Faculty Bibliography
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department:Medicine. General Internal Medicine
recentyears:2
school:SOM
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14488
Two-Year Outcomes of Surgical Treatment of Moderate Ischemic Mitral Regurgitation
BACKGROUND:In a trial comparing coronary-artery bypass grafting (CABG) alone with CABG plus mitral-valve repair in patients with moderate ischemic mitral regurgitation, we found no significant difference in the left ventricular end-systolic volume index (LVESVI) or survival after 1 year. Concomitant mitral-valve repair was associated with a reduced prevalence of moderate or severe mitral regurgitation, but patients had more adverse events. We now report 2-year outcomes. METHODS:We randomly assigned 301 patients to undergo either CABG alone or the combined procedure. Patients were followed for 2 years for clinical and echocardiographic outcomes. RESULTS:At 2 years, the mean (±SD) LVESVI was 41.2±20.0 ml per square meter of body-surface area in the CABG-alone group and 43.2±20.6 ml per square meter in the combined-procedure group (mean improvement over baseline, -14.1 ml per square meter and -14.6 ml per square meter, respectively). The rate of death was 10.6% in the CABG-alone group and 10.0% in the combined-procedure group (hazard ratio in the combined-procedure group, 0.90; 95% confidence interval, 0.45 to 1.83; P=0.78). There was no significant between-group difference in the rank-based assessment of the LVESVI (including death) at 2 years (z score, 0.38; P=0.71). The 2-year rate of moderate or severe residual mitral regurgitation was higher in the CABG-alone group than in the combined-procedure group (32.3% vs. 11.2%, P<0.001). Overall rates of hospital readmission and serious adverse events were similar in the two groups, but neurologic events and supraventricular arrhythmias remained more frequent in the combined-procedure group. CONCLUSIONS:In patients with moderate ischemic mitral regurgitation undergoing CABG, the addition of mitral-valve repair did not lead to significant differences in left ventricular reverse remodeling at 2 years. Mitral-valve repair provided a more durable correction of mitral regurgitation but did not significantly improve survival or reduce overall adverse events or readmissions and was associated with an early hazard of increased neurologic events and supraventricular arrhythmias. (Funded by the National Institutes of Health and Canadian Institutes of Health Research; ClinicalTrials.gov number, NCT00806988.).
PMID: 27040451
ISSN: 1533-4406
CID: 5451202
Why Does the Physical Exam Stop at the Navel? [Newspaper Article]
It's like our patients are Humpty Dumpty, and the pieces are divvied out between different medical fields
PROQUEST:1789796837
ISSN: 0362-4331
CID: 2529912
Penis transplant: welcome to the frontier of a fascinating science [Newspaper Article]
ORIGINAL:0012724
ISSN: 0261-3077
CID: 3158872
Phagocytosis and Killing of Carbapenem-Resistant ST258 Klebsiella pneumoniae by Human Neutrophils
Carbapenem-resistant Klebsiella pneumoniae strains classified as multilocus sequence type 258 (ST258) are among the most widespread multidrug-resistant hospital-acquired pathogens. Treatment of infections caused by these organisms is difficult, and mortality is high. The basis for the success of ST258, outside of antibiotic resistance, remains incompletely determined. Here we tested the hypothesis that ST258 K. pneumoniae has enhanced capacity to circumvent killing by human neutrophils, the primary cellular defense against bacterial infections. There was limited binding and uptake of ST258 by human neutrophils, and correspondingly, there was limited killing of bacteria. On the other hand, transmission electron microscopy revealed that any ingested organisms were degraded readily within neutrophil phagosomes, thus indicating that survival in the neutrophil assays is due to limited phagocytosis, rather than to microbicide resistance after uptake. Our findings suggest that enhancing neutrophil phagocytosis is a potential therapeutic approach for treatment of infection caused by carbapenem-resistant ST258 K. pneumoniae.
PMCID:4837910
PMID: 26768252
ISSN: 1537-6613
CID: 2043092
[S.l.] : Quartz, 2016
From a medical standpoint, we absolutely shouldn't cancel the Rio Olympics
(Website)CID: 3159912
Phase IB study of cabozantinib in patients with relapsed and/or refractory multiple myeloma [Letter]
PMCID:5003505
PMID: 27020089
ISSN: 1528-0020
CID: 2198842
PLEASE OPEN YOUR MOUTH: WHAT DO WE NEED TO TEACH RESIDENTS TO HELP ADDRESS HEALTH DISPARITY IN ORAL HEALTH? [Meeting Abstract]
ISI:000392201601085
ISSN: 1525-1497
CID: 2481772
DEVELOPING A PATIENT EMPOWERMENT PROGRAM (PEP) TO ACHIEVE BETTER PATIENT OUTCOMES BY PREPARING PATIENTS TO PARTICIPATE IN MEDICAL ENCOUNTERS [Meeting Abstract]
ISI:000392201600172
ISSN: 1525-1497
CID: 2481702
A PATIENT EMPOWERMENT PROGRAM (PEP) CAN CHANGE PATIENT EXPECTATIONS OF PATIENT-PROVIDER ROLES IN COMMUNICATION [Meeting Abstract]
ISI:000392201600035
ISSN: 1525-1497
CID: 2481682
