tbuckley/cabot-search huggingface dataset:
In patients with coronary disease and CKD, initial invasive therapy did not improve angina-related health status
Authors: William G. Herrington, Natalie Staplin
Journal: Annals of Internal Medicine (2020)

ACP Journal Club18 August 2020In patients with coronary disease and CKD, initial invasive therapy did not improve angina-related health statusWilliam G. Herrington, MD, Natalie Staplin, PhDWilliam G. Herrington, MDMRC Population Health Research Unit at the University of Oxford, Oxford, UK (W.G.H., N.S.)Search for more papers by this author, Natalie Staplin, PhDMRC Population Health Research Unit at the University of Oxford, Oxford, UK (W.G.H., N.S.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/ACPJ202008180-017 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Source CitationSpertus JA, Jones PG, Maron DJ, et al. Health status after invasive or conservative care in coronary and advanced kidney disease. N Engl J Med. 2020;382:1619-28. https://pubmed.ncbi.nlm.nih.gov/32227754Clinical Impact RatingsCardiology: Nephrology: References1 Maron DJ, Hochman JS, Reynolds HR, et al. Initial invasive or conservative strategy for stable coronary disease. N Engl J Med. 2020;382:1395-407. [PMID: 32227755] Google Scholar2 Spertus JA, Jones PG, Maron DJ, et al. Health-status outcomes with invasive or conservative care in coronary disease. N Engl J Med. 2020;382:1408-19. [PMID: 32227753] Google Scholar3 Reynolds HR, Shaw LJ, Min JK, et al. Association of sex with severity of coronary artery disease, ischemia, and symptom burden in patients with moderate or severe ischemia: secondary analysis of the ISCHEMIA randomized clinical trial. JAMA Cardiol. 2020;5:1-14. [PMID: 32227128] Google Scholar4 Sarnak MJ, Amann K, Bangalore S, et al. Chronic kidney disease and coronary artery disease: JACC State-of-the-Art review. J Am Coll Cardiol. 2019;74:1823-38. [PMID: 31582143] Google Scholar Author, Article, and Disclosure InformationAffiliations: MRC Population Health Research Unit at the University of Oxford, Oxford, UK (W.G.H., N.S.)Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M19-3045.This article was published at Annals.org on 4 August 2020. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics 18 August 2020Volume 173, Issue 4Page: JC17KeywordsAnginaAngiographyChronic kidney diseaseHazard ratioIschemiaQuality of lifeRenal diseasesRevascularizationStenosisStroke ePublished: 18 August 2020 Issue Published: 18 August 2020 Copyright & PermissionsCopyright © 2020 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...
SAT0162 Correlation beetwen bone mass index and bone mass density measured at a non-weight-bearing site: study on 712 postmenopausal women
Authors: G Palombi, A Trucchia, A Iagnocco, G Valesini
Journal: Annals of the Rheumatic Diseases (2001)

<h3>Background</h3> Body weight is highly related to bone mineral density (BMD), regardless of age, menopausal duration, or any other variables. Low body mass index (BMI) constitutes a risk for fragility fractures. Thin postmenopausal women are more at risk of developing non-traumatic fractures. Fatness is positively associated with BMD, both at weight-bearing and non-weight-bearing sites. Therefore, it is presumable that the both mechanical load, induced by greater body weight, and hormonal factors, through the effects of adipose tissue on levels of circulating estrogens, are responsible for greater skeletal density in obese people. <h3>Objectives</h3> The aim of the present study was to demonstrate the correlation between BMI and BMD evaluated at the distal radius. That site has been chosen because it is a non-weight-bearing area and consequently it is not influenced by the mechanical load. <h3>Methods</h3> A total of 712 Caucasian menopausal women, aged 41–100 years (mean age 65, mean duration of menopause 17,4 yrs.) was studied. The sample was divided into 4 groups according to BMI (modified WHO classification): underweight (BMI18.5–24.9, 315 patients, mean age 64,5 yrs., mean duration of menopause 17,2 yrs.), overweight (BMI &gt;25–29.9, 270 patients, mean age 66.1 yrs., mean duration of menopause 18,6 yrs.), obese (BMI &gt;30; 133 patients, mean age 63.8 yrs., mean duration of menopause 15.3 yrs). BMD was studied using dual-energy X-ray absorptiometry (HOLOGIC DTX 100). The examinations were performed on the distal radius of the non-dominant forearm. Diagnosis of osteoporosis was made according to the WHO report (T score &lt;-2.5 SD: osteoporosis. T score ?1 to -2.5 SD: osteopenia. T score 0 to ?1 SD: normal). The ANOVA procedure and the Chi square test were used for statistical analysis of the results. <h3>Results</h3> Results are reported on Table 1. <h3>Conclusion</h3> As expected, the mean value of BMD was higher in the obese group (p &lt; 0.000001). The analysis of prevalence of osteoporosis and osteopenia in all the groups studied showed a negative correlation between body size and bone mass loss. In particular it was observed the finding of a progressive reduction of the number of osteoporotic women with the increasing BMI, while the percentage of osteopenic subjects was almost constant (p &lt; 0.004). The importance of the present study was the demonstration of a strong positive correlation between BMI and BMD at non-weight-bearing site. The findings confirms the protective role of adipose tissue on the bone independently of the influence of the mechanical load.
Understanding Electrocardiography in Adult Patients With Congenital Heart Disease
Authors: Victor Waldmann, Nicolas Combes, Magalie Ladouceur, David S. Celermajer, Laurence Iserin, Michael A. Gatzoulis, Paul Khairy, Eloi Marijon
Journal: JAMA Cardiology (2020)

Congenital heart disease in adults is still a relatively new concept for many cardiologists, and the complexity as well as diversity of cardiac phenotypes encountered necessitate that systematic, practical information be available for the nonspecialist. The analysis of the 12-lead electrocardiogram is an invaluable cornerstone in the clinical appraisal of these patients.Consideration of the main anatomic and pathophysiological aspects of the various congenital heart conditions can shed light on their distinctive electrocardiogram patterns, which are an electrical reflection of intrinsic cardiac anatomy abnormalities, surgical scarring, and progressive cardiac remodeling attributable to hemodynamic perturbations. While congenital heart disease may be diagnosed or suspected on electrocardiogram observation in adults who are previously undiagnosed, specific markers have also been identified to optimize risk stratification in certain defects.This review outlines that main electrocardiogram patterns in adult patients with congenital heart disease can be appreciated by the understanding of the underlying pathophysiology. Periodic surveillance is of particular importance in this population to unmask early electric signs of disease evolution.
Using fractional exhaled nitric oxide to guide step-down treatment decisions in asthma: practical considerations
Authors: Kay Wang, Jan Y. Verbakel, Jason Oke, Alexander Fleming-Nouri, Norihiro Harada, Ryo Atsuta, Tomoyuki Fujisawa, Tomotaka Kawayama, Hiromasa Inoue, Stephen Lazarus, Stanley Szefler, Fernando D. Martinez, Dominick Shaw, Ian D. Pavord, Mike Thomas
Journal: European Respiratory Journal (2020)

<b>Using <i>F</i><sub>ENO</sub> to guide safe step-down treatment decisions in patients with well-controlled asthma should involve gradual, carefully monitored reductions and consider other potential risk factors for acute exacerbations</b>https://bit.ly/2E2W679
Bioluminescence and dual probe fluorescence imaging of subcutaneous and ortothopic ovarian tumors in SCID Beige mice with spectral resolution of VivoFluor 680 and VivoFluor 750 probes.
Authors: Steven Smith, Muhammad Ahsan, Tamara Troy, David West, Ning Zhang, Peter Lassota
Journal: Cancer Research (2007)

LB-84  Non-invasive bioluminescence imaging of tumor cells labeled with luciferase has proven to provide invaluable information on the tumor location and burden in animal models of human cancers. Recent technological advances in fluorophores and optical signal detection technology have made possible rapid sequential imaging and quantitation of bioluminescent and fluorescent signals using a single instrument. This allows collecting additional data on the biological status of the tumor, such as receptor expression, invasiveness, and apoptosis rate. Here we present a proof-of-concept study where subcutaneous and orthotopic human ovarian SK-OV-3 tumors tagged with luciferase were targeted in vivo with two fluorescent probes binding to the HER2/neu receptor expressed on the tumor cell surface. The emission maxima for the two fluorescent probes were 702 nm, and 779 nm, respectively. We registered and analyzed bioluminescent and fluorescent images under conditions optimized for the detection of the above probes. Using epi- and trans-illumination we were able to improve the signal to background ratio to greater than 40 for the VivoFluo 680 probe and greater than 150 for the VivoFluor 750 probe. Selection of proper excitation and emission filters and utilizing the spectral “unmixing” feature of the IVIS Spectrum imaging system, permitted separate registration of signals from each of the probes, despite their co-localization. This fluorescence imaging technology could be used for in vivo detection of primary and metastatic tumors in experimental models of cancer as well as intraoperatively during clinical surgeries.
Factors Associated With Burnout and Stress in Trainee Physicians
Authors: Anli Yue Zhou, Maria Panagioti, Aneez Esmail, Raymond Agius, Martie Van Tongeren, Peter Bower
Journal: JAMA Network Open (2020)

<h3>Importance</h3> Evidence suggests that physicians experience high levels of burnout and stress and that trainee physicians are a particularly high-risk group. Multiple workplace- and non–workplace-related factors have been identified in trainee physicians, but it is unclear which factors are most important in association with burnout and stress. Better understanding of the most critical factors could help inform the development of targeted interventions to reduce burnout and stress. <h3>Objective</h3> To estimate the association between different stressors and burnout/stress among physicians engaged in standard postgraduate training (ie, trainee physicians). <h3>Data Sources</h3> Medline, Embase, PsycINFO, and Cochrane Database of Systematic reviews from inception until April 30, 2019. Search terms included<i>trainee</i>,<i>foundation year</i>,<i>registrar</i>,<i>resident</i>, and<i>intern</i>. <h3>Study Selection</h3> Studies that reported associations between stressors and burnout/stress in trainee physicians. <h3>Data Extraction and Synthesis</h3> Two independent reviewers extracted the data and assessed the quality of the evidence. The main meta-analysis was followed by sensitivity analyses. All analyses were performed using random-effects models, and heterogeneity was quantified using the<i>I</i><sup>2</sup>statistic. <h3>Main Outcome and Measures</h3> The main outcome was the association between burnout/stress and workplace- or non–workplace-related factors reported as odds ratios (ORs) and their 95% CIs. <h3>Results</h3> Forty-eight studies were included in the meta-analysis (n = 36 266, median age, 29 years [range, 24.6-35.7 years]). One study did not specify participants' sex; of the total population, 18 781 participants (52%) were men. In particular, work demands of a trainee physician were associated with a nearly 3-fold increased odds for burnout/stress (OR, 2.84; 95% CI, 2.26-3.59), followed by concerns about patient care (OR, 2.35; 95% CI, 1.58-3.50), poor work environment (OR, 2.06; 95% CI, 1.57-2.70), and poor work-life balance (OR, 1.93; 95% CI, 1.53-2.44). Perceived/reported poor mental or physical health (OR, 2.41; 95% CI, 1.76-3.31), female sex (OR, 1.34; 95% CI, 1.20-1.50), financial worries (OR, 1.35; 95% CI, 1.07-1.72), and low self-efficacy (OR, 2.13; 95% CI, 1.31-3.46) were associated with increased odds for burnout/stress, whereas younger age and a more junior grade were not significantly associated. <h3>Conclusions and Relevance</h3> The findings of this study suggest that the odds ratios for burnout and stress in trainee physicians are higher than those for work-related factors compared with nonmodifiable and non–work-related factors, such as age and grade. These findings support the need for organizational interventions to mitigate burnout in trainee physicians.
In stable coronary disease with moderate or severe ischemia, initial invasive therapy plus medical therapy did not improve CV outcomes at 3 years
Authors: Eric R. Bates
Journal: Annals of Internal Medicine (2020)

ACP Journal Club18 August 2020In stable coronary disease with moderate or severe ischemia, initial invasive therapy plus medical therapy did not improve CV outcomes at 3 yearsEric R. Bates, MDEric R. Bates, MDUniversity of Michigan, Ann Arbor, MI, USA (E.R.B.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/ACPJ202008180-014 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Source CitationMaron DJ, Hochman JS, Reynolds HR, et al. Initial invasive or conservative strategy for stable coronary disease. N Engl J Med. 2020;382:1395-1407. https://pubmed.ncbi.nlm.nih.gov/32227755Clinical Impact RatingsCardiology: References1 Fihn SD, Gardin JM, Abrams J, et al. 2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS guideline for the diagnosis and management of patients with stable ischemic heart disease. Circulation. 2012;126:e354-471. [PMID: 23166211] Google Scholar2 Chacko L, Howard JP, Rajkumar C, et al. Effects of percutaneous coronary intervention on death and myocardial infarction stratified by stable and unstable coronary artery disease: a meta-analysis of randomized controlled trials. Circ Cardiovasc Qual Outcomes. 2020;13:e006363. [PMID: 32063040] Google Scholar3 Boden WE, O’Rourke RA, Teo KK, et al. Optimal medical therapy with or without PCI for stable coronary disease. N Engl J Med. 2007;356:1503-16. [PMID: 17387127] Google Scholar4 Frye RL, August P, Brooks MM, et al. A randomized trial of therapies for type 2 diabetes and coronary artery disease. N Engl J Med. 2009;360:2503-15. [PMID: 19502645] Google Scholar5 De Bruyne B, Pijls NHJ, Kalesan B, et al. Fractional flow reserve–guided PCI versus medical therapy in stable coronary disease. N Engl J Med. 2012;367:991-1001. [PMID: 22924638] Google Scholar Author, Article, and Disclosure InformationAffiliations: University of Michigan, Ann Arbor, MI, USA (E.R.B.)Disclosures: The commentator has disclosed no conflicts of interest. The form can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M19-3045.This article was published at Annals.org on 4 August 2020. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics 18 August 2020Volume 173, Issue 4Page: JC14KeywordsAnginaAngiographyCoronary arteriesCoronary revascularizationHeart failureIschemiaQuality of lifeRevascularizationStable coronary artery diseaseStenosis ePublished: 18 August 2020 Issue Published: 18 August 2020 Copyright & PermissionsCopyright © 2020 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...
Beta-blocker use and acute exacerbations of COPD following myocardial infarction: a Danish nationwide cohort study
Authors: Daniel B Rasmussen, Uffe Bodtger, Morten Lamberts, Christian Torp-Pedersen, Gunnar Gislason, Peter Lange, Magnus T Jensen
Journal: Thorax (2020)

Introduction Patients with chronic obstructive pulmonary disease (COPD) are undertreated with beta-blockers following myocardial infarction (MI), possibly due to fear for acute exacerbations of COPD (AECOPD). Is beta-blocker use associated with increased risk of AECOPD in patients following first-time MI? Methods Danish nationwide study of patients with COPD following hospitalisation for MI from 2003 to 2015. Multivariable, time-dependent Cox regression accounting for varying beta-blocker use based on claimed prescriptions during up to 13 years of follow-up. Results A total of 10 884 patients with COPD were discharged after first-time MI. The 1-year rate of AECOPD was 35%, and 65% used beta-blockers at 1 year. Beta-blocker use was associated with a lower risk of AECOPD (multivariable-adjusted HR 0.78, 95% CI 0.74–0.83). This association was independent of the type of MI (HR 0.70, 95% CI 0.59–0.83 in ST-elevation MI (STEMI) and HR 0.80, 95% CI 0.75–0.84 in non-STEMI), presence or absence of heart failure (HR 0.82, 95% CI 0.74–0.90 and HR 0.77, 95% CI 0.72–0.82, respectively), beta-blocker dosage and type, as well as exacerbation severity. Results were similar in 1118 patients with full data on COPD severity and symptom burden (median forced expiratory volume in 1 s as percentage of predicted was 46 and majority had moderate dyspnoea), and in 1358 patients with severe COPD and frequent AECOPD with a high 1-year rate of AECOPD of 70%. Discussion Beta-blocker use was not associated with increased risk of AECOPD following MI. This finding was independent of COPD severity, symptom burden and exacerbation history, and supports the safety of beta-blockers in patients with COPD, including high-risk patients with severe disease.
Serious Ivermectin Toxicity and Human <i>ABCB1</i> Nonsense Mutations
Authors: Eloise Baudou, Anne Lespine, Geneviève Durrieu, François André, Peggy Gandia, Clarisse Durand, Séverine Cunat
Journal: New England Journal of Medicine (2020)

Ivermectin Toxicity and Nonsense Mutations Encephalopathy and coma developed in a 13-year-old boy shortly after he received a single dose of ivermectin to prevent scabies infection. ABCB1 sequencin...
Comparison of five major airflow limitation criteria to identify high-risk individuals with COPD: a contemporary population-based cohort
Authors: Yunus Çolak, Børge G Nordestgaard, Jørgen Vestbo, Peter Lange, Shoaib Afzal
Journal: Thorax (2020)

Background Different airflow limitation criteria are often used to diagnose COPD. We investigated head-to-head whether Global Initiative for Chronic Obstructive Lung Disease (GOLD) (FEV 1 /FVC &lt;0.70) and four lower limit of normal (LLN) (FEV 1 /FVC &lt;LLN) criteria to diagnose airflow limitation differ in identifying individuals at risk of COPD exacerbations and mortality. Methods 108 246 individuals aged 20–100 years randomly selected from the general population were followed from 2003 through 2018 to determine risk of COPD exacerbations, respiratory mortality and all-cause mortality. LLN criteria used equations from Global Lung Initiative (GLI), National Health and Nutrition Examination Survey (NHANES), European Community for Steel and Coal (ECSC) and Copenhagen City Heart Study (CCHS)/Copenhagen General Population Study (CGPS). Results Prevalence of airflow limitation was 17% for GOLD, 8.6% for GLI, 10% for NHANES, 8.2% for ECSC and 14% for CCHS/CGPS. During 14.4 years follow-up, we observed 2745 COPD exacerbations, 762 respiratory deaths and 10 338 all-cause deaths. Comparing individuals with versus without airflow limitation, HRs for COPD exacerbations were 17 (95% CI 14 to 20) for GOLD, 21 (18 to 24) for GLI, 20 (17 to 23) for NHANES, 21 (18 to 24) for ECSC and 18 (16 to 21) for CCHS/CGPS. Corresponding HRs for respiratory mortality were 3.7 (3.1 to 4.3), 6.4 (5.6 to 7.5), 5.7 (4.9 to 6.6), 6.2 (5.3 to 7.2) and 4.5 (3.9 to 5.2), and for all-cause mortality 1.5 (1.4 to 1.5), 1.9 (1.8 to 2.0), 1.8 (1.7 to 1.9), 1.9 (1.8 to 2.0) and 1.7 (1.6 to 1.7), respectively. Differences in Harrell’s C were minute for these outcomes; nonetheless, Harrell’s C was slightly higher for LLN criteria compared with GOLD for mortality outcomes. Conclusions The prevalence of airflow limitation ranged from 8% to 17% using GOLD and four different LLN criteria; however, identified individuals with the five different criteria had similar risk of COPD exacerbations and mortality.
In high-risk patients with acute upper GI bleeding, urgent vs. early endoscopy did not differ for 30-day mortality
Authors: Heidi S. Ahmed, David R. Lichtenstein
Journal: Annals of Internal Medicine (2020)

Lau JY, Yu Y, Tang RS, et al. Timing of endoscopy for acute upper gastrointestinal bleeding. N Engl J Med. 2020;382:1299-308. 32242355.
Prostate-Specific Antigen Density: A Means to Enhance Detection of Prostate Cancer
Authors: Jacob Ramon, Laurent Boccon-Gibod, Thierry Billebaud, Marcello Kobelinsky, Alain Meulemans, Marie-Christine Dauge, Liliane Boccon-Gibod, Arnauld Villers, Liliane Astier
Journal: European Urology (1994)
Rapid assessment of chest pain
Authors: J. M Ryan
Journal: BMJ (2002)

Editor—Rapid assessment of chest pain continues to attract the attention of healthcare planners and providers involved in the management of this common emergency. Wood et al's editorial on this subject makes cogent arguments for a clinical trial to assess the impact of rapid medical and surgical management of exertional angina.1

We are concerned at the terminology used by Wood et al. The term that they use—“casualty”—is outdated and has long been replaced by the term “accident and emergency medicine” or, increasingly, “emergency medicine.” It reflects ignorance of the role that trained specialists in emergency medicine have in the assessment of suspected chest pain.

Modern emergency departments, under the supervision of senior doctors trained in emergency medicine, use a wide variety of diagnostic tools not mentioned by Wood et al, including cardiac markers and continuous ST segment monitoring, to stratify risk for patients presenting with chest pain. The outmoded concept of casualty officers finding it difficult to distinguish between cardiac and non-cardiac pain fails to acknowledge the developments in emergency medicine that have taken place over the past two decades, particularly in the assessment and management of acute chest pain of suspected cardiac origin by senior emergency physicians.

It is regrettable that the BMJ perpetuates the use of such an outdated term as casualty. All staff who deliver emergency care know that specialists in emergency medicine provide a specialist opinion for patients presenting with acute chest pain. The role of multidisciplinary care in the provision of quality emergency medicine is a fairly modern concept. Cooperation and liaison between emergency doctors and cardiologists in the management of patients with chest pain is one example of this. It is disappointing that this editorial has failed to acknowledge the role of trained emergency specialists.

We would appeal to the BMJ that the term casualty as used in this editorial should suffer a similar fate to the term “accident” and be banished from use in the BMJ in the future.2
T Cell Costimulation Blockade Blunts Age-Related Heart Failure
Authors: Elisa Martini, Marco Cremonesi, Cristina Panico, Pierluigi Carullo, Cecilia Assunta Bonfiglio, Simone Serio, Elena Jachetti, Mario Paolo Colombo, Gianluigi Condorelli, Marinos Kallikourdis
Journal: Circulation Research (2020)