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Sep 2, 2016

From the heart

The story

Sipping espresso next to the Colosseum is more fun than your typical night float admitting shift. But if you missed the European Society of Cardiology's annual meeting in Rome, we've got you covered with some of the major research highlights. And really, isn't that the next best thing? 

Stent it

NORSTENT, a non-industry sponsored mega-trial of 9,000 patients who underwent PCI in Norway, compared second-generation drug-eluting stents to bare metal stents. Drug-eluting stents cut rates of target lesion revascularization in half at 5-year follow-up, but they did not show a mortality benefit or reduce hospitalizations.
NEJM 

Shock it

Patients with ischemic cardiomyopathy and reduced ejection fraction benefit from ICD placement, but the role of ICDs in nonischemic cardiomyopathy has been unclear. The DANISH trial looked at ICD placement in addition to medical therapy in 1,100 highly adherent patients with nonischemic heart failure. They found no difference in mortality between the ICD and non-ICD groups, despite a 50% reduction in sudden death in patients who received ICDs. Some think that a mortality difference was not seen because the unusually good medical therapy cut the number of cardiac events in both groups to atypically low levels.
NEJM

Put it in reverse

Factor Xa inhibitors were like your hospital's furnace – they did their job well but couldn’t really be shut off. Enter andexanet alfa, a recombinant protein that reduces activity levels of rivaroxaban and apixaban in stable patients. Investigators put the protein to the test in a cohort study of 67 adults with acute major bleeding. The drug suppressed anti-Factor Xa activity within hours of infusion, and hemostasis was achieved in 80% of patients.
NEJM

Say it on rounds

When your significant other needs a text message in the middle of a busy shift

The best things come to those who wait. Unless you're caring for osteoporotic vertebral fractures, where up to 40% of patients fail supportive treatment when surgery is delayed. An RCT found that vertebroplasty doubled the rate of adequate pain control compared to sham surgery when performed within 6 weeks of fracture. At 6 months patients used less pain medication and reported improved daily activity scores.
Lancet

When you stay for another drink the night before you're on call

Separating risk from benefit is tough when you're on service. The same goes for aspirin therapy after GI bleeds, where a retrospective study of 300 patients found that aspirin users had a higher rate of GI bleeding than non-aspirin users (19% vs 7%) five years after the initial bleed. The aspirin users, however, had fewer cardiovascular events (22% vs 37%) and deaths from other causes.
Gastroenterology

Brush up

Cirrhosis

All forms of chronic liver injury lead to cirrhosis, an irreversible fibrosis of the liver. The big four causes are hepatitis B, hepatitis C, alcoholism, and nonalcoholic steatohepatitis (NASH), with NASH rising in prominence as nationwide obesity levels spiral out of control. Signs of decompensation include ascites, hepatic encephalopathy, variceal hemorrhage, hepatorenal syndrome, and spontaneous bacterial peritonititis (SBP). 

What's the evidence

For prompt paracentesis in the setting of suspected SBP? Delayed paracentesis, defined as paracentesis > 12 hours after admission, was associated with a 2.7x higher mortality risk than early paracentesis in a 2014 study of cirrhotics with confirmed SBP. If you have any reason to suspect SBP (think: admission for decompensated cirrhosis) in a patient with a tappable fluid pocket, stick a needle in before shift change. 

What your neuro friends are talking about

Take a look at the journal Science if you're curious about neural mechanisms for lexical processing in dogs. But if you just want to see wonder-pups on their best behavior in MRI scanners, check out here. And here. And here.

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