tbuckley/cabot-search huggingface dataset:
Predictors of Outcomes in Low-Flow, Low-Gradient Aortic Stenosis
Authors: Marie-Annick Clavel, Christina Fuchs, Ian G. Burwash, Gerald Mundigler, Jean G. Dumesnil, Helmut Baumgartner, Jutta Bergler-Klein, Rob S. Beanlands, Patrick Mathieu, Julien Magne, Philippe Pibarot
Journal: Circulation (2008)

Background— Patients with low-flow, low-gradient aortic stenosis have a poor prognosis with conservative therapy but a high operative mortality if treated surgically. Recently, we proposed a new index of aortic stenosis severity derived from dobutamine stress echocardiography, the projected aortic valve area at a normal transvalvular flow rate, as superior to other conventional indices to differentiate true-severe from pseudosevere aortic stenosis. The objective of this study was to identify the determinants of survival, functional status, and change in left ventricular ejection fraction during follow-up of patients with low-flow, low-gradient aortic stenosis. Methods and Results— One hundred one patients with low-flow, low-gradient aortic stenosis (aortic valve area ≤1.2 cm 2 , left ventricular ejection fraction ≤40%, and mean gradient ≤40 mm Hg) underwent dobutamine stress echocardiography and an assessment of functional capacity using the Duke Activity Status Index. A subset of 72 patients also underwent a 6-minute walk test. Overall survival was 70±5% at 1 year and 57±6% at 3 years. After adjusting for age, gender, and the type of treatment (aortic valve replacement versus no aortic valve replacement), significant predictors of mortality during follow-up were a Duke Activity Status Index ≤20 ( P =0.0005) or 6-minute walk test distance ≤320 m ( P &lt;0.0001, in the subset of 72 patients), projected aortic valve area at a normal transvalvular flow rate ≤1.2 cm 2 ( P =0.03), and peak dobutamine stress echocardiography left ventricular ejection fraction ≤35% ( P =0.03). More severe stenosis, defined as projected aortic valve area ≤1.2 cm 2 , was a predictor of mortality only in the no aortic valve replacement group. The Duke Activity Status Index, 6-minute walk test, and left ventricular ejection fraction improved significantly during follow-up in the aortic valve replacement group, but remained unchanged or decreased in the no aortic valve replacement group. Conclusion— In patients with low-flow, low-gradient aortic stenosis, the most significant risk factors for poor outcome were (1) impaired functional capacity as measured by Duke Activity Status Index or 6-minute walk test distance; (2) more severe valve stenosis as measured by projected aortic valve area at a normal transvalvular flow rate; and (3) reduced peak stress left ventricular ejection fraction, a composite measure accounting for both resting left ventricular function and contractile reserve.
P468 URINARY NEUTROPHIL GELATINASE-ASSOCIATED LIPOCALIN PREDICTS OUTCOME OF KIDNEY FUNCTION AND MORTALITY IN PATIENTS WITH CIRRHOSIS AND BACTERIAL INFECTIONS
Authors: R. Barreto, C. Elia, E. Sola, R. Moreira, X. Ariza, E. Rodriguez, I. Graupera, I. Alfaro, M. Morales Ruiz, E. Poch, M. Guevara, J. Fernandez, W. Jimenez, V. Arroyo, P. Gines
Journal: Journal of Hepatology (2014)
Undiagnosed coeliac disease in patients with emphysema: a fortuitous association?
Authors: M. De Menthon, D. J. Dusser, L. Guillevin, P. R. Burgel
Journal: European Respiratory Journal (2010)

In this observation, the fluorescence confocal microimaging of the distal lung displayed characteristic PAP globular structures that appeared highly fluorescent in vivo.We reviewed 173 alveolar areas explored with confocal fluorescence endomicroscopy from 24 smoking non-PAP subjects, including nine patients with various interstitial lung diseases (ILD) (sarcoidosis n51; respiratory bronchiolitis-interstitial lung disease n54; asbestosis n51; systemic sclerosis n51; histiocytosis n51; and cryptogenic organising pneumonia n51) and 15 healthy volunteers.None of the alveolar areas explored in the non-PAP ILD patients and healthy volunteers displayed the fluorescent globular material that was observed in our PAP patient.Therefore, these endomicroscopic characteristics appear strongly suggestive of the diagnosis of PAP during the bronchoscopy procedure.In a previous study [3], the authors were able to demonstrate that, in smokers, the strong fluorescence of the alveolar macrophages was related to the retention of tobacco tar in the alveolar fluid and macrophages.Tobacco tar is highly fluorescent at 488 nm excitation [10].From this observation, it cannot be excluded that the visualisation of the globular fluorescent substance is related to the presence of the tobacco tar within the lipoproteinaceous PAP material.Therefore, the alveolar FCFM findings in nonsmoking PAP patients may differ from those described in our observation.However, because the majority of patients with primary PAP are active smokers [5,11], this may represent a small limitation for the procedure, which should be further explored.In conclusion, fluorescence bronchoalveoscopy is a minimally invasive and safe technique that may provide specific in vivo microimaging of PAP in real-time in smoking patients.
Should we stop the effective antibiotics immediately when treating severe sepsis patients with antibiotic-related thrombocytopenia?
Authors: Chih-Jen Yang, Tun-Chieh Chen, Chuan-Sheng Wang, Yen-Hsu Chen, Jhi-Jhu Hwang, Ming-Shyan Huang, Po-Liang Lu
Journal: Journal of Infection (2009)
Activation of Lipoprotein Lipase
Authors: THOMAS F. WHAYNE, JAMES M. FELTS
Journal: Circulation Research (1970)

Injection of heparin into a number of animal species releases lipoprotein lipase into the circulation. We have studied the effect of heparin added in vitro to the lipase activity in post-heparin serum from six mammalian species. With the exception of man, all animals were studied under anesthesia. Our results demonstrate that only post-heparin serum from the rat developed increasing lipoprotein lipase activity when increasing concentrations of heparin were added to the assay system. Heparin decreased activity in the other species. These results prompted us to test the effect of adding rat serum to post-heparin serum from the other species in the presence of increasing concentrations of heparin. Rat serum stimulated lipoprotein lipase activity markedly. In guinea pigs, post-heparin serum activity increased 2,700% at a heparin concentration of 1.0 U/ml in the assay system. This effect may be related to the extremely low level of high-density lipoprotein in the guinea pig and the presence of a unique high-density lipoprotein in the rat.
GnRH agonist therapy as ovarian protectants in female patients undergoing chemotherapy: a review of the clinical data
Authors: R. Beck-Fruchter, A. Weiss, E. Shalev
Journal: Human Reproduction Update (2008)

Cancer survival rates in young women are improving due to progress in treatment. This includes aggressive chemotherapy, a treatment that often poses a threat to fertility. GnRH agonists were proposed as ovarian protectors during gonadotoxic therapies. This study was undertaken in order to determine the clinical evidence concerning this issue. The medical literature was searched for studies that reported on ovarian function after the administration of GnRH agonists concomitant with chemotherapy. Twelve studies met the predetermined selection criteria. Data on ovarian function were obtained for 579 women who received chemotherapy. Among 345 women who received GnRH agonist co-treatment, ovarian function was preserved in 91% and 9% had premature ovarian failure. In 234 women who did not receive GnRH agonist co-treatment, ovarian function was preserved in 41% and failed in 59%. Only two of the studies were randomized. The control and the GnRH agonist groups differed in several important characteristics: the follow-up times were not equal, different treatment protocols were utilized and end-points were poorly defined and inconsistent between the studies. The effectiveness of GnRH agonists as fertility-preserving agents is debatable. A thorough literature search has found insufficient evidence to show that GnRH agonist co-treatment is effective in protecting the ovary from the damage of chemotherapy. A large randomized controlled trial with adequate follow-up is needed.
Improving the reporting of pragmatic trials: an extension of the CONSORT statement
Authors: M. Zwarenstein, S. Treweek, J. J Gagnier, D. G Altman, S. Tunis, B. Haynes, A. D Oxman, D. Moher
Journal: BMJ (2008)

<b>Background</b> The CONSORT statement is intended to improve reporting of randomised controlled trials and focuses on minimising the risk of bias (internal validity). The applicability of a trial's results (generalisability or external validity) is also important, particularly for pragmatic trials. A pragmatic trial (a term first used in 1967 by Schwartz and Lellouch) can be broadly defined as a randomised controlled trial whose purpose is to inform decisions about practice. This extension of the CONSORT statement is intended to improve the reporting of such trials and focuses on applicability. <b>Methods </b>At two, two-day meetings held in Toronto in 2005 and 2008, we reviewed the CONSORT statement and its extensions, the literature on pragmatic trials and applicability, and our experiences in conducting pragmatic trials. <b>Recommendations</b> We recommend extending eight CONSORT checklist items for reporting of pragmatic trials: the background, participants, interventions, outcomes, sample size, blinding, participant flow, and generalisability of the findings. These extensions are presented, along with illustrative examples of reporting, and an explanation of each extension. Adherence to these reporting criteria will make it easier for decision makers to judge how applicable the results of randomised controlled trials are to their own conditions. Empirical studies are needed to ascertain the usefulness and comprehensiveness of these CONSORT checklist item extensions. In the meantime we recommend that those who support, conduct, and report pragmatic trials should use this extension of the CONSORT statement to facilitate the use of trial results in decisions about health care.
The Problem of Boundary in the ‘Exploded Teenager’
Authors: E.B. Daniels, jr.
Journal: Psychotherapy and Psychosomatics (1972)

Many adolescent boys are admitted to state mental hospitals with a background of emotional deprivation, and current uncontrollable acting-out. Their history is characterized by an absent father and indifferent mother, disrupted home, and eventual institutionalization. Their behavior subsequent to admission is often similar to the schizophrenic or psychopath. However, two primary features characterize their everyday life: their unusual <i>charm</i>, and their use of the <i>lived body</i> to relate to the World and the Other. The 'exploded teenager', as a clinical type, presents still-problematic but new perspectives on adolescence in the development of both normal and pathological adult life.
Multivessel Coronary Artery Bypass Grafting Versus Percutaneous Coronary Intervention in ESRD
Authors: Tara I. Chang, David Shilane, Dhruv S. Kazi, Maria E. Montez-Rath, Mark A. Hlatky, Wolfgang C. Winkelmayer
Journal: Journal of the American Society of Nephrology (2012)

Thirty to sixty percent of patients with ESRD on dialysis have coronary heart disease, but the optimal strategy for coronary revascularization is unknown. We used data from the United States Renal Data System to define a cohort of 21,981 patients on maintenance dialysis who received initial coronary revascularization with either coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI) between 1997 and 2009 and had at least 6 months of prior Medicare coverage as their primary payer. The primary outcome was death from any cause, and the secondary outcome was a composite of death or myocardial infarction. Overall survival rates were consistently poor during the study period, with unadjusted 5-year survival rates of 22%–25% irrespective of revascularization strategy. Using multivariable-adjusted proportional hazards regression, we found that CABG compared with PCI associated with significantly lower risks for both death (HR=0.87, 95% CI=0.84–0.90) and the composite of death or myocardial infarction (HR=0.88, 95% CI=0.86–0.91). Results were similar in analyses using a propensity score-matched cohort. In the absence of data from randomized trials, these results suggest that CABG may be preferred over PCI for multivessel coronary revascularization in appropriately selected patients on maintenance dialysis.
Angiopoietin expression in synovial membranes from patients with RA
Authors: M D Smith
Journal: Annals of the Rheumatic Diseases (2003)

On the origin of rice bodies with apatite crystalsWe read with interest the article of Li-Yu et al on synovial rice bodies containing calcium hydroxyapatite crystals. 1 From their findings the authors assume that the pathogenesis of this "apparently" rare coincidence of fibrin with bone-like apatite crystals remains unexplained.A brief case report may give insight into the development of such a coincidence.A specimen taken at operation from the knee joint of a 55 year old woman with longstanding seropositive rheumatoid arthritis and rapid joint destruction owing to ischaemic bone necroses of the femoral and tibial compartment exhibited macroscopically a synovial membrane entirely covered with villous fibrin. 2 Light microscopy showed villi of older fibrin including a lot of tissue fragments (fig 1A).Sections stained with haematoxylin and eosin showed that these particles consisted of irregular shaped bone sequesters and basophilic granules as well as shreds of hyaline cartilage.In alizarin red stained sections the bone fragments were usually faintly stained (fig 1B).However, a multitude of tiny granules were characterised by a strong stainability with this "calcium dye" (fig 1C). 3 From this observation it can be deduced that bone debris from osteonecrotic areas gained access to the synovial membrane via the synovial fluid.The shreds of bone debris induced a preferentially "fibrinous inflammation", leading to villi with entrapped cartilage and bone fragments of different size as well as tiny bone particles appearing as alizarin red granules.With respect to the development of rice bodies of fibrin with enclosed "apatite crystals" it may be assumed that parts of the villous fibrin with bone particles can become detached from their synovial adherence and "reappear" in the synovial fluid with the formation of rice bodies.The morphological findings described in the case report are an unusual major form of fibrinous debris synovitis due to large bone necroses.However, minor forms of this synovial reaction, originally described by Freund in 1927, 4 are not rare, and histological investigations on synovial membranes from
Nonrandom inclusion of H-2K and H-2D antigens in Friend virus particles from mice of various strains.
Authors: J E Bubbers, S Chen, F Lilly
Journal: The Journal of Experimental Medicine (1978)

Friend murine leukemia virus (FV), isolated from infectious serum of several mouse strains, has been examined for the presence of H-2 antigens. Following banding of the virus on a discontinuous sucrose gradient, pelleting, and disruption with Nonidet P-40 detergent, virus preparations were tested for their capacity to inhibit the lysis of target cells mediated by various anti-H-2K or anti-H-2D antisera. Virus from mice homozygous for the H-2b, H-2d, H-2g H-2k, and H-2ol haplotypes or heterozygous for the H-2g/H-2k, H-2b/H-2d, and H-2b/H-2k haplotypes was used. Of the six H-2D or H-2K alleles examined, the products of only two, H-2Db and H-2Kk were detected. Virus preparations contained no, one, or both antigens, depending on the genotype of the host animal. Control preparations from normal mouse serum and preparations in which the virus had not been disrupted demonstrated no H-2 activity. Furthermore, attempts to neutralize FV spleen focus forming activity with anti-H-2Db or anti-H-2Kk antisera yielded negative results.
Patterns of HER-2/neu Amplification and Overexpression in Primary and Metastatic Breast Cancer
Authors: R Simon, A Nocito, T Hübscher, C Bucher, J Torhorst, P Schraml, L Bubendorf, M M Mihatsch, H Moch, K Wilber, A Schötzau, J Kononen, G Sauter
Journal: JNCI Journal of the National Cancer Institute (2001)

Background: Only 25% of patients with HER-2/neu-positive metastatic breast tumors respond favorably to trastuzamab (Herceptin) treatment. We hypothesized that a high failure rate of patients on trastuzamab could result if some of the metastases were HER-2 negative and these metastases ultimately determine the course of the disease. Methods: We used tissue microarrays (TMAs) containing four samples each from 196 lymph node-negative primary tumors, 196 lymph node-positive primary tumors, and three different lymph node metastases from each lymph node-positive tumor to estimate HER-2 gene amplification by fluorescence in situ hybridization (FISH) and Her-2 protein overexpression by immunohistochemistry (IHC). Results: FISH and IHC analyses gave the same result with respect to HER-2 status for 93.7% of the tissues contained in the TMAs. Tissue samples were, therefore, considered to be HER-2 positive if they were positive for either HER-2 DNA amplification or Her-2 protein expression and HER-2 negative if both FISH and IHC gave a negative result. The HER-2 status of lymph node-positive primary tumors was maintained in the majority of their metastases. For HER-2-positive primary tumors, 77% (95% confidence interval [CI] = 59% to 90%) had entirely HER-2-positive metastases, 6.5% (95% CI = 8% to 21%) had entirely HER-2-negative metastases, and 16.3% (95% CI = 5% to 34%) had a mixture of HER-2-positive and HER-2-negative metastases. For HER-2-negative primary tumors, 95% (95% CI = 88% to 98%) had metastases that were entirely negative for HER-2. Conclusions: Our data suggest that differences in HER-2 expression between primary tumors and their lymph node metastases cannot explain the high fraction of nonresponders to trastuzamab therapy.
Training with inspiratory pressure support in patients with severe COPD
Authors: A. van 't Hul, R. Gosselink, P. Hollander, P. Postmus, G. Kwakkel
Journal: European Respiratory Journal (2005)

This study evaluates the effects of training with noninvasive ventilatory support in patients with chronic obstructive pulmonary disease in a randomised, controlled, observer-blinded trial. Twenty-nine patients with chronic obstructive pulmonary disease and with a ventilatory limited exercise capacity (forced expiratory volume in one second < 60% predicted, breathing reserve at maximal exercise < 20% of maximally voluntary ventilation, resting arterial oxygen tension > or = 8 kPa (60 mmHg), end-exercise arterial oxygen saturation measured by pulse oximetry > or = 85%) completed an 8-week supervised outpatient cycle exercise programme. Fourteen patients were randomised to training with inspiratory pressure support of 10 cmH2O and 15 patients to training with control (sham) inspiratory pressure support of 5 cmH2O. Outcome measures were the incremental shuttle walking test and a constant-load cycle endurance test at 75% of peak work rate including the measurement of physiological responses, and health status measured using the St. George's Respiratory Questionnaire. Statistically significant between-group differences were found in favour of the inspiratory pressure support of 10 cmH2O group for improvement in shuttle walking distance (16+/-17 versus 3+/-13%), cycle endurance (164+/-124 versus 88+/-128%), and the reduction in minute ventilation during exercise (-11+/-10 versus -2+/-9%). It was concluded that exercise training with inspiratory pressure support of 10 cmH2O resulted in statistically significantly larger improvements in exercise performance than training with inspiratory pressure support of 5 cmH2O in patients with chronic obstructive pulmonary disease suffering from a ventilatory limited exercise capacity. Inspiratory pressure support of 10 cmH2O may be considered as adjunct during high-intensity exercise training.
Are medical trainees following best practice guidelines when performing arterial blood gas sampling on acute surgical patients? Mathuri Sakthithasan, Michael Magro , Aklak Choudhury, Robert Fowlerqueen's hospital. Barking, Havering and Redbridge university hospitals NHS trust, Romford, United Kingdom
Authors: Mathuri Sakthithasan, Michael Magro, Aklak Choudhury
Journal: International Journal of Surgery (2012)
Urine C-Peptide Creatinine Ratio Is a Noninvasive Alternative to the Mixed-Meal Tolerance Test in Children and Adults With Type 1 Diabetes
Authors: Rachel E.J. Besser, Johnny Ludvigsson, Angus G. Jones, Timothy J. McDonald, Beverley M. Shields, Bridget A. Knight, Andrew T. Hattersley
Journal: Diabetes Care (2011)

Stimulated serum C-peptide (sCP) during a mixed-meal tolerance test (MMTT) is the gold standard measure of endogenous insulin secretion, but practical issues limit its use. We assessed urine C-peptide creatinine ratio (UCPCR) as an alternative.Seventy-two type 1 diabetic patients (age of diagnosis median 14 years [interquartile range 10-22]; diabetes duration 6.5 [2.3-32.7]) had an MMTT. sCP was collected at 90 min. Urine for UCPCR was collected at 120 min and following a home evening meal.MMTT 120-min UCPCR was highly correlated to 90-min sCP (r = 0.97; P < 0.0001). UCPCR ≥ 0.53 nmol/mmol had 94% sensitivity/100% specificity for significant endogenous insulin secretion (90-min sCP ≥ 0.2 nmol/L). The 120-min postprandial evening meal UCPCR was highly correlated to 90-min sCP (r = 0.91; P < 0.0001). UCPCR ≥ 0.37 nmol/mmol had 84% sensitivity/97% specificity for sCP ≥ 0.2 nmol/L.UCPCR testing is a sensitive and specific method for detecting insulin secretion. UCPCR may be a practical alternative to serum C-peptide testing, avoiding the need for inpatient investigation.
Gene Silencing in Severe Systemic Inflammation
Authors: Charles E McCall, Barbara K Yoza
Journal: American Journal of Respiratory and Critical Care Medicine (2007)

This critical care perspective appraises reprogramming of gene expression in inflammatory diseases as an emerging concept of clinical importance. We emphasize gene reprogramming that "silences" acute proinflammatory genes during severe systemic inflammation, wherein in the systemic inflammatory response syndrome (SIRS) exists as a continuum during severe sepsis, septic shock, and the multiorgan dysfunction and failure phenotypes without infection. In contrast, silencing of acute proinflammatory genes is not apparent in sites of localized inflammatory processes like rheumatoid arthritis. We discuss in three parts the clinical context and the translational basic science associated with gene silencing during the SIRS continuum of severe systemic inflammation: (1) reprogramming of acute proinflammatory genes; (2) a "nuclear factor-kappaB paradox," coupled with RelB expression, that combine to silence genes using an epigenetic (inherited and reversible) signature on the nucleosome; and (3) the potential clinical importance of compartmentalization in gene silencing. Our emergent understanding of these physiologic processes may provide a novel framework for developing treatments.