tbuckley/cabot-search huggingface dataset:
Interaction of Impaired Coronary Flow Reserve and Cardiomyocyte Injury on Adverse Cardiovascular Outcomes in Patients Without Overt Coronary Artery Disease
Authors: Viviany R. Taqueti, Brendan M. Everett, Venkatesh L. Murthy, Mariya Gaber, Courtney R. Foster, Jon Hainer, Ron Blankstein, Sharmila Dorbala, Marcelo F. Di Carli
Journal: Circulation (2014)

Background— Minimally elevated serum cardiac troponin reflects myocardial injury and is associated with increased mortality, even absent coronary artery disease (CAD). We sought to investigate the relationship between low-level troponin elevation and impaired coronary flow reserve (CFR), an integrated measure of coronary vasomotor function, and to assess their contributions to adverse outcomes in patients without overt CAD. Methods and Results— Consecutive patients (n=761) undergoing evaluation for suspected CAD with troponin before stress myocardial perfusion positron emission tomography were followed up (median, 2.8 years) for major adverse cardiovascular events, including cardiovascular death, nonfatal myocardial infarction, or late revascularization. Patients with flow-limiting CAD, left ventricular ejection fraction &lt;40%, or revascularization within 60 days of imaging were excluded. CFR was quantified from stress/rest myocardial blood flow with the use of positron emission tomography. Compared with patients with negative troponin, those with at least 1 positive troponin (n=97) had higher pretest clinical scores, more renal dysfunction, and lower left ventricular ejection fraction and CFR. In adjusted analysis, impaired CFR remained independently associated with positive troponin (odds ratio, 2.18; 95% confidence interval, 1.37–3.47; P =0.001), and both impaired CFR and positive troponin were independently associated with major adverse cardiovascular events (hazard ratio, 2.25; 95% confidence interval, 1.31–3.86; P =0.003; and hazard ratio, 2.42; 95% confidence interval, 1.34–4.40; P =0.004, respectively). Impaired CFR and positive troponin identified patients at highest risk of major adverse cardiovascular events (log-rank P &lt;0.0001), with a significant interaction ( P &lt;0.007) seen between CFR and troponin. Conclusions— In patients without overt CAD, impaired CFR was independently associated with minimally elevated troponin and major adverse cardiovascular events. Impaired CFR, here reflecting microvascular dysfunction, modified the effect of a positive troponin on adverse outcomes.
Establish severity of blood loss and psychological status before surgery
Authors: J B Wright, M Greenberg
Journal: BMJ (1995)

EDITOR,—In the paper on their trial of hysterectomy, endometrial ablation, and endometrial resection for dysfunctional uterine bleeding S B Pinion and colleagues do not say how they assessed depression.1 They do, however, report extremely high levels of depression before surgery, which, despite falling afterwards, remained significantly raised. These findings are in keeping with the likelihood that a complicated relation exists between emotional problems and dysfunctional uterine bleeding.2 3 For example, if a woman is suffering from uncomfortable and unusually heavy menstrual blood loss it is easy …
In vivo evaluation of a hollow fiber liver assist device
Authors: Hugo O. Jauregui, Claudy J-P. Mullon, Donna Trenkler, Sharda Naik, Henry Santangini, Philip Press, Thomas E. Muller, Barry A. Solomon
Journal: Hepatology (1995)

Orthotopic liver transplantation is the only effective form of therapy currently available for patients with fulminant hepatic failure (FHF). The use of an extracorporeal (EC) liver assist device (LAD) may result in improved presurgical clinical management. Alternatively, patients treated with LADs could avoid the transplantation procedure if they are able to regenerate a critical mass of hepatocytes that will sustain functional viability. In this study, the efficacy of a prototype hollow fiber LAD seeded with rabbit hepatocytes was assessed in vivo by the use of two different animal models: (1) normal rabbits injected with diazepam or lidocaine, and (2) a galactosamine (Gal)-intoxicated rabbit model of FHF. The EC LAD clearly decreased the blood levels of the two drugs and significantly generated diazepam and lidocaine metabolites indicating the maintenance of active P450 forms in the cellular component of the devices. A 6-hour EC treatment significantly increased the survival time and delayed the onset of hepatic encephalopathy (HE) in the Gal-intoxicated rabbits. Histological evaluations of postmortem livers showed greater hepatocyte regenerative activity in the animals treated with hepatocyte-seeded LADs than in the two control groups, e.g., rabbits not treated or treated with unseeded devices. These findings support the concept that a microporous hollow fiber LAD seeded with rabbit hepatocytes is able to sustain drug detoxification in vivo as well as to modify the course of FHF in a well-characterized animal model. (Hepatology 1995;21:460-469.)
Improving Global Health — Margaret Chan at the WHO
Authors: Miriam Shuchman
Journal: New England Journal of Medicine (2007)

When Dr. Margaret Chan of China was elected director-general of the WHO, some observers suspected that the Chinese government had backed her candidacy in hopes of planting a lackey at the United Nations to do its bidding. In contrast, many global health experts have spoken positively about Chan's China connection. Dr. Miriam Shuchman reports.
Effect of chronic myocardial infarction on vagal cardiopulmonary baroreflex.
Authors: A J Minisi, M D Thames
Journal: Circulation Research (1989)

Sensory endings in the left ventricle are damaged by acute myocardial infarction. The goal of our experiments was to determine whether reflexes that originate in the heart are impaired by chronic myocardial infarction. Inferoposterior (n = 11) or anterior (n = 10) infarction was produced in dogs by ligation and intracoronary injection of rapidly hardening latex into either the proximal left anterior descending or left circumflex coronary arteries. Four weeks after infarction, the changes in renal sympathetic nerve activity induced by phenylephrine infusion, hemorrhage, and volume expansion were assessed before and after sinoaortic baroreceptor denervation. The results in infarct dogs were compared with the results in 11 sham-operated dogs. With arterial baroreceptors intact, baroreflex sensitivity (defined as the percent change in renal nerve activity per millimeter of mercury change in mean pulmonary artery wedge pressure) was similar in all groups of dogs. Following sinoaortic denervation, dogs with anterior and inferoposterior infarction had impaired responses to volume expansion. The responses during hemorrhage were abolished in dogs with inferoposterior infarction. We conclude that chronic myocardial infarction impairs reflexes that originate in the heart in response to changes in cardiac filling pressures.
Australia plans to restrict antiretrovirals to high risk cases as swine flu spreads
Authors: R. Rouse
Journal: BMJ (2009)

Health authorities in Australia are bracing for a fraught winter, as the novel H1N1 influenza A virus spreads alongside seasonal flu.

Although the federal government claims that years of pandemic planning have put Australia among the world’s best prepared nations, the roll out of strategies to contain the virus has been marked by anger and confusion in key sectors, including general practice. The response is complicated by the fact that each of Australia’s eight states and territories has its own pandemic plan in addition to the national one. 

More than 1500 cases (as at 15 June) of the H1N1 variant of flu …
STUDIES ON THE EFFECT OF CERTAIN TOXIC SUBSTANCES IN BACTERIAL CULTURES ON THE MOVEMENT OF THE INTESTINES
Authors: E. E. Ecker, A. Rademaekers
Journal: The Journal of Experimental Medicine (1926)

Following intravenous injection, filtrates of young cultures of B. paratyphosus B often produce marked diarrhea in rabbits. A study was made of the effect of these toxic filtrates on the motility of the small intestines of the rabbit. The observations were made on a segment of the small intestines in situ, and in the living animal. It was found that an immediate slight rise of tone of the longitudinal muscles occurred following intravenous injection of sterile broth. The same rise was noted after the injection of the toxic filtrate; but with these it was followed later (10 minutes elapsing at least) by a very strong but gradual rise of the diastolic and systolic tone, i.e., by spasmodic contraction of the intestinal muscle, which persisted at times for as long as 2 hours. In order to record simultaneously the effect on the longitudinal and circular muscles, and the propulsive efficiency of the segment the Sollmann and Rademaekers modification of Baur's technique was employed. This arrangement showed that the stimulation of the longitudinal muscles is accompanied by a similarly strong stimulation of the circular muscles, by peristalsis, and therefore by a greatly increased propulsion of intestinal contents which was sufficient to overcome the inhibition that usually occurs after preparation of the animal. With this arrangement an instance of peristaltic spasm was also noted. Broth alone failed to produce the phenomenon. Isotonic magnesium chloride or sulfate added to the bath relaxed the muscles again. Animals under deep urethane anesthesia did not show the diarrhea occurring in the intact controls, but sometimes exhibited it after the effect of the anesthetic had disappeared. So far no effects have been observed on the isolated strip (Magnus method), and further studies are being made to localize the effect, to neutralize it with a specific antiserum, and to observe the effect of filtrates of other members of the bacterial group including the dysentery bacilli.
Etiology of Diarrhea Among Travelers and Foreign Residents in Nepal
Authors: David N. Taylor, Robin Houston, David R. Shlim, Manoon Bhaibulaya, Beth L. P. Ungar, Peter Echeverria
Journal: JAMA (1988)

A bacterial pathogen was isolated from 47% of 328 expatriate patients with diarrhea seen at two medical clinics in Nepal in 1986. Enterotoxigenic Escherichia coli (24%), Shigella (14%), and Campylobacter species (9%) were isolated most frequently. Enteroinvasive and adherence factor-positive E coli were isolated from 2% and 1% of patients, respectively. Giardia lamblia was detected in 12% of patients, rotavirus in 8%, and Cryptosporidium and Entamoeba histolytica each in 5%. Blastocystis hominis was present in 33% of patients but in only 9% of those who took trimethoprim-sulfamethoxazole. More than one enteropathogen was detected in 17% of patients. Patients with prolonged symptoms (longer than two weeks) were more likely to have Giardia (27%) and less likely to have Shigella (5%) than were patients with acute symptoms. The isolation rates of bacterial pathogens decreased with length of stay in Nepal. A wide variety of enteropathogens were detected in travelers to Nepal, and Shigella and protozoa were particularly important. Length of time abroad and duration of symptoms were important diagnostic considerations.
Meta-analyses: funnel plots
Authors: P. Sedgwick
Journal: BMJ (2011)

Researchers undertook a meta-analysis of the effects of home monitoring on blood pressure. Randomised controlled trials were included if participants had essential hypertension and were trying to achieve blood pressure targets. The participants who did home blood pressure monitoring used ambulatory monitors. The control intervention was standard blood pressure monitoring in the healthcare system. In total, 13 randomised controlled trials were identified, with length of intervention ranging from two months to three years.1 Primary outcome measures included the difference between treatment arms in mean systolic blood pressure. It was reported that home blood pressure monitoring resulted in lower systolic blood pressure than standard monitoring, with an overall mean difference of 4.2 mm Hg (95% confidence interval 1.5 to 6.9 mm Hg). A funnel plot was presented (figure⇓). The funnel plot displayed asymmetry, and Egger’s test gave a statistically significant result (P=0.038). Funnel plot for the meta-analysis of the effects of home blood pressure monitoring on systolic blood pressure in comparison with standard monitoring Which of the following may have led to asymmetry in the funnel plot?
Improved severe hepatopulmonary syndrome after liver transplantation in an adolescent with end-stage liver disease secondary to biliary atresia
Authors: Tae Jun Park, Keun Soo Ahn, Yong Hoon Kim, Hyungseop Kim, Ui Jun Park, Hyoung Tae Kim, Won Hyun Cho, Woo-Hyun Park, Koo Jeong Kang
Journal: Clinical and Molecular Hepatology (2014)

Hepatopulmonary syndrome (HPS) is a serious complication of end-stage liver disease, which is characterized by hypoxia, intrapulmonary vascular dilatation, and liver cirrhosis. Liver transplantation (LT) is the only curative treatment modality for patients with HPS. However, morbidity and mortality after LT, especially in cases of severe HPS, remain high. This case report describes a patient with typical findings of an extracardiac pulmonary arteriovenous shunt on contrast-enhanced transesophageal echocardiography (TEE), and clubbing fingers, who had complete correction of HPS by deceased donor LT. The patient was a 16-year-old female who was born with biliary atresia and underwent porto-enterostomy on the 55th day after birth. She had been suffered from progressive liver failure with dyspnea, clubbing fingers, and cyanosis. Preoperative arterial blood gas analysis revealed severe hypoxia (arterial O2 tension of 54.5 mmHg and O2 saturation of 84.2%). Contrast-enhanced TEE revealed an extracardiac right-to-left shunt, which suggested an intrapulmonary arteriovenous shunt. The patient recovered successfully after LT, not only with respect to physical parameters but also for pychosocial activity, including school performance, during the 30-month follow-up period.
Atherosclerosis and Coronary Heart Disease
Authors: Harry B. Greenberg
Journal: JAMA (1973)

A good deal of practical as well as highly technical information makes<i>Atherosclerosis and Coronary Heart Disease</i>interesting and, at times, fascinating reading. In 51 short (from three to seven pages) but well-documented essays, its contributors touch on topics that range from the determinants of myocardial oxygen consumption and lactic acid accumulation to the surgical management of coronary insufficiency (artery-vein grafting and correcting structural defects) and the makeup of the coronary care unit. Cardiac arrhythmias develop in about 90% of persons suffering acute myocardial infarction, according to Dreifus. He comments on the potent, sometimes life-saving, inotropic and antifibrillatory actions of bretylium tosylate and discusses the effects on cardiac automaticity and conduction of the other agents used to control the tachyarrhythmias. And for the bradyarrhythmias that may precede ventricular fibrillation, he recommends artificial cardiac pacing. Knoebel, Konecke, and Fisch note that increasing the heart rate (electrical overdrive) may also control a
Pretreatment Endoscopy - Pro &amp; Contra: Is Endoscopy Needed before Treatment in All Patients with Gastroesophageal Reflux Disease?
Authors: N. Vakil
Journal: Endoscopy (2006)

The role of endoscopy in reflux disease has changed from being primarily diagnostic to one of risk management. Objective studies of routine endoscopy have shown little change in outcomes after the examination. Screening and surveillance for Barrett’s esophagus is still an unconfirmed strategy. In most developed countries, including western Europe and North America, middle-aged patients (over the age of 50) with gastroesophageal reflux disease would benefit more from colonoscopy than upper endoscopy.
Tissue glycogen content and glucose intolerance
Authors: Masato Kasuga, Wataru Ogawa, Takeshi Ohara
Journal: Journal of Clinical Investigation (2003)

Insulin stimulates glycogen synthesis in the the liver and skeletal muscle. After a mixed meal, the secretion of insulin from pancreatic β cells thus results in about 20% and 30% of the carbohydrate intake being stored in the form of glycogen in the liver and skeletal muscle, respectively (1, 2). Defects in this process can therefore be a major contributor to postprandial hyperglycemia. Indeed, the glycogen contents of the liver and skeletal muscle are reduced in individuals with type 2 diabetes (3, 4).

Glycogen metabolism is controlled predominantly by the coordinated action of two enzymes, glycogen synthase and glycogen phosphorylase, both of which are regulated by phosphorylation and allosteric modulators. Insulin promotes the net dephosphorylation of both glycogen synthase and glycogen phosphorylase through the inhibition of protein kinases and the activation of protein phosphatases. Among the protein kinases, glycogen synthase kinase–3 (GSK-3) is thought to be an important target for insulin in its stimulation of glycogen synthase activity (5, 6). Among the protein phosphatases, protein phosphatase 1 (PP1) has been implicated in this action of insulin (6).

PP1 is an abundant protein serine-threonine phosphatase that is expressed in all compartments of eukaryotic cells. The catalytic subunit of PP1 thus interacts with a wide variety of targeting subunits that localize it to specific sites within the cell. A family of proteins that target PP1 to glycogen and thereby regulate its activity has been identified. These proteins include GM (PPP1R3), GL (PPP1R4), PTG (protein targeting to glycogen or PPP1R5), and PPP1R6.
Reporting Impaired Physicians
Authors: Lainie S. Ross
Journal: JAMA (1990)

<h3>To the Editor.—</h3> The article by Dr Reuben and Ms Noble, "House Officer Responses to Impaired Physicians,"<sup>1</sup>addresses the serious issue of how medicine self-regulates. Although Dr Reuben and Ms Noble acknowledge that their study is limited because "the use of case scenarios does not permit us to comment on what house officers would do if situations similar to the case scenarios actually occurred," they claim that "in contrast to the commonly held notion that there is underreporting of physician impairment, our data suggest that the vast majority of house officers would have taken some initial action...." The first scenario describes an abusive physician who is noted to have the smell of alcohol on his breath, but it does not state whether the physician acted competently or not. Nor does it state whether the physician acted inebriated or may have just had a few sips of wine with dinner.
Efficacious and Clinically Relevant Conditioned Medium of Human Adipose-derived Stem Cells for Therapeutic Angiogenesis
Authors: Suk Ho Bhang, Seahyoung Lee, Jung-Youn Shin, Tae-Jin Lee, Hyeon-Ki Jang, Byung-Soo Kim
Journal: Molecular Therapy (2014)

Using stem cell-conditioned medium (CM) might be a viable alternative to stem cell transplantation, which is often hampered by low grafting efficiency and potential tumorigenesis, but the concentrations of angiogenic growth factors in CM are too low for therapeutic use and some components of the medium are not for human use. We used three-dimensional (3D) spheroid culture of human adipose-derived stem cells (ADSCs) with clinically relevant medium composed of amino acids, vitamins, glucose, and human serum to produce clinically relevant CM containing angiogenic and/or antiapoptotic factors such as vascular endothelial cell growth factor, fibroblast growth factor 2, hepatocyte growth factor, and chemokine (C-X-C motif) ligand 12. The concentrations of these factors were 23- to 27-fold higher than that in CM produced by conventional monolayer culture. Compared with injection of either monolayer culture CM or human ADSC, injection of spheroid culture CM to an ischemic region in mice significantly enhanced endothelial cell growth, CD34(+)/PTPRC(-) (endothelial progenitor) cell mobilization from bone marrow, and bone marrow cell homing to the ischemic region, resulting in improved blood vessel density, limb salvage, and blood perfusion in a mouse hindlimb ischemia model. The stem cell CM developed in this study will likely be an effective alternative to conventional stem cell transplantation therapy.
Resting technetium-99m tetrofosmin myocardial SPECT with and without attenuation correction for detecting viable myocardium: Comparison with FDG-PET
Authors: Ichiro Matsunari, Jens Stollfuss, Jan Schneider-Eicke, Guido Böning, Edward Ficaro, Sybille Ziegler, Stephan Nekolla, Markus Schwaiger
Journal: Journal of the American College of Cardiology (1996)
Effect of physical activity on femoral bone density in men
Authors: A G Need, J M Wishart, F Scopacasa, M Horowitz, H A Morris, B E C Nordin
Journal: BMJ (1995)

nosed (11 cases; relative risk 2A42 (95% confidence interval 1 2 to 4 3)).The combined relative risk of cancers that are known to be associated with tobacco smoking was reduced (0A49), but the combined relative risk of cancers of specified sites other than those associated with smoking was close to that expected (1-01). CommentWe found a low incidence of cancers associated with tobacco smoking, mainly lung and bladder cancer, among patients with Parkinson's disease.In addition, smokers are less likely to develop Parkinson's disease.'The most simple explanation of these findings is that tobacco smoking in some way exerts a protective effect against the development of Parkinson's disease, possibly through the effect of nicotine on dopamine concentrations in the brain,5 and that patients with Parkinson's disease therefore tend to have smoked less during their lives than the population at large.The close temporal association between diagnosis of Parkinson's disease and incidence of brain tumours suggests that brain tumours may on rare occasions be erroneously diagnosed as Parkinson's disease.We found an excess of six cases of brain tumours among 7046 patients with Parkinson's disease.This implies that no more than one in 1000 diagnoses of Parkinson's disease is an unrecognised brain tumour.The increased incidence of malignant melanoma lends support to the idea that treatment with levodopa may increase the incidence of malignant melanoma.3Malignant melanoma cells possess a unique biochemical pathway for the conversion of levodopa to melamine, and they selectively incorporate levodopa.4Levodopa treatment may therefore accelerate the growth of a preclinical melanoma.We emphasise, however, that the observed effect is rather weak: ground one excess case per 3500 patients with Parkin- son's disease per year.We thank Dr Annie Sasco for helpful comments on a draft ofthe article.