tbuckley/cabot-search huggingface dataset:
Non-invasive assessment of the atrial cycle length during atrial fibrillation in man: introducing, validating and illustrating a new ECG method
Authors: Magnus Holm, Steen Pehrson, Max Ingemansson, Leif Sörnmo, Rolf Johansson, Lennart Sandhall, Max Sunemark, Birgit Smideberg, Christian Olsson, S.Bertil Olsson
Journal: Cardiovascular Research (1998)

Objectives: Atrial fibrillation (AF) in man has previously been shown to include a wide variety of atrial activity. Assessment of the characteristics of this arrhythmia with a commonly applicable tool may therefore be important in the choice and evaluation of different therapeutic strategies. As the AF cycle length has been shown to correlate locally with atrial refractoriness and globally with the degree of atrial organization, with, in general, shorter cycle length during apparently random AF compared to more organized AF, we have developed a new method for non-invasive assessment of the AF cycle length using the surface and the esophagus (ESO) ECG. Methods and Results: From the frequency spectrum of the residual ECG, created by suppression of the QRST complexes, the dominant atrial cycle length (DACL) was derived. By comparison with multiple intracardiac simultaneously acquired right and left AF cycle lengths in patients with paroxysmal AF, we found that the DACL in lead V1, ranging from 130 to 185 ms, well represented a spatial average of the right AF cycle lengths, whereas the DACL in the ESO ECG, ranging from 140 to 185 ms, reflected both the right and the left AF cycle length, where the influence from each structure depended on the atrial anatomy of the individual, as determined by MRI. In patients with chronic AF, the method was capable of following changes in the AF cycle length due to administration of d,l-sotalol and 5 min of ECG recording was sufficient for the DACL to be reproducible. Conclusions: We conclude that this new non-invasive method, named 'Frequency Analysis of Fibrillatory ECG' (FAF-ECG), is capable of assessing both the magnitude and the dynamics of the atrial fibrillation cycle length in man.
An Address on the Utility of Scientific Work in Practice
Authors: J. Paget
Journal: BMJ (1887)

I WISH to speak on the utility of scientific work in the practice of medicine and surgery; not in the sense of using, forjthe purposes of practice, all the medical scientific knowledge that has been acquired, but in that of using, after a scientific manner, all the opportunities which practice affords for the acquirement of more knowledge.In our calling careful practice and scientific study should be inseparable; they always may be so; and I want to urge that everyone of you should be, to the full measure of his ability, a scientific student both now and all his life long.I have seen enough to makelme sure that
Primary Hepatic Tuberculoma Appears Similar to Hepatic Malignancy on F-18 FDG PET/CT
Authors: Yue-Tao Wang, Feng Lu, Feng Zhu, Zuo-Bin Qian, Ya-Ping Xu, Tao Meng
Journal: Clinical Nuclear Medicine (2009)

A 42-year-old woman was hospitalized with right upper abdominal pain, anorexia, and evening fever. Abdominal CT showed a hypodense lesion in the posterior segment of the right hepatic lobe which was enhanced on the portal venous phase. MRI revealed the lesion was hypointense in T1W1 images and slight hyperintense in T2W2 images. F-18 FDG PET/CT images showed the lesion was FDG-avid on both early and delayed images. An FDG-avid lymph node was observed between the inferior vena cava and pancreas. The appearance of F-18 FDG PET/CT was strongly suggestive of hepatic malignancy and a possible lymph node metastasis. The patient underwent hepatectomy and histopathologic examination demonstrated caseating granulomas of the liver and reactive caseating lymphadenitis. A primary hepatic tuberculoma is rare, but is an important differential diagnosis in patients with a hepatic mass on F-18 FDG PET/CT.
Human Prostate Cancer Blocks the Generation of Dendritic Cells from CD34&amp;plus; Hematopoietic Progenitors
Authors: Galina V. Shurin, Maryam Aalamian, Georgi Pirtskhalaishvili, Svetlana Bykovskaia, Edith Huland, Hartwig Huland, Michael R. Shurin
Journal: European Urology (2001)
INACTIVATION OF BACTERIAL EXOTOXINS AND ENDOTOXIN BY IRON
Authors: Aaron Janoff, Benjamin W. Zweifach
Journal: The Journal of Experimental Medicine (1960)

After incubation with various agents in vitro, the lethal effects of aqueous solutions of Cl. perfringens alpha toxin, C. diphtheriae toxin, and E. coli endotoxin were tested in mice, guinea pigs, and rabbits, respectively. Iron, copper, cysteine, ascorbic acid, and versene counteracted the lethal effects of alpha toxin in mice, while magnesium, manganese, zinc, and citrate did not. Iron also counteracted the lethal effects of diphtheria toxin in guinea pigs. After incubation of endotoxin with iron, its lethal effects and tissue-necrotizing actions in rabbits were counteracted. However, the pyrogenic properties of the toxin were not affected. The solubilities of perfringens alpha toxin and diphtheria toxin were markedly reduced after incubation with detoxifying metals, and resolubilization of these toxins with chelators resulted in partial restoration of toxicity. Addition of versene to detoxified endotoxin also resulted in partial recovery of lethal effectiveness. The inactivation of bacterial toxins by iron under in vitro conditions is not specific to this metal, is a reversible process, and may be due to desolubilization, reduction, or to competition by the metal for sites on the toxin normally bound by other cations in vivo. Although no evidence is presented in this paper to support the view that there is a relationship between the inactivation of endotoxin and the storage iron in the reticuloendothelial system of shocked animals, the observation of an in vitro inactivation of endotoxin by inorganic iron warrants consideration of such a mechanism.
Impairment in Aortic Elastic Properties and Mechanics of Ascending Aorta in Patients with Bicuspid Aortic Valve
Authors: Selen Yurdakul, Betül Cengiz, Şükrü Taylan Şahin, Ayşen Bozkurt, Saide Aytekin
Journal: Journal of the American College of Cardiology (2013)
Implementing the Learning Health System: From Concept to Action
Authors: Sarah M. Greene, Robert J. Reid, Eric B. Larson
Journal: Annals of Internal Medicine (2012)

Clinicians and health systems are facing widespread challenges, including changes in care delivery, escalating health care costs, and the need to keep up with rapid scientific discovery. Reorganizing U.S. health care and changing its practices to render better, more affordable care requires transformation in how health systems generate and apply knowledge. The “rapid-learning health system”—posited as a conceptual strategy to spur such transformation—leverages recent developments in health information technology and a growing health data infrastructure to access and apply evidence in real time, while simultaneously drawing knowledge from real-world care-delivery processes to promote innovation and health system change on the basis of rigorous research. This article describes an evolving learning health system at Group Health Cooperative, the 6 phases characterizing its approach, and examples of organization-wide applications. This practical model promotes bidirectional discovery and an open mind at the system level, resulting in willingness to make changes on the basis of evidence that is both scientifically sound and practice-based. Rapid learning must be valued as a health system property to realize its full potential for knowledge generation and application.
Comparison of Fasting and 2-Hour Glucose and HbA1c Levels for Diagnosing Diabetes: Diagnostic criteria and performance revisited
Authors: Michael M Engelgau, Theodore J Thompson, William H Herman, James P Boyle, Ronald E Aubert, Susan J Kenny, Ahmed Badran, Edward S Sous, Mohamed A Ali
Journal: Diabetes Care (1997)

OBJECTIVE Nearly two decades ago, the National Diabetes Data Group (NDDG) and the World Health Organization (WHO) Expert Committee on Diabetes Mellitus published diagnostic criteria for diabetes. We undertook this study to compare the performance of three glycemic measures for diagnosing diabetes and to evaluate the performance of the WHO criteria. RESEARCH DESIGN AND METHODS In a cross-sectional population-based sample of 1,018 Egyptians ≥ 20 years of age, fasting and 2-h glucose and HbA1c levels were measured, and diabetic retinopathy was assessed by retinal photograph. Evidence for bimodal distributions was examined for each glycemic measure by fitting models for the mixture of two distributions using maximum likelihood estimates. Sensitivity and specificity for cutpoints of each glycemic measure were calculated by defining the true diabetes state (gold standard) as 1) the upper (diabetic) component of the fitted bimodal distribution for each glycemic measure, and 2) the presence of diabetic retinopathy. Receiver operating characteristic (ROC) curves were constructed to determine the performance of the glycemic measures in detecting diabetes as defined by diabetic retinopathy. RESULTS In the total population, the point of intersection of the lower and upper components that minimized misclassification for the fasting and 2-h glucose and HbA1c were 7.2 mmol/l (129 mg/dl), 11.5 mmol/l (207 mg/dl), and 6.7%, respectively. When diabetic retinopathy was used to define diabetes, ROC curve analyses found that fasting and 2-h glucose values were superior to HbA1c (P &amp;lt; 0.01). The performance of a fasting glucose of 7.8 mmol/l (140 mg/dl) was similar to a 2-h glucose of 12.2–12.8 mmol/l (220–230 mg/dl), and the performance of a 11.1 mmol/l (200 mg/dl) 2-h glucose was similar to a fasting glucose of 6.9–7.2 mmol/l (125–130 mg/dl). CONCLUSIONS Optimal cutpoints for defining diabetes differ according to how diabetes itself is defined. When diabetes is defined as the upper component of the bimodal population distribution, a fasting glucose level somewhat lower than the current WHO cutpoint and a 2-h glucose level somewhat higher than the current WHO cutpoint minimized misclassification. When diabetic retinopathy defines diabetes, we found that the current fasting diagnostic criterion favors specificity and the current 2-h criterion favors sensitivity. These results should prove valuable for defining the optimal tests and cutpoint values for diagnosing diabetes.
Plasma thrombospondin‐1 is increased during acute sickle cell vaso‐occlusive events and associated with acute chest syndrome, hydroxyurea therapy, and lower hemolytic rates
Authors: Enrico M Novelli, Gregory J. Kato, Margaret V. Ragni, Yingze Zhang, Mariana E. Hildesheim, Mehdi Nouraie, Suchitra Barge, Michael P. Meyer, Andrea Cortese Hassett, Victor R. Gordeuk, Mark T. Gladwin, Jeffrey S. Isenberg
Journal: American Journal of Hematology (2011)

Platelets are activated in sickle cell disease (SCD), and particularly during vaso-occlusive episodes (VOE). Thrombospondin-1 (TSP1), a major secretory product of activated platelets, is increased in the circulation in VOE and binds to sickle red blood cells (RBC) promoting vascular adhesion. Thus, we hypothesized that TSP1 may represent a plasma biomarker of disease severity in SCD. We tested the plasma collected from patients in steady state (n = 27) and VOE (n = 14), as well as healthy controls (n = 17) at the University of Pittsburgh Medical Center (UPMC), and from patients in steady state enrolled in the walk-PHaSST clinical trial (n = 483). We found that TSP1 levels were increased in VOE in the UPMC cohort. Among steady-state patients at UPMC, TSP1 values correlated positively with lifetime history of acute chest syndrome (r = 0.72, P < 0.0001) and hemoglobin concentration (r = 0.49, P = 0.01), and negatively with markers of hemolysis, such as LDH (r = -0.50, P = 0.009). Analysis of the walk-PHaSST cohort also showed a positive association between TSP1 levels and hydroxyurea use (r = 0.14, P = 0.003), and confirmed the negative associations with the severity of hemolysis. Our results suggest that TSP1 levels are associated with more VOE, hydroxyurea use and lower rates of hemolysis. High TSP1 concentrations may indicate higher risk of the viscosity/vaso-occlusion phenotype of SCD.
United Kingdom research governance strategy: Reforming clinical research and development in England
Authors: R. Sullivan
Journal: BMJ (2004)

Editor—The National Cancer Research Institute does not set the research strategies of its partners, as Kerrison et al say.1 They also do not grasp its mission, which is to double the number of patients entering cancer clinical trials by 2005 (a target it has already surpassed).

They suggest that the formal research networks in cancer were set up as a result of the outcomes of the Pharmaceutical Industry Competitiveness Taskforce. The institute was created as a result of the high political profile after the publication of the EURO-CARE II data and the subsequent partnership with major governmental and nongovernmental cancer research funders. The taskforce's conclusions post-date establishment of the institute.

The suggestion that “the private sector will have an important role in identifying and implementing research priorities in other disease groups” seems misleading. The private sector, while bringing substantial and welcome funding to cancer research, does not set the overall NHS research priority. Industry by its very nature is partisan and concerned only with commercially viable areas. Government, charities, and the NHS have wider concerns for all cancer research.

The statement that these partnerships will provide “much needed strategic direction” and the apparent concern that industry will somehow lead the United Kingdom down the US path also needs careful scrutiny.

The jury remains out on whether changes to cancer networks will improve strategic direction. Indeed, current organisational changes may lead to the opposite. With fiscal control in primary care trusts and with the need for strategic health authorities to hit substantial service targets, research and development could become a low priority. Furthermore, the new cancer research networks are accountable for their spending, and public funding is not being siphoned off into commercial research. Industry does, however, have legitimate concerns about the cost of conducting clinical trials in the United Kingdom that need to be addressed.

Kerrison et al state that, “Research governance means a change of emphasis from professional codes of conduct to legal rules.” This implies that either new laws will be enacted to make performance of the research governance framework a legal duty or the framework will form a contract between, say, a charity and a university—neither of which is correct.
Commentary: The emperor's new phone
Authors: E. Fottrell
Journal: BMJ (2015)

Low cost mobile phones have unquestionably revolutionised access to information and communication worldwide. Mobile health (m-health)—the application of mobile technology in healthcare and health promotion—can create unique opportunities for citizen participation in identifying health priorities and solutions and can enable collaboration between individuals, researchers, and health authorities in real time to inform (or misinform) the public.

Innovations in m-health have been used effectively in high income countries for smoking cessation, weight loss, diet and physical activity, treatment adherence, disease management, and more.1 2 3 4 M-health has also shown promise in some of the world’s poorest settings and hardest to reach populations, with initiatives including health promotion programmes using text or voice messaging, decision support apps, rapid diagnostics, early warning systems, and outbreak and disease surveillance methods.

However, technology is not neutral—it is affected by the contextually determined relationships between innovations, people, and systems.5 It is not surprising, therefore, that most of the literature on m-health in low income settings focuses on pilot studies assessing the feasibility and acceptability of m-health interventions in different …
Portal vein thrombosis, cirrhosis, and liver transplantation
Authors: Claire Francoz, Dominique Valla, François Durand
Journal: Journal of Hepatology (2012)

Portal vein thrombosis is not uncommon in candidates for transplantation. Partial thrombosis is more common than complete thrombosis. Despite careful screening at evaluation, a number of patients are still found with previously unrecognized thrombosis per-operatively. The objective is to recanalize the portal vein or, if recanalization is not achievable, to prevent the extension of the thrombus so that a splanchnic vein can be used as the inflow vessel to restore physiological blood flow to the allograft. Anticoagulation during waiting time and transjugular intrahepatic portosystemic shunt (TIPS) are two options to achieve these goals. TIPS may achieve recanalization in patients with complete portal vein thrombosis. However, a marked impairment in liver function, which is a characteristic feature of most candidates for transplantation, may be a contraindication for TIPS. Importantly, the MELD score is artificially increased by the administration of vitamin K antagonists due to prolonged INR. When patency of the portal vein and/or superior mesenteric vein is not achieved, only non-anatomical techniques (renoportal anastomosis or cavoportal hemitransposition) can be performed. These techniques, which do not fully reverse portal hypertension, are associated with higher morbidity and mortality risks. Multivisceral transplantation including the liver and small bowel needs to be evaluated. In the absence of prothrombotic states that may persist after transplantation, there is no evidence that pre-transplant portal vein thrombosis justifies long term anticoagulation post-transplantation, provided portal flow has been restored through conventional end-to-end portal anastomosis.
PLATELET REACTIVITY IN METABOLIC SYNDROME: RELATIONSHIP BETWEEN GLYCEMIC CONTROL, OBESITY AND ON-TREATMENT PLATELET REACTIVITY
Authors: Carlos L. Alviar, Vivek Kumar, Joseph Burdowski, Eugenia Gianos, Jeffrey Berger, Revathi Balakrishnan, Anish Vani, Yu Guo, Jinfeng Xu, Arthur Schwartzbard, Steven Sedlis, James Slater, Binita Shah
Journal: Journal of the American College of Cardiology (2014)
Medicine takes two of top three places in research assessment exercise
Authors: G. Watts
Journal: BMJ (2008)

An unofficial ranking of the results of the 2008 research assessment exercise has allocated two of the top three places to medical research institutions. Heading the list of 132 UK higher education bodies is the Institute of Cancer Research. In third place is the London School of Hygiene and Tropical Medicine.

The analysis, which was commissioned by the Times Higher Education and is in its issue of 18/25 December, was greeted with delight by both institutions.

“It’s the result of many years of hard work in fostering methodological rigour, supporting junior staff in achieving excellence, and publishing in high impact journals,” said Andrew Haines, director of the School …
Comparison of the prognostic value of dipyridamole and dobutamine myocardial perfusion scintigraphy in hemodialysis patients
Authors: An S. De Vriese, Dirk A. De Bacquer, Francis H. Verbeke, Olivier De Winter, Philippe R. Franken, Johan H. De Sutter, Natascha Walgraeve, Luc Missault, Frank W. De Geeter
Journal: Kidney International (2009)
Natural History of Tetralogy of Fallot in Infancy
Authors: LAWRENCE I. BONCHEK, ALBERT STARR, CECILLE O. SUNDERLAND, VICTOR D. MENASHE
Journal: Circulation (1973)

We employ a classification system for tetralogy (TF) that correlates clinical findings with the nature and severity of right ventricular (RV) outflow obstruction. Group 0 infants are acyanotic, Group 1 and 2 infants have intermittent or mild cyanosis with hypoxic spells, Group 3 infants have severe cyanosis without spells, and Group 4 infants have severe cyanosis and pulmonary artery (PA) hypoplasia without spells. Since 1964, 59 infants were identified as having TF, documented by catheterization. Contrary to previous reports, the majority (40 of 59) were acyanotic (Group 0) at birth. Cyanosis and hypoxic spells subsequently developed at mean ages of 6.1 and 13.4 mo respectively, due to increasing muscular infundibular hypertrophy, as well as fibrosis and growth failure of the RV outflow tract, due to diminished pulmonary blood flow. At catheterization (mean age 12.7 mo) only two were still in Group 0. An understanding of the progressive nature of TF suggests that infants in groups 1-3 can have total correction before significant undergrowth of the RV outflow tract occurs. Shunts are performed only in Group 4 infants. Twenty-eight infants from ten weeks to two years old had total correction. Five were under six months. There were two operative deaths (7%) and no late deaths. Heart block did not occur. Late hemodynamic studies in 17 patients reveal good relief of RV obstruction (mean RV-PA gradient 19 mm Hg) and no significant shunts. The natural history of TF in infancy can be successfully interrupted in most cases by early correction.
P193 Longitudinal Associations Between Fev1 And Hba1c In A Uk Cohort Of Young People With Cystic Fibrosis
Authors: L. Selby, T. Rootsey, R. Williams, K. Ong, D. McShane
Journal: Thorax (2014)

<h3>Objectives</h3> To interrogate the UK national data set and explore longitudinal relationships between FEV1, HbA1c and OGTT parameters in young people with CF up to the age of 23 years. <h3>Methods</h3> The UK CF data set (2007 to 2012) recording annual measurements of height, weight, BMI,% predicted FEV1 and FVC, HbA1c and 2 h glucose (2 hrGlu) (&gt;10 years only) was interrogated. HbA1c values &gt;6.5% and 5.7–6.5% were used to define ‘undiagnosed’ diabetes and a pre-diabetic state respectively in patients not labelled as having CFRD. Data from cases with known CFRD were censored. Longitudinal models analysed%FEV1 and %FVC as dependent variables and HbA1c or 2 hrGlu, BMI SDS and age as covariates in patients with HbA1c in the pre-diabetic range. <h3>Results</h3> 2105 patients (1097 males), 87.9% with DF508 mutations, median (range) age 13.7 (5.6–22) years, mean (SD) BMI Z score -0.11+/-1.1, %FEV1 82.1+/-20.3 at first visit were included. Median range follow up was 3 (1–5) years. 2 hrGlu was available in a subgroup (n = 636). Median HbA1c (Table 1) but not 2 hrGlu (slope -0.1, p = 0.3), within the pre-diabetic range (5.7–6.5%) were inversely associated with %FEV1. <h3>Conclusion</h3> In this large UK data set, longitudinal increases in HbA1c within the pre-diabetic range were associated with declining lung function. Our findings support the rationale for trials to invervene early to manage hyperglycaemia in young CF patients with pre-diabetes.