Persius/hicric huggingface dataset:
Levosimendan

# Overview
Levosimendan (INN) (Template:PronEng) is a calcium sensitiser used in the management of acutely decompensated congestive heart failure. It is marketed  under the trade name Simdax (Abbott).

# Mode of action
Levosimendan is a calcium sensitiser  it increases the sensitivity of the heart to calcium, thus increasing cardiac contractility without a rise in intracellular calcium. Levosimendan exerts its positive inotropic effect by increasing calcium sensitivity of myocytes by binding to cardiac troponin C in a calcium-dependent manner. It also has a vasodilatory effect, by opening adenosine triphosphate (ATP)-sensitive potassium channels in vascular smooth muscle to cause smooth muscle relaxation. The combined inotropic and vasodilatory actions result in an increased force of contraction, decreased preload and decreased afterload. Moreover, by opening also the mitochondrial (ATP)-sensitive potassium channels in cardiomyocytes, the drug exerts a cardioprotective effect.

# Clinical use

## Indications
Levosimendan is indicated for inotropic support in acutely-decompensated severe congestive heart failure.
Some of the Phase-III studies in the extensive clinical program were the trials LIDO (200 patients), RUSSLAN (500), CASINO (250), REVIVE-I (100), REVIVE-II (600) and finally SURVIVE (1350)
, a head-to-head trial between levosimendan and dobutamine in acute decompensated heart failure. In total, the clinical data base includes more than 3500 patients in Phase IIb and III double-blind studies, which is the highest number ever in testing a drug for acute decompensated heart failure.
The drug has a marketing authorization in 48 countries (Aug 9, 2007).

## Contraindications
The use of levosimendan is contraindicated in patients with: moderate-to-severe renal impairment, severe hepatic impairment, severe ventricular filling or outflow obstruction, severe hypotension and tachycardia, and/or history of torsades de pointes.

## Adverse effects
Common adverse drug reactions (1% of patients) associated with levosimendan therapy include: headache, hypotension, arrhythmias (atrial fibrillation, extrasystoles, atrial tachycardia, ventricular tachycardia), myocardial ischaemia, hypokalaemia and/or nausea (Rossi, 2006).

## Formulations
Levosimendan is marketed as a 2.5 mg/mL concentrated solution for IV infusion. The concentrate is diluted with glucose 5% solution before infusion.
Splenic vein

# Overview
In anatomy, the splenic vein (in the past called the lienal vein) is the blood vessel that drains blood from the spleen.
It joins with the superior mesenteric vein, to form the hepatic portal vein and follows a course superior to the pancreas, along side of the similarly named artery, the splenic artery.
It collects branches from the stomach and  pancreas and most notably from the large intestine, which is drained by the inferior mesenteric vein and joins with splenic vein shortly before it forms the portal vein.

# Additional images
- The pancreas and duodenum from behind.
Life support
Life support, in the medical field, refers to a set of therapies for preserving a patient's life when essential body systems are not functioning sufficiently to sustain life unaided. Life support therapies utilize some combination of several techniques: feeding tubes, intravenous drips, total parenteral nutrition, mechanical respiration, heart/lung bypass, urinary catheterization and dialysis. The same techniques are also used for intensive care or in some cases during surgery, though life support is employed to stabilize a patient and is typically not sufficient to allow full recovery from their condition.

# Ethics
It has been proposed that the practice of artificially prolonging the life of an individual who will not recover to be unethical.
Roman Catholic moral teachings, pronounced in 1993, suggest that the employment of artificial means is not necessary to fulfill the duty to respect life; however the term "artificial means" may vary in meaning between different schools of thought within and outside Catholicism. Most Catholic theologians however, divide the issue into "ordinary" and "extraordinary" means, and believe that it is an ethical imperative to continue the ordinary means, but ethically neutral to withhold the extraordinary means. They define ordinary means as things like feeding, and extraordinary means as things like artificial breathing. Also you could say that it is illegal in some states.
by:college professors
Lincosamides
Lincosamides (eg. lincomycin, clindamycin) are a class of drugs which bind to the 23s portion of the 50S subunit of bacterial ribosomes and inhibit early elongation of peptide chain by inhibiting transpeptidase reaction. In this sense they have a similar action to macrolides.

# History and uses
The first lincosamide to be discovered was lincomycin, which is a true antibiotic (one occurring naturally rather than being synthetic), from "Streptomyces lincolnensis".
Lincomycin has been superseeded by clindamycin, which exhibits improved antibacterial activity.  Clindamycin also exhibits some activity against parasitic protozoa, and has been used in toxoplasmosis and malaria.
They are normally used to treat staphylococci and streptococci, and have proved useful in treating Bacteroides fragili and some other anaerobes.

# Resistance
Target bacteria may alter the drug's binding site (similar to resistance found in macrolides and streptogramins).  The resistance mechanism is methylation of the 23s binding site.  If this occurs then the bacteria are resistant to both the macrolides and the lincosamides.  Also, enzymatic inactivation of clindamycin has been described (rare).

# Formulation
The lincosamides, as the hydrochloride salt, are bitter to taste, so for oral formulation they are given as the palmitate esters, or formulated in capsules.  Clindamycin is given intravenously as clindamycin phosphate, which is then converted into active clindamycin wihin the body.

# Pharmacodynamics
These are bacteriostatic drugs and antagonists of macrolides and streptogramins.

# Further reading
- Van Bambeke F. Mechanisms of action. In Armstrong D, Cohen J. Infectious diseases. Mosby, London, 1999, pp7/1.1-7/1.14
de:Lincosamid
Lipid rescue
Lipid Rescue is a term that has been coined to describe the use of intravenous lipid emulsion to treat severe local anaesthetic toxicity.
To date, Intralipid, a commonly available intravenous lipid emulsion is the only such emulsion to be shown to be effective in this way.
This is supported by animal evidence 
 and human case reports of successful use in this way. In the UK, efforts have been made to publicise this use more widely
Lixisenatide

# Overview
Lixisenatide (intended trade name Lyxumia) is a once-daily injectable GLP-1 receptor agonist discovered by Zealand Pharma A/S of Denmark and licensed and developed by Sanofi. As of  September 2010 it is in clinical trials for diabetes. Lixisenatide was accepted for review by the US FDA on February 19, 2013, and approved by the European Commission on February 1, 2013. On September 12, 2013, Sanofi delayed the approval process in the US, citing internal data from a cardiovascular risk study. The drug will likely be resubmitted for approval in 2015.
GLP-1 is a naturally-occurring peptide that is released within minutes of eating a meal. It is known to suppress glucagon secretion from pancreatic alpha cells and stimulate insulin secretion by pancreatic beta cells. GLP-1 receptor agonists are in development as an add-on treatment for type 2 diabetes and their use is endorsed by the European Association for the Study of Diabetes, the American Diabetes Association, the American Association of Clinical Endocrinologists and the American College of Endocrinology.
The GetGoal phase III clinical program will provide data for lixisenatide in adults with type 2 diabetes treated with various oral anti-diabetic agents or insulin. With ten trials in the program, GetGoal started in May 2008 and has enrolled more than 4,300 patients. To date, GetGoal-X, GetGoal-L, GetGoal-L Asia, GetGoal-Mono, GetGoal-S and GetGoal-F1 have reported positive top-line results supporting efficacy and safety for lixisenatide.

# Chemistry
Lixisenatixe has been described as "des-38-proline-exendin-4 (Heloderma suspectum)-(139)-peptidylpenta-L-lysyl-L-lysinamide", meaning it is derived from the first 39 amino acids in the sequence of the peptide exendin-4, found in the Gila monster (Heloderma suspectum), omitting proline at position 38 and adding six lysine residues. Its complete sequence is:
Loxommatidae
The Baphetids or Loxommatids were large tetrapod predators of the Late Carboniferous period (Namurian through Westphalian) of Europe.  Fragmentary remains from the Early Carboniferous of Canada have been tentatively assigned to the group.
Not only are they included among the very early tetrapodomorphs, but they were also among the first of the Carboniferous fossil tetrapods to be found and were originally described in 1850 by William Dawson.  They are known mainly from skulls; very little skeletal material has been found.  But even from this quite a lot can be deduced.  The presence of lateral lines and the long rows of needle-like teeth show that most were fish-eaters.  Their best-known characteristic was a curious, keyhole-shaped orbit formed by excavation of the lacrimal and prefrontal bones in front of the eye.  It has been suggested that this space accommodated a salt gland or some kind of electrosensory organ.  Perhaps the better hypothesis is that the space allowed room for the contraction of an enlarged pterygoideus muscle.  In that case, this skull modification would represent an early form of skull fenestration for jaw muscles.
The skull is shallow.  Unlike the better-known embolomeres, the baphetid cheek and skull roof are sutured together.  There is a strongly embayed spiracular ("otic") notch, but the stapes is distally broad, which seems to rule out a sensitive hearing apparatus.  The palate is closed -- a primitive character, but very different from the temnospondyls.  The coronoids bear no teeth or denticles, while the dentary has a double tooth row.
Since the taxon is based almost exclusively on skulls, the body is very poorly known.  It is often said that the body was crocodile-like, but this appears to be largely supposition.
It is not clear whether all of the genera assigned to this group are really closely related.  The traditional four genera of baphetids (Loxomma, Baphetes, Megalocephalus, and Spathicephalus) have recently been supplemented by Eucritta, a somewhat different form.  It has also been suggested that Crassigyrinus may be closely related.
Baphetids have been previously considered primitive temnospondyls and more recently batrachosaurs (reptile-like amphibia).   It is likely, however, that they represent one more of a number of early Carboniferous tetrapodomorph radiations.  Computer-assisted phylogenetic analyses of a data matrix using characteristics of most of the major groups of terrestrial vertebrates place the Baphetids close to the ancestry of amniotes.
With the reinterpretation of Ichthyostega and its relatives as aquatic forms, baphetids are good candidates for the spot of first tetrapodomorph group to actually spend substantial time on land. If so, baphetids may be a rather important taxon.
Luteal phase
The luteal phase (or secretory phase) is the latter phase of the estrous cycle in animals, and the menstrual cycle in humans and great apes. It begins with the formation of the corpus luteum and ends in either pregnancy or luteolysis. The main hormone controlling this stage is progesterone, which is significantly higher during the luteal phase than other phases of the cycle.
Some sources define the end of the luteal phase to be a distinct "ischemic phase".

# Luteal phase defect
Luteal phase defect (LPD) is believed to interfere with the implantation of embryos  The lactational amenorrhea method of birth control works primarily by preventing ovulation, but is also known to cause LPD.
Lymph vessel

# Overview
In anatomy, lymph vessels are thin walled, valved structures that carry lymph. As part of the lymphatic system, lymph vessels are complimentary with the vascular system. In contrast to the vascular system, which carries blood under pressure to the entire body, lymph is not under pressure and is propelled in a passive fashion, assisted by the aforementioned valves.  Fluid that leaks from the vascular system is returned to general circulation via lymphatic vessels.
Generally, lymph flows away from the tissues to lymph nodes and eventually to either the right lymphatic duct or the largest lymph vessel in the body, the thoracic duct. These vessels drain into the right and left subclavian veins respectively.

# Function
Lymph vessels act as a reservoir from plasma and other substances including cells that leaked from the vascular system and transport lymph fluid back from the tissues to the circulatory system. Without functioning lymph vessels, lymph cannot be effectively drained and edema typically results.

# Additional images
- Lymphatic system
- Section across portal canal of pig. X 250.
Labrea fever

# Overview
Labrea fever, also known as Labrea's black fever and Labrea hepatitis, is a lethal tropical viral infection discovered in the 1950s in the city of Labrea, in the Brazilian Amazon basi], where it occurs mostly in the area south of the Amazon River, in the states of Acre, Amazonas and Rondonia. The disease has also been diagnosed in Colombia and Peru. The similar form in Colombia has been named Santa Marta fever.
Its main manifestation is a fulminant hepatitis which may kill in less than a week, and which characteristically affects children and young adults, and more males than females. It is accompanied also by an encephalitis in many cases. The disease is highly lethal: in a study carried out in 1986 at Boca do Acre, also in the Amazon, 39 patients out of 44 died in the acute phase of the disease. Survivors may develop chronic disease.

# Symptoms and signs
Labrea fever has a sudden onset, with jaundice (bilious color of the skin), anorexia (lack of appetite), hematemesis (blood vomit), headache, fever and severe prostration. Death occurs by acute liver failure (ALF). In the last phase, neurological symptoms such as agitation, delirium, convulsions and hemorrhagic coma commonly appear.

# Etiology
Labrea fever is a coinfection or superinfection of hepatitis D or delta virus and hepatitis B (HBV). The infection by delta virus may occur in a patient who already has the HBV, or both viruses may infect at the same time a previously uninfected patient. Delta virus can only multiply in the presence of HBV, therefore vaccination against HBV prevents infection. Thus, American and Brazilian scientists have determined that the delta virusa, virus, which is a small circular RNA virus, is normally unable to cause illness by itself, due to a defect. When it is combined with HBV, Labrea hepatitis may ensue. The main discovery of delta virus and HBV association was done by Dr. Gilberta Bensabath, a leading tropical virologist of the Instituto Evandro Chagas, of Belem, state of Para, and her collaborators.
Infected patients show extensive destruction of liver tissue, with steatosis of a particular type (microsteatosis, characterized by small fat droplets inside the cells), and infiltration of large numbers of inflammatory cells called morula cells, comprised mainly by macrophages containing delta virus antigens.
In the 1987 Boca do Acre study, scientists did an epidemiological survey and reported delta virus infection in 24% of asymptomatic HBV carriers, 29% of acute nonfulminant hepatitis B cases, 74% of fulminant hepatitis B cases, and 100% of chronic hepatitis B cases. The delta virus seems to be endemic in the Amazon region.

# Treatment and prevention
Treatment is similar to hepatitis B, but due to its high lethality, more aggressive therapeutic approaches are recommended in the acute phase. In absence of a specific vaccine against delta virus, the vaccine against HBV must be given soon after birth in risk groups.
Levy process
In probability theory, a Levy process, named after the French mathematician Paul Levy, is any continuous-time stochastic process that starts at 0, admits cadlag modification and has "stationary independent increments"  this phrase will be explained below.  The most well-known examples are the Wiener process and the Poisson process.

# Properties

## Independent increments
A continuous-time stochastic process assigns a random variable Xt to each point t  0 in time.  In effect it is a random function of t.  The increments of such a process are the differences Xs  Xt between its values at different times t < s.  To call the increments of a process independent means that increments Xs  Xt and  Xu  Xv are independent random variables whenever the two time intervals do not overlap and, more generally, any finite number of increments assigned to pairwise non-overlapping time intervals are mutually (not just pairwise) independent.

## Stationary increments
To call the increments stationary means that the probability distribution of any increment Xs  Xt depends only on the length s  t of the time interval; increments with equally long time intervals are identically distributed.
In the Wiener process, the probability distribution of Xs  Xt is normal with expected value 0 and variance s  t.
In the Poisson process, the probability distribution of Xs  Xt is a Poisson distribution with expected value (s  t), where  > 0 is the "intensity" or "rate" of the process.

## Divisibility
The probability distributions of the increments of any Levy process are infinitely divisible.  There is a Levy process for each infinitely divisible probability distribution.

## Moments
In any Levy process with finite moments, the nth moment \mu_n(t) = E(X_t^n) is a polynomial function of t; these functions satisfy a binomial identity:

# Levy-Khinchin representation
It is possible to characterise all Levy processes by looking at their characteristic function. This leads to the Levy-Khinchin representation. If  X_t  is a Levy process, then its characteristic function satisfies the following relation:
\int_{\mathbb{R}\backslash\{0\}} \big( e^{i\theta x}-1 -i\theta x \mathbf{I}_{|x|<1}\big)\,W(dx) \Bigg)
where a \in \mathbb{R}, \sigma\ge 0 and \mathbf{I} is the indicator function. The Levy measure W must be such that
A Levy process can be seen as comprising of three components: a drift, a diffusion component and a jump component. These three components, and thus the Levy-Khinchin representation of the process, are fully determined by the Levy-Khinchin triplet (a,\sigma^2, W).  So one can see that a purely continuous Levy process is a Brownian motion with drift.
MIRACL Study

# Objective
To assess whether early initiation of treatment with a statin can reduce the occurrence of these early events.

# Methods
The Myocardial Ischemia Reduction with Acute Cholesterol Lowering (MIRACL) trial was a randomized, double-blinded trial wherein 3086 adults (18 years and above) with unstable angina or non-Q-wave MI were randomly assigned to receive treatment with atorvastatin (80 mg/day) or placebo between 24 and 96 hours after hospital admission and followed-up through 16 weeks. Primary predefined end point event was defined as time to death, nonfatal acute MI, cardiac arrest with resuscitation, or recurrent symptomatic myocardial ischemia with objective evidence and requiring emergency re-hospitalization.

# Results
- Primary end point occurred in 14.8% in patients treated with atorvastatin compared with 17.4% in the placebo group.
- No significant differences in risk of death, nonfatal myocardial infarction, or cardiac arrest between the two groups.
- Atorvastatin group had a lower risk of symptomatic ischemia with objective evidence and requiring emergency re-hospitalization.

# Conclusion
After an acute coronary event early treatment with 80 mg/day atorvastatin reduces recurrent ischemic events in the first 16 weeks, mostly recurrent symptomatic ischemia requiring re-hospitalization.
Mace (spray)
Mace is a tear gas in the form of an aerosol spray which propels the lachrymator mixed with a volatile solvent.  It is sometimes used as a self-defense device.  This form of mace is legal in very few countries, thus its use is becoming uncommon.
The original formulation consisted of 1% CN gas in a solvent of 2-butanol, propylene glycol, cyclohexene, and dipropylene glycol methyl ether. Some formulations now also include Oleoresin Capsicum (active ingredient in pepper spray).
Mace was originally manufactured under the name "Chemical Mace" by Lake Erie Chemical (a former division of Smith & Wesson) in 1962, but is now a registered trademark of Mace Security International. The Mace sold today by Mace Security International is pepper spray rather than tear gas.  Many other companies now manufacture similar products.

# Mace vs. pepper spray
Due to the current brand-name use of the term "Mace" to refer to pepper sprays and the fact that mace is illegal in most Western countries, it is very difficult to find information on traditional mace.  "Mace" and "Pepper Spray" are frequently used interchangeably.

# Training
Most law enforcement agencies require that their personnel become certified on similar aerosol spray devices such as pepper spray before using them in the field. Inert units which use the same mechanism but spray an inactive saccharine solution are also used for training purposes. 

# Effect
The effect of Mace varies on humans. Most common is a burning sensation on the area affected with the spray. If in contact with eyes it causes automatic closing of the eyes due to intense pain if open. This along with a feeling of suffocating if inhaled it causes the person to be very vulnerable and dependent, resulting in easy overpowering (for example, law enforcement officials over a suspect). Effects can be minimal on those under the influence of alcohol or drugs.  The duration of the effects vary from 30 minutes up to 2 hours, depending on the person and treatment.

# Mace in History
During the September 11, 2001 terrorist attacks Mace was supposedly used by the hijackers of American Airlines Flight 11 to prevent entry to the first-class area and keep passengers at the rear of the plane. The official 9/11 Commission Report states that "The hijackers quickly gained control and sprayed Mace, pepper spray, or some other irritant in the first-class cabin, in order to force the passengers and flight attendants toward the rear of the plane."
Macrocytosis
Macrocytosis is the enlargement of red blood cells with near-constant haemoglobin concentration, and is defined by a mean corpuscular volume (MCV) of greater than 100 femtolitres (the precise criterion varies between laboratories).

# Causes
Most commonly this etiology is bone marrow dysplasia primary to alcohol abuse.  Other causes may include:
- Vitamin B12 or folate deficiency
- hypothyroidism
- Hydroxyurea (patient information)
- reticulocytosis
- liver disease
- myeloproliferative disease

# Complications
No complications arise from macrocytosis itself and a prognosis will be determined from its aetiology.