tbuckley/cabot-search huggingface dataset:
Abstract 19504: Three Common Mental Status Scoring Systems are Predictive of Adverse Events in the Inpatient Setting
Authors: Brian J Robertson-Dick, Linda Tien, Matthew M Churpek, Trevor C Yuen, Dana P Edelson
Journal: Circulation (2012)

Introduction: Altered mental status has been shown to be one of the most accurate predictors of adverse events in hospitalized patients. Many early warning scores utilize the Alert-Verbal-Painful-Unresponsive (AVPU) scale to characterize mental status. The Glasgow Coma Scale (GCS) and Richmond Agitation-Sedation Scale (RASS) have both been validated in critically ill and trauma patients but are not well-characterized in the general inpatient ward population. We sought to compare GCS, RASS, and AVPU in their association with adverse outcomes in hospitalized ward patients. Methods: The nursing staff at the University of Chicago Medical Center began documenting GCS and RASS on adult ward patients once per 12-hour shift in August 2011. We conducted an electronic chart review of these hospitalizations up through February 2012. AVPU was abstracted from the eye subscale of the GCS. The primary outcome was the composite of ICU transfer, cardiac arrest, or mortality within 24 hours of an observation. Predictive accuracy was calculated and compared using the area under the receiver operating characteristic curve (AUROC). Results: A total of 107,944 paired observations were made in 11,383 patients, of which 757 experienced at least one adverse outcome. The raw data are shown in the figure. GCS, RASS and AVPU were highly correlated with each other (Spearman’s rho of 0.57 for GCS vs. AVPU, 0.26 for RASS vs. AVPU and 0.12 for GCS vs. RASS, p&lt;0.001 for all three pair-wise comparisons). The AUROCs for AVPU, GCS, and RASS were 0.55 (95% CI: 0.54-0.56), 0.59 (95% CI: 0.58-0.60), and 0.60 (95% CI: 0.59-0.61), respectively. Simultaneous use of RASS and GCS produced an AUROC of 0.61 (95% CI: 0.60-0.63). Conclusions: GCS and RASS are both significantly better predictors of adverse events on the wards than the more commonly used AVPU scale, and may be worth collecting routinely in hospitalized ward patients. In addition, the combination of GCS and RASS may be more predictive than either alone.
Buttock granulomas: a consequence of intramuscular injection of Sandostatin detected by In-111 octreoscan.
Authors: DAVID RIDEOUT, MICHAEL GRAHAM
Journal: Clinical Nuclear Medicine (2001)

From the University of Iowa College of Medicine* and the Department of Radiology,† University of Iowa Hospitals and Clinics, Iowa City, Iowa Received for publication August 8, 2000. Accepted November 17, 2000. Reprint requests: Michael M. Graham, University of Iowa Hospitals and Clinics, Room 3563 JPP, Department of Radiology, 200 Hawkins Drive, Iowa City, Iowa, 52242. E-mail: [email protected]
Clinical and Angiographic Outcomes After Treatment of De Novo Coronary Stenoses With a Novel Platinum Chromium Thin-Strut Stent
Authors: Dean J. Kereiakes, Louis A. Cannon, Robert L. Feldman, Jeffrey J. Popma, Raymond Magorien, Robert Whitbourn, Ira M. Dauber, Abram C. Rabinowitz, Michael W. Ball, Barry Bertolet, Ameer Kabour, Michael C. Foster, John C. Wang, Paul Underwood, Keith D. Dawkins
Journal: Journal of the American College of Cardiology (2010)
Making Practical Markets for Vaccines
Authors: Donald W Light
Journal: PLoS Medicine (2005)

potential in poor nations to transform themselves. The AMC, which is not like a market in most ways, becomes a longterm contract best aimed at late-stage and existing vaccines, not at research for nonexistent vaccines. An advanced commitment is a slower, less effi cient way to incentivize research to discover an effective new vaccine than direct research support. As a complement to public and charitable funding of research and development, an advanced commitment can buy many more million doses, to save millions more lives, at a much lower price because the risk and cost of research and development are being borne by the funders. While advanced commitments are a good idea for overcoming long delays due to patent enforcements, what leaders need is a different kind of report on how to make a big splash and a real difference with between US$1 billion and $5 billion, a report that outlines how advanced commitments can be most effective in saving lives and how the key issues in the manufacturing, organization, and delivery of vaccines in poor regions can be addressed. I will fi rst identify the problems in what could be called the “core draft” of the CGD model by Michael Kremer, who holds the Gates professorship at Harvard, and then comment briefl y on how the fi nal report to leaders fudges and qualifi es Kremer’s model with addons to please all readers, so that what is being proposed becomes less coherent and more diffi cult to pin down.
Abstract 16149: Central Systolic Blood Pressure Estimated by an Osillometric Method or From an Invasive Brachial Pressure Waveform: A Direct Comparison
Authors: Shih-Hsien Sung, Hao-Min Cheng, Kang-Ling Wang, Chen-Huan Chen
Journal: Circulation (2011)

OBJECTIVES: The accuracy of noninvasively estimated central systolic blood pressure (SBP) remains controversial. The present study investigated the accuracy of a new oscillometric method by direct ...
Managing acute appendicitis
Authors: J. Howie
Journal: BMJ (2003)

Editor—Like many others will have been, I was astonished at the assertion in Benjamin and Patel's leader that mortality from negative appendicectomy (1.5%) exceeded that of appendicectomy for acute appendicitis (0.2%).1 It is clear from reading their source document, that this is a seriously misleading statistic, the figure of 1.5% representing the mortality of comorbidity rather than that of the appendicectomy itself.2

In a study of all 805 deaths from appendicitis or appendicectomy in Scotland (population 5 million) over 10 years to 1963, mortality from appendicectomy for appendicitis was 0.62%, and that from negative appendicectomy was 0.06%. Seventy one of the 605 patients (11.7%) for whom clinical records could be studied had previously been treated non-operatively for suspected appendicitis, and 55 of them died from gangrenous or perforated appendicitis.3 For patients aged 12-29, in whom diagnostic difficulty is greatest, mortality from appendicectomy for appendicitis and for negative appendicectomy was 0.16% and 0.02%; the death rate from missed appendicitis—difficult to calculate exactly—was at least 0.04%.

Attempting to project these results to the then competing management strategies I described as conservative (operating on around 60% of patients admitted with possible appendicitis) and radical (operating on 80% of such admissions) for patients in the age group 12-29,4 I estimated that avoidable mortality (death from missed appendicitis plus that from negative appendicectomy) from the two approaches was virtually identical at 1.13 and 1.07 patients per 10 000 admissions—figures which then represented 0.6 avoidable deaths per year in Scotland. It is hard to believe that all the advances described by Benjamin and Patel since then can have done all that much to improve these statistics.

Two other observations are relevant.

Firstly, appendicectomy but not appendicitis runs in families.

Secondly, conservative surgeons become radical surgeons when dealing with medical and nursing colleagues and their families when they present with possible appendicitis. In this field at least, surgery—like general practice—combines the skills of a behavioural with those of a biomedical science.

Jones ends his review of the contemporary management of suspected acute appendicitis by saying that we can be sure that emphasis on technology at the expense of clinical evaluation will diminish, rather than improve, the quality of care for patients with acute abdominal pain—a truth that surely has much wider applications.5
Abstract 3255: Left ventricular stroke volume reduction after Surgical Ventricular Restoration: a diastolic dysfunction?
Authors: Marisa Di Donato, Fabio Fantini, Serenella Castelvecchio, Claudio Bussadori, Francesca Giacomazzi, Lorenzo Menicanti
Journal: Circulation (2007)

Background. Experimental studies and theoretical considerations suggest that reduction of left ventricle (LV) stroke volume (SV) following Surgical Ventricular Restoration (SVR) is a consequence of diastolic dysfunction. Aim. To analyze changes in SV following SVR and assess if SV reduction is related to diastolic dysfunction. Patients. 134 consecutive patients submitted to SVR for symptoms of HF and/or angina. Patients with mitral regurgitation were excluded. Results. SV improved in 43 patients (54 ± 13 to 60 ± 15 ml; p 0.0001)-G1- and decreased in 91 patients (69 ± 19 to 48 ± 13 ml, p 0.0001)-G2-. The greater EDV reduction, the greater SV reduction (r = 0.609) and the greater EF improvement (r = 0.402)(Graph). Preoperatively, EF and SV were lower in G1 (31 ± 8 vs 35 ± 8%, p 0.002 and 54 ± 13 vs 69 ± 19 ml, respectively); no differences in LV volumes and Diastolic Filling Pattern (DP). Post surgery G2 shows smaller EDV and ESV and lower SV. DP significantly increased in G1 (from 1.42 ± 0.8 to 1.7 ± 0.7, p 0.01) and was higher than in G2, after surgery (p 0.008). NYHA class at FUP improved (2.4 ± 0.6 to 1.6 ± 0.6 in G1 and 2.4 ± 0.7 to 1.7 ± 0.6 in G2, p 0.001) Post-operative data Conclusions. Post-SVR stroke volume reduction is not related to diastolic dysfunction; paradoxically, diastolic function is more impaired in patients with SV improvement and larger residual volumes.
Serial 3 Tesla Magnetic Resonance Imaging Identifies Changes in Carotid Plaque Morphology Following Acute Cerebrovascular Events
Authors: A C Lindsay, I Kylintireas, J M Lee, B J MacIintosh, C Cunnington, W Kuker, A Handa, P Jezzard, Robson, S Neubauer, J Kennedy, R P Choudhury
Journal: Circulation (2009)
Abstract 14277: Catheter Ablation of Atrial Fibrillation Without Dabigratan Discontinuation: Preliminary Safety and Efficacy Data
Authors: Luigi Di Biase, David Tschopp, Javier E. Sanchez, Dhanunjay Lakkireddy, Subba Reddy Vanga, Paul Coffeen, Jeffery Whitehill, David Kessler, Naushad Shaik, George Mounir, Rodney Horton, J. David Burkhardt, Pasquale Santangeli, Rong Bai, Sanghamitra Mohanty, Moussa Mansour, Prasant Mohanty, Andrea Natale
Journal: Circulation (2011)

Introduction: Catheter ablation of atrial fibrillation is associated with a potential risk of periprocedural stroke/TIA and bleeding complications. In this multicenter study we sought to determine ...
Prospective Evaluation of On-Clopidogrel Platelet Reactivity Over Time in Patients Treated With Percutaneous Coronary Intervention
Authors: Gianluca Campo, Giovanni Parrinello, Paolo Ferraresi, Barbara Lunghi, Matteo Tebaldi, Matteo Miccoli, Jlenia Marchesini, Francesco Bernardi, Roberto Ferrari, Marco Valgimigli
Journal: Journal of the American College of Cardiology (2011)
The role of gender in studies of ventricle enlargement in schizophrenia: a predominantly male effect
Authors: M Flaum, S Arndt, N C Andreasen
Journal: American Journal of Psychiatry (1990)

Two previously reported neuroimaging studies from the authors' laboratory demonstrated larger lateral ventricles in schizophrenic patients than in normal control subjects. This diagnostic effect was accounted for almost entirely by the male subjects. In this report the role of gender is further explored through reexamining these data sets and those of two earlier studies. Although Gender by Diagnosis effects were not demonstrated, in three of the four studies male schizophrenic subjects had significantly larger ventricles than their control counterparts; there were no differences among the female subjects. One study suggested the opposite effect, but this may be attributable to a non-representative control group.
Abstract 9197: In Situ Stem Cell Therapy Using Human Adipose Tissue-Derived Multi-lineage Progenitor Cells Combined with HMG-CoA Reductase Inhibitor Synergistically Reduce Serum Cholesterol Level in Hyperlipidemic Watanabe Rabbits
Authors: Hanayuki Okura, Ayami Saga, Mayumi Soeda, Jyunko Tani, Mariko Moriyama, Hiroyuki Moriyama, Shizuya Yamashita, Akihiro Ichinose, Shinya Tahara, Takao Hayakawa, Akifumi Matsuyama
Journal: Circulation (2011)

Background: Familial hypercholesterolemia (FH) is an autosomal co-dominant disease characterized by high concentrations of pro-atherogenic lipoproteins and premature atherosclerosis. We examined th...
Abstract 5316: hERG 1b as a Potential Target for Inherited and Acquired Long QT Syndrome
Authors: Gail A Robertson, Harinath Sale, David Tester, Thomas J O’Hara, Pallavi Phartiyal, Jinling Wang, Jia-Qiang He, Yoram Rudy, Michael J Ackerman
Journal: Circulation (2008)

Cardiac I Kr is a critical repolarizing current in the heart and a target for inherited and acquired long QT syndrome. Biochemical studies show that native I Kr channels are heteromers composed of both hERG 1a and 1b subunits, yet our current understanding of I Kr functional properties derives primarily from studies of homo-oligomers of the original hERG 1a isolate. The hERG 1a and 1b subunits are identical except at the amino (NH2) terminus, which in hERG 1b is much shorter and has a unique primary sequence. We compared the biophysical properties of currents produced by hERG 1a and 1a/1b channels expressed in HEK-293 cells at near-physiological temperatures. We found that heteromeric hERG 1a/1b currents are much larger than hERG 1a currents and conduct 80% more charge during an action potential. This surprising difference corresponds to a two-fold increase in the apparent rates of activation and recovery from inactivation, which reduces rectification and facilitates current rebound during repolarization. Kinetic modeling shows these gating differences account quantitatively for the differences in current amplitude between the two channel types. Depending on the action potential model used, loss of 1b predicts an increase in action potential duration of 27 ms (7%) or 41 ms (17%), respectively. Drug sensitivity was also different. Compared to homomeric 1a channels, heteromeric 1a/1b channels were inhibited by E-4031 with a slower time course and a corresponding four-fold positive shift in the IC 50 . Differences in current kinetics and drug sensitivity were modeled by “NH2 mode” gating with conformational states bound by the amino terminus in hERG 1a homomers but not 1a/1b heteromers. The importance of hERG 1b in vivo is supported by the identification of a 1b-specific A8V missense mutation in 1/269 unrelated genotype-negative LQTS patients and absent in 400 control alleles. Mutant 1bA8V expressed alone or with hERG 1a in HEK-293 cells nearly eliminated 1b protein. Thus, mutations specifically disrupting hERG 1b function are expected to reduce cardiac I Kr , prolong QT interval and enhance drug sensitivity, thus representing a potential mechanism underlying inherited or acquired LQTS.
Drug-Eluting Balloon Versus Standard Balloon Angioplasty for Infrapopliteal Arterial Revascularization in Critical Limb Ischemia
Authors: Thomas Zeller, Iris Baumgartner, Dierk Scheinert, Marianne Brodmann, Marc Bosiers, Antonio Micari, Patrick Peeters, Frank Vermassen, Mario Landini, David B. Snead, K. Craig Kent, Krishna J. Rocha-Singh
Journal: Journal of the American College of Cardiology (2014)
Abiraterone acetate and prednisone in patients (Pts) with progressive metastatic castration resistant prostate cancer (CRPC) after failure of docetaxel-based chemotherapy
Authors: D. C. Danila, D. E. Rathkopf, M. J. Morris, S. F. Slovin, L. H. Schwartz, K. Farmer, A. Anand, C. Haqq, M. Fleisher, H. I. Scher
Journal: Journal of Clinical Oncology (2008)

5019 Background: A proportion of CRPC overexpress androgen synthetic enzymes and are dependent on androgens for growth. Abiraterone acetate (AA) inhibits 17 α-hydroxylase and C17,20-lyase to decrease serum androgen to undetectable levels. Methods: AA plus prednisone was studied in Pts with metastatic CRPC who had progressed on docetaxel based chemotherapy. Pts received oral AA 1000 mg QD, and prednisone 5 mg BID in 28 day cycles. The primary endpoint a >50% decline in PSA from baseline. Changes in bone and soft tissue disease were also monitored, as were pre- and post-therapy circulating tumor cell (CTC) number. Results: 43 Pts were screened and 38 treated. The median (interquartile range) age was 73 years (64–81) and PSA 86.3 ng/mL (33–311.5) while 32 (84%) had > 5 CTC per 7.5 ml of blood at baseline. Prior systemic therapy included 3 or more hormone in 29 (76%), including ketoconazole in 17 (45%); while 26 (68%) received 1, and 12 (32%) 2 lines of chemotherapy. Sites of metastases were bone only in 10 (26%), bone and lymph nodes in 15 (39%), bone and visceral in 11 (29%), while 2 had soft tissue and no bone disease. Of 35 evaluable patients (3 are too early), 11 (31%) progressed within 3 months (m), 9 (26%) within 6 m, and 2 (6%) after 6 m. Seven and 6 pts remain on treatment for 3–6 and 6+ months respectively. At 3 m, 14 of 35 pts (40%, 95% CI 26–57%) achieved a decline in PSA >50% from baseline. CTC were <5 pre- or <5 after therapy in 6 and 11 pts, of whom 3 and 7 are still on treatment; CTC count remained >5 in 21 pts, of whom 15 progressed (P =0.099) There was no grade 3 or 4 hypertension or hypokalemia. One pt discontinued treatment due to transaminitis and myositis. Conclusion: AA plus prednisone is well tolerated and active in progressive CRPC post-chemotherapy. Classifying these patients as hormone-refractory is a misnomer with the potential to deny patients potentially effective treatments. A phase III trial is planned with this regimen. (Supported by Cougar Biotechnology) Author Disclosure Employment or Leadership Consultant or Advisory Role Stock Ownership Honoraria Research Expert Testimony Other Remuneration Cougar Biotechnology Cougar
Adolescent Depression
Authors: David A. Brent, Boris Birmaher
Journal: New England Journal of Medicine (2002)

A 16-year-old boy is brought by his parents to his primary care physician because of a decline in school performance, which began at least three years earlier but has become more severe in the past year. He reports boredom, a lack of enjoyment and motivation, poor selfesteem, a feeling of hopelessness, difficulty sleeping, poor concentration, and passive thoughts of suicide without a plan or intent. How should he be treated?
Abstract 5443: MicroRNA 92a Controls Vessel Growth And Functional Recovery After Ischemia
Authors: Angelika Kuehbacher, Guillaume Carmona, Masayoshi Iwasaki, Ariane Fischer, Jana S Burchfield, Emmanouill Chavakis, Michael Potente, Masamichi Koyanagi, Carmen Urbich, Andreas M Zeiher, Stefanie Dimmeler
Journal: Circulation (2008)
Abstract 1042: Viral Chemokine Modulating Protein, M-T7, Interrupts Chemokine : Glycosaminoglycan (GAG) Interaction: M-T7 Inhibitory Activity is Dependent upon Y46 and V210 aminoacid residues
Authors: Erbin Dai, Dana McIvor, Liying Liu, Ganesh Munaswamy-Ramanujam, Yunming Sun, Jeffrey Esko, Israel F Charo, Grant McFadden, Alexandra Lucas
Journal: Circulation (2007)

Background: Chemokines bind to glycosaminoglycans (GAGs) forming gradients that direct inflammatory cell invasion. The viral chemokine modulating protein (CMP), MT-7 binds the C terminal, GAG-binding domain of chemokines and has been previously reported to significantly reduce cell invasion and plaque growth in rat aortic and renal transplant models. Two other viral CMPs, M-T1 and M3 CMPs bind the N terminal domain of chemokines that bind to cell surface receptors. To determine the role of CC chemokine receptor 2 (CCR2) and GAGs for M-T7 anti-inflammatory activity, effects of M-T7 on plaque growth were assessed after mouse CCR2 deficient (CCR2−/−) or GAG deficient (NDST1−/−) aortic allograft transplant. Mononuclear cell migration in response to MCP-1 or RANTES into mouse ascites was also tested. Active sites necessary for M-T7 inhibition of chemokine function and monocyte activation, were assessed by infusion of in the mouse cell migration and human monocyte membrane fluidity assays. Results: M-T7 significantly reduced cell migration and intimal hyperplasia in wild type CCR2+/+ (p&lt;0.009), and CCR2−/− aortic transplants (p&lt;0.026). M-T1 and M3 inhibited cell invasion and plaque in CCR2+/+, but not CCR2−/− mice. M-T7 inhibited plaque growth and CC chemokine (MCP-1 and RANTES)-induced cell migration in wild type mice (P&lt;0.01), but not in NDST1−/− mice (P=0.34). Selected M-T7 point mutations Ty (Y)46A, and Val (V) 210A no longer block chemokine-induced cell migration nor monocyte activation, whereas Asn (N) 40, Asn (N) 63 and Val (V)129 retain inhibitory activity. Conclusions: M-T7 but not M-T1 nor M3, blocks cell migration and plaque growth in CCR2 deficient (CCR2−/−) mouse aortic transplant models. M-T7 loses the ability to block cell migration and plaque growth in NDST1−/−, GAG (heparan sulfate) deficient mice. Point mutations Tyr46 and Val 210 lack inflammatory for mouse and human inflammatory monocyte responses indicating that these amino acid residues on the M-T7 CMP protein are required for inhibitory activity.
Abstract 16075: Predicting Clinical Deterioration on the Wards: Subjective vs Objective Metrics of Patient Acuity
Authors: Anshuman Das, Trevor C Yuen, Matthew M Churpek, Dana P Edelson
Journal: Circulation (2011)

BACKGROUND: The Modified Early Warning Score (MEWS), derived from vital signs, and the Patient Acuity Rating (PAR), a seven-point clinical judgment-based score, have both been independently validat...
Abstract 8921: Long-Term Effects of Smoking and Smoking Cessation on Exercise Stress Testing: Three-Year Outcomes From a Randomized Clinical Trial
Authors: Asha Asthana, Megan E Piper, Patrick E McBride, Ann Ward, Michael C Fiore, Timothy B Baker, James H Stein
Journal: Circulation (2011)

Background The long-term effects of continued smoking and smoking cessation on prognostic markers obtained during treadmill stress testing (TST) are unknown. This study evaluated the long-term effects of smoking cessation and continued smoking on TST parameters that predict cardiovascular disease (CVD) risk. Methods In a prospective, double-blind, randomized, placebo-controlled trial of 5 smoking cessation pharmacotherapies, symptom-limited TST was performed to determine peak METs, rate-pressure product (RPP), heart rate (HR) increase, HR reserve, and 60-second HR recovery, before and 3 years after the target smoking cessation date. Relationships between TST parameters and treatments among successful abstainers and continuing smokers were evaluated using multivariable analyses. Results At baseline, the 600 current smokers (61% female) were mean (standard deviation) 43.4 (11.5) years old and smoked 20.7 (8.4) cigarettes/day. Their exercise capacity was 8.7 (2.3) METs, HR reserve was 86.6 (9.6)%, HR increase was 81.1 (20.9) beats/minute, and HR recovery was 22.3 (11.3) beats. Cigarettes/day and pack-years were independently and inversely associated with baseline peak METs (p&lt;0.001), RPP (p&lt;0.01, pack-years only), HR increase (p&lt;0.05), and HR reserve (p&lt;0.01). After 3 years, 168 (28%) had quit smoking. Abstainers had greater improvements than continuing smokers (all p&lt;0.001) in RPP (+2,055 mmHg*beats/minute), HR increase (+5.9 beats/minute), and HR reserve (+3.7%), even after statistical adjustment (all p&lt;0.001). Conclusions Smokers with a higher smoking burden have lower exercise capacity, lower HR reserve, and a blunted exercise HR response. After 3 years, TST improvements suggestive of improved CVD prognosis were observed among successful abstainers, despite weight gain.
Abstract 13829: The Effects of Exercise Training on Systemic Brain Natriuretic Peptide (BNP) and N-terminal BNP Expression in Heart Failure Patients: An Individual Patient Meta-analysis
Authors: Neil A Smart, Tim Meyer, John Butterfield, Claudio Passino, Malfatto Gabriella, Fillipo Sarullo, Solrun Jonsdottir, Ulrik Wisloff, Francesco Giallauria
Journal: Circulation (2010)

Background: BNP and the N-terminal portion (NT-pro-BNP) have emerged as powerful tools in the diagnosis and prognosis of heart failure. Exercise training has been shown to reduce BNP/NT-pro-BNP lev...