tbuckley/cabot-search huggingface dataset:
Abstract 5164: Loss of SOCS3 Expression in T Cells Reveals a Regulatory Role for Interleukin-17 in Atherosclerosis
Authors: Soraya Taleb, Melissa Romain, Bhama Ramkhelawon, Catherine Uyttenhove, Gerard Pasterkamp, Olivier Herbin, Bruno Esposito, Nicolas Perez, Hideo Yasukawa, Jacques van Snick, Akihiko Yoshimura, Alain Tedgui, Ziad Mallat
Journal: Circulation (2009)

Atherosclerosis is an inflammatory vascular disease responsible for the first cause of mortality worldwide. Recent studies have clearly highlighted the critical role of the immuno-inflammatory balance in the modulation of disease development and progression. However, the immuno-regulatory pathways that control atherosclerosis remain largely unknown. Here, we show that loss of Suppressor of Cytokine Signaling 3 (SOCS3) in T cells increases both interleukin (IL)17 and IL10 production, induces an anti-inflammatory macrophage phenotype, and leads to unexpected IL17-dependent reduction in lesion development and vascular inflammation. In vivo administration of IL17 reduces endothelial vascular cell adhesion molecule (VCAM)-1 expression, vascular T cell infiltration and significantly limits atherosclerotic lesion development. In contrast, overexpression of SOCS3 in T cells reduces IL17 and accelerates atherosclerosis. We also show that in human lesions, increased levels of Stat3 phosphorylation and IL17 are associated with a stable plaque phenotype. These results identify novel SOCS3-controlled IL17 regulatory pathways in atherosclerosis and may have important implications to the understanding of the increased susceptibility to vascular inflammation in patients with dominant-negative STAT3 mutations and defective Th17 differentiation.
Hypertension treatment and control in sub-Saharan Africa
Authors: J. Burdon, R W Montgomery, R. Walker, N Unwin, K G M M Alberti, R. Cooper, W. Muna
Journal: BMJ (1998)

Editor—Cooper et al call for the inclusion of antihypertensive treatment among health priorities in sub-Saharan Africa.1 Assuming that the patient needs one drug to control his or her blood pressure and that compliance is good, they estimate that one death could be prevented at a cost of $1800 (£1130). 

Some patients need two or more drugs to control their hypertension, and compliance rates for chronic diseases in Africa are low for many reasons, including poverty, lack of access to health services, mobility of the population, and a lack of understanding of the nature of chronic disease. In the Republic of Congo patients arrive at a health centre to be cured. A doctor who can only control an illness is often seen as having failed, and the patient will then either try a new doctor or consult the local healer. 

The Centre Medical Evangelique runs an externally funded project for patients with epilepsy. The cost of the treatment is only $18-$24 (£11.70-£15.10) a year, and most patients see a considerable change in their condition. The programme is mobile to facilitate access. Despite this the average non-attendance at any consultation is about 40%. This figure is likely to be higher for a similar programme of antihypertensive treatment, because the patient often experiences no improvement in symptoms and may have side effects from the medicine prescribed. 

I think that Cooper et al’s figure of $1800 per life saved is optimistic. Even if accurate it means that antihypertensive treatment cannot rank alongside the provision of clean water, vaccination, and oral rehydration in terms of lives saved per unit cost. So what should be done for hypertension in sub-Saharan Africa? I believe we should treat patients with symptoms or complications, or both, as they are more likely to be compliant with treatment. We should also treat those who want to be treated and who understand the importance of continuing treatment. Doctors and other interested parties need to disseminate information to their communities about the nature and risks of hypertension. 

Finally, the authors do not mention the value of dietary salt restriction. This is cheap and particularly effective in African populations.2 Measures such as this would have a greater impact on the prevalence of hypertension in the African continent.
High CD34+ Cell Counts Decrease Hematologic Toxicity of Autologous Peripheral Blood Progenitor Cell Transplantation
Authors: Nicolas Ketterer, Gilles Salles, Michel Raba, Daniel Espinouse, Anne Sonet, Pierre Tremisi, Charles Dumontet, Isabelle Moullet, Assia Eljaafari-Corbin, Eve-Marie Neidhardt-Berard, Fadhela Bouafia, Bertrand Coiffier
Journal: Blood (1998)
Abstract 1248: Effects of Fenofibrate on Cardiovascular (CVD) Events in Patients with Type 2 Diabetes Mellitus (DM) after Adjustment for Statin Use and Other Drugs: the FIELD Study
Authors: John Simes, Merryn Voysey, Rachel O’Connell, James Best, Russell Scott, Paul Glasziou, Chris Pardy, Christian Ehnholm, Karen Byth, Anthony Keech
Journal: Circulation (2008)

The FIELD study randomised 9795 patients with DM to fenofibrate or placebo. Fenofibrate was associated with an 11% relative risk reduction (RRR) in total CVD events (hazard ratio [HR] 0.89, 95% CI 0.80 – 0.99; p=0.035) and a nonsignificant 11% reduction in the primary outcome, coronary events (coronary heart disease death or nonfatal myocardial infarction (MI)), (HR 0.89, 0.75–1.05; p=0.16), Lancet 2005 ; 366 ; 1849 –61 . However a greater uptake of other drugs, especially statins, among patients assigned placebo meant intention-to-treat effects of fenofibrate were attentuated. For patients who took other drugs, we assumed future CVD events were reduced by 25% by statins (based on randomised trial evidence), by 20% for a first other major CVD drug (antihypertensives, antiplatelets) and by 15% for additional CVD drugs. Fenofibrate effects were adjusted for uptake of other drugs by applying these estimates to each patient for the period from drug commencement. Fenofibrate effects were then also adjusted for those discontinuing fenofibrate ( adjusted for drop-out : Stat Med 1988 ; 7 : 1179 ). Among 4895 assigned fenofibrate average non-usage of the study drug over the 5 year trial period was 11%, while statin use was 8%. Among 4900 assigned placebo, statin use was 16%. There was a slightly greater use of other CVD drugs in the placebo group (1 to 3% extra). After adjustment for these additional therapies, statistical evidence of treatment benefit was stronger and the effect of fenofibrate on coronary and total CVD events was greater (table ). Further, the excess of CVD deaths associated with fenofibrate was reduced and remains consistent with a chance imbalance. Effects of fenofibrate on CVD events were underestimated in the original analysis. Adjusted results suggest a plausible 15% reduction of CVD events with fenofibrate. The methods used preserve comparisons between the randomised groups and are applicable to other long-term trials. Fenofibrate effects % Risk Redn (95% CI)
Abstract 1116: Atrial Fibrillation Patients At The Highest Risk Of Thromboembolism Have The Least Knowledge Of Warfarin Use
Authors: Megan B Smith, Nedra Christensen, Shiquan Wang, Jennifer Strohecker, Jeffrey L Anderson, Benjamin D Horne, John D Day, J. P Weiss, Brian G Crandall, Jeffrey S Osborn, J. B Muhlestein, Donald L Lappe, Heidi Moss, Jessica Oliver, Krista Viau, Thomas J Bunch
Journal: Circulation (2009)
Abstract 17436: Co-Existing Mitral Regurgitation in Significant Aortic Stenosis: Adverse Impact on Left Ventricular Geometry, Function and Patient Outcome
Authors: Praveen Mehrotra, Katrijn Jansen, Michael H Picard, Judy Hung
Journal: Circulation (2011)

Background: Mitral Regurgitation (MR) often co-exists with aortic stenosis (AS). The impact of MR on left ventricular (LV) parameters and prognosis in severe AS is unclear yet important for clinical decision-making. We sought to determine the effect of co-existing functional MR on LV remodeling, diastolic function, and mortality in patients (pts) with severe AS. Methods: Pts with severe AS (aortic valve area (AVA) &lt; 1.0 cm 2 ) and LVEF ≥ 55% were searched for in our echo database over 12 months. Primary mitral valve disorders (rheumatic and calcific mitral stenosis (mean gradient &gt;5 mmHg) and prolapse) were excluded. 43 pts with severe AS and co-existing ≥ moderate functional MR (+MR) were compared to 139 pts of similar age with severe AS but ≤ mild functional MR (-MR). Indexed end-diastolic (EDVi), end-systolic (ESVi), and left atrial (LAVi) volumes, LV mass, and diastolic function were measured by 2D and Doppler echo. Mortality was assessed by Social Security death index and adjusted for cardiac risk factors and covariates (Cox regression). Results: AVA (0.77 vs. 0.79 cm 2 , p=0.5) and mean aortic gradient (40 vs. 41 mmHg, p=0.5) were similar in both groups while the forward stroke volume index (SVi) (38 vs. 42 mL/m 2 , p=0.009) was lower in +MR. LV mass index (122 vs.103 gm/m 2 , p&lt;0.001), EDVi (57 vs. 53 mL/m 2 , p=0.05), and ESVi (19 vs.16 mL/m 2 , p=0.02) were higher in the +MR group. +MR pts also had a higher LAVi (62 vs. 42 mL/m 2 , p&lt;0.001), pulmonary artery systolic pressure (PASP) (47 vs. 40 mmHg, p&lt;0.001), E/E' ratio (18.6 vs. 15.7, p=0.02), and deceleration time (231 vs. 263 ms, p=0.007). Survival (follow-up of 2.6 yrs) was lower in +MR group (67 vs. 85%, HR 2.9 (95% CI: 1.3 - 6.6, p=0.009). Conclusions: Co-existing functional MR in pts with severe AS is associated with adverse LV remodeling, higher PASP and increased mortality. These observations may be due to simultaneous volume and pressure overload despite similar AS severity and have important implications for clinical-decision making.
Tackling health inequalities in primary care
Authors: J. Macleod, R. Loudon, D. Darvill, L. Smeeth, I. Heath
Journal: BMJ (1999)

Editor—Smeeth and Heath discuss how health inequalities might be tackled in primary care.1 We endorse their views on the importance of accurate measurement of social position and their reminder that it is people who are most at risk of serious disease who have most to gain from effective medical interventions.2

The authors emphasise the assessment of socioeconomic factors in individual consultations. Although this may sometimes be important, in general it is not the main issue, and their suggestion of yet another task to be completed in an already crowded agenda may put some people off. The recording of accurate, useful data on social position need not involve general practitioners directly at all and can be recorded at registration.

Occupational class and place of residence are not fixed, and some social mobility is now a feature of society in the United Kingdom.3 It should be sufficient, however, simply to ask patients to inform the practice of changes in their address or employment–as most general practices do now. The main use of such information is not to guide the treatment of individuals but to allow rational resource allocation at practice or primary care group level. Poorer people experience more serious disease in their shorter lives than their more affluent counterparts, which has implications for doctors who work with them. These issues have been considered in detail in relation to child health.4

Imprecision in the measurement of the material circumstances that a person experiences has probably led to dilution of estimates of the health consequences of these circumstances. In other words, we could improve our descriptions of health inequalities and when we do they will probably be even more striking than they are at present. Description of a problem is important but so is exploration of a solution. We hope that the bigger role for primary care lies in exploring a solution–through advocacy, rational and equitable delivery of effective interventions, and political lobbying.
Abstract 12269: Health Care Insurance Status and Cardiac Performance Measure Compliance: Insights from the ACC's NCDR PINNACLE Registry
Authors: Kim G Smolderen, John A Spertus, Fengming Tang, William Oetgen, William B Borden, Henry H Ting, Paul S Chan
Journal: Circulation (2010)

Background: While lack of health insurance affects access to outpatient care, the association of health insurance and receiving evidenced-based treatment among outpatients with coronary artery disease (CAD) and heart failure (HF) in not known. Methods: Within the ACC's Practice Innovation And Clinical Excellence (PINNACLE) program, we identified 136,204 cardiac patients with an index outpatient visit from over 26 US practices between January 1, 2009 and December 31, 2009. Using modified Poisson regression, we compared compliance rates for 6 ACC/AHA performance measures related to CAD and HF medications by patients' insurance status (insured vs. not insured). Results: Of 136,204 patients, 8278 (6%) patients were uninsured and 127,695 (94%) patients were insured. Uninsured patients with CAD were 4%, 7%, and 15% less likely to receive treatment with B-blocker, lipid lowering, and anti-platelet therapy, respectively, than insured patients (Table). However, much of the disparity in lipid lowering and anti-plat...
Abstract 12986: The Neutrophil/lymphocyte Ratio is a Factor for Predicting Concomitant Coronary Artery Disease in Patients with Abdominal Aortic Aneurysms
Authors: Akira Funayama, Tetsu Watanabe, Shinpei Kadowaki, Taro Narumi, Yuki Honda, Yoichiro Otaki, Hiromasa Hasegawa, Shintaro Honda, Satoshi Nishiyama, Hiroki Takahashi, Takanori Arimoto, Tetsuro Shishido, Takehiko Miyashita, Kiyoharu Sakurai, Takuya Miyamoto, Isao Kubota
Journal: Circulation (2013)

Background: Abdominal aortic aneurysm is a progressive atherosclerotic condition, and it is not unusual to find such aneurysms accompanied by coronary artery disease (CAD). CAD is considered a seri...
Antidepressant pharmacotherapy of depression associated with multiple sclerosis
Authors: R B Schiffer, N M Wineman
Journal: American Journal of Psychiatry (1990)

In a double-blind clinical trial involving 28 patients with multiple sclerosis and major depressive disorder, 14 patients were randomly assigned to a 5-week trial of desipramine and individual psychotherapy and 14 to placebo plus psychotherapy. Clinical judgments indicated that patients treated with desipramine improved significantly more than the placebo group. This was confirmed by scores on the Hamilton Rating Scale for Depression but not by Beck Depression Inventory scores. Side effects limited desipramine dosage in half of the treated patients. The authors conclude that desipramine has a modest beneficial effect in serious depression associated with multiple sclerosis but that side effects may be more of a limiting factor than in patients without medical or neurologic disease.
Association of Epicardial Fat With Cardiovascular Risk Factors and Incident Myocardial Infarction in the General Population
Authors: Amir A. Mahabadi, Marie H. Berg, Nils Lehmann, Hagen Kälsch, Marcus Bauer, Kaffer Kara, Nico Dragano, Susanne Moebus, Karl-Heinz Jöckel, Raimund Erbel, Stefan Möhlenkamp
Journal: Journal of the American College of Cardiology (2013)
Abstract 2713: Comparison of MRI Myocardial Tissue Tagging and Tissue Doppler Imaging for Assessment of Mechanical Dyssynchrony
Authors: Kenneth C Bilchick, Robert H Helm, Kristy L Kessler, Gail Hefter, Anne R Capriotti, Daniel P Judge, Stuart Russell, Nael F Osman, Theodore Abraham, Albert C Lardo
Journal: Circulation (2007)

Background: Echocardiographic (EC) indices of mechanical dyssynchrony (MD) are based largely upon longitudinal strain, whereas magnetic resonance imaging myocardial tissue tagging (MRI-MT) assessment is based on circumferential strain, the latter being the primary direction of myocardial contraction. Methods: We sought to compare cardiac MRI studies with an EC protocol using 2D imaging, tissue Doppler imaging (TDI), and M-mode in 32 subjects. Absolute strain, time to peak strain in 6 segments, TDI septal-to-lateral delay (SLD; MD if ≥ 70 ms), and M-mode septal-to-posterior wall motion delay (SPWMD; MD if ≥ 130 ms) were measured and compared to the MRI-MT-based CURE (circumferential uniformity ratio estimate, CURE; 0 –1, 0 = asynchrony, 1 = perfect synchrony; MD if &lt; 0.75), which recently has been shown to predict clinical CRT response. Results: The 8 control subjects (normal QRSd; CURE 0.975 ± 0.01; SLD 26 ± 27 ms) had less MD by MRI-MT (p = 0.0001) and TDI (p = 0.04) as compared to 24 subjects with ejection fraction ≤ 35% (QRSd 135 ≤ 35 ms; CURE 0.695 ± 0.17; SLD 59 ± 39 ms). There was a moderate correlation between TDI and MRI-MT (R = 0.62), with a discordance rate of 22% overall and 25% in cardiomyopathy subjects, in some cases due to abnormal CURE with normal SLD and, in others, normal CURE with abnormal SLD. The M-mode assay (SPWMD) could not be assessed in 10 patients with septal akinesis (AK), although there was MD by TDI and MRI-MT in most of these subjects. In the patients without AK, the discordance rate between TDI and M-mode was 33%. Conclusions: MRI-MT assessment of circumferential strain and MD is complementary to TDI with a good correlation, but also a significant discordance rate.
Abstract 20570: Left Ventricular Deformation by 2-D Speckle Tracking Echocardiogram for the Diagnosis of Acute Myocarditis With Preserved LV Ejection Fraction
Authors: Ju-Feng Hsiao, Crystal R Bonnichsen, Yuki Koshino, Haydar K Saleh, Yang Yu, Patricia A Pellikka, Fletcher A Miller, Leslie T Cooper, Hector R Villarraga
Journal: Circulation (2010)
Abstract 2503: Emerging Roles of Coronary Vasospasm and Ventricular Fibrillation in the Pathogenesis of Out-of-Hospital Cardiac Arrest
Authors: Yusuke Takagi, Satoshi Yasuda, Jun Takahashi, Morihiko Takeda, Masaharu Nakayama, Kenta Ito, Masanori Hirose, Yuji Wakayama, Koji Fukuda, Hiroaki Shimokawa
Journal: Circulation (2009)
Clinical course of alcoholism in 636 male inpatients
Authors: M A Schuckit, T L Smith, R Anthenelli, M Irwin
Journal: American Journal of Psychiatry (1993)

This study was undertaken to determine the relative order of appearance of symptoms in alcohol dependence.The age at which 21 alcohol-related major life events first occurred was investigated in 636 male alcohol-dependent inpatients through a standardized, structured personal interview with each subject and at least one resource person.A general pattern of first occurrence of these events was observed. Heavy drinking escalated further when the subjects were in their late 20s, followed by evidence of interference with functioning in multiple life areas in the early 30s, a subsequent perception of loss of control, and then an intensification of social and job-related problems, along with evidence of deterioration in body systems, in the mid- to late 30s. Similar patterns of problems emerged when the alcoholic subjects were divided into subgroups based on onset of alcohol dependence before or after age 30, presence or absence of a family history of alcoholism, and presence or absence of additional psychiatric disorders.These data indicate that there is a typical progression of events related to alcohol dependence. This information can be useful for clinicians in their work with patients and for teachers and researchers as well.
Report Reviews Secondhand Smoke Risks
Authors: Bridget M. Kuehn
Journal: JAMA (2006)

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Abstract 15340: Dispatcher-Assisted Cardiopulmonary Resuscitation and Favorable Neurological Outcome in Cardiac Arrest
Authors: Kei Nishikawa, Ken Nagao, Tukasa Yagi, Eizo Tachibana, Asuka Kasai, Naohiro Yonemoto, Morimasa Takayama, Shinichi Shirai, Hiroshi Nonogi, Takeshi Kimura
Journal: Circulation (2012)

BACKGROUND The AHA 2010 guidelines for cardiopulmonary resuscitation (CPR) recommended that dispatchers should assertively provide telephone CPR instructions to rescuers for patients with suspected...
Abstract 2381: Aneurysmal Subarachnoid Hemorrhage: Metabolic and Blood Flow Patterns
Authors: parham moftakhar, Thomas C Glenn, John Boscardin, Neil A Martin
Journal: Circulation (2007)

Objective: The purpose of this study is to classify and describe the clinically distinct metabolic and hemodynamic phases post-ASAH. Methods: 224 patients who suffered an ASAH (mean age 55±14; 74% female, 26% male) were examined. Patients underwent daily transcranial Doppler (TCD) and cerebral blood flow (CBF) studies (using 133 Xe clearance). Due to the paucity of data on post-hemorrhage day (PHD) 0, the internal carotid artery end-diastolic (ICA ED ) velocity, a surrogate for CBF, was used for the first 24 hours. The brain arteriovenous oxygen difference (AVDO 2 ) was recorded for each patient and the cerebral metabolic rate of oxygen (CMRO 2 ) was calculated. Clinical outcome was evaluated based on the Glasgow Outcome Scale (GOS) 6 months after rupture. Results: Following ASAH, 3 distinct hemodynamic phases arose for the entire study population. Phase I (hypoperfusion phase), occurs on the day of rupture (PHD 0) and is defined by a low ICA ED velocity (mean 17.8±1.1 cm/s), normal middle cerebral artery (MCA) velocity (mean V MCA 58.0±23.4 cm/s), and normal Lindegaard Ratio ([LR], mean 1.66±0.50). Phase II (relative hyperemia), (PHD 1–3), is characterized by an increasing ICA ED (mean 35.4±1.0 cm/s, p&lt;0.0001), a relative hyperemia (mean CBF 15 40.1±1.5 ml/100g/minute, CMRO 2 1.17±0.41 ml/100g/min), a rising V MCA (mean 71.5±5.8 cm/sec, p&lt;0.0001), and a rising but normal LR (mean 2.21±0.19, p&lt;0.0001). During phase III (vasospasm phase, PHD 4–21), both the ICA ED and CBF decrease (mean ICA ED 19.9±0.9 cm/s, p&lt;0.0001; mean CBF 15 36.8±0.7 ml/100g/minute, p=0.04), V MCA continues to rise (mean 107.6±2.9cm/sec, p&lt;0.0001), and the LR is further increased (mean 3.25±0.08, p&lt;0.0001). The CMRO 2 remains low (mean 1.17±0.40 ml/100g/min, p=1). Based on the GOS up to 90% of patients who experienced either a relative or absolute hyperemia had good outcomes. Conclusions: After an ASAH, 3 discrete metabolic and hemodynamic phases arise each with the potential for its own unique phase-specific management and therapy. Relative hyperemia, or “luxury perfusion,” during Phase II in the setting of non-elevated ICPs may provide some type of benefit for patients.
Preliminary data on DSM-III associated features of major depressive disorder in children and adolescents
Authors: Geller B, Chestnut Ec, Miller, Price Dt, Yates E
Journal: American Journal of Psychiatry (1985)

Fifty-nine subjects 5-16 years old with major depressive disorder were assessed for the presence of separation anxiety and antisocial behavior, mentioned in DSM-III as associated features of the disorder in children and adolescents. The findings of the study support the existence of these associated features.