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Mitral Valve Surgery for Functional Regurgitation: Insights into Heart Failure and Readmission

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World Journal of Cardiovascular Surgery 2022年第6期12卷 135-152页

作者： Joseph A. Gancayco Alexander P. Kossar Codruta Chiuzan isaac george Division of Cardiothoracic Surgery New York Presbyterian Hospital College of Physicians and Surgeons of Columbia University New York USA Department of Biostatistics Mailman School of Public Health Columbia University New York USA

Background: Functional mitral regurgitation (FMR) is an increasing burden as population ages. Mitral valve repair (MVr) is the preferred surgical treatment of FMR despite limited evidence supporting its efficacy. Mitral valve replacement (MVR) is the alternative procedure typically reserved for patients who are at higher risk or refractory to MVr. The present study aims to determine which of the two procedures is more effective in the surgical treatment of FMR. Methods: 344 charts of FMR patients who received either MVr (n = 263) or MVR (n = 81) from 2004-2016 at our institution were reviewed. Treatment efficacy was assessed based on heart failure (HF)-readmission and survival rates within 5 years from discharge. Propensity score approach with inverse probability weighting and Cox regression models were employed to evaluate procedural impact on survival and rehospitalizations, respectively. Follow-up echocardiographic data from the original cohort was assessed for differences in metrics between procedural groups at >6 months (MVr: n = 75;MVR: n = 23) and 1 year (MVr: n = 75;MVR: n = 18) post-op. Results: MVR patients had a lower risk of being readmitted for HF within 5 years compared to the MVr group (HR-adj (95% CI): 0.60 (0.41 - 0.88), p = 0.008). MVR patients also had a higher overall risk of death (HR-adj (95% CI): 1.82 (1.05 - 3.16), p = 0.034) but this was borderline significantly different at 5 years cut-off (p = 0.057). Conclusions: Higher HF readmission in MVr patients than in sicker, higher surgical-risk MVR patients reflects the inadequacy of MVr to treat FMR. Novel approaches to MVR may be necessary to adequately manage FMR.

关键词： Mitral Regurgitation Mitral Valve Repair Mitral Valve Replacement Heart Failure

Is Anticoagulation Warranted after Left Atrial Appendage Ligation in Patients at Risk for Stroke after Cardiac Surgery?

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World Journal of Cardiovascular Surgery 2023年第2期13卷 26-43页

作者： Alexander P. Kossar Yaagnik D. Kosuri Samantha Nemeth Brigitte E. Kazzi Yuming Ning James Doolittle Denise McLaughlin Paul Kurlansky isaac george Division of Cardiothoracic Surgery New-York Presbyterian Hospital/Columbia University Irving Medical Center New York USA Columbia HeartSource Center for Innovation and Outcomes Research Columbia University Irving Medical Center New York USA

Objectives: Left atrial appendage ligation (LAAL) may constitute alternative stroke prophylaxis in patients with atrial fibrillation (AF). Herein we describe the 30-day post discharge outcomes of cardiac surgery patients with elevated stroke risk with or without anticoagulation (AC) following epicardial LAAL. Methods: Data were reviewed for 479 consecutive adult patients who underwent epicardial LAAL from 2014-2019 (median CHA2DS2-VASc score = 4.0). There were 251 and 228 patients discharged with and without AC, respectively, who were followed for 30 days. Patients were matched via 1:1 Propensity Score Matching (PSM;n = 115 per group). Post-discharge outcomes included stroke, bleeding, readmission for cardiac re-intervention, mortality, and a composite endpoint comprised of the aforementioned outcomes. Results: There was no difference in post-discharge stroke incidence regardless of AC (adjusted cumulative incidence (ACI) 0.009 CI [0.001 - 0.043] with AC vs 0.009 CI [0.001 - 0.43] without AC;p = 0.826), post-discharge bleeding (ACI 0.018 CI [0.003 - 0.057] with AC vs 0.009 CI [0.001 - 0.046] without AC;p = 0.738), readmission for cardiac re-intervention (ACI 0.009 CI [0.009 - 0.009] with AC vs 0 CI [NA] without AC;p = 0.340, post-discharge mortality (ACI 0 CI NA with AC vs 0.009 CI [0.001 - 0.046] without AC;p = 0.123, or in the composite outcome (ACI 0.026 CI [0.007 - 0.069] with AC vs 0.027 CI [0.007 - 0.071] without AC;p = 0.824. Conclusion: Cessation of AC in patients with elevated stroke risk following epicardial LAAL during cardiac surgery does not affect stroke rate, mortality, or bleeding incidence up to 30 days post-discharge in this preliminary analysis.

关键词： Arrhythmias Minimally Invasive Surgery Perioperative Care

Multi-Modality Imaging in a Hybrid Setting Facilitates Transcatheter Closure of a Traumatic Ventricular Septal Defect

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World Journal of Cardiovascular Surgery 2013年第6期3卷 186-189页

作者： Tamim Nazif Rebecca T. Hahn Robert Sommer Susheel K. Kodali Mathew R. Williams isaac george Divisions of Interventional Cardiology and Cardiothoracic Surgery Columbia University College of Physicians and Surgeons New York USA

We present a case of transcatheter closure of a traumatic ventricular septal defect (VSD), in which simultaneous 3-dimensional (3D) transesophageal echocardiography (TEE) and angiography played a critical role in defe... 详细信息

关键词： Ventricular Septal Defect Transcatheter Percutaneous

Anticancer potential of metabolic compounds from marine actinomycetes isolated from Lagos Lagoon sediment

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Journal of Pharmaceutical Analysis 2019年第3期9卷 201-208页

作者： Olabisi Flora Davies-Bolorunduro isaac Adeyemi Adeleye Moshood Olushola Akinleye Peng george Wang Department of Microbiology University of Lagos Akoka Lagos Nigeria Department of Pharmaceutical Chemistry University of Lagos Idi-Araba Lagos Nigeria Department of Chemistry Georgia State University Atlanta GA United States

Thirty-two actinomycetes strains were isolated from sediment samples from 12 different sites at Lagos Lagoon and identified using standard physiological and biochemical procedures as well as 16S rDNA gene sequence analysis. Secondary metabolites were extracted from the strains and their anticancer activity on the K562 (Human acute myelocytic leukemia), HeLa (cervical carcinoma), AGS (Human gastric), MCF- 7 (breast adenocarcinoma) and HL-60 (Human acute promyelocytic leukemia) cell lines was determined. The metabolic extracts exhibited cytotoxicity with IC50 values ranging from 0.030 mg/mL to 4.4 mg/mL. The Streptomyces bingchenggensis ULS14 extract was cytotoxic against all the cell lines tested. The bioactivity-guided extraction and purification of the metabolic extracts from this strain yielded two purified anticancer compounds: ULDF4 and ULDF5. The structures of the extracted compounds were determined using spectroscopic analyses, including electrospray ionization mass spectrophotometer and nuclear magnetic resonance (1 Dimensional and 2 Dimensional), and were shown to be structurally similar to staurosporine and kigamicin. The IC50 of ULDF4 and ULDF5 against the HeLa cell line was 0.034 mg/mL and 0.075 mg/mL, respectively. This study is the first to reveal the anticancer potential of actinomycetes from Lagos Lagoon, which could be exploited for therapeutic purposes.

关键词： Streptomyces bingchenggensis ULS14 Metabolic extracts Cytotoxicity Spectroscopy Kigamicin Staurosporine

Hyoscyamine-producing marine Actinomycetes from Lagos Lagoon sediment

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Asian Pacific Journal of Tropical Biomedicine 2015年第3期5卷 196-201页

作者： Davies Olabisi Flora Adeleye isaac Adeyemi Wang Peng george Department of Microbiology.University of Lagos Department of Chemistry Georgia State University

Objective:To isolate and screen Actinoniycetes from Lagos Lagoon soil sediments for production of bioactive ***:Sediment samples were collected from four different locations of Lagos Lagoon and were dried for 2 weeks after which the Actinoniycetes were isolated by serial dilution using the spread plate method on starch casein and Kuster's agar supplemented with 80 ug/mL cycloheximide to prevent fungal *** plates were incubated at 28 C for 1-2 *** were selected based on their colonial characteristics as well as their Gram's reaction and subciiltured using the same media for isolation until pure cultures were obtained and incubated at 28 C for 3 ***,they were inoculated into starch casein and Kuster's broth media and incubated for 8 *** secondary metabolites were screened for antimicrobial activity against the following microorganisms:methicillin resistant Staphylococcus *** aureus ATCC *** coli ATCC *** aeruginosa ATCC *** albicans and Enterocolitis faecal is ATCC *** staphylococci isolated from HIV patients were also used(Staphylococcus *** xylosus and Staphylococcus epidennidis).The antimicrobial metabolites of the Actinoniycetes isolates were identified using gas chromatography(GC).Results:Crude extracts of isolates showed antimicrobial activity against some of the test *** GC data analysis showed the antibiotic profile of these ***:Analysis of the crude extracts of the isolates using GC method,revealed the presence of antibiotics including an anticholinergic hyoscyamine among other conclusions.

关键词： Marine Actinomycetes Streptomyces Antimethicillin resistance Molecular identification Morphological characteristics Gas chromatography

Antimethicilin resistance agents from marine actinomycetes from soil sediments of Lagos Lagoon

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Journal of Coastal Life Medicine 2015年第3期3卷 193-198页

作者： Davies Olabisi Flora Adeleye isaac Adeyemi Wang Peng george Department of Microbiology University of LagosAkokaLagos StateNigeria Department of Chemistry Georgia State UniversityAtlantaGeorgiaUSA

Objective:To evaluate the isolation of actinomycetes strains with potential for producing antimicrobials with high methicilin resistance ***:The soil samples were collected from four different locations of Lagos *** Actinomycetes were isolated from the samples by serial dilution using spread plate *** were selected based on their cultural characteristics as well as their Gram reaction and phenotypically and molecularly characterized Streptomyces *** were inoculated in starch casein and Kuster’s broth media and secondary metabolites were screened for antimicrobial activity against the following microorganisms:methicillin resistant Staphylococcus aureus,Staphylococcus aureus ATCC 29213,Escherichia coli ATCC 29522,Pseudomonas aeruginosa ATCC 27853,Candida albicans,Enterococcus faecalis ATCC ***-negative staphylococci isolated from HIV patients were also used(Staphylococcus warneri,Staphylococcus xylosus and Staphylococcus epidermidis).The antimicrobial metabolites of the isolates were identified using gas chromatography-mass ***:Extracts from isolates ULS12 and ULS13 showed antimicrobial activity against methicillin resistant Staphylococcus aureus while ULK3 inhibited Candida albicans *** gas chromatography-mass spectrometer data analysis showed the antibiotic profile of these ***:The isolates ULS12 and ULS13 were found to display the highest antimicrobial activity against the test organisms and could be a potential source of new antibiotics.

关键词： Marine actinomycetes Streptomyces Antimethicillin resistance Molecular identification Morphological characteristics GC-MS

Himalomycin A and cycloheximide-producing marine actinomycete from Lagos Lagoon soil sediment

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Journal of Coastal Life Medicine 2015年第5期 361-365页

Objective:To isolate and screen Actinomycetes from Lagos Lagoon soil sediments for antibiotic ***:Soil samples were collected from four different locations of Lagos Lagoon and were dried for 2 *** were isolated by serial dilution using spread plate method on starch casein and Kuster’s agar supplemented with 80μg/mL cycloheximide to prevent fungal *** plates were incubated at 28°C for 1-2 *** were selected based on their cultural characteristics as well as their Gram’s reaction and subcultured on same media for isolation and incubated at 28°C for 3 *** cultures were maintained on nutrient agar slants at 4°***,they were inoculated into starch casein and Kuster’s broth media and incubated at 28°C for 8 *** resulting crude extracts were screened for antimicrobial activity against the following microorganisms:methicillin resistant Staphylococcus aureus,Staphylococcus aureus ATCC 29213,Escherichia coli ATCC 29522,Pseudomonas aeruginosa ATCC 27853,Candida albicans and Enterococcus faecalis ATCC ***-negative staphylococci isolated from HIV patients were also used(Staphylococcus warneri,Staphylococcus xylosus and Staphylococcus epidermidis).Extraction of secondary metabolites was carried out and analysed using gas chromatography-mass ***:All the isolates displayed varying antimicrobial activity against at least one of the test *** A was identified in the extract from isolate *** gas chromatography-mass spectrometer data analysis showed the antibiotic profile of these ***:The isolate ULS7 was found to display the highest antimicrobial activity against the test organisms.

关键词： Marine Actinomycetes Streptomyces Himalomycin A Cycloheximide Molecular identification Morphological characteristics Gaschromatography-mass spectrometer

Knowledge, Attitude and Practice of Physicians in the Treatment of Hypertension in North-Central Nigeria

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World Journal of Cardiovascular Diseases 2014年第5期4卷 251-256页

作者： Umar Gati Adamu Idogonsit Okon Ibok Aisha Abdullahi isaac Olajide Ogundele george Alaba Okuku Department of Hematology and Blood Transfusion Federal Medical Centre Bida Nigeria Department of Medicine Federal Medical Centre Bida Nigeria Department of Nursing Services General Hospital Minna Nigeria Department of Obstetrics and Gynaecology Federal Medical Centre Bida Nigeria

Background and Objectives: Hypertension is a global health hazard and most cases are first attended to by the physicians. Achieving a control will depend on the knowledge, attitude and practice of the physicians. We therefore determined the knowledge, attitude and practices of physicians on the detection and treatment of arterial hypertension in north-central Nigeria. Design and Methods: A cross-sectional study of 100 of the 250 physicians attending a continuing medical education lecture series in Bida was conducted using a pre-validated self administered questionnaire. Results: The mean age of the physicians was 41.05 ± 8.71 years and 59 (73.8%) were males. Forty-one (51.2%) of them have practiced for more than 10 years. Arterial hypertension was considered an important health problem by 93.8% of the physicians, 30% of them believed that it should not be referred to a specialist. Majority of the physicians request for urinalysis (96.2%), electrocardiogram (95.0%), fasting blood glucose (88.8%), blood urea nitrogen (98.8%) and fasting lipid profile (97.5%) to either assess target organ damage or associated co-morbid conditions. Fifty-seven (71.2%) of the physicians prescribe diuretics as the initial drug. However, the knowledge of the other drugs on initiation of therapy of mild uncomplicated hypertension was poor. The sources of information on arterial hypertension by physicians were scientific programs (73.8%), drug companies (38.8%) and journals in 11.3%. Conclusion: The knowledge, attitude and practice of physicians in the detection and management of hypertension were modest. Educative programs like continuing medical education, seminars, and conferences on cardiovascular disorders are advised to be organized regularly to strengthen these and update the physicians.

关键词： Arterial Hypertension Physicians Continuing Medical Education North-Central Nigeria

Improving hospital-based trauma care for road traffic injuries in Malawi

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World Journal of Emergency Medicine 2017年第2期8卷 85-90页

作者： Linda Chokotho Wakisa Mulwafu isaac Singini Yasin Sjalale Kathryn H. Jacobsen Belt Cure Hospital Blantyre Malawi Department of Surgery College of Medicine University of Malawi Blantyre Malawi Johns Hopkins Project Blantyre Malawi Blantyre Adventist Hospital Blantyre Malawi Department of Global & Community Health George Mason University Fairfax Virginia USA

BACKGROUND: The mortality rate from road traffic injuries has increased in sub-Saharan Africa as the number of motor vehicles increase. This study examined the capacity of hospitals along Malawi's main north-south highway to provide emergency trauma ***: Structured interviews and checklists were used to evaluate the infrastructure, personnel, supplies, and equipment at all four of Malawi's central hospitals, ten district hospitals, and one mission hospital in 2014. Most of these facilities are along the main north-south highway that spans the ***: Between July 2013 and March 2014, more than 9 200 road traffic injuries(RTIs) and 100 RTI deaths were recorded by the participating hospitals. All of the hospitals reported staff shortages, especially during nights and weekends. Few clinicians had completed formal training in emergency trauma management, and healthcare workers reported gaps in knowledge and skills, especially at district hospitals. Most central hospitals had access to the critical supplies and medications necessary for trauma care, but district hospitals lacked some of the supplies and equipment needed for diagnosis, treatment, and personal ***: The mortality and disability burden from road traffi c injuries in Malawi(and other low-income countries in sub-Saharan Africa) can be reduced by ensuring that every central and district hospital has a dedicated trauma unit with qualified staff who have completed primary trauma care courses and have access to the equipment necessary to save lives.

关键词： Traffic accidents Emergency medical services Developing countries Road traffi c injuries Sub-Saharan Africa