tbuckley/cabot-search huggingface dataset:
Excessive daytime sleepiness in patients with metabolic syndrome
Authors: Adel Salah Bediwy, Amr M. El-Sherbini, Nashwa Noor
Journal: European Respiratory Journal (2014)

Background: Metabolic syndrome is a medical disorder that predispose to cardiovascular diseases. Excessive daytime sleepiness (EDS) is a common finding in patients with metabolic syndrome. Aim: To assess the presence of EDS in subjects with metabolic syndrome and to find its correlations with apnea hypopnea index (AHI), Hamilton depression rating score (HDRS), body mass index (BMI), age and fasting plasma glucose (FPG). Method: 76 patients with metabolic syndrome were evaluated for EDS by Epworth sleepiness score (ESS) and for sleep apnea by polysomnography. Results: 22 subjects (28.9%) had EDS, 37 subjects (48.7%) had sleep apnea and 35 subjects (46.05%) had depression. ESS showed no significant correlation with AHI while it showed significant positive correlations with each of HDRS, BMI, age and FPG. Conclusions: Other explanations of EDS in subjects with metabolic syndrome can be related to obesity, depression, or diabetes rather than to sleep apnea. Subjects with metabolic syndrome should be screened for sleep apnea regardless of EDS.
Resilient adolescents whose parents have serious affective and other psychiatric disorders: importance of self-understanding and relationships
Authors: W R Beardslee, D Podorefsky
Journal: American Journal of Psychiatry (1988)

Eighteen young men and women whose parents had major affective disorders, often in combination with other serious psychiatric disorders, were selected from a larger sample on the basis of their good behavioral functioning as adolescents at initial assessment. When they were reassessed an average of 2 1/2 years later, 15 of the 18 were still functioning well. Considerable self-understanding, a deep commitment to relationships, and the ability to think and act separately from their parents characterized these young people. Many of them were taking care of their ill parents. The implications of these findings for preventive and clinical intervention are discussed.
Late-breaking abstract: Cardiac function in a revascularized coronary artery disease cohort with obstructive sleep apnoea with and without daytime sleepiness in the RICCADSA trial
Authors: Yuksel Peker, Helena Glantz, Erik Thunstrom, Bjorn Cederin, Johan Herlitz, Jan Ejdeback
Journal: European Respiratory Journal (2011)

Objectives:  The RICCADSA study is a randomized, controlled trial started in 2005 addressing the impact of CPAP in revascularized coronary artery disease (CAD) patients and concomitant OSA (Apnoea-Hypopnoea-Index [AHI]≥15/h) without daytime sleepiness (Epworth Sleepiness Scale    Participants and methods:  Among 660 screened CAD patients, 511 (399 OSA, 112 non-OSA) have been assessed by echocardiography and p-NT proBNP at baseline.   Results:  Compared to non-OSA subjects, patients with OSA had thicker interventricular septum and left ventricular posterior wall, enlarged left atrium and more diastolic dysfunction. Left ventricular ejection fraction was similar (56.9 vs 58.3%; ns). P-NTproBNP values were higher in the OSA patients (484.4 vs 332.5 ng/L; p=0.040). Within the OSA group, none of the echocardiographic measures differed significantly between sleepy and non-sleepy OSA subjects. However, p-NT proBNP values were higher (578.9 vs 336.7 ng/L; p=0.002) in the non-sleepy OSA subjects.   Conclusions:  In this RICCADSA cohort, adverse alterations in cardiac structure as well as diastolic dysfunction were more common and p-NT-proBNP values increased in OSA patients compared to non-OSA patients. Whether the more elevated p-NT-proBNP values in the non sleepy subjects reflect a poorer prognosis and if CPAP is effective in OSA patients remain to be demonstrated when the trial is completed.
Abstract 12437: Prediction of Mitral Regurgitation Progression With Advanced Ischemic Cardiomyopathy - A Multi-Modality Study
Authors: Kenya Kusunose, Nancy Obuchowski, Joao Cavalcante, Rayji S Tsutsui, Zoran B Popovic, James D Thomas, Milind Y Desai, Scott D Flamm, Brian P Griffin, Deborah H Kwon
Journal: Circulation (2014)

Introduction: Ischemic mitral regurgitation (IMR) is associated with poor outcomes. Determining risk for the presence and progression of IMR may be critical for risk stratification. Hypothesis: We hypothesize that a multi-modality approach can evaluate the progression of IMR in patients with advanced ischemic cardiomyopathy (ICM) and create a risk model for the prediction of IMR progression. Methods: Consecutive ICM patients who underwent cardiac magnetic resonance (CMR) and echocardiograms at baseline with echocardiographic follow-up were included. CMR was used to assess global and regional left ventricular (LV) remodeling, myocardial scarring, and mitral valve geometry. The effective regurgitant orifice area (EROA) was calculated from the proximal isovelocity surface area by echocardiography. We identified the best performing model for prediction of worsening IMR based on the c-index. Results: We evaluated 693 patients (age 62±11). The following factors were independently predictive of an increased EROA at baseline (n=693): higher total scar% (p=0.002) and higher ESVi (p&lt;0.001). In regards to progression of IMR over time, the following variables were independently predictive (n=481): older age (p=0.015), lower GFR (p&lt;0.001), higher EROA at baseline (p&lt;0.001), lower tenting area (p=0.008), higher ESVi (p=0.001), and the interaction of total scar % and treatment type (medical vs revascularization vs valve surgery, Figure) (p=0.001). The c-index for worsened IMR prediction for the ICM was 0.730 from our training sample (n=164). Conclusions: The variables which predict IMR at baseline and progression of IMR over time slightly differ. Higher total scar% and higher ESVi are independently associated with increasing IMR at baseline. However, higher EROA at baseline, lower tenting area, higher ESVi and total scar% * treatment type were associated with progression of IMR over time. The risk model of IMR progression was moderately predictive in this cohort.
Psychosocial functioning in children after the death of a parent
Authors: M A Fristad, R Jedel, R A Weller, E B Weller
Journal: American Journal of Psychiatry (1993)

Eight weeks after the death of a parent, children from stable families (N = 38) were compared to depressed inpatients (N = 38) and normal children (N = 19). School behavior, interest in school, peer involvement, peer enjoyment, and self-esteem were similar for bereaved and normal children. Bereaved children functioned significantly better than depressed inpatients. As a group, the bereaved children from stable families did not experience significant, acute psychosocial dysfunction.
Synergistic Effects of IL-12 and IL-18 in Skewing Tumor-Reactive T-Cell Responses Towards a Type 1 Pattern
Authors: Qiao Li, Abbey L. Carr, Elizabeth J. Donald, Joseph J. Skitzki, Ryugi Okuyama, Lloyd M. Stoolman, Alfred E. Chang
Journal: Cancer Research (2005)

Abstract We have previously described the antitumor reactivity of tumor-draining lymph node (TDLN) cells after secondary activation with antibodies. In this report, we examined the effects of interleukin (IL)-12 and IL-18 on modulating the immune function of antibody-activated murine TDLN cells. TDLN cells were activated with anti-CD3/anti-CD28 monoclonal antibody followed by stimulation with IL-12 and/or IL-18. IL-18 in combination with IL-12 showed a synergistic effect in augmenting IFNγ and granulocyte macrophage colony-stimulating factor secretion, whereas IL-18 alone had minimal effect. Concurrently, IL-18 prevented IL-12–stimulated TDLN cells from producing IL-10. The IL-12/IL-18–cultured TDLN cells therefore manifested cytokine responses skewed towards a Th1/Tc1 pattern. IL-12 and IL-18 stimulated CD4+ TDLN cells and enhanced IFNγ production by CD4+ cells to a greater extent than by CD8+ cells. Use of NF-κB p50−/− TDLN cells suggested the involvement of NF-κB in the IL-12/IL-18 polarization effect. Furthermore, a specific NF-κB inhibitor significantly suppressed IL-12/IL-18–induced IFNγ secretion, thus confirming the requirement for NF-κB activation in IL-12/IL-18 signaling. In adoptive immunotherapy, IL-12– and IL-18–cultured TDLN cells infiltrated pulmonary tumor nodules and eradicated established tumor metastases more efficiently than T cells generated with IL-12 or IL-18 alone. Antibody depletion revealed that both CD4+ and CD8+ cells were involved in the tumor rejection induced by IL-12/IL-18–cultured TDLN cells. These studies indicate that IL-12 and IL-18 can be used to generate potent CD4+ and CD8+ antitumor effector cells by synergistically polarizing antibody-activated TDLN cells towards a Th1 and Tc1 phenotype.
Abstract 17182: Long-term Prognosis in Patients with Type 1 and Type 2 Diabetes Mellitus after Coronary Artery Bypass Grafting
Authors: Martin Holzmann, Björn Rathsman, Jeanette Kuhl, Thomas Nyström, Ulrik Sartipy
Journal: Circulation (2014)

Introduction:  Patients with diabetes mellitus (DM) have an increased risk of adverse outcomes after coronary artery bypass grafting (CABG). Prior studies in patients with DM have reported prognosis in relation to treatment with insulin or not, and not in relation to type of DM. The prognosis after CABG in patients with type 1 or type 2 diabetes mellitus (DM1 or DM2) is not known.   Methods:  We included all patients who underwent primary isolated CABG in Sweden during 2003 through 2013 from the SWEDEHEART register, and the Swedish National Diabetes Register identified patients with DM1 or DM2. Cox proportional hazards regression was used to calculate hazard ratios (HR) with 95% confidence intervals (CI) for all-cause mortality in patients with DM1 or DM2 compared with no diabetes mellitus.   Results:  In total 36 035 patients underwent primary isolated CABG during the study period, of whom 628 (1.7%) had DM1, and 7544 (21%) had DM2. Patients with DM1 were younger (59 vs. 67 years), and had reduced kidney function (31% vs 24%), and peripheral vascular disease (21% vs 11%) more often than patients with DM2 or no diabetes. During a mean follow-up time of 5.8 (±3.1) years (210 228 person-years) in total 5980 (17%) died of whom 122 (19%) had DM1, and 1385 (18%) had DM2. The age-adjusted estimated survival is shown in Figure 1. After multivariable adjustment for age, sex, chronic obstructive pulmonary disease, peripheral vascular disease, renal function, and left ventricular ejection fraction HRs with 95% CI for death in patients with DM1, and DM2, compared with patients without diabetes were 2.17 (1.79 to 2.62), and 1.17 (1.10 to 1.25), respectively.   Conclusions:  Patients with DM1 had a more than doubled long-term risk of death compared with patients without diabetes after CABG. The long-term risk of death in patients with DM2 was only slightly increased.  Figure 1. Cox age-adjusted survival in 36 035 patients who underwent primary isolated CABG in relation to Type 1, Type 2 or no diabetes mellitus.
Identification of intramural epithelial networks linked to peribiliary glands that express progenitor cell markers and proliferate after injury in mice
Authors: Frank DiPaola, Pranavkumar Shivakumar, Janet Pfister, Stephanie Walters, Gregg Sabla, Jorge A. Bezerra
Journal: Hepatology (2013)

Peribiliary glands (PBGs) are clusters of epithelial cells residing in the submucosal compartment of extrahepatic bile ducts (EHBDs). Though their function is largely undefined, they may represent a stem cell niche. Here, we hypothesized that PBGs are populated by mature and undifferentiated cells capable of proliferation in pathological states. To address this hypothesis, we developed a novel whole-mount immunostaining assay that preserves the anatomical integrity of EHBDs coupled with confocal microscopy and found that PBGs populate the entire length of the extrahepatic biliary tract, except the gallbladder. Notably, in addition to the typical position of PBGs adjacent to the duct mucosa, PBGs elongate and form intricate intramural epithelial networks that communicate between different segments of the bile duct mucosa. Network formation begins where the cystic duct combines with hepatic ducts to form the common bile duct (CBD) and continues along the CBD. Cells of PBGs and the peribiliary network stain positively for α-tubulin, mucins, and chromogranin A, as well as for endoderm transcription factors SRY (sex determining region Y)-box 17 and pancreatic and duodenal homeobox 1, and proliferate robustly subsequent to duct injury induced by virus infection and bile duct ligation. Conclusion : PBGs form elaborate epithelial networks within the walls of EHBDs, contain cells of mature and immature phenotypes, and proliferate in response to bile duct injury. The anatomical organization of the epithelial network in tubules and the link with PBGs support an expanded cellular reservoir with the potential to restore the integrity and function of the bile duct mucosa in diseased states. (Hepatology 2013;58:1486–1496)
Abstract 3434: The Role Of Notch Signaling In The Adult Myocardium: Control Of Myocyte Hypertrophy And Differentiation
Authors: Mohamed Nemir, Mario Lepore, Adrien Croquelois, Andrea Domenighetti, Freddy Radtke, Thierry Pedrazzini
Journal: Circulation (2008)

Background . Notch signaling is essential during development and in homeostasis of several organ systems. Mutations in Notch genes cause cardiac malformations. However the role of this pathway in the adult heart has not been addressed. Methods . We investigated Notch signaling in models of cardiac hypertrophy and failure. Notch activation was analyzed by immunostaining and quantitative RT-PCR. Cardiac response to stress was investigated in mice lacking Notch1 in the heart and in transgenics overexpressing Jagged1 in the myocardium. Results . The wild-type heart responded to hemodynamic stress by an upregulation of the Notch ligand Jagged1 on cardiac myocytes and an activation of Notch1. Immunostaining showed that Notch1 activation occurred predominantly in cardiomyocytes. Nkx2.5- and GATA4-positive cardiac precursor cells also activated Notch. In cultured cardiomyocytes, Notch signaling interfered with terminal differentiation. In vitro, proliferating Nkx2.5-positive precursor cells displayed intense NIC staining. Under differentiation conditions, these cells downregulated the Notch pathway and produced cardiomyocytes. Pharmacological inhibition of the Notch pathway in vivo exacerbated cardiac hypertrophy and was detrimental to the adaptive response of the heart to stress. Similarly, mice with cardiac-specific deletion of Notch1 exhibited cardiac fibrosis, impaired cardiac function and decreased survival. To investigate the effects of chronic Notch activation in the heart, we generated transgenics with cardiac Jagged1 overexpression. A large proportion (40 –50%) of these mice demonstrated atrial enlargement, impairment of ventricular function, and die at 3 months of age. Conclusions . Notch signaling is crucial for maintaining cardiac integrity in the adult mammalian heart. Activation of the Notch pathway relies on stimulated Jagged1 expression. In cardiomyocytes, Notch regulates the extent of the hypertrophic response and probably contributes to cell survival. In cardiac precursors, Notch controls cardiogenic differentiation. Importantly, both chronic inhibition and activation are detrimental to cardiac function, suggesting that fine tuning of Notch signaling in the heart is mandatory for proper cardiac homeostasis.
Principles and Problems of Ischemic Heart Disease.
Authors: Edward Shapiro
Journal: Annals of Internal Medicine (1968)

benign vs. early myelGema are discussed.The author leans heavily on maintenance of a stable level of gamma- globulin for diagnosis of benign disease.The book in- cludes discussions on the concept of autoimmune diseases, the entity of purpurahypergammaglobulinemia and ma- lignant disease in general.The latter subject is again treated anecdotically and as such is more interesting for its speculations than for its hard data.The book is of interest primarily to internists and those physicians who see numbers of patients with ma- lignant disorders.It is worth reading particularly for the enjoyment of traveling through the years of observation and thinking of this monumental physician.
Polymyalgia rheumatica in primary care: managing diagnostic uncertainty:
Authors: Rammya Mathew, Ahmed Rashid
Journal: BMJ (2015)

A 78 year old white woman presented with a six week history of bilateral shoulder stiffness and pain. Stiffness was the main symptom—it was so severe that she could not dress herself or brush her hair. She also had constitutional features including anorexia, weight loss, and profound lethargy. She was a smoker with a 30 pack year history. Initial blood tests showed markedly raised inflammatory markers, with an erythrocyte sedimentation rate of 98 mm in the first hour (reference range 0-12) and C reactive protein of 933 nmol/L (0-47.6). A diagnosis of polymyalgia rheumatica was considered. 



### 1. What other differential diagnoses need to be considered?

#### Short answer

Given her symptoms, risk factors, and raised inflammatory markers, underlying cancer must be excluded. Other differential diagnoses include inflammatory polyarthropathy, vasculitis, and drug induced or autoimmune myositis.

#### Discussion

Several conditions can mimic polymyalgia rheumatica (table⇓).

View this table:

Polymyalgia rheumatica mimics



Because of the patient’s smoking history, the presence of constitutional features, and the reported weight loss, it is essential to rule out underlying cancer. Pain in the shoulders could be secondary to myeloma, bony metastases, or secondary hypercalcaemia. Given her age and demographic, important primary cancers to consider are lung and breast cancer.

Polymyalgic syndrome also overlaps with other inflammatory disorders including late onset rheumatoid arthritis, which tends to present symmetrically, with pain and swelling in the small joints of the hands and feet, and less commonly in the larger joints.1 Seronegative arthropathy is also a possibility, but it usually affects younger patients.2 A late onset variant …
Onset of adolescent eating disorders
Authors: N. Stettler, A. M Tershakovec, M. B Leonard, G C Patton
Journal: BMJ (1999)

Editor—Patton et al reported a positive association between dieting and the development of eating disorders in adolescents.1 A causal effect of dieting on the development of these serious psychiatric conditions was implied in the conclusion. We believe, however, that the data presented did not support the suggested causal effect.2

Unlike in a randomised clinical trial, in a cohort study the participants select themselves; in this case the exposure of interest was dieting. Participants at risk of developing eating disorders may have been more likely to expose themselves to dieting. To avoid bias the exposed and unexposed participants in a cohort study should be similar for other important determinants of outcome.3 There is no evidence that this was true in this study. In fact, after adjustment for psychiatric disorders at baseline the hazard ratio of severe dieting decreased threefold, which suggests that the exposed and unexposed groups differed for other, unadjusted, factors.

In a cohort study the participants must be free of the disease at inclusion.3 Although the 37 incident cases may not have displayed, at baseline, all the signs necessary for the diagnosis of an eating disorder, some of those who were on a diet at the beginning of the study may actually have been in the early stages of an eating disorder; dieting might be an early, non-specific sign of later development of eating disorders and not a cause.

Although some of these points were raised in the discussion, the conclusion and key messages emphasised that adolescents who diet are at increased risk of developing an eating disorder. We agree that inappropriate dietary behaviours should be discouraged; given the global epidemic of obesity, the importance of promoting a healthy lifestyle, including weight control by a reasonable diet and exercise, should be emphasised for all adolescents.
Abstract MP03: Epidemiology of Hospitalized Heart Failure Patients with Preserved Ejection Fraction: The ARIC Heart Failure Surveillance Project
Authors: Sunil K Agarwal, Xiaoxi Liu, Lisa M Wruck, Patricia P Chang, Stuart D Russell, Anita Deswal, Amil Shah, Ervin Fox, Dalane Kitzman, Scott D Soloman, Josef Coresh, Gerardo Heiss, Wayne Rosamond
Journal: Circulation (2013)

Background Despite the high burden of heart failure with preserved ejection fraction (HFpEF), information about its epidemiology is limited. We describe the population distribution of HFpEF according to criteria commonly used to ascertain heart failure (HF) and compare the characteristics and outcomes of patients with HFpEF to those with HF with reduced ejection fraction (HFrEF). Methods From the Atherosclerosis Risk in Communities (ARIC) HF surveillance of 21 hospitals in four US communities during 2005-2008, potential HF events were sampled based on ICD discharge codes from patients ages 55 years and older, . Trained study personnel abstracted charts (unweighted n =4784), and the presence of HF was determined both by computerized classification and by a panel of standardized physicians. Left ventricular ejection fraction (EF) was missing in 19%; HFpEF was defined as HF with EF ≥ 50%. All statistical analyses incorporated sampling weights. A multivariable logistic model of the probability of HFpEF was developed using variables associated with HFpEF in univariate analyses (p&lt;0.2). Results The proportion of the hospitalized HF patients with HFpEF varied only slightly according to HF classification schema: NHANES (49%), Modified Boston (48%), Framingham (47%), ‘2008 Consensus criteria’ (44%), and ARIC review panel (43%). The following characteristics were independently associated with HFpEF (Odds Ratio and 95% Confidence Interval): female (2.28; 1.87, 2.82), history of sleep apnea (1.90; 1.30, 2.77), systolic blood pressure (1.08; 1.05, 1.12) per 10 mm of Hg increase), atrial fibrillation (1.29 (1.03, 1.61), heart rate (0.91; 0.87, 0.95 per 10 beats per minute increase), paroxysmal nocturnal dyspnea (0.70; 0.54, 0.92), and study community. Length of hospital stay was comparable for HFpEF and HFrEF patients (median = 5 days, p for geometric mean = 0.76). Absolute mortality at one-year was 4.4% lower among HFpEF compared to HFrEF (12.3% vs. 16.7%, p&lt;0.05) with age, gender, and race adjusted case fatality OR= 0.75 (95% CI 0.56, 0.99). Conclusions The proportion of patients with HFpEF among HF patients hospitalized in 2005-2008 varied from 43 to 49% according to the main published HF classification schema. HFpEF patients had a similar length of hospital stay but lower one-year case fatality than those with HFrEF. These results support increasing efforts to better characterize HFpEF and its course to reduce the total burden of HF.
Spontaneous ejaculation associated with anxiety: psychophysiological considerations
Authors: D. E. Redmond, Thomas R. Kosten, M. F. Reiser
Journal: American Journal of Psychiatry (1983)

The association of anxiety with sexual excitement has been noted since the early part of this century. The authors present case reports of a schizophrenic and a neurotic patient in whom no direct sexual precipitants of spontaneous ejaculation could be identified but in whom severe anxiety was evident. The central noradrenergic neurophysiology that anxiety may share with sexual excitement could provide a basis for spontaneous ejaculation during anxiety. The pharmacology of spontaneous ejaculation during opiate withdrawal is used to elaborate this central noradrenergic model.
Comparison of quality of life (QOL) of patients with acute myelogenous leukemias (AML) in long-term first complete remission (CR) after bone marrow transplantation (BMT) - Allogeneic or autologous - Or intensive chemotherapy consolidation (ICC): EORTC-GIMEMA AML 8A study
Authors: R Zittoun, Stefan Suciu, G Solbu, M. Watson, P. Muus, F. Mandelli, P. Stryckmans, M Peetermans, J Thaler, R. Willemze
Journal: Blood (1995)