tbuckley/cabot-search huggingface dataset:
Effect of psychosis on suicide risk in 1,593 patients with unipolar and bipolar affective disorders
Authors: D W Black, G Winokur, A Nasrallah
Journal: American Journal of Psychiatry (1988)

The authors report suicide risk among 1,593 patients with major depression or bipolar disorder, 443 (27.8%) of whom were psychotic (260 bipolar and 183 unipolar). The subjects were followed for 0-14 years, and their suicide experience was compared with that of the state population. Eight (19.5%) of the 41 suicide victims were from the psychotic group. The psychotic and nonpsychotic subjects in each diagnostic group had similar risks for suicide. A higher risk for suicide was not found in the bipolar subjects. The authors conclude that among patients with major affective disorder psychosis per se does not predispose to suicide.
Discontinuation of thioridazine
Authors: A. F Bisset
Journal: BMJ (2002)

Editor—Until the Committee on the Safety of Medicines restricted the use of thioridazine in 2000, it was the most widely used antipsychotic drug in the United Kingdom, with 50 million years of safe use by patients worldwide. In Scotland in 1999, were 250 808 were prescriptions dispensed in primary care (hospital data not available, but the safety committee reports that it was the most widely used antipsychotic drug in hospitals too). This dropped to 39 177 in 2001, according to information from the Primary Care Information Unit in Edinburgh.

Is thioridazine safer, cheaper, and more effective than alternative antipsychotic drug treatments for anxiety, agitation, mania, and hypomania? We do not have enough evidence to answer this because thioridazine has been widely used for 30 years—before the days of rigorous randomised controlled trials. Lack of evidence is not evidence of no benefit. Conversely, there is only evidence of a handful of adverse cardiac events, some of which may not have been directly caused by thioridazine or may have been due to combination with other drugs. Although the reported cardiac deaths are lamentable, it seems that thioridazine is much safer than other effective drugs such as aspirin, which continues to be sold over the counter. Even if adverse events are under-reported, there is far more practical evidence of long term safety for thioridazine compared with much more expensive and much less tried and tested drugs. A recent study noted that many new drugs have a high rate of serious side effects which go undetected until late in postmarketing surveillance.2 The Committee for the Safety of Medicines needs to balance these relative risks.

The manufacturers of thioridazine have raised few objections to the restricted use of thioridazine because it is an extremely cheap drug, costing only a few pence compared with newer antipsychotics that may be up to a hundred times more expensive, as well as having different and sometimes distressing side effects. The prescription costs of antipsychotic drugs has risen sharply in Scotland in the past two years.

Anecdotally, considerable numbers of patients with hypomania, anxiety, and agitation are having considerable problems in adjusting to a change of drugs, and, as Davies et al point out, informed consent may be a problem.1 It would be very helpful if the National Institute for Clinical Excellence or Health Technology Board for Scotland reviewed the evidence, risks, and benefits of thioridazine, and considered more humane guidelines for its future use. It seems quite wrong to deprive so many patients of a well tried drug.
Combined preoperative chemotherapy and radiotherapy in patients with locally advanced esophageal cancer. Interim analysis of a phase II trial.
Authors: M Stahl, H Wilke, U Fink, M Stuschke, M K Walz, J R Siewert, M Molls, W Fett, H B Makoski, N Breuer, U Schmidt, W Niebel, H Sack, F W Eigler, S Seeber
Journal: Journal of Clinical Oncology (1996)

PURPOSE The prognosis of patients with locally advanced esophageal cancer (LAEC) remains poor when treated with local modalities. An intensive preoperative program with chemoradiotherapy was used to evaluate the curative resection rate, pathologic response, and survival of patients with LAEC. PATIENTS AND METHODS Ninety patients with LAEC were treated preoperatively with chemotherapy (three courses of fluorouracil, leucovorin, etoposide, and cisplatin [FLEP]) followed by concurrent chemoradiotherapy (one course of cisplatin plus etoposide in combination with 40 Gy of radiation). Transthoracic esophagectomy was performed 4 weeks after the end of radiation. RESULTS Seventy-two patients were included in this evaluation. Forty-four (61%) underwent a complete tumor resection, and 16 (22%) had no tumor in the resected specimen (pathologic complete response [PCR]). The operative mortality rate was 15%. At a median follow-up time of 22 months (range, 12 to 41), the median survival duration of all 72 patients was 17 months (range, 1 to 41+). The calculated survival rates at 3 years were 33%, 42%, and 68% for all patients, patients after complete resection, and patients with PCR, respectively. CONCLUSION This combined treatment modality is active in LAEC, with a PCR in 33% of the patients undergoing surgery. The results appear improved compared with those reported with surgery alone, by approximately doubling the 3-year survival rate. The high efficacy of preoperative chemoradiation warrants evaluation of the role of surgery in LAEC.
Safety of transdermal fentanyl (TF) in front-line approach to severe cancer pain. Meta-analysis of randomized clinical trials
Authors: M. Maltoni, E. Scarpi, B. Poggi, D. Tassinari
Journal: Journal of Clinical Oncology (2007)

19627 Background: To assess the safety of TF when compared with Slow Releasing Oral Morphine (SROM) in the front-line approach to severe cancer pain. Methods: A systematic review of literature in the MEDLINE and EMBASE data bases from 1966 to October 2006, using “Administration, Cutaneous” [MeSH term], “Administration, Oral” [MeSH term], “Analgesic, Opioid/*administration &amp; dosage/adverse effects” [MeSH term], “Delayed-Action Preparations” [MeSH term], “Fentanyl/*administration &amp; dosage/adverse effects” [MeSH term], “Cancer Pain/*drug therapy” [MeSH term], “Morphine/*administration &amp; dosage/adverse effects” [MeSH term] as search terms was performed independently by two authors (DT and MM). All the randomized phase III trials comparing TF and SROM were considered eligible and included into the analysis. The overall side effects odds ratio (OR) was the primary end point of the analysis; overall gastrointestinal side effects, constipation, nausea, somnolence, the patient's preference and the trial withdrawal pooled ORs the secondary ones. Heterogeneity between the trials was analysed using the Mantel-Haenszel test, and the outcome analysis was performed using a fixed effects model and an alpha error lower than 5%. Results: 3 trials met the selection criteria and were included into the analysis. The safety of TF and SROM was analysed in 373 patients (188 and 185 respectively treated with TF and SROM). A significant difference in favour of TF was observed for constipation (OR=0.42, p=0.002), somnolence (OR=0.559, p=0.018) and the preference of the patient (OR=0.39, p&lt;0.001): no significant differences were observed for overall side effects (OR=0.82, p=0.51), overall gastrointestinal side effects (OR=0.87, p=0.6), nausea (OR=1.2, p=0.446) and trial withdrawal (OR=0.62, p=0.59). No heterogeneity was documented between the trials. Conclusion: Although no differences exist between TF and SROM in efficacy (with equianalgesic doses) and safety (when assessed as overall safety profile) on the whole, the differences in the peculiar safety profile of the two opiates seems to favour TF in patient's preference in the choice of front-line treatment of severe cancer pain. No significant financial relationships to disclose.
Cigarette smoking, tar yields, and non-fatal myocardial infarction: 14000 cases and 32000 controls in the United Kingdom
Authors: S Parish, R Collins, R Peto, L Youngman, J Barton, K Jayne, R Clarke, P Appleby, V Lyon, S Cederholm-Williams, J Marshall, P Sleight
Journal: BMJ (1995)

<h3>Abstract</h3> <b>Objectives</b>: To assess the effects of cigarette smoking on the incidence of non-fatal myocardial infarction, and to compare tar in different types of manufactured cigarettes. <b>Methods</b>: In the early 1990s responses to a postal questionnaire were obtained from 13926 survivors of myocardial infarction (cases) recently discharged from hospitals in the United Kingdom and 32389 of their relatives (controls). Blood had been obtained from cases soon after admission for the index myocardial infarction and was also sought from the controls. 4923 cases and 6880 controls were current smokers of manufactured cigarettes with known tar yields. Almost all tar yields were 7-9 or 12-15 mg/cigarette (mean 7.5 mg for low tar (&lt;10 mg) and 13.3 for medium tar (&gt;/=10 mg)). The cited risk ratios were standardised for age and sex and compared myocardial infarction rates in current cigarette smokers with those in non-smokers who had not smoked cigarettes regularly in the past 10 years. <b>Results</b>: At ages 30-49 the rates of myocardial infarction in smokers were about five times those in non-smokers (as defined); at ages 50-59 they were three times those in non-smokers, and even at ages 60-79 they were twice as great as in non-smokers (risk ratio 6.3, 4.7, 3.1, 2.5, and 1.9 at 30-39, 40-49, 50-59, 60-69, 70-79 respectively; each 2P&lt;0.00001). After standardisation for age, sex, and amount smoked, the rate of non-fatal myocardial infarction was 10.4% (SD 5.4) higher in medium tar than in low tar cigarette smokers (2P=0.06). This percentage was not significantly greater at ages 30-59 (16.6% (7.1)) than at 60-79 (1.0% (8.5)). In both age ranges the difference in risk between cigarette smokers and non-smokers was much larger than the difference between one type of cigarette and another (risk ratio 3.39 and 3.95 at ages 30-59 for smokers of similar numbers of low and of medium tar cigarettes, and risk ratio 2.35 and 2.37 at ages 60-79). Most possible confounding factors that could be tested for were similar in low and medium tar users, with no significant differences in blood lipid or albumin concentrations. <b>Conclusion</b>: The present study indicates that the imminent change of tar yields in the European Union to comply with an upper limit of 12 mg/cigarette will not increase (and may somewhat decrease) the incidence of myocardial infarction, unless they indirectly help perpetuate tobacco use. Even low tar cigarettes still greatly increase rates of myocardial infarction, however, especially among people in their 30s, 40s, and 50s, and far more risk is avoided by not smoking than by changing from one type of cigarette to another.
Abstract 12661: A Novel Mutation in a Lamin A/C Gene Associated with Dilated Cardiomyopathy, Degeneration of Cardiac Conduction System, and Altered Gene Expression
Authors: Nobue Yagihara, Keiko Sonoda, Hiroshi Watanabe, Hiroaki Obata, Akinori Sato, Masaomi Chinushi, Haruo Hanawa, Yoshihiko Ikeda, Hatsue Ishibashi-Ueda, Makoto Kodama
Journal: Circulation (2011)

Background: Lamins A and C form a nuclear envelope-associated lattice as the main structural components of the nuclear lamina and play an important role for chromatin structure, regulation of gene ...
Implementation of IDSA/ATS and national guidelines for community acquired pneumonia by Greek chest phycisians
Authors: Charalampos Triantafyllidis, Vasilios Kapordelis, Georgios Papaetis, Dora Orfanidou, Maria Apostolidou, Ioannis Nikolopoulos, Elissavet-Christina Filippidou, Angelos Pefanis
Journal: European Respiratory Journal (2012)

BACKGROUND: The implementation of practice guidelines for CAP by Greek physicians and its impact on cost and patients9 outcome remain unknown.  MATERIAL & METHODS: A prospective observational study incorporating 350 immunocompetent hospitalized pts with CAP. The aim was to investigate whether the 2007 IDSA/ATS and the Greek national guidelines for CAP are implemented by chest physicians in “Sotiria” General hospital in Athens, Greece. We: a) assessed whether the decision of hospital admission was correct or not and b) evaluated whether the administered antimicrobial regimen was in accordance to guidelines. Fine score (PSI) was applied by the authors to determine the severity of CAP.  RESULTS: The mean age was 56.3±22.2years and the duration of hospitalization 10.9±11.8days. 218 (62.29%) pts were male and 132 (37.71%) female. The mortality rate was 12.29%. 167 (47.71%) pts were admitted to the hospital, despite they were classified as risk class I or II and therefore could be treated as outpatients. Implementation of CAP guidelines as far as the initial antimicrobial regimen is concerned was poor (211pts, 60.29%). Patients treated with an initial antimicrobial in accordance to guidelines performed statistically signifigant lower mortality and a trend towards shorter length of hospitalization compared to pts receiving initial regimen in discordance to guidelines (p=0.04 & p=0.066 respectively).  CONCLUSION: The implementation of CAP guidelines by chest physicians in the major Greek hospital for thoracic diseases is poor. Improvement of adherence may improve patients9 outcome, shorten the length of hospitalization and reduce the financial burden for the national health system.
Anatomic response correlation with biological response
Authors: G. Kasymjanova, N. MacDonald, M. Roseman, H. Kreisman, C. Pepe, J. S. Agulnik, B. Gagnon, D. Small
Journal: Journal of Clinical Oncology (2009)

8092 Background: Chronic systemic inflammation is a well recognized strong adverse prognostic factor in advanced NSCLC. We have previously identified that in stage IIIB/IV NSCLC the presence of elevated C-reactive protein is associated with early progression of the disease and reduction in median survival. Little is known, however, about CRP behavior over time and its correlation with response to chemotherapy and survival. Methods: Newly diagnosed NSCLC with IIIB/IV disease had CRP measured prior to 1st treatment and after 2 cycles of chemotherapy between February 2005 and September 2008. For each measure CRP level was categorized as &lt; 10mg/L or ≥10mg/L. Response was evaluated by chest CT following two cycles of CTX and rated as progression (PD) or freedom from progression (FFP). We investigated the association between change in CRP and response to 2 cycles of CTX, as well as survival. Results: 143 pts were enrolled. Of those, 62 patients had a CRP level &lt;10mg/L and 81 patients ≥10mg/L at the time of diagnosis. After 2 cycles 70% and 72% of pts in each category remained in the same category and 30% and 28% of patients changed category: in 24/81 pts CRP decreased below 10mg/L and in 17/62 pts CRP increased above 10mg/L. Thus, after two cycles 69 pts had CRP &lt;10mg/L and 74 pts ≥10mg/L. The rate of progression after 2 cycles was significantly lower among pts with CRP &lt;10mg/L after 2 cycles of chemo ( Table ). Median survival was 19 (16–22) mo for those with CRP &lt;10mg/L and 9.3 (7.1–11.4) mo for those with CRP ≥10mg/L after 2 cycles (P&lt;0.001). The hazard increased by 66% (HR 1.7) for those pts with CRP increased above cut-off point of 10 mg/L and decreased by 60% (HR 1.6) for pts whose CRP decreased below cutoff point. Conclusions: The presence of an inflammatory state expressed by high levels of CRP either prior to treatment or following 2 cycles of chemotherapy correlates significantly with both first-line chemotherapy response and survival. Normalization of CRP might improve the prognosis of patients in terms of survival and response to chemotherapy. [Table: see text] No significant financial relationships to disclose.
The direct cellular target of topically applied pimecrolimus may not be infiltrating lymphocytes
Authors: D.F. Fiorentino, R.O. Chen, D.B. Stewart, K.K. Brown, U.N. Sundram
Journal: British Journal of Dermatology (2010)

Journal Article The direct cellular target of topically applied pimecrolimus may not be infiltrating lymphocytes Get access D.F. Fiorentino, D.F. Fiorentino Departments of Dermatology David F. Fiorentino. E‐mail: fiorentino@stanford.edu Search for other works by this author on: Oxford Academic Google Scholar R.O. Chen, R.O. Chen Departments of Dermatology Search for other works by this author on: Oxford Academic Google Scholar D.B. Stewart, D.B. Stewart Departments of Dermatology Search for other works by this author on: Oxford Academic Google Scholar K.K. Brown, K.K. Brown Departments of Dermatology Search for other works by this author on: Oxford Academic Google Scholar U.N. Sundram U.N. Sundram Pathology, Stanford University School of Medicine, Stanford, CA 94305, U.S.A. Search for other works by this author on: Oxford Academic Google Scholar British Journal of Dermatology, Volume 164, Issue 5, 1 May 2011, Pages 996–1003, https://doi.org/10.1111/j.1365-2133.2010.10190.x Published: 01 May 2011
Problems with temporary cardiac pacing
Authors: J J Murphy
Journal: BMJ (2001)

Temporary transvenous cardiac pacing is a potentially life saving intervention used primarily to correct profound bradycardia. In Britain temporary pacing is usually provided in district general hospitals by general physicians as part of an emergency service. In practice, pacing wires are inserted by doctors in training, with little teaching or supervision, and complication rates are high. Can such a service be allowed to continue?

Differences in the provision of health care make international comparisons difficult. In North America and Western Europe temporary pacing is generally the province of specialist cardiac units. In Britain the procedure remains a part of training in general medicine. Pacing is usually learnt at a junior level and taught at the bedside by fellow doctors in training. On average, a doctor will see two temporary pacings and do two under supervision before being left unsupervised.1 In the only prospective study in district hospitals consultants were involved in just …
Autoimmune Enteropathy with Goblet-Cell Antibodies
Authors: D Rogahn, C P Smith, A Thomas
Journal: Journal of the Royal Society of Medicine (1999)

Boari flap was undertaken, and histological examination confirmed the presence of a single pTaG 1 papillary transitional cell carcinoma in the lower third of the ureter. Subsequent cystoscopies at three and six months were normal. One year after the surgical procedure the patient developed painless haematuria. IVU demonstrated normal upper tracts and bladder, but cystoscopy revealed multiple superficial pTaGl papillary bladder tumours. These were managed with a combination of endoscopic treatment and intravesical chemotherapy with ethoglucid. The patient remained tumour-free for 2 years when he developed recurrent multiple pTaG1 bladder tumours. These were treated with transurethral resection and intravesical mitomycin, followed by intravesical BCG. The bladder became clear of tumour and remained so for over 3 years. However, despite normal cystoscopy the patient reported haematuria. On IVU the kidneys and bladder were normal but there was a filling defect in the reconstructed lower third of the right ureter (Figure 1). A right nephroureterectomy was performed with excision of a generous margin of the bladder, and histological examination revealed a single pTaG1 tumour in the Boari flap and another pTaGI tumour in the right renal pelvis.
Th17 clones in BOS evaluated by enzyme linked immunospot assay
Authors: Simona Miserere, Rita Di Domenica, Monica Morosini, Anna Maria Grasso, Emanuela Cova, Federica Meloni
Journal: European Respiratory Journal (2012)

IL-17- and Th17-associated cytokines have been linked to the development of acute and chronic rejection after lung transplantation in both animal models and humans. An increase in IL17 mRNA expression and of IL17 levels in BAL have been described in LTR with BOS and during AR episodes in comparison with Stables Recipients.  On the other hand a decrease in IL10-producing clone number and in Treg cell frequency has been described in BOS patients.  Aim of the present study was to assess with a feasible method the balance between IFN-gamma/IL17- producing clones and IL10-producing cells/Treg cells in the peripheral blood of 26 LTR (13 stable recipients, 13 BOSpatients).  IFNgamma IL17 and IL10 producing clones were assessed by ELISPOT.  CD4 + CD25 high CD127 dim  were assessed by flow-citometry.  A significant increase of IL17 and IFN-gamma producing cells in the peripheral blood was observed in patients who developed BOS (p= 0,03 and 0,04 respectively) while Treg cell count decreased significantly (p= 0,002) and IL10 showed a non significant trend toward a decrease.  Moreover the ratio between IL 17 and IL 10 or Treg cell count was significantly increased in BOS (0,85 vs 0,21; 10,4 vs 1,9 respectively) while IFNgamma/IL10 ratio did not significantly change.  In conclusion detection of IL17/Treg ratio in the peripheral blood of LTR represents a feasible and useful tool in the identification of patients at higher risk of BOS development.By this way the role of Th17 axis in BOS pathogenesis is further confirmed.
Mouse Model of Familial Hypertrophic Cardiomyopathy with E99K ACTC Mutation Recapitulates Many Features of Hypertrophic Cardiomyopathy in Patients
Authors: Weihua Song, Emma Dyer, Dominic Wells, Sian E Harding, Daniel J Stuckey, Carolyn A Carr, Kieran Clarke, Steven B Marston
Journal: Circulation (2008)
Evaluation of Ileorectal Anastomosis for the Treatment of Ulcerative Proctocolitis
Authors: O Backer, A Hjortrup, J Kjærgaard
Journal: Journal of the Royal Society of Medicine (1988)

Of 327 patients treated for ulcerative proctocolitis, 165 underwent surgery and an ileorectal anastomosis was performed in 59: 19 of these patients were operated upon in one stage and 40 in two stages. In 13 cases the anastomoses had to be converted, 5 during the initial hospitalization and 8 during a later admission. Three patients developed carcinoma of the rectal stump. The median follow-up period was 15 years. It is concluded that ileorectal anastomosis has a place in the treatment of inflammatory bowel disease, but requires careful follow up of the patients.