A multi-stem cell basis for craniosynostosis and calvarial mineralization.

Craniosynostosis is a group of disorders of premature calvarial suture fusion. The identity of the calvarial stem cells (CSCs) that produce fusion-driving osteoblasts in craniosynostosis remains poorly understood. Here we show that both physiologic calvarial mineralization and pathologic calvarial fusion in craniosynostosis reflect the interaction of two separate stem cell lineages; a previously identified cathepsin K (CTSK) lineage CSC (CTSK CSC) and a separate discoidin domain-containing receptor 2 (DDR2) lineage stem cell (DDR2 CSC) that we identified in this study.

Using Cognitive Load Theory to Improve Teaching in the Clinical Workplace.

Introduction: Cognitive load theory (CLT) views working memory as the primary bottleneck for learning, as it is limited in both capacity and retention. CLT delineates three types of activities that impose on working memory: intrinsic load, germane load, and extraneous load. These three constructs have practical ramifications for direct teaching, learning environments, and curricular design.

Five-Year Outcomes after PCI or CABG for Left Main Coronary Disease.

Background: Long-term outcomes after percutaneous coronary intervention (PCI) with contemporary drug-eluting stents, as compared with coronary-artery bypass grafting (CABG), in patients with left main coronary artery disease are not clearly established.

Methods: We randomly assigned 1905 patients with left main coronary artery disease of low or intermediate anatomical complexity (according to assessment at the participating centers) to undergo either PCI with fluoropolymer-based cobalt-chromium everolimus-eluting stents (PCI group, 948 patients) or CABG (CABG group, 957 patients). The primary outcome was a composite of death, stroke, or myocardial infarction.

Sudden unexpected death in epilepsy, periictal physiology, and the SUDEP-7 Inventory.

Sudden unexpected death in epilepsy (SUDEP) is a significant public health burden. Epidemiological studies have identified clinical SUDEP risk factors across large populations, but the means to apply this information to individual patients are lacking. The SUDEP-7 Inventory was developed as a marker of clinical SUDEP risk and has been used in studies of potential SUDEP biomarkers.

Left main coronary artery disease: pathophysiology, diagnosis, and treatment.

The advent of coronary angiography in the 1960s allowed for the risk stratification of patients with stable angina. Patients with unprotected left main coronary artery disease have an increased risk of death related to the large amount of myocardium supplied by this vessel. Although coronary angiography remains the preferred imaging modality for the evaluation of left main coronary artery stenosis, this technique has important limitations.

Coronary balloon angioplasty, stents, and scaffolds.

Since the first coronary angioplasty on Sept 16, 1977, the field of percutaneous coronary intervention has evolved rapidly. Now marking its 40th anniversary, percutaneous coronary intervention has become one of the most common medical procedures worldwide. Much of this progress has been due to the iteration and improvement of angioplasty technologies.

Practical determination of aortic valve calcium volume score on contrast-enhanced computed tomography prior to transcatheter aortic valve replacement and impact on paravalvular regurgitation: Elucidating optimal threshold cutoffs.

Background: The threshold for the optimal computed tomography (CT) number in Hounsfield Units (HU) to quantify aortic valvular calcium on contrast-enhanced scans has not been standardized. Our aim was to find the most accurate threshold to predict paravalvular regurgitation (PVR) after transcatheter aortic valve replacement (TAVR).

Methods: 104 patients who underwent TAVR with the CoreValve prosthesis were studied retrospectively.

Everolimus-Eluting Stents or Bypass Surgery for Left Main Coronary Artery Disease.

Background: Patients with obstructive left main coronary artery disease are usually treated with coronary-artery bypass grafting (CABG). Randomized trials have suggested that drug-eluting stents may be an acceptable alternative to CABG in selected patients with left main coronary disease.

Methods: We randomly assigned 1905 eligible patients with left main coronary artery disease of low or intermediate anatomical complexity to undergo either percutaneous coronary intervention (PCI) with fluoropolymer-based cobalt-chromium everolimus-eluting stents (PCI group, 948 patients) or CABG (CABG group, 957 patients).

Scorecard implementation improves identification of postpartum patients at risk for venous thromboembolism.

Objective: To evaluate if an intensive educational intervention in the use of a standardized venous thromboembolism (VTE) risk assessment tool (scorecard) improves physicians' identification and chemoprophylaxis of postpartum patients at risk for VTE.

Methods: After implementation of a VTE scorecard and prior to an intensive educational intervention, postpartum patients (n = 140) were evaluated to assess scorecard completion, risk factors, and chemoprophylaxis. A performance improvement campaign focusing on patient safety, VTE prevention, and scorecard utilization was then conducted.

Marijuana Use and Psychiatric Disorders in Perinatally HIV-Exposed Youth: Does HIV Matter?

Objective:  To examine longitudinal reciprocal relationships between marijuana use and psychiatric disorders, and identify the role of HIV in a sample (N = 340) of youth perinatally infected with HIV (PHIV+) and youth perinatally exposed but uninfected with HIV (PHIV-) (60.6% PHIV+; 9-16 years at baseline; 51% female). 

Methods:  Cross-lagged structural equation modeling was used to examine longitudinal associations between changes in marijuana use and changes in any behavioral, mood, and anxiety disorders at three time points across adolescence.

Orbital Atherectomy Plaque Modification Assessment of the Femoropopliteal Artery Via Intravascular Ultrasound (TRUTH Study).

Objective: The Tissue Removal Assessment with Ultrasound of the SFA and Popliteal (TRUTH) study assessed the performance of the orbital atherectomy system (OAS) to treat femoropopliteal arteries, including determining its effect on plaque removal.

Methods: Patients with symptomatic femoropopliteal peripheral arterial disease were treated with the OAS followed by adjunctive balloon angioplasty (BA). Intravascular ultrasound (IVUS) images were collected pre- and post-OAS and post-OAS BA.

Skeletal Muscle Changes in Chronic Cardiac Disease and Failure.

Peak exercise performance in healthy man is limited not only by pulmonary or skeletal muscle function but also by cardiac function. Thus, abnormalities in cardiac function will have a major impact on exercise performance. Many cardiac diseases affect exercise performance and indeed for some cardiac conditions such as atherosclerotic heart disease, exercise testing is frequently used not only to measure functional capacity but also to make a diagnosis of heart disease, evaluate the efficacy of treatment, and predict prognosis.

Validation of the SYNTAX revascularization index to quantify reasonable level of incomplete revascularization after percutaneous coronary intervention.

Incomplete revascularization is common after percutaneous coronary intervention (PCI). Whether a "reasonable" degree of incomplete revascularization is associated with a similar favorable long-term prognosis compared with complete revascularization remains unknown. We sought to quantify the proportion of coronary artery disease burden treated by PCI and evaluate its impact on outcomes using a new prognostic instrument-the Synergy Between PCI with Taxus and Cardiac Surgery (SYNTAX) Revascularization Index (SRI).

Reasonable incomplete revascularisation after percutaneous coronary intervention: the SYNTAX Revascularisation Index.

Aims: Incomplete revascularisation is common after percutaneous coronary intervention (PCI). While the absolute amount of residual coronary artery disease (CAD) after PCI has been shown to be associated with worse outcomes, whether the proportion of treated CAD is prognostically important remains to be determined. We sought to quantify the proportion of CAD burden treated by PCI and to evaluate its impact on outcomes using a new prognostic instrument - the SYNTAX Revascularisation Index (SRI).

Advanced heart failure in patients infected with human immunodeficiency virus: is there equal access to care?

Background: Human immunodeficiency virus (HIV) infection has evolved from a highly stigmatized disease with certain progression to acquired immunodeficiency syndrome (AIDS) to a chronic disease affecting over 1 million Americans. With the success of current anti-retroviral therapies, cardiovascular disease, including advanced heart failure (HF), will be a major cause of morbidity and mortality in this population.

Methods: A survey concerning heart transplantation (HT) and left ventricular assist device (LVAD) implantation attitudes and outcomes in HIV-infected patients was distributed to 103 American and 9 Canadian HT centers via fax, e-mail or telephone.

Ischemic outcomes after coronary intervention of calcified vessels in acute coronary syndromes. Pooled analysis from the HORIZONS-AMI (Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction) and ACUITY (Acute Catheterization and Urgent Intervention Triage Strategy) TRIALS.

Objectives: This study sought to determine the frequency and impact of coronary calcification among patients undergoing percutaneous coronary intervention (PCI) for acute coronary syndromes (ACS).

Background: Small studies in patients with stable coronary artery disease have suggested a worse prognosis after PCI of calcified compared with noncalcified lesions. Little is known about the impact of coronary calcification on outcomes after PCI for patients presenting with non-ST-segment elevation and ST-segment elevation ACS.

A rapid needs assessment of the Rockaway Peninsula in New York City after Hurricane Sandy and the relationship of socioeconomic status to recovery.

Objectives: We conducted a rapid needs assessment in the Rockaway Peninsula-one of the areas of New York City most severely affected by Hurricane Sandy on October 29, 2012-to assess basic needs and evaluate for an association between socioeconomic status (SES) and storm recovery.

Methods: We conducted a cross-sectional survey within the Rockaways 3 weeks after the hurricane made landfall to elicit information regarding basic utilities, food access, health, relief-effort opinions, and SES. We used a modified cluster sampling method to select households with a goal of 7 to 10 surveys per cluster.

Relation between coronary calcium and major bleeding after percutaneous coronary intervention in acute coronary syndromes (from the Acute Catheterization and Urgent Intervention Triage Strategy and Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction Trials).

Percutaneous coronary intervention (PCI) of calcified coronary lesions has been associated with increased rates of adverse ischemic events. However, the potential association between the presence and severity of calcific deposits and bleeding complications has yet to be investigated. Data from 6,855 patients with non-ST-segment elevation acute coronary syndrome (NSTEACS) or ST-segment elevation myocardial infarction (STEMI) treated with PCI were pooled from 2 large-scale randomized controlled trials-Acute Catheterization and Urgent Intervention Triage Strategy and Harmonizing Outcomes with Revascularization and Stents in Acute Myocardial Infarction.