tbuckley/cabot-search huggingface dataset:
Cardiac Effects of Growth Hormone in Adults With Growth Hormone Deficiency
Authors: Patrick Maison, Philippe Chanson
Journal: Circulation (2003)

Background— Growth hormone (GH) treatment may improve morphological and functional cardiac parameters in adults with GH deficiency (GHD). However, clinical trials reported to date involved few patients and yielded variable effects. Methods and Results— We systematically reviewed blinded, placebo-controlled, randomized clinical trials of GH treatment in adults with GHD and open studies in patients with GHD before and after GH treatment, evaluating the effects of GH on cardiac parameters assessed by echocardiography. Sixteen trials (9 blinded and 7 open), involving a total of 468 patients, were identified in 3 bibliographic databases. GH dosage, duration of treatment, and study populations varied among the studies. We conducted a combined analysis of effects on left ventricular mass (LVM), interventricular septum thickness (IVS), left ventricular posterior wall (LVPW), left ventricular end-systolic (LVESD) and diastolic (LVEDD) diameters, stroke volume, E/A ratio, isovolumic relaxation time (IRT), and fractional shortening. Overall effect size was used to evaluate significance, and weighted mean difference between GH and control was given to appreciate size of the effect. GH treatment was associated with a significant increase in LVM: +10.8 (SD: 9.3) g ( P =0.02); IVS: +0.28 (0.38) mm ( P &lt;0.001), LVPW: 0.98 (0.22) mm ( P =0.05), LVEDD: +1.34 (1.13) mm ( P &lt;0.001), and stroke volume: +10.3 (8.7) mL ( P &lt;0.001). A trend toward a difference in fractional shortening was observed: +1.1 (1.1)% ( P =0.06). Overall effect sizes were not significant for LVESD, E/A, and IRT. Conclusions— GH treatment is associated with a significant positive effect on LVM, IVS, LVPW, LVEDD, and stroke volume, as assessed by echocardiography, in adults with GHD.
Inflammation and Immunity in the Pathogenesis of Pulmonary Arterial Hypertension
Authors: Marlene Rabinovitch, Christophe Guignabert, Marc Humbert, Mark R. Nicolls
Journal: Circulation Research (2014)

This review summarizes an expanding body of knowledge indicating that failure to resolve inflammation and altered immune processes underlie the development of pulmonary arterial hypertension. The chemokines and cytokines implicated in pulmonary arterial hypertension that could form a biomarker platform are discussed. Pre-clinical studies that provide the basis for dysregulated immunity in animal models of the disease are reviewed. In addition, we present therapies that target inflammatory/immune mechanisms that are currently enrolling patients, and discuss others in development. We show how genetic and metabolic abnormalities are inextricably linked to dysregulated immunity and adverse remodeling in the pulmonary arteries.
Electrophysiological demonstration of concealed conduction in the human atrium.
Authors: R J Sung, R J Myerburg, A Castellanos
Journal: Circulation (1978)

In the course of electrophysiological evaluation of six patients with sick sinus syndrome, two patients with chronic conduction system disease and four patients with paroxysmal supraventricular tachycardia or atrial flutter-fibrillation, the phenomenon of concealed conduction within the atrium (At) was repeatedly observed. One pair of intracardiac electrodes was used to deliver electrical stimulus (St) to the high right At and two additional pairs of electrodes were utilized to record high right and low septal right atrial electrograms. The interelectrode distances were 10 mm apart. In all 12 patients, high right atrial capture could be accomplished at a pacing rate of greater than or equal to 200 beats/min. Concealed intra-atrial conduction was evident when the intra-atrial conduction time of the propagated St during 2:1 St-At block was more than 40 msec longer than that during 1:1 St-At conduction at half the St frequency. This indicated that the nonpropagated St during 2:1 St-At block partially penetrated the At and in turn, delayed conduction of the subsequently propagated St. Futher observations revealed that a gradual increase in the St frequency resulted in a progressive prolongation of the intra-atrial conduction time and a shifting of 2:1 to 3:1 St-At block (alternating Wenckebach periodicity in the At) in five patients. These findings clearly demonstrate the occurrence of concealed conduction in the human At.
Ultrafiltration Versus Usual Care for Hospitalized Patients With Heart Failure
Authors: Bradley A. Bart, Andrew Boyle, Alan J. Bank, Inder Anand, Maria Teresa Olivari, Mark Kraemer, Shari Mackedanz, Paul A. Sobotka, Mike Schollmeyer, Steven R. Goldsmith
Journal: Journal of the American College of Cardiology (2005)
Relationships of Serum Ferritin, Transferrin Saturation, and <i>HFE</i> Mutations and Self-Reported Diabetes in the Hemochromatosis and Iron Overload Screening (HEIRS) Study
Authors: Ronald T. Acton, James C. Barton, Leah V. Passmore, Paul C. Adams, Mark R. Speechley, Fitzroy W. Dawkins, Phyliss Sholinsky, David M. Reboussin, Gordon D. McLaren, Emily L. Harris, Thomas C. Bent, Thomas M. Vogt, Oswaldo Castro
Journal: Diabetes Care (2006)

We evaluated the associations of self-reported diabetes with serum ferritin concentration, transferrin saturation (TfSat), and HFE C282Y and H63D mutations in six racial/ethnic groups recruited at five field centers in the Hemochromatosis and Iron Overload Screening (HEIRS) study.Analyses were conducted on 97,470 participants. Participants who reported a previous diagnosis of diabetes and/or hemochromatosis or iron overload were compared with participants who did not report a previous diagnosis.The overall prevalence of diabetes was 13.8%; the highest prevalence was in Pacific Islanders (20.1%). Of all participants with diabetes, 2.0% reported that they also had hemochromatosis or iron overload. The mean serum ferritin concentration was significantly greater in women with diabetes in all racial/ethnic groups and in Native-American men with diabetes than in those without diabetes. The mean serum ferritin concentration was significantly lower in Asian men with diabetes than in those without diabetes. Mean TfSat was lower in participants with diabetes from all racial/ethnic groups except Native-American women than in those without diabetes. There was no significant association of diabetes with HFE genotype. The mean serum ferritin concentration was greater (P < 0.0001) in women with diabetes than in those without diabetes for HFE genotypes except C282Y/C282Y and C282Y/H63D. Log serum ferritin concentration was significantly associated with diabetes in a logistic regression analysis after adjusting for age, sex, racial/ethnic group, HFE genotype, and field center.Serum ferritin concentration is associated with diabetes, even at levels below those typically associated with hemochromatosis or iron overload.
UK commission recommends new ways to fund care of elderly people
Authors: J. Warden
Journal: BMJ (1999)

The Royal Commission on Long Term Care for the Elderly-set up when the Labour government came into power in the United Kingdom-has called for a fairer way of paying for the care that many elderly people require.

The royal commission's report, which is published this week, has proposed implementing a split between living costs and care costs. This split would allow personal care and nursing …
How children with asthma breathe: have we been overlooking a problem?
Authors: Vikas Goyal, Peter D. Sly
Journal: European Respiratory Journal (2013)

Asthma is one of the most common chronic diseases globally, with an estimated 300 million sufferers [1] and is diagnosed in up to 10% of paediatric populations in many developed countries. Despite many advances in the treatment of asthma, there remain a percentage of patients, including children, who do not respond, or respond poorly to current treatment. These are the patients for whom clinicians think of alternative diagnoses. THOMAS et al. [2] have investigated abnormal breathing patterns in adults with asthma using the Nijmegen questionnaire and have identified as many as 29% of patients as having dysfunctional breathing. Symptoms suggestive of dysfunctional breathing include: dyspnoea, deep sighing, chest pain, chest tightness, frequent yawning, hyperventilation and breathlessness during exercise [2]. The same authors also showed a positive response with breathing retraining in a randomised control trial [3]. Some others have reported some ongoing benefit of breathing retraining in patients with dysfunctional breathing in a 5-year follow-up [4]. Thus both the problem of dysfunctional breathing in adults diagnosed with asthma and the benefit such patients obtain from breathing retraining is reasonably well established. Psychological problems in children diagnosed with asthma have been described [5–8]. Various authors have suggested that the mainstay of the diagnosis of psychogenic and functional breathing disorders is a full and meticulously taken history
Follistatin-like protein 1 regulates chondrocyte proliferation and chondrogenic differentiation of mesenchymal stem cells
Authors: Yury Chaly, Harry C Blair, Sonja M Smith, Daniel S Bushnell, Anthony D Marinov, Brian T Campfield, Raphael Hirsch
Journal: Annals of the Rheumatic Diseases (2014)

Objectives Chondrocytes, the only cells in the articular cartilage, play a pivotal role in osteoarthritis (OA) because they are responsible for maintenance of the extracellular matrix (ECM). Follistatin-like protein 1 (FSTL1) is a secreted protein found in mesenchymal stem cells (MSCs) and cartilage but whose function is unclear. FSTL1 has been shown to modify cell growth and survival. In this work, we sought to determine whether FSTL1 could regulate chondrogenesis and chondrogenic differentiation of MSCs. Methods To study the role of FSTL1 in chondrogenesis, we used FSTL1 knockout (KO) mice generated in our laboratory. Proliferative capacity of MSCs, obtained from skulls of E18.5 embryos, was analysed by flow cytometry. Chondrogenic differentiation of MSCs was carried out in a pellet culture system. Gene expression differences were assessed by microarray analysis and real-time PCR. Phosphorylation of Smad3, p38 MAPK and Akt was analysed by western blotting. Results The homozygous FSTL1 KO embryos showed extensive skeletal defects and decreased cellularity in the vertebral cartilage. Cell proliferation of FSTL1-deficient MSCs was reduced. Gene expression analysis in FSTL1 KO MSCs revealed dysregulation of multiple genes important for chondrogenesis. Production of ECM proteoglycans and collagen II expression were decreased in FSTL1-deficient MSCs differentiated into chondrocytes. Transforming growth factor β signalling in FSTL1 KO cells was significantly suppressed. Conclusions FSTL1 is a potent regulator of chondrocyte proliferation, differentiation and expression of ECM molecules. Our findings may lead to the development of novel strategies for cartilage repair and provide new disease-modifying treatments for OA.
MUSINGS ON SIXTY YEARS IN PUBLIC HEALTH
Authors: Lester Breslow
Journal: Annual Review of Public Health (1998)

These reflections on six decades in public health work come from both personal experiences and observations in the field. Attention is given to changes in health problems during the period and how public health workers have responded to them. The commentary also touches on how one proceeds in public health, includes suggestions for effectiveness, notes some difficulties encountered, and briefly describes health progress. The evolution of public health to encompass a much broader scope of activity than in the 1930s and how that has come about is emphasized.
Antihypertensive Treatment and Multifactorial Approach for Renal Protection in Diabetes
Authors: Paola Fioretto, Anna Solini
Journal: Journal of the American Society of Nephrology (2005)

Type 2 diabetes is reaching epidemic proportions throughout the world, representing the most common cause of ESRD. Early identification of renal impairment associated with diabetes and initiation of renoprotective therapy are imperative. High BP, dyslipidemia, long duration of diabetes, and poor glycemic control are important risk factors; their modification, renal function monitoring, and combined therapies are the current integrated approaches to treat patients with diabetic kidney disease. Strong evidence suggests that achieving target BP goals via inhibition of the renin-angiotensin-aldosterone system confers significant renal protection for diabetic patients. Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers lower BP and reduce both the progression of renal damage and adverse cardiovascular events; some important renoprotective actions seem to be independent of the antihypertensive effect. Stringent quality of glycemic control is another key point to prevent onset of nephropathy or slow its progression. Evidence from basic research and clinical trials indicates that hypolipidemic drugs, mainly statins, contribute to modulate the progression of renal damage in diabetes; their use should be considered in any patient with diabetes. Smoking cessation may slow nephropathy progression; given the additional health benefits of stopping smoking, this advice is an important part of the strategy of diabetic nephropathy treatment and prevention. In conclusion, a target-driven, long-term, intensified intervention aimed at multiple risk factors should be recommended in patients with diabetes to preserve their kidney function.
The Vascular Smooth Muscle Cells Apoptosis in Asymptomatic Diabetic Carotid Plaques: Role of Glycemic Control
Authors: Raffaele Marfella, Clara Di Filippo, Alfonso Baldi, Mario Siniscalchi, Ferdinando Carlo Sasso, Basilio Crescenzi, Francesca Cirillo, Giovanni Francesco Nicoletti, Francesco D’Andrea, Gisberta Chiorazzo, Emilio Musacchio, Francesco Rossi, Mario Verza, Ludovico Coppola, Michele D’Amico
Journal: Journal of the American College of Cardiology (2006)
Profiling hospital performance to monitor the quality of care: the case of COPD
Authors: N. Agabiti, V. Belleudi, M. Davoli, F. Forastiere, A. Faustini, R. Pistelli, D. Fusco, C. A. Perucci
Journal: European Respiratory Journal (2009)

Comparative outcomes data are widely used to monitor quality of care in the cardiovascular area; little is available in the respiratory field. We applied validated methods to compare hospital outcomes for chronic obstructive pulmonary disease (COPD) exacerbation. From the hospital information system, we selected all hospital admissions for COPD exacerbation in Rome (for 2001–2005). Vital status within 30 days was obtained from the municipality mortality register. Each hospital was compared to a pool of hospitals with the lowest adjusted mortality rate (the benchmark). Age, sex and several potential clinical predictors were covariates in logistic regression analysis. 12,756 exacerbated COPD patients were analysed (mean age 74 yrs, 71% males). Diabetes, hypertension, ischaemic heart disease, heart failure and arrhythmia were the most common coexisting conditions. The average crude mortality in the benchmark group was 3.8%; in the remaining population it was 7.5% (range 5.2–17.2%). In comparison with the benchmark, the relative risk of 30-day mortality varied widely across the hospitals (range 1.5–5.9%). A large variability in 30-day mortality after COPD exacerbation exists even considering patients’ characteristics. Although these results do not detect mechanisms related to worse outcomes, they may be useful to stimulate providers to revision and improvement of COPD care management.
Case-control study of severe life threatening asthma (SLTA) in a developing community
Authors: L van der Merwe, A de Klerk, M Kidd, P G Bardin, E M van Schalkwyk
Journal: Thorax (2006)

<b>Background:</b> Distinct risk factors for asthma death have not been identified in developing communities. This study was conducted to distinguish risk factors for severe life threatening asthma (SLTA), a proxy for asthma death, in a developing country. <b>Methods:</b> A case-control study was performed at a University Hospital serving developing communities in the Western Cape Province, South Africa, over the period October 1997 to April 2000. Thirty consecutive patients with SLTA admitted to the intensive care unit (ICU) were compared with 60 chronic asthmatic patients, without a history of SLTA, who had attended the hospital outpatient respiratory clinic over the same period. <b>Results:</b> The risk of SLTA in comparison with controls increased with female sex (odds ratio (OR) 3.3, 95% CI 1.2 to 9.6, p = 0.02), rural residence (OR 8.1, 95% CI 2.6 to 25.3, p = 0.0005), and absence of a formal income (OR 5.7, 95% CI 2 to 16.6, p = 0.002). Cases were more likely to have had more than one hospital admission in the previous year (OR 8, 95% CI 2.5 to 25.2, p = 0.0009) and more than one emergency room visit in the previous year (OR 4.4, 95% CI 1.19 to 16.4, p = 0.04). Patients with SLTA were less likely to use inhaled corticosteroids (OR 5.6, 95% CI 1.9 to 16.5, p = 0.003) and more likely to use inhaled fenoterol (OR 6, 95% CI 2.2 to 16.2, p = 0.0004). Patients with SLTA also had lower mean (SE) forced expiratory volume in 1 second (FEV<sub>1</sub>) measurements (66.9 (9.5)% predicted <i>v</i> 82.5 (4.0)% predicted; p = 0.03) and lower FEV<sub>1</sub>/FVC ratios (60.7 (4.1)% predicted <i>v</i> 69.6 (1.9)% predicted; p = 0.05) documented before the episode of SLTA. <b>Conclusions:</b> Risk factors for SLTA that are mainly analogous to those distinguished in other environments have been identified in a geographical area characterised by a third world socioeconomic context. Rural residence and poverty may increase the risk of SLTA.
The effect of posture and abdominal binding on respiratory pressures
Authors: N Koulouris, DA Mulvey, CM Laroche, J Goldstone, J Moxham, M Green
Journal: European Respiratory Journal (1989)

We examined the effect of posture on the generation of respiratory pressures in 6 highly trained subjects. Transdiaphragmatic pressure was measured at FRC during bilateral percutaneous phrenic nerve stimulation (twitch Pdi) and maximal sniffs (sniff Pdi), with the abdomen bound and unbound. Maximum static inspiratory (PImax) and expiratory (PEmax) mouth pressures were measured with the abdomen unbound. Three postures were examined: seated (Se), semi-supine (30s), and supine (Su). Changes of posture did not significantly alter twitch Pdi. By contrast, sniff Pdi and static mouth pressures were significantly reduced in the Su posture. Abdominal binding significantly increased twitch Pdi only. We conclude that voluntary respiratory manoeuvres requiring activation, recruitment and coordination of different muscle groups are performed better in the Se position. We suggest that posture be standardised for serial comparative measurements of voluntary respiratory pressures in a given subject.
Twinship and Risk of Postmenopausal Breast Cancer
Authors: James R. Cerhan, Lawrence H. Kushi, Janet E. Olson, Stephen S. Rich, Wei Zheng, Aaron R. Folsom, Thomas A. Sellers
Journal: JNCI Journal of the National Cancer Institute (2000)

Intrauterine exposure to high levels of endogenous estrogens has been hypothesized to increase the risk of breast cancer. Because estrogens and other pregnancy hormones are substantially elevated in twin pregnancies, and possibly more so in dizygotic twin pregnancies, we evaluated the association between aspects of twin membership (i.e., belonging to a twin pair) and the risk of breast cancer.In a cohort of 29 197 postmenopausal Iowa women with no prior diagnosis of cancer (except for nonmelanoma skin cancer), breast cancer risk factors were determined by use of a mailed questionnaire in 1986 (baseline); twin membership, sex of the twin, and zygosity were determined by use of a follow-up questionnaire in 1992.Within the cohort, 1.8% (n = 538) of the women reported being a twin; of these, 24% (n = 130) were monozygotic twins, 63% (n = 337) were dizygotic twins, and 13% (n = 71) did not know their zygosity. From 1986 through 1996, 1230 breast cancers in the cohort were ascertained by linkage to the Iowa Cancer Registry. Compared with singletons, women who belonged to a twin pair were at elevated risk of breast cancer (multivariate-adjusted risk ratio [RR] = 1.72; 95% confidence interval [CI] = 1.22-2.42), with adjustment for educational level, family history of breast cancer, height, body mass index, body fat distribution, age at menarche, age at first live birth, use of hormone replacement therapy, and alcohol use. Multivariate-adjusted risk was elevated (in comparison with singletons) if the sex of the other twin was female (RR = 1.82; 95% CI = 1.20-2.75); however, this risk was limited to female dizygotic twins (RR = 2.14; 95% CI = 1. 21-3.79), since no excess risk was evident for monozygotic twins (RR = 1.04; 95% CI = 0.43-2.50). The risk to women with a male twin was also elevated (RR = 1.49; 95% CI = 0.80-2.78) in comparison with singletons, but this estimate was not statistically significant.This cohort study lends further support to the theory that there are important intrauterine influences on carcinogenesis of the breast.
No Evidence of Survival Benefit With Addition of Gemtuzumab Ozogamicin to Standard Medical Research Council Induction Chemotherapy
Authors: Morten Krogh Jensen
Journal: Journal of Clinical Oncology (2013)

TO THEEDITOR:Burnett et al 1 recently published thefirst results of the Medical Research Council (MRC) acute myeloid leukemia (AML) trial AML16 that comprised patients older than 60 years with high-risk myelodysplastic syndrome or AML, a trial that suggested a modest increase in 3-year cumulative survival for pa- tientsreceivinggemtuzumabozogamicin(GO)onday1ofthefirst inductioncourse.Apparently,therewasnointeractionwithother treatment  1(p3924) The results of the random assign- ment between standard MRC induction chemotherapy (daunorubi- cin/cytarabine) versus the experimental daunorubicin/clofarabine arm were not presented, although these data were bound to be avail- able concomitant with the GO results. Thesupplementarydatasectiondoesindeedsuggestthattherewasa clinically meaningful interaction, albeit not statistically significant, with other treatment interventions. Thus, the cumulative 3-year survival was only significantly improved among patients receiving the experimental daunorubicin/clofarabine induction courses, whereas there was no evi- dence of a significant survival benefit for patients receiving the standard MRC induction chemotherapy (randomized daunorubicin/cytarabine: oddsratio,0.9;95%CI,0.71to1.16;andnonrandomizeddaunorubicin/ cytarabine: odds ratio, 0.96; 95% CI, 0.75 to 1.22). ThestudydoesnotmeritreconsiderationofGOasacomponent of therapy for older patients with AML treated with standard MRC induction chemotherapy, as suggested. 2