tbuckley/cabot-search huggingface dataset:
Mechanisms of immune-mediated myocyte injury.
Authors: W HBarry
Journal: Circulation (1994)

Much progress has been made in defining the mechanisms by which altered systolic and diastolic function of the heart may be produced by components of the immune system activated during allograft rejection and myocarditis and in patients with dilated cardiomyopathy. It is clear that injury of the vascular bed can occur via both humoral and cellular mediators and probably accounts for the acute alterations in ventricular compliance that occur during allograft rejection, as well as the accelerated development of graft atherosclerosis. Altered myocyte function and lysis can be produced by CTL in vitro, but the importance of this injury process in vivo remains uncertain. Other cells present in the inflammatory infiltrate can also affect myocyte function and survival. Neutrophils may cause lysis of myocytes, and cytokines produced by infiltrating macrophages and HtL may reach a sufficient concentration in the interstitial microenvironment to decrease myocyte catecholamine responsiveness and/or directly depress ...
How to Achieve a High-Performance Health Care System in the United States
Authors: Thomas James
Journal: Annals of Internal Medicine (2008)

Letters6 May 2008How to Achieve a High-Performance Health Care System in the United StatesThomas James III, MDThomas James III, MDFrom Humana, Louisville, KY.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-148-9-200805060-00019 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:The recent position paper by the American College of Physicians (1) was insightful. I think the factual information and most of the recommendations were right on the mark. My only concern is the absence of any mention of physician accountability in the discussion on controlling health care costs. The recommendation to “create incentives to encourage patients to be prudent purchasers” will require changes in current insurance regulations, but this is an absolute necessity. Because that was the only recommendation in the section on cost control, it seems to be a one-sided solution. Patients certainly may create demand, ...References1. Public Policy Committee of the American College of Physicians. Achieving a high-performance health care system with universal access: what the United States can learn from other countries. Ann Intern Med. 2008;148:55-75. [PMID: 18056654] LinkGoogle Scholar2. Sox HC. Medical professionalism and the parable of the craft guilds [Editorial]. Ann Intern Med. 2007;147:809-10. [PMID: 18056668] LinkGoogle Scholar Author, Article, and Disclosure InformationAuthors: Thomas JamesIII, MDAffiliations: From Humana, Louisville, KY.Disclosures:Employment: Humana. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoMedical Professionalism and the Parable of the Craft Guilds Harold C. Sox Achieving a High-Performance Health Care System with Universal Access: What the United States Can Learn from Other CountriesAmerican College of Physicians* How to Achieve a High-Performance Health Care System in the United States Harvey S. Zarren How to Achieve a High-Performance Health Care System in the United States Jack A. Ginsburg , Robert B. Doherty , and J. Fred Ralston Jr. How to Achieve a High-Performance Health Care System in the United States S. Ward Casscells and MG Elder Granger How to Achieve a High-Performance Health Care System in the United States Arvind R. Cavale How to Achieve a High-Performance Health Care System in the United States Richard S. Leff How to Achieve a High-Performance Health Care System in the United States Richard L. Cruess and Sylvia R. Cruess Metrics 6 May 2008Volume 148, Issue 9Page: 711KeywordsBehaviorConflicts of interestDrug therapyHealth careHealth care qualityHealth care utilizationMotivation ePublished: 6 May 2008 Issue Published: 6 May 2008 Copyright & PermissionsCopyright © 2008 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...
Metabolic consequences and predictability of ventricular fibrillation in hypoxia. A 31P- and 23Na-nuclear magnetic resonance study of the isolated rat heart.
Authors: SNeubauer, J BNewell, J SIngwall
Journal: Circulation (1992)

BACKGROUNDVentricular fibrillation has deleterious metabolic and functional consequences for the heart. This study had two purposes: first, to define the effects of ventricular fibrillation during hypoxia on energy metabolism and accumulation of intracellular Na+ and, second, to test whether the occurrence of ventricular fibrillation can be predicted from functional or metabolic parameters.METHODS AND RESULTSIsolated isovolumic rat hearts were perfused with oxygenated Krebs-Henseleit buffer at 37 degrees C. After a prehypoxic period, hearts were subjected to hypoxic perfusion (95% N2-5% CO2) for 30 minutes. High-energy phosphates and intracellular pH were determined by 31P-nuclear magnetic resonance (NMR) spectroscopy, and intracellular Na+ accumulation was followed by 23Na-NMR spectroscopy in combination with the shift reagent dysprosium triethylenetetraminehexa-acetate. Five of 10 (31P-NMR) and four of 10 (23Na-NMR) hearts developed spontaneous ventricular fibrillation at 19 +/- 2 minutes (31P-NMR) and ...
Protein p67. A calcium-binding protein localized at the sarcolemma of secretory atrial myocytes.
Authors: HIida, HNishitani, YShibata
Journal: Circulation Research (1992)

Bovine heart 67-kd protein (p67) was coisolated with calpactin I complex by cycles of Ca(2+)-dependent precipitation followed by solubilization with EGTA-containing buffer. Using affinity-purified anti-p67 antibody and anti-p36 (36-kd subunit of calpactin I) antibody, we examined the localization of the two proteins in secretory atrial myocytes and other endocrine tissues of adult rats. Immunofluorescence microscopy showed that p67 was expressed both in the atrial myocytes in situ and in cultured atrial myocytes in which we failed to detect p36 and that p67 appeared to be closely associated with the cell surface. We also found that p67 was colocalized with p36 in the thyroid follicle epithelium and zona reticularis of the adrenal gland. On the other hand, neither p67 nor p36 was detectable in pancreas islet cells. Immunoelectron microscopy revealed that p67 was localized at the sarcolemma in the atrial myocytes in situ. The p67, which was shown to be a globular molecule with a diameter of 18-25 nm by a lo...
Hypoxia does not alter angiotensin converting enzyme activity in hamster pulmonary microvessels.
Authors: J MShepard, W LJoyner, J PGilmore
Journal: Circulation Research (1987)

Studies were initiated to investigate the effects of hypoxia on the conversion of angiotensin I (AI) to angiotensin II (AII) in microvessels of the lung. Using the technique of allografting neonatal lung tissue into the cheek pouch of normal hamsters, the microvessels of the lung, pulmonary arterioles, and venules could be visualized and manipulated by direct in vivo microscopy. The microvessels of the lung were studied 7-10 days after allografting by anesthetizing the hamster with pentobarbital (6.0 mg/100 g body weight i.p.) and then preparing the lung tissue for observation. The tissue was suffused with a Ringer's bicarbonate solution bubbled with a normal (20% O2-5% CO2-75% N2) or a low (95% N2-5% CO2) oxygen mixture. After equilibration, a pulmonary arteriole or venule was selected for observation, and the vessel geometry was recorded. Then, a micropipette containing either AI or AII was positioned alongside the vessel, and the agent was delivered continuously for 2 minutes. Lumen diameter was record...
Enhanced aldosterone response to angiotensin II in human hypertension.
Authors: E SKisch, R GDluhy, G HWilliams
Journal: Circulation Research (1976)

Adrenal and vascular responsiveness to graded doses of angiotensin II (A II) were recorded for seven normal subjects and 12 patients with essential hypertension while in balance on an intake of 200 mEq sodium/100 mEq potassium. Patients with essential hypertension had been previously studied and known to have normal responses of plasma renin activity to sodium restriction and upright posture. A II was administered for 30 minutes at rates of 0.1, 0.3, 1, and 3 ng/kg per minute and plasma aldosterone responses were assessed 20 and 30 minutes later; blood pressure was monitored at intervals of 1 minute during infusion of A II at each rate. A significant increment in plasma aldosterone occurred at an infusion rate of 0.3 ng/kg per minute in patients with hypertension. This change was not seen until the infusion rate reached 1.0 ng/kg per minute in the normotensive control subjects. Even at an A II infusion rate of 1 ng/kg per minute, the increment in plasma aldosterone levels in normotensive subjects (4.2 +/-...
Advanced Age: A Predictor Of Difficut Lithiasis During ERCP?
Authors: A Nakhli, M Sabbah, D Trad, N Bellil, A Ouakaa, H Elloumi, N Bibani, D Gargouri
Journal: Endoscopy (2021)

Aims Endoscopic retrograde cholangiopancreatography (ERCP) with sphincterotomy and stone extraction using a Dormia balloon or a basket is the standard treatment for common bile duct (CBD) stones. When the clearance of the CBD cannot be obtained by standard techniques, it is referred to as difficult lithiasis. Advanced age is one of the causes of difficult lithiasis (1,2). The objective of this study was to identify parameters that could explain the higher failure rate in older age.
Rapid suppression of complex ventricular arrhythmias with high-dose oral amiodarone.
Authors: N DMostow, T RVrobel, DNoon, LRakita
Journal: Circulation (1986)

Although amiodarone is effective for the suppression of complex ventricular arrhythmias, a major problem with its use is the long delay between the initiation of therapy and the onset of effective suppression of arrhythmia. To test the hypothesis that rapid loading with oral amiodarone to a target serum concentration can overcome much of this delay, eight patients with refractory, sustained, hemodynamically compromising ventricular arrhythmias and 10 patients with potentially life-threatening ventricular arrhythmias were treated with a flexible, very high dose, oral loading protocol (800 to 2000 mg two to three times a day). Dosage was adjusted on the basis of amiodarone serum concentrations to maintain the trough serum concentrations between 2.0 and 3.0 micrograms/ml. Comparison of 24 hr Holter electrocardiograms obtained before and during therapy revealed statistically significant reductions in premature ventricular complexes (PVCs) and paired PVCs beginning the first day of therapy and a reduction in v...
Night visiting in general practice
Authors: G. Robinson
Journal: BMJ (1993)

pictures of identifiable patients unless we have their permission or the permission of their next of kin.In the case of Tony Bland his parents had given permission for the press to reproduce his picture.They will have had their own reasons for taking that decision, but we believe that publishing a picture ofhim adds importantly to the information available in words.Some doctors have never seen a patient in a persistent vegetative state.Another reason for publishing pictures is to distinguish one section of the journal from another.We rarely publish pictures, tables, or graphs in the editorial section, and we do not add pictures to the original papers.We deliberately include them in the news section to give this section a different identity.These pages are designed to look "newsy," which means including pictures.Newspapers carry pictures, and so do journals like Nature, Science, and the Economist.Sometimes these pictures will not be as relevant as we would like.But this problem is experienced by all publications putting together news pages fast.What J K Anand and J W Myles may not understand is that the BMJ is the most general of the world's general medical journals.Few general practitioners read either the Lancet or the New England J7ournal of Medicine, and few doctors
Uncomplicated urinary tract infection in women
Authors: Tammy C Hoffmann, Mina Bakhit, Chris Del Mar
Journal: BMJ (2021)

We searched Medline and the Cochrane Library to identify published systematic reviews and randomised controlled trials on the diagnosis and management of uncomplicated urinary tract infections, including antibiotic benefits and harms, natural history of the condition, and commonly used alternative treatments (cranberry, urinary alkalisers, non-steroidal antiinflammatory drugs).We included journal articles identified in the references of articles from the initial search.We searched for relevant NICE guidelines on uncomplicated urinary tract infections.We have referred to recent systematic reviews and meta-analyses but have cited individual clinical studies where there is no higher quality of evidence.
Importance of preexcited QRS morphology during induced atrial fibrillation to the diagnosis and localization of multiple accessory pathways.
Authors: LFananapazir, L DGerman, J JGallagher, J ELowe, E NPrystowsky
Journal: Circulation (1990)

The present investigation evaluates the ability of several electrocardiographic (ECG) and electrophysiologic methods to identify multiple accessory pathways in 47 patients in whom the presence and sites of multiple accessory pathways were confirmed intraoperatively. To establish ECG features that suggested the presence of multiple accessory pathways in these patients, we initially studied the 12-lead ECG during maximal preexcitation in 101 patients with single accessory pathways. Distinctive 12-lead ECG patterns were noted for six defined anatomic areas around the right and left atrioventricular groove. Multiple preexcited QRS morphologies, each typical for a separate accessory pathway, and atypical preexcited QRS morphologies were recorded during atrial fibrillation in 31 of 47 (66%) patients with multiple accessory pathways. By comparison, the ECG during sinus rhythm and rapid atrial pacing identified 14 (32%) and 26 (55%) of the patients, respectively. In 12 (26%) patients in whom evidence for multiple...
Altered pulmonary microvascular reactivity to norepinephrine in canine pacing-induced heart failure.
Authors: M ITownsley, V HPitts, J LArdell, ZZhao, W HJohnson
Journal: Circulation Research (1994)

Pulmonary hypertension in congestive heart failure causes medial hypertrophy in pulmonary vessels and thickening of the endothelial basement membrane. In this study, the functional consequences of such pulmonary vascular adaptations were evaluated. Heart failure was induced in dogs by rapid ventricular pacing (240 beats per minute) for 28 days, at which time left ventricular shortening fraction was decreased by 57% compared with that at baseline. Lung lobes from paced (n = 56) and control dogs (n = 68) were isolated and perfused with autologous blood. Total, arterial (Ra), and venous (Rv) vascular resistances were significantly increased and vascular capacitance decreased in lobes from paced animals compared with controls. Increments in Ra and Rv after intra-arterial boluses of norepinephrine were measured before and after sequential addition of the alpha 1- and alpha 2-receptor antagonists prazosin (16 mumol/L) and yohimbine (0.1 mumol/L) in the presence or absence of propranolol (5 mumol/L). Norepinephr...
Hemodynamic and metabolic effects of sodium nitroprusside on the performance and metabolism of regional ischemic myocardium
Authors: P LLuz, J SForrester, H LWyatt, J VTyberg, RChagrasulis, W WParmley, H JSwan
Journal: Circulation (1975)

To assess the effects of sodium nitroprusside (5-10 mug/min) on total and regional cardiac performance, energetics, and lactate metabolism during acute ischemia, studies were performed in 21 open-chest dogs. For studies of regional function and metabolism, length gauges were sutured to the epicardial surface and an epicardial vein adjacent to the artery to be occluded was cannulated. Following occlusion of the left anterior descending coronary artery, cardiac output, mean arterial pressure, epicardial vein blood flow, and systolic shortening of the ischemic segment decreased significantly, In the blood samples from the ischemic zone, but not in those from the coronary sinus, lactate extraction shifted to production. In seven control dogs these alterations persisted throughout the experiment. In 14 animals treated with nitroprusside, cardiac output increased while peripheral resistance and mean arterial pressure decreased. Systolic shortening in the ischemic segment increased from 1.10 +/- 0.24 (SEM) to 1....
Modulation of conduction slowing in ischemic rabbit myocardium by calcium-channel activation and blockade.
Authors: GKabell
Journal: Circulation (1988)

Ventricular action potentials and longitudinal conduction times over short distances of epicardium were recorded in isolated rabbit hearts. Global ischemia produced a progressive decrease of resting membrane potential, depression of action potentials, and conduction slowing to approximately 50% of control values over 8 to 10 min. Verapamil (2 X 10(-6) M) markedly attenuated ischemia-induced conduction slowing in association with less depression of maximum upstroke velocity (Vmax) and slightly less change in resting membrane potential. In contrast, Bay K 8644 (10(-7) M), a calcium-channel agonist, exacerbated ischemia-induced conduction slowing and depression of Vmax but did not significantly affect resting membrane potential. Regression analysis of Vmax vs resting membrane potential and the square of conduction velocity vs Vmax demonstrated that verapamil and Bay K 8644 shifted these relationships in opposite directions. The results indicate that the calcium-channel activation state can modulate slowing o...
Mechanisms of flunarizine-induced vasodilation in the rabbit mesenteric artery.
Authors: TItoh, SSatoh, TIshimatsu, TFujiwara, YKanmura
Journal: Circulation Research (1987)

The vasodilating effects of flunarizine on smooth muscle strips of rabbit mesenteric artery have been investigated and compared with those of nifedipine. Flunarizine (30-300 nM) dose-dependently inhibited Ca2+-induced contractions in Ca2+-free solution containing 100 mM K+. Double reciprocal analysis showed that this inhibition was either competitive at low concentrations (30-100 nM; nifedipine-like) or noncompetitive at high concentrations (0.3-1 microM). The latter seemed to be partly related to an inhibition of contractile proteins as estimated from Ca2+-induced contractions in saponin-treated chemically skinned muscle strips. In contrast to the actions of nifedipine, flunarizine inhibited norepinephrine (NE)-induced contractions more than those induced by high K+, and at 0.3 microM, this agent totally blocked NE-induced contraction. Flunarizine also inhibited NE-induced contraction in Ca2+-free solution containing 2 mM EGTA. In Ca2+-free solution, NE rapidly hydrolyzed phosphatidylinositol 4,5-bisphos...
Quantification of apolipoprotein B in grossly normal human aorta.
Authors: H FHoff, C LHeideman, J WGaubatz, A MGotto, E EErickson, R LJackson
Journal: Circulation Research (1977)

A quantitiative electroimmunodiffusion (EID) assay was developed for apolipoprotein B (apoB), the major apoprotein of human plasma low density lipoproteins (LDL) and very low density lipoproteins (VLDL). Specificity, sensitivity (30-200 ng) and reproducibility (11%) were established. We used this system to determine the amount of buffer-soluble apoB in supernatant fractions from homogenates of the intima from grossly normal human aortas. Assays of whole tissue minces yielded only one-third of the apoB in supernatant fractions. Intimal homogenates contained 0.34-18.45 mug of apoB/mg of tissue, dry weight (mean 5.42 +/- 3.95 SD). We also found that no apoB was detected in the homogenates of adjacent tunica media. Furthermore, most of the intimal apoB was found in the LDL density (d) fraction (d 1.006-1.063) after differential ultracentrifugation, while the VLDL (d less than 1.006) fraction contained only negligible amounts of apoB. By electron microscopy, it was determined that the LDL density fraction cont...
Mechanism of atrial sounds in atrial fibrillation. Phonoechocardiographic correlation. Report of a case.
Authors: V SBamrah, C VHughes, F ETristani
Journal: Circulation (1976)

Audible atrial sounds were noted in a patient with congestive cardiomyopathy and atrial fibrillation with slow ventricular rate. Oscillatory motion of similar periodicity as fibrillation waves in the ECG and the sounds in the phonocardiogram was demonstrated in aortic and left ventricular walls, mitral, tricuspid and aortic leaflets by echocardiography. This suggests that the fibrillation motion of the atria is forceful enough to cause vibration of the cardiohemic system resulting in the audible sounds.
Prejunctional and postjunctional actions of endogenous norepinephrine at the sympathetic neuroeffector junction in canine coronary arteries.
Authors: R ACohen, J TShepherd, P MVanhoutte
Journal: Circulation Research (1983)

The effects of endogenous and of exogenous norepinephrine were studied in isolated rings of canine left circumflex coronary artery and its first ventricular branch. Norepinephrine was released from adrenergic nerve endings by transmural electrical stimulation and by tyramine. In rings contracted with prostaglandin F2 alpha, transmural electrical stimulation resulted in frequency-dependent relaxations which were blocked by propranolol or tetrodotoxin; tyramine and exogenous norepinephrine caused concentration-dependent relaxations which were blocked by propranolol. The tyramine-induced relaxations also were inhibited by cocaine. The left circumflex artery was less sensitive than its branch to beta-adrenergic activation; this difference was significant even between rings of the two vessels immediately adjacent to the branching point and was abolished by phentolamine. In the presence of propranolol, transmural electrical stimulation, tyramine and phenylephrine, produced contractions of the left circumflex ar...
Spatz 3 Adjustable Balloon System: Feasibility, Efficacy And Safety Issues Of A Dual Center Experience
Authors: G de Nucci, C Simeth, R Reati, ED Mandelli, D Redaelli, D Morganti, E Colombo, C d’Urbano, SA Berra, F Monica, G Manes
Journal: Endoscopy (2021)

Aims Intragastric balloons for weight loss and as bridge to major bariatric surgery are effective tools, but they could be associated with early period intolerance and a diminished effect within 8-12 weeks. The introduction of an adjustable balloon could improve comfort and offer greater efficacy over the time. Spatz 3 is a dynamic bariatric device with a long implantation time (12 months), system for inflation/deflation of the balloon, and safety mechanism for bowel migration despite an eventual deflation. There are few data about its efficacy and safety in a large followed up bariatric population.
Effects of thrombin inhibition on the development of acute platelet-thrombus deposition during angioplasty in pigs. Heparin versus recombinant hirudin, a specific thrombin inhibitor.
Authors: MHeras, J HChesebro, W JPenny, K RBailey, LBadimon, VFuster
Journal: Circulation (1989)

The effect of recombinant hirudin and the dosage of heparin on acute platelet-thrombus deposition during carotid angioplasty in anesthetized pigs was prospectively assessed. Fifty-five animals (mean weight, 33.9 kg) were randomized to one of six heparin dosages: heparin boluses of 35, 50, 100, 150, 200, or 250 units/kg followed by a continuous infusion of 35, 50, 100, 150, 200, or 250 units/kg/hr, respectively. Another five pigs received a bolus of 1 mg/kg hirudin (recombinant desulphatohirudin), a specific thrombin inhibitor, followed by an infusion of 1 mg/kg/hr. Bilateral carotid angioplasty was performed in all pigs 20 minutes after starting the infusion; they were sacrificed 57 +/- 12 minutes after the procedure. Deep medial arterial injury was present in approximately 75% of the dilated segments, and subendothelial injury in the remaining 25%. Mean log of number of platelets and molecules of fibrinogen per centimeter squared of deep injury in segments from all the animals treated with heparin were 4...