tbuckley/cabot-search huggingface dataset:
Abstract 16078: Pulmonary Vasculopathy Assessed By Intravascular Ultrasound in Persistent Pulmonary Hypertension After Mitral Valve Replacement, Comparation to Idiopathic Pulmonary Arterial Hypertension and Healthy Controls
Authors: Juan Carlos J Grignola, Leticia L Fernandez-Lopez, Enric E Domingo-Ribas, Rio R Aguilar, Cristian Humberto C Arredondo, German G Zavala, Antonio A Roman
Journal: Circulation (2015)

Purpose: The aim of the study is to assess pulmonary vasculopathy (wall fibrosis, pulmonary arterial pulsatility and elastic modulus ) in patients with persistent pulmonary hypertension (pulmonary systolic pressure by ECHO &gt; 50 mmhg ) at least 1 year after mitral valve replacement with normal function of the valve. The evaluation was carried out by intravascular ultrasound (IVUS) in medium sized pulmonary arteries. We compared three groups: Group 1 ( persistent pulmonary hypertension after mitral valve replacement), Group 2 (pulmonary hypertension belonging to the group 1 of the Dana Point classification) and Group 3 (healthy controls). Methods: We studied 43 patients, 15 in Group 1 , 18 Group 2 and 10 in Group 3. Group 1: 13 females, the mean age of this group was 74+-7 years; Group 2: 14 females, 53+-14 years and Group 3: 6 females, 51+-5 years. All patients were submitted to left and right heart catheterization, and IVUS in medium sized elastic PA ( 2-3 mm diameter ) of the inferior lobes. Studied variables were: mean pulmonary artery pressure (PAP, mm Hg), pulmonary wedge pressure, aortic pressure, cardiac output (CO,l/min), pulmonary vascular resistance (PVR, Wood Units), IVUS pulsatility and elastic modulus (EM,mm Hg). Local pulsatility was estimated by IVUS: (systolic- diastolic lumen area/ diastolic lumen area) X 100. PA stiffness was assessed by the elastic modulus (EM= pulse pressure/ IVUSp). Results: In Group 3 all variables were statistically different from the other 2 groups (p&lt;0.01). Variables are shown in table. Conclusions: Group 1, even with a lower mean PAP than Group 2 (p&lt;0.05) showed a similar anatomical ( wall fibrosis ) and similar functional wall remodeling ( EM ).
Using the Localized Scleroderma Cutaneous Assessment Tool (Lo <scp>SCAT</scp> ) to classify morphoea by severity and identify clinically significant change
Authors: N.M. Teske, H.T. Jacobe
Journal: British Journal of Dermatology (2019)

ObjectivesTo ascertain the clinical significance of scores on the Localized Scleroderma Cutaneous Assessment Tool (LoSCAT) and identify the change in scores correlated with clinically meaningful change.
Global Snapshots: Bangladesh - dramatic improvements
Authors: Julie-Anne Greenslade
Journal: BMJ (2003)

Poor, packed, flat, watery, and full of rickshaws--the common images of Bangladesh for most people. But, through new innovative and comprehensive approaches, Bangladesh is making remarkable progress in tackling healthcare needs and reducing the growth rate of the population.

With 129 million people crammed into 133 910 km2, Bangladesh is the most densely populated country in the world.1 This is equivalent to twice the UK population in half the land, with a population growing at a rate of 2.2% each year.2 During monsoon, up to two thirds of the country is flooded with recurrent cyclones destroying property, agriculture, and thousands of lives. …
Amazon rainforest: biodiversity and biopiracy
Authors: Klaus Morales dos Santos, Tulio Vinicius de Oliveira Campos
Journal: BMJ (2005)

The Amazon rainforest is home to a flora with an enormous and vastly unexplored pharmacological potential. <b>Klaus Morales</b> and <b>Tulio Vinicius</b> investigate why biopiracy is becoming a threat to Brazilian biodiversity
Fake it till you custom-make it: a non-inferior thermoplastic mandibular advancement device?
Authors: Kate Sutherland, Oyku Dalci
Journal: Thorax (2019)

Oral appliances, of the mandibular advancement device (MAD) variety, are an effective treatment for obstructive sleep apnoea (OSA). In recent years, non-inferiority of MAD compared with continuous positive airway pressure (CPAP) in controlling important short-term health outcomes, like blood pressure, has been demonstrated, despite residual mild OSA on MAD treatment.1 2 This equivalent effectiveness is potentially attributable to greater usage and treatment preference for MAD over CPAP which counteracts any inferior efficacy.2

It is well recognised that Apnoea Hypopnea Index (AHI) changes with MAD vary from individual to individual, with some patients achieving major improvement or resolution of OSA, and others left with varying degrees of residual OSA.3 This uncertainty around therapeutic efficacy remains a clinical barrier. Therefore, MADs are generally reserved for second-line therapy in the event of CPAP failure, or preferentially for less severe and/or less obese patients who respond better on average, although these characteristics are of low accuracy in predicting MAD therapeutic response.3 Despite years of interest in clinical prediction tools for MAD treatment outcomes, current methods either lack verifiable utility or feasibility for routine clinical use.4

The success of MAD therapy also depends on clinical expertise and follow-up and quality of the oral device itself. There are numerous device options which vary in sophistication and customisation. The current guideline for MAD therapy recommend a customised, titratable (allowing adjustment to level of mandibular protrusion) device, over a non-custom device.5 However, this is a guideline only, due to limited device comparison trials. For customised MADs, titratable devices have been shown to have better efficacy than fixed, non-adjustable devices.6 Several studies report clear benefits of customised devices over non-customised options.7–9 However, the drawback of customisation is greater financial outlay and optimisation time, which ultimately may not …
Viewpoint: Learning through teaching
Authors: David Holt
Journal: BMJ (2007)

One of the things that stood out about my anaesthesia elective was the one to one teaching that I received every day. I was paired with a staff doctor or fellow and was the only student for whom he or she was responsible. Sometimes the teacher to student ratio was even two to one, if a staff and intern were both present. It was obvious from the start that I was benefiting immensely from this apprenticeship. I learnt about cardiac output and stroke volume while I was monitoring patients' blood pressure. I learnt to …
Are patients your first concern?
Authors: Tasanee Smith
Journal: BMJ (2003)

Being a medical student is great. No sooner than you have tried one specialty, you are off to sample the next; I cannot imagine more varied and interesting career prospects. And yet, I am often advised to ‘get out while you can.’ Something strange is happening after qualification to produce an alarming number of cynical and disillusioned doctors.

A consultant listed the difficulties for me—hectic takes, long ward rounds, outpatient clinics bursting at the seams, administration and audit, journals piling up, urgent phone calls, revalidation and continuing medical education, meeting after meeting. And yet, we know that women wait at home, desperately anxious about the lump their general practitioner has found, as 14 days and nights crawl by before their hospital appointment. An elderly woman bound to her bed hears she must wait six months for her hip replacement, and hospital wards are full of patients awaiting decisions about their management and the results of investigations.

Everybody is waiting …
“I’m just a medical student”
Authors: Prizzi Zarsadias
Journal: BMJ (2009)

When I was faced with the daunting task of catheterising a real patient for the first time I reflexively responded with the magical phrase, “I’m just a medical student.” I thought it was the safe and sensible thing to say and spared the patient from enduring me fumbling by their bedside. That was until a nurse responded with “Just a medical student? You are a medical student, and you are doing this catheterisation.” That day I learnt not to hide behind my status as a student and …
Japan tests medical students for approachability
Authors: Karen Hebert
Journal: BMJ (2005)

Japanese medical students must prove that they are approachable before they can qualify. This reflects the Japanese medical profession's objective to move away from just expecting students to acquire knowledge toward effective interaction with patients.

From April 2005, all of the 108 Japanese universities that have a medical or dental school will have to implement the Common Achievement Test (CAT) for their …
Soundings: The “mum test”
Authors: Carl Morris
Journal: BMJ (2000)

Who would you rather be treated by? An exceptionally gifted diagnostician who is completely committed to your wellbeing, or a burnt out cynic who is not interested in you at all? And would it change things if one was wearing ripped jeans, while the other was in a suit? It's a silly question of course. You wouldn't last very long in the health service in ripped jeans.

So do clothes matter? Well yes they do. Many …
Characteristics and Trends Among Patients With Cardiovascular Disease Referred to Palliative Care
Authors: Haider J. Warraich, Steven P. Wolf, Robert J. Mentz, Joseph G. Rogers, Greg Samsa, Arif H. Kamal
Journal: JAMA Network Open (2019)

<h3>Importance</h3> Use of palliative care (PC) for patients with cardiovascular disease (CVD) has increased recently. However, it is unknown if patients are receiving earlier referrals to PC. <h3>Objective</h3> To assess characteristics and trends of patients with CVD referred to PC. <h3>Design, Setting, and Participants</h3> Cohort study in which analysis of data from the multicenter Quality Data Collection Tool for Palliative Care registry from January 2, 2015, through December 29, 2017, included patients with CVD 18 years or older referred to initial PC consultation who had a documented palliative performance score (PPS) . <h3>Exposures</h3> Patients with CVD who presented for an initial PC visit. <h3>Main Outcomes and Measures</h3> The primary outcome was PPS. Secondary outcomes included symptoms and end-of-life documentation. <h3>Results</h3> Among 1801 patients (mean [SD] age, 77.7 [13.7] years) from 16 sites in the analysis, 875 (48.6%) were women and 1339 (74.3%) were white. A low PPS score (0%-30%), consistent with bedbound status, was recorded for 521 patients (28.9%), with no change through time. The most common moderate to severe symptoms were poor well-being, tiredness, anorexia, and dyspnea. Year of encounter was associated with improved symptoms of pain (odds ratio, 1.25; 95% CI, 1.05-1.50) and with constipation (odds ratio, 1.32; 95% CI, 1.03-1.69). No change through time was noted in other symptoms or end-of-life documentation. Although the proportion of referrals from general medicine increased from 43.2% (167 of 387) in 2015 to 52.9% (410 of 775) in 2017, the proportion of referrals from cardiologists decreased from 16.5% (64 of 387) in 2015 to 10.5% (81 of 775) in 2017. The proportion of patients referred to PC who were black decreased from 11.9% (46 of 387) in 2015 to 6.3% (49 of 775) in 2017. While 69.5% of all patients with CVD (1252 of 1801) had a primary diagnosis of heart failure, the proportion of non–heart failure CVD diagnoses, such as coronary artery disease and valvular heart disease, increased from 25.6% (99 of 387) in 2015 to 30.1% (233 of 775) in 2017. <h3>Conclusions and Relevance</h3> Patients with CVD demonstrated significant symptom burden, and there was no evidence in the registry of change in the PPSs of patients with CVD referred to PC through time. Cardiologists provided comparatively fewer referrals to PC for patients with CVD, and this proportion decreased through time. The proportion of racial and ethnic minorities referred to PC was small and decreased through time. These findings reinforce the need for cardiologists to be more engaged with PC and consider referring appropriate patients with CVD sooner.
Abstract 21273: Burden of Arrhythmias in Hypertrophic Obstructive Cardiomyopathy in United States From 2000 Through 2014: A National Population-Based Cohort Study
Authors: Byomesh K Tripathi, Shilp Arora, Chayakrit Krittanawong, Hafeez UH Virk, Madan Badal, Abhishek Mishra, Varun Kumar, Sopan Lahewala, Nirali Patel, Prashant Patel, Edo Kulaski
Journal: Circulation (2017)

Background: Hypertrophic obstructive cardiomyopathy (HOCM) is the leading cause of sudden cardiac death (SCD) in young adults and ventricular arrhythmias are known to cause SCD in these high-risk patients. The risk of SCD increases with increasing age. This data is first of its kind to address the trends in the prevalence of arrhythmias in HOCM population. Methods: The study cohort was extracted from Nationwide inpatient sample (NIS) from 2000 to 2014. Appropriate international classification of diseases, 9th Revision, Clinical Modification (ICD-9-CM) codes were used to diagnose HOCM (425.1 and 425.11) and arrhythmias (427.xx). P-values for trends were generated by Cochrane-Armitage test for categorical variables and simple linear regression for continuous variables. Results: We noted 49.13 % incidence of any arrhythmias in HOCM patients with a relative increase of 27.92% over study period (2000-2014). Atrial fibrillation was most prevalent arrhythmia in this patient population (33.39%).Highest increase in incidence over study period was observed in bundle branch blocks ( relative increase 189.64%), atrioventricular blocks ( relative increase 119.85%), premature atrial/ventricular complex ( relative increase 123.28%), atrial flutter ( relative increase 66.86%), ventricular tachycardia (relative increase 60.54%) and atrial fibrillation ( relative increase 24.31%). Conclusion: Patients with HOCM are at increased risk of arrhythmias. Even after improvement in the early diagnosis and treatment of these high-risk patients, the burden of arrhythmias i.e., AF, ventricular arrhythmias, premature arrhythmias and atrioventricular blocks has increased exponentially through 2000-2014. It was also accompanied by increase in-hospital mortality in HOCM population.
Multicenter Preclinical Validation of BET Inhibition for the Treatment of Pulmonary Arterial Hypertension
Authors: Diederik E. Van der Feen, Kondababu Kurakula, Eve Tremblay, Olivier Boucherat, Guido P. L. Bossers, Robert Szulcek, Alice Bourgeois, Marie-Claude Lampron, Karima Habbout, Sandra Martineau, Roxane Paulin, Ewelina Kulikowski, Ravi Jahagirdar, Ingrid Schalij, Harm Jan Bogaard, Beatrijs Bartelds, Steeve Provencher, Rolf M. F. Berger, Sébastien Bonnet, Marie-José Goumans
Journal: American Journal of Respiratory and Critical Care Medicine (2019)

Rationale: Pulmonary arterial hypertension (PAH) is a degenerative arteriopathy that leads to right ventricular (RV) failure. BRD4 (bromodomain-containing protein 4), a member of the BET (bromodomain and extra-terminal motif) family, has been identified as a critical epigenetic driver for cardiovascular diseases.Objectives: To explore the therapeutic potential in PAH of RVX208, a clinically available BET inhibitor.Methods: Microvascular endothelial cells, smooth muscle cells isolated from distal pulmonary arteries of patients with PAH, rats with Sugen5416 + hypoxia- or monocrotaline + shunt-induced PAH, and rats with RV pressure overload induced by pulmonary artery banding were treated with RVX208 in three independent laboratories.Measurements and Main Results: BRD4 is upregulated in the remodeled pulmonary vasculature of patients with PAH, where it regulates FoxM1 and PLK1, proteins implicated in the DNA damage response. RVX208 normalized the hyperproliferative, apoptosis-resistant, and inflammatory phenotype of microvascular endothelial cells and smooth muscle cells isolated from patients with PAH. Oral treatment with RVX208 reversed vascular remodeling and improved pulmonary hemodynamics in two independent trials in Sugen5416 + hypoxia-PAH and in monocrotaline + shunt-PAH. RVX208 could be combined safely with contemporary PAH standard of care. RVX208 treatment also supported the pressure-loaded RV in pulmonary artery banding rats.Conclusions: RVX208, a clinically available BET inhibitor, modulates proproliferative, prosurvival, and proinflammatory pathways, potentially through interactions with FoxM1 and PLK1. This reversed the PAH phenotype in isolated PAH microvascular endothelial cells and smooth muscle cells in vitro, and in diverse PAH rat models. RVX208 also supported the pressure-loaded RV in vivo. Together, these data support the establishment of a clinical trial with RVX208 in patients with PAH.
Associations of Symptomatic Knee Osteoarthritis With Histopathologic Features in Subchondral Bone
Authors: Koji Aso, S. Mohsen Shahtaheri, Roger Hill, Deborah Wilson, Daniel F. McWilliams, David A. Walsh
Journal: Arthritis & Rheumatology (2019)

Objective Subchondral bone and the osteochondral junction are thought to contribute to osteoarthritis ( OA ) knee pain. We undertook this study to identify osteochondral pathologies specifically associated with symptomatic human knee OA . Methods Medial tibial plateau samples from 2 groups of subjects (n = 31 per group) were matched for macroscopic chondropathy scores. The symptomatic chondropathy group had undergone total knee replacement for OA knee pain, at which time specimens of the medial tibial plateau were obtained. The asymptomatic chondropathy group included subjects who died of unrelated illness (specimens were obtained at postmortem examination) and who had not previously sought help for knee pain. OA histopathology, immunoreactivity for nerve growth factor ( NGF ) and CD 68 (macrophages), tartrate‐resistant acid phosphatase–positive subchondral osteoclasts, and synovitis were compared between groups. Results Mankin scores, subchondral bone density, and subchondral CD 68‐immunoreactive macrophage infiltration were similar between the 2 groups. NGF ‐like immunoreactivity was found in subchondral mononuclear cells and osteoclasts, as well as in chondrocytes. NGF in osteochondral channels and osteoclast densities in subchondral bone were higher in the symptomatic chondropathy group than in the asymptomatic chondropathy group ( P &lt; 0.01 and P = 0.02, respectively), as were synovitis scores ( P &lt; 0.01). Osteochondral pathology was not significantly associated with synovitis score. The differences in NGF expression and in osteoclast density remained significant after adjustment for age and synovitis score ( P = 0.01 and P = 0.04, respectively). Osteochondral NGF and osteoclast densities, together with synovitis scores, explained ~28% of sample allocation to symptomatic or asymptomatic groups. Conclusion Subchondral pathology was associated with symptomatic knee OA , independent of chondropathy and synovitis. Increased NGF expression in osteochondral channels and increased osteoclast density appear to be key features associated with bone pain in knee OA .
Towards precision medicine: advances in 5‐hydroxymethylcytosine cancer biomarker discovery in liquid biopsy
Authors: Chang Zeng, Emily Kunce Stroup, Zhou Zhang, Brian C.‐H. Chiu, Wei Zhang
Journal: Cancer Communications (2019)

Abstract Robust and clinically convenient biomarkers for cancer diagnosis, early detection, and prognosis have great potential to improve patient survival and are the key to precision medicine. The advent of next‐generation sequencing technologies enables a more sensitive and comprehensive profiling of genetic and epigenetic information in tumor‐derived materials. Researchers are now able to monitor the dynamics of tumorigenesis in new dimensions, such as using circulating cell‐free DNA (cfDNA) and tumor DNA (ctDNA). Mutation‐based assays in liquid biopsy cannot always provide consistent results across studies due partly to intra‐ and inter‐tumoral heterogeneity as well as technical limitations. In contrast, epigenetic analysis of patient‐derived cfDNA is a promising alternative, especially for early detection and disease surveillance, because epigenetic modifications are tissue‐specific and reflect the dynamic process of cancer progression. Therefore, cfDNA‐based epigenetic assays are emerging to be a highly sensitive, minimally invasive tool for cancer diagnosis and prognosis with great potential in future precise care of cancer patients. The major obstacle for applying epigenetic analysis of cfDNA, however, has been the lack of enabling techniques with high sensitivity and technical robustness. In this review, we summarized the advances in epigenome‐wide profiling of 5‐hydroxymethylcytosine (5hmC) in cfDNA, focusing on the detection approaches and potential role as biomarkers in different cancer types.
The SPRINT trial suggests that markers of tubule cell function in the urine associate with risk of subsequent acute kidney injury while injury markers elevate after the injury
Authors: Alexander L. Bullen, Ronit Katz, Alexandra K. Lee, Cheryl A.M. Anderson, Alfred K. Cheung, Pranav S. Garimella, Vasantha Jotwani, William E. Haley, Areef Ishani, James P. Lash, Javier A. Neyra, Henry Punzi, Anjay Rastogi, Erik Riessen, Rakesh Malhotra, Chirag R. Parikh, Michael V. Rocco, Barry M. Wall, Udayan Y. Bhatt, Michael G. Shlipak, Joachim H. Ix, Michelle M. Estrella
Journal: Kidney International (2019)
Death's Enemy: The Pilgrimage of Victor Frankenstein
Authors: Anja Weidmann
Journal: BMJ (2003)

Since its first publication in 1818, Frankenstein has been the inspiration for countless retellings both in books and films. Death's Enemy is the latest addition to this famous family. The novel follows Victor Frankenstein from precocious childhood, through medical school, and beyond. Having drunk and whored his way through university, Frankenstein gets a brutal introduction to the life of a 19th century surgeon in the army as part of Napoleon's ill …
Abstract 17657: The MAGGIC Risk Score: Validation of a Simple Tool for the Prediction of Morbidity and Mortality in Heart Failure With Preserved Ejection Fraction
Authors: Jonathan D Rich, David A Klein, Sanjay V Saraf, Benjamin H Freed, Michael A Burke, Mathew S Maurer, Daniel Burkhoff, Sanjiv J Shah
Journal: Circulation (2013)

Background: Heart failure with preserved ejection fraction (HFpEF) is associated with morbidity and mortality rates comparable to HF with reduced EF (HFrEF). Whereas several risk models for HFrEF m...
Threat of war is affecting mental health of Iraqi children
Authors: Jocalyn Clark
Journal: BMJ (2003)

The vast majority of Iraq's 13 million children will be affected if the war between Iraq and the West goes ahead, a report released by a Canadian led team of health experts concludes.

The report, based on a humanitarian fact finding mission in Iraq that included interviews with 100 families in Baghdad, Karbala, and Basra in January 2003, warns that Iraqi children are at grave risk of starvation, disease, death, and psychological trauma.

Casualties are predicted to be in the tens of thousands in the …
School pupil allowed to observe intimate examination
Authors: Helen Barratt
Journal: BMJ (2001)

A hospital trust has been forced to apologise after it emerged that a 15 year old work experience student was present during an intimate examination without the patient's consent. The female patient who has not been named lodged a complaint after noticing the girl during the procedure at North Manchester General Hospital.

The trust refused to go into details, but emphasised that the girl, who was wearing a white coat, had taken no part in the patient's treatment or care. However, the trust confirmed that she had been shadowing Roger Williams, a consultant general surgeon at the hospital, who is thought to have allowed the girl to attend checks in several other cases. Thousands of school pupils undertake work experience placements in hospitals each year as it is now an almost essential prerequisite for applying for a place at medical school. However, the policies dictating what they can and cannot do are normally very restrictive.

A spokesperson for the trust said, “We have already acknowledged that [our] policy for work experience students was not followed in this case. The staff involved have been warned against this in future and all staff have been reminded …