tbuckley/cabot-search huggingface dataset:
UK report into acute kidney injury deaths recommends electrolyte checks in all emergency admissions
Authors: Susan Mayor
Journal: BMJ (2009)

All patients admitted to hospital as an emergency should have their electrolytes checked on admission and appropriately thereafter, recommends a UK confidential inquiry that found serious deficits in the care for many patients who died in hospital with acute kidney injury (AKI).

Only half of these patients had received good clinical care, according to an assessment by independent experts of their case notes and information on their management. Care was judged to have been good in even fewer, only one in three, patients who developed acute kidney injury after hospital admission, compared with patients admitted with the problem. 

Acute kidney injury could have been avoided in one fifth of the patients who developed it after admission to hospital if they had received better monitoring of electrolytes, recognition of risk factors, and prompt management, the inquiry says.

“Failure of the heart or the lungs to maintain their life-sustaining roles is immediately evident but when the kidneys fail in their function it may go unnoticed,” explained Tom Treasure, chairman of the National …
SYNCOPE: A REVIEW
Authors: R D WILLIAMS
Journal: Annals of Internal Medicine (1949)

Article1 June 1949SYNCOPE: A REVIEWRUSSELL D. WILLIAMS, M.D., F.A.C.P.RUSSELL D. WILLIAMS, M.D., F.A.C.P.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-30-6-1143 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptINTRODUCTIONThis discussion of syncope is divided into three parts: first, a brief consideration of the subject, second, a description of the various syndromes, and third, a review of some biological aspects of the reaction in certain instances. The work of Weiss and his associates1 forms the basis of our present knowledge; his classical review in the Oxford Medicine was written about 1937. Since then the chief contributions have come from Engel and Romano3, 6 who have not only utilized the relatively new technic of the electroencephalogram, but have also studied fainting from a modern psychological point of view.Fainting...Bibliography1. WEISS S: Syncope and related syndromes, Oxford Med., 1937, ii, 250 (9). Google Scholar2. MORITZ A: Sudden death, New England Jr. Med., 1940, ccxxiii, 798. CrossrefGoogle Scholar3. ENGELROMANO NEJ: Studies of syncope. III. Differentiation between vasodepressor and hysterical fainting, Psychosom. Med., 1945, vii, 3. Google Scholar4. ARMSTRONG HJ: Principles and practice of aviation medicine, 1943, Williams and Wilkins, Baltimore. Google Scholar5. ENGELFERRISLOGAN GLEBM: Hyperventilation—analysis of clinical symptomatology, Ann. Int. Med., 1947, xxvii, 683. Google Scholar6. ENGELROMANO MDJ: Studies of syncope. IV. Biologic interpretation of vasodepressor syncope, Psychosom. Med., 1947, ix, 288. CrossrefGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: Monterey, California*Read before the Regional Meeting of the American College of Physicians, Topeka, Kansas, March 19, 1948.From the Department of Medicine, Winter Veterans Administration Hospital, Topeka, Kansas. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byDie cerebralen Anfallsleiden: Genuine Epilepsie, symptomatische Hirnkrämpfe und die Narkolepsie 1 June 1949Volume 30, Issue 6Page: 1143-1155KeywordsElectroencephalographyHospital medicineSyncope Issue Published: 1 June 1949 PDF downloadLoading ...
Abstract 19852: The Relationship Between Obesity and Heart Failure is Stronger than Those for Other CVD Subtypes and Not Explained by Traditional Risk Factors
Authors: Chiadi Ndumele, Kunihiro Matsushita, Mariano Lazo, Natalie A Bello, Roger S Blumenthal, Gary Gerstenblith, Vijay Nambi, Christie Ballantyne, Scott D Solomon, Elizabeth Selvin, Aaron Folsom, Josef Coresh
Journal: Circulation (2014)

Background: Although obesity is a risk factor for various subtypes of cardiovascular disease (CVD), the mechanisms responsible for these relationships likely differ. Limited studies have prospectively compared the associations between obesity and CVD subtypes within the same population. Hypothesis: We hypothesized that the association of obesity with heart failure (HF) is stronger than those with other subtypes of CVD, and not fully explained by traditional risk factors. Methods: We followed 13,730 ARIC participants without CVD at baseline (1987-1989) and with body mass index (BMI) ≥18.5 kg/m2. BMI (kg/m2) was categorized as normal (18.5-24.9), overweight (25-29.9), obese (30-34.9) and severely obese (≥35). Participants were followed prospectively for incident HF, coronary heart disease (CHD), and stroke. Cox regression models with adjustment for demographic and traditional CVD risk factors were constructed to estimate the associations between BMI and CVD subtypes. Seemingly unrelated regression was used to compare coefficients for the different risk associations, to account for correlations in the error terms. Results: The mean age was 54 years (SD +/- 6) and 56% were female. Over a median follow-up of 23 years, there were 2,090 HF events, 1,577 CHD events, and 948 strokes. Incident HF demonstrated the highest hazard ratios in association with higher BMI among CVD subtypes in all models, and was the only CVD subtype demonstrating significant associations with higher BMI categories in the fully adjusted model (Table). Indeed, in the fully adjusted model, the risk coefficient between severe obesity and HF was significantly greater than those for CHD and stroke (both p&lt;0.0001). Conclusions: The relationship between obesity and HF was stronger than those for other CVD subtypes, and was not explained by traditional risk factors. Research efforts should focus on elucidating non-traditional pathways linking obesity to HF and devising novel preventive strategies.
Abstract 17453: Clinical Features of Peripartum Spontaneous Coronary Artery Dissection
Authors: Marysia S Tweet, Sharonne N Hayes, Rajiv Gulati, Carl H Rose, Patricia J Best
Journal: Circulation (2014)

Background: Spontaneous coronary artery dissection (SCAD) is the principal cause of peripartum myocardial infarction (MI). Clinical features remain incompletely understood. Methods: Medical records of all women enrolled in a SCAD registry at the Mayo Clinic were reviewed to identify those who were either pregnant or ≤12 weeks postpartum at time of initial event. Diagnosis of SCAD was confirmed with coronary angiography in all cases. Obstetrical outcomes and incidence of recurrent SCAD events were assessed. Results: In total, 38 of 363 women enrolled in the registry met criteria for peripartum MI due to SCAD. Mean age at time of SCAD was 36±3 (range 27-42) years; 3 patients were pregnant at the time of initial event, and all pregnancies except 2 resulted in a live birth. Ten (26%) were diagnosed with multivessel SCAD (MV-SCAD). Most (60%) postpartum events occurred within 30 days of delivery. Antecedent co-morbidities included gestational hypertension/preeclampsia (9), fibromuscular dysplasia (7), gestational diabetes (4), and mixed connective tissue disease (1). Compared to US population birth data, women with peripartum SCAD were more likely to be ≤ 30 years at the time of first delivery (60% vs 42%) and more often multiparous (80% vs 59%). On long-term follow-up (median 3.7 years, IQR 1.1-7.1), 5 (13%) women experienced recurrent SCAD, with one episode occurring following a subsequent pregnancy. MV-SCAD was not associated with increased risk of recurrence (p=0.44). Conclusion: Women with peripartum SCAD are both older than the general obstetrical population at the time of first pregnancy and frequently multiparous at time of initial SCAD event. The highest frequency of SCAD was encountered during the first postpartum month, suggesting variations in hormonal and hemodynamic factors may contribute to SCAD events in susceptible women.
Abstract 2525: Identification and characterization of class I HDAC-specific small-molecule inhibitors with a novel pharmacophore
Authors: Yunfei Wang, Ryan Stowe, Christie E. Pinello, Lisa Y. Zhao, Guimei Tian, Peter Hodder, William R. Roush, Daiqing Liao
Journal: Cancer Research (2014)

Abstract Small-molecule inhibitors of HDACs (HDIs) have therapeutic potentials for treating cancer, metabolic disorders, cardiovascular diseases and neurodegenerative maladies. Two FDA-approved HDIs (vorinostat and romidepsin) are in clinical use for cancer therapy and a variety of other HDIs have been actively tested in clinical trials. Current challenges facing drug development of HDIs include the lack of isoform specificity, undesirable toxicity and suboptimal therapeutic efficacy against solid tumors. Most HDIs in preclinical or clinical evaluations belong to the hydroxamic acid or aminobenzamide classes. The former class lacks isoform specificity and the latter has not yet been approved for clinical use. Thus, the identification of HDIs with novel chemical properties and isoform-specificity may unleash the considerable therapeutic potential of targeting HDACs. We have conducted a high-throughput screening of &amp;gt;620,000 compounds and identified a lead with a hitherto undescribed pharmacophore with an inhibitory specificity against the class I HDACs, and a low two-digit nanomolar potency. An array of synthetic analogs established the structure-activity relationship. These novel inhibitors induced histone hyperacetylation, suppressed cancer cell proliferation of diverse cancer cell lines including the NCI-60 panel, and malignant cell-biological features associated with tumor metastasis. These compounds are under active preclinical development for cancer therapy. Citation Format: Yunfei Wang, Ryan Stowe, Christie E. Pinello, Lisa Y. Zhao, Guimei Tian, Peter Hodder, William R. Roush, Daiqing Liao. Identification and characterization of class I HDAC-specific small-molecule inhibitors with a novel pharmacophore. [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 2525. doi:10.1158/1538-7445.AM2014-2525
Abstract #5543: Lovastatin induces apoptosis of ovarian cancer cells and modulates the efficacy of chemotherapeutics: Implications for patient treatment
Authors: Anna Martirosyan, James Clendening, Carolyn Goard, Linda Penn
Journal: Cancer Research (2009)

AACR Annual Meeting-- Apr 18-22, 2009; Denver, CO

The statin family of cholesterol control agents have recently been shown to have promise as anticancer therapeutics. By inhibiting HMG CoA reductase (HMGCR) and the mevalonate pathway, statins can trigger cells from certain tumor types to undergo apoptosis, in the absence of damage to normal, non-transformed cells. To maximally exploit these readily available agents for patient care, it is important to both identify statin-sensitive tumor types and delineate the mechanisms of statin-induced apoptosis. In this report we show that lovastatin can trigger ovarian cancer cells to undergo apoptosis by two complementary anticancer mechanisms. We first demonstrate that human ovarian cancer cells are sensitive to lovastatin-induced apoptosis via inhibition of HMGCR, independently of p53 mutation status. Second, we show that lovastatin synergizes with doxorubicin, a chemotherapeutic used to treat drug-resistant disease, by a mechanism that increases intracellular doxorubicin within drug-resistant cells. This activity does not depend upon HMGCR inhibition, but instead inhibits P-glycoprotein-mediated drug efflux. Elevated doxorubicin retention is accompanied by enhanced DNA damage and apoptosis, arguing for the combination of lovastatin and doxorubicin to treat drug-resistant cancers, including ovarian cancer. While previous studies exploring the effect of lovastatin on P-gp were limited, our results are made distinctly more relevant to the clinic. To achieve this, we used human cell systems selected to overexpress human P-glycoprotein as well as physiologically attainable concentrations of both doxorubicin and lovastatin in its biologically relevant acid form. This work should serve as evidence that chemotherapeutics combined with statins may have profound, synergistic effects. Whether these effects are positive or negative may depend on several variables which need to be explored. Ultimately, exploiting the ability of statins to both trigger apoptosis and block P-glycoprotein should be done in such a way to maximize anticancer activity without increasing toxicity.

Citation Information: In: Proc Am Assoc Cancer Res; 2009 Apr 18-22; Denver, CO. Philadelphia (PA): AACR; 2009. Abstract nr 5543.
Aqueous misdirection after glaucoma drainage device implantation
Authors: David S. Greenfield, Celso Tello, Donald L. Budenz, Jeffrey M. Liebmann, Robert Ritch
Journal: Ophthalmology (1999)

Objective To describe the clinical presentation, outcome, and possible underlying mechanism of aqueous misdirection after glaucoma drainage device implantation. Design Retrospective, noncomparative, interventional case series. Participants Ten eyes (five primary open-angle glaucoma, four chronic angle-closure glaucoma, one nanophthalmos) of nine patients with a mean age of 68.5 ± 12.0 years (range, 43–83 years). Intervention The authors reviewed the medical records of all patients with a clinical diagnosis of aqueous misdirection after Baerveldt glaucoma drainage device implantation at two tertiary care referral centers from October 1992 to October 1997. Surgery was performed in a standardized fashion; all drainage tubes were inserted in the anterior chamber and occluded with an external 7–0 polyglactin ligature. All eyes were treated with topical corticosteroids, cycloplegia, and aqueous suppressants. Eyes with persistent aqueous misdirection received neodymium:YAG (Nd:YAG) hyaloidotomy or pars plana vitrectomy. Main outcome measures Visual acuity, intraocular pressure, biomicroscopic anterior chamber depth, and antiglaucomatous medication. Results All eyes had axial shallowing of the anterior chamber, one or more patent iridotomies, and no ophthalmoscopic or B-scan ultrasonographic evidence of serous or hemorrhagic ciliochoroidal detachment. Median time to the development of angle-closure glaucoma was 33.5 days (range, 1–343 days) and mean intraocular pressure at diagnosis was 27.7 ± 18.7 mmHg (range, 10–62 mmHg). Normalization of anterior segment anatomy was achieved with aqueous suppression and cycloplegia (one eye); Nd:YAG capsulotomy (four eyes); pars plana vitrectomy alone (two eyes) or with lensectomy (one eye), and pars plana vitrectomy with intraocular lens explanation (two eyes). Mean final intraocular pressure was 14.1 ± 6.0 mmHg at a mean follow-up of 9.1 ± 7.8 months after the development of aqueous misdirection (range, 1–23 months). Conclusions Aqueous misdirection may develop days to months after glaucoma drainage device implantation. In this series, there was a poor response to medical therapy, and normalization in anterior chamber depth required aggressive laser and surgical therapy.
Allergic to life: psychological factors in environmental illness
Authors: G E Simon, W J Katon, P J Sparks
Journal: American Journal of Psychiatry (1990)

Environmental illness is an increasingly frequent and medically unexplained syndrome of "allergy" to common environmental agents. A recent outbreak of chemical-induced illness allowed study of psychological factors in environmental illness. Thirty-seven symptomatic plastics workers completed structured diagnostic interviews and self-report measures of somatization and psychopathology. The 13 subjects who developed environmental illness scored higher on all measures than those who did not. The greatest differences were in prior history of anxiety or depressive disorder (54% versus 4%) and number of medically unexplained physical symptoms before exposure (6.2 versus 2.9). These findings suggest that psychological vulnerability strongly influences chemical sensitivity following chemical exposure.
Predictors of New‐Onset Widespread Pain in Older Adults: Results From a Population‐Based Prospective Cohort Study in the UK
Authors: John McBeth, Rosie J. Lacey, Ross Wilkie
Journal: Arthritis & Rheumatology (2014)

Objective In older adults, widespread pain (WP) is common, although its etiology is unclear. This study sought to identify factors associated with an increased risk of developing WP in adults age ≥50 years. Methods A population‐based prospective study was conducted. A baseline questionnaire was administered to subjects to collect data on pain, psychological status, lifestyle and health behaviors, and sociodemographic and clinical factors. Participants free of WP (as defined by the American College of Rheumatology 1990 criteria for fibromyalgia) were followed up for 3 years, and those with new‐onset WP at followup were identified. Logistic regression analyses were used to test the relationship between baseline factors and new‐onset WP. Multiple imputation was used to test the results for sensitivity to missing data. Results In this population‐based study, 4,326 subjects (1,562 reporting no pain at baseline and 2,764 reporting some pain at baseline) participated at followup. Of these participants, 800 (18.5%) reported a status of new WP at followup (of whom, 121 [7.7%] had reported no pain at baseline and 679 [24.6%] had reported some pain at baseline). The majority of the study factors were associated with new‐onset WP. However, only a few factors showed a persistent association with new‐onset WP in the multivariate analysis, including age (odds ratio [OR] 0.97, 95% confidence interval [95% CI] 0.96–0.99), baseline pain status (OR 1.1, 95% CI 1.08–1.2), anxiety (OR 1.5, 95% CI 1.01–2.1), physical health‐related quality of life (OR 1.3, 95% CI 1.1–1.5), cognitive complaint (OR 1.3, 95% CI 1.04–1.6), and nonrestorative sleep (OR 1.9, 95% CI 1.2–2.8). These associations persisted after adjustment for the presence of diffuse osteoarthritis (OA), which led to a modest increase in model fit (C‐statistic 0.738, compared with 0.731 in the model excluding diffuse OA). The results were not sensitive to missing data. Conclusion Of the factors measured in this study, nonrestorative sleep was the strongest independent predictor of new‐onset WP.
Beta-blocker therapy for secondary prevention of myocardial infarction in elderly diabetic patients
Authors: Jersey Chen, Thomas A Marciniak, Martha J Radford, Yun Wang, Harlan M Krumholz
Journal: Journal of the American College of Cardiology (1999)

We sought to determine the use and association with one-year mortality of beta-blocker therapy for the treatment of acute myocardial infarction (AMI) in elderly diabetic patients and to examine whether beta-blocker therapy was associated with increased rates of hospital readmission for diabetic complications traditionally associated with beta-blockers.Although many randomized trials have demonstrated that beta-blockers are effective in reducing mortality after AMI, some experts are concerned about the use of beta-blockers in diabetic patients. Little is known about the effectiveness and complication rate of beta-blocker therapy after AMI for elderly diabetics in community practice settings.We conducted a retrospective cohort study using the National Cooperative Cardiovascular Project, which contained data abstracted from hospital medical records of Medicare beneficiaries admitted with an AMI during 1994 and 1995.Out of 45,308 patients without contraindications to beta-blocker therapy, 7.4% were insulin-treated diabetics and 18.5% were non-insulin-treated diabetics. Beta-blockers were prescribed at discharge for 45% of insulin-treated diabetics, 48.1% of non-insulin-treated diabetics and 51% of nondiabetics (p < 0.001). After adjusting for demographic and clinical factors, diabetics continued to be less likely to receive beta-blockers at discharge compared with nondiabetics (odds ratio [OR] for insulin-treated diabetics 0.88, 95% confidence interval [CI] 0.82 to 0.96; OR for non-insulin-treated diabetics 0.93, 95% CI 0.88 to 0.98). After adjusting for potential confounders, beta-blockers were associated with lower one-year mortality for insulin-treated diabetics (hazard ratio [HR] = 0.87, 95% CI 0.72 to 1.07), non-insulin-treated diabetics (HR = 0.77, 95% CI 0.67 to 0.88) and nondiabetics (HR = 0.87, 95% CI 0.80 to 0.94). Beta-blocker therapy was not significantly associated with increased six-month readmission rates for diabetic complications among diabetics and nondiabetics.Beta-blockers are associated with a lower one-year mortality rate for elderly diabetic patients to a similar extent as for nondiabetics, without increased risk of readmission for diabetic complications. Increasing the use of beta-blockers in elderly diabetic patients represents an opportunity to improve the care and outcomes of these patients after AMI.
Abstract 19885: Impact of Cardiovascular Risk Factors on rAAV.Thymosin ß4 Mediated Vascular Regeneration in Large Animals
Authors: Rabea Hinkel, Andrea Howe, Sarah Straub, Wira Husada, Seugmin Lee, Ildiko Bock-Marquette, Simone Renner, Eckhard Wolf, Christian Kupatt
Journal: Circulation (2014)

Diabetes and hypercholesterolemia are two of the major risk factors for developing cardiovascular disease, especially in combination with chronic myocardial ischemia it represents one of the most common causes of disability or death. New pro-angiogenic factors like Thymosin ß4 (Tß4), a small 4.9 kDa peptide influences cell motility and migration might be suitable for inducing therapeutic neovascularization in chronic myocardial ischemia a cardiovascular risk factors. Methods: Chronic ischemia was induced via reduction stent graft in the circumflex artery, leading to a total occlusion on day 28 (d28). Beside wildtyp animals (wt) ± high fat diet (hypercholesteric (hyp), choselsterol 78±1 wt vs 90±2 hyp), d iabetic transgenic pigs were used (increased blood glucose 305 ±12 mg/dL) . Regional application of rAAV Tß4 (5x10E12 viral particles, d28) was performed in wt, hyp and diabetic pigs respectively. Global myocardial function was obtained at day 28 and 56. Regional myocardial function and post mortem angiography were examined on day 56. Histological analysis of capillary density (capillaries/field (C/F)) was performed in the ischemic tissue. Results: rAAV.Tß4 transduction significantly enhanced capillaries (278±6 vs. 148±6 c/hpf) and collaterals (9±1 vs. 3±1) compared to control wt animals. Furthermore, global (EF: 47±4 vs. 29±3 %); and regional myocardial function (SES at 150 b/min: 73±5 vs. 10±6 % of non-ischemic area) were increased after Tß4 overexpression. In the models of cardiovascular risk factors and chronic myocardial ischemia increased neovascularization and improved myocardial function could be achieved after rAAV Tß4 application, albeit at a lower level (capillaries: diabetic: 190±4 (Tß4) vs. 120±5 (control) c/hpf hyp: 188±6 (Tß4) vs 130±12 (control) c/hpf; collaterals: diabetic: 4±1 (Tß4) vs. 2±1 (control) hyp: 6±1 (Tß4) vs 3±1 (control); EF: diabetic: 32±2 % (Tß4) vs. 27±1 % (control) hyp: 42±4 % (Tß4) vs 28±3 % (control)). Conclusion: Long term Thymosin ß4 expression induced neovascularization and improved myocardial perfusion and function even in pigs with additional risk factors. Therefore, rAAV.Tß4 appears suitable for treatment of ischemic cardiomyopathy associated with these cardiovascular risk factors.