The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Feb 2006
Depletion of DNA methyltransferase 1 and/or DNA methyltransferase 3b mediates growth arrest and apoptosis in lung and esophageal cancer and malignant pleural mesothelioma cells.
DNA methyltransferase (DNMT)1, DNMT3b, or both, facilitate malignant transformation through chromatin remodeling mechanisms. The present study was undertaken to examine the effects of antisense-mediated inhibition of DNMT expression in cultured thoracic malignancies. ⋯ Antisense oligos targeting DNMT1 and DNMT3b induce genomic stress, and mediate potent growth inhibition in lung and esophageal cancer and MPM cells. These findings support further evaluation of DNMT knockdown strategies for cancer therapy.
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J. Thorac. Cardiovasc. Surg. · Jan 2006
Randomized Controlled TrialImproved myocardial protection during coronary artery surgery with glucose-insulin-potassium: a randomized controlled trial.
We sought to assess the role of glucose-insulin-potassium in providing myocardial protection in nondiabetic patients undergoing coronary artery surgery with cardiopulmonary bypass. ⋯ Glucose-insulin-potassium therapy improves early postoperative cardiovascular performance, reduces inotrope requirement, and might reduce myocardial injury. These potential benefits are not at the expense of increased noncardiac morbidity.
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J. Thorac. Cardiovasc. Surg. · Jan 2006
Randomized Controlled TrialSingle crossclamp improves 6-month cognitive outcome in high-risk coronary bypass patients: the effect of reduced aortic manipulation.
We hypothesized that a strategy that reduced aortic manipulation would reduce the incidence of cognitive deficits in patients undergoing coronary artery bypass grafting compared with the "traditional" approach and that neurobehavioral outcomes with the reduced aortic manipulation strategy would approach those obtained with off-pump coronary artery bypass surgery. ⋯ A surgical strategy designed to minimize aortic manipulation can significantly reduce the incidence of cognitive deficits in coronary artery bypass grafting patients compared with traditional techniques. In this series, the results of the reduced aortic manipulation strategy were not significantly different from those in patients having off-pump coronary artery bypass surgery, thus emphasizing surgical technique as the primary cause of brain damage in coronary artery bypass grafting patients.
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J. Thorac. Cardiovasc. Surg. · Jan 2006
Comparative StudyClinical outcomes of nonelective coronary revascularization with and without cardiopulmonary bypass.
Patients who undergo emergent coronary artery bypass grafting pose a greater challenge in terms of intraoperative and postoperative mortality and morbidity compared to elective coronary artery bypass. Coronary artery bypass without cardiopulmonary bypass (off-pump coronary artery bypass) might benefit these high-risk patients by eliminating the cardiopulmonary bypass and therefore decreasing the systemic inflammatory response associated with it. The aim of this study was to compare the early clinical outcome after nonelective off-pump coronary artery bypass with a matched set of patients undergoing coronary artery bypass with cardiopulmonary bypass (on pump). ⋯ Nonelective coronary revascularization without cardiopulmonary bypass is associated with comparable operative mortality and stroke and abbreviated length of stay. Off-pump coronary artery bypass might also decrease the need for intra-aortic balloon pump placement and lower the rate of postoperative renal failure and hemorrhage-related re-exploration compared with that of conventional on-pump coronary artery bypass in this subset of patients.
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J. Thorac. Cardiovasc. Surg. · Jan 2006
The relationship of postoperative electrographic seizures to neurodevelopmental outcome at 1 year of age after neonatal and infant cardiac surgery.
The occurrence of a seizure after the arterial switch operation is associated with a worse long-term neurodevelopmental outcome. The significance of seizures after neonatal and infant repair of other congenital heart defects is not known. ⋯ The occurrence of a seizure after cardiac operation is a marker of central nervous system injury. However, in this cohort of neonates and infants with complex congenital heart defects, the occurrence of a seizure was not predictive of a worse developmental outcome at 1 year of age as assessed by the Bayley Scales of Infant Development II.