In patients with multiple myeloma who were treated with at least three prior therapies (median five), daratumumab demonstrated substantial clinical activity and was well tolerated, investigators reported in the Lancet.

Overall response rates were observed in 31 of 106 people (ORR 29.2%; 95% confidence interval, 20.8-38.9), stringent complete responses in 3, and very good partial responses in 10 people. In total, 87 patients (82%) had received more than three lines of therapy: all patients had been treated previously with proteasome inhibitors and immunomodulatory drugs, and dexamethasone. In addition, 103 (97%) were refractory to the last line of therapy before study enrollment, and 95% were refractory to the most recent proteasome inhibitors and immunomodulatory drugs.

“Resistance to any previous therapy had no effect on the activity of daratumumab, lending support to a novel mechanism of action, but these findings need to be confirmed in larger studies,” wrote Dr. Sagar Lonial, executive vice chair of the department of hematology medical oncology, Emory University, Atlanta, and colleagues (Lancet. 2016 Jan 7. doi: 10.1016/S0140-6736[15]01120-4).

Daratumumab was well tolerated. The most common hematologic treatment-emergent adverse events of any grade were anemia (33%), thrombocytopenia (25%), and neutropenia (23%). The overall favorable safety profile makes it a promising candidate for combination regimens, and the monoclonal IgG1 antibody has shown early activity in combination with lenalidomide and dexamethasone, according to the researchers.

The open-label, multicenter, phase II trial included 106 patients who received daratumumab 16 mg/kg. The median time since initial diagnosis was 4.8 years (1.1-23.8 years), median number of previous therapies was 5 (2-14), and 80% of patients had received autologous stem cell transplantation.

In patients with multiple myeloma who were treated with at least three prior therapies (median five), daratumumab demonstrated substantial clinical activity and was well tolerated, investigators reported in the Lancet.

Overall response rates were observed in 31 of 106 people (ORR 29.2%; 95% confidence interval, 20.8-38.9), stringent complete responses in 3, and very good partial responses in 10 people. In total, 87 patients (82%) had received more than three lines of therapy: all patients had been treated previously with proteasome inhibitors and immunomodulatory drugs, and dexamethasone. In addition, 103 (97%) were refractory to the last line of therapy before study enrollment, and 95% were refractory to the most recent proteasome inhibitors and immunomodulatory drugs.

“Resistance to any previous therapy had no effect on the activity of daratumumab, lending support to a novel mechanism of action, but these findings need to be confirmed in larger studies,” wrote Dr. Sagar Lonial, executive vice chair of the department of hematology medical oncology, Emory University, Atlanta, and colleagues (Lancet. 2016 Jan 7. doi: 10.1016/S0140-6736[15]01120-4).

Daratumumab was well tolerated. The most common hematologic treatment-emergent adverse events of any grade were anemia (33%), thrombocytopenia (25%), and neutropenia (23%). The overall favorable safety profile makes it a promising candidate for combination regimens, and the monoclonal IgG1 antibody has shown early activity in combination with lenalidomide and dexamethasone, according to the researchers.

The open-label, multicenter, phase II trial included 106 patients who received daratumumab 16 mg/kg. The median time since initial diagnosis was 4.8 years (1.1-23.8 years), median number of previous therapies was 5 (2-14), and 80% of patients had received autologous stem cell transplantation.

In patients with multiple myeloma who were treated with at least three prior therapies (median five), daratumumab demonstrated substantial clinical activity and was well tolerated, investigators reported in the Lancet.

Overall response rates were observed in 31 of 106 people (ORR 29.2%; 95% confidence interval, 20.8-38.9), stringent complete responses in 3, and very good partial responses in 10 people. In total, 87 patients (82%) had received more than three lines of therapy: all patients had been treated previously with proteasome inhibitors and immunomodulatory drugs, and dexamethasone. In addition, 103 (97%) were refractory to the last line of therapy before study enrollment, and 95% were refractory to the most recent proteasome inhibitors and immunomodulatory drugs.

“Resistance to any previous therapy had no effect on the activity of daratumumab, lending support to a novel mechanism of action, but these findings need to be confirmed in larger studies,” wrote Dr. Sagar Lonial, executive vice chair of the department of hematology medical oncology, Emory University, Atlanta, and colleagues (Lancet. 2016 Jan 7. doi: 10.1016/S0140-6736[15]01120-4).

Daratumumab was well tolerated. The most common hematologic treatment-emergent adverse events of any grade were anemia (33%), thrombocytopenia (25%), and neutropenia (23%). The overall favorable safety profile makes it a promising candidate for combination regimens, and the monoclonal IgG1 antibody has shown early activity in combination with lenalidomide and dexamethasone, according to the researchers.

The open-label, multicenter, phase II trial included 106 patients who received daratumumab 16 mg/kg. The median time since initial diagnosis was 4.8 years (1.1-23.8 years), median number of previous therapies was 5 (2-14), and 80% of patients had received autologous stem cell transplantation.

Clinical question: Does an early invasive strategy for acute coronary syndrome improve short-term outcomes?

Bottom line: According to this real-world observational study, an early invasive strategy—coronary angiogram within 72 hours of presentation—is associated with lower risks of short-term cardiac death and rehospitalization for myocardial infarction (MI). However, this inference may not be valid because of a lack of key clinical information that may have influenced the data. (LOE = 2b-)

Reference: Hansen KW, Sorensen R, Madsen M, et al. Effectiveness of an early versus a conservative invasive treatment strategy in acute coronary syndromes. Ann Intern Med. 2015;163(10):737-746.

Study design: Cohort (retrospective)

Funding source: Foundation

Allocation: Uncertain

Setting: Inpatient (any location) with outpatient follow-up

Synopsis: Using data from a Danish national registry, these investigators included patients aged 30 years to 90 years who were hospitalized with a first episode of unstable angina or acute MI. Patients were identified as having had an early invasive strategy (diagnostic coronary angiogram within 72 hours of hospitalization) or a conservative invasive strategy (coronary angiogram after 72 hours or no angiogram). The primary outcome was cardiac death or rehospitalization for MI within 60 days.

The investigators used propensity score matching to balance the baseline characteristics of the 2 groups in the initial cohort of 54,000 patients, resulting in 9852 matched patient-pairs. Notably, 42% of the conservative-strategy patients in the propensity-matched cohort received no cardiac catheterization. Overall, treatment with an early invasive strategy was associated with lower risks of cardiac death (5.9% vs 7.6%; number needed to treat [NNT] = 59; P < .001), all-cause death (7.3% vs 10.6%; NNT = 30; P < .001), and rehospitalization for MI (3.4% vs 5%; NNT = 63; P < .001).

However, as an accompanying editorial suggests, the causal inference is not necessarily valid. Given the use of an administrative database, the investigators lacked important clinical information, including indications for the angiograms performed, troponin levels, ejection fractions, and electrocardiogram findings. Without these key data, it is difficult to say whether they were comparing apples to apples, even after propensity score matching. Additionally, the study really just measures the timing of the initial angiogram without taking into account procedures done later that may have affected outcomes. As such, the validity of this study is questionable and, although the results agree with previous randomized clinical trial outcomes, it neither strengthens nor weakens what is already known.

Dr. Kulkarni is an assistant professor of hospital medicine at Northwestern University in Chicago.

Clinical question: Does an early invasive strategy for acute coronary syndrome improve short-term outcomes?

Bottom line: According to this real-world observational study, an early invasive strategy—coronary angiogram within 72 hours of presentation—is associated with lower risks of short-term cardiac death and rehospitalization for myocardial infarction (MI). However, this inference may not be valid because of a lack of key clinical information that may have influenced the data. (LOE = 2b-)

Reference: Hansen KW, Sorensen R, Madsen M, et al. Effectiveness of an early versus a conservative invasive treatment strategy in acute coronary syndromes. Ann Intern Med. 2015;163(10):737-746.

Study design: Cohort (retrospective)

Funding source: Foundation

Allocation: Uncertain

Setting: Inpatient (any location) with outpatient follow-up

Synopsis: Using data from a Danish national registry, these investigators included patients aged 30 years to 90 years who were hospitalized with a first episode of unstable angina or acute MI. Patients were identified as having had an early invasive strategy (diagnostic coronary angiogram within 72 hours of hospitalization) or a conservative invasive strategy (coronary angiogram after 72 hours or no angiogram). The primary outcome was cardiac death or rehospitalization for MI within 60 days.

The investigators used propensity score matching to balance the baseline characteristics of the 2 groups in the initial cohort of 54,000 patients, resulting in 9852 matched patient-pairs. Notably, 42% of the conservative-strategy patients in the propensity-matched cohort received no cardiac catheterization. Overall, treatment with an early invasive strategy was associated with lower risks of cardiac death (5.9% vs 7.6%; number needed to treat [NNT] = 59; P < .001), all-cause death (7.3% vs 10.6%; NNT = 30; P < .001), and rehospitalization for MI (3.4% vs 5%; NNT = 63; P < .001).

However, as an accompanying editorial suggests, the causal inference is not necessarily valid. Given the use of an administrative database, the investigators lacked important clinical information, including indications for the angiograms performed, troponin levels, ejection fractions, and electrocardiogram findings. Without these key data, it is difficult to say whether they were comparing apples to apples, even after propensity score matching. Additionally, the study really just measures the timing of the initial angiogram without taking into account procedures done later that may have affected outcomes. As such, the validity of this study is questionable and, although the results agree with previous randomized clinical trial outcomes, it neither strengthens nor weakens what is already known.

Dr. Kulkarni is an assistant professor of hospital medicine at Northwestern University in Chicago.

Clinical question: Does an early invasive strategy for acute coronary syndrome improve short-term outcomes?

Bottom line: According to this real-world observational study, an early invasive strategy—coronary angiogram within 72 hours of presentation—is associated with lower risks of short-term cardiac death and rehospitalization for myocardial infarction (MI). However, this inference may not be valid because of a lack of key clinical information that may have influenced the data. (LOE = 2b-)

Reference: Hansen KW, Sorensen R, Madsen M, et al. Effectiveness of an early versus a conservative invasive treatment strategy in acute coronary syndromes. Ann Intern Med. 2015;163(10):737-746.

Study design: Cohort (retrospective)

Funding source: Foundation

Allocation: Uncertain

Setting: Inpatient (any location) with outpatient follow-up

Synopsis: Using data from a Danish national registry, these investigators included patients aged 30 years to 90 years who were hospitalized with a first episode of unstable angina or acute MI. Patients were identified as having had an early invasive strategy (diagnostic coronary angiogram within 72 hours of hospitalization) or a conservative invasive strategy (coronary angiogram after 72 hours or no angiogram). The primary outcome was cardiac death or rehospitalization for MI within 60 days.

The investigators used propensity score matching to balance the baseline characteristics of the 2 groups in the initial cohort of 54,000 patients, resulting in 9852 matched patient-pairs. Notably, 42% of the conservative-strategy patients in the propensity-matched cohort received no cardiac catheterization. Overall, treatment with an early invasive strategy was associated with lower risks of cardiac death (5.9% vs 7.6%; number needed to treat [NNT] = 59; P < .001), all-cause death (7.3% vs 10.6%; NNT = 30; P < .001), and rehospitalization for MI (3.4% vs 5%; NNT = 63; P < .001).

However, as an accompanying editorial suggests, the causal inference is not necessarily valid. Given the use of an administrative database, the investigators lacked important clinical information, including indications for the angiograms performed, troponin levels, ejection fractions, and electrocardiogram findings. Without these key data, it is difficult to say whether they were comparing apples to apples, even after propensity score matching. Additionally, the study really just measures the timing of the initial angiogram without taking into account procedures done later that may have affected outcomes. As such, the validity of this study is questionable and, although the results agree with previous randomized clinical trial outcomes, it neither strengthens nor weakens what is already known.

Dr. Kulkarni is an assistant professor of hospital medicine at Northwestern University in Chicago.

Updated guidelines regarding the treatment of patients with venous thromboembolism advise abandoning the routine use of compression stockings for prevention of postthrombotic syndrome in patients who have had an acute deep vein thrombosis, according to Dr. Clive Kearon, lead author of the American College of Chest Physicians’ 10th edition of “Antithrombotic Therapy for VTE Disease” (Chest. 2015. doi: 10.1016/j.chest.2015.11.026).

The VTE guidelines include 12 recommendations. Two other key changes from the previous guidelines include new treatment recommendations about which patients with isolated subsegmental pulmonary embolism (PE) should, and should not, receive anticoagulant therapy, and as a recommendation for the use of non–vitamin K antagonist oral anticoagulants (NOACs) instead of warfarin for initial and long-term treatment of VTE in patients without cancer.

It is another of the group’s “living guidelines,” intended to be flexible, easy-to-update recommendations … based on the best available evidence, and to identify gaps in our knowledge and areas for future research,” Dr. Kearon of McMaster University, Hamilton, Ont., said in an interview.

“Clinicians and guideline developers would like clinician decisions to be supported by very strong, or almost irrefutable, evidence,” he said. ”It’s difficult to do studies that provide irrefutable evidence, however,” and most of the updated recommendations are not based on the highest level of study evidence – large, randomized controlled trials.

Nevertheless, “the quality of evidence that supports guidelines and clinical decision making is much better now than it was 20 or 30 years ago,” Dr. Kearon said, mainly because more recent studies are considerably larger and involve multiple clinical centers. Plus, “we’re continually improving our skills at doing high-quality studies and studies that have a low potential for bias.”

The old recommendation to use graduated compression stockings for 2 years after DVT to reduce the risk of postthrombotic syndrome was mainly based on findings of two small single-center randomized trials, published in the Lancet and Annals of Internal Medicine, in which patients and study personnel were not blinded to stocking use. Since then, a much larger multicenter, placebo-controlled trial found that routine use of graduated compression stockings did not reduce postthrombotic syndrome or have other important benefits in 410 patients with a first proximal DVT randomized to receive either active or placebo compression stockings. The incidence of postthrombotic syndrome was 14% in the active group and 13% in the placebo group – a nonsignificant difference. The same study also found that routine use of graduated compression stockings did not reduce leg pain during the 3 months after a DVT – although the stockings were still able to reduce acute symptoms of DVT, and chronic symptoms in patients with postthrombotic syndrome.

The recommendation to replace warfarin with NOACs is based on new data suggesting that the agents are associated with a lower risk of bleeding, and on observations that NOACs are much easier for patients and clinicians to use. Several of the studies upon which earlier guidelines were based have been reanalyzed, Dr. Kearon and his coauthors wrote. There are also now extensive data on the comparative safety of NOACs and warfarin.

“Based on less bleeding with NOACs and greater convenience for patients and health care providers, we now suggest that a NOAC is used in preference to VKA [vitamin K antagonist] for the initial and long-term treatment of VTE in patients without cancer,” they wrote.

The recommendation to employ watchful waiting over anticoagulation in some patients with subsegmental pulmonary embolism is based on a compendium of clinical evidence rather than on large studies. A true subsegmental PE is unlikely to need anticoagulation, because it will have arisen from a small clot and thus carry a small risk of progression or recurrence.

“There is, however, high-quality evidence for the efficacy and safety of anticoagulant therapy in patients with larger PE, and this is expected to apply similarly to patients with subsegmental PE,” the authors wrote. “Whether the risk of progressive or recurrent VTE is high enough to justify anticoagulation in patients with subsegmental PE is uncertain.”

If clinical assessment suggests that anticoagulation isn’t appropriate, these patients should have a confirmatory bilateral ultrasound to rule out proximal DVTs, especially in high-risk locations. If a DVT is detected, clinicians may choose to conduct subsequent ultrasounds to identify and treat any evolving proximal clots.

The guideline has been endorsed by the American Association for Clinical Chemistry, the American College of Clinical Pharmacy, the International Society for Thrombosis and Haemostasis, and the American Society of Health-System Pharmacists.

Dr. Kearon has been compensated for speaking engagements sponsored by Boehringer Ingelheim and Bayer Healthcare related to VTE therapy. Some of the other guideline authors also disclosed relationships with pharmaceutical companies.

[email protected]

Updated guidelines regarding the treatment of patients with venous thromboembolism advise abandoning the routine use of compression stockings for prevention of postthrombotic syndrome in patients who have had an acute deep vein thrombosis, according to Dr. Clive Kearon, lead author of the American College of Chest Physicians’ 10th edition of “Antithrombotic Therapy for VTE Disease” (Chest. 2015. doi: 10.1016/j.chest.2015.11.026).

The VTE guidelines include 12 recommendations. Two other key changes from the previous guidelines include new treatment recommendations about which patients with isolated subsegmental pulmonary embolism (PE) should, and should not, receive anticoagulant therapy, and as a recommendation for the use of non–vitamin K antagonist oral anticoagulants (NOACs) instead of warfarin for initial and long-term treatment of VTE in patients without cancer.

It is another of the group’s “living guidelines,” intended to be flexible, easy-to-update recommendations … based on the best available evidence, and to identify gaps in our knowledge and areas for future research,” Dr. Kearon of McMaster University, Hamilton, Ont., said in an interview.

“Clinicians and guideline developers would like clinician decisions to be supported by very strong, or almost irrefutable, evidence,” he said. ”It’s difficult to do studies that provide irrefutable evidence, however,” and most of the updated recommendations are not based on the highest level of study evidence – large, randomized controlled trials.

Nevertheless, “the quality of evidence that supports guidelines and clinical decision making is much better now than it was 20 or 30 years ago,” Dr. Kearon said, mainly because more recent studies are considerably larger and involve multiple clinical centers. Plus, “we’re continually improving our skills at doing high-quality studies and studies that have a low potential for bias.”

The old recommendation to use graduated compression stockings for 2 years after DVT to reduce the risk of postthrombotic syndrome was mainly based on findings of two small single-center randomized trials, published in the Lancet and Annals of Internal Medicine, in which patients and study personnel were not blinded to stocking use. Since then, a much larger multicenter, placebo-controlled trial found that routine use of graduated compression stockings did not reduce postthrombotic syndrome or have other important benefits in 410 patients with a first proximal DVT randomized to receive either active or placebo compression stockings. The incidence of postthrombotic syndrome was 14% in the active group and 13% in the placebo group – a nonsignificant difference. The same study also found that routine use of graduated compression stockings did not reduce leg pain during the 3 months after a DVT – although the stockings were still able to reduce acute symptoms of DVT, and chronic symptoms in patients with postthrombotic syndrome.

The recommendation to replace warfarin with NOACs is based on new data suggesting that the agents are associated with a lower risk of bleeding, and on observations that NOACs are much easier for patients and clinicians to use. Several of the studies upon which earlier guidelines were based have been reanalyzed, Dr. Kearon and his coauthors wrote. There are also now extensive data on the comparative safety of NOACs and warfarin.

“Based on less bleeding with NOACs and greater convenience for patients and health care providers, we now suggest that a NOAC is used in preference to VKA [vitamin K antagonist] for the initial and long-term treatment of VTE in patients without cancer,” they wrote.

The recommendation to employ watchful waiting over anticoagulation in some patients with subsegmental pulmonary embolism is based on a compendium of clinical evidence rather than on large studies. A true subsegmental PE is unlikely to need anticoagulation, because it will have arisen from a small clot and thus carry a small risk of progression or recurrence.

“There is, however, high-quality evidence for the efficacy and safety of anticoagulant therapy in patients with larger PE, and this is expected to apply similarly to patients with subsegmental PE,” the authors wrote. “Whether the risk of progressive or recurrent VTE is high enough to justify anticoagulation in patients with subsegmental PE is uncertain.”

If clinical assessment suggests that anticoagulation isn’t appropriate, these patients should have a confirmatory bilateral ultrasound to rule out proximal DVTs, especially in high-risk locations. If a DVT is detected, clinicians may choose to conduct subsequent ultrasounds to identify and treat any evolving proximal clots.

The guideline has been endorsed by the American Association for Clinical Chemistry, the American College of Clinical Pharmacy, the International Society for Thrombosis and Haemostasis, and the American Society of Health-System Pharmacists.

Dr. Kearon has been compensated for speaking engagements sponsored by Boehringer Ingelheim and Bayer Healthcare related to VTE therapy. Some of the other guideline authors also disclosed relationships with pharmaceutical companies.

[email protected]

Updated guidelines regarding the treatment of patients with venous thromboembolism advise abandoning the routine use of compression stockings for prevention of postthrombotic syndrome in patients who have had an acute deep vein thrombosis, according to Dr. Clive Kearon, lead author of the American College of Chest Physicians’ 10th edition of “Antithrombotic Therapy for VTE Disease” (Chest. 2015. doi: 10.1016/j.chest.2015.11.026).

The VTE guidelines include 12 recommendations. Two other key changes from the previous guidelines include new treatment recommendations about which patients with isolated subsegmental pulmonary embolism (PE) should, and should not, receive anticoagulant therapy, and as a recommendation for the use of non–vitamin K antagonist oral anticoagulants (NOACs) instead of warfarin for initial and long-term treatment of VTE in patients without cancer.

It is another of the group’s “living guidelines,” intended to be flexible, easy-to-update recommendations … based on the best available evidence, and to identify gaps in our knowledge and areas for future research,” Dr. Kearon of McMaster University, Hamilton, Ont., said in an interview.

“Clinicians and guideline developers would like clinician decisions to be supported by very strong, or almost irrefutable, evidence,” he said. ”It’s difficult to do studies that provide irrefutable evidence, however,” and most of the updated recommendations are not based on the highest level of study evidence – large, randomized controlled trials.

Nevertheless, “the quality of evidence that supports guidelines and clinical decision making is much better now than it was 20 or 30 years ago,” Dr. Kearon said, mainly because more recent studies are considerably larger and involve multiple clinical centers. Plus, “we’re continually improving our skills at doing high-quality studies and studies that have a low potential for bias.”

The old recommendation to use graduated compression stockings for 2 years after DVT to reduce the risk of postthrombotic syndrome was mainly based on findings of two small single-center randomized trials, published in the Lancet and Annals of Internal Medicine, in which patients and study personnel were not blinded to stocking use. Since then, a much larger multicenter, placebo-controlled trial found that routine use of graduated compression stockings did not reduce postthrombotic syndrome or have other important benefits in 410 patients with a first proximal DVT randomized to receive either active or placebo compression stockings. The incidence of postthrombotic syndrome was 14% in the active group and 13% in the placebo group – a nonsignificant difference. The same study also found that routine use of graduated compression stockings did not reduce leg pain during the 3 months after a DVT – although the stockings were still able to reduce acute symptoms of DVT, and chronic symptoms in patients with postthrombotic syndrome.

The recommendation to replace warfarin with NOACs is based on new data suggesting that the agents are associated with a lower risk of bleeding, and on observations that NOACs are much easier for patients and clinicians to use. Several of the studies upon which earlier guidelines were based have been reanalyzed, Dr. Kearon and his coauthors wrote. There are also now extensive data on the comparative safety of NOACs and warfarin.

“Based on less bleeding with NOACs and greater convenience for patients and health care providers, we now suggest that a NOAC is used in preference to VKA [vitamin K antagonist] for the initial and long-term treatment of VTE in patients without cancer,” they wrote.

The recommendation to employ watchful waiting over anticoagulation in some patients with subsegmental pulmonary embolism is based on a compendium of clinical evidence rather than on large studies. A true subsegmental PE is unlikely to need anticoagulation, because it will have arisen from a small clot and thus carry a small risk of progression or recurrence.

“There is, however, high-quality evidence for the efficacy and safety of anticoagulant therapy in patients with larger PE, and this is expected to apply similarly to patients with subsegmental PE,” the authors wrote. “Whether the risk of progressive or recurrent VTE is high enough to justify anticoagulation in patients with subsegmental PE is uncertain.”

If clinical assessment suggests that anticoagulation isn’t appropriate, these patients should have a confirmatory bilateral ultrasound to rule out proximal DVTs, especially in high-risk locations. If a DVT is detected, clinicians may choose to conduct subsequent ultrasounds to identify and treat any evolving proximal clots.

The guideline has been endorsed by the American Association for Clinical Chemistry, the American College of Clinical Pharmacy, the International Society for Thrombosis and Haemostasis, and the American Society of Health-System Pharmacists.

Dr. Kearon has been compensated for speaking engagements sponsored by Boehringer Ingelheim and Bayer Healthcare related to VTE therapy. Some of the other guideline authors also disclosed relationships with pharmaceutical companies.

[email protected]

March 19-20, 2016
Hilton Shanghai Hongqiao
Shanghai, China

Program Directors
Haiquan S. Chen
G. Alec Patterson
David J. Sugarbaker

Overview
Lung and esophageal disease remain a global concern as two of the deadliest issues facing patients and thoracic surgeons. The 2016 AATS Focus on Thoracic Surgery: Lung and Esophageal Cancer meeting will concentrate on the complex nature of treating both lung and esophageal disease while also discussing innovative approaches to enhancing patient care.

The two-day program features a mixture of lectures, relevant case studies, panel discussions and videos. The faculty includes local and internationally recognized experts in lung and esophageal disease, ensuring that attendees will receive insights from a broad spectrum of leaders in thoracic surgery.

View Preliminary Program

March 19-20, 2016
Hilton Shanghai Hongqiao
Shanghai, China

Program Directors
Haiquan S. Chen
G. Alec Patterson
David J. Sugarbaker

Overview
Lung and esophageal disease remain a global concern as two of the deadliest issues facing patients and thoracic surgeons. The 2016 AATS Focus on Thoracic Surgery: Lung and Esophageal Cancer meeting will concentrate on the complex nature of treating both lung and esophageal disease while also discussing innovative approaches to enhancing patient care.

The two-day program features a mixture of lectures, relevant case studies, panel discussions and videos. The faculty includes local and internationally recognized experts in lung and esophageal disease, ensuring that attendees will receive insights from a broad spectrum of leaders in thoracic surgery.

View Preliminary Program

March 19-20, 2016
Hilton Shanghai Hongqiao
Shanghai, China

Program Directors
Haiquan S. Chen
G. Alec Patterson
David J. Sugarbaker

Overview
Lung and esophageal disease remain a global concern as two of the deadliest issues facing patients and thoracic surgeons. The 2016 AATS Focus on Thoracic Surgery: Lung and Esophageal Cancer meeting will concentrate on the complex nature of treating both lung and esophageal disease while also discussing innovative approaches to enhancing patient care.

The two-day program features a mixture of lectures, relevant case studies, panel discussions and videos. The faculty includes local and internationally recognized experts in lung and esophageal disease, ensuring that attendees will receive insights from a broad spectrum of leaders in thoracic surgery.

View Preliminary Program

June 24-25, 2016
Renaissance Boston Waterfront Hotel
Boston, MA

Co-Directors
Thoralf M. Sundt, III, MD
Steven Yule, PhD

Program Committee
David J. Bunnell, PA-C, APACVS
David C. Fitzgerald, CCP, AMSECT
Jake Jaquiss, MD
M. Blair Marshall, MD
Shannon Pengel, RN
Kenneth Shann, CCP, LP, AMSECT
Marco Zenati, MD

Course Goal — The course provides members of the surgical care team with an introduction to the principles of patient safety and error management and provides them with practical tools that can be implemented in their care environment.

Target Audience — Recognizing that surgical safety is the product of the collective efforts of the entire care team, this course is directed at nurses and nurse practitioners, physician assistants, perfusionists, anesthesiologists, critical care physicians and surgeons. While the central focus is on cardiothoracic surgical care, the principles are universal and are applicable to all surgical specialties, making the course worthwhile for anyone involved in delivering surgical care.

Note: Approved by the American Board of Thoracic Surgery for Maintenance of Certification

Course Description — Improving patient care remains a constant mission for all members of the surgical team. The inaugural AATS Surgical Patient Safety Course has been designed to promote a culture of safety and reduce preventable patient harm by engaging, educating and equipping members of the cardiothoracic surgical team in the multidimensional approach to patient safety. Featuring didactic and interactive presentations and focused workshops, the course will provide attendees with the essential knowledge, skills and attitudes about patient safety that can improve care in the present and future.

View Preliminary Program

June 24-25, 2016
Renaissance Boston Waterfront Hotel
Boston, MA

Co-Directors
Thoralf M. Sundt, III, MD
Steven Yule, PhD

Program Committee
David J. Bunnell, PA-C, APACVS
David C. Fitzgerald, CCP, AMSECT
Jake Jaquiss, MD
M. Blair Marshall, MD
Shannon Pengel, RN
Kenneth Shann, CCP, LP, AMSECT
Marco Zenati, MD

Course Goal — The course provides members of the surgical care team with an introduction to the principles of patient safety and error management and provides them with practical tools that can be implemented in their care environment.

Target Audience — Recognizing that surgical safety is the product of the collective efforts of the entire care team, this course is directed at nurses and nurse practitioners, physician assistants, perfusionists, anesthesiologists, critical care physicians and surgeons. While the central focus is on cardiothoracic surgical care, the principles are universal and are applicable to all surgical specialties, making the course worthwhile for anyone involved in delivering surgical care.

Note: Approved by the American Board of Thoracic Surgery for Maintenance of Certification

Course Description — Improving patient care remains a constant mission for all members of the surgical team. The inaugural AATS Surgical Patient Safety Course has been designed to promote a culture of safety and reduce preventable patient harm by engaging, educating and equipping members of the cardiothoracic surgical team in the multidimensional approach to patient safety. Featuring didactic and interactive presentations and focused workshops, the course will provide attendees with the essential knowledge, skills and attitudes about patient safety that can improve care in the present and future.

View Preliminary Program

June 24-25, 2016
Renaissance Boston Waterfront Hotel
Boston, MA

Co-Directors
Thoralf M. Sundt, III, MD
Steven Yule, PhD

Program Committee
David J. Bunnell, PA-C, APACVS
David C. Fitzgerald, CCP, AMSECT
Jake Jaquiss, MD
M. Blair Marshall, MD
Shannon Pengel, RN
Kenneth Shann, CCP, LP, AMSECT
Marco Zenati, MD

Course Goal — The course provides members of the surgical care team with an introduction to the principles of patient safety and error management and provides them with practical tools that can be implemented in their care environment.

Target Audience — Recognizing that surgical safety is the product of the collective efforts of the entire care team, this course is directed at nurses and nurse practitioners, physician assistants, perfusionists, anesthesiologists, critical care physicians and surgeons. While the central focus is on cardiothoracic surgical care, the principles are universal and are applicable to all surgical specialties, making the course worthwhile for anyone involved in delivering surgical care.

Note: Approved by the American Board of Thoracic Surgery for Maintenance of Certification

Course Description — Improving patient care remains a constant mission for all members of the surgical team. The inaugural AATS Surgical Patient Safety Course has been designed to promote a culture of safety and reduce preventable patient harm by engaging, educating and equipping members of the cardiothoracic surgical team in the multidimensional approach to patient safety. Featuring didactic and interactive presentations and focused workshops, the course will provide attendees with the essential knowledge, skills and attitudes about patient safety that can improve care in the present and future.

View Preliminary Program

Aortic Symposium
May 12–13, 2016
New York, NY

Course Directors
Joseph S. Coselli
Steven L. Lansman

Registration and Housing Information

96th Annual Meeting
May 14-18, 2016
Baltimore, MD

President & Annual Meeting Chair
Joseph S. Coselli

Annual Meeting Co-Chairs
Charles D. Fraser
David R. Jones

Annual Meeting Registration PackagesAllied Health Package: Registration for the Saturday Courses, Sunday Symposium and the 96th Annual Meeting (Monday-Wednesday). Register before March 25, 2016, for only $400, after which the fee goes up to $500.

Resident/Fellow and Medical Student Package: Registration for the Saturday Courses, Sunday Symposium and the 96th Annual Meeting (Monday-Wednesday).

Register before March 25, 2016, and attend for no charge. After that date, the fee is $300.

Saturday Courses and Sunday Symposium Registration: Register for a Saturday course and/or a Sunday symposium and have access to all other courses/symposia that same day. Note: Registration for the Saturday courses and/or Sunday symposium is separate from the Annual Meeting fee.

Registration & Housing Information 

View the preliminary program

Aortic Symposium
May 12–13, 2016
New York, NY

Course Directors
Joseph S. Coselli
Steven L. Lansman

Registration and Housing Information

96th Annual Meeting
May 14-18, 2016
Baltimore, MD

President & Annual Meeting Chair
Joseph S. Coselli

Annual Meeting Co-Chairs
Charles D. Fraser
David R. Jones

Annual Meeting Registration PackagesAllied Health Package: Registration for the Saturday Courses, Sunday Symposium and the 96th Annual Meeting (Monday-Wednesday). Register before March 25, 2016, for only $400, after which the fee goes up to $500.

Resident/Fellow and Medical Student Package: Registration for the Saturday Courses, Sunday Symposium and the 96th Annual Meeting (Monday-Wednesday).

Register before March 25, 2016, and attend for no charge. After that date, the fee is $300.

Saturday Courses and Sunday Symposium Registration: Register for a Saturday course and/or a Sunday symposium and have access to all other courses/symposia that same day. Note: Registration for the Saturday courses and/or Sunday symposium is separate from the Annual Meeting fee.

Registration & Housing Information 

View the preliminary program

Aortic Symposium
May 12–13, 2016
New York, NY

Course Directors
Joseph S. Coselli
Steven L. Lansman

Registration and Housing Information

96th Annual Meeting
May 14-18, 2016
Baltimore, MD

President & Annual Meeting Chair
Joseph S. Coselli

Annual Meeting Co-Chairs
Charles D. Fraser
David R. Jones

Annual Meeting Registration PackagesAllied Health Package: Registration for the Saturday Courses, Sunday Symposium and the 96th Annual Meeting (Monday-Wednesday). Register before March 25, 2016, for only $400, after which the fee goes up to $500.

Resident/Fellow and Medical Student Package: Registration for the Saturday Courses, Sunday Symposium and the 96th Annual Meeting (Monday-Wednesday).

Register before March 25, 2016, and attend for no charge. After that date, the fee is $300.

Saturday Courses and Sunday Symposium Registration: Register for a Saturday course and/or a Sunday symposium and have access to all other courses/symposia that same day. Note: Registration for the Saturday courses and/or Sunday symposium is separate from the Annual Meeting fee.

Registration & Housing Information 

View the preliminary program

I hadn’t originally planned to be an obstetrician-gynecologist; in fact, I trained as an internist for 2 years. But as I became more exposed to the real-life experience of medical care, I realized that ob.gyn. would allow me to take care of women in all facets of their lives, from family planning to childbirth to endocrine problems and even depression.

Having joined the American College of Obstetricians and Gynecologists in 1965, my tenure as an ob.gyn. has spanned almost the exact length of this 50th anniversary retrospective of Ob.Gyn.News. But in my experience, those early days of my practice were actually the turning point for our specialty.

I’m an observer, not a historian. But I can’t imagine that any other specialty was more impacted by societal change in the mid-1960s than ours.

Courtesy Rivermend Health

For one thing, when I was training, we were an overwhelmingly male group of residents who were learning about how to take care of women. Our commitment was not in question, but our ability to truly connect with women was certainly underdeveloped.

I’m gratified now to see that the demographics of ob.gyn. have changed, because they should. Without disrespecting my male ob.gyn. brethren, I was pleased to see that more than 80% of ob.gyn. trainees are now women. Importantly, many of them are learning now from female ob.gyns. This foretells a future in which connections between patient and physician are as strong as they should be.

Moreover, ob.gyn. trainees today have the highest proportions of African American and Hispanic trainees compared with any other specialty. We are doing a better job of representing, within our ranks, the women whom we treat. This continues to bolster our relationships, and in no other field is a trusting, intimate relationship as important as in ours.

Of course, the mid-1960s also heralded dramatic changes within reproductive health. Women were beginning to dip their toes into being able to control their own fertility and, in so doing, to prevent pregnancy. This also gave us the opportunity to focus on a woman’s greater well-being, helping her to address her own health before becoming pregnant. It pivoted the role of the ob.gyn. and charted us on a course to being, for many women, their primary point of care. And it gave women educational, professional, and economic opportunities the likes of which had never existed before.

Outside of fertility planning, we also began to make inroads in obstetric care – and to make some mistakes. The 1960s heralded some developments that we still embrace, but we also began a path toward dependence on technology and overinvasive care that we are trying to step away from today.

And, we had difficult conversations then that we have now. The more things change, the more they stay the same.

One of the most exciting, and essential, changes that I have seen since I began my career is the voice of the woman in ob.gyn. care. We speak with our patients. We screen them for depression and for intimate partner violence. We discuss their lives and whether they are using the birth control that is best for them. We try to reflect their own preferences in our approach to their labor and delivery. We missed an opportunity to do this in the past, to discuss a woman’s social history. We know now that there is more to a woman’s well-being than whether she smokes and drinks.

It makes sense that our specialty has changed, because we are the only specialty dedicated to women, and the last 50 years have brought about intense societal change for women.

We still have further to go. We can be slow to evolve, and we constantly face challenges that other specialties don’t confront. But I believe that the same dedication to women that inspired me to go into ob.gyn. 50 years ago is the same inspiration that is leading today’s trainees to do the same.

Dr. Pion is a clinical professor at the UCLA School of Medicine. He has served on the faculty of the University of Washington and the University of Hawaii, and worked for more than 25 years in the development and production of TV and radio programming on health care. He is a fellow of the American College of Obstetricians and Gynecologists.

I hadn’t originally planned to be an obstetrician-gynecologist; in fact, I trained as an internist for 2 years. But as I became more exposed to the real-life experience of medical care, I realized that ob.gyn. would allow me to take care of women in all facets of their lives, from family planning to childbirth to endocrine problems and even depression.

Having joined the American College of Obstetricians and Gynecologists in 1965, my tenure as an ob.gyn. has spanned almost the exact length of this 50th anniversary retrospective of Ob.Gyn.News. But in my experience, those early days of my practice were actually the turning point for our specialty.

I’m an observer, not a historian. But I can’t imagine that any other specialty was more impacted by societal change in the mid-1960s than ours.

Courtesy Rivermend Health

For one thing, when I was training, we were an overwhelmingly male group of residents who were learning about how to take care of women. Our commitment was not in question, but our ability to truly connect with women was certainly underdeveloped.

I’m gratified now to see that the demographics of ob.gyn. have changed, because they should. Without disrespecting my male ob.gyn. brethren, I was pleased to see that more than 80% of ob.gyn. trainees are now women. Importantly, many of them are learning now from female ob.gyns. This foretells a future in which connections between patient and physician are as strong as they should be.

Moreover, ob.gyn. trainees today have the highest proportions of African American and Hispanic trainees compared with any other specialty. We are doing a better job of representing, within our ranks, the women whom we treat. This continues to bolster our relationships, and in no other field is a trusting, intimate relationship as important as in ours.

Of course, the mid-1960s also heralded dramatic changes within reproductive health. Women were beginning to dip their toes into being able to control their own fertility and, in so doing, to prevent pregnancy. This also gave us the opportunity to focus on a woman’s greater well-being, helping her to address her own health before becoming pregnant. It pivoted the role of the ob.gyn. and charted us on a course to being, for many women, their primary point of care. And it gave women educational, professional, and economic opportunities the likes of which had never existed before.

Outside of fertility planning, we also began to make inroads in obstetric care – and to make some mistakes. The 1960s heralded some developments that we still embrace, but we also began a path toward dependence on technology and overinvasive care that we are trying to step away from today.

And, we had difficult conversations then that we have now. The more things change, the more they stay the same.

One of the most exciting, and essential, changes that I have seen since I began my career is the voice of the woman in ob.gyn. care. We speak with our patients. We screen them for depression and for intimate partner violence. We discuss their lives and whether they are using the birth control that is best for them. We try to reflect their own preferences in our approach to their labor and delivery. We missed an opportunity to do this in the past, to discuss a woman’s social history. We know now that there is more to a woman’s well-being than whether she smokes and drinks.

It makes sense that our specialty has changed, because we are the only specialty dedicated to women, and the last 50 years have brought about intense societal change for women.

We still have further to go. We can be slow to evolve, and we constantly face challenges that other specialties don’t confront. But I believe that the same dedication to women that inspired me to go into ob.gyn. 50 years ago is the same inspiration that is leading today’s trainees to do the same.

Dr. Pion is a clinical professor at the UCLA School of Medicine. He has served on the faculty of the University of Washington and the University of Hawaii, and worked for more than 25 years in the development and production of TV and radio programming on health care. He is a fellow of the American College of Obstetricians and Gynecologists.

I hadn’t originally planned to be an obstetrician-gynecologist; in fact, I trained as an internist for 2 years. But as I became more exposed to the real-life experience of medical care, I realized that ob.gyn. would allow me to take care of women in all facets of their lives, from family planning to childbirth to endocrine problems and even depression.

Having joined the American College of Obstetricians and Gynecologists in 1965, my tenure as an ob.gyn. has spanned almost the exact length of this 50th anniversary retrospective of Ob.Gyn.News. But in my experience, those early days of my practice were actually the turning point for our specialty.

I’m an observer, not a historian. But I can’t imagine that any other specialty was more impacted by societal change in the mid-1960s than ours.

Courtesy Rivermend Health

For one thing, when I was training, we were an overwhelmingly male group of residents who were learning about how to take care of women. Our commitment was not in question, but our ability to truly connect with women was certainly underdeveloped.

I’m gratified now to see that the demographics of ob.gyn. have changed, because they should. Without disrespecting my male ob.gyn. brethren, I was pleased to see that more than 80% of ob.gyn. trainees are now women. Importantly, many of them are learning now from female ob.gyns. This foretells a future in which connections between patient and physician are as strong as they should be.

Moreover, ob.gyn. trainees today have the highest proportions of African American and Hispanic trainees compared with any other specialty. We are doing a better job of representing, within our ranks, the women whom we treat. This continues to bolster our relationships, and in no other field is a trusting, intimate relationship as important as in ours.

Of course, the mid-1960s also heralded dramatic changes within reproductive health. Women were beginning to dip their toes into being able to control their own fertility and, in so doing, to prevent pregnancy. This also gave us the opportunity to focus on a woman’s greater well-being, helping her to address her own health before becoming pregnant. It pivoted the role of the ob.gyn. and charted us on a course to being, for many women, their primary point of care. And it gave women educational, professional, and economic opportunities the likes of which had never existed before.

Outside of fertility planning, we also began to make inroads in obstetric care – and to make some mistakes. The 1960s heralded some developments that we still embrace, but we also began a path toward dependence on technology and overinvasive care that we are trying to step away from today.

And, we had difficult conversations then that we have now. The more things change, the more they stay the same.

One of the most exciting, and essential, changes that I have seen since I began my career is the voice of the woman in ob.gyn. care. We speak with our patients. We screen them for depression and for intimate partner violence. We discuss their lives and whether they are using the birth control that is best for them. We try to reflect their own preferences in our approach to their labor and delivery. We missed an opportunity to do this in the past, to discuss a woman’s social history. We know now that there is more to a woman’s well-being than whether she smokes and drinks.

It makes sense that our specialty has changed, because we are the only specialty dedicated to women, and the last 50 years have brought about intense societal change for women.

We still have further to go. We can be slow to evolve, and we constantly face challenges that other specialties don’t confront. But I believe that the same dedication to women that inspired me to go into ob.gyn. 50 years ago is the same inspiration that is leading today’s trainees to do the same.

Dr. Pion is a clinical professor at the UCLA School of Medicine. He has served on the faculty of the University of Washington and the University of Hawaii, and worked for more than 25 years in the development and production of TV and radio programming on health care. He is a fellow of the American College of Obstetricians and Gynecologists.

T cells

Image courtesy of NIAID

A new study suggests that having a certain type of cancer or receiving certain chemotherapeutic agents

can affect T-cell function and make patients ineligible for engineered T-cell therapy.

However, researchers found that proper timing of T-cell collection can increase the number of patients eiligible for the therapy.

And the team developed a culture technique that can boost T cells’ fitness for expansion, which can increase eligibility as well.

Nathan Singh, MD, of the University of Pennsylvania in Philadelphia, and his colleagues described this work in Science Translational Medicine.

The researchers set out to determine why some patients’ T cells fail to multiply in culture. The team studied T cells from children with acute lymphoblastic leukemia (ALL) or non-Hodgkin lymphoma (NHL) who were undergoing chemotherapy. (NHL subtypes included Burkitt lymphoma, diffuse large B-cell lymphoma, primary mediastinal large B-cell lymphoma, primary lymphoma of bone, and follicular lymphoma.)

The researchers found that T cells from patients with ALL expanded better in culture than those from patients with NHL.

The team said a threshold of greater than 5-fold expansion during test expansion was associated with a high likelihood of successful clinical expansion.

Nearly 80% of patients with ALL met this threshold at diagnosis, but the rate declined over the course of therapy, falling to about 40% during maintenance therapy.

About 25% of NHL patients met the threshold at diagnosis, but few samples demonstrated any expansion after therapy began (12.5% of samples at all remaining time points tested).

The researchers said the difference in the proportion of ALL and NHL samples that met the expansion threshold was significant at all time points tested.

Analysis revealed that ALL patients had higher numbers of naïve T cells and stem central memory T cells, T cell subtypes known to be highly potent and proliferative with an enhanced capacity for self-renewal.

The researchers also found that certain chemotherapy drugs—namely, cyclophosphamide and cytarabine—selectively depleted early lineage T cells.

Fortunately, the team discovered that poor expansion can be rescued by exposing T cells to signaling molecules that stimulate T-cell activity. Culture with IL-7 and IL-15 boosted the expansion capacity of T cells from patients with NHL and those with ALL.

The researchers therefore concluded that using this culture technique or collecting T cells prior to chemotherapy can increase the number of patients eligible for engineered T-cell therapy.

T cells

Image courtesy of NIAID

A new study suggests that having a certain type of cancer or receiving certain chemotherapeutic agents

can affect T-cell function and make patients ineligible for engineered T-cell therapy.

However, researchers found that proper timing of T-cell collection can increase the number of patients eiligible for the therapy.

And the team developed a culture technique that can boost T cells’ fitness for expansion, which can increase eligibility as well.

Nathan Singh, MD, of the University of Pennsylvania in Philadelphia, and his colleagues described this work in Science Translational Medicine.

The researchers set out to determine why some patients’ T cells fail to multiply in culture. The team studied T cells from children with acute lymphoblastic leukemia (ALL) or non-Hodgkin lymphoma (NHL) who were undergoing chemotherapy. (NHL subtypes included Burkitt lymphoma, diffuse large B-cell lymphoma, primary mediastinal large B-cell lymphoma, primary lymphoma of bone, and follicular lymphoma.)

The researchers found that T cells from patients with ALL expanded better in culture than those from patients with NHL.

The team said a threshold of greater than 5-fold expansion during test expansion was associated with a high likelihood of successful clinical expansion.

Nearly 80% of patients with ALL met this threshold at diagnosis, but the rate declined over the course of therapy, falling to about 40% during maintenance therapy.

About 25% of NHL patients met the threshold at diagnosis, but few samples demonstrated any expansion after therapy began (12.5% of samples at all remaining time points tested).

The researchers said the difference in the proportion of ALL and NHL samples that met the expansion threshold was significant at all time points tested.

Analysis revealed that ALL patients had higher numbers of naïve T cells and stem central memory T cells, T cell subtypes known to be highly potent and proliferative with an enhanced capacity for self-renewal.

The researchers also found that certain chemotherapy drugs—namely, cyclophosphamide and cytarabine—selectively depleted early lineage T cells.

Fortunately, the team discovered that poor expansion can be rescued by exposing T cells to signaling molecules that stimulate T-cell activity. Culture with IL-7 and IL-15 boosted the expansion capacity of T cells from patients with NHL and those with ALL.

The researchers therefore concluded that using this culture technique or collecting T cells prior to chemotherapy can increase the number of patients eligible for engineered T-cell therapy.

T cells

Image courtesy of NIAID

A new study suggests that having a certain type of cancer or receiving certain chemotherapeutic agents

can affect T-cell function and make patients ineligible for engineered T-cell therapy.

However, researchers found that proper timing of T-cell collection can increase the number of patients eiligible for the therapy.

And the team developed a culture technique that can boost T cells’ fitness for expansion, which can increase eligibility as well.

Nathan Singh, MD, of the University of Pennsylvania in Philadelphia, and his colleagues described this work in Science Translational Medicine.

The researchers set out to determine why some patients’ T cells fail to multiply in culture. The team studied T cells from children with acute lymphoblastic leukemia (ALL) or non-Hodgkin lymphoma (NHL) who were undergoing chemotherapy. (NHL subtypes included Burkitt lymphoma, diffuse large B-cell lymphoma, primary mediastinal large B-cell lymphoma, primary lymphoma of bone, and follicular lymphoma.)

The researchers found that T cells from patients with ALL expanded better in culture than those from patients with NHL.

The team said a threshold of greater than 5-fold expansion during test expansion was associated with a high likelihood of successful clinical expansion.

Nearly 80% of patients with ALL met this threshold at diagnosis, but the rate declined over the course of therapy, falling to about 40% during maintenance therapy.

About 25% of NHL patients met the threshold at diagnosis, but few samples demonstrated any expansion after therapy began (12.5% of samples at all remaining time points tested).

The researchers said the difference in the proportion of ALL and NHL samples that met the expansion threshold was significant at all time points tested.

Analysis revealed that ALL patients had higher numbers of naïve T cells and stem central memory T cells, T cell subtypes known to be highly potent and proliferative with an enhanced capacity for self-renewal.

The researchers also found that certain chemotherapy drugs—namely, cyclophosphamide and cytarabine—selectively depleted early lineage T cells.

Fortunately, the team discovered that poor expansion can be rescued by exposing T cells to signaling molecules that stimulate T-cell activity. Culture with IL-7 and IL-15 boosted the expansion capacity of T cells from patients with NHL and those with ALL.

The researchers therefore concluded that using this culture technique or collecting T cells prior to chemotherapy can increase the number of patients eligible for engineered T-cell therapy.

Hemostasis-monitoring device

Photo courtesy of the Wyss

Institute at Harvard University

Scientists have developed a blood coagulation assay that, they say, is more reliable than existing assays and could one day be used to diagnose rare bleeding disorders and prevent toxic effects of anticoagulant and antiplatelet drugs.

The team created a microfluidic device with hollow channels through which blood is flowed and devised an algorithm for analyzing patient-specific data to predict when blood clots will form.

Together, these components make up the assay, which can monitor blood coagulation and platelet function.

Donald Ingber, MD, PhD, of the Wyss Institute for Biologically Inspired Engineering at Harvard University in Boston, Massachusetts, and his colleagues described the assay in Nature Communications.

The team developed a microfluidic device in which blood flows through a life-like network of small “vessels.” The blood is subjected to true-to-life shear stresses and force gradients of the human vascular network.

The device contains hollow channels that mimic the pathology of the narrowing of small blood vessels, which can often cause a shift in the fluid mechanics of blood flow that can lead to life-threatening blood clots or internal bleeds.

The device mimics rapid changes in blood flow dynamics associated with stenosis or narrowing of small blood vessels by pumping pressurized blood flow through the device’s microfluidic channels.

Using automated pressure sensors and a proprietary algorithm, data acquired from the device is analyzed in real-time, thereby predicting the time at which a certain blood sample will obstruct the blood vessel network.

“By combining our fabricated microfluidic device that mimics blood flow dynamics of small arterioles with our novel data analysis software, we can rapidly quantitate hemostasis in real-time and predict if blood clots will develop in an individual or blood sample,” Dr Ingber explained.

He and his colleagues found they could accurately monitor the effects of anticoagulant and antiplatelet drugs in blood samples from human subjects.

The team was able to monitor platelet function as well. In particular, they found they could detect abnormal platelet function in samples from patients with Hermansky–Pudlak syndrome, a rare bleeding disorder characterized by a deficiency of platelet-dense granules that cannot be easily identified using conventional assays.

The novel assay also proved successful in large animal experiments. The scientists integrated their device directly into a vascular access line that was inserted into the femoral vein of a living pig to measure clinical clotting parameters over time. They recorded precise predictions for clotting times that were more accurate and faster than currently used clinical assays.

The team noted that their device uses inexpensive in-line pressure sensors to measure clot formation. As a result, it does not require additional instrumentation, and it can be integrated directly into the blood lines of extracorporeal devices.

The scientists said the device’s ability to be configured for lab use or real-time patient monitoring opens the door for countless potential uses that could improve patient care.

Hemostasis-monitoring device

Photo courtesy of the Wyss

Institute at Harvard University

Scientists have developed a blood coagulation assay that, they say, is more reliable than existing assays and could one day be used to diagnose rare bleeding disorders and prevent toxic effects of anticoagulant and antiplatelet drugs.

The team created a microfluidic device with hollow channels through which blood is flowed and devised an algorithm for analyzing patient-specific data to predict when blood clots will form.

Together, these components make up the assay, which can monitor blood coagulation and platelet function.

Donald Ingber, MD, PhD, of the Wyss Institute for Biologically Inspired Engineering at Harvard University in Boston, Massachusetts, and his colleagues described the assay in Nature Communications.

The team developed a microfluidic device in which blood flows through a life-like network of small “vessels.” The blood is subjected to true-to-life shear stresses and force gradients of the human vascular network.

The device contains hollow channels that mimic the pathology of the narrowing of small blood vessels, which can often cause a shift in the fluid mechanics of blood flow that can lead to life-threatening blood clots or internal bleeds.

The device mimics rapid changes in blood flow dynamics associated with stenosis or narrowing of small blood vessels by pumping pressurized blood flow through the device’s microfluidic channels.

Using automated pressure sensors and a proprietary algorithm, data acquired from the device is analyzed in real-time, thereby predicting the time at which a certain blood sample will obstruct the blood vessel network.

“By combining our fabricated microfluidic device that mimics blood flow dynamics of small arterioles with our novel data analysis software, we can rapidly quantitate hemostasis in real-time and predict if blood clots will develop in an individual or blood sample,” Dr Ingber explained.

He and his colleagues found they could accurately monitor the effects of anticoagulant and antiplatelet drugs in blood samples from human subjects.

The team was able to monitor platelet function as well. In particular, they found they could detect abnormal platelet function in samples from patients with Hermansky–Pudlak syndrome, a rare bleeding disorder characterized by a deficiency of platelet-dense granules that cannot be easily identified using conventional assays.

The novel assay also proved successful in large animal experiments. The scientists integrated their device directly into a vascular access line that was inserted into the femoral vein of a living pig to measure clinical clotting parameters over time. They recorded precise predictions for clotting times that were more accurate and faster than currently used clinical assays.

The team noted that their device uses inexpensive in-line pressure sensors to measure clot formation. As a result, it does not require additional instrumentation, and it can be integrated directly into the blood lines of extracorporeal devices.

The scientists said the device’s ability to be configured for lab use or real-time patient monitoring opens the door for countless potential uses that could improve patient care.

Hemostasis-monitoring device

Photo courtesy of the Wyss

Institute at Harvard University

Scientists have developed a blood coagulation assay that, they say, is more reliable than existing assays and could one day be used to diagnose rare bleeding disorders and prevent toxic effects of anticoagulant and antiplatelet drugs.

The team created a microfluidic device with hollow channels through which blood is flowed and devised an algorithm for analyzing patient-specific data to predict when blood clots will form.

Together, these components make up the assay, which can monitor blood coagulation and platelet function.

Donald Ingber, MD, PhD, of the Wyss Institute for Biologically Inspired Engineering at Harvard University in Boston, Massachusetts, and his colleagues described the assay in Nature Communications.

The team developed a microfluidic device in which blood flows through a life-like network of small “vessels.” The blood is subjected to true-to-life shear stresses and force gradients of the human vascular network.

The device contains hollow channels that mimic the pathology of the narrowing of small blood vessels, which can often cause a shift in the fluid mechanics of blood flow that can lead to life-threatening blood clots or internal bleeds.

The device mimics rapid changes in blood flow dynamics associated with stenosis or narrowing of small blood vessels by pumping pressurized blood flow through the device’s microfluidic channels.

Using automated pressure sensors and a proprietary algorithm, data acquired from the device is analyzed in real-time, thereby predicting the time at which a certain blood sample will obstruct the blood vessel network.

“By combining our fabricated microfluidic device that mimics blood flow dynamics of small arterioles with our novel data analysis software, we can rapidly quantitate hemostasis in real-time and predict if blood clots will develop in an individual or blood sample,” Dr Ingber explained.

He and his colleagues found they could accurately monitor the effects of anticoagulant and antiplatelet drugs in blood samples from human subjects.

The team was able to monitor platelet function as well. In particular, they found they could detect abnormal platelet function in samples from patients with Hermansky–Pudlak syndrome, a rare bleeding disorder characterized by a deficiency of platelet-dense granules that cannot be easily identified using conventional assays.

The novel assay also proved successful in large animal experiments. The scientists integrated their device directly into a vascular access line that was inserted into the femoral vein of a living pig to measure clinical clotting parameters over time. They recorded precise predictions for clotting times that were more accurate and faster than currently used clinical assays.

The team noted that their device uses inexpensive in-line pressure sensors to measure clot formation. As a result, it does not require additional instrumentation, and it can be integrated directly into the blood lines of extracorporeal devices.

The scientists said the device’s ability to be configured for lab use or real-time patient monitoring opens the door for countless potential uses that could improve patient care.

Bottles of warfarin

Photo courtesy of NIGMS

The American College of Chest Physicians has released a new edition of guidelines for the treatment of patients with venous thromboembolism (VTE).

This 10th edition of the guidelines, published in CHEST, includes 54 recommendations. However, only 20 of these recommendations were deemed “strong,” and none were based on high-quality evidence.

“The guideline presents stronger recommendations and weaker suggestions for treatment based on the best available evidence and identifies gaps in our knowledge and areas for future research,” said lead author Clive Kearon, MD, PhD, of McMaster University in Hamilton, Ontario, Canada.

One of the key recommendations in the guidelines is a preference for novel oral anticoagulants (NOACs) over vitamin K antagonist (VKA) therapy for initial and long-term treatment of VTE in patients without cancer.

The guideline authors say that, since the publication of the 9th edition, studies have shown that NOACs are as effective as VKA therapy, and NOACs confer a reduced risk of bleeding and increased convenience for patients and healthcare providers.

As long-term anticoagulant therapy for patients without cancer, the guideline authors suggest dabigatran, rivaroxaban, apixaban, or edoxaban over VKA therapy. But they suggest VKA therapy over low-molecular-weight heparin.

For patients with VTE and cancer, the guideline authors suggest low-molecular-weight heparin over VKA, dabigatran, rivaroxaban, apixaban, or edoxaban.

The guidelines advise against an inferior vena cava filter for patients with VTE who are receiving anticoagulant treatment.

Another change to guideline recommendations from the 9th edition to the 10th edition concerns the routine use of compression stockings. Based on recent evidence, the 10th edition advises against routinely using compression stockings to prevent post-thrombotic syndrome in patients with acute deep vein thrombosis (DVT).

The 10th edition also suggests which patients diagnosed with isolated subsegmental pulmonary embolism (PE) should, and should not, receive anticoagulant therapy.

For subsegmental PE and no proximal DVT, the guidelines suggest clinical surveillance over anticoagulation if patients have a low risk of recurrent VTE and anticoagulation over clinical surveillance if patients have a high risk of recurrence.

The guidelines suggest thrombolytic therapy for patients with PE and hypotension and systemic therapy over catheter-directed thrombolysis.

To date, the updated guidelines have been endorsed by the American Association for Clinical Chemistry, American College of Clinical Pharmacy, International Society for Thrombosis and Haemostasis, and American Society of Health-System Pharmacists.

Bottles of warfarin

Photo courtesy of NIGMS

The American College of Chest Physicians has released a new edition of guidelines for the treatment of patients with venous thromboembolism (VTE).

This 10th edition of the guidelines, published in CHEST, includes 54 recommendations. However, only 20 of these recommendations were deemed “strong,” and none were based on high-quality evidence.

“The guideline presents stronger recommendations and weaker suggestions for treatment based on the best available evidence and identifies gaps in our knowledge and areas for future research,” said lead author Clive Kearon, MD, PhD, of McMaster University in Hamilton, Ontario, Canada.

One of the key recommendations in the guidelines is a preference for novel oral anticoagulants (NOACs) over vitamin K antagonist (VKA) therapy for initial and long-term treatment of VTE in patients without cancer.

The guideline authors say that, since the publication of the 9th edition, studies have shown that NOACs are as effective as VKA therapy, and NOACs confer a reduced risk of bleeding and increased convenience for patients and healthcare providers.

As long-term anticoagulant therapy for patients without cancer, the guideline authors suggest dabigatran, rivaroxaban, apixaban, or edoxaban over VKA therapy. But they suggest VKA therapy over low-molecular-weight heparin.

For patients with VTE and cancer, the guideline authors suggest low-molecular-weight heparin over VKA, dabigatran, rivaroxaban, apixaban, or edoxaban.

The guidelines advise against an inferior vena cava filter for patients with VTE who are receiving anticoagulant treatment.

Another change to guideline recommendations from the 9th edition to the 10th edition concerns the routine use of compression stockings. Based on recent evidence, the 10th edition advises against routinely using compression stockings to prevent post-thrombotic syndrome in patients with acute deep vein thrombosis (DVT).

The 10th edition also suggests which patients diagnosed with isolated subsegmental pulmonary embolism (PE) should, and should not, receive anticoagulant therapy.

For subsegmental PE and no proximal DVT, the guidelines suggest clinical surveillance over anticoagulation if patients have a low risk of recurrent VTE and anticoagulation over clinical surveillance if patients have a high risk of recurrence.

The guidelines suggest thrombolytic therapy for patients with PE and hypotension and systemic therapy over catheter-directed thrombolysis.

To date, the updated guidelines have been endorsed by the American Association for Clinical Chemistry, American College of Clinical Pharmacy, International Society for Thrombosis and Haemostasis, and American Society of Health-System Pharmacists.

Bottles of warfarin

Photo courtesy of NIGMS

The American College of Chest Physicians has released a new edition of guidelines for the treatment of patients with venous thromboembolism (VTE).

This 10th edition of the guidelines, published in CHEST, includes 54 recommendations. However, only 20 of these recommendations were deemed “strong,” and none were based on high-quality evidence.

“The guideline presents stronger recommendations and weaker suggestions for treatment based on the best available evidence and identifies gaps in our knowledge and areas for future research,” said lead author Clive Kearon, MD, PhD, of McMaster University in Hamilton, Ontario, Canada.

One of the key recommendations in the guidelines is a preference for novel oral anticoagulants (NOACs) over vitamin K antagonist (VKA) therapy for initial and long-term treatment of VTE in patients without cancer.

The guideline authors say that, since the publication of the 9th edition, studies have shown that NOACs are as effective as VKA therapy, and NOACs confer a reduced risk of bleeding and increased convenience for patients and healthcare providers.

As long-term anticoagulant therapy for patients without cancer, the guideline authors suggest dabigatran, rivaroxaban, apixaban, or edoxaban over VKA therapy. But they suggest VKA therapy over low-molecular-weight heparin.

For patients with VTE and cancer, the guideline authors suggest low-molecular-weight heparin over VKA, dabigatran, rivaroxaban, apixaban, or edoxaban.

The guidelines advise against an inferior vena cava filter for patients with VTE who are receiving anticoagulant treatment.

Another change to guideline recommendations from the 9th edition to the 10th edition concerns the routine use of compression stockings. Based on recent evidence, the 10th edition advises against routinely using compression stockings to prevent post-thrombotic syndrome in patients with acute deep vein thrombosis (DVT).

The 10th edition also suggests which patients diagnosed with isolated subsegmental pulmonary embolism (PE) should, and should not, receive anticoagulant therapy.

For subsegmental PE and no proximal DVT, the guidelines suggest clinical surveillance over anticoagulation if patients have a low risk of recurrent VTE and anticoagulation over clinical surveillance if patients have a high risk of recurrence.

The guidelines suggest thrombolytic therapy for patients with PE and hypotension and systemic therapy over catheter-directed thrombolysis.

To date, the updated guidelines have been endorsed by the American Association for Clinical Chemistry, American College of Clinical Pharmacy, International Society for Thrombosis and Haemostasis, and American Society of Health-System Pharmacists.