Persius/hicric huggingface dataset:
Results of the TRANSFER AMI study published in NEJM
June 25, 2009: The TRANSFER-AMI Trial Investigators reported today in the New England Journal of Medicine  that among ST-segment elevation myocardial infarction (STEMI) patients treated with fibrinolysis, routine early adjunctive PCI is superior to delayed rescue angioplasty.
While in many community hospitals without cardiac catheterization facilities fibrinolytic therapy is the standard of care , the Trial of Routine Angioplasty and Stenting After Fibrinolysis to Enhance Reperfusion in Acute Myocardial Infarction (TRANSFER-AMI Trial) sought to investigate the safety and efficacy of transferring high risk STEMI patients to angioplasty centers within 6 hours of drug treatment. It should be noted that this was not a trial of facilitated PCI: in a trial of facilitated PCI all patients would be treated with PCI and the trial would test whether adjunctive therapy prior to the PCI improved outcomes.  This was a trial instead in which all patients received fibrinolysis, and the question was whether an early PCI could improve the outcomes with a lytic agent. PCI was performed either early in all patients (routine adjunctive PCI) or late in only those select patients who failed fibrinolysis (rescue angioplasty).
In this open label, active control, parallel assignment, safety/efficacy study, 1059 high risk STEMI patients presenting at Canadian hospitals unable to perform PCI were randomized either to immediate transfer for routine PCI within 6 hours after fibrinolysis (routine early adjunctive PCI arm, n=537) or to rescue or delayed PCI only when fibrinolytic therapy failed (standard therapy arm, n=532).  Patients in both treatment strategy arms were administered tenecteplase, aspirin and unfractionated heparin or enoxaparin prior at presentation in the emergency department.  The primary endpoint was a 30 day composite of all cause death, reinfarction, recurrent ischemia, heart failure or cardiogenic shock.  The secondary endpoint was incidence of major/severe bleeding (according to TIMI and GUSTO classifications) within 30 days.
Compared to standard treatment, routine early adjunctive PCI was associated with an absolute reduction in the primary endpoint from 17.2% (n=90) to 11.0% (n=59), which translates to a relative risk reduction of 0.64 (95% Confidence Interval : 0.47  0.87, p=0.004).  Rates of TIMI major or severe GUSTO bleeding did not significantly differ between treatment strategy arms (6.1% versus 7.4% for standard and routine early PCI groups respectively, p=0.39).  While much of the benefit in the composite endpoint was driven by a reduction in recurrent ischemia, there was also a reduction in new onset heart failure. There were trends toward a benefit in recurrent MI.
This trial adds to a growing body of literature that demonstrates that among patients treated with fibrinolysis for STEMI, routine, early transfer of all patients for adjunctive PCI is superior to a strategy of delayed transfer for rescue PCI among those select patients who have failed fibrinolysis.

# Slides
For the slides presented at ACC 2008, click here.
Ruthenium(II) tris(bathophenanthroline disulfonate)
Ruthenium(II) tris(bathophenanthroline disulfonate) is a chemical compound used as a protein dye in biochemistry for differentiating and detecting different proteins in laboratory settings.
In recent years, 2-D electrophoresis has been widely accepted as a standard procedure to separate complex protein mixtures in proteome studies (Proteomics). Protein visualisation by Ruthenium(II) tris(bathophenthroline disulfonate) has become a firmly established and widely used method in proteomic analysis and a crucial step in protein expression profiling.
For protein detection, it is advantageous to use fluorescent labels containing chromophores which have longer excitation wavelength and [[Emission (electromagnetic radiation)
Originally, the ruthenium transition metal complex, ruthenium(II) tris(4,7-diphenyl-1,10-phenanthroline disulfonate)  also termed as ruthenium(II) tris(bathophentroline disulfonate) (RuBPS) was synthesized by Bannwarth as a precursor molecule for a dye that was used as a non-radioactive label for oligo nucleotides. Later, Rabilloud et al. used RuBPS as a fluorescent label for protein detection in polyacrylamide gels . The fact that RuBPS is not only easy to synthesize but also easy to handle, induced further developments in this field.
Lamanda et al. improved the RuBPS staining protocol by selectively destaining the polyacrylamide matrix while the protein content remained tinctured. This new technique entailed a variety of advantages like strong signals, ameliorated signal to background ratio, better linearity and advanced baseline resolution.
Schizoid personality disorder (patient information)
For the WikiDoc page for this topic, click here

# Overview
Schizoid personality disorder is a psychiatric condition in which a person has a lifelong pattern of indifference to others and social isolation.

# What are the symptoms of Schizoid personality disorder?
A person with schizoid personality disorder:
- Appears aloof and detached
- Avoids social activities that involve emotional intimacy with other people
- Does not want or enjoy close relationships, even with family members

# What causes Schizoid personality disorder?
- The causes of schizoid personality disorder are unknown. This disorder may be related to schizophrenia and it shares many of the same risk factors.
- However, schizoid personality disorder is not as disabling as schizophrenia. It does not cause hallucinations, delusions, or the complete disconnection from reality that occurs in untreated (or treatment-resistant) schizophrenia.

# Diagnosis
Like other personality disorders, schizoid personality disorder is diagnosed based on a psychological evaluation and the history and severity of the symptoms.

# Treatment options
- People with this disorder rarely seek treatment, and little is known about which treatments work. Talk therapy may not be effective, because people with schizoid personality disorder have difficulty relating well to others.
- However, one approach that appears to help is to put fewer demands for emotional closeness or intimacy on the person with this condition.
- People with schizoid personality disorder often do better in relationships that do not focus on emotional closeness. They are better at handling relationships that focus only on recreation, work, or intellectual activities and expectations.

# Where to find medical care for Schizoid personality disorder?
Directions to Hospitals Treating Schizoid personality disorder

# What to expect (Outlook/Prognosis)?
- Schizoid personality disorder is a long-term (chronic) illness that usually dos not improve much over time.
- Social isolation often prevents the person from seeking the help or support that might improve the outcome.
- Limiting emotional intimacy may help people with this condition make and keep connections with other people.

# Source
Serotonin-noradrenaline-dopamine reuptake inhibitor
Serotonin-norepinephrine-dopamine-reuptake-inhibitors (SNDRI) are a class of psychoactive antidepressants. They act upon neurotransmitters in the brain, namely, serotonin, norepinephrine and dopamine. These three biogenic monoamines are associated with depression and increasing the availability in the brain is used to treat the disease.
SNDRIs are so-called triple reuptake inhibitors, which elevate extracellular plasma concentrations of all three monoamine neurotransmitters, serotonin, norepinephrine and dopamine in the synaptic cleft. These compounds show high potency but low selectivity between the different monoamine transporter proteins. No SNDRIs are yet on the market, although  the first of these agents tesofensine is currently in clinical trials, and other compounds such as brasofensine and GlaxoSmithKline's NS2359 are under development.
It should be noted that some SNRI drugs such as Venlafaxine (Effexor) and Sibutramine (Meridia/Reductil) are known to weakly inhibit the reuptake of dopamine at high doses, and so while these drugs are selective for the serotonin and noradrenaline transporters at normal doses, they can start to act as SNDRIs when taken at doses above the normal therapeutic range.
Sudden infant death syndrome historical perspective

# Overview
Sudden infant death syndrome (SIDS) is a rare syndrome which follows autosomal recessive pattern of inheritance. Sudden infant death syndrome (SIDS) is one of the leading cause of infant death especially ages between one month and one year in the United States of America.

# Historical Perspective

## Discovery
- In 1830, Kopps proposed thymic asthma which might lead to the death of the child due to enlargement of the thymus.
- During 18th century some others suggested that the sudden death in the infant is due to the asphyxial mechanisms, suffocation catarrh, superstition or the actions of witches and gods.
- In 1969, Horgan was the first to coin the term SIDS (sudden infant death syndrome).
- In 1971, the term SIDS (sudden infant death syndrome) was accepted as an official diagnosis on death certificates.
- In 1979, World Health Organization (WHO) allocated a unique code number for SIDS under the number 798.0 as WHO International Classification of Diseases.
- In 1982, Kelly et al was the first to discover the apneic periods in newborn sibs of sudden infant death syndrome (SIDS).
- In 1986, Bass et al was the first to report accidental asphyxiation of infants by the objects on the crib or violent shaking which will eventually results in very severe form called shaken baby syndrome.
- In 1986, Smialek was the first to collect information on infants twins who died suddenly and simultaneously.
- In 1990, Back to Sleep program was introduced and there is significant decrease in the cases of SIDS. 
- In 1992, Filiano and Kinney was the first to report the association between developmental hypoplasia of the arcuate nucleus and developing of SIDS (sudden infant death syndrome).
- In 1995, Pinholster cited about the breathing pattern and the conditions that can predispose to sudden infant death syndrome (SIDS)
- In 2004, Mage and Donner gave a detailed explanations on infant respiratory mortality that happened in the regions of U.S., U.K., and Scandinavia.
- "Wear and Tear hypothesis says that the sudden death in the infant is the result of painful, stressful, or traumatic exposures that the infant exposed in utero due to neonatal regulatory systems incompatible with allostasis.
Wild-type (senile) ATTR amyloidosis medical therapy

# Overview
Pharmacologic medical therapies for wild-type ATTR amyloidosis related polyneuropathy include patisiran and indotersen. Several other medications are under investigation, but liver transplantation remains the gold standard for therapy.

# Medical Therapy
Pharmacologic medical therapies for wild-type ATTR amyloidosis related polyneuropathy include patisiran and indotersen. Several other medications are under investigation, but liver transplantation remains the gold standard for therapy.

## Treatment of cardiac involvement
- Prophylactic placement of an implantable cardioverter defibrillator (ICD) is recommended to prevent sudden cardiac death.
- Use of commonly employed drugs such as diuretics, beta-blockers, angiotensin-converting enzyme (ACE) inhibitors, and angiotensin receptor blockers (ARBs)   in amyloidosis is complicated.
- Due to the restrictive effect of the disease, ventricular compliance is poor and end-diastolic volumes are low.
- Patients often require a higher filling pressure to distend the stiffened heart, and diuretic therapy reduces preload, which can further reduce stroke volume and systolic blood press
- Digoxin binds to amyloid fibrils and can lead to locally high levels; it also must be used with caution.
AAOS classification of periprosthetic hip fracture

# Overview
The "hip" joint is known as a ball-and-socket joint. It allows the femur bone to bend and rotate at the pelvis. Comparing to the injuries to the knee, ankle, and shoulder which are well documented, injuries to the hip, pelvis, and thigh get little attentions due to their lower prevalence. A hip fracture is a known as a fracture of the upper quarter of the femur bone while any other types of injuries to the socket, or acetabulum, itself is not considered a "hip fracture." Management of fractures to the socket is a completely different consideration. The hip fracture count as a serious problems associated with serious and life-threatening complications. Hip fractures most commonly occur due to the:
Fall to the side of the hip
A direct blow to the side of the hip
Other medical conditions such as osteoporosis, cancer, or stress injuries affecting the strength.
During fracture the most common site of fracture are:
The head of the femur
The neck of the femur
Between or below the greater trochanter and the lesser trochanters

# American Academy of Orthopedic Surgeons (AAOS) classification
Hip fractures are categorized as:
- level I: proximal femur distally to the lower extent of the lesser trochanter
- level II: 10 cm of femur distal to level I
- level III: femur distal to level II

# Related Chapters
- Hip fracture
Amphotericin B lipid complex clinical pharmacology

# Clinical Pharmacology

## Pharmacokinetics
The assay used to measure amphotericin B in the blood after the administration of ABELCET does not distinguish amphotericin B that is complexed with the phospholipids of ABELCET from amphotericin B that is uncomplexed.
The pharmacokinetics of amphotericin B after the administration of ABELCET are nonlinear. Volume of distribution and clearance from blood increase with increasing dose of ABELCET, resulting in less than proportional increases in blood concentrations of amphotericin B over a dose range of 0.6-5 mg/kg/day. The pharmacokinetics of amphotericin B in whole blood after the administration of ABELCET and amphotericin B desoxycholate are:
The large volume of distribution and high clearance from blood of amphotericin B after the admistration of ABELCET probably reflect uptake by tissues. The long terminal elimination half-life probably reflects a slow redistribution from tissues. Although amphotericin B is excreted slowly, there is little accumulation in the blood after repeated dosing. AUC of amphotericin B increased approximately 34% from day 1 after the administration of ABELCET 5 mg/kg/day for 7 days. The effect of gender or ethnicity on the pharmacokinetics of ABELCET has not been studied.
Tissue concentrations of amphotericin B have been obtained at autopsy from one heart transplant patient who received three doses of ABELCET at 5.3 mg/kg/day:
This pattern of distribution is consistent with that observed in preclinical studies in dogs in which greatest concentrations of amphotericin B after ABELCET administration were observed in the liver, spleen, and lung; however, the relationship of tissue concentrations of amphotericin B to its biological activity when administered as ABELCET is unknown.

### Special Populations
Hepatic Impairment: The effect of hepatic impairment on the disposition of ABELCET is not known.
Renal Impairment: The effect of renal impairment on the disposition of ABELCET is not known. The effect of dialysis on the elimination of ABELCET has not been studied; however, amphotericin B is not removed by hemodialysis when administered as amphotericin B desoxycholate.
Pediatric and Elderly Patients:  The pharmacokinetics and pharmacodynamics of pediatric patients (16 years of age) and elderly patients (65 years of age) have not been studied.
Amphotericin B lipid complex indications and usage

# Indications And Usage
ABELCET is indicated for the treatment of invasive fungal infections in patients who are refractory to or intolerant of conventional amphotericin B therapy. This is based on open-label treatment of patients judged by their physicians to be intolerant to or failing conventional amphotericin B therapy.

## Description of Clinical Studies
Fungal Infections
Data from 473 patients were pooled from three open-label studies in which ABELCET was provided for the treatment of patients with invasive fungal infections who were judged by their physicians to be refractory to or intolerant of conventional amphotericin B, or who had preexisting nephrotoxicity. Results of these studies demonstrated effectiveness of ABELCET in the treatment of invasive fungal infections as a second line therapy.
Patients were defined by their individual physician as being refractory to or failing conventional amphotericin B therapy based on overall clinical judgement after receiving a minimum total dose of 500 mg of amphotericin B. Nephrotoxicity was defined as a serum creatinine that had increased to >2.5 mg/dL in adults and >1.5 mg/dL in pediatric patients, or a creatinine clearance of <25 mL/min while receiving conventional amphotericin B therapy.
Of the 473 patients, four were enrolled more than once; each enrollment contributed separately to the denominator. The median age was 39 years (range of <1 to 93 years); 307 patients were male and 166 female. Patients were Caucasian (381, 81%), African-American (41, 9%), Hispanic (27, 6%), Asian (10, 2%), and various other races (14, 3%). The median baseline neutrophil count was 4,000 PMN/mm3; of these, 101 (21%) had a baseline neutrophil count <500/mm3.
Two-hundred eighty-two patients of the 473 patients were considered evaluable for response to therapy; the other 191 patients were excluded on the basis of unconfirmed diagnosis, confounding factors, concomitant systemic antifungal therapy, or receiving 4 doses or less of ABELCET. For evaluable patients, the following fungal infections were treated (n=282): aspergillosis (n=111), candidiasis (n=87), zygomycosis (n=25), cryptococcosis (n=16), and fusariosis (n=11). There were fewer than 10 evaluable patients for each of several other fungal species treated.
For each type of fungal infection listed above there were some patients successfully treated. However, in the absence of controlled studies it is unknown how response would have compared to either continuing conventional amphotericin B therapy or the use of alternative antifungal agents.
Renal Function: Patients with aspergillosis who initiated treatment with ABELCET when serum creatinine was above 2.5 mg/dL experienced a decline in serum creatinine during treatment (Figure 1). Serum creatinine levels were also lower during treatment with ABELCET when compared to the serum creatinine levels of patients treated with conventional amphotericin B in a retrospective historical control study. Meaningful statistical testing of the differences between these two groups is precluded since these data were obtained from two separate studies.
Amphotericin B liposomal dosage and administration

# Dosage and Administration
AmBisome should be administered by intravenous infusion, using a controlled infusion device, over a period of approximately 120 minutes.
An in-line membrane filter may be used for the intravenous infusion of AmBisome; provided the mean pore diameter of the filter is not less than 1.0 micron.
NOTE: An existing intravenous line must be flushed with 5% Dextrose Injection prior to infusion of AmBisome. If this is not feasible, AmBisome must be administered through a separate line.
Infusion time may be reduced to approximately 60 minutes in patients in whom the treatment is well-tolerated. If the patient experiences discomfort during infusion, the duration of infusion may be increased.
The recommended initial dose of AmBisome for each indication for adult and pediatric patients is as follows:
Dosing and rate of infusion should be individualized to the needs of the specific patient to ensure maximum efficacy while minimizing systemic toxicities or adverse events.
Doses recommended for visceral leishmaniasis are presented below:
For immunocompetent patients who do not achieve parasitic clearance with the recommended dose, a repeat course of therapy may be useful.
For immunocompromised patients who do not clear parasites or who experience relapses, expert advice regarding further treatment is recommended.
Ampicillin sulbactam other size packages available

# Other Size Packages Available
UNASYN is also supplied in glass vial and piggyback bottles in the following package sizes:
- Vials containing 1.5 g (NDC 0049-0013-83) equivalent of UNASYN (1 g ampicillin as the sodium salt plus 0.5 g sulbactam as the sodium salt)
- Vials containing 3 g (NDC 0049-0014-83) equivalent of UNASYN (2 g ampicillin as the sodium salt plus 1 g sulbactam as the sodium salt)
- Bottles containing 1.5 g (NDC 0049-0022-83) equivalent of UNASYN (1 g ampicillin as the sodium salt plus 0.5 g sulbactam as the sodium salt)
- Bottles containing 3 g (NDC 0049-0023-83) equivalent of UNASYN (2 g ampicillin as the sodium salt plus 1 g sulbactam as the sodium salt)
ADD-Vantage vials containing 1.5 g (NDC 0049-0031-83) equivalent of UNASYN (1 g ampicillin as the sodium salt plus 0.5 g sulbactam as the sodium salt) are distributed by Pfizer Inc. ADD-Vantage vials containing 3 g (NDC 0049-0032-83) equivalent of UNASYN (2 g ampicillin as the sodium salt plus 1 g sulbactam as the sodium salt) are distributed by Pfizer Inc. The 1.5 g UNASYN ADD-Vantage vials are only to be used with Abbott Laboratories. ADD-Vantage Flexible Diluent Container containing 0.9% Sodium Chloride Injection, USP, 50 mL, 100 mL, or 250 mL sizes. The 3 g UNASYN ADD-Vantage vials are only to be used with Abbott Laboratories' ADD-Vantage Flexible Diluent Container containing 0.9% Sodium Chloride Injection, USP, 100 mL or 250 mL sizes.