bluuebunny/crossref_metadata_2025_split huggingface dataset:
Morphologically and immunohistochemically undifferentiated gastric neoplasia in a patient with multiple metastatic malignant melanomas: a case report
Authors: Alghisi Federico , Crispino Pietro , Cocco Andrea , Richetta Antonio G , Nardi Francesco , Paoluzi Paolo , Badiali Danilo 
Published: April 2008

Abstract

Introduction
Malignant melanoma is a neoplasia which frequently involves the gastrointestinal tract (GIT). GIT metastases are difficult to diagnose because they often recur many years after treatment of the primary cutaneous lesion and also manifest clinically at an advanced stage of the neoplasia. Furthermore, GIT metastases can appear in various morphological forms, and therefore immunohistochemistry is often useful in distinguishing between a malignant melanoma and other malignancies.

Case presentation
We report the case of a 60-year-old man with a multiple metastatic melanoma who underwent an upper endoscopy to clarify the possible involvement of the gastric wall with a mass localized in the upper abdomen involving the pancreas and various lymph nodes, which was previously described with computed tomography. Clinically, the patient reported a progressive loss of appetite, nausea and vomiting. The upper endoscopy and histological examination revealed a gastric location of an undifferentiated neoplasm with an absence of immunohistochemical characteristics referable to the skin malignant melanoma that was removed previously.

Conclusion
The present case report shows the difficulty in diagnosing a metastatic melanoma in the GIT and therefore, it seems worthwhile to consider metastatic malignant melanoma in the differential diagnosis of undifferentiated neoplasia.
Nonsteroidal anti-inflammatory drugs and breast cancer risk in the National Institutes of Health–AARP Diet and Health Study
Authors: Gierach Gretchen L , Lacey James V , Schatzkin Arthur , Leitzmann Michael F , Richesson Douglas , Hollenbeck Albert R , Brinton Louise A 
Published: April 2008

Abstract
Introduction
By inhibiting cyclooxygenase-2, nonsteroidal anti-inflammatory drugs (NSAIDs) decrease aromatase activity and might reduce breast cancer risk by suppressing estrogen synthesis. Epidemiologic evidence for a protective role of NSAIDs in breast cancer, however, is equivocal.

Methods
We tested NSAID use for its association with breast cancer incidence in the National Institutes of Health–AARP Diet and Health Study, where 127,383 female AARP (formerly known as the American Association of Retired Persons) members with no history of cancer, aged 51 to 72 years, completed a mailed questionnaire (1996 to 1997). We estimated relative risks of breast cancer for NSAID exposures using multivariate Cox proportional hazards regression models. The state cancer registry and mortality index linkage identified 4,501 primary incident breast cancers through 31 December 2003, including 1,439 estrogen receptor (ER)-positive cancers and 280 ER-negative cancers.

Results
Proportional hazards models revealed no statistically significant association between overall NSAIDs and total breast cancer. As cyclooxygenase inhibition by aspirin (but not other NSAIDs) is irreversible, we tested associations by NSAID type. Although we observed no significant differences in risk for daily use (versus nonuse) of aspirin (relative risk = 0.93, 95% confidence interval = 0.85 to 1.01) or nonaspirin NSAIDS (relative risk = 0.96, 95% confidence interval = 0.87 to 1.05), risk of ER-positive breast cancer was significantly reduced with daily aspirin use (relative risk = 0.84, 95% confidence interval = 0.71 to 0.98) – a relationship not observed for nonaspirin NSAIDS. Neither aspirin nor nonaspirin NSAIDs were associated with risk of ER-negative breast cancer.

Conclusion
Breast cancer risk was not significantly associated with NSAID use, but daily aspirin use was associated with a modest reduction in ER-positive breast cancer. Our results provide support for further evaluating relationships by NSAID type and breast cancer subtype.
Improved outcomes from the administration of progesterone for patients with acute severe traumatic brain injury: a randomized controlled trial
Authors: Xiao Guomin , Wei Jing , Yan Weiqi , Wang Weimin , Lu Zhenhui 
Published: April 2008

Abstract
Background
Severe traumatic brain injury (TBI) has been increasing with greater incidence of injuries from traffic or sporting accidents. Although there are a number of animal models of TBI using progesterone for head injury, the effects of progesterone on neurologic outcome of acute TBI patients remain unclear. The aim of the present clinical study was to assess the longer-term efficacy of progesterone on the improvement in neurologic outcome of patients with acute severe TBI.

Methods
A total of 159 patients who arrived within 8 hours of injury with a Glasgow Coma Score ≤ 8 were enrolled in the study. A prospective, randomized, placebo-controlled trial of progesterone was conducted in the Neurotrauma Center of our teaching hospital. The patients were randomized to receive either progesterone or placebo. The primary endpoint was the Glasgow Outcome Scale score 3 months after brain injury. Secondary efficacy endpoints included the modified Functional Independence Measure score and mortality. In a follow-up protocol at 6 months, the Glasgow Outcome Scale and the modified Functional Independence Measure scores were again determined.

Results
Of the 159 patients randomized, 82 received progesterone and 77 received placebo. The demographic characteristics, the mechanism of injury, and the time of treatment were compared for the two groups. After 3 months and 6 months of treatment, the dichotomized Glasgow Outcome Scale score analysis exhibited more favorable outcomes among the patients who were given progesterone compared with the control individuals (P = 0.034 and P = 0.048, respectively). The modified Functional Independence Measure scores in the progesterone group were higher than those in the placebo group at both 3-month and 6-month follow-up (P < 0.05 and P < 0.01). The mortality rate of the progesterone group was significantly lower than that of the placebo group at 6-month follow-up (P < 0.05). The mean intracranial pressure values 72 hours and 7 days after injury were lower in the progesterone group than in the placebo group, but there was no statistical significance between the two groups (P > 0.05). Instances of complications and adverse events associated with the administration of progesterone were not found.

Conclusion
Our data suggest that acute severe TBI patients with administration of progesterone hold improved neurologic outcomes for up to 6 months. These results provide information important for further large and multicenter clinical trials on progesterone as a promising neuroprotective drug.

Trial Registration
ACTRN12607000545460.
Human-macaque comparisons illuminate variation in neutral substitution rates
Authors: Tyekucheva Svitlana , Makova Kateryna D , Karro John E , Hardison Ross C , Miller Webb , Chiaromonte Francesca 
Published: April 2008

Abstract
Background
The evolutionary distance between human and macaque is particularly attractive for investigating local variation in neutral substitution rates, because substitutions can be inferred more reliably than in comparisons with rodents and are less influenced by the effects of current and ancient diversity than in comparisons with closer primates. Here we investigate the human-macaque neutral substitution rate as a function of a number of genomic parameters.

Results
Using regression analyses we find that male mutation bias, male (but not female) recombination rate, distance to telomeres and substitution rates computed from orthologous regions in mouse-rat and dog-cow comparisons are prominent predictors of the neutral rate. Additionally, we demonstrate that the previously observed biphasic relationship between neutral rate and GC content can be accounted for by properly combining rates at CpG and non-CpG sites. Finally, we find the neutral rate to be negatively correlated with the densities of several classes of computationally predicted functional elements, and less so with the densities of certain classes of experimentally verified functional elements.

Conclusion
Our results suggest that while female recombination may be mainly responsible for driving evolution in GC content, male recombination may be mutagenic, and that other mutagenic mechanisms acting near telomeres, and mechanisms whose effects are shared across mammalian genomes, play significant roles. We also have evidence that the nonlinear increase in rates at high GC levels may be largely due to hyper-mutability of CpG dinucleotides. Finally, our results suggest that the performance of conservation-based prediction methods can be improved by accounting for neutral rates.
Predictive validity of acute stress disorder in children and
adolescents
Authors: Dalgleish Tim , Meiser-Stedman Richard , Kassam-Adams Nancy , Ehlers Anke , Winston Flaura , Smith Patrick , Bryant Bridget , Mayou Richard A. , Yule William 
Published: April 2008

SummaryAdult research suggests that the dissociation criterion of acute stress
disorder has limited validity in predicting posttraumatic stress disorder
(PTSD). We addressed this issue in child and adolescent survivors
(n=367) of road accidents. Dissociation accounted for no
significant unique variance in later PTSD, over and above other acute stress
disorder criteria. Furthermore, thresholds of either three or more
re-experiencing symptoms, or six or more re-experiencing/hyperarousal
symptoms, were as effective at predicting PTSD as the full acute stress
disorder diagnosis.
Efficacy of Quichua healers as psychiatric diagnosticians
Authors: Incayawar Mario 
Published: April 2008

SummaryTraditional healers' practices are widespread around the world, yet their diagnostic skills have rarely been investigated. This exploratory study examines whetheryachactaitas(Quichua healers) in the Andes identify cases of psychiatric illness in their communities. For over 18 months, tenyachactaitasparticipated in the identification of 50 individuals with the condition known asllaqui.Medical and psychiatric evaluation indicated that most of those so diagnosed had a DSM–III–R mental disorder. None of the participants withllaquiwas considered healthy in biomedical or psychiatric terms. It is suggested thatyachactaitasmight indeed identify general psychiatric cases in their communities, and that this might be useful for screening purposes.
Proposals for massive expansion of psychological therapies would
be counterproductive across society
Authors: Summerfield Derek , Veale David 
Published: April 2008

SummaryIn 2007 the UK Government announced a substantial expansion of funding for
psychological therapies in England to provide better support for people with
conditions such as anxiety and depression. Will these services result in the
medicalisation of normal distress? Or are they simply an evidenced-based
solution for a previously unmet need? In this debate Derek Summerfield and
David Veale discuss the issues raised by these controversial proposals.
Five-year follow-up of an evidence-based prescribing intervention
Authors: Meagher David , Pullela Ananth , Meisinger Marek , Geaney Niamh , O'Brien Sinead 
Published: April 2008

Aims and MethodWe studied the impact of an evidence-based multidisciplinary intervention to reduce six sub-optimal aspects of psychotropic prescribing, combined as a Prescribing Practice Quality (PPQ) score over a 5-year follow-up period in a community mental health service.ResultsSub-optimal prescribing practices were significantly reduced after 1 year and these improvements were sustained at 5-year follow-up. The PPQ scores were significantly reduced (P<0.001) in both the overall population attending at each follow-up point as well as in the ever-present population (n=163). Use of high-dose antipsychotics and thioridazine ceased entirely; use of sedative hypnotic agents was less amenable to reduction.Clinical ImplicationsMultifaceted interventions can achieve sustained improvements in prescribing practices in real-world settings.
Audit of metabolic syndrome in adults prescribed clozapine in community and long-stay in-patient populations
Authors: Morgan David , Sargeant Matthew , Chukwuma Jude , Hughes Gwenllian 
Published: April 2008

Aims and MethodsTo calculate the prevalence of metabolic syndrome in patients receiving clozapine in community and long-stay in-patient settings. Patients were assessed using measures specified by the Expert Panel of the US National Cholesterol Education Program.ResultsThe prevalence of the metabolic syndrome was calculated as 53% in the community groups and 11% in the in-patient group, although both sample sizes (particularly the in-patient group) were small. Women were more frequently affected than men in the community population.Clinical ImplicationsThe higher percentage of metabolic syndrome in the community patients receiving clozapine has implications with respect to physical health. The reasons for the lower percentage in the in-patient group are unclear. Our findings point to a possible difference in the physical health of long-stay psychiatric in-patients and patients in the community.
Comparison of older people with psychosis living in the community and in care homes
Authors: Clancy Emily , Baldwin Robert C. 
Published: April 2008

Aims and MethodTo compare two groups of older people with chronic schizophrenia or delusional disorder living in the community and in care homes, along the domains of morbidity suggested by prior research. From the case-load of one old age psychiatrist, 22 individuals with chronic psychosis residing in care homes were compared to 23 living in their own homes. The measures used were: the Positive and Negative Symptom Score (PANSS; Kay et al, 1987); the Mini Mental State Examination (MMSE; Folstein et al, 1975); the Burvill Physical Illness Scale (Burvill et al, 1990); and an Activities of Daily Living Scale (IADL; Lawton et al, 1969).ResultsThose in care homes had significantly higher PANSS scores (38.9 v. 21.0, P<0.01), largely accounted for by significantly more deficit symptoms (14.2 v. 5.6, P<0.01). They also had poorer cognition and significantly greater impairment in daily-life activities but their medical condition was not significantly worse. Most were seen only by a psychiatrist.Clinical ImplicationsThe greater morbidity and disablement of older people with chronic schizophrenia or delusional disorder living in care homes is likely to be intrinsic to the disorder but does not appear to be taken into account in current service planning or delivery.
Exploration of in-patient attitudes towards smoking within a large mental health trust
Authors: Smith Jennifer , O'Callaghan Charlotte 
Published: April 2008

Aims and MethodTo explore the smoking habits of in-patients on psychiatric wards, their beliefs about the effects of smoking on health, and their attitudes towards hospital and government smoking policies. Face-to-face interviews with 135 in-patients were conducted.ResultsA total of 54.1% of participants smoked. Smoking was less prevalent in those aged 65 years and older (P<0.001). Non-smokers were more likely to believe smoking to be harmful to health (P=0.002). Overall, 71.1% of the participants favoured the existing smoking policy, with only 3.0% wanting a complete ban on smoking and 54.1% agreeing with banning smoking in public places.Clinical ImplicationsFurther studies are warranted into the views of in-patients elsewhere and to see whether attitudes change as trusts tighten their smoking policies. Outdoor smoking areas may need to be considered, although in practice this may not be possible in all trusts.
To trust or not to trust? Faith issues in psychopharmacological prescribing
Authors: Khokhar Waqqas Ahmad , Hameed Imran , Ali Mohammed Mubashir , Sadiq Javaria , Bowie Peter 
Published: April 2008

Aims and MethodTo ascertain attitudes, awareness, knowledge and variations in prescribing habits of psychiatrists when addressing issues of faith, culture and dietary requirements (in keeping with the General Medical Council's and the Royal College of Psychiatrists' guidelines), and how these may affect the trust in doctor–patient relations. We undertook a cross-sectional postal survey aimed at clinicians in South West Yorkshire Mental Health Trust.ResultsWe obtained 38 responses (40% of the total number of questionnaires sent out) from two mailshots. Although the majority of respondents indicated that they were aware of the presence of potentially forbidden animal-derived ingredients in medication, only half expressed the view that a discussion regarding the above should take place prior to prescribing such medication.Clinical ImplicationsDiversity training combined with taking a genuine interest in patients' wishes will not only minimise ‘mistrust’ but also facilitate prescribing in a therapeutic relationship.
Outcome measures for orthopaedic interventions on the hip
Authors: Ashby E. , Grocott M. P. W. , Haddad F. S. 
Published: April 2008

Orthopaedic outcome measures are used to evaluate the effect of operative interventions. They are used for audit and research. Knowledge of these measures is becoming increasingly important with league tables comparing surgeons and hospitals being made accessible to the profession and the general public.Several types of tool are available to describe outcome after hip surgery such as generic quality-of-life questionnaires, disease-specific quality-of-life questionnaires, hip-specific outcome measures and general short-term clinical measures. We provide an overview of the outcome measures commonly used to evaluate hip interventions.
The survival of support rings in complex acetabular revision surgery
Authors: Carroll F. A. , Hoad-Reddick D. A. , Kerry R. M. , Stockley I. 
Published: April 2008

Between 1980 and 2000, 63 support rings were used in the management of acetabular deficiency in a series of 60 patients, with a mean follow-up of 8.75 years (2 months to 23.8 years). There was a minimum five-year follow-up for successful reconstructions. The indication for revision surgery was aseptic loosening in 30 cases and infection in 33. All cases were Paprosky III defects; IIIA in 33 patients (52.4%) and IIIB in 30 (47.6%), including four with pelvic dissociation. A total of 26 patients (43.3%) have died since surgery, and 34 (56.7%) remain under clinical review. With acetabular revision for infection or aseptic loosening as the definition of failure, we report success in 53 (84%) of the reconstructions. A total of 12 failures (19%) required further surgery, four (6.3%) for aseptic loosening of the acetabular construct, six (9.5%) for recurrent infection and two (3.2%) for recurrent dislocation requiring captive components. Complications, seen in 11 patients (18.3%), included six femoral or sciatic neuropraxias which all resolved, one grade III heterotopic ossification, one on-table acetabular revision for instability, and three early post-operative dislocations managed by manipulation under anaesthesia, with no further instability. We recommend support rings and morcellised bone graft for significant acetabular bone deficiency that cannot be reconstructed using mesh.
Intramedullary nailing of fractures of the tibia in diabetics
Authors: Aderinto J. , Keating J. F. 
Published: April 2008

We reviewed 27 diabetic patients who sustained a tibial fracture treated with a reamed intramedullary nail and compared them with a control group who did not have diabetes. There were 23 closed fractures and four were open. Union was delayed until after six months in 12 of the 23 (52%) diabetic patients with closed fractures and ten of the 23 (43%) control patients (p = 0.768). In two patients with diabetes (9%), closed tibial fractures failed to unite and required exchange nailing, whereas all closed fractures in the control group healed without further surgery (p = 0.489). In both the diabetic and control groups with closed fractures two patients (9%) developed superficial infections. There were two (9%) deep infections in diabetic patients with closed fractures, but none in the control group (p = 0.489). Overall, there was no significant difference in the rate of complications between the diabetic patients and the control group, but there was a tendency for more severe infections in patients with diabetes.
Reconstruction for instability of the sternoclavicular joint using the tendon of the sternocleidomastoid muscle
Authors: Armstrong A. L. , Dias J. J. 
Published: April 2008

We describe a new method of stabilising a painful unstable sternoclavicular joint using the sternocleidomastoid tendon and passing it through the medial clavicle and onto the manubrium sternum. This method is simple, reproducible and avoids the potential risks of reefing the joint to the first rib. The technique was used in seven cases of sternoclavicular joint instability in six patients who were reviewed at a mean of 39.7 months (15 to 63). Instability was markedly reduced or eliminated in all cases, but in one there was occasional persistant subluxation. There were minor scar complications after two procedures and one patient had transient ulnar neuritis. This procedure provides satisfactory results in the medium term.
Lack of an Effect of Body Mass on the Hemodynamic Response to Arginine Vasopressin During Septic Shock
Authors: Lam Simon W. , Bauer Seth R. , Cha Stephen S. , Oyen Lance J. 
Published: April 2008

Study Objective. To determine whether body mass alters the effectiveness of a fixed‐dose infusion of arginine vasopressin.Design. Retrospective medical record review.Setting. All intensive care units of a tertiary medical center.Patients. Sixty‐six mechanically ventilated patients who received a fixed‐dose intravenous infusion of arginine vasopressin at 0.04 U/minute as the sole agent for hemodynamic support during septic shock.Measurements and Main Results. Patients were divided into four groups on the basis of body mass index. Effectiveness was measured as hemodynamic stability, which was defined as the proportion of patients achieving a mean arterial pressure (MAP) of 65 mm Hg or higher, the magnitude of the change in MAP at 1 hour, and the need for additional rescue vasopressors. Secondary outcomes included mortality and length of stay. Baseline characteristics of all four groups were comparable for age, sex, and severity of illness determined by using Acute Physiology and Chronic Health Evaluation II (APACHE II), Simplified Acute Physiology II (SAPS II), and Sequential Organ Failure Assessment (SOFA) scores. The only significant differences in baseline characteristics among the groups were in their central venous pressures. The four groups similarly achieved hemodynamic stability at 1 hour after the administration of arginine vasopressin (p=0.41). We observed no significant differences among groups in the magnitude of MAP change (p=0.62), need for rescue catecholamine vasopressors (p=0.17), 28‐day mortality rates (p=0.31), or length of stay in the intensive care unit (p=0.43).Conclusion. Body mass index did not alter the effects of arginine vasopressin on hemodynamic stability or changes in MAP when the drug was administered as a fixed‐dose infusion of 0.04 U/minute. Our results do not support weight‐based dosing of vasopressin, unlike the dosing for catecholamine vasopressors.