tbuckley/cabot-search huggingface dataset:
The Role of Arrhythmias in Defining Cardiac Dysfunction during Sepsis
Authors: Allan J. Walkey, Daniel Ambrus, Emelia J. Benjamin
Journal: American Journal of Respiratory and Critical Care Medicine (2013)

To the Editor:

We read with interest the article by Takasu and colleagues investigating cardiac and renal pathologic changes in patients who died with sepsis (1). We have two comments and two questions for the authors:

The authors correctly point out that it is “difficult to know the extent of sepsis-induced myocardial depression” among their study subjects, who on average had normal ejection fractions and among whom only 13/38 (34%) required potent β-agonists (e.g., dobutamine or epinephrine). Circulatory failure from distributive shock requiring vasopressors may or may not occur in the setting of cardiac dysfunction. The study by Takasu and colleagues highlights the need for more clear definitions of “cardiac dysfunction” during sepsis.

New-onset arrhythmias [particularly atrial fibrillation (AF)] during sepsis traditionally have not been considered signs of “cardiac dysfunction.” However, epidemiologic evidence suggests that new-onset AF represents an additional “organ failure” in patients with severe sepsis. For example, hospital mortality rates of patients with new-onset AF during sepsis are similar to patients without new-onset AF, but with one additional organ failure (2). We propose that future studies include dysfunction of the cardiac electrical system as evidence of “cardiac dysfunction during sepsis,” that is, serious arrhythmias such as AF, atrial flutter, ventricular tachycardia, or ventricular fibrillation.

In regards specifically to the study by Takasu and colleagues, data from Table E4 in their online supplement shows that 6/38 (16%) of patients with sepsis had pre-existing AF and 1/38 (2.6%) developed new-onset AF. Was AF systematically ascertained by the investigators? The proportions of patients identified with AF during sepsis are much lower than previous reports.

Finally, genomic and transcriptomic variation in connexin-43 previously has been demonstrated in patients and experimental models of AF (3). Although the tissue under examination in the present study was ventricular, rather than atrial, was there overlap between the seven patients with sepsis with connexin-43 abnormalities and the seven patients who had AF during sepsis? Specifically, might AF represent an alternative mechanism for the association between sepsis and connexin-43 abnormalities? Alternatively, could connexin-43 perturbations in sepsis be a mechanism predisposing susceptible patients to AF?
Dissociation between adipose tissue expression and serum levels of adiponectin during and after diet-induced weight loss in obese subjects with and without the metabolic syndrome
Authors: Carl Johan Behre, Anders Gummesson, Margareta Jernås, Theodore C. Lystig, Björn Fagerberg, Björn Carlsson, Lena M.S. Carlsson
Journal: Metabolism (2007)
Regulation by C5a of Neutrophil Activation during Sepsis
Authors: Niels C. Riedemann, Ren-Feng Guo, Kurt D. Bernacki, Jayne S. Reuben, Ines J. Laudes, Thomas A. Neff, Hongwei Gao, Cecilia Speyer, Vidya J. Sarma, Firas S. Zetoune, Peter A. Ward
Journal: Immunity (2003)
Any Oasis Will Do
Authors: Joyce O. Hislop
Journal: Annals of Internal Medicine (2003)

On Being a Patient20 May 2003Any Oasis Will DoJoyce O. Hislop, RN, OCNJoyce O. Hislop, RN, OCNFrom Dallas, PA 18612.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-138-10-200305200-00016 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Setting: A memorial service, held on Sorber Mountain, Noxen, Pennsylvania. It is a brilliant October day. About 100 people are gathered under a huge white tent stretched above the top of a long, grass-covered hill. The view extends across the distant mountains for miles, and overhead a large hawk flies in great, lazy circles. The deceased man's daughter is speaking to his family, friends, and business associates.Dad was fortunate to enjoy 78 years of relatively good health. In his last few years he found this mountain retreat to be a tougher climb than when he was younger, and reluctantly ... Author, Article, and Disclosure InformationAffiliations: From Dallas, PA 18612.Corresponding Author: Joyce O. Hislop, RN, OCN, Box 195A, RR#1, Dallas, PA 18612; e-mail, [email protected]com. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byLife on the Receiving End: A Qualitative Analysis of Health Providers??? Illness Narratives 20 May 2003Volume 138, Issue 10Page: 848-849KeywordsBreathingChildrenChocolateDiureticsGamesHeart failureInflammationMedical dialysisNurses ePublished: 20 May 2003 Issue Published: 20 May 2003 Copyright & PermissionsCopyright © 2003 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...
Loss of Pentameric Symmetry in C-Reactive Protein Induces Interleukin-8 Secretion Through Peroxynitrite Signaling in Human Neutrophils
Authors: Tarek Khreiss, Levente József, Lawrence A. Potempa, János G. Filep
Journal: Circulation Research (2005)

Plasma levels of C-reactive protein (CRP), nitrotyrosine, and interleukin-8 (IL-8) are known predictors of acute cardiovascular events. Peroxynitrite (ONOO − ) may function as an intracellular signal for the production of IL-8; however, it is not known whether CRP regulates these events. Emerging evidence suggests that some bioactivities of CRP are expressed only when the pentameric structure of CRP is lost, resulting in formation of monomeric or modified CRP (mCRP). We studied the impact of human native CRP and bioengineered mCRP that cannot rearrange into the pentameric structure on ONOO − formation and ONOO − -mediated IL-8 gene expression in human leukocytes. Incubation of human whole blood or isolated neutrophils with mCRP (0.1 to 100 μg/mL) for 4 hours increased IL-8 gene expression and secretion that was blocked ≈70% by the NO synthase inhibitor N ω-nitro- l -arginine methyl ester (L-NAME). In neutrophils, mCRP simultaneously increased superoxide production and endothelial nitric oxide synthase-mediated NO formation, leading to enhanced ONOO − formation, and consequently activation of nuclear factor-κB and activator protein-1. Native CRP had no detectable effect at 4 hours, whereas it enhanced IL-8 release after a 24-hour incubation that was blocked by L-NAME. An anti-CD16 antibody, but not an anti-CD32 antibody, produced 60% to 70% reductions in mCRP-stimulated NO formation and IL-8 release (both P &lt;0.05). These results suggest that loss of the pentameric symmetry in CRP, resulting in formation of mCRP, leads to IL-8 release from human neutrophils via peroxynitrite-mediated activation of nuclear factor-κB and activator protein-1.
WHO calls for $5m for earthquake relief
Authors: A. Gulland
Journal: BMJ (2015)

The World Health Organization has called for $5m (£3.3m; €4.6m) to help it respond to the grave humanitarian situation in Nepal after the country was hit by an earthquake measuring 7.8 on the Richter scale.

Both the earthquake, which struck on 25 April, and around 60 aftershocks have caused heavy damage as well as thousands of deaths and injuries. Unicef said on 27 April that nearly 5000 people had died and 50 000 had been injured, although these figures are expected to rise. Thousands more have been left homeless and are sheltering in tents. Even those …
Endothelial inclusions in dermatomyositis.
Authors: W.L Norton, E Velayos, L Robison
Journal: Annals of the Rheumatic Diseases (1970)

Abnormalities of the microvasculature of muscle from patients with polymyositis have been reported by Gonzilez-Angulo, Fraga, and Mintz (1968).These changes were similar to those of systemic lupus erythematosus (SLE) and scleroderma (Norton, Hurd, Lewis, and Ziff, 1968).Although the nature of the vascular injury is unknown, the capillaries of active lesions of SLE have recently been shown to contain characteristic endothelial inclusions (Gyorkey, Min, Sinkovics, and Gyorkey, 1969; Norton, 1969).The present report describes the occurrence of similar inclusions in skin and muscle of dermatomyositis.Attempts to define the nature -of the inclusions are described and their possible significance is discussed.
Die Laparoskopie bei der Diagnostik des „akuten Bauches”
Authors: H. Frangenheim
Journal: Endoscopy (1971)

Gynecological peritoneoscopy in diagnosis of acute abdomen is emphasized. Intraperitoneal hemorrhage, acute inflammatory processes, torsion of organs and ileus, acute spastic complaints and primarily surgical conditions can be differentiated during early peritoneoscopy. Even in small children there are no side effects or additional risks. Gynecological peritoneoscopy in acute abdomen is performed in general anesthesia and, when the intraabdominal findings demand for surgical intervention, laparotomy follows immediately.
1060-101 Angiographically apparent thrombus after fibrinolytic administration is associated with impaired epicardial flow and myocardial perfusion in ST elevation myocardial infarction patients with open arteries
Authors: Ajay J Kirtane, Dimitrios Karmpaliotis, Aaron Weisbord, Anh Bui, Sabina A Murphy, Daniela Budiu, Ioanna Kosmidou, Julian M Aroesty, Robert P Giugliano, Christopher P Cannon, Elliot M Antman, Eugene Braunwald, C.Michael Gibson
Journal: Journal of the American College of Cardiology (2004)
People's Health in People's Hands: A Model for Panchayati Raj
Authors: R N Villar
Journal: BMJ (1994)

When one considers the enormous problems that face the Indian health care system the trials and tribulations of Britain's meagre NHS pale into insignificance. And yet, after reading People's Health in People's Hands, I sense similarities between our two countries.

Dr Antia and Kavita Bhatia have put together a compelling argument for restructuring and reshaping the Indian health care system. Though I have now visited the country in a medical capacity on eight occasions, this book taught me a lot. It taught me what I had long suspected: that neither the legislature nor the ministers have a clear idea of public health problems. Primary health care is …
The mortality of treated acute PE
Authors: S. Iles
Journal: Thorax (2010)

Oseltamivir (2e3 mg/kg/day as currently recommended) was administered to 82% A/ H1N1+ve and 12% A/H1N1eve patients.In the A/H1N1+ve group, treatment was started within 24e48 h from symptom onset upon virological confirmation.Oseltamivir was well tolerated and no treatment cessation was required.In one AH1N1+ve patient complications were associated with development of oseltamivir resistance. 5linical course and duration of disease are reported in table 1.In the entire CF patient population, shorter disease duration was seen in oseltamivir treated patients (5, 4e11 vs 10, 6e14 days; p¼0.008), a difference apparently limited to the A/H1N1eve subset.During illness, 68% A/H1N1+ve and 80% A/H1N1eve patients developed pulmonary exacerbations (p¼0.127).Disease course was uncomplicated in 85% and 88% patients, respectively (p¼0.639).Of note, immunosuppressive therapy for organ transplantation did not increase risk of complications in either group.Four patients with severe pulmonary disease (3 A/H1N1+ve, 1 A/H1N1eve) died of respiratory failure: none had been vaccinated and all had received antiviral therapy (online supplementary table S2).No significant FEV 1 decline was observed in both groups after 1 and 6 months from symptom onset (online supplementary figure S2).In none of the cases, new isolation of Pseudomonas aeruginosa or Burkholderia cepacia complex was documented.In conclusion, in a cohort of patients who consecutively presented to Italian CF centres for flu-like symptoms during the 2009 pandemic period, accurate diagnostic testing did not identify clinical characteristics specifically associated with A/H1N1 infection, the only exception being younger age in A/H1N1+ve patients.The use of a reliable identification method allowed appropriate treatment to be initiated.Systematic collection of data at patient presentation and subsequent follow-up provided further information on A/H1N1 infection in CF, which will be useful to patients for the next influenza season.Influenza A/H1N1 has no major impact in CF, but patients with poor clinical conditions due to the disease are exposed to substantial risk of complications and unfavourable outcomes.Annual vaccination for seasonal influenza and A/H1N1 influenza is recommended in CF, with continuing efforts towards higher vaccination coverage levels especially in adult subjects.
CASES ILLUSTRATING THE VARIOUS FORMS OF CHRONIC DIFFUSE NEPHRITIS; MITRAL REGURITATION FOLLOWING ACUTE RHEUMATISM.Clinical lecture delivered
Authors: JAMES M. ANDERS
Journal: JAMA (1893)

Chronic Diffuse Nephritis.\p=m-\J.R., thirty-three years of age, single, a worker in the gas house, near the fire, where he is much exposed to becoming overheated and to draughts, comes to us with the following his- tory.Family history negative.When thirty years old, he had typho-malaria fever, and since this at- tack he has never been quite well.Soon afterward he developed rheumatism in the left knee, of a sub- acute type\p=m-\not having the fever, sweats, etc.Six months ago he began to complain of pain in the right knee ; at the same time the left leg began to swell around the knee, which extended downward to the foot.Two weeks ago there was present, as there is now, much oedema-especially of the right leg.One month ago his abdomen began to swell.He says he would feel perfectly well now if it were not for the presence of some dyspeptic symptoms.You notice a peculiar pallor of the skin, which latter is also harsh and inelastic, as shown by pinching up a fold, which as you see returns to its former condi¬ tion slowly.This is common to persons suffering from kidney trouble.He has no heart complica¬ tions, as there exists no evidence of hypertrophy, and no murmur.His urine contains albumen, also a few hyoline and granular casts.In these cases you frequently get no history of acute diffuse nephritis with rigors, fever, bloody and scanty urine; but, as in this instance, the trouble
SCARLATINA AND THE STREPTOCOCCUS INFECTION.
Authors: ROSA ENGELMANN
Journal: JAMA (1895)

The clinical history and symptomatology of scarlatina point to a virulent infection. Streptococci are found in the throat, cervical glands and other lymphoid structures, as well as in the blood, pleural, pericardial and peritoneal secretions, internal organs and skin of patients succumbing to this dread disease. Mr. Bergé, in a paper read at a recent meeting of the Biological Society of Paris, maintains that scarlet fever is the result of a local infection by the streptococcus. In an article upon "The Local Lesion of Scarlet Fever," Dowson speaks of the "accidental inoculation of the tonsil by minute scratches while taking food." No one questions the common etiology of idiopathic and surgical scarlatina. Their relation to puerperal fever and pelvic suppuration is admitted. Consequently their affinity to any local abscess formation, septicemia or pyemia must be conceded. No clinician has failed to observe the likeness of the course and progress of
An appointment system in a practice with immigrant patients.
Authors: S Carne
Journal: BMJ (1967)

In the group practice of which I am a partner patients have been seen by appointment for over six years. We adopted an appointment system when the two previously separate parts of the practice joined on 1 January 1962. It was essential to do something of this nature because of the shortage of space in the waiting-room. The premises now used by the group were those originally occupied by a single-handed general practitioner with a list of 1,600 patients. The space available was barely adequate for his needs. We were able to convert two rooms into extra consulting-rooms, so that at any one time three doctors can now consult, but there was no one room bigger than that used as the waiting-room. Unless we had two waiting-spaces, which would have been difficult to administer, we had no alternative but to restrict the number of patients waiting to be seen at any one time. In that the waiting-room, which has seats for only 12 people, has rarely been full to capacity, and patients no longer have to wait in the street outside ; and in spite of there being three doctors,'each seeing up to 12 patients an hour ; and notwithstanding the fact that some patients (children always) come accompanied by at least one relative, the appoint ment system has worked. I have described elsewhere the mechanics of our system of arranging appointments (Carne, 1963). We in our group believe that patients should, whenever possible, have choice of doctor. Even more important, we believe that one doctor should normally treat every member of each family. Most important of all, we aim to arrange our bookings so that each illness episode is dealt with by the same G.P. To assist the recep tionists (we need two working full-time on a shift system plus a full-time secretary) we have colour-coded our appointment cards, and we colour-code the family medical record envelopes where one member of the group deals with their personal problems. A high proportion of the patients in the practice are immi grants (Carne, 1967). Some of the social difficulties, with particular reference to the poverty of their housing, have been described elsewhere (Carne, 1962). It was therefore thought worth while to study the utilization of an appointment system by such patients.
Induction of protoporphyrin IX by aminolaevulinic acid in actinic keratosis, psoriasis and normal skin: preferential porphyrin enrichment in differentiated cells
Authors: T. Smits, A.I.M. van Laarhoven, A. Staassen, P.C.M. van de Kerkhof, P.E.J. van Erp, M.-J.P. Gerritsen
Journal: British Journal of Dermatology (2009)

In photodynamic therapy the endogenous photosensitizer protoporphyrin IX (PpIX) is synthesized following topical application of aminolaevulinic acid (ALA). However, different tissues have distinct PpIX-accumulating properties, due to differences in penetration of ALA through the stratum corneum and/or alterations in the haem cycle. Preferential PpIX accumulation has been reported in terminally differentiated cell cultures but ex vivo data are lacking.To study the intrinsic PpIX-accumulating capabilities of skin explants from lesional and nonlesional skin in psoriasis and actinic keratosis, with normal skin serving as a control, and to study PpIX accumulation in relation to differentiation status in normal skin.Skin explants from patients with psoriasis, actinic keratosis and normal skin were incubated with ALA and PpIX was measured spectrofluorometrically. PpIX was measured in basal (beta1-integrin-positive) and suprabasal (beta1-integrin-negative) keratinocytes in normal skin. In addition, PpIX accumulation was studied in cell cultures at different levels of confluence and after induction of terminal differentiation.No significant differences in PpIX content were found between the different tissues. However, increased PpIX was found in beta1-integrin-negative compared with beta1-integrin-positive cells. In addition, in subconfluent cell cultures less PpIX was found compared with confluent cell cultures. Induction of terminal differentiation in vitro, however, resulted in less PpIX, which was likely to be related to cell volume.As no significant differences in PpIX synthesis could be found between the different tissue types, these data emphasize the importance of the penetration route of ALA through the stratum corneum. Preferential PpIX accumulation observed in suprabasal epidermal keratinocytes and confluent cell cultures points towards a terminal differentiation-specific effect.
130. Insertion of Transgenes into the E3 or L3 Region To Allow Tumor Selective Expression from Armed Oncolytic Adenoviruses
Authors: Michael Robinson, Satya Yendluri, Derek Ko, Lynda Hawkins, Karin Jooss
Journal: Molecular Therapy (2006)

The ability to arm oncolytic vectors with transgenes gives researchers a mechanism for potential improvements in the vector potency. However, depending on the method for transgene insertion, the growth and selectivity of the oncolytic vector may be affected, ultimately reducing the efficacy of the vector. Here, a novel approach of inserting transgenes into various regions of the Ad5 genome that utilizes the Ad5 transcriptional machinery to allow high levels of transgene expression with minimal effect on the growth, cytotoxicity or selectivity of the vectors is described. A tumor-selective replication-competent vector backbone in which E1A expression is controlled by the human E2F promoter to restrict virus replication to pRb-pathway defective cells was used. The cDNA for a nontoxic, secreted protein transgene was inserted into either the E3 or L3 region of the viral genome. In the E3 region, the gp19K or the 14.7K genes were used as insertion sites. In the L3 region, a novel use of splice acceptor sites was utilized to insert the cDNA either after the 23K gene or between the hexon and 23K genes. No effect was observed on virus production for any virus tested compared to the parental unarmed virus. The insertion site of the transgene did not affect the cytotoxicity of the vectors compared to the parental vector, with similar levels of cell killing seen in the SW780 bladder cancer cell line. Tumor-selective killing of these vectors was also unaffected. Transgene expression did vary amongst the vectors, the highest expression levels from the virus with transgene inserted after 23K in L3. Expression levels where at least 10-fold higher compared to a non-replicating Ad5 vector that expressed the transgene from the constitutive CMV promoter. This observation was expected as the L3 transcript is one of the most abundant in an infected cell. Insertion of the transgene into the E3 14.7K gene resulted expression levels 2-to 3-fold higher than the non-replicating Ad5 vector. Transgene expression was markedly reduced from all vectors in cells in which DNA replication was blocked, demonstrating the tumor-selective nature of the transgene expression at these insertion sites. These studies show that by utilizing the adenoviral transcriptional machinery and the novel splice acceptor sites, transgenes can be inserted into several different loci and can be expressed to various high levels in a tumor-specific manner with minimal effect on the vector growth and efficacy.
Contempo 1997: Family Medicine-Reply
Authors: David Nicklin
Journal: JAMA (1997)

In Reply.  —We agree with Dr Solan that evidence for the efficacy of vitamin E in the prevention of coronary artery disease is less compelling than that for antiplatelet agents and estrogen in women. However, there is considerable evidence of benefit. Large prospective epidemiological cohort studies have shown strong associations between vitamin E use and decreased risk of cardiovascular events. Four populationbased studies involving more than 172 000 men and women show remarkable agreement, with high vitamin E intake being associated with a consistent reduction in risk of cardiovascular morbidity and mortality of between 36% and 58%. 1-2   Randomized controlled trials, primarily of secondary prevention, have yielded less impressive results. A large randomized controlled trial of large doses of natural (not synthetic) vitamin E in smokers and nonsmokers with proven coronary artery disease showed a risk reduction for nonfatal myocardial infarction and cardiovascular death of 47% in the vitamin E group, but