tbuckley/cabot-search huggingface dataset:
Estimating the population impact of screening strategies for identifying and treating people at high risk of cardiovascular disease: modelling study
Authors: 李君
Journal: BMJ (2010)

Objectives
To estimate the potential population impact of different screening strategies for identifying and treating people at high risk of cardiovascular disease, including strategies using routine data for cardiovascular risk stratification, in light of the UK government's recommended national strategy to screen all adults aged 40-74 for cardiovascular risk.


Design
Modelling study using data from a prospective cohort, EPIC-Norfolk (European Prospective Investigation of Cancer-Norfolk).


Setting
An English county.


Participants
16 970 men and women aged 40-74 and free from cardiovascular disease and diabetes at baseline.


Main outcome measures
The main outcomes were the population attributable fraction, the number needed to screen to prevent one new case of cardiovascular disease, the number needed to treat to prevent one new case of cardiovascular disease, and the number of new cardiovascular events that could be prevented. Relative risk reductions for estimated treatment effects were derived from meta-analyses of clinical trials or guidelines from the National Institute for Health and Clinical Excellence.


Results
1362 cardiovascular events occurred over 183 586 person years of follow-up. Compared with the recommended government strategy, a stepwise screening approach using a simple risk score incorporating routine data could prevent a similar number (lower to upper estimates) of new cardiovascular events annually in the United Kingdom (26 789, 20 778 to 36 239) and 25 134 (19 450 to 34 134), respectively but requiring only 60% of the population to be invited to attend a vascular risk assessment. A similar number of cardiovascular events (25 016, 19 563 to 33 372) could also be prevented by inviting everyone aged 50-74 for a vascular assessment. Using a participant completed Finnish diabetes risk score questionnaire or anthropometric cut-off points for risk prestratification was less effective.


Conclusions
Compared with the UK government's recommended national strategy to screen all adults aged 40-74 for cardiovascular risk, an approach using routine data for cardiovascular risk stratification before inviting people at high risk for a vascular risk assessment may be similarly effective at preventing new cases of cardiovascular disease, with potential cost savings.
Abstract 8928: ST-Segment Elevation in Lead aVR is the Strongest Predictor of Severe Left Main or 3-Vessel Disease in Patients with Non-ST-Segment Elevation Acute Coronary Syndrome
Authors: Masami Kosuge, Toshiaki Ebina, Kiyoshi Hibi, Satoshi Morita, Noriaki Iwahashi, Nobuhiki Maejima, Mitsuaki Endo, Kengo Tsukahara, Kazuaki Uchino, Toshiyuki Ishikawa, Satoshi Umemura, Kazuo Kimura
Journal: Circulation (2010)

In non-ST-segment elevation acute coronary syndrome (NSTE-ACS), early identification of patients who require urgent coronary artery bypass graft surgery (CABG), such as those with severe left main or 3-vessel disease (LM/3VD), is crucial in determining the early use of clopidogrel, which can increase the risk of surgical bleeding.   Methods:  We studied 572 patients with NSTE-ACS who underwent coronary angiography during hospitalization. ST-segment deviations were measured on admission ECG. Troponin T, brain natriuretic peptide (BNP), and high-sensitivity C-reactive protein (hsCRP) were also measured on admission. Severe LM/3VD was defined as ≥75% stenosis of LM and/or 3VD with ≥90% stenosis in ≥2 proximal lesions of the left anterior descending coronary artery and other major epicardial artery. Patients were divided into the 3 groups according to angiographic findings: G-A, no LM/3VD (n=460); G-B, LM/3VD but not severe LM/3VD (n=57); and G-C, severe LM/3VD (n=55).   Results:  Age, sex, and coronary risk factors except for diabetes mellitus were similar among the 3 groups. In G-A, G-B, and G-C, the rates of diabetes mellitus were 30%, 51%, and 55% Killip class ≥2 was 6%, 16%, and 31% positive troponin T was 29%, 49%, and 60% the levels of BNP were 168±281, 337±472, and 398±373 pg/ml; hsCRP was 0.265±0.392, 0.353±0.307, and 0.962±1.130 mg/dl; the degrees of summed ST-segment depression in all leads except aVR were 2.6±3.6, 6.7±5.1, and 10.5±7.3 mm; ST-segment elevation in lead aVR (ST↑aVR) was 0.1±0.3, 0.6±0.5, and 1.3±0.5 mm; the rates of urgent CABG were 2%, 4%, and 60% and death or (re)infarction at 30 days was 3%, 7%, and 13%, respectively (all p   Conclusions:  Our findings suggest that admission ST-segment elevation in lead aVR of ≥1.0 mm strongly predicts severe LM/3VD in patients with NSTE-ACS.
肝炎肝硬化患者血清可溶性肿瘤坏死因子受体I、白细胞介素10、白细胞介素18水平及意义
Authors: 谭永港, 刘俊, 丁世华, 刘新民
Journal: BMJ (2006)

为探讨可溶性肿瘤坏死因子受体(sTNFR)Ⅰ、白细胞介素(IL)-10、IL-18 在肝炎肝硬化发病中的作用.将62例肝炎肝硬化患者按Child-Pugh分级,检测其血清sTNFRⅠ、IL-10、IL-18水平.结果示肝炎肝硬化患者sTNFRⅠ、IL-18水平显著升高,且随Child-Pugh评分升高而上升;IL-10水平变化则相反.sTNFRⅠ水平与凝血酶原活动度(PTA)、白蛋白(ALB)、总胆红素(TBIL)呈负相关;IL-10水平与PTA、ALB呈正相关,与TBIL呈负相关;IL-18水平与TBIL呈正相关,与PTA、ALB呈负相关.提示sTNFRⅠ、IL-10、IL-18与肝损害程度密切相关。
Abstract 1000: Dichotomous Roles Of TNF-{alpha} Receptors p55 And p75 In Acute Ischemia/reperfusion Injury And Late Ischemic Preconditioning
Authors: Michael P Flaherty, Yiru Guo, Xian-Liang Tang, Sumit Tiwari, Greg Hunt, Arash Rezazadeh, Roberto Bolli, Buddhadeb Dawn
Journal: Circulation (2007)

We have previously demonstrated that TNF-alpha signaling is critical for the development of protection afforded by the late phase of ischemic preconditioning (PC). In the current study, we investig...
预防术后静脉血栓栓塞 应当对更多患者进行术后静脉血栓栓塞预防，且疗程可能超过目前的推荐意见
Authors: Alexander, Cohen, 杜斌
Journal: BMJ (2010)

评估住院患者静脉血栓栓塞（VTE）的危险并进行预防，是改进医疗安全、预防并发症、降低病死率以及节约医疗费用的重要方法。Sweetland及其同事所进行的前瞻性队列研究（doi：10．1136／bmj．b4583）为所有外科医生敲响了警钟。该研究对VTE危险相对较低的一组中年女性患者进行观察。入选患者没有VTE或肿瘤病史，住院接受一次手术或住院当天手术。手术种类包括小手术或活检，超过60％的患者接受当天手术。
Cardiovascular Morbidity and Mortality in the Atherosclerosis and Folic Acid Supplementation Trial (ASFAST) in Chronic Renal Failure
Authors: Sophia Zoungas, Barry P. McGrath, Pauline Branley, Peter G. Kerr, Christine Muske, Rory Wolfe, Robert C. Atkins, Kathy Nicholls, Margaret Fraenkel, Brian G. Hutchison, Robert Walker, John J. McNeil
Journal: Journal of the American College of Cardiology (2006)
Abstract 2642: Prevalence and Importance of Cardiac Arrhythmias after Acute Ischemic Stroke
Authors: Jesper K Jensen, James L Januzzi, Dan Atar, Hans Mickley
Journal: Circulation (2008)

Although heart rhythm monitoring following acute ischemic stroke is widely practiced, the prevalence of arrhythmia during the acute phase of ischemic stroke is debated. Several studies have claimed the potential threat of QT prolongation possibly leading to Torsades de Pointes ventricular tachycardia (VT) or ventricular fibrillation (VF). Furthermore, knowledge of the true rate of occult atrial fibrillation (AF) among ischemic stroke patients is sparse. 224 consecutive patients with acute ischemic stroke underwent daily 12-lead ECG during the first 5 days after hospital admission; as well as 24 hour Holter monitoring was performed in all patients. Patients with prior AF, established ischemic heart disease and heart failure were excluded. Patients were followed for 40 months for vital status. The mean age of the patients was 69 years. No patient had VT or VF. Previously unsuspected AF could be demonstrated in only 13 of 224 patients (6%). All 13 were detected by Holter monitoring, while nearly half were missed by ECG. During follow-up 53 (24 %) patients died. The presence of AF was significantly associated with mortality (log-rank p &lt;0.0001; Figure ). In Cox analysis, patients with AF had an increased mortality compared to patients without AF (HR=2.44; [95 % CI, 1.00 – 6.00], P = 0.05) with adjustment for age and stroke severity and renal failure. The fear of serious ventricular arrhythmias in the acute phase of ischemic stroke appears to be groundless. However, new onset AF can be demonstrated in one of 20 patients with acute ischemic stroke and seems to be associated with an increased mortality during long-term follow-up.
High Sensitivity C-Reactive Protein
Authors: Joseph F. Malouf, Ravi Kanagala, Faisal O. Al Atawi, A. Gabriela Rosales, Diane E. Davison, Narayana S. Murali, Teresa S.M. Tsang, Krishnaswamy Chandrasekaran, Naser M. Ammash, Paul A. Friedman, Virend K. Somers
Journal: Journal of the American College of Cardiology (2005)
Abstract 12691: Central Obesity is a Risk Factor for Hypertension Independent of Body Mass Index in Elderly Individuals: Results of a Population-Based Study
Authors: Renato B Mello, Leila B Moreira, M Gus, Mario Wiehe, Flavio D Fuchs, Sandra C Fuchs
Journal: Circulation (2011)

Identification of risk factors for hypertension is demanded in elderly individuals in face of its higher prevalence at this age. The risks of central obesity were scarcely studied in this group, pa...
Abstract 5470: Coronary Plaque Inflammation as a Predictor for Death at Long Term Follow Up
Authors: Martijn Meuwissen, Allard C van der Wal, Steven A Chamuleau, Karel T Koch, Robbert J de Winter, Jose P Henriques, Rene J van der Schaaf, Jan Baan, Marije M Vis, Jan G Tijssen, Jan J Piek
Journal: Circulation (2008)

Objective: To evaluate the association between plaque inflammation and the number and clinical presentation of future coronary sybdromes after directional coronary atherectomy (DCA).  Methods: A total of 124 patients with stable or unstable angina or acute myocardial infarction underwent DCA. Cryostat sections of atherectomy specimen were immunohistochemically stained with the monoclonal antibodies a -actin (smooth muscle cells; SMC), CD-68 (macrophages; MAC), CD-3 (T-cells) and C3/43 (HLA-DR molecules; HLA) for recognition of plaque inflammation. A quantitative measure of plaque inflammation was planimetrically assessed as the percentage immunopositive tissue area of the total tissue area. T-cells were counted and expressed per mm2. Patients were followed for 8 years to document death, acute (AMI, UA) and stable (PCI, CABG) coronary syndromes (CS).  Results: A total of 66 acute and 41 stable CSs occurred in 73 patients. A total of 32 patients died. A best cut off value for MAC for prediction of death, using the receiver operating curve, was determined at 13,7 %. The survival curve below shows a strong prediction for death for patients with > 13,7 % plaque MACs. Furthermore, in 23 patients more than one CS occurred. There was a positive relation between plaque inflammation and the sum of acute CSs (MAC; p=0,0001, T-cells; p=0,0068, HLA; p=0,049).  Conclusion: The extent of initial plaque inflammation is associated with frequent future acute coronary syndromes and a strong predictor for death. These results suggest an ongoing inflammatory process responsible for recurrent plaque destabilization underlying new acute coronary syndromes and death at long term follow up.
Abstract 11836: Deceleration Time of Early Diastolic Velocity of Mitral Annulus by Tissue Doppler Image: A Novel Index of Left Ventricular End-diastolic Pressure
Authors: Kazushi Takemoto, Kumiko Hirata, Takashi Tanimoto, Takashi Kubo, Kouhei Ishibashi, Takashi Yamano, Yasushi Ino, Toshio Imanishi, Takashi Akasaka
Journal: Circulation (2012)

PURPOSE: This study aimed to examine the diagnostic utility of the deceleration time (DT) of early diastolic velocity of mitral annulus by tissue Doppler velocity image, a method for the assessment...
Abstract 9849: Aerobic Exercise Improves Endothelial Dysfunction in Pre-Diabetes Patients
Authors: Sabyasachi Sen, Anne Lagoy, Ashequl Islam, Sarah Witkowski
Journal: Circulation (2011)

Current literature confirms presence of endothelial cell dysfunction in diabetes compared to non-diabetes state. However there is lack of data on endothelial function in Pre-diabetes (defined as per Diabetes Care, Clinical Guideline, Jan'11 ). Methods: We selected exercise-naive patients, 20-70 yrs, BMI 25-34.9, n=20 in each group and studied their endothelial function after 150min/week of aerobic exercise (similar to Diabetes Prevention Program) and after non exercise phase (6wks phase each), in a cross over design with a 4 wk wash-out period between the 2 groups. For endothelial function assessment we looked at, 1. flow mediated dilatation (FMD of brachial artery), 2. CD34/KDR +ve cell count from peripheral blood derived mononuclear cell fraction at day0 by Flow cytometry (FACS) 3. endothelial progenitor cell (EPC) associated colony-forming units (Hill-CFU) at day5 of culture, 4.endothelial bio-inflammatory markers and BP, fasting lipids, insulin, glucose. We also looked at gene expression profile of critical endothelial function genes in CD34/KDR+ve cells. Results: FMD studies (undertaken by 3 observers, blinded to glycemic status) showed, mean FMD in non-exercise group of 5.7+0.6% and post exercise it improved to 11.2±0.9%. Both CFU estimation, at day5 and CD34/KDR +ve cells estimation at day0 showed significant increase in numbers following exercise. There was no weight loss noted between 2 groups, however, there was statistically significant reduction in leptin, IL-6, TNFα, fasting Triglyceride, LDL and ApoB levels. Insulin sensitivity (HOMA) improved in the exercise group. Gene expression analysis of CD34+ve cells showed decrease of eNOS and increase of PECAM-1 in non-exercise which improved significantly following exercise, with no change in von-Willebrand's factor. Summary: Prediabetic patients have significant endothelial dysfunction, similar to patients with diabetes. In this population, FMD measurements and CD34/KDR+ve cell number and gene profile assays along with usual biochemical markers can serve as robust bio-markers for monitoring endothelial cell dysfunction. Conclusion: Pre-diabetic state is associated with significant endothelial dysfunction which can be improved, by undertaking regular aerobic exercise.
The British Society of Gastroenterology
Authors: S R Bloom, M G Bryant, J M Polak
Journal: Gut (1975)

The 36th annual meeting was held in Oxford on 25-27 September under the Presidency of Dr S. C. Truelove.The meeting proper was preceded by a teaching day on 24 September when there were two sessions, one on liver disease (Chairman: Dr J. Badenoch), and the other on gastrointestinal disorders (Chairman: Sir Francis Avery Jones).There were 14 sessions each allocated to a different subject,
THE COLLEGE OF PHYSICIANS OF PHILADELPHIA
Authors: J Lister
Journal: JAMA (1913)

Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue JAMA HomeNew OnlineCurrent IssueFor Authors Publications JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry (1919-1959) Podcasts Clinical Reviews Editors' Summary Medical News Author Interviews More JN Learning / CMESubscribeJobsInstitutions / LibrariansReprints & Permissions Terms of Use | Privacy Policy | Accessibility Statement 2023 American Medical Association. All Rights Reserved Search All JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Forum Archive JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry Input Search Term Sign In Individual Sign In Sign inCreate an Account Access through your institution Sign In Purchase Options: Buy this article Rent this article Subscribe to the JAMA journal
Soundings: Much doth it profit a subtle doc
Authors: Liam Farrell
Journal: BMJ (2003)

My native village of Rostrevor dates to pre-Christian times, and the Farrell clan have been here all along, a savage race as ancient and atavistic as the peat; to us the good old days means hunter-gathering, not poncing about in fake Victorian costumes. The ancestral Farrells used to own all the land, until the Druids stole it from us.

Gaelic football is our passion; my son Jack now wears the same red and black worn by his father and his father's father before him, and I am one of the team mentors. Mentor was Telemachus's adviser during Ulysses's suspiciously protracted return from Troy, and I am sure that if deep browed Homer could have foreseen how Mentor's name would be hijacked by a bunch of overweight balding men running up and down the touchline in unflattering pink lycra, he would have been both charmed and delighted.

The role of team doctor is a broad church. Of course I treat injuries and advise on fitness etc etc, but when the honour of the parish is at stake, the Hippocratic oath becomes but a trifling matter.

Last year we reached the county final, and on the big day I introduced myself beforehand to the referee, assuring him that my medical skills were available to both sides if needed, thus “winning him with honest trifles to betrayals of deeper consequence.” It proved a wise investment.

Rostrevor was two points ahead with only minutes left, when one of our lads went down from an accidental boot to the ear. In emergency medicine every second counts, and I burst on to the field to gasps from the crowd.

Sprinting desperately, I arrived just in time before the brat got up, pushing him back down with one heavy hand while putting on a Robert Jones bandage with the other (this was a cunning and time consuming choice).

Aware of the thin line between safely running down the clock and the referee smelling a rat, I timed it carefully. I tied the last knot with a flourish and seconds later the final whistle blew, the other mentors surged forward and carried me shoulder high on a glorious lap of honour, and we drank the blood of our enemies and exulted in the lamentations of their women.

“Let me have around me men that are fat,” I thought.
Abstract 1150: Diacylglycerol Oil-Rich Diet Induces Lower Glucose-Dependent Insulinotropic Polypeptide and Insulin Responses in Obese Men
Authors: Masumi Ai, Akira Tanaka, Masao Takeshita, Sayaka Hari, Yoshihisa Katsuragi
Journal: Circulation (2009)

Introduction: Obesity is a major risk factor for cardiovascular disease (CVD). Glucose-dependent insulinotropic polypeptide (GIP) directly links overnutrition to obesity. A higher fat to carbohydra...
Abstract 12619: EBP50 is Necessary for Intimal Hyperplasia following Angioplasty: Regulation of EGF Receptor Signaling and p21 Expression
Authors: Gyun Jee Song, Stacey Barrick, Kristen L Balogh, Nathalie M Fiaschi-Taesch, Alessandro Bisello
Journal: Circulation (2010)

Background: The Ezrin Binding Protein 50 (EBP50), a scaffolding protein regulates expression and activity of various membrane receptors. The role of EBP50 in the vasculature is poorly understood. P...
Abstract 16698: Induction of Mesp1 by Brachyury(t) Generates the Common Multipotent Cardiovascular Stem Cell
Authors: Robert David, Veronica Jarsch, Florian Schwarz, Wolfgang-Michael Franz
Journal: Circulation (2011)

Aims: Our recent work demonstrated that common cardiovascular progenitor cells are characterized and induced by the expression of the transcription factor MesP1 in vertebrate embryos and murine embryonic stem cells. As the proliferative potential of stem cell derived cardiomyocytes is limited, it is crucial to understand how MesP1 expression is mediated, in order to achieve reasonable and reliable yields for novel stem cell based therapeutic options. As potential upstream regulators of MesP1 we therefore analysed Eomes and Brachyury(T), which had been controversely discussed to be crucial for cardiovasculogenic lineage formation. Methods and results: Wild-type and transgenic murine embryonic stem cell lines, mRNA-analyses, embryoid body formation, and cell sorting revealed that the MesP1 positive population emerges from the Brachyury(T) positive fraction. In situ hybridizations using wild-type mouse embryos confirmed that Brachyury(T) colocalises with MesP1 in vivo . Likewise, shRNA based loss of Brachyury(T) causes a dramatic decrease of MesP1 expression accompanied by reduced cardiac markers in differentiating embryonic stem cells, which is reflected in vivo via in situs using Brachyury(T) knock-out embryos where MesP1 mRNA is greatly abolished. We finally defined a 3.4 kb proximal MesP1-promoter fragment which is directly bound and activated by Brachyury(T) via a T responsive element as shown via Bandshift, Chromatin Immuneprecipitation and Reporter Assays. Conclusion: Our work contributes to the understanding of the earliest cardiovasculogenic events and may become an important prerequisite for cell therapy, tissue engineering and pharmacological testing in the culture dish using pluripotent stem cell derived as well as directly reprogrammed cardiovascular cell types.
Setting Up a Quality Assurance Program in Endoscopy
Authors: G Naylor, L Gatta, A Butler, S Duffet, M Wilcox, A T Axon, S O'Mahony
Journal: Endoscopy (2003)

Background: Both patients and government demand proof of quality of care and value for money. Our unit ist in a large teaching hospital, performing over 6000 procedures per year. We have designed and implemented a Quality Assurance (QA) program, the basis of which we believe could be a model for endoscopy QA. Methods: A QA team was formed and a literature search undertaken. An initial 3 month audit was then performed into indications for, and complications of, all procedures. The results of this initial audit led us to concentrate on colonoscopy and ERCP. The specific items of data collected were based on the "Core Quality Indicators" developed by the American Society for Gastrointestinal Endoscopy (ASGE). We also analysed data relating to endoscope disinfection, equipment failure and carried out a patient satisfaction survey. The data were presented at 3-monthly QA meeting, and appropriate action taken. Result: We performed a detailed audit of ERCP (217 procedures) and colonoscopy (904 procedures). Patients risk was stratified using the American Society of Anaesthesiology (ASA) classification. Using these data we established our technical success and complication rates for colonoscopy and ERCP. Audit of equipment revealed that on average an endoscope was away for repair 9 % of the time. Contamination of endoscopes was frequent with glutaraldehyde disinfection; the rate of contamination fell dramatically when we changed our disinfection method. Conclusion: A QA program can be implemented in busy endoscopy units. There are significant problems, however, in ensuring that such a programm is effective: these include inadequate funding/staffing, lack of suitable information technology and lack of clear guidelines for dealing with poor performance.
Abstract 3605: Nanoparticle-based Monocyte-Selective Delivery of PPAR{gamma} Agonist Pioglitazone Inhibits Plaque Rupture in ApoE-Deficient Mice
Authors: Tetsuya Matoba, Kensuke Egashira, Jun-ichiro Koga, Kaori Hara, Hiroyuki Tsujimoto, Kenji Sunagawa
Journal: Circulation (2008)

Background: Preventing plaque rupture is the most effective strategy to reduce acute coronary syndrome (ACS). Monocytes/macrophages play a key role in plaque destabilization and rupture leading to ...
Haploidentical Hematopoietic Stem Cell Transplantation With Reduced Intensity Conditioning, T-Cell Replete Grafts and Post-Transplant Cyclophosphamide In Pediatrics
Authors: Valeria Cortez Ginani, Roseane Gouveia, Victor Zecchin, Daniele Porto Barros, Adriane Ibanez, Leticia Alves Ribeiro, Olga Margareth Wanderley Oliveira Felix, Mariane Pereira Diniz, Pharm, Antonio Sergio Petrilli
Journal: Blood (2013)
Long-term assessment of esophageal remodeling in patients with pediatric eosinophilic esophagitis treated with topical corticosteroids
Authors: Jessica Rajan, Robert O. Newbury, Arjun Anilkumar, Ranjan Dohil, David H. Broide, Seema S. Aceves
Journal: Journal of Allergy and Clinical Immunology (2015)