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<1>
Accession Number
2011263253
Authors
Moller C.H. Perko M.J. Lund J.T. Andersen L.W. Kelbaek H. Madsen J.K.
Winkel P. Gluud C. Steinbruchel D.A.
Institution
(Moller, Perko, Lund, Steinbruchel) Department of Cardio-Thoracic Surgery,
Rigshospitalet, Copenhagen University Hospital, Denmark
(Moller, Winkel, Gluud) Center for Clinical Intervention Research,
Rigshospitalet, Copenhagen University Hospital, Denmark
(Andersen) Department of Cardio-Thoracic Anesthesiology, Rigshospitalet,
Copenhagen University Hospital, Denmark
(Kelbaek) Department of Cardiology, Rigshospitalet, Copenhagen University
Hospital, Denmark
(Madsen) Department of Cardiology, Gentofte Hospital, Copenhagen
University Hospital, Denmark
Title
Three-year follow-up in a subset of high-risk patients randomly assigned
to off-pump versus on-pump coronary artery bypass surgery: The Best Bypass
Surgery Trial.
Source
Heart. 97 (11) (pp 907-913), 2011. Date of Publication: June 2011.
Publisher
BMJ Publishing Group (Tavistock Square, London WC1H 9JR, United Kingdom)
Abstract
Objective: To evaluate off-pump versus on-pump coronary artery bypass
grafting (CABG) in patients with three-vessel disease and a high-risk
operative profile. Design: A randomised clinical trial. Setting:
Rigshospitalet, University Hospital, Copenhagen, Denmark. Participants:
341 patients with three-vessel disease and a EuroSCORE of 5 or greater.
Main exclusion criteria were previous heart surgery, poor left ventricular
function (ejection fraction <30%), or unstable preoperative condition.
Intervention: CABG performed with versus without cardiopulmonary bypass.
Main outcome measure: The primary outcome was a composite of major adverse
cardiac and cerebrovascular events (MACCE) including all-cause mortality,
acute myocardial infarction, cardiac arrest with successful resuscitation,
low cardiac output syndrome/cardiogenic shock, stroke and coronary
reintervention. Results: MACCE occurred in 69 (40%) patients allocated to
off-pump versus 54 (33%) patients allocated to on-pump CABG during the
median 3.7 years of follow-up (HR 1.22; 95% CI 0.86 to 1.75; p=0.26).
All-cause mortality was significantly increased in the off-pump group (24%
vs 15%; HR 1.66, 95% CI 1.02 to 2.73; p=0.04), but cardiac-related death
was not significantly different (10% vs 7%; HR 1.30, 95% CI 0.64 to 2.66;
p=0.47). An insignificant trend towards a reduction in myocardial
infarction after off-pump CABG was observed (7% vs 14%; HR 0.53, 95% CI:
0.27 to 1.04; p=0.06). Conclusions: No significant difference in the
primary outcome of MACCE was found between off-pump and on-pump CABG.
However, mortality seemed higher after off-pump CABG. Trial registration:
http://clinicaltrials.gov/number, NCT00120991.

<2>
Accession Number
2011263252
Authors
Abdel-Wahab M. Zahn R. Horack M. Gerckens U. Schuler G. Sievert H.
Eggebrecht H. Senges J. Richardt G.
Institution
(Abdel-Wahab, Richardt) Heart Center, Segeberger Kliniken GmbH, University
of Kiel, Am Kurpark 1, 23795 Bad Segeberg, Germany
(Zahn) Department of Cardiology, Clinical Center of Ludwigshafen,
Ludwigshafen, Germany
(Horack, Senges) Institute of Myocardial Infarction Research, University
of Heidelberg, Ludwigshafen, Germany
(Gerckens) Department of Cardiology, HELIOS Hospital, Siegburg, Germany
(Schuler) Heart Center, University of Leipzig, Leipzig, Germany
(Sievert) Cardiovascular Center Frankfurt, Sankt Katharinen, Frankfurt am
Main, Germany
(Eggebrecht) Clinic for Cardiology, West German Heart Center Essen, Essen,
Germany
Title
Aortic regurgitation after transcatheter aortic valve implantation:
Incidence and early outcome. Results from the German transcatheter aortic
valve interventions registry.
Source
Heart. 97 (11) (pp 899-906), 2011. Date of Publication: June 2011.
Publisher
BMJ Publishing Group (Tavistock Square, London WC1H 9JR, United Kingdom)
Abstract
Background: Significant aortic regurgitation (AR) is rare following
surgical aortic valve replacement and has been associated with worse
outcome. Following transcatheter aortic valve implantation (TAVI), AR is
common, but little is known about its determinants and its effect on
clinical outcome. Objective: To evaluate early outcome and risk factors
possibly associated with AR after TAVI. Methods: Data were analysed from
690 patients with severe aortic stenosis treated with TAVI enrolled in the
prospective multicentre German transcatheter aortic valve interventions
registry. The occurrence of AR was evaluated angiographically after device
deployment and removal of the catheter and guidewire. Significant AR was
defined as AR>=2/4. Results: The study population's mean age was 81.466.3
years and men represented 44%. The mean logistic Euroscore was 20.4613.1%.
Overall, 84% of patients received the Medtronic CoreValve system and 16%
received the Edwards Sapien valve. Significant AR occurred in 119 patients
(17.2%). Factors independently associated with significant AR were aortic
valve area (adjusted OR=0.10), annulus measurement by transoesophageal
echocardiography (adjusted OR=1.94), male gender (adjusted OR=1.80),
cardiogenic shock (adjusted OR=1.94) and renal failure (adjusted OR=0.53).
In-hospital death rates were significantly higher in patients with
significant AR than in those with no/mild AR (15.1% vs 6.7%, OR=2.50, 95%
CI 1.37 to 4.55), as were rates of low cardiac output (20% vs 4.4%) and
respiratory failure (16.5% vs 7.1%). Using multivariate analysis, the
presence of post-procedural AR>=2/4 remained a strong independent
predictor of inhospital death (adjusted OR=2.43, 95% CI 1.22 to 4.85).
Conclusion: Significant AR after TAVI is common and is associated with
increased in-hospital mortality. Long-term follow-up is critical to
further define the impact of residual AR on clinical outcome. Until these
data become available, every effort should be made to prevent and treat
this complication.

<3>
Accession Number
2011287743
Authors
Rittger H. Rieber J. Kogler K. Sinha A. Schmidt M. Breithardt O.-A. Biggar
P. Einsle F. Diegeler A. Brachmann J.
Institution
(Biggar) III. Medizinische Klinik, Klinikum Coburg, Ketschendorfer Str.
33, Coburg 96450, Germany
(Diegeler) Herz- und Gefasklinik, Klinik fur Herzchirurgie, Rhon Klinikum,
Bad Neustadt/Saale, Germany
(Rittger, Kogler, Sinha, Schmidt, Breithardt, Brachmann) II. Medizinische
Klinik, Klinikum Coburg, Ketschendorfer Str. 33, Coburg 96450, Germany
(Rieber) Medizinische Poliklinik, Ludwig-Maximilians-Universitat, Klinikum
Innenstadt, Munchen, Germany
(Einsle) Institut fur Psychologie, Technische Universitat Dresden,
Dresden, Germany
Title
Clinical outcome and quality of life after interventional treatment of
left main disease with drug-eluting-stents in comparison to CABG in
elderly and younger patients.
Source
Clinical Research in Cardiology. 100 (5) (pp 439-446), 2011. Date of
Publication: May 2011.
Publisher
D. Steinkopff-Verlag (P.O. Box 100462, Darmstadt D-64204, Germany)
Abstract
Introduction: The aim of this study was to prospectively assess the
clinical outcome and quality of life of elderly patients who underwent
either coronary artery bypass grafting (CABG) or percutaneous coronary
intervention (PCI) with drug-eluting stents (DES) for treatment of
significant left main disease (LMD) compared to a younger patient
population. Methods: Consecutive patients, admitted into our institution
between 04/2004 and 12/2007 with LMD and a life expectancy of >1 year were
prospectively included and stratified in two groups (either CABG or left
main stenting [LMS] with DES) based on the patients' age at inclusion (>
or <=75 years). Rates of death, myocardial infarction (MI), stroke, and
target lesion revascularization (TLR) were evaluated over a 12 month
follow-up. Six months after the initial procedure, additionally, quality
of life was assessed using the SF-36 questionnaire. Results: A total of
300 patients was included; 56 of the 95 PCI patients (59%) were <=75 years
and 39 (44%) >75 years, whereas 155 of 205 patients in the CABG group were
<=75 years (76%), and 50 patients (24%) were >75 years. Mean follow-up was
312 +/- 226 days in the PCI and 377 +/- 286 in the CABG group. Rates of
death and MI were not significantly different between the four groups at
the end of follow-up. There was no difference in quality of life after 6
months. Conclusion: In this prospective trial, PCI of LM with DES in
elderly patients was feasible with a short- and intermediate term outcome
comparable to CABG procedure and to a younger patient cohort. 2010
Springer-Verlag.

<4>
Accession Number
2011249199
Authors
Yavuz S. Kasap M. Parlar H. Agirbas H. Torol S. Kanli A. Hosten T. Kanko
M. Berki T.
Institution
(Yavuz, Parlar, Agirbas, Kanko, Berki) Department of Cardiovascular
Surgery, School of Medicine, Kocaeli University, Baki Komsuoglu Avenue,
Campus of Umuttepe, Turkey
(Kasap, Torol, Kanli) Department of Medical Biology, School of Medicine,
Kocaeli University, Kocaeli, Turkey
(Hosten) Department of Anaesthesiology, School of Medicine, Kocaeli
University, Kocaeli, Turkey
Title
Heat shock proteins and myocardial protection during cardiopulmonary
bypass.
Source
Journal of International Medical Research. 39 (2) (pp 499-507), 2011.
Date of Publication: 2011.
Publisher
Field House Publishing LLP (6 Sompting Avenue, Worthing BN14 8HN, United
States)
Abstract
This prospective randomized study investigated the effects of two
different cardioplegia techniques on myocardial heat shock protein 70
(HSP70) mRNA levels. Patients undergoing elective coronary artery bypass
grafting with cardiopulmonary bypass (CPB) were divided into two equal
groups. All patients received the same anaesthesia. Myocardial
preservation was achieved by delivering intermittent antegrade isothermic
blood cardioplegia in one group and antegrade plus continuous retrograde
isothermic blood cardioplegia in the other. Biopsies for measurement of
HSP70 mRNA levels were taken from the right atria before surgical
manipulation of the heart, and later from the same place following CPB.
HSP70 mRNA levels were evaluated using quantitative real-time reverse
transcription-polymerase chain reaction. Crossing-point values for HSP70
and beta-actin were used to evaluate up-regulation. There was a
significant increase in HSP70 mRNA levels in response to CPB in both
groups, but no significant between-group difference in HSP70
up-regulation. Further investigation is required to evaluate the
correlation between the level of HSP induction and the degree of
myocardial protection in more heterogeneous groups of patients. 2011
Field House Publishing LLP.

<5>
Accession Number
2011275781
Authors
Metterlein T. Zink W. Kranke E. Haneya A. Graf B. Kranke P.
Institution
(Metterlein, Zink, Graf) University Hospital Regensburg, Department of
Anesthesiology, Franz-Josef-Strauss-Allee 11, 93051 Regensburg, Germany
(Haneya) Department of Cardiosurgery, University Hospital Regensburg,
Regensburg, Germany
(Kranke) Department of Cardiosurgery, University Hospital Wurzburg,
Wurzburg, Germany
(Kranke) Department of Anesthesia and Critical Care, University Hospital
Wurzburg, Wurzburg, Germany
Title
Cardiopulmonary bypass in malignant hyperthermia susceptible patients: A
systematic review of published cases.
Source
Journal of Thoracic and Cardiovascular Surgery. 141 (6) (pp 1488-1495),
2011. Date of Publication: June 2011.
Publisher
Mosby Inc. (11830 Westline Industrial Drive, St. Louis MO 63146, United
States)
Abstract
Objectives: Malignant hyperthermia susceptibility is an important risk
factor during general anesthesia. Affected patients have an asymptomatic
but potentially lethal hypermetabolic reaction after contact with volatile
anesthetics or succinylcholine. Classic symptoms include hemodynamic
instability, combined with acidosis, rigor, and hyperthermia. During
cardiopulmonary bypass, these signs may be obscured, delaying correct
diagnosis and lifesaving treatment. Malignant hyperthermia-susceptible
individuals are more sensitive to heat and stress, so rewarming and
catecholamine administration may trigger an episode, necessitating
prophylactic measures. Methods: This systematic review identified typical
malignant hyperthermia symptoms during cardiopulmonary bypass and
investigated other factors in cardiac surgery that might trigger an
episode in susceptible individuals. Approaches used to treat and prevent
malignant hyperthermia during cardiopulmonary bypass were systematically
analyzed. We conducted a systematic search for reports about malignant
hyperthermia and cardiopulmonary bypass. Search terms included malignant
hyperthermia and cardiopulmonary bypass, extracorporeal circulation, or
cardiac surgery. Results: We found 24 case reports and case series
including details of 26 patients. In 14 cases, malignant hyperthermia
crises during or shortly after cardiopulmonary bypass were described.
Fourteen reports discussed prevention of an episode. Early symptoms of a
malignant hyperthermia episode include excessive carbon dioxide production
and metabolic acidosis. Massively increased creatine kinase levels are a
strong indicator of a malignant hyperthermia reaction. Rewarming is
associated with development of clinical signs of malignant hyperthermia.
Conclusions: In potentially susceptible patients, apart from avoiding
classic trigger substances, aggressive rewarming should not be applied.
Hemodynamic instability in conjunction with the described symptoms should
result in a diagnostic algorithm. 2011 by The American Association for
Thoracic Surgery.

<6>
Accession Number
2011275777
Authors
Sezai A. Minami K. Nakai T. Hata M. Yoshitake I. Wakui S. Shiono M.
Hirayama A.
Institution
(Sezai, Minami, Hata, Yoshitake, Wakui, Shiono) Department of
Cardiovascular Surgery, Nihon University, School of Medicine, 30-1
Oyaguchi-kamimachi, Itabashi-ku Tokyo, 173-8610, Japan
(Nakai, Hirayama) Department of Cardiology, Nihon University, School of
Medicine, Tokyo, Japan
Title
Landiolol hydrochloride for prevention of atrial fibrillation after
coronary artery bypass grafting: New evidence from the PASCAL trial.
Source
Journal of Thoracic and Cardiovascular Surgery. 141 (6) (pp 1478-1487),
2011. Date of Publication: June 2011.
Publisher
Mosby Inc. (11830 Westline Industrial Drive, St. Louis MO 63146, United
States)
Abstract
Objective: Atrial fibrillation occurs frequently after cardiac surgery and
not only prolongs hospitalization but also influences the prognosis. We
investigated whether landiolol hydrochloride, an ultrashort-acting
beta-blocker, could reduce postoperative atrial fibrillation in a
randomized controlled trial. Methods: The subjects were 140 patients
undergoing coronary artery bypass grafting at the Nihon University School
of Medicine. The primary end point was occurrence/non-occurrence of atrial
fibrillation up to 1 week postoperatively. Logistic regression analysis
was performed to investigate risk factors for atrial fibrillation among
preoperative, perioperative, and postoperative variables. Results: Atrial
fibrillation occurred in 7 patients (10%) in the landiolol group versus 24
patients (34.3%) in the placebo group; the landiolol group had a
significantly lower incidence (P = .0006). Postoperative heart rate was
significantly lower in the landiolol group than in the placebo group. On
returning to the intensive care unit, the landiolol group had
significantly lower inflammatory and ischemic parameters. Medical costs
were also significantly lower in the landiolol group. Multivariate
analysis revealed that significant risk factors for atrial fibrillation
were a European System for Cardiac Operative Risk Evaluation of 10 or
more, preoperative non-use of angiotensin receptor blockers, and non-use
of landiolol. Conclusions: Postoperative atrial fibrillation was reduced
by treatment with landiolol hydrochloride. Amelioration of ischemia, an
anti-inflammatory effect, and inhibition of sympathetic hypertonia by
landiolol presumably reduced the occurrence of atrial fibrillation.
Hypotension or bradycardia did not develop in any of the patients,
indicating the safety of this beta-blocker. These findings suggest that
landiolol hydrochloride could be useful in the perioperative management of
patients undergoing cardiac surgery. 2011 by The American Association for
Thoracic Surgery.

<7>
Accession Number
2011270590
Authors
Mansouri M. Bageri K. Noormohammadi E. Mirmohammadsadegi M. Mirdehgan A.
Ahangaran A.G.
Institution
(Mansouri, Bageri, Ahangaran) Anesthesiology and Critical Care Research
Center, Isfahan University of Medical Sciences, Isfahan, Iran, Islamic
Republic of
(Noormohammadi, Mirmohammadsadegi, Mirdehgan) Department of Cardiac
Surgery, Chamran Heart Hospital, Isfahan University of Medical Sciences,
Isfahan, Iran, Islamic Republic of
(Mansouri) Department of Cardiac Anesthesiology, Chamran Heart Hospital,
University of Medical Sciences, PO Box 8166173414, Isfahan, Iran, Islamic
Republic of
Title
Randomized controlled trial of bilateral intrapleural block in cardiac
surgery.
Source
Asian Cardiovascular and Thoracic Annals. 19 (2) (pp 133-138), 2011.
Date of Publication: April 2011.
Publisher
SAGE Publications Inc. (2455 Teller Road, Thousand Oaks CA 91320, United
States)
Abstract
The aim of this study was to determine the efficacy of bilateral
intrapleural block with bupivacaine as a preemptive analgesic for
postoperative pain in coronary artery bypass graft surgery. In a
double-blind prospective clinical trial, 70 patients were randomly divided
into a bupivacaine group (20 mL bupivacaine 0.25% and 0.5 mL adrenaline
1/200,000 each side) and a control group (20.5 mL normal saline each
side). Evaluation of the severity of pain was performed using the visual
analog scale at 12 and 24 h after entering the intensive care unit and
again during chest tube removal. Pain scores at 12 and 24h after intensive
care unit admission were significantly lower in the bupivacaine group.
There were no sideeffects related to intrapleural block, such as
pneumothorax or emphysema. In coronary artery bypass graft candidates,
preemptive analgesia with bilateral intrapleural block using bupivacaine
provided relatively less painful conditions during the first 24 h after
surgery, but it did not improve the clinical outcome. The Author(s) 2011.

<8>
Accession Number
2011280744
Authors
Garcia-Altes A. Peiro S.
Institution
(Garcia-Altes) Fundacion Instituto de Investigacion en Servicios de Salud,
Barcelona, Spain
(Peiro) Centro Superior de Investigacion en Salud Publica (CSISP),
Valencia, Spain
Title
A systematic review of cost-effectiveness evidence of endoscopic saphenous
vein harvesting: Is it efficient?.
Source
European Journal of Vascular and Endovascular Surgery. 41 (6) (pp
831-836), 2011. Date of Publication: June 2011.
Publisher
W.B. Saunders Ltd (32 Jamestown Road, London NW1 7BY, United Kingdom)
Abstract
Objective: Greater saphenous vein harvest for coronary and lower extremity
bypass requires the longest incision of any surgical procedure. Endoscopic
vein harvest allows better results in some clinical variables compared to
open harvesting techniques. The objective of this study is to present the
results of a systematic review of the scientific evidence about the
efficiency of endoscopic saphenous vein harvest. Methods: We performed a
systematic review in the bibliographical databases Pubmed, National Health
Service Economic Evaluation Database, and NHS Health Technology Assessment
Database. The search strategy was "endoscopic AND harvesting", in the
period January 1970-December 2009. Results: We identified only 3 economic
evaluation studies, 2 cost analyses with some methodological limitations,
and 1 cost-utility analysis. All of them suggest lower hospital costs for
endoscopic harvesting. Conclusions: Available evidence does not allow
recommendations to be made based on the efficiency of endoscopic saphenous
vein harvest, although it suggests lower costs for endoscopic harvesting.
More scientific evidence about the long-term efficacy and the
effectiveness of this technique is necessary, with studies measuring final
outcomes, and carrying out complete and rigorous economic evaluations.
2011 European Society for Vascular Surgery. Published by Elsevier Ltd. All
rights reserved.

<9>
Accession Number
2011274691
Authors
Royse C.F. Andrews D.T. Newman S.N. Stygall J. Williams Z. Pang J. Royse
A.G.
Institution
(Royse, Andrews, Williams, Pang) Anaesthesia and Pain Management Unit,
Department of Pharmacology, University of Melbourne, Carlton, VIC,
Australia
(Royse, Andrews) Department of Anaesthesia and Pain Management, Royal
Melbourne Hospital, Australia
(Newman, Stygall) Department of Health Psychology and Honorary, Unit of
Behavioural Medicine, University College London, United Kingdom
(Newman, Stygall) Faculty of Health Sciences, City University, London,
United Kingdom
(Royse) Department of Surgery, University of Melbourne, Australia
(Royse) Department of Cardiac Surgery, Royal Melbourne Hospital, Australia
Title
The influence of propofol or desflurane on postoperative cognitive
dysfunction in patients undergoing coronary artery bypass surgery.
Source
Anaesthesia. 66 (6) (pp 455-464), 2011. Date of Publication: June 2011.
Publisher
Blackwell Publishing Ltd (9600 Garsington Road, Oxford OX4 2XG, United
Kingdom)
Abstract
We investigated the influence of either propofol or desflurane on the
incidence of postoperative cognitive dysfunction in a randomised trial of
180 patients undergoing coronary artery bypass surgery. The primary
outcome was incidence of postoperative cognitive dysfunction at 3 months,
defined as >= 1 SD deterioration in two or more of 12 neurocognitive
tests. Secondary outcomes included early postoperative cognitive
dysfunction (between days three and seven), delirium on day one, morbidity
and length of hospital stay. Early postoperative cognitive dysfunction was
significantly higher with propofol compared with desflurane (56/84 (67.5%)
vs 41/83 (49.4%), respectively, p = 0.018), but this effect was not seen
at 3 months (10/87 (11.2%) vs 9/90 (10.0%), respectively. There was no
difference in delirium (7/89 (7.9%) vs 12/91 (13.2%), respectively, length
of hospital stay (median (IQR [range]) 7 (6-9 [4-15]) vs 6 (5-7 [5-16)
days, respectively or other morbidities. Desflurane was associated with
reduced early cognitive dysfunction. 2011 The Association of
Anaesthetists of Great Britain and Ireland.

<10>
Accession Number
2011274689
Authors
Vassalos A. Peng E. Young D. Walker S. Pollock J. Macarthur K. Lyall F.
Danton M.H.D.
Institution
(Vassalos) Department of Anaesthetics, Royal Alexandra Hospital, Paisley,
United Kingdom
(Peng) Department of Cardiac Surgery, Royal Hospital for Sick Children,
Glasgow, United Kingdom
(Pollock, Macarthur, Danton) Department of Paediatric Cardiac Surgery,
Royal Hospital for Sick Children, Glasgow, United Kingdom
(Young) Department of Mathematics and Statistics, University of
Strathclyde, Glasgow, United Kingdom
(Walker, Lyall) Department of Maternal and Fetal Health, University of
Glasgow, United Kingdom
Title
Pre-operative sildenafil and pulmonary endothelial-related complications
following cardiopulmonary bypass: A randomised trial in children
undergoing cardiac surgery.
Source
Anaesthesia. 66 (6) (pp 472-480), 2011. Date of Publication: June 2011.
Publisher
Blackwell Publishing Ltd (9600 Garsington Road, Oxford OX4 2XG, United
Kingdom)
Abstract
In a randomised trial, we compared the effects of oral sildenafil (0.5
mg.kg^-1) and placebo, administered the day before cardiac
surgery, in 24 children. In sildenafil vs placebo patients,
pre-cardiopulmonary bypass median (IQR [range])
cyclic-guanosine-monophosphate was not significantly different (29.9
(2.1-208.1 [0.5-391.5]) vs 5.2 (0.3-54.6 [0-628.9]) pmol.ml ^-1,
respectively). Post-cardiopulmonary bypass, nitrate/nitrite levels were
also not significantly different (0.7 (0-8.0 [0-142.8]) vs 0 (0-2.7
[0-52.7]) muM, respectively). Postoperatively, mean (SD) pulmonary
vascular resistance (2.64 (2.28) vs 1.90 (1.12) WU.m^-2,
respectively and oxygenation index (5.29 (4.60) vs 3.38 (2.54),
respectively) remained unchanged, whilst oxygen delivery (57.18 (21.24) vs
74.13 (35.46) ml.min ^-1.m^-2, respectively) and
bi-ventricular systolic function (left ventricle 3.78 (0.94) vs 4.55
(1.08) cm.s^-1, respectively; p = 0.002; right ventricle 6.93
(1.47) vs 8.09 (2.25) cm.s^-1, respectively; p < 0.001) were
significantly reduced in the sildenafil group. In this trial,
pre-operative sildenafil did not affect postoperative pulmonary vascular
resistance. There was, however, a negative impact on ventricular function
and oxygenation. 2011 The Association of Anaesthetists of Great Britain
and Ireland.

<11>
Accession Number
2011229826
Authors
De Luca L. Altamura L. Corvo P. De Persio G. Ghini A.S. Petrolini A.
Aurigemma C. Tomai F.
Institution
(De Luca, Altamura, Corvo, De Persio, Ghini, Petrolini, Aurigemma, Tomai)
Department of Cardiovascular Sciences, Interventional Cardiology Unit,
European Hospital, Rome, Italy
(Tomai) Department of Cardiovascular Sciences, Division of Cardiology,
European Hospital, Via Portuense, 700, 00149, Rome, Italy
Title
Long-term outcome of provisional side-branch T-stenting for the treatment
of unprotected distal left main coronary artery disease.
Source
Catheterization and Cardiovascular Interventions. 77 (6) (pp 765-772),
2011. Date of Publication: 01 May 2011.
Publisher
Wiley-Liss Inc. (111 River Street, Hoboken NJ 07030-5774, United States)
Abstract
Percutaneous coronary intervention (PCI) on distal left main (LM) remains
an independent predictor of poor outcome. The strategy of implanting one
stent on the main branch (MB), with provisional stenting on the
side-branch (SB) only when required (provisional T-stenting), has become
the default approach to most bifurcation lesions. This prospective
registry sought to investigate the long-term safety and efficacy of
provisional SB T-stenting for the treatment of unprotected distal LM
disease in patients undergoing PCI. From January 2006 to May 2009, 107
consecutive patients affected by unprotected distal LM disease underwent
PCI at our center with the intent to use a provisional SB-stenting
technique. We evaluated the rate of major adverse cardiac events (MACE) at
long-term follow-up (up to 12-41 months). Procedural success was obtained
in 98% of patients. A final kissing balloon inflation was performed in 95%
and intravascular ultrasound in 83% of patients. Additional stenting on
the SB after provisional stenting on MB was required in 29% of lesions.
Long-term follow-up (3.5 years; 25-75th percentile and 1.1-4.5 years) was
completed in 97% of patients. The cumulative incidence of MACE was 32.7%:
all-cause death was 15.8%, nonfatal myocardial infarction 8.4%, and target
vessel revascularization 21.5%. At multivariable analysis, age (hazard
ratio, 2.08; 95% confidence interval: 2.01-3.32, P = 0.03), European
System for Cardiac Operative Risk Evaluation (HR 1.20, 95% CI: 1.04-1.33,
P = 0.02), and diabetes mellitus (HR 3.48, 95% CI: 1.12-6.87, P = 0.01)
were identified as independent predictors of MACE. In patients with
unprotected distal LM disease undergoing PCI, a provisional strategy of
stenting the MB only is associated with good long-term clinical outcomes.
2011 Wiley-Liss, Inc.

<12>
Accession Number
2011270646
Authors
Von Rhein M. Scheer I. Loenneker T. Huber R. Knirsch W. Latal B.
Institution
(Von Rhein, Latal) Child Development Center, University Children's
Hospital, Zurich, Switzerland
(Scheer) Department of Diagnostic Imaging, University Children's Hospital,
Zurich, Switzerland
(Huber) Sleep Research Center, University Children's Hospital, Zurich,
Switzerland
(Knirsch) Department of Pediatric Cardiology, University Children's
Hospital, Zurich, Switzerland
(Loenneker, Latal) Center for Integrative Human Physiology, University of
Zurich, Zurich, Switzerland
(Loenneker) Orphanbiotec Research Foundation, Zurich, Switzerland
Title
Structural brain lesions in adolescents with congenital heart disease.
Source
Journal of Pediatrics. 158 (6) (pp 984-989), 2011. Date of Publication:
June 2011.
Publisher
Mosby Inc. (11830 Westline Industrial Drive, St. Louis MO 63146, United
States)
Abstract
Objectives: To assess long-term neurodevelopmental outcome of adolescents
with congenital heart disease after open-heart surgery and to evaluate
whether deficits are associated with cerebral injury detectable on
magnetic resonance imaging (MRI). Study design: We conducted a cohort
study with longitudinal follow-up of 53 adolescents (mean age, 13.7 years;
range, 11.4 to 16.9 years) who had undergone open-heart surgery with
full-flow cardiopulmonary bypass during childhood and compared them with
41 age-matched controls. Assessment included conventional MRI and
neurodevelopmental testing. Results: MRI abnormalities were detected in 11
of the 53 patients (21%), comprising predominately white matter
abnormalities and volume loss. Neurodevelopmental outcome was impaired in
several domains, including neuromotor, intellectual, and executive
functions, as well as visuomotor perception and integration. Adolescents
with cerebral abnormalities had greater impairment in most
neurodevelopmental domains compared with those without cerebral
abnormalities. Conclusions: Cerebral abnormalities can be detected in a
significant proportion of adolescents with corrected congenital heart
disease. These abnormalities are found predominately in the white matter
and are apparently of hypoxic-ischemic origin, most likely acquired during
the neonatal period. Copyright 2011 Mosby Inc. All rights reserved.

<13>
Accession Number
21247431
Authors
Barkhordari K. Karimi A. Shafiee A. Soltaninia H. Khatami M.R. Abbasi K.
Yousefshahi F. Haghighat B. Brown V.
Institution
(Barkhordari) Department of Anesthesiology and Critical Care, Tehran Heart
Center, Tehran University of Medical Sciences, Iran.
Title
Effect of pentoxifylline on preventing acute kidney injury after cardiac
surgery by measuring urinary neutrophil gelatinase - associated lipocalin.
Source
Journal of cardiothoracic surgery. 6 (pp 8), 2011. Date of Publication:
2011.
Abstract
Based on Acute Kidney Injury Network (AKIN) criteria, we considered acute
kidney injury (AKI) as an absolute increase in the serum creatinine (sCr)
level of more than or equal to 0.3 mg/dl or 50%. The introduction of
Urinary neutrophil gelatinase-associated lipocalin (UNGAL) has conferred
earlier diagnosis of AKI. Pentoxifylline (PTX), a non-specific
phosphodiesterase inhibitor, can suppress the production of some factors
of inflammatory response and presumably prevent AKI. We examined the PTX
on the development of AKI in cardiac surgery patients by measuring the
levels of UNGAL. We performed a double blind randomized clinical trial,
enrolling 28 consecutive patients undergoing elective coronary artery
bypass graft (CABG) surgery. Patients were divided into two groups, one to
receive PTX 5 mg/kg intravenous bolus injection, followed by 1.5 mg/kg/h
continuous intravenous infusion until 3 hours after cessation of CPB and
the other group received placebo. UNGAL was measured before, 3 and 24
hours after surgery. In addition serum creatinine was measured before and
24, 48, 72 and 96 hours after surgery and C-reactive protein (CRP) only 24
hours postoperatively. Both groups did not differ in demographic and
baseline characteristics. 12 patients developed AKI 48 hours after
surgery; 5 of them were in the intervention group and 7 in the control
group (p= 0.445). There was an increase of UNGAL in both groups
postoperatively, although not significant. Mean sCr was significantly
increased in the control group at 24 and 48 hours after surgery (24-h
mean: 0.79 +/- 0.18 mg/dl vs. 1.03 +/- 0.43 mg/dl, P value = 0.02; 48-h
mean: 1.17 +/- 0.24 mg/dl vs. 0.98 +/- 0.20 mg/dl, P value = 0.03,
respectively). PTX had a positive effect in preventing AKI reflecting in
changes in sCr, and the increase of UNGAL was consistent with the
emergence of AKI (Pearson's correlation = 0.30). Our study demonstrates a
weak correlation between UNGAL and sCr after cardiac surgery. The rise of
UNGAL in these patients may be reduced by administration of PTX although
we did not show significance. PTX could reduce the occurrence of AKI as
determined by attenuation of sCr rise without causing hemodynamic
instability or increased bleeding. Overall, we suggest future studies with
larger sample sizes to elucidate this effect and determine the different
aspects of administrating PTX. ISRCTN: IRCT138807302622N1.

<14>
Accession Number
21219624
Authors
Haga K.K. McClymont K.L. Clarke S. Grounds R.S. Ng K.Y. Glyde D.W.
Loveless R.J. Carter G.H. Alston R.P.
Institution
(Haga) School of Medicine and Veterinary Medicine, University of
Edinburgh, Chancellors Building, 47 Little France Crescent, Edinburgh,
EH16 4TJ, UK.
Title
The effect of tight glycaemic control, during and after cardiac surgery,
on patient mortality and morbidity: A systematic review and meta-analysis.
Source
Journal of cardiothoracic surgery. 6 (pp 3), 2011. Date of Publication:
2011.
Abstract
Hyperglycaemia is a common occurrence during cardiac surgery, however,
there remains some uncertainty surrounding the role of tight glycaemic
control (blood glucose <180 mg/dL) during and/or after surgery. The aim of
this study was to systematically review the literature to determine the
effects of tight versus normal glycaemic control, during and after cardiac
surgery, on measures of morbidity and mortality. The literature was
systematically reviewed, based on pre-determined search criteria, for
clinical trials evaluating the effect of tight versus normal glycaemic
control during and/or after cardiac surgery. Each paper was reviewed by
two, independent reviewers and data extracted for statistical analysis.
Data from identified studies was combined using meta-analysis (RevMan5).
The results are presented either as odds ratios (OR) or mean differences
(MD) with 95% confidence intervals (CIs). A total of seven randomised
controlled trials (RCTs) were identified in the literature, although not
all trials could be used in each analysis. Tight glycaemic control reduced
the incidence of early mortality (death in ICU) (OR 0.52 [95% CI 0.30,
0.91]); of post-surgical atrial fibrillation (odds ratio (OR 0.76 [95%CI
0.58, 0.99]); the use of epicardial pacing (OR 0.28 [95%CI 0.15, 0.54]);
the duration of mechanical ventilation (mean difference (MD) -3.69 [95% CI
-3.85, -3.54]) and length of stay in the intensive care unit (ICU) (MD
-0.57 [95%CI -0.60, -0.55]) days. Measures of the time spent on mechanical
ventilation (I2 94%) and time spent in ICU (I2 99%) both had high degrees
of heterogeneity in the data. The results from this study suggest that
there may be some benefit to tight glycaemic control during and after
cardiac surgery. However, due to the limited number of studies available
and the significant variability in glucose levels; period of control; and
the reporting of outcome measures, further research needs to be done to
provide a definitive answer on the benefits of tight glycaemic control for
cardiac surgery patients.

<15>
Accession Number
2011280986
Authors
Kandzari D.E. Mauri L. Popma J.J. Turco M.A. Gurbel P.A. Fitzgerald P.J.
Leon M.B.
Institution
(Kandzari) Department of Interventional Cardiology, Interventional
Cardiology Research, Piedmont Heart Institute, Atlanta, GA, United States
(Mauri) Division of Cardiovascular Medicine, Brigham and Women's Hospital,
Harvard Medical School, Boston, MA, United States
(Popma) Department of Innovations in Interventional Cardiology, Beth
Israel Deaconess Medical Center, Harvard Medical School, Boston, MA,
United States
(Turco) Center for Cardiac and Vascular Research, Washington Adventist
Hospital, Takoma Park, MD, United States
(Gurbel) Sinai Center for Thrombosis Research, Sinai Hospital, Baltimore,
MD, United States
(Fitzgerald) Center for Cardiovascular Technology, Division of
Cardiovascular Medicine, Stanford University Medical Center, Palo Alto,
CA, United States
(Leon) Center for Interventional Vascular Therapy, Columbia University
Medical Center/New York Presbyterian Hospital, New York, NY, United States
Title
Late-term clinical outcomes with zotarolimus- and sirolimus-eluting
stents: 5-Year follow-up of the ENDEAVOR III (a randomized controlled
trial of the Medtronic Endeavor Drug [ABT-578] eluting coronary stent
system versus the cypher sirolimus-eluting coronary stent system in de
novo native coronary artery lesions).
Source
JACC: Cardiovascular Interventions. 4 (5) (pp 543-550), 2011. Date of
Publication: May 2011.
Publisher
Elsevier Inc. (360 Park Avenue South, New York NY 10010, United States)
Abstract
Objectives: This study sought to compare late safety and efficacy outcomes
following percutaneous coronary revascularization with zotarolimus-eluting
stents (ZES) and sirolimus-eluting stents (SES). Background: Despite
higher late lumen loss and binary restenosis with ZES compared with SES,
it is uncertain whether differences in early angiographic measures
translate into more disparate late clinical events. Methods: Clinical
outcomes were prospectively evaluated through 5 years in the ENDEAVOR III
(A Randomized Controlled Trial of the Medtronic Endeavor Drug [ABT-578]
Eluting Coronary Stent System Versus the Cypher Sirolimus-Eluting Coronary
Stent System in De Novo Native Coronary Artery Lesions) that randomized
436 patients of relatively low anatomic and clinical risk to treatment
with ZES (n = 323) or SES (n = 113) and evaluated a primary endpoint of
8-month angiographic late lumen loss. Results: At 5 years (completeness of
follow-up: 95.2%), pre-specified endpoints of all-cause mortality (5.2%
vs. 13.0%, p = 0.02), myocardial infarction (1.0% vs. 4.6%, p = 0.03), and
the composite event rates of cardiac death/myocardial infarction (1.3% vs.
6.5%, p = 0.009) and major adverse cardiac events (14.0% vs. 22.2%, p =
0.05) were significantly lower among patients treated with ZES. Rates of
target lesion (8.1% ZES vs. 6.5% SES, p = 0.68) and target vessel
revascularization were similar between treatment groups. Stent thrombosis
was infrequent and similar in both groups (0.7% ZES vs. 0.9% SES, p =
1.0). Between 9 months and 5 years, progression of major adverse cardiac
events was significantly more common with SES than with ZES (16.7% vs.
7.8%, p = 0.015). Conclusions: Despite initially higher angiographic late
lumen loss, rates of clinical restenosis beyond the protocol-specified
angiographic follow-up period remain stable with ZES compared with the
rates for SES, resulting in similar late-term efficacy. Over 5 years,
significant differences in death, myocardial infarction, and composite
endpoints favored treatment with ZES. (The Medtronic Endeavor III Drug
Eluting Coronary Stent System Clinical Trial [ENDEAVOR III]; NCT00217256).
2011 American College of Cardiology Foundation.

<16>
Accession Number
2011260529
Authors
Najjar S.S. Rao S.V. Melloni C. Raman S.V. Povsic T.J. Melton L. Barsness
G.W. Prather K. Heitner J.F. Kilaru R. Gruberg L. Hasselblad V. Greenbaum
A.B. Patel M. Kim R.J. Talan M. Ferrucci L. Longo D.L. Lakatta E.G.
Harrington R.A.
Institution
(Najjar, Talan, Ferrucci, Longo, Lakatta) Intramural Research Program,
National Institute on Aging, National Institutes of Health, Baltimore, MD,
United States
(Najjar) MedStar Health Research Institute, Washington Hospital Center,
110 Irving St NW, Washington, DC 20010, United States
(Rao, Melloni, Povsic, Patel, Kim, Harrington) Division of Cardiology,
Department of Medicine, Duke University School of Medicine, Durham, NC,
United States
(Rao, Melloni, Povsic, Melton, Barsness, Prather, Kilaru, Hasselblad,
Patel, Harrington) Duke Clinical Research Institute, Duke University
Medical Center, Durham, NC, United States
(Raman) Division of Cardiovascular Medicine, Ohio State University,
Columbus, OH, United States
(Barsness) Mayo Clinic, Rochester, MN, United States
(Heitner) New York Methodist Hospital, Brooklyn, NY, United States
(Gruberg) Division of Cardiology, SUNY, Stony Brook University Medical
Center, Stony Brook, NY, United States
(Greenbaum) Division of Cardiology, Henry Ford Health System, West
Bloomfield, MI, United States
Title
Intravenous erythropoietin in patients with ST-segment elevation
myocardial infarction - REVEAL: A randomized controlled trial.
Source
JAMA - Journal of the American Medical Association. 305 (18) (pp
1863-1872), 2011. Date of Publication: 11 May 2011.
Publisher
American Medical Association (515 North State Street, Chicago IL 60654,
United States)
Abstract
Context: Acute ST-segment elevation myocardial infarction (STEMI) is a
leading cause of morbidity and mortality. In experimental models of MI,
erythropoietin reduces infarct size and improves left ventricular (LV)
function. Objective: To evaluate the safety and efficacy of a single
intravenous bolus of epoetin alfa in patients with STEMI. Design, Setting,
and Patients: A prospective, randomized, double-blind, placebo-controlled
trial with a dose-escalation safety phase and a single dose (60 000 U of
epoetin alfa) efficacy phase; the Reduction of Infarct Expansion and
Ventricular Remodeling With Erythropoietin After Large Myocardial
Infarction (REVEAL) trial was conducted at 28 US sites between October
2006 and February 2010, and included 222 patients with STEMI who underwent
successful percutaneous coronary intervention (PCI) as a primary or rescue
reperfusion strategy. Intervention: Participants were randomly assigned to
treatment with intravenous epoetin alfa or matching saline placebo
administered within 4 hours of reperfusion. Main Outcome Measure: Infarct
size, expressed as percentage of LV mass, assessed by cardiac magnetic
resonance (CMR) imaging performed 2 to 6 days after study medication
administration (first CMR) and again 12+/-2 weeks later (second CMR).
Results: In the efficacy cohort, the infarct size did not differ between
groups on either the first CMR scan (n=136; 15.8% LV mass [95% confidence
interval {CI}, 13.3-18.2% LV mass] for the epoetin alfa group vs 15.0% LV
mass [95% CI, 12.6-17.3% LV mass] for the placebo group; P=.67) or on the
second CMR scan (n=124; 10.6% LV mass [95% CI, 8.4-12.8% LV mass] vs 10.4%
LV mass [95% CI, 8.5-12.3% LV mass], respectively; P=.89). In a
prespecified analysis of patients aged 70 years or older (n=21), the mean
infarct size within the first week (first CMR) was larger in the epoetin
alfa group (19.9% LV mass; 95% CI, 14.0-25.7% LV mass) than in the placebo
group (11.7% LV mass; 95% CI, 7.2-16.1% LV mass) (P=.03). In the safety
cohort, of the 125 patients who received epoetin alfa, the composite
outcome of death, MI, stroke, or stent thrombosis occurred in 5 (4.0%; 95%
CI, 1.31%-9.09%) but in none of the 97 who received placebo (P=.04).
Conclusions: In patients with STEMI who had successful reperfusion with
primary or rescue PCI, a single intravenous bolus of epoetin alfa within 4
hours of PCI did not reduce infarct size and was associated with higher
rates of adverse cardiovascular events. Subgroup analyses raised concerns
about an increase in infarct size among older patients. Trial
Registration: clinicaltrials.gov Identifier: NCT00378352. 2011 American
Medical Association. All rights reserved.

<17>
Accession Number
2011189089
Authors
Frederich R. Alexander J.H. Fiedorek F.T. Donovan M. Berglind N. Harris S.
Chen R. Wolf R. Mahaffey K.W.
Institution
(Frederich, Fiedorek, Donovan, Berglind, Chen, Wolf) Bristol-Myers Squibb,
Princeton, NJ, United States
(Alexander, Mahaffey) Duke Clinical Research Institute, Durham, NC, United
States
(Harris) AstraZeneca, Wilmington, DE, United States
Title
A systematic assessment of cardiovascular outcomes in the saxagliptin drug
development program for type 2 diabetes.
Source
Postgraduate Medicine. 122 (3) (pp 16-27), 2010. Date of Publication:
May 2010.
Publisher
Medquest Communications LLC (3800 Lakeside Avenue, Suite 201, Cleveland OH
44114, United States)
Abstract
Objective: The objective was to assess the relative risk (RR) for
cardiovascular (CV) events across all 8 randomized phase 2/3 trials
evaluating saxagliptin in patients with type 2 diabetes mellitus. Methods:
Cardiovascular events (death, myocardial infarction [MI], stroke,
revascularization procedures, and cardiac ischemia) were reported by
investigators through standard adverse event reporting procedures and were
systematically identified. Post hoc blinded adjudication of all deaths,
MIs, and strokes was performed using prespecified endpoint definitions by
an independent clinical events committee (CEC). Results: A total of 4607
randomized and treated patients (n = 3356 treated with saxagliptin
[2.5-100 mg/d]; n = 1251, comparator [n = 656, placebo; n = 328,
metformin; n = 267, uptitrated glyburide]) were included. The median ages
were 54 years (saxagliptin) and 55 years (comparator) (interquartile
range, 47-61 each); 51% were female, 73% were white, 52% were
hypertensive, 44% had hypercholesterolemia, 39% had a smoking history, 20%
had a first-degree family member with premature coronary heart disease,
and 12% had prior CV disease. Cardiovascular events were experienced by 61
patients (38 [1.1%], saxagliptin; 23 [1.8%], comparator), and CV
death/MI/stroke events were reported by investigators in 41 patients: 23
(0.7%), saxagliptin; 18 (1.4%), comparator (relative risk, 95% confidence
interval [CI], 0.44 [0.24-0.82]). The CEC reviewed 147 patients with
potential CV events and identified a total of 40 patients with CV
death/MI/stroke: 22 (0.7%), saxagliptin; 18 (1.4%), comparator (RR, 0.43
[0.23-0.80]). Component proportions for CV death, MI, and stroke were
(saxagliptin vs comparator): 7 (0.2%) vs 10 (0.8%), 8 (0.2%) vs 8 (0.6%),
and 11 (0.3%) vs 5 (0.4%), respectively. Conclusion: No increased risk of
CV death/MI/stroke was observed in patients randomly assigned saxagliptin
across a broad drug development program. Although this systematic overview
has inherent and important limitations, the data support a potential
reduction in CV events with saxagliptin. The hypothesis of CV protection
with saxagliptin will be tested prospectively in a large randomized
clinical outcome trial evaluating saxagliptin compared with standard of
care in patients with type 2 diabetes at increased risk for CV events.
Postgraduate Medicine.

<18>
Accession Number
70422815
Authors
Plante A. Mathieu M.E. Dahdah N. Miro J. Bigras J.L. Curnier D.
Institution
(Plante, Mathieu, Curnier) Universite de Montreal, Departement de
Kinesiologie, Montreal, QC, Canada
(Mathieu, Dahdah, Miro, Bigras, Curnier) Service de Cardiologie
Pediatrique, Centre de recherche CHU Sainte Justine, Montreal, QC, Canada
Title
Exercise rehabilitation for children with congenital heart disease.
Source
Cardiology in the Young. Conference: 45th Annual Meeting of the
Association for European Paediatric Cardiology, AEPC with Joint Sessions
with the Japanese Society of Pediatric Cardiology and Cardiac Surgery
Granada Spain. Conference Start: 20110518 Conference End: 20110521.
Conference Publication: (var.pagings). 21 (pp S95), 2011. Date of
Publication: May 2011.
Publisher
Cambridge University Press
Abstract
Introduction: The improvement in medical diagnosis and treatment, from
pharmacology to surgery, induced an increased survival in children with
congenital diseases. In adults with cardiovascular diseases several
randomised control trials show beneficial effects of exercise training.
Meta analyses have validated the benefits of cardiovascular rehabilitation
but none in children with congenital diseases. Aims: Determine the
benefits of cardiovascular rehabilitation using Meta analysis methods in
children with congenital heart diseases. Methods: Research criteria used
were: exercise training, rehabilitation, readaptation, heart disease,
heart failure, limited to article in English or French, for subjects' age
<25 years and to randomised control trials (RCT) published between January
1966 and December 2010 in database from Pub Med, Embase, Web of Science
and CINAHL. All the references were reviewed by 2 independent scientists.
Results: 5 RCT studies (n subjects5173) met the selection criteria. The
mean differences reach : 4,21 [1,69-6,73], p=0,001 for maximal oxygen
uptake (ml.kg.min^-3) ; 9,4 [3,2-15,6], p=0,003 for maximal
power (watts) and 5,9 [20,4-12,2], p=0,03 for heart rate
(beat.min^-2) at maximal exercise. Conclusions: The results
observed in children with congenital heart disease are in agreement and
conformity with those observed in adult subjects for the parameters
analysed. Exercise training improved significantly maximal oxygen uptake
and peak power at maximal exercise. Despite these positive observations,
this meta analysis suffer from the limited number of subjects and the lack
of data concerning the major acute cardiovascular events which do not
permit to extrapolate the entire benefits observe in an adult population.
To our best knowledge there is no study evaluating the impact of exercise
training in morbid-mortality in a congenital heart disease population from
children to adults.