tbuckley/cabot-search huggingface dataset:
Continuation and Maintenance Use of Antidepressants in Recurrent Depression
Authors: Claudi L.H. Bockting, Mascha C. ten Doesschate, Jan Spijker, Philip Spinhoven, Maarten W.J. Koeter, Aart H. Schene
Journal: Psychotherapy and Psychosomatics (2007)

Maintenance antidepressant (AD) medication is the most commonly used preventive strategy in a highly recurrent disease, i.e. depression. Little is known about the discontinuation of maintenance AD use and the association with recurrence in daily clinical practice. The purpose was to examine the discontinuation rate of maintenance AD in daily clinical practice in recurrently depressed patients and the associated risk of recurrence.Prospectively AD maintenance medication and recurrence were examined in 172 euthymic patients with recurrent depression. AD user profiles before recurrence (nonusers, intermittent users, continuous users) were examined and related to recurrence over a 2-year follow-up period.Less than half of the patients (42%) used AD continuously. Taking into account the minimal required adequate used dosage (> or = 20 mg fluoxetine equivalent), only 26% of the patients used AD as recommended by international guidelines. Despite continuous use of AD, 60.4% relapsed in 2 years. This relapse rate was comparable to the rate of the intermittent users (63.6%). In patients who stopped taking AD after remission and who received additional preventive CT, the recurrence rates were significantly lower than in non-AD-using patients treated with usual care (8 vs. 46%).The majority of recurrently depressed patients treated with AD discontinue maintenance AD therapy in daily primary and secondary clinical practice. AD seems to offer poor protection against relapse in this patient group. Patients who stopped using AD experienced less relapse, especially if they were treated with preventive CT. Alternative maintenance treatments (including preventive cognitive therapy after discontinuation of AD) should be studied in recurrently depressed patients with intermittent good remission, not only in secondary but also in primary care.
Evaluation of quality of contents of general practice records.
Authors: S J Jachuck, P Price, C L Bound
Journal: BMJ (1984)

The quality of contents of general practice records was assessed by retrieving clinical information pertaining to hypertension in 171 consecutive records, and the quality of communication storage was assessed by seeking evidence of tuberculin skin tests or BCG vaccination, or both, in 298 consecutive records. There was no mention of urine analysis and blood test results in 43.3% and no record of fundal examination in 61.4% of the records of patients with hypertension. Electrocardiography was performed in 67.8% and chest x ray examination was done in 65.5% of these patients. These observations have importance for patient care, education, and research. The information regarding tuberculin skin test or BCG immunization, or both, was not available in 78% of the records. Reassessment of the individuals, however, showed that 89% of the studied population had had the test or vaccination, or both. There was thus a deficiency in communication and storage.
Urinary tract infections after renal transplantation: do they matter?
Authors: P J Griffin, J R Salaman
Journal: BMJ (1979)

The effect of urinary tract infections on renal function was assessed in 86 patients with renal allografts that had functioned for more than one year. Follow-up periods ranged from one to 10 years. Recurrent or persistent urinary sepsis was quite common in these long-term survivors but had no observable effect on graft function or survival of patients or grafts. Treatment of asymptomatic urinary tract infections was largely unsuccessful. Probably such infections may be safely ignored.
Salbutamol reduces pulmonary neutrophil sequestration of platelet-activating factor in humans.
Authors: J R Masclans, J A Barberà, W MacNee, J Pavia, C Piera, F Lomeña, K F Chung, J Roca, R Rodriguez-Roisin
Journal: American Journal of Respiratory and Critical Care Medicine (1996)

To investigate whether salbutamol inhibits platelet-activating factor (PAF)-induced neutrophil sequestration in the lungs, we studied eight nonatopic, nonsmoking, healthy subjects (six men; aged 27.0 +/- 1.5 (SE) yr) with PAF-induced bronchial response. Prior to PAF challenge (24 micrograms), they inhaled either salbutamol (300 micrograms) or placebo in a randomized, double-blind, crossover manner two weeks apart. Respiratory system resistance (Rrs), arterial blood gases, and neutrophil counts were measured 4, 8, 12 and 30 min after PAF. Neutrophil kinetics in the lungs were assessed by tracking autologous 99mTc-erythrocytes and 111in-neutrophils. Compared with salbutamol, arterial blood neutrophil counts fell (p < 0.04) maximally at 4 min after PAF, followed by a mild rebound neutrophilia, whereas Rrs increased (p < 0.01) and Pao2 decreased (p < 0.05) at 4 min only. The intrapulmonary activity of 111in-neutrophils after pretreatment with placebo was higher compared with salbutamol (1.98 +/- 0.15 versus 1.33 +/- 0.23 cps/mCi/pixel) (p < 0.01) although both their initial sequestration (first-pass) and subsequent washout were not significantly different. Inhaled salbutamol blocks pulmonary neutrophil sequestration and lung function abnormalities following PAF challenge in humans.
David Alexander (“Sandy”) Mann
Authors: Christopher Booth, Susan Turner
Journal: BMJ (2006)

was chief surgeon at Sarajevo's State Hospital for over 30 years.At the outbreak of the war in Bosnia and Hercegovina in May 1992, this hospital was part of the Yugoslav national army network of hospitals, serving army personnel but also dignitaries and local residents.As most of the staff had military training and the hospital was right in the centre of the city, it rapidly filled with casualties.Conditions were horrific and Abdullah would operate with his team under temporarily rigged lights, often without basic equipment, anaesthetic gases, or analgesia.In the first winter of the war in 1992, conditions in the State Hospital were especially harsh.There was little food, scarce medical and surgical supplies, and no heating.Abdullah had a practical solution for his patients even then."We will show them that this is not so cold at all."The next morning his entire team made its rounds in short sleeved white coats, which the patients found highly amusing.Through all this, Abdullah's close partner and ally was his brother Bakir Nakas, who initially was an infectious diseases specialist but when the war started turned to hospital administration and managing, and lobbying for international aid to the hospital.They were a notable team, Bakir more diplomatic and outgoing, and Abdullah more taciturn.Abdullah worked 1500 consecutive days during the war and its aftermath.He was a
Peer review: a flawed process at the heart of science and journals
Authors: R. Smith
Journal: Journal of the Royal Society of Medicine (2006)

Peer review is at the heart of the processes of not just medical journals but of all of science. It is the method by which grants are allocated, papers published, academics promoted, and Nobel prizes won. Yet it is hard to define. It has until recently been unstudied. And its defects are easier to identify than its attributes. Yet it shows no sign of going away. Famously, it is compared with democracy: a system full of problems but the least worst we have.

When something is peer reviewed it is in some sense blessed. Even journalists recognize this. When the BMJ published a highly controversial paper that argued that a new `disease', female sexual dysfunction, was in some ways being created by pharmaceutical companies, a friend who is a journalist was very excited—not least because reporting it gave him a chance to get sex onto the front page of a highly respectable but somewhat priggish newspaper (the Financial Times). `But,' the news editor wanted to know, `was this paper peer reviewed?'. The implication was that if it had been it was good enough for the front page and if it had not been it was not. Well, had it been? I had read it much more carefully than I read many papers and had asked the author, who happened to be a journalist, to revise the paper and produce more evidence. But this was not peer review, even though I was a peer of the author and had reviewed the paper. Or was it? (I told my friend that it had not been peer reviewed, but it was too late to pull the story from the front page.)
RELATION OF LEFT ATRIAL SPONTANEOUS ECHO CONTRAST IN PATIENTS WITH MITRAL STENOSIS TO INFLAMMATORY MARKERS
Authors: Mehmet G. Kaya, Mahmut Akpek, Deniz Elcik, Omer Sahin, Nihat Kalay, Mikail Yarl&yacute;oglues, Orhan Dogdu, Idris Ardic, Abdurrahman Oguzhan, Ali Ergin
Journal: Journal of the American College of Cardiology (2012)
Merkel cell carcinoma and Merkel cell polyomavirus: a systematic review and meta-analysis
Authors: J. Santos-Juanes, I. Fernández-Vega, N. Fuentes, C. Galache, P. Coto-Segura, B. Vivanco, A. Astudillo, P. Martínez-Camblor
Journal: British Journal of Dermatology (2015)

Several observational studies have assessed the correlation between Merkel cell carcinoma and Merkel cell polyomavirus with variable results. The objective of this systematic review was to determine whether there is a correlation between Merkel cell carcinoma and Merkel cell polyomavirus. Studies assessing the relationship between Merkel cell carcinoma and Merkel cell polyomavirus from January 2008 to August 2014 were pooled from Medline, Embase, PubMed, Cochrane Database of Systemic Reviews and Google Scholar. From each study we collected the first author's last name, publication year, country of origin, type of study design, characteristics of participants, possible variables incorporated into the multivariable analyses and the risk ratio (RR) for Merkel cell carcinoma associated with Merkel cell polyomavirus combined with the corresponding 95% confidence interval (CI). Methodological assessment of the study was evaluated using the Newcastle–Ottawa scale. Crude RR was calculated from the data provided in each article. Meta-analyses for the global RR and for the proportion of positives in both case and control samples were performed. In addition, in order to explore the sources of heterogeneity among the studies, meta-regression and sensitivity analyses are also provided. A total of 22 studies were identified for the analysis. The pooled RR from random-effects analysis was determined to be 6·32 (95% CI, 4·02–9·93). Global proportions of positive samples were 0·79 (95% CI, 0·72–0·84) and 0·12 (95% CI, 0·08–0·19) in the case and control groups, respectively. The findings support the association between Merkel cell carcinoma and Merkel cell polyomavirus. However, a non-negligible percentage of positive results have been identified in controls. Some caution must be taken in the interpretation of these results because heterogeneity between studies was found.
Neoadjuvant Chemotherapy and Short-term Morbidity in Patients Undergoing Mastectomy With and Without Breast Reconstruction
Authors: Nicholas B. Abt, José M. Flores, Pablo A. Baltodano, Karim A. Sarhane, Francis M. Abreu, Carisa M. Cooney, Michele A. Manahan, Vered Stearns, Martin A. Makary, Gedge D. Rosson
Journal: JAMA Surgery (2014)

Neoadjuvant chemotherapy (NC) is increasingly being used in patients with breast cancer, and evidence-based reports related to its independent effects on morbidity after mastectomy with immediate breast reconstruction are limited.To determine the effect of NC on 30-day postoperative morbidity in women undergoing mastectomy with or without immediate breast reconstruction.All women undergoing mastectomy with or without immediate breast reconstruction from January 1, 2005, through December 31, 2011, at university and private hospitals internationally were analyzed using the American College of Surgeons National Surgical Quality Improvement Program 2005-2011 databases. Patients who received NC were compared with those without a history of NC to estimate the relative odds of 30-day postoperative overall, systemic, and surgical site morbidity using model-wise multivariable logistic regression.Neoadjuvant chemotherapy.Thirty-day postoperative morbidity (overall, systemic, and surgical site).Of 85,851 women, 66,593 (77.6%) underwent mastectomy without breast reconstruction, with 2876 (4.3%) receiving NC; 7893 patients were excluded because of missing exposure data. The immediate breast reconstruction population included 19,258 patients (22.4%), with 820 (4.3%) receiving NC. After univariable analysis, NC was associated with a 20% lower odds of overall morbidity in the group undergoing mastectomy without breast reconstruction (odds ratio [OR], 0.80; 95% CI, 0.71-0.91) but had no significant effect in the immediate breast reconstruction group (OR, 0.98; 95% CI, 0.79-1.23). After adjustment for confounding, NC was independently associated with lower overall morbidity in the group undergoing mastectomy without breast reconstruction (OR, 0.61; 95% CI, 0.51-0.73) and the immediate tissue expander reconstruction subgroup (OR, 0.49; 95% CI, 0.30-0.84). Neoadjuvant chemotherapy was associated with decreased odds of systemic morbidity in 4 different populations: complete sample (OR, 0.59; 95% CI, 0.49-0.71), mastectomy without breast reconstruction (OR, 0.59; 95% CI, 0.48-0.72), any immediate breast reconstruction (OR, 0.57; 95% CI, 0.37-0.88), and the tissue expander subgroup (OR, 0.41; 95% CI, 0.23-0.72).Our study supports the safety of NC in women undergoing mastectomy with or without immediate breast reconstruction. Neoadjuvant chemotherapy is associated with lower overall morbidity in the patients undergoing mastectomy without breast reconstruction and in those undergoing tissue expander breast reconstruction. In addition, the odds of systemic morbidity were decreased in patients undergoing mastectomy with and without immediate breast reconstruction. The mechanisms behind the protective association of NC remain unknown and warrant further investigation.
Reply to J. Boix et al.
Authors: C. Triantos, A. Burroughs
Journal: Endoscopy (2007)

We thank Drs Boix and colleagues for the presentation of their results of emergency sclerotherapy. We concur with them that, with competent endoscopists (which is the likely situation in the randomized trials we evaluated with meta-analysis), sclerotherapy is an effective therapy, particularly if associated with vasoactive therapy for bleeding esophageal varices. Our data show that it is comparable to ligation and can be used as the endoscopic therapy of first choice. Their results confirm our interpretation of the data contained in the randomized trials.
Lipid Research Clinics Program
Authors: Roger A. Renfrew
Journal: JAMA (1984)

<h3>To the Editor.—</h3> The article by the Lipid Research Clinics Program<sup>1</sup>on reduction in instances of coronary artery disease was a very useful study for the physician interested in primary prevention of coronary artery disease. I have had relatively poor success keeping patients on a regimen of cholestyramine in my own practice because of the cost. The least expensive form of cholestyramine resin available through a local pharmacy would cost my patient $31.20 a week to take 24 g/day. This comes to a total cost of $1,622.40 a year. If, as the study suggests, there are 1 1/2 million Americans who would qualify for this form of therapy, the cost considerations become impressive. Some simple arithmetic demonstrates that the cost nationwide for each patient spared a cardiac end point is $715,764.70. Who says that coronary artery surgery is expensive?
Medical Ethics and the Elderly
Authors: Michael Vassallo
Journal: Journal of the Royal Society of Medicine (2004)

In most specialties healthcare professionals are treating increasing numbers of elderly patients. Often the management decisions go far beyond diagnosis and treatment, demanding a knowledge of ethics as well as the law. The publication of an updated edition of Medical Ethics and the Elderly is particularly timely in view of developments such as the Human Rights Act 1998, the draft bill on mental incapacity and new guidelines on cardiopulmonary resuscitation. It begins with the obligatory chapters on principles of ethics, confidentiality, consent and mental incapacity, and these form the basis for the discussion of ethical issues in clinical work. Most of the chapters, indeed, deal with specific difficulties commonly encountered in the management of older patients. Chapters on stroke and dementia are very comprehensive and offer guidance on many of the clinical dilemmas that arise in treatment of these common conditions. Other particularly noteworthy chapters are those on life-sustaining therapy, cardiopulmonary resuscitation, advance directives and achieving a good death.

The style and layout is user-friendly. Most chapters can be read in isolation, allowing the reader to dip into an area of interest; key points at the end of every chapter highlight what is to be learned. All difficult ethical decisions must be taken within the legal boundaries, and many chapters include useful summaries of the law of the land. Where opinions differ—for example, on the matter of achieving a good death—the various points of view are sensitively and fairly described. This impartial approach will help clinicians to understand points of view different from their own. Some chapters include algorithms that allow for those difficult circumstances where personal opinions (including those of relatives), ethical issues and legalities must all be taken into account. Particularly useful are those relating to initiation of feeding, cardiopulmonary resuscitation and life-sustaining treatment. If there is room for improvement, it is in the discussion of some of the illustrative cases—too simplistic in my opinion.

Medical Ethics and the Elderly will appeal primarily to professionals working in general and geriatric medicine, though much of it is of general interest. Examination candidates may well find it useful, now that ethics is being included in undergraduate and postgraduate curricula. I personally found the book informative and enjoyable, and will be keeping it handy for reference.
Effects of angiotensin-converting enzyme inhibition on altered renal hemodynamics induced by low protein diet in the rat.
Authors: E Fernández-Repollet, E Tapia, M Martínez-Maldonado
Journal: Journal of Clinical Investigation (1987)

We assessed the role of angiotensin II in mediating the alterations in renal hemodynamics known to result from low protein feeding to normal rats by examining the effect of the angiotensin-converting enzyme (ACE) inhibitor captopril. 2 wk of low protein (6% casein) diet resulted in decreased glomerular filtration rate (normal protein [NP], 1.82 +/- 0.17 vs. low protein [LP], 0.76 +/- 0.01 ml/min; P less than 0.05) and renal plasma flow (NP, 6.7 +/- 0.2 vs. LP, 3.3 +/- 0.3 ml/min; P less than 0.05); renal vascular resistance rose (NP, 8.7 +/- 0.4 vs. LP, 19.8 +/- 1.4 dyn . s per cm5; P less than 0.05). These changes were accompanied by a significant decrease in plasma renin activity (NP, 7.0 +/- 0.7 vs. LP, 4.4 +/- 0.8 ng A I/ml per h; P less than 0.05), plasma aldosterone concentration (NP, 7.0 +/- 0.6 vs. LP, 4.1 +/- 0.7 ng/dl; P less than 0.05), and urinary PGE2 excretion (NP, 3,120 +/- 511 vs. LP, 648 +/- 95 pg/mgCr; P less than 0.05); by contrast renal renin content was significantly increased (NP, 2,587 +/- 273 vs. LP, 7,032 +/- 654 ng A I/mg protein; P less than 0.05). Treatment with captopril (30 mg/kg per d) raised glomerular filtration rate (GFR; LP + capt, 1.6 +/- 0.2 ml/min) and renal plasma flow (RPF; LP + capt, 6.7 +/- 0.7 ml/min), and reduced renal vascular resistance (LP + capt, 9.2 +/- 0.5 dyn/s per cm5) in low protein-fed animals. These values were not different from those measured in untreated and captopril-treated rats fed a normal (23%) protein diet. There were no changes in systemic mean arterial pressure in any group of rats. These data provide evidence that intrarenal angiotensin II mediates the changes in intrarenal hemodynamics induced by protein deprivation. The effects of low protein feeding may be partly potentiated by the reduction in PGE2 synthesis. However, the normalization of GFR and RPF in view of only modest increases in PGE2 excretion after captopril (LP, 648 +/- 95 vs. LP + capt, 1,131 +/- 82 pg/mgCr; P less than 0.05) suggests that if PGE2 is involved in these changes, it plays a permissive but not essential role in the increased renovascular resistance.
A Tyrosine Kinase Created by Fusion of the<i>PDGFRA</i>and<i>FIP1L1</i>Genes as a Therapeutic Target of Imatinib in Idiopathic Hypereosinophilic Syndrome
Authors: Jan Cools, Daniel J. DeAngelo, Jason Gotlib, Elizabeth H. Stover, Robert D. Legare, Jorges Cortes, Jeffrey Kutok, Jennifer Clark, Ilene Galinsky, James D. Griffin, Nicholas C.P. Cross, Ayalew Tefferi, James Malone, Rafeul Alam, Stanley L. Schrier, Janet Schmid, Michal Rose, Peter Vandenberghe, Gregor Verhoef, Marc Boogaerts, Iwona Wlodarska, Hagop Kantarjian, Peter Marynen, Steven E. Coutre, Richard Stone, D. Gary Gilliland
Journal: New England Journal of Medicine (2003)

Idiopathic hypereosinophilic syndrome involves a prolonged state of eosinophilia associated with organ dysfunction. It is of unknown cause. Recent reports of responses to imatinib in patients with the syndrome suggested that an activated kinase such as ABL, platelet-derived growth factor receptor (PDGFR), or KIT, all of which are inhibited by imatinib, might be the cause. We treated 11 patients with the hypereosinophilic syndrome with imatinib and identified the molecular basis for the response. Nine of the 11 patients treated with imatinib had responses lasting more than three months in which the eosinophil count returned to normal. One such patient had a complex chromosomal abnormality, leading to the identification of a fusion of the Fip1-like 1 (FIP1L1) gene to the PDGFRalpha (PDGFRA) gene generated by an interstitial deletion on chromosome 4q12. FIP1L1-PDGFRalpha is a constitutively activated tyrosine kinase that transforms hematopoietic cells and is inhibited by imatinib (50 percent inhibitory concentration, 3.2 nM). The FIP1L1-PDGFRA fusion gene was subsequently detected in 9 of 16 patients with the syndrome and in 5 of the 9 patients with responses to imatinib that lasted more than three months. Relapse in one patient correlated with the appearance of a T674I mutation in PDGFRA that confers resistance to imatinib. The hypereosinophilic syndrome may result from a novel fusion tyrosine kinase - FIP1L1-PDGFRalpha - that is a consequence of an interstitial chromosomal deletion. The acquisition of a T674I resistance mutation at the time of relapse demonstrates that FIP1L1-PDGFRalpha is the target of imatinib. Our data indicate that the deletion of genetic material may result in gain-of-function fusion proteins.
PREDICTIVE VALUE OF EJECTION FRACTION AND RENAL FUNCTION IN HIGH RISK ACUTE CORONARY SYNDROME PATIENTS: RESULTS FROM THE SYNERGY TRIAL
Authors: Melvin R. Echols, Micheal C. Kontos, Kristi Prather, Douglas D. Schocken, Stuart D. Russell, Judith S. Hochman, Luigi Biasucci, John French, Kenneth Mahaffey
Journal: Journal of the American College of Cardiology (2010)
Use of magnetically oriented orthogonal collagen scaffolds for hemi-corneal reconstruction and regeneration
Authors: Nicolas Builles, Hélène Janin-Manificat, Marilyne Malbouyres, Virginie Justin, Marie-Rose Rovère, Graziella Pellegrini, Jim Torbet, David J.S. Hulmes, Carole Burillon, Odile Damour, Florence Ruggiero
Journal: Biomaterials (2010)