tbuckley/cabot-search huggingface dataset:
Abstract 9460: Robotic Surgery in Obstructive Sleep Apnea Syndrome to Reduce the Cardiometabolic Risk in Hypertensive Patients
Authors: Salvatore Lenti, Giulia Burali, Mario Felici, Pier Guido Ciabatti
Journal: Circulation (2012)

Introduction . It is confirmed the association between OSAS (Obstructive Sleep Apnea Syndrome) and increased cardiometabolic risk in obese hypertensive patients, determined by a multifactorial origin and by the activation of the adrenergic system. In the OSAS the apneas and arousals always end with a hypertensive peak that occurs in the phase of hypoventilation, altering the normal nocturnal Blood Pressure (BP) pattern that it is similar to the daytime pattern. The aim of the study . Assess the reduction in BP, sleep apnea and metabolic parameters in hypertensive patients undergoing Robotic Surgery using TORS (Trans Oral Robotic Surgery) with Da Vinci Robot, compared to a control group subjected to CPAP (Continuous Positive Airway Pressure). Materials and Methods . We enrolled 32 patients (20 M, 12 F, average age 53 years) hypertensive, undergoing therapy (average drugs taken 3.2) and obese (BMI &gt; 30), with OSAS (diagnosed with polysomnography presenting AHI - Apnea-Hypopnea Index - &gt; 30), with alterations in metabolic parameters (LDL &gt; 156 mg/dL, glycated hemoglobin &gt; 7.0 %), S02 &lt; 85%, with Mean Arterial Pressure (MAP) of 136 mmHg during a 24 h BP monitoring (ABPM) with non-dipper profile, with ECG Heart Rate (HR) increase &gt; 80, with values of NT pro-BNP (Brain Natriuretic Peptide N-terminal) &gt; 500 pg/mL, and underwent TORS with the lingual tonsil resection, tonsillectomy and septoplasty. Also were compared with 30 patients, with similar demographic and clinical characteristics, who underwent CPAP. Results . After 6 months we obtain an average reduction of AHI 5, improvement in metabolic parameters (LDL &lt; 130 mg/dL, glycated hemoglobin &lt; 6.0 %), the MAP has been reduced to 106 mmHg (profile dipper), the HR has been reduced to less than 60, and we have also observed a reduction of the NT pro-BNP values to &lt; 300 pg/mL; also there was a reduction in therapy (2.2 drugs taken). While in the group with CPAP we only recorded S02 &gt; 95%, MAP 120 and reduced AHI between 15 and 18. Conclusions . The TORS although an invasive surgical technique, but more specific and aesthetically better, has showed a significant reduction of AHI, cardiometabolic parameters and BP compared to the use of CPAP, contributing to greater therapeutic efficacy with reduced need for medications.
Abstract 14465: Clinical Characteristics and Prognostic Impact of Extremely Poor Blood Pressure Response to Bicycle Exercise
Authors: Masafumi Fukumitsu, Yusuke Sata, Michio Nakanishi, Tetsuo Arakawa, Reon Kumasaka, Teruo Noguchi, Yoichi Goto, Masaru Sugimachi, Hiroshi Takaki
Journal: Circulation (2011)

Background: Poor systolic blood pressure (SBP) response to exercise has been proposed to be a strong predictor of mortality in patients with heart failure (HF) by several studies, but not emphasize...
Abstract 5542: Role of Scavenger Receptor BI in Sepsis
Authors: Ling Guo, Eric Smart, Xiangan Li
Journal: Circulation (2008)

Scavenger receptor BI (SR-BI) is a well-established HDL receptor that regulates plasma HDL cholesterol levels by selectively uptake cholesterol ester from HDL. We recently reported a novel function of SR-BI namely protection against endotoxin-induced animal death. Using a lipopolysaccharides (LPS) induced endotoxic animal model, we found that LPS challenge induced 90% fatality of SR-BI null mice while all the wild type littermates survived, indicating that SR-BI plays a pivotal role in protection against LPS toxicity in vivo. In the current studies, we determined whether SR-BI plays a protective role in sepsis using an established septic animal model (cecal ligation and puncture, CLP). We demonstrate that CLP treatment induced 100% fatality of SR-BI null mice (n=20) whereas only 21% fatality of wild type littermates (n=27) and 36% fatality of heterozygous littermates (n=30). Moreover, SR-BI null mice exhibited exaggerated and prolonged inflammatory response as shown by elevated proinflammatory cytokine levels in serum upon CLP treatment compared to wild type littermates. Further studies revealed that the plasma LPS levels were significantly higher in SR-BI null mice compared to wild type control mice, indicating that SR-BI is required for LPS clearance in sepsis. Our findings clearly demonstrate that SR-BI is a critical protective modulator in sepsis in mice, which may reveal a novel target for the intervention of sepsis. (Supported by grant from American Heart Association 0530241N) This research has received full or partial funding support from the American Heart Association, AHA National Center.
TV: May 33rd
Authors: Ayan Panja
Journal: BMJ (2004)

Much debated and relatively rare, dissociative identity disorder is a condition in which a patient has two or more personalities. It is purported to follow severe childhood trauma or abuse and is assumed to be a protective mechanism of the mind. May 33rd, Guy Hibbert's drama about this disorder, used accounts from women who claim to have suffered ritual abuse to create the character of 35 year old Ella Wilson. In Ella we saw how the change from one personality to another could happen instantly, leaving her scared, confused, and vulnerable. One second Ella was enjoying a cigarette, the next she was repulsed by it.

One day she consulted osteopath Edward Sorgesen. He quickly realised the complexity of her problem—that she led disparate lives as five different personalities. Edward soon assumed the role of Samaritan. A harrowing story unfolded.

After the slow and beautiful development of trust between the two, Edward learnt from Ella's medical records that she had a severely scarred cervix and Fallopian tubes as a result of brutal childhood abortions following ritual abuse. She talked about this lucidly as one of her five personalities. The rituals continued to the present day and Ella was called repeatedly on a mobile phone by her abusers while lodging with Edward and his wife and son. Her phone's ring tone acted as a trigger, snapping her back into the submissive personality, allowing her to be beguiled back to her abusers.​abusers.




Figure 1



May 33rd: a refreshing portrayal of mental illness

Credit: BBC






An alarming feature of this film was the unpredictability surrounding any severe mental health problem. What can be done to protect these people? How can others be educated about their changeable behaviour? At one point, Edward offered to go with Ella and the police to the house of her abusers. She explained that the police would yet again ignore the claims of a woman with known mental health problems and would end up apologising to her abusers for wasting their time.

The power of May 33rd was its realism—no distracting Hollywood glitter, but just a television audience and a humbling feeling of “There but for the grace of God...”

This compelling one-off production was truly refreshing. It clearly brought home how a mental health problem—acute or chronic—could be just as terrifying as any other major illness. The tragic end to this film showed Ella coming full circle. Innocent, helpless, and mentally ill, and having finally found and felt emotional warmth, she ended up back in the realm of her tormentors. Could this outcome have been avoided? This film opened up our minds to the possibility that it could.
Abstract 14272: Posttraumatic Stress Disorder, Major Depression and Incidence of Coronary Heart Disease
Authors: Viola Vaccarino, Amit Shah, Cherie Rooks, Emir Veledar, J. Douglas Bremner, Jack Goldberg
Journal: Circulation (2011)

Background. Posttraumatic stress disorder (PTSD) is an emerging risk factor for CHD, but is comorbid with major depressive disorder (MDD), an established CHD risk factor. We sought to determine the...
Abstract 290: Out-of-Hospital Airway Management Performance in the United States
Authors: Henry E Wang, N. C Mann, Gregory Mears, Karen Jacobson, Donald M Yealy
Journal: Circulation (2010)

Objective: Advanced airway management techniques (endotracheal intubation (ETI), alternate airway insertion (AA) and cricothyroidotomy (CRIC)) are common in out-of-hospital resuscitation. While pri...
Abstract 1399: Caffeinated Coffee Blunts the Myocardial Protective Effects of Statins Against Ischemia-Reperfusion Injury
Authors: Ghassan H Abu Said, Yumei Ye, Yu Lin, Saraswathy Manickavasagam, Ming-He Huang, Yochai Birnbaum
Journal: Circulation (2007)

Background: Studies have shown controversial results whether caffeinated coffee adversely affects cardiovascular morbidity and mortality. With average daily intake of 3.1 cups of coffee, the daily ...
Fortnightly Review: How to ensure that guidelines are effective
Authors: R. Thomson, M. Lavender, R. Madhok
Journal: BMJ (1995)

#### Summary points

The assessment of a health practice and the development of a policy for the use of that practice is the final step in a long process that begins with a research idea and ends in actual changes in people's health. All the accumulated research, development, and experience is converted into practical recommendations that largely determine what happens to a patient. In this pivotal position the design of a policy deserves whatever effort is required to ensure that all the proceeding work is put to the best effect1

There is an explosion of interest in guidelines, reflected in a vivid debate ranging from “the best thing since sliced bread” to cries of “cookbook medicine” and fears of constraint on clinical freedom.2 3 4 5 6 7 8 Furthermore, the Department of Health has introduced an initiative to encourage the adoption of evidence based guidelines within purchaser-provider contracts,9 10 and a review of the effectiveness of clinical guidelines has recently been published.11

The subject of guidelines is complex. Even for enthusiasts, ensuring that guidelines are effective by addressing each part of the complex chain of development, dissemination, implementation, and evaluation (fig 1) can be a daunting task. There are an increasing number of publications on the subject--for example, on the details of guideline development and effectiveness.1 12 13 14 15 16 In particular, the seminal work of Grimshaw and Russell has led to a …
Abstract 4759: Endothelin-1: A Useful Prognostic Marker After Acute Myocardial Infarction
Authors: Xavier Freixa, Ada Doltra, José Tomás Ortiz, Sergio Argiró, Eduard Guasch, Magda Heras, Marcelo Jiménez, Amadeo Betriu, Mónica Masotti
Journal: Circulation (2009)

INTRODUCTION: High Endothelin-1 (E-1) levels have been linked to poor clinical outcomes after myocardial infarction (MI). Vasoconstriction of the coronary microcirculation seems to be the underlying mechanism. However, the relationship between E-1 levels and microvascular integrity in the setting of MI has not been analyzed. OBJECTIVES To assess the effect of E-1 on microvascular integrity, necrosis volume, left ventricular ejection fraction (LVEF) and myocardial savage (M-sav) in evolving MI. METHODS: We measured E-1 levels in a consecutive series of 127 patients (pts) presenting with a first MI. Blood samples for E-1 measurements were taken 6 to 24 hours after MI onset. MRI was performed within 1 week following presentation and microvascular obstruction (MO), necrosis volume and LVEF was assessed by ce-CMR. M-sav was definded as the % of angiographic area at risk by the BARI score that spared necrosis on the MRI. RESULTS: Mean age was 60.9±11,8 years and 94(80%) were males. MI location was anterior in 47.2%. As shown in table , high E-1 levels were associated to admission Killip ≥2, higher prePCI TIMI 0, worse postPCI MBG and higher mortality at 30 days. MO was documented in 48%. High E-1 values were also associated with MO and worse M-sav while no significant correlation was obtained with necrosis volume and LVEF. Compared to Troponin I/CKMB peak values, E-1 levels showed better correlation with MO, M-sav, Killip on admission, MBG postPCI and mortality at 30 days. CONCLUSIONS: In humans, high E-1 levels after MI are closely associated with the presence of MO and worse M-sav. E-1 assessment renders prognostic information, independent from that provided by LVEF and necrosis volume
Abstract 14923: Disruption of Ca2+ Homeostasis induces activation of Heat Shock Proteins and a Shift in Cytoskeleton Composition
Authors: Cathrine Husberg, Giulio Agnetti, Staale Nygaard, Kristin Breivik Andersson, Geir Christensen, Jennifer E Van Eyk
Journal: Circulation (2011)

BACKGROUND: Alteration of Ca2+ homeostasis is known to be an important mechanism underlying the progression to heart failure. However, a conditional, cardiac specific SERCA2 knockout (SERCA2 KO) mo...
Abstract 17011: Loss-of-function SIRT3 Single Nucleotide Polymorphisms in Patients With Pulmonary Arterial Hypertension (PAH): Insights into the Metabolic Basis of PAH
Authors: Vikram Gurtu, Roxane Paulin, Linda Webster, Ian Paterson, Steeve Provencher, Sebastien Bonnet, Evangelos Michelakis
Journal: Circulation (2013)
Abstract 14623: "Estrogen Prevents Aortic Calcification by inducing MGP Expression and Inhibiting BMP Expression in an Estrogen Receptor alpha Dependent Way
Authors: Mariana K Osako, Hironori Nakagami, Hiromi Rakugi, Ryuichi Morishita
Journal: Circulation (2010)

Background: Unopposed RANKL (receptor activator of NFkB ligand) activation causes osteoporosis and vascular calcification in mice, and both phenotypes coincide in women with estrogen deficiency. RA...
Abstract 1527: Impact Of Glomerular Filtration Rate On Outcome In Consecutive Patients With Stemi In Clinical Practice: Results Of The Acos-registry
Authors: Anselm K Gitt, Harm Wienbergen, Frank Towae, Martin G Gottwik, Jochen Senges
Journal: Circulation (2007)

Background: Patients with renal failure have a higher cardiovascular morbidity and mortality. Little is known about the impact of renal failure on the acute outcome of ST-elevation myocardial infarction (STEMI) in clinical practice. Methods: Between 2000 and 2002 a total of 8303 consecutive patients with STEMI were enrolled into the multicenter ACOS-registry in Germany. We examined the impact of the glomerular filtration rate (GFR) on hospital outcome in clinical practice. GFR was calculated using the Cockroft-Gault-Formula. Results: Patients with reduced GFR were older, more often female, more often had prior myocardial infarctions and coronary interventions, a higher prevalence of concomitant diseases and a worse TIMI-risk score. than patients with GFR &gt;90 ml/min. Patients with impaired GFR did receive acute reperfusion therapy significantly less often. After adjustment for these differences by multivariate regression analysis, renal failure was associated with significant higher hospital mortality (GFR 30–59 ml/min: OR 2.38; GFR &lt; 30 ml/min: OR 5.18, p&lt;0.01). Conclusion: In consecutive STEMI-patients severe renal failure (GFR&lt;30 ml/min) was independently associated with a more than 5-fold increased hospital mortality in clinical practice.
Abstract 15729: Neuregulin 1beta/erbb2 Signaling is Critical for Cardiac Recovery After Ischemic Injury
Authors: Laura Pentassuglia, Yukio Kuramochi, Chee Lim, Amish Patel, Xuyang Peng, Carlos Arteaga, Douglas B Sawyer
Journal: Circulation (2010)

Introduction: ErbB2 plays a critical role in developing and adult heart. Neuregulin-1beta (Nrg) modulates PI3Kinase, MAPK, and Src/FAK signalling pathways in cardiac myocytes and thereby modulates cell survival and other phenotypes. Nrg is activated in the heart by ischemia/reperfusion injury, leading us to hypothesize that Nrg/ErbB modulates myocyte-matrix and myocyte-myocyte coupling and the response of the heart to ischemic injury at the intercalated disk. Methods: Co-immunoprecipitation assays were performed to assess interactions between ErbB receptors and components of the FAC. Isolated mouse hearts were perfused according to the Langerdorff method, and subjected 15 min ischemia followed by 30 min of reperfusion (I/R). Hearts were fixed and immunostaining, histological and electron microscopy analysis was performed. Results: Nrg induced ErbB2/ErbB4 co-immunoprecipitation with Src, FAK, p130CAS, and Paxilin in isolated myocytes. In isolated hearts subjected to I/R injury, phosphorylation of erbB2, FA...
Predicting readmission to the psychiatric hospital in a managed care environment: implications for quality indicators
Authors: J S Lyons, M T O'Mahoney, S I Miller, J Neme, J Kabat, F Miller
Journal: American Journal of Psychiatry (1997)

This study examined predictors of hospital readmission to determine whether readmissions can serve as a quality indicator for an inpatient psychiatric service.A series of 255 patients consecutively admitted to any of seven psychiatric hospitals in a regional managed care program were followed to determine whether they were readmitted within 6 months of discharge. Case managers assessed patients with the use of a reliable outcome management/decision support system designed for acute psychiatric services.Patients with greater impairment in self-care, more severe symptoms, and more persistent illnesses were more likely to be readmitted than other patients. Suicidal patients were less likely to be readmitted. There was no evidence to suggest that poor hospital outcome or premature discharge was associated with readmission either within 30 days or within 6 months.Although patients at risk for hospital admission can be identified, it does not appear that the success of the hospital intervention per se influences the likelihood of readmission. Use of readmission rates as quality indicators for hospital care providers is not recommended.
Abstract 2819: Identification and Characterization of Super-Responders to Cardiac Resynchronization Therapy: An Echocardiographic Study
Authors: Amira Zaroui, Patricia Reant, Erwan Donal, Aude Mignot, Pierre Bordachar, Antoine Deplagne, Aude Solnon, Christophe Leclercq, Raymond Roudaut, Stephane Lafitte
Journal: Circulation (2008)

In some patients, cardiac resynchronization therapy (CRT) has been recently shown to induce a spectacular effect on left ventricular (LV) function and inverted remodeling with nearby normalization of LV contraction. Objectives: To analyze and characterize super-responders (CRTSR) by echocardiography before CRT. 186 patients have been investigated before and 6 months after implantation of a CRT device with conventional indication according to ESC guidelines. Echocardiographies including measurements of LV dimensions, and contraction by 2-dimensional strain, and pressure assessment, mitral valve analysis were performed at baseline and at 6 months in an independent core-center lab. CRTSR were defined as a reduction of end-systolic volume of at least 15% and an ejection fraction (EF)&gt;50% and were compared to normal responder patients (CRTNo, patients with a reduction of end-systolic volume of at least 15% but an EF &lt;50%). 17/186 patients (9.1%) were identified as CRTSR, only 2 with ischemic cardiomyopathy (p&lt;0.01). No difference was observed regarding NYHA status, EKG duration or EF between CRTSR and CRTNo at baseline. CRTSR presented with significant lower end-diastolic and end-systolic diameters (64±9mm vs 73±9mm (p&lt;0.01) and 53±7.4mm vs 63±8.4mm (p&lt;0.01), respectively), and end-diastolic and end-systolic volumes 161±44ml vs 210±76ml (p&lt;0.02) and 123±43ml vs 163±69ml (p&lt;0.01)) as well as a higher LV dP/dt max (714±251mmHg.s −1 vs 527±188 mmHg.s −1 (p&lt;0.05)). Regarding strain analysis, CRTSR had significantly higher longitudinal values than CRTNo (−12.8±3% vs −9±2.6%, p&lt;0.001) whereas no difference was observed for other components (p ns). Global longitudinal strain obtained by ROC curves was identified as the best parameter for predicting CRTSR with a cut-off value of −11% (Se=80%, Spe=87%, AUC=0.89, p&lt;0.002) and was confirmed as an independent predictor by the logistic regression (RR: 21.3, p&lt;0.0001). In a large multicenter study, CRT super-responders (EF&gt;50%) were observed in 9% of the population and were associated with less-depressed LV function as determined by strain analysis. Global longitudinal strain appears to be the best predictor of CRTSR.
Small-volume 7.5% NaCl adenocaine/Mg2+ preserves cardiac function during hypotensive resuscitation in the pig following severe hemorrhagic shock
Authors: Asger Granfeldt, Hayley L. Letson, Janus A Hyldebrandt, Edward R. Wang, Pablo A. Salcedo, Torben K. Nielsen, Else Tønnesen, Jakob Vinten-Johansen, Geoffrey P. Dobson
Journal: Circulation (2012)

[Extract]  Background: Cardiac rescue is critical for successful resuscitation. Previously, we reported that ~1 ml/kg 7.5% NaCl with Adenocaine (adenosine and lidocaine) and Mg2+ (ALM) successfully resuscitated rats following severe hemorrhagic shock, and that in pigs ALM significantly reduced the volume of Ringers acetate required to raise MAP to a target of 50 mmHg following 74% blood loss. The present study examines the effect of small volume 7.5% NaCl ALM on cardiac function during 60 min hypotensive resuscitation following 90 min shock in the porcine model.

Methods: Pigs (35-40kg) were subjected to pressure-controlled hemorrhage at a mean arterial pressure (MAP) of 35-40mmHg for 90 min (~75% blood loss). Pigs were randomly assigned to receive either 4 ml/kg 7.5% NaCl ALM (ALM n=8) or 4 ml/kg 7.5% NaCl (Control n=8). Cardiac output (CO), stroke volume, left-ventricular pressures and hemodynamics were collected continuously. Significance *p<0.05.

Results: MAP, end-systolic pressure and CO were significantly higher in the ALM pigs at the end of hypotensive resuscitation (Table). The higher CO was due to a higher stroke volume (SV) maintained at a significantly lower heart rate (HR). Paradoxically dP/dtmax tended to be higher in the Control group during the first 45min of hypotensive resuscitation (p=0.066) with no difference at 60min. Systolic ejection times were significantly increased in the ALM group and inversely related to HR. There was no difference in LV end-diastolic pressure between the two groups indicating that preload was similar during hypotensive resuscitation. LV blood flow at 30min resuscitation was comparable in the two groups (Control: 2.86±0.6 vs. ALM: 4.1±1.4 ml/min/g; p=0.7)

Conclusion: Superior cardiac rescue was achieved in ALM by a higher SV and CO, lower HR and longer ejection times vs Controls. Longer isovolumic contraction and ejection times may be due to suppression of SA nodal activity or rebalancing of sympathetic/parasympathetic control.