tbuckley/cabot-search huggingface dataset:
Impact of Changes in Resuscitation Practice on Survival and Neurological Outcome After Out-of-Hospital Cardiac Arrest Resulting From Nonshockable Arrhythmias
Authors: Peter J. Kudenchuk, Jeffrey D. Redshaw, Benjamin A. Stubbs, Carol E. Fahrenbruch, Florence Dumas, Randi Phelps, Jennifer Blackwood, Thomas D. Rea, Mickey S. Eisenberg
Journal: Circulation (2012)

Background— Out-of-hospital cardiac arrest (OHCA) claims millions of lives worldwide each year. OHCA survival from shockable arrhythmias (ventricular fibrillation/ tachycardia) improved in several communities after implementation of American Heart Association resuscitation guidelines that eliminated “stacked” shocks and emphasized chest compressions. “Nonshockable” rhythms are now the predominant presentation of OHCA; the benefit of such treatments on nonshockable rhythms is uncertain. Methods and Results— We studied 3960 patients with nontraumatic OHCA from nonshockable initial rhythms treated by prehospital providers in King County, Washington, over a 10-year period. Outcomes during a 5-year intervention period after adoption of new resuscitation guidelines were compared with the previous 5-year historical control period. The primary outcome was 1-year survival. Patient demographics and resuscitation characteristics were similar between the control (n=1774) and intervention (n=2186) groups, among whom 471 of 1774 patients (27%) versus 742 of 2186 patients (34%), respectively, achieved return of spontaneous circulation; 82 (4.6%) versus 149 (6.8%) were discharged from hospital, 60 (3.4%) versus 112 (5.1%) with favorable neurological outcome; 73 (4.1%) versus 135 (6.2%) survived 1 month; and 48 (2.7%) versus 106 patients (4.9%) survived 1 year (all P ≤0.005). After adjustment for potential confounders, the intervention period was associated with an improved odds of 1.50 (95% confidence interval, 1.29–1.74) for return of spontaneous circulation, 1.53 (95% confidence interval, 1.14–2.05) for hospital survival, 1.56 (95% confidence interval, 1.11–2.18) for favorable neurological status, 1.54 (95% confidence interval, 1.14–2.10) for 1-month survival, and 1.85 (95% confidence interval, 1.29–2.66) for 1-year survival. Conclusion— Outcomes from OHCA resulting from nonshockable rhythms, although poor by comparison with shockable rhythm presentations, improved significantly after implementation of resuscitation guideline changes, suggesting their potential to benefit all presentations of OHCA.
Broad-Spectrum CC-Chemokine Blockade by Gene Transfer Inhibits Macrophage Recruitment and Atherosclerotic Plaque Formation in Apolipoprotein E–Knockout Mice
Authors: Christina A. Bursill, Robin P. Choudhury, Ziad Ali, David R. Greaves, Keith M. Channon
Journal: Circulation (2004)

Background— The CC-chemokines (CKs) recruit monocytes/macrophages to sites of inflammation; several different CC-CKs play a role in the pathogenesis of atherosclerosis. The vaccinia virus expresses a 35-kDa soluble protein (35K) that binds to and inactivates nearly all of the CC-CKs, providing a potentially useful therapeutic strategy for broad-spectrum CC-CK inhibition in atherosclerosis. A recombinant adenovirus encoding soluble 35K (Ad35K) was generated to investigate the effect of 35K gene transfer on atherosclerosis in Western diet–fed apolipoprotein E–knockout (ApoE KO) mice. Methods and Results— ApoE KO mice received tail-vein injections of phosphate-buffered saline, Ad35K, or control adenovirus AdGFP encoding green fluorescence protein. Two weeks after Ad35K gene transfer, atherosclerotic lesion area was significantly reduced in aortic roots by 55% compared with PBS or AdGFP control mice ( P &lt;0.05). Furthermore, 35K gene transfer strikingly reduced the macrophage content in aortic root lesions by 85% ( P &lt;0.01) and reduced lipid deposition in descending aortas by more than half ( P &lt;0.05). By an in vitro chemotaxis assay, plasma and aortic homogenates from 35K gene transfer mice promoted significantly less CC-CK–induced cell migration than did PBS or AdGFP controls. Conclusions— These findings show that a single intravenous injection of a recombinant adenovirus encoding the broad-spectrum CC-CK inhibitor 35K can reduce atherosclerosis by inhibiting CC-CK–induced macrophage recruitment in atherosclerotic ApoE KO mice. These experiments suggest that CC-CKs play an important role in atherogenesis and are a rational target for therapeutic intervention.
Comparison of spirometry criteria for the diagnosis of COPD: results from the BOLD study
Authors: W M Vollmer, Thorn Gíslason, P Burney, P L Enright, A Gulsvik, A Kocabas, A S Buist
Journal: European Respiratory Journal (2009)

Published guidelines recommend spirometry to accurately diagnose chronic obstructive pulmonary disease (COPD). However, even spirometry-based COPD prevalence estimates can vary widely. We compared properties of several spirometry-based COPD definitions using data from the international Burden of Obstructive Lung Disease (BOLD)study. 14 sites recruited population-based samples of adults aged ≥40 yrs. Procedures included standardised questionnaires and post-bronchodilator spirometry. 10,001 individuals provided usable data. Use of the lower limit of normal (LLN) forced expiratory volume in 1 s (FEV 1 ) to forced vital capacity (FVC) ratio reduced the age-related increases in COPD prevalence that are seen among healthy never-smokers when using the fixed ratio criterion (FEV 1 /FVC &lt;0.7) recommended by the Global Initiative for Chronic Obstructive Lung Disease. The added requirement of an FEV 1 either &lt;80% predicted or below the LLN further reduced age-related increases and also led to the least site-to-site variability in prevalence estimates after adjusting for potential confounders. Use of the FEV 1 /FEV 6 ratio in place of the FEV 1 /FVC yielded similar prevalence estimates. Use of the FEV 1 /FVC&lt;LLN criterion instead of the FEV 1 /FVC &lt;0.7 should minimise known age biases and better reflect clinically significant irreversible airflow limitation. Our study also supports the use of the FEV 1 /FEV 6 as a practical substitute for the FEV 1 /FVC.
Importance of Cardiovascular Autonomic Dysfunction in IDDM Subjects With Diabetic Nephropathy
Authors: Echkard Zander, Bernd Schulz, Peter Heinke, Eckhard Grimmberger, Gudrun Zander, Hans Detlef Cottschling
Journal: Diabetes Care (1989)

Diabetic nephropathy (DNP) is associated with increased cardiovascular mortality. This may be contributed to by associated cardiovascular autonomic dysfunction (CAD). The aim of this study was to investigate the prevalence of CAD in patients with insulin-dependent diabetes mellitus (IDDM) at different stages of DNP. We studied patients with incipient DNP (group 1, n = 10), overt DNP (group 2, n = 20), renal insufficiency (group 3, n = 27), and end-stage renal failure (group 4, n = 12) and compared them with 30 IDDM patients without clinical signs of DNP (group 5) and with 17 nondiabetic controls (group 6). All groups were matched for age and diabetic groups were matched for duration of diabetes. Assessments of CAD included beat-to-beat variation during forced respiration, heart-rate response to standing, heart-rate response to Valsalva maneuver, basal heart rate, and blood pressure response to standing. Clinical evaluation included assessment of the history and an examination for peripheral polyneuropathy. We found mean impairment of heart-rate variation during respiration, in response to Valsalva maneuver, and in heart-rate response to standing in all diabetic groups compared with nondiabetic controls (P less than .01). Heart-rate responses differed significantly between patients with renal insufficiency (groups 3 and 4) and with other patient groups (group 5; P less than .01). CAD was shown to be more prevalent in patients with DNP, more so as DNP progresses. To some extent, it is already present in the early stages of DNP. CAD may be a contributory factor for increased cardiovascular mortality in patients with DNP.(ABSTRACT TRUNCATED AT 250 WORDS)
Does a 3-month multidisciplinary intervention improve pain, body composition and physical fitness in women with fibromyalgia?
Authors: Ana Carbonell-Baeza, Virginia A Aparicio, Francisco B Ortega, Ana M Cuevas, Inmaculada C Alvarez, Jonatan R Ruiz, Manuel Delgado-Fernandez
Journal: British Journal of Sports Medicine (2010)

Objective To determine the effects of a 3-month multidisciplinary intervention on pain (primary outcome), body composition and physical fitness (secondary outcomes) in women with fibromyalgia (FM). Methods 75 women with FM were allocated to a low-moderate intensity 3-month (three times/week) multidisciplinary (pool, land-based and psychological sessions) programme (n=33) or to a usual care group (n=32). The outcome variables were pain threshold, body composition (body mass index and estimated body fat percentage) and physical fitness (30 s chair stand, handgrip strength, chair sit and reach, back scratch, blind flamingo, 8 feet up and go and 6 min walk test). Results The authors observed a significant interaction effect (group*time) for the left (L) and right (R) side of the anterior cervical (p&lt;0.001) and the lateral epicondyle R (p=0.001) tender point. Post hoc analysis revealed that pain threshold increased in the intervention group (positive) in the anterior cervical R (p&lt;0.001) and L (p=0.012), and in the lateral epicondyle R (p=0.010), whereas it decreased (negative) in the anterior cervical R (p&lt;0.001) and L (p=0.002) in the usual care group. There was also a significant interaction effect for chair sit and reach. Post hoc analysis revealed improvement in the intervention group (p=0.002). No significant improvement attributed to the training was observed in the rest of physical fitness or body composition variables. Conclusions A 3-month multidisciplinary intervention three times/week had a positive effect on pain threshold in several tender points in women with FM. Though no overall improvements were observed in physical fitness or body composition, the intervention had positive effects on lower-body flexibility.
Is Acanthosis Nigricans a Marker of Insulin Resistance in Obese Children?
Authors: Valeria Hirschler, Claudio Aranda, Adriana Oneto, Claudio Gonzalez, Mauricio Jadzinsky
Journal: Diabetes Care (2002)

Acanthosis nigricans (AN) was proposed as an insulin resistance marker and an independent risk factor for type 2 diabetes (1). A number of studies had associated AN with insulin resistance (IR) and much higher prevalence of type 2 diabetes in childhood. (2)

Although children with AN are often obese, only few studies have considered the roles of BMI and AN as independent markers of IR. The purpose of this research was to compare several indexes of IR (i.e., homeostasis model assessment of IR [HOMA-IR], insulin-like growth factor binding protein 1 [IGFBP1] levels, and base insulinemia) in obese children with and without AN and to determine the rate of association between AN and BMI, HDL, triglycerides, and other predictors of type 2 diabetes.

A total …
Glucagon, catecholamine and pancreatic polypeptide secretion in type I diabetic recipients of pancreas allografts.
Authors: P Diem, J B Redmon, M Abid, A Moran, D E Sutherland, J B Halter, R P Robertson
Journal: Journal of Clinical Investigation (1990)

Successful pancreas transplantation in type I diabetic patients restores normal fasting glucose levels and biphasic insulin responses to glucose. However, virtually no data from pancreas recipients are available relative to other islet hormonal responses or hormonal counterregulation of hypoglycemia. Consequently, glucose, glucagon, catecholamine, and pancreatic polypeptide responses to insulin-induced hypoglycemia and to stimulation with arginine and secretin were examined in 38 diabetic pancreas recipients, 54 type I diabetic nonrecipients, and 26 nondiabetic normal control subjects. Glucose recovery after insulin-induced hypoglycemia in pancreas recipients was significantly improved. Basal glucagon levels were significantly higher in recipients compared with nonrecipients and normal subjects. Glucagon responses to insulin-induced hypoglycemia were significantly greater in the pancreas recipients compared with nonrecipients and similar to that observed in control subjects. Glucagon responses to intravenous arginine were significantly greater in pancreas recipients than that observed in both the nonrecipients and normal subjects. No differences were observed in epinephrine responses during insulin-induced hypoglycemia. No differences in pancreatic polypeptide responses to hypoglycemia were observed when comparing the recipient and nonrecipient groups, both of which were less than that observed in the control subjects. Our data demonstrate significant improvement in glucose recovery after hypoglycemia which was associated with improved glucagon secretion in type I diabetic recipients of pancreas transplantation.
Cytotoxic and hormonal treatment for metastatic breast cancer: a systematic review of published randomized trials involving 31,510 women.
Authors: R Fossati, C Confalonieri, V Torri, E Ghislandi, A Penna, V Pistotti, A Tinazzi, A Liberati
Journal: Journal of Clinical Oncology (1998)

PURPOSE A systematic review of randomized clinical trials (RCTs) was undertaken to assess the effectiveness of medical treatment for metastatic breast cancer. METHODS RCTs published between 1975 and 1997 have been classified according to 12 therapeutic comparisons: (1) polychemotherapy (PCHT) agents versus single agent; (2) PCHT regimens with anthracycline versus PCHT without anthracycline; (3) other PCHT versus cyclophosphamide, methotrexate, and fluorouracil (CMF); (4) chemotherapy (CHT) with epirubicin versus CHT with doxorubicin; (5) CHT versus same CHT delivered with less intensive schedules; (6) other endocrine therapy (OET) versus tamoxifen; (7) OET plus tamoxifen versus tamoxifen alone; (8) OET versus medroxyprogesterone; (9) OET versus aromatase inhibitors; (10) OET versus megestrol; (11) endocrine therapy (ET) versus same ET at lower doses; and (12) CHT plus ET versus CHT. Tumor response rates, mortality hazards ratio (HR) and frequency of severe side effects were the outcome measures. RESULTS A total of 189 eligible trials (31,510 patients) were identified. All provided response rates and 133 (70%) data or survival curves needed for calculation of the HR. In eight of 12 comparisons, statistically significant differences for response emerged (1, 2, 3, 5, 7, 8, 11, 12); all but no. 8 favored the first term of the comparison. Overall survival analysis showed better results of (a) PCHT versus single-agent CHT (HR=0.82; 95% confidence interval [CI], 0.75 to 0.90); (b) CHT with doxorubicin versus CHT with epirubicin (HR=1.13; 95% CI, 1.00 to 1.27); (c) CHT versus the same CHT delivered with less intensive schedules (HR=0.90; 95% CI, 0.83 to 0.97); (d) ET versus the same ET at lower doses (HR=0.86; 95% CI, 0.77 to 0.97). Quality of life was measured in only 2,995 of 31,510 patients (9.5%). CONCLUSION Despite some evidence of effectiveness of specific regimens, the relevance of these findings is limited by the modest survival benefit and the lack of evaluation of the quality-of-life impact of these treatments.
STUDIES ON THE MECHANISM OF EXPERIMENTAL PROTEINURIA
Authors: Alvin L. Sellers, Stephen Smith, Jessie Marmorston, Howard C. Goodman
Journal: The Journal of Experimental Medicine (1952)

When renin is administered intramuscularly to the rat, massive proteinuria occurs without a significant elevation of mean arterial blood pressure. The intravenous administration of renin to normal rats results in a great increase in urinary protein excretion. This response to renin is abolished by bilateral adrenalectomy. While the adrenalectomized rat fails to respond to intravenous renin with increased proteinuria, it does exhibit a normal elevation in mean arterial blood pressure. It is concluded that in the rat, the proteinuric property of renin is not related to the ability of this compound to elevate arterial blood pressure. The passage of plasma proteins has been followed through the kidney and into the urine by attaching them to the dye T-1824 (Evan's blue). The intra-peritoneal injection of renin causes a massive, transient proteinuria in the rat. From a study of frozen sections of the kidney of rats whose plasma proteins are labelled with T-1824, it is concluded that the preponderant basis for renin proteinuria is an increase in glomerular permeability.
Novel site-specific mast cell subpopulations in the human lung
Authors: C K Andersson, M Mori, L Bjermer, C-G Lofdahl, J S Erjefalt
Journal: Thorax (2009)

Lung mast cells are stereotypically divided into connective tissue (MC(TC)) and mucosal (MC(T)) mast cells. This study tests the hypothesis that each of these subtypes can be divided further into site-specific populations created by the microenvironment within each anatomical lung compartment.Surgical resections and bronchial and transbronchial biopsies from non-smoking individuals were obtained to study mast cells under non-inflamed conditions. Morphometric and molecular characteristics of mast cell populations were investigated in multiple lung structures by immunohistochemistry and electron microscopy.MC(T) and MC(TC) coexisted in all compartments, with MC(T) being the prevailing type in bronchi, bronchioles and the alveolar parenchyma and MC(TC) being more abundant in pulmonary vessels and the pleura. Each of the MC(TC) and MC(T) phenotypes could be further differentiated into site-specific populations. MC(TC) were significantly larger in pulmonary vessels than in small airway walls, while the reverse was observed for MC(T). Within each MC(TC) and MC(T) population there were also distinct site-specific expression patterns of the IgE receptor, interleukin-9 receptor, renin, histidine decarboxylase, vascular endothelial growth factor, fibroblast growth factor, 5-lipoxygenase and leukotriene C4 synthase (eg, bronchial MC(T) consistently expressed more histidine decarboxylase than alveolar MC(T)). Renin content was high in vascular MC(TC) but markedly lower in MC(TC) in other compartments. For both MC(TC) and MC(T), the IgE receptor was highly expressed in conducting airways but virtually absent in alveolar parenchyma.These findings demonstrate novel site-specific subpopulations of lung MC(TC) and MC(T) at baseline conditions. This observation may have important implications in the future exploration of mast cells in a number of pulmonary diseases.
Teaching medical students about bereavement is hard
Authors: J. Fuller
Journal: BMJ (1999)

—The paper by Saunderson and Ridsdale and the accompanying commentary by Jewell, about attitudes towards responding to bereavement, raise several difficult questions for those teaching undergraduate medical students.1 We are told by the doctors interviewed that they were inadequately prepared by their medical school for the task of caring for dying patients. Most medical schools have paid attention to teaching this for some time; …
In healthy volunteers, immunohistochemistry supports squamous to columnar metaplasia as mechanism of expansion of cardia, aggravated by central obesity
Authors: Mohammad H Derakhshan, Elaine V Robertson, Yeong Yeh Lee, Tim Harvey, Rod K Ferrier, Angela A Wirz, Clare Orange, Stuart A Ballantyne, Scott L Hanvey, James J Going, Kenneth EL McColl
Journal: Gut (2015)

<h3>Introduction</h3> Recently, we showed that the length of cardiac mucosa in healthy volunteers correlated with age and obesity. We have now examined the immunohistological characteristics of this expanded cardia to determine whether it may be due to columnar metaplasia of the distal oesophagus. <h3>Methods</h3> We used the squamocolumnar junction (SCJ), antral and body biopsies from the 52 <i>Helicobacter pylori</i>-negative healthy volunteers who had participated in our earlier physiological study and did not have hiatus hernia, transsphincteric acid reflux, Barrett9s oesophagus or intestinal metaplasia (IM) at cardia. The densities of inflammatory cells and reactive atypia were scored at squamous, cardiac and oxyntocardiac mucosa of SCJ, antrum and body. Slides were stained for caudal type homeobox 2 (CDX-2), villin, trefoil factor family 3 (TFF-3) and liver–intestine (LI)-cadherin, mucin MUC1, Muc-2 and Muc-5ac. In addition, biopsies from 15 Barrett9s patients with/without IM were stained and scored as comparison. Immunohistological characteristics were correlated with parameters of obesity and high-resolution pH metry recording. <h3>Results</h3> Cardiac mucosa had a similar intensity of inflammatory infiltrate to non-IM Barrett9s and greater than any of the other upper GI mucosae. The immunostaining pattern of cardiac mucosa most closely resembled non-IM Barrett9s showing only slightly weaker CDX-2 immunostaining. In distal oesophageal squamous mucosa, expression of markers of columnar differentiation (TFF-3 and LI-cadherin) was apparent and these correlated with central obesity (correlation coefficient (CC)=0.604, p=0.001 and CC=0.462, p=0.002, respectively). In addition, expression of TFF-3 in distal oesophageal squamous mucosa correlated with proximal extension of gastric acidity within the region of the lower oesophageal sphincter (CC=−0.538, p=0.001). <h3>Conclusions</h3> These findings are consistent with expansion of cardia in healthy volunteers occurring by squamo columnar metaplasia of distal oesophagus and aggravated by central obesity. This metaplastic origin of expanded cardia may be relevant to the substantial proportion of cardia adenocarcinomas unattributable to <i>H. pylori</i> or transsphincteric acid reflux.
Relationship Between GHb Concentration and Erythrocyte Survival Determined From Breath Carbon Monoxide Concentration
Authors: Mark A. Virtue, Julie K. Furne, Frank Q. Nuttall, Michael D. Levitt
Journal: Diabetes Care (2004)

OBJECTIVE—Subjects with decreased erythrocyte survival have an unusually low GHb percentage. The goal of this study was to determine whether hyperglycemia, as reflected by GHb percentage, is associated with decreased erythrocyte survival. RESEARCH DESIGN AND METHODS—Erythrocyte survival was quantitated in 23 subjects with type 2 diabetes, and these values were correlated with the subjects’ GHb percentage. Erythrocyte survival was determined from the difference between the subjects’ alveolar carbon monoxide (CO) concentration and atmospheric CO concentration. Reticulocyte counts were obtained in 16 subjects. RESULTS—Although the vast majority of the subjects had erythrocyte life spans that fell within the normal range (123 ± 23 days), there was a highly significant inverse correlation (r = −0.66, P &amp;lt; 0.01) between life span and GHb percentage, with an average decline in life span of 6.9 days for each 1% rise in GHb. The reticulocyte count inversely correlated with erythrocyte life span (r = −0.77, P &amp;lt; 0.01). CONCLUSIONS—Hyperglycemia, as evidenced by high GHb percentage, is associated with an appreciable decrease in erythrocyte life span. Because GHb appears to be formed over the lifetime of the erythrocyte, this decreased erythrocyte survival suggests that high GHb percentages may systematically underestimate the true degree of hyperglycemia.