tbuckley/cabot-search huggingface dataset:
Rethinking sexual health clinics
Authors: R. Sockanathan
Journal: BMJ (1995)

In a reply to their article Rethinking Sexual Health Clinics Yvonne Stedman and Max Elstein are right to suggest that sexual health clinics should be provided under one roof. Patients would get a better and distinctive service by an experienced well trained trusted doctor as opposed to the current situation in which services are provided by different professionals at various times. Providing sexual health care under one roof would enable the Health of the Nations targets to be achieved with minimum cost to the government. Three studies showed that among female patients attending genitourinary medicine clinics 37 of 356 were at risk of an unwanted pregnancy only 33 of 71 adolescent females used oral contraceptives and 78 of 159 under 16 years old were not using any contraception. These figures clearly indicate the need for family planning and sexual health and genitourinary medicine services to be under one roof. As a specialist in genitourinary medicine the author now offers contraceptive advice to patients who require it but does not prescribe as facilities are not readily available except for emergency contraception. The unwanted delay in treatment of genitourinary infection leads to avoidable morbidity. It would be ideal if the Joint Committee on Higher Medical Training of the Royal College of Physicians integrated with the education and training committee of the Faculty of Family Planning and Reproductive Health care of the Royal College of Obstetricians and Gynaecologists to formulate a structured training program in family planning and reproductive health care to be made available to trainee specialists in genitourinary medicine. If this could be implemented a comprehensive sexual health service would be available in the National Health Service ensuring better care.
Abstract 17889: Sequential Side-Main-Side Branch Balloon Dilation - Sms Technique - As an Alternative to Final Kissing Balloon Inflation in Bifurcation Lesions Treated with Provisional Stenting
Authors: Alfonso Medina, Pedro Martín, Javier Suarez de Lezo, Manuel Pan, Jose Nóvoa, Jose Suárez de Lezo, Francisco Melián, Francisco Mazuelos, Eduardo Caballero, Jose Segura
Journal: Circulation (2011)

Introduction. Final kissing balloon inflation is recommended in provisional stenting in order to accommodate the stent to the bifurcation anatomy. However KBI induces an asymmetry in the proximal stent and does not totally correct the deformation induced under the side branch origin after isolated SB dilation. Objective. To evaluate with IVUS the scaffolding and changes in stent geometry with a new sequential balloon dilation technique which we named SMS-technique. Methods. 63 patients with a true bifurcation coronary lesion (LM 4, LAD 47, LCx 10 and RCA 2) were treated with the SMS technique (Figure). The stent diameter was selected using the distal main branch (MB) reference, then (S) side branch balloon angioplasty was performed with a balloon selected according to its diameter. (M) another balloon, selected according to the proximal main branch reference diameter, was inflated proximally and at the carinal region. (S) final balloon angioplasty of the side branch (SB). An IVUS study was performed at each step. Results. Primary success was obtained in all lesions. Two patients needed a second stent. The table shows the quantitative IVUS findings at each step (*p&lt;0,01). After SMS technique, complete apposition at the proximal stent segment was achieved in all cases. No cases of stent thrombosis were recorded. Conclusion. The SMS technique provides optimal apposition of the stent at the proximal segment of the MB and correction of the stent deformation under the SB origin.
Disruption of the Purine Nucleotide Cycle
Authors: Richard L. Sabina, Judith L. Swain, Bernard M. Patten, Tetsuo Ashizawa, William E. O'Brien, Edward W. Holmes
Journal: Journal of Clinical Investigation (1980)

A patient with symptoms of easy fatigability, postexercise myalgias, and delayed recovery of muscle strength after activity is described. Skeletal muscle from this patient had <1.0% normal myoadenylate deaminase activity and NH3 was not released from muscle after ischemic exercise. In association with this enzyme deficiency, exercise led to a >90% reduction in muscle content of adenine nucleotides. No inosine monophosphate accumulated after exercise and total purine content of the muscle fell to 21% of control. Repletion of the adenine nucleotide pool in this patient was delayed compared to controls, and ATP content had only returned to 68% of control at 165 min after exercise. These studies demonstrate that disruption of the purine nucleotide cycle as a consequence of myoadenylate deaminase deficiency results in marked alterations in ATP content of muscle, and potentially, these changes in ATP content could account for muscle dysfunction in this patient.
Controlled Hypothermia
Authors: P. M. Hellings
Journal: BMJ (1958)

Hypothermia is a technique of comparatively recent application, and may be described as a method of reducing the normal body temperature of the whole patient.The method was first practised by Smith and Fay (1939) in the attempted treatment of neoplasms, with a view to slowing the rate of tumour growth at lowered temperatures.More recently McQuiston (1949) used hypothermia during cardiac surgery carried out on hypoxaemic child- ren.Further interest was taken in this when Bigelow et al. (1950) suggested that the lowered oxygen demand of the brain during hypothermia would protect it against ischaemia during intracardiac operations.Since then the method has been used extensively as an aid to cardiac surgery.The application of hypothermia to neurosurgical con- ditions is of more recent origin.Rosomoff and Gilbert (1955) noted a reduced brain volume when experiment- ing with dogs under hypothermia, and accordingly re- commended its use in neurosurgery.Lougheed et al.(1955) folowed with a report on two cases in which hypothermia had been used for the surgical treatment of vascular lesions, and Botterell et al. (1956) reported on the use of hypothermia in the management of 22 cases of intracranial aneurysms., The Investigation Thus the value of hypothermia in the treatment of neuro- surgical conditions had been established on a broad basis by the end of 1956, when work was begun with a view to developing a practical and routine method for use with a busy neurosurgical unit.From November, 1956, until December, 1957, 123 patients whose ages ranged from 6 to 78 years were treated under hypothermia.This paper shows how the routine method was evolved and established.At the outset an unselected series of ruptured intracranial aneurysms and angiomas were treated surgically under hypothermia; later, when it became evident that the method was safe and the value of the improved operating conditions was appreciated, confidence grew, and the method was used SHIVERING V-LV SYSTOIC B.P. r X X TEMPERATVRE
Abstract 3744: Cystatin C Is Associated With Mitral Annular Calcification In Elderly Adults: Results From The Cardiovascular Health Study
Authors: Folkert W Asselbergs, Dariush Mozaffarian, Ronit Katz, Bryan Kestenbaum, Linda F Fried, John S Gottdiener, Michael G Shlipak, David S Siscovick
Journal: Circulation (2007)

Background : A high prevalence of cardiac calcification has been observed in patients with end-stage kidney disease. The association between cardiac calcification and milder kidney disease has been less thoroughly characterized. We hypothesize that renal function is associated with mitral annular calcification (MAC), aortic annular calcification (AAC), and aortic valve sclerosis (AVS) in elderly. Methods and results : From the Cardiovascular Health Study (CHS), we analyzed 3,929 subjects (74 ± 5 years, 60% women), who underwent a 2-dimensional echocardiogram between 1994 –1995. Measures of kidney function were creatinine-based estimated glomerular filtration rate (eGFR) as calculated by the MDRD equation and cystatin C levels. MAC was present in 42 %, AAC in 44%, and AVS in 54% of the subjects. Subjects with MAC, AAC, and AVS were significantly older and significantly more subjects used anti-hypertensive medication and had prevalent cardiovascular disease (p&lt;0.05). Participants with MAC had higher blood pressure levels, LDL-cholesterol levels, waist to hip ratio, fibrinogen levels and a higher prevalence of diabetes (p&lt;0.05). Participants with AVS were more likely to be male, had higher systolic blood pressure, lower HDL-cholesterol, and higher waist to hip ratio (p&lt;0.05). Levels of cystatin C were significantly higher in subjects with MAC in comparison to subjects without MAC (mean ± standard deviation 1.12 ± 0.33 versus 1.07 ± 0.25 mg/L, p&lt;0.001). We found similar differences in those with and without AAC (1.11 ± 0.33 versus 1.07 ± 0.25 mg/L, p&lt;0.001). Using logistic regression analysis, there was a significant and graded association between quartiles of Cystatin C levels and MAC (adjusted odds ratios and 95% confidence intervals) 1.0, 1.09 (0.91 to 1.32), 1.16 (0.96 to 1.40), and 1.27 (1.04 to 1.55) for quartiles 1 through 4 respectively (p for trend 0.017). In addition, Cystatin C levels were significantly associated with AAC (p&lt;0.001), but this association became non-significant after adjustment for co-variates (p&lt;0.174). No associations were present between Cystatin C and aortic sclerosis, and eGFR and cardiac calcifications. Conclusion : Cystatin C was significantly associated with the presence of MAC in a population-based cohort of elderly.
n–3 Fatty Acids in Patients with Cardiac Risk Factors
Authors: M Carla Roncaglioni, Massimo Tombesi, M Giuseppina Silletta
Journal: New England Journal of Medicine (2013)

To the Editor: In the study by the Risk and Prevention Study Collaborative Group (May 9 issue),1 Roncaglioni et al. describe the cardiovascular effects of supplementation with 1 g of n–3 fatty acids on cardiovascular outcomes. The same dose was used and the same null difference in outcomes was found in the Outcome Reduction with an Initial Glargine Intervention (ORIGIN)2 trial. As in the ORIGIN trial, the authors used olive oil as a placebo. Olive oil is a source of monounsaturated fatty acids, which have been associated with beneficial changes in lipid metabolism and possibly with a reduced risk of incident events of coronary heart disease.2,3 I wonder whether the negative results of this trial could be explained by the relatively low dose of n–3 fatty acids and the comparison with a placebo that is actually not a true placebo but rather a source of fatty acids with beneficial effects. I think it is time to test the possibility that the pleiotropic effects of higher doses of n–3 fatty acids4 may be associated with a cardiovascular benefit.
Albumin Replacement in Severe Sepsis or Septic Shock
Authors: Christian J. Wiedermann, Michael Joannidis
Journal: New England Journal of Medicine (2014)

To the Editor: The Albumin Italian Outcome Sepsis study conducted by Caironi et al. (April 10 issue)1 is the third large-scale, randomized trial to compare albumin with crystalloids in adult patients with severe sepsis. The first such trial was the Saline versus Albumin Fluid Evaluation study.2 In addition, the Early Albumin Resuscitation during Septic Shock study has been completed and its mortality results published.3 In all three trials, mortality was lower among patients receiving albumin, and the respective relative risks coincided closely, ranging from 0.87 to 0.94 (Fig. 1). Although the effect did not attain statistical significance in any of the individual trials, the pooled relative risk in all three trials is 0.92 (95% confidence interval [CI], 0.84 to 1.00; P = 0.046), indicating a significant reduction in mortality associated with albumin use among adults with severe sepsis. This result supports the conclusion of a previous metaanalysis involving predominantly small trials with different control fluids and patient populations.4 The result is also consistent with the observed reduction in mortality associated with albumin use among patients with spontaneous bacterial peritonitis, a disease that shares important pathophysiological features with severe sepsis.5
Abstract 2953: Myocardial Uptake of 7′(Z)-[ <sup>123</sup> I]Iodorotenone During Vasodilator Stress in Dogs with Coronary Stenoses
Authors: Alexis Broisat, Mirta Ruiz, Henry F VanBrocklin, Norman C Goodman, Stephen M Hanrahan, Mustafa Janabi, Denny D Watson, George A Beller, David K Glover
Journal: Circulation (2007)

There is a well recognized need for a new generation of SPECT perfusion tracers with improved myocardial extraction over a wide flow range. 7′(Z)-[ 123 I]Iodorotenone (ZIROT) is a new myocardial perfusion imaging (MPI) agent with excellent myocardial uptake and favorable biodistribution. Our objective was to fully characterize the myocardial ZIROT extraction vs flow relationship during vasodilator stress in a large animal model. Accordingly, the adenosine A 2A receptor agonist ATL-146e was infused i.v. (0.3 μg/kg/min) in 5 anesthetized, open-chest dogs with critical LAD stenoses. When LCx flow was maximal, 111 MBq (3mCi) of ZIROT and microspheres were co-injected and the dogs were euthanized 5 min later. The LV was divided into 4 short axis slices for ex vivo imaging followed by gamma well counting of myocardial segments. At the time of ZIROT injection, transmural flow in the stenotic LAD zone was similar to baseline (0.90 ± 0.22 vs 0.87 ± 0.11 ml/min/g, respectively P = NS), whereas normal LCx zone flow increased significantly (3.25 ± 0.51 vs 1.00 ± 0.17 ml/min/g, P&lt;0.05). As shown, myocardial ZIROT extraction tracked regional myocardial blood flow better than either 201 thallium or 99m Tc-sestamibi in our previous studies using a similar canine model. Furthermore, the ZIROT LAD/LCx activity ratios obtained by ex vivo imaging or gamma well counting (0.42 ± 0.08 and 0.45 ± 0.1 respectively) only slightly underestimated the LAD/LCx microsphere flow ratio (0.32 ± 0.09). The ability of ZIROT to more accurately track blood flow over a wide range makes it a very promising new MPI agent with potential for improved CAD detection and better quantitative estimation of the severity of flow impairment.
Stability of mood despite HIV illness progression in a group of homosexual men
Authors: J G Rabkin, R R Goetz, R H Remien, J B Williams, G Todak, J M Gorman
Journal: American Journal of Psychiatry (1997)

The authors investigated the association between mood status and progression of HIV illness.In a research clinic at a university medical center, 112 HIV-positive and 52 HIV-negative homosexual men were enrolled in a 4-year prospective study with semi-annual assessments. The main study measures were psychiatric diagnoses according to the Structured Clinical Interview for DSM-III-R; level of functioning and psychiatric symptoms according to the Global Assessment of Functioning Scale (axis V, DSM-III-R), the Hamilton depression and anxiety scales, the Brief Symptom Inventory, and the Beck Hopelessness Scale; stage of HIV illness; and CD4 cell count.Among the HIV-positive men, there was no increase in rates of syndromal depression and anxiety over the 4 years despite substantial HIV illness progression. On all occasions, mean psychopathology symptom ratings were within the normal or not depressed range. However, compared to the HIV-negative men, the HIV-positive men had slightly more anxiety and somatic depressive symptoms throughout. The only measure that showed an increase in distress over time was orientation to the future; among the HIV-positive men, hopes for the future waned across assessments. Attrition in the group was largely attributable to the loss of men with lower CD4 cell counts and more advanced HIV illness. However, study dropouts did not differ on any psychiatric measure from subjects who remained during the first 3 years.In this group no significant increase in syndromal or symptomatic depression or anxiety over nine semiannual assessments was found, despite substantial HIV illness progression and some deaths. Psychopathology did not predict dropout or death.
Birth Weight, Ethnicity, and Exposure to Trihalomethanes and Haloacetic Acids in Drinking Water during Pregnancy in the Born in Bradford Cohort
Authors: Rachel B. Smith, Susan C. Edwards, Nicky Best, John Wright, Mark J. Nieuwenhuijsen, Mireille B. Toledano
Journal: Environmental Health Perspectives (2015)

Evidence for a relationship between trihalomethane (THM) or haloacetic acid (HAA) exposure and adverse fetal growth is inconsistent. Disinfection by-products exist as complex mixtures in water supplies, but THMs and HAAs have typically been examined separately.We investigated joint exposure at the individual level to THMs and HAAs in relation to birth weight in the multi-ethnic Born in Bradford birth cohort.Pregnant women reported their water consumption and activities via questionnaire. These data were combined with area-level THM and HAA concentrations to estimate integrated uptake of THMs into blood and HAA ingestion, accounting for boiling/filtering. We examined the relationship between THM and HAA exposures and birth weight of up to 7,438 singleton term babies using multiple linear regression, stratified by ethnicity.Among Pakistani-origin infants, mean birth weight was significantly lower in association with the highest versus lowest tertiles of integrated THM uptake (e.g., -53.7 g; 95% CI: -89.9, -17.5 for ≥ 1.82 vs. < 1.05 μg/day of total THM) and there were significant trends (p < 0.01) across increasing tertiles, but there were no associations among white British infants. Neither ingestion of HAAs alone or jointly with THMs was associated with birth weight. Estimated THM uptake via showering, bathing, and swimming was significantly associated with lower birth weight in Pakistani-origin infants, when adjusting for THM and HAA ingestion via water consumption.To our knowledge, this is the largest DBP and fetal growth study to date with individual water use data, and the first to examine individual-level estimates of joint THM-HAA exposure. Our findings demonstrate associations between THM, but not HAA, exposure during pregnancy and reduced birth weight, but suggest this differs by ethnicity. This study suggests that THMs are not acting as a proxy for HAAs, or vice-versa.Smith RB, Edwards SC, Best N, Wright J, Nieuwenhuijsen MJ, Toledano MB. 2016. Birth weight, ethnicity, and exposure to trihalomethanes and haloacetic acids in drinking water during pregnancy in the Born in Bradford cohort. Environ Health Perspect 124:681-689; http://dx.doi.org/10.1289/ehp.1409480.
Abstract 18955: VSMC-Targeted Aptamer-siRNA Chimeras as Inhibitors of Intimal Hyperplasia
Authors: William H Thiel, Thomas Bair, Andrew S Peek, Bojana Stanic, Maysam Takapoo, Jennifer Streeter, Xiuying Y Liu, Mark A Behlke, Francis J Miller, Paloma H Giangrande
Journal: Circulation (2012)

Arterial revascularization by stenting is associated with restenosis due to proliferation of vascular smooth muscle cells (VSMCs) and intimal hyperplasia. Although the use of cell cycle inhibitors in drug eluting stents (DES) has reduced the rate of in-stent restenosis, this approach also inhibits re-endothelialization, thereby requiring prolonged antithrombotic regimens to prevent stent thrombosis. Delivery of nucleic acid aptamers by DES is a potential novel approach due to their high specific binding affinity and potential for modification by medicinal chemistry. The goal of this study was to identify RNA aptamers that (1) internalize into VSMCs and/or (2) specifically inhibit VSMC activation. Using an in vivo compatible RNA aptamer library, VSMC-specific aptamers were selected using a cell-internalization SELEX (systematic evolution of ligands by exponential enrichment) process with iterative rounds of positive selection using VSMCs and negative selection using endothelial cells (ECs). The top candidate aptamers demonstrated 15-20-fold specificity for internalization into cultured VSMCs vs . ECs. Specificity of these aptamers was confirmed by ex vivo studies that demonstrated preferential internalization into denuded, but not endothelium-intact, aortic segments. In addition, several of the VSMC-targeting aptamers exhibited differential effectiveness in inhibiting VSMC migration as measured by Boyden chamber assays. In proof-of-concept delivery studies, we next engineered aptamer-siRNA chimeras using siRNAs targeting Nox1 NADPH oxidase, which has been implicated in intimal hyperplasia. These VSMC-targeting aptamer-siRNA chimeras retain specificity for VSMCs and are being evaluated for efficacy in reducing intimal formation in a murine model of vascular injury. In conclusion, we developed novel VSMC-targeting aptamers that may serve as a platform technology to selectively deliver therapeutics to VSMCs over ECs. The aptamers that inhibited cell migration present an opportunity for dual-action VSMC-targeted therapeutic agents. Future refinement of this panel of VSMC-directed aptamers will enable broader application of targeted therapies for vascular-proliferative diseases.
Abstract 310: Thrombospondin 2 Protects Against Uncontrolled Cardiac Inflammation and Injury During Viral Myocarditis
Authors: Melissa Swinnen, Davy Vanhoutte, Yigal Pinto, Peter Carmeliet, Stephane Heymans
Journal: Circulation (2008)

Background-The matricellular protein thrombospondin 2 (TSP2), a secreted extracellular matrix (ECM) glycoprotein, plays a crucial role in controlling cell-matrix interaction in tissue repair and cancer biology. Our previous data revealed that increased TSP2 reinforces the matrix and protects the against heart failure during hypertension. The present study investigated whether TSP2 may protects against exaggerated cardiac inflammation, injury and dysfunction during viral myocarditis. Methods and Results-Therefore, mortality, cardiac inflammation and function were investigated in TSP2-null (KO) and wild type (WT) mice, and after adeno-associated virus (AAV)-9 mediated TSP-2 overexpression in WT, in a mouse model of coxsackievirus B3 (CVB3)-induced (106 CCID50 ip CBV3, 14 days) myocarditis. Absence of TSP2 resulted in an increased mortality in TSP2-null as compared with WT mice in both viral myocarditis (KO: 37,5% vs WT: 0%; n=8 per group). Histological analysis revealed increased cardiac inflammation (60 % increase of CD3-positive T-lymphocytes), necrosis and injury in TSP2-null compared to WT mice at 14 days of viral myocarditis. Ultrastructural analysis showed increased inflammation, matrix disruption and myocyte injury in absence of TSP2, together resulting in depressed systolic function (% FS; 40.1 ± 2.3 in WT vs. 24.6 ± 1.7 in KO mice, P&lt;0.05) and increased cardiac dilatation (end-diastolic dimensions, mm; 2.6 ± 0.18 in WT vs. 3.6 ± 0.06 in KO mice, P&lt;0.05) at 14 days at echocardiography. In concordance, AAV9-gene transfer of TSP2, with 50 % increase in cardiac TSP-2 expression, significantly reduced cardiac inflammation (60% reduction) and injury at 14 days as compared to control AAV9-GFP. Conclusion-Together, these data clearly point towards a novel protective role for TSP2 against uncontrolled inflammation, myocardial injury and dysfunction in acute viral myocarditis.
Abstract 3700: Impact of Vascular Events on Mortality in AF Patients: Insights from ACTIVE W
Authors: Raffaele De Caterina, Salim Yusuf, Stuart Connolly, Janice Pogue, Jeff Healey, Andrzej Budaj, Susan Chrolavicius
Journal: Circulation (2006)

Background and Methods: Guidelines and clinical decision-making regarding antithrombotic therapy in atrial fibrillation (AF) have focused primarily on stroke prevention. However AF patients on anti...