https://www.wikidoc.org/api.php?action=feedcontributions&user=C+Michael+Gibson&feedformat=atomwikidoc - User contributions [en]2024-03-28T19:58:28ZUser contributionsMediaWiki 1.40.0https://www.wikidoc.org/index.php?title=Cardiac_amyloidosis_medical_therapy&diff=1587389Cardiac amyloidosis medical therapy2019-10-30T18:16:13Z<p>C Michael Gibson: /* Overview */</p>
<hr />
<div>__NOTOC__<br />
{{Cardiac amyloidosis}}<br />
{{CMG}}; {{AE}} {{RT}}; {{AN}}; {{CZ}}; {{LG}}<br />
<br />
==Overview==<br />
Major cardiac manifestations of systemic amyloidosis include [[heart failure]] and fatal [[arrhythmias]]. Therefore, in addition to treating the underlying disease, the treatment of cardiac amyloidosis includes the treatment of heart failure and arrhythmias. Treatment of heart failure associated with cardiac amyloidosis differs from therapy usually administered in patients with systolic or [[diastolic dysfunction]]. Loop diuretics are the drugs of choice in the treatment of heart failure in cardiac amyloidosis.<br />
<br />
==Medical Therapy==<br />
===Treatment of Underlying Disease===<br />
'''ATTR Amyloidosis'''<br />
<br />
Tafamidis (ATTR stabilization molecule) has been approved by regulatory agencies for treatment of patients with ATTR cardiomyopathy and NYHA functional class I-III symptoms. The ATTR-ACT study randomized 441 patients with ATTR amyloid cardiomyopathy (mutant or while type) to tafamidis 80 mg, 20 mg, or placebo, and followed the patients for 30 months.<ref>{{Cite web|url=https://www.nejm.org/doi/full/10.1056/NEJMoa1805689|title=Tafamidis Treatment for Patients with Transthyretin Amyloid Cardiomyopathy|last=Maurer|first=Mathew S.|date=10/29/2019|website=|archive-url=|archive-date=|dead-url=|access-date=}}</ref> Compared with placebo, tafamidis reduced mortality (29.5 vs 42.8% HR 0.70; 95% CI 0.51 to 0.86) and cardiovascular hospitalizations (0.48 vs 0.70 per year; RR 0.68; 95% CI 0.56 to 0.81). <br />
====AL Amyloidosis====<br />
The definitive treatment of AL amyloidosis includes antiplasma cell therapy aimed at halting the process of paraprotein production responsible for the formation of amyloid. Major treatment strategies include:<ref name="pmid15078166">{{cite journal |author=De Lorenzi E, Giorgetti S, Grossi S, Merlini G, Caccialanza G, Bellotti V |title=Pharmaceutical strategies against amyloidosis: old and new drugs in targeting a "protein misfolding disease" |journal=[[Current Medicinal Chemistry]] |volume=11 |issue=8 |pages=1065–84 |year=2004 |month=April |pmid=15078166 |doi= |url=}}</ref><ref name="pmid14684147">{{cite journal |author=Gertz MA, Lacy MQ, Dispenzieri A |title=Therapy for immunoglobulin light chain amyloidosis: the new and the old |journal=[[Blood Reviews]] |volume=18 |issue=1 |pages=17–37 |year=2004 |month=March |pmid=14684147 |doi= |url=}}</ref><br />
* [[Chemotherapy]]<br />
* Autologous [[hematopoietic stem cell transplantation]] (HSCT)<br />
<br />
=====Chemotherapy=====<br />
Most common chemotherapy regimens used in the treatment of AL amyloidosis are:<br />
* [[Melphalan]] and [[prednisone]]<ref name="pmid12060126">{{cite journal |author=Sanchorawala V, Wright DG, Seldin DC, ''et al.'' |title=Low-dose continuous oral melphalan for the treatment of primary systemic (AL) amyloidosis |journal=[[British Journal of Haematology]] |volume=117 |issue=4 |pages=886–9 |year=2002 |month=June |pmid=12060126 |doi= |url=}}</ref><br />
* Melphalan and [[dexamethasone]]<ref name="pmid15070667">{{cite journal |author=Palladini G, Perfetti V, Obici L, ''et al.'' |title=Association of melphalan and high-dose dexamethasone is effective and well tolerated in patients with AL (primary) amyloidosis who are ineligible for stem cell transplantation|journal=[[Blood]] |volume=103 |issue=8 |pages=2936–8 |year=2004 |month=April |pmid=15070667 |doi=10.1182/blood-2003-08-2788 |url=}}</ref><br />
* [[Thalidomide]] and dexamethasone<ref name="pmid15572585">{{cite journal |author=Palladini G, Perfetti V, Perlini S, ''et al.'' |title=The combination of thalidomide and intermediate-dose dexamethasone is an effective but toxic treatment for patients with primary amyloidosis (AL) |journal=[[Blood]] |volume=105 |issue=7 |pages=2949–51 |year=2005 |month=April |pmid=15572585 |doi=10.1182/blood-2004-08-3231 |url=}}</ref><br />
* [[Cyclophosphamide]] and dexamethasone<br />
* [[Bortezomib]],<ref name="pmid18024372">{{cite journal |author=Kastritis E, Anagnostopoulos A, Roussou M, ''et al.'' |title=Treatment of light chain (AL) amyloidosis with the combination of bortezomib and dexamethasone |journal=[[Haematologica]] |volume=92 |issue=10 |pages=1351–8 |year=2007 |month=October |pmid=18024372 |doi=10.3324/haematol.11325 |url=}}</ref> pomalidomide<ref name="pmid22493299">{{cite journal |author=Dispenzieri A, Buadi F, Laumann K, ''et al.'' |title=Activity of pomalidomide in patients with immunoglobulin light-chain amyloidosis |journal=[[Blood]] |volume=119 |issue=23 |pages=5397–404 |year=2012 |month=June |pmid=22493299 |doi=10.1182/blood-2012-02-413161 |url=}}</ref><ref name="pmid23572409">{{cite journal |author=Elkinson S, McCormack PL |title=Pomalidomide: first global approval |journal=[[Drugs]] |volume=73 |issue=6 |pages=595–604 |year=2013 |month=May |pmid=23572409 |doi=10.1007/s40265-013-0047-x |url=}}</ref> and [[lenalidomide]]<ref name="pmid17008538">{{cite journal |author=Dispenzieri A, Lacy MQ, Zeldenrust SR, ''et al.'' |title=The activity of lenalidomide with or without dexamethasone in patients with primary systemic amyloidosis |journal=[[Blood]] |volume=109 |issue=2 |pages=465–70 |year=2007 |month=January |pmid=17008538 |doi=10.1182/blood-2006-07-032987 |url=}}</ref><ref name="pmid16960148">{{cite journal |author=Sanchorawala V, Wright DG, Rosenzweig M, ''et al.'' |title=Lenalidomide and dexamethasone in the treatment of AL amyloidosis: results of a phase 2 trial |journal=[[Blood]] |volume=109 |issue=2 |pages=492–6 |year=2007 |month=January |pmid=16960148 |doi=10.1182/blood-2006-07-030544 |url=}}</ref> either as monotherapy or with other agents. These agents are especially helpful in relapsing and refractory patients.<br />
<br />
Of all the chemotherapy regimens, treatment with IV melphalan has shown the highest success rate, with a complete hematologic response in ≈40% of patients. However patients with advanced [[heart failure]], [[pleural effusion]], markedly thickened ventricular wall and elevated [[troponin]] levels are associated with poor prognosis in patients treated with chemotherapy. In patients with cardiac amyloid, an [[ejection fraction]] of <40% is considered an absolute contraindication for high dose chemotherapy. A standard regimen of melphalan includes pulsed dose administration of melphalan and prednisone for 3 to 5 days every 6 weeks. An alternative regimen is monthly injection of slow continuous low-dose melphalan. Bortezomib, a novel proteasome inhibitor, has been shown to be associated with higher response rates similar to that of HSCT.<ref name="pmid18245653">{{cite journal |author=Wechalekar AD, Lachmann HJ, Offer M, Hawkins PN, Gillmore JD |title=Efficacy of bortezomib in systemic AL amyloidosis with relapsed/refractory clonal disease |journal=[[Haematologica]] |volume=93 |issue=2 |pages=295–8 |year=2008 |month=February |pmid=18245653 |doi=10.3324/haematol.11627 |url=}}</ref><ref name="pmid19498019">{{cite journal |author=Reece DE, Sanchorawala V, Hegenbart U, ''et al.'' |title=Weekly and twice-weekly bortezomib in patients with systemic AL amyloidosis: results of a phase 1 dose-escalation study |journal=[[Blood]] |volume=114 |issue=8 |pages=1489–97 |year=2009 |month=August |pmid=19498019 |doi=10.1182/blood-2009-02-203398 |url=}}</ref> Frequent assessment of plasma free light chains and cardiac biomarkers should be a part of the treatment strategy, to optimize risk/benefit ratio and to prevent chemotherapy related toxicity.<ref name="pmid16434487">{{cite journal |author=Palladini G, Lavatelli F, Russo P, ''et al.'' |title=Circulating amyloidogenic free light chains and serum N-terminal natriuretic peptide type B decrease simultaneously in association with improvement of survival in AL |journal=[[Blood]] |volume=107 |issue=10 |pages=3854–8 |year=2006 |month=May |pmid=16434487 |doi=10.1182/blood-2005-11-4385 |url=}}</ref><br />
<br />
=====Autologous Hematopoietic Stem Cell Transplantation (HSCT)=====<br />
[[HSCT]] is one of the two widely used regimens in the treatment of AL amyloidosis, the other being a combination of melphalan and dexamethasone. This treatment strategy includes administration of high-dose IV melphalan followed by stem cell rescue.<ref name="pmid14676787">{{cite journal |author=Sanchorawala V, Wright DG, Seldin DC, ''et al.'' |title=High-dose intravenous melphalan and autologous stem cell transplantation as initial therapy or following two cycles of oral chemotherapy for the treatment of AL amyloidosis: results of a prospective randomized trial |journal=[[Bone Marrow Transplantation]] |volume=33 |issue=4 |pages=381–8 |year=2004 |month=February |pmid=14676787 |doi=10.1038/sj.bmt.1704346 |url=}}</ref><ref name="pmid16835967">{{cite journal |author=Vesole DH, Pérez WS, Akasheh M, Boudreau C, Reece DE, Bredeson CN |title=High-dose therapy and autologous hematopoietic stem cell transplantation for patients with primary systemic amyloidosis: a Center for International Blood and Marrow Transplant Research Study |journal=[[Mayo Clinic Proceedings. Mayo Clinic]] |volume=81 |issue=7 |pages=880–8 |year=2006 |month=July |pmid=16835967 |doi=10.4065/81.7.880 |url=}}</ref> In selected patients response rates can approach 60%.<ref name="pmid22781604">{{cite journal |author=Qiu ZX, Wang MJ, Wang LH, ''et al.'' |title=[Clinical investigation of primary amyloidosis with autologous hematopoietic stem cell transplantation] |language=Chinese |journal=[[Zhonghua Xue Ye Xue Za Zhi = Zhonghua Xueyexue Zazhi]] |volume=33 |issue=3 |pages=187–90 |year=2012 |month=March |pmid=22781604 |doi= |url=}}</ref><ref name="pmid15942100">{{cite journal |author=Shimojima Y, Matsuda M, Ishii W, ''et al.'' |title=High-dose melphalan followed by autologous stem cell support in primary systemic AL amyloidosis with multiple organ involvement |journal=[[Internal Medicine (Tokyo, Japan)]] |volume=44 |issue=5 |pages=484–9 |year=2005 |month=May |pmid=15942100 |doi= |url=}}</ref><ref name="pmid17673601">{{cite journal |author=Sanchorawala V, Skinner M, Quillen K, Finn KT, Doros G, Seldin DC |title=Long-term outcome of patients with AL amyloidosis treated with high-dose melphalan and stem-cell transplantation |journal=[[Blood]] |volume=110 |issue=10 |pages=3561–3 |year=2007 |month=November |pmid=17673601 |pmc=2077307 |doi=10.1182/blood-2007-07-099481 |url=}}</ref> Although HSCT has been shown to be associated with reduced mortality, selection of patients remains a critical step while employing this method in the treatment of AL amyloidosis. Reports indicate best results were obtained in patients with one or two organ involvement, no cardiac dysfunction and in those with [[nephrotic syndrome]] as the predominant manifestation of systemic [[amyloidosis]]. On the contrary, patients with multi-organ involvement, cardiac dysfunction and renal insufficiency are at high risk for morbidity and mortality when treated with HSCT. Poor prognostic predictors include:<br />
* Multi-organ involvement<br />
* Cardiac dysfunction<ref name="pmid12719281">{{cite journal |author=Palladini G, Campana C, Klersy C, ''et al.'' |title=Serum N-terminal pro-brain natriuretic peptide is a sensitive marker of myocardial dysfunction in AL amyloidosis |journal=[[Circulation]] |volume=107 |issue=19 |pages=2440–5 |year=2003 |month=May |pmid=12719281 |doi=10.1161/01.CIR.0000068314.02595.B2 |url=}}</ref><br />
* Elevated [[cardiac biomarker]]s<ref name="pmid15044258">{{cite journal |author=Dispenzieri A, Gertz MA, Kyle RA, ''et al.'' |title=Prognostication of survival using cardiac troponins and N-terminal pro-brain natriuretic peptide in patients with primary systemic amyloidosis undergoing peripheral blood stem cell transplantation |journal=[[Blood]] |volume=104 |issue=6 |pages=1881–7 |year=2004 |month=September |pmid=15044258 |doi=10.1182/blood-2004-01-0390 |url=}}</ref><br />
* High pre-transplant free light chain ratio<ref name="pmid20798235">{{cite journal |author=Kumar S, Dispenzieri A, Katzmann JA, ''et al.'' |title=Serum immunoglobulin free light-chain measurement in primary amyloidosis: prognostic value and correlations with clinical features |journal=[[Blood]] |volume=116 |issue=24 |pages=5126–9 |year=2010 |month=December |pmid=20798235 |pmc=3012533 |doi=10.1182/blood-2010-06-290668 |url=}}</ref><br />
* Elevated serum [[uric acid]]<ref name="pmid18315995">{{cite journal |author=Kumar S, Dispenzieri A, Lacy MQ, ''et al.'' |title=Serum uric acid: novel prognostic factor in primary systemic amyloidosis |journal=[[Mayo Clinic Proceedings. Mayo Clinic]] |volume=83 |issue=3 |pages=297–303 |year=2008 |month=March |pmid=18315995 |doi=10.4065/83.3.297 |url=}}</ref><br />
<br />
Treatment related mortality limits the use of HSCT in every patient and thus warrants a need for the careful selection of patients.<br />
<br />
In a randomized controlled trial conducted by the French Myeloma Collaborative Group comparing high dose melphalan followed by HSCT with melphalan and dexamethasone combination regimen, it was found that there exists no significant differences in the treatment outcomes between the two regimens.<ref name="pmid17855669">{{cite journal |author=Jaccard A, Moreau P, Leblond V, ''et al.'' |title=High-dose melphalan versus melphalan plus dexamethasone for AL amyloidosis |journal=[[The New England Journal of Medicine]] |volume=357 |issue=11 |pages=1083–93 |year=2007 |month=September |pmid=17855669 |doi=10.1056/NEJMoa070484 |url=}}</ref><br />
<br />
'''Investigational Agents'''<br />
<br />
Several [[Cardiac amyloidosis future or investigational therapies|investigational products]] are currently being studied in clinical trials. These include small interfering RNA (siRNA) molecules which reduce the production of the amyloid precursor misfolded protein and ATTR stabilization molecules. <br />
===Treatment of Heart Failure===<br />
Heart failure in cardiac amyloidosis (CA) is due to extracellular deposition of amyloid fibrils which results in reduced myocardial compliance and myonecrosis. This extensive infltration of amyloid results in non-compliant, small ventricles leading to impaired filling. Infiltration of the atria further worsens the situation as it impairs atrial contraction. <br />
<br />
====Acute Pharmacotherapy====<br />
Pharmacotherapy in heart failure associated with amyloidosis is different from heart failure due to other causes in that loop diuretics are the main stay of treatment and beta-blockers and ACE inhibitors may be harmful. TTR CA responds better to pharmacotherapy than AL cardiac amyloidosis.<br />
<br />
* Loop diuretics are the drugs of choice in the treatment of heart failure in cardiac amyloidosis. Higher doses of diuretics are used if concomitant [[nephrotic syndrome]] is present.<br />
* Hospitalization and IV diuretics are recommended in the presence of severe symptoms. Careful monitoring of blood pressure and renal function is warranted as rigorous use of diuretics can progress to [[azotemia]]. Addition of an [[aldosterone antagonist]] such as [[spironolactone]] to loop diuretics is well tolerated. Patients with [[anasarca]] have reduced absorption rate for the drugs and hence are given intravenous medications.<br />
* Beta-blockers have been shown to have no proven benefit in the treatment of heart failure associated with amyloidosis. Moreover their use may worsen the condition in patients in whom cardiac output is dependent on heart rate due to presence of a low, fixed stroke volume.<br />
* Clinical experience with ACE inhibitors in this scenario has shown that these agents are often associated with profound hypotension in AL type CA. The reason for that is possibly by exposing a subclinical neuropathy.<br />
*[[Calcium channel blockers]] bind to the amyloid fibrils and thereby have been reported to increase the incidence of [[congestive heart failure]] and produce [[arrhythmias]]. Because of this abnormal binding to amyloid fibrils patients with cardiac amyloidosis may be exceptionally sensitive to the negative inotropic effects of these drugs and hence, these drugs are contraindicated in patients with both AL and TTR cardiac amyloidosis.<ref name="pmid4003315">{{cite journal |author=Gertz MA, Skinner M, Connors LH, Falk RH, Cohen AS, Kyle RA |title=Selective binding of nifedipine to amyloid fibrils |journal=[[The American Journal of Cardiology]] |volume=55 |issue=13 Pt 1 |pages=1646 |year=1985 |month=June |pmid=4003315 |doi= |url= |accessdate=2012-02-13}}</ref><ref name="pmid4003314">{{cite journal |author=Gertz MA, Falk RH, Skinner M, Cohen AS, Kyle RA |title=Worsening of congestive heart failure in amyloid heart disease treated by calcium channel-blocking agents |journal=[[The American Journal of Cardiology]] |volume=55 |issue=13 Pt 1 |pages=1645 |year=1985 |month=June |pmid=4003314 |doi= |url= |accessdate=2012-02-13}}</ref><ref name="pmid7014028">{{cite journal |author=Rubinow A, Skinner M, Cohen AS |title=Digoxin sensitivity in amyloid cardiomyopathy |journal=[[Circulation]] |volume=63 |issue=6 |pages=1285–8 |year=1981 |month=June |pmid=7014028 |doi= |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=7014028 |accessdate=2012-02-13}}</ref><ref name="pmid8339658">{{cite journal |author=Pollak A, Falk RH |title=Left ventricular systolic dysfunction precipitated by verapamil in cardiac amyloidosis |journal=[[Chest]] |volume=104 |issue=2 |pages=618–20 |year=1993 |month=August |pmid=8339658 |doi= |url=}}</ref><ref name="pmid6891504">{{cite journal |author=Griffiths BE, Hughes P, Dowdle R, Stephens MR |title=Cardiac amyloidosis with asymmetrical septal hypertrophy and deterioration after nifedipine |journal=[[Thorax]] |volume=37 |issue=9 |pages=711–2 |year=1982 |month=September |pmid=6891504 |pmc=459412 |doi= |url=}}</ref><br />
*[[Digoxin]] also binds to amyloid fibrils and is associated with increased risk of digitalis toxicity.<br />
<br />
*In patients with [[bradycardia|symptomatic bradycardia]], [[pacemaker]]s may be indicated.<ref name="pmid9399732">{{cite journal |author=Mathew V, Olson LJ, Gertz MA, Hayes DL |title=Symptomatic conduction system disease in cardiac amyloidosis |journal=[[The American Journal of Cardiology]] |volume=80 |issue=11 |pages=1491–2 |year=1997 |month=December |pmid=9399732 |doi= |url=http://linkinghub.elsevier.com/retrieve/pii/S0002-9149(97)82785-3 |accessdate=2012-02-13}}</ref><ref name="pmid9259166">{{cite journal |author=Mathew V, Chaliki H, Nishimura RA |title=Atrioventricular sequential pacing in cardiac amyloidosis: an acute Doppler echocardiographic and catheterization hemodynamic study |journal=[[Clinical Cardiology]] |volume=20 |issue=8 |pages=723–5 |year=1997 |month=August |pmid=9259166 |doi= |url= |accessdate=2012-02-13}}</ref><br />
<br />
===Treatment of Atrial Fibrillation===<br />
Involvement of the atria in CA increases the risk for developing [[atrial fibrillation]] (AFib). Interstitial deposition of amyloid fibrils makes the atria less compliant and forms a substrate for the development of AFib. <ref name="pmid12379579">{{cite journal |author=Röcken C, Peters B, Juenemann G, ''et al.'' |title=Atrial amyloidosis: an arrhythmogenic substrate for persistent atrial fibrillation |journal=[[Circulation]] |volume=106 |issue=16 |pages=2091–7 |year=2002 |month=October |pmid=12379579 |doi= |url=}}</ref> AFib with rapid ventricular rate can be treated using the following drugs:<br />
<br />
* Low dose [[beta-blocker]]s: Should be used with caution and with constant blood pressure monitoring<br />
*[[Digoxin]]: Digoxin should be used with caution in patients with CA as these patients are more prone for digitalis toxicity.<br />
*[[Amiodarone]]: Amiodarone is used for rhythm control and is proved to be well tolerated in these patients.<br />
<br />
===Anticoagulation===<br />
Occurrence of intracardiac thrombi is frequent in patients with cardiac amyloidosis especially in the AL type. [[Atrial fibrillation]], poor left ventricular diastolic function and atrial mechanical dysfunction have been shown to be associated with increased risk for developing intracardiac thrombi. Thrombi can be present even when the patient is in sinus rhythm.<ref name="pmid19414641">{{cite journal |author=Feng D, Syed IS, Martinez M, ''et al.'' |title=Intracardiac thrombosis and anticoagulation therapy in cardiac amyloidosis |journal=[[Circulation]] |volume=119 |issue=18 |pages=2490–7 |year=2009 |month=May |pmid=19414641|doi=10.1161/CIRCULATIONAHA.108.785014 |url=}}</ref><ref name="pmid17984380">{{cite journal |author=Feng D, Edwards WD, Oh JK, ''et al.'' |title=Intracardiac thrombosis and embolism in patients with cardiac amyloidosis |journal=[[Circulation]] |volume=116 |issue=21 |pages=2420–6 |year=2007 |month=November |pmid=17984380 |doi=10.1161/CIRCULATIONAHA.107.697763 |url=}}</ref> Indications for anticoagulation with [[warfarin]] include:<br />
<br />
* Presence of AFib<br />
* Diminutive transmitral A wave and depressed left atrial appendage velocity on echo signalling atrial failure, especially in AL type CA<br />
<br />
Because of the increased risk for thromboembolism and subsequent stroke in patients with CA, anticoagulation is not withheld once indicated unless an absolute contraindication exists.<br />
<br />
===Supportive Measures===<br />
<br />
* Physical activity may continue as long as the patient can tolerate it.<br />
* Diet restrictions vary with the extent of [[cardiomyopathy]] and [[heart failure]]. These may include [[salt]] and/or [[fluid]] restrictions.<br />
<br />
==References==<br />
{{reflist|2}}<br />
<br />
{{WikiDoc Help Menu}}<br />
{{WikiDoc Sources}}<br />
[[CME Category::Cardiology]]<br />
<br />
[[Category:Disease]]<br />
[[Category:Cardiology]]<br />
[[Category:Rheumatology]]</div>C Michael Gibsonhttps://www.wikidoc.org/index.php?title=Cardiac_amyloidosis_future_or_investigational_therapies&diff=1587387Cardiac amyloidosis future or investigational therapies2019-10-30T18:12:23Z<p>C Michael Gibson: </p>
<hr />
<div>__NOTOC__<br />
{{Cardiac amyloidosis}}<br />
{{CMG}}; {{AE}} {{RT}}; {{AN}}<br />
<br />
==Overview==<br />
Several investigational products targeting ATTR amyloid are being studied in clinical trials. These include small interfering RNA (siRNA) molecules which reduce the production of the amyloid precursor misfolded protein and ATTR stabilization molecules. <br />
<br />
==Future or Investigational Therapies==<br />
Potential future treatment options targeting cardiac TTR amyloidosis include:<br />
<br />
* AG10: AG10 is a selective, oral TTR stabilizer which mimics a protective TTR mutation known as T119M. In a phase 2 clinical trial, AG10 was found to be safe and effective. This trial randomized 49 patients with mutant or wild-type TTR amyloid cardiomyopathy with NYHA class II to III heart failure symptoms to AG10 400 mg, 800 mg, or placebo twice daily for 28 days, and found the medication to be well tolerated and to achieve near-complete stabilization of TTR.<ref>{{Cite web|url=https://www.sciencedirect.com/science/article/pii/S0735109719339208?via%3Dihub|title=Transthyretin Stabilization by AG10 in Symptomatic Transthyretin Amyloid Cardiomyopathy|last=Judge|first=Daniel P.|date=10/29/2019|website=|archive-url=|archive-date=|dead-url=|access-date=}}</ref> A phase 3 trial (ATTRIBUTE-CM) is ongoing (NCT03458130).<br />
* Patisiran: this is a siRNA molecule which has shown promise in patients with polyneuropathy from hereditary TTR amyloidosis. A cardiac subgroup study showed favorable biomarker results as well.<ref>{{Cite web|url=https://www.nejm.org/doi/10.1056/NEJMoa1716153?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3dwww.ncbi.nlm.nih.gov|title=Patisiran, an RNAi Therapeutic, for Hereditary Transthyretin Amyloidosis|last=Adams|first=David|date=10/29/19|website=|archive-url=|archive-date=|dead-url=|access-date=}}</ref><br />
<br />
==References==<br />
{{Reflist|2}}<br />
<br />
{{WikiDoc Help Menu}}<br />
{{WikiDoc Sources}}<br />
[[CME Category::Cardiology]]<br />
<br />
[[Category:Disease]]<br />
[[Category:Cardiology]]<br />
[[Category:Rheumatology]]</div>C Michael Gibsonhttps://www.wikidoc.org/index.php?title=Cardiac_amyloidosis_future_or_investigational_therapies&diff=1587385Cardiac amyloidosis future or investigational therapies2019-10-30T18:10:50Z<p>C Michael Gibson: /* Future or Investigational Therapies */</p>
<hr />
<div>__NOTOC__<br />
{{Cardiac amyloidosis}}<br />
{{CMG}}; {{AE}} {{RT}}; {{AN}}<br />
<br />
==Overview==<br />
Several investigational products targeting ATTR amyloid are being studied in clinical trials. These include small interfering RNA (siRNA) molecules which reduce the production of the amyloid precursor misfolded protein and ATTR stabilization molecules. <br />
<br />
==Future or Investigational Therapies==<br />
Potential future treatment options targeting cardiac TTR amyloidosis include:<br />
<br />
* AG10: AG10 is a selective, oral TTR stabilizer which mimics a protective TTR mutation known as T119M. In a phase 2 clinical trial, AG10 was found to be safe and effective. This trial randomized 49 patients with mutant or wild-type TTR amyloid cardiomyopathy with NYHA class II to III symptoms to AG10 400 mg, 800 mg, or placebo twice daily for 28 days, and found the medication to be well tolerated and achieve near-complete stabilization of TTR.<ref>{{Cite web|url=https://www.sciencedirect.com/science/article/pii/S0735109719339208?via%3Dihub|title=Transthyretin Stabilization by AG10 in Symptomatic Transthyretin Amyloid Cardiomyopathy|last=Judge|first=Daniel P.|date=10/29/2019|website=|archive-url=|archive-date=|dead-url=|access-date=}}</ref> A phase 3 trial (ATTRIBUTE-CM) is ongoing (NCT03458130).<br />
* Patisiran: this is a siRNA molecule which has shown promise in patients with polyneuropathy from hereditary TTR amyloidosis. A cardiac subgroup study showed favorable biomarker results as well.<ref>{{Cite web|url=https://www.nejm.org/doi/10.1056/NEJMoa1716153?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3dwww.ncbi.nlm.nih.gov|title=Patisiran, an RNAi Therapeutic, for Hereditary Transthyretin Amyloidosis|last=Adams|first=David|date=10/29/19|website=|archive-url=|archive-date=|dead-url=|access-date=}}</ref><br />
<br />
==References==<br />
{{Reflist|2}}<br />
<br />
{{WikiDoc Help Menu}}<br />
{{WikiDoc Sources}}<br />
[[CME Category::Cardiology]]<br />
<br />
[[Category:Disease]]<br />
[[Category:Cardiology]]<br />
[[Category:Rheumatology]]</div>C Michael Gibsonhttps://www.wikidoc.org/index.php?title=Cerebellum&diff=1579983Cerebellum2019-08-19T13:49:25Z<p>C Michael Gibson: /* External links */</p>
<hr />
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Components = |<br />
Artery = [[Superior cerebellar artery|SCA]], [[anterior inferior cerebellar artery|AICA]], [[posterior inferior cerebellar artery|PICA]] |<br />
Vein = [[superior cerebellar veins|superior]], [[inferior cerebellar veins|inferior]] |<br />
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BrainInfoNumber = |<br />
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MeshNumber = A08.186.211.132.810.428.200 |<br />
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DorlandsSuf = |<br />
}}<br />
{{SI}}<br />
{{CMG}}<br />
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<br />
==Overview==<br />
<br />
The '''cerebellum''' ([[Latin]]: "little brain") is a region of the [[brain]] that plays an important role in the integration of [[perception|sensory perception]] and [[motoneuron|motor]] output. Many [[neural pathway]]s link the cerebellum with the [[motor cortex]]—which sends information to the [[muscle]]s causing them to move—and the [[spinocerebellar tract]]—which provides feedback on the position of the body in space ([[proprioception]]). The cerebellum integrates these pathways, using the constant feedback on body position to fine-tune motor movements.<br />
<br />
Because of this 'updating' function of the cerebellum, [[lesion]]s within it are not so debilitating as to cause [[paralysis]], but rather present as [[feedback]] deficits resulting in disorders in fine movement, [[Equilibrioception|equilibrium]], posture, and [[motor learning]]. Initial observations by [[physiology|physiologists]] during the 18th century indicated that patients with cerebellar damage show problems with [[motor coordination]] and movement. Research into cerebellar function during the early to mid 19th century was done via lesion and ablation studies in [[animal]]s. Research physiologists noted that such lesions led to animals with strange movements, awkward gait, and muscular weakness. These observations and studies led to the conclusion that the cerebellum was a motor control structure.<ref name="Fine">{{cite journal | author=Fine EJ, Ionita CC, Lohr L | title=The history of the development of the cerebellar examination | journal=Semin Neurol | year=2002 | pages=375-84 | volume=22 | issue=4 | id=PMID 12539058}}</ref> However, modern research shows that the cerebellum has a broader role in a number of key cognitive functions, including [[attention]] and the processing of [[language]], music, and other sensory temporal stimuli. <br />
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==General features==<br />
<br />
The cerebellum is located in the inferior posterior portion of the head (the [[rhombencephalon|hindbrain]]), directly dorsal to the [[pons]], and inferior to the [[occipital lobe]] (Figs. 1 and 3). Because of its large number of tiny [[granule cell]]s, the cerebellum contains nearly 50% of all [[neuron]]s in the brain, but it only takes up 10% of total brain volume. The cerebellum receives nearly 200 million input fibers; in contrast, the [[optic nerve]] is composed of a mere one million fibers.<br />
<br />
The cerebellum is divided into two large hemispheres, much like the [[telencephalon|cerebrum]], and contains ten smaller lobules. The [[cytoarchitectonics|cytoarchitecture]] ([[cell (biology)|cellular]] organization) of the cerebellum is highly uniform, with connections organized into a rough, three-dimensional array of perpendicular [[biological neural network|circuit]] elements. This organizational uniformity makes the nerve circuitry relatively easy to study. To envision this "perpendicular array," one might imagine a tree-lined street with wires running straight through the branches of one tree to the next.<br />
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==Development and evolution==<br />
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[[Image:CajalCerebellum.jpg|right|thumb|300px|Figure 2: Drawing of the [[cell (biology)|cells]] in the chicken cerebellum by [[Santiago Ramón y Cajal|S. Ramón y Cajal]].]]<br />
<br />
During the early stages of [[embryogenesis|embryonic development]], the brain starts to form in three distinct segments: the [[prosencephalon]], [[mesencephalon]], and [[rhombencephalon]]. The rhombencephalon is the most caudal (toward the tail) segment of the embryonic brain; it is from this segment that the cerebellum develops. Along the embryonic rhombencephalic segment develop eight swellings, called [[rhombomere]]s. The cerebellum arises from two rhombomeres located in the [[alar plate]] of the [[neural tube]], a structure that eventually forms the brain and spinal cord. The specific rhombomeres from which the cerebellum forms are rhombomere 1 (Rh.1) caudally (near the tail) and the "isthmus" rostrally (near the front).<!--<br />
--><ref name="Muller">{{cite journal | author=Muller F, O'Rahilly R | title=The human brain at stages 21–23, with particular reference to the cerebral cortical plate and to the development of the cerebellum | journal=Anat Embryol (Berl) | year=1990 | pages=375–400 | volume=182 | issue=4 | id=PMID 2252222}}</ref><br />
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Two primary regions are thought to give rise to the neurons that make up the cerebellum. The first region is the ventricular zone in the roof of the [[fourth ventricle]]. This area produces [[Purkinje cell]]s and deep cerebellar [[nucleus (neuroanatomy)|nuclear]] neurons. These cells are the primary output neurons of the cerebellar cortex and cerebellum. The second germinal zone (cellular birthplace) is known as the external granular layer. This layer of cells—found on the exterior the cerebellum—produces the granule neurons. Once born, the granule neurons migrate from this exterior layer to form an inner layer known as the internal granule layer. The external granular layer ceases to exist in the mature cerebellum, leaving only granule cells in the internal granule layer. The cerebellar [[white matter]] may be a third germinal zone in the cerebellum; however, its function as a germinal zone is controversial.<br />
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The cerebellum is of [[archipallium|archipalliar]] [[phylogeny|phylogenetic]] origin. The [[pallium (anatomy)|pallium]] is a term for gray matter that forms the cortex. The archipallium is the one of the most [[evolution]]arily primitive brain regions. The circuits in the cerebellar cortex look similar across all [[class (biology)|class]]es of [[vertebrate]]s, including fish, reptiles, birds, and [[mammals]] (e.g., Fig. 2). This has been taken as evidence that the cerebellum performs functions important to all vertebrate [[species]].<br />
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==Anatomy==<br />
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The cerebellum contains similar [[gray matter|gray]] and white matter divisions as the [[cerebrum]]. Embedded within the white matter—which is known as the ''[[arbor vitae (anatomy)|arbor vitae]]'' (Tree of Life) in the cerebellum due to its branched, treelike appearance—are four deep cerebellar nuclei. Three gross phylogenetic segments are largely grouped by general function. The three cortical layers contain various cellular types that often create various feedback and feedforward loops. [[Oxygen]]ated [[blood]] is supplied by three [[artery|arterial]] branches off the [[basilar artery|basilar]] and [[vertebral artery|vertebral arteries]].<br />
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===Divisions===<br />
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The cerebellum can be divided according to three different criteria: gross anatomical, phyologenetical, and functional.<br />
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====Gross anatomical divisions====<br />
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On gross inspection, three lobes can be distinguished in the cerebellum: the '''flocculonodular lobe''', the '''anterior lobe''' (rostral to the "primary fissure"), and the '''posterior lobe''' (dorsal to the "primary fissure"). The latter two can be further divided in a midline '''[[cerebellar vermis]]''' and lateral '''cerebellar hemispheres'''.<br />
<br />
{| align=center<br />
| [[Image:CerebellumRegions.jpg|thumb|center|400px|Figure 3: Cerebellum and surrounding regions; sagittal view of one hemisphere. A: [[Midbrain]]. B: [[Pons]]. C: [[Medulla oblongata|Medulla]]. D: [[Spinal cord]]. E: [[ventricular system|Fourth ventricle]]. F: [[Arbor vitae (anatomy)|''Arbor vitae'']]. G: [[Cerebellar_tonsils|Tonsil]]. H: Anterior lobe. I: Posterior lobe.]] || [[Image:CerebellumDiv.png|thumb|center|380px|Figure 4: Schematic representation of the major anatomical subdivisions of the cerebellum. Superior view of an "unrolled" cerebellum, placing the vermis in one plane.]]<br />
|}<br />
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====Phylogenetic and functional divisions====<br />
The cerebellum can also be divided in three parts based on both [[phylogenetics|phylogenetic]] criteria (the evolutionary age of each part) and on functional criteria (the incoming and outgoing connections each part has and the role played in normal cerebellar function). From the phylogenetically oldest to the newest, the three parts are:<br />
<br />
{| class="wikitable"<br />
| '''Functional denomination''' (''phylogenetic denomination)'' || '''Anatomical parts''' || '''Role'''<br />
|- <br />
| '''Vestibulocerebellum''' ''(Archicerebellum)'' || Flocculonodular lobe (and immediately adjacent vermis) || The vestibulocerebellum regulates balance and eye movements. It receives [[vestibular system|vestibular]] input from both the [[semicircular canals]] and from the [[vestibular nuclei]], and sends fibres back to the medial and lateral vestibular nuclei. It also receives [[visual system|visual]] input from the [[superior colliculi]] and from the [[visual cortex]] (the latter via the [[pontine nuclei]], forming a cortico-ponto-cerebellar pathway). Lesions of the vestibulocerebellum cause disturbances of balance and [[gait]].<br />
|- <br />
| '''Spinocerebellum''' ''(Paleocerebellum)'' || Vermis and intermediate parts of the hemispheres ("paravermis") || The spinocerebellum regulates body and limb movements. It receives [[proprioceptive|proprioception]] input from the dorsal columns of the [[spinal cord]] (including the [[spinocerebellar tract]]) as well as from the [[trigeminal nerve]], as well as from visual and [[auditory system|auditory]] systems. It sends fibres to deep cerebellar nuclei which in turn project to both the cerebral cortex and the brain stem, thus providing modulation of descending motor systems. The spinocerebellum contains sensory maps as it receives data on the position of various body parts in space: in particular, the vermis receives fibres from the trunk and proximal portions of limbs, while the intermediate parts of the hemispheres receive fibres from the distal portions of limbs. The spinocerebellum is able to elaborate proprioceptive input in order to anticipate the future position of a body part during the course of a movement, in a "feed forward" manner.<br />
|- <br />
| '''Cerebrocerebellum''' ''(Neocerebellum)'' || Lateral parts of the hemispheres || The neocerebellum is involved in planning movement and evaluating sensory information for action. It receives input exclusively from the cerebral cortex (especially the [[parietal lobe]]) via the pontine nuclei (forming cortico-ponto-cerebellar pathways), and sends fibres mainly to the ventrolateral [[thalamus]] (in turn connected to motor areas of the [[premotor cortex]] and [[primary motor area]] of the cerebral cortex) and to the [[red nucleus]] (in turn connected to the [[inferior olivary nucleus]], which links back to the cerebellar hemispheres). The neocerebellum is involved in planning movement that is about to occur<ref>{{cite book|last=Kingsley |first=R. E.|authorlink=|title=Consise Text of Neuroscience|edition=2nd edition|publisher=Lippincott Williams and Wilkins|location=|year=2000|isbn=0-683-30460-7|series=}}</ref> and has purely cognitive functions as well.<br />
|}<br />
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Much of what is understood about the functions of the cerebellum stems from careful documentation of the effects of focal lesions in human patients who have suffered from injury or disease or through animal lesion research.<br />
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===Deep nuclei===<br />
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The four deep cerebellar nuclei are in the center of the cerebellum, embedded in the white matter. These nuclei receive [[Inhibitory postsynaptic potential|inhibitory]] ([[GABA]]ergic) inputs from Purkinje cells in the cerebellar cortex and [[Excitatory postsynaptic potential|excitatory]] ([[glutamate]]rgic) inputs from [[mossy fiber]] pathways. Most output fibers of the cerebellum originate from these nuclei. One exception is that fibers from the flocculonodular lobe synapse directly on [[vestibular nuclei]] without first passing through the deep cerebellar nuclei. The vestibular nuclei in the [[brainstem]] are analogous structures to the deep nuclei, since they receive both mossy fiber and Purkinje cell inputs.<br />
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From lateral to medial, the four deep cerebellar nuclei are the [[dentate nucleus|dentate]], [[Nucleus_emboliformis|emboliform]], [[Globose nucleus|globose]], and [[fastigial nucleus|fastigial]]. An easy [[mnemonic]] device to remember these names and positions relative to their position from the midline is the phrase "'''D'''on't '''E'''at '''G'''reasy '''F'''ood", where each letter indicates the lateral to medial location in the cerebellar white matter. Some animals do not have distinct emboliform and globose nuclei, instead having a single, fused nucleus interpositus (interposed nucleus). In animals with distinct emboliform and globose nuclei, the term ''interposed nucleus'' is often used to refer collectively to these two nuclei. <br />
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In general, each pair of deep nuclei is associated with a corresponding region of cerebellar surface anatomy. The dentate nuclei are deep within the lateral hemispheres, the interposed nuclei are located in the paravermal (intermediate) zone, and the fastigial nuclei are in the vermis. These structural relationships are generally maintained in the neuronal connections between the nuclei and associated cerebellar cortex, with the dentate nucleus receiving most of its connections from the lateral hemispheres, the interposed nuclei receiving inputs mostly from the paravermis, and the fastigial nucleus receiving primarily afferents from the vermis.<br />
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===Cortical layers===<br />
[[Image:CerebCircuit.png|thumb|300px|right|Figure 5: Microcircuitry of the cerebellum. Excitatory synapses are denoted by (+) and inhibitory synapses by (-). MF: [[Mossy fiber]]. DCN: Deep cerebellar nuclei. IO: [[Inferior olivary nucleus|Inferior olive]]. CF: [[Climbing fiber]]. GC: Granule cell. PF: [[Parallel fiber]]. PC: [[Purkinje cell]]. GgC: Golgi cell. SC: Stellate cell. BC: Basket cell.]]<br />
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[[Image:L7cerebellum.png|thumb|300px|right|Figure 6: [[Confocal laser scanning microscopy|Confocal]] [[micrograph]] from mouse cerebellum expressing green-fluorescent protein in [[Purkinje cells]].]]<br />
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There are three layers to the cerebellar cortex; from outer to inner layer, these are the molecular, Purkinje, and granular layers. The function of the cerebellar cortex is essentially to modulate information flowing through the deep nuclei. The microcircuitry of the cerebellum is schematized in Figure 5. [[Mossy fiber|Mossy]] and [[climbing fiber]]s carry sensorimotor information into the deep nuclei, which in turn pass it on to various premotor areas, thus regulating the [[Gain#Electronics|gain]] and timing of motor actions. Mossy and climbing fibers also feed this information into the cerebellar cortex, which performs various computations, resulting in the regulation of Purkinje cell firing. Purkinje neurons feed back into the deep nuclei via a potent inhibitory [[synapse]]. This synapse regulates the extent to which mossy and climbing fibers activate the deep nuclei, and thus control the ultimate effect of the cerebellum on motor function. The synaptic strength of almost every synapse in the cerebellar cortex has been shown to undergo [[synaptic plasticity]]. This allows the circuitry of the cerebellar cortex to continuously adjust and fine-tune the output of the cerebellum, forming the basis of some types of motor learning and coordination. Each layer in the cerebellar cortex contains the various cell types that comprise this circuitry.<br />
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====Granular layer====<br />
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The innermost layer contains the cell bodies of two types of cells: the numerous and tiny [[granule cell]]s, and the larger [[Golgi cell]]s. Mossy fibers enter the granular layer from their main point of origin, the pontine nuclei. These fibers form excitatory synapses with the granule cells and the cells of the deep cerebellar nuclei. The granule cells send their T-shaped axons—known as [[parallel fiber]]s—up into the superficial molecular layer, where they form hundreds of thousands of synapses with Purkinje cell [[dendrite]]s. The human cerebellum contains on the order of 60 to 80 billion granule cells, making this single cell type by far the most numerous neuron in the brain (roughly 70% of all neurons in the brain and spinal cord, combined). Golgi cells provide inhibitory feedback to granule cells, forming a synapse with them and projecting an axon into the molecular layer.<br />
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====Purkinje layer====<br />
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The middle layer contains only one type of cell body—that of the large [[Purkinje cell]]. Purkinje cells are the primary integrative neurons of the cerebellar cortex and provide its sole output. Purkinje cell dendrites are large arbors with hundreds of spiny branches reaching up into the molecular layer (Fig. 6). These dendritic arbors are flat—nearly all of them lie in planes—with neighboring Purkinje arbors in parallel planes. Each parallel fiber from the granule cells runs [[orthogonality|orthogonally]] through these arbors, like a wire passing through many layers. Purkinje neurons are GABAergic—meaning they have inhibitory synapses—with the neurons of the deep cerebellar and vestibular nuclei in the brainstem. Each Purkinje cell receives excitatory input from 100,000 to 200,000 parallel fibers. Parallel fibers are said to be responsible for the simple (all or nothing, [[amplitude]] invariant) spiking of the Purkinje cell.<br />
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Purkinje cells also receive input from the [[inferior olivary nucleus]] via [[climbing fiber]]s. A good mnemonic for this interaction is the phrase "climb the other olive tree", given that climbing fibers originate from the contralateral inferior olive. In striking contrast to the 100,000-plus inputs from parallel fibers, each Purkinje cell receives input from exactly one climbing fiber; but this single fiber "climbs" the dendrites of the Purkinje cell, winding around them and making a large number of synapses as it goes. The net input is so strong that a single [[action potential]] from a climbing fiber is capable of producing a "complex spike" in the Purkinje cell: a burst of several spikes in a row, with diminishing amplitude, followed by a pause during which simple spikes are suppressed.<br />
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====Molecular layer==== <br />
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This outermost layer of the cerebellar cortex contains two types of inhibitory [[interneuron]]s: the [[stellate cell|stellate]] and [[basket cell]]s. It also contains the dendritic arbors of Purkinje neurons and parallel fiber tracts from the granule cells. Both stellate and basket cells form GABAergic synapses onto Purkinje cell dendrites.<br />
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===Peduncles===<br />
Similarly, the cerebellum follows the trend of "threes", with three major input and output peduncles (fiber bundles). These are the superior (brachium conjunctivum), middle (brachium pontis), and inferior (restiform body) cerebellar peduncles. <br />
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{| class="wikitable"<br />
| '''Peduncle''' || '''Description'''<br />
|- <br />
| [[Superior cerebellar peduncles|Superior]] || While there are some afferent fibers from the [[anterior spinocerebellar tract]] that are conveyed to the anterior cerebellar lobe via this peduncle, most of the fibers are efferents. Thus, the superior cerebellar peduncle is the major output pathway of the cerebellum. Most of the efferent fibers originate within the [[dentate nucleus]] which in turn project to various [[midbrain]] structures including the [[red nucleus]], the ventral lateral/ventral anterior nucleus of the [[thalamus]], and the [[medulla]]. The dentatorubrothalamocortical (dentate nucleus > [[red nucleus]] > [[thalamus]] > [[premotor cortex]]) and cerebellothalamocortical (cerebellum > thalamus > premotor cortex) pathways are two major pathways that pass through this peduncle and are important in motor planning.<br />
|- <br />
| [[Middle cerebellar peduncles|Middle]] || This is composed entirely of afferent fibers originating within the [[pontine nuclei]] as part of the massive corticopontocerebellar tract (cerebral cortex > pons > cerebellum). These fibers descend from the sensory and motor areas of the cerebral [[neopallium|neocortex]] and make the middle cerebellar peduncle the largest of the three cerebellar peduncles.<br />
|- <br />
| [[Inferior cerebellar peduncle|Inferior]] || This carries many types of input and output fibers that are mainly concerned with integrating [[Proprioception|proprioceptive]] sensory input with motor [[Vestibular system|vestibular functions]] such as balance and posture maintenance. Proprioceptive information from the body is carried to the cerebellum via the dorsal [[spinocerebellar tract]]. This tract passes through the inferior cerebellar peduncle and synapses within the paleocerebellum. Vestibular information projects onto the archicerebellum.<BR>The [[climbing fiber]]s of the [[Inferior olivary nucleus|inferior olive]] run through the inferior cerebellar peduncle.<BR>This peduncle also carries information directly from the [[Purkinje cells]] out to the [[vestibular nuclei]] in the dorsal brainstem located at the junction between the [[pons]] and [[medulla]].<br />
|}<br />
<br />
There are three sources of input to the cerebellum, in two categories consisting of mossy and climbing fibers, respectively. Mossy fibers can originate from the pontine nuclei, which are clusters of neurons located in the pons that carry information from the contralateral cerebral cortex. They may also arise within the spinocerebellar tract whose origin is located in the [[Anatomical position|ipsilateral]] [[spinal cord]]. Most of the output from the cerebellum initially synapses onto the deep cerebellar nuclei before exiting via the three peduncles. The most notable exception is the direct inhibition of the vestibular nuclei by Purkinje cells.<br />
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===Blood supply===<br />
[[Image:CerebellumArteries.jpg|right|thumb|300px|Figure 7: The three major arteries of the cerebellum: the SCA, AICA, and PICA.]]<br />
Three arteries supply blood to the cerebellum (Fig. 7): the [[superior cerebellar artery]] (SCA), [[anterior inferior cerebellar artery]] (AICA), and [[posterior inferior cerebellar artery]] (PICA).<br />
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====Superior cerebellar artery====<br />
The SCA branches off the lateral portion of the basilar artery, just inferior to its bifurcation into the posterior cerebral artery. Here it wraps posteriorly around the pons (to which it also supplies blood) before reaching the cerebellum. The SCA supplies blood to most of the cerebellar cortex, the cerebellar nuclei, and the middle and superior cerebellar peduncles.<br />
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====Anterior inferior cerebellar artery====<br />
The AICA branches off the lateral portion of the basilar artery, just superior to the junction of the vertebral arteries. From its origin, it branches along the inferior portion of the pons at the cerebellopontine angle before reaching the cerebellum. This artery supplies blood to the anterior portion of the inferior cerebellum, and to the [[facial nerve|facial]] (CN VII) and [[vestibulocochlear nerve]]s (CN VIII).<br />
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Obstruction of the AICA can cause [[paresis]], [[paralysis]], and loss of sensation in the face; it can also cause [[hearing impairment]]. Moreover, it could cause an infarct of the cerebellopontine angle. This could lead to [[hyperacusia]] (dysfunction of the stapedius muscle, innervated by [[CN VII]]) and [[vertigo (medical)|vertigo]] (wrong interpretation from the vestibular semi-circular canal's [[endolymph]] acceleration caused by alteration of [[CN VIII]]).<br />
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====Posterior inferior cerebellar artery====<br />
The PICA branches off the lateral portion of the vertebral arteries just inferior to their junction with the basilar artery. Before reaching the inferior surface of the cerebellum, the PICA sends branches into the medulla, supplying blood to several [[cranial nerve]] nuclei. In the cerebellum, the PICA supplies blood to the posterior inferior portion of the cerebellum, the inferior cerebellar peduncle, the [[nucleus ambiguus]], the [[vagus nerve|vagus]] motor nucleus, the spinal [[trigeminal nerve|trigeminal]] nucleus, the [[solitary nucleus]], and the [[vestibulocochlear nerve|vestibulocochlear]] nuclei.<br />
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==Dysfunction==<br />
{{seemain|Ataxia}}<br />
<br />
''Ataxia'' is a complex of symptoms, generally involving a lack of coordination, that is often found in disease processes affecting the cerebellum. To identify cerebellar problems, the [[neurological examination]] includes assessment of gait (a broad-based gait being indicative of ataxia), finger-pointing tests and assessment of posture.<ref name="Fine" /> Structural abnormalities of the cerebellum (hemorrhage, infarction, neoplasm, degeneration) may be identified on cross-sectional imaging. [[Magnetic resonance imaging]] is the modality of choice, as [[computed tomography]] is insufficiently sensitive for detecting structural abnormalities of the cerebellum.<ref>{{cite journal |author=Gilman S |title=Imaging the brain. Second of two parts |journal=N. Engl. J. Med. |volume=338 |issue=13 |pages=889-96 |year=1998 |pmid=9516225 |doi=}}</ref><br />
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==Theories about cerebellar function==<br />
Two main theories address the function of the cerebellum, both dealing with motor coordination. One claims that the cerebellum functions as a regulator of the "timing of movements". This has emerged from studies of patients whose timed movements are disrupted.<!--<br />
--><ref name="Ivry">{{cite journal | author=Ivry RB, Keele SW, Diener HC | title=Dissociation of the lateral and medial cerebellum in movement timing and movement execution | journal=Exp Brain Res | year=1988 | pages=167-80 | volume=73 | issue=1 | id=PMID 3208855}}</ref><br />
<br />
The second, "Tensor Network Theory" provides a mathematical model of transformation of sensory (covariant) space-time coordinates into motor (contravariant) coordinates by cerebellar neuronal networks.<!--<br />
--><ref name="Neuroscience1980-Pellionisz">{{cite journal | author =Pellionisz, A., Llinás, R. | year =1980 | month = | title =Tensorial Approach To The Geometry Of Brain Function: Cerebellar Coordination Via A Metric Tensor | journal = Neuroscience | volume =5 | issue = | pages = 1125&mdash;-1136 | id = | url= http://usa-siliconvalley.com/inst/pellionisz/80_metric/80_metric.html}}</ref><!--<br />
--><ref name="Neuroscience1985-Pellionisz">{{cite journal | author = Pellionisz, A., Llinás, R. | year =1985 | month = | title= Tensor Network Theory Of The Metaorganization Of Functional Geometries In The Central Nervous System | journal = Neuroscience | volume =16 | issue =2 | pages = 245–273| url = http://usa-siliconvalley.com/inst/pellionisz/85_metaorganization/85_metaorganization.html }}</ref><br />
<br />
Like many controversies in the physical sciences, there is evidence supporting each of the above hypotheses. Studies of motor learning in the [[vestibulo-ocular reflex]] and [[eyeblink conditioning]] demonstrate that the timing and [[amplitude]] of learned movements are encoded by the cerebellum.<!--<br />
--><ref name="Boyden"> {{cite journal | author=Boyden ES, Katoh A, Raymond JL | title=Cerebellum-dependent learning: the role of multiple plasticity mechanisms | journal=Annu Rev Neurosci | year=2004 | pages=581–609 | volume=27 | id=PMID 15217344}}</ref><br />
Many [[synaptic plasticity]] mechanisms have been found throughout the cerebellum. The Marr-Albus model mostly attributes motor learning to a single plasticity mechanism: the [[long-term depression]] of parallel fiber synapses. The Tensor Network Theory of sensorimotor transformations by the cerebellum has also been experimentally supported.<!--<br />
--><ref name="Neuroscience1982-Pellionisz">{{cite journal | author=Pellionisz A, Llinas R | title=Space-time representation in the brain. the cerebellum as a predictive space-time metric tensor | journal=Neuroscience | year=1982 | pages=2949–70 | volume=7 | issue=12 | id=PMID 7162624}}</ref><!--<br />
--><ref name="Neuroscience1986-Gielen">{{cite journal | author=Gielen CC, van Zuylen EJ | title=Coordination of arm muscles during flexion and supination: application of the tensor analysis approach | journal=Neuroscience | year=1986 | pages=527-39 | volume=17 | issue=3 | id=PMID 3703248}}</ref><br />
<br />
With the advent of more sophisticated [[neuroimaging]] techniques such as [[positron emission tomography]] (PET),<!--<br />
--><ref name="Obayashi">{{cite journal | author=Obayashi S | title=Possible mechanism for transfer of motor skill learning: implication of the cerebellum | journal=Cerebellum | year=2004 | pages=204-11 | volume=3 | issue=4 | id=PMID 15686098}}</ref><br />
and fMRI,<!--<br />
--><ref name="Kim">{{cite journal | author=Kim SG, Ugurbil K, Strick PL | title=Activation of a cerebellar output nucleus during cognitive processing | journal=Science | year=1994 | pages=949-51 | volume=265 | issue=5174 | id=PMID 8052851}}</ref><br />
numerous diverse functions are now at least partially attributed to the cerebellum. What was once thought to be primarily a motor/sensory integration region is now proving to be involved in many diverse cognitive functions. Paradoxically, despite the importance of this region and the heterogeneous role it plays in motor and sensory functions, people who have lost their entire cerebellum through disease, injury, or surgery can live reasonably normal lives.<br />
<br />
==Cerebellar modeling==<br />
<br />
As mentioned in the preceding section, there have been many attempts to [[Mathematical model|model]] the cerebellar function.<!--<br />
--><ref name="BrianTheory-Marr">{{cite book | last =Pellionisz | first =A | editor=Palm G., & Aertsen, A. | year =1986 | title =Brain Theory | chapter = David Marr's Theory of the Cerebellar Cortex: A Model in Brain Theory for the 'Galilean Combination of Simplification, Unification and Mathematization' | chapterurl =http://www.usa-siliconvalley.com/inst/pellionisz/marr/marr.html | pages =253–257 | publisher =Springer Verlag}}</ref> <br />
The insights provided by the models have also led to extrapolations in the domains of [[artificial intelligence]] methodologies, especially [[neural networks]]. Some of the notable achievements have been ''Cerebellatron '',<!--<br />
--><ref name="Lecturenotes-Hines">{{cite web | author = Dr Evor L. Hines | url = http://www.eng.warwick.ac.uk/eng/staff/elh/ise/session06/ise0629.html | title = Intelligent Systems Engineering - Major Characteristics of Expert Systems and Artificial Neural Networks | work = Intelligent Systems Engineering (ES3770) Lecture Notes | publisher School of Engineering, Warwick University = | accessdate=2006-03-28}}</ref><br />
''Cerebellar Model Associative Memory'' or ''CMAC'' networks,<!--<br />
--><!-- [http://athene.riv.csu.edu.au/~dcornfor/Papers/Cornforth_ANNES2001_25.pdf] as of 2006-03-28 bad link --><br />
and ''SpikeFORCE'' for robotic movement control,<!--<br />
--><ref name="SpikeFORCE">{{cite web | author = | authorlink = | coauthors = | year = | url = http://www.neuro-it.net/Activities/Alicante2003/spikeforce | title = SpikeFORCE: Real-time Spiking Networks for Robot Control | format = PDF | work = | publisher = | accessdate =2006-03-28 }}</ref><br />
and "Tensor Network Theory".<!--<br />
--><ref name="EncNeuro-Pellionisz">{{cite book | last = Pellionisz | first = András J. | editor = George Adelman | chapter = Tensor Network Theory of the Central Nervous System | chapterurl = http://usa-siliconvalley.com/inst/pellionisz/encyclopaedia/encyclopaedia.html | pages = 1196–1198 | title =Encyclopedia of Neuroscience | edition=II | publisher =Birkhauser}}</ref><br />
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==Additional images==<br />
<gallery><br />
Image:CT of brain of Mikael Häggström S3 I8.JPG|[[Computed tomography]] of head, with cerebellum visible at lower part.<br />
Image:Illu cerebrum lobes.jpg|Lobes<br />
Image:Illu diencephalon .jpg|[[Diencephalon]]<br />
Image:Gray677.png|Scheme showing the connections of the several parts of the [[brain]]. <br />
Image:Gray702.png|Upper surface of the cerebellum.<br />
Image:Gray703.png|Under surface of the cerebellum.<br />
Image:Gray704.png|Sagittal section of the cerebellum, near the junction of the [[vermis]] with the hemisphere. <br />
Image:Gray705.png|Dissection showing the projection fibers of the cerebellum.<br />
Image:Gray745.png|Dissection showing the course of the [[cerebrospinal fibers]].<br />
Image:Gray768.png|Diagram showing the positions of the three principal [[Subarachnoid space|subarachnoid cisternæ]].<br />
Image:Human cerebellum anterior view description.JPG|Human cerebellum anterior view<br />
Image:Human brain midsagittal view description.JPG|Human brain midsagittal view<br />
</gallery><br />
<br />
==See also== <br />
*[[Brain]]<br />
*[[Central nervous system]]<br />
*[[List of regions in the human brain|Regions in the human brain]]<br />
<br />
==External links==<br />
*A worldwide list of laboratories that do {{wayback|cerebellum.stanford.edu/|research on the cerebellum}}<br />
*[http://socrates.berkeley.edu/~ivrylab/research/cerebellum+timing.html Cerebellum and timing] at University of California, Berkeley<br />
*[http://www.mult-sclerosis.org/cerebellum.html Cerebellum and multiple sclerosis] at mult-sclerosis.org<br />
*[http://thalamus.wustl.edu/course/cerebell.html Basal ganglia and cerebellum] at Washington University in St. Louis<br />
*[http://biology.about.com/library/organs/brain/blcerebellumimage.htm Cerebellum images] at About.com<br />
* {{BrainMaps|cerebellum}}<br />
*[http://www.ii.bham.ac.uk/clinicalimmunology/Neuroimmunology/cerebellum.htm Histological section of primate cerebellum] at University of Birmingham<br />
<br />
==Further reading==<br />
<div class="references-small"><br />
* Ito M. ''Cerebellum and Neural Control''. New York: Raven Press; 1984. ISBN 0-89004-106-7<br />
* Kandel ER, Schwartz JH, Jessell TM. ''Principles of Neural Science'', 4th ed. McGraw-Hill, New York (2000). ISBN 0-8385-7701-6<br />
* Llinás, R, Sotelo C. ''The Cerebellum Revisited''. New York: Springer; 1992. ISBN 0-387-97693-0<br />
* Parent A, Carpenter MB. ''Carpenter's Human Neuroanatomy''. 9th ed. Philadelphia: Williams and Wilkins; 1995. ISBN 0-683-06752-4<br />
</div><br />
<br />
==References==<br />
{{Reflist|2}}<br />
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{{Rhombencephalon}}<br />
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[[Category:Neuroanatomy]]<br />
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{{WS}}</div>C Michael Gibsonhttps://www.wikidoc.org/index.php?title=Get_involved&diff=1500181Get involved2018-10-28T14:07:29Z<p>C Michael Gibson: </p>
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[[Category:Help]]</div>C Michael Gibsonhttps://www.wikidoc.org/index.php?title=When_do_we_meet%3F&diff=1500179When do we meet?2018-10-28T12:54:49Z<p>C Michael Gibson: Created page with "We meet every morning at 8:30 AM at 930 Commonwealth Avenue in Boston Massachusetts."</p>
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[[Category:Help]]</div>C Michael Gibsonhttps://www.wikidoc.org/index.php?title=User:C_Michael_Gibson&diff=1495854User:C Michael Gibson2018-09-28T16:41:27Z<p>C Michael Gibson: /* Disclosures: */</p>
<hr />
<div>[[Image:Cmg v4 small.jpg|right|250px|WikiDoc Founder C. Michael Gibson, M.S., M.D.]]<br />
'''C. Michael Gibson M.S., M.D.''', Professor of Medicine, Harvard Medical School <br />
<br />
Founder and Chairman of the Board, WikiDoc Foundation (a 509 (a)(1) Charitable Organization); Chief Executive Officer, Baim Institute for Clinical Research; Founder and Chairman of the [http://www.perfuse.org PERFUSE Study Group]<br />
<br />
'''Contact:''' mgibson@wikidoc.org[mailto:mgibson@wikidoc.org]; or at his G mail address: charlesmichaelgibson@gmail.com [mailto:charlesmichaelgibson@gmail.com]<br />
<br />
'''Mailing Address:''' C. Michael Gibson, M.S., M.D., Beth Israel Deaconess Medical Center<br />
330 Brookline Avenue, Overland 540, Boston, MA 02215 Boston MA, 02215.<br />
<br />
'''Headshot:''' Download headshot [//www.wikidoc.org/images/e/e6/Cmg_v4_small.jpg here]<br />
<br />
View Dr. Gibon's TEDx talk about WikiDoc on YouTube [https://www.youtube.com/watch?v=DMwZnFwueQU here]<br />
<br />
Download Dr. Gibson's slides from his TEDx talk about WikiDoc [//www.wikidoc.org/images/a/a6/Tedx_talk_v5.pptx here]<br />
<br />
<br />
__NOTOC__<br />
----<br />
C. Michael Gibson, M.S., M.D. is an interventional cardiologist, cardiovascular researcher and educator who pioneered our understanding of the "open artery hypothesis" as well our understanding of the importance of restoring flow downstream in the capillary bed in the "open microvasculature hypothesis" in heart attack patients. Gibson was chosen as one of the most influential scientific minds between 2002 and 2012 in a 2014 report from Thompson Reuters [http://sciencewatch.com/grr/presenting-highly-cited-researchers].<br />
<br />
Gibson founded www.wikidoc.org, the world's most widely viewed open source textbook of medicine (viewed 700,000 to 2.2 million times daily, hundreds of millions of times annually). He is Editor-In-Chief of over 2,200 active contributors which have edited the content millions of times. Gibson served as medical lead in a partnership with Google, Microsoft and Yahoo to design a scheme of classifying medical content for the internet (www.schema.org) to improve medical search results. Gibson also founded www.clinicaltrialresults.org and has conducted 2,000 TV / video interviews and serves as the anchor person for medical meetings such as TCT TV.<br />
<br />
For many years, Gibson has been chosen by his peers as one of Boston's Top Doctors in Boston Magazine. U.S. News & World Report also lists Gibson as one of America's top doctors. Gibson invented several of the measures of coronary blood flow that are widely used today (the TIMI frame count and the TIMI myocardial perfusion grade).<br />
<br />
Formerly Harvard Clinical Research Institute (HCRI), Gibson leads the Baim Institute for Clinical Research as CEO. It is a leading, non-profit academic research organization (ARO) that delivers insight, innovation and leadership in today’s dynamic research environment. Baim collaborates with the world’s most highly respected researchers from renowned institutions to help advance health and quality of life around the world. The entity has managed 450 studies which have enrolled over 160,000 patients, and has played a role in 50 FDA submissions.<br />
<br />
Gibson has led his own Academic Research Organization ([http://www.perfuse.org PERFUSE]) for over 25 years now, and has been principal investigator of or led core services for 106 clinical trials, the results of which have been published in leading journals such as the New England Journal of Medicine. The PERFUSE Study Group offers a full line of trial management, social media portals, CEC, DSMB and core lab services for phase 1-4 trials worldwide. Under Gibson's direction, the PERFUSE Study Group created the master database that unified data from over 25 years of TIMI studies (TIMI 1-50) in nearly 100,000 patients and coordinated data analyses for the TIMI study group and functioned as the TIMI Data Coordinating Center which he directed. Gibson has led phase 1-4 clinical trials, and cardiology megatrials of over 15,000 patients.<br />
<br />
==Education and Academic Positions==<br />
Dr. Gibson received his B.S., M.S., and M.D. degrees from the University of Chicago. He was an Intern, Resident and Chief Resident at the Brigham and Women’s Hospital, Harvard Medical School. He received his training as an interventional cardiologist and served as the Director of the Coronary Care Unit at Beth Israel Hospital, Harvard Medical School. Dr. Gibson then served as the Chief of Cardiology and Director of Interventional Cardiology at the West Roxbury Veterans Affairs Medical Center, Harvard Medical School. While at the West Roxbury VA, he also served as an Associate Physician at the Brigham and Women’s Hospital. He then moved on to Allegheny General Hospital as Vice Chairman of Medicine for Clinical Research and Director of Invasive Cardiology. He subsequently relocated to the west coast and served as Associate Chief of Cardiology, Chief of Interventional Cardiology and Director of the Cardiac Catheterization Laboratory at University of California San Francisco (UCSF). In 2000, Gibson returned to Harvard Medical School in Boston. Until 2003, Dr. Gibson served as Chief Academic Officer and Director of Core Services at Harvard Clinical Research Institute (HCRI), until 2005 he served as Associate Chief of Cardiology and Director of Academic Affairs in the Cardiovascular Division at the Beth Israel Deaconess Medical Center. Until 2009 he served as the Director of the TIMI Data Coordinating Center at the Brigham and Women’s Hospital. He is currently a full time interventional cardiologist and Chief of Clinical Research in the Cardiovascular Division at Beth Israel Deaconess Medical Center, Harvard Medical School. <br />
<br />
==Research==<br />
Dr. Gibson’s work has largely focused on investigating the pathophysiology of coronary artery disease and the efficacy of pharmacologic and device based therapies. His work has been presented in many thousands manuscripts, abstracts, trial summaries, textbooks and textbook chapters. Gibson's work has been cited over 56,957 times, and he has an h-index of 104 and an i10-index of 385. Updated numbers can be found here https://scholar.google.com/citations?hl=en&user=vzV233IAAAAJ <br />
<br />
Over 25 years ago, Gibson founded the PERFUSE Study Group, an academic research organization which provides academic leadership, site identification and management, statistical analyses, regulatory guidance, angiographic, MRI, CT and EKG core laboratory services, and data management services for a wide variety of studies including trials in acute coronary syndromes, antiplatelets, antithrombins, reperfusion injury, atherosclerosis regression, new devices, angiogenesis, and new imaging modalities. Gibson directed the TIMI angiographic core laboratory and invented the TIMI frame count (CTFC) in which the number of cineframes for dye to reach standardized distal landmarks is counted (an index of epicardial blood flow). Gibson also invented the TIMI myocardial perfusion grade (the blush, a measure of microvascular perfusion). The TIMI frame count and the TIMI myocardial perfusion grade are both multivariate predictors of 2 year mortality in acute MI, and are now widely used both clinically and in the assessment of new reperfusion strategies. The methods invented by Gibson and his research have played a critical role in our understanding of "the open artery hypothesis" and more recently in what Gibson has termed "the open microvasculature hypothesis". On Google scholar, the TIMI Frame Count is listed as being cited in over 4,700 articles ([http://scholar.google.com/scholar?hl=en&lr=&q=%22timi+frame+count%22&btnG=Search for updated numbers click here]) and the TIMI myocardial perfusion grade is listed as being cited in over 1,800 articles ([http://scholar.google.com/scholar?hl=en&q=%22timi+myocardial+perfusion+grade%22&btnG=Search for updated numbers click here]).<br />
<br />
Under Gibson's direction, the PERFUSE Study Group created the master database that unified data from over 25 years of TIMI studies (TIMI 1-50) in nearly 100,000 patients and coordinated data analyses for the TIMI study group and functioned as the TIMI Data Coordinating Center. <br />
<br />
Within the Thrombolysis In Myocardial Infarction (TIMI) Study Group, Dr. Gibson has served as a Principle Investigator of multiple international trials within the TIMI Study Chairman’s Office.<br />
<br />
Dr. Gibson's specific research interests include the following:<br />
<br />
*'''Acute Coronary Syndrome Research Including unstable angina, non ST elevation MI and ST elevation MI:''' Gibson invented the angiographic endpoints that are used in assessing drug and device therapies such as the TIMI frame count and the TIMI myocardial perfusion grade. He has been the principal investigator of trials of novel thrombolytic agents (BB 10153) and novel mechanisms of delivery of thrombolytic agents such as ICE T – TIMI 49 (Intra-coronary Tenecteplase During Balloon Angioplasty). Gibson led the angiographic core laboratory analysis of a number of thrombolytic trials (TIMI4 (tPA and APSAC), TIMI 10 trials (TNK), ADVANCE MI (TNK + eptifibatide), TIMI 14 (lytic + abciximab), FASTER (lytic + aggrastat), CLARITY (lytic + clopidogrel), STEP AMI (lytic + cangrelor)<br />
<br />
*'''Antiplatelet Trials:''' Gibson has led trials of glycoprotein 2b3a inhibitor inhibition (PROTECT, TITAN), thienopyridine trials such as the TRITON study of prasugrel, trials of novel antiplatelets such as elinogrel (ERASE MI), and is a member of the executive committee of trials of cangrelor. Gibson led the angiographic core laboratory for trials of eptifibatide (ESPRIT, INTEGRITI, ADVANCE MI, TITAN, EARLY ACS), abciximab (TIMI 14, INFUSE AMI, IC Clearly), and tirofiban (FASTER, TACTICS), clopidogrel (CLARITY TIMI 28), ticagrelor (PLATO) and cangrelor (STEP AMI).<br />
<br />
*'''Antithrombin Trials:''' Gibson has led large scale international trials of novel antithrombins such as the development of rivaroxaban, a factor Xa inhibitor (ATLAS TIMI 46 and 51). Gibson has led angiographic core laboratory efforts in the evaluation of rNAPc2 (a fVIIa/TF inhibitor) in the ANTHEM study, and the SEPIA-ACS1 TIMI 42 (Study Program to Evaluate the Prevention of Ischemia with direct Anti-Xa inhibition in Acute Coronary Syndromes 1 - Thrombolysis in Myocardial Infarction 42).<br />
<br />
*'''Reperfusion Injury Trials:''' Gibson has led the angiographic core laboratory analysis of reperfusion injury trials such as the LIMIT trial of rhuMAb CD18, the DELTA MI trial (Direct Inhibition of δ Protein Kinase C Enzyme to Limit Total Infarct Size in Acute Myocardial Infarction), the INOT-44 trial (Nitric Oxide in Myocardial Infarction Size (NOMI), and the INTESIVE trial (Apidra®/Lantus® therapy versus Sliding Scale Insulin on infarct size in hyperglycemic subjects with anterior STEMI undergoing percutaneous coronary intervention (PCI). Gibson is currently the Study Chairman and Principal Investigator of the multicenter international EMBRACE MI trial of [[Bendavia]].<br />
<br />
*'''Lipid Lowering and Atherosclerosis Regression Trials:''' Gibson’s career started with the Harvard Atherosclerosis Reversibility Project where he developed the angiographic and statistical methodology to conduct angiographic atherosclerosis regression trials. Gibson participated in and has published manuscripts from the PROVE It study (PCI PROVE IT). Gibson has served as the site PI for trials of medical therapy in stable angina (the AVERT study). Gibson serves on the Executive committee of trials of CTEP inhibition (ACCELERATE). Gibson serves as the study chairman of the AEGIS trials evaluating the efficacy and safety of APO A1 infusions (HDL) to halt atherosclerosis and prevent atherothrombotic events. Gibson has participated in the publication of PCSK9 inhibitor trial data.<br />
<br />
*'''New Device Trials:''' Gibson has led new device studies such as novel delivery systems for intracoronary therapies such as the Clearway catheter in the INFUSE AMI and IC Clearly trials, and aspiration thrombectomy (INFUSE AMI). He has served as the angiographic core laboratory for trials of perfusion balloons, directional atherectomy, self expanding stents, therapeutic ultrasound studies (PLUS) and markers of saphenous vein graft proximal connectors (PAS-Port (Study of the PAS-Port® Proximal Anastomosis System in Coronary Bypass Surgery (EPIC)).<br />
<br />
*'''Imaging Trials:''' Gibson has served as the angiographic core laboratory for trials of new echocardiographic contrast agents (ECHOGEN) vs angiography, and positron emission tomography (PET) vs angiography trials.<br />
<br />
*'''CMR Core Laboratory Trials:''' Gibson is co-principal investigator of CMR core laboratory studies such as ALLAY (efficacy and safety of aliskiren in combination with Losartan compared to Losartan), the TRACS Study (The Effects of Fx-1006A on Transthyretin Stabilization and Clinical Outcome Measures in Patients With Non-V30M Transthyretin Amyloidosis), the ACT-34 CMI (Autologous Cellular Therapy Utilizing CD34+ Cells), the INTESIVE trial (Apidra®/Lantus® therapy versus Sliding Scale Insulin on infarct size in hyperglycemic subjects with anterior STEMI undergoing percutaneous coronary intervention (PCI)), and the FX1B-201 Study (Safety and Efficacy Evaluation of Fx-1006A in Patients With V122I or Wild-Type Transthyretin (TTR) Amyloid Cardiomyopathy).<br />
<br />
*'''CT Angiographic Core Laboratory Trials:''' Gibson has led the CT core laboratory for trials such as the markers of saphenous vein graft proximal connectors (PAS-Port (Study of the PAS-Port® Proximal Anastomosis System in Coronary Bypass Surgery (EPIC)).<br />
<br />
*'''Coronary Artery Bypass Graft Trials:''' Gibson led the angiographic core laboratory analysis of the PREVENT 4 study (Project of Ex-vivo Vein Graft Engineering via Transfection) of 2200 patients.<br />
<br />
*'''New Electrocardiography Technology Trials:''' Gibson is the leader of trials of an implantable technology (the AngelMed Guardian Device) designed to monitor and alert the patient to the presence of ST segment elevation (ALERT AMI trial). Gibson has led the angiographic core laboratory for trials such as OCCULT MI study of 84 lead EKG technologies (Optimal Cardiovascular Diagnostic Evaluation Enabling Faster Treatment of Myocardial Infarction). Gibson's team has also served as an EKG core laboratory.<br />
<br />
*'''Angiogenesis Trials:''' Gibson assessed angiographic endpoints in early trials of angiogenesis (VIVA trial).<br />
<br />
*'''Stem Cell Therapy:''' Gibson is Chair of the Data Safety Monitoring Board for the first phase III stem cell study (RENEW)<br />
<br />
*'''NIH Studies:''' Gibson has led the angiographic core laboratory for a number of NIH studies including the Harvard Atherosclerosis Reversibility Project (HARP), the PEARL study of estrogens in restenosis, and the ASCERT study comparing PCI to CABG.<br />
<br />
*'''Diabetes:''' Gibson coordinates the Clinical Event Committee efforts to adjudicate tens of thousands of adverse events and hundreds of thousands of EKGs in ongoing trials of novel anti-diabetic agents.<br />
<br />
===Publications===<br />
*Gibson's work has been cited over 56,957 times, and he has an h-index of 104 and an i10-index of 385. Updated numbers can be found here https://scholar.google.com/citations?hl=en&user=vzV233IAAAAJ<br />
<br />
*Peer reviewed research publications: > 530 (for an update, click [http://www.ncbi.nlm.nih.gov/pubmed?term=Gibson%20CM here])<br />
<br />
*Non peer-reviewed reviews, chapters, monographs and editorials: 57<br />
<br />
*Professional Educational Materials or Reports, in Print or Other Media: 686<br />
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*WikiDoc pages edited: Over 70,000 under C Michael Gibson and CMichaelGibson<br />
<br />
===Editorial Boards===<br />
Dr. Gibson has served in the past on the editorial board of numerous journals such as Circulation, the Journal of the American College of Cardiology, Cardiac Catheterization and Intervention and the American Heart Journal.<br />
<br />
==Education==<br />
===WikiDoc===<br />
Dr. Gibson is Founder and Chairman of the Board of WikiDoc Foundation (a 509 (a)(1) Charitable Organization). This is the world's largest medical textbook / encyclopedia. WikiDoc contains [[Special:Statistics|200,059]] chapters updated millions of times by over 2,200 active contributors and viewed hundreds of thousands of times daily. In 2010, WikiDoc was selected as a Google Grant recipient. Dr. Gibson has personally made over 70,000 edits to WikiDoc.<br />
<br />
===Schema.org===<br />
Although there is a vast amount of medical information on the internet, search engine's often return results that are not highly specific. This is because search engines do not account for the structure of the underlying medical knowledge or the relationships among keywords.<br />
Gibson was one of the co-creators of a www.schema.org-based [http://schemaorg-medicalext.appspot.com/docs/meddocs.html schema] that allows webmasters and content publishers to mark up health and medical content on the web. The health and medical schema is intended to make it easier for people to locate the optimal web pages by exposing structured information contained in web pages to search engines. As a result, more relevant content rich pages will be returned in search results.<br />
<br />
===Internet Educational Sites===<br />
<br />
Dr. Gibson is Founder and Editor-in-Chief of [http://www.clinicaltrialresults.org Clinical Trial Results] where he created the first weekly TV show for Cardiologists "This Week in Cardiology" and has provided slides summarizing clinical trials since 1999. Gibson has conducted 2,000 TV / video interviews and serves as the anchor person for medical meetings such as TCT TV. Gibson also created the original [http://www.timi.org TIMI.org], website, the website of the TIMI Study Group.<br />
<br />
===Traditional Textbooks===<br />
Dr. Gibson also edits a textbook entitled “Gibson's Treatment Strategies in Interventional Cardiology” which is optimized for hand held devices. In the past, Gibson has authored the chapter on Primary Angioplasty in Randomized Trials in Cardiovascular Disease published as a companion to Braunwald's Heart Disease. In the past he has co-authored the chapter “Recognition and Management of Patients with Stable Angina Pectoris" in Braunwald and Goldman’s Primary Cardiology. He has served as lead author of the section on myocardial perfusion imaging in an imaging textbook which is a companion to Braunwald’s Heart Disease. Gibson has authored the chapter “Profiles in Coronary Artery Disease” in the fifth and sixth editions of Grossman and Baim’s Textbook of Interventional Cardiology.<br />
<br />
===American Heart Association===<br />
Gibson has served as a member of the Professional Education Committee of the American Heart Association.<br />
<br />
==Physician==<br />
Gibson is a practicing interventional cardiologist. He has served as a cath lab director. In 2009 and 2010, Dr. Gibson was chosen by his peers as one of Boston's Top Doctors in Boston Magazine.<br />
<br />
In 2010, Dr. Gibson was selected as one of America's Top Doctors by Castle Connolly Medical Ltd. In the same year, he was also selected to be included in the Consumers' Research Council of America’s Guide to America’s Top Cardiologists.<br />
<br />
In 2011, Dr. Gibson was featured as one of Boston's Super doctors on my.superdoctors.com. In the same year, he was also selected to be included in the Consumers' Research Council of America’s Guide to America’s Top Cardiologists.<br />
<br />
In 2011 U.S. News & World Report listed Dr. Gibson as one of America's Top Doctors as selected by Castle Connolly Medical Ltd. [http://health.usnews.com/top-doctors/c-michael-gibson-interventional-cardiologist-22CC000361 health.usnews.com]<br />
<br />
==Awards==<br />
[[Image:C-Michael-Gibson-award.jpg|right]]<br />
[[Image:C Michael Gibson Distinguished fellow.jpg|right]]<br />
Dr. Gibson graduated from college Phi Beta Kappa, and from medical school Alpha Omega Alpha, both from the University of Chicago. In 1993 he was selected as the Julian and Eunice Cohen Scholar in Medicine at the Brigham and Women's Hospital. <br />
<br />
In conjunction with delivering the opening plenary lecture at the 10th annual Great Wall of China Symposium in 2003, Gibson was awarded the Gold Medal by the Institute of Geriatric Cardiology, Chinese Peoples Liberation Army General Hospital, Beijing China for his achievements in cardiovascular science. <br />
<br />
In 2005, the John Paul II Hospital in Krakow, Poland awarded Gibson the Pro Bono Curantium Gold Medal for Merit, and a research laboratory was named there in his honor. He was the 4th such awardee, the others being Pope John Paul II and Dr. Valentine Fuster. In that same year, Gibson was awarded the Medal of the Jagiellonian University for his outstanding achievements in education and research in cardiovascular science. <br />
<br />
In 2009, the Cardiovascular Division of Istanbul University, Turkey, established the C. Michael Gibson Research and Education Center. In that same year, the Turkish Cardiac Society honored Gibson for establishing WikiDoc on, September 27th, World Heart Day.<br />
<br />
In 2007 and 2009, Dr. Gibson was selected by Who's Who as the Clinical Researcher of the Year. <br />
<br />
In 2009 and 2010, Dr. Gibson was chosen by his peers as one of Boston's Top Doctors in Boston Magazine.<br />
<br />
In 2010, Dr. Gibson was selected as one of America's Top Doctors by Castle Connolly Medical Ltd. In the same year, he was also selected to be included in the Consumers' Research Council of America’s Guide to America’s Top Cardiologists.<br />
<br />
In 2011, Dr. Gibson was featured as one of Boston's Super doctors on my.superdoctors.com. In the same year, he was also selected to be included in the Consumers' Research Council of America’s Guide to America’s Top Cardiologists.<br />
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In 2011 U.S. News & World Report listed Dr. Gibson as one of America's Top Doctors as selected by Castle Connolly Medical Ltd. [http://health.usnews.com/top-doctors/c-michael-gibson-interventional-cardiologist-22CC000361 health.usnews.com]<br />
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In 2012 Gibson was appointed a Distinguished Fellow of New Westminster College, which is the highest honour that New Westminster College bestows upon senior leaders to recognize their distinguished record of ethical leadership. Other Distinguished Fellows include world leaders, cabinet ministers, 12 ambassadors, an astronaut, 27 generals and admirals, surgeons and medical doctors.<br />
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==Disclosures:==<br />
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Dr. Gibson follows the conflict of interest policies set forth by Harvard Medical School and the Beth Israel Deaconess Medical Center. The Baim Institute follows the same conflict of interest policies as Harvard Medical School and Beth Israel Deaconess Medical Center. The dates of payments are based on the date payment was received (on a cash basis) rather than the date of billing (accrual basis).<br />
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''Executive Position (with $0.00 monies received by Dr. Gibson)''<br />
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Chief Executive Office, Baim Institute for Clinical Research<br />
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''Present Research/Grant Funding (within the last year)''<br />
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Ongoing: Angel Medical Corporation;<br />
Bayer Corp.;<br />
CSL Behring;<br />
Janssen Pharmaceuticals;<br />
Johnson & Johnson Corporation;<br />
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Terminated but within one year: Portola Pharmaceuticals (contract terminated with BIDMC on 12/31/2017)<br />
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''Consulting''<br />
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Amarin Pharama, Amgen, Bayer Corporation, Boehringer Ingelheim, Boston Clinical Research Institute, Cardiovascular Research Foundation, Chiesi, CSL Behring, Eli Lilly, Gilead Sciences, Inc., Impact Bio LTD, Janssen Pharmaceuticals, Johnson & Johnson Corporation, The Medicines Company, MedImmune, Medtelligence, Merck & Co, Inc., Novo Nordisk, Pfizer, Pharma Mar, Portola Pharmaceuticals (began 1/1/2018), Sanofi, Somahlution, St. Francis Hospital, Verseon Corportation, Web MD<br />
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For Trials that Dr. Gibson actively serves as PI of and receives research grant support on an ongoing basis, there is less than $25,000 per year in consulting monies received per the Harvard, BIDMC, Baim policies.<br />
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''Royalties as a Contributor''<br />
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UpToDate in Cardiovascular Medicine<br />
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''Spouse conflicts of interests (Employee of Boston Clinical Research Institute)''<br />
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Amarin, Amgen, Bayer, Boehringer Ingelheim, Boston Scientific, Cardiovascular Research Foundation, Chiesi, Eli Lilly, Gilead Sciences, Inc., Impact Bio, Janssen, Johnson and Johnson, The Medicines Company, Medtelligence, MedImmune, Merck & Co. Inc., Novo Nordisk, Pfizer, PharmaMar, Portola, Sanofi, Somahlution, St. Francis Hospital, Verseon Corporation<br />
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@CMichaelGibson is largely a news service citing articles in the news media related to healthcare. A retweet does not constitute an endorsement. RTs which link to other websites are provided as a service to followers, but linking to the sites does not constitute endorsement of those sites by @CMichaelGibson, and @CMichaelGibson is not responsible for the content of external websites. Please note that other users of Twitter may utilize your tweets beyond the control of @CMichaelGibson. Tweets are educational and do not represent medical advice, see your doctor or healthcare provider. Tweets are educational only and are not meant to promote an unapproved or off label use of a medical drug or device. #cmgsays says quotes may have been said by others as well as anonymous individuals.<br />
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Key words, synonyms: CM Gibson, M Gibson, C Gibson, C.M. Gibson, M. Gibson, C. Gibson, Dr. C.M. Gibson, Dr. M. Gibson, Charles Michael Gibson, Charles M. Gibson, Gibson CM, Gibson CM M.D., C. Michael Gibson M.S. M.D., Mike Gibson, Dr. Mike Gibson, Mike Gibson M.D., Dr. C. Michael Gibson, Dr. CM Gibson, Dr. Gibson, Doctor Gibson <br />
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[[Category:Cardiologists]]</div>C Michael Gibsonhttps://www.wikidoc.org/index.php?title=User:C_Michael_Gibson&diff=1495837User:C Michael Gibson2018-09-28T16:16:57Z<p>C Michael Gibson: /* Disclosures: */</p>
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<div>[[Image:Cmg v4 small.jpg|right|250px|WikiDoc Founder C. Michael Gibson, M.S., M.D.]]<br />
'''C. Michael Gibson M.S., M.D.''', Professor of Medicine, Harvard Medical School <br />
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Founder and Chairman of the Board, WikiDoc Foundation (a 509 (a)(1) Charitable Organization); Chief Executive Officer, Baim Institute for Clinical Research; Founder and Chairman of the [http://www.perfuse.org PERFUSE Study Group]<br />
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'''Contact:''' mgibson@wikidoc.org[mailto:mgibson@wikidoc.org]; or at his G mail address: charlesmichaelgibson@gmail.com [mailto:charlesmichaelgibson@gmail.com]<br />
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'''Mailing Address:''' C. Michael Gibson, M.S., M.D., Beth Israel Deaconess Medical Center<br />
330 Brookline Avenue, Overland 540, Boston, MA 02215 Boston MA, 02215.<br />
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'''Headshot:''' Download headshot [//www.wikidoc.org/images/e/e6/Cmg_v4_small.jpg here]<br />
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View Dr. Gibon's TEDx talk about WikiDoc on YouTube [https://www.youtube.com/watch?v=DMwZnFwueQU here]<br />
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Download Dr. Gibson's slides from his TEDx talk about WikiDoc [//www.wikidoc.org/images/a/a6/Tedx_talk_v5.pptx here]<br />
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__NOTOC__<br />
----<br />
C. Michael Gibson, M.S., M.D. is an interventional cardiologist, cardiovascular researcher and educator who pioneered our understanding of the "open artery hypothesis" as well our understanding of the importance of restoring flow downstream in the capillary bed in the "open microvasculature hypothesis" in heart attack patients. Gibson was chosen as one of the most influential scientific minds between 2002 and 2012 in a 2014 report from Thompson Reuters [http://sciencewatch.com/grr/presenting-highly-cited-researchers].<br />
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Gibson founded www.wikidoc.org, the world's most widely viewed open source textbook of medicine (viewed 700,000 to 2.2 million times daily, hundreds of millions of times annually). He is Editor-In-Chief of over 2,200 active contributors which have edited the content millions of times. Gibson served as medical lead in a partnership with Google, Microsoft and Yahoo to design a scheme of classifying medical content for the internet (www.schema.org) to improve medical search results. Gibson also founded www.clinicaltrialresults.org and has conducted 2,000 TV / video interviews and serves as the anchor person for medical meetings such as TCT TV.<br />
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For many years, Gibson has been chosen by his peers as one of Boston's Top Doctors in Boston Magazine. U.S. News & World Report also lists Gibson as one of America's top doctors. Gibson invented several of the measures of coronary blood flow that are widely used today (the TIMI frame count and the TIMI myocardial perfusion grade).<br />
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Formerly Harvard Clinical Research Institute (HCRI), Gibson leads the Baim Institute for Clinical Research as CEO. It is a leading, non-profit academic research organization (ARO) that delivers insight, innovation and leadership in today’s dynamic research environment. Baim collaborates with the world’s most highly respected researchers from renowned institutions to help advance health and quality of life around the world. The entity has managed 450 studies which have enrolled over 160,000 patients, and has played a role in 50 FDA submissions.<br />
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Gibson has led his own Academic Research Organization ([http://www.perfuse.org PERFUSE]) for over 25 years now, and has been principal investigator of or led core services for 106 clinical trials, the results of which have been published in leading journals such as the New England Journal of Medicine. The PERFUSE Study Group offers a full line of trial management, social media portals, CEC, DSMB and core lab services for phase 1-4 trials worldwide. Under Gibson's direction, the PERFUSE Study Group created the master database that unified data from over 25 years of TIMI studies (TIMI 1-50) in nearly 100,000 patients and coordinated data analyses for the TIMI study group and functioned as the TIMI Data Coordinating Center which he directed. Gibson has led phase 1-4 clinical trials, and cardiology megatrials of over 15,000 patients.<br />
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==Education and Academic Positions==<br />
Dr. Gibson received his B.S., M.S., and M.D. degrees from the University of Chicago. He was an Intern, Resident and Chief Resident at the Brigham and Women’s Hospital, Harvard Medical School. He received his training as an interventional cardiologist and served as the Director of the Coronary Care Unit at Beth Israel Hospital, Harvard Medical School. Dr. Gibson then served as the Chief of Cardiology and Director of Interventional Cardiology at the West Roxbury Veterans Affairs Medical Center, Harvard Medical School. While at the West Roxbury VA, he also served as an Associate Physician at the Brigham and Women’s Hospital. He then moved on to Allegheny General Hospital as Vice Chairman of Medicine for Clinical Research and Director of Invasive Cardiology. He subsequently relocated to the west coast and served as Associate Chief of Cardiology, Chief of Interventional Cardiology and Director of the Cardiac Catheterization Laboratory at University of California San Francisco (UCSF). In 2000, Gibson returned to Harvard Medical School in Boston. Until 2003, Dr. Gibson served as Chief Academic Officer and Director of Core Services at Harvard Clinical Research Institute (HCRI), until 2005 he served as Associate Chief of Cardiology and Director of Academic Affairs in the Cardiovascular Division at the Beth Israel Deaconess Medical Center. Until 2009 he served as the Director of the TIMI Data Coordinating Center at the Brigham and Women’s Hospital. He is currently a full time interventional cardiologist and Chief of Clinical Research in the Cardiovascular Division at Beth Israel Deaconess Medical Center, Harvard Medical School. <br />
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==Research==<br />
Dr. Gibson’s work has largely focused on investigating the pathophysiology of coronary artery disease and the efficacy of pharmacologic and device based therapies. His work has been presented in many thousands manuscripts, abstracts, trial summaries, textbooks and textbook chapters. Gibson's work has been cited over 56,957 times, and he has an h-index of 104 and an i10-index of 385. Updated numbers can be found here https://scholar.google.com/citations?hl=en&user=vzV233IAAAAJ <br />
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Over 25 years ago, Gibson founded the PERFUSE Study Group, an academic research organization which provides academic leadership, site identification and management, statistical analyses, regulatory guidance, angiographic, MRI, CT and EKG core laboratory services, and data management services for a wide variety of studies including trials in acute coronary syndromes, antiplatelets, antithrombins, reperfusion injury, atherosclerosis regression, new devices, angiogenesis, and new imaging modalities. Gibson directed the TIMI angiographic core laboratory and invented the TIMI frame count (CTFC) in which the number of cineframes for dye to reach standardized distal landmarks is counted (an index of epicardial blood flow). Gibson also invented the TIMI myocardial perfusion grade (the blush, a measure of microvascular perfusion). The TIMI frame count and the TIMI myocardial perfusion grade are both multivariate predictors of 2 year mortality in acute MI, and are now widely used both clinically and in the assessment of new reperfusion strategies. The methods invented by Gibson and his research have played a critical role in our understanding of "the open artery hypothesis" and more recently in what Gibson has termed "the open microvasculature hypothesis". On Google scholar, the TIMI Frame Count is listed as being cited in over 4,700 articles ([http://scholar.google.com/scholar?hl=en&lr=&q=%22timi+frame+count%22&btnG=Search for updated numbers click here]) and the TIMI myocardial perfusion grade is listed as being cited in over 1,800 articles ([http://scholar.google.com/scholar?hl=en&q=%22timi+myocardial+perfusion+grade%22&btnG=Search for updated numbers click here]).<br />
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Under Gibson's direction, the PERFUSE Study Group created the master database that unified data from over 25 years of TIMI studies (TIMI 1-50) in nearly 100,000 patients and coordinated data analyses for the TIMI study group and functioned as the TIMI Data Coordinating Center. <br />
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Within the Thrombolysis In Myocardial Infarction (TIMI) Study Group, Dr. Gibson has served as a Principle Investigator of multiple international trials within the TIMI Study Chairman’s Office.<br />
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Dr. Gibson's specific research interests include the following:<br />
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*'''Acute Coronary Syndrome Research Including unstable angina, non ST elevation MI and ST elevation MI:''' Gibson invented the angiographic endpoints that are used in assessing drug and device therapies such as the TIMI frame count and the TIMI myocardial perfusion grade. He has been the principal investigator of trials of novel thrombolytic agents (BB 10153) and novel mechanisms of delivery of thrombolytic agents such as ICE T – TIMI 49 (Intra-coronary Tenecteplase During Balloon Angioplasty). Gibson led the angiographic core laboratory analysis of a number of thrombolytic trials (TIMI4 (tPA and APSAC), TIMI 10 trials (TNK), ADVANCE MI (TNK + eptifibatide), TIMI 14 (lytic + abciximab), FASTER (lytic + aggrastat), CLARITY (lytic + clopidogrel), STEP AMI (lytic + cangrelor)<br />
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*'''Antiplatelet Trials:''' Gibson has led trials of glycoprotein 2b3a inhibitor inhibition (PROTECT, TITAN), thienopyridine trials such as the TRITON study of prasugrel, trials of novel antiplatelets such as elinogrel (ERASE MI), and is a member of the executive committee of trials of cangrelor. Gibson led the angiographic core laboratory for trials of eptifibatide (ESPRIT, INTEGRITI, ADVANCE MI, TITAN, EARLY ACS), abciximab (TIMI 14, INFUSE AMI, IC Clearly), and tirofiban (FASTER, TACTICS), clopidogrel (CLARITY TIMI 28), ticagrelor (PLATO) and cangrelor (STEP AMI).<br />
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*'''Antithrombin Trials:''' Gibson has led large scale international trials of novel antithrombins such as the development of rivaroxaban, a factor Xa inhibitor (ATLAS TIMI 46 and 51). Gibson has led angiographic core laboratory efforts in the evaluation of rNAPc2 (a fVIIa/TF inhibitor) in the ANTHEM study, and the SEPIA-ACS1 TIMI 42 (Study Program to Evaluate the Prevention of Ischemia with direct Anti-Xa inhibition in Acute Coronary Syndromes 1 - Thrombolysis in Myocardial Infarction 42).<br />
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*'''Reperfusion Injury Trials:''' Gibson has led the angiographic core laboratory analysis of reperfusion injury trials such as the LIMIT trial of rhuMAb CD18, the DELTA MI trial (Direct Inhibition of δ Protein Kinase C Enzyme to Limit Total Infarct Size in Acute Myocardial Infarction), the INOT-44 trial (Nitric Oxide in Myocardial Infarction Size (NOMI), and the INTESIVE trial (Apidra®/Lantus® therapy versus Sliding Scale Insulin on infarct size in hyperglycemic subjects with anterior STEMI undergoing percutaneous coronary intervention (PCI). Gibson is currently the Study Chairman and Principal Investigator of the multicenter international EMBRACE MI trial of [[Bendavia]].<br />
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*'''Lipid Lowering and Atherosclerosis Regression Trials:''' Gibson’s career started with the Harvard Atherosclerosis Reversibility Project where he developed the angiographic and statistical methodology to conduct angiographic atherosclerosis regression trials. Gibson participated in and has published manuscripts from the PROVE It study (PCI PROVE IT). Gibson has served as the site PI for trials of medical therapy in stable angina (the AVERT study). Gibson serves on the Executive committee of trials of CTEP inhibition (ACCELERATE). Gibson serves as the study chairman of the AEGIS trials evaluating the efficacy and safety of APO A1 infusions (HDL) to halt atherosclerosis and prevent atherothrombotic events. Gibson has participated in the publication of PCSK9 inhibitor trial data.<br />
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*'''New Device Trials:''' Gibson has led new device studies such as novel delivery systems for intracoronary therapies such as the Clearway catheter in the INFUSE AMI and IC Clearly trials, and aspiration thrombectomy (INFUSE AMI). He has served as the angiographic core laboratory for trials of perfusion balloons, directional atherectomy, self expanding stents, therapeutic ultrasound studies (PLUS) and markers of saphenous vein graft proximal connectors (PAS-Port (Study of the PAS-Port® Proximal Anastomosis System in Coronary Bypass Surgery (EPIC)).<br />
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*'''Imaging Trials:''' Gibson has served as the angiographic core laboratory for trials of new echocardiographic contrast agents (ECHOGEN) vs angiography, and positron emission tomography (PET) vs angiography trials.<br />
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*'''CMR Core Laboratory Trials:''' Gibson is co-principal investigator of CMR core laboratory studies such as ALLAY (efficacy and safety of aliskiren in combination with Losartan compared to Losartan), the TRACS Study (The Effects of Fx-1006A on Transthyretin Stabilization and Clinical Outcome Measures in Patients With Non-V30M Transthyretin Amyloidosis), the ACT-34 CMI (Autologous Cellular Therapy Utilizing CD34+ Cells), the INTESIVE trial (Apidra®/Lantus® therapy versus Sliding Scale Insulin on infarct size in hyperglycemic subjects with anterior STEMI undergoing percutaneous coronary intervention (PCI)), and the FX1B-201 Study (Safety and Efficacy Evaluation of Fx-1006A in Patients With V122I or Wild-Type Transthyretin (TTR) Amyloid Cardiomyopathy).<br />
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*'''CT Angiographic Core Laboratory Trials:''' Gibson has led the CT core laboratory for trials such as the markers of saphenous vein graft proximal connectors (PAS-Port (Study of the PAS-Port® Proximal Anastomosis System in Coronary Bypass Surgery (EPIC)).<br />
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*'''Coronary Artery Bypass Graft Trials:''' Gibson led the angiographic core laboratory analysis of the PREVENT 4 study (Project of Ex-vivo Vein Graft Engineering via Transfection) of 2200 patients.<br />
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*'''New Electrocardiography Technology Trials:''' Gibson is the leader of trials of an implantable technology (the AngelMed Guardian Device) designed to monitor and alert the patient to the presence of ST segment elevation (ALERT AMI trial). Gibson has led the angiographic core laboratory for trials such as OCCULT MI study of 84 lead EKG technologies (Optimal Cardiovascular Diagnostic Evaluation Enabling Faster Treatment of Myocardial Infarction). Gibson's team has also served as an EKG core laboratory.<br />
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*'''Angiogenesis Trials:''' Gibson assessed angiographic endpoints in early trials of angiogenesis (VIVA trial).<br />
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*'''Stem Cell Therapy:''' Gibson is Chair of the Data Safety Monitoring Board for the first phase III stem cell study (RENEW)<br />
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*'''NIH Studies:''' Gibson has led the angiographic core laboratory for a number of NIH studies including the Harvard Atherosclerosis Reversibility Project (HARP), the PEARL study of estrogens in restenosis, and the ASCERT study comparing PCI to CABG.<br />
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*'''Diabetes:''' Gibson coordinates the Clinical Event Committee efforts to adjudicate tens of thousands of adverse events and hundreds of thousands of EKGs in ongoing trials of novel anti-diabetic agents.<br />
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===Publications===<br />
*Gibson's work has been cited over 56,957 times, and he has an h-index of 104 and an i10-index of 385. Updated numbers can be found here https://scholar.google.com/citations?hl=en&user=vzV233IAAAAJ<br />
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*Peer reviewed research publications: > 530 (for an update, click [http://www.ncbi.nlm.nih.gov/pubmed?term=Gibson%20CM here])<br />
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*Non peer-reviewed reviews, chapters, monographs and editorials: 57<br />
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*Professional Educational Materials or Reports, in Print or Other Media: 686<br />
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*WikiDoc pages edited: Over 70,000 under C Michael Gibson and CMichaelGibson<br />
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===Editorial Boards===<br />
Dr. Gibson has served in the past on the editorial board of numerous journals such as Circulation, the Journal of the American College of Cardiology, Cardiac Catheterization and Intervention and the American Heart Journal.<br />
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==Education==<br />
===WikiDoc===<br />
Dr. Gibson is Founder and Chairman of the Board of WikiDoc Foundation (a 509 (a)(1) Charitable Organization). This is the world's largest medical textbook / encyclopedia. WikiDoc contains [[Special:Statistics|200,059]] chapters updated millions of times by over 2,200 active contributors and viewed hundreds of thousands of times daily. In 2010, WikiDoc was selected as a Google Grant recipient. Dr. Gibson has personally made over 70,000 edits to WikiDoc.<br />
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===Schema.org===<br />
Although there is a vast amount of medical information on the internet, search engine's often return results that are not highly specific. This is because search engines do not account for the structure of the underlying medical knowledge or the relationships among keywords.<br />
Gibson was one of the co-creators of a www.schema.org-based [http://schemaorg-medicalext.appspot.com/docs/meddocs.html schema] that allows webmasters and content publishers to mark up health and medical content on the web. The health and medical schema is intended to make it easier for people to locate the optimal web pages by exposing structured information contained in web pages to search engines. As a result, more relevant content rich pages will be returned in search results.<br />
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===Internet Educational Sites===<br />
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Dr. Gibson is Founder and Editor-in-Chief of [http://www.clinicaltrialresults.org Clinical Trial Results] where he created the first weekly TV show for Cardiologists "This Week in Cardiology" and has provided slides summarizing clinical trials since 1999. Gibson has conducted 2,000 TV / video interviews and serves as the anchor person for medical meetings such as TCT TV. Gibson also created the original [http://www.timi.org TIMI.org], website, the website of the TIMI Study Group.<br />
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===Traditional Textbooks===<br />
Dr. Gibson also edits a textbook entitled “Gibson's Treatment Strategies in Interventional Cardiology” which is optimized for hand held devices. In the past, Gibson has authored the chapter on Primary Angioplasty in Randomized Trials in Cardiovascular Disease published as a companion to Braunwald's Heart Disease. In the past he has co-authored the chapter “Recognition and Management of Patients with Stable Angina Pectoris" in Braunwald and Goldman’s Primary Cardiology. He has served as lead author of the section on myocardial perfusion imaging in an imaging textbook which is a companion to Braunwald’s Heart Disease. Gibson has authored the chapter “Profiles in Coronary Artery Disease” in the fifth and sixth editions of Grossman and Baim’s Textbook of Interventional Cardiology.<br />
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===American Heart Association===<br />
Gibson has served as a member of the Professional Education Committee of the American Heart Association.<br />
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==Physician==<br />
Gibson is a practicing interventional cardiologist. He has served as a cath lab director. In 2009 and 2010, Dr. Gibson was chosen by his peers as one of Boston's Top Doctors in Boston Magazine.<br />
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In 2010, Dr. Gibson was selected as one of America's Top Doctors by Castle Connolly Medical Ltd. In the same year, he was also selected to be included in the Consumers' Research Council of America’s Guide to America’s Top Cardiologists.<br />
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In 2011, Dr. Gibson was featured as one of Boston's Super doctors on my.superdoctors.com. In the same year, he was also selected to be included in the Consumers' Research Council of America’s Guide to America’s Top Cardiologists.<br />
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In 2011 U.S. News & World Report listed Dr. Gibson as one of America's Top Doctors as selected by Castle Connolly Medical Ltd. [http://health.usnews.com/top-doctors/c-michael-gibson-interventional-cardiologist-22CC000361 health.usnews.com]<br />
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==Awards==<br />
[[Image:C-Michael-Gibson-award.jpg|right]]<br />
[[Image:C Michael Gibson Distinguished fellow.jpg|right]]<br />
Dr. Gibson graduated from college Phi Beta Kappa, and from medical school Alpha Omega Alpha, both from the University of Chicago. In 1993 he was selected as the Julian and Eunice Cohen Scholar in Medicine at the Brigham and Women's Hospital. <br />
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In conjunction with delivering the opening plenary lecture at the 10th annual Great Wall of China Symposium in 2003, Gibson was awarded the Gold Medal by the Institute of Geriatric Cardiology, Chinese Peoples Liberation Army General Hospital, Beijing China for his achievements in cardiovascular science. <br />
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In 2005, the John Paul II Hospital in Krakow, Poland awarded Gibson the Pro Bono Curantium Gold Medal for Merit, and a research laboratory was named there in his honor. He was the 4th such awardee, the others being Pope John Paul II and Dr. Valentine Fuster. In that same year, Gibson was awarded the Medal of the Jagiellonian University for his outstanding achievements in education and research in cardiovascular science. <br />
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In 2009, the Cardiovascular Division of Istanbul University, Turkey, established the C. Michael Gibson Research and Education Center. In that same year, the Turkish Cardiac Society honored Gibson for establishing WikiDoc on, September 27th, World Heart Day.<br />
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In 2007 and 2009, Dr. Gibson was selected by Who's Who as the Clinical Researcher of the Year. <br />
<br />
In 2009 and 2010, Dr. Gibson was chosen by his peers as one of Boston's Top Doctors in Boston Magazine.<br />
<br />
In 2010, Dr. Gibson was selected as one of America's Top Doctors by Castle Connolly Medical Ltd. In the same year, he was also selected to be included in the Consumers' Research Council of America’s Guide to America’s Top Cardiologists.<br />
<br />
In 2011, Dr. Gibson was featured as one of Boston's Super doctors on my.superdoctors.com. In the same year, he was also selected to be included in the Consumers' Research Council of America’s Guide to America’s Top Cardiologists.<br />
<br />
In 2011 U.S. News & World Report listed Dr. Gibson as one of America's Top Doctors as selected by Castle Connolly Medical Ltd. [http://health.usnews.com/top-doctors/c-michael-gibson-interventional-cardiologist-22CC000361 health.usnews.com]<br />
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In 2012 Gibson was appointed a Distinguished Fellow of New Westminster College, which is the highest honour that New Westminster College bestows upon senior leaders to recognize their distinguished record of ethical leadership. Other Distinguished Fellows include world leaders, cabinet ministers, 12 ambassadors, an astronaut, 27 generals and admirals, surgeons and medical doctors.<br />
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==Disclosures:==<br />
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Dr. Gibson follows the conflict of interest policies set forth by Harvard Medical School and the Beth Israel Deaconess Medical Center. The Baim Institute follows the same conflict of interest policies as Harvard Medical School and Beth Israel Deaconess Medical Center. The dates of payments are based on the date payment was received (on a cash basis) rather than the date of billing (accrual basis).<br />
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''Executive Position (with $0.00 monies received by Dr. Gibson)''<br />
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Chief Executive Office, Baim Institute for Clinical Research<br />
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''Present Research/Grant Funding (within the last year)''<br />
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Ongoing: Angel Medical Corporation;<br />
Bayer Corp.;<br />
CSL Behring;<br />
Janssen Pharmaceuticals;<br />
Johnson & Johnson Corporation;<br />
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Terminated but within one year: Portola Pharmaceuticals (ceased with BIDMC on 12/31/2017)<br />
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''Consulting''<br />
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Amarin Pharama, Amgen, Bayer Corporation, Boehringer Ingelheim, Boston Clinical Research Institute, Cardiovascular Research Foundation, Chiesi, CSL Behring, Eli Lilly, Gilead Sciences, Inc., Impact Bio LTD, Janssen Pharmaceuticals, Johnson & Johnson Corporation, The Medicines Company, MedImmune, Medtelligence, Merck & Co, Inc., Novo Nordisk, Pfizer, Pharma Mar, Portola Pharmaceuticals (began 1/1/2018), Sanofi, Somahlution, St. Francis Hospital, Verseon Corportation, Web MD<br />
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For Trials that Dr. Gibson actively serves as PI of and receives research grant support on an ongoing basis, there is less than $25,000 per year in consulting monies received per the Harvard, BIDMC, Baim policies.<br />
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''Royalties as a Contributor''<br />
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UpToDate in Cardiovascular Medicine<br />
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''Spouse conflicts of interests (Employee of Boston Clinical Research Institute)''<br />
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Amarin, Amgen, Bayer, Boehringer Ingelheim, Boston Scientific, Cardiovascular Research Foundation, Chiesi, Eli Lilly, Gilead Sciences, Inc., Impact Bio, Janssen, Johnson and Johnson, The Medicines Company, Medtelligence, MedImmune, Merck & Co. Inc., Novo Nordisk, Pfizer, PharmaMar, Portola, Sanofi, Somahlution, St. Francis Hospital, Verseon Corporation<br />
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==Twitter disclaimer for C. Michael Gibson==<br />
@CMichaelGibson is largely a news service citing articles in the news media related to healthcare. A retweet does not constitute an endorsement. RTs which link to other websites are provided as a service to followers, but linking to the sites does not constitute endorsement of those sites by @CMichaelGibson, and @CMichaelGibson is not responsible for the content of external websites. Please note that other users of Twitter may utilize your tweets beyond the control of @CMichaelGibson. Tweets are educational and do not represent medical advice, see your doctor or healthcare provider. Tweets are educational only and are not meant to promote an unapproved or off label use of a medical drug or device. #cmgsays says quotes may have been said by others as well as anonymous individuals.<br />
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In view of the possibility of human error by @CMichaelGibson, he does not warrant that the information contained herein is in every respect accurate or complete, and @CMichaelGibson is not responsible for any errors or omissions or for the results obtained from the use of such. Readers are encouraged to confirm the information contained in the tweets with other sources. Patients and consumers reading articles linked to from the tweets should review the information carefully with their professional healthcare provider. The tweets are not intended to replace medical advice offered by physicians. @CMichaelGibson makes no representations or warranties with respect to any treatment, action, or application of medication or preparation by any person following the information offered or provided within or through the tweets. @CMichaelGibson is not be liable for any direct, indirect, consequential, special, exemplary, or other damages arising there from.<br />
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Some information on drugs and medical devices presented in the twitter account may be investigational and/or approved for limited use. It is the responsibility of health care providers to ascertain the status of each drug or device planned for use in their clinical practice. If you are a patient, check with your healthcare provider.<br />
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You agree to hold harmless and indemnify @CMichaelGibson against any liability for any claims and expenses, including reasonable attorney's fees, relating to any violation.<br />
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You may have a simple link from your website to the twitter account of @CMichaelGibson or its RSS feed. However, you must first ask @CMichaelGibson for his permission if you intend to frame @CMichaelGisbon ' s twitter feed on your site or incorporate pieces of it into a different site or product in a way that is not clear to our users. You acknowledge and agree not to link to or incorporate an RSS feed of @CMichaelGibson if you engage in illegal, obscene, or offensive content, or if the link in any way has a negative impact on the reputation of @CMichaelGibson.<br />
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This agreement shall be governed by the laws of the state of Massachusetts applicable to agreements wholly made and performed in Massachusetts. In the event that you believe you have been irreparably harmed by any cause of action relating to @CMichaelGibson, you agree to inform @CMichaelGibson in writing and grant @CMichaelGibson thirty (30) days to cure the harm before initiating any action. Any legal action, suit or proceeding arising out of or relating to this agreement or a breach thereof, shall be instituted in a court of competent jurisdiction in Boston MA, and you hereby consent and submit to personal jurisdiction of such court, waive any objection to venue in such court and consent to service of process by overnight courier or express mail at your last known address. Any cause of action initiated by you must be initiated within 6 months after the claim or cause of action has arisen or be barred. Publication of information found on @CMichaelGibson may be in violation of the laws of the country or jurisdiction from where you are viewing this information. Laws in your country or jurisdiction may not protect or allow the same kinds of speech or distribution. @CMichaelGibson does not encourage the violation of any laws; and cannot be responsible for any violations of such laws, should you link to this domain or use, reproduce, or republish the information contained herein. All correspondence should be addressed in writing to C. Michael Gibson, 1 Carter Drive, Natick MA 01760.<br />
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Key words, synonyms: CM Gibson, M Gibson, C Gibson, C.M. Gibson, M. Gibson, C. Gibson, Dr. C.M. Gibson, Dr. M. Gibson, Charles Michael Gibson, Charles M. Gibson, Gibson CM, Gibson CM M.D., C. Michael Gibson M.S. M.D., Mike Gibson, Dr. Mike Gibson, Mike Gibson M.D., Dr. C. Michael Gibson, Dr. CM Gibson, Dr. Gibson, Doctor Gibson <br />
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[[Category:Cardiologists]]</div>C Michael Gibsonhttps://www.wikidoc.org/index.php?title=User:C_Michael_Gibson&diff=1495833User:C Michael Gibson2018-09-28T16:10:45Z<p>C Michael Gibson: /* Disclosures: */</p>
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<div>[[Image:Cmg v4 small.jpg|right|250px|WikiDoc Founder C. Michael Gibson, M.S., M.D.]]<br />
'''C. Michael Gibson M.S., M.D.''', Professor of Medicine, Harvard Medical School <br />
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Founder and Chairman of the Board, WikiDoc Foundation (a 509 (a)(1) Charitable Organization); Chief Executive Officer, Baim Institute for Clinical Research; Founder and Chairman of the [http://www.perfuse.org PERFUSE Study Group]<br />
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'''Contact:''' mgibson@wikidoc.org[mailto:mgibson@wikidoc.org]; or at his G mail address: charlesmichaelgibson@gmail.com [mailto:charlesmichaelgibson@gmail.com]<br />
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'''Mailing Address:''' C. Michael Gibson, M.S., M.D., Beth Israel Deaconess Medical Center<br />
330 Brookline Avenue, Overland 540, Boston, MA 02215 Boston MA, 02215.<br />
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'''Headshot:''' Download headshot [//www.wikidoc.org/images/e/e6/Cmg_v4_small.jpg here]<br />
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View Dr. Gibon's TEDx talk about WikiDoc on YouTube [https://www.youtube.com/watch?v=DMwZnFwueQU here]<br />
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Download Dr. Gibson's slides from his TEDx talk about WikiDoc [//www.wikidoc.org/images/a/a6/Tedx_talk_v5.pptx here]<br />
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__NOTOC__<br />
----<br />
C. Michael Gibson, M.S., M.D. is an interventional cardiologist, cardiovascular researcher and educator who pioneered our understanding of the "open artery hypothesis" as well our understanding of the importance of restoring flow downstream in the capillary bed in the "open microvasculature hypothesis" in heart attack patients. Gibson was chosen as one of the most influential scientific minds between 2002 and 2012 in a 2014 report from Thompson Reuters [http://sciencewatch.com/grr/presenting-highly-cited-researchers].<br />
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Gibson founded www.wikidoc.org, the world's most widely viewed open source textbook of medicine (viewed 700,000 to 2.2 million times daily, hundreds of millions of times annually). He is Editor-In-Chief of over 2,200 active contributors which have edited the content millions of times. Gibson served as medical lead in a partnership with Google, Microsoft and Yahoo to design a scheme of classifying medical content for the internet (www.schema.org) to improve medical search results. Gibson also founded www.clinicaltrialresults.org and has conducted 2,000 TV / video interviews and serves as the anchor person for medical meetings such as TCT TV.<br />
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For many years, Gibson has been chosen by his peers as one of Boston's Top Doctors in Boston Magazine. U.S. News & World Report also lists Gibson as one of America's top doctors. Gibson invented several of the measures of coronary blood flow that are widely used today (the TIMI frame count and the TIMI myocardial perfusion grade).<br />
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Formerly Harvard Clinical Research Institute (HCRI), Gibson leads the Baim Institute for Clinical Research as CEO. It is a leading, non-profit academic research organization (ARO) that delivers insight, innovation and leadership in today’s dynamic research environment. Baim collaborates with the world’s most highly respected researchers from renowned institutions to help advance health and quality of life around the world. The entity has managed 450 studies which have enrolled over 160,000 patients, and has played a role in 50 FDA submissions.<br />
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Gibson has led his own Academic Research Organization ([http://www.perfuse.org PERFUSE]) for over 25 years now, and has been principal investigator of or led core services for 106 clinical trials, the results of which have been published in leading journals such as the New England Journal of Medicine. The PERFUSE Study Group offers a full line of trial management, social media portals, CEC, DSMB and core lab services for phase 1-4 trials worldwide. Under Gibson's direction, the PERFUSE Study Group created the master database that unified data from over 25 years of TIMI studies (TIMI 1-50) in nearly 100,000 patients and coordinated data analyses for the TIMI study group and functioned as the TIMI Data Coordinating Center which he directed. Gibson has led phase 1-4 clinical trials, and cardiology megatrials of over 15,000 patients.<br />
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==Education and Academic Positions==<br />
Dr. Gibson received his B.S., M.S., and M.D. degrees from the University of Chicago. He was an Intern, Resident and Chief Resident at the Brigham and Women’s Hospital, Harvard Medical School. He received his training as an interventional cardiologist and served as the Director of the Coronary Care Unit at Beth Israel Hospital, Harvard Medical School. Dr. Gibson then served as the Chief of Cardiology and Director of Interventional Cardiology at the West Roxbury Veterans Affairs Medical Center, Harvard Medical School. While at the West Roxbury VA, he also served as an Associate Physician at the Brigham and Women’s Hospital. He then moved on to Allegheny General Hospital as Vice Chairman of Medicine for Clinical Research and Director of Invasive Cardiology. He subsequently relocated to the west coast and served as Associate Chief of Cardiology, Chief of Interventional Cardiology and Director of the Cardiac Catheterization Laboratory at University of California San Francisco (UCSF). In 2000, Gibson returned to Harvard Medical School in Boston. Until 2003, Dr. Gibson served as Chief Academic Officer and Director of Core Services at Harvard Clinical Research Institute (HCRI), until 2005 he served as Associate Chief of Cardiology and Director of Academic Affairs in the Cardiovascular Division at the Beth Israel Deaconess Medical Center. Until 2009 he served as the Director of the TIMI Data Coordinating Center at the Brigham and Women’s Hospital. He is currently a full time interventional cardiologist and Chief of Clinical Research in the Cardiovascular Division at Beth Israel Deaconess Medical Center, Harvard Medical School. <br />
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==Research==<br />
Dr. Gibson’s work has largely focused on investigating the pathophysiology of coronary artery disease and the efficacy of pharmacologic and device based therapies. His work has been presented in many thousands manuscripts, abstracts, trial summaries, textbooks and textbook chapters. Gibson's work has been cited over 56,957 times, and he has an h-index of 104 and an i10-index of 385. Updated numbers can be found here https://scholar.google.com/citations?hl=en&user=vzV233IAAAAJ <br />
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Over 25 years ago, Gibson founded the PERFUSE Study Group, an academic research organization which provides academic leadership, site identification and management, statistical analyses, regulatory guidance, angiographic, MRI, CT and EKG core laboratory services, and data management services for a wide variety of studies including trials in acute coronary syndromes, antiplatelets, antithrombins, reperfusion injury, atherosclerosis regression, new devices, angiogenesis, and new imaging modalities. Gibson directed the TIMI angiographic core laboratory and invented the TIMI frame count (CTFC) in which the number of cineframes for dye to reach standardized distal landmarks is counted (an index of epicardial blood flow). Gibson also invented the TIMI myocardial perfusion grade (the blush, a measure of microvascular perfusion). The TIMI frame count and the TIMI myocardial perfusion grade are both multivariate predictors of 2 year mortality in acute MI, and are now widely used both clinically and in the assessment of new reperfusion strategies. The methods invented by Gibson and his research have played a critical role in our understanding of "the open artery hypothesis" and more recently in what Gibson has termed "the open microvasculature hypothesis". On Google scholar, the TIMI Frame Count is listed as being cited in over 4,700 articles ([http://scholar.google.com/scholar?hl=en&lr=&q=%22timi+frame+count%22&btnG=Search for updated numbers click here]) and the TIMI myocardial perfusion grade is listed as being cited in over 1,800 articles ([http://scholar.google.com/scholar?hl=en&q=%22timi+myocardial+perfusion+grade%22&btnG=Search for updated numbers click here]).<br />
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Under Gibson's direction, the PERFUSE Study Group created the master database that unified data from over 25 years of TIMI studies (TIMI 1-50) in nearly 100,000 patients and coordinated data analyses for the TIMI study group and functioned as the TIMI Data Coordinating Center. <br />
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Within the Thrombolysis In Myocardial Infarction (TIMI) Study Group, Dr. Gibson has served as a Principle Investigator of multiple international trials within the TIMI Study Chairman’s Office.<br />
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Dr. Gibson's specific research interests include the following:<br />
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*'''Acute Coronary Syndrome Research Including unstable angina, non ST elevation MI and ST elevation MI:''' Gibson invented the angiographic endpoints that are used in assessing drug and device therapies such as the TIMI frame count and the TIMI myocardial perfusion grade. He has been the principal investigator of trials of novel thrombolytic agents (BB 10153) and novel mechanisms of delivery of thrombolytic agents such as ICE T – TIMI 49 (Intra-coronary Tenecteplase During Balloon Angioplasty). Gibson led the angiographic core laboratory analysis of a number of thrombolytic trials (TIMI4 (tPA and APSAC), TIMI 10 trials (TNK), ADVANCE MI (TNK + eptifibatide), TIMI 14 (lytic + abciximab), FASTER (lytic + aggrastat), CLARITY (lytic + clopidogrel), STEP AMI (lytic + cangrelor)<br />
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*'''Antiplatelet Trials:''' Gibson has led trials of glycoprotein 2b3a inhibitor inhibition (PROTECT, TITAN), thienopyridine trials such as the TRITON study of prasugrel, trials of novel antiplatelets such as elinogrel (ERASE MI), and is a member of the executive committee of trials of cangrelor. Gibson led the angiographic core laboratory for trials of eptifibatide (ESPRIT, INTEGRITI, ADVANCE MI, TITAN, EARLY ACS), abciximab (TIMI 14, INFUSE AMI, IC Clearly), and tirofiban (FASTER, TACTICS), clopidogrel (CLARITY TIMI 28), ticagrelor (PLATO) and cangrelor (STEP AMI).<br />
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*'''Antithrombin Trials:''' Gibson has led large scale international trials of novel antithrombins such as the development of rivaroxaban, a factor Xa inhibitor (ATLAS TIMI 46 and 51). Gibson has led angiographic core laboratory efforts in the evaluation of rNAPc2 (a fVIIa/TF inhibitor) in the ANTHEM study, and the SEPIA-ACS1 TIMI 42 (Study Program to Evaluate the Prevention of Ischemia with direct Anti-Xa inhibition in Acute Coronary Syndromes 1 - Thrombolysis in Myocardial Infarction 42).<br />
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*'''Reperfusion Injury Trials:''' Gibson has led the angiographic core laboratory analysis of reperfusion injury trials such as the LIMIT trial of rhuMAb CD18, the DELTA MI trial (Direct Inhibition of δ Protein Kinase C Enzyme to Limit Total Infarct Size in Acute Myocardial Infarction), the INOT-44 trial (Nitric Oxide in Myocardial Infarction Size (NOMI), and the INTESIVE trial (Apidra®/Lantus® therapy versus Sliding Scale Insulin on infarct size in hyperglycemic subjects with anterior STEMI undergoing percutaneous coronary intervention (PCI). Gibson is currently the Study Chairman and Principal Investigator of the multicenter international EMBRACE MI trial of [[Bendavia]].<br />
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*'''Lipid Lowering and Atherosclerosis Regression Trials:''' Gibson’s career started with the Harvard Atherosclerosis Reversibility Project where he developed the angiographic and statistical methodology to conduct angiographic atherosclerosis regression trials. Gibson participated in and has published manuscripts from the PROVE It study (PCI PROVE IT). Gibson has served as the site PI for trials of medical therapy in stable angina (the AVERT study). Gibson serves on the Executive committee of trials of CTEP inhibition (ACCELERATE). Gibson serves as the study chairman of the AEGIS trials evaluating the efficacy and safety of APO A1 infusions (HDL) to halt atherosclerosis and prevent atherothrombotic events. Gibson has participated in the publication of PCSK9 inhibitor trial data.<br />
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*'''New Device Trials:''' Gibson has led new device studies such as novel delivery systems for intracoronary therapies such as the Clearway catheter in the INFUSE AMI and IC Clearly trials, and aspiration thrombectomy (INFUSE AMI). He has served as the angiographic core laboratory for trials of perfusion balloons, directional atherectomy, self expanding stents, therapeutic ultrasound studies (PLUS) and markers of saphenous vein graft proximal connectors (PAS-Port (Study of the PAS-Port® Proximal Anastomosis System in Coronary Bypass Surgery (EPIC)).<br />
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*'''Imaging Trials:''' Gibson has served as the angiographic core laboratory for trials of new echocardiographic contrast agents (ECHOGEN) vs angiography, and positron emission tomography (PET) vs angiography trials.<br />
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*'''CMR Core Laboratory Trials:''' Gibson is co-principal investigator of CMR core laboratory studies such as ALLAY (efficacy and safety of aliskiren in combination with Losartan compared to Losartan), the TRACS Study (The Effects of Fx-1006A on Transthyretin Stabilization and Clinical Outcome Measures in Patients With Non-V30M Transthyretin Amyloidosis), the ACT-34 CMI (Autologous Cellular Therapy Utilizing CD34+ Cells), the INTESIVE trial (Apidra®/Lantus® therapy versus Sliding Scale Insulin on infarct size in hyperglycemic subjects with anterior STEMI undergoing percutaneous coronary intervention (PCI)), and the FX1B-201 Study (Safety and Efficacy Evaluation of Fx-1006A in Patients With V122I or Wild-Type Transthyretin (TTR) Amyloid Cardiomyopathy).<br />
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*'''CT Angiographic Core Laboratory Trials:''' Gibson has led the CT core laboratory for trials such as the markers of saphenous vein graft proximal connectors (PAS-Port (Study of the PAS-Port® Proximal Anastomosis System in Coronary Bypass Surgery (EPIC)).<br />
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*'''Coronary Artery Bypass Graft Trials:''' Gibson led the angiographic core laboratory analysis of the PREVENT 4 study (Project of Ex-vivo Vein Graft Engineering via Transfection) of 2200 patients.<br />
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*'''New Electrocardiography Technology Trials:''' Gibson is the leader of trials of an implantable technology (the AngelMed Guardian Device) designed to monitor and alert the patient to the presence of ST segment elevation (ALERT AMI trial). Gibson has led the angiographic core laboratory for trials such as OCCULT MI study of 84 lead EKG technologies (Optimal Cardiovascular Diagnostic Evaluation Enabling Faster Treatment of Myocardial Infarction). Gibson's team has also served as an EKG core laboratory.<br />
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*'''Angiogenesis Trials:''' Gibson assessed angiographic endpoints in early trials of angiogenesis (VIVA trial).<br />
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*'''Stem Cell Therapy:''' Gibson is Chair of the Data Safety Monitoring Board for the first phase III stem cell study (RENEW)<br />
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*'''NIH Studies:''' Gibson has led the angiographic core laboratory for a number of NIH studies including the Harvard Atherosclerosis Reversibility Project (HARP), the PEARL study of estrogens in restenosis, and the ASCERT study comparing PCI to CABG.<br />
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*'''Diabetes:''' Gibson coordinates the Clinical Event Committee efforts to adjudicate tens of thousands of adverse events and hundreds of thousands of EKGs in ongoing trials of novel anti-diabetic agents.<br />
<br />
===Publications===<br />
*Gibson's work has been cited over 56,957 times, and he has an h-index of 104 and an i10-index of 385. Updated numbers can be found here https://scholar.google.com/citations?hl=en&user=vzV233IAAAAJ<br />
<br />
*Peer reviewed research publications: > 530 (for an update, click [http://www.ncbi.nlm.nih.gov/pubmed?term=Gibson%20CM here])<br />
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*Non peer-reviewed reviews, chapters, monographs and editorials: 57<br />
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*Professional Educational Materials or Reports, in Print or Other Media: 686<br />
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*WikiDoc pages edited: Over 70,000 under C Michael Gibson and CMichaelGibson<br />
<br />
===Editorial Boards===<br />
Dr. Gibson has served in the past on the editorial board of numerous journals such as Circulation, the Journal of the American College of Cardiology, Cardiac Catheterization and Intervention and the American Heart Journal.<br />
<br />
==Education==<br />
===WikiDoc===<br />
Dr. Gibson is Founder and Chairman of the Board of WikiDoc Foundation (a 509 (a)(1) Charitable Organization). This is the world's largest medical textbook / encyclopedia. WikiDoc contains [[Special:Statistics|200,059]] chapters updated millions of times by over 2,200 active contributors and viewed hundreds of thousands of times daily. In 2010, WikiDoc was selected as a Google Grant recipient. Dr. Gibson has personally made over 70,000 edits to WikiDoc.<br />
<br />
===Schema.org===<br />
Although there is a vast amount of medical information on the internet, search engine's often return results that are not highly specific. This is because search engines do not account for the structure of the underlying medical knowledge or the relationships among keywords.<br />
Gibson was one of the co-creators of a www.schema.org-based [http://schemaorg-medicalext.appspot.com/docs/meddocs.html schema] that allows webmasters and content publishers to mark up health and medical content on the web. The health and medical schema is intended to make it easier for people to locate the optimal web pages by exposing structured information contained in web pages to search engines. As a result, more relevant content rich pages will be returned in search results.<br />
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===Internet Educational Sites===<br />
<br />
Dr. Gibson is Founder and Editor-in-Chief of [http://www.clinicaltrialresults.org Clinical Trial Results] where he created the first weekly TV show for Cardiologists "This Week in Cardiology" and has provided slides summarizing clinical trials since 1999. Gibson has conducted 2,000 TV / video interviews and serves as the anchor person for medical meetings such as TCT TV. Gibson also created the original [http://www.timi.org TIMI.org], website, the website of the TIMI Study Group.<br />
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===Traditional Textbooks===<br />
Dr. Gibson also edits a textbook entitled “Gibson's Treatment Strategies in Interventional Cardiology” which is optimized for hand held devices. In the past, Gibson has authored the chapter on Primary Angioplasty in Randomized Trials in Cardiovascular Disease published as a companion to Braunwald's Heart Disease. In the past he has co-authored the chapter “Recognition and Management of Patients with Stable Angina Pectoris" in Braunwald and Goldman’s Primary Cardiology. He has served as lead author of the section on myocardial perfusion imaging in an imaging textbook which is a companion to Braunwald’s Heart Disease. Gibson has authored the chapter “Profiles in Coronary Artery Disease” in the fifth and sixth editions of Grossman and Baim’s Textbook of Interventional Cardiology.<br />
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===American Heart Association===<br />
Gibson has served as a member of the Professional Education Committee of the American Heart Association.<br />
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==Physician==<br />
Gibson is a practicing interventional cardiologist. He has served as a cath lab director. In 2009 and 2010, Dr. Gibson was chosen by his peers as one of Boston's Top Doctors in Boston Magazine.<br />
<br />
In 2010, Dr. Gibson was selected as one of America's Top Doctors by Castle Connolly Medical Ltd. In the same year, he was also selected to be included in the Consumers' Research Council of America’s Guide to America’s Top Cardiologists.<br />
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In 2011, Dr. Gibson was featured as one of Boston's Super doctors on my.superdoctors.com. In the same year, he was also selected to be included in the Consumers' Research Council of America’s Guide to America’s Top Cardiologists.<br />
<br />
In 2011 U.S. News & World Report listed Dr. Gibson as one of America's Top Doctors as selected by Castle Connolly Medical Ltd. [http://health.usnews.com/top-doctors/c-michael-gibson-interventional-cardiologist-22CC000361 health.usnews.com]<br />
<br />
==Awards==<br />
[[Image:C-Michael-Gibson-award.jpg|right]]<br />
[[Image:C Michael Gibson Distinguished fellow.jpg|right]]<br />
Dr. Gibson graduated from college Phi Beta Kappa, and from medical school Alpha Omega Alpha, both from the University of Chicago. In 1993 he was selected as the Julian and Eunice Cohen Scholar in Medicine at the Brigham and Women's Hospital. <br />
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In conjunction with delivering the opening plenary lecture at the 10th annual Great Wall of China Symposium in 2003, Gibson was awarded the Gold Medal by the Institute of Geriatric Cardiology, Chinese Peoples Liberation Army General Hospital, Beijing China for his achievements in cardiovascular science. <br />
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In 2005, the John Paul II Hospital in Krakow, Poland awarded Gibson the Pro Bono Curantium Gold Medal for Merit, and a research laboratory was named there in his honor. He was the 4th such awardee, the others being Pope John Paul II and Dr. Valentine Fuster. In that same year, Gibson was awarded the Medal of the Jagiellonian University for his outstanding achievements in education and research in cardiovascular science. <br />
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In 2009, the Cardiovascular Division of Istanbul University, Turkey, established the C. Michael Gibson Research and Education Center. In that same year, the Turkish Cardiac Society honored Gibson for establishing WikiDoc on, September 27th, World Heart Day.<br />
<br />
In 2007 and 2009, Dr. Gibson was selected by Who's Who as the Clinical Researcher of the Year. <br />
<br />
In 2009 and 2010, Dr. Gibson was chosen by his peers as one of Boston's Top Doctors in Boston Magazine.<br />
<br />
In 2010, Dr. Gibson was selected as one of America's Top Doctors by Castle Connolly Medical Ltd. In the same year, he was also selected to be included in the Consumers' Research Council of America’s Guide to America’s Top Cardiologists.<br />
<br />
In 2011, Dr. Gibson was featured as one of Boston's Super doctors on my.superdoctors.com. In the same year, he was also selected to be included in the Consumers' Research Council of America’s Guide to America’s Top Cardiologists.<br />
<br />
In 2011 U.S. News & World Report listed Dr. Gibson as one of America's Top Doctors as selected by Castle Connolly Medical Ltd. [http://health.usnews.com/top-doctors/c-michael-gibson-interventional-cardiologist-22CC000361 health.usnews.com]<br />
<br />
In 2012 Gibson was appointed a Distinguished Fellow of New Westminster College, which is the highest honour that New Westminster College bestows upon senior leaders to recognize their distinguished record of ethical leadership. Other Distinguished Fellows include world leaders, cabinet ministers, 12 ambassadors, an astronaut, 27 generals and admirals, surgeons and medical doctors.<br />
<br />
==Disclosures:==<br />
<br />
Dr. Gibson follows the conflict of interest policies set forth by Harvard Medical School and the Beth Israel Deaconess Medical Center. The Baim Institute follows the same conflict of interest policies as Harvard Medical School and Beth Israel Deaconess Medical Center.<br />
<br />
''Executive Position (with $0.00 monies received by Dr. Gibson)''<br />
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Chief Executive Office, Baim Institute for Clinical Research<br />
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<br />
''Present Research/Grant Funding (within the last year)''<br />
<br />
Ongoing: Angel Medical Corporation;<br />
Bayer Corp.;<br />
CSL Behring;<br />
Janssen Pharmaceuticals;<br />
Johnson & Johnson Corporation;<br />
<br />
Terminated but within one year: Portola Pharmaceuticals (ceased with BIDMC on 12/31/2017)<br />
<br />
<br />
''Consulting''<br />
<br />
Amarin Pharama, Amgen, Arena Pharmaceuticals, Bayer Corporation, Boehringer Ingelheim, Boston Clinical Research Institute, Cardiovascular Research Foundation, Chiesi, CSL Behring, Eli Lilly, Gilead Sciences, Inc., Impact Bio LTD, Janssen Pharmaceuticals, Johnson & Johnson Corporation, The Medicines Company, MedImmune, Medtelligence, Merck & Co, Inc., Novo Nordisk, Pfizer, Pharma Mar, Portola Pharmaceuticals (began 1/1/2018), Sanofi, Somahlution, St. Francis Hospital, Verseon Corportation, Web MD<br />
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For Trials that Dr. Gibson actively serves as PI of and receives research grant support on an ongoing basis, there is less than $25,000 per year in consulting monies received per the Harvard, BIDMC, Baim policies.<br />
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<br />
''Royalties as a Contributor''<br />
<br />
UpToDate in Cardiovascular Medicine<br />
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''Spouse conflicts of interests (Employee of Boston Clinical Research Institute)''<br />
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Amarin, Amgen, Areana, Bayer, Boehringer Ingelheim, Boston Scientific, Cardiovascular Research Foundation, Chiesi, Eli Lilly, Gilead Sciences, Inc., Impact Bio, Janssen, Johnson and Johnson, The Medicines Company, Medtelligence, MedImmune, Merck & Co. Inc., Novo Nordisk, Pfizer, PharmaMar, Portola, Sanofi, Somahlution, St. Francis Hospital, Verseon Corporation<br />
<br />
==Twitter disclaimer for C. Michael Gibson==<br />
@CMichaelGibson is largely a news service citing articles in the news media related to healthcare. A retweet does not constitute an endorsement. RTs which link to other websites are provided as a service to followers, but linking to the sites does not constitute endorsement of those sites by @CMichaelGibson, and @CMichaelGibson is not responsible for the content of external websites. Please note that other users of Twitter may utilize your tweets beyond the control of @CMichaelGibson. Tweets are educational and do not represent medical advice, see your doctor or healthcare provider. Tweets are educational only and are not meant to promote an unapproved or off label use of a medical drug or device. #cmgsays says quotes may have been said by others as well as anonymous individuals.<br />
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That is not to say that you will not find valuable and accurate educational information in @CMichaelGibson's posts; some of the time you will. However, @CMichaelGibson cannot guarantee the validity of the information found on Twitter. The content of any given article may recently have been changed, vandalized or altered by someone whose opinion does not correspond with the consensus in the medical field in your country, state, or city.<br />
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In view of the possibility of human error by @CMichaelGibson, he does not warrant that the information contained herein is in every respect accurate or complete, and @CMichaelGibson is not responsible for any errors or omissions or for the results obtained from the use of such. Readers are encouraged to confirm the information contained in the tweets with other sources. Patients and consumers reading articles linked to from the tweets should review the information carefully with their professional healthcare provider. The tweets are not intended to replace medical advice offered by physicians. @CMichaelGibson makes no representations or warranties with respect to any treatment, action, or application of medication or preparation by any person following the information offered or provided within or through the tweets. @CMichaelGibson is not be liable for any direct, indirect, consequential, special, exemplary, or other damages arising there from.<br />
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@CMichaelGibson is not responsible for errors or omissions or for any consequences from application of the information on the twitter account, and makes no warranty, expressed or implied, with respect to the currency, completeness, or accuracy of the contents of the twitter account or any of the links or images. Application of this information in a particular situation remains the professional responsibility of the practitioner or viewer.<br />
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Some information on drugs and medical devices presented in the twitter account may be investigational and/or approved for limited use. It is the responsibility of health care providers to ascertain the status of each drug or device planned for use in their clinical practice. If you are a patient, check with your healthcare provider.<br />
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You may have a simple link from your website to the twitter account of @CMichaelGibson or its RSS feed. However, you must first ask @CMichaelGibson for his permission if you intend to frame @CMichaelGisbon ' s twitter feed on your site or incorporate pieces of it into a different site or product in a way that is not clear to our users. You acknowledge and agree not to link to or incorporate an RSS feed of @CMichaelGibson if you engage in illegal, obscene, or offensive content, or if the link in any way has a negative impact on the reputation of @CMichaelGibson.<br />
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This agreement shall be governed by the laws of the state of Massachusetts applicable to agreements wholly made and performed in Massachusetts. In the event that you believe you have been irreparably harmed by any cause of action relating to @CMichaelGibson, you agree to inform @CMichaelGibson in writing and grant @CMichaelGibson thirty (30) days to cure the harm before initiating any action. Any legal action, suit or proceeding arising out of or relating to this agreement or a breach thereof, shall be instituted in a court of competent jurisdiction in Boston MA, and you hereby consent and submit to personal jurisdiction of such court, waive any objection to venue in such court and consent to service of process by overnight courier or express mail at your last known address. Any cause of action initiated by you must be initiated within 6 months after the claim or cause of action has arisen or be barred. Publication of information found on @CMichaelGibson may be in violation of the laws of the country or jurisdiction from where you are viewing this information. Laws in your country or jurisdiction may not protect or allow the same kinds of speech or distribution. @CMichaelGibson does not encourage the violation of any laws; and cannot be responsible for any violations of such laws, should you link to this domain or use, reproduce, or republish the information contained herein. All correspondence should be addressed in writing to C. Michael Gibson, 1 Carter Drive, Natick MA 01760.<br />
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If you need specific advice (for example, medical, legal, financial, or risk management) please seek a professional who is licensed or knowledgeable in that area.<br />
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Key words, synonyms: CM Gibson, M Gibson, C Gibson, C.M. Gibson, M. Gibson, C. Gibson, Dr. C.M. Gibson, Dr. M. Gibson, Charles Michael Gibson, Charles M. Gibson, Gibson CM, Gibson CM M.D., C. Michael Gibson M.S. M.D., Mike Gibson, Dr. Mike Gibson, Mike Gibson M.D., Dr. C. Michael Gibson, Dr. CM Gibson, Dr. Gibson, Doctor Gibson <br />
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[[Category:Cardiologists]]</div>C Michael Gibsonhttps://www.wikidoc.org/index.php?title=User:C_Michael_Gibson&diff=1495825User:C Michael Gibson2018-09-28T16:05:10Z<p>C Michael Gibson: /* Disclosures: */</p>
<hr />
<div>[[Image:Cmg v4 small.jpg|right|250px|WikiDoc Founder C. Michael Gibson, M.S., M.D.]]<br />
'''C. Michael Gibson M.S., M.D.''', Professor of Medicine, Harvard Medical School <br />
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Founder and Chairman of the Board, WikiDoc Foundation (a 509 (a)(1) Charitable Organization); Chief Executive Officer, Baim Institute for Clinical Research; Founder and Chairman of the [http://www.perfuse.org PERFUSE Study Group]<br />
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'''Contact:''' mgibson@wikidoc.org[mailto:mgibson@wikidoc.org]; or at his G mail address: charlesmichaelgibson@gmail.com [mailto:charlesmichaelgibson@gmail.com]<br />
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'''Mailing Address:''' C. Michael Gibson, M.S., M.D., Beth Israel Deaconess Medical Center<br />
330 Brookline Avenue, Overland 540, Boston, MA 02215 Boston MA, 02215.<br />
<br />
'''Headshot:''' Download headshot [//www.wikidoc.org/images/e/e6/Cmg_v4_small.jpg here]<br />
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View Dr. Gibon's TEDx talk about WikiDoc on YouTube [https://www.youtube.com/watch?v=DMwZnFwueQU here]<br />
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Download Dr. Gibson's slides from his TEDx talk about WikiDoc [//www.wikidoc.org/images/a/a6/Tedx_talk_v5.pptx here]<br />
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<br />
__NOTOC__<br />
----<br />
C. Michael Gibson, M.S., M.D. is an interventional cardiologist, cardiovascular researcher and educator who pioneered our understanding of the "open artery hypothesis" as well our understanding of the importance of restoring flow downstream in the capillary bed in the "open microvasculature hypothesis" in heart attack patients. Gibson was chosen as one of the most influential scientific minds between 2002 and 2012 in a 2014 report from Thompson Reuters [http://sciencewatch.com/grr/presenting-highly-cited-researchers].<br />
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Gibson founded www.wikidoc.org, the world's most widely viewed open source textbook of medicine (viewed 700,000 to 2.2 million times daily, hundreds of millions of times annually). He is Editor-In-Chief of over 2,200 active contributors which have edited the content millions of times. Gibson served as medical lead in a partnership with Google, Microsoft and Yahoo to design a scheme of classifying medical content for the internet (www.schema.org) to improve medical search results. Gibson also founded www.clinicaltrialresults.org and has conducted 2,000 TV / video interviews and serves as the anchor person for medical meetings such as TCT TV.<br />
<br />
For many years, Gibson has been chosen by his peers as one of Boston's Top Doctors in Boston Magazine. U.S. News & World Report also lists Gibson as one of America's top doctors. Gibson invented several of the measures of coronary blood flow that are widely used today (the TIMI frame count and the TIMI myocardial perfusion grade).<br />
<br />
Formerly Harvard Clinical Research Institute (HCRI), Gibson leads the Baim Institute for Clinical Research as CEO. It is a leading, non-profit academic research organization (ARO) that delivers insight, innovation and leadership in today’s dynamic research environment. Baim collaborates with the world’s most highly respected researchers from renowned institutions to help advance health and quality of life around the world. The entity has managed 450 studies which have enrolled over 160,000 patients, and has played a role in 50 FDA submissions.<br />
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Gibson has led his own Academic Research Organization ([http://www.perfuse.org PERFUSE]) for over 25 years now, and has been principal investigator of or led core services for 106 clinical trials, the results of which have been published in leading journals such as the New England Journal of Medicine. The PERFUSE Study Group offers a full line of trial management, social media portals, CEC, DSMB and core lab services for phase 1-4 trials worldwide. Under Gibson's direction, the PERFUSE Study Group created the master database that unified data from over 25 years of TIMI studies (TIMI 1-50) in nearly 100,000 patients and coordinated data analyses for the TIMI study group and functioned as the TIMI Data Coordinating Center which he directed. Gibson has led phase 1-4 clinical trials, and cardiology megatrials of over 15,000 patients.<br />
<br />
==Education and Academic Positions==<br />
Dr. Gibson received his B.S., M.S., and M.D. degrees from the University of Chicago. He was an Intern, Resident and Chief Resident at the Brigham and Women’s Hospital, Harvard Medical School. He received his training as an interventional cardiologist and served as the Director of the Coronary Care Unit at Beth Israel Hospital, Harvard Medical School. Dr. Gibson then served as the Chief of Cardiology and Director of Interventional Cardiology at the West Roxbury Veterans Affairs Medical Center, Harvard Medical School. While at the West Roxbury VA, he also served as an Associate Physician at the Brigham and Women’s Hospital. He then moved on to Allegheny General Hospital as Vice Chairman of Medicine for Clinical Research and Director of Invasive Cardiology. He subsequently relocated to the west coast and served as Associate Chief of Cardiology, Chief of Interventional Cardiology and Director of the Cardiac Catheterization Laboratory at University of California San Francisco (UCSF). In 2000, Gibson returned to Harvard Medical School in Boston. Until 2003, Dr. Gibson served as Chief Academic Officer and Director of Core Services at Harvard Clinical Research Institute (HCRI), until 2005 he served as Associate Chief of Cardiology and Director of Academic Affairs in the Cardiovascular Division at the Beth Israel Deaconess Medical Center. Until 2009 he served as the Director of the TIMI Data Coordinating Center at the Brigham and Women’s Hospital. He is currently a full time interventional cardiologist and Chief of Clinical Research in the Cardiovascular Division at Beth Israel Deaconess Medical Center, Harvard Medical School. <br />
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==Research==<br />
Dr. Gibson’s work has largely focused on investigating the pathophysiology of coronary artery disease and the efficacy of pharmacologic and device based therapies. His work has been presented in many thousands manuscripts, abstracts, trial summaries, textbooks and textbook chapters. Gibson's work has been cited over 56,957 times, and he has an h-index of 104 and an i10-index of 385. Updated numbers can be found here https://scholar.google.com/citations?hl=en&user=vzV233IAAAAJ <br />
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Over 25 years ago, Gibson founded the PERFUSE Study Group, an academic research organization which provides academic leadership, site identification and management, statistical analyses, regulatory guidance, angiographic, MRI, CT and EKG core laboratory services, and data management services for a wide variety of studies including trials in acute coronary syndromes, antiplatelets, antithrombins, reperfusion injury, atherosclerosis regression, new devices, angiogenesis, and new imaging modalities. Gibson directed the TIMI angiographic core laboratory and invented the TIMI frame count (CTFC) in which the number of cineframes for dye to reach standardized distal landmarks is counted (an index of epicardial blood flow). Gibson also invented the TIMI myocardial perfusion grade (the blush, a measure of microvascular perfusion). The TIMI frame count and the TIMI myocardial perfusion grade are both multivariate predictors of 2 year mortality in acute MI, and are now widely used both clinically and in the assessment of new reperfusion strategies. The methods invented by Gibson and his research have played a critical role in our understanding of "the open artery hypothesis" and more recently in what Gibson has termed "the open microvasculature hypothesis". On Google scholar, the TIMI Frame Count is listed as being cited in over 4,700 articles ([http://scholar.google.com/scholar?hl=en&lr=&q=%22timi+frame+count%22&btnG=Search for updated numbers click here]) and the TIMI myocardial perfusion grade is listed as being cited in over 1,800 articles ([http://scholar.google.com/scholar?hl=en&q=%22timi+myocardial+perfusion+grade%22&btnG=Search for updated numbers click here]).<br />
<br />
Under Gibson's direction, the PERFUSE Study Group created the master database that unified data from over 25 years of TIMI studies (TIMI 1-50) in nearly 100,000 patients and coordinated data analyses for the TIMI study group and functioned as the TIMI Data Coordinating Center. <br />
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Within the Thrombolysis In Myocardial Infarction (TIMI) Study Group, Dr. Gibson has served as a Principle Investigator of multiple international trials within the TIMI Study Chairman’s Office.<br />
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Dr. Gibson's specific research interests include the following:<br />
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*'''Acute Coronary Syndrome Research Including unstable angina, non ST elevation MI and ST elevation MI:''' Gibson invented the angiographic endpoints that are used in assessing drug and device therapies such as the TIMI frame count and the TIMI myocardial perfusion grade. He has been the principal investigator of trials of novel thrombolytic agents (BB 10153) and novel mechanisms of delivery of thrombolytic agents such as ICE T – TIMI 49 (Intra-coronary Tenecteplase During Balloon Angioplasty). Gibson led the angiographic core laboratory analysis of a number of thrombolytic trials (TIMI4 (tPA and APSAC), TIMI 10 trials (TNK), ADVANCE MI (TNK + eptifibatide), TIMI 14 (lytic + abciximab), FASTER (lytic + aggrastat), CLARITY (lytic + clopidogrel), STEP AMI (lytic + cangrelor)<br />
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*'''Antiplatelet Trials:''' Gibson has led trials of glycoprotein 2b3a inhibitor inhibition (PROTECT, TITAN), thienopyridine trials such as the TRITON study of prasugrel, trials of novel antiplatelets such as elinogrel (ERASE MI), and is a member of the executive committee of trials of cangrelor. Gibson led the angiographic core laboratory for trials of eptifibatide (ESPRIT, INTEGRITI, ADVANCE MI, TITAN, EARLY ACS), abciximab (TIMI 14, INFUSE AMI, IC Clearly), and tirofiban (FASTER, TACTICS), clopidogrel (CLARITY TIMI 28), ticagrelor (PLATO) and cangrelor (STEP AMI).<br />
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*'''Antithrombin Trials:''' Gibson has led large scale international trials of novel antithrombins such as the development of rivaroxaban, a factor Xa inhibitor (ATLAS TIMI 46 and 51). Gibson has led angiographic core laboratory efforts in the evaluation of rNAPc2 (a fVIIa/TF inhibitor) in the ANTHEM study, and the SEPIA-ACS1 TIMI 42 (Study Program to Evaluate the Prevention of Ischemia with direct Anti-Xa inhibition in Acute Coronary Syndromes 1 - Thrombolysis in Myocardial Infarction 42).<br />
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*'''Reperfusion Injury Trials:''' Gibson has led the angiographic core laboratory analysis of reperfusion injury trials such as the LIMIT trial of rhuMAb CD18, the DELTA MI trial (Direct Inhibition of δ Protein Kinase C Enzyme to Limit Total Infarct Size in Acute Myocardial Infarction), the INOT-44 trial (Nitric Oxide in Myocardial Infarction Size (NOMI), and the INTESIVE trial (Apidra®/Lantus® therapy versus Sliding Scale Insulin on infarct size in hyperglycemic subjects with anterior STEMI undergoing percutaneous coronary intervention (PCI). Gibson is currently the Study Chairman and Principal Investigator of the multicenter international EMBRACE MI trial of [[Bendavia]].<br />
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*'''Lipid Lowering and Atherosclerosis Regression Trials:''' Gibson’s career started with the Harvard Atherosclerosis Reversibility Project where he developed the angiographic and statistical methodology to conduct angiographic atherosclerosis regression trials. Gibson participated in and has published manuscripts from the PROVE It study (PCI PROVE IT). Gibson has served as the site PI for trials of medical therapy in stable angina (the AVERT study). Gibson serves on the Executive committee of trials of CTEP inhibition (ACCELERATE). Gibson serves as the study chairman of the AEGIS trials evaluating the efficacy and safety of APO A1 infusions (HDL) to halt atherosclerosis and prevent atherothrombotic events. Gibson has participated in the publication of PCSK9 inhibitor trial data.<br />
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*'''New Device Trials:''' Gibson has led new device studies such as novel delivery systems for intracoronary therapies such as the Clearway catheter in the INFUSE AMI and IC Clearly trials, and aspiration thrombectomy (INFUSE AMI). He has served as the angiographic core laboratory for trials of perfusion balloons, directional atherectomy, self expanding stents, therapeutic ultrasound studies (PLUS) and markers of saphenous vein graft proximal connectors (PAS-Port (Study of the PAS-Port® Proximal Anastomosis System in Coronary Bypass Surgery (EPIC)).<br />
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*'''Imaging Trials:''' Gibson has served as the angiographic core laboratory for trials of new echocardiographic contrast agents (ECHOGEN) vs angiography, and positron emission tomography (PET) vs angiography trials.<br />
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*'''CMR Core Laboratory Trials:''' Gibson is co-principal investigator of CMR core laboratory studies such as ALLAY (efficacy and safety of aliskiren in combination with Losartan compared to Losartan), the TRACS Study (The Effects of Fx-1006A on Transthyretin Stabilization and Clinical Outcome Measures in Patients With Non-V30M Transthyretin Amyloidosis), the ACT-34 CMI (Autologous Cellular Therapy Utilizing CD34+ Cells), the INTESIVE trial (Apidra®/Lantus® therapy versus Sliding Scale Insulin on infarct size in hyperglycemic subjects with anterior STEMI undergoing percutaneous coronary intervention (PCI)), and the FX1B-201 Study (Safety and Efficacy Evaluation of Fx-1006A in Patients With V122I or Wild-Type Transthyretin (TTR) Amyloid Cardiomyopathy).<br />
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*'''CT Angiographic Core Laboratory Trials:''' Gibson has led the CT core laboratory for trials such as the markers of saphenous vein graft proximal connectors (PAS-Port (Study of the PAS-Port® Proximal Anastomosis System in Coronary Bypass Surgery (EPIC)).<br />
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*'''Coronary Artery Bypass Graft Trials:''' Gibson led the angiographic core laboratory analysis of the PREVENT 4 study (Project of Ex-vivo Vein Graft Engineering via Transfection) of 2200 patients.<br />
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*'''New Electrocardiography Technology Trials:''' Gibson is the leader of trials of an implantable technology (the AngelMed Guardian Device) designed to monitor and alert the patient to the presence of ST segment elevation (ALERT AMI trial). Gibson has led the angiographic core laboratory for trials such as OCCULT MI study of 84 lead EKG technologies (Optimal Cardiovascular Diagnostic Evaluation Enabling Faster Treatment of Myocardial Infarction). Gibson's team has also served as an EKG core laboratory.<br />
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*'''Angiogenesis Trials:''' Gibson assessed angiographic endpoints in early trials of angiogenesis (VIVA trial).<br />
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*'''Stem Cell Therapy:''' Gibson is Chair of the Data Safety Monitoring Board for the first phase III stem cell study (RENEW)<br />
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*'''NIH Studies:''' Gibson has led the angiographic core laboratory for a number of NIH studies including the Harvard Atherosclerosis Reversibility Project (HARP), the PEARL study of estrogens in restenosis, and the ASCERT study comparing PCI to CABG.<br />
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*'''Diabetes:''' Gibson coordinates the Clinical Event Committee efforts to adjudicate tens of thousands of adverse events and hundreds of thousands of EKGs in ongoing trials of novel anti-diabetic agents.<br />
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===Publications===<br />
*Gibson's work has been cited over 56,957 times, and he has an h-index of 104 and an i10-index of 385. Updated numbers can be found here https://scholar.google.com/citations?hl=en&user=vzV233IAAAAJ<br />
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*Peer reviewed research publications: > 530 (for an update, click [http://www.ncbi.nlm.nih.gov/pubmed?term=Gibson%20CM here])<br />
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*Non peer-reviewed reviews, chapters, monographs and editorials: 57<br />
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*Professional Educational Materials or Reports, in Print or Other Media: 686<br />
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*WikiDoc pages edited: Over 70,000 under C Michael Gibson and CMichaelGibson<br />
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===Editorial Boards===<br />
Dr. Gibson has served in the past on the editorial board of numerous journals such as Circulation, the Journal of the American College of Cardiology, Cardiac Catheterization and Intervention and the American Heart Journal.<br />
<br />
==Education==<br />
===WikiDoc===<br />
Dr. Gibson is Founder and Chairman of the Board of WikiDoc Foundation (a 509 (a)(1) Charitable Organization). This is the world's largest medical textbook / encyclopedia. WikiDoc contains [[Special:Statistics|200,059]] chapters updated millions of times by over 2,200 active contributors and viewed hundreds of thousands of times daily. In 2010, WikiDoc was selected as a Google Grant recipient. Dr. Gibson has personally made over 70,000 edits to WikiDoc.<br />
<br />
===Schema.org===<br />
Although there is a vast amount of medical information on the internet, search engine's often return results that are not highly specific. This is because search engines do not account for the structure of the underlying medical knowledge or the relationships among keywords.<br />
Gibson was one of the co-creators of a www.schema.org-based [http://schemaorg-medicalext.appspot.com/docs/meddocs.html schema] that allows webmasters and content publishers to mark up health and medical content on the web. The health and medical schema is intended to make it easier for people to locate the optimal web pages by exposing structured information contained in web pages to search engines. As a result, more relevant content rich pages will be returned in search results.<br />
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===Internet Educational Sites===<br />
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Dr. Gibson is Founder and Editor-in-Chief of [http://www.clinicaltrialresults.org Clinical Trial Results] where he created the first weekly TV show for Cardiologists "This Week in Cardiology" and has provided slides summarizing clinical trials since 1999. Gibson has conducted 2,000 TV / video interviews and serves as the anchor person for medical meetings such as TCT TV. Gibson also created the original [http://www.timi.org TIMI.org], website, the website of the TIMI Study Group.<br />
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===Traditional Textbooks===<br />
Dr. Gibson also edits a textbook entitled “Gibson's Treatment Strategies in Interventional Cardiology” which is optimized for hand held devices. In the past, Gibson has authored the chapter on Primary Angioplasty in Randomized Trials in Cardiovascular Disease published as a companion to Braunwald's Heart Disease. In the past he has co-authored the chapter “Recognition and Management of Patients with Stable Angina Pectoris" in Braunwald and Goldman’s Primary Cardiology. He has served as lead author of the section on myocardial perfusion imaging in an imaging textbook which is a companion to Braunwald’s Heart Disease. Gibson has authored the chapter “Profiles in Coronary Artery Disease” in the fifth and sixth editions of Grossman and Baim’s Textbook of Interventional Cardiology.<br />
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===American Heart Association===<br />
Gibson has served as a member of the Professional Education Committee of the American Heart Association.<br />
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==Physician==<br />
Gibson is a practicing interventional cardiologist. He has served as a cath lab director. In 2009 and 2010, Dr. Gibson was chosen by his peers as one of Boston's Top Doctors in Boston Magazine.<br />
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In 2010, Dr. Gibson was selected as one of America's Top Doctors by Castle Connolly Medical Ltd. In the same year, he was also selected to be included in the Consumers' Research Council of America’s Guide to America’s Top Cardiologists.<br />
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In 2011, Dr. Gibson was featured as one of Boston's Super doctors on my.superdoctors.com. In the same year, he was also selected to be included in the Consumers' Research Council of America’s Guide to America’s Top Cardiologists.<br />
<br />
In 2011 U.S. News & World Report listed Dr. Gibson as one of America's Top Doctors as selected by Castle Connolly Medical Ltd. [http://health.usnews.com/top-doctors/c-michael-gibson-interventional-cardiologist-22CC000361 health.usnews.com]<br />
<br />
==Awards==<br />
[[Image:C-Michael-Gibson-award.jpg|right]]<br />
[[Image:C Michael Gibson Distinguished fellow.jpg|right]]<br />
Dr. Gibson graduated from college Phi Beta Kappa, and from medical school Alpha Omega Alpha, both from the University of Chicago. In 1993 he was selected as the Julian and Eunice Cohen Scholar in Medicine at the Brigham and Women's Hospital. <br />
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In conjunction with delivering the opening plenary lecture at the 10th annual Great Wall of China Symposium in 2003, Gibson was awarded the Gold Medal by the Institute of Geriatric Cardiology, Chinese Peoples Liberation Army General Hospital, Beijing China for his achievements in cardiovascular science. <br />
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In 2005, the John Paul II Hospital in Krakow, Poland awarded Gibson the Pro Bono Curantium Gold Medal for Merit, and a research laboratory was named there in his honor. He was the 4th such awardee, the others being Pope John Paul II and Dr. Valentine Fuster. In that same year, Gibson was awarded the Medal of the Jagiellonian University for his outstanding achievements in education and research in cardiovascular science. <br />
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In 2009, the Cardiovascular Division of Istanbul University, Turkey, established the C. Michael Gibson Research and Education Center. In that same year, the Turkish Cardiac Society honored Gibson for establishing WikiDoc on, September 27th, World Heart Day.<br />
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In 2007 and 2009, Dr. Gibson was selected by Who's Who as the Clinical Researcher of the Year. <br />
<br />
In 2009 and 2010, Dr. Gibson was chosen by his peers as one of Boston's Top Doctors in Boston Magazine.<br />
<br />
In 2010, Dr. Gibson was selected as one of America's Top Doctors by Castle Connolly Medical Ltd. In the same year, he was also selected to be included in the Consumers' Research Council of America’s Guide to America’s Top Cardiologists.<br />
<br />
In 2011, Dr. Gibson was featured as one of Boston's Super doctors on my.superdoctors.com. In the same year, he was also selected to be included in the Consumers' Research Council of America’s Guide to America’s Top Cardiologists.<br />
<br />
In 2011 U.S. News & World Report listed Dr. Gibson as one of America's Top Doctors as selected by Castle Connolly Medical Ltd. [http://health.usnews.com/top-doctors/c-michael-gibson-interventional-cardiologist-22CC000361 health.usnews.com]<br />
<br />
In 2012 Gibson was appointed a Distinguished Fellow of New Westminster College, which is the highest honour that New Westminster College bestows upon senior leaders to recognize their distinguished record of ethical leadership. Other Distinguished Fellows include world leaders, cabinet ministers, 12 ambassadors, an astronaut, 27 generals and admirals, surgeons and medical doctors.<br />
<br />
==Disclosures:==<br />
<br />
Dr. Gibson follows the conflict of interest policies set forth by Harvard Medical School and the Beth Israel Deaconess Medical Center. The Baim Institute follows the same conflict of interest policies as Harvard Medical School and Beth Israel Deaconess Medical Center.<br />
<br />
''Executive Position (with $0.00 monies received by Dr. Gibson)''<br />
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Chief Executive Office, Baim Institute for Clinical Research<br />
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<br />
''Present Research/Grant Funding (within the last year)''<br />
<br />
Ongoing: Angel Medical Corporation;<br />
Bayer Corp.;<br />
CSL Behring;<br />
Janssen Pharmaceuticals;<br />
Johnson & Johnson Corporation;<br />
<br />
Terminated but within one year: Portola Pharmaceuticals (ceased with BIDMC on 12/31/2017)<br />
<br />
<br />
''Consulting''<br />
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Amarin Pharama, Amgen, Arena Pharmaceuticals, Bayer Corporation, Boehringer Ingelheim, Boston Clinical Research Institute, Cardiovascular Research Foundation, Chiesi, CSL Behring, Eli Lilly, Gilead Sciences, Inc., Impact Bio LTD, Janssen Pharmaceuticals, Johnson & Johnson Corporation, The Medicines Company, MedImmune, Medtelligence, Merck & Co, Inc., Novo Nordisk, Pfizer, Pharma Mar, Portola Pharmaceuticals (began 1/1/2018), Sanofi, Somahlution, St. Francis Hospital, Verseon Corportation, Web MD<br />
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For Trials that Dr. Gibson actively serves as PI of and receives research grant support on an ongoing basis, there is less than $25,000 per year in consulting monies.<br />
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<br />
''Royalties as a Contributor''<br />
<br />
UpToDate in Cardiovascular Medicine<br />
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''Spouse conflicts of interests (Employee of Boston Clinical Research Institute)''<br />
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Amarin, Amgen, Areana, Bayer, Boehringer Ingelheim, Boston Scientific, Cardiovascular Research Foundation, Chiesi, Eli Lilly, Gilead Sciences, Inc., Impact Bio, Janssen, Johnson and Johnson, The Medicines Company, Medtelligence, MedImmune, Merck & Co. Inc., Novo Nordisk, Pfizer, PharmaMar, Portola, Sanofi, Somahlution, St. Francis Hospital, Verseon Corporation<br />
<br />
==Twitter disclaimer for C. Michael Gibson==<br />
@CMichaelGibson is largely a news service citing articles in the news media related to healthcare. A retweet does not constitute an endorsement. RTs which link to other websites are provided as a service to followers, but linking to the sites does not constitute endorsement of those sites by @CMichaelGibson, and @CMichaelGibson is not responsible for the content of external websites. Please note that other users of Twitter may utilize your tweets beyond the control of @CMichaelGibson. Tweets are educational and do not represent medical advice, see your doctor or healthcare provider. Tweets are educational only and are not meant to promote an unapproved or off label use of a medical drug or device. #cmgsays says quotes may have been said by others as well as anonymous individuals.<br />
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You may have a simple link from your website to the twitter account of @CMichaelGibson or its RSS feed. However, you must first ask @CMichaelGibson for his permission if you intend to frame @CMichaelGisbon ' s twitter feed on your site or incorporate pieces of it into a different site or product in a way that is not clear to our users. You acknowledge and agree not to link to or incorporate an RSS feed of @CMichaelGibson if you engage in illegal, obscene, or offensive content, or if the link in any way has a negative impact on the reputation of @CMichaelGibson.<br />
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Key words, synonyms: CM Gibson, M Gibson, C Gibson, C.M. Gibson, M. Gibson, C. Gibson, Dr. C.M. Gibson, Dr. M. Gibson, Charles Michael Gibson, Charles M. Gibson, Gibson CM, Gibson CM M.D., C. Michael Gibson M.S. M.D., Mike Gibson, Dr. Mike Gibson, Mike Gibson M.D., Dr. C. Michael Gibson, Dr. CM Gibson, Dr. Gibson, Doctor Gibson <br />
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[[Category:Cardiologists]]</div>C Michael Gibsonhttps://www.wikidoc.org/index.php?title=User:C_Michael_Gibson&diff=1495822User:C Michael Gibson2018-09-28T16:01:12Z<p>C Michael Gibson: /* Disclosures: */</p>
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<div>[[Image:Cmg v4 small.jpg|right|250px|WikiDoc Founder C. Michael Gibson, M.S., M.D.]]<br />
'''C. Michael Gibson M.S., M.D.''', Professor of Medicine, Harvard Medical School <br />
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Founder and Chairman of the Board, WikiDoc Foundation (a 509 (a)(1) Charitable Organization); Chief Executive Officer, Baim Institute for Clinical Research; Founder and Chairman of the [http://www.perfuse.org PERFUSE Study Group]<br />
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'''Contact:''' mgibson@wikidoc.org[mailto:mgibson@wikidoc.org]; or at his G mail address: charlesmichaelgibson@gmail.com [mailto:charlesmichaelgibson@gmail.com]<br />
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'''Mailing Address:''' C. Michael Gibson, M.S., M.D., Beth Israel Deaconess Medical Center<br />
330 Brookline Avenue, Overland 540, Boston, MA 02215 Boston MA, 02215.<br />
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'''Headshot:''' Download headshot [//www.wikidoc.org/images/e/e6/Cmg_v4_small.jpg here]<br />
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View Dr. Gibon's TEDx talk about WikiDoc on YouTube [https://www.youtube.com/watch?v=DMwZnFwueQU here]<br />
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Download Dr. Gibson's slides from his TEDx talk about WikiDoc [//www.wikidoc.org/images/a/a6/Tedx_talk_v5.pptx here]<br />
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<br />
__NOTOC__<br />
----<br />
C. Michael Gibson, M.S., M.D. is an interventional cardiologist, cardiovascular researcher and educator who pioneered our understanding of the "open artery hypothesis" as well our understanding of the importance of restoring flow downstream in the capillary bed in the "open microvasculature hypothesis" in heart attack patients. Gibson was chosen as one of the most influential scientific minds between 2002 and 2012 in a 2014 report from Thompson Reuters [http://sciencewatch.com/grr/presenting-highly-cited-researchers].<br />
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Gibson founded www.wikidoc.org, the world's most widely viewed open source textbook of medicine (viewed 700,000 to 2.2 million times daily, hundreds of millions of times annually). He is Editor-In-Chief of over 2,200 active contributors which have edited the content millions of times. Gibson served as medical lead in a partnership with Google, Microsoft and Yahoo to design a scheme of classifying medical content for the internet (www.schema.org) to improve medical search results. Gibson also founded www.clinicaltrialresults.org and has conducted 2,000 TV / video interviews and serves as the anchor person for medical meetings such as TCT TV.<br />
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For many years, Gibson has been chosen by his peers as one of Boston's Top Doctors in Boston Magazine. U.S. News & World Report also lists Gibson as one of America's top doctors. Gibson invented several of the measures of coronary blood flow that are widely used today (the TIMI frame count and the TIMI myocardial perfusion grade).<br />
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Formerly Harvard Clinical Research Institute (HCRI), Gibson leads the Baim Institute for Clinical Research as CEO. It is a leading, non-profit academic research organization (ARO) that delivers insight, innovation and leadership in today’s dynamic research environment. Baim collaborates with the world’s most highly respected researchers from renowned institutions to help advance health and quality of life around the world. The entity has managed 450 studies which have enrolled over 160,000 patients, and has played a role in 50 FDA submissions.<br />
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Gibson has led his own Academic Research Organization ([http://www.perfuse.org PERFUSE]) for over 25 years now, and has been principal investigator of or led core services for 106 clinical trials, the results of which have been published in leading journals such as the New England Journal of Medicine. The PERFUSE Study Group offers a full line of trial management, social media portals, CEC, DSMB and core lab services for phase 1-4 trials worldwide. Under Gibson's direction, the PERFUSE Study Group created the master database that unified data from over 25 years of TIMI studies (TIMI 1-50) in nearly 100,000 patients and coordinated data analyses for the TIMI study group and functioned as the TIMI Data Coordinating Center which he directed. Gibson has led phase 1-4 clinical trials, and cardiology megatrials of over 15,000 patients.<br />
<br />
==Education and Academic Positions==<br />
Dr. Gibson received his B.S., M.S., and M.D. degrees from the University of Chicago. He was an Intern, Resident and Chief Resident at the Brigham and Women’s Hospital, Harvard Medical School. He received his training as an interventional cardiologist and served as the Director of the Coronary Care Unit at Beth Israel Hospital, Harvard Medical School. Dr. Gibson then served as the Chief of Cardiology and Director of Interventional Cardiology at the West Roxbury Veterans Affairs Medical Center, Harvard Medical School. While at the West Roxbury VA, he also served as an Associate Physician at the Brigham and Women’s Hospital. He then moved on to Allegheny General Hospital as Vice Chairman of Medicine for Clinical Research and Director of Invasive Cardiology. He subsequently relocated to the west coast and served as Associate Chief of Cardiology, Chief of Interventional Cardiology and Director of the Cardiac Catheterization Laboratory at University of California San Francisco (UCSF). In 2000, Gibson returned to Harvard Medical School in Boston. Until 2003, Dr. Gibson served as Chief Academic Officer and Director of Core Services at Harvard Clinical Research Institute (HCRI), until 2005 he served as Associate Chief of Cardiology and Director of Academic Affairs in the Cardiovascular Division at the Beth Israel Deaconess Medical Center. Until 2009 he served as the Director of the TIMI Data Coordinating Center at the Brigham and Women’s Hospital. He is currently a full time interventional cardiologist and Chief of Clinical Research in the Cardiovascular Division at Beth Israel Deaconess Medical Center, Harvard Medical School. <br />
<br />
==Research==<br />
Dr. Gibson’s work has largely focused on investigating the pathophysiology of coronary artery disease and the efficacy of pharmacologic and device based therapies. His work has been presented in many thousands manuscripts, abstracts, trial summaries, textbooks and textbook chapters. Gibson's work has been cited over 56,957 times, and he has an h-index of 104 and an i10-index of 385. Updated numbers can be found here https://scholar.google.com/citations?hl=en&user=vzV233IAAAAJ <br />
<br />
Over 25 years ago, Gibson founded the PERFUSE Study Group, an academic research organization which provides academic leadership, site identification and management, statistical analyses, regulatory guidance, angiographic, MRI, CT and EKG core laboratory services, and data management services for a wide variety of studies including trials in acute coronary syndromes, antiplatelets, antithrombins, reperfusion injury, atherosclerosis regression, new devices, angiogenesis, and new imaging modalities. Gibson directed the TIMI angiographic core laboratory and invented the TIMI frame count (CTFC) in which the number of cineframes for dye to reach standardized distal landmarks is counted (an index of epicardial blood flow). Gibson also invented the TIMI myocardial perfusion grade (the blush, a measure of microvascular perfusion). The TIMI frame count and the TIMI myocardial perfusion grade are both multivariate predictors of 2 year mortality in acute MI, and are now widely used both clinically and in the assessment of new reperfusion strategies. The methods invented by Gibson and his research have played a critical role in our understanding of "the open artery hypothesis" and more recently in what Gibson has termed "the open microvasculature hypothesis". On Google scholar, the TIMI Frame Count is listed as being cited in over 4,700 articles ([http://scholar.google.com/scholar?hl=en&lr=&q=%22timi+frame+count%22&btnG=Search for updated numbers click here]) and the TIMI myocardial perfusion grade is listed as being cited in over 1,800 articles ([http://scholar.google.com/scholar?hl=en&q=%22timi+myocardial+perfusion+grade%22&btnG=Search for updated numbers click here]).<br />
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Under Gibson's direction, the PERFUSE Study Group created the master database that unified data from over 25 years of TIMI studies (TIMI 1-50) in nearly 100,000 patients and coordinated data analyses for the TIMI study group and functioned as the TIMI Data Coordinating Center. <br />
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Within the Thrombolysis In Myocardial Infarction (TIMI) Study Group, Dr. Gibson has served as a Principle Investigator of multiple international trials within the TIMI Study Chairman’s Office.<br />
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Dr. Gibson's specific research interests include the following:<br />
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*'''Acute Coronary Syndrome Research Including unstable angina, non ST elevation MI and ST elevation MI:''' Gibson invented the angiographic endpoints that are used in assessing drug and device therapies such as the TIMI frame count and the TIMI myocardial perfusion grade. He has been the principal investigator of trials of novel thrombolytic agents (BB 10153) and novel mechanisms of delivery of thrombolytic agents such as ICE T – TIMI 49 (Intra-coronary Tenecteplase During Balloon Angioplasty). Gibson led the angiographic core laboratory analysis of a number of thrombolytic trials (TIMI4 (tPA and APSAC), TIMI 10 trials (TNK), ADVANCE MI (TNK + eptifibatide), TIMI 14 (lytic + abciximab), FASTER (lytic + aggrastat), CLARITY (lytic + clopidogrel), STEP AMI (lytic + cangrelor)<br />
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*'''Antiplatelet Trials:''' Gibson has led trials of glycoprotein 2b3a inhibitor inhibition (PROTECT, TITAN), thienopyridine trials such as the TRITON study of prasugrel, trials of novel antiplatelets such as elinogrel (ERASE MI), and is a member of the executive committee of trials of cangrelor. Gibson led the angiographic core laboratory for trials of eptifibatide (ESPRIT, INTEGRITI, ADVANCE MI, TITAN, EARLY ACS), abciximab (TIMI 14, INFUSE AMI, IC Clearly), and tirofiban (FASTER, TACTICS), clopidogrel (CLARITY TIMI 28), ticagrelor (PLATO) and cangrelor (STEP AMI).<br />
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*'''Antithrombin Trials:''' Gibson has led large scale international trials of novel antithrombins such as the development of rivaroxaban, a factor Xa inhibitor (ATLAS TIMI 46 and 51). Gibson has led angiographic core laboratory efforts in the evaluation of rNAPc2 (a fVIIa/TF inhibitor) in the ANTHEM study, and the SEPIA-ACS1 TIMI 42 (Study Program to Evaluate the Prevention of Ischemia with direct Anti-Xa inhibition in Acute Coronary Syndromes 1 - Thrombolysis in Myocardial Infarction 42).<br />
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*'''Reperfusion Injury Trials:''' Gibson has led the angiographic core laboratory analysis of reperfusion injury trials such as the LIMIT trial of rhuMAb CD18, the DELTA MI trial (Direct Inhibition of δ Protein Kinase C Enzyme to Limit Total Infarct Size in Acute Myocardial Infarction), the INOT-44 trial (Nitric Oxide in Myocardial Infarction Size (NOMI), and the INTESIVE trial (Apidra®/Lantus® therapy versus Sliding Scale Insulin on infarct size in hyperglycemic subjects with anterior STEMI undergoing percutaneous coronary intervention (PCI). Gibson is currently the Study Chairman and Principal Investigator of the multicenter international EMBRACE MI trial of [[Bendavia]].<br />
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*'''Lipid Lowering and Atherosclerosis Regression Trials:''' Gibson’s career started with the Harvard Atherosclerosis Reversibility Project where he developed the angiographic and statistical methodology to conduct angiographic atherosclerosis regression trials. Gibson participated in and has published manuscripts from the PROVE It study (PCI PROVE IT). Gibson has served as the site PI for trials of medical therapy in stable angina (the AVERT study). Gibson serves on the Executive committee of trials of CTEP inhibition (ACCELERATE). Gibson serves as the study chairman of the AEGIS trials evaluating the efficacy and safety of APO A1 infusions (HDL) to halt atherosclerosis and prevent atherothrombotic events. Gibson has participated in the publication of PCSK9 inhibitor trial data.<br />
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*'''New Device Trials:''' Gibson has led new device studies such as novel delivery systems for intracoronary therapies such as the Clearway catheter in the INFUSE AMI and IC Clearly trials, and aspiration thrombectomy (INFUSE AMI). He has served as the angiographic core laboratory for trials of perfusion balloons, directional atherectomy, self expanding stents, therapeutic ultrasound studies (PLUS) and markers of saphenous vein graft proximal connectors (PAS-Port (Study of the PAS-Port® Proximal Anastomosis System in Coronary Bypass Surgery (EPIC)).<br />
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*'''Imaging Trials:''' Gibson has served as the angiographic core laboratory for trials of new echocardiographic contrast agents (ECHOGEN) vs angiography, and positron emission tomography (PET) vs angiography trials.<br />
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*'''CMR Core Laboratory Trials:''' Gibson is co-principal investigator of CMR core laboratory studies such as ALLAY (efficacy and safety of aliskiren in combination with Losartan compared to Losartan), the TRACS Study (The Effects of Fx-1006A on Transthyretin Stabilization and Clinical Outcome Measures in Patients With Non-V30M Transthyretin Amyloidosis), the ACT-34 CMI (Autologous Cellular Therapy Utilizing CD34+ Cells), the INTESIVE trial (Apidra®/Lantus® therapy versus Sliding Scale Insulin on infarct size in hyperglycemic subjects with anterior STEMI undergoing percutaneous coronary intervention (PCI)), and the FX1B-201 Study (Safety and Efficacy Evaluation of Fx-1006A in Patients With V122I or Wild-Type Transthyretin (TTR) Amyloid Cardiomyopathy).<br />
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*'''CT Angiographic Core Laboratory Trials:''' Gibson has led the CT core laboratory for trials such as the markers of saphenous vein graft proximal connectors (PAS-Port (Study of the PAS-Port® Proximal Anastomosis System in Coronary Bypass Surgery (EPIC)).<br />
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*'''Coronary Artery Bypass Graft Trials:''' Gibson led the angiographic core laboratory analysis of the PREVENT 4 study (Project of Ex-vivo Vein Graft Engineering via Transfection) of 2200 patients.<br />
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*'''New Electrocardiography Technology Trials:''' Gibson is the leader of trials of an implantable technology (the AngelMed Guardian Device) designed to monitor and alert the patient to the presence of ST segment elevation (ALERT AMI trial). Gibson has led the angiographic core laboratory for trials such as OCCULT MI study of 84 lead EKG technologies (Optimal Cardiovascular Diagnostic Evaluation Enabling Faster Treatment of Myocardial Infarction). Gibson's team has also served as an EKG core laboratory.<br />
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*'''Angiogenesis Trials:''' Gibson assessed angiographic endpoints in early trials of angiogenesis (VIVA trial).<br />
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*'''Stem Cell Therapy:''' Gibson is Chair of the Data Safety Monitoring Board for the first phase III stem cell study (RENEW)<br />
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*'''NIH Studies:''' Gibson has led the angiographic core laboratory for a number of NIH studies including the Harvard Atherosclerosis Reversibility Project (HARP), the PEARL study of estrogens in restenosis, and the ASCERT study comparing PCI to CABG.<br />
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*'''Diabetes:''' Gibson coordinates the Clinical Event Committee efforts to adjudicate tens of thousands of adverse events and hundreds of thousands of EKGs in ongoing trials of novel anti-diabetic agents.<br />
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===Publications===<br />
*Gibson's work has been cited over 56,957 times, and he has an h-index of 104 and an i10-index of 385. Updated numbers can be found here https://scholar.google.com/citations?hl=en&user=vzV233IAAAAJ<br />
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*Peer reviewed research publications: > 530 (for an update, click [http://www.ncbi.nlm.nih.gov/pubmed?term=Gibson%20CM here])<br />
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*Non peer-reviewed reviews, chapters, monographs and editorials: 57<br />
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*Professional Educational Materials or Reports, in Print or Other Media: 686<br />
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*WikiDoc pages edited: Over 70,000 under C Michael Gibson and CMichaelGibson<br />
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===Editorial Boards===<br />
Dr. Gibson has served in the past on the editorial board of numerous journals such as Circulation, the Journal of the American College of Cardiology, Cardiac Catheterization and Intervention and the American Heart Journal.<br />
<br />
==Education==<br />
===WikiDoc===<br />
Dr. Gibson is Founder and Chairman of the Board of WikiDoc Foundation (a 509 (a)(1) Charitable Organization). This is the world's largest medical textbook / encyclopedia. WikiDoc contains [[Special:Statistics|200,059]] chapters updated millions of times by over 2,200 active contributors and viewed hundreds of thousands of times daily. In 2010, WikiDoc was selected as a Google Grant recipient. Dr. Gibson has personally made over 70,000 edits to WikiDoc.<br />
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===Schema.org===<br />
Although there is a vast amount of medical information on the internet, search engine's often return results that are not highly specific. This is because search engines do not account for the structure of the underlying medical knowledge or the relationships among keywords.<br />
Gibson was one of the co-creators of a www.schema.org-based [http://schemaorg-medicalext.appspot.com/docs/meddocs.html schema] that allows webmasters and content publishers to mark up health and medical content on the web. The health and medical schema is intended to make it easier for people to locate the optimal web pages by exposing structured information contained in web pages to search engines. As a result, more relevant content rich pages will be returned in search results.<br />
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===Internet Educational Sites===<br />
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Dr. Gibson is Founder and Editor-in-Chief of [http://www.clinicaltrialresults.org Clinical Trial Results] where he created the first weekly TV show for Cardiologists "This Week in Cardiology" and has provided slides summarizing clinical trials since 1999. Gibson has conducted 2,000 TV / video interviews and serves as the anchor person for medical meetings such as TCT TV. Gibson also created the original [http://www.timi.org TIMI.org], website, the website of the TIMI Study Group.<br />
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===Traditional Textbooks===<br />
Dr. Gibson also edits a textbook entitled “Gibson's Treatment Strategies in Interventional Cardiology” which is optimized for hand held devices. In the past, Gibson has authored the chapter on Primary Angioplasty in Randomized Trials in Cardiovascular Disease published as a companion to Braunwald's Heart Disease. In the past he has co-authored the chapter “Recognition and Management of Patients with Stable Angina Pectoris" in Braunwald and Goldman’s Primary Cardiology. He has served as lead author of the section on myocardial perfusion imaging in an imaging textbook which is a companion to Braunwald’s Heart Disease. Gibson has authored the chapter “Profiles in Coronary Artery Disease” in the fifth and sixth editions of Grossman and Baim’s Textbook of Interventional Cardiology.<br />
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===American Heart Association===<br />
Gibson has served as a member of the Professional Education Committee of the American Heart Association.<br />
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==Physician==<br />
Gibson is a practicing interventional cardiologist. He has served as a cath lab director. In 2009 and 2010, Dr. Gibson was chosen by his peers as one of Boston's Top Doctors in Boston Magazine.<br />
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In 2010, Dr. Gibson was selected as one of America's Top Doctors by Castle Connolly Medical Ltd. In the same year, he was also selected to be included in the Consumers' Research Council of America’s Guide to America’s Top Cardiologists.<br />
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In 2011, Dr. Gibson was featured as one of Boston's Super doctors on my.superdoctors.com. In the same year, he was also selected to be included in the Consumers' Research Council of America’s Guide to America’s Top Cardiologists.<br />
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In 2011 U.S. News & World Report listed Dr. Gibson as one of America's Top Doctors as selected by Castle Connolly Medical Ltd. [http://health.usnews.com/top-doctors/c-michael-gibson-interventional-cardiologist-22CC000361 health.usnews.com]<br />
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==Awards==<br />
[[Image:C-Michael-Gibson-award.jpg|right]]<br />
[[Image:C Michael Gibson Distinguished fellow.jpg|right]]<br />
Dr. Gibson graduated from college Phi Beta Kappa, and from medical school Alpha Omega Alpha, both from the University of Chicago. In 1993 he was selected as the Julian and Eunice Cohen Scholar in Medicine at the Brigham and Women's Hospital. <br />
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In conjunction with delivering the opening plenary lecture at the 10th annual Great Wall of China Symposium in 2003, Gibson was awarded the Gold Medal by the Institute of Geriatric Cardiology, Chinese Peoples Liberation Army General Hospital, Beijing China for his achievements in cardiovascular science. <br />
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In 2005, the John Paul II Hospital in Krakow, Poland awarded Gibson the Pro Bono Curantium Gold Medal for Merit, and a research laboratory was named there in his honor. He was the 4th such awardee, the others being Pope John Paul II and Dr. Valentine Fuster. In that same year, Gibson was awarded the Medal of the Jagiellonian University for his outstanding achievements in education and research in cardiovascular science. <br />
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In 2009, the Cardiovascular Division of Istanbul University, Turkey, established the C. Michael Gibson Research and Education Center. In that same year, the Turkish Cardiac Society honored Gibson for establishing WikiDoc on, September 27th, World Heart Day.<br />
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In 2007 and 2009, Dr. Gibson was selected by Who's Who as the Clinical Researcher of the Year. <br />
<br />
In 2009 and 2010, Dr. Gibson was chosen by his peers as one of Boston's Top Doctors in Boston Magazine.<br />
<br />
In 2010, Dr. Gibson was selected as one of America's Top Doctors by Castle Connolly Medical Ltd. In the same year, he was also selected to be included in the Consumers' Research Council of America’s Guide to America’s Top Cardiologists.<br />
<br />
In 2011, Dr. Gibson was featured as one of Boston's Super doctors on my.superdoctors.com. In the same year, he was also selected to be included in the Consumers' Research Council of America’s Guide to America’s Top Cardiologists.<br />
<br />
In 2011 U.S. News & World Report listed Dr. Gibson as one of America's Top Doctors as selected by Castle Connolly Medical Ltd. [http://health.usnews.com/top-doctors/c-michael-gibson-interventional-cardiologist-22CC000361 health.usnews.com]<br />
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In 2012 Gibson was appointed a Distinguished Fellow of New Westminster College, which is the highest honour that New Westminster College bestows upon senior leaders to recognize their distinguished record of ethical leadership. Other Distinguished Fellows include world leaders, cabinet ministers, 12 ambassadors, an astronaut, 27 generals and admirals, surgeons and medical doctors.<br />
<br />
==Disclosures:==<br />
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Dr. Gibson follows the conflict of interest policies set forth by Harvard Medical School and the Beth Israel Deaconess Medical Center. The Baim Institute follows the same conflict of interest policies as Harvard Medical School and Beth Israel Deaconess Medical Center.<br />
<br />
''Executive Position (with $0.00 monies received by Dr. Gibson)''<br />
<br />
Chief Executive Office, Baim Institute for Clinical Research<br />
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''Present Research/Grant Funding (within the last year)''<br />
<br />
Angel Medical Corporation;<br />
Bayer Corp.;<br />
CSL Behring;<br />
Janssen Pharmaceuticals;<br />
Johnson & Johnson Corporation;<br />
Portola Pharmaceuticals (ceased with BIDMC on 12/31/2017)<br />
<br />
<br />
''Consulting''<br />
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Amarin Pharama, Amgen,<br />
Arena Pharmaceuticals, Bayer Corporation, Boehringer Ingelheim, Boston Clinical Research Institute, Cardiovascular Research Foundation, Chiesi, CSL Behring, Eli Lilly, Gilead Sciences, Inc., Impact Bio LTD, Janssen Pharmaceuticals, Johnson & Johnson Corporation, The Medicines Company, MedImmune, Medtelligence, Merck & Co, Inc., Novo Nordisk, Pfizer, Pharma Mar, Portola Pharmaceuticals (began 1/1/2018), Sanofi, Somahlution, St. Francis Hospital, Verseon Corportation, Web MD<br />
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''Royalties as a Contributor''<br />
<br />
UpToDate in Cardiovascular Medicine<br />
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''Spouse conflicts of interests (Employee of Boston Clinical Research Institute)''<br />
<br />
Amarin, Amgen, Areana, Bayer, Boehringer Ingelheim, Boston Scientific, Cardiovascular Research Foundation, Chiesi, Eli Lilly, Gilead Sciences, Inc., Impact Bio, Janssen, Johnson and Johnson, The Medicines Company, Medtelligence, MedImmune, Merck & Co. Inc., Novo Nordisk, Pfizer, PharmaMar, Portola, Sanofi, Somahlution, St. Francis Hospital, Verseon Corporation<br />
<br />
==Twitter disclaimer for C. Michael Gibson==<br />
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Key words, synonyms: CM Gibson, M Gibson, C Gibson, C.M. Gibson, M. Gibson, C. Gibson, Dr. C.M. Gibson, Dr. M. Gibson, Charles Michael Gibson, Charles M. Gibson, Gibson CM, Gibson CM M.D., C. Michael Gibson M.S. M.D., Mike Gibson, Dr. Mike Gibson, Mike Gibson M.D., Dr. C. Michael Gibson, Dr. CM Gibson, Dr. Gibson, Doctor Gibson <br />
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[[Category:Cardiologists]]</div>C Michael Gibsonhttps://www.wikidoc.org/index.php?title=User:C_Michael_Gibson&diff=1495815User:C Michael Gibson2018-09-28T15:53:51Z<p>C Michael Gibson: /* Disclosures: */</p>
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<div>[[Image:Cmg v4 small.jpg|right|250px|WikiDoc Founder C. Michael Gibson, M.S., M.D.]]<br />
'''C. Michael Gibson M.S., M.D.''', Professor of Medicine, Harvard Medical School <br />
<br />
Founder and Chairman of the Board, WikiDoc Foundation (a 509 (a)(1) Charitable Organization); Chief Executive Officer, Baim Institute for Clinical Research; Founder and Chairman of the [http://www.perfuse.org PERFUSE Study Group]<br />
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'''Contact:''' mgibson@wikidoc.org[mailto:mgibson@wikidoc.org]; or at his G mail address: charlesmichaelgibson@gmail.com [mailto:charlesmichaelgibson@gmail.com]<br />
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'''Mailing Address:''' C. Michael Gibson, M.S., M.D., Beth Israel Deaconess Medical Center<br />
330 Brookline Avenue, Overland 540, Boston, MA 02215 Boston MA, 02215.<br />
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'''Headshot:''' Download headshot [//www.wikidoc.org/images/e/e6/Cmg_v4_small.jpg here]<br />
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View Dr. Gibon's TEDx talk about WikiDoc on YouTube [https://www.youtube.com/watch?v=DMwZnFwueQU here]<br />
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Download Dr. Gibson's slides from his TEDx talk about WikiDoc [//www.wikidoc.org/images/a/a6/Tedx_talk_v5.pptx here]<br />
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__NOTOC__<br />
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C. Michael Gibson, M.S., M.D. is an interventional cardiologist, cardiovascular researcher and educator who pioneered our understanding of the "open artery hypothesis" as well our understanding of the importance of restoring flow downstream in the capillary bed in the "open microvasculature hypothesis" in heart attack patients. Gibson was chosen as one of the most influential scientific minds between 2002 and 2012 in a 2014 report from Thompson Reuters [http://sciencewatch.com/grr/presenting-highly-cited-researchers].<br />
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Gibson founded www.wikidoc.org, the world's most widely viewed open source textbook of medicine (viewed 700,000 to 2.2 million times daily, hundreds of millions of times annually). He is Editor-In-Chief of over 2,200 active contributors which have edited the content millions of times. Gibson served as medical lead in a partnership with Google, Microsoft and Yahoo to design a scheme of classifying medical content for the internet (www.schema.org) to improve medical search results. Gibson also founded www.clinicaltrialresults.org and has conducted 2,000 TV / video interviews and serves as the anchor person for medical meetings such as TCT TV.<br />
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For many years, Gibson has been chosen by his peers as one of Boston's Top Doctors in Boston Magazine. U.S. News & World Report also lists Gibson as one of America's top doctors. Gibson invented several of the measures of coronary blood flow that are widely used today (the TIMI frame count and the TIMI myocardial perfusion grade).<br />
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Formerly Harvard Clinical Research Institute (HCRI), Gibson leads the Baim Institute for Clinical Research as CEO. It is a leading, non-profit academic research organization (ARO) that delivers insight, innovation and leadership in today’s dynamic research environment. Baim collaborates with the world’s most highly respected researchers from renowned institutions to help advance health and quality of life around the world. The entity has managed 450 studies which have enrolled over 160,000 patients, and has played a role in 50 FDA submissions.<br />
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Gibson has led his own Academic Research Organization ([http://www.perfuse.org PERFUSE]) for over 25 years now, and has been principal investigator of or led core services for 106 clinical trials, the results of which have been published in leading journals such as the New England Journal of Medicine. The PERFUSE Study Group offers a full line of trial management, social media portals, CEC, DSMB and core lab services for phase 1-4 trials worldwide. Under Gibson's direction, the PERFUSE Study Group created the master database that unified data from over 25 years of TIMI studies (TIMI 1-50) in nearly 100,000 patients and coordinated data analyses for the TIMI study group and functioned as the TIMI Data Coordinating Center which he directed. Gibson has led phase 1-4 clinical trials, and cardiology megatrials of over 15,000 patients.<br />
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==Education and Academic Positions==<br />
Dr. Gibson received his B.S., M.S., and M.D. degrees from the University of Chicago. He was an Intern, Resident and Chief Resident at the Brigham and Women’s Hospital, Harvard Medical School. He received his training as an interventional cardiologist and served as the Director of the Coronary Care Unit at Beth Israel Hospital, Harvard Medical School. Dr. Gibson then served as the Chief of Cardiology and Director of Interventional Cardiology at the West Roxbury Veterans Affairs Medical Center, Harvard Medical School. While at the West Roxbury VA, he also served as an Associate Physician at the Brigham and Women’s Hospital. He then moved on to Allegheny General Hospital as Vice Chairman of Medicine for Clinical Research and Director of Invasive Cardiology. He subsequently relocated to the west coast and served as Associate Chief of Cardiology, Chief of Interventional Cardiology and Director of the Cardiac Catheterization Laboratory at University of California San Francisco (UCSF). In 2000, Gibson returned to Harvard Medical School in Boston. Until 2003, Dr. Gibson served as Chief Academic Officer and Director of Core Services at Harvard Clinical Research Institute (HCRI), until 2005 he served as Associate Chief of Cardiology and Director of Academic Affairs in the Cardiovascular Division at the Beth Israel Deaconess Medical Center. Until 2009 he served as the Director of the TIMI Data Coordinating Center at the Brigham and Women’s Hospital. He is currently a full time interventional cardiologist and Chief of Clinical Research in the Cardiovascular Division at Beth Israel Deaconess Medical Center, Harvard Medical School. <br />
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==Research==<br />
Dr. Gibson’s work has largely focused on investigating the pathophysiology of coronary artery disease and the efficacy of pharmacologic and device based therapies. His work has been presented in many thousands manuscripts, abstracts, trial summaries, textbooks and textbook chapters. Gibson's work has been cited over 56,957 times, and he has an h-index of 104 and an i10-index of 385. Updated numbers can be found here https://scholar.google.com/citations?hl=en&user=vzV233IAAAAJ <br />
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Over 25 years ago, Gibson founded the PERFUSE Study Group, an academic research organization which provides academic leadership, site identification and management, statistical analyses, regulatory guidance, angiographic, MRI, CT and EKG core laboratory services, and data management services for a wide variety of studies including trials in acute coronary syndromes, antiplatelets, antithrombins, reperfusion injury, atherosclerosis regression, new devices, angiogenesis, and new imaging modalities. Gibson directed the TIMI angiographic core laboratory and invented the TIMI frame count (CTFC) in which the number of cineframes for dye to reach standardized distal landmarks is counted (an index of epicardial blood flow). Gibson also invented the TIMI myocardial perfusion grade (the blush, a measure of microvascular perfusion). The TIMI frame count and the TIMI myocardial perfusion grade are both multivariate predictors of 2 year mortality in acute MI, and are now widely used both clinically and in the assessment of new reperfusion strategies. The methods invented by Gibson and his research have played a critical role in our understanding of "the open artery hypothesis" and more recently in what Gibson has termed "the open microvasculature hypothesis". On Google scholar, the TIMI Frame Count is listed as being cited in over 4,700 articles ([http://scholar.google.com/scholar?hl=en&lr=&q=%22timi+frame+count%22&btnG=Search for updated numbers click here]) and the TIMI myocardial perfusion grade is listed as being cited in over 1,800 articles ([http://scholar.google.com/scholar?hl=en&q=%22timi+myocardial+perfusion+grade%22&btnG=Search for updated numbers click here]).<br />
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Under Gibson's direction, the PERFUSE Study Group created the master database that unified data from over 25 years of TIMI studies (TIMI 1-50) in nearly 100,000 patients and coordinated data analyses for the TIMI study group and functioned as the TIMI Data Coordinating Center. <br />
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Within the Thrombolysis In Myocardial Infarction (TIMI) Study Group, Dr. Gibson has served as a Principle Investigator of multiple international trials within the TIMI Study Chairman’s Office.<br />
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Dr. Gibson's specific research interests include the following:<br />
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*'''Acute Coronary Syndrome Research Including unstable angina, non ST elevation MI and ST elevation MI:''' Gibson invented the angiographic endpoints that are used in assessing drug and device therapies such as the TIMI frame count and the TIMI myocardial perfusion grade. He has been the principal investigator of trials of novel thrombolytic agents (BB 10153) and novel mechanisms of delivery of thrombolytic agents such as ICE T – TIMI 49 (Intra-coronary Tenecteplase During Balloon Angioplasty). Gibson led the angiographic core laboratory analysis of a number of thrombolytic trials (TIMI4 (tPA and APSAC), TIMI 10 trials (TNK), ADVANCE MI (TNK + eptifibatide), TIMI 14 (lytic + abciximab), FASTER (lytic + aggrastat), CLARITY (lytic + clopidogrel), STEP AMI (lytic + cangrelor)<br />
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*'''Antiplatelet Trials:''' Gibson has led trials of glycoprotein 2b3a inhibitor inhibition (PROTECT, TITAN), thienopyridine trials such as the TRITON study of prasugrel, trials of novel antiplatelets such as elinogrel (ERASE MI), and is a member of the executive committee of trials of cangrelor. Gibson led the angiographic core laboratory for trials of eptifibatide (ESPRIT, INTEGRITI, ADVANCE MI, TITAN, EARLY ACS), abciximab (TIMI 14, INFUSE AMI, IC Clearly), and tirofiban (FASTER, TACTICS), clopidogrel (CLARITY TIMI 28), ticagrelor (PLATO) and cangrelor (STEP AMI).<br />
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*'''Antithrombin Trials:''' Gibson has led large scale international trials of novel antithrombins such as the development of rivaroxaban, a factor Xa inhibitor (ATLAS TIMI 46 and 51). Gibson has led angiographic core laboratory efforts in the evaluation of rNAPc2 (a fVIIa/TF inhibitor) in the ANTHEM study, and the SEPIA-ACS1 TIMI 42 (Study Program to Evaluate the Prevention of Ischemia with direct Anti-Xa inhibition in Acute Coronary Syndromes 1 - Thrombolysis in Myocardial Infarction 42).<br />
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*'''Reperfusion Injury Trials:''' Gibson has led the angiographic core laboratory analysis of reperfusion injury trials such as the LIMIT trial of rhuMAb CD18, the DELTA MI trial (Direct Inhibition of δ Protein Kinase C Enzyme to Limit Total Infarct Size in Acute Myocardial Infarction), the INOT-44 trial (Nitric Oxide in Myocardial Infarction Size (NOMI), and the INTESIVE trial (Apidra®/Lantus® therapy versus Sliding Scale Insulin on infarct size in hyperglycemic subjects with anterior STEMI undergoing percutaneous coronary intervention (PCI). Gibson is currently the Study Chairman and Principal Investigator of the multicenter international EMBRACE MI trial of [[Bendavia]].<br />
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*'''Lipid Lowering and Atherosclerosis Regression Trials:''' Gibson’s career started with the Harvard Atherosclerosis Reversibility Project where he developed the angiographic and statistical methodology to conduct angiographic atherosclerosis regression trials. Gibson participated in and has published manuscripts from the PROVE It study (PCI PROVE IT). Gibson has served as the site PI for trials of medical therapy in stable angina (the AVERT study). Gibson serves on the Executive committee of trials of CTEP inhibition (ACCELERATE). Gibson serves as the study chairman of the AEGIS trials evaluating the efficacy and safety of APO A1 infusions (HDL) to halt atherosclerosis and prevent atherothrombotic events. Gibson has participated in the publication of PCSK9 inhibitor trial data.<br />
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*'''New Device Trials:''' Gibson has led new device studies such as novel delivery systems for intracoronary therapies such as the Clearway catheter in the INFUSE AMI and IC Clearly trials, and aspiration thrombectomy (INFUSE AMI). He has served as the angiographic core laboratory for trials of perfusion balloons, directional atherectomy, self expanding stents, therapeutic ultrasound studies (PLUS) and markers of saphenous vein graft proximal connectors (PAS-Port (Study of the PAS-Port® Proximal Anastomosis System in Coronary Bypass Surgery (EPIC)).<br />
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*'''Imaging Trials:''' Gibson has served as the angiographic core laboratory for trials of new echocardiographic contrast agents (ECHOGEN) vs angiography, and positron emission tomography (PET) vs angiography trials.<br />
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*'''CMR Core Laboratory Trials:''' Gibson is co-principal investigator of CMR core laboratory studies such as ALLAY (efficacy and safety of aliskiren in combination with Losartan compared to Losartan), the TRACS Study (The Effects of Fx-1006A on Transthyretin Stabilization and Clinical Outcome Measures in Patients With Non-V30M Transthyretin Amyloidosis), the ACT-34 CMI (Autologous Cellular Therapy Utilizing CD34+ Cells), the INTESIVE trial (Apidra®/Lantus® therapy versus Sliding Scale Insulin on infarct size in hyperglycemic subjects with anterior STEMI undergoing percutaneous coronary intervention (PCI)), and the FX1B-201 Study (Safety and Efficacy Evaluation of Fx-1006A in Patients With V122I or Wild-Type Transthyretin (TTR) Amyloid Cardiomyopathy).<br />
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*'''CT Angiographic Core Laboratory Trials:''' Gibson has led the CT core laboratory for trials such as the markers of saphenous vein graft proximal connectors (PAS-Port (Study of the PAS-Port® Proximal Anastomosis System in Coronary Bypass Surgery (EPIC)).<br />
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*'''Coronary Artery Bypass Graft Trials:''' Gibson led the angiographic core laboratory analysis of the PREVENT 4 study (Project of Ex-vivo Vein Graft Engineering via Transfection) of 2200 patients.<br />
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*'''New Electrocardiography Technology Trials:''' Gibson is the leader of trials of an implantable technology (the AngelMed Guardian Device) designed to monitor and alert the patient to the presence of ST segment elevation (ALERT AMI trial). Gibson has led the angiographic core laboratory for trials such as OCCULT MI study of 84 lead EKG technologies (Optimal Cardiovascular Diagnostic Evaluation Enabling Faster Treatment of Myocardial Infarction). Gibson's team has also served as an EKG core laboratory.<br />
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*'''Angiogenesis Trials:''' Gibson assessed angiographic endpoints in early trials of angiogenesis (VIVA trial).<br />
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*'''Stem Cell Therapy:''' Gibson is Chair of the Data Safety Monitoring Board for the first phase III stem cell study (RENEW)<br />
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*'''NIH Studies:''' Gibson has led the angiographic core laboratory for a number of NIH studies including the Harvard Atherosclerosis Reversibility Project (HARP), the PEARL study of estrogens in restenosis, and the ASCERT study comparing PCI to CABG.<br />
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*'''Diabetes:''' Gibson coordinates the Clinical Event Committee efforts to adjudicate tens of thousands of adverse events and hundreds of thousands of EKGs in ongoing trials of novel anti-diabetic agents.<br />
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===Publications===<br />
*Gibson's work has been cited over 56,957 times, and he has an h-index of 104 and an i10-index of 385. Updated numbers can be found here https://scholar.google.com/citations?hl=en&user=vzV233IAAAAJ<br />
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*Peer reviewed research publications: > 530 (for an update, click [http://www.ncbi.nlm.nih.gov/pubmed?term=Gibson%20CM here])<br />
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*Non peer-reviewed reviews, chapters, monographs and editorials: 57<br />
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*Professional Educational Materials or Reports, in Print or Other Media: 686<br />
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*WikiDoc pages edited: Over 70,000 under C Michael Gibson and CMichaelGibson<br />
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===Editorial Boards===<br />
Dr. Gibson has served in the past on the editorial board of numerous journals such as Circulation, the Journal of the American College of Cardiology, Cardiac Catheterization and Intervention and the American Heart Journal.<br />
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==Education==<br />
===WikiDoc===<br />
Dr. Gibson is Founder and Chairman of the Board of WikiDoc Foundation (a 509 (a)(1) Charitable Organization). This is the world's largest medical textbook / encyclopedia. WikiDoc contains [[Special:Statistics|200,059]] chapters updated millions of times by over 2,200 active contributors and viewed hundreds of thousands of times daily. In 2010, WikiDoc was selected as a Google Grant recipient. Dr. Gibson has personally made over 70,000 edits to WikiDoc.<br />
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===Schema.org===<br />
Although there is a vast amount of medical information on the internet, search engine's often return results that are not highly specific. This is because search engines do not account for the structure of the underlying medical knowledge or the relationships among keywords.<br />
Gibson was one of the co-creators of a www.schema.org-based [http://schemaorg-medicalext.appspot.com/docs/meddocs.html schema] that allows webmasters and content publishers to mark up health and medical content on the web. The health and medical schema is intended to make it easier for people to locate the optimal web pages by exposing structured information contained in web pages to search engines. As a result, more relevant content rich pages will be returned in search results.<br />
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===Internet Educational Sites===<br />
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Dr. Gibson is Founder and Editor-in-Chief of [http://www.clinicaltrialresults.org Clinical Trial Results] where he created the first weekly TV show for Cardiologists "This Week in Cardiology" and has provided slides summarizing clinical trials since 1999. Gibson has conducted 2,000 TV / video interviews and serves as the anchor person for medical meetings such as TCT TV. Gibson also created the original [http://www.timi.org TIMI.org], website, the website of the TIMI Study Group.<br />
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===Traditional Textbooks===<br />
Dr. Gibson also edits a textbook entitled “Gibson's Treatment Strategies in Interventional Cardiology” which is optimized for hand held devices. In the past, Gibson has authored the chapter on Primary Angioplasty in Randomized Trials in Cardiovascular Disease published as a companion to Braunwald's Heart Disease. In the past he has co-authored the chapter “Recognition and Management of Patients with Stable Angina Pectoris" in Braunwald and Goldman’s Primary Cardiology. He has served as lead author of the section on myocardial perfusion imaging in an imaging textbook which is a companion to Braunwald’s Heart Disease. Gibson has authored the chapter “Profiles in Coronary Artery Disease” in the fifth and sixth editions of Grossman and Baim’s Textbook of Interventional Cardiology.<br />
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===American Heart Association===<br />
Gibson has served as a member of the Professional Education Committee of the American Heart Association.<br />
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==Physician==<br />
Gibson is a practicing interventional cardiologist. He has served as a cath lab director. In 2009 and 2010, Dr. Gibson was chosen by his peers as one of Boston's Top Doctors in Boston Magazine.<br />
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In 2010, Dr. Gibson was selected as one of America's Top Doctors by Castle Connolly Medical Ltd. In the same year, he was also selected to be included in the Consumers' Research Council of America’s Guide to America’s Top Cardiologists.<br />
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In 2011, Dr. Gibson was featured as one of Boston's Super doctors on my.superdoctors.com. In the same year, he was also selected to be included in the Consumers' Research Council of America’s Guide to America’s Top Cardiologists.<br />
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In 2011 U.S. News & World Report listed Dr. Gibson as one of America's Top Doctors as selected by Castle Connolly Medical Ltd. [http://health.usnews.com/top-doctors/c-michael-gibson-interventional-cardiologist-22CC000361 health.usnews.com]<br />
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==Awards==<br />
[[Image:C-Michael-Gibson-award.jpg|right]]<br />
[[Image:C Michael Gibson Distinguished fellow.jpg|right]]<br />
Dr. Gibson graduated from college Phi Beta Kappa, and from medical school Alpha Omega Alpha, both from the University of Chicago. In 1993 he was selected as the Julian and Eunice Cohen Scholar in Medicine at the Brigham and Women's Hospital. <br />
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In conjunction with delivering the opening plenary lecture at the 10th annual Great Wall of China Symposium in 2003, Gibson was awarded the Gold Medal by the Institute of Geriatric Cardiology, Chinese Peoples Liberation Army General Hospital, Beijing China for his achievements in cardiovascular science. <br />
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In 2005, the John Paul II Hospital in Krakow, Poland awarded Gibson the Pro Bono Curantium Gold Medal for Merit, and a research laboratory was named there in his honor. He was the 4th such awardee, the others being Pope John Paul II and Dr. Valentine Fuster. In that same year, Gibson was awarded the Medal of the Jagiellonian University for his outstanding achievements in education and research in cardiovascular science. <br />
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In 2009, the Cardiovascular Division of Istanbul University, Turkey, established the C. Michael Gibson Research and Education Center. In that same year, the Turkish Cardiac Society honored Gibson for establishing WikiDoc on, September 27th, World Heart Day.<br />
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In 2007 and 2009, Dr. Gibson was selected by Who's Who as the Clinical Researcher of the Year. <br />
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In 2009 and 2010, Dr. Gibson was chosen by his peers as one of Boston's Top Doctors in Boston Magazine.<br />
<br />
In 2010, Dr. Gibson was selected as one of America's Top Doctors by Castle Connolly Medical Ltd. In the same year, he was also selected to be included in the Consumers' Research Council of America’s Guide to America’s Top Cardiologists.<br />
<br />
In 2011, Dr. Gibson was featured as one of Boston's Super doctors on my.superdoctors.com. In the same year, he was also selected to be included in the Consumers' Research Council of America’s Guide to America’s Top Cardiologists.<br />
<br />
In 2011 U.S. News & World Report listed Dr. Gibson as one of America's Top Doctors as selected by Castle Connolly Medical Ltd. [http://health.usnews.com/top-doctors/c-michael-gibson-interventional-cardiologist-22CC000361 health.usnews.com]<br />
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In 2012 Gibson was appointed a Distinguished Fellow of New Westminster College, which is the highest honour that New Westminster College bestows upon senior leaders to recognize their distinguished record of ethical leadership. Other Distinguished Fellows include world leaders, cabinet ministers, 12 ambassadors, an astronaut, 27 generals and admirals, surgeons and medical doctors.<br />
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==Disclosures:==<br />
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Dr. Gibson follows the conflict of interest policies set forth by Harvard Medical School and the Beth Israel Deaconess Medical Center. The Baim Institute follows the same conflict of interest policies as Harvard Medical School and Beth Israel Deaconess Medical Center.<br />
''Executive Position (with $0.00 monies received by Dr. Gibson)''<br />
<br />
Chief Executive Office, Baim Institute for Clinical Research<br />
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<br />
''Present Research/Grant Funding (within the last year)''<br />
<br />
Angel Medical Corporation;<br />
Bayer Corp.;<br />
CSL Behring;<br />
Janssen Pharmaceuticals;<br />
Johnson & Johnson Corporation;<br />
Portola Pharmaceuticals (ceased with BIDMC on 12/31/2017)<br />
<br />
<br />
''Consulting''<br />
<br />
Amarin Pharama;<br />
Amgen;<br />
Arena Pharmaceuticals; <br />
Bayer Corporation;<br />
Boehringer Ingelheim;<br />
Boston Clinical Research Institute;<br />
Cardiovascular Research Foundation;<br />
Chiesi;<br />
CSL Behring;<br />
Eli Lilly;<br />
Gilead Sciences, Inc.; <br />
Impact Bio LTD;<br />
Janssen Pharmaceuticals;<br />
Johnson & Johnson Corporation;<br />
The Medicines Company;<br />
MedImmune;<br />
Medtelligence;<br />
Merck & Co, Inc.;<br />
Novo Nordisk;<br />
Pfizer;<br />
Pharma Mar;<br />
Portola Pharmaceuticals (began 1/1/2018);<br />
Sanofi;<br />
Somahlution;<br />
St. Francis Hospital;<br />
Verseon Corportation;<br />
Web MD<br />
<br />
<br />
''Royalties as a Contributor''<br />
<br />
UpToDate in Cardiovascular Medicine<br />
<br />
''Spouse conflicts of interests (Employee of Boston Clinical Research Institute)''<br />
<br />
Amarin, Amgen, Areana, Bayer, Boehringer Ingelheim, Boston Scientific, Cardiovascular Research Foundation, Chiesi, Eli Lilly, Gilead Sciences, Inc., Impact Bio, Janssen, Johnson and Johnson, The Medicines Company, Medtelligence, MedImmune, Merck & Co. Inc., Novo Nordisk, Pfizer, PharmaMar, Portola, Sanofi, Somahlution, St. Francis Hospital, Verseon Corporation<br />
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==Twitter disclaimer for C. Michael Gibson==<br />
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Key words, synonyms: CM Gibson, M Gibson, C Gibson, C.M. Gibson, M. Gibson, C. Gibson, Dr. C.M. Gibson, Dr. M. Gibson, Charles Michael Gibson, Charles M. Gibson, Gibson CM, Gibson CM M.D., C. Michael Gibson M.S. M.D., Mike Gibson, Dr. Mike Gibson, Mike Gibson M.D., Dr. C. Michael Gibson, Dr. CM Gibson, Dr. Gibson, Doctor Gibson <br />
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[[Category:Cardiologists]]</div>C Michael Gibsonhttps://www.wikidoc.org/index.php?title=User:C_Michael_Gibson&diff=1495813User:C Michael Gibson2018-09-28T15:49:00Z<p>C Michael Gibson: /* Disclosures: */</p>
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<div>[[Image:Cmg v4 small.jpg|right|250px|WikiDoc Founder C. Michael Gibson, M.S., M.D.]]<br />
'''C. Michael Gibson M.S., M.D.''', Professor of Medicine, Harvard Medical School <br />
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Founder and Chairman of the Board, WikiDoc Foundation (a 509 (a)(1) Charitable Organization); Chief Executive Officer, Baim Institute for Clinical Research; Founder and Chairman of the [http://www.perfuse.org PERFUSE Study Group]<br />
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'''Contact:''' mgibson@wikidoc.org[mailto:mgibson@wikidoc.org]; or at his G mail address: charlesmichaelgibson@gmail.com [mailto:charlesmichaelgibson@gmail.com]<br />
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'''Mailing Address:''' C. Michael Gibson, M.S., M.D., Beth Israel Deaconess Medical Center<br />
330 Brookline Avenue, Overland 540, Boston, MA 02215 Boston MA, 02215.<br />
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'''Headshot:''' Download headshot [//www.wikidoc.org/images/e/e6/Cmg_v4_small.jpg here]<br />
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View Dr. Gibon's TEDx talk about WikiDoc on YouTube [https://www.youtube.com/watch?v=DMwZnFwueQU here]<br />
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Download Dr. Gibson's slides from his TEDx talk about WikiDoc [//www.wikidoc.org/images/a/a6/Tedx_talk_v5.pptx here]<br />
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__NOTOC__<br />
----<br />
C. Michael Gibson, M.S., M.D. is an interventional cardiologist, cardiovascular researcher and educator who pioneered our understanding of the "open artery hypothesis" as well our understanding of the importance of restoring flow downstream in the capillary bed in the "open microvasculature hypothesis" in heart attack patients. Gibson was chosen as one of the most influential scientific minds between 2002 and 2012 in a 2014 report from Thompson Reuters [http://sciencewatch.com/grr/presenting-highly-cited-researchers].<br />
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Gibson founded www.wikidoc.org, the world's most widely viewed open source textbook of medicine (viewed 700,000 to 2.2 million times daily, hundreds of millions of times annually). He is Editor-In-Chief of over 2,200 active contributors which have edited the content millions of times. Gibson served as medical lead in a partnership with Google, Microsoft and Yahoo to design a scheme of classifying medical content for the internet (www.schema.org) to improve medical search results. Gibson also founded www.clinicaltrialresults.org and has conducted 2,000 TV / video interviews and serves as the anchor person for medical meetings such as TCT TV.<br />
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For many years, Gibson has been chosen by his peers as one of Boston's Top Doctors in Boston Magazine. U.S. News & World Report also lists Gibson as one of America's top doctors. Gibson invented several of the measures of coronary blood flow that are widely used today (the TIMI frame count and the TIMI myocardial perfusion grade).<br />
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Formerly Harvard Clinical Research Institute (HCRI), Gibson leads the Baim Institute for Clinical Research as CEO. It is a leading, non-profit academic research organization (ARO) that delivers insight, innovation and leadership in today’s dynamic research environment. Baim collaborates with the world’s most highly respected researchers from renowned institutions to help advance health and quality of life around the world. The entity has managed 450 studies which have enrolled over 160,000 patients, and has played a role in 50 FDA submissions.<br />
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Gibson has led his own Academic Research Organization ([http://www.perfuse.org PERFUSE]) for over 25 years now, and has been principal investigator of or led core services for 106 clinical trials, the results of which have been published in leading journals such as the New England Journal of Medicine. The PERFUSE Study Group offers a full line of trial management, social media portals, CEC, DSMB and core lab services for phase 1-4 trials worldwide. Under Gibson's direction, the PERFUSE Study Group created the master database that unified data from over 25 years of TIMI studies (TIMI 1-50) in nearly 100,000 patients and coordinated data analyses for the TIMI study group and functioned as the TIMI Data Coordinating Center which he directed. Gibson has led phase 1-4 clinical trials, and cardiology megatrials of over 15,000 patients.<br />
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==Education and Academic Positions==<br />
Dr. Gibson received his B.S., M.S., and M.D. degrees from the University of Chicago. He was an Intern, Resident and Chief Resident at the Brigham and Women’s Hospital, Harvard Medical School. He received his training as an interventional cardiologist and served as the Director of the Coronary Care Unit at Beth Israel Hospital, Harvard Medical School. Dr. Gibson then served as the Chief of Cardiology and Director of Interventional Cardiology at the West Roxbury Veterans Affairs Medical Center, Harvard Medical School. While at the West Roxbury VA, he also served as an Associate Physician at the Brigham and Women’s Hospital. He then moved on to Allegheny General Hospital as Vice Chairman of Medicine for Clinical Research and Director of Invasive Cardiology. He subsequently relocated to the west coast and served as Associate Chief of Cardiology, Chief of Interventional Cardiology and Director of the Cardiac Catheterization Laboratory at University of California San Francisco (UCSF). In 2000, Gibson returned to Harvard Medical School in Boston. Until 2003, Dr. Gibson served as Chief Academic Officer and Director of Core Services at Harvard Clinical Research Institute (HCRI), until 2005 he served as Associate Chief of Cardiology and Director of Academic Affairs in the Cardiovascular Division at the Beth Israel Deaconess Medical Center. Until 2009 he served as the Director of the TIMI Data Coordinating Center at the Brigham and Women’s Hospital. He is currently a full time interventional cardiologist and Chief of Clinical Research in the Cardiovascular Division at Beth Israel Deaconess Medical Center, Harvard Medical School. <br />
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==Research==<br />
Dr. Gibson’s work has largely focused on investigating the pathophysiology of coronary artery disease and the efficacy of pharmacologic and device based therapies. His work has been presented in many thousands manuscripts, abstracts, trial summaries, textbooks and textbook chapters. Gibson's work has been cited over 56,957 times, and he has an h-index of 104 and an i10-index of 385. Updated numbers can be found here https://scholar.google.com/citations?hl=en&user=vzV233IAAAAJ <br />
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Over 25 years ago, Gibson founded the PERFUSE Study Group, an academic research organization which provides academic leadership, site identification and management, statistical analyses, regulatory guidance, angiographic, MRI, CT and EKG core laboratory services, and data management services for a wide variety of studies including trials in acute coronary syndromes, antiplatelets, antithrombins, reperfusion injury, atherosclerosis regression, new devices, angiogenesis, and new imaging modalities. Gibson directed the TIMI angiographic core laboratory and invented the TIMI frame count (CTFC) in which the number of cineframes for dye to reach standardized distal landmarks is counted (an index of epicardial blood flow). Gibson also invented the TIMI myocardial perfusion grade (the blush, a measure of microvascular perfusion). The TIMI frame count and the TIMI myocardial perfusion grade are both multivariate predictors of 2 year mortality in acute MI, and are now widely used both clinically and in the assessment of new reperfusion strategies. The methods invented by Gibson and his research have played a critical role in our understanding of "the open artery hypothesis" and more recently in what Gibson has termed "the open microvasculature hypothesis". On Google scholar, the TIMI Frame Count is listed as being cited in over 4,700 articles ([http://scholar.google.com/scholar?hl=en&lr=&q=%22timi+frame+count%22&btnG=Search for updated numbers click here]) and the TIMI myocardial perfusion grade is listed as being cited in over 1,800 articles ([http://scholar.google.com/scholar?hl=en&q=%22timi+myocardial+perfusion+grade%22&btnG=Search for updated numbers click here]).<br />
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Under Gibson's direction, the PERFUSE Study Group created the master database that unified data from over 25 years of TIMI studies (TIMI 1-50) in nearly 100,000 patients and coordinated data analyses for the TIMI study group and functioned as the TIMI Data Coordinating Center. <br />
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Within the Thrombolysis In Myocardial Infarction (TIMI) Study Group, Dr. Gibson has served as a Principle Investigator of multiple international trials within the TIMI Study Chairman’s Office.<br />
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Dr. Gibson's specific research interests include the following:<br />
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*'''Acute Coronary Syndrome Research Including unstable angina, non ST elevation MI and ST elevation MI:''' Gibson invented the angiographic endpoints that are used in assessing drug and device therapies such as the TIMI frame count and the TIMI myocardial perfusion grade. He has been the principal investigator of trials of novel thrombolytic agents (BB 10153) and novel mechanisms of delivery of thrombolytic agents such as ICE T – TIMI 49 (Intra-coronary Tenecteplase During Balloon Angioplasty). Gibson led the angiographic core laboratory analysis of a number of thrombolytic trials (TIMI4 (tPA and APSAC), TIMI 10 trials (TNK), ADVANCE MI (TNK + eptifibatide), TIMI 14 (lytic + abciximab), FASTER (lytic + aggrastat), CLARITY (lytic + clopidogrel), STEP AMI (lytic + cangrelor)<br />
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*'''Antiplatelet Trials:''' Gibson has led trials of glycoprotein 2b3a inhibitor inhibition (PROTECT, TITAN), thienopyridine trials such as the TRITON study of prasugrel, trials of novel antiplatelets such as elinogrel (ERASE MI), and is a member of the executive committee of trials of cangrelor. Gibson led the angiographic core laboratory for trials of eptifibatide (ESPRIT, INTEGRITI, ADVANCE MI, TITAN, EARLY ACS), abciximab (TIMI 14, INFUSE AMI, IC Clearly), and tirofiban (FASTER, TACTICS), clopidogrel (CLARITY TIMI 28), ticagrelor (PLATO) and cangrelor (STEP AMI).<br />
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*'''Antithrombin Trials:''' Gibson has led large scale international trials of novel antithrombins such as the development of rivaroxaban, a factor Xa inhibitor (ATLAS TIMI 46 and 51). Gibson has led angiographic core laboratory efforts in the evaluation of rNAPc2 (a fVIIa/TF inhibitor) in the ANTHEM study, and the SEPIA-ACS1 TIMI 42 (Study Program to Evaluate the Prevention of Ischemia with direct Anti-Xa inhibition in Acute Coronary Syndromes 1 - Thrombolysis in Myocardial Infarction 42).<br />
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*'''Reperfusion Injury Trials:''' Gibson has led the angiographic core laboratory analysis of reperfusion injury trials such as the LIMIT trial of rhuMAb CD18, the DELTA MI trial (Direct Inhibition of δ Protein Kinase C Enzyme to Limit Total Infarct Size in Acute Myocardial Infarction), the INOT-44 trial (Nitric Oxide in Myocardial Infarction Size (NOMI), and the INTESIVE trial (Apidra®/Lantus® therapy versus Sliding Scale Insulin on infarct size in hyperglycemic subjects with anterior STEMI undergoing percutaneous coronary intervention (PCI). Gibson is currently the Study Chairman and Principal Investigator of the multicenter international EMBRACE MI trial of [[Bendavia]].<br />
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*'''Lipid Lowering and Atherosclerosis Regression Trials:''' Gibson’s career started with the Harvard Atherosclerosis Reversibility Project where he developed the angiographic and statistical methodology to conduct angiographic atherosclerosis regression trials. Gibson participated in and has published manuscripts from the PROVE It study (PCI PROVE IT). Gibson has served as the site PI for trials of medical therapy in stable angina (the AVERT study). Gibson serves on the Executive committee of trials of CTEP inhibition (ACCELERATE). Gibson serves as the study chairman of the AEGIS trials evaluating the efficacy and safety of APO A1 infusions (HDL) to halt atherosclerosis and prevent atherothrombotic events. Gibson has participated in the publication of PCSK9 inhibitor trial data.<br />
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*'''New Device Trials:''' Gibson has led new device studies such as novel delivery systems for intracoronary therapies such as the Clearway catheter in the INFUSE AMI and IC Clearly trials, and aspiration thrombectomy (INFUSE AMI). He has served as the angiographic core laboratory for trials of perfusion balloons, directional atherectomy, self expanding stents, therapeutic ultrasound studies (PLUS) and markers of saphenous vein graft proximal connectors (PAS-Port (Study of the PAS-Port® Proximal Anastomosis System in Coronary Bypass Surgery (EPIC)).<br />
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*'''Imaging Trials:''' Gibson has served as the angiographic core laboratory for trials of new echocardiographic contrast agents (ECHOGEN) vs angiography, and positron emission tomography (PET) vs angiography trials.<br />
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*'''CMR Core Laboratory Trials:''' Gibson is co-principal investigator of CMR core laboratory studies such as ALLAY (efficacy and safety of aliskiren in combination with Losartan compared to Losartan), the TRACS Study (The Effects of Fx-1006A on Transthyretin Stabilization and Clinical Outcome Measures in Patients With Non-V30M Transthyretin Amyloidosis), the ACT-34 CMI (Autologous Cellular Therapy Utilizing CD34+ Cells), the INTESIVE trial (Apidra®/Lantus® therapy versus Sliding Scale Insulin on infarct size in hyperglycemic subjects with anterior STEMI undergoing percutaneous coronary intervention (PCI)), and the FX1B-201 Study (Safety and Efficacy Evaluation of Fx-1006A in Patients With V122I or Wild-Type Transthyretin (TTR) Amyloid Cardiomyopathy).<br />
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*'''CT Angiographic Core Laboratory Trials:''' Gibson has led the CT core laboratory for trials such as the markers of saphenous vein graft proximal connectors (PAS-Port (Study of the PAS-Port® Proximal Anastomosis System in Coronary Bypass Surgery (EPIC)).<br />
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*'''Coronary Artery Bypass Graft Trials:''' Gibson led the angiographic core laboratory analysis of the PREVENT 4 study (Project of Ex-vivo Vein Graft Engineering via Transfection) of 2200 patients.<br />
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*'''New Electrocardiography Technology Trials:''' Gibson is the leader of trials of an implantable technology (the AngelMed Guardian Device) designed to monitor and alert the patient to the presence of ST segment elevation (ALERT AMI trial). Gibson has led the angiographic core laboratory for trials such as OCCULT MI study of 84 lead EKG technologies (Optimal Cardiovascular Diagnostic Evaluation Enabling Faster Treatment of Myocardial Infarction). Gibson's team has also served as an EKG core laboratory.<br />
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*'''Angiogenesis Trials:''' Gibson assessed angiographic endpoints in early trials of angiogenesis (VIVA trial).<br />
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*'''Stem Cell Therapy:''' Gibson is Chair of the Data Safety Monitoring Board for the first phase III stem cell study (RENEW)<br />
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*'''NIH Studies:''' Gibson has led the angiographic core laboratory for a number of NIH studies including the Harvard Atherosclerosis Reversibility Project (HARP), the PEARL study of estrogens in restenosis, and the ASCERT study comparing PCI to CABG.<br />
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*'''Diabetes:''' Gibson coordinates the Clinical Event Committee efforts to adjudicate tens of thousands of adverse events and hundreds of thousands of EKGs in ongoing trials of novel anti-diabetic agents.<br />
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===Publications===<br />
*Gibson's work has been cited over 56,957 times, and he has an h-index of 104 and an i10-index of 385. Updated numbers can be found here https://scholar.google.com/citations?hl=en&user=vzV233IAAAAJ<br />
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*Peer reviewed research publications: > 530 (for an update, click [http://www.ncbi.nlm.nih.gov/pubmed?term=Gibson%20CM here])<br />
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*Non peer-reviewed reviews, chapters, monographs and editorials: 57<br />
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*Professional Educational Materials or Reports, in Print or Other Media: 686<br />
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*WikiDoc pages edited: Over 70,000 under C Michael Gibson and CMichaelGibson<br />
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===Editorial Boards===<br />
Dr. Gibson has served in the past on the editorial board of numerous journals such as Circulation, the Journal of the American College of Cardiology, Cardiac Catheterization and Intervention and the American Heart Journal.<br />
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==Education==<br />
===WikiDoc===<br />
Dr. Gibson is Founder and Chairman of the Board of WikiDoc Foundation (a 509 (a)(1) Charitable Organization). This is the world's largest medical textbook / encyclopedia. WikiDoc contains [[Special:Statistics|200,059]] chapters updated millions of times by over 2,200 active contributors and viewed hundreds of thousands of times daily. In 2010, WikiDoc was selected as a Google Grant recipient. Dr. Gibson has personally made over 70,000 edits to WikiDoc.<br />
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===Schema.org===<br />
Although there is a vast amount of medical information on the internet, search engine's often return results that are not highly specific. This is because search engines do not account for the structure of the underlying medical knowledge or the relationships among keywords.<br />
Gibson was one of the co-creators of a www.schema.org-based [http://schemaorg-medicalext.appspot.com/docs/meddocs.html schema] that allows webmasters and content publishers to mark up health and medical content on the web. The health and medical schema is intended to make it easier for people to locate the optimal web pages by exposing structured information contained in web pages to search engines. As a result, more relevant content rich pages will be returned in search results.<br />
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===Internet Educational Sites===<br />
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Dr. Gibson is Founder and Editor-in-Chief of [http://www.clinicaltrialresults.org Clinical Trial Results] where he created the first weekly TV show for Cardiologists "This Week in Cardiology" and has provided slides summarizing clinical trials since 1999. Gibson has conducted 2,000 TV / video interviews and serves as the anchor person for medical meetings such as TCT TV. Gibson also created the original [http://www.timi.org TIMI.org], website, the website of the TIMI Study Group.<br />
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===Traditional Textbooks===<br />
Dr. Gibson also edits a textbook entitled “Gibson's Treatment Strategies in Interventional Cardiology” which is optimized for hand held devices. In the past, Gibson has authored the chapter on Primary Angioplasty in Randomized Trials in Cardiovascular Disease published as a companion to Braunwald's Heart Disease. In the past he has co-authored the chapter “Recognition and Management of Patients with Stable Angina Pectoris" in Braunwald and Goldman’s Primary Cardiology. He has served as lead author of the section on myocardial perfusion imaging in an imaging textbook which is a companion to Braunwald’s Heart Disease. Gibson has authored the chapter “Profiles in Coronary Artery Disease” in the fifth and sixth editions of Grossman and Baim’s Textbook of Interventional Cardiology.<br />
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===American Heart Association===<br />
Gibson has served as a member of the Professional Education Committee of the American Heart Association.<br />
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==Physician==<br />
Gibson is a practicing interventional cardiologist. He has served as a cath lab director. In 2009 and 2010, Dr. Gibson was chosen by his peers as one of Boston's Top Doctors in Boston Magazine.<br />
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In 2010, Dr. Gibson was selected as one of America's Top Doctors by Castle Connolly Medical Ltd. In the same year, he was also selected to be included in the Consumers' Research Council of America’s Guide to America’s Top Cardiologists.<br />
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In 2011, Dr. Gibson was featured as one of Boston's Super doctors on my.superdoctors.com. In the same year, he was also selected to be included in the Consumers' Research Council of America’s Guide to America’s Top Cardiologists.<br />
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In 2011 U.S. News & World Report listed Dr. Gibson as one of America's Top Doctors as selected by Castle Connolly Medical Ltd. [http://health.usnews.com/top-doctors/c-michael-gibson-interventional-cardiologist-22CC000361 health.usnews.com]<br />
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==Awards==<br />
[[Image:C-Michael-Gibson-award.jpg|right]]<br />
[[Image:C Michael Gibson Distinguished fellow.jpg|right]]<br />
Dr. Gibson graduated from college Phi Beta Kappa, and from medical school Alpha Omega Alpha, both from the University of Chicago. In 1993 he was selected as the Julian and Eunice Cohen Scholar in Medicine at the Brigham and Women's Hospital. <br />
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In conjunction with delivering the opening plenary lecture at the 10th annual Great Wall of China Symposium in 2003, Gibson was awarded the Gold Medal by the Institute of Geriatric Cardiology, Chinese Peoples Liberation Army General Hospital, Beijing China for his achievements in cardiovascular science. <br />
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In 2005, the John Paul II Hospital in Krakow, Poland awarded Gibson the Pro Bono Curantium Gold Medal for Merit, and a research laboratory was named there in his honor. He was the 4th such awardee, the others being Pope John Paul II and Dr. Valentine Fuster. In that same year, Gibson was awarded the Medal of the Jagiellonian University for his outstanding achievements in education and research in cardiovascular science. <br />
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In 2009, the Cardiovascular Division of Istanbul University, Turkey, established the C. Michael Gibson Research and Education Center. In that same year, the Turkish Cardiac Society honored Gibson for establishing WikiDoc on, September 27th, World Heart Day.<br />
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In 2007 and 2009, Dr. Gibson was selected by Who's Who as the Clinical Researcher of the Year. <br />
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In 2009 and 2010, Dr. Gibson was chosen by his peers as one of Boston's Top Doctors in Boston Magazine.<br />
<br />
In 2010, Dr. Gibson was selected as one of America's Top Doctors by Castle Connolly Medical Ltd. In the same year, he was also selected to be included in the Consumers' Research Council of America’s Guide to America’s Top Cardiologists.<br />
<br />
In 2011, Dr. Gibson was featured as one of Boston's Super doctors on my.superdoctors.com. In the same year, he was also selected to be included in the Consumers' Research Council of America’s Guide to America’s Top Cardiologists.<br />
<br />
In 2011 U.S. News & World Report listed Dr. Gibson as one of America's Top Doctors as selected by Castle Connolly Medical Ltd. [http://health.usnews.com/top-doctors/c-michael-gibson-interventional-cardiologist-22CC000361 health.usnews.com]<br />
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In 2012 Gibson was appointed a Distinguished Fellow of New Westminster College, which is the highest honour that New Westminster College bestows upon senior leaders to recognize their distinguished record of ethical leadership. Other Distinguished Fellows include world leaders, cabinet ministers, 12 ambassadors, an astronaut, 27 generals and admirals, surgeons and medical doctors.<br />
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==Disclosures:==<br />
<br />
<br />
''Executive Position (with $0.00 monies received by Dr. Gibson)''<br />
<br />
Chief Executive Office, Baim Institute for Clinical Research<br />
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<br />
''Present Research/Grant Funding (within the last year)''<br />
<br />
Angel Medical Corporation;<br />
Bayer Corp.;<br />
CSL Behring;<br />
Janssen Pharmaceuticals;<br />
Johnson & Johnson Corporation;<br />
Portola Pharmaceuticals (ceased with BIDMC on 12/31/2017)<br />
<br />
<br />
''Consulting''<br />
<br />
Amarin Pharama;<br />
Amgen;<br />
Arena Pharmaceuticals; <br />
Bayer Corporation;<br />
Boehringer Ingelheim;<br />
Boston Clinical Research Institute;<br />
Cardiovascular Research Foundation;<br />
Chiesi;<br />
CSL Behring;<br />
Eli Lilly;<br />
Gilead Sciences, Inc.; <br />
Impact Bio LTD;<br />
Janssen Pharmaceuticals;<br />
Johnson & Johnson Corporation;<br />
The Medicines Company;<br />
MedImmune;<br />
Medtelligence;<br />
Merck & Co, Inc.;<br />
Novo Nordisk;<br />
Pfizer;<br />
Pharma Mar;<br />
Portola Pharmaceuticals (began 1/1/2018);<br />
Sanofi;<br />
Somahlution;<br />
St. Francis Hospital;<br />
Verseon Corportation;<br />
Web MD<br />
<br />
<br />
''Royalties as a Contributor''<br />
<br />
UpToDate in Cardiovascular Medicine<br />
<br />
''Spouse conflicts of interests (Employee of Boston Clinical Research Institute)''<br />
<br />
Amarin, Amgen, Areana, Bayer, Boehringer Ingelheim, Boston Scientific, Cardiovascular Research Foundation, Chiesi, Eli Lilly, Gilead Sciences, Inc., Impact Bio, Janssen, Johnson and Johnson, The Medicines Company, Medtelligence, MedImmune, Merck & Co. Inc., Novo Nordisk, Pfizer, PharmaMar, Portola, Sanofi, Somahlution, St. Francis Hospital, Verseon Corporation<br />
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==Twitter disclaimer for C. Michael Gibson==<br />
@CMichaelGibson is largely a news service citing articles in the news media related to healthcare. A retweet does not constitute an endorsement. RTs which link to other websites are provided as a service to followers, but linking to the sites does not constitute endorsement of those sites by @CMichaelGibson, and @CMichaelGibson is not responsible for the content of external websites. Please note that other users of Twitter may utilize your tweets beyond the control of @CMichaelGibson. Tweets are educational and do not represent medical advice, see your doctor or healthcare provider. Tweets are educational only and are not meant to promote an unapproved or off label use of a medical drug or device. #cmgsays says quotes may have been said by others as well as anonymous individuals.<br />
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@CMichaelGibson is not a professional health care provider, nor is it a suitable replacement for a licensed healthcare provider.<br />
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@CMichaelGibson is intended to be an educational tool, not a tool for any form of healthcare delivery.<br />
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Below is @CMichaelGibson's statement regarding liability, limitations, warranty, validity, guarantee, negligence, responsibility, damages, product liability, errors, omissions, indemnification, legal action, and contract (or lack thereof of any of the above).<br />
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@CMichaelGibson is not a substitute for a licensed health care professional. @CMichaelGibson is not intended to guide medical decision making, but is instead intended as an educational tool.<br />
<br />
That is not to say that you will not find valuable and accurate educational information in @CMichaelGibson's posts; some of the time you will. However, @CMichaelGibson cannot guarantee the validity of the information found on Twitter. The content of any given article may recently have been changed, vandalized or altered by someone whose opinion does not correspond with the consensus in the medical field in your country, state, or city.<br />
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While @CMichaelGibson strives to have the most up to date and accurate data, you agree to consult published medical literature or the package insert for official trial results, dosing information or instructions for use of pharmaceutical products and devices. Off label use of drugs and devices is not encouraged. Tweets by @CMichaelGibson and links to articles of a forward looking investigational nature may present data to support the rationale for the use of a variety of pharmacologic agents and devices in both approved and non-approved indications. Actual prescribing information is by intent minimal or completely lacking. These tweets by @CMichaelGibson and links to articles has been prepared for scientific educational purposes, and cannot be considered an inducement to use any drug or device in non-registered indications. @CMichaelGibson does not recommend the use of any drug or device in any manner inconsistent with that described in the full prescribing information.<br />
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In following @CMichaelGibson, you assume responsibility for the accuracy of the information and its utilization. In following @CMichaelGibson, you agree to hold @CMichaelGibson free of responsibility and/or liability for potential damages or injury to persons or property as a matter of products liability, negligence, copyright infringement or otherwise from any use or operation of any methods, products, instructions or ideas contained in the material herein.<br />
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The views expressed by @CMichaelGibson are those of @CMichaelGibson and do not necessarily reflect the views of any organization. A tweet does not constitute a guarantee or endorsement of the organization of the quality or the value of the product or the claim made by the author or any manufacturer.<br />
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Key words, synonyms: CM Gibson, M Gibson, C Gibson, C.M. Gibson, M. Gibson, C. Gibson, Dr. C.M. Gibson, Dr. M. Gibson, Charles Michael Gibson, Charles M. Gibson, Gibson CM, Gibson CM M.D., C. Michael Gibson M.S. M.D., Mike Gibson, Dr. Mike Gibson, Mike Gibson M.D., Dr. C. Michael Gibson, Dr. CM Gibson, Dr. Gibson, Doctor Gibson <br />
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[[Category:Cardiologists]]</div>C Michael Gibsonhttps://www.wikidoc.org/index.php?title=User:C_Michael_Gibson&diff=1495805User:C Michael Gibson2018-09-28T15:39:17Z<p>C Michael Gibson: </p>
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<div>[[Image:Cmg v4 small.jpg|right|250px|WikiDoc Founder C. Michael Gibson, M.S., M.D.]]<br />
'''C. Michael Gibson M.S., M.D.''', Professor of Medicine, Harvard Medical School <br />
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Founder and Chairman of the Board, WikiDoc Foundation (a 509 (a)(1) Charitable Organization); Chief Executive Officer, Baim Institute for Clinical Research; Founder and Chairman of the [http://www.perfuse.org PERFUSE Study Group]<br />
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'''Contact:''' mgibson@wikidoc.org[mailto:mgibson@wikidoc.org]; or at his G mail address: charlesmichaelgibson@gmail.com [mailto:charlesmichaelgibson@gmail.com]<br />
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'''Mailing Address:''' C. Michael Gibson, M.S., M.D., Beth Israel Deaconess Medical Center<br />
330 Brookline Avenue, Overland 540, Boston, MA 02215 Boston MA, 02215.<br />
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'''Headshot:''' Download headshot [//www.wikidoc.org/images/e/e6/Cmg_v4_small.jpg here]<br />
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View Dr. Gibon's TEDx talk about WikiDoc on YouTube [https://www.youtube.com/watch?v=DMwZnFwueQU here]<br />
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Download Dr. Gibson's slides from his TEDx talk about WikiDoc [//www.wikidoc.org/images/a/a6/Tedx_talk_v5.pptx here]<br />
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__NOTOC__<br />
----<br />
C. Michael Gibson, M.S., M.D. is an interventional cardiologist, cardiovascular researcher and educator who pioneered our understanding of the "open artery hypothesis" as well our understanding of the importance of restoring flow downstream in the capillary bed in the "open microvasculature hypothesis" in heart attack patients. Gibson was chosen as one of the most influential scientific minds between 2002 and 2012 in a 2014 report from Thompson Reuters [http://sciencewatch.com/grr/presenting-highly-cited-researchers].<br />
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Gibson founded www.wikidoc.org, the world's most widely viewed open source textbook of medicine (viewed 700,000 to 2.2 million times daily, hundreds of millions of times annually). He is Editor-In-Chief of over 2,200 active contributors which have edited the content millions of times. Gibson served as medical lead in a partnership with Google, Microsoft and Yahoo to design a scheme of classifying medical content for the internet (www.schema.org) to improve medical search results. Gibson also founded www.clinicaltrialresults.org and has conducted 2,000 TV / video interviews and serves as the anchor person for medical meetings such as TCT TV.<br />
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For many years, Gibson has been chosen by his peers as one of Boston's Top Doctors in Boston Magazine. U.S. News & World Report also lists Gibson as one of America's top doctors. Gibson invented several of the measures of coronary blood flow that are widely used today (the TIMI frame count and the TIMI myocardial perfusion grade).<br />
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Formerly Harvard Clinical Research Institute (HCRI), Gibson leads the Baim Institute for Clinical Research as CEO. It is a leading, non-profit academic research organization (ARO) that delivers insight, innovation and leadership in today’s dynamic research environment. Baim collaborates with the world’s most highly respected researchers from renowned institutions to help advance health and quality of life around the world. The entity has managed 450 studies which have enrolled over 160,000 patients, and has played a role in 50 FDA submissions.<br />
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Gibson has led his own Academic Research Organization ([http://www.perfuse.org PERFUSE]) for over 25 years now, and has been principal investigator of or led core services for 106 clinical trials, the results of which have been published in leading journals such as the New England Journal of Medicine. The PERFUSE Study Group offers a full line of trial management, social media portals, CEC, DSMB and core lab services for phase 1-4 trials worldwide. Under Gibson's direction, the PERFUSE Study Group created the master database that unified data from over 25 years of TIMI studies (TIMI 1-50) in nearly 100,000 patients and coordinated data analyses for the TIMI study group and functioned as the TIMI Data Coordinating Center which he directed. Gibson has led phase 1-4 clinical trials, and cardiology megatrials of over 15,000 patients.<br />
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==Education and Academic Positions==<br />
Dr. Gibson received his B.S., M.S., and M.D. degrees from the University of Chicago. He was an Intern, Resident and Chief Resident at the Brigham and Women’s Hospital, Harvard Medical School. He received his training as an interventional cardiologist and served as the Director of the Coronary Care Unit at Beth Israel Hospital, Harvard Medical School. Dr. Gibson then served as the Chief of Cardiology and Director of Interventional Cardiology at the West Roxbury Veterans Affairs Medical Center, Harvard Medical School. While at the West Roxbury VA, he also served as an Associate Physician at the Brigham and Women’s Hospital. He then moved on to Allegheny General Hospital as Vice Chairman of Medicine for Clinical Research and Director of Invasive Cardiology. He subsequently relocated to the west coast and served as Associate Chief of Cardiology, Chief of Interventional Cardiology and Director of the Cardiac Catheterization Laboratory at University of California San Francisco (UCSF). In 2000, Gibson returned to Harvard Medical School in Boston. Until 2003, Dr. Gibson served as Chief Academic Officer and Director of Core Services at Harvard Clinical Research Institute (HCRI), until 2005 he served as Associate Chief of Cardiology and Director of Academic Affairs in the Cardiovascular Division at the Beth Israel Deaconess Medical Center. Until 2009 he served as the Director of the TIMI Data Coordinating Center at the Brigham and Women’s Hospital. He is currently a full time interventional cardiologist and Chief of Clinical Research in the Cardiovascular Division at Beth Israel Deaconess Medical Center, Harvard Medical School. <br />
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==Research==<br />
Dr. Gibson’s work has largely focused on investigating the pathophysiology of coronary artery disease and the efficacy of pharmacologic and device based therapies. His work has been presented in many thousands manuscripts, abstracts, trial summaries, textbooks and textbook chapters. Gibson's work has been cited over 56,957 times, and he has an h-index of 104 and an i10-index of 385. Updated numbers can be found here https://scholar.google.com/citations?hl=en&user=vzV233IAAAAJ <br />
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Over 25 years ago, Gibson founded the PERFUSE Study Group, an academic research organization which provides academic leadership, site identification and management, statistical analyses, regulatory guidance, angiographic, MRI, CT and EKG core laboratory services, and data management services for a wide variety of studies including trials in acute coronary syndromes, antiplatelets, antithrombins, reperfusion injury, atherosclerosis regression, new devices, angiogenesis, and new imaging modalities. Gibson directed the TIMI angiographic core laboratory and invented the TIMI frame count (CTFC) in which the number of cineframes for dye to reach standardized distal landmarks is counted (an index of epicardial blood flow). Gibson also invented the TIMI myocardial perfusion grade (the blush, a measure of microvascular perfusion). The TIMI frame count and the TIMI myocardial perfusion grade are both multivariate predictors of 2 year mortality in acute MI, and are now widely used both clinically and in the assessment of new reperfusion strategies. The methods invented by Gibson and his research have played a critical role in our understanding of "the open artery hypothesis" and more recently in what Gibson has termed "the open microvasculature hypothesis". On Google scholar, the TIMI Frame Count is listed as being cited in over 4,700 articles ([http://scholar.google.com/scholar?hl=en&lr=&q=%22timi+frame+count%22&btnG=Search for updated numbers click here]) and the TIMI myocardial perfusion grade is listed as being cited in over 1,800 articles ([http://scholar.google.com/scholar?hl=en&q=%22timi+myocardial+perfusion+grade%22&btnG=Search for updated numbers click here]).<br />
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Under Gibson's direction, the PERFUSE Study Group created the master database that unified data from over 25 years of TIMI studies (TIMI 1-50) in nearly 100,000 patients and coordinated data analyses for the TIMI study group and functioned as the TIMI Data Coordinating Center. <br />
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Within the Thrombolysis In Myocardial Infarction (TIMI) Study Group, Dr. Gibson has served as a Principle Investigator of multiple international trials within the TIMI Study Chairman’s Office.<br />
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Dr. Gibson's specific research interests include the following:<br />
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*'''Acute Coronary Syndrome Research Including unstable angina, non ST elevation MI and ST elevation MI:''' Gibson invented the angiographic endpoints that are used in assessing drug and device therapies such as the TIMI frame count and the TIMI myocardial perfusion grade. He has been the principal investigator of trials of novel thrombolytic agents (BB 10153) and novel mechanisms of delivery of thrombolytic agents such as ICE T – TIMI 49 (Intra-coronary Tenecteplase During Balloon Angioplasty). Gibson led the angiographic core laboratory analysis of a number of thrombolytic trials (TIMI4 (tPA and APSAC), TIMI 10 trials (TNK), ADVANCE MI (TNK + eptifibatide), TIMI 14 (lytic + abciximab), FASTER (lytic + aggrastat), CLARITY (lytic + clopidogrel), STEP AMI (lytic + cangrelor)<br />
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*'''Antiplatelet Trials:''' Gibson has led trials of glycoprotein 2b3a inhibitor inhibition (PROTECT, TITAN), thienopyridine trials such as the TRITON study of prasugrel, trials of novel antiplatelets such as elinogrel (ERASE MI), and is a member of the executive committee of trials of cangrelor. Gibson led the angiographic core laboratory for trials of eptifibatide (ESPRIT, INTEGRITI, ADVANCE MI, TITAN, EARLY ACS), abciximab (TIMI 14, INFUSE AMI, IC Clearly), and tirofiban (FASTER, TACTICS), clopidogrel (CLARITY TIMI 28), ticagrelor (PLATO) and cangrelor (STEP AMI).<br />
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*'''Antithrombin Trials:''' Gibson has led large scale international trials of novel antithrombins such as the development of rivaroxaban, a factor Xa inhibitor (ATLAS TIMI 46 and 51). Gibson has led angiographic core laboratory efforts in the evaluation of rNAPc2 (a fVIIa/TF inhibitor) in the ANTHEM study, and the SEPIA-ACS1 TIMI 42 (Study Program to Evaluate the Prevention of Ischemia with direct Anti-Xa inhibition in Acute Coronary Syndromes 1 - Thrombolysis in Myocardial Infarction 42).<br />
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*'''Reperfusion Injury Trials:''' Gibson has led the angiographic core laboratory analysis of reperfusion injury trials such as the LIMIT trial of rhuMAb CD18, the DELTA MI trial (Direct Inhibition of δ Protein Kinase C Enzyme to Limit Total Infarct Size in Acute Myocardial Infarction), the INOT-44 trial (Nitric Oxide in Myocardial Infarction Size (NOMI), and the INTESIVE trial (Apidra®/Lantus® therapy versus Sliding Scale Insulin on infarct size in hyperglycemic subjects with anterior STEMI undergoing percutaneous coronary intervention (PCI). Gibson is currently the Study Chairman and Principal Investigator of the multicenter international EMBRACE MI trial of [[Bendavia]].<br />
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*'''Lipid Lowering and Atherosclerosis Regression Trials:''' Gibson’s career started with the Harvard Atherosclerosis Reversibility Project where he developed the angiographic and statistical methodology to conduct angiographic atherosclerosis regression trials. Gibson participated in and has published manuscripts from the PROVE It study (PCI PROVE IT). Gibson has served as the site PI for trials of medical therapy in stable angina (the AVERT study). Gibson serves on the Executive committee of trials of CTEP inhibition (ACCELERATE). Gibson serves as the study chairman of the AEGIS trials evaluating the efficacy and safety of APO A1 infusions (HDL) to halt atherosclerosis and prevent atherothrombotic events. Gibson has participated in the publication of PCSK9 inhibitor trial data.<br />
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*'''New Device Trials:''' Gibson has led new device studies such as novel delivery systems for intracoronary therapies such as the Clearway catheter in the INFUSE AMI and IC Clearly trials, and aspiration thrombectomy (INFUSE AMI). He has served as the angiographic core laboratory for trials of perfusion balloons, directional atherectomy, self expanding stents, therapeutic ultrasound studies (PLUS) and markers of saphenous vein graft proximal connectors (PAS-Port (Study of the PAS-Port® Proximal Anastomosis System in Coronary Bypass Surgery (EPIC)).<br />
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*'''Imaging Trials:''' Gibson has served as the angiographic core laboratory for trials of new echocardiographic contrast agents (ECHOGEN) vs angiography, and positron emission tomography (PET) vs angiography trials.<br />
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*'''CMR Core Laboratory Trials:''' Gibson is co-principal investigator of CMR core laboratory studies such as ALLAY (efficacy and safety of aliskiren in combination with Losartan compared to Losartan), the TRACS Study (The Effects of Fx-1006A on Transthyretin Stabilization and Clinical Outcome Measures in Patients With Non-V30M Transthyretin Amyloidosis), the ACT-34 CMI (Autologous Cellular Therapy Utilizing CD34+ Cells), the INTESIVE trial (Apidra®/Lantus® therapy versus Sliding Scale Insulin on infarct size in hyperglycemic subjects with anterior STEMI undergoing percutaneous coronary intervention (PCI)), and the FX1B-201 Study (Safety and Efficacy Evaluation of Fx-1006A in Patients With V122I or Wild-Type Transthyretin (TTR) Amyloid Cardiomyopathy).<br />
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*'''CT Angiographic Core Laboratory Trials:''' Gibson has led the CT core laboratory for trials such as the markers of saphenous vein graft proximal connectors (PAS-Port (Study of the PAS-Port® Proximal Anastomosis System in Coronary Bypass Surgery (EPIC)).<br />
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*'''Coronary Artery Bypass Graft Trials:''' Gibson led the angiographic core laboratory analysis of the PREVENT 4 study (Project of Ex-vivo Vein Graft Engineering via Transfection) of 2200 patients.<br />
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*'''New Electrocardiography Technology Trials:''' Gibson is the leader of trials of an implantable technology (the AngelMed Guardian Device) designed to monitor and alert the patient to the presence of ST segment elevation (ALERT AMI trial). Gibson has led the angiographic core laboratory for trials such as OCCULT MI study of 84 lead EKG technologies (Optimal Cardiovascular Diagnostic Evaluation Enabling Faster Treatment of Myocardial Infarction). Gibson's team has also served as an EKG core laboratory.<br />
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*'''Angiogenesis Trials:''' Gibson assessed angiographic endpoints in early trials of angiogenesis (VIVA trial).<br />
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*'''Stem Cell Therapy:''' Gibson is Chair of the Data Safety Monitoring Board for the first phase III stem cell study (RENEW)<br />
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*'''NIH Studies:''' Gibson has led the angiographic core laboratory for a number of NIH studies including the Harvard Atherosclerosis Reversibility Project (HARP), the PEARL study of estrogens in restenosis, and the ASCERT study comparing PCI to CABG.<br />
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*'''Diabetes:''' Gibson coordinates the Clinical Event Committee efforts to adjudicate tens of thousands of adverse events and hundreds of thousands of EKGs in ongoing trials of novel anti-diabetic agents.<br />
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===Publications===<br />
*Gibson's work has been cited over 56,957 times, and he has an h-index of 104 and an i10-index of 385. Updated numbers can be found here https://scholar.google.com/citations?hl=en&user=vzV233IAAAAJ<br />
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*Peer reviewed research publications: > 530 (for an update, click [http://www.ncbi.nlm.nih.gov/pubmed?term=Gibson%20CM here])<br />
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*Non peer-reviewed reviews, chapters, monographs and editorials: 57<br />
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*Professional Educational Materials or Reports, in Print or Other Media: 686<br />
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*WikiDoc pages edited: Over 70,000 under C Michael Gibson and CMichaelGibson<br />
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===Editorial Boards===<br />
Dr. Gibson has served in the past on the editorial board of numerous journals such as Circulation, the Journal of the American College of Cardiology, Cardiac Catheterization and Intervention and the American Heart Journal.<br />
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==Education==<br />
===WikiDoc===<br />
Dr. Gibson is Founder and Chairman of the Board of WikiDoc Foundation (a 509 (a)(1) Charitable Organization). This is the world's largest medical textbook / encyclopedia. WikiDoc contains [[Special:Statistics|200,059]] chapters updated millions of times by over 2,200 active contributors and viewed hundreds of thousands of times daily. In 2010, WikiDoc was selected as a Google Grant recipient. Dr. Gibson has personally made over 70,000 edits to WikiDoc.<br />
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===Schema.org===<br />
Although there is a vast amount of medical information on the internet, search engine's often return results that are not highly specific. This is because search engines do not account for the structure of the underlying medical knowledge or the relationships among keywords.<br />
Gibson was one of the co-creators of a www.schema.org-based [http://schemaorg-medicalext.appspot.com/docs/meddocs.html schema] that allows webmasters and content publishers to mark up health and medical content on the web. The health and medical schema is intended to make it easier for people to locate the optimal web pages by exposing structured information contained in web pages to search engines. As a result, more relevant content rich pages will be returned in search results.<br />
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===Internet Educational Sites===<br />
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Dr. Gibson is Founder and Editor-in-Chief of [http://www.clinicaltrialresults.org Clinical Trial Results] where he created the first weekly TV show for Cardiologists "This Week in Cardiology" and has provided slides summarizing clinical trials since 1999. Gibson has conducted 2,000 TV / video interviews and serves as the anchor person for medical meetings such as TCT TV. Gibson also created the original [http://www.timi.org TIMI.org], website, the website of the TIMI Study Group.<br />
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===Traditional Textbooks===<br />
Dr. Gibson also edits a textbook entitled “Gibson's Treatment Strategies in Interventional Cardiology” which is optimized for hand held devices. In the past, Gibson has authored the chapter on Primary Angioplasty in Randomized Trials in Cardiovascular Disease published as a companion to Braunwald's Heart Disease. In the past he has co-authored the chapter “Recognition and Management of Patients with Stable Angina Pectoris" in Braunwald and Goldman’s Primary Cardiology. He has served as lead author of the section on myocardial perfusion imaging in an imaging textbook which is a companion to Braunwald’s Heart Disease. Gibson has authored the chapter “Profiles in Coronary Artery Disease” in the fifth and sixth editions of Grossman and Baim’s Textbook of Interventional Cardiology.<br />
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===American Heart Association===<br />
Gibson has served as a member of the Professional Education Committee of the American Heart Association.<br />
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==Physician==<br />
Gibson is a practicing interventional cardiologist. He has served as a cath lab director. In 2009 and 2010, Dr. Gibson was chosen by his peers as one of Boston's Top Doctors in Boston Magazine.<br />
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In 2010, Dr. Gibson was selected as one of America's Top Doctors by Castle Connolly Medical Ltd. In the same year, he was also selected to be included in the Consumers' Research Council of America’s Guide to America’s Top Cardiologists.<br />
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In 2011, Dr. Gibson was featured as one of Boston's Super doctors on my.superdoctors.com. In the same year, he was also selected to be included in the Consumers' Research Council of America’s Guide to America’s Top Cardiologists.<br />
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In 2011 U.S. News & World Report listed Dr. Gibson as one of America's Top Doctors as selected by Castle Connolly Medical Ltd. [http://health.usnews.com/top-doctors/c-michael-gibson-interventional-cardiologist-22CC000361 health.usnews.com]<br />
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==Awards==<br />
[[Image:C-Michael-Gibson-award.jpg|right]]<br />
[[Image:C Michael Gibson Distinguished fellow.jpg|right]]<br />
Dr. Gibson graduated from college Phi Beta Kappa, and from medical school Alpha Omega Alpha, both from the University of Chicago. In 1993 he was selected as the Julian and Eunice Cohen Scholar in Medicine at the Brigham and Women's Hospital. <br />
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In conjunction with delivering the opening plenary lecture at the 10th annual Great Wall of China Symposium in 2003, Gibson was awarded the Gold Medal by the Institute of Geriatric Cardiology, Chinese Peoples Liberation Army General Hospital, Beijing China for his achievements in cardiovascular science. <br />
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In 2005, the John Paul II Hospital in Krakow, Poland awarded Gibson the Pro Bono Curantium Gold Medal for Merit, and a research laboratory was named there in his honor. He was the 4th such awardee, the others being Pope John Paul II and Dr. Valentine Fuster. In that same year, Gibson was awarded the Medal of the Jagiellonian University for his outstanding achievements in education and research in cardiovascular science. <br />
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In 2009, the Cardiovascular Division of Istanbul University, Turkey, established the C. Michael Gibson Research and Education Center. In that same year, the Turkish Cardiac Society honored Gibson for establishing WikiDoc on, September 27th, World Heart Day.<br />
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In 2007 and 2009, Dr. Gibson was selected by Who's Who as the Clinical Researcher of the Year. <br />
<br />
In 2009 and 2010, Dr. Gibson was chosen by his peers as one of Boston's Top Doctors in Boston Magazine.<br />
<br />
In 2010, Dr. Gibson was selected as one of America's Top Doctors by Castle Connolly Medical Ltd. In the same year, he was also selected to be included in the Consumers' Research Council of America’s Guide to America’s Top Cardiologists.<br />
<br />
In 2011, Dr. Gibson was featured as one of Boston's Super doctors on my.superdoctors.com. In the same year, he was also selected to be included in the Consumers' Research Council of America’s Guide to America’s Top Cardiologists.<br />
<br />
In 2011 U.S. News & World Report listed Dr. Gibson as one of America's Top Doctors as selected by Castle Connolly Medical Ltd. [http://health.usnews.com/top-doctors/c-michael-gibson-interventional-cardiologist-22CC000361 health.usnews.com]<br />
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In 2012 Gibson was appointed a Distinguished Fellow of New Westminster College, which is the highest honour that New Westminster College bestows upon senior leaders to recognize their distinguished record of ethical leadership. Other Distinguished Fellows include world leaders, cabinet ministers, 12 ambassadors, an astronaut, 27 generals and admirals, surgeons and medical doctors.<br />
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==Disclosures:==<br />
<br />
<br />
''Executive Position (with $0.00 monies received by Dr. Gibson)''<br />
<br />
Chief Executive Office, Baim Institute for Clinical Research<br />
<br />
<br />
''Present Research/Grant Funding (within the last year)''<br />
<br />
Angel Medical Corporation;<br />
Bayer Corp.;<br />
CSL Behring;<br />
Janssen Pharmaceuticals;<br />
Johnson & Johnson Corporation;<br />
Portola Pharmaceuticals (ceased with BIDMC on 12/31/2017)<br />
<br />
<br />
''Consulting''<br />
<br />
Amarin Pharama;<br />
Amgen;<br />
Arena Pharmaceuticals; <br />
Bayer Corporation;<br />
Boehringer Ingelheim;<br />
Boston Clinical Research Institute;<br />
Cardiovascular Research Foundation;<br />
Chiesi;<br />
CSL Behring;<br />
Eli Lilly;<br />
Gilead Sciences, Inc.; <br />
Impact Bio LTD;<br />
Janssen Pharmaceuticals;<br />
Johnson & Johnson Corporation;<br />
The Medicines Company;<br />
MedImmune;<br />
Medtelligence;<br />
Merck & Co, Inc.;<br />
Novo Nordisk;<br />
Pfizer;<br />
Pharma Mar;<br />
Portola Pharmaceuticals (began 1/1/2018);<br />
Sanofi;<br />
Somahlution;<br />
St. Francis Hospital;<br />
Verseon Corportation;<br />
Web MD<br />
<br />
<br />
''Royalties as a Contributor''<br />
<br />
UpToDate in Cardiovascular Medicine<br />
<br />
==Twitter disclaimer for C. Michael Gibson==<br />
@CMichaelGibson is largely a news service citing articles in the news media related to healthcare. A retweet does not constitute an endorsement. RTs which link to other websites are provided as a service to followers, but linking to the sites does not constitute endorsement of those sites by @CMichaelGibson, and @CMichaelGibson is not responsible for the content of external websites. Please note that other users of Twitter may utilize your tweets beyond the control of @CMichaelGibson. Tweets are educational and do not represent medical advice, see your doctor or healthcare provider. Tweets are educational only and are not meant to promote an unapproved or off label use of a medical drug or device. #cmgsays says quotes may have been said by others as well as anonymous individuals.<br />
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Key words, synonyms: CM Gibson, M Gibson, C Gibson, C.M. Gibson, M. Gibson, C. Gibson, Dr. C.M. Gibson, Dr. M. Gibson, Charles Michael Gibson, Charles M. Gibson, Gibson CM, Gibson CM M.D., C. Michael Gibson M.S. M.D., Mike Gibson, Dr. Mike Gibson, Mike Gibson M.D., Dr. C. Michael Gibson, Dr. CM Gibson, Dr. Gibson, Doctor Gibson <br />
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[[Category:Cardiologists]]</div>C Michael Gibsonhttps://www.wikidoc.org/index.php?title=Go_radial&diff=1313938Go radial2017-05-30T16:50:03Z<p>C Michael Gibson: ←Redirected page to Radial artery catheterization</p>
<hr />
<div>#redirect:[[Radial artery catheterization]]</div>C Michael Gibsonhttps://www.wikidoc.org/index.php?title=Left_radial&diff=1313936Left radial2017-05-30T16:49:08Z<p>C Michael Gibson: ←Redirected page to Radial artery catheterization</p>
<hr />
<div>#redirect:[[Radial artery catheterization]]</div>C Michael Gibsonhttps://www.wikidoc.org/index.php?title=Right_radial&diff=1313934Right radial2017-05-30T16:48:30Z<p>C Michael Gibson: ←Redirected page to Radial artery catheterization</p>
<hr />
<div>#redirect:[[Radial artery catheterization]]</div>C Michael Gibsonhttps://www.wikidoc.org/index.php?title=Radial_approach&diff=1313933Radial approach2017-05-30T16:47:41Z<p>C Michael Gibson: ←Redirected page to Radial artery catheterization</p>
<hr />
<div>#redirect:[[Radial artery catheterization]]</div>C Michael Gibsonhttps://www.wikidoc.org/index.php?title=Radial_first&diff=1313931Radial first2017-05-30T16:46:47Z<p>C Michael Gibson: ←Redirected page to Radial artery catheterization</p>
<hr />
<div>#redirect:[[Radial artery catheterization]]</div>C Michael Gibsonhttps://www.wikidoc.org/index.php?title=Radial_artery_catheterization&diff=1313930Radial artery catheterization2017-05-30T16:46:09Z<p>C Michael Gibson: synonyms and keywords</p>
<hr />
<div>__NOTOC__<br />
{{Radial artery catheterization}}<br />
{{SI}}<br />
{{CMG}}; '''Associate Editor-In-Chief:''' [[Varun Kumar]], M.B.B.S.; [[Lakshmi Gopalakrishnan]], M.B.B.S.; {{AO}}<br />
<br />
Synonyms and Keywords: Radial first, Radialfirst, #radialfirst, radial approach, right radial, left radial, go radial<br />
<br />
==[[Radial artery cathetarization overview|Overview]]==<br />
<br />
==[[Radial artery|Radial Artery Anatomy]]==<br />
<br />
==[[Radial Catheterization Advantages|Advantages]]==<br />
<br />
==[[Radial catheterization pitfalls|Potential Pitfalls]]==<br />
<br />
==[[Radial catheterization contraindication|Contraindications]]==<br />
<br />
==[[Radial catheterization allen's test|Pre-procedure Assessment]]==<br />
<br />
==[[Radial catheterization procedure|Procedure]]==<br />
<br />
==[[Radial catheterization hemostasis|Achieving Hemostasis after Radial Artery Catheterization]]==<br />
<br />
==[[Radial catheterization complications|Complications]]==<br />
<br />
==[[Best practices for transradial angiography and intervention|Best Practices for Transradial Angiography]]==<br />
<br />
{{Coronary Angiography}}<br />
<br />
[[Category:Angiopedia]]<br />
<br />
{{WikiDoc Help Menu}}<br />
{{WikiDoc Sources}}</div>C Michael Gibsonhttps://www.wikidoc.org/index.php?title=Radialfirst&diff=1313929Radialfirst2017-05-30T16:44:33Z<p>C Michael Gibson: link</p>
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<div>#redirect:[[Radial artery catheterization]]</div>C Michael Gibsonhttps://www.wikidoc.org/index.php?title=Radialfirst&diff=1313928Radialfirst2017-05-30T16:43:18Z<p>C Michael Gibson: Created page with "#redirect:Radial artery catheterization"</p>
<hr />
<div>#redirect:Radial artery catheterization</div>C Michael Gibsonhttps://www.wikidoc.org/index.php?title=Low_pressure_AS&diff=1288017Low pressure AS2017-01-31T15:00:19Z<p>C Michael Gibson: ←Redirected page to Low flow, low gradient aortic stenosis</p>
<hr />
<div>#redirect:[[Low flow, low gradient aortic stenosis]]</div>C Michael Gibsonhttps://www.wikidoc.org/index.php?title=Gallstone_disease_historical_perspective&diff=1233904Gallstone disease historical perspective2016-06-01T20:44:38Z<p>C Michael Gibson: </p>
<hr />
<div>__NOTOC__<br />
{{Gallstone disease}}<br />
{{CMG}}<br />
<br />
== Historical Perspective ==<br />
<br />
<br />
==References==<br />
{{Reflist|2}}<br />
<br />
[[Category:Gastroenterology]]<br />
[[Category:Hepatology]]<br />
[[Category:Surgery]]<br />
[[Category:Abdominal pain]]<br />
[[Category:Disease]]<br />
[[Category:Primary care]]<br />
[[Category:Needs overview]]<br />
<br />
{{WH}}<br />
{{WS}}</div>C Michael Gibsonhttps://www.wikidoc.org/index.php?title=Peridontal_disease&diff=1233721Peridontal disease2016-06-01T15:57:08Z<p>C Michael Gibson: Created page with "__NOTOC__ {{CMG}} ==Overview== Many adults in the U.S. currently have some form of the disease. Periodontal diseases range from simple gum inflammation to serious disease th..."</p>
<hr />
<div>__NOTOC__<br />
<br />
{{CMG}}<br />
<br />
==Overview==<br />
Many adults in the U.S. currently have some form of the disease. Periodontal diseases range from simple gum inflammation to serious disease that results in major damage to the soft tissue and bone that support the teeth. In the worst cases, teeth are lost. Whether your gum disease is stopped, slowed, or gets worse depends a great deal on how well you care for your teeth and gums every day, from this point forward.<br />
<br />
==Causes==<br />
Our mouths are full of bacteria. These bacteria, along with mucus and other particles, constantly form a sticky, colorless “plaque” on teeth. Brushing and flossing help get rid of plaque. Plaque that is not removed can harden and form “tartar” that brushing doesn’t clean. Only a professional cleaning by a dentist or dental hygienist can remove tartar.<br />
<br />
==Pathophysiology==<br />
===Gingivitis?===<br />
The longer plaque and tartar are on teeth, the more harmful they become. The bacteria cause inflammation of the gums that is called “gingivitis.” In gingivitis, the gums become red, swollen and can bleed easily. Gingivitis is a mild form of gum disease that can usually be reversed with daily brushing and flossing, and regular cleaning by a dentist or dental hygienist. This form of gum disease does not include any loss of bone and tissue that hold teeth in place.<br />
<br />
===Periodontitis===<br />
When gingivitis is not treated, it can advance to “periodontitis” (which means “inflammation around the tooth”). In periodontitis, gums pull away from the teeth and form spaces (called “pockets”) that become infected. The body’s immune system fights the bacteria as the plaque spreads and grows below the gum line. Bacterial toxins and the body’s natural response to infection start to break down the bone and connective tissue that hold teeth in place. If not treated, the bones, gums, and tissue that support the teeth are destroyed. The teeth may eventually become loose and have to be removed.<br />
<br />
==Risk Factors==<br />
* Smoking. Need another reason to quit smoking? Smoking is one of the most significant risk factors associated with the development of gum disease. Additionally, smoking can lower the chances for successful treatment.<br />
* Hormonal changes in girls/women. These changes can make gums more sensitive and make it easier for gingivitis to develop.<br />
* Diabetes. People with diabetes are at higher risk for developing infections, including gum disease.<br />
* Other illnesses and their treatments. Diseases such as [[AIDS]] and its treatments can also negatively affect the health of gums, as can treatments for cancer.<br />
* Medications. There are hundreds of prescription and over the counter medications that can reduce the flow of saliva, which has a protective effect on the mouth. Without enough saliva, the mouth is vulnerable to infections such as gum disease. And some medicines can cause abnormal overgrowth of the gum tissue; this can make it difficult to keep teeth and gums clean.<br />
* Genetic susceptibility. Some people are more prone to severe gum disease than others.<br />
<br />
==Epidemiology and Demographics==<br />
People usually don’t show signs of gum disease until they are in their 30s or 40s. Men are more likely to have gum disease than women. Although teenagers rarely develop periodontitis, they can develop gingivitis, the milder form of gum disease. Most commonly, gum disease develops when plaque is allowed to build up along and under the gum line.<br />
<br />
==Natural History, Complications, Prognosis==<br />
There may be other reasons people with gum disease sometimes develop additional health problems. For example, something else may be causing both the gum disease and the other condition, or it could be a coincidence that gum disease and other health problems are present together.<br />
<br />
In some studies, researchers have observed that people with gum disease (when compared to people without gum disease) were more likely to develop heart disease or have difficulty controlling blood sugar. Other studies showed that women with gum disease were more likely than those with healthy gums to deliver preterm, low birth weight babies. But so far, it has not been determined whether gum disease is the cause of these conditions.<br />
<br />
More research is needed to clarify whether gum disease actually causes health problems beyond the mouth, and whether treating gum disease can keep other health conditions from developing.<br />
<br />
==Symptoms==<br />
* [[Bad breath]] that won’t go away<br />
* Red or swollen gums<br />
* Tender or bleeding gums<br />
* Painful chewing<br />
* Loose teeth<br />
* Sensitive teeth<br />
* Receding gums or longer appearing teeth<br />
<br />
==Physical Examination==<br />
* Examine the gums and note any signs of inflammation.<br />
* Use a tiny ruler called a “probe” to check for and measure any pockets. In a healthy mouth, the depth of these pockets is usually between 1 and 3 millimeters. This test for pocket depth is usually painless.<br />
<br />
==Diagnostic Studies==<br />
The dentist or hygienist may take an x-ray to see whether there is any bone loss.<br />
<br />
==Treatment==<br />
You may be referred to a periodontist. Periodontists are experts in the diagnosis and treatment of gum disease and may provide you with treatment options that are not offered by your dentist. The main goal of treatment is to control the infection. The number and types of treatment will vary, depending on the extent of the gum disease. Any type of treatment requires that the patient keep up good daily care at home. The doctor may also suggest changing certain behaviors, such as quitting smoking, as a way to improve treatment outcome.<br />
<br />
===Deep Cleaning: Scaling and Root Planing===<br />
The dentist, periodontist, or dental hygienist removes the plaque through a deep-cleaning method called scaling and root planing. Scaling means scraping off the tartar from above and below the gum line. Root planing gets rid of rough spots on the tooth root where the germs gather, and helps remove bacteria that contribute to the disease. In some cases a laser may be used to remove plaque and tartar. This procedure can result in less bleeding, swelling, and discomfort compared to traditional deep cleaning methods.<br />
<br />
===Medications===<br />
Medications may be used with treatment that includes scaling and root planning, but they cannot always take the place of surgery. Depending on how far the disease has progressed, the dentist or periodontist may still suggest surgical treatment. Long-term studies are needed to find out if using medications reduces the need for surgery and whether they are effective over a long period of time. Listed on the next page are some medications that are currently used.<br />
<br />
====Prescription antimicrobial mouthrinse====<br />
*A prescription mouthrinse containing an antimicrobial called chlorhexidine<br />
*It is used to control bacteria when treating gingivitis and after gum surgery<br />
*It's used like a regular mouthwash<br />
<br />
====Antiseptic chip====<br />
*A tiny piece of gelatin filled with the medicine [[chlorhexidine]] <br />
*This medicine controls bacteria and reduce the size of periodontal pockets<br />
*After root planing, it's placed in the pockets where the medicine is slowly released over time<br />
<br />
====Antibiotic gel====<br />
*A gel that contains the antibiotic [[doxycycline]]<br />
*It is used to control bacteria and reduce the size of periodontal pockets<br />
*The periodontist puts it in the pockets after scaling and root planing<br />
*The antibiotic is released slowly over a period of about seven days<br />
<br />
====Antibiotic microspheres====<br />
*Tiny, round particles that contain the antibiotic [[minocycline]]<br />
*It is used to control bacteria and reduce the size of periodontal pockets<br />
*The periodontist puts the microspheres into the pockets after scaling and root planing. The particles release [[minocycline]]<br />
slowly over time.<br />
<br />
====Enzyme suppressant====<br />
* A low dose of the medication doxycycline that keeps destructive enzymes in check <br />
* This medicine is used to hold back the body's enzyme response -- If not controlled, certain enzymes can break down gum tissue <br />
* This medication is in tablet form. It is used in combination with scaling and root planing.<br />
<br />
====Oral antibiotics====<br />
* Antibiotic tablets or capsules<br />
* For short term treatment of an acute or locally persistent periodontal infection <br />
* These come as tablets or capsules and are taken by mouth<br />
<br />
===Surgery===<br />
<br />
====Flap Surgery====<br />
Surgery might be necessary if inflammation and deep pockets remain following treatment with deep cleaning and medications. A dentist or periodontist may perform flap surgery to remove tartar deposits in deep pockets or to reduce the periodontal pocket and make it easier for the patient, dentist, and hygienist to keep the area clean. This common surgery involves lifting back the gums and removing the tartar. The gums are then sutured back in place so that the tissue fits snugly around the tooth again. After surgery the gums will heal and fit more tightly around the tooth. This sometimes results in the teeth appearing longer.<br />
<br />
====Bone and Tissue Grafts====<br />
In addition to flap surgery, your periodontist or dentist may suggest procedures to help regenerate any bone or gum tissue lost to periodontitis. Bone grafting, in which natural or synthetic bone is placed in the area of bone loss, can help promote bone growth. A technique that can be used with bone grafting is called guided tissue regeneration. In this procedure, a small piece of mesh-like material is inserted between the bone and gum tissue. This keeps the gum tissue from growing into the area where the bone should be, allowing the bone and connective tissue to regrow. Growth factors – proteins that can help your body naturally regrow bone – may also be used. In cases where gum tissue has been lost, your dentist or periodontist may suggest a soft tissue graft, in which synthetic material or tissue taken from another area of your mouth is used to cover exposed tooth roots.<br />
<br />
==Prevention==<br />
* Brush your teeth twice a day (with a fluoride toothpaste).<br />
* Floss regularly to remove plaque from between teeth. <br />
* Use a device such as a special brush or wooden or plastic pick recommended by a dental professional.<br />
* Visit the dentist routinely for a check-up and professional cleaning.<br />
* Don’t smoke<br />
<br />
==References==<br />
{{Reflist|2}}</div>C Michael Gibsonhttps://www.wikidoc.org/index.php?title=Peridontal_disease_(patient_information)&diff=1233719Peridontal disease (patient information)2016-06-01T15:55:51Z<p>C Michael Gibson: /* Natural History */</p>
<hr />
<div>__NOTOC__<br />
<br />
{{CMG}}<br />
<br />
==Overview==<br />
Many adults in the U.S. currently have some form of the disease. Periodontal diseases range from simple gum inflammation to serious disease that results in major damage to the soft tissue and bone that support the teeth. In the worst cases, teeth are lost. Whether your gum disease is stopped, slowed, or gets worse depends a great deal on how well you care for your teeth and gums every day, from this point forward.<br />
<br />
==Causes==<br />
Our mouths are full of bacteria. These bacteria, along with mucus and other particles, constantly form a sticky, colorless “plaque” on teeth. Brushing and flossing help get rid of plaque. Plaque that is not removed can harden and form “tartar” that brushing doesn’t clean. Only a professional cleaning by a dentist or dental hygienist can remove tartar.<br />
<br />
==Pathophysiology==<br />
===Gingivitis?===<br />
The longer plaque and tartar are on teeth, the more harmful they become. The bacteria cause inflammation of the gums that is called “gingivitis.” In gingivitis, the gums become red, swollen and can bleed easily. Gingivitis is a mild form of gum disease that can usually be reversed with daily brushing and flossing, and regular cleaning by a dentist or dental hygienist. This form of gum disease does not include any loss of bone and tissue that hold teeth in place.<br />
<br />
===Periodontitis===<br />
When gingivitis is not treated, it can advance to “periodontitis” (which means “inflammation around the tooth”). In periodontitis, gums pull away from the teeth and form spaces (called “pockets”) that become infected. The body’s immune system fights the bacteria as the plaque spreads and grows below the gum line. Bacterial toxins and the body’s natural response to infection start to break down the bone and connective tissue that hold teeth in place. If not treated, the bones, gums, and tissue that support the teeth are destroyed. The teeth may eventually become loose and have to be removed.<br />
<br />
==Risk Factors==<br />
* Smoking. Need another reason to quit smoking? Smoking is one of the most significant risk factors associated with the development of gum disease. Additionally, smoking can lower the chances for successful treatment.<br />
* Hormonal changes in girls/women. These changes can make gums more sensitive and make it easier for gingivitis to develop.<br />
* Diabetes. People with diabetes are at higher risk for developing infections, including gum disease.<br />
* Other illnesses and their treatments. Diseases such as [[AIDS]] and its treatments can also negatively affect the health of gums, as can treatments for cancer.<br />
* Medications. There are hundreds of prescription and over the counter medications that can reduce the flow of saliva, which has a protective effect on the mouth. Without enough saliva, the mouth is vulnerable to infections such as gum disease. And some medicines can cause abnormal overgrowth of the gum tissue; this can make it difficult to keep teeth and gums clean.<br />
* Genetic susceptibility. Some people are more prone to severe gum disease than others.<br />
<br />
==Epidemiology and Demographics==<br />
People usually don’t show signs of gum disease until they are in their 30s or 40s. Men are more likely to have gum disease than women. Although teenagers rarely develop periodontitis, they can develop gingivitis, the milder form of gum disease. Most commonly, gum disease develops when plaque is allowed to build up along and under the gum line.<br />
<br />
==Natural History, Complications, Prognosis==<br />
There may be other reasons people with gum disease sometimes develop additional health problems. For example, something else may be causing both the gum disease and the other condition, or it could be a coincidence that gum disease and other health problems are present together.<br />
<br />
In some studies, researchers have observed that people with gum disease (when compared to people without gum disease) were more likely to develop heart disease or have difficulty controlling blood sugar. Other studies showed that women with gum disease were more likely than those with healthy gums to deliver preterm, low birth weight babies. But so far, it has not been determined whether gum disease is the cause of these conditions.<br />
<br />
More research is needed to clarify whether gum disease actually causes health problems beyond the mouth, and whether treating gum disease can keep other health conditions from developing.<br />
<br />
==Symptoms==<br />
* [[Bad breath]] that won’t go away<br />
* Red or swollen gums<br />
* Tender or bleeding gums<br />
* Painful chewing<br />
* Loose teeth<br />
* Sensitive teeth<br />
* Receding gums or longer appearing teeth<br />
<br />
==Physical Examination==<br />
* Examine the gums and note any signs of inflammation.<br />
* Use a tiny ruler called a “probe” to check for and measure any pockets. In a healthy mouth, the depth of these pockets is usually between 1 and 3 millimeters. This test for pocket depth is usually painless.<br />
<br />
==Diagnostic Studies==<br />
The dentist or hygienist may take an x-ray to see whether there is any bone loss.<br />
<br />
==Treatment==<br />
You may be referred to a periodontist. Periodontists are experts in the diagnosis and treatment of gum disease and may provide you with treatment options that are not offered by your dentist. The main goal of treatment is to control the infection. The number and types of treatment will vary, depending on the extent of the gum disease. Any type of treatment requires that the patient keep up good daily care at home. The doctor may also suggest changing certain behaviors, such as quitting smoking, as a way to improve treatment outcome.<br />
<br />
===Deep Cleaning: Scaling and Root Planing===<br />
The dentist, periodontist, or dental hygienist removes the plaque through a deep-cleaning method called scaling and root planing. Scaling means scraping off the tartar from above and below the gum line. Root planing gets rid of rough spots on the tooth root where the germs gather, and helps remove bacteria that contribute to the disease. In some cases a laser may be used to remove plaque and tartar. This procedure can result in less bleeding, swelling, and discomfort compared to traditional deep cleaning methods.<br />
<br />
===Medications===<br />
Medications may be used with treatment that includes scaling and root planning, but they cannot always take the place of surgery. Depending on how far the disease has progressed, the dentist or periodontist may still suggest surgical treatment. Long-term studies are needed to find out if using medications reduces the need for surgery and whether they are effective over a long period of time. Listed on the next page are some medications that are currently used.<br />
<br />
====Prescription antimicrobial mouthrinse====<br />
*A prescription mouthrinse containing an antimicrobial called chlorhexidine<br />
*It is used to control bacteria when treating gingivitis and after gum surgery<br />
*It's used like a regular mouthwash<br />
<br />
====Antiseptic chip====<br />
*A tiny piece of gelatin filled with the medicine [[chlorhexidine]] <br />
*This medicine controls bacteria and reduce the size of periodontal pockets<br />
*After root planing, it's placed in the pockets where the medicine is slowly released over time<br />
<br />
====Antibiotic gel====<br />
*A gel that contains the antibiotic [[doxycycline]]<br />
*It is used to control bacteria and reduce the size of periodontal pockets<br />
*The periodontist puts it in the pockets after scaling and root planing<br />
*The antibiotic is released slowly over a period of about seven days<br />
<br />
====Antibiotic microspheres====<br />
*Tiny, round particles that contain the antibiotic [[minocycline]]<br />
*It is used to control bacteria and reduce the size of periodontal pockets<br />
*The periodontist puts the microspheres into the pockets after scaling and root planing. The particles release [[minocycline]]<br />
slowly over time.<br />
<br />
====Enzyme suppressant====<br />
* A low dose of the medication doxycycline that keeps destructive enzymes in check <br />
* This medicine is used to hold back the body's enzyme response -- If not controlled, certain enzymes can break down gum tissue <br />
* This medication is in tablet form. It is used in combination with scaling and root planing.<br />
<br />
====Oral antibiotics====<br />
* Antibiotic tablets or capsules<br />
* For short term treatment of an acute or locally persistent periodontal infection <br />
* These come as tablets or capsules and are taken by mouth<br />
<br />
===Surgery===<br />
<br />
====Flap Surgery====<br />
Surgery might be necessary if inflammation and deep pockets remain following treatment with deep cleaning and medications. A dentist or periodontist may perform flap surgery to remove tartar deposits in deep pockets or to reduce the periodontal pocket and make it easier for the patient, dentist, and hygienist to keep the area clean. This common surgery involves lifting back the gums and removing the tartar. The gums are then sutured back in place so that the tissue fits snugly around the tooth again. After surgery the gums will heal and fit more tightly around the tooth. This sometimes results in the teeth appearing longer.<br />
<br />
====Bone and Tissue Grafts====<br />
In addition to flap surgery, your periodontist or dentist may suggest procedures to help regenerate any bone or gum tissue lost to periodontitis. Bone grafting, in which natural or synthetic bone is placed in the area of bone loss, can help promote bone growth. A technique that can be used with bone grafting is called guided tissue regeneration. In this procedure, a small piece of mesh-like material is inserted between the bone and gum tissue. This keeps the gum tissue from growing into the area where the bone should be, allowing the bone and connective tissue to regrow. Growth factors – proteins that can help your body naturally regrow bone – may also be used. In cases where gum tissue has been lost, your dentist or periodontist may suggest a soft tissue graft, in which synthetic material or tissue taken from another area of your mouth is used to cover exposed tooth roots.<br />
<br />
==Prevention==<br />
* Brush your teeth twice a day (with a fluoride toothpaste).<br />
* Floss regularly to remove plaque from between teeth. <br />
* Use a device such as a special brush or wooden or plastic pick recommended by a dental professional.<br />
* Visit the dentist routinely for a check-up and professional cleaning.<br />
* Don’t smoke</div>C Michael Gibsonhttps://www.wikidoc.org/index.php?title=Peridontal_disease_(patient_information)&diff=1233713Peridontal disease (patient information)2016-06-01T15:52:16Z<p>C Michael Gibson: /* Treatment */</p>
<hr />
<div>__NOTOC__<br />
<br />
{{CMG}}<br />
<br />
==Overview==<br />
Many adults in the U.S. currently have some form of the disease. Periodontal diseases range from simple gum inflammation to serious disease that results in major damage to the soft tissue and bone that support the teeth. In the worst cases, teeth are lost. Whether your gum disease is stopped, slowed, or gets worse depends a great deal on how well you care for your teeth and gums every day, from this point forward.<br />
<br />
==Causes==<br />
Our mouths are full of bacteria. These bacteria, along with mucus and other particles, constantly form a sticky, colorless “plaque” on teeth. Brushing and flossing help get rid of plaque. Plaque that is not removed can harden and form “tartar” that brushing doesn’t clean. Only a professional cleaning by a dentist or dental hygienist can remove tartar.<br />
<br />
==Natural History==<br />
===Gingivitis?===<br />
The longer plaque and tartar are on teeth, the more harmful they become. The bacteria cause inflammation of the gums that is called “gingivitis.” In gingivitis, the gums become red, swollen and can bleed easily. Gingivitis is a mild form of gum disease that can usually be reversed with daily brushing and flossing, and regular cleaning by a dentist or dental hygienist. This form of gum disease does not include any loss of bone and tissue that hold teeth in place.<br />
<br />
===Periodontitis===<br />
When gingivitis is not treated, it can advance to “periodontitis” (which means “inflammation around the tooth”). In periodontitis, gums pull away from the teeth and form spaces (called “pockets”) that become infected. The body’s immune system fights the bacteria as the plaque spreads and grows below the gum line. Bacterial toxins and the body’s natural response to infection start to break down the bone and connective tissue that hold teeth in place. If not treated, the bones, gums, and tissue that support the teeth are destroyed. The teeth may eventually become loose and have to be removed.<br />
<br />
==Risk Factors==<br />
* Smoking. Need another reason to quit smoking? Smoking is one of the most significant risk factors associated with the development of gum disease. Additionally, smoking can lower the chances for successful treatment.<br />
* Hormonal changes in girls/women. These changes can make gums more sensitive and make it easier for gingivitis to develop.<br />
* Diabetes. People with diabetes are at higher risk for developing infections, including gum disease.<br />
* Other illnesses and their treatments. Diseases such as [[AIDS]] and its treatments can also negatively affect the health of gums, as can treatments for cancer.<br />
* Medications. There are hundreds of prescription and over the counter medications that can reduce the flow of saliva, which has a protective effect on the mouth. Without enough saliva, the mouth is vulnerable to infections such as gum disease. And some medicines can cause abnormal overgrowth of the gum tissue; this can make it difficult to keep teeth and gums clean.<br />
* Genetic susceptibility. Some people are more prone to severe gum disease than others.<br />
<br />
==Epidemiology and Demographics==<br />
People usually don’t show signs of gum disease until they are in their 30s or 40s. Men are more likely to have gum disease than women. Although teenagers rarely develop periodontitis, they can develop gingivitis, the milder form of gum disease. Most commonly, gum disease develops when plaque is allowed to build up along and under the gum line.<br />
<br />
==Natural History, Complications, Prognosis==<br />
There may be other reasons people with gum disease sometimes develop additional health problems. For example, something else may be causing both the gum disease and the other condition, or it could be a coincidence that gum disease and other health problems are present together.<br />
<br />
In some studies, researchers have observed that people with gum disease (when compared to people without gum disease) were more likely to develop heart disease or have difficulty controlling blood sugar. Other studies showed that women with gum disease were more likely than those with healthy gums to deliver preterm, low birth weight babies. But so far, it has not been determined whether gum disease is the cause of these conditions.<br />
<br />
More research is needed to clarify whether gum disease actually causes health problems beyond the mouth, and whether treating gum disease can keep other health conditions from developing.<br />
<br />
==Symptoms==<br />
* [[Bad breath]] that won’t go away<br />
* Red or swollen gums<br />
* Tender or bleeding gums<br />
* Painful chewing<br />
* Loose teeth<br />
* Sensitive teeth<br />
* Receding gums or longer appearing teeth<br />
<br />
==Physical Examination==<br />
* Examine the gums and note any signs of inflammation.<br />
* Use a tiny ruler called a “probe” to check for and measure any pockets. In a healthy mouth, the depth of these pockets is usually between 1 and 3 millimeters. This test for pocket depth is usually painless.<br />
<br />
==Diagnostic Studies==<br />
The dentist or hygienist may take an x-ray to see whether there is any bone loss.<br />
<br />
==Treatment==<br />
You may be referred to a periodontist. Periodontists are experts in the diagnosis and treatment of gum disease and may provide you with treatment options that are not offered by your dentist. The main goal of treatment is to control the infection. The number and types of treatment will vary, depending on the extent of the gum disease. Any type of treatment requires that the patient keep up good daily care at home. The doctor may also suggest changing certain behaviors, such as quitting smoking, as a way to improve treatment outcome.<br />
<br />
===Deep Cleaning: Scaling and Root Planing===<br />
The dentist, periodontist, or dental hygienist removes the plaque through a deep-cleaning method called scaling and root planing. Scaling means scraping off the tartar from above and below the gum line. Root planing gets rid of rough spots on the tooth root where the germs gather, and helps remove bacteria that contribute to the disease. In some cases a laser may be used to remove plaque and tartar. This procedure can result in less bleeding, swelling, and discomfort compared to traditional deep cleaning methods.<br />
<br />
===Medications===<br />
Medications may be used with treatment that includes scaling and root planning, but they cannot always take the place of surgery. Depending on how far the disease has progressed, the dentist or periodontist may still suggest surgical treatment. Long-term studies are needed to find out if using medications reduces the need for surgery and whether they are effective over a long period of time. Listed on the next page are some medications that are currently used.<br />
<br />
====Prescription antimicrobial mouthrinse====<br />
*A prescription mouthrinse containing an antimicrobial called chlorhexidine<br />
*It is used to control bacteria when treating gingivitis and after gum surgery<br />
*It's used like a regular mouthwash<br />
<br />
====Antiseptic chip====<br />
*A tiny piece of gelatin filled with the medicine [[chlorhexidine]] <br />
*This medicine controls bacteria and reduce the size of periodontal pockets<br />
*After root planing, it's placed in the pockets where the medicine is slowly released over time<br />
<br />
====Antibiotic gel====<br />
*A gel that contains the antibiotic [[doxycycline]]<br />
*It is used to control bacteria and reduce the size of periodontal pockets<br />
*The periodontist puts it in the pockets after scaling and root planing<br />
*The antibiotic is released slowly over a period of about seven days<br />
<br />
====Antibiotic microspheres====<br />
*Tiny, round particles that contain the antibiotic [[minocycline]]<br />
*It is used to control bacteria and reduce the size of periodontal pockets<br />
*The periodontist puts the microspheres into the pockets after scaling and root planing. The particles release [[minocycline]]<br />
slowly over time.<br />
<br />
====Enzyme suppressant====<br />
* A low dose of the medication doxycycline that keeps destructive enzymes in check <br />
* This medicine is used to hold back the body's enzyme response -- If not controlled, certain enzymes can break down gum tissue <br />
* This medication is in tablet form. It is used in combination with scaling and root planing.<br />
<br />
====Oral antibiotics====<br />
* Antibiotic tablets or capsules<br />
* For short term treatment of an acute or locally persistent periodontal infection <br />
* These come as tablets or capsules and are taken by mouth<br />
<br />
===Surgery===<br />
<br />
====Flap Surgery====<br />
Surgery might be necessary if inflammation and deep pockets remain following treatment with deep cleaning and medications. A dentist or periodontist may perform flap surgery to remove tartar deposits in deep pockets or to reduce the periodontal pocket and make it easier for the patient, dentist, and hygienist to keep the area clean. This common surgery involves lifting back the gums and removing the tartar. The gums are then sutured back in place so that the tissue fits snugly around the tooth again. After surgery the gums will heal and fit more tightly around the tooth. This sometimes results in the teeth appearing longer.<br />
<br />
====Bone and Tissue Grafts====<br />
In addition to flap surgery, your periodontist or dentist may suggest procedures to help regenerate any bone or gum tissue lost to periodontitis. Bone grafting, in which natural or synthetic bone is placed in the area of bone loss, can help promote bone growth. A technique that can be used with bone grafting is called guided tissue regeneration. In this procedure, a small piece of mesh-like material is inserted between the bone and gum tissue. This keeps the gum tissue from growing into the area where the bone should be, allowing the bone and connective tissue to regrow. Growth factors – proteins that can help your body naturally regrow bone – may also be used. In cases where gum tissue has been lost, your dentist or periodontist may suggest a soft tissue graft, in which synthetic material or tissue taken from another area of your mouth is used to cover exposed tooth roots.<br />
<br />
==Prevention==<br />
* Brush your teeth twice a day (with a fluoride toothpaste).<br />
* Floss regularly to remove plaque from between teeth. <br />
* Use a device such as a special brush or wooden or plastic pick recommended by a dental professional.<br />
* Visit the dentist routinely for a check-up and professional cleaning.<br />
* Don’t smoke</div>C Michael Gibsonhttps://www.wikidoc.org/index.php?title=Peridontal_disease_(patient_information)&diff=1233711Peridontal disease (patient information)2016-06-01T15:51:12Z<p>C Michael Gibson: /* Enzyme suppressant */</p>
<hr />
<div>__NOTOC__<br />
<br />
{{CMG}}<br />
<br />
==Overview==<br />
Many adults in the U.S. currently have some form of the disease. Periodontal diseases range from simple gum inflammation to serious disease that results in major damage to the soft tissue and bone that support the teeth. In the worst cases, teeth are lost. Whether your gum disease is stopped, slowed, or gets worse depends a great deal on how well you care for your teeth and gums every day, from this point forward.<br />
<br />
==Causes==<br />
Our mouths are full of bacteria. These bacteria, along with mucus and other particles, constantly form a sticky, colorless “plaque” on teeth. Brushing and flossing help get rid of plaque. Plaque that is not removed can harden and form “tartar” that brushing doesn’t clean. Only a professional cleaning by a dentist or dental hygienist can remove tartar.<br />
<br />
==Natural History==<br />
===Gingivitis?===<br />
The longer plaque and tartar are on teeth, the more harmful they become. The bacteria cause inflammation of the gums that is called “gingivitis.” In gingivitis, the gums become red, swollen and can bleed easily. Gingivitis is a mild form of gum disease that can usually be reversed with daily brushing and flossing, and regular cleaning by a dentist or dental hygienist. This form of gum disease does not include any loss of bone and tissue that hold teeth in place.<br />
<br />
===Periodontitis===<br />
When gingivitis is not treated, it can advance to “periodontitis” (which means “inflammation around the tooth”). In periodontitis, gums pull away from the teeth and form spaces (called “pockets”) that become infected. The body’s immune system fights the bacteria as the plaque spreads and grows below the gum line. Bacterial toxins and the body’s natural response to infection start to break down the bone and connective tissue that hold teeth in place. If not treated, the bones, gums, and tissue that support the teeth are destroyed. The teeth may eventually become loose and have to be removed.<br />
<br />
==Risk Factors==<br />
* Smoking. Need another reason to quit smoking? Smoking is one of the most significant risk factors associated with the development of gum disease. Additionally, smoking can lower the chances for successful treatment.<br />
* Hormonal changes in girls/women. These changes can make gums more sensitive and make it easier for gingivitis to develop.<br />
* Diabetes. People with diabetes are at higher risk for developing infections, including gum disease.<br />
* Other illnesses and their treatments. Diseases such as [[AIDS]] and its treatments can also negatively affect the health of gums, as can treatments for cancer.<br />
* Medications. There are hundreds of prescription and over the counter medications that can reduce the flow of saliva, which has a protective effect on the mouth. Without enough saliva, the mouth is vulnerable to infections such as gum disease. And some medicines can cause abnormal overgrowth of the gum tissue; this can make it difficult to keep teeth and gums clean.<br />
* Genetic susceptibility. Some people are more prone to severe gum disease than others.<br />
<br />
==Epidemiology and Demographics==<br />
People usually don’t show signs of gum disease until they are in their 30s or 40s. Men are more likely to have gum disease than women. Although teenagers rarely develop periodontitis, they can develop gingivitis, the milder form of gum disease. Most commonly, gum disease develops when plaque is allowed to build up along and under the gum line.<br />
<br />
==Natural History, Complications, Prognosis==<br />
There may be other reasons people with gum disease sometimes develop additional health problems. For example, something else may be causing both the gum disease and the other condition, or it could be a coincidence that gum disease and other health problems are present together.<br />
<br />
In some studies, researchers have observed that people with gum disease (when compared to people without gum disease) were more likely to develop heart disease or have difficulty controlling blood sugar. Other studies showed that women with gum disease were more likely than those with healthy gums to deliver preterm, low birth weight babies. But so far, it has not been determined whether gum disease is the cause of these conditions.<br />
<br />
More research is needed to clarify whether gum disease actually causes health problems beyond the mouth, and whether treating gum disease can keep other health conditions from developing.<br />
<br />
==Symptoms==<br />
* [[Bad breath]] that won’t go away<br />
* Red or swollen gums<br />
* Tender or bleeding gums<br />
* Painful chewing<br />
* Loose teeth<br />
* Sensitive teeth<br />
* Receding gums or longer appearing teeth<br />
<br />
==Physical Examination==<br />
* Examine the gums and note any signs of inflammation.<br />
* Use a tiny ruler called a “probe” to check for and measure any pockets. In a healthy mouth, the depth of these pockets is usually between 1 and 3 millimeters. This test for pocket depth is usually painless.<br />
<br />
==Diagnostic Studies==<br />
The dentist or hygienist may take an x-ray to see whether there is any bone loss.<br />
<br />
==Treatment==<br />
You may be referred to a periodontist. Periodontists are experts in the diagnosis and treatment of gum disease and may provide you with treatment options that are not offered by your dentist.<br />
<br />
The main goal of treatment is to control the infection. The number and types of treatment will vary, depending on the extent of the gum disease. Any type of treatment requires that the patient keep up good daily care at home. The doctor may also suggest changing certain behaviors, such as quitting smoking, as a way to improve treatment outcome.<br />
Deep Cleaning (Scaling and Root Planing)<br />
<br />
===Scaling and Root Planing===<br />
The dentist, periodontist, or dental hygienist removes the plaque through a deep-cleaning method called scaling and root planing. Scaling means scraping off the tartar from above and below the gum line. Root planing gets rid of rough spots on the tooth root where the germs gather, and helps remove bacteria that contribute to the disease. In some cases a laser may be used to remove plaque and tartar. This procedure can result in less bleeding, swelling, and discomfort compared to traditional deep cleaning methods.<br />
<br />
===Medications===<br />
Medications may be used with treatment that includes scaling and root planning, but they cannot always take the place of surgery. Depending on how far the disease has progressed, the dentist or periodontist may still suggest surgical treatment. Long-term studies are needed to find out if using medications reduces the need for surgery and whether they are effective over a long period of time. Listed on the next page are some medications that are currently used.<br />
<br />
====Prescription antimicrobial mouthrinse====<br />
*A prescription mouthrinse containing an antimicrobial called chlorhexidine<br />
*It is used to control bacteria when treating gingivitis and after gum surgery<br />
*It's used like a regular mouthwash<br />
<br />
====Antiseptic chip====<br />
*A tiny piece of gelatin filled with the medicine [[chlorhexidine]] <br />
*This medicine controls bacteria and reduce the size of periodontal pockets<br />
*After root planing, it's placed in the pockets where the medicine is slowly released over time<br />
<br />
====Antibiotic gel====<br />
*A gel that contains the antibiotic [[doxycycline]]<br />
*It is used to control bacteria and reduce the size of periodontal pockets<br />
*The periodontist puts it in the pockets after scaling and root planing<br />
*The antibiotic is released slowly over a period of about seven days<br />
<br />
====Antibiotic microspheres====<br />
*Tiny, round particles that contain the antibiotic [[minocycline]]<br />
*It is used to control bacteria and reduce the size of periodontal pockets<br />
*The periodontist puts the microspheres into the pockets after scaling and root planing. The particles release [[minocycline]]<br />
slowly over time.<br />
<br />
====Enzyme suppressant====<br />
* A low dose of the medication doxycycline that keeps destructive enzymes in check <br />
* This medicine is used to hold back the body's enzyme response -- If not controlled, certain enzymes can break down gum tissue <br />
* This medication is in tablet form. It is used in combination with scaling and root planing.<br />
<br />
====Oral antibiotics====<br />
* Antibiotic tablets or capsules<br />
* For short term treatment of an acute or locally persistent periodontal infection <br />
* These come as tablets or capsules and are taken by mouth<br />
<br />
===Surgery===<br />
<br />
====Flap Surgery====<br />
Surgery might be necessary if inflammation and deep pockets remain following treatment with deep cleaning and medications. A dentist or periodontist may perform flap surgery to remove tartar deposits in deep pockets or to reduce the periodontal pocket and make it easier for the patient, dentist, and hygienist to keep the area clean. This common surgery involves lifting back the gums and removing the tartar. The gums are then sutured back in place so that the tissue fits snugly around the tooth again. After surgery the gums will heal and fit more tightly around the tooth. This sometimes results in the teeth appearing longer.<br />
<br />
====Bone and Tissue Grafts====<br />
In addition to flap surgery, your periodontist or dentist may suggest procedures to help regenerate any bone or gum tissue lost to periodontitis. Bone grafting, in which natural or synthetic bone is placed in the area of bone loss, can help promote bone growth. A technique that can be used with bone grafting is called guided tissue regeneration. In this procedure, a small piece of mesh-like material is inserted between the bone and gum tissue. This keeps the gum tissue from growing into the area where the bone should be, allowing the bone and connective tissue to regrow. Growth factors – proteins that can help your body naturally regrow bone – may also be used. In cases where gum tissue has been lost, your dentist or periodontist may suggest a soft tissue graft, in which synthetic material or tissue taken from another area of your mouth is used to cover exposed tooth roots.<br />
<br />
==Prevention==<br />
* Brush your teeth twice a day (with a fluoride toothpaste).<br />
* Floss regularly to remove plaque from between teeth. <br />
* Use a device such as a special brush or wooden or plastic pick recommended by a dental professional.<br />
* Visit the dentist routinely for a check-up and professional cleaning.<br />
* Don’t smoke</div>C Michael Gibsonhttps://www.wikidoc.org/index.php?title=Peridontal_disease_(patient_information)&diff=1233707Peridontal disease (patient information)2016-06-01T15:47:05Z<p>C Michael Gibson: </p>
<hr />
<div>__NOTOC__<br />
<br />
{{CMG}}<br />
<br />
==Overview==<br />
Many adults in the U.S. currently have some form of the disease. Periodontal diseases range from simple gum inflammation to serious disease that results in major damage to the soft tissue and bone that support the teeth. In the worst cases, teeth are lost. Whether your gum disease is stopped, slowed, or gets worse depends a great deal on how well you care for your teeth and gums every day, from this point forward.<br />
<br />
==Causes==<br />
Our mouths are full of bacteria. These bacteria, along with mucus and other particles, constantly form a sticky, colorless “plaque” on teeth. Brushing and flossing help get rid of plaque. Plaque that is not removed can harden and form “tartar” that brushing doesn’t clean. Only a professional cleaning by a dentist or dental hygienist can remove tartar.<br />
<br />
==Natural History==<br />
===Gingivitis?===<br />
The longer plaque and tartar are on teeth, the more harmful they become. The bacteria cause inflammation of the gums that is called “gingivitis.” In gingivitis, the gums become red, swollen and can bleed easily. Gingivitis is a mild form of gum disease that can usually be reversed with daily brushing and flossing, and regular cleaning by a dentist or dental hygienist. This form of gum disease does not include any loss of bone and tissue that hold teeth in place.<br />
<br />
===Periodontitis===<br />
When gingivitis is not treated, it can advance to “periodontitis” (which means “inflammation around the tooth”). In periodontitis, gums pull away from the teeth and form spaces (called “pockets”) that become infected. The body’s immune system fights the bacteria as the plaque spreads and grows below the gum line. Bacterial toxins and the body’s natural response to infection start to break down the bone and connective tissue that hold teeth in place. If not treated, the bones, gums, and tissue that support the teeth are destroyed. The teeth may eventually become loose and have to be removed.<br />
<br />
==Risk Factors==<br />
* Smoking. Need another reason to quit smoking? Smoking is one of the most significant risk factors associated with the development of gum disease. Additionally, smoking can lower the chances for successful treatment.<br />
* Hormonal changes in girls/women. These changes can make gums more sensitive and make it easier for gingivitis to develop.<br />
* Diabetes. People with diabetes are at higher risk for developing infections, including gum disease.<br />
* Other illnesses and their treatments. Diseases such as [[AIDS]] and its treatments can also negatively affect the health of gums, as can treatments for cancer.<br />
* Medications. There are hundreds of prescription and over the counter medications that can reduce the flow of saliva, which has a protective effect on the mouth. Without enough saliva, the mouth is vulnerable to infections such as gum disease. And some medicines can cause abnormal overgrowth of the gum tissue; this can make it difficult to keep teeth and gums clean.<br />
* Genetic susceptibility. Some people are more prone to severe gum disease than others.<br />
<br />
==Epidemiology and Demographics==<br />
People usually don’t show signs of gum disease until they are in their 30s or 40s. Men are more likely to have gum disease than women. Although teenagers rarely develop periodontitis, they can develop gingivitis, the milder form of gum disease. Most commonly, gum disease develops when plaque is allowed to build up along and under the gum line.<br />
<br />
==Natural History, Complications, Prognosis==<br />
There may be other reasons people with gum disease sometimes develop additional health problems. For example, something else may be causing both the gum disease and the other condition, or it could be a coincidence that gum disease and other health problems are present together.<br />
<br />
In some studies, researchers have observed that people with gum disease (when compared to people without gum disease) were more likely to develop heart disease or have difficulty controlling blood sugar. Other studies showed that women with gum disease were more likely than those with healthy gums to deliver preterm, low birth weight babies. But so far, it has not been determined whether gum disease is the cause of these conditions.<br />
<br />
More research is needed to clarify whether gum disease actually causes health problems beyond the mouth, and whether treating gum disease can keep other health conditions from developing.<br />
<br />
==Symptoms==<br />
* [[Bad breath]] that won’t go away<br />
* Red or swollen gums<br />
* Tender or bleeding gums<br />
* Painful chewing<br />
* Loose teeth<br />
* Sensitive teeth<br />
* Receding gums or longer appearing teeth<br />
<br />
==Physical Examination==<br />
* Examine the gums and note any signs of inflammation.<br />
* Use a tiny ruler called a “probe” to check for and measure any pockets. In a healthy mouth, the depth of these pockets is usually between 1 and 3 millimeters. This test for pocket depth is usually painless.<br />
<br />
==Diagnostic Studies==<br />
The dentist or hygienist may take an x-ray to see whether there is any bone loss.<br />
<br />
==Treatment==<br />
You may be referred to a periodontist. Periodontists are experts in the diagnosis and treatment of gum disease and may provide you with treatment options that are not offered by your dentist.<br />
<br />
The main goal of treatment is to control the infection. The number and types of treatment will vary, depending on the extent of the gum disease. Any type of treatment requires that the patient keep up good daily care at home. The doctor may also suggest changing certain behaviors, such as quitting smoking, as a way to improve treatment outcome.<br />
Deep Cleaning (Scaling and Root Planing)<br />
<br />
===Scaling and Root Planing===<br />
The dentist, periodontist, or dental hygienist removes the plaque through a deep-cleaning method called scaling and root planing. Scaling means scraping off the tartar from above and below the gum line. Root planing gets rid of rough spots on the tooth root where the germs gather, and helps remove bacteria that contribute to the disease. In some cases a laser may be used to remove plaque and tartar. This procedure can result in less bleeding, swelling, and discomfort compared to traditional deep cleaning methods.<br />
<br />
===Medications===<br />
Medications may be used with treatment that includes scaling and root planning, but they cannot always take the place of surgery. Depending on how far the disease has progressed, the dentist or periodontist may still suggest surgical treatment. Long-term studies are needed to find out if using medications reduces the need for surgery and whether they are effective over a long period of time. Listed on the next page are some medications that are currently used.<br />
<br />
====Prescription antimicrobial mouthrinse====<br />
*A prescription mouthrinse containing an antimicrobial called chlorhexidine<br />
*It is used to control bacteria when treating gingivitis and after gum surgery<br />
*It's used like a regular mouthwash<br />
<br />
====Antiseptic chip====<br />
*A tiny piece of gelatin filled with the medicine [[chlorhexidine]] <br />
*This medicine controls bacteria and reduce the size of periodontal pockets<br />
*After root planing, it's placed in the pockets where the medicine is slowly released over time<br />
<br />
====Antibiotic gel====<br />
*A gel that contains the antibiotic [[doxycycline]]<br />
*It is used to control bacteria and reduce the size of periodontal pockets<br />
*The periodontist puts it in the pockets after scaling and root planing<br />
*The antibiotic is released slowly over a period of about seven days<br />
<br />
====Antibiotic microspheres====<br />
*Tiny, round particles that contain the antibiotic [[minocycline]]<br />
*It is used to control bacteria and reduce the size of periodontal pockets<br />
*The periodontist puts the microspheres into the pockets after scaling and root planing. The particles release [[minocycline]]<br />
slowly over time.<br />
<br />
====Enzyme suppressant====<br />
* A low dose of the medication doxycycline that keeps destructive enzymes in check To hold back the body's enzyme response -- If not controlled, certain enzymes can break down gum tissue This medication is in tablet form. It is used in combination with scaling and root planing.<br />
Oral antibiotics Antibiotic tablets or capsules For short term treatment of an acute or locally persistent periodontal infection These come as tablets or capsules and are taken by mouth.<br />
Surgical Treatments<br />
<br />
Flap Surgery. Surgery might be necessary if inflammation and deep pockets remain following treatment with deep cleaning and medications. A dentist or periodontist may perform flap surgery to remove tartar deposits in deep pockets or to reduce the periodontal pocket and make it easier for the patient, dentist, and hygienist to keep the area clean. This common surgery involves lifting back the gums and removing the tartar. The gums are then sutured back in place so that the tissue fits snugly around the tooth again. After surgery the gums will heal and fit more tightly around the tooth. This sometimes results in the teeth appearing longer.<br />
<br />
Bone and Tissue Grafts. In addition to flap surgery, your periodontist or dentist may suggest procedures to help regenerate any bone or gum tissue lost to periodontitis. Bone grafting, in which natural or synthetic bone is placed in the area of bone loss, can help promote bone growth. A technique that can be used with bone grafting is called guided tissue regeneration. In this procedure, a small piece of mesh-like material is inserted between the bone and gum tissue. This keeps the gum tissue from growing into the area where the bone should be, allowing the bone and connective tissue to regrow. Growth factors – proteins that can help your body naturally regrow bone – may also be used. In cases where gum tissue has been lost, your dentist or periodontist may suggest a soft tissue graft, in which synthetic material or tissue taken from another area of your mouth is used to cover exposed tooth roots.<br />
<br />
Since each case is different, it is not possible to predict with certainty which grafts will be successful over the long-term. Treatment results depend on many things, including how far the disease has progressed, how well the patient keeps up with oral care at home, and certain risk factors, such as smoking, which may lower the chances of success. Ask your periodontist what the level of success might be in your particular case.<br />
Second Opinion<br />
<br />
When considering any extensive dental or medical treatment options, you should think about getting a second opinion. To find a dentist or periodontist for a second opinion, call your local dental society. They can provide you with names of practitioners in your area. Additionally, dental schools may sometimes be able to offer a second opinion. Call the dental school in your area to find out whether it offers this service.<br />
<br />
==Prevention==<br />
* Brush your teeth twice a day (with a fluoride toothpaste).<br />
* Floss regularly to remove plaque from between teeth. <br />
* Use a device such as a special brush or wooden or plastic pick recommended by a dental professional.<br />
* Visit the dentist routinely for a check-up and professional cleaning.<br />
* Don’t smoke</div>C Michael Gibsonhttps://www.wikidoc.org/index.php?title=Peridontal_disease_(patient_information)&diff=1233705Peridontal disease (patient information)2016-06-01T15:46:03Z<p>C Michael Gibson: /* Complications */</p>
<hr />
<div>__NOTOC__<br />
<br />
{{CMG}}<br />
<br />
==Overview==<br />
Many adults in the U.S. currently have some form of the disease. Periodontal diseases range from simple gum inflammation to serious disease that results in major damage to the soft tissue and bone that support the teeth. In the worst cases, teeth are lost. Whether your gum disease is stopped, slowed, or gets worse depends a great deal on how well you care for your teeth and gums every day, from this point forward.<br />
<br />
==Causes==<br />
Our mouths are full of bacteria. These bacteria, along with mucus and other particles, constantly form a sticky, colorless “plaque” on teeth. Brushing and flossing help get rid of plaque. Plaque that is not removed can harden and form “tartar” that brushing doesn’t clean. Only a professional cleaning by a dentist or dental hygienist can remove tartar.<br />
<br />
==Natural History==<br />
===Gingivitis?===<br />
The longer plaque and tartar are on teeth, the more harmful they become. The bacteria cause inflammation of the gums that is called “gingivitis.” In gingivitis, the gums become red, swollen and can bleed easily. Gingivitis is a mild form of gum disease that can usually be reversed with daily brushing and flossing, and regular cleaning by a dentist or dental hygienist. This form of gum disease does not include any loss of bone and tissue that hold teeth in place.<br />
<br />
===Periodontitis===<br />
When gingivitis is not treated, it can advance to “periodontitis” (which means “inflammation around the tooth”). In periodontitis, gums pull away from the teeth and form spaces (called “pockets”) that become infected. The body’s immune system fights the bacteria as the plaque spreads and grows below the gum line. Bacterial toxins and the body’s natural response to infection start to break down the bone and connective tissue that hold teeth in place. If not treated, the bones, gums, and tissue that support the teeth are destroyed. The teeth may eventually become loose and have to be removed.<br />
<br />
==Risk Factors==<br />
* Smoking. Need another reason to quit smoking? Smoking is one of the most significant risk factors associated with the development of gum disease. Additionally, smoking can lower the chances for successful treatment.<br />
* Hormonal changes in girls/women. These changes can make gums more sensitive and make it easier for gingivitis to develop.<br />
* Diabetes. People with diabetes are at higher risk for developing infections, including gum disease.<br />
* Other illnesses and their treatments. Diseases such as [[AIDS]] and its treatments can also negatively affect the health of gums, as can treatments for cancer.<br />
* Medications. There are hundreds of prescription and over the counter medications that can reduce the flow of saliva, which has a protective effect on the mouth. Without enough saliva, the mouth is vulnerable to infections such as gum disease. And some medicines can cause abnormal overgrowth of the gum tissue; this can make it difficult to keep teeth and gums clean.<br />
* Genetic susceptibility. Some people are more prone to severe gum disease than others.<br />
<br />
==Epidemiology and Demographics==<br />
People usually don’t show signs of gum disease until they are in their 30s or 40s. Men are more likely to have gum disease than women. Although teenagers rarely develop periodontitis, they can develop gingivitis, the milder form of gum disease. Most commonly, gum disease develops when plaque is allowed to build up along and under the gum line.<br />
<br />
==Symptoms==<br />
* [[Bad breath]] that won’t go away<br />
* Red or swollen gums<br />
* Tender or bleeding gums<br />
* Painful chewing<br />
* Loose teeth<br />
* Sensitive teeth<br />
* Receding gums or longer appearing teeth<br />
<br />
==Physical Examination==<br />
* Examine the gums and note any signs of inflammation.<br />
* Use a tiny ruler called a “probe” to check for and measure any pockets. In a healthy mouth, the depth of these pockets is usually between 1 and 3 millimeters. This test for pocket depth is usually painless.<br />
<br />
==Diagnostic Studies==<br />
The dentist or hygienist may take an x-ray to see whether there is any bone loss.<br />
<br />
==Treatment==<br />
You may be referred to a periodontist. Periodontists are experts in the diagnosis and treatment of gum disease and may provide you with treatment options that are not offered by your dentist.<br />
<br />
The main goal of treatment is to control the infection. The number and types of treatment will vary, depending on the extent of the gum disease. Any type of treatment requires that the patient keep up good daily care at home. The doctor may also suggest changing certain behaviors, such as quitting smoking, as a way to improve treatment outcome.<br />
Deep Cleaning (Scaling and Root Planing)<br />
<br />
===Scaling and Root Planing===<br />
The dentist, periodontist, or dental hygienist removes the plaque through a deep-cleaning method called scaling and root planing. Scaling means scraping off the tartar from above and below the gum line. Root planing gets rid of rough spots on the tooth root where the germs gather, and helps remove bacteria that contribute to the disease. In some cases a laser may be used to remove plaque and tartar. This procedure can result in less bleeding, swelling, and discomfort compared to traditional deep cleaning methods.<br />
<br />
===Medications===<br />
Medications may be used with treatment that includes scaling and root planning, but they cannot always take the place of surgery. Depending on how far the disease has progressed, the dentist or periodontist may still suggest surgical treatment. Long-term studies are needed to find out if using medications reduces the need for surgery and whether they are effective over a long period of time. Listed on the next page are some medications that are currently used.<br />
<br />
====Prescription antimicrobial mouthrinse====<br />
*A prescription mouthrinse containing an antimicrobial called chlorhexidine<br />
*It is used to control bacteria when treating gingivitis and after gum surgery<br />
*It's used like a regular mouthwash<br />
<br />
====Antiseptic chip====<br />
*A tiny piece of gelatin filled with the medicine [[chlorhexidine]] <br />
*This medicine controls bacteria and reduce the size of periodontal pockets<br />
*After root planing, it's placed in the pockets where the medicine is slowly released over time<br />
<br />
====Antibiotic gel====<br />
*A gel that contains the antibiotic [[doxycycline]]<br />
*It is used to control bacteria and reduce the size of periodontal pockets<br />
*The periodontist puts it in the pockets after scaling and root planing<br />
*The antibiotic is released slowly over a period of about seven days<br />
<br />
====Antibiotic microspheres====<br />
*Tiny, round particles that contain the antibiotic [[minocycline]]<br />
*It is used to control bacteria and reduce the size of periodontal pockets<br />
*The periodontist puts the microspheres into the pockets after scaling and root planing. The particles release [[minocycline]]<br />
slowly over time.<br />
<br />
====Enzyme suppressant====<br />
* A low dose of the medication doxycycline that keeps destructive enzymes in check To hold back the body's enzyme response -- If not controlled, certain enzymes can break down gum tissue This medication is in tablet form. It is used in combination with scaling and root planing.<br />
Oral antibiotics Antibiotic tablets or capsules For short term treatment of an acute or locally persistent periodontal infection These come as tablets or capsules and are taken by mouth.<br />
Surgical Treatments<br />
<br />
Flap Surgery. Surgery might be necessary if inflammation and deep pockets remain following treatment with deep cleaning and medications. A dentist or periodontist may perform flap surgery to remove tartar deposits in deep pockets or to reduce the periodontal pocket and make it easier for the patient, dentist, and hygienist to keep the area clean. This common surgery involves lifting back the gums and removing the tartar. The gums are then sutured back in place so that the tissue fits snugly around the tooth again. After surgery the gums will heal and fit more tightly around the tooth. This sometimes results in the teeth appearing longer.<br />
<br />
Bone and Tissue Grafts. In addition to flap surgery, your periodontist or dentist may suggest procedures to help regenerate any bone or gum tissue lost to periodontitis. Bone grafting, in which natural or synthetic bone is placed in the area of bone loss, can help promote bone growth. A technique that can be used with bone grafting is called guided tissue regeneration. In this procedure, a small piece of mesh-like material is inserted between the bone and gum tissue. This keeps the gum tissue from growing into the area where the bone should be, allowing the bone and connective tissue to regrow. Growth factors – proteins that can help your body naturally regrow bone – may also be used. In cases where gum tissue has been lost, your dentist or periodontist may suggest a soft tissue graft, in which synthetic material or tissue taken from another area of your mouth is used to cover exposed tooth roots.<br />
<br />
Since each case is different, it is not possible to predict with certainty which grafts will be successful over the long-term. Treatment results depend on many things, including how far the disease has progressed, how well the patient keeps up with oral care at home, and certain risk factors, such as smoking, which may lower the chances of success. Ask your periodontist what the level of success might be in your particular case.<br />
Second Opinion<br />
<br />
When considering any extensive dental or medical treatment options, you should think about getting a second opinion. To find a dentist or periodontist for a second opinion, call your local dental society. They can provide you with names of practitioners in your area. Additionally, dental schools may sometimes be able to offer a second opinion. Call the dental school in your area to find out whether it offers this service.<br />
<br />
==Prevention==<br />
* Brush your teeth twice a day (with a fluoride toothpaste).<br />
* Floss regularly to remove plaque from between teeth. <br />
* Use a device such as a special brush or wooden or plastic pick recommended by a dental professional.<br />
* Visit the dentist routinely for a check-up and professional cleaning.<br />
* Don’t smoke</div>C Michael Gibsonhttps://www.wikidoc.org/index.php?title=Peridontal_disease_(patient_information)&diff=1233702Peridontal disease (patient information)2016-06-01T15:40:06Z<p>C Michael Gibson: </p>
<hr />
<div>__NOTOC__<br />
<br />
{{CMG}}<br />
<br />
==Overview==<br />
Many adults in the U.S. currently have some form of the disease. Periodontal diseases range from simple gum inflammation to serious disease that results in major damage to the soft tissue and bone that support the teeth. In the worst cases, teeth are lost. Whether your gum disease is stopped, slowed, or gets worse depends a great deal on how well you care for your teeth and gums every day, from this point forward.<br />
<br />
==Causes==<br />
Our mouths are full of bacteria. These bacteria, along with mucus and other particles, constantly form a sticky, colorless “plaque” on teeth. Brushing and flossing help get rid of plaque. Plaque that is not removed can harden and form “tartar” that brushing doesn’t clean. Only a professional cleaning by a dentist or dental hygienist can remove tartar.<br />
<br />
==Natural History==<br />
===Gingivitis?===<br />
The longer plaque and tartar are on teeth, the more harmful they become. The bacteria cause inflammation of the gums that is called “gingivitis.” In gingivitis, the gums become red, swollen and can bleed easily. Gingivitis is a mild form of gum disease that can usually be reversed with daily brushing and flossing, and regular cleaning by a dentist or dental hygienist. This form of gum disease does not include any loss of bone and tissue that hold teeth in place.<br />
<br />
===Periodontitis===<br />
When gingivitis is not treated, it can advance to “periodontitis” (which means “inflammation around the tooth”). In periodontitis, gums pull away from the teeth and form spaces (called “pockets”) that become infected. The body’s immune system fights the bacteria as the plaque spreads and grows below the gum line. Bacterial toxins and the body’s natural response to infection start to break down the bone and connective tissue that hold teeth in place. If not treated, the bones, gums, and tissue that support the teeth are destroyed. The teeth may eventually become loose and have to be removed.<br />
<br />
==Risk Factors==<br />
* Smoking. Need another reason to quit smoking? Smoking is one of the most significant risk factors associated with the development of gum disease. Additionally, smoking can lower the chances for successful treatment.<br />
* Hormonal changes in girls/women. These changes can make gums more sensitive and make it easier for gingivitis to develop.<br />
* Diabetes. People with diabetes are at higher risk for developing infections, including gum disease.<br />
* Other illnesses and their treatments. Diseases such as [[AIDS]] and its treatments can also negatively affect the health of gums, as can treatments for cancer.<br />
* Medications. There are hundreds of prescription and over the counter medications that can reduce the flow of saliva, which has a protective effect on the mouth. Without enough saliva, the mouth is vulnerable to infections such as gum disease. And some medicines can cause abnormal overgrowth of the gum tissue; this can make it difficult to keep teeth and gums clean.<br />
* Genetic susceptibility. Some people are more prone to severe gum disease than others.<br />
<br />
==Epidemiology and Demographics==<br />
People usually don’t show signs of gum disease until they are in their 30s or 40s. Men are more likely to have gum disease than women. Although teenagers rarely develop periodontitis, they can develop gingivitis, the milder form of gum disease. Most commonly, gum disease develops when plaque is allowed to build up along and under the gum line.<br />
<br />
==Symptoms==<br />
* [[Bad breath]] that won’t go away<br />
* Red or swollen gums<br />
* Tender or bleeding gums<br />
* Painful chewing<br />
* Loose teeth<br />
* Sensitive teeth<br />
* Receding gums or longer appearing teeth<br />
<br />
==Physical Examination==<br />
* Examine the gums and note any signs of inflammation.<br />
* Use a tiny ruler called a “probe” to check for and measure any pockets. In a healthy mouth, the depth of these pockets is usually between 1 and 3 millimeters. This test for pocket depth is usually painless.<br />
<br />
==Diagnostic Studies==<br />
The dentist or hygienist may take an x-ray to see whether there is any bone loss.<br />
<br />
==Treatment==<br />
You may be referred to a periodontist. Periodontists are experts in the diagnosis and treatment of gum disease and may provide you with treatment options that are not offered by your dentist.<br />
<br />
The main goal of treatment is to control the infection. The number and types of treatment will vary, depending on the extent of the gum disease. Any type of treatment requires that the patient keep up good daily care at home. The doctor may also suggest changing certain behaviors, such as quitting smoking, as a way to improve treatment outcome.<br />
Deep Cleaning (Scaling and Root Planing)<br />
<br />
===Scaling and Root Planing===<br />
The dentist, periodontist, or dental hygienist removes the plaque through a deep-cleaning method called scaling and root planing. Scaling means scraping off the tartar from above and below the gum line. Root planing gets rid of rough spots on the tooth root where the germs gather, and helps remove bacteria that contribute to the disease. In some cases a laser may be used to remove plaque and tartar. This procedure can result in less bleeding, swelling, and discomfort compared to traditional deep cleaning methods.<br />
<br />
===Medications===<br />
Medications may be used with treatment that includes scaling and root planning, but they cannot always take the place of surgery. Depending on how far the disease has progressed, the dentist or periodontist may still suggest surgical treatment. Long-term studies are needed to find out if using medications reduces the need for surgery and whether they are effective over a long period of time. Listed on the next page are some medications that are currently used.<br />
<br />
====Prescription antimicrobial mouthrinse====<br />
*A prescription mouthrinse containing an antimicrobial called chlorhexidine<br />
*It is used to control bacteria when treating gingivitis and after gum surgery<br />
*It's used like a regular mouthwash<br />
<br />
====Antiseptic chip====<br />
*A tiny piece of gelatin filled with the medicine [[chlorhexidine]] <br />
*This medicine controls bacteria and reduce the size of periodontal pockets<br />
*After root planing, it's placed in the pockets where the medicine is slowly released over time<br />
<br />
====Antibiotic gel====<br />
*A gel that contains the antibiotic [[doxycycline]]<br />
*It is used to control bacteria and reduce the size of periodontal pockets<br />
*The periodontist puts it in the pockets after scaling and root planing<br />
*The antibiotic is released slowly over a period of about seven days<br />
<br />
====Antibiotic microspheres====<br />
*Tiny, round particles that contain the antibiotic [[minocycline]]<br />
*It is used to control bacteria and reduce the size of periodontal pockets<br />
*The periodontist puts the microspheres into the pockets after scaling and root planing. The particles release [[minocycline]]<br />
slowly over time.<br />
<br />
====Enzyme suppressant====<br />
* A low dose of the medication doxycycline that keeps destructive enzymes in check To hold back the body's enzyme response -- If not controlled, certain enzymes can break down gum tissue This medication is in tablet form. It is used in combination with scaling and root planing.<br />
Oral antibiotics Antibiotic tablets or capsules For short term treatment of an acute or locally persistent periodontal infection These come as tablets or capsules and are taken by mouth.<br />
Surgical Treatments<br />
<br />
Flap Surgery. Surgery might be necessary if inflammation and deep pockets remain following treatment with deep cleaning and medications. A dentist or periodontist may perform flap surgery to remove tartar deposits in deep pockets or to reduce the periodontal pocket and make it easier for the patient, dentist, and hygienist to keep the area clean. This common surgery involves lifting back the gums and removing the tartar. The gums are then sutured back in place so that the tissue fits snugly around the tooth again. After surgery the gums will heal and fit more tightly around the tooth. This sometimes results in the teeth appearing longer.<br />
<br />
Bone and Tissue Grafts. In addition to flap surgery, your periodontist or dentist may suggest procedures to help regenerate any bone or gum tissue lost to periodontitis. Bone grafting, in which natural or synthetic bone is placed in the area of bone loss, can help promote bone growth. A technique that can be used with bone grafting is called guided tissue regeneration. In this procedure, a small piece of mesh-like material is inserted between the bone and gum tissue. This keeps the gum tissue from growing into the area where the bone should be, allowing the bone and connective tissue to regrow. Growth factors – proteins that can help your body naturally regrow bone – may also be used. In cases where gum tissue has been lost, your dentist or periodontist may suggest a soft tissue graft, in which synthetic material or tissue taken from another area of your mouth is used to cover exposed tooth roots.<br />
<br />
Since each case is different, it is not possible to predict with certainty which grafts will be successful over the long-term. Treatment results depend on many things, including how far the disease has progressed, how well the patient keeps up with oral care at home, and certain risk factors, such as smoking, which may lower the chances of success. Ask your periodontist what the level of success might be in your particular case.<br />
Second Opinion<br />
<br />
When considering any extensive dental or medical treatment options, you should think about getting a second opinion. To find a dentist or periodontist for a second opinion, call your local dental society. They can provide you with names of practitioners in your area. Additionally, dental schools may sometimes be able to offer a second opinion. Call the dental school in your area to find out whether it offers this service.<br />
<br />
==Prevention==<br />
* Brush your teeth twice a day (with a fluoride toothpaste).<br />
* Floss regularly to remove plaque from between teeth. <br />
* Use a device such as a special brush or wooden or plastic pick recommended by a dental professional.<br />
* Visit the dentist routinely for a check-up and professional cleaning.<br />
* Don’t smoke<br />
<br />
==Complications==<br />
<br />
In some studies, researchers have observed that people with gum disease (when compared to people without gum disease) were more likely to develop heart disease or have difficulty controlling blood sugar. Other studies showed that women with gum disease were more likely than those with healthy gums to deliver preterm, low birth weight babies. But so far, it has not been determined whether gum disease is the cause of these conditions.<br />
<br />
There may be other reasons people with gum disease sometimes develop additional health problems.<br />
<br />
For example, something else may be causing both the gum disease and the other condition, or it could be a coincidence that gum disease and other health problems are present together.<br />
<br />
More research is needed to clarify whether gum disease actually causes health problems beyond the mouth, and whether treating gum disease can keep other health conditions from developing.<br />
<br />
In the meantime, it’s a fact that controlling gum disease can save your teeth – a very good reason to take care of your teeth and gums.</div>C Michael Gibsonhttps://www.wikidoc.org/index.php?title=Peridontal_disease_(patient_information)&diff=1233695Peridontal disease (patient information)2016-06-01T15:32:15Z<p>C Michael Gibson: /* Physical Examination */</p>
<hr />
<div>__NOTOC__<br />
<br />
{{CMG}}<br />
<br />
==Overview==<br />
Many adults in the U.S. currently have some form of the disease. Periodontal diseases range from simple gum inflammation to serious disease that results in major damage to the soft tissue and bone that support the teeth. In the worst cases, teeth are lost. Whether your gum disease is stopped, slowed, or gets worse depends a great deal on how well you care for your teeth and gums every day, from this point forward.<br />
<br />
==Causes==<br />
Our mouths are full of bacteria. These bacteria, along with mucus and other particles, constantly form a sticky, colorless “plaque” on teeth. Brushing and flossing help get rid of plaque. Plaque that is not removed can harden and form “tartar” that brushing doesn’t clean. Only a professional cleaning by a dentist or dental hygienist can remove tartar.<br />
<br />
<br />
==Natural History==<br />
===Gingivitis?===<br />
The longer plaque and tartar are on teeth, the more harmful they become. The bacteria cause inflammation of the gums that is called “gingivitis.” In gingivitis, the gums become red, swollen and can bleed easily. Gingivitis is a mild form of gum disease that can usually be reversed with daily brushing and flossing, and regular cleaning by a dentist or dental hygienist. This form of gum disease does not include any loss of bone and tissue that hold teeth in place.<br />
<br />
===Periodontitis===<br />
When gingivitis is not treated, it can advance to “periodontitis” (which means “inflammation around the tooth”). In periodontitis, gums pull away from the teeth and form spaces (called “pockets”) that become infected. The body’s immune system fights the bacteria as the plaque spreads and grows below the gum line. Bacterial toxins and the body’s natural response to infection start to break down the bone and connective tissue that hold teeth in place. If not treated, the bones, gums, and tissue that support the teeth are destroyed. The teeth may eventually become loose and have to be removed.<br />
<br />
==Risk Factors==<br />
<br />
* Smoking. Need another reason to quit smoking? Smoking is one of the most significant risk factors associated with the development of gum disease. Additionally, smoking can lower the chances for successful treatment.<br />
* Hormonal changes in girls/women. These changes can make gums more sensitive and make it easier for gingivitis to develop.<br />
* Diabetes. People with diabetes are at higher risk for developing infections, including gum disease.<br />
* Other illnesses and their treatments. Diseases such as [[AIDS]] and its treatments can also negatively affect the health of gums, as can treatments for cancer.<br />
* Medications. There are hundreds of prescription and over the counter medications that can reduce the flow of saliva, which has a protective effect on the mouth. Without enough saliva, the mouth is vulnerable to infections such as gum disease. And some medicines can cause abnormal overgrowth of the gum tissue; this can make it difficult to keep teeth and gums clean.<br />
* Genetic susceptibility. Some people are more prone to severe gum disease than others.<br />
<br />
==Epidemiology and Demographics==<br />
People usually don’t show signs of gum disease until they are in their 30s or 40s. Men are more likely to have gum disease than women. Although teenagers rarely develop periodontitis, they can develop gingivitis, the milder form of gum disease. Most commonly, gum disease develops when plaque is allowed to build up along and under the gum line.<br />
<br />
==Symptoms==<br />
* [[Bad breath]] that won’t go away<br />
* Red or swollen gums<br />
* Tender or bleeding gums<br />
* Painful chewing<br />
* Loose teeth<br />
* Sensitive teeth<br />
* Receding gums or longer appearing teeth<br />
<br />
==Physical Examination==<br />
* Examine the gums and note any signs of inflammation.<br />
* Use a tiny ruler called a “probe” to check for and measure any pockets. In a healthy mouth, the depth of these pockets is usually between 1 and 3 millimeters. This test for pocket depth is usually painless.<br />
<br />
==Diagnostic Studies==<br />
The dentist or hygienist may take an x-ray to see whether there is any bone loss.<br />
<br />
==Treatment==<br />
Refer you to a periodontist. Periodontists are experts in the diagnosis and treatment of gum disease and may provide you with treatment options that are not offered by your dentist.<br />
<br />
The main goal of treatment is to control the infection. The number and types of treatment will vary, depending on the extent of the gum disease. Any type of treatment requires that the patient keep up good daily care at home. The doctor may also suggest changing certain behaviors, such as quitting smoking, as a way to improve treatment outcome.<br />
Deep Cleaning (Scaling and Root Planing)<br />
<br />
The dentist, periodontist, or dental hygienist removes the plaque through a deep-cleaning method called scaling and root planing. Scaling means scraping off the tartar from above and below the gum line. Root planing gets rid of rough spots on the tooth root where the germs gather, and helps remove bacteria that contribute to the disease. In some cases a laser may be used to remove plaque and tartar. This procedure can result in less bleeding, swelling, and discomfort compared to traditional deep cleaning methods.<br />
Medications<br />
<br />
Medications may be used with treatment that includes scaling and root planning, but they cannot always take the place of surgery. Depending on how far the disease has progressed, the dentist or periodontist may still suggest surgical treatment. Long-term studies are needed to find out if using medications reduces the need for surgery and whether they are effective over a long period of time. Listed on the next page are some medications that are currently used.<br />
Medications Medications What is it? Why is it used? How is it used?<br />
Prescription antimicrobial mouthrinse A prescription mouthrinse containing an antimicrobial called chlorhexidine To control bacteria when treating gingivitis and after gum surgery It's used like a regular mouthwash.<br />
Antiseptic chip A tiny piece of gelatin filled with the medicine chlorhexidine To control bacteria and reduce the size of periodontal pockets After root planing, it's placed in the pockets where the medicine is slowly released over time.<br />
Antibiotic gel A gel that contains the antibiotic doxycycline To control bacteria and reduce the size of periodontal pockets The periodontist puts it in the pockets after scaling and root planing. The antibiotic is released slowly over a period of about seven days.<br />
Antibiotic microspheres Tiny, round particles that contain the antibiotic minocycline To control bacteria and reduce the size of periodontal pockets The periodontist puts the microspheres into the pockets after scaling and root planing. The particles release minocycline<br />
slowly over time.<br />
Enzyme suppressant A low dose of the medication doxycycline that keeps destructive enzymes in check To hold back the body's enzyme response -- If not controlled, certain enzymes can break down gum tissue This medication is in tablet form. It is used in combination with scaling and root planing.<br />
Oral antibiotics Antibiotic tablets or capsules For short term treatment of an acute or locally persistent periodontal infection These come as tablets or capsules and are taken by mouth.<br />
Surgical Treatments<br />
<br />
Flap Surgery. Surgery might be necessary if inflammation and deep pockets remain following treatment with deep cleaning and medications. A dentist or periodontist may perform flap surgery to remove tartar deposits in deep pockets or to reduce the periodontal pocket and make it easier for the patient, dentist, and hygienist to keep the area clean. This common surgery involves lifting back the gums and removing the tartar. The gums are then sutured back in place so that the tissue fits snugly around the tooth again. After surgery the gums will heal and fit more tightly around the tooth. This sometimes results in the teeth appearing longer.<br />
<br />
Bone and Tissue Grafts. In addition to flap surgery, your periodontist or dentist may suggest procedures to help regenerate any bone or gum tissue lost to periodontitis. Bone grafting, in which natural or synthetic bone is placed in the area of bone loss, can help promote bone growth. A technique that can be used with bone grafting is called guided tissue regeneration. In this procedure, a small piece of mesh-like material is inserted between the bone and gum tissue. This keeps the gum tissue from growing into the area where the bone should be, allowing the bone and connective tissue to regrow. Growth factors – proteins that can help your body naturally regrow bone – may also be used. In cases where gum tissue has been lost, your dentist or periodontist may suggest a soft tissue graft, in which synthetic material or tissue taken from another area of your mouth is used to cover exposed tooth roots.<br />
<br />
Since each case is different, it is not possible to predict with certainty which grafts will be successful over the long-term. Treatment results depend on many things, including how far the disease has progressed, how well the patient keeps up with oral care at home, and certain risk factors, such as smoking, which may lower the chances of success. Ask your periodontist what the level of success might be in your particular case.<br />
Second Opinion<br />
<br />
When considering any extensive dental or medical treatment options, you should think about getting a second opinion. To find a dentist or periodontist for a second opinion, call your local dental society. They can provide you with names of practitioners in your area. Additionally, dental schools may sometimes be able to offer a second opinion. Call the dental school in your area to find out whether it offers this service.<br />
<br />
==Prevention==<br />
* Brush your teeth twice a day (with a fluoride toothpaste).<br />
* Floss regularly to remove plaque from between teeth. <br />
* Use a device such as a special brush or wooden or plastic pick recommended by a dental professional.<br />
* Visit the dentist routinely for a check-up and professional cleaning.<br />
* Don’t smoke<br />
<br />
==Complications==<br />
<br />
In some studies, researchers have observed that people with gum disease (when compared to people without gum disease) were more likely to develop heart disease or have difficulty controlling blood sugar. Other studies showed that women with gum disease were more likely than those with healthy gums to deliver preterm, low birth weight babies. But so far, it has not been determined whether gum disease is the cause of these conditions.<br />
<br />
There may be other reasons people with gum disease sometimes develop additional health problems.<br />
<br />
For example, something else may be causing both the gum disease and the other condition, or it could be a coincidence that gum disease and other health problems are present together.<br />
<br />
More research is needed to clarify whether gum disease actually causes health problems beyond the mouth, and whether treating gum disease can keep other health conditions from developing.<br />
<br />
In the meantime, it’s a fact that controlling gum disease can save your teeth – a very good reason to take care of your teeth and gums.</div>C Michael Gibsonhttps://www.wikidoc.org/index.php?title=Peridontal_disease_(patient_information)&diff=1233691Peridontal disease (patient information)2016-06-01T15:31:17Z<p>C Michael Gibson: /* Risk Factors */</p>
<hr />
<div>__NOTOC__<br />
<br />
{{CMG}}<br />
<br />
==Overview==<br />
Many adults in the U.S. currently have some form of the disease. Periodontal diseases range from simple gum inflammation to serious disease that results in major damage to the soft tissue and bone that support the teeth. In the worst cases, teeth are lost. Whether your gum disease is stopped, slowed, or gets worse depends a great deal on how well you care for your teeth and gums every day, from this point forward.<br />
<br />
==Causes==<br />
Our mouths are full of bacteria. These bacteria, along with mucus and other particles, constantly form a sticky, colorless “plaque” on teeth. Brushing and flossing help get rid of plaque. Plaque that is not removed can harden and form “tartar” that brushing doesn’t clean. Only a professional cleaning by a dentist or dental hygienist can remove tartar.<br />
<br />
<br />
==Natural History==<br />
===Gingivitis?===<br />
The longer plaque and tartar are on teeth, the more harmful they become. The bacteria cause inflammation of the gums that is called “gingivitis.” In gingivitis, the gums become red, swollen and can bleed easily. Gingivitis is a mild form of gum disease that can usually be reversed with daily brushing and flossing, and regular cleaning by a dentist or dental hygienist. This form of gum disease does not include any loss of bone and tissue that hold teeth in place.<br />
<br />
===Periodontitis===<br />
When gingivitis is not treated, it can advance to “periodontitis” (which means “inflammation around the tooth”). In periodontitis, gums pull away from the teeth and form spaces (called “pockets”) that become infected. The body’s immune system fights the bacteria as the plaque spreads and grows below the gum line. Bacterial toxins and the body’s natural response to infection start to break down the bone and connective tissue that hold teeth in place. If not treated, the bones, gums, and tissue that support the teeth are destroyed. The teeth may eventually become loose and have to be removed.<br />
<br />
==Risk Factors==<br />
<br />
* Smoking. Need another reason to quit smoking? Smoking is one of the most significant risk factors associated with the development of gum disease. Additionally, smoking can lower the chances for successful treatment.<br />
* Hormonal changes in girls/women. These changes can make gums more sensitive and make it easier for gingivitis to develop.<br />
* Diabetes. People with diabetes are at higher risk for developing infections, including gum disease.<br />
* Other illnesses and their treatments. Diseases such as [[AIDS]] and its treatments can also negatively affect the health of gums, as can treatments for cancer.<br />
* Medications. There are hundreds of prescription and over the counter medications that can reduce the flow of saliva, which has a protective effect on the mouth. Without enough saliva, the mouth is vulnerable to infections such as gum disease. And some medicines can cause abnormal overgrowth of the gum tissue; this can make it difficult to keep teeth and gums clean.<br />
* Genetic susceptibility. Some people are more prone to severe gum disease than others.<br />
<br />
==Epidemiology and Demographics==<br />
People usually don’t show signs of gum disease until they are in their 30s or 40s. Men are more likely to have gum disease than women. Although teenagers rarely develop periodontitis, they can develop gingivitis, the milder form of gum disease. Most commonly, gum disease develops when plaque is allowed to build up along and under the gum line.<br />
<br />
==Symptoms==<br />
* [[Bad breath]] that won’t go away<br />
* Red or swollen gums<br />
* Tender or bleeding gums<br />
* Painful chewing<br />
* Loose teeth<br />
* Sensitive teeth<br />
* Receding gums or longer appearing teeth<br />
<br />
==Physical Examination==<br />
<br />
Ask about your medical history to identify underlying conditions or risk factors (such as smoking) that may contribute to gum disease.<br />
Examine your gums and note any signs of inflammation.<br />
Use a tiny ruler called a “probe” to check for and measure any pockets. In a healthy mouth, the depth of these pockets is usually between 1 and 3 millimeters. This test for pocket depth is usually painless.<br />
<br />
==Diagnostic Studies==<br />
The dentist or hygienist may take an x-ray to see whether there is any bone loss.<br />
<br />
==Treatment==<br />
Refer you to a periodontist. Periodontists are experts in the diagnosis and treatment of gum disease and may provide you with treatment options that are not offered by your dentist.<br />
<br />
The main goal of treatment is to control the infection. The number and types of treatment will vary, depending on the extent of the gum disease. Any type of treatment requires that the patient keep up good daily care at home. The doctor may also suggest changing certain behaviors, such as quitting smoking, as a way to improve treatment outcome.<br />
Deep Cleaning (Scaling and Root Planing)<br />
<br />
The dentist, periodontist, or dental hygienist removes the plaque through a deep-cleaning method called scaling and root planing. Scaling means scraping off the tartar from above and below the gum line. Root planing gets rid of rough spots on the tooth root where the germs gather, and helps remove bacteria that contribute to the disease. In some cases a laser may be used to remove plaque and tartar. This procedure can result in less bleeding, swelling, and discomfort compared to traditional deep cleaning methods.<br />
Medications<br />
<br />
Medications may be used with treatment that includes scaling and root planning, but they cannot always take the place of surgery. Depending on how far the disease has progressed, the dentist or periodontist may still suggest surgical treatment. Long-term studies are needed to find out if using medications reduces the need for surgery and whether they are effective over a long period of time. Listed on the next page are some medications that are currently used.<br />
Medications Medications What is it? Why is it used? How is it used?<br />
Prescription antimicrobial mouthrinse A prescription mouthrinse containing an antimicrobial called chlorhexidine To control bacteria when treating gingivitis and after gum surgery It's used like a regular mouthwash.<br />
Antiseptic chip A tiny piece of gelatin filled with the medicine chlorhexidine To control bacteria and reduce the size of periodontal pockets After root planing, it's placed in the pockets where the medicine is slowly released over time.<br />
Antibiotic gel A gel that contains the antibiotic doxycycline To control bacteria and reduce the size of periodontal pockets The periodontist puts it in the pockets after scaling and root planing. The antibiotic is released slowly over a period of about seven days.<br />
Antibiotic microspheres Tiny, round particles that contain the antibiotic minocycline To control bacteria and reduce the size of periodontal pockets The periodontist puts the microspheres into the pockets after scaling and root planing. The particles release minocycline<br />
slowly over time.<br />
Enzyme suppressant A low dose of the medication doxycycline that keeps destructive enzymes in check To hold back the body's enzyme response -- If not controlled, certain enzymes can break down gum tissue This medication is in tablet form. It is used in combination with scaling and root planing.<br />
Oral antibiotics Antibiotic tablets or capsules For short term treatment of an acute or locally persistent periodontal infection These come as tablets or capsules and are taken by mouth.<br />
Surgical Treatments<br />
<br />
Flap Surgery. Surgery might be necessary if inflammation and deep pockets remain following treatment with deep cleaning and medications. A dentist or periodontist may perform flap surgery to remove tartar deposits in deep pockets or to reduce the periodontal pocket and make it easier for the patient, dentist, and hygienist to keep the area clean. This common surgery involves lifting back the gums and removing the tartar. The gums are then sutured back in place so that the tissue fits snugly around the tooth again. After surgery the gums will heal and fit more tightly around the tooth. This sometimes results in the teeth appearing longer.<br />
<br />
Bone and Tissue Grafts. In addition to flap surgery, your periodontist or dentist may suggest procedures to help regenerate any bone or gum tissue lost to periodontitis. Bone grafting, in which natural or synthetic bone is placed in the area of bone loss, can help promote bone growth. A technique that can be used with bone grafting is called guided tissue regeneration. In this procedure, a small piece of mesh-like material is inserted between the bone and gum tissue. This keeps the gum tissue from growing into the area where the bone should be, allowing the bone and connective tissue to regrow. Growth factors – proteins that can help your body naturally regrow bone – may also be used. In cases where gum tissue has been lost, your dentist or periodontist may suggest a soft tissue graft, in which synthetic material or tissue taken from another area of your mouth is used to cover exposed tooth roots.<br />
<br />
Since each case is different, it is not possible to predict with certainty which grafts will be successful over the long-term. Treatment results depend on many things, including how far the disease has progressed, how well the patient keeps up with oral care at home, and certain risk factors, such as smoking, which may lower the chances of success. Ask your periodontist what the level of success might be in your particular case.<br />
Second Opinion<br />
<br />
When considering any extensive dental or medical treatment options, you should think about getting a second opinion. To find a dentist or periodontist for a second opinion, call your local dental society. They can provide you with names of practitioners in your area. Additionally, dental schools may sometimes be able to offer a second opinion. Call the dental school in your area to find out whether it offers this service.<br />
<br />
==Prevention==<br />
* Brush your teeth twice a day (with a fluoride toothpaste).<br />
* Floss regularly to remove plaque from between teeth. <br />
* Use a device such as a special brush or wooden or plastic pick recommended by a dental professional.<br />
* Visit the dentist routinely for a check-up and professional cleaning.<br />
* Don’t smoke<br />
<br />
==Complications==<br />
<br />
In some studies, researchers have observed that people with gum disease (when compared to people without gum disease) were more likely to develop heart disease or have difficulty controlling blood sugar. Other studies showed that women with gum disease were more likely than those with healthy gums to deliver preterm, low birth weight babies. But so far, it has not been determined whether gum disease is the cause of these conditions.<br />
<br />
There may be other reasons people with gum disease sometimes develop additional health problems.<br />
<br />
For example, something else may be causing both the gum disease and the other condition, or it could be a coincidence that gum disease and other health problems are present together.<br />
<br />
More research is needed to clarify whether gum disease actually causes health problems beyond the mouth, and whether treating gum disease can keep other health conditions from developing.<br />
<br />
In the meantime, it’s a fact that controlling gum disease can save your teeth – a very good reason to take care of your teeth and gums.</div>C Michael Gibsonhttps://www.wikidoc.org/index.php?title=Peridontal_disease_(patient_information)&diff=1233677Peridontal disease (patient information)2016-06-01T15:25:54Z<p>C Michael Gibson: /* Prevention */</p>
<hr />
<div>__NOTOC__<br />
<br />
{{CMG}}<br />
<br />
==Overview==<br />
Many adults in the U.S. currently have some form of the disease. Periodontal diseases range from simple gum inflammation to serious disease that results in major damage to the soft tissue and bone that support the teeth. In the worst cases, teeth are lost. Whether your gum disease is stopped, slowed, or gets worse depends a great deal on how well you care for your teeth and gums every day, from this point forward.<br />
<br />
==Causes==<br />
Our mouths are full of bacteria. These bacteria, along with mucus and other particles, constantly form a sticky, colorless “plaque” on teeth. Brushing and flossing help get rid of plaque. Plaque that is not removed can harden and form “tartar” that brushing doesn’t clean. Only a professional cleaning by a dentist or dental hygienist can remove tartar.<br />
<br />
<br />
==Natural History==<br />
===Gingivitis?===<br />
The longer plaque and tartar are on teeth, the more harmful they become. The bacteria cause inflammation of the gums that is called “gingivitis.” In gingivitis, the gums become red, swollen and can bleed easily. Gingivitis is a mild form of gum disease that can usually be reversed with daily brushing and flossing, and regular cleaning by a dentist or dental hygienist. This form of gum disease does not include any loss of bone and tissue that hold teeth in place.<br />
<br />
===Periodontitis===<br />
When gingivitis is not treated, it can advance to “periodontitis” (which means “inflammation around the tooth”). In periodontitis, gums pull away from the teeth and form spaces (called “pockets”) that become infected. The body’s immune system fights the bacteria as the plaque spreads and grows below the gum line. Bacterial toxins and the body’s natural response to infection start to break down the bone and connective tissue that hold teeth in place. If not treated, the bones, gums, and tissue that support the teeth are destroyed. The teeth may eventually become loose and have to be removed.<br />
<br />
==Risk Factors==<br />
<br />
Smoking. Need another reason to quit smoking? Smoking is one of the most significant risk factors associated with the development of gum disease. Additionally, smoking can lower the chances for successful treatment.<br />
Hormonal changes in girls/women. These changes can make gums more sensitive and make it easier for gingivitis to develop.<br />
Diabetes. People with diabetes are at higher risk for developing infections, including gum disease.<br />
Other illnesses and their treatments. Diseases such as AIDS and its treatments can also negatively affect the health of gums, as can treatments for cancer.<br />
Medications. There are hundreds of prescription and over the counter medications that can reduce the flow of saliva, which has a protective effect on the mouth. Without enough saliva, the mouth is vulnerable to infections such as gum disease. And some medicines can cause abnormal overgrowth of the gum tissue; this can make it difficult to keep teeth and gums clean.<br />
Genetic susceptibility. Some people are more prone to severe gum disease than others.<br />
<br />
==Epidemiology and Demographics==<br />
People usually don’t show signs of gum disease until they are in their 30s or 40s. Men are more likely to have gum disease than women. Although teenagers rarely develop periodontitis, they can develop gingivitis, the milder form of gum disease. Most commonly, gum disease develops when plaque is allowed to build up along and under the gum line.<br />
<br />
==Symptoms==<br />
* [[Bad breath]] that won’t go away<br />
* Red or swollen gums<br />
* Tender or bleeding gums<br />
* Painful chewing<br />
* Loose teeth<br />
* Sensitive teeth<br />
* Receding gums or longer appearing teeth<br />
<br />
==Physical Examination==<br />
<br />
Ask about your medical history to identify underlying conditions or risk factors (such as smoking) that may contribute to gum disease.<br />
Examine your gums and note any signs of inflammation.<br />
Use a tiny ruler called a “probe” to check for and measure any pockets. In a healthy mouth, the depth of these pockets is usually between 1 and 3 millimeters. This test for pocket depth is usually painless.<br />
<br />
==Diagnostic Studies==<br />
The dentist or hygienist may take an x-ray to see whether there is any bone loss.<br />
<br />
==Treatment==<br />
Refer you to a periodontist. Periodontists are experts in the diagnosis and treatment of gum disease and may provide you with treatment options that are not offered by your dentist.<br />
<br />
The main goal of treatment is to control the infection. The number and types of treatment will vary, depending on the extent of the gum disease. Any type of treatment requires that the patient keep up good daily care at home. The doctor may also suggest changing certain behaviors, such as quitting smoking, as a way to improve treatment outcome.<br />
Deep Cleaning (Scaling and Root Planing)<br />
<br />
The dentist, periodontist, or dental hygienist removes the plaque through a deep-cleaning method called scaling and root planing. Scaling means scraping off the tartar from above and below the gum line. Root planing gets rid of rough spots on the tooth root where the germs gather, and helps remove bacteria that contribute to the disease. In some cases a laser may be used to remove plaque and tartar. This procedure can result in less bleeding, swelling, and discomfort compared to traditional deep cleaning methods.<br />
Medications<br />
<br />
Medications may be used with treatment that includes scaling and root planning, but they cannot always take the place of surgery. Depending on how far the disease has progressed, the dentist or periodontist may still suggest surgical treatment. Long-term studies are needed to find out if using medications reduces the need for surgery and whether they are effective over a long period of time. Listed on the next page are some medications that are currently used.<br />
Medications Medications What is it? Why is it used? How is it used?<br />
Prescription antimicrobial mouthrinse A prescription mouthrinse containing an antimicrobial called chlorhexidine To control bacteria when treating gingivitis and after gum surgery It's used like a regular mouthwash.<br />
Antiseptic chip A tiny piece of gelatin filled with the medicine chlorhexidine To control bacteria and reduce the size of periodontal pockets After root planing, it's placed in the pockets where the medicine is slowly released over time.<br />
Antibiotic gel A gel that contains the antibiotic doxycycline To control bacteria and reduce the size of periodontal pockets The periodontist puts it in the pockets after scaling and root planing. The antibiotic is released slowly over a period of about seven days.<br />
Antibiotic microspheres Tiny, round particles that contain the antibiotic minocycline To control bacteria and reduce the size of periodontal pockets The periodontist puts the microspheres into the pockets after scaling and root planing. The particles release minocycline<br />
slowly over time.<br />
Enzyme suppressant A low dose of the medication doxycycline that keeps destructive enzymes in check To hold back the body's enzyme response -- If not controlled, certain enzymes can break down gum tissue This medication is in tablet form. It is used in combination with scaling and root planing.<br />
Oral antibiotics Antibiotic tablets or capsules For short term treatment of an acute or locally persistent periodontal infection These come as tablets or capsules and are taken by mouth.<br />
Surgical Treatments<br />
<br />
Flap Surgery. Surgery might be necessary if inflammation and deep pockets remain following treatment with deep cleaning and medications. A dentist or periodontist may perform flap surgery to remove tartar deposits in deep pockets or to reduce the periodontal pocket and make it easier for the patient, dentist, and hygienist to keep the area clean. This common surgery involves lifting back the gums and removing the tartar. The gums are then sutured back in place so that the tissue fits snugly around the tooth again. After surgery the gums will heal and fit more tightly around the tooth. This sometimes results in the teeth appearing longer.<br />
<br />
Bone and Tissue Grafts. In addition to flap surgery, your periodontist or dentist may suggest procedures to help regenerate any bone or gum tissue lost to periodontitis. Bone grafting, in which natural or synthetic bone is placed in the area of bone loss, can help promote bone growth. A technique that can be used with bone grafting is called guided tissue regeneration. In this procedure, a small piece of mesh-like material is inserted between the bone and gum tissue. This keeps the gum tissue from growing into the area where the bone should be, allowing the bone and connective tissue to regrow. Growth factors – proteins that can help your body naturally regrow bone – may also be used. In cases where gum tissue has been lost, your dentist or periodontist may suggest a soft tissue graft, in which synthetic material or tissue taken from another area of your mouth is used to cover exposed tooth roots.<br />
<br />
Since each case is different, it is not possible to predict with certainty which grafts will be successful over the long-term. Treatment results depend on many things, including how far the disease has progressed, how well the patient keeps up with oral care at home, and certain risk factors, such as smoking, which may lower the chances of success. Ask your periodontist what the level of success might be in your particular case.<br />
Second Opinion<br />
<br />
When considering any extensive dental or medical treatment options, you should think about getting a second opinion. To find a dentist or periodontist for a second opinion, call your local dental society. They can provide you with names of practitioners in your area. Additionally, dental schools may sometimes be able to offer a second opinion. Call the dental school in your area to find out whether it offers this service.<br />
<br />
==Prevention==<br />
* Brush your teeth twice a day (with a fluoride toothpaste).<br />
* Floss regularly to remove plaque from between teeth. <br />
* Use a device such as a special brush or wooden or plastic pick recommended by a dental professional.<br />
* Visit the dentist routinely for a check-up and professional cleaning.<br />
* Don’t smoke<br />
<br />
==Complications==<br />
<br />
In some studies, researchers have observed that people with gum disease (when compared to people without gum disease) were more likely to develop heart disease or have difficulty controlling blood sugar. Other studies showed that women with gum disease were more likely than those with healthy gums to deliver preterm, low birth weight babies. But so far, it has not been determined whether gum disease is the cause of these conditions.<br />
<br />
There may be other reasons people with gum disease sometimes develop additional health problems.<br />
<br />
For example, something else may be causing both the gum disease and the other condition, or it could be a coincidence that gum disease and other health problems are present together.<br />
<br />
More research is needed to clarify whether gum disease actually causes health problems beyond the mouth, and whether treating gum disease can keep other health conditions from developing.<br />
<br />
In the meantime, it’s a fact that controlling gum disease can save your teeth – a very good reason to take care of your teeth and gums.</div>C Michael Gibsonhttps://www.wikidoc.org/index.php?title=Peridontal_disease_(patient_information)&diff=1233675Peridontal disease (patient information)2016-06-01T15:24:41Z<p>C Michael Gibson: /* Symptoms */</p>
<hr />
<div>__NOTOC__<br />
<br />
{{CMG}}<br />
<br />
==Overview==<br />
Many adults in the U.S. currently have some form of the disease. Periodontal diseases range from simple gum inflammation to serious disease that results in major damage to the soft tissue and bone that support the teeth. In the worst cases, teeth are lost. Whether your gum disease is stopped, slowed, or gets worse depends a great deal on how well you care for your teeth and gums every day, from this point forward.<br />
<br />
==Causes==<br />
Our mouths are full of bacteria. These bacteria, along with mucus and other particles, constantly form a sticky, colorless “plaque” on teeth. Brushing and flossing help get rid of plaque. Plaque that is not removed can harden and form “tartar” that brushing doesn’t clean. Only a professional cleaning by a dentist or dental hygienist can remove tartar.<br />
<br />
<br />
==Natural History==<br />
===Gingivitis?===<br />
The longer plaque and tartar are on teeth, the more harmful they become. The bacteria cause inflammation of the gums that is called “gingivitis.” In gingivitis, the gums become red, swollen and can bleed easily. Gingivitis is a mild form of gum disease that can usually be reversed with daily brushing and flossing, and regular cleaning by a dentist or dental hygienist. This form of gum disease does not include any loss of bone and tissue that hold teeth in place.<br />
<br />
===Periodontitis===<br />
When gingivitis is not treated, it can advance to “periodontitis” (which means “inflammation around the tooth”). In periodontitis, gums pull away from the teeth and form spaces (called “pockets”) that become infected. The body’s immune system fights the bacteria as the plaque spreads and grows below the gum line. Bacterial toxins and the body’s natural response to infection start to break down the bone and connective tissue that hold teeth in place. If not treated, the bones, gums, and tissue that support the teeth are destroyed. The teeth may eventually become loose and have to be removed.<br />
<br />
==Risk Factors==<br />
<br />
Smoking. Need another reason to quit smoking? Smoking is one of the most significant risk factors associated with the development of gum disease. Additionally, smoking can lower the chances for successful treatment.<br />
Hormonal changes in girls/women. These changes can make gums more sensitive and make it easier for gingivitis to develop.<br />
Diabetes. People with diabetes are at higher risk for developing infections, including gum disease.<br />
Other illnesses and their treatments. Diseases such as AIDS and its treatments can also negatively affect the health of gums, as can treatments for cancer.<br />
Medications. There are hundreds of prescription and over the counter medications that can reduce the flow of saliva, which has a protective effect on the mouth. Without enough saliva, the mouth is vulnerable to infections such as gum disease. And some medicines can cause abnormal overgrowth of the gum tissue; this can make it difficult to keep teeth and gums clean.<br />
Genetic susceptibility. Some people are more prone to severe gum disease than others.<br />
<br />
==Epidemiology and Demographics==<br />
People usually don’t show signs of gum disease until they are in their 30s or 40s. Men are more likely to have gum disease than women. Although teenagers rarely develop periodontitis, they can develop gingivitis, the milder form of gum disease. Most commonly, gum disease develops when plaque is allowed to build up along and under the gum line.<br />
<br />
==Symptoms==<br />
* [[Bad breath]] that won’t go away<br />
* Red or swollen gums<br />
* Tender or bleeding gums<br />
* Painful chewing<br />
* Loose teeth<br />
* Sensitive teeth<br />
* Receding gums or longer appearing teeth<br />
<br />
==Physical Examination==<br />
<br />
Ask about your medical history to identify underlying conditions or risk factors (such as smoking) that may contribute to gum disease.<br />
Examine your gums and note any signs of inflammation.<br />
Use a tiny ruler called a “probe” to check for and measure any pockets. In a healthy mouth, the depth of these pockets is usually between 1 and 3 millimeters. This test for pocket depth is usually painless.<br />
<br />
==Diagnostic Studies==<br />
The dentist or hygienist may take an x-ray to see whether there is any bone loss.<br />
<br />
==Treatment==<br />
Refer you to a periodontist. Periodontists are experts in the diagnosis and treatment of gum disease and may provide you with treatment options that are not offered by your dentist.<br />
<br />
The main goal of treatment is to control the infection. The number and types of treatment will vary, depending on the extent of the gum disease. Any type of treatment requires that the patient keep up good daily care at home. The doctor may also suggest changing certain behaviors, such as quitting smoking, as a way to improve treatment outcome.<br />
Deep Cleaning (Scaling and Root Planing)<br />
<br />
The dentist, periodontist, or dental hygienist removes the plaque through a deep-cleaning method called scaling and root planing. Scaling means scraping off the tartar from above and below the gum line. Root planing gets rid of rough spots on the tooth root where the germs gather, and helps remove bacteria that contribute to the disease. In some cases a laser may be used to remove plaque and tartar. This procedure can result in less bleeding, swelling, and discomfort compared to traditional deep cleaning methods.<br />
Medications<br />
<br />
Medications may be used with treatment that includes scaling and root planning, but they cannot always take the place of surgery. Depending on how far the disease has progressed, the dentist or periodontist may still suggest surgical treatment. Long-term studies are needed to find out if using medications reduces the need for surgery and whether they are effective over a long period of time. Listed on the next page are some medications that are currently used.<br />
Medications Medications What is it? Why is it used? How is it used?<br />
Prescription antimicrobial mouthrinse A prescription mouthrinse containing an antimicrobial called chlorhexidine To control bacteria when treating gingivitis and after gum surgery It's used like a regular mouthwash.<br />
Antiseptic chip A tiny piece of gelatin filled with the medicine chlorhexidine To control bacteria and reduce the size of periodontal pockets After root planing, it's placed in the pockets where the medicine is slowly released over time.<br />
Antibiotic gel A gel that contains the antibiotic doxycycline To control bacteria and reduce the size of periodontal pockets The periodontist puts it in the pockets after scaling and root planing. The antibiotic is released slowly over a period of about seven days.<br />
Antibiotic microspheres Tiny, round particles that contain the antibiotic minocycline To control bacteria and reduce the size of periodontal pockets The periodontist puts the microspheres into the pockets after scaling and root planing. The particles release minocycline<br />
slowly over time.<br />
Enzyme suppressant A low dose of the medication doxycycline that keeps destructive enzymes in check To hold back the body's enzyme response -- If not controlled, certain enzymes can break down gum tissue This medication is in tablet form. It is used in combination with scaling and root planing.<br />
Oral antibiotics Antibiotic tablets or capsules For short term treatment of an acute or locally persistent periodontal infection These come as tablets or capsules and are taken by mouth.<br />
Surgical Treatments<br />
<br />
Flap Surgery. Surgery might be necessary if inflammation and deep pockets remain following treatment with deep cleaning and medications. A dentist or periodontist may perform flap surgery to remove tartar deposits in deep pockets or to reduce the periodontal pocket and make it easier for the patient, dentist, and hygienist to keep the area clean. This common surgery involves lifting back the gums and removing the tartar. The gums are then sutured back in place so that the tissue fits snugly around the tooth again. After surgery the gums will heal and fit more tightly around the tooth. This sometimes results in the teeth appearing longer.<br />
<br />
Bone and Tissue Grafts. In addition to flap surgery, your periodontist or dentist may suggest procedures to help regenerate any bone or gum tissue lost to periodontitis. Bone grafting, in which natural or synthetic bone is placed in the area of bone loss, can help promote bone growth. A technique that can be used with bone grafting is called guided tissue regeneration. In this procedure, a small piece of mesh-like material is inserted between the bone and gum tissue. This keeps the gum tissue from growing into the area where the bone should be, allowing the bone and connective tissue to regrow. Growth factors – proteins that can help your body naturally regrow bone – may also be used. In cases where gum tissue has been lost, your dentist or periodontist may suggest a soft tissue graft, in which synthetic material or tissue taken from another area of your mouth is used to cover exposed tooth roots.<br />
<br />
Since each case is different, it is not possible to predict with certainty which grafts will be successful over the long-term. Treatment results depend on many things, including how far the disease has progressed, how well the patient keeps up with oral care at home, and certain risk factors, such as smoking, which may lower the chances of success. Ask your periodontist what the level of success might be in your particular case.<br />
Second Opinion<br />
<br />
When considering any extensive dental or medical treatment options, you should think about getting a second opinion. To find a dentist or periodontist for a second opinion, call your local dental society. They can provide you with names of practitioners in your area. Additionally, dental schools may sometimes be able to offer a second opinion. Call the dental school in your area to find out whether it offers this service.<br />
<br />
==Prevention==<br />
Brush your teeth twice a day (with a fluoride toothpaste).<br />
Floss regularly to remove plaque from between teeth. Or use a device such as a special brush or wooden or plastic pick recommended by a dental professional.<br />
Visit the dentist routinely for a check-up and professional cleaning.<br />
Don’t smoke<br />
<br />
==Complications==<br />
<br />
In some studies, researchers have observed that people with gum disease (when compared to people without gum disease) were more likely to develop heart disease or have difficulty controlling blood sugar. Other studies showed that women with gum disease were more likely than those with healthy gums to deliver preterm, low birth weight babies. But so far, it has not been determined whether gum disease is the cause of these conditions.<br />
<br />
There may be other reasons people with gum disease sometimes develop additional health problems.<br />
<br />
For example, something else may be causing both the gum disease and the other condition, or it could be a coincidence that gum disease and other health problems are present together.<br />
<br />
More research is needed to clarify whether gum disease actually causes health problems beyond the mouth, and whether treating gum disease can keep other health conditions from developing.<br />
<br />
In the meantime, it’s a fact that controlling gum disease can save your teeth – a very good reason to take care of your teeth and gums.</div>C Michael Gibsonhttps://www.wikidoc.org/index.php?title=Peridontal_disease_(patient_information)&diff=1233666Peridontal disease (patient information)2016-06-01T15:21:47Z<p>C Michael Gibson: /* Risk Factors */</p>
<hr />
<div>__NOTOC__<br />
<br />
{{CMG}}<br />
<br />
==Overview==<br />
Many adults in the U.S. currently have some form of the disease. Periodontal diseases range from simple gum inflammation to serious disease that results in major damage to the soft tissue and bone that support the teeth. In the worst cases, teeth are lost. Whether your gum disease is stopped, slowed, or gets worse depends a great deal on how well you care for your teeth and gums every day, from this point forward.<br />
<br />
==Causes==<br />
Our mouths are full of bacteria. These bacteria, along with mucus and other particles, constantly form a sticky, colorless “plaque” on teeth. Brushing and flossing help get rid of plaque. Plaque that is not removed can harden and form “tartar” that brushing doesn’t clean. Only a professional cleaning by a dentist or dental hygienist can remove tartar.<br />
<br />
<br />
==Natural History==<br />
===Gingivitis?===<br />
The longer plaque and tartar are on teeth, the more harmful they become. The bacteria cause inflammation of the gums that is called “gingivitis.” In gingivitis, the gums become red, swollen and can bleed easily. Gingivitis is a mild form of gum disease that can usually be reversed with daily brushing and flossing, and regular cleaning by a dentist or dental hygienist. This form of gum disease does not include any loss of bone and tissue that hold teeth in place.<br />
<br />
===Periodontitis===<br />
When gingivitis is not treated, it can advance to “periodontitis” (which means “inflammation around the tooth”). In periodontitis, gums pull away from the teeth and form spaces (called “pockets”) that become infected. The body’s immune system fights the bacteria as the plaque spreads and grows below the gum line. Bacterial toxins and the body’s natural response to infection start to break down the bone and connective tissue that hold teeth in place. If not treated, the bones, gums, and tissue that support the teeth are destroyed. The teeth may eventually become loose and have to be removed.<br />
<br />
==Risk Factors==<br />
<br />
Smoking. Need another reason to quit smoking? Smoking is one of the most significant risk factors associated with the development of gum disease. Additionally, smoking can lower the chances for successful treatment.<br />
Hormonal changes in girls/women. These changes can make gums more sensitive and make it easier for gingivitis to develop.<br />
Diabetes. People with diabetes are at higher risk for developing infections, including gum disease.<br />
Other illnesses and their treatments. Diseases such as AIDS and its treatments can also negatively affect the health of gums, as can treatments for cancer.<br />
Medications. There are hundreds of prescription and over the counter medications that can reduce the flow of saliva, which has a protective effect on the mouth. Without enough saliva, the mouth is vulnerable to infections such as gum disease. And some medicines can cause abnormal overgrowth of the gum tissue; this can make it difficult to keep teeth and gums clean.<br />
Genetic susceptibility. Some people are more prone to severe gum disease than others.<br />
<br />
==Epidemiology and Demographics==<br />
People usually don’t show signs of gum disease until they are in their 30s or 40s. Men are more likely to have gum disease than women. Although teenagers rarely develop periodontitis, they can develop gingivitis, the milder form of gum disease. Most commonly, gum disease develops when plaque is allowed to build up along and under the gum line.<br />
<br />
==Symptoms==<br />
<br />
Bad breath that won’t go away<br />
Red or swollen gums<br />
Tender or bleeding gums<br />
Painful chewing<br />
Loose teeth<br />
Sensitive teeth<br />
Receding gums or longer appearing teeth<br />
<br />
==Physical Examination==<br />
<br />
Ask about your medical history to identify underlying conditions or risk factors (such as smoking) that may contribute to gum disease.<br />
Examine your gums and note any signs of inflammation.<br />
Use a tiny ruler called a “probe” to check for and measure any pockets. In a healthy mouth, the depth of these pockets is usually between 1 and 3 millimeters. This test for pocket depth is usually painless.<br />
<br />
==Diagnostic Studies==<br />
The dentist or hygienist may take an x-ray to see whether there is any bone loss.<br />
<br />
==Treatment==<br />
Refer you to a periodontist. Periodontists are experts in the diagnosis and treatment of gum disease and may provide you with treatment options that are not offered by your dentist.<br />
<br />
The main goal of treatment is to control the infection. The number and types of treatment will vary, depending on the extent of the gum disease. Any type of treatment requires that the patient keep up good daily care at home. The doctor may also suggest changing certain behaviors, such as quitting smoking, as a way to improve treatment outcome.<br />
Deep Cleaning (Scaling and Root Planing)<br />
<br />
The dentist, periodontist, or dental hygienist removes the plaque through a deep-cleaning method called scaling and root planing. Scaling means scraping off the tartar from above and below the gum line. Root planing gets rid of rough spots on the tooth root where the germs gather, and helps remove bacteria that contribute to the disease. In some cases a laser may be used to remove plaque and tartar. This procedure can result in less bleeding, swelling, and discomfort compared to traditional deep cleaning methods.<br />
Medications<br />
<br />
Medications may be used with treatment that includes scaling and root planning, but they cannot always take the place of surgery. Depending on how far the disease has progressed, the dentist or periodontist may still suggest surgical treatment. Long-term studies are needed to find out if using medications reduces the need for surgery and whether they are effective over a long period of time. Listed on the next page are some medications that are currently used.<br />
Medications Medications What is it? Why is it used? How is it used?<br />
Prescription antimicrobial mouthrinse A prescription mouthrinse containing an antimicrobial called chlorhexidine To control bacteria when treating gingivitis and after gum surgery It's used like a regular mouthwash.<br />
Antiseptic chip A tiny piece of gelatin filled with the medicine chlorhexidine To control bacteria and reduce the size of periodontal pockets After root planing, it's placed in the pockets where the medicine is slowly released over time.<br />
Antibiotic gel A gel that contains the antibiotic doxycycline To control bacteria and reduce the size of periodontal pockets The periodontist puts it in the pockets after scaling and root planing. The antibiotic is released slowly over a period of about seven days.<br />
Antibiotic microspheres Tiny, round particles that contain the antibiotic minocycline To control bacteria and reduce the size of periodontal pockets The periodontist puts the microspheres into the pockets after scaling and root planing. The particles release minocycline<br />
slowly over time.<br />
Enzyme suppressant A low dose of the medication doxycycline that keeps destructive enzymes in check To hold back the body's enzyme response -- If not controlled, certain enzymes can break down gum tissue This medication is in tablet form. It is used in combination with scaling and root planing.<br />
Oral antibiotics Antibiotic tablets or capsules For short term treatment of an acute or locally persistent periodontal infection These come as tablets or capsules and are taken by mouth.<br />
Surgical Treatments<br />
<br />
Flap Surgery. Surgery might be necessary if inflammation and deep pockets remain following treatment with deep cleaning and medications. A dentist or periodontist may perform flap surgery to remove tartar deposits in deep pockets or to reduce the periodontal pocket and make it easier for the patient, dentist, and hygienist to keep the area clean. This common surgery involves lifting back the gums and removing the tartar. The gums are then sutured back in place so that the tissue fits snugly around the tooth again. After surgery the gums will heal and fit more tightly around the tooth. This sometimes results in the teeth appearing longer.<br />
<br />
Bone and Tissue Grafts. In addition to flap surgery, your periodontist or dentist may suggest procedures to help regenerate any bone or gum tissue lost to periodontitis. Bone grafting, in which natural or synthetic bone is placed in the area of bone loss, can help promote bone growth. A technique that can be used with bone grafting is called guided tissue regeneration. In this procedure, a small piece of mesh-like material is inserted between the bone and gum tissue. This keeps the gum tissue from growing into the area where the bone should be, allowing the bone and connective tissue to regrow. Growth factors – proteins that can help your body naturally regrow bone – may also be used. In cases where gum tissue has been lost, your dentist or periodontist may suggest a soft tissue graft, in which synthetic material or tissue taken from another area of your mouth is used to cover exposed tooth roots.<br />
<br />
Since each case is different, it is not possible to predict with certainty which grafts will be successful over the long-term. Treatment results depend on many things, including how far the disease has progressed, how well the patient keeps up with oral care at home, and certain risk factors, such as smoking, which may lower the chances of success. Ask your periodontist what the level of success might be in your particular case.<br />
Second Opinion<br />
<br />
When considering any extensive dental or medical treatment options, you should think about getting a second opinion. To find a dentist or periodontist for a second opinion, call your local dental society. They can provide you with names of practitioners in your area. Additionally, dental schools may sometimes be able to offer a second opinion. Call the dental school in your area to find out whether it offers this service.<br />
<br />
==Prevention==<br />
Brush your teeth twice a day (with a fluoride toothpaste).<br />
Floss regularly to remove plaque from between teeth. Or use a device such as a special brush or wooden or plastic pick recommended by a dental professional.<br />
Visit the dentist routinely for a check-up and professional cleaning.<br />
Don’t smoke<br />
<br />
==Complications==<br />
<br />
In some studies, researchers have observed that people with gum disease (when compared to people without gum disease) were more likely to develop heart disease or have difficulty controlling blood sugar. Other studies showed that women with gum disease were more likely than those with healthy gums to deliver preterm, low birth weight babies. But so far, it has not been determined whether gum disease is the cause of these conditions.<br />
<br />
There may be other reasons people with gum disease sometimes develop additional health problems.<br />
<br />
For example, something else may be causing both the gum disease and the other condition, or it could be a coincidence that gum disease and other health problems are present together.<br />
<br />
More research is needed to clarify whether gum disease actually causes health problems beyond the mouth, and whether treating gum disease can keep other health conditions from developing.<br />
<br />
In the meantime, it’s a fact that controlling gum disease can save your teeth – a very good reason to take care of your teeth and gums.</div>C Michael Gibsonhttps://www.wikidoc.org/index.php?title=Peridontal_disease_(patient_information)&diff=1233664Peridontal disease (patient information)2016-06-01T15:21:20Z<p>C Michael Gibson: /* What is Gingivitis? */</p>
<hr />
<div>__NOTOC__<br />
<br />
{{CMG}}<br />
<br />
==Overview==<br />
Many adults in the U.S. currently have some form of the disease. Periodontal diseases range from simple gum inflammation to serious disease that results in major damage to the soft tissue and bone that support the teeth. In the worst cases, teeth are lost. Whether your gum disease is stopped, slowed, or gets worse depends a great deal on how well you care for your teeth and gums every day, from this point forward.<br />
<br />
==Causes==<br />
Our mouths are full of bacteria. These bacteria, along with mucus and other particles, constantly form a sticky, colorless “plaque” on teeth. Brushing and flossing help get rid of plaque. Plaque that is not removed can harden and form “tartar” that brushing doesn’t clean. Only a professional cleaning by a dentist or dental hygienist can remove tartar.<br />
<br />
<br />
==Natural History==<br />
===Gingivitis?===<br />
The longer plaque and tartar are on teeth, the more harmful they become. The bacteria cause inflammation of the gums that is called “gingivitis.” In gingivitis, the gums become red, swollen and can bleed easily. Gingivitis is a mild form of gum disease that can usually be reversed with daily brushing and flossing, and regular cleaning by a dentist or dental hygienist. This form of gum disease does not include any loss of bone and tissue that hold teeth in place.<br />
<br />
===Periodontitis===<br />
When gingivitis is not treated, it can advance to “periodontitis” (which means “inflammation around the tooth”). In periodontitis, gums pull away from the teeth and form spaces (called “pockets”) that become infected. The body’s immune system fights the bacteria as the plaque spreads and grows below the gum line. Bacterial toxins and the body’s natural response to infection start to break down the bone and connective tissue that hold teeth in place. If not treated, the bones, gums, and tissue that support the teeth are destroyed. The teeth may eventually become loose and have to be removed.<br />
<br />
==Risk Factors==<br />
<br />
Smoking. Need another reason to quit smoking? Smoking is one of the most significant risk factors associated with the development of gum disease. Additionally, smoking can lower the chances for successful treatment.<br />
Hormonal changes in girls/women. These changes can make gums more sensitive and make it easier for gingivitis to develop.<br />
Diabetes. People with diabetes are at higher risk for developing infections, including gum disease.<br />
Other illnesses and their treatments. Diseases such as AIDS and its treatments can also negatively affect the health of gums, as can treatments for cancer.<br />
Medications. There are hundreds of prescription and over the counter medications that can reduce the flow of saliva, which has a protective effect on the mouth. Without enough saliva, the mouth is vulnerable to infections such as gum disease. And some medicines can cause abnormal overgrowth of the gum tissue; this can make it difficult to keep teeth and gums clean.<br />
Genetic susceptibility. Some people are more prone to severe gum disease than others.<br />
<br />
==Epidemiology and Demographics==<br />
People usually don’t show signs of gum disease until they are in their 30s or 40s. Men are more likely to have gum disease than women. Although teenagers rarely develop periodontitis, they can develop gingivitis, the milder form of gum disease. Most commonly, gum disease develops when plaque is allowed to build up along and under the gum line.<br />
<br />
==Risk Factors==<br />
<br />
==Symptoms==<br />
<br />
Bad breath that won’t go away<br />
Red or swollen gums<br />
Tender or bleeding gums<br />
Painful chewing<br />
Loose teeth<br />
Sensitive teeth<br />
Receding gums or longer appearing teeth<br />
<br />
==Physical Examination==<br />
<br />
Ask about your medical history to identify underlying conditions or risk factors (such as smoking) that may contribute to gum disease.<br />
Examine your gums and note any signs of inflammation.<br />
Use a tiny ruler called a “probe” to check for and measure any pockets. In a healthy mouth, the depth of these pockets is usually between 1 and 3 millimeters. This test for pocket depth is usually painless.<br />
<br />
==Diagnostic Studies==<br />
The dentist or hygienist may take an x-ray to see whether there is any bone loss.<br />
<br />
==Treatment==<br />
Refer you to a periodontist. Periodontists are experts in the diagnosis and treatment of gum disease and may provide you with treatment options that are not offered by your dentist.<br />
<br />
The main goal of treatment is to control the infection. The number and types of treatment will vary, depending on the extent of the gum disease. Any type of treatment requires that the patient keep up good daily care at home. The doctor may also suggest changing certain behaviors, such as quitting smoking, as a way to improve treatment outcome.<br />
Deep Cleaning (Scaling and Root Planing)<br />
<br />
The dentist, periodontist, or dental hygienist removes the plaque through a deep-cleaning method called scaling and root planing. Scaling means scraping off the tartar from above and below the gum line. Root planing gets rid of rough spots on the tooth root where the germs gather, and helps remove bacteria that contribute to the disease. In some cases a laser may be used to remove plaque and tartar. This procedure can result in less bleeding, swelling, and discomfort compared to traditional deep cleaning methods.<br />
Medications<br />
<br />
Medications may be used with treatment that includes scaling and root planning, but they cannot always take the place of surgery. Depending on how far the disease has progressed, the dentist or periodontist may still suggest surgical treatment. Long-term studies are needed to find out if using medications reduces the need for surgery and whether they are effective over a long period of time. Listed on the next page are some medications that are currently used.<br />
Medications Medications What is it? Why is it used? How is it used?<br />
Prescription antimicrobial mouthrinse A prescription mouthrinse containing an antimicrobial called chlorhexidine To control bacteria when treating gingivitis and after gum surgery It's used like a regular mouthwash.<br />
Antiseptic chip A tiny piece of gelatin filled with the medicine chlorhexidine To control bacteria and reduce the size of periodontal pockets After root planing, it's placed in the pockets where the medicine is slowly released over time.<br />
Antibiotic gel A gel that contains the antibiotic doxycycline To control bacteria and reduce the size of periodontal pockets The periodontist puts it in the pockets after scaling and root planing. The antibiotic is released slowly over a period of about seven days.<br />
Antibiotic microspheres Tiny, round particles that contain the antibiotic minocycline To control bacteria and reduce the size of periodontal pockets The periodontist puts the microspheres into the pockets after scaling and root planing. The particles release minocycline<br />
slowly over time.<br />
Enzyme suppressant A low dose of the medication doxycycline that keeps destructive enzymes in check To hold back the body's enzyme response -- If not controlled, certain enzymes can break down gum tissue This medication is in tablet form. It is used in combination with scaling and root planing.<br />
Oral antibiotics Antibiotic tablets or capsules For short term treatment of an acute or locally persistent periodontal infection These come as tablets or capsules and are taken by mouth.<br />
Surgical Treatments<br />
<br />
Flap Surgery. Surgery might be necessary if inflammation and deep pockets remain following treatment with deep cleaning and medications. A dentist or periodontist may perform flap surgery to remove tartar deposits in deep pockets or to reduce the periodontal pocket and make it easier for the patient, dentist, and hygienist to keep the area clean. This common surgery involves lifting back the gums and removing the tartar. The gums are then sutured back in place so that the tissue fits snugly around the tooth again. After surgery the gums will heal and fit more tightly around the tooth. This sometimes results in the teeth appearing longer.<br />
<br />
Bone and Tissue Grafts. In addition to flap surgery, your periodontist or dentist may suggest procedures to help regenerate any bone or gum tissue lost to periodontitis. Bone grafting, in which natural or synthetic bone is placed in the area of bone loss, can help promote bone growth. A technique that can be used with bone grafting is called guided tissue regeneration. In this procedure, a small piece of mesh-like material is inserted between the bone and gum tissue. This keeps the gum tissue from growing into the area where the bone should be, allowing the bone and connective tissue to regrow. Growth factors – proteins that can help your body naturally regrow bone – may also be used. In cases where gum tissue has been lost, your dentist or periodontist may suggest a soft tissue graft, in which synthetic material or tissue taken from another area of your mouth is used to cover exposed tooth roots.<br />
<br />
Since each case is different, it is not possible to predict with certainty which grafts will be successful over the long-term. Treatment results depend on many things, including how far the disease has progressed, how well the patient keeps up with oral care at home, and certain risk factors, such as smoking, which may lower the chances of success. Ask your periodontist what the level of success might be in your particular case.<br />
Second Opinion<br />
<br />
When considering any extensive dental or medical treatment options, you should think about getting a second opinion. To find a dentist or periodontist for a second opinion, call your local dental society. They can provide you with names of practitioners in your area. Additionally, dental schools may sometimes be able to offer a second opinion. Call the dental school in your area to find out whether it offers this service.<br />
<br />
==Prevention==<br />
Brush your teeth twice a day (with a fluoride toothpaste).<br />
Floss regularly to remove plaque from between teeth. Or use a device such as a special brush or wooden or plastic pick recommended by a dental professional.<br />
Visit the dentist routinely for a check-up and professional cleaning.<br />
Don’t smoke<br />
<br />
==Complications==<br />
<br />
In some studies, researchers have observed that people with gum disease (when compared to people without gum disease) were more likely to develop heart disease or have difficulty controlling blood sugar. Other studies showed that women with gum disease were more likely than those with healthy gums to deliver preterm, low birth weight babies. But so far, it has not been determined whether gum disease is the cause of these conditions.<br />
<br />
There may be other reasons people with gum disease sometimes develop additional health problems.<br />
<br />
For example, something else may be causing both the gum disease and the other condition, or it could be a coincidence that gum disease and other health problems are present together.<br />
<br />
More research is needed to clarify whether gum disease actually causes health problems beyond the mouth, and whether treating gum disease can keep other health conditions from developing.<br />
<br />
In the meantime, it’s a fact that controlling gum disease can save your teeth – a very good reason to take care of your teeth and gums.</div>C Michael Gibsonhttps://www.wikidoc.org/index.php?title=Peridontal_disease_(patient_information)&diff=1233660Peridontal disease (patient information)2016-06-01T15:20:14Z<p>C Michael Gibson: /* Periodontitis */</p>
<hr />
<div>__NOTOC__<br />
<br />
{{CMG}}<br />
<br />
==Overview==<br />
Many adults in the U.S. currently have some form of the disease. Periodontal diseases range from simple gum inflammation to serious disease that results in major damage to the soft tissue and bone that support the teeth. In the worst cases, teeth are lost. Whether your gum disease is stopped, slowed, or gets worse depends a great deal on how well you care for your teeth and gums every day, from this point forward.<br />
<br />
==Causes==<br />
Our mouths are full of bacteria. These bacteria, along with mucus and other particles, constantly form a sticky, colorless “plaque” on teeth. Brushing and flossing help get rid of plaque. Plaque that is not removed can harden and form “tartar” that brushing doesn’t clean. Only a professional cleaning by a dentist or dental hygienist can remove tartar.<br />
<br />
<br />
==What is Gingivitis?==<br />
<br />
The longer plaque and tartar are on teeth, the more harmful they become. The bacteria cause inflammation of the gums that is called “gingivitis.” In gingivitis, the gums become red, swollen and can bleed easily. Gingivitis is a mild form of gum disease that can usually be reversed with daily brushing and flossing, and regular cleaning by a dentist or dental hygienist. This form of gum disease does not include any loss of bone and tissue that hold teeth in place.<br />
<br />
===Periodontitis===<br />
When gingivitis is not treated, it can advance to “periodontitis” (which means “inflammation around the tooth”). In periodontitis, gums pull away from the teeth and form spaces (called “pockets”) that become infected. The body’s immune system fights the bacteria as the plaque spreads and grows below the gum line. Bacterial toxins and the body’s natural response to infection start to break down the bone and connective tissue that hold teeth in place. If not treated, the bones, gums, and tissue that support the teeth are destroyed. The teeth may eventually become loose and have to be removed.<br />
<br />
==Risk Factors==<br />
<br />
Smoking. Need another reason to quit smoking? Smoking is one of the most significant risk factors associated with the development of gum disease. Additionally, smoking can lower the chances for successful treatment.<br />
Hormonal changes in girls/women. These changes can make gums more sensitive and make it easier for gingivitis to develop.<br />
Diabetes. People with diabetes are at higher risk for developing infections, including gum disease.<br />
Other illnesses and their treatments. Diseases such as AIDS and its treatments can also negatively affect the health of gums, as can treatments for cancer.<br />
Medications. There are hundreds of prescription and over the counter medications that can reduce the flow of saliva, which has a protective effect on the mouth. Without enough saliva, the mouth is vulnerable to infections such as gum disease. And some medicines can cause abnormal overgrowth of the gum tissue; this can make it difficult to keep teeth and gums clean.<br />
Genetic susceptibility. Some people are more prone to severe gum disease than others.<br />
<br />
==Epidemiology and Demographics==<br />
People usually don’t show signs of gum disease until they are in their 30s or 40s. Men are more likely to have gum disease than women. Although teenagers rarely develop periodontitis, they can develop gingivitis, the milder form of gum disease. Most commonly, gum disease develops when plaque is allowed to build up along and under the gum line.<br />
<br />
==Risk Factors==<br />
<br />
==Symptoms==<br />
<br />
Bad breath that won’t go away<br />
Red or swollen gums<br />
Tender or bleeding gums<br />
Painful chewing<br />
Loose teeth<br />
Sensitive teeth<br />
Receding gums or longer appearing teeth<br />
<br />
==Physical Examination==<br />
<br />
Ask about your medical history to identify underlying conditions or risk factors (such as smoking) that may contribute to gum disease.<br />
Examine your gums and note any signs of inflammation.<br />
Use a tiny ruler called a “probe” to check for and measure any pockets. In a healthy mouth, the depth of these pockets is usually between 1 and 3 millimeters. This test for pocket depth is usually painless.<br />
<br />
==Diagnostic Studies==<br />
The dentist or hygienist may take an x-ray to see whether there is any bone loss.<br />
<br />
==Treatment==<br />
Refer you to a periodontist. Periodontists are experts in the diagnosis and treatment of gum disease and may provide you with treatment options that are not offered by your dentist.<br />
<br />
The main goal of treatment is to control the infection. The number and types of treatment will vary, depending on the extent of the gum disease. Any type of treatment requires that the patient keep up good daily care at home. The doctor may also suggest changing certain behaviors, such as quitting smoking, as a way to improve treatment outcome.<br />
Deep Cleaning (Scaling and Root Planing)<br />
<br />
The dentist, periodontist, or dental hygienist removes the plaque through a deep-cleaning method called scaling and root planing. Scaling means scraping off the tartar from above and below the gum line. Root planing gets rid of rough spots on the tooth root where the germs gather, and helps remove bacteria that contribute to the disease. In some cases a laser may be used to remove plaque and tartar. This procedure can result in less bleeding, swelling, and discomfort compared to traditional deep cleaning methods.<br />
Medications<br />
<br />
Medications may be used with treatment that includes scaling and root planning, but they cannot always take the place of surgery. Depending on how far the disease has progressed, the dentist or periodontist may still suggest surgical treatment. Long-term studies are needed to find out if using medications reduces the need for surgery and whether they are effective over a long period of time. Listed on the next page are some medications that are currently used.<br />
Medications Medications What is it? Why is it used? How is it used?<br />
Prescription antimicrobial mouthrinse A prescription mouthrinse containing an antimicrobial called chlorhexidine To control bacteria when treating gingivitis and after gum surgery It's used like a regular mouthwash.<br />
Antiseptic chip A tiny piece of gelatin filled with the medicine chlorhexidine To control bacteria and reduce the size of periodontal pockets After root planing, it's placed in the pockets where the medicine is slowly released over time.<br />
Antibiotic gel A gel that contains the antibiotic doxycycline To control bacteria and reduce the size of periodontal pockets The periodontist puts it in the pockets after scaling and root planing. The antibiotic is released slowly over a period of about seven days.<br />
Antibiotic microspheres Tiny, round particles that contain the antibiotic minocycline To control bacteria and reduce the size of periodontal pockets The periodontist puts the microspheres into the pockets after scaling and root planing. The particles release minocycline<br />
slowly over time.<br />
Enzyme suppressant A low dose of the medication doxycycline that keeps destructive enzymes in check To hold back the body's enzyme response -- If not controlled, certain enzymes can break down gum tissue This medication is in tablet form. It is used in combination with scaling and root planing.<br />
Oral antibiotics Antibiotic tablets or capsules For short term treatment of an acute or locally persistent periodontal infection These come as tablets or capsules and are taken by mouth.<br />
Surgical Treatments<br />
<br />
Flap Surgery. Surgery might be necessary if inflammation and deep pockets remain following treatment with deep cleaning and medications. A dentist or periodontist may perform flap surgery to remove tartar deposits in deep pockets or to reduce the periodontal pocket and make it easier for the patient, dentist, and hygienist to keep the area clean. This common surgery involves lifting back the gums and removing the tartar. The gums are then sutured back in place so that the tissue fits snugly around the tooth again. After surgery the gums will heal and fit more tightly around the tooth. This sometimes results in the teeth appearing longer.<br />
<br />
Bone and Tissue Grafts. In addition to flap surgery, your periodontist or dentist may suggest procedures to help regenerate any bone or gum tissue lost to periodontitis. Bone grafting, in which natural or synthetic bone is placed in the area of bone loss, can help promote bone growth. A technique that can be used with bone grafting is called guided tissue regeneration. In this procedure, a small piece of mesh-like material is inserted between the bone and gum tissue. This keeps the gum tissue from growing into the area where the bone should be, allowing the bone and connective tissue to regrow. Growth factors – proteins that can help your body naturally regrow bone – may also be used. In cases where gum tissue has been lost, your dentist or periodontist may suggest a soft tissue graft, in which synthetic material or tissue taken from another area of your mouth is used to cover exposed tooth roots.<br />
<br />
Since each case is different, it is not possible to predict with certainty which grafts will be successful over the long-term. Treatment results depend on many things, including how far the disease has progressed, how well the patient keeps up with oral care at home, and certain risk factors, such as smoking, which may lower the chances of success. Ask your periodontist what the level of success might be in your particular case.<br />
Second Opinion<br />
<br />
When considering any extensive dental or medical treatment options, you should think about getting a second opinion. To find a dentist or periodontist for a second opinion, call your local dental society. They can provide you with names of practitioners in your area. Additionally, dental schools may sometimes be able to offer a second opinion. Call the dental school in your area to find out whether it offers this service.<br />
<br />
==Prevention==<br />
Brush your teeth twice a day (with a fluoride toothpaste).<br />
Floss regularly to remove plaque from between teeth. Or use a device such as a special brush or wooden or plastic pick recommended by a dental professional.<br />
Visit the dentist routinely for a check-up and professional cleaning.<br />
Don’t smoke<br />
<br />
==Complications==<br />
<br />
In some studies, researchers have observed that people with gum disease (when compared to people without gum disease) were more likely to develop heart disease or have difficulty controlling blood sugar. Other studies showed that women with gum disease were more likely than those with healthy gums to deliver preterm, low birth weight babies. But so far, it has not been determined whether gum disease is the cause of these conditions.<br />
<br />
There may be other reasons people with gum disease sometimes develop additional health problems.<br />
<br />
For example, something else may be causing both the gum disease and the other condition, or it could be a coincidence that gum disease and other health problems are present together.<br />
<br />
More research is needed to clarify whether gum disease actually causes health problems beyond the mouth, and whether treating gum disease can keep other health conditions from developing.<br />
<br />
In the meantime, it’s a fact that controlling gum disease can save your teeth – a very good reason to take care of your teeth and gums.</div>C Michael Gibsonhttps://www.wikidoc.org/index.php?title=Peridontal_disease_(patient_information)&diff=1233649Peridontal disease (patient information)2016-06-01T15:11:31Z<p>C Michael Gibson: </p>
<hr />
<div>__NOTOC__<br />
<br />
{{CMG}}<br />
<br />
==Overview==<br />
Many adults in the U.S. currently have some form of the disease. Periodontal diseases range from simple gum inflammation to serious disease that results in major damage to the soft tissue and bone that support the teeth. In the worst cases, teeth are lost. Whether your gum disease is stopped, slowed, or gets worse depends a great deal on how well you care for your teeth and gums every day, from this point forward.<br />
<br />
==Causes==<br />
Our mouths are full of bacteria. These bacteria, along with mucus and other particles, constantly form a sticky, colorless “plaque” on teeth. Brushing and flossing help get rid of plaque. Plaque that is not removed can harden and form “tartar” that brushing doesn’t clean. Only a professional cleaning by a dentist or dental hygienist can remove tartar.<br />
<br />
<br />
==What is Gingivitis?==<br />
<br />
The longer plaque and tartar are on teeth, the more harmful they become. The bacteria cause inflammation of the gums that is called “gingivitis.” In gingivitis, the gums become red, swollen and can bleed easily. Gingivitis is a mild form of gum disease that can usually be reversed with daily brushing and flossing, and regular cleaning by a dentist or dental hygienist. This form of gum disease does not include any loss of bone and tissue that hold teeth in place.<br />
<br />
==Periodontitis==<br />
<br />
When gingivitis is not treated, it can advance to “periodontitis” (which means “inflammation around the tooth”). In periodontitis, gums pull away from the teeth and form spaces (called “pockets”) that become infected. The body’s immune system fights the bacteria as the plaque spreads and grows below the gum line. Bacterial toxins and the body’s natural response to infection start to break down the bone and connective tissue that hold teeth in place. If not treated, the bones, gums, and tissue that support the teeth are destroyed. The teeth may eventually become loose and have to be removed.<br />
<br />
==Risk Factors==<br />
<br />
Smoking. Need another reason to quit smoking? Smoking is one of the most significant risk factors associated with the development of gum disease. Additionally, smoking can lower the chances for successful treatment.<br />
Hormonal changes in girls/women. These changes can make gums more sensitive and make it easier for gingivitis to develop.<br />
Diabetes. People with diabetes are at higher risk for developing infections, including gum disease.<br />
Other illnesses and their treatments. Diseases such as AIDS and its treatments can also negatively affect the health of gums, as can treatments for cancer.<br />
Medications. There are hundreds of prescription and over the counter medications that can reduce the flow of saliva, which has a protective effect on the mouth. Without enough saliva, the mouth is vulnerable to infections such as gum disease. And some medicines can cause abnormal overgrowth of the gum tissue; this can make it difficult to keep teeth and gums clean.<br />
Genetic susceptibility. Some people are more prone to severe gum disease than others.<br />
<br />
==Epidemiology and Demographics==<br />
People usually don’t show signs of gum disease until they are in their 30s or 40s. Men are more likely to have gum disease than women. Although teenagers rarely develop periodontitis, they can develop gingivitis, the milder form of gum disease. Most commonly, gum disease develops when plaque is allowed to build up along and under the gum line.<br />
<br />
==Risk Factors==<br />
<br />
==Symptoms==<br />
<br />
Bad breath that won’t go away<br />
Red or swollen gums<br />
Tender or bleeding gums<br />
Painful chewing<br />
Loose teeth<br />
Sensitive teeth<br />
Receding gums or longer appearing teeth<br />
<br />
==Physical Examination==<br />
<br />
Ask about your medical history to identify underlying conditions or risk factors (such as smoking) that may contribute to gum disease.<br />
Examine your gums and note any signs of inflammation.<br />
Use a tiny ruler called a “probe” to check for and measure any pockets. In a healthy mouth, the depth of these pockets is usually between 1 and 3 millimeters. This test for pocket depth is usually painless.<br />
<br />
==Diagnostic Studies==<br />
The dentist or hygienist may take an x-ray to see whether there is any bone loss.<br />
<br />
==Treatment==<br />
Refer you to a periodontist. Periodontists are experts in the diagnosis and treatment of gum disease and may provide you with treatment options that are not offered by your dentist.<br />
<br />
The main goal of treatment is to control the infection. The number and types of treatment will vary, depending on the extent of the gum disease. Any type of treatment requires that the patient keep up good daily care at home. The doctor may also suggest changing certain behaviors, such as quitting smoking, as a way to improve treatment outcome.<br />
Deep Cleaning (Scaling and Root Planing)<br />
<br />
The dentist, periodontist, or dental hygienist removes the plaque through a deep-cleaning method called scaling and root planing. Scaling means scraping off the tartar from above and below the gum line. Root planing gets rid of rough spots on the tooth root where the germs gather, and helps remove bacteria that contribute to the disease. In some cases a laser may be used to remove plaque and tartar. This procedure can result in less bleeding, swelling, and discomfort compared to traditional deep cleaning methods.<br />
Medications<br />
<br />
Medications may be used with treatment that includes scaling and root planning, but they cannot always take the place of surgery. Depending on how far the disease has progressed, the dentist or periodontist may still suggest surgical treatment. Long-term studies are needed to find out if using medications reduces the need for surgery and whether they are effective over a long period of time. Listed on the next page are some medications that are currently used.<br />
Medications Medications What is it? Why is it used? How is it used?<br />
Prescription antimicrobial mouthrinse A prescription mouthrinse containing an antimicrobial called chlorhexidine To control bacteria when treating gingivitis and after gum surgery It's used like a regular mouthwash.<br />
Antiseptic chip A tiny piece of gelatin filled with the medicine chlorhexidine To control bacteria and reduce the size of periodontal pockets After root planing, it's placed in the pockets where the medicine is slowly released over time.<br />
Antibiotic gel A gel that contains the antibiotic doxycycline To control bacteria and reduce the size of periodontal pockets The periodontist puts it in the pockets after scaling and root planing. The antibiotic is released slowly over a period of about seven days.<br />
Antibiotic microspheres Tiny, round particles that contain the antibiotic minocycline To control bacteria and reduce the size of periodontal pockets The periodontist puts the microspheres into the pockets after scaling and root planing. The particles release minocycline<br />
slowly over time.<br />
Enzyme suppressant A low dose of the medication doxycycline that keeps destructive enzymes in check To hold back the body's enzyme response -- If not controlled, certain enzymes can break down gum tissue This medication is in tablet form. It is used in combination with scaling and root planing.<br />
Oral antibiotics Antibiotic tablets or capsules For short term treatment of an acute or locally persistent periodontal infection These come as tablets or capsules and are taken by mouth.<br />
Surgical Treatments<br />
<br />
Flap Surgery. Surgery might be necessary if inflammation and deep pockets remain following treatment with deep cleaning and medications. A dentist or periodontist may perform flap surgery to remove tartar deposits in deep pockets or to reduce the periodontal pocket and make it easier for the patient, dentist, and hygienist to keep the area clean. This common surgery involves lifting back the gums and removing the tartar. The gums are then sutured back in place so that the tissue fits snugly around the tooth again. After surgery the gums will heal and fit more tightly around the tooth. This sometimes results in the teeth appearing longer.<br />
<br />
Bone and Tissue Grafts. In addition to flap surgery, your periodontist or dentist may suggest procedures to help regenerate any bone or gum tissue lost to periodontitis. Bone grafting, in which natural or synthetic bone is placed in the area of bone loss, can help promote bone growth. A technique that can be used with bone grafting is called guided tissue regeneration. In this procedure, a small piece of mesh-like material is inserted between the bone and gum tissue. This keeps the gum tissue from growing into the area where the bone should be, allowing the bone and connective tissue to regrow. Growth factors – proteins that can help your body naturally regrow bone – may also be used. In cases where gum tissue has been lost, your dentist or periodontist may suggest a soft tissue graft, in which synthetic material or tissue taken from another area of your mouth is used to cover exposed tooth roots.<br />
<br />
Since each case is different, it is not possible to predict with certainty which grafts will be successful over the long-term. Treatment results depend on many things, including how far the disease has progressed, how well the patient keeps up with oral care at home, and certain risk factors, such as smoking, which may lower the chances of success. Ask your periodontist what the level of success might be in your particular case.<br />
Second Opinion<br />
<br />
When considering any extensive dental or medical treatment options, you should think about getting a second opinion. To find a dentist or periodontist for a second opinion, call your local dental society. They can provide you with names of practitioners in your area. Additionally, dental schools may sometimes be able to offer a second opinion. Call the dental school in your area to find out whether it offers this service.<br />
<br />
==Prevention==<br />
Brush your teeth twice a day (with a fluoride toothpaste).<br />
Floss regularly to remove plaque from between teeth. Or use a device such as a special brush or wooden or plastic pick recommended by a dental professional.<br />
Visit the dentist routinely for a check-up and professional cleaning.<br />
Don’t smoke<br />
<br />
==Complications==<br />
<br />
In some studies, researchers have observed that people with gum disease (when compared to people without gum disease) were more likely to develop heart disease or have difficulty controlling blood sugar. Other studies showed that women with gum disease were more likely than those with healthy gums to deliver preterm, low birth weight babies. But so far, it has not been determined whether gum disease is the cause of these conditions.<br />
<br />
There may be other reasons people with gum disease sometimes develop additional health problems.<br />
<br />
For example, something else may be causing both the gum disease and the other condition, or it could be a coincidence that gum disease and other health problems are present together.<br />
<br />
More research is needed to clarify whether gum disease actually causes health problems beyond the mouth, and whether treating gum disease can keep other health conditions from developing.<br />
<br />
In the meantime, it’s a fact that controlling gum disease can save your teeth – a very good reason to take care of your teeth and gums.</div>C Michael Gibsonhttps://www.wikidoc.org/index.php?title=Peridontal_disease_(patient_information)&diff=1233646Peridontal disease (patient information)2016-06-01T15:10:16Z<p>C Michael Gibson: </p>
<hr />
<div>__NOTOC__<br />
<br />
If you have been told you have periodontal (gum) disease, you’re not alone. Many adults in the U.S. currently have some form of the disease. Periodontal diseases range from simple gum inflammation to serious disease that results in major damage to the soft tissue and bone that support the teeth. In the worst cases, teeth are lost.<br />
<br />
Whether your gum disease is stopped, slowed, or gets worse depends a great deal on how well you care for your teeth and gums every day, from this point forward.<br />
<br />
==Causes==<br />
Our mouths are full of bacteria. These bacteria, along with mucus and other particles, constantly form a sticky, colorless “plaque” on teeth. Brushing and flossing help get rid of plaque. Plaque that is not removed can harden and form “tartar” that brushing doesn’t clean. Only a professional cleaning by a dentist or dental hygienist can remove tartar.<br />
<br />
<br />
==What is Gingivitis?==<br />
<br />
The longer plaque and tartar are on teeth, the more harmful they become. The bacteria cause inflammation of the gums that is called “gingivitis.” In gingivitis, the gums become red, swollen and can bleed easily. Gingivitis is a mild form of gum disease that can usually be reversed with daily brushing and flossing, and regular cleaning by a dentist or dental hygienist. This form of gum disease does not include any loss of bone and tissue that hold teeth in place.<br />
<br />
==Periodontitis==<br />
<br />
When gingivitis is not treated, it can advance to “periodontitis” (which means “inflammation around the tooth”). In periodontitis, gums pull away from the teeth and form spaces (called “pockets”) that become infected. The body’s immune system fights the bacteria as the plaque spreads and grows below the gum line. Bacterial toxins and the body’s natural response to infection start to break down the bone and connective tissue that hold teeth in place. If not treated, the bones, gums, and tissue that support the teeth are destroyed. The teeth may eventually become loose and have to be removed.<br />
<br />
==Risk Factors==<br />
<br />
Smoking. Need another reason to quit smoking? Smoking is one of the most significant risk factors associated with the development of gum disease. Additionally, smoking can lower the chances for successful treatment.<br />
Hormonal changes in girls/women. These changes can make gums more sensitive and make it easier for gingivitis to develop.<br />
Diabetes. People with diabetes are at higher risk for developing infections, including gum disease.<br />
Other illnesses and their treatments. Diseases such as AIDS and its treatments can also negatively affect the health of gums, as can treatments for cancer.<br />
Medications. There are hundreds of prescription and over the counter medications that can reduce the flow of saliva, which has a protective effect on the mouth. Without enough saliva, the mouth is vulnerable to infections such as gum disease. And some medicines can cause abnormal overgrowth of the gum tissue; this can make it difficult to keep teeth and gums clean.<br />
Genetic susceptibility. Some people are more prone to severe gum disease than others.<br />
<br />
==Epidemiology and Demographics==<br />
People usually don’t show signs of gum disease until they are in their 30s or 40s. Men are more likely to have gum disease than women. Although teenagers rarely develop periodontitis, they can develop gingivitis, the milder form of gum disease. Most commonly, gum disease develops when plaque is allowed to build up along and under the gum line.<br />
<br />
==Risk Factors==<br />
<br />
==Symptoms==<br />
<br />
Bad breath that won’t go away<br />
Red or swollen gums<br />
Tender or bleeding gums<br />
Painful chewing<br />
Loose teeth<br />
Sensitive teeth<br />
Receding gums or longer appearing teeth<br />
<br />
==Physical Examination==<br />
<br />
Ask about your medical history to identify underlying conditions or risk factors (such as smoking) that may contribute to gum disease.<br />
Examine your gums and note any signs of inflammation.<br />
Use a tiny ruler called a “probe” to check for and measure any pockets. In a healthy mouth, the depth of these pockets is usually between 1 and 3 millimeters. This test for pocket depth is usually painless.<br />
<br />
==Diagnostic Studies==<br />
The dentist or hygienist may take an x-ray to see whether there is any bone loss.<br />
<br />
==Treatment==<br />
Refer you to a periodontist. Periodontists are experts in the diagnosis and treatment of gum disease and may provide you with treatment options that are not offered by your dentist.<br />
<br />
The main goal of treatment is to control the infection. The number and types of treatment will vary, depending on the extent of the gum disease. Any type of treatment requires that the patient keep up good daily care at home. The doctor may also suggest changing certain behaviors, such as quitting smoking, as a way to improve treatment outcome.<br />
Deep Cleaning (Scaling and Root Planing)<br />
<br />
The dentist, periodontist, or dental hygienist removes the plaque through a deep-cleaning method called scaling and root planing. Scaling means scraping off the tartar from above and below the gum line. Root planing gets rid of rough spots on the tooth root where the germs gather, and helps remove bacteria that contribute to the disease. In some cases a laser may be used to remove plaque and tartar. This procedure can result in less bleeding, swelling, and discomfort compared to traditional deep cleaning methods.<br />
Medications<br />
<br />
Medications may be used with treatment that includes scaling and root planning, but they cannot always take the place of surgery. Depending on how far the disease has progressed, the dentist or periodontist may still suggest surgical treatment. Long-term studies are needed to find out if using medications reduces the need for surgery and whether they are effective over a long period of time. Listed on the next page are some medications that are currently used.<br />
Medications Medications What is it? Why is it used? How is it used?<br />
Prescription antimicrobial mouthrinse A prescription mouthrinse containing an antimicrobial called chlorhexidine To control bacteria when treating gingivitis and after gum surgery It's used like a regular mouthwash.<br />
Antiseptic chip A tiny piece of gelatin filled with the medicine chlorhexidine To control bacteria and reduce the size of periodontal pockets After root planing, it's placed in the pockets where the medicine is slowly released over time.<br />
Antibiotic gel A gel that contains the antibiotic doxycycline To control bacteria and reduce the size of periodontal pockets The periodontist puts it in the pockets after scaling and root planing. The antibiotic is released slowly over a period of about seven days.<br />
Antibiotic microspheres Tiny, round particles that contain the antibiotic minocycline To control bacteria and reduce the size of periodontal pockets The periodontist puts the microspheres into the pockets after scaling and root planing. The particles release minocycline<br />
slowly over time.<br />
Enzyme suppressant A low dose of the medication doxycycline that keeps destructive enzymes in check To hold back the body's enzyme response -- If not controlled, certain enzymes can break down gum tissue This medication is in tablet form. It is used in combination with scaling and root planing.<br />
Oral antibiotics Antibiotic tablets or capsules For short term treatment of an acute or locally persistent periodontal infection These come as tablets or capsules and are taken by mouth.<br />
Surgical Treatments<br />
<br />
Flap Surgery. Surgery might be necessary if inflammation and deep pockets remain following treatment with deep cleaning and medications. A dentist or periodontist may perform flap surgery to remove tartar deposits in deep pockets or to reduce the periodontal pocket and make it easier for the patient, dentist, and hygienist to keep the area clean. This common surgery involves lifting back the gums and removing the tartar. The gums are then sutured back in place so that the tissue fits snugly around the tooth again. After surgery the gums will heal and fit more tightly around the tooth. This sometimes results in the teeth appearing longer.<br />
<br />
Bone and Tissue Grafts. In addition to flap surgery, your periodontist or dentist may suggest procedures to help regenerate any bone or gum tissue lost to periodontitis. Bone grafting, in which natural or synthetic bone is placed in the area of bone loss, can help promote bone growth. A technique that can be used with bone grafting is called guided tissue regeneration. In this procedure, a small piece of mesh-like material is inserted between the bone and gum tissue. This keeps the gum tissue from growing into the area where the bone should be, allowing the bone and connective tissue to regrow. Growth factors – proteins that can help your body naturally regrow bone – may also be used. In cases where gum tissue has been lost, your dentist or periodontist may suggest a soft tissue graft, in which synthetic material or tissue taken from another area of your mouth is used to cover exposed tooth roots.<br />
<br />
Since each case is different, it is not possible to predict with certainty which grafts will be successful over the long-term. Treatment results depend on many things, including how far the disease has progressed, how well the patient keeps up with oral care at home, and certain risk factors, such as smoking, which may lower the chances of success. Ask your periodontist what the level of success might be in your particular case.<br />
Second Opinion<br />
<br />
When considering any extensive dental or medical treatment options, you should think about getting a second opinion. To find a dentist or periodontist for a second opinion, call your local dental society. They can provide you with names of practitioners in your area. Additionally, dental schools may sometimes be able to offer a second opinion. Call the dental school in your area to find out whether it offers this service.<br />
<br />
==Prevention==<br />
Brush your teeth twice a day (with a fluoride toothpaste).<br />
Floss regularly to remove plaque from between teeth. Or use a device such as a special brush or wooden or plastic pick recommended by a dental professional.<br />
Visit the dentist routinely for a check-up and professional cleaning.<br />
Don’t smoke<br />
<br />
==Complications==<br />
<br />
In some studies, researchers have observed that people with gum disease (when compared to people without gum disease) were more likely to develop heart disease or have difficulty controlling blood sugar. Other studies showed that women with gum disease were more likely than those with healthy gums to deliver preterm, low birth weight babies. But so far, it has not been determined whether gum disease is the cause of these conditions.<br />
<br />
There may be other reasons people with gum disease sometimes develop additional health problems.<br />
<br />
For example, something else may be causing both the gum disease and the other condition, or it could be a coincidence that gum disease and other health problems are present together.<br />
<br />
More research is needed to clarify whether gum disease actually causes health problems beyond the mouth, and whether treating gum disease can keep other health conditions from developing.<br />
<br />
In the meantime, it’s a fact that controlling gum disease can save your teeth – a very good reason to take care of your teeth and gums.</div>C Michael Gibsonhttps://www.wikidoc.org/index.php?title=Peridontal_disease_(patient_information)&diff=1233643Peridontal disease (patient information)2016-06-01T15:00:46Z<p>C Michael Gibson: Created page with "__NOTOC__ If you have been told you have periodontal (gum) disease, you’re not alone. Many adults in the U.S. currently have some form of the disease. Periodontal diseases..."</p>
<hr />
<div>__NOTOC__<br />
<br />
If you have been told you have periodontal (gum) disease, you’re not alone. Many adults in the U.S. currently have some form of the disease. Periodontal diseases range from simple gum inflammation to serious disease that results in major damage to the soft tissue and bone that support the teeth. In the worst cases, teeth are lost.<br />
<br />
Whether your gum disease is stopped, slowed, or gets worse depends a great deal on how well you care for your teeth and gums every day, from this point forward.<br />
<br />
Back to TopBack to top<br />
What causes gum disease?<br />
<br />
Our mouths are full of bacteria. These bacteria, along with mucus and other particles, constantly form a sticky, colorless “plaque” on teeth. Brushing and flossing help get rid of plaque. Plaque that is not removed can harden and form “tartar” that brushing doesn’t clean. Only a professional cleaning by a dentist or dental hygienist can remove tartar.<br />
<br />
Back to TopBack to top<br />
Gingivitis<br />
<br />
The longer plaque and tartar are on teeth, the more harmful they become. The bacteria cause inflammation of the gums that is called “gingivitis.” In gingivitis, the gums become red, swollen and can bleed easily. Gingivitis is a mild form of gum disease that can usually be reversed with daily brushing and flossing, and regular cleaning by a dentist or dental hygienist. This form of gum disease does not include any loss of bone and tissue that hold teeth in place.<br />
<br />
Back to TopBack to top<br />
Periodontitis<br />
<br />
When gingivitis is not treated, it can advance to “periodontitis” (which means “inflammation around the tooth”). In periodontitis, gums pull away from the teeth and form spaces (called “pockets”) that become infected. The body’s immune system fights the bacteria as the plaque spreads and grows below the gum line. Bacterial toxins and the body’s natural response to infection start to break down the bone and connective tissue that hold teeth in place. If not treated, the bones, gums, and tissue that support the teeth are destroyed. The teeth may eventually become loose and have to be removed.<br />
<br />
Back to TopBack to top<br />
Risk Factors <br />
<br />
Smoking. Need another reason to quit smoking? Smoking is one of the most significant risk factors associated with the development of gum disease. Additionally, smoking can lower the chances for successful treatment.<br />
Hormonal changes in girls/women. These changes can make gums more sensitive and make it easier for gingivitis to develop.<br />
Diabetes. People with diabetes are at higher risk for developing infections, including gum disease.<br />
Other illnesses and their treatments. Diseases such as AIDS and its treatments can also negatively affect the health of gums, as can treatments for cancer.<br />
Medications. There are hundreds of prescription and over the counter medications that can reduce the flow of saliva, which has a protective effect on the mouth. Without enough saliva, the mouth is vulnerable to infections such as gum disease. And some medicines can cause abnormal overgrowth of the gum tissue; this can make it difficult to keep teeth and gums clean.<br />
Genetic susceptibility. Some people are more prone to severe gum disease than others.<br />
<br />
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Who gets gum disease?<br />
<br />
People usually don’t show signs of gum disease until they are in their 30s or 40s. Men are more likely to have gum disease than women. Although teenagers rarely develop periodontitis, they can develop gingivitis, the milder form of gum disease. Most commonly, gum disease develops when plaque is allowed to build up along and under the gum line.<br />
<br />
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How do I know if I have gum disease?<br />
<br />
Symptoms of gum disease include:<br />
<br />
Bad breath that won’t go away<br />
Red or swollen gums<br />
Tender or bleeding gums<br />
Painful chewing<br />
Loose teeth<br />
Sensitive teeth<br />
Receding gums or longer appearing teeth<br />
<br />
Any of these symptoms may be a sign of a serious problem, which should be checked by a dentist. At your dental visit the dentist or hygienist should:Image of Tooth Anatomy<br />
<br />
Ask about your medical history to identify underlying conditions or risk factors (such as smoking) that may contribute to gum disease.<br />
Examine your gums and note any signs of inflammation.<br />
Use a tiny ruler called a “probe” to check for and measure any pockets. In a healthy mouth, the depth of these pockets is usually between 1 and 3 millimeters. This test for pocket depth is usually painless.<br />
<br />
The dentist or hygienist may also:<br />
<br />
Take an x-ray to see whether there is any bone loss.<br />
Refer you to a periodontist. Periodontists are experts in the diagnosis and treatment of gum disease and may provide you with treatment options that are not offered by your dentist.<br />
<br />
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How is gum disease treated?<br />
<br />
The main goal of treatment is to control the infection. The number and types of treatment will vary, depending on the extent of the gum disease. Any type of treatment requires that the patient keep up good daily care at home. The doctor may also suggest changing certain behaviors, such as quitting smoking, as a way to improve treatment outcome.<br />
Deep Cleaning (Scaling and Root Planing)<br />
<br />
The dentist, periodontist, or dental hygienist removes the plaque through a deep-cleaning method called scaling and root planing. Scaling means scraping off the tartar from above and below the gum line. Root planing gets rid of rough spots on the tooth root where the germs gather, and helps remove bacteria that contribute to the disease. In some cases a laser may be used to remove plaque and tartar. This procedure can result in less bleeding, swelling, and discomfort compared to traditional deep cleaning methods.<br />
Medications<br />
<br />
Medications may be used with treatment that includes scaling and root planning, but they cannot always take the place of surgery. Depending on how far the disease has progressed, the dentist or periodontist may still suggest surgical treatment. Long-term studies are needed to find out if using medications reduces the need for surgery and whether they are effective over a long period of time. Listed on the next page are some medications that are currently used.<br />
Medications Medications What is it? Why is it used? How is it used?<br />
Prescription antimicrobial mouthrinse A prescription mouthrinse containing an antimicrobial called chlorhexidine To control bacteria when treating gingivitis and after gum surgery It's used like a regular mouthwash.<br />
Antiseptic chip A tiny piece of gelatin filled with the medicine chlorhexidine To control bacteria and reduce the size of periodontal pockets After root planing, it's placed in the pockets where the medicine is slowly released over time.<br />
Antibiotic gel A gel that contains the antibiotic doxycycline To control bacteria and reduce the size of periodontal pockets The periodontist puts it in the pockets after scaling and root planing. The antibiotic is released slowly over a period of about seven days.<br />
Antibiotic microspheres Tiny, round particles that contain the antibiotic minocycline To control bacteria and reduce the size of periodontal pockets The periodontist puts the microspheres into the pockets after scaling and root planing. The particles release minocycline<br />
slowly over time.<br />
Enzyme suppressant A low dose of the medication doxycycline that keeps destructive enzymes in check To hold back the body's enzyme response -- If not controlled, certain enzymes can break down gum tissue This medication is in tablet form. It is used in combination with scaling and root planing.<br />
Oral antibiotics Antibiotic tablets or capsules For short term treatment of an acute or locally persistent periodontal infection These come as tablets or capsules and are taken by mouth.<br />
Surgical Treatments<br />
<br />
Flap Surgery. Surgery might be necessary if inflammation and deep pockets remain following treatment with deep cleaning and medications. A dentist or periodontist may perform flap surgery to remove tartar deposits in deep pockets or to reduce the periodontal pocket and make it easier for the patient, dentist, and hygienist to keep the area clean. This common surgery involves lifting back the gums and removing the tartar. The gums are then sutured back in place so that the tissue fits snugly around the tooth again. After surgery the gums will heal and fit more tightly around the tooth. This sometimes results in the teeth appearing longer.<br />
<br />
Bone and Tissue Grafts. In addition to flap surgery, your periodontist or dentist may suggest procedures to help regenerate any bone or gum tissue lost to periodontitis. Bone grafting, in which natural or synthetic bone is placed in the area of bone loss, can help promote bone growth. A technique that can be used with bone grafting is called guided tissue regeneration. In this procedure, a small piece of mesh-like material is inserted between the bone and gum tissue. This keeps the gum tissue from growing into the area where the bone should be, allowing the bone and connective tissue to regrow. Growth factors – proteins that can help your body naturally regrow bone – may also be used. In cases where gum tissue has been lost, your dentist or periodontist may suggest a soft tissue graft, in which synthetic material or tissue taken from another area of your mouth is used to cover exposed tooth roots.<br />
<br />
Since each case is different, it is not possible to predict with certainty which grafts will be successful over the long-term. Treatment results depend on many things, including how far the disease has progressed, how well the patient keeps up with oral care at home, and certain risk factors, such as smoking, which may lower the chances of success. Ask your periodontist what the level of success might be in your particular case.<br />
Second Opinion<br />
<br />
When considering any extensive dental or medical treatment options, you should think about getting a second opinion. To find a dentist or periodontist for a second opinion, call your local dental society. They can provide you with names of practitioners in your area. Additionally, dental schools may sometimes be able to offer a second opinion. Call the dental school in your area to find out whether it offers this service.<br />
<br />
Back to TopBack to top<br />
How can I keep my teeth and gums healthy?<br />
<br />
Brush your teeth twice a day (with a fluoride toothpaste).<br />
Floss regularly to remove plaque from between teeth. Or use a device such as a special brush or wooden or plastic pick recommended by a dental professional.<br />
Visit the dentist routinely for a check-up and professional cleaning.<br />
Don’t smoke<br />
<br />
Can gum disease cause health problems beyond the mouth? <br />
<br />
In some studies, researchers have observed that people with gum disease (when compared to people without gum disease) were more likely to develop heart disease or have difficulty controlling blood sugar. Other studies showed that women with gum disease were more likely than those with healthy gums to deliver preterm, low birth weight babies. But so far, it has not been determined whether gum disease is the cause of these conditions.<br />
<br />
There may be other reasons people with gum disease sometimes develop additional health problems.<br />
<br />
For example, something else may be causing both the gum disease and the other condition, or it could be a coincidence that gum disease and other health problems are present together.<br />
<br />
More research is needed to clarify whether gum disease actually causes health problems beyond the mouth, and whether treating gum disease can keep other health conditions from developing.<br />
<br />
In the meantime, it’s a fact that controlling gum disease can save your teeth – a very good reason to take care of your teeth and gums.</div>C Michael Gibsonhttps://www.wikidoc.org/index.php?title=Parvo_B19&diff=1233636Parvo B192016-06-01T14:33:12Z<p>C Michael Gibson: ←Redirected page to Parvovirus B19</p>
<hr />
<div>#redirect:[[Parvovirus B19]]</div>C Michael Gibsonhttps://www.wikidoc.org/index.php?title=Pancytopenia_resident_survival_guide&diff=1233631Pancytopenia resident survival guide2016-06-01T14:30:31Z<p>C Michael Gibson: /* Differential */</p>
<hr />
<div>__NOTOC__<br />
<br />
== Quick-take ==<br />
*[[Urgent hematology consult]]<br />
*[[Send out labs as detailed below]] <br />
*[[Bone marrow biopsy]]<br />
<br />
== Visual summary ==<br />
<br />
[[File:Pancytopenia Visual Guide.PNG|border|frameless|506x506px]]<br />
<br />
== Differential ==<br />
'''Hypercellular bone marrow (1/Y):'''<br />
<br />
Common: [[Myelodysplastic Syndrome]] ([[MDS]]) (3-4/100K). <br />
<br />
Rare: [[Paroxysmal nocturnal hemoglobinuria]] ([[PNH]]), [[aleukemic leukemia]], severe [[megaloblastic anemia]]<br />
<br />
'''Hypocellular bone marrow (1/X):'''<br />
<br />
[[Aplastic anemia]] (Bone marrow [[stem cell]] failure): idiopathic (most common), viruses ([[Parvo B19]], [[HIV]], [[EBV]], [[HHV6]]), medications ([[chloramphenicol]], [[NSAIDs]], sulfa drugs), other infection (anaplasma)<br />
<br />
== Workup ==<br />
[[Bone marrow biopsy]] required for definitive diagnosis.<br />
<br />
== Treatment ==<br />
Once identified, treat underlying cause.<br />
<br />
Aplastic anemia: Allogeneic stem cell transplant. <br />
<br />
== Example A/P ==<br />
Mr. Smith is a 61yo M who was referred from his PCP after presenting with diffuse petechiae. CBC revealed pancytopenia (PLT:11, WBC:1.8, HCT: 24)<br />
<br />
<nowiki>#</nowiki>Pancytopenia:<br />
<br />
Given patient's age, most likely MDS. Bone marrow biopsy will help narrow differential. <br />
<br />
The presence of decreased WBC and HCT makes ITP, TTP less likely.<br />
<br />
Dx: <br />
<br />
- Hematology consulted, appreciate recs. <br />
<br />
- Plan for bone marrow biopsy tomorrow AM. NPO at midnight. <br />
<br />
- Peripheral blood smear <br />
<br />
- Daily CBC to monitor; <br />
<br />
- Peripheral flow cytometry <br />
<br />
- SPEP with immunofixation and free light chains <br />
<br />
- Anemia labs: Retics, Folate/B12, Iron, TIBC, Direct coombs, Haptoglobin <br />
<br />
- Aplastic anemia labs: Hep serologies, HIV, LFTs, Blood parasite smear <br />
<br />
- Autoimmune labs: ANA <br />
<br />
Tx:<br />
<br />
- Type and screen, transfusion consent to be obtained.<br />
<br />
- Transfuse for HCT < 21</div>C Michael Gibsonhttps://www.wikidoc.org/index.php?title=Aleukemic_leukemia&diff=1233598Aleukemic leukemia2016-06-01T13:43:59Z<p>C Michael Gibson: Created page with "__NOTOC__ ==Overview== Aleukemic leukemia is a form of leukemia in which abnormal (or leukemic) cells are not identified in the peripheral blood. The leukocyte count is n..."</p>
<hr />
<div>__NOTOC__<br />
<br />
==Overview==<br />
Aleukemic leukemia is a form of [[leukemia]] in which abnormal (or leukemic) cells are not identified in the peripheral blood. The leukocyte count is normal or reduced.</div>C Michael Gibsonhttps://www.wikidoc.org/index.php?title=Pancytopenia_resident_survival_guide&diff=1233573Pancytopenia resident survival guide2016-06-01T12:59:41Z<p>C Michael Gibson: </p>
<hr />
<div>__NOTOC__<br />
<br />
== Quick-take ==<br />
*[[Urgent hematology consult]]<br />
*[[Send out labs as detailed below]] <br />
*[[Bone marrow biopsy]]<br />
<br />
== Visual summary ==<br />
<br />
[[File:Pancytopenia Visual Guide.PNG|border|frameless|506x506px]]<br />
<br />
== Differential ==<br />
'''Hypercellular bone marrow (1/Y):'''<br />
<br />
Common: [[Myelodysplastic Syndrome]] ([[MDS]]) (3-4/100K). <br />
<br />
Rare: [[Paroxysmal nocturnal hemoglobinuria]] ([[PNH]]), [[aleukemic leukemia]], severe [[megaloblastic anemia]]<br />
<br />
'''Hypocellular bone marrow (1/X):'''<br />
<br />
Aplastic anemia (BM stem cell failure): idiopathic (most common), viruses (ParvoB19, HIV, EBV, HHV6), meds (chloramphenicol, NSAIDs, sulfa), other infection (anaplasma)<br />
<br />
== Workup ==<br />
[[Bone marrow biopsy]] required for definitive diagnosis.<br />
<br />
== Treatment ==<br />
Once identified, treat underlying cause.<br />
<br />
Aplastic anemia: Allogeneic stem cell transplant. <br />
<br />
== Example A/P ==<br />
Mr. Smith is a 61yo M who was referred from his PCP after presenting with diffuse petechiae. CBC revealed pancytopenia (PLT:11, WBC:1.8, HCT: 24)<br />
<br />
<nowiki>#</nowiki>Pancytopenia:<br />
<br />
Given patient's age, most likely MDS. Bone marrow biopsy will help narrow differential. <br />
<br />
The presence of decreased WBC and HCT makes ITP, TTP less likely.<br />
<br />
Dx: <br />
<br />
- Hematology consulted, appreciate recs. <br />
<br />
- Plan for bone marrow biopsy tomorrow AM. NPO at midnight. <br />
<br />
- Peripheral blood smear <br />
<br />
- Daily CBC to monitor; <br />
<br />
- Peripheral flow cytometry <br />
<br />
- SPEP with immunofixation and free light chains <br />
<br />
- Anemia labs: Retics, Folate/B12, Iron, TIBC, Direct coombs, Haptoglobin <br />
<br />
- Aplastic anemia labs: Hep serologies, HIV, LFTs, Blood parasite smear <br />
<br />
- Autoimmune labs: ANA <br />
<br />
Tx:<br />
<br />
- Type and screen, transfusion consent to be obtained.<br />
<br />
- Transfuse for HCT < 21</div>C Michael Gibsonhttps://www.wikidoc.org/index.php?title=Pancytopenia_resident_survival_guide&diff=1233572Pancytopenia resident survival guide2016-06-01T12:58:06Z<p>C Michael Gibson: /* Workup */</p>
<hr />
<div>__NOTOC__<br />
<br />
== Quick-take ==<br />
*[[Urgent hematology consult]]<br />
*[[Send out labs as detailed below]] <br />
*[[Bone marrow biopsy]]<br />
<br />
== Visual summary ==<br />
<br />
[[File:Pancytopenia Visual Guide.PNG|border|frameless|506x506px]]<br />
<br />
== Differential ==<br />
'''Hypercellular bone marrow (1/Y):'''<br />
<br />
Common: [[Myelodysplastic Syndrome]] ([[MDS]]) (3-4/100K). <br />
<br />
Rare: PNH, aleukemic leukemia, severe megaloblastic anemia<br />
<br />
'''Hypocellular bone marrow (1/X):'''<br />
<br />
Aplastic anemia (BM stem cell failure): idiopathic (most common), viruses (ParvoB19, HIV, EBV, HHV6), meds (chloramphenicol, NSAIDs, sulfa), other infection (anaplasma)<br />
<br />
== Workup ==<br />
[[Bone marrow biopsy]] required for definitive diagnosis.<br />
<br />
== Treatment ==<br />
Once identified, treat underlying cause.<br />
<br />
Aplastic anemia: Allogeneic stem cell transplant. <br />
<br />
== Example A/P ==<br />
Mr. Smith is a 61yo M who was referred from his PCP after presenting with diffuse petechiae. CBC revealed pancytopenia (PLT:11, WBC:1.8, HCT: 24)<br />
<br />
<nowiki>#</nowiki>Pancytopenia:<br />
<br />
Given patient's age, most likely MDS. Bone marrow biopsy will help narrow differential. <br />
<br />
The presence of decreased WBC and HCT makes ITP, TTP less likely.<br />
<br />
Dx: <br />
<br />
- Hematology consulted, appreciate recs. <br />
<br />
- Plan for bone marrow biopsy tomorrow AM. NPO at midnight. <br />
<br />
- Peripheral blood smear <br />
<br />
- Daily CBC to monitor; <br />
<br />
- Peripheral flow cytometry <br />
<br />
- SPEP with immunofixation and free light chains <br />
<br />
- Anemia labs: Retics, Folate/B12, Iron, TIBC, Direct coombs, Haptoglobin <br />
<br />
- Aplastic anemia labs: Hep serologies, HIV, LFTs, Blood parasite smear <br />
<br />
- Autoimmune labs: ANA <br />
<br />
Tx:<br />
<br />
- Type and screen, transfusion consent to be obtained.<br />
<br />
- Transfuse for HCT < 21</div>C Michael Gibsonhttps://www.wikidoc.org/index.php?title=Pancytopenia_resident_survival_guide&diff=1233570Pancytopenia resident survival guide2016-06-01T12:57:26Z<p>C Michael Gibson: </p>
<hr />
<div>__NOTOC__<br />
<br />
== Quick-take ==<br />
*[[Urgent hematology consult]]<br />
*[[Send out labs as detailed below]] <br />
*[[Bone marrow biopsy]]<br />
<br />
== Visual summary ==<br />
<br />
[[File:Pancytopenia Visual Guide.PNG|border|frameless|506x506px]]<br />
<br />
== Differential ==<br />
'''Hypercellular bone marrow (1/Y):'''<br />
<br />
Common: [[Myelodysplastic Syndrome]] ([[MDS]]) (3-4/100K). <br />
<br />
Rare: PNH, aleukemic leukemia, severe megaloblastic anemia<br />
<br />
'''Hypocellular bone marrow (1/X):'''<br />
<br />
Aplastic anemia (BM stem cell failure): idiopathic (most common), viruses (ParvoB19, HIV, EBV, HHV6), meds (chloramphenicol, NSAIDs, sulfa), other infection (anaplasma)<br />
<br />
== Workup ==<br />
Bone marrow biopsy required for definitive diagnosis.<br />
<br />
== Treatment ==<br />
Once identified, treat underlying cause.<br />
<br />
Aplastic anemia: Allogeneic stem cell transplant. <br />
<br />
== Example A/P ==<br />
Mr. Smith is a 61yo M who was referred from his PCP after presenting with diffuse petechiae. CBC revealed pancytopenia (PLT:11, WBC:1.8, HCT: 24)<br />
<br />
<nowiki>#</nowiki>Pancytopenia:<br />
<br />
Given patient's age, most likely MDS. Bone marrow biopsy will help narrow differential. <br />
<br />
The presence of decreased WBC and HCT makes ITP, TTP less likely.<br />
<br />
Dx: <br />
<br />
- Hematology consulted, appreciate recs. <br />
<br />
- Plan for bone marrow biopsy tomorrow AM. NPO at midnight. <br />
<br />
- Peripheral blood smear <br />
<br />
- Daily CBC to monitor; <br />
<br />
- Peripheral flow cytometry <br />
<br />
- SPEP with immunofixation and free light chains <br />
<br />
- Anemia labs: Retics, Folate/B12, Iron, TIBC, Direct coombs, Haptoglobin <br />
<br />
- Aplastic anemia labs: Hep serologies, HIV, LFTs, Blood parasite smear <br />
<br />
- Autoimmune labs: ANA <br />
<br />
Tx:<br />
<br />
- Type and screen, transfusion consent to be obtained.<br />
<br />
- Transfuse for HCT < 21</div>C Michael Gibsonhttps://www.wikidoc.org/index.php?title=Pancytopenia_resident_survival_guide&diff=1233568Pancytopenia resident survival guide2016-06-01T12:29:43Z<p>C Michael Gibson: /* Differential */</p>
<hr />
<div>{{NOTOC}}<br />
<br />
== Quick-take ==<br />
Urgent hematology consult. Send out labs as detailed below. Plan for pt to get bone marrow biopsy.<br />
<br />
== Visual summary ==<br />
<br />
[[File:Pancytopenia Visual Guide.PNG|border|frameless|506x506px]]<br />
<br />
== Differential ==<br />
'''Hypercellular bone marrow (1/Y):'''<br />
<br />
Common: [[Myelodysplastic Syndrome]] ([[MDS]]) (3-4/100K). <br />
<br />
Rare: PNH, aleukemic leukemia, severe megaloblastic anemia<br />
<br />
'''Hypocellular bone marrow (1/X):'''<br />
<br />
Aplastic anemia (BM stem cell failure): idiopathic (most common), viruses (ParvoB19, HIV, EBV, HHV6), meds (chloramphenicol, NSAIDs, sulfa), other infection (anaplasma)<br />
<br />
== Workup ==<br />
Bone marrow biopsy required for definitive diagnosis.<br />
<br />
== Treatment ==<br />
Once identified, treat underlying cause.<br />
<br />
Aplastic anemia: Allogeneic stem cell transplant. <br />
<br />
== Example A/P ==<br />
Mr. Smith is a 61yo M who was referred from his PCP after presenting with diffuse petechiae. CBC revealed pancytopenia (PLT:11, WBC:1.8, HCT: 24)<br />
<br />
<nowiki>#</nowiki>Pancytopenia:<br />
<br />
Given patient's age, most likely MDS. Bone marrow biopsy will help narrow differential. <br />
<br />
The presence of decreased WBC and HCT makes ITP, TTP less likely.<br />
<br />
Dx: <br />
<br />
- Hematology consulted, appreciate recs. <br />
<br />
- Plan for bone marrow biopsy tomorrow AM. NPO at midnight. <br />
<br />
- Peripheral blood smear <br />
<br />
- Daily CBC to monitor; <br />
<br />
- Peripheral flow cytometry <br />
<br />
- SPEP with immunofixation and free light chains <br />
<br />
- Anemia labs: Retics, Folate/B12, Iron, TIBC, Direct coombs, Haptoglobin <br />
<br />
- Aplastic anemia labs: Hep serologies, HIV, LFTs, Blood parasite smear <br />
<br />
- Autoimmune labs: ANA <br />
<br />
Tx:<br />
<br />
- Type and screen, transfusion consent to be obtained.<br />
<br />
- Transfuse for HCT < 21</div>C Michael Gibsonhttps://www.wikidoc.org/index.php?title=Pancytopenia_resident_survival_guide&diff=1233567Pancytopenia resident survival guide2016-06-01T12:29:08Z<p>C Michael Gibson: </p>
<hr />
<div>{{NOTOC}}<br />
<br />
== Quick-take ==<br />
Urgent hematology consult. Send out labs as detailed below. Plan for pt to get bone marrow biopsy.<br />
<br />
== Visual summary ==<br />
<br />
[[File:Pancytopenia Visual Guide.PNG|border|frameless|506x506px]]<br />
<br />
== Differential ==<br />
'''Hypercellular bone marrow (1/Y):'''<br />
<br />
Common: [[Myelodysplastic Syndrome]] [[MDS]] (3-4/100K). <br />
<br />
Rare: PNH, aleukemic leukemia, severe megaloblastic anemia<br />
<br />
'''Hypocellular bone marrow (1/X):'''<br />
<br />
Aplastic anemia (BM stem cell failure): idiopathic (most common), viruses (ParvoB19, HIV, EBV, HHV6), meds (chloramphenicol, NSAIDs, sulfa), other infection (anaplasma)<br />
== Workup ==<br />
Bone marrow biopsy required for definitive diagnosis.<br />
<br />
== Treatment ==<br />
Once identified, treat underlying cause.<br />
<br />
Aplastic anemia: Allogeneic stem cell transplant. <br />
<br />
== Example A/P ==<br />
Mr. Smith is a 61yo M who was referred from his PCP after presenting with diffuse petechiae. CBC revealed pancytopenia (PLT:11, WBC:1.8, HCT: 24)<br />
<br />
<nowiki>#</nowiki>Pancytopenia:<br />
<br />
Given patient's age, most likely MDS. Bone marrow biopsy will help narrow differential. <br />
<br />
The presence of decreased WBC and HCT makes ITP, TTP less likely.<br />
<br />
Dx: <br />
<br />
- Hematology consulted, appreciate recs. <br />
<br />
- Plan for bone marrow biopsy tomorrow AM. NPO at midnight. <br />
<br />
- Peripheral blood smear <br />
<br />
- Daily CBC to monitor; <br />
<br />
- Peripheral flow cytometry <br />
<br />
- SPEP with immunofixation and free light chains <br />
<br />
- Anemia labs: Retics, Folate/B12, Iron, TIBC, Direct coombs, Haptoglobin <br />
<br />
- Aplastic anemia labs: Hep serologies, HIV, LFTs, Blood parasite smear <br />
<br />
- Autoimmune labs: ANA <br />
<br />
Tx:<br />
<br />
- Type and screen, transfusion consent to be obtained.<br />
<br />
- Transfuse for HCT < 21</div>C Michael Gibson