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Experience with Miniaturized Cardiopulmonary Bypass in Cardiac Surgery: A Prospective Comparison of the NovoSCI Ready System to Off-Pump and Conventional Coronary Artery Bypass Grafting

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World Journal of Cardiovascular Surgery 2014年第12期4卷 232-238页

作者： Dominic Emerson Debbie Baldwin Miguel Pinales michael greenberg Melissa Mattes Gregory Trachiotis Veterans Affairs Medical Center Washington DC USA Georgetown University Hospital Washington DC USA The George Washington University Hospital Washington DC USA

The major source of morbidity following cardiopulmonary bypass (CPB) is the systemic inflammatory response (SIRS response) which leads to multiple derangements in different organ systems. To combat this, miniaturized cardiopulmonary bypass circuits (MCPBC) have been created to lessen the inflammatory response to CPB. Here we examine early outcomes following coronary artery bypass grafting (CABG) using a MCPBC system compared to conventional bypass techniques at a single institution. Methods: 60 consecutive patients undergoing elective CABG were prospectively enrolled. Nine patients underwent coronary artery bypass grafting (CABG) with conventional CPB (cCABG), 33 underwent off-pump CABG (OPCAB), and the remaining 18 patients underwent CABG with a MCPBC system. Demographics and outcomes were compared between groups and statistical analyses applied. Results: No significant difference was observed in mortality between groups, with only one death reported in total. Morbidity was also low, totaling only 6.7%, with none occurring in the MCPBC group. The MCPBC group required less PRBC and total blood product transfusion than the cCABG and OPCABG groups (p = 0.05), but changes in PLT and Hct over time were not different between groups. Conclusions: The MCPBC system was shown to be comparable to conventional bypass and OPCABG in terms of postoperative complications and mortality. Furthermore, the MCPBC system had the advantage of a decreased transfusion requirement. Based on our preliminary observations, this mini-cardiopulmonary bypass circuit provides a safe alternative to conventional bypass techniques.

关键词： Miniaturized Circuits Coronary Artery Bypass Graft Outcomes

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Long-Term Survival after CABG in Diabetics with Aggressive Risk Factor Management

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World Journal of Cardiovascular Surgery 2014年第12期4卷 217-222页

作者： Kendal Endicott Conor Hynes Dominic Emerson Peter Kokkinos michael greenberg Gregory Trachiotis Division of Cardiothoracic Surgery Veterans Affairs Medical Center Washington DC USA Division of Cardiology Veterans Affairs Medical Center Washington DC USA Division of Cardiothoracic Surgery The George Washington University Washington DC USA

Objectives: Diabetes is a well-established risk factor for cardiovascular disease, and diabetics have a threefold increase in risk of death from cardiovascular disease compared to non-diabetics. Following coronary artery bypass grafting, tight glycemic control improves short-term outcomes, however limited data exist for long-term outcomes. Here we examine these outcomes in diabetics using aggressive risk factor management. Methods: A retrospective review of all patients under-going coronary artery bypass between 1991 and 2000 at a single Veterans Affairs Medical Center was undertaken. 973 patients were included, 313 with diabetes and 660 without. Strict glucose control was maintained for all patients. Additional risk factor modification, including anti-platelets medications, statins, and beta blockers were also used. Survival analysis was performed. Results: The diabetic group was at higher risk, with age, BSA, and NYHA class all being greater (p < 0.05). The mean follow-up time was 6.7 ± 3 years. There were 28 deaths/1000 person-years for non-diabetics, and 48 deaths/1000 person-years for diabetics. Survival rates were significantly higher for non-diabetics (72% versus 58% in the diabetic group, p < 0.001). Cox proportional hazard analysis demonstrated mortality risk was 57% higher for diabetic patients (hazard ratio = 1.57;CI: 1.19 - 2.09;p = 0.002). The mortality risk in diabetics with and without prior MI was similar (HR = 0.83;CI: 0.54 - 1.28;p = 0.40). Conclusions: Diabetics undergoing coronary bypass have poorer long-term survival than non-diabetics despite perioperative glycemic control and risk factor modification. The long-term survival decrease in diabetics with history of MI is attenuated with surgical revascularization.

关键词： Coronary Artery Bypass Graft Diabetes Mortality Myocardial Infarction

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Brain Natriuretic Peptide as an Additional Metric for Determining Operative Candidates among Veterans with Aortic Stenosis

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World Journal of Cardiovascular Surgery 2017年第9期7卷 111-118页

作者： Matthew Skancke Jacob Lambdin Richard Amdur Jason Morrisette michael greenberg Gregory Trachiotis Division of Cardiothoracic Surgery Veterans Affairs Medical Center Washington DC USA Division of Cardiology Veterans Affairs Medical Center Washington DC USA Division of Cardiothoracic Surgery the George Washington University Washington DC USA

Objective: As the veteran population ages, the incidence of clinically significant aortic stenosis (AS) is increasing and aortic stenosis has become a veterans’ health issue. This analysis focused on using serum Brain Natriuretic Peptide (BNP) levels as an adjunct to aid decision making for early aortic valve replacement (AVR) in veterans with severe AS to reduce hospital admission rates. Methods: We retrospectively reviewed the charts of patients referred to the heart valve clinic at the Washington DC, Veterans Affairs Medical Center (VAMC) Heart Center between 2004 and 2015 who were diagnosed with severe AS. We identified veterans who had a BNP drawn in addition to traditional echocardiography during their diagnostic workup. This cohort was then stratified based on their serum BNP levels and whether they received medical therapy or aortic valve replacement. The primary endpoint of interest was admission to a VAMC for valvular heart failure. Results: Univariate analysis of BNP quartile and operative status showed a reduction in number of admissions for veterans who underwent AVR with BNP between 101 and 300 (0.64 vs. 3.71, p = 0.054) and 301 and 1000 (1.36 vs. 4.0, p = 0.003) compared to veterans treated medically. There was no difference in number of admissions for veterans with BNP lower than 100 (p = 0.455) or higher than 1000 (p = 0.659). Conclusion: BNP may be a useful adjunct for selecting patients with AS for earlier AVR leading to lower rates of hospital admissions in the veteran population. Continued analysis in a larger cohort will be needed to further validate the utility of BNP stratification as a diagnostic tool to risk stratify patients with AS in a heart valve clinic.

关键词： BNP Aortic Stenosis Valve Replacement

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纽约地铁:乞丐的天堂

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英语学习 2005年第8期 23-25页

作者： michael greenberg 秋叶

On New York's subway carriages atcertain hours of the evening,the paradeof panhandlers' is *** is asthough one has paid two bucks to attend abeggar's *** members of the audience sitfacing one another in rows,while performersenter on cue through sliding steel doors to trytheir luck on the cramped stage. Competition *** audience is hardened and *** the Poet,tall,trim in a golden corduroyjacket,decent shoes,and black linen *** is brash and satirical as he delivers,ina theatrical voice,the same strung-togetherproverbs he has been offering for years. "In theland of the blind the one-eyed man is king."Heseems more like an adventurer than a beggar,baiting us,repeating tabloid gossip,not asking forour support so much as claiming it as his due.

关键词：亚伯拉罕

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谁能识破骗子的伎俩?

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英语学习 2004年第11期 18-20页

作者： michael greenberg 秋叶

With the hope of renting my apartment while away onvacation,I place an ad on a well-known web site.A coupleof queries float in that quickly fade *** I receivean e-mail from a woman who identifies herself as"Gladys ***.I will be in New York City working as especial faculty atColumbia University",she writes."How many beds you have?"Idescribe my apartment,mentioning my five-year-old son's bedroom."How many are you?"I ask *** shoots back with:"We

关键词：骗子谁能

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Heart Valve Clinic: A Model for Treatment of Structural Heart Disease

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World Journal of Cardiovascular Surgery 2017年第1期7卷 1-9页

作者： Kendal Endicott Jacob Lambdin Jason Morrisette Amy Kirkpatrick Christian Nagy Frederick Mordini michael greenberg Gregory Trachiotis Division of Cardiology and Cardiothoracic Surgery The Heart Center Washington DC Veterans Affairs Medical Center Washington DC USA The George Washington University Washington DC USA

Background and Aim of the Study: Valvular heart disease (VHD) should be managed by a Heart Valve Team (HVT) for optimal treatment. Although the prevalence of VHD is increasing, an overall lack of universal implementation of the HVT continues to exist. Here we present our model of care within a Veteran’s Affairs Medical Center (VAMC). Materials and Methods: All patients referred to our VAMC with structural valvular disease have been managed within our multidisciplinary heart valve clinic since 2006. The heart valve clinic consists of a dedicated valve surgeon as well as both a dedicated noninvasive imaging cardiologist and cardiac MRI/CT cardiologist. Cases are reviewed on a weekly basis with multidisciplinary input to guide treatment strategy. Therapy includes medical management, facilitation of further diagnostic workup, and referral for operative intervention. Results: Between 2006 and 2015, 560 patients have been evaluated in HVC. Overall, new patient yearly volume has nearly tripled with now over 90 new consults seen yearly. Of the patients evaluated, 313 were referred for operative intervention with follow up post-operatively to affirm adequate post-procedural function. Following HVC referral trends, operative yearly volume has increased 33% over the last year years compared to the first three years of the program. The heart valve clinic has also matured to support a dedicated TAVR program. Conclusions: As the options for heart valve therapy and indications for surgery continue to evolve, a multidisciplinary team to guide decision making is imperative. We present the success and growth of our heart valve clinic within a VAMC as a structural model that can be translated into both the community and academic setting.

关键词： Acquired Disease Valve Replacement

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往昔风情：纽约的推车小贩

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英语学习 2009年第7期 29-32页

作者： michael greenberg 秦苑文(选译)

文章讲纽约的往昔，今日的我们却依然会深有共鸣，因为我们的许多城市至今还有许多推车小贩挣扎在生存的边缘。文中的温情与酸楚也许能令我们有所了悟：同一座城市里，有些人活得容易，有些人活得艰辛，而城市本身，应当是为所有人的吧。

关键词：纽约风情城市所有人

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The Structural Impact of Aortic Valve Replacement on Mitral Regurgitation

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World Journal of Cardiovascular Surgery 2016年第2期6卷 19-24页

作者： Conor F. Hynes Dominic A. Emerson michael D. greenberg Federico E. Mordini Gregory D. Trachiotis Division of Cardiothoracic Surgery Veterans Affairs Medical Center Washington DC USA Division of Cardiology Veterans Affairs Medical Center Washington DC USA Division of Cardiothoracic Surgery The George Washington University Washington DC USA

Background: Structural changes to the mitral annulus occur following aortic valve replacement (AVR) for severe aortic stenosis which may influence functional mitral regurgitation (MR). Methods: A retrospective review of 44 patients who underwent open AVR for aortic stenosis at a single center from 2010-2013 was performed. Patients undergoing concomitant aortic root surgery or with severe MR were excluded. MR was evaluated with preoperative and postoperative transthoracic echocardiograms. Univariate and multivariable analyses were performed to assess for factors associated with postoperative MR improvement and worsening. Results: Prior to AVR, none had severe MR, 5% (2 patients) had moderate, 9% (4 patients) mild-to-moderate, 46% (20 patients) mild, and 23% (9 patients) trace MR. Of patients with pre-operative MR, 44% (16 patients) experienced improvement of MR. Six patients had worsening of MR and the remaining 22 patients had no change. Cases of more severe MR were more likely to improve compared with mild or trace MR (P = 0.04). MR worsening was significantly more likely in patients with bicuspid aortic valves (83% vs. 24%;P = 0.004), and with larger aortic annulus diameters (P = 0.03). MR worsening was less frequent in cases of mitral annular calcification (0% vs 42%;P = 0.04) and left atrial enlargement (17% vs 65%;P = 0.03). Logistic regression analysis revealed negative predictors for MR improvement were mitral annular calcification (P = 0.04) and larger aortic annulus diastolic diameter (P = 0.05). Conclusion: Structural factors such as aortic annular size, mitral annular calcification and valve morphology may impact MR following AVR and should be investigated further as potential targets of surgical therapy.

关键词： Aortic Valve Replacement Cardiac Anatomy/Pathologic Anatomy Mitral Regurgitation

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Long Term Results of Valve Operations in Patients with Diabetes

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World Journal of Cardiovascular Surgery 2012年第4期2卷 61-65页

作者： Stephen J. Huddleston Erin Goheen Isaac Opoku-Asare Peter Kokkinos michael D. greenberg Gregory D. Trachiotis Department of Surgery Division of Cardiac Surgery The Johns Hopkins Medical Institutions and the Departments of Medicine and Cardiology and Cardiothoracic Surgery at The Washington DC Veterans Affairs Medical Center and The George Washington Department of Surgery Division of Cardiac Surgery The Johns Hopkins Medical Institutions and the Departments of Medicine and Cardiology and Cardiothoracic Surgery at The Washington DC Veterans Affairs Medical Center and The George Washington University Washington USA Department of Surgery Division of Cardiac Surgery The Johns Hopkins Medical Institutions and the Departments of Medicine and Cardiology and Cardiothoracic Surgery at The Washington DC Veterans Affairs Medical Center and The George Washington University Washington USA

Diabetes Mellitus (DM) adversely affects survival in patients with Coronary Artery Disease (CAD) undergoing Coronary Artery Bypass Grafting (CABG) surgery. The influence of diabetes on events after valve operations is less defined. We analyzed the effect of diabetes on short and long term outcomes in patients undergoing valvular operations. A total of 2200 patients had cardiac surgery at a single VA Medical Center between 1991 and 2008. 355 patients had undergone valve replacement or repair. Data documenting the presence of diabetes was collected prospectively and captured into the Veterans Affairs electronic medical record. Of the 355 patients who had a valvular operation, 259 (79%) had an Aortic Valve Replacement (AVR), 69 (20%) had a Mitral Valve Repair/Replacement (MVR), and 4 (1%) had a Tricsupid Valve Repair/Replacement (TVR), and 19% (n = 69) of all patients had diabetes. 44% of patients with DM and 38% of patients without DM had a combined valve and CABG procedure. During a total follow up of 18 yrs, 42 (60%) of patients with diabetes and 186 (65%) of patients without diabetes were alive (p = 0.118). At 1, 5, 10, 15 yrs survival in patients with versus without diabetes were 91% v 87%;71% v 74%;40% v 56%;23% v 48% (p = NS). The presence of diabetes does not appear to adversely effect long-term survival in patients undergoing valve operations.

关键词： Cardiac Heart Valve Diabetes

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Research evolution of metal organic frameworks: A scientometric approach with human-in-the-loop

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Journal of Data and Information Science 2024年第3期9卷 44-64页

作者： Xintong Zhao Kyle Langlois Jacob Furst Yuan An Xiaohua Hu Diego Gomez Gualdron Fernando Uribe-Romo Jane greenberg Drexel University 3141 Chestnut StPhiladelphiaPAUSA University of Central Florida 4000 Central Florida BlvdOrlandoFLUSA Colorado School of Mines 1500 Illinois StGoldenCOUSA

Purpose:This paper reports on a scientometric analysis bolstered by human-in-the-loop,domain experts,to examine the field of metal-organic frameworks(MOFs)*** analyses reveal the intellectual landscape of a *** study engaged MOF scientists in the design and review of our research *** materials are an essential component in next-generation renewable energy storage and biomedical *** research approach demonstrates how engaging experts,via human-in-the-loop processes,can help develop a comprehensive view of a field’s research trends,influential works,and specialized ***/methodology/approach:Ascientometric analysis was conducted,integrating natural language processing(NLP),topic modeling,and network analysis *** analytical approach was enhanced through a human-in-the-loop iterative process involving MOF research scientists at selected *** researcher feedback was incorporated into our *** data sample included 65,209 MOF research ***3 and software tool VOSviewer were used to perform the ***:The findings demonstrate the value of including domain experts in research workflows,refinement,and interpretation of *** each stage of the analysis,the MOF researchers contributed to interpreting the results and method refinements targeting our focus Research evolution of metal organic frameworks:A scientometric approach with human-in-the-loop on MOF *** study identified influential works and their *** findings also underscore four main MOF research directions and *** limitations:This study is limited by the sample(articles identified and referenced by the Cambridge Structural Database)that informed our *** implications:Our findings contribute to addressing the current gap in fully mapping out the comprehensive landscape of MOF ***,the results will help domain scientists target future research directions.

关键词： Scientometric Metal-Organic Frameworks(MOFs) Network analysis Topic modeling Human-in-the-loop

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