tbuckley/cabot-search huggingface dataset:
Abstract 1595: Positive Inotropic Effect Of Relaxin-2 In Atrial Myocardium Of Terminally Failing Hearts: Role Of Protein Kinase A And Potassium Channels
Authors: Thomas Dschietzig, Till Kinkel, Konstantin Alexiou, Gert Baumann, Karl Stangl
Journal: Circulation (2007)

The insulin-like peptide relaxin, a pregnancy hormone, exerts anti-fibrotic, renal, central nervous, and vascular effects, and is a positive inotropic agent in rat atrial myocardium. We have recently demonstrated that relaxin acts as compensatory mediator in human heart failure. This is the first investigation of the inotropic effects of relaxin-2 in human myocardium. We used human right and left atrial as well as right and left ventricular myocardial samples obtained from donor hearts that were not transplanted for technical reasons (n=5) and from explanted, terminally failing hearts (n=8; 4 patients with dilated cardiomyopathy, 4 patients with ischemic cardiomyopathy). In right and left atrial preparations from both donor and failing hearts, human relaxin-2 evoked positive inotropic effects (EC50 of peak developed tension for isometric twitches; donor, 0.5 ± 0.1 nM [right atrium] and 0.6 ± 0.1 nM [left atrium]; failing, 0.6 ± 0.1 nM [right atrium] and 0.6 ± 0.1 nM [left atrium]; maximum peak developed tension in percent of baseline; donor, 283 ± 35 % [right atrium] and 267 ± 30 % [left atrium]; failing, 258 ± 38 % [right atrium] and 268 ± 34 % [left atrium]). These effects could be prevented by treatment with the protein kinase A inhibitor 5–24 amide and with glibenclamide, a blocker of ATP-sensitive potassium channels. Staurosporine, a protein kinase C inhibitor, and KT-5823, a protein kinase G inhibitor, had no effects. On the other hand, a positive inotropic effect of relaxin-2 could be found neither in donor nor in failing right and left ventricular myocardium although all preparations showed similar inotropic responses to increased extracellular calcium concentrations. In conclusion, our findings indicate that the positive inotropic atrial effect of human relaxin-2 is well preserved in terminally failing human myocardium. The effect is mediated via protein kinase A and ATP-sensitive potassium channels. In ventricular myocardium, there is no such inotropic action of relaxin.
Pulmonary Hypertension in Heart Failure. Epidemiology, Right Ventricular Function, and Survival
Authors: Mario Gerges, Christian Gerges, Anna-Maria Pistritto, Marie B. Lang, Pia Trip, Johannes Jakowitsch, Thomas Binder, Irene M. Lang
Journal: American Journal of Respiratory and Critical Care Medicine (2015)

Patients with pulmonary hypertension due to left heart disease (PH-LHD) and a diastolic pulmonary vascular pressure gradient ≥ 7 mm Hg, representing PH out of proportion to pulmonary arterial wedge pressure, have pulmonary vascular disease and increased mortality. Little information exists on this condition, recently labeled as "combined pre- and post-capillary PH" (Cpc-PH).To investigate epidemiology, risk factors, right ventricular function, and outcomes in patients with chronic heart failure and Cpc-PH.The study population was identified from a retrospective chart review of a clinical database of 3,107 stable patients who underwent first diagnostic right heart catheterization and from a prospective cohort of 800 consecutive patients at a national university-affiliated tertiary center.The retrospective cohort had 664 patients with systolic heart failure (SHF) and 399 patients with diastolic heart failure (DHF), 12% of whom were classified as Cpc-PH. The prospective cohort had 172 patients with SHF (14% Cpc-PH) and 219 patients with DHF (12% Cpc-PH). Chronic obstructive pulmonary disease (P = 0.034) and the tricuspid annular plane systolic excursion to systolic pulmonary artery pressure ratio (P = 0.015) predicted Cpc-PH in SHF. Younger age (P = 0.004), valvular heart disease (P = 0.046), and the tricuspid annular plane systolic excursion to systolic pulmonary artery pressure ratio predicted Cpc-PH in DHF (P = 0.016). Right ventricular-pulmonary vascular coupling was worse in Cpc-PH patients (end-systolic elastance to effective arterial elastance [Ees/Ea]: SHF: 1.05 ± 0.25; P = 0.002; DHF: 1.17 ± 0.27; P = 0.027) than in those with isolated post-capillary PH (Ees/Ea: SHF: 1.52 ± 0.51; DHF: 1.45 ± 0.29).Cpc-PH is rare in chronic heart failure. Right ventricular-pulmonary vascular coupling is poor in Cpc-PH and could be one explanation for dismal outcomes.
Algorithm of diagnosis and surgical treatment of pulmonary hemorrhage
Authors: Georgiy Pakhomov, Rustem Hayaliev, Alisher Yusubov
Journal: European Respiratory Journal (2014)

Objective:  Development and improvement of the algorithm of diagnosis and surgical treatment of pulmonary hemorrhages (PH).   Material and methods . The paper analyzes the results of surgical treatment of 47 patients with PH for the period from 2010 to 2013. Men - 29(61.7%), women - 22(46.8%). Five of the patients were previously conducted operations - hydatidectomy from lungs. Examination of patients with PH included CT - 12 and bronchoscopy - 32 patients. Diagnosed below diseases: erosive bronchitis - 6, bronchiectasis - 3, hydatid disease - 6, mass lesions - 9, pneumonia - 1, cystic disease - 3, specific tubercular process - 1, tromboembolism of small branches of the pulmonary artery - 1.   Results of treatment:  in 30 cases performed primary hemostasis and treatment of the main disease, the remaining 17 patients underwent surgeries: in 7 cases hydatidectomy (41.1%), 4 - wedge resection of lung (23.5%), 3 - bilobektomy (17.6%), 1 - lobectomy (5.88%), 1 - extirpation of the mediastinal cyst (5.88%), 1 - transcatheter embolization of bronchial artery (5.88%). Postoperative complications occurred in 2 patients (11.7%), in one case - postoperative pneumonia, another noted festering of wound - complications eliminated conservatively. Hospital mortality is not registered.   CONCLUSIONS:  All patients to confirm the diagnosis is recommended to perform bronchoscopy, which can also serve as a therapeutic tool to stop bleeding from small vessels. At the height of PH, in the presence of conditions for angiography contrast aortography needed to identify possible sources of bleeding. When organic lesions of the lung tissue in patients previously performed operations, and recurrent bleeding it is indicated resection interventions.
Long-term treatment in asthma and COPD
Authors: JB Wempe, TE Renkema, GH Koeter, DS Postma
Journal: European Respiratory Journal (1990)

The efficacy of drugs may be assessed by their influence on mucociliary clearance. The criterion is the abbreviation of the elimination-half-time of radio-labelparticles, e.g. TE99• The interesting information of such tests is that not the so called secretolytics, but betaagonists and theophyllin are effective. However the message is rather artificial and the clinical relevancy of such effects give rise to some doubts. There is a wide spectrum of objectives for acute clinical trials. Compared are: -different substances representing one class, e.g. betaagonist with respect to the relation of effects and side effects and especially to the duration of action, different types of drugs such as beta-agonists versus theophylline, different routes (oral, inhalative, se, iv), different types of aerosol generation or particles (MDI, nebulizer, powder, different shapes and volumes of spacers etc.), different formulations, different dosing intervals, -combinations of different drugs to look at synergistic effects. Acute clinical trials are easier to perform than subacute or longterm trials. But even in acute studies we are faced with one big problem: the patient. The ideal patient in the biometric point of view may be characterized as follows: highly cooperative, stable, even in case of stopping the medication for hours or several days. But nevertheless he has to fulfil the criteria of manifest asthma. The real patient in real life is quite different. Compliance is limited (with respect to the use of drugs and to the frequency of measurements prescribed by the protocol)unstable and needs some medication or does not suffer from asthma. The design of protocols has to talce into account these conditions otherwise, violations are preprogrammed. What can we learn by clinical trials for the management of COPD-patients? For several reasons it may be difficult to judge the results of clinical trials: the labels for the diseases and therefore the selection criteria are different in different countries, -the question has to be answered whether significant differences are clinically relevant, principally we have to judge whether results coming from selected patients and elaborated by more or less artificial methods are applicable for clinical practice, -and finally, what does an acute effect mean for long term treaunent? Acute clinical trials give valuable information about potency of a drug, onset and duration of action in comparison with placebo or standard drugs or different routes of application or formulations. The relevancy of different models for clinical application the results decrease from: bronchospasmolytic effect, protection in challenge test, influence on mucociliary clearance. In every single case the effect of drug and the optimal dose has to be evaluated individually. Fortunately there are simple and reliable methods available such as peak flow recordings and the diary.
Radiation Dose From Single Heartbeat Coronary CT Angiography Performed Using a 320 Detector-Row Volume Scanner
Authors: Andrew J. Einstein
Journal: Circulation (2009)

Abstract #251 Andrew J. Einstein, Carl D. Elliston, Columbia Univ Medical Ctr, New York, NY; Andrew E. Arai, Marcus Y. Chen, Natl Heart Lung and Blood Inst, Bethesda, MD; Richard Mather, Toshiba America Medical Systems, Tustin, CA; Gregory D. Pearson, Robert L. DeLaPaz, Edward L. Nickoloff, Ajoy Dutta, David J. Brenner, Columbia Univ Medical Ctr, New York, NY Andrew J. Einstein, 2009 Finalist and Presenting Author
Impact of Exercise Type and Dose on Pain and Disability in Knee Osteoarthritis: A Systematic Review and Meta‐Regression Analysis of Randomized Controlled Trials
Authors: C. Juhl, R. Christensen, E. M. Roos, W. Zhang, H. Lund
Journal: Arthritis & Rheumatology (2013)

To identify the optimal exercise program, characterized by type and intensity of exercise, length of program, duration of individual supervised sessions, and number of sessions per week, for reducing pain and patient-reported disability in knee osteoarthritis (OA).A systematic review and meta-analysis of randomized controlled trials were performed. Standardized mean differences (SMDs) were combined using a random-effects model. Study-level covariates were applied in meta-regression analyses in order to reduce between-study heterogeneity.Forty-eight trials were included. Similar effects in reducing pain were found for aerobic, resistance, and performance exercise (SMD 0.67, 0.62, and 0.48, respectively; P = 0.733). These single-type exercise programs were more efficacious than programs that included different exercise types (SMD 0.61 versus 0.16; P < 0.001). The effect of aerobic exercise on pain relief increased with an increased number of supervised sessions (slope 0.022 [95% confidence interval 0.002, 0.043]). More pain reduction occurred with quadriceps-specific exercise than with lower limb exercise (SMD 0.85 versus 0.39; P = 0.005) and when supervised exercise was performed at least 3 times a week (SMD 0.68 versus 0.41; P = 0.017). No impact of intensity, duration of individual sessions, or patient characteristics was found. Similar results were found for the effect on patient-reported disability.Optimal exercise programs for knee OA should have one aim and focus on improving aerobic capacity, quadriceps muscle strength, or lower extremity performance. For best results, the program should be supervised and carried out 3 times a week. Such programs have a similar effect regardless of patient characteristics, including radiographic severity and baseline pain.
Soundings: What price entertainment?
Authors: Trisha Greenhalgh
Journal: BMJ (2004)

A man wakes up in casualty after a grand mal seizure. The junior doctor explains that it's probably simple epilepsy but that he may need further tests to exclude something more serious. He will be admitted overnight for observation.

Six million of us have watched the man being wheeled, fitting, from the ambulance to the resuscitation room. We have seen his vomit being sucked through a tube by an impassive nurse. We have zoomed in on a close up of him spitting out his airway, and another of his wife crouching to wipe away tear smeared makeup from public view.

A doctor explains the diagnosis articulately to camera. Six or more months into their rotation, the casualty officers know their emergency routines backwards. Despite being frighteningly young, they inspire confidence in the viewers. “That guy over there's had a heart attack. He's waiting for a porter to take him to coronary care.”

We zoom again, to an elderly man on a trolley, clammy with sweat and clutching a cotton sheet. A voiceover tells us his age, the area in which he lives, his ethnic origin, and that his wife is demented and his daughter distraught. At the end of the programme, the voiceover will tell us, with scripted compassion, that the man did not survive.

A bloke slipped on spiked railings trying to break into a pop festival. He's done a nasty to his bum. He talks to camera. “Stupid thing to do, wasn't it?” asks the interviewer while the man waits, attached to a morphine drip, for the surgeon to arrive. He is presented in somewhat comical terms—a bit of light relief from the serious cases.

Real drama, real ratings. The television-watching public, no longer entertained by fiction, demands a nightly menu of the abject, the gory, and the plain intrusive. Hospitals need to generate income, some desperately. Those featured in these fly-on-the-wall programmes presumably give what a lawyer would call consent, and they get a take-home memoir to show friends. Win-win all round, then.

The next patient whose private suffering becomes the nation's entertainment could be your mother or mine. Where is the ethical committee whose job it is to make the case for protecting the sick and vulnerable from these uncivilised incursions?
Overall survival is significantly higher in sarcoidosis than in IPF patients after lung transplantation
Authors: Hans Henrik Schultz, Claus Andersen, Daniel Steinbrüchel, Elisabeth Bendstrup, Michael Perch, Jørn Carlsen, Martin Iversen
Journal: European Respiratory Journal (2013)

Background 

Among the current indications for lung transplantation, Sarcoidosis represents 2.5% and idiopathic pulmonary fibrosis (IPF)25%. There are no specific selection criteria regarding lung transplantation for sarcoidosis patients and the criteria are generally assumed to be similar to IPF criteria. The purpose of this study was to compare outcome in lung transplant recipients transplanted for sarcoidosis and IPF.

Methods: 

Single center retrospective study from a national lung transplant center comprising all 620 lung transplants from 1992-2012 including all 25 patients with sarcoidosis and all 53 with IPF. Two IPF patients were excluded, one due to retransplantation, and one because of combined heart and lung transplantation.

Results: 

17 males and 8 females with pulmonary sarcoidosis were transplanted (8 single and 17 double lung transplantation).

38 males and 15 females with IPF were transplanted (26 single and 24 double lung transplantation).

Overall survival was significantly higher in sarcoidosis patients compared to IPF patients (p=0.042).

The estimated TLC of donor were the same (p=.744). Actual TLC of recipient prior to transplantation were lower in the IPF group (p=.009), and the Recipient/donor TLC ratio was lower in the IPF group (P=.008).

Conclusion: 

Patients with sarcoidosis have a significantly higher survival after lung transplantation than patients with IPF.This difference cannot be explained by numbers of acute rejections, recipient age, or estimated TLC in donors, but is due to frequent early deaths in the IPF group. This, seems to be correlated to a lower pretransplant TLC and a lower recipient/donor TLC ratio in the IPF recipients.
Bladder Cancer
Authors: Peter E. Clark, Neeraj Agarwal, Matthew C. Biagioli, Mario A. Eisenberger, Richard E. Greenberg, Harry W. Herr, Brant A. Inman, Deborah A. Kuban, Timothy M. Kuzel, Subodh M. Lele, Jeff Michalski, Lance C. Pagliaro, Sumanta K. Pal, Anthony Patterson, Elizabeth R. Plimack, Kamal S. Pohar, Michael P. Porter, Jerome P. Richie, Wade J. Sexton, William U. Shipley, Eric J. Small, Philippe E. Spiess, Donald L. Trump, Geoffrey Wile, Timothy G. Wilson, Mary Dwyer, Maria Ho
Journal: Journal of the National Comprehensive Cancer Network (2013)

Urothelial tumors represent a spectrum of diseases with a range of prognosis. After a diagnosis is established at any point within the urothelial tract, the patient remains at risk for developing a new lesion at a different or the same location and at a similar or more advanced stage. Continued monitoring for recurrence is an essential part of management, because most recurrences are superficial and can be managed endoscopically. Within each category of disease, more refined methods to determine prognosis and guide management, based on molecular staging, are under development with the goal of optimizing the individual patient's likelihood of cure and chance for organ preservation. For patients with more extensive disease, newer treatments typically involve combined-modality approaches, using recently developed surgical procedures, or three-dimensional treatment planning for more precise delivery of radiation therapy. Although these are not appropriate in all cases, they do offer the promise of an improved quality of life and prolonged survival. Finally, within the category of metastatic disease, a number of new agents have been identified that appear to be superior to those currently considered to be standard therapies. Experts believe, therefore, that the treatment of urothelial tumors will evolve rapidly over the next few years, with improved outcomes for patients at all stages of disease.
Changing hepatitis D virus epidemiology in a hepatitis B virus endemic area with a national vaccination program
Authors: Hsi‐Hsun Lin, Susan Shin‐Jung Lee, Ming‐Lung Yu, Ting‐Tsung Chang, Chien‐Wei Su, Bor‐Shen Hu, Yaw‐Sen Chen, Chun‐Kai Huang, Chung‐Hsu Lai, Jiun‐Nong Lin, Jaw‐Ching Wu
Journal: Hepatology (2015)

The emergence of hepatitis D virus (HDV) infection in the era of widespread HBV vaccination has not been described before. We aimed to investigate the changing epidemiology of HDV infection among high‐ and low‐risk populations after an outbreak of human immunodeficiency virus (HIV) infection among injection drug users (IDUs) in Taiwan. A prospective, multicenter, cohort study of 2,562 hepatitis B surface antigen (HBsAg)‐positive individuals was conducted to determine the prevalence, genotype, and risk factors of HDV infection from 2001 through 2012. The prevalence rates of HDV infection were 74.9%, 43.9%, 11.4%, 11.1%, and 4.4% among HIV‐infected IDUs, HIV‐uninfected IDUs, HIV‐infected men who have sex with men, HIV‐infected heterosexuals, and the general population of HBsAg‐positive subjects, respectively. A significant increase in the trend of HDV prevalence from 38.5% to 89.8% was observed in HIV‐infected IDUs (odds ratio = 3.06; 95% confidence interval: 1.68‐5.56; P = 0.0002). In multivariate analysis, injection drug use, hepatitis C virus infection, HIV infection, serum HBsAg level ≧250 IU/mL, duration of drug use, and older age were significant factors associated with HDV infection. HDV genotype IV (72.2%) was the prevalent genotype circulating among IDUs, whereas genotype II was predominant in the non‐IDU populations (73.3%). In the HIV cohort born after 1987 who were HBsAg negative, over half (52.9%) had antibody to hepatitis B surface antigen antibody levels of &lt;10 mIU/mL and there was a significantly higher HBsAg seroprevalence in the HIV cohort, compared to the control group (8.1% vs. 0.0%; P = 0.02). Conclusion : In the era of HBV vaccination, IDUs and HIV‐infected individuals have emerged as high‐risk groups and a reservoir for HDV infection. Effective strategies are needed to curb the reemerging epidemic of HDV infection in these high‐risk groups. (H epatology 2015;61:1870–1879)
Abstract MP26: Highly Sensitive Cardiac Troponin T is Associated with Cognitive Function and Incidence of Dementia
Authors: Andrea L Schneider, Andreea M Rawlings, A. R Sharrett, Alvaro Alonso, Thomas Mosley, Ron Hoogeveen, Christie M Ballantyne, Rebecca F Gottesman, Elizabeth Selvin
Journal: Circulation (2013)

Introduction: Clinical cardiovascular disease is a major risk factor for cognitive impairment and dementia, but less is known about the association of subclinical myocardial damage (measured by highly sensitive cardiac troponin T [hs-cTnT]) with cognition and dementia in the general population. Hypothesis: We hypothesized that higher levels of hs-cTnT would be associated with lower cognitive test scores and increased risk of dementia. Methods: We conducted cross-sectional (1996-1998) and prospective (follow-up through 2009) analyses of 8,601 participants in the ARIC Study without a history of cardiovascular disease or stroke. Cognition was measured by 3 tests: Delayed Word Recall (DWR), Digit Symbol Substitution (DSS), and Word Fluency (WF). Dementia was defined using ICD-9 codes. Linear regression and Cox proportional hazards models were adjusted for demographic, lifestyle, and cardiovascular factors. Results: 66% of participants had detectable hs-cTnT (≥0.003 μg/L) (mean age 63; 59% female; 20% black). In cross-sectional analyses, higher hs-cTnT was associated with lower scores on DSS (p-trend &lt;0.001) and WF (p-trend=0.002), but not DWR (p-trend=0.09) (Table). Similarly, hs-cTnT ≥0.014 μg/L (≥99th percentile) vs. &lt;0.014 μg/L was associated with lower scores on DSS (-1.78 points [95% CI: -2.61, -0.95]) and WF (-1.04 words [95% CI: -2.00, -0.07]), but not on DWR. Over a median of 12 years, there were 338 incident dementia cases. In prospective analyses, higher baseline levels of hs-cTnT were associated with increased dementia risk (p-trend &lt;0.001) (Table). Conclusion: Higher levels of hs-cTnT were associated with lower cognitive test scores at baseline and increased dementia risk during follow-up. Our results suggest that subclinical myocardial damage is associated with cognition and dementia. This association may be driven by shared risk factors for myocardial and cerebral injury or as a direct result of subclinical small vessel or cardiac disease; more work is needed to elucidate potential mechanisms.