tbuckley/cabot-search huggingface dataset:
Local Capture by Atrial Pacing in Spontaneous Chronic Atrial Fibrillation
Authors: Claudio Pandozi, Leopoldo Bianconi, Mauro Villani, Antonio Castro, Giuliano Altamura, Salvatore Toscano, Anna P. Jesi, Giuseppe Gentilucci, Fabrizio Ammirati, Francesco Lo Bianco, Massimo Santini
Journal: Circulation (1997)

Atrial fibrillation (AF) is considered to be maintained by multiple reentrant circuits without or with a very short excitable gap. However, the possibility of local atrial capture has been shown recently in experimental AF or induced AF in humans.This study was undertaken to evaluate the feasibility of atrial capture-suggestive of an excitable gap-in spontaneous chronic AF. Decremental pacing was performed in 47 right atrial sites in 14 patients with chronic AF, not taking antiarrhythmic drugs. A Franz catheter (for pacing and monophasic action potential recording) and a recording quadripolar catheter positioned about 10 mm apart were used. Local capture was achieved in 41 (87.2%) sites for a total of 100 captures. In 71 episodes the capture was lost within 15 seconds, while in the remaining 29, pacing was stopped after 15 seconds of stable capture. AF types immediately before capture were type 1 in 83 and type 2 in 17 episodes. Type 3 AF was never captured. Pacing cycle at capture was 175.7 +/- 20.9 ms. The baseline atrial interval (FF) was 185.4 +/- 24.5, significantly longer than the FF recorded during pacing immediately before capture (176.0 +/- 19.8 ms) (P < .02).During spontaneous chronic AF in humans, (1) local capture by atrial pacing is possible up to at least 15 mm from the pacing site, (2) regional entrainment is possible during type 1 and type 2 AF but not type 3 AF, and (3) pacing before capture accelerates AF, probably by transient or local capture. These findings suggest that an excitable gap is present in chronic AF, therefore supporting the hypothesis that leading circle reentry is not the unique electrophysiological mechanism maintaining the arrhythmia.
The Consult Guys - Surgery With a Prosthetic Valve: What About the Warfarin?
Authors: Geno J. Merli, Howard H. Weitz
Journal: Annals of Internal Medicine (2014)

Web Exclusives20 May 2014The Consult Guys - Surgery With a Prosthetic Valve: What About the Warfarin?FREEGeno J. Merli, MD, Howard H. Weitz, MDGeno J. Merli, MDSearch for more papers by this author, Howard H. Weitz, MDSearch for more papers by this authorAuthor, Article and Disclosure Informationhttps://doi.org/10.7326/G14-3005 SectionsSupplemental MaterialAboutVisual Abstract ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail The Consult Guys bring a new perspective to the art and science of medicine with lively discussion and analysis of real-world cases and situations.For more videos from and information on The Consult Guys, visit www.annals.org/ConsultGuys. Comments0 CommentsSign In to Submit A Comment Author, Article and Disclosure InformationAffiliations: Disclosures: Geno J. Merli, MD, reports the following: Research grants/contracts: Bristol-Myers Squibb, Bayer, sanofi-aventis; Consultancies: Bristol-Myers Squibb, Bayer, sanofi-aventis. Howard H. Weitz, MD, reports that he has no financial relationships or interests to disclose. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics 20 May 2014Volume 160, Issue 10Page: CG5KeywordsSurgeryConflicts of interestResearch reporting guidelinesResearch grants ePublished: 20 May 2014 Issue Published: 20 May 2014 CopyrightCopyright © 2014 by American College of Physicians. All Rights Reserved.Loading ...
Epigenetic regulation of RAC1 induces synaptic remodeling in stress disorders and depression
Authors: Sam A Golden, Daniel J Christoffel, Mitra Heshmati, Georgia E Hodes, Jane Magida, Keithara Davis, Michael E Cahill, Caroline Dias, Efrain Ribeiro, Jessica L Ables, Pamela J Kennedy, Alfred J Robison, Javier Gonzalez-Maeso, Rachael L Neve, Gustavo Turecki, Subroto Ghose, Carol A Tamminga, Scott J Russo
Journal: Nature Medicine (2013)
A SIMPLE MEANS OF ASCERTAINING IF A STERILIZING HUT IS HOT ENOUGH TO DESTROY LICE AND NITS IN CLOTHING OR BLANKETS
Authors: A. Bacot
Journal: BMJ (1917)

fXDICAL JouW4I 1 tllese two pairs of metal pieces and gradually tiglhtened fromn day to day, supination being complete wlhen the two
Peroxynitrite, the Breakdown Product of Nitric Oxide, Is Beneficial in Blood Cardioplegia but Injurious in Crystalloid Cardioplegia
Authors: R. S. Ronson, V. H. Thourani, X.-L. Ma, S. L. Katzmark, D. Han, Z.-Q. Zhao, M. Nakamura, R. A. Guyton, J. Vinten-Johansen
Journal: Circulation (1999)

Peroxynitrite (ONOO(-)) has been implicated as a primary mediator in the deleterious effects of nitric oxide (NO) in crystalloid solutions, possibly due to a lack of detoxification mechanisms, leading to the formation of.OH. In contrast, ONOO(-) may exert cardioprotective effects in blood environments secondary to detoxification and the subsequent formation of NO-donating nitrosothiols. This dichotomy in physiological effects of ONOO(-) may exist between crystalloid and blood cardioplegia (BCP) environments. In the present study, we tested the hypothesis that ONOO(-) is cardiotoxic in crystalloid cardioplegia but cardioprotective in BCP in ischemically injured hearts.In anesthetized dogs on cardiopulmonary bypass, global 37 degrees C ischemia was imposed for 30 minutes, followed by 60 minutes of intermittent 4 degrees C hyperkalemic crystalloid (Plegisol) or BCP with (+) or without (-) 5 micromol/L authentic ONOO(-). After 2 hours of reperfusion, left ventricular (LV) function (end-systolic pressure-volume relations, in percent of baseline) was 56+/-3% in Plegisol-, which was further reduced in Plegisol+ to 40+/-4%.* In contrast, postischemic systolic function was better in BCP+ groups than in BCP- groups (96+/-2%* versus 82+/-2%, respectively). Differences in functional recovery could not be attributed to differences in hemodynamics. LV end-diastolic stiffness was significantly increased with the addition of ONOO(-) in both Plegisol (298+/-26% versus 466+/-30%*) and BCP (201+/-22% versus 267+/-13%*) groups. Consistent with increased LV chamber stiffness, myocardial edema was increased in BCP+ compared with BCP- (78.9+/-0.3% versus 76.4+/-0.3%*) and in Plegisol+ compared with Plegisol- (81.1+/-0.3% versus 79.6+/-0.4%*). Creatine kinase activity was significantly increased in Plegisol+ (48+/-6) compared with that in Plegisol- (31+/-6) but was unchanged in BCP- (14+/-2) relative to BCP+ (18+/-1). Nitrotyrosine (ng/mg protein) accumulation in LV myocardial biopsy samples confirmed myocardial exposure to ONOO(-) or its metabolites (Plegisol- 1.2+/-0.1, Plegisol+ 3.31+/-0.3*, BCP- 1.4+/-0.2, BCP+ 2.9+/-0.2*).We conclude that (1) the postcardioplegic cardiodynamic effects of ONOO(-) depend on its environment and (2) ONOO(-) in crystalloid solution impairs postcardioplegia systolic and diastolic functional recovery, whereas (3) ONOO(-) in BCP increases functional recovery. This environment-dependent dichotomy in the effect of ONOO(-) may affect the benefits of NO-related adjuncts to crystalloid or BCP solutions (*P<0.05 versus group without ONOO(-)). :II-384-II-391.)
MENTAL CAPACITY AND INCOMPETENCY: A PSYCHO-LEGAL PROBLEM
Authors: ROBERT ROSS MEZER, PAUL D. RHEINGOLD
Journal: American Journal of Psychiatry (1962)

An overall view of the question of mental capacity is presented. The definitions seem to be stating the degree of irrationality or abnormality necessary to invalidate deeds or to require action by society. Each case was decided on a completely individual basis. Furthermore, the law usually looked upon the determination of each specific capacity as an entity unto itself, and thus essentially prevented the development of relations between the various capacities. It seemed to us that further work is indicated along the lines of developing scales to evaluate the degree of illness, as well as the effects of illness upon the performance of life's daily tasks, including the common legal definitions. It is hoped that the reader gained some appreciation of the complexities and difficulties involved in these human interpersonal problems of mental capacity.
A Cost-effectiveness Analysis of Total Hip Arthroplasty for Osteoarthritis of the Hip
Authors: Rowland W. Chang
Journal: JAMA (1996)

<h3>Objective.</h3> —To quantify the trade-off between the expected increased short- and long-term costs and the expected increase in quality-adjusted life expectancy (QALE) associated with total hip arthroplasty (THA) for persons with functionally significant hip osteoarthritis. <h3>Design.</h3> —A cost-effectiveness study was performed from the societal perspective by constructing stochastic tree, decision analytic models designed to estimate lifetime functional outcomes and costs of THA and nonoperative managements. <h3>Main Outcome Measures.</h3> —A modified four-state American College of Rheumatology functional status classification was used to measure effectiveness. These functional classes were assigned utility values to allow the relative effectiveness of THA to be expressed in quality-adjusted life years (QALYs). Lifetime costs included costs associated with primary and potential revision surgeries and long-term care costs associated with the functionally dependent class. <h3>Data Used in the Cost-effectiveness Model.</h3> —Probability and incidence rate data were summarized from the literature. The THA hospital cost data were obtained from local teaching hospitals' cost accounting systems. Estimates of recurring medical costs for functionally significant hip osteoarthritis and for custodial care were derived from the literature. <h3>Results.</h3> —The THA cost-effectiveness ratio increases with age and is higher for men than for women. In the base-case scenario for 60-year-old white women who have functionally significant but not dependent hip osteoarthritis, the model predicts that THA is cost saving because of the high costs of custodial care associated with dependency due to worsening hip osteoarthritis and that the procedure increases QALE by about 6.9 years. In the base-case scenario for men aged 85 years and older, the average lifetime cost associated with THA is $9100 more than nonoperative management, with an average increase in QALE of about 2 years. Thus, the THA cost-effectiveness ratio for men aged 85 years and older is $4600 per QALY gained, less than that of procedures intended to extend life such as coronary artery bypass surgery or renal dialysis. Worst-case analysis suggests that THA remains minimally cost-effective for this oldest age category ($80 000/QALY) even if probabilities, rates, utilities, costs, and the discount rate are simultaneously varied to extreme values that bias the analysis against surgery. <h3>Conclusions.</h3> —For persons with hip osteoarthritis associated with significant functional limitation, THA can be cost saving or, at worst, cost-effective in improving QALE when both short- and long-term outcomes are considered. Further research is needed to determine whether this procedure is actually being used in this cost-effective manner, especially in older age categories. (<i>JAMA</i>. 1996;275:858-865)
Hemodynamic Consequences of Oxygen Breathing in Left Ventricular Failure
Authors: WALTER J. DALY, ROY H. BEHNKE
Journal: Circulation (1963)

As in normal men, oxygen breathing in patients with left ventricular failure is associated with a further reduction of cardiac index, partially the result of decreased stroke index and partially the result of decreased heart rate. The decrease in heart rate and cardiac index is associated with a decrease in left ventricular work index without impairing the delivery of oxygen to the tissues or the over-all tissue pO 2 . In this group of patients, oxygen breathing did not result in a decreased pulmonary vascular resistance.
Therapeutic Footwear for the Neuropathic Foot: An algorithm
Authors: Rutger Dahmen, Rob Haspels, Bart Koomen, Agnes F. Hoeksma
Journal: Diabetes Care (2001)

Neuropathy may bring about changes in form and function of the foot, which may lead to ulceration and progressive deformity. These manifestations often require specially adapted footwear. A comprehensive concept of the medical, functional, and technical requirements for this type of footwear is still lacking to date. In this article, We present an algorithm that should facilitate prescription and manufacture of adequate shoes. This algorithm attempts to establish a link between the requirements from a medical and functional point of view and the technical possibilities of orthopedic shoe technology.
Prevention of cardiovascular disease in general practice: a proposed model.
Authors: E E Anggard, J M Land, C J Lenihan, C J Packard, M J Percy, L D Ritchie, J Shepherd
Journal: BMJ (1986)

A screening model based in general practice for the detection of subjects at risk of premature cardiovascular disease is described. Opportunistic screening is performed by a trained nurse who also gives initial advice on management. Immediate feedback to patients is possible since a rapid dry chemistry technique is used to measure blood cholesterol concentrations. The collation and analysis of data are achieved using a microcomputer. A central deidentified database is incorporated to allow epidemiological studies and intervention strategy evaluations to be made. Nineteen health centres have evaluated the model, and 40,000 subjects have been screened: 10% had diastolic blood pressures of over 95 mm Hg and 15% had a blood cholesterol concentration over 7 mmol/l (270 mg/100 ml) and 2% over 9 mmol/l (347 mg/100 ml). The initial data suggest that the model is acceptable to both health centre personnel and the general public and that the offer of screening is taken up by all elements of the target population.
Role of Cardiac Magnetic Resonance Imaging in the Assessment of Myocardial Viability
Authors: Kesavan Shan, Godwin Constantine, Mohan Sivananthan, Scott D. Flamm
Journal: Circulation (2004)

D ysfunctional myocardium that remains viable has the potential for contractile recovery after reperfusion. 1 Dysfunctional but viable myocardium has been broadly divided into 2 closely linked pathophysiological states, myocardial hibernation and stunning.Stunned myocardium is the result of an ischemic insult leading to contractile dysfunction despite adequate reperfusion.Hibernating myocardium describes downregulation of myocyte metabolism as a result of prolonged reduction in perfusion, or, in some cases, repetitive episodes of myocardial stunning. 2The exact nature of structural changes in hibernating myocardium remains controversial. 3However, a spectrum of histological alterations has been noted, ranging from cellular dedifferentiation (fetal phenotype) to cellular degeneration (with more extensive fibrosis) with loss of contractile and cytoskeletal proteins.Worsening histological perturbations correlate with increasing duration of chronically low perfusion.Thus, accurate and early detection of viable myocardium has become an increasingly important guide to prognosis and therapy.Until recently, scintigraphic techniques and stress echocardiography were the mainstay of diagnosis. 4,5The focus of the present article is on the rapidly emerging clinical role of cardiovascular MRI (CMR) in the detection of viable myocardium.
A call to challenge the "Selling of Sickness"
Authors: L. Tiefer, K. Witczak, I. Heath
Journal: BMJ (2013)

A partnership model for a new social health movement

The sense that medicine is out of control is generating a rising tide of concern that includes the BMJ ’s Too Much Medicine campaign.1 Throughout history, unscrupulous people have preyed on our universal fears of suffering and death and made money by selling dubious remedies. The hope that the growing scientific foundation for medical practice would consign such activity to historical oblivion has proved to be a vain one. Indeed, contemporary enthusiasm for the commercialization and marketing of healthcare seems to offer ever wider opportunities to sell medical treatments. The results of medical research are often distorted or suppressed for commercial gain, and systems that attempt to control clinicians’ behaviour through payment by results drive overdiagnosis and overtreatment.2 3 Patients experience well documented harms as more and more often financial imperatives are allowed to trump clinical judgment.4 Harm is also caused by well meaning doctors trying to save lives …
Natriuretic activity of human and monkey atria.
Authors: M N Nemeh, J P Gilmore
Journal: Circulation Research (1983)

Recent evidence indicates that mammalian atria contain a substance that produces a rapid onset natriuresis in anesthetized rats. In the present experiments, small portions of human right atria obtained from patients undergoing coronary bypass surgery, as well as monkey atria and ventricles obtained from the Regional Primate Center, Seattle, were boiled or acid extracted and lyophilized. These materials (30 mg/kg) were dissolved in Ringer's lactate and injected intravenously into anesthetized monkeys to determine their effects on renal function. Their effects were also compared with those of furosemide (0.1 mg/kg) and chlorothiazide (10 mg/kg). Human and monkey atrial extracts produced significant increases in sodium and calcium excretion that were independent of changes in creatinine clearance. Monkey ventricular extract had no consistent renal effects. Furosemide, but not chlorothiazide, mimicked the renal responses to human and monkey atrial extracts in terms of time of onset, duration, and pattern of electrolyte excretion. These data suggest that primate atrial tissue contains a heat- and acid-stable natriuretic factor similar to that first described in the rat, suggesting that mammalian atrial natriuretic factors are cross-reactive among species. In addition, atrial natriuretic factors may have a mechanism of action similar to that of furosemide.
Tc-99m Exametazime (HMPAO)-Labeled Leukocyte Scintigraphy in Premature Infants
Authors: Pavel Koranda, Jarmila Drymlová, Tomáš Malý, Lumír Kantor, Jaroslav Ptáček, Miroslav Mysliveček
Journal: Clinical Nuclear Medicine (2011)

Two cases of successful detection of inflammatory foci using Tc-99m exametazime (HMPAO)-labeled leukocyte scintigraphy in premature infants were reported. Necrotizing enterocolitis was detected in a child with a body weight of 1.6 kg. Scintigraphy confirmed a neonatal osteomyelitis in the distal part of the leg of another patient weighing 2.2 kg. These 2 cases indicate that it is feasible to perform Tc-99m HMPAO-labeled leukocyte scintigraphy even if the blood sample volume is lower than the minimal volumes required by the guidelines for pediatric patients.
Measuring Diabetic Neuropathy: Assessment and Comparison of Clinical Examination and Quantitative Sensory Testing
Authors: Raelene E Maser, Viggo K Nielsen, Eric B Bass, Qurashia Manjoo, Janice S Dorman, Sheryl F Kelsey, Dorothy J Becker, Trevor J Orchard
Journal: Diabetes Care (1989)

The need for a standardized and valid means of assessing diabetic neuropathy has been increasingly recognized. To identify potential components of such an assessment, interobserver variation (neurologist and internist) of a standard neurologic examination and the comparability of this examination with vibratory and thermal sensitivity testing was studied. The study population comprised the first 100 participants in a neuropathy substudy of 25- to 34-yr-old subjects with insulin-dependent diabetes mellitus taking part in a cohort follow-up study. Symptoms of dysesthesias, paresthesias, and burning, aching, or stabbing pain revealed good interobserver agreement. Signs of neuropathy, more prevalent in the great toe than index finger, showed poor interobserver agreement for vibration, but fair interobserver agreement for touch and pinprick. Mean quantitative sensory thresholds differed significantly by clinical category of abnormal vibratory and pinprick sensations. Threshold testing showed twice the prevalence of abnormality compared with clinical examination. It is concluded that components of the clinical examination can be identified that, along with quantitative sensory-threshold testing, may provide a satisfactory core assessment for use both in epidemiologic studies and incorporation into more in-depth protocols required for clinical research and practice. The clinical relevance of the greater prevalence of abnormalities on threshold testing will be established by long-term follow-up.
Allergic Reaction to Penicillin Present in Milk
Authors: Konrad Wicher
Journal: JAMA (1969)

An allergic reaction developed in a patient, highly sensitive to penicillin, after ingestion of milk. This milk was examined by both bacteriological and immunological assays and was found to contain approximately 10 units/ml of penicillin. It was concluded that the allergic reaction of the patient was due to the penicillin in the milk.
Circadian rhythm of baroreflex reactivity and adrenergic vascular response
Authors: V. HOSSMANN, G. A FITZGERALD, C. T DOLLERY
Journal: Cardiovascular Research (1980)

Journal Article Circadian rhythm of baroreflex reactivity and adrenergic vascular response Get access VOLKER HOSSMANN, VOLKER HOSSMANN * From the Department of Clinical Pharmacology, Royal Postgraduate Medical School, London *Present address: Lehrstuhl für Innere Medizin II, Universität zu Köln, Ostmerheimerstrasse 200, D5-Köln 91, West Germany. Search for other works by this author on: Oxford Academic PubMed Google Scholar GARRET A FITZGERALD, GARRET A FITZGERALD From the Department of Clinical Pharmacology, Royal Postgraduate Medical School, London Search for other works by this author on: Oxford Academic PubMed Google Scholar COLIN T DOLLERY COLIN T DOLLERY † From the Department of Clinical Pharmacology, Royal Postgraduate Medical School, London *Present address: Lehrstuhl für Innere Medizin II, Universität zu Köln, Ostmerheimerstrasse 200, D5-Köln 91, West Germany. Search for other works by this author on: Oxford Academic PubMed Google Scholar Cardiovascular Research, Volume 14, Issue 3, March 1980, Pages 125–129, https://doi.org/10.1093/cvr/14.3.125 Published: 01 March 1980
US is to allow sales of emergency contraceptives without restrictions
Authors: M. McCarthy
Journal: BMJ (2013)

Ending a 12 year battle, the Obama administration has decided to abandon its efforts to keep age restrictions on the over the counter emergency contraceptives known as “morning after” pills.

The levonorgestrel based drugs can safely prevent pregnancy if they are taken shortly after unprotected sex, preferably within 24 hours, though they can still be effective up to 72 hours.

But concerns that unrestricted sales of the drugs over the counter would promote promiscuity and undermine parental authority had led to political pressure to limit young women’s access to the drugs.

In addition, although the drugs are thought to prevent pregnancy by suppressing ovulation and inhibiting fertilization, many anti-abortion …
Abdominal pain and disorder of coagulation.
Authors: M. Yaqoob, R. Ahmad
Journal: BMJ (1988)

It is strange that Dr Forsvthe should ask why it takes the secretary of state a vear to determine an appeal under section 190 when the issues are so much weightier.)isciplinary pro- ceedings may arise from a clash of personalities.-Whatever the result of the current deliberations between the DHSS and the Joint Consultants Committee, the lMN6I )112 or similar procedure would lose some of its unf:airness if regional health authorities were stripped of their responsibilitics.if onlv becausc thcv do not tollow the fundamental principles of natural justice in which the accused consultant is told who his accuser is.