tbuckley/cabot-search huggingface dataset:
Abstract 16754: Bone Mineral Density is Abnormal in Children with Protein Losing Enteropathy Following the Fontan Procedure
Authors: David J Goldberg, Kathryn Dodds, Catharine M Avitabile, Jill L Brodsky, Andrew C Glatz, Elizabeth B Rand, Edna E Mancilla, Jack Rychik
Journal: Circulation (2011)

BACKGROUND: Protein losing enteropathy (PLE) is a rare but potentially devastating complication of single ventricle physiology following the Fontan operation. Pathological spinal compression fractures have been observed clinically in children with PLE but there are no reports of bone mineral density (BMD), vitamin D [25(OH)D)], or calcium metabolism in this population. OBJECTIVE: To describe abnormalities in BMD in a cross section of children with single ventricle physiology complicated by PLE following the Fontan operation. METHODS: Cross-sectional sample of children and young adults with a confirmed diagnosis of PLE. Serum levels of 25(OH)D, calcium, total protein, and albumin were recorded from the first outpatient encounter of each subject at The Single Ventricle Survivorship Program at The Children's Hospital of Philadelphia. Corrected calcium (cCa) was calculated from the serum calcium and albumin levels. BMD was measured using dual energy X-ray absorptiometry (DXA), and Z-scores were generated using appropriate software. RESULTS: DXA results were available for evaluation in 12 patients (8M/4F). Age at DXA ranged from 7.2 - 25.2 years. The mean Z-score was -1.73 SD for the entire cohort, 42% below -2 SDs. Serum 25(OH)D levels were abnormal in 58%. Mean serum calcium level was 8.6 ± 0.6 mg/dL, mean serum total protein was 5.1 ± 1.1 g/dL, mean serum albumin was 2.9 ± 0.8 g/dL, and mean cCa was 9.4 ± 0.4 g/dL. Of those on chronic corticosteroid therapy, the mean DXA Z-score was -3.15 SD, 67% below -2 SDs. There was a positive correlation between cCa and DXA Z-score and a negative correlation between total protein and DXA Z-score. Patients on corticosteroid therapy had a significantly lower DXA Z-score than those not on corticosteroids (-3.15 vs. -0.31, p=0.02). CONCLUSION: Children with PLE are at risk for abnormal BMD compared to age- and sex-matched controls. There are a number of factors that may contribute to abnormal BMD including corticosteroid use, chronic illness, and protein loss through the enteric mucosa. In this cohort, corticosteroid therapy, a marker of chronic disease, appeared to be associated with decreased BMD. Routine bone health screening is warranted for children with PLE, particularly those receiving corticosteroid therapy.
Abstract 3049: Clinical Outcomes after Urgent Coronary Artery Bypass Surgery in Patients on Clopidogrel: Are the Risks Tangible or Anecdotal?
Authors: Steve K Singh, Nachum Nesher, Nimesh D Desai, Elsyed Elmistekawy, Fuad Moussa, George T Christakis, Bernard S Goldman, Gideon N Cohen, Claude Laflamme, Jeannie Callum, Stephen E Fremes
Journal: Circulation (2007)

PURPOSE : Clopidogrel is indicated in acute and chronic coronary syndromes and often administered prior to angiography. These patients are often sent subsequently for coronary artery bypass grafting (CABG) surgery, where potential increase in bleeding risk must be balanced with risk of ongoing ischemia if CABG delayed. This study aimed to test the hypothesis that patients undergoing urgent CABG who received clopidogrel, versus those who did not, have worse bleeding outcomes and early mortality. METHODS : We reviewed 451 consecutive patients (04/2005–12/2006) who underwent urgent CABG at our institution: 262 never received clopidogrel pre-CABG, 189 received clopidogrel &lt;5 days prior. The latter all received intraoperative antifibrinolytics. The primary endpoint was in-hospital death, massive transfusion (&gt;10U PRBC) or massive blood loss (&gt;2L chest-tube loss/24 hrs). RESULTS : Patient characteristics were comparable between groups. Prior MI (71% vs 46%), NYHA class 3– 4 (94% vs 81%) and prior PCI (22% vs 13%) were higher in the clopidogrel group (p&lt;0.05). Cross-clamp time was statistically higher in the clopidogrel group (97±30 vs 90±28 min, p=0.02); cardiopulmonary bypass and total operative times were similar. There was no difference in the primary endpoint of in-hospital death or massive bleeding indices (clopidogrel: 7% vs no clopidogrel: 6%, p=0.9). Death, bleeding indices, renal failure, post-op MI and stroke, were no different even after adjusting for the date of stopping clopidogrel pre-CABG. Chart audit showed bleeding as a significant contributor to cause of deaths, was no different in either cohort. After multivariable regression analysis, clopidogrel or the duration it was stopped pre-CABG, were not predictors of outcomes (death, MI, stroke or chest reopening for bleeding). Significant independent predictors of the primary endpoint included pre-op renal dysfunction, peripheral vascular disease and pre-op hemoglobin. CONCLUSION : Clopidogrel, or the time it was stopped prior to CABG, was not a risk factor for in-hospital death, massive bleeding, or other poor early outcomes in patients undergoing urgent CABG. Practice measures such as the use of antifibrinolytic agents may ameliorate the adverse effects of clopidogrel.
Abstract 1869: Real-Time Three-Dimensional Echocardiography of the Left Atrial Appendage: Initial Experience in Humans with Validation by 64-Slice Computed Tomography
Authors: Sanjiv J Shah, Dianna M Bardo, Lynn Weinert, Lissa Sugeng, Bradley P Knight, John J Lopez, Roberto M Lang
Journal: Circulation (2007)

Background: Real-time left atrial appendage (LAA) quantification is increasingly important with the advent of LAA occluder devices for stroke prevention. However, accurate quantification is difficult using 2D-TEE because measurements must be made in multiple views, and LAA orifice cannot be viewed directly. We aimed to determine the accuracy of LAA geometry measured by a new matrix-array (mTEE) probe which can provide unique real-time 3D (RT3D) views of the LAA. Methods: 29 consecutive patients (age 53±18) referred for 2D-TEE underwent additional RT3D-mTEE (Philips ie33; frame rate 8–10/s). The LAA orifice diameter and LAA depth were measured from biplane 2D images, and 2D LAA orifice area was calculated as an ellipse. LAA orifice area and LAA depth were measured in 3D and correlated to 2D. In 8 patients who had cardiac CT available, 2D- and 3D-TEE LAA measurements were correlated with 64-slice CT. All LAA measurements were made at atrial end-diastole. Results: All 29 patients underwent RT3D-mTEE without complication. The LAA was well-visualized in 3D in 26/29 (90%). Because the shape of the LAA orifice in 3D was an ellipsoid with an irregular contour, 2D images resulted in underestimation of area vs. 3D (3.0±1.2 vs. 4.2±2.2 cm 2 ). LAA depth by 2D and 3D correlated well (3.7±0.7 vs. 3.4±0.7; r=0.72, p=0.001). CT LAA orifice area correlated well with 3D-TEE (r=0.98, p&lt;0.0001) but not with 2D-TEE (p=0.78). Conclusions: RT3D-TEE for analysis of LAA geometry is safe and feasible and appears to be more accurate than 2D-TEE. RT3D-TEE provides unique visualization of the LAA orifice in real-time, making it the ideal tool for intra-procedural sizing and placement of LAA occluder devices.
Abstract 8193: Echocardiographic Predictors of Progression from Paroxysmal to Persistent Atrial Fibrillation: Result from the Japanese Rhythm Management Trial II for Atrial Fibrillation (J-RHYTHM II) Study
Authors: Takeki Suzuki, Tsutomu Yamazaki, Satoshi Ogawa, Ryozo Nagai, Takeshi Yamashita
Journal: Circulation (2011)

Background: Several clinical factors such as age, hypertension, and heart failure are known to be associated with progression from paroxysmal to persistent atrial fibrillation (AF). On the other hand, which echocardiographic variables are associated with the progression remains unknown. Method: We used 286 patients in the J-RHYTHM II study, a randomized clinical trial examining effect of calcium channel blocker (amlodipine) and angiotensin receptor blocker (candesartan) in Japanese patients with paroxysmal AF and hypertension. Echocardiographic evaluation was performed at baseline. Left ventricular end-diastolic diameter (LVDd), left ventricular end-systolic diameter (LVDs), left ventricular ejection fraction (LVEF), interventricular septum (IVS), left ventricular posterior wall (LVPW), and left atrial dimension (LAD) were measured in a standard manner. The end point was development of persistent AF, defined as incidence of AF lasting for longer than 7 days and/or need of electrical cardioveresion. Cox proportional hazards models were used to examine the associations between echocardiographic variables and development of persistent AF. Results: Among echocardiographic variables, LVDd, LVDs, and LAD were associated with development of persistent AF (Table). Only LAD was significantly associated with progression from paroxysmal into persistent AF after adjustment by after adjustment by age, sex, and other potential confounding factors. One millimeter increase in LAD was associated with 7% increased risk of developing persistent AF (HR 1.07, 95% CI 1.01-1.14). This means that a 10 mm increase in LAD was associated with twice the risk of developing persistent AF (HR 1.97, 95% CI 1.09-3.58). Conclusion: LAD is associated with progression from paroxysmal to persistent AF in patients with paroxysmal AF and hypertension. LAD may be a good echocardiographic predictor of AF progression.
Abstract 82: Preserved Heart Rate Variability During Rapid Head Cooling Correlated to Better Survival and Neurological Outcomes in a Pig Model of Cardiac Arrest
Authors: Yongqin Li, Jun Guan, Denise Barbut, Giuseppe Ristagno, Joe Bisera, Max H Weil, Wanchun Tang
Journal: Circulation (2010)

Background: Rapid head cooling initiated with CPR improves survival and neurological outcomes after prolonged cardiac arrest. However, the effects of head cooling on cardiac electrical activity aft...
Abstract 13068: Measures of Adiposity and Presence of Subclinical Atherosclerosis in Retired National Football League Players
Authors: Salim S Virani, Lisa Pompeii, Andrew E Lincoln, Reginald E Dunn, Andrew M Tucker, Vijay Nambi, Khurram Nasir, Roberrt A Vogel, Nathan D Wong, Arthur J Roberts, Christie M Ballantyne
Journal: Circulation (2011)

Background: It is not known which measure of adiposity (body mass index [BMI] or waist circumference [WC]) is best associated with subclinical atherosclerosis in athletes who often have increased B...
Abstract 11473: J Wave with Characteristic Electrocardiographic Repolarization Pattern during Acute Myocardial Infarction and Increased Risk of Development of Ventricular Fibrillation
Authors: Takuya Ozawa, Tomoyasu Suzuki, Masato Oda, Hiroshi Watanabe, Takeshi Kashimura, Masahiro Ito, Satoru Hirono, Masaomi Chinushi, Shogo Ito, Tsutomu Imaizumi, Marek Jastrzebski, Kalina Kawecka-Jaszcz, Piotr Kukla, Yoshifusa Aizawa
Journal: Circulation (2011)

Background: J waves with or without ST-segment elevation have been associated with increased risk of development of ventricular fibrillation (VF) in Burugada syndrome and idiopathic VF. Recently, w...
Abstract 14172: Validation of the Noga 3D Left Ventricular Electromechanical Mapping System for Assessment of Cardiac Function and Localized Transendocardial Stem Cell Injection in a Porcine Ischemia-Reperfusion Model
Authors: Sharven Taghavi, Jason M Duran, Remus M Beretta, Catherine Makarewich, Foram Udeshi, Thomas E Sharp, Hajime Kubo, Steven R Houser, Jon C George
Journal: Circulation (2011)

Introduction: As ischemic heart disease continues to be a major cause of mortality, novel strategies of measuring cardiac function and delivering therapeutics are warranted. The NOGA mapping system...
Abstract 2362: High Serum Erythropoietin Level is Associated with Poor Prognosis in Heart Failure Patients with Systolic Dysfunction but not with Preserved Systolic Function
Authors: Mika Matsumoto, Takeshi Tsujino, Masaaki Lee-Kawabata, Yoshiro Naito, Akira Ezumi, Shinji Nakao, Akiko Goda, Chikako Yoshida, Kunihiro Akahori, Tsuyoshi Sakoda, Mitsumasa Ohyanagi, Tohru Masuyama
Journal: Circulation (2008)

Introduction: It is known that serum levels of erythropoietin (EPO) are elevated in patients with chronic heart failure (CHF) and correlate with the severity of CHF. Serum EPO levels have been examined in stable CHF patients with LV systolic dysfunction (LVSDF) but not in patients with preserved LV ejection fraction (PLVEF). Moreover, the data about EPO are also lacking in acute decompensated HF (ADHF) patients. Hypothesis: Serum EPO levels may be different between patients with LVSDF and with PLVEF, and between patients in an acute decompensated state and in a stable, compensated state. Methods: We studied 52 patients who were admitted to our hospital with ADHF (NYHA functional class of III or IV). There were 22 females, and mean age was 73 years. They were divided into 2 groups: LVSDF (LV ejection fraction (EF) &lt; 45%, n = 37) and PLVEF (LVEF ≥ 45%, n = 15). Serum EPO, hemoglobin (Hb) and plasma brain natriuretic peptide (BNP) levels were measured on admission and after treatment. The estimated glomerular filtration rate (eGFR) was calculated using the Modification of Diet in Renal Disease Study equation. Results: On admission, serum EPO levels were higher in the LVSDF than in the PLVEF groups (84 ± 12 vs. 55 ± 9 mU/ml, p &lt; 0.05). After treatment, NYHA functional classes equally improved to I or II, and serum EPO and plasma BNP levels decreased in both groups (LVSDF: 31 ± 5 vs. 84 ± 12 mU/ml, p &lt; 0.05; 526 ± 82 vs. 1134 ± 163 pg/ml, p &lt; 0.05; PLVEF: 24 ± 4 vs. 55 ± 9 mU/ml, p &lt; 0.05; 240 ± 53 vs. 523 ± 87 pg/ml, p &lt; 0.05). The Hb levels and eGFR were not different between the groups on admission. When plasma BNP levels were matched between the 2 groups, the same tendency was observed in the levels of EPO. The higher EPO levels (&gt; 50 mU/ml) in ADHF were associated with higher incidence of cardiac death or HF hospitalizations (log-rank test, p &lt; 0.05) only in the LVSDF group. Conclusions: Serum EPO levels were higher in patients with LVSDF than in those with PLVEF in ADHF. Elevated serum EPO levels were associated with a poor prognosis in the LVSDF group, but not in the PLVEF group. Serum EPO levels may be useful prognostic value only in HF patients with LVSDF.
评论：卵巢癌的诊断——问题多于答案
Authors: Robin, Fox, 王涛, 金滢, 潘凌亚
Journal: BMJ (2009)

Hamilton及其同事进行了一项病历对照研究，他们以初级保健为基础，确定了7个与卵巢癌相关的症状，即：腹胀、尿频、腹痛、绝经后阴道流血、食欲减退、便血和胀气。他们报道，在诊断卵巢癌前至少半年，如果出现上述前3种症状，与卵巢癌显著相关。除了腹胀的阳性预测值是2．5％外，其他的几个症状阳性预测值均小于1％。这项研究获取的证据增加了初级保健中对几种癌症危险信号症状的认识。。由于英国目前大部分患者都是先看初级保健医生而不是专科医生，因而这项研究尤为重要。
A role of Wnt signalling pathway in the hematopoietic differentiation of murine embryonic stem cells
Authors: Zhongling Feng, Ewa Carrier
Journal: Cancer Research (2004)

Proc Amer Assoc Cancer Res, Volume 45, 2004

2794 

There is emerging evidence that stem cell biology could provide new insights into cancer biology. Evidence shows that many pathways that are classically associated with cancer may also regulate normal stem cell development. One particularly interesting pathway that has also been shown to regulate both differentiation and oncogenesis in different organs is the Wnt signalling pathway. Wnt proteins are intercellular signaling molecules that regulate development in several organisms and contribute to cancer when dysregulated. Under the appropriate culture conditions, embryonic stem (ES) cells can differentiate in vitro into complex structures called embryoid bodies (EBs) that contain a number of different cell types. In the present study, the differentiation effect of murine interleukin-3 (mIL-3, Chemicon; 10 μg/ml), human interleukin-6 (hIL-6, Stemcell Technologies Inc., Vancouver, Canada; 10 μg/ml), and Erythropoietin (EPO, Amgen, 3 U/ml) was examined alone or in combination. Cells from EBs were processed for Wright-Giemsa staining, immunofluorenscence staining, RT-PCR and Western Blot experiments after 9 to 14 days of primary differentiation culture and secondary differentiation culture. Here we report that Wnt/β-Catenin signalling down-regulates in hematopoietic differentiation of murine embryonic stem cells (ESc). We found that differentiation induced by interleukin-3 (IL-3), interleukin-6 (IL-6) and erythropoietin (EPO) combination resulted in high expression of CD3e, CD11b (Mac-1), CD45R/B220, Ly-6G, and TER-119 in differentiated ES cells. A high expression of β-Catenin was observed in two undifferentiated ES cell lines. Gene and protein expression analysis revealed that the Wnt downstream signalling pathway including β-Catenin, GSK-3β, Axin, and TCF4 was significantly down regulated as ES cells differentiated into hematopoietic progenitors. Our results indicate that Wnt/β-Catenin signalling pathway is essential for the hematopoietic differentiation of murine ESc and may support β-Catenin as a crucial factor in the maintenance of ES cells in their undifferentiated state.
Abstract 2816: Assessment Of Left Ventricular Mechanical Dyssynchrony With Radial Strain By Speckle-tracking Best Predicts Response To Cardiac Resynchronization Therapy
Authors: Victoria Delgado, Claudia Ypenburg, Laurens F Tops, Sjoerd A Mollema, Nina Ajmone Marsan, Martin J Schalij, Ernst E van der Wall, Jeroen J Bax
Journal: Circulation (2007)

Background: Recently, 2-dimensional strain by speckle tracking imaging has emerged as a new technology for assessment of myocardial deformation in three dimensions: radial, circumferential and longitudinal. The current study evaluates which type of deformation study can best identify left ventricular mechanical dyssynchrony (LVMD) and predicts response to cardiac resynchronization therapy (CRT). Methods: One-hundred fifty-two consecutive patients underwent echocardiographic study before implantation of the CRT device and at 6 months follow-up. Radial (RS) and circumferential (CS) strains were applied to midventricular short axis views; difference in time to peak systolic strain value between anteroseptal-to-posterior walls was used to study LVMD. Longitudinal strain (LS) was applied to apical 4-chamber views and LVMD was calculated as the difference between basal septum-to-basal lateral walls. Patients with a decrease of LV end-systolic volume ≥15% at 6 months follow-up were considered responders. Results: After 6 months of CRT, 85 pts (56%) showed response to CRT. Compared to non-responders, responders had significant more LVMD when it was assessed by RS (212±146 ms vs. 127±108 ms; p&lt;0.001), whereas there were no differences with neither CS nor LS (Table ). With RS, the optimal cut-off value to predict response to CRT was identified at a time-difference value of ≥130 ms yielding a sensitivity of 83% and a specificity of 71%. Conclusions: Radial strain by speckle-tracking imaging is a useful tool to assess LVMD and best predicts echocardiographic response to CRT. Left Ventricular Mechanical Dyssynchrony assessed by radial, circumferential and longitudinal strain
Abstract 1016: Regenerative Cellular Therapy: How To Enrich The Mesenchymal Stem Cell Content In The Periinfarction Zone After Myocardial Infarction
Authors: Sonja Schrepfer, Tobias Deuse, William Stein, Hermann Reichenspurner, Michael P Fischbein, Robert C Robbins, Marc P Pelletier
Journal: Circulation (2007)

Background: The pluripotent capacity of adult mesenchymal stem cells (MSCs) makes this cell type a potential candidate for tissue regeneration after myocardial infarction (MI). However, the most effective route of MSC application and the impact of contributory cytokine enhancement remains to be elucidated. Methods and Results: Murine CD90 + CD45-CD34-sca-1 + c-kit-MSCs were culture-expanded, stably transfected with firefly luciferase for bioluminescence imaging (BI), and labeled with CSFE for histology (H). High-throughput proteomics and a battery of in vitro and in vivo assays were used to profile 20 key cardiac-specific cytokines upregulated following MI for their effects on the biologic performance of MSCs. VEGF and HGF showed most effective enhancement of MSC proliferation, migration, and trans-membrane invasion. After LAD ligation, syngeneic mice received intraperitoneal (IP), intravenous (IV) or intramyocardial (IC) MSC injections. The development of cardiac MSC content was closely monitored by in vivo BI and H. Cytokine enhancement (CE) protocol: VEGF 8ng/ml and HGF 40ng/ml were injected into the infarction border zone to attract MSCs to the heart (after IV- or IP-injection) or to retain them in the heart (after IC-injection). 1 day after IP injection, a maximum of only 0.4 ± 0.5 cells/HPF was detected in the heart. Most IP-injected MSCs failed to be absorbed and enter the circulation. They rapidly decayed to &lt;10% within the peritoneum over 4 ± 2 days. Due to their large size (19um), huge amounts of IV-injected MSCs were trapped within the pulmonary capillaries, causing hemodynamic alterations if &gt;10 6 cells were used. After 1 day, a maximum of 1 ± 0.5 cells/HPF was found in the heart and CE significantly increased the cell content to 6 ± 3 cells/HPF (p=0.020). IC-injected MSCs vanished rapidly and cell counts dropped to 32 ± 18% at 6 days and 9 ± 6% at 12 days. Interestingly, the CE protocol significantly prolonged intramyocardial MSC survival and preserved higher cell counts (125 ± 21% at 6 days, p&lt;0.001 and 87 ± 31% at 12 days, p&lt;0.001). Conclusions: The most effective route of MSC application seems to be direct injection into the heart combined with cytokine enhancement in the border zone to create a beneficial microenviroment for cell survival.
Abstract 23: The Systemic Inflammatory Response Syndrome Following Cardiac Surgery
Authors: Niall S MacCallum, Sarah E Gordon, Gregory J Quinlan, Timothy W Evans, Simon J Finney
Journal: Circulation (2007)

The systemic inflammatory response syndrome (SIRS) is the leading cause of morbidity &amp; mortality in the critically ill. It is associated with a 50% reduction in 5 year life expectancy. SIRS is defined as 2 of the following criteria: heart rate &gt;90, respiratory rate &gt;20 or pCO 2 &lt;4.3kPa, temperature &lt;36 or &gt;38°C, white cell count &lt;4 or &gt;12 x10 9 /l. These criteria are used to stratify patients for specific therapies &amp; in research to define interventional groups. Cardiac surgery is associated with systemic inflammation. The validity of the SIRS criteria have never been formally evaluated post cardiac surgery. We undertook to describe the incidence of SIRS post cardiac surgery &amp; relate this to outcome. Methods: We retrospectively analysed prospectively collected data from 2764 consecutive admissions following cardiac surgery (coronary bypass grafting 1425, valve surgery 763, combined procedure 252, other 324). The number of criteria met simultaneously within 1 hour epochs was recorded for the entire admissions. Results: 96.4%, 57.9% &amp; 12.2% of patients met at least 2, 3 or 4 criteria respectively within 24hrs of admission. The temperature criterion was least often fulfilled. ICU mortality was 2.67%. Length of stay exceeded 3 days in 18.5% of patients. The capacity of the criteria to predict mortality &amp; prolonged ICU stay is presented in the table . Discussion: Nearly all patients fulfilled the standard 2 criteria definition of SIRS within 24hrs of admission. This definition does not adequately define the subgroup of patients with greater systemic inflammation, mortality or length of stay. Thus, some clinical manifestations of inflammation are very common following cardiac surgery, although not necessarily prognostic. By contrast, the presence of 3 or more criteria was more discriminatory of death &amp; prolonged ICU stay. We propose that 3 or more SIRS criteria is a more appropriate threshold that defines those patients with clinically significant inflammation post cardiac surgery.
Abstract 16345: Arterial Wave Reflection is the Most Important Pulsatile Hemodynamic Prognostic Indicator in Acute Heart Failure Syndrome
Authors: Shih-Hsien Sung, Hao-Min Cheng, Wen-Chung Yu, Chen-Huan Chen
Journal: Circulation (2011)

Background The importance of arterial wave reflections in the pathogenesis of heart failure may have been underestimated. The present study investigated the differential prognostic roles of wave re...