No abstract

A single oral dose of 2.5 mg vitamin D significantly enhanced the ability of participants' whole blood to restrict BCG-lux luminescence in vitro without affecting antigen-stimulated IFN-gamma responses. Clinical trials should be performed to determine whether vitamin D supplementation prevents reactivation of latent TB infection. Clinical trial registered with www.clinicaltrials.gov (NCT 00157066).

Background-Beating heart coronary artery bypass grafting (CABG) improves early postoperative cardiac function in patients with normal ventricular function, but its effect in patients with impaired function is uncertain. We compared a novel hybrid technique of on-pump beating heart CABG (ONBEAT) with conventional on-pump CABG (ONSTOP) in patients with impaired ventricular function. Methods and Results-In a single-center randomized trial, 50 patients with impaired ventricular function were randomly assigned to ONBEAT or ONSTOP. Patients underwent cardiac magnetic resonance imaging for function and delayed hyperenhancement early and later after surgery. Serial assessment of biochemical markers was also undertaken. Preoperative characteristics were well matched; cardiac index was 2.85Ϯ0.53 (ONBEAT) and 2.62Ϯ0.59 L · min Ϫ1 · m Ϫ2 (ONSTOP). Early after surgery, there was a trend toward a greater reduction in end-systolic volume index in ONSTOP patients versus ONBEAT (Ϫ9Ϯ8 versus Ϫ4Ϯ11 mL · m Ϫ2 ; Pϭ0.06). The changes were sustained and significant at 6 months (Ϫ14Ϯ18 versus Ϫ2Ϯ19 mL · m Ϫ2 ; Pϭ0.04). Furthermore, the incidence of new hyperenhancement at 6 days was higher in ONBEAT patients (Pϭ0.05), with 6 of 17 (35%) sustaining 8.2Ϯ5.2 g of new hyperenhancement each versus 2 of 23 (9%) in the ONSTOP group, each with 9.8Ϯ9.0 g (Pϭ0.86). Finally, median area under the curve for troponin was higher in ONBEAT at 461 (interquartile range, 226 to 1141) g/L versus 160 (interquartile range, 98 to 357) g/L for ONSTOP (Pϭ0.002). Conclusions-The incidence of new irreversible myocardial injury was significantly higher in ONBEAT than in ONSTOP patients. Furthermore, at 6 months, only ONSTOP patients demonstrated an improvement in ventricular geometry. The most likely mechanism is inadequate coronary perfusion to distal myocardial territories in patients with severe proximal coronary disease. (Circulation. 2008;118:2130-2138.)