tbuckley/cabot-search huggingface dataset:
Strength-Duration Relationship for Human Transvenous Defibrillation
Authors: Michael R. Gold, Stephen R. Shorofsky
Journal: Circulation (1997)

Background One of the basic characteristics of electrical defibrillation is the strength-duration relationship, or the effect of pulse width on defibrillation efficacy. This relationship is important for understanding the mechanism of defibrillation and for the design of optimal waveforms. However, a detailed evaluation of the strength-duration relationship for human transvenous defibrillation has not been performed previously. Methods and Results This was a prospective study of 29 patients undergoing initial defibrillator implantation with a uniform dual coil, transvenous lead. In each patient defibrillation thresholds were measured for either short (2, 3, 4, 6 ms) or long (6, 12, 18 ms) pulse durations, with the order of testing randomized. The shock waveform was a truncated monophasic pulse from a capacitor of 150 μF. The leading edge voltage at defibrillation threshold was 566±100 V for 2-ms pulses. Voltages declined exponentially with increasing pulse width reaching an asymptote by 6 ms (451±68 V, P &lt;.05). Defibrillation threshold voltage was insensitive to longer pulse widths. Stored energy at defibrillation threshold showed a similar relationship with pulse width. In contrast, mean current decreased monotonically over the full range of pulse durations evaluated, and there was no evidence of a rheobase. Conclusions The shape of the strength-duration curve and the lack of rheobase current indicate a fundamental difference between cardiac stimulation and defibrillation. The relationship between pulse duration and defibrillation threshold voltage or stored energy is well modeled by a parallel capacitor resistor circuit with a time constant of 5.3 ms.
IMPROVED METHOD OF TESTING COLOR PERCEPTION.
Authors: WILLIAM THOMSON
Journal: JAMA (1900)

Dr. Williams' remarks leave but little to be said in favor of the use of a lantern for examination of the color sense. In the system in use of the Pennsylvania Railroad the lantern of Donders has been advised for the testing by the ophthalmic expert, but I am now convinced that a test of this kind should be used in conjunction with the colored wool stick by all the examiners who act under the direction of the division superintendent. Two-fifths of the time of a railway employee's life is spent in governing his action by colored lights by night. The lantern furnishes the test. It also gives us the means of detection of central scotomata, or the color defects caused by central amblyopia induced by tobacco and alcohol. It consists of a small kerosene lamp, or spring candle-stick on which can be placed an asbestos chimney seven inches in
The human skin blanching assay—use and abuse
Authors: P.M. Gaylarde
Journal: British Journal of Dermatology (1986)

Journal Article The human skin blanching assay—use and abuse Get access P.M. Gaylarde P.M. Gaylarde The Royal Free Hospital, Hampstead, London NW3 2QG, U.K. Search for other works by this author on: Oxford Academic Google Scholar British Journal of Dermatology, Volume 114, Issue 5, 1 May 1986, Pages 636–637, https://doi.org/10.1111/j.1365-2133.1986.tb04075.x Published: 01 May 1986
Frequency of Fragmented QRS in Patients with Severe Aortic Valve Stenosis
Authors: Mustafa Tarık Ağaç, Levent Korkmaz, Hüseyin Bektaş, Zeydin Acar, Hakan Erkan, İbrahim Halil Kurt, Adem Adar, Şükrü Çelik
Journal: Journal of the American College of Cardiology (2013)
Complementary medicine: Physiotherapists want update in the law
Authors: R. Pickis
Journal: BMJ (1993)

register should be well defined.Having a list of recognised qualifications or colleges would be pointless as a potential patient would find it almost impossible to ascertain which were bona fide; in addition, there would be no opportunity to impose sanctions.Lastly, hypnotherapy does not have to be confined to the medical profession as a medical qualification is not a prerequisite to being a good hypnotherapist.Indeed, some lay therapists are better than their medical
Long-term Efficacy of Acetazolamide on Cheyne-Stokes Respiration in Congestive Heart Failure
Authors: Shahrokh Javaheri
Journal: American Journal of Respiratory and Critical Care Medicine (2006)

We very much appreciated Dr. Javaheri’s recent article concerning the effects of acetazolamide on Cheyne-Stokes respiration (CSR) in congestive heart failure (1). Since CSR in heart failure, characterized by repetitive central apneas alternating with a crescendo–decrescendo tidal volume, is acknowledged to behighly prevalent (2) and probably can also be a therapeutic target, the article has relevance not only for pulmonary/sleep specialists but cardiologists as well. According to this study, acetazolamide was taken 1 h before bedtime for a week by heart failure patients with CSR. The author reported that apnea–hypopnea and nocturnal oxygen desaturation were ameliorated, subjective perception of sleep quality and daytime symptoms were improved, and PaCO2 in arterial blood gases was decreased. Although Dr. Javaheri suggested that a changing apneic threshold might have played a major role (1), other mechanisms could be considered, including the changes in controller/plant gains and circulation time. A further decline in PaCO2 secondary to the metabolic acidosis produced by acetazolamide may pose a risk of exaggerating CSR by jeopardizing respiratory stability. In a recent case series, five heart failure patients with CSR were treated nightly for a year with continuous positive airway pressure (CPAP) of 5–8 cm H2O, resulting in improved central sleep apnea, sleep quality, and cardiac function (3). An additional data analysis of ventilatory response to rebreathing hypercapnia in four of five normocapnic patients revealed that the slope of the regression line of minute ventilation versus PaCO2 was significantly decreased after 3 mo of CPAP, suggesting that chemoreceptor sensitivity was diminished after appropriate treatment. Dr. Javaheri did not show changes in chemosensitivity, but had previously reported that an enhanced sensitivity to CO2 could predispose some heart failure patients to develop CSR (4). Although the central action of acetazolamide might have improved daytime symptoms in heart failure patients (1), acetazolamide is a second-line diuretic for treatment of heart failure due to its adverse effects (such as hyperpnea, numbness, and nocturia) and pharmacologic acclimatization, which would occur within a few months after starting administration. Nonetheless, the long-term efficacy and safety of acetazolamide in improving CSR in heart failure has not yet been established. Sleep-disordered breathing is a major public health problem (5), and its interactionwith cardiac function has been called a new cardiovascular frontier (6), as indicated by the fact that only 17 yr have passed since one of the earliest prevalence studies dealing with CSR in heart failure appeared in a journal for cardiologists (2).
Congenital Absence versus Acquired Attenuation of One Pulmonary Artery
Authors: RASHID A. MASSUMI, ROBERT F. DONOHOE
Journal: Circulation (1965)

tion of a pulmonary artery was the unequivo- cal evidence of its occlusion or atresia not- withstanding Maier's emphasis in 1954 on how closely acquired attenuation of one pul- monary artery could masquerade as true atresia.8The purpose of this presentation is to point out the frequent errors of diagnosis based on this premise and to suggest certain technical refinements aimed at improving diagnostic accuracy.The two cases of actual and one case of apparent absence of one pulmonary artery presented here were chosen from over 35 cases of congenital and acquired unilateral pulmonary artery involvement and serve to illustrate the essential points of distinction. Case ReportsCase 1 This 23-year-old mentally retarded Negro girl, product of a normal pregnancy and delivery, was noted to have a slow physical development when she was 22 years old.A heart murmur was dis- covered at this time.Cyanosis and clubbing of all extremities were noted when she was 8 years of age, but squatting and fainting were never observed.-She was committed to an institution for retarded children at the age of 9 years.There was no history of cough, chesit colds, or hemop- tysis.The striking findings were marked, univer- sally distributed cyanosis and clubbing, small stature, mentality and interests of a 5-year-old girl, and short, stubby fingers.The only audible murmur was a grade III/VI late ejection mur- mur, loudest in the third left interspace para- sternally.The electrocardiogram showed marked right atrial and ventricular hypertrophy.Breath sounds were of normal vesicular quality throughout but were weaker over the right lung.Rales were absent.Chest roentgenogram (fig. 1) showed a cen- trally located heart of normal size and a small right lung with conspicuously absent right main pulmonary artery.There was a lace-like vascular pattern in the parahilar area of the right lung.
Elevated coronary vascular resistance in the presence of reduced resting blood flow distal to a severe coronary stenosis
Authors: A. S MOST, D. O WILLIAMS, H. GEWIRTZ
Journal: Cardiovascular Research (1985)

Vascular reserve in underperfused myocardium has recently been described. This seemingly paradoxical observation conflicts with older concepts of the coronary circulation which hold that flow deficits do not develop until reserve is fully exhausted. To examine this phenomenon in greater detail in an animal model mimicking a fixed human coronary artery stenosis, we analysed the records of 25 carefully selected, sedated pigs all instrumented with a rigid intralumenal coronary stenosis (82% lumenal diameter reduction). Each animal satisfied the following criteria: 1) perfused myocardial mass beyond the stenosis was within a narrow weight range (16 to 24 g); and 2) post stenosis (distal) epicardial (Epi) and endocardial (endo) flows were ≤ 90% of respective flows in a region perfused by the non-stenosed circumflex (CX) coronary artery. Accordingly, distal flow was reduced compared to circumflex zone flow (p<0.01) in the Epi (173 ± 51 to 113 ± 32 ml·100g−1·min−1), Endo (146 ± 39 to 116 ± 27) and transmural (Tm) regions (164 ± 45 to 124 ± 31). Despite a flow deficit and constant severity of stenosis, distal zone Tm resistance (0.55 ± 0.21 mmHg/ml·100 g−1·min−1) exceeded the minimum level achievable with intravenous infusion of adenosine (0.25 ± 0.07) in a separate group of eight animals without a stenosis. Distal transmural resistance also varied over a five fold range (0.27 to 1.33) and in 20/25 animals exceeded the highest level (0.37) seen in non-stenosis animals during adenosine infusion. Additional evidence suggesting that the distal vascular bed was not fully dilated was the lack of strong correlation between distal flow and aortic pressure. Further support for this concept was the close correlation between distal Tm, Epi and to a lesser degree, Endo flows (p<0.01) with myocardial oxygen demand as reflected in respective flows in the Cx zone (r = 0.84, 0.93 and 0.54). Finally, the range of flow deficits as measured by the dista1: CX flow ratio varied widely (Endo 0.22 to 0.87; Epi 0.64 to 0.90; Tm 0.45 to 0.88) and did not correlate with the rate-pressure product. Thus, since arteriolar resistance was greater than an achievable minimum, residual vasodilatory reserve was present in the majority of animals studied despite reduced resting blood flow distal to the stenosis. The degree of reserve and range of flow deficits was found to vary widely. In clinical terms, these findings suggest that the variable severity of clinical symptoms in patients with seemingly similar coronary stenoses may reflect, at least in part, individual differences in residual vasodilatory reserve even under circumstances in which flow is reduced at rest.
The Curse: A Study in Family Communication
Authors: JAMES B. RAYBIN
Journal: American Journal of Psychiatry (1970)

The curse, or sinister prophecy, is discussed from the viewpoint of its role in family communications. Illustrations are presented from four families. The creation and maintenance of a curse as part of a larger family mythology involves individual problems in identification and magical thinking, as well as family problems of homeostasis and the transmission of irrationality. Therapy of individuals and families caught up in a mythological system is an arduous task, as there is much resistance to change what is often seen as one's inevitable fate.
Correlation of in vitro and in vivo methods by means of mass dose and fiber distribution for amosite and fibrous ferroactinolite.
Authors: D L Coffin, L D Palekar, P M Cook
Journal: Environmental Health Perspectives (1983)

Oncogenesis and in vitro data (reported elsewhere in detail) are compared on the basis of relative activity by mass and by dimensional fiber parameters. When tumor induction is compared to the number of fibers of various lengths and aspect ratios in the dose in rats to the degree of tumor induction, a degree of difference with the long thin fiber concept of tumorigenesis by mineral fibers is noted. Consistency is re-established, however, when cognizance is taken of the change in the length and aspect ratio that took place during residence in the lung. This change resulted in a severalfold excess for ferroactinolite of all fiber lengths with high aspect ratios, produced as a result of longitudinal splitting of the introduced fibers. The response by mass in the in vitro procedures did not mimic oncogenesis. When mass was so adjusted that there were an equal number of mineral fibers, aspect ratio greater than 3, for dose for the two minerals, agreement was closer in both the rabbit alveolar macrophage toxicity test and the clonal cytotoxicity assay in Chinese hamster ovary cells. When activity was related to the number of mineral fibers, the same aspect ratio computed to have been contained in the mass dose, agreement with the relative induction of lung tumors was closer. In all cases, erythrocyte lysis was more active in reflecting the number of mineral fibers.
Risks to surgeons and patients from HIV and hepatitis.
Authors: E H Boxall
Journal: BMJ (1993)

tuberculosis in health care workers in central France.I studied cases of tuberculosis in hospital em- ployees between 1984 and 1992.Sixty two cases of occupationally acquired tuberculosis occurred during this period.In all cases the employees had had BCG vaccination, but in 41 cases the tuberculosis occurred more than 15 years after the vaccination.The World Health Organisation and many authors consider that BCG vaccination gives about 80% protection, but only for 15 years.2Thus in these 41 cases the protection offered by BCG vaccination may have disappeared.Health care workers should have a tuberculin skin test at least every two years.A further BCG injection should be given if the result of the test is negative.In 44 cases in this study tuberculosis was detected by a routine chest x ray examination.Chest x ray screening, though more costly, is more effective than skin testing.As the number of patients admitted to hospital with HIV infection and tuberculosis increases, the risk of nosocomial transmission to staff may rise, and new thought must be given to prevention.
Preprogrammed Intravenous Insulin Infusion in Diabetic Humans: Metabolic Consequences of Altering Meal Size
Authors: Claire Levy-Marchal, Kusiel Perlman, Bernard Zinman, A Michael Albisser
Journal: Diabetes Care (1986)

New implantable, variable-rate, intravenous insulin infusion systems offer the possibility of increased dietary flexibility in the treatment of diabetes mellitus. However, the development of insulin infusion algorithms required to maintain near-normal glycemia in the presence of a nonconstant diet first requires information concerning the metabolic response to meals of varying size when the insulin dose is fixed. With this goal in mind, we studied five type I diabetics aged 16-40 yr who were treated for 3 wk with a portable intravenous insulin infusion system. Initially, the patient's usual prescribed diabetic diet was provided, and an individual waveform of insulin infusion resulting in diurnal normoglycemia was defined for each meal. Subsequently, small (12% of total daily calories) and large (36% of total daily calories) versions of the regular breakfast (24% of total daily calories) were provided without change in the insulin infusion waveforms, and the resulting metabolic profiles were studied. The overall mean fasting plasma glucose levels before the meals of varying size were not significantly different, but the incremental rises in plasma glucose with the small (31 +/- 5 mg/dl), regular (48 +/- 7 mg/dl), and large (64 +/- 5 mg/dl) breakfasts varied directly with the meal size. The subsequent mean plasma glucose levels before the regular lunch were significantly different (P less than .05) after the small (50 +/- 4 mg/dl) and large breakfasts (131 +/- 9 mg/dl), compared with the regular breakfast (81 +/- 7 mg/dl). Despite these differences, the plasma glucose levels before dinner were virtually identical. We conclude that large variations in meal size produce glycemic changes in keeping with the caloric content of the meal.(ABSTRACT TRUNCATED AT 250 WORDS)
1136-82 Tetrahydrobiopterin depletion leads to endothelial nitric oxide synthase dysfunction in ischemic hearts
Authors: Yong Xia, Roberto Biondi, Tiebaud Liebgott, Nazareno Paolocci, A.J Cardounel, Giuseppe Ambrosio, Jay L Zweier
Journal: Journal of the American College of Cardiology (2004)
FORGETTING: PSYCHOLOGICAL REPRESSION
Authors: A. Carver
Journal: BMJ (1920)

r TEDI BRursa amelioration but rather the reverse, the headlache, Kernig's sign, and retraction of the head all being more pronounced, it was decided to try the effect of intrathecal injections of the man's own blood serum, in the hope that antibacterial sub- stances might be present in sufficienit quantity favourably to influence the supposed infection of the menitiges.Accordingly about 50 c.cm. of blood were removed from a vein in the arm into a bottle which was then allowed to stan(d over- night in ice-cold water; 20 c.cm. of the resulting serum, after being warmed by placing the container in warm water, were theD slowly injected into the subarachnoid space by lumtbar puncture after removal of the same quantity of cerebio-spinal duid.This proceeding was repeated on the three following days; only 12 c.cm. of serum, however, was injected each day as the cerebro-spinal fluid was under less tension and no more could be conveniently abstracted.A further 5 c.cm. were in- jected two days later (June 14th).From June 9th 10 grains of helmitol were given every four hours until June 14th, when the appearance of a considerable quantity of blood in the urine led to its being reduced to 5 grains every four hours.This haema- turia quickly cleared up, and though the urine contained a trace ol albumin until June 21st it was subsequently free; there was no evideuce to the naked eye of bacteriuria, and the reaction was acid.
Glycoprotein-D–Adjuvant Vaccine to Prevent Genital Herpes
Authors: Lawrence R. Stanberry, Spotswood L. Spruance, Anthony L. Cunningham, David I. Bernstein, Adrian Mindel, Stephen Sacks, Stephen Tyring, Fred Y. Aoki, Moncef Slaoui, Martine Denis, Pierre Vandepapeliere, Gary Dubin
Journal: New England Journal of Medicine (2002)

An effective prophylactic vaccine would help control the spread of genital herpes.We conducted two double-blind, randomized trials of a herpes simplex virus type 2 (HSV-2) glycoprotein-D-subunit vaccine with alum and 3-O-deacylated-monophosphoryl lipid A in subjects whose regular sexual partners had a history of genital herpes. In Study 1, subjects were seronegative for herpes simplex virus type 1 (HSV-1) and HSV-2; in Study 2, subjects were of any HSV serologic status. At months 0, 1, and 6, subjects received either vaccine or a control injection and were evaluated for 19 months. The primary end point was the occurrence of genital herpes disease in all subjects in Study 1 and in HSV-2-seronegative female subjects in Study 2.A total of 847 subjects who were seronegative for both HSV-1 and HSV-2 (268 of them women, in Study 1) and 1867 subjects who were seronegative for HSV-2 (710 of them women, in Study 2) underwent randomization and received injections. Vaccination was well tolerated and elicited humoral and cellular responses. Overall, the efficacy of the vaccine was 38 percent in Study 1 (95 percent confidence interval, -18 to 68 percent; 15 cases occurred in the vaccine group and 24 in the control group), and efficacy in female subjects was 42 percent in Study 2 (95 percent confidence interval, -31 to 74 percent; 9 cases occurred in the vaccine group and 16 in the control group). In both studies, further analysis showed that the vaccine was efficacious in women who were seronegative for both HSV-1 and HSV-2: efficacy in Study 1 was 73 percent (95 percent confidence interval, 19 to 91 percent; P=0.01), and efficacy in Study 2 was 74 percent (95 percent confidence interval, 9 to 93 percent; P=0.02). It was not efficacious in women who were seropositive for HSV-1 and seronegative for HSV-2 at base line or in men.These studies suggest that the glycoprotein D vaccine has efficacy against genital herpes in women who are seronegative for both HSV-1 and HSV-2 at base line but not in those who are seropositive for HSV-1 and seronegative for HSV-2. It had no efficacy in men, regardless of their HSV serologic status.
Ocular Pathology: A Color Atlas
Authors: Jay I. Perlman
Journal: JAMA (1993)

This text is a revised second edition of the companion text to Ocular Pathology: A Text and Atlas by the same authors. At the time the first edition of the color atlas was released, it was a much needed addition to the pool of available ocular pathology texts. Until then no comprehensive color atlas of ocular histopathology existed, and one was desperately needed.  Despite its usefulness, however, many shortcomings existed. Not least was the insufficient size of the pictures, making for poor identification of many pathologic entities. It would appear that the authors became aware of the shortcomings, leading to the development of this second edition.  The organization and content of the second edition are designed to complement the recently revised third edition of the text. The new larger format makes for an even more valuable atlas. The photographs are not only larger, but in many cases the picture contrast
Management of suspected myocardial infarction before admission: updated audit
Authors: N Prasad, V S Srikanthan, A Wright, F G Dunn
Journal: BMJ (1998)

Although the timing of aspirin administration is not as critical as thrombolytic treatment in patients with suspected acute myocardial infarction, aspirin should be given as soon as possible after the onset of symptoms.1 2 We reported a low rate (3%) of aspirin administration by general practitioners in patients with suspected acute myocardial infarction.3 We also found a low rate of intravenous opiate administration and inappropriate use of intramuscular analgesia by general practitioners before patients were admitted to hospital.3 Most of the media's attention, however, focused on aspirin. We therefore repeated an audit of the rate of aspirin and opiate administration by general practitioners to patients with chest pain before their referral to this coronary care unit. We also assessed the final …