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Swami Vivekananda, whose 150th birth anniversary is being celebrated this year, used to say, 'This life is short; its vanities are transient. He alone lives who lives for others'. Norman Borlaug was one such person, who lived and worked for the cause of ensuring food for all. As a scientist, he helped to breed outstanding varieties of dwarf wheat, which could help to triple the average yield. As a humanist, he placed faces before figures, and helped to highlight the fact that the persistence of hunger, in the midst of opportunities to increase food production through synergy between technology and public policy, is inexcusable. Dr Borlaug was not satisfied with scientific know-how alone. He wanted to convert scientific know-how into field level do - how. On the last day of his life, a scientist showed him a new equipment to trace soil fertility. Dr Borlaug's last words before his death were, 'Take the tracer to the farmer'. On the occasion of his birth centenary on March 25, 2014 we should all follow his advice and accelerate progress in linking the lab with land. His life and work will be eternal sources of inspiration and lead us to convert his vision of a hunger-free world into reality. Borlaug's Approach to Increasing Wheat Yield [ABSTRACT FROM AUTHOR]

The article discusses the scientist J. B. S. Haldane and his attributes in genetics and agricultural productivity. Particular focus is given to the government policy of agricultural industries of U.S. Also included are his research in genotypes, the International Genetics Congress, and his experiences in India.

Innovations in cardiac imaging have fundamentally advanced the understanding and treatment of cardiovascular disease. These advances in noninvasive cardiac imaging have also expanded the role of the cardiac imager and dramatically increased the demand for imagers who are cross-trained in multiple modalities. However, we hypothesize that there is significant variation in the availability of cardiac imaging expertise and a disparity in the adoption of advanced imaging technologies across the United States. To evaluate this, we have brought together the leaders of cardiovascular imaging societies, imaging trainees, as well as collaborated with national imaging accreditation commissions and imaging certification boards to assess the state of cardiac imaging and the diversity of the imaging workforce in the United States. Aggregate data confirm the presence of critical gaps, such as limited access to imaging and imaging expertise in rural communities, as well as disparities in the imaging workforce, notably among women and underrepresented minorities. Based on these results, we have proposed solutions to promote and maintain a robust and diverse community of cardiac imagers and improve equity and accessibility for cardiac imaging technologies., Competing Interests: Disclosures Dr Douglas reports research grant to the institution HeartFlow; research support to Caption Health-in Kind; honoraria to Wolters Kluwer; and Foresite Labs scientific advisory board. Dr Hahn reports speaker fees from Abbott Structural, Baylis Medical, Edwards Lifesciences, Medtronic, Philips Healthcare, and Siemens Healthineers; Dr Hahn has institutional consulting contracts for which she receives no direct compensation with Abbott Structural, Edwards Lifesciences, Medtronic, and Novartis; she is Chief Scientific Officer for the Echocardiography Core Laboratory at the Cardiovascular Research Foundation for multiple industry-sponsored tricuspid valve trials, for which she receives no direct industry compensation. Dr Lang reports grants from Philips Imaging and Ultrasight. Dr Chareonthaitawee reports Clario and Ionetix; royalties from UpToDate. Dr Srichai reports consulting from Clario and royalties from UpToDate. Dr Burroughs is a member of medical advisory board in Bristol Myers Squibb, Health Kit, and Lantheus and conducted clinical research in Cytokinetic. Dr Blankstein reports research support in Novartis, Inc, and Amgen Inc; consultant in Caristo, Inc, Elucid, Inc, Heartflow, Inc, Nanox AI. The other authors report no conflicts.

The COVID-19 pandemic has evolved since the publication of the initial American Society of Echocardiography (ASE) statements providing guidance to echocardiography laboratories. In light of new developments, the ASE convened a diverse, expert writing group to address the current state of the COVID-19 pandemic and to apply lessons learned to echocardiography laboratory operations in future pandemics. This statement addresses important areas specifically impacted by the current and future pandemics: (1) indications for echocardiography, (2) application of echocardiographic services in a pandemic, (3) infection/transmission mitigation strategies, (4) role of cardiac point-of-care ultrasound/critical care echocardiography, and (5) training in echocardiography., (Copyright © 2023. Published by Elsevier Inc.)

Over the 12 months since the start of the coronavirus disease 2019 pandemic, an explosion of investigation and an increase in experience have led to vast improvement in our knowledge about this disease. However, coronavirus disease 2019 remains a huge public health threat., (Copyright © 2021 American Society of Echocardiography. Published by Elsevier Inc. All rights reserved.)

In 2018, an estimated 1.8 million persons living in Nigeria had HIV infection (1.3% of the total population), including 1.1 million (64%) who were receiving antiretroviral therapy (ART) (1). Effective ART reduces morbidity and mortality rates among persons with HIV infection and prevents HIV transmission once viral load is suppressed to undetectable levels (2,3). In April 2019, through the U.S. President's Emergency Plan for AIDS Relief (PEPFAR),* CDC launched an 18-month ART Surge program in nine Nigerian states to rapidly increase the number of persons with HIV infection receiving ART. CDC analyzed programmatic data gathered during March 31, 2019-September 30, 2020, to describe the ART Surge program's progress on case finding, ART initiation, patient retention, and ART Surge program growth. Overall, the weekly number of newly identified persons with HIV infection who initiated ART increased approximately eightfold, from 587 (week ending May 4, 2019) to 5,329 (week ending September 26, 2020). The ART Surge program resulted in 208,202 more HIV-infected persons receiving PEPFAR-supported ART despite the COVID-19 pandemic (97,387 more persons during March 31, 2019-March 31, 2020 and an additional 110,815 persons during April 2020-September 2020). Comprehensive, data-guided, locally adapted interventions and the use of incident command structures can help increase the number of persons with HIV infection who receive ART, reducing HIV-related morbidity and mortality as well as decreasing HIV transmission., Competing Interests: All authors have completed and submitted the International Committee of Medical Journal Editors form for disclosure of potential conflicts of interest. No potential conflicts of interest were disclosed.

Introduction : Acute myeloid leukemia (AML) is a deadly disease associated with poor outcomes. For over four decades, therapeutic options for AML were limited to high dose cytotoxic chemotherapy. Scientific breakthroughs have not only enhanced our understanding of the molecular underpinnings of this disease but also resulted in the development of several targeted therapies with superior efficacy and lesser toxicities than conventional chemotherapy. The FDA approval of small molecule inhibitors for specific AML subsets highlights the importance of genetic and molecular profiling to optimally personalize AML therapy in the modern era. Areas covered : In this article, we review the medical literature from PubMed on recent FDA approved drugs for AML by their mechanism of action: small molecule inhibitors, antibody-drug conjugate, cytotoxic, and epigenetic agents. We describe how to incorporate these agents into the current treatment paradigm for specific AML patients. Expert opinion : Knowing the molecular characteristics of patients with AML is of utmost importance to plan the best management. There are promising drugs targeting leukemogenesis by various mechanisms. It is important to consider clinical trial options for patients if and when available. We have provided a brief overview of the most promising agents on the horizon for AML therapy.

Intraoperative transesophageal echocardiography is a standard diagnostic and monitoring tool employed in the management of patients undergoing an entire spectrum of cardiac surgical procedures, ranging from "routine" surgical coronary revascularization to complex valve repair, combined procedures, and organ transplantation. Utilizing a protocol as a starting point for imaging in all procedures and all patients enables standardization of image acquisition, reduction in variability in quality of imaging and reporting, and ultimately better patient care. Clear communication of the echocardiographic findings to the surgical team, as well as understanding the impact of new findings on the surgical plan, are paramount. Equally important is the need for complete understanding of the technical steps of the surgical procedures being performed and the complications that may occur, in order to direct the postprocedure evaluation toward aspects directly related to the surgical procedure and to provide pertinent echocardiographic information. The rationale for this document is to outline a systematic approach describing how to apply the existing guidelines to questions on cardiac structure and function specific to the intraoperative environment in open, minimally invasive, or hybrid cardiac surgery procedures., (Copyright © 2020 American Society of Echocardiography. Published by Elsevier Inc. All rights reserved.)

Background: Patients with end-stage renal disease (ESRD) requiring chronic haemodialysis who undergo coronary artery bypass graft surgery (CABG) are at significant risk for perioperative mortality. However, the impact of changes in ESRD patient volume and characteristics over time on operative outcomes is unclear., Methods: Using the Nationwide Inpatient Sample database (1988-03), we evaluated rates of CABG surgery with and without concurrent valve surgery among ESRD patients and outcomes including in-hospital mortality, and length of hospital stay. Multivariate regression models were used to account for patient characteristics and potential cofounders., Results: From 1988 to 2003, annual rates of CABG among ESRD patients doubled from 2.5 to 5 per 1000 patient-years. Concomitantly, patient case-mix changed to include patients with greater co-morbidities such as diabetes, hypertension and obesity (all P < 0.001). Nonetheless, among ESRD patients, in-hospital mortality rates declined nearly 6-fold from over 31% to 5.4% (versus 4.7% to 1.8% among non-ESRD), and the median length of in-hospital stay dropped in half from 25 to 13 days (versus 14 to 10 days among non-ESRD)., Conclusions: Since 1988, an increasing number of patients with ESRD have been receiving CABG in the USA. Despite increasing co-morbidities, operative mortality rates and length of in-hospital stay have declined substantially. Nonetheless, mortality rates remain almost 3-fold higher compared to non-ESRD patients indicating a need for ongoing improvement.

Background: Recent advances in surgical technique allow repair of most mitral valves with degenerative disease. However, few long-term data exist to support the superiority of repair versus prosthetic valve replacement, and repair could be limited by late durability or other problems. This study was designed to compare survival characteristics of mitral valve repair versus prosthetic replacement for degenerative disorders during a 20-year period., Methods: From 1986 to 2006, 2,580 patients underwent isolated mitral valve procedures (with or without coronary artery bypass grafting), with 989 classified as having degenerative origin. Of these, 705 received valve repair, and 284 had prosthetic valve replacement. Differences in baseline characteristics between groups were assessed, and unadjusted survival estimates were generated using Kaplan-Meier methods. Survival curves were examined after adjustment for differences in baseline profiles using a Cox model, and average adjusted survival differences were quantified by area under the curve methodology. Survival differences during 15 years of follow-up also were assessed with propensity matching., Results: Baseline characteristics were similar, except for (variable: repair, replacement) age: 62 years, 68 years; concomitant coronary artery bypass grafting: 24%, 32%; ejection fraction: 0.51, 0.55; congestive heart failure: 68%, 43%; and preoperative arrhythmia: 11%, 7% (all p < 0.05). Long-term survival was significantly better in the repair group, both for unadjusted data (p < 0.001) and for risk-adjusted results (p = 0.040). Patient survival in the course of 15 years averaged 7.3% better with repair, and increased with time of follow-up: 0.7% better for 0 to 5 years, 4.9% better for 5 to 10 years, and 21.3% better for 10 to 15 years. Treatment interaction between repair or replacement and age was negative (p = 0.66). In the propensity analysis, survival advantages of repair versus replacement were similar in magnitude with a p value of 0.046., Conclusions: As compared with prosthetic valve replacement, mitral repair is associated with better survival in patients with degenerative disease, especially after 10 to 15 years. This finding supports the current trend of increasing repair rates for degenerative disorders of the mitral valve.

Background/aims: Acute renal failure is associated with a high risk of mortality when it complicates coronary artery bypass graft (CABG) surgery. We examined a large nationwide database from 1988 to 2003 and hypothesized that mortality in CABG-associated acute renal failure needing dialysis (ARF-D) had declined during this period., Methods: The Nationwide Inpatient Sample containing data on inpatient stays across 20% of US hospitals was used for our study. Multivariate logistic regression was used to determine an association between year and ARF-D mortality with standardized risk adjustment., Results: Incidence of ARF-D increased from 0.2 to 0.6% while mortality simultaneously decreased from 47.4% in 1988 to 29.7% in 2003. In the multivariable model, year was significantly associated with declining ARF-D mortality., Conclusions: The incidence of post-CABG ARF-D more than doubled from 1988 to 2003, while mortality simultaneously decreased by over one-third. Improved survival after ARF-D following CABG may be counterbalanced by increased morbidity and resource utilization., (Copyright 2009 S. Karger AG, Basel.)

Acute renal failure (ARF) is common after cardiac surgery and more frequent after complex cardiac surgery. While the incidence of ARF is increasing after coronary artery bypass graft (CABG) surgery, trends in other forms of cardiac surgery remain unclear. We investigated the trend of ARF in various cardiac procedures and compared patterns using CABG surgery as a reference group. The study population consisted of discharges from the Nationwide Inpatient Sample from 1988 to 2003, grouped according to surgery as: CABG, CABG with mitral valve, CABG with other valve, valve alone, and heart transplant. Standard diagnostic codes were used to identify ARF among discharges. Multivariable regression was used to determine trends in ARF among various procedures with CABG as a reference group. The incidence of ARF increased in all five groups (p < 0.001) over the 16-year period. The ARF incidence was highest in the heart transplant group (17%). Compared to the CABG population, patients following heart transplantation developed ARF at higher rates during the study period. In contrast, while ARF increased over time in other groups, the rates of rise were slower than in CABG patients. Among heart surgery procedures, ARF incidence is highest in heart transplantation. The incidence of ARF is also increasing at a faster rate in this group of patients in contrast to other procedure groups when compared to CABG surgery. The disproportionate increase in ARF burden after heart transplantation is a concern due to its strong association with chronic kidney disease and mortality.

Background: The Gore TAG thoracic endoprosthesis (W. L. Gore and Associates, Flagstaff, AZ) was approved by the U.S. Food and Drug Administration (FDA) for the treatment of thoracic aortic aneurysms on March 23, 2005, and remains the only FDA approved thoracic device to date. We present our experience with the TAG device for the 2 years post-approval to better characterize "real world" use and results outside the clinical trial setting., Methods: Between March 23, 2005, and March 23, 2007, n = 91 thoracic endograft procedures were performed at our institution. Of these, n = 83 (91%) utilized the TAG device and form the basis of this report. Indications for endovascular repair were: fusiform or saccular aneurysm (n = 43; 52%), acute or chronic dissection (n = 30; 36%), acute or chronic traumatic transection (n = 7; 8%), and false aneurysm after prior aortic surgery (n = 3; 4%). A "hybrid" approach involving carotid-carotid bypass (n = 2), stage I elephant trunk procedure (n = 3), aortic arch debranching (n = 7), or complete visceral debranching (n = 5) was required in 20% of patients to create an adequate landing zone., Results: Primary technical success rate was 98.8% (n = 82/83). Thirty-day rates of mortality and permanent stroke were both 3.6% (n = 3 each). Permanent paraparesis/paraplegia rate was 2.4% (n = 2). The 30-day rate of vascular or device-related complications requiring additional endovascular or open procedures was 7.2% (n = 6). During a mean duration of follow-up of 14 +/- 8 months (range 0-28), there was one late death from aneurysm rupture (1.2%) and one late conversion to open repair (1.2%)., Conclusions: "Real world" utilization of the TAG device includes high rates of off-label use (nearly 50%) and "hybrid" techniques (20%) for the treatment of multiple pathologic entities of the thoracic and thoracoabdominal aorta. Regardless, short to mid-term results appear promising. Longer follow-up is needed to determine the durability of this approach.

Objective: Acute renal failure remains a major complication of coronary artery bypass graft surgery that is strongly associated with in-hospital mortality. Based on similar observations in other clinical settings, we tested the hypothesis that the diagnosis of acute renal failure associated with coronary artery bypass graft surgery is increasing in the United States., Design: Observational cohort study., Setting: The Nationwide Inpatient Sample database was used to test the hypothesis. This database contains discharge information from 20% of U.S. hospitals., Patients: Hospital discharges coded for coronary artery bypass graft surgery from 1988 to 2003 comprised the study population; those also coded for acute renal failure formed the subset of interest., Interventions: None., Measurements and Main Results: Multivariable regression models were constructed, including adjustment for risk factors and comorbidities, to identify the relationship between year of surgery and diagnosis of acute renal failure and mortality. The incidence of acute renal failure diagnosis increased significantly during the study period from 1.1% to 4.1% (p < .0001). The proportion of acute renal failure cases that required dialysis decreased from 15.8% to 8.7% (p < .0001). Despite an increase in comorbid disease burden, mortality in the acute renal failure subgroup declined from 39.5% to 17.9% (p < .0001). The percentage of acute renal failure survivors with postdischarge special-care requirements increased from 35.5% to 64.5% (p < .0001)., Conclusions: Our findings suggest that the observed increase in acute renal failure diagnosis rates may be partly attributable to less restrictive criteria for acute renal failure diagnosis, consistent with acute renal failure patterns observed in other clinical settings. Although the need for dialysis is a relatively clear benchmark for diagnosing acute renal failure, use of alternate criteria to define this disorder has become more common, perhaps contributing to higher diagnosis rates. We conclude that the nationwide trend of acute renal failure associated with coronary artery bypass graft surgery has significantly increased from 1988 to 2003. Despite declining mortality, acute renal failure remains a burden on healthcare resources., ((C) 2007 Lippincott Williams & Wilkins, Inc.)