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In a randomized trial, patients with coronary artery disease and an ejection fraction of 35% or less were randomly assigned to undergo either coronary-artery bypass grafting (CABG) or CABG plus surgical ventricular reconstruction. At a median of 48 months, there was no significant difference between the two groups in the primary outcome of death or hospitalization for cardiac causes.
A genomewide association study indicates that a locus on chromosome 12 confers susceptibility (with a hazard ratio of approximately 1.3) to ischemic stroke. This locus is close to NINJ2, which encodes a cell adhesion molecule that shows increased expression on glia in response to nerve injury. A second gene near this locus influences blood pressure and hypertension.
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Aberrant signaling by members of the transforming growth factor β (TGF-β) family causes hereditary vascular disease. This study implicates HtrA serine peptidase 1 (HTRA1), a protease that represses signaling of TGF-β members, as occurs in patients with hereditary ischemic cerebral small-vessel disease.
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On the basis of data from U.S. national surveys, the authors estimate that losing health insurance was more common in 2001–2004 than in 1983–1986. Between the earlier and the later surveys, people who lost insurance became more likely to transition to public insurance than to private insurance, a finding that suggests that the availability of public insurance programs has become increasingly important for people who lose their private insurance.
A 65-year-old woman with osteoarthritis of the right knee seeks advice regarding minimally invasive total knee arthroplasty. Joint-replacement surgery is appropriate for patients with moderate-to-severe symptoms and functional limitation despite conservative therapy. The minimally invasive technique reduces postoperative pain and accelerates recovery but requires a surgeon with specific expertise and experience.
A 54-year-old woman was admitted to the hospital because of respiratory failure, hypotension, and a cavitary lesion in the lung. She had had cough and shortness of breath for a week, which abruptly worsened, and she collapsed at home. In the emergency department, she was hypotensive and unresponsive; chest imaging showed consolidation of the right upper lobe with a cavity. Tension pneumothorax developed after insertion of a jugular venous catheter. Despite placement of a chest tube and mechanical ventilation, the patient died. An autopsy was performed.
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