Miracle-dz/UniFAR-FTUs huggingface dataset:
Left bundle branch block causes relative but not absolute septal underperfusion during exercise.

AIMS Left bundle branch block (LBBB) often causes septal perfusion defects in radionuclide myocardial perfusion imaging using exercise (Ex) but rarely using vasodilator stress. We studied whether this is due to an underlying structural disease inherent to spontaneous LBBB or whether it is also found in temporary LBBB induced by right ventricular pacing (PM) indicating a functional rather than a structural alteration. METHODS AND RESULTS Regional myocardial blood flow (MBF) at rest and at Ex was measured with 15O-H2O and PET in 10 age-matched healthy volunteers (controls), 10 LBBB patients and 10 PM patients with right ventricular pacing off and on (PM off and PM on). Although at Ex septal MBF tended to be higher in LBBB than in controls (3.04 +/- 1.18 vs. 2.27 +/- 0.72 mL/min/g; P = ns), the ratio septal/lateral MBF was 19% lower in LBBB than in controls (P < 0.05). Similarly, switching PM on at Ex decreased the ratio septal/lateral MBF by 17% (P < 0.005). CONCLUSION The apparent septal perfusion defect in LBBB is mainly due to a relative lateral hyperperfusion rather than to an absolute septal flow decrease. This pattern seems to be reversibly inducible by right ventricular pacing, suggesting a functional rather than a structural alteration.
Occurrence of late gadolinium enhancement in ventricular ballooning or Tako-Tsubo syndrome: increased wall stress should not be overlooked.

With great interest, we read the article by Rolf et al. 1 The histological basis of late gadolinium enhancement (LGE) in magnetic resonance imaging (MRI) was examined in 15 patients with transient ventricular ballooning or the so-called Tako-Tsubo syndrome. While all patients exhibited increased collagen-1 in endomyocardial biopsies, it was higher in five patients who showed LGE. After 14 days, LGE and collagen-1 normalized. Since focal LGE pattern did not match the areas of increased collagen that were diffusely spread over the left ventricle, collagen-1 alone cannot explain the occurrence of LGE. We agree that an increase of the interstitial space …
Relationship between burnout and professional conduct and attitudes among US medical students.

CONTEXT The relationship between professionalism and distress among medical students is unknown. OBJECTIVE To determine the relationship between measures of professionalism and burnout among US medical students. DESIGN, SETTING, AND PARTICIPANTS Cross-sectional survey of all medical students attending 7 US medical schools (overall response rate, 2682/4400 [61%]) in the spring of 2009. The survey included the Maslach Burnout Inventory (MBI), the PRIME-MD depression screening instrument, and the SF-8 quality of life (QOL) assessment tool, as well as items exploring students' personal engagement in unprofessional conduct, understanding of appropriate relationships with industry, and attitudes regarding physicians' responsibility to society. MAIN OUTCOME MEASURES Frequency of self-reported cheating/dishonest behaviors, understanding of appropriate relationships with industry as defined by American Medical Association policy, attitudes about physicians' responsibility to society, and the relationship of these dimensions of professionalism to burnout, symptoms of depression, and QOL. RESULTS Of the students who responded to all the MBI items, 1354 of 2566 (52.8%) had burnout. Cheating/dishonest academic behaviors were rare (endorsed by <10%) in comparison to unprofessional conduct related to patient care (endorsed by up to 43%). Only 14% (362/2531) of students had opinions on relationships with industry consistent with guidelines for 6 scenarios. Students with burnout were more likely to report engaging in 1 or more unprofessional behaviors than those without burnout (35.0% vs 21.9%; odds ratio [OR], 1.89; 95% confidence interval [CI], 1.59-2.24). Students with burnout were also less likely to report holding altruistic views regarding physicians' responsibility to society. For example, students with burnout were less likely to want to provide care for the medically underserved than those without burnout (79.3% vs 85.0%; OR, 0.68; 95% CI, 0.55-0.83). After multivariable analysis adjusting for personal and professional characteristics, burnout was the only aspect of distress independently associated with reporting 1 or more unprofessional behaviors (OR, 1.76; 95% CI, 1.45-2.13) or holding at least 1 less altruistic view regarding physicians' responsibility to society (OR, 1.65; 95% CI, 1.35-2.01). CONCLUSION Burnout was associated with self-reported unprofessional conduct and less altruistic professional values among medical students at 7 US schools.
Anxiety is a better predictor of platelet reactivity in coronary artery disease patients than depression.

AIMS Depression and anxiety are linked to coronary events but the mechanism(s) remains unclear. We investigated the associations of depression and anxiety with serotonin-mediated platelet hyperactivity in coronary artery disease (CAD) patients in a cross-sectional study. METHODS AND RESULTS Three months after an acute coronary event, stable CAD patients (n = 83) on aspirin and clopidogrel were evaluated for depression (beck depression inventory) and anxiety (hospital anxiety and depression scale), and their platelet reactivity was measured (optical aggregometry and flow cytometric fibrinogen binding in response to adenosine diphosphate (ADP = 5 microM) and two serotonin + epinephrine doses [5HT:E (L) = 4 microM + 4 microM and 5HT:E (H) = 10 microM + 4 microM]. Platelet reactivity was significantly higher in depressed and anxious than in depressed only or non-depressed-and-non-anxious patients. Aggregation (mean +/- SE) was 41.9 +/- 2.6% vs. 32.2 +/- 2.6% vs. 30.4 +/- 3.7% with 5HT:E (L) and 46.9 +/- 2.7% vs. 35.6 +/- 2.7% vs. 31.7 +/- 3.8% with 5HT:E (H) (P < 0.05 for both). Differences in ADP aggregations were not significant, perhaps because of clopidogrel therapy. Flow cytometry findings were similar. In a multivariate linear regression model adjusted for age, body mass index, and each other, anxiety symptoms independently predicted all 5HT:E-mediated platelet reactivity measures, whereas depression predicted none. CONCLUSION Anxiety is associated with elevated serotonin-mediated platelet reactivity in stable CAD patients and symptoms of anxiety show strong, independent correlations with platelet function.
Food groups and weight gain in Japanese men

Identifying subjects at high risk of weight gain according to consumption of food groups is important for individualizing nutritional education, but prospective studies of this issue have been few. We determined whether intake of specific food groups could predict future weight gain. We evaluated data from health checkups on 1236 Japanese men aged 28 to 87 years in 2005 and 2006. Dietary intake was assessed by a 24‐h dietary recall at baseline. Weight change was measured after 1 year. Weight increased in 44.7% (n = 553) of participants. Multivariate regression analysis involving many food groups showed a significant association between sugar intake and weight gain after adjustment for age, body mass index (BMI), total energy intake, alcohol, smoking and regular physical exercise (β = 0.22, P = 0.04). The effect of intake of ‘fats and oils’ was significant when adjusted for age and BMI, however, it became insignificant after adjustment for age, BMI and total energy intake. Intake of sugar, which was evaluated as a food group, was predictive of subsequent weight gain among Japanese men, even after adjustment for many confounders. This corroborates the evidence so far concerning the links between sugar intake and weight gain. Further long‐term research is required to give robust recommendation to the public.
Circulating microRNA: a novel potential biomarker for early diagnosis of acute myocardial infarction in humans.

AIMS microRNA (miRNA) is reported to be present in the blood of humans and has been increasingly suggested as a biomarker for diseases. We aim to determine the potential of cardiac-specific miRNAs in circulation to serve as biomarkers for acute myocardial infarction (AMI). METHODS AND RESULTS By verifying their tissue expression patterns with real-time polymerase chain reaction (PCR) analysis, muscle-enriched miRNAs (miR-1, miR-133a, and miR-499) and cardiac-specific miR-208a were selected as candidates for this study. With miRNA microarray and real-time PCR analyses, miR-1, miR-133a, and miR-499 were present with very low abundance, and miR-208a was absent in the plasma from healthy people. In the AMI rats, the plasma levels of these miRNAs were significantly increased. Especially, miR-208a in plasma was undetected at 0 h, but was significantly increased to a detectable level as early as 1 h after coronary artery occlusion. Further evaluation of the miRNA levels in plasma from AMI patients (n = 33) demonstrated that all four miRNA levels were substantially higher than those from healthy people (n = 30, P < 0.01), patients with non-AMI coronary heart disease (n = 16, P < 0.01), or patients with other cardiovascular diseases (n = 17, P < 0.01). Notably, miR-208a remained undetectable in non-AMI patients, but was easily detected in 90.9% AMI patients and in 100% AMI patients within 4 h of the onset of symptoms. By receiver operating characteristic curve analysis, among the four miRNAs investigated, miR-208a revealed the higher sensitivity and specificity for diagnosing AMI. CONCLUSION Elevated cardiac-specific miR-208a in plasma may be a novel biomarker for early detection of myocardial injury in humans.
Adaptations to a diet‐based weight‐reducing programme in obese women resistant to weight loss

The aim of this study was to assess energy intake, resting metabolic rate (RMR), appetite sensations, eating behaviours and sleep duration and quality in obese women resistant to body weight loss when subjected to a diet‐based weight‐reducing programme. A pooled cohort of obese women (n = 75; aged 39 ± 8 years; body mass index: 33 ± 4 kg m−2) participated in a 12–16‐week diet‐based weight loss programme targeting a daily energy deficit of 500–700 kcal d−1. Women were classified in tertiles a posteriori based on the response of their body weight to dietary supervision (high, moderate and low responders). Post‐intervention, mean weight loss was 3.3 ± 2.8 kg and explained by the 2.9 ± 2.6 kg reduction in fat mass. Mean weight loss was 6.2 ± 1.6, 3.4 ± 0.6 and 0.2 ± 1.4 kg in participants classified in the high, middle and low tertiles, respectively. Women in the low tertile reduced their daily energy intake and susceptibility to hunger during the programme to a lesser extent than those in the high tertile and had higher fasting hunger in response to the dietary intervention. Women in the high tertile maintained their RMR, which was in contrast to the significant decrease predicted by their weight loss. They also reported a significant improvement in sleep quality and an increase in sleep duration compared with other tertiles. The differences in the response of body weight to dietary supervision may be explained, in part, by variations in energy intake, eating behaviours, appetite sensations and sleep duration and quality.
Cancer: Principles and Practice of Oncology

The third edition of DeVita, Hellman, and Rosenberg's by now classic text on cancer preserves the multimodal, integrated approach to clinical evaluation and treatment of that disease. The editors see to that approach by close supervision of the 66 individual chapters, each of which is written by one or more recognized experts. For a multiauthored text to be successful, information presented must be cogent and up-to-date. For the busy practitioner, it helps to read a scientific style that is lucid, if not graceful, succinct but not overwhelming. Most of us have tried to look up specific material and find information that will help us deal with daily clinical problems. Too often a comprehensive text leaves us no better off than we began—bogged down with excess cumbersome detail and without the help we had hoped to find. Happily, such is not the case with this text, nor was it a problem
Eating behaviours are different in youth with obesity and severe obesity

The study purposes were to: (i) Investigate eating behaviours among patients in a paediatric weight management clinical practice and (ii) Compare eating behaviour phenotypes between children with severe obesity and obesity. This was a retrospective cross‐sectional study using data collected during clinical encounters. Participants were included if they were 2–12 years old, had a body mass index ≥95th percentile and if a parent or guardian completed the Child Eating Behaviour Questionnaire (CEBQ). Participants (n = 149) were children with severe obesity (n = 108) and obesity (n = 41). The mean Satiety Responsiveness score was significantly lower for children with severe obesity than for children with obesity. Girls with severe obesity had significantly higher Enjoyment of Food and significantly lower Satiety Responsiveness and Slowness in Eating than girls with obesity. The findings demonstrate the potential clinical utility of the CEBQ for informing tailored treatment strategies through identifying eating behaviour phenotypes.
Attrition and weight loss outcomes for patients with complex obesity, anxiety and depression attending a weight management programme with targeted psychological treatment

The objective of the study is to investigate the effect of baseline anxiety and depression, using different definitions for caseness, on attrition and weight outcomes following a multidisciplinary weight management programme. The study design is a prospective observational study. The Hospital Anxiety and Depression Scale (HADS) was used to measure anxiety and depression with ‘caseness’ scoring ≥11 and severity ≥14. The participants were all patients who began a weight management programme between 1 October 2008 and 30 September 2009 (n = 1838). The setting was the Glasgow and Clyde Weight Management Service (GCWMS), a specialist multidisciplinary service, which aims to achieve a minimum of ≥5 kg weight loss. The results were as follows: patients with HADS score ≥14 were referred to the integrated psychology service for psychological assessment or intervention. Patients with caseness (HADS ≥11) for anxiety (33%) and depression (27%) were significantly younger, heavier, more socio‐economically deprived and a higher proportion was female. There was a significant positive correlation between HADS anxiety and depression scores and increasing body mass index (r2 = 0.094, P < 0.001 and r2 = 0.175, P < 0.001, respectively). Attendance and completion was lower throughout follow‐up amongst patients with anxiety or depression. More patients with HADS score ≥11 achieved ≥5 kg or ≥5% weight loss and by 12 months those with anxiety had a significantly higher mean weight loss (P = 0.032). Participants who scored for severe anxiety (HADS ≥14) achieved similar weight loss to those without, whilst participants who scored for severe depression achieved significantly greater weight loss than non‐cases at 3, 6 and 12 months of follow‐up (P < 0.01). Despite a less favourable case‐mix of risk‐factors for poor weight loss, patients who scored caseness for severe anxiety or depression and were offered additional psychological input achieved similar or better weight loss outcomes.
Recombinant apolipoprotein A-I Milano rapidly reverses aortic valve stenosis and decreases leaflet inflammation in an experimental rabbit model.

AIMS Aortic stenosis (AS) is associated with significant morbidity and mortality. Recombinant apolipoprotein A-I Milano (rApoA-I(M)) induces atherosclerotic plaque regression. The aims of this study were to determine the effects of rApoA-I(M) on experimental aortic valve degeneration and its mechanisms of action. METHODS AND RESULTS New Zealand White rabbits (n = 20) were fed an atherogenic diet for 9 months and then randomized to either placebo or rApoA-I(M). Echocardiography was used to assess the effect of the treatments on AS. Porcine aortic valve myofibroblasts (PAVMF) treated with oxidized low-density lipoprotein served to define the effects of rApoA-I(M) on the expression of monocyte chemoattractant protein-1 (MCP-1), nuclear factor (NF)-kappaB, and alkaline phosphatase (AP). Recombinant apolipoprotein A-I Milano increased aortic valve area (AVA) by 32% (0.25 +/- 0.05 to 0.34 +/- 0.07 cm(2), P < 0.01); whereas AVA remained unchanged in the placebo group (0.24 +/- 0.05 to 0.26 +/- 0.04 cm(2), P = 0.58). Histopathological examination of aortic valves in the rApoA-I(M) animals showed significantly less leaflet thickening, inflammation, and calcification vs. the placebo group. In vitro, rApoA-I(M) significantly inhibited MCP-1, AP, and NF-kappaB and decreased intracellular cholesterol content in PAVMF. CONCLUSION Recombinant apolipoprotein A-I Milano treatment reverses AS in this experimental rabbit model. The beneficial effects seem to be mediated by enhanced cholesterol removal and by reduced inflammation and calcification.
‘Life in the age of screens’: parent perspectives on a 24‐h no screen‐time challenge

Screens have become ubiquitous in modern society. Their use frequently underlies sedentary behaviour, a well‐established determinant of obesity. As part of a family oriented clinic offering a 2‐year lifestyle program for obese children and youth, we explored parents’ experiences with a 24‐h no screen‐time challenge, an intervention designed to raise awareness of screen‐time habits and to help families develop strategies to limit their use. In total, 15 parents representing 13 families participated. A focus group with nine parents and six phone interviews with those who could not join in person were conducted. Interviews were transcribed verbatim and analysed qualitatively. Key elements to successful completion of the 24‐h no screen‐time challenge emerged, namely: clear rules about permitted activities during the 24‐h period; togetherness, i.e. involving all family members in the challenge; and busyness, i.e. planning a full schedule in order to avoid idleness and preclude the temptation to use screens. Our findings suggest that practitioners aiming to increase awareness of screen‐time or to limit their use may be more likely to succeed if they include all family members, offer concrete alternatives to screen‐based activities and provide tailored strategies to manage discretionary time.
Attitudes of Older Adults About Community-Based Services

Abstract We currently lack critical information about an important component of community-based service use-attitudes about these services. To understand such attitudes, 115 older adults (age 65+) participated in in-depth interviews. Because of their vulnerability to poor health status, insufficient resources, and low use of formal services relative to their needs, we oversampled African-American and rural elders. Both positive and negative attitudes were expressed about formal services, with five overarching categories of concern emerging from the analyses. These concerns included (1) the quality of the program or staff; (2) security; (3) cost and eligibility requirements; (4) transportation; and (5) logistical elements. Implications and recommendations are suggested.
Bilateral mammary artery vs. single mammary artery grafting: promising early results: but will the match finish with enough players?

This editorial refers to ‘Randomized trial to compare bilateral vs. single internal mammary coronary artery bypass grafting: 1-year results of the Arterial Revascularisation Trial (ART)’, by D.P. Taggart et al. , doi:10.1093/eurheartj/ehq318 A single internal mammary artery (SIMA) rather than vein graft to the left anterior descending coronary artery is undoubtedly the standard therapy in coronary bypass surgery. Surprisingly, the usage of two mammary arteries has not been accepted as the standard of care and the benefits and disadvantages have been a matter of debate for years. Numerous compelling retrospective studies have documented a clear benefit for bilateral mammary artery (BIMA) grafting over SIMA grafting in reducing the long-term risk of death, cardiac death, and late cardiac events.1 Nevertheless, there is a wide discrepancy between these findings in the literature and clinical practice. In the USA, BIMA usage is only around 4%2 and in Europe 12%. 3 The saphenous vein is still a widely used graft because of its accessibility, sufficient length, and ease of manipulation. Bilateral mammary artery grafting has been associated with an increased rate of sternal dehiscence a potential complication, particularly in diabetics.4 It seems however that using skeletonized BIMA grafts may lower the incidence of sternal complications.5 Another argument that is often used against BIMA usage is that composite grafting is susceptible to the effect of flow competition and may lead to a higher incidence of graft occlusion or string sign in up to 20% of the patients.6 Nonetheless, this compares favourably with an astonishing 45% …
Adipocyte fatty acid binding protein in atherosclerotic plaques is associated with local vulnerability and is predictive for the occurrence of adverse cardiovascular events.

AIMS There is an increasing need for translational studies identifying molecular targets contributing to atherosclerotic plaque destabilization. Local molecular plaque markers that are related to plaque vulnerability may hold predictive value to identify patients who are at increased risk to suffer from cardiovascular events. Animal studies revealed that adipocyte fatty acid binding protein (FABP4) is associated with the progression of atherosclerosis; however, FABP4 expression studies in human atherosclerotic plaques are lacking. We investigated FABP4 expression in carotid atherosclerotic lesions in relation to plaque composition and future cardiovascular events. METHODS AND RESULTS Atherosclerotic plaques were obtained from 561 patients undergoing carotid endarterectomy (CEA). Plaques were analysed for the presence of macrophages, lipid core, smooth-muscle cells, collagen, calcification, and intraplaque haemorrhage. Patients were followed for 3 years after CEA. The primary outcome was defined as the composite of vascular death, vascular event, and surgical or percutaneous vascular intervention. Fatty acid binding protein levels correlated with unstable plaque characteristics and symptomatic lesions. Patients with increased FABP4 plaque levels showed a two-fold increased risk [HR = 1.99, 95% confidence interval (95% CI) (1.30-3.04)] (P = 0.005) to reach the primary outcome during follow-up. Increased FABP4 levels related to primary outcome, independent from general cardiovascular risk factors [HR = 1.33, 95% CI (1.08-1.65)] (P = 0.008). CONCLUSION FABP4 levels in atherosclerotic lesions are associated with an unstable plaque phenotype and an increased risk for cardiovascular events during follow-up. Besides risk stratification for adverse future cardiovascular events, the outcome of the present study supports the relevance of exploring FABP4 antagonists as a potential pharmaceutical intervention to treat atherosclerotic disease progression.