tbuckley/cabot-search huggingface dataset:
Abstract 2405: Effect of Early Emergency Room Notification on Door-to-Balloon Time in Patients Presenting with ST Elevation Myocardial Infarction
Authors: Youssef Kardouh, Anjani Rao, Kimberly Green, Joselyn Ymana, Shukri David
Journal: Circulation (2007)

Background: The goal of mechanical reperfusion therapy in the setting of ST Segment Elevation Myocardial Infarction (STEMI) is to re-establish blood flow to the affected vascular bed as quickly as possible. Primary angioplasty has been shown to be superior to fibrinolysis when door-to-balloon (DTB) time is less than 60 minutes. The median DTB time in the United States is 185 minutes and only 3% of patients are currently being mechanically reperfused within the 90 minutes as recommended by American College of Cardiology guidelines. The purpose of this study is to see if an aggressive approach involving emergency medical services (EMS), emergency room (ER) personnel, and the early activation of cardiac interventional team could improve reperfusion times. We evaluated the feasibility of pre-hospital Electrocardiogram (phECG) to triage patients with STEMI directly to the cardiac catheterization laboratory (CCL) compared to the standard therapy at two primary PCI centers Methods: The EMS personnel obtained a 12-lead ECG during initial assessment in the field from patients with symptoms of myocardial infarction. The ECG was immediately transmitted to the ER physician by cellular link to a computer receiving station located in the ER. The ER physician reviewed the 12-lead ECG digital tracing. The cardiac catheterization laboratory (CCL) team was activated from the patients’ homes. Patients were transported from the field directly to the CCL by EMS bypassing ER admission. Results: From Oct 2003 to May 2007, 142 consecutive patients with STEMI who presented to Providence Hospital and Medical Centers were included in the study. The conventional treatment group (125 patients) had a mean DTB time of 123 minutes. We identified 359 phECGs transmitted to the ER, 43 of which had inadequate transmission signal. Adequate phECG transmission was detected in 88% cases. We diagnosed 17 patients with STEMI by phECG who were included for the analysis. The mean DTB time was significantly lower in patients diagnosed using phECG (46 minutes vs. 123 minutes, p&lt;0.001). Conclusion: Utilizing the phECG as a tool to bypass ER triage significantly decreases DTB times in patients with STEMI. This technology has the potential to substantially expedite reperfusion therapy in patients with STEMI.
Interpretation of electrocardiograms
Authors: P. Mills
Journal: BMJ (1995)

explained on analytical grounds as lipid analyses performed in different laboratories give consistent results."3Also, the men in the present study served as an internal control.The influence of diet and parity cannot be excluded as major contributors to this phenomenon, but Gupta and colleagues do not provide good data on these points.The endocrine control of plasma high density lipoprotein choles- terol concentrations has been widely studied, and the effect of insulin resistance in this group may be important.4Gupta and colleagues' study adds weight to the increasing body of evidence that Asian women are at increased risk of coronary heart disease.We may expect an increase in the incidence of coronary heart disease in the British Asian population in the next decade, and further studies are urgently required.
Abstract 12225: The Impact of Cessation of Antibiotic Prophylaxis for the Prevention of Infective Endocarditis in Children: A Population-Based Study in England
Authors: Mark J Dayer, Sara K Pasquali, Michael Cohen-Wolkowiez, Martin H Thornhill, David J Couper, Jamie M Forde, Peter B Lockhart, Jennifer S Li
Journal: Circulation (2011)

Background: In March of 2008, the National Institute of Health and Clinical Excellence (NICE) in the United Kingdom instituted guidance recommending complete cessation of antibiotic prophylaxis (AP...
Evidence based medicine
Authors: B. H Smith
Journal: BMJ (1996)

# Rich sources of evidence are ignored {#article-title-2}

EDITOR,—It is reassuring that David L Sackett and colleagues have made two important concessions from their previous extreme position relating to evidence based medicine1 2: firstly, they have recognised the importance of clinical skill, as distinct from the consideration of scientific evidence; and, secondly, they have allowed other forms of evidence to take a …
Abstract 16929: Are Patients Implanted with a Ventricular Assist Device as Destination Therapy Created Equal? Analysis of Outcomes by Implant Indications
Authors: Simon Maltais, Mary E Davis, Nicholas A Haglund, John A Schirger, Keith Aaronson, Francis D Pagani, John M Stulak
Journal: Circulation (2014)

Introduction: A growing number of patients are implanted with a continuous-flow left ventricular assist device (CF-LVAD) for destination therapy (DT). Hypothesis: We sought to determine if indication for DT was associated with adverse events and survival. Methods: Between May 2004 and May 2014, 211 patients (age 66 (19-82), 89% male) underwent implantation of a HeartMate II CF-LVAD. The cohort was stratified according to primary listed indication for DT at time of implant: Group 1=advanced age (n=124, 59%); Group 2=high BMI (n=33, 16%), and Group 3=end-organ comorbidities (n=54, 25%). DT patients who later became BTT were eliminated for homogeneity. Results: Follow-up was available in all patients for a total of 376 patient-years of support (median 1.4 years). Preoperative characteristics (creatinine 1.5, INTERMACS 3, IABP 49%) were comparable between groups (all p&gt;0.05). Overall 1, 3 and 5-year survival was 81%, 58%, and 41%, respectively. Kaplan-Meier analysis revealed comparable survival between groups stratified by DT indications (Figure, p=0.07). While gastrointestinal (GI) bleeding was more frequent in patients implanted for advanced age DT indications (p=0.01, group 1 vs group 2 and 3), the incidence of adverse events (pump thrombus/exchange, stroke) was comparable between groups. After adjusting for covariates (creatinine, hemoglobin, prior sternotomy and diabetes), Cox regression analysis demonstrated only preoperative renal dysfunction (HR 1.86 CI 1.28, 2.69; p=0.001) and lower Hemoglobin (HR 0.82 CI 0.71, 0.95; p=0.008) were associated with late mortality after implantation. Conclusions: Advanced age remains the most frequent contemporary indication for DT in patients undergoing CF-LVAD implantation. Indication for DT implantation does not influence long-term survival. Elderly patients may be at greater risk of GI bleeding events. These results continue to favor a uniform selection process across the spectrum of DT indications.
Genital Herpes
Authors: David W. Kimberlin, Dwight J. Rouse
Journal: New England Journal of Medicine (2004)

A 22-year-old woman presents to her gynecologist with genital lesions. Examination reveals bilateral labial ulcerations, cervical ulcerations, and mildly tender inguinal lymphadenopathy. To her knowledge, neither she nor any of the four sexual partners she has had, including her husband of two years, has ever had herpes. How should this patient's case be managed?
Abstract 2530: Optimization of 5,6-fused pyrimidine-based kinase inhibitors by computer-aided drug design for the treatment of AML
Authors: Yung Chang Hsu, Hui-Yi Shiao, Yi-Yu Ke, John T. A. Hsu, Wen-Hsing Lin, Chun-Hwa Chen, Hsing-Pang Hsieh
Journal: Cancer Research (2014)

Abstract FMS-like receptor tyrosine kinase-3 (FLT3), a member of the class III tyrosine kinase receptor family, is expressed by immature hematopoietic cells, and highly associates with acute myeloid leukemia (AML). While acquired resistance to selective FLT3 inhibitors, the treatment became inefficient. Many literatures suggested that dual FLT3-Aurora inhibition may overcome selective FLT3 inhibitor resistance, in part due to inhibition of Aurora kinase, and may benefit patients with FLT3-mutated AML. Thus, utilizing dual FLT3-Aurora inhibitors may be the viable therapy for the treatment of AML. Recently, our group reported a novel AURKA inhibitor by using high-throughput parallel synthesis and structure-based drug design (SBDD). Based on this, we wanted to modify the selective AURKA inhibitor to maintain its Aurora A inhibition as well as improve its FLT3 activity to develop dual FLT3-Aurora kinase inhibitors. Through rapid construction of the platform of FLT3 virtual screening, the lead was quickly and efficiently identified. Proceeding investigation of structure-activity relationship could lead to 6-phenyl pyrrolopyrimidine analogue, showing FLT3 inhibition with an IC50 of 101 nM as well as Aurora kinase A inhibition with an IC50 of 33 nM. To further increase the level of inhibition of FLT3, binding energy calculations and docking study of FLT3 model were introduced to select terminal groups of the side chain with high priority. The selected compounds were synthesized and evaluated the bioactivity. The dramatic antiproliferation of the dual FLT3-AURKA inhibitor against MOLM-13 and MV4-11 (FLT3-ITD (+) human AML cell lines) was observed, and its biologic mechanism of inhibition of FLT3 and Aurora kinase A was proved the by significant evidence of biomarker. For this finding, this novel inhibitor holds potential for further development of preclinical investigations as an anti-AML drug candidate. Citation Format: Yung Chang Hsu, Hui-Yi Shiao, Yi-Yu Ke, John T. A. Hsu, Wen-Hsing Lin, Chun-Hwa Chen, Hsing-Pang Hsieh. Optimization of 5,6-fused pyrimidine-based kinase inhibitors by computer-aided drug design for the treatment of AML. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr 2530. doi:10.1158/1538-7445.AM2014-2530
Abstract P141: Dairy Consumption and Risk of Type 2 Diabetes: 3 Cohorts of US Adults and An Updated Meta-Analysis
Authors: Mu Chen, Qi Sun, Edward Giovannucci, Walter Willett, Dariush Mozaffarian, Frank B Hu
Journal: Circulation (2014)

Introduction: The relation between consumption of different types of dairy foods and risk of type 2 diabetes (T2D) remains uncertain. Hypothesis: We hypothesized that total dairy intake is not associated with incident T2D but some specific types of dairy foods may be associated with reduced risk of T2D in US adults. Methods: We followed 41,705 men in Health Professionals Follow-Up Study (1986-2010), 67,812 women in Nurses’ Health Study (1980-2010), and 86,158 women in the Nurses’ Health Study II (1991-2009). Diet was assessed by validated food-frequency questionnaires, and data were updated every 4 yrs. Incident T2D was confirmed by a validated supplementary questionnaire. Analyses were performed by using Cox regression models and fixed-effect meta-analyses were conducted to summarize the estimates of association if no significant heterogeneities were shown otherwise random-effect models were used. Results: During 4,054,783 person-years of follow-up, we documented 14,372 incident T2D cases. After adjustment for age, BMI, and other lifestyle and dietary risk factors, total dairy consumption was not associated with T2D risk and the pooled HR (95% CI) for each 1 serving/d increase in total dairy was 0.99 (0.98, 1.01). Among different types of dairy products, yogurt was consistently associated with lower T2D risk in all three cohorts, with a pooled HR of 0.83 (0.76, 0.91) for each 1 serving/d increment. Other types of dairy foods such as milk and cheese were not significantly associated with T2D. The results were confirmed by a meta-analysis of 13 prospective cohorts (543,438 participants and 39,555 diabetes cases): the RRs (95% CIs) were 0.98 (0.96, 1.01) and 0.83 (0.73, 0.95) for 400g total dairy/d and for 200g yogurt/d, respectively. Conclusion: These results suggest that intake of yogurt is associated with a reduced risk of T2D, whereas other dairy foods are not associated with incidence of T2D.
Decisions will be taken after receipt of final report next autumn
Authors: P. Leech
Journal: BMJ (1996)

social worker for the child.Who looks after the family?A guardian ad litem may be appointed (with his or her own costly legal representation), but the guardian's role is specifically to ensure the welfare of the children.There is a desperate need for a social worker for the family, to provide unbiased advice, explain parents' rights, and support the family at complex conferences.Current practice undermines not only the family but also the key social workers, whose therapeutic relationships and opinions are not valued.Overspent, uncapped budgets are used to obtain assessments and therapy from outside social services.Practice varies enormously between teams in the same authority.Foster care is overflowing with children, and its use should be audited.Professionals reading of the heartbreaking cases in which a child has died realise that social services have addressed the causes thoroughly: they now use this system for all disclosures.Referrals to social services are not neutral and may not remain confidential; they may be very damaging.I would support any doctor who thinks carefully before making a routine referral to social services.
The effects of physical activity coaching in patients with COPD after an acute exacerbation
Authors: Miek Hornikx, Heleen Demeyer, Carlos Augusto Marcal Camillo, Wim Janssens, Thierry Troosters
Journal: European Respiratory Journal (2014)

Rationale   During a hospital admission for an acute COPD exacerbation, physical activity (PA) is low and does not completely recover after discharge. As physical inactivity has been associated with impaired prognosis, PA promoting strategies may become important as an intervention immediately after hospital discharge.   Methods   26 patients were randomly assigned to an intervention group (N=14), coached towards higher PA or a control group (N=12) receiving usual care. Patients in the intervention group wore the Fitbit Ultra®, an accelerometer providing real time information on PA, around the ankle during one month. PA was discussed with a dedicated physiotherapist by means of 3 weekly telephone contacts (12 in total).   Results   Despite randomization, patients in the intervention group had a significantly lower FEV 1  (31±8 vs 45±10% (p steps : p=0.86; PA walking : p=0.91)   Conclusion   Pilot data suggest that PA recovers after an acute exacerbation to levels determined by the baseline condition. Contrary to our expectations, physical activity coaching in the month after hospital discharge does not result in higher levels of PA.
No evidence of transmission of chronic lymphocytic leukemia through blood transfusion
Authors: Henrik Hjalgrim, Klaus Rostgaard, Senthil K. Vasan, Henrik Ullum, Christian Erikstrup, Ole B. V. Pedersen, Kaspar R. Nielsen, Kjell-Einar Titlestad, Mads Melbye, Olof Nyrén, Gustaf Edgren
Journal: Blood (2015)
Abstract 4370: Intramyocardial Administration of Erythropoietin Promotes Cell Proliferation, Induces Early Angiogenesis and Attenuates Cardiac Remodeling
Authors: Ralf Gäbel, Christian Klopsch, Dario Furlani, Wenzhong Li, Can Yerebakan, Weiwei Wang, Erik Pittermann, Andreas Dryndao, solvig lenz, Ren-Ke Li, Nan Ma, Gustav Steinhoff
Journal: Circulation (2008)

Erythropoietin (EPO) protects the ischemic myocardium from heart failure development after myocardial infarction (MI). However, little is known about its intracardiac cell proliferation and early angiogenesis. We hypothesize that EPO may contribute to cell proliferation, angiogenesis and eventually induce a beneficial remodeling process. Following permanent LAD ligation in rats, EPO (3000 U/kg; n=99) or saline (n=95) was delivered along the infarction border. In control animals without MI (n=55) saline was injected intramyocardially. After 6 weeks follow-up, left ventricle was catheterized and analyzed for cardiac performance. The level of eNOS mRNA was dramatically increased 9.3 fold in non-infarcted area of EPO treated rats at 24 h detected by real time PCR and confirmed by immunohistology. We found a 45 % enhancement in Ki-67+ cell numbers near the infarction at 48 h after EPO treatment (n=6, P&lt;0.001). Hematopoietic cell lineages including c-Kit+ and CD34+ cells were augmented in the peripheral blood after 48h. Capillary density was enhanced by 17% as early as 1 week (n=6, P&lt;0.001). Myocyte apoptosis was reduced by 41% and 37% at border zone after 1 and 6 weeks (n=6, P&lt;0.05). Cardiac troponin T level, a highly sensitive and specific indicator of myocardial cell death, was significantly reduced in peripheral blood 2 weeks after EPO injection (n=5, P&lt;0.05). Cardiomyocyte size and interstitial fibrosis at 6 weeks were decrease by 13% and 23% (n=6, P=0.015, P&lt;0.001). Intramyocardial EPO delivery enhanced left ventricular performance at baseline and Dobutamine stress conditions compared with MI rats (cardiac output: 65% and 71% increase at baseline and stress; end-diastolic pressure: 51% and 53% reduction respectively, n=11–14, P&lt;0.05). To conclude, intramyocardial EPO delivery induces early cell poliferation, angiogenesis and attenuates post MI remodeling.
FK506 inhibits the enhancing effects of transforming growth factor (TGF)-β1 on collagen expression and TGF-β/Smad signalling in keloid fibroblasts: implication for new therapeutic approach
Authors: C-S. Wu, P-H. Wu, A-H. Fang, C-C.E. Lan
Journal: British Journal of Dermatology (2012)

Background Keloid is a unique proliferative disorder of fibroblasts resulting from derailment of the typical wound healing process. Due to lack of animal models for therapeutic testing, treatment of keloids remains a clinical challenge. Transforming growth factor (TGF)‐β1‐related signalling plays a key role in keloid formation. As tacrolimus (FK506) has been reported to inhibit the effects of TGF‐β1 on cultured fibroblasts, we hypothesized that FK506 may be useful in treating keloids. Objectives To explore the effects of FK506 on TGF‐β1‐stimulated keloid fibroblasts (KFs) in terms of proliferation, migration and collagen production and to investigate the regulatory pathways involved. Methods Fibroblasts derived from keloids were treated with TGF‐β1 with or without FK506. Relevant assays including 5‐bromo‐2′‐deoxyuridine incorporation assay, in vitro scratch assay, reverse transcription–polymerase chain reaction (PCR), quantitative PCR and Western blotting were performed. Results The proliferation and migration of KFs were significantly higher than those of normal fibroblasts. FK506 markedly inhibited KF proliferation, migration and collagen production enhanced by TGF‐β1. The increase in TGF‐β receptor I and II expression in TGF‐β1‐treated KFs was suppressed by FK506 treatment. TGF‐β1 increased the phosphorylation of Smad2/3 and Smad4 in KFs, and this enhancing effect was abrogated by FK506. In addition, FK506 significantly increased the expression of Smad7 which was suppressed by TGF‐β1 treatment. Conclusions Our results demonstrate that FK506 effectively blocks the TGF‐β/Smad signalling pathway in KFs by downregulation of TGF‐β receptors and suggest that FK506 may be included in the armamentarium for treating keloids.
Phase I study of sunitinib (SU) in combination with pemetrexed (Pem) in patients (pts) with advanced solid tumors (ST)
Authors: K. Nakagawa, I. Okamoto, T. Shimizu, M. Miyazaki, J. Tsurutani, Y. Ichikawa, M. Terashima, M. Takeda, S. Fumita, T. Kiriyama
Journal: Journal of Clinical Oncology (2009)

e14630 Background: SU is an oral, multitargeted tyrosine kinase inhibitor of VEGFRs, PDGFRs, KIT, RET, FLT3, and CSR-1, and shows antitumor activities in several types of solid malignancies. Non-small-cell lung cancer (NSCLC) xenograft data indicate SU enhanced the antitumor activity of Pem. This phase I study was designed to evaluate the safety, tolerability, and pharmacokinetics (PK) of combination therapy with the oral SU and Pem for Japanese patients with advanced ST. Methods: Pts with ST refractory to standard therapy were randomly assigned to receive either oral SU 50 mg/day for 2 weeks followed by 1 week rest (Schedule 2/1, S-2/1) or SU 37.5 mg continuous daily dose (CDD). Fixed-dose Pem (500mg/m 2 IV) was administered on day1 every 21 days. A standard “3+3” design was employed in both treatment schedules and treatment continued until tumor progression or dose-limiting toxicity (DLT) was observed. Results: A total of 12 pts (med. age 63 years, range 49–69; 10 Male/ 2 Female) have been enrolled (6 pts in the S-2/1 arm and 6 pts in the CDD arm). The most common cancer is NSCLC (9 pts, 75%). All patients completed their first cycle for DLT evaluation, and no DLTs were observed in either treatment arm. The most common toxicities were fatigue (n=8), anorexia (n=6), and thrombocytopenia (n=12). Treatment-related ≥ grade 3 adverse events (AEs) included fatigue (n=1), hypertension (n=1), neutropenia (n=4), leucopenia (n=3), thrombocytopenia (n=2), lymphopenia (n=2), and increased ALT (n=1). Three pts (S-2/1: 2, CDD: 1) required dose reduction of SU due to G3 toxicities. All toxicities were clinically manageable and reversible. One pt with NSCLC had a documented PR with cavity formation inside the tumor. Conclusions: SU 37.5 mg/day (CDD schedule) plus Pem 500mg/m 2 every 21 days, and SU 50 mg/day (S-2/1 schedule) plus Pem 500mg/m 2 every 21 days were well tolerated and associated with encouraging antitumor activity. [Table: see text]
Abstract 21: The Effects of Carbohydrate Amount and Type on Kidney Function in Healthy Adults: Results From the Omnicarb Trial
Authors: Stephen P Juraschek, Alex R Chang, Lawrence J Appel, Cheryl A Anderson, Deidra C Crews, Jeanne Charleston, Edgar R Miller
Journal: Circulation (2015)

Background: While there is considerable interest in the effect of glycemic index (GI) and amount of carbohydrate (%carb) on health, few studies have examined the effects of GI and %carb on kidney function, an important risk factor for cardiovascular disease. We determined the effects of reducing GI and %carb on kidney function. Methods: We conducted a four-period, randomized, crossover feeding study in overweight/obese adults without diabetes or kidney disease (N=163). Participants were fed each of four diets for 5 weeks, separated by 2-week washout periods. Weight was held constant. The four diets were: high GI (GI >65) with high %carb (58% kcal from carbohydrates) (reference diet), low GI (GI <45) with low %carb (40% kcal from carbohydrates), low GI with high %carb; and high GI with low %carb. Plasma was collected at baseline and at the end of each feeding period. Primary outcomes were β2-microglobulin, cystatin C, and estimated glomerular filtration rate based on cystatin C (eGFRcys). Instead of serum ...