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    <recommendedItem id="20100101_19_284"
                     title="STS: Leg Artery Access Linked to Dissection (CME/CE)"
                     score="0.004"
                     href="http://www.medpagetoday.com/MeetingCoverage/STS/tb/18139?impressionId=1265773894251"
                     
      &lt;p&gt;FORT LAUDERDALE  --  Avoiding femoral artery cannulization during cardiac surgery might eliminate some of the rare but potentially catastrophic aortic dissections that occur during the procedure, researchers said here.&lt;/p&gt;
&lt;p&gt;Doctors identified the femoral location as an increased risk factor in an analysis of records from the Society of Thoracic Surgeons&apos; national database of more than 2.2 million cardiac surgeries. That search yielded 1,294 incidents of aortic dissection.&lt;/p&gt;
&lt;p&gt;&quot;Prevention is the key,&quot; Matthew Williams, MD, of the University of Louisville, said at the annual meeting of the Society of Thoracic Surgeons here.&lt;/p&gt;
&lt;p&gt;Williams and colleagues reported that aortic dissection occurs in only 0.06% of cardiac surgeries but accounts for almost one percent of perioperative deaths.&lt;/p&gt;
&lt;p&gt;&quot;Aortic dissection is a low frequency but catastrophic event,&quot; Williams said, noting that 48% of aortic dissections during surgery prove fatal. Some 9% of the survivors suffer strokes and 14% experience kidney failure.&lt;/p&gt;
&lt;p&gt;He recalled becoming interested in the research after one of his patients, a woman, experienced aortic dissection during a procedure. &quot;She walked out of the hospital,&quot; he said.&lt;/p&gt;
&lt;p&gt;He told &lt;em&gt;MedPage Today&lt;/em&gt; that &quot;the incidence of these aortic dissections is so small that only a large database project such as this one could possibly get at these cases.&quot;&lt;/p&gt;
&lt;p&gt;According to his presentation materials, researchers created a logistic regression model based on 2004-2007 STS data. The analysis turned up nine significant risk factors, including femoral cannulization, preoperative steroids, and Asian race. Diabetes appeared to be protective.&lt;/p&gt;
&lt;p&gt;When aortic dissection occurs during surgery, Williams said, doctors generally stop the operation and attempt to restart it by cannulization in another area.&lt;/p&gt;
&lt;p&gt;He said he has considered femoral access as a last resort and prefers either central aortic cannulization or axial cannulization.&lt;/p&gt;
&lt;p&gt;He said improving outcomes and identifying what causes aortic dissection in these surgical cases may require changes and updates in the information captured by the database. He said a clinical trial would require so many patients that it would not be practical.&lt;/p&gt;
&lt;p&gt;Aubrey Galloway, MD, of the New York University School of Medicine, who was the discussant for Williams&apos; talk, said that the imprecise nature of the way the data are gathered might have misidentified the femoral access point as a culprit procedure.&lt;/p&gt;
&lt;p&gt;&quot;It may be that femoral access was employed in response to another dissection site,&quot; he said.&lt;/p&gt;
&lt;p&gt;Williams responded that by tweaking the information acquired by the database it might be possible to better determine these associations.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;Williams listed no relevant disclosures; Galloway disclosed financial relationships with Medtronic and Edwards Life Sciences and Estech.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_295"
                     title="STS: Aorta Repair Done at Warmer Temperatures (CME/CE)"
                     score="0.003"
                     href="http://www.medpagetoday.com/MeetingCoverage/STS/tb/18156?impressionId=1265773894251"
                     
      &lt;p&gt;FORT LAUDERDALE  --  Doctors here suggest it is safe to perform aortic arch surgery using moderate hypothermia  --  cooling the body to about 26 degrees C rather than 18 degrees C  --  without jeopardizing cerebral protection.&lt;/p&gt;
&lt;p&gt;Researchers at Emory University in Atlanta said their aortic arch repair techniques have been evolving over the past decade, including performing the surgery at higher body temperatures.&lt;/p&gt;
&lt;p&gt;&quot;The optimal management during aortic arch surgery is controversial,&quot; Emory&apos;s Bradley Leshnower, MD, noted in his oral presentation at the annual meeting of the Society of Thoracic Surgeons here. &quot;The main issue is cerebral protection during the period of circulatory arrest.&quot;&lt;/p&gt;
&lt;p&gt;Since modern aortic surgery was first performed in 1975, body temperatures have traditionally been lowered to about 18 degrees Celsius (64.4 degrees Fahrenheit) in order to protect organs from damage once circulatory arrest has been achieved.&lt;/p&gt;
&lt;p&gt;&quot;Since that time, two additional methods of surgery with protection have evolved and are used in conjunction with hypothermia: retrograde cerebral perfusion and selective antegrade cerebral perfusion,&quot; Leshnower said.&lt;/p&gt;
&lt;p&gt;&quot;At Emory we use a strategy of cerebral protection that we call unilateral selective antegrade reperfusion,&quot; he explained. &quot;Our hypothesis was that by using adjunctive selective antegrade perfusion, we could safely perform arch reconstruction using more moderate levels of hypothermia and thereby avoid the adverse effects of deep hypothermia.&quot;&lt;/p&gt;
&lt;p&gt;Matthew Williams, MD, of the University of Louisville, noted that temperature is critical because &quot;the deeper the hypothermia, the more problems occur in clotting.&quot;&lt;/p&gt;
&lt;p&gt;&quot;Even the tiniest pinpricks in the aorta that would immediately clot off at normal temperatures will bleed profusely among hypothermia patients,&quot; he said.&lt;/p&gt;
&lt;p&gt;In their retrospective study, Leshnower and colleagues identified 412 aortic arch procedures performed between January 2004 and December 2009.&lt;/p&gt;
&lt;p&gt;All cases involved hypothermia circulatory arrest and unilateral selective antegrade reperfusion. The mean age of the patients was 57, and about two-thirds were male. About 10% had a history of renal failure and the same proportion had a history of stroke. Among the cases were 85 reoperations.&lt;/p&gt;
&lt;p&gt;&quot;About three-fourths of the cases were done electively, and the remaining 24% were done for emergent Type 1 aortic dissections,&quot; Leshnower said.&lt;/p&gt;
&lt;p&gt;The procedures included 344 hemiarch reconstructions and 68 total arch replacements. Among them were 175 aortic root replacements.&lt;/p&gt;
&lt;p&gt;Overall, the average temperature for circulatory arrest was 25.7 degrees Celsius (range 19 - 30). The average circulatory arrest time was 30 minutes.&lt;/p&gt;
&lt;p&gt;In the safety analysis the researchers found: &lt;ul&gt; &lt;li&gt;Overall mortality was 7%, but &quot;as we gained experience with this procedure, our results improved and our mortality was reduced to 4.8% in the latter half of the series,&quot; Leshnower said.&lt;/li&gt; &lt;li&gt;Permanent neurological dysfunction  --  a focal stroke  --  occurred in 3.6%.&lt;/li&gt; &lt;li&gt;Temporary neurological dysfunction  --  cognitive deficits observed postoperatively  --  occurred in 5.1%. &quot;These deficits are considered to be a sign of inadequate cerebral protection,&quot; Leshnower explained.&lt;/li&gt; &lt;li&gt;Renal failure requiring dialysis as a measure of lower body, end organ ischemia occurred in 4.6%&lt;/li&gt; &lt;li&gt;There were no cases of paraplegia.&lt;/li&gt; &lt;/ul&gt;&lt;/p&gt;
&lt;p&gt;In a subgroup analysis, Leshnower and colleagues observed a mortality rate of 14.4% in the emergent cases, compared with 4.8% in the elective group.&lt;/p&gt;
&lt;p&gt;&quot;There was also a significantly higher percentage of permanent neurologic dysfunction and renal failure requiring dialysis in the dissection group. However, there was no difference in our temporary neurologic dysfunction rate,&quot; he said.&lt;/p&gt;
&lt;p&gt;He noted that a multivariate analysis failed to show that higher temperatures were related to adverse outcomes.&lt;/p&gt;
&lt;p&gt;&quot;We feel that the use of moderate hypothermia with selective antegrade cerebral reperfusion is an effective method of cerebral protection as evidenced by our low rate of permanent and temporary neurologic dysfunction,&quot; he said.&lt;/p&gt;
&lt;p&gt;&quot;We feel that the use of this technique avoids the adverse effects of deep hypothermia and is an effective strategy for circulation management in the aortic arch surgery in both the emergent and elective settings.&quot;&lt;/p&gt;
&lt;p&gt;Randall Griepp, MD, of Mount Sinai School of Medicine in New York City, who pioneered the technique back in 1975, praised the report from the floor of the session but added a caution.&lt;/p&gt;
&lt;p&gt;&quot;These are terrific results. But you should do some postoperative cognitive testing. The perfusion of the distal aorta does become an issue somewhere around an hour or so. There have been reports of injury, including paraplegia, when higher temperatures are used. You have not seen it in your series but you are beginning to flirt with the limits of depriving the lower body of blood flow.&quot;&lt;/p&gt;
&lt;p&gt;He said that the estimation of temporary neurologic dysfunction may not appear until six weeks to a year after surgery for those patients who go beyond 25 to 30 minutes with circulatory arrest.&lt;/p&gt;
&lt;p&gt;Leshnower also noted that his study could not prove that bleeding times were reduced, because a proper historical control group using similar surgical and protection techniques is not available.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;Leshnower had no disclosures but one of the co-authors revealed financial relationships with Terumo. Williams and Griepp had no disclosures.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_250"
                     title="Cancer Research &quot;Giant&quot; Lawrence Garfinkel Dies at 88"
                     score="0"
                     href="http://www.medpagetoday.com/Pulmonology/Smoking/tb/18108?impressionId=1265773894251"
                     
      &lt;p&gt;Epidemiologist Lawrence Garfinkel, MA, a legendary researcher for the American Cancer Society whose work helped establish a link between cancer and smoking and other activities, died of cardiovascular disease Thursday in Seattle, Washington at 88.&lt;/p&gt;
&lt;p&gt;&quot;The American Cancer Society today mourns the loss of one of its most important historical figures,&quot; said John R. Seffrin, PhD, the society&apos;s chief executive officer.&lt;/p&gt;
&lt;p&gt;&quot;Larry Garfinkel joined the American Cancer Society as a young scientist in 1947, and for more than four decades played an instrumental role in expanding knowledge of and reducing death from smoking.&quot;&lt;/p&gt;
&lt;p&gt;Garfinkel&apos;s 1982 Cancer Prevention Study-II (CPS-II) is the largest contemporary study of tobacco and mortality, with 1.2 million participants and 77,000 data-compiling volunteers across 50 states, the District of Columbia, and Puerto Rico.&lt;/p&gt;
&lt;p&gt;CPS-II uncovered the effects of lifestyle factors, such as obesity, alcohol consumption, medications, genetic elements, that affect cancer and other chronic diseases, the analysis of which still reveals important clues about cancer today.&lt;/p&gt;
&lt;p&gt;The study also found lung cancer mortality rates in women increased five-fold from data collected in the original Cancer Prevention Study, while cancer rates among non-smoking women remained the same. This information provided strong evidence that lung cancer was almost exclusively a disease found in smokers.&lt;/p&gt;
&lt;p&gt;Garfinkel was born on January 11, 1922 in Manhattan&apos;s Lower East Side and was raised in the South Bronx.&lt;/p&gt;
&lt;p&gt;He served in the army during World War II, where he was seriously injured in northern France in August, 1944.&lt;/p&gt;
&lt;p&gt;Ultimately, Garfinkel graduated from the City College of New York and received a Masters Degree from Columbia University. He also received several honorary doctorates.&lt;/p&gt;
&lt;p&gt;Garfinkel began work for the ACS in 1947.&lt;/p&gt;
&lt;p&gt;He assisted E. Cuyler Hammond, MD, and Daniel Horn, MD, in the first ACS prospective mortality study of 187,783 males in the late 1940&apos;s by coordinating much of the field work, including training thousands of ACS volunteers in data collection techniques.&lt;/p&gt;
&lt;p&gt;Garfinkel acted as the co-principal investigator of the larger Cancer Prevention Study I (CPS-I) in 1959. The study enrolled 1 million participants across 25 states and required over 68,000 volunteers to collect data.&lt;/p&gt;
&lt;p&gt;In the 1960s, he contributed to more than two dozen major papers on the relation between smoking and health. He was co-author of one of the first reports combining epidemiology with pathology and provided some of the first direct evidence of lung damage related to smoking.&lt;/p&gt;
&lt;p&gt;Garfinkel also contributed to issuance of the landmark 1964 Surgeon General&apos;s report on smoking and health.&lt;/p&gt;
&lt;p&gt;He was appointed director of ACS research in 1979 after Hammond&apos;s retirement.&lt;/p&gt;
&lt;p&gt;Garfinkel retired from the ACS in 1989. Over the course of his career, he had contributed to more than 100 journal articles.&lt;/p&gt;
&lt;p&gt;Richard D. Klausner, MD, then-director of the National Cancer Institute, said at the time: &quot;Few individuals have contributed as much to our present-day knowledge about the disease consequences of smoking.&lt;/p&gt;
&lt;p&gt;&quot;His remarkable achievement is an important reminder what a tremendous impact an individual can make, and inspires all of us to continue the fight against cancer.&quot;&lt;/p&gt;
&lt;p&gt;Garfinkel continued to volunteer with the ACS after his retirement and taught biostatistics at the New York University Dental School.&lt;/p&gt;
&lt;p&gt;He is survived by his brothers, Harold and Melvin; his sons, Martin and Herb; a daughter-in-law, Margaret Cary, and two grandchildren.&lt;/p&gt;

    </recommendedItem>
    <recommendedItem id="20100101_19_174"
                     title="AACR-IASLC: MicroRNA Linked to SCLC Response (CME/CE)"
                     score="-0.005"
                     href="http://www.medpagetoday.com/MeetingCoverage/AACR-IASLC/tb/18008?impressionId=1265773894251"
                     
      &lt;p&gt;CORONADO, Calif.  --  Tiny genetic segments may give a big tip-off to platinum chemoresistance in patients with small cell lung cancer, researchers said.&lt;/p&gt;
&lt;p&gt;Three microRNAs were linked to de novo chemoresistance in a small study led by Glen J. Weiss, MD, of Scottsdale Healthcare and the Translational Genomics Research Institute (TGen), both in Scottsdale, Ariz.&lt;/p&gt;
&lt;p&gt;He presented the results here at the Joint Conference on Molecular Origins of Lung Cancer sponsored by the American Association for Cancer Research and the International Association for the Study of Lung Cancer.&lt;/p&gt;
&lt;p&gt;Further validation would be needed before denying any patient chemotherapy based on the findings, cautioned Tyler Jacks, PhD, of the Massachusetts Institute of Technology and president of the AACR.&lt;/p&gt;
&lt;p&gt;However, &quot;biomarkers of this sort will be useful in diagnosing patients and applying relevant therapies  --  in this instance perhaps applying novel therapies, given the belief that the conventional therapies will be of no value to these individuals,&quot; he said as discussant on the study at a press conference.&lt;/p&gt;
&lt;p&gt;Weiss agreed.&lt;/p&gt;
&lt;p&gt;&quot;This is early stage,&quot; he said in an interview. &quot;But hopefully down the road it will have implications for treating patients with small cell [lung cancer].&quot;&lt;/p&gt;
&lt;p&gt;Non-small cell lung cancer has been a success story for personalized treatment.&lt;/p&gt;
&lt;p&gt;It was revolutionized by discovery of epidermal growth factor receptor (EGFR) mutations as both a prognostic factor and treatment target for the EGFR tyrosine kinase inhibitors.&lt;/p&gt;
&lt;p&gt;But for small cell lung cancer, the standard treatment is platinum-based chemotherapy with only two real options in first-line treatment, the researchers said.&lt;/p&gt;
&lt;p&gt;Worse, 15% to 30% of small cell tumors are intrinsically resistant to platinum chemotherapy and never respond.&lt;/p&gt;
&lt;p&gt;&quot;[Small cell] lung cancer patients haven&apos;t had a real advance in 15 years or more for chemotherapy,&quot; Weiss told &lt;em&gt;MedPage Today&lt;/em&gt;. &quot;What we&apos;re trying to do is identify the group that doesn&apos;t respond to standard therapy so that we can identify new treatments for them up front instead of treating everyone the same.&quot;&lt;/p&gt;
&lt;p&gt;Among the genetic possibilities for these efforts, microRNA  --  RNA molecules of around 20 nucleotides in length  --  are a good option, Weiss explained.&lt;/p&gt;
&lt;p&gt;They regulate gene expression like messenger RNA but are smaller and more stable across a variety of fluid and tissue types, he said.&lt;/p&gt;
&lt;p&gt;In the study, the researchers analyzed diagnostic tumor samples from 34 patients with small cell lung cancer.&lt;/p&gt;
&lt;p&gt;Among them, 19% had de novo chemoresistance marked by progressive disease. Most had had a partial or complete response to chemotherapy (61.9% and 9.5%, respectively).&lt;/p&gt;
&lt;p&gt;After extraction of total RNA, microRNA profiling revealed 16 top candidates for association with progressive disease.&lt;/p&gt;
&lt;p&gt;The 28 samples with sufficient RNA for further testing showed three microRNAs linked to chemoresistance that were validated by quantitative real-time PCR: &lt;ul&gt; &lt;li&gt;miR-92a-2* with a &lt;em&gt;P&lt;/em&gt;-value of 0.010&lt;/li&gt; &lt;li&gt;miR-147 with a &lt;em&gt;P&lt;/em&gt;-value of 0.018&lt;/li&gt; &lt;li&gt;miR-574-5p with a &lt;em&gt;P&lt;/em&gt;-value of 0.039&lt;/li&gt; &lt;/ul&gt;&lt;/p&gt;
&lt;p&gt;Many of the patients had comorbidities at baseline, including 47.1% with hypertension and 32% with emphysema or chronic obstructive pulmonary disease. But these did not predict chemotherapy response.&lt;/p&gt;
&lt;p&gt;The next step is to validate the biomarkers in an independent cohort of small cell lung cancer patients, the researchers concluded.&lt;/p&gt;
&lt;p&gt;Then studies will need to determine what does work in these chemoresistant patients, Weiss said.&lt;/p&gt;
&lt;p&gt;&quot;We&apos;ve learned that if we&apos;re going to make the next hurdle and if we&apos;re going to better treat this disease, we need more personalized care,&quot; agreed Roy Herbst, MD, PhD, of M.D. Anderson Cancer Center in Houston.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The study was supported by the American Cancer Society-Sylvia Chase Pilot Grant, IBIS Foundation of Arizona, and the TGen Foundation.&lt;/p&gt;&lt;p&gt;Weiss reported recieving lab support from TGen Foundation and Scottsdale Healthcare Foundation as well as being party to provisional patents related to microRNAs in lung cancer.&lt;/p&gt;&lt;p&gt;Jacks provided no information on conflicts of interest.&lt;/p&gt;&lt;p&gt;Herbst has reported financial relationships with Genentech, Lilly, Amgen, and AstraZeneca. &lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20090101_4_904"
                     title="STS: Lung Surgery Mortality Lower at Academic Centers"
                     score="-0.005"
                     href="