tbuckley/cabot-search huggingface dataset:
Mortality following inpatient addictions treatment. Role of tobacco use in a community-based cohort
Authors: Richard D. Hurt, Kenneth P. Offord, Ivana T. Croghan, Leigh Gomez-Dahl, Thomas E. Kottke, Robert M. Morse, L. Joseph Melton
Journal: JAMA (1996)

To determine the impact of tobacco- and alcohol-related deaths on overall mortality following inpatient treatment for alcoholism and other nonnicotine drugs of dependence.Population-based retrospective cohort study.Olmsted County, Minnesota (the Rochester Epidemiology Project), and the Inpatient Addiction Program (IAP) at Mayo Clinic, Rochester.All 845 Olmsted County residents admitted to an inpatient addiction program for treatment of alcoholism and other nonnicotine drugs of dependence during the period 1972 through 1983.Patients were followed up through the medical record linkage system of the Rochester Epidemiology Project through December 1994 to obtain vital status, and death certificates were obtained for those who died. The underlying cause of death was classified as alcohol related, tobacco related, both, or neither based on the classification from the Centers for Disease Control and Prevention. The observed number of deaths by underlying cause were compared with the expected number using cause-specific 1987 death rates for the white population of the United States. All-cause mortality was also compared with that expected for persons in the West North Central Region of the United States of like age, sex, and year of birth. Univariate and multivariate assessments were made to identify predictors of all-cause mortality from baseline demographic information.At admission, the mean (SD) age of the 845 patients was 41.4 (14.5) years, and 35% were women. Altogether, 78% had alcohol as their only nonnicotine drug of dependence and 18% had alcohol and other nonnicotine drugs of dependence, while 4% were classified as having a nonalcohol, nonnicotine drug dependence alone. At admission, 75% were current and 8% former cigarette smokers, 3% were current cigar or pipe smokers, and 2% were current users of smokeless tobacco. Follow-up after the index IAP admission totaled 8913 person-years (mean [SD] of 10.5 [5.6] years per patient). Death certificates were obtained for 96% (214) of the 222 patients who died. Of these 214 deaths, 50.9% (109) had a tobacco-related and 34.1% (73) had an alcohol-related underlying cause (P<.001). The cumulative mortality significantly exceeded that expected (P<.001); at 20 years, the observed mortality was 48.1% vs an expected 18.5%. Multivariate predictors of mortality, even after adjusting for expected mortality, were older age at admission (P<.001) and male sex (P<.001).Patients previously treated for alcoholism and/or other nonnicotine drug dependence had an increased cumulative mortality that was due more to tobacco-related than to alcohol-related causes. Nicotine dependence treatment is imperative in such high-risk patients.
Use and interpretation of virological tests for hepatitis C
Authors: Jean-Michel Pawlotsky
Journal: Hepatology (2002)

Four virological markers of hepatitis C virus (HCV) infection are used clinically for management of patients with hepatitis C, namely the HCV genotype, HCV RNA, HCV core antigen, and antibody to HCV (anti-HCV). The diagnosis of acute and chronic hepatitis C is based on both anti-HCV detection using enzyme immunoassays (EIA) and HCV RNA detection using a sensitive molecular biology-based technique. Other virological tools, including HCV genotype determination and HCV RNA quantification, are now used to tailor treatment to the individual patient and to determine its efficacy. This article reviews the kinetics of HCV markers during acute and chronic HCV infection, together with current assays and their practical use in the management of HCV-infected patients.
A Reality Check for Overdiagnosis Estimates Associated With Breast Cancer Screening
Authors: R. Etzioni, J. Xia, R. Hubbard, N. S. Weiss, R. Gulati
Journal: JNCI Journal of the National Cancer Institute (2014)

The frequency of overdiagnosis associated with breast cancer screening is a topic of controversy. Published estimates vary widely, but identifying which estimates are reliable is challenging. In this article we present an approach that provides a check on these estimates. Our approach leverages the close link between overdiagnosis and lead time by identifying the average lead time most consistent with a given overdiagnosis frequency. We consider a high-profile study that suggested that 31% of breast cancers diagnosed in the United States in 2008 were overdiagnosed and show that this corresponds to an average lead time of about nine years among localized cases. Comparing this estimate with the average lead time for invasive, screen-detected breast cancers of 40 months, around which there is a relative consensus, suggests the published estimate of overdiagnosis is excessive. This approach provides a novel way to appraise estimates of overdiagnosis given knowledge of disease natural history.
Finsbury Health Centre's demise
Authors: W. D Savage
Journal: BMJ (2009)

<h3>Background</h3> General Practitioners (GPs) have a central role in decisions about prescribing anticipatory medications (AMs) to help control symptoms at the end of life. (Faull, et al. 2013) Little is known about GPs’ decision-making processes in prescribing AMs and the subsequent use of prescribed drugs. <h3>Aim</h3> To explore GPs decision-making processes in the prescribing and use of AMs for patients at the end of life. <h3>Method</h3> A qualitative interpretive descriptive enquiry with a purposive sample of thirteen GPs working across one English county. Data was collected in 2017 via semi-structured interviews and analysed inductively using Braun and Clarke’s thematic analysis. <h3>Results</h3> Three themes were constructed from the data: 1) ‘Something we can do’. AMs were a tangible intervention GPs felt they could offer to provide symptom relief for patients approaching death. 2) ‘Getting the timing right’. The prescribing of AMs was recognised as a harbinger of death for patients and families. GPs preferred to prescribe drugs weeks before death was expected, while recognising this meant that many prescribed AMs were never used. 3) ‘Delegating care whilst retaining accountability’. GPs relied on nurse to assess when to administer drugs and keep them updated about their use. <h3>Conclusion</h3> GPs view AMs as key to symptom management for dying people. AMs are routinely prescribed even though they are often not used. In order to feel comfortable delegating care, GPs need regular access to nurses and trust in their skills to administer drugs appropriately. Patient and family experiences of AMs warrant urgent investigation.
Effect of platelet factors on migration of cultured bovine aortic endothelial and smooth muscle cells.
Authors: L Bell, J A Madri
Journal: Circulation Research (1989)

Endothelial cell (EC) injury and the response of EC and smooth muscle cells (SMCs) to injury contribute to the pathophysiology in patients with vascular disease and atherosclerosis. Since platelets have been suggested to play an important role in modulating vascular injury, the present study was undertaken to examine the influence and mechanism of action of individual platelet factors on bovine aortic EC and SMC migration using an in vitro wound assay system. Serotonin decreased EC proliferation and reduced EC migration 21 +/- 1% (p less than 0.005), which was attenuated by imipramine. Transforming growth factor-beta reduced EC proliferation and decreased EC migration 52 +/- 3% (p less than 0.005). Norepinephrine increased EC proliferation but decreased EC migration 26 +/- 2% (p less than 0.005), which was abolished by phenoxybenzamine. Histamine increased EC proliferation but reduced EC migration 29 +/- 2% (p less than 0.005), which was attenuated by diphenhydramine. Platelet-derived growth factor decreased EC proliferation and decreased EC migration 40 +/- 2% (p less than 0.005). In contrast, serotonin increased SMC proliferation and increased SMC migration 31 +/- 2% (p less than 0.005), which was abolished by ketanserin. Transforming growth factor-beta increased SMC migration 35 +/- 5% (p less than 0.005). Norepinephrine increased SMC proliferation and increased SMC migration 43 +/- 4% (p less than 0.005), which was abolished by propranolol. Histamine increased SMC proliferation and increased SMC migration 38 +/- 3% (p less than 0.005), which was abolished by cimetidine. Platelet-derived growth factor increased SMC proliferation and increased SMC migration 40 +/- 3% (p less than 0.005).(ABSTRACT TRUNCATED AT 250 WORDS)
Proteomic patterns established with capillary electrophoresis and mass spectrometry for diagnostic purposes
Authors: Eva M. Weissinger, Stefan Wittke, Thorsten Kaiser, Hermann Haller, Sebastian Bartel, Ronald Krebs, Igor Golovko, Harald D. Rupprecht, Marion Haubitz, Hartmut Hecker, Harald Mischak, Danilo Fliser
Journal: Kidney International (2004)
Murder in the NHS
Authors: D Turner
Journal: BMJ (1994)

<h3>Objectives</h3> Hospital management systems, currently under the network environment, are an emerging category of information systems. The decomposition of hospital management systems into the workflow of mobile agents’ architectures does not seem an appropriate solution, since mobile agents can allow servers to be made more flexible, with components being added and removed at runtime. Mobile agents can reduce network load and permit disconnected operation during which a client can also ‘launch’ a mobile agent into the network. <h3>Methods</h3> In this paper, we study a hospital management system based on workflow. It can cope with the rapidly evolving business environment better than most other systems as they are more flexible and open. We describe a possible architecture of such a hospital management system. Mobile agents enable a flexible and adaptive system with the possibility of simulation, analysis and monitoring of process execution in order to identify potential inconsistencies and to provide appropriate information to the administrator for the purpose of process improvement. Then we discuss the functionalities and the collaborations of mobile agents, followed by process state transitions and the executing process of the hospital management system. <h3>Results</h3> We implemented the described architecture and proposed solutions to the problems arising while the hospital management system was being implemented. The prototype design could provide a more flexible and adaptive infrastructure for incorporating dynamic changes into the currently executing process model. Due to a mobile agent system, its modular design both reduces the complexity of the system and is also easy to expand, as well as having good robustness and reliability. <h3>Conclusions</h3> We have constructed a hospital management system based on workflow which provides more flexibility, adaptability and expansibility, and is more robust and reliable than existing systems. <h3>Acknowledgments</h3> This work was financially supported in part by the National Natural Science Foundation of China under Grant Nos. 61263023 and 51174103. It was also subsidized by key projects of the Yunnan Education Department (Grant Nos. 2012Z107 and 2013Z129).
Teaching Medical Ethics
Authors: Frank W. McKee
Journal: JAMA (1979)

<h3>To the Editor.—</h3> Almost eight precious pages ofThe Journalwere devoted to a SPECIAL COMMUNICATION by Siegler (239:951, 1978) and an editorial by Pellegrino (239:960,1978) about medical ethics. In addition to assuring dullards or latecomers to the medical scene that Sir William Osier will have few peers in history, the point of these articles seems to be that a large population of individuals with or about to obtain medical degrees are not really physicians, and, therefore, these benighted souls must be shown how to achieve a more commendable status. The ultimate supposition is that a medical student, house officer, or attending practitioner, steeped or being steeped in the spectrum of basic and clinical science, can be "taught" ethics, not only in context but as a free-standing subject. Having been exposed from day 1 of medical school to a series of real physicians, beginning with George W. Corner in anatomy
The Vectorcardiogram of Left Ventricular Hypertrophy
Authors: PHILIP VARRIALE, JOSEPH C. ALFENRRO, RICHARD J. KENNEDY
Journal: Circulation (1966)

Direct spatial vectorcardiograms were made by using the Frank lead system on 50 patients with known left ventricular hypertrophy of both systolic and diastolic overload types. Three distinctive loop patterns were demonstrated in the horizontal plane. In addition important quantitative measurements are described for the three planar projections. From these data, five criteria are proposed for the definitive vectorcardiographic diagnosis of left ventricular hypertrophy.
Regulatory Action on Rosiglitazone by the U.S. Food and Drug Administration
Authors: Janet Woodcock, Joshua M. Sharfstein, Margaret Hamburg
Journal: New England Journal of Medicine (2010)

There have been ongoing concerns about the safety of the diabetes drugs containing rosiglitazone (Avandia, Avandaryl, and Avandamet) — a thiazolidinedione antidiabetic agent indicated as an adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus. In 2007, a meta-analysis of controlled clinical trials found increases in the risk of myocardial infarction and a near-significant increased risk of death from cardiovascular causes when rosiglitazone was compared with placebo or with standard diabetes drugs.1 Following an advisory committee meeting held in July 2007, the U.S. Food and Drug Administration (FDA) added information about the possibility . . .
Unexplained Elevation of Serum Alkaline Phosphatase Levels-Reply
Authors: Peter G. Steinherz
Journal: JAMA (1985)

In Reply.—  The case history described by Dr Dodds and those sent to us directly by other readers ofThe Journalsince publication of the article highlight the need for increased awareness of the entity by clinicians.  The question as to the source of the enzyme and the stimulus for its brief hypersecretion is still unresolved. Unfortunately, details are not available in the references cited by Dr Dodds, as these consist of brief anecdotal case reports or collections of few cases. Their own authors state at times that their comments regarding the source of the enzyme and specific patterns are speculation. 1,2 We cannot, therefore, draw definite conclusions about hyperphosphatasemia from the information available and can only confirm that its occurrence is benign.
Multifunctional receptor-targeted nanocomplexes for magnetic resonance imaging and transfection of tumours
Authors: Gavin D. Kenny, Claudio Villegas-Llerena, Aristides D. Tagalakis, Frederick Campbell, Katharina Welser, Mauro Botta, Alethea B. Tabor, Helen C. Hailes, Mark F. Lythgoe, Stephen L. Hart
Journal: Biomaterials (2012)

The efficient targeted delivery of nucleic acids in vivo provides some of the greatest challenges to the development of genetic therapies. We aim to develop nanocomplex formulations that achieve targeted transfection of neuroblastoma tumours that can be monitored simultaneously by MRI. Here, we have compared nanocomplexes comprising self-assembling mixtures of liposomes, plasmid DNA and one of three different peptide ligands derived from ApoE, neurotensin and tetanus toxin for targeted transfection in vitro and in vivo. Neurotensin-targeted nanocomplexes produced the highest levels of transfection and showed a 4.7-fold increase in transfected luciferase expression over non-targeted nanocomplexes in Neuro-2A cells. Transfection of subcutaneous Neuro-2A tumours in vivo with neurotensin-targeted nanocomplexes produced a 9.3-fold increase in gene expression over non-targeted controls. Confocal microscopy analysis elucidated the time course of DNA delivery with fluorescently labelled nanocomplex formulations in cells. It was confirmed that addition of a gadolinium lipid conjugate contrast agent allowed real time in vivo monitoring of nanocomplex localisation in tumours by MRI, which was maintained for at least 24 h. The peptide-targeted nanocomplexes developed here allow for the specific enhancement of targeted gene therapy both in vitro and in vivo, whilst allowing real time monitoring of delivery with MRI.
Polyps of the Colon-Reply
Authors: Richard H. Marshak
Journal: JAMA (1976)

There are 10 to 15 million people in the United States with colonic polyps. The great majority of these polyps are harmless, and it is unnecessary and impossible to remove all of them. The radiologist can readily determine which polyps are harmless and which are potential carcinomas. Polyps on long, thin pedicles are clinically harmless lesions, especially when they are smaller than 1.5 cm in diameter. We, and others, have never seen carcinoma cells jump over a pedicle. This event is so rare that it is the subject of individual case reports, and some of these reports are doubtful. The incidence of carcinoma in lesions 1 cm or less varies between 0.5% and 1.2%; therefore, we feel that there is no harm in observing these lesions. We do not observe polyps larger than 1.5 cm in diameter even on long stalks, sessile lesions, or short pedicled lesions, except
The emergence of Sézary cells during the treatment of cutaneous T-cell lymphoma
Authors: M. SATO, O. ISHIKAWA, Y. MIYACHI
Journal: British Journal of Dermatology (2006)

Summary A 52-year-old man with cutaneous T-cell lymphoma presented with Sezary syndrome-like features including exfoliative erythroderma, lymphadenopathy and leukaemic change without the presence of Sezary cells. Southern blot hybridization analysis revealed T-cell receptor β-chain gene rearrange-ments, both in the peripheral blood and in the lymph node. Atypical large cells with convoluted nuclei (Sezary-like cells) first appeared during combined chemotherapy. Although Sezary syndrome is characterized by its particular manifestations and the presence of Sezary cells in the peripheral blood, the clinical significance of Sezary cells has been questioned. It still needs to be decided whether or not the Sezary cell is malignant.
Gout, Hyperlipidemia, and Diabetes Interrelationships
Authors: Donald Berkowitz
Journal: JAMA (1966)

A primary association between hypertriglyceridemia and decreased glucose tolerance has been demonstrated in patients with hyperlipidemia or gout or both. Impaired tolerance was found in 72% of 25 patients with hypertriglyceridemia whereas only 12% of 25 patients with essential hypercholesterolemia had this abnormality. In 25 gouty patients, triglyceride levels were normal in six, and abnormal glucose tolerance was present in one of these. Nineteen of the group had hypertriglyceridemia and of these, 74% had decreased carbohydrate tolerance. The results indicate that abnormalities in triglyceride metabolism may be a fundamental factor in the pathogenesis of diabetes and that the presence of hypertriglyceridemia may be used to predict the presence of coexistent diabetes. Cholesterol levels, by themselves, are of little significance in this respect.
Mouse fukutin deletion impairs dystroglycan processing and recapitulates muscular dystrophy
Authors: Aaron M. Beedle, Amy J. Turner, Yoshiaki Saito, John D. Lueck, Steven J. Foltz, Marisa J. Fortunato, Patricia M. Nienaber, Kevin P. Campbell
Journal: Journal of Clinical Investigation (2012)

Dystroglycan is a transmembrane glycoprotein that links the extracellular basement membrane to cytoplasmic dystrophin. Disruption of the extensive carbohydrate structure normally present on α-dystroglycan causes an array of congenital and limb girdle muscular dystrophies known as dystroglycanopathies. The essential role of dystroglycan in development has hampered elucidation of the mechanisms underlying dystroglycanopathies. Here, we developed a dystroglycanopathy mouse model using inducible or muscle-specific promoters to conditionally disrupt fukutin (Fktn), a gene required for dystroglycan processing. In conditional Fktn-KO mice, we observed a near absence of functionally glycosylated dystroglycan within 18 days of gene deletion. Twenty-week-old KO mice showed clear dystrophic histopathology and a defect in glycosylation near the dystroglycan O-mannose phosphate, whether onset of Fktn excision driven by muscle-specific promoters occurred at E8 or E17. However, the earlier gene deletion resulted in more severe phenotypes, with a faster onset of damage and weakness, reduced weight and viability, and regenerating fibers of smaller size. The dependence of phenotype severity on the developmental timing of muscle Fktn deletion supports a role for dystroglycan in muscle development or differentiation. Moreover, given that this conditional Fktn-KO mouse allows the generation of tissue- and timing-specific defects in dystroglycan glycosylation, avoids embryonic lethality, and produces a phenotype resembling patient pathology, it is a promising new model for the study of secondary dystroglycanopathy.
The Duodenum in Liver Cirrhosis: Endoscopic, Morphological and Clinical Findings
Authors: S. Vigneri, R. Termini, A. Piraino, A. Scialabba, E. Bovero, G. Pisciotta, N. Fontana
Journal: Endoscopy (1991)

Endoscopic studies were performed to determine whether changes occurred in the duodenum related to portal hypertension in patients with liver cirrhosis. The total of 271 patients studied were subdivided into three groups: 83 patients with liver cirrhosis and portal hypertension, 53 with liver cirrhosis but no portal hypertension, and 135 controls. In the duodenum of cirrhotic patients with portal hypertension several changes were observed on endoscopy that were also present in the other two groups. Atrophy and vascular malformations, however, were present only in the duodenum of cirrhotic patients with portal hypertension, although in only a few patients and with statistical significance only for vascular malformations (p less than 0.01, phi = 0.21). Eleven percent of the patients had more than one endoscopic finding, but the associations of findings were without statistical significance. No statistically significant correlation was observed between the clinical severity of cirrhosis or the severity of esophageal varices and the endoscopic findings. Finally, there was no statistically significant difference between the histological findings of duodenitis in the three groups of patients.