Ethanol promotes arteriogenesis and restores perfusion to chronically ischemic myocardium.

BACKGROUND: Moderate alcohol consumption is known to be cardioprotective compared with either heavy drinking or complete abstinence. We assessed the hypothesis that ethanol supplementation would improve myocardial function in the setting of chronic ischemia. METHODS AND RESULTS: Sixteen male Yorkshire swine underwent placement of an ameroid constrictor into the left circumflex artery to induce chronic myocardial ischemia. Postoperatively, animals were supplemented with either 90 mL of ethanol (EtOH) daily (50%/V, EtOH) or 80 g of sucrose of equal caloric value (SUC), serving as controls. Seven weeks after ameroid placement, arteriolar density (1.74 ± 0.210% versus 3.11 ± 0.368% area of arterioles per low-powered field in sucrose (SUC) versus EtOH; P=0.004), myocardial perfusion (ratio of blood flow to the at-risk myocardium compared with the normal ventricle during demand pacing was 0.585 ± 0.107 versus 1.08 ± 0.138 for SUC versus EtOH; P=0.014), and microvascular reactivity were significantly increased in ethanol-treated animals compared with controls in the at-risk myocardium. Analysis of vascular endothelial growth factor and NOTCH pathway signaling suggested proneovascular and proliferative activity in the ischemic area. The average peak blood alcohol level in the treatment group was 40 ± 4 mg/dL, consistent with levels of moderate drinking in humans. CONCLUSIONS: Ethanol supplementation increased arteriolar density and significantly improved myocardial perfusion and endothelium-dependent vasorelaxation in chronically ischemic myocardium. These findings suggest that, at moderate doses, ethanol directly promotes vasculogenesis and improves microvascular function, resulting in significant improvements in myocardial perfusion in the setting of chronic ischemia.

Increased Utilization of American Administrative Databases and Large-scale Clinical Registries in Orthopaedic Research, 1996 to 2016.

INTRODUCTION: Administrative databases and clinical registries provide large sample sizes that characterize specific outcomes and trends over time in orthopaedic surgery. METHODS: A literature review of all English-language orthopaedic surgery journals was conducted. All publications from 1996 to 2016 were reviewed for the utilization of an administrative database or clinical registry. We performed a linear regression with logarithmic transformation to identify trends in database utilization. RESULTS: Eight hundred forty-nine publications used a database from 1996 to 2016. Each year, 35.3% more database publications are reported than the previous year (95% confidence interval, 30.0 to 40.7), from zero articles in 1996 to 286 in 2016. The ratio of database research publications to overall orthopaedic publications increased from zero in 1996 to 2% in 2016. The most commonly used databases included the National Inpatient Sample and the National Surgical Quality Improvement Program. CONCLUSION: Database research in orthopaedics has grown at a faster rate than orthopaedic literature as a whole.