Persius/hicric huggingface dataset:
Measuring Fractional Flow Reserve During PCI Improves 1-Year Outcomes
January 26, 2009 By Michael W Tempelhof, MD 
Percutaneous coronary intervention (PCI) for treatment of NSTEMI and/or STEMI from ischemia has been associated with improvements in short-term and long-term clinical outcomes. However, in ischemic patients with multiple vessel disease, determination of which lesion is the culprit stenotic lesion requiring intervention is often difficult.
Fractional Flow Reserve (FFR): is the ratio of maximal blood flow in a stenotic vessel to normal maximal flow.
STUDY OBJECTIVE: To investigate whether FFR-guided PCI would be associated with better outcomes (rates of major adverse cardiac events (MACE) at 1 year, death, MI, or repeat revascularization at 1 year) vs. routine angiography-guided PCI in ischemic patients with multivessel disease.
STUDY DESIGN and METHODS: 1005 Patients with stenoses of >50% in at least two of the three major coronary arteries where randomized to either routine PCI, or FFR-guided PCI, where FFR was measured in all significant stenoses, with stenting in lesions with an FFR 0.8.
RESULTS: Rates of MACE at 1 year was significantly lower in the FFR arm compared with the routine-PCI arm (13.2% vs. 18.3%, p = 0.02). The incidence of death (1.8% vs. 3.0%, p = 0.19), myocardial infarction (MI) (5.7% vs. 8.7%, p = 0.07), and coronary artery bypass grafting or revascularization at year (6.5% vs. 9.5%, p = 0.08) was similar between both arms.
Mean procedure time was similar between the two study arms 70 minutes. Quantity of contrast dye utilized was significantly lower in the FFR arm, 272ml vs. 302 ml for standard PCI arm. The number of patients who were angina free at 1 year was also similar between the two arms (81% vs. 78%, p = 0.2). As measured by the EuroQOL-5D, the quality of life scores were similar between the two arms(p = 0.65).
CONCLUSIONS: The FAME trial results indicate that FFR-guided PCI is associated with a significantly lower incidence of MACE at year compared with routine angiography-guided PCI in ischemic patients with multivessel disease. FFR-guided PCI had a favorable cost-benefit ratio, similar procedural times to standard PCI and exposed patients to less contrast dye.
Tonino PA, De Bruyne B, Pijls NH, et al., on behalf of the FAME Investigators. Fractional flow reserve versus angiography for guiding percutaneous coronary intervention.

# Source
N Engl J Med. 2009 Jan 15;360(3):213-24.
Stents: Johnson & Johnson Reports Significant Decrease in Stent Sales
July 19, 2007 by Scott P. Williams
Although healthcare conglomerate Johnson & Johnson reported a 9% increase in its second quarter profits compared to one year ago, the company saw a 20% decrease in sales within its recently troubled stent unit.
On a conference call reviewing the sales numbers, a Johnson & Johnson executive attributed the decrease in sales to the following trio of trends:  1.) ewer stent procedures, amid a growing sense that the devices have been over-used 2.)  growing preference for bare-metal stents, in response to concerns about the safety of the drug-coated kind 3.) ore competition overseas, where Medtronic and Abbott Labs are getting into the stent business.
These three trends were complimented by Johnson & Johnsons May 2007 announcement that it would not seek federal approval for CoStar, its most recent drug-eluting stent.  The announcement was made after a trial comparing CoStar to Boston Scientifics drug-coated stent Taxus Express produced an unfavorable result for Johnson & JohnsonThe study found that patients receiving the CoStar stent had a higher rate of the composite of death, myocardial infarction or need for repeat stenting procedure within eight months. Additionally, the angiographic data showed a greater degree of narrowing of the stented artery due to scar tissue in the stent. Boston Scientific executives suggested that the unfavorable results stemmed from CoStars drug delivery method, not the drug itself, but Johnson & Johnsonhas turned its focus to CoStars drug rather than its delivery method.
Though Johnson & Johnsons second quarter sales reports are hardly surprising given CoStars failure and recent market trends surrounding a decline in stent use, the outcomes stand in stark contrast to the conglomerates results and expectations over the past five years.  In January 2003 to herald the arrival of Cypher, the New York Times ran an article with the optimistic headline A Rare Chance to Take Back a Market; Johnson & Johnsons New Stent May Dominate Angioplasties.  In line with the predominant thought of the time, the article states that Cypher keeps coronary arteries open more successfully and much longer than... plain metal devices.
Claims about the benefits of drug-eluting stents boosted Johnson & Johnsons earnings through early 2006.  According to the International Herald Tribune, the company reported that its earnings rose 16 % in the first quarter based on sales of medical devices like its Cypher coronary stent.
However, recently the merits of drug-eluting stents have been intensely challenged and debated.  The discussion was brought to the forefront of cardiology in 2006 when the BASKET-LATE study and the Camenzind meta-analysis suggested that drug-eluting stents had higher rates of death and myocardial infarction than bare metal stents.   In this past quarter, Johnson & Johnson was hit the hardest by the decrease in revenue generated from Cypher, which saw its sales dip by 41% in the United States and 30% abroad.
References
Systemic EBV positive T-cell lymphoproliferative disease of childhood
Synonyms and keywords:

# Overview

# Historical Perspective

# Classification

# Pathophysiology

# Causes

# Differentiating Systemic EBV positive T-cell lymphoproliferative disease of childhood from other Diseases

# Epidemiology and Demographics

# Risk Factors

# Natural History, Complications and Prognosis

# Diagnosis
History and Symptoms | Physical Examination | Laboratory Findings | CT | Other Diagnostic Studies

# Treatment
Medical Therapy | Surgery | Primary Prevention | Secondary Prevention | Future or Investigational Therapies |  Cost Effectiveness of Therapy

# Case Studies
ACC/AHA guideline on the secondary prevention of hypercholestrolemia

# 2013 ACC AHA guideline on the treatment of blood cholesterol secondary prevention

# Secondary Prevention

# Initiating and Management of Statin Therapy in Individuals with Clinical ASCVD
Clinical ASCVD is defined as acute coronary syndromes or history of MI, stable or unstable angina, coronary revascularization, stroke, or TIA presumed to be of atherosclerotic origin, and peripheral arterial disease or revascularization.
Differentiating drug-induced lupus erythematosus from other diseases

# Overview

# Differentiating Drug-Induced Lupus Erythematosus from other Diseases
As a reminder, rheumatologic conditions tend to declare themselves over time, as opposed to immediately displaying all the classic clinical manifestations of the disease.
There is an inherited difficulty in distinguishing true drug-induced autoimmunity from an exacerbation of pre-existing autoimmunity or unmasking of a second autoimmune disease. It 
will become even more important to recognize medication-induced lupus syndromes given the expanding list of medications associated with DIL.
Here are possible differentials to DIL:
- Idiopathic systemic lupus erythematosus
- Systemic sclerosis (scleroderma)
- Rheumatoid arthritis
- Connective tissue diseases
- Granulomatosis with polyangiitis
- Fibromyalgia
- Lichen planus
- Chronic radiation dermatitis
- Rosacea
- Psoriasis
- Dermatomyositis
- Granuloma annulare
- Actinic keratosis
+lupus+erythematosus?diagnosisId=51883&moduleId=101
,-a-one-time-hit-or-a-harbinger-of-future-autoimmunity-a-case-report.html
Tetradecanoylphorbol-13-acetate response element gene transcriptions
Activator protein 1 (AP-1) was first discovered as a 12-O-Tetradecanoylphorbol-13-acetate (TPA)-activated transcription factor that bound to a cis-regulatory element of the human metallothionein IIa (hMTIIa) promoter and SV40.

# Consensus sequences
The AP-1 binding site was identified as the TPA response element (TRE) with the consensus sequence 5-TGA G/C TCA-3.
12-O-tetradecanoylphorbol-13-acetate (TPA) responsive element (TRE) (TGAGTCA).

# Samplings
Copying the consensus sequence for the DNA-binding factor (TRE): 3'-TGAGTCA-5' or 3'-TGACTCA-5' and putting the sequence in "F" does not find either sequence in either A1BG promoter using nucleotide positions as can be found by the computer programs.
For the Basic programs testing consensus sequence 3'-TGA(G/C)TCA-5' (starting with SuccessablesTRE.bas) written to compare nucleotide sequences with the sequences on either the template strand (-), or coding strand (+), of the DNA, in the negative direction (-), or the positive direction (+), the programs are, are looking for, and found:
- negative strand in the negative direction (from ZSCAN22 to A1BG) is SuccessablesTRE--.bas, looking for 3'-TGA(G/C)TCA-5', 0.
- negative strand in the positive direction (from ZNF497 to A1BG) is SuccessablesTRE-+.bas, looking for 3'-TGA(G/C)TCA-5', 0.
- positive strand in the negative direction (from ZSCAN22 to A1BG) is SuccessablesTRE+-.bas, looking for 3'-TGA(G/C)TCA-5', 0.
- positive strand in the positive direction (from ZNF497 to A1BG) is SuccessablesTRE++.bas, looking for 3'-TGA(G/C)TCA-5', 0.
- complement, negative strand, negative direction is SuccessablesTREc--.bas, looking for 3'-ACT(C/G)AGT-5', 0.
- complement, negative strand, positive direction is SuccessablesTREc-+.bas, looking for 3'-ACT(C/G)AGT-5', 0.
- complement, positive strand, negative direction is SuccessablesTREc+-.bas, looking for 3'-ACT(C/G)AGT-5', 0.
- complement, positive strand, positive direction is SuccessablesTREc++.bas, looking for 3'-ACT(C/G)AGT-5', 0.
- inverse complement, 3'-TGA(C/G)TCA-5' is the same as 3'-TGA(G/C)TCA-5'.
- inverse, 3'-ACT(C/G)AGT-5' is the same as 3'-ACT(C/G)AGT-5', the complement.

# Acknowledgements
The content on this page was first contributed by: Henry A. Hoff.
Aboriginal Protection and restriction of the sale of opium act 1897
The Aboriginal Protection and Restrictions of the Sale of Opium Act 1897 was an Act of the Parliament of Queensland.
As a result of dispersal, malnutrition, opium and diseases, it was widely believed in Queensland that Aborigines were members of a 'dying race'. Pressure from some quarters of the community saw the Government of Queensland commission Archibald Meston to look at the plight of these dispossessed people. He made a number of recommendations, and some of these became the basis of the Aboriginal Protection and Restriction of the Sale of Opium Act 1897. The creators of this Act saw it as a solution to a short term problem, but the administrators of the legislation had a different idea, and from the beginning used it as a device for social engineering and control. It became the instrument with which Aboriginal people could be stripped of the most basic human rights. The Act was the first measure of separate legal control over the Aboriginal people and as Reynolds has pointed out it 'was far more restrictive than any  legislation operating in New South Wales or Victoria, and implemented a system of tight controls and closed reserves.'
Administrators were able to gain control of Aboriginal affairs through the extensive use of Regulations which could be made lawful simply through proclamation by the Governor-in-Council. In this manner, decision-making passed from politicians to the public servants. The welfare of Aborigines was, after all, only one small part of a busy member's portfolio. But not only did public servants have responsibility for a huge amount of delegated legislation, individual protectors had extensive autonomy in administering the Act and Regulations. The Act could be used to justify definitions of aboriginality, but even with the help of the Act, these were often contradictory and generally subject to interpretation or variation throughout the first decades after Federation. For example, in 1905, Queensland's Chief Protector of Aboriginals cited the Act to define a 'half-caste' as 'Any person being the offspring of an aboriginal mother and other than an aboriginal father  whether male or female, whose age, in the opinion of the Protector, does not exceed sixteen, is deemed to be an aboriginal...', then went on to describe a 'quadroon' as  the offspring of a half-caste woman, by a white, &c. (presumably other non-Aboriginal) father.  Definitions were no clearer fifteen years later. The Queensland Aboriginals Department refers to European half-caste mothers in its 1920 Report alongside half-breeds, half-castes and Aboriginals: it does not expand upon how the Department made the distinction between a half-breed and half-caste, a native and an Aboriginal. Where no other information was available, white observers judged degrees of ancestry. In Queensland at least, once it had bestowed a racial category upon its charges, the Aboriginals Department treated its subjects according to their variations in skin colour. For girls and women of mixed descent, such judgements affected their entire future.
Differentiating Secondary adrenal insufficiency from other diseases

# Overview
Secondary adrenal insufficiency must be differentiated from primary adrenal insufficiency, acute adrenal insufficiency/adrenal crisis, adrenal hemorrhage, congenital adrenal hyperplasia and salt losing nephropathy based on clinical features, such as fatigue and weight loss and laboratory findings.

# Secondary Adrenal Insufficiency
Secondary adrenal insufficiency must be differentiated from other diseases that may cause hypotension, fatigue, and skin pigmentation.
Adrenal insufficiency must be differentiated from other causes of headache, polyuria and polydypsia.
Class III recommendations in guidelines for cardiovascular medicine

# Overview
Class III recommendations are defined as conditions for which there is evidence and/or general agreement that the procedure or treatment is not useful/effective and in some cases may be harmful. Class III guidelines may be further classified by either level of evidence (either A, B, or C) or by whether there is evidence of either harm or no benefit. The list of Class III recommendations is populated from all guidelines published by American cardiology societies. Out of a a total of 65 guidelines, there are 584 class III recommendations (57 LOE-A, 229 LOE-B, 277 LOE-C, and 21 of unclassified LOE).

# Class III Recommendations in Guidelines for Cardiovascular Medicine
- Class III recommendations are defined as conditions for which there is evidence and/or general agreement that the procedure or treatment is not useful/effective and in some cases may be harmful.
- Class III recommendations may be further classified according to the level of evidence (LOE):
LOE A: Defined as evidence obtained from either multiple populations, multiple randomized clinical trials, or meta-analyses of randomized clinical trials.
LOE B: Defined as evidence obtained from either a limited number of populations, a single randomized clinical trial, or meta-analyses of non-randomized studies.
LOE C: Defined as evidence obtained from either a very limited number of populations, consensus opinion of experts, case studies, or standard of care.
- LOE A: Defined as evidence obtained from either multiple populations, multiple randomized clinical trials, or meta-analyses of randomized clinical trials.
- LOE B: Defined as evidence obtained from either a limited number of populations, a single randomized clinical trial, or meta-analyses of non-randomized studies.
- LOE C: Defined as evidence obtained from either a very limited number of populations, consensus opinion of experts, case studies, or standard of care.
- Class III recommendations may also be classified according to the reasoning behind the development of the recommendation, which may be due to evidence of no benefit or due to evidence of harm.
- The following class III recommendations include the most recent guidelines in cardiovascular medicine published by American cardiology societies.
To view the list of guidelines used to populate the list of recommendations and organized by year of publication, click here.
Alternatively, to view the list of guidelines used to populate the list of recommendations and organized by guideline name (keywords), click here.
- To view the list of guidelines used to populate the list of recommendations and organized by year of publication, click here.
- Alternatively, to view the list of guidelines used to populate the list of recommendations and organized by guideline name (keywords), click here.

## List of Class III Recommendations
Differentiating Anti-NMDA receptor encephalitis from other diseases

# Overview
In the differential diagnosis of anti-NMDA encephalitis, other autoimmune encephalitides with specific antibody associations should be considered, including those associated with antibodies against AMPA receptors, GABA-B receptors, LGI1, Caspr2, and MOG. Clinical and serological evaluations are crucial for accurate diagnosis and appropriate management.

# Differentiating Anti-NMDA Receptor Encephalitis from other Diseases
-cb: oligoclonal bands; EEG: electroencephalograph; NMDA: N-methyl-D-aspartate; AMPA: -amino-3-hydroxy-5-methyl-4-isoxazol-propionic acid; GABA:
-amino-butyric acid receptor; CASPR2: contactin-associated protein-like 2; Lgi1: leucine-rich, glioma-inactivated 1; mGluR5: metabotrophic glutamate receptor 5.
Other etiologies causing Anti NMDA encephalitis like features
Guidelines for the Management of Aneurysmal Subarachnoid Hemorrhage

# 2012 AHA/ASA Guidelines for the Management of Aneurysmal Subarachnoid Hemorrhage

## Risk Factors for and Prevention of aSAH: Recommendations

## Natural History and Outcome of aSAH: Recommendations

## Clinical Manifestations and Diagnosis of aSAH: Recommendations

## Medical Measures to Prevent Rebleeding After aSAH: Recommendations

## Surgical and Endovascular Methods of Treatment of Ruptured Cerebral Aneurysms: Recommendations

## Hospital Characteristics and Systems of Care: Recommendations

## Anesthetic Management During Surgical and Endovascular Treatment: Recommendations

## Management of Cerebral Vasospasm and DCI After aSAH: Recommendations
It should be noted that this agent has been shown to improve neuroogical outcomes but not cerebral vasospasm. The value of other calcium antagonists, whether administered orally or intravenously, remains uncertain.

## Management of Hydrocephalus Associated With aSAH: Recommendations

## Management of Seizures Associated With aSAH: Recommendations

## Management of Medical Complications Associated With aSAH: Recommendations
Major or mild neurocognitive disorder due to traumatic brain injury

# Overview

# Major or Mild Neurocognitive Disorder Due to Traumatic Brain Injury

## DSM-V Diagnostic Criteria for Major or Mild Neurocognitive Disorder Due To Traumatic Brain Injury
- A. The criteria are met for major or mild neurocognitive disorder.
AND
- B. There is evidence of a traumatic brain injurythat is, an impact to the head or other mechanisms of rapid movement or displacement of the brain within the skull, with one or more of the following:
- 1.Loss of consciousness.
- 2.Post-traumatic amnesia.
- 3.Disorientation and confusion.
- 4.Neurological signs (e.g., neuro imaging demonstrating injury; a new onset of seizures; a marked worsening of a preexisting seizure disorder; visual field cuts; anosmia;  hemiparesis).
AND
- C. The neurocognitive disorder presents immediately after the occurrence of the traumatic brain injury or immediately after recovery of consciousness and persists past the
acute post-injury period.

# Epidemiology and Demographics

## Prevalence
The prevalence of traumatic brain injury is 59,000 per 100,000 (59%) in males in the overall population.

# Risk Factors
- Low Glasgow Coma Scale score
- Midline shift
- Obliteration of third ventricle
- Older age (older than 40 years)
- Petechial hemorrhages
- Pupillary non reactivity
- Repeated concussions
- Subarachnoid hemorrhage
- Worse motor function

# Differential Diagnosis
- Factitious disorder
- Posttraumatic stress disorder
- Somatic symptom disorder
Squamous cell carcinoma natural history complications and prognosis

# Natural History
Once Squamous cell carcinoma (SCC) develops on the skin it grows slowly. If neglected and once it reaches the size of 2 cm and more it is three times more likely to spread to other areas than the smaller lesions. Usual size ranges from 1 cm to 5 cm. It is the mechanical interference of this fungiform exophytic lesion that brings it to the notice of the patient or the clinician.

# Complications
When treated, early squamous cell carcinoma is completely curable by 95% - 98%. If left untreated it has the tendency to spread to other areas like lymph nodes, internal organs. Immunosuppressed patients have a far more tendency to develop aggressive form of the tumor. Other possible complications of this tumor are skin abscesses and Cellulitis.
The primary complication of this lesion once treated is recurrence, which usually occurs with in the first year after resection.

# Prognosis
This lesion has a cure rate of 95% - 98%. But once the lesion spreads to other regions beyond skin, like lymph nodes and internal organs less than half of the patients live five years. A sub set of SCC carries the risk of local recurrence, nodal or distant metastasis (usually to the lungs) and eventually death. Tumors in this sub set are termed high risk SCC. Tumor related factors in high risk SCC are
- Tumor location (ie. lips, ears, anogenital region, within a scar or chronic wound) - Metastatic rates for lesions on lips (13.7%) and ears (11.%) are particularly high. The 5 year survival rates after metastasis from these sites are usually range from 25% - 40%. Primary SCCs on the trunk and limbs are associated with a metastatic rate of 4.9%. Marjolin's ulcer, a sub type of SCC behaves aggressively with a metastatic rate of 35%. Similarly SCCs arising from injured and chronically diseased skin have a metastatic rate of 40%.
- Tumor size greater than 2 cm (1.5 cm for lesions on ear or lip) - Lesions less than 2 cm have a metastatic potential of 9.1% whereas in those of size more than 2 cm the rates spike up to 30.3%.
- Invasion to subcutaneous fat - less than 2 mm - 95% survival rate, from 2-9 mm - 80% survival rate, more than 9 mm - 65% survival rate.
- Poorly differentiated cells
- Recurrent tumor
- Perineural involvement  - the metastatic rate in such involvement can reach 45%. The degree of nerve involvement likely has a major impact on the prognosis. 
The 3 year disease specific survival rate for  SCC is 85%. The figure reaches 100% in lesions with no high risk factors. The overall survival rates drop down drastically once the lesion spreads to lymph nodes and internal organs.
The Physical Examination in Cardiovascular Disease: The Extremities

# Acrocyanosis
Acrocyanosis is constant, painless symmetric cyanosis of the hands which is due to vasospasm of the small vessels of the skin. It can occur on the feet, although less common

# Arterial Bruit

# Clubbing
Clubbing refers to a thickening and widening of the digits and extremities caused by the proliferation of distal tissues

# Cyanosis
- Cyanosis is defined as the abnormal blue discoloration of the mucuous membranes or skin caused by an extreme reduction of oxygen in the blood
- Increase of the reduced hemoglobin of about 5 g/dl
- Can be confined to the periphery or generalized: 
Central: Mucuous membranes and lips 
Peripheral: Nose, earlobes and phalanges
- Central: Mucuous membranes and lips
- Peripheral: Nose, earlobes and phalanges

# Edema
- Pedal edema is defined as non-painful swelling of the feet.