tbuckley/cabot-search huggingface dataset:
Abstract 17180: Longitudinal Dissociation in the His Bundle: Persistent Bundle Branch Block Can be Corrected by Permanent His Bundle Pacing
Authors: Pugazhendhi Vijayaraman, Kenneth A Ellenbogen, Gopi Dandamudi
Journal: Circulation (2014)

Introduction: Focal disease in the main body of the His bundle (HB) is the cause for majority of the bundle branch block (BBB) patterns on EKG. Temporary distal HB pacing (HBP) has previously been shown to correct BBB in high number of patients. Anecdotal reports have confirmed abolition of BBB by permanent HBP. Hypothesis: The aim of our study is to report the incidence of correction of BBB during permanent HBP in patients undergoing pacemaker (PM) implantation. Methods: Permanent HBP was attempted in 185 patients referred for PM implantation. Pts with QRS duration (d) ≥110 ms and BBB were included in the study. Pts with normal QRS or CHB were excluded. HBP was performed using the Medtronic SelectSecure 3830 pacing lead. Baseline QRSd, paced QRSd, correction of BBB and HB pacing threshold were recorded. Results: Fifty patients met the inclusion-exclusion criteria. Mean age 73±12 yrs; men 65%, HTN 81%, DM 30%, CAD 38%, AF 42%, SSS 39%, AV disease 61%, RBBB 31, LBBB 14, IVCD 5). Permanent HBP was successful in correcting BBB in 42 (84%) patients. Underlying BBB was corrected by HBP in 29 of 31 (94%) patients with RBBB; 11 of 14 (79%) patients with LBBB; 1 of 5 (20%) patients with IVCD. Baseline QRSd improved from 141±15 ms to 124±17 ms. HBP threshold at implant was 1.5±1.3 V @ 0.5 ms. Conclusions: Permanent HBP corrected underlying BBB in the vast majority of patients with right or left BBB (40 of 45, 89%) compared to only 1 of 5 (20%) patients with IVCD. This confirms that focal disease in the main HB is the cause for BBB in the patients referred for PM implantation.
Abstract 2031: Risk Assessment Following a Myocardial Infraction: Additive Value of Heart Rate Turbulence, Repolarization Alternans, and Deceleration Capacity.
Authors: Derek Exner, Michael P Slawnych, Katherine Kavanagh, Darelene Ramadan, Sandeep G Aggarwal, L B Mitchell, Raphael Schneider, Georg Schmidt, Henry J Duff, Refine Investigators
Journal: Circulation (2007)
Managing osteoporosis in older people with fractures
Authors: M. J Parker, B. Yung, J. Aram, A. Seif, B. McManus, I. P Williams
Journal: BMJ (1999)

Editor—Articles that raise the profile of osteoporosis should not lead to overreactions by exaggerating both the consequences of the condition and the effectiveness of preventive methods. Doube’s editorial on osteoporosis in elderly people unfortunately does this.1

This is a difficult condition on which to put precise figures for mortality and morbidity as many of the outcomes are related to other conditions customarily present in this population. The aetiology of a hip fracture is related to the processes of ageing, including impaired mobility, vision, and neuromuscular coordination. To attribute all subsequent deterioration to the fracture is inappropriate. The mortality of 33% quoted by Doube relates to the mortality at one year,2 and all deaths over this period should not be attributed to the hip fracture. About 10% of deaths will be expected in this elderly population over one year and a further 10% can be accounted for by associated medical conditions, which leaves a more realistic mortality figure of about 10%.3 The figure of 33% of the surviving patients requiring institutional care is also exaggerated; a more realistic figure of around 10% is appropriate.2

The quoted effectiveness of preventive measures should not be overestimated. Doube states that vitamin D analogues will reduce the fracture rate by 50%. This is at variance with the Cochrane review on vitamin D analogues, which states that “uncertainty remains about the efficacy of vitamin D” and recommends further randomised trials on this question.4

Unquestionably, we need to direct more attention to reducing the number of osteoporotic fractures. Any measure undertaken must be based on good quality evidence, which is currently not available. We need to define who needs treatment, what treatment should be used and for how long, and how effective this treatment is. Let us set about getting these answers before we recommend what may be ineffective interventions.
Abstract 13015: Cardiac Tamponade as a Rare Presentation of Chronic Lymphocytic Leukemia
Authors: Yasir Abdul Ghaffar, Imran Haider, Mohsin F Salih, Teijo N Musunuru
Journal: Circulation (2014)

An 89 year old male with a past medical history of CAD , diastolic HFpEF, HTN, HLD, DM, sick sinus syndrome with permanent pacemaker, OSA presented to the office with complaints of fatigue and progressive exertional dyspnea for 2 weeks. On examination his BP was 86/61mm Hg with a systolic drop of 20mmhg during inspiration by palpatory method, RR was 24 breaths/min, HR was 64 bpm, O2 sat. was 85% on RA. JVP was raised at 15cm. Cardiopulmonary examination revealed distant heart sounds, bibasilar crepitations and mild bilateral pedal eema. No lymphadenopathy was palpable. Initial lab assessment showed Hb of 9.5gdl, WBCs of 14.3 K/ul, potassium of 6.2mmol/, increased BUN/Creatinine ratio of 67/1.7, LDH of 642 U/L, Troponin I of 0.04ng/ml and BNP of 338pg/ml. EKG demonstrated av-paced rhythm without any evidence of electrical alternans or low voltage. CXR showed significant cardiomegaly. Transthoracic echocardiogram revealed normal LV cavity size, wall thickness and systolic function. A large pericardial effusion with early right ventricular diastolic collapse suggesting tamponade. The patient underwent emergent closed pericardiocentesis with complete resolution of symptoms. . Pericardial fluid analysis showed glucose of 78mg/dl, protein of 4.2g/dl, PH of 7.21, LDH of 1913 U/L, 1195000/uL RBCs, 212427/uL nucleated cells(Differential count N 3%, L 93%, M 2%, E 2% and B 0). Cytology was positive for PAX-5, CD-5 and negative for Cyclin-D1 &amp; CD-10 which was consistent with CLL. The patient was evaluated by the oncologist and he was started on rituximab and bendamustine. Follow up echocardiograms did not show any recurrence of effusion. The presence of pulsus paradouxs with other signs including hypotension, muffled heart sounds and raised jugular venous pressure greatly increases its sensitivity for cardiac tamponade which was evident in this case. Our case is unique because cardiac tamponade is rarely reported as an initial presentation of Chronic Lymphocytic Leukemia.
Methadone works if used properly
Authors: Andrew Byrne
Journal: BMJ (2007)

<h3>Abstract</h3> Understanding the factors that influence the airborne survival of viruses such as SARS-CoV-2 in aerosols is important for identifying routes of transmission and the value of various mitigation strategies for preventing transmission. We present measurements of the stability of SARS-CoV-2 in aerosol droplets (∼5-10µm equilibrated radius) over timescales spanning from 5 seconds to 20 minutes using a novel instrument to probe survival in a small population of droplets (typically 5-10) containing ∼1 virus/droplet. Measurements of airborne infectivity change are coupled with a detailed physicochemical analysis of the airborne droplets containing the virus. A decrease in infectivity to ∼10 % of the starting value was observable for SARS-CoV-2 over 20 minutes, with a large proportion of the loss occurring within the first 5 minutes after aerosolisation. The initial rate of infectivity loss was found to correlate with physical transformation of the equilibrating droplet; salts within the droplets crystallise at RHs below 50% leading to a near instant loss of infectivity in 50–60% of the virus. However, at 90% RH the droplet remains homogenous and aqueous, and the viral stability is sustained for the first 2 minutes, beyond which it decays to only 10% remaining infectious after 10 minutes. The loss of infectivity at high RH is consistent with an elevation in the pH of the droplets, caused by volatilisation of CO<sub>2</sub> from bicarbonate buffer within the droplet. Three different variants of SARS-CoV-2 were compared and found to have a similar degree of airborne stability at both high and low RH. <h3>Significance</h3> The aerosol microenvironment is highly dynamic exposing pathogens, such as the SARS-CoV-2 virus when exhaled in respiratory aerosol, to extreme conditions of solute concentration, pH and evaporative cooling. Yet surviving this environment is a key step in the transmission of such pathogens. Understanding the impact that airborne transport has on pathogens and the influence of environmental conditions on pathogen survival can inform the implementation of strategies to mitigate the spread of diseases such as COVID-19. We report changes in the infectivity of the airborne virus over timescales spanning from 5 s to 20 minutes and demonstrate the role of two microphysical processes in this infectivity loss: particle crystallisation and aerosol droplet pH change.
Lesson of the week: Central venous air embolism causing pulmonary oedema mimicking left ventricular failure
Authors: A. Fitchet, A. P Fitzpatrick
Journal: BMJ (1998)

Human recombinant erythropoietin is used to treat chronic anemia in patients with end-stage renal failure. Erythropoietin causes hypertension, and hypertensive encephalopathy has been associated with its use. We describe six dialysis-dependent, chronic renal failure patients who developed hypertension, headache, and seizures while on erythropoietin. Four of the six patients had posterior white matter changes on neuroimaging. The encephalopathy was managed by prompt antihypertensive and anticonvulsant treatment and by discontinuation of erythropoietin. Hypertensive posterior leukoencephalopathy is associated with erythropoietin use.
Abstract 4852: Changes In Left Ventricular Structure And Function Over 12 Months In Patients With Mild Or Asymptomatic Heart Failure With Previous Symptoms In The Resynchronization Reverses Remodelling In Systolic Left Ventricular Dysfunction (reverse) Study
Authors: Martin St. John Sutton, Stefano Ghio, Ted Plappert, Luigi Tavazzi, Jean Claude Daubert, William T Abraham, Michael R Gold, Michael R Gold, Cecilia Linde
Journal: Circulation (2008)

Background: Cardiac Resynchronization Therapy (CRT) induces LV reverse remodeling that translates into symptom relief and improved survival in New York Heart Association (NYHA) symptom class III/IV heart failure (HF). We hypothesized that CRT would also result in LV reverse remodeling in NYHA class I/II (asymptomatic or minimally symptomatic) HF and slow disease progression. Method: All patients in the RE synchronization re VE rses R emodeling in S ystolic left v Entricular dysfunction (REVERSE) study had an EF&lt;40% and a QRS&gt;120ms and had optimal HF therapy for at least 1 month. Echograms were obtained at baseline, pre-hospital discharge (PHD), 6 and 12 months. At the PHD visit two limited echos were performed (one with CRT OFF and one with CRT ON), to assess the acute mechanical effect of pacing. LV volume indices, EF, LV mass and severity of mitral regurgitation (MR) were quantified at all time points by a Core Echo lab. Results: Of 610 patients, 82% had NYHA class II and 18% had class I HF. Patients were randomized 2:1 to CRT ON (n=419) or CRT OFF (n=191). LV volume indices at end-systole and end-diastole decreased and EF increased significantly from baseline to 12 months in CRT ON, but did not change in CRT OFF. LV mass and severity of MR did not change in either group at 12 months (Table ). When CRT ON was switched to CRT OFF at PHD, there were no significant acute changes in LV size or function. Conclusion: CRT results in major structural and functional LV reverse remodeling in patients with NYHA class I/II HF that may delay the natural disease progression. The progressive reverse LV remodeling is demonstrated on top of the attenuation seen with optimal medical therapy in NYHA class I/II (CRT OFF group). The echo findings in REVERSE may have important clinical implications for use of CRT in the optimal therapy of patients with NYHA class I/II heart failure. Table. Mean ± S.D. (n) Echocardiographic Parameters: CRT ON vs. CRT OFF
Medical, judicial, and statutory regulation of ECT in the United States
Authors: William Winslade, E. H. Liston, J. W. Ross, K. D. Weber
Journal: American Journal of Psychiatry (1984)

The standards for ECT recommended by an APA task force report and those embodied in federal court orders and state statutes and regulations are compared. The authors conclude that there is serious boundary and role confusion owing to progressive intrusion of state authority into areas traditionally held to lie in the domain of medical judgment and clinical care. In spite of comprehensive safeguards promulgated by the psychiatric community, overregulation by legislatures and courts is commonplace, interposing law between physicians and patients and resulting in delays or denials of service while failing to resolve critical legal issues involving competence and consent.
Response to Letter Regarding Article, “Improved Quality of Life After 1 Year With an Invasive Versus a Noninvasive Treatment Strategy in Claudicants: One-Year Results of the Invasive Revascularization or Not in Intermittent Claudication (IRONIC) Trial”
Authors: Joakim Nordanstig, Charles Taft, Marlene Hensäter, Angelica Perlander, Klas Österberg, Lennart Jivegård
Journal: Circulation (2015)
A Genetic Variant in TGFBR3-CDC7 Is Associated with Visual Field Progression in Primary Open-Angle Glaucoma Patients from Singapore
Authors: Sameer Trikha, Ehsan Saffari, Monisha Nongpiur, Mani Baskaran, Henrietta Ho, Zheng Li, Peng-Yi Tan, John Allen, Chiea-Chuen Khor, Shamira A. Perera, Ching-Yu Cheng, Tin Aung, Eranga Vithana
Journal: Ophthalmology (2015)
Abstract 1743: Identification of a Novel Susceptibility Locus at 9q21 for Familial Bicuspid Aortic Valve Disease
Authors: Stephen H McKellar, Marineh Yagubyan, Ramanath Majumdar, David J Tester, Mariza de Andrade, Vidu Garg, Michael J Ackerman, Thoralf M Sundt
Journal: Circulation (2007)

Background: Bicuspid aortic valve disease (BAV), the most common congenital cardiovascular malformation, has an incidence of 0.5–1.0% of live births. While most cases of BAV appear to be sporadic, familial inheritance patterns have been observed consistent with autosomal dominant inheritance with variable penetrance. However, little is known about specific genetic loci responsible for familial BAV. Here, we performed linkage analysis on a large multi-generational pedigree affected with BAV. Methods: We identified a large, five-generation pedigree (136 family members) with 10 individuals having BAV. Two-dimensional echocardiography was used to assign aortic valve phenotype. Genome-wide linkage analysis using 430 microsatellite markers (Marshfield Clinic) and fine mapping using 100 single nucleotide polymorphisms (Affymetrix) on chromosome 9 was performed on genomic DNA from all available family members. Logarithm of odds (LOD) scores of &gt;2.0 were considered suggestive of linkage. Comprehensive splice site/open reading frame mutational analysis of candidate genes residing in the putative locus is underway using PCR, DHPLC, and DNA sequencing. A candidate gene, KLF9, Krüppel-like factor 9 was analyzed for mutations because of its role in cardiogenesis. Results: Multi-point genome-wide linkage analysis demonstrated a 7 cM region on chromosome 9q21 that was suggestive of linkage for familial BAV with a maximum multipoint LOD score of 2.8 flanked by the microsatellite markers GATA7D12 and D9S1834. This region contains several candidate genes with biological plausibility for BAV phenotype. KLF9- encoded Krüppel-like factor 9, localized to chromosome 9q21, was targeted as a prime candidate gene for familial BAV. However, no mutations involving the translated exons of KLF9 were detected. Further fine mapping studies and candidate gene analysis are currently underway. Conclusions: We report a novel susceptibility locus on chromosome 9q21 for BAV in a large multi-generational family. Although coding region mutations in KLF9 are not responsible for BAV in this pedigree, several candidate genes with biological plausibility for the development of congenital BAV lie within this region and warrant further scrutiny.
Tracing the Ontogeny of IgG-Switched CLL: High-Throughput Immunogenetic Evidence
Authors: Anna Vardi, Evangelia Stalika, Maria Karypidou, Lesley-Ann Sutton, Vasilis Bikos, Achilles Anagnostopoulos, Sarka Pospisilova, Nikolaos Maglaveras, Richard Rosenquist, Kostas Stamatopoulos, Ioanna Chouvarda, Anastasia Hadzidimitriou
Journal: Blood (2014)
Risk Factors Associated with Childhood Strabismus
Authors: Susan A. Cotter, Rohit Varma, Kristina Tarczy-Hornoch, Roberta McKean-Cowdin, Jesse Lin, Ge Wen, Jolyn Wei, Mark Borchert, Stanley P. Azen, Mina Torres, James M. Tielsch, David S. Friedman, Michael X. Repka, Joanne Katz, Josephine Ibironke, Lydia Giordano
Journal: Ophthalmology (2011)
Abstract P099: Soy Food, Bean, Total Legume Consumption and Blood Pressure: The INTERMAP Study
Authors: Linda M Oude Griep, Jeremiah Stamler, Queenie Chan, Linda van Horn, Lyn M Steffen, Katsuyuki Miura, Hirotsugu Ueshima, Nagako Okuda, Liancheng Zhao, Martha L Daviglus, Paul Elliott
Journal: Circulation (2013)

Background: Legumes, including soy foods and beans, are nutrient-dense high-quality sources of vegetable protein. Evidence from prospective cohort studies suggests beneficial associations between legume consumption and cardiovascular diseases, however, little is known about their impact on blood pressure (BP). Our objective was to quantify associations with BP of consumption of soy food, beans, and total legume consumption, each considered separately. Methods: We used cross-sectional data from the International Study of Macro-/Micronutrients and Blood Pressure (INTERMAP) on 4,680 men and women ages 40-59 years from Japan, China, United Kingdom, and United States. During four visits, eight BP and four 24-hr dietary recalls were collected. Regression coefficients per 2SD higher soy food, bean, and total legume intake were estimated using multivariable linear regression models. To estimate overall association, country-specific regression coefficients were pooled, weighted by inverse of their variance. Adjustments were for age, gender, sample, intake of total energy and alcohol, 24-hr urinary sodium excretion, smoking, education, dietary supplement use, adherence to any special diet, history of cardiovascular diseases or diabetes, family history of hypertension, use of antihypertensive, cardiovascular, or diabetes medication, body mass index, and intake of low-fat dairy, vegetables, fibre-rich grain products, red and processed meats, fish and shellfish, and mutually for soy foods or beans. Results: Average daily legume intakes (g/1000 kcal) were 69 in Asian participants and 19 in Western participants. Soy foods contributed 91% of total legume intake in Asian participants; beans were the main source of legumes (68%) in Western countries. In Asian participants, high correlation coefficients were found between intake of soy foods and iron (r=0.34), arginine (r=0.34), aspartic acid (r=0.34), phenylalanine (r=0.32), isoleucine (r=0.30), and magnesium (r=0.30). In Western participants, soy foods were related to dietary magnesium (r=0.30) and beans were highly correlated with dietary fiber (r=0.44) and magnesium (r=0.22). Total legume intake higher by 76 g/1000 kcal (2SD) was associated with a diastolic BP difference of -0.75 mm Hg (P=0.009) in the total population, -0.70 mm Hg (P=0.05) in Asian, and -0.86 mm Hg (P=0.08) in Western participants. In the total population, diastolic BP differences were -0.62 mm Hg for soy foods (P=0.04) and -0.42 mm Hg for beans and peas (P=0.06). With regard to systolic BP, a significant inverse association was found for soy food intake higher by 41 g/1000 kcal in Western participants (-1.78 mm Hg, P=0.05). Conclusion: Higher intake of legumes, especially soy foods, was associated with lower BP levels.
Rituximab in severe, treatment-refractory interstitial lung disease
Authors: Rezaur Abdullah, Damien Ming, Gregory Keir, Toby Maher, Athol Wells, Elisabetta Renzoni
Journal: European Respiratory Journal (2013)

Background   In a subgroup of patients with severe interstitial lung disease (ILD) progressing despite conventional immunosuppression, rituximab, a B cell-depleting monoclonal antibody, may offer an effective rescue therapy.   Methods   Retrospective assessment of 50 patients with severe, progressive ILD (34 with connective tissue disease-associated ILD, 7 with fibrotic hypersensitivity pneumonitis, 3 with likely drug-induced ILD, the rest with miscellaneous ILD patterns, excluding idiopathic pulmonary fibrosis) treated with rituximab between 2010 and 2012. At the time of rituximab treatment, mean DLco was 25.5 % (±9.9%), and FVC was 49.1% (±17.6%). Change in pulmonary function tests compared to pre-rituximab levels, was assessed at six to twelve months post-treatment. Changes in lung function before and after treatment were analysed by Wilcoxon signed rank test.   Results   In contrast with a median decline in forced vital capacity (FVC) and diffusing capacity for carbon monoxide (DLco) of 14.6% and 18.8% respectively in the six to twelve months prior to rituximab, analysis of paired pulmonary function data revealed a median improvement in FVC of 5.7% (p   Conclusions   In a subgroup of patients with severe, progressive ILD unresponsive to conventional immunosuppression, rituximab may offer a safe and effective therapeutic intervention. Future prospective, controlled trials are warranted to validate these findings.
Abstract 9771: Reg1, a Novel RNA-Aptamer Direct Factor IXa-inhibitor (pegnivacogin) Reduces Platelet Activation in Healthy Volunteers and Residual Platelet Aggregation in Patients with ACS. A Radar Substudy
Authors: Ingo Ahrens, Vera Putz, Steven L Zelenkosfke, Martin Moser, Thomas J Povsic, John H Alexander, Richard C Becker, Christopher P Rusconi, Christoph Bode
Journal: Circulation (2011)

Background and Rationale: Residual platelet reactivity is a predictor of cardiovascular adverse events in patients with acute coronary syndromes (ACS) undergoing percutaneous coronary interventions (PCI). In addition to patient factors and antiplatelet therapy, the choice of anticoagulant determines the risk for periprocedural ischemic and bleeding events. The ideal anticoagulant would demonstrate a fast onset, effective anticoagulation, and controlable reversibility. REG1 consisting of pegnivacogin, a RNA-aptamer direct factor IXa inhibitor, and anivamersen, its specific, and titratable active control agent meets these requirements. We examined whether inhibition of factor IXa with pegnivacogin affects platelet reactivity in vitro and in vivo in healthy volunteers and in a subset of patients with ACS undergoing PCI from the phase IIb RADAR trial ( NCT00932100 ). Methods and Results: For the in vitro study, blood from healthy volunteers was spiked with pegnivacogin (50µg/ml) and ADP-induced platelet activation was measured by flow cytometry (expression of CD62P and PAC-1 binding). Platelet aggregation was assessed by light transmission aggregometry (LTA). For the in vivo measurements, LTA was done with blood from patients with ACS enrolled in the RADAR trial. Blood samples were taken before and 20 minutes after the administration of pegnivacogin. All patients were loaded with clopidogrel (600mg) and aspirin (&gt;325mg). In vitro pegnivacogin significantly reduced maximum ADP-induced CD62P-expression (100% vs 89.8+/- 12.1%, p=0.0035) and PAC-1 binding (100% vs 83+/-18.5%, p=0.0006). Furthermore maximum platelet aggregation was reduced by 26.3+/-16.4% (p=0.0031). In patients with ACS residual platelet aggregation (1µM ADP) was reduced from 33.3+/-4% to 14.7+/-8.1% (n=4, p=0.005) 20 minutes after intravenous pegnivacogin (1mg/kg). Conclusion: The novel IXa inhibitor pegnivacogin decreases ADP-induced platelet activation and aggregation in vitro and in vivo. In addition to its effect as an anticoagulant, REG1 may provide a means to overcome residual platelet reactivity in patients with ACS undergoing PCI, this may contribute to clinical outcomes and should be studied in appropriately sized phase 3 clinical trials.