bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effects of Basic Fibroblast Growth Factor on Rat Vocal Fold Fibroblasts
Authors: Suehiro Atsushi , Hirano Shigeru , Kishimoto Yo , Tateya Ichiro , Rousseau Bernard , Ito Juichi 
Published: May 2017

Objectives The overarching goal of this line of research is to translate basic fibroblast growth factor (bFGF) treatment for vocal fold scarring into practical clinical use. In a previous canine investigation, we demonstrated that bFGF improves phonation threshold pressure, mucosal wave amplitude, and histologic measures in vocal folds treated after injury. In the present study, we studied the effects of bFGF on gene expression of the extracellular matrix and growth factors in rat vocal fold fibroblasts. Methods Fibroblasts harvested from the vocal folds of 5 rats were treated with 3 concentrations of bFGF (0, 10, and 100 ng/mL). The fibroblasts were collected at 24 hours and 72 hours after bFGF administration. Quantitative polymerase chain reaction was then used to investigate the gene expression of the investigated growth factors and extracellular matrices. Results The results revealed significantly down-regulated expression of procollagen I and significantly up-regulated expression of hyaluronic acid synthase (HAS) 2 and fibronectin in fibroblasts treated with bFGF. The administration of bFGF also resulted in the up-regulation of bFGF and hepatocyte growth factor (HGF). No changes in the expression of HAS-1, tropoelastin, or procollagen III were observed between the treatment and control conditions. Conclusions Treatment with bFGF induces the down-regulation of procollagen I and the up-regulation of HAS-2 in vocal fold fibroblast cell cultures. These gene expression alterations to key mediators of the wound healing process may translate into potential benefits in the remediation of vocal fold injury. The up-regulation of HGF, an antifibrotic effector molecule, may demonstrate additional benefits by optimizing the wound healing environment and by accelerating the wound repair cascade. These findings may provide fuel for additional discoveries into the development of growth factor therapy for the treatment of vocal fold scar.
Congenital Laryngeal Webs: Surgical Course and Outcomes
Authors: Goudy Steven , Bauman Nancy , Manaligod José , Smith Richard J. H. 
Published: May 2017

Objectives We compare the success of different surgical options in the treatment of laryngeal webs. Methods We performed a retrospective study spanning the years 1980 to 2005. Results Eighteen patients were identified. The average age at diagnosis was 6 months (range, 1 day to 2.5 years). The presenting symptoms included weak cry, stridor, airway obstruction, and difficulty breathing. Associated cardiac defects consistent with the diagnosis of 22q-syndrome were present in 7 patients. Webs were classified as grade I (5 patients), grade II (2 patients), grade III (10 patients), or grade IV (1 patient) according to the Cohen classification. In 5 patients, only endoscopic lysis was required. The remaining 13 patients underwent open procedures; 9 patients in this group required tracheotomy. An average of 1.3 open airway procedures was necessary to achieve a decannulation rate of 89%. After operation, 34% of patients had residual webbing and 20% had a weak or aphonic voice. Conclusions Management of laryngeal webs is dependent on the severity of airway obstruction. Grade I and II webs can be treated endoscopically; more severe laryngeal webs usually require tracheotomy and open airway reconstruction.
Non-Invasive Cardiac Investigations in Patients Awaiting Renal Transplantation
Authors: Langford E J , De Belder A J , Cairns H , Hendry B M , Wainwright R J 
Published: May 2017

Patients with chronic renal failure undergoing renal transplantation have a high prevalence of cardiovascular disease. Invasive investigation may identify those at risk of cardiac death during or after renal transplantation, but which patients should undergo cardiac catheterization is currently not clear. In 95 patients awaiting renal transplantation we assessed the ability of echocardiography and exercise electrocardiography to identify patients at risk of cardiac death. Echocardiography identified impaired left ventricular (LV) systolic function in 20%, severe in 8%. Of the patients with severe LV dysfunction, 25% died before transplantation. Of those undergoing exercise electrocardiography, 44% did not achieve 85% of maximum predicted heart rate. No coronary artery disease requiring intervention was identified by exercise testing. These findings indicate that echocardiography, but not exercise electrocardiography, should be part of the assessment for renal transplantation.
Risk Factors for Basal Cell Carcinoma in the UK: Case-Control Study in 806 Patients
Authors: Lear J T , Tan B B , Smith A G , Bowers W , Jones P W , Heagerty A H , Strange R C , Fryer A A 
Published: May 2017

Basal cell carcinoma (BCC) is the commonest malignant neoplasm in white people. We present a large UK case-control study in which conditional logistic regression analysis of age-matched and gender-matched data sets was used to compare, first, cases with controls (n=403) and second, patients having multiple BCC with those having a single BCC (n=278). Eye/hair colour, occupation, skin type, social class, tumour site at presentation and smoking history were assessed. Social class 1/2, skin type 1, red/blonde hair and blue/green eyes were all related to BCC risk, social class most strongly (odds ratio 2.36, P=0.007). Truncal site at presentation was a risk factor for the development of multiple BCC (odds ratio 4.03, P=0.002). These data support the view that genetically mediated differences in ultraviolet responsiveness are important in BCC, though the scale of their effect is small. They may be exploitable in primary and secondary prevention as well as giving insights into pathogenesis. In particular, the fact that patients presenting with a truncal tumour are at increased risk of further BCC suggests that intermittent exposure in genetically predisposed individuals may contribute to a cancer susceptibility syndrome.
Longitudinal Intestinal Lengthening and Tailoring: Results in 20 Children
Authors: Bianchi A 
Published: May 2017

Longitudinal intestinal lengthening and tailoring (LILT) is increasingly favoured as a treatment for short-bowel syndrome. In a personal series, 20 children underwent LILT between 1982 and 1997. There was negligible morbidity (hemiloop anastomotic stenosis in 2) and no operative mortality. At a mean follow-up of 6.4 years overall survival was 45%, and certain features were clearly related to outcome. Survivors had >40cm of residual small bowel (commonly jejunum) and had little hepatic dysfunction despite parenteral nutrition of similar time and nature as non-survivors. Children who did not survive had < 40 cm of residual small bowel and developed early lethal hepatic dysfunction of unclear aetiology. Outcome did not seem to be influenced by the presence of the ileocaecal valve or the length of residual colon. Children born with short-bowel should be offered LILT at an early stage when still in good physical condition, so as to avoid liver-damaging intraluminal stasis and bacterial translocation and to enhance intestinal adaptation and hepatoprotective factors.
Does an Increase in the Sensitivity of Serum Thyrotropin Assays Reduce Diagnostic Costs for Thyroid Disease in the Community?
Authors: Vanderpump M P J , Neary R H , Manning K , Clayton R N 
Published: May 2017

Many authorities now advocate that the first-line assessment of thyroid function should be measurement of thyrotropin (TSH). The latest serum TSH assays (third generation) are more sensitive than the second generation but the reagents are more costly. We have examined whether overall assay reagent costs would be higher or lower with a third-generation assay, in a laboratory that serves a population of almost 500 000. In a prospective study over six weeks, 505 samples with a second-generation serum TSH less than 0.5 mU/L (303 for screening and 202 for monitoring thyroxine therapy) had an additional third-generation TSH analysis. With a second-generation assay for screening, 11% more free thyroxine (FT4) measurements were required to exclude thyrotoxicosis but there was a 42% saving on the reagent budget compared with a third-generation assay. In patients taking thyroxine, 33% more FT4 measurements were required to exclude over-replacement but the calculated saving in reagent costs was 53%. The costs of all other aspects of the two methods were similar. In this community-based sample, the improvement in sensitivity yielded by the third-generation assay at the lower end of the normal range reduced the number of confirmatory FT4 levels required to exclude thyrotoxicosis or over-replacement with thyroxine, but reagent costs were nevertheless higher than for second-generation assays. In financial terms, there is little justification for use of assays with sensitivity greater than the second generation (0.1 mU/L).
Qualitative Medical Sociology: What are its Crowning Achievements?
Authors: Chard J A , Lilford R J , Court B V 
Published: May 2017

Doctors and epidemiologists seldom read or cite qualitative medical sociology; it is little published in medical journals. A large number of articles bewail this lack and provide arguments explaining and justifying the subject. Any examples used in such articles are selected ad hoc. We made a systematic search for the literature and used citation analysis to select the world's top 100 articles. We analysed this trawl and provide resumes of a selection from the ‘classics’. Mental health and the organization of medicine are the themes within medical sociology with highest impact. Much highly cited work consists of historical and theoretical analysis done ‘at the desk’ rather than observation or interview ‘in the field’. Citation rates, even for the most famous works in medical sociology, are a small fraction of those for high impact biomedical research.
The positive relationship between alcohol and heart disease in eastern Europe: potential physiological mechanisms
Authors: Mckee Martin , Britton Annie 
Published: May 2017

Research into the effect of alcohol on cardiovascular disease has indicated protective effects from moderate consumption. These observations, made in industrialized countries, have influenced policies on alcohol in countries where the situation may be quite different—specifically, where consumption is substantially higher or patterns of drinking are different. In central and eastern Europe and the former Soviet Union, a growing body of epidemiological research indicates a positive rather than negative association between alcohol consumption and cardiovascular deaths, especially sudden cardiac deaths. By means of a systematic review of published work, we examine whether there is a physiological basis for the observed association between alcohol and heart disease seen in eastern Europe, focusing on the effects of high levels of consumption and of irregular or binge drinking. In binge drinkers, cardioprotective changes in high-density lipoproteins are not seen, and adverse changes in low-density lipoproteins are acquired. Irregular drinking is associated with an increased risk of thrombosis, occurring after cessation of drinking. It predisposes both to histological changes in the myocardium and conducting system and to a reduction in the threshold for ventricular fibrillation. Measures of frequency as well as quantity of consumption should be included in epidemiological studies. Taken with the epidemiological evidence emerging from eastern Europe, these observations have important implications for estimates of the burden of disease attributable to alcohol.
The National Health Service: past and future
Authors: Langlands Alan 
Published: May 2017

Alan Langlands is the Chief Executive of the National Health Service in England and the most senior health service manager in the UK. He is the Secretary of State for Health's principal policy adviser for the NHS and is directly accountable to him for the effective stewardship of a revenue budget of £34bn. He joined the NHS in 1974 as a graduate trainee and has spent his working life in health care management. His experience includes time spent managing major teaching hospitals in London (the Middlesex and University College Hospitals and the Hospital for Women, Soho), running Harrow Health Authority; and developing a Health Care practice within Powers Perrin, an international management consultancy firm. From 1990–1992 he was the Regional General Manager of North West Thames Regional Health Authority; during 1993, he was seconded to the Department of Health as Deputy Chief Executive of the NHS where he was responsible for a major review of the top management of the NHS. Sir Alan is a science graduate of the University of Glasgow and holds the diploma of the Institute of Health Services Management. He is an Honorary Professor at the University of Warwick Business School and a board member of the Centre for Corporate Strategy and Change at the University. He is also an honorary fellow of the Faculty of Public Health Medicine of the Royal College of Physicians.
Primary care
Authors: Ferguson John J 
Published: May 2017

Dr John Ferguson is the current President of the Section of General Practice of the Royal Society of Medicine. He was in academic general practice in Edinburgh for 20 years and was involved in the continuum of medical education as a Senior Lecturer in the Department of General Practice and an Associate Regional Adviser in General Practice to the Edinburgh Postgraduate Board for Medicine. He is the past Chairman of the Examination Board of the Royal College of General Practitioners in London. In September 1992, he was appointed to the new post of Medical Director to the Prescription Pricing Authority in Newcastle upon Tyne, which is an NHS Special Health Authority, whose responsibility is to process over 518 million prescriptions per annum in England, and to arrange the payment in excess of £4.94 billion.
Use of complementary therapies by patients attending musculoskeletal clinics
Authors: Chandola A , Young Y , Mcalister J , Axford J S 
Published: May 2017

Patients with musculoskeletal disorders commonly seek treatment outside orthodox medicine (complementary therapy). In patients attending hospital clinics we investigated the prevalence of such behaviour and the reasons for it. Patients attending rheumatology and orthopaedic clinics who agreed to participate were interviewed on the same day by means of a structured questionnaire in three sections: the first section about demographic characteristics; the second about the nature and duration of the complaint, the length of any treatment and whether the patient was satisfied with conventional treatment; and the third about the use of complementary medicine, the types of therapy that had been considered and the reasoning behind these decisions. The data were examined by univariate and bivariate analysis as well as logistic regression multivariate analysis. 166 patients were interviewed (99% response rate) and the predominant diagnosis was rheumatoid arthritis (22.3%). 109 patients (63%) were satisfied with conventional medical treatment; 63 (38%) had considered the use of complementary therapies, and 47 (28%) had tried such a therapy. 26 of the 47 who had used complementary therapy said they had gained some benefit. Acupuncture, homoeopathy, osteopathy and herbal medicine were the most popular types of treatment to be considered. Patients of female gender (P=0.009) and patients who had expressed dissatisfaction with current therapies (P=0.01) were most likely to have considered complementary medicine. These results indicate substantial use of complementary therapy in patients attending musculoskeletal disease clinics. The reasons for dissatisfaction with orthodox treatment deserve further investigation, as does the effectiveness of complementary treatments, which must be demonstrated before they are integrated with orthodox medical practice.
Artificial neural networks: a potential role in osteoporosis
Authors: Rae Sarah A , Wang Wen Jia , Partridge Derek 
Published: May 2017

Artificial neural networks are computer software systems that recognize patterns in complex data sets. A recent development in neural computing, multiversion systems (MVS), has led to enhanced analytical power, and this was harnessed to demonstrate the value of risk factors in predicting the result of osteoporosis investigations by quantitative ultrasound. 274 women were screened in an open-access osteoporosis service. A conventional risk factor questionnaire was completed for each patient by the osteoporosis specialist nurse. An MVS was trained on 180 randomly selected data sets and tested on the remaining 94. The results were compared with those from logistic regression analysis in predictive power, both from the selected 20-item questionnaire and for a limited 5-item questionnaire comprising age, height, height loss, weight and years since the menopause. The MVS approach predicted the T-score categorization of the patients from the 20-item questionnaire with 83.0% accuracy, whereas logistic regression yielded an accuracy of only 72.8% (P=0.04). From the 5-item database the MVS yielded a best prediction accuracy of 73.1%, whereas the logistic regression prediction accuracy was 60% (P=0.04). These results suggest that 20 risk factors can be used by an MVS to predict the outcome of osteoporosis investigations with a power that outperforms conventional statistical methods. Use of this system may improve the selection of patients for osteoporosis investigations, since even with only 5 risk factors the system performs nearly as well as that based on the full 20 factors.
Clinical Experience during the Paediatric Undergraduate Course
Authors: Ahmed S F , Hughes I A 
Published: May 2017

Medical students at the Cambridge Clinical School are provided with a list of 42 core conditions they should encounter and 20 core skills they should perform during their attachment. By self-completion questionnaires we assessed their clinical experience and the amount of teaching they received, relating the results to marks gained in end-of-attachment assessments. 103 (93%) of 110 students in year one and 123 (96%) of 128 in year two completed the questionnaires. Of the 42 core conditions, 13 were seen by under 70% of the students in year one. In year two, exposure rate increased for 26 core conditions by a median of 7% (range 2–40) and decreased in 13 core conditions by a median value 4% (range 5–13) (P=0.0005, χ2). Only mandatory core skills were performed by over 90% of students. 5% of students did not perform any newborn examinations and under 60% observed neonatal resuscitation or a high-risk delivery. Students' core condition score was associated with their core skill score (r=0.5), hospital grade (r=0.3) and exposure to acute paediatrics (r=0.3) (P<0.005). There was no significant association between clinical experience and the objective examination score or the amount of teaching received. There was an inverse association between the number of students at a hospital and the number of core conditions with an exposure rate above 70% at that hospital (r=0.7, P<0.05). This study suggests that clinical experience may be better judged by the clinical supervisor than by assessment of theoretical knowledge.
Acupuncture for vulvodynia
Authors: Powell J , Wojnarowska F 
Published: May 2017

Vulvodynia is the sensation of burning and/or pain of the vulva in the absence of abnormal clinical findings. We offered acupuncture to twelve patients with this syndrome. All had experienced severe distress and impairment of sexual function and usual treatments had failed. The patients attended weekly for acupuncture and progress was monitored at each visit by enquiry, a questionnaire and a visual analogue scale for pain. Half had treatment for the first five weeks only, the other half for the second five weeks only. Side-effects were negligible. Two patients felt so much improved that they declared themselves ‘cured’; three believed their symptoms had improved and wished to continue acupuncture; four felt slightly better and judged acupuncture more effective than any other treatment; and three noted no effect at all. Acupuncture is time-consuming and a large part of its beneficial effect in this study may have come from the regular specialist contact. However, in view of the patients' lack of response to other measures their satisfaction with the acupuncture was surprisingly high.
Effectiveness of the progestin-only pill for migraine treatment in women: A systematic review and meta-analysis
Authors: Warhurst Samantha , Rofe Christopher J , Brew Bruce J , Bateson Deborah , McGeechan Kevin , Merki-Feld Gabriele S , Garrick Raymond , Tomlinson Susan E 
Published: May 2017

Background Migraine is highly prevalent in women (18%). Peak morbidity affects their most productive years, coinciding with peak fertility. Hormonal contraception is often tailored for migraine prevention. Estrogen-containing contraceptives may be contraindicated in women experiencing migraine with aura due to the risk of vascular events. While improvements in migraine with a progestin-only pill (POP), which inhibits ovulation are documented, the strength and quality of evidence has not been formally evaluated. Objectives To determine the effectiveness of progestin-only contraceptives for migraine treatment by systematic review and meta-analysis. Data sources and selection MEDLINE, EMBASE and Cochrane Libraries were searched (1980 to September 2016) for studies on progestin-only treatments for migraine. Studies in English on >4 non-menopausal women aged 18–50 with migraine diagnosed by formal criteria were included. Data extraction and analysis Data were quality-assessed using the GRADE system. A random effects model was used for pooled analyses. Results Pooled analyses of four studies demonstrated that desogestrel 75 mcg/day, POP significantly but modestly reduced the number of migraine attacks and migraine days. Reduced intensity and duration, reduced analgesic and triptan use were observed, along with improved headache-related quality of life. GRADE analysis indicated evidence was low to very low for each outcome measure. Adverse effects resulted in treatment cessation for <10% of participants. Two studies compared desogestrel POP to a combined oral contraceptive, demonstrating similar migraine outcomes for both treatments. Conclusions The desogestrel POP shows promise in improving migraine in women. Current evidence is observational and based on small samples of women using only one oral progestin-only formulation. Further randomized trials on additional progestin-only contraceptives are required to confirm their role in migraine management.
Lactic Acidosis and Fatal Myocardial Failure Due to Clozapine
Authors: Koren Wladimir , Kreis Yitzhak , Duchowiczny Kira , Prince Tal , Sancovici Sigmund , Sidi Yechezkel , Gur Hanan 
Published: May 2017

Objective To describe a patient with neutropenic fever complicated by hyperglycemia, lactic acidosis, and fatal myocardial failure associated with clozapine therapy. Case Summary A 37-year-old Ashkenazic Jewish man was admitted for agranulocytosis and fever, which developed after 11 weeks of clozapine monotherapy for drug-resistant schizophrenia. Complete blood counts and a routine serum chemical analysis had been normal before the treatment was initiated, and remained within normal limits during the first 10 weeks of the treatment. On the day of admission, the patient deteriorated rapidly and developed extreme hyperglycemia, severe lactic acidosis, recurrent cardiac arrest, cardiogenic shock, and coma. He died 36 hours later despite intensive treatment. Discussion Clozapine intake induced fatal aganulocytosis, associated with hyperglycemia, lactic acidosis, and heart failure. White blood cell count monitoring was insufficient to predict these adverse effects. Conclusions Clozapine should be avoided in high-risk patients (e.g., the elderly, women, Ashkenazic Jews).