tbuckley/cabot-search huggingface dataset:
Ultrasound-assisted cannulation of the internal jugular vein. A prospective comparison to the external landmark-guided technique.
Authors: B GDenys, B FUretsky, P SReddy
Journal: Circulation (1993)

BACKGROUNDCentral venous access is an essential part of patient management in many clinical settings and is usually achieved with a blinded, external landmark-guided technique. The purpose of this study is to evaluate whether an ultrasound technique can improve on the traditional method.METHODS AND RESULTSWe prospectively evaluated an ultrasound-guided method in 302 patients undergoing internal jugular venous cannulation and compared the results with 302 patients in whom an external landmark-guided technique was used. Ultrasound was used exclusively in an additional 626 patients. Cannulation of the internal jugular vein was achieved in all patients (100%) using ultrasound and in 266 patients (88.1%) using the landmark-guided technique (p < 0.001). The vein was entered on the first attempt in 78% of patients using ultrasound and in 38% using the landmark technique (p < 0.001). Average access time (skin to vein) was 9.8 seconds (2-68 seconds) by the ultrasound approach and 44.5 seconds (2-1,000 seconds) by ...
Treatment of prolonged ventricular fibrillation. Immediate countershock versus high-dose epinephrine and CPR preceding countershock.
Authors: J TNiemann, C BCairns, JSharma, R JLewis
Journal: Circulation (1992)

BACKGROUNDEarly countershock of ventricular fibrillation has been shown to improve immediate and long-term outcome of cardiac arrest. However, a number of investigations in the laboratory and in the clinical population indicate that immediate countershock of prolonged ventricular fibrillation most commonly is followed by asystole or a nonperfusing spontaneous cardiac rhythm, neither of which rarely respond to current therapy. The use of epinephrine in doses greater than those currently recommended has recently been shown to improve both cerebral and myocardial perfusion during cardiopulmonary resuscitation (CPR). The purpose of this study was to compare cardiac resuscitation outcome between immediate countershock of prolonged ventricular fibrillation with high-dose epinephrine therapy and conventional CPR before countershock of prolonged ventricular fibrillation in a canine model.METHODS AND RESULTSAfter sedation, intubation, induction of anesthesia, and instrumentation, ventricular fibrillation was elect...
Membrane electrical properties of vesicular Na-Ca exchange inhibitors in single atrial myocytes.
Authors: D RBielefeld, R WHadley, P MVassilev, J RHume
Journal: Circulation Research (1986)

Na-loading single frog atrial cells produce changes in membrane currents that are similar to the creep currents originally observed in Na-loaded cardiac Purkinje fibers. Exposure to the Na ionophore, monensin, was used to induce creep currents in isolated atrial cells. The sensitivity of myocardial creep currents to three compounds that have been shown to be inhibitors of Na-Ca exchange flux activity in isolated sarcolemmal vesicles was assessed. Dodecylamine, quinacrine, and the amiloride analog, 3',4'-dichlorobenzamil block creep currents at concentrations well below those required to block Na-dependent Ca uptake in sarcolemmal vesicles. The estimated Ki's for inhibition of myocardial creep currents were 3 microM for dodecylamin, 10 micron for quinacrine, and 4 microM for 3',4'-dichlorobenzamil. The sensitivity of creep currents to these compounds is consistent with the hypothesis that creep currents may represent the electrogenic activity of a Na-Ca exchange carrier. In an additional series of experime...
Regional thallium uptake in irreversible defects. Magnitude of change in thallium activity after reinjection distinguishes viable from nonviable myocardium.
Authors: VDilsizian, N MFreedman, S LBacharach, PPerrone-Filardi, R OBonow
Journal: Circulation (1992)

BACKGROUNDThallium reinjection immediately after stress-redistribution imaging identifies ischemic but viable myocardium in as many as 50% of the regions characterized by conventional redistribution imaging as irreversibly injured. However, we have previously shown that some regions in which irreversible defects persist despite reinjection are metabolically active, and hence viable, by positron emission tomography. In the current study, we determined whether the severity of reduction in thallium activity within irreversible defects on redistribution images and the magnitude of change in regional thallium activity after reinjection can further discriminate viable from nonviable myocardium in such defects.METHODS AND RESULTSWe studied 150 patients with coronary artery disease by exercise thallium tomography using the rest-reinjection protocol. The three sets of images (stress, redistribution, and reinjection) were then analyzed quantitatively. The increase in regional thallium activity from redistribution t...
Epidemiology and prognostic factors of pleural empyema
Authors: Antonio Bobbio, Samir Bouam, Jerome Frenkiel, Kevin Zarca, Ludovic Fournel, Emelyne Canny, Philippe Icard, Raphaël Porcher, Marco Alifano
Journal: Thorax (2021)

Infection of the pleural cavity invariably leads to hospitalisation, and a fatal outcome is not uncommon. Our aim was to study the epidemiology of pleural empyema on a nationwide basis in the whole population and in three subgroups of patients, namely post-lung resection, associated cancer and those with no surgery and no cancer.Data from patients aged ≥18 years hospitalised with a diagnosis of pleural infection in France between January 2013 and December 2017 were retrieved from the medical-administrative national hospitalisation database and retrospectively analysed. Mortality, length of stay and costs were assessed.There were 25 512 hospitalisations for pleural empyema. The annual rate was 7.15 cases per 100 000 habitants in 2013 and increased to 7.75 cases per 100 000 inhabitants in 2017. The mean age of patients was 62.4±15.6 years and 71.7% were men. Post-lung resection, associated cancer and no surgery-no cancer cases accounted for 9.8%, 30.1% and 60.1% of patients, respectively. These groups were significantly different in terms of clinical characteristics, mortality and risk factors for length of stay, costs and mortality. Mortality was 17.1% in the whole population, 29.5% in the associated cancer group, 17.7% in the post-lung resection group and 10.7% in the no surgery-no cancer group. In the whole population, age, presence of fistula, higher Charlson Comorbidity Index (>3), alcohol abuse, arterial hypertension, hyperlipidaemia, atheroma, atrial fibrillation, performance status >3 and three subgroups of pleural empyema independently predicted mortality.Empyema is increasing in incidence. Factors associated with mortality are recent lung resection and associated diagnosis of cancer.
Microtubules and desmin filaments during onset of heart hypertrophy in rat: a double immunoelectron microscope study.
Authors: S CWatkins, J LSamuel, FMarotte, BBertier-Savalle, LRappaport
Journal: Circulation Research (1987)

The distribution of tubulin and desmin, the constituent proteins of microtubules and intermediate filaments, respectively, were studied in normal and hypertrophied rat myocardium by high-resolution immunofluorescence and immunoelectron microscopy. Cardiac hypertrophy was induced in 25-day-old rats by aortic stenosis. In the normal heart, double immunolabelling of ultrathin frozen sections of papillary muscle using gold-labelled probes for tubulin and desmin showed that microtubules ran primarily in a longitudinal direction through the intermyofibrillar spaces, perpendicularly to the desmin filaments. Microtubules were present near nuclei, mitochondria, and plasma membranes, while desmin filaments formed transverse connections between adjacent Z disks. No tubulin was observed near the intercalated disks, which were rich in desmin filaments. In hypertrophied hearts, myocytes exhibited the typical morphological features of developing hypertrophy. While there was little difference in the distribution of the m...
Plasmin-mediated Cleavage of High Molecular Weight Kininogen Contributes to Acetaminophen-Induced Acute Liver Failure
Authors: Michael W. Henderson, Erica M Sparkenbaugh, Shaobin Wang, Anton Ilich, Denis F. Noubouossie, Reiner K. Mailer, Thomas Renné, Matthew J. Flick, James P Luyendyk, Zu-Lin Chen, Sidney Strickland, R. Todd Stravitz, Keith R McCrae, Nigel S Key, Rafal Pawlinski
Journal: Blood (2021)
Positron emission tomography with 11C CGP-12177 to assess beta-adrenergic receptor concentration in idiopathic dilated cardiomyopathy.
Authors: PMerlet, JDelforge, ASyrota, EAngevin, BMazière, CCrouzel, HValette, DLoisance, ACastaigne, J LRandé
Journal: Circulation (1993)

BACKGROUNDPositron emission tomography (PET) with 11C-labeled CGP-12177 (CGP) has been shown to have the potential to noninvasively measure beta-adrenergic receptor concentration in dog heart. The present study was undertaken to evaluate the clinical value of this technique.METHODS AND RESULTSEight normal subjects and 10 patients with heart failure related to an idiopathic cardiomyopathy were studied. Estimation of beta-receptor concentration was based on a graphic method applied on myocardial PET time-concentration curves obtained after an intravenous injection of 11C-CGP followed 30 minutes later by a coinjection of labeled and unlabeled CGP. The clinical tolerance of these injections was good. Left ventricular concentration of beta-receptors was decreased in patients compared with controls (3.12 +/- 0.51 versus 6.60 +/- 1.18 pmol/mL, respectively; p < 0.001). This 53% decrease agrees with previous in vitro data. In eight of the 10 patients, the beta-receptor concentration obtained from PET was compared...
Superoxide dismutase conjugated to polyethylene glycol provides sustained protection against myocardial ischemia/reperfusion injury in canine heart.
Authors: YTamura, L GChi, E MDriscoll, P THoff, B AFreeman, K PGallagher, B RLucchesi
Journal: Circulation Research (1988)

Disagreement regarding the cardioprotective role of superoxide dismutase may relate to the use of different durations for induction of ischemic injury and reperfusion. The present study employed superoxide dismutase conjugated to polyethylene glycol (PEG-SOD), which has a half-life greater than 30 hours. Two protocols differing in the mode of administration and the duration of the reperfusion interval were used. Dogs were subjected to occlusion of the circumflex coronary artery for 90 minutes, then reperfused for 6 hours (Protocol A) or 4 days (Protocol B). The dogs received either polyethylene glycol conjugated to albumin (PEG-ALB) or PEG-SOD (1,000 U/kg). In Protocol A, treatment was administered starting 15 minutes before coronary occlusion and continued for 2 hours, terminating 15 minutes after reperfusion. Infarct size was determined 6 hours later. In Protocol B, the conjugated proteins were given 15 minutes before reperfusion and ended simultaneously with reperfusion. Infarct size was measured after...
Recombinant hirudin for unstable angina pectoris. A multicenter, randomized angiographic trial.
Authors: E JTopol, VFuster, R AHarrington, R MCaliff, N SKleiman, D JKereiakes, MCohen, AChapekis, H KGold, M ATannenbaum
Journal: Circulation (1994)

BACKGROUNDCoronary artery thrombosis plays an important pathophysiological role in unstable angina and non-Q-wave myocardial infarction. To date, heparin and thrombolytic therapy has not provided complete or consistent benefit. We hypothesized that recombinant hirudin, a direct thrombin inhibitor, would prevent accumulation of coronary artery thrombus in a manner superior to heparin.METHODS AND RESULTSPatients with rest ischemic pain, abnormal ECG, and baseline angiogram indicating a > or = 60% stenosis of a culprit coronary artery or saphenous vein graft with visual appearance of thrombus were randomized to one of two different doses of heparin (either a target activated partial thromboplastin time [aPTT] of 65 to 90 or 90 to 110 seconds) or one of four doses of hirudin (0.05, 0.10, 0.20, or 0.30 mg.kg-1.h-1 infusion) in a dose-escalating protocol. After 72 to 120 hours of study drug, a repeat coronary angiogram was obtained, and the paired studies underwent quantitative analysis. The primary end point w...
Liberal or Restrictive Transfusion after Cardiac Surgery.
Authors: Hemant R. Mutneja, Shilpa Arora, Aviral Vij
Journal: New England Journal of Medicine (2015)

To the Editor: In their article on red-cell transfusion, Murphy et al. (March 12 issue) 1 report substantial nonadherence to treatment in both study groups — one of which had a restrictive threshold for hemoglobin level in red-cell transfusions and one of which had a liberal threshold. Although nonadherence (defined as either the failure to transfuse red cells within 24 hours after a patient’s hemoglobin fell below an assigned threshold or the administration of a transfusion when the hemoglobin level was above the assigned threshold) increases the likelihood of a null result for the primary outcome, it might confound the finding of increased 90-day mortality in the restrictive-threshold group, since patients in that group who received transfusions above the restrictive threshold were assumed to be sicker, whereas patients in the group with a liberal threshold were assumed to be healthier (and hence not receiving transfusions below the liberal threshold). Did the authors observe an increase in mortality in association with nonadherence to treatment in the restrictive-threshold group?
Determinants of blood flow to vital organs during cardiopulmonary resuscitation in dogs.
Authors: H RHalperin, J ETsitlik, A DGuerci, E DMellits, H RLevin, A YShi, NChandra, M LWeisfeldt
Journal: Circulation (1986)

Whether blood flow during cardiopulmonary resuscitation (CPR) results from intrathoracic pressure fluctuations or direct cardiac compression remains controversial. From modeling considerations, blood flow due to intrathoracic pressure fluctuations should be insensitive to compression rate over a wide range, but dependent on the applied force and compression duration. If direct compression of the heart plays a major role, however, flow should be dependent on compression rate and force, but above a threshold, insensitive to compression duration. These differences in hemodynamics produced by changes in rate and duration form a basis for determining whether blood flow during CPR results from intrathoracic pressure fluctuations or from direct cardiac compression. Manual CPR was studied in eight anesthetized, 21 to 32 kg dogs after induction of ventricular fibrillation. There was no surgical manipulation of the chest. Myocardial and cerebral blood flows were determined with radioactive microspheres. At nearly c...
Regional Nodal Irradiation in Early-Stage Breast Cancer
Authors: Thomas Mulliez, Liv Veldeman, Wilfried De Neve
Journal: New England Journal of Medicine (2015)

In the European Organization for Research and Treatment of Cancer (EORTC) trial reported by Poortmans et al. (July 23 issue), 1there was no improvement in overall survival at 10 years among patients who underwent internal mammary and medial supraclavicular lymphnode irradiation (regional nodal irradiation), as compared with patients who did not undergo regional nodal radiation (82.3% vs. 80.7%, P = 0.06).Poortmans et al. report that analyses at 15 years and 20 years are planned.Nevertheless, distant disease-free survival was improved among patients who underwent regional nodal irradiation, as compared with patients who did not undergo regional nodal irradiation (78% vs. 75%, P = 0.02).The NCIC Clinical Trials Group MA.20 trial reported by Whelan et al. 2 in the same issue of the Journal showed a similar improvement in distant disease-free survival at 10 years (86.3% in the nodal-irradiation group vs. 82.4% in the control group, P = 0.03).Breast-cancer mortality was lower among patients in the nodal-irradiation group than among patients in the control group in the EORTC trial.The number needed to treat to avoid one death from breast cancer was 39.As stated by Burstein and Morrow in the accompanying editorial, better "treatment selection for the individual patient" is probably needed. 3Because internal mammary irradiation carries a small risk of cardiac toxic effects, it should be offered selectively. 1 We suggest that lymphoscintigraphy can be helpful.Almost all patients with breast cancer who have T1 or T2 tumors (small tumors) and N0 nodes (no clinically detectable regional lymph-node involvement) currently undergo an axillary sentinel-node biopsy.In a review of the literature, presurgery lymphoscintigraphy showed physiologic drainage from a peritumoral injection site to the internal mam-mary basin in approximately 20% of patients. 4Also, an analysis of the published data showed that when internal mammary drainage was present and an axillary sentinel node was found to be positive, the risk of concomitant invasion to the internal mammary nodes was higher than 40% (75 of 183 patients). 5
Hydrogen peroxide and hydroxyl radical mediation of activated leukocyte depression of cardiac sarcoplasmic reticulum. Participation of the cyclooxygenase pathway.
Authors: G TRowe, N HManson, MCaplan, M LHess
Journal: Circulation Research (1983)

Human peripheral blood leukocytes, activated by phorbol myristate acetate, disrupt canine sarcoplasmic reticulum calcium transport, in vitro, by an oxygen-derived free radical mechanism. Activated leukocytes significantly depress Ca++ uptake activity and Ca++ -stimulated, Mg++ -dependent ATPase activity. The depression is completely inhibited by sodium-azide (0.1 mM) or the combination of superoxide dismutase (10 micrograms/ml) and catalase (10 micrograms/ml). Exogenous hydrogen peroxide (0.441-4.41 mM) uncoupled Ca++ uptake activity from ATP hydrolysis, and this effect was inhibited by catalase. Mannitol alone did not inhibit the effects of activated leukocytes, but superoxide plus mannitol (20-100 mM) resulted in normal ATPase activity, while Ca++ uptake remained depressed. In the presence of indomethacin and ibuprofen, activated leukocytes depressed Ca++ uptake and had no effect on ATPase activity. 2-Amino-methyl-4-t-butyl-6-iodophenol (MK-447) further depressed Ca++ uptake and partially inhibited the ...
Partition of carotid sinus baroreceptor response in dogs with chronic renal hypertension.
Authors: EKoushanpour, K JKenfield
Journal: Circulation Research (1981)

This study was designed to determine whether resetting of the carotid sinus baroreceptors in chronic renal hypertension is due to altered distensibility of the wall, or changes in the properties of the receptor elements, or both. Dogs were made hypertensive by 50% constriction of the left renal artery with a Goldblatt clamp and by right nephrectomy one week later. Five to nine weeks after nephrectomy, when mean blood pressure had risen by 35-46 mm Hg, the isolated carotid sinus wall deformation, measured from still photographs, and gross baroreceptor nerve action potentials (N) were recorded in response to step intrasinus pressure forcings (P), ranging from zero to 300 mm Hg, in increments of 25 mm Hg. Measured wall deformation was converted to strain-energy density (SED), a scalar value, as the best indicator of the mechanical state of the sinus wall. Plots of N vs. P data followed an S-shaped pattern, but were shifted toward the P-axis, as compared to controls. Plots of SED vs. P, though linear over mos...
A randomized, blinded, placebo-controlled trial of recombinant human tissue-type plasminogen activator in patients with unstable angina pectoris.
Authors: H KGold, J AJohns, R CLeinbach, TYasuda, EGrossbard, RZusman, DCollen
Journal: Circulation (1987)

Twenty-four patients with unstable angina pectoris, defined as chest pain at rest with transient ST segment deviation of at least 1 mm, were randomly assigned to blinded treatment with either placebo or intravenous recombinant human tissue-type plasminogen activator (rt-PA). Before randomization, all patients were treated with oral beta-blockers, calcium antagonists, nitrates, and continuous intravenous heparin for a monitoring period of 12 to 28 hr. After this monitoring period the 24 patients were randomly assigned to receive either placebo or 1.75 mg/kg intravenous rt-PA given over 12 hr at a rate of 0.75 mg/kg over 1 hr, 0.5 mg/kg over 4 hr, and 0.5 mg/kg over 7 hr. One patient, assigned to receive placebo, developed acute myocardial infarction after randomization but before receiving the study drug. Ischemic events were recorded during a hospital follow-up period of at least 4 days unless a further intervention was indicated or the coronary angiogram was normal. The follow-up period was 7 +/- 5 days ...
Double-blind efficacy and safety study of a novel anti-ischemic agent, ranolazine, versus placebo in patients with chronic stable angina pectoris. Ranolazine Study Group.
Authors: UThadani, MEzekowitz, LFenney, Y KChiang
Journal: Circulation (1994)

BACKGROUNDRanolazine modulates the metabolism of ischemic myocardial cells and improves the efficiency of oxygen use. This study was conducted to evaluate the antianginal and anti-ischemic effects and safety of different doses of ranolazine administered three times daily (tid) compared with placebo in patients with stable angina pectoris.METHODS AND RESULTSPatients with stable angina pectoris took part in the study. Previous antianginal drugs were discontinued under medical supervision. Three hundred nineteen patients received single-blind placebo for up to 18 days, and 318 stopped exercise because of angina of moderate severity, had evidence of myocardial ischemia (> or = 1-mm ST segment depression), and were randomized to one of four study groups in a double-blind manner: ranolazine 30 mg tid (n = 81), ranolazine 60 mg tid (n = 81), ranolazine 120 mg tid (n = 78), and placebo tid (n = 79). After the 4-week double-blind phase, symptom-limited exercise tests were repeated at 1 hour (peak test) and 8 hours...
Modification and Implementation of NCCN Guidelines™ on Hepatobiliary Cancers in the Middle East and North Africa Region
Authors: Muhammed Aasim Yusuf, Vinay Kumar Kapoor, Refaat Refaat Kamel, Ather Kazmi, Najam Uddin, Nehal Masood, Abdulmajeed Al-Abdulkareem
Journal: Journal of the National Comprehensive Cancer Network (2010)

The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) on Hepatobiliary Cancers address hepatocellular cancer, cancer of the gallbladder, extrahepatic cholangiocarcinoma, and intrahepatic cholangiocarcinoma. Hepatocellular cancer incidence is higher in the Middle East and North Africa (MENA) region than in the West, and hepatitis B and C infections are particularly important; the incidence of gallbladder cancer is among the highest in the world. Regional problems include delay in diagnosis, shortage of trained staff, and insufficient liver transplant facilities. Furthermore, costs associated with molecular and targeted therapies are an increasing concern. A committee was formed, consisting of leading specialists and decision-makers from the region, with each member being tasked to suggest modifications to the existing guidelines based on review of the literature and consultations with local colleagues. This committee met as a group, and then continued to discuss and debate the suggested modifications electronically. Several recommendations were finalized after vigorous debate. The final approved recommendations were then presented in April 2009 to the chair of the NCCN Hepatobiliary Cancers Panel for onward transmission and approval. This project represents an effort to modify and implement the NCCN Guidelines on Hepatobiliary Cancers in the MENA region, while taking into consideration local differences in patient and disease characteristics. The hope is that this will form the basis of future local, regional, and international cooperation in guideline development and research.