tbuckley/cabot-search huggingface dataset:
Electrophysiological and Electroanatomic Characterization of the Atria in Sinus Node Disease
Authors: Prashanthan Sanders, Joseph B. Morton, Peter M. Kistler, Steven J. Spence, Neil C. Davidson, Azlan Hussin, Jitendra K. Vohra, Paul B. Sparks, Jonathan M. Kalman
Journal: Circulation (2004)

The normal sinus pacemaker complex is an extensive structure within the right atrium. We hypothesized that patients with sinus node disease (SND) would have evidence of diffuse atrial abnormalities.Sixteen patients with symptomatic SND and 16 age-matched controls were studied. The following were evaluated: effective refractory periods (ERPs) from the high and low lateral right atrium (RA), high septal RA, and distal coronary sinus (CS); conduction time along the CS and lateral RA; P-wave duration; and conduction at the crista terminalis. Electroanatomic mapping was performed to define the sinus node complex and determine regional conduction velocity, double potentials, fractionated electrograms, regional voltage, and areas of electrical silence. Patients with SND demonstrated significant increase in atrial ERP at all right atrial sites, increased atrial conduction time along the lateral RA and CS, prolongation of the P-wave duration, and greater number and duration of double potentials along the crista terminalis. Electroanatomic mapping demonstrated the sinus node complex in SND to be more often unicentric, localized to the low crista terminalis at the site of the largest residual voltage amplitude. There was significant regional conduction slowing with double potentials and fractionation associated with areas of low voltage and electrical silence (or scar).SND is associated with diffuse atrial remodeling characterized by structural change, conduction abnormalities, and increased right atrial refractoriness. There was a change in the nature of sinus pacemaker activity with loss of the normal multicentric pattern of activation, caudal shift of the pacemaker complex, and abnormal and circuitous conduction around lines of conduction block.
Safety and efficacy of everolimus, a mTOR inhibitor, as single agent in a phase 1/2 study in patients with myelofibrosis
Authors: Paola Guglielmelli, Giovanni Barosi, Alessandro Rambaldi, Roberto Marchioli, Arianna Masciulli, Lorenzo Tozzi, Flavia Biamonte, Niccolò Bartalucci, Elisabetta Gattoni, Maria Letizia Lupo, Guido Finazzi, Alessandro Pancrazzi, Elisabetta Antonioli, Maria Chiara Susini, Lisa Pieri, Elisa Malevolti, Emilio Usala, Ubaldo Occhini, Alberto Grossi, Silvia Caglio, Simona Paratore, Alberto Bosi, Tiziano Barbui, Alessandro M. Vannucchi
Journal: Blood (2011)
Computerised evidence based guidelines in primary care: Interactive decision support is here and essential for 21st century primary care
Authors: C. B Prince
Journal: BMJ (2003)

EDITOR—I am worried that the paper by Rousseau et al on computerised evidence based guidelines in primary care may inhibit the development of primary care in the 21st century.1

My practice been using interactive decision support as an important facet of modern general practice for several years and received a …
Diagnosing and managing unstable angina. Agency for Health Care Policy and Research.
Authors: E Braunwald, R H Jones, D B Mark, J Brown, L Brown, M D Cheitlin, C A Concannon, M Cowan, C Edwards, V Fuster
Journal: Circulation (1994)

This Quick Reference Guide for Clinicians contains recommendations on the care of patients with unstable angina based on a combination of evidence obtained through extensive literature reviews and consensus among members of a private-sector, expert panel. Principal conclusions include: Many patients suspected of having unstable angina can be discharged home after adequate initial evaluation. Further outpatient evaluation may be scheduled for up to 72 hours after initial presentation for patients with clinical symptoms of unstable angina judged at initial evaluation to be at low risk for complications. Patients with acute ischemic heart disease judged to be at intermediate or high risk of complications should be hospitalized for careful monitoring of their clinical course. Intravenous thrombolytic therapy should not be administered to patients without evidence of acute myocardial infarction. Assessment of prognosis by noninvasive testing often aids selection of appropriate therapy. Coronary angiography is appropriate for patients judged to be at high risk for cardiac complications or death based on their clinical course or results of noninvasive testing. Coronary artery bypass surgery should be recommended for almost all patients with left main disease and many patients with three-vessel disease, especially those with left ventricular dysfunction. The discharge care plan should include continued monitoring of symptoms; appropriate drug therapy, including aspirin; risk-factor modification; and counseling.
Insulin Kinetics, Models, and Delivery Schedules
Authors: Mones Berman
Journal: Diabetes Care (1980)

Several insulin models are examined as to their responses to various insulin inputs and glucose utilization and production control. It is shown that the action of insulin on glucose utilization correlates best with model compartments having a 30–50-min delay compared with plasma, whereas glucose production control is rapid. It is further shown that whereas the predicted plasma insulin response curves are nearly the same for various models, the responses at possible sites of action (e.g., receptors or slowly exchanging tissues) can differ considerably for the different models. By determining the parameter values for the glucose-insulin system in a patient through isotope kinetics studies, it is possible to use the patient's model either as a direct algorithm for insulin delivery or as a tool for studying glucose control under various conditions and thus aid in the design of appropriate algorithms or schedules for insulin delivery.
Association Between Exposure to Low to Moderate Arsenic Levels and Incident Cardiovascular Disease
Authors: Katherine A. Moon, Eliseo Guallar, Jason G. Umans, Richard B. Devereux, Lyle G. Best, Kevin A. Francesconi, Walter Goessler, Jonathan Pollak, Ellen K. Silbergeld, Barbara V. Howard, Ana Navas-Acien
Journal: Annals of Internal Medicine (2013)

Background: Long-term exposure to high levels of arsenic is associated with increased risk for cardiovascular disease, whereas risk from long-term exposure to low to moderate arsenic levels (<100 µg/L in drinking water) is unclear. Objective: To evaluate the association between long-term exposure to low to moderate arsenic levels and incident cardiovascular disease. Design: Prospective cohort study. Setting: The Strong Heart Study baseline visit between 1989 and 1991, with follow-up through 2008. Patients: 3575 American Indian men and women aged 45 to 74 years living in Arizona, Oklahoma, and North and South Dakota. Measurements: The sum of inorganic and methylated arsenic species in urine at baseline was used as a biomarker of long-term arsenic exposure. Outcomes were incident fatal and nonfatal cardiovascular disease. Results: A total of 1184 participants developed fatal and nonfatal cardiovascular disease. When the highest and lowest quartiles of arsenic concentrations (>15.7 vs. <5.8 µg/g creatinine) were compared, the hazard ratios for cardiovascular disease, coronary heart disease, and stroke mortality after adjustment for sociodemographic factors, smoking, body mass index, and lipid levels were 1.65 (95% CI, 1.20 to 2.27; P for trend < 0.001), 1.71 (CI, 1.19 to 2.44; P for trend < 0.001), and 3.03 (CI, 1.08 to 8.50; P for trend = 0.061), respectively. The corresponding hazard ratios for incident cardiovascular disease, coronary heart disease, and stroke were 1.32 (CI, 1.09 to 1.59; P for trend = 0.002), 1.30 (CI, 1.04 to 1.62; P for trend = 0.006), and 1.47 (CI, 0.97 to 2.21; P for trend = 0.032). These associations varied by study region and were attenuated after further adjustment for diabetes, hypertension, and kidney disease measures. Limitation: Direct measurement of individual arsenic levels in drinking water was unavailable. Conclusion: Long-term exposure to low to moderate arsenic levels was associated with cardiovascular disease incidence and mortality. Primary Funding Source: National Heart, Lung, and Blood Institute and National Institute of Environmental Health Sciences.
The Clinical Applications of Coronary Arteriography
Authors: Richard W. Booth
Journal: JAMA (1961)

An effort was made to determine the value of coronary arteriography in a variety of clinical situations. Eighty-six patients were studied with no resultant mortality and little morbidity. Five cases are presented to typify the usefulness of this test. Arteriography is valuable in the diagnosis of obscure heart disease or in determining the presence of complicating atherosclerosis in patients with heart disease of known types. After myocardial infarction an idea can be obtained of the development of collateral circulation or of the general state of the coronary vessels. Coronary arteriography offers a unique method of evaluating the results of treatment. Finally the changes that accompany the advancing atherosclerotic process can be studied serially in the living patient in a manner not previously possible.
Hepatocellular carcinoma in HIV-infected patients comes of age: The convergence of epidemiology and treatment effectiveness
Authors: Mark Sulkowski
Journal: Journal of Hepatology (2009)

The early 21st century has witnessed the maturation of HIV, HBV and HCV epidemics with respect to disease recognition, understanding and medical treatment. Most notably, the availability of safe, potent antiretroviral therapy (ART) in settings with adequate resources has transformed HIV infection into a chronic disease that, for many infected patients, may not substantially limit life expectancy [1,2]. Consequently, chronic medical conditions such as diabetes mellitus, hypertension, coronary artery disease, viral hepatitis-related liver disease and malignancy have emerged as major causes of morbidity and mortality in HIV-infected patients; many of whom are over the age of 50 [3–7].
Prothrombin 20210G&gt;A is an ancestral prothrombotic mutation that occurred in whites approximately 24 000 years ago
Authors: Ariella Zivelin, Ronit Mor-Cohen, Victoria Kovalsky, Nurit Kornbrot, Jacqueline Conard, Flora Peyvandi, Paul A. Kyrle, Rogier Bertina, Ferial Peyvandi, Joseph Emmerich, Uri Seligsohn
Journal: Blood (2006)
Functional Study Of Histamine N-methyltransferase (hnmt) Genetic Polymorphisms In Patients With Aspirin-intolerant Chronic Urticaria
Authors: Y. Kang, S. Kim, Y. Ye, G. Hur, S. Lee, H. Lee, C. Suh, D. Nahm, H. Park
Journal: Journal of Allergy and Clinical Immunology (2007)
A Leap of Faith
Authors: Michael D. Iseman
Journal: Annals of Internal Medicine (1992)

▪ Large-scale, epidemic transmission of tuberculosis to patients, nonprofessional staff, nurses, and physicians has been documented recently in hospitals, clinics, acquired immunodeficiency syndrome (AIDS) residencies, and correctional facilities. Prominent factors in these outbreaks have included human immunodeficiency virus (HIV) infection and AIDS, delayed diagnosis of tuberculosis, multidrug-resistant strains of tuberculosis that resulted in protracted shedding of mycobacteria, and ventilation patterns in buildings that resulted in the accumulation of infectious particles. Multiple deaths from tuberculosis have resulted. Various strategies, including vaccines, masks, augmented ventilation, air filters, and ultraviolet irradiation have been proposed to control this situation. Although no well-controlled studies exist to document the utility of any of these modalities, ultraviolet germicidal irradiation seems both the best theoretical model and the most practical tactic. Ultraviolet systems should be widely deployed throughout high-risk institutions.
Urinary Iron Excretion in Patients With Prosthetic Heart Valves
Authors: John R. Walsh
Journal: JAMA (1966)

Intravascular destruction of erythrocytes sufficient to produce hemolytic anemia occurs with incompetent prosthetic heart valves. Renal hemosiderosis results from chronic intravascular hemolysis. Increased urinary iron loss eventually produces an iron-deficiency state even in the presence of renal hemosiderosis. Deferoxamine mesylate, an iron-chelating agent, increases the urinary iron excretion in this combination of circumstances, suggesting that it removes iron from the kidney. A compensated hemolytic state has occurred in some of these patients after iron therapy, and reoperation was thereby avoided. Elevated serum lactic dehydrogenase values indicate hemolysis and remain unchanged with iron therapy. Iron therapy had no influence on erythrocyte survival.
Emphysema in Coal Workers' Pneumoconiosis
Authors: R. Ryder, J. P. Lyons, H. Campbell, J. Gough
Journal: BMJ (1970)

A correlation survey has been carried out between the pathological, physiological, and radiological findings pertaining to emphysema in 247 deceased coal miners and ex-miners, most of whom had been diagnosed as suffering from coal workers9 pneumoconiosis during life. The pathological findings, which included large lung sections and detailed histology in every case, were compared with similar findings in a contrast non-mining population matched for age and sex. The results indicated that emphysema was much more common among the coal miners, both with simple and with complicated pneumoconiosis, than among the contrast group. In addition the extent of the emphysema as measured by a recognized “counting” method carried out on paper-mounted lung sections was remarkably closely related to ventilatory impairment as evidenced by the forced expiratory volume in one second. Extensive emphysema was more commonly found in those pneumoconiosis cases, both simple and complicated, showing the finer punctiform type of radiological change than in cases showing the larger micronodular and nodular opacities.
Clinical usefulness of a functional assay for the von Willebrand factor cleaving protease (ADAMTS 13) and its inhibitor in a patient with thrombotic thrombocytopenic purpura
Authors: M.E. Rick, H. Austin, S.F. Leitman, D.M. Krizek, D.L. Aronson
Journal: American Journal of Hematology (2004)

Abstract Decreased von Willebrand factor cleaving protease activity (VWFCP, ADAMTS 13) leads to persistence of unusually large multimers of von Willebrand factor that bind to platelets, causing platelet aggregates, microangiopathic hemolysis, and thrombocytopenia in patients with thrombotic thrombocytopenic purpura (TTP). The clinical value of measuring ADAMTS 13 and its inhibitor is not fully defined; the case reported here illustrates the usefulness of the assay to help confirm the clinical diagnosis in a patient with other potential causes for thrombotic microangiopathy; the assay also helped in making treatment decisions. A patient with systemic lupus erythematosis (SLE) presented with fever and abdominal pain, thrombocytopenia, and anemia. Thrombotic microangiopathy was diagnosed by the appearance of schistocytes, decreasing platelet count, and evidence of hemolysis. ADAMTS 13 was decreased and an inhibitor was demonstrated in the patient's initial blood sample within 24 hr of admission. Plasma exchange was initiated, and serial assays showed increased ADAMTS 13 activity and decreased inhibitor after each plasma exchange; there was a rebound in inhibitor and a decrease in ADAMTS 13 activity prior to the next exchange that lessened over time. Increasing levels of protease activity correlated with clinical and laboratory improvement. Measurement of ADAMTS 13 activity and its inhibitor aided in the diagnosis of this complicated case of a patient with other potential causes for microangiopathic hemolysis. Subsequent levels correlated with the clinical course, and disappearance of the inhibitor indicated that long‐term plasma exchange or other immunosuppressive treatment was not needed. Am. J. Hematol. 75:96–100, 2004. Published 2004 Wiley‐Liss, Inc. †
Exploiting metabolic and antioxidant pathways to maintain vision in blinding disease
Authors: Pavitra S. Ramachandran, Ji Yun Song, Jean Bennett
Journal: Journal of Clinical Investigation (2015)

The use of gene therapy for blinding disease shows growing promise; however, due to an ever-expanding list of disease-causing genes and mutations, the identification of a generic gene-based treatment is urgently needed. In many forms of degenerative retinal disease, there may be a window of opportunity to preserve daylight vision, as the cone photoreceptors degenerate more slowly than do the rods. In this issue of the JCI, Venkatesh et al. and Xiong et al. exploit two different pathways to promote cone cell survival and preserve vision in murine retinal degeneration models. These studies provide hope for developing a universal reagent to treat many different blinding disorders.
Osteoporosis in young haemophiliacs from western India
Authors: Anish P. Nair, Farah Jijina, Kanjaksha Ghosh, Manisha Madkaikar, Mitu Shrikhande, Manish Nema
Journal: American Journal of Hematology (2007)

Abstract Arthropathies and joint deformities in patients with severe hemophilia result in prolonged immobilization, reduced physical activity, and predispose them for osteoporosis. This can lead to an increasing tendency of bone fragility and fractures in patients after trivial trauma. The aim of this study was to find out (i) the prevalence of osteoporosis in hemophilia patients and (ii) the association of osteoporosis with hemophilic arthropathy and related restricted physical activity. In this case–control study, 50 consecutive severe hemophilia patients aged between 20 and 50 years were evaluated for osteoporosis with measurement of bone mass density (BMD) by a DEXA scan and values were compared with that of 50 sex matched normal healthy controls. Major joints of the limbs were evaluated to determine the extent of joint damage and related disability. Forty‐two patients had severe hemophilia A and 8 patients severe hemophilia B (efficient factor activity &lt; 0.01 U/ml). BMD values (gms/cm 2 ) of lumbar spine and left hip of the patients were significantly lower than that of controls (0.825 vs. 0.939; P &lt; 0.0001 and 0.725 vs. 0.938; P &lt; 0.0001, respectively). The incidence of osteoporosis ( T score: −2.5 or more) was significantly higher in hemophiliacs. Incidence of fractures in adult life was also significantly higher in hemophiliacs compared to controls (12% vs. 0%). There was statistically significant correlation between joint evaluation scores and BMD of hip, but not with that of the lumbar spine. There was no correlation between Hepatitis‐C virus status and BMD of any site. This shows that development of osteoporosis is a significant problem in patients with severe hemophilia in this country. Hence appropriate preventive measures such as early treatment and adequate mobilization, exercises, encouragement to participate in sporting activities, early assessment of bone density, and administration of anti‐osteoporotic therapy is recommended. Am. J. Hematol., 2007. © 2007 Wiley‐Liss, Inc.
High Blood Pressure and Long-Term Exposure to Indoor Noise and Air Pollution from Road Traffic
Authors: Maria Foraster, Nino Künzli, Inmaculada Aguilera, Marcela Rivera, David Agis, Joan Vila, Laura Bouso, Alexandre Deltell, Jaume Marrugat, Rafel Ramos, Jordi Sunyer, Roberto Elosua, Xavier Basagaña
Journal: Environmental Health Perspectives (2014)

Traffic noise has been associated with prevalence of hypertension, but reports are inconsistent for blood pressure (BP). To ascertain noise effects and to disentangle them from those suspected to be from traffic-related air pollution, it may be essential to estimate people's noise exposure indoors in bedrooms.We analyzed associations between long-term exposure to indoor traffic noise in bedrooms and prevalent hypertension and systolic (SBP) and diastolic (DBP) BP, considering long-term exposure to outdoor nitrogen dioxide (NO2).We evaluated 1,926 cohort participants at baseline (years 2003-2006; Girona, Spain). Outdoor annual average levels of nighttime traffic noise (Lnight) and NO2 were estimated at postal addresses with a detailed traffic noise model and a land-use regression model, respectively. Individual indoor traffic Lnight levels were derived from outdoor Lnight with application of insulations provided by reported noise-reducing factors. We assessed associations for hypertension and BP with multi-exposure logistic and linear regression models, respectively.Median levels were 27.1 dB(A) (indoor Lnight), 56.7 dB(A) (outdoor Lnight), and 26.8 μg/m3 (NO2). Spearman correlations between outdoor and indoor Lnight with NO2 were 0.75 and 0.23, respectively. Indoor Lnight was associated both with hypertension (OR = 1.06; 95% CI: 0.99, 1.13) and SBP (β = 0.72; 95% CI: 0.29, 1.15) per 5 dB(A); and NO2 was associated with hypertension (OR = 1.16; 95% CI: 0.99, 1.36), SBP (β = 1.23; 95% CI: 0.21, 2.25), and DBP (β⊇= 0.56; 95% CI: -0.03, 1.14) per 10 μg/m3. In the outdoor noise model, Lnight was associated only with hypertension and NO2 with BP only. The indoor noise-SBP association was stronger and statistically significant with a threshold at 30 dB(A).Long-term exposure to indoor traffic noise was associated with prevalent hypertension and SBP, independently of NO2. Associations were less consistent for outdoor traffic Lnight and likely affected by collinearity.
New ophthalmic findings in fetal alcohol syndrome
Authors: Elizabeth Rasche González
Journal: JAMA (1981)

Tortuosity of the retinal vessels—both arterial and venous—may be a dead giveaway that a young patient is suffering from fetal alcohol syndrome (FAS), says I. Matthew Rabinowicz, MD, FRCS.  Another important sign of the syndrome, he says, is optic nerve hypoplasia or atrophy, sometimes found in conjunction with pallor of the optic disc.  Rabinowicz, who is chief of ophthalmology at the Children's Eye Hospital of Michigan, Kresge Eye Institute of Wayne State University, Detroit, announced these findings at the recent meeting of the American Academy of Ophthalmology in Chicago. They emerged from a study of 17 cases of FAS diagnosed according to standard diagnostic criteria. All except one of the children, ranging in age from 3 days to 10 years, had been born to mothers who reported a history of heavy alcohol consumption during pregnancy.  Some of Rabinowicz's findings confirmed those of other ophthalmologists. But disc hypoplasia has been reported
Inappropriate Secretion of Antidiuretic Hormone after Transsphenoidal Surgery for Pituitary Tumors
Authors: Joseph F. Cusick, Thad C. Hagen, James W. Kindling
Journal: New England Journal of Medicine (1984)

THE syndrome of inappropriate secretion of antidiuretic hormone (ADH) has been noted in association with a variety of neurologic disorders,1 2 3 but its occurrence as a transient complication of pituitary surgery performed by the transsphenoidal approach has been incompletely defined and poorly recognized.2 In our patients, the onset of this syndrome was delayed until the second week after the surgical procedure, so that its manifestations usually occurred after the patient had been sent home for convalescence. This temporal factor, in conjunction with the often nonspecific character of the clinical presentation of the syndrome, indicates a need for careful awareness of such . . .