APR 15, 2016


The story

Medical news looks a lot like the Sci-Fi channel this week, as researchers are using technology to make magic happen all over the body.


A 24-year-old quadriplegic gained partial motor control over his right hand after researchers implanted an electrode in his brain. The electrode reads neuronal activity and sends it to an electrical stimulation system connected to the patient's right arm, bypassing his nerves.


Traditional fixes to esophageal defects don't work well and have high complication rates. To replace a large esophageal defect in a 24-year-old man, researchers covered a metal stent in a mixture of extracellular matrix, muscle, and platelet rich plasma gel. The stent was removed after three years, and the neo-esophagus looks like the real thing on endoscopy, biopsy, and others. 


The world's first successful penis transplant was done in 2014 in South Africa, and as of writing has made at least one person pregnant. Now, US surgeons are planning to bring the procedure stateside to help veterans who've suffered tough-to-think-about injuries on the battlefield. Finding willing donors remains a large barrier, but there's hope that the tissue can one day be grown in lab.

The takeaway

Grab on (ok, maybe not the best choice of words) to the tissue regeneration and advanced transplant wave. It's shaping up quickly.

Say it on rounds

When your head hurts after a long night out

Try aspirin. The USPSTF offered similar advice this week for adults aged 50 - 59 with a > 10% 10-year risk of cardiovascular disease. For patients in the 60 - 69 age group, the panel recommends daily aspirin use as an individual patient decision that factors in bleeding risk. Because aspirin's benefits are seen with long-term use but risk of bleeding is immediate, aspirin should only be be given to patients who are likely to take the medicine for 10 years or more.

When the data in your chart review slows your laptop to a crawl

You're only scratching the surface. Researchers measured the BMIs of 2.3 million Israeli teenagers upon enrollment in the military and matched them to causes of premature death over 40 years. Teenagers in the US-defined 50th to 75th percentile of BMI were 1.5x more likely to die from cardiovascular disease than a skinnier reference group (BMI 5th to 25th percentile), prompting concern that even an upper-normal BMI may be unhealthy in adolescents.

When you mix up the names of your patients and co-workers

Sometimes the brain just doesn’t work like it’s supposed to. The same could be said for the immune system in sepsis, where a new gene expression study shows evidence of acquired immune dysfunction during critical illness. The large cohort study performed on ICU patients in the Netherlands found that ICU-acquired infections were more frequent and severe in patients who were more severely ill upon admission.

When the X-Ray tech takes a prolonged coffee break

Don't sweat it. A retrospective chart review of over 1,300 adults who underwent ultrasound-guided right internal jugular vein catheterization found an overall success rate of 97%, while the rate of catheter misplacement was about 1%. The authors suggest that routine CXR may be unnecessary, especially if it delays the management of critically ill patients. 
Crit Care Med

Brush up

Anti-coagulation in a-fib

The CHA2DS2-VASc score helps clinicians choose whether or not to anti-coagulate patients with atrial fibrillation. Congestive heart failure, hypertension, age > 65, vascular disease, and diabetes score one point each. Add another point for age > 75 years and female sex, and two points for a prior stroke. All patients with a score of 2 or greater should be started on an oral anticoagulant to prevent cardioembolic stroke.

What's the evidence

For anti-platelet therapy in patients with a-fib and cardiac stents? The 2013 WOEST trial examined aspirin and plavix (aka triple therapy) vs. plavix only following PCI in patients already on warfarin. The risk of bleeding was significantly higher in the triple therapy group, while the rates of in-stent restenosis and need for revascularization were similar. AHA guidelines now recommend ditching aspirin if your patient has the fib and needs a stent. 

What your tech friends are talking about

Sean Parker of Napster and Facebook fame is pouring some of his mega-millions – $250 mil, to be exact – into cancer immunotherapy research at 6 academic medical centers. The structure of the gift is designed to help the institutions share research and collaborate.

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