tbuckley/cabot-search huggingface dataset:
Abstract 13759: Testosterone in Hypertensive Patients: A Secret Player?
Authors: Nikolaos Ioakeimids, Charalambos Vlachopoulos, Dimitris Terentes-Printzios, Euaggelia Christoforatou, Alexandros Synodinos, Alexis Samentzas, Athanasios Aggelis, Ioanna Dima, Konstantinos Aznaouridis, Christodoulos Stefanadis
Journal: Circulation (2011)

Objective:  Impaired left ventricular diastolic (LVD) relaxation, reduced exercise capacity and increased aortic stiffness identify hypertensive patients at increased CV risk. Low testosterone concentration has been associated with increased risk for CV events, however, the influence of androgen deficiency on LVD function, exercise workload and aortic stiffness in patients with essential hypertension (HTN) is unknown.   Methods:  82 non diabetic hypertensive men (56±8 y/o, BMI 2 ) and 75 age-matched subjects with normal blood pressure (BP) underwent exercise treadmill testing. Peak exercise capacity was measured in metabolic equivalents, (METS). Diastolic Doppler parameters were used to assess LVD function. Aortic stiffness was evaluated with carotid femoral pulse wave velocity (PWVc-f). Total testosterone (TT) levels were measured in all participants. Hypogonadism (HypG) was defined when TT levels were below 3.4 ng/ml.   Results:  Compared to normotensive subjects, patients with HTN had decreased TT (3.9 vs 4.6 ng/ml) and a higher prevalence of HypG (34 vs 16%), (all P   Conclusion:  Androgen deficiency confers an incremental unfavourable impact on maximal workload, LV early diastolic relaxation and aortic stiffness in men with HTN. Our data allow identification of hypertensive patients without overt CV disease who might warrant more intensive follow-up.
Abstract 17723: The Effect of Trans-Catheter Aortic Valve Replacement on Left Ventricular Systolic and Diastolic Function Measured by Speckle Tracking Echocardiography
Authors: Taisei Kobayashi, Howard C Herrmann, Nimesh D Desai, Joseph E Bavaria, Martin G Keane
Journal: Circulation (2012)

Background: Symptomatic aortic stenosis is associated with a high rate of death in untreated patients. In the PARTNER trial, patients randomized to transcatheter aortic valve replacement (TAVR) had a survival benefit as compared to “standard care”. Speckle tracking echocardiography (STE) is a novel quantitative method for assessing global left ventricular function which is more sensitive to subtle changes over time. The aim of this study was to compare LV function before and after TAVR using STE. Methods: Patients (n=166) undergoing randomization for TAVR from 11/15/2007 until 1/1/2011 were included in our study. Pre and post-procedure echoes between 6 -12months and beyond 12 months after TAVR were evaluated. Speckle tracking was performed using Tomtec software. Paired T-tests were used to compare average strain rates at differing points in time. The degree of para-valvular leak, transfemoral vs. transapical approach and age were separately weighted in analysis. Results: 357 transthoracic echoes were anal...
Abstract 19097: Enhanced Beta-Adrenergic Signaling Reverses Atrophic Gene Regulation in the Unloaded Heart
Authors: Henriette L Brinks, Isabel Breyer, Thierry P Carrel, Joseph Rabinowitz, Walter J Koch, Hendrik T Tevaearai, Marie-Noelle Giraud
Journal: Circulation (2010)

Objective:  Mechanical unloading via a left ventricular assist device (LVAD) results in beneficial reversal of hypertrophy and reinstated adrenergic response as well as detrimental progressive atrophy and currently efforts are made towards limitation of this atrophy to promote ventricular recovery using beta-adrenergic agonist. We have previously shown that the βARKct peptide inhibits desensitizing of β-adrenergic receptor signaling to enhance regenerative capacity in failing hearts via virus-mediated gene therapy. Treatment of unloaded hearts with βARKct adeno-associated virus-6 (AAV6) was assessed using a gene array to identify potential beneficial and anti-atrophic effects.   Methods:  Non-failing rat hearts were heterotopically transplanted, treated with different doses of AAV6-βARKct (10 11  and 6x10 11  total viral particles) and harvested after 3 and 30 days of unloading (n=6/group). Total mRNA was purified and an array of 47 genes was analyzed using microfluid cards.   Results:  Several genes involved in myocyte calcium cycling (Ryanodine Receptor-2, SERCA2a, Phospholamban), cardiac metabolism (Glycogen-Synthase, Glycerol-3-phosphate-dehydrogenase) and cellular integrity (Troponin-C, -T and -I) were significantly downregulated in unloaded hearts, but significantly recovered towards control levels in the βARKct-treated groups showing a dose dependent effect. Matrix remodeling reflected by Fibroblast Growth Factor-2 was upregulated 4-fold (±1.5) at 3 days in controls, but showed normalization after βARKct gene therapy in unloaded hearts. Expression of fetal genes (MHC-β, MHC-α) remained switched. Caspase-9 reflecting induced apoptosis was briefly induced after 3 days, but normalized thereafter independent of treatment.   Conclusion:  Recent clinical studies have associated treatment with a beta-adrenergic agonist with enhanced rate of recovery through improved ventricular function. Our results suggest that unloading-induced atrophy may be limited by enhanced β-adrenergic signalling and introduce bARKct gene therapy as a promising tool for LVAD therapy towards myocardial recovery.
Reaction of nonsmokers to carbon monoxide inhalation. Cardiopulmonary responses at rest and during exercise
Authors: R. B. Chevalier
Journal: JAMA (1966)

Exposure of 10 volunteers to 0.5% CO for 2.5 to 3.5 min resulted in COHb levels similar to that of heavy smokers: 3.95 +- 1.87% (SD) as calculated from alveolar air analyses. This resulted in a less efficient exercise (greater O/sub 2/ debt for equal work) as well as some barely significant changes, including reduced inspiratory capacity, total lung capacity, and resting pulmonary diffusing capacity and increased maximum breathing capacity. Same changes were seen in smokers as compared with nonsmokers.
Abstract 1796: A Clinical Prediction Rule for Early Emergency Department Discharge of Lower Risk Patients with Chest Pain
Authors: Vlad Cotarlan, David Ho, John Pineda, Pavlo I Netrebko, Timothy McConnell, Anwer Qureshi, Jamshid Shirani
Journal: Circulation (2007)

Background. Emergency Department (ED) evaluation of patients with acute chest pain and non-diagnostic electrocardiography (ECG) remains a frequent and difficult problem. Stress testing is generally requested and may lead to costly, unnecessary and prolonged ED stay. We aimed to identify clinical characteristics that allow early discharge with outpatient evaluation of such patients. Methods. Between 02/2006 and 02/2007, 459 adults [age 56±13 years, 228 (50%) men] who presented to ED with chest pain and had no ischemic ECG changes and 2 negative cardiac enzymes measurements on arrival and 6 hours later, underwent stress echocardiography (n=396) or coronary computed tomographic angiography (n=63) prior to discharge. Results. Non-invasive evaluation for coronary artery disease (CAD) was negative in 367 (80%), indeterminate in 30 (7%) and positive in 62 (13%) [Table ]. Univariate predictors for a normal stress test were lower Framingham risk score, lower age, normal ECG (no ischemic changes), atypical chest pain and the absence of diabetes, hypertension, high cholesterol and previous CAD. Multivariate logistic regression identified normal ECG (RR=2.3, p=0.002), atypical chest pain (RR=3.0, p=0.001), no diabetes (RR=2.5, p=0.001) or absence of previous CAD (RR=2.8, p&lt;0.001) as strong independent predictors for a negative non-invasive test. The same four variables were strong independent predictors of ED discharge. Of 459 patients, 186 (41%) had none of the four independent predictors. None of those had positive non-invasive test or obstructive CAD on angiogram (n=1). Conclusion. A substantial portion (2/5) of patients seen in ED for chest pain evaluation can be safely discharged after 2 sets of negative cardiac enzymes (~6 hours) if they have a normal ECG, atypical chest pain, no diabetes or previous CAD. These patients can be evaluated for CAD as an outpatient. This strategy may significantly decrease length of stay, ED clutter and cost of in-patient evaluation.
Abstract P175: Chest Compression Depth/Force Needed for Excellent Aortic Pressures During Real In-Hospital Pediatric Cardiac Arrest
Authors: Robert M Sutton, Matthew R Maltese, Dana Niles, Akira Nishisaki, Kristy Arbogast, Aaron Donoghue, Mark A Helfaer, Robert A Berg, Vinay Nadkarni
Journal: Circulation (2009)

Introduction: Pediatric chest compression (CC) depth guideline recommendations were developed by expert clinical consensus. Little clinical data exists relating target hemodynamic outcomes (systoli...
Abstract 2718: Cognitive Function is Poorer in Heart Failure
Authors: Susan J Pressler, Usha Subramanian, David Kareken, Susan M Perkins, Irmina Gradus-Pizlo, Mary Jane Sauve, Rebecca Sloan, JinShil Kim, Yan Ding, Heather Jaynes
Journal: Circulation (2008)

Background: Heart failure (HF) patients have been found to have cognitive deficits but studies have been limited by small samples and lack of comparison groups. Objective: To determine the types, frequency, and severity of cognitive deficits among patients (pts) with chronic HF compared to age- and education-matched healthy (HC) participants and participants with major medical conditions but not HF (MC). Methods: In this comparative study, face-to-face interviews were completed by 414 participants (249 HF pts, 63 HC, 102 MC) to assess function in cognitive domains of language, working memory, memory (verbal learning total and delayed recall), psychomotor speed, and executive function. Characteristics of HF pts were: mean age 62.9 yrs; 63% men; mean education 12.9 yrs; mean LVEF 28%; NYHA I-15%; II-34%; III-39%; IV-12%). HC and MC groups were matched on education and premorbid intellect, but HC were younger than HF and MC groups. Comparisons among the 3 groups were made using ANCOVA adjusting for intellect, age, and education. Family members of all participants were interviewed separately to validate cognitive deficits. Results: No differences were found among HF, HC and MC participants in language or working memory. In verbal learning total recall, HF pts had poorer scores than HC and MC participants (p&lt;.0001). In delayed recall, HF pts had poorer scores than MC participants (p=.0152). In psychomotor speed, HF pts had poorer scores than HC and MC participants (p&lt;.0001) on 1 test and poorer scores than MC (p=.0177) on the 2 nd . In executive function (verbal fluency and mental flexibility), HF pts had poorer scores than MC participants (p = .0022; p = .0428). Family member reported more difficulty in memory among HF pts (p&lt; .0001) than HC ((p&lt; .0001) and more negative behavior changes than HC (p=.0025) and MC participants (p=.0291). Conclusions: This carefully characterized sample of HF pts had poorer cognitive function than HC and MC participants. Domains most affected were memory, psychomotor speed processing, and executive function. Studies are needed to 1) evaluate the trajectory of cognitive function across the trajectory of HF; and 2) test novel interventions to improve cognitive function in HF.
Abstract 14180: The Histone Methyltransferase Smyd1 Regulates Cardiac Hypertrophy In Adult Myocardium
Authors: Sarah Franklin, Tara L Rasmussen, Todd Kimball, Tammy Tran, Manuel Rosa-Garrido, Haodong Chen, Ricardo Gray, Shanxi Jiang, W. R MacLellan, Shuxun Ren, Yibin Wang, Haley Tucker, Thomas M Vondriska
Journal: Circulation (2013)

Transcriptionally active and inactive chromatin is associated with structurally loosely or densely packed DNA, respectively, a dichotomy correlated with specific post-translational modifications on...
Meningococcal disease in a backpackers’ hostel in Scotland: a risk assessment for prophylaxis
Authors: L C Davis, K A Smith, L J Willocks
Journal: Eurosurveillance (2009)

This paper outlines the risk assessment and communication strategy carried out by the Lothian Health Protection Team after notification of a probable case of meningococcal disease (later confirmed as Neisseria meningitidis) in a resident of a city centre backpackers hostel. Six close contacts were identified from the hostel and given rifampicin prophylaxis. Two days after commencing rifampicin one of these contacts was admitted to hospital with a purpuric/petechial rash and thrombocytopenia. The final diagnosis for this contact was thrombocytopenia, either idiopathic or secondary to rifampicin. This example and the potential side effects of administering rifampicin prophylaxis highlight the importance of a thorough risk assessment of contacts of a case to avoid prescribing prophylaxis to anyone other than those at highest risk of becoming a subsequent case.
肩痛-发热-腰痛
Authors: 李爽, 黄晓明
Journal: BMJ (2011)

男性,56岁,因左肩痛、活动受限半个月于加10年4月中旬首次就诊于某基层医院.半个月前患者无明显诱因出现左肩部疼痛,疼痛无放射,伴左肩向各方向活动受限,不伴手部感觉异常,未特殊治疗. 肩痛是基层医院临床常见症状之一,对主诉肩痛的患者,可能病因按病变部位分为肩关节本身病变、肩关节附近病变、其他部位病变的肩关节牵涉痛。
Abstract 519: Pathogenic Mechanisms of Il-17 In Atherogenesis - In Vivo and In Vitro Studies
Authors: Christian Erbel, Lili Chen, Sultan Celik, Nadine Wambsganss, Felix Lasitschka, Dietmar Boeckler, Hugo A Katus, Thomas J Dengler
Journal: Circulation (2008)

Atherosclerotic plaque typically contains infiltrates of activated macrophages and T cells. In human carotid artery plaques, we previously showed the presence of IL-17 producing T cells (Th17) and IL-23. This study investigated possible pathogenic mechanisms of IL-17 on atherogenesis in ApoE −/− mice and its effects on vascular cells in vitro. 25 female ApoE −/− mice fed a normal diet were treated with a specific blocking antibody against IL-17 for 12 weeks (100 μg intraperitoneally once per week) compared to unteated mice (reveiving a control IgG). In vitro endothelial cells and RAW cells were either treated with IL-17 1000ng/ml alone as well as in addition to TNF-α or LPS. SMCs were incubated with IL-17 or additional IFN-γ to induce apoptosis. IL-17 mAb treatment resulted in a &gt; 60% reduction of plaque volume and fractional luminal stenosis in the aortic root. IL-17 mAb treated mice showed higher percentage of collagen content in the lesion, especially in the area of the fibrous cap. In addition, the amount of SMCs was also significantly higher in the area of the fibrous cap in IL-17 mAb treated mice. RT-PCR results showed signifcantly reduced caspase 3 expression in IL-17 mAb treated mice. The possible stabilizing effects in IL-17 mAb treated mice was in line with findings that IL-17 was found to induce apoptosis in SMCs in vitro. In vitro studies further showed that IL-17 itself induced pro-inflammatory changes in macrophages as well as endothelial cells and also acted synergistically with TNF-α or LPS. Functional blockade of Th1 cytokine IL-17 reduces atherosclerotic plaque, stabilizes the atherosclerotic lesion by higher amount of SMC and collagen content in the area of the fibrous cap as well as reduced apoptosis in the lesion. Inflammatory changes in ECs, Ms and SMCs leading to cell death and increased immune cell infiltration may represent possible pathogenic mechanisms of IL-17 in atherogenesis.
Abstract 138: Disadvantageous Effects of Carvedilol on Mortality and Inflammatory Responses to Endotoxin-Induced Shock in Rats
Authors: Koji Sato, Takumi Taniguchi, Akihide Kurita, Ken Yamamoto
Journal: Circulation (2011)

Background  Recent studies showed that beta-blocker suppressed the LPS-induced cytokine and tissue factor in vitro and attenuated myocardial dysfunction in septic animals. However, our previous report showed that 10mg/kg/day Carvedilol increased mortality rate and did not inhibit inflammatory responses in endotoxic rats. The purpose of this study is to evaluate the dose-effects of Carvedilol on mortality and inflammatory responses to endotoxin-induced shock in rats.   Methods  Fifty-three male Sprague Dawley rats were randomly assigned to one of the following four groups, control group (n=12): no medication, high-dose treatment group (H group) (n=12): Oral administration of Carvedilol (10mg/kg/day ) for 5 days, medium-dose treatment group(M group)(n=15):Carvediolol (5mg/kg/day) for 5 days, low-dose treatment group(L group)(n=14):Carvedilol (2mg/kg/day) for 5 days. All animals were anesthetized with intraperitoneal pentobarbital. Endotoxic shock was induced by 15 mg of endotoxin injection. There were no therapies before, during or after endotoxin injection. Hemodynamics and arterial blood gases were evaluated, and mortality rate were assessed for the 8-hr observation period. Plasma cytokine concentrations were measured at baseline, 2, 4 and 5-hr after endotoxin injection.   Results  The mortality rates at 8-hrs after endotoxin injection was 17%, 71%, 73% and 75% for control, L, M, H group, respectively. The mortality rates in the all treatment groups were significantly higher than that in the control group (P   Conclusion  This study indicates that any doses of Carvedilol have disadvantage effects on mortality and inflammatory responses to endotoxin-induced shock in rats.
Validity of utilization management criteria for psychiatry
Authors: Ronald L. Goldman, Charlene Raye Weir, Charles W. Turner, Charles B. Smith
Journal: American Journal of Psychiatry (1997)

This study examined the validity of four psychiatric utilization management criteria sets: the 1992 and 1993 InterQual Intensity, Severity, and Discharge (ISD) criteria, the Managed Care Appropriateness Protocol, and an instrument developed by the Department of Veterans Affairs (VA).The appropriateness of acute care admission and continued stay for 70 randomly selected VA psychiatric inpatients was retrospectively assessed with each criteria set. The sensitivity and specificity of each instrument were evaluated by comparing its assessments to the consensus of judgments of a panel of expert psychiatrists who reviewed the same cases. Sensitivity was defined as the proportion of admissions or continued-stay days the panel found appropriate for acute care that the criteria judged to be appropriate for acute care; specificity was the proportion the panel found inappropriate for acute care that the criteria judged to be inappropriate for acute care.For admissions, there were only minor differences in the validity of the four criteria sets as assessed by agreement with the panel's judgments. For each of 4 continued-stay days studied, either the sensitivity or specificity of the 1993 InterQual ISD criteria was below 0.30. The specificity of the 1992 InterQual ISD criteria was below 0.60 for 2 days. In contrast, for the Managed Care Appropriateness Protocol, sensitivity was 0.73-0.93 and specificity was 0.78-0.88 over the 4 days.The findings raise major concerns about the validity of the widely used InterQual ISD psychiatry criteria, suggest that the Managed Care Appropriateness Protocol may be a useful tool for psychiatric utilization management, strongly underline the need to validate all criteria used to assess medical care, and support the appropriateness of the procedures used to perform these assessments.
Abstract 3542: Role of Mitochondrial Oxidative Stress in Angiotensin II Mediated Hypertension
Authors: Anna E Dikalova, Alfiya T Bikineyeva, David G Harrison, Sergey I Dikalov
Journal: Circulation (2008)

Oxidative stress is strongly implicated in the pathogenesis of hypertension; however, the role of mitochondrial oxidative stress is not clear. We have investigated the role of mitochondria in endothelial dysfunction and hypetention using cultured bovine endothelial cells (BAECs) and mice infused with angiotensin II (AngII). Production of O 2 •− was measured by dihydroethidium and HPLC. Nitric oxide and H 2 O 2 were detected by ESR. Sytolic blood presure was measured in mice infused with saline, AngII (0.7mg/kg/day), AngII plus mitochondria targeted antioxidant mitoTEMPO or non-targeted antioxidant TEMPOL (50 μg/kg/day). AngII significantly increased mitochondrial H 2 O 2 . MitoTEMPO blocked AngII-induced oxidative stress and restored NO • production in BAECs and mouse aorta. Supplementation of BAECs with malonate, inhibitor of complex II, or rotenone abolished AngII induced oxidative stress. Interestingly, inhibition of mitochondrial oxidative stress decreased the activity of NADPH oxidases. Co-infusion of mitoTEMPO with AngII significantly attenuated the increase in the blood pressure by 30-mm Hg (Fig. 1 ), while i.p. injection to hypertensive mice decreased the blood presure by 20-mm Hg. We suggest that mitoTEMPO can be used as an effective inhibitor of the oxidative stress induced by Ang II as well as an antihypertensive agent and, thereby, can be effective in ameliorating hypertension-related nephrosclerosis, diabetic nephropathy, or atherosclerosis. Figure 1. (A) Attenuation of hypertensive effect of Ang II in C57Blk/6 mice by co-infusion of mitoTEMPO. (B) Dose dependent effect of mitoTEMPO (50, 150 and 500 μg/kg/day) after 14-days of Ang II and drug administration. This research has received full or partial funding support from the American Heart Association, AHA National Center.
Abstract 15166: Early Revascularization Improves Mortality in Elderly Patients with Acute Myocardial Infarction Complicated by Cardiogenic Shock
Authors: Paul A Rogers, Henry Huang, Mahboob Alam, David Paniagua, Biswajit Kar, Hani Jneid
Journal: Circulation (2011)

Background: Compared to a strategy of initial medical stabilization (IMS), early revascularization (ERV) improves mortality in patients with acute myocardial infarction (AMI) complicated by cardiog...
Abstract 6119: Ultrasound 2D Speckle Tracking Differentiates Stunned from Scarred Myocardium after Acute MI
Authors: Susanna Prat-Gonzalez, Gonzalo Pizarro, Babu A. Benson, Borja Ibanez, Giovanni Cimmino, Chiara Giannarelli, Valentin Fuster, Juan Badimon, Javier Sanz, Mario J. Garcia
Journal: Circulation (2008)

Background: The aim of this study was to evaluate 2D Speckle Tracking radial strain by ultrasound in stunned and scarred myocardium as defined by cardiac magnetic resonance (CMR) in a porcine reperfusion model of acute MI. Methods: Seven pigs underwent MI induction by 90′ mid-LAD balloon occlusion. CMR was performed in a 1.5 T magnet 4 days post-MI. For edema imaging a T2-weighted sequence was employed. Delayed enhancement (DE) images were acquired 10–15 minutes after the administration of 0.2 mmol/kg of Gd-DTPA using an inversion recovery gradient-echo sequence. Before CMR, echocardiographic short axis images of the LV were obtained at the basal, mid and apical levels. Echo and CMR images were matched and divided into 6 segments per slice. DE and edema were defined as those regions with signal intensity &gt;3 SD of the mean signal of remote normal myocardium, and quantified as % of the LV. Stunned myocardium was defined as edema- DE. Radial strain was compared in segments containing predominantly normal myocardium (&lt;10% edema; n=70), stunned myocardium [&gt;25% (edema - DE); n=12] or predominantly scar (&gt;75 % DE; n=19). Results: A total of 126 segments were analyzed. Radial strain was negatively correlated with the amount of edema (r=−0.41) and scar (r=−0.39, p&lt;0.0001 for both). Radial strain was significantly lower in necrotic than in normal segments (p&lt;0.001). Stunned segments showed intermediate degrees of myocardial deformation. (Figure ) Conclusions: Our study suggests that 2D Speckle Tracking radial strain can be a simple tool to differentiate stunned from scarred segments. This could be particularly useful in unstable patients after acute MI.