tbuckley/cabot-search huggingface dataset:
Epicardial and endocardial mapping of ventricular tachycardia in patients with myocardial infarction. Is the origin of the tachycardia always subendocardially localized?
Authors: W Kaltenbrunner, R Cardinal, M Dubuc, M Shenasa, R Nadeau, G Tremblay, M Vermeulen, P Savard, P L Pagé
Journal: Circulation (1991)

BACKGROUND Left ventricular endocardial reentry is the conventional concept underlying surgery for ventricular tachycardia (VT). We assessed the incidences of patterns showing complete reentry circuits at either the subendocardial or subepicardial level and of patterns in which left ventricular endocardial mapping could only in part account for a reentrant mechanism. METHODS AND RESULTS We retrospectively analyzed epicardial and left ventricular endocardial isochronal maps of 47 VTs induced in 28 patients with chronic myocardial infarction (inferior, 14 patients; anteroseptal, 14 patients). Electrograms were recorded intraoperatively from 128 sites with epicardial sock and transatrial left ventricular endocardial balloon electrode arrays. Given the methodology used in this study, the mapping characteristics of the tachycardias suggested five types of activation patterns: 1) complete (90% or more of VT cycle length) subendocardial reentry circuits in seven VTs (15%) and seven patients (25%), 2) complete subepicardial reentry circuits in four VTs (9%) and four patients (14%), 3) incompletely mapped circuits with a left ventricular endocardial breakthrough preceding the epicardial breakthrough in 25 VTs (53%) and 21 patients (75%), 4) incompletely mapped circuits with a left ventricular epicardial breakthrough preceding the endocardial breakthrough in three VTs (6%) and three patients (11%), and 5) a right ventricular epicardial breakthrough preceding the left ventricular endocardial breakthrough in eight VTs (17%) and seven patients (25%). After surgery, one type 3 VT and three type 5 VTs were reinducible. Thus, left ventricular endocardial reentry substrates (types 1 and 3) accounted for 68% of VTs, but substrates involving subepicardial (types 2 and 4) and deep septal layers (type 5) accounted for 32% of VTs. CONCLUSIONS In a substantial number of VTs, a substrate localization that is at variance with the conventional concept can be detected by simultaneous epicardial and endocardial mapping and may require modification of the surgical approach conventionally aimed at endocardial layers.
New oral anticoagulants for preventing venous thromboembolism
Authors: E. R. Haut, B. D. Lau, M. B. Streiff
Journal: BMJ (2012)

Are we at the point of diminishing returns?

Orthopaedic surgery is known to be associated with a high risk of venous thromboembolism, and prophylaxis for orthopaedic patients is vital. In the linked systematic review and meta-analysis (doi:10.1136/bmj.e3675), Gomez-Outes and colleagues present a comparative effectiveness review that examines newer anticoagulant agents (dabigatran, rivaroxaban, and apixaban) in the prevention of venous thromboembolism after hip or knee replacement surgery.1

This review used randomised controlled trials that had directly compared one of the newer agents with enoxaparin to indirectly compare the effects of these drugs on venous thromboembolism outcomes and clinically relevant bleeding. The review therefore gives us an idea of what the results of a head to head trial would be like. This type of network meta-analysis in which multiple treatments are compared using both direct comparisons of interventions within randomised controlled trials and indirect comparisons across trials on the basis of a common comparator is on the methodological cutting edge of systematic reviews, but it can be fraught with peril if not done with scientific rigour.2 It found that rivaroxaban led to significantly lower rates of symptomatic venous thromboembolism than enoxaparin but at the cost of significantly increased bleeding. Both apixaban and dabigatran were as effective as enoxaparin in preventing venous thromboembolism, but apixaban …
Comparison of the action of calcium antagonists on basophil histamine release
Authors: C. Bindslev Jensen, P. Clementsen, P. Stahl Skov, U. G. Svendsen, O. Thastrup, S. Norn
Journal: Allergy (1987)

The inhibitory capacity of calcium antagonists on basophil histamine release was examined in allergic patients and in controls. All dihydropyridines tested (nifedipine, nimodipine, nitrendipine, nicardipine, felodipine) dose‐dependently inhibited anti‐IgE‐ and A23187‐induced release with an order of potency of felodipine &gt; nicardipine &gt; nifedipine = nimodipine = nitrendipine. Only the inhibition induced by felodipine and nicardipine on anti‐IgE‐induced release could be counteracted by increasing extracellular calcium. Diltiazem, not belonging to the dihydropyridines, was a weak inhibitor. A combination of felodipine and verapamil in low concentrations exerted a synergistic inhibitory effect on histamine release, whereas this was not the case with other combinations of antagonists. The results suggest differences in the mode of action of the 1.4‐dihydropyridines. This might be of significance in the search for calcium antagonists suitable in the treatment of allergic diseases.
Food and Drug Regulation After 75 Years
Authors: Arthur Hull Hayes
Journal: JAMA (1981)

THE FOOD and Drugs Act that Theodore Roosevelt signed into law on June 30, 1906, both grew out of and anticipated a partnership between medicine and government in the continuing and evolving effort to protect the public from unsafe and misbranded food and drugs. The first general law against adulteration of food in the United States was adopted by Massachusetts in 1784. More than a century was to go by, however, before the US Congress adopted a comprehensive law authorizing federal regulation of food and drugs and making it illegal to manufacture or offer for sale food or drug products that were adulterated or misbranded. Industrialization and urbanization vastly changed food production and distribution practices in the latter half of the 19th century and gave rise to both the need for and the ability to process food for shipment and storage. Questionable and often clearly dangerous practices were all too
Improving clinical research
Authors: P. M Stewart
Journal: BMJ (2003)

Impact of trading in the multi-dealer spot foreign exchange market is described using a structural vector autoregressive model. The model is derived in terms of return, signed trading volume, signed order book volume, and signed insidemarket order flow. EUR/USD and EUR/JPY data samples with whole-pip pricing and decimal pip-pricing are used. The results show that market impact is determined primarily by the signed trading volume and decays on the 10-second time scale. Signed inside-market order flow may be important for currency pairs with wide bid/offer spreads. Two subtle effects, the limit order book’s push and pull, are described. <b>TOPICS:</b>Currency, exchanges/markets/clearinghouses
Metagenomic Analysis of Tuberculosis — Current Limitations
Authors: Suzanne M Hingley-Wilson
Journal: New England Journal of Medicine (2013)

Golwala raises the valid issues of renal function with low-molecular-weight heparin and assays of anticoagulation in the patients who received bridged therapy; because of budgetary issues, we did not collect these data.Korantzopoulos asks for additional data on the surgical procedures.Subpectoral implantation was an exclusion criterion in the trial.We did not collect data on the use of the micropuncture technique.The use of electrocautery and creation of the pocket with insertion of a gauze pad before lead implantation is standard practice in most Canadian implantation centers, and hence we did not collect detailed data on this approach.
Effect of Screening for Coronary Artery Disease Using CT Angiography on Mortality and Cardiac Events in High-Risk Patients With Diabetes
Authors: Joseph B. Muhlestein, Donald L. Lappé, Joao A. C. Lima, Boaz D. Rosen, Heidi T. May, Stacey Knight, David A. Bluemke, Steven R. Towner, Viet Le, Tami L. Bair, Andrea L. Vavere, Jeffrey L. Anderson
Journal: JAMA (2014)

Coronary artery disease (CAD) is a major cause of cardiovascular morbidity and mortality in patients with diabetes mellitus, yet CAD often is asymptomatic prior to myocardial infarction (MI) and coronary death.To assess whether routine screening for CAD by coronary computed tomography angiography (CCTA) in patients with type 1 or type 2 diabetes deemed to be at high cardiac risk followed by CCTA-directed therapy would reduce the risk of death and nonfatal coronary outcomes.The FACTOR-64 study was a randomized clinical trial in which 900 patients with type 1 or type 2 diabetes of at least 3 to 5 years' duration and without symptoms of CAD were recruited from 45 clinics and practices of a single health system (Intermountain Healthcare, Utah), enrolled at a single-site coordinating center, and randomly assigned to CAD screening with CCTA (n = 452) or to standard national guidelines-based optimal diabetes care (n = 448) (targets: glycated hemoglobin level <7.0%, low-density lipoprotein cholesterol level <100 mg/dL, systolic blood pressure <130 mm Hg). All CCTA imaging was performed at the coordinating center. Standard therapy or aggressive therapy (targets: glycated hemoglobin level <6.0%, low-density lipoprotein cholesterol level <70 mg/dL, high-density lipoprotein cholesterol level >50 mg/dL [women] or >40 mg/dL [men], triglycerides level <150 mg/dL, systolic blood pressure <120 mm Hg), or aggressive therapy with invasive coronary angiography, was recommended based on CCTA findings. Enrollment occurred between July 2007 and May 2013, and follow-up extended to August 2014.The primary outcome was a composite of all-cause mortality, nonfatal MI, or unstable angina requiring hospitalization; the secondary outcome was ischemic major adverse cardiovascular events (composite of CAD death, nonfatal MI, or unstable angina).At a mean follow-up time of 4.0 (SD, 1.7) years, the primary outcome event rates were not significantly different between the CCTA and the control groups (6.2% [28 events] vs 7.6% [34 events]; hazard ratio, 0.80 [95% CI, 0.49-1.32]; P = .38). The incidence of the composite secondary end point of ischemic major adverse cardiovascular events also did not differ between groups (4.4% [20 events] vs 3.8% [17 events]; hazard ratio, 1.15 [95% CI, 0.60-2.19]; P = .68).Among asymptomatic patients with type 1 or type 2 diabetes, use of CCTA to screen for CAD did not reduce the composite rate of all-cause mortality, nonfatal MI, or unstable angina requiring hospitalization at 4 years. These findings do not support CCTA screening in this population.clinicaltrials.gov Identifier: NCT00488033.
The Changing Faces of Children with Cleft Lip and Palate
Authors: John B. Mulliken
Journal: New England Journal of Medicine (2004)

Many expectant parents worry, consciously or unconsciously, that their baby will be born with a malformation. Cleft lip with or without cleft palate is one of the most common birth defects and is certainly the most visible. The incidence varies among ethnic groups, ranging from 3.6 per 1000 live births among Native Americans to 2.0 per 1000 among Asians, 1.5 per 1000 among Indians, 1.0 per 1000 among people of European ancestry, and 0.3 per 1000 among Africans. Cleft lip with or without cleft palate is more frequent among boys. In contrast, isolated cleft palate is twice as common among . . .
Release of Serotonin from Human Platelets Induced by Aggregated Immunoglobulins of Different Classes and Subclasses
Authors: Peter M. Henson, Hans L. Spiegelberg
Journal: Journal of Clinical Investigation (1973)

The ability of human myeloma proteins of different classes and subclasses and of macroglobulins (all aggregated with bis-diazotized benzidine or heat) to aggregate washed human platelets and release [3H]-serotonin from the platelets was investigated and compared with the activity of normal IgG and tetanus-antitetanus IgG antigen-antibody complexes. Aggregated IgG1, IgG2, IgG3, IgG4, and normal IgG complexes all aggregated platelets and caused release of serotonin to similar extents. In contrast, IgA1, IgA2, IgD, and IgE myeloma proteins as well as IgM macroglobulins were completely inactive in this respect. Approximately 50% of the actvity remained in aggregated, mildly reduced and alkylated IgG myeloma proteins and their Fc fragments, whereas aggregated F(ab′)2 fragments were completely inactive. Addition of fresh serum inhibited the release of serotonin caused by aggregated IgG1 and IgG3 proteins and normal IgG antigen-antibody complexes by about 50% but had no effect upon the release of serotonin obtained with IgG2 and IgG4 proteins. This inhibition appeared to be mediated by complement. The release of serotonin was not accompanied by liberation of the cytoplasmic enzyme lactic dehydrogenase, indicating that no significant lysis of the platelets occurred. Addition of neutrophils did not enhance the serotonin release.
Gentle yet effective treatment for elderly patients with refractory or relapsing multiple myeloma
Authors: Arumugam Manoharan
Journal: American Journal of Hematology (2000)

Fourteen patients, aged 65–85 years, with refractory (11) or relapsing (3) multiple myeloma were treated with a “protracted-sequential” protocol comprising vincristine 1–2 mg or vindesine 3 mg/M2 (max. 5 mg) IVI over 4 hr on D1, prednisolone 40–50 mg PO D1–14, and melphalan 2–4 mg PO or cyclophosphamide 50–100 mg PO D15–28; cycles were repeated at 4–6 weekly intervals. Treatment was continued for 12 months if the response was optimal or indefinitely if the response was suboptimal. Five patients responded optimally; their survival from the commencement of this protocol ranged from 30 to 120 months. The other nine patients achieved a partial response, their survival ranging from 4+ to 79 months. The treatment is simple, nontoxic, and as convenient as the “classic combination” of melphalan and prednisolone. Am. J. Hematol. 65:81–82, 2000. © 2000 Wiley-Liss, Inc.
Drug-Drug Interaction
Authors: John A. Oates
Journal: JAMA (1969)

Interference With the Delivery of Drugs to Their Sites of Action  An increasing number of mechanisms have been described whereby one drug can modify profoundly the action of another. In some of these interactions, the therapeutic effect of a drug may be blocked when another agent prevents it from reaching the site of its pharmacologic action.  Interference With Absorption.—  One mechanism for interference with the absorption of drugs is illustrated in the study by Northcutt et al in this issue (p 1852), which demonstrates that absorption of orally administered thyroxine and liothyronine (triiodothyronine) by humans is prevented by the anion exchange resin, cholestyramine, which binds these drugs in the intestinal tract. This is an example of the general phenomenon of drug binding by this resin. In experimental animals, cholestyramine has been found to impair the absorption of other drugs including digitoxin, aspirin, secobarbital, and phenylbutazone. It would be valuable to
Are all bases covered?
Authors: Louise Barrett, S. Peter Henzi
Journal: Behavioral and Brain Sciences (2002)

In addition to ensuring that appropriate standards of evidence are employed when attempting to identify adaptations, researchers should investigate all nonevolutionary factors that could potentially explain their results. Evolutionary analyses may be undermined by alternative, non-evolutionary explanations either because not all relevant information is included in an evolutionary analysis, or because inappropriate methods incapable of detecting an adaptation are employed.
975-82 Role of Biplane Transesophageal Echocardiography in Assessing Severity of Aortic Stenosis: Planimetry vs. Continuity Equation
Authors: Miguel Zabalgoltia, Avanindra Jain, Rex Outtrim, Edward Sako, Robert A. O’Rourke
Journal: Journal of the American College of Cardiology (1995)
Science commentary: Why conjugate vaccines protect longer
Authors: A. Berger
Journal: BMJ (1998)

The effectiveness of polysaccharide vaccines against diseases such as meningococcal meningitis is limited because they do not stimulate a T cell response, which is required to activate long term immunological memory. Also, polysaccharide vaccines induce poor responses in infants. Up to 40% of cases of meningitis in the United Kingdom are caused by Neisseria meningitidis type c; N …
TCT-122 Electrode irrigation alters RF ablation treatment zone geometry and preserves medial and adventitial tissue while maintaining injury to renal nerves
Authors: John Keating, Peter Markham, James Stanley, Abraham R. Tzafriri, Gee Wong, Anna Spognardi, Kristine Fuimaono, Debby Grunewald, Patrick O'Fallon, Elazer Edelman
Journal: Journal of the American College of Cardiology (2013)
GP referrals may explain fivefold difference in rates of squint surgery across England
Authors: Z. Kmietowicz
Journal: BMJ (2013)

The proportion of children aged under 15 years in England undergoing surgery to correct squint has fallen threefold in the past 50 years, though there is much variation in the proportion around the country, a study has found.

Researchers from Surrey, London, and Oxford used routine hospital data collected as part of the Oxford record linkage study from 1963 to 2010 and figures from across local authorities in England from 1968 to 2010 to look at …
External or Closed-Chest Cardiac Massage
Authors: Peter C. Gazes
Journal: JAMA (1961)

CARDIAC ARREST can occur either as ventricular fibrillation or as ventricular standstill. This emergency has been met by opening the chest and directly massaging the heart and also, if immediately available, by the external cardiac pacemaker and defibrillator. More recently, Kouwenhoven and associates<sup>1</sup>have described a method of intact chest or external cardiac massage. It is based on the fact that anatomically the heart is limited anteriorly by the sternum and posteriorly by the vertebral bodies, and its lateral movement is restricted by the pericardium. Pressure on the sternum compresses the heart between it and the spine, forcing blood out, and relaxation allows the heart to fill. The thoracic cage in an unconscious individual is very mobile and a movement range of 3 to 4 cm. is possible. The patient should preferably be on a rigid support. The heel of one hand is placed on the sternum, just
The Treatment of Chlorosis by Iron and some Other Drugs
Authors: R. Stockman
Journal: BMJ (1893)

THIs metal has a certain reputation as a hmematinic.In this country it is never given alone for such purposes, but very frequently as compound syrups of the phosphates and hypophosphites, in which manganese is always present as an adjuvant to the iron.In France and Germany it is used to some extent.Most of the standard textbooks either deny its efficacy or speak very doubtfully regarding it.although Binz states that many experienced clinicians believe it to be a valuable aid to iron in the treatment of anwmia, and that for this reason the sulphate of manganese is included in the German Pharmacopoeia.Bartholow also says: "There is no doubt its combination with iron much increases the efficacy of the latter."A glance at its history will show us on what foundation rests such reputation as it may have.The black oxide (MnO,) was first used by Brdra in Italy (1822) in atonic diarrheea.and as an emmenagogue and antichlorotic.Ktlgler3' (1838) recommends it as useful in scrofulosis.The former seems to have used it quite empirically- the latter from an idea that workers in manganese were exempt from scrofula.Various chemists have found traces of it in the bones, gall stones, liver, gastric juice, blood (Wurzer, 1830), and other tissues of man.Both in man and animals its presence seems to be purely accidental, that is to say, it is not an essential component of any tissue or organ, but is derived from vegetable food, which in turn gets it from the soil.Marchessaux (1844), Millon,60 and Riche"' have confirmed its presence in human blood.Renewed interest in the matter arose from the researches of Hannon,62 P6trequin,53 and Burin du Buisson,5' who claimed that manganese is an essential and constant constituent of the blood of man, that it is present in the corpuscles only, and that its administration is essential for the complete recovery of many cases of aniemia.Hannon, indeed, de- scribes three varieties of anaemia: (1) where iron is deficient;(2) where manganese is deficient; (3) where both are deficient.The results of Petrequin, of Burin du Buisson, and oi several others are completely vitiated by the fact that they always gave iron along with the manganese, and often in four times larger quantity.Hannon, however, gave mangasnese alone with asserted good results.On the other hand Gl6nard ,5 examining the blood of forty persons in good health who were bled " in the ordinary course," found in one only a trace of manganese, and as he found none in the blood of a man- ganese miner, he argues that it cannot be absorbed by any channel.Kobert and Cahn have proved that manganese salts given by the mouth are not absorbed.The traces found in the tissues and urine sometimes must be due to its presence in our food.Dr. Broadbent6I treated seven cases of anaemia with it, and believes that it has a certain value.Three of these were anuemic children suffering from ascarides, porrigo, vaginitis, and other complications.Their recovery may be fairly ascribed to treatment directed to cure the complications, rather than to any action of manganese on the bloodi.
EU policy on e-cigarettes is a "dog's dinner," says UK regulator
Authors: M. Limb
Journal: BMJ (2013)

In the post-Hinckley era, four states (Montana, Idaho, Utah, and Kansas) abolished their traditional insanity statutes in 1979 in favor of what are in certain circumstances <i>mens rea</i> insanity statutes. These changes were controversial and attracted early attention of legal scholars and courts in the individual states and at the U.S. Supreme Court. A 2006 Supreme Court decision in <i>Clark v. Arizona</i> had distinct but related concerns that helped crystallize the Court9s attention on both <i>mens rea</i> and traditional insanity defense statutes. This decision led to a dramatic precedent that may have settled these matters for generations to come. This article will discuss the changes in the Arizona statutory and case law and the interplay between these changes and the important decisions of the U.S. Supreme Court during the same time span. The result of the changes has led to a situation in Arizona where, for the most serious criminal defendants with mental illness, there is no current mechanism to acquit a defendant on the basis of insanity by a <i>mens rea</i> statute or otherwise.