tbuckley/cabot-search huggingface dataset:
Preoperative Radiotherapy for Resectable Rectal Cancer
Authors: Calogero Cammà, Marco Giunta, Francesco Fiorica, Luigi Pagliaro, Antonio Craxì, Mario Cottone
Journal: JAMA (2000)

ContextThe benefit of adjuvant radiotherapy for resectable rectal cancer has been extensively studied, but data on survival are still equivocal despite a reduction in the rate of local recurrence.ObjectiveTo assess the effectiveness of preoperative radiotherapy followed by surgery in the reduction of overall and cancer-related mortality and in the prevention of local recurrence and distant metastases.Data SourcesComputerized bibliographic searches of MEDLINE and CANCERLIT (1970 to December 1999), including non-English sources, were supplemented with hand searches of reference lists. The medical subject headings used were rectal cancer, radiotherapy, surgery, RCT, randomized, and clinical trial.Study SelectionStudies were included if they were randomized controlled trials (RCTs) comparing preoperative radiotherapy plus surgery with surgery alone and if they included patients with resectable histologically proven rectal adenocarcinoma, without metastatic disease. Fourteen RCTs were analyzed.Data ExtractionData on population, intervention, and outcomes were extracted from each RCT according to the intention-to-treat method by 3 independent observers and combined using the DerSimonian and Laird method.Data SynthesisRadiotherapy plus surgery compared with surgery alone significantly reduced the 5-year overall mortality rate (odds ratio [OR] 0.84; 95% confidence interval [CI], 0.72-0.98; P = .03), cancer-related mortality rate (OR, 0.71; 95% CI, 0.61-0.82; P&lt;.001), and local recurrence rate (OR, 0.49; 95% CI, 0.38-0.62; P&lt;.001). No reduction was observed in the occurrence of distant metastases (OR, 0.93; 95% CI, 0.73-1.18; P = .54).ConclusionsIn patients with resectable rectal cancer, preoperative radiotherapy significantly improved overall and cancer-specific survival compared with surgery alone. The magnitude of the benefit is relatively small and criteria are needed to identify patients most likely to benefit from adjuvant radiotherapy.
Effectiveness of general practice based, practice nurse led telephone coaching on glycaemic control of type 2 diabetes: the Patient Engagement And Coaching for Health (PEACH) pragmatic cluster randomised controlled trial
Authors: I. D. Blackberry, J. S. Furler, J. D. Best, P. Chondros, M. Vale, C. Walker, T. Dunning, L. Segal, J. Dunbar, R. Audehm, D. Liew, D. Young
Journal: BMJ (2013)

<b>Objective</b> To evaluate the effectiveness of goal focused telephone coaching by practice nurses in improving glycaemic control in patients with type 2 diabetes in Australia. <b>Design</b> Prospective, cluster randomised controlled trial, with general practices as the unit of randomisation. <b>Setting</b> General practices in Victoria, Australia. <b>Participants</b> 59 of 69 general practices that agreed to participate recruited sufficient patients and were randomised. Of 829 patients with type 2 diabetes (glycated haemoglobin (HbA<sub>1c</sub>) &gt;7.5% in the past 12 months) who were assessed for eligibility, 473 (236 from 30 intervention practices and 237 from 29 control practices) agreed to participate. <b>Intervention</b> Practice nurses from intervention practices received two days of training in a telephone coaching programme, which aimed to deliver eight telephone and one face to face coaching episodes per patient. <b>Main outcome measures</b> The primary end point was mean absolute change in HbA<sub>1c</sub> between baseline and 18 months in the intervention group compared with the control group. <b>Results</b> The intervention and control patients were similar at baseline. None of the practices dropped out over the study period; however, patient attrition rates were 5% in each group (11/236 and 11/237 in the intervention and control group, respectively). The median number of coaching sessions received by the 236 intervention patients was 3 (interquartile range 1-5), of which 25% (58/236) did not receive any coaching sessions. At 18 months' follow-up the effect on glycaemic control did not differ significantly (mean difference 0.02, 95% confidence interval −0.20 to 0.24, P=0.84) between the intervention and control groups, adjusted for HbA<sub>1c</sub> measured at baseline and the clustering. Other biochemical and clinical outcomes were similar in both groups. <b>Conclusions</b> A practice nurse led telephone coaching intervention implemented in the real world primary care setting produced comparable outcomes to usual primary care in Australia. The addition of a goal focused coaching role onto the ongoing generalist role of a practice nurse without prescribing rights was found to be ineffective. <b>Trial registration</b> Current Controlled Trials ISRCTN50662837.
Liver transplantation in patients with alcoholic cirrhosis: selection criteria and rates of survival and relapse.
Authors: G L Bird, J G O'Grady, F A Harvey, R Y Calne, R Williams
Journal: BMJ (1990)

To evaluate the outcome of liver transplantation in patients with alcoholic cirrhosis with respect to selection criteria, survival, and evidence suggesting a return to harmful drinking.Nine year retrospective study.Cambridge and King's College Hospital liver transplant programme.24 Patients (three women, 21 men) with alcoholic cirrhosis.Survival, rehabilitation, and clinical and laboratory evidence of a return to harmful drinking after transplantation.15 Patients were selected for transplantation because of repeated admission to hospital for the complications of advanced portal hypertension despite abstinence, and six because they had a hepatocellular carcinoma superimposed on alcoholic cirrhosis. Three patients who were not abstinent received transplants. The one year survival rate was 66%, and of the 18 patients surviving at least three months, 17 had been rehabilitated. In three patients laboratory variables and histological examination of the liver suggested a return to drinking, though they did not admit to taking alcohol. These patients represented the only cases in the series that were not abstinent before transplantation.The survival and rehabilitation of patients who received transplants for alcoholic cirrhosis compared favourably with those of patients who received transplants for cirrhosis of other aetiology. The criteria for selection for liver transplantation in patients with alcoholic cirrhosis should include recurrent complications related to severe portal hypertension despite maximum medical treatment in addition to a minimum period of six months of abstinence before transplantation.
A CASE OF RETAINED MENSES RELIEVED BY OPERATION
Authors: J. T. Hartill
Journal: BMJ (1910)

E TH BaTisH 71 ovum was unfortunately missed at the time of the operation, and the sac was empty on examination afterwards.Probably the gestation was of about five weeks' duration.2. The satisfactory result of the adoption of the Fowler position, pelvic drainage, and absorption of saline solution by the rectum on the peritoneal infection.
Light sensitivity and chromium dermatitis
Authors: JAN E. WAHLBERG, GOURAN WENNERSTEN
Journal: British Journal of Dermatology (1977)

In 25 consecutive cases of chromium contact allergy we have made four parallel serial dilution tests and irradiated three of the test rows, two with solar-spectriim-like radiation from a 150 W Xenon lamp (4/5 MED and 4 MED) and one row with long-wave ultraviolet radiation (blacklight) alone. Comparing an unirradiated row (control) and the row irradiated with 4/5 MED, the reactions were significantly more intense in 48% of the cases, i.e. the patients reacted at lower chromium concentrations. In a corresponding comparison with 4 MED a significantly more intense reaction was obtained in 36% of the cases, whereas blacklight showed no significant difference compared with the control row. The most intense reactions were obtained in the cases which were anamnestically photosensitive and had low MED values.
Blood lipid concentrations of dioxins and furans in a sample of BASF employees included in the IARC registry of workers exposed to phenoxy acid herbicides and/or chlorophenols.
Authors: P Messerer, A Zober, H Becher
Journal: Environmental Health Perspectives (1998)

Depending on process conditions, polychlorinated dibenzo-p-dioxins (PCDDs) and polychlorinated dibenzofurans (PCDFs) may be generated as low-level byproducts of chlorophenol and chlorophenoxy herbicides manufacture. A stratified random sample of 20 active employees from a cohort of phenoxy herbicide workers was selected in 1995 for determining PCDD and PCDF congeners in blood lipids to assess the extent of past PCDD and PCDF exposure in this cohort and whether that exposure might explain site-specific cancer findings in the total cohort. This cohort is included in the IARC International Registry of Persons Exposed to Phenoxyacid Herbicides and Their Contaminants. For the 19 persons who participated, median PCDD and PCDF concentrations were comparable to background concentrations in the general population. Median levels of 2,3,7,8-tetrachlorodibenzo-p-dioxin, the sum of hexachlorodibenzo-p-dioxin, pentachlorodibenzofurans, and two dioxin toxicity equivalents values were statistically higher in 7 employees assigned to synthesis operations than for 12 employees assigned to other operations. However, the PCDD and PCDF concentrations were low relative to those seen in other dioxin-exposed cohorts. We conclude that PCDD and PCDF exposures of cohort members are unlikely to explain the elevated standardized mortality ratios observed in this cohort for several cancer sites.
Discontinuation rates for use of statins are high
Authors: L. A Simons
Journal: BMJ (2000)

EDITOR—Packham et al describe an almost fourfold increase in the use of statins between 1996 and 1998.1 The rationale for this treatment is well established,2 yet drug discontinuation rates are generally far lower in controlled trials than in routine care.3 We have conducted an Australia-wide assessment of discontinuation rates in patients newly prescribed lipid lowering drugs.

Using national prescription records, we identified 420 543 patients prescribed …
Disrupted Slit-Robo signalling results in membranous ventricular septum defects and bicuspid aortic valves
Authors: Mathilda T.M. Mommersteeg, Mason L. Yeh, John G. Parnavelas, William D. Andrews
Journal: Cardiovascular Research (2015)

AimsThe mesenchymal cushions lining the early embryonic heart undergo complex remodelling to form the membranous ventricular septum as well as the atrioventricular and semilunar valves in later life. Disruption of this process underlies the most common congenital heart defects. Here, we identified a novel role for Slit-Robo signalling in the development of the murine membranous ventricular septum and cardiac valves.
Alternative Splicing of <i>Cyr61</i> Is Regulated by Hypoxia and Significantly Changed in Breast Cancer
Authors: Marc Hirschfeld, Axel zur Hausen, Herta Bettendorf, Markus Jäger, Elmar Stickeler
Journal: Cancer Research (2009)

Hypoxia is known to induce the transcriptional activation of pathways involved in angiogenesis, growth factor signaling, and tissue invasion and is therefore a potential key regulator of tumor growth. Cyr61 (cysteine rich 61) is a secreted, matricellular protein with proangiogenic capabilities and is transcriptionally induced under hypoxic conditions. High expression levels of Cyr61 were already detected in various cancer types and linked to tumor progression and advanced stages in breast cancer. Besides hypoxia, there is some evidence that posttranscriptional pre-mRNA processing could be involved in the regulation of Cyr61 expression, but was thus far not investigated. We studied the expression pattern of Cyr61 mRNA and protein in breast cancer cell lines as well as in matched pairs of noncancerous breast tissue, preinvasive lesions, and invasive breast cancers, respectively. In addition, we analyzed the potential regulatory capability of hypoxia on Cyr61 expression by functional tissue culture experiments. Our study revealed a stage-dependent induction of Cyr61 mRNA and protein in breast cancer tumorigenesis and for the first time alternative splicing of the Cyr61 gene due to intron retention. Breast carcinogenesis was accompanied by a shift from an intron 3 retaining toward an intron 3 skipping mRNA phenotype consecutively leading to processing of the biological active Cyr61 protein. The functional analyses strongly emphasize that hypoxia serves as a specific inducer of alternative Cyr61 splicing toward the intron skipping mRNA isoform with potential biological consequences in tumor cells.
100 COMBINATION OF CALCINEURIN INHIBITORS AND GENOTYPES AT THE IL12A LOCUS INFLUENCES RISK OF RECURRENT PRIMARY BILIARY CIRRHOSIS AFTER LIVER TRANSPLANTATION
Authors: M. Carbone, G. Mells, G. Alexander, R. Sandford, R. Westbrook, M. Heneghan, J. Neuberger
Journal: Journal of Hepatology (2013)
Why Not Rate Health and Life Insurance Premiums by Risks?
Authors: Joseph Stokes
Journal: New England Journal of Medicine (1983)

The purpose of insurance is to spread the risk of costly, unpredictable events. Insurance carriers establish premiums on the basis of community experience, individual experience, or individual risk. Community rating simply estimates the anticipated claims of the community and divides that estimated cost by the number of insured. Experience rating adjusts such community-rated premiums according to previous claims paid to the insured. For instance, drivers found at fault in motor-vehicle accidents frequently find these accidents reflected in their subsequent automobile-liability insurance premiums. Risk rating adjusts the premium according to the likelihood that the insured individual will sustain the event. For . . .
Treatment of Rheumatoid Arthritis with Fenoprofen: Comparison with Aspirin
Authors: E. C. Huskisson, J. A. Wojtulewski, H. Berry, J. Scott, F. D. Hart, H. W. Balme
Journal: BMJ (1974)

Fenoprofen, a compound with analgesic, anti-inflammatory, and antipyretic properties in animals, has been compared with placebo in a double-blind cross-over trial in 60 patients with rheumatoid arthritis. There was a statistically highly significant reduction in pain, duration of morning stiffness, analgesic requirements, and articular index, with increase in grip strength. There was no significant reduction in joint size or temperature. In a subsequent double-blind group-comparative study fenoprofen proved to be as effective as aspirin in relieving the symptoms of rheumatoid arthritis, with strikingly fewer side effects. Almost half of the patients taking aspirin were unable to tolerate the drug in adequate dosage for six months. The remainder were able to take on average only 4 g daily, and at this dose almost half still complained of tinnitus and deafness. Fenoprofen is likely to be useful for patients who cannot tolerate aspirin and other more toxic anti-inflammatory drugs or whose disease is not of sufficient severity to justify their use.
[94] PERSISTENT IMPAIRMENT OF HCV-SPECIFIC CDS CELL RESPONSE IN HCV-RNA NEGATIVE PATIENTS AFTER SUCCESSFUL PEG-INTERFERON/RIBAVIRIN TREATMENT
Authors: G. Missale, M. Pilli, A. Penna, A. Zerbini, L. Sacchelli, C. Mori, S. Mezzadri, C. Ferrari
Journal: Journal of Hepatology (2007)
Detection of Nicotinic Acid Deficiency
Authors: P. Ellinger
Journal: BMJ (1945)

<h3>ABSTRACT</h3> Glucocorticoid (GC) administration is an effective therapy commonly used in the treatment of autoimmune and inflammatory diseases. However, the use of GC can give rise to serious complications. The main detrimental side effect of GC therapy is significant bone loss, resulting in glucocorticoid-induced osteoporosis (GIOP). We performed a systematic review and network meta-analysis (NMA) to evaluate whether the use of calcium supplementation, with or without vitamin D, vitamin D metabolites and vitamin D analogues is capable of increasing bone mineral density (BMD) at the lumbar spine, femoral neck, and hip in adult patients undergoing glucocorticoid therapies compared to no treatment.
Suicide: Survivors: A Guide for Those Left Behind
Authors: L. D. Hankoff
Journal: JAMA (1991)

As its title indicates, Wrobleski has written a self-help manual for persons who are closely related in some way to someone who died by suicide. While it is directed at the general public and, of course, at those who have need for help in relation to the crisis of losing a loved one by suicide, it also contains important information and a point of view that could benefit health care professionals. The volume opens somewhat dramatically with the author's description of her own loss, a married 21-year-old daughter who shot herself. Wrobleski then goes well beyond her personal experience to present a commonsense view of suicide in the United States for those who need to come to terms with it as a personal loss. The self-help approach to problems of every imaginable type has become a kind of American vogue, and I approached this volume with a bit of acquired
Ambiguity and Workarounds as Contributors to Medical Error
Authors: Steven J. Spear, Mark Schmidhofer
Journal: Annals of Internal Medicine (2005)

Why are some organizations error-prone-regularly subject to interruptions and inconveniences, some of which periodically coalesce catastrophically-whereas other organizations, although similar in the products and services they generate and the process technologies they use, are reliable, adaptable, and continuously self-improving, relentlessly learning from experience to get ever better? Analyzing medical error reports and studies of high-performing, non-health care organizations reveals 2 differences. High performers know how to prevent problems from producing further consequences once they occur and how to prevent their recurrence. They do this by specifying how work is expected to proceed-who will do what for whom, with what purpose, when, where, and how-before work is actually done. Then, when anything contrary to expectations occurs, it is immediately identified as a problem. Through this approach, the effects of problems are contained, the causes are quickly investigated, process knowledge is deepened, and recurrence is prevented. In contrast, error-prone organizations tolerate ambiguity, a prevailing lack of clarity over what is supposed to happen at any given time. Problems are thus hard to identify, and, even when recognized, they are worked around. People "get the job done," but don't initiate efforts to learn from the problem or improve the process. We believe that coupling high degrees of specification with rapid responses to individual problems can improve health care. Superlative manufacturing, service, and military organizations apply this approach to myriad processes and situations, and initial health care trials of this approach have been promising. We discuss how such an approach could be initiated in health care more broadly.
Definitive Diagnosis of Choledochal Cyst by 99mTc-Pyridoxylideneglutamate Sequential Scintiphotography
Authors: SHIN-HWA YEH, ROBERT C. STADALNIK, GERALD L. DeNARDO, WING-KAY CHAU
Journal: Clinical Nuclear Medicine (1978)

Sequential supine scintiphotography of the abdomen was performed after intravenous administration of 99mTc-pyridoxylideneglutamate (99mTc-PG) to verify the presence of choledochal cyst in an 18-month-old boy who presented with a mass in the right upper quadrant of the abdomen. The total body radioactivity effect, which is similar to the total body opacification during intravenous cholangiography or urography, was clearly demonstrated as a cold area corresponding to the cyst and assisted in the diagnosis. The specific finding was sequential filling of the gallbladder and cyst. In view of the relatively low radiation dose and good physical characteristics of 99mTc for imaging,99mTc-PG sequential scintiphotography is useful for the definitive preoperative diagnosis of choledochal cyst in infants and children.
Corticosteroid Therapy and Aseptic Necrosis
Authors: LAWRENCE N. PARKER
Journal: Annals of Internal Medicine (1983)

Letters and Corrections1 December 1983Corticosteroid Therapy and Aseptic NecrosisLAWRENCE N. PARKER, M.D.LAWRENCE N. PARKER, M.D.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-99-6-882_3 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptTo the editior: On endocrinology rounds recently, one of our fellows presented a consult request concerning the occurrence of aseptic (avascular) necrosis of the femoral head in a young man who was receiving physiologic doses of corticosteroids for secondary adrenal insufficiency. The replacement steroids were incriminated as the cause by the consulting physicians. Although I was aware that widely read textbooks and journals still list the association of high-dose corticosteroid therapy and aseptic necrosis (1, 2), I was surprised that even physiologic doses of corticosteroids were suspect. I therefore attempted to find the original evidence for this assumption. The source...References1. AVIOLI L. Bone diseases. In: WYNGAARDEN JB, SMITH LH JR, eds. Cecil Textbook of Medicine. 16th Ed. Philadelphia: W. B. Saunders Company; 1982:1348. Google Scholar2. GRIFFITHS H. Etiology, pathogenesis, and early diagnosis of ischemic necrosis of the hip. JAMA. 1981;246:2615-7. CrossrefMedlineGoogle Scholar3. HEIMANN W and FREIBERGER R. Avascular necrosis of the femoral and humeral heads after high-dose corticosteroid therapy. N Engl J Med. 1960;263:672-5. CrossrefMedlineGoogle Scholar4. SUTTON R, BENEDECK T, and EDWARDS G. Aseptic bone necrosis and corticosteroid therapy. Arch Intern Med. 1963;112:594-602. CrossrefMedlineGoogle Scholar5. PATTERSON R, BICKEL W, and DAHLIN D. Idiopathic avascular necrosis of the head of the femur. J Bone Joint Surg. 1964;46-A:267-82. Google Scholar6. Physicians Desk Reference. 37th Ed. Oradell, New Jersey: Medical Economics Co. ; 1983:1427. Google Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAuthors: LAWRENCE N. PARKER, M.D.Affiliations: University of California at Irvine—VA Medical Center Program Long Beach, CA 90822 PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byOsteonecrosis of the Femoral Head in Patients With Inflammatory Arthritis or Asthma Receiving Corticosteroid TherapyAvascular Necrosis and CorticosteroidsSTEVEN SNYDER, M.D. 1 December 1983Volume 99, Issue 6Page: 882-882KeywordsCorticosteroid therapyEndocrinologyNecrosisSteroids ePublished: 1 December 2008 Issue Published: 1 December 1983 PDF downloadLoading ...
Practolol in Treatment of Angina Pectoris. A Double-blind Trial
Authors: C. F. George, R. E. Nagle, B. L. Pentecost
Journal: BMJ (1970)

Twenty-four patients with angina pectoris entered a double-blind trial of the cardioselective beta-adrenergic blocking agent practolol. Seventeen experienced less angina and consumed fewer glyceryl trinitrate tablets when on the active preparation. There was also a decrease in the mean number of attacks suffered by patients while on practolol and a reduction in the number of glyceryl trinitrate tablets taken. These results are of statistical significance at, at least, the 5% level.