tbuckley/cabot-search huggingface dataset:
Neuraxial Modulation for Refractory Ventricular Arrhythmias
Authors: Tara Bourke, Marmar Vaseghi, Yoav Michowitz, Vineet Sankhla, Mandar Shah, Nalla Swapna, Noel G. Boyle, Aman Mahajan, Calambur Narasimhan, Yash Lokhandwala, Kalyanam Shivkumar
Journal: Circulation (2010)

Background— Reducing sympathetic output to the heart from the neuraxis can protect against ventricular arrhythmias. The purpose of this study was to assess the value of thoracic epidural anesthesia (TEA) and left cardiac sympathetic denervation (LCSD) in the management of ventricular arrhythmias in patients with structural heart disease. Methods and Results— Clinical data of 14 patients (25 to 75 years old, mean±SD of 54.2±16.6 years; 13 men) who underwent TEA, LCSD, or both to control ventricular tachycardia (VT) refractory to medical therapy and catheter ablation were reviewed. Twelve patients were in VT storm, and 2 experienced recurrent VT despite maximal medical therapy and catheter ablation procedures. The total number of therapies per patient before either procedure ranged from 5 to 202 (median of 24; 25th and 75th percentile, 5 and 56). Eight patients underwent TEA, and 9 underwent LCSD (3 patients had both procedures). No major procedural complications occurred. After initiation of TEA, 6 patients had a large (≥80%) decrease in VT burden. After LCSD, 3 patients had no further VT, 2 had recurrent VT that either resolved within 24 hours or responded to catheter ablation, and 4 continued to have recurrent VT. Nine of 14 patients survived to hospital discharge (2 TEA alone, 3 TEA/LCSD combined, and 4 LCSD alone), 1 of the TEA alone patients underwent an urgent cardiac transplantation. Conclusions— Initiation of TEA and LCSD in patients with refractory VT was associated with a subsequent decrease in arrhythmia burden in 6 (75%) of 8 patients (68% confidence interval 51% to 91%) and 5 (56%) of 9 patients (68% confidence interval 34% to 75%), respectively. These data suggest that TEA and LCSD may be effective additions to the management of refractory ventricular arrhythmias in structural heart disease when other treatment modalities have failed or may serve as a bridge to more definitive therapy.
Characterization of the suppressor cell activity in human cord blood lymphocytes.
Authors: M A Rodriguez, A D Bankhurst, J L Ceuppens, R C Williams
Journal: Journal of Clinical Investigation (1981)

Newborn mononuclear cells are known to have increased suppressor activity when compared with adult cells. However, the precise phenotypic description of the suppressor cell subpopulation has not yet been reported. This study was designed to examine the surface markers on human cord blood cells as defined by monoclonal antibodies and to characterize cord blood mononuclear cells that suppress in vitro pokeweed mitogen-driven immunoglobulin production. The pattern of fluorescence with the 9,6-monoclonal antibody suggested either a decreased density or a partial blocking of E-receptors on cord blood lymphocytes. Otherwise, human cord and adult cells had similar proportions of T cell subpopulations. Different subsets of newborn cells isolated by a monoclonal antibody rosetting technique were tested for suppressor activity. Cord blood lymphocytes recognized by the OKT8 monoclonal antibody constituted the major functional suppressor cell subpopulation. These cells were present in both E-rosetting and non-E-rosetting populations. Removal of OKT8+ mononuclear cord blood cells abrogated most of the suppressor activity. Thus the major suppressor cell present in cord blood is an OKT8 positive lymphocyte.
Visualization and Functional Assessment of Proximal and Middle Left Anterior Descending Coronary Stenoses in Humans With Magnetic Resonance Imaging
Authors: W. Gregory Hundley, Craig A. Hamilton, Geoffrey D. Clarke, L. David Hillis, David M. Herrington, Richard A. Lange, Robert J. Applegate, Mark S. Thomas, Jerri Payne, Kerry M. Link, Ronald M. Peshock
Journal: Circulation (1999)

Background —Coronary artery bypass grafting improves survival in patients with &gt;70% luminal diameter narrowing of the 3 major epicardial coronary arteries, particularly if there is involvement of the proximal portion of the left anterior descending (LAD) coronary artery. Measurement of coronary flow reserve can be used to identify functionally important luminal narrowing of the LAD artery. Although magnetic resonance imaging (MRI) has been used to visualize coronary arteries and to measure flow reserve noninvasively, the utility of MRI for detecting significant LAD stenoses is unknown. Methods and Results —Thirty subjects (23 men, 7 women, age 36 to 77 years) underwent MRI visualization of the left main and LAD coronary arteries as well as measurement of flow in the proximal, middle, or distal LAD both at rest and after intravenous adenosine (140 μg/kg per minute). Immediately thereafter, contrast coronary angiography and when feasible, intracoronary Doppler assessments of coronary flow reserve, were performed. There was a statistically significant correlation between MRI assessments of coronary flow reserve and (a) assessments of coronary arterial stenosis severity by quantitative coronary angiography and (b) invasive measurements of coronary flow reserve ( P &lt;0.0001 for both). In comparison to computer-assisted quantitative coronary angiography, the sensitivity and specificity of MRI for identifying a stenosis &gt;70% in the distal left main or proximal/middle LAD arteries was 100% and 83%, respectively. Conclusions —Noninvasive MRI measures of coronary flow reserve correlated well with similar measures obtained with the use of intracoronary Doppler flow wires and predicted significant coronary stenoses (&gt;70%) with a high degree of sensitivity and specificity. MRI-based measurement of coronary flow reserve may prove useful for identification of patients likely to obtain a survival benefit from coronary artery bypass grafting.
The Causes of Autoimmune Thyroid Disease*
Authors: LESLIE J. DEGROOT, JOSE QUINTANS
Journal: Endocrine Reviews (1989)

RESEARCH on the cause of autoimmune thyroid disease (AITD) has in the past focused on potentially unique and specific abnormalities that could provide a unitary explanation for these illnesses [Graves' disease (GD), Hashimoto's thyroiditis (HT), and primary thyroid failure]. Evolving knowledge of the human immune system and results of studies on thyroid autoimmunity have suggested to us for many years (1) that the cause of autoimmunity is instead multifactorial. We believe that some level of self-reactivity is a normal—indeed, necessary—aspect of immune function. The development of autoimmune disease involves genetic and environmental influences that amplify normal self-reactivity and which evolve over a lifetime. The course is not always unidirectional, since activation of autoregulatory responses can apparently reverse it. In this article we first provide an abbreviated summary of immune function and then review contemporary research on autoimmunity as related to the thyroid gland, including studies that begin to explain immune responses in molecular terms. Last, we offer a construction of AITD as a multifactorial process evolving through recognizable stages over years and attempt to integrate the experimental findings into this scheme.
FURTHER OBSERVATIONS ON THE RELATION OF THE EYE TO IMMUNITY IN EXPERIMENTAL SYPHILIS
Authors: Alan M. Chesney, Alan C. Woods
Journal: The Journal of Experimental Medicine (1944)

Two experiments are reported in which rabbits originally inoculated with syphilis and treated late in the course of the disease (174th to 210th day) were reinoculated subsequently in both corneas with the homologous strain of syphilitic virus. In each animal one cornea was inoculated with dead tubercle bacilli prior to reinoculation with the syphilitic virus. This procedure was carried out in order to bring about a non-specific inflammatory reaction with resultant vascularization, the intention being to find out if such vascularization would render the cornea more resistant to inoculation with the homologous strain of syphilitic virus. The results of both experiments were similar and while they were not conclusive, they indicated that there was a tendency for corneas which had been injected with dead tubercle bacilli to be more refractory to a subsequent inoculation with homologous syphilitic virus than the corneas of the same animals that had not been injected with dead tubercle bacilli. This tendency may be interpreted as suggestive evidence for the view that in the syphilitic rabbit there develop circulating antibodies toward the homologous strain of T. pallidum.
Role of endogenous ceruloplasmin in low density lipoprotein oxidation by human U937 monocytic cells.
Authors: E Ehrenwald, P L Fox
Journal: Journal of Clinical Investigation (1996)

Oxidation of lipids and lipoproteins by macrophages is an important event during atherogenesis. Activation of monocytic cells by zymosan and other agonists results in the release of multiple oxidant species and consequent oxidation of LDL. We now show evidence that ceruloplasmin, a copper-containing acute phase reactant, is secreted by zymosan-activated U937 monocytic cells, and that the protein has an important role in LDL oxidation by these cells. In one approach, ceruloplasmin has been shown to exhibit oxidant activity under the appropriate conditions. Exogenous addition of purified human ceruloplasmin stimulates U937 cell oxidation of LDL to nearly the same extent as activation by zymosan. In contrast to previous cell-free experiments (Ehrenwald, E., G.M. Chisom, and P.L. Fox. 1994. Intact human ceruloplasmin oxidatively modifies low density lipoprotein. J. Clin. Invest. 93:1493-1501.) in which ceruloplasmin by itself (in PBS) oxidizes LDL, under the conditions of the current experiments (in RPMI 1640 medium) ceruloplasmin only oxidizes LDL in the presence of cells; the mechanism by which cells overcome the inhibition by medium components has not been ascertained. As further evidence for a role of ceruloplasmin, activation of U937 cells with zymosan induces ceruloplasmin mRNA and ceruloplasmin protein synthesis after a 5-6 h lag that is consistent with that preceding LDL oxidation. Finally, neutralization by a highly specific polyclonal antibody to human ceruloplasmin inhibits LDL oxidation by at least 65%. Moreover, multiple antisense oligodeoxynucleotides targeted to different regions of the ceruloplasmin mRNA block LDL oxidation by up to 95%. The specific action of the antisense oligonucleotides has been verified by showing inhibition of ceruloplasmin synthesis and by the ability of exogenous ceruloplasmin to overcome the inhibition. In summary, these results are consistent with a mechanism in which cell-derived ceruloplasmin participates in oxidation of LDL by U937 monocytic cells. The data also show that cellular factors in addition to ceruloplasmin, possibly active oxygen species and/or lipoxygenases, are essential and act synergistically with ceruloplasmin to oxidize LDL.
Aneurysms of the Thoracic Aorta
Authors: JOHN W. JOYCE, JOHN F. FAIRBAIRN, OWINGS W. KINCAID, JOHN L. JUERGENS
Journal: Circulation (1964)

The clinical features and follow-up data on 107 patients who had a clinical diagnosis of aneurysm of the thoracic aorta made at the Mayo Clinic in the period 1945 through 1955 were reviewed. The ratio of male to female was 2.8 to 1, and the average age at the time of diagnosis was 59.3 years. Fusiform aneurysms were four times as frequent as saccular aneurysms; the most common location of the former was the descending thoracic aorta and of the latter the ascending thoracic aorta. Most of the aneurysms (73 per cent) were probably arteriosclerotic in origin. Symptoms, usually pain, and physical signs were present in a minority of patients and indicated a large aneurysm with a poor prognosis. Diastolic hypertension was present in almost half of the patients at the time of diagnosis and had an adverse effect on the patient's survival. Associated arteriosclerotic cardiovascular disease was present in 40 (37 per cent) of the patients at the time of diagnosis; some of these patients had multiple associated cardiovascular lesions. The presence of associated coronary, cerebral, or other peripheral arterial occlusive or aneurysmal disease had the most deleterious effect on survival. The prognosis for patients with large aneurysms was poorer than for those with small aneurysms. Information as to the cause of death was available in 59 (83 per cent) of the 71 patients known to be dead at the time of follow-up. Approximately a third of the deaths were due to rupture of the thoracic aortic aneurysm, and approximately a half, to associated cardiovascular disease, particularly that due to arteriosclerosis. It is believed that this study of patients with untreated aneurysms of the thoracic aorta may be used as a guide to the selection of patients with aneurysm for surgical treatment and may serve as a basis for evaluating the long-term results of such treatment.
LETTER FROM LONDON.
Authors: L. S. McMurtry
Journal: JAMA (1889)

(FROM OUR SPECIAL CORRESPONDENT.) Sir Joseph Lister: His Operative Work—Abdominal Surgery at the Samaritan Free Hospital for Women—Operative Methods—The Museum in Lincoln' s-Inn-Fields. The hospitals and clinics of the metropolis are so numerous, and the number and variety of patients and diseases so great, that one must of necessity make a selection. Fortunately the days and hours for visits and operations are published, and the visitor need have no difficulty in arranging his visits and thereby utilize all his time. My first visit to Kings' College Hospital was on Friday, the 22d of February, at 2 o'clock, the day and hour of Sir Joseph Lister's clinical lecture. Of course I had an especial desire to see the operative work and to know something of the<i>personnel</i>of the man who of all now living has most advanced the science and art of surgery. I remarked as much to Sir Joseph
Gastro-oesophageal reflux disease in children: NICE guidance
Authors: I. Davies, S. Burman-Roy, M. S. Murphy
Journal: BMJ (2015)

#### The bottom line

Gastro-oesophageal reflux is a normal physiological event, whereas gastro-oesophageal reflux disease (GORD) occurs when this process causes symptoms severe enough to merit medical treatment or when there are associated complications. In infants and children it is particularly difficult to differentiate between the two conditions because of the wide variety of potential symptoms and the lack of a simple, reliable, and widely available diagnostic test. The true burden of the problem is therefore difficult to quantify, and it is accepted that clinical practice varies greatly.

Children affected by the disease include premature and term neonates, otherwise well infants and children, and those with known risk factors, such as repaired diaphragmatic hernia and other congenital anomalies or severe neurodisabilities. This last group of children may have complex comorbidities and the underlying pathophysiology may have important differences.

This article summarises the most recent guidance from the National Institute for Health and Care Excellence (NICE) on how to recognise, diagnose, and manage gastro-oesophageal reflux disease in infants, children, and young people. …
Depressed contractile function in reperfused canine myocardium: metabolism and response to pharmacological agents
Authors: H. J SMITH
Journal: Cardiovascular Research (1980)

Regional myocardial function was measured with miniature ultrasonic crystals before, during, and after 10 min of coronary occlusion in anaesthetised open-chest dogs. In normal myocardium, intracoronary isoprenaline (0.1 micrograms . min-1) increased contraction velocity during the first third of systole (early systolic velocity) from 13.8 +/- 2.5 to 19.4 +/- 3.9 mm . s-1 . cm-1, (P < 0.01), and blood flow (microspheres) from 0.55 +/- 0.04 to 0.80 +/- 0.12 cm3 . min-1 . g-1 (P < 0.05); lactate extraction was unchanged. Coronary occlusion induced dyskinesia with a fall in early systolic velocity to -10.0 +/- 2.4 mm . s . -1 . cm-1 (P < 0.01). Abrupt reperfusion after 10 min of ischaemia permitted recovery towards normal, but regional function then deteriorated over 15 min. After a second infusion of isoprenaline, early systolic velocity increased from 0.8 +/- 2.2 to 14.2 +/- 2.5 mm . s-1 . cm-1 (P < 0.01), blood flow 0.44 +/- 0.03 to 0.73 +/- 0.14 cm3 . min-1 . g-1 (P < 0.01) and oxygen consumption 50 +/- 5 to 58 +/- 5 mm3 . min-1 . g-1 (P < 0.05). Lactate extraction was unchanged. In a further series of experiments, administration of nitroglycerin and methoxamine accelerated recovery from dyskinesia induced by coronary occlusion, but did not modify late deterioration during reperfusion. Similarly, neither propranolol nor hypertonic mannitol were found to modify reperfusion damage. Four agents which affect calcium ion movement were studied. Verapamil and isoprenaline, drugs which respectively diminish and enhance calcium slow current, had no effect on reperfusion damage. By contrast, ruthenium red, a non-specific calcium inhibitor reduced deterioration and calcium ionophore (A23187; Lilly) increased it. muDepressed function in reperfused myocardium is not the result of residual ischaemia per se, gut is consistent with calcium overload during the period of reperfusion.
Ligamentous Laxity in Secondary School Athletes
Authors: William A. Grana
Journal: JAMA (1978)

An increase in ligamentous laxity has been said to predispose athletes to injury of the joint. To evaluate the usefulness of testing ligamentous laxity to predict a predisposition to injury in secondary school athletes, 166 male football players, 84 female basketball players, and 32 male basketball players were tested. The results were compared with those for 167 males and 223 females in high school but not involved in interscholastic sports. No correlation could be found between ligamentous laxity and the occurrence or type of injury.
An inhaled glucocorticoid does not prevent tolerance to the bronchoprotective effect of a long-acting inhaled beta 2-agonist.
Authors: D H Yates, S A Kharitonov, P J Barnes
Journal: American Journal of Respiratory and Critical Care Medicine (1996)

There is increasing evidence for the development of tolerance to the protective effects of inhaled beta 2-agonists against bronchoconstrictor stimuli. Animal studies have suggested that glucocorticoids protect against the down-regulation of beta 2-receptors after chronic exposure to beta 2-agonists. In a double-blind placebo-controlled crossover study in 12 patients with mild asthma, we investigated the effect of inhaled budesonide or identical placebo on the protection conferred by albuterol (200 micrograms) against methacholine-induced bronchoconstriction before and after treatment with the long-acting beta 2-agonist salmeterol. Patients were randomized to be treated for 3 wk with inhaled budesonide (800 micrograms twice a day) or placebo; salmeterol (50 micrograms twice a day) was added during the third week. Airway responsiveness to methacholine was measured 15 min after albuterol, both before and exactly 12 h [corrected] after the last salmeterol dose. Mean FEV1 increased significantly after 2 wk of budesonide (p < 0.05) and increased further after salmeterol (p < 0.05) compared with placebo. After 2 wk, the bronchoprotective effect of albuterol against methacholine was significantly greater with budesonide than with placebo (3.4 versus 2.4 doubling dilutions; p < 0.05), consistent with an improvement in airway hyperresponsiveness with budesonide therapy. However, regular salmeterol treatment for 1 wk significantly diminished the protection conferred by albuterol against methacholine challenge, both with budesonide and with placebo (-1.1 +/- 0.42 and -1.41 +/- 0.30 doubling dilutions, respectively). There was no significant difference in the loss of bronchoprotection seen with salmeterol between budesonide and placebo treatment periods. Our study suggests that even a high dose of an inhaled glucocorticoid fails to prevent the loss of bronchoprotection produced by regular beta 2-agonist therapy.
An epidemiologic study to screen for chronic myelocytic leukemia in war victims exposed to mustard gas.
Authors: Mostafa Ghanei, Ali Akbar Vosoghi
Journal: Environmental Health Perspectives (2002)

Chemical agents such as mustard gas (or sulfur mustard), which has alkylating characteristics, were used against Iranian combatants in the Iraq-Iran war. Previous studies have not shown a strong link between these chemical agents and the development of chronic myelocytic leukemia (CML). The purpose of this study was to evaluate the increased risk of CML development in Iranian soldiers exposed to mustard gas during the war. Based on a descriptive study of 2,500 cases with documented exposure to various chemical warfare agents, 665 patients had documented exposure to mustard gas. We screened the latter using the leukocyte alkaline phosphatase (LAP) test and performed further cytochemical studies on cases with positive results. From among the 665 cases with documented exposure to mustard gas, 9 cases had LAP scores < 20; 2 of these 9 cases had CML and a score of zero (0.3%). We detected cytogenetic abnormalities in 7 patients with low LAP scores and atypical lymphocytes of 5-11% in 40 patients. The risk ratio of CML developing in victims exposed to mustard gas (cutaneous or respiratory) may be higher in comparison with the normal population, although confounding factors (e.g., the possibility of exposure to combined chemical agents, excluding patients who did not manifest blisters) limited our results. Because the increased development of CML in young patients with a documented history of exposure to mustard gas cannot be disregarded, further studies are needed.
Daily Aspirin — Only Half the Answer
Authors: Jerry Spivak
Journal: New England Journal of Medicine (2004)

Polycythemia vera is a chronic clonal hematopoietic–stem-cell disorder of unknown cause characterized by autonomous bone marrow function. Among the long-term consequences of this unregulated hematopoiesis are the extramedullary production of blood, primarily in the spleen and the liver, with painful and debilitating organomegaly and portal hypertension; hyperuricemia with secondary gout and renal stones; often intractable aquagenic pruritus; and hemorrhage, usually mucocutaneous. In a small proportion of cases, clonal succession or evolution, frequently abetted by chemotherapy, leads to myelofibrosis and bone marrow failure or acute leukemia. However, it is a short-term consequence, thrombosis, that causes much of the illness and death . . .
Effect of glutathione aerosol on oxidant-antioxidant imbalance in idiopathic pulmonary fibrosis
Authors: Z Borok, R Buhl, G J Grimes, A D Bokser, R C Hubbard, K J Holroyd, J H Roum, D B Czerski, A M Cantin, R G Crystal
Journal: The Lancet (1991)
Effectiveness of Influenza Vaccines during an Epidemic of Asian Influenza
Authors: Benjamin F. Gundelfinger, W. T. Stille, Joseph A. Bell
Journal: New England Journal of Medicine (1958)

THE identification of a new antigenic variant of influenza virus of the A group from epidemics occurring in the Far East in April and May, 1957,1 , 2 permitted a revision in the antigenic composition of influenza vaccines before their anticipated use during the fall and winter. The new Asian viruses were found to be sufficiently different antigenically from previously known influenza viruses of the A type to indicate that vaccines containing the older antigens might provide little if any protection against illness due to the new strain. By early summer of 1957, it was evident that the Asian strain of influenza . . .
Fasting plasma insulin is an independent predictor of cardiac events at one year after percutaneous coronary revascularization
Authors: Karine Sautière, Jean Marc Lablanche, Grégory Perrard, Jean-Marc Aubert, Sébastien Caudemont, Pascal Pigny, François Cuilleret, Sophie Susen, Christophe Bauters, Jean Charles Fruchart, Eric Van Belle
Journal: Journal of the American College of Cardiology (2003)