bluuebunny/crossref_metadata_2025_split huggingface dataset:
Potential of Induced Pluripotent Stem Cells for the Regeneration of the Tracheal Wall
Authors: Imaizumi Mitsuyoshi , Nomoto Yukio , Sugino Takashi , Miyake Masao , Wada Ikuo , Nakamura Tatsuo , Omori Koichi 
Published: May 2017

Objectives Our previous studies focused on basic research and the clinical applications of an artificial trachea. However, the prefabricated artificial trachea cannot be utilized for pediatric airways, because the tracheal frame needs to expand as the child develops. The purpose of this study was to evaluate the potential of induced pluripotent stem (iPS) cells for the regeneration of the tracheal wall. Methods We cultured iPS cells in a 3-dimensional (3-D) scaffold in chondrocyte differentiation medium (bioengineered scaffold model), and the results were compared with those in a 3-D scaffold without iPS cells (control scaffold model). The 3-D scaffolds were implanted into tracheal defects in 8 nude rats. After 4 weeks, the regenerated tissue was histologically examined. Results Implanted iPS cells were confirmed to exist in all 5 rats implanted with bioengineered scaffolds. Cartilage-like tissue was observed in the regenerated tracheal wall in 2 of the 5 rats in the bioengineered scaffold model, but in none of the 3 rats in the control scaffold model. Conclusions Implanted iPS cells were confirmed to exist in the bioengineered scaffold. Cartilage-like tissue was regenerated in the tracheal defect. This study demonstrated the potential of iPS cells in the regeneration of the tracheal wall.
Haemoglobin concentration and erythrocyte sedimentation rate in primary care patients
Authors: Kanfer E J , Nicol B A 
Published: May 2017

The erythrocyte sedimentation rate (ESR) remains a commonly measured indicator of disease, but is subject to several non-disease influences. The haemoglobin concentration (Hb) and ESR were measured in 1249 consecutive patients (492 men, 757 women) from primary care practices. An inverse correlation was found between Hb and ESR throughout the range of measured Hb, and in particular there was a significant difference in the median ESR of patients in the highest and lowest quartile for non-anaemic Hb (P<0.001). These results indicate that correct clinical analysis of an ESR result should take into account the Hb, both in anaemic and in non-anaemic patients. Interpretative difficulties due to external influences on the measured ESR could be resolved by replacement of this test with plasma viscosity estimation.
Double-Blind, Placebo-Controlled, Randomized Clinical Trial of Homoeopathic Arnica C30 for Pain and Infection after Total Abdominal Hysterectomy
Authors: Hart Oliver , Mullee Mark A , Lewith George , Miller John 
Published: May 2017

Homoeopathic potencies of arnica have been used for many years to aid postoperative recovery. The effects of arnica C30 on pain and postoperative recovery after total abdominal hysterectomy were evaluated in a double-blind, randomized, controlled study. Of 93 women entered into the study, 20 did not complete protocol treatment: nine were excluded because they failed to comply with the protocol, nine had their operations cancelled or changed within 24 h and two had to be withdrawn because of the recurrence of previously chronic painful conditions. Those who did not complete protocol treatment were equally divided between the arnica (nine patients) and placebo groups (11 patients). 73 patients completed the study, of whom 35 received placebo and 38 received arnica C30. The placebo group had a greater median age and the arnica group had slightly longer operations; nevertheless, no significant difference between the two groups could be demonstrated. We conclude that arnica in homoeopathic potency had no effect on postoperative recovery in the context of our study.
Tracheal Microaspiration in Adult Cystic Fibrosis
Authors: Ledson M J , Wilson G E , Tran J , Walshaw M J 
Published: May 2017

Gastro-oesophageal reflux (GOR) has been implicated in the aetiology of lung disease. Cystic fibrosis (CF) patients have a high incidence of GOR symptoms with demonstrable episodes of oesophageal acidification. We studied 24-hour ambulatory tracheal and oesophageal pH in 11 CF patients with GOR symptoms to identify any episodes of tracheal acidification and define their temporal relation to oesophageal reflux and respiratory symptoms. 8 patients had evidence of significant GOR (DeMeester score mean 58; range 17–107) and in 6 it was gross (DeMeester score >30). 4 patients had tracheal acidification (defined as tracheal pH <5.5): all had greatly raised DeMeester scores. Two patterns of lowered tracheal pH were seen: a gradual drift downwards of tracheal pH to <5.5 which recovered slowly, and an acute fall in tracheal pH to <5.5 with rapid recovery. Only one patient had a fall in peak expiratory flow in conjunction with a decline in tracheal pH, and no association was found between the presence of tracheal microaspiration and pulmonary function. We conclude that tracheal acidification occurs in adult CF patients with GOR.
An Audit of the Investigation and Treatment of Folic Acid Deficiency
Authors: Haslam Neil , Probert Christopher S 
Published: May 2017

On the suspicion that folate deficiency was not being thoroughly investigated we conducted a retrospective study of management in a teaching hospital. Notes from 84 consecutive patients with low red cell folates (mean age 69.5 years, range 21–95, M:F 33:51) were reviewed for haemoglobin, mean cell volume, dietary history, alcohol consumption, drug history, relevant medical history, relevant investigations, treatment, repeat measurement of red cell folate and diagnosis of deficiency. In 52 (61.9%, mean age 72.9 years, range 33–95, M:F 21:51) no diagnosis was reached. In only 32 (38.1 %, mean age 63.9 years, range 21–89, M:F 12:20) was a definitive diagnosis established: 5 had coeliac disease, 1 had Crohn's disease, 9 had drug-associated deficiency (4 methotrexate, 3 phenytoin, 1 trimethoprim and 1 valproate), 1 had combined variable immunodeficiency and 16 had dietary deficiency. In most cases of folic acid deficiency no attempt was made to establish aetiology. We recommend that younger patients without an obvious cause are investigated initially by dietary assessment and measurement of anti-endomysial antibody and by duodenal biopsy with small-bowel follow-through if clinically indicated.
Psychological stress and burnout in medical students: a five-year prospective longitudinal study
Authors: Guthrie E , Black D , Bagalkote H , Shaw C , Campbell M , Creed F 
Published: May 2017

The aim of this study was to assess psychological morbidity and symptoms of burnout in medical students during their undergraduate training, and to identify baseline factors that predict psychological morbidity in students in the final year of the course. It was a 5-year prospective longitudinal cohort study. Students were assessed in years 1, 4 and 5 of their medical undergraduate training by means of the GHQ-12 and the Maslach Burnout Inventory. 172 (84.3%), 157 (77.0%) and 155 (75.9%) students out of an original group of 204 completed assessments in years 1, 4 and 5, respectively. 18 students were above threshold on the GHQ-12 on all three occasions, 25 on two occasions and 43 on one occasion; 69 students were never a ‘case’. Students who were cases on two or more occasions were more likely to find the medical course stressful during the first year, but not subsequent years. There was no significant difference between the percentages of men and women who scored as cases on the GHQ-12 in any of the years. The best predictor of psychological morbidity in the final year of the course was the GHQ-12 score in year 1. This study suggests that a small group of students repeatedly experience psychological distress during their medical training.
Access to complementary medicine in general practice: survey in one UK health authority
Authors: Wearn A M , Greenfield S M 
Published: May 2017

Complementary therapy (CT) has become increasingly popular with the general public and interest from the health professions has been rising. There has been no study focusing on the pattern of availability of CT within urban and inner-city general practice. We aimed to describe the prevalence and pattern of access to complementary therapy in this setting, identifying the characteristics of practices offering CT and the perceived barriers to service provision. We sent a postal questionnaire to all 254 general practices on the Birmingham Family Health Services Authority list. Practices were asked whether they offered any access to CTs, how services were organized and which therapies were available and to identify any barriers to provision. 175 practices (68.9%) responded. Half of the practices offered access to CT. Of these, half offered an in-house service, usually provided by the doctor (81.8%). Of GPs practising therapies themselves, 58% began in or after 1990. Seventeen separate therapies were offered, most commonly acupuncture, osteopathy, chiropractic, hypnotherapy and homoeopathy. Practices significantly more likely to offer access to CT were of larger list size and training or teaching practices. They were equally likely to be fundholders or non-fundholders. Practices offering an in-house service tended to be fundholding, training and of larger list size. Finance was perceived as the major barrier. In the area studied, many patients now have some access to CT within primary care, often within their own practice. In the main, therapies offered are the ‘medically acceptable face' of complementary medicine.
Management and outcome of patients undergoing surgery after acute upper gastrointestinal haemorrhage
Authors: Rockall T A 
Published: May 2017

Most patients with acute upper gastrointestinal haemorrhage are managed conservatively or with endoscopic intervention but some ultimately require surgery to arrest the haemorrhage. We have conducted a population-based multicentre prospective observational study of management and outcomes. This paper concerns the subgroup of 307 patients who had an operation because of continued or recurrent haemorrhage or high risk of further bleeding. The principal diagnostic group was those with peptic ulcer. Of 2071 patients with peptic ulcer presenting with acute haemorrhage, 251 (12%) had an operative intervention with a mortality of 24%. In the non-operative group mortality was 10%. The operative intervention rate increased with risk score, ranging from 0% in the lowest risk categories to 38% in the highest. Much of the discrepancy between operative and non-operative mortality was explainable by case mix; however, for high-risk cases mortality was significantly higher in the operated group. In 78% of patients who underwent an operation for bleeding peptic ulcer there had been no previous attempt at endoscopic haemostasis. For patients admitted to surgical units, the operative intervention rate was about four times higher than for those admitted under medical teams. In patients with acute upper gastrointestinal haemorrhage operative intervention is infrequent and largely confined to the highest-risk patients. The continuing high mortality in surgically treated patients is therefore to be expected. The reasons for the low use of endoscopic treatment before surgery are not revealed by this study, but wider use of such treatments might further reduce the operative intervention rate. Physicians and surgeons have not yet reached consensus on who needs surgery and when.
Promoting physical activity in general practice: should prescribed exercise be free?
Authors: Tai Sharon See , Gould Mairi , Smith Paul , Iliffe Steve 
Published: May 2017

In the UK there are numerous schemes whereby general practitioners can prescribe exercise programmes, usually based in leisure centres. Of the factors that discourage adherence to such programmes in the USA, cost has proved important. We collected demographic and questionnaire data from 152 inner-London patients (108 women, 44 men) before they started an exercise programme on a National Health Service prescription, and analysed the results according to whether they dropped out of the programme (78%) or not. Use of logistic regression revealed only one previous barrier to exercise, ‘not knowing about local exercise facilities’, as a significant positive determinant of adherence (adjusted odds ratio 3.51,95% confidence interval, 1.04 to 11.86). For ‘lack of money' patients were more likely to drop out of the programme (adjusted odds ratio 0.25, 95% CI 0.07–0.85). The very low cost of participation in this scheme, did not encourage adherence, particularly by those who had cited ‘lack of money' as a previous barrier. The case of making prescribed exercise free or even low-cost remains unproven.
The limits of pressure sore prevention
Authors: Hagisawa Satsue , Barbenel Joseph 
Published: May 2017

Pressure sore prevalence and incidence were assessed in 275 patients who were admitted to a well-staffed internal medicine ward during a 12-month study period or who were present on day 1. Pressure sore risk was assessed by use of the Braden scale and patients scoring 16 or less were provided with intensive preventive care. During the study period 5.1% (95% confidence interval 2.7–7.8) of 275 patients had pressure sores (prevalence) and 4.4% (1.9–6.9) developed sores (incidence). None of the 239 patients who were assessed as not being at risk developed a sore. 36 patients were assessed as being at risk at some time during the study and 12 of these developed sores despite receiving high-quality preventive care. The results suggest that not all pressure sores can be prevented in severely ill patients. We believe that the 4.4% incidence of sores in this study approaches the current limit of prevention.
Long-term improvement in activities of daily living in women with systemic sclerosis attending occupational therapy
Authors: Zanatta Elisabetta , Rodeghiero Francesca , Pigatto Erika , Galozzi Paola , Polito Pamela , Favaro Maria , Punzi Leonardo , Cozzi Franco 
Published: May 2017

IntroductionSystemic sclerosis often affects hand function, leading to severe disability in many subjects. There is little data available on the effects of occupational therapy in systemic sclerosis in current literature. The aim of our study was therefore to evaluate the effects of a cycle of occupational therapy on performing activities of daily living in a group of women with systemic sclerosis.MethodTwenty women with systemic sclerosis were included in the study: 10 followed a cycle of occupational therapy; 10 were enrolled as controls. An occupational therapy cycle consisted of six meetings of 90 minutes each over a 3-week period. All women were evaluated by the Health Assessment Questionnaire and Evaluation of Daily Activity Questionnaire at baseline and after 24 weeks. The use of devices and alternative strategies was also assessed.ResultsWe observed a significant reduction in the Health Assessment Questionnaire and Evaluation of Daily Activity Questionnaire scores in occupational therapy subjects after 6 months compared to controls. There was also evidence of significant improvement in four dimensions of the Evaluation of Daily Activity Questionnaire: eating; indoor mobility; outdoor mobility; and communication. The number of devices in the occupational therapy group increased significantly.ConclusionOur findings suggest a relevant role for occupational therapy in improving activities of daily living in women with systemic sclerosis. The use of strategies learned during occupational therapy sessions allows for long-lasting beneficial effects.
Design of a Primary Screen for Developmental Neurotoxicity
Authors: Walker Richard F. , Guerriero Frederick J. , Wier Patrick J. 
Published: May 2017

A battery of tests was devised for routine use as a primary screen for developmental neurotoxicity. The battery was divided into pre-weaning and postweaning tests using rats as subjects. Since the rat CNS is structurally incomplete at birth, preweaning tests were predominantly physical, using specific landmarks of somatic maturation and regional brain growth as indices of normal development. Pupillary responses to light and positional responses to gravity (negative geotaxis) were also included in the preweaning battery to monitor reflex behavior, a relatively simple CNS function. The postweaning battery predominantly contained functional tests to evaluate higher order behaviors that develop after completion of neurogenesis. The postweaning tests were divided into 4 subsets designed to evaluate (I) neuromuscular function, (II) memory, (III) problem solving, and (IV) neuroendocrine function, respectively. Curiosity, rhythmicity, patency of monoamine neurons, and physical measures of brain growth were included within the subsets so as to evaluate a spectrum of CNS functions. Preliminary findings suggest that tests and instrumentation selected for the proposed battery provide an informative, objective, comprehensive and cost-efficient means to screen for developmental neurotoxicity.
Drug Interactions of Macrolides: Emphasis on Dirithromycin
Authors: Watkins Vish S , Polk Ron E , Stotka Jennifer L 
Published: May 2017

Objective To describe the drug interactions of dirithromycin, a new macrolide, and to compare them with those of other macrolides. Data Sources A literature search was performed using MEDLINE to identify articles published between January 1980 and July 1995 concerning the drug interactions of macrolides. Published abstracts were also examined. All studies using dirithromycin were performed under the sponsorship of Eli Lilly and Company. Data Synthesis Erythromycin, the first macrolide discovered, is metabolized by the cytochrome P450 enzyme system. By decreasing their metabolism, erythromycin can interact with other drugs metabolized by the cytochrome P450 enzymes. The lack of such interactions would be a desirable feature in a newer macrolide. We describe studies performed to detect any interactions of dirithromycin with cyclosporine, theophylline, terfenadine, warfarin, and ethinyl estradiol. The studies showed that dirithromycin, like azithromycin, is much less likely to cause the interactions detected with clarithromycin and erythromycin. A review of the literature showed differences among macrolides in their abilities to inhibit cytochrome P450 enzymes and, thus, to cause drug–drug interactions. Erythromycin and clarithromycin inhibit cytochrome P450 enzymes, and have been implicated in clinically significant interactions. Azithromycin and dirithromycin neither inhibit cytochrome P450 enzymes nor are implicated in clinically significant drug–drug interactions. Conclusions Dirithromycin, a new macrolide, does not inhibit the cytochrome P450 enzyme system. The concomitant use of dirithromycin with cyclosporine, theophylline, terfenadine, warfarin, or ethinyl estradiol was studied in pharmacokinetic and pharmacodynamic studies. In vitro, dirithromycin did not bind cytochrome P450. In healthy subjects, erythromycin increases the clearance of cyclosporine by 51%, whereas dirithromycin causes no significant changes in the pharmacokinetics of cyclosporine. In kidney transplant recipients, administration of dirithromycin was associated with a significant (p < 0.003) decrease of 17.4% in the clearance of cyclosporine. In patients taking low-dose estradiol, the administration of dirithromycin caused a significant (p < 0.03) increase of 9.9% in the clearance of ethinyl estradiol; escape ovulation did not occur. Unlike erythromycin and clarithromycin, dirithromycin had no significant effects on the pharmacokinetics of theophylline, terfenadine, or warfarin. The alterations typical of drug interactions that are based on inhibition of the cytochrome P450 system occurring with erythromycin and clarithromycin were not observed with dirithromycin.
Response to Initial Griseofulvin Therapy in Pediatric Patients with Tinea Capitis
Authors: Abdel-Rahman Susan M , Nahata Milap C , Powell Dwight A 
Published: May 2017

Objective To estimate the response rate to initial griseofulvin therapy in pediatric patients with tinea capitis and to determine whether clinical or epidemiologic variables differed between patients responding positively and negatively to therapy. Methods A review of patients' medical records with a confirmed diagnosis of tinea capitis was performed retrospectively over a 2-year period. Patients were included only if a positive dermatophyte culture was obtained and the initial prescription for griseofulvin was filled at our pharmacy. Responders were children not returning to the clinic or returning without signs or symptoms of infection. Nonresponders were those returning within 8 months with signs and symptoms of disease, requiring additional therapy. Results During July 1993-June 1995, 479 positive fungal cultures were confirmed in 474 patients, and 857 prescriptions for griseofulvin were filled for 765 patients at our institution. Of 122 evaluable patients meeting both criteria, 60.7% were classified as responders to initial prescribed therapy. The remaining 39.3% returned to the clinic within 8 months of initial therapy, requiring additional treatment. An additional 10.7% had a recurrence at a later date. There was no correlation between clinical response and dosage, age, race, or gender, although there was a trend toward longer treatment duration among responders. Conclusions It is evident that tinea capitis persists in the urban pediatric population. Our data suggest that griseofulvin, the current drug of choice, may be ineffective in at least one-third of pediatric patients with tinea capitis.