tbuckley/cabot-search huggingface dataset:
Changing Epidemiology of Abdominal Aortic Aneurysms in England and Wales
Authors: Edward Choke, Badri Vijaynagar, John Thompson, Akhtar Nasim, Matthew J. Bown, Robert D. Sayers
Journal: Circulation (2012)

Recent studies from Australia, New Zealand, and Sweden have reported declines in abdominal aortic aneurysm (AAA) incidence, prevalence, and mortality. This finding may have important implications for screening programs. This study determined trends in AAA incidence and mortality in England and Wales.Cause-specific mortality data for England and Wales were obtained from UK Office for National Statistics, and hospital admissions and procedures data for England were obtained from Hospital Episode Statistics from 2001 to 2009. Poisson regression models were constructed to estimate the relative change over time. Age-standardized rates for AAA mortality in England and Wales fell significantly by 35.7% from 2001 to 2009, which was largely due to a 35.3% drop in age-standardized ruptured AAA deaths. During the same period, ruptured AAA admissions and emergency AAA repairs in England declined by 29.3% and 35.5%, respectively. In contrast, nonruptured AAA admissions remained static, and nonemergency AAA repairs increased by 17.2%. The average ages for hospital admissions for nonruptured AAAs and ruptured AAAs increased by 0.19 years of age per annum (P<0.001) and 0.09 years of age per annum (P<0.001), respectively. Nonruptured AAA admissions increased by 21.4% in age band 75 years or more but declined by 11.7% in ages <75 years.AAA mortality, ruptured AAA admission, and emergency AAA repair have declined in England and Wales. However, nonruptured AAA admission has remained steady, with an increasing rate in older population offsetting a decreasing rate in younger population. This suggests a shift in AAA presentation to the older population. Present screening strategies may need reassessment to include consideration for increasing the age at which to screen men for AAAs.
Feel the anxiety about examining patients and do it anyway
Authors: C. M. Buckwell, M. Ornstein, A. Cushing, D. Lothian
Journal: BMJ (2011)

The assertion that some doctors are reluctant to perform certain clinical examinations for fear of upsetting patients’ sensitivities is troubling.1 It is important to understand the patient’s perspective and concerns, but doctors must also be able to manage patients’ anxieties and provide good clinical care.

As medical educators …
Activation of Platelet-Activating Factor Receptor and Pleiotropic Effects on Tyrosine Phospho-EGFR/Src/FAK/Paxillin in Ovarian Cancer
Authors: Margarita Aponte, Wei Jiang, Montaha Lakkis, Ming-Jiang Li, Dale Edwards, Lina Albitar, Allison Vitonis, Samuel C. Mok, Daniel W. Cramer, Bin Ye
Journal: Cancer Research (2008)

Abstract Among the proinflammatory mediators, platelet-activating factor (PAF, 1-O-alkyl-2-acetyl-sn-glycero-3-phosphorylcholine) is a major primary and secondary messenger involved in intracellular and extracellular communication. Evidence suggests that PAF plays a significant role in oncogenic transformation, tumor growth, angiogenesis, and metastasis. However, PAF, with its receptor (PAFR) and their downstream signaling targets, has not been thoroughly studied in cancer. Here, we characterized the PAFR expression pattern in 4 normal human ovarian surface epithelial (HOSE) cell lines, 13 ovarian cancer cell lines, paraffin blocks (n = 84), and tissue microarrays (n = 230) from patients with ovarian cancer. Overexpression of PAFR was found in most nonmucinous types of ovarian cancer but not in HOSE and mucinous cancer cells. Correspondingly, PAF significantly induced cell proliferation and invasion only in PAFR-positive cells (i.e., OVCA429 and OVCA432), but not in PAFR-negative ovarian cells (HOSE and mucinous RMUG-L). The dependency of cell proliferation and invasion on PAFR was further confirmed using PAFR-specific small interfering RNA gene silencing probes, antibodies against PAFR and PAFR antagonist, ginkgolide B. Using quantitative multiplex phospho-antibody array technology, we found that tyrosine phosphorylation of EGFR/Src/FAK/paxilin was coordinately activated by PAF treatment, which was correlated with the activation of phosphatidylinositol 3-kinase and cyclin D1 as markers for cell proliferation, as well as matrix metalloproteinase 2 and 9 for invasion. Specific tyrosine Src inhibitor (PP2) reversibly blocked PAF-activated cancer cell proliferation and invasion. We suggest that PAFR is an essential upstream target of Src and other signal pathways to control the PAF-mediated cancer progression. [Cancer Res 2008;68(14):5839–48]
Neoplasms and nonneoplastic liver lesions in winter flounder, Pseudopleuronectes americanus, from Boston Harbor, Massachusetts.
Authors: R A Murchelano, R E Wolke
Journal: Environmental Health Perspectives (1991)

A variety of neoplasms and nonneoplastic hepatic lesions have been noted in winter flounder, Pseudopleuronectes americanus, from Boston Harbor, Massachusetts. Inflammatory lesions include cholangiitis, pericholangiitis, pericholangial fibrosis, hepatitis, and pancreatitis. Necrotic lesions consist essentially of focal coagulative necrosis and a distinctive vacuolated cell lesion of the hepatic parenchyma. The most conspicuous and numerous proliferative lesion is macrophage aggregate hyperplasia and hypertrophy. Preneoplastic lesions include principally basophilic foci of cellular alteration and hepatocellular adenoma. Carcinomas consist of several morphologic varieties: hepatocarcinoma, cholangiocarcinoma, and anaplastic adenocarcinoma. The pathogenesis of the lesions observed is discussed with respect to anthropogenically introduced chemical contaminants and the resistant hepatocyte model of hepatocarcinogenesis. This study, and others of bottom-living food fish with enzootic neoplastic disease, warrants further evaluation, particularly with respect to possible bioaccumulation of chemical contaminants in edible tissues.
Experimental induction of ovarian Sertoli cell tumors in rats by N-nitrosoureas.
Authors: A Maekawa, H Onodera, H Tanigawa, K Furuta, J Kanno, T Ogiu, Y Hayashi
Journal: Environmental Health Perspectives (1987)

Spontaneous ovarian tumors are very rare in ACI, Wistar, F344 and Donryu rats; the few neoplasms found are of the granulosa/theca cell type. Ovarian tumors were also rare in these strains of rats when given high doses of N-alkyl-N-nitrosoureas continuously in the drinking water for their life-span; however, relatively high incidences of Sertoli cell tumors or Sertoli cell tumors mixed with granulosa cell tumors were induced in Donryu rats after administration of either a 400 ppm N-ethyl-N-nitrosourea solution in the drinking water for 4 weeks or as a single dose of 200 mg N-propyl-N-nitrosourea per kg body weight by stomach tube. Typical Sertoli cell tumors consisted of solid areas showing tubular formation. The tubules were lined by tall, columnar cells, with abundant, faintly eosinophilic, often vacuolated cytoplasm, and basally oriented, round nuclei, resembling seminiferous tubules in the testes. In some cases, Sertoli cell tumor elements were found mixed with areas of granulosa cells. The induction of ovarian Sertoli cell tumors in Donryu rats by low doses of nitrosoureas may provide a useful model for these tumors in man.
Alternate Mechanisms of Initial Pattern Recognition Drive Differential Immune Responses to Related Poxviruses
Authors: William E. O'Gorman, Padma Sampath, Erin F. Simonds, Rachel Sikorski, Mark O'Malley, Peter O. Krutzik, Hannah Chen, Vijay Panchanathan, Geeta Chaudhri, Gunasegaran Karupiah, David B. Lewis, Steve H. Thorne, Garry P. Nolan
Journal: Cell Host & Microbe (2010)
Ongoing Evolution of Strand Composition in Bacterial Genomes
Authors: Eduardo P. C. Rocha, Antoine Danchin
Journal: Molecular Biology and Evolution (2001)

We tried to identify the substitutions involved in the establishment of replication strand bias, which has been recognized as an important evolutionary factor in the evolution of bacterial genomes. First, we analyzed the composition asymmetry of 28 complete bacterial genomes and used it to test the possibility that asymmetric deamination of cytosine might be at the origin of the bias. The model showed significant correlation to the data but left unexplained a significant portion of the variance and indicated a systematic underestimation of GC skews in comparison with TA skews. Second, we analyzed the substitutions acting on the genes from five fully sequenced Chlamydia genomes that had not suffered strand switch since speciation. This analysis showed that substitutions were not at equilibrium in Chlamydia trachomatis or in C. muridarum and that strand bias is still an on-going process in these genes. Third, we identified substitutions involved in the adaptation of genes that had switched strands after speciation. These genes adapted quickly to the skewed composition of the new strand, mostly due to C→T, A→G, and C→G asymmetric substitutions. This observation was reinforced by the analysis of genes that switched strands after divergence between Bacillus subtilis and B. halodurans. Finally, we propose a more extended model based on the analysis of the substitution asymmetries of Chlamydia. This model fits well with the data provided by bacterial genomes presenting strong strand bias.
Who Benefits From Health System Change?
Authors: David M. Cutler
Journal: JAMA (2014)

The organization of medical care is changing more rapidly now than at any point in the last century.For decades, health care was a cottage industry: physicians practiced independently or in small groups and had arms-length relationships with hospitals, imaging and laborator y facilities, and other health care entities.Those organizations alternately competed and cooperated as part of an informal local health care system.Recent years have seen the advent of large, integrated, corporate medicine.Today, the typical US city has 3 to 4 integrated health care systems, generally anchored around large hospitals and extending to suburban areas. 1 These systems are conglomerations of hospitals, primary care and specialist physicians, outpatient facilities, and postacute care facilities.There remains a fringe of unaffiliated institutions and physicians, but the number of such institutions is declining.Why is this occurring?And who benefits from it?Three reports in this issue of JAMA examine this question.Joynt and colleagues 2 examined the question of why consolidation is occurring, focusing on the conversion of not-for-profit hospitals to for-profit status.During their study period (2002-2010), 237 hospitals (5.2% of their sample) converted from not-for-profit to for-profit status.For each converting hospital, the authors identified up to 3 matched control hospitals based on size category, teaching status, and region.In their primary analysis, they compared clinical and economic outcomes 2 years before conversion to 2 years after conversion and used difference-in-differences models to minimize any temporary economic and clinical outcomes occurring just before the conversion and to identify changes that occurred after a reasonable period.A central finding of the study by Joynt et al was that hospitals that converted from not-for-profit to for-profit status had very poor financial performance prior to conversion.The typical converting hospital had a patient-based operating margin ([net revenue from patient care and related revenue -total operating expenses]/net revenue from patient care and related revenue) of -6.6% and a total margin ([total revenue -total costs]/total revenue), including non-patient care activities, of -1.2%.Performance at this level is clearly not sustainable.Thus, part of the rationale for conversion is to stabilize cash flow.Based on the findings of Joynt et al, hospitals converting to for-profit status were successful at this.Between 2 years before and 2 years after conversion, operating margins at converting hospitals increased by 3.2%, and total margins increased by 2.2%.Operating margins remained negative, but the
Metoclopramide and Depression
Authors: CHRISTOPHER D. ADAMS
Journal: Annals of Internal Medicine (1985)

Letters and Corrections1 December 1985Metoclopramide and DepressionCHRISTOPHER D. ADAMS, M.D.CHRISTOPHER D. ADAMS, M.D.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-103-6-960_1 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptTo the editor: In their letter on metoclopramide and depression, Bottner and Tullio (1) recommend gradual dosage increases for patients manifesting depression while taking metoclopramide. The validity of these recommendations has been shown at our facility recently in two diabetic patients with gastroparesis.Patient 1:A 38-year-old man with insulin-dependent diabetes mellitus for 12 years began having episodes of severe abdominal pain accompanied by adynamic ileus in 1979. Several surgical procedures were done to relieve this problem. Surgical findings included malrotation of the bowel, papillitis of the ampulla of Vater, and pancreatic fibrosis, but no other evidence of situs inversus....Reference1. BOTTNER R and TULLIO C. Metoclopramide and depression [Letter]. Ann Intern Med. 1985;103:482. LinkGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAuthors: CHRISTOPHER D. ADAMS, M.D. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byMetoclopramide and Homicidal Ideation: A Case Report and Literature ReviewMetoclopramide-Induced Encephalopathy in Parkinson DiseaseLate-Onset Major Depression With Delusions After Metoclopramide TreatmentGeriatric TherapyODrug-induced illness in the elderly 1 December 1985Volume 103, Issue 6_Part_1Page: 960-960KeywordsAbdominal painDiabetes mellitusFibrosisGastroparesisInsulin ePublished: 1 December 2008 Issue Published: 1 December 1985 PDF downloadLoading ...
A follow-up study of terbinafine (SF-327, LamisilR) in the treatment of onychomycosis
Authors: C.C. Harland, M.J.D. Goodfield, E.G.V. Evans
Journal: British Journal of Dermatology (1990)

Journal Article A follow‐up study of terbinafine (SF‐327, Lamisil®) in the treatment of onychomycosis Get access C.C. Harland, C.C. Harland Departments of Dermatology, University Hospital, Nottingham Search for other works by this author on: Oxford Academic Google Scholar M.J.D. Goodfield, M.J.D. Goodfield General Infirmary at Leeds Search for other works by this author on: Oxford Academic Google Scholar E.G.V. Evans E.G.V. Evans Regional Mycology Laboratory, Leeds General Infirmary Search for other works by this author on: Oxford Academic Google Scholar British Journal of Dermatology, Volume 123, Issue s37, 1 July 1990, Pages 31–32, https://doi.org/10.1111/j.1365-2133.1990.tb04433.x Published: 01 July 1990
Dutch MP calls for European medical register after doctor facing 21 criminal charges is found working in Germany
Authors: T. Sheldon
Journal: BMJ (2013)

A former consultant neurologist, currently the defendant in one of the largest criminal investigations in Dutch medical history, was in early January still working in a German hospital.

Ernst Jansen Steur, 67, was identified in the SLK Clinic in Heilbronn near Stuttgart by a Dutch journalist. Media reports claim that he has worked in five German hospitals since 2006.

Consequently, the Dutch health minister, Edith Schippers, has repeated calls for a central register of doctors working in the European Union. However, the SLK Clinic has said that Jansen Steur presented them with all the necessary qualifications, including a licence to practise and recognition of his specialist training, dating from 2006. It was unaware of the …
Waiting times: monitoring the total postreferral wait
Authors: T Smith
Journal: BMJ (1994)

To determine whether the period spent on the true inpatient waiting list is a valid indication of the total time that patients have to wait for an operation; and to assess the feasibility of monitoring the total "postreferral waiting time" by using existing computerised information systems.Three randomly selected Scottish hospitals.Waiting list patients admitted to hospital for operations during June to August 1993 in six major specialties, separate attention being focused on cataract operations and hip and knee replacements.The total time that patients have to wait for an operation after the initial general practitioner referral--the postreferral waiting time--compared with that spent at the final stage of the process on the true inpatient waiting list.In the specialties investigated roughly half (58 days; 53%) of the average postreferral wait of 110 days was spent on the true inpatient waiting list, one third (35 days; 32%) being spent on the outpatient waiting list and one sixth (17 days; 15%) waiting between waiting lists. Only a quarter of cataract patients (73/292) were treated within three months of general practitioner referral compared with over three quarters (228/292) within three months of being placed on the inpatient waiting list. Nevertheless, within a year over 99% of patients (290) had been treated whichever date was taken as the starting point.Monitoring postreferral waiting times would provide a much more accurate picture for purchasers and patients of waiting times for treatment than is obtained by focusing exclusively on the true inpatient waiting list and facilitate fairer comparisons between NHS trusts in national league tables. Stringent national and local monitoring is essential to ensure (a) that future reductions in the time waiting on true inpatient waiting lists are not gained at the expense of longer periods waiting to be placed on the lists, and (b) that no increases occur in the number of patients placed instead on deferred waiting lists or exempted from the normal maximum waiting time guarantees.
Five-year results of a controlled study of BCG immunotherapy after surgical resection in bronchogenic carcinoma.
Authors: J W Millar, P Roscoe, S J Pearce, S Ludgate, N W Horne
Journal: Thorax (1982)

Ninety-two patients with histologically confirmed bronchogenic carcinoma treated by surgical resection of the tumour were subsequently given immunotherapy with BCG (Glaxo). The patients were randomly allocated into three groups. Twenty-nine patients received multipuncture BCG (50 to 250 X 10(6) viable units), and twenty-six patients intradermal BCG (0.4 to 0.9 X 10(6) viable units), treatment being given at 1, 2, 6, 9, 13, 26, and 52 weeks after operation. Thirty-seven control patients did not receive any BCG immunotherapy; two patients in the control group were lost to follow-up. The overall five-year survival in all groups was 37%. Favourable prognostic features were squamous carcinoma (45% five-year survival), the absence of involved mediastinal nodes at operation (46%), and lobectomy (45%), but even the presence of involved mediastinal nodes was associated with a 19% five-year survival. There were no statistically significant differences between the survival of the control group and either group treated by immunotherapy considered individually or in combination. The influence of the presence of positive mediastinal lymph nodes and the extent of surgical resection on survival was not affected by immunotherapy. No serious side-effects of immunotherapy were encountered.
Survival after liver transplantation in cirrhotic patients with and without hepatocellular carcinoma: A comparative study
Authors: J Figueras, E Jaurrieta, C Valls, C Benasco, A Rafecas, X Xiol, J Fabregat, T Casanovas, J Torras, C Baliellas, L Ibanez, P Moreno, L Casais
Journal: Hepatology (1997)

Cumulative recurrence after surgical resection for hepatocellular carcinoma (HCC) is very high. Several retrospective analyses have shown that liver transplantation was more effective than resection for patients with HCC at early tumor stages. Consequently, in January 1990, we decided to prospectively indicate orthotopic liver transplantation (OLT) as the first surgical treatment for small, localized HCC in cirrhotic patients without nodal involvement independently of the degree of liver function. The aim of this prospective cohort study was to analyze prognosis, recurrence rate, and survival after liver transplantation in patients in whom the main indication was HCC with cirrhosis. Thirty-eight patients in whom the main indication for liver transplantation was HCC and hepatic cirrhosis were compared with 136 transplantations because of cirrhosis without tumor, performed in our unit from January 1990 to December 1995. HCC arising in noncirrhotic livers and those incidently discovered after OLT were excluded from the study. Chemoembolization using doxorubicin, lipiodol, and Gelfoam was performed before OLT in 31 patients with good liver function. There were no differences in gender, but HCC patients were older (57 ± 7 vs. 50 ± 10 years [ P &lt; .001]). Liver function was better in HCC (Child-Pugh score: 6.9 ± 2 vs. 8.6 ± 1.8; P &lt; .001), and hepatitis C virus antibody was positive in 31 (82%) vs. 51 (37%) ( P &lt; .007). Seven tumors had bilobar involvement (18%). Capsule was present in 22 (58%). The mean size of the tumor was 3.4 ± 2 cm. Seventeen tumors (45%) were larger than 3 cm, and 4 (11%) were larger than 5 cm. The average number of nodules was 2 ± 1. The tumor-node-metastasis stage of the tumors was pT1 in 6 patients (16%), 11 were pT2 (29%), 12 were pT3 (31%), and 9 were pT4 (24%). Seven patients were retransplanted in the HCC group (18%) and 19 (14%) in the nontumor group (not significant). Tumor recurrence was detected in three patients (8%). One, 3-, and 5-year survival rates were 82% vs. 79%, 75% vs. 71%, and 63% vs. 68%, respectively, for patients with and without HCC, and no differences were found between the two groups ( P = .84). Survival was significantly reduced in patients with a macroscopic vascular invasion and tumors greater than 5 cm in diameter. Recurrence and mortality after liver transplantation in cirrhotic patients with carefully selected HCC are similar to the results in cirrhotic patients without tumor.
On the reputed decline in gastric carcinoma: necropsy study from western Norway.
Authors: H Maartmann-Moe, F Hartveit
Journal: BMJ (1985)

Carcinoma of the stomach is said to be decreasing in many countries, Norway included. About 10% of all cases in Norway occur in the county of Hordaland. They do not differ in any known respect from cases in the rest of the country. A series of 575 cases coming to necropsy from Hordaland over 25 years was examined and the findings compared with the total number reported to the Norwegian Cancer Registry from the same district. Although the incidence of histological verification rose over the period from 49 to 85%, the number of histologically confirmed cases remained relatively constant, the considerable decline being confined to cases without such documentation. The results suggest that increased diagnostic effort has led to the exclusion of cases previously classified clinically as gastric carcinoma and that the incidence of the disease itself has not changed radically in the county of Hordaland.