tbuckley/cabot-search huggingface dataset:
Abstract 3521: Relationship Between Time from Symptom Onset to Hospital Presentation and Treatment with and Timeliness of Reperfusion Therapy for Patients with ST-Elevation Myocardial Infarction
Authors: Henry H Ting, Elizabeth H Bradley, Yongfei Wang, Brahmajee K Nallamothu, Jeptha P Curtis, Bernard J Gersh, Veronique L Roger, Judith H Lichtman, Harlan M Krumholz
Journal: Circulation (2007)

Background: Whether patients with STEMI with longer times from symptom onset to hospital presentation are less likely to be treated with any reperfusion therapy or treated with less urgency resulting in longer door-to-balloon and door-to-needle times is not known. The relationship between delay in hospital presentation and the quality of reperfusion therapy for patients with STEMI has not been examined Methods: We constructed 3 cohorts of STEMI patients to analyze use of any reperfusion (n=440,398), door-to-balloon time (n=67,207), and door-to-drug time (n=183,441) as a function of delay in hospital presentation. We constructed multivariable generalized linear models for each outcome to estimate the associations between delay in hospital presentation adjusted for all patient and hospital characteristics. Results: In adjusted analysis, longer times from symptom onset to hospital presentation was associated with lower use of any reperfusion therapy (p&lt;0.0001 for trend). For early presenters with times of ≤1 hour, &gt;1 to 2 hours, and &gt;2 to 3 hours, 77%, 77%, and 73% of patients received any reperfusion therapy, respectively, and late presenters with times &gt;9 to 10 hours, &gt;10 to 11 hours, and &gt;11 to 12 hours were treated with any reperfusion therapy in 53%, 50%, and 46%, respectively. Delay in hospital presentation was associated with longer drug-to-balloon and door-to-drug times (p&lt;0.0001 for trend). For time intervals of ≤ 1 hour, &gt;1 to 2 hours, &gt;2 to 3 hours, &gt;9 to 10 hours, &gt;10 to 11 hours, and &gt;11 to 12 hours, patients with STEMI were treated with door-to-balloon times of 99, 101, 106, 123, 125, and 123 minutes respectively. For delay time intervals of ≤ 1 hour, &gt;1 to 2 hours, &gt;2 to 3 hours, &gt;9 to 10 hours, &gt;10 to 11 hours, and &gt;11 to 12 hours, patients were treated with door-to-drug times of 32, 34, 36, 46, 44, and 46 minutes, respectively. Conclusions: Longer time from symptom onset to hospital presentation has important implications for subsequent treatment and was associated with lower use of any reperfusion therapy and longer door-to-balloon and door-to-drug times. Longer delay in hospital presentation is associated with worse system performance for reperfusion therapy quality and represents an opportunity to improve quality of care for STEMI patients.
Abstract 4879: Overexpression of GTP-Cyclohydrolase I in Vascular Endothelium Prevents Oxidative Stress-Induced eNOS Translocation From Caveolae to Cytosol
Authors: Timothy E Peterson, Zvonimir S Katusic, Livius V d’Uscio
Journal: Circulation (2009)

GTP-Cyclohydrolase I (GTPCH I) is the rate-limiting enzyme for tetrahydrobiopterin biosynthesis, an essential co-factor required for enzymatic activity of endothelial nitric oxide synthase (eNOS). Recent studies have suggested that endothelium-targeted overexpression of GTPCH I has vasoprotective effects. Therefore, we hypothesized that in endothelium GTPCH I localization in caveolae protects eNOS against oxidative stress. Human umbilical vein endothelial cells (HUVECs) were incubated with recombinant adenovirus encoding the human GTPCH I gene (Ad-GTPCH I, 100 MOI) or control recombinant adenoviral vector (Ad-ΔE1) for 12 hours in serum-free media. Cells were then fed with growth medium for 48 hours prior to analysis. Using sucrose gradient ultracentrifugation we detected both protein expression and enzymatic activity of GTPCH I in caveolar microdomains of HUVECs. Treatment of Ad-ΔE1 transduced endothelial cells for 24 hours with LY83583 (1 μ M), a superoxide anion generator, significantly decreased enzymatic activity of GTPCH I in caveolae-enriched membranes (0.49±0.12 pmol neopterin/mg protein; P&lt;0.05 vs. control: 0.92±0.07 pmol neopterin/mg). Furthermore, LY83583 translocated eNOS from caveolae to cytosol in Ad-ΔE1 treated endothelial cells (P&lt;0.05; n=3). This effect was specific because there was no change in caveolin-1 expression and no decrease in cell viability. Treatment of HUVECs with Ad-GTPCH I significantly increased GTPCH I activity in caveolae-enriched membranes (1.37±0.22 pmol neopterin/mg; P&lt;0.05; n=4). Interestingly, LY83583-induced dislocation of eNOS from caveolar membrane fraction was significantly prevented by overexpression of GTPCH I (P&lt;0.05; n=3). Our results suggest that overexpression of GTPCH I increases its enzymatic activity in caveolae. This effect preserves strategically key localization of eNOS in cell membrane during oxidative stress. This research has received full or partial funding support from the American Heart Association, National Center.
Should doctors have a dual role, preserving life and assisting death?
Authors: T. Brewin
Journal: BMJ (1995)

We report a case of a middle-aged woman, normally fit and well, presenting with acute onset neurological deficit with progression to nadir in &lt;1 hour. Initial MRI spine showed no significant abnormality, although second MRI spine showed abnormal signal in three to four segments with no compressive lesion. CT aortic angiography excluded vascular or ischaemic abnormality. We made a diagnosis of idiopathic acute transverse myelitis (ATM). She was treated with steroids and made significant progress improving from T11 ASIA A paraplegia to T11 ASIA C paraplegia by the time of discharge. Awareness of idiopathic ATM presenting hyperacutely with initial MRI spine being normal is important for prompt diagnosis and management.
Abstract 1849: Comparison of Coronary Artery Bypass Surgery and Percutaneous Coronary Intervention for the Treatment of Unprotected Left Main Coronary Disease in Octogenarians
Authors: Jonathan DeBlois, Pierre Voisine, Olivier F Bertrand, Siamak Mohammadi, Gerald Barbeau, Melanie Rousseau, Eric Larose, François Dagneais, Patrick Mathieu, Jean Perron, Onil Gleeton, Jean-Pierre Déry, Richard Baillot, Guy Proulx, Louis Roy, Bernard Noël, Daniel Doyle, Robert DeLarochellière, Josep Rodés-Cabau
Journal: Circulation (2007)

Background: Very little data exists regarding percutaneous coronary intervention (PCI) as an alternative to coronary artery bypass graft (CABG) for the treatment of unprotected left main disease (LMD) in octogenarians, and no studies to date have compared CABG and PCI for the treatment of LMD in this population. The objectives of our study were to compare the acute and midterm follow-up results of PCI and CABG for the treatment of significant LMD in octogenarians. Methods: A total of 163 consecutive patients ≥80 years old diagnosed with LMD have undergone coronary revascularization in our center between 2002 and 2006. One hundred and one patients underwent CABG and 62 patients had PCI (non-surgical candidates: 30%, very high surgical risk patients: 61%, patient refusal of CABG: 9%). All complications occurring within the first 30 days following the procedure were recorded, and major adverse cardiovascular events -MACCE- (cardiac death, myocardial infarction, cerebrovascular event, revascularization) were evaluated at follow-up. Results: Patients who underwent PCI were older (85 ± 3 yrs vs. 82 ± 2 yrs, p&lt;0.0001), presented more frequently with an acute coronary syndrome (92% vs. 50%, p&lt;0.0001), and had a higher EuroSCORE (9.5 ± 2.7 vs. 8.5 ± 2.5, p=0.01). Drug-eluting stents were used in 48% of PCI patients. There were no significant differences in the incidence of MACCE at 30 days between groups (CABG: 28%, PCI: 19%, p=0.22), but the CABG group was associated with a higher rate of atrial fibrillation (48% vs. 14%, p&lt;0.0001) and acute renal failure (17% vs. 6%, p=0.05). The incidence of MACCE occurring between 30 days and 24 ± 17 months follow-up was higher in the PCI group (32% vs. 13%, p=0.005), but the cumulative incidence of MACCE was similar in both groups (CABG 39% vs. PCI 44%, p=0.53). Conclusions: PCI was associated with a 30-day cardiac event rate similar to that of CABG for the treatment of unprotected LMD in octogenarians. Surgical patients experienced fewer cardiac events during the follow-up period, but the cardiovascular event-free survival rate was similar between groups at 2-year follow-up. Further randomized studies with longer-term follow-up comparing both revascularization strategies in this high risk coronary population are warranted.
THE RELATION BETWEEN PHYSICAL CONSTITUTION AND THE INCIDENCE OF DISEASE
Authors: J. Feigenbaum, David Howat
Journal: Journal of Clinical Investigation (1934)

The problem associating constitution with the occurrence of disease in indi- viduals is a very old one.It is probably as old as the study of disease itself, and its importance must have become impressed upon the minds of men investi- gating disease from the earliest times.Scrutiny of the Hippocratic writings (460 B.C.-375 B.C.), however, does not reveal any definite allusion to the re- lation between constitution and disease, although there are vague hints that these two elements are related in Hippocrates' mind.Any direct reference to this subject is likewise lacking in Galen's work (A.D. 130-200).Avicenna (circ.A.D. 980-1037) in his Canon does make numerous allusions to the im- portance of a recognition of the " temperament " in the study of character and in defining certain functions in an individual, but he does not correlate form with disease.The following sentences are worth quoting inasmuch as they indi- cate the status which the study of constitution had reached about A.D. 1000, a rather uncertain period in medical scientific history (1)."The external con- figuration of the body, including the physiognomy, is a reflection of the func- tional capacity of the internal organs and general make-up of the individual.The character, talents, physical form, shape of individual features, general de- velopment and indeed every detail of the physique, length of limbs, of fingers, cutaneous markings, contour of the eyes and ears etc., are all part and parcel with the functional conformation of the viscera and the mental characters."An interesting opinion on the relation between function and form is provided by Walkington in the "Optick Glasse of Humors" (1663).This author takes great pains to point out all the information that can be gained by physiognomical study.In this respect Walkington may be regarded as a precursor to that psychiatric school which links up certain constitutional types with psychiatric disease.The great clinical teachers Sydenham (1624-1689) and Boerhaave (1668-1738) did not add any new contributions to the subject.There was renewed awakening of interest in the problem at the beginning of the nineteenth century, with an enthusiasm which was sustained until Pasteur's bacteriologic work eclipsed all else for the time in medicine.A rich literature grew up on the continent, while the group of celebrated English clinicians of the nineteenth century left some lasting contributions.Jonathan Hutchinson was perhaps the keenest student of constitution in this group.He possessed a wide background of clinical training, and he could therefore draw upon this experi-
Another healthcare funding review
Authors: J. Dixon
Journal: BMJ (2001)

Survey 100 doctors, nurses, or members of the public at random and ask them about the NHS and most would probably put “thronic underinvestment” at the top of the list of ills. The evidence is plain—shabby hospitals, waiting lists, lack of equipment, and difficulty retaining staff. It has been ever thus. Because the NHS is largely funded through central taxation and because there is no objective way of deciding the right level of funding for the NHS “Seeds”1 the decision is a political judgment and therefore ripe for constant attack. It is also ripe for a constant search for better methods of financing health care. This week a group of medical, nursing, patient, and private sector organisations published the latest in a long line of inquiries into healthcare funding.2

For the past 20 years real growth in NHS spending has averaged about 3% a year, though the growth curve has been more like a roller coaster ride than a steady ascent.3 Last year the government pledged £19.4bn ($29.1bn) over four years—roughly double the average in real terms, sustained for four years. While welcome, this still leaves us short …
Abstract 891: SM22-GRK5 Induced Hypertension (HBP) is Mediated by the {beta}1-Adrenergic Receptor ({beta}1AR) Coupling to Gi
Authors: David M Harris, Stephanie Pesant, Brent DeGeorge, Heather I Cohn, Maggie Shapiro, Elizabeth Mandel, Andrea D Eckhart
Journal: Circulation (2006)

Abnormal βAR signaling is associated with HBP and contributes to the increased contractile state of vascular smooth muscle (VSM). G protein receptor kinases (GRK) have been shown to phosphorylate a...
Abstract P227: Cardiac Arrhythmias, Hemodynamic Instability and Death Following Low Volume 7.5% NaCl With 6% Dextran-70 or 10% Hetastarch Resuscitation in the vivo Rat Model of Hemorrhagic Shock
Authors: Hayley L Letson, Geoffrey P Dobson
Journal: Circulation (2009)

Objective: Small volumes of hypertonic solutions in combination with colloids are popular on the battlefield to resuscitate soldiers from hemorrhagic shock, and in some civilian trauma care units. The aim of the study was to examine the individual and combined effects of 7.5% NaCl, 6% dextran-70 or 10% hetastarch on ventricular arrhythmias, QRS amplitudes and hemodynamics following 60 min of hemorrhagic shock.  Methods: Male fed Sprague-Dawley rats (300–400g, n=32) were anaesthetized and randomly assigned to one of four groups:  control (bleed only),  7.5% saline,  7.5% NaCl/6% Dextran-70,  7.5% NaCl/10% hetastarch.  Hemorrhagic shock was induced by removal of up to 50% blood volume over 20 min until mean arterial pressure (MAP) decreased to 35–40 mmHg. Animals were left in shock at 32°C for 60 min. Resuscitation was commenced with small bolus’s (0.3 ml or ~3% of shed blood) injected into the femoral vein and Lead II ECG, MAP and heart rate (HR) were monitored.  Results: 0.3 ml of 7.5% saline at resuscitation led to a drop in MAP to about 10 mmHg lasting for 4 min, increased to around 60 mmHg and then slowly declined to 40 mmHg over the next hour. No arrhythmias were detected. Curiously, 0.3 ml of 7.5% NaCl/6% Dextran-70 led to a 1.5 fold increase in the QRS amplitude, ventricular arrhythmias and cardiac instability after 10 min, and an increase in HR of 20 to 40 bpm. The MAP initially fell then quickly returned to 35–38 mmHg for ~4 min, increased to above 55 mmHg and stabilized at around 50 mmHg for 60 min. 0.3 ml of 7.5% NaCl/10% hetastarch resulted in a 63% mortality (5 of the 8 rats died from ventricular fibrillation 5 min post-bolus). Arrhythmias were prominent in all animals that survived and MAP increased to around 70 mmHg and slowly decreased to 45 to 50 mmHg at 60 min recovery. No change in QRS amplitude occurred, and HR did not change significantly.  Conclusion: Small volumes of 7.5% NaCl/6% Dextran-70 in the rat model of hemorrhagic shock led to increased QRS amplitude and ventricular arrhythmias, and 7.5% NaCl/10% hetastarch led to a 63% mortality and severe arrhythmias. Though hetastarch has been reduced to 6% in commercially available Hextend (7.5% NaCl/6% hetastarch), caution may still have to be exercised when using bolus injections on the battlefield or trauma care units.
Efficacy of Proton Pump Inhibitor Drugs for Inducing Clinical and Histologic Remission in Patients With Symptomatic Esophageal Eosinophilia: A Systematic Review and Meta-Analysis
Authors: Alfredo J. Lucendo, Ángel Arias, Javier Molina-Infante
Journal: Clinical Gastroenterology and Hepatology (2015)
Abstract 16979: Impact of ICD Shock Testing and Non-Testing on Arrhythmia Therapy Efficacy
Authors: Peter Nordbeck, Marcus Warmuth, Wolfgang R Bauer, Georg Ertl, Oliver Ritter
Journal: Circulation (2011)

Background: Defibrillation testing is often performed during implantation of implantable cardioverter defibrillators (ICD) to confirm therapy efficacy, even though there are no prospective data suggesting that outcome is improved by this procedure when modern ICDs are implanted. The aim of the study was to investigate whether shock testing during ICD implantation is feasible for predicting future effectiveness of ICD therapy. Methods: The retrospective analysis included a cohort of consecutive patients who received an ICD device with telemedicine capacity in our clinic, with each tachycardia episode monitored and evaluated online. All devices were implanted by means of standard surgical techniques, and shock testing was conducted or desisted due to the attending cardiologist's and surgeon's discretion. Results: 357 patients who received either an ICD or CRT-ICD with home monitoring capacity could be enclosed in the study. From 219 patients, in which ICD shock testing was performed during implantation, initial shock testing revealed satisfactory results in 210 cases; otherwise, additional surgical measures led to shock testing success. 138 patients were not tested. Compared to the shock testing group, implantation for primary prevention was more common in the non-testing group. In the shock testing group, 124 patients had VT/VF requiring ICD shock therapy. First shock efficacy was 99% for the first VT event in this group, with only one patient undergoing an ineffective first shock delivery. In this patient, the VT could be terminated with the second shock. However, in the long run 7 patients had at least one documented episode with an ineffective shock, despite the fact that previous shocks had been successful. In the non-testing group, 76 patients required ICD shock therapy and first shock efficacy was 100% for the first VT event in this group. Accordingly, there was no significant difference regarding first shock efficacy between patients with ICD for primary or secondary prevention. Conclusions: Shock efficacy for treatment of the first ventricular tachycardia was generally high, regardless whether shock testing was performed during implantation or not. This result challenges the current paradigm of ICD shock testing during implantation.
G07 : The phase 3 C-EDGE treatment-naïve (TN) study of a 12-week oral regimen of grazoprevir (GZR, MK-5172)/ elbasvir (EBR, MK-8742) in patients with chronic HCV genotype (GT) 1, 4, or 6 infection
Authors: S. Zeuzem, R. Ghalib, K.R. Reddy, P.J. Pockros, Z.B. Ari, Y. Zhao, D. Brown, M. DiNubile, M. Robertson, J. Wahl, E. Barr, J. Butterton
Journal: Journal of Hepatology (2015)
BMA Annual Representative Meeting: Doctors support embryo selection to help ill siblings
Authors: Linda Beecham
Journal: BMJ (2003)

The BMA has supported the idea of preimplantation selection of embryos to help to treat a seriously ill sibling.

The BMA's annual representative meeting endorsed the judgment in a recent High Court appeal in the Hashmi case (12 April 2003, p 782) when it was agreed that cord blood from the selected baby would be harvested for bone marrow stem cells to help a brother who would otherwise die.

“We need to have this facility to use this technique when it is needed,” Dr Michael Wilks, chairman of the medical ethics committee, told the meeting. But he emphasised that each case had to be treated on an individual basis.

The proposer of the motion, Dr Peter Dangerfield from Liverpool, pointed to the dramatic increases in medical knowledge which had produced more ethical dilemmas.

But did a caring profession have the right to deny treatment to people if it was scientifically possible, he asked.

The life of the unborn child, whose cells were being used, would not be interfered with. The stem cells would be used to save another person who was under sentence of death. If the technique was not supported there was a risk of it going underground or of patients going abroad to be treated where there would be no governmental or ethical control.

But Dr Gregory Gardner, a GP in Birmingham, said the matter was a question of choice: “Should the role of public policy be to go along with unfettered public choice or should it include limiting choices so we would not be tempted to make bad decisions?” He believed the selection of certain embryos and the destruction of others was “eugenics with a vengeance.”
Abstract 11953: Global Circumferential Strain from Routine Cardiac Magnetic Resonance Image Analysis Using a Novel Off-Line Approach: Comparison with Echocardiographic Strain and Left Ventricular Ejection Fraction
Authors: Toshinari Onishi, Samir K Saha, Daniel Ludwig, Tetsuari Onishi, Olusegun A Oyenuga, Erik B Schelbert, David Schwartzman, John Gorcsan
Journal: Circulation (2011)

Background: Cardiac magnetic resonance (CMR) imaging is considered the gold standard for left ventricular (LV) strain and ejection fraction (EF). However, strain by CMR tagging is complex and time-...
B lymphocyte antigen D8/17: a peripheral marker for childhood-onset obsessive-compulsive disorder and Tourette's syndrome?
Authors: T K Murphy, W K Goodman, M W Fudge, R C Williams, E M Ayoub, M Dalal, M H Lewis, J B Zabriskie
Journal: American Journal of Psychiatry (1997)

It has been hypothesized that Sydenham's chorea, a major manifestation of rheumatic fever, may provide a medical model for obsessive-compulsive disorder and associated conditions, such as Tourette's syndrome. Monoclonal antibody D8/17 identifies a B lymphocyte antigen with expanded expression in nearly all patients with rheumatic fever and is thought to be a trait marker for susceptibility to this complication of group A streptococcal infection. The authors investigated whether D8/17 expression is greater than normal in some forms of obsessive-compulsive disorder and Tourette's syndrome.By immunofluorescence techniques, 31 patients with childhood-onset obsessive-compulsive disorder and/or Tourette's syndrome or chronic tic disorder and 21 healthy comparison subjects were evaluated for percentage of D8/17-positive B cells. None had rheumatic fever or Sydenham's chorea. Levels of antineuronal antibodies and streptococcal antibodies were also determined.The average percentage of B cells expressing the D8/17 antigen was significantly higher in the patients (mean = 22%, SD = 5%) than in the comparison subjects (mean = 9%, SD = 2%). When classified categorically, all patients but only one comparison subject were D8/17 positive. No difference between groups in the presence of antineuronal antibodies or high streptococcal titers was found.Patients with childhood-onset obsessive-compulsive disorder or Tourette's syndrome had significantly greater B cell D8/17 expression than comparison subjects despite the absence of documented Sydenham's chorea or rheumatic fever. These findings suggest that D8/17 may serve as a marker for susceptibility among some forms of childhood-onset obsessive-compulsive disorder and Tourette's syndrome, as well as rheumatic fever or Sydenham's chorea.
Abstract 1262: Metabolomic Profiles Are Associated With Baseline Insulin Resistance and Improvement in Insulin Resistance With Weight Loss in the WLM Trial
Authors: Svati H Shah, David R Crosslin, Sarah Nelson, Carol Haynes, Christy L Boling, James Bain, Michael Muehlbauer, Robert D Stevens, Phillip J Brantley, Victor Stevens, Jack F Hollis, Lawrence J Appel, Lillian Lien, Christopher B Newgard, Laura P Svetkey
Journal: Circulation (2009)

Background. Insulin resistance (IR) improves with weight loss but this response is heterogeneous. As part of the MURDOCK WLM study, we hypothesized that metabolomic profiling would identify novel b...