Research Spotlight

McLean, H. Q., H. Caspard, M. R. Griffin, K. A. Poehling, M. Gaglani, E. A. Belongia, H. K. Talbot, T. R. Peters, K. Murthy and C. S. Ambrose (2017). “Effectiveness of live attenuated influenza vaccine and inactivated influenza vaccine in children during the 2014-2015 season.” Vaccine 35(20): 2685-2693.

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BACKGROUND: A clinical study found that live attenuated influenza vaccine (LAIV) was superior to inactivated influenza vaccine (IIV) against drifted A(H3N2) viruses in children. During the 2014-2015 influenza season, widespread circulation of antigenically and genetically drifted A(H3N2) viruses provided an opportunity to evaluate subtype-specific vaccine effectiveness (VE) of quadrivalent LAIV (LAIV4) and IIV in children. METHODS: Children (2-17years) with febrile acute respiratory illness <5days' duration were enrolled at 4 outpatient sites in the United States during the 2014-2015 influenza season. Nasal swabs were tested for influenza by reverse transcription polymerase chain reaction; vaccination dates were obtained from medical records or immunization registries. VE was estimated using a test-negative design comparing odds of vaccination among influenza cases and test-negative controls with adjustment for potential confounders. RESULTS: Among 1696 children enrolled, 1511 (89%) were included in the analysis. Influenza was detected in 427 (28%) children; 317 had influenza A(H3N2) and 110 had influenza B. Most influenza isolates were characterized as a drifted strain of influenza A(H3N2) or a drifted strain of B/Yamagata. For LAIV4, adjusted VE was 50% (95% confidence interval [CI], 27-66%) against any influenza, 30% (95% CI, -6% to 54%) against influenza A(H3N2), and 87% (95% CI, 63-96%) against type B. For IIV, adjusted VE was 39% (95% CI, 18-54%) against any influenza, 40% (95% CI, 16-58%) against A(H3N2), and 29% (95% CI, -15% to 56%) against type B. Odds of influenza for LAIV4 versus IIV recipients were similar against influenza A(H3N2) (odds ratio [OR], 1.17; 95% CI, 0.73-1.86) and lower against influenza B (OR, 0.18; 95% CI, 0.06-0.55). CONCLUSIONS: LAIV4 and IIV provided similar protection against a new antigenic variant A(H3N2). LAIV4 provided significantly greater protection than IIV against a drifted influenza B strain.

O’Hair, D. P., T. K. Bajwa, S. J. Chetcuti, G. M. Deeb, R. C. Stoler, R. F. Hebeler, B. Maini, M. Mumtaz, N. S. Kleiman, M. J. Reardon, S. Li, D. H. Adams, D. R. Watson, S. J. Yakubov, J. J. Popma and G. Petrossian (2017). “One-year outcomes of transcatheter aortic valve replacement in patients with end-stage renal disease.” Ann Thorac Surg 103(5): 1392-1398.

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BACKGROUND: End-stage renal disease (ESRD) poses unique challenges in the treatment of patients with severe aortic stenosis. Although surgical valve replacement in ESRD patients has been associated with increased mortality, the outcomes from transcatheter aortic valve replacement (TAVR) are not clearly defined. METHODS: The CoreValve US Expanded Use Study is a prospective, nonrandomized study of TAVR in extreme-risk patients with comorbidities excluding them from the Pivotal Trial. We report on patients with ESRD. The primary endpoint was a composite of all-cause mortality or major stroke at 1 year. RESULTS: Ninety-six patients with ESRD underwent TAVR with the CoreValve (Medtronic, Minneapolis, MN) and have reached 1-year follow-up. Mean Society of Thoracic Surgeons Predicted Risk of Mortality score was 16.2% +/- 8.4%. The rate of all-cause mortality or major stroke at 1 year was 30.3%. The all-cause mortality rate was 5.3% at 30 days and 30.3% at 1 year. The rate at 1 year of any stroke or transient ischemic attack was 2.1%; major vascular injury was 5.2%; and new permanent pacemaker was 26.8%. Valve performance improved postprocedure and remained improved at 1 year (effective orifice area 1.71 cm2, mean gradient 9.33 mm Hg) CONCLUSIONS: Early mortality in patients with ESRD is comparable to previously published data on extreme-risk patients without ESRD, but our data suggest a higher mortality rate at 1 year for ESRD patients, likely due to comorbid conditions. Stroke and major vascular injury are infrequent, and improved valve hemodynamics are maintained at 1 year.

Kron, I. L., D. J. LaPar, M. A. Acker, D. H. Adams, G. Ailawadi, S. F. Bolling, J. W. Hung, D. S. Lim, M. J. Mack, P. T. O’Gara, M. K. Parides and J. D. Puskas (2017). “2016 update to the american association for thoracic surgery consensus guidelines: Ischemic mitral valve regurgitation.” J Thorac Cardiovasc Surg 153(5): 1076-1079.

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We are very pleased to update The American Association for Thoracic Surgery (AATS) Consensus Guidelines on ischemic mitral valve regurgitation (IMR) (Figure 1). These Guidelines were developed based on the results of published randomized clinical trials, large observational studies, and the expert opinion of the authors. Subsequent to the publication of the 2015 AATS IMR Guidelines,1 the 2-year follow-up results of the Cardiothoracic Surgical Trials Network (CTSN) severe and moderate ischemic mitral regurgitation (MR) trials were published.2,3

Testa, G., E. C. Koon, L. Johannesson, G. McKenna, T. Anthony, G. B. Klintmalm, R. T. Gunby, Jr., A. M. Warren, J. M. Putman, G. dePrisco, J. M. Mitchell, K. Wallis and M. Olausson (2017). “Living donor uterus transplantation: A single center’s observations and lessons learned from early setbacks to technical success.” Am J Transplant: Apr [Epub ahead of print].

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Uterus transplantation is a vascularized composite allograft transplantation. It allows women who do not have a uterus to become pregnant and deliver a baby. In this paper we analyze the first 5 cases of Living Donor Uterus Transplantation performed in the US. The first 3 recipients lost their uterus grafts at day 14, 12 and 6 after transplant. Vascular complications, related to both inflow and outflow problems, were identified as the primary reason for the graft losses. Two recipients, 6 and 3 months post-transplant have functioning grafts with regular menstrual cycles. Ultimate success will be claimed only after a live birth. This paper is an in-depth analysis of evaluation, surgical technique and follow-up of these five living donor uterus transplants. The lessons learned were instrumental in allowing us to evolve from failure to technical and functional success. We aim to share our conclusions and build on the knowledge in the evolving field of uterus transplantation.

Schiller, L. R. (2017). “Antidiarrheal drug therapy.” Curr Gastroenterol Rep 19(5): 18.

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INTRODUCTION: Acute diarrhea often runs a self-limited course and little by way of treatment is needed except for oral rehydration therapy. Chronic diarrhea poses a longer-term problem. If not treatable with specific therapy aimed at the underlying pathophysiology, chronic diarrhea often needs long-term symptomatic therapy. PURPOSE OF REVIEW: This paper aims to examine the options for symptomatic, nonspecific treatment of diarrhea. RECENT FINDINGS: The most frequently used therapies are opiate antidiarrheal drugs. These drugs are effective for a wide variety of diarrheal conditions and generally can be used safely if monitored closely. They work by slowing motility and allowing more time for absorption. They vary in potency and in addictive liability. In recent years, a variety of other drugs have been developed, which provide more targeted therapy that can mitigate diarrhea in specific situations. These drugs work on other regulatory pathways in the gut or on mucosal absorptive mechanisms. There is evidence for efficacy for both traditional and newer agents used for the symptomatic management of diarrhea. Opiates are used most often for this indication. Other agents may benefit individuals, but further research is needed to establish indications and best practices.