tbuckley/cabot-search huggingface dataset:
Bleeding after endoscopic sphincterotomy or papillary balloon dilation among users of antithrombotic agents
Authors: Tsuyoshi Hamada, Hideo Yasunaga, Yousuke Nakai, Hiroyuki Isayama, Hiroki Matsui, Hiromasa Horiguchi, Kiyohide Fushimi, Kazuhiko Koike
Journal: Endoscopy (2015)

<b>Background and study aims:</b> Severe bleeding is a potentially lethal complication after endoscopic sphincterotomy (EST) and endoscopic papillary balloon dilation (EPBD) for choledocholithiasis. This study aimed to evaluate the impact of antiplatelet agents and anticoagulants on this complication. <b>Patients and methods: </b>Patients who underwent EST and EPBD were identified in a Japanese nationwide administrative database covering 1090 hospitals. Adjusting for other potential risk factors, we evaluated the association between oral administration of antiplatelet agents and/or anticoagulants (continuation, discontinuation, and non-use) and clinically significant bleeding within 3 days of the procedure. <b>Results: </b>In total, 61 002 patients were analyzed (EST, 54 493 patients; EPBD, 6509). The rate of severe bleeding was 0.8 % in both groups, but EPBD was performed more frequently than EST in patients with chronic renal failure, liver cirrhosis, and in those receiving antiplatelet agents or anticoagulants. The impact of continuation/discontinuation of antiplatelet agents on severe bleeding was not statistically significant in the EST or EPBD groups. The use of anticoagulants was associated with a statistically significant increase in severe bleeding compared with non-use for EST (1.6 % 27 of 1688 patients vs. 0.8 % 429 of 52 805 patients; adjusted odds ratio [OR] 1.70; 95 % confidence interval [CI] 1.10 – 2.63) and for EPBD (3.0 % [8 of 263 patients] vs<i>.</i> 0.7 % 46 of 6246 patients; adjusted OR 2.91; 95 %CI 1.36 – 6.24). <b>Conclusions: </b>EST and EPBD can be safely performed in patients receiving antiplatelet agents. Users of anticoagulants are at high risk of bleeding, and the periprocedural management of these should be further investigated.
Abstract 14891: Traf7 Controls Cardiomyocyte Proliferation In Zebrafish
Authors: Eva Patzel, Ina M Berger, Linda Gartner, John B Buhrdel, Wolfgang Rottbauer, Steffen Just
Journal: Circulation (2011)

Genetic programs controlling cardiomyocyte proliferation remain largely unknown. The zebrafish has become a powerful model organism to identify novel disease causing genes and the gene-associated s...
Evidence for primary care services at A&amp;E
Authors: S. J. Johnson
Journal: BMJ (2015)

We at Greenbrook Healthcare were delighted that the recent Royal College of Emergency Medicine (RCEM) report recommends co-locating GP services with emergency departments, but we believe that the RCEM’s view that 22% of patients can be managed by a primary care team to be a serious underestimate.1 As a provider of four primary care led urgent care centres …
Legal guardianship in drug refusal: an illusory solution
Authors: T G Gutheil, R Shapiro, R L St Clair
Journal: American Journal of Psychiatry (1980)

The use of legal guardianship appears to offer a ready resolution to the complex forensic issue of involuntary medication for psychiatric inpatients. The authors, with the aid of clinical examples, show that the gap between theory and practice may render this solution illusory and illustrate the profound complications for treatment introduced by the guardianship process itself. After examining the complexities of this problem, they consider alternative methods for preserving the patient's rights both to receive and to refuse medication.
Abstract 2340: Should Real-time Three-dimensional Echocardiography Become The Preoperative Standard For The Evaluation Of The Mechanisms Of Atrioventricular Valve Regurgitation In The Patient With Congenital Heart Disease?
Authors: Ken Takahashi, Akio Inage, Murray Robertson, Dyck John, Ross David, Rebeyka Ivan, Jeffrey F Smallhorn
Journal: Circulation (2007)

Objective: The purpose of this study was to determine whether Real-time three-dimensional echocardiography (RT3D) is superior to two-dimensional echocardiography (2D) in determining mechanisms and site(s) of atrioventricular valve (AV valve) regurgitation in congenital heart disease. Background: Data is lacking on the utility of RT3D echo in congenital abnormalities of the AV valves. Methods: Between May 2006 and April 2007, 35 cases were prospectively studied prior to AV valve repair (20 left and 15 right) by 2D transthoracic (2DTTE), 2D transesophageal (2DTEE) and RT3D (Philips matrix array X 3–1 and X 7–2). Thirty one had significant and 4 mild regurgitation. Ages ranged from 24 days to 30 years (mean 13.8 years), weight 2.2 to 42kg (mean 26.1Kg). The 2DTTE and TEE were reviewed by a blinded observer. The 3D data were analyzed by a separate observer. In 28 patients surgical findings and regurgitation from saline testing were recorded by digital video and later analyzed by an experienced cardiac surgeon. The remaining 7 had a detailed description of the valve morphology documented immediately after surgery. Surgical findings were used as the gold standard for the assessment of structural abnormalities, with RT3D for the evaluation of regurgitation. Results: See table for structural abnormalities. For both the left and right AV valve, saline testing provided a poorer correlation with RT3D color Doppler jet location, in particular for regurgitant jets from the commmissures (p &lt; 0.01). Conclusion: Transthoracic RT3D provides new and superior information as to the mechanisms and site(s) of AV valve failure in congenital heart disease. Concordance between 2D TTE, 2D TEE and 3D TTE compared to surgical findings
Time-to-Reperfusion in Patients Undergoing Interhospital Transfer for Primary Percutaneous Coronary Intervention in the U.S
Authors: Anjan Chakrabarti, Harlan M. Krumholz, Yongfei Wang, John S. Rumsfeld, Brahmajee K. Nallamothu
Journal: Journal of the American College of Cardiology (2008)
Spatial distribution of PKA activity during carcinoma cell migration revealed by FRET-based analysis
Authors: Adriana A. Paulucci, Kathleen L. O’Connor
Journal: Cancer Research (2006)

1814   Cell motility is a fundamental and indispensable aspect of carcinoma invasion and metastasis that is delicately controlled by both cAMP synthesis and degradation. The metabolism of cAMP, through its subsequent effect on PKA activity, is known to differentially regulate RhoA and Rac1 small GTPases. Since RhoA and Rac1 regulate spatially distinct yet essential aspects of actin cytoskeletal reorganization, we hypothesize that cAMP/PKA activity is not uniform in migrating cells and preferentially localizes to the leading edge. To test our hypothesis, we transfect Clone A cells with the A Kinase Activity Reporter (AKAR), a CFP-YFP based FRET construct designed by Zhang  et al  (PNAS, 2001, 98:14997). The Clone A cells, which bind to and migrate randomly on laminin via signaling through the α2β1 and α6β4 integrins, were plated on laminin coated coverslips for 45 mins and then fixed prior to FRET analysis by confocal microscopy. We report FRET values as a ratio of sensitized emissions to the intensity of CFP signal. Here, we find that migrating Clone A cells display a high level of PKA activity at the leading edge of the cell compared to the cell body. Moreover, membrane ruffles located within the lamellipodium show low PKA activity, consistent with the known activation of RhoA within these ruffles (O’Connor  et al , JCB, 2000, 148:253). Cells pretreated with H-89 or transfected with a S475A (non-phosphorylatable) mutant of AKAR displayed little or no FRET and were devoid of PKA activity gradients. Conversely, cells treated with IBMX or transfected with a CFP-YFP (constitutive FRET) construct showed uniformly high FRET ratios, as expected. We further show that PKA controls the membrane localization of RhoA by immunocytochemistry and activity of RhoA downstream of β1 integrins using the Rhotekin affinity precipitation assay, supporting the idea that PKA controls the spatial regulation of RhoA. In summary, using FRET-based sensor to detect the spatial distribution of active PKA within a migrating cell, we are able to show that PKA activity gradients exist. Furthermore, these data represent supporting evidence that cAMP/PKA may play an important role in establishing the leading edge during cell migration by regulating the spatial activation of key signaling molecules.
Identification and functional roles of miRNAs associated with bladder cancer and disease progression
Authors: Marie Ostenfeld, Jesper Bramsen, Jorgen Kjems, Torben Orntoft, Lars Dyrskjot
Journal: Cancer Research (2008)

AACR Annual Meeting-- Apr 12-16, 2008; San Diego, CA

4433 

Small non-coding microRNAs (miRNAs) have recently emerged as central regulators of gene expression. Accordingly, miRNAs have been shown to regulate processes such as tumorigenesis, development, and differentiation. We profiled the expression of miRNAs in bladder cancer using spotted LNA based oligonucleotide microarrays. By comparing the miRNA expression between 11 normal bladder biopsies, 27 Ta tumors (9 progressing to T2-4), 40 T1 tumors (20 progressing to T2-4) and 27 T2-4 tumors we identified several miRNAs with significant differential expression. We identified 17 miRNAs significantly regulated between normal and cancer; amongst others miR-126, miR-145, miR-143 and miR-21 previously found to be regulated in cancer. We identified several miRNAs differentially expressed between superficial and muscle invasive tumors. When comparing non-progressing to progressing tumors, as well as when comparing patients that survived chemotherapy to those that succumb, sets of miRNAs were detected that differed between the patient groups. In addition, we aimed to understand the function of the most significant dysregulated miRNAs in bladder cancer compared to normal urothelium (upregulation of miR20a, -21, and -510, and downregulation of mir145), and those related to progression of bladder cancer (down- and upregulation of miR29c and -129, respectively). The expression profile of the miRNAs was examined by array analysis using locked nucleic acid (LNA)-modified probes and quantitative real time PCR (qPCR) in a range of immortalized and tumorigenic bladder cell lines. The selected miRNAs were overexpressed by transfection of precursor miRNA molecules or knocked down using LNA molecules in the cell lines and verified by qPCR and luciferase-based reporter assay. Knockdown or overexpression of miR21, a commonly upregulated miRNA in cancer, did unexpectedly not influence the viability of the cell lines, neither the response to anti-cancer agents etoposide, vincristine, and siramesine. On the contrary, transfection of pre-miR145 induced a growth arrest in all cell lines followed by induction of cell death 96 hours post-transfection as determined by loss of the plasma membrane integrity and nuclear condensation. In addition, overexpression of miR129 and -510 also reduced the proliferation of the cell lines. These results directly implicate bladder cancer-associated miRNAs as important regulators of cellular viability in vitro .
Epinephrine infusions in patients with social phobia
Authors: L A Papp, J M Gorman, M R Liebowitz, A J Fyer, B Cohen, D F Klein
Journal: American Journal of Psychiatry (1988)

To assess the role of peripheral epinephrine in social anxiety, the authors infused 11 patients meeting DSM-III criteria for social phobia with intravenous epinephrine over 60 minutes. Although the mean plasma epinephrine level increased from 113 to 928 pg/ml, only one of the 11 patients experienced observable anxiety; this finding suggests that an increase in plasma epinephrine level alone is inadequate to cause social anxiety. Of the variables measured, only the average minute volume correlated with self-rated anxiety. Ventilatory indexes might be better correlates of subjective anxiety than other physiological variables.
Abstract 21543: Prediction of Left Atrial Global Strain and Strain Rates During Atrial Contraction and Relaxation in Healthy Individuals
Authors: Gustavo G Blume, Marion Barnes, Patricia A Pellikka, Stephen Cha, Teresa Tsang
Journal: Circulation (2010)

Background: Strain and strain rate imaging of the left atrium (LA) allows detailed assessment of atrial myocardial contractility and relaxation. In this study, we are reporting the global strain an...
A patient self-assessment diabetes screening score:: development, validation, and comparison to other diabetes risk assessment scores
Authors: Heejung Bang, Alison M. Edwards, Andrew S. Bomback, Christie M. Ballantyne, David Brillon, Mark A. Callahan, Steven M. Teutsch, Alvin I. Mushlin, Lisa M. Kern
Journal: Annals of Internal Medicine (2009)

Background
National guidelines disagree on who should be screened for undiagnosed diabetes. No existing diabetes risk score is highly generalizable or widely followed.
Abstract 19567: LAMP2 Cardiomyopathy: The Consequences of Impaired Autophagy
Authors: Ronny Alcalai, Michael Arad, Hiroko Wakimoto, Jon G Seidman, Christine E Seidman
Journal: Circulation (2010)

Human mutations in the gene encoding lysosome-associated membrane protein-2 (LAMP2) cause Danon disease with profound cardiac manifestations: massive hypertrophy, conduction system abnormalities, and malignant ventricular arrhythmias. To understand the mechanisms accounting for LAMP2 cardiomyopathy we engineered a hypomorphic mutation (in-frame exon 6 deletion, designated L2Δ6) into the endogenous mouse Lamp2 gene. Although 25% of neonatal L2Δ6 mice died, surviving male L2Δ6 mice had near normal life expectancy. L2Δ6 hearts showed abnormal lysosome biogenesis and function: enzymes were mislocalized, lysosomes were abnormally distributed throughout the cytosol, and autophagosomes accumulated in myocytes with reduced total autophagic flux and over-expression of LC3-II. Cardiac studies showed preserved contractile function but abnormal relaxation, significant ventricular hypertrophy and prominent myocardial fibrosis. Electrophysiologic analyses revealed conduction system abnormalities and pacing-induced vent...
Abstract 13053: Annexin-A1 Bioactive Peptide Provides Neuroprotection by Attenuating Microglial Activation Following Cardiac Surgery in Rats
Authors: Zhiquan Zhang, Qing Ma, Mihai V Podgoreanu
Journal: Circulation (2013)

Background: Neuroinflammation induced by cardiopulmonary bypass (CPB) and deep hypothermic circulatory arrest (DHCA) plays critical roles in perioperative cerebral injury, and is mediated in part b...
THE INTERNIST AS HIS OWN PSYCHIATRIST
Authors: Alfred Stengel
Journal: Annals of Internal Medicine (1933)

Article1 September 1933THE INTERNIST AS HIS OWN PSYCHIATRISTALFRED STENGEL, M.D., M.A.C.P.ALFRED STENGEL, M.D., M.A.C.P.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-7-3-281 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptThe term psychiatrist as used in the title and the following discussion is intended to indicate not only the physician's relation to psychiatry proper but also to psycho-neurology and the whole range of functional diseases and all of the disorders attributable to disturbances of the sympathetic and parasympathetic systems. All of these fields of study are so interrelated that at least from the internist's standpoint wide separation is undesirable and in the absence of a comprehensive designation I have chosen the term psychiatrist to indicate the physician's relation to all nervous and mental backgrounds of disease as well as the... This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: Philadelphia, Pennsylvania*Read at the Montreal Meeting of the American College of Physicians, February 9, 1933. Nextarticle Advertisement FiguresReferencesRelatedDetails Metrics 1 September 1933Volume 7, Issue 3Page: 281-291 ePublished: 1 December 2008 Issue Published: 1 September 1933 PDF downloadLoading ...
Innovations:A Futuristic Megalab in Wyoming.
Authors: QD Skinner
Journal: Environmental Health Perspectives (1994)

Basic research designed to answer environmental health questions is usually conducted in laboratories at the bench. Bench research allows financial investors, scientists, and society to maximize control over experiments, develop experimental procedures, and test hypotheses in a safe and cost-effective manner. However, results of experiments conducted at the bench may not be representative of what happens when the same experiments are repeated on a commercial scale or in the larger and more complex natural environment.
A Comprehensive Approach to Sexual Violence Prevention
Authors: Kathleen C. Basile
Journal: New England Journal of Medicine (2015)

Sexual violence is a widespread problem that is associated with negative health outcomes throughout life.1 Recent national data reveal that, among women reporting a history of rape, 40% were first raped before 18 years of age and 38% between 18 and 24 years of age.1 The college years may be a particularly vulnerable time for women, given the increase in partying and alcohol use. One study showed that 20% of undergraduate women were victims of sexual violence since beginning college.2 Nevertheless, sexual violence is a preventable public health problem.In this issue of the Journal, Senn et al.3 report . . .
Abstract MP022: B-Type Natriuretic Peptide is Associated with Higher Blood Pressure: Results from the Multi-Ethnic Study of Atherosclerosis
Authors: Annis M Marney, Richard Kronmal, Susan Lakoski, David Siskovick, Michael Criqui, Lori Daniels, Mary Cushman
Journal: Circulation (2012)

B-type natriuretic peptide (BNP) predicts cardiovascular morbidity and mortality in the general population. Its relationship with blood pressure in ambulatory populations is not well established. We hypothesized that BNP concentrations would be positively associated with blood pressure in the Multi-Ethnic Study of Atherosclerosis (MESA). MESA is an epidemiological study of 6,814 men and women from 4 ethnic groups (45-84 years) without known cardiovascular disease. N-terminal pro-BNP was measured at baseline in 6,213 subjects. We used linear regression with systolic blood pressure (SBP) as the outcome and log (natural) BNP (lnBNP), use of BP medications, body mass index (BMI), age, sex, and race as predictors. For every 1 standard deviation higher lnBNP, SBP was 4 mmHg higher ( table ). The regression coefficient for lnBNP was larger (p=0.001) in those on vs not on BP medications (figure). We conclude BNP was significantly associated with SBP in this population. Whether BNP changes with SBP over time is unknown. Table: Multivariable Linear Regression of SBP Predictor Standardized Coeff. Std Error 95% CI Antihypertensive medication 6.5 0.56 5.39-7.60 * lnBNP 4.0 0.31 3.38-4.58 * BMI 3.1 0.28 2.60-3.69 * Age 5.6 0.29 5.03-6.17 * Sex 1.7 0.53 0.69-2.77 † Chinese vs Caucasian 5.1 0.83 3.48-6.73 * African-American vs Caucasian 7.5 0.67 6.22-8.85 * Hispanic vs Caucasian 3.9 0.66 2.57-5.17 * * P &lt;0.001, † P =0.001 Figure: Lowess smoother for relationship of standardized ln(BNP) and SBP (mm/hg)
Abstract 4955: Analysis of Heart Transplant Waitlist Mortality for Children
Authors: William T Mahle, Robert N Vincent
Journal: Circulation (2008)

Background: The outcomes following pediatric heart transplantation (tx) have continued to improve, but pre-tx attrition has been a major concern. Historically, the risk of death while awaiting tx has been greater in children than adults. We sought to determine if recent advances in medical management have reduced the risk of death for children awaiting heart tx. Methods. An analysis of the Scientific Registry of Transplant Recipients was undertaken to determine the risk of death while awaiting tx for children as compared to adults. Deaths were determined from the Social Security Death Master File and Centers for Medicaid and Medicare Service. Results: During the 10 yr study period the number of children listed for heart tx increased by an average of 1% each year. Over the same time the number of pediatric donors decreased slightly. The number of deaths per patient listed decreased significantly in the non-infant pediatric patients and adults (table ). In the infant population the proportion of deaths did not change over time and generally exceeded 20%. In the most recent era–for the first time–non-infant pediatric patients had proportionally fewer waiting list deaths than adults. When one examines the annual death rates expressed per 1,000 patient-yrs at risk the non-infant pediatric pts also showed a marked reduction from 409.4 to 185.7, p&lt;.01, whereas the rates for infants showed no improvement 1688.8 to 1788.9. Conclusion: For children ages 1–17yrs waiting list mortality has improved dramatically in spite of a static rate of pediatric organ donation, suggesting that improved medical management has contributed to improved survival. There has been no improvement in waiting list mortality in the infant population. Whether the increased use of ABO incompatible donor organs and the advent of ventricular assist devices for this population will reduce waitlist mortality for this vulnerable group remains to be determined. Waiting List Mortality
Abstract 16576: The Role of Undetectable Cardiac High Sensitivity Troponin T and Copeptin for Prediction of 90 Day Outcomes in Low- to Intermediate-Risk Patients With Suspected ACS: A BIC-8 Biomarker Substudy
Authors: Mehrshad Vafaie, Anna Slagman, Julia Searle, Christian Hamm, Kurt Huber, Christian Müller, Jörn O Vollert, Stefan Blankenberg, Evangelos Giannitsis, Martin Möckel
Journal: Circulation (2014)

Introduction: The international randomized multicentre BIC-8 trial demonstrated that patients with suspected ACS and a negative baseline troponin, who also tested negative for copeptin, could safely be discharged and did not experience a higher rate of MACE within 30 days compared to patients managed according to current guidelines. Objective: This BIC8-substudy evaluates the usefulness of copeptin in patients with undetectable (below limit of detection (LOD)), compared to detectable (at or above LOD) high sensitivity troponin T (hsTnT) at presentation. Methods: In the original study, patients (n=902) were randomized 1:1 into standard and experimental arm. In the experimental arm, further patient care was based on copeptin levels at admission. After 30 and 90 days, a telephone follow-up was performed. Since hsTnT at LOD was evaluated in a post-randomization cohort, all analyses were executed on the entire study population. For the hsTnT assay (Elecsys, Roche), LOD was defined as a value below 5 ng/l. Copeptin values were determined using the BRAHMS Copeptin us Kryptor assay (Thermo Scientific). Results: Of all patients enrolled in the original study (n=902), hsTnT at admission was available in 893 patients (99.0%). The majority of patients had detectable hsTnT values (65.4%, n=584). 34.6% (n=309) had no detectable hsTnT-values. In these patients, no myocardial infarctions (MIs) or deaths occurred within 90 days. In patients with detectable hsTnT-values, in 3.3% the combined endpoint of death or MI occurred within 90 days (table 1). In the subgroup of patients with a copeptin value ≥10 pmol/l the event-rate was 8.2% (10/122) and in patients below this value 2.0% (9/441), (RR = 4.02, p=0.003). Conclusion: In low-to-intermediate risk patients with suspected ACS, undetectable hsTnT values at admission allow a safe discharge without occurrence of death or MI within 90 days. In patients with detectable hsTnT, Copeptin is useful to stratify patients at higher risk for death/MI.