In patients undergoing cardiac surgery who were at moderate-to-high risk for death, a restrictive strategy regarding red-cell transfusion was noninferior to a liberal strategy with respect to the composite outcome of death from any cause, myocardial infarction, stroke, or new-onset renal failure with dialysis, with less blood transfused. (Funded by the Canadian Institutes of Health Research and others; TRICS III ClinicalTrials.gov number, NCT02042898 .).

nhanced Recovery After Surgery (ERAS) is a multimodal, transdisciplinary care improvement initiative to promote recovery of patients undergoing surgery throughout their entire perioperative journey. 1 These programs aim to reduce complications and promote an earlier return to normal activities. 2,3 The ERAS protocols have been associated with a reduction in overall complications and length of stay of up to 50% compared with conventional perioperative patient management in populations having noncardiac surgery. 4-6 Evidence-based ERAS protocols have been published across multiple surgical specialties. 1 In early studies, the ERAS approach showed promise in cardiac surgery (CS); however, evidence-based protocols have yet to emerge. 7 To address the need for evidence-based ERAS protocols, we formed a registered nonprofit organization (ERAS Cardiac Society) to use an evidence-driven process to develop recommendations for pathways to optimize patient care in CS contexts through collaborative discovery, analysis, expert consensus, and best practices. The ERAS Cardiac Society has a formal collaborative agreement with the ERAS Society. This article reports the first expert-consensus review of evidence-based CS ERAS practices. Methods We followed the 2011 Institute of Medicine Standards for Developing Trustworthy Clinical Practice Guidelines, using a standardized algorithm that included experts, key questions, subject champions, systematic literature reviews, selection and appraisal of evidence quality, and development of clear consensus recommendations. 8 We minimized repetition of existing guidelines and consensus statements and focused on specific information in the framework of ERAS protocols.

In patients undergoing cardiac surgery who were at moderate-to-high risk for death, a restrictive strategy for red-cell transfusion was noninferior to a liberal strategy with respect to the composite outcome of death from any cause, myocardial infarction, stroke, or new-onset renal failure with dialysis at 6 months after surgery. (Funded by the Canadian Institutes of Health Research and others; TRICS III ClinicalTrials.gov number, NCT02042898 .).

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Our results suggest preparing to teach and actively teaching may have independent positive effects on peer teacher learning outcomes.

Studies of brilliant carotenoid-based coloration in birds have traditionally centred on the role that these colours play in attracting mates. More recently, biologists have begun to take a biochemical approach to understanding the types of pigments found in feathers and how these relate to the expression of ornamental coloration. Nevertheless, surprisingly few studies have assessed the types and amounts of carotenoids present in the diet or blood of animals in relation to season, sex, condition or sexually attractive colour traits, particularly for wild birds. It is conceivable not only that the total concentration of pigments available is an important predictor of sexual attractiveness and mate quality, but also that specific pigments vary among individuals and play more important physiological and pigmenting roles than others. We investigated the carotenoid content of blood and feathers in wild-caught, yellow-pigmented male American goldfinches (Carduelis tristis) throughout the year to determine the optimal biochemical strategy for becoming colourful. We found that birds acquired two main yellow hydroxycarotenoids (lutein and zeaxanthin) from the diet during both moulting and non-moulting periods. Blood concentrations of both pigments changed significantly over time, with moulting birds accumulating higher levels of both lutein and zeaxanthin, but proportionally more zeaxanthin, than non-moulting birds. Moulting birds that acquired more lutein and more zeaxanthin in blood deposited a higher concentration of carotenoid pigments (canary xanthophylls A and B) into plumage and acquired more colourful feathers. In sum, these results indicate that (a) the types of dietary carotenoids available across seasons do not change in American goldfinches, (b) seasonal fluctuations in plasma-carotenoid signatures may result from differences in dietary access or pigment processing, and (c) the best biochemical strategy for becoming a colourful, wild male goldfinch is to accumulate as many dietary/blood pigments as possible during moult.

Key Points Question What are the growth rate and risk of complications in patients with moderately dilated ascending aortas? Findings This systematic review and meta-analysis of 20 studies including 8800 patients found that the ascending aorta growth rate was 0.61 mm/y, and the incidence of elective aortic surgery was 13.82%. The linearized mortality rate was 1.99% per patient-year, while the rate of aortic dissection, aortic rupture, and mortality was 2.16% per patient-year. Meaning More robust natural history data from prospective studies are needed to better inform clinical decision making in patients with ascending aortic aneurysms.

Perioperative results of extended arch procedures are encouraging. Further follow-up is required to see if long-term complications are reduced with these emerging techniques. The proposed classification system will facilitate future comparison of short- and long-term results of different techniques of extended arch repair for ATAAD.