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Biomedical subjects

K Krieger

Publications and source records attributed to K Krieger.

At least 19 recordsLinked to original sources

Clinical and epidemiological characteristics of Eimeria infections in first-year grazing cattle.

Infections with Eimeria parasites can lead to severe diarrhoea with considerable clinical and economic consequences in first-year grazing stock. To identify and characterise the cause of diarrhoea observed during previous years, 164 animals on 14 dairy farms in northwestern Germany were included in this study. The calves were physically and parasitologically examined prior to turnout and until 21 days post turnout (d.p.t.). Mean animal weights decreased from 194.9 kg at the start to 189.3 kg bodyweight at the end of the study. In all herds, oocyst counts were very low prior to turnout and increased after the calves had been kept on pasture for at least 7 days. On Day 9 post turnout, 90% and at the end of the study (21 d.p.t.) 70% of all animals showed Eimeria-positive faecal samples. During the course of the study, 79 (48.2%) animals passed faecal samples with more than 100,000 oocysts per gram. The predominant species identified was Eimeria alabamensis, which accounted for more than 83% of the oocysts counted. These parasitological findings matched the clinical observations. Diarrhoea was found in 130 (79.3%) of the study animals. At 5d.p.t. and thus prior to the rise of faecal oocyst counts, a significant increase in diarrhoea was recorded. Calves showing diarrhoea excreted statistically significantly more often over 100,000 E. alabamensis oocysts per gram faeces (0.28; p = 0.0002) than calves without diarrhoea. Diarrhoea was also found during significantly more study days in animals with high oocyst counts (0.39; p = 0.0001). These data indicate that in endemic areas first-year grazing calves must be considered at risk to develop clinical coccidiosis due to E. alabamensis infection during the first 2-3 weeks post turnout.

Animal Husbandry↗

Effects of a combinations of emodepside and praziquantel on parasites of reptiles and rodents.

A new combination of two anthelmintic compounds containing emodepside and praziquantel (Profender, Bayer AG, Levekusen, Germany) was tested in pet rodents and reptiles. Topical application of the two compounds led to the quick disappearance of nematodes and cestodes from a broad spectrum of hosts including mice, jirds, snakes, anole lizards, turtles, monitor lizards, etc. In reptiles the dosage had to be increased, since the thick outer layer of the epidermis hinders the penetration of the compounds. In animals with an extremely thick epidermis (e.g. monitor lizards, leguans) the new product was applied under the armpits.

Administration, Topical↗

Efficacy and safety of imidacloprid 10% plus moxidectin 2.5% spot-on in the treatment of sarcoptic mange and otoacariosis in dogs: results af a European field study.

Efficacy and safety of treatment with imidacloprid 10%+moxidectin 2.5% spot-on (Advocate, Advantage multi; Bayer AG, Leverkusen, Germany) were tested in dogs naturally infested with Sarcoptes scabiei or Otodectes cynotis in a multi-centre, controlled, randomized, blinded field study conducted in France, Germany, Albania and the UK. The study was performed according to a non-inferiority design to demonstrate that the efficacy of imidacloprid/moxidectin spot-on was not inferior to that of a control product containing selamectin (Stronghold spot-on; Pfizer). All Sarcoptes-infested dogs were topically treated twice (days 0 and 28) with the dosage recommended by the respective manufacturer (27 dogs with imidacloprid/moxidectin, 26 with selamectin). All Otodectes-infested dogs were treated on day 0 (35 dogs with imidacloprid/moxidectin, 34 with selamectin), and only those still positive on day 28 received a second treatment. Parasitological cure rate in Sarcoptes-infested dogs was 100% for both treatments, while parasitological cures rates in the Otodectes-infested dogs at day 28 and day 56 were 68.6 and 85.7% with imidacloprid/moxidectin, and 64.7 and 88.2% with Stronghold. Non-inferiority of Advocate was confirmed statistically. Clinical assessment of skin lesion scores at day 56 showed that with either product >96% of the dogs treated against sarcoptic mange were improved or cured, the difference between the groups being non-significant. On the basis of a final clinical assessment of lesion scores, 80% of the dogs treated with imidacloprid/moxidectin against otoacariosis and 85.3% of those treated with selamectin were rated cured or improved. Only three mild, possibly drug-related adverse reactions were observed among alI treated animals (two in the imidacloprid/moxidectin group, one in the selamectin group). It is concluded that imidacloprid/moxidectin spot-on is an effective and safe treatment for sarcoptic mange and otoacariosis in the dog.

Administration, Topical↗

Evaluation of the efficacy and safety of imidacloprid 10% plus moxidectin 2.5% spot-on in the treatment of generalized demodicosis in dogs: results of a European field study.

Efficacy and safety of the test product imidacloprid 10%+moxidectin 2.5% spot on (Advocate, Advantage multi) in the treatment of canine generalized demodicosis were evaluated in a multi-centre, controlled, randomized, blinded field study in Albania, France, and Germany. The study was conducted according to a non-inferiority design to demonstrate that the efficacy of the test product is not inferior to that of a control product containing milbemycin oxime (Interceptor, tablets for oral application). Of the 72 dogs enrolled, all of which expressed clinical signs of generalized demodicosis, 63 completed the study. Of these, 30 dogs were treated 2-4 times, at 4-week intervals, with the test product at the recommended dose of at least 0.1 ml/kg body weight. Thirty-three dogs were treated daily for two to four periods of 4 weeks with the control product according to label instructions (0.5-1 or 1-2 mg/kg body weight). Presence of mites in deep skin scrapings and clinical improvement were assessed 3-6 times at each inspection at 4-week intervals. Treatment was discontinued in dogs negative for mites on two subsequent examinations 4 weeks apart or at the last examination on day 84. At the end of the trial, dogs in both groups showed a similar clinical improvement. No Demodex mites were detected in 26 of 30 dogs treated with imidacloprid/moxidectin and in 29 of 33 dogs treated with milbemycin oxime. Statistical evaluation confirmed that the efficacy of the test product in the treatment of generalized canine demodicosis was not inferior to that of milbemycin oxime.

Administration, Topical↗

Efficacy of toltrazuril as a metaphylactic and therapeutic treatment of coccidiosis in first-year grazing calves.

A multicentric, placebo-controlled, randomised, blinded and blocked field study was conducted to evaluate the efficacy and safety of toltrazuril (Baycox, Bayer AG, Leverkusen, Germany) in the treatment of coccidiosis in first-year grazing calves naturally infected with Eimeria spp. Three-hundred and thirty-one calves were enrolled in the study and allocated to one of two treatments at a ratio of 1:1. One hundred and sixty-seven animals were treated once orally with 15 mg/kg toltrazuril, and 164 animals served as placebo-treated controls. Two treatment regimes were compared, a metaphylactic (treatment on the day, or 1 day after, turn out) and a therapeutic treatment (4 or 7 days after turn out). During an observation period of 14 days after treatment the animals were clinically examined for diarrhoea and faecal samples were regularly assessed for Eimeria oocysts. Other possible causes of diarrhoea were excluded on the basis of microbiological and virological examination. Animals were predominantly infected with Eimeria alabamensis. Number of days with diarrhoea in animals treated with toltrazuril was significantly lower compared to the placebo-treated group (therapeutic treatment: P=0.0024; metaphylactic treatment: P<0.0001). Furthermore, the number of animals with diarrhoea during the observation period for a minimum of at least 3 days, the number of animals positive for Eimeria oocysts, and the number of animals with both diarrhoea for a period of at least 3 days and positive for Eimeria oocysts, were significantly lower (P<0.01), in the toltrazuril- compared to the placebo-treated animals. Body weight in the toltrazuril-treated animals significantly exceeded that of the placebo-treated animals at the end of the observation period. Mean difference in body weight was higher in the metaphylactic (+7.3 kg) compared to the therapeutic treatment group (+3.4 kg). No adverse reactions were observed. The results indicate that toltrazuril is highly efficacious and safe in the metaphylactic and therapeutic treatment of coccidiosis caused by E. alabamensis in first-year grazing calves.

Animals↗

Effect of dietary beta-carotene on the early embryonic development and uterine fluid composition of gilts.

The role of beta-carotene in reproduction was investigated in gilts assigned to three dietary supplementations: VA (4000 IU vitamin A); VA + VA (4000 IU + 8300 IU); VA + BC (4000 IU + 100 mg beta-carotene) per kg diet for 14 weeks. Gilts were slaughtered at day 12 of gestation. In the VA + BC group, number of corpora lutea was lowest, but the number of embryos was greatest, resulting in a non-significant decreased prenatal mortality (p<0.07). The proportion of less developed spherical and tubular embryos compared with filamentous was greatest in the VA + BC group (p<0.01). No differences were observed for vitamin A and retinal binding protein (RBP) in the uterine fluid. When animals were grouped according to the development of blastocysts, vitamin A and RBP levels were higher in the VA + BC group with only filamentous embryos (p<0.01). This indicates that the supplementation of beta-carotene to gilts might affect embryonic losses possibly because of slower alterations in the uterine environment, resulting in a higher and less variable number of embryos, despite an apparently more heterogeneous development.

Animal Feed↗

Uptake of clozapine into HL-60 promyelocytic leukaemia cells.

The atypical antipsychotic, clozapine, exerts superior efficacy in therapy-resistant schizophrenia, but unfortunately induces agranulocytosis with an incidence of 0.8 - 1 %. In this study, we investigated the cellular uptake of clozapine into human promyelocytic leukaemia HL-60 cells using HPLC with electrochemical detection. On incubation with 1.25 to 40 microM clozapine for 30 min, a saturable, energy- and temperature-dependent uptake process takes place (K m = 18.8 microM, k cat = 1.36 nmol/5 min/mg protein at 37 degrees C). This suggests membrane passage of clozapine by a carrier mechanism. 10 microM Indatraline, an inhibitor of dopamine, noradrenaline and serotonin (5-HT) reuptake, but not the selective 5-HT reuptake inhibitor fluvoxamine, markedly reduced the transport of clozapine by 62 %, whereas addition of 10 mM glucose to the incubation medium increased intracellular clozapine concentrations by 28 %. Since cyclosporine A, vinblastine or verapamil up to a final concentration of 10 microM did not alter the intracellular accumulation of clozapine, an involvement of P-glycoprotein seems to be unlikely. In summary, clozapine uptake into HL-60 cells meets criteria of an active unidirectional transport. Its molecular correlates remain to be established.

Antipsychotic Agents↗

Preoperative predictors of late postoperative outcome among patients with nonischemic mitral regurgitation with 'high risk' descriptors and comparison with unoperated patients.

Among patients with chronic nonischemic mitral regurgitation (MR), high short-term mortality risk can be identified by left (LV) and/or right ventricular (RV) ejection fraction (EF) criteria (LVEF </=45% and/or RVEF </=30%). Mitral valve replacement or repair (MVR) significantly improves outcome in this subgroup, but predictors of late postoperative survival are not known, and the benefit of MVR has not been defined in patients matched for severity of LV and RV dysfunction. Therefore, prospective assessment of 14 consecutive high risk MR patients was performed before MVR and during 9 years (average) postoperatively to define echocardiographic and radionuclide angiographic predictors of survival; survival also was evaluated in a contemporaneous series of 9 high risk unoperated MR patients, and in subgroups of operated and unoperated patients matched for EF. Of 14 MVR patients, 4 died (3 cardiac: 1 sudden, 2 congestive heart failure). Only preoperative RVEF </=20% significantly predicted postoperative deaths (rest p = 0.032; exercise p = 0.05). Of 9 unoperated patients, 8 died. Mortality risk of unoperated patients remained higher than that of MVR patients when groups were matched for preoperative LVEF (p = 0.0001). Among patients with RVEF >20%, MVR significantly improved survival versus medical treatment (rest: p < 0.0001, exercise: p = 0.0003). In high risk MR patients, MVR improves survival; preoperative RV performance can define subgroups with different long-term postoperative survival.

Chronic Disease↗

Specific binding of 3H-spiperone to peripheral blood cells: relevance for the interpretation of binding studies in psychiatric disorders.

1. There is an ongoing discussion regarding the elevated binding of 3H-spiperone to lymphocytes of schizophrenic patients. Several authors described an atypical binding pattern with a saturable high-affinity and a nonsaturable binding site both displaceable by (+)-butaclamol. Recent findings are still controversial (Fartacek et al., 1997; Wodarz et al., 1996), possibly due to methodological differences. The authors investigated 3H-spiperone binding to different peripheral blood cells including B- and T-lymphoblastoids. 2. B-lymphocytes (KD = 0.081 nM; Bmax = 0.46 x 10(-15) mol/10(6) cells) and macrophages (KD = 0.1-1 nM, Bmax = 2.44 x 10(-15) mol/10(6) cells) are characterized by a minor but saturable binding of 3H-spiperone in a concentration range between 0.5 and 1 nM. Above 1 nM, only non-saturable binding was measurable. Interestingly, Epstein-Barr virus (EBV) transformed lymphoblastoids (KD = 0.13 nM) have nearly the same affinity for 3H-spiperone as native B-cells, but an increased number of binding sites (Bmax = 1.76 x 10(-15) mol/10(6) cells). 3. Membranes from B-lymphoblastoids displayed a saturable binding in a concentration between 0 and 1.8 nM of 3H-spiperone (KD = 0.5 nM and Bmax = 1.72 x 10(-15) mol/mg protein). Extraction with 1% digitonin resulted in a similar binding characteristic (KD = 0.17 nM and Bmax = 1.97 x 10(-15) mol/mg protein). 4. T-cells, granulocytes and MOLT-3-cells did not show is a saturable binding even not at high concentrations of 3H-spiperone. 5. The pharmacological profile of the high-affinity 3H-spiperone binding site is clearly different from the dopamine D2 and D4, serotonin 5-HT2 histamine H1 and noradrenergic alpha1 and alpha2 receptor, respectively. 6. In summary, the results suggest that spiperone binding studies to enriched lymphocytes of psychiatric patients should be interpreted cautiously. Variable amounts of leucocytes might result in a higher proportion of nonsaturable, butaclamol displaceable spiperone binding with relevance for the calculation of KD and Bmax of the saturable high-affinity site. Interestingly, homogenous B-lymphoblastoid cell lines have the same binding characteristics as native B-lymphocytes and therefore should be recommended for characterization of 3H-spiperone binding sites.

B-Lymphocytes↗

Active [3H]-dopamine uptake displayed by native lymphocyte suspensions is mainly due to contaminating platelets.

Kinetic and pharmacologic properties of specific [3H]-dopamine uptake by native human lymphocytes were investigated. Our results suggest that uptake of [3H]-dopamine measured with lymphocytes after separation over Ficoll-Paque or Percoll is mainly caused by platelets which are always part of freshly prepared lymphocyte suspensions. The investigations were extended to well-defined cell lines in order to compare the pharmacological properties of native and immortalized cells regarding the uptake of [3H]-dopamine without any influence of contaminating cells such as platelets. Using the human neuroblastoma cell line IMR32 we demonstrate a GBR-12909 and cocaine-sensitive specific uptake of dopamine, whereas dopamine uptake in platelets is performed by an imipramine-sensitive serotonin transporter. Blood-derived stable cell lines (MOLT-3 and EBV-transformed B-lymphocytes) exhibited no [3H]-dopamine uptake. The view that specific [3H]-dopamine uptake on native human lymphocytes is mainly caused by platelets and not specific for lymphocytes is supported by the finding that homogenous B- and T-lymphoblastoids (MOLT-3 and EBV-transformed B-lymphocytes) exhibited no comparable uptake.

Blood Platelets↗

Thyroid hormone treatment after coronary-artery bypass surgery.

BACKGROUND: Thyroid hormone has many effects on the cardiovascular system. During and after cardiopulmonary bypass, serum triiodothyronine concentrations decline transiently, which may contribute to postoperative hemodynamic dysfunction. We investigated whether the perioperative administration of triiodothyronine (liothyronine sodium) enhances cardiovascular performance in high-risk patients undergoing coronary-artery bypass surgery. METHODS: We administered triiodothyronine or placebo to 142 patients with coronary artery disease and depressed left ventricular function. The hormone was administered as an intravenous bolus of 0.8 microgram per kilogram of body weight when the aortic cross-clamp was removed after the completion of bypass surgery and then as an infusion of 0.113 microgram per kilogram per hour for six hours. Clinical and hemodynamic responses were serially recorded, as was any need for inotropic or vasodilator drugs. RESULTS: The patients' preoperative serum triiodothyronine concentrations were normal (mean [+/- SD] value, 81 +/- 22 ng per deciliter [1.2 +/- 0.3 nmol per liter]), and they decreased by 40 percent (P < 0.001) 30 minutes after the onset of cardiopulmonary bypass. The concentrations in patients given intravenous triiodothyronine became supranormal and were significantly higher than those in patients given placebo (P < 0.001). However, the concentrations were once again similar in the two groups 24 hours after surgery. The mean postoperative cardiac index was higher in the triiodothyronine group (2.97 +/- 0.72 vs. 2.67 +/- 0.61 liters per minute per square meter of body-surface area, P = 0.007), and systemic vascular resistance was lower (1073 +/- 314 vs. 1235 +/- 387 dyn.sec.cm-5, P = 0.003). The two groups did not differ significantly in the incidence of arrhythmia or the need for therapy with inotropic and vasodilator drugs during the 24 hours after surgery, or in perioperative mortality and morbidity. CONCLUSIONS: Raising serum triiodothyronine concentrations in patients undergoing coronary-artery bypass surgery increases cardiac output and lowers systemic vascular resistance, but does not change outcome or alter the need for standard postoperative therapy.

Aged↗

Triiodothyronine improves left ventricular function without oxygen wasting effects after global hypothermic ischemia.

Cardiopulmonary bypass results in a "euthyroid sick" state. Recently, interest has focused on the relationship between low serum triiodothyronine levels and postoperative cardiovascular hemodynamics. The present study was undertaken to more clearly define the acute effects of triiodothyronine on myocardial mechanics and energetics after hypothermic global ischemia using an ex-vivo canine heart preparation to model the clinical condition. Experiments were performed on isolated hearts subjected to hyperkalemic arrest with 90 minutes of hypothermic (10 degrees C) ischemia. Isolated hearts were cross-perfused by euthyroid support dogs in which triiodothyronine levels spontaneously decreased by 65% to 75% (p < 0.01) after the initiation of cross-perfusion. In nine heart preparations, triiodothyronine (Triostat) was given as a bolus dose (0.2 micrograms/kg) after 1 hour of baseline data collection with a subsequent measurable rise in serum triiodothyronine levels (p < 0.01). In six postischemic hearts, reverse triiodothyronine was given as a 0.2 micrograms/kg bolus. Triiodothyronine was also administered to a group of eight nonischemic, continuously perfused isolated hearts. Intrinsic myocardial contractility was assessed by analysis of the preload recruitable stroke work area, energetic efficiency from the myocardial oxygen consumption-pressure-volume area relationship, and coronary vascular resistance from analysis of coronary flow and perfusion pressure. Acute administration of triiodothyronine to postischemic hearts improved the preload recruitable stroke work area from 9.5 +/- 1.42 to 14.9 +/- 2.03 x 10(7) erg/ml, a 56% increase from baseline (p < 0.001), but had no effect on the preload recruitable stroke work area of the nonischemic hearts. The inotropic response resulting from triiodothyronine treatment did not alter the myocardial oxygen consumption-pressure-volume area relationship. Triiodothyronine treatment was associated with significantly decreased coronary resistance and increased coronary flow through a range of diastolic loading conditions in the postischemic hearts. The biologically inactive thyroid hormone metabolite reverse triiodothyronine was without effect on any of the measured parameters. On the basis of these results, we conclude that the low triiodothyronine state of cardiopulmonary bypass can be reproduced in this isolated heart model and that acute triiodothyronine treatment results in a unique inotropic action manifest only in the postischemic reperfused myocardium and is accomplished without oxygen wasting effects.

Animals↗

Ultrathin-layer microelectrophoretic determination of lactate dehydrogenase isoenzymes in corneal and conjunctival epithelium of the cow.

In order to evaluate the impact of tissue oxygenation on the distribution pattern of lactate dehydrogenase isoenzymes, activities of the isoenzymes were measured in microdissected samples of bovine tissue. A highly sensitive ultrathin-layer electrophoretic technique was used to determine the distribution pattern of lactate dehydrogenase isoenzymes in basal, intermediate and superficial layers of the epithelium of central and peripheral cornea and in the epithelium of the bulbar conjunctiva. Measurements revealed almost homogeneous intraepithelial distribution patterns of lactate dehydrogenase isoenzymes in both tissues. In the cornea the lactate dehydrogenase isoenzymes 4 and 5, which are regarded to be specialized for anaerobic glucose metabolism, were found to predominate. In the well-oxygenated conjunctival epithelium most of the activity could be ascribed to the lactate dehydrogenase isoenzyme 3. In contrast to the isoenzymatic activities, total activity of lactate dehydrogenase was inhomogeneously distributed; maximum activities were found in the basal layer of corneal epithelium and in the intermediate layer of conjunctival epithelium. The results indicate that oxygen supply is relevant rather for the intraepithelial distribution of total enzyme activity than for the expression of lactate dehydrogenase isoenzymes.

Animals↗

Iron regulation of triosephosphate isomerase transcript stability in the yeast Saccharomyces cerevisiae.

By differential hybridization we have identified cDNA clones that are derived from iron-regulated genes in Saccharomyces cerevisiae. Sequencing of seven cDNA clones revealed that five clones correspond to TPI1 encoding triosephosphate isomerase (Tpi1p) and one corresponds to TDH3 encoding glyceraldehyde-3-phosphate dehydrogenase (Tdh3p). During iron-limited growth mRNA levels for Tpi1p and Tdh3p were at least 3-fold lower than during iron-saturated growth; as shown with a hem1 mutant strain this regulation does not require haem synthesis. mRNA half-lives of TPI1 (TDH3) were 11.5 min (18 min) in low-iron medium and 30 min (32.5 min) in high-iron medium, indicating iron-regulation of transcript half-lives; the stabilities of the ACT1 and PDC1 transcripts were not influenced by iron. Increased glycerol production during growth in low-iron, as compared to high-iron medium, is consistent with a modification of the glycolytic flux during iron-limited growth in S. cerevisiae.

Cloning, Molecular↗

Internal mammary artery is a safe conduit for repeat coronary revascularization.

The safety of repeat coronary revascularization using the internal mammary artery (IMA) as a conduit was examined in patients undergoing repeat revascularization between January 1988 and June 1991. The 71 patients in whom the IMA was used as one of the conduits were compared with 57 patients in whom only vein grafts were used. Patients undergoing IMA grafts were likely to have more vessels revascularized. Nevertheless, there were no significant differences in outcome between the two groups as measured by complications or period of hospitalization. In a multivariate analysis, the only independent predictor of poor outcome was emergency surgical treatment. The current study would indicate that IMA grafts are safe in the setting of repeat coronary revascularization.

Aged↗

Reoperative coronary artery bypass surgery. Improved preservation of myocardial function with retrograde cardioplegia.

BACKGROUND: Cardiac-related mortality remains high for reoperative coronary artery bypass graft surgery (rCABG) compared with first-time surgery (fCABG). Retrograde cardioplegia (RC) has been suggested but not proven to improve the results for rCABG. METHODS AND RESULTS: We therefore reviewed the records of 240 consecutive patients who had undergone rCABG at our institution since 1988. The interval to reoperation was 9.1 +/- 4.2 years (mean +/- SD), with a range from 0.2 to 18 years. Only 46% of grafts were patent at the time of rCABG. The incision to cardiopulmonary bypass (CPB), incision to cross-clamp (XCL), and XCL per graft time intervals were significantly prolonged compared with 100 consecutive fCABG patients operated on during the same time period. Blood utilization was also significantly increased in rCABG compared with fCABG patients. Overall operative mortality was 5.8% and 0% for rCABG and fCABG patients, respectively (P < .05). High-risk criteria (emergency surgery, angina at rest requiring intravenous nitroglycerin or intra-aortic balloon pump [IABP] support [urgent surgery], recent [<21 days] myocardial infarction, or ejection fraction < 30%) were noted in 136 rCABG patients (57%) and 28 fCABG patients (28%) (P < .001). Profound postoperative myocardial dysfunction (postoperative IABP dependence) occurred in only one of 104 low-risk patients (1%), compared with 14 of 136 high-risk patients (10%) (P < .005). Operative mortality was noted in 13 high-risk patients (9.5%) compared with one low-risk patient (1%) (P < .005). RC was used in 80 patients without complication. Postoperative IABP dependence developed in only 2 of 53 high-risk/RC patients (3.8%) compared with 12 of 83 high-risk/non-RC patients (14.5%) (P < .05). At follow-up, rCABG and fCABG patients enjoyed similar symptomatic improvement. CONCLUSIONS: We conclude that retrograde cardioplegia, possibly by minimizing the increased ischemia associated with rCABG, improves the results of rCABG, specifically in regard to preventing profound myocardial dysfunction in high-risk patients.

Coronary Artery Bypass↗