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Abstract Background and Objective: One of the main causes of increased mortality in cancer patients is bacteremia. On the other hand, antibiotic resistance is the major cause of treatment failure in malignant diseases especially in hematological malignancies. The aim of this study was to diagnose the bacterial strains isolated from blood specimens of cancer patients and to determine their antibiotic susceptibility. Material and Methods: In this cross-sectional study, 0.5 ml of venous blood was taken from 613 cancer patients especially leukemia, and blood cultures and antibiotic susceptibility tests were performed using standard methods. Using disc diffusion method, antibiotic susceptibility was performed with a wide range of antibiotics. Results: Out of 613 cultured specimens, 153 (25%) were found to be positive including 76.47% of gram negative and 23.53% of gram positive bacteria. The most common isolated bacteria were E. coli, coagulase-negative Staphylococci, Klebsiella, Staphylococcus aureus and Pseudomonas aeroginosa, respectively. Conclusion: It seems that Ceftriaxone is the best choice for the treatment of gram negative caused bacteremia and Gentamicin for bacteremia caused by gram positive agents. Given the high level of resistance to the commonly used antibiotics, it seems reasonable to avoid of early and inappropriate use of antibiotics to prevent the development of drug resistant bacteria. Keywords: Cancer, Blood Cultures, Bacteremia, Antibiotic Resistance

Background and Objective: One of the main causes of increased mortality in cancer patients is bacteremia. On the other hand, antibiotic resistance is the major cause of treatment failure in malignant diseases especially in hematological malignancies. The aim of this study was to diagnose the bacterial strains isolated from blood specimens of cancer patients and to determine their antibiotic susceptibility. Material and Methods: In this cross-sectional study, 0.5 ml of venous blood was taken from 613 cancer patients especially leukemia, and blood cultures and antibiotic susceptibility tests were performed using standard methods. Using disc diffusion method, antibiotic susceptibility was performed with a wide range of antibiotics. Results: Out of 613 cultured specimens, 153 (25%) were found to be positive including 76.47% of gram negative and 23.53% of gram positive bacteria. The most common isolated bacteria were E. coli, coagulase-negative Staphylococci, Klebsiella, Staphylococcus aureus and Pseudomonas aeroginosa, respectively. Conclusion: It seems that Ceftriaxone is the best choice for the treatment of gram negative caused bacteremia and Gentamicin for bacteremia caused by gram positive agents. Given the high level of resistance to the commonly used antibiotics, it seems reasonable to avoid of early and inappropriate use of antibiotics to prevent the development of drug resistant bacteria. [ABSTRACT FROM AUTHOR]

Background: The task of writing structured content reviews and guidelines has grown stronger and more complex. We propose to go beyond search tools and toward curation tools by automating time-consuming and repetitive steps of extracting and organizing information., Methods: SciScribe is built as an extension of IBM's Deep Search platform, which provides document processing and search capabilities. This platform was used to ingest and search full-content publications from PubMed Central (PMC) and official, structured records from the ClinicalTrials and OpenPayments databases. Author names and NCT numbers, mentioned within the publications, were used to link publications to these official records as context. Search strategies involve traditional keyword-based search as well as natural language question and answering via large language models (LLMs)., Results: SciScribe is a web-based tool that helps accelerate literature reviews through key features: (1) accumulating a personal collection from publication sources, such as PMC or other sources; (2) incorporating contextual information from external databases into the presented papers, promoting a more informed assessment by readers; (3) semantic questioning and answering of documents to quickly assess relevance and hierarchical organization; and (4) semantic question answering for each document within a collection, collated into tables., Conclusions: Emergent language processing techniques are opening new avenues to accelerate and enhance the literature review process, for which we have demonstrated a use case implementation in cardiac surgery. SciScribe automates and accelerates this process, mitigates errors associated with repetition and fatigue, and contextualizes results by linking relevant external data sources instantaneously., Competing Interests: Conflict of Interest Statement The authors reported no conflicts of interest. The Journal policy requires editors and reviewers to disclose conflicts of interest and to decline handling or reviewing manuscripts for which they may have a conflict of interest. The editors and reviewers of this article have no conflicts of interest., (Copyright © 2024 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.)

Objective: Patients are increasingly using the internet to obtain health care information. US News and World Report Best Hospital rankings received more than 103 million views in 2021. Considering 21% of thoracic surgery patients are minorities, 27.9% are in the bottom quartile of household income, and 70% have Medicare/Medicaid or no insurance, online patient educational materials (PEMs) should be accessible and written at a level easily understood by majority of patients. We performed a comprehensive analysis of readability of websites containing patient-centered resources across all adult thoracic surgery areas., Methods: Online PEMs on thoracic surgical procedures were collected from top 50 hospitals for pulmonology and lung surgery ranked by US News and World Report Best Hospital as of December 1, 2021. Text pertaining to thoracic surgical procedures was collected and divided into 4 procedural genres: esophageal, lung, transplant procedures, and other. Texts were analyzed using OleanderSoftware's Readability Suite through the Raygor readability test., Results: Three hundred seventy-two articles met criteria for analysis. Websites were difficult to read; mean (standard deviation) readability score for all content required a 13.9 (3.6) grade level for comprehension. The mean (standard deviation) readability for esophageal, lung, lung transplant, and other surgeries were 14.5 (3.6), 13.1 (3.6), 11.5 (3.9), and 13.4 (3.7), respectively., Conclusions: Online PEMs required at least a college reading level to comprehend, well exceeding the sixth-grade level recommended by the American Medical Association. As digital health becomes increasingly relevant, improving the readability of online PEMs in adult cardiac surgery will facilitate equitable access to high-quality care., Competing Interests: Conflict of Interest Statement The authors reported no conflicts of interest. The Journal policy requires editors and reviewers to disclose conflicts of interest and to decline handling or reviewing manuscripts for which they may have a conflict of interest. The editors and reviewers of this article have no conflicts of interest., (Copyright © 2024 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.)

Objective: Anterior mitral anular calcification, particularly in radiation heart disease, and previous valve replacement with destroyed intervalvular fibrosa are challenging for prosthesis sizing and placement. The Commando procedure with intervalvular fibrosa reconstruction permits double-valve replacement in these challenging conditions. We referenced outcomes after Commando procedures to standard double-valve replacements., Methods: From January 2011 to January 2022, 129 Commando procedures and 1191 aortic and mitral double-valve replacements were performed at the Cleveland Clinic, excluding endocarditis. Reasons for the Commando were severe calcification after radiation (n = 67), without radiation (n = 43), and others (n = 19). Commando procedures were referenced to a subset of double-valve replacements using balancing-score methods (109 pairs)., Results: Between balanced groups, Commando versus double-valve replacement had higher total calcium scores (median 6140 vs 2680 HU, P  = .03). Hospital outcomes were similar, including operative mortality (12/11% vs 8/7.3%, P  = .35) and reoperation for bleeding (9/8.3% vs 5/4.6%, P  = .28). Survival and freedom from reoperation at 5 years were 54% versus 67% ( P  = .33) and 87% versus 100% ( P  = .04), respectively. Higher calcium score was associated with lower survival after double-valve replacement but not after the Commando. The Commando procedure had lower aortic valve mean gradients at 4 years (9.4 vs 11 mm Hg, P  = .04). After Commando procedures for calcification, 5-year survival was 60% and 59% with and without radiation, respectively ( P  = .47)., Conclusions: The Commando procedure with reconstruction of the intervalvular fibrosa destroyed by mitral anular calcification, radiation, or previous surgery demonstrates acceptable outcomes similar to standard double-valve replacement. More experience and long-term outcomes are required to refine patient selection for and application of the Commando approach., Competing Interests: The authors reported no conflicts of interest. The Journal policy requires editors and reviewers to disclose conflicts of interest and to decline handling or reviewing manuscripts for which they may have a conflict of interest. The editors and reviewers of this article have no conflicts of interest., (© 2023 The Author(s).)

Objectives: Identifying the optimal solution for young adults requiring aortic valve replacement (AVR) is challenging, given the variety of options and their lifetime complication risks, impacts on quality of life, and costs. Decision analytic techniques make comparisons incorporating these measures. We evaluated lifetime valve-related outcomes of mechanical aortic valve replacement (mAVR) versus the Ross procedure (Ross) using decision tree microsimulations modeling., Methods: Transition probabilities, utilities, and costs derived from published reports were entered into a Markov model decision tree to explore progression between health states for hypothetical 18-year-old patients. In total, 20,000 Monte Carlo microsimulations were performed to model mortality, quality-adjusted-life-years (QALYs), and health care costs. The incremental cost-effectiveness ratio (ICER) was calculated. Sensitivity analyses was performed to identify transition probabilities at which the preferred strategy switched from baseline., Results: From modeling, average 20-year mortality was 16.3% and 23.2% for Ross and mAVR, respectively. Average 20-year freedom from stroke and major bleeding was 98.6% and 94.6% for Ross, and 90.0% and 82.2% for mAVR, respectively. Average individual lifetime (60 postoperative years) utility (28.3 vs 23.5 QALYs) and cost ($54,233 vs $507,240) favored Ross over mAVR. The average ICER demonstrated that each QALY would cost $95,345 more for mAVR. Sensitivity analysis revealed late annual probabilities of autograft/left ventricular outflow tract disease and homograft/right ventricular outflow tract disease after Ross, and late death after mAVR, to be important ICER determinants., Conclusions: Our modeling suggests that Ross is preferred to mAVR, with superior freedom from valve-related morbidity and mortality, and improved cost-utility for young adults requiring aortic valve surgery., Competing Interests: T.K. serves as a consultant for Edwards Lifesciences. All other authors reported no conflicts of interest. The Journal policy requires editors and reviewers to disclose conflicts of interest and to decline handling or reviewing manuscripts for which they may have a conflict of interest. The editors and reviewers of this article have no conflicts of interest., (© 2023 The Author(s).)

Background: Relationships between pulmonary hypertension (PHTN), mitral valve intervention (MVI), and death among patients with Shone's syndrome (SS) are unclear. Our recent data suggested temporal progression of MV disease and early survival benefit with MVI at initial operation. In this expanded cohort, we characterized trajectory and impact of PHTN on survival, and its relationship to MVI(s)., Methods: Record review of 219 SS patients undergoing operation at our quaternary center between 1956-2022, 111 of whom were pediatric (< age 18 yrs.). Patients were determined to have PHTN using a time-defined hierarchical algorithm consisting of cardiac catheterization data, echocardiographic parameters, pulmonary vasodilator therapy, and record-verified PHTN diagnosis. Analysis includes risk-adjusted predicted survival and freedom from PHTN curves stratified by MVI timing., Results: Among 219 patients, 92 (43%) had mitral valve stenosis on presentation, with mean gradients of 3.5 (IQR 4.7). Sixty patients had at least one MVI (15 (6%) and 8 (3%) had 3 or more). Median follow-up was 19 years (IQR 29) with 18 (8%) deaths. Ninety-three (42%) patients developed PHTN, with 50% and 25% freedom from PHTN at 37 and 51 years from presentation. PHTN was strongly associated with death (p <0.001). In unadjusted analyses, MVI, even if successive, delayed the onset of PHTN at 10 years and improved survival (p<0.001). However, this protective effect was lost after risk-adjustment., Conclusions: PHTN development in SS is progressive and mirrors the survival curve, suggesting it is a major mortality risk-factor. Salutary effects of early and/or successive MVI are reduced after risk-adjustment., (Copyright © 2023. Published by Elsevier Inc.)

Objective: Increasing use of bioprostheses for surgical aortic valve replacement (SAVR) in younger patients, together with wider use of transcatheter aortic valve replacement, necessitates understanding risks associated with surgical valve reintervention. Therefore, we sought to identify risks of reoperative SAVR compared with those of primary isolated SAVR., Methods: From January 1980 to July 2017, 7037 patients underwent nonemergency isolated SAVR, with 753 reoperations and 6284 primary isolated operations. These 2 groups were propensity score-matched on 46 preoperative variables, yielding 581 patient pairs for comparing outcomes., Results: Among propensity score-matched patients, aortic clamp time (median 63 vs 52 minutes; P < .0001), cardiopulmonary bypass time (median 88 vs 67 minutes; P < .0001), and postoperative stay (median 7.1 vs 6.9 days; P = .003) were longer for reoperative SAVR than primary isolated SAVR. Hospital mortality after reoperative SAVR decreased from 3.4% in 1985 to 1.3% in 2011, similar to that of primary isolated SAVR. Occurrence of stroke, deep sternal wound infection, and new renal dialysis was similar. Blood transfusion (67% vs 36%; P < .0001) and reoperations for bleeding/tamponade (6.4% vs 3.1%; P = .009) were more common after reoperative SAVR. Survival at 1, 5, 10, and 20 years was 94%, 82%, 64%, and 33% after reoperative SAVR and 95%, 86%, 72%, and 46% after elective primary isolated SAVR., Conclusions: Risk of mortality and morbidity after reoperative SAVR has declined and is now similar to that of primary isolated SAVR. Decisions regarding prosthesis choice and SAVR versus transcatheter aortic valve replacement should be made in the context of lifelong disease management rather than avoidance of reoperation., (Copyright © 2022 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.)

Objectives: Guidelines suggest aortic valve replacement (AVR) for low-risk asymptomatic patients. Indications for transcatheter AVR now include low-risk patients, making it imperative to understand state-of-the-art surgical AVR (SAVR) in this population. Therefore, we compared SAVR outcomes in low-risk patients with those expected from Society of Thoracic Surgeons (STS) models and assessed their intermediate-term survival., Methods: From January 2005 to January 2017, 3493 isolated SAVRs were performed in 3474 patients with STS predicted risk of mortality <4%. Observed operative mortality and composite major morbidity or mortality were compared with STS-expected outcomes according to calendar year of surgery. Logistic regression analysis was used to identify risk factors for these outcomes. Patients were followed for time-related mortality., Results: With 15 observed operative deaths (0.43%) compared with 55 expected (1.6%), the observed:expected ratio was 0.27 for mortality (95% confidence interval [CI], 0.14-0.42), stroke 0.65 (95% CI, 0.41-0.89), and reoperation 0.50 (95% CI, 0.42-0.60). Major morbidity or mortality steadily declined, with probabilities of 8.6%, 6.7%, and 5.2% in 2006, 2011, and 2016, respectively, while STS-expected risk remained at approximately 12%. Mitral valve regurgitation, ventricular hypertrophy, pulmonary, renal, and hepatic failure, coronary artery disease, and earlier surgery date were residual risk factors. Survival was 98%, 91%, and 82% at 1, 5, and 9 years, respectively, superior to that predicted for the US age-race-sex-matched population., Conclusions: STS risk models overestimate contemporary SAVR risk at a high-volume center, supporting efforts to create a more agile quality assessment program. SAVR in low-risk patients provides durable survival benefit, supporting early surgery and providing a benchmark for transcatheter AVR., (Copyright © 2021 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.)

We read with interest the authors' review and metanalysis of the Commando procedure in "Surgical Aortic Mitral Curtain Replacement: Systematic Review and Metanalysis of Early and Long-Term Results" [...].