tbuckley/cabot-search huggingface dataset:
Abstract 20782: Incidence and Predictors of Postoperative Atrial Fibrillation in Patients Undergoing Elective Noncardiac Surgery in a large cohort of patients
Authors: Anitha Rajamanickam, Ali Usmani, Patel Preethi, Jelica Janicijevic, Changhong Yu, Michael Pecic, Eric Hixson, Michael Kattan, Mina Chung
Journal: Circulation (2010)

Background:  Postoperative atrial fibrillation (AF) after cardiothoracic surgery has been well described. However, the incidence and predictors of AF after noncardiac surgery (NCS) have not been well defined.   Methods:  Patients undergoing elective NCS in 2005-2007 requiring at least an overnight stay were identified through a surgery scheduling system. Demographics, diagnoses, labs, medications and postoperative AF were obtained from the electronic medical record. AF was validated by individual chart analysis and data was collected regarding use of Intravenous medications and /or cardioversion for rate and rhythm control. Missing values in the predictor variables were multiply imputed by chained equations in order to effectively utilize the sample size. A stepwise selection method was used to identify significant predictive variables of postoperative AF in a multivariable logistic regression analysis. A concordance index was calculated for the final model including the selected predictors.   Results:  Postoperative AF developed in 946 of 34,793 patients (2.7%), of which 690 (73%) had new onset AF, 594 (63%) needed intravenous medications for rate and rhythm control and 68 (7%) needed urgent cardioversion. Multivariable logistic analysis identified older age, male sex, surgeries with increased bleeding risk, vascular surgery, prior history of pulmonary embolism or AF, insulin dependent diabetes and sodium as significant independent predictors of postoperative AF (p   Conclusions:  Similar to cardiac surgery, older age, prior AF, and higher risk vascular surgeries were associated with postoperative AF after NCS. Statin use was associated with a lower incidence suggesting that future studies of statins for NCS may be of interest.
Abstract 7: Professionals Decrease Survival After Takeover from Lay Rescuers by Interrupting the Automated External Defibrillator Protocol
Authors: Jocelyn Berdowski, Ron J Schulten, Rudolph W Koster
Journal: Circulation (2008)

Introduction - There are no guidelines for transition of care with ongoing cardiopulmonary resuscitation (CPR) from rescuers with automated external defibrillator (AED) to paramedics. The objective...
18F-FDG and 18F-NaF PET/CT Findings of a Multiple Myeloma Patient With Thyroid Cartilage Involvement
Authors: Aylin Oral, Bulent Yazici, Özgür Ömür, Melda Comert, Guray Saydam
Journal: Clinical Nuclear Medicine (2015)

Thyroid cartilage is a very rare extramedullary involvement location in multiple myeloma. We present both 18F-NaF and 18F-FDG PET/CT findings of a multiple myeloma patient with thyroid cartilage involvement. In this patient, increased FDG and more intensely increased NaF uptake were seen on thyroid cartilage. In addition, some bone lesions had more intense NaF than FDG uptake, and some were only NaF avid. Although 18F-FDG PET/CT has an important role in plasma cell neoplasms, we considered that 18F-NaF PET/CT is also very useful to detect small lytic lesions that might be overlooked on 18F-FDG PET/CT.
Abstract 3108: Single Molecule Troponin Detection to Assess for Transient Myocardial Ischemia
Authors: Marc S Sabatine, David A Morrow, Quynh Anh Lu, James A de Lemos, Petr Jarolim, John A Todd, Eugene Braunwald
Journal: Circulation (2007)

Background : It has been proposed that small amounts of cardiac troponin (Tn) may be released from myocytes in the setting of reversible myocardial injury. We hypothesized that a more sensitive Tn assay could permit the quantification of transient myocardial ischemia. Methods : Blood samples were obtained before and 4 hrs after stress testing with perfusion imaging in 99 pts w/o recent angina. Tn was measured using the current generation TnT assay (Roche, limit of detection, LOD, 0.01 ng/ml) and the new Singulex TnI assay, which, using single molecule counting technology, has a LOD 50 fold lower (0.2 pg/ml). Pts were categorized by severity of ischemia on perfusion imaging; median changes in Tn levels were compared across ischemic groups. Results : Using the Singulex assay, TnI was detectable in all pts before stress testing (median 4.4 pg/ml). The median duration of angina during testing was 0, 0, and 3 mins in pts with none, mild, and mod/sev ischemia. By 4 hrs, TnI levels were unchanged in pts w/o ischemia, whereas circulating levels had significantly increased by 1.37 pg/ml (24%) in pts with mild ischemia (P=.002) and by 2.08 pg/ml (40%) in pts with mod/sev ischemia (P=.0006) (Fig ). In a multivariable model that included mins of exercise, angina, and ST changes, change in TnI was a significant predictor of ischemia (OR 3.36, P=.03). In contrast, using the existing TnT assay there were no detectable differences in Tn levels (median difference 0.00 ng/ml in all groups). Conclusion : A 50-fold more sensitive troponin assay can quantify rises in circulating troponin in patients experiencing brief, provoked myocardial ischemia. The clinical applications of such assays warrant further study.
Abstract 1534: Structural and Functional Remodeling of the Coupling between Sarcolemmal Ca <sup>2+</sup> Channels and the Ryanodine Receptor in Atrial Fibrillation
Authors: Ilse Lenaerts, Virginie Bito, Patricia Holemans, Hein Heidbüchel, Karin R. Sipido, Rik Willems
Journal: Circulation (2008)

Background: Permanent atrial fibrillation (AF) in humans has been associated with structural and electrical remodelling. Data on contractile remodelling and control of sarcoplasmic reticulum (SR) Ca 2+ release via the ryanodine receptor (RyR) in permanent AF are however limited. Methods : Ewes were atrially paced at 600 bmp for a median of 23 weeks resulting in permanent AF (mean of 89.6±6 days, N=13) and compared to matched, non-instrumented control animals (CTRL, N=17). Atrial myocytes were isolated and cell shortening (field stimulation), membrane currents (whole cell voltage clamp) and [Ca 2+ ] i (Fluo-3) were measured. Protein expression was analyzed by immunoblotting. T-tubule density was quantified from confocal Z-stack images of cells stained with di-8-ANEPPS. Data are shown as mean±SEM of at least 17 cells and 5 animals. Results: Myocyte shortening and underlying [Ca 2+ ] i transients were profoundly reduced in AF (by 54.8% and 62%, p&lt;0.01). This reduced cell shortening could be corrected by increasing [Ca 2+ ] i during caffeine-induced Ca 2+ release from the SR (L/L 0 9.7±0.5% in AF vs. 10.8±0.5% in CTRL). SR Ca 2+ content (integrated Na + /Ca 2+ exchange current during caffeine application) was not different (CTRL 1.9±0.3 pC/pF vs. AF 2±0.4 pC/pF), but calculated fractional SR Ca 2+ release during a depolarizing step to +10 mV was reduced in AF (by 20.6%, p&lt;0.05). Peak Ca 2+ current density was modestly decreased (at &lt;10 mV by 23.9%, p&lt;0.01). T-tubules were present in the CTRL atrial myocytes though their density was much lower than in ventricular cells (11.4% vs. 20.6%, p&lt;0.05). T-tubule density was robustly reduced in AF vs. CTRL (by 45%, p&lt;0.01) with a reduction of myocyte surface:volume ratio (by 26%, p&lt;0.01). The organization of RyR was apparently unchanged but protein expression was reduced (by 18.6%, p&lt;0.05). Conclusion: In permanent AF, reduced SR Ca 2+ release is a major factor in the reduced cell contraction. Loss of T-tubules contributes to uncoupling of sarcolemmal Ca 2+ channels to RyR and reduced fractional SR Ca 2+ release despite preserved SR Ca 2+ content.
Abstract 4421: Concomitant Hydrochlorothiazide Therapy in Hypertensive Patients is Associated with Reduced Cardiovascular Morbidity and Mortality Independent of Blood Pressure and Electrocardiographic Left Ventricular Hypertrophy: The LIFE Study
Authors: Peter M Okin, Richard B Devereux, Darcy A Hille, Sverre E Kjeldsen, Lars H Lindholm, Jonathan M Edelman, Bjorn Dahlof
Journal: Circulation (2008)
Abstract 15401: HDL-Cholesterol Determines Nocturnal Blood Pressure Decline in the Elderly with Treated Hypertension
Authors: Kazumasa Harada, Taro Kariya, Aya Tanaka, Ayumi Toba, Yasuko Imai, Rie Aoyama, Masamitsu Sugie, Hajime Yokota, Taizo Ishiyama, Yusuke Tsuboko, Hajime Fujimoto, Kazuhiro Takeda
Journal: Circulation (2011)

Background:  High-density lipoprotein cholesterol (HDL-C) levels have an inverse correlation with incidence of ischemic heart disease, and Framingham heart study recently showed the association between low baseline HDL-C and elevated incidence of heart failure. Moreover, HDL-C increases the production of nitric oxide. The aim of this study was to test whether HDL-C level would be associated with nocturnal blood pressure (BP) decline.   Methods:  We performed 24-h ambulatory BP monitoring in 1062 patients (74.8±0.2 yrs; men, 43%) with treated hypertension. Patients were classified as non-dipper BP status by night-to-day systolic BP ratio >0.9.   Results:  Mean 24-h systolic/ diastolic BPs were 131±1/ 72±1mmHg. Mean nocturnal BP decline was 3.8±0.3%, and it significantly correlated with age (r= -0.17), BNP (r= -0.15), and serum HDL-C levels (r=0.16). In the multiple linear regression analysis, HDL-C (p=0.001) was an independent determinant of nocturnal BP decline after adjustment for age, sex, BMI (body mass index), total cholesterol, triglyceride, LDL-cholesterol, and agents for dyslipidemia. In the multiple logistic regression analysis, the non-dipper hazard was 2.87 (95% confidence interval [CI], 1.95 to 4.24; p   Conclusion:  Low HDL-C level was associated with a blunted decrease in nocturnal BP in the elderly with hypertension. HDL-C might be a good target for prevention of heart failure in the elderly, as non-dipper BP status predicts its incidence.
bmjlearning.com: Learning outcomes
Authors: Kieran Walsh
Journal: BMJ (2006)

“Now, what I want is, Facts. Teach these boys and girls nothing but Facts. Facts alone are wanted in life. Plant nothing else, and root out everything else.” So said Mr Gradgrind, the headmaster in Charles Dickens's Hard Times. And facts are what medical education was once all about. If you went to medical school before 1990 then you learnt facts and were tested on these facts.

But knowledge of facts on their own is not enough to make a good doctor. Indeed, educational research has shown that the methods used to teach may have as big an effect on the retention of information as the content itself.1 The ensuing process movement in medical education led to innovations such as interprofessional education and problem based learning. How we learn is certainly important, but concentrating too much on this can lead us to forget about the key skills that are needed to practise medicine. And in response to this, the most recent movement in medical education has been the emergence of outcomes based education. Concentrating on outcomes means focusing on what patients and professionals most want—the development of competent and well qualified medical professionals.1

Concentrating on outcomes could be more important than concentrating on processes or even the content. In the past your aims when teaching may have been to teach about pneumonia or to help students learn about pneumonia or, more specifically, to help students learn how to diagnose and treat pneumonia. But many educationalists would now say that the best way would be to aim that, on completion of the learning, your students will competently diagnose and treat patients with pneumonia. But we have a way to go before we can prove this. One recent review of the effectiveness of medical education showed that only 18% of studies looked at learners' application of skills and that less than 2% measured changes in patient outcomes as a result of medical education.2

Despite this, outcomes based medical education is on the rise. In Britain we now have a curriculum for junior doctors that is based on outcomes and on the achievement of defined competencies.3 At BMJ Learning we have long been sold on the concept of outcomes. The learning outcomes of one of our most recent modules on cancer care are that, on completing it, you should competently diagnose and treat patients with nausea and vomiting that is related to cancer. We think that these are valid outcomes and that the learning module will help you achieve them, and that the subsequent assessment will enable you to prove that you have achieved them. But we are open to argument and are willing to listen to those who tell us that, to coin a phrase of Yeats, “the best modern way” is not necessarily the best way. Have a look and let us know what you think.
肠易激综合征的诊断标准与分型——国内共识意见解读（一）
Authors: 孙菁, 袁耀宗
Journal: BMJ (2008)

由于生活节奏的加快以及社会环境的改变等众多因素，肠易激综合征（irritable bowel syndrome，IBS）在我国的发病率也有逐渐升高的趋势。有流行病学调查显示我国社区人群IBS患病率为5．7％，其中22％因IBS症状而就诊。只有深入掌握其诊断及治疗的基本概念，才能更好地促进我国医学界对IBS的诊疗和研究进展。
Nationally determined pay could result in high marginal costs
Authors: P. Flower
Journal: BMJ (1996)

Alternatives to hospital careStudy's results may not apply elsewhere EDrroR,-I wish to urge caution in extrapolating the results ofJoanna Coast and colleagues' study, which implies that a tenth of patients admitted to general hospitals could be relocated to more appropriate care.'I am leading a "total fundholding" project in Winchester, in which the practice will purchase all care on behalf of our patients, and have been examining the practice's use of acute services.We obviously have an inter- est in using expensive acute services carefully, and to that end we have followed up all our acute
Abstract 628: Triggers of Atrial Fibrillation are Suppressed in the Setting of General Anesthesia
Authors: Joseph Schuller, Jeffrey B Sanders, Christopher M Lowery, Diego Belardi, Michelle S Khoo, William H Sauer, Laurent Lewkowiez
Journal: Circulation (2008)

Introduction: The elimination of triggers initiating atrial fibrillation (AF) with catheter ablation is an effective method for treating this arrhythmia. Therefore reliable identification and succe...
Abstract 15218: Intramyocardial Injection of Bone Marrow Mononuclear Cells in Patients with Chronic Myocardial Ischemia: an Intra-Patient Comparison
Authors: Sander Rodrigo, Jan van Ramshorst, Saskia L Beeres, Petra Dibbets-Schneider, Albert de Roos, Willem E Fibbe, Jaap J Zwaginga, Ernst E van der Wall, Martin J Schalij, Jeroen J Bax, Douwe E Atsma
Journal: Circulation (2011)

Purpose In previous trials, intramyocardial bone marrow cell (BMC) injection has demonstrated to improved myocardial perfusion (MP) and anginal symptoms in patients with chronic myocardial ischemia. However, the reported beneficial effect varies between trials, possibly due to unknown bias between treatment groups. Therefore, in order to exclude potential patient-specific biasing factors, an intra-patient comparison on the effect of BMC injection versus placebo injection was performed. Methods Sixteen patients with chronic myocardial ischemia (14 male, 64±10 years), who recently received intramyocardial placebo injection in the setting of a randomized cell therapy trial, were enrolled. Using the NOGA-system, injection of 100x106 BMC was performed. Anginal symptoms and quality of life (QoL) were evaluated at baseline, 3 and 6 months. Single-photon emission computed tomography and magnetic resonance imaging were performed at baseline and 3 months to assess MP and left ventricular (LV) function. Results Impr...
Abstract 10808: Left Ventricular Diastolic Dysfunction in HIV-Negative Infants Exposed In Utero to Antiretroviral Therapy from HIV-Positive Mothers: The Prospective NHLBI CHAART-I Study
Authors: Sharon O'Brien, Nao Sasaki, Benjamin W Eidem, Steven D Colan, Irene Cheng, James D Wilkinson, Bruce Thompson, Tracie L Miller, E John Orav, Ricardo H Pignatelli, Louis L Bezold, William T Shearer, Kenneth C Rich, Sulekha Kumar, Philip LaRussa, Thomas J Starc, Julie S Glickstein, Ellen R Cooper, Steven E Lipshultz
Journal: Circulation (2011)

Background: HIV-negative children exposed in utero to antiretroviral therapy (ART) have decreased left ventricular (LV) mass, dimension, and septal wall thickness with increased contractility. Dias...
Abstract 3752: Mineralocorticoid Receptor Antagonism Prevents Aldosterone Mediated Dysfunction of Human Endothelial Progenitor Cells in Vitro, in Vivo and in Patients
Authors: Thomas Thum, Kerstin Schmitter, Daniela Fraccarollo, Julian Widder, Ertl Georg, Johann Bauersachs
Journal: Circulation (2008)

Hyperaldosteronism has been associated with vascular injury. Bone marrow derived endothelial progenitor cells (EPC) play an important role in endothelial repair and vascular homeostasis. We therefore examined the effects of aldosterone and its blockade by the mineralocorticoid receptor (MR) antagonist eplerenone on EPC number and function in vitro , in vivo and a clinical trial . EPCs expressed the MR at the gene and protein level. Aldosterone treatment of human EPC led to a translocation of the MR into the nucleus and impaired multiple cellular functions, such as differentiation, migration, proliferation and incorporation in vascular networks. Impaired EPC function was rescued by pharmacological antagonism or genetic ablation of the MR. Aldosterone increased the intracellular production of reactive oxygen species (ROS), which was attenuated by MR blockade. Aldosterone-mediated increase of ROS was mainly protein kinase A-dependent and resulted in cAMP activation with subsequent impairment of EPC migration. Chronic aldosterone infusion in mice (implanted minipumps, 50mg/kg/d for 14d) impaired EPC functionality and resulted in endothelial dysfunction. MR antagonism prevented those effects. In patients with hyperaldosteronism, EPC displayed reduced migratory potential compared with age-matched healthy controls. Impaired function of EPC from patients with hyperaldosteronism significantly correlated with endothelial dysfunction assessed by peripheral arterial tonometry. Importantly, MR antagonism in patients with hyperaldosteronism improved EPC as well as endothelial function. EPC function is impaired in hyperaldosteronism by increased intracellular ROS production and cAMP activation. Beneficial effects of MR antagonists in cardiovascular disease prevention and therapy especially during hyperaldosteronism may be mediated in part by improved EPC biology.
Abstract 15708: Does Targeted Low Dose Heparin Negate the Efficacy and Safety of Bivalirudin in Patients Undergoing Percutaneous Coronary Intervention? Insights from a Propensity Score Matched Analysis of the EVENT Registry
Authors: Sripal Bangalore, David J Cohen, Neal Kleiman, Tal Regev-Beinart, Laura Mauri, Event Registry Investigators
Journal: Circulation (2010)
Abstract 3588: Primary Percutaneous Coronary Intervention Does Not Prevent In-Hospital Development of Cardiogenic Shock
Authors: Matias Lindholm, Soren Boesgaard, Jens J Thune, Henning Kelbaek, Henning R Andersen, Lars Kober
Journal: Circulation (2006)

Introduction Primary percutaneous interventions (PCI) are superior to fibrinolysis with regards to restoration of blood flow in patients with acute ST-elevation myocardial infarction (STEMI). More ...
Abstract 8847: Racial Differences in Competing Risks for First Cardiovascular Events and Non-Cardiovascular Death in Middle-Aged and Older Adults
Authors: Matthew J Feinstein, Hongyan Ning, Joseph Kang, Alain Bertoni, Mercedes Carnethon, Donald M Lloyd-Jones
Journal: Circulation (2011)

Background: Standard survival models may over-estimate risks of incident cardiovascular disease (CVD) if they do not account for the competing risk of non-CVD death. No studies to date have compared first CVD events and non-CVD death between races in a competing risks framework. Methods: Using data from 2 multi-center, NHLBI-sponsored cohorts (ARIC and CHS), we used competing Cox models to estimate hazards for first CVD events and non-CVD death within and between races. Results: Of 14569 ARIC study participants (ppts) aged 45-64y with mean follow up of 10.5y, 11.6% had CVD and 5.0% had non-CVD death as a first event; among 4237 CHS study ppts aged 65-84y and followed for 8.5y, these figures were 43.2% and 15.7%, respectively. Figures 1 and 2 show competing cumulative incidence curves for ARIC men for specific event types. CVD events were significantly more likely to occur first rather than non-CVD death in all sex-race groups. Compared with whites, middle-aged blacks were 1.4-2.1 times more likely to have non-CVD death or CVD as first events; these disparities disappeared by older adulthood. After adjustment for CVD risk factors (RFs), however, middle-aged black men were less likely than whites to experience a first CVD event. Most likely first CVD events were CHD in white men and heart failure in black men and all women. Conclusions: Our finding that CVD events are more likely than non-CVD death to occur first in all sex-race groups re-affirms the importance of broadly applied CVD prevention programs. CVD affects blacks at a younger age than whites; the earlier burden of CVD among black men may be due to elevated CVD RF levels. Racial disparities in first CVD incidence disappear by older adulthood.
Abstract 8722: Temporal Trends in Incidence of Stroke Among Children: a 14-Year Statewide Study
Authors: Sampada K Gandhi, James S McKinney, Jeanine E Sedjro, Jerry Q Cheng, Yingzi Deng, Nora M Cosgrove, Javier Cabrera, John B Kostis
Journal: Circulation (2011)

Objectives: Although a rare condition, stroke is one of the top 10 causes of death among children. However, little is known about current trends in the incidence of pediatric stroke. We examined all hospitalizations with a diagnosis of stroke in children admitted to all non-federal New Jersey hospitals from 1994-2007. Methods: Children (age &gt;30 days to ≤19 years) admitted with a primary or secondary diagnosis of stroke for the first time were included in the analysis. Demographic and clinical information were assessed using the Myocardial Infarction Data Acquisition System (MIDAS) statewide database. Results: During the 14 year study period, 1,034 children were admitted with a first time hospitalized stroke. The time trend of incidence followed a quadratic function where the rate decreased from 1994 to a nadir at 1999-2001 and increased after this year (p=0.0003). Interestingly, this parabolic relationship could be explained by two factors: better treatment of sickle cell disease with blood transfusions after year 1998 (p=0.0001), and an improved diagnostic accuracy with increasing use of diffusion-weighted MRI since 2001 (p=0.0002). In addition, increased prevalence of hypertension and obesity among children, better awareness of stroke and more referrals of young patients to neurologists may have contributed to the rise in the incidence of pediatric stroke in recent years. When strokes were categorized into ischemic and hemorrhagic, the incidence of the former showed a quadratic trend mimicking the overall shape described above (p=0.0001), while the incidence of hemorrhagic stroke remained stable during the study period (p=0.12). Conclusion: After an initial decrease concurrent with changes in treatment of sickle cell disease, the incidence of pediatric stroke is on the rise due to more widespread use of diffusion-weighted MRI and increased prevalence of hypertension and obesity.