bluuebunny/crossref_metadata_2025_split huggingface dataset:
Interrogating a clinical database to study treatment of hypotension in the critically ill
Authors: Lee Joon , Kothari Rishi , Ladapo Joseph A , Scott Daniel J , Celi Leo A 
Published: June 2012

ObjectiveIn intensive care, it is imperative to resolve hypotensive episodes (HEs) in a timely manner to minimise end-organ damage. Clinical practice guidelines generally recommend initial treatment with fluid resuscitation followed by vasoactive agent administration if patients remain hypotensive. However, the impact of such interventions on patient outcomes has not been clearly established. Hence, the objective of this study was to investigate the relationship between fluid and vasoactive agent interventions and patient outcomes, while highlighting the utility of electronic medical records in clinical research.DesignRetrospective cohort study.SettingIntensive care units (ICUs) at a large, academic, tertiary medical center.ParticipantsPatients in Multi-parameter Intelligent Monitoring in Intensive Care II (a large electronic ICU database) who experienced a single HE during their ICU stay. 2332 patients had complete data.Primary and secondary outcome measuresThe primary outcome of interest was inhospital mortality. Secondary outcomes were ICU length of stay (LOS), HE duration, Hypotension Severity Index (defined as the mean arterial pressure curve area below 60 mm Hg during the HE) and rise in serum creatinine.ResultsFluid resuscitation was associated with significantly shorter ICU LOS among ICU survivors (p=0.007). Vasoactive agent administration significantly decreased HE duration (p<0.001) and Hypotension Severity Index (p=0.002) but was associated with increased inhospital mortality risk (p<0.001), prolonged ICU LOS among ICU survivors (p=0.04) and rise in serum creatinine (p=0.002) after adjustment for confounders. Propensity score analyses as well as sensitivity analyses in treatment-, diagnosis- and ICU service-specific subpopulations corroborated the relationship between vasoactive agents and increased inhospital mortality.ConclusionsAn adverse relationship between vasoactive agents and inhospital mortality was found in patients with hypotension. This study has implications for the care of critically ill patients with hypotension and illustrates the utility of electronic medical records in research when randomised controlled trials are difficult to conduct.
Prostate cancer mortality risk in relation to working underground in the Wismut cohort study of German uranium miners, 1970–2003
Authors: Walsh Linda , Dufey Florian , Tschense Annemarie , Schnelzer Maria , Sogl Marion , Kreuzer Michaela 
Published: June 2012

ObjectiveA recent study and comprehensive literature review has indicated that mining could be protective against prostate cancer. This indication has been explored further here by analysing prostate cancer mortality in the German ‘Wismut’ uranium miner cohort, which has detailed information on the number of days worked underground.DesignAn historical cohort study of 58 987 male mine workers with retrospective follow-up before 1999 and prospective follow-up since 1999.Setting and participantsUranium mine workers employed during the period 1970–1990 in the regions of Saxony and Thuringia, Germany, contributing 1.42 million person-years of follow-up ending in 2003.Outcome measureSimple standardised mortality ratio (SMR) analyses were applied to assess differences between the national and cohort prostate cancer mortality rates and complemented by refined analyses done entirely within the cohort. The internal comparisons applied Poisson regression excess relative prostate cancer mortality risk model with background stratification by age and calendar year and a whole range of possible explanatory covariables that included days worked underground and years worked at high physical activity with γ radiation treated as a confounder.ResultsThe analysis is based on miner data for 263 prostate cancer deaths. The overall SMR was 0.85 (95% CI 0.75 to 0.95). A linear excess relative risk model with the number of years worked at high physical activity and the number of days worked underground as explanatory covariables provided a statistically significant fit when compared with the background model (p=0.039). Results (with 95% CIs) for the excess relative risk per day worked underground indicated a statistically significant (p=0.0096) small protective effect of −5.59 (−9.81 to −1.36) ×10−5.ConclusionEvidence is provided from the German Wismut cohort in support of a protective effect from working underground on prostate cancer mortality risk.
GaPP: a pilot randomised controlled trial of the efficacy of action of gabapentin for the management of chronic pelvic pain in women: study protocol: Figure 1
Authors: Horne Andrew W , Critchley Hilary O D , Doust Ann , Fehr Daniel , Wilson John , Wu Olivia , Jack S , Porter Maureen , Lewis Steff , Bhattacharya Siladitya 
Published: June 2012

IntroductionChronic pelvic pain (CPP) affects >1 million UK women. Annual healthcare costs are estimated at >£150 million. Proven interventions for CPP are limited, and treatment is often unsatisfactory. Gabapentin is increasingly prescribed due to reports of effectiveness in other chronic pain conditions, but there are insufficient data supporting value in CPP specifically. The mechanism by which gabapentin exerts its analgesic action is unknown. Given the prevalence and costs of CPP, the authors believe that a large, multicentre, placebo-controlled, double-blind randomised controlled trial to evaluate the efficacy of gabapentin in management of CPP is required. The focus of this study is a pilot to inform planning of a future randomised controlled trial.Methods and analysisThe authors plan to perform a two-arm, parallel, randomised controlled pilot trial. The authors aim to recruit 60 women with CPP in NHS Lothian and NHS Grampian (UK) and randomise them to gabapentin or placebo. Response to treatment will be monitored by questionnaire compared at 0, 3 and 6 months. The primary objective is to assess recruitment and retention rates. The secondary objectives are to determine the effectiveness and acceptability to participants of the proposed methods of recruitment, randomisation, drug treatments and assessment tools and to perform a pretrial cost-effectiveness assessment of treatment with gabapentin.Ethics and disseminationEthical approval has been obtained from the Scotland A Research Ethics Committee (LREC 12/SS/0005). Data will be presented at international conferences and published in peer-reviewed journals.Trial registration numberISRCTN70960777.
Multicenter study to assess the efficacy and safety of sacroplasty in patients with osteoporotic sacral insufficiency fractures or pathologic sacral lesions
Authors: Kortman Keith , Ortiz Orlando , Miller Todd , Brook Allan , Tutton Sean , Mathis John , Georgy Bassem 
Published: June 2012

ObjectiveTo assess the outcomes and safety after CT-guided percutaneous sacroplasty in patients with painful sacral insufficiency fractures or pathologic sacral lesions.MethodsA retrospective multicenter analysis of consecutive patients undergoing CT-guided sacroplasty for painful sacral insufficiency fractures or sacral lesions was undertaken. The inclusion criteria consisted of severe sacral pain not responding to conservative medical management with imaging evidence of unilateral or bilateral sacral insufficiency fractures or lesions. Outcome measures included hospitalization status (inpatient or outpatient), pre-treatment and post-treatment visual analog scale (VAS) scores, analgesic use and complications. Patients were followed at approximately 1 month and for at least 1 year after their sacroplasty procedure.ResultsTwo hundred and forty-three patients were included in the study, 204 with painful sacral insufficiency fractures and 39 with symptomatic sacral lesions. The average pre-treatment VAS score of 9.2±1.1 was significantly improved after sacroplasty to 1.9±1.7 in patients with sacral insufficiency fractures (p<0.001). The average pre-treatment VAS score of 9.0±0.9 in patients with sacral lesions was significantly improved after sacroplasty to 2.6±2.4 (p<0.001). There were no major complications or procedure-related deaths. One patient who was treated for a sacral insufficiency fracture experienced radicular pain due to local extravasation of cement that subsequently required surgical decompression for symptomatic relief.ConclusionsCT-guided percutaneous sacroplasty is a safe and effective procedure in the treatment of painful sacral insufficiency fractures or lesions. It is associated with prompt and durable pain relief and should be considered as an effective treatment option in this patient population.
TWISTING ALL THE WAY: FROM ALGEBRAS TO MORPHISMS AND CONNECTIONS
Authors: ASCHIERI PAOLO 
Published: June 2012

Given a Hopf algebra H and an algebra A that is an H-module algebra we consider the category of left H-modules and A-bimodules [Formula: see text], where morphisms are just right A-linear maps (not necessarily H-equivariant). Given a twist [Formula: see text] of H we then quantize (deform) H to [Formula: see text], A to A⋆ and correspondingly the category [Formula: see text] to [Formula: see text]. If we consider a quasitriangular Hopf algebra H, a quasi-commutative algebra A and quasi-commutative A-bimodules, we can further construct and study tensor products over A of modules and of morphisms, and their twist quantization. This study leads to the definition of arbitrary (i.e., not necessarily H-equivariant) connections on quasi-commutative A-bimodules, to extend these connections to tensor product modules and to quantize them to A⋆-bimodule connections. Their curvatures and those on tensor product modules are also determined.
Cardiac Pain
Authors: WHITE JAMES C. 
Published: June 2012

It may be concluded that the pathways of cardiac pain have been thoroughly established, with the exception of the conduction of anginal attacks occasionally referred to the neck and jaws. Afferent impulses traverse axons that travel in the cervical and thoracic sympathetic cardiac nerves. In the case of the cervical pathway, all impulses on entering the paravertebral ganglionated chain in the neck must descend to the upper thoracic level before they can gain access to the spinal cord. Other impulses reach the 3 superior thoracic ganglia via the more direct thoracic cardiac nerves. Both the cervical and thoracic fibers join the spinal nerves over the communicant sympathetic rami. After passing through the intervertebral foramina, they enter the posterior roots and terminate in the lateral horn of the spinal cord. Here they establish synapses with secondary afferent neurons of the spinothalamic tract, decussate to the opposite anterior column, and are carried rostrally to the nucleus ventralis posterolateralis of the thalamus. This is the principal locus in the brain for the perception of visceral pain. In contrast to well-defined cutaneous sensibility, there is no cortical area for exact visceral localization in the postcentral region of the cerebral cortex.
Another factor in the poor localization of cardiac pain is the paucity of sensory endings in the heart. A third appears to be the limited number of secondary sensory fibers in the spinothalamic tracts. These central axons must be shared with other impulses from the surface of the body. As a result, pain from the heart is in large part referred to the cutaneous distribution of the upper 4 thoracic spinal segments. Accounting for the superficial reference of visceral pain by Mackenzie's theory of a viscerocutaneous reflex is no longer justifiable. Even after cutaneous afferent fibers are interrupted by procaine or amputation of the arm, pain from the heart can still be felt over its previous distribution.
Neither stimulation of the vagi nor interruption of transmission in these nerves has been found to have any beneficial effect in patients suffering from angina pectoris. Sensory denervation of the heart must therefore be carried out by destruction of the upper ganglia in the thoracic sympathetic trunks or by severing the corresponding posterior spinal roots.
Nitroglycerin and Other Nitrites in the Treatment of Angina Pectoris
Authors: RISEMAN JOSEPH E. F. , ALTMAN GEORGE E. , KORETSKY SIDNEY 
Published: June 2012

The close chemical relationship between glyceryl trinitrate and erythrol tetranitrate suggests that these 2 drugs, despite clinical evidence to the contrary, should be equally effective in preventing attacks of angina pectoris. This proved to be true when the drugs were administered by the same route. Thus, erythrol tetranitrate when administered sublingually (instead of being swallowed, as is the custom) behaves like nitroglycerin and is one of the most effective vasodilators available. Conversely, nitroglycerin when swallowed (instead of being taken sublingually, as is the custom) is ineffective and erratic in activity. A similar striking increase in vasodilating action on sublingual administration is seen also with mannitol hexanitrate and triethanolamine trinitrate and to a lesser extent with pentaerythritol tetranitrate but not with sodium nitrite.
The prolonged effect of erythrol tetranitrate, when administered sublingually or in the buccal pouch, makes it particularly valuable in the clinical management of patients with angina pectoris.
A Case of Abnormal Cardiac Position (Levoposition)
Authors: ROWE G. G. , PAUL L. W. 
Published: June 2012

Dextroposition and levoposition are both believed to be forms of cardiac malposition that arise in early fetal life. It is believed that this is the first case of levoposition reported.
When cardiac positions are grossly abnormal, special investigations are required to establish normality of cardiac function, since usual criteria for physical findings, electrocardiographic data, and radiographic determination of size and shape may not be applicable.
Transventricular Mitral Valvotomy
Authors: GERBODE FRANK 
Published: June 2012

In a consecutive series of 200 operations for relief of mitral stenosis, transventricular valvotomy was performed whenever digital valvotomy was found to be ineffective. The operative mortality was 12.5 per cent.
In a series of 17 second operations for mitral stenosis, the transventricular method was similarly used, with 2 operative deaths. A left lateral thoracotomy was employed, with reentry through the left atrium.
The results of transventricular valvotomy were more satisfactory than when the usual commissurotomy through the left atrium was employed.
Environmental Factors in Coronary Heart Disease
Authors: MATHUR KRISHNA S. 
Published: June 2012

Various factors relating to coronary heart disease were investigated in 2 groups of patients: 553 patients with clinical coronary heart disease and 1,056 persons selected in a field survey of the general population.
The incidence of coronary disease was high in the urban population, in the upper socioeconomic classes, and in persons with highest amounts of total dietary fat and highest percentage of calories from dietary fat. Total serum cholesterol, serum phospholipid, and cholesterol/phospholipid ratio were higher in the coronary group.
Finally, it seemed that physical activity was less and emotional stress and strain greater in the patients with coronary disease.
No relation between coronary disease and smoking or alcohol was established.
Impending Myocardial Infarction
Authors: BEAMISH R. E. , STORRIE V. MARIE 
Published: June 2012

Coronary occlusion with myocardial infarction is a common condition with a high mortality. The mechanism of coronary occlusion in such cases is not always clear, but thrombosis, either directly or indirectly, is a dominant process.
In many instances premonitory symptoms give warning that myocardial infarction is threatening. It is suggested that these symptoms form a recognizable pattern which permits recognition of impending myocardial infarction with a high degree of accuracy. Three common presentations are described.
Frequency of diagnosis of impending infarction may be increased by a program of patient education.
Frompt administration of anticoagulants appears to influence the outcome favorably, particularly in the first few days or weeks of symptoms.
Common Circulatory Measurements in Smokers and Nonsmokers
Authors: BLACKBURN HENRY , BROZEK JOSEF , TAYLOR HENRY L. 
Published: June 2012

Pulse rates and blood pressure, and circulatory responses to pressor stimuli were compared in habitual smokers and nonsmokers in an attempt to ascertain possible "chronic effects" of tobacco smoking on the circulation.
Several common cardiovascular measurements were made in 4 groups, a total of 1,093 men, ages 17 to 67, and comparisons made with reference to the cigarette smoking habit. Acute effects of smoking were eliminated and, when possible, effects of age and weight were eliminated statistically.
Relative body weight is consistently lower in the "heavy" cigarette smokers compared to those who "never" smoked.
Basal oxygen consumption is slightly higher in smokers than in nonsmokers. Pulse rate during work and recovery is significantly higher in one group of middle-aged men if pathologic cases in the group are considered.
In "normal" populations, somewhat preselected for absence of hypertension, no differences in resting blood pressures are found between smokers and nonsmokers. In the broader studies, involving samples of the working population, smoking is associated with lower systolic and diastolic pressures.
Circulatory responses to stimuli of the cold pressor test and carbon dioxide inhalation reveal a small but significant diminished diastolic pressure response to cold and possibly a greater systolic response to carbon dioxide in smokers.
Young student groups, with short duration of smoking habit, show no significant differences between smokers and nonsmokers for these circulatory parameters.
The associations found do not provide evidence for large or important differences in circulatory reactivity between groups of habitual smokers and nonsmokers. There is little evidence for deterioration of cardiovascular "fitness" in smokers performing work tests.
The small magnitude of the differences found in circulatory measurements, plus certain sources of bias which are discussed, preclude serious consideration at present of these factors as underlying causes of the increased mortality rate among smokers. Other questions unanswered concern the importance of individual circulatory responses, individual hypersensitivity to smoking, and the significance of acute pressor and other effects of smoking on persons with cardiovascular disease, latent or manifest.
Pulmonary Artery Banding
Authors: ALBERT HAROLD M. , FOWLER RICHARD L. , CRAIGHEAD CLAUDE C. , GLASS BERTRAM A. , ATIK MOHAMMAD 
Published: June 2012

The technic of banding the pulmonary artery is described.
Twenty infants with intractable cardiac failure secondary to interventricular septal defects have had banding with one operative and one late death.
The operation is palliative, and definitive surgery probably must be done when the child is 3 to 5 years of age.
Banding the pulmonary artery is a relatively safe procedure but the mortality of banding plus ventricular closure and unbanding remains to be evaluated.
Effects of Reduced Glomerular Filtration Rate on Responsiveness to Chlorothiazide and Mercurial Diuretics
Authors: REUBI F. C. , COTTIER P. T. 
Published: June 2012

Clearance experiments have been performed in 24 subjects with different levels of glomerular filtration, suffering from renal disease without edema, in order to compare the diuretic, saluretic, and kaliuretic responses to a single intravenous injection of meralluride, chlorothiazide, or both together. The inulin clearances of these patients ranged from 5.9 to 135 ml. per minute. The effects of the drugs were studied under constant loading with saline over 3 hours after injection.
Our results indicate that over a wide range (15 to 20 ml. per minute up to normal values) a permanent reduction of the glomerular filtration rate has little influence on the diuretic and saluretic effects of meralluride or chlorothiazide. Below 15 to 20 ml. per minute a further reduction results in a sharp decrease in the diuretic and saluretic actions. This can be best explained by assuming that the diuretic agents block an increasing fraction or the tubular reabsorption of water, sodium, and chloride related to the decrease in glomerular filtration rate. This fraction, however, seems to be limited to 30 to 40 per cent of the filtered load. Some dispersion in the glomerulo-tubular activity may account for the splay of the experimental curves.
The kaliuretic effect of chlorothiazide is proportional to the glomerular filtration rate. This effect can be blocked by meralluride.
At high levels of glomerular filtration the diuretic and saluretic actions of meralluride and chlorothiazide are additive. At lower levels of filtration, such a summation effect is not demonstrable. Apparently, both drugs given together cannot block the reabsorption of more than 30 to 40 per cent of the filtered load.
A single injection of chlorothiazide does not lower the arterial blood pressure of hypertensive subjects, loaded with saline, but produces a slight decrease in the glomerular filtration rate, averaging 7 per cent.
The Association of Complete Heart Block and Adams-Stokes Syndrome in Two Cases of Mobitz Type of Block
Authors: KAUFMAN JEROME G. , WACHTEL FRED W. , ROTHFIELD EDWIN , BERNSTEIN ARTHUR 
Published: June 2012

Two cases exhibiting the Mobitz-type of second-degree atrioventricular heart block are reported.
This rhythm may be unstable, and progression to complete heart block and Adams-Stokes seizures has been observed.
Congenital Mitral Insufficiency
Authors: TALNER NORMAN S. , STERN AARON M. , SLOAN HERBERT E. 
Published: June 2012

The clinical and hemodynamic findings in 10 patients with mitral insufficiency on a congenital basis are described.
Six of these patients have had repair of the defects with dramatic clinical improvement noted. The findings at the time of surgical repair have been summarized.
The severity of the symptoms and the benefits to be derived from surgical repair should encourage vigorous attempts to establish the correct diagnosis. This is best accomplished by either recording the typical left atrial pressure pulse of mitral insufficiency during left heart catheterization or by left ventricular angiography to demonstrate the regurgitation of contrast material into the left atrium.
Effect of Exercise on Electrocardiograms of Patients with Low Serum Potassium
Authors: GEORGOPOULOS A. J. , PROUDFIT W. L. , PAGE IRVINE H. 
Published: June 2012

Twelve adult patients (10 hypertensive and two normotensive) with low serum potassium levels but without electrocardiographic signs diagnostic of hypokalemia were subjected to nonstrenuous exercise.
Electrocardiographic signs of hypokalemia appeared following exercise in all but the two hypertensive patients receiving digitalis. The severity of the changes and the duration correlated with the degree of hypokalemia present prior to exercise. The results were similar in the normotensive and hypertensive patients and in those made chronically or acutely hypokalemic. Following potassium repletion, exercise did not produce electrocardiographic changes of hypokalemia.
The frequency with which S-T segment and T-wave changes occurred following exercise during potassium depletion suggested that hypokalemia can introduce an error in interpreting results of exercise tolerance tests in patients receiving thiazide compounds, when serum potassium is at the low normal or borderline level.
These results may reflect intracellular myocardial potassium depletion brought on by exercise.
Plasma Heparin Levels in Normal Man
Authors: ENGELBERG H. , Dudley Anne 
Published: June 2012

Endogenous plasma heparin levels were determined in duplicate in 153 males and 103 females.
Heparin is normally present in human plasma in values ranging from 10 to 24 units per cent (1 to 2.4 mg. per liter). The range of average values was from 1.53 to 1.77 mg. per liter.
No age or sex difference was found.