sikora-Frac M.; Stecka-Wierzbicka J.;
Swiatkowski M.; Swierczynski R.; Szpajer M.; Szymkowiak K.; Tarach J.;
Tarasiewicz U.; Wiatr D.; Wojewoda P.; Woszczak-Marcinkowska H.; Zadrozny
J.; Hancu N.; Albota A.; Bala C.; Barbonta D.; Botnariu G.; Bradescu O.;
Busegeanu M.; Bzduch M.; Catrinoiu D.; Caziuc R.; Cerghizan A.; Cheta D.;
Cif A.; Ciomos D.; Cosma D.; Creteanu G.; Crisan I.; Danciulescu R.;
Dobjanschi C.; Dodan R.; Duma L.; Ferariu I.; Ghenes T.; Ghise G.; Graur
M.; Ilinca M.; Marton R.; Mindrescu N.; Morosanu A.; Morosanu M.; Mota M.;
Nafornita V.; Negrisan G.; Nicodim S.; Nicolau A.; Nita C.; Onaca A.;
Panus C.; Pletea N.; Pop C.; Pop L.; Popa B.; Roman G.; Rosu M.; Sandu N.;
Serban V.; Sima A.; Stamoran L.; Strugariu M.; Suciu G.; Szilagyi I.;
Vacaru G.; Veresiu I.; Vlad A.; Adasheva T.; Ageev F.; Akhmedganov N.;
Akinina A.; Alexandrov A.; Ambatiello L.; Ametov A.; Ausheva A.; Babaeva
L.; Babenko A.; Balyasnikova E.; Bart B.; Belova J.; Berstein L.;
Bondarenko I.; Bondarev E.; Bulkina O.; Chernikova N.; Chumak B.; Deeva
T.; Demicheva O.; Demidova T.; Doskina E.; Duganova A.; Dzhaiani N.;
Egorova I.; Ettinger O.; Feofanova S.; Fofanova T.; Galaktionov P.;
Gavrilova N.; Gilyarevsky S.; Gnidkina N.; Golubev A.; Gornyakova N.;
Grigorova S.; Grineva E.; Gurevich V.; Irtuganov N.; Ivanova L.; Jaiani
N.; Kalashnikova M.; Karpov Y.; Khalimov Y.; Khorocheva G.; Kirillova E.;
Kistner J.; Kobalava Z.; Kochergina I.; Kravchenko T.; Krylov K.; Kulkova
P.; Kuparev I.; Kurbanova E.; Lysenko T.; Markovich A.; Martyanova I.;
Martynyuk T.; Masiinvets M.; Mavlyavieva E.; Maychuk E.; Melnichenko G.;
Mikhailusova M.; Mkrtumyan A.; Mychka V.; Nebieridze D.; Nesterova E.;
Orlov V.; Orlova V.; Orlova Y.; Papov F.; Patroucherva I.; Petunina N.;
Pirozhinskaya S.; Podachina S.; Postnikova S.; Pshikova O.; Rogova L.;
Romashevskiy B.; Runikhina N.; Sadulayeva I.; Safaryan A.; Sakovich E.;
Saprikina T.; Sargsyan V.; Semikozova O.; Shkolnik E.; Shubina A.; Shustov
S.; Sinitsina I.; Solovyeva E.; Storogakov G.; Stovpyuk O.; Sussekov A.;
Telnova M.; Temirov A.; Terekhov V.; Tereschenko S.; Tiourina T.;
Tolkacheva V.; Tsoy U.; Urazgyldeeva S.; Vasyuk Y.; Vinnitskay N.;
Voevodina E.; Volkova A.; Zadionchenko V.; Zalevskaya A.; Zhelninova T.;
Zhukova N.; Zilov A.; Bernatova J.; Duris T.; Markova I.; Martinka E.;
Michalova L.; Minarik P.; Peter L.; Raslova K.; Silvia D.; Subadova M.;
Tisonova J.; Vohnout B.; Adam M.; Badat A.; Bester A.; Bester F.; Blacking
L.; Bouwer D.; Brice B.; Cassimjee S.; Cronje T.; Deftereos J.; Distiller
L.; Ellis G.; Forster O.; Fulat M.; Gani M.; Gibson G.; Hansa S.;
Hendricks N.; Herbst L.; Hitzeroth J.; Joffe B.; Kelbe C.; Kelbe D.; King
J.; Kramer B.; Landau S.; Levitt N.; Meyer-Nell S.; Moore R.; Muller D.;
Nell H.; Omar M.; Randeree H.; Seeber M.; Seedat; Segynu D.; Siebert M.;
Van den Berg E.; Van der Walt P.; Van Dyk C.; Van Niekerk F.; Van Zyl L.;
Wellman H.; Bertomeu V.; Botella M.; Buno M.; Calle A.; Cano Perez J.;
Coves M.; Juanatey J.G.; Garcia-Mayor R.; Gaztambide S.; Gippini A.;
Goikolea I.; Gonzalez J.; Hillman N.; Lopez Garcia Aranda V.; Magueda I.;
Mato J.; Mazon P.; Morillas P.; Novials A.; Pallardo L.; Perez L.;
Rodriguez J.; Romero L.; Sagarra E.; Shamagian L.; Soto A.; Torrealday H.;
Valero R.; Agergaard S.; Agewall S.; Andersson K.; Bergstrom O.;
Bjornstedt Bennermo M.; Blomgren J.; Boman K.; Brohall G.; Cherfan C.;
Dahlen C.; Dotevall A.; Enander P.; Ericsson U.; Hallgren P.; Hansson A.;
Henareh L.; Henriksson P.; Herlitz J.; Holmqvist J.; Jarevi G.; Linderfalk
C.; Jonasson L.; Jovinge S.; Kalen J.; Kilstrup M.; Leosdotir M.; Leppert
J.; Ljungberg J.; Lofdahl B.; Lundman P.; Lysell-Bergstrom C.; Mathiesen
U.; Mellbin L.; Morner S.; Nathanson D.; Nilsson L.; Peterson M.;
Quittenbaum S.; Rosengren A.; Ryttberg B.; Scheel S.; Svensson K.; Tenerz
A.; Vasko P.; Waldenstrom A.; Wieloch M.; Spinas G.; Braendle M.; Felix
B.; Gerber P.; Moccetti T.; Pitteloud N.; Kultursay H.; Aydinalp A.; Balci
M.; Cayli M.; Hatipoglu E.; Ilkova H.; Kayikcioglu M.; Koc M.;
Muderrisoglu H.; Sari R.; Saygili F.; Tekin K.; Tutuncu N.; Yurekli B.;
Adler A.; Ali A.; Balasubramanian; Bandypadhyay P.; Barakat O.; Barnett
A.; Borthwick L.; Brookes; Burton J.; Cecil J.; Chaterjee S.; Clark J.;
Collinson D.; Collinson S.; Crasto W.; Donnelly R.; du Plessis J.; Egan
S.; Ellery A.; Evans R.; Ewing J.; Fox C.; Gibson M.; Hall T.; Higgs E.;
Hollway M.; Hughes E.; Jackson N.; Jalihawi H.; Jones G.; Knights H.;
Korsheed S.; Kumar Singh R.; Laithwaite D.; Lawrence I.; Litchfield J.;
Manning G.; McNally P.; Millar-Craig M.; Mohammed I.; Narayanan R.; Nayani
G.; Norris A.; Purohit J.; Quinn M.; Ramtoola; Randall J.; Rea R.;
Reckless J.; Richardson T.; Robertson D.; Robinson A.; Salem K.; Sampson
M.; Savage M.; Shaker J.; Srinivasan T.; Tracy I.; Tringham J.; Viljoen
A.; Ward A.; Waterhouse H.; Wijenaike N.; Wiles P.; Ahmann A.; Ahmed I.;
Alam A.; Arakaki R.; Asad S.; Banarer S.; Baum H.; Belew K.; Bergenstal
R.; Bethel M.; Boyer C.; Catton S.; Challans P.; Childs B.; Christian R.;
Clement S.; Cuddihy R.; Dailey G.; Damberg G.; De Bold C.; De Lemos J.;
Donovan D.; Dudl J.; Dunbar J.; Ebner S.; Failor R.; Feinglos M.; Flaker
G.; Freiburghaus M.; Furlong K.; Gardner D.; Gillespie E.; Goland R.;
Goldberg R.; Gotham A.; Guthrie R.; Hamaty M.; Hirsch I.; Jabbour S.;
Janci M.; Javorsky B.; Jones S.; Kamana V.; Kashyap M.; Kaufman S.; Kearns
P.; Khera A.; Klopfenstein B.; Kniffen W.; Kringas P.; Licata A.;
Lopez-Jimenez C.; Madden M.; Marx C.; McCall A.; McCallum J.; McFarlane
S.; McGuire D.; Melish J.; Meneghini L.; Miller S.; Miranda-Palma B.;
Mitchell R.; Nasr C.; Nelson J.; Niblack P.; Nylen E.; Osei K.; Pandey A.;
Papademetriou V.; Pilar Solano M.; Sameshima L.; Savarese V.; Schnure J.;
Schuster D.; Shin J.; Taylor A.; Thomson P.; Ting-Ryan M.; Trence D.; Vo
A.; Weiland K.; Wells K.; Wu P.; Zimering M.; Zimmerman R.; Ascanio P.;
Brajkovich I.; Carrillo E.; Coll J.; Gonzalez K.; Gonzalez N.; Jimenez E.;
Lopez R.; Marante D.; Morr I.; Paolillo M.; Perche D.; Portillo M.;
Valbuena H.; Velarde M.; Vergara G.; Augensen N.; Azzalina J.; Fidaly S.;
Bollero G.; Casiello A.I.; Ferraro F.; Guridi M.J.; Ines M.; Martin M.E.;
Pascual A.; Pereyra J.; Toscanelli M.; Appiah M.; Grech S.; Pouras S.;
Watts C.; Denke E.; Feik C.; Litvinenko M.; Platonenko O.; Shadur S.;
Johnson J.; Bonilla E.; Carraway B.; Faith J.; Greer C.; Harding A.;
Heston J.; Lin Y.; Mecca T.; Schuler M.; Rizk C.; Sissoko A.; Strickland
K.; Andrade A.; Lux L.; Machado D.; Mancin E.; Aquino J.; Belanger B.;
Bourque C.; Gagnier K.; Hagerimana A.; McNeil A.; Osachoff J.; Richard B.;
Rogan J.; Styner L.; Maturana X.; Naranjo M.E.; Li E.; Liu Q.; Shuai M.;
Tan Z.; Tang M.; Zhao J.; Ardila M.; Gomez A.M.; Uscategui A.M.;
Marinkovic N.; Miocevic V.V.; Pezo S.; Andersen I.; Bastrup-Larsen B.;
Jeppesen E.; Kofoed-Djursner M.; Joe H.; Hiironen V.; Tarvainen M.; Von
Hedenberg H.; Guillarme C.; Rastelli O.; Roy P.; Igel L.; Lenz T.; Leptich
A.; Peikert S.; Domokos S.; Szotyorine-Polcza G.; Wenczl M.; Chaudhary S.;
Jaiswal G.; Khatri P.; Shah K.; Gibson S.; Bechar Y.; Erdheim D.; Eyal N.;
Frankel M.; Shimoni S.; Tsuri J.; Bianco L.; Cali R.; Sganga P.; Jang M.;
Kim J.M.; Kim Y.; Lim S.; Park J.S.; Song Y.; Kalve E.; Dienyte E.;
Alvarado F.; Rodriguez R.; Bar J.; Lijfering-Lorie K.; Palstra M.; Van der
Kuijl K.; Van de Wetering A.; Eriksen S.; Hejazifar S.; Jendeberg A.;
Johannessen G.; Khammari I.; Meredith E.L.; Dayag A.M.; Figueroa P.;
Hoffmann Korpalska A.; Przemyk M.; Craciunescu A.; Lupu D.; Osanu A.;
Popscu L.; Toader C.; Kirsanova T.; Timoshina E.; Gomez B.; Jankularova
I.; Brett S.; Meyer A.; Pereira V.; Vawda N.; Castano B.; Farre Avella
J.M.; Jimenez I.; Turet N.; Froberg M.; Reppert E.; Wessman S.; Boschung
Y.; Carrozzino F.; Gerstl K.; Cetin Z.; Demirci S.; Ovalioglu S.; Lenehan
A.; McLean H.; Mutsaers K.; Redfern P.; Scoggins A.; Isea Y.; Alvarez M.;
Alvarez D'Amelio A.; Aqueveque S.; Argenta M.; Aviles A.; Barreiro E.;
Battistessa Y.; Bergamo S.; Bertran B.; Bocanera M.; Bowen L.; Brescia H.;
Caceres M.; Cappi A.; Cardelli A.; Carolini E.; Carpintero S.; Carrique
A.; Carrique P.; Casquero M.; Castro M.; Cendali G.; Chatelain M.;
Costanzi A.; Cristofaro C.; Crunger P.; Ehrich S.; Espinosa M.; Esposito
L.; Flenche M.; Fracaro V.; Funosas C.; Garrido I.; Gomez Garrido A.;
Guzman A.; Izzicupo M.; Luca S.; Luciani C.; Majul S.; Moreno Cepeda I.;
Moschin Y.; Niemann G.; Novas V.; Olmi M.; Palma F.; Peralta A.; Puig A.;
Rodera Vigil M.; Ronderos G.; Rosell M.; Samudio M.; Santicchia C.;
Szczygiel V.; Takla M.; Tinnirello C.; Tonin S.; Tristan A.; Troncoso C.;
Vignau S.; Yanez K.; Zarate M.; Appeldorf R.; Batrouney B.; Bonner A.;
Bonner M.; Cahill P.; Carr J.; Caruana M.; Chare J.; Doran A.; Flavel;
Gein J.; Griek S.; Hulley A.; Keays P.; Kent S.; Lai N.; Legg H.; Long A.;
Lynch L.; Maxwell V.; McNamara K.; Nairn J.; Nichols V.; Peeler C.;
Phillips J.; Price-Smith S.; Ryan S.; Stockle P.; Tapp E.; Taverner P.;
Tulloch G.; Viola V.; Wilson L.; Beck A.; Damon S.; Drexel V.; Grabner E.;
Hofurthner A.; Kivioja P.; Kretschmer S.; Lener P.; Maiweg J.; Tscherner
D.; Weichelt H.; Winkler J.; Jones D.; Alves L.; Batista R.; Bernardes A.;
Demore de Souza A.; Ferraz R.; Ferreira A.; Freitas E.; Guanaes D.;
Kuschel K.; Muniz R.; Nasser-Hissa V.; Nhan P.; Osorio R.; Queirantes C.;
Reboucas R.; Souza C.; Tonani M.; Vicente C.; Zilli A.; Andersen K.; Aro
L.; Barber C.; Barnable B.; Berard L.; Bernier A.; Boudreault C.;
Bourbonnais A.; Bourgeois L.; Boutin D.; Boyer D.; Branco N.; Briol L.;
Brousseau M.; Burke M.; Chambers C.; Champoux A.; Chan S.; Colborne C.;
Coles K.; Couture M.; Cryderman C.; DeCurtis D.; Dewar C.; Drown J.; Dunn
P.; Eichmann D.; Eikel L.; Fox B.; Gauthier S.; Gibbons D.; Hicks R.; Ho
V.; Kitagawa H.; Kooistra L.; Landry F.; Lapointe F.; Larrivee L.; Leonard
P.; Louch D.; MacNair D.; Magennis L.; Mallette D.; Marchand C.; McLean
S.; Meilleur M.; Murdock H.; Naud M.; Olson K.; Otis J.; Ouimet F.;
Paquette H.; Peck C.; Pelletier A.; Perkins L.; Petrie F.; Pockett S.;
Poulin F.; Poulin M.; Primbas K.; Renton J.; Rouatt S.; Roy M.; Scarcelli
D.; Schellenberg S.; Schellevis K.; Schmidt N.; Scott L.; Skarpinsky B.;
Smith B.; Smith E.; Stafford C.; Stata C.; Sternberg B.; St-Jean N.;
Stoger S.; Thibodeau C.; Toupin A.; Ullyatt L.; Velonas J.; Vienneau R.;
Wall C.; Zaniol D.; Arau M.; Fuentes J.; Hidalgo J.; Landaeta O.; Padilla
I.; Sanzana S.; Tellos G.; Toro F.; Vergara R.; Che T.; Du Y.; He Y.;
Huang C.; Li H.; Liu S.; Luo X.; Ma Y.; Pan S.; Wan Q.; Wang H.; Wang S.;
Xie Y.; Xu X.; Xu Y.; Zhao F.; Zhou M.; Accini M.; Bello O.; Caceres A.;
Camargo S.; Figueroa J.; Florez M.; Gomez Morales K.; Granados L.;
Martinez M.; Medina Ramos M.; Mejia C.; Montoya L.; Ramos C.; Restrepo P.;
Rodriguez D.; Santamaria A.; Valencia T.; Spanic V.; Borre Hansen A.;
Bulow M.; Ehlers G.; Frederiksen A.; Gottschalck H.; Hejlskov B.; Holm
Fruesnsgaard Pedersen L.; Hornum H.; Jansen S.; Johansen A.; Jorgensen A.;
Kjaeulff Svaneborg T.; Kruse A.; Lund K.; Lundgaard M.; Madsen J.; Meier
A.; Muurholm A.; Nedergaard A.; Nielsen S.; Norgaard D.; Olsen A.; Raae
D.; Reiter P.; Sigsgaard U.; Vestergaar I.; Witt A.; Mitt T.; Timmusk P.;
Heikkila E.; Heiskanen R.; Huotari E.; Keskitalo A.; Kylmala L.; Laitinen
M.; Laukkanen M.; Leskinen S.; Liesivuori J.; Lukkari-Kuronen L.; Merisalo
P.; Muurinen E.; Nikkanen P.; Niskanen T.; Pasanen P.; Pekkonen L.; Retsu
A.; Soppela A.; Andreu N.; Ankotche A.; Bairras C.; Boch C.; Camachon L.;
Cherchouly A.; Coudret S.; Demer C.; Gilg R.; Lemonade L.; Madec O.;
Pinotti D.; Poirier I.; Tenne N.; Vogler C.; Amman M.; Andratschke-Gentsch
B.; Beckmann H.; Bischoff S.; Bleich B.; Bueschges G.; Busch E.;
Deigentasch S.; Dietze S.; Dollinger M.; El-Bahay C.; Flehmig G.; Frenzel
I.; Geissler K.; Guerro J.; Heike B.; Holler D.; Inhoffen C.; Klein K.;
Kraehe I.; Kress P.; Krueger H.; Lenz R.; Linnebach B.; Lueck A.; Markhof
P.; Matthies K.; Meier C.; Metzler E.; Moor E.; Noll I.; Paulsen S.;
Pfeffer B.; Promnitz N.; Saljew B.; Schad S.; Schoner C.; Sellmann R.;
Tanis M.; Vogelbusch J.; Wagner E.; Winkler S.; Zenker K.; Zvork S.;
Balogh E.; Buncsikne Molnar S.; Gulyasne Gaspar E.; Herold M.; Kovacs E.;
Kozmane Paszternak A.; Maarne Nagy S.; Nagyne Zoltan A.; Nemeth Z.; Roth
T.; Rozsa I.; Szalai M.; Anuradha M.; Bawa T.; Bhaskar B.; Chalkhore S.;
Choudhary D.; Dhanalaxmi T.; Dhingra V.; Gayatri R.; Gnanasundram R.;
Gopal U.; Govindaraj S.; Indira P.; James S.; Karkuzhli K.; Koppikar V.;
Malhotra N.; Manmohan B.; Mazher A.; Menon R.; Nalini S.; Panda M.; Patel
K.; Poongothai S.; Ramanathan S.; Ramu I.; Sangeetha K.; Sankar K.;
Savitha; Seeli Abraham C.; Shrinivas K.; Sudha S.; Tripathi S.; Vaseem A.;
Yamuna A.; Banques R.; Chong J.; Courcy M.; Donnelly E.; Fauzi A.; Gately
M.; Hanlon G.; Kelly-Conroy M.; McAteer S.; McGovern G.; Meaney E.; Storey
S.; Todd M.; Aharonof-Segal M.; Aliazarov N.; Arbeli S.; Butbul E.; Chagai
E.; Confino K.; Domb L.; Dvir R.; Erez N.; Foiening O.; Frishberg A.;
Genin I.; Gertman R.; Golan L.; Grosberd A.; Hadad D.; Israeli S.;
Kaplunski Y.; Karpf D.; Katzir A.; Kivity Z.; Li L.; Livshitz L.; Nachmias
A.; Orr I.; Peer E.; Platner N.; Pritulo L.; Rojansky A.; Rosenblat T.;
Saranga H.; Schterchman G.; Shenhar S.; Shkliar T.; Stam T.; Stinmann S.;
Suliman A.; Tsirulnikov E.; Uziel K.; Weinshtock S.; Yedid-Am S.; Yuval
R.; Zuker S.; Brunella L.; Durante A.; Nada E.; Pugolotti M.; Robusto A.;
Testa M.; Toniato R.; Ha I.; Jung S.; Kim C.; Mi Ran K.; Song B.; Wi Y.;
Yang K.; You J.; Gaisute R.; Ozolina L.; Dzagajeva N.; Kasperaviciene V.;
Krikstaponiene Z.; Montviliene R.; Morkunaite K.; Piepoliene L.; Stoniene
E.; Stonkus S.; Ulpaityte I.; Arenas-Vanhorn M.; Espitia-Serrato L.;
Garcia-Munoz E.; Nunez V.; Sainz T.; Bakker H.; Danse I.; De Greef S.; De
Jong C.; De Wit M.; Didden E.; Dommerholt R.; Goddrie M.; Haazer C.;
Havenaar J.; Hendriks-Van Woerden M.; Jongenotter M.; Kort I.; Koster L.;
Kramer H.; Maarssen E.; Posthuma-Visscher M.; Reijnierse-Buitenwerf H.;
Rood P.; Swets E.; Tousain W.A.; Van Buchem-Damming G.; Van
Buijsen-Nutters A.; Van de Loo R.; Van den Hondel M.; Van den Berg A.; Van
der Knaap-van Keulen M.; Van der Zeijst M.; Van Setten-Van der Meer L.;
Von Bannisseht E.E.; Wouda Z.; Aarsland T.; Amlie L.; Andresen B.;
Bakketun A.; Bognaes A.; Botten C.; Coucheron S.; Halsne A.; Hansen H.;
Holthe T.; Husby E.; Iversen E.; Kvalvik A.; Landbakk T.; Lovseth E.; Moen
S.; Orvik E.; Ovrehus G.; Salater S.; Sorgard B.; Sorstrom A.; Tandberg
L.; Veiding B.; Vinje G.; Winge A.; Abquina G.; Patena B.; Reyes R.;
Tamondong A.; Vega A.; Vitug L.; Makuch M.; Torun A.; Adam A.; Basaraba
M.; Chira C.; Darida C.; Haica C.; Nedelcu A.; Patru D.; Patrut L.; Rau
I.; Rotaru N.; Szabo L.; Vrinceanu G.; Sovenko T.; Zatsevskaya O.;
Horynova Z.; Vankova L.; Barkhuizen M.; Barnard L.; Bekker D.; Botha D.;
Commerford A.; de Klerk A.; De Waal A.; Devchand S.; Drummond F.; Du Toit
A.; Du Toit S.; Ellis T.; Engelbrecht M.; Eramus T.; Fonda K.; Goosen A.;
Gopel E.; Govender P.; Hodge E.; Ismael F.; Jonker E.; Jonker L.; Joubert
A.; Kilian M.; Koegenlenberg N.; Lehner L.; Lingham R.; Llyod T.; Mangoeng
P.; Mapele S.; Meiring J.; Methusi P.; Mmethi M.; Mohamed K.; Moore A.;
Ndiweni H.; Parker F.; Schoneman J.; Smit M.; Steyn A.; Van Dongren J.;
Van Schalkwyk S.; Van Staden L.; van Wyngaard G.; Wolf A.; Ashbaugh R.;
Bande C.; Barquero R.; Gaspar R.; Martin E.; Megia B.; Rodriguez C.;
Seoane A.; Viaplana J.; Akesson Jacobsson I.; Andersson C.; Asperen M.;
Backlund M.; Berglund M.; Bjorck L.; Borjesson M.; Brolin G.; Danielsson
Frojd M.; Duckert A.; Eriksson K.; Fehling K.; Glaas A.; Hage C.; Hoglund
K.; Jernhed H.; Johansson K.; Johansson S.; Lidin M.; Lundell L.; Lundgren
C.; Magnusson K.; Matsson E.; Norman J.; Nystrom K.; Ojutkangas M.;
Olofsson M.; Olsson C.; Pettersson U.; Pramberg E.; Raschperger A.; Sjolin
M.; Soderlund M.; Stensgaard Nake E.; Torebo E.; Uggeldahl I.; Walldin C.;
Welin-Berger B.; Dwyer A.; Meyer-Lazzarini V.; Morello R.; Schefer M.;
Oney S.; Seker T.; Tavlayan S.; Appleby M.; Astin J.; Baker M.; Brann H.;
Brennan C.; Bryan L.; Campbell D.; Carey J.; Cox K.; Davis C.; Dyson B.;
Everdell R.; Gammon B.; Godden J.; Gray T.; Griffiths E.; Grimes Y.; Hall
D.; Hall K.; Holme A.; Howe J.; Lambley-Burke R.; Nation M.; Norcott K.;
Mitchell K.; Poxon S.; Quick C.; Shute C.; Thomas J.; Vinnell T.; Bawa S.;
Bogan C.; Fallye O.; Ginsberg J.; Gregory B.; House B.; Isonaga M.;
Keanne-Richmond P.; Kelly C.; Kimpel J.; Leiby A.; Lyons L.; McCoy B.;
Monk A.; Pelayo E.; Perron M.; Posey D.; Rehan M.; Suarez R.; Tilton L.;
Waite K.; White G.; Chacon R.; Meza Y.; Misticchio F.; Torres M.; Urbaneja
H.
Institution
(Gerstein, Yusuf) Department of Medicine, Population Health Research
Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON,
Canada
(Bosch) Population Health Research Institute and School of Rehabilitation
Science, McMaster University and Hamilton Health Sciences, Hamilton, ON,
Canada
(Dagenais) Institut Universitaire de Cardiologie et de Pneumologie de
Quebec, Quebec, QC, Canada
(Diaz) Estudios Clinicos Latino America, Rosario, Argentina
(Jung) McMaster University and Hamilton Health Sciences, Hamilton, ON,
Canada
(Maggioni) Associazione Nazionale Medici Cardiologi Ospedalieri (ANMCO)
Research Center, Florence, Italy
(Pogue) Population Health Research Institute, McMaster University and
Hamilton Health Sciences, Hamilton, ON, Canada
(Probstfield) University of Washington, Seattle, United States
(Ramachandran) India Diabetes Research Foundation, Chennai, India
(Riddle) Oregon Health and Science University, Portland, United States
(Ryden) Department of Medicine, Karolinska Institute, Stockholm, Sweden
Publisher
Massachussetts Medical Society
Abstract
Background: The provision of sufficient basal insulin to normalize fasting
plasma glucose levels may reduce cardiovascular events, but such a
possibility has not been formally tested. Method(s): We randomly
assigned 12,537 people (mean age, 63.5 years) with cardiovascular risk
factors plus impaired fasting glucose, impaired glucose tolerance, or type
2 diabetes to receive insulin glargine (with a target fasting blood
glucose level of <=95 mg per deciliter [5.3 mmol per liter]) or standard
care and to receive n-3 fatty acids or placebo with the use of a 2-by-2
factorial design. The results of the comparison between insulin glargine
and standard care are reported here. The coprimary outcomes were nonfatal
myocardial infarction, nonfatal stroke, or death from cardiovascular
causes and these events plus revascularization or hospitalization for
heart failure. Microvascular outcomes, incident diabetes, hypoglycemia,
weight, and cancers were also compared between groups. Result(s): The
median follow-up was 6.2 years (interquartile range, 5.8 to 6.7). Rates of
incident cardiovascular outcomes were similar in the insulin-glargine and
standard-care groups: 2.94 and 2.85 per 100 person-years, respectively,
for the first coprimary outcome (hazard ratio, 1.02; 95% confidence
interval [CI], 0.94 to 1.11; P = 0.63) and 5.52 and 5.28 per 100
person-years, respectively, for the second coprimary outcome (hazard
ratio, 1.04; 95% CI, 0.97 to 1.11; P = 0.27). New diabetes was diagnosed
approximately 3 months after therapy was stopped among 30% versus 35% of
1456 participants without baseline diabetes (odds ratio, 0.80; 95% CI,
0.64 to 1.00; P = 0.05). Rates of severe hypoglycemia were 1.00 versus
0.31 per 100 person-years. Median weight increased by 1.6 kg in the
insulin-glargine group and fell by 0.5 kg in the standard-care group.
There was no significant difference in cancers (hazard ratio, 1.00; 95%
CI, 0.88 to 1.13; P = 0.97). Conclusion(s): When used to target
normal fasting plasma glucose levels for more than 6 years, insulin
glargine had a neutral effect on cardiovascular outcomes and cancers.
Although it reduced new-onset diabetes, insulin glargine also increased
hypoglycemia and modestly increased weight. Copyright © 2012
Massachusetts Medical Society.

<48>
Accession Number
625902220
Title
Comparing the placement of a left-sided double-lumen tube via fiberoptic
bronchoscopy guidance versus conventional intubation using a Macintosh
laryngoscope, to reduce the incidence of malpositioning: Study protocol
for a randomized controlled pilot trial.
Source
Trials. 20 (1) (no pagination), 2019. Article Number: 51. Date of
Publication: 15 Jan 2019.
Author
Ryu T.; Kim E.; Kim J.H.; Woo S.J.; Roh W.S.; Byun S.H.
Institution
(Ryu, Kim, Kim, Woo, Roh, Byun) Department of Anesthesiology and Pain
Medicine, School of Medicine, Catholic University of Daegu, 33,
Duryugongwon-ro 17-gil, Nam-gu, Daegu 42472, South Korea
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: A fiberoptic bronchoscope (FOB) is commonly used to identify
the proper placement of a double-lumen endotracheal tube (DLT) for good
lung isolation during thoracic surgery. We hypothesized that the
FOB-guided method for DLT placement composed of tracheal intubation under
initial guidance by a FOB via the bronchial lumen and subsequent selective
left-bronchial intubation could be used to reduce the incidence of DLT
malposition and reduce the time required for completion of DLT placement
and confirmation of proper DLT position during intubation using a
left-sided DLT, in comparison to the conventional method under direct
laryngoscopy using a Macintosh laryngoscope. Methods/design: In this
randomized controlled pilot trial, 50 patients, aged 18-70 years,
scheduled for elective thoracic surgery will be recruited and randomly
assigned to two groups according to the method of DLT placement: a
FOB-guided method (F) group and a conventional method (C) group.
Regardless of the group, the DLT placement processes will be followed by
subsequent confirmation processes, using a FOB. If the DLT is misplaced,
the position would be corrected. The primary outcome is the incidence of
DLT malpositioning observed via a FOB during confirmation after DLT
placement. The secondary outcomes consist of the time required to achieve
the entire DLT intubation process, which is the sum of the duration of DLT
placement and the duration of confirmation of the proper position, the
incidence of failed tracheal intubation on the first and second attempt,
and complications associated with the intubation process.
 Discussion(s): This pilot study was designed as the first randomized
controlled trial to confirm our hypothesis. This should provide
information for a further full-scale trial, and the outcomes of the study
should provide clinical evidence on the usefulness of the FOB-guided
method for DLT placement, in comparison to the conventional method. Trial
registration: Clinical Research Information Service; CRIS, ID: KCT0002663.
Retrospectively registered on 24 January 2018. Copyright © 2019
The Author(s).

<49>
Accession Number
620208406
Title
Meta-analysis of the Sources of Bleeding after Adult Cardiac Surgery.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 32 (4) (pp 1618-1624),
2018. Date of Publication: August 2018.
Author
Biancari F.; Kinnunen E.-M.; Kiviniemi T.; Tauriainen T.; Anttila V.;
Airaksinen J.K.E.; Brascia D.; Vasques F.
Institution
(Biancari, Brascia) Department of Surgery, University of Turku, Turku,
Finland
(Biancari, Kinnunen, Tauriainen) Department of Surgery, University of
Oulu, Oulu, Finland
(Biancari, Kiviniemi, Anttila, Airaksinen) Heart Center, Turku University
Hospital and University of Turku, Turku, Finland
(Vasques) Department of Anesthesia, Padua University Hospital, Padua,
Italy
Publisher
W.B. Saunders
Abstract
Objective: The aim of this study was to pool data on the proportion and
prognostic impact of sources of bleeding in patients requiring
re-exploration after adult cardiac surgery. Design(s): Systematic
review of the literature and meta-analysis. Setting(s):
Multistitutional study. Measurements and Main Results: A literature
review was performed to identify studies published since 1990 evaluating
the outcome after reoperation for bleeding or tamponade after adult
cardiac surgery. Eighteen studies including 5,1497 patients fulfilled the
selection criteria. Reoperation for bleeding/tamponade was performed in
2,455 patients (4.6%; 95% confidence interval [CI] 3.9%-5.2%,
I2 92%). These had a significantly higher risk of
in-hospital/30-day mortality compared with patients not reoperated for
bleeding (pooled rates: 9.3% v 2.3%; risk ratio 3.30; 95% CI 2.52-4.32;
I2 47%; 8 studies; 25,463 patients). Surgical sites of bleeding
were identified in 65.7% of cases (95% CI 58.3%-73.2%; I2 94%),
cardiac site bleeding in 40.9% of cases (95% CI 29.7%-52.0%; I2
94%), and mediastinal/sternum site bleeding in 27.0% of cases (95% CI
16.8%-37.3%; I2 94%). The main sites of bleeding were the body
of the graft (20.2%), the sternum (17.0%), vascular sutures (12.5%), the
internal mammary artery harvest site (13.0%), and anastomoses (9.9%). In
metaregression, surgical site bleeding was associated with a lower risk of
in-hospital/30-day mortality compared with diffuse bleeding (p = 0.003).
 Conclusion(s): Surgical site bleeding is identified in two-thirds of
patients undergoing re-exploration after adult cardiac surgery. Meticulous
surgical technique and systematic intraoperative checking of potential
surgical sites of bleeding at the time of the original cardiac surgery may
reduce the risk of such a severe complication. Copyright © 2017
Elsevier Inc.

<50>
Accession Number
619934147
Title
Effects of Dexmedetomidine-Isoflurane versus Isoflurane Anesthesia on
Brain Injury After Cardiac Valve Replacement Surgery.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 32 (4) (pp 1581-1586),
2018. Date of Publication: August 2018.
Author
Kang F.; Tang C.; Han M.; Chai X.; Huang X.; Li J.
Institution
(Kang, Tang, Han, Chai, Huang, Li) Department of Anesthesiology, Anhui
Provincial Hospital Affiliated to Anhui Medical University, Anhui
Province, China
Publisher
W.B. Saunders
Abstract
Objectives: To compare dexmedetomidine combined with isoflurane versus
isoflurane anesthesia on brain injury after cardiac surgery.
 Design(s): A prospective, randomized, single-blind study.
 Setting(s): University hospital. Participant(s): Adult patients
undergoing elective valve replacement surgery. Intervention(s):
Ninety-seven patients scheduled for valve replacement surgery were
randomly divided into 2 groups: dexmedetomidine and isoflurane (Dex-Iso, n
= 50) and isoflurane alone (Iso, n = 47). Dexemedetomidine was infused at
0.6 mug/kg as a bolus, followed with 0.2 mug/kg/h until the end of
surgery. Measurements and Main Results: Jugular blood samples were
drawn for analysis of matrix metalloproteinase-9 (MMP-9) and glial
fibrillary acidic protein (GFAP) levels on time points of: T1 (before
induction); T2 (5 minutes after cardiopulmonary bypass [CPB] onset); T3
(after CPB off); T4 (the first day after operation); T5 (the second day
after operation). Plasma lactate levels in arterial and jugular venous
blood also were quantified. The difference between arterial and jugular
bulb venous blood lactate levels (AVDL) was calculated. An antisaccadic
eye movement (ASEM) test was carried out on the day before the operation
and the seventh day postoperatively. In both groups, serum MMP-9 and GFAP
concentrations increased after CPB, with the peak values occurring after
CPB. At time point T5, MMP-9 and GFAP levels were close to those at T1.
MMP-9 concentrations in the Dex-Iso group were lower than the Iso group at
T3 and T4. GFAP concentrations in the Dex-Iso group were lower at T3 but
were higher than the Iso group at T2. No significant differences were
found in AVDL between the 2 groups perioperatively except at T2. The ASEM
scores decreased significantly postoperatively. There was no significant
difference in the ASEM scores between the 2 treatment groups before and
after the operation. Conclusion(s): The use of dexmedetomidine
decreased the biochemical markers of brain injury but did not improve the
neuropsychological test result after cardiac surgery. Copyright ©
2017 Elsevier Inc.

<51>
Accession Number
620795999
Title
The Future of Biomarker-Guided Therapy for Heart Failure After the Guiding
Evidence-Based Therapy Using Biomarker Intensified Treatment in Heart
Failure (GUIDE-IT) Study.
Source
Current Heart Failure Reports. 15 (2) (pp 37-43), 2018. Date of
Publication: 01 Apr 2018.
Author
Ibrahim N.E.; Januzzi J.L.
Institution
(Ibrahim, Januzzi) Cardiology Division, Massachusetts General Hospital, 55
Fruit Street, GRB-800, Boston, MA 02114, United States
(Ibrahim, Januzzi) Harvard Medical School, Boston, MA, United States
(Januzzi) Baim Institute for Clinical Research, Boston, MA, United States
Publisher
Current Science Inc. (E-mail: info@current-reports.com)
Abstract
Purpose of Review: Biomarker-guided management of patients with chronic
heart failure with reduced ejection fraction (HFrEF) remains
controversial. Recent Findings: Biomarkers have established roles for
diagnosis and prognostication in HF. Pilot data suggested that use of
natriuretic peptides might be helpful to guide HF care. The recent Guiding
Evidence-Based Therapy Using Biomarker Intensified Treatment in Heart
Failure (GUIDE-IT) randomized-controlled trial did not find therapy guided
by NT-proBNP to be more effective than usual care in improving the primary
endpoint of HF hospitalization or cardiovascular mortality amongst
patients with chronic HFrEF. Patients in GUIDE-IT received similar care
and had similar NT-proBNP lowering regardless of treatment allocation.
 Summary: Though biomarkers retain important standing for diagnosis
and prognosis in HF, the GUIDE-IT trial results suggest carefully managed
patients may not benefit from a biomarker-guided strategy. Future studies
focusing this intervention on patients treated in a more real-world
setting are needed. Copyright © 2018, Springer Science+Business
Media, LLC, part of Springer Nature.

<52>
Accession Number
625869364
Title
Randomized trial of endoscopic or open vein-graft harvesting for
coronary-artery bypass.
Source
New England Journal of Medicine. 380 (2) (pp 132-141), 2019. Date of
Publication: 10 Jan 2019.
Author
Zenati M.A.; Bhatt D.L.; Bakaeen F.G.; Stock E.M.; Biswas K.; Michael
Gaziano J.; Kelly R.F.; Tseng E.E.; Bitondo J.; Quin J.A.; Hossein Almassi
G.; Haime M.; Hattler B.; DeMatt E.; Scrymgeour A.; Huang G.D.
Institution
(Zenati, Quin, Haime) Division of Cardiac Surgery, Veterans Affairs Boston
Healthcare System, 1400 VFW Parkway, Boston, MA 02132
(Bhatt, Michael Gaziano) Division of Cardiology, Veterans Affairs (VA)
Boston Healthcare System, Harvard Medical School, Boston
(Zenati, Quin, Haime) Department of Surgery, Brigham and Women's Hospital,
Harvard Medical School, Boston
(Bhatt) Brigham and Women's Hospital Heart and Vascular Center, Harvard
Medical School, Boston
(Bitondo) Massachusetts General Hospital, Boston
(Bakaeen) Departments of Thoracic and Cardiovascular Surgery, Heart and
Vascular Institute, Cleveland Clinic, Cleveland
(Bakaeen) VA Pittsburgh Healthcare System, Pittsburgh
(Stock, Biswas, DeMatt) Cooperative Studies Program Coordinating Center,
Office of Research and Development, Department of Veterans Affairs, Perry
Point, MD
(Kelly) Minneapolis VA Medical Center, University of Minnesota,
Minneapolis
(Tseng) San Francisco VA Medical Center, University of California, San
Francisco, San Francisco
(Hossein Almassi) Zablocki VA Medical Center, Medical College of
Wisconsin, Milwaukee
(Hattler) VA Eastern Colorado Healthcare System, Denver
(Scrymgeour) Cooperative Studies Program Pharmacy Coordinating Center,
Department of Veterans Affairs, Albuquerque, NM
(Huang) Cooperative Studies Program Central Office, Office of Research and
Development, Department of Veterans Affairs, WA, United States
Publisher
Massachussetts Medical Society
Abstract
BACKGROUND The saphenous-vein graft is the most common conduit for
coronary-artery bypass grafting (CABG). The influence of the vein-graft
harvesting technique on long-term clinical outcomes has not been well
characterized. METHODS We randomly assigned patients undergoing CABG at 16
Veterans Affairs cardiac surgery centers to either open or endoscopic
vein-graft harvesting. The primary outcome was a composite of major
adverse cardiac events, including death from any cause, nonfatal
myocardial infarction, and repeat revascularization. Leg-wound
complications were also evaluated. RESULTS A total of 1150 patients
underwent randomization. Over a median follow-up of 2.78 years, the
primary outcome occurred in 89 patients (15.5%) in the open-harvest group
and 80 patients (13.9%) in the endoscopic-harvest group (hazard ratio,
1.12; 95% confidence interval [CI], 0.83 to 1.51; P=0.47). A total of 46
patients (8.0%) in the open-harvest group and 37 patients (6.4%) in the
endoscopic-harvest group died (hazard ratio, 1.25; 95% CI, 0.81 to 1.92);
myocardial infarc-tions occurred in 34 patients (5.9%) in the open-harvest
group and 27 patients (4.7%) in the endoscopic-harvest group (hazard
ratio, 1.27; 95% CI, 0.77 to 2.11), and revascularization occurred in 35
patients (6.1%) in the open-harvest group and 31 patients (5.4%) in the
endoscopic-harvest group (hazard ratio, 1.14; 95% CI, 0.70 to 1.85).
Leg-wound infections occurred in 18 patients (3.1%) in the open-harvest
group and in 8 patients (1.4%) in the endoscopic-harvest group (relative
risk, 2.26; 95% CI, 0.99 to 5.15). CONCLUSIONS Among patients undergoing
CABG, we did not find a significant difference between open vein-graft
harvesting and endoscopic vein-graft harvesting in the risk of major
adverse cardiac events. (Funded by the Cooperative Studies Program, Office
of Research and Development, Department of Veterans Affairs; REGROUP
ClinicalTrials.gov number, NCT01850082). Copyright © 2018
Massachusetts Medical Society.

<53>
Accession Number
625869356
Title
Hybrid minimally invasive esophagectomy for esophageal cancer.
Source
New England Journal of Medicine. 380 (2) (pp 152-162), 2019. Date of
Publication: 10 Jan 2019.
Author
Mariette C.; Markar S.R.; Dabakuyo-Yonli T.-H.S.; Meunier B.; Pezet D.;
Collet D.; D'Journo X.B.; Brigand C.; Perniceni T.; Carrere N.; Mabrut
J.-Y.; Msika S.; Peschaud F.; Prudhomme M.; Bonnetain F.; Piessen G.
Institution
(Mariette, Piessen) Department of Digestive and Oncologic Surgery, Claude
Huriez University Hospital, Rue Michel Polonovski, Lille F59000, France
(Mariette, Piessen) INSERM, Centre Hospitalier Universitaire (CHU) Lille,
Unite Mixte de Recherche 1172-JPARC Jean-Pierre Aubert Research Center,
Team "Mucins, epithelial differentiation, and carcinogenesis, Universite
de Lille, Lille, France
(Dabakuyo-Yonli) Epidemiology and Quality of Life Unit, INSERM Unite 1231,
Centre Georges Francois Leclerc, Dijon, France
(Meunier) Department of Hepatobiliary and Digestive Surgery, CHU Rennes,
University of Rennes 1, Rennes, France
(Pezet) Universite Clermont Auvergne, INSERM, CHU Clermont-Ferrand,
Service de Chirurgie Digestive, Clermont-Ferrand, France
(Collet) Department of Digestive Surgery, Haut Leveque University
Hospital, Bordeaux, France
(D'Journo) Department of Thoracic Surgery, Hopital Nord, Aix-Marseille
Universite, Assistance Publique-Hopitaux de Marseille, Marseille, France
(Brigand) Department of Digestive Surgery, Strasbourg University,
Strasbourg, France
(Perniceni) Department of Digestive Surgery, Institut Mutualiste
Montsouris, Paris, France
(Carrere) Department of Digestive Surgery, Purpan Hospital, CHU Toulouse,
Universite Toulouse III, Toulouse, France
(Mabrut) Department of General Surgery and Liver Transplantation, Hopital
de la Croix-Rousse, Hospices Civils de Lyon, Equipe Mixte de Recherche
3738, Universite Lyon 1, Lyon, France
(Msika) Department of Digestive and General Surgery, CHU Louis Mourier,
Assistance Publique-Hopitaux de Paris (AP-HP), Universite Paris 7, Denis
Diderot, PRES Sorbonne Paris Cite, Colombes, France
(Peschaud) Department of Surgery and Oncology, Centre Hospitalier
Universitaire Ambroise Pare, AP-HP, Universite de Versailles,
Boulogne-Billancourt, France
(Prudhomme) Department of Digestive Surgery, CHU Nimes, Nimes, France
(Bonnetain) Methodology and Quality of Life Unit in Cancer, INSERM Unite
Mixte de Recherche 1098, University Hospital of Besancon, Besancon, France
(Markar) Department of Surgery and Cancer, Imperial College, London,
United Kingdom
Publisher
Massachussetts Medical Society
Abstract
BACKGROUND Postoperative complications, especially pulmonary
complications, affect more than half the patients who undergo open
esophagectomy for esophageal cancer. Whether hybrid minimally invasive
esophagectomy results in lower morbidity than open esophagectomy is
unclear. METHODS We performed a multicenter, open-label, randomized,
controlled trial involving patients 18 to 75 years of age with resectable
cancer of the middle or lower third of the esophagus. Patients were
randomly assigned to undergo transthoracic open esophagectomy (open
procedure) or hybrid minimally invasive esophagectomy (hybrid procedure).
Surgical quality assurance was implemented by the credentialing of
surgeons, standardization of technique, and monitoring of performance.
Hybrid surgery comprised a two-field abdominal-thoracic operation (also
called an Ivor-Lewis procedure) with laparoscopic gastric mobilization and
open right thoracotomy. The primary end point was intraoperative or
postoperative complication of grade II or higher according to the
Clavien-Dindo classification (indicating major complication leading to
intervention) within 30 days. Analyses were done according to the
intention-to-treat principle. RESULTS From October 2009 through April
2012, we randomly assigned 103 patients to the hybrid-procedure group and
104 to the open-procedure group. A total of 312 serious adverse events
were recorded in 110 patients. A total of 37 patients (36%) in the
hybrid-procedure group had a major intraoperative or postoperative
complication, as compared with 67 (64%) in the open-procedure group (odds
ratio, 0.31; 95% confidence interval [CI], 0.18 to 0.55; P<0.001). A total
of 18 of 102 patients (18%) in the hybrid-procedure group had a major
pulmonary complication, as compared with 31 of 103 (30%) in the
open-procedure group. At 3 years, overall survival was 67% (95% CI, 57 to
75) in the hybrid-procedure group, as compared with 55% (95% CI, 45 to 64)
in the open-procedure group; disease-free survival was 57% (95% CI, 47 to
66) and 48% (95% CI, 38 to 57), respectively. CONCLUSIONS We found that
hybrid minimally invasive esophagectomy resulted in a lower incidence of
intraoperative and postoperative major complications, specifically
pulmonary complications, than open esophagectomy, without compromising
overall and disease-free survival over a period of 3 years. (Funded by the
French National Cancer Institute; ClinicalTrials.gov number,
NCT00937456.) Copyright © 2019 Massachusetts Medical Society.

<54>
Accession Number
2001290921
Title
Tranexamic acid in coronary artery surgery: One-year results of the
Aspirin and Tranexamic Acid for Coronary Artery Surgery (ATACAS) trial.
Source
Journal of Thoracic and Cardiovascular Surgery. 157 (2) (pp 644-652.e9),
2019. Date of Publication: February 2019.
Author
Myles P.S.; Smith J.A.; Kasza J.; Marasco S.; Esmore D.; Krum H.; Tonkin
A.; Buxton B.; Heritier S.; Merry A.; Liew D.; McNeil J.; Forbes A.;
Cooper D.J.; Wallace S.; Meehan A.; Myles P.; Galagher W.; Farrington C.;
Ditoro A.; Wutzlhofer L.; Story D.; Peyton P.; Baulch S.; Sidiropoulos S.;
Potgieter D.; Baker R.A.; Pesudovs B.; O'Loughlin J Wells E.; Coutts P.;
Bolsin S.; Osborne C.; Ives K.; Smith J.; Hulley A.; Christie-Taylor G.;
Painter T.; Lang S.; Mackay H.; Cokis C.; March S.; Bannon P.G.; Wong C.;
Turner L.; Scott D.; Silbert B.; Said S.; Corcoran P.; de Prinse L.;
Bussieres J.S.; Gagne N.; Lamy A.; Semelhago L.; Chan M.T.V.; Underwood
M.; Choi G.S.Y.; Fung B.; Landoni G.; Lembo R.; Monaco F.; Simeone F.;
Marianello D.; Alvaro G.; De Vuono G.; van Dijk D.; Dieleman J.; Numan S.;
McGuinness S.; Parke R.; Raudkivi P.; Gilder E.; Byrne K.; Dunning J.;
Termaat J.; Mans G.; Jayarajah M.; Alderton J.; Waugh D.; Platt M.J.; Pai
A.; Sevillano A.; Lal A.; Sinclair C.; Kunst G.; Knighton A.; Cubas G.M.;
Saravanan P.; Millner R.; Vasudevan V.; Patteril M.; Lopez E.; Basu R.; Lu
J.
Institution
(Myles, Cooper, Marasco, Wallace) Department of Anaesthesia and
Perioperative Medicine, Alfred Hospital, Melbourne, Australia
(Myles, Smith, Kasza, Cooper, Marasco, McNeil, Wallace, Forbes) Department
of Anaesthesia and Perioperative Medicine, Monash University, Melbourne,
Australia
(Smith) Department of Cardiothoracic Surgery, Monash Medical Centre,
Clayton, Australia
(Silbert) Department of Anaesthesia, St Vincent's Hospital, Fitzroy,
Australia
(Jayarajah) Department of Cardiothoracic Anaesthesia and Cardiac Critical
Care, South West Cardiac Centre, Derriford Hospital, Plymouth, United
Kingdom
(Painter) Royal Adelaide Hospital and Discipline of Acute Care Medicine,
University of Adelaide, Adelaide, Australia
(Bussieres) Department of Anesthesiology, Institut Universitaire de
Cardiologie et de Pneumologie de Quebec, Quebec City, Quebec, Canada
(McGuinness) Department of Cardiothoracic & Vascular Intensive Care Unit,
Auckland City Hospital, Auckland, New Zealand
(Byrne) Department of Anaesthesia, Waikato Hospital, New Zealand
(Chan) Department of Anesthesiology and Intensive Care, The Chinese
University of Hong Kong, Hong Kong
(Landoni) Department of Anesthesia and Intensive Care, IRCCS San Raffaele
Scientific Institute and Vita-Salute San Raffaele University, Milan, Italy
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Background: Tranexamic acid reduces blood loss and transfusion
requirements in cardiac surgery but may increase the risk of coronary
graft thrombosis. We previously reported the 30-day results of a trial
evaluating tranexamic acid for coronary artery surgery. Here we report the
1-year clinical outcomes. Method(s): Using a factorial design, we
randomly assigned patients undergoing coronary artery surgery to receive
aspirin or placebo and tranexamic acid or placebo. The results of the
tranexamic acid comparison are reported here. The primary 1-year outcome
was death or severe disability, the latter defined as living with a
modified Katz activities of daily living score of less than 8. Secondary
outcomes included a composite of myocardial infarction, stroke, and death
from any cause through to 1 year after surgery. Result(s): The rate
of death or disability at 1 year was 3.8% in the tranexamic acid group and
4.4% in the placebo group (relative risk, 0.85; 95% confidence interval,
0.64-1.13; P =.27), and this did not significantly differ according to
aspirin exposure at the time of surgery (interaction P =.073). The
composite rate of myocardial infarction, stroke, and death up to 1 year
after surgery was 14.3% in the tranexamic acid group and 16.4% in the
placebo group (relative risk, 0.87; 95% CI, 0.76-1.00; P =.053).
 Conclusion(s): In this trial of patients having coronary artery
surgery, tranexamic acid did not affect death or severe disability through
to 1 year after surgery. Further work should be done to explore possible
beneficial effects on late cardiovascular events. Copyright ©
2018 The American Association for Thoracic Surgery

<55>
Accession Number
2001243438
Title
Aspirin in coronary artery surgery: 1-year results of the Aspirin and
Tranexamic Acid for Coronary Artery Surgery trial.
Source
Journal of Thoracic and Cardiovascular Surgery. 157 (2) (pp 633-640),
2019. Date of Publication: February 2019.
Author
Myles P.S.; Smith J.A.; Kasza J.; Silbert B.; Jayarajah M.; Painter T.;
Cooper D.J.; Marasco S.; McNeil J.; Bussieres J.S.; McGuinness S.; Chan
M.T.V.; Wallace S.; Forbes A.
Institution
(Myles, Cooper, Marasco, Wallace) Alfred Hospital, Melbourne, Australia
(Myles, Smith, Kasza, Cooper, Marasco, McNeil, Wallace, Forbes) Monash
University, Melbourne, Australia
(Smith) Monash Medical Centre, Clayton, Australia
(Silbert) St Vincent's Hospital, Fitzroy, Australia
(Jayarajah) South West Cardiac Centre, Derriford Hospital, Plymouth,
United Kingdom
(Painter) Royal Adelaide Hospital and Discipline of Acute Care Medicine,
University of Adelaide, Adelaide, Australia
(Bussieres) Institut Universitaire de Cardiologie et de Pneumologie de
Quebec, Quebec City, Quebec, Canada
(McGuinness) Auckland City Hospital, Auckland, New Zealand
(Chan) The Chinese University of Hong Kong, Hong Kong, Hong Kong
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Background: Aspirin may reduce the risk of vascular graft thrombosis after
cardiovascular surgery. We previously reported the 30-day results of a
trial evaluating aspirin use before coronary artery surgery. Here we
report the 1-year outcomes evaluating late thrombotic events and
disability-free survival. Method(s): Using a factorial design, we
randomly assigned patients undergoing coronary artery surgery to receive
aspirin or placebo and tranexamic acid or placebo. The results of the
aspirin comparison are reported here. The primary 1-year outcome was death
or severe disability, the latter defined as living with a modified Katz
activities of daily living score < 8. Secondary outcomes included a
composite of myocardial infarction, stroke and death from any cause
through to 1 year after surgery. Result(s): Patients were randomly
assigned to aspirin (1059 patients) or placebo (1068 patients). The rate
of death or severe disability was 4.1% in the aspirin group and 3.5% in
the placebo group (relative risk, 1.17; 95% confidence interval,
0.76-1.81; P =.48). There was no significant difference in the rates of
myocardial infarction (P =.11), stroke (P =.086), or death (P =.24), or a
composite of these cardiovascular end points (P =.68). With the exception
of those with a low European System for Cardiac Operative Risk Evaluation
score (P =.03), there were no interaction effects on these outcomes with
tranexamic acid (all tests of interaction P >.10). Conclusion(s): In
patients undergoing coronary artery surgery, preoperative aspirin did not
reduce death or severe disability, or thrombotic events through to 1 year
after surgery. Copyright © 2018 The American Association for
Thoracic Surgery

<56>
Accession Number
625518472
Title
Incidence, Characteristics, and Outcomes of Myocardial Infarction in
Patients with Peripheral Artery Disease: Insights from the EUCLID Trial.
Source
JAMA Cardiology. 4 (1) (pp 7-15), 2019. Date of Publication: January 2019.
Author
Olivier C.B.; Mulder H.; Hiatt W.R.; Jones W.S.; Fowkes F.G.R.; Rockhold
F.W.; Berger J.S.; Baumgartner I.; Held P.; Katona B.G.; Norgren L.;
Blomster J.; Patel M.R.; Mahaffey K.W.
Institution
(Olivier, Mahaffey) Stanford Center for Clinical Research, Department of
Medicine, Stanford University, School of Medicine, 300 Pasteur Dr,
Stanford, CA 94305, United States
(Mulder, Jones, Rockhold, Patel) Duke Clinical Research Institute, Duke
University, School of Medicine, Durham, NC, United States
(Hiatt) Division of Cardiology, University of Colorado, School of
Medicine, Aurora, United States
(Hiatt) CPC Clinical Research, University of Colorado, School of Medicine,
Aurora, United States
(Fowkes) Usher Institute of Population Health Sciences and Informatics,
University of Edinburgh, Edinburgh, United Kingdom
(Berger) Department of Medicine, New York University, School of Medicine,
New York, United States
(Berger) Department of Surgery, New York University, School of Medicine,
New York, United States
(Baumgartner) Swiss Cardiovascular Center, Inselspital, University of
Bern, Bern, Switzerland
(Held) AstraZeneca Gothenburg, Molndal, Sweden
(Katona) AstraZeneca Gaithersburg, Gaithersburg, MD, United States
(Norgren) Faculty of Medicine and Health, Orebro University, Orebro,
Sweden
(Blomster) Turku University Hospital, Turku, Finland
Publisher
American Medical Association (E-mail: smcleod@itsa.ucsf.edu)
Abstract
Importance: Patients with peripheral artery disease (PAD) are at high risk
for myocardial infarction (MI). Objective(s): To characterize the
incidence and types of MI in a PAD population, identify factors associated
with MI, and determine the association of MI with cardiovascular mortality
and acute limb ischemia. Design, Setting, and Participant(s): The
Study Comparing Cardiovascular Effects of Ticagrelor and Clopidogrel in
Patients With Peripheral Artery Disease (EUCLID) was a double-blind
randomized clinical trial conducted at 811 sites in 28 countries that
randomized 13885 patients with symptomatic PAD to monotherapy with
ticagrelor or clopidogrel. Participants had an ankle-brachial index (ABI)
of 0.80 or less or previous lower extremity revascularization. Median
follow-up was 30 months. For these analyses, patients were evaluated for
MI occurrence during follow-up irrespective of treatment. Data were
analyzed from June 2017 to September 2018. Main Outcomes and
Measures: An adjudication clinical events committee classified MI as type
1 (spontaneous), type 2 (secondary), type 3 (sudden cardiac death), type
4a (less than 48 hours after percutaneous coronary intervention), type 4b
(definite stent thrombosis), or type 5 (less than 72 hours after coronary
artery bypass graft). A multivariate regression model was developed by
stepwise selection to identify factors associated with MI, and a
time-dependent multivariate Cox regression analysis was performed to
determine the association of MI with cardiovascular death and acute limb
ischemia requiring hospitalization. Result(s): Of the 13885 patients
included in this analysis, 9997 (72.0%) were male, and the median
(interquartile range) age was 66 (60-73) years. Myocardial infarction
occurred in 683 patients (4.9%; 2.4 events per 100 patient-years) during a
median follow-up of 30 months. Patients experiencing MI were older (median
[interquartile range] age, 69 [62-75] vs 66 [60-72] years), more likely to
have diabetes (349 of 683 [51.1%] vs 4996 of 13202 [37.8%]) or a previous
lower extremity revascularization (466 of 683 [68.2%] vs 7409 of 13202
[56.1%]), and had a lower ABI (if included by ABI) compared with censored
patients. Of the 683 patients with MI during follow-up, the most common MI
type was type 1 (405 [59.3%]), followed by type 2 (236 [34.6%]), type 4a
(14 [2.0%]), type 3 (12 [1.8%]), type 4b (11 [1.6%]), and type 5 (5
[0.7%]). Postrandomization MI was independently associated with
cardiovascular death (adjusted hazard ratio, 9.0; 95% CI, 7.3-11.2; P
<.001) and acute limb ischemia requiring hospitalization (adjusted hazard
ratio, 2.5; 95% CI, 1.3-5.0; P =.008). Conclusions and Relevance:
Approximately 5% of patients with symptomatic PAD had an MI during a
median follow-up of 30 months. Type 1 MI (spontaneous) was the most common
MI type; however, one-third of MIs were type 2 MI (secondary). More
research is needed to identify therapies to reduce the risk of MI in
patients with PAD and to improve management of type 2 MI. Copyright
© 2018 American Medical Association. All rights reserved.

<57>
Accession Number
623175250
Title
Meta-analysis of efficacy and safety of dual antiplatelet therapy versus
aspirin monotherapy after coronary artery bypass grafting.
Source
European Journal of Preventive Cardiology. 26 (2) (pp 215-218), 2019. Date
of Publication: 01 Jan 2019.
Author
Khan S.U.; Talluri S.; Rahman H.; Lekkala M.; Khan M.S.; Riaz H.; Shah H.;
Kaluski E.; Sattur S.
Institution
(Khan, Talluri, Rahman, Lekkala, Shah, Kaluski, Sattur) Guthrie Clinic,
Robert Packer Hospital, United States
(Khan) Cook County Hospital, United States
(Riaz) Cleveland Clinic, United States
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)

<58>
Accession Number
626000152
Title
A randomized-controlled, double-blind study to evaluate the efficacy of
caudal midazolam, ketamine and neostigmine as adjuvants to bupivacaine on
postoperative analgesic in children undergoing lower abdominal surgery.
Source
Acta bio-medica : Atenei Parmensis. 89 (4) (pp 513-518), 2019. Date of
Publication: 15 Jan 2019.
Author
Shirmohammadie M.; Ebrahim Soltani A.; Arbabi S.; Nasseri K.
Institution
(Shirmohammadie) Kurdistan University of Medical Sciences, Sanandaj, Iran,
Islamic Republic of
Publisher
NLM (Medline)
Abstract
* Background: Caudal epidural is the most commonly used technique for the
management of postoperative pain in children. The aim of the present study
was to assess and compare the efficacy of caudal bupivacaine as a
postoperative analgesic alone or combined with midazolam, ketamine, and
neostigmine in pediatric patients undergoing lower abdominal surgery.
 METHOD(S): Eighty pediatric patients categorized under the American
Society of Anesthesiologists Physical Status I and II Classification
System, who have been scheduled to undergo lower abdominal surgery were
randomly designated into four groups to receive caudal block with either 1
ml/kg of 0.25% caudal bupivacaine for group B, 1 ml/kg of 0.25% caudal
bupivacaine mixed with 2 mug/kg neostigmine for group BN, 1 ml/kg of 0.25%
caudal bupivacaine mixed with 0.5 mg/kg ketamine for group BK or 1 ml/kg
of 0.25% caudal bupivacaine mixed with 50 mcg/kg midazolam for group BM.
Postoperative analgesia was examined by a blinded anesthetist utilizing a
Revised Faces Pain Scale.Consumption of the total amount of rescue
analgesic each 24 h, postoperative time to requirement of the first dose
and any adverse effects were noted. RESULT(S): The four groups were
comparable as regards age, sex, weight, duration of surgery, heart rate,
blood pressure and the time from induction of anesthesia to response to
voice. The Revised Faces Pain Scale was 2.6+/-1.5 in group BN, 3.1+/-1.8
in group BM, 4.4+/-2.4 in group BK, and 5.6+/-1.3 in group B (p=0.005).
Postoperative duration of analgesia was 433+/-68 min, 769+/-118 min,
1097+/-126 min and 1254+/-176 min in groups B, BK, BM and BN respectively
(P=0.001). The dose of rescue analgesic within 24 h in group B was
significantly higher than those of the other three groups (P<0.05).
 CONCLUSION(S): Addition of either neostigmine, midazolam, or ketamine
to caudal bupivacaine extended analgesia time and decreased rescue
analgesic compared to bupivacaine alone in children who underwent lower
abdominal surgery.

<59>
Accession Number
626009395
Title
Is Atherothromboaspiration a Possible Solution for the Prevention of
No-Reflow Phenomenon in Acute Coronary Syndromes? Single Centre Experience
and Review of the Literature.
Source
Current vascular pharmacology. 17 (2) (pp 164-179), 2019. Date of
Publication: 2019.
Author
Manolis A.S.
Institution
(Manolis) Third Department of Cardiology, Athens University School of
Medicine, Sotiria Hospital, Athens, Greece
Publisher
NLM (Medline)
Abstract
BACKGROUND: Intracoronary thrombus in acute Myocardial Infarction (MI)
confers higher rates of no-reflow with attendant adverse consequences.
Earlier Randomized-Controlled-Trials (RCTs) of routine thromboaspiration
during Percutaneous Coronary Intervention (PCI) indicated a clinical
benefit, but more recent RCTs were negative. However, data of selective
use of this adjunctive approach remain scarce. OBJECTIVE(S): The aim
of this single-centre prospective study was to report the results of
selective thromboaspiration during PCI in patients with intracoronary
thrombi, and also to provide an extensive literature review on current
status of thromboaspiration. METHOD(S): The study included 90
patients (77 men; aged 59.3+/-12.7 years) presenting with acute MI
(STElevation MI (STEMI) in 74, non-STEMI in 16) who had intracoronary
thrombi and were submitted to thromboaspiration. RESULT(S): Total
(n=67) or subtotal (n=18) vessel occlusions were present in 85 (94%)
patients. Thromboaspiration and subsequent PCI were successful in 89/90
(98.9%) patients, with coronary stenting in 86 (96.6%). In 4 patients with
residual thrombus, a mesh-covered stent was implanted. IIb/IIIa-inhibitors
were administered in 57 (63.3%) patients. No-reflow occurred in only 1
(1.1%) patient. The postprocedural course was uneventful. Review of the
literature revealed several early observational and RCTs and meta-analyses
favouring manual, not mechanical, thrombectomy. However, newer RCTs and
meta-analyses significantly curtailed the initial enthusiasm for the
clinical benefits of routine use of thromboaspiration. CONCLUSION(S):
Selective thromboaspiration for angiographically visible thrombi in MI
patients undergoing PCI, as an adjunct to mechanical reperfusion and to
IIb/IIIa-inhibitors, may be an option since this manoeuvre may improve
procedural and clinical outcome. Copyright© Bentham Science
Publishers; For any queries, please email at epub@benthamscience.net.

<60>
Accession Number
625989074
Title
Technology Access, Technical Assistance, and Disparities in Inpatient
Portal Use.
Source
Applied clinical informatics. 10 (1) (pp 40-50), 2019. Date of
Publication: 01 Jan 2019.
Author
Grossman L.V.; Masterson Creber R.M.; Ancker J.S.; Ryan B.; Polubriaginof
F.; Qian M.; Alarcon I.; Restaino S.; Bakken S.; Hripcsak G.; Vawdrey D.K.
Institution
(Grossman, Alarcon, Bakken, Hripcsak, Vawdrey) Department of Biomedical
Informatics, Columbia University, NY, United States
(Masterson Creber, Ancker) Department of Healthcare Policy and Research,
Weill Cornell Medical College, NY, United States
(Ryan, Polubriaginof, Vawdrey) Value Institute, New York-Presbyterian
Hospital, NY, United States
(Qian) Department of Biostatistics, Mailman School of Public Health,
Columbia University, NY, United States
(Restaino) Department of Medicine, New York-Presbyterian Hospital, NY,
United States
Publisher
NLM (Medline)
Abstract
BACKGROUND: Disadvantaged populations, including minorities and the
elderly, use patient portals less often than relatively more advantaged
populations. Limited access to and experience with technology contribute
to these disparities. Free access to devices, the Internet, and technical
assistance may eliminate disparities in portal use. OBJECTIVE(S): To
examine predictors of frequent versus infrequent portal use among
hospitalized patients who received free access to an iPad, the Internet,
and technical assistance. MATERIALS AND METHODS: This subgroup analysis
includes 146 intervention-arm participants from a pragmatic randomized
controlled trial of an inpatient portal. The participants received free
access to an iPad and inpatient portal while hospitalized on medical and
surgical cardiac units, together with hands-on help using them. We used
logistic regression to identify characteristics predictive of frequent
use. RESULT(S): More technology experience (adjusted odds ratio
[OR]=5.39, p=0.049), less severe illness (adjusted OR=2.07, p=0.077), and
private insurance (adjusted OR=2.25, p=0.043) predicted frequent use, with
a predictive performance (area under the curve) of 65.6%. No significant
differences in age, gender, race, ethnicity, level of education,
employment status, or patient activation existed between the frequent and
infrequent users in bivariate analyses. Significantly more frequent users
noticed medical errors during their hospital stay. DISCUSSION AND
 CONCLUSION(S): Portal use was not associated with several
sociodemographic characteristics previously found to limit use in the
inpatient setting. However, limited technology experience and high illness
severity were still barriers to frequent use. Future work should explore
additional strategies, such as enrolling health care proxies and improving
usability, to reduce potential disparities in portal use. Copyright
Georg Thieme Verlag KG Stuttgart . New York.

<61>
Accession Number
626007553
Title
The Ross procedure versus prosthetic and homograft aortic valve
replacement: a systematic review and meta-analysis.
Source
European journal of cardio-thoracic surgery : official journal of the
European Association for Cardio-thoracic Surgery. 55 (2) (pp 247-255),
2019. Date of Publication: 01 Feb 2019.
Author
McClure G.R.; Belley-Cote E.P.; Um K.; Gupta S.; Bouhout I.; Lortie H.;
Alraddadi H.; Alsagheir A.; McIntyre W.F.; Dorobantu D.-M.; Bossard M.;
Kim K.; Stoica S.; Eikelboom J.; Ouzounian M.; Chu M.W.A.; Parry D.;
El-Hamamsy I.; Whitlock R.P.
Institution
(McClure, Um) Michael G. DeGroote School of Medicine, McMaster University,
Hamilton, ON, Canada
(McClure, Gupta, Alsagheir, McIntyre, Kim, Whitlock) Department of
Clinical Epidemiology and Biostatistics, McMaster University, Hamilton,
ON, Canada
(Belley-Cote, McIntyre, Eikelboom) Department of Medicine, McMaster
University, Hamilton, ON, Canada
(Belley-Cote, Bossard, Eikelboom, Whitlock) Population Health Research
Institute, Hamilton, ON, Canada
(Gupta, Alraddadi, Alsagheir, Parry, Whitlock) Division of Cardiac
Surgery, McMaster University, Hamilton, ON, Canada
(Bouhout, El-Hamamsy) Division of Cardiac Surgery, Montreal Heart
Institute, Universite de Montreal, Montreal, QC, Canada
(Lortie) Department of Medicine, Universite de Sherbrooke, Sherbrooke, QC,
Canada
(Dorobantu, Stoica) Bristol Heart Institute, University Hospitals Bristol
NHS Foundation Trust, Bristol, United Kingdom
(Dorobantu) Department of Cardiology, "Prof. Dr. CC Iliescu" Institute for
Cardiovascular Diseases, Bucharest, Romania
(Bossard) Division of Cardiology, Heart Center, Luzerner Kantonsspital,
Luzern, Switzerland
(Ouzounian) Division of Cardiac Surgery, Peter Munk Cardiac Centre,
University of Toronto, Toronto, ON, Canada
(Chu) Division of Cardiac Surgery, Western University, London, ON, Canada
Publisher
NLM (Medline)
Abstract
OBJECTIVES: Young adults undergoing aortic valve replacement (AVR) have
decreased life expectancy compared to matched controls. The Ross procedure
aims to improve valve lifespan while avoiding anticoagulation. We prepared
a systematic review and meta-analysis to assess the Ross procedure
compared to conventional AVR. METHOD(S): We searched MEDLINE, EMBASE
and Cochrane CENTRAL for studies evaluating the Ross procedure versus any
conventional AVR in adult patients. We performed screening, full-text
assessment, risk of bias evaluation and data collection independently and
in duplicate. We evaluated the risk of bias with the ROBINS-I and Cochrane
tools and quality of evidence with the GRADE framework. We pooled data
using the random- and fixed-effects models. RESULT(S): Thirteen
observational studies and 2 randomized controlled trials (RCTs) were
identified (n=5346). No observational study was rated as having low risk
of bias. The Ross procedure was associated with decreased late mortality
in observational and RCT data [mean length of follow-up 2.6years, relative
risk (RR) 0.56, 95% confidence interval (CI) 0.38-0.84, I2 = 58%, very low
quality]. The RCT estimate of effect was similar (mean length of follow-up
8.8years, RR 0.33, 95% CI 0.11-0.96, I2 = 66%, very low quality). No
difference was observed in mortality <30days after surgery. All-site
reintervention was similar between groups in cohorts and significantly
reduced by the Ross procedure in RCTs (RR 1.41, 95% CI 0.89-2.24, I2 =
55%, very low quality and RR 0.41, 95% CI 0.22-0.78, I2 = 68%, high
quality, respectively). CONCLUSION(S): Observational data, with
residual confounding, and RCT data suggest a late survival benefit with
the Ross procedure with no increased risk of reintervention when compared
to conventional AVR. Considering the quality of available evidence and
limited follow-up, additional high-quality randomized studies are required
to strengthen these findings. Systematic review PROSPERO registration:
CRD42016052512.

<62>
Accession Number
626002282
Title
Cardiogenic Necrotizing Enterocolitis: A Clinically Distinct Entity from
Classical Necrotizing Enterocolitis.
Source
European journal of pediatric surgery : official journal of Austrian
Association of Pediatric Surgery ... [et al] = Zeitschrift fur
Kinderchirurgie. 29 (1) (pp 14-22), 2019. Date of Publication: 01 Feb
2019.
Author
Siano E.; Lauriti G.; Ceccanti S.; Zani A.
Institution
(Siano, Zani) Division of General and Thoracic Surgery, Hospital for Sick
Children, Toronto, ON, Canada
(Lauriti) Department of Pediatric Surgery, Spirito Santo Hospital, G.
d'Annunzio University, Chieti-Pescara, Pescara, Italy
(Ceccanti) Pediatric Surgery Unit, Sapienza University of Rome, Azienda
Policlinico Umberto I, Rome, Italy
(Zani) Department of Surgery, University of Toronto, Toronto, ON, Canada
Publisher
NLM (Medline)
Abstract
AIM: The main purpose of this study was to investigate if necrotizing
enterocolitis (NEC) has a different presentation and outcome in patients
with congenital heart defect (CHD) (cardiogenic NEC) from those without
(classical NEC). MATERIALS AND METHODS: A systematic review of the
literature on the characteristics of infants with NEC and CHD was
performed by three independent investigators using a defined strategy
(PubMed, Cochrane, Embase, and Web of Science). A meta-analysis was
conducted on studies comparing NEC in infants with CHD and non-CHD infants
using RevMan 5.3. RESULT(S): Systematic review: Of 7,291 abstracts
screened, 126 full-text articles were analyzed and 51 studies were
included. NEC had an incidence of 5.1% in CHD infants (7,728/151,046,
range 0-24%) and 0.8% in non-CHD infants (26,430/3,256,891, range
0.1-8.9%; p<0.0001). In very low birth weight infants, NEC occurred in
6.3% of CHD patients (6,361/100,454pts) and in 8.9% of non-CHD
(23,201/257,794pts; p<0.0001). In CHD cases, NEC occurred before cardiac
surgery in 48% cases and surgery for NEC was required in 31% infants
(2,037/6,683). Meta-analysis: In eight comparative studies, the incidence
of NEC was higher in CHD infants (6%, 768/13,145) than in infants with no
CHD (0.9%, 32,625/3,354,323pts; p<0.00001, odds ratio [OR] 1.84, 95%
confidence interval [CI] 1.7-1.9). The overall mortality was higher in
infants with CHD and NEC (38%, 243/640) than in those without CHD (27%,
6651/24810; p<0.00001, OR 3.4, 95% CI 2.8-4.1). CONCLUSION(S): This
is the first evidence-based study showing that infants with cardiogenic
NEC have different demographics and outcomes than those with classical
NEC. The risk of developing NEC and the mortality rate are higher among
infants with CHD than in those without. Conversely, the need for
intestinal surgery is lower in babies with cardiogenic NEC than in those
with classical NEC. Further studies are needed to establish preventative
and management interventions that are specific to infants with or at risk
of developing cardiogenic NEC. Copyright Georg Thieme Verlag KG
Stuttgart . New York.

<63>
Accession Number
626001933
Title
A model-based cost-effectiveness analysis of Patient Blood Management.
Source
Blood transfusion = Trasfusione del sangue. 17 (1) (pp 16-26), 2019. Date
of Publication: 01 Jan 2019.
Author
Kleineruschkamp A.; Meybohm P.; Straub N.; Zacharowski K.; Choorapoikayil
S.
Institution
(Kleineruschkamp, Meybohm, Zacharowski, Choorapoikayil) Department of
Anaesthesiology, Intensive Care Medicine and Pain Therapy, University
Hospital Frankfurt, Frankfurt, Germany
(Straub) Statistics and Prognosis, Institute of Market Research, Munich,
Germany
Publisher
NLM (Medline)
Abstract
BACKGROUND: Patient blood management (PBM) is a multidisciplinary concept
focused on the management of anaemia, minimisation of iatrogenic blood
loss and rational use of allogeneic blood products. The aims of this study
were: (i) to analyse post-operative outcome in patients with liberal vs
restrictive exposure to allogeneic blood products and (ii) to evaluate the
cost-effectiveness of PBM in patients undergoing surgery. MATERIALS AND
METHODS: A systematic literature review and meta-analysis were performed
to compare post-operative complications in predominantly non-transfused
patients (restrictive transfusion group) and patients who received one to
three units of red blood cells (liberal transfusion group). Outcome
measures included sepsis with/without pneumonia, acute renal failure,
acute myocardial infarction and acute stroke. In a second step, a health
economic model was developed to calculate cost-effectiveness of PBM
(PBM-arm vs control-arm) for simulated cohorts of 10,000 cardiac and
non-cardiac surgical patients based on the results of the meta-analysis
and costs. RESULT(S): Out of 478 search results, 22 studies were
analysed in the meta-analysis. The pooled relative risk of any
complication in the restrictive transfusion group was 0.43 for non-cardiac
and 0.34 for cardiac surgical patients. In the simulation model, PBM was
related to reduced complications (1,768 vs 1,245) and complication-related
deaths (411 vs 304) compared to standard care. PBM-related costs of
therapy exceeded costs of the control arm by 150 per patient. However,
total costs, including hospitalisation, were higher in the control-arm for
both non-cardiac ( 2,885.11) and cardiac surgery patients ( 1,760.69). The
incremental cost-effectiveness ratio including hospitalisation showed
savings of 30,458 (non-cardiac and cardiac surgery patients) for
preventing one complication and 128,023 (non-cardiac and cardiac surgery
patients) for prevention of one complication-related death in the PBM-arm.
DISCUSSION: Our results indicate that PBM may be associated with fewer
adverse clinical outcomes compared to control management and may, thereby,
be cost-effective.

<64>
Accession Number
626002684
Title
THE USE OF MELD SCORE (MODEL FOR END-STAGE LIVER DISEASE) AND DERIVATIVES
IN CARDIAC TRANSPLANTATION.
Source
Arquivos brasileiros de cirurgia digestiva : ABCD = Brazilian archives of
digestive surgery. 31 (2) (pp e1370), 2018. Date of Publication: 2018.
Author
Moraes A.C.O.; Fonseca-Neto O.C.L.D.
Institution
(Moraes, Fonseca-Neto) Hospital Universitario Oswaldo Cruz, Recife, PE,
Brazil
Publisher
NLM (Medline)
Abstract
INTRODUCTION: Heart transplantation is still the best therapeutic
alternative for the treatment of end-stage heart failure. The use of
criteria that consider the complications associated with this procedure
can guarantee a better evaluation of the recipient and prepare the team
for possible unsatisfactory post-transplant results. The use of the MELD
score has been expanded to evaluate cirrhotic patients undergoing various
procedures, including cardiac transplantation. OBJECTIVE(S): To
analyze the knowledge on MELD score and its derivatives to the prognosis
of patients with end-stage heart failure considered for heart
transplantation. METHOD(S): Was carried out an integrative review of
the publications of the last ten years in Pubmed and Lilacs databases,
using the descriptors "heart transplantation", "liver disease" and
"prognosis". From the total of 111 articles found, six were selected and
composed the sample. RESULT(S): The MELD-XI score (eXcluding INR) was
the most analyzed in the studies due to the exclusion of INR, since many
patients with heart failure use anticoagulants, which may alter their
value. MELD and derivatives were associated with unsatisfactory results in
cardiac transplantation. CONCLUSION(S): The MELD score can be
considered as a good predictor for heart transplantation; however, there
are still few studies that make this correlation.

<65>
Accession Number
625988673
Title
Lack of Benefit on Treating Asymptomatic Bacteriuria Prior to
Cardiovascular Surgery: a Systematic Review and Meta-Analysis.
Source
Brazilian journal of cardiovascular surgery. 33 (6) (pp 641-643), 2018.
Date of Publication: 01 Nov 2018.
Author
Gomez-Ochoa S.A.; Espin-Chico B.B.
Institution
(Gomez-Ochoa) Researcher GERMINA-UIS Group. School of Medicine, Health
Sciences Faculty, Universidad Industrial de Santander, Bucaramanga,
Colombia
(Espin-Chico) Public Health Faculty. Escuela Politecnica Superior de
Chimborazo, Riobamba, Ecuador
Publisher
NLM (Medline)

<66>
Accession Number
625955648
Title
Automated oxygen administration versus conventional oxygen therapy after
major abdominal or thoracic surgery: Study protocol for an international
multicentre randomised controlled study.
Source
BMJ Open. 9 (1) (no pagination), 2019. Date of Publication: 01 Jan 2019.
Author
L'Her E.; Jaber S.; Verzilli D.; Jacob C.; Huiban B.; Futier E.; Kerforne
T.; Pateau V.; Bouchard P.-A.; Gouillou M.; Nowak E.; Lellouche F.
Institution
(L'Her) Medical Intensive Care, CHRU de Brest-La Cavale Blanche, Brest,
France
(L'Her, Pateau) LATIM INSERM UMR 1101, FHU Techsan, Universite de Bretagne
Occidentale, Brest, France
(Jaber, Verzilli) Intensive Care Unit, Department of Anesthesiology B DAR
B CHU de Montpellier, Universite Montpellier 1, Montpellier, France
(Jacob, Huiban) Anesthesiology Department, CHRU de Brest-La Cavale
Blanche, Brest, France
(Futier) Anesthesiology Department, Hopital Estaing, Centre Hospitalier
Universitaire Clermont-Ferrand, Clermont-Ferrand, France
(Kerforne) Anesthesiology Department, CHU de Poitiers, Poitiers Cedex,
France
(Pateau) RandD, Oxynov Inc, Technopole Brest Iroise, Plouzane, France
(Bouchard, Lellouche) Research Laboratory, Centre de Recherche de
l'Institut de Cardiologie et de Pneumologie de Quebec, Quebec, France
(Gouillou, Nowak) Centre d'Investigation Clinique CIC INSERM 1412, CHRU de
Brest-La Cavale Blanche, Brest, France
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Introduction Hypoxemia and hyperoxia may occur after surgery with
potential related complications. The FreeO 2 PostOp trial is a
prospective, multicentre, randomised controlled trial that evaluates the
clinical impact of automated O 2 administration versus conventional O 2
therapy after major abdominal or thoracic surgeries. The study is powered
to demonstrate benefits of automated oxygen titration and weaning in term
of oxygenation, which is an important surrogate for complications after
such interventions. Methods and analysis After extubation, patients are
randomly assigned to the Standard (manual O 2 administration) or FreeO 2
group (automated closed-loop O 2 administration). Stratification is
performed for the study centre and a medical history of chronic
obstructive pulmonary disease (COPD). Primary outcome is the percentage of
time spent in the target zone of oxygen saturation, during a 3-day time
frame. In both groups, patients will benefit from continuous oximetry
recordings. The target zone of oxygen saturation is SpO 2 =88%-92% for
patients with COPD and 92%-96% for patients without COPD. Secondary
outcomes are the nursing workload assessed by the number of manual O 2
flow adjustments, the time spent with severe desaturation (SpO 2 <85%) and
hyperoxia area (SpO 2 >98%), the time spent in a hyperoxia area (SpO 2
>98%), the VO 2, the duration of oxygen administration during
hospitalisation, the frequency of use of mechanical ventilation (invasive
or non-invasive), the duration of the postrecovery room stay, the
hospitalisation length of stay and the survival rate. Ethics and
dissemination The FreeO 2 PostOp study is conducted in accordance with the
declaration of Helsinki and was registered on 11 September 2015
(http://www.clinicaltrials.gov). First patient inclusion was performed on
14 January 2016. The results of the study will be presented at academic
conferences and submitted to peer-reviewed journals. Trial registration
number NCT02546830. Copyright © © Author(s) (or their
employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use.
See rights and permissions. Published by BMJ.

<67>
Accession Number
625764782
Title
Cardiovascular risk reduction with icosapent ethyl for
hypertriglyceridemia.
Source
New England Journal of Medicine. 380 (1) (pp 11-22), 2019. Date of
Publication: 03 Jan 2019.
Author
Bhatt D.L.; Steg P.G.; Miller M.; Brinton E.A.; Jacobson T.A.; Ketchum
S.B.; Doyle R.T.; Juliano R.A.; Jiao L.; Granowitz C.; Tardif J.-C.;
Ballantyne C.M.
Institution
(Bhatt) Brigham and Women's Hospital Heart and Vascular Center, Harvard
Medical School, 75 Francis St., Boston, MA 02115, United States
(Steg) FACT (French Alliance for Cardiovascular Trials), Departement
Hospitalo-Universitaire FIRE (Fibrose, Inflammation, and Remodeling),
Assistance Publique-Hopitaux de Paris, Hopital Bichat, Universite
Paris-Diderot, INSERM Unite 1148, Paris, France
(Steg) National Heart and Lung Institute, Imperial College, Royal Brompton
Hospital, London, United Kingdom
(Miller) Department of Medicine, University of Maryland School of
Medicine, Baltimore, MD, United States
(Brinton) Utah Lipid Center, Salt Lake City, UT, United States
(Jacobson) Office of Health Promotion and Disease Prevention, Department
of Medicine, Emory University School of Medicine, Atlanta, GA, United
States
(Ketchum, Doyle, Juliano, Jiao, Granowitz) Amarin Pharma, Bedminster, NJ,
United States
(Tardif) Montreal Heart Institute, Universite de Montreal, Montreal, QC,
Canada
(Ballantyne) Department of Medicine, Baylor College of Medicine, Center
for Cardiovascular Disease Prevention, Methodist De-Bakey Heart and
Vascular Center, Houston, TX, United States
Publisher
Massachussetts Medical Society
Abstract
Background: Patients with elevated triglyceride levels are at increased
risk for ischemic events. Icosapent ethyl, a highly purified
eicosapentaenoic acid ethyl ester, lowers triglyceride levels, but data
are needed to determine its effects on ischemic events. Method(s): We
performed a multicenter, randomized, double-blind, placebo-controlled
trial involving patients with established cardiovascular disease or with
diabetes and other risk factors, who had been receiving statin therapy and
who had a fasting triglyceride level of 135 to 499 mg per deciliter (1.52
to 5.63 mmol per liter) and a low-density lipoprotein cholesterol level of
41 to 100 mg per deciliter (1.06 to 2.59 mmol per liter). The patients
were randomly assigned to receive 2 g of icosapent ethyl twice daily
(total daily dose, 4 g) or placebo. The primary end point was a composite
of cardiovascular death, nonfatal myocardial infarction, nonfatal stroke,
coronary revascularization, or unstable angina. The key secondary end
point was a composite of cardiovascular death, nonfatal myocardial
infarction, or nonfatal stroke. Result(s): A total of 8179 patients
were enrolled (70.7% for secondary prevention of cardiovascular events)
and were followed for a median of 4.9 years. A primary end-point event
occurred in 17.2% of the patients in the icosapent ethyl group, as
compared with 22.0% of the patients in the placebo group (hazard ratio,
0.75; 95% confidence interval [CI], 0.68 to 0.83; P<0.001); the
corresponding rates of the key secondary end point were 11.2% and 14.8%
(hazard ratio, 0.74; 95% CI, 0.65 to 0.83; P<0.001). The rates of
additional ischemic end points, as assessed according to a prespecified
hierarchical schema, were significantly lower in the icosapent ethyl group
than in the placebo group, including the rate of cardiovascular death
(4.3% vs. 5.2%; hazard ratio, 0.80; 95% CI, 0.66 to 0.98; P = 0.03). A
larger percentage of patients in the icosapent ethyl group than in the
placebo group were hospitalized for atrial fibrillation or flutter (3.1%
vs. 2.1%, P = 0.004). Serious bleeding events occurred in 2.7% of the
patients in the icosapent ethyl group and in 2.1% in the placebo group (P
= 0.06). Conclusion(s): Among patients with elevated triglyceride
levels despite the use of statins, the risk of ischemic events, including
cardiovascular death, was significantly lower among those who received 2 g
of icosapent ethyl twice daily than among those who received
placebo. Copyright © 2018 Massachusetts Medical Society.

<68>
Accession Number
625764779
Title
Marine n-3 fatty acids and prevention of cardiovascular disease and
cancer.
Source
New England Journal of Medicine. 380 (1) (pp 23-32), 2019. Date of
Publication: 03 Jan 2019.
Author
Manson J.E.; Cook N.R.; Lee I.-M.; Christen W.; Bassuk S.S.; Mora S.;
Gibson H.; Albert C.M.; Gordon D.; Copeland T.; D'Agostino D.; Friedenberg
G.; Ridge C.; Bubes V.; Giovannucci E.L.; Willett W.C.; Buring J.E.
Institution
(Manson, Cook, Lee, Christen, Bassuk, Mora, Gibson, Albert, Gordon,
Copeland, D'Agostino, Friedenberg, Ridge, Bubes, Giovannucci, Willett,
Buring) Department of Medicine, Brigham and Women's Hospital, Harvard
Medical School, 900 Commonwealth Ave., Boston, MA 02215, United States
(Manson, Cook, Lee, Willett, Buring) Department of Epidemiology, Harvard
T.H. Chan School of Public Health, Boston, MA, United States
(Giovannucci, Willett) Department of Nutrition, Harvard T.H. Chan School
of Public Health, Boston, MA, United States
Publisher
Massachussetts Medical Society
Abstract
Background: Higher intake of marine n-3 (also called omega-3) fatty acids
has been associated with reduced risks of cardiovascular disease and
cancer in several observational studies. Whether supplementation with n-3
fatty acids has such effects in general populations at usual risk for
these end points is unclear. Method(s): We conducted a randomized,
placebo-controlled trial, with a two-by-two factorial design, of vitamin
D3 (at a dose of 2000 IU per day) and marine n-3 fatty acids (at a dose of
1 g per day) in the primary prevention of cardiovascular disease and
cancer among men 50 years of age or older and women 55 years of age or
older in the United States. Primary end points were major cardiovascular
events (a composite of myocardial infarction, stroke, or death from
cardiovascular causes) and invasive cancer of any type. Secondary end
points included individual components of the composite cardiovascular end
point, the composite end point plus coronary revascularization (expanded
composite of cardiovascular events), site-specific cancers, and death from
cancer. Safety was also assessed. This article reports the results of the
comparison of n-3 fatty acids with placebo. Result(s): A total of
25,871 participants, including 5106 black participants, underwent
randomization. During a median follow-up of 5.3 years, a major
cardiovascular event occurred in 386 participants in the n-3 group and in
419 in the placebo group (hazard ratio, 0.92; 95% confidence interval
[CI], 0.80 to 1.06; P = 0.24). Invasive cancer was diagnosed in 820
participants in the n-3 group and in 797 in the placebo group (hazard
ratio, 1.03; 95% CI, 0.93 to 1.13; P = 0.56). In the analyses of key
secondary end points, the hazard ratios were as follows: for the expanded
composite end point of cardiovascular events, 0.93 (95% CI, 0.82 to 1.04);
for total myocardial infarction, 0.72 (95% CI, 0.59 to 0.90); for total
stroke, 1.04 (95% CI, 0.83 to 1.31); for death from cardiovascular causes,
0.96 (95% CI, 0.76 to 1.21); and for death from cancer (341 deaths from
cancer), 0.97 (95% CI, 0.79 to 1.20). In the analysis of death from any
cause (978 deaths overall), the hazard ratio was 1.02 (95% CI, 0.90 to
1.15). No excess risks of bleeding or other serious adverse events were
observed. Conclusion(s): Supplementation with n-3 fatty acids did not
result in a lower incidence of major cardiovascular events or cancer than
placebo. Copyright © 2018 Massachusetts Medical Society.

<69>
Accession Number
625764777
Title
Vitamin D supplements and prevention of cancer and cardiovascular disease.
Source
New England Journal of Medicine. 380 (1) (pp 33-44), 2019. Date of
Publication: 03 Jan 2019.
Author
Manson J.E.; Cook N.R.; Lee I.-M.; Christen W.; Bassuk S.S.; Mora S.;
Gibson H.; Gordon D.; Copeland T.; D'Agostino D.; Friedenberg G.; Ridge
C.; Bubes V.; Giovannucci E.L.; Willett W.C.; Buring J.E.
Institution
(Manson, Cook, Lee, Christen, Bassuk, Mora, Gibson, Gordon, Copeland,
D'Agostino, Friedenberg, Ridge, Bubes, Giovannucci, Willett, Buring)
Department of Medicine, Brigham and Women's Hospital, Harvard Medical
School, 900 Commonwealth Ave., Boston, MA 02215, United States
(Manson, Cook, Lee, Willett, Buring) Department of Epidemiology, Harvard
T.H. Chan School of Public Health, Boston, MA, United States
(Giovannucci, Willett) Department of Nutrition, Harvard T.H. Chan School
of Public Health, Boston, MA, United States
Publisher
Massachussetts Medical Society
Abstract
Background: It is unclear whether supplementation with vitamin D reduces
the risk of cancer or cardiovascular disease, and data from randomized
trials are limited. Method(s): We conducted a nationwide, randomized,
placebo-controlled trial, with a two-by-two factorial design, of vitamin
D3 (cholecalciferol) at a dose of 2000 IU per day and marine n-3 (also
called omega-3) fatty acids at a dose of 1 g per day for the prevention of
cancer and cardiovascular disease among men 50 years of age or older and
women 55 years of age or older in the United States. Primary end points
were invasive cancer of any type and major cardiovascular events (a
composite of myocardial infarction, stroke, or death from cardiovascular
causes). Secondary end points included site-specific cancers, death from
cancer, and additional cardiovascular events. This article reports the
results of the comparison of vitamin D with placebo. Result(s): A
total of 25,871 participants, including 5106 black participants, underwent
randomization. Supplementation with vitamin D was not associated with a
lower risk of either of the primary end points. During a median follow-up
of 5.3 years, cancer was diagnosed in 1617 participants (793 in the
vitamin D group and 824 in the placebo group; hazard ratio, 0.96; 95%
confidence interval [CI], 0.88 to 1.06; P = 0.47). A major cardiovascular
event occurred in 805 participants (396 in the vitamin D group and 409 in
the placebo group; hazard ratio, 0.97; 95% CI, 0.85 to 1.12; P = 0.69). In
the analyses of secondary end points, the hazard ratios were as follows:
for death from cancer (341 deaths), 0.83 (95% CI, 0.67 to 1.02); for
breast cancer, 1.02 (95% CI, 0.79 to 1.31); for prostate cancer, 0.88 (95%
CI, 0.72 to 1.07); for colorectal cancer, 1.09 (95% CI, 0.73 to 1.62); for
the expanded composite end point of major cardiovascular events plus
coronary revascularization, 0.96 (95% CI, 0.86 to 1.08); for myocardial
infarction, 0.96 (95% CI, 0.78 to 1.19); for stroke, 0.95 (95% CI, 0.76 to
1.20); and for death from cardiovascular causes, 1.11 (95% CI, 0.88 to
1.40). In the analysis of death from any cause (978 deaths), the hazard
ratio was 0.99 (95% CI, 0.87 to 1.12). No excess risks of hypercalcemia or
other adverse events were identified. Conclusion(s): Supplementation
with vitamin D did not result in a lower incidence of invasive cancer or
cardiovascular events than placebo. Copyright © 2018
Massachusetts Medical Society.

<70>
Accession Number
2001474518
Title
Ultrasound-Guided Continuous Thoracic Erector Spinae Plane Block Within an
Enhanced Recovery Program Is Associated with Decreased Opioid Consumption
and Improved Patient Postoperative Rehabilitation After Open Cardiac
Surgery-A Patient-Matched, Controlled Before-and-After Study.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2019.
Date of Publication: 2019.
Author
Macaire P.; Ho N.; Nguyen T.; Nguyen B.; Vu V.; Quach C.; Roques V.;
Capdevila X.
Institution
(Macaire, Nguyen) Department of Anesthesiology and Critical Care Medicine,
Vinmec International Hospital, Hanoi, Vietnam
(Ho, Vu, Quach) Department of Cardiac Surgery, Vinmec International
Hospital, Ho Chi Minh City, Vietnam
(Nguyen) Department of Anesthesiology and Critical Care Medicine, Vinmec
International Hospital, Ho Chi Minh City, Vietnam
(Roques) Department of Anesthesiology and Critical Care Medicine, Hospital
Virgen de la Arrixaca, Murcia, Spain
(Capdevila) Department of Anesthesiology and Critical Care Medicine,
Lapeyronie University Hospital, Cedex, France
(Capdevila) Montpellier NeuroSciences Institute, Montpellier University,
Montpellier, France
Publisher
W.B. Saunders
Abstract
Objectives: Open cardiac surgery may cause severe postoperative pain. The
authors hypothesized that patients receiving a bundle of care using
continuous erector spinae plane blocks (ESPB) would have decreased
perioperative opioid consumption and improved early outcome parameters
compared with standard perioperative management. Design(s): A
consecutive, patient-matched, controlled before-and-after study.
 Setting(s): Two tertiary teaching hospitals. Participant(s): The
study comprised 67 consecutive patients undergoing elective cardiac
surgery with cardiopulmonary bypass. Intervention(s): In a controlled
before-and-after trial, this study compared a historical group of 20
consecutive open cardiac surgery patients matched with a prospective group
of 47 consecutive patients receiving continuous bilateral ESPB (0.25
mL/kg/side of ropivacaine 0.5%) after general anesthesia induction. For
postoperative analgesia, both groups received paracetamol. The control
group received intravenous (IV) morphine, 0.5 mg/h, and IV nefopam, 100
mg/24 h. In the ESPB group, 8 hours after the loading dose, catheters were
connected to a pump infusing intermittent automatic boluses of ropivacaine
0.2% every 6 hours. If needed, for both groups, rescue analgesia was
provided with IV ketorolac, 30 mg, and IV morphine, 30 micro g/kg.
 Measurements and Main Results: Morphine consumption in the first 48
hours was significantly decreased in the ESPB group (40 [25-45] mg in the
control group compared with 0 [0-0] mg in the ESPB group [p < 0.001]) as
was intraoperative sufentanil (0.8 [0.6-0.9] micro g/kg/h and 0.2
[0.16-0.3] micro g/kg/h, respectively; p < 0.001). Times to chest tube
removal, first mobilization, pain (Visual Analogue Scale) values 2 hours
after chest tube removal, pain values at rest 1 month after surgery, and
postoperative adverse events were significantly decreased in the ESPB
group. There was no difference for extubation time and pain during first
mobilization. Conclusion(s): The authors report for the first time
that the use of a bundle of care including a continuous bilateral ESPB is
associated with a significant decrease in intraoperative and postoperative
opioid consumption, optimized rapid patient mobilization, and chest tube
removal after open cardiac surgery. Copyright © 2018 Elsevier
Inc.

<71>
Accession Number
2000753024
Title
Atrial fibrillation and ischemic events with rivaroxaban in patients with
stable coronary artery disease (AFIRE): Protocol for a multicenter,
prospective, randomized, open-label, parallel group study.
Source
International Journal of Cardiology. 265 (pp 108-112), 2018. Date of
Publication: 15 August 2018.
Author
Yasuda S.; Kaikita K.; Ogawa H.; Akao M.; Ako J.; Matoba T.; Nakamura M.;
Miyauchi K.; Hagiwara N.; Kimura K.; Hirayama A.; Matsui K.
Institution
(Yasuda) Department of Cardiovascular Medicine, National Cerebral and
Cardiovascular Center Hospital, 5-7-1 Fujishiro-dai, Suita, Osaka
565-8565, Japan
(Kaikita) Department of Cardiovascular Medicine, Graduate School of
Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto
860-8556, Japan
(Ogawa) National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai,
Suita, Osaka 565-8565, Japan
(Akao) Department of Cardiology, National Hospital Organization Kyoto
Medical Center, 1-1 Mukaihata-cho, Fukakusa, Fushimi-ku, Kyoto 612-8555,
Japan
(Ako) Department of Cardiovascular Medicine, Kitasato University School of
Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara 252-0373, Japan
(Matoba) Department of Cardiovascular Medicine, Kyushu University
Hospital, 3-1-1 Maidashi, Fukuoka 812-8582, Japan
(Nakamura) Division of Cardiovascular Medicine, Toho University Ohashi
Medical Center, 2-17-6, Ohashi, Meguro-ku, Tokyo 153-8515, Japan
(Miyauchi) Department of Cardiology, Juntendo University School of
Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
(Hagiwara) Department of Cardiology, Tokyo Women's Medical University,
8-1, Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan
(Kimura) Department of Cardiology, Yokohama City University Medical
Center, 4-57, Urafune-cho, Minami-ku, Yokohama 232-0024, Japan
(Hirayama) Division of Cardiology, Nihon University School of Medicine,
30-1 Ohyaguchi Kamicho, Itabashi-ku, Tokyo 173-8610, Japan
(Matsui) Department of Community, Family, and General Medicine, Kumamoto
University Hospital, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan
Publisher
Elsevier Ireland Ltd
Abstract
Background: In atrial fibrillation (AF) patients with coronary artery
disease (CAD), anticoagulants are commonly used in combination with
antiplatelet drugs. However, dual therapy can increase the risk of
bleeding, and the potential therapeutic benefits must be weighed against
this. Therefore, it is recommended that dual therapy is only used for a
limited time, and that monotherapy with anticoagulants should start from 1
year after percutaneous coronary intervention (PCI). However, there is a
lack of evidence on the use of monotherapy, in particular with direct oral
anticoagulants, in this group of patients. Method(s): The AFIRE Study
is a multicenter, prospective, randomized, open-label, parallel group
study conducted in patients aged >=20 years with non-valvular AF (NVAF)
and CAD. Patients who have undergone PCI or coronary artery bypass graft
at least 1 year prior to enrollment, or those without significant coronary
lesions requiring PCI (>=50% stenosis), will be included. Approximately
2200 participants will be randomized to receive either rivaroxaban
monotherapy or rivaroxaban plus an antiplatelet drug (aspirin,
clopidogrel, or prasugrel). The primary efficacy endpoints are the
composite of cardiovascular events (stroke, non-central nervous system
embolism, myocardial infarction, and unstable angina pectoris requiring
revascularizations) and all-cause mortality. The primary safety endpoint
is major bleeding as defined by the International Society on Thrombosis
and Haemostasis criteria. Conclusion(s): This study will be the first
to assess the efficacy and safety of rivaroxaban monotherapy in NVAF
patients with stable CAD. Copyright © 2018

<72>
Accession Number
2000824091
Title
Outcomes following the surgical management of left ventricular outflow
tract obstruction; A systematic review and meta-analysis.
Source
International Journal of Cardiology. 265 (pp 62-70), 2018. Date of
Publication: 15 August 2018.
Author
Collis R.A.; Rahman M.S.; Watkinson O.; Guttmann O.P.; O'Mahony C.;
Elliott P.M.
Institution
(Collis, Watkinson, Guttmann, O'Mahony, Elliott) Institute of
Cardiovascular Science, University College London, Gower Street, London
WC1E 6BT, United Kingdom
(Collis, Watkinson, Guttmann, O'Mahony, Elliott) Barts Heart Centre, St
Bartholomew's Hospital, West Smithfield, London EC1A 7BE, United Kingdom
(Rahman) Institute of Statistical Research and Training (ISRT), University
of Dhaka, Dhaka, Bangladesh
Publisher
Elsevier Ireland Ltd
Abstract
Background: Left ventricular outflow tract obstruction (LVOTO) causes
exertional symptoms in two thirds of patients with hypertrophic
cardiomyopathy (HCM). Consensus guidelines recommend surgical intervention
in patients with drug refractory symptoms. The primary aim of this study
was to perform a systematic review and meta-analysis to determine
morbidity and mortality after surgery. Method(s): Study Selection:
Studies reporting outcomes following surgical intervention for symptomatic
LVOTO in HCM. Data Extraction: Articles from searching two scientific
databases (PubMed and Web of Science) were reviewed and data were
extracted by two investigators. Meta-analysis of data was performed with
heterogeneity assessed using I2 statistic. Result(s): 85
studies were included in the systematic review and 35 studies in the
meta-analysis. Contemporary early (<30 days) and late (>30 days) mortality
following septal myectomy were 1.4% (CI 0.8, 2.4) I2 9.0%, p =
0.36 and 0.7% (CI 0.3, 1.2) I2 70.7%, p < 0.05 respectively.
Sixty-eight studies (80%) reported perioperative complications. The
contemporary rate of a perioperative ventricular septal defect was 1.4%
(0.8, 2.3) I2 0%, p < 0.05. Late morbidities including atrial
fibrillation, stroke, heart failure and transplant were reported in fewer
than 22% of studies and few studies compared mortality and clinical
outcomes using different surgical approaches to LVOTO. The incidence rate
(IR) of reintervention with a further surgical procedure was 0.3% (CI 0.2,
0.4) I2 52.5%, p < 0.05. Conclusion(s): Contemporary
surgical management of LVOTO is associated with low operative mortality
rates but further studies are needed to investigate the impact of surgical
therapy on non-fatal early and late complications. Copyright ©
2018 Elsevier B.V.

<73>
[Use Link to view the full text]
Accession Number
625718604
Title
Pharmacologic interventions for preventing delirium in adult patients
after cardiac surgery: Protocol of a systematic review and network
meta-analysis.
Source
Medicine. 97 (52) (pp e13881), 2018. Date of Publication: 01 Dec 2018.
Author
Wen J.; Zeng H.; Li Z.; He G.; Jin Y.
Institution
(Wen) Shanghai University of Traditional Chinese Medicine, Shanghai, China
(Wen, Jin) Shanghai University of Medicine & Health Sciences, Shanghai,
China
(Zeng, Li) Second Clinical College of Guangzhou University of Chinese
Medicine, Guangzhou, China
(He) First Clinical College of Guangzhou University of Chinese Medicine,
Guangzhou, China
Publisher
NLM (Medline)
Abstract
BACKGROUND: Delirium is common in adult patients undergoing cardiac
surgery and related to a high morbidity and mortality. Although a variety
of pharmacologic interventions have been applied in delirium prevention,
there is still uncertainty concerning which drug is optimal. Thus, we plan
to conduct a systematic review and network meta-analysis (NMA) of
published studies to assess the efficacy and safety of pharmacologic
interventions for preventing delirium among those patients.
 METHOD(S): A systematic literature search will be conducted in
Embase, PubMed, and the Cochrane Library. The primary outcome will be the
incidence of postoperative delirium. Secondary outcomes will include
all-cause mortality and length of hospital or intensive care unit stay. A
frequentist NMA will be conducted using Stata version 14.0. The
inconsistency between direct and indirect comparisons will be evaluated
using a node splitting method. In addition, surface under the cumulative
ranking area will be used to evaluate superiority of different treatments.
 RESULT(S): The findings of our review will be submitted to a
peer-reviewed publication. CONCLUSION(S): Our study will generate
convincing evidence regarding the effectiveness and safety of different
pharmacologic interventions for delirium prevention in cardiac surgery
patients.

<74>
Accession Number
2000611624
Title
Outcomes associated with mammalian target of rapamycin (mTOR) inhibitors
in heart transplant recipients: A meta-analysis.
Source
International Journal of Cardiology. 265 (pp 71-76), 2018. Date of
Publication: 15 August 2018.
Author
Jennings D.L.; Lange N.; Shullo M.; Latif F.; Restaino S.; Topkara V.K.;
Takeda K.; Takayama H.; Naka Y.; Farr M.; Colombo P.; Baker W.L.
Institution
(Jennings, Lange) Department of Pharmacy, Columbia University Medical
Center, New York, NY, United States
(Shullo) WVU Medicine, West Virginia Health System, Morgantown, WV, United
States
(Latif, Restaino, Topkara, Farr, Colombo) Division of Cardiology,
Department of Medicine, Columbia University Medical Center, New York, NY,
United States
(Takeda, Takayama, Naka) Division of Cardiovascular Surgery, Department of
Surgery, Columbia University Medical Center, New York, NY, United States
(Baker) Department of Pharmacy Practice, University of Connecticut,
Storrs, CT, United States
Publisher
Elsevier Ireland Ltd
Abstract
Background: Data evaluating mTOR inhibitor use heart transplant (HT)
patients comes from relatively small studies and controversy exists
regarding their specific role. We performed a meta-analysis of randomized
trials to evaluate the efficacy and safety of mTOR inhibitors in HT
patients. Method(s): We performed a systematic literature search of
Medline and Embase through July 2017 identifying studies evaluating mTOR
inhibitors in HT patients reporting effects on coronary allograft
vasculopathy (CAV), renal function, acute cellular rejection (ACR),
cytomegalovirus (CMV) infection, and discontinuation due to adverse drug
events (ADE). Data were pooled using a random-effects model producing a
mean difference (MD; for continuous data) or odds ratio (OR; for
dichotomous data) and 95% confidence interval (CI). Result(s): 14
trials reported at least one outcome of interest. Change in mean maximal
intimal thickness was significantly reduced with mTOR (-0.04 [-0.07 to
-0.02]) compared to calcineurin inhibitor/mycophenolate mofetil (CNI/MMF).
Rates of CMV infection were also significantly reduced (0.26; [0.2 to
0.32]) with mTOR regimens compared to CNI/MMF therapy. ACR was more
frequent with CNI-sparing regimens 6.46 [1.55 to 26.95]). eGFR was
significantly improved with CNI-sparing therapies (mean difference 12.09
mL/min [2.43 to 21.74]), but was similar between CNI/mTOR versus CNI/MMF
regimens (p > 0.05). Rates of discontinuation due to ADE were higher in
mTOR-containing regimens (OR 2.15 [1.28 to 3.60], p = 0.01), while
mortality rates were similar (OR 0.91 [0.61 to 1.37], p = 0.62).
 Conclusion(s): mTOR-containing regimens can attenuate CAV and CMV
risk in HT recipients. A mTOR/MMF combination preserves renal function but
increases the risk of ACR. Copyright © 2018 Elsevier B.V.

<75>
Accession Number
621627348
Title
Ticagrelor in Peripheral Artery Disease Endovascular Revascularization
(TI-PAD): Challenges in clinical trial execution.
Source
Vascular Medicine (United Kingdom). 23 (6) (pp 513-522), 2018. Date of
Publication: 01 Dec 2018.
Author
Rogers R.K.; Hiatt W.R.; Patel M.R.; Shishehbor M.H.; White R.; Khan N.D.;
Bhalla N.P.; Jones W.S.; Low Wang C.C.
Institution
(Rogers, Hiatt) Department of Medicine, Division of Cardiology, University
of Colorado School of Medicine, Aurora, CO, United States
(Hiatt, White, Low Wang) CPC Clinical Research, Aurora, CO, United States
(Patel, Jones) Duke University Health System and Duke Clinical Research
Institute, Durham, NC, United States
(Shishehbor) Harrington Heart & Vascular Institute, University Hospitals
of Cleveland, Cleveland, OH, United States
(Khan, Bhalla) AstraZeneca, Wilmington, DE, United States
(Low Wang) Department of Medicine, Division of Endocrinology, University
of Colorado School of Medicine, Aurora, CO, United States
Publisher
SAGE Publications Ltd (E-mail: info@sagepub.co.uk)
Abstract
There is limited evidence to guide clinical decision-making for
antiplatelet therapy in peripheral artery disease (PAD) in the setting of
lower extremity endovascular treatment. The Ticagrelor in Peripheral
Artery Disease Endovascular Revascularization Study (TI-PAD) evaluated the
role of ticagrelor versus aspirin as monotherapy in the management of
patients following lower extremity endovascular revascularization. The
trial failed to recruit the targeted number of patients, likely due to
aspects of the design including the lack of option for dual antiplatelet
therapy, and inability to identify suitable patients at study sites. In
response, the protocol underwent amendments, but these changes did not
adequately stimulate recruitment, and thus TI-PAD was prematurely
terminated. This article describes the rationale for TI-PAD and challenges
in trial design, subject recruitment and trial operations to better inform
the conduct of future trials in PAD revascularization. ClinicalTrials.gov
Identifier: NCT02227368 Copyright © The Author(s) 2018.

<76>
Accession Number
616133266
Title
Effect of high-dose sodium selenite in cardiac surgery patients: A
randomized controlled bi-center trial.
Source
Clinical Nutrition. 37 (4) (pp 1172-1180), 2018. Date of Publication:
August 2018.
Author
Schmidt T.; Pargger H.; Seeberger E.; Eckhart F.; von Felten S.; Haberthur
C.
Institution
(Schmidt, Eckhart, Haberthur) Department for Anesthesia, Intensive Care
Medicine and Rescue Medicine, Lucerne Cantonal Hospital, Lucerne,
Switzerland
(Pargger, Seeberger) Department of Anesthesiology, Operative Intensive
Care, Preclinical Emergency Medicine and Pain Management, University
Hospital Basel, Switzerland
(von Felten) Department of Clinical Research, Clinical Trial Unit,
University Hospital Basel, Switzerland
(Haberthur) Department of Anesthesiology and Intensive Care Medicine,
Hirslanden Clinic, Zurich, Switzerland
Publisher
Churchill Livingstone
Abstract
Background & aims: Cardiac surgery is accompanied by oxidative stress and
systemic inflammatory response, which may be associated with organ
dysfunction and increased mortality. Selenium and selenoenzymes are
important constituents of anti-oxidative defense. We hypothesized that
high-dose sodium selenite supplementation can attenuate the postoperative
inflammation and might, therefore, improve clinical outcome.
 Method(s): Randomized, placebo-controlled, double-blinded, bi-center
study on 411 adult patients undergoing elective cardiac surgery. Patients
received an intravenous bolus of 4000 mug selenium (in the form of sodium
selenite) or placebo after induction of anesthesia and 1000 mug/d selenium
or placebo during their intensive care unit (ICU) stay. Primary outcome
measure was the Sequential Organ Failure Assessment (SOFA) score on the
second postoperative day. Secondary endpoints included the change in
perioperative selenium levels, change of inflammatory and cardiac markers,
use of vasoactive medication, incidence of acute kidney injury, ICU and
hospital length of stay, and mortality. Result(s): The perioperative
administration of high-dose sodium selenite prevented the postoperative
drop of blood and serum selenium levels, reduced the number of patients
depending on postoperative vasoactive support but failed to reduce the
postoperative SOFA score and its related organ-specific scores compared to
placebo. Except for an increase of postoperative procalcitonin and
bilirubin levels in the sodium selenite group, other inflammatory markers,
organ function variables and clinical endpoints remained unchanged.
 Conclusion(s): The perioperative administration of high-dose sodium
selenite in cardiac surgery patients prevented the postoperative fall of
blood selenium levels and reduced the need for postoperative vasoactive
support by a yet unknown mechanism. Trial registration: Registered under
ClinicalTrials.gov Identifier no. NCT01141556. Copyright © 2017
Elsevier Ltd and European Society for Clinical Nutrition and Metabolism

<77>
Accession Number
625438051
Title
Transcatheter mitral-valve repair in patients with heart failure.
Source
New England Journal of Medicine. 379 (24) (pp 2307-2318), 2018. Date of
Publication: 13 Dec 2018.
Author
Stone G.W.; Lindenfeld J.A.; Abraham W.T.; Kar S.; Lim D.S.; Mishell J.M.;
Whisenant B.; Grayburn P.A.; Rinaldi M.; Kapadia S.R.; Rajagopal V.;
Sarembock I.J.; Brieke A.; Marx S.O.; Cohen D.J.; Weissman N.J.
Institution
(Stone) Columbia University Medical Center, Cardiovascular Research
Foundation, 1700 Broadway, 8th Fl., New York, NY 10019, United States
(Stone) New York-Presbyterian Hospital, Cardiovascular Research
Foundation, United States
(Stone, Marx) Columbia University Medical Center, New York, United States
(Lindenfeld) Advanced Heart Failure, Vanderbilt Heart and Vascular
Institute, Nashville, United States
(Abraham) Departments of Medicine, Physiology, and Cell Biology, Division
of Cardiovascular Medicine, Davis, United States
(Abraham) Heart and Lung Research Institute, Ohio State University,
Columbus, United States
(Kapadia) Department of Cardiovascular Medicine, Heart and Vascular
Institute, Cleveland Clinic, Cleveland, United States
(Sarembock) Christ Hospital, Cincinnati, OH, United States
(Kar) Smidt Heart In-stitute, Cedars-Sinai Medical Center, Los Angeles,
United States
(Mishell) Kaiser Permanente-San Francisco Hospital, San Francisco, CA,
United States
(Lim) Division of Cardiology, University of Virginia, Charlottesville,
United States
(Whisenant) Intermountain Medical Center, Murray, UT, United States
(Grayburn) Baylor University Medical Center, Baylor Heart and Vascular
Institute, United States
(Rinaldi) Carolinas Medical Center, Charlotte, NC, United States
(Rajagopal) Piedmont Hospital, Atlanta, United States
(Brieke) University of Colorado Hospital, Aurora, United States
(Cohen) Saint Luke's Mid America Heart Institute, University of
Missouri-Kansas City, School of Medicine, Kansas City, United States
(Weissman) MedStar Health Research Institute, Hyattsville, MD, United
States
Publisher
Massachussetts Medical Society
Abstract
BACKGROUND Among patients with heart failure who have mitral regurgitation
due to left ventricular dysfunction, the prognosis is poor. Transcatheter
mitral-valve repair may improve their clinical outcomes. METHODS At 78
sites in the United States and Canada, we enrolled patients with heart
failure and moderate-to-severe or severe secondary mitral regurgitation
who remained symptomatic despite the use of maximal doses of
guideline-directed medical therapy. Patients were randomly assigned to
transcatheter mitral-valve repair plus medical therapy (device group) or
medical therapy alone (control group). The primary effectiveness end point
was all hospitalizations for heart failure within 24 months of follow-up.
The primary safety end point was freedom from device-related complications
at 12 months; the rate for this end point was compared with a prespecified
objective performance goal of 88.0%. RESULTS Of the 614 patients who were
enrolled in the trial, 302 were assigned to the device group and 312 to
the control group. The annualized rate of all hospitalizations for heart
failure within 24 months was 35.8% per patient-year in the device group as
compared with 67.9% per patient-year in the control group (hazard ratio,
0.53; 95% confidence interval [CI], 0.40 to 0.70; P<0.001). The rate of
freedom from device-related complications at 12 months was 96.6% (lower
95% confidence limit, 94.8%; P<0.001 for comparison with the performance
goal). Death from any cause within 24 months occurred in 29.1% of the
patients in the device group as compared with 46.1% in the control group
(hazard ratio, 0.62; 95% CI, 0.46 to 0.82; P<0.001). CONCLUSIONS Among
patients with heart failure and moderate-to-severe or severe secondary
mitral regurgitation who remained symptomatic despite the use of maximal
doses of guideline-directed medical therapy, transcatheter mitral-valve
repair resulted in a lower rate of hospitalization for heart failure and
lower all-cause mortality within 24 months of follow-up than medical
therapy alone. The rate of freedom from device-related complications
exceeded a prespecified safety threshold. Copyright © 2018
Massachusetts Medical Society.

<78>
Accession Number
625438048
Title
Percutaneous repair or medical treatment for secondary mitral
regurgitation.
Source
New England Journal of Medicine. 379 (24) (pp 2297-2306), 2018. Date of
Publication: 13 Dec 2018.
Author
Obadia J.-F.; Messika-Zeitoun D.; Leurent G.; Iung B.; Bonnet G.; Piriou
N.; Lefevre T.; Piot C.; Rouleau F.; Carrie D.; Nejjari M.; Ohlmann P.;
Leclercq F.; Saint Etienne C.; Teiger E.; Leroux L.; Karam N.; Michel N.;
Gilard M.; Donal E.; Trochu J.-N.; Cormier B.; Armoiry X.; Boutitie F.;
Maucort-Boulch D.; Barnel C.; Samson G.; Guerin P.; Vahanian A.; Mewton N.
Institution
(Obadia) Hopital Cardiovasculaire Louis Pradel, Chirurgie
Cardio-Vasculaire et Transplantation Cardiaque, 28, Ave. Doyen Lepine,
Bron Cedex 69677, France
(Obadia) Hopital Cardiovasculaire Louis Pradel, Chirurgie
Cardio-Vasculaire et Transplantation Cardiaque, France
(Armoiry) Pharmacy Department, Laboratoire Mateis, France
(Barnel, Samson, Mewton) Hopital Cardiovasculaire Louis Pradel, Clinical
Investigation Center and Heart Failure Department, INSERM 1407, Hospices
Civils de Lyon, Claude Bernard University, Lyon, France
(Messika-Zeitoun, Iung, Vahanian) Assistance Publique-Hopitaux de Paris
(APHP), Hopital Bichat, France
(Karam) APHP, Hopital Europeen Georges Pom-pidou, Paris, France
(Leurent, Donal) Centre Hospitalier Universitaire (CHU) Rennes, Hopital
Pontchaillou, Rennes, France
(Bonnet) Assistance Publique-Hopitaux de Marseille (APHM), Hopital de la
Timone, France
(Michel) Hopital Saint Joseph, Marseille, France
(Piriou, Trochu, Guerin) CHU Nantes, Hopital Guillaume et Rene Laennec,
Nantes, France
(Lefevre, Cormier) Institut Jacques Cartier, Massy, France
(Piot) Clinique du Millenaire, France
(Leclercq) CHU Montpellier, Hopital Arnaud-de-Villeneuve, Montpellier,
France
(Rouleau) CHU Angers, Angers, France
(Carrie) CHU Toulouse, Hopital Rangueil, Toulouse, France
(Nejjari) Centre Cardiologique du Nord, Saint-Denis, France
(Ohlmann) Hopitaux Universitaires de Strasbourg, Nouvel Hopital Civil,
Strasbourg, France
(Saint Etienne) Centre Hospitalier Regional Universitaire (CHRU) de Tours,
Hopital Trousseau, Tours, France
(Teiger) APHP, Hopital Henri Mondor, Creteil, France
(Leroux) CHU Bordeaux, Hopital Haut-Leveque, Pessac, France
(Gilard) CHRU Brest, Hopital de La Cavale Blanche, Brest, France
(Boutitie, Maucort-Boulch) Service de Biostatistique-Bioinformatique, Pole
Sante Publique, Hospices Civils de Lyon, Centre National de la Recherche
Scientifique (CNRS), Laboratoire de Biometrie et Biologie Evolutive,
Equipe Biostatistique-Sante, Villeurbanne, France
(Messika-Zeitoun) University of Ottawa Heart Institute, Division of
Cardiology, Ottawa, Canada
Publisher
Massachussetts Medical Society
Abstract
BACKGROUND In patients who have chronic heart failure with reduced left
ventricular ejection fraction, severe secondary mitral-valve regurgitation
is associated with a poor prognosis. Whether percutaneous mitral-valve
repair improves clinical outcomes in this patient population is unknown.
METHODS We randomly assigned patients who had severe secondary mitral
regurgitation (defined as an effective regurgitant orifice area of >20
mm2 or a regurgitant volume of >30 ml per beat), a left
ventricular ejection fraction between 15 and 40%, and symptomatic heart
failure, in a 1:1 ratio, to undergo percutaneous mitral-valve repair in
addition to receiving medical therapy (intervention group; 152 patients)
or to receive medical therapy alone (control group; 152 patients). The
primary efficacy outcome was a composite of death from any cause or
unplanned hospitalization for heart failure at 12 months. RESULTS At 12
months, the rate of the primary outcome was 54.6% (83 of 152 patients) in
the intervention group and 51.3% (78 of 152 patients) in the control group
(odds ratio, 1.16; 95% confidence interval [CI], 0.73 to 1.84; P=0.53).
The rate of death from any cause was 24.3% (37 of 152 patients) in the
intervention group and 22.4% (34 of 152 patients) in the control group
(hazard ratio, 1.11; 95% CI, 0.69 to 1.77). The rate of unplanned
hospitalization for heart failure was 48.7% (74 of 152 patients) in the
intervention group and 47.4% (72 of 152 patients) in the control group
(hazard ratio, 1.13; 95% CI, 0.81 to 1.56). CONCLUSIONS Among patients
with severe secondary mitral regurgitation, the rate of death or unplanned
hospitalization for heart failure at 1 year did not differ significantly
between patients who underwent percutaneous mitral-valve repair in
addition to receiving medical therapy and those who received medical
therapy alone. Copyright © 2018 Massachusetts Medical Society.

<79>
Accession Number
625057742
Title
Long-term performance of an external stent for saphenous vein grafts: the
VEST IV trial.
Source
Journal of cardiothoracic surgery. 13 (1) (pp 117), 2018. Date of
Publication: 19 Nov 2018.
Author
Taggart D.P.; Webb C.M.; Desouza A.; Yadav R.; Channon K.M.; De Robertis
F.; Di Mario C.
Institution
(Taggart) Nuffield Department of Surgery, University of Oxford, John
Radcliffe Hospital, Oxford, United Kingdom
(Webb) National Heart & Lung Institute, Imperial College London, London,
United Kingdom
(Webb, Di Mario) Department of Cardiology, Royal Brompton Hospital, Sydney
Street, London SW3 6NP, United Kingdom
(Desouza, Yadav) Department of Cardiothoracic Surgery, Royal Brompton
Hospital, Sydney Street, London, United Kingdom
(Channon) Department of Cardiovascular Medicine, University of Oxford,
John Radcliffe Hospital, Oxford, United Kingdom
(De Robertis) Department of Cardiothoracic Surgery, Harefield Hospital,
Middlesex, London, UK
Publisher
NLM (Medline)
Abstract
BACKGROUND: Externally stenting saphenous vein grafts reduces intimal
hyperplasia, improves lumen uniformity and reduces oscillatory shear
stress 1 year following surgery. The present study is the first to present
the longer-term (4.5 years) performance and biomechanical effects of
externally stented saphenous vein grafts. METHOD(S): Thirty patients
previously implanted with the VEST external stent in the randomized,
within-patient-controlled VEST I study were followed up for adverse
events; 21 of these were available to undergo coronary angiography and
intravascular ultrasound. RESULT(S): Twenty-one stented and 29
nonstented saphenous vein grafts were evaluated by angiography and
ultrasound at 4.5+/-0.3 years. Vein graft failure rates were comparable
between stented and nonstented grafts (30 and 23% respectively; p=0.42).
All failures were apparent at 1 year except for one additional nonstented
failure at 4.5 years. In patent vein grafts, Fitzgibbon perfect patency
remained significantly higher in the stented versus nonstented vein grafts
(81 and 48% respectively, p=0.002), while intimal hyperplasia area (4.27
mm2+/-1.27 mm2 and 5.23 mm2+/-1.83 mm2 respectively, p<0.001) and
thickness (0.36 mm+/-0.09 mm and 0.42 mm+/-0.11 mm respectively, p<0.001)
were significantly reduced. Intimal hyperplasia proliferation correlated
with lumen uniformity and with the distance between the stent and the
lumen (p=0.04 and p<0.001 respectively). CONCLUSION(S): External
stenting mitigates saphenous vein graft remodeling and significantly
reduces diffuse intimal hyperplasia and the development of lumen
irregularities 4.5 years after coronary artery bypass surgery. Close
conformity of the stent to the vessel wall appears to be an important
factor. TRIAL REGISTRATION: NCT01415245 . Registered 11 August 2011.

<80>
Accession Number
619492656
Title
Protective Invasive Ventilation in Cardiac Surgery: A Systematic Review
With a Focus on Acute Lung Injury in Adult Cardiac Surgical Patients.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 32 (4) (pp 1922-1936),
2018. Date of Publication: August 2018.
Author
Zochios V.; Klein A.A.; Gao F.
Institution
(Zochios) University Hospitals Birmingham NHS Foundation Trust, Department
of Critical Care Medicine, Queen Elizabeth Hospital Birmingham, Edgbaston,
Birmingham, United Kingdom
(Zochios, Gao) Perioperative Critical Care and Trauma Trials Group,
Institute of Inflammation and Ageing, Centre of Translational Inflammation
Research, University of Birmingham, Birmingham, United Kingdom
(Klein) Department of Cardiothoracic Anesthesia and Critical Care
Medicine, Papworth Hospital NHS Foundation Trust, Papworth Everard,
Cambridge, United Kingdom
(Gao) The 2nd Affiliated Hospital and Yuying Children's Hospital, Wenzhou
Medical University, Wenzhou, China
Publisher
W.B. Saunders

<81>
Accession Number
624073315
Title
Effects of methylprednisolone on blood-brain barrier and cerebral
inflammation in cardiac surgery - A randomized trial 11 Medical and Health
Sciences 1103 Clinical Sciences 11 Medical and Health Sciences 1109
Neurosciences.
Source
Journal of Neuroinflammation. 15 (1) (no pagination), 2018. Article
Number: 283. Date of Publication: 27 Sep 2018.
Author
Danielson M.; Reinsfelt B.; Westerlind A.; Zetterberg H.; Blennow K.;
Ricksten S.-E.
Institution
(Danielson, Reinsfelt, Westerlind, Ricksten) Department of Anesthesiology
and Intensive Care Medicine, Sahlgrenska University Hospital, University
of Gothenburg, Gothenburg SE-413 45, Sweden
(Zetterberg, Blennow) Deparment of Anesthesiology and Intensive Care
Medicine, Sahlgrenska University Hospital, Sahlgrenska Academy, University
of Gothenburg, Gothenburg SE-41345, Sweden
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Cognitive dysfunction is a frequent complication to open-heart
surgery. Cerebral inflammation caused by blood-brain barrier (BBB)
dysfunction due to a systemic inflammatory response is considered a
possible etiology. The effects of the glucocorticoid, methylprednisolone,
on cerebrospinal fluid (CSF) markers of BBB function, neuroinflammation,
and brain injury in patients undergoing cardiac surgery with
cardiopulmonary bypass were studied. Method(s): In this prospective,
randomized, blinded study, 30 patients scheduled for elective surgical
aortic valve replacement were randomized to methylprednisolone 15 mg/kg (n
= 15) or placebo (n = 15) as a bolus dose administered after induction of
anesthesia. CSF and blood samples were obtained the day before and 24 h
after surgery for assessment of systemic and brain inflammation
(interleukin-6, interleukin-8, tumor necrosis factor-alpha), axonal injury
(total-tau, neurofilament light chain protein), neuronal injury
(neuron-specific enolase), astroglial injury (S-100B, glial fibrillary
acidic protein), and the BBB integrity (CSF/serum albumin ratio).
 Result(s): In the control group, there was a 54-fold and 17-fold
increase in serum interleukin-6 and interleukin-8, respectively. This
systemic activation of the inflammatory cytokines was clearly attenuated
by methylprednisolone (p < 0.001). The increase of the CSF levels of the
astroglial markers was not affected. A postoperative BBB dysfunction was
seen in both groups as the CSF/serum albumin ratio increased from 6.4 +/-
8.0 to 8.0 in the placebo group (p < 0.01) and from 5.6 +/- 2.3 to 7.2 in
the methylprednisolone group (p < 0.01) with no difference between groups
(p = 0.98). In the CSF, methylprednisolone attenuated the interleukin-6
release (p < 0.001), which could be explained by the fall in systemic
interleukin-6, and the serum to CSF gradient of IL-6 seen both at baseline
and after surgery. In the CSF, methylprednisolone enhanced the
interleukin-8 release (p < 0.001) but did not affect postoperative changes
in CSF levels of tumor necrosis factor alpha. Serum levels of S-100B and
neuron-specific enolase increased in both groups with no difference
between groups. CSF levels of total tau, neurofilament light chain
protein, and neuron-specific enolase were not affected in any of the
groups. Conclusion(s): Preventive treatment with high-dose
methylprednisolone attenuated the systemic inflammatory response to
open-heart surgery with cardiopulmonary bypass, but did not prevent or
attenuate the increase in BBB permeability or the neuroinflammatory
response. Trial registration: Clinical Trials, Identifier: NCT01755338,
registered 24 December 2012 Copyright © 2018 The Author(s).

<82>
[Use Link to view the full text]
Accession Number
615007679
Title
Laparoscopic Lavage Versus Primary Resection for Acute Perforated
Diverticulitis: Review and Meta-analysis.
Source
Annals of Surgery. 267 (2) (pp 252-258), 2018. Date of Publication: 01 Feb
2018.
Author
Penna M.; Markar S.R.; Mackenzie H.; Hompes R.; Cunningham C.
Institution
(Penna, Markar, Mackenzie) Department of Surgery and Cancer, Imperial
College London, London, United Kingdom
(Penna, Hompes, Cunningham) Department of Colorectal Surgery, Churchill
Hospital, University Hospitals of Oxford, Old Road, Oxford OX3 7LE, United
Kingdom
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Objective: To compare clinical outcomes after laparoscopic lavage (LL) or
colonic resection (CR) for purulent diverticulitis. Background(s):
Laparoscopic lavage has been suggested as an alternative treatment for
traditional CR. Comparative studies to date have shown conflicting
results. Method(s): Electronic searches of Embase, Medline, Web of
Science, and Cochrane databases were performed. Weighted mean differences
(WMD) were calculated for effect size of continuous variables and pooled
odds ratios (POR) calculated for discrete variables. Result(s): A
total of 589 patients recruited from 3 randomized controlled trials (RCTs)
and 4 comparative studies were included; 85% as Hinchey III. LL group had
younger patients with higher body mass index and lower ASA grades, but
comparable Hinchey classification and previous diverticulitis rates. No
significant differences were noted for mortality, 30-day reoperations and
unplanned readmissions. LL had higher rates of intraabdominal abscesses
(POR = 2.85; 95% confidence interval, CI, 1.52-5.34; P = 0.001),
peritonitis (POR = 7.80; 95% CI 2.12-28.69; P = 0.002), and increased
long-term emergency reoperations (POR = 3.32; 95% CI 1.73-6.38; P <
0.001). Benefits of LL included shorter operative time, fewer cardiac
complications, fewer wound infections, and shorter hospital stay. Overall,
90% had stomas after CR, of whom 74% underwent stoma reversal within
12-months. Approximately, 14% of LL patients required a stoma; 48%
obtaining gut continuity within 12-months, whereas 36% underwent elective
sigmoidectomy. Conclusion(s): The preservation of diseased bowel by
LL is associated with approximately 3 times greater risk of persistent
peritonitis, intraabdominal abscesses and the need for emergency surgery
compared with CR. Future studies should focus on developing composite
predictive scores encompassing the wide variation in presentations of
diverticulitis and treatment tailored on case-by-case basis. ©
Copyright 2017 Wolters Kluwer Health, Inc. All rights reserved.

<83>
Accession Number
623034410
Title
Ticagrelor versus clopidogrel in patients with symptomatic peripheral
artery disease and prior coronary artery disease: Insights from the EUCLID
trial.
Source
Vascular Medicine (United Kingdom). 23 (6) (pp 523-530), 2018. Date of
Publication: 01 Dec 2018.
Author
Berger J.S.; Abramson B.L.; Lopes R.D.; Heizer G.; Rockhold F.W.;
Baumgartner I.; Fowkes F.G.R.; Held P.; Katona B.G.; Norgren L.; Jones
W.S.; Millegard M.; Blomster J.; Reist C.; Hiatt W.R.; Patel M.R.;
Mahaffey K.W.
Institution
(Berger) Departments of Medicine and Surgery, New York University School
of Medicine, New York, NY, United States
(Abramson) University of Toronto, Toronto, ON, Canada
(Lopes, Heizer, Rockhold, Jones, Reist, Patel) Duke Clinical Research
Institute, Duke University School of Medicine, Durham, NC, United States
(Baumgartner) Swiss Cardiovascular Center, Inselspital, Bern University
Hospital, University of Bern, Bern, Switzerland
(Fowkes) Usher Institute of Population Health Sciences and Informatics,
University of Edinburgh, Edinburgh, United Kingdom
(Held, Millegard, Blomster) AstraZeneca Gothenburg, Molndal, Sweden
(Katona) AstraZeneca Gaithersburg, Gaithersburg, MD, United States
(Norgren) Faculty of Medicine and Health, Orebro University, Orebro,
Sweden
(Hiatt) University of Colorado School of Medicine and CPC Clinical
Research, Aurora, CO, United States
(Mahaffey) Stanford Center for Clinical Research, Stanford University
School of Medicine, Stanford, CA, United States
Publisher
SAGE Publications Ltd (E-mail: info@sagepub.co.uk)
Abstract
Patients with peripheral artery disease (PAD) are at heightened risk of
cardiovascular morbidity and mortality. We sought to evaluate the risk of
concomitant coronary artery disease (CAD) in patients with symptomatic PAD
versus PAD without diagnosed CAD, and whether ticagrelor was superior to
clopidogrel in reducing that risk. The EUCLID trial randomized 13,885
patients with PAD to antithrombotic monotherapy with ticagrelor or
clopidogrel. CAD was defined as prior myocardial infarction (MI),
percutaneous coronary intervention (PCI), or coronary artery bypass graft
(CABG) surgery. Median follow-up was 30 months. Among 4032 (29%) patients
with PAD and CAD, 63% had prior MI, 54% prior PCI, and 38% prior CABG.
After adjustment for baseline characteristics, patients with PAD and CAD
had significantly higher rates of the primary endpoint (cardiovascular
death/MI/stroke, 15.3% vs 8.9%, hazard ratio (HR) 1.50, 95% CI: 1.13-1.99;
p=0.005), but no statistically significant increase in acute limb ischemia
(HR 1.28, 95% CI: 0.57-2.85; p=0.55) or major bleeding (HR 1.10, 95% CI:
0.49-2.48; p=0.81) versus PAD without CAD. Among patients with PAD and
CAD, there was no differential treatment effect between ticagrelor versus
clopidogrel for the primary efficacy endpoint (HR 1.02, 95% CI: 0.87-1.19;
p=0.84), acute limb ischemia (HR 1.03, 95% CI: 0.63-1.69; p=0.89), or
major bleeding (HR 1.06, 95% CI: 0.66-1.69; p=0.81). There was a
statistically significant interaction between prior coronary stent
placement and study treatment (p=0.03) with a numerical reduction in the
primary efficacy endpoint with ticagrelor versus clopidogrel (13.8% vs
16.8%, HR 0.82, 95% CI: 0.65-1.03; p=0.09). Patients with PAD and prior
CAD had higher composite rates of cardiovascular death, MI, and ischemic
stroke versus PAD without diagnosed CAD. There were no significant
differences between ticagrelor and clopidogrel in cardiovascular events or
major bleeding. ClinicalTrials.gov Identifier: NCT01732822. Copyright
© The Author(s) 2018.

<84>
Accession Number
624150801
Title
Meta-Analysis of Potent P2Y12-ADP Receptor Antagonist Therapy Compared to
Clopidogrel Therapy in Acute Coronary Syndrome Patients with Chronic
Kidney Disease.
Source
Thrombosis and Haemostasis. 118 (10) (pp 1839-1846), 2018. Date of
Publication: 2018.
Author
Bonello L.; Laine M.; Lemesle G.; Puymirat E.; Dabry T.; Thuny F.;
Paganelli F.; Aradi D.; Frere C.; Burtey S.; Sibbing D.; Mancini J.
Institution
(Bonello, Laine, Dabry, Thuny, Paganelli) Service de Cardiologie, Centre
Hospitalier Universitaire de Marseille, Hopital NORD, Aix-Marseille
Universite, Hopital Nord, MARS Cardio, INSERM UMRS 1076, Chemin des
Bourrely, Marseille 13015, France
(Bonello, Burtey) Vascular Research Center of Marseille, Aix-Marseille
Universite, Marseille, France
(Lemesle) Departement de Cardiologie, Hopital Universitaire de Lille,
Lille, France
(Puymirat) Departement de Cardiologie, Hopital Europeen Georges Pompidou,
Assistance Publique des Hopitaux de Paris, Paris, France
(Aradi) Heart Center Balatonfured, Semmelweis University Budapest,
Budapest, Hungary
(Frere) Department of Haematology, Assistance Publique Hopitaux de Paris,
Pitie-Salpetriere Hospital, Paris, France
(Burtey) Centre de Nephrologie et Transplantation Renale, Hopital de la
Conception, Marseille, France
(Sibbing) Department of Cardiology, German Center for Cardiovascular
Research, Ludwig-Maximilians-Universitat, Munchen, Germany
(Mancini) Department of Public Health (BIOSTIC), Aix-Marseille University,
Hopital de la Timone, Marseille, France
Publisher
Georg Thieme Verlag (E-mail: iaorl@iaorl.org)
Abstract
Background ?The clinical benefit of anti-platelet agents in patients with
chronic kidney disease (CKD) is uncertain. In addition, the risk-benefit
ratio of potent oral P2Y12-adenosine diphosphate (ADP) receptor
antagonists (PPAs), namely, prasugrel and ticagrelor, compared with
clopidogrel in CKD patients suffering from acute coronary syndrome (ACS)
remains unknown. Objective ?We performed a meta-analysis of all studies
comparing the clinical outcomes of PPA and clopidogrel therapy in CKD
patients suffering from ACS. Methods ?We searched PubMed, the Cochrane
library, Google Scholar, Clinical trial.org and the abstracts of
international cardiology congresses from April 2000 to October 2017.
Clinical studies comparing PPA with clopidogrel in ACS patients with CKD
were selected. Our literature research identified five studies which were
included in the meta-analysis. The primary endpoint was a composite of
major adverse cardiovascular events (MACEs) at the latest follow-up
available. Secondary endpoint included bleedings. Results ?We included
data from three sub-group analysis of randomized clinical trials and two
prospective observational studies (n = 31,234). Overall, PPAs were
associated with lower rates of major cardiovascular events, with a pooled
hazard ratio (pHR) of 0.88 (95% confidence interval [CI]: 0.79-0.99; p =
0.03), without increased bleedings (pHR = 1.10) (95% CI: 0.95-1.27; p =
0.18). In a sensitivity analysis restricted to studies enrolling
invasively managed patients, the benefit of PPA on MACE was maintained
(pHR = 0.85) (95% CI: 0.77-0.93; p < 0.001), including a reduction in
mortality (pHR = 0.82) (95% CI: 0.7-0.96; p = 0.016). Conclusion ?Compared
with clopidogrel, PPAs were associated with a reduced rate of MACE without
increased bleedings in CKD patients with ACS. Among invasively managed
patients, this benefit from PPA included a reduction in
mortality. Copyright © 2018 Georg Thieme Verlag KG Stuttgart .
New York.

<85>
Accession Number
625834028
Title
The effect of local anesthetic continuous wound infusion for the
prevention of postoperative pneumonia after on-pump cardiac surgery with
sternotomy: the STERNOCAT randomized clinical trial.
Source
Intensive Care Medicine. (no pagination), 2019. Date of Publication: 2019.
Author
Amour J.; Cholley B.; Ouattara A.; Longrois D.; Leprince P.; Fellahi
J.-L.; Riou B.; Hariri S.; Latremouille C.; Remy A.; Provenchere S.;
Carillion A.; Achouh P.; Labrousse L.; Tran Dinh A.; Ait Hamou N.;
Charfeddine A.; Lafourcade A.; Hajage D.; Bougle A.; Puybasset L.;
Margetis D.; Lebreton G.; Laalie M.; Barreda T.; D'Alessandro C.;
Boughenou M.-F.; Bel A.; Jouan J.; Du Puy Montbrun L.; Menasche P.;
Quessard A.
Institution
(Amour, Hariri, Carillion, Ait Hamou, Charfeddine, Bougle) Department of
Anesthesiology and Critical Care Medicine, Pitie-Salpetriere Hospital,
Institut de Cardiologie, Reanimation de Chirurgie Cardiaque, Sorbonne
Universite, UMR INSERM 1166, IHU ICAN, Assistance Publique-Hopitaux de
Paris (AP-HP), 47-83 Boulevard de l'Hopital, Paris 75013, France
(Cholley) Department of Anesthesiology and Critical Care Medicine, Hopital
Europeen Georges Pompidou, Universite Paris-Descartes, Sorbonne Paris
Cite, AP-HP, Paris, France
(Ouattara, Remy) Biology of Cardiovascular Diseases and Department of
Anesthesiology and Critical Care, Magellan Medico-Surgical Center,
University of Bordeaux, INSERM, UMR 1034, Bordeaux, France
(Longrois, Provenchere, Tran Dinh) Department of Anesthesiology and
Critical Care Medicine, Hopital Bichat-Claude Bernard, Unite INSERM U1148
(Laboratory for Vascular Translational Science), Universite Paris-Diderot,
Sorbonne Paris Cite, AP-HP, Paris, France
(Leprince) Department of Cardiovascular and Thoracic Surgery,
Pitie-Salpetriere Hospital, Sorbonne Universite, UMR INSERM 1166, IHU
ICAN, Assistance Publique-Hopitaux de Paris (AP-HP), Paris, France
(Fellahi) Universite Claude Bernard Lyon 1, Inserm U1060, Department of
Anesthesiology and Critical Care Medicine, Hopital Louis Pradel, Hospices
Civils de Lyon, Lyon, France
(Riou) Department of Emergency Medicine and Surgery, Pitie-Salpetriere
Hospital, Sorbonne Universite, UMR INSERM 1166, IHU ICAN, Assistance
Publique-Hopitaux de Paris (AP-HP), Paris, France
(Latremouille, Achouh) Department of Cardiovascular and Thoracic Surgery,
Hopital Europeen Georges Pompidou, Universite Paris-Descartes, Sorbonne
Paris Cite, AP-HP, Paris, France
(Labrousse) Department of Cardiovascular and Thoracic Surgery, Magellan
Medico-Surgical Center, University of Bordeaux, INSERM, UMR 1034,
Bordeaux, France
(Lafourcade, Hajage) Department of Biostatistic, Public Health and Medical
Information, Pitie-Salpetriere Hospital, Sorbonne Universite, Assistance
Publique-Hopitaux de Paris (AP-HP), Paris, France
Publisher
Springer Verlag (E-mail: service@springer.de)
Abstract
Purpose: Postoperative pain after cardiac surgery, exacerbated by cough
and sternal mobilization, limits clearance of bronchopulmonary secretions
and may predispose to postoperative pneumonia. In this study, we tested
the ability of local anesthetic continuous wound infusion to prevent
pneumonia after cardiac surgery with sternotomy and cardiopulmonary bypass
(CPB) owing to better analgesia and bronchopulmonary drainage.
 Method(s): In this randomized, double-blind, placebo-controlled trial
conducted in five academic centers, patients undergoing cardiac surgery
with sternotomy and CPB were enrolled from February 2012 until November
2014, and were followed over 30 days. Patients were assigned to a 48-h
infusion (10 ml h-1) of l-bupivacaine (12.5 mg h-1)
or placebo (saline) via a pre-sternal multiperforated catheter. Anesthesia
and analgesia protocols were standardized. The primary end point was the
incidence of pneumonia during the study period, i.e., until hospital
discharge or 30 days. We hypothesized a 30% reduction in the incidence of
pneumonia. Result(s): Among 1493 randomized patients, 1439 completed
the trial. Pneumonia occurred in 36/746 patients (4.9%) in the
l-bupivacaine group and in 42/739 patients (5.7%) in the placebo group
(absolute risk difference taking into account center and baseline risk of
postoperative pneumonia, - 1.3% [95% CI - 3.4; 0.8] P = 0.22). In the
predefined subgroup of patients at high risk, l-bupivacaine decreased the
incidence of pneumonia (absolute risk difference, - 5.6% [95% CI - 10.0; -
1.1], P = 0.01). Conclusion(s): After cardiac surgery with
sternotomy, continuous wound infusion of l-bupivacaine failed to decrease
the incidence of pneumonia. These findings do not support the use of local
anesthetic continuous wound infusion in this indication. Further study
should investigate its effect in high-risk patients. Trial registration:
EudraCT Number: 2011-003292-10; Clinicaltrials.gov Identifier:
NCT01648777. Copyright © 2018, Springer-Verlag GmbH Germany, part
of Springer Nature.

<86>
Accession Number
625957739
Title
Comparison of hemodynamic response and postoperative pain score between
general anaesthesia with intravenous analgesia versus general anesthesia
with caudal analgesia in pediatric patients undergoing open-heart surgery.
Source
Annals of Cardiac Anaesthesia. 22 (1) (pp 35-40), 2018. Date of
Publication: January-March 2019.
Author
Samantaray D.J.; Trehan M.; Chowdhry V.; Reedy S.
Institution
(Samantaray, Chowdhry) Department of Cardiac Anaesthesiology, Care
Hospital, Bhubaneswar, India
(Trehan) Department of Anaesthesiology, Apollo Hospital, Krishna Vihar
Patrapada, Bhubaneswar, Odisha KV?18, India
(Reedy) Department of Anaesthesiology, KK Womens and Children Hospital,
Singapore, Singapore
Publisher
Wolters Kluwer Medknow Publications (B9, Kanara Business Centre, off Link
Road, Ghatkopar (E), Mumbai 400 075, India)
Abstract
Context: Regional anesthesia may attenuate adverse physiological stress
responses associated with cardiothoracic surgery. In this study,
hemodynamic stress response at the different time of surgical stimuli was
compared between patients receiving general anesthesia (GA) along with
caudal epidural analgesia with GA with intravenous analgesia in pediatric
population undergoing open-heart surgery. Aim(s): This study aims to
compare the hemodynamic response at the different time of surgical stimuli
and postoperative pain score, in pediatric patients undergoing open-heart
procedures. Settings and Design: We designed a prospective randomized
controlled trial to study hemodynamic effects between Group I and Group
II. Fifty patients were randomly allocated equally into Group I (GA +
caudal epidural) and Group II (GA + intravenous analgesia) by sealed
envelope technique. Subjects and Methods: After obtaining approval from
Institutional Ethical Committee, this prospective study was conducted in
50 American Society of Anesthesiologist Classes II and III pediatric
patients aged between 1 and 12 years posted for cardiac surgery in our
institution. Statistical Analysis: ANOVA, two-way ANOVA, and Student's
test. Result(s): The heart rate, systolic blood pressure, diastolic
blood pressure and mean blood pressure variations were compared between
Groups I and II at different time intervals. The variations were found to
be significantly higher at the time of skin incision and 2 min after skin
incision in Group II as compared to Group I. Pain score was compared
between the groups and was found to be significantly lower with Group I
(2.5 +/- 1.2) as compared to Group II (4.6 +/- 1.7), P = (0.004).
 Conclusion(s): Caudal analgesia with GA (Group I) was found to have
better hemodynamic control and significantly better postoperative pain
relief in the first 24 h after awakening. Copyright © 2019
Wolters Kluwer Medknow Publications. All rights reserved.

<87>
Accession Number
625422665
Title
Steroids in cardiac surgery trial: a substudy of surgical site infections.
Source
Canadian Journal of Anesthesia. (no pagination), 2018. Date of
Publication: 2018.
Author
McClure G.R.; Belley-Cote E.P.; Harlock J.; Lamy A.; Stacey M.; Devereaux
P.J.; Whitlock R.P.
Institution
(McClure) Michael G. DeGroote School of Medicine, McMaster University,
Hamilton, ON, Canada
(McClure, Belley-Cote, Devereaux, Whitlock) Department of Clinical
Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
(Belley-Cote, Devereaux) Department of Medicine, McMaster University,
Hamilton, ON, Canada
(Belley-Cote) Department of Medicine, Universite de Sherbrooke,
Sherbrooke, QC, Canada
(Belley-Cote, Lamy, Devereaux, Whitlock) Population Health Research
Institute, Hamilton, ON, Canada
(Harlock, Stacey) Division of Vascular Surgery, McMaster University,
Hamilton, ON, Canada
(Lamy, Whitlock) Division of Cardiac Surgery, McMaster University,
Hamilton, ON, Canada
(Whitlock) David Braley Cardiac, Vascular and Stroke Research Institute,
Room 1C1-5B, 237 Barton St. E, Hamilton, ON L8L 2X2, Canada
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
Purpose: Postoperative infection, particularly in cardiac surgery, results
in significant morbidity, mortality, and healthcare cost. Identification
of novel predictors of postoperative infection can target high-risk
populations for prophylactic intervention. Method(s): Steroids in
cardiac surgery (SIRS) was a multi-centre randomized-controlled trial
assessing intraoperative administration of methylprednisone during cardiac
surgery, which enrolled 7,507 patients across 80 centres in 18 countries.
It demonstrated that administration of steroids had no effect on mortality
or major morbidity after cardiac surgery. Our primary objective was to
identify risk factors for postoperative surgical site infections using
SIRS participants as a cohort. We excluded patients who did not undergo
surgery, died intraoperatively, or died within 48 hr of the operation.
Patients were assessed for development of "surgical site infection" over
the first 30 days postoperatively. Using theoretical and previously
identified risk factors, we used forward stepwise entry to create a binary
logistic regression model. Result(s): Follow-up at 30 days was
complete for all patients; 7,406 were included in the cohort. Surgical
site infection occurred in 180 (4.8%) and 184 (5.0%) of patients in the
placebo and steroid arms respectively. Significant risk factors (P < 0.05
level) included: diabetes managed with insulin (adjusted odds ratio [aOR]:
1.55; 95% confidence interval [CI] 1.13 to 2.12), oral hypoglycemics (aOR
1.60; 95% CI 1.18 to 2.16), or diet (aOR 1.81; 95% CI 1.16 to 2.83),
female sex (aOR 1.34; 95% CI 1.05 to 1.71), renal failure with (aOR 2.03;
95% CI 1.06 to 3.91), and without (aOR 1.50; 95% CI 1.04 to 2.14)
dialysis, > 96 min cardiopulmonary bypass (CPB) time (aOR 1.84; 95% CI
1.44 to 2.35), body mass index (BMI) < 22.3 (aOR 0.44; 95% CI 0.28 to
0.71) or > 30 (aOR 1.49; 95% CI 1.17 to 1.89), peak intensive care unit
blood glucose (aOR 1.02 per mmol.L-1; 95% CI 1.00 to 1.04), and
coronary artery bypass grafting (CABG) operation type (aOR 2.59; 95% CI
1.87 to 3.59). Conclusion(s): Patients undergoing CABG, requiring
longer CPB, with higher BMI, or with diabetes, are at elevated risk of
surgical site infection. Strategies to mitigate this risk warrant further
investigation. Copyright © 2018, Canadian Anesthesiologists'
Society.

<88>
Accession Number
625954659
Title
Perivascular hyaluronan-new cure for venous insufficiency.
Source
CardioVascular and Interventional Radiology. Conference: Interventional
Radiology Olbert Symposium, IROS 2019. Germany. 42 (1 Supplement 1) (pp
S3), 2019. Date of Publication: January 2019.
Author
Grunwald J.; Ragg J.C.
Institution
(Grunwald, Ragg) BerlinGermany
Publisher
Springer New York LLC
Abstract
Purpose: Injectable hyaluronan gels offer three options to treat venous
insufficiency: 1) Percutaneous valvuloplasty (PVP), aiming at the
restoration of local valve function; 2) focal venoplasty (FVP), aiming at
diameter reduction to reduce reflux, and 3) segmental venoplasty (SVP) to
reduce diameters as an adjunct to endoluminal procedures. Material(s)
and Method(s): PVP was studied in 22 patients (14 f, 8 m, 32 - 54 y., GSM
valves, diameter 7.0 - 12.0 mm), using a prototype hyaluronan (XL type,
Vivacy). FVP was evaluated in 16 patients (11 f, 5 m, 46 - 69 y.) for
reflux reduction in GSV or sidebranch insufficiency (L-type, Vivacy). SVP
was investigated in 20 cases (13 f, 7 m, 41 - 72 yrs.) with GSV or SSV
insufficiency, adjunctive to Biomatrix sclerofoam (Venartis), using
another hyaluronan (S-Type, short durability, Vivacy). For this
collective, target segments were split and randomized to hyaluronan vs.
NaCl 0,09%. Result(s): PVP established orthograde flow in 22/22
cases. With FVP, 13/16 cases were successful (81.3%) in obtaining
alternate (n = 10) or orthograde flow (n = 4), correlating well with
clinical improvement. With SVP, technical success (> 50% lumen reduction)
was obtained in all cases (20/20). In all hyaluronan compressed segments,
there were no postinterventional complaints, compared to 18/20 cases (90%)
after standard procedures. All hyaluronan applications were without
adverse reactions. Conclusion(s): PVP is effective and safe to
restore valve function. Also FVP for haemodynamic purposes showed
feasibility, effectivity and safety, while clear indications need further
studies. SVP adjunctive to endovenous ablation significantly improves
post-treatment comfort.

<89>
Accession Number
2001465937
Title
Clinical Practice Patterns and Bias in Randomized Trials: A Survey of
Investigators in the BEST-CLI Trial.
Source
Annals of Vascular Surgery. Conference: Vascular and Endovascular Surgery
Society - 2019 Annual Winter Meeting. United States. 55 (pp 18), 2019.
Date of Publication: February 2019.
Author
Farber A.; Menard M.; Assmann S.; Albaghdadi M.S.; Young M.N.; Villarreal
M.F.; Siami S.; Sopko G.; Reid D.; Strong M.; Rosenfield K.
Institution
(Farber, Villarreal) Boston Medical Center, Boston, MA, United States
(Menard, Strong) Brigham and Women's Hospital, Boston, MA, United States
(Assmann, Siami) New England Research Institutes, Inc. (NERI), Watertown,
MA, United States
(Albaghdadi, Young, Rosenfield) Massachusetts General Hospital, Boston,
MA, United States
(Sopko, Reid) National Heart, Lung, and Blood Institute (NHLBI) of the
National Institutes of Health (NIH), Bethesda, MD, United States
Publisher
Elsevier Inc.
Abstract
Introduction: Bias often confounds interpretation of research trial
results. Best Endovascular versus Best Surgical Therapy for Patients with
Critical Limb Ischemia (BEST-CLI) is a randomized trial comparing surgical
and endovascular revascularization strategy in patients with CLI. Because
blinding of treatment strategy is not feasible, differential collection of
data between the open and endovascular arms can lead to ascertainment
bias. We assessed the degree of this bias related to the BEST-CLI trial.
 Method(s): A cross-sectional electronic survey was carried out to
evaluate investigator demographics, self-reported primary specialty,
geographic location, volume of CLI cases, and institutional practice
patterns with respect to pre- and post-procedure cardiac testing.
 Result(s): The survey was sent to 932 BEST-CLI investigators; 183
(20%) completed the survey, including 140 (77%) vascular surgeons and 43
(23%) non-surgeon interventionalists. A cardiac evaluation protocol was
routinely followed by 65% and 32% of investigators before open and
endovascular revascularization, respectively (p<0.0001). Cardiac stress
testing was more commonly ordered in the open surgery group (median 50% of
patients vs 5%, p<0.0001). Post-procedural protocols to assess for cardiac
complications were used by 29% and 21% of investigators after open and
endovascular revascularization, respectively (p=0.0004). ECG and troponins
were more likely to be ordered after open than endovascular surgery
(P<0.0001). Vascular surgeons were more likely to order evaluation for ECG
changes, heart failure, and arrhythmia than non-surgical
interventionalists (94% vs. 84%; p=0.0499, 96% vs. 81%, p=0.01; 89% vs.
72%, p=0.01, respectively.) Conclusion(s): BEST-CLI Investigators
evaluate for presence of cardiac disease before and after intervention
differently based on whether the patient is undergoing open or
endovascular revascularization. This ascertainment bias can influence the
detection of cardiac complications in this patient population and thus may
influence reported outcomes. Copyright © 2018

<90>
Accession Number
625973756
Title
Allo-immunity and graft rejection after checkpoint inhibitor therapy (CPI)
in solid organ transplant (SOT) recipients.
Source
Journal of Clinical Oncology. Conference: 2018 Annual Meeting of the
American Society of Clinical Oncology, ASCO 2018. United States. 36 (15
Supplement 1) (no pagination), 2018. Date of Publication: May 2018.
Author
Abdel-Wahab N.; Abudayyeh A.; Shah M.; Johnson D.H.; Trinh V.; Abdelrahim
M.; Gaber A.O.; Suarez-Almazor M.E.; Diab A.
Institution
(Abdel-Wahab, Abudayyeh, Shah, Johnson, Trinh, Abdelrahim, Gaber,
Suarez-Almazor, Diab) Section of Rheumatology & Clinical Immunology,
Department of General Internal Medicine, The University of Texas MD
Anderson Cancer Center, Houston, TX; Section of Nephrology, The University
of Texas MD Anderson Cancer Center, Houston, TX; The University of Texas
MD Anderson Cancer Center, Houston, TX; The University of Texas MD
Anderson Cancer Center, Houston, TX; The University of Texas MD Anderson
Cancer Center, Houston, TX; Houston Methodist, Houston, TX; Houston
Methodist, Houston, TX; Section of Rheumatology & Clinical Immunology,
Department of General Internal Medicine, The
Publisher
American Society of Clinical Oncology
Abstract
Background: The safety of CPI in patients (pts) with prior SOT was never
fully assessed because they were always excluded from clinical trials due
to the risk of allo-immunity and organ rejection, and being on
immunosupresive therapy (IST). Method(s): We identified from pharmacy
records pts who had received CPI between January 2004 and June 2017 at our
institution (n = 4,406). Claims data were obtained for all pts from 6
months prior to first infusion to last follow-up or death. ICD 9 & 10
diagnostic codes were used to identify pts with organ transplant (n =
173). Medical records were reviewed to identify SOT pts. We systematically
reviewed the literature databases through September 2017 to identify
similar pts. Result(s): A total of 24 pts were retrieved, 6 from
institutional databases and 18 from literature. Median age was 61.5
(14-79) years; 75% were male; 67% had metastatic melanoma. Other cancer
types included cutaneous squamous cell, non-small cell lung,
hepatocellular, and duodenal carcinomas. Renal transplant was reported in
67%. Other SOT included liver and heart. Median time to initiation of CPI
after SOT was 8 (1-25) years. Most received anti-PD1 agents (79%). At CPI
initiation, all pts were kept on prednisone (<= 10 mg), mTOR inhibitors,
or other IST to maintain graft tolerance. Graft rejection occured in 50%
of pts (8/16 kidney, 3/6 liver, and 1/2 heart transplants); 92% received
anti-PD1 therapy. Median time to rejection was 21 (5-60) days. In 8 pts
with biopsies, 6 had a T-cell mediated rejection, and 2 had mixed cellular
and antibody infiltrates. Management of rejection included appropriate
IST, and 29% remained dependent on dialysis. CPI was discontinued in all
pts. Among all rejected cases, only one pt with cardiac transplant
recovered. Interestingly, other irAEs occurred mainly in non rejected
cases. They all improved with appropriate IST. In melanoma pts, 27% (4/15)
responded to CPI. In all pts, death was reported in 35% (n = 8), in 4 pts
was due to organ rejection (2 liver and 2 kidney). Conclusion(s):
High rejection rate was evident in SOT pts shortly after CPI and was
associated with high mortality rate. Further studies are needed to
establish the risk-benefit profile in this population.

<91>
Accession Number
625945300
Title
Comparing high and low levels of continuous positive airway pressure on
lung aeration in patients with pleural drainage: A feasibility study for a
randomized controlled trial.
Source
Physiotherapy research international : the journal for researchers and
clinicians in physical therapy. 24 (1) (pp e1753), 2019. Date of
Publication: 01 Jan 2019.
Author
Dos Santos E.D.C.; Pontes Campos A.E.; do Carmo O.F.; Lunardi A.C.
Institution
(Dos Santos, Lunardi) Master and Doctoral Programs in Physical Therapy,
Universidade Cidade de Sao Paulo, Sao Paulo, Brazil
(Dos Santos, Pontes Campos) Department of Biological and Health Sciences,
Universidade Federal do Amapa, Macapa, Brazil
(do Carmo) Neurology Institute of Amapa, Macapa, Amapa, Brazil
(Lunardi) Department of Physical Therapy of School of Medicine, University
of Sao Paulo, Sao Paulo, Brazil
Publisher
NLM (Medline)
Abstract
OBJECTIVE: We explored the feasibility of use of continuous positive
airway pressure (CPAP) with 15- and 4-cmH2 O for a randomized controlled
trial with patients with pleural drainage. METHOD(S): Ten patients
with traumatic pleural effusion drained within 24 hr, with controlled pain
received randomly CPAP with 0-, 4-, and 15-cmH2 O. Computed tomography was
used to assess the lung aeration. Patients reported the level of
tolerability. Air leak was also observed as a parameter of safety. The
levels of pressure were compared using the Friedman test followed by the
Tukey test as post hoc. RESULT(S): The lung area under CPAP with 15
cmH2 O (median = 3,913 mm2 ; IQR = 3,416-4,390 mm2 ) was greater than 4
(median = 3,495 mm2 ; IQR = 3,075-3,954 mm2 ) and 0 cmH2 O (median = 3,382
mm2 ; IQR = 2,962-3,658 mm2 ; p < 0.001). There was no difference between
lung areas under CPAP with 4 and 0 cmH2 O. All levels of pressure were
well tolerated by patients. No air leak was observed during the
assessments. CONCLUSION(S): CPAP with 15 cmH2 O is able to expand
lungs of patients with pleural drainage. CPAP with 4 cmH2 O seems not have
therapeutic effect. In addition, CPAP with 15 cmH2 O is well tolerated and
safe in this population. Copyright © 2018 John Wiley & Sons, Ltd.

<92>
Accession Number
625947688
Title
Perioperative statin administration with decreased risk of postoperative
atrial fibrillation, but not acute kidney injury or myocardial infarction:
A meta-analysis.
Source
Scientific reports. 7 (1) (pp 10091), 2017. Date of Publication: 30 Aug
2017.
Author
Zhen-Han L.; Rui S.; Dan C.; Xiao-Li Z.; Qing-Chen W.; Bo F.
Institution
(Zhen-Han, Bo) Department of Metabolism and Endocrinology, Shanghai East
Hospital, Tongji University School of Medicine, Shanghai 200120, China
(Rui, Xiao-Li) Department of Cardiology, First Affiliated Hospital of
Chongqing Medical University, Chongqing 400016, China
(Dan, Qing-Chen) Department of Cardiothoracic Surgery, First Affiliated
Hospital of Chongqing Medical University, Chongqing 400016, China
Publisher
NLM (Medline)
Abstract
A controversy effect of perioperative statin use for preventing
postoperative atrial fibrillation (POAF) and acute kidney injury (AKI)
after cardiac surgery still remains. We thus performed current systematic
review and meta-analysis to comprehensively evaluate effects of statin in
cardiac surgery. 22 RCTs involving 5243 patients were included.
Meta-analysis of 18 randomized controlled trials with 3995 participants
suggested that perioperative statin use could decrease the risk of POAF
(relative risk [RR] 0.69, 95%CI 0.56 to 0.86, P=0.001), with a moderate
heterogeneity (I 2=65.7%, P H <0.001). And the beneficial effect was found
only in patients receiving coronary artery bypass graft (CABG), but not in
patients undergoing valve surgery. However, perioperative statin use was
not associated with lower risks of AKI (RR 0.98, 95%CI 0.70 to 1.35,
P=0.884, I 2=33.9%, P H =0.157) or myocardial infarction (MI) (RR 0.84,
95%CI 0.58 to 1.23, P=0.380, I 2=0%, P H =0.765), and even an increased
trend of AKI was observed in patients with valve surgery. Perioperative
statin use could decrease the inflammation response with no impact on
clinical outcomes. In conclusion, perioperative statin use is useful in
preventing POAF, particularly in patients with CABG, and ameliorate
inflammation, while it has no effect on AKI and MI after cardiac surgery.

<93>
Accession Number
2001465654
Title
Catheter Ablation of Ventricular Tachycardia in Patients With a
Ventricular Assist Device: A Systematic Review of Procedural
Characteristics and Outcomes.
Source
JACC: Clinical Electrophysiology. 5 (1) (pp 39-51), 2019. Date of
Publication: January 2019.
Author
Anderson R.D.; Lee G.; Virk S.; Bennett R.G.; Hayward C.S.; Muthiah K.;
Kalman J.; Kumar S.
Institution
(Anderson, Lee, Kalman) Department of Cardiology, Royal Melbourne
Hospital, Faculty of Medicine, Dentistry, and Health Science, University
of Melbourne, Melbourne, Australia
(Virk, Kumar) Department of Cardiology, Westmead Hospital, Westmead,
Australia
(Bennett) Bristol Heart Institute, Bristol Royal Infirmary, Bristol,
United Kingdom
(Hayward, Muthiah) Heart Failure and Transplant Unit, Department of
Cardiology, St. Vincent's Hospital, Darlinghurst, Australia
(Kumar) Department of Cardiology, Westmead Applied Research Centre,
University of Sydney, Westmead, Australia
Publisher
Elsevier Inc
Abstract
Objectives: This is a systematic review summarizing the procedural
characteristics and outcomes of ventricular assist device (VAD)-related
ventricular tachycardia (VT) ablation. Background(s): Drug-refractory
VT refractory commonly develops post-VAD implantation. Procedural and
outcome data come from small series or case reports. Method(s): An
electronic search was performed using major databases. Primary outcomes
were VT recurrence, mortality, and cardiac transplantation. Secondary
endpoints were acute procedural success and procedural complications.
 Result(s): Eighteen studies were included, with a total of 110
patients (mean age 59.6 +/- 11 years, 89% men; VT storm 34%). Scar-related
re-entry was the predominant mechanism of VT (90.3%) and cannula-related
VT in 19.3% cases. Electroanatomical mapping interference occurred in 1.8%
of cases; there were no reports of catheter entrapment. Noninducibility of
clinical VT was achieved in 77.9%; procedural complications occurred in
9.4%. At a mean follow-up of 263.5 +/- 267.0 days, VT recurred in 43.6%,
23.4% underwent cardiac transplant, and 48.1% died. There were no
procedural-related deaths and no death was directly related to ventricular
arrhythmia. In follow-up, there was a significant reduction in implantable
cardioverter-defibrillator therapies or shocks (57.1% vs. 23.8%). Ablation
allowed VT storm termination in 90% of patients. Conclusion(s):
VAD-related VT is predominantly related to pre-existing intrinsic
myocardial scar rather than inflow cannula site insertion. Catheter
ablation is a reasonable treatment strategy, albeit with expectedly high
rate of recurrence, transplantation, and mortality related to severe
underlying disease. Copyright © 2019

<94>
Accession Number
2001306417
Title
Meta-Analysis Comparing Mitral Valve Repair Versus Replacement for
Degenerative Mitral Regurgitation Across All Ages.
Source
American Journal of Cardiology. 123 (3) (pp 446-453), 2019. Date of
Publication: 1 February 2019.
Author
Jung J.C.; Jang M.-J.; Hwang H.Y.
Institution
(Jung, Hwang) Department of Thoracic and Cardiovascular Surgery, Seoul
National University Hospital, Seoul National University College of
Medicine, Seoul, South Korea
(Jang) Medical Research Collaborating Center, Seoul National University
Hospital, Seoul National University College of Medicine, Seoul, South
Korea
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Although current guidelines recommend mitral valve repair (MVr) over
mitral valve replacement (MVR) for patients with mitral regurgitation
(MR), it is unclear if it should be also recommended in elderly patients
with limited life expectancy. This study was conducted to compare the
results of MVr with those of MVR to determine the optimal treatment option
for patients with degenerative MR, particularly according to the patient's
age. A literature search of 5 electronic databases was performed. The
primary outcome was all-cause mortality. The secondary outcomes included
early mortality and freedom from reoperation. A metaregression analysis
and subgroup analysis were performed according to the mean age of the
study population. Twelve retrospective studies (2,950 and 1,252 patients
in the MVr and MVR groups, respectively) were selected. Pooled analyses
demonstrated that the risk of all-cause mortality was significantly higher
in the MVR group than in the MVr group both in all studies and in studies
presenting adjusted results (hazard ratio[95% confidence interval] =
1.57[1.39 to 1.77] and 1.53[1.34 to 1.74], respectively). This benefit was
similar across all ages when the metaregression analysis and the subgroup
analysis were performed (p = 0.879 and 0.123, respectively). Early
mortality and risk of reoperation were also higher in the MVR group than
in the MVr group (risk ratio[95% confidence interval] = 4.51[3.12 to 6.51]
and hazard ratio[95% confidence interval] = 1.47[1.09 to 1.98],
respectively). In conclusion, this study indicates that MVr is beneficial
compared with MVR in patients with degenerative MR regardless of patients'
age in terms of all-cause mortality. Copyright © 2018 Elsevier
Ltd

<95>
Accession Number
625859158
Title
Guided meditation as an adjunct to enhance postoperative recovery after
cardiac surgery: Study protocol for a prospective randomized controlled
feasibility trial.
Source
Trials. 20 (1) (no pagination), 2019. Article Number: 39. Date of
Publication: 11 Jan 2019.
Author
Packiasabapathy S.; Susheela A.T.; Mueller A.; Patxot M.; Gasangwa D.-V.;
O'Gara B.; Shaefi S.; Marcantonio E.R.; Yeh G.Y.; Subramaniam B.
Institution
(Susheela, Mueller, Patxot, Gasangwa, O'Gara, Shaefi, Subramaniam)
Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel
Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215, United
States
(Susheela, Mueller, O'Gara, Shaefi, Marcantonio, Yeh, Subramaniam) Harvard
Medical School, 25 Shattuck St, Boston, MA 02115, United States
(Marcantonio, Yeh) Division of General Medicine and Primary Care, Beth
Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215,
United States
(Packiasabapathy) Department of Anesthesia, Critical Care and Pain
Medicine, Indiana University School of Medicine, 340 W 10th St #6200,
Indianapolis, IN 46202, United States
(Subramaniam) Beth Israel Deaconess Medical Center, 375 Longwood Avenue,
W/MASCO-414, Boston, MA 02215, United States
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Cardiac surgical procedures are associated with postoperative
neurological complications such as cognitive decline and delirium, which
can complicate recovery and impair quality of life. Perioperative
depression and anxiety may be associated with increased mortality after
cardiac surgeries. Surgical prehabilitation is an emerging concept that
includes preoperative interventions to potentially reduce postoperative
complications. While most current prehabilitation interventions focus on
optimizing physical health, mind-body interventions are an area of growing
interest. Preoperative mind-body interventions such as Isha Kriya
meditation, may hold significant potential to improve postsurgical
outcomes. Method(s): This is a prospective, randomized controlled
feasibility trial. A total of 40 adult patients undergoing cardiac surgery
will be randomized to one of three study groups. Participants randomized
to either of the two intervention groups will receive meditative
intervention: (1) commencing two weeks before surgery; or (2) commencing
only from the day after surgery. Meditative intervention will last for
four weeks after the surgery in these groups. Participants in the third
control group will receive the current standard of care with no meditative
intervention. All participants will undergo assessments using
neurocognitive, sleep, depression, anxiety, and pain questionnaires at
various time points in the perioperative period. Blood samples will be
collected at baseline, preoperatively, and postoperatively to assess for
inflammatory biomarkers. The primary aim of this trial is to assess the
feasibility of implementing a perioperative meditative intervention
program. Other objectives include studying the effect of meditation on
postoperative pain, sleep, psychological wellbeing, cognitive function,
and delirium. These will be used to calculate effect size to design future
studies. Discussion(s): This study serves as the first step towards
understanding the feasibility of implementing a mind-body intervention as
a prehabilitative intervention to improve postoperative surgical outcomes
after cardiac surgery. Trial registration: Clinicaltrials.gov,
NCT03198039. Registered on 23 June 2017. Copyright © 2019 The
Author(s).

<96>
Accession Number
625598841
Title
Extended-time of Noninvasive Positive Pressure Ventilation Improves Tissue
Perfusion after Coronary Artery Bypass Surgery: a Randomized Clinical
Trial.
Source
Brazilian journal of cardiovascular surgery. 33 (3) (pp 250-257), 2018.
Date of Publication: 01 May 2018.
Author
Nasrala M.L.S.; Bolzan D.W.; Lage Y.G.; Prado F.S.; Arena R.; Lima P.R.L.;
Feguri G.; Silva A.M.C.; Marcondi N.O.; Hossne N.; Guizilini S.; Gomes
W.J.
Institution
(Nasrala, Bolzan, Marcondi, Hossne, Guizilini, Gomes) Cardiology and
Cardiovascular Surgery Disciplines, Escola Paulista de Medicina,
Universidade Federal de Sao Paulo (EPM-UNIFESP), Sao Paulo, SP, Brazil
(Nasrala, Lage, Prado, Lima, Feguri) Physical Therapy Department, Hospital
Santa Rosa, Cuiaba, MT, Brazil
(Lage, Prado, Lima, Feguri) Physical Therapy Department, Hospital Sao
Mateus, Cuiaba, MT, Brazil
(Arena) Department of Physical Therapy, College of Applied Health
Sciences, University of Illinois Chicago, Chicago, IL, United States
(Silva) Public Health Department, Universidade Federal do Mato Grosso
(UFMT), Cuiaba, MT, Brazil
(Guizilini) Department of the Human Movement Sciences, Universidade
Federal de Sao Paulo (UNIFESP), Sao Paulo, SP, Brazil
Publisher
NLM (Medline)
Abstract
OBJECTIVE: To compare the effects of extended- versus short-time
noninvasive positive pressure ventilation on pulmonary function, tissue
perfusion, and clinical outcomes in the early postoperative period
following coronary artery bypass surgery in patients with preserved left
ventricular function. METHOD(S): Patients were randomized into two
groups according to noninvasive positive pressure ventilation intensity:
short-time noninvasive positive pressure ventilation n=20 (S-NPPV) and
extended-time noninvasive positive pressure ventilation n=21 (E-NPPV).
S-NPPV was applied for 60 minutes during immediate postoperative period
and 10 minutes, twice daily, from postoperative days 1-5. E-NPPV was
performed for at least six hours during immediate postoperative period and
60 minutes, twice daily, from postoperative days 1-5. As a primary
outcome, tissue perfusion was determined by central venous oxygen
saturation and blood lactate level measured after anesthetic induction,
immediately after extubation and following noninvasive positive pressure
ventilation protocols. As a secondary outcome, pulmonary function tests
were performed preoperatively and in the postoperative days 1, 3, and 5;
clinical outcomes were recorded. RESULT(S): Significant drop in blood
lactate levels and an improvement in central venous oxygen saturation
values in the E-NPPV group were observed when compared with S-NPPV group
after study protocol (P<0.01). The E-NPPV group presented higher
preservation of postoperative pulmonary function as well as lower
incidence of respiratory events and shorter postoperative hospital stay
(P<0.05). CONCLUSION(S): Prophylactic E-NPPV administered in the
early postoperative period of coronary artery bypass surgery resulted in
greater improvements in tissue perfusion, pulmonary function and clinical
outcomes than S-NPPV, in patients with preserved left ventricular
function. TRIAL REGISTRATION: Brazilian Registry of Clinical trial -
RBR7sqj78 - http://www.ensaiosclinicos.gov.br.

<97>
Accession Number
625598556
Title
Effect of Plasma Level of Vitamin D on Postoperative Atrial Fibrillation
in Patients Undergoing Isolated Coronary Artery Bypass Grafting.
Source
Brazilian journal of cardiovascular surgery. 33 (3) (pp 217-223), 2018.
Date of Publication: 01 May 2018.
Author
Ozsin K.K.; Sanri U.S.; Toktas F.; Kahraman N.; Yavuz S.
Institution
(Ozsin, Sanri, Toktas, Kahraman, Yavuz) Department of Cardiovascular
Surgery, Bursa Yuksek Ihtisas Training and Research Hospital, University
of Health Sciences, Turkey
Publisher
NLM (Medline)
Abstract
OBJECTIVE: Postoperative atrial fibrillation (PoAF) is a common
complication after coronary artery bypass grafting (CABG). The aim of the
present study was to evaluate the association between development of PoAF
and vitamin D levels in patients undergoing isolated CABG. METHOD(S):
This prospective randomized clinical trial was conducted on the patients
with isolated CABG. The study was terminated when 50 patients in both
PoAF(+) group and PoAF(-) group were reached. Development of AF until
discharge period was assessed. Vitamin D level was measured immediately
after AF; it was measured on the discharge day for the patients without
PoAF. Predictive values of the independent variables were measured for the
development of PoAF. RESULT(S): The groups were separated as PoAF(-)
group (66% male, mean age 58.18+/-10.98 years) and PoAF(+) group (74%
male, mean age 61.94+/-10.88 years). 25(OH) vitamin D level (OR=0.855, 95%
CI: 0.780-0.938, P=0.001) and > 65 years (OR=3.525, 95% CI: 1.310-9.483,
P=0.013) were identified as an independent predictor of postoperative AF
after CABG surgery in multivariate analysis. The cut-off level for 25(OH)
vitamin D level in receiver-operating characteristic curve analysis was
determined as 7.65 with sensitivity of 60% and specificity of 64% for
predicting PoAF (area under the curve: 0.679, P=0.002).
 CONCLUSION(S): Vitamin D level is considered an independent predictor
for development of PoAF. Lower vitamin D levels may be one of the reasons
for PoAF.

<98>
Accession Number
625598030
Title
Effects of High-Intensity Inspiratory Muscle Training Associated with
Aerobic Exercise in Patients Undergoing CABG: Randomized Clinical Trial.
Source
Brazilian journal of cardiovascular surgery. 33 (4) (pp 376-383), 2018.
Date of Publication: 01 Jul 2018.
Author
Miozzo A.P.; Stein C.; Marcolino M.Z.; Sisto I.R.; Hauck M.; Coronel C.C.;
Plentz R.D.M.
Institution
(Miozzo, Stein, Marcolino, Sisto, Hauck, Coronel, Plentz) Universidade
Federal de Ciencias da Saude de Porto Alegre, Porto Alegre, RS, Brazil
(Miozzo, Stein, Marcolino, Sisto, Hauck, Coronel, Plentz) Instituto de
Cardiologia, Porto Alegre, RS, Brazil
Publisher
NLM (Medline)
Abstract
OBJECTIVE: Evaluate the interaction between high-intensity inspiratory
muscle training (IMT) and aerobic exercise on physical capacity,
respiratory muscle strength, peripheral muscle strength, and quality of
life of patients who underwent coronary artery bypass grafting (CABG).
 METHOD(S): Twenty-four patients underwent CABG were randomized into
two groups. During 36 sessions, one group received IMT associated with
aerobic exercise and the other group received only aerobic exercise.
Primary outcome was the distance in the six-minute walk distance (6MWD)
test. Secondary outcomes included respiratory muscle strength, peripheral
muscle strength, and quality of life. Measures were taken at the baseline,
at the 12th session, the 24th session, and 36th session. RESULT(S):
Baseline characteristics were similar between the groups. There was no
statistically significant difference between the two groups in any outcome
[6MWD - P=0.935; peak oxygen consumption (PeakVO2) - P=0.853; maximal
inspiratory pressure (MIP) - P=0.243; maximal expiratory pressure (MEP) -
P=0.268; sitting-rising test (SRT) - P=0.212], but there was interaction
in MIP (P=0.000) and all outcomes improved in the two groups (6MWD -
P=0.000; PeakVO2 - P=0.000; MIP - P=0.000; MEP - P=0.000; SRT - P=0.000).
 CONCLUSION(S): There was an improvement of all outcomes in both
groups, but IMT was not able to provide additional benefits. The use of
this combination should be used with caution to not generate higher costs
in the rehabilitation process of these patients.

<99>
Accession Number
625597797
Title
Preventive Effect of Preoperative Vitamin D Supplementation on
Postoperative Atrial Fibrillation.
Source
Brazilian journal of cardiovascular surgery. 33 (4) (pp 347-352), 2018.
Date of Publication: 01 Jul 2018.
Author
Cerit L.; Ozcem B.; Cerit Z.; Duygu H.
Institution
(Cerit, Duygu) Department of Cardiology, Near East University, Nicosia,
Cyprus
(Ozcem) Department of Cardiovascular Surgery, Near East University,
Nicosia, Cyprus
(Cerit) Department of Pediatric Cardiology, Near East University, Nicosia,
Cyprus
Publisher
NLM (Medline)
Abstract
OBJECTIVE: To assess the relationship between preoperative vitamin D
(vitD) supplementation and the development of postoperative atrial
fibrillation (POAF). METHOD(S): The study group consisted of 328
consecutive patients. The influence of preoperative vitD supplementation
on POAF was reviewed in 136 patients who underwent coronary artery bypass
graft surgery with vitD insufficiency (n=80) and vitD deficiency (n=56).
Patients were assigned to receive either oral vitD (50.000 U) (treatment
group, n=68) or not (control group, n=68) 48 hours before surgery.
Patients were followed up during hospitalisation process with respect to
POAF. RESULT(S): There was no significant difference between
treatment and control groups with regards to age, gender, diabetes
mellitus, smoking history, chronic obstructive pulmonary disease, left
atrial diameter, and biochemical parameters. Also, there was no
significant difference between these groups with regards to mean vitD
level on both insufficiency and deficiency patients (24.6+/-3.7 vs.
24.9+/-3.9 ng/ml P=0.837, 11.4+/-4.9 vs. 10.9+/-5.2 ng/ml P=0.681,
respectively). Although the occurrence of POAF was not significantly
different among treatment and control groups in patients with vitD
insufficiency (31% vs. 33% P=0.538), there was a significant difference
between the two groups regarding to POAF in patients with vitD deficiency
(18% vs. 29% P=0.02). CONCLUSION(S): Although preoperative vitD
supplementation was not found to be associated with prevention of POAF in
patients with vitD insufficiency, it was found to be strongly associated
with prevention of POAF in those with vitD deficiency.

<100>
[Use Link to view the full text]
Accession Number
625619925
Title
The impact of preoperative frailty status on outcomes after transcatheter
aortic valve replacement: An update of systematic review and
meta-analysis.
Source
Medicine. 97 (51) (pp e13475), 2018. Date of Publication: 01 Dec 2018.
Author
Huang L.; Zhou X.; Yang X.; Yu H.
Institution
(Huang, Zhou, Yu) Department of Anesthesiology, West China Hospital, China
(Yang) Department of Obstetrics and Gynecology, West China Second
University Hospital, Sichuan University, Chengdu, Sichuan, China
Publisher
NLM (Medline)
Abstract
BACKGROUND: Frailty is a syndrome of impaired physiologic reserve and
decreased resistance to stressors and can often be seen in high-risk
patients undergoing transcatheter aortic valve replacement (TAVR).
Preoperative frailty status is thought to be related to adverse outcomes
after TAVR. We conducted this systematic review and meta-analysis to
determine the impact of preoperative frailty status on outcomes among
patients after TAVR. METHOD(S): PubMed, Embase, and the Cochrane
Library were searched for relevant studies through January 2018. Fourteen
articles (n = 7489) meeting the inclusion criteria were finally included.
Possible effects were calculated using meta-analysis. RESULT(S): The
pooled risk ratios (RRs) of late mortality (>6 months) and acute kidney
injury after TAVR in frail group were 2.81 (95% confidence interval (CI)
1.90-4.15, P < .001, I = 84%) and 1.41 (95% CI 1.02-1.94, P = .04, I =
24%), respectively. Compared with non-frail group, significantly higher
incidence of 30-day mortality (RR 2.03, 95% CI 1.63-2.54, P < .001, I =
0%) and life threatening or major bleeding after TAVR (RR 1.48, 95% CI
1.20-1.82, P < .001, I = 14%) was found in frail group. There was no
significant association between frailty and incidence of stroke after TAVR
(RR 0.93, 95% CI 0.53-1.63, P = .80, I = 0%). CONCLUSION(S):
Preoperative frailty status is proved to be significantly associated with
poor outcomes after TAVR. Our findings may remind doctors in the field of
a more comprehensive preoperative evaluation for TAVR candidates. More
well-designed and large-sample sized prospective studies are further
needed to figure out the best frailty assessment tool for patients
undergoing TAVR.

<101>
[Use Link to view the full text]
Accession Number
625618946
Title
The efficacy of thoracic paravertebral block for thoracoscopic surgery: A
meta-analysis of randomized controlled trials.
Source
Medicine. 97 (51) (pp e13771), 2018. Date of Publication: 01 Dec 2018.
Author
Hu Z.; Liu D.; Wang Z.-Z.; Wang B.; Dai T.
Institution
(Hu, Wang, Wang, Dai) Department of Thoracic Surgery, Austria
(Liu) Department of Respiratory and Critical Care Medicine, Affiliated
Hospital of Southwest Medical University, China
Publisher
NLM (Medline)
Abstract
BACKGROUND: The efficacy of thoracic paravertebral block for thoracoscopic
surgery remains controversial. We conduct a systematic review and
meta-analysis to explore the impact of thoracic paravertebral block on
thoracoscopic surgery. METHOD(S): We search PubMed, EMbase, Web of
science, EBSCO, and Cochrane library databases through August 2018 for
randomized controlled trials (RCTs) assessing the effect of thoracic
paravertebral block on thoracoscopic surgery. This meta-analysis is
performed using the random-effect model. RESULT(S): Six RCTs
involving 300 patients are included in the meta-analysis. Overall,
compared with control group for thoracoscopic surgery, thoracic
paravertebral block results in significantly reduced pain scores within 6
hours (Std. MD = -2.15; 95% CI = -3.67 to -0.62; P = .006), postoperative
anesthesia consumption during 48 hours (Std. MD = -1.81; 95% CI = -3.05 to
-0.58; P = .004), and hospital stay (Std. MD = -1.19; 95% CI = -2.13 to
-0.26; P = .01), but has no important impact on pain scores at 24 hours
(Std. MD = -1.10; 95% CI = -2.77-0.57; P = .20), and 48 hours (Std. MD =
-1.25; 95% CI = -2.86-0.36; P = .13). CONCLUSION(S): Thoracic
paravertebral block can substantially enhance pain management for
thoracoscopic surgery.

<102>
Accession Number
620142123
Title
Allogeneic mesenchymal stem cells for treatment of AKI after cardiac
surgery.
Source
Journal of the American Society of Nephrology. 29 (1) (pp 260-267), 2017.
Date of Publication: January 2018.
Author
Swaminathan M.; Stafford-Smith M.; Chertow G.M.; Warnock D.G.; Paragamian
V.; Brenner R.M.; Lellouche F.; Fox-Robichaud A.; Atta M.G.; Melby S.;
Mehta R.L.; Wald R.; Verma S.; Mazer C.D.; Lombard F.W.; Schroder J.;
Kurtzberg J.; Bisnar T.; Conte J.; Dodd-O J.; Rabb H.; Katz N.; Shah A.;
Huyette-Arrizza E.; Bellot C.; Kramer R.; Tolson B.; Solomon R.; Brooks
C.; Mora-Mangano C.; Wong J.; Kashani K.; Naka Y.; Umanath K.; Yee J.;
Kilic A.; Lecker S.; Frendl G.; MacKensen B.; Simon M.; Dagenais F.;
Ferland M.-C.; Bouchard P.-A.; Whitlock R.; Ainsworth C.; McDonald E.;
Curley G.; Yagnik S.; Crescini C.; Ferland A.; Maier K.; Denault A.; Ly
H.; Bainbridge D.; Bentall T.; Legare J.-F.; Grocott H.
Institution
(Swaminathan, Stafford-Smith) Division of Cardiothoracic Anesthesiology,
Department of Anesthesiology, Duke University School of Medicine, Durham,
NC, United States
(Chertow) Department of Medicine (Nephrology), Stanford University,
Stanford, CA, United States
(Warnock) Division of Nephrology, Department of Medicine, Birmingham, AB,
United States
(Paragamian, Brenner) Division of Cardiothoracic Surgery, Department of
Surgery, University of Alabama at Birmingham, Birmingham, AB, United
States
(Lellouche) AlloCure Inc., Burlington, MA, United States
(Fox-Robichaud) Department of Anesthesiology and Critical Care Medicine,
Institut Universitaire de Cardiologie et de Pneumologie de Quebec, Laval
University, Quebec City, QC, Canada
(Atta) Division of Critical Care, Department of Medicine and Thrombosis,
Atherosclerosis Research Institute, McMaster University and Hamilton
Health Sciences, Hamilton, ON, Canada
(Melby) Division of Nephrology, Department of Medicine, Johns Hopkins
University School of Medicine, Baltimore, MD, United States
(Mehta) Division of Nephrology, Department of Medicine, University of
California, San Diego, CA, United States
(Wald) Division of Nephrology, Li Ka Shing Knowledge Institute, St.
Michael's Hospital, Canada
(Verma) Department of Surgery, Division of Cardiac Surgery, Keenan
Research Centre for Biomedical Science, Li Ka Shing Knowledge Institute of
St. Michael's Hospital, Canada
(Mazer) Department of Anesthesia, Keenan Research Centre for Biomedical
Science, Li Ka Shing Knowledge Institute of St. Michael's Hospital,
University of Toronto, St. Michael's Hospital, 30 Bond Street, Toronto, ON
M5B 1W8, Canada
(Lombard, Schroder, Kurtzberg, Bisnar) Duke University, United States
(Conte, Dodd-O, Rabb, Katz, Shah, Huyette-Arrizza) Johns Hopkins
University, United States
(Bellot) University of Alabama, Birmingham, United States
(Kramer, Tolson) Maine Medical Center, United States
(Solomon) Fletcher Allen Health Care, United States
(Brooks) University of Virginia, United States
(Mora-Mangano, Wong) Stanford University, United States
(Kashani) Mayo Clinic, United States
(Naka) Columbia University, United States
(Umanath, Yee) Henry Ford Hospital, United States
(Kilic) Ohio State University, United States
(Lecker) Beth Israel Deaconess, Medical Center, United States
(Frendl) Brigham and Women's Hospital, United States
(MacKensen) University of Washington, United States
(Simon, Dagenais, Ferland, Bouchard) Institut Universitaire de Cardiologie
et de Pneumologie, Quebec, Canada
(Whitlock, Ainsworth, McDonald) McMaster-Hamilton General Hospital,
Thrombosis and Atherosclerosis Research Institute, Canada
(Curley, Yagnik, Crescini) St. Michael's Hospital, Canada
(Ferland, Maier) Libin Cardiovascular Institute of Alberta Foothills
Hospital, Canada
(Denault, Ly) Montreal Heart Institute, Canada
(Bainbridge, Bentall) London Health Sciences Centre, University Hospital,
Canada
(Legare) Capital District Health Authority, Queen Elizabeth II Health
Sciences Centre, Canada
(Grocott) St. Boniface Hospital, University of Manitoba, Canada
Publisher
American Society of Nephrology (E-mail: email@asn-online.org)
Abstract
AKI after cardiac surgery remains strongly associated with mortality and
lacks effective treatment or prevention. Preclinical studies suggest that
cell-based interventions may influence functional recovery. We conducted a
phase 2, randomized, double-blind, placebo-controlled trial in 27 centers
across North America to determine the safety and efficacy of allogeneic
human mesenchymal stem cells (MSCs) in reducing the time to recovery from
AKI after cardiac surgery. We randomized 156 adult subjects undergoing
cardiac surgery with evidence of early AKI to receive intra-aortic MSCs
(AC607; n=67) or placebo (n=68). The primary outcome was the time to
recovery of kidney function defined as return of postintervention
creatinine level to baseline. The median time to recovery of kidney
function was 15 days with AC607 and 12 days with placebo (25th, 75th
percentile range, 10-29 versus 6-21, respectively; hazard ratio, 0.81; 95%
confidence interval, 0.53 to 1.24; P=0.32). We did not detect a
significant difference between groups in 30-day all-cause mortality (16.7%
with AC607; 11.8% with placebo) or dialysis (10.6% with AC607; 7.4% with
placebo). At follow-up, 12 patients who received AC607 and six patients
who received placebo had died. Rates of other adverse events did not
differ between groups. In these patients with AKI after cardiac surgery,
administration of allogeneic MSCs did not decrease the time to recovery of
kidney function. Our results contrast with those in preclinical studies
and provide important information regarding the potential effects of MSCs
in this setting. Copyright © 2018 by the American Society of
Nephrology.

<103>
Accession Number
623664113
Title
Long-term use of carvedilol in patients with ST-segment elevation
myocardial infarction treated with primary percutaneous coronary
intervention.
Source
PLoS ONE. 13 (8) (no pagination), 2018. Article Number: e0199347. Date of
Publication: August 2018.
Author
Watanabe H.; Ozasa N.; Morimoto T.; Shiomi H.; Bingyuan B.; Suwa S.;
Nakagawa Y.; Izumi C.; Kadota K.; Ikeguchi S.; Hibi K.; Furukawa Y.; Kaji
S.; Suzuki T.; Akao M.; Inada T.; Hayashi Y.; Nanasato M.; Okutsu M.;
Kametani R.; Sone T.; Sugimura Y.; Kawai K.; Abe M.; Kaneko H.; Nakamura
S.; Kimura T.
Institution
(Watanabe, Ozasa, Shiomi, Bingyuan, Kimura) Department of Cardiovascular
Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
(Morimoto) Department of Clinical Epidemiology, Hyogo College of Medicine,
Hyogo, Japan
(Suwa) Division of Cardiology, Juntendo University Shizuoka Hospital,
Izunokuni, Japan
(Nakagawa, Izumi) Division of Cardiology, Tenri Hospital, Nara, Japan
(Kadota) Division of Cardiology, Kurashiki Central Hospital, Kurashiki,
Japan
(Ikeguchi) Division of cardiology, Shiga General Hospital, Moriyama, Japan
(Hibi) Division of Cardiology, Yokohama City University Medical Center,
Yokohama, Japan
(Furukawa, Kaji) Division of Cardiology, Kobe City Medical Center General
Hospital, Kobe, Japan
(Suzuki) Division of Cardiology, Toyohashi Heart Center, Toyohashi, Japan
(Akao) Department of Cardiology, National Hospital Organization Kyoto
Medical Center, Kyoto, Japan
(Inada) Cardiovascular Center, Osaka Red Cross Hospital, Osaka, Japan
(Hayashi) Division of Cardiology, Tsuchiya General Hospital, Hiroshima,
Japan
(Nanasato) Cardiovascular Center, Nagoya Daini Red Cross Hospital, Nagoya,
Japan
(Okutsu) Division of Cardiology, Nozaki Tokushukai Hospital, Osaka, Japan
(Kametani) Division of Cardiology, Nagoya Tokushukai General Hospital,
Kasugai, Japan
(Sone) Division of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan
(Sugimura) Division of Cardiology, Kawakita General Hospital, Tokyo, Japan
(Kawai) Division of Cardiology, Chikamori Hospital, Kochi, Japan
(Abe) Division of Cardiology, Yotsuba Circulation Clinic, Matsuyama, Japan
(Kaneko) Division of Cardiology, Hoshi General Hospital, Koriyama, Japan
(Nakamura) Division of Cardiology, New Tokyo Hospital, Chiba, Japan
Publisher
Public Library of Science (E-mail: plos@plos.org)
Abstract
Background Despite its recommendation by the current guidelines, the role
of long-term oral beta-blocker therapy has never been evaluated by
randomized trials in uncomplicated ST-segment elevation myocardial
infarction (STEMI) patients without heart failure, left ventricular
dysfunction or ventricular arrhythmia who underwent primary percutaneous
coronary intervention (PCI). Methods and results In a multi-center,
open-label, randomized controlled trial, STEMI patients with successful
primary PCI within 24 hours from the onset and with left ventricular
ejection fraction (LVEF) 40% were randomly assigned in a 1-to-1 fashion
either to the carvedilol group or to the no beta-blocker group within 7
days after primary PCI. The primary endpoint is a composite of all-cause
death, myocardial infarction, hospitalization for heart failure, and
hospitalization for acute coronary syndrome. Between August 2010 and May
2014, 801 patients were randomly assigned to the carvedilol group (N =
399) or the no beta-blocker group (N = 402) at 67 centers in Japan. The
carvedilol dose was up-titrated from 3.4+/-2.1 mg at baseline to 6.3
+/-4.3 mg at 1-year. During median follow-up of 3.9 years with 96.4%
follow-up, the cumulative 3-year incidences of both the primary endpoint
and any coronary revascularization were not significantly different
between the carvedilol and no beta-blocker groups (6.8% and 7.9%, P =
0.20, and 20.3% and 17.7%, P = 0.65, respectively). There also was no
significant difference in LVEF at 1-year between the 2 groups (60.9+/-8.4%
and 59.6+/-8.8%, P = 0.06) Conclusion Long-term carvedilol therapy added
on the contemporary evidence-based medications did not seem beneficial in
selected STEMI patients treated with primary PCI. Trial registration
CAPITAL-RCT (Carvedilol Post-Intervention Long-Term Administration in
Large-scale Randomized Controlled Trial) ClinicalTrials.gov.number, NCT
01155635. Copyright © 2018 Watanabe 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.

<104>
Accession Number
619074939
Title
The effect of tranexamic acid to reduce blood loss and transfusion on
off-pump coronary artery bypass surgery: A systematic review and
cumulative meta-analysis.
Source
Journal of Clinical Anesthesia. 44 (pp 23-31), 2018. Date of Publication:
January 2018.
Author
Dai Z.; Chu H.; Wang S.; Liang Y.
Institution
(Dai, Chu, Wang, Liang) Department of Anesthesiology, The Affiliated
Hospital of Qingdao University, 16 Jiangsu Road, Qingdao 276000, China
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Study Objective To assess the safety and efficacy of tranexamic acid (TA)
on off-pump coronary artery bypass (OPCAB) surgery. Design Meta-analysis.
Setting Operating room, OPCAB surgery, all surgeries were elective
measurements. Searching the following data sources respectively:
PubMed/MEDLINE, the Cochrane Library, EMBASE and reference lists of
identified articles, we performed a meta-analysis of postoperative 24 h
blood loss, postoperative allogeneic transfusion, re-operation for massive
bleeding, postoperative mortality, and postoperative thrombotic
complications. Main results Using electronic databases, we selected 15
randomized control trials (RCTs), carried out between 2003 and 2016, with
a total of 1250 patients for our review. TA significantly reduced the
postoperative 24 h blood loss (mean difference - 213.32 ml, 95% confidence
intervals, - 247.20 ml to - 179.43 ml; P < 0.0001). And, TA also
significantly reduced the risk of packed red blood cell (PRBCs)
transfusion (risk ratio 0.62; 95% confidence intervals 0.51 to 0.76; P <
0.0001) and fresh frozen plasma (FFP) transfusion (0.65; 0.52 to 0.81; P <
0.001). There were no statistical significance on platelet transfusion
(risk difference - 0.00, 95% confidence interval - 0.02 to 0.02; P = 0.73)
and re-operation (0.00, - 0.02 to 0.02; P = 1.00). No association was
found between TA and morbility (risk difference - 0.00, 95% confidence
interval - 0.02 to 0.02; P = 0.99) and thrombotic complications (- 0.01, -
0.01 to 0.02; P = 0.70). Conclusions TA reduced the probability of
receiving a PRBCs and FFP transfusion during OPCAB surgery. And no
association with postoperative death and thrombotic events was found.
However, further trials with an appropriate sample size are required to
confirm TA safety in OPCAB surgery. Copyright © 2017 Elsevier
Inc.

<105>
Accession Number
624971429
Title
A perioperative surgeon-controlled open-lung approach versus conventional
protective ventilation with low positive end-expiratory pressure in
cardiac surgery with cardiopulmonary bypass (PROVECS): Study protocol for
a randomized controlled trial 11 Medical and Health Sciences 1102
Cardiorespiratory Medicine and Haematology.
Source
Trials. 19 (1) (no pagination), 2018. Article Number: 624. Date of
Publication: 13 Nov 2018.
Author
Lagier D.; Fischer F.; Fornier W.; Fellahi J.-L.; Colson P.; Cholley B.;
Jaber S.; Baumstarck K.; Guidon C.; Quintana G.; Gaillat F.; Nedir P.;
Duponq R.; Gomert R.; Guinard B.; Heraud F.; Villacorta J.; Degirmenci S.;
Pernoud N.; Samarani G.; Lalande M.; Huynh T.M.; Gros C.; Elmiloudi F.;
Tacquard C.; Bilger A.; Levy F.; Cinca E.; Bongarzone C.; Heger B.; Balvay
V.; Berns M.; Oulehri W.; Ouattara A.
Institution
(Lagier, Guidon) Department of Cardiovascular Anesthesiology and Critical
Care Medicine, La Timone University Hospital, AP-HM, Aix-Marseille
University, 264 rue saint Pierre, Marseille, cedex 5 13005, France
(Fischer) Department of Cardiovascular and Thoracic Anesthesiology, Nouvel
Hopital Civil, Strasbourg, France
(Fornier, Fellahi) Department of Anesthesiology and Critical Care
Medicine, Louis Pradel University Hospital, University Claude Bernard, 28
Avenue du Doyen Lepine, Bron 69677, France
(Colson) Department of Anesthesiology and Critical Care Medicine, Arnaud
de Villeneuve University Hospital, 371 Avenue du Doyen Gaston Giraud,
Montpellier 34295, France
(Cholley) Department of Anesthesiology and Critical Care Medicine, Hopital
Europeen Georges Pompidou, AP-HP, University Paris Descartes-Sorbonne
Paris Cite, 20 Rue Leblanc, Paris 75015, France
(Jaber) Department of Anesthesiology and Critical Care Medicine, Saint
Eloi University Hospital, 80 Avenue Augustin Fliche, Montpellier 34295,
France
(Baumstarck) Unite de Recherche EA3279, Aix-Marseille University, 27 bd
Jean Moulin, Marseille, Marseille, cedex 5 13385, France
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Postoperative pulmonary complications (PPCs) are frequent
after on-pump cardiac surgery. Cardiac surgery results in a complex
pulmonary insult leading to high susceptibility to perioperative pulmonary
atelectasis. For technical reasons, ventilator settings interact with the
surgical procedure and traditionally, low levels of positive
end-expiratory pressure (PEEP) have been used. The objective is to compare
a perioperative, multimodal and surgeon-controlled open-lung approach with
conventional protective ventilation with low PEEP to prevent PPCs in
patients undergoing cardiac surgery. Methods/design: The perioperative
open-lung protective ventilation in cardiac surgery (PROVECS) trial is a
multicenter, two-arm, randomized controlled trial. In total, 494 patients
scheduled for elective cardiac surgery with cardiopulmonary bypass (CPB)
and aortic cross-clamp will be randomized into one of the two treatment
arms. In the experimental group, systematic recruitment maneuvers and
perioperative high PEEP (8 cmH2O) are associated with ultra-protective
ventilation during CPB. In this group, the settings of the ventilator are
controlled by surgeons in relation to standardized protocol deviations. In
the control group, no recruitment maneuvers, low levels of PEEP (2 cmH2O)
and continuous positive airway pressure during CPB (2 cmH2O) are used. Low
tidal volumes (6-8 mL/kg of predicted body weight) are used before and
after CPB in each group. The primary endpoint is a composite of the single
PPCs evaluated during the first 7 postoperative days. Discussion(s):
The PROVECS trial will be the first multicenter randomized controlled
trial to evaluate the impact of a perioperative and multimodal open-lung
ventilatory strategy on the occurrence of PPCs after on-pump cardiac
surgery. The trial design includes standardized surgeon-controlled
protocol deviations that guarantee a pragmatic approach. The results will
help anesthesiologists and surgeons aiming to optimize ventilatory
settings during cardiac surgery. Trial registration: Clinical Trials.gov,
NCT 02866578. Registered on 15 August 2016. Last updated 11 July
2017. Copyright © 2018 The Author(s).

<106>
Accession Number
625597622
Title
Selenium, Vitamin C and N-Acetylcysteine do not Reduce the Risk of Acute
Kidney Injury after Off-Pump CABG: a Randomized Clinical Trial.
Source
Brazilian journal of cardiovascular surgery. 33 (2) (pp 129-134), 2018.
Date of Publication: 01 Mar 2018.
Author
Amini S.; Robabi H.N.; Tashnizi M.A.; Vakili V.
Institution
(Amini) Department of Anesthesia, Faculty of Medicine, Mashhad University
of Medical Sciences, Mashhad, Iran, Islamic Republic of
(Robabi) Department of Anesthesiology and Critical Care, Mashhad
University of Medical Sciences, Mashhad, Iran, Islamic Republic of
(Tashnizi) Department of Cardiac Surgery, Mashhad University of Medical
Sciences, Mashhad, Iran, Islamic Republic of
(Vakili) Department of Community Medicine, Mashhad University of Medical
Sciences, Mashhad, Iran, Islamic Republic of
Publisher
NLM (Medline)
Abstract
OBJECTIVE: The aim of this study was to investigate the impact of
perioperative administration of N-acetylcysteine, selenium and vitamin C
on the incidence and outcomes of acute kidney injury after off-pump
coronary bypass graft surgery. METHOD(S): 291 patients requiring
elective off-pump coronary bypass graft surgery were randomized to receive
either N-acetylcysteine, vitamin C and selenium 600 mg, 1500 mg, 0.5 mg,
and nothing orally twice a day, respectively, from the day before to 2
days after surgery. They were assessed for the development of acute kidney
injury using Acute Kidney Injury Network criteria, time of onset, its
severity and duration, duration of mechanical ventilation, intensive care
unit and hospital length of stay, and in-hospital mortality.
 RESULT(S): 272 patients completed the study. The total incidence of
acute kidney injury was 22.1% (n=60) with 14 (20.9%), 15 (22.1%), 21
(31.8%), and 10 (14.1%) patients in the vitamin C, NAC, selenium, and
control groups, respectively (P=0.096). We did not register significant
differences in the incidence, the time of occurrence, the severity and the
duration of acute kidney injury, as well as the duration of mechanical
ventilation, the intensive care unit and hospital length of stay, and the
in-hospital mortality among the four groups. CONCLUSION(S): We found
that perioperative administration of N-acetylcysteine, vitamin C and
selenium were not effective in preventing acute kidney injury and
associated morbidity and mortality after off-pump coronary bypass graft
surgery.

<107>
Accession Number
623693383
Title
Echocardiographic evaluation of velocity ratio, velocity time integral
ratio, and pulmonary valve area in dogs with pulmonary valve stenosis.
Source
Journal of Veterinary Internal Medicine. 32 (5) (pp 1570-1578), 2018. Date
of Publication: September/October 2018.
Author
Nishimura S.; Visser L.C.; Belanger C.; Oldach M.S.; Gunther-Harrington
C.T.; Stern J.A.
Institution
(Nishimura, Visser, Belanger, Oldach, Gunther-Harrington, Stern)
Department of Medicine and Epidemiology, School of Veterinary Medicine,
University of California, Davis, Davis, United States
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Background: Velocity ratio, velocity time integral (VTI) ratio, and
pulmonary valve area indexed to body surface area (iPVA) are methods of
assessment of pulmonary valve stenosis (PS) severity that are less
dependent on blood flow. Studies evaluating these methods are limited.
 Objective(s): To determine the effects of butorphanol, atenolol, and
balloon valvuloplasty (BV) on velocity ratio, VTI ratio, iPVA, mean PG,
and max PG. Animals: Twenty-seven dogs with PS (max PG >50 mm Hg).
 Method(s): Prospective study. All dogs underwent an echocardiogram at
baseline, 5-minutes after administration of butorphanol (0.2-0.25 mg/kg
IV), and 2-to-4 weeks after atenolol (1-1.5 mg/kg q12h). Twenty-one of
these were evaluated 24-hours after BV. Result(s): There were no
significant differences (P >.05) amongst any of the methods of assessment
of PS severity after butorphanol. After atenolol, mean (SD) of mean (57.0
[21.0] mm Hg) and max PG (93.1 [33.8] mm Hg) were significantly decreased
(P <=.047) compared with baseline (65.2 [26.2] mm Hg and 108 [44.4] mm Hg,
respectively). After atenolol, there were no significant (P >=.12)
differences in velocity ratio (0.29 [0.09]), VTI ratio (0.18 [0.05]), or
iPVA (0.43 [0.16] cm2/m2) compared with baseline
(0.30 [0.09], 0.19 [0.09], 0.44 [0.17] cm2/m2,
respectively). Conclusions and Clinical Importance: Atenolol might reduce
mean and max PG but does not alter less flow-dependent methods of
assessment of PS severity (velocity ratio, VTI ratio, and iPVA) in dogs
with PS. Results support an integrative approach to assessment of PS
severity that includes less flow-dependent methods, particularly in states
of altered flow or right ventricular function. Copyright © 2018
The Authors. Journal of Veterinary Internal Medicine published by Wiley
Periodicals, Inc. on behalf of the American College of Veterinary Internal
Medicine.

<108>
Accession Number
625927091
Title
Radial Artery Versus Right Internal Thoracic Artery Versus Saphenous Vein
as the Second Conduit for Coronary Artery Bypass Surgery: A Network
Meta-Analysis of Clinical Outcomes.
Source
Journal of the American Heart Association. 8 (2) (pp e010839), 2019. Date
of Publication: 22 Jan 2019.
Author
Gaudino M.; Lorusso R.; Rahouma M.; Abouarab A.; Tam D.Y.; Spadaccio C.;
Saint-Hilary G.; Leonard J.; Iannaccone M.; D'Ascenzo F.; Di Franco A.;
Soletti G.; Kamel M.K.; Lau C.; Girardi L.N.; Schwann T.A.; Benedetto U.;
Taggart D.P.; Fremes S.E.
Institution
(Gaudino, Rahouma, Abouarab, Leonard, Di Franco, Soletti, Kamel, Lau,
Girardi) Department of Cardio-Thoracic Surgery Weill Cornell Medicine New
York NY
(Lorusso) Department of Cardio-Thoracic Surgery Heart & Vascular Centre
Maastricht University Medical Hospital and CARIM (Cardiovascular Research
Institute Maastricht) Maastricht The Netherlands
(Tam, Fremes) Schulich Heart Centre Sunnybrook Health Science University
of Toronto Canada
(Spadaccio) Department of Cardiothoracic Surgery Golden Jubilee National
Hospital Glasgow United Kingdom
(Spadaccio) Institute of Cardiovascular and Medical Sciences University of
Glasgow United Kingdom
(Saint-Hilary) Department of Matematical Sciences Politecnico di Torino
Turin Italy
(Iannaccone, D'Ascenzo) Department of Cardiology "Citta della Scienza e
della Salute" University of Turin Italy
(Schwann) University of Toledo Medical Center Toledo OH
(Benedetto) School of Clinical Sciences Bristol Heart Institute University
of Bristol United Kingdom
(Taggart) 10 University of Oxford United Kingdom
Publisher
NLM (Medline)
Abstract
Background There remains uncertainty regarding the second-best conduit
after the internal thoracic artery in coronary artery bypass grafting. Few
studies directly compared the clinical results of the radial artery ( RA
), right internal thoracic artery ( RITA ), and saphenous vein ( SV ). No
network meta-analysis has compared these 3 strategies. Methods and Results
MEDLINE and EMBASE were searched for adjusted observational studies and
randomized controlled trials comparing the RA , SV , and/or RITA as the
second conduit for coronary artery bypass grafting. The primary end point
was all-cause long-term mortality. Secondary end points were operative
mortality, perioperative stroke, perioperative myocardial infarction, and
deep sternal wound infection ( DSWI ). Pairwise and network meta-analyses
were performed. A total of 149 902 patients (4 randomized, 31
observational studies) were included ( RA , 16 201, SV , 112 018, RITA, 21
683). At NMA , the use of SV was associated with higher long-term
mortality compared with the RA (incidence rate ratio, 1.23; 95% CI ,
1.12-1.34) and RITA (incidence rate ratio, 1.26; 95% CI , 1.17-1.35). The
risk of DSWI for SV was similar to RA but lower than RITA (odds ratio,
0.71; 95% CI , 0.55-0.91). There were no differences for any outcome
between RITA and RA , although DSWI trended higher with RITA (odds ratio,
1.39; 95% CI , 0.92-2.1). The risk of DSWI in bilateral internal thoracic
artery studies was higher when the skeletonization technique was not used.
Conclusions The use of the RA or the RITA is associated with a similar and
statistically significant long-term clinical benefit compared with the SV
. There are no differences in operative risk or complications between the
2 arterial conduits, but DSWI remains a concern with bilateral ITA when
skeletonization is not used.

<109>
Accession Number
625906488
Title
Clinical effects of acute kidney injury after transcatheter aortic valve
implantation: a systematic review and meta-analysis.
Source
Internal and emergency medicine. 14 (1) (pp 161-175), 2019. Date of
Publication: 01 Jan 2019.
Author
Ma M.; Gao W.-D.; Gu Y.-F.; Wang Y.-S.; Zhu Y.; He Y.
Institution
(Ma) Department of Cardiology, Sixth People's Hospital of Chengdu, Chengdu
610051, China
(Ma, Zhu, He) Department of Cardiology, West China Hospital, Sichuan
University, No. 37 GuoXue Street, Chengdu 610041, China
(Gao) Department of Cardiology, Jiangmen Central Hospital, Jiangmen
529030, China
(Gu) Department of Cardiology, LuoYang Central Hospital Affiliated to
ZhengZhou University, No 288 Zhongzhou Road, Luoyang 471000, China
(Wang) Department of Cardiology, First People's Hospital of Chengdu,
Chengdu 610016, China
Publisher
NLM (Medline)
Abstract
Several observational studies have shown that postoperative acute kidney
injury (AKI) may significantly worsen the prognosis of a transcatheter
aortic valve implantation (TAVI). The purpose of this systematic review
and meta-analysis is to evaluate the recent evidence on the impact of AKI
on clinical outcomes following TAVI. A comprehensive search in PubMed,
Embase and the Cochrane Library was performed for relevant studies by two
independent investigators. We pooled the odds ratio (OR) from individual
studies, and performed heterogeneity, quality assessment and publication
bias analysis. Forty-three eligible studies comprising 544,112 patients
were included. Postoperative AKI not only significantly increased the risk
for short-term and long-term all-cause mortality (OR 6.25, 95% CI
5.72-6.83, P<0.00001; OR 3.49, 95% CI 2.78-4.40, P<0.00001, respectively),
but also increased the risk for early myocardial infarction (OR 3.98, 95%
CI 1.90-8.31, P=0.0002), major and life-threatening bleeding (OR 1.51, 95%
CI 1.12-2.03, P=0.007; OR 2.35, 95% CI 1.80-3.06, P<0.00001,
respectively), major vascular complications (OR 1.69, 95% CI 1.30-2.18,
P<0.0001), need for blood transfusion (OR 2.15, 95% CI 1.89-2.46,
P<0.00001) renal replacement therapy (OR 22.36, 95% CI 11.88-42.12,
P=0.0002) and cerebrovascular accidents (OR 1.92, 95% CI 1.23-2.98,
P=0.004). Acute kidney injury following TAVI is associated with increased
postoperative mortality and morbidity. Future efforts are required to
determine whether early prevention of post-procedural AKI after TAVI
impacts upon clinical outcomes.

<110>
Accession Number
625905945
Title
Risk factors associated with cardiac complication after total joint
arthroplasty of the hip and knee: a systematic review.
Source
Journal of orthopaedic surgery and research. 14 (1) (pp 15), 2019. Date of
Publication: 11 Jan 2019.
Author
Elsiwy Y.; Jovanovic I.; Doma K.; Hazratwala K.; Letson H.
Institution
(Elsiwy, Jovanovic, Doma, Hazratwala) Orthopaedic Research Institute of
Queensland, Townsville, QLD, Australia
(Elsiwy, Letson) College of Medicine and Dentistry, James Cook University,
Townsville, QLD, Australia
(Doma) College of Healthcare Sciences, James Cook University, Townsville,
QLD, Australia
Publisher
NLM (Medline)
Abstract
BACKGROUND: Cardiac complication represents a major cause of morbidity and
mortality after total joint arthroplasty, thus necessitating investigation
into the associated risks in total hip arthroplasty and total knee
arthroplasty. There remains a lack of clarity for many risk factors in the
current literature. The aim of this systematic review is to assess the
most recent published literature and identify the risk factors associated
with cardiac complication in total hip arthroplasty and total knee
arthroplasty. METHOD(S): Scopus, PubMed, CINHAL, and Cochrane were
searched to identify studies published since 2008 reporting on risk
factors associated with cardiac complication in elective primary in total
hip arthroplasty and total knee arthroplasty in patients >=18years old
with osteoarthritis. Reported odds ratios, hazard ratios, and relative
risk were the principal summary measures collected. The included studies
were too heterogeneous to enable meta-analysis. RESULT(S): Fifteen
studies were included in this systematic review. Increasing age and
history of cardiac disease were found by most studies to be positively
associated with risk of cardiac complication. There was no strong
association found between obesity and cardiac complication. The evidence
for other risk factors was less clear in the examined literature, although
there is suggestive evidence for male gender and cerebrovascular disease
increasing risk. CONCLUSION(S): Increasing age and history of cardiac
disease increases the risk of cardiac complication after total hip
arthroplasty and total knee arthroplasty. Other risk factors commonly
attributed to increased risk in non-cardiac surgery including hypertension
and obesity require further evaluation in arthroplasty. SYSTEMATIC REVIEW
REGISTRATION: A detailed protocol was published in the PROSPERO database
(registration number CRD42018095887 ) for this systematic review.

<111>
Accession Number
625925229
Title
The effect of methylprednisolone prophylaxis on inflammatory monocyte
subsets and suppressive regulatory T cells of patients undergoing
cardiopulmonary bypass.
Source
Perfusion (United Kingdom). (no pagination), 2019. Date of Publication:
2019.
Author
Hao X.; Han J.; Zeng H.; Wang H.; Li G.; Jiang C.; Xing Z.; Hao Y.; Yang
F.; Hou X.
Institution
(Hao, Wang, Jiang, Xing, Yang, Hou) Center for Cardiac Intensive Care,
Beijing Anzhen Hospital, Capital Medical University, Beijing, China
(Han, Zeng, Li, Hao) Institute of Infectious Diseases, Beijing Ditan
Hospital, Capital Medical University, Beijing, China
(Han, Zeng, Li, Hao) Beijing Key Laboratory of Emerging Infectious
Diseases, Beijing, China
Publisher
SAGE Publications Ltd (E-mail: info@sagepub.co.uk)
Abstract
Background: Cardiopulmonary bypass (CPB) during open-heart surgery
triggers an inflammatory response that can cause significant morbidity and
mortality. Human monocytes and regulatory T (Treg) cells are
phenotypically and functionally heterogeneous and have been shown to play
a significant role in the inflammatory dysfunction triggered by CPB.
Glucocorticoids (GCs) have been widely administered for decades in
patients undergoing CPB to reduce this inflammatory response. However, it
has not been clearly established how routine prophylactic administration
of glucocorticoids (GCs) affects monocyte and Treg subsets.
 Method(s): Thirty-six patient who underwent heart surgery with CPB
were randomly assigned to a methylprednisolone group (MG, N = 18; 500 mg
in the CPB priming) and a non-methylprednisolone group (NMG, N = 18). The
circulating monocyte and Treg subsets were analyzed by flow cytometry.
 Result(s): The MG and NMG groups had comparable percentages of
monocyte subsets and similar expression levels of HLA-DR, CD86, CD64 and
toll-like receptor 4 (TLR4). Remarkably, methylprednisolone increased the
percentage of CD4+CD25+ Treg cells among CD4+ T cells in patients
undergoing CPB, but did not increase the proportion of suppressive Treg
cells, either resting or activated, in these patients undergoing CPB.
 Conclusion(s): Our results showed that prophylactic administration of
methylprednisolone neither decreased the percentages and counts of
inflammatory monocyte subsets nor did it induce the expansion of
suppressive Treg cells in patients undergoing CPB. These results clarified
the effects of GCs on cell-mediated immune responses and provided
additional evidence in practice. Trial registration: Clinicaltrials.gov:
NCT01296074. Registered 14 February 2011. Copyright © The
Author(s) 2019.

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